Efficacy of preoperative skin traction in hip fracture patients: A prospective, randomized study

Objective: To compare the analgesic benefit of preoperative skin traction w ith the placement of a pillow under the injured extremity in patients with hip fractures. Design: Prospective, randomized clinical study. Setting: University-affiliated teaching institution. Patients and Participants: One hundred consecutive patients with hip fractu res admitted to the authors' institution who met inclusion criteria were en rolled. Fifty-five patients had femoral neck fractures, and forty-five pati ents had intertrochanteric fractures. The average patient age was seventy-e ight years. Intervention: All patients were preoperatively randomized into two interven tion groups. One group underwent placement of five pounds of skin traction on the injured extremity, whereas the second underwent placement of a pillo w under the injured extremity. Fifty patients were enrolled in each interve ntion group. Results: With respect to immediate postintervention pain levels, patients t reated with a pillow showed a trend toward better pain relief, as compared with patients treated with skin traction; however, this was not statistical ly significant. On the morning after admission, patients treated with a pil low had a statistically significant greater reduction in pain (p = 0.04). T hese patients also requested a statistically significant lower amount of pa in medication (p < 0.01). Conclusions: The authors think that preoperative skin traction in patients with hip fractures does not provide significant pain relief as compared wit h pillow placement under the injured extremity, and thus should not be rout inely performed in this patient population for analgesia.