Is preoperative traction for proximal femoral fractures beneficial to the patient or a comfort to the doctor?

Background and Purpose: Despite the high incidence of hip fractures, there is no agreement on the use of preoperative traction. To assess current application of traction and the reasons for its use, an inventory study was performed. Material and Methods: Questionnaires were sent to 248 surgical and orthopedic departments, informing about the frequency preoperative traction was used and the reasons for doing so. It was also asked, if there were problems admitting these patients and scheduling them for operation. Results were compared with the current literature. Results: Overall response was 89.9%. Orthopedic surgeons applied traction significantly more frequently compared to trauma surgeons (83.0% vs. 67.9%; p < 0.02). Preoperative traction was standard practice in 20.2% of the trauma departments. The main reason for the use of traction was the assumed reduction in pain. In 22.4% of the hospitals there were (capacity) problems admitting patients with hip fractures, and if admitted, the waiting time for operation was > 24 h in 27.4%. Conclusion: 20% of the Dutch trauma and orthopedic surgeons still practice preoperative traction, whereas literature review shows that preoperative traction is related to numerous complications, without any clinically proven beneficial effects. From this perspective preoperative traction for proximal femoral fractures, although applied on large scale in the Netherlands, should no longer be routinely applied.

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