Pre-operative skin traction in hip fractures may not be beneficial - Results from a meta-analysis

Abstract Background Skin traction is still used as a routine preoperative treatment for hip fractures. Traction is widely believed to reduce pain and prevent further displacement of the fracture, but its value is controversial. To determine its clinical benefit, we conducted a systematic review and meta-analysis of studies of hip fracture patients treated with and without skin traction. Methods The Medline, PubMed, EMBASE, CNKI, and Wanfang databases were searched for studies of hip fracture patients treated with or without skin traction. The search was limited to studies published between January 1, 1990 and March 30, 2019. The main endpoints were pain score, analgesia consumption, time from admission to surgery, operative time, pressure sores or erythema, deep vein thrombosis (DVT), and other complications. Results Twelve randomized controlled trials (N = 1,339) met our inclusion criteria. The results of our analysis showed that pain scores were not significantly different between the patients treated with versus without skin traction until 24 hours postoperatively. There were also no significant differences between the groups in analgesia consumption, time from admission to surgery, operative time, or DVT . However, the incidence of pressure sores and other complications was significantly higher in the traction group than in the no-traction group. Conclusions The present study showed that skin traction for hip fracture did not affect operative time or reduce pain scores until 24 hours postoperatively, but increased the risk of pressure sores and other complications. Studies reporting pain scores more than 24 hours postoperatively are limited. The increased rate of complications in the skin traction group suggests that the clinical use of skin traction should be reduced barring a decrease in wait times from admission to surgery, although more studies with larger sample sizes are needed to verify our findings.