Preoperative position splint versus skin traction in patients with hip fracture: An experimental study
Introduction
Hip fracture causes functional disability and negatively affects quality of life in older people and is an important health problem with high morbidity and mortality rates (McLaughlin et al., 2006). Worldwide, approximately 1.6 million hip fractures occur in older people each year, and it is estimated that the incidence will increase by 310% in men and by 240% in women (equivalent to 4.5–6.3 million hip fractures) by the year 2050 because of the aging global population (Maher et al., 2012, Endo et al., 2013). Most patients (24–75%) cannot return home because of the morbidity after hip fracture and must stay in hospital or transfer to nursing homes (McLaughlin et al., 2006, Maher et al., 2012). Lengthy hospitalization leads to intense use of medical treatment, nursing care, surgical and rehabilitation services. The intense use of these services is a budgetary burden for individuals, families and institutions (Rapp et al., 2010). Pain and immobilization negatively affect the comfort of patients with hip fracture. Being confined to bed for a long time may lead to many complications including; pressure ulcers, infections, thromboembolism, pulmonary problems, delirium, nerve damage and constipation (Beaupre et al., 2005, Foster, 2006, Maher et al., 2012, Maher et al., 2013, Draper and Scott, 1997). Nurses play a key role in maintaining the health of patients, alleviating pain, enhancing comfort, and avoiding complications using evidence-based nursing care interventions (Wunderlich, 2013, Maher et al., 2013, Harvey et al., 2013).
Section snippets
Literature review
Hip fractures are classified as intracapsular or extracapsular fractures (see Table 1.). When the hip fracture occurs, movement at the fracture site can cause pain, make reduction difficult and increase complications such as avascular necrosis and nerve damage (Handoll et al., 2011). Surgery must be performed as soon as possible to minimize the risk of complications (Koval and Cooley, 2005, Beaupre et al., 2005). However, surgery can be delayed due to other health problems that must be managed,
Aim
There were two main motives for our study: a) the need for an updated, well-designed, prospective, randomized controlled study to relieve pain and; b) the need to prevent complications and increase comfort and ‘satisfaction with treatment and care’ (STC) in patients with hip fracture and the need for evidence to change routine clinical practice. We aimed to compare the effects of preoperative position splint and skin traction on pain, comfort, complications, and STC in patients with hip
Study sample
Of those enrolled in the study, 73.5% of the patients had intertrochanteric and subtrochanteric fractures, while 26.5% had femoral neck fractures and there were no femoral head fractures. The characteristics of the participants (n = 68) are shown in Table 2. At the beginning of the study, the characteristics of the participants in the two groups were similar in terms of gender (p = .808), marital status (p = .223), education (p = .779), chronic disease presence (p = .642), antithrombotic
Ethical statement
The study “Preoperative position splint versus skin traction in patients with hip fracture: An experimental study” was approved by the Clinical Research Ethics Board at an authorized hospital affiliated with the Turkish Ministry of Health (Ethical Committee Approval Number: B.10.4.ISM.4.06.68.49/242). Permission to perform the research was granted by the Chief of the Orthopedics and Traumatology Clinic in GMMAH. The study (clinical trials registration number: NCT02287571) was a prospective
Conflicts of interest
There are no conflicts of interest for the authors of this manuscript.
Funding
No financial support.
Author contributions
All authors meet at least one of the following criteria (suggested by the ICMJE: from http://www.icmje.org/ethical_1author.html):
1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; 2) drafting the article or revising it critically for important intellectual content; and 3) final approval of the version to be published.
Betul TOSUN: 1) substantial contributions to conception and design, acquisition of data, or analysis and
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Cited by (8)
The use of skin traction in the adult patients with proximal femur fracture. What are the effects, advantages and disadvantages? A scoping review
2023, International Journal of Orthopaedic and Trauma NursingThe effectiveness of skin traction in reducing pain in adults with a hip fracture: A systematic review
2021, International Journal of Orthopaedic and Trauma NursingCitation Excerpt :Other authors suggest the simple placement of a pillow under the fractured limb (Koval and Cooley, 2005; Beaupre et al., 2005); in one of the studies included in the present review, patients nursed with a pillow beneath the affected leg did not report significantly higher levels of pain than those nursed with skin traction (Endo et al., 2013). The ideal alternative to avoid traction is urgent surgical treatment of the fractured hip (Tosun et al., 2018). Effective measures can be taken to reorganise trauma lists in order to operate on more patients within the optimum time-frame of 48 h wherever this is possible.
Pain relief differentiated according to the length of time that preoperative skin traction was carried out for hip fractures: A systematic review and meta-analysis
2021, International Journal of Orthopaedic and Trauma NursingCitation Excerpt :Before surgical intervention, several preoperative treatments for hip fracture patients (e.g., skin traction, skeletal traction, splints, nerve blockade, and pillow care) have been developed in anticipation of pain relief, reduced analgesic needs, ease of fracture reduction at surgery, and reduction of blood transfusions (Biz et al., 2019; Endo et al., 2013; Jerre et al., 2000; Kobayashi et al., 2020; Manafi et al., 2015; Matullo et al., 2016; Rosen et al., 2001; Saygi et al., 2010; Tosun et al., 2018; Wennberg et al., 2019; Yip et al., 2002; Yuenyongviwat et al., 2020). Among the preoperative treatments, skin traction was still a common practice in many countries until the introduction of surgery in the 1950s (Biz et al., 2019; Endo et al., 2013; Jerre et al., 2000; Kobayashi et al., 2020; Manafi et al., 2015; Rosen et al., 2001; Saygi et al., 2010; Tosun et al., 2018; Yip et al., 2002; Yuenyongviwat et al., 2020). Pain management is one of the most important preoperative managements, as hip fractures can be painful (Barnes, 2002; Endo et al., 2013; Jerre et al., 2000; Kobayashi et al., 2020; Manafi et al., 2015; Rosen et al., 2001; Saygi et al., 2010; Yip et al., 2002; Yuenyongviwat et al., 2020).
Pain relief after more than 24 hours of preoperative skin traction in patients with intertrochanteric fractures: A retrospective comparative cohort study
2020, International Journal of Orthopaedic and Trauma NursingClinical practice and nursing management of pre-operative skin or skeletal traction for hip fractures in elderly patients: a cross-sectional three-institution study
2019, International Journal of Orthopaedic and Trauma NursingQuantitative research in orthopaedic and trauma nursing
2018, International Journal of Orthopaedic and Trauma Nursing