Preoperative position splint versus skin traction in patients with hip fracture: An experimental study

doi:10.1016/j.ijotn.2017.07.002

International Journal of Orthopaedic and Trauma Nursing

Volume 28, February 2018, Pages 8-15

https://doi.org/10.1016/j.ijotn.2017.07.002 Get rights and content

Abstract

Aim

The aim of the study was to compare the effects of a preoperative position splint and skin traction on pain, comfort, complications, and satisfaction with the treatment and care for patients with hip fracture.

Method

This randomized trial was conducted with a total of 68 patients with hip fracture in a tertiary care hospital in Turkey. Preoperatively, a position splint was applied to the patients in the intervention group (n = 34) and skin traction was applied to patients (n = 34) in the control group. Outcomes studied were pain, comfort, satisfaction and complications.

Results

Mann-Whitney U Test showed a significant difference between the position splint group and skin traction group regarding pain severity after the application (p < .05). A significant difference was demonstrated between the two groups concerning comfort levels after the application (p < .05). The position splint group was significantly more satisfied with the treatment and care than the control group in the later period after the application (p < .05). The number of preoperative complications in the position splint group was significantly fewer than that of the skin traction group in the preoperative period (p < .05).

Conclusion

Preoperative position splint application in patients with hip fracture relieved pain and complications and increased comfort and satisfaction with treatment and care.

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 Nursing
Hip surgery is normally the chosen therapy for proximal femur fractures. Surgery within 24–48 h after hip fracture is recommended, but surgery may not always be performed promptly. Consequently, skin-traction is applied to reduce complications. The purpose of this review is to assess both advantages and disadvantages of skin traction.
A scoping review was conducted. The research question was: which are the effects of skin traction, its advantages and disadvantages in adult patients with proximal femur fractures hospitalised in orthopaedic wards? The search was done in the databases PubMed, CINAHL, Cochrane, Embase, DOAJ, ClinicalTrials.gov and OpenDissertation.
9 records were included, skin traction effects were summarised in 7 categories: pain, pressure sores, comfort and relaxation, thromboembolism, damage from adhesive, complications and quality of care. The possible advantage is pain reduction between 24 and 60 h, the possible disadvantage is skin damage.
The routine use of skin traction does not appear recommended, but more consistent evidence is necessary to make clinic decisions. Future RCTs could focus on the effects of skin traction 24–60 h after hospitalisation and before surgery.
The effectiveness of skin traction in reducing pain in adults with a hip fracture: A systematic review
2021, International Journal of Orthopaedic and Trauma Nursing
Citation 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.
Femoral fractures are associated with high mortality and morbidity, including pain. Skin traction may be used pre-operatively as an adjunct to analgesia to decrease pain.
To evaluate the effects on pain of the use of pre-operative skin traction in adults with a fracture of the proximal femur.
Is the use of pre-operative skin traction effective in reducing pain in adults with proximal femoral fractures?
A systematic review was conducted based on a search of PubMed, CINAHL Complete, MEDLINE Complete, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews. The keywords ‘preoperative’, ‘skin traction’, ‘hip fractures’ and ‘pain’ were used. Randomised controlled trials published in English between April 2011 and November 2020 were included and appraised using the Cochrane Risk of Bias tool.
Five articles met the inclusion criteria; all were randomised controlled trials. The results confirm those of earlier reviews: skin traction does not significantly decrease pain and analgesia use. The quality of the evidence available is weak.
There is no strong evidence for the routine pre-operative use of skin traction in adults with a hip fracture. As the quality of the evidence is weak, further high-quality research on this topic is warranted.
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 Nursing
Citation 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).
Conduct a systematic review and meta-analysis pertaining to pain relief differentiated by time within 24 h of preoperative skin traction for hip fracture.
PubMed, Google Scholar, Cochrane Library, Web of Science, and MEDLINE were searched for relevant articles published in the English language on comparison of pain relief between preoperative skin traction and no traction for hip fracture.
Five studies involving 413 patients with hip fractures (skin traction, n = 207; no traction, n = 206) were included. The visual analog scale (VAS) score within 1 h postadmission in the skin traction group was significantly smaller than that in the no traction group. In contrast, there was no significant difference in the VAS scores of the two groups at 4–6 h postadmission.
Evidence indicates that preoperative skin traction for hip fracture can provide pain relief within 1 h postadmission, but not at 4–6, 12, and 24 h postadmission. Accordingly, alternative preoperative pain relief methods for hip fractures should be carefully considered.
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 Nursing
The primary aim of the study was to investigate pain relief after more than 24 h of preoperative skin traction (because of delay in surgery due to comorbidities and system issues) in patients with intertrochanteric fractures.
We performed a retrospective comparative cohort study of 56 patients who underwent intramedullary nailing for the treatment of intertrochanteric fractures and who had waited for surgery for more than 48 h after admission due to comorbidities or system issues. Preoperative therapy was randomly selected with a ratio of one to two and patients classified as skin traction (n = 18) or no traction (n = 38). The Verbal Rating Scale (VRS) was used to assess pain at 12–60 h post-admission.
There was no significant difference in VRS at 12 h after admission (1.1 ± 1.0 vs. 0.8 ± 0.9, p = 0.73), but patients who received skin traction had a lower VRS pain score at 24–60 h after admission compared to those with no traction (24 h, 0.4 ± 0.8 vs. 1.1 ± 1.0, p < 0.05; 36 h, 0.2 ± 0.5 vs. 0.9 ± 0.9, p < 0.05; 48 h, 0.2 ± 0.4 vs. 0.8 ± 0.9, p < 0.05; 60 h, 0.2 ± 0.4 vs. 0.9 ± 0.9, p < 0.05).
Skin traction for patients with intertrochanteric fractures for more than 24 h preoperatively resulted in a lower VRS pain score. Therefore, more than 24 h of preoperative skin traction for patients with intertrochanteric fractures may give effective pain relief in situations where surgery is delayed.
Clinical 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 Nursing
Femoral fractures are a major healthcare problem worldwide. One of the most difficult issues is their preoperative care, which is still managed by either skeletal or skin traction in some countries, including Italy. These issues are discussed and compared with the contemporary literature.
This study aims to analyse the distribution of these treatment options within the orthopaedic community and the reasons for their use, as well as to identify how this may impact nursing care in terms of pain management, hygiene care, venous thromboembolism (VTE)prophylaxis and prevention of pressure ulcers.
For this cross-sectional study, a 12-item survey was administered to the nursing staff, consultants and residents of the Orthopaedic Units in three different hospitals in NorthEastern Italy. The questionnaire investigated the routine use of skeletal or skin traction for the preoperative management of hip fractures in those settings.
136 surveys were completed, providing a response rate of 87.74%. Preoperative traction for hip fractures was still in use in the three hospitals, mainly applied by experienced surgeons for subtrochanteric fractures. Pain management, VTE and pressure ulcer prevention were perceived as worse only with skeletal traction, while hygiene was described as more difficult with both skeletal and skin traction.
Based on the data and the literature revision, skin or skeletal traction for patients with proximal femoral fractures should be discouraged as standard practice. This is supported widely in the international literature, and consideration of knowledge translation strategies should be made to refine current practice in these settings.
Quantitative research in orthopaedic and trauma nursing
2018, International Journal of Orthopaedic and Trauma Nursing

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View full text

Preoperative position splint versus skin traction in patients with hip fracture: An experimental study

Abstract

Aim

Method

Results

Conclusion

Introduction

Section snippets

Literature review

Aim

Study sample

Ethical statement

Conflicts of interest

Funding

Author contributions

Pain

Clin. Effect Nurs.

J. Orthop. Sci.

Orthop. Nurs.

Int. J. Orthop. Trauma Nurs.

Int. J. Orthop. Trauma Nurs.

Asian Nurs. Res.

Hip fractures

TOTBID J.

Best practices for elderly hip fracture patients a systematic overview of the evidence

J. Gen. Intern. Med.

The Braden scale for predicting pressure sore risk

Nurs. Res.

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

Eur. J. Trauma

A prospective study of pain reduction and knee dysfunction comparing femoral skeletal traction and splinting in adult trauma patients

J. Orthop. Trauma

Fragility hip fractures in elderly patients in Bhubaneswar, India (2012-2014): a prospective multicenter study of 1031 elderly patients

Geriatr. Orthop. Surg. Rehabil.

Ortopedik Önlemler

The satisfaction level of patients with trauma on pain

J. Med. Sci.

Examining the validity of pressure ulcer risk assessment scales: developing and using illustrated patient simulations to collect the data information point: visual Analogue Scale

J. Clin. Nurs.

Pre-operative traction for hip fractures in adults (Review)

Cochrane Libr.

The national association of orthopaedic nurses (NAON) scope and standards of orthopaedic nursing practice, 3rd edition

Orthop. Nurs.

Effects of three methods of femoral site immobilization on bleeding and comfort after coronary angiogram

Am. J. Crit. Care