Moderate evidence does not support routine use of preoperative traction for patients with a hip fracture.

Management of Hip Fractures in the Elderly
Endorsed by: OTA, AGS, AAPM&R, ASBMR, USBJI, The Hip Society, AACE, ORA
Moderate Evidence MODERATE EVIDENCE
Rationale
Seven moderate strength studies (Anderson et al 17, Finsen et al 18, Needoff et al 19, Resch et al 20, Rosen et al 21, Saygi et al 22, Yip et al 23) compared skin traction to no traction. There was no difference noted between the two groups with regard to decreased pain or decreased doses of analgesia administered. A meta-analysis of the data showed that preoperative traction offered no benefit to hip fracture patients.
 
One high strength study (Resch et al 24) showed no difference in pain alleviation and number of analgesics administered when comparing skeletal traction to skin traction in hip fracture patients. However, half of the patients in the skeletal traction group found the application of skeletal traction to be painful.
 
Risks and Harms of Implementing this Recommendation
There are no known harms of implementing this recommendation.
 
Future Research
Future research regarding preoperative modalities to minimize patient pain should be continued to be investigated.
 
  1. (17) Anderson GH, Harper WM, Connolly CD, Badham J, Goodrich N, Gregg PJ. Preoperative skin traction for fractures of the proximal femur. A randomised prospective trial. J Bone Joint Surg Br 1993;75(5):794-796.
  2. (18) Finsen V, Borset M, Buvik GE, Hauke I. Preoperative traction in patients with hip fractures. Injury 1992;23(4):242-244.
  3. (19) Needoff M, Radford P, Langstaff R. Preoperative traction for hip fractures in the elderly: a clinical trial. Injury 1993;24(5):317-318.
  4. (20) Resch S, Bjärnetoft B. Preoperative skin traction or pillow nursing in hip fractures: a prospective, randomized study in 123 patients. 2005. http://www.nzgg.org.nz/search?search=acute+management;http://dx.doi.org/10.1080/096382805 00055800; http://www.ncbi.nlm.nih.gov/pubmed/16278188; http://www.ingentaconnect.com/content/apl/tids
  5. (21) Rosen JE, Chen FS, Hiebert. Efficacy of preoperative skin traction in hip fracture patients: a prospective, randomized study. 2001. http://www.nzgg.org.nz/search?search=acute+management;http://dx.doi.org/10.1080/110381203 10004475; http://informahealthcare.com/loi/occ
  6. (22) Saygi B, Ozkan K, Eceviz E, Tetik C, Sen C. Skin traction and placebo effect in the preoperative pain control of patients with collum and intertrochanteric femur fractures. Bull NYU Hosp Jt Dis 2010;68(1):15-17.
  7. (23) Yip DK, Chan CF, Chiu PK, Wong JW, Kong JK. Why are we still using pre-operative skin traction for hip fractures? Int Orthop 2002;26(6):361-364.