ORIGINAL ARTICLE   

Minerva Ortopedica e Traumatologica 2019 September;70(3):121-5

DOI: 10.23736/S0394-3410.19.03938-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Does preoperative skeletal traction still have a role in acetabular fractures?

Alessandro APRATO ✉, Luca TOLOSANO, Marco FAVUTO, Kristijan ZOCCOLA, Gabriele COMINETTI, Luigi SABATINI, Alessandro MASSÈ

University of Turin, Turin, Italy

BACKGROUND: Skeletal traction is often preoperatively used for acetabular fractures despite the lack of clear evidence concerning its efficacy. Supporters of this technique advocate advantages in pain management, fracture reduction and consequently surgical time reduction, eventually also reducing the rate of avascular necrosis. The present research seeks to evaluate the efficacy of preoperative skeletal traction applied to acetabular fractures. Patients preoperatively treated with skeletal traction have been compared with those without clinical results, quality of reduction, surgical time and rate of conversion to total hip arthroplasty (THA) have been evaluated.
METHODS: Patients with an acetabular fracture treated with open reduction and fixation in a referral center were included in this study. The research was conducted using data from medical records, discharge letters, pre and postoperative imaging as well as phone interviews. Patients were divided into two groups according to the preoperative treatment (skeletal traction or nothing). Age, gender, fracture type, time between trauma and surgery, surgical time, quality of reduction with Matta criteria, clinical evaluation by Merle d’Aubigné-Postel (MAP) Score at last follow-up, and subsequent THA were recorded and statistically analyzed.
RESULTS: The skeletal traction group included 93 patients while 74 did not undergo such procedure. The two groups were comparable in terms of age (P=0.441), gender distribution (P=0.846), time from trauma (P=0.531) to surgery and follow-up (P=0.495). No significant differences were found for clinical outcome (P=0.294), surgical time (P=0.975), quality of reduction (P=0.134 and P= 0.329 respectively for reviewer A and B) and subsequent THA rate (P=0.988).
CONCLUSIONS: According to our results, preoperative skeletal traction for acetabular fracture does not reduce intraoperative time, does not improve neither the rate of anatomical reductions nor the clinical outcome; it also does not reduce the rate of conversion to THA. At present there is an insufficient level of evidence to support this preoperative treatment as routine for acetabular fractures.

KEY WORDS: Traction; Treatment outcome; Fracture fixation, internal