Bryant traction in paediatric femoral shaft fractures, home traction versus hospitalisation

Bryant traction in paediatric femoral shaft fractures, home traction versus hospitalisation

Summary Aim To evaluate Bryant traction at home in terms of feasibility, morbidity, effect on length of hospital stay, outcome and costs. Patients and methods Retrospective analysis of 54 children treated for femoral shaft fracture (1991–2004). Results of ‘home traction’ (A, n = 38) and ‘hospital tr...

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Bibliographic Details
Published in:Injury Vol. 39; no. 4; pp. 456 - 462
Main Authors: Scheerder, F.J.M, Schnater, J.M, Sleeboom, Chr, Aronson, D.C
Format: Journal Article
Language:English
Published: Oxford Elsevier Ltd 01-04-2008
Elsevier
Subjects:
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Bryant traction
Child, Preschool
Children
Complications
Cost-Benefit Analysis
Costs
Diseases of the osteoarticular system
Feasibility Studies
Female
Femoral Fractures - economics
Femoral Fractures - therapy
Femoral shaft fractures
Gallows traction
General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation
Home Care Services - economics
Home traction
Hospital stay
Hospitalization - economics
Humans
Injuries of the limb. Injuries of the spine
Male
Medical sciences
Orthopedics
Parents - education
Parents - psychology
Patient Selection
Personal Satisfaction
Retrospective Studies
Traction - instrumentation
Traction - methods
Traumas. Diseases due to physical agents
Treatment Outcome
Costs
Home traction
Complications
Femoral shaft fractures
Hospital stay
Children
Gallows traction
Bryant traction
Human
Femur
Diseases of the osteoarticular system
Fracture
Traction
Trauma
Health economy
Anesthesia
Complication
Hospital
Child
Public health
Comparative study
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Summary:Summary Aim To evaluate Bryant traction at home in terms of feasibility, morbidity, effect on length of hospital stay, outcome and costs. Patients and methods Retrospective analysis of 54 children treated for femoral shaft fracture (1991–2004). Results of ‘home traction’ (A, n = 38) and ‘hospital traction’ (B, n = 16) were compared. Data were collected regarding demographics, length of hospital stay, traction period, various aspects of the fractures, co-morbidity, morbidity, and follow-up. The parents’ experience was evaluated by telephone questionnaire. Results Two early treatment failures occurred. One patient stopped home traction at 8 days due to skin problems and had a spica cast applied at another hospital, with subsequent development of a compartment syndrome. The other patient was placed in a hip spica after 2 weeks of hospital traction because of difficulty in getting satisfactory X-rays. At follow-up, one unacceptable shortening of 3 cm had occurred in the home traction group. There was only a significant difference in hospital stay (A 7.0 days versus B 22.5 days), total traction period (A 28.0 days versus B 22.5 days) and costs (group B 3× versus group A). The parents were overall pleased with traction at home. Complications occurred as much in the home traction group as in the control group and fracture position at union was equal in both groups. Conclusions Treatment with home traction is feasible, simple and effective; it reduces hospital stay to 1 week, and costs to one-third. Good patient selection and instructions of the parents are mandatory.
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ISSN:0020-1383
1879-0267
DOI:10.1016/j.injury.2007.07.029