[The conservative treatment of femur fractures by Perkins traction. Management in adverse situations].

In adverse situations and in hospitals of less prosperous countries, the operative treatment of fractures may for many reasons not be possible and conservative procedures remain the treatment of choice. This applies to the rule that under difficult conditions fracture treatment should be as conservative as possible and as operative as necessary, if at all feasible. This report goes on 109 Patients with femur fractures consecutively treated by Perkins traction in East African hospitals between Nov. 1991 and Sept. 1999. Out of them, 44 patients had wide open fractures, 41 of them caused by explosives and bullets. The Perkins procedure is a traction without a fixating splint. As soon as possible, the patient is forced to sit up in his bed, the removable parts of the springs are dropped and the patient starts with exercises flexing and stretching the knee. With the right traction weight and the bodys counterweight the fragments of the fracture find an alignment, and a malrotation of the distal fragment is prevented. Exercises as early as possible stimulate a rapid callus formation and prevent muscle atrophy and stiffness of the joints. We have seen 2 posttraumatic deep infections, 5 refractures in patients whose traction was removed too early or who fell down whilst walking with crutches. All patients had a good callus formation and in all patients, except two, the traction could be removed after 6-12 weeks, in the most cases even after 6-9 weeks. To the patients with refractures, the traction was reapplied and callus consolidation then occurred without major problems. At the time of removal of the traction all patients showed a flexion of the knee of at least 80 degrees -90 degrees and all were able to nearly fully stretch the knee joint.Compared with other methods of conservative treatment of femur fractures, Perkins traction has some advantages: simple management, immediate start of exercises, simple exercises, early callus formation, no stiffness of the joints and only few x-ray controls. Malalignment, non union, excessive shortening and rotation of the distal fragment are uncommon.