Carlo Biz1, Ilaria Fantoni2, Nicola Crepaldi3, Filippo Zonta4, Lisa Buffon5, Marco Corradin6, Alessandra Lissandron7, Pietro Ruggieri8. 1. Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Via Giustiniani 2, 35128, Padova, Italy. Electronic address: carlo.biz@unipd.it. 2. Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Via Giustiniani 2, 35128, Padova, Italy. Electronic address: ilaria.fantoni@studenti.unipd.it. 3. Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Via Giustiniani 2, 35128, Padova, Italy. Electronic address: nicola.crepaldi88@gmail.com. 4. Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Via Giustiniani 2, 35128, Padova, Italy. Electronic address: filippo.zonta@studenti.unipd.it. 5. Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom. Electronic address: Lisa.Buffon@gstt.nhs.uk. 6. Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Via Giustiniani 2, 35128, Padova, Italy. Electronic address: marco.corradin@studenti.unipd.it. 7. Orthopaedic and Traumatology Clinic, Padua Hospital, Padova, Italy. Electronic address: alessandra.lissandron@aopd.veneto.it. 8. Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Via Giustiniani 2, 35128, Padova, Italy. Electronic address: pietro.ruggieri@unipd.it.
Abstract
BACKGROUND: 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. OBJECTIVE: 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. DESIGN: 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. FINDINGS: 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. CONCLUSIONS AND RECOMMENDATIONS: 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.
BACKGROUND: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. OBJECTIVE: 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. DESIGN: 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. FINDINGS: 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. CONCLUSIONS AND RECOMMENDATIONS: 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.