• M J Parker and H H Handoll.
• Orthopaedic Department, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, UK, PE3 6DA. mjparker@doctors.org.uk
• Cochrane Db Syst Rev. 2001 Jan 1 (3): CD000168.

BackgroundPre-operative traction following an acute hip fracture remains standard practice in some hospitals.ObjectivesTo evaluate the effects of traction applied to the injured limb prior to surgery for a fractured hip. Different methods of applying traction (skin or skeletal) were considered.Search StrategyWe searched the Cochrane Musculoskeletal Injuries Group's specialised register (April 2001), the Cochrane Controlled Trials Register (The Cochrane Library Issue 1, 2001), MEDLINE (1966 to February 2001), EMBASE (1988 to 2001 Week 11), CINAHL (1982 to February 2001), the National Research Register Issues 3, 2000 and 1, 2001, and reference lists of articles. Date of most recent search: April 2001.Selection CriteriaAll randomised or quasi-randomised trials comparing either skin or skeletal traction with no traction, or skin with skeletal traction for patients with an acute hip fracture prior to surgery.Data Collection And AnalysisBoth reviewers independently assessed trial quality, using a nine item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, the data are presented graphically.Main ResultsSeven randomised trials, mainly of moderate quality, involving a total of 1038 predominantly elderly patients, were identified and included in the review. This review update includes a newly identified trial. The inclusion of this trial, which focussed on analgesia outcomes, resulted in no important change in the results or conclusions. Six trials compared traction with no traction. Although no data pooling was possible, overall these provided no evidence of benefit from traction, either in the relief of pain, ease of fracture reduction or quality of fracture reduction at time of surgery. One of these trials included both skin and skeletal traction groups. This trial and one other which compared skeletal traction with skin traction found no important differences between these two methods, although the initial application of skeletal traction was noted as being more painful and most costly.Reviewer's ConclusionsFrom the evidence available, the routine use of traction (either skin or skeletal) prior to surgery for a hip fracture does not appear to have any benefit. However, the evidence is also insufficient to rule out the potential advantages for traction, in particular for specific fracture types, or to confirm additional complications due to traction use. Further, high quality trials would be required to confirm or refute the absence of benefits of traction.

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