A Cochrane review [Abstract] 1 included 11 studies (6 randomised, 5 quasi-randomised) with a total of 1 654 predominantly elderly patients with hip fractures. Ten trials compared predominantly skin traction with no traction. The available data provided no evidence of benefit from traction either in the relief of pain (pain soon after immobilisation [VAS score 0: none to 10: worst pain]: mean difference 0.11, 95% CI -0.27 to 0.50; 3 trials), ease of fracture reduction or quality of fracture reduction at time of surgery. There were inconclusive data for pressures sores and other complications, including fracture fixation failure. Three minor adverse effects (sensory disturbance and skin blisters) related to skin traction were reported.One of the trials included both skin and skeletal traction groups. This trial and one other compared skeletal traction with skin traction and found no important differences between these two methods, although the initial application of skeletal traction was noted as being more painful and more costly.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes) and by limitations in study quality.
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