Preoperative skin traction or pillow nursing in hip fractures: A prospective, randomized study in 123 patients

Purpose: To study the influence on pain and handling of different preoperative immobilization procedures for hip fractures. Method: 123 consecutive patients with displaced cervical and trochanteric hip fractures were randomized to skin traction, placement in a special foam pillow (Lasse pillow), and comfortable placement with an ordinary pillow under the hip from admission to operation. The effect on pain alleviation was evaluated with a Visual Analogue Scale and by the number of doses of analgesics administered. The processing time through the emergency department, X-ray department and to the ward as well as time to operation was registered. Results: No clinically significant difference in the VAS pain evaluation was found. There was no difference in the total consumption of analgesics in the emergency department or on the ward and no effect of immobilization type on the processing time or time to operation. Fracture type did not affect the outcome. Approximately one third of the patients found placement on a regular pillow or the application of skin traction uncomfortable as opposed to only one of 19 of the patients lying in the special Lasse pillow. There was no other difference in processing time with regard to different forms of pillow nursing and skin traction. Conclusion: The most convenient immobilization should be chosen as there is no significant difference concerning pain and handling time. Increased attention to analgesic medication and rapid handling to be operated are of importance to promote the rehabilitation process.