Country | Nigeria | South Africa | Tanzania | East Africa | Sierra Leone | India | India | Kenya | Uganda | Nepal | Malawi | Malawi | Ethiopia | Cambodia | Kenya | Kenya | | |
When | 18 years 1954-1971 | 3 years | not reported | 8 years 1991-1999 | 25 months 2003-2005 | 59 months 2003-2007 | 24 months year not stated | 24 months 2005-2007 | 13 months 2007-2008 | 16 months 2010-2011 | 10 months 2010-2011 | 28 months 2010-2012 | ? 2007-2012 | 7 month recruitment 2007 | 12 months 2010-2011 | 6 months 2012-2013 | | |
Age Included | 20+ | not reported | not reported | not reported | 15+ skeletally mature | 22+ | 20+ | 18+ | 15+ | 13+ | 14+ | 12+ | 16+ | 14+ | 19+ | 18+ | | |
Mean Age | not reported | not reported | not reported | not reported | 34.2 | median 27 | 30 | 41 (includes tibia fractures) | 31 | not reported | 34.5 | 33.3 | approx 30 | 33 | 42 | 31.5 | | 34 |
Gender | Male | not reported | not reported | not reported | not reported | 43 | 15 | 160 | 45 | 37 | not reported | 13 | 114 | 60 | not stated | 115 | 45 | 647 | 81% |
Female | not reported | not reported | not reported | not reported | 10 | 2 | 40 | 15 | 13 | not reported | 7 | 23 | 8 | not stated | 33 | 5 | 156 | 19% |
Fracture age | recent but not explicitly stated | not reported | recent but not explicitly stated | not reported | <2 weeks | mean 13 weeks (4-44 weeks) | <14 days | 41 recent | up to 33 days | recent but not explicitly stated | recent but not explicitly stated | 32 delayed union | recent but not explicitly stated | <42 days | | <7 days | | |
Type of study | retrospective cohort | cohort | cohort | cohort | retrospective cohort compared to another traction method | prospective cohort | retrospective cohort | prospective cohort | prospective cohort | retrospective cohort, much data presented jointly with tibial nailing | prospective cohort | prospective cohort | prospective cohort | retrospective cohort | quasi-experimental (patient choice) | prospective cohort | | |
Traction | No. patients | 33 | 54 | 15 | 109 | 53 | 0 | 0 | 0 | 0 | 0 | 20 | 0 | 68 | 50 | 79 | 25 | 506 | |
No. fractures | 33 | 58 | 15 | 109 | 54 | 0 | 0 | 0 | 0 | 0 | 20 | 0 | 69 | 52 | 79 | 25 | 514 | |
IM nail | No. patients | 0 | 67 | 0 | 0 | 0 | 17 | 200 | 60 | 50 | 6 | 0 | 137 | 0 | 37 | 69 | 25 | 668 | |
No. fractures | 0 | 67 | 0 | 0 | 0 | 17 | 200 | 60 | 50 | 6 | 0 | 141 | 0 | 37 | 69 | 25 | 672 | |
Open | traction | not reported | not reported | not reported | 44 (40%) | 4 (7.6%) | N/A | N/A | N/A | N/A | N/A | 0 | N/A | 25 (36%) | 16 (32%) | not reported | 0 | | 31% |
IM nailing | N/A | not reported | N/A | N/A | N/A | no (not explicit) | 0 | 3 (5%) | 0 | 0 | N/A | 7 (7%) | N/A | 7 (19%) | not reported | 0 | | 7% |
Follow-up | mean | "if they lived in the vicinity" | | "very short" | "poor" | 4.6 months | 33 months | 10 months | | | | until inpatient discharge | 381 days | 8 months | 6 months | 12 weeks | 3 months | | |
range | | | | | 3-9 months | 6-72 months | 6-12 months | some beyond 30 weeks | minimum 6 months/ fracture healed | | | | 4-21 months | 4+ months | | 3 months-119 days | | |
percentage | | | | | 67% reported on | 100% | | 69% (includes tibial; minimum 58%) | 71% reported on | | | 79% | | | | | | |
Associated injuries deemed significant | no | not reported | not reported | some, level not reported | 47.2% | 53% | no (not explicit) | not reported | 40% (excluded if major) | not reported | no | 25% | not reported | no | 100% | no | | |
Time to surgery | mean | | | | | | | | 13.2 days | | | 17 days (SD 10) in acute | | 20.7 days | | | | | |
range | | | | | | | | | 0-33 days | | | | | | | <7 days inclusion criteria | | |
Bed days | Traction | mean | 65 | 49 | | | 52.1 | | | | | | 46 | | 45 | 52.3 | 60 | 66.7 | | 54 |
range | 45-121 | | | | 25-108 | | | | | | 29-74 | | 30-60+ | | | 44-119 days | | |
IM nail | mean | | 38.5 | | | | 7 | | 10 (includes tibial) | 20.1 (6.9 post op) | | | 30 in acute | | 34.9 | 30 | 11.48 | | 28 (excluding Soren et al.) |
range | | | | | | 4-20 days | | 3-22 (includes tibial) | 2-11 post op | | | 1 to 90 | | | | 4-19 days | | |
Blood loss | no transfusions | | | | | 5 required transfusion up to 2 pints | 50-100ml | | | | | mean 279ml (SD202) fresh | | mean 2.5 units transfused | | | | |
Infection | Traction | Pinsite | n | "common" | | | 2 deep infections | 23 | | | | | | 7 | | 8 | 14 | | excluded | 52 | 27% |
percentage | one excluded patient died of related sepsis | | | rates pinsite infection not reported | 43% | | | | | | 35% (41% of those with skeletal traction) | | 12% | 27% | | | | |
IM nailing | Deep | n | | | | | | 0 | 0 | 1 | 1 | 0 | | 7 | | 1 | | excluded | 10 | 2% |
percentage | | | | | | 0% | 0% | 2% | 2% | 0% | | 5% | | 3% | | | | |
Superficial | n | | | | | | 0 | 0 | 1 | 1 | 0 | | 1 | | 1 | | excluded | 4 | 1% |
percentage | | | | | | 0% | 0% | 2% | 2% | 0% | | 1% | | 3% | | | | |
Total | n | | | | | | 0 | 0 | 2 | 2 | 0 | | 8 | | 2 | | excluded | 14 | 3% |
percentage | | | | | | 0% | 0% | 3% | 4% | 0% | | 6% | | 5% | | | | |
Union | Non-union | Traction | n | 0 | 2 | 0 | 0 | 4 | | | | | | | | 1 | 10 | | | 17 | 4% |
percentage | 0% | 3% | 0% | 0% | 7% | | | | | | | | 1% | 19% | | | | |
IM nail | n | | | | | | 0 | 0 | | 0 | | | 1 | | 3 | | | 4 | 1% |
percentage | | | | | | 0% | 0% | | 0% | | | 1% | | 8% | | | | |
Delayed Union | Traction | n | | | | 1 | | | | | | | 2 | | | | | 4 | 7 | 5% |
percentage | | | | 1% | | | | | | | 10% | | | | | 16% | | |
IM nail | n | | | | | | 1 | 0 | | 2 | | | | | | | 1 | 4 | 1% |
percentage | | | | | | 6% | 0% | | 4% | | | | | | | 4% | | |
| Malunion | Traction | n | | | | 0 | 5 | | | | | | 1 | | 1 | 2 | 34 | 9 | 52 | 13% |
percentage | | | | 0% | 9% | | | | | | 5% | | 1% | 4% | 43% | 36% | | |
IM nail | n | | | | | | 0 | 0 | | 4 | | | | | 0 | 21 | | 25 | 7% |
percentage | | | | | | 0% | 0% | | 8% | | | | | 0% | 30% | | | |
Shortening | Traction | n | | | | 0 | 3 (>2.5 cm) | | | | | | 2 (≥3cm) | | 11 (>2cm) | | | | 16 | 6% |
percentage | | | | 0% | 6% | | | | | | 10% | | 16% | | | | | |
IM nail | n | | | | | | 1 (3.5cm) | 0 | | 0 | | | | | | | | 1 | 0.4% |
percentage | | | | | | 6% | 0% | | 0% | | | | | | | | | |
Refracture | Traction | n | | 2 | | 5 | 2 | | | | | | | | | | | | 9 | 4% |
percentage | | 3% | | 5% | 4% | | | | | | | | | | | | | |
IM nail | n | | | | | | 0 | 0 | 1 | 2 (intra op) | | | | | | | | 3 | 1% |
percentage | | | | | | 0% | 0% | 2% | 4% | | | | | | | | | |
Futher theatre trips | Traction | n | | 6 | | | 2 | | | | | | | | | 2 | | | 10 | 6% |
percentage | | 10% | | | 4% | | | | | | | | | 4% | | | | |
If all non union included | n | 0 | 6 | | 0 | 6 | | | | | | | | 1 | 12 | | | 25 | 7% |
percentage | 0% | 10% | | 0% | 11% | | | | | | | | 1% | 23% | | | | |
IM nail | n | | | | | | 3 | 0 | 3 | 4 | 1 | | 9 | | 3 | | | 23 | 5% |
percentage | | | | | | 18% | 0% | 5% | 8% | 17% | | 6% | | 5% | | | | |
Death | n | | 6 | | | | | | | | | | 5 | | | | | | |
Details | skin traction used predominantly, physio late introduction only | 2 deaths in perkins group and 4 in kuntscher nailing. 7 "failures" in IM nail group | 2 patients treated with kuntscher nail as soft tissue interposition suspected on x-ray | no deep vein thromboses, 41 cases gunshot wounds, complications clinically defined | 4 pins also had to be resited for infection | 20 weeks post injury and short pre op; image intensifier used | some intra operative x-ray used so only 8 opened at fracture site | 4 screw loosening | 2 pulmonary emboli pre-op | gapping at fracture site requiring dynamization | variable traction methods used, malunion case was one of two with shortening | 32 delayed presentations, all had intraoperative antibiotics, mobilisation delayed as had to pay for crutches to be made | | inpatient discharge only after suture removal 14/7 post op, 1/52 oral antibiotics routine in operative group | | longest stay related to time to clear bills | | |