Table 1

Summary of effectiveness study characteristics

Pearson 197710 Usdin 196911 Bewes 197412 Mandrella 200213 Gosselin & Lavaly 200714 Boopalan et al 201415 Aiyer et al 200616 Soren et al 200917 Sekempi et al 201118 Chakraborty et al 201119 Doorgakant & Mkandawire 201220 Young et al 201321 Bezabeh et al 201222 Gosselin et al 200925 Opondo et al 201326 Kamau et al 201427 TotalMean
CountryNigeriaSouth AfricaTanzaniaEast AfricaSierra LeoneIndiaIndiaKenyaUgandaNepalMalawiMalawiEthiopiaCambodiaKenyaKenya
When18 years 1954-19713 yearsnot reported8 years 1991-199925 months 2003-200559 months 2003-200724 months year not stated24 months 2005-200713 months 2007-200816 months 2010-201110 months 2010-201128 months 2010-2012? 2007-20127 month recruitment 200712 months 2010-20116 months 2012-2013
Age Included20+not reportednot reportednot reported15+ skeletally mature22+20+18+15+13+14+12+16+14+19+18+
Mean Agenot reportednot reportednot reportednot reported34.2median 273041 (includes tibia fractures)31not reported34.533.3approx 30334231.534
GenderMalenot reportednot reportednot reportednot reported43151604537not reported1311460not stated1154564781%
Femalenot reportednot reportednot reportednot reported102401513not reported7238not stated33515619%
Fracture agerecent but not explicitly statednot reportedrecent but not explicitly statednot reported<2 weeksmean 13 weeks (4-44 weeks)<14 days41 recentup to 33 daysrecent but not explicitly statedrecent but not explicitly stated32 delayed unionrecent but not explicitly stated<42 days<7 days
Type of studyretrospective cohortcohortcohortcohortretrospective cohort compared to another traction methodprospective cohortretrospective cohortprospective cohortprospective cohortretrospective cohort, much data presented jointly with tibial nailingprospective cohortprospective cohortprospective cohortretrospective cohortquasi-experimental (patient choice)prospective cohort
TractionNo. patients335415109530000020068507925506
No. fractures335815109540000020069527925514
IM nailNo. patients067000172006050601370376925668
No. fractures067000172006050601410376925672
Opentractionnot reportednot reportednot reported44 (40%)4 (7.6%)N/AN/AN/AN/AN/A0N/A25 (36%)16 (32%)not reported031%
IM nailingN/Anot reportedN/AN/AN/Ano (not explicit)03 (5%)00N/A7 (7%)N/A7 (19%)not reported07%
Follow-upmean"if they lived in the vicinity""very short""poor"4.6 months33 months10 monthsuntil inpatient discharge381 days8 months6 months12 weeks3 months
range3-9 months6-72 months6-12 monthssome beyond 30 weeksminimum 6 months/ fracture healed4-21 months4+ months3 months-119 days
percentage67% reported on100%69% (includes tibial; minimum 58%)71% reported on79%
Associated injuries deemed significantnonot reportednot reportedsome, level not reported47.2%53%no (not explicit)not reported40% (excluded if major)not reportedno25%not reportedno100%no
Time to surgerymean13.2 days17 days (SD 10) in acute20.7 days
range0-33 days<7 days inclusion criteria
Bed daysTractionmean654952.1464552.36066.754
range45-12125-10829-7430-60+44-119 days
IM nailmean38.5710 (includes tibial)20.1 (6.9 post op)30 in acute34.93011.4828 (excluding Soren et al.)
range4-20 days3-22 (includes tibial)2-11 post op1 to 904-19 days
Blood lossno transfusions5 required transfusion up to 2 pints50-100mlmean 279ml (SD202) freshmean 2.5 units transfused
InfectionTractionPinsiten"common"2 deep infections237814excluded5227%
percentageone excluded patient died of related sepsisrates pinsite infection not reported43%35% (41% of those with skeletal traction)12%27%
IM nailingDeepn0011071excluded102%
percentage0%0%2%2%0%5%3%
Superficialn0011011excluded41%
percentage0%0%2%2%0%1%3%
Totaln0022082excluded143%
percentage0%0%3%4%0%6%5%
UnionNon-unionTractionn02004110174%
percentage0%3%0%0%7%1%19%
IM nailn0001341%
percentage0%0%0%1%8%
Delayed UnionTractionn12475%
percentage1%10%16%
IM nailn102141%
percentage6%0%4%4%
MalunionTractionn051123495213%
percentage0%9%5%1%4%43%36%
IM nailn004021257%
percentage0%0%8%0%30%
ShorteningTractionn03 (>2.5 cm)2 (≥3cm)11 (>2cm)166%
percentage0%6%10%16%
IM nailn1 (3.5cm)0010.4%
percentage6%0%0%
RefractureTractionn25294%
percentage3%5%4%
IM nailn0012 (intra op)31%
percentage0%0%2%4%
Futher theatre tripsTractionn622106%
percentage10%4%4%
If all non union includedn0606112257%
percentage0%10%0%11%1%23%
IM nailn3034193235%
percentage18%0%5%8%17%6%5%
Deathn65
Detailsskin traction used predominantly, physio late introduction only2 deaths in perkins group and 4 in kuntscher nailing. 7 "failures" in IM nail group2 patients treated with kuntscher nail as soft tissue interposition suspected on x-rayno deep vein thromboses, 41 cases gunshot wounds, complications clinically defined4 pins also had to be resited for infection20 weeks post injury and short pre op; image intensifier usedsome intra operative x-ray used so only 8 opened at fracture site4 screw loosening2 pulmonary emboli pre-opgapping at fracture site requiring dynamizationvariable traction methods used, malunion case was one of two with shortening32 delayed presenta­tions, all had intra­operative antibiotics, mobilisa­tion delayed as had to pay for crutches to be madeinpatient discharge only after suture removal 14/7 post op, 1/52 oral antibiotics routine in operative grouplongest stay related to time to clear bills