The Impact of Maintained Traction on Intertrochanteric Fracture Site Compression With a Cephalomedullary Device

Introduction: Cephalomedullary nailing is a standard treatment for intertrochanteric fractures, typically performed on a fracture table with traction released before fracture site compression. However, releasing traction requires additional assistance, may prolong the procedure, and could adversely affect fracture alignment. This study evaluates the effectiveness of maintaining continuous traction during intraoperative compression of inter- and pertrochanteric femur fractures, comparing outcomes to the traditional approach involving traction release. Materials and Methods: In this retrospective study, patients with AO/OTA 31A1 and 31A2 fractures treated with cephalomedullary nailing were divided into two groups: one with traction maintained during compression (experimental), and a historical control with traction released before compression. All procedures were performed on a fracture table under longitudinal traction. Intraoperative fluoroscopy was used to measure fracture site compression. Postoperative radiographs were analyzed to assess femoral neck shaft angles as a marker of reduction quality. Results: Average fracture site compression was significantly greater in the traction-maintained group (7.4 mm, 95% CI 6.4–8.4) compared with controls (2.1 mm, 95% CI 1.5–2.7; P <0.001). Neck shaft angles were also increased in the experimental group (131.8°, 95% CI 130.9–132.6) versus the control group (127.7 degrees, 95% CI 126.3–129.2; P <0.001). Discussion: Maintaining traction throughout cephalomedullary nailing, including during fracture compression, is a simplified and effective technique that results in improved fracture compression and alignment compared with standard practice.