The Use of Modified Neufeld Traction in the Management of Femoral Fractures in Polytrauma

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Abstract
The choice of treatment modalities for the fractured femur in the polytrauma patient is a continuing dilemma. Prevention and treatment of respiratory complications requires maximum patient mobility. Conventional traction methods restrict turning in bed and preclude moving the patient out of bed. Immediate open reduction results in additional blood loss, tissue trauma, and a higher rate of infection and nonunion. Immediate closed intramedullary nailing is an excellent method but requires special equipment and surgical expertise. To meet the mobilization requirements of good pulmonary care and avoid the problems of early open reduction, before the availability of immediate closed nailing, we adopted the use of modified Neufeld single-rope roller traction for the initial treatment of closed, Grade I open, and some Grade II open femur fractures. In 30 cases, the traction was used to maintain the fracture for 7 to 14 days preceding delayed internal fixation, while in another 22 cases the traction was used as the definitive treatment modality in conjunction with cast bracing. Sixty patients with femoral fractures were treated with this traction method. Eight patients died, the other 52 were followed to fracture healing. There was one delayed union. There were no nonunions and no wound infections in either the internal fixation or continued traction groups. This traction system is an effective way to meet the needs of the polytrauma patient with a femur fracture.

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