Author:
Attenasio Andrea,Kraeutler Matthew J.,Hong Ian S.,Baskar Suriya,Patel Deepak V.,Wright Craig,Jankowski Jaclyn M.,Liporace Frank A.,Yoon Richard S.
Abstract
Abstract
Background
Traction tables have long been utilized in the management of fractures by orthopaedic surgeons. The purpose of this study was to systematically review the literature to determine the complications inherent to the use of a perineal post when treating femur fractures using a traction table.
Methods
A systematic review was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) using PubMed, EMBASE, and Cochrane Library. The search phrase used was “fracture” AND “perineal” AND “post” AND (“femur” OR “femoral” OR “intertrochanteric” OR “subtrochanteric”). Inclusion criteria for this review were: level of evidence (LOE) of I – IV, studies reporting on patients surgically treated for femur fractures, studies reporting on patients treated on a fracture table with a perineal post, and studies that reported the presence or absence of perineal post-related complications. The rate and duration of pudendal nerve palsy were analyzed.
Results
Ten studies (2 prospective and 8 retrospective studies; 2 LOE III and 8 LOE IV) were included consisting of 351 patients of which 293 (83.5%) were femoral shaft fractures and 58 (16.5%) were hip fractures. Complications associated with pudendal nerve palsies were reported in 8 studies and the mean duration of symptoms ranged between 10 and 639 days. Three studies reported a total of 11 patients (3.0%) with perineal soft tissue injury including 8 patients with scrotal necrosis and 3 patients with vulvar necrosis. All patients that developed perineal skin necrosis healed through secondary intention. No permanent complications relating to pudendal neurapraxia or soft tissue injuries were reported at final follow-up timepoints.
Conclusion
The use of a perineal post when treating femur fractures on a fracture table poses risks for pudendal neurapraxia and perineal soft tissue injury. Post padding is mandatory and supplemental padding may also be required. Appropriate perineal skin examination prior to use is also important. Occurring at a higher rate than previously thought, appropriate post-operative examination for any genitoperineal soft tissue complications and sensory disturbances should not be ignored.
Publisher
Springer Science and Business Media LLC
Subject
Anesthesiology and Pain Medicine,Orthopedics and Sports Medicine,Surgery
Reference45 articles.
1. Choudhry B, Leung B, Filips E, Dhaliwal K. Keeping the traction on in Orthopaedics. Cureus. 2020;12:e10034.
2. Rankin JO. A new fracture table to be used in conjunction with the fluoroscope. JBJS. 1927;9:447–9.
3. Wininger AE, Mei-Dan O, Ellis TJ, Lewis BD, Kollmorgen RC, Echo A et al. Post-Related Complications in Hip Arthroscopy Are Reported Significantly Greater in Prospective Versus Retrospective Literature: A Systematic Review. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2022;38:1658–63.
4. Bailey TL, Stephens AR, Adeyemi TF, Xu Y, Presson AP, Aoki SK et al. Traction Time, Force and Postoperative Nerve Block Significantly Influence the Development and Duration of Neuropathy Following Hip Arthroscopy. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019;35:2825–31.
5. Sarraj M, Chen A, Ekhtiari S, Rubinger L. Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review. Hip Int. 2020;30:662–72.
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献