Bryant traction in paediatric femoral shaft fractures, home traction versus hospitalisation

Aim: To evaluate Bryant traction at home in terms of feasibility, morbidity, effect on length of hospital stay, outcome and costs. Patients and methods: Retrospective analysis of 54 children treated for femoral shaft fracture (1991-2004). Results of 'home traction' (A, n = 38) and 'hospital traction' (B, n = 16) were compared. Data were collected regarding demographics, length of hospital stay, traction period, various aspects of the fractures, co-morbidity, morbidity, and follow-up. The parents' experience was evaluated by telephone questionnaire. Results: Two early treatment failures occurred. One patient stopped home traction at 8 days due to skin problems and had a spica cast applied at another hospital, with subsequent development of a compartment syndrome. The other patient was placed in a hip spica after 2 weeks of hospital traction because of difficulty in getting satisfactory X-rays. At follow-up, one unacceptable shortening of 3 cm had occurred in the home traction group. There was only a significant difference in hospital stay (A 7.0 days versus B 22.5 days), total traction period (A 28.0 days versus B 22.5 days) and costs (group B 3× versus group A). The parents were overall pleased with traction at home. Complications occurred as much in the home traction group as in the control group and fracture position at union was equal in both groups. Conclusions: Treatment with home traction is feasible, simple and effective; it reduces hospital stay to 1 week, and costs to one-third. Good patient selection and instructions of the parents are mandatory.