The Role of Knee Immobilization and Skin Traction in Preoperative Pain Management of Isolated Intertrochanteric Fractures: A Randomized Clinical Trial

Baroutkoub, Mojtaba; Khannejad, Khannejad; Abdollahzadeh, Mohammad Ali; Hasanzade, Arman; Amoozadeh Omrani, Farzad; Barati, Hassan; Keipourfard, Ali; Shahrooei, Fateme

doi:10.22118/jsmj.2025.507532.3848

The Role of Knee Immobilization and Skin Traction in Preoperative Pain Management of Isolated Intertrochanteric Fractures: A Randomized Clinical Trial

Document Type : Original Article

Authors

Mojtaba Baroutkoub ¹

khannejad khannejad ²

Mohammad Ali Abdollahzadeh ³

Arman Hasanzade ⁴

Farzad Amoozadeh Omrani ³

Hassan Barati ³

Ali Keipourfard ³

Fateme Shahrooei ⁵

¹ Department of orthopaedic surgery, Imam Hossein hospital, Shahid Beheshti University of medical sciences, Tehran, Iran,

² School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

³ Department of orthopaedic surgery, Imam Hossein hospital, Shahid Beheshti University of medical sciences, Tehran, Iran.

⁴ Department of General Surgery, Imam Hossein Medical and Educational center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

⁵ School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,

10.22118/jsmj.2025.507532.3848

Abstract

Objectives: Effective pain management is essential for patients with hip and intertrochanteric fractures, particularly when surgery is delayed. Several studies have looked at skin traction for preoperative pain in hip fractures, but few focus on isolated intertrochanteric fractures. There is also limited research on splint use for limb immobilization and pain management. In this randomized controlled trial (RCT), we compared the efficacy of skin traction and knee immobilization for pain relief in isolated intertrochanteric fractures.
Methods: Patients requiring surgery for isolated intertrochanteric fractures were randomly assigned to three groups. The control group received routine care, including morphine sulfate (MS), while the other groups received knee immobilization or skin traction in addition to routine care. Pain severity was assessed using the Visual Analog Scale (VAS) at baseline, 12 hours, and 24 hours post-treatment.
Results: A total of 96 patients were included in the final analysis. All three groups experienced significant pain relief (P-value <0.001). Pain relief in the skin traction group was significantly superior compared to the other groups at 12 hours (P-value <0.001), but this difference was not evident at 24 hours. Additionally, there was no significant difference in additional morphine administration between the skin traction (OR: 1.00, CI: 0.37-2.68) and knee immobilization (OR: 1.48, 95% CI: 0.54-4.07) groups compared to the control group.
Conclusion: Our evaluation demonstrated that while both skin traction and knee immobilization can reduce pain, skin traction is more effective than knee immobilization after 12 hours. However, this superior effect was not observed at 24 hours.

Keywords

Intertrochanteric Fractures

Skin Traction

Knee Immobilization

Preoperative Pain Management

Randomized Controlled Trial

Subjects