Strategies to Manage Traction-Table Complications

Traction tables are used in different types of procedures for the hip and femur, including fracture fixation, hip arthroscopy, and less-invasive arthroplasty. Although there is a relatively low incidence of traction table-related complications, usage is not without risks. Complications range from the relatively benign, such as transient post­operative groin numbness, to the catastrophic and life-threatening, such as injuries to the perineal integument and soft tissues, neurologic impairment, and iatrogenic compartment syndrome of the well leg. Although severe events are rare, they have serious implications to patient safety. Reviewing the Current Literature In the November 2010 Journal of the American Academy of Orthopaedic Surgeons, my colleagues and I published a review that assessed the medical literature relating to traction-table complications after surgery. In our analysis, several key themes emerged. First, greater awareness by surgeons of these events—especially for potentially catastrophic events—is critical to improving patient safety and quality. Second, certain positions on traction tables should be avoided—especially the hemilithotomy position—to avoid complications. Third, efforts should be made to ensure that positioning and draping permit ongoing evaluation of the uninjured extremities and the overall condition of patients. For example, reduce the use of shower curtains or drapes since these make it difficult for surgeons to see the well leg or check the abdomen in trauma patients. “Although there is a relatively low incidence of traction-table related complications, usage is not without risks.” Specific types of patients and situations can increase the likelihood of traction-table complications. Patients with complex fracture patterns and older individuals appear to be at greater risk for these complications. Complex fractures often require longer surgery durations. This can put...