Treatment of Adult Femoral Shaft Fractures Using the Perkins Traction at Addis Ababa Tikur Anbessa University Hospital: The Ethiopian Experience
Authors: Bezabeh Bahiru , Wamisho Biruk L , Coles Maxime JM 
Published: October 2012

Abstract
This is a prospective study to evaluate the efficacy of the Perkins traction in the treatment of adult femoral shaft fractures from October 1, 2007, to the present at the Black Lion Hospital in Addis Ababa University Hospital in Ethiopia. All femur fractures admitted to the hospital were reviewed and evaluated for treatment. Black Lion Hospital (Tikur Anbessa) is the university hospital in Addis Ababa and the highest tertiary teaching hospital in a country of 85 million inhabitants. A 67-bed orthopedic department offers the main ground for teaching to the undergraduate medical students. The hospital is also the pivotal center for the formation of the orthopedic residents. Patients from different parts of the country are referred to this institution for orthopedic care. A total of 68 adult (older than 16 years) patients with 69 femoral shaft fractures were considered for treatment during the study period. Consent was obtained and prospective treatment initiated. A standard Perkins traction was applied by an orthopedic team composed of consultants, orthopedic residents, physical therapists, and nurses. A protocol was developed for patients undergoing such traction. The physiotherapists will supervise all individual or group therapy sessions. Progressive knee range of motion to facilitate quadriceps and hamstring muscle strengthening exercises were implemented four times a day and recorded. Demographic information, fracture patterns, duration of traction, thigh circumference leg length discrepancy, and pin sites were routinely monitored and charted. Data were computerized and analyzed weekly, and appropriate adjustments were made accordingly. Clinical evidence of a competent callus and confirmation by radiographic studies will influence the cessation of traction to allow gait training with toe-touch crutch ambulation. Progress will be monitored during the following outpatient visits in the fracture clinic. A total of 68 consecutive patients with 69 femoral shaft fractures were treated with the Perkins traction. There were 60 men (88.2%) and only 8 women (11.8%), for a ratio of 8 men to 1 woman. The age of the cohort patient varied between 18 and 28 years.
The mechanisms of injury for most of the fractures were motor vehicle accidents, resulting in an isolated femoral shaft fracture in 49.2% of the patients. Half of the fractures were by means of closed injury (n  =  44; 64.7%). One patient with a bilateral femoral shaft fracture was also added to the study. The right side was more often involved, with 41 fractures (60%), than the left, with 28 fractures (40%). Most of the fractures involved the proximal third of the femur (n  =  34; 50%), but the most common fracture pattern was transverse (n  =  29; 42.6%), followed by a comminuted pattern (n  =  18; 26.5%). Three segmental fractures were also encountered.
The mean hospital stay was 45 days (33 patients; 48.5%), with the length of time in traction varying from 30 to 40 days. Only 2 patients remained in traction for a period of 60 days. At the end of the traction period, 8 patients (11.8%) showed a decrease in the quadriceps mass, and 7 patients (10.3%) showed stiffness of the knee with a range of motion limited to 0° to 90°. Most patients were discharged after about 8 months of treatment. One patient suffered a nonunion, and one was malunited. Superficial pin care infections were noted in 8 patients (11.8%) and treated appropriately.
The conservative treatment of 69 femoral shaft fractures using the Perkins traction at Black Lion University Hospital in Addis Ababa, Ethiopia, has been proven to be a safe and effective method. It should be encouraged in countries like ours where it is a luxury to have a C-Arm in the operating room and where the hardware often is not available to perform a stable stabilization of the long bone fractures.