An alternative to the orthopaedic traction table (fracture table): A prototype of low cost, easy reproduction and good applicability
Background: Orthopaedic traction tables are used as an aid in numerous surgical procedures. The present paper aims to present a prototype of an external device of lower limb traction, which is portable, of simple construction, and can be installed on any operating table, with possible application in surgical and teaching practices. We will compare the quality of radiographic images obtained with the help of this prototype (PT) to those images obtained with the aid of the conventional traction table (CT).
Materials and methods: Cross-sectional, observational, and double blind study, approved by the Research Ethics Committee. On two occasions 36 randomly selected radiographs of the lower limbs, 18 of which obtained on the CT and the remaining on the PT, were evaluated by nine physicians. These radiographs were obtained from three volunteer and none of them presented musculoskeletal system disorders previously diagnosed in the study. Examiners rated each picture from 1 to 5, according to the quality of the image obtained. The responses were submitted to statistical analysis by SPSS ®, v23. Comparisons were considered significant when p <0.05, with a 95% confidence interval.
Results: The average ratings were similar and all significance tests between the averages were higher than 0.9. The intra-observer agreement was 76.13% for the PT and 82.69% for the CT. The inter-observer agreement was low for both models. Due to its lower weight and smaller size compared to the CT and the material used for prototyping, the production cost of the PT is quite affordable.
Conclusions: The PT presented in this paper is a good alternative to CT.
Keywords: Traction table, Fracture table, Orthopaedic surgery, Orthopaedic prototype, Lower limbs.
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FIGURE 1. Prototype table. A, Side view of the PT. B, Top view of the PT. C and D. Details of a proximal traction system, telescoped and interchangeable.
FIGURE 2. Images in PT. A, Anteroposterior incidence. B, Details of anteroposterior incidence. C, Lateral incidence. D, Details of Lateral incidence.
FIGURE 3. Images in the CT. A, Anteroposterior incidence. B, Details of anteroposterior incidence. C, Lateral incidence. D, Details of Lateral incidence.
FIGURE 4. Average ratings of all the 36 radiographs in the study. A, Average rating of the 18 radiographs with the PT. B, Average of the 18 images with the CT. X1, X3 and X5 correspond to the proximal femur in the AP incidence; X2, X4 and X6 to the proximal femur in lateral incidence; X7, X9 X11 and the shaft femur in AP incidence; X8, X10 X12 and the shaft femur in lateral incidence; X13, RX15 and X17 knee AP incidence; X14, X16 and X18 knee in lateral incidence.
FIGURE 5. Average per appraiser. A, Ratings on the PT. B, Ratings on the CT. ORT1, ORT2 and ORT3 correspond to the three orthopaedic surgeons; RES1, RES2 and RES3 to the three residents; RAD1, RAD2 and RAD3 to the three radiologists.
FIGURE 6. Osteosynthesis of femoral neck fracture with the help of the PT. A, Pre-operative radiograph. B, Positioning detail in the PT. C and D, Trans-operative fluoroscopy.
FIGURE 7. Prototype table. A, Oblique view of the PT. B, Details of distal traction system. C, Oblique view. D, Details of Positions in the PT.
TABLE 1. Average score.
TABLE 2. Significance test.
Levene’s Test to assess the equality of the average of notes of the PT compared to CT.
TABLE 3. Paired average.
Student's t-test: paired average of all notes (PT + CT) in two different periods (T1 and T2).
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict of interest.
Ethical standards The study complies with the 1964 Helsinki Declaration and its later amendments. The study was approved by the local Research Ethics Committee (CAAE: 53481216.8.0000.5049 - Brazil) , and all patients provided informed consent before being enrolled.
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