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PubMed1993

Comparison of sacrospinalis myoelectric activity and pain levels in patients undergoing static and intermittent lumbar traction.

The purposes of this study of low back pain patients were to determine: 1) if presence of sacrospinalis myoelectric activity is a consistent phenomenon in supine and prone positions; 2) if there is a difference between magnitudes of myoelectric activity for two types of lumbar traction (static and intermittent); and 3) if there is a difference in patient perceived pain level after traction between the two types of traction. Results show that surface electrode myoelectric activity is absent in resting supine and prone positions, there is no significant difference in magnitude of myoelectric activity between the two different types of traction, and more than 50% of patients in both traction groups experienced decreased pain after traction.

Adult↗
PubMed1998

Traction versus supine side bending. Which technique best determines curve flexibility?

STUDY DESIGN: A prospective study performed in two institutions where patients scheduled for surgical management of scoliosis were evaluated with traction and supine side bending radiographs to determine curve flexibility. OBJECTIVE: To determine if there is a difference in the flexibility of curves as determined by side bending or traction films. METHODS: Fifty-eight patients scheduled for surgery underwent preoperative radiographic evaluation using supine side bending and traction radiographs. The surgeons were free to use the information as they saw fit in determining levels of fusion. All curves were measured using the method of Cobb. Curves were analyzed in three groups: > 60 degrees, 50-60 degrees, and < 50 degrees. A comparison then was made between the traction and side bend films to determine which method demonstrated greater flexibility. Measurement error was assumed to be +/- 5 degrees. If the measurements were within 5 degrees, then the two methods were considered to be equivalent. RESULTS: In curves > 60 degrees, greater flexibility was seen on traction films. In curves < 50 degrees, side bending showed greater flexibility. In curves between 50 degrees and 60 degrees, side bending showed greater flexibility in the thoracic spine, whereas in the lumbar spine both films showed equivalent flexibility. CONCLUSIONS: Traction shows greater curve flexibility in curves > 50 degrees, whereas in curves < 50 degrees, side bending shows greater flexibility.

Adolescent↗
PubMed1999

Magnetic resonance evaluation of the intervertebral disc, spinal ligaments, and spinal cord before and after closed traction reduction of cervical spine dislocations.

STUDY DESIGN: A prospective clinical study using magnetic resonance imaging of the cervical spine in a consecutive series of patients with cervical spine dislocations. OBJECTIVES: To determine the incidence of intervertebral disc herniations and injury to the spinal ligaments before and after awake closed traction reduction of cervical spine dislocations. SUMMARY OF BACKGROUND DATA: Prior series in which the prereduction imaging of disc herniations in the dislocated cervical spine are described have been anecdotal and have involved small numbers of patients. In addition, no uniform clinical criteria to define the presence of an intervertebral disc herniation in the dislocated cervical spine has been described. The incidence of disc herniations in the unreduced dislocated cervical spine is unknown. METHODS: Eleven consecutive patients with cervical spine dislocations who met the clinical criteria for an awake closed traction reduction had prereduction and postreduction magnetic resonance imaging. Using strict clinical criteria for the definition of an intervertebral disc herniation, the presence or absence of disc herniation, spinal ligament injury, and cord injury was determined. Neurologic status before, during, and after the closed reduction maneuver was documented. RESULTS: Disc herniations were identified in 2 of 11 patients before reduction. Awake closed traction reduction was successful in 9 of the 11 patients. Of the nine patients with a successful closed reduction, two had disc herniations before reduction, and five had disc herniations after reduction. No patient had neurologic worsening after attempted awake closed traction reduction. CONCLUSIONS: The process of closed traction reduction appears to increase the incidence of intervertebral disc herniations. The relation of these findings, however, to the neurologic safety of awake closed traction reduction remain unclear.

Adolescent↗
PubMed2002

Biomechanical study and digital modeling of traction resistance in posterior thoracic implants.

STUDY DESIGN: Posterior implants were used to test the resistance of seven human thoracic spines to traction, and results were compared with those of a digital study. OBJECTIVES: To compare the use of hook and screw fixation methods for posterior thoracic surgery in a study supplemented by a digital analysis using the finite-element method. SUMMARY OF BACKGROUND DATA: The maximum break strength of pedicular screws on bone has already been studied several times. Far fewer studies have investigated the stresses that may be applied to pedicular and laminar hooks or compared these hooks with pedicular screws in the thorax. METHODS: For this study, seven human thoracic spines were used, identifying 49 groups of two vertebrae each. The assemblies used a bolt in the medullary cavity. The central diameter of this bolt could be varied using tubes to suit the individual medullary cavity, spreading the stresses over the entire centrum during traction. The assembly was placed on an Instron machine. Vertical traction was applied up to the maximum break strength, that is, the strength recorded at the top of the traction curve read out directly on the Instron machine. Traction speed in all the tests was 5 mm per minute. Four pedicular screws and two pedicular-laminar clips were used alternately. In these tests, 25 values were obtained with hooks and 24 with screws. The group with screw fixation was tested in two halves, with 12 tests using 4-mm diameter screws and 12 tests using 5-mm diameter screws. For the digital study, the vertebra model comprised nearly 63,000 nodes and 14,000 elements. Elastic field calculations were carried out using the Abaqus finite-element calculation method. RESULTS: Each time pedicular-laminar traction was used, the pedicles broke at the base. Where screws were used, a medial fissure was found at the base of the pedicle. For the hooks, the maximum break strength was 1150 +/- 388 N. It was 820 +/- 418 N when 4-mm diameter screws were used and 1395 +/- 435 N when 5-mm screws were used. The most fragile vertebrae were found to be at T5-T6 and T7-T8. The screw-instrumented model showed that stresses were concentrated at the medial part of the pedicle, inside the medullary cavity. Use of a long screw did not lead to noticeable stress reduction. The hook-instrumented model showed that the stresses were greatest in the lower part of the pedicles. CONCLUSIONS: Screw fixation is the most appropriate from a mechanical point of view. During tests, however, screw fixation falls short of its promises. This leads to the hypothesis that in most cases screws pull out because the bony anchoring of the pedicle screwing fails. Screws are less effective if their anchoring in the pedicles cannot be guaranteed, which is probably the reason for their relative weakness. Screw diameter should be chosen according to the size of each pedicle. The findings showed that hooks impose additional stresses on the vertebrae.

Aged↗
PubMed2006

Duration of preoperative traction associated with sciatic neuropathy after hip fracture surgery.

UNLABELLED: An unknown percentage of patients who have internal fixation for hip fractures have sciatic neuropathy develop. In most cases, the cause for this complication is unknown. We retrospectively reviewed 2202 consecutive patients treated in our hospital for hip fractures to ascertain whether there was any relationship between duration of preoperative traction and postoperative sciatic neuropathy, and to determine the incidence of sciatic neuropathy after surgery for hip fractures. All patients had preoperative skin traction. Patients with and without sciatic neuropathy were compared using nonparametric tests. The median duration of traction was 2.6 days in the group that had sciatic neuropathy develop and 0.9 days in the group that did not. Also, patients in the group that had sciatic palsy develop were older. There seemed to be no other difference between the groups for any of the studied variables. Sixteen patients (0.7 %) had postoperative sciatic neuropathy. Our data suggest sciatic neuropathy after surgery for hip fractures may be related to the duration of preoperative traction. Some investigators have reported that there seems to be no evidence of benefit from skeletal or skin traction. A potential for damage to the sciatic nerve may be an argument to stop routine use of preoperative traction. LEVEL OF EVIDENCE: Diagnostic study, Level III (study of nonconsecutive patients; without consistently applied reference "gold" standard).

Aged↗
PubMed2005

Atraumatic vertebral artery dissection after cervical corpectomy: a traction injury?

STUDY DESIGN: Case report with review of the literature. OBJECTIVES: Presented is the first case of vertebral artery dissection secondary to intraoperative traction in cervical spine surgery. The pathogenesis and management of vertebral dissection in the immediate postoperative period are reviewed in detail. SUMMARY OF BACKGROUND DATA: Vertebral artery dissection is commonly associated with direct trauma, atraumatic or spontaneous. There are numerous reports of direct injury to the vertebral artery with cervical spine surgery, and it is a well-recognized risk. Cervical traction is also used routinely for improved placement of intervertebral devices/grafts. This is the first report of vertebral artery dissection occurring intraoperatively secondary to traction. The postoperative management is reviewed in detail. METHODS: Case study with extensive review of the literature. RESULTS: The patient underwent C6 corpectomy without intraoperative complications. Intraoperative wake-up test was normal. The patient remained intubated overnight for airway precautions. On postoperative day 1, the patient was lethargic and not following commands. Emergent CT of the brain and cervical spine revealed multiple posterior circulation infarcts with normal cervical spine and no hematoma. A stat angiogram revealed vertebral dissection. Medical management was initially attempted; however, infarcts continued, eventually requiring posterior fossa craniectomy/decompression and sacrificing the vertebral at the O-A junction. CONCLUSIONS: This is the first report of vertebral artery dissection occurring secondary to traction in cervical spine surgery. Surgeons must be aware that traction, even when performed appropriately, is not without risks. Anomalous vertebral arteries, osteophytes, and numerous other anatomic variants can lead to vertebral injury with traction.

Cervical Vertebrae↗
PubMed2006

Radiographic analysis of intervertebral separation with a 0 degrees and 30 degrees rope angle using the Saunders cervical traction device.

STUDY DESIGN: Radiographic analysis of cervical intervertebral separation, (IVS) while using the Saunders Cervical Traction Device (SCTD) (Chattanooga Corp., Chattanooga, TN) on a healthy population. OBJECTIVE: To determine whether a rope angle of 0 degrees or 30 degrees achieves higher posterior and anterior IVS when using the SCTD. SUMMARY OF BACKGROUND DATA: To our knowledge, research using a 0 degrees rope angle and the SCTD has not been documented. METHODS: A convenience sample of 15 females and 5 males, with no history of cervical dysfunction, trauma, or pain, participated in the study. Static mechanical cervical traction, using the SCTD at a 0 degrees rope angle, was applied for 2 minutes using 11.34 kg (25 lb) of force. A cross-table lateral cervical spine radiograph was obtained before traction and again at 2 minutes of traction. Two weeks later, the subjects underwent the same procedure with the rope angle set at 30 degrees . RESULTS: A 0 degrees rope angle produced a significant mean difference in anterior IVS at all cervical segments as compared to a 30 degrees rope angle. Traction measurements comparing posterior IVS at 0 degrees and 30 degrees were not statistically significant. However, the posterior IVS increased significantly at a 0 degrees rope angle, with the exception of C2-C3. CONCLUSIONS: The research findings may have treatment implications when applying cervical traction with the SCTD. Further research using subjects with cervical nerve root compression will need to be conducted to substantiate clinical outcomes.

Adult↗
PubMed1982

Halo traction with the Circolectric bed in the treatment of severe spinal deformities: a preliminary report.

The role of preoperative traction has long been recognized in the treatment of patients with severe spinal deformities. However, the many complications associated with halo-femoral and halo-pelvic types of traction have led us to develop a program of halo traction combined with the use of a Circolectric bed. Between 1974 and 1979, 18 patients were treated in this manner. Results were analyzed by dividing the patients into three groups, based on the severity of deformity and the specific traction program employed. Results have been very encouraging, both with preoperative traction for curve correction and postoperative traction for maintaining correction.

Adolescent↗
PubMedDate not supplied

Guided abduction traction in the treatment of congenital hip dislocation.

Guided abduction is a form of overhead traction conceptually similar to the Pavlik harness. It is used in older children or in children in which the Pavlik harness has failed. The results of 27 congenitally dislocated hips treated by guided abduction traction from December 1979 to June 1989 were reviewed. Ages ranged from 1 month to 28 months. Twenty (74%) of the 27 hips underwent a gentle, often spontaneous, closed reduction, followed by abduction casting and bracing. Two hips developed radiographic evidence of avascular necrosis; five hips developed temporary irregular ossification. Closed reduction was unobtainable in any child older than 24 months. Two children needed additional reconstructive procedures, one an innominate pelvic osteotomy and the other a valgus derotation osteotomy. Both had had open reductions. Recent reports stated that preliminary traction in the treatment of congenitally dislocated hips is of no value. We consider guided abduction traction a valuable treatment modality resulting in a reduced incidence of open reduction. When comparing our results with those of a Salt Lake City study performed without preliminary traction, our incidence of open reduction is lower (26 versus 49%). Our study supports the use of preliminary traction to decrease the need for open reduction in congenitally dislocated hips.

Braces↗
PubMed1996

An investigation into the application and maintenance of Hamilton Russell traction on three orthopaedic wards.

This study is concerned with the application and maintenance of Hamilton Russell traction, a form of vectored skin traction. It may be used in the treatment of fractures of the femur for the purposes of immobilization and for pain relief prior to surgery. A preliminary questionnaire demonstrated a poor level of knowledge in nurses working in an orthopaedic area. It was therefore speculated that application and maintenance of the traction would be inaccurate. The angles making up the resultant traction forces were measured in 11 systems. The theoretical traction force was established using mathematics. The actual force was measured using a goniometer. A comparison was then made. The results in all 11 systems demonstrated a highly statistically significant difference between the theoretical and actual positions of the traction force (P < 0.0005). The practical implications of this are discussed and recommendations for a protocol of application and maintenance suggested. Areas for further research are identified.

Biomechanical Phenomena↗
PubMed2006

Static and dynamic loading effects on temporomandibular joint disc tractional forces.

UNLABELLED: Mechanical fatigue-related degeneration of the temporomandibular joint (TMJ) disc may be promoted by tractional forces. This study tested the hypotheses that tractional forces following static loading of the TMJ disc: (1) increase with compressive strain at the start of movement, and (2) are velocity-dependent during movement. Sixty-four porcine discs received a 10-N static load via an acrylic indenter for 1 or 30 sec before cyclic movement. Physical data were recorded and analyzed by ANOVA. The results showed that compressive strain and tractional forces were largest for the start of movement following 30 sec of static loading (p <or= 0.0001) and were correlated (R(2) = 0.84). Peak tractional forces were linearly and positively related to velocity of movement (R(2) = 0.85), and were highest during Cycle 1 after 30 sec of loading (p <or= 0.0067). The results demonstrated that tractional forces were strain-related at the start of movement and velocity-dependent during movement. ABBREVIATIONS: ANOVA = analysis of variance, PBS = phosphate-buffered physiological saline solution, TMJ = temporomandibular joint, mu(T) =tractional coefficient, mu(s) = static coefficient of friction.

Analysis of Variance↗
PubMed1990

A cephalometric study to compare the effects of cervical traction and Andresen therapy in the treatment of Class II division 1 malocclusion. Part 1--Skeletal changes.

Lateral cephalometric radiographs at the beginning of treatment, end of active treatment, and post-treatment of 30 Andresen and 40 cervical traction patients were analysed, and compared with those of a control group of 22 untreated cases. The cervical traction group was divided into a non-extraction group and an extraction of maxillary second molars group. A clinically significant reduction of ANB was achieved, mainly by mandibular changes in the Andresen group and by maxillary changes in the cervical traction groups. Cervical traction was associated with a small distal positioning and anterior downward tipping of the maxilla during treatment. A more favourable sagittal position of the mandible was achieved in the Andresen group compared to the cervical traction groups, particularly the non-extraction group, where a greater transient backward rotation of the mandible occurred during treatment. A significant, but clinically small increase in mandibular body length occurred in Andresen patients compared to the control. However, in both treatment groups this was due to an increase in growth of the vertical ramus. The lower face heights, both anterior and posterior, increased in all groups, with the anterior upper face height also increasing in the cervical traction group.

Activator Appliances↗
PubMed1994

[Effects of intermittent cervical traction on muscle pain. Flowmetric and electromyographic studies of the cervical paraspinal muscles].

The effects of cervical intermittent traction on neck and shoulder pain were evaluated in 96 patients. Namely, a 15-second traction of the neck was repeated with a 5-second interval between tractions. In 39 patients, blood flowmetry and electromyography were performed in the cervical paraspinal muscles before and after the traction treatment. The pain was relieved in 76 out of 96 cases (79.2%). The blood flow in the affected muscles was significantly decreased as compared with the controls. However, it showed a significant increase following the treatment in patients whose pain was relieved. The mean frequency of the initial myoelectric signals as observed with the surface electrode on the affected muscles was significantly lower than the controls. It increased however following the traction treatment in the case in which the pain was relieved. In conclusion, it may be stated that the cervical intermittent traction is effective in relieving pain, increasing the frequency of myoelectric signals and improving blood flow in affected muscles.

Adolescent↗
PubMed1982

Compartmental pressure changes during calcaneal traction in tibial fractures.

The effect of calcaneal traction on the compartmental pressure in the legs of five individuals with tibial fractures was studied. Mean resting pressures without traction were found to be 31.9 mmHg for the deep posterior compartment and 27.0 mmHg for the anterior compartment. For each kilogram weight of traction applied the deep posterior pressure rose by 5.7 per cent of the resting value and the anterior pressure by 1.6 per cent. It is suggested that the weight of traction should be only sufficient to render the patient comfortable and maintain alignment of the limb. Excessive traction is likely to increase the risk of compartmental ischaemia. The application of six kilograms of traction would raise the mean resting pressure by 34 per cent from 31.9 to 42.7 mmHg.

Ankle↗
PubMed1996

Scoliosis elasticity assessed by manual traction: 49 juvenile and adolescent idiopathic cases.

We assessed preoperative curve elasticity in 49 consecutive patients with juvenile or adolescent idiopathic scoliosis who were operated on with Harrington distraction rods. Preoperatively, the curve was determined from posteroanterior radiographs taken in the standing position and in the supine position, with traction. In the latter, the radiographs were taken at the moment of maximal traction when one technician applied traction to the ankles and another to the wrists. The scoliotic curve in the 10 patients with juvenile scoliosis averaged 59 degrees and 32 degrees in the standing and supine positions with traction, respectively. Immediately postoperatively, the curve averaged 19 degrees. 39 patients with adolescent scoliosis had a scoliotic curve which averaged 58 degrees in the standing position and 32 degrees in the supine position with traction. The mean postoperative measurement was 21 degrees. These findings suggest that manual traction is a simple and reliable means of predicting the minimal correction of the scoliotic curve to be expected, using Harrington distraction rods.

Adolescent↗
PubMed2000

The efficacy of side arm traction in the reduction of supracondylar fracture humerus in children.

156 consecutive children with supracondylar fracture humerus were reviewed. Of these, 56 children with severely displaced fractures were treated with side arm traction. A retrospective review revealed that a mean post-reduction Baumann angle of 74.2 degrees for boys and 75.9 degrees for girls; and mean post-reduction humero-ulna angle of 11.6 degrees for boys and 12.7 degrees for girls was achieved. A linear correlation was noted between the duration of traction and the age of the patient, older patients requiring longer traction. The region below the line in the graph, plotting the duration of traction (y-axis) versus the age of the patient (x-axis) shows when the fracture is unstable; and the region above the line shows when the fracture is stable and can only be reduced by surgery. 10 children presented late; 6 presented within the unstable period and were successfully reduced with traction; while 4 presented stable and required open reduction. We conclude that traction is an acceptable and safe method for reduction of this fracture, and can be used to reduce late presentations while their fractures are still unstable.

Arm↗
PubMed1975

Preoperative skeletal traction in scoliosis.

To determine the role of preoperative traction in the treatment of spinal curves, ten patients with curves averaging 81 degrees by the Cobb measurement were studied. Each patient was treated in traction by means of a halo or skull tongs and femoral pins for two to three weeks prior to the surgical correction of the scoliosis with instrumentation. Weights were added to the traction apparatus, 1.8 kilograms a day, to a maximum of 18.1 kilograms. Pretraction supine roentgenograms were compared with supine roentgenograms made at three-day intervals throughout the traction period. Preoperative traction resulted in an average improvement of the curves of 34 degrees, or 41 per cent of the initial curve. Most of the correction was obtained within the first week of traction. Further correction during surgery with Harrington instrumentation yielded 13.5 degrees on the average (16 per cent) so that combined correction averaged 47 degrees, or 57 per cent.

Adolescent↗
PubMed1989

A mobile traction device for MR and CT imaging.

The development of a spinal traction device for use in Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) imaging is described. Such a device has arisen from the need to apply continuous traction to patients having suffered acute cervical spine trauma. Previous traction techniques have proven unsuitable for use in the MRI scanner, particularly as they lack stability, are awkward to implement and prove quite cumbersome to manage. Traction may be applied to a patient for periods of time in excess of 1 hour with a minimum of discomfort. Materials are used which have a negligible proton density and a low atomic number, yielding no detectable magnetic resonance and very small x-ray cross sections respectively. Calibrated traction may be applied to patients via tongs or a head harness, the latter rendering the device suitable for general transport of injured patients with traction applied. The device is compact, light and strong and contains no ferrometallic parts. Thus far in excess of 40 patients have been scanned, most in a FONAR beta-3000M .3 Tesla electromagnetic MR imager and some also in a GE 9800 Quickscan CT scanner. No artefact has been demonstrated in any of the images to date for any of the MR pulse sequences or CT kVp. Modifications likely include refinement of the tensioning mechanism, inclusion of x-ray cassette facilities and improvement of aesthetic design.

Equipment Design↗