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PubMed1997

Management of traction wire fracture complicating mechanical basket lithotripsy.

BACKGROUND AND STUDY AIMS: The application of basket catheters has become the main method of removing calculi from the biliary and pancreatic duct. However, larger or impacted stones have to be crushed and fragmented by mechanical lithotriptors before removal is possible. Sometimes, fracture of the traction wire occurs as a severe and fraught complication. We describe a precautionary measure which helps to manage this complication. PATIENTS AND METHODS: In a series of 569 consecutive patients suffering from bile or pancreatic duct stones we found 60 (10.5%) who required mechanical lithotripsy for oversized or impacted calculi. Mechanical lithotripsy was always performed initially with a long metal sheath (80 cm) in combination with a standard traction wire. If the traction wire fractured we replaced the long metal sheath stepwise by shorter ones (70cm, 60cm and 50 cm, respectively), allowing immediate continuation of the lithotriptic procedure using the same traction wire. RESULTS: During the lithotriptic procedure three of our patients (5%) were afflicted by traction wire fracture. Two patients could be relieved directly by changing the initial metal sheath to shorter ones. Because of the exceptional hardness of a pancreatic duct stone the third patient needed stone fragmentation by extracorporeal shock wave lithrotripsy (ESWL) before complete mechanical clearance of the duct could be accomplished. CONCLUSION: We advocate the initial use of a long metal sheath (80cm) to perform mechanical lithotripsy. In case of traction wire fracture the use of a shorter metal sheath allows immediate successful continuation of the procedure, thereby frequently avoiding procedures such as ESWL or surgery.

Bile Duct Diseases↗
PubMed1989

Electrophysiological effects of left ventricular free wall traction in intact hearts.

Transmural multipolar electrodes, sonomicrometers implanted within the left ventricular wall, and cardiac electrical stimulation techniques were used to examine the effect of transient mechanically applied traction to the left ventricular free wall on local electrophysiological properties. Twenty-five open-chest dogs were atrially paced (cycle length 400 ms) followed by insertion of timed premature extrastimuli at left ventricular epicardial pacing sites either in the vicinity of (traction zone) or remote from (nontraction-control zone) the site of left ventricular free wall traction. Electrophysiological recordings were made before and during intermittent left ventricular free wall traction applied in late diastole (rate 25 cm/s; duration 170 ms). In 22 of 25 dogs, application of traction resulted in early local ventricular activation (mean activation advancement 64 +/- 15 ms), altered QRS morphology of the last conducted atrial drive train beat, and a relative prolongation of ventricular refractoriness in the traction zone. Conversely, in the nontraction-control zone, early activation did not occur and refractoriness was unchanged. Alterations in regional myocardial blood flow (assessed by microsphere technique) did not appear responsible for the observed changes. Furthermore, phenol interruption of local sympathetic or combined sympathetic and parasympathetic innervation or verapamil pretreatment had no impact on the mechanically induced electrophysiological changes. Thus, in normal myocardium in situ, regional abnormalities in wall motion may be associated with alterations of local ventricular activation and refractoriness, factors that in the diseased heart could lead to increased susceptibility to arrhythmias.

Animals↗
PubMed1993

Cephalometric study on the influence of vertical traction of teeth on maxillofacial bones in young dogs.

The influence of one-sided vertical traction of teeth on maxillofacial bones was investigated using cephalometric radiographs and tetracycline-labeling in young dogs. On the frontal view of the dry skull, traction resulted in a downward distortional deformity of the maxilla including the nasal floor. Cephalometry of radiographs revealed a downward displacement of the upper premolar and incisor teeth, medial maxillary region, and alveolar process of molar, canine and incisor on the right side, where traction was applied. Displacement was from 2.2 +/- 0.4 (mean +/- S.D.) mm at P3 to 0.8 +/- 0.2 mm at I1. In the control group without traction, it was 0.0 +/- 0.0 at P3 and 0.2 +/- 0.1 at I1. Tetracycline-labeling disclosed, in the frontal cut surface of maxillofacial bones at P3, that traction affected not only the periodontal tissue and alveolar processes, but also the neighboring bones and midpalatal suture. The ratio of the labeled area in the bone, measured using an image analyzer in 6 sectors of the cut surface, was 1.2 +/- 0.3% in the left upper sector to 13.0 +/- 4.3% in the right lower sector. In the control group, it was 1.2 +/- 0.4% in the left upper and 4.8 +/- 1.1% in the right lower sector. In conclusion, vertical traction of teeth induces a vertical deformation of the maxilla.

Animals↗
PubMed2003

Traction versus side-bending radiographs: is the proximal thoracic curve the stiffer curve in double thoracic curves?

This is a consecutive study of patients with adolescent idiopathic scoliosis requiring surgical intervention. The purpose was to determine the best radiographic method of evaluating the flexibility of the proximal thoracic (PT) curve in patients with a double thoracic curve pattern. The PT curve averaged 40 degrees (range, 27 degrees-67 degrees) on posteroanterior (PA) radiographs, 30 degrees (range, 12 degrees60 degrees) on supine side-bending radiographs, and 24 degrees (range, 8 degrees -55 degrees) on traction radiographs. The flexibility index (FI) for the PT curve was 0.72 (range, 0.40-0.96) on side-bending and 0.58 (range, 0.29-0.82) on traction. The main thoracic (MT) curve averaged 62 degrees (range, 45 degrees-102 degrees) on PA, 40 degrees (range, 19 degrees-88 degrees) on supine side-bending, and 35 degrees (range, 17 degrees-76 degrees) on traction radiographs. The FI for the MT curve was 0.62 (range, 0.30-0.89) on side bending and 0.56 (range, 0.32-0.81) on traction. There was a statistically significant difference between the flexibility of the PT curve on supine traction as compared with the side-bending films (P<0.0005). Comparison of the MT curve flexibility with the PT curve demonstrated the PT curve to be less flexible in 11 of 15 cases (P = 0.16). The authors conclude that for double thoracic curve patterns, the PT curve is usually the smaller, yet often the stiffer curve. Furthermore, the supine traction radiograph demonstrates greater flexibility of the PT curve than does the supine side-bending radiograph. Clinically, this may assist scoliosis surgeons in assessing the PT curve and achieving a stable, balanced spine.

Adolescent↗
PubMed1989

Effect of traction on the vasculature of chorioallantoic membranes of chick embryos.

In order to investigate the effect of traction of the vasculature on induction or acceleration of neovascularization, the chorioallantoic membranes (CAMs) of the developing chick embryo were placed under tension with 10-0 nylon sutures and subsequently examined histologically. In the initial phase of the study, CAMs from 6- to 8-day-old chick embryos were placed under traction and sampled serially. The cell proliferation and migration from the ectoderm to the mesoderm were observed from half a day to 3 days after the initiation of traction, and increase in the density of the mesodermal vessels was initially observed after 3 days. In the second study, CAMs from embryos at each age from 7 to 16 days were placed under traction and sampled after 1 day. As the CAMs developed, the ectodermal cell proliferation and migration decreased. This may be related with the increase of desmosomes among the ectodermal cells during the CAM development. The above results suggest that traction can induce the changes of the vasculature, and the effect of traction varies with the development of CAMs.

Allantois↗
PubMed1997

[Results of surgery of vitreomacular traction syndromes].

PURPOSE: The vitreomacular traction syndrome is a rare entity in which partial posterior vitreous detachment is combined with persistent macular adherence, thus causing macular traction. In most cases, an epimacular membrane is associated with this vitreomacular traction. We evaluate here the results of vitreous surgery for this syndrome. METHODS: We reviewed 18 consecutive eyes that had undergone vitrectomy and posterior epiretinal membrane stripping, to define the visual results and complications of surgery for the vitreomacular traction syndrome. Minimum follow-up was 3 months. RESULTS: Patients' average age was 63.5 years. All had evidence of cystic macular changes on biomicroscopic examination. Sixteen patients had an epiretinal membrane, and two, a full-thickness macular hole. Cystoid macular edema was present in 7 eyes on fluorescein angiography. The release of vitreomacular traction improved vision in 72% of eyes, with six patients obtaining 20/40 visual acuity or better. Complications of surgery included progression of nuclear sclerosis, and epiretinal membrane formation. CONCLUSION: Vitrectomy for vitreomacular traction syndrome may improve visual acuity, but the visual prognosis remains poor.

Adult↗
PubMed2006

Alignment of displaced or impacted teeth with the traction chain.

To align those teeth in the dental arch that cannot erupt or are displaced, they must be surgically exposed. After the traction device is attached, the tooth is again covered with the mucoperiosteal flap to protect the tissues involved. For this reason, the loss of this traction device must be absolutely avoided in order to prevent another surgical intervention. Here at the University of Ulm, we have developed and tested an optimized traction chain for that purpose. The chain is attached to the tooth with a laser-roughened pad applying the acid-etching technique. The chain links serve as fixation elements for traction devices such as elastic ligatures or piggyback archwires. At the same time, one can determine the distance covered by the tooth by the number of the erupting chain links. We demonstrate the clinical application of this traction device in two cases.

Child↗
PubMed2006

Is anterior release effective to increase flexibility in idiopathic thoracic scoliosis? Assessment by traction films.

With the advent of thoracoscopy, anterior release procedures in adolescent idiopathic scoliosis (AIS) have come into more frequent use, however, the indication criteria for an anterior release in thoracic AIS are still controversial in the literature. To date, few studies have assessed the influence on spinal flexibility and no study has so far been able to show a beneficial effect on the correction rate as compared to a single posterior procedure. The objective of this study was to evaluate the influence of thoracic disc excision on coronal spinal flexibility. Six patients (5 females, 1 male) with AIS and a mean age of 15.6 years (range 13-20 years) underwent an open anterior thoracic release prior to posterior instrumentation. Cotrel dynamic traction along with radiographs of the whole spine including traction films were conducted pre- and postoperatively and were evaluated retrospectively. The mean preoperative thoracic curve was 89.7 degrees +/- 15.4 degrees (range 65 degrees-110 degrees). The flexibility rate in Cotrel traction was 22.8 +/- 8.1%. After performance of the anterior release the thoracic curve showed a mean increase of coronal correction by 5.5 degrees +/- 5.0 degrees as assessed by traction radiographs. The flexibility index changed by 6.2 +/- 5.6%. After posterior instrumentation the thoracic curve was corrected to a mean of 36.5 degrees +/- 10.1 degrees (correction rate 59.6%). Disc excision in idiopathic thoracic scoliosis only slightly increased spinal flexibility as assessed by traction films. In our view a posterior release with osteotomy of the concave ribs (concave thoracoplasty, CTP) is more effective in increasing spinal flexibility. According to our clinical experience, an anterior release prior to posterior instrumentation in AIS should only be considered in hyperkyphosis, coronal imbalance or massive curves.

Adolescent↗
PubMed1999

Halo femoral traction and sliding rods in the treatment of a neurologically compromised congenital scoliosis: technique.

In severe congenital scoliosis, traction (whether with a halo or instrumental) is known to expose patients to neurologic complications. However, patients with restrictive lung disease may benefit from halo traction during the course of the surgical treatment. The goal of treatment of such deformities is, therefore, twofold: improvement of the respiratory function and avoidance of any neurologic complications. We report our technique to treat a 17-year-old girl with a multi-operated congenital scoliosis of 145 degrees and cor pulmonale. Pre-operative halo gravity traction improved her vital capacity from 560 c.c. to 700 c.c., but led to mild neurologic symptoms (clonus in the legs). To avoid further neurologic compromise, her first surgery consisted of posterior osteotomies and the implantation of two sliding rods connected to loose dominoes without any attempt at correction. Correction was then achieved over a 3-week period with a halofemoral traction. This allowed the two rods to slide while the neurologic status of the patient was monitored. Her definitive surgery consisted of locking the dominoes and the application of a contralateral rod. Satisfactory outcome was achieved for both correction of the deformity (without neurologic sequels) and improvement of her pulmonary function (1200 c.c. at 2 years). This technique using sliding rods in combination with halofemoral traction can be useful in high-risk, very severe congenital scoliosis.

Adolescent↗
PubMed2004

Dynamic traction and minimal internal fixation for thumb and digital pilon fractures.

PURPOSE: This study evaluates the use of limited internal fixation and dynamic traction for the treatment of severely displaced digital and thumb pilon fractures. METHODS: Six patients were evaluated both clinically and radiographically at an average of 29 months after surgery (range, 18-36 months) for pain, range of motion, and radiographic signs of joint space narrowing and congruence. Surgery involved the placement of a pin for dynamic traction and an assessment of the adequacy of the articular alignment. A limited incision and supplemental K-wires were often used to improve the position of severely displaced fragments or for the repair of the central tendon. RESULTS: Three patients were pain free, 2 patients experienced pain with prolonged activity, and 1 patient had pain associated with activities of daily living. Average digital arc of motion of the proximal interphalangeal joint was 94 degrees (range, 90 degrees-100 degrees) and thumb interphalangeal motion was 62.5 degrees (range, 60 degrees-65 degrees). The average duration of digital traction was 3.5 weeks. Four patients had greater than 1 mm incongruity of the articular surface immediately after surgery. At final evaluation, all patients had good joint congruency and 2 patients had joint space narrowing but were asymptomatic. There was 1 minor pin tract infection. CONCLUSIONS: Dynamic traction combined with limited internal fixation can be an effective treatment for displaced intra-articular pilon fractures. This technique may allow for earlier removal of traction and simultaneous repair of soft tissue injuries.

Activities of Daily Living↗
PubMed2005

Traction radiography for the diagnosis of scapholunate ligament tears.

The diagnosis of scapholunate ligament injury by traction radiography was investigated within a consecutive study. The right wrists of 25 healthy volunteers and 22 wrists with arthroscopically proven complete scapholunate ligament tears were examined. Traction radiography was performed under fluoroscopy with a force of 5 kg applied to the thumb. In the normal wrists, this led to selective widening of the scapholunate joint space whereas the lunotriquetral distance remained unchanged. In 25 healthy right wrists, the median scapholunate distance measured 2.1 (range 1.3-2.6) mm on resting radiographs and 2.2 (range 1.7-3.5) mm on the stress radiographs. For the 22 wrists with complete scapholunate ligament tears, the median scapholunate distance was increased from 2.0 (range 1.0-3.0) mm to 3.8 (range 3.0-5.5) mm by traction (median difference of 1.8 (range 1.0-3.0) mm). In conclusion, a scapholunate distance of 3.0 mm or more in unloaded wrists or widening of the scapholunate interval by 1.0 mm or more under thumb traction should both be considered as pathological findings. We recommend traction radiography as a simple and valuable diagnostic procedure for suspected scapholunate ligament injury.

Adult↗
PubMed2000

Treatment of extensive bone and soft tissue defects of the lower limb by traction and free-flap transfer.

Twenty patients with extensive bone and soft tissue defects and posttraumatic osteomyelitis were treated between 1983 and 1995. In all cases an external fixator was used for bone fixation. Bone defects were managed with the Ilizarov intercalary bone transport. Two types of traction were used: the Ilizarov type and a 'new' Ljubljana type. The results of treatment were compared between the two types of traction. In all cases delayed bony union was observed. Osteomyelitis never reactivated. All patients were satisfied with treatment. They were all independent except for one amputee. The Ljubljana traction method was found to have the following advantages: no discrepancy in leg length, no orthopaedic support was needed, the aesthetic outcome was better, the traction time was reduced and there was less soft tissue damage during bone traction.

Adolescent↗
PubMed1978

Pain and cervical traction variation during manual turning [proceedings].

An experiment using a dummy with a cervical traction recorder was used in place of a patient. Nurses and orderlies from the Spinal Unit carried out manual lifting and turning techniques, used in the conservative treatment of spinal injury. Variation in manual traction continues throughout a turn. Traction force may be quadrupled or quartered. Inco-ordination between the individuals lifting, causes bending forces in the neck. This, together with sharp variation in traction, elicits pain. Manual traction, lifting, and turning, should be totally avoided, by employing kinetic nursing, provided by the use of the Roto Rest Spinal Bed.

Cervical Vertebrae↗
PubMed2002

The role of pelvic traction in the management of primary monosymptomatic nocturnal enuresis.

OBJECTIVE: To determine whether pelvic traction is beneficial in children with primary nocturnal enuresis. PATIENTS AND METHODS: There can be disproportionate growth between the spinal column and neural tube in prepubertal children. The normal elongation of the vertebral column in children during sleep could stretch the filum terminale and nerve roots, representing a minor degree of tethering that affects neural function and contributes to nocturnal enuresis. Pelvic traction induces a similar or more intense stretch while a patient is fully awake (and able to control their bladder). Releasing the potential tethering in this way, combined with conditioning therapy, could be beneficial. Fifty patients (aged 7-17 years) with monosymptomatic primary nocturnal enuresis were evaluated in a prospective study. All had 10 sessions of pelvic traction applied over 4 weeks and were followed up for 3 months afterward; no other medications were given. RESULTS: All patients had fewer wet nights, with variable degrees of success (20-80%) during and 3 months after traction. CONCLUSION: Pelvic traction is a safe, simple, economic and effective treatment for primary monosymptomatic nocturnal enuresis.

Adolescent↗
PubMed2002

Changes in sagittal lumbar configuration with a new method of extension traction: nonrandomized clinical controlled trial.

OBJECTIVE: To determine if a new method of lumbar extension traction can increase lordosis in chronic low back pain (LBP) subjects with decreased lordosis. DESIGN: Nonrandomized controlled trial with follow-up at 3 months and 1(1/2) years. SETTING: Primary care spine clinic in Nevada. PATIENTS: Beginning in mid-1998, the first 48 consecutive patients, who met the inclusion criteria of chronic LBP with decreased lordosis and who completed the treatment program were matched for sex, age, height, weight, and pain scores to 30 control subjects with chronic LBP, who received no treatment. INTERVENTIONS: A new form of 3-point bending lumbar extension traction was provided in-office 3 to 4 times a week for 12+/-4 weeks. Per session, traction duration was started at 3 minutes and was increased to a maximum of 20 minutes. For short-term pain relief, torsion lumbar spinal manipulation was provided in the initial 3 weeks. MAIN OUTCOME MEASURES: Pain as measured on a visual analog scale (VAS) and standing lateral lumbar radiographic measurements. RESULTS: Pain scales and radiographic measurements did not change in the control subjects. In the traction group, VAS ratings decreased from mean +/- standard deviation of 4.4+/-1.9 pretreatment to 0.6+/-0.9 posttreatment (P<.001), and radiographic angles (except at T12-L1) showed statistically significant changes. Mean changes were 5.7 degrees at L4-5 (P<.001), 11.3 degrees between posterior tangents on L1 and L5 (P<.001), 9.1 degrees in Cobb angle at T12-S1 (P<.001), 4.6 degrees in pelvic tilt (P<.001), and 4.7 degrees in Ferguson's sacral base angle (P<.001). At long-term follow-up (17(1/2)mo), 34 of the 48 (71%) subjects returned. Improvements in lordosis were maintained in all 34. CONCLUSIONS: This new method of lumbar extension traction is the first nonsurgical rehabilitative procedure to show increases in lumbar lordosis in chronic LBP subjects with hypolordosis. The fact that there was no change in control subjects' lumbar lordosis indicates the stability of the lumbar lordosis and the repeatability of x-ray procedures. Because, on average, chronic LBP patients have hypolordosis, additional randomized trials should be performed to evaluate the clinical significance of restoration of the lumbar lordosis in chronic LBP subjects.

Adult↗
PubMed2002

[The early axial traction of the cervical spine after anaesthesia with intubation and extreme reclination of the head].

OBJECTIVE: Patients who have an operation under general anaesthesia with muscle relaxation often complain about neck pain if the head needs to be placed in extreme reclination to facilitate surgical access. Patients complain about vertigo, light muscle tenseness but also about severe joint blockages in the neck region. Due to this complication the standard practise in some hospitals is to refer these patients routinely to a physiotherapist postoperatively. This study investigated the influence of an axial traction - a treatment which can easily be learned by anaesthesiologists - on blockages of the cervical spine in those patients. METHODS: In two randomised groups (n = 15 each) of preoperative inconspicuous patients the following directions of motion were investigated: Ante- and retroflexion of C0/1, side inclination C0/1, side nodding and side movement C2/3 to C6/T1, dorsal movement C5/Th2. The examinations took place at the preoperative anaesthetic round, shortly before extubation, two hours after extubation and the next day. Additionally the patients were asked about their discomfort. An axial traction of the cervical spine was performed in one group after extubation. The number of new blockages and the subjective discomfort of the patients was compared with the Chi-Square test. RESULTS: An axial traction of the cervical spine reduces the frequency and the intensity of symptoms significantly. CONCLUSION: It was investigated whether an axial traction of the cervical spine - a treatment that can easily be learned by anaesthesiologists - could improve patients' comfort. The study showed that an axial traction of the cervical spine immediately after extubation reduces the frequency and intensity of symptoms significantly. This treatment is highly effective, not very time consuming and, if done correctly, without any risk for the patient. By using this treatment routinely, additional expenses for physiotherapeutic interventions could be reduced.

Adult↗
PubMed2005

Association of vascular injury with the proximal side branch and assessment of thrombosis rates in a new microarterial traction model.

The higher rate of anastomotic failure in avulsion injuries has been attributed mostly to the uncertainty in determining the uninjured vessel segment suitable for anastomosis and resection past a proximal branch that has been proposed to achieve good arterial flow. A graded, longitudinal, microarterial traction model in rats has been used to examine the histopathologic aspects of the extent of vascular injury and its association with the proximal side branch. Additionally, anastomoses were performed following traction, and thromboses rates were determined. Results indicated a more proximal vessel injury with increasing rates of traction and, although the vessel segment proximal to the side branch was spared, up to a certain degree of traction, the injury extended beyond this point with more aggressive traction force. Consistently increasing rates of thromboses, significantly higher than the control group, were demonstrated. This model may be of use in further studies on the efficacy of various antithrombotic agents.

Animals↗
PubMedDate not supplied

[The effect of traction treatment on blood flow in the immature hip--an animal study].

9 immature pigs (age: 8-12 weeks) underwent longitudinal traction with 10%, 30%, and 50% body weight followed by overhead traction with 10% and 30% body weight. Microcirculation of the femoral head was monitored by a laser-doppler flow probe and macrocirculation within the lateral circumflex artery by an ultrasonic perivascular transit time flow probe. Changes in blood flow during each traction period were compared to the preceding resting period and expressed in percentages. With any type of longitudinal and overhead traction a trend towards an improvement in micro-and macrocirculation of the hip joint was observed although no significant differences could be detected. Our results encourage the use of traction as a concept in management of developmental dislocation of the hip.

Animals↗