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At least 235 records · Page 13Linked to original sources
PubMed2002

Direction of lateral traction in Ejnell's technique: an experimental study and case report of bilateral vocal cord paralysis.

In order to develop the method of laterofixation of the vocal cord (Ejnell's method) in cases of bilateral vocal cord paralysis, six autopsy specimens of normal larynx were obtained. We inserted traction sutures under conditions of direct visualization and studied the relationship between the direction of the traction exerted by the suture and subsequent enlargement of the glottis. When the vocal cord was pulled perpendicular to the thyroid cartilage wing, the mean glottal area was 106.2% of its area before traction. When the vocal cord was pulled perpendicular to the median line of the glottis, the mean glottal area was 112.7% of its area before traction. The latter angle of traction therefore produced more efficient enlargement of the glottis (p < 0.05; paired t-test). Based on an anatomic study of cadaveric laryngeal regions, a formula was developed to predict at which point the needle should be placed in order to produce optimal results using Ejnell's technique. Further clinical studies will be carried out in patients to test the validity of this formula.

Aged↗
PubMedDate not supplied

Femur fracture immobilization with traction splints in multisystem trauma patients.

OBJECTIVE: To evaluate the frequency of concomitant injuries that can complicate and/or contraindicate the use of traction splints (TSs) for femur fracture immobilization (FFI) in a population of multisystem trauma patients. METHODS: This was a descriptive, prospective study utilizing a data collection tool to identify patients with multisystem trauma for which a TS was in place for FFI. Patient care records and follow-up diagnoses were reviewed to identify patients with positive femur fracture(s) who concurrently had injuries that can complicate and/or contraindicate TS use. Injuries considered to complicate or contraindicate traction splint use include 1) pelvic injury, 2) patellar fracture or ligamentous knee injury, and 3) tibia/fibula fracture. RESULTS: Forty patients were identified as having a TS in place with an underlying diagnosis of multisystem trauma. All 40 had follow-up diagnosis information available, 39 of which were positive for femur fracture on the side of the extremity on which the splint was placed, or bilaterally. The incidence of complicating and/or contraindicating injuries was 38%. CONCLUSION: Traction splints are commonly used in the prehospital and transport setting for immobilization of femur fractures. There are limited data available on the benefit of traction splint use for femur fracture in the prehospital or transport environment. This study identified that concomitant injuries that complicate and/or contraindicate traction splint use are common.

Adolescent↗
PubMed2005

Use of suspension traction system for renal positioning during laparoscopic partial nephrectomy.

BACKGROUND AND PURPOSE: The technical difficulty of laparoscopic partial nephrectomy (LPN) lies mainly in the steps required during warm ischemia time (WIT), which includes tumor excision and renal reconstruction. We present a renal-suspension traction system to place the tumor in stable optimal view during the critical steps of LPN. PATIENTS AND METHODS: Thirty-three patients underwent LPN from October 2002 through December 2003. Eight had a renal sling placed intraoperatively because of difficult access to the tumor. Perioperative parameters were assessed. The renal hilum was dissected and the tumor exposed. To keep the tumor oriented perfectly toward the camera and the working ports, a 2-0 braided polyglactin (Vicryl) traction suture was passed through Gerota's fascia, catching the renal capsule; brought out through the abdominal wall; and secured to the skin with a clamp. RESULTS: All surgical margins were negative. For the traction and nontraction groups, the mean sizes of the tumor were 2.5 cm and 2.2 cm, respectively (P = 0.426). The estimated blood loss was 125 mL and 246 mL respectively (P = 0.041). The WIT average 27.4 minutes and 30.12 minutes (P = 0.470). The surgical time was 192 minutes and 235 minutes respectively, (P = 0.062). Based on our findings, we have devised a renal suspension traction algorithm for specific tumor locations during LPN. CONCLUSIONS: The renal suspension traction system allows precision in tumor excision and renal reconstruction during the critical steps of LPN. With the renal suspension system we devised, we are able to simplify LPN for tumors located away from optimal port access.

Carcinoma, Renal Cell↗
PubMed1985

Lumbar traction: its effect on respiration.

The purpose of this study was to examine the effects of lumbar traction on inspiratory vital capacity (IVC), tidal volume (TV), and respiratory rate (fb). Using an 8-L recording spirometer, we measured the above values on 30 healthy volunteers during three conditions--lying supine, lying supine with a traction garment applied, and lying supine with the traction garment and a distractive force applied. The differences in IVC, TV, and fb among the three conditions were examined by using an analysis of variance for repeated measures followed by a Tukey test. Statistically significant differences were found for IVC, TV, and fb among the three conditions (p less than .001). The results indicated that IVC and TV were lowest and fb was highest when the distractive force was applied to the traction garment. We suggest that when lumbar traction is used for patients who have respiratory disease, the patients should be observed closely for signs of respiratory distress during the first few treatments.

Adult↗
PubMed1995

Active traction splinting for proximal interphalangeal joint injuries.

Proximal interphalangeal joint injuries can severely affect hand function. Early, active motion is important in ensuring a good range of motion and a functional outcome. Active traction splinting is a dynamic splinting system that can be performed with either open or closed reduction of phalangeal joint fractures, especially at the proximal interphalangeal level. This system allows for continued traction on the involved joint and thereby aids in providing a dynamic force that will unload the joint throughout its arc of motion and noticeably decrease pain. Early, active therapy and the continual in-line traction enables the patient to achieve an almost full range of motion early in the course of rehabilitation. This combination contributes significantly to improve patient understanding and compliance. The benefits of the active traction system are reduction of fragments, marked decrease in pain, and early range of motion with improved patient compliance. Early, active motion facilitates improved joint nutrition, contouring, and healing. Active traction splinting for proximal interphalangeal joint injuries is a relatively simple and effective method for treating these complex injuries.

Adult↗
PubMed1985

Blunt multiple trauma (ISS 36), femur traction, and the pulmonary failure-septic state.

Fifty-six blunt multiple trauma patients (HTI-ISS 22-57) were studied for the effects of immediate versus delayed internal fixation of a femur or acetabular fracture on the pulmonary failure septic state. The pulmonary failure septic state may be defined as an alveolar arterial oxygen tension difference greater than 100, plus fever and leukocytosis. These patients were divided into four groups. Group I (N = 20) had immediate internal fixation, postoperative ventilatory support, and was sitting up at 30 hours. Group II (N = 20) had 10 days of femur traction and postoperative ventilatory support. Group III (N = 9) was immediately extubated after surgery and had 30 days of femur traction. Group IV (N = 7) had special circumstances that should increase the duration of the pulmonary failure septic state. These four groups of patients were statistically identical by 20 different criteria on admission except that Group I had more recognized chest injuries than Group II (12 vs. 9). Group I required 3.4 +/- 2.6 days of ventilator support and 7.5 +/- 3.8 intensive care unit (ICU) days; they had 12 +/- 8.8 elevated white counts, 3.8 +/- 4 febrile days, 0.05 positive blood cultures per patient, four fracture complications out of 93 fractures, 59 injections of narcotics, and 23 +/- 8.6 acute care days. Ten days of femur traction doubled the duration of the pulmonary failure septic state relative to Group I at a statistically significant level for nine out of 10 criteria, while increasing the number of positive blood cultures by a factor of 10, the number of fracture complications by a factor of 3.5, and the use of injectable narcotics by a factor of 2. Thirty days of femur traction increased the duration of the pulmonary failure septic state relative to Group I by a factor of 3 to 5 for all criteria at a statistically significant level, while increasing fracture complications by a factor of 17, positive blood cultures by a factor of 74, and the use of narcotics by a factor of 2. Group IV, which had four out of seven immediate internal fixations, behaved similarly to Group II. Femoral shaft traction should be avoided in the blunt multiple trauma patients because it greatly increases the cost of care and the risk of multiple systems organ failure.(ABSTRACT TRUNCATED AT 400 WORDS)

Acetabulum↗
PubMed1988

Traction bow for acute reduction of fracture and/or dislocation of the thoracic or thoracolumbar spine.

Treatment of acute fractures and/or fracture dislocations of the thoracic or thoracolumbar spine has traditionally involved bedrest or the use of traction devices with external hanging weights, until surgical correction can be accomplished. A fiberglass tubular traction bow with continuous adjustable elastic tension has been designed for the application of skeletal traction. When used to treat thoracic or thoracolumbar fractures and/or dislocations, it can maintain distraction forces in an uninterrupted fashion. Ten patients with acute fractures and/or dislocations of the thoracic or thoracolumbar spine were treated with this traction bow. All of the spinal deformities showed dramatic improvement within the first 3 h of treatment. The patients all showed immediate lessening of acute severe pain, and those with incomplete neurologic loss showed improvement of their neurologic function. The patients all tolerated the device well and were able to undergo radiologic examination and, ultimately, spinal fusion while they were stabilized in the traction bow. We believe this device is especially valuable for immediate reduction of spine and care of patients with fractures or fracture dislocations of the thoracolumbar spine.

Adolescent↗
PubMedDate not supplied

Roller traction: mobilizing patients with acetabular fractures.

Patients with acetabular fractures unamenable to open reduction and internal fixation are subject to 6-12 weeks of traction and, traditionally, bed rest. Using roller traction allows the patient to be mobilized to a bedside chair and to stand without disrupting the traction. This is accomplished by slightly modifying a standard lower extremity skeletal traction setup. Roller pulleys and stopper clamps are substituted for the usual pulleys. These are attached to extra-long horizontal bars that expand the lateral space that the patient can now use around the bed. Roller traction helps prevent the common complications of prolonged bed rest, particularly deep vein thrombosis, skin breakdown, pulmonary stasis and boredom.

Acetabulum↗
PubMedDate not supplied

Transverse traction in the treatment of scoliosis. A preliminary report.

Nineteen scoliotic patients were treated with the standard Harrington distraction rod supplemented with transverse traction. The latter consists of a compressive device (either Harrington';s or Cotrel's) applied to the convex side of the curve to correct disc space wedging and then drawn toward the distraction rod with a simple traction apparatus. Intraoperative roentgenograms were taken with the Harrington distraction rod alone after maximal distraction was applied. This was followed by postoperative roentgenograms with the transverse traction added. The 50.3% correction by distraction rod alone is increased to 66% with the addition of transverse traction. Detailed analysis of each curve, segment by segment, showed that the correction was augmented, not only in the center of the curve, where the compression corrected disc space wedging, but in the ends of the curve as well. This series uses each patient as his or her own control in demonstrating increased correction added by transverse traction.

Adolescent↗
PubMed1992

The traction angle and cervical intervertebral separation.

Seventeen normal young adults were evaluated for cervical intervertebral separation under different traction angles through motorized intermittent traction in the supine position. In all cases, the anterior and posterior intervertebral spaces were increased by traction at neutral position and in 30 degrees flexion, but not in 15 degrees extension. The effects of separation were 1) neutral position: anterior intervertebral separation C4-5 (12%) greater than C3-4 (8%), posterior intervertebral separation C6-7 (37%) greater than C3-4 (22%) greater than C4-5 (19%); and 2) 30 degrees flexion: anterior intervertebral separation C2-3 (21%) greater than C4-5 (16%) greater than C5-6 (15%) greater than C3-4 (10%), posterior intervertebral separation C6-7 (20%) greater than C5-6 (19%) greater than C4-5 (17%). There was a significant decrease in intervertebral separation posteriorly in extension traction, especially at C6-7 (-50%), C5-6 (-37%), C4-5 (-26%), and C3-4 (-14%). The separation of facet joint surfaces was found after traction at 15 degrees extension, but not in the neutral or flexion positions.

Adult↗
PubMed1993

Closed reduction of traumatic cervical spine dislocation using traction weights up to 140 pounds.

The purpose of this study was to demonstrate that Gardner-Wells skull tong traction up to 140 lb was both safe and effective in reducing dislocation, without fractures, of facet joints involving the C4-C7 vertebral bodies when applied by experienced practitioners in a spinal cord injury center under close scrutiny. Twenty-four awake patients were selected for the study (age range, 16-82 years). These patients were evaluated for the number of millimeters (7-17 mm) of dislocation as measured from the posterior aspect of the superior vertebral body to the posterior aspect of the inferior vertebral body at the level of injury. The maximum weight required to produce the reduction of the facet joints and the time from the onset of traction were recorded. The patients' neurologic status was monitored before traction, after each increment in weight applied, and after reduction. Careful examination of motor function and sensation was done and recorded at each interval. The 24 patients with cervical spine dislocation of the facet joints underwent successful reduction with traction weights (range, 10-140 lb). Seventeen patients required weights of more than 50 lb. The traction procedures lasted for a period of 8-187 minutes per procedure. Worsening neurologic status did not occur in any of the patients involved in this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1997

The biomechanics of gravity-dependent traction of the lumbar spine.

STUDY DESIGN: This study evaluated the biomechanical responses evoked by the use of a gravity-dependent, self-operated traction device. These responses were determined by radiographs and were correlated with the body weight of the patient who was supported by a seat strap. OBJECTIVES: To examine the biomechanical effectiveness of the LTX 3000 Lumbar Rehabilitation System. SUMMARY OF BACKGROUND DATA: The LTX 3000 Lumbar Rehabilitation System (Spinal Designs International, Minneapolis, MN) was used to administer the lumbar fraction. No previous study has been conducted on this device. METHODS: For each of the 14 healthy male patients (age range, 19-69 years), lumbar lengthening, alterations in spinal curvature, and thoracic spine movement were assessed using radiographs taken: 1) before traction; 2) at 2, 10, and 15 minutes after the onset of traction; and 3) 2 minutes after traction was completed. Strain on the buttocks-supporting seat strap was recorded continuously during study sessions. RESULTS: The entire patient pool displayed an average maximal lumbar lengthening of 6.39 +/- 4.21 mm. The amount of lumbar lengthening was influenced by the degree of thoracic immobilization and by the amount of prior LTX 3000 (Spinal Designs International) use. Significant curvature reduction was observed during and after traction for the entire patient pool. Strain measurements correlated well with the measured response in the radiographs. CONCLUSIONS: Proper use of the LTX 3000 (Spinal Designs International) induces significant lumbar lengthening and curvature reduction in healthy patients. Measurements of body weight supported by the seat strap could help determine if thoracic immobilization has been achieved and if the patient is responding to the lumbar unloading.

Adult↗
PubMed2006

Surgical treatment of scoliosis with pelvic obliquity in cerebral palsy: the influence of intraoperative traction.

STUDY DESIGN: Continuous retrospective series. OBJECTIVES: To compare two techniques sequentially used for surgical correction of neuromuscular scoliosis with pelvic obliquity in children with cerebral palsy. SUMMARY OF BACKGROUND DATA: In nonwalking patients with cerebral palsy, scoliosis is frequently associated with pelvic obliquity. We compared intraoperative traction with no traction with instrumentation to the pelvis to correct pelvic obliquity. METHODS: The initial 59 patients had surgery in the knee-chest position with pelvic obliquity correction by posterior vertebral instrumentation distraction, rotation, and compression. The sequential 51 patients were placed prone and had asymmetric traction applied between a halo and the high pelvic side lower extremity with pelvic correction maneuvers done before posterior surgery and instrumentation. RESULTS: Anesthetic duration was longer in Group 1 because of complexity of the intraoperative correction maneuvers, which also produced less correction of scoliosis and pelvic obliquity compared with the asymmetric traction technique. At 8.6 years of follow-up, frontal and sagittal plane correction improved in all surviving patients. CONCLUSION: We think that intraoperative reduction by asymmetric traction is a reliable and safe technique to correct neuromuscular scoliosis and pelvic obliquity in nonwalking spastic quadriplegic patients.

Cerebral Palsy↗
PubMedDate not supplied

Preliminary traction in the treatment of developmental dislocation of the hip.

The benefit of preliminary traction in the treatment of developmental dislocation of the hip has not been clearly demonstrated. We retrospectively analyzed the results of traction treatment of 90 dislocated hips in 72 patients. After a 3-week course of traction, patients underwent attempted closed reduction. Fifty-two hips (58%) were managed successfully by closed reduction, whereas 38 hips (42%) required primary open reduction. chi 2 analysis revealed no significant difference in either the rate of successful closed reduction or the incidence of avascular necrosis compared to recently published series in which preliminary traction was not used. On the basis of presentation radiographs and arthrograms, we were unable to identify a subgroup of patients that clearly benefited from the use of traction in the treatment of developmental dislocation of the hip.

Arthrography↗
PubMed1991

Effect of cervical traction with a tenaculum on the uterocervical angle.

The effect of cervical traction on the uterocervical angle was measured radiographically in 24 women undergoing diagnostic curettage. A radio-opaque guidewire was inserted through the cervical canal into the uterine cavity and a lateral pelvic X-ray taken before and after traction. The traction force was measured with a spring-balance attached to the tenaculum. Cervical traction in a caudal direction (force 2 N) reduced the median uterocervical angle, from 75 degrees to 10 degrees (P = 0.001). Moderate cervical traction straightens the uterus and the routine use of a tenaculum theoretically makes insertion of an intrauterine device safer and the passage of an embryo transfer catheter less traumatic.

Cervix Uteri↗
PubMed1996

Cervical spine imaging in trauma patients: a simple scheme of rationalising arm traction using zonal divisions of the vertebral bodies.

OBJECTIVE: To evaluate the effectiveness of arm traction for cervical spine imaging in trauma patients and devise a scheme to predict the probability of visualising the C7/T1 level in trauma patients. METHODS: 98 trauma patients were studied. Each vertebral body was divided into three equal horizontal zones, the disc space between vertebral bodies being equivalent to one zone. The fifth cervical vertebra was used as the starting level (zone 1). Zones obtained pre and post arm traction on the lateral cervical spine radiographs were recorded. Results were analysed to show the probability of imaging the lower cervical spine, including the cervico-thoracic junction. RESULTS: If the initial film showed less than zone 10 (mid-C7 vertebra), the probability of showing zone 13 (upper body of T1) with arm traction was only 7.7%, that is, one success in every 13 pulls; or conversely, 12 failures in every 13 pulls. CONCLUSIONS: Unless an initial cervical spine radiograph includes the upper one third of the body of the C7 vertebra, the probability of attaining the C7/T1 level with arm traction is < 15%. It is suggested that all initial radiographs of the lateral cervical spine in major trauma patients be done with arm traction, and where the upper one third of the body of C7 vertebra is not seen, then computerised tomography, swimmer's, or oblique views be considered.

Arm↗
PubMed1992

Lung traction causes an increase in plasma prostacyclin concentration and decrease in mean arterial blood pressure.

The effects of lung traction on arterial blood pressure and plasma prostacyclin concentrations were studied in five patients undergoing partial pneumonectomy or lobectomy. After manual traction of a lung segment, mean arterial blood pressure decreased from 77 +/- 5 mm Hg (mean +/- SEM, before lung traction) to 59 +/- 5 mm Hg. The concentrations of 6-keto prostaglandin F1 alpha (a stable breakdown product of prostacyclin) increased significantly from 46 +/- 6 pg/mL (mean +/- SEM, before thoracotomy) to 593 +/- 91 pg/mL. Four of five patients showed facial flushing and palmar erythema. Arterial blood pressure returned to pretraction value, and both the facial flushing and palmar erythema disappeared within 30 min after lung traction. These results suggest that traction of the lung stimulates release and/or production of prostacyclin, which results in facial flushing, palmar erythema, and decrease in arterial blood pressure.

Adolescent↗
PubMed2000

Improving the endoscopic view of the hypopharynx with anterior neck traction during the trumpet manoeuvre.

The postcricoid subsite is difficult to visualize on flexible laryngopharyngoscopy. The view can be improved with either auto-insufflation manoeuvres or anterior neck skin traction. In this study, the view of the hypopharynx was graded whilst anterior neck skin traction was applied during the trumpet manoeuvre; the latter involves the patient blowing on his finger as if blowing up a balloon. On auto-insufflation alone, the postcricoid site was demonstrated in 22/25 (88 per cent) of cases and the upper oesophageal sphincter (UOS) in two out of 25 (eight per cent). Of the 22 cases in whom only the postcricoid site was demonstrated, subsequent neck skin traction revealed the UOS in eight. Overall, the use of auto-insufflation solely or in combination with traction resulted in UOS visualization in 40 per cent (10/25) of cases. The application of skin traction during trumpeting is easy to perform and should be used routinely.

Female↗