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At least 253 records · Page 14Linked to original sources

Preoperative Cotrel traction in idiopathic scoliosis.

Eighty consecutive patients with idiopathic scoliosis were treated preoperatively with Cotrel traction. Distraction X-rays were taken 2 or 3 days after start of traction and 8-10 days later. In 47 patients equal distraction force was applied in both instances. The force, averaging 28 klb, was measured on the head sling. Cotrel traction reduced the spinal curve 37.5 per cent in the first and 38.9 per cent in the second measurement. The difference is not significant. Preoperative Cotrel traction did not improve the surgical curve correction. Postoperative loss of correction and complication rate was insignificantly reduced compared with the results in a previous study. Cotrel traction does, however, give some indication of the surgical correction achievable.

Adolescent↗

[The influence of the traction on the wrist in the course of healing of the radius distal part comminuted fractures].

Traction and external fixation are the methods of choice by treating the comminuted fractures of the distal part of the radius. Bringing in two screws into the second metacarpal bone and the radius proximity from the fracture makes possible the traction and fixate the fractured bone splinters. The reposition of the comminuted fractures needs a very strong traction and provides to expand the ligaments and the wrist articular capsula. The aim of our study is to explain the mechanical influence of the external stabilization on the wrist and the wrist function after the immobilisation with the distraction. In 15 patients the examination was performed. The wrist was estimated on the base of clinical examination and rentgenography. Those examinations were performed within the moment of reduction of the dislocation, than 6 weeks and after next 6 weeks. All results are illustrated on graphics and x-ray pictures. The results of our study prove the profitable influence of the traction on the healing of the damaged articular surface in good clinical and functional position. Even a strong traction has in comparison to the control group (healing conservatively or by using various methods of the internal fixation) no influence on the wrist function.

Adult↗

Howard H. Hepburn and the development of skull tongs for cervical spine traction.

The first use of skull tongs for cervical spine traction is credited primarily to W.G. Crutchfield. In 1933, Crutchfield described his application of extension tongs to the calvaria of a 23-year-old woman with a traumatic C2-C3 fracture. Less recognized are the contributions of Howard H. Hepburn, who designed skull tongs for cervical spine traction at the University of Alberta several years before Crutchfield's first case. Hepburn was the first neurosurgeon at the University of Alberta in Edmonton. On the basis of his experience treating wounded soldiers in World War I, he developed the hypothesis that traction would promote healing in cervical spine injuries. Hepburn designed skull extension tongs that were modeled on common ice tongs, and he used an automobile inner tube as an elastic to keep the tongs firmly applied to the patient's head. These tongs were first used in the mid-1920s, and by 1930 they were applied routinely. Crutchfield's 1933 report refers to the application of "Edmonton extension tongs." This suggests that he was at least indirectly aware of Hepburn's work, although how this information reached him is not entirely clear. Hepburn attended a meeting of the British Medical Society in 1930, and he is thought to have discussed his tongs during the conference. Hepburn's work has received some attention previously; his original tongs were included in a 1973 Smithsonian Institute exhibit on cervical spine traction as an example of an early cranial traction device. However, his contributions are underappreciated in the neurosurgical community and deserve wider recognition.

Canada↗

[Biomechanical experiments for measuring traction lengthening of the lumbar spine during weight bath therapy].

INTRODUCTION: Weight-bath as an effective traction therapy has successfully been applied in Hungary for nearly a half century, however, it has still been constrained exclusively to empirical bases until the numerical biomechanical analysis of Bene and Kurutz appeared in 1993. Due to their calculations, for cervical suspension in traction bath, the value and distribution of tensile force along the spine became known, however, the most important information, namely, the deformation of spine segments to be stretched by the therapy is so far unknown. AIMS: In this paper the results of a wide-ranging in vivo biomechanical experimental analysis are presented, aimed partly to obtain the traction deformation effects of weight-bath therapy, partly to obtain the biomechanical traction model of human lumbar segments. The analysis aimed to clear the effect of decompression, extra weights, sex, aging, body height and weight. PATIENTS/METHODS: The experiments have been executed during the prescribed 20 minutes long weight-bath treatment of patients having indication for cervical suspension. Patients with other forms of suspension, like armpit bars, have been excluded from the analysis. Two groups of patients have been distinguished: 67 patients without and 88 patients with extra weight loads of 20-20 N (2-2 kgf) applied on the ankles. Extension values of lumbar segments LIII-IV, LIV-V and LV-SI have been measured. Tensile deformations have been specified as the change of the distance between two spinous process of vertebrae, measured by a special subequal ultrasound method developed by the research group. The experimental results have been evaluated by using special software for analyzing ultrasound pictures. More than 3500 ultrasound pictures of 400 lumbar segments of 155 patients have been measured and evaluated. RESULTS: As for the results, at the end of the treatment, elongation of lumbar segments has been demonstrated practically in 60% of patients without and in 75% of patients with extra weights. The mean extension of a lower lumbar segment after a 20 minutes long weight-bath treatment is about 1.2-1.4 mm, while with extra weights it is about 1.3-1.6 mm, in the average of the deformed segments only. In the average of all segments, the above mean extensions are 0.7-0.9 mm, and with extra weights yield 0.8-1.4 mm. CONCLUSIONS: Just being suspended in water, due to the decompression, even without any extra weights, significant extension has been registered: a mean value of 1.0-1.2 mm per segments for the deformable, and 0.4-0.6 mm for all segments. The 20 minutes long treatment time in itself has a significant effect: the average additional extension is 0.2-0.4 mm per segments without, and about 0.5 mm with extra weights. The deformation capacity of lumbar segments decreases with increasing age of patients. Elongations increase with increasing body height. Body weight shows different tendency depending on the sudden elastic and time-dependent viscous deformations. Significant difference has been observed in reaction time of male and female patients: female patients react later, however the final traction effect seems to be equal.

Age Factors↗

Effectiveness of lumbar traction with routine conservative treatment in acute herniated disc syndrome.

OBJECTIVE: To assess the effectiveness of lumbar traction with routine conservative treatment in acute herniated disc syndrome. DESIGN: Randomized double-blind controlled trial. SETTING: Outpatient clinic of physical medicine and rehabilitation. METHOD: 120 participants who met the diagnostic criteria of acute herniated disc syndrome were randomized into two groups. The study group received treated traction, and the control group received sham traction. All patients had routine conservative treatments (consisting of NSAIDs, instruction of proper back activity and precaution, back exercise, and heat modality). The main outcome measurement was the Oswestry score, which was collected on the first day and at the 4th week of the treatment. At the end of the study, all patients recorded global improvement and satisfaction. RESULTS: Of 120 patients divided into two groups equally, 12 and 6 cases in the control and intervention groups dropped out of the study. The mean (SD) change of the Oswestry score were 19.25 (15.9) and 25.25 (16.68) in control and intervention groups respectively. There was no significant difference between the two groups with the p-value of 0.067 and 95%CI of - 0.42-12.43. Approximately 89% of patients in each group had improvement of their symptoms, and 90% in each group were satisfied with lumbar traction. Co-intervention with heat modality, NSAIDs use and back exercise did not differ between the two groups. CONCLUSION: The data do not support the benefit of traction for patients with acute herniated disc syndrome. The patient can be conservatively treated at home with proper instruction.

Acute Disease↗

Clinical application of intraoperative skeletal traction in the dog.

The purpose of this clinical study was to evaluate the technical feasibility of a method for pre-operative and intra-operative traction for reduction of fractures of the appendicular skeleton. Traction was used in 24 diaphyseal fractures in 21 dogs. For each dog, the data pertaining to signalment, limb circumference, fracture type, interval between fracture and surgery, and the traction modalities were recorded. In patients with a latency between trauma and surgery of less than three days, the duration of traction required to realign the bone segments was shorter than that required for older fractures (P = 0.02). Intraoperative malalignments were corrected by manoeuvres performed with the traction stand. Once realigned, fracture segments were kept stable for prolonged periods, without the need for a surgical assistant. Postoperative radiographs were evaluated for fracture reduction and axial alignment. Postoperative alignment was judged excellent in 21 fractures and good in three fractures. Fractures were stabilized using external skeletal fixation (n = 10), plates (n = 11) or locked nails (n = 3), depending on the fracture type. The use of the technique was straight-forward and easily applied in a surgical setting. However, its use requires careful application because of the potential for iatrogenic tissue damage.

Animals↗

Effects of different cervical traction weights on neck pain and mobility.

AIMS AND OBJECTIVES: This study investigated the effects of 3 different traction weights on neck pain and range of motion/mobility. MATERIALS AND METHODS: Ninety subjects, 42 men and 48 women, with neck pain due to cervical spondylosis participated in the study. They were assigned into three groups, each of which was subjected to a different cervical traction(CT) weight namely: group A = 7.5% total body weight(TBW), group B = 10%TBW, and group C =15%TBW CT respectively. Pain intensity and neck mobility, pre-treatment and post-treatment, were assessed using visual analogue scale(VAS) and universal goniometer respectively. RESULTS: There was no significant difference(p < 0.05) pre-treatment, but existed post-treatment (p < 0.05) between the groups for neck pain and mobility. Nineteen subjects had reactions due to the CT application: 3,5 and 11 in groups A,B and C respectively. The least reactions were recorded with the use of 7.5% TBW traction and the highest with the 15% TBW traction. The 10%TBW CT recorded the most significant pain relief and neck flexibility/mobility compared with the 7.5% TBW and 15% TBW CT therapy. CONCLUSION: This study established the 10% TBW CT as the ideal weight with minimal side effects and with highest therapeutic efficacy. Therefore clinicians could adopt this weight in managing neck disorders requiring traction.

Adult↗

[Treatment of lumbar sciatica with or without neurological deficit using mechanical traction. A double-blind study].

Traction therapy for low back pain with sciatica has been evaluated in a double blind study. 60 patients hospitalized for sciatica with or without signs of sensory or motor deficiency were randomized to 3 treatment groups: "placebo traction" (5 kg), "light traction" (15 kg) and "normal traction" (50 kg). Clinical evaluation after 4, 8 and 12 traction sessions showed no difference between the three groups.

Adult↗

Unstable femoral shaft fractures: a comparison of interlocking nailing versus traction and casting methods.

Among 60 femur fractures not amenable to fixation by simple intramedullary nailing, 30 were treated with balanced skeletal traction followed by cast bracing or spica casting, and 30 were treated with closed interlocking nailing. The criteria for using an interlocking nail were fractures with less than 50% cortical contact or fractures with rotationally insecure purchase of the nail in either the proximal or distal fragment. In terms of fracture severity, patient age, injury severity, and clinical follow-up, the patient groups were similar. There were three open fractures in each group. The average hospital stay was 61 days for the traction group, and 19 days for the interlocking nail group (p less than 0.001). Time to clinical and radiographic union averaged 34 weeks with traction and casting and 18 weeks with interlocking nail fixation (p less than 0.001). Failure by the criteria of Johnson et al (2) occurred in 67% of the traction group and in 3% of the interlocking nail group (p less than 0.001). Minor complications were more common in the traction group. On the basis of this study and the experience of others, interlocking nail fixation appears to be the method of choice for managing unstable femoral shaft fractures.

Adolescent↗

Tibial plateau fractures: definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction.

Results of a decade of experience with 988 tibial plateau fractures are presented. Maximum plateau depression was measured on initial and follow-up x-ray studies, and knee instability was clinically evaluated to identify minor and major fractures as a guide to management. Demographic, treatment, and complication data were gathered prospectively in 753 fractures. Four hundred thirty-seven "major" tibial plateau fractures (44% of cases) were treated operatively; the remainder were treated by traction. Three hundred twenty patients who sustained only a plateau fracture were followed from 1 to 10 years, with an average of 3.7 years. Nonsurgical treatment included Buck's traction (89% of closed treatment cases) or a "knee exerciser" device utilizing skeletal traction in a Hodgson-Pearson apparatus. Early intermittent passive and active knee motion was encouraged. The complication rate of traction was 8%. The complication rate in operated patients was 19%, much of which was due to infection. Methods for objective and subjective scoring of both traction and operative results were developed and utilized. Results show that anatomic reduction of plateau fractures, in addition to early motion, is a major factor contributing to successful management of this potentially disabling injury.

Adolescent↗

Extraoral traction to the maxilla with face mask: a follow-up of 17 consecutively treated patients with and without cleft lip and palate.

Lateral cephalometric films of seven cleft palate (CP) or unilateral cleft lip and palate (UCLP) and ten nonCLP patients were obtained immediately before extraoral traction with face mask, immediately after, and at 6 months follow-up. The mean age at start of treatment was 7 years for the CLP patients and 11 years for the nonCLP patients. The average duration of traction was 8 months in both groups. The traction force was gradually increased from 300 to 800 g on each side. Five angular measurements were defined and recorded. The mean net effect in anterior displacement of the maxilla in the CLP group was +0.2 degrees (range +2.5 degrees to -2.5 degrees) and in the nonCLP group +1.0 degree (range +2.5 degrees to -1.0 degree). The orthopaedic effect of extraoral traction to the maxilla was found to be independent of skeletal morphology, age, peak height velocity (PHV), and duration of traction, and thus to be unpredictable. Normal overjet was obtained in most patients, because of a combination of anterior displacement of the maxilla, posterior displacement of the mandible, tipping of the incisors, and a possible anterior sliding of the maxillary dental arch on its base.

Adolescent↗

Dynamic splinting: a systematic approach to the selection of elastic traction.

Elastic traction is an important but occasionally misapplied component of upper-extremity dynamic splints. Information regarding a systematic approach for selection of elastic traction has been limited. A biomechanical analysis of dynamic splinting methods was done to identify factors that might help educate therapists in the proper application of elastic traction. Material properties of elastic traction were measured with a mechanical testing system capable of accurately identifying physical properties of various substances. Results of this analysis indicated that specific spring constant values for clinically used bands ranged from 134 to 531 g, original length values ranged from 0.7 to 3.2 in., the consistency of bands labeled as identical by the manufacturer was generally very good, and each band's ability to maintain its material properties with repeated elongation was similar from band to band and showed gradual diminution after several hundred repetitions. These data were combined with theoretical constructs of splint fabrication to devise a simple and logical method for analysis and determination of elastic traction requirements for various diagnostic applications. A goniometer, ruler, and spring scale are the only tools necessary to perform the analysis. Simple charts depicting forces and moments provide identification of the appropriate rubber band for application.

Arthritis, Rheumatoid↗

Autotraction versus manual traction in patients with prolapsed lumbar intervertebral discs.

Forty-nine patients with lumbago-sciatica and prolapsed lumbar intervertebral discs, comparable concerning anamnestical and clinical data were randomized for autotraction and manual traction given by the same therapist for a period of one week while strict bed rest was prescribed. A blind overall assessment performed immediately after the traction period, after two weeks follow-up training and three months after hospitalization showed that the two traction modalities are equally efficient. As treatment for hospitalized patients with lumbar intervertebral disc prolapses the relatively simple manual traction variety should be preferred, if any. Traction is suggested to be used as a prognostical aid. Pain intensity was significantly reduced in all body parts. About one fourth of patients avoided operation. After two years there was no recurrence of symptoms.

Adolescent↗

Intervertebral disc pressures during traction.

Pressures in the third lumbar discs were measured in vivo during active and passive traction. During active traction an increase in pressure was always recorded, with larger increases corresponding to larger traction forces. During passive traction the pressure remained close to the resting pressure; sometimes slight increases were recorded, sometimes slight decreases. It is concluded that when traction is applied so that the back muscles contract, then disc pressures will increase.

Adult↗

Overhead traction in the treatment of congenital dislocation of the hip.

Long-term results of traction treatment for congenital hip dislocation (CDH) performed between 1984 and 1990 are presented. The new traction scheme consists of 4 distinctive phases. It is based on gradually changed direction of traction--first, from the longitudinal direction to flexion and abduction against the hypomochilion. The traction is applied by means of non irritable adhesive tape using 1/4-1/5 of the child's body weight. The period of active traction is followed by retention period in Hanausek's biomechanical device. The success rate of the scheme, in terms of reduction, was 90 per cent. In 31 per cent the Salter innominate osteotomy was performed because of residual deformity. In 10 per cent of the cases open reduction was necessary.

Combined Modality Therapy↗

[Effects of caudal traction of the spinal cord on evoked spinal cord potentials in the cat].

This study attempts clarify the mechanism of neurological deficits in tethered cord syndrome using evoked spinal cord potentials (ESCPs). ESCPs in response to both sciatic nerve (SN-ESCP) and spinal cord stimulation (SC-DESCP) were recorded from the dorsal epidural space. With a fixed degree of caudal traction on the spinal cord in ten cats for 2-4 hours, ESCPs were increased in amplitude in the N1 and N2 deflections of the SC-DESCPs to 158% and 154% at L5 and decreased to 91% and 76% after transient augmentation at L3. On the other hand, the amplitude in the N1 deflection of the SN-ESCPs at L3 and L5 was decreased to 40% and 68%. These findings suggest that not only the force but also the duration of traction influence the degree of the spinal cord dysfunction. When the spinal cords of 17 cats received compression with traction and without traction, the SN-ESCPs of the former became positive earlier than that of the latter. The extent of the recovery in amplitude of both SC-DESCPs and SN-ESCPs propagated over compression site was far limited in the former than in the latter. These results would indicate that the spinal cord subjected to traction is vulnerable to compression.

Animals↗

Bivector traction for unstable cervical spine fractures: a description of its application and preliminary results.

The management of acute, displaced odontoid fractures requires the restoration of sagittal alignment and rigid external or internal immobilization to prevent late instability and achieve union. This report introduces a new traction technique for the reduction of posteriorly displaced type 2 odontoid fractures. Seven patients with traumatic injuries to the dens were placed in bivector traction for an awake closed reduction. Sagittal alignment was restored and maintained in all patients with no neurologic deterioration or traction-related complications during an average of 11 days (range, 2-28 days) in traction. The overall sagittal alignment corrected from an initial average of 12.2 mm (range, 5-22 mm) of posterior displacement to an average of 1.1 mm (range, 0-3 mm) at the completion of reduction. Only one patient had residual angulation, which measured 5 degrees. Three patients achieved an osseous union and the remaining four required a posterior C1-C2 fusion for nonunion. Although operative stabilization may be the preferred approach in this patient population and injury pattern, we conclude that bivector traction is a safe and effective technique for the initial management of posteriorly displaced odontoid fractures. In addition, its role can be expanded to the closed reduction of lower cervical spine fractures in patients with fixed flexion deformities secondary to ankylosing spondylitis or disseminated intraosseous segmental hyperostosis.

Accidental Falls↗

[Femoral shaft fracture in children younger than 4 years: shorter hospital stays with the help of at home traction apparatus].

OBJECTIVE: Evaluation of home traction as a treatment as a treatment of femoral shaft fractures in children with the objective to shorten the hospital stay. DESIGN: Retrospective. SETTING: Paediatric Surgical Centre Amsterdam (EKZ/AMC and AZVU), the Netherlands. METHOD: In the period 1991-1995, 18 femoral shaft fractures in children younger then 4 years were treated. In ten of them traction was applied at home (in the other cases the parents refused to co-operate, the home situation was not appropriate, there were additional medical problems or there was a suspicion of child abuse). During follow-up of the group treated at home with traction, angulation, deformity and leg length discrepancy were determined with special attention to complications. The parents' experience of this method was evaluated by telephone (n = 8). RESULTS: The median age of the children was 2.4 years. The mean hospital stay was 7 days (range: 3-12), the mean follow-up 2.4 years (range: 1.0-4.3). Angulation, rotational deformities and leg length discrepancy > 1 cm did not occur. Oedema and pain were seen in 1 patient as a result of incorrect treatment at home. In one patient a compartment syndrome occurred after a switch from traction to a plaster treatment in another hospital. With exception of some small practical and informational problems, parents were very pleased with this method. CONCLUSION: Treatment at home of femoral shaft fractures in children with traction is a simple and effective method which reduces the hospital stay to one week with minimal complications. Good patient selection and instructions of the parents are mandatory.

Child, Preschool↗