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PubMed1991

Recurrent carpal tunnel syndrome, epineural fibrous fixation, and traction neuropathy.

This article has reviewed recurrent carpal tunnel syndrome, epineural fibrous fixation, and traction neuropathy of the median nerve. The problems surrounding the diagnosis and treatment of recurrent CTS have been discussed at length. The percent of failures from traditional open ligament surgery is observed to be high, and will become more prevalent as more casual treatments are carried out. This article makes a positive statement with reference to mobilization of the median nerve and anatomic restoration of the transverse carpal ligament. Fibrous fixation of the median nerve is a product of life and function. All cases are different, reflecting the strength, abilities, and personalities of the patients. A bottom line is drawn on these patients, where the summation of the problems of life become symptomatic and disabling. Epineural fibrous fixations induce median nerve traction, governed by hand, wrist, and forearm movements. Traction and tension suggest the intermittent disturbance of nerve nutrition and nerve conduction as the elastic limits of the nerve are approached. These factors accumulate and, in time, cause traction neuropathies with pain. This is followed by a reduced work capability. This impairment can be reversed by surgical nerve mobilization followed by functional nerve gliding therapy. A background history injury to the hand and wrist may be significant, as well as factors such as overuse and misuse of the hand and extremity. Prior to surgery, the careful application of diagnostic stress tests are essential, for the differential diagnosis of fixation traction and positional peripheral neuropathies. Nerve mobilization supported by magnification and the techniques of hand surgery has been successful by the methods discussed and has permitted, importantly, the restoration of the anatomic retinaculum for the flexor tendon system. This can be restored in carpal tunnel surgery and reconstructed with basic ligament material in recurrent carpal tunnel surgery.

Aftercare↗
PubMed2006

[A study of highpull extraoral traction on the treatment of growing patients with skeletal Class II malocclusion].

PURPOSE: To evaluate the effect of highpull extraoral traction on growing patients with skeletal Class II malocclusion. METHODS: 11 pairs of cephalograms obtained before and after highpull extra-oral traction treatment were used in this study, treatment changes were measured with Pancherz analysis, and compared with the control group. Independent samples group t test with SPSS 11.0 software package was used for statistical analysis. RESULTS: highpull extra-oral traction had inhibitive effect on forward and downward maxillary growth. Changes on SNA, A-Olp between the two groups were statistically different (P<0.01). Upper molars were moved back (P<0.01). CONCLUSION: highpull extraoral traction had orthopedic effect on the correction of skeletal Class II malocclusion of growing patients, including inhibition of maxillary growth and allowance of fully expression of mandibular growth. Meanwhile, dental-alveolar changes on the vertical and sagittal plane were beneficial to further improvement of the dental and facial appearance of the patients.

Cephalometry↗
PubMed1986

Shoulder harness traction for roentgenographic assessment of the cervical spine.

We evaluated the clinical usefulness of a new shoulder traction device to facilitate a rapid complete cervical spine examination in an uncooperative patient population with multiple trauma. Forty-eight patients were randomly designated to receive the shoulder traction device or the standard technique (manual traction on the patient's upper extremities). Patient groups were equivalent in mean coma scale scores, trauma scores, age, and incidence of cervical fracture. Male-female ratios differed between groups, yet were biased against the harness technique. Fewer roentgenograms (lateral view) were required to visualize adequately all cervical vertebrae when the harness device was utilized (mean roentgenograms per patient, 1.2 vs 2.6; P less than .01). Shoulder harness traction during roentgenographic evaluation of the cervical spine may be a useful method to promote visibility of the lower cervical vertebrae.

Accidents↗
PubMed1992

Acute effect of traction, compression, and hip joint tamponade on blood flow of the femoral head: an experimental model.

Blood flow rates of the canine femoral head were experimentally determined during traction, compression, and hip joint tamponade using the hydrogen washout technique. In puppies, blood flow rate of the femoral head was significantly decreased with either traction or compression applied at one half body weight. Either maneuver, when combined with hip joint tamponade, reduced blood flow rate of the femoral head an average of more than 70% as compared with the initial control rate. In adult dogs, combinations of either traction or compression, at one-half body weight, with hip joint tamponade did not significantly decrease blood flow rate of the femoral head as compared with control values. Perfusion defect of blue silicone could be observed only in puppies around the hip during combinations of traction or compression with hip joint tamponade and involved the posterior superior capital branches of the medial circumflex artery and the arteries in the ligamentum teres. These experimental data may have important implications for the pathogenesis of iatrogenic avascular necrosis in the treatment of congenitally dislocated hip, Legg-Perthes disease, and avascular necrosis following nondisplaced femoral neck fracture.

Animals↗
PubMed1979

The value of traction during roentgenography of the wrist and metacarpophalangeal joints.

Traction on wrist and metacarpophalangeal joints during radiography produces 'vacuum phenomenon' due to the release of intra-articular gas. The resultant pneumoarthrogram clearly portrays the articular cartilage. Manual traction radiography of the wrist and the metacarpophalangeal joints has the following potential uses. 1. Detection of joint effusion; increased interosseous space during traction without release of intraarticular gas is indicative of joint disease with effusion. 2. Separation of the carpal bones; the traction separates the carpal bones and allows evaluation. 3. Differentiation of arthralgia from arthritis. 4. Evaluation of midcarpal, radiocarpal compartments, and the metacarpophalangeal joints can be performed before the secondary ossification centers are ossified. 5. Evaluation of the integrity of the joint cartilage.

Adolescent↗
PubMed1984

Genu recurvatum: a complication of prolonged femoral skeletal traction.

Genu recurvatum is a rare complication of prolonged skeletal traction. The literature reports very few cases, the majority secondary to wire traction applied to the tibia in the treatment of femoral shaft fractures. A case of genu recurvatum in a 12-year-old girl as a complication of prolonged femoral skeletal traction was treated at the Kobe University Hospital. A proximal open wedge tibial osteotomy using iliac bone grafts was the surgical treatment initiated at the time of diagnosis. Follow-up after 1 year showed recurrence of the genu recurvatum. Early surgical intervention, prolonged casting and application of knee orthosis were all contributory factors in the recurrence of genu recurvatum in our patient. It should be emphasized that extreme care should be taken in treating femoral shaft fractures in children, especially those requiring wire traction in the tibia or femur, in order to prevent genu recurvatum.

Adolescent↗
PubMed2006

Management of grade III supracondylar fracture of the humerus by straight-arm lateral traction.

Supracondylar fracture of the humerus is a common upper limb fracture in children for which treatment is controversial and often technically difficult, and complications are common. Cubitus varus is the most prevalent complication encountered in such fractures, with a mean incidence rate of 30%. A variety of methods for treating displaced fractures have been recommended. We reviewed 20 cases of severely displaced grade III supracondylar fractures of the humerus in children. There was marked swelling and distorted local anatomy in all these fractures, which were managed conservatively with straight-arm lateral traction. The patients were treated in skin traction for 2 weeks, following which they commenced physiotherapy. The traction was applied with the arm at 90 degrees of abduction and the forearm in supination. None of the patients developed any complication, and all had the full range of movements. None had cubitus varus deformity, and none of these patients required further surgical treatment. There was a complete patient and parent satisfaction. Open or closed reduction with internal fixation is the most common method of treating these injuries, however in some cases this can be very difficult and dangerous. If the local anatomy and swelling do not allow this treatment then non-operative measures have to be adopted. We conclude that straight-arm lateral traction is a safe and effective method of treating these fractures, especially when the local anatomy is disturbed and the swelling makes operative intervention relatively more risky and difficult. Moreover, this method is also appropriate in areas where access to specialised centres in treating these injuries is either difficult or delayed.

Child↗
PubMed2000

Traumatic vertical atlantoaxial instability: the risk associated with skull traction. Case report and literature review.

Traumatic overdistraction between C1 and C2 may occur when all the ligaments connecting C2 to the skull are ruptured, and may be manifested when an attempt to reduce C1-C2 subluxation is made by means of traction. We describe here the case of a patient with traumatic anterior atlantoaxial dislocation, who developed atlantoaxial vertical dissociation after skull traction using a Gardner-Halo with lb 4.02 (1.5 kg) of weight. The identification of patients who are susceptible to this complication is difficult. In this case, it might have been prevented by avoiding spinal traction. The aim of this report was to show that vertical dissociation may occur in C -C2 anterior dislocation submitted to spinal traction, and that other forms of reduction must be considered to treat these pathologies and avoid this potentially fatal complication.

Adolescent↗
PubMed1982

Posteroanterior traction in maxillonasal dysplasia (Binder syndrome). A roentgen stereometric study with the aid of metallic implants.

The study was undertaken to examine the effect of posteroanterior traction in an 11-year-old boy with maxillonasal dysplasia. Movement of the maxillary bones and of the mandible was recorded, by means of roentgen stereophotogrammetry, in relationship to the frontal bone during and after treatment. In the examined child face-mask therapy mainly influenced the position of the mandible while the recorded advancement of the maxillary bones was slight (0.6 mm.). It is possible that the limited maxillary response to traction may be due to insufficient growth capacity of the circummaxillary sutures in a child with maxillonasal dysplasia. While movement of the maxillary bones and of the mandible during traction conformed with the pattern of treatment effect described by Delaire a total maxillary relapse occurred in the posttreatment observation period (no retention), possibly in adaptation to the retropositioned mandible. In our patient, posteroanterior traction accomplished improvement of the maxillary retrusion in relationship to the mandible only.

Child↗
PubMed1984

Orthopaedic traction device--an analysis of forces.

By using hanging weights as loads in traction treatment, one has to consider the transient forces created in the traction cord when the weights are displaced. These forces are transmitted to the patient who experiences them, at least in some circumstances, as pain or discomfort. In this paper we describe experiments by which these forces are measured. The traditional traction device, using hanging weights, is compared with two other devices. The study shows that by using these new traction devices--one with a clock spring, the other with a vacuum cylinder--as load generators, the transient forces are reduced to a great extent.

Acceleration↗
PubMed1995

"Preplacement" of the back of the halo vest in patients undergoing cervical traction for cervical spine injuries: a technical note.

BACKGROUND: In patients with unstable cervical spine injuries initially managed with in-line traction, there is some risk of loss of cervical alignment and of new neurologic deficit when the halo vest is applied. This report outlines a simple technique which facilitates halo application in these patients. METHODS: The back of the halo vest is "prepositioned" before traction is instituted. Once alignment is optimized, halo vest application is easily completed without lifting the patient or discontinuing cervical traction. RESULTS: The authors have used this technique in four patients without complication. CONCLUSIONS: In patients with unstable cervical spine injuries who require an initial period of in-line traction, halo vest application is made easier and safer by "prepositioning" the back of the vest.

Cervical Vertebrae↗
PubMed2005

The use of traction to simplify intramedullary fixation of paediatric forearm fractures.

A minority of paediatric and early adolescent diaphyseal forearm fractures require operative fixation. The method of closed reduction and intramedullary stabilisation of such fractures using stainless steel pins or flexible titanium nails has well documented success rates. The literature proposing their use advises the wires are inserted with the forearm resting free on a radiolucent arm table. In our experience, this technique is demanding; the fracture sites are unstable, often with soft tissue interposition, and the proximal radial fragment is difficult to control by closed means because of the overlying muscle mass. The technique, we describe, employs a standard Maquet Orthostar traction table (Maquet, Colima Ave, Hylton Riverside, Sunderland, UK) to effect a stable closed reduction of diaphyseal forearm fractures to simplify the procedure of passing the radial wire. The traction is then released to allow elbow flexion and the ulna wire to be passed, the ulna fracture having been reduced by the traction and stabilised by the radial wire. In summary, the use of traction to reduce and stabilise the radial fracture has simplified the surgery and reduced operative time.

Bone Wires↗
PubMed2006

Halo traction in basilar invagination: technical case report.

BACKGROUND: In the management of basilar invagination, traction therapy may help by pulling down the odontoid process away from the brain stem that may result in clinical and radiological improvement. We aimed to discuss the role of the halo vest apparatus traction on the reduction of severe anterior compression pathologies in basilar invagination. CASE DESCRIPTION: We describe a simple and safe cervical traction method by the halo vest apparatus that is followed by rigid posterior occipitocervical fixation and foramen magnum decompression in a patient who presented with basilar invagination and symptoms of severe brain stem compression. An MR-suitable halo vest apparatus was used for reduction of the deformity. The reduction of the basilar invagination was achieved gradually by distracting the halo crown in stages. CONCLUSION: The halo vest apparatus can be safely used in complex craniocervical junction anomalies. An effective cervical traction can be performed in basilar invagination, and reduction of the deformity may be achieved without the risk of overdistraction. In some cases, even partial reduction of the deformity may facilitate brain stem and spinal cord relief without any need of posterior decompression. Patients may benefit from ambulatory functions because bed rest is eliminated in this procedure. Neurovascular structures and the degree of the reduction can be observed on MRIs when an MR-suitable device is used.

Atlanto-Axial Joint↗
PubMed2003

The efficacy of traction for back pain: a systematic review of randomized controlled trials.

OBJECTIVE: To assess the efficacy of traction for patients with low back pain (LBP) with or without radiating pain, taking into account the clinical technique or parameters used. DATA SOURCES: A computer-aided search of MEDLINE, CINAHL, AMED, and the Cochrane Collaboration was conducted for randomized controlled trials (RCTs) in the English language, from 1966 to December 2001. STUDY SELECTION: RCTs were included if: participants were over the age of 18 years, with LBP with or without radiating pain; the intervention group received traction as the main or sole treatment; the comparison group received sham traction or another conservative treatment; and the study used 1 of 4 primary outcome measures. DATA EXTRACTION: The study was conducted in 2 strands. Strand 1 assessed methodologic quality using a specific criteria list recommended by the Cochrane Back Review Group. The strength of the evidence was then rated using the Agency for Health Care Policy and Research system. Strand 2 applied further inclusion criteria based on recommended clinical parameters. One reviewer conducted the selection and data extraction. DATA SYNTHESIS: Strand 1: 1 study scored 9 points (maximum score, 10 points); the other 12 scored between 0 and 3 points, indicating that most were of poor quality. Nine studies reported negative findings, but only 1 study was of a high quality. Three studies reported positive findings and 1 study was inconclusive. Strand 2: only 4 trials having low methodologic quality were included, 2 of which reported negative findings, and 2 positive findings. CONCLUSION: The evidence for the use of traction in LBP remains inconclusive because of the continued lack of methodologic rigor and the limited application of clinical parameters as used in clinical practice. Further trials, which give attention to these areas, are needed before any firm conclusions and recommendations may be made.

Humans↗
PubMed2001

Interface pressure produced by the traction post on a standard orthopaedic table.

Lower limb traction is applied with counter traction in the groin. The resultant tissue pressures can be high and may result in skin necrosis or nerve palsies. Volunteers were positioned on a fracture table and traction applied to the left leg. Perineal contact pressures were measured using pressure transducers connected to a laptop computer. Pressure readings and pain scores were recorded with different types of padding, whilst the leg was repositioned. Maximal pressures exceeded the 70 mmHg limit known to cause tissue damage. Larger (10 cm) padding devices significantly reduced the pressures. When employing the perineal traction post, care should be taken to pad this carefully to avoid the sequelae of high tissue pressure.

Humans↗
PubMed1997

Permanent Erb palsy: a traction-related injury?

Historically, the primary risk factor attributed to brachial plexus injury during birth has been excessive traction applied at delivery to an entrapped anterior shoulder. However, recent evidence has suggested that not all cases of brachial plexus palsy are attributable to traction. We have encountered several cases of permanent Erb palsy associated with birth that were not attributable to traction applied at delivery. We reviewed cases of neonates with documented permanent Erb palsy that occurred either in the absence of shoulder dystocia or in the neonate's posterior arm in the presence of anterior shoulder dystocia. We identified four cases that occurred in the absence of shoulder dystocia and four cases that occurred in the posterior arm of infants with anterior shoulder dystocia. These data further support the notion that the etiology of permanent brachial plexus palsy associated with birth may not be related to traction.

Dystocia↗
PubMed1984

New traction devices to aid reduction of shoulder dislocations.

A set of traction devices that aid in the reduction of shoulder dislocations is described and their use and efficiency are discussed. A series of 47 consecutive patients seen over a six-month period and diagnosed as having shoulder dislocations with no other major trauma composed the study population. After radiographic confirmation and premedication with analgesics and muscle relaxants, the devices were used. The traction- countertraction method was used initially. When this method was unsuccessful, the Stimson method was performed using an alternate traction strap. These devices were successful in 96% of the relocations attempted. No complications were encountered. The traction devices were found to be effective and easy to use.

Adolescent↗
PubMed1999

Traction may enhance the imaging of spine injuries with plane radiographs: implications for the laboratory versus the clinic.

OBJECTIVE: In some of our work to quantify injury we had been unsuccessful in quantifying confirmed bony damage with conventional X-ray positioning. This motivated the current study to evaluate whether external loading would enhance radiologic imaging and interpretation of spinal injuries. It was hypothesized that traction loads would enhance injury manifestation on planar radiographic images. DESIGN: Test-retest of fractured specimens both unloaded and loaded followed by dissection. METHODS: Fresh, and previously frozen, cervical spines of pigs (80 kg) were set in potting fixtures and subjected to various types of loads until failure occurred. An aluminum fixture frame was fabricated to clamp the vertebrae over the X-ray film, and apply calibrated traction loads. Injuries were evaluated during dissection and compared to radiographic film evidence. Three examples are demonstrated in this technical note. RESULTS: The application of 45-112 N (10-25 lbs) of traction load enabled the visibility of some injuries on film while it also enhanced imaging of others. CONCLUSIONS: Two major implications of this work when fractures are suspected are: Scientists using cadaveric material should consider the need to load spines in modest traction during positioning (112 N proved adequate in this study of porcine cervical spines) to enhance fracture imaging; we all need reminding that negative radiographs do not rule out massive fracture.

Animals↗