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PubMedDate not supplied

Lateral traction during shoulder arthroscopy: its effect on tissue perfusion measured by pulse oximetry.

We studied the effect of three methods of shoulder traction during arthroscopy on arterial oxygen saturation measured by a pulse oximeter applied to the fingertip of the arm in traction. Simple longitudinal traction ablated the oxygen saturation in only 1 of 30 patients. Adding vertical traction perpendicular to the arm ablated the oxygen saturation in 25 of 30 patients when a 2-inch wide sling was used and in 7 of 30 patients when a 4-inch sling was used. In this series, the pulse oximeter did not demonstrate gradual gradations in arterial oxygen saturation loss. Rather, the pulse oximeter provided an all-or-none warning signal for tissue hypoxia.

Adolescent↗
PubMed2006

One-stage combined surgery with or without preoperative traction for developmental dislocation of the hip in older children.

PURPOSE: To compare one-stage combined surgery with and without preoperative traction, in older children with developmental dislocation of the hip (DDH). METHODS: Records of 9 children who underwent combined surgery for DDH with preoperative traction in 12 hips (group 1) and 12 undergoing the same procedure without preoperative traction in 16 hips (group 2) were retrospectively reviewed. The surgery consisted of open reduction, Salter's innominate osteotomy and femoral shortening with derotation varus osteotomy. The mean age of the patients at the time of operation was 5.8 years. The mean follow-up period was 5.9 years. RESULTS: At final follow-up, clinical outcome in group 1 was worse than that in group 2, though radiographic assessment demonstrated no significant difference between the groups. CONCLUSION: One-stage combined surgery without preoperative traction is effective in the treatment of DDH in older children, and has a lower complication rate, but radiographically the groups did not differ.

Bone Diseases, Developmental↗
PubMed1981

The use of Perkins' traction in the treatment of femoral shaft fractures.

The treatment of fractures of the femoral shaft by traction may delay union and produce stiffness of the knee. The technique of Perkins' method is described and the results reported in 50 cases. All patients had at least 120 degrees of flexion of the knee when traction was discontinued, and 47 patients were considered to have clinical and radiological union of the fracture by 12 weeks. The main complications of the method was loosening of the Denham pin or infection of the pin-track in the proximal tibia. It is suggested that Perkins' traction is an excellent form of treatment for fractures of the femoral shaft, and has several advantages over other forms of traction.

Adolescent↗
PubMed2004

Complications associated with traction on the hip during arthroscopy.

We studied 16 hips (eight cadaver specimens) using arthrography, arthroscopy and anatomical dissection, under incremental traction of up to a maximum of 64 kg, to determine the relationship of the portals to nearby neurovascular structures. The distance of each arthroscopic portal (anterior, anterolateral, and posterolateral) to the associated neurovascular structures was measured after the application of 23 kg of traction. Traction of up to 64 kg on the lower limb failed to produce evidence of labral or capsular injury. Furthermore, traction of 23 kg resulted in little change in the position of adjacent neurovascular structures relative to the standard arthroscopic portals.

Arthroscopy↗
PubMedDate not supplied

Traction intolerance syndrome: a psychiatric complication of femoral fractures.

Traction Intolerance Syndrome is defined as a behavioral and/or emotional reaction related to skeletal traction severe enough to require psychiatric consultation and/or the use of major psychiatric medication for prolonged periods in the absence of pre-existing major psychiatric illness. Patients often attribute these reactions to the predicament of traction. This syndrome was present in five of nine patients between the ages of sixteen and forty-five who underwent traction for more than three weeks admitted to the UCLA Orthopedic Service during calendar year 1975. Moreover, all the patients were between sixteen and twenty-six years of age, and all the patients in that age range developed the syndrome. The multiple contributions to the pathogenesis of these reactions are described, and the interventions of the liaison psychiatrist in intervention at the biological, psychological, family and hospital staff levels are discussed.

Adaptation, Psychological↗
PubMed2001

Clinical outcome from mechanical intermittent cervical traction for the treatment of cervical radiculopathy: a case series.

STUDY DESIGN: Case series. OBJECTIVE: To describe the clinical outcomes of 15 patients with cervical radiculopathy treated with mechanical intermittent cervical traction. BACKGROUND: Effectiveness of traction for the treatment of cervical spinal syndromes is controversial and the outcome of this treatment has not been established in the literature. METHODS AND MEASURES: Fifteen patients (45.5 +/- 13 years) completed a course of treatment using mechanical intermittent cervical traction. Eleven patients presented at baseline with radicular symptoms of 12 weeks duration or less, and 4 patients had long-standing radicular symptoms lasting more than 12 weeks. Outcome was measured using the Neck Disability Index (NDI) and the Numeric Pain Rating Scale (NPRS). RESULTS: Eight of the 15 cases (53%) in this series demonstrated complete pain resolution; these patients had symptom duration of 12 weeks and less. Seven of these 8 cases displayed a final NDI of 10% or less. Three out of 4 of the patients with symptom duration more [corrected] than 12 weeks showed no reduction in pain or increased pain rating, with minimal change in perceived disability of 12% or less. CONCLUSION: In this case series, patients with radicular symptoms lasting for 12 weeks and less demonstrated a reduction in pain and perceived disability. The NDI, when used in conjunction with the NPRS, provides a more comprehensive assessment of the patient with cervical radiculopathy, thus allowing the clinician to make a better judgment about the clinical effects of cervical traction.

Adult↗
PubMed2004

Intermittent cervical traction and thoracic manipulation for management of mild cervical compressive myelopathy attributed to cervical herniated disc: a case series.

STUDY DESIGN: Case series. OBJECTIVE: To describe the management of 7 patients with grade 1 cervical compressive myelopathy attributed to herniated disc using intermittent cervical traction and manipulation of the thoracic spine. BACKGROUND: Intermittent cervical traction has been indicated for the treatment of patients with herniated disc and has been suggested to be helpful for patients with cervical compressive myelopathy. Manipulation of the thoracic spine has been utilized to safely improve active range of motion and decrease pain in patients with neck pain. METHODS AND MEASURES: Seven women with neck pain, 35 to 45 years of age, were identified as having signs and symptoms consistent with grade 1 cervical compressive myelopathy. Symptom duration ranged from less than 1 week to 52 weeks. All patients were treated with intermittent cervical traction and thoracic manipulation for a median of 9 sessions (range, 2-12 sessions) over a median of 56 days (range, 14-146 days). Numeric Pain Rating Scale and Functional Rating Index scores served as the primary outcome measures. RESULTS: The median decrease in pain scores was 5 (range, 2-8) from a baseline of 6 (range, 4-8), and median improvement in Functional Rating Index scores was 26% (range, 10%-50%) from a baseline of 44% (range, 35%-71%). Dizziness was eliminated in 3 out of 4 patients and chronic headache symptoms were improved in 3 out of 3 patients. There were no adverse events or outcomes. CONCLUSIONS: Intermittent cervical traction and manipulation of the thoracic spine seem useful for the reduction of pain scores and level of disability in patients with mild cervical compressive myelopathy attributed to herniated disc. A thorough neurological screening exam is recommended prior to mechanical treatment of the cervical spine.

Adult↗
PubMed1980

The effect of axial tension on the load bearing capacity of traction pins.

Skeletal traction is often used in the conservative treatment of fractures. Although a small diameter traction pin causes less trauma, its use is limited by the strength of the pin and the holding power of the bone. Both theoretical analysis and in vitro experiments were conducted to investigate the bending resistance of traction pins subjected to an applied traction force. The results of this study indicate that thin K-wires could be prevented by applying tension. The possibility of a pin cutting through bone is minimal if the cortical bone structure of the patient is normal. However, further in vivo study is necessary to ascertain whether necrosis might occur due to excessive contact stress between the pin and the bone.

Bone and Bones↗
PubMed1980

Auto-traction for treatment of lumbago-sciatica. A multicentre controlled investigation.

In this controlled prospective study of the Auto-traction method for the treatment of lumbago-sciatica, 82 patients were randomly allocated to either treatment with Auto-traction for up to three 1-hour sessions in 1 week, or they were given a corset and advised to rest. The orthopaedic surgeons participating in the study worked at six different hospitals and all had limited experience of the Auto-traction method obtained during a 1-week course. All patients were clinically evaluated by an independent observer who also performed the follow-up examinations 1 and 3 weeks after the treatment sessions. In addition a 3-month follow-up was performed by letter. The Auto-traction method gave prompt relief of pain and a normalizing of the SLR test more often than treatment with only a corset and rest. The difference between the two treatment groups was statistically significant. The immediate difference noted between the treatment groups had decreased slightly at 3 weeks but was still statistically significant at this time.

Back Pain↗
PubMedDate not supplied

Blood pressure and pulse rate changes associated with cervical traction.

BACKGROUND: This study was carried out at the Physiotherapy unit of the University of Maiduguri Teaching Hospital, to observe the effects of continuous cervical traction for 10 minutes on arterial blood pressure and pulse rate. METHODS: Forty healthy subjects free of any cardiovascular complications, participated in the study. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse rate (PR), were recorded before, during and after the application of cervical traction 10% body weight, using spty-pulse 2000 Electronic sphygmomanometer. RESULT: Analysis of variance showed statistically significant (P < 0.05) increase in systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse rate (PR) from 114.6 +/- 10.4 mmHg, 72.4 +/- 9.5 mmHg and 71.7 +/- 5.9 beats/min to 123.5 +/- 9.8 mmHg, 77.9 +/- 8.9 mmHg and 78.2 +/- 5.7 beats/min respectively following traction. CONCLUSION: It is advised that clinicians should comprehensively assess all cardiovascular parameters of patients before applying cervical traction.

Adult↗
PubMedDate not supplied

The setup and care of a patient in Buck's traction.

Buck's traction is certainly one of the more common traction setups seen in orthopaedic patient care today. However, just because it is common doesn't mean we can take it for granted. Specific setup techniques as well as patient evaluation methods must be understood if the traction is to accomplish its task. The goal of this article is to go through some of the basics in techniques and perhaps explain why this traction is so commonly used.

Beds↗
PubMed1999

[Traction-mobilization in 2-stage treatment of infected total knee prosthesis. Apropos of 12 cases].

INTRODUCTION: A two stages reimplantation is advised by most authors in salvage of infected total knee arthroplasty. This treatment is more difficult, but seems more successful in controlling infection. It set the problem of the attitude between the two operative stages: an antibiotic cement spacer is usually used, but articular mobilization is not possible, except with an articulating spacer. MATERIAL AND METHODS: Since 1989, we use traction-mobilisation between the two operative stages, with mobilization under traction up to 50 degrees, and on edge of bed up to 70-90 degrees, till the reimplantation. We used this method on 12 cases of chronic infection in total knee arthroplasty. The reimplantation was done 34 to 47 days later. The reimplantation was more easy and more comfortable in approach and exposition, and post operative mobilisation easier. RESULTS: We did not have any recurrence of infection in this patients, but the follow up is too short for some of them. One prosthesis was removed for mechanical failure. The mean range of motion is 86 degrees at two months, 96 degrees at one year. DISCUSSION: The antibiotic cement spacer presents the disadvantage of leaving material in a potentially infected environment. It does not allow mobilisation, except using an articulating spacer. Traction-mobilisation keep articular flexion, allows mobilization, and does not leave any material in articulation. But this method has the disadvantage of requiring an hospital care between the two stages: that is reasonable if the delay is short. CONCLUSION: Traction mobilization seems to be an alternative to cement spacer. It makes the reimplantation easier, facilitates post operative recovery of mobility, and does not seem to increase recurrence of infection.

Aged↗
PubMed2001

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

PURPOSE OF THE STUDY: The purpose of this experimental study was to compare posterior fixation systems using hooks and screws implanted in the thoracic spine. This study was completed by a digital analysis using the finished element method. MATERIAL AND METHODS: For the experimental study, we used 7 human thoracic spines. Forty-nine groups of 2 vertebrae were individualized. Traction was applied to maximum breaking force measured on an Instron. We used two types of instrumentations, alternating 4 pedicle screws and 2 pedicle-lamina hooks. For the digital study, we used a vertebral model composed of nearly 63 000 nodes and 14 000 elements. Elastic field calculations were carried out with a finished element abacus. RESULTS: The base of the pedicles broke when traction was applied to a pedicle-lamina hook assembly. The medial part of the pedicle broke when traction was applied to a pedicle screw assembly. Maximul break strength for hooks was 1 108 +/- 510 N. It was 820 +/- 418 N for 4 mm diameter screws and 1 395 +/- 435 for 5 mm screws. The most fragile vertebrae were T5-T6 and T7-T8. the screw-instrumented model showed that stress concentrated on the medial aspect of the pedicle, inside the medullary canal. Using a long screw did not reduce the stress force significantly. The hook-instrumented model showed that stress was greatest on the lower part of the pedicle. DISCUSSION: From a mechanical point of view, screw instrumentation is the more appropriate type of fixation. Screw fixation did not however demonstrate its superiority during the traction tests. For 4 mm screws, resistance was 23% weaker than with a hook assembly and for 5 mm screws, it was only 12% stronger. Pullout may be attributed to two principal causes, either fracture of the bony anchoring of the screw system or breakage of the pedicle. Bone thread pullout occurs when the screw threads do not penetrate sufficiently deep into the cortical bone due to the small diameter of the screw shaft. Using a larger diameter screw raises however the problem of damaging the pedicle. Pedicle breakage is seen with stronger stress forces and constitutes the upper limit of maximum break force. This leads us to formulate the hypothesis that in most cases, screw pullout occurs by breakage of the bony threading. Screws are less effective if they are not properly anchored in the pedicles, probably the reason for their relative weakness. Screw diameter should be adapted to the size of each pedicle. This would allow better transmission of stress from the screw to the pedicle. Hooks apply further stress to the vertebrae. The digital study showed that using a long screw crossing through the vertebra does not reduce the stress applied to the pedicles enough to justify its use.

Aged↗
PubMed1992

Intermittent cervical traction: a progenitor of lumbar radicular pain.

Twelve patients treated with cervical traction for complaints of cervical radicular pain subsequently developed lumbar radicular discomfort. Intermittent cervical traction therapy had been initiated at 15 pounds and increased to 30 pounds. Lumbar spine roentgenographs in four patients demonstrated a transitional lumbar vertebrae and ten patients had evidence of spinal osteoarthritis with associated degenerative changes. Abnormal electroneuromyographs were found in four patients. In two additional patients with normal electromyographs, the spinal evoked potentials were asymmetrically slowed suggesting chronic lumbar root compromise. The onset of lumbar radiculopathy after intermittent cervical traction suggests that axial tension induced in the spinal cord's dural coverings can be transmitted to lumbar nerve roots. When these structures are tethered by anatomic variants and/or associated degenerative changes, spinal root excursion may be limited, and lumbar pain may be precipitated by traction.

Adult↗
PubMed2004

Traction splint. An EMS relic?

Traction splints have been used in EMS for more than 40 years. However, they were originally designed for the treatment of femoral fractures -- not temporary stabilization. Multisystem trauma and other injuries contraindicate traction splint usage for many femoral fractures. Thus, with the relatively low usage of the traction splint, it may be time to revisit guidelines that require traction splints on every ambulance and rescue vehicle. They may be, in essence, an EMS relic we may want to part with.

Ambulances↗
PubMed2004

A modified method of traction for young children with congenital dislocation of the hip as a preliminary to reduction.

Many authors agree that preliminary traction prior to closed or open reduction for congenital dislocation of the hip is helpful. Different ways of traction have been used and each of them has its own advantages and disadvantages. One of the problems in the very young child is the difficulty in maintaining a suitable traction that is biomechanically effective. We found that using a rocker bed made the traction more "user friendly" for the child, the parent and the doctors.

Arthrography↗
PubMed2005

Development of a new mouth opening force test using an indirect cervical traction device.

BACKGROUND AND AIMS: There have been few reports of objective jaw opening tests, and such studies have involved devices specifically designed for research. In the present study, in order to conveniently and objectively assess mouth opening movements, we replaced the manual resistance used in Daniels and Worthingham's muscle test (DMT) with an indirect cervical traction device. We examined whether the maximum mouth opening force (MOF) could be reliably quantified using this device. METHODS: The subjects were 12 healthy individuals with a mean age of 28.8 years. The MOF measurement procedure was as follows: 1) the subject sat in the chair, and a head belt was placed under the chin so that a traction force was applied almost parallel to the body axis; 2) the researcher instructed the subject to maintain the maximum mouth opening; 3) as maximum resistance was approached, the rate of increase in the traction force decreased. Maximum opening force was recorded; 4) one measurement was taken per session, for a total of two measurements per subject. Pearson's correlation coefficients were used to assess the reproducibility of MOF values. RESULTS: The average MOF (mean +/- SD) in the first and second tests was 24.2 +/- 1.9 and 24.5 +/- 2.0 kg. There was an extremely high correlation between first and second measurements (r = 0.969). CONCLUSIONS: The presently described indirect cervical traction device can be used to reliably quantify MOF.

Adult↗
PubMed2005

[Outcome of hip fractures after traction treatment in elderly].

OBJECTIVE: To observe the outcome of hip fractures which accepted traction treatment instead of operation considering their general condition in elderly. METHODS: 102 cases of hip fractures accompanied by heart disease, hypertension, diabetes etc from Nov. 2000 to Jan. 2005 were accepted traction treatment. Among them, 37 cases are femoral neck and 65 cases are femoral intertrochanteric fractures. The average age was 75.8 years old, ranging from 48 to 98 years old. All cases were treated at home. RESULTS: one-year mortality was 8.8% (9/102). According to the incidence, the complications include bedsore (30/102, 29.4), pulmonary infection (6/102, 5.9%), DVT (2/102), PE (1/102), Urine infection (1/102). The rate of healing in femoral neck fractures was 51.7% (15/29); in intertrochanteric fractures was 97.6% (40/41). The decrease of Harris score between pre-injury and post-injury was 23.1 in femoral neck fractures and 15.6 in intertrochanteric fractures. CONCLUSION: For non-displacement and stable femoral neck fractures and some intertrochanteric fractures, good results could be obtained by traction treatment. Considering its low cost, traction treatment had its own indications.

Aged↗