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The stable traction substitute with a JBPF seems a very promising indication for pinless clamps, offering good patient comfort and easy care. The implantation of a JBPF is possible under the same conditions as for conventional calcaneal traction. Although the stability provided is less than for conventional external fixators, it is sufficient for a temporary traction device. The JBPF does not affect secondary ORIF.
A consecutive series of 100 patients with femoral neck fractures were assessed by a mental test score on admission. The 67 scoring within the normal range were randomly assigned to skin traction or no traction between admission and operation. Using pain assessment scales and records of analgesic consumption, there was found to be little difference between the two groups. The conclusion was that skin traction offered no benefits in pain control for the patient and therefore should not be used routinely.
Treatment of severely comminuted unstable intra-articular finger fractures has three goals: reconstruction of the articular surfaces, prevention of redislocation of those surfaces, and proper healing of the capsuloligamentous apparatus. Dynamic circle traction (DCT), as described by Schenck (1986), is based on these principles and is the first method of treatment combining traction with intermittent or continuous passive motion. In order to improve on this method we applied continuous, instead of intermittent, passive motion in a newly developed DCT-device (continuous dynamic circle-traction = CDCT). Its first clinical use is discussed below. Our results with DCT, in eight patients, and CDCT, in four patients, are encouraging. Full function was regained at follow-up, in both groups, in three-quarters of the metacarpophalangeal (MCP) and half of the proximal interphalangeal (PIP) joints involved. Average loss of range of motion of the other MCP and PIP joints was 3.7 degrees and 5.6 degrees respectively. Treatment with CDCT may yield better results than DCT; the small number of patients treated and the relatively short period of follow-up does not justify comparison of both methods.
Patients in cervical traction for the treatment of cervical spine syndromes frequently complain that the traction makes them worse. It is possible that such patients may be suffering from TMJ symptoms. The physician treating a patient with cervical traction should consider prescribing an occlusal splint for patients without posterior teeth. The splint should be designed to distribute the stresses through the mandible to the maxillae via the teeth, splint, and TMJ.
Long periods of skeletal traction are frequently needed in busy tertiary centres due to long waiting lists for surgery. A frequent complication is pin track infection, which leads to revision of pin insertion or switching over to skin traction. A prospective study was conducted on sixty patients with upper tibial pin insertion for various causes. Antibiotic (injection Cephazolin 0.5 g after sensitivity testing--250 mg on each side) was injected on thirty patients at the site of pin insertion and no antibiotic was injected in 30 controls. Only one stage one pin track infection was seen in the study group (3% cases), where as six cases had stage 1 infection, one case had stage 2 infection and two cases had stage 3 infections in the control group (30% cases). This study showed the usefulness of this modification in preventing morbidity in patients who are planned for long-term skeletal traction by temporarily suppressing the local flora.
PURPOSE: We present our experience with traction-compression-closure (TCC) for exomphalos major (EM) to achieve a safe and embryologically correct midline supraumbilical aesthetic closure with preservation of the umbilicus. METHODS: Nineteen neonates with EM were paralyzed and ventilated. The abdominal domain was increased by upward cord traction to assist liver-bowel reduction by gravity and sac ligation, followed by circumferential elastic body binder compression. The supraumbilical abdominal wall anomaly cicatrized spontaneously or was closed surgically as a midline scar, with preservation of the umbilicus. RESULTS: Over 7 years (1998-2004), 19 patients with EM were treated by TCC, 18 of whom survived. The patients' median gestational age was 36 weeks (range, 24-40 weeks); their median birth weight was 2312 g (range, 890-3000 g). The median time to reduction was 4 days (range, 3-5 days), whereas that to full enteral feeds was 6 days (range, 4-6 days). Mechanical ventilation for 7 days (range, 6-8 days) was not associated with any morbidity, and the time to home discharge was 11 days (range, 8-12 days). Five patients did not require any surgery. There was no episode of sac rupture or infection. CONCLUSION: Abdominal expansion by vertical cord traction followed by compression reduction (TCC) under muscle relaxation and ventilation is time well spent toward a safe and aesthetic midline abdominal wall closure without tension for EM.
OBJECTIVE: Our objective was to describe the effect of off-axis traction on the performance of modern vacuum extractors. STUDY DESIGN: Eight vacuum extractors were examined in the laboratory with a force indicator and fetal cephalic model. Devices evaluated included the 6 cm Malmstrom, Mity-Vac, M-Type, O'Neil, Posterior, Silc, Tender-Touch, and silicone elastomer. Maximal tractive force (pop-off) was measured for each device at 10-degrees increments from the vertical. RESULTS: Multivariate regression analysis described the best model as follows: Maximal tractive force = Constant + Angle + Vacuum (p < 0.05). The partial regression coefficients for angle were negative in all devices except the Posterior cup. At increasing angles of off-axis traction, maximal tractive force decreased in the following order: Silc, silicone elastomer, Tender-Touch, M-Type, Mity-Vac, O'Neill, Malmstrom, and Posterior. CONCLUSIONS: Application of oblique traction resulted in a linear decline in maximal tractive force. An understanding of in vitro performance may allow tailoring of cup selection to the clinical situation.
BACKGROUND: Cervical lordosis has been shown to be an important outcome of care; however, few conservative methods of rehabilitating sagittal cervical alignment have been reported. OBJECTIVE: To study whether a seated, retracted, extended, and compressed position would cause tension in the anterior cervical ligament, anterior disk, and muscle structures, and thereby restore cervical lordosis or increase the curvature in patients with loss of the cervical lordosis. STUDY DESIGN: Nonrandomized, prospective, clinical control trial. METHODS: Thirty preselected patients, after diagnostic screening for tolerance to cervical extension with compression, were treated for the first 3 weeks of care using cervical manipulation and a new type of cervical extension-compression traction (vertical weight applied to the subject's forehead in the sitting position with a transverse load at the area of kyphosis). Pretreatment and posttreatment Visual Analogue Scale (VAS) pain ratings were compared along with pretreatment and posttreatment lateral cervical radiographs analyzed with the posterior tangent method for changes in alignment. Results are compared to a control group of 33 subjects receiving no treatment and matched for age, sex, weight, height, and pain. RESULTS: Control subjects reported no change in VAS pain ratings and had no statistical significant change in segmental or global cervical alignment on comparative lateral cervical radiographs (difference in all angle mean values < 1.3 degrees ) repeated an average of 8.5 months later. For the traction group, VAS ratings were 4.1 pretreatment and 1.1 posttreatment. On comparative lateral cervical radiographs repeated after an average of 38 visits over 14.6 weeks, 10 angles and 2 distances showed statistically significant improvements, including anterior head weight bearing (mean improvement of 11 mm), Cobb angle at C2-C7 (mean improvement of -13.6 degrees ), and the angle of intersection of the posterior tangents at C2-C7 (mean improvement of 17.9 degrees ). Twenty-one (70%) of the treatment group subjects were followed for an additional 14 months; improvements in cervical lordosis and anterior weight bearing were maintained. CONCLUSIONS: Chiropractic biophysics (CBP) technique's extension-compression 2-way cervical traction combined with spinal manipulation decreased chronic neck pain intensity and improved cervical lordosis in 38 visits over 14.6 weeks, as indicated by increases in segmental and global cervical alignment. Anterior head weight-bearing was reduced by 11 mm; Cobb angles averaged an increase of 13 degrees to 14 degrees; and the angle of intersection of posterior tangents on C2 and C7 averaged 17.9 degrees of improvement.
AIM: To evaluate the advantages of keeping the right inferior muscle in traction during external surgery for inferior retinal detachment. PATIENTS AND METHODS: This was a prospective study involving ten patients consecutively operated on for rhegmatogenous retinal detachment at the Toulouse-Rangueil Teaching Hospital. Internal plugging by air or a C2F6-air mixture was systematically performed, together with external indentation and total subretinal fluid puncture. At the end of surgery, a 2.0 silk thread was set beneath the right inferior muscle and kept in traction from the forehead for a few days. The patient was maintained feet up, in a dorsal decubitus posture. RESULTS: Results proved excellent, with ten anatomical successes. However, one patient had to have gas reinjected and in another subretinal fluid persisted for 3 months. DISCUSSION: The risk of surgical failure in inferior retinal detachment is greater because dabbing is more difficult to perform. To make this dabbing easier, we propose maintaining the ocular globe rearward by maintaining traction on the right inferior muscle, which produced excellent results. CONCLUSION: The technique proposed is easy to perform, and combined with internal dabbing and adequate patient positioning, it should help improve the surgical outcome of inferior retinal detachments.
Unstable intra-articular fracture-dislocations about the proximal interphalangeal joint present a formidable management dilemma. Fourteen patients with comminuted injuries of the proximal interphalangeal joint were treated with dynamic digital traction and followed for an average of 24 months. Dorsal fracture-dislocation and pilon-type injuries made up the majority of cases. Average proximal interphalangeal joint articular surface involvement was 80%. Immediate motion was instituted after traction application. The device was applied in the office with readily available materials. At final follow-up examination, active arc of motion averaged 89 degrees at the proximal interphalangeal joint and 95 degrees for patients sustaining isolated injuries. X-ray films revealed fracture union, joint remodeling, and preservation of joint space. Patient satisfaction was high, with return to previous levels of activity and excellent functional joint restoration. Dynamic digital traction is recommended for unstable proximal interphalangeal joint fractures with comminution, including those associated with subluxation or dislocation.
Unstable intra-articular fractures that involve the proximal and middle phalanges often lead to joint stiffness and loss of function. Ten patients with comminuted intra-articular fractures of the proximal interphalangeal (PIP) joint were treated by dynamic traction splinting and early mobilizations. Distal traction, with a force of 300 g, was provided by a rubber band connecting a transosseous wire to a movable component on an arcuate splint made of thermoplastic material. Intermittent passive movement was carried out on a timed schedule. Follow-up at 16 months (5 months to 51/2 years) showed a pain-free final range of motion (ROM) of 87 degrees (5 degrees to 92 degrees), with preservation of articular symmetry and space. this is the first report of treatment of intraarticular fractures in the hand by a combination of dynamic traction and passive movement.
Dynamic traction and early motion have been used by hand therapists to treat proximal interphalangeal joint fractures with good results. However, metacarpophalangeal joint fractures have been neglected, perhaps because of their relative infrequency. The purpose of this case study is to report the authors' experience using dynamic traction in conjunction with early motion to treat a construction worker who fell from scaffolding and sustained a complex fracture of the left smallfinger proximal phalanx with involvement of the metacarpophalangeal joint. Range of motion of the patient's left small finger at discharge from therapy, approximately 22 weeks postoperatively, was as follows: metacarpophalangeal joint, hyperextension/65 (85 degrees passive flexion); proximal interphalangeal joint, 20/80 (5/90 passively); and distal interphalangeal joint, 0/50 (65 degrees passive flexion). The patient made a successful return to full-time construction work. The results of this case appear to support consideration of the use of dynamic traction and early motion for management of selected metacarpophalangeal joint fractures.
The relationship between the applied torque and the load required to pull off the calipers was established on cadavers. Torques of 0.7, 0.8 and 0.9 Newton-metres were applied to a specially adapted skull traction caliper whilst attached to the skull in the normal position when used clinically, and loads were applied in steps of 2 lb up to a maximum of 60 lb. It was found that at a torque of 0.7 Newton-metres, the caliper became detached at the maximum load, but still held during traction at torques above this value. Taking into account the fall in load with time that may occur clinically and the limiting torque for pull-out with a traction load of 60 lb, it is suggested for complete clinical safety that a torque of 0.9 Newton-metres should be applied. An open-ended torque release spanner was set for 0.9 Newton-metres for clinical use such that the compressive load is sufficient to prevent pull-out even in the unlikely event of 60 lb being applied for up to 21 days.
Skin traction based on an Ilizarov frame has been used to achieve skin closure in five cases of infected non-union of the tibia including one case of infected knee arthrodesis. Five patients presented with infected non-union of the tibia (all Staph. aureus, two of them MRSA) with overlying sinuses discharging pus at an average 16 months from injury (range 3-36 months). The infections were treated by excision of the sinus and infected skin, excision of the infected non-union, stabilisation of bone with an Ilizarov circular frame and either acute shortening with compression followed by distraction (3 patients), or bone transport (2 patients). After excision of the sinus, the skin defect was gradually closed using a skin traction device placed on an Ilizarov circular frame. The size of the wounds ranged from 5 x 14 cm to 3 x 5 cm and skin traction was completed at 4 weeks (range 2-8 weeks). When the wound edges were approximated, the wires were left in place until healthy granulation tissue built up to seal the remaining gap (sutures were used in two patients). At follow-up assessment at 18 months (range 7-24 months), all non-union were solidly united with no signs of infection of either the bone or underlying skin. The quality of skin at the stretching site was found to be of normal sensation, colour, mobility but thinner than normal. The quality of the skin at the docking site (left to granulate) was found to be adherent to the underlying bone, red or pink in colour, hypersensitive in 2 patients and numb in 3 patients.
The causes of Spinal-Traction-Syndrome are discussed in a case of marked Spinal-Traction-Syndrome, that appeared after correction of a thoracal scoliosis, instrumented according to Harrington. On account of our case we tend to support the opinion, that the cause for the Spinal-Traction-Syndrome is to be seen rather in the mechanical obstruction of the flexura duodeno-jejunalis than in the overstretching of vagus nerve.
Cervical traction and lumbopelvic traction are commonly prescribed for relief of neck pain and low back pain, respectively. Scientific validation of efficacy is scant, but considerable empirical benefit has been observed. In the absence of contraindications and with appropriate application, cervical and lumbopelvic traction may be used to provide symptomatic relief of neck and low back pain.
Rheumatoid cervical myelopathy presents one of the most daunting challenges in neurological surgery. Preoperative cervical traction can help to distract the dens from the brainstem prior to performing occipitocervical fusion in cases of cranial settling. Valuable millimetres gained in preoperative traction can be lost in placing the patient in the prone position after removing the halo to allow application of the Mayfield skull clamp. The authors have found that traction can be adequately maintained during surgery by applying the Mayfield skull clamp with skull pins to the halo ring itself.
PURPOSE: To study the influence on pain and handling of different preoperative immobilization procedures for hip fractures. METHOD: 123 consecutive patients with displaced cervical and trochanteric hip fractures were randomized to skin traction, placement in a special foam pillow (Lasse pillow), and comfortable placement with an ordinary pillow under the hip from admission to operation. The effect on pain alleviation was evaluated with a Visual Analogue Scale and by the number of doses of analgesics administered. The processing time through the emergency department, X-ray department and to the ward as well as time to operation was registered. RESULTS: No clinically significant difference in the VAS pain evaluation was found. There was no difference in the total consumption of analgesics in the emergency department or on the ward and no effect of immobilization type on the processing time or time to operation. Fracture type did not affect the outcome. Approximately one third of the patients found placement on a regular pillow or the application of skin traction uncomfortable as opposed to only one of 19 of the patients lying in the special Lasse pillow. There was no other difference in processing time with regard to different forms of pillow nursing and skin traction. CONCLUSION: The most convenient immobilization should be chosen as there is no significant difference concerning pain and handling time. Increased attention to analgesic medication and rapid handling to be operated are of importance to promote the rehabilitation process.