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At least 433 records · Page 24Linked to original sources
PubMed1999

Cranial nerve palsy as a complication of operative traction.

STUDY DESIGN: Case report. OBJECTIVE: This report documents one case of diplopia from abducens (sixth cranial) nerve palsy after spinal surgery using a Jackson table and cranial traction. SUMMARY OF BACKGROUND DATA: Cranial nerve deficits have frequently been described in the orthopedic literature after trauma, halo pelvic traction, and halo skeletal fixation. The theorized mechanism of injury to the abducens nerve involves stretch or traction force, which causes localized ischemia or a change in nerve position. An extensive literature search failed to show this type of injury using Gardner-Wells tongs in conjunction with the Jackson table. METHODS: This is a case report that included a chart review, examination of the patient, and a literature search. RESULTS: The patient had complete spontaneous resolution of abducens nerve dysfunction within 6 months. CONCLUSIONS: It is important for the surgeon to be aware of this potential complication and to inform patients who have diplopia that develops from abducens nerve palsy that most of these cranial nerve deficits spontaneously improve.

Abducens Nerve Injury↗
PubMed2001

Acute respiratory compromise associated with flexed cervical traction after C2 fractures.

STUDY DESIGN: Acute respiratory compromise is occasionally observed in a subgroup of patients with upper spinal injuries involving the C2 vertebrae. A retrospective review was performed to identify fracture types and risk factors for early respiratory deterioration following injury to the upper cervical spine. OBJECTIVES: To examine the frequency of respiratory complications encountered following traction manipulation of specific upper cervical spinal injuries involving the C2 vertebrae. SUMMARY OF BACKGROUND DATA: Major complications related to cervical skeletal traction are uncommon. Respiratory compromise with occasional mortality has been observed. Risk factors for acute respiratory failure are unknown. METHODS: The medical records of 166 consecutive patients with fractures of the C2 vertebrae admitted between January 1994 and July 1998 to a regional spinal cord injury center were examined. Demographic data, injury subtype, fracture displacement, respiratory status, treatment method, and outcome at discharge were examined. Patients with comorbidities compromising respiratory function were excluded. RESULTS: One hundred fifty-five patients met the inclusion criteria of this study. Sixty-one patients had Type II odontoid fractures of which 53 were displaced (32 posteriorly and 21 anteriorly). In addition, there were 21 patients with Type III odontoid fractures, 33 with axis C2 body fractures, 32 with Hangman's fractures, and eight patients with an os odontoideum. Thirteen of 32 patients with posteriorly displaced odontoid fractures experienced acute respiratory compromise following reduction with cervical skeletal traction and immobilization, while only three of the remaining 123 patients had respiratory difficulties. Respiratory distress as a consequence of cervical spine fractures resulted in three deaths. Two of these patients had posteriorly displaced Type II odontoid fractures whose airway could not be emergently intubated. CONCLUSION: Frequent respiratory deterioration (40% of patients) during acute management of posteriorly displaced Type II odontoid fractures after reduction was observed. Physicians must be aware that cervical flexion in the treatment of posteriorly displaced odontoid fractures may significantly increase the risk of airway obstruction due to the presence of acute retropharyngeal swelling. This may be avoided with elective nasotracheal intubation in this upper cervical spine fracture subtype.

Acute Disease↗
PubMed2001

The use of traction methods to correct severe cervical deformity in rheumatoid arthritis patients: a report of five cases.

STUDY DESIGN: A case series is presented. OBJECTIVES: To describe the methods of correction used in this study for flexible severe cervical deformity, and to report the results in patients with rheumatoid arthritis. SUMMARY OF BACKGROUND DATA: Long-standing rheumatoid arthritis can lead to severe cervical deformity, causing significant functional deficits and poor cosmesis. Information on the use of traction combined with surgical stabilization to achieve correction of flexible deformity in rheumatoid patients is sparse in the English literature. METHODS: A review of five cases, including pertinent history, physical examination, radiographic evaluation, traction techniques, surgical stabilization, and outcomes, was conducted. RESULTS: Excellent correction of deformity and radiographic union were achieved in all the patients. One patient had minimal loss of correction after surgery and thereafter remained stable. Pin tract infections were the only significant complication. CONCLUSIONS: Severe cervical flexible deformity in rheumatoid patients can cause significant disability and can be treated successfully with a combination of traction techniques and surgical stabilization.

Adult↗
PubMed2001

Scoliosis and severe pelvic obliquity in a patient with cerebral palsy: surgical treatment utilizing halo-femoral traction.

STUDY DESIGN: Case report of severe scoliosis and associated pelvic obliquity in a 14-year-old patient with cerebral palsy. OBJECTIVES: To report the presentation of the case, the operative considerations, and the management of this spinal deformity. SUMMARY OF BACKGROUND DATA: Spinal deformity in cerebral palsy may include scoliosis, kyphosis, and hyperlordosis. Pelvic obliquity is a frequent feature associated with neuromuscular scoliosis. The severity of the pelvic obliquity deformity presented here is unusual, and this case study delineates an effective surgical treatment plan for these patients using intraoperative halo-femoral traction. METHODS: A same-day, two-stage surgical reconstruction was performed to effectively correct this spinal deformity. The patient underwent an anterior spinal fusion from T10 to S1 and a posterior spinal fusion from T2 to the pelvis; the posterior procedure was performed with the patient in intraoperative halo-femoral traction. Sacral fixation was obtained using the Galveston technique bilaterally. RESULTS: The patient responded well to surgical intervention, had no complications, and continues to have stable correction of his pelvic obliquity deformity 2 years after surgery. CONCLUSION: It is concluded that scoliosis with associated severe pelvic obliquity deformities can be treated with anterior and posterior spinal fusion and instrumentation with intraoperative halo-femoral traction in the properly selected and prepared patient with cerebral palsy.

Adolescent↗
PubMed2006

CT imaging techniques for describing motions of the cervicothoracic junction and cervical spine during flexion, extension, and cervical traction.

STUDY DESIGN: Computerized tomographic study of human cadavers undergoing traction and flexion-extension bending. OBJECTIVES: To investigate the feasibility of using computerized tomography techniques to quantify relative vertebral motions of the cervical spine and cervicothoracic junction (CTJ), and to define normative CTJ kinematics. SUMMARY OF BACKGROUND DATA: Despite developing an understanding of the mechanical behavior of the cervical spine, little remains known about the cervicothoracic junction. The CTJ is more difficult to image than other cervical regions given the anatomic features of the surrounding bones obstructing CTJ visualization. As such, limited data have been reported describing the responses of the CTJ for motions and loading in the sagittal plane, confounding the clinical assessment of its injuries and surgical treatments used at this region. METHODS: Helical CT images of the cervical spine and CTJ were acquired incrementally during each of flexion, extension, and cervical traction. Vertebral surfaces were reconstructed using the specialized image analysis software, 3DVIEWNIX. A mathematical description of relative vertebral motions was derived by computing rigid transformations. Euler angles and translations were calculated. Regional spine stiffness was defined for traction. RESULTS: The CTJ was found to be much stiffer (779 N/mm) than the cervical spine (317 N/mm) in tension. In flexion-extension bending, the CTJ was similar to the lower cervical spine. The CTJ demonstrated significantly less coupled motion than the cervical spine. CONCLUSIONS: The CTJ, as a transition region between the cervical and thoracic spines, has unique kinematic characteristics. This application of kinematic CT methods is useful for quantifying unreported normative ranges of motion for the CTJ, difficult by other conventional radiologic means.

Aged↗
PubMed2003

Treatment of complex interphalangeal joint fractures with dynamic external traction: a series of 20 cases.

Data are reported for a series of 20 patients who were treated with the pins and rubbers traction system for fractures of the proximal interphalangeal joints of the long fingers. This technique allows fracture reduction with external dynamic traction and immediate active mobilization. Two patients in the series were lost to follow-up monitoring. For two others, the pins and rubbers traction system needed to be removed early (during the first week) because of intolerance or infection. Sixteen patients who were reexamined after minimal follow-up periods of 1 year demonstrated a mean active range of motion of 85.9 degrees for the injured joint; only one patient experienced intermittent pain.

Adolescent↗
PubMed2002

Skeletal traction and delayed percutaneous fixation of complicated supracondylar humerus fractures due to delayed or unsuccessful reductions and extensive swelling in children.

The functional and radiological results of 13 supracondylar humerus fractures of 13 children were evaluated to determine the efficiency of delayed percutaneous fixation of the fractures after a period of skeletal overhead traction. All the fractures were complicated by delayed reduction, extensive swelling or unsuccessful reduction manipulations. As the unfavourable preexisting factors subsided under skeletal traction, anatomical reduction and fixation of fractures by percutaneous pinning were performed under general anesthesia. The average follow-up period was 21 months. Bauman and lateral capitellohumeral angles were measured and statistically analyzed. Functional and cosmetic results were evaluated by physical examination of the elbows. There were 11 excellent and two fair functional results while all cosmetic results were excellent or good. As a result, skeletal traction and delayed percutaneous pinning is accepted as an alternative method of treatment for complicated supracondylar humerus fractures in children.

Bone Nails↗
PubMedDate not supplied

Internal fixation versus traction and casting of adolescent femoral shaft fractures.

We compared the results of traction plus subsequent casting with rigid internal fixation in a large series of adolescent femoral shaft fractures. Of 90 patients with 96 femoral shaft fractures, 49 (52 fractures) underwent rigid internal fixation, whereas 41 (44 fractures) underwent traction and subsequent casting until healing occurred. The traction and casting group had a mean hospital stay of 26 days. The operative group had a mean hospital stay of 9 days and had fewer complications than the nonoperative group. Adolescent femoral shaft fractures can be operatively treated with excellent results and a decreased complication rate. Operation results in shorter hospitalization, which has psychological, social, educational, and economic advantages over conservative treatment.

Adolescent↗
PubMedDate not supplied

The use of modified Neufeld's skeletal traction in children and adolescents.

A modified form of Neufeld's skeletal traction is described. This technique is a useful method of treating children and adolescents with femoral or pelvic fractures. The advantage over standard femoral skeletal traction is early mobilization of the patient to a sitting position. Additionally, the patient can be placed in this form of traction at home, allowing earlier discharge from the hospital.

Adolescent↗
PubMedDate not supplied

Experimental traction injuries of ventral spinal nerve roots. A scanning electron microscopic study.

The aims of this experimental scanning electron microscopic study were to identify the levels at which cervical ventral nerve roots, or the rootlets by which they are attached to the spinal cord, rupture under traction and to document the resulting damage. This information would provide the basis of a rationale for repairing rootlet avulsions which may follow brachial plexus traction injuries in man and which cause severe impairment of upper limb function. Traction was applied to C4 to T1 ventral roots until rupture occurred, in 10 freshly fixed and three living anaesthetized Wistar albino rats and in one human post-mortem specimen. Rupture occurred at the rootlet-cord junction in 80% of cases. Most individual myelinated fibres broke at the central-peripheral nervous system (CNS-PNS) transitional node which, in the cervical region, lies at the bottom of an endoneurial invagination surrounding each fibre and extending deep to the cord surface. Fibre rupture at more distal levels occurred internodally, and a length of axon commonly protruded well beyond the level of sheath rupture. Some sheaths broke cleanly across but the torn surfaces of others tapered, perhaps because of rupture at Schmidt-Lanterman incisures. The cellular and connective tissue rootlet sheaths ruptured where they were continuous with the pia mater. Ruptured fixed and unfixed tissues were ultrastructurally similar. It is clear from the findings of this study that regeneration would take place entirely in a PNS environment. The endoneurial invaginations would ensure that sprouts emerging from transitional nodes would be guided distally into rootlets surgically apposed to the torn transitional zone.

Animals↗
PubMed1986

MR imaging of the acutely injured patient with cervical traction.

Magnetic resonance (MR) imaging of the patient with acute cervical injury is important because of the potential prognostic significance of the appearance of the spinal cord at the time of injury. However, cervical traction may involve equipment incompatible with the magnetic environment, and transferring the patient to the imaging table may make it difficult to maintain traction. The authors describe a simple, inexpensive, and reliable method for providing cervical traction within the magnet room.

Humans↗
PubMed2004

Laboratory stresses and tractional forces on the TMJ disc surface.

The etiology of degenerative disease of the TMJ may involve fatigue produced by surface tractional forces and compressive stresses. This study tested the time-dependent effects of compressive loading and stress-field translation on TMJ disc-surface tractional forces and stresses. In laboratory experiments with 50 porcine discs, an acrylic indenter imposed 10 N static loads for 10 and 60 sec, followed by translation of the loaded indenter along the mediolateral axis of the disc. Maximum tractional forces were found to occur following 60 sec of static loading (p < 0.001), and increased with translation velocity (R(2) = 0.73); whereas maximum compressive stresses occurred after 10 sec of static loading (p < 0.001). Overall, the results were consistent with current mechanical theories of the time-dependent effects of compressive loading of cartilage.

Animals↗
PubMed2004

The effect of cervical traction combined with conventional therapy on grip strength on patients with cervical radiculopathy.

OBJECTIVE: To determine if combining intermittent cervical traction with conventional physical therapy methods is more effective than using conventional approaches alone in the improvement of the grip strength and treatment of the patients with unilateral cervical 7 (C7) radiculopathy. DESIGN: Randomized controlled trial (RCT). SETTING: An outpatient physical therapy clinic, University of Social Welfare and Rehabilitation Science, Iran. PATIENTS: A sample of convenience of 30 patients with unilateral C7 radiculopathy participated in this study. Patients were assigned randomly to a control (N = 15, mean age = 46.93 +/- 5.32) and an experimental group (N = 15, mean age = 47.53 +/- 5.6). INTERVENTIONS: Electrotherapy/exercise treatment for control group and combined cervical traction and electrotherapy/exercise for experimental group. Ten physical therapy sessions, three times a week for each group. MAIN OUTCOME MEASURES: Grip strength as an appropriate objective parameter was measured before treatment and after 5 and 10 treatment sessions. RESULTS: Statistical analysis (paired t-test) revealed significant increase in grip strength after 10 treatment sessions in control (p < 0.01) and experimental group (p < 0.01) compared with pretreatment score. In the ANCOVA, controlling for pretest scores, no significant difference was found between the two groups in the after 10 treatment sessions grip score (p = 0.65). However, the change in grip strength after five sessions was significantly greater for the experimental group than for the control group (p = 0.04). CONCLUSIONS: The application of cervical traction combined with electrotherapy and exercise produced an immediate improvement in the hand grip function in patients with cervical radiculopathy.

Cervical Vertebrae↗
PubMed1993

Preoperative skin traction for fractures of the proximal femur. A randomised prospective trial.

We report the results of a randomised trial to determine the effects of skin traction on 252 patients awaiting surgery for fractures of the proximal femur. They were allocated randomly to be nursed free in bed or to receive Hamilton-Russell skin traction. No differences were found between the groups in terms of pain suffered, analgesia required, frequency of pressure sores or ease of operation. The application of skin traction to patients with fractures of the upper femur is time-consuming and we recommend therefore that its routine use should be discontinued.

Adult↗
PubMed2003

Closed reduction of developmental dislocation of the hip by prolonged traction.

The efficacy of traction before an attempted closed reduction for patients with developmental dislocation of the hip remains controversial. We treated 55 children (62 dislocations of the hip) by preliminary, prolonged traction for a mean of eight weeks. All were followed up for at least two years in order to observe the development of any avascular changes within the femoral head. Of the 55 children, 27 (31 dislocations) were followed up until they were over six years of age. Fifty-seven of the 62 hips (92%) showed a successful closed reduction. Only one had radiological evidence of avascular necrosis of the femoral head. Of the 31 hips which were followed up to over six years of age, 15 (48%) showed residual subluxation. Our method of prolonged preliminary traction leads to a high rate of successful closed reduction, a low incidence of avascular necrosis and a reduced need for secondary operations.

Female↗
PubMedDate not supplied

[Internal cardiac massage in dogs: a new technique proposition for emergency pericardiotomy--ligament traction].

PURPOSE: Describe a technique of emergency pericardiotomy, named as Ligament Traction (LT), to reduce the necessary time to begin the Internal Cardiac Massage. To perform the ICM an emergency toracotomy and pericardiotomy are necessary, both in remote time. The technique usually employed is the "T" pericardiotomy, whose execution depends on the apprehension of the pericardium with an Allis forceps. This apprehension is difficult and complicates the reanimation of the patient. METHODS: Twenty canine corpses were divided into two groups: Group I--"T" pericardiotomy (n=10), and Group II--the LT technique (n=10). The LT consisted on the traction of the pericardiumphrenic ligament and the section of the pericardium next to its apex. The incision was elongated with the introduction of the fingers, also allowing the positioning of the heart in the hand of the operator and the immediate beginning of the ICM. RESULTS: Group I presented an execution period of 21.79 +/- 0.88 second, and Group II of 8.58 +/- 1.38, with p<0.0001 (highly expressive). CONCLUSION: The technique of pericardiotomy by Ligament Traction concur to outliving, because it avoids a larger time of cerebral ischemia, due to the early beginning of the circulation.

Animals↗
PubMed1993

Morphologic effect of preoperative maxillofacial orthopedics (T-traction) on the maxilla in unilateral cleft lip and palate patients.

Sixty-eight children born with complete unilateral cleft lip and palate were studied using dental casts taken at ages 0-0.1; 0.2-0.4; and 0.5-0.6 years of age. They were all treated with preoperative maxillofacial orthopedics using an external device (T-traction). The treatment was started after the first model was taken. Dental casts were analyzed regarding the morphology of the cleft region and the maxillary segments before and after treatment. The measurements were compared with measurements on dental casts of nontreated cleft children of similar age. The results suggest that a more normal anatomy of the cleft region occurs during the first 6 months of life whether preoperative maxillofacial orthopedics (T-traction) is used or not. However, this normalized growth seems to occur faster with the T-traction.

Cleft Lip↗
PubMed1996

Congenital dislocation of the hip in the older child. The effectiveness of overhead traction.

We studied the use of overhead traction in the treatment of congenital dislocation of the hip in thirty-five children (fifty hips) whose mean age at the time of the diagnosis was thirty-three months (range, eighteen to seventy-two months). None of the children had had any previous treatment. The mean time in traction was twenty-three days (range, eight to thirty-six days). Closed reduction was successful for relocation of the femoral head in thirty-eight of the fifty hips; twenty of these hips needed no additional treatment, sixteen were treated with an innominate osteotomy because of severe acetabular dysplasia, and two needed femoral derotation and an innominate osteotomy to correct persistent subluxation. In the remaining twelve hips, closed reduction failed at the outset and an open reduction was necessary. Femoral shortening also was performed in seven of the twelve hips to maintain concentric reduction. After a mean duration of follow-up of forty-eight months (range, thirty-two to sixty-five months), thirty-three hips were rated as class 1; seven, as class 2; four, as class 3; and five, as class 4, according to the criteria of Severin. The remaining hip could not be so classified. Avascular necrosis developed in two hips that had been treated with closed reduction followed by Salter osteotomy and in three hips that had been treated with primary open reduction. We found that preliminary overhead traction facilitated closed reduction of untreated congenitally dislocated hips in children who were eighteen to seventy-two months old.

Casts, Surgical↗