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PubMedDate not supplied

Insertion force measurement of cervical traction tongs: a biomechanical study.

OBJECTIVES: To measure the insertion forces for various cervical traction tong pins and the force required to penetrate cadaveric skull specimens. DESIGN: Cadaveric study testing tong pin forces. METHODS: Insertion force and pin indicator displacement were measured in three tongs from each of three manufacturers (PMT, Depuy Ace, Gardner-Wells) after tightening pins per the manufacturer's recommendations and beyond. The force required for skull penetration was measured by driving each pin into cadaveric temporal specimens until the specimen failed or was penetrated. RESULTS: Forces generated at the recommended pin settings were: PMT, 141 +/- 12 newtons; Ace, 0 +/- 0 newtons; Gardner-Wells, 132 +/- 9 newtons. The Ace tong required 1.0-millimeter indicator protrusion beyond manufacturer's recommended setting before generating clinically significant forces (120 +/- 8 newtons). Unlike the PMT and Ace pins, overtightening of the Gardner-Wells pins (by as little as 0.3 mm beyond recommended indicator displacement) resulted in substantially larger pin force (>448 newtons). Average failure loads of the temporal bone specimens were: PMT, 721 +/- 298 newtons; Ace, 636 +/- 351 newtons; Gardner-Wells, 965 +/- 227 newtons. CONCLUSIONS: Although pin forces generated at the recommended end point for PMT and Gardner-Wells tongs appear safe, insufficient force was generated for Ace tongs. Furthermore, overtightening of the Gardner-Wells pins generated loads in excess of those that may be required to penetrate the skull.

Biomechanical Phenomena↗
PubMedDate not supplied

Retrograde nailing of femur: surgical technique with tibial traction.

A modified surgical technique for femoral retrograde nailing is described. A tibial skeletal traction in the proximal metaphysis is placed to obtain fracture reduction during surgery. This technique enables fracture control during the procedure, avoiding the need of an assistant.

Femoral Fractures↗
PubMed1976

Trauma or treatment? The role of intermittent traction in the treatment of cervical soft tissue injuries.

Neurophysiology does not provide a satisfactory theory which explains the phenomenon of muscular "spasm" which is said to be present in the neck following soft-tissue injury. Lacking knowledge as to whether long continued intermittent traction--ranging from 10 pounds to total body weight pull--is therapeutic or traumatic, such treatments nevertheless are prescribed in physiotherapy departments and at home for months. They are believed to be non-physiological and irrational and, in the author's opinon, represent the persistence of several medical myths associated with the "rear-end" collision. The question is moot whether the intractable complaints following such injuries are not caused, in large part, by the repeated traumas to muscles, disks, and joints produced by strong intermittent distraction. Experimental anatomical studies also argue against the hopes expressed in favor of such treatment, namely: to relieve spasm and/or traumatic fibro-myositis (?), to enlarge the neural foramina and relieve "radiculitis," and to hasten recovery by means of a conjectured internal massage.

Cervical Vertebrae↗
PubMed1981

90-90 skeletal femoral traction for femoral shaft fractures in children.

Ninety consecutive nonpathologic traumatic fractures of the shaft of the femur in pediatric patients above 3 years of age were seen from 1972 to 1976. Patients with less than 6 months' followup, patients with concomitant trauma to the same extremity, and one patient with decerebrate rigidity were excluded from the study. This left for evluation 60 fractures in 59 patients, all treated by 90-90 femoral skeletal traction. The average length of followup was 17.4 months. There were no pin tract infections. All patients had a full range of active and passive motion of the involved extremity. All of the children were engaged in the normal activities of their age group. Final femoral lengths by teleroentgenograms in patients followed over 1 year could not be correlated with the original fracture position whether distracted, end-on, or overriding. It is recommended that no more than 5 mm of overriding be accepted when using this method of treatment.

Adolescent↗
PubMed2002

Femoral shaft fractures in children: traction and casting versus elastic stable intramedullary nailing.

BACKGROUND: Treatment of pediatric femoral fractures by 90/90 traction and spica casting (TXN/CST) has begun to be replaced by elastic stable intramedullary nailing (ESIN). The purpose of our study was to perform a cost analysis of TXN/CST versus ESIN in addition to comparing clinical/functional parameters. METHODS: We reviewed all children admitted with femoral shaft fractures between January 1995 and April 1998. Overall cost and clinical/radiographic outcome measures were analyzed, and 60% of patients' parents completed a follow-up telephone interview. Sixty-eight patients representing 71 femoral shaft fractures that had complete data and 1-year follow-up were included. RESULTS: No difference existed between the two groups for standard clinical/functional criteria. ESIN was associated with a lower overall cost than TXN/CST. ESIN also resulted in better scar acceptance, and higher overall parent satisfaction. CONCLUSION: Less cost and comparable clinical outcome make ESIN a better option than traditional TXN/CST for femoral fracture care in the skeletally immature patient.

Adolescent↗
PubMedDate not supplied

Clinical standards in skeletal traction pin site care.

This descriptive study describes orthopaedic nursing practice behavior relevant to the treatment of skeletal traction pin sites. Data describe clinical practice norms for such variables as product usage, treatment frequency, and aseptic technique. These norms can be used as the basis for further scientific investigation of pin care and the development of uniform treatment standards within the nursing specialty domain.

Adult↗
PubMedDate not supplied

Care of the school-aged child in 90/90 traction.

Children in the school-aged period are those most likely to sustain a fractured femur. One method of treatment for this age group is immobilization of the fracture in 90/90 traction. Specific needs of these children are discussed, and related nursing problems are identified. The physiologic and psychosocial aspects of nursing care are also addressed. Emphasis is placed on the developmental tasks inherent in this age group. Mastery of illness and hospitalization are central issues for the school-aged child and can be facilitated through the efforts of nursing and hospital staff. A therapeutic play program is also a beneficial adjunct to treatment and nursing care.

Child↗
PubMedDate not supplied

Brain abscess as a complication of halo traction.

The occurrence of a brain abscess as a complication of halo traction and immobilization in the management of scoliosis is reported. Previous reports suggest that this complication is rare. Unique in this case is the development of an intracerebral abscess without skull perforation by the halo device and without evidence of contiguous spread of infection. Attention of clinical signs (headache) and the use of computerized axial tomography may allow for early detection and appropriate care.

Adult↗
PubMed2006

A convenient dynamic wire traction-fixation method for hand and forearm fractures.

We report on a convenient intraoperative distraction technique, called the modified Dynamic Wire-framed Traction (mDWT) method, that assists in fracture reduction and/or is used as an external fixator in patients with unstable distal radius fractures and in other hand and forearm fractures. The mDWT device is easily assembled with wires at the time of surgery, and its configuration produces sufficient longitudinal distraction force that makes reduction easier and facilitates additional fixation procedures. Furthermore, the device can be converted into a simple unilateral external fixator that can be retained postoperatively. Our experience with 13 patients shows that the mDWT method is easy to apply and is a cost-effective technique when used as an intraoperative distraction device or as an external fixator.

Adult↗
PubMed1981

Incidence of avascular necrosis of the femoral head in congenital hip dislocation related to the degree of abduction during preliminary traction.

Two-hundred and twenty-two congenitally dislocated hips of 173 patients had been abducted in one of two fashions, prior to closed reduction under general anaesthesia. In both forms of treatment, the hips were in 90 degrees of flexion while they were abducted. Group 1 included those who were abducted up to 90 degrees and Group 2 those who were abducted to not more than 60 degrees. The incidence of total avascular necrosis was 90% when the limbs were abducted to no more than 60 degrees and 17% in those abducted up to 90 degrees. The incidence of partial avascular necrosis was not affected by the degree of abduction of the hips. The incidence of avascular necrosis in Group 2 patients is comparable to that in recent reports of patients who received their traction with the hips in extension; this suggests that the flexed position is not harmful, and it is certainly effective and convenient.

Child, Preschool↗
PubMedDate not supplied

Deformity and function in supracondylar fractures of the humerus in children variously treated by closed reduction and splinting, traction, and percutaneous pinning.

The radiographs of 137 patients with supracondylar fractures of the humerus treated by closed reduction and splinting, traction, and closed reduction and percutaneous pinning (CRPP) were reviewed to determine the adequacy of the initial reduction and the maintenance of the reduction. Eighty-four patients were examined for function and deformity. Initially, Baumann's angle was adequate and similar in all patients, but the humerocapitellar angle was better with CRPP. Maintenance of reduction in both planes was superior with CRPP, and significantly better clinical results were achieved by CRPP. Nevertheless, there was no functional loss in any patient, and no parent wanted correction of deformity.

Adolescent↗
PubMed1993

Calcaneal pin traction in the management of unstable tibial fractures.

Twenty-five patients with unstable tibial shaft fractures who were initially managed with calcaneal pin traction and subsequent plaster of Paris were retrospectively reviewed to determine if this form of management would adversely affect the outcome. There were no pin track problems. Residual subtalar joint stiffness, as measured by a foot-plate goniometer, was noted in only three patients and this could not be attributed directly to this form of fracture management. All fractures went on to union. This method is a reasonable option in the management of unstable tibial fractures.

Adolescent↗
PubMed1999

Changes in gastric intramucosal pH following mesenteric traction in patients undergoing pancreas surgery.

BACKGROUND/AIM: During major abdominal surgery, mesenteric traction (MT) may result in hemodynamic instability mainly due to endogenous prostacyclin release. Gastric intramucosal pH (pHi) and PiCO2 are indicators of splanchnic tissue perfusion with a predictive value for the postoperative outcome. We investigated the influence of MT on gastric pHi and on postoperative outcome in patients undergoing pancreas surgery. METHODS: Forty-six consecutive patients scheduled for pancreas surgery were investigated. We registered hemodynamics and pHi by gastric tonometry and documented postoperative outcome (complications, hospital stay). Baseline data (T0) were recorded after skin incision. Further assessments followed 30, 60 and 120 min after intentional MT (T1-3) and at the end of surgery (T4). RESULTS: Thirty-three patients demonstrated a decrease in mean arterial pressure (MAP) following MT, whereas 13 patients showed entirely stable hemodynamics. The significant reduction in MAP in patients with an MT response was not associated with changes in pHi as compared to patients with no response (stable MAP) (T0 7.34 +/- 0.08 vs. 7.35 +/- 0.06; T1 7.34 +/- 0.05 vs. 7.32 +/- 0.07; T2 7.32 +/- 0. 05 vs. 7.31 +/- 0.08; T3 7.32 +/- 0.05 vs. 7.32 +/- 0.07; T4 7.26 +/- 0.1 vs. 7.27 +/- 0.08; mean +/- SD, MT response vs. no response). Neither MT response nor gastric intramucosal acidosis as evidenced by a pHi <7.32 at the end of surgery predicted postoperative complications or longer hospital stay. CONCLUSION: No deterioration of gastric pHi was found, which could reflect acceptable splanchnic perfusion and oxygenation despite systemic blood pressure reactions in patients experiencing an MT response.

Adult↗
PubMed1990

A cephalometric study to compare the effects of cervical traction and Andresen therapy in the treatment of class II division 1 malocclusion. Part 2--Dentoalveolar changes.

Absolute distal movement of upper first molars together with distal tipping, but no significant extrusion, occurred with cervical traction. Distal movement of the maxillary first molars was more stable in the group where maxillary 2nd molars had been extracted. With Andresen treatment a restraining effect took place on the upper molars, while mesial movement of the lower first molars contributed to correction of the molar relationship.

Activator Appliances↗
PubMed1981

Retraction of canines with axial control using extra-oral traction.

Retraction of canines with control of tooth inclination is described, using the direct application of extra-oral traction. the technique requires a modified facebow to be inserted into buccal tubes on canine bands; no archwires or springs are involved. In the upper arch the facebow is connected to a standard variable pull headgear, while a supported cervical strap is required for the lower canines. Preliminary investigations are outlined and the procedure is illustrated by some clinical cases from a pilot feasibility study.

Cuspid↗
PubMed1978

The Carshalton halo-pelvic traction apparatus.

The 'Hong Kong' halo-pelvic traction frame is widely used for correcting spinal deformation and as a holding apparatus for spinal operations. A study at Queen Mary's Hospital for Children, Carshalton, suggested that there were considerable possibilities for improvement. Firstly the supporting rods are cranked and do not apply the forces in a linear mode, whilst a reduction in the number of flexible joints would improve stability. Secondly, and more important, the accuracy of the measurement of forces applied is capable of considerable improvement and this would markedly reduce the possibility that undesirably large forces could be used. An improved frame has now been designed, manufactured and tested intensively. In this new design the supporting rods are straight whilst the forces applied are measured by means of potentiometric sensor in each rod, with read-out on a meter calibrated in kilograms. The frame has been fitted to one patient with satisfactory results.

Humans↗