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An original method of skeletal traction used in the treatment of 92 children is described. Good and excellent results were obtained in 84 of them.
Oblique traction on the thumb metacarpal, originally described for the treatment of Bennett's fracture, has been applied to comminuted intra-articular fractures of the thumb metacarpal to counter the forces that cause shortening and varus angulation. It also has been applied to fractures of the trapezium to restore congruity of the trapeziometacarpal joint. It was successful in achieving and maintaining a satisfactory reduction in eight patients with these three types of fractures.
Although function does not return after complete spinal cord injuries, partial recovery is possible after incomplete lesions Halofemoral traction may produce early decompression of injured neural elements in the spinal canal by anatomic realignment of the spinal column. It also acts to stabilize the very unstable thoracolumbar fracture dislocation and prevent displacement as well as further neurologic trauma. The body jacket is easy to make and apply. It allows early mobilization of patients when utilized in conjunction with the posterior spinal fusion and Harrington rod fixation.
We use the Delbet and Tessier's head frame in order to complete a continuous traction on the jaw. In post operative period, this method can achieve a better result of major facial deformities.
The continuous traction of firmly grown-in collar electrodes from the right ventricle is a simple technique poor in complications with a high success rate, which can be recommended taking into consideration the indications in the failure of the immediate manual extraction and which can be performed in every centre for cardiac pacemakers. Apart from the consideration of adequate informations in literature this evidence above all depends on the evaluation of data of 29 cases from 10 centres for cardiac pacemakers.
Treatment of cervical spine injuries dates from 4000 B.C.; however, the development of safe and effective methods of cervical traction did not appear until the 20th century. Although many devices have been introduced to stabilize the cervical spine, the invention of spring-loaded tongs by Gardner in 1973 was a significant technological advance. Gardner tongs are easily applied, have little tendency to become dislodged, and cause few complications.
As epidurography uses a water-soluble contrast medium in the diagnosis of disc lesions, this procedure can be repeated, unlike conventional myelography which uses an oily contrast medium. Successful employment of epidurography before and after traction in 14 cases of adult prolapsed intervertebral disc syndrome is described.
The authors present a methodical study concerning traction strength of the ligaments and the periarticular tendons of the knee. The straining potential and the mechanical strength of these elements are made clear. This study permits applications in chronic laxities of the knee by giving the mechanical value of the different kinds of tendon reconstruction.
A dislocation of the elbow occurred in a 7-year-old boy during overhead skeletal traction treatment for a supracondylar fracture of the humerus. Closed reduction of the dislocation was successful. A review of the literature failed to reveal a report of a similar incident.
A 73-year-old woman with vulvar cancer T2NO was treated with high dose rate fractionated interstitial radiotherapy after 30 Gy of external radiotherapy. Sufficient space to insert 12 needles was made by pulling the vulva out perpendicular to the perineal skin. Four surgical threads were introduced between the vulva and the underlying pubic bones. A pair of custom-made templates were attached sandwiching the vulva pulled out with the threads. Using traction technique 12 stainless needles were easily inserted and replaced by plastic tubes. Forty Gy/10 fractions/six days was delivered, and the tumor has been controlled clinically and histologically so far.
In this paper the results of skeletal traction and irrigation therapy (STIT) used for open fracture complicated with large-sized full-thickness skin-deficit and infection wounds (OFIW) were presented. Fourteen patients of OFIW were treated by the plaster cast and wound dressing (PCWD), and 30 patients of OFIW were treated by STIT. The results indicated that after one week of treatment, the white blood cell count in the STIT group, compared to 17.6 +/- 1.0 x 10(9)/L from before treatment, returned to 8.8 +/- 0.8 x 10(9)/L, and in contrast, the cell count of the PCWD group was about 13.0 +/- 1.4 x 10(9)/L. All of wound exudate culture in the STIT group was negative, and those of 7 cases (7/14) in PCWD group were positive (P < 0.01). The symptoms and signs such as pain, fever and septic exudate on the wound in the STIT group were much milder than those in the PCWD group. There were 5 cases (35.7%) of toxicemia and septicemia, 2 cases (14.3%) of osteomyelitis, 2 cases (14.3%) of amputation, 1 case (7.1%) of delayed union and 3 cases (21.4%) of malunion in the PCWD group, and no complications in the STIT group.
We describe an intraoperative complication of laparoscopic cholecystectomy and make recommendations to avoid its occurrence. We describe a case in which the liver was lacerated during a routine laparoscopic cholecystectomy. The laceration occurred when the gallbladder was retracted into the suprahepatic space, causing a traction injury of the quadrate lobe, 2 cm lateral to the falciform ligament. The placement of the epigastric trocar through the falciform ligament fixed the liver to the abdominal wall, facilitating the injury. When placing the epigastric trocar, care should be taken to avoid placement through the falciform ligament. If this is not possible, retraction of the gallbladder into the suprahepatic space should be accomplished while observing the liver edge. If the liver edge seems to be under tension, division of the falciform ligament to allow for easy retraction of the liver is recommended.
After application of a modified Orthofix mini-extraskeletal fixator, the hind limb of New Zealand White rabbits was osteotomized and then slowly lengthened at a rate of 1 mm/day. After a 20 mm gain in length, the net weight and the length of muscular and tendinous portions were measured and histological examination was carried out in triceps surae muscles. Quantitative analysis showed a significant increase in the gained length of the muscular portion (28.05% to 30.65%). Histological studies of these lengthened muscles showed a generalized increase in cellularity with scanty inflammatory cell infiltration near the myotendinous junction. The increased cellularity is due to the presence of muscle precursor cells characterized by large, oval and pale-stained vesicular nuclei and two prominent nucleoli. The nuclei of these precursor cells were larger and more numerous near the myotendinous junction, and gradually changed into a flattened and more condensed form at a distance from the junction. Occasionally, chains of centrally-located nuclei of primitive myoblasts were also visible. It is concluded that traction neogenesis of the skeletal muscle during limb lengthening does exist and occurs mainly near the myotendinous junction.
A thorough understanding of the underlying diseases and of the halo pin traction device will allow for appropriate treatment of complications. Consultation or referral to the neurosurgeon is advised to prevent serious sequelae. The following points should be remembered: 1. Pins should only be tightened during the first 24-hour period after application. 2. Pin infection is treated by local wound care in most cases. 3. CT scan cannot completely exclude the presence of an abscess secondary to artifact, but MRI may be compatible with the newer devices. 4. Pin penetration of the inner table of the skull requires admission. 5. Any suspected loss of alignment or reduction of the cervical spine requires C-spine immobilization. 5. Nasotracheal or fiberoptic intubation or emergent cricothyroidotomy should be used if orotracheal intubation proves difficult due to the device. 7. The anterior portion of the vest is removable for cardiopulmonary resuscitation without compromising the stability of the device.
In addition to the major therapeutic modalities for use in back pain already discussed, a number of other forms of treatment are also available and in common use some of which at least have a solid scientific basis. Recent data suggest that subthreshold TENS is no effective treatment for low back pain. Whether this is also true of higher-dose TENS is not yet clear. Electro-acupuncture, in contrast, does appear to be effective, but not biofeedback or traction. Other commonly employed treatment modalities, such as cryotherapy, heat, massage or ultrasound cannot definitively be assessed at present, since controlled trials have not been carried out.
Prevention of inadvertent injuries to patients and hospital staff becomes more important than ever in today's hospital environment. The sharp ends of traction pins, a previous hazard, can be made safe using materials easily found throughout the hospital. Our method uses items that are easily replaced and easy to apply.
Clinical and radiological analysis has been carried out in series of 71 dysplastic hips in children aged 7-21 months of life (mean 16 months) treated with an over head traction. At one year follow-up there were clinically 22% excellent results, radiologically 10% excellent results and 25% poor ones. At the age of 5 complete remodeling of the hip was found in 21% of cases, and poor radiological result in 29% of cases. Avascular necrosis of the femoral head was found in 25% of patients at 1 year follow-up.
The effects exerted on the cervical spine by a traction of 150 N was studied by means of an improved radiographic technique. The technique is presented together with results from a study including fifteen test subjects with and without clinical symptoms of neck pain. In a minority of discs a widening not exceeding 1 mm was seen. This widening was not correlated to presence of roentgen signs indicating degenerative disease of the disc nor to clinical symptomatology.