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PubMed1999

Vitrectomy for traction macular edema.

PURPOSE: Traction macular edema may develop through contraction of macular epiretinal membranes (ERM), or due to persistent vitreomacular traction during the evolution of vitreomacular traction syndrome (VMS). The purpose of this retrospective study was to determine the effect of vitreous surgery and the release of the vitreomacular traction or the removal of epiretinal membranes, on the evolution of traction induced macular edema. MATERIAL AND METHODS: Fourteen eyes from 14 patients presenting with idiopathic or secondary epiretinal membranes, and 11 eyes from 10 patients presenting with vitreomacular traction syndrome, underwent vitrectomy for reduced vision and cystoid macular edema, identified by slit-lamp examination and fluorescein angiography. No coexistent ocular conditions that might have caused macular traction were present. History, preoperative eye examination, operative findings, postoperative course and final examination as well as pre- and postoperative fluorescein angiography were reviewed. RESULTS: In the ERM group, cystoid macular edema disappeared in all cases during the postoperative period and the mean visual acuity (VA) at the end of the follow-up (0.48 +/- 0.23) significantly increased compared to the preoperative one (0.29 +/- 0.2) (p=0.004). In the group of patients suffering from VMS, the posterior vitreous traction on the macula was released and macular edema disappeared in all cases but one. The mean v.a. at the end of the follow-up (0.42 +/- 0.24) significantly increased compared to the preoperative one (0.18 +/- 0.1) (p=0.01). Complications included intraoperative small petechias and postoperative progressive nuclear sclerosis, retinal detachment and retinal pigment epitheliopathy. CONCLUSIONS: Cystoid macular edema may develop secondary to vitreomacular traction syndrome or epiretinal membrane contraction. Vitrectomy is effective in releasing macular traction which, in turn, may induce a decrease of the macular edema with improvement of visual acuity.

Aged↗
PubMed1993

[Use of vertical and horizontal traction sutures in eyelid surgery].

BACKGROUND: Patients with lid surgery may benefit from traction sutures. However no detailed descriptions of the techniques exists. We describe our techniques and experiences in patients with cicatricial ectropion and large lid defects. PATIENTS AND METHODS: In 33 patients with severe cicatricial ectropion, the wound was extended with transtarsal traction sutures before skin grafts or sliding flaps were sutured in place. Horizontal traction sutures allowed wound closure in 7 patients with tumors of the medial canthal area or large traumatic lid defects. In all patients monofil 4-0 polypropylene suture material was used. RESULTS: Vertical transtarsal traction sutures and horizontal traction sutures did not cause any irritations of the lids or wound edges. Postoperative overcorrection of the lower lid margin was achieved in all ectropion patients. However, five patients required additional surgery. Three patients were operated for bilateral cicatricial ectropion simultaneously. Postoperative shrinkage of the free skin-graft was more accelerated on the side where the transtarsal traction sutures were first removed. Horizontal traction sutures allowed wound closure in all seven patients who had undergone medial canthal reconstruction and traumatic lid repair. CONCLUSION: Traction sutures with monofil 4-0 polypropylene material can fixate the lid margins and wound edges in the preoperatively desired position. There is evidence that the traction sutures can influence postoperative wound contraction. Our technique of transtarsal traction sutures has several advantages as compared with previously described techniques.

Adolescent↗
PubMed1986

Electrophysiologic effects of papillary muscle traction in the intact heart.

In this study we used transmural multipolar electrodes, sonomicrometers implanted within the left ventricular wall, and cardiac electrical stimulation techniques to examine the effect of transient mechanical posterior papillary muscle traction on local myocardial electrophysiologic characteristics. Nine open-chest dogs were atrially paced (cycle length 400 msec) followed by insertion of timed premature extrastimuli at left ventricular epicardial pacing sites either in the vicinity of (traction zone) or remote from (nontraction zone) the site of papillary muscle traction. Electrophysiologic recordings were made before and during periods of intermittent papillary muscle traction of predetermined timing, application rate (25 cm/sec), and duration (170 msec). Papillary muscle traction was applied in late diastole just before the last beat of each atrial drive train. In seven of nine dogs application of transient papillary muscle traction resulted in significantly earlier local ventricular activation (mean activation advancement 30 +/- 13 msec), altered QRS morphology of the last conducted atrial drive-train beat, and relative prolongation of ventricular functional refractory period in the traction zone. Conversely, in nontraction zones in these seven dogs, early activation did not occur and refractoriness remained unchanged as tested by a locally placed extrastimulus. In two of nine dogs traction failed to induce early activation and changes in refractoriness did not occur. Alterations in regional myocardial blood flow (assessed by radioactive microsphere technique) did not appear responsible for the observed changes, since there was no demonstrable traction-induced difference in regional blood flow between the traction and nontraction zones.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1981

Unilateral lumbar traction.

Unilateral lumbar traction has been theorized to be superior to bilateral lumbar traction in certain cases. Many patients who cannot tolerate bilateral lumbar traction are comfortable with this method. It enables the physical therapist to administer lumbar traction to patients with protective scoliosis who would otherwise be unable to tolerate treatment. Although the theory behind the treatment seems sound, very little unilateral lumbar traction is used clinically because of problems with patient positioning and adaptability of available equipment. This paper described a technique of effectively administering unilateral lumbar traction. The technique involves a heavy-duty lumbar traction harness, with bilateral pelvic straps, that can be used for conventional lumbar traction. It is constructed in such a way that when only one side of the pelvic harness is coupled to the traction source, a stronger force is transferred to that side of the spine. Although separation occurs on both sides of the spine, greater separation and stretching is achieved on the side of the pull.

Humans↗
PubMed1996

Comparison of the use of supine bending and traction radiographs in the selection of the fusion area in adolescent idiopathic scoliosis.

STUDY DESIGN: A study was done to evaluate the use of voluntary supine side bending radiographs and Risser table traction radiographs in adolescent patients undergoing posterior spinal fusion for idiopathic scoliosis. OBJECTIVES: To compare the usefulness of supine side bending and traction radiographs in assessing curve flexibility and determining fusion levels in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Supine side bending radiographs have been used in the preoperative evaluation of idiopathic scoliosis to determine curve flexibility and fusion area. Traction films have been used to determine the flexibility of large curves and neuromuscular curves where active side bending is not possible. No study to date has compared the use of these films in patients with adolescent idiopathic scoliosis undergoing surgery. METHODS: Seventy-five patients with more than a 2-year follow-up period after surgery were included in this study. Preoperative radiographs included a standing posteroanterior and lateral film and both supine maximal voluntary side bending films and a traction film done on a Risser table. A preoperative review of these radiographs was done to determine curve flexibility and fusion levels. At follow-up evaluation, the patients were examined for any evidence of decompensation or "adding-on" of levels. RESULTS: For curves less than 60 degrees, side bending radiographs showed greater curve correction than traction radiographs, whereas the opposite was true for curves greater than 60 degrees. For King I and II curves, side bending radiographs were superior for determination of lumbar curve flexibility and for distinguishing these two types of curves. On traction radiographs, the stable vertebra was 1.4 vertebral levels higher than on the standing film. When the fusion level was moved proximally because of the traction radiograph, decompensation or "adding-on" commonly occurred. CONCLUSIONS: Supine bending radiographs are superior to traction radiographs for assessing curve flexibility except for curves more than 60 degrees. The selection of the distal extent of fusion based on the traction radiograph gave a large number of poor results. The selection of fusion levels in adolescent Idiopathic scoliosis is best determined by a combination of standing posteroanterior and lateral radiographs and the supine maximum voluntary bend films.

Adolescent↗
PubMed1997

Efficacy of traction for nonspecific low back pain. 12-week and 6-month results of a randomized clinical trial.

STUDY DESIGN: A randomized clinical trial. OBJECTIVES: To assess the efficacy of motorized continuous traction for low back pain. SUMMARY OF BACKGROUND DATA: The available studies on the efficacy of lumbar traction do not allow clear conclusions because of severe methodologic flaws. The current trial aimed to overcome these shortcomings. METHODS: Patients with at least 6 weeks of nonspecific low back pain were selected. High-dose traction was compared with sham (or low-dose) traction. Sham traction was given with a specially developed brace that becomes tighter in the back during traction. This was experienced as if real traction were exerted. The patients and the outcome assessor were unaware of treatment allocation. Outcome measures were: patient's global perceived effect, severity of main complaints, functional status, pain, range of motion, work absence, and medical treatment. Results for the outcome measures at 12 weeks and 6 months after randomization are presented. RESULTS: One hundred and fifty-one patients were randomly allocated to one of the two treatment methods. Intention-to-treat analysis of the 12-week and 6-month results showed no statistically significant differences between the groups on all outcome measures: all 95% confidence intervals included the value zero. The number of patients lost to follow-up study was very low. Other analyses showed the same results. CONCLUSIONS: Most common flaws of earlier studies on traction therapy could be overcome. This trial did not support the claim that traction is efficacious for patients with low back pain.

Adult↗
PubMedDate not supplied

Comparison of inpatient and outpatient traction in developmental dislocation of the hip.

We studied 83 hips in 72 children being treated for developmental hip dislocation to assess the influence of home traction upon the incidence and severity of avascular necrosis (AVN). We compared two types of traction prior to closed or open reduction: inpatient Bryant's skin traction (40 hips), and outpatient (home) Bryant's skin traction (43 hips). No routine in-traction radiographs were taken in either group. After traction, a stable closed reduction was achieved in 55 hips (66%). Open reduction was performed on 28 hips (34%). The rate of severe AVN involving growth disturbance and resultant deformity (Bucholz types II, III, and IV) was low in both traction groups (inpatient, three out of 40, outpatient, one out of 43). These results demonstrate that an outpatient traction program without attention to radiographic hip station is as safe as identically instituted inpatient programs, as well as those that emphasize achievement of a traction reduction or a predetermined hip station.

Ambulatory Care↗
PubMed1998

[Experimental study of the architecture of skin following tension traction and wound closure].

The experiment performed on domestic pig, was designed to investigate the architecture of the stretching skin and the effect of tension traction on the wound closure. An 7 cm x 3.5 cm was drawn at a standard position. Drawing horizontal and vertical lines on the traction area, points of 1 cm apart were tattooed on the lines. A traction force measuring device was used to draw the wound edges together. Measurements of the distances between the points were made. An 7 cm x 10 cm wound was made on identical sites of each hind leg. In the experiment the traction tension was applied on the edges of wound immediately after the wound debridement. The results showed the stretched distance in the two areas was 5-7 times the width of the wound. The gain of skin from traction was 61-89 percent in the width of the wound. The wounds from traction five days could be closed 5 days after traction. It was concluded that the skin which could be used for traction was abundant. Wound closure with the skin traction technique had many advantages, such as rapid decreasing the size of wound and early closing of wound.

Animals↗
PubMed2006

Intraoperative skeletal traction in the dog: a cadaveric study.

A standard skeletal traction technique was applied to each major segment of the appendicular skeleton of ten fresh dog cadavers. Opposition points and anchorage points for the application of traction were determined for each skeletal segment. Traction was exerted by means of a micrometric traction stand, connected to the limb by bands or a stirrup. Traction was applied to the antebrachium and the tibia through nylon traction bands anchored to the metacarpus and metatarsus, respectively. A traction stirrup applied to the condylar region was used as the anchorage point to load the humerus and femur. Once a peak force of 25 kg weight was achieved, the load was monitored for half an hour to check for any variation. After that, each skeletal segment was osteotomized in the mid-diaphyseal region, and evaluated for any angular malalignment due to a mismatch between the axis of the bone and the applied loading. Any ensuing angular malalignment was successfully corrected by manoeuvres using the traction stand. The technique used in this study to perform intraoperative skeletal traction proved to be reliable and consistent for each segment of the appendicular skeleton.

Animals↗
PubMed2006

Brachial plexus palsy associated with halo traction before posterior correction in severe scoliosis.

OBJECTIVE: To retrospectively analyse clinical features and related factors of brachial plexus palsy associated with halo traction before posterior correction in severe scoliosis. METHOD: 300 Cases of severe scoliosis performed with halo traction before posterior correction were considered with 7 cases suffering from brachial plexus palsy (2 males and 5 females). The average age was 14 years (range, 9-19 years). The average Cobb angle was 110 degrees (range, 90 degrees - 135 degrees); Diagnoses were idiopathic scoliosis (1), congenital scoliosis (3), and neuromuscular scoliosis (3). Halo-gravity traction was used in 3 cases preoperatively; and Halo-femoral traction used in 4 cases postoperatively (anterior release 2 cases, anterior epiphyseal arrest 1 case, combined anterior and posterior release 1 case). RESULTS: Traction was used for an average of 3.5 weeks before spinal fusion (range, 2-6 weeks) for these 7 patients. The average traction weight was 8 kg; the average traction weight was 19 % ( range 13-26%) of the average body weight (40.2 kg). The mean stature was 175 cm; all the 7 patients had a long and thin body configuration. Duration between brachial plexus paralysis and detection was 1 to 3 hours. All the 7 patients suffered different degree from numbness of ulnaris of the hand and antebrachium. Median nerve palsy was found in 3 cases, ulnar nerve paralysis was found in 4 cases. Complete nerve functional restoration had been achieved by the end of three months after rehabilitation training, drug treatment were adopted. CONCLUSION: Brachial plexus palsy associated with halo traction in severe scoliosis is related to the weight of traction, body type and patient-pathology status. If the symptoms are promptly detected with rehabilitation training and appropriate drug treatment adopted, complete nerve functional restoration can be achieved.

Acute Disease↗
PubMed2005

Diabetic vitreopapillary traction and macular oedema.

PURPOSE: To describe an association between optic disc traction and diabetic macular oedema (DME) unresponsive to laser treatment. METHODS: A retrospective review of all patients with DME who attended our clinic between September 2001 and November 2003 was undertaken. The patients had undergone ophthalmic history and examination, fluorescein angiography, and optical coherence tomography (OCT) of the macular area and optic nerve head (ONH). A total of 10 nonvitrectomized eyes that were found to have an elevation of the ONH secondary to vitreopapillary traction were included in the analysis. Eyes with additional traction at the posterior pole were excluded. RESULTS: Out of the 10 eyes (seven patients, aged 47-79 years) with vitreo-papillary traction, nine had previously undergone argon laser photocoagulation(s) for DME. In seven eyes (seven patients), OCT verified the vitreopapillary traction as the sole traction, whereas in the fellow eyes of three patients vitreomacular traction was evident as well. In the seven eyes with only vitreopapillary traction, OCT demonstrated parapapillary serous retinal detachment in two eyes and a diffuse DME in all eyes (mean foveal thickness, 396+/-144 microm). Maximal thickness of the papillo-macular bundle site was adjoining the elevated ONH in three eyes, and was maximal at the central macula in the other four eyes. Ultrasonography (n=5) revealed an incomplete detachment of the posterior hyaloid in each, adherent only at the ONH. CONCLUSIONS: Diffuse DME unresponsive to laser treatment may be associated with vitreopapillary traction. Further studies should indicate whether these two phenomena could suggest a cause and effect in such eyes.

Aged↗
PubMed2004

Traction radiography performed under general anesthetic: a new technique for assessing idiopathic scoliosis curves.

STUDY DESIGN: A prospective review of 24 patients with late-onset idiopathic scoliosis. OBJECTIVES.: To compare curve flexibility measured using supine bending radiography and traction radiography; to examine the correlation of each technique with postoperative correction; and to determine the influence of each technique on the decision to perform concomitant anterior release surgery with posterior instrumentation. SUMMARY OF BACKGROUND DATA: Assessment of curve flexibility is important in decision making before surgical correction of scoliosis. Supine bending radiographs are presently the gold standard technique by which flexibility is assessed, but their reliability has been questioned. No literature has shown a conclusively superior role for traction radiography in assessing idiopathic scoliosis curves. METHODS: Each patient had erect anteroposterior radiographs and supine bending radiographs. On the day of surgery, traction radiography was performed under general anesthetic. The correction obtained in the Cobb angle between the bending and traction radiographs was compared. The influence of the traction radiography on the decision for anterior release surgery and its correlation with postoperative result was examined. RESULTS: Traction radiography demonstrated significantly greater curve flexibility than supine bending radiographs (P < 0.001). Eleven of 13 patients planned for anterior release surgery and posterior instrumentation avoided anterior release after review of the traction radiography. No significant difference was demonstrated between the traction radiography and postoperative correction (P = 0.13). CONCLUSION: Traction radiography is superior to supine bending radiography in assessing curve mobility before surgery. This method benefits patients by allowing them to avoid anterior release surgery and helps predict postoperative correction.

Adolescent↗
PubMed1994

Human small intestinal contractions and aboral traction forces during fasting and after feeding.

Small intestinal intraluminal pressure activity and aboral traction forces were explored in 19 healthy volunteers using a combined manometry and traction force detecting assembly sited in the upper small intestine. Each aboral traction event was classified as being associated with either a propagating or a stationary contraction and its force measured. During phase I no contractions or traction events were seen. During phase II, traction events related to propagating contractions mean (SEM) (2.2 (0.2)/min) and to stationary contractions (0.3 (0.1)/min) generated similar force/event (7.5(0.9 g v 8.7 (1.4) g, p > 0.05). During phase III, all traction events were related to propagating contractions and generated 9.3 (2.4) g force/event (p > 0.05 v phase II). After feeding, traction events related to propagating contractions generated similar force/event to those related to stationary contractions (5.9 (1.0) g v 9.3 (2.7) g, p > 0.05 v each other and v fasting). No consistent pattern was seen in the temporal distribution of the traction events or in the pattern of the amplitude of the force of successive traction events.

Adult↗
PubMed2002

Traction fields, moments, and strain energy that cells exert on their surroundings.

Adherent cells exert tractions on their surroundings. These tractions can be measured by observing the displacements of beads embedded on a flexible gel substrate on which the cells are cultured. This paper presents an exact solution to the problem of computing the traction field from the observed displacement field. The solution rests on recasting the relationship between displacements and tractions into Fourier space, where the recovery of the traction field is especially simple. We present two subcases of the solution, depending on whether or not tractions outside the observed cell boundaries are set to be zero. The implementation is computationally efficient. We also give the solution for the traction field in a representative human airway smooth muscle cell contracted by treatment with histamine. Finally, we give explicit formulas for reducing the traction and displacement fields to contraction moments, the orientation of the principal axes of traction, and the strain energy imparted by the cell to the substrate.

Acrylic Resins↗
PubMed1991

Overdistraction: a hazard of skull traction in the management of acute injuries of the cervical spine.

In acute cervical spine trauma, skull traction is used to reduce a dislocation or fracture dislocation, to immobilize an unstable lesion until definitive treatment (operative or conservative) is possible or, more rarely, as a definitive treatment until healing occurs. This method may be dangerous when an unstable lesion is accidentally overdistracted. A few cases have been reported in the literature, some with neurological complications. We report five cases in which overdistraction was seen. Two hangman's fractures were overdistracted. One of the two patients developed a Cheyne-Stokes breathing pattern during traction which resolved after the weight was reduced. Furthermore, two hyperextension/distraction injuries (C4/5 and C6/7) and one bilateral C5/6 fracture dislocation were overdistracted without neurological deterioration. Occipitocervical dislocations, fractures of the odontoid process, hangman's fractures, hyperextension/distraction injuries and bilateral dislocations or fracture dislocations may present disruption of both the anterior and posterior elements. Therefore, these injuries are specially vulnerable to overdistraction when skull traction is used. To prevent accidental overdistraction during skull traction, we recommend the use of less weight than is generally proposed in the literature. To reduce a dislocation, we start traction weight at 2 kg and slowly increase it under continuous neurological and radiological monitoring until reduction is completed. Traction of 5-7 kg is usually sufficient; however, heavier traction may occasionally be necessary. After reduction is completed, traction is reduced to 2 kg. This weight is sufficient to immobilize a lesion until definitive treatment is possible. Inadvertent rotation may be prevented by placing sandbags on both sides of the head.

Adolescent↗
PubMed2002

[The conservative treatment of femur fractures by Perkins traction. Management in adverse situations].

In adverse situations and in hospitals of less prosperous countries, the operative treatment of fractures may for many reasons not be possible and conservative procedures remain the treatment of choice. This applies to the rule that under difficult conditions fracture treatment should be as conservative as possible and as operative as necessary, if at all feasible. This report goes on 109 Patients with femur fractures consecutively treated by Perkins traction in East African hospitals between Nov. 1991 and Sept. 1999. Out of them, 44 patients had wide open fractures, 41 of them caused by explosives and bullets. The Perkins procedure is a traction without a fixating splint. As soon as possible, the patient is forced to sit up in his bed, the removable parts of the springs are dropped and the patient starts with exercises flexing and stretching the knee. With the right traction weight and the bodys counterweight the fragments of the fracture find an alignment, and a malrotation of the distal fragment is prevented. Exercises as early as possible stimulate a rapid callus formation and prevent muscle atrophy and stiffness of the joints. We have seen 2 posttraumatic deep infections, 5 refractures in patients whose traction was removed too early or who fell down whilst walking with crutches. All patients had a good callus formation and in all patients, except two, the traction could be removed after 6-12 weeks, in the most cases even after 6-9 weeks. To the patients with refractures, the traction was reapplied and callus consolidation then occurred without major problems. At the time of removal of the traction all patients showed a flexion of the knee of at least 80 degrees -90 degrees and all were able to nearly fully stretch the knee joint.Compared with other methods of conservative treatment of femur fractures, Perkins traction has some advantages: simple management, immediate start of exercises, simple exercises, early callus formation, no stiffness of the joints and only few x-ray controls. Malalignment, non union, excessive shortening and rotation of the distal fragment are uncommon.

Adult↗
PubMed2005

Current use of lumbar traction in the management of low back pain: results of a survey of physiotherapists in the United Kingdom.

OBJECTIVE: To identify the current use of traction and the types of patients, treatment parameters, and treatment modalities used in conjunction with traction. DESIGN: Postal survey, with 4 sections: professional characteristics of respondent, current use of traction, patient selection, and treatment parameters. SETTING: Musculoskeletal outpatient departments (private and nonprivate practitioners). PARTICIPANTS: Random sample (N=1491) of chartered physiotherapists in the UK who work in the management of low back pain (LBP). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Descriptive analysis of information on current use and practice in applying traction. RESULTS: A response rate of 83% (n=1239) was achieved; 41% (n=507) use lumbar traction, which is most commonly used in the management of subacute LBP patients presenting with nerve root symptoms. Treatment parameters were established for weights (5-60 kg), frequency (2-3 times weekly), and length of treatment (4 wk). In addition, traction is commonly used with other modalities (87%): mobilizations, advice, and exercise. CONCLUSIONS: Survey results show the continued use of lumbar traction despite the recommendations of numerous guidelines. Results also clarify the types of patients and the parameters used in the application of traction.

Attitude of Health Personnel↗
PubMed1995

Efficacy of traction for non-specific low back pain: a randomised clinical trial.

Previous trials to assess the efficacy of lumbar traction for back pain have been methodologically flawed. To avoid these shortcomings, we conducted a randomised controlled trial in which high-dose traction was compared with sham traction. The sham traction was given with a specially developed brace that tightens in the back during traction. To the patient, the experience is that of traction. The patients and outcome assessor were blinded for the assigned treatment. 151 patients with at least six weeks of non-specific low back pain were randomised. Intention to treat analysis showed no differences between the groups on all outcome measures (patients' global perceived effect, severity of main complaints, functional status and pain); all 95% confidence intervals included the value zero. The number of withdrawals from treatment, loss to follow-up, and protocol deviations was low. Consequently, the per-protocol analysis showed results similar to the intention to treat analysis. Subgroup analyses did not show any group for which traction might seem promising. Our data do not support the claim that traction is effective for patients with low back pain.

Adult↗