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Subtrochanteric femoral fractures in children. Alignment after 90 degrees-90 degrees traction and cast application.

Fifteen children younger than 10 years of age with subtrochanteric fractures treated by a uniform method were evaluated. These patients had been treated with femoral skeletal traction, with the hip and knee flexed to 90 degrees until radiographic callus appeared, then with a hip spica cast. True neck to shaft and anteversion angles were calculated bilaterally using a biplanar method. Leg lengths were measured radiographically and clinically. Mean age at injury was 4.5 years, and mean followup was 6.5 years. Overgrowth averaged 10 mm after fracture. Anteversion at final followup differed only by a mean of 2 degrees from the contralateral side (range, -3 degrees to +4 degrees), and the mean neck shaft angle differed by only 1 degree. Remodeling of coronal angulation was 50% or more in all cases.

Adolescent↗

[Treatment of intraarticular finger fractures with the help of the traction system of "pins and rubbers" according to Y. Suzuki].

The results of treatment of intraarticular finger fractures by means of Y. Suzuki's pins and rubbers traction system are presented. The system consists of 2-3 thin K-wires and 2 rubber bands, is easy to assemble, effective, and less clumsy then the ones applied previously. It also allows for the reduction of palmar displacement of bony fragments. Sixteen intraarticular fractures have been treated. The average total range of motion of the injured PIP joint was 82 degrees at the average follow-up of 8.5 months.

Adolescent↗

Treatment of congenital hip dislocation by muscle release, skeletal traction and closed reduction in older children.

A method of treatment of congenital hip dislocation by preliminary multiple muscle releases around the hip, followed by skeletal traction, is employed for closed reduction and immobilization with long leg cast. In 29 hips treated during the period from 1961 to 1972, the results justify the method for treatment of children 3 to 11 years of age with neglected high posterior congenital hip dislocations. The main prerequisite for the procedure is a fairly well-developed acetabulum.

Casts, Surgical↗

[Erectile dysfunction caused by neurapraxia of the pudendal nerve after the use of a traction table for the treatment of traumatic fractures. Report of a case and review of the literature].

OBJECTIVE: To describe a case of erectile dysfunction as a result of traction on the fracture table. METHODS: We report on a 39-year-old man who developed erctile dysfunction postoperatively and for several months thereafter, following intramedullary nailing with the Grosse-Kept bolt type fixation system. RESULTS: The patient spontaneously recovered erectile function six months after orthopaedic treatment. CONCLUSION: Erectile dysfunction induced by orthopaedic fracture table is a complication that should be taken into account. There are many procedures available to reduce the risk of this complication.

Adult↗

Fracture-dislocation of the middle phalanx at the proximal interphalangeal joint: repair with a simple intradigital traction-fixation device.

Fracture-dislocation of the middle phalanx at the proximal interphalangeal joint is a difficult problem. Open reduction and internal fixation, the panacea for so many unstable fractures, has not been the solution to this injury. During the past three decades, a number of papers have combined old methods with newer concepts, including intradigital traction, "ligamentotaxis," and the beneficial effects of early motion on articular cartilage remodeling. This report describes a simple device, using these new concepts and constructed with available materials, which can be placed on the finger in the office or emergency department, thus avoiding open surgery. Results are compared with other intradigital techniques for treatment of this injury.

Adult↗

[The morphofunctional validation of the use of vibration-traction for the correction of contractures of the joints].

Experiments in modelling joint contracture have shown that vibrotracture with step-by-step frequency rise in one procedure and discrete rise in traction power in the course of procedures may correct joint contracture. Basing on these experimental findings, the authors have developed highly effective method of vibrotraction treatment of joint contractures (patent N 1804819).

Animals↗

Papillofoveal traction in macular hole formation: the role of optical coherence tomography.

OBJECTIVES: To determine the validity of the assumption that optical coherence tomographic scans of macular holes have a discrete linear signal (DLS) that represents a detached posterior vitreous face, and to analyze the DLS in macular hole pathogenesis. METHODS: Optical coherence tomographic scans were taken of 3 situations in which the vitreous conditions were known: (1) dissected intact vitreous, (2) clinically evident Weiss rings, and (3) maculae before and after saccades in eyes without a biomicroscopic posterior vitreous detachment. In addition, 70 eyes of 35 patients with macular holes underwent clinical examination and optical coherence tomographic scanning that passed through the optic disc and the fovea or macular hole. RESULTS: Spatial properties of the DLS matched those of the posterior vitreous face in the situations examined. Of the 70 eyes, 16 (23%) had a biomicroscopic posterior vitreous detachment, whereas a DLS was demonstrated in 40 (57%). Of the 54 eyes without a biomicroscopic posterior vitreous detachment, 18 (33%) had a DLS attached focally to the optic disc margin and the fovea or macular hole. All 7 of the "can opener" holes examined had a nasally "hinged" central flap, 6 with a focally attached DLS. CONCLUSIONS: The DLS corresponds to the posterior vitreous face. Anteronasal papillofoveal traction may generate some macular holes.

Fovea Centralis↗

Lens-sparing vitrectomy for progressive tractional retinal detachments associated with stage 4A retinopathy of prematurity.

OBJECTIVE: To describe the results of lens-sparing vitrectomy in infants with progressive, fovea-threatening, tractional retinal detachments associated with stage 4A retinopathy of prematurity. METHODS: In a retrospective, interventional, consecutive clinical case series, the records of patients with stage 4A retinopathy of prematurity who underwent lens-sparing vitrectomy for progressive retinal detachments were reviewed. Retinal attachment status, reversed or arrested retinal dragging, and visual acuity were assessed after the procedure. RESULTS: Thirty-two eyes of 29 patients underwent lens-sparing vitrectomy at a mean postconceptional age of 43 weeks. Thirty (94%) of 32 eyes had complete retinal reattachment and arrest or reversal of retinal dragging after 1 lens-sparing vitrectomy. Visual acuity of at least central, steady, and unmaintained was observed in 17 (81%) of the 21 eyes in which it was tested and at least central, steady, and maintained vision was measured in 13 (62%) of 21 eyes, with 1 eye achieving 20/40 visual acuity. CONCLUSIONS: Lens-sparing vitrectomy is a safe and effective procedure for the treatment of fovea-threatening retinal detachments in patients with stage 4A retinopathy of prematurity.

Birth Weight↗

Diabetic traction detachment.

One hundred thirty-six of 124 patients with diabetic traction detachment (TD) were observed for an average of 4.6 years (range, 3.0 to 9.4 years) with no surgical intervention. Visual acuity was maintained or improved in 51 of these eyes; 71 continued to be 20/200 or better. Diabetic TDs remained stable for long periods, those of more severe grade being more stable. At final examination, 60% (81/136) were graded at the same anatomic level (36/136) or an improved level (45/136). Spontaneous reattachment occurred in 20% (27/136); 78% (21/27) of these eyes had small detachments (TD1). The status of the vitreous and the vitreoretinal adhesion determined both the degree of detachment and the incidence of spontaneous reattachment.

Diabetic Retinopathy↗

Pars plana vitrectomy. Treatment for tractional macula detachment secondary to proliferative diabetic retinopathy.

Pars plana vitrectomies were performed on 43 eyes with traction macular detachment secondary to proliferative diabetic retinopathy. Anatomic success, as judged by reattachment of the macula, occurred 28 (65%) eyes. Improved visual acuity occurred in 11 (26%) eyes. Severe complications occurring after vitrectomy included moderate to severe rubeosis iridis diabetica (28%), neovascular glaucoma (16%), vitreous hemorrhage (49%), and phthisis bulbi (14%). Eyes that received scatter photocagulation therapy at some time prior to macular detachment had a substantially lower incidence of successful postoperative reattachment of the macula than eyes never treated with photocoagulation.

Adolescent↗

Traction retinal detachment. A cell-mediated event.

In posterior-segment penetrating injuries, the role of cellular and extracellular structures for the development of fraction retinal detachment is a matter of controversy. With the use of immunofluorescence techniques, we studied the cellular components of intravitreal membranes, with particular attention to the presence of intracellular contractile proteins. Our results demonstrate increasing concentrations of intracellular actin filaments in 12- to 21-day-old membrane specimens at the time when traction retinal detachment is most likely to occur in the rabbit eye. The sequence of events reflects the same process that occurs in the wound-healing response throughout the body. The specialized anatomy of the eye, particularly the vitreoretinal relationship at the vitreous base, accounts for the disastrous consequence of fraction retinal detachment.

Actins↗

Rhegmatogenous retinal detachments caused by paravascular vitreoretinal traction.

We describe three cases of shallow posterior rhegmatogenous retinal detachment caused by tiny retinal tears. The clinical appearance of the detachments was very similar to that of idiopathic central serous chorioretinopathy or traction retinal detachment. However, the correct diagnosis was made by finding a tiny paravascular break. Vitrectomy without a thermal adhesion was successful in repairing the detachments.

Adult↗

Results and prognostic factors in vitrectomy for diabetic traction retinal detachment of the macula.

The level of final visual acuity results and the prognostic factors predictive of the level were analyzed in 360 eyes that had pars plana vitrectomy for diabetic traction retinal detachment of the macula. Fifty-nine percent of the eyes had improved visual acuity on final examination. The percentage of eyes that achieved a final visual acuity of 20/100 or better and the percentage that achieved 5/200 or better increased from 21% to 36% and from 57% to 72%, respectively, during the study. Preoperative factors associated with a favorable visual prognosis were a visual acuity of 5/200 or better, the absence of iris neovascularization, a clear crystalline lens or only minimal cataract formation, clear media or only mild vitreous hemorrhage, panretinal photocoagulation of at least one fourth of the retina, and the absence of severe preoperative retinal neovascularization. Intraoperative factors associated with a favorable visual prognosis include the avoidance of performing a lensectomy, the absence of iatrogenic retinal breaks, and the avoidance of using intraocular gas bubbles.

Adolescent↗

Results and prognostic factors in vitrectomy for diabetic traction-rhegmatogenous retinal detachment.

The results of pars plana vitrectomy for diabetic traction-rhegmatogenous retinal detachment were analyzed in 172 eyes, and the factors associated with a final visual acuity of 5/200 or better were identified. Forty-eight percent of eyes had improved vision on final examination. The proportion of eyes with a final visual acuity of 20/100 or better and 5/200 or better remained virtually the same during the ten-year study interval. Preoperative factors associated with a visual acuity of 5/200 or better were a preoperative visual acuity of 5/200 or better, the absence of iris neovascularization, and the absence of retinal detachment involving the macula. The intraoperative factor associated with a final visual acuity of 5/200 or better was the absence of iatrogenic retinal breaks.

Adult↗

Effect of silicone oil on experimental traction retinal detachment.

The use of silicone oil as a retinal tamponade in the treatment of proliferative vitreoretinopathy is often complicated by membrane reproliferation. We studied the development of traction retinal detachments following the intravitreal injection of 15,000 retinal pigment epithelial cells in silicone-, perfluoropropane-, and fluid-filled rabbit eyes. By 28 days a higher proportion of silicone-filled eyes (83%) had severe proliferative vitreoretinopathy than either the perfluoropropane-filled (30%) or fluid-filled (10%) eyes. An in vitro proliferation assay using the vitreous samples showed that the silicone-filled vitreous had increased mitogenic activity for retinal pigment epithelial cells compared with the gas-filled or fluid-filled vitreous. Silicone oil appears to increase proliferation by stimulating the release of more or different mitogenic factors as well as by concentrating active factors into a smaller volume near the retina.

Animals↗

Suppression of experimental tractional retinal detachment by low-dose radiation therapy.

We used a standardized model of traction retinal detachment (TRD) created by cellular membranes in the rabbit to test the effects of low-dose radiation therapy in suppressing TRD. The vitreous and lens were removed from pigmented rabbits, and homologous conjunctival fibroblasts were grown in cell culture. After resolution of postoperative inflammation, 50,000 fibroblasts in 0.1 mL of culture fluid were injected into the vitreous cavity. Ten eyes were maintained as controls. Nineteen eyes received 6 Gy (600 rad) of x-ray irradiation one to three hours after cellular injection. Eyes were monitored weekly for three weeks with indirect ophthalmoscopy. Seven (70%) of ten control eyes developed TRD at one week; no additional TRDs were noted at weeks 2 and 3. Significantly smaller numbers of irradiated eyes developed TRD: at week 1, two (11%) of 19; at week 2, five (28%) of 18; and at week 3, five (29%) of 17.

Animals↗

Traction fibre: toward a "tensegral" model of the spindle.

Most current hypotheses of mitotic mechanisms are based on the "PAC-MAN" paradigm in which chromosome movement is generated and powered by disassembly of kinetochore microtubules (k-MTs) by the kinetochore. Recent experiments demonstrate that this model cannot explain force generation for anaphase chromosome movement [Pickett-Heaps et al., 1996: Protoplasma 192:1-10]. Another such experiment is described here: a UV-microbeam cut several kinetochore fibres (k-fibres) in newt epithelial cells at metaphase and the half-spindle immediately shortened: in several cells, the remaining intact spindle fibres bowed outwards as they came under increased compression. Thus, severing of k-MTs can lead to increased tension between chromosomes and poles. This observation cannot be explained by models in which force is produced by motor molecules at the kinetochore actively disassembling k-MTs. Rather, we argue that tensile forces act along the whole k-fibre, which, therefore, can be considered as a classic "traction fibre." We suggest that anaphase polewards force is generated by MTs interacting with the spindle matrix and when k-MTs are severed, polewards force continues to act on the remaining kMT-stub; spindle MTs act as rigid struts concurrently resisting and being controlled by these forces. We suggest that the principles of "cellular tensegrity" [Ingber, 1993: J. Cell Sci. 104:613-627] derived from the behaviour and organization of the interphase cell apply to the spindle. In an evolutionary context, this argument further suggests that the spindle might originally have evolved as the mechanism by which a single tensegral unit (cytoplast) is divided into two cytoplasts; use of the spindle for segregating chromosomes might represent a secondary, more recent development of this primary function. If valid, this concept has implications for the way the spindle functions and for the spindle's relationship to cytokinesis.

Animals↗

Exertion of tractional force requires the coordinated up-regulation of cell contractility and adhesion.

Although it is understood that cells exert mechanical forces on the extracellular matrix to promote structural organization, the exact mechanism of force transduction is not clearly understood. Using an in vitro force measurement assay, we evaluated two opposing conditions that inhibit or promote matrix organization by fibroblasts: serum deprivation and lysophosphatidic acid stimulation. Under serum deprivation, in spite of significant cell spreading and pseudopodial motility, rabbit corneal fibroblasts generated little or no force on the matrix within 2 h of observation. Lysophosphatidic acid stimulation of serum-starved cells caused dramatic cell contraction (within 2 min), which correlated temporally with a rapid increase in the tractional force generation on the matrix (0.52 x 10(-7) - 1.9 x 10(-7) N; n = 7 experiments). No cell translocation was observed during the period of force generation in response to lysophosphatidic acid-stimulation. These findings, taken together with a concomitant up-regulation of stress fibers in lysophosphatidic acid stimulated fibroblasts, indicate that contractility of non-motile cells involved in forming stress fibers and strong cell-matrix adhesion is the principal force-generating mechanism involved in matrix organization.

Actins↗