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At least 127 records · Page 7Linked to original sources
PubMed1994

Surgical results in the vitreomacular traction syndrome.

PURPOSE: The vitreomacular traction syndrome is a distinct clinical entity in which partial posterior vitreous detachment is present in combination with persistent macular adherence, causing traction-induced visual deficit. The authors evaluate the results of vitreous surgery for this syndrome. METHODS: The authors reviewed 20 consecutive eyes that underwent vitrectomy and posterior hyaloid/epiretinal membrane stripping to better define the clinical features, visual results, and complications of surgery for the vitreomacular traction syndrome. FINDINGS: Eyes were categorized anatomically as having either "classic" vitreomacular traction syndrome (8 [40%] eyes had 360 degrees midperipheral vitreous detachment) or "variable" vitreomacular traction syndrome (12 [60%] eyes had a variety of midperipheral areas of vitreous separation). Release of vitreomacular traction resulted in improvement in vision of two or more lines in 15 (75%) eyes, with 8 (40%) obtaining 20/50 visual acuity or better. All eyes were followed for at least 6 months. Complications of vitreous surgery included progression of nuclear sclerosis (83% of phakic eyes), epiretinal membrane formation (40%), and retinal breaks (20%). CONCLUSION: The vitreomacular traction syndrome represents a wide spectrum of vitreoretinal anatomic configurations that can produce visual deficit. Vitrectomy surgery to release macular traction may improve visual acuity.

Aged↗
PubMed1994

Traction forces generated by locomoting keratocytes.

Traction forces produced by moving fibroblasts have been observed as distortions in flexible substrata including wrinkling of thin, silicone rubber films. Traction forces generated by fibroblast lamellae were thought to represent the forces required to move the cell forwards. However, traction forces could not be detected with faster moving cell types such as leukocytes and growth cones (Harris, A. K., D. Stopak, and P. Wild. 1981. Nature (Lond.). 290:249-251). We have developed a new assay in which traction forces produced by rapidly locomoting fish keratocytes can be detected by the two-dimensional displacements of small beads embedded in the plane of an elastic substratum. Traction forces were not detected at the rapidly extending front edge of the cell. Instead the largest traction forces were exerted perpendicular to the left and right cell margins. The maximum traction forces exerted by keratocytes were estimated to be approximately 2 x 10(-8) N. The pattern of traction forces can be related to the locomotion of a single keratocyte in terms of lamellar contractility and area of close cell-substratum contact.

Animals↗
PubMed2004

Calcium transients induce spatially coordinated increases in traction force during the movement of fish keratocytes.

The coordination of protrusion with retraction is essential for continuous cell movement. In fish keratocytes the activation of stretch-activated calcium channels, and the resulting increase in intracellular calcium, trigger release of the rear cell margin when forward movement is impeded. Although it is likely that retraction involves a calcium-dependent increase in cytoskeletal contractility, it is not known how the timing, magnitude and localization of contractile forces are organized during retraction. We have addressed this question using a new gelatin traction force assay in combination with calcium imaging to determine what changes in cytoskeletal force production accompany calcium-induced retraction. We find that individual calcium transients are followed within seconds by a rapid increase in traction stress that is maintained, or increases in a stepwise manner, until retraction occurs. Increases in traction stress are accompanied by a distinct sequence of changes in the spatial distribution of large traction stresses. Regions of increased traction stress enlarge at the lateral cell margins and expand forward along the cell margin. In particular, rearward facing propulsive' tractions at the leading edge of the cell, which are normally very low, increase several fold. Following retraction, a precipitous drop in traction stress is observed. Such distinct variations in traction stress are not observed in cells when calcium transients are absent. These results suggest a mechanism by which global increases in intracellular calcium can locally regulate contractile force production, in order to maintain a rapid highly directed mode of movement.

Animals↗
PubMed1994

Animal traction in South Africa: research priorities in veterinary science.

During June 1994, members of numerous organisations with a vested interest in animal traction in South Africa met for a one-day workshop, the initial activity of a Forum on Working Animals. The workshop was sponsored by the Foundation for Research Development in South Africa. The individuals who attended were representatives of academic and government institutions, farmer and civic organisations, and included veterinarians and veterinary scientists, administrators, traction experts from the region and from abroad, agricultural engineers, sociologist, anthropologists and animal welfare experts. The objectives of the workshop were twofold: to address research priorities in veterinary science for traction animals and to identify future actions. Since it was a one-day workshop only, there was insufficient time to address issues in depth. However, problems were identified and appropriate actions were suggested. These actions were then delegated to a number of participants, to be refined and reported on at a subsequent workshop. Two key questions were considered and discussed by the participants, and a consensus reached for each. The first was to consider which species of traction animals are best suited to South African conditions. It was agreed that, in order of suitability, these are donkeys, cattle, mules and horses. The second question concerned the criteria which determine the usefulness of traction animals to South African communities. Two recommendations were made by the participants. The first recommendation was to design a questionnaire which would address the role of traction animals in the South African community and to identify communities in which the questionnaire would be implemented. At present, no information exists on the demographics of traction animals and their users. A list of questions was suggested and a working group from 6 institutions was identified to address this action. The second recommendation was to develop a research programme to study the 4 species which are most suitable for animal traction in South Africa.

Animals↗
PubMed1992

Hypertension associated with skeletal traction in children.

Since traction-associated hypertension seems to be a relatively unknown phenomenon, a survey was done of its incidence in children treated with skeletal traction for fractures and orthopaedic diseases. The correlation with hypercalcaemia, a possible aetiological factor, was also explored. Blood pressure was recorded three times a day with an automatic oscillometric unit during the stay in the hospital. Serum calcium, creatinine and total protein concentrations were measured once a week. Patients with pre-existing diseases or renal trauma were excluded. Arterial hypertension (systolic and/or diastolic) was found in 31/50 children (62%). In almost half of these the rise in systolic blood pressure was 10 mmHg or more above the 95th percentile. Hypertension occurred in most cases within the first 3 weeks of treatment; in 7 children it developed after 3 or more weeks of traction. All children became normotensive within 1 week after discontinuation of traction. Clinical symptoms were rare: two children complained of headache. In no instance had traction to be discontinued before the planned date because of hypertension. In the hypertensive group were more preschool children and more humeral fractures as compared to the normotensive group (n = 19). Hypercalcaemia occurred in 11 children and was equally distributed in hypertensive and in normotensive children. It is concluded that arterial hypertension is a frequent finding in children in traction, but its clinical relevance is uncertain. Hypercalcaemia is not a rare finding in immobilized children, but probably plays no causative role in traction-related hypertension.

Adolescent↗
PubMed1985

The mechanics of skull traction calipers.

The relationship between the torque applied to the loading screw and the load required to pull off Cone's type of skull traction caliper was established on cadavers. It was found that at a torque of 0.7 Newton metres (Nm), which corresponds to a compressive force of 13 lb (58 N) on the skull, the caliper became detached at the maximum traction load of 60 lb, but still held during this traction load at compressive forces above 18 lb (80 N). Clinically, an instrumented load cell was incorporated into one of the fixing pins on a skull traction caliper and it was found that the compressive load fell on average by 15 per cent over a period of 21 days of traction. Taking into account this fall in load with time and the limiting torque for pull-out with a traction force of 60 lb (265 N) it is suggested, for complete clinical safety, that a compressive load of 20 lb (88 N) obtained at a torque of 0.85 Nm should be applied to the loading screw of a Cone's type of caliper. Using these values in a loading analysis of the securing pins, suggestions are made as to the ideal design of skull traction calipers and the shortcomings of various designs of existing calipers are discussed, in particular the pins' lengths, compressive load and the pins' placement.

Adult↗
PubMed2004

Fourth and sixth cranial nerve injury after halo traction in children: a report of two cases.

BACKGROUND: Spinal traction is the application of a longitudinal force to the spinal column as a means of stabilizing a damaged or abnormal spine. Although not well documented in the ophthalmic literature, complications include cranial nerve palsies, with the sixth nerve being most commonly affected. Fourth nerve palsies have not previously been reported to our knowledge. We present 2 cases of combined fourth and sixth palsies after cervical traction. METHODS: Retrospectively, we reviewed the ophthalmic findings in 2 children with diplopia after spinal traction. RESULTS: Case 1 suffered a traumatic rotatory atlantoaxial subluxation and underwent halo traction. Case 2 required traction to correct a scoliosis secondary to osteogenesis imperfecta. In both cases, sixth nerve palsies were apparent soon after traction. Careful orthoptic examination revealed additional fourth nerve involvement. After 3 months, both cases showed partial resolution of the cranial nerve injuries. CONCLUSIONS: Cranial nerve injury may occur with spinal traction. Fourth nerve palsy may be underreported because of masking by a coinciding sixth nerve palsy.

Abducens Nerve Injury↗
PubMed1997

Controlled cord traction versus minimal intervention techniques in delivery of the placenta: a randomized controlled trial.

OBJECTIVES: Our purpose was to compare the controlled cord traction technique with the minimal intervention technique for delivery of the placenta. The primary outcome was the incidence of postpartum hemorrhage. Secondary outcomes included duration of third stage of labor, frequency of retained placenta, hemorrhagic shock, the need for blood transfusion, and the need for uterotonic agents to control postpartum hemorrhage. STUDY DESIGN: A total of 1648 women who were delivered vaginally were randomly allocated during labor to the controlled cord traction group (n = 827) or the minimal intervention group (n = 821). In the controlled cord traction group women received oxytocin, 10 units intramuscularly, with delivery of the baby's anterior shoulder, after which the placenta was delivered actively by controlled cord traction (Brandt-Andrews method). In the minimal intervention group the placenta was delivered by maternal pushing. Continuous intravenous oxytocin was given after delivery of the placenta. Odds ratios with 95% confidence intervals were calculated for each variable. RESULTS: The overall incidence of postpartum hemorrhage was significantly lower in the controlled cord traction group (5.8% vs 11%; odds ratio 0.50, 95% confidence interval 0.34 to 0.73). The incidence of retained placenta (> or = 30 minutes) was 1.6% in the controlled cord traction group and 4.5% in the minimal intervention group (odds ratio 0.31, 95% confidence interval 0.15 to 0.63). Significantly more patients in the minimal intervention group required additional uterotonic agents to control hemorrhage (5.1% vs 2.3%; odds ratio 0.44, 95% confidence interval 0.24 to 0.78). CONCLUSION: The controlled cord traction technique for delivery of the placenta results in a significantly lower incidence of postpartum hemorrhage and retained placenta, as well as less need for uterotonic agents, compared with the minimal intervention technique.

Delivery, Obstetric↗
PubMed2001

Loads in the lumbar spine during traction therapy.

The purpose of the present study was to determine the loads acting on the lumbar spine when traction therapy was given in the Fowler's position. The study had two parts: a theoretical analysis which showed that traction produced a flexion moment on the spine as well as axial distraction; and an experimental study which measured the flexion moment induced by the adoption of the Fowler's position. The Fowler's position is clinically essential in that it flexes the spine and takes up the slack of the posterior tissues before the traction force is applied. Hence the axial tension and flexion moment generated by the traction force are more effective in stretching the posterior tissues. The angle of pull on the traction harness influences the friction between the body and the couch. However, this consideration is not necessary if a split traction table is used. The mechanical effects of traction are compared with those produced by postero-anterior mobilisation. The relative magnitude and direction of loads produced, and their variation with segmental level should be considered by therapists when choosing a technique for treating low back pain.

Adult↗
PubMed1988

The effect of axial traction during orotracheal intubation of the trauma victim with an unstable cervical spine.

Axial (in-line) traction is recommended as a stabilizing maneuver during orotracheal intubation of a trauma victim with a potential cervical spine injury. There are no published data demonstrating the safety of this technique in trauma patients with an unstable cervical spine. In our study, 17 victims of blunt traumatic arrest had radiographic analysis of the cervical spine during orotracheal intubation, with and without axial traction. Four (24%) had unstable injuries, which included a C6-7 fracture dislocation, a Hangman's fracture, and two atlanto-occipital dislocations. Axial traction during oral intubation in these victims resulted in a mean distraction at the fracture site of 7.75 mm. Axial traction produced 4 mm of posterior subluxation in the C6-7 fracture dislocation, demonstrating that axial traction alone may result in subluxation, as well as distraction. This depends on the direction of the traction force and integrity of surrounding tissues. We recommend that trauma patients requiring intubation prior to a complete examination and radiographic analysis of the cervical spine be nasotracheally intubated without axial traction, and that the head and neck be stabilized in the neutral position. If a contraindication to nasotracheal intubation exists, a cricothyroidotomy should be performed.

Emergencies↗
PubMed2002

Deep skin slough following skin traction for hip fractures.

INTRODUCTION: Elderly patients who fracture their hips are susceptible to complications associated with bed rest before surgery. In some institutions a skin traction device is used in order to relieve pain before surgery. The authors followed ten patients who developed severe (deep) skin slough and evaluated the relationship to the skin traction device. The need for use of a skin traction device is debated and the need for multidisciplinary treatment if this complication develops is emphasised. PATIENTS AND METHODS: All patients who had serious skin slough between January and December 2000 were evaluated. A serious skin slough was defined as any new and abrupt case of a full-thickness skin loss involving damage or necrosis of subcutaneous tissue, but not through the underlying fascia and not extending to underlying bone, tendon or joint capsule. Preoperative assessment including background illness and medications, the application of a skin traction device, the type of surgery that was performed, and complications were noted. RESULTS: Ten patients (nine females and one male) aged 76-90 years met the criteria of serious skin slough. The leading chronic illness was cardiovascular. Among these patients there were intertrochanteric fractures (n = 5), subcapital fractures (n = 4) and a subtrochanteric fracture (n = 1). In all patients a skin traction device was used. In seven out of the ten patients the skin slough occurred during or immediately after surgery. Other postoperative complications included uncontrolled glucose levels (> 130 mg/dl during fasting) (two cases) and urinary tract infections (two cases). The skin slough was treated with a daily wound care regimen by a trained nurse and included daily changing of wet dressings and application of Vaseline gauze. All patients were allowed immediate ambulation after the surgery and were discharged 9-15 days after the surgery. Although improvement of the slough was noted in all patients, none of them had fully recovered, and they had to continue treatment in outpatient clinics. DISCUSSION: The main goal of treatment in elderly patients who fractured their hips is to return them to their previous activities of daily living. A skin traction device, although useful for many of the patients, has the disadvantage of causing serious skin slough. This complication can interfere with the normal curve of rehabilitation and cause prolonged hospital stay. Whenever this complication is expected, the application of the skin traction device should be avoided. Moreover, careful handling of the patients by physicians, physiotherapists and nurses is mandatory. If this complication develops, vigorous multidisciplinary care is recommended.

Aged↗
PubMed2001

Maintenance of condylar position using an occlusal splint after mechanical vibrating-traction of the TMJ.

Although adequate relief of excess mechanical loading to the joint has been accepted as one of the important treatment concepts in the orthopaedic field, a treatment method for the temporomandibular joint (TMJ) to relieve excess mechanical loading has not yet been established. This study aimed to clarify the effect of an occlusal splint on the maintenance of the distracted condylar position achieved by vibrating-traction method. Vibrating dynamic traction force was applied for 5 min to the right TMJ using vibrating-traction apparatus. A flat stabilization splint was adjusted to keep the mandibular position and the condylar displacement was evaluated for 6 h after the dynamic traction procedure. Mean vertical displacement of the mandibular right first molar immediately after the vibrating-traction for the six subjects was 156 microm (ranging from 141 to 179 microm). The calculated mean condylar displacement immediately after the traction was 480 mum and could be kept to be 381 mum even after 6 h by wearing the flat stabilization splint. From the results of this study, it was revealed that the mechanically tracted condylar position could be maintained by a flat occlusal splint. It was suggested that the vibrating-traction method followed by the provision of occlusal support might have a possibility to work as a mechanical relieving procedure for the TMJ.

Adult↗
PubMedDate not supplied

Traction splinting of femoral shaft fractures in a paediatric emergency department: time is of the essence?

OBJECTIVE: To describe the use of traction splinting in children with femoral shaft fracture and to determine if timing of traction splinting application effects outcome. METHODS: A retrospective descriptive study conducted over a five and a half year period (1 January 1996 to 1 July 2001) on children presenting with femoral shaft fracture to a Paediatric trauma centre. Data were collected on all children with a radiological diagnosis of fracture to the femoral shaft. Evidence for hypovolaemic shock and neurovascular compromise was sought. The administration of parenteral analgesia and whether a validated pain scale was employed to monitor pain relief was documented. The use of traction splint or other leg splint device before arrival in the ED and subsequent changes to splinting in hospital were noted. Times to perform radiographic examination and femoral nerve block were also recorded. RESULTS: Ninety-five (95) patients met the study inclusion criteria with 66.3% having some form of immobilization and 70% administered parenteral analgesia in the pre-hospital setting. In only 7.3% of patients was a Thomas splint traction applied within 2 h of arrival. Adverse clinical outcome was not reported in any patient regardless of time to application of Thomas splint traction. The application of Thomas splint traction in the ED resulted in a significant delay in the performance of diagnostic radiographs and femoral nerve block. CONCLUSIONS: The timing of traction splinting is not associated with poor outcome in isolated paediatric femoral shaft fracture provided effective analgesia has been administered in a timely fashion.

Analgesia↗
PubMed2002

A new 3-point bending traction method for restoring cervical lordosis and cervical manipulation: a nonrandomized clinical controlled trial.

OBJECTIVE: To evaluate a new 3-point bending type of cervical traction. DESIGN: Nonrandomized controlled trial of prospective, consecutive patients compared with control subjects. Follow-up patient data were obtained at 3 and 15(1/2) months, and 8 1/10 months for controls. SETTING: Data were collected at a spine clinic in Nevada. PATIENTS: Volunteer subjects consisted of 30 patients and 24 controls. Subjects had cervicogenic pain (neck pain, headaches, arm pain, and/or numbness). Subjects were included if their Ruth Jackson radiographic stress lines measured less than 25 degrees but were excluded if they had suspected disk herniation or canal stenosis. All subjects completed the first follow-up examinations, and 25 of 30 patients completed the long-term follow-up examination. INTERVENTIONS: Spinal manipulation for pain and a new form of 3-point bending cervical traction to improve lordosis. Cervical manipulation was provided for the first 3 to 4 weeks of treatment. Traction treatment consisted of 3 to 5 sessions per week for 9 +/- 1 weeks. MAIN OUTCOMES MEASURES: Besides pain visual analog scale (VAS) ratings, pre- and posttreatment lateral cervical radiographs were analyzed. RESULTS: Control subjects reported no change in the pain VAS ratings and had no statistically significant change in segmental or global radiographic alignment. For the traction group, VAS ratings were 4.3 pretreatment and 1.6 posttreatment. Traction group radiographic measurements showed statistically significant improvements (P <.008 in all instances of statistical significance), including anterior head weight bearing (improved 6.2mm), Cobb angle at C2-7 (improved 12.1 degrees ), and angle between posterior tangents at C2-7 (improved 14.2 degrees ). For the treatment group, at 15(1/2)-month follow-up, only minimal loss of C2-7 lordosis (3.5 degrees ) was observed. CONCLUSIONS: Sagittal cervical traction with transverse load at midneck (2-way cervical traction) combined with cervical manipulation can improve cervical lordosis in 8 to 10 weeks as indicated by increases in segmental and global cervical alignment. Magnitude of lordosis at C2-7 remained stable at long-term follow-up.

Adult↗
PubMed2000

Lumbar spine traction: evaluation of effects and recommended application for treatment.

Despite the widespread use of traction, little is known of the mode of effect, and application remains largely anecdotal. The efficacy of traction is also unclear because of generally poor design of the clinical trials to date, and because subgroups of patients most likely to benefit have not been specifically studied. These observations prompted this review, the purposes of which are to evaluate the mechanisms by which traction may provide benefit and to provide rational guidelines for the clinical application of traction. Traction has been shown to separate the vertebrae and it appears that large forces are not required. Vertebral separation could provide relief from radicular symptoms by removing direct pressure or contact forces from sensitised neural tissue. Other mechanisms proposed to explain the effects of traction (e.g. reduction of disc protrusion or altered intradiscal pressure) have been shown not to occur. We conclude that traction is most likely to benefit patients with acute (less than 6 weeks' duration) radicular pain with concomitant neurological deficit. The apparent lack of a dose-response relationship suggests that low doses are probably sufficient to achieve benefit.

Animals↗
PubMedDate not supplied

[The effect of halo-gravity traction in the preoperative treatment of neuromuscular scoliosis].

The purpose of this study is to evaluate the influence of halo-gravity-traction on paralytic scoliosis in various neurologic diseases. Between 1980 and 1993 preoperative halo-gravity-traction was applied in 32 patients with paralytic scoliosis (23 patients with myelomeningocele, 6 patients with poliomyelitis, 3 patients with cerebral palsy). In the myelomeningocele group the average curvature before treatment was 97.8 degrees, after surgery 45.1 degrees; which is an improvement of 53.9%. Halo-gravity-traction accounted for 12.8% improvement. In the poliomyelitis group the average curvature before treatment was 104.3 degrees, after surgery 58.0 degrees; which is an improvement of 44.4%. Halo-gravity-traction accounted for 16.9% improvement. In the cerebral palsy group the average curvature before treatment was 75.0 degrees, after surgery 39.0 degrees; which is an improvement of 48.0%. Halo-gravity-traction accounted for -2.7% improvement. If there is an effect the question remains, whether this will have consequences for the surgical outcome. The comparison between good and bad responders with the surgical result shows, that this result is independent of the halo-gravity-traction. From this results we draw the conclusion, that preoperative halo-gravity-traction can not be recommended in paralytic scoliosis.

Adolescent↗
PubMed2006

Mechanical traction for mechanical neck disorders: a systematic review.

OBJECTIVE: To assess whether mechanical traction, either alone or in combination with other treatments, improves pain, function/disability, patient satisfaction and global perceived effect in adults with mechanical neck disorders. METHODS: We conducted a systematic review up to September 2004 of randomized controlled trials and used pre-defined levels of evidence for qualitative analysis. Two independent reviewers conducted study selection, data abstraction and methodological quality assessment. Using a random effects model, relative risk and standardized mean differences were calculated. The reasonableness of combining studies was assessed on clinical and statistical grounds. In the absence of heterogeneity, pooled effect measures were calculated. RESULTS: Of the 10 selected trials, one study was of high quality. Our review revealed low-quality trials for mechanical neck disorders, showing evidence of benefit favouring intermittent traction for pain reduction. Continuous traction showed no significant difference for defined outcomes. CONCLUSION: Inconclusive evidence for continuous and intermittent traction exists due to trial methodological quality. Two clinical conclusions may be drawn, one favouring the use of intermittent traction and the other not supporting the use of continuous traction. Attention to research design flaws and description of traction characteristics is needed.

Adult↗
PubMed1995

The efficacy of traction for back and neck pain: a systematic, blinded review of randomized clinical trial methods.

BACKGROUND AND PURPOSE: The purpose of this study was to conduct a systematic analysis of the literature to assess the efficacy of traction for patients with neck or back pain. SUBJECTS: For this purpose, randomized clinical trials comparing traction with other treatments were selected. METHODS: A computer-aided search of the literature was conducted for relevant articles, followed by blinded assessment of the methods of the studies. The main outcome measures were (1) scoring for quality of the designated conduct of studies (based on a methodological checklist with four main categories: study population, interventions, measurement of effect, and data presentation) and the main conclusions of author(s) with regard to traction and (2) calculation of confidence intervals and power of the studies. RESULTS: Only three studies scored more than 50 points (maximum score = 100 points), suggesting that most of the selected studies were of poor quality. None of these three studies showed favorable results for traction. Only four studies, of which one scored more than 50 points, had an acceptable power (1- beta > 80%). CONCLUSION AND DISCUSSION: The available reports of studies on the efficacy of traction for back and neck pain do not allow clear conclusions due to the methodological flaws in their design and conduct. Most studies lacked power (1-beta) due to small sample sizes. To date, no conclusions can be drawn about whether a specific traction modality for back or neck pain is effective, or more efficacious than other treatments. There are no clear indications, however, that traction is an ineffective therapy for back and neck pain. Further trials are needed in which much more attention should be paid to proper design and conduct, as well as to clear descriptions of crucial methodological features and results.

Back Pain↗