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At least 145 records · Page 8Linked to original sources
PubMed1988

Prostacyclin mediation of vasodilation following mesenteric traction.

Eight untreated patients (group I) and four patients who received ibuprofen preoperatively (group II) scheduled for elective abdominal aortic aneurysm repair were studied. Heart rate (HR); systolic, diastolic, and mean arterial pressure (MAP); systolic and diastolic pulmonary artery pressure; pulmonary capillary wedge pressure (PCWP); cardiac output (CO); and central venous pressure (CVP) were recorded pre-induction, before mesenteric traction, and 5, 15, and 30 min post-mesenteric traction. Plasma samples were obtained at these times for analysis of six-keto-prostaglandin F1 alpha (PGF1 alpha) concentration by radioimmunoassay. Group II patients received ibuprofen 12 mg/kg orally 1 1/2 h before surgery. Plasma samples from six group I patients and all group II patients taken 5 min after mesenteric traction were added to isolated helical strips of cat superior mesenteric arteries precontracted with norepinephrine (200 ng/ml) for analysis of reduction in developed force. In group I, abdominal mesenteric traction resulted in a significant decrease in MAP (P less than 0.03) and SVR (P less than 0.005) with an increase in CO (P less than 0.05) at 5 min post-mesenteric traction, which returned to mean pre-mesenteric traction values by 30 min and a significant increase in PGF1 alpha concentrations. There was a significant positive correlation between PGF1 alpha and CO (P less than 0.001) and a significant negative correlation between PGF1 alpha and SVR (P less than 0.01) at 5 min post-mesenteric traction.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Preliminary traction as a single determinant of avascular necrosis in developmental dislocation of the hip.

The role of preliminary traction before closed reduction in the treatment of developmental dysplasia of the hip has been questioned by many authors lately. However, the studies advocating or opposing the use of this treatment modality include several other parameters besides traction. Thus, it is unclear whether the affection is the result of preliminary traction or concurrent variables such as the "human position." This study aimed to put forward the effect of preliminary traction as a single determinant of avascular necrosis. We had two groups of patients who had developmental dislocation of the hip. The first group consisted of 52 patients treated with preliminary traction before closed reduction and the other group comprised 40 patients treated with closed reduction without preliminary traction. Both groups were similar in age, gender, side, level of dislocation, and method and duration of immobilization. Three patients from the first group developed avascular necrosis, which was not statistically significant. Preliminary traction did not affect the rate of avascular necrosis.

Age Factors↗
PubMedDate not supplied

Skeletal traction versus external fixation for pediatric femoral shaft fractures: a comparison of hospital costs and charges.

OBJECTIVES: To compare the hospital costs, charges, and reimbursement for treatment of pediatric femur fractures by two treatment methods: external fixation and 90-90 traction with spica casting. DESIGN: Retrospective clinical review. SETTING: Department of Orthopaedic Surgery, Children's Hospital Oakland, regional pediatric trauma center. PATIENTS: Twenty-nine consecutive patients between the ages of five and ten with a fracture of the femoral shaft were treated by one of two methods: external fixation (sixteen patients) or 90-90 skeletal traction followed by spica casting (thirteen patients). INTERVENTION: External fixation or 90-90 traction followed by spica casting. MAIN OUTCOME MEASURE: Hospital billing data including costs, charges, reimbursement for the initial inpatient hospitalization, and outpatient financial data until fracture union and cessation of treatment. RESULTS: There was no difference in age, total treatment time, mechanism of injury, or number of associated injuries between the two groups. The average charge for treatment with skeletal traction and spica casting was $32,094 per patient versus $21,439 for external fixation (p < 0.001). The average cost for treatment with traction and spica casting was $22,396 per patient versus $11,520 for external fixation (p < 0.001); reimbursement was $30,846 and $7,490, respectively (p < 0.001). The number of days in the hospital was larger for the traction group than for the external fixation group (22.3 days versus 4.7 days, p < 0.0001). CONCLUSIONS: External fixation of pediatric femoral shaft fractures results in decreased hospital costs and length of hospitalization, but produces significantly less income for the hospital when compared with skeletal traction followed by spica casting.

California↗
PubMed1981

The use of modified Neufeld traction in the management of femoral fractures in polytrauma.

The choice of treatment modalities for the fractured femur in the polytrauma patient is a continuing dilemma. Prevention and treatment of respiratory complications requires maximum patient mobility. Conventional traction methods restrict turning in bed and preclude moving the patient out of bed. Immediate open reduction results in additional blood loss, tissue trauma, and a higher rate of infection and nonunion. Immediate closed intramedullary nailing is an excellent method but requires special equipment and surgical expertise. To meet the mobilization requirements of good pulmonary care and avoid the problems of early open reduction, before the availability of immediate closed nailing, we adopted the use of modified Neufeld single-rope roller traction for the initial treatment of closed, Grade I open, and some Grade II open femur fractures. In 30 cases, the traction was used to maintain the fracture for 7 to 14 days preceding delayed internal fixation, while in another 22 cases of the traction was used as the definitive treatment modality in conjunction with case bracing. Sixty patients with femoral fractures were treated with this traction methods. Eight patients died, the other 52 were followed to fracture healing. There was one delayed union. There were no nonunions and no wound infections in either the internal fixation or continued traction groups. This traction system is an effective way to meet the needs of the polytrauma patient with a femur.

Adolescent↗
PubMed1996

Spinal deformity and axial traction.

Axial traction to correct spinal deformity is a very old concept. The oldest reference available is in ancient Hindu mythological epics (written between 3500 BC and 1800 BC) where it is mentioned how Lord Krishna corrected the hunchback of one of his devotees. Later, Hippocrates (460 BC to 377 BC) described certain devices. Galen (131 AD to 201 AD), a follower of Hippocrates, used axial traction with direct pressure. Ibn Sena (980 AD to 1037 AD) in the Middle East also used similar methods. Osteopaths of Turkey also used axial traction to correct spinal deformities. But gradually mechanical methods for the correction of the spinal deformity went into disrepute due to the invariable production of paraplegia. In the past few decades, interest in the correction of spinal deformity has been rejuvenated due to better understanding of anatomy, physiology, and pathomechanics of spinal deformity. Controlled axial traction has been the keystone of several modern procedures such as Cotrel traction, Halo traction, and Harrington Outrigger instrumentation, etc. It appears that the primitive ways of application of axial traction by crude methods did not totally vanish but have been modified. In Indian tribal areas, bone setters still practice it in modified form.

History, 20th Century↗
PubMed1998

Distraction of lumbar vertebrae in gravitational traction.

STUDY DESIGN: Experimental study of 30 patients diagnosed with low back pain resulting from lumbar disc herniation, disc degeneration, and segmental instability. Patients underwent gravitational traction, and widening of the intervertebral space and posterior facets was measured on radiographs. This same procedure was performed with a group of 30 healthy individuals. OBJECTIVES: To determine the effect of gravitational traction on the widening of the intervertebral space and the other vertebral structures in patients with low back pain and in healthy individuals. SUMMARY OF BACKGROUND DATA: Gravitational traction is performed by suspending the patient in a hanging, upright position for an extended period of time. In spite of disagreement among authors about the effect of lumbar traction, recent innovations have enabled the distraction of vertebrae. METHODS: A specially designed apparatus was used to apply gravitational traction. Pre- and post-traction radiographs were obtained to study the changes in the L2-L3, L3-L4, L4-L5, and L5-S1 intervertebral spaces; Ferguson's angle; L1-S1 total distance; and blood pressure. RESULTS: Distraction was more than approximately 3 mm in each intervertebral space in both groups. CONCLUSION: Gravitational traction had a very apparent effect on intervertebral space and was found to be an effective method to distract lumbar vertebrae. Discomfort experienced by the patient during suspension may be overcome by making biomedical changes to the suspension corset.

Adult↗
PubMed1999

Randomized trial comparing interferential therapy with motorized lumbar traction and massage in the management of low back pain in a primary care setting.

STUDY DESIGN: A randomized trial designed to compare interferential therapy with motorized lumbar traction and massage management for low back pain in a primary care setting. OBJECTIVE: To measure and compare the outcome of interferential therapy and management by motorized lumbar traction and massage. SUMMARY OF BACKGROUND DATA: Management of low back pain by interferential therapy and motorized lumbar traction and massage is common in Germany. No reports of previous randomized trials for the outcome from interferential therapy were found. METHODS: Consenting patients were randomly assigned into one of two groups. A pretreatment interview was performed by the patient using a computer-based questionnaire. It also incorporated the Oswestry Disability Index and a pain visual analog scale. Management consisted of six sessions over a 2- to 3-week period. Oswestry Disability Indexes and pain visual analog scale scores also were obtained immediately after and at 3 months after treatment. RESULTS: A total of 152 patients were recruited. The two treatment groups had similar demographic and clinical baseline characteristics. The mean Oswestry Disability Index before treatment was 30 for both groups (n = 147). After treatment, this had dropped to 25, and, at 3 months, were 21 (interferential therapy) and 22 (motorized lumbar traction and massage). The mean pain visual analog scale score before treatment was 50 (interferential therapy) and 51 (motorized lumbar traction and massage). This had dropped, respectively, to 46 and 44 after treatment and to 42 and 39 at 3 months. CONCLUSIONS: This study shows a progressive fall in Oswestry Disability Index and pain visual analog scale scores in patients with low back pain treated with either-interferential therapy or motorized lumbar traction and massage. There was no difference in the improvement between the two groups at the end of treatment. Although there is evidence from several trials that traction alone is ineffective in the management of low back pain, this study could not exclude some effect from the concomitant massage.

Adult↗
PubMed2005

Acute quadriplegia following closed traction reduction of a cervical facet dislocation in the setting of ossification of the posterior longitudinal ligament: case report.

STUDY DESIGN: A case report of acute quadriplegia resulting from closed traction reduction of traumatic bilateral cervical facet dislocation in a 54-year-old male with concomitant ossification of the posterior longitudinal ligament (OPLL). OBJECTIVES: To report an unusual presentation of a spinal cord injury, examine the approach to reversal of the injury, and review the treatment and management controversies of acute cervical facet dislocations in specific patient subgroups. SUMMARY OF BACKGROUND DATA: The treatment of acute cervical facet dislocations is an area of ongoing controversy, especially regarding the question of the necessity of advanced imaging studies before closed traction reduction of the dislocated cervical spine. The safety of an immediate closed, traction reduction of the cervical spine in awake, alert, cooperative, and appropriately select patients has been reported in several studies. To date, there have been no permanent neurologic deficits resulting from awake, closed reduction reported in the literature. A case of temporary, acute quadriplegia with complete neurologic recovery following successful closed traction reduction of a bilateral cervical facet dislocation in the setting of OPLL is presented. METHODS: The clinical neurologic examination, radiographic, and advanced imaging studies before and after closed, traction reduction of a cervical facet dislocation are evaluated and discussed. A review of the literature regarding the treatment of acute cervical facet dislocations is presented. RESULTS: Radiographs showed approximately 50% subluxation of the fifth on the sixth cervical vertebrae, along with computerized tomography revealing extensive discontinuous OPLL. The cervical facet dislocation was successfully reduced with an awake, closed traction reduction, before magnetic resonance imaging (MRI) evaluation. The patient subsequently had acute quadriplegia develop, with the ensuing MRI study illustrating severe spinal stenosis at the C5, C6 level as a result of OPLL or a large extruded disc herniation. Following an immediate anterior decompression and a posterior stabilization procedure, the patient regained full motor and sensory function. CONCLUSIONS: This case report highlights the advantages and shows some safety concerns regarding immediate, closed traction reduction of cervical facet dislocation with real-time neural monitoring in an awake, alert, oriented, and appropriately select patient before MRI studies in the setting of preexisting central stenosis from OPLL.

Acute Disease↗
PubMedDate not supplied

Current practice in use of prereduction traction for congenital dislocation of the hip.

To define the current application of preliminary traction for congenital dislocation of the hip (CDH), 335 members of the Pediatric Orthopaedic Society were surveyed, with an 87% response rate. Most respondents believe that traction reduces the incidence of avascular necrosis (AVN) and enables easier reduction. Only 5% of those surveyed do not use traction, but it is used more frequently in the Northeastern United States. Home traction, favored by 31% of the respondents, is used longer than hospital traction. Although traction is commonly used, a consensus to use preliminary traction has not been achieved. Practice patterns should not be used to determine effectiveness of a treatment.

Canada↗
PubMed2004

Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children.

BACKGROUND: Titanium elastic nails are commonly used to stabilize femoral fractures in school-aged children, but there have been few studies assessing the risks and benefits of this procedure compared with those of traditional traction and application of a spica cast. This prospective cohort study was designed to evaluate these two methods of treatment, with a specific focus on the first year after injury, the period when the treatment method should have the greatest impact. METHODS: Eighty-three consecutive children, six to sixteen years of age, were studied prospectively. Factors that were analyzed included clinical and radiographic data, complications, hospital charges, and outcome data. Outcome and recovery were assessed both with the American Academy of Orthopaedic Surgeons Pediatric Outcomes Data Collections Instrument, version 2.0, and according to a series of important recovery milestones including the time to walking with aids, time to independent walking, time absent from school, and time until full activity was allowed. RESULTS: Thirty-five children (thirty-five fractures), with a mean age of 8.7 years, were treated with traction and application of a spica cast, and forty-eight children (forty-nine fractures), with a mean age of 10.2 years, were treated with titanium elastic nails. All fractures healed, and no child sustained a complication that was expected to cause permanent disability. At one year after the fracture, eighty of the children had acceptable alignment and no inequality between the lengths of the lower extremities. The remaining three children, who had an unsatisfactory result, had been treated with traction and a spica cast. Twelve patients (34%) treated with traction and a cast had a complication compared with ten patients (21%) treated with titanium elastic nails. Compared with the children treated with traction and a cast, those treated with titanium elastic nails had shorter hospitalization, walked with support sooner, walked independently sooner, and returned to school earlier. These differences were significant (p < 0.0001). We could detect no difference in total hospital charges between the two groups. CONCLUSIONS: The results of this prospective study support the recent empiric observations and published results of retrospective series indicating that a child in whom a femoral fracture is treated with titanium elastic nails achieves recovery milestones significantly faster than a child treated with traction and a spica cast. Hospital charges for the two treatment methods are similar. The complication rate associated with nailing compares favorably with that associated with traction and application of a spica cast.

Adolescent↗
PubMedDate not supplied

The effect of prereduction traction on the results of closed reduction of developmental dislocation of the hip.

A group of 86 developmentally dislocated hips in children aged 6-48 months was treated by closed reduction before 1957 without preliminary traction, and another group of 176 hips was treated after 1957 with prereduction traction. The results in these two groups were compared to clarify the effect of prereduction traction. During the treatment of these cases, subcutaneous adductor tenotomy was performed when obviously indicated. Otherwise preliminary traction was the only variable between the two groups. To rule out tenotomy as a factor influencing the result, the hips of children aged 6-36 months who had prereduction traction as the single variable were taken out of the group and the results analyzed. It is concluded that prereduction traction decreases the incidence of avascular necrosis of the femoral head when developmentally dislocated hips of children aged 6-36 months are treated with closed reduction with traction as the single variable.

Child, Preschool↗
PubMed1985

Cervical spine disorders. A comparison of three types of traction.

A randomized clinical trial was conducted to evaluate the efficacy of three commonly employed forms of traction in the treatment of cervical spine disorders. One hundred consenting men and women with disorders of the cervical spine were randomly assigned to one of four treatment groups, static traction, intermittent traction, manual traction, or no traction. All patients, regardless of group assignment, were seen twice weekly. The four groups were shown to be similar with regard to age, sex, diagnosis, chronicity, and prescores on the seven outcome measures. Although the entire cohort of neck patients, regardless of group assignment, improved significantly on all the outcome variables over the 6-week period, patients receiving intermittent traction performed significantly better than those assigned to the no traction group in terms of pain (P = 0.03), forward flexion (P = 0.01), right rotation (P = 0.004) and left rotation (P = 0.05).

Adult↗
PubMed1984

Comminuted femoral-shaft fractures: treatment by roller traction, cerclage wires and an intramedullary nail, or an interlocking intramedullary nail.

In a retrospective study, we attempted to assess progress in the treatment of comminuted fractures of the femoral shaft at Parkland Memorial Hospital from 1978 to 1983. Seventy-nine comminuted femoral-shaft fractures were available for follow-up: thirty-two treated by roller traction, twenty-three treated by cerclage wires and an intramedullary nail, and twenty-four treated by an interlocking intramedullary nail. Using the classification of Winquist and Hansen, Grade-III and IV comminuted fractures accounted for 69 per cent of those treated by roller traction, 68 per cent of those treated by nailing and cerclage wires, and 96 per cent of those treated by an interlocking nail. The frequency of multiple injuries was 38 per cent in the patients treated by roller traction, 39 per cent in those treated by nailing and cerclage wires, and 58 per cent in those treated by an interlocking nail. The average hospitalization times were thirty-one days for roller traction, sixteen days for cerclage wires and an intramedullary nail, and 19.5 days for an interlocking nail. The average length of follow-up was 132 weeks after roller traction, 115 weeks after cerclage wiring and an intramedullary nail, and sixty weeks after insertion of an interlocking nail. All fractures were followed until after union; the average times to union were 18.4 weeks after roller traction, thirty-four weeks after open reduction and intramedullary nailing with cerclage wires, and 13.8 weeks after insertion of an interlocking nail. For the purposes of this study, treatment was assumed to have failed if a change in treatment was necessary, an unplanned reoperation was performed, femoral shortening exceeded 2.5 centimeters, angulation was more than 15 degrees, non-union or a deep infection developed, motion of the knee was less than 70 degrees of flexion, or a refracture occurred. By these criteria, the frequency of failure after roller traction was 66 per cent (secondary to malalignment and shortening); after insertion of an intramedullary nail with cerclage wires, 39 per cent (secondary to unplanned surgery, non-union, shortening, and infection); and after use of an interlocking nail, 4 per cent (secondary to shortening). Currently, at our institution, an interlocking intramedullary nail is the treatment of choice for comminuted femoral-shaft fractures because it encourages early union with maintenance of length and alignment and the results are predictable.

Adolescent↗
PubMedDate not supplied

The efficacy of traction for lumbar back pain: design of a randomized clinical trial.

OBJECTIVE: To present the design of a trial on the efficacy of lumbar traction. DESIGN: Randomized clinical trial. PATIENTS: Patients with a minimum of 6 wk, nonspecific low back pain. INTERVENTION: High-dose, motorized, continuous traction with a force between 35% and 50% of the total body weight was compared with sham or low-dose traction with a force between 0 and 20% of body weight. The sham traction was given with a specially developed brace that becomes tighter in the back during traction. This is experienced by patients as if traction were exerted. OUTCOME MEASURES: Primary measures were the patient's global impression of the effect and the severity of three main complaints. Secondary effect measures were functional status, pain, range of motion, work absence and recurrences. The effect measures were rated before randomization and 4 wk, 12 wk and 6 months later. CONCLUSION: There have been a number of earlier trials on the efficacy of lumbar traction; they suffer, however, from severe methodological flaws. This trial aimed to avoid these shortcomings.

Analysis of Variance↗
PubMed1992

Tissue engineering science: consequences of cell traction force.

Blood and tissue cells mechanically interact with soft tissues and tissue-equivalent reconstituted collagen gels in a variety of situations relevant to biomedicine and biotechnology. A key phenomenon in these interactions is the exertion of traction force by cells on local collagen fibers which typically constitute the solid network of these tissues and gels and impart gross mechanical integrity. Two important consequences of cells exerting traction on such collagen networks are first, when the cells co-ordinate their traction, resulting in cell migration, and second, when their traction is sufficient to deform the network. Such cell-collagen network interactions are coupled in a number of ways. Network deformation, for example, can result in net alignment of collagen fibers, eliciting contact guidance, wherein cells move with bidirectional bias along an axis of fiber alignment, potentially leading to a nonuniform cell distribution. This may govern cell accumulation in wounds and be exploited to control cell infiltration of bioartificial tissues and organs. Another consequence of cell traction is the resultant stress and strain in the network which modulate cell protein and DNA synthesis and differentiation. We summarize, here, relevant mathematical theories which we have used to describe the inherent coupling of cell dynamics and tissue mechanics in cell-populated collagen gels via traction. The development of appropriate models based on these theories, in an effort to understand how events in wound healing govern the rate and extent of wound contraction, and to measure cell traction forces in vitro, are described. Relevant observations and speculation from cell biology and medicine that motivate or serve to critique the assumptions made in the theories and models are also summarized.

Biomechanical Phenomena↗
PubMed2002

Traction bronchiectasis in cryptogenic fibrosing alveolitis: associated computed tomographic features and physiological significance.

Our objective was to evaluate the associated CT features and physiological consequences of traction bronchiectasis in patients with cryptogenic fibrosing alveolitis (CFA). The CT scans of 212 patients with CFA (158 men, 54 women; mean age 62.2+/-10.6 years) were evaluated independently by two observers. The extent of fibrosis, the proportions of a reticular pattern and ground-glass opacification and the extent of emphysema were scored at five levels. The predominant CT pattern, coarseness of a reticular pattern and severity of traction bronchiectasis were graded semiquantitatively. Physiological indices were correlated with CT features. There was traction bronchiectasis on CT in 202 of 212 (95%) patients. Increasingly severe traction bronchiectasis was independently associated with increasingly extensive CFA ( p<0.0005), a coarser reticular pattern ( p<0.001), a lower proportion of ground-glass opacification ( p<0.005) and less extensive emphysema ( p<0.0005). Increasingly severe traction bronchiectasis was independently related to depression of DL(CO) ( p<0.005), FVC ( p=0.02) and pO(2) ( p<0.0005), but not indices of air-flow obstruction. In CFA, traction bronchiectasis increases with more extensive disease, a lower proportion of ground-glass opacification and a coarser reticular pattern, but it decreases with concurrent emphysema. Increasingly severe traction bronchiectasis is associated with additional physiological impairment for a given extent of pulmonary fibrosis and emphysema.

Bronchiectasis↗
PubMedDate not supplied

Interexaminer differences in the traction test of the superior oblique tendon.

PURPOSE: The traction test of the superior oblique tendon is used for the manual evaluation of the looseness or tightness of the tendon. Because of the subjective nature of this test, knowledge of other clinical findings may lead to a bias in its interpretation. We studied interexaminer differences in the results of the test to assess the reliability of this traction test. METHODS: Examiner A examined all of the patients and collected all clinical findings, including the results of magnetic resonance imaging. Each of the nine noninformed examiners participated in one or more traction tests without prior information regarding the clinical findings of the patient. The traction tests were performed on 31 patients under general anesthesia. The examiners performed the traction test alternately with examiner A and evaluated the laxity and tightness in the tendon based on a nine-step scale (-4 to +4). The results were recorded in a masked manner, and later a comparison between the evaluation results of examiner A and those of the other examiners was made. RESULTS: Examiner A and the other examiners were in agreement within one grading step on 27 of the 31 (87.1%) traction tests. CONCLUSIONS: We demonstrated that the interexaminer differences in the interpretations of the traction test were acceptable, and that after the noninformed examiners had performed the test several times, their interpretations became closer to those of examiner A.

Diagnostic Techniques, Ophthalmological↗
PubMed2001

Optical coherence tomography of tractional macular elevations in eyes with proliferative diabetic retinopathy.

PURPOSE: To document the findings of optical coherence tomography in eyes with tractional macular elevation associated with proliferative diabetic retinopathy, paying special attention to differentiating between tractional retinal detachment and retinoschisis. DESIGN: Observational case series. METHODS: We retrospectively reviewed images of optical coherence tomography obtained from 17 consecutive eyes (17 patients) with proliferative diabetic retinopathy without vitreous opacity and showing tractional macular elevation with or without foveal involvement. RESULTS: Tractional retinal detachment and retinoschisis could be differentiated in the cross-sectional images of optical coherence tomography. Retinoschisis with or without associated retinal detachment was observed in 16 of 17 eyes (94%), whereas retinal detachment was observed in only six of 17 eyes (35%). Five eyes showed both findings of retinal detachment and retinoschisis. CONCLUSIONS: Optical coherence tomography is useful for distinguishing tractional retinoschisis from retinal detachment in eyes with proliferative diabetic retinopathy and macular elevation. Tractional retinoschisis with or without retinal detachment is the most frequent pattern of tractional macular elevation in eyes with proliferative diabetic retinopathy.

Adult↗