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At least 19 recordsLinked to original sources
PubMed2000

Pre-operative traction for fractures of the proximal femur.

BACKGROUND: Pre-operative traction following an acute hip fracture remains standard practice in some hospitals. OBJECTIVES: To evaluate the effects of traction applied to the injured limb prior to surgery for a fractured hip. Different methods of applying traction (skin or skeletal) were considered. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, MEDLINE (1983 to August 1999), CINAHL (1982 to July 1999), EMBASE (1980 to September 1999), CENTRAL (Issue 4, 1999 of The Cochrane Library) and bibliographies of trial reports. Date of the most recent search: September 1999. SELECTION CRITERIA: All randomised or quasi-randomised trials comparing either skin or skeletal traction with no traction, or skin with skeletal traction for patients with an acute hip fracture prior to surgery. DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality, using a nine item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, the data are presented graphically. MAIN RESULTS: Five randomised trials, mainly of moderate quality, involving a total of 635 predominantly elderly patients, were identified and included in the review. The review has been updated twice to include additional and new data from two of the studies. The availability of this additional data resulted in no important change in the results nor conclusions. The four trials which compared traction with no traction found no evidence of benefit from traction, either in the relief of pain, ease of fracture reduction or quality of fracture reduction at time of surgery. One of these trials included both skin and skeletal traction groups. This trial and one other which compared skeletal traction with skin traction found no important differences between these two methods, although the initial application of skeletal traction was noted as being more painful and most costly. REVIEWER'S CONCLUSIONS: From the evidence available, the routine use of traction (either skin or skeletal) prior to surgery for a hip fracture does not appear to have any benefit. Where a policy of general or selective application of traction exists, the choice of method must remain a decision based on evaluation of the individual patient. Further, high quality trials would be required to confirm or refute the absence of benefits of traction.

Femoral Fractures↗
PubMedDate not supplied

A prospective, randomized clinical trial comparing tibial nailing using fracture table traction versus manual traction.

OBJECTIVE: We sought to determine the effectiveness of intramedullary tibial nailing using manual traction with the leg draped free versus standard fracture table positioning and traction. STUDY DESIGN: Prospective, randomized clinical trial. METHODS: Eighty-five tibial shaft fractures (in seventy-nine patients) treated by intramedullary nailing were randomized either to manual traction with the leg draped free or to standard fracture table traction applied through a boot attachment. RESULTS: We found that manual traction provided results, in terms of intraoperative parameters and quality of fracture reduction, similar to those with standard fracture table traction. Manual traction significantly reduced positioning time (twelve minutes versus twenty-five minutes, p = 0.002) and also allowed for multiple simultaneous or sequential procedures in polytrauma patients without the need for re-positioning or re-draping. This saved a further thirty-two minutes (mean) in 37 percent of cases treated by manual traction. CONCLUSION: Manual traction for intramedullary nailing of the tibia is an effective technique that can save a significant amount of time without sacrificing the quality of reduction or fixation of tibial shaft fractures. It is especially useful in polytrauma patients with multiple lower-extremity injuries.

Adolescent↗
PubMed1995

The fibroblast-populated collagen microsphere assay of cell traction force--Part 2: Measurement of the cell traction parameter.

In Part 1 of this work, we formulated and analyzed a mathematical model for our fibroblast-populated collagen microsphere (FPCM) assay of cell traction forces (Moon and Tranquillo, 1993). In this assay, the FPCM diameter decreases with time as the cells compact the gel by exerting traction on collagen fibrils. In Part 1 we demonstrated that the diameter reduction profiles for varied initial cell concentration and varied initial FPCM diameter are qualitatively consistent with the model predictions. We show here in Part 2 how predictions of a model similar to that of Part 1, along with the determination of the growth parameters of the cells and the viscoelastic parameters of the gel, allow us to estimate the magnitude of a cell traction parameter, the desired objective index of cell traction forces. The model is based on a monophasic continuum-mechanical theory of cell-extracellular matrix (ECM) mechanical interactions, with a species conservation equation for cells (1), a mass conservation equation for ECM (2), and a mechanical force balance for the cell/ECM composite (3). Using a constant-stress rheometer and a fluids spectrometer in creep and oscillatory shear modes, respectively, we establish and characterize the linear viscoelastic regime for the reconstituted type 1 collagen gel used in our FPCM traction assay and in other assays of cell-collagen mechanical interactions. Creep tests are performed on collagen gel specimens in a state resembling that in our FPCM traction assay (initially uncompacted, and therefore nearly isotropic and at a relatively low collagen concentration of 2.1 mg/ml), yielding measurements of the zero shear viscosity, mu 0 7.4 x 10(6) Poise), and the steady-state creep compliance, J0e. The shear modulus, G (155 dynes/cm2), is then determined from the inverse of J0e in the linear viscoelastic regime. Oscillatory shear tests are performed in strain sweep mode, indicating linear viscoelastic behavior up to shear strains of approximately 10 percent. We discuss the estimation of Poisson's ratio, v, which along with G and mu 0 specifies the assumed isotropic, linear viscoelastic stress tensor for the cell/collagen gel composite which appears in (3). The proliferation rate of fibroblasts in free floating collagen gel (appearing in (1)) is characterized by direct cell counting, yielding an estimate of the first-order growth rate constant, k (5.3 x 10(-6) s-1). These independently measured and estimated parameter values allow us to estimate that the cell traction parameter, tau 0, defined in the active stress tensor which also appears in (3), is in the range of 0.00007-0.0002 dyne.cm4/mg collagen.cell.(ABSTRACT TRUNCATED AT 400 WORDS)

Biomechanical Phenomena↗
PubMed1998

Preoperative traction for hip fracture: a randomized comparison between skin and skeletal traction in 78 patients.

153 consecutive patients with displaced cervical and trochanteric hip fractures were considered for inclusion in this study. 75 were excluded because of senile confusion and the remaining 78 were randomized to skeletal or skin traction preoperatively. The effect on pain alleviation was evaluated with a Visual Analogue Scale (VAS) and by the number of doses of analgesics administered. The processing time through the emergency department, radiographic department and to the ward, as well as time to operation, was registered. No significant difference in the VAS pain evaluation was found. There was a small significant increase in consumption of analgesics of no clinical importance in patients with skin traction, and no effect of traction type on the processing time or time to operation. Fracture type did not affect the outcome. Since half of the patients found the application of skeletal traction painful, compared to one fifth with skin traction, skeletal traction should not be routinely used to alleviate pain preoperatively in these patients.

Aged↗
PubMed2002

Reducibility of cervical disk herniation: evaluation at MR imaging during cervical traction with a nonmagnetic traction device.

The authors evaluated the reducibility of cervical disk herniation at magnetic resonance (MR) imaging performed with the patient in cervical traction. After the acquisition of neutral-state images, cervical traction images were obtained in 29 patients and seven healthy volunteers while they wore a portable intermittent traction device. During traction, all volunteers and 21 patients had a substantial increase in the length of the cervical vertebral column. The disk herniation was completely resolved in three patients and partially reduced in 18. The reducibility of cervical disk herniation can be evaluated at MR imaging performed during cervical traction.

Adult↗
PubMed1994

[3-week traction with 3-week spica-cast immobilization is as good as 6-week traction, and much cheaper].

OBJECTIVE: To gain insight into the clinical en economic results of the treatment of femoral shaft fractures in children by means of traction for 3 weeks and spica immobilization for 3 weeks as an outpatient in comparison with traction for 6 weeks. DESIGN: Retrospective. SETTING: Sophia children's hospital in Rotterdam. METHOD: Between 1981 and 1989, 278 children were admitted because of a femoral shaft fracture. This follow-up study concerned 229 children of whom 139 were treated by means of 6 weeks' traction (group 1) and 90 received the combination treatment (group 2). The two groups were comparable with regard to age, sex, cause, type and site of the fracture. RESULTS: All fractures healed, complications were rare and equally divided between the two groups. There was no significant difference between the two groups with regard to shortening and angulation of bone fragments. The mean duration of hospital stay was almost 47 days in group 1 as against 22 days in group 2, leading to a reduction of Dfl. 19,500.--in hospitalization costs per child. CONCLUSION: The results of treatment of femoral shaft fractures by means of traction in combination with spica immobilization equal those of 6 weeks' traction. The shortened duration of hospital stay leads to a considerable reduction in costs.

Adolescent↗
PubMed1976

An evaluation of extraoral combined high-pull traction and cervical traction to the maxilla.

The effects of extraoral combined high-pull traction and cervical traction of known duration (mean, 122 days) and magnitude (2.5 to 3 pounds total per side) were studied by means of serial lateral cephalometric head films of thirty patients. The lateral cephalometric head films used were taken at three different times: before the extraoral force was applied, after the prescribed period of continuous headgear wear, and as long as possible after the extraoral force was discontinued. Changes in the dentition and associated structures were described both for the period of continuous headgear wear and for an average of 3.2 years later. The following conclusions are based on statistical analysis of the observed changes: 1. The position of the maxilla and the palatal plane was not significantly affected by relatively short periods of extraoral combined high-pull traction and cervical traction to the maxillary first molars as used for this investigation. 2. The maxillary first molars can be moved distally and bodily with this appliance without extrusion. 3. On the average, the mandibular first molars uprighted distally in response to the extraoral force to the maxilla. 4. The maxillary and mandibular first molars demonstrated a strong tendency to recover to their original positions and inclinations relative to their respective bases during the posttreatment period. 5. The amount and direction of growth in the posttreatment period may be important in determining how the Class I relationship is maintained.

Cephalometry↗
PubMed1988

Analysis of the traction forces in different skull traction systems.

During transportation of patients under skull traction, swinging of the weights produces acceleration forces that not only can cause pain and discomfort for the patient, but also can cause worsening of the cervical fracture or dislocation. Skull traction systems also involve friction forces. In a system with one pulley, the friction forces were 10 to 21.5% of the weight applied but, in a system with three pulleys (Stryker SurgiBed 965), they were as much as 65%. A new spring traction device that permits traction during transportation showed better physical characteristics than the hanging weight systems.

Beds↗
PubMed1994

The dynamic traction method. Combining movement and traction for intra-articular fractures of the phalanges.

Dynamic traction is a new method of treatment of intra-articular fractures in the hand, combining the old idea of traction and the recent one of movement. Traction reduces fracture fragments through ligamentotaxis, and helps prevent joint ligament and periarticular contracture. Motion encourages cartilage regeneration and helps maintain mobility. Both early and long-term results have been excellent. The historical development of dynamic traction is detailed, and a summary given of the physiologic basis for the method's success.

Bone Transplantation↗
PubMedDate not supplied

Intracranial aneurysm and hemorrhage following skull caliper traction. Review of skull traction complications.

Serious complications of caliper skull traction for fracture-dislocations of the cervical spine are so rare that they are not discussed in most standard textbooks. A fusiform intracranial aneurysm which followed the placement of skull tongs is reported. Subsequent aneurysmal rupture produced an intracerbral hematoma requiring drainage. The literature recording the complications of skull caliper traction is reviewed and the indications for skull traction and the need for scrupulous surgical technique are emphasized.

Cerebral Hemorrhage↗
PubMed2001

Macular traction detachment and diabetic macular edema associated with posterior hyaloidal traction.

PURPOSE: To review the clinical, photographic, fluorescein angiographic, and optical coherence tomographic findings in patients with the diabetic macular traction and edema (DMTE) associated with posterior hyaloidal traction (PHT). METHODS: We performed a prospective review of nine eyes of nine patients with diabetic macular edema (DME) and PHT on clinical examination. The patients had a comprehensive ophthalmic history and examination, color photographs, fluorescein angiography, and optical coherence tomography (OCT). RESULTS: All patients had diabetic retinopathy and DME. Of the nine eyes, eight patients had previous focal or grid photocoagulation. All nine eyes had a thickened, taut, glistening posterior hyaloid on clinical biomicroscopic examination with no posterior vitreous separation. Fluorescein angiography was performed on seven eyes, and all had early hyperfluorescence with deep, diffuse, late leakage in the macular area consistent with DMTE associated with PHT. Optical coherence tomography scans of the macular region revealed retinal thickening in all eyes with a mean retinal thickness of 556.9 +/- 114.7 microns. In addition, eight of the nine eyes had a shallow macular traction detachment associated with PHT. CONCLUSION: Eyes with DME associated with PHT may have a shallow, subclinical, macular detachment. Optical coherence tomography may be useful in evaluating patients with DME to see if a macular detachment is present.

Aged↗
PubMed1992

Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction.

Pars plana vitrectomy with separation of the posterior hyaloid was performed in 10 eyes with diabetic macular edema and traction associated with a thickened and taut premacular posterior hyaloid. Nine of the 10 eyes had previous macular photocoagulation. Preoperative fluorescein angiography showed a deep and diffuse pattern of leakage in the macula. Intraoperatively, the attached and thickened posterior hyaloid was lifted and separated from the retina. Postoperatively, vision improved in nine eyes. The macular traction and edema resolved in eight eyes and decreased in two. Complications included a vitreous hemorrhage, a rhegmatogenous retinal detachment, cataract formation, and a mild epimacular membrane, each occurring in one eye. Vitreous surgery can improve the visual prognosis of some eyes with diabetic macular traction and edema associated with a thickened and taut posterior hyaloid.

Adult↗
PubMedDate not supplied

Traction basics: Part II. Traction equipment.

Traction is a treatment modality used for the reduction or immobilization of fractures or dislocations. It is used to maintain alignment, decrease muscle spasms, relieve pain, correct, lessen or prevent deformities, expand joint spaces prior to surgery, promote rest to diseased or injured body parts and to promote exercise. Nurses need a working knowledge of the various types of traction along with its rationale, correct setup, and maintenance. They must become familiar with potential complications and use nursing diagnoses to work with patients to strive to achieve expected patient outcomes.

Humans↗
PubMedDate not supplied

Traction basics: Part III. Types of traction.

Traction is a treatment modality used for the reduction or immobilization of fractures or dislocations. It is used to maintain alignment, decrease muscle spasms, relieve pain, correct, lessen or prevent deformities, expand joint spaces prior to surgery, promote rest to diseased or injured body parts and to promote exercise. Nurses need a working knowledge of the various types of traction along with its rationale, correct setup, and maintenance. They must become familiar with potential complications and use nursing diagnoses to work with patients to strive to achieve expected patient outcomes.

Humans↗
PubMedDate not supplied

Traction basics: Part IV. Traction for lower extremities.

Traction is a treatment modality used for the reduction or immobilization of fractures or dislocations. It is used to maintain alignment; decrease muscle spasms, relieve pain; correct, lessen, or prevent deformities, expand joint spaces before surgery; promote rest to diseased or injured body parts; and promote exercise. Nurses need a working knowledge of the various types of traction along with its rationale, correct setup, and maintenance. They must become familiar with potential complications and use nursing diagnoses to work with patients to strive to achieve expected patient outcomes.

Humans↗