Mechanical traction for mechanical neck disorders: a systematic review.
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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. (+info)
Management of grade III supracondylar fracture of the humerus by straight-arm lateral traction.
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Supracondylar fracture of the humerus is a common upper limb fracture in children for which treatment is controversial and often technically difficult, and complications are common. Cubitus varus is the most prevalent complication encountered in such fractures, with a mean incidence rate of 30%. A variety of methods for treating displaced fractures have been recommended. We reviewed 20 cases of severely displaced grade III supracondylar fractures of the humerus in children. There was marked swelling and distorted local anatomy in all these fractures, which were managed conservatively with straight-arm lateral traction. The patients were treated in skin traction for 2 weeks, following which they commenced physiotherapy. The traction was applied with the arm at 90 degrees of abduction and the forearm in supination. None of the patients developed any complication, and all had the full range of movements. None had cubitus varus deformity, and none of these patients required further surgical treatment. There was a complete patient and parent satisfaction. Open or closed reduction with internal fixation is the most common method of treating these injuries, however in some cases this can be very difficult and dangerous. If the local anatomy and swelling do not allow this treatment then non-operative measures have to be adopted. We conclude that straight-arm lateral traction is a safe and effective method of treating these fractures, especially when the local anatomy is disturbed and the swelling makes operative intervention relatively more risky and difficult. Moreover, this method is also appropriate in areas where access to specialised centres in treating these injuries is either difficult or delayed. (+info)
Is anterior release effective to increase flexibility in idiopathic thoracic scoliosis? Assessment by traction films.
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With the advent of thoracoscopy, anterior release procedures in adolescent idiopathic scoliosis (AIS) have come into more frequent use, however, the indication criteria for an anterior release in thoracic AIS are still controversial in the literature. To date, few studies have assessed the influence on spinal flexibility and no study has so far been able to show a beneficial effect on the correction rate as compared to a single posterior procedure. The objective of this study was to evaluate the influence of thoracic disc excision on coronal spinal flexibility. Six patients (5 females, 1 male) with AIS and a mean age of 15.6 years (range 13-20 years) underwent an open anterior thoracic release prior to posterior instrumentation. Cotrel dynamic traction along with radiographs of the whole spine including traction films were conducted pre- and postoperatively and were evaluated retrospectively. The mean preoperative thoracic curve was 89.7 degrees +/- 15.4 degrees (range 65 degrees-110 degrees). The flexibility rate in Cotrel traction was 22.8 +/- 8.1%. After performance of the anterior release the thoracic curve showed a mean increase of coronal correction by 5.5 degrees +/- 5.0 degrees as assessed by traction radiographs. The flexibility index changed by 6.2 +/- 5.6%. After posterior instrumentation the thoracic curve was corrected to a mean of 36.5 degrees +/- 10.1 degrees (correction rate 59.6%). Disc excision in idiopathic thoracic scoliosis only slightly increased spinal flexibility as assessed by traction films. In our view a posterior release with osteotomy of the concave ribs (concave thoracoplasty, CTP) is more effective in increasing spinal flexibility. According to our clinical experience, an anterior release prior to posterior instrumentation in AIS should only be considered in hyperkyphosis, coronal imbalance or massive curves. (+info)
Perkins traction for adult femoral shaft fractures: a report on 53 patients in Sierra Leone.
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A retrospective study of 53 consecutive adult patients with 54 femoral shaft fractures treated with Perkins traction over a 25-month period was carried out. Mean length of stay was 52.1 days (range 25-108), and mean duration of traction was 45.0 days (range 23-66). At a mean follow-up of 4.6 months (range 3-9), 50 (92.6%) had healed and 5 (9.3%) had a malunion. There were 4 (7.4%) non-unions, 3 (5.5%) had shortening of more than 2.5 cm and 2 (3.7%) had a re-fracture. The rate of pin tract infection was very high at 42.6% (23 patients). (+info)
Ligamentum flavum hematoma in the cervical spine - case report.
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A 67-year-old man presented with a rare case of ligamentum flavum hematoma manifesting as progressive tetraplegia following cervical traction therapy. Magnetic resonance imaging of the cervical spine showed a posterior mass that was continuous with the ligamentum flavum at the C3-4 levels. Complete resection of the mass that contained brownish hemorrhage was performed, resulting in excellent symptom relief. We speculate that repeated trivial trauma to the degenerative ligamentum flavum was the main predisposing factor in the present case. Ligamentum flavum hematoma is a rare cause of spinal root or cord compression which typically occurs in the lower thoracic or lumbar spine, but may also appear in the cervical spine. (+info)
One-stage combined surgery with or without preoperative traction for developmental dislocation of the hip in older children.
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PURPOSE: To compare one-stage combined surgery with and without preoperative traction, in older children with developmental dislocation of the hip (DDH). METHODS: Records of 9 children who underwent combined surgery for DDH with preoperative traction in 12 hips (group 1) and 12 undergoing the same procedure without preoperative traction in 16 hips (group 2) were retrospectively reviewed. The surgery consisted of open reduction, Salter's innominate osteotomy and femoral shortening with derotation varus osteotomy. The mean age of the patients at the time of operation was 5.8 years. The mean follow-up period was 5.9 years. RESULTS: At final follow-up, clinical outcome in group 1 was worse than that in group 2, though radiographic assessment demonstrated no significant difference between the groups. CONCLUSION: One-stage combined surgery without preoperative traction is effective in the treatment of DDH in older children, and has a lower complication rate, but radiographically the groups did not differ. (+info)
Transcondylar traction as a closed reduction technique in vertically unstable pelvic ring disruption.
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Little information is provided in the literature describing an efficient reduction technique for pelvic ring disruption. The aim of this study is to assess the use of the transcondylar traction as a closed reduction technique for vertically unstable fracture-dislocations of the sacro-iliac joint. Twenty-four pelvic ring disruptions were treated with attempted closed reduction followed by percutaneous screw fixation. Transcondylar traction was used as a closed reduction technique. Closed reduction to within 1 cm of residual displacement was obtained in all cases. No incidence of infection, digestive, cutaneous, or vascular complications occurred. We observed secondary displacement in three patients. Correction of the vertical displacement is better achieved when performed within 8 days after the trauma. Two posterior screws and a complementary anterior fixation is typically required to avoid further displacement in case of sacral fractures. However, an open approach should be preferred in both cases of crescent iliac fracture-sacroiliac dislocation and transforaminal fracture associated with peripheral neurological deficit. A vertical sacral fracture should make the surgeon more wary of fixation failure and loss of reduction. (+info)
Treatment of femoral fractures in neonates.
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BACKGROUND: Fractures of the femur in neonates are relatively uncommon. The infants feel pain and discomfort, causing parental distress, and the hospital stay is longer. Treatment of this specific fracture is problematic because of the small size of the baby. OBJECTIVES: To review the results of the treatment of neonatal femoral fractures. METHODS: We retrospectively reviewed all neonatal fractures of the femur during a 12 year period. Thirteen fractures of the femur in 11 babies were treated with improvised Bryant skin traction of both legs. All the patients were reexamined after a mean follow-up period of 5.2 years. RESULTS: All fractures healed satisfactorily clinically and radiographically, with no residual deformity, leg length discrepancy or functional impairment. CONCLUSIONS: Bryant's traction for 2-3 weeks in hospital is a safe method for the treatment of femoral fractures in neonates, and the outcome is good. (+info)