Rotation Traction Research Articles

The internal rotation traction radiograph does not improve the reliability in the AO classification system for pertrochanteric fractures. An inter- and intra-observer reliability assessment

IntroductionThe most universal method for classifying pertrochanteric fractures is the AO/OTA classification. These fractures are classified into different categories according to the features found in the anteroposterior radiograph of the hip. Anteroposterior radiograph of the hip with internal rotation traction can improve the characterization of the fracture. Inter- and intra-observer reliability in any classification is essential to achieve a homogeneous agreement for decision making. Our objective is assessing the overall reliability and by level of experience of the new AO/OTA classification of pertrochanteric fractures. Materials and methodsA hospital registry was used to collect patients with pertrochanteric hip fracture who had anteroposterior radiograph of the hip with and without internal rotation traction. We selected six evaluators stratified by levels of expertise in orthopedic trauma, leaving three groups: advanced, intermediate and beginner. Radiographs were sent through electronic forms and inter- and intra-observer reliability was calculated using the kappa (K) statistic. Results115 (one hundred fifteen) patients were included, each with their corresponding anteroposterior radiograph of the hip with and without internal rotation traction. Overall inter- and intra-observer reliability was moderate on both anteroposterior radiographs of the hip with and without internal rotation traction. Regarding the different levels of experience, the advanced level group reached a substantial inter- and intra-observer reliability in both anteroposterior radiographs with and without traction, while the rest of the groups with lower level of experience obtained a lesser reliability. ConclusionOur study found that the internal rotation traction x-ray did not improve the reliability of the new AO/OTA classification for pertrochanteric fractures, as assessed by inter- and intra-observer agreement, in either the overall group or in groups divided by experience level.

The Mycenaean Settlement on Tsoungiza Hill. By James C. Wright and Mary K. Dabney (Nemea Valley Archaeological Project 3). Princeton: American School of Classical Studies at Athens 2020. Pp. 1240. $150. ISBN 978-0-87661-924-7 (cloth).

<i>The Mycenaean Settlement on Tsoungiza Hill</i>. By James C. Wright and Mary K. Dabney (Nemea Valley Archaeological Project 3). Princeton: American School of Classical Studies at Athens 2020. Pp. 1240. $150. ISBN 978-0-87661-924-7 (cloth).

Mechanical Parameters and Trajectory of Two Chinese Cervical Manipulations Compared by a Motion Capture System.

Objective: To compare the mechanical parameters and trajectory while operating the oblique pulling manipulation and the cervical rotation–traction manipulation.Methods: An experimental research measuring kinematics parameter and recording motion trajectories of two cervical manipulations were carried out. A total of 48 healthy volunteers participated in this study, who were randomly divided into two groups of 24 representing each of the two manipulations. A clinician performed two manipulations in two groups separately. A motion capture system was used to monitor and analyze kinematics parameters during the operation.Results: The two cervical manipulations have similar thrust time, displacement, mean velocity, max velocity, and max acceleration. There were no significant differences in active and passive amplitudes between the two cervical rotation manipulations. The thrust amplitudes of the oblique pulling manipulation and the cervical rotation–traction manipulation were 5.735 ± 3.041° and 2.142 ± 1.742°, respectively. The thrust amplitudes of the oblique pulling manipulation was significantly greater than that of the cervical rotation–traction manipulation (P < 0.001).Conclusion: Compared with the oblique pulling manipulation, the cervical rotation–traction manipulation has a less thrust amplitudes.

Radiographic evaluation of the glenohumeral joint space in patients undergoing arthroscopic shoulder surgery in the beach-chair position

BackgroundShoulder arthroscopy can be performed with the patient in the lateral decubitus or beach-chair position, but in both cases, glenohumeral (GH) joint spaces must be increased to improve visualization and allow access of the optical instrument. The aim of this study was to determine the effects of limb setup and longitudinal traction on the opening of the GH space with patients placed in the beach-chair (dorsal decubitus) position.MethodsGH spaces at 3 test points corresponding to the anatomic locations of Bankart lesions were determined indirectly from radiographic images obtained from 67 patients presenting shoulder pathology with an indication for arthroscopic surgery. Measurements were made with the operative limb in neutral rotation and positioned in relation to the coronal plane in adduction, 45° of abduction, or adduction with an axillary spacer, in each case with and without longitudinal traction.ResultsGH spaces were optimized at 2 of 3 test points when the operative limb was positioned in adduction or neutral rotation and manual longitudinal traction was applied with or without a polystyrene spacer placed under the axilla, but use of the spacer was essential to maximize the GH space at all 3 locations. In contrast, 45° of abduction proved to be the least appropriate position because it afforded the smallest GH space values with or without traction.ConclusionAppropriate positioning of the patient on the operating table is a critical aspect of shoulder arthroscopy. Radiographic images revealed that adducted upper-limb traction with the use of an axillary spacer in patients in the beach-chair position generates a significant increase in the GH space in the lower half of the glenoid cavity, thereby facilitating visualization and access of the optical equipment to the GH compartments.

Internal Rotation Traction Radiograph Improves Proximal Femoral Fracture Classification Accuracy and Agreement.

The objective of this study is to assess the clinical utility of internal rotation traction radiography in the classification of proximal femoral fractures. The study cohort included 78 consecutive patients who were surgically treated for a proximal femoral fracture and for whom preoperative physician-assisted internal rotation traction radiographs of the fractured hip were obtained in addition to standard radiographs. Two radiologists who were blinded to clinical information independently classified each fracture without the traction view and then with the traction view. The radiologists also reported their confidence (expressed as a percentage) in their classifications. The reference standard was the consensus interpretation of intraoperative C-arm fluoroscopic images by two orthopedic surgeons and one radiologist. Classification accuracy was compared using the McNemar test. Subjective confidence and confidence-weighted accuracy were compare using paired t tests. Agreement with the reference standard and interreader agreement were calculated using the kappa statistic and were compared using the z-test after bootstrapping was performed to obtain the standard error. With the traction view, the pooled accuracy increased from 44.9% to 72.4%, subjective confidence increased from 87% to 94%, and confidence-weighted accuracy increased from 51.7% to 74.3% (p < 0.001). With the traction view, the kappa statistic for agreement with the reference standard increased from 0.530 to 0.791 and from 0.381 to 0.625 for the two readers, and interreader agreement increased from 0.480 to 0.678 (p < 0.001). The addition of an internal rotation traction radiographic view significantly improves radiologist accuracy and confidence as well as interreader agreement in the classification of proximal femoral fractures, all of which would be expected to best guide appropriate surgical management.

An innovative robotic training system imitating the cervical spine behaviors during rotation–traction manipulation

The present study demonstrated an innovative humanoid robot applied during Rotation–Traction (RT) manipulation practice and evaluation process. A mass–damper–spring mechanical system with an electromagnetic clutch was designed to emulate the cervical spine and a 3-DOF non-planar model was built to replace the neck part. With the help of an excellent electromechanical system and appropriate control strategy, the robot could imitate the entire dynamic responses of the human cervical spine during the RT manipulation process. Moreover, a novel adaptive force tracking impedance control was adopted to ensure a variable contact force in the unknown environment to imitate the real biomechanics of the human neck. In comparison to existing impedance control methods, the proposed control scheme is not only utility but also robust against external disturbances such as varying stiffness or uncertainties of the robot. The stability of the proposed impedance control was theoretically examined. Test results revealed that the cervical spine robot could faithfully replicate the biomechanical properties of the human cervical spine during RT manipulation and it is helpful in training and evaluating interns.

Cervical Spine Mechanism for Reproduction of the Biomechanical Behaviours of the Human Neck during Rotation-Traction Manipulation.

Rotation-traction (RT) manipulation is a commonly used physical therapy procedure in TCM (traditional Chinese medicine) for cervical spondylosis. This procedure temporarily separates the C3 and C4 cervical vertebrae from each other when a physician applies a jerky action while the neck is voluntarily turned by the patient to a specific position as instructed by the physician, where the cervical vertebrae are twisted and locked. However, a high rate of cervical injury occurs due to inexperienced physician interns who lack sufficient training. Therefore, we developed a cervical spine mechanism that imitates the dynamic behaviours of the human neck during RT manipulation. First, in vivo and in vitro experiments were performed to acquire the biomechanical feature curves of the human neck during RT manipulation. Second, a mass-spring-damper system with an electromagnetic clutch was designed to emulate the entire dynamic response of the human neck. In this system, a spring is designed as rectilinear and nonlinear to capture the viscoelasticity of soft tissues, and an electromagnetic clutch is used to simulate the sudden disengagement of the cervical vertebrae. Test results show that the mechanism can exhibit the desired behaviour when RT manipulation is applied in the same manner as on humans.

Randomized controlled trials of needle knife therapy combined with rotation traction manipulation for the treatment of cervical spondylotic radiculopathy

To compare the therapeutic effects between needle knife therapy combined with rotation traction manipulation and rotation traction manipulation for the treatment of cervical spondylotic radiculopathy. From November 2013 to June 2015, 80 patients with cervical spondylotic radiculopathy meeting the inclusion criteria were divided into two groups randomly:the control group in which 39 patients were treated with rotation traction manipulation, and the treatment group in which 41 patients were treated with needle knife combined with rotation traction manipulation. The patients in the control group were treated once dayly for 2 weeks, which was 1 course. The patients in the treatment group were treated with needle knife firstly once a week for 2 weeks, which was 1 course;then were treated with the same methods as the patients in the control group. The symptoms, signs score and the therapeutic effects of the two groups before and after treatment were observed. After treatment, symptoms and signs scores declined in both groups(P<0.05). The results of the treatment group were better than effects in the control group(P<0.05). In the treatment group, 19 patients got an excellent result, 16 good, 5 fair and 1 bad;while in the control group, 10 patients got an excellent result, 10 good, 16 fair and 3 bad;the results of the treatment group were better than the results of the control group(P<0.01). Needle knife combined with rotation traction manipulation is an effective method for the treatment of cervical spondylotic radiculopathy, which is better than using manipulation method simply. Needle knife therapy has follow advantages:improving local blood circulation, reducing local content of pain substance, increasing production of substances resisting pain, opening channels and collaterals, and make body reaching new static and dynamic balance on the new foundation.

The Most Utilized Rotation and Translation Movement While in Ball-Possession among Futsal Players

The objective of this study was to identify the most utilized rotation and traction related movements among international futsal players when they are in a ball possession situation. A total of 4 matches from The AFF Futsal Championship 2014 were analyzed. The analyzed matches consist of two semifinal matches, 3rd-4th placing match and the final match. There are four indicators for rotation movement (half-trunk rotation, half-body rotation, quick-half trunk rotation, and quick-body rotation) and four indicators for traction movement (front traction, back traction, side traction, and sudden stop) that are selected to be observed in this study. Each indicator was divided into two categories, which are attacking and defensive mode. All matches were recorded using a full high definition video camera and analyzed using SportCode Elite (v. 10) and Dartfish EasyTag (v. 1.0.8) software. Two trained and experienced analysts were assigned to analyze all 4 matches. Inter- and Intra- analyst reliability studies were also performed in order to examine the content validity of the data obtained. Overall results indicated that the front traction during the defensive mode is the most utilized movement, among others, while back traction during the attacking mode is the least utilized movement. Front traction during attacking mode was found to be the highest number of usage during attacking mode while sudden stop traction during defensive mode is the least utilized movement among other defensive movements. Regardless of attacking or defensive mode, results show that front traction is the most utilized movement, followed by half-trunk rotation and side traction. This study also show that the rotation (47%) and traction movements (53%) utilized during competitive games are quite balanced. A similar result was also obtained when comparing between attacking (46%) and defensive mode distribution (54%) from overall data. Further study on futsal games should focus on the most utilized movement during competitive matches to understand more about the nature of the games.

Reduction of Anterior Shoulder Dislocations by Spaso Technique: Clinical Results

The Spaso technique consists of forward flexion, external rotation, and gentle traction for the reduction of anterior shoulder dislocations with the patient in the supine position. The aim of this prospective study was to assess clinical efficacy of the Spaso technique and to evaluate its complications. We prospectively evaluated 52 shoulder dislocations using the Spaso technique. All reductions were performed by residents in training. Rescue methods if initial reduction was unsuccessful were at the discretion of the treating physician. Fifty-two patients were enrolled and 39 (75%) dislocations were successfully reduced without anesthesia or assistance. The mean reduction time was 3.2 min, and 87% of successful reductions occurred in less than 5 min. If we exclude the first 20 cases as a learning period, the success rate increases up to 87.5%. There were no complications associated with using the Spaso technique in this series. Patients with concomitant greater tuberosity fractures and late presentation had a lower success rate, although this was not statistically significant. The Spaso method is effective in reducing anterior shoulder dislocations without anesthesia or assistance and may decrease reduction time and length of stay in the Emergency Department.

Anterior dislocation of shoulder: Reduction in the emergency department without analgesia by scapular rotation and humeral traction

Study objectives: We evaluate pain during the reduction procedure of an anterior dislocation of shoulder. Artl technique, which consisted of a scapular rotation and traction on the humerus, was performed without analgesia. Methods: An open prospective study over an 18-month period included patients presenting with anterior dislocation of the shoulder. We recorded the duration of dislocation, recurrence rate, position of dislocated humeral head, time of traction needed to reduce the dislocation, and complications. The patient was seated athwart the chair, and the axilla of dislocated shoulder rested on the back of a seat padded with drapes. Pain was evaluated at arrival, after placing and resting the shoulder astride the back of the chair, and at postreduction using a visual analogic ruler. Standard shoulder radiographs were taken pre- and postreduction. Results: Reduction was attempted on 43 consecutive patients, 29 men and 14 women aged 42±23 years. Dislocation lasted 110±73 minutes, except 3 that lasted 10, 19, and 26 hours. Thirty-four dislocations were inaugural. Humeral head locations were 26 subcoracoid, 15 subglenoid, and 2 erecta. Associated fractures were 7 trochanter, 3 trochanter and Bankart, 3 trochanter and surgical neck of humerus, and 13 Hill Sachs notches. None received analgesia before reduction, with patient agreement. Pain on arrival peaked at 85±15 mm, it dropped to less than 30 mm after resting of the patient's axilla astride the back of the seat and during reduction. After reduction, pain reached 0 to 10 mm. Reduction was successful with 96% of patients in 27±23 seconds and in less than 10 seconds with 52% of patients. Success rate was 98%. We recorded 1 episode of prereduction circumflex nerve hypoesthesia and 1 failed reduction of a subcoracoid dislocation that had lasted 26 hours and was treated under general anesthesia. Conclusion: This technique alleviates pain on resting the dislocated shoulder on the back of a seat without the use of analgesics. Rate of success is high (98%) even with associated fracture, inaugural dislocation, or prolonged dislocation time beyond 110 minutes.

Arthroscopic relationship of the axillary nerve to the shoulder joint capsule: An anatomic study

Twelve right shoulders in fresh cadavers were dissected to determine the relation of the axillary nerve to the shoulder capsule and glenoid. Needles transfixed the nerve to the capsule and into the shoulder joint. Arthroscopy was performed to determine the location of the needles on the glenoid clock. The needles were then removed and the position of the shoulder changed to determine the effect on the position of the axillary nerve. The axillary nerve was held to the shoulder capsule with loose areolar tissue in the zone between 5 and 7 o'clock and was close to the glenoid in the neutral position, in extension, and in internal rotation. With shoulder abduction, external rotation, and perpendicular traction, the capsule became taut and the axillary nerve moved away from the glenoid. Abduction, external rotation, and perpendicular traction increase the zone of safety during arthroscopic anterioinferior capsulotomy adjacent to the glenoid between the 5 and 7 o'clock positions.

Nonconservative Stability of a Friction Loaded Disk

This paper investigates the vibration of an annular disk that is subjected to rotation and in-plane frictional traction distributed over a sector of the disk’s two faces. Technical applications include noise, vibration, and harshness in automotive and aircraft disk brakes, clutches, transmissions, and other rotating machine components. To the degree that the rotor-to-stator friction in such cases is directed along the disk’s deformable surface, it is treated here as a nonconservative follower-type load. The vibration model incorporates membrane stiffness which derives both from rotation, and from the stresses established as a result of friction. The plane stress state is determined in closed form as a Fourier series, and that solution is compared with the companion, but computationally intensive, results from finite element analysis. For the cases of sector-shaped and full annular loading, the vibration model predicts the critical mode, which is defined as the one that becomes dynamically unstable at the lowest friction level. Vibration modes and propagating waves that fall into opposite symmetry classes are shown to have opposite stability characteristics in the presence of frictional loading.

Traction Reduction of Acute and Acute-on-Chronic Slipped Capital Femoral Epiphysis

Gentle reduction of acute or the acute portion of acute-on-chronic severe slipped capital femoral epiphyses (SCFE) is generally recommended. Reports of the use of longitudinal traction with medial rotation traction, although few, are uniform in describing a high rate of success with rare complications. Of 30 acute or acute-on-chronic SCFEs examined at the author's institution between 1970 and 1990, 13 underwent attempted traction reduction with longitudinal traction and medial rotation. Only five of these 13 hips had discernible reduction. One of these five hips developed aseptic necrosis; however, this hip was clearly distracted from the acetabulum by excessive longitudinal traction that may have contributed to the development of osteonecrosis. One of the seven hips that failed traction reduction developed aseptic necrosis, and one of the 17 acute SCFEs pinned in situ developed aseptic necrosis. All three hips developing necrosis were in a group of 14 hips with moderate to severe SCFEs and complete inability to bear weight with severe pain.