Traction Technique Research Articles

Hip Arthroscopy Distraction Without the Use of a Perineal Post: Prospective Study

Hip arthroscopy is being used with increasing frequency as the understanding of arthroscopic management of groin pain improves. To access the hip joint arthroscopically, traction must be placed on the leg. In most cases, countertraction is provided with a padded post in the groin. Complications of traction are often attributed to the post and include perineal or pudendal neuropraxias and skin complications. The purpose of this study was to investigate the safety of a traction technique that avoids a perineal post. A supine position is used with the foot in a standard traction boot. The patient is moved down the table such that his or her perineum is located 7 to 10 cm proximal to the traction post. The post is also located 5 to 10 cm lateral to midline. The operative table is placed in 15° to 20° of Trendelenburg. With this position, enough friction is generated between the patient's upper body and bed to allow successful hip distraction without the post contacting with the perineum. One hundred seventy patients (111 men and 59 women) were followed prospectively and evaluated for possible side effects of this traction technique immediately postoperatively and 1 and 14 days and 3 and 6 months postoperatively. Patients were examined at each visit. No significant complications related to traction occurred during follow-up. The described technique has been used in more than 2000 hip arthroscopies without a documented groin or perineal complication. It allows easy positioning and access to the central compartment.

Screw-wire traction technique: aid to anatomical reduction of multi-segment mid-facial fractures

The screw-wiretractiondeviceisconstructedinasterileoper-ating environment. The free edges of a stainless steel tie wireare held with Lawson Tait artery forceps. The wire is twistedto form a loop that is reduced to a dimension of 3mm arounda straight Warwick James elevator or straight artery forcepsand then cut to a length of 5cm. The mounted screw is placedthrough the wire loop ready to be applied to the predrilledscrew hole (Fig. 1). The hole is drilled and the traction unitis applied as shown in Fig. 2.

Open accurate reduction for irreducible mallet fractures through a new pulp traction technique with primary tendon repair

Sixteen patients with bony mallet fingers were treated by a new technique of open reduction through a T-shaped dorsal incision and oblique wire fixation via pulp traction with additional primary extensor repair. Surgical indications included fractures with intra-articular involvement over 1/3 of the articular surface, distal phalanx subluxation, and displacement greater than 3 mm irreducible by extension block pinning. The cases were analysed prospectively for a mean follow-up period of 12 months. The results were evaluated using Crawford's criteria. Eleven cases were evaluated as excellent, three cases as good, and two cases as fair. Complications included three cases with transient nail deformity, two cases with flexion limitation of 5° and 10°, and three cases with extension lag between 5°–10°. This new method of accurate reduction achieves good clinical outcomes, with comparatively less complications in mallet fractures irreducible to closed extension block reduction.

A novel anchorage technique for transnasal traction in rigid external maxillary distraction

We describe an effective technique for anchorage of transnasal traction in the management of maxillary rotation during external distraction.

Comparative Performance of Ankle Arthroscopy with and without Traction

Ankle arthroscopy has evolved as a diagnostic and therapeutic tool. Traditionally, it is performed with traction because of the tight ankle joint space. Original traction techniques were invasive but have progressed to the commonly used noninvasive modalities. Recent reports have suggested traction may be unnecessary. The purpose of this study was to compare prospectively ankle arthroscopy with and without traction in terms of ease of visualization of anatomic structures according to the Ferkel's ankle arthroscopy criteria. Under Institutional Review Board approval, 103 patients received ankle arthroscopies, first with noninvasive traction and subsequently without traction. An independent observer scored each arthroscopy based on the 21-point Ferkel's criteria. For each structure adequately visualized, one point was given. Inadequate visualization was defined as excessive force or as visible cartilage scuffing. The maximum possible score was 21 points and the lowest was zero. Fifty-five females and 48 males, average age 35 (range, 16 to 71) years, participated in the study. Noninvasive traction facilitated visualization of all structures of the anterior ankle in more than 90% of cases except for the anterior compartment and lateral gutters, which were better visualized without traction with the ankle in dorsiflexion. No difference was seen when visualizing the talus. Traction arthroscopy performed better when evaluating the central and posterior ankle. The mean score difference was statistically significant, 11.2 versus 18.5 points, favoring noninvasive traction arthroscopy. The complication rate was 4%. Noninvasive traction facilitated complete ankle arthroscopy. Dorsiflexion improved visualization of the anterior compartment and lateral ankle gutter. The authors recommend noninvasive traction when performing ankle arthroscopy.

Nail Hooks and Elastic Bands External Dynamic Traction for Fractures of the Proximal Interphalangeal Joint

Intra-articular fractures of the proximal interphalangeal joint remain a treatment challenge for hand specialists. The purpose of this investigation was to review the results of 12 patients, 6 men and 6 women (average age, 21 y), who were treated using the nail hooks and elastic bands external dynamic traction technique for their intra-articular proximal interphalangeal joint fractures. Of the total 12 fractures, 6 involved the proximal phalanx and 6 involved the middle phalanx. The final arc of motion at the proximal interphalangeal joint averaged 89 degrees (range, 25 to 111 degrees). At the conclusion of treatment: 1 patient developed a radial deviation and 1 developed a slight ulnar deviation. All patients were able to return to their preinjury level of functioning. Nail hooks and elastic bands external dynamic traction provides an effective treatment for intra-articular proximal interphalangeal joint fractures. It is an inexpensive, easily applied, nonoperative method of treatment.

A Minimally Invasive Gradual Traction Technique for Inverted Nipple Correction

An inverted nipple affects not only the aesthetic appearance of the breast but also breastfeeding. Most surgical procedures can cause injury to normal lactiferous ducts and sensory dysfunction. The authors present a simple, safe, and minimally invasive technique for treating inverted nipples. A distracter was made using the distal end of a 5- or 10-ml disposable syringe. The length was 1.3-1.5 cm, and pinholes with a diameter of 1 mm were punctured at 3, 6, 9, and 12 o'clock at the apex of the distracter. The inverted nipple was pulled out, and two steel wires with a diameter of 0.6 mm were crossed through the nipple base and fixed to the external distracter. After surgery, the wires were tightened once per month. According to the severity of the nipple inversion, the distracter was removed after 4-6 months of traction. This method was used to correct 604 inverted nipples of 310 patients. The follow-up period ranged from 6 months to 2 years. No complications associated with surgery such as infection, depigmentation, sensory disturbance, or nipple necrosis occurred. The great majority of the patients (95.8 %) were satisfied with the aesthetic results. The described technique is minimally invasive, simple, safe, reliable, and low in cost. Satisfying aesthetic results can be achieved without destroying breastfeeding function or nipple sensation. This journal requires that authors assign a level of evidence to each article.

Extrication of penile entrapment in a polyethylene terephthalate (PET) bottle: a technique of suture traction and Dundee and literature review

To describe the use of a technique of suture traction and Dundee in penile entrapment in the polyethylene terephthalate (PET) bottle case. MEASURES AND METHODS: The technique of suture traction in conjunction with Dundee was performed for the management of penile entrapment in PET bottle neck. First, the technique of Dundee (manual compression after multiple prepuce punctures) was used to alleviate and resolve the preputial edema; second, the persistent suture traction power was applied to achieve the removal with lubrication. A review of the literature is also summarized in this report. Current treatment options and outcomes are also evaluated. The PET bottle neck was removed intact successfully in 50 min. Follow-up revealed he got full recovery without any complications. Literature review shows that penile incarceration in PET bottle is frequently described as an isolated case report or small series, the approach for dealing with these problems are often described using cutting instruments, the PET bottle could produce a fatal harm in extreme situation. The technique combined suture traction with Dundee could be easy to perform without any special tools required in the management of penile entrapment involving PET bottles. It could be applied safely for the low-grade penile injury.

Mapping Three-Dimensional Stress and Strain Fields within a Soft Hydrogel Using a Fluorescence Microscope

Three-dimensional cell culture is becoming mainstream as it is recognized that many animal cell types require the biophysical and biochemical cues within the extracellular matrices to perform truly physiologically realistic functions. However, tools for characterizing cellular mechanical environment are largely limited to cell culture plated on a two-dimensional substrate. We present a three-dimensional traction microscopy that is capable of mapping three-dimensional stress and strain within a soft and transparent extracellular matrix using a fluorescence microscope and a simple forward data analysis algorithm. We validated this technique by mapping the strain and stress field within the bulk of a thin polyacrylamide gel layer indented by a millimeter-size glass ball, together with a finite-element analysis. The experimentally measured stress and strain fields are in excellent agreements with results of the finite-element simulation. The unique contributions of the presented three-dimensional traction microscopy technique are: 1), the use of a fluorescence microscope in contrast with the confocal microscope that is required for the current three-dimensional traction microscopes in the literature; 2), the determination of the pressure field of an incompressible gel from strains; and 3), the simple forward-data-analysis algorithm. Future application of this technique for mapping animal cell traction in three-dimensional nonlinear biological gels is discussed.

A pilot feasibility study for immediate relief of referred knee pain by hip traction in hip osteoarthritis

It is generally accepted that osteoarthritis of the hip is a common cause of pain and disability. In clinical practice, a variety of conservative and surgical methods are available for patients with hip osteoarthritis. Nonsurgical interventions are recommended as the first-line treatment for hip osteoarthritis [1]. As one of the conservative therapies used in nonsurgical interventions, physical therapy, including hip traction and stretching, has been shown to reduce pain and improve hip function in patients with hip osteoarthritis [2]. Pain originating from the hip joint is distributed not only in the groin area but also in the buttocks, anterior thighs, and knees [3, 4]. Knee pain arising from the hip joint is one of the characteristics of referred pain in hip osteoarthritis. However, the effects of physical therapy on referred pain have not been well documented. We developed an original hip traction technique using a lumbar traction machine. Of note, patients treated with this method experienced immediate relief of referred knee pain. This study describes the results of immediate relief of referred knee pain because using hip traction.

Laser sheath for tunneled dialysis catheters extraction

The number of patients with acute renal failure and end-stage renal disease undergoing hemodialysis (HD) has increased during the past years, and the management of vascular access is pivotal. Among tunneled dialysis catheters (TDC), Tesio twin-catheter system (Medcomp, Harleysville, PA, USA) provides good long-term survival with acceptably high blood flow and low complication rates [1, 2]. Unfortunately, catheter infection is still a serious and common complication related to temporary HD vascular access. When catheter infection and/or dysfunction occur, extraction is mandatory [3]. Although the development of a fibro-epithelial sheath is a common occurrence, TDC extraction is usually easily performed by traction or cut down technique [3, 4]. However, when the catheters are tethered or attached to central veins and/or to right atrium, these techniques could lead to their rupture and retention and could increase the risk of vascular or atrial wall avulsion. Laser extraction technique is usually adopted for pacing leads, but it can also be helpful in TDC extraction to avoid the previous mentioned complications. A circumferential Excimer laser beam applied at the tip of a specialized telescopic sheath is passed over the lead. The energy source comes from a xenon chloride laser with an output wave length of 308 nm. It is a cool cutting laser (50 C) with a very limited absorption depth; twothirds of the energy are absorbed within 0.06 mm from the tip of the sheath by proteins and lipids instead of water. These technical characteristics allow the ablation of the fibro-epithelial sheath surrounding TDC without damaging the endothelial wall and the catheter itself [5]. According to these assumptions, our laboratory has decided to adopt this technique to extract tethered TDCs. A woman of 57 years, affected by endstage renal disease, was admitted to our Department for a Tesio twin-catheter system-associated bacteraemia. A transesophageal echocardiographic evaluation showed a thrombus occluding the apex of the right atrial appendage. A valvular involvement was excluded. After 2 months of oral anticoagulation therapy, she underwent TDC extraction performed using an Excimer Laser system emitting energy at the tip of a flexible, fiber-optic 12F-sheath (Spectranetics Inc., Colorado Springs, CO, USA). The procedure was performed under assistant sedation with i.v. midazolam. First, the TDC was isolated. Then, an A. Curnis L. Bontempi M. Cerini F. Vassanelli A. Lipari N. Ashofair C. Pagnoni L. Dei Cas Division of Cardiology, EP Lab, Post Graduate School of Cardiology, Spedali Civili, University of Brescia, Brescia, Italy

Management of Proximal Phalangeal Fractures of the Hand Using Finger Nail Traction and a Digital Splint: A Prospective Study of 43 Cases

BackgroundProximal phalangeal fractures are common fractures of the hand. The fractures are difficult to treat because of vicinity of two important joints and crossing long tendons. The purpose of this study was to evaluate the efficacy of nail traction technique in the management of proximal phalangeal fractures of the hand.MethodsPatients (n=43) with proximal phalangeal fractures were treated by nail traction and evaluated prospectively. We assessed all the patients at the time of presentation and then followed a standard protocol for recruiting patients. After application of nail traction, the patients were initially assessed at 12th day. The outcome measures included post reduction radiographic evaluation and total active motion (TAM) in finger at the final follow-up appointment. All the patients were followed for one year.ResultsThe post-reduction X-ray evaluation showed good reduction in 33 cases, fair reduction in 8 and poor reduction in 2 cases. At final assessment, 35 patients had good TAM score, six had fair and two had poor TAM score. Complications were noted in two patients and these included pressure necrosis in palm and stiffness in proximal interphalangeal joint.ConclusionsThe results of this prospective study show that with careful selection of patients, nail traction seems to be simple, safe and effective technique for managing proximal phalangeal fractures.

Anterior open bite with temporomandibular disorders treated with intermaxillary traction using skeletal anchorage system

J Korean Assoc Oral Maxillofac Surg 2012;38:284-94) Objectives: The anterior open bite with temporomandibular disorders (TMD) is one of the most challenging cases both orthodontically and surgically. We introduce an intermaxillary traction treatment for patients with anterior open bite and TMD using a skeletal anchorage system (SAS). Materials and Methods: This study was comprised of 52 patients with anterior open bite and TMD. A total of four mini-screws were inserted, two screws each into the maxilla and mandible, to obtain a class II pattern of elastic application with 120-200 g force. Adjunctive muscle relaxation treatments, such as splint therapy, medication, and botulinum toxin injection were applied during or before intermaxillary traction. At least one treatment among adjunctive muscle relaxation treatment, mentioned above, was applied to 96.2% of patients. We evaluated the clinical characteristics of patients, TMD symptom changes, amount of open bite improved. The degree of open bite improvement was compared between the open bite- reduced group (21 patients) and not-reduced group (5 patients). Results: TMD symptoms (muscle/joint pain, joint sound, mouth opening) remained or improved in most patients, and worsened in about 10% of patients for each items. Anterior open bite was improved by a mean of 1.75 mm (P<0.01) during treatment. The open bite-reduced group exhibited a significant open bite improvement compared to the not-reduced group ( P<0.05), with 37% of open bite improvement occurring during the first 3 months of treatment. Conclusion: The intermaxillary traction technique using SAS is a valid modality for correction of anterior open bite and improvement of TMD symptoms.

Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video)

Endoscopic submucosal dissection (ESD) is the standard of care for treating gastric intramucosal neoplasias in Japan. However, it is seldom performed in Western countries, mainly because it is technically very challenging. Several traction methods have been proposed to facilitate submucosal dissection, but they are usually not widely available or are difficult to apply. Our main aim was to evaluate the feasibility of a new method, the clip-band technique, for improving the visualization of the submucosal layer during ESD. Observational, experimental, feasibility study conducted in a porcine model. University Hospital of the Canary Islands, Research Animal Laboratory. Animal study. After completion of the circumferential cutting, a clip-band traction system was applied. Efficacy and safety of the clip-band technique. Eighteen ESDs performed in live domestic pigs were completed without any serious complications. The mean specimen size was 35.38 ± 12.17 mm, the mean cutting time was 13.06 ± 10.52 minutes, and the mean dissection time was 16.67 ± 9.01 minutes. The clip-band technique was not compared with the standard ESD technique. This initial study shows that the clip-band traction technique is feasible and that it permits safe, effective, and relatively inexpensive gastric ESD.

Hexagonal Six-point Traction Technique for Optimum Surgical Exposure of the Subaortic Region

Surgery of the subaortic region is challenging because of spatial limitations. We present our technique of enhanced exposure of this region that allows for a smooth, expeditious, and safe repair of such lesions as subaortic stenosis, hypertrophic cardiomyopathy, subaortic ventricular septal defects, and related pathologies. Using a hexagonal 6-point traction technique, approximately 84% of the cross-sectional area of the aortic root is made available to the surgeon for a transaortic subaortic resection keeping the use of retractors to a minimum. The technique ensures protection of the aortic valve leaflets and the enhanced exposure may contribute to improved surgical outcomes.

Management of Symptomatic Inadvertently Placed Endocardial Leads in the Left Ventricle

There are limited data regarding the clinical care of inadvertently placed endocardial leads in the left ventricle (LV). We clarified the appropriate management within the context of our experience and published literature. Hospital charts dating from October 2008 to December 2010 were reviewed at a high-volume cardiovascular tertiary referral center. Six patients were identified with inadvertently placed leads in the LV through an atrial septal defect. Six patients (four males, two females) underwent LV lead removal, four through open surgical intervention and two percutaneously. Three (50%) patients presented with severe mitral regurgitation; one (16%) with a thromboembolic transient ischemic attack and two (33%) were asymptomatic. The mean age was 68.5 ± 8.48 years (55-78). Mean ejection fraction was 38.47 ± 11.1% (25%-50%). Four patients (66%) had a pacemaker and two (33%) had implantable cardioverter defibrillators. Comorbidities consisted of diabetes mellitus (50%), chronic renal failure (16%), severe chronic pulmonary hypertension (16%), and congestive heart failure (33%). Hypertension and coronary arterial disease were present in all patients. All patients had complete extraction or repositioning without intraoperative complications or mortality within 30 days. At 6-month follow-up, the patient with severe pulmonary hypertension died of pneumonia and the other five were alive and well. The avoidance and early recognition of inadvertently placed endocardial leads in the LV is imperative in order to avoid potentially serious sequelae and invasive interventions. Treatment usually consists of surgical extraction, although anticoagulation and percutaneous simple traction techniques are an option in certain scenarios.

Clinical study on massage in treating cervical spondylosis of vertebral artery type

Objective To observe the clinical efficacy of combined massage and traction technique in the treatment of cervical spondylosis of vertebral artery type (CSA).

Humerus Axial Traction with Acromial Fixation Reduction Maneuver for Anterior Shoulder Dislocation

Many techniques have been described for the reduction of anterior glenohumeral dislocation, but each of the techniques has its disadvantages. A new shoulder reduction technique is needed to overcome these disadvantages. An alternate technique of humerus axial traction with acromial fixation is presented. The technical description of this procedure focuses on the pre-reduction and post-reduction process. The use of acromial countertraction, the choice of the most loosely packed position of the shoulder joint, and the operator's ability to reduce muscle spasm are the main principles discussed. This modified technique increases the possibilities for the reduction of shoulder dislocation in different clinical situations.

Dynamic Hip Screw Fixation of Intertrochanteric Fractures of Femur: A Comparison of Outcome With and Without Using Traction Table

Intertrochanteric fracture of the femur is one of the common fractures in the elderly. Dynamic Hip Screw (DHS) fixation is the gold standard for treatment of intertrochanteric femoral fracture. Conventional methods of achieving reduction prior to instrumentation require utilization of a traction table. A manual traction technique applied in the supine position using only a translucent table was devised to do away with the use of traction table. The rationale for this technique includes enhanced ease of set up, the ability to perform multiple procedures without repositioning and prevention of traction table related complications. Use of the reduction method with a traction table or application of manual traction during dynamic hip screw fixation of intertrochanteric femoral fracture was both feasible and safe.

The clinical value of " Push-pull traction-relax homing-Repeatedly confirmed" in the prevention of bile duct injury in LC

Objective To study the value of the technique of Push-pull traction-relax homingrepeatedly confirmed in the prevention of bile duct injury in LC. Methods From March 2001-August 2009, we applied this technique in 4800 cases of LC. The technique of Push-pull traction showed the structures of in the Calot's triangle. The technique of relax homing was to restore the cystic duct,hepatic duct and common bile duct to their original anatomical positions. The technique of confirmed repeatedly identified the positions of the cystic duct, the common hepatic duct and the common bile duct. Results There was no bile duct injury. Conversion to open surgery happened in 118patients due to difficulties in identifying the Calot's triangle structures, bile duct stones, gallbladder cancer, and gallbladder-duodenal fistula. Conclusions The Push-pull traction-relax homing-repeatedly confirmed technique could effectively prevent bile duct injury in LC. The method is simple, easy to master and worthy of promotion. Key words: Laparoscopy; Cholecystectomy; Bile duct injury