Traction Weight Research Articles

Intraoperative Shoulder Traction as Cause of C5 Palsy: Magnetic Resonance Imaging Study

During surgery, shoulder traction is often used for better fluoroscopic imaging of the lower cervical spine. Traction on the C5 root has been implicated as a potential cause of C5 palsy after cervical spine surgery. Using magnetic resonance imaging, this study was undertaken to determine the impact of upper extremity traction on the C5 root orientation. In this study, 5 subjects underwent coronal magnetic resonance imaging of the cervical spine and left brachial plexus. Using a wrist restraint, sequential traction on the left arm with 10, 20, and 30 lb. was applied. Measurements of the angle between the spinal axis and C5 nerve root and the angle between the C5 nerve root and the upper trunk of the brachial plexus were obtained. The measurements were taken by a trained neuroradiologist and analyzed for significance. The angle between the C5 nerve root and the vertical spinal axis remained within 3 and 4 degrees of the mean and was not found to be associated with increased traction weight (P= 0.753). The angle between the C5 root and the upper trunk increased with increasing weight and was found to be statistically significant (P= 0.003). While the cause of C5 palsy is likely multifactorial, this study provides evidence that, in the awake volunteer, upper extremity traction leads to C5 root and upper trunk tension. These results suggest that shoulder traction in the anesthetized patient could lead to tension of the C5 nerve root and subsequent injury and palsy.

A Modeling Method for the Driving Process of Heavy-Haul Train Based on Multi-Mass Model

Unlike the locomotive, heavy-haul trains have large carrying capacity and consist of hundreds of carriages; the longitudinal impulse in the train has significant coupled nonlinear characteristics during its operation. With the continuous increase in traction weight, problems with the existing control models gradually appear, vehicle decoupling and derailment occur, and the trains often fail to operate on schedule. Using the coupler characteristic curve, this paper comprehensively considers uncertain factors such as the train loading weight, line ramps, vehicle dynamic performance differences, and changeable operating environment to accurately model the heavy-haul train coupling force and train longitudinal dynamic multiple points. We optimize the target curve of the ideal running speed of the train and design the corresponding running tracking control strategy. The simulation results show that the ideal target speed curve optimization method designed in this paper can effectively improve key indicators such as safety, punctuality and energy saving in train operation to make trains more safely and efficiently run.

Impact of Various Weights in the Intraoperative Skull-Skeletal Traction on Correction of Adolescent Idiopathic Scoliosis.

Study Design:A retrospective study.Objectives:Intraoperative skull-skeletal traction (ISST) facilitates the surgical scoliosis correction, but it is also associated with neurological risk. The objective of the present study was to investigate the impact of various traction weights on neurophysiological change and curve correction in surgery for adolescent idiopathic scoliosis (AIS).Methods:A retrospective review of a consecutive series of posterior spinal fusions for AIS patients undergoing corrections with the use of ISST by 2 surgeons in one institution was performed. Intraoperative prone, post-traction radiographs were performed on all cases. The cases were divided into 2 groups, high and low traction weights, based on whether the weight used was ≥35% or <35% of body weight. The frequency of neurophysiological changes and the curve correction were compared between the 2 groups.Results:The intraoperative correction magnitudes by ISST were significantly larger in the high ISST group than in the low ISST group (35° vs 26°, P < .001). Changes in motor-evoked potential (MEP) were more frequently observed in the high ISST group (47% vs 26%, P = .049). A multivariate analysis showed that high ISST was associated with 3 times higher risk of MEP change (95% confidence interval = 1.1-8.0, P = .03) and higher final postoperative correction rates (68% vs 60%, P = .001).Conclusions:The high ISST for AIS was associated with increased intraoperative and ultimate curve corrections, and potentially facilitated better final correction. However, the high weight group was associated with an increased frequency of intraoperative MEP changes.

Efficiency of preoperative Halo-gravity traction in severe kyphoscoliosis secondary to neurofibromatosis type Ⅰ

Objective: To evaluate the efficiency of preoperative Halo-gravity traction (HGT) in the treatment of severe kyphoscoliosis secondary to neurofibromatosis type Ⅰ (NF1). Methods: A retrospective review was conducted on patients with severe kyphoscoliosis secondary to NF1 at Department of Spinal Surgery, Drum Tower Hospital, Medical School of Nanjing University between July 2007 and May 2016. A total of 29 patients including 17 males and 12 females were finally enrolled and the age was (13.7±2.9) years. The Cobb angle of major coronal curve and global kyphosis were measured before and after HGT. The forced vital capacity (FVC)and forced expiratory volume in 1 second (FEV(1)) before and after traction were also recorded. The paired t test was used for comparison analysis. Results: The average maximum traction weight of HGT was (12.2±2.8) kg and the traction duration was (10.2±6.6) weeks. The coronal Cobb angle before HGT was (87.5±36.5)°, which improved to (68.4±25.9)° after HGT with a correction rate of (21.9±12.1)% (t=9.14, P<0.001); the average global kyphosis before HGT was (79.1±27.1)°, which improved to (59.9±19.4)° after HGT and the correction rate was (20.2±14.1)% (t=8.55, P<0.001). One patient had transient brachial plexus palsy which resolved completely after reducing the traction weight. After HGT treatment, FVC increased from (0.83±0.16) L to (0.89±0.19) L (t=1.48, P=0.12) and FEV(1) increased from (0.72±0.16) L to (0.78±0.20) L (t=0.49,P=0.63). FVC predicted and FEV(1) predicted improved from (42.9±20.1)% and (40.6±19.6)% to (46.9±20.5)% (t=0.98,P=0.33) and (43.6±25.8)% (t=1.24,P=0.22), respectively. Conclusion: Preoperative HGT in the treatment of severe kyphoscoliosis secondary to NF1 can improve spinal deformity and pulmonary function to some extent, which can further benefit the patients by improving their surgical tolerance.

Skeletal traction for the management of lower limb fractures: Its relevance today

Purpose: Skeletal traction is one of the modalities of treatment for fractures involving appendicular skeleton. The purpose of our study is to evaluate the clinical and radiological outcomes of skeletal traction applied to injuries involving lower limb as a temporary / definitive procedure.Methods: We have included 108 patients with various injuries involving bones of lower limb. Modalities of traction included upper/lower tibial pin traction/calcaneal pin traction. Steinmann pins (4.5mm to 5.5mm) Bohler stirrup and Bohler Braun splint were used for applying traction. X-rays were taken before and after skeletal traction and also every time when the weight of traction was either increased or decreased. The end point for removal of the traction apparatus was either surgery or POP application or fracture union. Until then quadriceps and ankle mobilisation exercises were performed. Results: Results were analysed based on skin healing, bone healing, joint scores (Harris hip score, WOMAC score, Peterson score). Complications usually encountered were pin tract Infections. Most of the cases showed good results in either assisting the surgeon for closed manipulation and implantation during surgery, or for successful healing in good alignment in patients who were not fit for surgery or not willing for surgery.Conclusion: Skeletal traction, even though rarely used nowadays, is still an important modality of treatment in selected situations where surgery may be delayed, denied or contraindicated for various reasons.

Skull-femoral traction after posterior release for correction of adult severe scoliosis: efficacy and complications

BackgroundIt is a great challenge for spine surgeons to correct severe rigid scoliosis. We developed a three- staged correction (one stage posterior release and screw placement, two stage skull-femoral traction and three stage posterior instrumentation) for adult severe scoliosis. The objective of this study is to investigate safety and efficacy of a three- staged correction for adult severe scoliosis.MethodsA retrospective review was performed for patients with severe scoliosis receiving three- staged correction (one stage posterior release and screw placement, two stage skull-femoral traction and three stage posterior instrumentation) from June 2001 to October 2014. The inclusion criteria were as follows: [1] age more than 18 years; [2] main curve larger than 90°; [3] a minimum 2-year follow-up. Patients were excluded if they had a history of surgery or anterior release or receiving three column osteotomies.ResultsA total of 63 patients were included (37 female and 26 male), with a mean age of 22.7 years (range: 18–30 years) and follow-up of 42.6 months (range: 24–108 months). The aetiology was congenital in 27 patients, neuromuscular in 18, idiopathic in 11, neurofibromatosis-1 in 4 and Marfan syndrome in 3. The mean traction weight was 28.4 kg (range: 18–32 kg), equal to 57.2% of patients’ body weight (range: 42.7–72.3%). The mean traction time was 22.7 days (range: 12–44 days). Postoperative correction rate was 55% (range: 38–78%) for scoliosis and 51% (range: 32–75%) for kyphosis. Contribution of traction to correction was 51% (range: 36–70%) for scoliosis and was 43% (range: 34–55%) for kyphosis.ConclusionsThree- staged correction (one stage posterior release and screw placement, two stage skull-femoral traction and three stage posterior instrumentation) could effectively correct adult severe scoliosis. The incidence of complications of skull-femoral traction was not low, but transient and could be successfully managed.

Research on the driving strategy of heavy-haul train based on improved genetic algorithm

The driving safety of heavy-haul train is affected by the train’s traction weight, the length of train, the line profile, the line speed limit, and other factors. Generally, when the train is running on a continuously long and steep downgrade line, it needs using the circulating air braking to adjust speed. When it is braking, the brake wave is transmitted non-linearly along the direction of the train. When it is relieved, it must be ensured that there is sufficient time for the train to be inflated. Therefore, it is difficult to ensure the safe operation of the heavy-haul train. In this article, a new method of the train’s driving strategy based on improved genetic algorithm is proposed. First, a mathematical model for the operation of heavy-haul train is established with multiple parameters. Then, according to the improved genetic algorithm and the mathematical model of the heavy-haul train, the driving strategy of the chromosome of the train is studied. Finally, the driving curve which can ensure the safe running of the heavy-haul train can be obtained. By comparing the simulated driving curve with the actual one, the results show the effectiveness of the proposed method.

Benefits and complications of halo-gravity traction in adolescents with severe idiopathic or secondary scoliosis prior to vertebral fusion. Series of 16 cases

In the treatment of severe scoliosis, pre-surgical halo-gravity traction (HGT) achieves an increase in curve flexibility and in preoperative pulmonary function as well as a neurologic risk reduction following final surgery. Our aim was to describe the benefits and complications of HGT in adolescents with idiopathic scoliosis or secondary scoliosis while awaiting vertebral fusion. A descriptive and retrospective study. Sixteen patients admitted to hospital and carrying a HGT between January 2014 and December 2017 were included. The main judgment criteria were the height gain, the final weight of traction, the decrease in the Cobb angle, the gain in the forced vital capacity (FVC) and the description of complications. There were eight teenagers with an idiopathic scoliosis aged-mean (SD) 12.1(1.9) years old, a height gain of 7.6(2.3)cm, a final weight of traction of 13.7(3.9)kg corresponding to 37.2(7.5)% of body weight. Cobb angle mean(SD) of 97.5(8)° was reduced of 26.9(11.1)° at the end of traction. And a FVC gain mean (SD) of 12.4(8.8)%. Likewise, eight adolescents with a secondary scoliosis aged-mean(SD) 12.8(1.2) years old, a height gain of 9.2(2.8)cm, a final weight of traction of 12.7(1.3)kg corresponding to 38.9(11.6)% of body weight. Cobb angle mean(SD) of 100(13.8)° was reduced of 26.5(8.4)° at the end of traction. And a FVC gain mean(SD) of 7.1(9.7)%. The most frequent complications in the group of idiopathic scoliosis ( n = 8) were neck pain (75%), headache (37.5%), pin pain (25%), visual disorders, thorax pain and pin infection (12.5%). In the group of secondary scoliosis ( n = 8), neck pain (100%), headache (62.5%), back pain (50%), pin pain and anxiety (25%), neurological disorders and pin infection (12.5%). HGT was in general well tolerated and should be considered before vertebral fusion to improve spinal flexibility and respiratory function in idiopathic or secondary scoliosis.

A Method of Facilitating Mobility in Children Undergoing Halo Skeletal Traction

The earliest documented use of skeletal traction devices was detailed by Hippocrates. From the Middle Ages through to the evolution of modern medicine, patients undergoing skeletal traction were confined to bed. Early to mid-1900s studies document the use of a halo to apply skeletal traction to manage spinal deformities. Adapted wheelchairs for halo traction were developed in the mid-1900s. Our halo traction program team modified wheelchairs and walkers to provide out-of-bed mobility. Optimization of patient independence during mobility in halo traction and the staff’s ability to manage increasing amounts of halo traction weight were considered during program development.

Preoperative Halo-Gravity Traction for Severe Thoracic Kyphoscoliosis Patients from Tibet: Radiographic Correction, Pulmonary Function Improvement, Nursing, and Complications.

BackgroundThis study investigated the outcomes of preoperative HGT as an adjunct treatment for severe thoracic kyphoscoliosis, its role in radiographic correction, and pulmonary function improvement, together with nursing strategy and incidence of complications.Material/MethodsEleven patients with a mean age of 18.8 years were retrospectively reviewed. Inclusion criteria were: patients with severe kyphoscoliosis (coronal Cobb angle and kyphosis angle ≥80°); duration of HGT ≥8 weeks; patients undergoing HGT for at least 12 h per day; traction weight no less than 40% of body weight; and patients not receiving physical therapies. All patients underwent respiratory training.ResultsThe major coronal curve scoliosis averaged 114.00±24.43° and was reduced to 80.55±17.98° after HGT. The major kyphosis was 103.91±18.95° and was reduced to 80.55±17.98°. Significantly improved percent-predicted values for FVC was found after HGT (p=0.014), and significantly increased forced expiratory volume in 1 s (FEV1%) was also observed (p<0.001), with significantly improved percent-predicted values for PEF (p=0.003) after HGT.ConclusionsOur data reveal that preoperative HGT can be performed safely, and can help achieve excellent curve correction in both the coronal and sagittal planes, together with improved respiratory function and no severe complications in patients with severe thoracic kyphoscoliosis.

Effect of different traction weight on preventing leakage of urine in elderly patients with indwelling urethral catheterization

Objective To explore the appropriate traction weight of traction method for the prevention of leakage of urine in elderly patients with indwelling urethral catheterization so as to provide a theoretical basis for clinical work. Methods A total of 120 indwelling urethral catheterization patients with leakage of urine in department of geriatrics of Jiangdu People's Hospital of Yangzhou (affiliated Hospital of School of Medicine, Yangzhou University) were selected by convenient sampling from January 2014 to August 2016. They were randomly divided into four groups and accepted traction method for the prevention of leakage of urine involving traction weight with 50, 100, 150, 200 g. The preventive effect and situation of comfort of patients were compared among four groups. Results The effective rate in prevention of leakage of urine of traction weight with 50, 100, 150, 200 g was 16.7%, 100%, 100%, 100% with a statistically significant difference among four groups with different traction weight (Hc=73.849, P<0.001) . The results of intercomparsion showed that the effects of groups with traction weight of 100, 150, 200 g were statistically better than that of the group with traction weight of 50 g (χ2 = 42.857, P<0.001) . There were statistically significant differences in degree of comfort among four groups with different traction weight (Hc=57.674, P<0.001) . Compared with the group with traction weight of 150 g, the incidence of moderate or severe discomfort was 70% in the group with traction weight of 200 g with a significant difference (χ2=19.817, P<0.001) . There was no statistically significant difference in the incidence of moderate or severe discomfort between the group with traction weight of 100 g and 150 g (χ2= 0.162, P=0.688) . Conclusions The optimum traction weight for the prevention of leakage of urine in elderly patients with indwelling urethral catheterization is 100-150 g. Key words: Aged; Indwelling urethral catheterization; Leakage of urine; Traction weight

BRAKE OF THE FRONT DRIVE WHEELS OF THE TRACTOR "BELARUS"

The increase in the energy saturation of the new models of tractors "Belarus", as well as the mass of towed trailers and agro-technological tools that are mounted with them, required an increase in the efficiency of the tractor braking system. The purpose of the study is to increase the efficiency of the braking system of the wheeled tractor "Belarus MTZ" by creating wheel brakes for the front axle with minimal changes in its standard design. The developed drum brake with hydraulic drive of the front drive wheels of the tractor "Belarus MTZ-1221" does not require significant changes in the standard design of the front axle of the MTZ tractor and is adaptive to the anti-lock system, which operates on the basis of measurement and analysis of force factors. The design of the developed brake mechanism allows its adaptation to the anti-lock system, which operates on the basis of measuring and analyzing the forces that arise in the contact of the wheels of the front axle of the tractor with the supporting surface. The braking effect of the tractor "Belarus MTZ-1221" is provided by additional use of its coupling weight, which falls on its front axle. A set of design documentation for the drum brake for the front driving wheels of the tractor "Belarus MTZ-1221" was developed. The use of an additional traction weight of the tractor due to the wheel brakes of the wheels of the front axle of the tractor "Belarus MTZ-1221" will increase the efficiency of its braking, as well as increase the competitiveness of wheeled tractors produced by the JSC "Minsk tractor works". Bench tests confirmed the possibility of braking the calculated moments corresponding to the weight load on the front axle of the tractor "Belarus MTZ-1221". Consequently, the developed brake mechanism will ensure effective use of the tractive weight of "Belarus MTZ-1221" tractor.

Cervical traction therapy with and without neck support: A finite element analysis

BackgroundCervical traction is commonly used for treating neck pain. However, few studies have investigated the biomechanical impact such traction has on soft tissues. ObjectivesTo analyze the biomechanics of cervical traction therapy in a supine position with and without neck support (NS and non-NS). MethodsA finite element model of the cervical spine was constructed to investigate the mechanism behind cervical traction therapy. An axial traction force of 100-N was loaded on the upper surface of C0 to simulate traction weight. Neck support traction was simulated by additionally constraining anterior-posterior motion of the surface of the C4 vertebral lamina. The average von Mises stress, tensile force and motions of related tissues were calculated and compared between the two conditions. Stress in the posterior annulus fibers under flexion was also recorded for comparison. ResultsAt the C4-C5 and C5-C6 levels, NS traction resulted in less of a decrease in the lordotic angle. At these levels, the highest average stress was distributed in the posterior annulus fibers with non-NS traction and both traction therapies produced greater stress on the posterior annulus fibers than physical flexion. The intradiscal pressure in all intervertebral discs between C4-T1 decreased during both traction therapies. ConclusionNeck support traction therapy produced less tension on the posterior annulus fibers and ligaments posterior to it at the C4-C5 and C5-C6 levels. In order to minimize the potential harm to soft tissue in clinical practice, it may be beneficial to use a neck support according to the targeted level.

Modeling of Vibroimpact Processes which Occurs in Feet Changing of the Walking Units at Viscoelastic Grounds

At research of planets walking machines could be more effective than wheeled and tracked ones. They have higher ground and shape passableness. Walking machines traction properties, in execution of ground works for example, are also higher. It is especially important in traction weight deficit, characterized by weakened gravity. In the paper executed mathematical modeling of vibro-impact processes, which appears during feet changing, and investigated influence on walking unit dynamic in weakened gravity. During modeling on feet changing walking unit has been investigated as system of bodies — frame and weightless movers (feet). As design scheme was accepted the two-feet one with vertical translational motion of frame and antiphase leg motion. The frame movement is executed by the impact of kinematic impulses created by the movers, their character determined by relative contact points motion of walking mechanisms in contact phase with ground. Modes with periodical feet motion have been modelled. Time dependencies of relative vertical motions of walking mechanisms contact points was approximated by trigonometric polynomial. In mathematical describing of grounds was used the viscoelastic model with different relations of viscous and elastic properties. Elastic force, which proportional to the ground deformation and unidirectional viscous friction force, which proportional to deformation speed, were introduced. The modeling results have shown, in feet changing occurs their oscillations at the ground. The oscillations are accompanied by support reactions alteration and their maximum values could be bigger than static by few times. The effect occurs at different grounds. This property can be used for implementation of increased traction forces in individual cycle phases. At increasing of movement speed the amplitude of support reactions changing is rising. In weakened gravity conditions that could result in transformation of static stable walking to running already at low velocities. The results can be demand in walking robots development, designed to planet surface investigation.

Titanium elatic intramedullary nail and end caps to treat length-unstable femoral shaft fracture of children

Objective To evaluate the outcome of Titanium Elatic Intramedullary Nail (TEINs) for treatment of lengthunstable femoral shaft fracture of children. Methods Retrospectively analyze the data of total of 21 children with length-unstable femoral shaft fractures, from December 2011 to June 2014, were treated with TEINs and end caps. This study involved 15 boys and 6 girls, with age ranged from 5 years and 6 months to 10 years and 10 months, whose average age was 7 years and 5 months. Firstly children were treated with traction for 3-7 days, with traction weight of 1/4 to 1/6 of the weight. After that, shortening and angular deformity were significantly corrected. Then surgeries of close reduction and internal fixation with TEINs were done in general anesthesia. TEINs were supported with double nail C shape. The lateral tip of TEIN located near the epiphyseal plate of greater trochanter, and the medial tip near the epiphyseal plate of femur head. Cut the tail of TEINs, set and screw the end caps in- to cortex, keeping the tail of TEINs and fracture fixed. Spica casting was used for 4 weeks after operation. The last follow-up time was 2 years, and the follow up results were analyzed. Results 21 children were followed up ranged from 22 to 26 months, with the mean follow up 23.4 months. Remove the spica casting and bear loading at 4 weeks after operation. All fractures healed, with healing time of 5 to 8 weeks (an average of 6.2 weeks). At the last follow-up, the limb force line was good with no angular deformity. Femur overgrew 4.2-21.1 mm, with an average of 6.1 mm. At the last follow-up, the patients were evaluated with Harris score, and the excellent and good rate was 100%. No case of TEINs push-out, limited hip mobility, fracture nonunion, delayed healing or other complications was found. Only 1 case got a mild lameness. All parents were satisfied with their outcome. Conclution TEINs and end caps are effective methods for the length-unstable femoral shaft fracture in children. These results indicated that the risk of TEINs push-out can be reduced. Key words: Child; Femoral fractures; Internal fixators; Fracture fixation, intramedullary

Ventriculoperitoneal Shunt Fracture Following Application of Halo-Gravity Traction

Ventriculoperitoneal (VP) shunt malfunctions are very common, and shunt fracture is one of the most common causes. Shunt fractures are often a result of calcification and tethering, which predispose the tubing to fracture when mechanical stresses are applied. This case report describes a case of shunt fracture following application of halo-gravity traction for correction of spinal deformity. Chart and imaging data for a single case were reviewed and reported in this retrospective case study. A 10-year-old female, being treated for syndromic scoliosis, underwent posterior surgical release and application of halo-gravity traction. Increasing weight of traction was applied over a period of 6 weeks, for gradual deformity correction. It was noted on the 6-week cervical spine radiograph that the VP shunt had fractured at the base of the neck. The patient was taken to the operating room and intraoperative findings confirmed shunt fracture. This was repaired without complications. This case, to our best knowledge, is the first reported occurrence of shunt fracture following application of halo-gravity traction. It demonstrates the importance of careful monitoring of patients with VP shunts, when they are undergoing traction for correction of spinal deformity. Level IV.

Anterior or Posterior Release for Severe Rigid Scoliosis: Which is Safer and More Effective?

Introduction Various correction methods have been developed to treat severe rigid scoliosis. The anterior release was performed for many years to improve the flexibility of rigid scoliosis, however, the safety and efficacy of combined anterior/posterior approach were questioned by many authors. This study aimed to evaluate the efficacy and safety of two-stage posterior surgery for severe rigid scoliosis and to determine whether posterior release is safer and more effective than anterior release. Patients and Methods A total of 27 patients undergoing the staged posterior procedure were included in P–P group and 32 patients undergoing staged anterior/posterior procedure were included in A–P group. Halo-femoral traction was used after the release procedure for both the groups. The flexibility and correction rate were evaluated to quantify the contribution of spinal release and traction to curve flexibility. Radiographic outcomes were compared between the two groups before surgery, after release and traction, immediately postoperatively, and at the last follow-up. Results Gender, release and fusion segments, duration and weight of traction, main curve magnitude, and curve type were similar between the two groups. Significant lower flexibility of main curve ( p = 0.001) and higher global kyphosis ( p &lt; 0.001) was found in P–P group. For patients in the P–P group, the flexibility of major curve averaged 14.1% before surgery, which increased to 32.5% after posterior release and Halo-femoral traction ( p &lt; 0.001) and showed 44.9% correction postoperatively. Compared with patients in A–P group, patients in the P–P group seemed more benefited from release and Halo-femoral traction (18.4 vs.12.9%, p = 0.021) although they had significantly more rigid scoliosis before surgery (14.1 vs. 21.0%, p &lt; 0.001). Besides, the final correction rate of the main curve was similar between the two groups (50.1 vs. 44.9%, p = 0.094). Five patients in the A–P group were found to have respiratory system related complications, whereas only one patient in P–P group experienced superficial pin site infection combined with deep venous thrombosis of the left limb. Conclusion Staged posterior surgery provides a safe and effective option for the treatment of severe rigid scoliosis. And posterior release seems superior for anterior release regarding the surgical outcomes.

Low Friction Traction for Cervical Spine Dislocation

In order to reduce the magnitude of the force applied to skull for treatment of acute cervical spine dislocation, we developed a method of skeletal traction based on reduction of friction forces under the patient’s head. Traction force was applied to sculls of five patients with cervical fracture-dislocations. A difference in friction interface between the patient’s head and shoulder girdle was created. The traction weight required for the reduction of the vertebral dislocation was significantly lower than an expected minimal traction weight in the commonly used techniques (p = 0.013). The presented method permits an effective and safe reduction of dislocated cervical vertebra by a relatively low traction force.

Cost-Effective Traction for Arthroscopic Shoulder Surgery

The application of traction has enhanced views during arthroscopic shoulder surgery, easing visualization and accurate intervention within the shoulder joint and the subacromial space. Many innovative traction techniques are currently employed, including the use of padded traction equipment attached to boom arms and further, pedal-activated, hydraulic traction equipment. Variations in patient positioning and cost-benefit analysis of the use of traction in both beach chair and lateral decubitus positions have been performed in the literature. We demonstrate the use of readily available, simple and inexpensive resources in the beach chair position, allowing the application of traction with minimal set-up time and complexity. Initial equipment outlay requires a drip stand attached to a clamp at the end of the operating trolley, permitting a hook to be applied to the arm that is attached to traction cord and weights. We minimized the cost of ongoing consumable items per case to include a stockinette and benzoic tincture. The theatre team experiences a short learning curve associated with the ease of reliability and reproducibility of this technique.

Vertebral column resection for complex congenital kyphoscoliosis and type I split spinal cord malformation

Congenital progressive kyphoscoliosis associated with split spinal cord malformation (SSCM) is a very rare disease. Here, we present the case of a 23-year-old woman who was found kyphoscoliosis when she was 10 years old and developed rapidly. Thereafter, no management was proposed before her consultation at our center. On examination, numbness was found in the right low limbs, kyphoscoliosis was detected in thoracolumbar, the trunk deviated to the right on standing view and curvature of the thoracolumbar spine was left-sided, the left rib hump was severe and there was little muscle tissue felt under the right side paravertebral area, the pelvis was oblique with the right side higher than the left side, the right arcus costarum was 5 cm below the right iliac crest. One-stage corrective surgery was determined, at first, halo-wheelchair traction gradually with increased traction weights out of hospital for a month; then, after a reasonable correction achieved without any neurological deficits. The one-stage operation was taken through single posterior segmental pedicle screw instrumented fusion with VCR between T12 and L1. Post-operative recovery was uneventful and there were no complications, she was discharged 10 days post operation. At 2 years follow-up, the patient's outcome is excellent with balance and correction of the deformity. Based on the Grand Round case and relevant literature, we discuss the different options for the treatment of congenital kyphoscoliosis associated with type I SSCM. In the patient whose kyphoscoliosis is severe and rigid, we recommend an initial release followed by halo-wheelchair traction gradually to correct the deformity, once optimal correction acquires during the traction, the posterior instrumented fusion with VCR upper the bony spur could be done safely without the resection of bony spur.