Wire Traction Research Articles

New internal transport distraction device for reconstructing segmental defects of the mandible

We have developed a new internal distraction device for the transport of bone, which comprises a bridging reconstruction plate, a bracket with miniplates for fixing the transport disc, a traction mechanism, and traction wire. The entire device except for part of the traction mechanism is placed internally. Activation of the traction mechanism slides the bracket on the rail of the reconstruction plate with the traction wire, which carries the transport disc along the rail. The traction mechanism can be removed after the period of distraction, leaving only the other components during consolidation.

A simple technique to facilitate the Le Fort I osteotomy downfracture

In order to mobilize and reposition the maxilla when treating dentofacial deformities, the Le Fort I maxillary osteotomy is commonly used. Like other surgical procedures, this procedure is not without inherent difficulties. At times, it may be difficult to initially mobilize the maxilla after performing the osteotomies. Techniques used to help in the initial mobilization and downfracture of the maxilla from the pterygoid plates include digital pressure to the dentoalveolus, disimpaction forceps, spreaders, and other instruments. These techniques are similar in that they all apply a unidirectional downward vector of force on the maxilla and have various drawbacks. We present a technique that uses a 0.5-mm stainless steel traction wire to facilitate Le Fort I maxillary downfracturing by applying a forward and downward vector of force simultaneously. After vertical downfracture of the maxilla, lateral traction on the wire can be used to complete the pterygomaxillary disjunction. This technique has several advantages and is atraumatic, and requires no special instrumentation; thus, downfracturing of the maxilla is done with relatively little effort and minimal risk.

Successful Endoscopic Retrieval of an Impacted Trapezoid Basket with Severed Traction Wires

Successful Endoscopic Retrieval of an Impacted Trapezoid Basket with Severed Traction Wires

Rigid external distraction of the midface with direct wiring of the distraction unit in patients with craniofacial dysplasia.

The development of craniofacial distraction techniques represents a significant advancement in the management of craniofacial dysplasias. For distraction of the midface after Le Fort III osteotomy, two levels of anchorage to the moving segments are necessary. In this report, the authors connected the distraction forces directly to the infraorbital rims, using a surgical wire for superior anchorage. They performed this technique in four patients with craniofacial dysplasia for the management of severe maxillary hypoplasia using RED II system. This configuration not only simplified the placement of the system but also made the removal of the device much easier. The authors did not have any problems with the wire traction unit, such as wire breakdown or bony tunnel disruption. It is a cheap, simple, and effective configuration that can be easily performed without any complication.

Lengthening of the amputation stumps of the distal phalanges using the modified Ilizarov method

Purpose: The purpose of this study was to introduce the technique for distraction lengthening of the traumatic amputation stumps of distal phalanges less than 10 mm long by using the Ilizarov minifixator (Ito Medical Instruments, Tokyo, Japan) and to report the treatment results and the problems we encountered. Method: Six patients (3 men and 3 women) underwent lengthening of the traumatic amputation stumps of distal phalanges using the Ilizarov minifixator. The mean pre-operative length of the distal phalanges was 6.0 mm and the mean deficiency in length was 9.5 mm compared with the contralateral finger or thumb. Results: In 5 of the 6 patients callus lengthening was completed without early consolidation or bone failure related to the traction wires. The mean gain in lengthening of the distal phalanx was 6.8 mm and the mean final length of the distal phalanx was 12.8 mm. After surgery 4 patients had onychoplasty and advancement flap coverage of the distal phalangeal tip because of excessive skin tension and 1 patient had arthrodesis because of flexion contracture of the distal interphalangeal joint. The patients were satisfied with the cosmetic improvement of their fingertips. Conclusions: Although this callus distraction method required multiple surgical procedures it is considered worthy of more frequent application especially in young patients. (J Hand Surg 2003;28A:316-322. Copyright © 2003 by the American Society for Surgery of the Hand.)

Retrieval of an impacted Dormia basket and stone in situ using a novel method

ERCP has been the mainstay of treatment for choledocholithiasis. Rarely, endoscopic removal of bile duct stones may be complicated by impaction of a Dormia basket or fracture of the traction wire during mechanical lithotripsy.1-4 With the advent of the Soehendra lithotriptor, stones captured within an impacted basket are either crushed or the wires of the Dormia basket broken to release the trapped basket. We present here a novel method for retrieval of an entrapped Dormia basket where the central wire of the basket fractured just outside the oral cavity during an attempt to use the Soehendra lithotriptor.

Management of traction wire fracture complicating mechanical basket lithotripsy.

The application of basket catheters has become the main method of removing calculi from the biliary and pancreatic duct. However, larger or impacted stones have to be crushed and fragmented by mechanical lithotriptors before removal is possible. Sometimes, fracture of the traction wire occurs as a severe and fraught complication. We describe a precautionary measure which helps to manage this complication. In a series of 569 consecutive patients suffering from bile or pancreatic duct stones we found 60 (10.5%) who required mechanical lithotripsy for oversized or impacted calculi. Mechanical lithotripsy was always performed initially with a long metal sheath (80 cm) in combination with a standard traction wire. If the traction wire fractured we replaced the long metal sheath stepwise by shorter ones (70cm, 60cm and 50 cm, respectively), allowing immediate continuation of the lithotriptic procedure using the same traction wire. During the lithotriptic procedure three of our patients (5%) were afflicted by traction wire fracture. Two patients could be relieved directly by changing the initial metal sheath to shorter ones. Because of the exceptional hardness of a pancreatic duct stone the third patient needed stone fragmentation by extracorporeal shock wave lithrotripsy (ESWL) before complete mechanical clearance of the duct could be accomplished. We advocate the initial use of a long metal sheath (80cm) to perform mechanical lithotripsy. In case of traction wire fracture the use of a shorter metal sheath allows immediate successful continuation of the procedure, thereby frequently avoiding procedures such as ESWL or surgery.

特発性股関節軟骨融解の１例

A case of idiopathic chondrolysis of the hip in an adolescent Japanese girl is reported. She was initially treated with nonweight bearing, skin traction and physical therapy, however hip motion was gradually impaired. The hip was then placed in a continuous passive motion machine with wire traction for 2 months and the function of the hip improved.It is considered that continuous passive motion with skeletal traction may be efficacious against idiopathic condrolysis of the hip.

Three-year experience with a stylet for lead extraction: a multicenter study.

The extraction of chronically implanted and infected pacemaker and defibrillator leads is an important issue. This article describes the experience gathered between 1990 and 1994 by seven European centers regarding a locking stylet that is uniformly applicable for a wide variety of internal pacing coil diameters. This interventional locking stylet for lead extraction has an outer diameter of 0.4 mm (0.016 inches). The stylet consists of a hollow shaft in which an inner traction wire is embedded. At the tip of the inner traction wire an anchoring mechanism, which can be opened by retraction, is applied. Removal attempts were made for 150 leads, 110 in ventricular and 40 in atrial positions. Complete removal was possible in 122 cases (81%). Partial removal was possible in 18 cases (12%). Failure to remove the lead with the extraction stylet was experienced in 10 cases (7%). In seven patients, the leads were removed by cardiothoracic surgery; 3 defective leads were left in place. There were no serious complications associated with the procedure. None of the patients died. The experience with this extraction stylet for lead removal has shown good results. Despite a low complication rate thus far, each case for lead removal should be judged on the individual basis of benefit-to-risk ratio.

人工膝関節置換術後の早期深部感染の２例

Of the TKR (total knee replacement) cases we experienced in this department up tp 1995, 2 (1.5%) were complicated with an MRSA infection. In both cases, curettage of the lesion and continuous irrigation were conducted immediately arter the infection was diagnosed. In one case which demomstrated loosening of the implants, removal of the implants and artrodesis were necessary. However, we succeeded in suppressing the early infection and retaining the implants in the other case in which loosening did not occur.Factors accelerationg infection were assumed to be insufficient contral of the reticular gland which was the site of wire traction in the tibial tubercle and plural surgery duting the same hospitalization period in Case 1 and decreased defence function against local infection attributable to frequent steroid injections and marked anemia and hypoproteinemia after surgery in Case 2.The advantage of povidone odine is that it demonstrates action against bacteria including MRSA as wellas fungi and viruses of and it does not acquire bacterial resistance. Its toxicity in bone, cartilage and soft tissue is negligible. Compared with other disinfectants, its bacterididal action is strong and it inexpensive.We conchided that 0.1% povidone iodine solution was effective when utilized in continuous irrigation.

Dormia baskets impacted in the bile duct: release by extracorporeal shock-wave lithotripsy.

Endoscopic extraction of bile duct stones may be complicated by impaction of the Dormia basket with captured stones, or rupture of the traction wire of the basket during mechanical lithotripsy. In an attempt to release impacted baskets by nonoperative means, we studied the efficacy of extracorporeal shock-wave lithotripsy in this dangerous clinical situation. Fourteen extracorporeal shock-wave treatments were performed in 12 consecutive patients (eight women and four men; mean age 73.2 +/- 13.2 years, range 46-86 years) with an electrohydraulic shock-wave lithotriptor, using fluoroscopy (n = 13) or ultrasound (n = 1) for targeting. A total of 1845 +/- 334 (mean +/- SD) shock-wave discharges at a voltage of 22 +/- 4 kV were delivered per treatment. Nine treatment sessions (64%) were performed while patients were under general anesthesia. An attempt to extract the Dormia basket was made after disintegration of the captured stone had been confirmed by fluoroscopy. It was possible to remove the Dormia basket by nonsurgical means in 11 of the 12 patients (92%) after one treatment session, and after three treatment sessions in the remaining patient. Thus, disintegration of the stones allowed extraction of the Dormia basket in all patients. None of the patients needed surgical intervention. All patients were rendered free of bile duct stones after extracorporeal shock-wave lithotripsy and subsequent endoscopic removal of the fragments. No adverse effects of shock-wave therapy with subsequent extraction of the Dormia baskets were observed. Shock-wave therapy represents a primary nonsurgical therapeutic option in patients with either impacted Dormia baskets or broken devices which cannot be extracted by endoscopic means.

高齢者における下肢直達牽引の問題点

We reviewed the complications developing after treatment with wire traction for femoral neck fractures in thirty elderly female patients ranging in age from 69 to 90 years. Eight cases of wire movement, six cases of local infection, and nine cases of psychological symptoms were recorded during traction. Regarding the mobility of knee joint and quadriceps muscle power at four weeks postoperatively, no significant difference was found between traction through the distal part of the femur and the tibial tuberosity.

Subcutaneous wire traction technique without CO2 insufflation for laparoscopic cholecystectomy.

One hundred laparoscopic cholecystectomies were performed since April 1991. Eleven patients were treated with a new technique without CO2 insufflation, using a traction device to elevate the right upper quadrant wall. Two Kirschner wires were introduced subcutaneously to permit the abdominal wall to be lifted for satisfactory laparoscopic view, as the gas insufflation technique yields. Preoperative evacuation of the intestines and intraoperative muscle relaxation are necessary for easy and successful cholecystectomy. Three cases were converted to laparotomy because of remarkably distended intestine due to incorrect endotracheal intubations. No complications related to subcutaneous wire traction technique were noted in this series. Subcutaneous wire traction technique provides a simpler, and possibly safer alternative to the gas insufflation technique.

Sprengel deformity.

Eighteen cases of Sprengel deformity in sixteen patients were treated by the same surgeon. The operation was a modification of Green's procedure; all muscular attachments to the scapula are freed, the omovertebral band is cut, and the scapula is sutured into a pocket in the latissimus dorsi after the scapula has been rotated and moved caudad to a more normal position. No spring or wire traction is employed. The ages of the patients at operation ranged from twenty months to five years and ten months. The duration of follow-up ranged from three years to fourteen years and three months. In eleven of the fifteen patients who were available for follow-up, there was a moderate or dramatic improvement in appearance postoperatively. Preoperatively, the total abduction of the shoulder averaged 91 degrees (range, 60 to 120 degrees), and postoperatively, the abduction averaged 148 degrees. A radiographic geometric method was devised to quantitate lowering and derotation of the scapula. The lowering did not change appreciably with time. The original malrotation of the scapula was corrected initially but usually recurred after two years; however, this did not compromise the large increase in abduction postoperatively.

Asymmetrical arrest of the proximal tibial physis and genu recurvatum deformity.

We are reporting six cases of premature asymmetrical closure of the proximal tibial physis and associated genu recurvatum deformity and have reviewed the fourteen cases reported in the English-language literature. No single etiological factor could be implicated as the cause of the physeal arrest. Trauma, prolonged immobilization, tibial wire traction, and a surgical procedure involving the proximal tibial physis were observed risk factors among our patients. In our patients, established genu recurvatum due to deformity of the proximal end of the tibia and associated tibial length discrepancy were managed successfully by an opening-wedge osteotomy through the proximal one-third of the tibia and bone-grafting. Epiphyseodesis in the contralateral extremity may be required in patients with significant shortening of the tibia.

Instrumentation for distraction by limited surgery in scoliosis treatment

A principle for secondary instrumental spinal distraction by a rod appliance of the Knodt and Harrington types is described. The principle entails the rotation of the screw rod by wire traction. The wire is, in a secondary procedure, unwound from a wire barrel mounted onto the screw rod in the primary operative procedure. The study describes the devices employed, modified according to the wire traction—instrument distraction principle Previous results from intra-vital studies of the Harrington instrumentation have been reported from experiments performed 2. Thus, a final distraction force of 18 kp effected for correction of a scoliosis curvature, was taken as a value of distraction prior to secondary instrumental distraction by wire traction. In the extra vital study, the wire traction was adjusted to surmount a compressive force of 20 kpby means of a Bessmann weight scale. Wire traction created a distraction force of 39.5 kp, and a metric distraction, from the position resulting from 20 kp distraction to that resulting from 39.5 kp distraction, of 2.8 mm, which was considered to affect the prevalling scoliosis geometry to a considerable and sufficient extent.

Traction—A surgical/orthodontic procedure

Maxillary crowding may cause failure of eruption of the canine. The teeth so displaced are directed buccally or palatally. In both cases, surgical intervention is indicated after space has been made in the arch. Palatally displaced canines are treated by surgical excision of palatal mucosa to promote eruption. Wide excision is indicated to prevent the healing process from covering the exposed tooth crown. Because of the anatomy of the buccal mucosa, however, surgical excision of the crowns of buccally displaced canine frequently results in periodontal problems. An alternative technique is therefore presented; this involves the surgical exposure of the crowns of buccally displaced teeth to allow the attachment of a wire traction hook. The crown is then recovered. The traction hook provides a point of attachment, so that orthodontic forces may be applied to the unerupted tooth to guide its eruption. The preservation of the mucosal flap ensures a normal epithelial attachment develops on the buccal surface of the tooth, and the normal gingival anatomy of the buccal mucosa is maintained. The procedure may also be used in cases where upper incisors have been prevented from erupting because of the presence of supernumerary teeth. Even after surgical removal of the supernumerary teeth, the permanent incisors often fail to erupt. In such cases, the placement of traction hooks will enable the orthodontist to bring the unerupted teeth into their correct positions in the arch.

Torsion Deformities after Traction Treatment of Femoral Fractures in Children

The torsion of both femurs was investigated in 55 patients who had been treated 5-13 years earlier at the age of 1-16 years for femoral shaft fractures. By comparing the anteversion angle of the contralateral hips, determined by the Rippstein method, torsion deformities exceeding 10 degrees were found in the fractured femur of 10 patients. The maximum deformity found was + 27 degrees. None of the patients had complaints due to the torsion deformity. Deformities appeared more frequently in patients treated with adhesive overhead traction of the fractured leg than in patients treated with wire traction with the limb on an oblique frame. However, the difference was not highly significant (0.05 less than P less than 0.10). There was not correlation between age at the time of injury and torsion abnormalities and no correlation between the length of the observation period and the residual deformity, indicating growth correction. Examination of the rotational mobility of the hips was found to be a suitable screening test in the diagnosis of deformities exceeding 10 degrees. Radiological investigation of the anteversion angle of the femoral neck is necessary in the final assessment of a torsion deformity.

Evolution of treatment of paralytic scoliosis at Rancho Los Amigos Hospital

Between 1954 and 1970, 351 patients with severe paralytic scoliosis were treated at Rancho Los Amigos Hospital. During this time the treatment evolved through five stages: body cast alone, halo cast, halo cast with buttons and traction wires, Harrington instrumentation, and finally preoperative halo-femoral traction and Harrington instrumentation. Coincident with this evolution, correction improved from 20 to 57 per cent, the incidence of curve progression dropped from 38 to 0 per cent, and curve extension decreased from 25 to 0 per cent, while postoperative recumbency was reduced from one year to about three weeks. In addition, complications changed, in general decreasing except for the rate of pseudarthrosis, which remained essentially the same. Clinically significant hyperlordosis involving the thoracic and lumbar spine was seen in sixteen patients who had long fusions from the fourth cervical vertebra and above to the fourth lumbar vertebra or the sacrum.

Genu recurvatum: a late complication of tibial wire traction in fractures of the femur in children.

Seven cases of genu recurvatum following wire traction through the proximal end of the tibia in children treated for fractures of the femur are reported. A premature closure of the anterior part of the growth plate was most probably caused by too close a proximity of the wire to the tibial tuberosity. Where tibial wire traction is used in children it is advisable to insert the wire distal to the tuberosity.