Vertical Traction Research Articles

Design and Validation of a Novel Robotic Neck Brace for Cervical Traction.

Cervical traction is a common and effective treatment for degenerative disk diseases and pain in the cervical spine. However, the manual or mechanical methods of applying traction to the head-neck are limited due to variability in the applied forces and orientation of the head-neck relative to the shoulder during the procedure. Current robotic neck braces are not designed to provide independent rotation angles and independent vertical translation, or traction, to the brace end-effector connected to the head, making them unsuitable for traction application. This work proposes a novel architecture of a robotic neck brace, which can provide vertical traction to the head while keeping the head in a prescribed orientation, with flexion and lateral bending angles. In this paper, the kinematics of the end-effector attached to the head relative to a coordinate frame on the shoulders are described as well as the velocity kinematics and force control. The paper also describes benchtop experiments designed to validate the position control and the ability of the brace to provide a vertical traction force. It was shown that the maximum achievable end-effector orientations are 16° in flexion, 13.9° in extension, and ± 6.5° in lateral bending. The kinematic model of the active brace was validated using an independent motion capture system with a maximum root mean square error of 2.41°. In three different orientations of the end-effector, neutral, flexed, and laterally bent, the brace was able to provide a consistent upward traction force during intermittent force application. In these configurations, the force error has standard deviations of 0.55, 0.29, and 0.07N, respectively. This work validates the mechanism's ability to achieve a range of head orientations and provide consistent upward traction force in these orientations, making it a promising intervention tool in cases of cervical disk degeneration.

What Have We Learned in the Wrist Joint of Distal Radius Fracture through Wrist Arthroscopy?

Abstract Background Wrist arthroscopy is an efficient tool for the surgical treatment of distal radius fracture (DRF). It could show us the various conditions of the radiocarpal joint, its effectiveness seems to overwhelm that of fluoroscopy. Methods Since July 2005, we have performed wrist arthroscopy and plate presetting arthroscopic reduction technique (PART) for 141 extra-articular and 559 intra-articular DRFs and investigated various kinds of intra-articular conditions and advantages of wrist arthroscopy. Results The pathological conditions clarified and the advantages of PART in the surgical treatment of DRF are: (1) accurate reduction of intra-articular fragments is possible compared with fluoroscopic reduction, (2) intra-articular fragments (free body) undetected with radiograph and CT can be recognized, (3) screw protrusion into joint surface can be monitored, (4) intra-articular soft tissue injury associated with fracture can be evaluated and treated, and (5) debridement of joint hematoma can be performed. Severe complications such as tendon rupture, major neurovascular injury or compartment syndrome from arthroscopy were never encountered. Conclusions The volar locking plate fixation and simultaneous arthroscopic intervention is problematic because vertical traction must be applied and released during surgery. PART can overcome these difficulties and achieved good clinical results.

Use of a new vertical traction device for early traction-assisted staged closure of congenital abdominal wall defects: a prospective series of 16 patients

PurposeAbdominal wall closure in patients with giant omphalocele (GOC) and complicated gastroschisis (GS) remains to be a surgical challenge. To facilitate an early complete abdominal wall closure, we investigated the combination of a staged closure technique with continuous traction to the abdominal wall using a newly designed vertical traction device for newborns.MethodsFour tertiary pediatric surgery departments participated in the study between 04/2022 and 11/2023. In case primary organ reduction and abdominal wall closure were not amenable, patients underwent a traction-assisted abdominal wall closure applying fasciotens®Pediatric. Outcome parameters were time to closure, surgical complications, infections, and hernia formation.ResultsTen patients with GOC and 6 patients with GS were included. Complete fascial closure was achieved after a median time of 7 days (range 4–22) in GOC and 5 days (range 4–11) in GS. There were two cases of tear-outs of traction sutures and one skin suture line dehiscence after fascial closure. No surgical site infection or signs of abdominal compartment syndrome were seen. No ventral or umbilical hernia occurred after a median follow-up of 12 months (range 4–22).ConclusionTraction-assisted staged closure using fasciotens®Pediatric enabled an early tension-less fascial closure in GOC and GS in the newborn period.

INTRAOPERATIVE FASCIAL TRACTION FOR TREATMENT OF W2 AND W3 VENTRAL HERNIAS

Abstract Background Component separation techniques are increasingly employed in abdominal wall reconstruction surgery. The use of adjuvant techniques, such as intraoperative vertical dynamic fascial traction, enhances the compliance of the abdominal wall. This facilitates closure of the abdominal wall using less disruptive techniques without compromising effective treatment. Our aim is to retrospective review our results regarding the effectiveness and complication rate of intraoperative fascial traction for the treatment of complex ventral hernias. Method Conducted a retrospective analysis of 10 patients who underwent surgery using intraoperative fascial traction for W2 and W3 ventral hernias. Results Preoperatively, fascial distances measured ranged from 55 cm to 145 cm, with the majority of patients (70%) having a fascial distance greater than 10 cm. Most patients received other adjuvant treatments (nine cases with botulinum toxin injection and one with pre-operative progressive pneumoperitoneum). Posterior component techniques were employed in 40% of patients (half with W2 hernias and the other half with W3 hernias). The complication rate was 10%, with one case of hemorrhage requiring percutaneous embolization. During the average 6-month follow-up period (ranging from 1 to 17 months), one recurrence was observed. Conclusion Intraoperative fascial traction is a feasible and safe adjuvant technique for abdominal wall reconstruction. The use of adjuvants in complex abdominal wall hernia surgery may, in some patients, downstage the hernia, thereby avoiding the need for component separation techniques. This approach enables tension-free closure of the abdominal wall in a less invasive manner.

Vertical Mesh-Mediated Fascial Traction and Negative Pressure Wound Therapy: A Case Series of Nine Patients in General and Vascular Surgery.

Two patients in a vascular surgery unit and seven patients in an abdominal surgery unit with an OA were treated with VMMFT in combination with NPWT between September 2019 and June 2023. A DFC was achieved in seven of nine cases. The mean duration of OA was 9.6 ± 3.8 days, and fascial dehiscence at the beginning of OA was 14.2 ± 4.0 cm on average. Time to DFC after VMMFT was established was 6.2 ± 3.5 days (mean). No method-related complications occurred. The standardized combination of VMMFT and NPWT gave positive results in achieving DFC in our heterogenic patient group. Following a strict treatment pathway as shown here seems to improve OA outcome. It represents a promising further development of mesh-mediated fascial traction for OA treatment.

Assessment of myofascial medialization following intraoperative fascial traction (IFT) in a cadaveric model

PurposeIntraoperative fascial traction (IFT) for the treatment of large ventral hernias and loss of domain (LOD) hernias is a promising tool in abdominal wall surgery. However, little is known about the extent of gain in myofascial advancement especially for the anterior rectus sheath. We, therefore, used a cadaveric model to determine the medialization during IFT.Methods4 fresh frozen specimens were used. Retromuscular preparation was carried out followed by IFT with diagonal vertical traction for 30 min. Medial advancement of the anterior rectus sheath was measured after 15 and 30 min as well as traction forces.ResultsTotal medialization for anterior rectus sheath after 30 min of IFT was 10.5 cm (mean). The mean traction force was 16.28 kg. Total medialization was significantly higher during the first 15 min of vertical fascial traction (p < 0.05).ConclusionsIFT provides significant medialization for the anterior rectus sheath in the cadaveric model. The findings align with results from a retrospective case study. Therefore, we see IFT as a beneficial tool in abdominal wall surgery.

CICATRICIAL ECTROPION REPAIR DUE TO TRAUMA : A CASE REPORT

Introduction : Cicatricial ectropion is a complication that can occur after trauma. Scar tissue formation causes anterior lamellae shortening (skin and orbicularis muscle), resulting in outward lid margins rotation.&#x0D; Case Illustration : A 16 y.o male patient came with complaints of the left upper and lower eyelids folding outwards since 3 months ago after trauma, watery eye. Examination VOD 20/20, VOS 20/50. Scar on the superior and inferior lids, the inferior lid margin is folded out, inferior tarsal conjunctiva is visible, lagophthalmus 4 mm, fissure palpebral vertical (FPV) 12 mm, margin reflex distance (MRD) 1 = 4 mm, MRD2 = 8 mm, fissure palpebral horizontal (FPH) 30 mm, conjunctival injection. Corneal (macular) scars central-peripherally at 3-6 o'clock. Patient was diagnosed with cicatrical ectropion with left eye corneal scar and ectropion repair was performed with full-thickness skin graft from retroarticular. One week and six weeks after surgery, FPV improved to 10 mm, MRD1 = 4, MRD2 = 6 mm, FPH 30 mm, and lagophthalmos 2 mm became 1 mm.&#x0D; Discussion : Cicatricial ectropion is usually treated in 3 procedures: release vertical scar traction, horizontal lid tightening, repair anterior lamella can be done with full-thickness skin graft. horizontal lid tightening in this case not carried out because of no laxity.&#x0D; Conclusion : Scar traction release and repair anterior lamella with full-thickness skin graft from retroauricular was choice in this case because extensive defect and ectropion grade 3. After surgery anatomical structure of the lids and looks better aesthetically.

Evaluating a novel vertical traction device for early closure in open abdomen management: a consecutive case series.

In emergency surgery, managing abdominal sepsis and critically ill patients with imminent abdominal compartment syndrome (ACS) using an open abdomen (OA) approach has become standard practice for damage control. To prevent significant complications associated with OA therapy, such as abdominal infections, entero-atmospheric fistula (EAF), and abdominal wall hernia formation, early definitive fascial closure (DFC) is crucial. This study aims to assess the feasibility of a novel device designed to facilitate early fascial closure in patients with an open abdomen. Between 2019 and 2020, nine patients undergoing open abdomen management were enrolled in this study. All patients were treated using vertical mesh-mediated fascial traction combined with a novel vertical traction device (VTD). Data from these cases were collected and retrospectively analyzed. In this study, all patients were treated with OA due to impending ACS. Three patients died before achieving DFC, while the remaining six patients successfully underwent DFC. The mean number of surgical procedures after OA was 3 ± 1, and the mean time to DFC was 9 ± 3 days. The use of the VTD in combination with negative pressure wound therapy (NPWT) resulted in a 76% reduction in fascia-to-fascia distance until DFC was achieved. The application of the VTD did not affect ventilation parameters or the Simplified Acute Physiology Score II (SAPS II), but intra-abdominal pressure (IAP) was reduced from 31 ± 8 mmHg prior to OA to 8.5 ± 2 mmHg after applying the device. The primary complication associated with the device was skin irritation, with three patients developing skin blisters as the most severe manifestation. Overall, the novel VTD appears to be a safe and feasible option for managing OA cases. It may reduce complications associated with OA by promoting early definitive fascial closure.

Evaluation of Foveal Cone and Müller Cells in Epiretinal Membrane using Adaptive Optics OCT

To investigate cellular-level morphological alterations in the retinal neuroglia in eyes with epiretinal membrane (ERM). Prospective cross-sectional, observational study (November 2020-May 2022). We included 41 eyes with unilateral idiopathic ERM and 33 healthy eyes of healthy volunteers. We examined the foveal microstructures in all eyes using adaptive optics OCT (AO-OCT) with axial and lateral resolutions of 3.4 and 3.0 μm, respectively. Adaptive optics OCT images were acquired for a 2.5° (728μm) area at the foveal center. Foveal microstructures on AO-OCT images, best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution units, and associations between these parameters. Adaptive optics OCT imaging of healthy eyes and eyes with ERM revealed sharp hyperreflective lines of the external limiting membrane (ELM), accompanied by hyporeflective gaps, individual nuclei of the foveal cone photoreceptors, and Müller cell bodies. The arrangement of Müller cell bodies was more vertical in eyes with ERM than in normal eyes. Epiretinal membranes adhered to foveal Müller cells via the internal limiting membrane (ILM), exerting vertical traction that pulled the foveal cones anteriorly. Adaptive optics OCT also enabled visualization of outer segment (OS) discs. Hyperreflective changes in the OS discs were observed beneath the vertically thickened ellipsoid zone (EZ) in 15 eyes (36.6%) with ERM. For eyes with ERM, multiple regression analysis showed that the length from ILM to the inner border of the outer nuclear layer and the EZ thickness were significantly associated with BCVA (β=5.3×10-4 and 82.7×10-4, respectively), with associated 95% confidence intervals of 1.3×10-4 to 9.3×10-4 (P=0.011) and 39.0×10-4 to 126.5×10-4 (P<0.001), respectively. The EZ thickness was significantly and positively associated with the length from ELM to the retinal pigment epithelium (β=23.9×10-2, 95% confidence interval: 4.8×10-2 to 42.9×10-2; P=0.015). Cellular imaging of retinal neuroglia by AO-OCT may suggest possible mechanisms associated with visual impairment in patients with ERM, which could potentially contribute to the growing body of knowledge on its pathophysiology. However, these insights require further validation through extensive studies to fully ascertain their significance. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Post-Activation Performance Enhancement in Pull-Up Exercise with Elastic Resistance Training in Tac-tical Personnel

The Pull-up (PU) is a multi-joint upper body exercise that is included in the physical fitness assessments for tactical occupations such as police, firefighters, and military personnel. This study aimed to evaluate the post-activation performance enhancement (PAPE) in the PU exercise using elastic resistance training (ERT) and traditional resistance training (RT). A total of 18 resistance-trained male firefighters (28.3 [5.6] years; 178.1 [6.8] cm; 78.1 [8.2] kilograms; 24.6 [2.4] kg·m-2) participated in the study and performed four PAPE protocols in a cross-over fashion. Two protocols consisted of three sets of 3 repetitions at 75 and 85% of the maximum repetition (RM) in the lat pull down (LPD-M and LPD-H, respectively). The other two protocols consisted of three sets of 3 repetitions using elastic bands for vertical traction (VTEB) at “moderate” (VTEB- M) and “hard” intensity (VTEB-H), based on the Thera Band perceived exertion scale. Repetitions until failure in the PU exercise were measured before and after the application of the four protocols, with an 8-minute pause before and after the PAPE. Results showed a significant increase on repetitions until exhaustion after all PAPE protocols: LPD-M (P=0.007, d=0.19), LPD-H (P=0.023, d=0.17), VTEB-M (P=0.01, d=0.13) and VTEB-H (P=0.001, d=0.28). The use of ERT and traditional RT at moderate and high intensities represent a proper stimulus for the generation of PAPE in the PU. Keywords: Physical performance, conditioning activity, warm-up exercise, muscle power

Failure envelope considering the ultimate tensile capacity of suction caissons in sand

Little analytical work has been done to elucidate the ultimate capacity of suction caissons under vertical tensile (V), lateral (H), and moment (M) loads in soils. In this paper, in order to reveal the effect of vertical tensile, lateral, and moment loads on the ultimate capacity of suction caissons in sand, an analytical investigation was made using a traditional bearing capacity theory. Taking account of the vertical equilibrium of an annular element of a skirt, through the vertical tractions inside and outside the skirt of a suction caisson when a vertical tensile load is applied, the vertical displacement of the soils adjacent to the skirt of the suction caisson was presented. The most appropriate bearing capacity equation for predicting the experimental results was shown for suction caissons having an embedment larger than a diameter in sand. For the deformation-load responses of suction caissons with various embedment ratios in sand, subjected to inclined tensile loads, there was a good agreement between the results obtained from laboratory tests and those predicted by the present method. The failure surfaces, considering the ultimate tensile capacity in the H-M, H-V, and M−V planes, and in the H-M−V space, for suction caissons in sand, were presented.

Review of closed reduction techniques for femoral neck fracture

For patients with femoral neck fractures who plan to undergo internal fixation, satisfied alignment of fracture ends is an important prerequisite for internal fixation stability and fracture healing. There are many reports on the reduction methods of displaced femoral neck fractures, which can be summarized into three categories:First, the solely longitudinal traction of lower limbs, supplemented by other manipulations such as rotation and compression; Second, the resultant force formed by the longitudinal traction of lower limbs and the lateral traction;the third is accomplished by vertical traction in the axis of femur with hip joint flexed. Each reduction method has its own advantages, but no single method can be applied to all fracture displacement. In this paper, some classical reduction techniques in the literatures are briefly reviewed. It is hoped that clinicians will not be limited to a certain reduction method, they should analyze the injury mechanism and fracture displacement process according to the morphology features and flexibly select targeted reduction methods to improve the success rate of closed reduction of femoral neck fracture.

Impact of Traction Direction in Traction-Assisted Gastric Endoscopic Submucosal Dissection (with Videos)

BackgroundThe impact of traction direction in traction-assisted gastric endoscopic submucosal dissection (ESD) has not been adequately investigated. A clip with line (CWL) is a classical single-directional traction device. In contrast, a spring and loop with clip (SLC; S–O clip) is a newly developed multidirectional traction device.AimsTo investigate the impact of traction direction in gastric ESD by comparing the procedure-related outcomes of CWL-assisted ESD (CWL-ESD) and SLC-assisted ESD (SLC-ESD).MethodsWe retrospectively examined 140 patients with superficial gastric neoplasms who underwent SLC-ESD or CWL-ESD by a single ESD expert during November 2017–September 2020. The traction direction was classified based on the endoscopic finding in the following five categories: proximal, diagonally proximal, vertical, diagonally distal, and distal. In SLC-ESD, we set vertical traction, using the multidirectional traction function. Propensity score matching was conducted to compensate for the differences in lesion size, injection function of electrosurgical knife, ulcerative lesion, lesion location, and lesion position. The primary outcome was gastric ESD procedure time.ResultsPropensity score matching created 42 pairs. The median gastric ESD procedure time in the SLC-ESD group was significantly shorter than that in the CWL-ESD group (28.3 min vs. 51.0 min, P = 0.022). All traction direction in the SLC-ESD group was vertical, while only 16.7% in the CWL-ESD group. En bloc resection was attained without perforation in all the patients in both groups.ConclusionOur findings suggest that SLC can provide vertical traction, which reduces the gastric ESD procedure time.Graphical Multidirectional traction devices can provide vertical traction in most cases of gastric ESD, unlike single-directional traction devices. Vertical traction may reduce the gastric ESD procedure time.

Innovative seated vertical lumbar traction allows simultaneous computer work while inducing spinal height changes similar to supine lying.

Lumbar intervertebral disc height loss has been associated with spinal height change (SHC) and low back pain (LBP), including stenosis. Non-invasive methods to improve disc height loss require forms of lying down, which are unconducive to computer work. Intermittent vertical traction (VT) integrated with seated computer work may provide ergonomic alternatives for increasing SHC to promote LBP relief. The primary aim was to develop and introduce a safe VT prototype and dosage to induce and measure SHC. Prototype comfort and LBP ratings were exploratory secondary aims. Forty-one participants were stadiometry-measured for pre- and post-intervention SHC from seated VT at 35% body weight removed, supine lying (SL), and sitting at a computer (SIT) without VT. Pain ratings were recorded for those self-reporting LBP. VT prototype evaluations were compiled from a 3-question, 7-point Likert-style survey. SHC increased by 3.9 ± 3.4 mm in VT, 1.7 ± 3.4 mm in SIT, and 4.3 ± 3.1 mm in SL (P< 0.000). Post hoc findings were significant between VT and SIT (P< 0.000), and SL and SIT (P< 0.000). VT and SL LBP ratings both decreased, but not SIT. Intermittent seated VT is a promising alternative for postural relief during seated computer work, producing SHC similar to lying down without compromising workflow.

Vertical load distribution strategy of amphibious wheel-track vehicle using neural network and particle swarm optimization

Amphibious wheel-track vehicle (AWTV) can change the vertical load of the wheels and the tracks through the active hydro-pneumatic suspension system, which shows significant advantages in terms of maneuverability and road passing ability. However, AWTV is a strong nonlinear system. The irregularity of the road, and coupling characteristics between the vertical load of the wheel-tracks and the terrain will greatly affect the tractive efficiency of the whole vehicle. Therefore, how to effectively distribute the vertical load between the wheel and the track to improve the tractive efficiency of the whole vehicle is still a huge challenge. To address the above problems, based on the neural network (NN) and particle swarm optimization (PSO) algorithm, vertical load distribution strategy of the AWTV is proposed to improve its traction efficiency under different driving road in this paper. Firstly, the coupling dynamics model of AWTV with road and hydraulic system dynamics model of active suspension is established; Secondly, the wheel-track terrain model is built in EDEM-Recurdyn to collect data of vertical load and traction efficiency under the different soils and speeds, and the coupling function is obtained through NN; Then, the optimal vertical load of each axle is optimized through PSO; Finally, the feasibility and effectiveness of the strategy are verified by the simulation analysis under different road conditions and distribution strategies. The simulation and test results demonstrate that the proposed vertical load distribution strategy based on NN-PSO can effectively improve the traction performance of the AWTV in complex terrain environment, and have relatively superior control characteristics.

Three-dimensional finite element analysis of upper anterior teeth retraction and intrusion using clear aligners and mini-implants.

This study aimed to investigate the differences in treatment outcomes of upper anterior teeth retraction and intrusion with clear aligners and different types of elastics on mini-implants via the 3D finite element method. Cone-beam computed tomography (CBCT) was conducted to construct a 3D finite element model of maxillary bone, dentition, and clear aligners using Mimics, Geomagic, Solidworks, and Ansys. Four model groups were developed. Group 1 was the control group. Group 2 implanted a mini-implant between the upper second premolar and the upper first molar with a force of 0.98 N applied to the canine cut along the retracting direction for each side. Group 3 was based on Group 2, which implanted an additional mini-implant between the upper central incisors with a force of 0.98 N applied to the upper anterior teeth cuts. Group 4 was also based on Group 2, which implanted 2 additional mini-implants between the upper central and lateral incisors with a force of 0.56 N applied to the upper anterior teeth cuts for both sides. Anterior teeth torque changes, displacement patterns, and stress distributions were analyzed. Among all the experimental groups, the anterior teeth demonstrated intrusion and distal inclination, accompanied with varied degrees of torque loss. In Group 3, the maxillary and lateral incisors had the smallest sagittal coronal displacement. In Group 4, the intrusion values of the maxillary and lateral incisors were the largest among all the experimental groups. The maximum stress concentration in Group 2 was the most significant among all the experimental groups. Implanting the mini-implant between the central incisors for traction is conducive to torque control. By contrast, implanting the mini-implants between the central incisors and lateral incisors combined with vertical traction is conducive to simple intrusion, avoiding the "bowing effect" to a certain extent.

Оптимізація методики хірургічної корекції прихованого статевого члена в дітей

The purpose - to optimize the buried penis surgical treatment method in children for the most adequate functional and cosmetic results. Materials and methods. The clinical material includes 28 boys with a buried penis between the ages of 11 months to 7 years. Among them 9 (32.14%) children were admitted for repeated surgical interventions with unsatisfactory cosmetic results after previous surgical interventions in other medical institutions. Results. The method of surgical correction of the buried penis in children was offered. In patients whose penis glans could not be exposed, the foreskin stenotic ring was dissected on both sides on the lateral surfaces, or scar-altered tissues were partially excised circularly. During the maximum vertical traction per the ligature on the penis head, the skin at the base of the penis was circularly dissected. The dissection of the skin was extended to the inguinal folds on both sides. The penis spongy and cavernous bodies were skeletonized from the coronal sulcus to the pubic joint with careful excision of inelastic embryonic cords and scars. The skin of the anterior abdominal wall was lifted up with the help of traction ligatures or hooks and mobilized in an acute way. Maximum excision of subcutaneous fat in the suprapubic and inguinal areas was performed. The penis was moved into the hole formed in the lower part of the demobilized skin flap in the suprapubic area. For stable fixation of the penis, the deep fascia at the base of the corpora cavernosa was sutured to the pubic tubercle at maximum traction per the head, and the skin flap of the anterior abdominal wall was sutured with internal sutures to the crest of the upper pubic bone. The penis trunk was closed due to a sufficiently mobile foreskin, shifting the skin to the penoscrotal angle in the area of the formed hole in the abdomen skin flap. The postoperative wound was sutured in layers. Conclusions. Clinical differentiation of different types for penis size «visual» reduction in boys will allow a balanced approach to adequate correction of the defect. The proposed method of buried penis surgical correction in boys eliminates all the preconditions of the defect and demonstrates good anatomical, functional and cosmetic results. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committee of the listed institution. Informed consent of children and their parents was obtained for the research. No conflict of interests was declared by the authors.

Results after skin traction for femur shaft fractures in children below the age of four years

PurposeNonsurgical management has been identified as the treatment of choice for femoral shaft fractures in children below four years of age. For various reasons, the surgical approach has become increasingly popular in recent years. The aim of this study is to report results after vertical skin traction and analyze the benefits of this technique as well as to point out advantages compared with surgery in this age group.MethodsThe authors performed a retrospective data analysis, including all patients with femoral shaft fractures below the age of four who were treated with vertical skin traction at our institution between January 2006 and December 2016.ResultsSkin traction for a femoral shaft fracture was performed for 36 patients (mean age 1.6 years; 1 day–3.5 years). The mean duration of traction was 18.5 days (14–30). Complications included soft tissue affections (n = 5), which all healed spontaneously. Consolidation was observed in all fractures. Initial axial deviations and shortening did not change during traction until consolidation (p > 0.05), and no relevant torsion deformity occurred (p = 0.01). Patients gained full weight-bearing within 12.3 days (7–40) following end of traction. At the final follow-up, after a mean of 29.3 months (12–192), leg-length discrepancy (mean 7.1 mm; 5–20) was found on radiograms in nine cases, and axial deviations (mean 7.7°; 5–25) were documented in seven cases. None of the patients had limitations in daily activities or sports.ConclusionSkin traction is a technically easy, safe, and non-invasive treatment modality for femoral shaft fractures in children below the age of four years. Strong results are obtained benefited from a high potential of growth-related correction, and in principle no anesthesia is needed. A prolonged hospitalization and socio-economic factors maintain the ongoing debate in comparison with the surgical approach.Level of evidenceLevel III, retrospective.

Vertical traction device prevents abdominal wall retraction and facilitates early primary fascial closure of septic and non-septic open abdomen

PurposeOne of the major challenges in the management of patients with septic and non-septic open abdomen (OA) is to control abdominal wall retraction. The aim of this study was to evaluate the impact of a novel vertical traction device (VTD) on primary fascial closure (PFC) and prevention of fascial retraction.MethodsTwenty patients treated with OA were included in this retrospective multicenter study. All patients were initially stabilized with laparostomy and the abdomen temporarily sealed either with a Bogotá bag or a negative pressure wound therapy system (NPWT).ResultsThe mean duration of OA and fascia-to-fascia distance (FTF) prior to the VTD application were 3 days and 15 cm, respectively. At relook laparotomy 48 h after VTD implementation, the mean FTF distance significantly decreased to 10 cm (p = 0.0081). In all cases, PFC was achieved after a mean period of 7 days. Twelve patients received the VTD in combination with a NPWT, whereas in eight patients, the device was combined with an alternative temporary abdominal closure system (TAC). Although not statistically significant, the FTF distance remarkably decreased in both groups at relook laparotomy 48 h following the device implementation. The mean periods of PFC for patients with septic and non-septic OA were comparable (7.5 vs. 7 days). During follow-up, two patients developed an incisional hernia.ConclusionVertical traction device prevents fascial retraction and facilitates early PFC in OA. In combination with NPWT, rapid fascial closure of large abdominal defects can be achieved.

Evaluation of the effects of three different tracheotomy techniques on tracheal complications and decannulation

ObjectiveCompared to adults, pediatric tracheotomy is associated with a higher incidence of complications. Various surgical techniques have been described to minimize complications.The aim of this study is to investigate the effects of three different tracheotomy techniques on tracheal complications and decannulation. MethodsPediatric patients who underwent tracheotomy at Hacettepe University Department of Otorhinolaryngology were retrospectively analyzed. 62 patients were included in the study. Tracheotomy related complications and direct laryngoscopy images of all patients were examined in the postoperative period. The patients were divided into 3 groups according to the tracheotomy technique; vertical incision traction suture (VITS) technique (n: 24), vertical incision maturation suture (VIMS) technique (n: 19), inferior based flap (Björk) technique (BT) (n: 19). ResultsThe rate of severe suprastomal pathology was detected as 29.2% in the VITS group, 15.8% in the VIMS group and 26.3% in the BT group (p = 0.656). The accidental decannulation rate was detected as 20.8% in the VİTS group, 26.3% in the VİMS group and 10.5% BT group (p = 0.442). The rate of life-threatening occurrence until recannulated was detected as 60% in the VİTS group, 20% in the VİMS group and 0% in the BT group (p = 0.394). The rate of tracheocutaneous fistula was detected as 13.3% in the VİTS group, 40% in the VİMS group and 33.3% in the BT group (p= 0.337). ConclusionsThere were no differences in complication rates based on techniques, and that stomal complications were common in small children requiring tracheotomies.