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The optimal management of odontoid fractures in the elderly population is unclear and management of this group of patients is complicated by multiple co-morbidities. This study aimed to determine the outcomes after conservative management strategies were applied in this patient group.We carried out retrospective and prospective analyses of all patients with axial cervical spine injuries, at a single centre. We included patients aged over 60 years with type II and III odontoid fractures. Information was gathered on demographics, ASA grading-associated injuries and complications. The outcome measures were rates and type of union, pain and neurological functions, specifically ambulation.Fifty-seven adult patients with a median age of 78 years (range 60-92 years) were included. There were 42 type II and 15 type III odontoid fractures. Three patients required surgical fixation due to displaced fractures, which could not be reduced with manual traction. Twenty-four (41%) patients were managed with a rigid pinned halo orthosis to obtain adequate reduction and immobilisation. The remaining 30 (53%) were managed in a hard cervical collar. Patients managed with a halo were significantly younger and had more associated injuries than patients managed in a collar (age: t-test=4.05, p0.01, associated injuries: Chi-square=4.38, p0.05). At a mean follow-up of 25 weeks, 87% of type II and 100% of type III fractures had achieved bony union or stable, fibrous non-union. There were no statistical differences in fracture type, follow-up or neurological outcomes between the halo and collar groups. However, overall more patients managed in a collar developed stable fibrous non-union than bony fusion (Fisher's exact test, p0.05), although this was not significant when analysed by each fracture type individually. A regression model was constructed and identified fracture type as the only independent predictor of time to union, with type III fractures healing faster than type II.High rates of bony union and stable fibrous non-union with a good functional outcome can be achieved in the elderly population sustaining type II or III odontoid fractures, when managed non-surgically. Halo orthosis may not offer any clear advantage over hard collar in this group. Close follow-up is needed for late complications and there must be a willingness to perform surgery if conservative measures fail.

The purpose of this study was to determine if experienced physical therapists could consistently apply submaximal cervical manual traction force over repeated trials. Subjects were 21 physical therapists with a x age = 35.0 +/−6.7 years; x height = 174.5 +/− 8.4 cm; x weight = 74.8 +/− 13.9kg. Subjects had a x of 11.1 +/− 7.7 years of experience. A mannequin head was attached via a 0.635 cm steel cable to a tension dynamometer which records the maximum force applied. Each subject applied an initial traction force in the range of 4.5 – 13.5 kg (10–30 lbs). This was held for ten seconds and then the subject relaxed. The dynamometer was reset at zero and the subject attempted to reapply that initial level of traction force. This was repeated for three trials. Data were analyzed with a Pearson product moment correlation (r) followed by a coefficient of determination (r2) for reliability. Results for each of the three trials were r = 0.910 for trial one; 0.952 for trial two; and 0.967 for trial three. ...

Summary. The proper utilization and safety of rapidly developing celioscopic instrumentation remains uncertain. A porcine model was developed for testing two different types of mechanical, intra-abdominal retraction devices. One instrument was inflatable, forming a broad compliant interface for tissue retraction. The second device consisted of three rubber-shod metal arms which formed a rigid, noncontiguous sweep. Each intra-abdominal device was placed with identical manual traction upon the spleen, ileum and liver in sequential fashion with pressure maintained for 10 min. Photographic documentation of the gross effects of retraction was obtained along with histological sectioning of each portion of the involved viscera with controls. The retraction devices produced small contusions with punctate, petechial haemorrhages within the tissue, with the tips of each capable of tissue laceration. On each organ, the balloon retraction device produced the least amount of gross and histological damage, demonstrating iatrogenic injury directly attributable to device design.

Fifty patients with lumbago-sciatica due to a proven herniated intervertebral lumbar disc were randomised between two treatment groups: manual traction and careful isometric exercises. Treatment was given daily over a period of 5-7 days. A blind overall assessment subsequent to treatment showed that in both groups approximately 40% of the patients had improved, corresponding to that which could be expected from placebo. The effect of both manual traction and isometric exercises is doubtful in patients with lumbago-sciatica and herniated lumbar discs. In further research, discriminant analysis is recommended to elucidate what characterises responders and non-responders to lumbar traction.