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Purpose During transvenous lead extraction (TLE), the femoral snare has mainly been used as a bail-out procedure. The purpose of the present study is to evaluate the efficacy and safety of a TLE approach with a low threshold to use a combined superior and femoral approach. Methods This is a single-center observational study including all TLE procedures between 2012 till 2019. Results A total of 264 procedures (median age 63 (51–71) years, 67.0% male) were performed in the study period. The main indications for TLE were lead malfunction (67.0%), isolated pocket infection (17.0%) and systemic infection (11.7%). The median dwelling time of the oldest targeted lead was 6.8 (4.0–9.7) years. The techniques used to perform the procedure were the use of a femoral snare only (30%), combined rotational powered sheath and femoral snare (25%), manual traction only (20%), rotational powered sheath only (17%) and locking stylet only (8%). The complete and clinical procedural success rate was 90.2% and 97.7%, respectively, and complete lead removal rate was 94.1% of all targeted leads. The major and minor procedure-related complication rates were 1.1% and 10.2%, respectively. There was one case (0.4%) of emergent sternotomy for management of cardiac avulsion. Furthermore, there were 5 in-hospital non-procedure-related deaths (1.9%), of whom 4 were related to septic shock due to a Staphylococcus aureus endocarditis after an uncomplicated TLE with complete removal of all leads. Conclusion An effective and safe TLE procedure can be achieved by using the synergy between a superior and femoral approach.

The purpose of this study was to propose a new traction device, a multiplanar fracture reducer (MFR), for the treatment of tibial shaft fractures with intramedullary nails (IMN). The efficiencies of the multiplanar fracture reducer and manual traction (MT) in the treatment of tibial shaft fractures with IMN were compared. From January 2019 to January 2020, a total of 79 patients were enrolled in this study, among whom 38 were treated with MFR while 41 were treated with MT. Their demographics and fracture characteristics, surgical data, and prognostic data between the two groups were compared. The mean number of intra-operative fluoroscopies in the MFR group was less than that in the MT group (19.4 vs 21.2, p

The purpose of this prospective study was to compare the double reverse traction repositor (DRTR) and manual traction in retrograde intramedullary nailing (RE-IMN) for femoral shaft fractures. Seventy-seven patients with femur shaft fractures were randomized to undergo surgery with either DRTR or manual traction (MT) to facilitate RE-IMN between January 2018 and January 2019. Demographics, fracture characteristics, surgical data, post-operative complications, and functional outcomes were assessed. Data from 72 patients completing the final follow-up (12 months) were analysed in this study. The average number of intra-operative perspectives in the DRTR group was 27.7, which was significantly reduced compared with that in the MT group (31.3, p < 0.001). Fewer assistants were required in the DRTR group compared with the MT group (1.1 vs 1.9, p < 0.001). Fewer patients with open reduction were discovered in the DRTR group compared with the MT group (2.8 vs 19.4, p=0.024). Demographics, fracture characteristics, other surgical data, and prognostic parameters were comparative between the two groups. The DRTR can be effectively and safely used to treat femur shaft fractures with RE-IMN. The DRTR achieves similar results as MT and is also superior to MT in terms of intra-operative perspectives, the number of assistants, and the open reduction rate.

The objective of surgery for acetabular fractures is to achieve precise reduction to restore joint congruence, fix internal bone fragments, avoid displacement of the fracture and allow rapid rehabilitation. Open reduction and internal fixation is the benchmark method for displaced acetabular fractures, but open reductions can increase morbidity, causing neurovascular injury, blood loss, heterotopic bone formation, infection and poor wound healing. An anatomical reduction with a gap of 2 mm or less is a predictor of good joint function and reduced risk of post-traumatic osteoarthritis. The percutaneous approach is associated with fewer complications than open techniques, but acetabular geometry makes percutaneous screw insertion a challenging procedure. The percutaneous technique is recommended for non-displaced or slightly displaced fractures, and in obese, osteoporotic and elderly patients who cannot receive total joint arthroplasty. We recommend the use of intramedullary cannulated screws. Fracture reductions are achieved by manual traction of the affected bones. If some fracture displacement remains, accessory windows can be used to introduce a ball spike pusher, a hook or a Steinmann pin which can be used as a joystick to rotate the fracture. In this paper, we describe the accessory windows for the anterior column, the quadrilateral plate and the posterior column. We detail the position, direction and kind of screws used to stabilize the anterior and posterior columns. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170054

There are no established methods for subcutaneous implantable cardioverter-defibrillator (S-ICD) extraction other than simple manual traction for devices with short dwell time. However, as more chronic indwelling S-ICDs need removal for various reasons, understanding the S-ICD lead design and methods for its removal are essential. A case of a chronic indwelling S-ICD extraction is described, and a technique utilizing a modified mechanical polypropylene sheath to safely remove the lead is outlined in detail.

Caudal septal deviation leads to unfavorable esthetic as well as functional effects on the nasal airway. A modification to the tongue-in-groove (TIG) technique to correct these caudal septal deformities is described. With placement of a temporary suspension suture to the caudal septum, manual traction is applied, assuring that the caudal septum remains in the midline position while it is being secured with multiple through-and-through, trans-columellar and trans-septal sutures. From 2003 to 2016, 148 patients underwent endonasal septoplasty using this modified technique, with excellent functional and cosmetic outcomes and a revision rate of 1.4%. This modified TIG technique replaces the periosteal suture that secures the caudal septum to the midline nasal crest in the original TIG technique. This simplifies the procedure and minimizes the risk of securing the caudal septum off-midline when used in endonasal septoplasty.

In general, the removal of peripherally inserted central venous catheters (PICC) in neonates by gentle traction is easy. In our case, the removal of a 28G PICC in a term neonate was impossible by manual traction even with force. Previously described non-invasive interventions using a stylet were not successful because it was not possible to pass the stylet along the catheter hub of the narrow 28G PICC. In the end, the catheter could be removed non-operatively by cutting the catheter just distal to the hub and inserting a stylet of a new PICC (same brand and size) into the patients' retained catheter. Subsequently, the force of manual traction on the catheter could be increased without increased risk of catheter stretching and breakage. After catheter removal, the surface of the remaining PICC was intact.Conclusion: By thinking outside the box, surgical intervention was prevented in this neonate. What is Known: • On general, peripherally inserted central venous catheters (PICC) can be removed easily by gentle traction. • There are no clear recommendations about what to do if standard interventions fail to remove a PICC. What is New: • Our technique is a non-invasive option for difficult PICC removal and can prevent surgery. • The retained PICC is cut distal to the hub, and after stylet reinsertion, sustained manual traction is performed.

[Purpose] The purpose of this study was to examine the effect of manual spinal traction therapy on the pain and Oswestry disability index of patients with chronic back pain. [Participants and Methods] In this study, 30 patients with chronic back pain were evenly divided into an experimental group 1, who received manual traction therapy, and an experimental group 2, who received intermittent traction therapy. Both groups received therapy three times a week for eight weeks. A visual analogue scale was used to measure participants' back pain, and the Oswestry disability index was used to check the functional impediment they experienced as a result. [Results] In a within-group comparison, visual analogue scale and Oswestry disability index significantly decreased in both the experimental 1 and experimental 2. In a between-group comparison after treatment, there was a significantly greater decrease in visual analogue scale and Oswestry disability index in the experimental group 1 compared to the experimental 2. [Conclusion] The manual spinal traction therapy was an effective intervention scheme for the treatment of pain and disorder in patients with chronic back pain.

Introduction: Indications for cardiac devices have been increasing as well as the need for lead extractions as a result of infections, failed leads and device recalls. Powered laser sheaths, with a global trend towards the in-creasingly technological tools, meant to improve the procedure’s outcome but have economic implications. Objective: The aim of this study is to demonstrate the experience of a Bra-zilian center that uses simple manual traction in most lead removals per-formed annually, questioning the real need for expensive and technically challenging new devices. Methods: This retrospective observational study included 35 patients who had a transvenous lead extraction in the period of a year between January 1998 and October 2014 at Hospital de Messejana Dr. Carlos Alberto Studart Gomes, in Fortaleza, CE, Brazil. Data were collected through a records review. They were evaluated based on age, type of device, dwelling time, indication for removal, technique used and immediate outcomes. Results: The median dwelling time of the devices was 46.22 months. Infec-tion, lead fracture and device malfunction were the most common indica-tions. Simple traction was the method of choice, used in 88.9% of the pro-cedures. Manual traction presented high success rates, resulting in com-plete removal without complications in 90% of the cases. Conclusion: This article suggests that lead extraction by simple manual traction can still be performed effectively in countries with economic diffi-culties as a first attempt, leaving auxiliary tools for a second attempt in case of failure or contraindications to the simple manual traction technique.

The present study aimed to investigate the success rate, methods and associated complications of left ventricular lead (LVL) extraction and venous pathway reimplantation in patients with cardiac resynchronization therapy device/defibrillator (CRT/CRTD). A retrospective analysis was performed in the patients who underwent CRT/CRTD extraction and reimplantation at our hospital from January 2012 to October 2018. The methods, patient complications and success rate of extraction and reimplantation of LVL were analyzed. A total of 54 patients underwent CRT/CRTD removal (pacemaker infection, n=51; LVL dysfunction, n=3; CRT/CRTD, 34/20). A total of 54 LVLs were removed (3 active electrodes and 51 passive electrodes). The average implantation duration of the LVL was 53.5 months (range, 1-204 months), whereas the success rate of the LVL extraction was 100% (94% completely removed and 6% clinically removed. A total of 6 patients (11%) were treated only by manual traction, whereas the remaining patients had their LVL successfully removed using extraction tools. In the peri-operative period, one fatality occurred (2%). The highest complication rate of the lead extraction was 2% and no minor complications were observed. A total of 36 patients were reimplanted on the right side, which was successful in 31 cases (success rate, 86.1%), whereas 3 cases were successfully reimplanted on the left side. The total success rate of LVL reimplantation was 87.2%. The procedure of the LVL removal and reimplantation exhibited a high success rate and a lower incidence of complications compared with that in patients with cardiac devices.

To assess the outcomes of a modified extensor pollicis longus (EPL) rerouting technique for boutonniere deformity of the thumb in patients with rheumatoid arthritis.A total of 21 thumbs in 18 patients with a mean age of 63 years were retrospectively analyzed after an average follow-up period of 3.2 years. The preoperative deformities were classified as either mild (5 thumbs) or moderate (16 thumbs). After either metacarpophalangeal (MCP) joint synovectomy or implant arthroplasty, the ulnarly dislocated EPL tendon was reduced dorsally and sutured to the dorsal base of the proximal phalanx. If the interphalangeal (IP) joint extended with manual traction on the proximal portion of the extensor pollicis brevis tendon, no further treatment was considered. If the IP joint did not extend with this maneuver, the insertion of the extensor pollicis brevis tendon was dissected and transferred to the distal portion of the EPL tendon.The average MCP joint extensor lag improved from 62° (range, 32° to 85°) before surgery to 17° (range, active extension 12° to extensor lag 70°) at the final follow-up (P.05), whereas average MCP joint flexion decreased from 83° (range, 52° to 95°) to 68° (range, 30° to 90°) (P.05). Hyperextension at the IP joint was improved from 30° (range, 10° to 50°) before surgery to an average extensor lag of 2° (range, extensor lag 24° to hyperextension 20°) at the final follow-up. The average combined MCP and IP motion did not significantly change. The boutonniere deformity was improved in 18 of 21 thumbs. The 3 failures all had moderate-stage deformity prior to treatment.A modified EPL rerouting technique provided satisfactory results together with a low risk of IP joint extension loss.Therapeutic IV.

Background and objective Cervical radiculopathy is a common neuro-musculo-skeletal disorder causing pain and disability. Traction is part of the evidence based manual physical therapy management due to its mechanical nature, type of traction and parameters related to its applicability and are still to be explored more through research. Our objective was to determine the Effects of Mechanical versus Manual Traction in Manual Physical Therapy combined with segmental mobilization and exercise therapy in the physical therapy management of Patients with Cervical Radiculopathy. Methods This randomized control trial was conducted at department of physical therapy and rehabilitation, Rathore Hospital Faisalabad, from February to July 2015. Inclusion criteria were both male and female patients with evident symptoms of cervical spine radiculopathy and age ranged between 20-70 years. The exclusion criteria were Patients with history of trauma, neck pain without radiculopathy, aged less than 20 and more than 70. A total of 72 patients with cervical radiculopathy were screened out as per the inclusion criteria, 42 patients were randomly selected and placed into two groups by toss and trial method, and only 36 patients completed the study, while 6 dropped out. The mechanical traction was applied in group A and manual traction in group B along with common intervention of segmental mobilization and exercise therapy in both groups for 6 weeks. The patient's outcomes were assessed by self reported NPRS and NDI at the baseline and after completion of 06 weeks exercise program at 3 days per week. The data was analyzed through SPSS version-21, and paired T test was applied at 95% level significance to determine the statistical deference between two groups. Results Clinically the group of patients treated with mechanical traction managed pain (mean pre 6.26, mean post 1.43), and disability (mean pre 24.43 and mean post 7.26) more effectively as compared with the group of patients treated with manual traction (Pain mean pre 6.80, mean post 3.85 and disability mean pre 21.92 and post 12.19). Statistically the results of both mechanical and manual traction techniques are equally significant in group A and B for pain and disability (p-value less than 0.05). Conclusion If patients of cervical radiculopathy treated with mechanical traction, segmental mobilization, and exercise therapy will manage pain and disability more effectively than treated with manual traction, segmental mobilization, and exercise therapy.

Introduction We described the dynamic effects of traction on the radiolunate and capitolunate joints in a living body to explore the possibility of range of motion exercise of the wrist joint under traction as a new method of exercise. Methods Dynamic radiography was conducted while creating wrist passive movements by using manual traction and machinery traction with a measurement device. Subjects were 20 healthy men. The change in the percentage of contribution of the radiolunate and capitolunate joints with or without traction was calculated. Results Manual traction: During palmar flexion, the percentage of contribution of the radiolunate angle was increased from 39.4% to 49.9%, and the capitolunate angle was decreased from 60.6% to 50.1% with traction. During dorsiflexion, the radiolunate angle was increased from 60.2% to 70.0%, and the capitolunate angle was decreased from 39.8% to 30.0% with traction. Machinery traction: During palmar flexion, the radiolunate angle was increased from 46.1% to 56.4%, and the capitolunate angle was decreased from 53.9% to 43.6% with traction. During dorsiflexion, the radiolunate angle was increased from 68.7% to 72.0%, and the capitolunate angle was decreased from 31.3% to 28.0% with traction. Conclusions The movement of the radiolunate joint was increased and that of the capitolunate joint decreased with the addition of traction. Range of motion exercise with traction has the potential to be applied to an advanced rehabilitation program targeting the radiolunate joint under specific pathological conditions.

OBJECTIVE To determine the effects of manual traction in knee arthritis patients in comparison to electrotherapy (TENS). STUDY DESIGN Randomized Control Trial (Experimental Study). STUDY SETTINGS & PARTICIPANTS Study was conducted in a Tertiary Care Hospital with a sample of 310 participants. INTERVENTIONS Manual traction and Electrotherapy Transcutaneous electrical nerve stimulation (TENS) will be used to manage pain in patients with Knee Osteoarthritis. OUTCOME MEASURES Oxford Knee Pain Scale was used to measure pain and functional activities. RESULTS Improvements were seen in both groups but results of manual traction were more significant. There were major differences present in knee pain intensity before and after treatment. The group that received manual traction reported a decrease in the severity of pain of mean 15.01 which is comparatively better than the group that received electro therapy and reported a decrease in severity of pain of mean 12.42. CONCLUSION The result of this research supports the application of manual TF joint traction as a mean of stretching shortened articular and periarticular tissues with decreased in levels of pain either during the treatment or at the end of session. There is significant improvement in knee flexion AROM. Pain level decreases during every treatment session. KEY WORDS Knee Pain, Traction, Mobilization, Tibio-Femoral Joint, TENS, Knee OA.

Video Objective This video outlines the crucial steps in performing a single-site robotic salpingectomy with partial cornuectomy. This is presented as an alternative method for microinstert removal that is both minimally invasive and aesthetically pleasing. Setting This procedure was completed on women who were previously sterilized with hysteroscopic insertion of tubal microinsert and began experiencing pelvic pain or autoimmune-like symptoms. The procedures were performed in an ambulatory setting with same or next day discharge. Interventions Single-port bilateral salpingectomy with partial cornuectomy and closure of defect. Conclusion The women who originally opted for a microinsert sterilization had opted for a minimally invasive sterilization that did not require entry into the abdominal cavity. These women are likely to prefer a minimally invasive option with aesthetic results to reverse this procedure. Fewer incisions theoretically reduces risk of postoperative pain and reduces visible scars leading to reported patient satisfaction. Single-site robotic salpingectomy with partial cornuectomy provides these benefits in addition to preventing coil fragmentation by removing the cornua in addition to the fallopian tubes which permits avoidance of excessive manual traction on the insert that may result in fragmentation.

Background Long-term use of Port-a-Caths (PACs) is related to device-related delayed complications. The aim of this study is to describe the high success rate and safety of cardiac pacing lead extraction techniques used for PACs complicated by infection or migration and not removed by manual traction. Methods During a 13-year period (1997–2010), 19 consecutive PAC recipients (54.1 ± 13 years, 11 females) were referred to our hospital for PAC-related delayed complications and PACs not removable by manual traction (mean dwelling time 29.3 ± 31 months). Results PAC implantation indications included gastrointestinal cancer (21%), breast cancer (15.7%), other malignant diseases (52.6%), and nonmalignant diseases (10.5%). PAC removal indications were breakdown due to subclavian crush (63.1%), breakdown due to unsuccessful previous removal attempt (21%), sepsis (10.5%), or malfunction (5.3%). Removal of fractured free-floating catheters (16) migrated toward the venous blood course was attempted by tool-guided traction in all cases except 1 in whom mechanical dilation was necessary. For the 3 intact ones (2 infected and one malfunctioning) we used tool-guided traction and single-sheath mechanical dilation, depending on the vascular/cardiac-catheter setting. By using multiple venous approaches we removed 18 catheters completely and 1 partially, achieving clinical success in all of the patients. The most commonly used venous approach was transfemoral (TFA; 73.6%), followed by the original venous entry site approach (VEA; 15.7%) and internal transjugular approach (ITA; 10.5%). No major or minor complications were observed. Conclusions In experienced centers, cardiac pacing lead extraction techniques may be considered as an additional, efficacious, safe option for extraction of otherwise nonremovable entrapped PACs before surgery.

To describe the penile length after radical prostatectomy (RP) in a long-term follow-up.We evaluated prospectively the penile length of 105 patients with localized prostate cancer treated by open RP. Participants using therapy for penile rehabilitation were excluded from statistical analysis. Measurements of the stretched penis were taken preoperatively and at 3, 6, 12, 24, 36, 48, and 60 months postoperatively. The International Index of Erectile Function-Erectile Function (IIEF-EF) questionnaire was used to evaluate erectile function. The penile anthropometric measure used was the stretched length of the flaccid penis, from the pubopenile skin angle to the end of the glans, after the prepubic fat was depressed under maximum manual traction.The mean stretched penile length 3 months after RP decreased an average of 1 cm from baseline (P.001). This mean difference persisted until 24 months. At 36 months, the penile length differed 0.6 cm. At 48 months (-0.3 cm) and 60 months (+0.4 cm), the mean differences in penile length before and after RP were not significant (P = .080 and P = .065, respectively). Erectile function was a predictor for early return of penile length.Nearly 1 cm of penile shortening after RP may be expected up to 12 months. However, a trend toward recovery of penile length occurs after 24 months of follow-up and is completely re-established after 48 months. The preserved erectile function after RP is a predictor for penile length recovery.

Indirect fracture reduction is used to align diaphyseal fractures in small animals when using minimally-invasive fracture repair. Indirect reduction achieves functional fracture reduction without opening the fracture site. The limb is restored to length and spatial alignment is achieved to ensure proper angular and rotational alignment. Fracture reduction can be accomplished using a variety of techniques and devices, including hanging the limb, manual traction, distraction table, external fixators, and a fracture distractor.

Background There are limited published data regarding the percutaneous extraction of device leads jailed by a venous stent. Objective In this study we assessed the feasibility and safety of percutaneous extraction of stented device leads. Methods We reviewed our experience percutaneously extracting 7 chronically implanted device leads jailed to the wall of the left innominate and/or subclavian veins by a previously placed stent. Results All leads were successfully extracted by using a percutaneous approach. Both pacing leads and defibrillator leads were extracted. The oldest pacing lead extracted was 14 years old. The oldest defibrillator lead extracted was 6 years old. Three of the leads were extracted with simple manual traction alone. The 4 remaining leads required a more complex, femoral extraction approach for successful removal. Conclusion In our experience extracting 7 stented device leads, complete percutaneous removal was feasible 100% of the time using a combination of simple manual traction and a femoral approach. No major complications were associated with the extraction procedures.

In a previous study we could demonstrate that in terms of the required forces alternate traction is preferable to simultaneous traction for the obstetrical delivery of calves. The aims of this study were to examine the required energies for delivery of calves and to compare the effects of the factors of calf and traction method on the forces and energies required for the delivery. In a biomechanical in vitro model 12 stillborn Holstein-Friesian calves were pulled through the pelvic specimen of a cow at a controlled speed using two electric motors. Traction was applied simultaneously (ST) to both legs or alternately (AT) to one leg at a time to advance it 10 cm (AT 10) or 5 cm (AT5). Energies on each limb were measured digitally using load cells. The lowest energy for the entrance of the elbows in the pelvis was necessary using AT10 (19.9 ± 7.2 kJ, P < 0.05). In contrast, for the entrance of the chest, AT10 (104.9 ± 24.7 kJ) demanded 9% (P < 0.01) and 16% (P < 0.001) more energy than AT5 (96.7 ± 21.0 kJ) and ST (90.5 ± 24.9 kJ), respectively. Simultaneous traction tended to be better than AT5 (P = 0.09). Variance component estimates revealed that the factor calf contributed the main effect to the emerging forces and required energy. The traction method was responsible for up to 13% of the variance in most of the cases, but it accounted for 42% of the variance regarding the forces on the lower limb as the chest entered the pelvis. Based on these findings, the decision of the clinician whether or not to perform a manual traction should depend mainly on the calf. However, when such a decision has been made, alternate limb traction, 10 cm at a time, should be used until both elbows have entered the pelvis and a simultaneous traction should then be applied to complete extraction of the chest.

Background Removal of cardiac implantable electronic devices (CIEDs) by manual traction during orthotopic heart transplantation (OHT) sometimes results in retained lead fragments. Moreover, abandoned leads and retained lead fragments are a contraindication for magnetic resonance imaging (MRI) and may be a cause of CIED infection. Objective To eliminate complications of retained lead fragments, we completely removed residual leads using an excimer laser sheath technique during OHT. We report our clinical experience and high success rate of lead extraction using the excimer laser sheath compared with manual traction during OHT. Methods and results We obtained data on 84 consecutive patients receiving OHT between August 2007 and August 2017. Thirty-nine of 84 patients had undergone CIED implantation before OHT and removal of all their leads was attempted during OHT. From 2007 to 2014, defibrillator and pacemaker leads were extracted by manual traction in all patients (N = 22). After 2015, all leads were extracted with the excimer laser sheath, and surgical assistance was prepared for the procedure (N = 17). Complete procedural success was achieved in 100% of patients in the excimer laser group and 77% of patients in the manual traction group. Conclusion Extraction of abandoned leads using the excimer laser sheath system during OHT is novel and safe technique, and has a higher success rate than extraction using manual traction during OHT.

We described a 77-year-old patient, previously implanted with a dual-chamber pacemaker later upgraded to a cardiac resynchronization therapy-defibrillator (CRT-D) device with an active-fixation coronary sinus pacing lead, who underwent a transvenous mechanical extraction procedure for a device-related systemic infection. All leads were removed successfully with a transvenous approach. With regard to the coronary sinus (CS) lead (Attain 4195 StarFix, Medtronic Inc., Minneapolis, MN, USA), manual traction was ineffective and extraction required long and challenging mechanical dilatation up to distal CS using either conventional sheaths or modified CS lead delivery. (PACE 2010; 34:e66–e69)

Distal radius fractures (DRF) are a common injury, especially in the elderly. Displaced fractures can be reduced by closed reduction through several techniques, two of which are compared in this systematic review and meta-analysis. Closed reduction by finger-trap traction (FTT) seems to offer better correction of radial shortening. Additionally, there may be less pain and fewer complications associated with this technique. Closed reduction by manual traction seems to offer better correction of the dorsal tilt. Further research is needed to fully determine the optimal method of closed reduction. Cite this article: EFORT Open Rev 2018;3:114-120.DOI: 10.1302/2058-5241.3.170063

Ankle arthroscopy has emerged as a viable treatment option for multiple ankle pathologies and continues to have expanding indications as technology and techniques improve. Historically, ankle arthroscopy used skeletal traction, and it has transitioned to noninvasive soft-tissue distraction because of high rates of iatrogenic complications. Although soft-tissue distraction has decreased complications, it continues to be both cumbersome and time-consuming. Thus we propose a 1-step simple ankle arthroscopy distraction technique that uses an external positioning arm to allow the surgeon to apply manual traction in multiple positions without the use of any reprocessed sterile equipment.

A 66-year-old patient with idiopathic dilated cardiomyopathy underwent transvenous extraction of an implantable cardioverter-defibrillator. The distal part of the electrode was broken during manual traction through the left subclavian vein. In the present case, we showed a rare complication of transvenous lead extraction and its management.

Purpose: The aim of this paper is to see the effectiveness of cervical traction manual or mechanical as an adjunct to physical therapy in the treatment of radiating neck pain. Method: 50 subjects with radiating neck pain, 25 in each group were taken. Both groups received moist heat and cervical retraction exercises for five sessions. The KTr group received Kaltenborn manual traction and the Tr group received mechanical cervical traction. Outcome measures: Numeric Pain Rating Scale and cervical ROM were taken at baseline, after first treatment and at the end of 5th day. Neck disability index and Patient-Specific Functional Scale were taken at baseline and at the end of fifth session. Results: After 5 days of treatment, statistical improvements ([Formula: see text].05) were observed in all outcome measures in both groups. The immediate reduction in pain intensity and increased range of motion was observed in the KTr group. Conclusion: The study showed that both traction methods are equally effective when used as adjunct to physical therapy in radiating neck pain treatment. Immediate effects in reduction of pain and increase in the ROM are more in the manual traction group. Hence, manual cervical traction along with physical therapy can be considered as choice of treatment for immediate improvements in pain and ROM of the cervical spine.

We experienced a case with a remnant of a fractured guidewire in the coronary artery. Surgical removal of the total wire by manual traction was unsuccessful. The wire was then cut near the right coronary orifice, and its proximal portion was removed. Cardiac interventionists should recognize that percutaneous coronary intervention is associated with the risk of various cardiovascular accidents. Patients should be informed of such risks.

Objective The purpose of this study was to investigate the immediate effects of manual traction of the hip joint on joint space width (JSW) on asymptomatic subjects. Methods Asymptomatic, healthy male volunteers (n = 15), aged 25 to 34 years were included in this study. Three radiographs were obtained with the subjects in the supine position, before and after loading with 10% of his body weight, and after manual traction on only the right hip joint. Joint space width was measured by a radiologist at the point described by Jacobson and Sonne-Holm. Results There were significant changes in JSW on the right hip joint and left hip joint between the baseline (before loading) and immediately after loading. We also observed a significantly increased JSW on only the right hip joint between periods that followed loading and manual traction on the right hip joint. There was no significant change in JSW on the left hip joint between periods that followed loading and manual traction on the right hip joint. Conclusions The results of this study suggest that a significant increase in JSW in young, healthy male patients can occur immediately after manual traction of the hip joint.

Background: Dislocation injuries of the glenohumeral joint are common in the general public and generally are corrected without complication. One serious complication with shoulder dislocations, or the subsequent reduction, is a lesion to the axillary artery. This specific complication is most frequently seen in the elderly population, where vascular structures have become less flexible. Also, these injuries are most common in association with anterior dislocations of the shoulder. Objectives: To bring awareness to the possibility of axillary artery injury with inferior dislocation of the shoulder, the treatment options, and a review. Case Report: We report a 15-year-old male athlete who inferiorly dislocated his shoulder during wrestling practice. The injury was reduced at the scene with manual traction and the patient was transferred to our clinic for evaluation. The patient was determined to have a pseudoaneurysm of the axillary artery, and the history and treatment of the illness are presented. Conclusion: Axillary artery injuries secondary to shoulder dislocations are rare, especially in the young athlete, and proper recognition and treatment offer patients a full recovery.

A case of successful lead extraction of atrial and ventricular pacing leads "jailed" by a stent in the superior limb of a Mustard baffle in a 40-year-old man with surgically corrected transposition of the great arteries and pacemaker pocket infection. Manual traction alone was sufficient to remove the jailed leads with no subsequent complications.

We assessed preoperative curve elasticity in 49 consecutive patients with juvenile or adolescent idiopathic scoliosis who were operated on with Harrington distraction rods. Preoperatively, the curve was determined from posteroanterior radiographs taken in the standing position and in the supine position, with traction. In the latter, the radiographs were taken at the moment of maximal traction when one technician applied traction to the ankles and another to the wrists. The scoliotic curve in the 10 patients with juvenile scoliosis averaged 59 degrees and 32 degrees in the standing and supine positions with traction, respectively. Immediately postoperatively, the curve averaged 19 degrees. 39 patients with adolescent scoliosis had a scoliotic curve which averaged 58 degrees in the standing position and 32 degrees in the supine position with traction. The mean postoperative measurement was 21 degrees. These findings suggest that manual traction is a simple and reliable means of predicting the minimal correction of the scoliotic curve to be expected, using Harrington distraction rods.

This report describes the evaluation, diagnosis and conservative treatment of an 80-year-old woman with a non-pathological ipsilateral fracture of the proximal, mid-shaft and distal humerus. The treatment goal was the prompt return of the patient to a satisfactory functional status without surgical intervention. The spiral diaphyseal fracture was reduced with manual traction without anaesthesia, and a U-slab casting was applied. Immobilisation was preserved for 6 weeks, and fracture healing progressed normally. Then the patient entered a rehabilitation programme with passive and active exercises. Complex fractures of the humerus are rare and often are misdiagnosed. Conservative treatment in an aged, self-sufficient patient with low activity demands or patients with multiple medical problems is a reasonable option with satisfactory results.

The objective of this study was to measure intradiscal pressure (IDP) changes in the lower cervical spine during a manual cervical distraction (MCD) procedure. Incisions were made anteriorly, and pressure transducers were inserted into each nucleus at lower cervical discs. Four skilled doctors of chiropractic (DCs) performed MCD procedure on nine specimens in prone position with contacts at C5 or at C6 vertebrae with the headpiece in different positions. IDP changes, traction forces, and manually applied posterior-to-anterior forces were analyzed using descriptive statistics. IDP decreases were observed during MCD procedure at all lower cervical levels C4-C5, C5-C6, and C6-C7. The mean IDP decreases were as high as 168.7 KPa. Mean traction forces were as high as 119.2 N. Posterior-to-anterior forces applied during manual traction were as high as 82.6 N. Intraclinician reliability for IDP decrease was high for all four DCs. While two DCs had high intraclinician reliability for applied traction force, the other two DCs demonstrated only moderate reliability. IDP decreases were greatest during moving flexion and traction. They were progressevely less pronouced with neutral traction, fixed flexion and traction, and generalized traction.

This level II prospective study investigates patient and fracture-related factors likely to affect closed reduction time in the surgical treatment of femur fractures, and the effect these factors have on closed reduction time. Seventy-nine diaphyseal femur fractures of 75 patients were included in the present study. All fractures were treated with indirect closed reduction by manual traction using antegrade nailing and static, locked, reamed intramedullary nails. The three variables considered to influence the duration of closed reduction, that is, the type of fracture, BMI, and the preoperative period (time from injury to surgery), were evaluated either separately or in a combination of two or three of the variables. Their influence on the closed reduction time was analyzed and evaluated. In this study according to the outcomes, a preoperative period ≤24 h had a significant effect in shortening the reduction time. The reduction time was not significantly affected by the type of fracture. The reduction time was prolonged in overweight patients, but the difference was not significant. When the three variables BMI, preoperative period, and fracture types were evaluated together, the common effect of these three variables was not significant. In conclusion, based on these results, we think that closed reduction should certainly be aimed for in femur fractures in which intramedullary nailing is planned. Also, early surgical intervention appears to have a beneficial effect on the success of closed reduction.

Degeneration in intervertebral discs is a complex multifactorial process. Studies have speculated the biomechanical and biochemical reasons factoring the degenerative disc pathology. Disc degeneration begins in inner nucleus pulposus (NP) that has high fluid content. As degeneration advances over time, the load is shifted from inner NP to outer annulus fibrosus (AF) that is more fibrous in nature. In addition to morphological changes in the discs that occur with degeneration in the form of tears and delamination, tissue compositional variations are also noted. These degenerative changes have not only been seen in the disc tissue matrix, but they are also quite apparent in the fibers of AF in the form of incompleteness and laxity [1]. These tensile fibers in AF have a critical functionality in maintaining the mechanical strength of the disc segments, and any form of degenerative impairment in these fibers may lead to abnormal physiology, both in the AF and NP. Despite past research have reported the annular and nucleus stresses in degenerative discs, area that still unclear is the relative contributions of degenerative properties in annular fibers — incompleteness and slackness — to the overall degenerative disc response. Typically, degeneration related neck pain that involve abnormal disc pressures has been shown to be temporarily relieved by the therapeutical application of manual traction forces. The objective of the present study is to understand the pattern of stresses in the AF and NP due to degenerative AF fibers when the manual traction forces are applied on the degenerated discs.

Open reduction and internal fixation is used to treat complex acetabular fractures. Traction on the femur is necessary to reduce the acetabulum and is accomplished by surgical assistants or with mechanical devices. To overcome the disadvantages of various traction methods, the author designed a simple, novel traction device that can be used on an ordinary orthopedic or radiolucent operating table and has advantages over manual traction and commercial traction tables. The device consists of a horizontal cross-bar supported over the patient by 2 free-standing legs and is constructed from commercially available parts.

Objective: Determine whether preoperative AP pelvis radiographies under manual traction influence surgeon choice for implants in intertrochanteric fractures compared with standard radiographies. Methods: Fifty-eight patients with intertrochanteric fractures were prospectively enrolled from four tertiary teaching hospitals. All patients had standard AP pelvis radiographies taken as well as radiographies under manual traction of affected limb, 116 images total. Three fellowship trained trauma surgeons and three hip surgeons blindly reviewed the images and indicated their implant choice for each case: extra or intramedullary fixation. The observers received randomly assigned images and were unaware of the radiography technique, patient number, and repetition of patients within the set of images. Statistical analyses were performed using Cohen Kappa method and McNemar, Q Cochran, and Wilcoxon tests. Results: Manual traction radiographies changed surgeon-implant choice in 35.06% (range: 27.6% to 43.1%). However, traction radiographies provided no improvement in weak inter-observer reliability for treatment indication (k=0.264, p

The purpose of this case series was to explore the effects of tibio-femoral (TF) manual traction on pain and passive range of motion (PROM) in individuals with unilateral motion impairment and pain in knee flexion. Thirteen participants volunteered for the study. All participants received 6 minutes of TF traction mobilization applied at end-range passive knee flexion. PROM measurements were taken before the intervention and after 2, 4, and 6 minutes of TF joint traction. Pain was measured using a visual analog scale with the TF joint at rest, at end-range passive knee flexion, during the application of joint traction, and immediately post-treatment. There were significant differences in PROM after 2 and 4 minutes of traction, with no significance noted after 4 minutes. A significant change in knee flexion of 25.9°, which exceeded the MDC(95,) was found when comparing PROM measurements pre- to final intervention. While pain did not change significantly over time, pain levels did change significantly during each treatment session. Pain significantly increased when the participant's knee was passively flexed to end range; it was reduced, although not significantly, during traction mobilization; and it significantly decreased following traction. This case series supports TF joint traction as a means of stretching shortened articular and periarticular tissues without increasing reported levels of pain during or after treatment. In addition, this is the first study documenting the temporal aspects of treatment effectiveness in motion restoration.

Hyperechoic microfoci are sometimes visualized in normal joints. We hypothesized that these microfoci may correspond to gas microbubbles produced by a vacuum phenomenon. The purpose of our study was to demonstrate the possibility of generating intraarticular hyperechoic microbubbles by creating a vacuum phenomenon through traction on a metacarpophalangeal joint. We applied manual traction to the second metacarpophalangeal (MCP) joint of 22 volunteer subjects to separate articular surfaces with the aim of producing a vacuum. For one subject, the production of a vacuum was verified on a radiograph performed during the traction maneuver. For all subjects, ultrasonographic examination of the MCP joints was performed before, during, and after traction maneuvers. Two radiologists evaluated the presence of intraarticular hyperechoic microfoci and measured the widening of the joint space during traction. In the first subject, the widening of the joint space and the production of an intraarticular gas-like cavity by traction was confirmed on the radiograph. In 10 out of the 22 volunteers, the widening of the joint space was immediately followed by the appearance of a large intraarticular hyperechoic band, which disappeared when the traction was stopped, followed by the appearance of hyperechoic microfoci that persisted several minutes. The widening of the joint during the traction maneuver was greater in the group where hyperechoic foci were produced than in the group with no hyperechoic foci (mean 2.5 vs. 1.2 mm and 2.2 vs. 0.8 mm, respectively, for observers 1 and 2; P

The treatment of unstable trochanteric femoral fractures is still challenging, and the proximal femoral nails are becoming more commonly used. The proximal femoral nailing is usually performed on a fracture table under traction which is associated with some possible complications. In our study, we tried to present the results of proximal nailing surgery performed in the lateral decubitus position and manual traction on a radiolucent table without the fracture table traction.

Background/Purpose Long-term central venous access devices (CVAD) play an integral role in the management of children who require nutritional support, chemotherapy, blood drawing, and transfusion of blood products. Infrequently, the CVAD may be difficult or impossible to remove with traction. Patient Population Four patients, with ages ranging from 6 to 13 years, had 4 CVAD in place for 431, 730, 2232, and 3285 days which could not be removed by manual traction and local exploration. Results With the use of technology developed for removal of embedded transvenous pacemaker catheters, each CVAD was successfully dislodged using a lead locking device (n = 3) or a lead locking device and an excimer laser (n = 1). There were no complications of the procedure in our series. Conclusions There is no consensus on optimal management of embedded CVADs. In this small series, devices used routinely to remove embedded transvenous pacemaker wires were used to extract 4 embedded CVADs without complication; however, use of this technology in pediatric surgical patients is controversial because a small percentage of adult cases have resulted in tamponade or hemothorax, potentially resulting in death. Selection of patients and use of the technology in the appropriate setting are important considerations in weighing the risks vs the benefits of extracting such catheters or leaving them in place.

Among the complications associated with the wide use of implanted cardiac pacemakers, the incidence of infection of the pacing system is reported to occur in 0% to 19% of the patients [1]. Signs and symptoms of infection in the generator pocket are most frequently observed, while septicemia is a less frequent but life-threatening event [2, 3]. Infections occurring after implantation of an implantable cardioverter-defibrillator (ICD) are an even more dangerous condition, and it is reported with an incidence of 2%–7% [4–7]. ICD devices have much in common with implanted pacemakers. Both systems consist of electrodes and a pulse generator, and are manufactured using the same materials. Thus it seems reasonable to apply the lessons learned from permanent pacemakers to defibrillator implants.

Recommended treatment options for acute septic arthritis in children include repeated aspiration, open arthrotomy, and arthroscopic drainage. However, reports of arthroscopic treatment of septic arthritis of the hip in a child are rare. We experienced a case of arthroscopic management of acute septic arthritis of the right hip joint in a three-year-old child using a 30。 , 2.7 mm arthroscope for the ankle joint through manual traction without use of a traction table. The patient had complete range of motion in the right hip joint two weeks after surgery and recurrent infection was not observed at the final follow-up two years postoperatively.

An experiment using a dummy with a cervical traction recorder was used in place of a patient. Nurses and orderlies from the Spinal Unit carried out manual lifting and turning techniques, used in the conservative treatment of spinal injury. Variation in manual traction continues throughout a turn. Traction force may be quadrupled or quartered. Inco-ordination between the individuals lifting, causes bending forces in the neck. This, together with sharp variation in traction, elicits pain. Manual traction, lifting, and turning, should be totally avoided, by employing kinetic nursing, provided by the use of the Roto Rest Spinal Bed.

Manual traction reduction without anesthesia and immediate immobilization in a spica cast were used to treat eighty-five children ranging in age from birth to ten years old who had closed femoral-shaft fractures and no associated injuries. Up to two centimeters of overriding, 30 degrees of anterior angulation, and 15 degrees of medial angulation were accepted. Any angulation in excess of these amounts, or lateral or posterior angulation, was corrected by wedging the cast at the fracture site. Further telescoping of the fracture fragments in the case was attributed to the child pressing the foot against the bottom of the cast and was prevented by removing the sole of the cast. Of the seventy-five children examined two to eighteen years after fracture, none had any residual skeletal deformity or joint stiffness. The length discrepancies of the fractured limbs ranged from 1.7 centimeters of shortening to 0.9 centimeter of overgrowth.

The purpose of this study was to determine whether a correlation exists between therapist's body weight and the amount of force they exert on the cervical spine when using a manual traction technique. Thirty-four subjects were weighed and then performed three repetitive traction maneuvers using a mannequin head attached to a tension dynamometer. The average force produced by these trials was divided by the subject's body weight to determine the ratio between these two factors, expressed as a percentage. The results indicated a positive correlation between therapist body weight and traction force which was significant at the 0.01 level. The mean traction force exerted by subjects was equivalent to approximately one-half their body weight (49%). This finding provides a more accurate means for documenting the amount of force applied to an individual's cervical spine when using manual traction techniques. J Orthop Sports Phys Ther 1989;10(10):408-411.

1. 1. Because I have seen four cases of concurrent femoral head fracture and traumatic hip dislocation in the past two years, it is my opinion that this injury is more common than is generally believed. 2. 2. The first step in treatment should be a simple manual traction reduction maneuver. If this is unsuccessful, operative reduction should be carried out. 3. 3. Early good results can be anticipated if reduction is accomplished and appropriate convalescent management is instituted. 4. 4. Following reduction, weight-bearing should be disallowed until serial roentgenograms demonstrate that there is no danger of femoral head necrosis.

A 3-year old boy with an acute onset of hip pain and limitation of motion had 4 mm of crescent shaped intra-articular gas produced by manual traction radiography. Hip aspiration produced more than 2 ml of fluid from the hip. Manual traction radiography producing the vacuum phenomenon with release of crescent shaped intra-articular gas did not exclude joint fluid in this patient.

We evaluated the clinical usefulness of a new shoulder traction device to facilitate a rapid complete cervical spine examination in an uncooperative patient population with multiple trauma. Forty-eight patients were randomly designated to receive the shoulder traction device or the standard technique (manual traction on the patient's upper extremities). Patient groups were equivalent in mean coma scale scores, trauma scores, age, and incidence of cervical fracture. Male-female ratios differed between groups, yet were biased against the harness technique. Fewer roentgenograms (lateral view) were required to visualize adequately all cervical vertebrae when the harness device was utilized (mean roentgenograms per patient, 1.2 vs 2.6; P less than .01). Shoulder harness traction during roentgenographic evaluation of the cervical spine may be a useful method to promote visibility of the lower cervical vertebrae.