Search

Background Cardiac implantable electronic device (CIED) implantation rate has been increasing worldwide. Despite proper surgical technique and preincisional intravenous antibiotics, the incidence of infected CIED remains high and leads to serious complications. When encountered with CIED infection, complete CIED system removal is indicated. Several lead extraction approaches have shown a high success rate. However, the facilities are limited in Thailand. In our current practice, we perform lead extraction using the Dotter basket snare femoral approach as our primary method. There are no prior data on this countertraction‐assisted transfemoral technique. Therefore, we aim to study the procedural outcome of countertraction‐assisted transfemoral lead removal technique of CIED infection in Thai patients. Methods Patients diagnosed with CIED infection and with a history of device infection were retrospectively included. Simple manual removal was performed. In case of failure, we proceeded with the modified countertraction‐assisted transfemoral technique. Results There were 35 patients in the study. The success rate was 94.3%. Most of the leads, 62.8%, were removed by simple manual traction. In the 37.1% who required further femoral approach lead extractions, procedural failure was observed in 5.7% and procedure‐related adverse events in 5.6%. CIED infection‐related death accounted for 5.7% and nosocomial infection‐related death, 2.8%. Conclusion The success rate of CIED infection lead explant and countertraction‐assisted transfemoral lead extraction technique was high with small complications and can be performed without advanced facilities. However, the procedure required a main center with a cardiovascular thoracic surgery support team., Countertraction is the cornerstone of the lead extraction in preventing of right ventricular (RV) inversion with less complications. Improvised technique, using telescopic system consisted of ablation catheter and deflectable sheath placement at RV apex, provided countertraction force whilst applying femoral lead extraction.

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.

BACKGROUND Managing elderly patients with infection or malfunction deriving from a cardiac implantable electronic device (CIED) may be challenging. The aim of this study was to evaluate safety and efficacy of mechanical transvenous lead extraction (TLE) in elderly patients. METHODS Patients who had undergone TLE in single tertiary referral center were divided in two groups (group 1: ≥ 80 years; group 2

Background: Data from large-volume centers in developed countries, using dedicated tools, show a high success rate with a good safety record for the percutaneous lead removal procedure. However, there are constraints to replicate the results in a resource-poor setting and there is limited data from India. Methods: We retrospectively analyzed lead removal procedures performed in our institution from 2008 to 2019. Results: Seventy-five patients underwent percutaneous removal of 138 leads. Of these, 44 procedures and 80 leads qualified as extraction with a median dwell time of 52.1 (IQR 28.2–117.2) months. Overall, 33/44 (75.0%) procedures were successful and 65/80 (81.2%) leads were successfully extracted. Manual traction was successful in the extraction of 44/57 (77.2%) leads. All leads implanted less than 2.7 years could be removed with manual traction alone. Specialized tools were used in 23 leads and 21 (91.3%) of those could be successfully extracted. Inability to use dedicated tools was an independent predictor of procedural failure (adjusted OR 14.0; 95% CI 1.8–110.2; p-value 0.012). Right-sided implant (adjusted OR 12.6; 95% CI 1.3–119.5; p-value 0.027) was also independently associated with failure. There was 1 death (1.3%) and minor complications occurred in 6 (8.0%) patients. Conclusions: In a resource-limited setting, percutaneous lead extraction of predominantly pacemaker leads by manual traction methods achieved success in extracting about three-fourths of the leads. Inability to use specialized tools was the main factor limiting success. The complication rate was low. Keywords: Cardiovascular implantable electronic devices, Lead extraction, Lead explantation, Percutaneous lead removal

A hérnia de disco é causada por uma degeneração do disco decorrente de alterações estruturais, ocasionando uma desestabilização e desarmonia do movimento. A tração manual é uma técnica em que se realiza o trabalho fisioterápico através da utilização das mãos. Diante disso, o estudo tem por objetivo revisar a literatura científica em relação aos efeitos da tração manual em pacientes com hérnia de disco cervical crônica. Trata-se de uma revisão bibliográfica de caráter descritivo-exploratório, feita a partir das bases de dados SciELO, Google, e artigos publicados. Resultados: Foram selecionados 5 artigos publicados no período entre 2014 e 2019 a respeito da temática, demonstrando que há evidências científicas a respeito da eficácia da tração manual no tratamento de hérnia cervical, devolvendo a capacidade funcional do indivíduo. Conclusão: O presente estudo demonstrou resultados positivos na utilização da tração manual aos pacientes portadores de hérnia cervical podendo até evitar o processo cirúrgico.

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.

[Purpose] This study investigated the effects of manual manipulation therapy on the pain and dysfunction of patients with lumbar spinal stenosis. [Participants and Methods] In this study, 30 patients with chronic back pain were evenly divided into an experimental group, who received manual traction therapy, and a control group, 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 (ODI) was used to check the functional impediment they experienced as a result. [Results] The intragroup comparison showed that the visual analog scale and the ODI significantly decreased in the control group and the experimental group, respectively. The intergroup comparison after treatment showed that the visual analog scale and the ODI of the experimental group were significantly lower than in the control group. [Conclusion] The results of this study suggest that manual manipulation therapy is an effective intervention for treating pain and dysfunction in patients with lumbar spinal stenosis.

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.

O uso de semeadoras de tração manual em pequenas propriedades apresenta viabilidade técnica e econômica, porém poucos trabalhos são desenvolvidos com esta tecnologia de semeadura para o feijão caupi, uma das principais culturas para a região do Cariri cearense. Neste sentido, o objetivo do presente artigo foi avaliar o espaçamento longitudinal e a produtividade de feijão caupi em função da velocidade e profundidade de trabalho de uma semeadora manual. O estudo foi conduzido no Centro de Ciências Agrárias e da Biodiversidade, da Universidade Federal do Cariri, Crato-CE. O delineamento adotado foi em blocos casualizados, em esquema fatorial 2x3, com quatro repetições, totalizando 24 observações. O primeiro fator foram duas profundidades de semeadura (menor: 1 cm e maior: 2 cm); e o segundo a velocidade (2,15; 3,90 e 4,71 km h-1). Foram analisadas a população inicial e final, o índice de sobrevivência, o espaçamento longitudinal, o número de vagens por planta e de grãos por vagem, a produtividade de grãos a 11% de umidade e a produtividade de vagens verdes. Os resultados evidenciaram maiores valores de espaçamentos falhos e menores de aceitáveis com o uso da menor profundidade e das maiores velocidades, com consequente redução na população final, porém, em função do feijão caupi produzir ramos laterais e aumentar a produção por planta, os dados de produtividade não foram influenciados pela profundidade e velocidade de trabalho.

Transvenous lead extraction (TLE) has undergone an explosive evolution since its inception as a rudimentary skill with limited technology and therapeutic options. Early techniques involved simple manual traction that frequently proved ineffective for chronically implanted leads, and carried a significant risk of myocardial avulsion, tamponade, and death. The morbidity and mortality associated with these early extraction techniques limited their application to use only in life-threatening situations, such as infection and sepsis. The past four decades, however, have witnessed significant advances in lead extraction technology, resulting in more efficacious techniques and tools, providing the skilled extractor with a well-equipped armamentarium. With the development of the discipline, we have witnessed a growth in the community of TLE experts coincident with a marked decline in the incidence of procedure-related morbidity and mortality, with recent registries at high-volume centers reporting high success rates with exceedingly low complication rates. Future developments in lead extraction are likely to focus on new tools that will allow for us to provide comprehensive device management, develop alternative systems for extraction training, and focus on the design of new leads conceived to facilitate future extraction.

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.

Background Permanent His bundle pacing (HBP) is a physiological alternative to right ventricular pacing. However, concerns remain about the feasibility and safety of lead extraction from the His bundle region. Objective The aim of our study was to assess the safety and feasibility of extraction of chronically implanted permanent HBP leads in addition to report on the feasibility of reimplanting in the His bundle region. Methods Patients undergoing extraction of leads from the His bundle location for standard indications were studied. The primary outcomes were removal success rates, need for extraction tools, and feasibility of reimplantation in the His bundle region. Results Thirty patients (male 23 (27%); mean age 73.3 ± 14 years) with permanent HBP leads of at least 6-month duration were included. The indications for removal of the HBP leads were infection (n = 3), lead failure (n = 22), nonfunctional lead (n = 3), and upgrade to implantable cardioverter-defibrillator (n = 2). The mean duration of the implanted leads was 25 ± 18 months (range 6–72 months). Removal of HBP leads was successful in 8 of 8 patients (100%) with ≤12-month duration and 21 of 22 patients (95%) with >12-month duration. Extraction tools were used in 4 patients, while manual traction was successful in the remaining patients. Reimplantation in the His-Purkinje conduction system was successful in 19 of 22 patients (86%). Conclusion In this largest study of HBP lead extractions, the overall success rate of extraction of chronically implanted HBP leads was high with a low complication rate. The need for mechanical extraction tools was low, and reimplantation in the His-Purkinje conduction system was feasible.

Latar Belakang : Herniated Nucleus Pulposus adalah kondisi penonjolan discus intervertebralis yang dapat menekan akar saraf yang keluar dari foramen intervertebralis sehingga menimbulkan nyeri radikular, dan pada akhirnya menyebabkan disabilitas lumbal. Metode Desain randomized two group pre test – post test dan menggunakan tehnik pulposive sampling bertujuan untuk mengetahui beda pengaruh pada intervensi SNAGs dan Mc k e nzie dibandingkan dengan Manual Traction dan Mc.K e nzie terhadap penurunan nyeri dan disabilitas lumbal pada penderita HNP lumbal . Penelitian ini dilaksanakan di RSAD Tk. II Pelamonia Makassar dengan sampel adalah penderita HNP lumbal yang sesuai dengan kriteria inklusi. Jumlah sampel adalah 16 orang yang dibagi secara acak kedalam 2 kelompok yaitu kelompok perlakuan 1 yang diberikan SNAGs dan Mc k e nzie sebanyak 8 orang dan kelompok perlakuan 2 yang diberikan Manual Traction dan Mc K e nzie sebanyak 8 orang. Alat ukur yang digunakan adalah Oswetry Disability Index (ODI). Hasil : Berdasarkan analisis uji paired sample t pada kelompok perlakuan I diperoleh nilai (p = 0.000 < 0,05) untuk nilai Oswetry Disability Index yang berarti bahwa pemberian Sustained Apophysial Glides dan Mc K e nzie dapat menghasilkan penurunan nyeri dan disabilitas lumbal yang signifikan. Sedangkan kelompok perlakuan II juga diperoleh nilai (p = 0.000 < 0,05) untuk nilai Oswetry Disability Index yang berarti bahwa pemberian Manual Traction dan Mc K e nzie dapat menghasilkan penurunan nyeri dan disabilitas lumbal yang signifikan. Kemudian berdasarkan uji Indepentent sample t diperoleh nilai (p = 0.000 < 0,05) untuk nilai Oswetry Disability Index yang berarti bahwa pemberian Sustained Apophysial Glides dan Mc Kenzie lebih efektif secara signifikan dibandingkan dengan pemberian Manual Traction dan Mc K e nzie terhadap penurunan nyeri dan disabilitas lumbal. Kesimpulan : Dapat disipulkan bahwa pemberian pemberian SNAGs dan Mc Ke nzie lebih efektif dibandingkan dengan Manual Traction dan Mc Ke nzie terhadap penurunan nyeri dan disabilitas lumbal pada penderita HNP . Kata kunci : Sustained Natural Apophyseal Glides , Manual traction, Mc Kenzie, ODI , HNP Lumbal

Toe arthroscopy has historically had limited applications but is beginning to emerge as a viable treatment option for select toe pathologies, and continues to have expanding indications as technology and techniques improve. Toe arthroscopy has used a multitude of distraction techniques to perform the procedures but all have had limited success. Thus, we propose a simple toe arthroscopy distraction technique that uses an external positioning arm to allow the surgeon to apply manual traction in multiple positions without the use of an assistant, external weights, or any reprocessed sterile equipment.

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.

Uterine intussusception is a rare condition in bitches. This study aimed to report an unusual case of prolapsed uterine intussusception in a female dog. A 2-year-old American Bully bitch was received with labor history of large fetus requiring manual traction. The animal presented mucosal prolapse through the vulva, unproductive contractions and abdominal discomfort. After partial correction of mucosal prolapse, the dog was referred to ovary-hysterectomy surgery to correct prolapsed mucosa. During the surgical procedure, surgeons observed that the uterine horns were invaginated into the uterine body, rotated, and the tissue was slightly devitalized and congested. As previously described, this condition occurred during the immediate postpartum period. Thus, we suggest that this period can be a facilitator for the establishment of uterine intussusception.

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: Manual traction is a commonly used technique in manual therapy. However, depicting changes in joint space distance via real time imaging during traction is seldomly applied. The aims of the study were to identify ACJ joint space distance changes during manual traction and creation of a classification of the techniques upon the largest change in the resultant parameter (l) representing joint space distance. Material and methods: Thirteen healthy volunteers were examined unilaterally. Acromioclavicular joint space distance changes were measured with dynamic ultrasound imaging during followingmanual traction techniques: International Academy of Orthopedic Medicine technique (IAOM AC), Karel Lewit’s Prague School of Manual Medicine & Rehabilitation technique (LAC) and author’s own proposition (B AC). The differences in joint space distance between resting position (RP) and the traction technique position, created three parameters of displacement - horizontal (x), vertical (y) and (l) - the resultant component. Results: Parameters were not coherent with normal distribution. Statistical differences showed significance in the (x) parameter for IAOM AC compared with L AC (p Conclusions: 1.Significant changes of (x) parameter did not correspond with the significance of the resultant parameter (l), which prevented authors from creating a classification of the techniques. 2.All traction techniques used in the study increased the joint space distance compared to RP, which confirms traction’s theoretical assumptions. 3.For clinical purpose the change of (x) parameter may prove crucial for therapy’s effectiveness, despite lack of change in the joint space distance in the resultant parameter (l) by itself.

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.

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.

Background Pediatric and congenital heart disease (CHD) patients requiring permanent pacing present unique challenges, including need for long duration of implant, small size, and structural abnormalities. We report 6 years of experience with a novel 4.1-Fr lumenless pacing lead (model 3830, Medtronic Inc., Minneapolis, MN, USA) in this population. Methods Retrospective review of M3830 leads implanted at a pediatric center from 2005 to 2011. Data were compared to a population with a conventional pacing lead (model 1488, St. Jude Medical Inc., St. Paul, MN, USA). Results A total of 193 patients with 198 model 3830 leads (125 atrial, 73 ventricular) were enrolled. CHD was present in 121 (63%). Age and weight at implant were 16.6 ± 8.5 years and 51.7 ± 23.5 kg, respectively. Length of follow-up was 26 ± 19 months (range 0–73). At implant, mean sensing and capture thresholds were good and remained stable over time. There were no significant differences in electrical performance compared to 101 leads in the comparison group. Implant complications were rare. Follow-up complications occurred in 4% of the M3830 leads and 16% of M1488 leads. Eleven M3830 leads required extraction. All were extracted without complications using only manual traction. There were three deaths in each group. One death in the M1488 group occurred during lead extraction. No other deaths were lead related. Conclusion During up to 6 years of use in pediatric and CHD patients, the M3830 lead has demonstrated excellent efficacy, a low rate of complications, and straightforward extractability relative to traditional pacing leads.

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.

A 6-year-old male castrated labrador retriever presented with endocardial pacemaker infection following migration and subsequent repositioning of the pulse generator. An epicardial lead and pulse generator were surgically implanted and the endocardial lead could not be removed with manual traction. The endocardial lead was severed, anchored, and abandoned at the thoracic inlet. The patient presented 4 months later with endocardial lead migration, bacteremia, and suspected glomerulonephritis. The endocardial pacemaker lead was transvenously extracted using a mechanical dilator sheath and locking stylet. This report of transvenous pacemaker lead extraction in a dog addresses the challenges and describes recent advances in extraction devices.

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.