Aim: Assessment of curve flexibility is important in decision making before surgical correction of scoliosis. Supine bending radiographs are presently the gold standard technique by which flexibility is assessed, but their reliability has been questioned. Our aim was to compare the usefulness of supine side bending and traction radiographs (with new electronic traction table) in assessing curve flexibility, examining the correlation of each technique with postoperative correction, determining fusion levels in patients undergoing posterior spinal fusion. Material and Method: 25 patients required surgical treatment with idiopathic scoliosis were evaluated prospectively. Thirteen were female. The average age was 12.87 years. Preoperative radiologic evaluation consisted of standing anteroposterior, lateral, supine lateral bending and traction graphs by electronic traction table. We designed a new electronic traction table in order to take the longitudinal traction and three-points lateral pressure radiographs. We situated the patient on the table and measured the patient’s weight. Then we made a longitudinal and lateral traction while asking the possible neurologic symptoms. If there was not any symptom we stopped at the seventy percent of the patient’s weight for the longitudinal and at the fifty percent for the lateral pressure. These radiographs had been taken before and under general anesthesia (UGA). The correction obtained in the Cobb angle between the bending and traction radiographs was compared. The influence of the traction radiography on the decision for surgery and its correlation with postoperative result was examined. Results: Longitudinal traction radiographs taken consciously provided the best amount of flexibility, with no significant difference from traction with the patient UGA (p = 0.17) but with significant difference from bending radiographs (p < 0.002). Better flexibility in traction radiographs helped us eliminate the need for anterior release in 5 patients. We decreased the fusion levels proximally or distally after all in 12 patients. No significant difference was demonstrated between the traction radiography and postoperative correction (P = 0.14). Conclusion: Flexibility obtained at traction radiographs with the patient conscious and UGA is clearly better in numerical values, and closer to the amount of surgical correction than the amount of flexibility at three-points lateral pressure radiographs and side-bending radiographs. This method benefits patients by allowing them to avoid anterior release surgery, assessing the fusion levels and helps predict postoperative correction. Longer follow ups are needed to see whether there is decompensation or not

Purpose: The purpose of this study is to investigate the relationships of traction force, traction time, and hip distraction to the development of nerve conduction abnormalities during hip arthroscopy. Method: Thirteen patients with hip pathology underwent hip arthroscopy. Traction forces applied to the operative leg were measured using a load-cell force transducer. Distraction of the hip joint was assessed using fluoroscopy. Nerve conduction studies of the tibial nerve was performed measuring the latency of the Hoffmann reflex (Hlat reflex). Measurements of the traction force, distraction of the hip, and nerve conduction studies were performed at routine intervals during the procedure, and compared to pre- and post-op values. Results: Nerve Conduction Studies- The mean baseline Hlat reflex was 30.4+/−2.2 milliseconds for all patients. Three patients lost the Hlat reflex immediately (t=0), and an additional three patients lost the Hlat reflex during the procedure (t=30, t=30, t=60). The remaining seven patients all had delayed conduction of the Hlat reflex over time. At one-hour post-op, the Hlat reflex was documented in all patients (mean 31.9+/−2.9 ms) and remained significantly different from baseline (p< 0.01). Clinically, one patient in the lost Hlat reflex group had an associated neuropraxia post-operatively. Traction Forces- The mean initial traction force at time of application for all patients was 97+/−28 lbs. The mean initial traction force of the lost Hlat reflex group and retained Hlat reflex group was 104+/−32.6 lbs and 91+/−24.1 lbs, respectively (p=0.44). Hip Distraction- The mean initial hip distraction at time of application of traction for all patients was 8.8+/−2 mm. The mean initial distraction of the lost Hlat reflex group and retained Hlat reflex group was 9.6+/−1.4 mm and 8+/−2.2 mm, respectively (p=0.15). Conclusion: Traction during hip arthroscopy is associated with significant nerve conduction abnormalities in the immediate post-operative period. Six of thirteen patients had complete loss of the Hlat reflex of the tibial nerve, one of these patients exhibiting clinical neuropraxia. Although length of time in traction may be a factor for the development of nerve conduction abnormalities, a more significant factor may be the change in length over time of the surrounding peripheral nerves

Magnetic resonance imaging (MRI) is the gold standard for the diagnosis of the pathologies affecting the glenohumeral joint and the rotator cuff diseases. MRI allows to highlight anatomic discontinuities of both muscles and tendons. However, MRI diagnostic accuracy has not proven to be highly sensitive in distinguishing between a partial-thickness tear and a full-thickness rotator cuff tear. The purpose of this study was to determine if MRI under axial traction can be helpful in increasing MRI sensitivity to identify partial-thickness rotator cuff tears. The study included 10 patients (4 males and 6 females) who had clinical examination and MRI suggesting a partial-thickness rotator cuff tear. They were candidates for shoulder arthroscopy because of persistent symptoms after at least three months of conservative treatment. The patients underwent a new MRI (under axial traction: MRI-AT) with a 4-kg weight applied to the affected arm. Then the patients underwent arthroscopy to confirm the diagnosis. Patients with a suspected full-thickness rotator cuff tear were excluded from the study. Patients’ average age was 52.4 years, and the dominant side was affected in 77.7% of the cases. Preoperative Constant-Murley Score was 57. MRI-AT showed that 3 patients were affected by a complete tear of the rotator cuff, 3 patients by a partial-thickness rotator cuff tear and 4 patients had no lesion. The analysis of data showed that: under axial traction the subacromial space increased by 0,2 mm (P value = 0,001075), the superior glenohumeral space decreased by 2.4 mm (P value = 0,07414), the inferior glenohumeral space increased by 0.3 mm (P value = 0,02942), the acromial angle decreased by 1.9° (P value = 0,0002104) and the acromion-glenohumeral angle decreased by 0.3° (P-value = 0,01974). Two experienced evaluators analyzed previous standard MRI and MRI-AT scans in a double-blinded fashion, with inter-rater evaluation of all the images and measures. Intraclass correlation coefficient (ICC) has been utilized to assess the reliability of the measures performed by different operators. ICC always resulted in more than 0.7, showing a high concordance among values in the same group. A comparative evaluation between standard MRI and MRI-AT has been conducted to highlight possible discrepancies and this has been compared to intraoperative findings. Concordance of the values was 89% between standard MRI and MRI-AT and 100% between MRI under axial traction and intraoperative findings. This study showed a high correlation between the diagnosis achieved with MRI-AT and the intraoperative arthroscopic findings. The use of MRI-AT in clinical practice may improve the diagnostic sensitivity of this method to detect a partial-thickness rotator cuff tear

Introduction and Objective. Low back pain (LBP) is a major cause of long-term disability in adults worldwide and it is frequently attributed to intervertebral disc (IVD) degeneration. So far, no consensus has been reached regarding appropriate treatment and LBP management outcomes remain disappointing. Spine unloading or traction protocols are common non-surgical approaches to treat LBP. These treatments are widely used and result in pain relief, decreased disability or reduced need for surgery. However, the underlying mechanisms -namely, the IVD unloading mechanobiology- have not yet been studied. The aim of this first study was to assess the feasibility of IVD unloading in a large animal organ culture set-up and evaluate its impact on mechanobiology. Materials and Methods. Bovine tail discs (diameter 16.1 mm ± 1.2 mm), including the endplates, were isolated and prepared for culture. Beside the day0 sample that was processed directly, three other discs were cultured for 3 days and processed on day4. One disc was loaded in the bioreactor according to a previously established physiological (compressive) loading protocol (2h/day, 0.2Hz). The two other discs were embedded in biocompatible resin, leaving the cartilage endplate free to permit nutrient diffusion, and fitted in the traction holder; one of these discs was kept in free swelling conditions, whereas the second was submitted to cyclic traction loading (2h/day, 0.2Hz) corresponding to 30% of the animal body weight corrected for organ culture. Results. The cell viability assessed on lactate dehydrogenase and ethidium homodimer stained histological slides was not different between the three cultured discs. This means that the disc viability was not affected neither by the embedding, nor by the traction itself. Compared to the physiologically loaded disc, the gene expression of COL1, COL2 and ACAN was higher in the nucleus pulposus and inner annulus fibrosus of the traction treated disc. In the outer annulus fibrosus of this disc TAGLN and MKX were higher expressed upon traction than in the physiologically loaded disc. Conclusions. Based on these preliminary data, we can conclude that large animal organ culture allows effective unloading of the disc, while preserving cell viability and modulating cellular gene expression responses. This sets the ground for future experiments and opens the door to an evidence-based improvement of clinical spine traction protocols and LBP management overall

The Poole Traction Splint (PTS) is a non-invasive technique that applies dynamic traction to the affected digit using materials readily available in the outpatient department. The primary aim of this study was to document the outcome of the PTS for hand phalangeal fractures. Over a four-year period (2017–2021), suitable patients were reviewed and referred for PTS to the hand physiotherapists. Functional outcome measures included range of motion (ROM), return to work, and a DASH score. In addition, a healthcare cost analysis was carried out. A total of 63 patients were treated with a PTS from 2017 to 2021. Data was analysed for 54 patients with 55 digits. The mean age was 43 years (17–72) and 53.7% (n=29) were female. There were 43 fractures involving the proximal phalanx and 12 involving the middle phalanx. The mean final composite range of movement averaged 209˚ (110–270°), classified as ‘good/excellent’ by ASSH criteria. The mean DASH score was 13.6 (0-43.2; n=45). All patients were able to return to work. Only two (3.7%) digits required conversion to surgical fixation. The PTS resulted in approximate savings of £2,452 per patient. The PTS is a cost-effective non-invasive low risk outpatient treatment method which provides a functional ROM and good functional outcomes in the treatment of complex phalangeal hand fractures, with minimal risk of surgical intervention being required

Introduction and Objective. The treatment of severe deformities often requiring aggressive techniques such as vertebral resection and osteotomies with high comorbidity. To mitigate this risk, several methods have been used to achieve a partial reduction of stiff curves. The objective of this study was to evaluate and quantify the effectiveness of the Perioperative Halo-Gravity Traction (HGT) in the Treatment of Severe Spinal Deformity in Children. Materials and Methods. A historical cohort of consecutive childs with severe spinal deformity who underwent to a perioperative HGT as a part of the treatment protocol. Minimum follow-up of 2 years. Demographic, clinical and radiological data, including time duration of perioperative HGT and Cobb angle in the coronal and sagittal plane. The radiological variables were measured before the placement of the halo, after placement of the halo, at the end of the period of traction, after surgery and in the final follow-up. Results. Seventeen males (57%) and twenty females (43%) were included in the final analysis. The mean age was 6.5 years (SD 4.8). The most frequent etiology for the spinal deformity was syndromic (13 patients). The average preoperative Cobb angle was 88º (range, 12–135). HGT was used in 17 cases prior to a primary surgery and in 20 cases prior to a revision surgery. After the HGT, an average correction of 34% of the deformity was achieved (p <0.05). After the surgery this correction improved. At 2-year follow-up there was a correction loss of 20% (p <0.05). There were 3 complications (8.1%): 2 pin infections and cervical subluxation. Conclusions. The application of HGT in cases of severe rigid deformity is useful allowing a correction of the preoperative deformity of 34%, facilitating surgery. Preoperative HGT seems to be a safe and effective intervention in pediatric patients with high degree deformity

Purpose: To determine whether skull-femoral traction is a predictor of final surgical correction in scoliosis surgery and obviates the need for anterior release in severe deformities. Methods: 20 patients underwent skeletal femoral traction with a maximum of 50% of their body weight with the use of supracondylar femoral pins. A unilateral pin was used in the presence of pelvic obliquity and bilateral pins in patients with a neutral pelvis. Counter traction was applied through Gardner Well tongs at approximately one third the weight. Pre-op radiographs were compared with dynamic films, intra-op traction films and immediate and final post-operative films. Complications related to traction were recorded. All patients underwent posterior alone surgery for their scoliosis corrections. Results: The mean curve magnitude was 80.3 degrees. NO anterior releases were performed. Intra-operative traction provided a mean correction of 60%. Final surgical correction was 70%. Level pelvis was achieved in all patients with pelvic obliquity. Traction provided up to 80% of the final correction in older adult scoliotics (> 50 yo) thus minimizing the force required on the pedicle screws to achieve correction. No traction related complications occurred. Conclusions: Intra-op skull-femoral traction aides in the correction of severe scoliotic curves. Excellent corrections were achieved without the need for anterior releases. Traction reduced pelvic obliquity in the neuromuscular patients. Reducing the magnitude of the curves facilitated exposure of the posterior spine and minimized forces applied to the pedicle screws during scoliosis correction

Background. Proximal phalangeal fractures are caused by an injury to the dorsum of the hand. This usually causes volar angulation which is unstable when reduced. K-wiring or external fixation can damage the soft tissue envelope, can introduce infection and can loosen or displace. Traction splinting is not well described for these fractures. Objectives. Functional and radiographic assessment of all patients with proximal phalangeal fractures treated with traction splinting. Methods. Theatre records were examined for relevant injuries over a 2 year period. These patients were then assessed using a QuickDASH score, a questionnaire specific to traction splinting and with pre-op, intra-op, post-op and follow-up radiographs. Results. A total of 7 patients were treated with traction splinting, all by the senior author (FJS). Clinical follow was 16 months (range12-20). QuickDASH scores were 0, 0, 0, 0, 0, 2.5, 25/100. With regard to work (n=6), all patients but one scored 0/100 for disability with one patient describing mild work related difficulties. Those participating in sports/performing arts (n=6) scored 0/100. There were no finger-tip pain or numbness issues. Finger length perception was satisfactory in all patients. The splint slipped in 3 patients, secondary to horse riding, showering and through scratching. Two patients reported having a measurable loss of motion in the affected digit (follow-up 18 and 20 months), both with mild functional deficit. Radiographic outcomes showed that traction achieved acceptable length restoration, with no angular deformities. Finger length was maintained in all but one patient who had a shortening of 3.2mm. Conclusions. Traction splinting is a non-invasive, safe and inexpensive method of treating proximal phalangeal fractures. Results of our follow-up study show excellent functional and radiographic outcomes with minimal long term morbidity for this treatment option

Objectives. Femoral shaft fracture treatment often results in mal-alignment and the high dosage of radiation exposure. The objective of this study is to develop a Parallel Manipulator Robot (PMR) on traction table to overcome these difficulties so as achieve better alignment for the fractured femur and reduce radiation to both patients and physicians. Methods. The distal platform of PMR is attached to the central pole on standard traction table by the boot adaptor. A leg model with soft tissue made by Pacific Research Laboratory, Inc. is flexed at the knee with patella on the top. A 2/3 circular ring, with 1/3 open circle down, fixed to the fractured distal femur with one trans-wire and one self-tapping screw, acting as adaptable stirrup fixing scheme. To secure proximal femur, an adapter is assembled on the traction table and fixed on the proximal femur. The distal femur is fixed to the 2/3 circular ring platform of PMR. Surgical planning is performed by first acquiring the bi-planar images from the C-Arm X-ray machine. After simulated fracture on 3-D femoral model is made, proximal and distal segments of the model will be superimposed with background bi-planar images. Finally the pre-fractured length and mechanical axis of 3-D femoral model will be restored. Afterwards, a table of schedule for length adjustments of six struts of PMR is generated. This length adjustment schedule is used to drive the PMR for fractured femur alignment and reduction. When reduction completed, a special designed device is used to fix the reduced femur. Then the PMR is removed from the traction table and the patient can be removed from the traction table. Results. Eight femoral sawbones model were artificially broken into eight different fracture patterns. All the fracture patterns have characteristics of distal segments overlapping with proximal segments but in the different locations. The operations of reduction were all following the initial tractions. The results showed that the mean errors were 1.31+-0.45mm for axial discrepancies, 2.43+-0.49mm for lateral translations, 2.26+-0.23mm for angulations. Conclusion. Femoral Shaft Fracture Reduction with PMR on traction table has been built with femoral soft tissue model. The experiments had been made on artificially broken femoral sawbone models. The experiments had been proven that such approach is accurate enough for femoral shaft reduction. Further experiments are necessary in order for it to be used clinically

Objective. Femoral shaft fracture treatment often results in mal-alignment and the high dosage of radiation exposure. The objective of this study is to develop a Parallel Manipulator Robot (PMR) on traction table to overcome these difficulties so as achieve better alignment for the fractured femur and reduce radiation to both patients and physicians. Method. The distal platform of PMR is attached to the central pole on standard traction table by the boot adaptor. A leg model with soft tissue made by Pacific Research Laboratory, Inc. is flexed at the knee with patella on the top. A 2/3 circular ring, with 1/3 open circle down, fixed to the fractured distal femur with one trans-wire and one self-tapping screw, acting as adaptable stirrup fixing scheme. To secure proximal femur, an adapter is assembled on the traction table and fixed on the proximal femur. The distal femur is fixed to the 2/3 circular ring platform of PMR. Surgical planning is performed by first acquiring the bi-planar images from the C-Arm X-ray machine. After simulated fracture on 3-D femoral model is made, proximal and distal segments of the model will be superimposed with background bi-planar images. Finally the pre-fractured length and mechanical axis of 3-D femoral model will be restored. Afterwards, a table of schedule for length adjustments of six struts of PMR is generated. This length adjustment schedule is used to drive the PMR for fractured femur alignment and reduction. When reduction completed, a special designed device is used to fix the reduced femur. Then the PMR is removed from the traction table and the patient can be removed from the traction table. Results. Eight femoral sawbones model were artificially broken into eight different fracture patterns. All the fracture patterns have characteristics of distal segments overlapping with proximal segments but in the different locations. The operations of reduction were all following the initial tractions. The results showed that the mean errors were 1.31+−0.45mm for axial discrepancies, 2.43+−0.49mm for lateral translations, 2.26+−0.23mm for angulations. Conclusion. Femoral Shaft Fracture Reduction with PMR on traction table has been built with femoral soft tissue model. The experiments had been made on artificially broken femoral sawbone models. The experiments had been proven that such approach is accurate enough for femoral shaft reduction. Further experiments are necessary in order for it to be used clinically

Aim: Supine lateral bending radiographs are the standard methods of evaluating curve flexibility before surgery in idiopathic scoliosis. Supine traction radiographs have also been used at the authors’ institution in addition to the supine lateral bending radiographs before surgery, believing that it is usually more helpful to analyze the response of the main and compensatory curves to corrective forces. The purpose of this prospective study was to use and evaluate the results of traction radiographs taken before general anesthesia (BGA) and under general anesthesia (UGA). Material and Method: 25 patients required surgical treatment with idiopathic scoliosis were evaluated prospectively. Thirteen were female. The average age was 12.87 years. We designed a new electronic traction table in order to take the longitudinal traction and three-points lateral pressure radiographs. We situated the patient on the table and measured the patient’s weight. Then we made a longitudinal and lateral traction while asking the possible neurologic symptoms. If there was not any symptom we stopped at the seventy percent of the patient’s weight for the longitudinal and at the fifty percent for the lateral pressure. These radiographs had been taken before and under general anesthesia (UGA). The influence of the traction radiographies on the decision for surgery and its correlation with postoperative result was examined. Results: Longitudinal traction radiographs taken consciously provided the best amount of flexibility, with no significant difference from traction with the patient UGA (p = 0.17) but with significant difference from bending radiographs (p < 0.002). No significant difference was demonstrated between the traction radiographies taken before and under general anesthesia and postoperative correction (P = 0.14). Conclusion: The curve flexibility in supine traction films taken with the patient BGA was nearly equal to the curve flexibility in supine traction films taken with the patient UGA in all patients and all types of curves. Thus, there is no need to obtain a normal supine traction film for flexibility analysis under general anesthesia. By this way; the surgeons will be able to give the patient a definitive plan before surgery because the decision can be finalized after seeing the traction radiographs with the patient before the general anesthesia and operation time will be shorter

Introduction The efficacy of traction for disc protrusion with neurological deficit, as in published trials, has been disappointing. Yet it is common for patients to experience relief of symptoms during short periods of traction. My thesis is that if traction is helpful, the patient needs to have it every day and preferably a few times a day. Methods This is a pilot study of a simple form of traction equipment which the patient uses at home. The criteria for inclusion of patients in the study has been; (a) diagnosis of disc protrusion with nerve root involvement made on the basis of history and clinical examination (before radiography); (b) evidence of neurological deficit on examination, and (c) findings on MRI Scan consistent with the diagnosis. Seventy one (71) were admitted to the trial, 43 males and 28 females; age range 23 to 60. Prior to referral several patients had already been advised to have surgery; two were actually booked-in for surgery (and both of these improved sufficiently to avoid surgery). Pain intensity and level of disability are detailed. Previous treatment is detailed. Results The majority of patients had significant improvement, as gauged by pain VAS, resumption of work and resumption of recreational activities. Only one patient required surgery. Discussion The home-traction was always supplemented by a gradually upgraded exercise program. Once the patient had been instructed in the use of the home equipment, they would be reviewed at only weekly or fortnightly consultations during the acute phase, hence as the treatment was essentially dependent upon self-help measures at home, the overall cost of this program of treatment for disc protrusion is inexpensive. This pilot study justifies a controlled clinical trial of gravity traction

The perineal traction post has been reported to cause pressure sores, skin necrosis, and pudendal nerve palsy. Tissue pressures of 70 mm Hg applied for two hours have been shown to result in microscopic tissue change whilst pressures of 1.4 kg/cm. 2. for 90 minutes produced severe or complete nerve conduction block. To demonstrate perineal traction post interface pressures. To assess effect of padding type on these pressures. Healthy volunteers were positioned supine on the traction table with the right lower limb supported in flexion and abduction. Longitudinal traction of 40kg was applied to the left lower limb through the boot. Pressures were measured using a pressure pad consisting of individual calibrated inch square pressure cells. The pad was placed around the traction post. Five different types of padding were used on a standard traction post. These were: gamgee, small gel pad, 10cm gel bolster, 10cm soft foam roll and 10cm hard foam roll. With each device, the leg was positioned in neutral, internal rotation, external rotation and adduction. Pressure readings and pain scores were recorded with each manoeuvre. Maximum pressures were experienced with the gamgee wrap. All subjects noted their highest pain score here. Peak pressures of 100 mm Hg were demonstrated over the ischial tuberosity and adductor tendons. The larger padding devices resulted in significantly lower pressures. Of the different positions, adduction was that which resulted in highest pressures and pain scores, though this was not significant. The highest pressures exceeded the 70 mm Hg limit known to cause tissue damage. These pressures can be reduced with alteration of the padding. In all procedures it is important to pad the post carefully and use adducted positions for as short a time as possible

The purpose of this study is to introduce our treatment by skeletal traction in brace and to report the safety and easiness of this method and low incidence of cubitus varus. In 1980 we developed a specially designed brace for treating the supracondylar fracture, along with a technique of spontaneous reduction by skeletal traction to develop an easy and safe treatment. The brace is made of plastics and aluminum alloy that are radiolucent. The humeral slide bar with attached axillary pad can be moved up and down to adjust the height of the upper arm for each patient. From 1980 to 1999 we have treated 190 children with displaced supracondylar fracture of the humerus. Their ages ranged from 2 to 14 years old and average of age was 7 years old. The fractures occurred most frequently between the ages of 5 to 6. More boys than girls were injured and the left elbow were more often than the right. Among 190 cases, severely displaced cases were most common. (64%) and moderate case 20%, mild case 16%. The period of follow up was 6 months to 11 years, mean 4 years. Placing the arm in the brace with the elbow flexed at right angle, unstable fracture site will be stabilized first. Skeletal traction is performed by a spring through the winged screw. The traction is maintained for three to four weeks. Spontaneous reduction of the displaced fragment can be expected and we emphasize that any manipulative technique is not performed during the treatment at all. Among 190 patients, cubitus varus occurred in only 3 (1.6%) cases because of technical failure. All patients except one obtained excellent functional results, one had 25 degrees of limitation of the elbow flexion. There were no vascular problems or Volkmann’s contracture and ectopic ossification. The results were satisfactory. Our treatment utilizing the brace and skeletal traction for supracondylar fracture of the humerus in children is safe and effective in preventing cubitus varus

Purpose: To analyse middle-term outcomes of treatment of patients with congenital luxation of hip using modified overhead traction. Material and Methods: During the years 1991–2001, a total of 116 patients (138 hip joints) were treated. The group comprised 99 girls and 17 boys with the average age 4.7 months (ranging from 1.5–11 months). Patients were divided into two subgroups: patients who have been treated at our department from the determination of the diagnosis and those referred to our department from other facilities after unsuccessful conservative therapy. Only those patients were evaluated in whom the traction therapy was completed at least 2 years ago, the mean follow-up period was 4.5 years (2–10). After the initial preparatory horizontal traction, we moved to a 4-week overhead regimen wherein we increased the abduction by 10 degrees every five days. After completing the dystraction, every hip joint was examined using arthrography and where the reposition was possible, the therapy continued with the fixation in plaster spike for 6 weeks. Pavlik harnes were used for the final phase of the treatment. Results: In the group of primarily treated patients, reposition was successful in 78 out of 91 hip joints (85.7%). In another 4 hip joints (4.4%), reluxation occurred after an average period of 3.5 weeks after the removal of the spike. Nine hip joints (9.9%), 7 of type IV and 2 of type IIIB, were non-repositionable. Much worse results were achieved in the group of patients who received previous treatment. Only 12 hip joints (25.5%) were maintained permanently repositionable but neither of them was of type IV. Reluxation within two weeks after the removal of the fixation occurred in another 5 hip joints (10.6%). A total of 30 hip joints (63.9%) could not be reposed due to arthrographic findings of reposition obstacles. All these patients were admitted for treatment after the 6th month of age. We have observed no case of avascular head necrosis in the group of 90 patients who received conservative treatment. Conclusion: Traction therapy is a safe and mild method of treatment for congenital luxation of the hip joint. The rate of success of the therapy depends on the sonographic findings and age of patients at the beginning of therapy. Considerably worse results are achieved in the group of patients who have already received unsuccessful inadequate treatment

Background and purpose: Lumbar traction is a common treatment for LBP with radiculopathy. Despite this, its benefits remain to be established. This paradox has significant economic and therapeutic consequences as 3–10% of patients with LBP in the UK have radiculopathy and over 40% of UK physiotherapists use this approach (Harte et al 2005). The purpose of this pragmatic randomised clinical trial was to assess the benefit of lumbar traction in addition to a manipulation package with these patients in a manner that reflects clinical practice. Methods: 30 patients meeting the inclusion criteria for lumbosacral radiculopathy were recruited from the NHS and randomly assigned to one of two treatment groups: Group 1 received manipulation, advice and exercises; Group 2 received traction, manipulation, advice and exercises. Outcome measures were recorded at baseline, completion of treatment and at 3 and 6 months post completion of treatment (MPQ, RMDQ, SF36, and the ALBPSQ). In addition VAS scores for back and leg pain and the percentage of overall improvement (patients perception) were recorded after each treatment. Results: 30 patients were recruited over an 11-month period: 40% male, mean age 44 years, mean duration of current episode 7 weeks. Post treatment results (n = 27) showed a significant improvement in all outcomes for both groups (paired t-test, p > .01) but there was no significant difference demonstrated between groups (ANCOVA). Conclusion: This pilot study demonstrates the feasibility of a trial with this sub-group of LBP patients and a large multi-centred trial would need to be conducted to fully address this research question

Introduction: To compare olecranon screw traction with percutaneous pinning for the treatment of Gartland III supracondylar fractures in children. Methods: This was a retrospective study of 151 patients between 1986 and 1996 treated with olecranon screw traction and 92 patients between 1996 and 2002 treated with percutaneous pinning. Both sets of patients were followed up clinically and radiologically following their injuries until there was evidence of fracture union and the child could demonstrate a satisfactory range of movement. Data recorded included demographics, fracture information, neurovascular injury, operation details, length of stay, length of follow up and clinical outcome. Radiographs were used to measure initial and final Baumann angles to give an indication of outcomes of distal humerus alignment. Results: Results are shown for the percutaneous pinning group with the olecranon screw traction results in brackets for comparison. The percutaneous pinning study included 54 (88) males and 38 (63) females with 63% (63%) left and 37% (37%) right elbow fractures. 46% (29%) of fractures occurred at home, 46% (56%) sustained the injury whilst playing and 7% (7%) occurred at school/nursery. The mean age was 6.0 (6.8) years with a range of 21–165 (12–168) months. The radial pulse was absent in 12% (13%). None of the fractures were open (compared with 5%). There were neurological deficits in 20% (17%). The median time to surgery was 5 hours. The fracture needed to be opened in 12% of cases as satisfactory reduction could not be achieved closed. The median stay length was 1 day (compared to a median stay on traction of 14 days). Mean follow up was 15.2 weeks. (Compared to 38.0 weeks). 2 % (3%) had cubitus varus detectable clinically. Median time to recovery for neurological deficit was 24 weeks (18 weeks). Mean initial Baumann’s angle was 74.6 degrees (73.7degrees). Mean final Baumann’s angle was 75.3 degrees (76.0 degrees). Discussion: Outcomes achieved from percutaneous pinning of displaced supracondylar fractures are similar to those from olecranon screw traction. The advantage of percutaneous pinning to both patient and provider is the reduced hospital stay and duration of follow up. Olecranon screw traction remains a possible treatment option for the management of this injury

Study Design: Prospective Cohort Study. Summary of Background Data: It has previously been suggested that fulcrum bending radiographs (Cheung et al Luk 1997) and traction radiography under anaesthetic (Davis et al 2003) predict the flexibility and correction obtained following surgery better than conventional supine bending radiographs. Objective: To compare fulcrum bending radiographs and traction radiographs for the prediction of surgical correction of idiopathic scoliosis. Subjects: The study was based on 16 patients with a diagnosis of idiopathic scoliosis who underwent corrective surgery. Outcome measures: The Cobb angle of the major curve was compared on the standing AP and fulcrum bending radiograph taken in the pre-op assessment clinic, the traction film undertaken under anaesthetic immediately prior to surgery and the first post operative standing radiograph taken. The post operative correction of the major curve was analysed using regression techniques and adjusted for the base line curve angle of the major curve. Results: The results were presented as an estimate of the parameter coefficient in the model associated with 95% confidence intervals. The median pre-operative Cobb angle of the major curve was 69 degrees, on the fulcrum bending film was 47 degrees, on the traction film was 30 degrees, and on the first post operative film was 30 degrees. There was no evidence to suggest that the fulcrum Cobb had an effect on the post operative correction of the major curve. There was however evidence to suggest that the traction Cobb angle had an effect on the post operative correction of the major curve (parameter estimate 0.87) 95% CI (0.174, 1.399), T value = 2.83, P = 0.016. Conclusion: Traction radiographs under anaesthetic better predict the surgical correction obtained in adolescent idiopathic scoliosis compared to fulcrum bending radiographs. These two techniques have not been directly compared before

Aim:. To review the use of traction x-rays under anaesthesia in Late Onset Scoliosis to correlate traction x-ray flexibility and postoperative correction using posterior nonsegmental all pedicle screw constructs. Methods:. Prospective study. Preoperative anteroposterior, lateral and side bending x-rays were done and Cobb angles were measured. Intraoperatively, traction anteroposterior x-rays were taken under anaesthesia and Cobb angles were measured. All patients underwent nonsegmental posterior all pedicle screw construct correction using Biomet implants. Cobb angles greater than 60 degees were included in the study. Calculations were done including correction rate, traction flexibility and traction correction index. Results were entered onto an excel spreadsheet and analyzed using Statistica software. Results:. 16 patients were studied, 3 boys and 13 girls, average age 14, ranging from 8 to 17 years. Preoperative Cobb angles were mean 82 (60 to 105) degrees. Traction x-rays mean Cobb angle was 42 degrees with mean traction flexibility rate 49%. Mean correction rate was 65% and mean traction correction index 106. Preoperative Cobb angles correlated with traction flexibility with a p value of 0.01. Traction x-rays Cobb angle correlated with the traction correction index (p = 0.003), postoperative x-rays (p = 0.000) and also with correction rate (p = 0.024). There was no correlation between preoperative Cobb angle and correction rate. Conclusion:. Traction x-rays under anaesthesia in late onset scoliosis are a good predictor of postoperative correction with posterior nonsegmental all pedicle screw constructs in curves greater than 60 degrees

Aim:. To compare the ability of fulcrum bend and traction radiographs to predict correction of AIS using pedicle screw only constructs and to compare the fulcrum bending correction index (FBCI) with a new measurement: the traction correction index (TCI). Method:. Retrospective radiographic analysis of eighty patients, average age 14 yrs, who underwent posterior correction of scoliosis using pedicle screw only construct. Analysis was carried out on the pre-op and immediate post-op PA radiographs and the pre-op fulcrum bend and traction radiographs. Correction rate, fulcrum flexibility, traction flexibility, FBCI and TCI was calculated. Results:. Preoperative mean Cobb angle of 63.9 degrees was corrected to 25.8 degrees postoperatively. The mean fulcrum bending Cobb angle was 37.6 degrees and traction Cobb angle 26.6 degrees. The mean fulcrum flexibility was 41.1%, traction flexibility 58.4% and correction rate 59.6%. The mean FBCI was 144.9% and TCI was 102.1%. Discussion:. Radiographic correction of scoliosis based on correction rate does not take into consideration the curve flexibility. It has been suggested by Cheung et al, that fulcrum bending radiographs predict curve correction in AIS. Ibrahim et al, have questioned this, and they suggested that traction radiographs are more predictive in a mixed group of patients with hybrid and screw only constructs. Conclusions:. When comparing fulcrum bend and traction radiographs, we found the latter to be more predictive of curve correction in AIS using pedicle screw constructs. The TCI better takes into account the curve flexibility than the FBCI. Conflict Of Interest Statement: No conflict of interest