Rigid External Distraction with Intranasal Bone-borne Traction Hooks for Midfacial Hypoplasia.

Rigid external distraction is currently performed to correct cases of severe maxillary hypoplasia. As an improvement of this technique, we propose the use of an intranasal bone-borne traction hook. This study is a retrospective chart review of the intranasal bone-borne traction hooks used in the treatment of severe maxillary hypoplasia. There were 110 patients treated with the hooks from 2005 to 2017. The maximum traction force was 7.75 kg, and there were few complications encountered during distraction. There were 76 patients who had the hooks removed under local anaesthesia. A cephalometric analysis was conducted in 56 patients. The average advancement of A-point was 9.9 ± 4.2 mm, 8.4 ± 2.5 mm, 11.0 ± 3.7 mm, 17.9 ± 4.4 mm for the trans-sutural distraction osteogenesis (DO), maxillary anterior segment DO, Le Fort I osteotomy DO and Le Fort III/II osteotomy DO, respectively. The average changes of sella-nasion-point A (SNA) were 8.89 ± 4.30 degrees, 8.21 ± 3.17 degrees, 10.49 ± 3.26 degrees, and 15.10 ± 4.00 degrees, respectively. The A point-nasion-B point (ANB) also showed increases in all procedures with P < 0.001. In conclusion, this technique sufficiently advances the midface and ensures the scars are concealed in the nasal base. The traction hook can bear a large traction force, causes minimal complications and is easily removed.

The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study.

BACKGROUND: Cervicogenic dizziness is a disabling condition commonly associated with cervical dysfunction. Although the growing interest with the importance of normal sagittal configuration of cervical spine, the missing component in the management of cervicogenic dizziness might be altered structural alignment of the cervical spinal region itself. AIM: To investigate the immediate and long-term effects of a 1-year multimodal program, with the addition of cervical lordosis restoration and anterior head translation (AHT) correction, on the severity of dizziness, disability, cervicocephalic kinesthetic sensibility, and cervical pain in patients with cervicogenic dizziness. DESIGN: A randomized controlled study with a 1 year and 10 weeks' follow-up. SETTING: University research laboratory. POPULATION: Seventy-two patients (25 female) between 40 and 55 years with cervicogenic dizziness, a definite hypolordotic cervical spine and AHT posture were randomly assigned to the control or an experimental group. METHODS: Both groups received the multimodal program; additionally, the experimental group received the Denneroll™ cervical traction. Outcome measures included AHT distance, cervical lordosis, dizziness handicap inventory (DHI), severity of dizziness, dizziness frequency, head repositioning accuracy (HRA) and cervical pain. Measures were assessed at three time intervals: baseline, 10 weeks, and follow-up at 1 year and 10 weeks. RESULTS: Significant group × time effects at both the 10 week post treatment and the 1-year follow-up were identified favoring the experimental group for measures of cervical lordosis (P<0.0005) and anterior head translation (P<0.0005). At 10 weeks, the between group analysis showed equal improvements in dizziness outcome measures, pain intensity, and HRA; DHI scale (P=0.5), severity of dizziness (P=0.2), dizziness frequency (P=0.09), HRA (P=0.1) and neck pain (P=0.3). At 1-year follow-up, the between-group analysis identified statistically significant differences for all of the measured variables including anterior head translation (2.4 cm [-2.3;-1.8], P<0.0005), cervical lordosis (-14.4° [-11.6;-8.3], P<0.0005), dizziness handicap inventory (29.9 [-34.4;-29.9], P<0.0005), severity of dizziness (5.4 [-5.9;-4.9], P<0.0005), dizziness frequency (2.6 [-3.1;-2.5], P<0.0005), HRA for right rotation (2.8 [-3.9;-3.3], P<0.005), HRA for left rotation (3.1 [-3.5;-3.4, P<0.0005], neck pain (4.97 [-5.3;-4.3], P<0.0005); indicating greater improvements in the experimental group. CONCLUSIONS: The addition of Denneroll™ cervical extension traction to a multimodal program positively affected pain, cervicocephalic kinesthetic sensibility, dizziness management outcomes at long-term follow-up. CLINICAL REHABILITATION IMPACT: Appropriate physical therapy rehabilitation for cervicogenic dizziness should include structural rehabilitation of the cervical spine (lordosis and head posture correction), as it might to lead greater and longer lasting improved function.

Richard's back: death, scoliosis and myth making.

The body of a mediaeval monarch was always under scrutiny, and Richard III's was no exception. In death, however, his body became subject to new forms of examination and interpretation: stripped naked after the battle of Bosworth, his corpse was carried to Leicester and exhibited before being buried. In 2012, it was rediscovered. The revelation that Richard suffered from scoliosis prompts this article to re-evaluate the historical sources about Richard's physique and his posthumous reputation. This article argues that Richard's death and his myth as 'crookback' are inextricably linked and traces attitudes to spinal curvature in the early modern period. It also considers how Shakespeare represented Richard as deformed, and aspects of performance history which suggest physical vulnerability. It then considers Richard's scoliosis from the perspective of medical history, reviewing classical accounts of scoliosis and arguing that Richard was probably treated with a mixture of axial traction and pressure. It demonstrates from the evidence of Richard's medical household that he was well placed to receive hands-on therapies and considers in particular the role of his physician and surgeon, William Hobbes. Finally, it shows how the case of Richard III demonstrates the close relationship between politics and medicine in the period and the contorted process of historical myth making.

Treatment of 94 outpatients with chronic discogenic low back pain with the DRX9000: a retrospective chart review.

BACKGROUND: This study's goal was a retrospective chart audit of 100 outpatients with discogenic low back pain (LBP) lasting more than 12 weeks treated with a 2-month course of motorized spinal decompression via the DRX9000 (Axiom Worldwide, Tampa, FL, U.S.A.). METHODS: Patients at a convenience sample of four clinics received 30-minute DRX9000 sessions daily for the first 2 weeks tapering to 1 session/week. Treatment protocol included lumbar stretching, myofascial release, or heat prior to treatment, with ice and/or muscle stimulation afterwards. Primary outcome was verbal numerical pain intensity rating (NRS) 0 to 10 before and after the 8-week treatment. RESULTS: Of the 100 initial subjects, three withdrew their protected health information, and three were excluded because their LBP duration was less than 12 weeks. The remaining 94 subjects (63% female, 95% white, age = 55 (SD 16) year, 52% employed, 41% retired, LBP median duration of 260 weeks) had diagnoses of herniated disc (73% of patients), degenerative disc disease (68%), or both (27%). Mean NRS equaled 6.05 (SD 2.3) at presentation and decreased significantly to 0.89 (SD 1.15) at end of 8-week treatment (P < 0.0001). Analgesic use also appeared to decrease (charts with data = 20) and Activities of Daily Living improved (charts with data = 38). Follow-up (mean 31 weeks) on 29/94 patients reported mean 83% LBP improvement, NRS of 1.7 (SD 1.15), and satisfaction of 8.55/10 (median 9). CONCLUSIONS: This retrospective chart audit provides preliminary data that chronic LBP may improve with DRX9000 spinal decompression. Randomized double-blind trials are needed to measure the efficacy of such systems.

New carpal ligament traction device for the treatment of carpal tunnel syndrome unresponsive to conservative therapy.

UNLABELLED: This study evaluated the treatment efficacy and patient satisfaction of a new hand traction device called C-TRAC in patients that failed conservative therapy for carpal tunnel syndrome (CTS). Patients were diagnosed with electromyography and nerve conduction studies. Only patients with a positive Phalens test and a Visual Analog Scale (VAS) of more than 5/10 were eligible for the study. The patients had tried nonsteroidal anti-inflammatory drugs (NSAIDS), resting hand splint during the night, acupuncture, and hand therapy for a minimum of four months. To test C-TRAC as the sole treatment for CTS, patients included in the study stopped all other forms of therapy (NSAIDS, hand therapy, acupuncture, massage, manipulations, and steroid injections). A group of 19 patients used C-TRAC hand traction device for 5 minutes three times daily for four weeks. After the four-week period the device was used as needed. The patients were followed up weekly for four weeks, then at seven months. VAS was used to assess pain, tingling, and numbness in the treated hand. The number of times patients woke up at night and satisfaction with the use of the device were also evaluated. The average VAS for pain decreased from 8.53 to 1.05. The average tingling decreased from 8.15 to 0.95. The average numbness decreased from 8.47 to 0.95. The average number of times patients woke up per night because of CTS symptoms decreased from 3.05 to 0.10. Patients showed significant improvement at four weeks and results were maintained at seven months follow-up. Fifteen patients (79%) rated their treatment as excellent and four (21%) as good and none (0%) as fair or poor. CLINICAL RELEVANCE: This device is very effective and well tolerated in treatment of CTS in patients that failed conservative therapy.

[Prevention of urethral stricture after transurethral vaporesection of prostate by adjustable urethral tractor].

OBJECTIVE: To reduce the complication by transurethral vaporesection of prostate (TUVP) using adjustable urethral tractor. METHODS: One hundred and six cases with benign prostate hypertrophy underwent TUVP and catheter traction after operation by an adjustable tractor. The results by catheter traction were compared with those by rubberized cloth paste and carbasus compression. RESULT: The urethral stricture occurred in 2.7%, 6.7%, 30.4% of cases by the catheter traction, rubberized cloth paste and carbasus compression respectively, which had statistical significance (P <0.01). CONCLUSION: The incidence of urethral stricture can be reduced by catheter traction after TUVP.

[A novel device for active shoulder rehabilitation with glenohumeral traction or compression]. / Ein neuartiges Gerät zur aktiven Schulterrehabilitation unter glenohumeraler Traktion oder Kompression.

The equipment available for rehabilitation of patients with joint conditions still lacks a device that, in common with usual physiotherapeutic measures (manipulation, proprioceptive neuromuscular facilitation, Bobath therapy), is based on traction and/or compression or oscillating forms. The novel "Shoulder Rotator" is such a simple device for the variable treatment of shoulder disorders in all three spatial dimensions. After individual instruction, the patient performs rotating glenohumeral exercises with simultaneous glenohumeral joint traction, compression, or oscillations against static or dynamic resistance. The "Shoulder Rotator" is similar to the established continuous passive motion device for the shoulder and is mounted on a mobile chair. The electronic device control is computerised and permits a wide variety of treatment options, individual regimes, and documentation. The oscillating, compression/distraction mode of operation provides an analgesic effect. The isolated compression mode along the rotatory axis enables conditioning of joint proprioception. The distraction mode along the rotatory axis facilitates muscular relaxation. Resistive rotatory exercises strengthen the rotatory glenohumeral muscles and help centre the humeral head in the glenoid. In addition to the advantage of adding documentation of treatment progress as required for evidence-based medicine, this novel device may bring about a cost-effective, genuine quality improvement in shoulder rehabilitation.

Simultaneous multiple-modality therapy for tension headaches and neck pain.

Eighty-one patients suffering from neck pain and tension-type headaches were treated by the application of a unique physical therapy device combining transcutaneous electrical nerve stimulation (TENS), traction, massage, vibration, and acupressure applied to the forehead, posterior cervical spine, and scapula. The device employed eight silver silicone electrodes for modality application. Its safety and effectiveness were assessed by evaluating patients before and after treatment. No complication ensued. Statistical analysis of visual analog scales for neck pain and headache yielded p values < 0.0001. Analysis of fibromyalgia neck and shoulder trigger points with three controls gave nonsignificant results. Conclusions were that 1) the device is safe and effective as judged by subjective patient input and 2) fibromyalgia trigger points are unaffected by the treatments. More objective measures are needed to provide evidence of efficacy.

Clinical trial of a cervical traction modality with electromyographic biofeedback.

A new design of cervical traction modality with closed loop traction weight control based on electromyographic (EMG) biofeedback was developed. It consists of the development of a high signal-to-noise ratio EMG scanner, on-line self-adjusted traction weight controller, computer interface hardware, and closed loop biofeedback control software. Six healthy, young adults received conventional cervical traction to establish basic information of cervical EMG activities. Twenty-four patients with cervical radiculopathy were randomly divided into two groups for clinical assessment by conventional and new EMG biofeedback traction modality. The average electromyographic activity in healthy subjects ranged from 2.41 to 3.49 microV, whereas EMG activity in patients with neck pain ranged from 4.75 to 6.97 microV. There was a significant decrease of EMG activity during the whole traction phase, especially at pull phase in healthy subjects, but it was not as significant in patients with cervical radiculopathy. There was no significant change of myoelectric activity in the paraspinal muscles at vertebral levels C1-2, C3-4, and C5-6. Comparison of the average EMG activity of the paraspinal C-5 muscle in different phases of cervical traction showed a more significant decrease of EMG activity during the pull phase of traction as well as after traction in the high muscle tension group (with EMG activity above 5 microV), especially with the biofeedback traction modality. The raised traction force from start to optimum was shortened from 4 to 2 wk to achieve the same effective outcome by biofeedback as conventional traction modality.

Design and assessment of an adaptive intermittent cervical traction modality with EMG biofeedback.

An intermittent cervical traction modality with closed-loop traction force control based on EMG biofeedback was developed and used for clinical study. This system consists of a EMG scanner, on-line self-adjusted traction force controller, audio/video alarm system, real time therapeutic status display, computer interface hardware, and control software. Twenty-four subjects with diagnosed cervical radiculopathy and muscle spasm symptom who were randomly divided into two groups served as subjects in this study. The control and experimental groups were treated with conventional open loop and new EMG biofeedback closed loop traction control protocols respectively. The results of this study indicate that the average reductions in paraspinal EMG signal during traction after 7 weeks treatment for experimental and control groups were 71 and 50 percent, respectively (p < 0.001). These results not only support the clinical use of intermittent, sitting traction to produce cervical paraspinal muscle relaxation, but also revealed that the average myoelectric activity of cervical paraspinal muscle during traction was reduced as traction force increased over the 7-week duration of traction treatment. Through EMG biofeedback traction force control, muscle injury, neck soreness, or pain after traction may be avoided.

[Commentary on the article "Is the mechanical traction of the cervical spine still acceptable?" by R. Dorian ]. / Stellungnahme zu dem Beitrag "Ist die apparative Traktion der HWS noch zu befürworten?" von R. Dorian.

Referring to literature Dorian reported on severe complications after apparative traction of the cervical vertebral column up to cross-sectional paralysis and sudden death during treatment. Based on these reports he presents a list of contraindications which comprises nearly all diseases of the cervical vertebral column. The author summarizes his statements claiming that the apparative traction at no means can be a routine method because of it's inherent extreme risks. The comment in hand states that none of the complications claimed have been exemplified by the author in the original paper. Neither authors are named in the text, nor such complications are mentioned in the papers cited in the publication index. A request to the author for completion of literature proofs remained negative. Such complications were also not encountered by 36 orthopedic surgeons in practice who together survey 375 years of treatment with this method. On the contrary a corresponding inquiry yielded that in opposition to the statement of Dorian the apparative traction of the cervical vertebral column is indeed a widely spread standard method in orthopedic practice. The incidents claimed are also unknown to various experts an to importers of traction devices neither from their own experience nor from the literature. Consequently none of the essential statements in Dorian's contribution is proven and therefore the conclusions are unallowable.

Neurological complications of dynamic reduction of Colles' fractures without anesthesia compared with traditional manipulation after local infiltration anesthesia.

To investigate whether or not injection of local anesthetic into the fracture hematoma on reduction of a Colles' fracture increases the risk of neurological complications, a prospective randomized trial was conducted. The outcome in 62 patients whose Colles' fractures were reduced in a new bone-alignment device without anesthesia was compared with that in 54 patients with Colles' fractures that were reduced manually after injection of local anesthetic. At follow-up, any symptoms and signs of nerve damage were recorded. Four cases of such damage were noted in the group treated without local anesthesia, as opposed to 14 in the group in which a local anesthetic was used. The difference is significant (p less than 0.01). The authors have previously shown that injection of local anesthetic into the hematoma of Colles' fractures increases the carpal tunnel pressure. Neurological complications after the use of local anesthesia in reducing Colles' fractures is considered to be secondary to the scarring and fibrosis caused by this increase in pressure.

[Harrington's surgical treatment of scoliosis]. / Die operative Behandlung der Skoliose nach Harrington.

In spite of intensive conservative treatment of scoliosis operation is almost necessary. Indication for operation is given by progression of scoliosis by angles over 50 degrees. In our hospital the method according to Harrington combined with the Cotrel transverse compression device is carried out. We report on our experiences over 13 years. Complications were exactly put to record.

[A fitting tool for the halo (author's transl)]. / Halo-Setzgerät

A simple fitting tool for placing the halo under local anesthesia is described.