- MeSH
- krční obratle * patofyziologie patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- svalová síla fyziologie MeSH
- terapie cvičením metody MeSH
- trakce klasifikace metody MeSH
- výhřez meziobratlové ploténky * diagnóza rehabilitace MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- dítě MeSH
- fixace fraktury metody MeSH
- fraktury kostí * terapie MeSH
- imobilizace metody MeSH
- konzervativní terapie metody MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- trakce metody MeSH
- uzavřená repozice fraktury metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- lidé MeSH
- obvazy * klasifikace škodlivé účinky MeSH
- sádrové obvazy škodlivé účinky MeSH
- trakce metody škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY The paper aimed to evaluate the long-term outcomes of the treatment of diaphyseal femur fractures in children treated with Bryant's vertical traction. Moreover, we also assessed the size of overgrowth in the injured femur. MATERIAL AND METHODS The study included 23 patients with 23 femoral shaft fractures treated with Bryant's vertical traction at our department in 2009-2014. The following parameters were assessed: sex, ïnjured side, weight, age, mechanism of injury, potential abuse, type of fracture, duration of traction, and total length of hospital stay. The healing time of the fracture was the same as the duration of traction. Also assessed was the size of femoral shortening after the removal of traction, the presence of skin complications in the course of treatment and potential development of compartment syndrome. At the mean follow-up of 47.8 months (range 22-85 months) from the date of injury the patients were evaluated clinically and radiologically for: length of limbs, presence of rotational deformity, range of motion of knee and hip joints, potential pain or limping, potential scoliosis of the spine and presence of scars after traction. Finally, through a questionnaire we learned about the opinions of parents as to the treatment method and about the possibility of home traction. RESULTS All the fractures healed. There was a total of 17 injured boys and 6 injured girls. Whereas 12 patients sustained a fracture of the left femur, 11 patients sustained a fracture of the right femur. The mean weight of patients at the time of injury was 13.9 kg (range 5-20 kg). The mean age at the time of traction was 30.8 months (range 1-70 months). The injury most frequently occurred from various falls, altogether in 15 cases (65.2%). Traffic accidents were registered as the cause of injury in 3 cases (13%). No abuse was confirmed. The average duration of traction was 19.8 days (range 8-26 days). The total length of hospital stay took on average 23.6 days (range 9-33 days). Skin excoriation and bullae due to irritation by the traction occurred in 21 children (91.3% cases). All the bullae healed, in 4 (17.4%) patients minor scars of 1x1 cm in size were formed around ankles. Not a single patient developed the compartment syndrome. The average femoral shortening after the removal of traction was 0.8 cm (range 0-2.3 cm). The follow-up examination, performed on average 47.8 months (range 22-85 months) from the date of injury revealed the average discrepancy of spinomalleolar distances in both the lower limps of 0 cm (range -1 to 1 cm). Radiographically measured lengths of both the femurs showed the average difference of 0 cm (range -1.4 to 0.9 cm). The resulting average overgrowth of injured femur was 0.9 cm (range 0.1 to 3.2 cm). Scoliosis of the spine was not reported in any of the patients. In 3 patients femur alignment demonstrated rotation, namely an external rotation of 10° in all the cases. All the children demonstrated full hip and knee joint mobility, identical to the uninjured side. After a heavy load one patient reported pain in the thigh and one walked with limp. The other patients showed no problems whatsoever. Treatment with the use of Bryant's traction was well tolerated by parents. Altogether 15 parents (65.2%) would opt for the same treatment method in case of a recurrent injury. The home traction option would be welcomed by 17 parents (73.9%). DISCUSSION The treatment by Bryant's vertical traction is condemned in Anglo-Saxon countries due to the risk for developing compartment syndrome, described in earlier studies. Neither our cohort, nor more recent studies reported the occurrence of compartment syndrome. The most frequent complication faced in our study was the skin complications underneath the traction, namely in a total of 91.3% of patients. In the literature, the other authors only make references to bullae occurrence, but do not provide any further specifications. Overgrowth after femoral shaft fractures is a very well described phenomenon. The size of femoral overgrowth described in our study was similar to that referred to in the available literature. A method frequently used abroad is the so-called home traction. This method, however, has so far failed to take root in our country, even though this therapeutic technique would be appreciated by parents. CONCLUSIONS The treatment of femoral shaft fractures by Bryant's vertical traction, in children up to the weight of 15 kg, is a simple and safe method with excellent functional outcomes and minimum serious complications. When treating the children with the body weight more than 15 kg, the risk of bullae formation increases, therefore in this weight category treatment shall be decided upon on a case by case basis. The resulting average overgrowth of injured femur was 0.9 cm which corresponds with the findings of other authors. The treatment method using the Bryant's traction is well tolerated by parents, even though most of them would welcome the option of home traction. Key words: traction, femur fracture, overgrowth, children.
- MeSH
- délka pobytu MeSH
- dítě MeSH
- dopravní nehody MeSH
- fraktury femuru terapie MeSH
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- trakce metody MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- ambulantní péče * metody organizace a řízení pracovní síly využití MeSH
- délka pobytu * MeSH
- dospělí MeSH
- fraktury femuru * diagnóza terapie MeSH
- jednotky intenzivní péče o novorozence * MeSH
- klíční kost * zranění MeSH
- kojenec MeSH
- komplikace porodu * MeSH
- lidé MeSH
- matky * výchova MeSH
- motorické dovednosti * fyziologie MeSH
- neurologie * MeSH
- novorozenec * MeSH
- ortopedické výkony * metody využití MeSH
- ortopedie * MeSH
- paréza * MeSH
- plexus brachialis * abnormality chirurgie patologie MeSH
- poloha plodu koncem pánevním * MeSH
- porodní poranění novorozence * MeSH
- přechodná tachypnoe novorozence * MeSH
- předškolní dítě MeSH
- propuštění pacienta * MeSH
- reflexní terapie * využití MeSH
- rehabilitace * MeSH
- těhotenství MeSH
- trakce * metody využití MeSH
- tramadol * aplikace a dávkování terapeutické užití MeSH
- zákroky plastické chirurgie MeSH
- Check Tag
- dospělí MeSH
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec * MeSH
- předškolní dítě MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
The authors describe their experience with treatment of two neurologically intact male patients, aged 70 and 74 years, presenting with combined lateral atlanto-axial dislocation and odontoid type II fracture. The mechanism of these two craniovertebral junction injuries had been lateroflexion of the neck. The initial attempt at closed reduction using axial traction failed. The authors succeeded with a closed reduction maneuver under general anaesthesia in the first patient in whom long-term stability was achieved by transarticular C2-C1 fixation, together with interlaminar fusion. In the second patient, closed reduction was unsuccessful due to intra-articular soft tissue interposition. Release and reduction were achieved by instrumentation of C1 lateral masses and transpedicular anchorage of screws into the C2.The subsequent Harms C1-C2 stabilisation proved to be effective both in achieving long-term stability and segmental fusion of lateral masses. Aspects of biomechanics as well as a review of pertinent literature are presented.
- MeSH
- atlas (obratel) chirurgie zranění MeSH
- axis chirurgie zranění MeSH
- dens axis * chirurgie zranění MeSH
- dislokace kloubu * diagnóza etiologie chirurgie MeSH
- fixace fraktury * metody MeSH
- fraktury páteře diagnóza etiologie chirurgie MeSH
- krční obratle chirurgie zranění MeSH
- lidé MeSH
- ortopedické výkony metody MeSH
- senioři MeSH
- trakce metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- novorozenecký screening MeSH
- ortopedické výkony metody MeSH
- trakce metody přístrojové vybavení MeSH
- ultrasonografie metody MeSH
- vývojová kyčelní dysplazie * diagnostické zobrazování chirurgie rehabilitace MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
PURPOSE OF THE STUDY Developmental dysplasia of the hip (DDH) is a disorder affecting the development of the acetabulum, proximal femur and joint capsule. The objective of this study was to analyse the results of closed reduction by overhead traction in subluxated and dislocated hips. MATERIAL AND METHODS In the period from 2002 to 2007, a total of 109 patients (124 hips) were treated by overhead traction. The indication criteria included adductor contracture and misalignment of the hip joint assessed as classes III A, III B or IV according to the Graf ultrasonographic classification. There were 96 (88 %) girls and 13 (12 %) boys. The left side was more frequently affected, at a ratio of 83 to 41, and bilateral DDH was found in 15 patients. Teratologic dislocations were not included in the study. The patients were divided into two groups according to age and the place of primary diagnosis. The children primarily diagnosed at our hospital Na Bulovce where placed in group 1, the patients diagnosed outside our hospital fell in group 2. The average age at the beginning of treatment was 2.2 months in the first group and 6 months in the second group. Our method of overhead traction consists of two phases. Horizontal traction is applied for two weeks in phase 1; the hips are then flexed beyond 90 degrees and gradually abducted for another 4 weeks in phase 2. The outcome of traction is examined by arthrography and a spica cast is applied in the safe zone. We observed the relation between the Graf classification and arthrograpy The outcome of closed reduction was compared between the groups and the development of avascular necrosis was observed. The hips treated by open reduction were assessed in a different study. RESULTS The efficiency of closed reduction was 84 % in group 1 and 60 % in group 2 in which also two cases of recurrent dislocation were found. No significant differences between the Graf classification and the final arthrographic findings were recorded in either group (p>0.05). Avascular necrosis as defined by the Salter criteria was not diagnosed. DISCUSSION Early reduction is essential to ensure normal development of the hip joint. Overhead traction therapy for misalignment of the hip joint is a safe method reducing damage to the femoral head. Its principle lies in gradual distraction of the contracted muscles and joint capsule with a concomitant change in traction direction in order to achieve a reduction manoeuvre without placing increased stress on the femoral head. CONCLUSIONS Overhead traction is the method of choice for management of Graf's class III A, III B and IV hips. For the efficiency of treatment, an early diagnosis and a correct indication are essential. To avoid complications such as avascular necrosis, it is necessary to observe the principle of a safe zone.
