BACKGROUND: Current research lacks comprehensive investigation into the biomechanical changes in the spinal cord and nerve roots during scoliosis correction. This study employs finite element analysis to extensively explore these biomechanical variations across different Cobb angles, providing valuable insights for clinical treatment.
METHODS: A personalized finite element model, incorporating vertebrae, ligaments, spinal cord, and nerve roots, was constructed using engineering software. Forces and displacements were applied to achieve Cobb angle improvements, designating T1/2-T4/5 as the upper segment, T5/6-T8/9 as the middle segment, and T9/10-L1/2 as the lower segment. Simulations under traction, pushing, and traction + torsion conditions were conducted, and biomechanical changes in each spinal cord segment and nerve roots were analyzed.
RESULTS: Throughout the scoliosis correction process, the middle spinal cord segment consistently exhibited a risk of injury under various conditions and displacements. The lower spinal cord segment showed no significant injury changes under traction + torsion conditions. In the early correction phase, the upper spinal cord segment demonstrated a risk of injury under all conditions, and the lower spinal cord segment presented a risk of injury under pushing conditions. Traction conditions posed a risk of nerve injury on both sides in the middle and lower segments. Under pushing conditions, there was a risk of nerve injury on both sides in all segments. Traction + torsion conditions implicated a risk of injury to the right nerves in the upper segment, both sides in the middle segment, and the left side in the lower segment. In the later correction stage, there was a risk of injury to the upper spinal cord segment under traction + torsion conditions, the left nerves in the middle segment under traction conditions, and the right nerves in the upper segment under pushing conditions.
CONCLUSIONS: When the correction rate reaches 61-68%, particular attention should be given to the upper-mid spinal cord. Pushing conditions also warrant attention to the lower spinal cord and the nerve roots on both sides of the main thoracic curve. Traction conditions require attention to nerve roots bilaterally in the middle and lower segments, while traction combined with torsion conditions necessitate focus on the right-side nerve roots in the upper segment, both sides in the middle segment, and the left-side nerve roots in the lower segment.

To explore whether the potential instability of the cervical spine and cervical muscle degeneration in patients with cervical spondylotic radiculopathy (CSR) affect the efficacy of cervical traction, and whether cervical traction can aggravate the potential instability of the cervical spine. We divided the 113 recruited CRS patients into three groups based on the differences in horizontal displacement and abnormal angle, and measured the degree of cervical muscle degeneration in the patients through MRI. Considering functional scores, VAS, NDI and PCS scores of the three groups post-treatment were significantly improved. Through the intergroup analysis, we found that the improvement in functional scores in the mild and moderate instability trend groups was better than that in the severe group. Through MRI measurements, we found that the degree of cervical muscle degeneration was significantly increased in the severe instability trend group. Regarding the changes in X-Ray imaging parameters pre- and post-treatment, no significant differences were observed pre- and post-treatment. For patients with CSR, the more serious their predisposition for cervical instability was, the more severe the degree of cervical muscle degeneration was, which means the worse the curative effect was, but cervical traction did not aggravate the potential degree of cervical instability.

UNASSIGNED: Several variables may affect the traction force during hip arthroscopy. Specifically, the degree of hip joint rotation may influence the magnitude of traction force during hip arthroscopy. However, there is currently limited research available on this particular issue.
UNASSIGNED: To quantify the traction force applied to the pulled limb in various traction states and rotational positions. Additionally, the study aimed to investigate potential correlations between femoral anteversion, BMI, anesthesia methods, and the traction force required for hip dislocation.
UNASSIGNED: It was hypothesized that traction force in different traction states and rotational positions would be different and that femoral anteversion, body mass index (BMI), and anesthesia methods may influence the traction force needed.
UNASSIGNED: Cross-sectional study; Level of evidence, 4.
UNASSIGNED: Patients who attended the sports medicine clinic of our department and underwent arthroscopic surgery for the diagnosis of femoroacetabular impingement between June and December 2022 were retrospectively evaluated. The traction force at the following 6 key timepoints was measured-initial traction, traction to the operable width, after joint puncture, after capsulotomy, at 20 minutes after capsulotomy, and at 40 minutes after capsulotomy. In each state, the hip was rotated to the internal rotational position, external rotational position, and neutral position. The traction force at different states and positions was recorded and analyzed. The differences in traction force between the different joint capsular physical states and rotational positions were tested by analysis of variance and the Tukey method. The Pearson test was used to analyze the correlation between BMI and femoral anteversion in different groups.
UNASSIGNED: A total of 41 patients were included in this study. The traction force increased after reaching the operable width and decreased significantly after capsulotomy (P < .05). Thereafter, the traction force decreased gradually over time (P < .05). Traction force in the external and internal rotational positions was significantly greater than that in the neutral position, across all states of traction (P < .05). Furthermore, the difference in traction force between the internal and neutral positions, as well as the difference in traction force between the external and neutral positions, was found to be significantly greater than the difference in traction force between the internal and external rotational positions in all traction states (P < .05). The difference between the traction forces in different rotational positions of the hip joint exhibited a negative correlation with femoral anteversion (Pearson correlation coefficient of neutral-internal in states 3, 4, and 5 was -0.33, -0.31, -0.31, respectively; P < .05) and a positive correlation with BMI (Pearson correlation coefficient of external-neutral in states 4 and 6 was 0.33 and 0.36, respectively; P < .05).
UNASSIGNED: Our findings show that the traction force decreased after joint puncture and capsulotomy and decreased over time during surgery. External or internal rotation increased the traction force. Patients with higher femoral anteversion or lower BMI may need lower traction force. These data may help in minimizing traction forces to help prevent complications due to traction during hip arthroscopy.

BACKGROUND The spring-and-loop with clip (S-O clip) consists of a spring and a nylon loop located on one side of the claws of the clip, and is used in gastric endoscopic submucosal dissection (ESD) to allow countertraction. This retrospective study included 290 patients with early gastric neoplasms (eGNs) and aimed to compare postoperative outcomes of ESD with and without the use of the S-O clip. MATERIAL AND METHODS We retrospectively reviewed the data of 347 patients with eGN who underwent ESD, with or without an S-O clip, at our institution between April 1, 2017 and March 31, 2023. Overall, 290 patients were analyzed after excluding ineligible participants. The control group (n=149; adenoma: 1, carcinoma: 148) underwent ESD without an S-O clip between April 2017 and March 2020, while the S-O group (n=141; adenoma: 4, carcinoma: 137) used the clip between April 2020 and March 2023. Primary outcomes included procedure time, en bloc resection rate, and complete resection rate. Subgroup analysis for examined procedure time concerning endoscopist expertise, submucosal fibrosis, and neoplasm locations. RESULTS The S-O group had a shorter procedure time (44.4±23.9 vs 61.1±40.9 min, P<0.001) and a higher complete resection rate (97.9% vs 92.6%, P<0.05) than the control group. Subgroup analysis revealed that the S-O clip significantly reduced procedure time for trainees compared to the control group (40.8±18.3 vs 61.1±35.6 min, P<0.05). CONCLUSIONS The scheduled use of S-O clips in gastric ESD is effective in improving procedural time and complete resection rates, benefiting endoscopists across all experience levels.

UNASSIGNED: Soccer boots are produced with different stud patterns and configurations to provide players with extra traction on specific surface types to minimize slipping and improve player performance. Excessive traction, however, can lead to foot fixation injuries, particularly anterior cruciate ligament tears.
UNASSIGNED: The purpose of this study was to explore the translational traction properties of 5 different outsole configurations moving in 4 different directions across both natural grass and artificial grass (AG) playing surfaces. It was hypothesized that longer studs or studs with an asymmetric shape would yield a higher traction coefficient compared with the recommended stud configuration for the given playing surface.
UNASSIGNED: Descriptive laboratory study.
UNASSIGNED: A custom-built testing apparatus recorded the translational traction of 5 different soccer boots moving in an anterior, posterior, medial, or lateral direction on both natural grass and AG playing surfaces. A 3-way analysis of variance was performed to determine the effect of outsole configuration on the traction, and a post hoc Tukey analysis was performed to compare different outsole configurations with a control.
UNASSIGNED: For the natural grass playing surface, the longer and asymmetric studs yielded a significantly higher (P < .05) traction coefficient on 75% of loading scenarios, while on AG, they yielded a significantly higher traction on 50% of loading scenarios.
UNASSIGNED: Some soccer boots yielded higher traction values compared with the recommended configuration.
UNASSIGNED: The results highlight the importance of boot selection on different playing surfaces. Higher traction values could increase the injury risk for players due to excessive traction and foot fixation.

Intertrochanteric fractures are a common occurrence in the general population; however, in patients with above-knee amputations, they are relatively rare. In this patient population, positioning on a fracture table presents a particularly difficult problem prior to the fixation of an intertrochanteric fracture. Here, we describe a 57-year-old man with extensive vasculopathy and reduced bone density who presents with an intertrochanteric fracture after a fall from standing. Adequate traction of the amputated leg was achieved via the modification of a standard fracture table and the utilization of a Bohler traction bow. Fixation of the intertrochanteric fracture was successful, and the patient suffered no postoperative complications.

Severe sickle retinopathy is commonly known in adults but not in children, hence any related treatment for sickle retinopathy in children was not well described. We reported 2 paediatric sickle patients (aged 12 and 13) presented with severe sickle retinopathy and described details of their disease progression and treatments over 2-3 years, along with the challenges faced when managing this particular group of young age sickle cell patients. Our case reports also demonstrated the benefits of laser photocoagulation treatment to early sickle proliferative disease, and how complications from advanced severe retinopathy hindered effective treatments.

OBJECTIVE: The aim of the study is to determine diagnostic traction for shoulder dystocia and to assess whether applied traction is modifiable with force training.
METHODS: We tethered a force-measuring fetal mannequin (PROMPT, Limbs & Things) within a simulated pelvis such that it would not deliver. We asked participants to apply traction to diagnose shoulder dystocia then stop. Blinded from participants\' view, we recorded the peak traction. We then asked them to apply what they perceived to be 20 lb (89 N) traction. Each participant estimated the traction s/he applied. The actual force applied was then revealed to the participants and another blinded sequence was performed. We then allowed participants to view actual force measurements in real time while they practiced getting to their diagnostic traction and to 20 lb (89 N); this was followed by another blinded sequence of traction applications and estimations. Median diagnostic traction and injury threshold values (20 lb [89 N]), and mean ratio of estimated to actual force applied were compared pretraining and posttraining, using Wilcoxon signed rank sum test and t test. Rates of clinical shoulder dystocia and associated brachial plexus injury before and after the study period were compared using chi-square. Significance was set at P < 0.05.
RESULTS: One hundred participants demonstrated a range of diagnostic traction. For 23 participants, traction exceeded injury thresholds, but the average was lowered with training. Before training, participants underestimated their own applied traction by an average of 30%.
CONCLUSIONS: Subjective diagnosis of shoulder dystocia during simulation training varies widely and exceeds possible injury threshold for 22% of participants. Accuracy of self-assessment applied delivery traction improves significantly with force training as does clinical diagnosis of shoulder dystocia and decrease in brachial plexus injury incidence.

Endoscopic submucosal dissection (ESD) is considered curative for patients with early gastrointestinal cancers. However, it is a technically challenging procedure that can be time-consuming and associated with complications such as bleeding and perforation. Traction devices and techniques have been developed to mitigate these risks and reduce procedure times. Most traction devices are unavailable in New Zealand, and traction techniques have not been widely utilized due to the precision required for successful outcomes. We report the first case of traction-assisted ESD performed in New Zealand for a gastric submucosal tumor. The procedure was successfully performed using the clip with rubber band traction technique. The lesion was resected en bloc, and histology confirmed an R0, curative resection. There were no complications, and the total procedure time was 54 minutes. In conclusion, traction techniques can be effectively employed for ESD in lesions with difficult submucosal access. They contribute to safer dissections and reduced procedure times.

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