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Purpose Both, knee joint distraction as a relatively new approach and valgus-producing opening-wedge high tibial osteotomy (HTO), are knee-preserving treatments for knee osteoarthritis (OA). The efficacy of knee joint distraction compared to HTO has not been reported. Methods Sixty-nine patients with medial knee joint OA with a varus axis deviation of <10° were randomized to either knee joint distraction ( n  = 23) or HTO ( n  = 46). Questionnaires were assessed at baseline and 3, 6, and 12 months. Joint space width (JSW) as a surrogate measure for cartilage thickness was determined on standardized semi-flexed radiographs at baseline and 1-year follow-up. Results All patient-reported outcome measures (PROMS) improved significantly over 1 year (at 1 year p  < 0.02) in both groups. At 1 year, the HTO group showed slightly greater improvement in 4 of the 16 PROMS ( p  < 0.05). The minimum medial compartment JSW increased 0.8 ± 1.0 mm in the knee joint distraction group ( p  = 0.001) and 0.4 ± 0.5 mm in the HTO group ( p  < 0.001), with minimum JSW improvement in favour of knee joint distraction ( p  = 0.05). The lateral compartment showed a small increase in the knee joint distraction group and a small decrease in the HTO group, leading to a significant increase in mean JSW for knee joint distraction only ( p  < 0.02). Conclusion Cartilaginous repair activity, as indicated by JSW, and clinical outcome improvement occurred with both, knee joint distraction and HTO. These findings suggest that knee joint distraction may be an alternative therapy for medial compartmental OA with a limited mechanical leg malalignment. Level of evidence Randomized controlled trial, Level I.

ObjectiveThis study aims to investigate the efficacy and safety of snare traction-assisted endoscopic submucosal dissection (ESD) for the management of circumferential superficial esophageal cancer.MethodsA total of 68 patients who underwent ESD for circumferential superficial esophageal cancer were included in this study. All the patients were divided into two groups based on whether the snare traction was used or not; the snare traction group (S-ESD, group n = 35) and the control group (C-ESD, group n = 33).ResultsThere was no significant difference in the size of the resected area between the groups [21.98 (18.30, 27.00) cm2 vs 24.00 (15.28, 30.72) cm2, P = 0.976]. The snare traction group had a shorter dissection time [92.00 (74.00, 121.00) min vs 110.00 (92.50, 137.00) min, P = 0.017] and a faster resection speed [0.28 ± 0.13 cm2/min vs 0.22 ± 0.11cm2/min, P = 0.040] compared to the control group. There were no statistically significant differences between the two groups in terms of hospital stay, cost, en bloc resection rate, R0 resection rate, curative resection rate, bleeding rate, perforation rate, stricture rate, and recurrence rate (P > 0.05).ConclusionSnare traction-assisted ESD is a safe and efficient approach for the treatment of circumferential superficial esophageal cancer. Its advantages includes shorter procedure so the anesthesia requirement, clear operative filed view, improved mucosal dissection efficiency, simple, and easily accessible equipment.

Background Supracondylar humeral fractures are common injuries in children and can be associated with high morbidity and lead to lifelong disability. The method of treatment affects the risk of complications and potentially the functional outcome. Closed reduction and percutaneous pinning CRPP has become the most widely used treatment method in high-income countries. In the current literature, both CRPP and lateral straight arm traction have been shown to give good results and reasonable levels of complications. The two methods have never been tested against each other in a randomised trial. Furthermore, these methods have not been analysed prospectively in the low and middle income context. Methods The study will be a prospective randomised trial comparing lateral straight arm traction LSAT against CRPP. Recruitment will be at 8 large referral hospitals in Ethiopia. Based on non-inferiority power calculation, we plan to recruit 220 patients. The principal outcome measure will be the PROMIS parent proxy upper extremity short form 8a score version 3.0 at 12 months. The secondary outcome measures will be the Flynn’s criteria; complications; PROMIS parent proxy upper extremity short form 8a score version 3.0 at 6 months; PROMIS parent proxy global health 7 + 2 score version 3.0 administered at 6 and 12 months; and economic analysis of hospital costs for the two treatment modalities. Discussion Supracondylar humeral fractures are common and serious injuries which occur frequently in LMICs where often half the population are under 18 years of age. Such countries have limited capacity for fracture care. Finding solutions which may avoid referral and operative intervention is paramount in developing access to timely and affordable care for all people. If LSAT is non-inferior to CRPP, then children can be treated locally in a cost-effective manner with avoidance of disability. Trial registration ISRCTN Ref 62164933. Registered on 25 July 2024.

Background Treatment methods for low back pain (LBP) can be divided into conservative, invasive and surgical treatment approaches with traction therapy as a non-surgical therapeutic option. A clinical study analysed the effect of using a traction-bed-device (Movento) on 35 patients suffering from osteoarthritis/spondylosis of the lumbar spine. Methods The study was performed as a multicentric, double-blind, randomised, controlled interventional study. The patients were treated over three weeks while staying in rehabilitation clinics. All patients were assessed initially at study entry, weekly and after 3 weeks as well as 12 weeks after discharge. The following outcome measures were used: Numerical Rating Scale (NRS), Roland-Morris Disability Questionnaire (RMDQ), (12) Progressive Isoinertial Lifting Evaluation (PILE-Tests) and the 36-Item Short Form Health Survey (SF36). One hundred ten patients between 40 and 75 years of age with a diagnosed osteochondrosis/spondylarthrosis with chronification stadium 1 and 2 according to Gerbershagen were enrolled in the study. Both study groups received conventional rehabilitation therapy. The intervention group additionally received additional therapy with a minimum of five hours with the Movento traction device per night with seven sessions per week and a duration of 21 days. The therapy is based on the unloading and loading of spinal tissueThe duration of the treatment was limited to a minimum of 5 h and a maximum of 8 h. Results The intervention group was able to show significantly better results in pain reduction (NRS) ( p  < 0.05), the Roland-Morris Questionnaire ( p  < 0.05), the PILE-Test ( p  < 0.05), the morning start-up time and the Finger-Floor-Distance measurement ( p  < 0.05) as well as the improvements in quality of life (SF-36). Conclusions The presented results show that an additional traction device can improve pain score, function, clinical scores as well as improvements in quality of life in patients with spondylosis. Key Points Findings Therapy with the traction-bed-device (Movento) in combination with specific back pain rehabilitation achieves statistically significant results compared to treatment without this device. Implications The results show that an additional traction device improves pain score, function, clinical scores as well as life quality and should be added to conservative rehabilitation methods. Caution It cannot be assumed that traction is always the same. In addition the effect of a 3 weeks treatment was not be maintained at 12 weeks after cessation of the intervention

BackgroundSince the snare traction-assisted ESD has been proven effective in treating flat lesions of the digestive tract, we modified and innovated the process and path of the traditional snare entering the digestive tract, aiming to investigate the efficacy and safety of using the per-nasal “GTS partner” assisted traction technology in gastric ESD.MethodsPatients with superficial gastric neoplasms were prospectively enrolled between November 2022 and May 2024 and randomly assigned to a conventional ESD (C-ESD) group or per-nasal “GTS partner” traction-assisted ESD (GTS-ESD) group. The primary outcomes were procedure time and dissection speed.ResultsThe GTS-ESD and C-ESD groups included 40 patients each, and all the enrolled patients underwent the assigned treatment. The median procedure time in the GTS-ESD group was shorter than that in the C-ESD group (38 min vs. 48 min; P < 0.001), and the mean resection speed of the GTS-ESD group was faster than that of the C-ESD group (17.95 mm2/min vs. 11.86 mm2/min; P = 0.033). The median resection speed of lesions ≥ 20 mm was faster by GTS-ESD than by C-ESD (21.21 mm2/min vs. 12.83 mm2/min, P = 0.002). The en bloc resection rate (100% vs 100%) and R0 resection rate (100% vs. 97.5%) were similar between the two groups. There were no adverse events related to the per-nasal “GTS partner” assisted traction technology, and the traction technology had little interference with the endoscopist.ConclusionsThe per-nasal “GTS partner” assisted traction technique can significantly shorten the gastric ESD procedure time and has the advantages of no damage to normal mucosa and adjustable traction direction, especially in the lower 1/3 of the stomach or lesions with a diameter of ≥ 20 mm.

Laparoscopic appendectomy (LA) traditionally uses 3 ports: 2 for the videoscope and 3 for the procedure. 1 More recently a large single port technique groups the 3 ports in a single site that uses a larger incision. 2 As an alternative to the 3-port and single-port methods, we developed a laparoscopic traction device to pull the appendix to facilitate its removal. See PDF] After approval of a study protocol by our hospital ethics committee, we randomly assigned 74 patients to the 2-port technique plus the traction device and 75 patients to the standard 3-port procedure. Analysis of the postoperative pain score revealed that the 2-port LA significantly reduced pain level compared with the 3-port LA (mean score 1.33 vs 3.27), and more than 98% of the individuals in the 2-port group had a score between 0 and 2 and about 93% in the 3-port group had a score between 3 and 5 (Mann-Whitney U = 199.5, P < .0001).

Background Cervical radiculopathy (CR) is a common condition, often associated with cervicogenic headache (CGH), a secondary headache arising from cervical spine disorders. Mechanical intermittent cervical traction (MICT) is frequently prescribed to treat CR symptoms. The purpose of the study was to make a preliminary estimate of efficacy of adding MICT to conventional rehabilitation on CGH in patients with cervical radiculopathy. Methods A total of 36 CR patients with CGH were randomly allocated to 3 equally sized groups (A, B and C). The treatment consisted of twelve sessions of conventional rehabilitation (4 weeks) combined with MICT (2 kg for group A, 8 kg for group B and 12 kg for group C). Primary outcomes were CGH intensity (visual analog scale) and frequency (days per week). Secondary outcomes were radicular pain intensity (visual analog scale), cervical range of motion (cervical range of motion instrument), proprioception (cervical range of motion instrument) and muscle strength (MicroFET2 dynamometer), handgrip strength (handheld dynamometer), function (Neck Disability Index), kinesiophobia (Tampa Scale for KInesiophobia), anxiety and depression (Hospital Anxiety and Depresion questionnaire), and quality of life (World Health Organization Quality of Life). Patients were assessed at baseline, one, three and six months after the beginning of treatment. The post hoc Dunn testing was used to determine which traction load had the better effect on CGH symptoms. Results At one, three and six months follow-ups, Group C exhibited the highest improvement in CGH intensity and frequency compared to the other groups ( p  = 0.021 and p  = 0.023; p  = 0.012 and p  = 0.01; p  = 0.005 and p  = 0.005). Both groups C and B showed a significant improvement in radicular pain compared to group A at one month follow-up ( p  = 0.05).The improvement in group C was significantly better in terms of function ( p  = 0.049) and anxiety ( p  = 0.011) at three months and quality of life at six months (Psychological p  = 0.046 and Environment p  = 0.006). Conclusions The blend of conventional rehabilitation alongside 12 kg MICT seems to be efficacious in diminishing both the intensity and frequency of CGH in patients with CR. These advantages appear to last for up to six months following the treatment period, potentially leading to decreased CGH severity and occurrence rates, heightened functionality, reduced anxiety levels, and an overall enhancement in quality of life. These findings are preliminary and require confirmation in larger trials. Trial registration The study protocol was retrospectively registered at the Pan African Clinical Trial Registry (PACTR202401838955948). Date of registration is 16/01/2024.

Background There is a growing interest concerning the understanding of and rehabilitation of the sagittal configuration of the cervical spine as a clinical outcome. However, the literature on the topic specific to conservative treatment outcomes of patients with chronic myofascial cervical pain syndrome (CMCPS) has not adequately addressed the relationship between cervical sagittal alignment and improved pain, disability and range of motion. Methods A randomized controlled study with a 1-year follow-up. Here, 120 (76 males) patients with chronic CMCPS and defined cervical sagittal posture abnormalities were randomly assigned to the control or an intervention group. Both groups received the Integrated neuromuscular inhibition technique (INIT); additionally, the intervention group received the denneroll cervical traction device. Alignment outcomes included two measures of sagittal posture: cervical angle (CV), and shoulder angle (SH). Patient relevant outcome measures included: neck pain intensity (NRS), neck disability (NDI), pressure pain thresholds (PPT), cervical range of motion using the CROM. Measures were assessed at three intervals: baseline, 10 weeks, and 1 year after the 10 week follow up. Results After 10 weeks of treatment, between group statistical analysis, showed equal improvements for both the intervention and control groups in NRS ( p  = 0.36) and NDI ( p  = 0.09). However, at 10 weeks, there were significant differences between groups favoring the intervention group for PPT ( p <0.001) and all measures of CROM ( p <0.001). Additionally, at 10 weeks the sagittal alignment variables showed significant differences favoring the intervention group for CV p <0.001 and SH ( p <0.001) indicating improved CSA. Importantly, at the 1-year follow-up, between group analysis identified a regression back to baseline values for the control group for the non-significant group differences (NRS and NDI) at the 10-week mark. Thus, all variables were significantly different between groups favoring the intervention group at 1-year follow up: NRS ( p <0.001), NDI ( p <0.001), PPT p <0.001), CROM ( p <0.001), CV ( p <0.001), SH ( p <0.001). Conclusion The addition of the denneroll cervical orthotic to a multimodal program positively affected CMCPS outcomes at long term follow up. We speculate the improved sagittal cervical posture alignment outcomes contributed to our findings. Trial registration Pan African Clinical Trial Registry Clinical Trial Registry: PACTR201801002968301 , registered 11 January 2018 (retrospectively registered).

Background Severe upper auricular adhesion malformation poses a significant challenge for complete correction through ear molding. This prospective randomized controlled study aimed to assess the efficacy of a new method in addressing severe upper auricular adhesions. Methods In this non-blinded randomized controlled study, we enrolled 72 infants with severe upper auricular adhesion malformation who underwent treatment with the EarWell system. They were randomly assigned to either the double-layer traction (DLT) group or the control group. We compared the effectiveness of treatment, treatment duration, and potential complications between the two groups. Results All 72 infants completed the treatment and follow-up, with 38 (52.8%) in the DLT group and 34 (47.2%) in the control group. The DLT group exhibited significantly shorter treatment times and a lower incidence of pressure sores than the control group. The DLT method, along with unilateral malformation, independently predicted positive long-term outcomes. Conclusions The DLT method demonstrated superior effectiveness, shorter treatment duration, and lower complication rates than traditional methods when treating severe upper auricular adhesion malformation in infants. The DLT method is safe and effective and merits broader adoption in clinical practice. Level of Evidence II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266

IntroductionEndoTrac is a line-attached sheath-type traction device that enables us to control the direction and the force of traction during endoscopic submucosal dissection (ESD). The efficacy of EndoTrac for gastric ESD has not been fully verified.Methods and analysisThe G-Trac study is a multicentre (nine general hospitals and two university hospitals in Japan) collaborative trial assessing the efficacy of EndoTrac for gastric ESDs. Patients with superficial gastric neoplasms will be enrolled and randomly assigned to undergo either conventional ESD or EndoTrac ESD. Allocation will be stratified according to tumour location, operator experience and tumour diameter at an allocation rate of 1:1. The type of endoknife used will be confirmed before randomisation. The primary outcome, procedure time, will be compared between the groups in both intention-to-treat and per-protocol analyses using the Wilcoxon rank sum test. The efficacy-related, safety-related and device-related outcomes will be assessed in the secondary analysis. The planned sample size of the 142 patients in the two groups will enable us to detect a difference with a power of 80% by using the Wilcoxon rank sum test, assuming an effect size of 0.54, asymptotic relative efficiency of 0.864 and a two-sided type 1 error rate of 5%.Ethics and disseminationThis trial was approved by the certified review board of Kobe University (22 December 2022). The results from this trial will be disseminated through peer-review journals, presentations at national and international conferences, and data sharing with other researchers.Trial registration numberjRCT1052220166.