[Foot lesions after the immobilization of lower extremities in plaster of Paris].
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OBJECTIVE: Dental gypsum products are liable to deterioration on exposure to the air because of reaction between calcium sulphate hemihydrate and water vapour. The purpose of this investigation was to refine the knowledge of the conditions and rates at which this occurred for a representative selection of such products with a view to improved storage recommendations. MATERIALS AND METHODS: Absorption of water from controlled atmospheres (25-40 degrees C, 75-99% RH) was monitored gravimetrically for a dental artificial Stone, Plaster of Paris, an Impression plaster and a gypsum-bonded Investment. RESULTS: An initial steady absorption stage was followed by a transition to a rapid absorption; this led to a completion stage as the presumed hydration reaction approached completion. The logarithm of time of the transition showed approximately linear dependence on the relative humidity (and not on water vapour pressure as might have been expected) and a slight but significant (P<0.005) negative dependence on temperature in the range 25-35 degrees C for Stone, Plaster of Paris and the Impression plaster, but not for the Investment (P>0.5). The behaviour for the first three materials at 40 degrees C departed significantly from the temperature-dependent trend (P<0.05) while the Investment showed no such effect. The absorption by the Investment was substantially faster than for the other materials. SIGNIFICANCE: There is no evidence to suggest that there is a 'safe' humidity for exposure to the atmosphere although for the Stone and Plasters at RH <70% in excess of 1000 h is predicted to be necessary before rapid reaction commences. For the Investment, the equivalent time at 70% RH is 1d.
From January 1985 to February 1987 361 patients with ruptured lateral ankle ligaments were treated at the Department of Trauma and reconstructive Surgery at the University Hospital of Hamburg. 225 patients were included in a retrospective study. They were divided into conservative and operative groups of treatment with subdivision of immobilized treatment (Plaster Paris short-leg-cast for 6 weeks) and functional therapy (special shoe). Clinical-radiological follow-up examinations of 49 operatively and 44 conservative treated patients were carried out 2 to 4 years after cessation of therapy. The clinical results were evaluated according to a questionnaire, X-ray and clinical controls. These results lead to the conclusion that operative treatment combined with conservative plaster cast immobilization yielded better mechanical stability than conservative-functional therapy. Best results were seen after surgical treatment, but conservative immobilization with prevailing good clinical-radiological results seems to be an alternative to operative therapy in carefully elected patients.
The management of fractures of the radial head is still a controversial subject. Fifty cases of radial head fractures have been treated by conservative means. These cases were immobilized in a plaster Paris cylinder cast for 3 weeks to restrict the movement of flexion and extension at the elbow, while encouraging supination and pronation movements from the very beginning. The cases have been evaluated and 43/50 have shown excellent results.
OBJECTIVE: To study the clinical problems about posterior atlanto-axial internal-fixation and fusion for atlanto-axial instability or dislocation. METHODS: Surgical treatments of 138 cases with atlanto-axial instability or dislocation were reviewed. There were 62 cases of odentoid malformation, 54 cases of odentoid fracture or rupture of transverse ligament, 22 cases of subluxation and rotation. All cases were treated using Gallie's technique. Six cases were also fixed with transarticular screws, and protected with Philadelphia collar. Other patients were fixed with plaster paris brackets. The followed-up period was 1 to 12 years with an average of 3 year and 5 months. RESULTS: According to Sumi's criteria, excellent 70 cases (50.7%), good 40 cases (29.0%), fair 15 cases (10.9%), poor 13 cases (9.4%). 9 cases with bone graft postponed fusion were cured by enhance external-fixation. 2 cases with nonunion were treated with revision surgery. Complication of cord injury happened in 1 case. CONCLUSION: Gallie's fusion technique is an effective method to manage the atlanto-axial instability or dislocation. Skull distraction before operation and reliable external-fixation post operative are important assistant measures. Key points for successful operation are careful wiring or cable traversing, decortication of posterior arc of C1, and maintaining the physiological height between C1 and C2 posterior arc. Indications and objectives should be conformed before revision surgery for failure cases.