Study casts--a method of evaluation and use. I. Why study casts?
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Diagnosis, Oral↗
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[The care of clasp-bearing teeth with cast fillings under a model-cast prosthesis].
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Dental Abutments↗
[Training dental technicians. 23. From chromium-cobalt-molybdenum castings to polished cast model dentures. 3: Preparation and polishing].
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Chromium Alloys↗
[Application to dental casting machine of the rapid heating infrared image furnace (author's transl)].
The authors tried to manufacture a casting machine in dentistry by application of the infrared image furnace with a high heating speed and an easy control of a heating temperature. This machine melts an alloy in a carbon crucible set in the furnace, held in the horizontal position. Then, the furnace is turned to the vertical position to drop a melted alloy on the casting mold, and the alloy is cast in the mold by the pressure of Argon gas. The functions of trial casting machine were follows. 1. The trial casting machine was capable of heating to 1250 degrees C within one minute under 4 kW electric power. 2. The castability of the 20% Au-Pd-Ag commercial alloy cast in all casting conditions by the trial casting machine was higher than that of Thermotrol D-2 automatic centrifugal casting machine. 3. Castings of the trial casting machine showed higher tensile strength and elongation than those of the centrifugal casting machine, and the deviation of values got by the trial casting machine was small. In particular, some casting of the trial casting machine showed three times or over elongation values as compared with those of the centrifugal casting machine. 4. When casting conditions (casting temperature, casting pressure) of the trial casting machine changed, the physical properties of castings did not change so much. However, when the mold was not prevented from heating by the furnace in casting, the elongation of castings increased.
Dental Casting Technique↗
Emergency care in patients wearing body casts.
OBJECTIVE: To describe a body cast modification that allows rapid chest exposure for cardiopulmonary resuscitation and alert the medical community to the 3% to 5% incidence of cardiopulmonary arrest in the hospital while wearing such a cast. DESIGN. Single trial timed cast cutting, multiple trial cast shell loading, and clinical observations of perforated casts for cracking or breakage. SETTING: University hospital castroom, mechanical engineering laboratory. INTERVENTION: Body casts mounted on a life-sized torso mold were perforated at 2-inch (50 mm), 1-inch (25 mm), or 1/2 inch (12 mm) intervals around the chest with a 12-mm-diameter vibrating drill. Using a cast saw, the chest piece of each body cast was removed and the time recorded. Engineering studies were performed on two cast shells with and without 12-mm-wide holes up to 1/2" (12 mm) apart, loading the fiberglass to the point of failure and recording the data. Body casts with 1" (25 mm)-interval holes worn by 40 patients were examined after 12 weeks for evidence of failure. MAIN OUTCOME MEASURES: Chest piece removal times of body cast shells with and without holes were compared. Loading data of cast shells were compared to determine if holes as close as 1/2" (12 mm) significantly weakened the cast. Forty casts, perforated at 1-inch (25 mm) intervals, were observed for failure after 12 weeks of wear. RESULTS: Chest exposure time of a mold encased in a fiberglass cast was reduced from 1 minute to 15 seconds; plaster cast removal was reduced from 3 minutes to 1 minute. Engineering studies of perforated casts showed no significant decrease in strength. Casts with and without holes could support chest forces of up to 330 pounds. No failure was observed in casts with perforations 1 inch (25 mm) apart worn for 12 weeks. CONCLUSION: Perforated body casts reduced removal time to 15 seconds without weakening of the cast and provide lifesaving time to perform effective CPR.
Cardiopulmonary Resuscitation↗
An analysis of iatrogenic complications from the total contact cast.
BACKGROUND: Many physicians continue to fear iatrogenic complications of the total contact cast, and use of this modality has remained restricted to a segment of the orthopaedic and podiatric communities. I examined the actual rate of complications and the factors associated with them in a large consecutive series of total contact casts drawn from the practice of a single surgeon to determine whether this modality is safe for multiple conditions in the neuropathic foot and ankle. METHOD: A consecutive series of 398 total contact casts spanning a 28-month period from the practice of a single physician were analyzed. All casts were placed by the same team of orthotists. This study comprised 70 patients with severe peripheral neuropathy; an average of 5.69 sequential casts per patient were placed. Three-hundred and sixty-seven casts were placed in diabetic patients, and 31 in patients with idiopathic peripheral neuropathy. By protocol, the initial cast was changed at an interval of no more than 1 week. On occasion, subsequent casts were left on longer, but on average casts were left in place for 7.69 days. Logistic regression analysis was used to analyze the contribution of patient factors to the chance of ulceration. RESULTS: Complications occurred in 22 casts, including six new pretibial ulcers, six new midfoot ulcers, four forefoot or toe ulcers, five hindfoot ulcers, and one malleolar ulcer. In no case was a preexisting ulcer made worse. This corresponds to an overall complication rate of 5.52% per cast. Overall, 30% of patients suffered one complication during the course of their treatment. With one exception, all new ulcers healed with simple modalities within 3 weeks, often with continued total contact casting. A single cast led to a proximal interphalangeal ulceration that exposed the joint and eventually required toe amputation. The rate of permanent sequelae from cast-related injuries was therefore 0.25%. In no case were the resultant odds ratios statistically different from 1.0, but several trends were observed. Charcot arthropathy represented the highest risk (odds ratio 1.46), while the presence of neuropathic ulceration was surprisingly benign (odds ratio 0.69). The presence of diabetes as opposed to other causes of neuropathy was associated with increased risk (odds ratio 1.34). The use of a cast after deformity-correcting surgery in a neuropathic patient was remarkably safe (odds ratio 0.44), as were casts in which the patient was instructed to remain nonweightbearing (odds ratio 0.27). Patient age was not a factor (odds ratio 1.03). The length of time the cast was left on was not statistically important (odds ratio 0.99), although strict protocols for cast changing likely altered this data. CONCLUSION: A frequently changed total contact cast is a safe modality for the offloading and immobilization of the neuropathic foot, albeit with an expected constant rate of minor, reversible complications. Patients should be informed of these complications and risks before cast application.
Casts, Surgical↗
Genetic evidence on the origins of Indian caste populations.
The origins and affinities of the approximately 1 billion people living on the subcontinent of India have long been contested. This is owing, in part, to the many different waves of immigrants that have influenced the genetic structure of India. In the most recent of these waves, Indo-European-speaking people from West Eurasia entered India from the Northwest and diffused throughout the subcontinent. They purportedly admixed with or displaced indigenous Dravidic-speaking populations. Subsequently they may have established the Hindu caste system and placed themselves primarily in castes of higher rank. To explore the impact of West Eurasians on contemporary Indian caste populations, we compared mtDNA (400 bp of hypervariable region 1 and 14 restriction site polymorphisms) and Y-chromosome (20 biallelic polymorphisms and 5 short tandem repeats) variation in approximately 265 males from eight castes of different rank to approximately 750 Africans, Asians, Europeans, and other Indians. For maternally inherited mtDNA, each caste is most similar to Asians. However, 20%-30% of Indian mtDNA haplotypes belong to West Eurasian haplogroups, and the frequency of these haplotypes is proportional to caste rank, the highest frequency of West Eurasian haplotypes being found in the upper castes. In contrast, for paternally inherited Y-chromosome variation each caste is more similar to Europeans than to Asians. Moreover, the affinity to Europeans is proportionate to caste rank, the upper castes being most similar to Europeans, particularly East Europeans. These findings are consistent with greater West Eurasian male admixture with castes of higher rank. Nevertheless, the mitochondrial genome and the Y chromosome each represents only a single haploid locus and is more susceptible to large stochastic variation, bottlenecks, and selective sweeps. Thus, to increase the power of our analysis, we assayed 40 independent, biparentally inherited autosomal loci (1 LINE-1 and 39 Alu elements) in all of the caste and continental populations (approximately 600 individuals). Analysis of these data demonstrated that the upper castes have a higher affinity to Europeans than to Asians, and the upper castes are significantly more similar to Europeans than are the lower castes. Collectively, all five datasets show a trend toward upper castes being more similar to Europeans, whereas lower castes are more similar to Asians. We conclude that Indian castes are most likely to be of proto-Asian origin with West Eurasian admixture resulting in rank-related and sex-specific differences in the genetic affinities of castes to Asians and Europeans.
Adult↗
The influence of working cast residual moisture and temperature on the fit of vacuum-forming athletic mouth guards.
STATEMENT OF PROBLEM: The comfort and effectiveness of athletic mouth guards are believed to depend on their degree of fit to oral tissues. Vacuum-forming machines are simpler and less expensive than pressure-forming machines. However, it is thought that vacuum-formed mouth guards often do not exhibit adequate adaptation. PURPOSE: The purpose of this study was to evaluate the effects of cast residual moisture and temperature on the fit of athletic mouth guards made with a vacuum-forming machine. MATERIAL AND METHODS: A metal master model simulating the cross section of the maxillary molar region was used to form 20 working plaster casts. The casts represented 4 (5 specimens each) conditions before the forming of the mouth guard specimens: storing in a wet environment at room temperature and storing in a dry environment at room temperature, 5 degrees C, and 40 degrees C. Mouth guard specimens were fabricated with ethylene vinyl acetate sheets (3.8-mm thick) with the use of a vacuum-forming machine. Test casts were created by pouring hand-mixed type III dental stone into each of the mouth guard specimens. The differences in the sagittal cross-sectional heights at the line angle area of the test casts and the working casts were compared. This was achieved by superimposing their 3-dimensional images scanned by a laser scanner. The air permeability was also measured for the hand-mixed stone casts under wet and dry conditions, the vacuum-mixed stone cast, and the high-strength stone specimen. This was achieved by measuring the volume of transmitted air passing through the specimen in the testing tube. One-way analysis of variance with the Scheffé post hoc test (P <.05) was applied to determine the conditions of the working cast required to achieve the best fit. RESULTS: With regard to the fit of the mouth guard specimens to the working cast, those with dry and heated working casts showed a significantly better fit than those with wet working casts (P<.05). A significantly larger volume of transmitted air was found in the dry stone specimen (P<.05) followed by the dry high-strength stone cast and then the wet stone cast. CONCLUSION: Within the limitations of this study, residual moisture in the working cast was the most critical factor in determining the fit of the mouth guard made by vacuum-forming machines. The best fit was achieved when the working cast was thoroughly dried and its surface temperature was elevated.
Air↗
The load applied to the foot in a patellar ligament-bearing cast.
The purpose of this study was to determine whether a patellar ligament-bearing cast reduces the load applied to a foot in a cast. In a study of ten people who had no history of gait abnormalities, disease involving the motor system, or deformities of the lower extremities, we compared the load applied to the plantar aspect of a foot in a cast (as detected with F-Scan computer-monitored pedobarographic sensors) with the total load that an extremity in a cast receives relative to the ground (as detected with force-plates). Six trials were completed three times by each person. The trials consisted of walking (1) while wearing regular shoes; (2) with a patellar ligament-bearing cast on one leg; (3) with a patellar ligament-bearing cast and an overlying soft knee brace, locked in full extension, on the leg; (4) with only a below-the-knee cast on the leg; (5) with a below-the-knee cast and an overlying knee brace, locked in full extension, on the leg; and (6) with only a knee brace, locked in full extension, on the leg. The loads at peak heel-strike for all three trials were averaged and normalized to body weight. The load on the plantar aspect of the foot, as compared with the total load, was reduced a mean of 11 percent when the patellar ligament-bearing cast was worn alone, and it was reduced a mean of 26 percent when the patellar ligament-bearing cast was used with an overlying knee brace locked in full extension. This difference was significant (p = 0.007). With the numbers available, we could not detect a significant difference between the reduction in load when a patellar ligament-bearing cast was worn alone compared with that when a below-the-knee cast was worn alone or between the reduction when a below-the-knee cast was worn alone compared with that when a below-the-knee cast was used with a knee brace (p = 0.3). In conclusion, we could not demonstrate a significant reduction in the load on the foot when a patellar ligament-bearing cast was used in a traditional fashion; however, a significant (p = 0.007) reduction in load was found when a knee brace locked in full extension was worn in addition to the patellar ligament-bearing cast.
Adult↗
Comparison of short and long arm plaster casts for displaced fractures in the distal third of the forearm in children.
BACKGROUND: Various methods of cast immobilization have been recommended for the treatment of distal forearm fractures in children. The purpose of this study was to determine if short arm casts are as effective as long arm casts in the treatment of displaced fractures of the distal third of the forearm in these patients. METHODS: In a prospective randomized trial, consecutive patients, four years of age or older, who presented to The Women's and Children's Hospital of Buffalo with a displaced fracture of the distal third of the forearm were randomized to treatment with a short or long arm plaster cast. Radiographs were analyzed for displacement, angulation, and deviation at the time of injury, after reduction, and at subsequent follow-up intervals. The cast index at the fracture level, used to assess the quality of the cast molding, was determined from the postreduction radiographs. Changes between postreduction and final values for displacement, angulation, and deviation; the ranges of motion of both wrists and elbows; the need for physical therapy; and responses to a questionnaire used to evaluate the effects of the cast on activities of daily living were compared between the groups. RESULTS: One hundred and thirteen of the 151 patients who were assessed for eligibility were analyzed. The follow-up rate was 92%, and the average duration of follow-up was eight months. Sixty long arm casts and fifty-three short arm casts were used. There were no significant differences between the two groups with regard to patient demographics, initial fracture characteristics, mechanism of injury, cast index, or the change in displacement, angulation, or deviation during treatment. The fractures that lost reduction in the cast had significantly higher cast indices, indicating poor cast-molding. A comparison of partially and completely displaced fractures revealed no difference between the groups with regard to the change between the postreduction and final amount of displacement. Patients treated with a short arm cast missed fewer school days and were less likely to require assistance with various activities of daily living. CONCLUSIONS: A well-molded short arm cast can be used as effectively as a long arm cast to treat fractures of the distal third of the forearm in children four years of age and older, and they interfere less with daily activities.
Activities of Daily Living↗
Comparison of feline nasal cavity dimensions measured by acoustic rhinometry and nasal casts.
BACKGROUND: The goal of this study was to evaluate the relationship between feline nasal cavity geometry determined in vivo by acoustic rhinometry (AR(in vivo)) and by nasal cavity casts. Cast cross-sectional areas were measured by acoustic rhinometry (AR(cast)), a fluid-displacement method (FDM), and slicing. A volume comparison between AR(in vivo) and AR(cast) was studied in cats with varying degrees of nasal obstruction after application of phenylpropanolamine, saline, or compound 48/80. METHOD: After measurements of AR(in vivo), impression material was injected into the nasal cavity to produce casts. Subsequently, the cross-sectional areas of the nasal impressions were measured by AR(cast) and FDM using ethanol. All casts were weighed to determine exact volume. Six casts also were sliced into segments of equal thickness for determination of cross-sectional area. RESULTS: Cast volume determined by AR(cast) was consistent with results obtained using FDM and weight. Volumes of the first 3 cm determined by AR(in vivo) ranged between 78 +/- 9% of cast volumes determined by AR(cast) for decongested cavities and 16 +/- 15% for congested cavities. CONCLUSION: AR(in vivo) does not reflect cast geometry, probably because of (1) underestimation by AR because of methodological problems caused by the cavity geometry, (2) deformation of compliant structures within the nasal passageways resulting from the casting procedure, and/or (3) the casting material reaches parts of the nasal cavity not accessible to sound, e.g., sinuses or recesses. Nevertheless, this study does not preclude the use of AR as a sensitive method suited to evaluate relative changes in nasal volume caused by experimental challenges of the nasal mucosa. Compared with AR(in vivo), casts still may be of use but it is less sensitive to measure relative changes after experimental challenge.
Animals↗
Effect of three types of half-limb casts on in vitro bone strain recorded from the third metacarpal bone and proximal phalanx in equine cadaver limbs.
OBJECTIVE: To determine effect of 3 half-limb casts on bone strains recorded from the proximal phalanx (P-1) and third metacarpal bone (MCIII) of equine cadaver limbs, using a mechanical testing machine. ANIMALS: 12 equine cadaver limbs and 4 live horses. PROCEDURE: Bone strains were recorded at middorsal P-1 and the dorsal cortical aspect of the distal third of MCIII while limbs were variably loaded with 100 to 1,000 lb of force. To determine ability of the cast to protect the distal portion of the limb from weight-bearing loads, strains were recorded with the limb in 1 of the 3 casts and with it unsupported. To determine cast-induced discomfort, weight-supporting and transfixation pin casts were evaluated on 2 live horses RESULTS: All 3 casts significantly reduced bone strain at P-1. Significant differences were observed: mean 61% reduction for the standard half-limb cast, 84% for the transfixation pin cast, and 97% for the weight-supporting cast at weight-bearing force of 500 lb. Only the weight-supporting cast significantly reduced strains recorded from MCIII. The weight-supporting cast was not well tolerated by 2 live horses. CONCLUSIONS: The 3 casts significantly reduced transfer of weight-bearing forces to the distal portion of the limb. The weight-supporting cast effectively reduced strain on the P-1 to near 0, but was well tolerated by live horses. The transfixation pin cast reduced strain on the P-1 by > 80% at weight-bearing loads of 500 lb, and live horses were comfortable. Standard half-limb casts significantly reduced strains on the P-1, but to a lesser degree than did other casts.
Animals↗
Effect of casting method on castability of titanium and dental alloys.
Titanium, once considered to be difficult to cast because of its relatively high melting point (1670 +/- 50 degrees C) and strong chemical affinity, can now be acceptably cast using newly developed casting apparatus. The objectives of this study were to examine the castability of commercially pure (CP) titanium using an ultra high-speed centrifugal casting machine and a pressure difference-type casting unit and to compare the castability of titanium with that of conventional dental casting alloys. To determine castability, two types of patterns were used: a mesh pattern of 22 x 24 mm cut polyether thread sieve, and a saucer pattern (24 mm diameter) perforated to create four T-shaped ends. The casting equipment significantly affected the mold filling of both patterns (p < 0.001). The castability indices obtained from both patterns of CP titanium cast in the centrifugal casting machine were significantly (p < 0.05) better than the indices of the castings produced in the pressure-difference casting unit. The radiographs of the saucer pattern cast in the centrifugal casting machine showed some pores that were fewer and smaller in size than the pores found in castings made in the pressure-difference unit. When the ultra high-speed centrifugal casting machine was used with the manufacturer's recommended mold material, the castability of titanium was similar to that of gold alloy or Ni-Cr alloy cast by conventional means.
Journal Article↗
Investigation of the effect of three sprue designs on the porosity and the completeness of titanium cast removable partial denture frameworks.
STATEMENT OF PROBLEM: Although titanium has been used to cast removable partial denture frameworks, the casting process is arduous and requires specialized equipment. PURPOSE: This study evaluated the ability of 3 sprue designs (tree, ball, and circular) to produce complete, void-free castings of removable partial denture frameworks made from commercially pure titanium. METHODS AND MATERIAL: A cast with a Kennedy class III, modification 1, partially edentulous arch was used. The blocked-out cast was modified to facilitate assessment of the completeness of the casting of the clasp arms. Thirty refractory casts were made, and 10 wax patterns for each sprue design were fabricated and invested with ethyl silicate investment. Castings were made with an arc-type automatic casting machine in an argon atmosphere. Castings were examined with radiographic equipment to detect the presence of voids in the castings, and the completeness to each casting was visually verified. Data on porosities were tabulated and statistically analyzed with 1-way ANOVA followed by Student Newman-Keuls test. Chi-square analysis was used to identify statistically significant differences in casting defects among the 3 sprue designs. RESULTS: No statistically significant differences in the total number of porosities were found between the 3 sprue designs (P =.51). Results of completeness of castings evaluated by using chi-square test revealed a statistically significant deference among the 3 sprue designs (P =.008). CONCLUSION: The ball-sprue design produced the most complete castings for the removable partial denture titanium frameworks.
Analysis of Variance↗
Botulinum toxin as an adjunct to serial casting treatment in children with cerebral palsy.
BACKGROUND: Although botulinum toxin A is frequently used to augment serial casting in the treatment of soft-tissue contractures in children with cerebral palsy, its effectiveness for this purpose has not been evaluated. The purpose of the present study was to determine whether botulinum toxin A injection increases the efficacy of serial casting. METHODS: A prospective, randomized trial was undertaken to compare serial casting only with serial casting combined with botulinum toxin A (Botox) injection for the treatment of ankle equinus contractures in twenty-three children with cerebral palsy. Range-of-motion testing, spasticity assessment, and computerized gait analysis were performed as long as twelve months after treatment. RESULTS: There was no difference between the groups with regard to the duration of casting required to correct the equinus contracture. Both groups maintained a significant improvement in passive ankle dorsiflexion throughout the follow-up period, although the group managed with casting and Botox had a significant loss of dorsiflexion when the values at six, nine, and twelve months were compared with the value at three months. Peak dorsiflexion during the stance and swing phases was significantly improved in both groups at three months but only in the group managed with casting alone at twelve months. Plantar flexor spasticity was significantly decreased at three months in both groups, but it was significantly decreased at six, nine, and twelve months only in the group managed with casting alone. Spasticity was significantly greater in the group managed with casting and Botox than it was in the group managed with casting only at six, nine, and twelve months. CONCLUSIONS: The present study demonstrates the efficacy of serial casting in the treatment of equinus contractures in children with cerebral palsy who are able to walk. Contrary to our hypothesis, the addition of botulinum toxin A to a serial casting regimen led to earlier recurrence of spasticity, contracture, and equinus during gait. The results of the present study suggest that botulinum toxin combined with serial casting for the treatment of fixed contractures will lead to a recurrence of plantar flexor spasticity and equinus contracture by six months in this patient population. While previous research has indicated that the injection of botulinum toxin A is superior to casting for the treatment of dynamic equinus, the present study suggests that serial casting alone is preferable for the treatment of fixed equinus contractures in children with cerebral palsy.
Adolescent↗
[Studies on the distortion of the cast crown by measuring volume change (author's transl)].
We made experimental cast crowns under various casting conditions, and measured their dimensional change of inner cervical margin and volume change compared with wax patterns. The relation between percentage of linear expansion (alpha) and percentage of cubic expansion (beta) of matter is beta not equal to 3alpha. When investment mold and cast metal equally expand or contract in all direction, the relation between the dimensional change (=alpha) and the volume change (=beta) of the cast crown must obey this expression beta not equal to 3alpha. When the relation between alpha and beta of the cast crown is not beta not equal to 3alpha, we consider the cast has distortion. Casting conditions were fifteen kinds by changing investment, casting method, linning material and mold temperature. The following results were obtained. 1) Placing wet asbestos liner, dimension was larger than its pattern. But, contraction of volume was great. 2) Placing kaowool liner and asbestos liner coated with vaseline contraction of volume was improved. 3) In case of ringless casting method, the cast crown gave best fit to metal die, and distortion was very small. 4) Judging from these results, hygroscopic expansion of investment by wet asbestos liner made volume contracts, and made the cast crown distort. 5) In case of casting at low temperature ceravest mold (150 degree C), dimension was as large as casting at high temperature mold (700 degree C). But, the lower the mold temperature, the larger the contraction of volume. Therefore, the cast crown fitted metal die, but had large distortion.
Crowns↗
A comparative study of the centrifugal and vacuum-pressure techniques of casting removable partial denture frameworks.
A study was undertaken to evaluate two techniques for casting accuracy on removable partial denture frameworks: centrifugal casting and vacuum-pressure casting. A standard metal die with predetermined reference points in a horizontal plane was duplicated in refractory investment. The casts were waxed, and castings of nickel-chrome alloy were fabricated by the two techniques. Both the casts and the castings were measured between the reference points with a measuring microscope. With both casting methods, the differences between the casts and the castings were significant, but no significant differences were found between castings produced by the two techniques. Vertical measurements at three designated points also showed no significant differences between the castings. Our findings indicate that dental laboratories should be able to use the vacuum-pressure method of casting removable partial denture frameworks and achieve accuracy similar to that obtained by the centrifugal method of casting.
Chromium↗
The prevention of skin excoriation under children's hip spica casts using the goretex pantaloon.
The purpose of this study is to determine whether the use of the Goretex Pantaloon cast liner for children's spica casts reduces urine excoriation of the skin under the cast and reduces the incidence of unplanned cast changes necessitated by cast soilage. Between 1988 and 1993, 72 consecutive children who had 147 hip spica casts applied were followed. The first 36 patients had 77 spica casts applied without the Goretex Pantaloon, and the last 36 patients had 70 spica casts with a Goretex liner. In the group of patients without Goretex, 22% of casts were associated with urine excoriation of the skin compared to 1.4% in the group of patients who had a Goretex liner applied. This was statistically significant (p = 0.0005). The incidence of unnecessary cast changes due to soiling of the cast was 14% in the non-Goretex group compared to 2.9% in the Goretex group (p = 0.05). The use of the Goretex liner in our series resulted in a savings of $38 per cast including the cost of the liners ($75). The Goretex Pantaloon cast liner used for children's spica casts prevents urine excoriation of the skin and is cost effective.
Casts, Surgical↗