The experimental replacement of segmental defects in bone with a plaster of Paris-epoxy resin mixture.
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The results of a randomized study comparing three different principles of treatment for rupture of the lateral ligaments of the ankle are presented. A total of 95 patients was treated and followed up for 17 months. In this series, 32 patients were treated with primary suture and plaster-of-Paris, 33 patients with plaster-of-Paris only and 30 patients with strapping. In all, 31 patients (97%) were completely free of symptoms in the operation group, 22 (67%) in the plaster-of-Paris group and 23 (77%) in the strapping group.
An inner tube was inflated and then surrounded with plaster wool and plaster-of-Paris bandages. The plaster and the wool were next progressively divided. There was no significant reduction of the pressure inside the tube until both the plaster and the wool had been divided and separated from the inner tube along the entire circumference. These findings demonstrated that wool and plaster applied to limbs likely to swell should be split right down to skin and widely separated immediately after their application. A plaster slab is safer still, but the wool must be cut before the crepe bandage is applied.
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The classical plaster bandage was devised in the mid 19th century. Until recently, osteoarticular trauma has been treated mostly by plaster cast immobilisation using plaster of Paris. Synthetic materials have been introduced on the market place in the seventies, but they have not superseded the traditional plaster of Paris. The more recent thermoplastic materials are used to make splints and orthoses, particularly at the wrist and hand. The present review of the literature confirms that synthetic materials present better physical and mechanical properties than the traditional plaster of Paris. In addition, they are lighter, they are more resistant to humidity, they are more radiotransparent and they generate less dust when removed. However, they are less malleable and cause higher pressure in case of limb edema. Plaster of Paris therefore remains indicated in the acute posttraumatic or postoperative period. This material is also cheaper, but the pecuniary benefit is limited for several reasons, particularly because plaster of Paris is associated with a higher rate of cast replacement.
It is difficult to treat the intra-articular fracture of distal tibia or Pilion's fracture. From 1987 to 1995, 43 cases of Pilon's fracture were admitted and treated with different methods. After treatment, they had been followed up for 1 to 8 years. According to Riiedi's Classification, there were type I 12 cases, type II 21 cases and type III 10 cases. The methods used on these patients included manual reduction and plaster of paris immobilization, calcaneous tubercle traction and plaster of paris immobilization, open reduction and internal fixation with Kirschner wires, and open reduction and internal fixation with AO plate. The outcome was evaluated according to Ovadia's criteria, for type I fracture, 8 cases were treated with conservative method with a satisfactory rate of 79.17% and 4 cases were treated with operation with a satisfactory rate of 91.67%; for type II, conservative method for 12 cases and the satisfactory rate was 33.33%, and operation for 9 cases with a satisfactory rate of 70.37%; for type III, conservative method for 2 cases, with poor result, and operation for 8 cases with satisfactory rate of 79.17%. The indication for conservative treatment was type I fracture. It showed that for Pilon's fracture, the outcome of open reduction and internal fixation was superior to that of the conservative treatment, especially in those having internal fixation with AO plate.
Treatment of osteomyelitis with local antibiotic delivery systems has become a common practice in orthopaedic surgery. This study attempted to show that locally produced pure or bioglass reinforced plaster of Paris, hydroxyapatite and sodium alginate are promising biomaterials and mainly because of economical reasons and availability, may be an alternative in clinical practice, especially for developing countries. A total of 32 rabbits were divided into four groups (n:8). In group A, sodium alginate + cephazoline; in group B, plaster of Paris + bioglass + cephazoline; in group C, plaster of Paris + hydroxyapatite + cephazoline and in group D, plaster of Paris + cephazoline were used. The blood serum cephazoline concentrations were analyzed by high performance liquid chromatography on days 1 to 10 everyday and then at days 13, 17, 18, 24, 25 and 30. The mean values +/- standard deviations and median values of blood serum antibiotic concentrations for groups A, B, C and D were 1.45 +/- 0.40 (1.42) mcg/ml, 1.53 +/- 0.64 (1.31) mcg/ml, 1.92 +/- 0.39 mcg/ml (1.90) and 1.41 +/- 0.65 (1.25) mcg/ml, respectively. The detected antibiotic level was constantly over the minimum inhibitory concentration for Staphylococcus aureus. In conclusion, it can be stated that these materials are promising as a antibiotic delivery system even with simple production methods.
There is no doubt that primary suturing of the ruptured ankle ligament gives the best results regarding joint stability. However, there are differing views concerning the follow-up treatment. In particular, there are controversial opinions about the value of a special shoe by Dr. Spring during the rehabilitation phase. During the period April 1984 to July 1985 100 patients with rupture of the fibular ligament were treated operatively, 50 of whom were treated post-operatively with 14-day lying plaster of Paris followed by a further 14 days with the special shoe from Dr. Spring and 50 with a lower leg walking plaster of Paris. The results were compared over a period of 8 weeks, using objective criteria. The subjective impressions followed after at least 6 months. After 8 weeks the mobility of the joint in dorsalflexion and pronation is similar in both groups; in plantar flexion and supination better mobility was seen after the plaster of Paris treatment. There was no significant difference in the duration of unfitness for work. Subjectively, there was a reduced tendency to swelling after the plaster of Paris treatment.
Movement of teeth during denture processing is an unsolved problem. This study investigates the amount of vertical tooth movement during controlled processing of acrylic, using 33 degrees and 0 degree teeth invested in specific mixes of plaster of Paris or dental stone. Forty sample set-ups each containing four posterior teeth were processed under strictly controlled laboratory conditions. Twenty of these samples carried 33 degrees teeth and the other twenty carried 0 degree teeth. Each group of twenty samples was randomly divided on a factorial design into batches of ten for investment in plaster of Paris or stone. The vertical movements were measured with a greater degree of accuracy than is required for clinical application. All results were analysed statistically. Significantly greater movement occurred with teeth invested in stone than those invested in plaster of Paris. Whereas, for teeth invested in stone, significantly greater movement occurred with 33 degrees than with 0 degree teeth, no such effect was found with teeth invested in plaster of Paris.
This study compares the standard plaster-of-Paris cast (Gypsona) with a combination case consisting of plaster-of-Paris covered with a double layer of a polymer casting bandage (Baycast). Thirteen subjects were studied. Each wore concurrently a standard plaster on one leg and a combination plaster on the other. Weight bearing was commenced immediately after application and continued for 8 hours, when they were removed for examination. All the standard plasters cracked, but only one of the combination plasters, and this was due to a technical error.
A 109Cd K x-ray fluorescence (XRF) system using a point source in a back-scatter geometry is described. The suitability of plaster-of-Paris phantoms as targets for intercalibration standards was evaluated. When the phantom concentrations were measured by inductively-coupled-plasma mass spectrometry (ICPMs), the calculated phantom concentrations underestimated true concentrations by an average of 15%. Since calculated values are used to calibrate the K XRF system, in vivo bone-lead concentrations may be similarly underestimated. The difference between calculated and measured concentration is attributable to impurities in the plaster of Paris (e.g. calcium carbonate). The ICPMS-measured concentrations were used to calibrate the K XRF system. The same phantoms were also measured as 'unknowns' by a bone-lead measurement system (Abiomed, Danvers, MA, USA). The commercial system overestimated the lowest-concentration phantoms and underestimated the phantoms with concentrations above 15 microg Pb/g plaster of Paris. The commercial system and our system were compared by measurement of the new phantoms in air and in water. The K XRF system exhibited better precision in both situations. On the basis of this work, we recommend that plaster-of-Paris phantoms used to calibrate K XRF measurement systems be analysed first by ICPMS or another valid analytical technique.
Patients who have inoperable or previously irradiated cervical recurrences, especially if very confined and alone, pose a challenging problem to the clinician. Low-dose irradiation and hyperthermia seems to be a promising method for salvage treatments in previously treated patients. In order to heat the vaginal apex, individualized prototype applicators utilizing commercial microwave antennas were constructed and tested in muscle equivalent phantom. The technical construction of vaginal applicators followed Pierquin's procedure for gynaecological brachy-therapy moulds: (1) a true negative vaginal print in alginate was made; (2) a positive mould in plaster of Paris was then constructed; (3) a negative vaginal print was produced in plaster of Paris and (4) heat moulding of a 0.1 cm thick sheet of cellulose acetate on the plaster mould was accomplished. Interstitial microwave antennas were inserted within the applicator and kept in place using silk wires or Teflon rings. The external part of the applicator was thermally sealed and protected with silicone. This was particularly useful in cases where an inner cooling system was required. Heat patterns in tissue equivalent phantom materials were determined using non-perturbing probes and infrared thermography. An illustrative clinical case is described.
Aerobic capacities and muscle strengths of the uninjured limbs have been measured in patients who had suffered fractures of the lower limb. In patients treated in plaster-of-Paris aerobic capacity and strength fell rapidly following injury, to an extent greater than might be expected as a result of resting in bed. Before removal of the plaster-of-Paris, both aerobic capacity and strength had improved. Further improvement occurred in the injured limb after resuming use of the injured limb. In patients treated by traction and thus subjected to long periods in bed, the reductions of aerobic capacity and strength, measured shortly after resuming movements, were more profound than in patients treated with plaster-of-Paris.
Plaster of Paris has been largely superceded for casting in orthopedic departments by synthetic cast materials. Despite its weight, its relative brittleness, its unpopularity with patients, and its messiness in application, plaster of Paris remains the mainstay of casting in the emergency department. This is due to a combination of economic reasons, the belief that synthetic casts leave less room for swelling and its relative ease of application compared to synthetic materials. We present a technique for synthetic cast application that avoids the problems of the rapidly setting cast and therefore allows the time for less experienced hands to produce a well-fitting cast or splint. We believe that this option, which allows the patient to have a lighter synthetic cast, rather than the traditional plaster of Paris cast, will be welcomed by both the patient and physician.
The introduction of polyurethane (PU) resin impregnated fibreglass bandages is likely to have a significant effect on modern orthopaedic practice. The manufacturers of these products claim many improved properties compared to plaster of Paris bandages, such as , high strength to weight ratio, rapid setting time and high radiolucency. This paper reports on a series of mechanical tests designed to assess the strength, flexibility, working time and wear properties of the current range of fibreglass bandages and to compare them with plaster of Paris bandages. The results have clearly demonstrated that the fibreglass bandages are mechanically superior and offer numerous advantages over plaster of Paris for use as the definitive casting material for both weight-bearing and non-weight-bearing casts.
Gypsum or plaster-of-Paris has given long and efficient service in the management of fractures of the leg, and in spite of the recent introduction of a variety of synthetic materials (Hunt, 1980) it remains the most commonly used splintage material. Plaster-of-Paris bandages can compete successfully with synthetic ones because of their convenience and easy use notwithstanding the superior strength, shorter curing time, water resistance, and radiotranslucence of the synthetics. However, Orthoplast in sheet form is a very satisfactory material for forming the tibial cast brace while synthetic bandages with plastic flexible hinges are advantageous for femoral cast bracing. Nowadays, in fact, plaster-of-Paris has been supplanted to some extent. A review of the methods of fracture splintage that were used before the introduction of gypsum helps to provide a perspective of the merits of this material, whose properties and availability have been taken for granted for more than a hundred years.
The mechanical properties of five synthetic fiberglass casting materials were evaluated and compared with the properties of plaster of Paris. Two of the tests were designed to bear clinical relevance and the third to determine intrinsic material properties. The effect of water on strength degradation was also evaluated. It was found that the synthetics as a group are far superior to plaster of Paris in all methods of testing and that, among the synthetics, KCast Tack Free, Deltalite "S", and KCast Improved were the stronger materials. Clinically, the most important results are that the synthetics attain their relatively high strength in a much shorter time frame than does plaster of Paris, and retain 70-90% of their strength after being immersed in water and allowed to dry.