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At least 325 records · Page 18Linked to original sources
PubMed1999

Does Kapandji wiring help in older patients? A retrospective comparative review of displaced intra-articular distal radial fractures in patients over 55 years.

Forty-six patients aged 55-90 with intra-articular displaced fractures of the distal radius were reviewed retrospectively. All patients were treated with either manipulation and plaster of Paris or Kapandji wiring. Radiographic and functional review was performed by an independent observer a mean of 17 months after the fracture. The results showed superior anatomical and functional results in the group treated with Kapandji wiring. The mean dorsal angle was significantly better in the wired group, and the improvement in dorsal angle, radial angle and radial length from presentation to final result was also significantly better. Functional results were excellent or good in 19/23 of the wired group, compared with 12/23 of the plaster group. There was a strong correlation between functional outcome and both dorsal angle and radial length at union. These results support the use of this method of wire fixation in older patients, as the technique is simple and complications were few.

Aged↗
PubMed1997

Skin surface pressure beneath an above-the-knee cast: plaster casts compared with fiberglass casts.

Complications related to immobilization in a cast after an injury or an operation may be related to the materials used for the cast or to the techniques of application, or to both. To evaluate the widely held clinical opinion that the use of a fiberglass cast is dangerous and inappropriate when subsequent swelling of the extremity is anticipated, we studied the skin surface pressures that were generated beneath above-the-knee casts made with different materials and applied with different techniques. A prosthetic model of the lower extremity was designed with an expandable calf compartment to simulate swelling after an injury or an operation. With use of this model, we measured the skin surface pressure beneath a plaster-of-Paris cast, a fiberglass cast that had been applied with a standard technique, and a fiberglass cast that had been applied with a stretch-relax technique. The highest mean skin surface pressure after application of the cast (p < 0.001) and after simulated swelling of the limb (p = 0.04) was generated by the fiberglass cast that had been applied with a standard technique. The lowest mean skin surface pressure after application of the cast (p = 0.006), simulated swelling of the limb (p < 0.001), and all subsequent steps of the experimental protocol (p < 0.001) was generated by the fiberglass cast that had been applied with the stretch-relax technique. The mean skin surface pressure generated by the plaster cast and by the fiberglass cast applied with the standard technique did not return to the value before application of the cast until anterior and posterior longitudinal cuts had been made in the cast and the cast had been spread at those cuts. When the fiber-glass cast had been applied with the stretch-relax technique, the mean pressure returned to the baseline value after only an anterior longitudinal cut and spreading at that cut. The principal pitfall of the use of a fiberglass cast is related to the technique of application. When the fiberglass cast had been applied with the standard technique, it generated a mean skin surface pressure that was higher than that associated with the plaster cast and it accommodated simulated swelling poorly. When the fiberglass cast had been properly applied, with the stretch-relax technique, it generated a mean skin surface pressure that was significantly lower (p = 0.006) than that associated with the plaster cast and it better accommodated simulated swelling without the need to sacrifice the structural integrity of the cast.

Calcium Sulfate↗
PubMed1985

Supracondylar fracture of the humerus in children: review of closed and open reduction leading to a proposal for treatment.

Of 70 supracondylar fractures of the humerus in children, 25 were treated by open reduction and internal fixation, 24 by closed manipulation and plaster and 21 by plaster-of-Paris only. Three of the fractures were operated on because of suspected vascular injury (with or without neurological symptoms), another seven because of instability and/or extreme swelling and 15 after unsatisfactory closed reduction. Traction was used in 3 of the 24 patients treated by closed methods and among the other 21, three fractures had to be manipulated twice. Three to six years after the injury, 6 of the 25 patients operated on had reduced flexion-extension and/or deformity exceeding 10 degrees. Five patients treated by closed reduction had reduced movements or deformity exceeding 10 degrees and three patients with originally undisplaced fractures had deformity exceeding 10 degrees. In this study the most severe fractures were selected for operation but, in spite of this, the results were better than for fractures treated by closed reduction and plaster. Based on this and previous studies, a plan suitable for most departments is suggested for the treatment of this fracture.

Adolescent↗
PubMed2000

Properties of a hybrid plaster-fibreglass cast.

OBJECTIVE: To examine the suitability of a plaster-fibreglass hybrid cast for orthopedic applications, comparing them to plaster of Paris (POP) and fibreglass constructs. METHOD: Groups of 10 standardized hybrid, POP and fibreglass casts were studied. An Instron servohydraulic system was used to test the casts in 3-point bending and shear. OUTCOME MEASURES: Strength, stiffness, weight, thickness and cost of the 3 types of cast, and shear strength at the interface between the POP and fibreglass in the hybrid casts. RESULTS: The hybrid casts were twice as strong as the POP constructs, were stiffer and weighed 14% less but were thicker and cost 2.5 times more. They were almost as strong as and less than half the cost of the fibreglass constructs but were thicker, not as stiff, and weighed 42% more. The shear strength of the POP-fibreglass interface in the hybrid casts was higher than the 3-point bending strength of this construct by a factor of 3. CONCLUSIONS: Plaster-fibreglass hybrid casts should be considered for orthopedic use on the basis of their strength, stiffness, weight and cost, combined with their acknowledged advantages of good moulding ability and water resistance.

Analysis of Variance↗
PubMed1980

Computerized tomographic determination of human thigh components. The effects of immobilization in plaster and subsequent physical training.

Thigh components were estimated by computerized tomography (CT) as well as by anthropometry in two healthy male soccer players (23--29 years), who for 5 weeks had one knee immobilized in a plaster of Paris. The investigations were performed on both thighs just after removal of the cast and after 5 weeks physical training of the inactivated quadriceps muscle. The different components were easily identified on a transverse scan through the middle of the thigh. The quadriceps muscle was 26% smaller after removal of the cast in the inactivated leg as compared with the contralateral leg; no differences were observed in the remaining thigh components. After rehabilitation a specific increase (22%) in the hypotrofic quadriceps muscle was observed, whereas no changes were disclosed in the remaining thigh components. The quadriceps muscle averaged 52% of the lean component in the uninjured thigh, and the subcutaneous part of the total cross-sectional area averaged 15%. The changes in the anthropometrically determined thigh components paralleled those observed by the CT scanning procedure. It is concluded that the loss in the lean thigh volume during immobilization in plaster cast is exclusively due to waste of the quadriceps muscle. CT scanning comprises a new valid tool to study changes in thigh components.

Adult↗
PubMed1998

A 15-year assessment of controlled trials of the management of tuberculosis of the spine in Korea and Hong Kong. Thirteenth Report of the Medical Research Council Working Party on Tuberculosis of the Spine.

The final results up to 15 years are reported of clinical trials of the management of tuberculosis of the spine in Korea and Hong Kong. In Korea, 350 patients with active spinal tuberculosis were randomised to ambulatory chemotherapy or bed rest in hospital (in Masan) or a plaster-of-Paris jacket for nine months (in Pusan). Patients in both centres were also randomised to either PAS plus isoniazid for 18 months or to the same drugs plus streptomycin for the first three months. In Hong Kong, all 150 patients were treated with the three-drug regime and randomised to either radical excision of the spinal lesion with bone graft or open debridement. On average, the disease was more extensive in Korea, but at 15 years (or 13 or 14 years in a proportion of the patients in Korea) the great majority of patients in both countries achieved a favourable status, no evidence of CNS involvement, no radiological evidence of disease, no sinus or clinically evident abscess, and no restriction of normal physical activity. Most patients had already achieved a favourable status much earlier. The earlier results of these trials are confirmed by the long-term follow-up with no late relapse or late-onset paraplegia. The results of chemotherapy on an outpatient basis were not improved by bed rest or a plaster jacket and the only advantage of the radical operation was less late deformity compared with debridement. A second series of studies has shown that short-course regimes based on isoniazid and rifampicin are as effective as the 18-month regimes: ambulatory chemotherapy with these regimes should now be the main management of uncomplicated spinal tuberculosis.

Adolescent↗
PubMed2001

Extracorporeal irradiation--novel use of a blood product irradiator.

A Cs-137 blood product irradiator (BPI) is used for extracorporeal irradiation of bone grafts. For dose verification purposes two bone phantoms were constructed of plaster of Paris and irradiated in the BPI. The first was a hollow cylinder measuring 15 cm x 3.3 cm to simulate cortical bone, filled with paraffin wax to simulate yellow bone marrow. The second was a concave ellipse 11.5 cm x 9.5 cm x 2.5 cm to simulate a section of ilium. The absorbed dose was measured with radiochromic film in the phantoms and in water for comparison with the manufacturer's calibration certificate. The relative dose distribution in the bone phantoms was measured using Li-F thermoluminescent dosimeters and normalized to a reference point near the centre of each phantom. The doses measured in water matched the calibration certificate within 4%. The doses measured at the cylindrical and elliptical phantom reference points were 49.9 Gy and 52.3 Gy respectively, compared to the nominal dose of 50.0 Gy. The relative doses within the cylindrical phantom ranged from 88% to 100% along the central axis of the wax cylinder, from 89% to 100% along the plaster/wax interface, and from 90% to 103% along the outer surface of the plaster cylinder. The relative doses within the elliptical phantom ranged from 100% to 108% along the inside surface, from 99% to 107% along the outer surface, and from 98% to 103% through the centre of the plaster ellipse. These data agree well with the isodose plot provided by the manufacturer.

Blood↗
PubMed2005

[Long-term results following fracture of the femoral neck in children].

PURPOSE OF THE STUDY: This retrospective study was designed to evaluate the severity and nature of long-term sequelae of femoral neck fractures in children in relation to the strategy and technique of therapy. MATERIAL: The study included 15 patients with a fracture of the femoral neck who, at the time of injury, had an opened proximal physis. The average age at the time of injury was 11.5 years (range, 4 to 16.3 years). There were eight boys and seven girls. Twelve children suffered injury due to a fall varying in gravity, two were knocked down by a vehicle, and one was injured as a co-driver in a car accident. The group involved no type I fracture, six type II, seven type III and two type IV fractures, as classified by the Delbet and Colonna system. METHODS: All children were operated on within an average of 4.1 days after injury. The delay was caused by a late referral from an outside hospital or was due to associated complications.However, the majority of fractures were treated within 24 hours of injury. Surgery was carried out from the anterolateral approach. Miniarthrotomy was performed in 11 patients to remove hematoma and decompress the intra-articular space. The methods of stabilization included Kirschner's wires in four children, compressive osteosynthesis using lag screws inserted extraphyseally in 10 children and the combination of both methods in one child. No plaster of Paris spica or traction was applied after surgery. RESULTS: The long-term results were evaluated at a minimum of 5 years after injury. The average follow-up was 9 years and 11 months, with the range from 5 years and 1 month to 15 years and 5 months, and 12 patients were involved. Six had a type II and six had a type III fracture. Ten patients were treated by arthrotomy. Stabilization of the fracture was performed with lag screws in nine children and Kirschner's wires in three patients. Both subjective and objective findings were evaluated by the modified Rattlif criteria. Concerning pain, eight (67 %) children had excellent outcomes, three (25 %) reported good outcomes and only one (8 %) had a poor outcome. The activity following injury was subjectively evaluated as excellent by 11 (92 %) patients and as good by one (8 %) patient. None of the patients was noticeably limited in their activity, as compared with the pre-injury state. Objective findings were based on X-ray images and the range of hip motion. No or minimal radiographic changes were found in five (42 %) patients and were assessed as excellent outcomes. A good outcome, i. e., a spherical head with a moderate neck deformity, was achieved in five (42 %) patients. A poor outcome, i. e., avascular necrosis free of revitalization, but with collapse, on X-ray images was recorded in two (16 %) patients. The values for the range of motion and limb-length discrepancy were excellent in eight (67 %), good in two (16.5 %) and poor in two (16.5 %) patients. Poor objective and subjective findings were recorded in the patients who had not undergone miniarthrotomy. DISCUSSION: A comparison with the literature data showed that the occurrence of each fracture type was in agreement with the reports of other authors. The finding of a higher frequency of type I fractures can be explained by a pathological slip due to hormonal changes. The opinions on treatment of these fractures have developed to the view that surgery is necessary in the early post-injury period, preferably with the use of compressive osteosynthesis or Kirschner's wires. However, subsequent immobilization in a plaster cast spica is not necessary. The subjective and objective findings were not exactly correlated due to differences in patients' age and different intervals between injury and treatment. CONCLUSIONS: The authors recommend early surgery and stabilization by compressive osteosynthesis or Kirschner's wires, together with miniarthrotomy in order to decompress the articular space.

Adolescent↗
PubMed1979

Primary excision and grafting of burns located over an open fracture.

Early excision of the burn, immediate autografting, reduction of the fracture, and stabilization with a plaster-of-paris cast is offered as an alternative method for managing burns with associated long-bone fractures. The opportunity to excise and immediately autograft a burn wound requires rethinking of the entire problem of burns associated with a fracture.

Adolescent↗
PubMed2005

Conservative treatment for closed fifth (small finger) metacarpal neck fractures.

BACKGROUND: Subcapital fractures of the fifth metacarpal bone, meaning fractures just below the knuckle of the little finger, account for approximately 20% of all hand fractures. Currently, there is no consensus concerning the optimal management of these fractures. Traditionally, treatment consists of closed reduction and external splinting in a neutral position using plaster of Paris (POP), involving the metacarpal joint, the proximal interphalangeal joint and the carpo-metacarpal joint. An alternative treatment strategy is functional treatment using taping or bracing that does not restrict movement. OBJECTIVES: To compare functional treatment with immobilization, and to compare different periods and types of immobilization, for the treatment of closed fifth metacarpal neck fractures in adults. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (July 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004), OVID OldMEDLINE (1951 to 1965), OVID MEDLINE (1966 to July 2004), OVID MEDLINE In-Process (July 2004), EMBASE (1988 to 2004, week 29), the Internet, and reference lists of articles. No language restrictions were applied. SELECTION CRITERIA: All randomized and quasi-randomized controlled trials which compare functional treatment with immobilization or different types of immobilization for closed fifth metacarpal neck fractures. DATA COLLECTION AND ANALYSIS: Two review authors assessed abstracts of all studies identified by the initial search, identified studies meeting the selection criteria, independently assessed the quality of the trial reports, and extracted and analysed the data. MAIN RESULTS: Five studies met the inclusion criteria including a total of 252 participants. Most studies were of poor quality. The primary outcome measure, function of the hand, was not used in any studies. There was no evidence that any of the treatment modalities was statistically significantly superior. AUTHORS' CONCLUSIONS: No included studies reported our primary outcome measure of interest, validated hand function. There was heterogeneity between the studies, which were of limited quality and size. No single non-operative treatment regimen for fracture of the neck of the fifth metacarpal can be recommended as superior to another in result. Further research is definitely warranted.

Bandages↗
PubMed2007

Transformation of 3DP gypsum model to HA by treating in ammonium phosphate solution.

Three-dimensional printing (3DP) is a CAD/CAM built-up using ink-jet printing technique. Commercially available 3DP system can form only gypsum model and not for bioceramics. On the other hand, transformation of hardened gypsum into hydroxyapatite (HA) by treatment in ammonium phosphate solution was found lately. In the present study, transformation of the 3DP gypsum block to HA was attempted. However, the fabricated 3DP block was soluble in water. To insolubilize, it was heated at 300 degrees C for 10 min, and then, gypsum was transformed to calcium sulfate hemihydrate, CaSO(4) x 0.5H(2)O. The 3D block was immersed in 1M (NH(4))(3)PO(4) x 3H(2)O solution at 80 degrees C for 1-24 h, and the transformation into HA within 4 h was ascertained. A heat-treated plaster of Paris (POP) block was also investigated for comparison. The unheated POP block consisting of gypsum dihydrate took 24 h to complete the transformation, while the heat-treated POP consisting calcium sulfate hemihydrate promoted the transformation into HA; but the transformed thickness in the block was less than the 3DP block. This is probably due to higher solubility of the hemihydrate than gypsum dihydrate. Accelerated transformation of the 3DP block was also caused by its porous structure, which enabled an easy penetration of the phosphate solution. With the present method, it is possible to transform the fabricated gypsum by 3D printing that is adaptive to the osseous defect into HA prostheses or scaffold.

Bone Substitutes↗
PubMed1993

In vitro pharmacokinetics of antibiotic release from locally implantable materials.

Local deposition of antibiotics has became increasingly popular in the management of open fractures or osteomyelitis, and several substances have been employed as the vehicle for delivery. Although the elution characteristics of some substances have been documented, a comparative study of the characteristics of the commonly used substances could establish the clinical indications for particular vehicles. Cylindrical pellets of uniform size (6 x 4 mm) were prepared from bone graft (BG), demineralized bone matrix (DBM), plaster of Paris (POP), or polymethylmethacrylate (PMMA), with 25 mg of tobramycin/g of substance in each pellet. The pellets were suspended in phosphate buffered saline, and the antibiotic concentration in the buffer was determined at various time intervals by an enzyme immunoassay. BG and DBM eluted 70 and 45% of their antibiotic load by 24 h, and negligible amounts were detected at 1 week; POP released 17% of its load by 24 h, with trace amounts detected at 3 weeks; and PMMA eluted 7% at 24 h, with trace amounts detected for as long as 14 days. These findings suggest that the optimal vehicle for local deposition of antibiotic depends on the clinical setting. BG and DBM may be best employed when brief antibiotic coverage is required (as for acute contaminated open fractures), whereas POP and PMMA may be better suited for long-term coverage (such as for established osteomyelitis).

Animals↗
PubMed2006

Dependence of calculus retropulsion on pulse duration during Ho: YAG laser lithotripsy.

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate the effect of optical pulse duration on stone retropulsion during Ho:YAG (lambda = 2.12 microm) laser lithotripsy. STUDY DESIGN/MATERIALS AND METHODS: A clinical Ho:YAG laser with pulse durations was employed to fragment calculus phantoms and to evaluate stone phantom retropulsion. At a given pulse energy, optical pulse durations were divided into two discrete conditions: short pulse (tau(p): 120 to approximately 190 microseconds at FWHM) and long pulse (tau(p): 210 to approximately 350 microseconds at FWHM). Plaster of Paris calculus phantoms were ablated at different energy levels using optical fibers of varying diameters (273, 365, and 550 microm in core size). The dynamics of the recoil action of a calculus phantom was monitored using a high-speed camera; the laser-induced craters were evaluated with optical coherent tomography (OCT). Bubble formation and collapse were recorded with a fast flash photography setup, and acoustic transients were measured with a hydrophone. RESULTS: Shorter pulse durations produced more stone retropulsion than longer pulses at any given pulse energy. Regardless of pulse duration, higher pulse energy and larger fibers resulted in larger ablation volume and retropulsion (P<0.05). For shorter pulse durations, more rapid bubble expansion was observed and higher amplitudes of the collapse pressure wave were measured (P<0.05). CONCLUSION: Less retropulsion and equivalent fragmentation occurred when Ho:YAG pulse duration increased.

Analysis of Variance↗
PubMed2004

The interaction of endosulfan with the Collembolan, Proisotoma minuta (Tullberg): toxicity, the effects of sub-lethal concentrations and metabolism.

An increased level of the Collembolan, Proisotoma minuta Tullberg was found in the cotton-growing areas of New South Wales, Australia. They were regularly exposed to endosulfan, a highly insecticidal compound. Toxicity, sub-lethal effects and metabolism of endosulfan were studied in P minuta that had been successfully maintained in a plaster of Paris and charcoal mixture substrate with freeze-dried yeast as a food. The 168-h LD50 values were 0.011, 0.049 and 0.055 mg liter(-1) for alpha- and beta-endosulfan and endosulfan sulfate, respectively. When P minuta were exposed to non-lethal concentrations of the endosulfans, egg production was inhibited. On recovery from the toxic effects of the endosulfans they resumed production of viable eggs. Conversion of alpha- and beta-endosulfan to endosulfan sulfate was found and the endosulfan sulfate could be further metabolized. The rate of metabolism of alpha-endosulfan was greater than that of beta-endosulfan and the product of endosulfan sulfate metabolism was not identified.

Animals↗
PubMed1990

Congenital dislocation of the knee.

Congenital dislocation of the knee (CDK), first described in 1922, is a rare condition sometimes associated with other congenital malformations. There is a total anterior dislocation with recurvatum and upward displacement of the proximal tibia. This review covers our ten year experience at the hospital San Juan de Dios, in Caracas, Venezuela, a children's hospital with three orthopaedic services. We have seen 22 affected knees in 14 patients. Newborn patients were treated on traction until reduction was achieved, followed by serial plaster of Paris casts until, optimally, 90 degrees of flexion was gained. Surgical treatment was used if conservative treatment had failed after six months, or if the patient first presented after the age of 12 months. All our patients were eventually able to walk, three with the assistance of calipers. Some limitation of knee flexion was commonly seen. The best results were achieved when treatment was started early.

Abnormalities, Multiple↗
PubMed1980

The management of amputations of the leg using a new rigid foam plaster for prosthetic fitting.

This paper describes the use of a rigid polyurethane foam to construct a stump socket for immediate or early prosthetic fitting in 15 patients with amputation through the leg. The foam plaster is poured into a prepared cotton sleeve, with a zip incorporated, and rolled out to a layer 4 mm thick. The filled sleeve is put around the stump and the zip closed, moulding the sleeve firmly to the stump. The closed sleeve hardens into a rigid polyurethane shell within 20 min. Aferwards the skeletal prosthetic components are fixed with the same rigid foam. The polyurethane foam socket is quickly and cleanly prepared, only one third of the weight of a plaster of Paris cast and is easily removed by means of the zip, allowing access to the stump.

Aged↗
PubMed1981

The correction of primary knee deformities in children.

One hundred and fourteen patients with primary knee deformity either genu varum, genu valgum or combined varus and valgus deformities were treated with serial plaster cylinder casts and wedging for six to nine months. The children were aged between 2 to 13 years, the peak incidence being in the third year of life. Forty-seven of the patients were found to have active or healed rickets but the remaining patients showed no evidence of rachitic lesions. Results showed that serial corrective plaster casts gave a satisfactory cosmetic appearance in 69 patients but the older the patient the less favourable was the result. Eighteen patients were resistant and underwent surgical osteotomy of the femur or tibia; in four instances multiple osteotomy was required. The conclusion was that plaster of Paris casts were a safe and effective method of correcting primary deformity of the knee in the majority of the patients.

Adolescent↗
PubMed1975

[Changes in bone turnover under immobilization and remobilization. Animal experiments using 45Ca and tetracycline labelling (author's transl)].

This paper presents an experimental study of rabbits immobilized in plaster of paris casts. By means of Tetracycline and 45Ca-labelling an immobilisation over 12 weeks showed a significant diminuition of bone formation. In the first stages of remobilisation the bone formation was found to be increased and became normally in a later stage. The lower dorsal spine was not sufficiently immobilized in our experiments. Therefore significant changes of bone turnover could not be observed.

Animals↗