[Apparatus for casting molds and application of plaster casts with horizontal-vertical shifting of the patient].
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Casts, Surgical↗
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Below-knee plaster cast for the treatment of metatarsus adductus.
Sixty-five infants with moderate (37 feet) or severe (48 feet) inflexible metatarsus adductus were treated with a below-knee plaster cast. The deformity was corrected in 6-8 weeks in all cases. At the 2- to 6-year follow-up (mean, 4 years), the correction was maintained in all children who had had a moderate deformity; of the 44 feet with severe deformity that were available for examination, six now had a moderate deformity, and one a severe deformity. All forefeet were flexible, and further treatment was unnecessary. Our results are similar to those for above-knee plaster casts. We conclude that a below-knee plaster cast is effective in the treatment of metatarsus adductus.
Casts, Surgical↗
Low molecular weight heparin (Innohep) as thromboprophylaxis in outpatients with a plaster cast: a venografic controlled study.
INTRODUCTION: The aim of this study was to investigate the incidence of deep vein thrombosis (DVT) in patients immobilized in plaster cast and the possible efficacy of prophylaxis with low molecular weight heparin (LMWH). MATERIAL AND METHODS: The study was a randomized, assessor-blinded, open multicenter (three centers) study. All patients over 18 years of age with planned plaster cast on a lower extremity of at least 3 weeks were eligible for participation. Written informed consent was obtained from 300 patients and they were randomized to either 3.500 IU anti-Xa of tinzaparin (Innohep) subcutaneously once daily or no prophylaxis. On the day the cast was removed, ascending unilateral venography was performed. Two experienced radiologists, unaware of treatment, assessed the pictures independently. The radiologist had to obtain consensus as to whether DVT was present or not. RESULTS: 300 patients were included (148 in the treatment group and 152 in the control group). Ninety-five were subsequently withdrawn. DVT was diagnosed in 10/99 patients in the treatment group and in 18/106 patients in the control group. This difference is not significant (P=.15, chi(2) test) and the odds ratio was 0.55 (95% confidence interval=0.34-1.26). CONCLUSION: DVT in legs after plaster casting is a big problem, with an incidence of almost 20%. An effective prophylactic regime is required. Once-daily dose of 3.500 IU anti-Xa of tinzaparin was not sufficient.
Adolescent↗
Effect of plaster-cast immobilization on the bone.
Plaster-cast of the right hind limb resulted in immobilization osteoporosis in rats. The alteration was characterized by loss of the bony substance as well as by a partial transformation of lamellar bone to primordial osseous tissue. In the basis of histological and histomorphometric findings, an accelerated osteoclastic activity, an increased osteocytic osteolysis and a decreased ossification are responsible for the observed changes.
Animals↗
[Treatment of compression fractures of the spine by repositioning and immobilization in hyperextensive plaster casts].
The treatment results of 57 patients were evaluated clinically and radiologically according to Daniaux. A comparison of the X-ray pictures taken immediately after injury and after reposition of displacement with those after removal of a plaster cast and at a follow-up examination revealed in all the patients improvement of various degree of the wedge-shaped deformation after reposition and application of a plaster cast. Loss of correction after removal of a plaster cast was found in 11 patients, mainly with the wedge shaped deformation and lowering also of the posterior part of the vertebral body. On final follow-up examination, loss of correction was found in further 12 patients. They were mainly patients aged over 50 years, most of them women, and patients with primary vertebral body deformation of over 1/3 of the height. The best results were obtained in young persons with the wedge-shaped deformation of the vertebral body of less than 1/3 of the original vertebral body height.
Adolescent↗
Low molecular weight heparin for the prevention of thromboembolism in outpatients immobilized by plaster cast.
In an open, randomized, prospective, interindividual trial, the incidence of thrombosis with (n = 126) and without (n = 127) LMWH prophylaxis once a day was determined in 253 outpatients immobilized in a plaster cast due to an injury of the lower limb. Furthermore, the influence of possible risk factors on the thrombus formation was determined. The histories of the patients were comparable. The average period of plaster cast immobilization was 15.7 days and did not differ between treatment groups. Thrombosis was diagnosed by compression ultrasound; patients with positive findings were investigated by means of ascending phlebography. There were 21 cases of thrombosis in the group without prophylaxis (16.5%) and only six cases of thrombosis (4.8%) with LMWH. This difference is statistically significant (2p < 0.01). Crucial risk factors were age over 30 years, obesity, varicose veins, and fractures. Patients without prophylaxis who had fractures developed DVT in 29% in contrast to 11.3% in patients with soft-tissue injuries. This study shows that LMWH prophylaxis should be mandatory for plaster cast immobilized patients regardless of preexisting risk factors for thromboembolism.
Adolescent↗
Plaster casts in the management of advanced ischaemic and neuropathic diabetic foot lesions.
The outcome of plaster cast treatment of diabetic ulcerations at different sites of the feet in 33 patients was assessed in a prospective study. They were selected for the study because the previous conservative treatment had been unsuccessful. The mean age was 68 years and Type 1/Type 2 ratio was 4/29. Fifteen patients had lesions of grade 2 severity according to Wagner's classification, 9 patients' lesions were grade 3, and 9 patients had grade 4 lesions. The lesions healed in 19 patients (58%). All 10 patients (100%) with plantar lesions healed, while 7 (44%) of the patients with ischaemic lesions on the toes underwent lower leg amputation (p less than 0.01). Other factors that were important in determining which patients underwent amputation included the presence of local pain (p less than 0.001), and ankle/arm pressure index (less than 0.5 vs greater than or equal to 0.5, p less than 0.001). We conclude that plaster cast treatment is more useful in the treatment of advanced foot lesions than has previously been reported.
Casts, Surgical↗
Rupture of the lateral ligaments of the ankle: operation or plaster cast? A propective study.
The material comprises 444 patients, aged 12-50 years, with acute sprain of the ankle, seen over an 11-month period (1.10. 1977 to 31.8. 1978). Clinical examination showed no rupture of the ligaments in 53. Arthrography in the remaining patients revealed rupture of the lateral ligaments in 209 (in two-thirds of the anterior talofibular ligament and in one-third of the anterior talofibular as well as calcaneofibular ligament). Conservative treatment with a below-knee plaster cast for 5 weeks was employed in 107 patients, while 102 were treated surgically by suture of the ruptured ligament(s) and subsequently wore a below-knee plaster cast for 5 weeks. The follow-up 1 year after the accident was attended by 63 per cent of the patients. Good results were found in 76 per cent of those treated by plaster cast only and in 81 per cent of those treated by surgery. The difference is not statistically significant.
Adolescent↗
[Biomechanical substantiation of U-shaped plaster cast with elastic bandage in diaphyseal fractures of crural bones].
The authors make a critical analysis of the traditional types of plaster bandages used for the functional treatment of diaphyseal fractures of the bones of the crus. The results of the investigation into the relaxation properties and the dependence of the force of the pressure of the elastic bandage on its relative lengthening are presented. The values of the pressure under the plaster cast using an elastic bandage depending on the crus parameters and the number of the turns of the bandage are defined. On the basis of mathematical modelling the biomechanical substantiation and the recommendations concerning an optimal use of the elastic bandage for the fixation of the plaster cast longuets are given.
Bandages↗
Treatment of isolated distal ulnar shaft fractures with below-elbow plaster cast. A prospective study.
In a prospective study 52 patients with an isolated fracture of the distal ulna were treated with a below-elbow plaster cast. The histories of 46 patients were reviewed after a mean follow-up of 3.5 years (ranging from 10 months to 7 years). Forty-three fractures united. There were two non-unions. One fracture displaced while in the plaster, so that there was no longer any bone contact between the fragments. The fracture was consequently treated by open reduction and internal fixation. The type of fracture, the initial displacement (all fractures had bone contact) or the initial angulation (maximum 10 deg) was not found to influence the final clinical results. Below-elbow plaster cast appeared to produce satisfactory results in 89% of the patients.
Adult↗
The transfixational plaster cast technique.
Unstable fractures of the forearm and leg as well as combined fractures of the arm and forearm are often difficult to treat adequately by closed reduction and plaster fixation. In tropical countries, however, open reduction is relatively contra-indicated because of increased risk of peri-operative infection, inadequate training of medical personnel, and lack of adequate equipment. Given these conditions, the use of the transfixational plaster cast offers an alternative which is simple, inexpensive, and with few complications. The principle and technique of the transfixational plaster cast are presented.
Bone Wires↗
Anxiety reaction in children during removal of their plaster cast with a saw.
We have had experience of an 18-month-old boy with a cardiomyopathy who died a few minutes after removal of his cast with a saw, apparently from a malignant cardiac arrhythmia triggered by anxiety. We therefore examined the anxiety reaction to this method of removal of a plaster cast in 20 healthy children; ten were provided with hearing protectors and ten were not. The level of anxiety was assessed by measuring the heart rate, a known physiological indicator of anxiety, before, during and five minutes after removal of the cast. The noise level was also measured. The results showed a mean increase in heart rate during the procedure of 27.9 beats per minute (bpm) (26.9%) in the children with no hearing protectors and 10.4 bpm (11.1%) in children who used hearing protectors (p < 0.001). Five minutes after the procedure the heart rate had returned to the baseline rate in all patients. We recommend that hearing protectors should be used in children undergoing removal of a plaster cast to decrease the anxiety reaction. If possible, clinicians should avoid the use of a saw for this purpose in children with a cardiomyopathy.
Anxiety↗
Evaluation of complex carpal trauma: thin-section direct longitudinal computed tomography scanning through a plaster cast.
Direct longitudinal computed tomography of the wrist, with a plaster cast on the forearm, is described. In a case of complex carpal injuries, the advantages of this method are compared with those of conventional radiographic studies.
Adult↗
[Mechanical stimulation of venous blood flow in below-the-knee plaster cast].
Physical methods became recently more important as an alternative to anticoagulation for prophylaxis of thromboembolism and were studied for their efficacy. The AV-impulse-system proved efficient in reducing thromboembolic complications in patients undergoing hip surgery by increasing the return of venous blood in the deep veins of the leg. In a preclinical trial we studied the influence of the AV-impulse-system and of active forefoot movement on venous blood return in 12 lower extremities of 6 healthy individuals immobilized in below the knee plaster casts. Our results show a significant increase in venous blood flow caused by the AV-impulse-system (p < 0.05) and by active forefoot movements (p < 0.05). Prevention of thromboembolic complications in trauma and orthopaedic patients immobilized in plaster cast seems possible by using the AV-impulse-system which significantly increases the venous blood flow independent from patient compliance.
Adult↗
[Alternative to plaster cast bandage of the thigh].
Immobilization by means of a femoral plaster-cast box cannot always cope with the wide variety and severity of the injuries and diseases in the knee-joint region. To achieve best possible rehabilitation, several alternative and subsequent methods of surgical bandaging are described, including indications, technique and pros and cons.
Bandages↗
Short arm plaster cast for distal pediatric forearm fractures.
Ten years' clinical experience with below-elbow plaster cast treatment of distal one third pediatric forearm fractures was subjected to an independent retrospective radiographic review. In the study population of 761 fractures, no significant displacement occurred while the forearm remained in plaster. The average angulation change was 4.5 degrees (SD +/- 2.2 degrees). In each angulation change > 5 degrees, poor cast molding was evident, as reflected by a high "cast index" (p < 0.01). Although this technique is technically demanding, excellent results are obtained in all distal pediatric forearm fractures if proper cast molding is used.
Casts, Surgical↗
Setting temperatures of plaster casts. The influence of technical variables.
It is known that plaster-of-Paris casts can cause burns. Experiments were done to determine what factors are involved in causing an elevation of the temperature in a freshly applied cast. A glass tube filled with water between the temperatures of 36 and 39 degrees Celsius was used to simulate a leg for this study. Standard plaster casts were applied to the tube and the following variables were studied: different temperatures of the dip water; different thicknesses of the cast; the presence of plaster residue in the dip water; and the effect of the plaster of a pillow placed under the tube. It was found that if the temperature of the dip water was higher than 24 degrees Celsius or the thickness of the cast was greater than eight ply, or both, and if the pillow was used to limit the dissipation of heat from the cast, temperatures high enough to cause skin burns could occasionally be reached. Variable results indicated that these were the factors operating in practice and that a combination of them posed the greatest hazard.
Burns↗
[You and your plaster cast--educating for health].
The study was developed in order to give patients carrying a plaster cast orientation into self-care. The authors supported their work on pre-existing works on the same theme. They point to Education for health as a means for health professionals to prevent problems arising from misinformation to people under medical attendance.
Casts, Surgical↗