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PubMed2001

Treatment of supracondylar humerus fractures in children: minimal possible duration of immobilization.

In the period from January 1980 until December 1990 we treated 147 children and adolescents with supracondylar humerus fracture, and followed the outcome in 127 of them. Three (2.4%) patients had no displacement of fractured bones and were treated only with plaster cast immobilization. Twenty three (18.1%) underwent closed reduction of fragments and application of a plaster cast. The majority (97; 76.4%) required manual reduction and the fixation of segments with Kirschner's wires laterally and medially. Four (3.1%) patients were treated with open reduction and fixation with Kirschner's wires. Both plaster cast immobilization and fragment fixation with Kirschner's wires lasted only 14 days and were immediately followed by rehabilitation. Such a short immobilization of extremities or fixation offragments did not result in any complication. Of 56 children available for long-term follow-up, we achieved excellent treatment results in 43 (76.6%) of the patients, good and fair in 12 (21.5%), and a poor result in only 1 patient (1.8%). There were no permanent vascular or neurological complications apart from slight weakness of the ulnar nerve in 3 patients. In conclusion 14 days seemed to be the biological minimum of time needed for this type offracture to heal in children and adolescents. Fixation of the fragments with Kirschner's wires and immobilization of the extremity for only 14 days brings a significant reduction of total treatment expenses, avoids repeated x-ray examination, facilitates early physical therapy and returns the child to its family.

Adolescent↗
PubMed1976

Relation of musical wind instruments to malocclusion.

Eighty-four seventh graders of both sexes, not undergoing orthodontic treatment, participated in a double-blind study to determine the effect on the anterior teeth of playing a musical wind instrument. The instrument players were just beginning their studies. Seventh graders not playing a musical wind instrument served as the control group. Impressions and plaster casts were made of each mouth at the beginning and conclusion of the study. The plaster casts were marked with the same numerical code assigned to each student. Overjet and overbite measurements of the anterior teeth were taken from the plaster casts and recorded. Findings indicate that, on an individual basis, the effect on the anterior teeth of playing a musical wind instrument is unpredictable. Only on a group basis can a class of musical wind instruments be theorized to have a certain effect on the anterior teeth. The playing of a musical wind instrument should not be used as a substitute for orthodontic treatment.

Adolescent↗
PubMed1988

[Conservative treatment of fractures of the scaphoid bone--indications].

Healing-up of the bone is achieved by immobilization in 96 to 98% of all recent scaphoid fractures. The average immobilization period is eleven weeks. Different methods of immobilization are used. The majority of authors apply an upper arm plaster cast including the thumb for a period of six weeks and then a forearm plaster cast. Even fractures showing a delayed healingup of the bone can be cured in more than two thirds of the cases by prolonged immobilization. In case of dislocated and not reducible fractures as well as fractures with great fragment diastases, conservative treatment with a fist plaster cast should only be performed exceptionally, for example if there is an increased anesthesia risk. In case of negative X-ray findings (four planes) and only clinical suspicion of scaphoid fracture, an initial fracture therapy is recommended with repeated X-ray examination 14 days later. Most of the fractures which have not healed up are vertical oblique fractures within the proximal third, fractures with great diastases, or fractures which have not been immobilized long enough.

Carpal Bones↗
PubMed2003

Evaluation of serial casting to correct equinovarus deformity of the ankle after acquired brain injury in adults.

OBJECTIVE: To determine the potential short-term benefit of serial plaster casting in the management of equinovarus deformity associated with acquired brain injury. DESIGN: Prospective uncontrolled interventional trial. SETTING: Inpatient rehabilitation facility in Australia. PARTICIPANTS: Sixteen patients (19 limbs) with equinovarus deformity or deteriorating ankle range of motion associated with severe plantarflexor and invertor muscle overactivity underwent serial plaster casting over an 18-month period. INTERVENTIONS: Below-knee plaster casts were reapplied weekly to increase joint range and muscle extensibility. MAIN OUTCOME MEASURES: Precasting goniometric measures of maximal ankle dorsiflexion range (in knee extension and flexion) were compared with 4 subsequent test occasions (after initial cast, midpoint of casting, after final cast, 1 wk after removal). The amount and type of assistance required to perform a standardized wheelchair-to-bed transfer before and 3 months from commencement of casting were also compared. RESULTS: Subjects who underwent the serial casting regimen had significantly improved ankle range (knee flexed mean, 18 degrees; knee extended mean, 16 degrees; P<.0001); 13 subjects reduced their need for transfer assistance (P<.0015). CONCLUSION: Serial casting appears to be effective, at least in the short term, in reducing the equinovarus deformity that occurs after acquired brain injury. Greater ankle mobility was associated with improved transfer independence in the majority of subjects.

Adolescent↗
PubMed1990

[Ambulatory thromboembolism prevention in traumatology using self-injection of heparin].

In a retrospective and prospective study, 303 patients with fractures of the ankle joint treated surgically with postoperative immobilization in a plaster cast were analysed. After the introduction of thromboembolism prophylaxis with heparin for all outpatients immobilized by plaster casts the incidence of thromboembolic complications decreased significantly, from 4.5% to zero. The prophylaxis was well accepted, about 90% of the subcutaneous injections being administered by the patients themselves or family members. No serious complications were seen. Therefore, this effective prophylaxis of thromboembolism should be practised in all outpatients with a plaster cast on the lower limb and an elevated risk of thromboembolism. A simple check-up to identify patients at risk is suggested.

Ankle Injuries↗
PubMed2000

Conservative interventions for treating distal radial fractures in adults.

BACKGROUND: Fracture of the distal radius is a common clinical problem particularly in elderly white women with osteoporosis, in whom the lifetime risk of this injury has been estimated as 15 per cent. OBJECTIVES: To determine the most appropriate conservative treatment for fractures (such as Colles') of the distal radius in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, Medline and reference lists of trials. Date of the most recent search: April 1998. SELECTION CRITERIA: Randomised or quasi-randomised clinical trials involving skeletally mature patients with a fracture of the distal radius, which compared commonly applied conservative interventions for fracture fixation. These included the application of an external support (plaster cast or brace) and fracture manipulation. DATA COLLECTION AND ANALYSIS: All trials, judged as fitting the selection criteria by both reviewers, were independently assessed by both reviewers for methodological quality. Data were extracted for anatomical, functional and clinical, including complications, outcomes. The trials were grouped into categories relating to cast position, extent and duration of immobilisation, use of braces, cast material and fracture manipulation. Although quantitative data from some trials are presented, the lack of good quality trials and trial heterogeneity inhibited pooling of results. MAIN RESULTS: Over 50 randomised trials comparing treatment options for distal radial fractures were identified. Twenty nine trials of these, involving a total of 3199 mainly female and older patients, met the inclusion criteria for this review. Comprehensive details of the individual trials are provided in tabular form, and their results, grouped as indicated above, have been presented in text and analyses tables. The poor quality and heterogeneity in terms of patient characteristics, interventions compared and outcome measurement, of the included trials meant that no meta-analyses were undertaken. REVIEWER'S CONCLUSIONS: There is insufficient evidence from randomised trials to determine which methods of conservative treatment are the most appropriate for the more common types of distal radial fractures in adults. Therefore, at present, practitioners applying conservative management should use an accepted technique with which they are familiar, and which is cost-effective from the perspective of their provider unit. Whilst tempting, any call for further research to clarify the most appropriate conservative treatment for this common fracture must be resisted for now. Instead it is important to reflect on the issues raised in this review, to ascertain patient preferences, prioritise researchable questions and undertake a systematic programme of research after agreeing a core data set for classification of fractures and outcomes.

Adult↗
PubMed2001

Popliteal artery injuries associated with fractures and dislocations about the knee.

The authors present the results of a retrospective review of popliteal artery injuries associated with fractures and dislocations about the knee. They treated 41 patients with popliteal artery injuries associated with either fractures about the knee or knee dislocations. Thirty-five of the patients were males, 6 females; the mean age was 23 years. The delay before accessing the hospital was 17 hours (range: 3 hours to 10 days). Thirty-two fractures were open. Together with the vascular injury, 12 femoral fractures, 20 tibial and fibular fractures, 5 knee dislocations, 4 femoral + tibial fractures were identified. Twenty-three patients underwent external fixation, 8 internal fixation, 6 plaster cast immobilization, 4 minimal osteosynthesis and plaster cast immobilization. The arterial injury was treated by end-to-end anastomosis in 5 cases, saphenous vein anastomosis in 29 cases and thrombectomy in 7 cases. Nine patients were amputated. Delay in surgery, blunt trauma, extensive soft tissue defect and bone fracture or dislocation, are associated with high amputation rate following popliteal artery injury. The influence of each of these factors alone on the amputation rate could not be evaluated in this study, as no statistically significant correlation could be demonstrated.

Adolescent↗
PubMedDate not supplied

Functional fracture bracing in metacarpal fractures: the Galveston metacarpal brace versus a plaster-of-Paris bandage in a prospective study.

A total of 133 patients with fractures of the second through the fifth metacarpal bones were randomized to receive either a functional brace (the Galveston metacarpal brace) or a dorsal/ulnar plaster cast. Only 42% of the patients in the metacarpal-brace group completed the treatment, in contrast to 81% of the patients in the plaster-cast group. Complications with the brace were due to 60% of the exclusion. No difference according to gender, age, fracture type, hand affected (right/left), or mechanism of injury was observed between the patients who completed the treatment and those who were excluded. Reduction of fractures could not be demonstrated. Reduction of mobility was more frequent in the plaster-cast group, but three months postinjury no reduction of mobility was observed in either group.

Adolescent↗
PubMed1990

[Rehabilitation of the knee movement after ligamentoplasty using Mac Intosh's procedure augmented by Kennedy-Lad: a comparison between recent and old rupture of the anterior cruciate ligament].

About 60 ligamentoplasties of the A.C.L. using the Mac Intosh procedure with augmentation by the Kennedy-Lad, the authors compare the rehabilitation of knee motion between fresh tears (30 cases) and old tears (30 cases) of the A.C.L. operated on by the same procedure. All the operations were performed by the same surgeon. The rehabilitation program was the same for everybody; no plaster cast, total weight-bearing after the 15th day, no more crutches-stick after the 21th day and beginning of flexion on the 12th day, 88 per cent of the knees were rehabilitated by the same physiotherapists. The plaster cast is usually incriminated to be the main reason of post-operative knee stiffness. But no plaster cast for fresh A.C.L. tear also give such a stiffness (16.5 per cent). The authors think that the initial injury increased by the surgical trauma, for a non conditioned patient are the main factors of post-operative stiffnesses. This study justifies the late reconstruction of "isolated" A.C.L. tears (between the 2nd and 3rd month), after "cooling down" of the lesions.

Adolescent↗
PubMed2002

Doctor, can I drive with this plaster? An evidence based response.

The purpose of this study is to assess the effect of the commonly used below elbow plaster casts on driving ability. The position of the Driver and Vehicle Licensing Agency and five motor insurance companies is established. The study aims to help doctors decide whether or not a patient is fit to drive with a plaster cast. Three types of cast were tested using one driver. A score was given for several driving abilities. The right Colles cast was found to have no effect on ability to drive. Scaphoid and Bennett's casts were found to have significant affects on driving ability. The DVLA has no specific guidelines regarding driving with a plaster cast and the position of insurance companies is variable, but will usually depend upon medical advice.

Automobile Driving↗
PubMed2001

Fractures of the distal radius. Current concepts for treatment.

The authors review the treatment of fractures of the distal radius, based on their experience and from data in the literature. The choice of a treatment for any given fracture must take into account first of all the stability of the fracture. The best results are achieved in stable fractures. Only minimally displaced distal radius fractures can be treated functionally. However, a plaster cast for one week is indicated for the comfort of the patient. In displaced but stable fractures both closed reduction and percutaneous fixation are indicated. In case of closed reduction, the plaster cast should be applied for 5 to 6 weeks with an above-elbow cast for 3 weeks. Percutaneous fixation gives the best results in extraarticular fractures in younger patients. Because of its simplicity however, it should not be ignored in the elderly osteoporotic patients. In the authors' experience, both techniques were only used for extraarticular fractures. Good and excellent results were found in the closed reduction and plaster cast group in 74% of the patients; the Kapandji technique gave 75% good and excellent results. These results are in line with other findings which show that, for simple fracture types, the Kapandji technique and closed reduction seem to give similar results. External fixation is widely used for intra-articular comminuted fractures. Dynamic external fixation does not show any advantage over static devices. Additional K-wires or bone grafting may be necessary. External fixation gives superior results to plate and screw fixation. Internal fixation should be reserved for fractures with ventral comminution or severe displacement with unacceptable reduction by closed or minimally invasive techniques.

Adolescent↗
PubMed1989

[Differentiated treatment of fractures of the distal radius].

The question of our study was, if in the case of such a numerous fracture as the distal radius fracture, a different individual treatment would be possible and if the results could be thereby improved. Both can be replied by yes. Of the 200 fractures 157 cases in the plaster cast on the forearm or in the plaster cast on the upper arm in the restored position are healed in bone. Forty three times only the conservative routine treatment has not been enough, that means for about 2 patients a week. These ones need an individual adjusted treatment, care and control, a consumption which can absolutely be required. By distinctive operative treatment it was managed to reduce the number of the secondary deviations of the whole collective to 16%. That mainly was for the benefit of the age group 20-59 years, by the patients over 60 years an operation, indicated by the fracture, is not always possible regarding the above-mentioned reasons. In such a case it is useful to discuss with the patient the problems and the result which can be expected for preventing disappointments.

Adolescent↗
PubMed1993

[Ambulatory prevention of thrombosis with low molecular weight heparin in plaster immobilization of the lower extremity].

Plaster cast immobilisation following trauma is a major risk factor for the development of deep vein thrombosis. In our controlled, randomized and prospective study on patients with minor injuries incidence of DVT in conservatively treated out-patients with plaster cast immobilisation of the leg was 3.9% in the control group (n = 126) without prophylaxis. By s.c. self-application of LMV heparin once daily the number of DVT in the prophylaxis group (n = 115) was reduced to 0. No severe side effects of NMH were observed. We conclude that thromboprophylaxis with LMW heparin once daily up to now conspiciously reduced the risk of DVT in outpatients with plaster cast immobilisation of the leg.

Adolescent↗
PubMed1994

Algodystrophy after Colles fractures is associated with secondary tightness of casts.

We describe a direct method of measuring the tightness of plaster casts. Tightness was measured weekly in 23 consecutive patients with Colles' fractures. Six had objective signs of algodystrophy nine weeks after the fracture. In these patients the plaster cast was significantly tighter during the first three weeks than in patients who did not develop algodystrophy. The complex relationship between these findings is discussed.

Adult↗
PubMed1994

[Implementing ambulatory prevention of thrombosis with low molecular weight heparin in plaster immobilization of the lower extremity].

Plaster cast immobilisation following trauma is a major risk factor for the development of deep vein thrombosis. In our controlled, randomized and prospective study in patients with minor injuries the incidence of deep vein thrombosis was 4.3% in conservatively treated outpatients with plaster cast immobilisation of the leg (n = 163 control group without prophylaxis). By application of low molecular weight heparin once daily the number of deep vein thrombosis in the prophylaxis group (n = 176) was reduced to 0% (p = 0.006). No severe side effects of low molecular weight heparin were observed. Subcutaneous injections were self-applicated by 89% of males and 72% of females. We conclude that thromboprophylaxis with low molecular weight heparin once daily is effective to reduce the risk of deep vein thrombosis in outpatients with plaster cast immobilisation of the leg.

Adolescent↗
PubMedDate not supplied

Patellar dislocation. The long-term results of nonoperative management in 100 patients.

One hundred patients were treated nonoperatively for primary acute patellar dislocations, either by plaster cast (N = 60), by posterior splint (N = 17), or by patellar bandage or brace (N = 23). Follow-up examinations were performed at an average of 13 years later (range, 6 to 26 years). Overall, there were 0.17 redislocations per follow-up year; the redislocation frequencies per follow-up year for each patient group were 0.29, patellar bandages or braces; 0.12, plaster cast; and 0.08, posterior splint. In addition, there were fewer recurrences and subsequent problems (patellofemoral pain or subluxations) in the group treated with posterior splints compared with the two other treatment groups. The most marked restrictions of knee joint movements were seen in the patients treated with plaster casts. Subjective assessment of treatment, however, did not differ significantly between the groups. Patients were also evaluated in relation to the treatment of redislocations and management of subsequent problems (i.e., patellofemoral pain or subluxations). Patients who were treated operatively for their redislocations exhibited better outcomes than patients treated nonoperatively. In the patients who had subsequent problems, the operation did not relieve the symptoms.

Adolescent↗
PubMed1995

[Pure dislocations of the tibio-talar joint. Apropos of 9 cases].

PURPOSE OF THE STUDY: The authors relate nine cases of pure traumatic dislocation of the tibio talar joint and propose to evaluate the clinical and radiological results at a long term follow-up (mean 12 years). MATERIAL AND METHODS: The series included 9 patients (7 men and 2 women) the average age was 33,2 years. The injury was a road traffic accident in 5 cases. Pure dislocation variety of the ankle joint was medial and posteromedial in 6 cases. Open skin injury was found in 7 cases. The mean follow-up was 12 years (5-19 years). 6 patients were reviewed by the same surgeon, 6 patients were examined clinically and with ankle X-rays. All patients except one were treated by reduction, immobilization with a plaster cast for 6 to 8 weeks. The joint was examined radiographically to detect the presence of tibio talar diastasis and degenerative arthritis. RESULTS: At term we had two very good results and 3 good results (no pain or pain occasionally). We have found in 5 cases a degenerative arthritis to the ankle joint (joint narrowing <50 per cent in 3 cases, > to 50 per cent in 2 cases). No joint instability was noted at revision. DISCUSSION: Pure traumatic dislocation of the tibio talar joint is a rare injury. Medial and posteromedial variety are not frequent. Immediate gravity is dominated by vascular and septic complications and long term result by degenerative arthritis. CONCLUSION: The authors think that closed dislocations need orthopedic treatment (closed reduction and immobilization with a plaster cast for 6 weeks), on the other hand, open dislocation need surgical treatment (reduction, ligamentous reconstruction and immobilization in a plaster cast for 6 weeks).

Adult↗