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PubMed2000

The effects of limb elevation and increased intramuscular pressure on nerve and muscle function in the human leg.

In this study we investigated the effects of increased intramuscular pressure (IMP) on nerve and muscle function in the leg and foot. In study A, muscle pressure was increased by inducing venous stasis in both legs, placed in plaster casts, of eight healthy subjects having a mean age of 29 years. The results from elevated and non-elevated limbs were compared. In study B, two different models for increasing IMP were studied in nine healthy subjects having a mean age of 32 years. The results of increased IMP and decreased blood perfusion pressure on local (= leg) and distal (= foot) function of muscle and nerve induced by venous stasis of a leg in a plaster cast and by external compression of the contralateral leg were compared. Contraction pressure of the tibialis anterior muscle in the leg was recorded. A biphasic compound muscle action potential was measured from the extensor hallucis brevis and the extensor digitorum muscles as an indication of foot muscle function. Muscle contraction pressure was 87 (SD 38) mm Hg in the vein-obstructed leg and 133 (SD 42) mm Hg in the externally compressed leg (P<0.05). In both studies the skin sensibility of the feet was significantly lower in the vein-obstructed elevated leg after 30 min (P<0.05). Vein stasis in an elevated human leg in a plaster cast defines a model for simulating imminent acute compartment syndrome with reversible neuromuscular dysfunction.

Action Potentials↗
PubMed1995

Effects of hydroxyapatite and alumina sheaths on postoperative peritendinous adhesions in chickens.

Two experimental methods for restoring flexor tendon sheath integrity and preventing adhesions around traumatized flexor tendons utilizing artificial tendon sheaths made of either hydroxyapatite (HAp) or alumina were studied in a flexor tendon-trauma model and compared to a standard tendon sheath repair and a control. Eighty toes were divided equally into a control group, a sheath repair group, an HAp group, and an alumina group. Profundus tendons in zone II were divided and repaired after sublimis excision in all groups. In the sheath repair group, the flexor sheath was also repaired after suturing the tendon. In artificial sheath groups, sheaths made of HAp and alumina were placed over the repair sites to protect them from the surrounding tissues. In the control group, after repairing the tendon, the flexor sheath was excised and no artificial sheaths were used. Each toe was immobilized in a plaster cast for 3 weeks. After three weeks, the plaster cast was removed followed by the removal of the sheaths in the artificial sheath groups through a small incision in the skin in zone II. Active mobilization was encouraged in each group. Postoperative adhesions were examined at 3, 6, 9, and 12 week intervals by using light microscopic techniques. To further explore the effects of artificial sheaths on tendon healing, transmission electron microscopy was done for the HAp and alumina groups at 3, 6, and 12 week intervals. Results demonstrated decreased severity of postoperative adhesions in the HAp as well as in the alumina groups in comparison with the sheath repair and controls. A space resembling the fibro-osseous canal was formed around the tendon after removing the sheaths. This space remained patent until 12 weeks, 9 weeks after removing the sheaths, and a newly formed tendon sheath-like structure lined by synovial cells and with a peritenon-like structure over the tendon surface was observed. In the sheath repair and control groups, the severity of adhesions was decreased with the passage of time, to some extent due to unrestricted mobility. However, a newly formed tendon sheath or peritenon-like structure was not observed. Electron microscopic studies confirmed good healing at the suture in the HAp and alumina groups with no evidence of necrosis. These results are qualitative in nature as no statistical tests were performed. From these results we conclude that if the tendon is separated from the surrounding granulation tissue by a barrier with good biocompatibility, the tendon can heal with fewer adhesions.(ABSTRACT TRUNCATED AT 400 WORDS)

Aluminum Oxide↗
PubMed1999

[Primary treatment of clubfoot].

Our primary club foot therapy consists of a combination of plaster cast manipulation, physiotherapy and surgical correction. The initial plaster cast method of 4 to 6 weeks is followed by a functional mobilisation of the foot. The main aim being the reduction of the malpositioned talus in the ankle mortise. If there is residual deformity surgery is planned after six month. We use the Cincinnati approach with the possibility of the dorsal, medial and lateral release, enabling a correction of the hind-, mid- and forefoot. The main part of postoperative care is seen in the functional rehabilitation of the foot by physiotherapy, in order to achieve a cosmetic foot with good functions. Physiotherapy is advised until the child enters school in order to preserve function and form into adult life. A high frequency of satisfactory results can be expected using this protocol.

Adult↗
PubMed1985

[Healing of ruptures of the anterior cruciate ligament treated with simple sutures. Possibilities, usefulness, clinical evaluation. Apropos of a series of 51 anterior cruciate ligament sutures using barbed wire with macroscopic verification of the healing].

Fifty-one ruptures of the anterior cruciate ligament were treated by early suture using barbed wires followed by plaster cast for 6 weeks. The state of healing was assessed by a second look during arthrotomy to remove the wire after an average of 6 months. In addition, 45 knees have been examined more than 20 months after the initial repair. Three out of 4 ligaments were found to be healed, but only one out of 3 had adequate tension and was correctly sited. The rate of satisfactory healing was high in cases of clear-cut rupture and when the pre-operative laxity was moderate. Associated lesions of the collateral ligaments healed satisfactorily thanks to the period of 6 weeks treatment in the plaster cast. The cases in which the cruciate ligaments had healed demonstrate subjective and objective stability better than others, even when the ligament had been found to be loose or incorrectly re-implanted and were superior from the functional point of view. There was no parallel between the true state of healing of the ligament and the clinical tests of stability. It is concluded that early suture of the cruciate ligament is worthwhile in cases of clear-cut rupture. In cases of attenuation or when there are severe lesions of the collateral ligaments, suture of the cruciate ligaments should be reinforced by carbon fibres. This management is valuable in active people or amateur sportsmen in whom rehabilitation is somewhat slow. In professional athletes peripheral ligamentoplasties lead to earlier resumption of sporting activities. In older patients, plaster cast immobilisation is sufficient to produce satisfactory results.

Adolescent↗
PubMed1980

Capillary density of tenotomized skeletal muscles. I. Experimental study in the rat.

Our purpose was to study the capillary density of rat gastrocnemius muscle by microangiography 7-21 days after achillotenotomy or immobilization in a plaster cast. Sixteen animals were tenotomized, 12 immobilized in a plaster cast, and 4 served as controls. The number of capillaries was counted per 1,000 muscle fibres from each sample. No site differences were found in control muscles, where on an average 1,250 capillaries per 1,000 muscle fibers were found. After tenotomy the number of capillaries was decreased 35%, 31%, and 32% on days 7, 14, and 21, respectively. In immobilized muscles the decrease in capillary density occurred slowly, the corresponding decrease being 23%, 33%, and 28% on days 7, 14, and 21, respectively. These results indicate that the capillary density of muscular tissue is greatly decreased following the disuse produced by tenotomy or immobilization.

Achilles Tendon↗
PubMed2002

[Orthopedic immobilization].

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.

Casts, Surgical↗
PubMed2006

[Treatment of medial epicondylar apophyseal avulsion injury in children].

OBJECTIVE: Surgical reduction and retention of apophyseal avulsion injuries at the medial epicondyle to prevent joint instability, lasting malalignment, or pseudarthrosis. INDICATIONS: Absolute: intraarticular apophyseal dislocation of the medial epicondyle, complete lesion of the ulnar nerve. Relative: dislocation of the apophysis (> 4 mm) in children > 5 years of age; the need for intervention increases in children as the degree of dislocation, age, and athletic activity increase. CONTRAINDICATIONS: Dislocation of the medial epicondyle (< or = 4 mm) in children < 5 years of age, provided the fragment location is not intraarticular. SURGICAL TECHNIQUE: Open reduction of the apophysis through a medial approach. Identification of the ulnar nerve. In young children or with small fragments fixation with Kirschner wire. Screw fixation in older children or for larger fragments. POSTOPERATIVE MANAGEMENT: Long upper-arm plaster cast until wound healing is achieved. Subsequently, upper-arm plaster cast for 3 weeks. Removal of Kirschner wires after 4-6 weeks, screw removal after 8-12 weeks. Physiotherapy only if marked reduction of elbow mobility is found 6 weeks after cast removal. RESULTS: From January 1, 1994 to December 31, 2003, 25 children with an average age of 12 years suffering from medial epicondylar avulsion fractures were operated on using open reduction and Kirschner wire fixation. An average of 3 years after the injury 14 of these children underwent follow-up examination using a procedure that took subjective, clinical and radiologic parameters into account. Two children showed a slight reduction in overall strength of the injured extremity when compared with the contralateral extremity. One child had a flexion deficit of 10 degrees, all other children showed movement limitations of < or = 5 degrees compared to the contralateral extremity. In all the cases available to follow-up, there was a slight increase in valgus alignment of the elbow joint compared with the uninjured side (3 degrees on average). All fractures consolidated within 6 weeks.

Adolescent↗
PubMed1986

Experimental study on thermal burns caused by plaster bandage.

Plaster bandage is frequently used in the field of orthopaedic surgery. Little is known however of thermal burns caused by plaster bandage. Experience has shown that heat producing levels differ depending on application conditions, i.e., water temperature into which plaster of Paris is dipped, thickness of the plaster cast, kind of plaster, etc. We made a series of experiments to find out what factors are related to elevation of the skin temperature in a plaster splint applied to a human forearm. The highest skin temperature of 47.7 degrees C was obtained upon application of a plaster bandage made of 30 layers of plaster with short setting time, dipped in water at 42 degrees C. In this condition the examinee had a first degree burn on the skin surface. Thus, care must be taken in applying a plaster bandage to assure that it does not cause a serious burn to the skin.

Burns↗
PubMedDate not supplied

Comparison of isometric muscle training and electrical stimulation supplementing isometric muscle training in the recovery after major knee ligament surgery. A preliminary report.

Eight patients undergoing reconstruction of the anterior cruciate ligament were randomly allocated into two groups. The control group received a standard plaster cast and isometric muscle training. The stimulated group received a standard plaster cast, isometric training, and percutaneous electrical stimulation during the recovery period. The patients were examined clinically and with repeated muscle biopsies before surgery, 1 week after surgery, and 5 weeks after surgery at the time of removal of the cast. The electrically stimulated group had better muscle function from a clinical point of view and their succinate dehydrogenase activities were significantly higher than those in the control group. Electrical stimulation thus could prevent the fall in oxidative enzyme activity which was noted in the control group. The results suggest that percutaneous electrical stimulation may be a way of preventing muscle atrophy after major knee ligament surgery in athletes.

Adult↗
PubMed1998

Distal femoral osteotomy for lateral compartment osteoarthritis of the knee.

Twenty-one patients with lateral compartment osteoarthritis and valgus deformity of the knee underwent distal femoral supracondylar osteotomy (medial closing wedge) between 1983 and 1993 with follow-up ranging from 1 to 8 years. Ten knees had plaster cast immobilization, 5 had fixation with 2 staples supplemented with a plaster cast, and 6 knees had rigid internal fixation with an AO blade plate. Thirty-three percent of patients had a satisfactory result using the HSS score, and 57% had a satisfactory result using the Knee Society Clinical Rating. Fifty-seven percent had a significant complication, including severe knee stiffness requiring manipulation under anesthesia (48%), nonunion/delayed union (19%), infection (10%), and fixation failure (5%). Five (19%) knees required total knee replacement within 5 years of surgery. Satisfactory results were obtained only in those patients who had less severe degrees of osteoarthritis confined to the lateral compartment (grades I to III), adequate correction of valgus deformity (the anatomical axis within 2 degrees from zero), and rigid internal fixation to permit postoperative early mobilization. These results indicate that distal femoral osteotomy is a satisfactory procedure in the young, active patient with osteoarthritis of the lateral compartment of the knee, but requires precise surgical technique and rigid internal fixation.

Adult↗
PubMed1997

[Surgical treatment for complicated clavicle fracture].

A review of 78 patients (43 males, 25 females), aged 17-62, operated on for complicated fracture of the clavicle served to present indications and surgical techniques for this treatment. The use of a metal plate allows for stable fixation of the fracture, thus further management of patients with concomitant thoracic, pulmonary, or spinal injuries does not require plaster cast immobilization. Inaccurate fracture fixation with compression screw as being unstable necessitates plaster cast immobilization. Coexisting shoulder dislocation has been primarily managed surgically.

Adolescent↗
PubMed1993

A radiographic comparison of short-arm cast and plaster and fiberglass wrist splints.

Prepackaged plaster and fiberglass splints are used in many emergency departments. This study evaluated the effectiveness of short-arm cast (SAC), volar fiberglass wrist splint (FWS), and volar plaster wrist splint (PWS) in limiting wrist range of motion. Ten healthy male volunteers between the ages of 18 and 35 years were included. Each wrist on each volunteer was immobilized with SAC, FWS, and PWS. Wrist radiographs were taken with each appliance and angular motion measured by two radiologists. PWS performed better than FWS in flexion, extension, radial deviation, and ulnar deviation (all P < .05). PWS was not statistically different than SAC in limiting flexion, extension, or radial deviation, although SAC performed better in ulnar deviation (P < .05). PWS limits wrist motion more effectively than FWS and performs in a similar manner to SAC in flexion, extension, and radial deviation.

Adolescent↗
PubMed1999

Botulinum toxin A versus fixed cast stretching for dynamic calf tightness in cerebral palsy.

OBJECTIVE: To compare botulinum toxin A injections with fixed plaster cast stretching in the management of cerebral palsied children with dynamic (i.e. non-fixed) calf tightness. METHODS: The settings were the Women's and Children's Hospital (WCH) and the Crippled Children's Association of South Australia (CCA), Adelaide, South Australia. Twenty children were selected by two paediatric rehabilitation specialists. A prospective, randomized, single-blind controlled study, was carried out, with 10 children in each arm. The clinicians were blinded as to the allocated interventions. The outcome measures for 6 months post intervention were clinical assessment, modified Ashworth Scale, Gross Motor Function Measure, 2 D-video ratings using a modified Physical Rating Scale and a global scoring scale and a parent satisfaction questionnaire. RESULTS AND CONCLUSION: Botulinum toxin A injections were of similar efficacy to serial fixed plaster casting in improving dynamic calf tightness in ambulant or partially ambulant children with cerebral palsy. The ease of outpatient administration, reduction of muscle tone and safety with botulinum toxin A was confirmed. Parents consistently favoured botulinum toxin A and highlighted the inconvenience of serial casting.

Botulinum Toxins, Type A↗
PubMed2004

Cast vs external fixation: a comparative study in elderly osteoporotic distal radial fracture patients.

AIM: This study compared fracture treatment with plaster cast vs external fixation. METHODS: Forty elderly female osteoporotic wrist fracture patients were randomized to be treated with either plaster cast (Group A) or external fixation (Group B). Bone mineral density less than -2.5 T-score was among the inclusion criteria. RESULTS: In Group A, four redisplacements occurred, whereas in Group B there were none (p = 0.005). Horesh score was higher in Group B (p < 0.006) than in Group A. Volar angle deformity (p < 0.0005) and radial angle deformity (p = 0.008) were lower in Group B. CONCLUSIONS: This study shows that external fixation improves stability in elderly osteoporotic wrist fracture patients.

Aged↗
PubMed1983

[Fractures of the femoral shaft in children. Apropos of a homogeneous series of 97 fractures].

The authors have analysed the results of 97 fractures of the femoral shaft in children. In 75 instances, the treatment was conservative-traction followed by a plaster cast after three weeks. The reduction was satisfactory in only 19 cases. The plaster cast did not prevent secondary displacement. After surgical treatment, complications were observed in one third of the cases. The review of the cases with a long follow up showed that with growth, there was good remodelling. In 95 p. 100 of the children there was no loss of function detectable by the family, and only a careful clinical and radiological examination was able to demonstrate some sequelae.

Adolescent↗
PubMed2004

Noninvasive monitoring of deterioration in skeletal muscle function with forearm cast immobilization and the prevention of deterioration.

BACKGROUND: In this research inactivity was simulated by immobilizing the forearm region in a plaster cast. Changes in skeletal muscle oxidative function were measured using near-infrared spectroscopy (NIRS), and the preventative effect of the training protocol on deterioration of skeletal muscle and the clinical utility of NIRS were examined. METHODS: Fourteen healthy adult men underwent immobilization of the forearm of the non-dominant arm by plaster cast for 21 days. Eight healthy adult subjects were designated as the immobilization group (IMM) and six were designated as the immobilization + training group (IMM+TRN). Grip strength, forearm circumference and dynamic handgrip exercise endurance were measured before and after the 21-day immobilization period. Using NIRS, changes in oxidative function of skeletal muscles were also evaluated. Muscle oxygen consumption recovery was recorded after the completion of 60 seconds of 40% maximum voluntary contraction (MVC) dynamic handgrip exercise 1 repetition per 4 seconds and the recovery time constant (TcVO2mus) was calculated. RESULTS: TcVO2mus for the IMM was 59.7 +/- 5.5 seconds (average +/- standard error) before immobilization and lengthened significantly to 70.4 +/- 5.4 seconds after immobilization (p < 0.05). For the IMM+TRN, TcVO2mus was 78.3 +/- 6.2 seconds before immobilization and training and shortened significantly to 63.1 +/- 5.6 seconds after immobilization and training (p < 0.05). CONCLUSIONS: The training program used in this experiment was effective in preventing declines in muscle oxidative function and endurance due to immobilization. The experimental results suggest that non-invasive monitoring of skeletal muscle function by NIRS would be possible in a clinical setting.

Journal Article↗
PubMedDate not supplied

[The management of congenital hip luxation with arthrographic control, an individual risk-reducing and time-saving method. I. Choice of method and risk assessment based on arthrographic findings].

In 388 congenital hip dislocations arthrography was used to indicate the safest form of treatment. Immediate reduction in the squatting (human) position of plaster cast (Fettweis, Salter) was followed by 3.4% of avascular necrosis of the femoral head, while plaster casts after preliminary traction showed 14.8% necrosis and unsuccessful closed reductions preceeding open reductions 11.8%. Further investigations demonstrated the influence of mechanical factors. A higher percentage of avascular necrosis was found in a narrow capsular entrance between a deformed upper limbus (or acetabular bulge) and a protruding transverse ligament with insufficient reduction (lateral displacement greater than 5 mm) and abduction of more than 45 degrees. The percentage of avascular necrosis was also depending on the development of the epiphyseal nucleus, it was 0.9% in normal forms of nuclei, 4.5% when the nucleus had not appeared at the beginning of treatment, 4.7% in small and 12.5% in retarded nuclei. The rate of necrosis was increasing with age and the degree of dislocation. Critical arthrographic findings have been described. In sufficiently open joints and full reductions Pavliks harness or hip spicas in squatting (human) position are applied immediately. With moderate narrowing of the acetabular entrance and lateral displacement traction is used for 3-4 weeks with repeated arthrography. In severe soft tissue changes of the acetabulum and lateral displacement (greater than 5-7 mm) open reduction is safer than a forced closed reduction.

Adolescent↗
PubMed1998

Space analysis: a comparison between sonic digitization (DigiGraph Workstation) and the digital caliper.

The introduction of the DigiGraph Workstation permits the use of sonic digitization to measure lateral cephalometric values, mesiodistal tooth size and arch perimeter discrepancy as a one-stop diagnostic record taking set-up. This study compared the reproducibility of mesiodistal total tooth widths and arch perimeter values, on plaster casts, given by the DigiGraph Workstation and by digital calipers. Forty-seven sets of plaster casts of Southern Chinese children (mean age 12.5 years) comprised the sample. Arch perimeter was measured using calipers in six segments from the distal of the first permanent molar to its antimere in each arch. The total mesiodistal widths of all teeth, excluding second and third molars, were also measured. The difference between the available arch perimeter and the total tooth widths was taken as the arch perimeter discrepancy. Sonic digitization of the study casts was completed according to instructions of the DigiGraph software. Paired t-tests and F-tests were used to compare the two methods. Compared with manual measurement, there was an over-estimation of the total tooth widths by 1 mm in the mandible and 0.5 mm in the maxilla, and an arch perimeter discrepancy of 1.6 mm in the mandible and 0.4 mm in the maxilla when using the sonic method. The sonic digitization was not as reproducible as the digital caliper and its clinical usefulness in evaluating the space problem of an individual malocclusion should be interpreted with caution.

Calibration↗