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At least 451 records · Page 25Linked to original sources
PubMed2004

Preventing falls and stump injuries in lower limb amputees during inpatient rehabilitation: completion of the audit cycle.

OBJECTIVES: To study the factors contributing to falls among recent lower limb amputees, and to reduce the number of falls during inpatient rehabilitation and resulting injuries. DESIGN: Retrospective, followed by prospective, cohort study, then a follow-up study conducted after interventions. SETTING: Twenty-bedded inpatient rehabilitation unit for amputees. SUBJECTS: Lower limb amputees. INTERVENTIONS: Patient education, environmental modifications and application of a bivalve plaster of Paris stump protector to patients who were aged 70 or over, or cognitively impaired. MAIN OUTCOME MEASURES: Numbers of falls and other accidents, and resulting injuries. RESULTS: In phase 1 of the study, a retrospective audit of incident forms that had been completed on lower limb amputees who had an accident during their inpatient rehabilitation, between 1 April 1996 and 31 Ocotber 1998, was carried out. This showed that approximately a third of admissions (32%) were complicated by an accident. Most accidents were falls. In phase 2, a prospective study of 113 patients admitted to the unit was undertaken. Patients who fell were significantly older than those who did not. In phase 3, 62 consecutive patients were studied. There were 37 accidents in total, of which 35 were falls. Compared with the phase 2 study, there was no reduction in the proportion of patients who had a fall or other accident in phase 3, but significantly fewer falls resulted in any injury (p = 0.05). CONCLUSIONS: Although the interventions employed did not reduce the proportion of patients who had falls or other accidents, significantly fewer falls resulted in injuries.

Accidental Falls↗
PubMed1977

Fracture of the patella treated by total excision. A long-term follow-up.

Thirty-one patients have been reviewed four and a half to thirteen years after total excision of the patella for fracture. This operation did not give the uniformly excellent results previously reported by some authors. The type of incision used was unimportant in the long term. Immobilisation in plaster-of-Paris for any period between one and eight weeks after operation had no adverse effect on the long-term results. There was no correlation between the amount of calcification or ectopic bone formation found in the patellar tendon and the degree of function or discomfort in the joint. There was no evidence that osteoarthritis is an inevitable sequel to patellectomy in man. Maximal recovery of knee function may take up to three years after patellectomy. In this series 22% of patients had excellent results, 39% good results and 39% poor results, according to defined criteria. The implications of these findings are discussed.

Adolescent↗
PubMed2001

Simple treatment for torus fractures of the distal radius.

Torus (buckle) fractures of the distal radius are common in childhood. Based on the results of a postal questionnaire and a prospective, randomised trial, we describe a simple treatment for this injury, which saves both time and money. Over a six-month period, we randomised 201 consecutive patients with this injury to treatment with either a traditional forearm plaster-of-Paris cast or a 'Futura-type' wrist splint. All patients were treated for a period of three weeks, followed by clinical and radiological review. There was no difference in outcome between the two groups, and all patients had a good result. Only one patient did not tolerate the splint which was replaced by a cast. The questionnaire showed a marked variation in the way in which these injuries are treated with regard to the method and period of immobilisation, the number of follow-up visits and radiographs taken. We suggest that a 'Futura-type' wrist splint can be used to treat these fractures. The patient should be reviewed on the following day to confirm the diagnosis and to give appropriate advice. There is no evidence that further follow-up is required. This simple treatment has major benefits in terms of cost and reduction of the number of attendances.

Adolescent↗
PubMedDate not supplied

A preliminary investigation into the development of 3-D printing of prosthetic sockets.

The socket is considered an element of major importance in the makeup of a prosthesis. Each socket is a tailor-made device, designed to fit the unique geometry of the patient's residual limb. The design and manufacture of a prosthetic socket traditionally has been a manual process that relies on the use of plaster of Paris casts to capture the shape of the patient's residual limb and then artisan fabrication techniques to manufacture the socket. Computer-aided design and manufacturing technologies have overcome some of the shortcomings of the traditional process, but the final manufacture of the prosthetic socket is still performed manually. Rapid prototyping (RP), a relatively new class of manufacturing technologies, creates physical models directly from three-dimensional (3-D) computer data. Previous research into the application of RP systems to the manufacture of prosthetic sockets has focused on expensive, high-end technologies that have proven too expensive. This paper investigates the use of a cheaper, low-end RP technology known as 3-D printing. Our investigation was an initial approach to using a technology that is normally associated with producing prototypes quickly, some of which could not be manufactured by alternative means. Under normal circumstances, these printed components are weak and relatively fragile. However, comfortable prosthetic sockets manufactured with 3-D printing have been used in preliminary fittings with patients.

Amputation Stumps↗
PubMed1987

Osteogenic potential of nonvital tissues and synthetic implant materials.

Following the application of various techniques to restore or rebuild alveolar bone with different implants, results are generally unpredictable. In successful cases it is not clear whether the materials are capable of initiating osteogenesis by metaplastic induction, where endogenous bone formation had failed, or initiating osteogenesis by stimulating the regeneration of existing vital bone tissue by irritation. In order to discriminate between these two possibilities, 40 Sprague-Dawley descent rats were implanted with both devitalized tissues and synthetic materials in an area where bone is not usually formed: the anterior eye chamber. The test materials consisted of two devitalized tissues: boiled bone marrow and demineralized dentin, and six synthetic materials: formalin 10% and 40%, formic acid 10% and 88%, plaster of Paris, and ceramic tricalcium phosphate (Durapatite). Test materials were inserted into 59 chambers, but bone was not formed in any of these cases following a three-week experimental test period. Following implantation of 21 control chambers with viable mature marrow, bone was formed in 5 of 21 cases (24%), following the three-week test period. These findings appear to indicate that the reported cases where bone regeneration successfully occurred following implantation probably resulted from unpredictable irritational factors upon the existing vital bone tissue rather than by metaplastic induction.

Animals↗
PubMed1993

Use of a tourniquet in the internal fixation of fractures of the distal part of the fibula. A prospective, randomized trial.

A prospective, randomized trial was undertaken to determine the rate of complications after the use of a tourniquet during open reduction and internal fixation of simple, closed fractures of the distal part of the fibula. Forty patients were operated on with use of a tourniquet (Group 1) and forty patients, without use of a tourniquet (Group 2). The average duration of the operation was significantly different between the two groups (41 +/- 9 minutes for Group 1 compared with 53 +/- 12 minutes for Group 2 [p = 0.026]). There were more complications in the patients in Group 1, two of whom had an isolated deep-vein thrombosis of the calf. The wound was possibly infected in eleven patients (seven in Group 1 and four in Group 2 [p < 0.05]) and frankly infected in three patients, all in Group 1 (p < 0.05). The plaster-of-Paris cast needed to be changed in three patients from Group 1. The patients in Group 1 returned to work an average of one week later than those in Group 2. The mean duration of follow-up was eighteen months (range, nine to thirty-two months). Given the lower prevalence of postoperative complications and the shorter time to recovery for the patients in Group 2, we believe that it is justified not to use a tourniquet in the operative treatment of simple, isolated fibular fractures.

Adult↗
PubMed1977

Replacement of carpal bones with exact-fitting silicone rubber implants. An experimental study.

In a pilot study in dogs, carpal bones were removed and replaced with silicone rubber implants fashioned to fit exactly into the space left by the excision. The implants were fabricated from Dow Corning MDX-4-4210 and Silastic 399 Medical Grade Elastomers. Bone cement was used for the cast and the mould was made of alginate or plaster of Paris. It was intended to replace the bone in a one-stage procedure. MDX-4-4210 was found unsuitable because adequate cure could only be achieved in about 5 hours, even when accelerated with external heating. Silastic 399 cured rapidly and was ideal for the experiment. Implants of exact fitting were fabricated, sterilized and inserted within 1--2 hours. 6 dogs were used and the follow-up period ranged from 1 to 7 months. The results were good in 5 and unsatisfactory in 1 dog because of postoperative infection. The method presented permits exact reproduction of the excised part, which guarantees an accurate fitting and consequently reduced risk of implant rotation and migration.

Animals↗
PubMed1985

The Mini-Cap. External immobilization of facial fractures.

A method is described for external immobilization of the facial skeleton. The method is only indicated in a few cases. By means of Vitallium screws and a small head cap of plaster of Paris it is possible to achieve stiff, external immobilization of facial fractures, even when they are situated in the frontal bones. The Mini-Cap permits the patient to rest comfortably and costs very little.

Adolescent↗
PubMed1978

Moulded supportive seating for the disabled.

In severe cases of physical disability intimate supportive seating may be required to provide maximum comfort, a good position for functional activities, improved respiration, relief of localized pressure, control of spasm, protection, or improved management. A service for providing such seating has been developed at Chailey Heritage. The seat is vacuum-formed from thermoplastic materials, having a soft non-absorbent foam for the linear and a hard semi-rigid outer shell. A mould is obtained by casting the patient using the vacuum consolidation technique and by recording the resulting impression using plaster-of-Paris. Nearly 200 seats have been made using the technique with a high rate of success.

Cerebral Palsy↗
PubMed1978

A new approach to the management of wounds of the extremities. Controlled environment treatment and its derivatives.

Controlled Environment Treatment is a new approach to wound management--for the first time it provides the surgeon with the means of controlling and optimizing the wound environment for the duration of the healing period. Equipment is commercially available and the technique is now being applied internationally; the technique has been established for the treatment of limbs--application to the trunk requires further investigation and development. Spin-offs have already occurred, one being the control of certain types of lymphoedema by the patient in their own home; the other concerns the application of plaster of Paris to produce casts having significantly superior physiological characteristics using minimal manipulative skills. The former is known as Pressure Environment Treatment, the latter is known as Controlled Pressure Casting; equipment is commercially available internationally.

Bandages↗
PubMed1980

Hip hinge thigh brace for early mobilization of proximal femoral shaft fractures.

A new design, the 'Hip Hinge Thigh Brace' is presented for the safe early functional mobilization of patients with proximal half femoral shaft fractures. The mechanics, prescription, application technique and early clinical experience are reported. Use of the newer Crystona plastic plaster is shown to provide a more functional brace than the plaster of Paris casts.

Acrylic Resins↗
PubMed1987

New splinting materials.

Plaster of Paris (P.o.P.) bandage has been the pre-eminent external splinting material for over 150 years and from time to time synthetic alternatives have been tried. So far none has seriously challenged the dominance of P.o.P. as a primary or secondary material in the management of fractures. The recent introduction of Polyurethane coated fibreglass bandage appears to offer a more serious challenge than previous contenders. This technical note reviews bandage type splinting materials and explains some of the properties of the PU materials.

Bandages↗
PubMed1988

Dust emission during cutting of polyurethane-impregnated bandages.

The airborne dust generated when cutting splinting bandages represents a potential respiratory hazard, particularly to those who regularly remove casts with a power saw. Plaster of Paris (POP) dust is already classified by the Health and Safety Executive as a nuisance dust. This paper reports on a study to determine the nature, size and concentration of dust produced when cutting polyurethane (PU) impregnated bandages using a power saw. It has been shown that, under severe conditions PU bandages produce lower airborne dust concentrations than POP bandage but that all of the bandages tested produced particles small enough to reach the final divisions of the lung. It is therefore recommended that a dust extraction unit be used when cutting all types of bandage.

Air Pollutants, Occupational↗
PubMed1991

The effect of hyaluronic acid on cartilage in the immobilized rabbit knee.

Out of 30 adult rabbits, 20 had one knee immobilized with a plaster of Paris cast for 6 or 12 weeks, and 10 rabbits were used as untreated controls. Prior to immobilization, 10 knees were injected with high-molecular weight hyaluronic acid. The articular cartilage of the femoral condyles was studied by light microscopy, whereas that of the patella and tibia was analyzed biochemically. Degenerative changes of the articular cartilage similar to those seen in arthrosis were observed after 6 weeks. The intraarticular injection of hyaluronic acid did not prevent these changes; instead, the reparative processes seemed inhibited.

Animals↗
PubMed1996

Tendon interposition arthroplasty for basal joint arthrosis. 38 thumbs followed for 4 years.

We reviewed 38 thumbs (35 patients) operated with a modified Burton procedure for basal joint arthrosis. There were 3 pintrack infections and 9 patients reported severe discomfort during the postoperative period in a plaster of Paris. After a follow-up of 4 (1-7) years, 28 patients rated the overall result as excellent, while 1 would not have consented to the operation if she had known the result in advance. Activities of daily living were markedly improved. Compared to the nonoperated hand, the key pinch was moderately reduced and grip strength was almost the same. The postoperative scaphometacarpal gap was 6 mm.

Activities of Daily Living↗
PubMed1977

A new method of cranioplasty. Technical note.

A new method of cranioplasty is described. The skull defect is exposed, and an impression is taken which is used for the construction of a plaster of Paris model of the defect. Methyl methacrylate is molded to the model and thus an accurate reproduction of the skull defect is produced. The technique has the main advantage of good cosmetic appearance and strength.

Humans↗
PubMed1996

History of spinal cord stereotaxy.

Stereotactic and functional neurosurgery has experienced a remarkable degree of development during the last 50 years, from the plaster of Paris frame of Spiegel and Wycis to the technology of frameless stereotaxis. Although predominantly used for intracranial procedures, stereotaxy has its roots in experimental studies of the spinal cord. The field of spinal cord stereotaxy has not received the same amount of attention as supratentorial surgery, but there have been significant contributions to the field that have helped to further our understanding of spinal cord anatomy and physiology. Now that frameless stereotaxis has reached clinical practice, there may be further developments in the field of spinal surgery: this technique may prove useful for spinal fusion operations and, possibly, intramedullary operations as well.

History, 20th Century↗
PubMed1986

A comparative study of synthetic cast material strength.

The strength of five commercially available synthetic orthopedic casting products are discussed. Using three testing designs, significant differences could be consistently determined. These testing methods provide a means of comparing the various casting products on the market. The authors point out that this study was a comparison of ultimate strength only, and did not compare the other characteristics of the products. It also was noted that all these synthetic casting materials were stronger than plaster-of-Paris casting material.

Casts, Surgical↗