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PubMed2004

Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children.

BACKGROUND: Titanium elastic nails are commonly used to stabilize femoral fractures in school-aged children, but there have been few studies assessing the risks and benefits of this procedure compared with those of traditional traction and application of a spica cast. This prospective cohort study was designed to evaluate these two methods of treatment, with a specific focus on the first year after injury, the period when the treatment method should have the greatest impact. METHODS: Eighty-three consecutive children, six to sixteen years of age, were studied prospectively. Factors that were analyzed included clinical and radiographic data, complications, hospital charges, and outcome data. Outcome and recovery were assessed both with the American Academy of Orthopaedic Surgeons Pediatric Outcomes Data Collections Instrument, version 2.0, and according to a series of important recovery milestones including the time to walking with aids, time to independent walking, time absent from school, and time until full activity was allowed. RESULTS: Thirty-five children (thirty-five fractures), with a mean age of 8.7 years, were treated with traction and application of a spica cast, and forty-eight children (forty-nine fractures), with a mean age of 10.2 years, were treated with titanium elastic nails. All fractures healed, and no child sustained a complication that was expected to cause permanent disability. At one year after the fracture, eighty of the children had acceptable alignment and no inequality between the lengths of the lower extremities. The remaining three children, who had an unsatisfactory result, had been treated with traction and a spica cast. Twelve patients (34%) treated with traction and a cast had a complication compared with ten patients (21%) treated with titanium elastic nails. Compared with the children treated with traction and a cast, those treated with titanium elastic nails had shorter hospitalization, walked with support sooner, walked independently sooner, and returned to school earlier. These differences were significant (p < 0.0001). We could detect no difference in total hospital charges between the two groups. CONCLUSIONS: The results of this prospective study support the recent empiric observations and published results of retrospective series indicating that a child in whom a femoral fracture is treated with titanium elastic nails achieves recovery milestones significantly faster than a child treated with traction and a spica cast. Hospital charges for the two treatment methods are similar. The complication rate associated with nailing compares favorably with that associated with traction and application of a spica cast.

Adolescent↗
PubMed2005

Total contact casting of the diabetic foot in daily practice: a prospective follow-up study.

OBJECTIVE: A limited number of clinical trials have shown that the total contact cast (TCC) is an effective treatment in neuropathic, noninfected, and nonischemic foot ulcers. In this prospective data collection study, we assessed outcome and complications of TCC treatment in neuropathic patients with and without peripheral arterial disease (PAD) or (superficial) infection. RESEARCH DESIGN AND METHODS: Ninety-eight consecutive patients selected for casting were followed until healing; all had polyneuropathy, 44% had PAD, and 29% had infection. Primary outcomes were percentage healed with a cast, time to heal, and number of complications. RESULTS: Ninety percent of all nonischemic ulcers without infection and 87% with infection healed in the cast (NS). In patients with PAD but without critical limb ischemia, 69% of the ulcers without infection and 36% with infection healed (P < 0.01). In multivariate analyses, PAD, infection, and heel ulcers were associated with a lower percentage healed (all P < 0.05). Median duration of cast treatment was 34 days. New ulcers, all superficial, developed in 9% and preulcerative lesions in 28% of the patients; these skin lesions healed in the cast within a maximum of 13 days. CONCLUSIONS: In comparison to pure neuropathic ulcers, ulcers with moderate ischemia or infection can be treated effectively with casting. However, when both PAD and infection are present or the patient has a heel ulcer, outcome is poor and alternative strategies should be sought. The high rate of preulcerative lesions stresses the importance of close monitoring during TCC treatment.

Aged↗
PubMed1994

An experimental model for the assessment of titanium denture casting techniques.

In order to establish the most suitable technique for the construction of cast titanium denture frames, an experimental model was developed for the quantification of casting success. A relatively large wax pattern (36 x 29 x 0.9 mm) was prepared from a grid sheet used for the construction of cast cobalt chromium partial denture frames. The pattern consisted of 100 circles and the number of completely cast circles was counted to obtain a percentage success rate. The castings were complete with pure titanium but incomplete (average 54%) with a titanium alloy. For an inspection of internal defects the radiographic conditions were optimised by adopting a relative density of about 2.0. The procedures described will help in establishing the most suitable casting technique for the construction of titanium denture frames for any casting system employed in a laboratory.

Dental Alloys↗
PubMed2001

Casting accuracy of experimental Ti-Cu alloys.

The purpose of the present study was to investigate the casting accuracy and the dimensional change of experimental titanium-copper alloys (3.0 and 5.0 mass% Cu; hereafter, only "%" will be used) and to compare the findings with those of pure titanium. Castings were made using an argon-arc melting/pressure difference-casting unit. The fit of the metals cast in both full crown and MOD inlay dies was evaluated by measuring the distance between the shoulder margin and the cervical shoulder of the die. The changes in the inner diameter of castings were determined. In addition, surface roughness measurements inside the castings were carried out using a conventional profilometer, and thermal expansion measurements were made on cast cylindrical specimens using a differential dilatometer. There were no significant differences in dimensional change between pure titanium and the titanium-copper alloys. The fit of the titanium-copper alloys was inferior to pure titanium. The results of surface roughness measurements showed significance differences between the roughness of the pure titanium and titanium-copper alloys.

Analysis of Variance↗
PubMed1994

The effects of casting on upper extremity motor disorders after brain injury.

OBJECTIVES: This study compares casting to traditional techniques, such as passive range of motion, static stretch, and splinting, in the treatment of the hypertonic upper extremity in individuals with severe brain injury. METHOD: Fifteen subjects with brain injury were randomly assigned to one of two groups. One group received a month of casting followed by a month of traditional therapy; the second group received 1 month of traditional therapy followed by casting. The subjects' limbs were evaluated for range of motion, clinical indications of spasticity, and functional use of the extremity at three intervals--before intervention, after the first month of intervention, and after the second month of intervention. Two sample t-tests and paired t-tests were used in data analysis. RESULTS: All but one subject showed a greater improvement in range of motion with casting than with traditional treatment; 11 subjects showed a greater improvement in clinical measures of spasticity with casting. There was no apparent correlation between these measures and functional use of the extremity. CONCLUSION: These findings suggest that casting is more effective than traditional techniques in reducing contracture and in decreasing hypertonicity in some cases. The greater improvements in these motor indicators with casting did not translate into greater gains in functional use of the upper extremities.

Adolescent↗
PubMed1992

[Studies on dimensional accuracy of working casts made by various impression techniques--influence of undercuts on dimensional accuracy].

The purpose of this research was to evaluate the clinical acceptability of various impression techniques by comparing the dimensional accuracy of their working casts. An original metallic model was designed for this experiment. It has reference points to overlap and compare the master model and the working casts for measuring their dimensional accuracy under the same condition. The amount of distortion in each area of the working casts was examined by the measuring points within the model. The master model simulated an abutment for a full veneer crown with undercuts between the adjacent teeth. It was planned so that the amount of undercuts and distances between the adjacent teeth could be changed. As a result, a small distortion of the working casts due to the undercuts was observed by the technique using an individual tooth tray and polysulfide rubber base impression material. There was no significant dimensional change in the working casts made with silicone rubber base material. For the working casts made by hydrocolloid-alginate combination technique, the dimensional change was greater and distortion was observed in the abutment cast when the undercuts of the adjacent teeth were great. However, the distortion was less when the undercuts were small.

Dental Casting Technique↗
PubMed1998

Effect of impression material on surface reactive layer when casting pure titanium in phosphate investment.

We evaluated the effect of impression materials used in preparation of pure titanium castings on the surface reactive layer. Surface roughness of the refractory models before and after firing was smaller when silicone rather than agar impression material was used. The surface roughness of castings prepared with T-invest varied little with the impression material. However, the surface roughness of the castings prepared with CD Titaninvest was less when silicone impression material was used. Surface hardness of the castings was slightly greater when agar impression material was used, and metallic texture analysis of the surface of the castings showed a chill layer and a columnar crystal layer extending from the surface toward the interior. A relatively non-corroded white layer and a markedly corroded black layer were observed in the chill layer, and their thickness was smaller when silicone impression material was used. Use of the Electron Probe Micro Analyzer (EPMA) to determine distribution of various elements in the superficial layer of the casting plates showed that the reactive layer contained less P and Si when silicone impression material was used rather than agar. NH4H2 PO4, which is a component of the bonding material in the investment, was present at a high concentration in the superficial layer of the agar impression material. This shows the importance of preparing refractory models with a non-water-absorbing impression material to obtain pure titanium casting plates with a smaller reactive layer.

Agar↗
PubMedDate not supplied

Accurate determination of cast weight for neonates with clubfoot.

The purpose of this study was to determine changes in cast weight during the first 48 hours after application so that the true weight of a neonate can be estimated without the need for removing the cast. Five types of cast materials were compared. Cast weight measurements were obtained before and after application and at intervals during 48 hours. Final cast weight averaged 107.5% of dry weight for plaster and 99% of dry weight for synthetic cast materials. For very low birth weight infants, the difference between the initial wet weight of plaster of Paris and its final dry weight may be significant for calculating drug and fluid dosages. The weight of an infant can now be calculated without the necessity of cast removal.

Casts, Surgical↗
PubMed2000

[Study of accuracy of one-piece casted and laser welded bridges].

OBJECTIVE: To assess whether laser welded bridge be fit for the clinical usage, this study compares the accuracy of laser welded multi-unit bridges with one-piece casted bridges. METHODS: A precise stainless mold which was 20 mm length composed of two abutments (one premolar and one molar) and one pontic (two missed teeth) was made. 5 wax patterns of four-unit FPD frame-works in one-piece casting based on the mold were made. After that, they were invested with inner (Bellavest) and outer investment (phosphate and gypsum). Then they were casted with CW-PA (Ni-Cr-Nb) alloys. The other 5 wax patterns of four-unit FPD frameworks were invested and casted in two halves. Each couple of frameworks were ultra-sonic washed in distilled water and inserted to the standard metal FPD mold accurately. Laser welding machine (DL-2002) was used to weld each couple of frameworks at 305V, 20 ms. Both groups of specimens were tested on their mesiodistal span dimensions and the diameters of alloy crowns. Then they were inserted to their original stainless mold, where the marginal fitness was examined. RESULTS: 1. The one-piece casted fixed multi-unit bridge couldn't be inserted to abutments completely because of distortion, while the laser welded bridge could be inserted to abutments completely. The average marginal opening of laser welded bridges was about 74 microns and conformed to clinical standard of fitness. 2. Mesiodistal dimensions of one-piece casted bridges at the inner, bottom and top margins were 19.5600 +/- 0.3877 mm, 41.2206 +/- 0.4140 mm, 41.0598 +/- 0.3379 mm respectively; while those of laser welded bridges were 20.2950 +/- 0.1191 mm, 41.9625 +/- 0.0788 mm, 42.0584 +/- 0.1089 mm, which were obviously close to metal abutments (P < 0.05). 3. The alloy crowns' diameters of one-piece casted bridges were examined as following, the premolar: phi IJ = 9.8386 +/- 0.0567 mm, phi LK = 9.9596 +/- 0.0548 mm, the molar: phi EF = 11.7948 +/- 0.0252 mm, phi HG = 11.9412 +/- 0.0763 mm; The alloy crowns' diameters of laser bridges were as following, the premolar: phi IJ = 9.7927 +/- 0.0636 mm, phi LK = 9.9438 +/- 0.0726 mm, the molar: phi EF = 11.8287 +/- 0.0863 mm, phi HG = 11.8893 +/- 0.1049 mm. There was no significant difference between the two groups (P < 0.05). CONCLUSION: Laser welding greatly improve the fitness of multi-unit fixed bridges.

Dental Abutments↗
PubMed1992

Luminal constrictions on corrosion casts of capillaries and postcapillary venules in rat exocrine pancreas correspond to pericyte processes.

The rat exocrine pancreas was studied as a model to demonstrate morphological features of different types of capillaries, using scanning electron microscopy of vascular corrosion casts and transmission electron microscopy of tissue sections. Two types of capillaries were discerned. The first type represents less undulated, slender, straight capillaries with numerous, shallow, circular or semilunar furrows on its cast's surface. In tissue sections, this type probably corresponds to non-fenestrated capillaries. The numerous grooves on its cast correspond to pericyte processes beneath the endothelial lining. The second type comprises capillaries of an undulated course and variable diameter with less numerous furrows. In addition, these casts showed circumscribed, smooth surfaced bulging areas defined by the grooves described. In tissue sections, this type probably corresponds to fenestrated capillaries, the bulging areas on its cast correspond to fenestrated regions of the endothelium. Fenestrated areas of capillary endothelium are less reinforced; pericyte processes are not present beneath these regions in tissue sections. The hypothesis that pericyte processes are responsible for surface indentations on capillary casts was supported by observations on postcapillary venules. Casts of these vascular segments showed also numerous circularly running furrows. Accordingly, the wall of postcapillary venules is provided with pericytes while smooth muscle cells are missing.

Animals↗
PubMed2004

[Effect of mold temperature on mechanical properties of Ti-Zr alloy castings].

OBJECTIVE: To investigate the influence of mold temperature on the mechanical properties of Ti-Zr alloy castings. METHODS: Ti-Zr alloy was cast into a mold which was made of a zircon (ZrO2.SiO2) investment with a casting machine (China) designed as vacuum, pressure and centrifuge. At three mold temperatures (room temperature, 300 degrees C, 600 degrees C) the Ti-Zr alloy was cast separately. The ultimate tensile strength (sigmab), 0.2% offset yield point strength (sigma0.2), and elongation to fracture (delta) were determined by a universal testing machine with 15 mm pre-marked gauge interval. The surface micro-structures of Ti-Zr alloy castings at three mold temperatures were observed by optical microscope. RESULTS: At a higher mold temperature during casting, the tensile strength and yield strength of Ti-Zr alloy were significantly increased, while the elongations were significantly decreased. The micro-structure of the surface was different from the inner part. There was a reacted layer in the outermost surface. The thickness of reacted layers at the three mold temperatures was about 35.5 man (room temperature), 55.0 microm (300 degrees C) and 65.5 microm (600 degrees C), respectively. The inner part of microstructure composed of main a phases within the prior alpha grain boundaries. CONCLUSION: The mold temperature is one of the major factors influencing Ti-Zr alloy mechanical properties. Comparing with Ti6Al4V alloy and Co-Cr alloy castings, Ti-Zr alloy is more suitable for denture frame.

Dental Alloys↗
PubMed2005

Effectiveness of ear protection in reducing anxiety during cast removal in children.

We studied the effect of wearing ear protection on 100 children undergoing cast removal. Pulse rate (PR) and mean arterial pressure (MAP) increases during cast removal were used as physiologic indicators of anxiety. One goal was to determine whether children of various ages are less anxious when wearing ear protection during cast removal. Another goal was to determine whether previous cast removal affects anxiety reactions. Results with children of all ages combined showed that PR increases were significantly lower for those who wore ear protection (P = .04). When wearing ear protection, children up to 6 years old had 9.7% lower PR increases, and 7- to 12-year-olds had 8.8% lower PR increases, but 13- to 17-year-olds had 4.5% higher PR increases. No differences were noted among the groups with respect to MAP increases. There were no significant differences between children who had a cast removed previously and children who were having a cast removed for the first time. Children younger than 13 seemed to benefit the most from wearing ear protection during cast removal.

Adolescent↗
PubMed2005

[The effect of long- or short-arm casting on the stability of reduction and bone mineral density in conservative treatment of Colles' fractures].

OBJECTIVES: We evaluated the effect of long- or short-arm casting on the stability of reduction and bone mineral density (BMD) in the forearm in patients treated conservatively for Colles' fractures (CF). METHODS: Eighty-three patients (48 females, 35 males; mean age 53 years; range 30 to 76 years) with an isolated unilateral CF underwent closed reduction followed by a randomly assigned long-arm (n=44) or short-arm (n=39) casting. Fractures were classified according to the Frykman's system. After reduction, radiographs of both forearms were taken, on which radial height and inclination, and volar tilt were measured and assessed according to the criteria by Sarmiento et al. In the first week, BMD measurements were made on the unaffected side to obtain reference values from four sites of the forearm, namely ultradistal, 1/3 proximal, middle diaphysis, and total. Following removal of the casts (mean 45.3 days; range 40 to 55 days), radiographic and BMD assessments were repeated. Osteoporosis was defined according to the criteria of the World Health Organization. RESULTS: The two casting groups were similar with respect to age, sex, Frykman's classification, involved side, and the dominant extremity. Osteoporosis was detected in 20% according to the T scores. All the sites in the fractured forearm showed density losses, but the difference was significant only in the middle diaphysis (p<0.05). No significant relationship was found between BMD losses and the cast type. Angular measurements showed significant deterioration after union; however, none was found to be related to the cast type (p>0.05). CONCLUSION: Our results show that BMD losses and deterioration in reduction following treatment of CF occur irrespective of which type of casting is used.

Adult↗
PubMed2005

Removable fiberglass de-loading cast for the management of neuropathic plantar ulceration of the foot.

BACKGROUND: Neuropathic plantar ulceration of the foot is treated by de-loading the ulcer. The total contact cast is considered to be the gold standard, but it is a labor-intensive procedure and frequent cast changes are needed. OBJECTIVES: To describe an alternative de-loading method using a fiberglass removable walking cast. METHODS: This prospective uncontrolled study comprised 24 diabetic and non-diabetic patients with a single planter neuropathic ulcer. Exclusion criteria included the presence of osteomyelitis or cellulites, peripheral vascular disease, severe foot or leg edema, more than one ulcer on the treated foot, ulcers on the other foot, visual problems, gait instability, and personality or psychiatric problems. All patients were treated with the removable fiberglass de-loading cast. At each weekly follow-up visit the cast was removed. Data were collected using a clinical report form. RESULTS: The ulcer healed completely in 21 of the 24 patients treated (87.5%). The mean time for healing was 6.8 weeks (range 3-20 weeks, SD = 4.2). New ulcers developed in six patients (25% of the group). CONCLUSIONS: The effectiveness and safety of the method is comparable to that of the total contact cast, but is less labor intensive because the cast is manufactured only once and serves for the whole length of treatment. Improving the technique is expected to lower the complication rate.

Adult↗
PubMed1991

Scanning electron microscopy of corrosion casting in medicine.

The aims of this review are: 1. to provide a bibliography of the publications that have used the corrosion casting technique; 2. to describe the advantages and limitations of the methodology; 3. to illustrate possible applications in the field of medicine, and 4. to highlight the significance of this method in the teaching of medical students. Thus, this paper is primarily focused on the scanning electron microscopical examination of vascular corrosion casts. The unsurpassed three-dimensionality of the corrosion casting technique compared to any other means stands out in particular. This can be especially useful when complex vascular-anatomical relationships are present. This applies not only to the portrayal of the modes of branching and varying vascular densities but also to regulatory arrangements, such as sphincters and arteriovenous anastomoses. Between 1966 and 1990, a total of 549 publications were found in the Medline literature data bank, containing the key words "corrosion casting", "microvascular cast", or "vascular cast" (as of August, 1990). Of those publications, most dealt with applications to experimental animals. By contrast, only 142 reports were mainly or partially concerned with human investigational material. The normal vascular system of nearly all organs, insofar as this is of direct medical relevance, has been largely resolved. In our opinion, one of the most important potential applications of the corrosion casting technique lies in the investigation of gastrointestinal, renal or hepatic ailments, which coincide with the reconstruction or rarefication of the vascular bed, e.g., in ulcers, ileitis terminalis, colitis ulcerosa, cirrhosis or glomerulonephritis.

Animals↗
PubMed1991

Transfixation pinning and casting of tibial fractures in calves: five cases (1985-1989).

Medical records of 5 calves with tibial fractures that were reduced and stabilized by transfixation pinning and casting were reviewed. Multiple Steinmann pins were placed transversely through proximal and distal fracture fragments, and the pin ends were incorporated in fiberglass cast material after fracture reduction. Cast material serves as an external frame to maintain pin position and fracture reduction. Calves were between 2 weeks and 6 months old and weighed between 40 and 180 kg. Three fractures were spiral in configuration and 2 were comminuted. One tibial fracture was open. After surgery, all calves were ambulatory within 24 hours. To improve tarsal flexion and achieve normal stance in 3 calves, cast revision was required on the caudal aspect of the limb. Good radiographic and clinical evidence of stability was observed in 5 to 10 weeks (mean 8 weeks), at which time the pis and cast were removed. Return to normal function was rapid and judged to be excellent at follow-up evaluation 3 to 12 months later. Advantages of transfixation pinning and casting in management of tibial fractures include flexibility in pin positioning, adequate maintenance of reduction, early return to weight-bearing status, joint mobility, and ease of ambulation. The inability to adjust fixation and alignment after cast application is a disadvantage of this technique compared with other external fixators.

Animals↗
PubMed1990

[Radiographic evaluation of 12% Au-Ag-Pd alloy cast lower denture plates constructed by dental student as a laboratory exercise].

We evaluated 12% Au-Ag-Pd alloy cast lower denture plates prepared by dental students in laboratory exercises for casting defects. First, we determined the most suitable exposure conditions for nondestructive radiographic test of 12% Au-Ag-Pd alloy. Subsequently, 130 plates were nondestructively evaluated by radiography under the most suitable exposure conditions. In radiographic testing using X-Omat RP films (Eastman Kodak Co.) and X-Omatic Fine Screen (Eastman Kodak Co.), the most suitable exposure conditions involved a target-to-film distance of 1.9 m, tube voltage of 148 Kvp, tube current of 10 mA, and exposure time of 1.5 sec. Preliminary radiographic examination of artificial casting defects revealed semispherical defects in the diameter of 0.25 mm in 1.6 mm-thick 12% Au-Ag-Pd alloy plates and detects of 0.26 mm in 2.4 mm thick plates. In the 130 cast plates, 56 casting defects were detected. These defects were found at the left webbing part in 40 (30.8%), right webbing part in 36 (27.7%), lingual bar in 7 (5.4%), I-bar in 4 (3.0%), and at other regions of the metal frames in 3 (2.3%) cases. These results indicate that nondestructive radiographic testing is as effective in detection of casting defects in 12% Au-Ag-Pd alloy cast plates as it is in Co-Cr and Ni-Cr alloy plates. This method was also found to be effective in evaluation of the practice metal frames constructed by dental students.

Dental Casting Technique↗
PubMed1990

Avoidance of cast breakage during removal from the impression.

Breakage of a dental cast during its removal from the impression may result in inaccuracies in the finished appliance. The origin and prevention of the factors that can lead to cast breakage are found in the diagnostic phase. Casts of isolated teeth that are long, have marked gingival recession, and have a narrow clinical neck are prone to fracture. If casts of these types of teeth cannot be avoided, measures can be taken to prevent fracture. Wax can be used to thicken teeth with narrow clinical necks or to block out interproximal spaces in adjacent teeth without proximal contacts. The materials used to make the impressions and casts should also be chosen carefully. Methods of removing the cast to avoid fracture include the use of a soldering iron to cut the tray. Once the tray is sectioned, the impression material is free to elongate, and the cast can be removed easily.

Dental Casting Technique↗