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PubMed2002

Venous thromboembolism in patients undergoing laparoscopic and arthroscopic surgery and in leg casts.

The risk of venous thrombosis and need for prophylaxis in patients having undergone minimally invasive procedures and in patients immobilized in a leg plaster are poorly defined. We performed a literature search to evaluate the risk of developing venous thromboembolism after 2 minimally invasive procedures, laparoscopic surgery and arthroscopy, and in patients with lower limb plaster casts. Despite problems of "contamination" because some surgeons use prophylaxis in some of these patients, we were able to determine that (1) laparoscopic cholecystectomy can be considered a low-risk procedure and therefore routine use of prophylaxis is probably not justified; (2) patients undergoing arthroscopic knee surgery are at low to moderate risk and thus prophylaxis is optional; and (3) patients with plaster cast immobilization because of trauma have a moderate risk of thrombosis and should receive prophylaxis.

Arthroscopy↗
PubMed1983

[Isolated luxation of the proximal tibio-fibular joint as a rare sports injury].

The authors present three cases of the rare isolated luxation of the fibular head. Anatomy, injuring mechanism and classification are described. The diagnosis is established by clinical examination and comparative X-ray radiography. If a luxation is irresponsible under general anesthesia (two of our cases), open reposition has to be performed with subsequent temporary nail or screw fixation. A postoperative immobilization with plaster cast on the thigh over a period of six months is necessary. After removal of the plaster cast, the material must immediately be removed in order to avoid complications such as fatigue fractures of the material. If this therapy scheme is observed, surgical treatment can be performed without problems and good functional therapy results will be achieved.

Adult↗
PubMed1994

[Is prevention of thromboembolism in ambulatory and conservative therapy of rupture of the fibular ligament of the upper ankle joint necessary?].

In a prospective clinical study, 111 outpatients with tears of the lateral ankle ligaments were investigated for the occurrence of deep venous thrombosis (DVT). All patients had been treated by a plaster cast for 1 week and had not received any form of DVT prophylaxis. After removal of the plaster cast (mean 7.1 days), colour flow imaging of the veins of the injured leg was performed. A phlebography was undertaken whenever there was any suspicion of DVT. Risk factors for thrombosis [3, 10] were documented in all patients. Besides injury and immobilisation, a median of 1.2 (0-4) risk factors for DVT was involved. Only 31 patients had no additional risk factors at all. Median age of the patients was 26.1 years (16-53 median range). Only 1 patient over 40 years of age was diagnosed as having DVT, and none under 40. Therefore, medicamentous prophylaxis of DVT is not considered necessary in outpatients younger than 40 years with ankle ligament tears treated by bi-valved casts in cases when there are no additional risk factors (Table 4) for DVT.

Adolescent↗
PubMed1983

[Chronic anterior and internal instabilities of the knee. Treatment].

The effective treatment of antero-medial instability aims to restore mobility which contra-indicates a long post-operative period of plaster cast immobilisation and a passive repair of the ligaments. Satisfactory techniques allow early mobilisation without the use of a plaster cast. They are difficult to perform and need precision. Lesions at the upper end of the medial ligament are best treated by a plastic procedure using the gracilis and lesions of the lower end by use of the semi tendinosus. It is particularly important to determine the precise position of the upper insertion of the medial ligament, to determine the ideal tension of the released ligaments and capsule, to fix the tendons through the bone and to avoid any plaster immobilisation. Walking without weight-bearing is allowed until the fifteenth day. The time off work was about 60 days. The results were satisfactory provided that the lesions were not too old and there were no lesions of the articular cartilage. Associated meniscus lesions were treated by partial resection or repair by suture.

Chronic Disease↗
PubMed1992

Intra-articular fractures at the base of the fifth metacarpal. A clinical and radiographical study of 64 cases.

The treatment of 64 intra-articular fractures at the base of the fifth metacarpal was studied. 11 fractures with minimal displacement had been immobilised in a plaster cast without reduction. The position was improved in five of 25 fractures treated by closed reduction and a plaster cast, six of nine fractures after percutaneous pinning, and 12 of 19 fractures after open reduction and internal fixation. At follow-up after a median of 4.3 years, 19 of 50 patients answering a questionnaire had intermittent pain, especially on firm grip. 43 patients were re-examined clinically and radiographically: 21 (49%) had decreased grip power, and 28 had radiographical signs of osteoarthrosis.

Adolescent↗
PubMed1993

Salvage, with arthrodesis, in intractable diabetic neuropathic arthropathy of the foot and ankle.

Twenty-nine patients who had diabetic neuropathic arthropathy of the foot and ankle were managed with open reduction and arthrodesis of various joints. Rigid internal fixation was used in all but four patients, who had external fixation. All patients had severe instability or a fixed deformity that precluded successful treatment with bracing. The sites of the fracture-dislocations or the neuropathic dislocations were the ankle in twenty-one patients, the subtalar joint in six, and the transverse tarsal joint in two. The ankle-brachial Doppler indices of these patients averaged 0.86 (range, 0.55 to 1.14). The involved extremities were graded at the initial evaluations according to the Wagner classification system for neuropathic ulceration. The grade was 0 in fourteen patients, I in seven, II in two, and III in six. A tibiocalcaneal arthrodesis was performed after a talectomy in eleven patients; a tibiotalar arthrodesis, in eight; a triple arthrodesis, in six; a pantalar arthrodesis, in two; and a tibiotalocalcaneal arthrodesis, in two. Postoperatively, all patients remained non-weight-bearing and wore a below-the-knee plaster cast for two months. Weight-bearing was then begun with the leg in a total-contact plaster cast, and use of the cast was continued for a mean of five months (range, four to fourteen months). Thereafter, a polypropylene ankle-foot orthosis was used permanently. The most recent evaluation of the patients was performed at an average of forty-two months (range, fourteen to sixty-eight months) after the arthrodesis. There were twenty complications in nineteen of the twenty-nine patients, and there were nine pseudarthroses (six tibiocalcaneal, one tibiotalar, and two talonavicular). However, seven of the pseudarthroses were clinically stable. In these patients, the arthrodesis was performed as an alternative to amputation, and salvage was successful in twenty-seven (93 per cent) of the twenty-nine patients.

Adult↗
PubMed1999

A system for the simulation and planning of orthodontic treatment using a low cost 3D laser scanner for dental anatomy capturing.

The detection and correction of malocclusions and other dental abnormalities is a significant area of work in orthodontic diagnosis. To assess the quality of occlusion between the teeth the orthodontist has to estimate distances between specific points located on the teeth of both arches. Distance measuring is based on the observation, by the orthodontist, of a plaster model of the mouth. Gathering of information required to make the diagnosis is a time consuming and costly operation. On the other hand, obtaining and manipulation of plaster casts constitute a huge problem in clinics, due to both the large space needed and high costs associated with plaster casts manufacturing. For this problem we present a new system for three-dimensional orthodontic treatment planning and movement of teeth. We describe a computer vision technique for the acquisition and processing of three-dimensional images of the profile of hydrocolloids dental imprints taken by mean of a own developed 3D laser scanner. Profile measurement is based on the triangulation method which detects deformation of the projection of a laser line on the dental imprints. The system is computer-controlled and designed to achieve depth and lateral resolutions of 0.1 mm and 0.2 mm, respectively, within a depth range of 40 mm. The developed diagnosis software system (named MAGALLANES) and the 3D laser scanner (named 3DENT) are both commercially available and have been designed to replace manual measurement methods, which use costly plaster models, with computer measurements methods and teeth movement simulation using cheap hydrocolloid dental wafers. This procedure will reduce the cost and acquisition time of orthodontic data and facilitate the conduct of epidemiological studies.

Adult↗
PubMed1979

Changes in connective tissue metabolism due to bone fractures in children aged 10--14 years. III. Urinary hydroxyproline and glycosaminoglycan excretion following bone fractures treated in different ways.

Urinary hydroxyproline and glycosaminoglycan excretion was studied in the course of fracture healing in twenty 10--14-year-old children with fracture of the femur or of the tibia and fibula. In 11 children reduction and plaster cast were used, in 5 osteosynthesis, and in 4 extension of 6--21 days duration combined with immobilization by plaster cast. In the state of resorption, an increase was observed in the urinary excretion of hydroxyproline and total glycosaminoglycans and in the six glycosaminoglycan fractions studied. As a result of the soft tissue damage accompanying the fracture, the excretion of hyaluronic acid, heparan sulphate, and dermatan sulphate showed the most marked increase. No statistically significant relationship could be demonstrated between the mode of treatment and the amounts of urinary hydroxyproline and glycosaminoglycan, but the stage of resorption was prolonged in the case of treatment with traction. At the beginning of regeneration, a decrease in hydroxyproline excretion and then an increase corresponding to the intensive synthesis of collagen were demonstrated. Glycosaminoglycan excretion during the development of fibrous callus was considerably below the control value. Excretion of the metabolites decreased markedly in the five operated patients. in the case of extension, the stage of regeneration prolonged by 4 to 10 days. In the stage of calcification, urinary hydroxyproline excretion was increased while the excretion of glycosaminoglycan and its fractions was the same as in the controls except in the patients treated with traction. No statistically significant relationship was found between the urinary amounts of hydroxyproline and glycosaminoglycan and the mode of treatment. In the case of traction, fracture repair and the formation of connective tissue callus were prolonged.

Adolescent↗
PubMedDate not supplied

[The material properties of a combined plaster-plastic cast].

The treatment of patients by a combined plaster/plastic cast often is more advantageous than the application of only one of these components. Now a compression test was made to check the attributes of the plaster, plastic and combined material. There were shown clear differences in the elastic behavior and the solidity of both casts, and the combination of both materials consequently was not really stable.

Calcium Sulfate↗
PubMed2001

Characteristic forms of the upper part of the oral cavity in newborns with isolated cleft palate.

OBJECTIVE: To determine the functional and morphological compensation of the lack of integrity in the upper part of the oral cavity in newborns with isolated cleft palate. Integrity of the upper part of the oral cavity is required for the effective pumping of amniotic fluid, the essential mode of nutrition in intrauterine life. The adaptation could be seen immediately after birth. MATERIALS: Plaster casts of the upper part of the oral cavity in 60 newborns with isolated cleft palate of various extent and plaster casts of the upper part of the oral cavity in 27 newborns without cleft were used. A number of surface points were identified and used for a trigonometric morphological analysis. RESULTS: The parameters of the upper part of the oral cavity in four groups of newborns with various extent of isolated cleft palate were compared with newborns without cleft palate. The results indicate a shift of the functional oral cavity into the nasal cavity and the pharynx, depending on the extent of the cleft. CONCLUSION: The pumping activity of the tongue forms the upper part of the oral cavity and consequently the tongue moves into the nasal cavity and pharynx, depending on the extent of the cleft. In this way, effective pumping of amniotic fluid is possible despite the cleft. This is of vital importance for the fetus during intrauterine life. A poorly passable or even unpassable respiratory way is only of secondary importance during that time.

Adaptation, Physiological↗
PubMed1975

[Fracture movement and fracture healing in plaster case fixation (author's transl)].

The fixation of a fracture in a plaster cast, or in traction is not absolutely rigid. Experiments were carried out on adaver tibial fractures placed in long leg plaster casts. It was observed that the possible deformity ranged between 4-8 degrees in a well-padded cast and 2-5 degrees in a nonpadded cast. Further observation were conducted while hip osteotomies were compressed by external fixator. These osteotomies are further protected by hip spicas. It was demonstrated that increasing the length of the cast did not increase the degree of fixation. It is suggested that fracture healing in conservatively treated cases is optimal if movement of the fragments remains within the physiological elastic limits of the not fractured bone. Fracture healing can be disturbed not only by extensively denudation and soft tissue disturbance, but also by under-or overstressing the bone and by unphysiological immobilisation.

Biomechanical Phenomena↗
PubMed1995

Fresh scaphoid fractures (analysis of 45 cases).

A study of fresh scaphoid fractures, treated at King Khalid University Hospital between 1983 to 1990, is presented. In a study of 45 patients, there were 43 males (95.5%) and two females (4.5%). Twenty-five patients (55.5%) had fractures on the right side and twenty (44.5%) on the left side. Six patients (13.3%) had fractures in the proximal third, thirty-five (77.7%) in the middle third and four (9%) in the distal third. Among the fractures located in the middle third, twenty-two (62.8%) were displaced and thirteen (37.2%) were undisplaced. Patients included in this study had initial treatment by immobilization in a below elbow thumb spica cast. Ten patients after failure of conservative treatment were treated by compression screw osteosynthesis. In this study, it has been observed that plaster cast immobilisation is a satisfactory method of treatment for stable-undisplaced fractures, while results in patients with unstable-displaced fractures are poor and they are best treated by early open reduction and internal fixation. By assessing the results of this study it is recommended that all scaphoid fractures should be assessed for stability. The treatment by plaster cast should be reserved for fractures involving distal third of scaphoid and for stable fractures of middle and proximal third. The unstable and displaced fractures should be treated by early screw fixation.

Adolescent↗
PubMed1982

Pre-operative correction in adolescent idiopathic scoliosis.

One hundred and sixty-seven patients with adolescent idiopathic scoliosis were allocated prospectively to one of three different groups for correction before undergoing posterior spinal fusion and Harrington instrumentation, In group 1 single curves were corrected by a Risser turnbuckle plaster jacket and double curves by halo-pelvic traction. In Group 2 patients performed Cotrel dynamic traction for three weeks and this was followed by correction in a plaster cast. In Group 3 patients were given Cotrel dynamic traction for one week only and the operation was performed without a plaster cast. There was no significant difference in the overall correction achieved among the patients in the three groups except that double curves corrected slightly better in Group 2. The correction achieved by Cotrel dynamic traction after three weeks was not significantly different from that obtained at 48 hours. An anteroposterior radiograph of the spine taken during Cotrel dynamic traction was a valuable guide to the mobility of the curve and is preferable to radiographs of the patients bending laterally, particularly with respect to curves over 70 degrees. The paper concludes that correction before operation is not required routinely in adolescent idiopathic curves unless the deformity is a severe and rigid one in which case a radiograph during Cotrel traction is a useful assessment.

Adolescent↗
PubMed1979

[Is treatment of C.D.H. by progressive reduction by traction still advisable? (author's transl)].

The authors analyse the results that they have obtained in the treatment of C.D.H. either by conservative or surgical methods. The prevention of osteochondritis remains the main worry. However traction leads to long-lasting immobilization and sometimes it is not sufficient. The authors think that osteochondritis may be related to hyper-pressure on the femoral head or to lesions of the vascular pedicle and that in some cases shortening of the femur or tenotomies may allow a decrease of the plaster cast period. The indications on capculotomy, rotation osteotomy, salter osteotomy are discussed. It is concluded that the periods of traction and plaster cast immobilization should be lessened as much as possible.

Age Factors↗
PubMedDate not supplied

Neuropathic plantar ulceration.

Management of 111 trophic plantar ulcers existing in 100 patients of leprosy have been reviewed. Male preponderance with 4th and 5th decade of life predilection was observed. Most of the patients were of lepromatous type. Ulcers were grouped into superficial and deep. They were treated by various methods viz. plaster cast alone and in combination with curettage, posterior tibial neurovascular decompression and metatarsectomy. It was observed that ulcers heal faster if conservative plaster cast treatment is clubbed with surgical treatment of the ulcer. Indications of various surgical methods is defined. Role of proper footwear in the management of plantar ulcers has been emphasized.

Casts, Surgical↗
PubMed1994

[A comparison of 2 methods of plastic cast fixation in treatment of loco classico radius fracture. A prospective, randomized study].

The purpose of this study was to compare the functional and radiological result of two different positions of the wrist in a plaster cast following Colles' fracture. For this prospective study, each of 50 patients with type A 2.2, A 3.3, C 1.2 or C 2.2 (AO classification) fractures of the radius was randomly assigned to one of two groups. Both groups were treated in the same way as far as anaesthesia and reduction were concerned. The only difference in treatment lay in the position of fixation in plaster. In group 1 the wrist was immobilized in neutral flexion-extension. In group 2 the wrist was dorsiflexed 20 degrees, while the carpus was pushed in a volar direction by an impression in the plaster cast. At review 2-7 years after the accidents, the two groups were compared with reference to symptoms, range of motion at the wrist, power of first closure and radiographic appearance. In group 1 there were 5 patients with significant disability, compared with only 1 in group 2. A significant difference was found in the range of movement between the two groups for flexion and ulnar abduction (p < 0.01). The loss of power of first clenching (difference between injured and healthy hand) was 6.2 mmHg for group 1 and 3.8 mmHg for group 2 (not significant). The radiographic examination showed significant differences both in sagittal inclination (p < 0.001) and in radial shortening (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Carpometacarpal dislocation of the thumb associated with ipsilateral fracture of the distal radius.

An acute carpometacarpal (CMC) dislocation of the thumb is itself an extremely rare injury, but one associated with a fracture of the distal radius has never before been reported. In our case, the fracture of the distal radius was treated by closed reduction and immobilization with a plaster cast, whereas the dislocation of the CMC of the thumb was treated with closed reduction, percutaneous fixation with Kirschner wires, and immobilization with a plaster cast. At the patient's two-year follow-up examination, the distal radius fracture displayed successful functional and radiographic results, but a subluxation of the CMC joint was evident.

Carpal Bones↗
PubMedDate not supplied

Effect of postoperative early ankle motion exercise using hinged ankle-foot orthoses in clubfoot.

The authors proposed early application of hinged ankle-foot orthoses for improving postoperative range of ankle motion after the complete subtalar release operation for clubfoot. Forty-eight patients (74 feet) with clubfoot were divided into two groups: group A patients (20 feet) were immobilized in plaster casts for 6 weeks after surgery, followed by non-hinged ankle-foot orthoses, and group B patients (54 feet) were immobilized in plaster casts for 4 weeks after surgery, followed by hinged ankle-foot orthoses. The range of ankle plantarflexion in group B showed a significant improvement compared with group A at 3 months and 1, 2, and 3 years after surgery. There was no statistical difference between the groups in the range of dorsiflexion except at 3 months of follow-up. The postoperative talo-calcaneal index was well maintained in both groups. Early range-of-motion exercises using the hinged ankle-foot orthoses achieved good ankle function, especially in plantarflexion, with no loss of radiologic correction.

Ankle↗