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PubMed1997

Mechanical evaluation of a soft cast material.

In this study, the structural and material properties of a new semi-rigid material, Scotchcast SoftCast (SCS), were compared to the properties of two rigid materials, plaster of paris (POP) and Scotchcast Plus (SCP). Cylinders and flat beams made from 4, 6, 8, and 10 layers of each casting material were tested in three-point bending and diametrical compression. Initial stiffness and yield force values of SCS casts were significantly lower than for casts of SCP and POP made of the same number of layers. Casts made from SCS may be indicated for non-rigid applications, but not where rigid immobilization is required.

Calcium Sulfate↗

PubMedDate not supplied

Fractures in children.

BACKGROUND: The burden of diseases in children in our environment is dominated by infections and malnutrition; paediatric trauma has low advocacy and as such is given scant attention. The aim of this study is to review and describe the pattern of paediatric fractures in our local setting. METHOD: A retrospective review of all the medical records of children below the age of fourteen years who were admitted to our center on account of major trauma between January 1999 and December 2003 was done. Those with incomplete records were excluded. RESULTS: The patients ranged in age from 1 +/-13 years with mean of 6.7 +/- 2.9 years. They were mostly males 60 (61.2%) and females 38 (38.8%). The causes of the accidents were diverse. Road traffic accidents were most common 47(51%). A great number of these resulted from unguarded children hit by motor vehicles while crossing the road 33 (36.7%). Forty-one (41.8%) patients fell from various heights. Of these number thirty (30.6%) fell while playing. Most fractures were close 70 (71.4%) while 25 (25.5%) were open fractures and 3 (3.1%) pathological fractures. The most common site of injury was the femoral shaft 33.7%; this was followed by fractures of the supracondylar region of the humerus 17.3%, distal radius 15.3% and tibialfibula 15.3%. More than half of the patients 58 (59.2%) presented fresh to our hospital, while 27 (27.6%) presented initially to traditional bonesetter (TBS) and 13 (13.3%) were referred from private practitioners. Of those twenty-seven patients from the TBS, seven came with compartment syndrome and three had frank gangrene. Most of the patients were managed conservatively. Preliminary traction followed by plaster of Paris (POP) application in 36 (36.7%), and manipulation under anaesthesia (M.U.A) and POP (30.6%), were common definitive treatments given. Sixteen patients (16.3%) had open reduction and internal fixation. Acute compartment syndrome 7 (7.1%) and frank gangrene 3 (3.1%) were the commonest complications and were due to late referral by traditional bonesetters. CONCLUSION: In our environment, fractures in children are common and are frequently associated with morbidities due to interference by traditional bonesetters. These injuries are highly preventable and paediatric trauma prevention strategies directed at parents, children as well as other road users would help to reduce the burden of such fractures especially in the developing countries where the burden of other childhood diseases obscures trauma care.

Accidents↗

PubMedDate not supplied

Congenital dislocation of the knee in Ibadan, Nigeria.

Between January 1996 and December 2001, 41 congenital dislocations of the knee joints (30 patients) were reduced with closed methods by immediate reduction without anaesthesia and serial casting in plaster of Paris immobilization for a period of six to eight weeks. The patients' age ranged from the age of one week to four weeks with a male to female ratio of 1.5:1. The right knee was involved in 46.65% the left in 16.6% and bilateral involvement in 36.65% of patients. Routine check of the hip did not reveal any patient with hip instability. All the patients followed up after 2 years showed excellent results. We conclude that congenital knee dislocation when discovered early and without any other congenital malformation can be managed conservatively with excellent results.

Age Distribution↗

PubMed1990

Plastic footwear for leprosy.

The anaesthetic foot in leprosy poses the most major problem in the rehabilitation of its patients. Various attempts have been made to produce protective footwear such as the microcellular rubber-car-tyre sandals. Unfortunately these attempts have had little success on a large scale because of the inability to produce them in large numbers and the stigma attached to such unusual footwear. While such footwear may be superior to the 'tennis' shoe in protecting the foot from injury by the penetration of sharp objects, it fails to distribute the weight-bearing forces which is the major cause of plantar damage and ulceration in the anaesthetic foot. This can be achieved by providing rigidity to the sole, as demonstrated by the healing of ulcers in plaster of paris casts or the rigid wooden clog. A new type of moulded plastic footwear has been evolved in conjunction with the plastic footwear industry which provides footwear that can be mass produced at a low price and which overcomes the stigma of leprosy. Controlled rigidity is provided by the incorporation of a spring steel shank between the sponge insole and the hard wearing plastic sole. Trials have demonstrated both the acceptability of the footwear and its protective effects as well as its hard wearing properties.

Humans↗

PubMedDate not supplied

Technique for fabrication of an "instant total-contact cast" for treatment of neuropathic diabetic foot ulcers.

Addressing pressure reduction in the treatment of diabetic foot wounds is a critical component of therapy. The total-contact cast has proven to be the gold standard of treatment because of its ability to reduce pressure and facilitate patient adherence to the off-loading regimen. Removable cast walkers have proven to be as effective as total-contact casts in pressure reduction, but this has not translated into equivalent time to healing. A simple technique to convert the removable cast walker into a device that is not as easily detached from the lower extremity, thereby encouraging the use of this device over a 24-hour period, is presented in this article. The procedure involves wrapping the cast walker with cohesive bandage or plaster of Paris. In the authors' opinion, this technique addresses many of the disadvantages of the total-contact cast, resulting in an adequate compromise in this aspect of care.

Bandages↗

PubMedDate not supplied

Two-dimensional wound measurement: comparison of 4 techniques.

Two- and three-dimensional wound measurement techniques are documented in the literature and used clinically, as well as in research. The purpose of this study was to compare 4 two-dimensional wound measurement techniques: linear length and width using a ruler, planimetry, computerized stereophotogrammetry (SPG) length and width, and computerized SPG area. Three plaster of Paris wound models were developed and baseline measurements of outer wound perimeters obtained via a Coordinate Measuring Machine. The convenience sample of raters included 66 upper-division baccalaureate nursing students, graduate nursing students, nursing staff, and wound care nurses. Each rater measured each wound twice in a randomly assigned order of methods written on a card drawn from an envelope. The least biased technique was the computer area, followed in order by the computer length and width, planimetry, and ruler length and width. The most accurate technique, given multiple raters, was determined by the standard error of measurement. The smallest standard error of measurement, thus the most accurate, was the computer area technique, followed in order by the ruler length and width, computer length and width, and planimetry. Interrater reliability of average ratings was high; only the SPG area measurements for single ratings were reliable enough for clinical or research purposes. Intrarater reliability was high for methods with low interrater reliability, suggesting that nurses are consistent in the direction of personal error.

Adult↗

PubMed1999

Fibrovascular ingrowth in porous ocular implants: the effect of material composition, porosity, growth factors, and coatings.

PURPOSE: Fibrovascular ingrowth into various porous ocular implants as a function of implant material composition, porosity, growth factors, and coatings was investigated in a pilot study in an animal model. METHODS: Eighty-one New Zealand white rabbits underwent unilateral enucleation and implantation with ocular implants composed of the following materials: coralline hydroxyapatite (HA) with 200-microm pores (HA200) or 500-microm pores (HA500), synthetic HA (synHA), and high-density porous polyethylene (PP). The HA200, HA500, and PP implants were implanted untreated or after treatment with recombinant human basic fibroblast growth factor (Rh-bFGF). Nine HA500 implants were implanted after coating with calcium sulfate (plaster of Paris) to provide a smooth outer surface. Implants were harvested at 1-, 2-, 4-, or 8-week intervals and were examined histologically. RESULTS: A significant difference was found between untreated HA500 and PP, with PP showing better ingrowth. There was no significant difference between untreated HA and PP, nor between untreated HA500 and synHA. Significant increases in ingrowth were found in HA200 compared with HA500, and in Rh-bFGF-treated implants compared with untreated controls. The calcium sulfate-coated implants showed less vascularization compared with the uncoated implants, although the difference was not significant. CONCLUSIONS: Fibrovascular ingrowth occurred earlier in HA200 implants than in HA500 implants, and was enhanced when implants were treated with Rh-bFGF.

Animals↗

PubMed1999

[A case of isolated avulsion fracture of the posterior cruciate ligament in a child].

PURPOSE OF THE STUDY: The authors report one case of isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament. They recommend the use of 3D CT Scan to appreciate the size, the displacement of the bone fragment or the occurrence of comminuted fracture. MATERIAL AND METHOD: A 12 years old girl was admitted for knee pain and swelling secondary to horse's hoof blow on the anterior aspect of the proximal tibia. Hemarthrosis, contusion of the anterior surface of the proximal tibia were present. Because of pain and swelling, the knee could not be examined with accuracy. Roentgenographic examination showed isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament. 3D CT Scan confirmed the lesion. Bony fragment was displaced and was not comminuted. Approach through the popliteal fossa was used and bony fragment was screwed back into its bed. RESULTS: Postoperatively, a long leg plaster of Paris was applied for 6 weeks. The patient was followed for 1.5 year. She returned to her previous occupation. There was no residual laxity. X ray confirmed fracture union. DISCUSSION: Results of primary repair of interstitial posterior cruciate ligament tears were inconsistent. On the contrary, good functional results were obtained with surgically treated avulsion fracture of the posterior cruciate ligament. Displaced bony fragment will be fixed properly to its bed. 3D CT Scan appreciate the size, the displacement or the occurrence of comminuted fracture. Those informations help to define surgical procedure: screw, wire-suture or staple.

Child↗

PubMed1976

[Comparison between physical properties of resin materials and those of gypsum materials for dental models and dies (author's transl)].

Setting time, water sorption, solubility, dimensional change, hardness, tensile strength, compressive strength, bending strength, and Young's modulus of resin model materials and gypsum model materials were determined. These results are following: 1) Setting time of Goldex is in general the same as that of dental plaster, and setting time of Alpha-Die and that of Dicodur are the same as densite type stone. But setting time of Rock Model is very long, that is, ten times as long as that of densite type stone. 2) Water sorption and solubility of gypsum model materials are larger than those of resin model materials. Solubility of Dicodur is larger in comparison with the other resin model materials. 3) During setting, all of gypsum model materials expand but all of resin model materials contract. The absolute values of dimensional change of Rock Model and of densite type stones are the same, but smaller compared with those of other materials. 4) The value of knoop hardness of resin model materials is between that of plaster of Paris and that of hydrocal type stones. 5) In comparison with densite type stone, resin model materials are 2.5 to 5.0 times in tensile strength, the same in compressive strength, and 1.5 to 2.3 times in bending strength. 6) Young's modulus of resin model materials is 1/3 to 1/5 as much as that of densite type stones.

Calcium Sulfate↗

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

[Transposition of the tendon of M. tibialis posterior an effective treatment of drop foot; retrospective study with follow-up in 12 patients].

OBJECTIVE: To evaluate the results of transposition of the tendon of the M. tibialis posterior in patients with a drop foot. DESIGN: Descriptive, retrospective and follow-up investigation. METHODS: Surgical treatment was carried out in 12 patients with a drop foot (9 women and 3 men, with an average age of 37 years) in the period 1986-1998. The aetiology of the drop foot was a traumatic or iatrogenic lesion of the peroneal nerve or sciatic nerve in 9 patients and in 3 patients spina bifida occulta, leprosy and a herniation of a lumbar disc respectively. None of the patients had important comorbidity. Treatment consisted of lengthening the Achilles tendon according to Huckstep, transposition of the tibial posterior tendon in two tails to the dorsomedial and dorsolateral side of the foot, and six weeks of immobilisation in plaster of Paris. RESULTS: The postoperative period was without complications. The treatment improved the heel-toe steppage gait in all patients. None of the 10 patients who had used an orthosis preoperatively still used it at the time of the follow up. Fifty per cent of the patients acquired a dorsiflexion of the foot of more than 0 degree. The results were in accordance with those in the literature. CONCLUSION: Transposition of the tibial posterior tendon is a worthwhile alternative for those patients with a drop foot (and without important comorbidity) who cannot walk satisfactorily with an ankle-foot orthosis.

Adolescent↗

PubMed1999

Inflammatory reactions associated with a calcium sulfate bone substitute.

OBJECTIVES: Loss of bone substance is a major source of disability that often requires grafting. Recently developed synthetic bone grafts have generated a lot of enthusiasm due to the lack of immunological reactions and infectious disease transmission risk. The current work describes some peculiar complications related to the use of calcium sulfate granules. METHODS: 15 implantations of calcium sulfate pellets Osteoset (Wright Medical Technology) were performed following resection of bone tumors at our service during 1999. Clinical or computerized tomography scans were available in all patients. RESULTS: 3 cases were encountered in which a severe inflammatory reaction developed. In one case serous drainage and an allergic reaction obligated graft removal. In another case, inflammation resolved two months following implantation. In the last case, wound breakdown occurred. CONCLUSIONS: A sterile inflammatory response has previously hindered the use of absorbable poly-lactic and poly-glycolic acid rods. Apparently due to rapid graft resorption, the resulting calcium-rich fluid incites inflammation. The single case of an allergic reaction is interesting. An allergy to plaster of Paris is rare and related to minor additives. These were not present in the bone substitute used. Inflammatory complications should be considered when assessing the risk-benefit ratio of using different types of bone replacement materials, and comparing allogeneic grafts to synthetic ones.

Adult↗

PubMed2000

Acoustic and mechanical properties of artificial stones in comparison to natural kidney stones.

PURPOSE: Standardized and reproducible artificial kidney stone models are important for performing comparative studies of different lithotripsy modalities. The acoustic and mechanical properties of renal calculi dictate the manner by which stones interact with the mechanical stresses produced by shock wave lithotripsy (SWL) or intracorporeal lithotripsy modalities. We have developed a novel artificial kidney stone model that is made of natural substances found in real kidney stones. These stone models appear to be much closer in physical properties to natural kidney stones than previously used stone models. MATERIALS AND METHODS: The acoustic and mechanical properties of six groups of artificial stone models were compared to corresponding natural stones of similar compositions. Moreover, three groups of artificial stone models made of plaster-of-Paris were compared to their natural counterparts. In terms of acoustic properties, stone density was measured using a pycnometer based on Archimedes' principle, whereas longitudinal and transverse (or shear) wave propagation speeds were measured using an ultrasound pulse transmission technique. These values were used to calculate wave impedance and dynamic mechanical properties (bulk modulus, Young's modulus, and shear modulus) of the stones. The microhardness of the stones was measured and the effect of composition on stone fragility was evaluated. RESULTS: Artificial stones, when compared to natural stones of similar composition, showed similar trends in longitudinal and transverse wave speeds, wave impedance, and dynamic elastic moduli. However, values for the artificial stones were uniformly low compared to those of natural stones, suggesting that these artificial stones may be more amenable to shock wave fragmentation. The results of SWL on stone fragmentation of artificial and natural stones also revealed similar trends with the exception of artificial cystine stones which were found to be the most resistant to shock wave fragmentation. CONCLUSIONS: The results indicate that the physical properties of artificial stones made of natural stone materials are comparable to renal calculi of the same chemical composition. The data suggests that these stone phantoms are suitable for performing standardized and reproducible in vitro investigations, especially with regards to fragility of kidney stones of different chemical compositions during SWL.

Acoustics↗

PubMed1999

Supracondylar fracture of the humerus in children--closed pinning.

The supracondylar fracture of the humerus is one of the most common in children, approximately one hundred per year, in Kuwait. The treatment consists in manipulation and fixation by plaster of Paris in the most stable position, usually maximal possible flexion in the elbow joint. For irreducible or unstable cases a percutaneous fixation by Kirschner wires was introduced in September 1993. Two or three Kirschner wires were used either parallel from radial condyle or cross fixation from ulnar and radial condyle. Cross fixation was used in older children without swelling of the elbow. This method has helped to reduce and stabilize the fracture allowing fixation of the elbow at 90 degrees flexion reducing the risk of the blood supply disturbance. The aim of this study was to find rules for proper selection of these two types of fixation.

Bone Nails↗

PubMed1999

[Evaluation of the effect of plastic casts from the aspect of prevention of thromboembolic disease].

Immobilization after trauma escalates risk of thrombosis. Our objective was to determine whether there is a difference in rates of deep vein thrombosis (DVT) after immobilization with plastic casts or routinely plaster of Paris in trauma patients. Despite both groups of patients do not show difference in blood coagulation tests (APTT, TT, PT, levels of fibrinogen and of D-dimer in plasma) during time of immobilization the evidence of DVT according to scintigraphy was lower in group of patients with plastic casts (3 per cent to 10 per cent).

Adolescent↗

PubMed2000

[Tibia reconstruction using cross-leg pedicled fibular flaps: report of two cases].

The paper presents the results of treatment of two children with cross-leg pedicle fibular flaps. A boy (10 years old) was operated because of an extensive defect of the proximal tibial shaft (15 cm) and soft tissue deficit due to osteosarcoma. He had been previously operated several times: tumor resection with chemiotherapy, bone reconstruction using allografts and two other procedures because of inflammatory complications. The second case was a 9-year old girl who underwent an extensive excision of congenital pseudoarthrosis of the tibia due to neurofibroma and reconstruction of the further fragment of the tibia. Vascularized fibula was nailed deep into the tibial shaft, beyond the previously implanted metal elements. This allowed to maintain a correct axis of the limb, a firm stabilization of the transplant and probably evoked a quick periosteal reaction of the tibia. Plaster of Paris was used to immobilize the limb. Postoperative course showed no complications. The flap pedicle was cut off after 3-4 weeks. Progressive bone healing followed by bony hypertrophy was observed after 8 weeks. The children were able to fully load the operated extremities and ambulate without crutches (the boys 12 months post-surgery and the girl 6 months post-surgery).

Child↗

PubMed2002

[Standardization of the method proposed by the World Health Organization for determining the susceptibility levels of leishmaniasis vectors to insecticides].

The WHO method for determining insecticide resistance was standardized for several species of Lutzomyia sand flies under laboratory and field conditions. The biological assays were applied solely to optimize the conditions for the control, i.e., without insecticide, and to estimate mortality due to handling or other unfavorable conditions. Adult female flies from 3 laboratory colonies and one field strain were tested: two laboratory strains of Lutzomyia longipalpis, one laboratory strain of Lutzomyia serrana and one field-collected strain of Lutzomyia quasitownsendi. The WHO method was compared with one modified in which, during the post-exposure period, the recommended plain tube apparatus was replaced with a plastic container layered with damp plaster of Paris. Three paper substrate types were compared under each condition: olive oil additive, silicon oil additive and plain paper. The measured variable was percent mortality in 24 h. For the WHO protocol, the L. longipalpis strains indicated a 0-10% mortality, L. serrana 20-80% and L. quasitownsendi 10-50%. With the modified WHO apparatus, the average mortality was < 4% for all species. No significant differences were observed among the paper treatments. These results indicate a strong species-specific effect of post-exposure conditions on sand flies. To establish baseline levels of insecticide resistance in Lutzomyia sand flies, the WHO method is recommended only for L. longipalpis, and the modified method for L. serrana, L. quasitownsendi and closely related species.

Animals↗

PubMed2002

Forearm bone non-union and its management.

A total of 125 patients with forearm (radio-ulnar) bone compound fractures resulting from missile injuries were examined 8 to 16 weeks after the time of injury with the objective of finding out the rate and causes of non-union. Initial management in each case was circular POP with windows for wound care or posterior slabs made of POP, Cramer-wire, or wood at random. Out of these, 22 (17.5%) patients had non-union. All were male, mean age 26 years, in good nutritional state and no underlying chronic illnesses found on routine examination. Fourteen had ulnar bone and 8 radial bone non-union. Four of the patients with ulnar non-union had both radio-ulnar fracture. All 22 patients had haematocrit values > 30%, had no associated injury and none had vascular injury at site of wounding. Seven (32%) had wound infection. All wounds healed within 2-4 weeks after injury. Diagnosis of non-union was made by clinical examination and x-rays of the forearm. All the 22 cases were operated on under general anaesthesia and exploration revealed that 18 had bone defects ranging from 1 cm to 5 cm, 2 had soft tissue interposition and 2 had failure of reduction as the obvious cause of non-union. Cancellous, slivered iliac bone grafts were made in all cases to bridge gaps and induce osteogenesis. Stabilization was made by rush-pins used as intramedullary nails in 12 cases in addition to either long or short arm plaster of paris casts in all cases. There was no post-operative infection including the donor site and all had well healed wounds and good union 8-10 weeks later. Bone defect is the most common cause of non-union of forearm bone fractures resulting from missile injury and early slivered cancellous bone graft is effective in the treatment of non-union.

Adult↗