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At least 487 records · Page 27Linked to original sources
PubMed2004

[Limitations of orthognathic model surgery: theoretical and practical implications].

Orthognathic model surgery is a classical technique used to simulate orthognathic surgical cases. However, a detailed analysis of this technique demonstrates that theoretical errors and inaccuracies can occur in routine practice. 2D and 3D cephalometric analysis is the first source of inaccuracies. Then, during the occlusal plane transfer from the patient to the semi-adjustable dental articulator, errors can occur by inaccurate manipulation of the facial bow. Simulating the operation on the plaster cast is difficult due to the lack of a real link between the cephalometric analysis and the model surgery. Rotation and translation movements of the plaster casts are insufficiently controlled during the model surgery stage. Finally, the splint, which transfers the final relative position of maxilla to the mandible, summates all of the errors of the previous stages.

Cephalometry↗
PubMedDate not supplied

[Augmentation of VDS (ventral derotation spondylodesis) using double rod instrumentation: surgical method and early results].

INTRODUCTION AND AIM OF THE STUDY: The advantages of the VDS according to Zielke with excellent three dimensional correction and shorter fusion levels in comparison to posterior instrumentation techniques are well known. A disadvantage is the postoperatively necessary long immobilisation in a body cast due to lack of primary stability. Aim of the presented double-rod-VDS is to optimize the system by augmentation and allow a postoperative plaster cast- and brace-free treatment. METHOD AND MATERIAL: Following thoracolumbar phrenotomy and ligation of the segmental vessels Kaneda-clamps are inserted. First VDS-screws are implanted into the posterior holes of these clamps. Using a M-4 compression rod, correction is obtained by centripetal compressive forces to the nuts. Next VDS-screws for the M-5 treated rod are inserted into the anterior holes of the Kaneda clamps. The rod is implanted in a slightly compressive manner and augments the system. Within a prospective study 12 patients with idiopathic and neuromuscular scoliosis underwent this surgical procedure. Three patients with thoracolumbar scoliosis have been followed for 12 months postoperatively and are presented as case reports. All patients were treated brace-free postoperatively, only using a semi-elastic vest for 4 months. RESULTS: Remarkable intra- and postoperative complications have not been noted. Curve correction ranged from 75 to 86%. Implant related complications and loss of correction have not been noted so far. The sagittal plane was within physiological limits postoperatively. Scanning stereography demonstrated excellent three dimensional correction. CONCLUSION: The results of the Double-rod-VDS allow the statement, that the advantages of the VDS according to Zielke are optimized by augmentation of the system with the possibility of plaster cast and brace-free postoperative treatment. Larger operation numbers and a longer follow-up period are needed for further assessment.

Adolescent↗
PubMed1996

Treatment protocol for fractures of the odontoid process.

Treatment results in 104 patients with odontoid fractures were reviewed. There were 2 type I, 62 type II, 32 type III fractures and eight epiphysiolyses in children <7 years old. Thirty-seven patients were managed nonoperatively using plaster casts, cervical braces, or halo devices. Sixty-seven patients were treated surgically including anterior screw fixation (ASF), posterior fusion (PF), and transoral anterior fusion (TAF). Plaster casts and cervical braces were effective for type I fractures and epiphysiolyses only. Halo devices provided successful results in stable type III fractures. ASF is the treatment of choice for most type II and unstable III fractures including some old cases. PF also provided successful union, although impaired cervical motion remained. It should be reserved for irreducible fractures, established nonunions, and as a salvage procedure. TAF should be limited to exceptional cases requiring anterior spinal cord decompression.

Adolescent↗
PubMed1982

[Therapy of hand joint fractures using the external fixator. Experiences - results].

In the treatment of multi-fragment fractures of the base of the radius plate osteosynthesis using the small-fragment instrument set is preferred to conservative treatment due to the superior results achieved. However, one still cannot dispense with an additional immobilization of the fracture in a plaster cast. The extension of intra-articular comminuted fractures of the base of the radius is a technically relatively simple procedure and does not require a supporting plaster cast. In this paper we report the results of the treatment of twenty-seven wrist-fracture patients who were treated by external fixator. We also describe the indications and operative techniques. The results are reported by functional and radiological findings. For a great number of cases the results were quite good. We can highly recommend this procedure in the treatment of wrist injuries due to the simplicity of the operative technique employed and minimal follow-up treatment needed in conjunction with the good results achieved.

Adult↗
PubMed1999

Recovery of isometric grip strength after Colles' fracture: a prospective two-year study.

Grip strength during short and sustained maximal voluntary isometric contractions was measured in 28 females and 5 males with displaced Colles' fracture involving the distal radio-ulnar joint. The patients were randomized into two groups, treated either through immobilization with plaster cast or with external fixation. The recovery of isometric grip strength was followed over a two-year period. A significant difference was registered between women with plaster casts and women with external fixators six weeks after the fracture. Regaining of grip strength occurred up to one year after the fracture. The pattern of recovery was slower for women with primary external fixation. Neither the dominant nor the non-dominant injured side regained short or sustained maximal voluntary isometric contraction. The dominant injured side showed no significant difference between sides but the non-dominant injured side remained significantly weaker. It is thus important to identify hand dominance. Pain during measurements was reduced after two years, but about one-fifth of the patients still perceived pain. The present findings may serve as guidance in physiotherapy for these patients.

Aged↗
PubMed2006

Digital surface photogrammetry for anthropometric analysis of the cleft infant face.

OBJECTIVE: To analyze the three-dimensional morphology of the cleft infant face with digital surface photogrammetry. DESIGN: Fifty plaster casts of unoperated infants with cleft lip and palate were imaged three-dimensionally with digital surface photogrammetry. Twenty-one standard craniofacial measurements were taken. The plaster casts were divided into 4 groups with unilateral, bilateral, complete, and incomplete clefts of the lip and palate. The measurements were compared with standard values for healthy infants. RESULTS: Significant differences (p < .0025) were found for the alar base width (33% to 55%), the alar base root width (59% to 103%), the width of the nose (7% to 25%), the length of the alar wing (18% to 25%), and the intercanthal (6% to 17%) and biocular (4% to 12%) width, depending on the cleft type. The vertical dimensions of the nose and the upper lip did not differ significantly from the controls. CONCLUSION: This study describes preliminary data on the cleft infant facial deformity. The obtained results were mainly in agreement with data in the limited literature. Three-dimensional photogrammetry has proven to be reliable and can be applied more readily to potentially uncooperative patients.

Cephalometry↗
PubMed2001

Adult patients with treated complete cleft lip and palate. Methodological and clinical studies.

The purpose of the present thesis was to investigate the quality of life, satisfaction with treatment, prevalence of temporomandibular disorders, psychosocial distress, and occlusal stability in a treated group of adults with complete cleft lip and palate (CLP). Sixty-eight adults (44 men and 24 women) with a mean age of 24.2 years (range 19.5-29.2) with treated CLP were compared with a gender- and age-matched group with no clefts. The CLP subjects were born between 1968 and 1977 and had undergone standardised plastic surgery at the Department of Plastic Surgery, University Hospital, Linköping, Sweden. Logopaedic, phoniatric, otological, and orthodontic examinations and treatment had been provided locally, supervised by the Cleft Plate Team. The subjects answered a multidimensional, self-report, standardised questionnaire regarding psychological and somatic conditions. The subjects underwent a clinical TMD examination and an evaluation of the occlusion. The reliability of the multidimensional questionnaire was analysed for the CLP group by a test-retest study within a 2-3 week interval and most questions showed an overall good reliability. A panel of professionals judged the outcome of the surgical treatment on colour slides of the CLP subjects. The dental plaster casts of 39 subjects born with complete unilateral cleft lip and palate (UCLP) were analysed (mean age 24.7 years, range 20.2-29.3) and compared with the dental plaster casts taken at mean age of 19.1 years (range 16.0-20.6). The overall level of quality of life was rather high in both groups. The CLP group rated some detached aspects, such as life meaning, family life, and private economy, significantly lower than did the group without clefts. Overall aspects such as well-being and social life were affected by having a treated cleft but not the more practical and tangible aspects of their daily living. There was an overall high level of satisfaction with all the different part of the body in both groups, but the CLP group reported significantly more dissatisfaction with their nose, lips, mouth, profile, and overall facial appearance than the group without clefts. The professionals and the subjects with CLP were generally not very satisfied with the results of surgical treatment. Thirty of the subjects with CLP (47%) wished to have more operations. The professional group recommended further operations in 38 of the subjects (59%) in particular, rhinoplasties. The CLP group had significantly higher frequencies of cross-bite than the group without clefts, but no differences regarding TMD pain were found between the two groups. In the subjects with treated UCLP, there was a significant deterioration in the occlusal score and the maxillary arch dimensions between 19 and 25 years. This was irrespective of the type of retention. The persisting morphological malocclusion with a low frequency of interferences has had no influence on TMD symptoms in the group of CLP patients studied. The conclusion is that the CLP subjects in the present study seemed to be psychosocially well adjusted to their disability. However, 47 per cent wished to have further surgical treatment. The persisting malocclusions did not provoke TMD symptoms.

Adaptation, Psychological↗
PubMed2006

Fracture-separation of the distal humeral epiphysis. Long-term follow-up of five cases.

Fracture-separation of the distal humeral epiphysis is a rare injury described in young children. The diagnosis is often difficult because most of the ossification centre are not visible. We report a long-term follow-up study of five cases, evaluated after an average of 38 years. At the time of fracture, all the patients were more than 3 years old. Three patients had been treated with overhead traction, closed reduction and immobilisation in a long-arm plaster cast, one patient with closed reduction and immobilisation and another one, initially not diagnosed, had been treated after 2 weeks with only immobilisation in a long-arm plaster cast. Cubitus varus deformity was observed in one of the five patients. In the remaining four cases the cubitus was less valgus than the opposite side. No patient complained of any functional disability even though in two of them, one treated late and another one who had an inadequate reduction, radiographic signs of degenerative arthritis were present. We believe that the amount of displacement of the fragments, the quality of the reduction and the age at the time of fracture are important factors influencing the development of cubitus varus deformity.

Adult↗
PubMed1999

Closed reduction versus Kapandji-pinning for extra-articular distal radial fractures.

In a randomized prospective trial, treatment of extra-articular distal radial fractures by closed reduction and plaster application was compared with Kapandji-pinning. Closed reduction and plaster cast was used in 50 patients, Kapandji-pinning in 48 patients. According to the Cooney score, good and excellent results were found in the closed reduction and plaster cast group in 74%, compared with 75% in the Kapandji-pinning group. After measuring the maintenance of reduction as well as the functional outcome at 1 year follow-up, no statistically significant differences could be found between the two groups. We conclude that both techniques can be used in treating extra-articular fractures of the distal radius.

Bone Nails↗
PubMed1975

Stabilization of comminuted fractures of the distal inch of the radius: percutaneous pinning.

Comminuted fractures of the distal inch of the radius have always been difficult to stabilize. Closed reduction and plaster cast fixation frequently result in recurring deformity and some loss of wrist function. A method of closed pinning with proper placement of multiple small Kirschner wires to supplement plaster cast fixation in selected comminuted fractures helps retain anatomical position of the major fragments of the distal end of the radius. This method is sound in principle and we recommend its use in the treatment of severly comminuted fractures of the distal end of the radius.

Adolescent↗
PubMedDate not supplied

Deficiency of protein S-mediated familial venous thrombophilia--a case report.

Deficiency of protein S causes potential problems of thrombosis. Cases of familial venous thrombosis due to deficiency of protein S were presented. First, an 85-year-old woman had pulmonary thromboembolism due to left deep femoral venous thrombosis, which might be triggered by leg fracture and the long-term treatment with a plaster cast. Next, her 29-year-old granddaughter had episodes of recurrent venous thrombosis in her legs and arms, which might be triggered by the treatment with a plaster cast and abortion. In the latter part, the aspects of risks for thromboembolism, potential problems in gestational period, and an advisability of thromboprophylaxis in patients with deficiency of protein S are described.

Adult↗
PubMed1979

[The use of an articulated brace in the treatment of juvenile kyphosis (author's transl)].

The authors have attempted to assess the efficiency of an articulated brace in the treatment of juvenile kyphosis (Scheuermann's disease and idiopathic kyphosis). Two series of patients were compared. Patients in both series were treated in a first stage by a plaster cast and in a second stage by a bivalve brace in the first series and an articulated brace in the second series. The technique of treatment by a plaster cast and by the brace is fully described. It is concluded that control of the lumbar lordosis is of great importance. The results were better with an articulated brace. The indications for treatment are given depending on the age at the onset of treatment, the type of spine deformity and its severity. In some cases of severe dorsolumbar kyphosis, surgery may be indicated.

Adolescent↗
PubMedDate not supplied

[Individual protective crown].

Protection of the worked out live teeth's crowns by covering them with protective crowns should be routine procedure when performing, stable prosthetic restoration. Carrying out of individual protective crown by the "intermediate" method, i.e. basing on plaster cast, is preceded by grinding operation in the mouth of the patient. Protective crown is made of quick-polymerizable acryl introduced into alginate impression and pressed against plaster cast prepared previously. Mechanically worked out crown is precise, esthetic and durable. The method of carrying out is simple, effective and safe for the patient in comparison with the methods used til now because there is no contact of the quick-polymerizable plastics with the tissues of polished teeth and with parodontium.

Crowns↗
PubMed1995

Augmentation of ventral derotation spondylodesis according to Zielke with double-rod instrumentation. Preliminary report on two-year results of thoracolumbar curves.

The advantages of VDS according to Zielke with excellent 3-dimensional correction and shorter fusion levels in comparison to posterior instrumentation techniques are well known. A disadvantage is the necessity of long postoperative immobilization in a body cast or brace due to lack of primary stability. The aim of the VDS double-rod instrumentation is augmentation of the system with the possibility of postoperative treatment without plaster cast or braces. Following thoracolumbophrenotomy and ligation of the segmental vessels double-hole vertebra clamps are inserted. First VDS screws are placed in the posterior holes of these plates. With a 4-mm threaded compression rod correction is obtained by centripetal compressive forces on the nuts. Next VDS screws for the 5-mm threaded rod are inserted into the anterior holes of the vertebral clamps. The rod is implanted in a slightly compressive manner and augments the system. In a prospective study 8 patients, 4 with idiopathic and 4 with neuromuscular scoliotic deformities, underwent this surgical procedure and now have a follow-up of 2 years. Curves ranged from 45 degrees to 131 degrees Cobb angle. All patients were treated without plaster casts or braces postoperatively, but with only a semielastic vest for 4 to 6 months. Unusual intra- and postoperative complications have not been noted. Correction of the primary curve averaged 69.4% at follow-up. Tilt of the caudal end vertebra was corrected 75% to an average of 6.3 degrees. Spontaneous partial correction of the upper secondary curve was noted in all cases. Rod fracture of the 5-mm rod without fracture of the 4-mm rod at this level was seen in 1 patient without loss of correction. Solid fusion was achieved at every level in all patients. The sagittal plane was not adversely affected by the instrumentation. However, larger patient numbers and a longer follow-up are necessary.

Adolescent↗
PubMed1992

[Thrombosis prevention in outpatients with lower limb injuries].

The antithrombotic effect of a low molecular weight heparin was examined in a prospective randomized trial of 204 outpatients (121 men, 83 women, mean age 34.7 [16-76] years) who required immobilization with a plaster cast because of injury to the lower limb. Subjects in group I (n = 99) received a daily subcutaneous injection (36 mg) of heparin fragment calcium throughout their period in plaster (mean of 15.6 [7-66] days), while group II subjects (n = 105, mean period in plaster 15.7 [7-41] days) acted as untreated controls. Thrombosis was diagnosed by compression sonography, and positive findings were confirmed by phlebography. Thrombosis occurred in 24 patients altogether, 6 in group I (6.1%) and 18 in group II (17.1%) (P less than 0.05). While patients with thromboses had a mean of 1.96 risk factors overall, those in group I had a mean of 2.6 risk factors. Patients without thrombosis had a mean of 1.24 risk factors. The rate of thrombosis was higher in patients with fractures (4 out of 27 in group I; 10 out of 35 in group II) than in those with ligament and soft-tissue injuries (2 out of 72 in group I; 8 out of 70 in group II). The severity of trauma is apparently an important thrombogenic factor.--General thrombo-prophylaxis seems advisable for surgical outpatients requiring immobilisation treatment with a plaster cast.

Adolescent↗
PubMedDate not supplied

Experience in the conservative treatment of congenital clubfoot in newborns and infants.

We studied 323 children with congenital clubfoot from 1970 to 1987. The principles of conservative treatment of congenital clubfoot in newborns have completely changed since 1973. The present principles we follow are to begin treatment immediately after birth; and adduction and varus removal by manipulation. In each case, we use a plaster cast, which is changed after a few days as long as the foot is limp and well corrigible. The knee is immobilized at 60 to 70 degrees in a plaster cast. During the manipulations, the surgeon's hand presses only the plantar side of the foot. The results can be described as good, since in each child we have removed adduction and varus as operation by posterior release and Achilles lengthening was necessary in only 50% of the children.

Casts, Surgical↗
PubMed1982

Muscle hypoextensibility in children with cerebral palsy: II. Therapeutic implications.

Twenty-nine children with cerebral palsy and triceps surae hypoextensibility were divided into 2 groups. In group I trophic regulation of the muscle was defective and in group II it was normal. Torque values were plotted against tibiocalcanean angles before and after treatment, which consisted of muscle lengthening by successive plaster casting or of surgical elongation of the tendon or the aponeurosis. In group I, casting had no effect, but surgery increased passive dorsiflexion and gave definite clinical improvement without modifying the range of passive muscle stretch. In group II, with normal muscle adaptation, plaster casts were successful when tolerated. Children in this group required braces after surgery to prevent rapid recurrence of hypoextensibility. Both casting and surgery increased the passive muscle stretch. There was a displacement of the starting point of the passive and active curves in both groups. This is an unavoidable side-effect which makes walking on tiptoes impossible after casting or surgery.

Achilles Tendon↗
PubMed1995

Dynamic orthopaedic brace in the treatment of ankle sprains.

Ankle sprains may lead to disabling sequelae such as joint instability and persistent pain. Immobilization with plaster cast may give rise to joint stiffness and muscle atrophy. Twenty patients with acute inversion sprains of the ankle were treated with a "dynamic" orthopaedic brace after a 10-day plaster immobilization. A control group, consisting of 10 subjects, received a weight-bearing short-leg plaster cast for 25 days. A clinical evaluation and an instrumental isokinetic investigation (Cybex) were performed as scheduled. The clinical findings suggest an earlier and more comprehensive functional recovery in the group receiving the "dynamic" brace compared to the casted group. The isokinetic test revealed a statistically significantly better performance for most parameters in the brace group especially regarding the ankle joint invertors.

Adult↗