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PubMed1992

[Overhead extension in delayed diagnosis of congenital hip dislocations in children, following failure of treatment with the Pavlik harness].

Authors report, based on a retrospective examination of 103 dislocated hips of 85 children, on experiences with the overhead treatment of congenital hip dislocations, resistant to Pavlik harness or lately recognized. The results are compared with those of 23 hips of 20 children treated with Pavlik harness and plaster casts. Follow-up time was 3-15, in average 7 years. It is stated that the overhead extension treatment not followed by stiff fixation resulted in 92 per cent reduction in resistant and lately recognized hip dislocations. This procedure has caused in only 4 per cent severe necrosis of the femoral head with lasting consequences. Their experience with Pavlik harness combined with plaster cast are unfavourable as in 4 of 23 hips treated subtotal, in another 7 partial femoral head necrosis has developed.

Adolescent↗

PubMed1983

Role of fixation in the treatment of nasal fractures.

Following the reduction of nasal fractures, fixation was performed in 3 ways: 1 Packing for 72 h and plaster cast for 1 week. 2 Packing for 72 h and adhesive tape for 1 week. 3 Adhesive tape for 1 week. At follow-up 3 months after the reduction, these groups were compared with a group of patients with nasal fractures which had not needed treatment and with a group of normals. It was concluded that among the group fixed with packing and plaster cast, significantly fewer patients were dissatisfied than in the other groups, and fewer complained of deformity. The physical examination showed an appreciable number of minor deformities in all groups including the normal group. A significantly higher frequency of nasal obstruction was found in the group of patients operated upon compared to the non-operated group and the normal group by physical examination, but not by the questionnaire. The present study does not support the point of view that a high percentage of cases of nasal fracture have to be operated upon by open reduction. Radiology has no medical or legal value in patients with nasal fractures and should not be used.

Adolescent↗

PubMed1985

Arthrodesis of the pastern joint in the horse.

Arthrodesis of the pastern joint was performed in six horses with a history of acute trauma and in 10 horses with a history of chronic lameness of one to six months duration. Five surgical techniques were employed: curettage of the joint, lag screw compression and immobilisation in a plaster cast; curettage, compression using a T plate and immobilisation; drilling, lag screw compression and immobilisation; lag screw compression and immobilisation; and curettage and immobilisation. Pre- and postoperative clinical course are described together with significant radiographical findings. The best results were achieved by luxating the joint to curette the articular cartilage, followed by fixation and compression with either lag screws or a T plate and immobilisation in a plaster cast.

Animals↗

PubMed1982

Treatment of Colles' fracture. A prospective comparison of three different positions of immobilization.

The usual treatment of Colles' fracture, i.e. fracture of the distal radius with dorsal angulation of the distal fragment, is closed reduction and immobilization in a plaster cast. The position of the forearm in the cast varies, according to the reports of various authors. Forty-two extra-articular-fractures of the distal radius have been randomly divided into three groups. All were reduced, and the forearms were then immobilized in three different positions of rotation according to the grouping. The study indicates that the position of the forearm during immobilization is of importance as regards redislocation. After application of a plaster cast with the forearm in pronation there seems to be less likelihood of redislocation occurring than when the forearm is immobilized in supination (P less than 0.05).

Aged↗

PubMed1998

[Acute ruptures of the Achilles tendon--apropos of 14 conservatively treated cases].

GOAL OF THE STUDY: To analyse the results of non surgical treatment (cast for 12 weeks) for complete and recent rupture of Achilles tendon. MATERIAL AND METHODS: We reviewed with an average follow up of 2 years 14 patients (14 ruptures). All patients evaluated subjective results on a linear scale. Objective results were given by clinical examination, ultrasonography and performance testing. RESULTS: Subjective results were excellent for 50% of cases, good for 29% and fair for 21%. Amyotrophy of the calf was always noted (mean 15 cm). The maximum force was reduced by 22% and the endurance by 47% in comparison with the healthy calf. All sportsmen but one were able to continue their sport as before. None of them had to change their job. DISCUSSION: The conservative treatment of fresh ruptured Achilles tendon by plaster cast for 12 weeks gives satisfactory results in comparison with surgical treatment followed by 6 weeks immobilisation. The results are not so good when compared to conservative or surgical treatment followed by immediate mobilisation. CONCLUSION: Conservative treatment by plaster cast for 12 weeks should be applied to non compliant patients or to patients who are not concerned by the functional results or unable to follow a programme of reeducation or to patients with chronic skin lesions.

Achilles Tendon↗

PubMed1997

External fixation versus percutaneous pinning for unstable Colles' fracture. Equal outcome in a randomized study of 60 patients.

60 patients > 20 years of age, with comminuted distal radial fractures of type Older 3 or 4, were randomly allocated to two treatment groups: external fixation a.m. Hoffmann or percutaneous Kirschner wire pinning combined with immobilization in a plaster cast. The groups were similar in age, gender, fracture type and dislocation. All patients were immobilized for 6 weeks and the outcome was assessed after 6 months. The groups showed similar results with respect to radiographic parameters and function. All fractures healed and no difference in complication rate was observed. We conclude that most unstable distal radial fractures, classified as Older's type 3 and 4, can be treated with percutaneous pinning and a plaster cast, which is simpler and cheaper than external fixation.

Adult↗

PubMed2000

Construction and testing of a computer-based intraoral laser scanner for determining tooth positions.

An optical set-up for intraoral data acquisition based on the principle of laser triangulation was developed. The system consists of a pig-tailed laser with line generating optics, a stepping motor driven positioning stage, a commercial CCD (charge coupled device) camera system with frame grabber interface, a control personal computer and a mirror system compensating for the fact that there is no possibility of watching an object directly in the mouth under a certain angle except from a facial position during intraoral scanning. Due to the size of the prototype measurements were still restricted to plaster casts. In order to evaluate its accuracy, the measurements were compared with those taken with a commercial laser scanner and a coordinate measurement table. The accuracy of the prototype scanner was determined to be DeltaXYZ=0.04 mm using gauge blocks of given dimensions and proved to range between the commercial laser scanner and the coordinate measurement table (i.e., it was slightly better than that of the commercial scanner). Applications in orthodontics were demonstrated by scanning plaster casts and measuring distances on reconstructed surfaces. The measured distances showed a maximum deviation of about +/-0.2 mm compared with the data of the coordinate measurement table, which served as a reference. In addition, reconstruction of three-dimensional tooth movements was performed on the scan data. The translational and rotational parameters gained from the superimposition of scanned point clouds and describing tooth movement were also in good accordance with the reference. The achieved accuracy proved to be sufficient for further development which should include a reduction in size and the use of more precise device components.

Dental Occlusion↗

PubMedDate not supplied

An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study.

BACKGROUND: Little information is available concerning risk factors for venous thromboembolism (VTE) in nonhospitalized patients. PARTICIPANTS AND METHODS: An epidemiologic case-control study of deep vein thrombosis (DVT) risk factors was conducted in 1272 outpatients by general practitioners. The case population (636 patients presenting with DVT) was paired with the control population (636 patients presenting with influenzal or rhinopharyngeal syndrome) according to sex and age. Deep vein thrombosis was to be documented by at least 1 objective test. Risk factors were classified into "intrinsic" ("permanent") and "triggering" ("transient") factors and were evidenced using univariate analysis. RESULTS: In the medical population, defined as patients who had not undergone surgery or application of a plaster cast to the lower extremities within the 3 weeks preceding inclusion (494 cases and 494 controls), intrinsic factors such as history of VTE, venous insufficiency, chronic heart failure, obesity, immobile standing position, history of more than 3 pregnancies, and triggering factors such as pregnancy, violent effort, or muscular trauma, deterioration of general condition, immobilization, long-distance travel, and infectious disease were significantly more frequent in the case patients than in the controls (odds ratio, >1; P<.05). In the overall population, additional risk factors were cancer, blood group A, plaster cast of the lower extremities, and surgery. In both populations, the number of risk factors per patient was greater in the case patients than in the controls. CONCLUSION: Several risk factors for DVT were identified in medical outpatients presenting with DVT, and their comprehension may improve appropriateness and efficiency of the different methods available for thromboprophylaxis. Arch Intern Med. 2000;160:3415-3420.

Adult↗

PubMedDate not supplied

[Traumatic luxation of the hip in children].

The authors report the long-term results of the non-surgical treatment of 15 cases of traumatic dislocation of the hip during the growth age, followed-up after an average of 14 years (5-26 years). There were 14 cases of posterior dislocation and 1 case of anterior dislocation (the latter complicated by ischemia due to compression of the common femoral artery), in patients aged from 3.5 to 15 years (average age 11 years). All of the cases were treated by non-surgical reduction under general anesthesia in an emergency situation, and a plaster cast which was worn for 30-55 days. At long-term follow-up the results were evaluated as follows good, with complete healing, in 67% of the cases; fair, with moderate, non-symptomatic radiographic arthritic changes, in 26%; poor in only 1 case (7%) which was complicated by necrosis of the femoral head. Post-traumatic arthrosis and cephalic necrosis were observed in patients aged more than 10 years, and where fracture was associated with the dislocation, indicating trauma of considerable intensity. The duration of immobilization in a plaster cast and no weight-bearing did not influence the results. Traumatic hip dislocation during the growth age has a better prognosis as compared to that occurring during adult age. Particularly favorable prognostic factors are age under 10 years and the absence of fractures associated with the dislocation.

Adolescent↗

PubMed1991

A critical comparison of three methods for measuring dental models.

A critical comparison of three methods for measuring distances between various fiducial points on orthodontic plaster casts is presented. The first method consisted of using a vernier caliper by which direct measurements (Dv) of the distances were recorded. The second method consisted of measuring the same casts using a reflex metrograph (Dm), where the co-ordinates of the points relative to two axes were recorded and the distances between various points were calculated. In the third method, reflection holograms of the casts were made, and the same distances were measured on the holographic images (Dh) using the reflex metrograph. The Wilcoxon sign rank test indicated no significant differences (p greater than 0.1) between measurements made by the various techniques. The means of the different distances scored varied within less than 0.5 mm (Dv-Dh), 0.5mm (Dv-Dm) and 0.2mm Dm-Dh). This study indicated that holograms can provide sufficiently accurate representations of orthodontic study models. Their retention as case records may solve the problem of the storage of orthodontic plaster casts.

Dental Records↗

PubMed1998

Short tau inversion recovery magnetic resonance imaging in occult scaphoid injuries: effect on management.

Over a 21-month period, 16 patients with possible scaphoid fractures, where conventional radiographs were essentially normal on the day of injury and 10 days later, were examined by coronal short tau inversion recovery (STIR) and T1 weighted sequences on a 0.2 Tesla scanner. The magnetic resonance (MR) examinations were done in between electively booked patients and management was altered in 50% of patients. It was expedient to do MR as radio-isotope facilities were not available at the hospital. In four patients, the examination was entirely normal. In another four patients, intercarpal fluid collections only were demonstrated (two generalized and two localized). In these patients a plaster cast was not re-applied. In two patients, bony injuries of the distal radius were demonstrated instead, with the scaphoid being normal. In the remaining six patients, variable appearances were shown, ranging from an actual fracture line demonstrated on both STIR and T1-weighted images with the remainder of the scaphoid being hyperintense on STIR and hypointense on T1, to non-visualization of the actual fracture line, which appeared to be represented by a much more hyperintense band through the waist of an otherwise hyperintense scaphoid on the STIR sequence. In all these patients a plaster cast was re-applied empirically, including those patients with a definite fracture and those patients with apparent bone contusion only. Although the T1-weighted images were anatomically superior, their addition did not alter management and it is suggested that coronal STIR images should suffice to demonstrate occult fractures of the scaphoid.

Adult↗

PubMed1985

Clinical fracture of the carpal scaphoid--an illusionary diagnosis.

The management of patients with clinical evidence of a fracture of the carpal scaphoid bone but without radiological evidence of a fracture is based on dogma emphasizing the need to immobilize the wrist in all cases. Because of the apparently high proportion of patients who spend up to six weeks in a plaster cast and in whom no fracture is ever demonstrated radiologically, a study was undertaken to determine the fate of those wrist injuries diagnosed as clinical fractures of the scaphoid. All patients who presented with clinical or radiological evidence of fractures of the scaphoid over a one year period were reviewed. Of the 108 patients in whom the diagnosis of clinical fracture of the scaphoid was made at the time of presentation none was proved radiologically to have a fracture of the scaphoid subsequently after a period of mobilization. These patients spent an average time of 21.9 days in a plaster cast which represents a significant loss of productivity to the community and inconvenience to the patient.

Adolescent↗

PubMed2002

A comparison of four methods of obtaining a negative impression of the foot.

Four methods are currently available for taking a negative impression of the foot for the purpose of fabricating an orthotic device: nonweightbearing plaster casting, partial-weightbearing foam impressions, and partial-weightbearing and nonweightbearing laser scanning. This study compares the reliability and accuracy of these methods. Each impression method was performed three times on each foot of 15 subjects. Measures of rearfoot and forefoot width, forefoot-to-rearfoot relationship, and arch height were obtained from the negative impressions. Additionally, rearfoot and forefoot width and forefoot-to-rearfoot relationship were measured clinically for each subject. This study found that 1) foot measures are significantly influenced by the method used to obtain a negative foot impression; 2) the methods differ in reliability; and 3) plaster casting may be preferable to the other three methods when it is important to capture the forefoot-to-rearfoot relationship, as in fabricating a functional orthosis.

Analysis of Variance↗

PubMed2002

[Pathological fractures of the knee].

The authors present the methods and results of treatment of 20 epiphyseal and low-metaphysis pathological knee fractures treated at the Department of Orthopedics of the Lublin University of Medical Sciences between 1962-1999. The average age was 39 years. Malignant tumours (2 lymphomas, 1 plasmocytoma, 1 hemangiopericitoma, 2 adenocarcinoma metastases) and benign lesions (10 giant cell tumours, 3 solitary bone cysts, 1 intraosseous extension of pigmented villonodular synovitis) causes 18 femur fractures and 2 tibia fractures. The fractures caused by lymphomas in 2 patients and plasmocytoma in 1 patients were treated with either a plaster cast or skeletal traction and healed within 16 weeks. Tumour resection and reconstruction with Rush rods, Kuntscher nail, plate and methylmetacrylate were performed in 2 cases. In 1 case with hemangiopericytoma hip exarticulation was performed. In 5 cases pain relief and weight bearing capacity of the limb was not achieved because of neoplasm recurrences; 5 deaths occurred within 6 months to 7 years after femur fracture because of pulmonary metastases. Benign bone lesions were treated by curettage of pathological tissues, burring bony walls of the lesions and filling the cavities with bone grafts or methylmetacrylate (1 case). Displaced fragments were reduced whenever possible. Limbs were immobilised in plaster casts. The follow-up period for patients with benign lesions was 8 years. All fractures healed. Arthritis with persistent pain and knee contracture was noted in 1 patient who underwent surgery 3 times for giant cell tumour recurrences, complicated by infection and varus deformity.

Adolescent↗

PubMed2006

Excessive rapid palatal expansion with Latham appliance for distal repositioning of protruded premaxilla in bilateral cleft lip and alveolus.

OBJECTIVE: This article reports a case of bilateral cleft lip and alveolus (BCLA) for which excessive rapid palatal expansion with a Latham appliance was performed for preoperative alignment of the protruded premaxilla. Postoperative changes of maxillary width were investigated with serial plaster casts. PATIENT AND RESULTS: A 3-month-old girl presented with complete BCLA in which the premaxilla was markedly protruded. Preoperative alignment of the protruded premaxilla with a Latham appliance was planned to facilitate primary lip repair. The appliance was placed when the patient was 4.5 months old. The necessary palatal expansion was estimated to be 7.0 mm in order to move the premaxilla backward into the ideal position. After palatal expansion and posterior repositioning of the protruded premaxilla, the primary operation, including cheiloplasty and gingivoperiosteoplasty, was performed when the patient was 7 months old. Excessive maxillary expansion might be a cause of transverse maxillomandibular discrepancy. Measurement with serial plaster casts demonstrated that maxillary widths increased from 42.3 mm pretreatment to 49.0 mm after orthopedic treatment but relapsed markedly to 43.5 mm at 3 months after the primary operation. Therefore, the net change of maxillary widths was only 1.2 mm. After alignment of the protruded premaxilla, tension-free soft tissue repairs were performed, and a harmonious alveolar arch was obtained without change in maxillary width. CONCLUSION: These results indicate that this method is useful for preoperative management of BCLA with protruded premaxilla.

Alveolar Process↗

PubMed2004

Dressings and topical agents for surgical wounds healing by secondary intention.

BACKGROUND: Many different wound dressings and topical applications are used to cover surgical wounds healing by secondary intention. It is not known whether these dressings heal wounds at different rates. OBJECTIVES: To assess the effectiveness of dressings and topical agents on surgical wounds healing by secondary intention SEARCH STRATEGY: We sought relevant trials from the Cochrane Central Register of Controlled Trials, Cochrane Wounds Group Specialised Trials Register, MEDLINE, EMBASE, and CINAHL databases in March 2002. SELECTION CRITERIA: All randomised controlled trials (RCTs) evaluating the effectiveness of dressings and topical agents for surgical wounds healing by secondary intention. DATA COLLECTION AND ANALYSIS: Eligibility for inclusion was confirmed by two reviewers who independently judged the methodological quality of the trials according to the Dutch Cochrane Centre list of factors relating to internal and external validity. Two reviewers summarised data from eligible studies using a data extraction sheet, any disagreements were referred to a third reviewer. MAIN RESULTS: Fourteen reports of 13 RCTs on dressings or topical agents for postoperative wounds healing by secondary intention were identified. WOUND HEALING: Whilst a single small trial of aloe vera supplementation vs gauze suggests delayed healing with aloe vera, the results of this trial are un interpretable since there was a large differential loss to follow up. A plaster cast applied to an amputation stump accelerated wound healing compared with elastic compression, WMD -25.60 days, 95% CI -49.08 to -2.12 days (1 trial). There were no statistically significant differences in healing for other dressing comparisons (e.g. gauze, foam, alginate; 11 trials). PAIN: Gauze was associated with significantly more pain for patients than other dressings (4 trials). PATIENT SATISFACTION: Patients treated with gauze were less satisfied compared with those receiving alternative dressings (3 trials). COSTS: Gauze is inexpensive but its use is associated with the use of significantly more nursing time than foam (2 trials). LENGTH OF HOSPITAL STAY: Four trials showed no difference in length of hospital stay. One trial found shorter hospital stay in people after amputation when plaster casts were applied compared with elastic compression (WMD -30.10 days; 95% CI -49.82 to -10.38). REVIEWERS' CONCLUSIONS: We found only small, poor quality trials; the evidence is therefore insufficient to determine whether the choice of dressing or topical agent affects the healing of surgical wounds healing by secondary intention. Foam is best studied as an alternative for gauze and appears to be preferable as to pain reduction, patient satisfaction and nursing time.

Bandages↗

PubMed1989

Chest wall restriction limits high airway pressure-induced lung injury in young rabbits.

High peak inspiratory pressures (PIP) during mechanical ventilation can induce lung injury. In the present study we compare the respective roles of high tidal volume with high PIP in intact immature rabbits to determine whether the increase in capillary permeability is the result of overdistension of the lung or direct pressure effects. New Zealand White rabbits were assigned to one of three protocols, which produced different degrees of inspiratory volume limitation: intact closed-chest animals (CC), closed-chest animals with a full-body plaster cast (C), and isolated excised lungs (IL). The intact animals were ventilated at 15, 30, or 45 cmH2O PIP for 1 h, and the lungs of the CC and C groups were placed in an isolated lung perfusion system. Microvascular permeability was evaluated using the capillary filtration coefficient (Kfc). Base-line Kfc for isolated lungs before ventilation was 0.33 +/- 0.31 ml.min-1.cmH2O-1.100g-1 and was not different from the Kfc in the CC group ventilated with 15 cmH2O PIP. Kfc increased by 850% after ventilation with only 15 cmH2O PIP in the unrestricted IL group, and in the CC group Kfc increased by 31% after 30 cmH2O PIP and 430% after 45 cmH2O PIP. Inspiratory volume limitation by the plaster cast in the C group prevented any significant increase in Kfc at the PIP values used. These data indicate that volume distension of the lung rather than high PIP per se produces microvascular damage in the immature rabbit lung.

Animals↗

PubMed1989

Treatment of sequestra, pseudarthroses, and defects in the long bones of children who have chronic hematogenous osteomyelitis.

We reviewed the results, after follow-up ranging from twenty-three months to six years, in thirty-four patients who were treated during childhood for hematogenous osteomyelitis of a major long bone complicated by sequestration of a portion of the diaphysis and by pseudarthrosis or segmental bone loss, or both. Of the thirty-four lesions, twenty-four were in the tibia, eight were in the femur, and two were in the humerus. In twenty-three patients (Group I), the infection was still active, while in the other eleven (Group II), it was quiescent at the time of admission to the hospital. In nine of the patients in Group I (four tibial and five femoral lesions), an involucrum bridged the osseous defect, indicating that the periosteal tube had not been destroyed. In these nine patients, sequestrectomy and débridement, appropriate antibiotic therapy, and prolonged immobilization in a plaster cast resulted in healing of the defect without recurrence of the infection. In the remaining fourteen patients (twelve tibial and two femoral lesions), there was no periosteal new-bone formation, and operative treatment consisted of two stages: the first, to resolve the infection, and the second, to heal the osseous defect with corticocancellous iliac grafts. In the eleven patients in Group II (eight tibial, one femoral, and two humeral lesions), there were no involucra. All of these patients were treated with cancellous bone grafts and prolonged immobilization. In twenty-two of the thirty-four patients (thirteen in Group I and nine in Group II), there were varying degrees of angular deformity at the pseudarthrosis, necessitating correction by manipulation when the plaster cast was applied postoperatively (ten patients), by fibular transposition (six patients), or by fibular osteotomy in addition to manipulation (six patients). Excluding complications specific to the fibular transfer procedure, the complications in the Group-I patients (six recurrent postoperative infections, one fracture of the graft, and one non-union of a fibular strut graft) were approximately as frequent as those in the Group-II patients (one failure of fusion and two fractures of the graft). Operative treatment resulted in healing of all but one tibial lesion, in a patient who nonetheless had good function at follow-up. Of the seven limb-length discrepancies of 2.8 centimeters or more, by the latest follow-up two had been treated uneventfully: one by femoral and the other by tibial lengthening.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗