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PubMedDate not supplied

[The treatment of hip dysplasia or dislocation with Fettweis' immobilization cast].

To verify the success of the cast immobilisation in a squatting position in the treatment of dysplasia and dislocation of the hip 41 children were reviewed whereby lapses up to 13 years had to be considered. In 9 hips the cast immobilisation leaded to an unsatisfactory result so that the joints had to be revised operatively. In the remaining 48 hips 31 (65%) were cured, 15 (31%) showed a light, 2 (4%) a grave remaining dysplasia. One hip joint showed an ischemic necrosis of the femoral head which corresponds to a rate of necrosis of 2.1%. As the concerned patient was treated with spreader pants in spite of the high grade of luxation of her hip it more likely that this avascular necrosis is caused by the preceding treatment and not by the cast immobilisation itself. Factors with negative effects on the result or bad prognostic signs respectively, were poor initial findings and reluxation during cast immobilization. The start of therapy had no noticeable influence on the result. On the other hand this factor was very important for the permanence of treatment. In hips with remaining dysplasia very often a clinical hypermobility was found. A positive Trendelenburg-sign was seen in the hip with defect-healed avascular necrosis of the femoral head and furthermore in 2 other hips with evident remaining dysplasia of the acetabulum. In comparison to other methods, the cast immobilisation according to Fettweis shows a low rate of avascular necrosis of the femoral head and a forced supplementary development of the dysplastic acetabulum. Because of its wide range of indication and its small rate of complications the Fettweis plaster cast is a very reliable method for the treatment of dysplasia and dislocation of the hip in infancy and early childhood.

Adolescent↗

PubMed2002

Compositional stability and marginal accuracy of complete cast crowns made with as-received and recast type III gold alloy.

STATEMENT OF PROBLEM: The effect of combining new and recast metal on the compositional stability of the alloy used and accuracy of the final restoration is not known. PURPOSE: This study characterized the elemental compositional stability of as-received and recast type III gold alloy. The effect of combining these alloys on the marginal accuracy of complete cast crowns also was evaluated. MATERIAL AND METHODS: Sixty standardized type III gold alloy complete crowns were made on epoxy resin dies duplicated from a metal master die with conventional laboratory techniques. Three casting protocols (n = 20 each) were established in relation to the proportion of as-received and recast gold alloys: Group A (100% as-received metal), Group B (50% wt new metal, 50% wt once recast metal), and Group C (100% once recast metal). An elemental analysis was performed at 3 sites along the cast crown (cervical, middle, and occlusal) with x-ray energy-dispersive spectroscopy. Marginal accuracy was measured with a microscope before and after cementation. Results were subjected to 1-way analysis of variance followed by the Ryan-Einot-Gabriel-Welsch multiple-range test at a 1% level of significance. RESULTS: Elemental composition was significantly different among the casting groups (P<.001). The mean weight percentage values were 72.4% to 75.7% Au, 4.5% to 7.0% Pd, 10.7% to 11.1% Ag, 7.8% to 8.4% Cu, and 1.0% to 1.4% Zn. Statistically but not clinically significant differences also were found for marginal accuracy. The marginal discrepancy was less than 25 microm for all casting conditions, with the lowest value recorded for Group A (7 microm), the highest for Group C (12 microm), and an intermediate value for Group B (9 microm) specimens. CONCLUSION: Recasting type III gold alloys may adversely affect the marginal accuracy of complete cast crowns. In this study, however, such effects were not clinically significant.

Analysis of Variance↗

PubMed2002

Accuracy of 3 conceptually different die systems used for implant casts.

STATEMENT OF PROBLEM: Given that meticulous implant prosthodontic procedures are recommended to obtain the best possible intraoral fit, the die systems used for multi-implant casts warrant further investigation. PURPOSE. The purpose of this in vitro study was to compare the accuracy of implant casts fabricated from 3 conceptually different die systems at the solid, sectioned, and repeated stages. MATERIAL AND METHODS: Thirty direct transfer implant impressions were made of the master cast with a polyether impression material. Ten experimental implant casts were fabricated for each of the 3 different die systems tested: double-pour (Pindex), plastic base (DVA), and die tray (KO Tray). The solid experimental casts were sectioned and then removed from the die system 30 times. Linear distances between steel balls placed on each abutment replica were measured with a traveling microscope to determine the accuracy of the experimental casts at different stages. Data were analyzed with repeated-measures analysis of variance (alpha=.05) and the post hoc Ryan-Einot-Gabriel-Welsch multiple-range test (REGWQ). RESULTS: Repeated-measures analysis of variance revealed a significant interaction between the die systems and different stages (P=.0432). REGWQ showed the die tray system to be significantly more accurate at the solid than at the sectioned and repeated stages. The die tray system was significantly less accurate than the double-pour and plastic base systems at the sectioned stage. CONCLUSION: Within the limitations of this study, the use of a double-pour or plastic base die system is recommended when sectioned dies are needed for a multi-implant-retained prosthesis.

Acrylic Resins↗

PubMed2002

Fit of cast commercially pure titanium and Ti-6Al-4V alloy crowns before and after marginal refinement by electrical discharge machining.

STATEMENT OF PROBLEM: Titanium has been suggested as a replacement for alloys currently used in single-tooth restorations and fixed partial dentures. However, difficulties in casting have resulted in incomplete margins and discrepancies in marginal fit. PURPOSE: This study evaluated and compared the marginal fit of crowns fabricated from a commercially pure titanium (CP Ti) and from Ti-6Al-4V alloy with crowns fabricated from a Pd-Ag alloy that served as a control. Evaluations were performed before and after marginal refinement by electrical discharge machining (EDM). MATERIAL AND METHODS: Forty-five bovine teeth were prepared to receive complete cast crowns. Stone and copper-plated dies were obtained from impressions. Fifteen crowns were cast with each alloy (CP Ti, Ti-6Al-4V, and Pd-Ag). Marginal fit measurements (in micrometers) were recorded at 4 reference points on each casting with a traveling microscope. Marginal refinement with EDM was conducted on the titanium-based crowns, and measurements were repeated. Data were analyzed with the Kruskal-Wallis test, paired t test, and independent t test at a 1% probability level. RESULTS: The Kruskal-Wallis test showed significant differences among mean values of marginal fit for the as-cast CP Ti crowns (mean [SD], 83.9 [26.1] microm) and the other groups: Ti-6Al-4V (50.8 [17.2] microm) and Pd-Ag (45.2 [10.4] microm). After EDM marginal refinement, significant differences were detected among the Ti-6Al-4V crowns (24.5 [10.9] microm) and the other 2 groups: CP Ti (50.6 [20.0] microm) and Pd-Ag (not modified by EDM). Paired t test results indicated that marginal refinement with EDM effectively improved the fit of CP Ti crowns (from 83.9 to 50.6 microm) and Ti-6Al-4V crowns (from 50.8 to 24.5 microm). However, the difference in improvement between the two groups was not significant by t test. CONCLUSION: Within the limitations of this study, despite the superior results for Ti-6Al-4V, both groups of titanium-based crowns had clinically acceptable marginal fits. After EDM marginal refinement, the fit of cast CP Ti and Ti-6Al-4V crowns improved significantly.

Alloys↗

PubMed2003

Evaluation of extensibility, passive torque and stretch reflex responses in triceps surae muscles following serial casting to correct spastic equinovarus deformity.

PRIMARY OBJECTIVE: Spastic equinovarus deformity of the ankle in adults with acquired brain injury can severely limit the achievement of rehabilitation goals. This study examined changes in triceps surae muscle extensibility, passive resistive torque and soleus stretch reflex responses in 10 adult brain injured subjects undergoing serial casting to correct ankle equinovarus deformity. METHOD: Goniometric measurement of maximal passive dorsiflexion was used to evaluate extensibility of the triceps surae muscles. Computer controlled ankle dynamometry and surface electromyography were used to identify passive resistive torque and soleus stretch reflex onset angle in response to stretches at two velocities. RESULTS: The mean casting period was 5 weeks. Casting was discontinued in one subject due to failure to achieve measurable gain in ankle range over three consecutive cast changes. Median improvements in maximal ankle dorsiflexion, with the knee flexed or extended, of 30 degrees and 15 degrees, respectively, were achieved in the remaining nine subjects (p < 0.0001). The median passive ankle range in response to a displacing torque of 10 Nm increased 4.3 degrees over the intervention period (p < 0.0001). Consistent soleus reflex activity in response to passive stretches at 25 degrees x s(-1) was elicited in only four subjects. A trend for the stretch reflex onset to move further into the available range was demonstrated in these subjects. CONCLUSION: In the present study, serial casting contributed to significant change in triceps surae extensibility and passive resistive torque, corresponding with improved maximal passive ankle dorsiflexion range and an increase in the angle achieved with a displacing torque of 10 N.m. Increased stretch reflex threshold was observed in some subjects. The use of pre-determined outcome criteria and careful measurement of responses to this intervention were important to prevent premature discontinuation of casting when gains were slower than expected.

Adolescent↗

PubMed1984

Reduction of hypertonicity by early casting in a comatose head-injured individual. A case report.

The patient in this report sustained a closed-head injury. Within six days of the injury, he demonstrated generalized hypertonicity accompanied by alternating strong decerebrate and decorticate posturing. By Day 10 after injury, normal passive ROM could no longer be maintained using neurophysiological therapeutic techniques. Therefore, we applied plaster casts to both ankles. Within 24 hours of cast application, the patient's general hypertonus had decreased, and by 72 hours after casting, the patient demonstrated seemingly purposeful movements of the left extremities. Although casts have been used previously to maintain ROM or decrease contractures and to improve balance of muscle function of the joint that was immobilized, we believe that the marked, generalized reduction in tone in body segments far removed from the ankles was an important clinical observation. We explored several possible mechanisms for these observations. Because the usual casting conditions for reflex inhibition were not obtained with this patient, other factors were suggested to be important: total even pressure and neutral warmth. Research is currently in progress at the Medical Center Hospital of Vermont to study further the effects of plaster casting and to understand the mechanisms underlying the effects.

Accidents, Home↗

PubMed1997

Shortening in femoral shaft fractures in children treated with spica cast.

Early spica cast treatment is one method used for children's femoral shaft fractures; it is increasingly advocated as treatment that allows early hospital discharge. The outcome of early spica cast treatment in 100 children, ages 2 to 10 years, with uncomplicated and isolated closed femoral shaft fractures treated at Johns Hopkins Hospital between October 1987 and March 1994 were analyzed. The objective was to identify those children who can be treated safely and dependably with early spica casting without excessive shortening of the fracture fragments. Eighty-one (81%) children had an acceptable outcome and 19 (19%) had an unacceptable outcome by the definition of more than 25 mm of fracture fragment overlap after clinical healing. A new clinical test, the telescope test, was statistically significant for correlation with spica cast outcome. Age, gender, fracture, location, mechanism of injury, fracture type, and resting radiograph of fracture fragment overlap were not statistically significant. The telescope test had a sensitivity of 80% and a specificity of 85% for predicting outcome. The relative risk for failure of spica cast treatment with a positive telescope test was 20.4 (95% confidence limits = 2.7-225.1). Children 2 to 10 years of age with uncomplicated femoral shaft fractures and a negative telescope test can be treated appropriately in most cases with early application of a spica cast.

Casts, Surgical↗

PubMed2000

Immediate hip spica casting for femur fractures in pediatric patients. A review of 175 patients.

Immediate closed reduction and application of a well-molded hip spica cast is a safe and effective treatment option for closed, isolated femur fractures in children who weigh between 10 and 100 pounds. Between 1988 and 1996, 190 immediate hip spica casts were placed on children with isolated femoral shaft fractures who weight between 10 and 100 pounds. Fifteen patients were lost to followup leaving 175 children who were evaluated and followed up for at least 2 years after the hip spica cast was removed (range 2-10 years). The femur fractures were reduced closed and placed in a 1 1/2 hip spica cast in the emergency room with the patient under conscious sedation or in the operating room with the patient under general anesthesia. All of the children returned home within 24 hours of the procedure. All 175 femur fractures united within 8 weeks. The only complication was a refracture in a 25 pound child who fell 1 week after the cast was removed. No significant residual angular deformities were present in any of the children at last followup. None of the children required external shoe lifts, epiphysiodesis, antibiotics, irrigation and debridements, or limb lengthening procedures for leg length inequalities. The authors think that immediate closed reduction and placement of a well-molded hip spica cast is a safe and reliable treatment option for isolated, closed femur fractures in children from birth to 10 years of age who weigh less than 80 pounds.

Adolescent↗

PubMed1989

The stiffness of cylindrical casts enforced with splint laminations: biomechanical considerations.

Splint lamination is often used to strengthen a plaster cast while minimizing its thickness and weight. We evaluated the following lamination configurations to determine the effectiveness of each relative to a 3-mm-thick short leg cast: anterior-posterior splints, medial-lateral splints, and an anteriorly placed fin. Theoretical stiffness was calculated as a function of the area moment of inertia, and then the actual casts were tested in three-point bending on a servohydraulic apparatus. The experimental results were correlated with the calculated data, and finite element studies were performed to correlate the experimental results with the geometries of the casts. The theoretical and experimental data indicate that anterior-posterior splint lamination reinforcement stiffens a cylindrical cast to flexion-extension bending moments more effectively than does medial-lateral splint placement. An anterior fin can stiffen the cast as effectively as a splint can. However, the fin must be relatively large, which may cause it to accentuate problems with clothing and be difficult to apply.

Biomechanical Phenomena↗

PubMed1993

Skin surface pressures under short leg casts.

Electronic sensors were used to measure skin surface pressures beneath plaster and fiberglass short leg casts. Pressures were recorded after casting, univalving, bivalving, and spreading of casts. Fiberglass resulted in significantly higher pressures than plaster. Beneficial effects of bivalving and cast spreading are confirmed by significant pressure drops. Application of casts by different orthopaedic surgeons and technologists showed pressure differences due to operator technique. However, fiberglass pressures again proved to be significantly greater than those caused by plaster. Excessive pressure beneath casts can cause skin ulceration, and results confirm the need for extreme care, especially when using fiberglass. It is suggested that plaster is safer than fiberglass when significant extremity swelling is likely or when a patient's skin is more vulnerable to breakdown.

Calcium Sulfate↗

PubMed1994

Spica cast treatment of femoral shaft fractures in children--the prognostic value of the mechanism of injury.

We reviewed the data on 47 closed femoral shaft fractures in 46 children 10 years of age or less treated by early closed reduction and spica cast immobilization from 1980 through 1988. These children were followed at least through the time of fracture union, spica cast removal, and onset of unprotected weight-bearing. Treatment was defined as being primarily by spica cast immobilization if less than 7 days of skin traction preceded closed reduction and cast application. The mean age at injury was 4.4 years (range, 0.2-9.9 years). Mechanisms of injury were identified and segregated into those involving high-energy and low-energy trauma. Twelve of 23 fractures (52%) caused by high energy required at least one repeat closed reduction or other treatment to correct excessive shortening or angulation that occurred following the initial reduction. Four children required prolonged skeletal traction before reapplication of a spica cast. In contrast, only 2 of 24 fractures (8%) caused by low-energy trauma required repeat closed reduction and none required skeletal traction. Whereas the mean age of the children sustaining high-energy trauma (6.1 years) was higher than that of children in the low-energy trauma group (2.9 years), 7 of 12 fractures caused by high energy that required repeat reduction occurred in children 7 years of age or less. Femoral shaft fractures in children caused by high energy are more likely to become displaced following closed reduction and early spica cast immobilization than fractures caused by low energy. These children require careful radiographic monitoring following this type of treatment to assess fracture alignment.

Casts, Surgical↗

PubMedDate not supplied

Functional status, personal health, and self-esteem of caregivers of children in a body cast: a pilot study.

BACKGROUND: There is a lack of literature describing the changes in daily routine that parents caring for a child in a body cast must experience. The investigator's clinical experience suggested that determining these changes in parental daily routine would inform nurses of appropriate interventions for these parents. PURPOSE: This Roy Adaptation Model-based pilot study was designed to examine the relation of personal health and self-esteem to functional status of caregivers of children in a body cast. Functional status was defined as performance of household activities, social and community activities, care of the child in the body cast activities, care of other children activities, personal care activities, and occupational activities. METHODS: Data was collected from 16 caregivers of children in body casts, birth to up to 3 years of age, and 14 caregivers of children in body casts, 3 to 12 years of age. RESULTS: The results of the study suggested that parents of children in body casts undergo many changes in their daily activities. Parents of children ages 3-12 years had more changes than parents of children ages birth to 3 years. The study findings suggest that a larger sample may yield some statistically significant results.

Adult↗

PubMedDate not supplied

Goretex fabric as a cast underliner in children.

The efficacy of using Goretex fabric as a cast liner to improve skin care was evaluated. A prospective study was performed of 20 patients undergoing casting using Goretex underliners. At each cast change or at the end of casting, skin condition was evaluated. No change in any standard treatment protocol regarding cast changes was made because of the Goretex liner. Goretex fabric provided improved ease of care and prevented cast soiling. The breathability of the fabric was believed to be a benefit in decreasing skin irritation.

Casts, Surgical↗

PubMedDate not supplied

A prospective study of early spica casting outcomes in the treatment of femoral shaft fractures in children.

We analyzed the early spica casting outcomes of 50 children age 2 to 10 years with uncomplicated femoral shaft fractures treated at Johns Hopkins Hospital between October 1987 and October 1990. Our objective was to develop criteria for the prospective identification of patients who can be safely and dependably treated with early spica casting without excessive shortening of the fracture fragments. Forty-one (82%) children had an acceptable outcome and nine (18%) had an unacceptable outcome according to our definition of > 25 mm of fracture fragment overlap at 3 to 4 weeks follow-up. A new clinical test, the telescope test, was statistically significant (p < 0.001) for association with spica casting outcome. Age, sex, fracture location, mechanism of injury, fracture type, and resting roentgenogram fracture fragment overlap were not statistically significant (p > 0.10). The telescope test had a sensitivity of 78%, a specificity of 85%, and a negative predictive value of 95% for predicting spica casting outcome. The relative risk of failing spica casting after a positive telescope test was 20.4 (95% CI, 2.74-225.10). We conclude that children 2 to 10 years of age with uncomplicated femoral shaft fractures and a negative telescope test can be safely treated with early spica casting and have a 95% change of having a successful outcome with this treatment.

Casts, Surgical↗

PubMed2007

Passive dorsiflexion flexibility after cast immobilization for ankle fracture.

Ankle fracture is frequently managed with cast immobilization, but immobilization may produce ankle contracture (loss of flexibility). We aimed to quantify recovery of ankle dorsiflexion flexibility in people treated with cast immobilization after ankle fracture, and to determine if initial orthopaedic management was associated with recovery. Ankle flexibility was measured in 150 people with plantarflexion contracture who had been referred for outpatient physical therapy following cast immobilization for ankle fracture. We obtained measurements using an instrumented footplate within 5 days of cast removal and then 4 weeks and 3 months later. Data were compared with published normative data. Both stiffness and the torque corresponding to the peak dorsiflexion angle at baseline decreased during the 3 month recovery period, but recovery was still incomplete 3 months after cast removal. Surgical fixation was associated with higher stiffness, preload and torque values. Passive ankle flexibility does not return to normal values within 3 months of cast removal after ankle fracture. Recovery of normal ankle dorsiflexion flexibility typically takes longer than the initial period of immobilization.

Ankle Injuries↗

PubMed1991

Neurodevelopmental therapy and upper-extremity inhibitive casting for children with cerebral palsy.

The purpose of this research was to study the effect of intensive neurodevelopmental therapy (NDT) and upper-extremity inhibitive casting, separately or in combination, on hand function, quality of upper-extremity movement and range of motion of 73 children with spastic cerebral palsy aged 18 months to eight years. There was no significant difference between intensive or regular therapy and casting or no casting for hand function, between intensive and regular NDT, or between intensive NDT plus casting and the other groups for quality of movement and range of motion. Casting led to increased quality of movement and wrist extension after six months. Casting with NDT improved the quality of upper-extremity movement and range of motion. There appear to be no immediate benefits from intensive therapy alone.

Arm↗

PubMed1996

Comparison of strains transferred to a bone simulant between as-cast and postsoldered implant frameworks for a five-implant-supported fixed prosthesis.

PURPOSE: To measure and compare the strains transferred by screw-fastening one-piece full-arch prostheses as cast and after sectioning and soldering. MATERIALS AND METHODS: Photoelastic resin was applied directly to five 3.75 x 13-mm Brånemark implants, situated 7 mm apart, in a silicone mold of an edentulous mandible. Four strain gauge rosettes were also incorporated in the resin to allow strain measurements at four locations. Three frameworks were made from a single master cast produced from an impression of the five-implant model with 4-mm abutments. These frameworks were sequentially secured to the master model with five gold slot screws tightened to 10 N cm. Strain indicator readings were recorded at a standardized time following the initial fastening of each prosthesis. The test was repeated three times. Each of the three castings were subsequently sectioned and soldered in two locations, mesial to the two terminal fixtures. After soldering, the three superstructures were returned to the master model for measurement of postsolder strains three times each. A one-way repeated-measures ANOVA was performed to determine differences between mean principal strains between the as-cast and postsoldered groups. RESULTS: A statistically significant difference was found in the principal strains between the as-cast and soldered frameworks. Overall, there was a decrease in the magnitude of strain for the soldered frameworks. CONCLUSIONS: Sectioning and soldering improved the as-cast accuracy as far as the amount of strain transferred to the bone simulant.

Alveolar Process↗

PubMed1991

The use of the walking cast to repair fractures in horses and ponies.

The walking cast was used to repair 46 fractures of long bones (distal radius and tibia, metacarpus and metatarsus) and 10 fractures of first phalanx of 35 horses and 21 ponies. The walking cast proved to be highly effective. Even heavily comminuted and 'hopeless' fractures, which could not be treated with osteosynthesis, were treated successfully, because the weight of the animal, a common failure factor in large animal orthopaedics, was relieved from the injured leg. Immediate full weight bearing was possible post operatively. In five cases the walking cast was used in combination with osteosynthesis. Infection was the main complication that caused the walking cast to fail. Osteomyelitis may also be treated with a walking cast. Because of its success rate of 57 per cent, which is impressive, considering the type of fractures treated, we recommend the walking cast for international accreditation.

Animals↗