[Proportion apparatus for 3 types of plaster or casting materials].
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Calcium Sulfate↗
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Forty degree angled coronal CT scanning of scaphoid fractures through plaster and fiberglass casts.
A method for obtaining coronal CT scans angled 40 degrees to the longitudinal axis of the wrist, parallel to the long axis of the scaphoid, is described. Its potential for evaluating scaphoid fractures is assessed in 10 patients with healing or clinically suspected fractures. Overlapping 3 mm thick angled coronal CT scans were obtained for each patient both in and out of cast. The CT images were compared to plain films and tomography. Comparisons were also made of CT images obtained through fiberglass and plaster casts. All fractures apparent by plain films and tomography were apparent by CT; one case suspected of fracture on initial plain films showed no evidence of fracture on CT and subsequent clinical course and plain films. Osseous union of healing fractures was more reliably assessed on CT than on plain films and plain film tomography. There was no degradation of CT images by either fiberglass or plaster casts; fiberglass casts allowed easy planning of tomographic slices from scout films. We conclude that direct 40 degree angled coronal CT examination of the scaphoid is a quick reliable method to detect scaphoid fractures and to assess their healing without the need of cast removal.
Carpal Bones↗
[Methods of making the plaster copies of skulls for the medical and criminalistic identification of individuals].
A possibility was studied to use the plaster copies of skulls in the forensic medical identification of personality by applying the craniofacial method. No dependence was found between the plaster casts and the moulding types. Differences between the same craniometric sizes in the skull and in its cast are of an incidental nature. Such incidental deviation is related with an accuracy of determining the localization of craniometric points and with an instrumental precision of measuring devices. The necessity is substantiated that, while making a craniofacial examination, it is necessary to mark all anthropometric points in the skull cast, with the original being a control. The use of a plaster skull cast is possible in those cases, when the burial of the remains must be done in full.
Calcium Sulfate↗
Can skin surface pressure under a cast reveal intracompartmental pressure?
Although monitoring intracompartmental pressure (IP) under a cast is very important, it is not possible to measure it in every patient undergoing cast treatment. This study aims to answer the question of whether skin surface pressure (SSP) under a cast can reveal IP. A plaster cast was applied to a sculpted inflatable forearm model with dorsal and volar compartments. SSP under the cast was measured at five different localizations from both dorsal and volar sides of the model and compared to the corresponding IP. In the second experiment, a posterior tibial compartment syndrome model was created in both limbs of five rabbits. Correlation analysis was performed between IP and SSP under the cast. All of the SSP measurements taken from the dorsal and volar side of the sculpted forearm model correlated with IP. Mean correlation coefficient of the measurements was 0.995 (P = 0.000) (SD 0.002, range 0.992-0.999). SSP and IP correlation analysis in the posterior tibial compartment syndrome model of 10 limbs in five rabbits revealed a high correlation. The mean correlation coefficient was 0.973 (P = 0.000) (SD 0.024, range 0.916-0.997). Measuring the pressure between the skin and cast can monitor IP. SSP monitoring can help the physician, patient or parents in the follow-up of patients undergoing cast treatment.
Animals↗
[Dislocation fractures of the Chopart and Lisfranc joint].
Dislocation fractures of Chopart's and Lisfranc's (mediotarsal) articulation result from the effects of impact and, because there are many possible complications, require a high level of experience on the part of the treating traumatologist. To avoid residual joint incongruities and intra-articular osteochondral fragments with subsequent early arthrosis and the corresponding complaints, the indications for open reduction and functionally stable osteosynthesis should be broad. The osteosynthesis can be achieved by transfixation with adjustable screws and 3.5 or 2.7 mm screws suitable for small fragments. This permits postoperative treatment to be carried out with a walking cast rather than a full plaster cast. In emergency patients with multiple injuries, dislocation fractures in the tarsal region require immediate and definitive treatment in order to avoid grave consequences and pain severe enough to influence the quality of life.
Adolescent↗
Measurements of pressure on the sole of the foot in plaster of Paris casts on the lower leg.
Pressure on the sole of the foot inside three different types of plaster cast, used in treatment of fracture of the lower leg, was measured on six normal persons. No significant difference was found between these pressures in below-knee plaster, full length plaster including the thigh and patellar-tendon-bearing plaster. Only occasionally a relief in pressure was found in patellar-tendon-bearing plasters.
Casts, Surgical↗
Early ambulation following spinal fusion and Harrington instrumentation in idiopathic scoliosis.
Eighty-six patients with idiopathic scoliosis managed by Harrington instrumentation and spinal arthrodesis were ambulated 10 days following surgery. Preoperative reduction of the curves was obtained by Cotrel traction and modified Cotrel localizer cast. Patients were kept immobilized in plaster cast for 7 months following operation. No significant loss of correction was found in these patients ambulated early as compared to a previous group kept recumbent for 3 to 6 months and reported by the authors (DBL). The only exception to this was a patient with double structural curve patterns. A successful surgical program for most cases of idiopathic scoliosis included: (1) Preoperative reduction and balancing of curves by non-skeletal traction and/or correction body cast; (2) Meticulous spinal arthrodesis and employment of Harrington distraction internal fixation; (3) Autogenous iliac bone graft; (4) Ambulation at two weeks following surgery in a well fitting body cast and removal of this cast after 7 months. Deep infection rate was 1 per cent without the use of routine prophylatic antibiotics. One neurological complication resulted from the use of a single distraction rod bridging two curves where the rod was not prebent to allow for kyphosis. There were no pseudarthroses. The average follow-up was 28 months with a range of 18-39 months.
Adolescent↗
A simplified method of total contact casting for diabetic foot ulcers.
A simplified method of total contact casting for diabetic plantar ulcerations is described in which a standard, well-molded short-leg walking cast is applied. Weekly cast changes are performed initially, followed by longer cast change intervals. Either fiberglass or plaster casting tape appears equally efficacious. Healing of all ulcers was demonstrated in 12 patients treated with this technique.
Aged↗
A new method for standardization of intraoral radiographs.
Standardization of intraoral radiographs is necessary for longitudinal studies of alveolar bone changes. Several methods of standardizing have been developed. These all involve fixing the geometric relations between the object, the x-ray tube, and the film. This usually involves a film holder, mounted on an occlusal stent and connected to the x-ray tube via an adapter ring. There is, however, a problem of compatibility between various commercial adapter rings and film holder assemblies. In an attempt to overcome this problem, we developed a method of producing cast acrylic adapters by making a plaster cast from a silicon rubber impression of the x-ray tube. The adapter was devised so that radiographs could be taken of all four segments using the same standard commercially available film holder. A total of 128 radiographs were taken from 42 patients who underwent various types of periodontal surgery; 64 were taken preoperatively and 64 at 6 months postoperatively. These pairs were superposed and approximately 58% were found by qualitative inspection to show total matching of geometric outlines as well as maintenance of position on the film, and approximately 73% to show geometric matching. Changes in alveolar bone height were evaluated for 11 of these totally matching pairs by counting millimetric grids and by a computer-based indirect digital imaging system. These were found to correlate satisfactorily (r = .63).
Alveolar Bone Loss↗
The technique of death masks making.
In taking death-masks two different techniques are used. In the technique using a plaster matrix the plaster mash is brought on the face. When the plaster-cast has dried it is filled with plaster mash. Later the matrix is removed in order to lay open the mask. In the technique using a plastic matrix the plastic powder Palgat is brought on the face after mixing it rapidly with icewater until it appears pappy. After that a layer of several centimeters of plaster mash follows in order to stabilize the delicate plastic matrix. Likewise the matrix is filled with plaster mash. The mask can be furnished with a collar and a fixation and the surface can be prepared. The skin relief of the face is reproduced finer using the cast of a plastic matrix.
Cadaver↗
[Supracondylar humerus fracture in childhood--an efficacy study. Results of a multicenter study by the Pediatric Traumatology Section of the German Society of Trauma Surgery--II: Costs and effectiveness of the treatment].
The following are the results and conclusions of a retrospective research study done on 886 patients with supracondylar fractures of the humerus. The study evaluates how effective the treatment procedures of the fractures are. The patients' fractures were categorized into four groups. It made it easier to differentiate between dislocated and undislocated fractures (see part I Weinberg A et al.). The following parameters were established to evaluate the treatment procedures and to create relevancy to the final outcome depending on the degree of difficulty of the fractures: Length of hospitalization, amount of repositioning procedures (including if an open or closed procedure was needed), amount of post repositioning procedures and the recommended change of therapy, method of retention and fixation, necessary metal removal, amount of check ups needed. The amount of x-ray exams could not be established due to insufficient documentation. The study showed a rather random pattern regarding length of hospitalization and the amount of check ups especially among type I and II patients. Open versus closed repositioning procedures did not seem to be advantageous. The implanted wires did not prevent infections. It just increased the treatment procedure by another hospitalization and anesthesia to remove the implanted wires. Physical therapy was not necessary and was only prescribed in cases of prolonged immobilization. The results of this study generated consequences regarding treatment procedures and developed a more efficient treatment protocol: Type I and II (dislocated and undislocated fractures in one plane) will be treated conservatively on an out-patient basis. Type I in a cast. Type II in a blount or plaster cast with flexed angle between 100 degrees and 130 degrees. Type III an IV (dislocated and undislocated fractures in two or three planes) will be treated if possible with a closed repositioning procedure. Otherwise a close repositioning procedure will be necessary and followed with some kind of KD-osteosynthese to capture the fracture. The patient will be hospitalized for a short period. The blount procedure will not be sufficient for this type of fracture. Therapy and procedure will be translated put in a perspective research study.
Adolescent↗
Measurement of breast volume in females: description of a reliable method.
Breast volume measurements were made on 47 adult subjects using a casting method. After drying, fast-setting plaster casts were filled with sand of known density to a level approximating the curvature of the chest wall. The reliability of both sand filling and casting proved to be high, r = 0.97, and r = 0.99, respectively. The total variable error was 10.2%. The effects of position (standing versus lying) was investigated in a separate sample of 15 subjects. No significant difference (P less than 0.05) was found between methods. The relationship between breast volume, girths, skinfolds, and body density was reported to be low.
Adolescent↗
Intramedullary nailing with reaming to treat non-union of the tibia.
The records of fifty-one patients who were treated by intramedullary nailing with reaming for non-union of the tibia were retrospectively reviewed. The fractures had been treated initially by closed reduction and immobilization in a cast, external fixation followed by immobilization in a cast, fixation by pins incorporated in a plaster cast, minimum internal fixation and immobilization in a cast, dynamic compression plating, or intramedullary nailing with or without reaming. After the initial treatment had failed, intramedullary nailing with reaming was done to gain union. Although closed nailing of the tibia was preferred, in thirty-three patients, the site of the non-union was opened to improve alignment by performing an osteotomy or to remove failed hardware. Bone grafts from the iliac crest were used in ten patients, and a fibular ostectomy or osteotomy was done in thirty-three. Of thirty-four open fractures (fourteen grade I, seven grade II, and thirteen grade III), eight were infected at the time of intramedullary nailing. The average time of the diagnosis of a non-union was 9.6 months; the average length of follow-up after nailing was twenty months. In forty-nine (96 per cent) of the fifty-one patients, tibial union occurred at an average of seven months postoperatively. Complications included persistent infection (three patients), acquired infection after intramedullary nailing with reaming (three patients), fracture of the nail that necessitated an additional operation (two patients), shortening of more than one centimeter (two patients), malrotation of more than 15 degrees (one patient), peroneal palsy (one patient), and amputation (one patient). When used to treat non-union of the tibia, intramedullary nailing with reaming can produce union as effectively as other alternatives, while enabling the patient to function more normally without external immobilization or walking aids.
Adolescent↗
Pressures generated in the thigh muscles and under the thigh cast of an uninjured subject wearing a cast-brace.
Intrinsic pressures within the thigh muscles of a normal subject were recorded with the subject in five different postures before and after application of a cast-brace. The extrinsic pressures between the plaster cast and the underlying skin also were recorded. The intrinsic muscle pressures were significantly increased when the cast-brace was applied.
Braces↗
Analysis of dental casts of 6-8- and 12-year-old Kenyan children.
Dental plaster casts of 97 6-8-year-old and 173 12-year-old Maasai, Kikuyu, and Kalenjin children were studied. The Kikuyu are Bantu, while Maasai and Kalenjin are Nilo-Hamitic subjects. The variables measured were palatal depth (PD) and length (PL); maxillary and mandibular anterior arc circumferences (AC1) and (AC2), respectively; posterior arc circumferences (PC1) and (PC2), inter-canine (CC1), and (CC2); inter-molar (MM1) and (MM2) distances, and mandibular length (ML). The data were analysed using SPSS package. The mean values of all the variables were generally higher in the males compared with the females and significant sex differences in the means (P < 0.01) were found in AC1, PC1, PC2, CC1, CC2, MM1, and MM2 in the 12-year-old subjects. The means of all variables, except PL, ML, PC2, and CC2, increased from 6 to 12 years of age and significant differences in the means for age were found in ML, AC1, PC2, PD, MM1, MM2, and CC1. Mean maxillary inter-molar distance increased with age by 0.17-0.34 mm in the three groups. Mean values of mandibular variables were highest in the Kikuyu, while maxillary variables were highest in the Maasai. The Maasai casts showed a marked decrease in CC2, PC2, AC2, and ML compared with the Kikuyu and Kalenjin. Ethnic and sex differences in the dental arches may be masked by anterior tooth positions that are influenced by the dento-alveolar complex and soft tissues. Corresponding mandibular and maxillary variables were strongly correlated and anterior and posterior arc circumferences were correlated with inter-canine and intermolar distances. Details of the norms for dental arch dimensions and changes with age may allow for appropriate assessment of dental occlusion and treatment planning for Kenyan children.
Age Factors↗
Emergency care in patients wearing body casts.
OBJECTIVE: To describe a body cast modification that allows rapid chest exposure for cardiopulmonary resuscitation and alert the medical community to the 3% to 5% incidence of cardiopulmonary arrest in the hospital while wearing such a cast. DESIGN. Single trial timed cast cutting, multiple trial cast shell loading, and clinical observations of perforated casts for cracking or breakage. SETTING: University hospital castroom, mechanical engineering laboratory. INTERVENTION: Body casts mounted on a life-sized torso mold were perforated at 2-inch (50 mm), 1-inch (25 mm), or 1/2 inch (12 mm) intervals around the chest with a 12-mm-diameter vibrating drill. Using a cast saw, the chest piece of each body cast was removed and the time recorded. Engineering studies were performed on two cast shells with and without 12-mm-wide holes up to 1/2" (12 mm) apart, loading the fiberglass to the point of failure and recording the data. Body casts with 1" (25 mm)-interval holes worn by 40 patients were examined after 12 weeks for evidence of failure. MAIN OUTCOME MEASURES: Chest piece removal times of body cast shells with and without holes were compared. Loading data of cast shells were compared to determine if holes as close as 1/2" (12 mm) significantly weakened the cast. Forty casts, perforated at 1-inch (25 mm) intervals, were observed for failure after 12 weeks of wear. RESULTS: Chest exposure time of a mold encased in a fiberglass cast was reduced from 1 minute to 15 seconds; plaster cast removal was reduced from 3 minutes to 1 minute. Engineering studies of perforated casts showed no significant decrease in strength. Casts with and without holes could support chest forces of up to 330 pounds. No failure was observed in casts with perforations 1 inch (25 mm) apart worn for 12 weeks. CONCLUSION: Perforated body casts reduced removal time to 15 seconds without weakening of the cast and provide lifesaving time to perform effective CPR.
Cardiopulmonary Resuscitation↗
[Asymmetric posture of the hip-joints in cerebral palsy (author's transl)].
Asymmetric posture of hip-joints is a common disorder in children with cerebral palsy. One hip is found in abduction-outward rotation, the other in adduction-inward rotation. Most of these patients are severely handicapped, with little voluntary control of muscular activity. Possible causes of the disorder are discussed. In treatment long leg plaster casts with diagonal traction are recommended, in milder cases a corrective plaster mould against malrotation can be applied. The technics of both are described.
Casts, Surgical↗
Treatment of slipped capital femoral epiphysis with a spica cast.
Thirteen patients who had seventeen slipped capital femoral epiphyses were managed with a spica cast between 1984 and 1986. The average time in the plaster cast was three months. Complications were noted in fourteen of the hips. Three pressure sores developed in two patients. Further slipping developed in three hips once the cast had been removed, and chondrolysis developed in one of these hips. Chondrolysis developed in eight additional hips, and the lesion was transient in four of them. Degenerative changes developed in all nine hips with chondrolysis, regardless of whether the chondrolysis was transient or permanent. The degenerative changes were Iowa Grade I in three of these hips, Grade II in two hips, and Grade III in four. Chondrolysis developed in six of the eight black patients and in four of the five black boys. Chondrolysis developed in six of the nine hips that had a Grade-II or III slip. These findings have led us to abandon the use of a spica cast as a mode of treatment for slipped capital femoral epiphysis.
Adolescent↗