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At least 649 records · Page 36Linked to original sources
PubMed1984

The strain on sutured Achilles tendons in walking cast. An EMG analysis.

To evaluate the strain on a sutured Achilles tendon during walking in a short leg cast the EMG activity of the triceps surae muscles was studied. The regression line of the EMG/torque relationship of the triceps surae in the noninjured leg was investigated during isometric contractions with the foot in the same plantarflexed position as the injured foot immobilized in plaster cast. A linear relationship was found between EMG activity (EMG signals converted to rectified mean square values) and torque, measured with Cybex II. The torque provided by the triceps surae of the injured leg was calculated from the registered EMG activity during walking and the regression line. The strain acting on the sutured Achilles tendon was calculated after measurement of the lever arm. There was no significant difference in calculated strain on the sutured Achilles tendon during nonweight bearing in a short leg cast and full weight bearing without external rotation movement of the leg. External rotation movement of the leg during full weight bearing gave increased strain on the sutured Achilles tendon. The actual strain is considered somewhat lower than the calculated one since other muscles than the triceps surae contribute to plantar flexion of the ankle joint. The results indicate that the strain during weight bearing in a short leg cast is unlikely to exceed the strength of a sutured Achilles tendon.

Achilles Tendon↗
PubMedDate not supplied

Comparative study of therapies for fibular ligament rupture of the lateral ankle joint in competitive basketball players.

This retrospective study compares the results of different therapies for fibular ligament rupture in a homogenous group of professional athletes. The endpoint "competitive sports" was an outcome consideration. Subjects were examined by means of a standardized questionnaire and a structured interview. One hundred and seventy-nine of the questionnaires were completed and returned for evaluation. All of the basketball players with severe ankle sprain (supination trauma with swelling, pain, and inability to bear stress) were included. Those players with fractures of the foot, pronation trauma, or additional distal fibula or tibia fractures were excluded from this study. Of the 179 basketball players 160 (89%) had suffered severe ankle sprain. The treatment was divided into three groups: primary surgery (N = 35), plaster cast (N = 39), and functional treatment (N = 89). While simple ligament injuries (Grade I and II) were mostly treated functionally, complex ligament injuries (Grade III) were usually operated on. A total of 119 (74%) of the players reported no further pain. For pain reduction surgical and functional treatments showed advantages over plaster treatment. In the surgical group 63% of the players judged their regained stability to be equivalent to that of their healthy leg. Only 50% of the players in the plaster and functional groups believed their ankle joints to have regained the same stability as before their injuries. Despite the achievement of good results through surgery, there were clear differences in the players' assessments of their performance in competitive sports. Most subjects (92%) did not have any problems in everyday life regardless of which kind of therapy had been chosen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Treatment of complete rupture of the lateral ligaments of the ankle: a randomized clinical trial comparing cast immobilization with functional treatment.

This study compared the therapeutic efficacy between cast immobilization and functional treatment of grade III ruptures of the lateral ankle ligaments. Subjects ( n=121) had closed physeal cartilage, age under 35 years, grade III rupture without previous or associated injuries, and practiced regular sports. Patients were randomized into an immobilization group (21 days plaster cast) or a functional one (15 days strapping plus early controlled mobilization). Symptoms (pain, swelling, stiffness, subjective instability), joint laxity, return to preinjury activity (time and level) and rate of reinjury were assessed 3, 6, and 12 months after sprain. Objective joint laxity was related to constitutional laxity, creating a new variable [talar tilt at injury - talar tilt at control]/contralateral talar tilt. The functional group showed significantly earlier and better return to physical activity, fewer symptoms at 3 and 6 months but no intergroup difference at 12 months. Functional treatment also showed better decrease in joint laxity. No intergroup differences were found in the reinjury rate. We conclude that functional treatment is safe, associated with a more rapid recovery, and particularly suitable in athletic populations.

Adolescent↗
PubMed2000

Comparison of different techniques for obturating experimental internal resorptive cavities.

Forty extracted maxillary central incisors were instrumented at the working length to a #50 file. The roots were sectioned transversely with a diamond disk at 7 mm from the anatomical apex. At the opening of the root canal of each section, hemicircular cavities were drilled with a specially designed bur. The corresponding root sections were cemented with glue, thus obtaining root canals with similar cavities that simulated internal resorptions. Teeth were embedded in plaster casts to facilitate their handling. The specimens were randomly separated into four groups of 10. The following obturation techniques were evaluated: lateral compaction (group A), hybrid technique (group B), Obtura II (group C), and Thermafil (group D). AH26 was used as the sealer. After obturation, the plaster was removed and the teeth were radiographed in buccolingual and mesiodistal directions to evaluate the quality of the obturation at the IRC. The incisors were then cut with a scalpel at the same level as the previous section, to examine, under a stereomicroscope, the type of material that filled the IRC. Obtura II gave the best results and in most of the specimens obturated with this technique, the IRC were filled mainly with gutta-percha. Statistical analysis of the data indicated that the differences between group C and the other groups were significant (P < 0.05).

Bismuth↗
PubMed1995

Validation of spiral CT and optical surface scanning for lower limb stump volumetry.

Spiral X-ray Computed Tomography (SXCT), Optical Surface Scanning (OSS), and hydrostatic weighing methods were used to measure stump volume of trans-tibial amputees. The precision and accuracy of these methods were assessed in a validation study. A repeated measures analysis of variance statistical design was employed that required each participant to be measured (scanned) twice at each of two separate measurement sessions. For OSS and SXCT, each scan was segmented twice to determine intra-observer error. Plaster cast replicas of subject stumps were formed by certified prosthetists to serve as a reference standard. Accuracy (bias) of SXCT and OSS was determined by comparison to volumetry by hydrostatic weighing. Ten trans-tibial amputees were recruited for this study and nine completed both sessions. Plaster replica measurement precision error relative to the mean was found to be less than 1% for all modalities. The precision was slightly inferior on subjects, 1.1% and 2.2% error for hydrostatic weighting and OSS respectively, due to patient instability during measurement, but was better with SXCT where the subjects' stumps were stabilized during scan acquisition. The OSS and SXCT methods offer advantages over hydrostatic weighing and other volumetry methods since the volume data are represented digitally and can be analyzed in multiple ways. SXCT enables study of the stump and its internal tissues with the prosthesis in place. It was found that SXCT is comparable to hydrostatic weighing in both precision and accuracy. While OSS had a high precision and reproducibility, it was found to have an associated bias.

Adult↗
PubMed1998

["Cast syndrome"].

The term "cast syndrome" (also called Wilkie's syndrome or superior mesenteric artery syndrome) means an intestinal obstruction caused by a duodenal vascular compression from the superior mesenteric artery. A case of this rare syndrome is reported in a 12-year-old child associated with the treatment by a plastered cast for idiopathic scoliosis. The pathogenesis, diagnosis, medical and surgical treatment are described.

Child↗
PubMed2003

The duration of immobilization causes the changing pharmacodynamics of mivacurium and rocuronium in rabbits.

In the clinical setting, in patients with a cast, it is not known whether the monitoring of the neuromuscular paralysis induced by either mivacurium or rocuronium in the contralateral limb is the correct interpretation. We compared the dose-response relationships and the neuromuscular blocking effects of mivacurium and rocuronium in 56 anesthetized rabbits immobilized in a plaster cast for 2, 4, and 6 wk. Train-of-four stimuli were simultaneously applied every 10 s to both common peroneal nerves, and the force of contraction of both tibialis anterior muscles was measured. Immobilization was associated with a rightward shift of the mivacurium and rocuronium dose-response curves after the duration of the immobilized limb, whereas no shift occurred in the contralateral limb. The 50% effective dose values for 0, 2, 4, and 6 wk of immobilization in the immobilized limb of mivacurium were 15.1 +/- 1.4, 18.2 +/- 1.5, 21.5 +/- 1.9, and 27.8 +/- 2.5 microg/kg, respectively, and they were unchanged in the contralateral limb. The calculated 50% effective dose values for the correspondence of rocuronium were 48.1 +/- 4.1, 56.2 +/- 4.2, 64.8 +/- 4.9, and 75.1 +/- 5.5 microg/kg, respectively, and they were unchanged in the contralateral limb. The rabbits receiving mivacurium and rocuronium had a significantly accelerated recovery from neuromuscular blockade compared with the placebo group in the immobilized limb after the immobilized duration, whereas there were no differences in the contralateral limb. The results of the present study showed that immobilization disuse atrophy produced by casting led to the development of resistance to both mivacurium and rocuronium; however, no resistance was shown in the contralateral limb. The peripheral nerve stimulator could be applied on the nonimmobilized limb, which might be associated with a normal recording if either mivacurium or rocuronium was used as neuromuscular relaxants.

Androstanols↗
PubMed2001

Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot.

We evaluated the ability of seven devices to immobilize a prosthetic ankle-foot complex against plantarflexion, dorsiflexion, inversion, and eversion forces: two casts (plaster of Paris and Fiberglas) and five removable braces (molded ankle/foot orthosis, composite boot brace, pneumatic boot walker, nonarticulating fracture boot, and ankle stirrup). Each device was applied to a prosthetic ankle-foot complex and evaluated on a test frame for resistance to sagittal motion and coronal torque. Results showed that casts offered significantly (P < or = 0.05) more resistance to motion in all directions tested than did the braces. The resistance offered by the devices tested depends on the conformity of the device to the shape of the foot in that plane and the material properties of the device. Braces offer the advantage of being easily removed and reapplied. Different braces offer specific advantages and disadvantages in different planes tested, and immobilization selection should be individualized based on this information.

Ankle↗
PubMed2004

The accuracy and reliability of measurements made on computer-based digital models.

For reasons of convenience and economy, orthodontists who routinely use and maintain pre- and posttreatment plaster casts are beginning to use computer-based digital models. The purpose of this study was to determine the accuracy (validity), reproducibility (reliability), efficacy, and effectiveness of measurements made on computer-based models. A plastic model occlusion ie, dentoform, served as a gold standard to evaluate the systematic errors associated with producing either plaster or computer-based models. Accuracy, reproducibility, efficacy, and effectiveness were tested by comparing the measurements of the computer-based models with the measurements of the plaster models--(1) accuracy: one examiner measuring 10 models made from a dentoform, twice; (2) reproducibility and efficacy: two examiners measuring 50 models made from patients, twice; and (3) effectiveness: 10 examiners measuring 10 models made from patients, twice. Reproducibility (reliability) was tested by using the intraclass correlation coefficient. Repeated measures of analysis of variance for multiple repeated measurements and Student's t-test were used to test for validity. Only measurements of maxillary and mandibular space available made on computer-based models differed from the measurements made on the dentoform gold standard. There was significantly greater variance for measurements made from computer-based models. Reproducibility was high for measurements made on both computer-based and plaster models. In conclusion, measurements made from computer-based models appear to be generally as accurate and reliable as measurements made from plaster models. Efficacy and effectiveness were similar to those of plaster models. Therefore, computer-based models appear to be a clinically acceptable alternative to conventional plaster models.

Analysis of Variance↗
PubMed1997

[Osteosynthesis of internal malleolar fracture by staplers].

PURPOSE OF THE STUDY: Rigid medial and lateral fixation should stabilize the syndesmosis without further additional supplementation. We used Titanium staples for medial malleolar fixation. MATERIAL: This study included 21 medial malleolar fractures (6 isolated medial malleolar fractures). Ankle fractures were classified according to Weber's system for lateral malleolar fracture. TECHNICAL: Tension band was used for Weber A lateral malleolar fracture and a plate for Weber B and C. One Weber A fracture was stabilized by staples. After reduction with clamps, three staples are placed perpendicular to the fracture line. All medial malleolar fractures were treated by staples including comminutive fractures or fractures who extended proximally into the tibia pilon. Only three transversal fractures of the anterior rim were treated by staples. Closure was made without any drainage. A below the knee cast was placed for 6 weeks. RESULTS: All fractures healed without further displacement. According to Weber Score, eleven ankle had an excellent result, seven a good result and three a bad result. We never removed the staples except in one case of technical error. DISCUSSION: Titanium staple present an attractive alternative for medial malleolar fixation. Plaster cast don't impair ankle function. Titanium staples are easy to use, are of little bulk and removal is not necessary. Skie et al. described three types of anterior rim fracture: one transversal and two oblique. The small size of the fragment makes reduction difficult to maintain, and impacted staple tends to displace laterally this small fragment. In this series we stapled only transverse fracture of the anterior rim (three times). But even in this case, it is difficult to maintain reduction during stapling. In case of lass of reduction, removal of the staple is responsible for fragmentation of the small fragment. Excluding the anterior rim fracture, other fractures, including T fractures and fractures who extend to the tibial pilon can be treated by this technique. CONCLUSION: Titanium staple is easy to use in medial malleolar fractures excluding anterior rim fractures.

Adult↗
PubMed1984

The use of flexible polyurethane foam in orthotics.

The casting of flexible polyurethane foam into a wide range of customised shapes has been found to offer a relatively straightforward solution to a number of problems associated with providing support for the physically handicapped. This note describes the techniques used for the production of such supports and reports on clinical experience of their use. A suitably prepared plaster cast of the patient, obtained in the usual way via vacuum consolidation of polystyrene beads, forms the lower surface of a wooden moulding box. Suitable quantities of the two chemicals, an isocyanate and a polyol, are then thoroughly and rapidly mixed together before being poured into the moulding box over which a weighted lid is placed to contain the foam and to improve its consistency. After removal, the finished product can then be trimmed and if necessary covered with fire-retardant leathercloth. To date polyurethane foam mouldings have been used with considerable success as seat cushions, seat backs and as spinal body supports which allow a patient to be nursed prone and supine following spinal fusion.

Construction Materials↗
PubMed1984

Fractures of the base of the fifth metatarsal distal to the tuberosity. Classification and guidelines for non-surgical and surgical management.

Between 1973 and 1982 forty-six fractures of the base of the fifth metatarsal, distal to the tuberosity, were treated and followed for a mean of forty months (range, six to 108 months). Roentgenographic criteria were used to define three types of fractures: acute fractures characterized by a narrow fracture line and absence of intramedullary sclerosis; those with delayed union, with widening of the fracture line and evidence of intramedullary sclerosis; and those with non-union and complete obliteration of the medullary canal by sclerotic bone. Of the twenty-five acute fractures in this series, fifteen were treated with a non-weight-bearing toe-to-knee cast, and fourteen of them healed in a mean of seven weeks. Only four of the other ten, which were treated with various weight-bearing methods, progressed to union. Of the twelve patients with delayed union, one refused treatment, one was treated with a bone graft, and ten were treated initially by immobilization of the limb in a plaster cast and weight-bearing. Of these ten fractures, seven healed in a mean of 15.1 months and three eventually required grafting for non-union. Of the nine non-unions in the series, which were treated primarily with medullary curettage and bone-grafting, eight healed in a mean of three months. In all, twenty fractures were treated surgically with an autogenous corticocancellous graft that was inlaid after thorough curettage and drilling of the sclerotic bone that obliterated the intramedullary cavity. Of these twenty fractures, nineteen progressed to complete healing and one, to asymptomatic non-union.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

The cost effectiveness of three different measures of breast volume.

BACKGROUND: Several methods including water displacement, casting, the Grossman-Roudner measuring device, photographs, mammograms, ultrasound, and magnetic resonance imaging (MRI) have been proposed for the measurement of breast volume. The most cost-effective method has not been determined. METHODS: This study compared breast volume measurements using the Grossman-Roudner measuring device (a piece of circular plastic with a cut along a radius line), plaster casting, and MRI. The Grossman-Roudner measuring device was formed into a cone around the breast, and the volume was read from a graduated scale on the overlapping edges. The volume of the cast was measured using a butter-sand mixture and water displacement. The volume from the MRI slices was calculated using the ANALYZE bioimaging software. For five women with breast sizes AA, A, B, C, and D, the three volume measures were repeated three times. For a single volume measurement, the cost of the time and materials was 1 US dollar for the Grossman-Roudner cone, 20 US dollars for the cast, and 1,400 US dollars for the MRI. Using the mean and standard deviations of the measurements, a power analysis determined the number of subjects needed to detect a 5% change in volume. The number of subjects was multiplied by the price per test to determine relative cost. RESULTS: As compared with the cost for the Grossman-Roudner cone method, the cost for the volume measurements was 64 to 189 times more using the cast and 373 to 33,500 more using MRI. CONCLUSIONS: The Grossman-Roudner cone was clearly the most cost-effective method for determining breast volume changes in studies testing topical therapies to alter breast size.

Breast↗
PubMed1984

Ruptured fibular ankle ligament: plaster or Pliton brace?

A prospective randomised study was performed in order to compare plaster cast with Pliton-80 cast brace with a mobile plastic shoe insert in the treatment of ruptured fibular ankle ligaments. The two treatment groups consisted of 65 patients in each and all were participating in the follow-up sixth months after the accident. There were no statistically significant differences in the overall results between the two treatment groups. Because 1) the mobile Pliton-80 bandage subjectively is more acceptable to the patients and -2) the disability time in the Pliton-80 group was considerably shorter than in the plaster group--it was concluded that the mobile Pliton-80 bandage can be recommended as the treatment of ruptures of the fibular ankle ligaments.

Adolescent↗
PubMed2004

Achilles tendon rupture: surgical versus non-surgical treatment.

OBJECTIVE: To ascertain the treatment method of choice for Achilles tendon rupture, which results in the most favourable functional outcome. METHODS: A comprehensive literature search was performed to retrieve relevant English language articles comparing surgical with non-surgical treatment. RESULTS: The literature search identified five prospective randomised controlled trials, three of which compare surgical with non-surgical treatment, one which compares functional early mobilisation with cast immobilisation after surgical repair and one which compares functional and cast immobilisation in non-surgical management of Achilles tendon rupture. CONCLUSION: Surgical treatment of Achilles tendon rupture is associated with a significantly lower incidence of re-rupture and therefore is the treatment method of choice. Non-surgical treatment may be acceptable for patients who refuse surgery or who are unfit for surgery. Functional early mobilisation appears to be associated with an improved functional outcome and should be considered in preference to plaster cast immobilisation where appropriate.

Achilles Tendon↗
PubMed1992

Open fractures of the tibia in children.

We describe the results of treatment of open tibial fractures in 92 children; 22 fractures were Gustilo type I, 51 type II and 19 type III. All children received tetanus prophylaxis, systemic antibiotics for 48 hours and thorough debridement and irrigation of the wound. Fifty-one wounds with minimal soft-tissue injury were closed primarily. The other 41 were initially left open; of these, 18 small wounds were allowed to heal secondarily and 23 larger wounds required split skin grafts or soft-tissue local or microvascular free flaps. Stable fractures were reduced and immobilised in an above-knee plaster cast (71%) and external fixation (28%) was used for unstable fractures, extensive soft-tissue injury and multiple injuries. Short-term complications included compartment syndrome (4%), superficial infection (8%), deep infection (3%), delayed union (16%), nonunion (7.5%) and malunion (6.5%): these incidences are similar to those reported in adults. Selective primary closure of wounds did not increase the incidence of infection. External fixation was associated with a greater occurrence of delayed and nonunion than plaster immobilisation, but this technique was used most often for the more severe injuries. Late review, at 1.5 to 9.8 years, showed a high incidence of continuing morbidity including pain at the healed fracture site (50%), restriction of sporting activity (23%), joint stiffness (23%), cosmetic defects (23%) and minor leg-length discrepancies (64%). Open tibial fractures in children are associated with a high incidence of early and late complications, which are more frequent in children with Gustilo type III injuries. The Gustilo classification was a useful guide for predicting the outcome and planning treatment.

Adolescent↗
PubMed2002

[Stress fractures of the tibia in elderly women].

Five women with stress fractures of the tibia with concomitant osteoarthritis of the knee were treated at the Department of Orthopaedics and Traumatology of the Lublin University of Medical Sciences between 1996 and 2001. The patients' age ranged from 57 to 78 years. Three fractures were located in the proximal part of the tibial shaft and 2 in the distal part of the tibial shaft. Two patients were unable to ambulate and 3 walked with crutches. In 2 cases the fracture healed after immobilisation in a walking cast for a period of 5 and 6 months respectively. Two cases with a concomitant varus or valgus deformity were treated surgically. In a 72-year-old woman the fracture healed 10 months after stabilisation with a locked intramedullary nail. In a 78-year-old woman the fracture healed 7 months after surgical correction of the tibial axis without internal fixation and a simultaneously performed Charnley knee arthrodesis. Immobilisation was achieved by a long plaster cast. A knee endoprosthesis was implanted in this patient a year after the first procedure because of advanced osteoarthrosis. A 72-years-old patient could not be treated because of poor general condition and advanced degenerative changes in both knee joints. All treated patients were pain free and ambulation parameters improved.

Aged↗