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PubMed1998

[Pediatric scaphoid fractures--treatment and prognosis].

From 1990 to 1994, we treated 28 children aged eight to fourteen years, with a scaphoid fracture. In eight of them, the initially suspected fracture could not be verified by X-ray earlier than two weeks after the injury. Eleven more patients--after false initial suspect of fracture--were discharged after two weeks without any complaints and negative X-ray control. These were not included in the series. Patients with radiologically evident fracture or clinically typical history and symptoms of scaphoid fracture--even without positive X-ray--were treated by below-elbow-thumb spica-cast for two weeks. After that period, all patients went for repeated clinical and radiological examination. All children with radiologically visible fracture or continuous, typical complaints underwent cast fixation for another four weeks. Symptom-free patients without radiological evidence of fracture were discharged. One displaced fracture was reduced and stabilized with a screw. In follow-up examination after six to forty months, all fractures showed good radiological consolidation, four patients reported occasional pain on straining the wrist. Scaphoid fractures in children seem to be more difficult to diagnose than to treat. Nondisplaced or slightly displaced fractures can be treated easily with plaster cast. Fractures that show dislocation of more than 1 mm should undergo open reduction and stabilization by a screw.

Adolescent↗
PubMed1999

3-dimensional analysis of cleft palate casts.

It is the aim of presurgical infant orthopedics (PSIO) to reduce the width of the cleft and to achieve optimal alignment of the cleft palate segments within the first few months of infancy prior to any surgical cleft closure. The question about the amount that PSIO can stimulate and steer the growth of the maxilla using a Hotz and Gnoinski passive appliance has not yet been satisfactorily answered. In this study, a 3-dimensional digital computer-aided procedure was developed to analyze metrically and to visualize the growth of the edentulous maxilla of cleft lip and palate in infants. In a pilot study, a series of digital scans of consecutive plaster casts was carried out. 5 infants with complete unilateral cleft lip and palate (UCLP), who had been treated with passive appliances were evaluated. Impressions were taken at the age of one week and after 3, 6 and 12 months. Following digitizing, the casts were computer-reconstructed and segmented perpendicular to the alveolar crest, the reference points being C1, C1', C2, C2' and I. The volume of the resulting segments was ascertained. Computer superimposition of reconstructed consecutive casts was employed to facilitate a visualization of the extent and direction of morphological changes. Our first results have shown that with our method it is possible to quantify the growth rate of defined segments of the maxilla. The 3-dimensional analysis presented here will be the basis for further studies to objectify PSIO.

Cleft Palate↗
PubMed1989

Fractures in patients who have myelomeningocele.

Thirty-seven (20 per cent) of 186 children who had myelomeningocele whose records were reviewed had sustained a total of seventy-six fractures. The frequency with which the fractures occurred was related directly to the level of neurological involvement. Thirteen (41 per cent) of the patients who had involvement at the thoracic level, fifteen (36 per cent) who had involvement at the upper lumbar level, eight (10 per cent) who had involvement at the lower lumbar level, and one (3 per cent) who had involvement at the sacral level sustained fractures. Sixty-five (86 per cent) of the fractures occurred before the child was nine years old, fifty-eight (76 per cent) were judged to be secondary to the limb being in a cast, and seventy-four (97 per cent) involved the lower extremity. Eleven patients, all of whom had thoracic or upper lumbar involvement, sustained fractures of multiple extremities. All fractures of the lower extremity were distal to the level of neurological involvement; they occurred predominantly in the femur in patients who had thoracic involvement and in the tibia in patients who had lumbar involvement. All of the metaphyseal and diaphyseal fractures healed satisfactorily, whether they were treated by immobilization in a plaster cast or in a bulky Webril dressing, although there were fewer complications in the latter group. The seven fractures that involved the physeal plate were a major problem, as three (43 per cent) had delayed union and two (29 per cent) developed premature growth arrest.

Child↗
PubMed1976

Early posterior ankle release in the treatment of congenital clubfoot.

Eighty-one patients (116 clubfeet) underwent posterior ankle release before the age of two years, following unsatisfactory responses to serial corrective casts applied according to the technique of Kite. Seventy-three per cent of these feet showed no or only mild talar flattening at an average follow-up of 7.5 years. Four years, following posterior ankle release there was a none-mild talar flattening rate of 69 per cent in this group compared to a 40 per cent none-mild rate in ankle release reduces the incidence of recurrent equinus deformity and the necessity for subsequent surgery in comparison to the results obtained with serial plaster casts or with tendo Achillis lengthening alone. Recent trends in clubfoot management have favored increasingly early operative intervention. Denham stated that "In the infant hard tissues (bone and cartilage) should be regarded as soft, and the soft tissues (tendon and ligament) as hard." Our operative experience with posterior ankle release supports this philosophy and indicates that early aggressive surgical management is the treatment of choice for the resistant clubfoot.

Age Factors↗
PubMed1977

[Synovectomy in the treatment of acute arthritis caused by Micrococcus pyogenes].

In addition to antibiotic therapy associated with immobilization in a plaster cast, effective in the majority of cases of acute arthritis caused by St. pyogenes and resection-arthrodesis which is necessary in the stage of osteoarthritis, synovectomy occupies an intermediate position. During a period--possibly not a short one--when the lesions are still purely synovial and do not regress under medical treatment, their ablation permits recovery from the infection with restoration of the functional activity of the joint. The experience is based on 26 observations (19 knees, 3 hips, 2 shoulders, 1 thumb, 1 metacarpo-phalangeal lesion). In 2/3 of cases these arthritides were iatrogenic (13 after cortisone infiltration, 4 postoperative, 1 haematogenic from i.v. catheterization). Synovectomy should be complete; haemostasis must be rigorous; an aspiration drain is left in place for 5 or 6 days; additional immobilization in plaster is not obligatory; antibiotic treatment is continued until the BSR has returned to normal. As regards control of the infection, this was obtained in 19 of 26 operations. As regards function, in 10 of these cases the results were very good, in 7 good (slight persistent restriction of movement), in only 2 cases the results were unsatisfactory. The factors that appear to affect the results are on the one hand rigorous technique and on the other sufficiently early operation before the lesions have become too fully established. However, a study of arthritides after cortisone infiltration of previously affected joints has shown that even relatively late operation can lead to satisfactory results (9 of 13).

Acute Disease↗
PubMed2004

The natural history of idiopathic toe-walking: a long-term follow-up of fourteen conservatively treated children.

AIM: To determine the long-term results after conservative treatment (physiotherapy, casting, orthoses, or a combination of these) of idiopathic toe-walking (ITW). METHODS: Tiptoe-walking is diagnosed as idiopathic (habitual) if no signs of neurological, orthopaedic, or psychiatric disease are detected. The diagnosis is one of exclusion. Sixteen former patients with ITW, all now at least 13 y old, were asked to participate in a follow-up investigation 7-21 y after being first diagnosed. Two cases were excluded because heel-cord lengthening had been performed later on in other hospitals. The remaining 14 patients completed a questionnaire. Eleven patients consented to a clinical examination, during which they were videotaped and their active and passive ankle-joint dorsiflexion measured. These data were compared with the assessment at the initial evaluation. In one instance, the toe-walking ceased after conservative treatment (plaster cast). In all other cases the toe-walking pattern recurred. RESULTS: At follow-up three patients showed some toe-walking when they were unobtrusively observed. When videotaped, they did not toe-walk, although a distinct heel-strike was missing. The remaining eight patients all walked with a heel-strike. Two patients had slight symptoms possibly related to toe-walking. No fixed contracture was present at the first evaluation, and none was found at follow-up. There was no systematic change in ankle-joint dorsiflexion from initial assessment to follow-up examination. CONCLUSION: Non-surgical treatment of ITW does not have a lasting effect and the long-term results in this study are considered to reflect the natural history, i.e. the toe-walking pattern eventually resolves spontaneously in the majority of children. Surgical treatment of ITW should be reserved for the few cases with a fixed ankle-joint contracture.

Child↗
PubMed2006

Laser imaging and computer-aided design and computer-aided manufacture in prosthetics and orthotics.

Although Hanger Orthopedic Group, Inc., has been developing clinical protocols for its INSIGNIA scanner for more than 2 years, there are many applications that are currently in development and will be released over the next 2-year period after this publication. It is the goal of Hanger Orthopedic Group, Inc., to replace all plaster casting procedures with the laser scan and move toward a paperless environment where all images and documents are passed through its virtual network. INSIGNIA currently has five major production centers throughout the United States, which support more than 600 INSIGNIA certified clinicians. These clinicians staff more than 600 clinics in North America, all under the Hanger company name. The central fabrication service and the central design center processes hundreds of shapes per day (Fig. 27). So that any clinician in the field can use the expertise of the central designers and central fabricators to help with overflow or problems they might be having, the network that exists within Hanger is tied together and enhanced by INSIGNIA. Through virtual modification and centralization of these services, each patient receives the virtual collaboration of several clinicians with a total of years of experience. INSIGNIA has enhanced the patient experience. The enhancement is not only in removing the plaster from the process, but also in exposing each patient to the team of prosthetic experts working collaboratively behind the scenes. The rehabilitation industry continues to be bombarded with compliance paperwork and justifications. The INSIGNIA scan and resulting measurement reports give inherent strength to justifications based on volume change, surgical revisions, or tissue change. The files are kept in a data warehouse where they are vaulted and preserved presumably forever. Also, any of the shape graphics or measurement instruments can be printed into a discrete report that can become part of the patient's permanent record. Many physicians receive update letters from their orthotic and prosthetic clinician with a status update before and after treatment of their patient. This update includes a descriptive narrative, a printout of the pertinent metrics, a printout of the scan graphic, and often a digital image of the patient wearing the device (Fig. 28). The network is HIPAA compliant, and all private health information is held in tight security. If a practitioner does not have a HIPAA agreement in place with Hanger Orthopedic Group, Inc., and would like one, or ifa practitioner would like to have an INSIGNIA representative call or visit with more information, the practitioner is encouraged to call 1-800-4-HANGER and request an INSIGNIA in-service or visit INSIGNIA on the web at www.hanger.com.

Adult↗
PubMed1974

Effect of denervation on the adaptation of sarcomere number and muscle extensibility to the functional length of the muscle.

1. The effects of denervation on the response of the cat soleus muscle to immobilization at different lengths by plaster casts has been investigated for a period of 4 weeks.2. The passive length-tension properties of the denervated immobilized muscles were not significantly different from those of non-denervated muscles. Muscles immobilized in the shortened position showed a marked decrease in extensibility whether they were denervated or not. In all the other cases the length-tension curves were not significantly differetn from those of normal muscles.3. The denervated soleus muscle immobilized in the lengthened position was found to produce 25% more sarcomeres in series, whilst those immobilized in the shortened position lost 35%. This adaptation was essentially the same as in muscles that had been immobilized but not denervated.4. Denervation was found to have no effect on the recovery of muscles that had been subjected to 4 weeks immobilization in the shortened position. In these muscles the sarcomere increased back to the normal level within 4 weeks after removal of the plaster cast.5. The adjustment of sarcomere number to the functional length of the muscles does not therefore seem to be directly under neuronal control. It appears to be a myogenic response to the amount of passive tension the muscle is subjected to.

Animals↗
PubMed1989

[Patellar fractures. Modified tension band osteosynthesis].

In a retrospective investigation, the ability of modified tension band osteosynthesis to retain 45 reduced fractures of the patella and the functional end result was studied. Postoperatively, 24 patients were immobilized in plaster casts for 0-14 days and the remainder for 25-56 days. Postoperative radiographs revealed nine fractures (four transverse, three comminuted and two pole fractures) with fragment displacements exceeding 2-3 millimeters. Among these, three fractures had secondary dislocation and, further, one exactly reduced pole fracture dislocated. Operation was complicated with infection in four cases: two superficial wound infections, one subcutaneous fistula and one pyarthron. Operative release of adhesions was performed in five cases, two patients were patellectomized and one required a condyle prosthesis. At follow-up 18-80 months after the injury, 37 patients were examined clinically. Among 29 patients without concomitant injuries, seven patients were free of symptoms and 13 patients were without any pain. Free knee movement and quadriceps atrophy less than or equal to 1.5 cm was found in 17 patients. The modified tension band can retain adequately reduced transverse and comminuted fractures of the patella, probably also without plaster immobilisation. Dislocated fracture of the patella is a serious lesion, which must be treated with care.

Adolescent↗
PubMed1999

Diagnosis and treatment of scaphoid fractures, can non-union be prevented?

In order to evaluate the diagnostic management of scaphoid fracture, 100 consecutive patients with clinically suspected scaphoid fractures were investigated. If a scaphoid fracture was seen on scaphoid radiographs, patients were immobilized in a plaster cast. If the radiographs were negative or dubious for scaphoid fracture, patients were referred for three phase bone scintigraphy. Then the patient was treated according to the result of the bone scan. A long-term follow-up (minimum 1 year) was performed in order to evaluate the incidence of non-union. In 49 of the 100 patients, a fracture of the scaphoid was recognized, in 29 of whom their scaphoid X-series was positive for scaphoid fracture. In 3 of the remaining 71 patients with negative scaphoid X-series, additional carpal box radiographs showed a scaphoid fracture, while 68 patients were referred for three-phase bone scintigraphy. Of these 68 patients, 17 patients (25%) showed a hotspot on the bone scan in the region of the scaphoid. We found that scaphoid radiographs, additional carpal box radiographs and the bone scan (in radiographically negative patients) in combination with conservative therapy did not lead to non-union at long-term follow-up in patients who were treated for scaphoid fracture. We conclude that when a scaphoid fracture is diagnosed within the 1st week followed by plaster immobilization, non-union of the scaphoid could be prevented.

Adolescent↗
PubMed1999

Colles' fracture: management by percutaneous crossed-pin fixation versus plaster of Paris cast immobilization.

Colles' fracture is the most common fracture seen in orthopedic practice, but no consensus has been reached on an effective method to maintain the initial reduction achieved. This prospective, randomized study of 50 patients evaluates the efficacy of maintaining reduction and consequent functional end results of two treatment methods, ie, percutaneous crossed-pin fixation followed by plaster of Paris cast immobilization with the wrist in functional position versus conventional plaster of Paris cast immobilization. The anatomical and functional end results were significantly better with percutaneous crossed-pin fixation at final follow-up.

Adult↗
PubMed1986

Pulmonary and cardiovascular consequences of immediate fixation or conservative management of long-bone fractures.

We randomly assigned patients with multiple trauma who had tibial or femoral fractures to one of two groups--one group received immediate fixation of all fractures, and the second group received conservative orthopedic management, consisting of traction or plaster casts. Studies were conducted twice each day for four days following injury. Mean cardiac index was 1.3 L/min/m2 higher and mean shunt was 5.2% lower in the immediate fixation group compared with the group receiving conservative treatment. Other pulmonary and systemic hemodynamic variables did not differ between the groups. The incidence of fat macroglobules in blood aspirated from the pulmonary capillaries was higher when compared with that in pulmonary arterial blood but was not significantly different between the two treatment groups. Platelet count was significantly lower and fibrinogen concentration was significantly higher in the group receiving immediate fixation. We found no diagnostic significance of the incidence of fat macroglobules in samples of blood aspirated from the pulmonary circulation. We conclude that patients receiving immediate fixation had less pulmonary dysfunction following multiple trauma and long-bone fractures.

Adolescent↗
PubMed1982

Leg ulcer. Conservative management or surgical treatment?

In a specific indigent socioeconomic setting, the nonsurgical management of 65 patients with chronic leg ulcers resulted in 59 cures. There were 42 patients (67%) with postphlebitic syndrome. Twenty-two patients (33%) had varicose veins (eight had postoperative vein stripping), 14 (22%) had deep-vein thrombosis, and 11 (15%) had associated neurological problems. Fifty-six patients (86%) were treated with pressure dressings that were changed once a week in an outpatient clinic, seven patients wore skintight plaster casts for variable periods of time, and two patients had split thickness skin grafts plus lumbar sympathectomies. In more than two thirds of the patients, the ulcers healed. In another 17 patients (26%), a satisfactory response to treatment was observed. In only six patients did therapy fail. Failures were attributed to the multiple medical and surgical problems of the patients or their lack of cooperation. Nonsurgical treatment of venous stasis ulcer is inexpensive and effective.

Adult↗
PubMed2000

Activity-induced fiber regeneration in rat soleus muscle.

In an attempt to understand why muscle recovery is limited following atrophy due to limb immobilization, satellite cell activity and muscle fiber regeneration were analyzed in rat soleus muscles. Adult rat hindlimbs were immobilized in plaster casts for a period of two to ten weeks. Soleus muscles were examined by electron microscopy for evidence of fiber degeneration or regeneration, and to quantify satellite cell nuclei. Immunocytochemical localization of embryonic myosin was used to identify regenerating myofibers. Soleus muscle wet weight to body weight ratios for the casted muscles significantly decreased over the 10-week immobilization period. The casted muscles displayed ultrastructural evidence of minor fiber damage, including myofibrillar atrophy, Z-disc disruption, and abnormal triadic junctions. No ultrastructural evidence of regeneration was seen in the casted animals. The number of satellite cells in the casted muscles significantly decreased from 6.4% to 3. 3% by eight to 10 weeks of immobilization. Approximately 1.0% of extrafusal fibers in the control soleus muscles appeared to be regenerating since they expressed embryonic myosin and were of a small diameter, while in casted muscles, only 0.1% of the fibers were embryonic myosin-positive. Following release from immobilization, a reappearance of embryonic myosin-positive fibers was noted within four days of renewed activity. In contrast to control muscles, embryonic myosin-positive fibers in the recovery muscles included both small and large diameter fibers. Subtle changes in functional activity influence muscle damage and subsequent myofiber regeneration. Reduced activity reduces muscle fiber regeneration, while increased activity, as seen by increased hindlimb weight bearing and return to normal activity following immobilization, increase regenerating fibers and also the expression of embryonic myosin in adult fibers.

Aging↗
PubMed1997

Monomelic amyotrophy following trauma and immobilization in children.

Two children aged 9 and 11 years suffered from left elbow sprain and right anterior tibial tuberosity cortical fracture respectively and were treated with plaster cast immobilization for about 30 days. They regained normal strength afterwards, but 9 and 2 months later developed insidious progressive weakness and wasting in the affected limb, mainly evident in the musculature surrounding the site of injury and sparing hand and foot muscles. Two to three years later the condition stabilized. Sensory abnormalities were not found. Electromyographic examination showed neurogenic pattern confined to the impaired extremity. The focal quality and the unusual disposition of muscle involvement suggest a correlation between trauma and/or immobilization and monomelic amyotrophy.

Adolescent↗
PubMed2000

A simulator for maxillofacial surgery integrating 3D cephalometry and orthodontia.

OBJECTIVES: This paper presents a new simulator for maxillofacial surgery that gathers the dental and maxillofacial analyses together into a single computer-assisted procedure. The idea is to first propose a repositioning of the maxilla via the introduction of 3D cephalometry applied to a 3D virtual model of the patient's skull. Orthodontic data are then integrated into this model, using optical measurements of plaster casts of the teeth. MATERIALS AND METHODS: The feasibility of the maxillofacial demonstrator was first evaluated on a dry skull. To simulate malformations (and thus simulate a "real" patient), the skull was modified and manually cut by the surgeon to generate a given maxillofacial malformation (with asymmetries in the sagittal, frontal, and axial planes). RESULTS: The validation of our simulator consisted of evaluating its ability to propose a bone repositioning diagnosis that would restore the skull to its original configuration. An initial qualitative validation is provided in this paper, with a 1.5-mm error in the repositioning diagnosis. CONCLUSIONS: These results mainly validate the concept of a maxillofacial numerical simulator that integrates 3D cephalometry and guarantees a correct dental occlusion.

Cephalometry↗
PubMed2003

Closed reduction methods for treating distal radial fractures in adults.

BACKGROUND: Fracture of the distal radius is a common clinical problem, particularly in older white women with osteoporosis. Displaced fractures are usually reduced using closed reduction methods, which are non-surgical and generally comprise traction and manipulation, and the resulting position stabilised by external means, typically plaster cast immobilisation. OBJECTIVES: To examine the evidence for the relative effectiveness of different methods of closed reduction for displaced fractures of the distal radius in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (to July 2002), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 3, 2002), MEDLINE (1966 to July week 4 2002), EMBASE (1988 to 2002 week 31), CINAHL (1982 to June week 4 2002), the UK National Research Register (Issue 2, 2002) and reference lists of articles. We also handsearched the British Volume of the Journal of Bone and Joint Surgery supplements (1996 onwards), and abstracts of the American Orthopaedic Trauma Association annual meetings. SELECTION CRITERIA: Randomised or quasi-randomised clinical trials evaluating different methods of closed reduction. We also included trials in which the use (or not) of anaesthesia could be classed as a co-intervention. DATA COLLECTION AND ANALYSIS: All trials judged as fitting the selection criteria by both reviewers were independently assessed by both reviewers for methodological quality. Data were extracted independently by one reviewer and checked by the other. Quantitative data are presented using relative risks or mean differences together with 95 per cent confidence limits. No pooling was possible. MAIN RESULTS: Three trials involving a total of 404, mainly female and older, patients with displaced fractures of the distal radius were included. These failed to assess functional outcome, and only one trial reported on complications. One trial found no statistically significant differences between mechanical reduction using finger trap traction and manual reduction in anatomical outcomes. One trial compared a novel method of manual reduction where the non-anaesthetised patient actively provided counter-traction versus traditional manual reduction under intravenous regional anaesthesia. While patients of the novel method group suffered more, yet not intolerable, pain during the reduction procedure, the latter was shorter in duration. No differences in anatomical outcome were detected. The third study compared mechanical reduction involving a special device without anaesthesia versus manual reduction under haematoma block (local anaesthesia). Less pain during the reduction procedure was recorded for the mechanical traction group. Both methods yielded similar radiological results. Fewer patients in the mechanical traction group had signs of neurological impairment, mainly finger numbness, at five weeks but this difference was not statistically significant by one year. REVIEWER'S CONCLUSIONS: There was insufficient evidence from comparisons tested within randomised trials to establish the relative effectiveness of different methods of closed reduction used in the treatment of displaced fractures of the distal radius in adults. Given the many unresolved questions over the management of these fractures, we suggest an integrated programme of research, which includes consideration of reduction methods, is the way forward.

Adult↗
PubMed1980

Contribution of breast volume and weight to body fat distribution in females.

Breast volume and body composition were measured in 45 adult females to determine the contribution of breast weight and breast volume to total body fat. Plaster casts were filled with sand of known density to obtain breast volume. Breast weight was computed as breast volume times its density. The correlation between total breast volume and percent body fat was r = .40. Breast weight (mean = 484 grams) accounted for 3.5 percent of the total weight of body fat, and at most, 12 percent of the estimated quantities of sex-specific fat. A theoretical model is proposed for the distribution of body fat in the female which subdivides total body fat into three components: reserve storage fat, essential fat, and expendable storage fat.

Adipose Tissue↗