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PubMed1982

Incidence of Carabelli's trait in Kenyan Africans and Asians.

Examination for incidence of Carabelli's trait was done on 1267 Africans and 781 Asian school children, 298 dental plaster casts and 248 skulls of Africans. The African sample is composed of 80% Bantu, 20% Nilote, and Nilo-Hamitic people. When observed intraorally, the trait is present in 31-35% of Africans and 26-27% of Asians. In the dental casts and skull sample of Africans, the trait is present as pit in 23-28%, groove in 20%, and as tubercle and cusp in 22%. The total trait frequency in Africans is 68%.

Adolescent↗
PubMed1994

Osteoporosis in men with a history of tibial fracture.

The long-term effects of bone fractures on bone mineral density (BMD) at various skeletal sites are poorly established, although a serious fracture, such as a tibia fracture, followed by long immobility and disuse may lead to permanently decreased BMD and, through this mechanism, may be a risk factor for osteoporotic fractures in later life. To determine whether such an injury leads to osteoporosis, we measured the areal BMD (g/cm2) from the lumbar spine (L2-4), right distal radius and ulna, and the femoral neck, distal femur, patella, proximal tibia, distal tibia, and calcaneus of both extremities in 14 men with a history of primarily nonunited (finally bone-grafted) shaft fracture of the tibia and 20 men with a history of primary union. For evaluation of the patients' BMD in the spine and distal forearm, 22 age-, weight-, and height-matched normal men were also measured. The average time of immobilization in a long plaster cast was 27 weeks in the former group of patients and 16 weeks in the latter. The measurements were performed an average of 9 years after the fracture using a dual-energy x-ray absorptiometric scanner. Compared with normal men (mean +/- SD = 1.116 +/- 0.160), the spinal BMDs were significantly lower in men with a history of a primary nonunion (0.979 +/- 0.100, -12.3%) and union (1.010 +/- 0.124, -9.5%). In distal radius and distal ulna, there were no significant differences between the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1989

The effect of external fixation stiffness on early healing of transverse osteotomies.

The effect of bending stiffness of external fixators on the early healing of transverse tibial osteotomies was studied in a canine model to determine whether there is a particular range of fixation stiffness where healing is poor. Five unilateral fixators with different stiffnesses were developed and employed along with a dynamic compression plate to fix experimental osteotomies of dog tibias and the contralateral intact tibias served as controls. The six experimental fixation devices were: plate (P), stainless steel sidebar fixator (SS), stiff aluminum sidebar fixator (SA), intermediate aluminum sidebar fixator (IA), flexible aluminum sidebar fixator (FA), and Delrin sidebar fixator (D). Compared with human tibial fixation methods, the fixators ranged from a rigidity greater than a plate on a human tibia to a flexibility similar to a plaster cast on a human lower leg. Sixty-four adult male mongrel dogs (29 +/- 3 kg) underwent surgery and 52 completed the 9-week study, leaving 7 to 10 dogs in each experimental group (P = 8, SS = 7, SA = 9, IA = 9, FA = 10, D = 9). After the 9-week survival period the experimental tibias were radiographed and callus area was digitized. Both the experimental and control tibias were then tested to failure in four-point bending, and failure moment, stiffness, and energy to failure were determined. Of the 52 osteotomies, only four developed nonunions: 3 of 10 in the FA group and 1 of 7 in the SS group. Using analysis of variance, no statistical differences were detected in failure force, stiffness, or energy to failure as a function of fixator groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Arthritis not immobilization causes bone loss in the carrageenan injection model of inflammatory arthritis.

One suggested cause of the high turnover osteopenia of experimental inflammatory arthritis is disuse of affected joints. To compare the influence of immobilization or disuse, or both, with that of inflammatory arthritis on bone turnover, rabbits were placed into four groups. In group 1, arthritis was induced in the right knee by seven intra-articular injections of 1% carrageenan, over 49 days; in group 2, a plaster cast was applied to immobilize the right hindlimb in flexion; in group 3, arthritis was induced and the hindlimb was immobilized; and in group 4, nothing was done (control). The fluorescent label calcein was administered in drinking water (0.05%) ad libitum to all groups on days 22-36. On day 49, specimens were prepared for analysis of bone volume and new bone volume at a near site (right femur) and at remote sites (contralateral femur and ipsilateral humerus). The data were analysed by multiple regression and Bonferroni tests. In group 1, new bone volume was three times higher than in group 2 or 4 (p < 0.05 for each comparison); this indicated increased bone remodeling in the right femur. This contrasted with group 2, in which neither index of bone remodeling was changed. The combination of immobilization with arthritis resulted in more intense osseous effects of inflammatory arthritis, with a one-quarter decrease in bone volume (group 3, 30.99 +/- 2.50; group 4, 42.07 +/- 2.38, p < 0.05), as well as a 4-fold increase in new bone volume (p < 0.001) compared with group 1.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed2006

Early cinematographic studies of generalized dystonia.

Among movement disorders, dystonia is a particularly complex phenomenon and difficult to describe. For this reason, cinematographic documents were particularly important to the establishment of this disorder within the neurological nosology. The seminal 1944 article on dystonia by E. Herz anchored its arguments in moving film documentation, published with frame-by-frame demonstrations of dystonic patients. Although the original films that comprised the basis of this article have not been located, two related contemporaneous films, one by Herz in association with T.J. Putnam, and one by S.P. Goodhart and B.H. Balser, have been located. Incorporating standard and several innovative filming techniques, these films and their accompanying text material capture the particular movements of dystonia, revealing the anatomical patterns of the twisting spasms, and emphasize their action exacerbation. The films demonstrate the variety of dystonic movements appreciated during this period, consider psychogenic, postencephalitic, and hereditary forms, and refer to the treatment of dystonia by surgery and plaster casts.

Dystonia↗
PubMedDate not supplied

Exercise effects on recovery of muscle acetylcholinesterase from reduced neuromuscular activity.

In order to investigate the effects of reduced and subsequently increased neuromuscular activity on muscle acetylcholinesterase (AChE), rats had one hindlimb immobilized with plaster casts for 4 weeks and were killed either at the end of immobilization (group I), after 4 weeks of resumed normal activity following cast removal (group R), or after 4 weeks of resumed activity supplemented with a daily treadmill-walking task (group E). Immobilization resulted in a decrease in adductor longus muscle weight to 66.4% of control; total muscle end-plate-associated AChE was decreased to 51.4%. Total muscle ACh hydrolysis was not significantly affected. Mild daily exercise during recovery increased total muscle end-plate AChE to control levels after 4 weeks, while in group R the corresponding level was significantly lower (84.4%). Decreased neuromuscular activity has different effects on end-plate AChE and non-end-plate AChE. Mild endurance-type overload during recovery from immobilization can accelerate recovery of end-plate AChE activity to normal.

Acetylcholine↗
PubMed1988

Adaptation of skeletal muscle to immobilization in a shortened position.

This study determined the morphological changes and adaptations that occur following immobilization of rat soleus and gastrocnemius muscles when the ankle joint is placed in complete plantar flexion for 2, 5, 7, 14, 21, and 28 days by means of plaster casts. Previous studies of such shortened muscles have shown that the number of sarcomeres in series is reduced, but how the sarcomeres are reduced has not been determined. We observed that the fibers in the mid-belly region of the muscles demonstrated a progressive degenerative process over the first few weeks. Myofibrils across the entire width of the affected fibers underwent dissolution. However, by 4 weeks new myofibrils were being formed, and sarcomere lengths appeared normal. Portions of the fibers near the tendon underwent segmental necrosis. These findings are similar to the response of the soleus and gastrocnemius muscles to tenotomy and are clinically relevant to orthopedic procedures that maintain muscles in shortened conditions for prolonged periods.

Adaptation, Physiological↗
PubMed2005

Robust visualization of the dental occlusion by a double scan procedure.

A detailed visualization of the dental occlusion in 3D image-based planning environments for oral and maxillofacial planning is important. With CT imaging however, this occlusion is often deteriorated by streak artifacts caused by amalgam fillings. Moreover, more detailed surface information at the level of the dental cuspids is often desired. In this paper, a double scan technique is introduced to image the dental occlusion by means of a newly designed 3D splint. The patient wears this splint between the upper and lower teeth during CT-scan. In a second step, the splint is positioned between the plaster casts of the upper and lower jaw, and this setup is scanned. Based on markers in the 3D splint, both data sets are fused and a combined visualization is possible. The accuracy, robustness and applicability in clinical routine is shown. This technology enables meticulous 3D cephalometric analysis, detailed maxillofacial planning and opens possibilities towards intraoperative support.

Cadaver↗
PubMed1990

Lumbar spondyloptosis. A long term follow up of three cases.

This paper reports the long term results of 3 patients with lumbosacral spondyloptosis who were treated by closed reduction, followed by 6 to 12 weeks plaster cast immobilisation, posterior fusion and finally anterior fusion after a further 3 to 6 months. The follow up was from 7.5 to 10.5 years. Spondyloptosis was diagnosed by estimating the slip angle and the percentage slip. The initial slip angle ranged from 40 degrees to 55 degrees with 46%-91% slip. The average improvement in the slip angle after reduction was 82% with 74% improvement in slip. There was some loss of correction in every case by the end of treatment: the average improvement in slip angle was 59% (36%-78%) with an average 52% (25%-69%) correction of slip. Fusion was obtained in every case and the clinical results were very satisfactory.

Adolescent↗
PubMed1992

Conservative treatment for acute rupture of the Achilles tendon.

Sixty-six patients with acute ruptures of the Achilles tendon were treated by immobilisation in a plaster cast for 12 weeks. Fifty-seven were followed up for a mean time of 70 months. Four re-ruptures occurred shortly after the initial treatment. Most patients had no or only slight complaints, three had moderate and one severe, problems. The activity level dropped slightly from 5.3 to 5.03 (Tegner score). The results are satisfactory with a low complication rate. The method is an alternative to operative repair, especially in patients declining operation and in those in whom operation or anaesthesia is contraindicated.

Achilles Tendon↗
PubMed1994

Stability of the elevated fragment in tibial plateau fractures. A radiographic stereophotogrammetric study of postoperative healing.

Five cases of fracture of the lateral tibial condyle of the split-depression type were treated by elevation of the depressed fragment, bone grafting and cancellous bone screws. During the operation, tantalum markers were inserted into the depressed fragment and the tibial metaphysis for radiographic stereophotogrammetric analysis. Postoperatively a plaster cast was applied for one month and weightbearing was not allowed for 3 months. In three cases, a depression of the elevated fragment, at the most 2.8 mm, recurred during the first month after operation. This was not considered to be significant and more aggressive postoperative mobilisation may be warranted.

Adult↗
PubMed1991

Prevention of neurovascular complications in extension osteotomy of the tibia in poliomyelitis.

Extension osteotomy of the proximal tibia was carried out in patients with quadriceps weakness after poliomyelitis in order to obtain a stable knee during the stance phase. Blood flow in the anterior and posterior tibial arteries was measured by Doppler sonography before, during and after operation. It was found that there was a correlation between the degree of extension of the knee after operation and a diminished blood flow. This probably explains some of the neurovascular complications reported in the literature after this procedure. We recommend that blood flow is monitored sonographically in the postoperative phase and that optimum extension is obtained gradually over a period of time in a hinged plaster cast.

Female↗
PubMed1992

Quantitative early phase scintigraphy in the prediction of healing of tibial fractures.

Imaging with technetium-99m methylene diphosphonate (99mTc-MDP) is established in the diagnosis of infection, neoplasia and ischaemic necrosis in orthopaedic practice, but its role in fracture healing is less well-defined. Previous studies have shown a relationship between fracture site activity (region A), activity in adjacent normal bone (region C) and time to union. The predictive value of the A/C ratio of the image obtained 300-800 s after injection was assessed in a prospective study of 50 patients with closed tibial fractures managed with plaster casts, external fixators and intramedullary nails. There were significant differences in absolute uptake and A/C ratio between the three groups (P less than 0.05), but this was not related to time to union. Reamed nailing alters the distribution of 99m-Tc-MDP uptake so as to reduce the A/C ratio (1.10 +/- 0.20), but there is a promising role for early phase bone scanning in non-operative (A/C = 1.40 +/- 0.21) or externally fixed (A/C = 1.26 +/- 0.22) fractures in conjunction with other non-invasive methods of monitoring the biomechanical environment.

Adolescent↗
PubMed1987

A prospective study of the treatment of severe tears of the lateral ligament of the ankle.

A prospective randomized clinical study was undertaken to compare bandaging, plaster cast immobilisation and operative treatment for recent tears of the lateral ligament of the ankle. The follow-up period was two years. Subjectively, only the fear of giving-way showed a clear difference in favour of operative repair. Objective evaluation, including stress radiographs, demonstrated no statistical differences between the three methods of treatment. Although bandaging appeared somewhat less satisfactory with respect to the resulting stability of the ankle, the differences were not statistically significant. The lateral ligament in patients over 40 years of age showed a statistically significant tendency to heal less well than that of younger patients. Severe ankle sprains in patients under 40 years of age should preferably be treated by operation, especially in younger patients and if the person is physically active. Lateral ligament tears in patients over 40 years of age should be treated conservatively and a secondary reconstruction carried out later, if necessary.

Adolescent↗
PubMed1986

Tibial realignment by oblique wedge osteotomy. A new method based on accurate measurement.

A new method for calculating the angle of correction in upper tibial osteotomies is described. The wedge differs from the current techniques in being oblique. The apex is sited on the medial cortex to lie level with the tibial tubercle. The wedge is coned downwards at an angle of 45 degrees, based laterally. This keeps clear of the bifurcation of the popliteal artery, whilst still being contained in the cancellous zone. The method of accurately determining the angle of the wedge and the width of the base using logarithmic calculations is outlined. Being oblique, on removal of the wedge, the cut surfaces match as they meet. Two screws are inserted to lie at right angles to the plane of osteotomy. A long leg plaster cast is worn for six weeks. Thereafter a cast brace is substituted to permit knee and ankle movements. The osteotomy unites rapidly across the large oblique contact surfaces. Pain relief has been substantial and lasting in every patient. The range of flexion returned to the level elicited under anaesthesia immediately prior to the operation.

Ankle↗
PubMed1987

Fine structural changes in the articular cartilage of the rat's knee following short-term immobilisation in various positions: a scanning electron microscopical study.

The knee joints of 36 rats were immobilised in a padded plaster cast (18 in the flexed and 18 in the extended position) for 1, 2 and 3 weeks. The femoral articular cartilage was then examined under the scanning electron microscope. After 1 week's immobilisation in the flexed position, the surface layer of the cartilage showed disruption and the superficial chondrocytes were necrotic. The sites of the necrotic chondrocytes were seen as pits on the cartilage surface. In the animals whose knees were immobilised in the extended position, the changes were not so great in severity or extent. After 2 weeks, more advanced changes could be detected in both groups, but they were more severe in the flexed group. After 3 weeks the changes in articular cartilage were diffuse in the flexed, but focal in the extended group. Diffuse necrosis of chondrocytes, with pit formation on the surface and disruption and disintegration of the collagen fibres, was seen to some extent in all the animals. In the flexed group the changes extended to the whole weightbearing surface of the articular cartilage of the femur, except the intercondylar sulcus. In the extended group, a superficial fibre network was found without the formation of closely packed collagen fibre bundles, and the changes in the chondrocytes were seen only in localised zones. The authors suggest that during immobilisation, especially in the flexed position, articular hypoxia occurs due to a decreased amount of synovial fluid, the increased compression of the cartilage surfaces and the increased intra-articular pressure. This causes degeneration and necrosis of the superficial chondrocytes and the superficial cartilage layer.

Animals↗
PubMed1984

A new method for osteosynthesis using dielectric (non-conductive) fixation devices.

Investigation in the field of electrophysiology shows that bioelectric phenomena of different origin are present in bone, the most important being the bioelectric potential connected with bone viability and metabolism. The negative biopotential is high at the fracture site where metabolism is also increased. During healing the negative values decrease and when it is complete the configuration of biopotentials along the length of the bone regains the pattern characteristic of intact bone. Negative biopotentials are needed to achieve callus formation and they disappear when healing has occurred. A metal device is used for osteosynthesis to obtain stable fixation of the fragments, but the electroconductive metal produces a 'short-circuit' of biopotentials along its length, so depriving the bone of necessary negative biopotential. Consequently the intensity of the metabolic processes is also reduced, leading to a relative delay in callus formation. Although a plaster cast may fail to provide adequate stability the natural electrophysiological conditions are preserved, and the period of callus formation is shortened. The negative biopotentials required for fracture union may be preserved by using non-conductive (dielectric) implants to achieve stable osteosynthesis.

Animals↗
PubMed1984

The early treatment of peritalar dislocation.

Peritalar dislocation is an uncommon injury and was first described after flying accidents. Ten patients are reported who sustained this injury after minor trauma. They were treated by closed reduction and immobilisation of the ankle in a plaster cast for between 10 and 12 weeks, the first 2 weeks being non-weightbearing. No degenerative changes were detectable in the subtalar joints one year after injury. Early reduction and immobilisation may be significant in reducing the incidence of degenerative arthritis in the subtalar joint.

Adolescent↗