[Technic of the plaster cast].
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Neuropathic foot ulceration is a major medical and economic problem among diabetic patients, and the traditional treatment involves bed rest with complete freedom from weight-bearing. We have investigated the use of walking plaster casts in the management of seven diabetic patients with long-standing, chronic plantar ulcers. Although all ulcers healed in a median time of 6 wk, this therapy was not without side effects, which are described in detail. We conclude that casting is a useful therapy for neuropathic ulcers, although several clinic visits, including cast removal and foot inspection, are necessary to avoid potential side effects caused by the casting of insensitive feet.
We compared two different treatments for displaced distal radius Colles' type fractures (Older type 3 and 4), at two hospitals. We found bridging external fixation superior to reduction and fixation in a dorsal plaster cast regarding both the end-anatomic results at 3 months and the functional scores at 3 and 9 months (modified Gartland and Werley).
The chemical composition, i.e. ash and calcium contents and organic, hydroxyproline, and hexosamine contents of the acetone-dried diaphyseal cortical bone powder of the tibias and the femurs, was studied in adult rats after a) below-knee amputation and b) immobilisation of the one hind leg in a plaster cast. There were no significant differences in the chemical composition of the chemical composition of the bones of the treated extremity as compared with the corresponding bones from the non-treated control leg, either at different times after the amputation and immobilisation, respectively, or when all obtained values from each bone were tested together. The percentage hydroxyproline content of the tibia was found to be significantly higher than that of the femur in both extremities, both in the amputation and in the immobilisation experiment. The pro mille hexosamine content of the tibia, on the other hand, was significantly lower than that of the femur in both extremeities in the immobilisation experiment.
The effect of immobilization for different periods (7, 14, 28 and 42 days) on the aerobic and anaerobic metabolism of rabbit muscles with different functions was studied by measuring the total activity of LDH and MDH as well as the distribution of their isoenzymes. The results showed that on plaster casting the characteristic aerobic metabolism of m. soleus declined with a concomitant increase in glycolytic processes. In m. gastrocnemius the anaerobic metabolism of the muscle was relatively decreased on immobilization, but glycolysis remained the prevailing energy yielding process. On immobilization the metabolism of m. soleus and that of m. gastrocnemius approached each other. This may indicate a certain dedifferentiation of the muscle tissue.
Based on the analysis of 45 cases of comminuted fractures of the lower extremity of the radius, this study points out the insufficiency of conventional treatments. The authors advocate a technique using a Kirschner's wire passed through the metacarpal bones and another one through the ulna, both beind embeded in plaster cast. This method was tested on 19 cases with encouraging results. The technique was precisely described and the authors think that it should be used in fractures incorrectly reduced by conventional methods.