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At least 775 records · Page 43Linked to original sources
PubMed1998

Prolonged progressive calcaneal bone loss despite early weightbearing rehabilitation in patients surgically treated for Achilles tendinosis.

We prospectively evaluated areal bone mineral density (BMD) of the calcaneus and calf-muscle strength (concentric and eccentric plantar flexion peak torque in Nm) in 10 recreational athletes (5 males and 5 females), mean age 40.9 years (range 26-55), who were selected to undergo surgical treatment for chronic Achilles tendinosis localized at the 2-6 cm level. Surgery was followed by immobilization in a plaster cast for 2 weeks, followed by flexibility training and slowly progressing strength training and weight-bearing activity. One patient was excluded after week 0 because of a new injury. Seven patients were back to their preinjury activity at the 26-week control, and eight patients at the 52-week control postoperatively. BMD in the calcaneus and calf-muscle strength on the injured and noninjured side was measured preoperatively (week 0) and postoperatively (weeks 2, 6, 16, 26, and 52). There were no significant differences in BMD between the injured and noninjured side at weeks 0, 2, and 6, but at weeks 16, 26, and 52, BMD was significantly (P < 0.05) lower (11.5%, 18.4%, and 16.4%, respectively) in the calcaneus of the injured side. Concentric and eccentric plantar flexion strength were significantly lower on the injured side preoperatively. Eccentric, but not concentric plantar flexion strength had recovered compared with the noninjured side 1 year postoperatively. Calf-muscle strength was not related to bone mass in the calcaneus. As a comparison, we used a group of 11 recreational athletes (10 males and 1 female), with a mean age of 46.1 years (range 28.9-58.5) who had been surgically treated for chronic Achilles tendinosis at the 2-6 cm level 39.5 +/- 11.8 months ago. In this group, there was no significant difference in BMD of the calcaneus between the injured and noninjured side. It seems that there was a delayed and prolonged calcaneal bone loss despite early weightbearing loading in patients surgically treated for chronic Achilles tendinosis at the 2-6 cm level. Around that time, when the Achilles tendon had healed (4-6 months) and the athletes returned to their sports, the calcaneal bone had a relatively low BMD and might possibly be vulnerable to heavy loadings. There were no signs of recovery 1 year postoperatively, but in a comparison group there were no significant side-to-side differences 39.5 months postoperatively.

Absorptiometry, Photon↗
PubMed2002

Primary bone grafting does not improve the results in severely displaced distal radius fractures.

We prospectively randomised 45 patients ages 20-70 years with distal radius fractures of Older type III and IV to one of two treatment groups. One group was treated with closed reduction, primary bone grafting, and external fixation for 3 weeks, followed by a plaster cast that allowed volar flexion, for an additional 3 weeks. The other group was treated with closed reduction and external fixation for 6 weeks. The functional and radiographic results were evaluated. There was no difference between the two groups in either clinical or radiographic outcome. We do not recommend external fixation and primary bone grafting as a routine method in these fractures.

Adult↗
PubMed2006

Less is more: lag screw only fixation of lateral malleolar fractures.

Displaced fractures of the lateral malleolus are typically treated with plate osteosynthesis with or without the use of lag screws, and immobilisation in a plaster cast for up to 6 weeks. Fixation through a smaller incision with less metal, such as lag screw only fixation, would theoretically lead to decreased infection rates and less irritation caused by hardware. The purpose of this study was to evaluate the benefits and success of lag screw only fixation of the lateral malleolus in non-comminuted oblique fractures of the lateral malleolus. A total of 25 patients who had non-comminuted unstable oblique fractures of their lateral malleolus that had been surgically fixed with lag screws only were retrospectively evaluated. All patients were younger than 60 years of age. Evaluation of the success of fixation, complications, resultant mobility and patient satisfaction was based on information gathered from chart reviews, X-ray findings and a standardised questionnaire based on the AOFAS Foot and Ankle Outcomes Questionnaire. These results were compared to an age-matched group of 25 consecutive patients treated with plate osteosynthesis. Of the 25 patients fixed with lag screws, nine had an unstable fracture of the lateral malleolus only, ten were bimalleolar fractures and six were trimalleolar. Eighteen patients were treated with two lag screws, and seven were treated with three lag screws. The bi- and trimalleolar fractures were treated with standard partially threaded cancellous screws. None of the lag screw-only group lost reduction. There were no documented wound infections in the lag screw group as compared to three deep infections in the plate group. Lag screw-only patients reported no palpable hardware as compared to 50% of the plate group. AOFAS scores at a mean of 12 months post-operative were similar in both groups. Lag screw only fixation of the lateral malleolus is a safe and effective method that has a number of advantages over plate osteosynthesis, in particular less soft tissue dissection, less prominent, symptomatic and palpable hardware and a reduced requirement for secondary surgical removal.

Adolescent↗
PubMed2001

Occupational therapy and Colles' fractures.

In this randomized trial, we enrolled 30 patients treated for a distal radius Colles' type fracture. The fractures were reduced if necessary and fixed in a below-elbow plaster cast for 5 weeks. One group consisting of 14 patients received instructions for shoulder; elbow and finger exercise and the other group consisting of 16 patients had occupational therapy. At 5 weeks, 3 and 9 months we measured the functional scores. There were no statistically significant differences between the groups at any time. It seems that for non-surgically treated patients with a distal radius fracture only instructions are necessary.

Activities of Daily Living↗
PubMed1998

The treatment of displaced supracondylar fractures of the humerus in children. A comparison of three methods.

This retrospective study compares the long-term results of the treatment of 135 children with displaced extension-type supracondylar fractures of the humerus using 3 different methods. Closed reduction and percutaneous fixation was superior with excellent and good results in 87% and had the lowest incidence of poor results (8%). Open reduction and wire fixation, and closed reduction with a plaster cast gave excellent and good results in 74% and 60% respectively. Closed reduction and wire fixation is recommended as the treatment for grades II and III supracondylar fractures.

Bone Wires↗
PubMed2002

The use of external fixators in the immobilization of pediatric fractures.

The use of external fixation in the immobilization of diaphyseal and metaphyseal fractures in children is still controversial, as these fractures are generally managed by immediate plaster casting, by traction followed by casting, by various methods of internal fixation, including the recently developed flexible rods, and by plating. Between 1982 and 1998, we treated 64 children with fractures of the long bones of the lower limb using external fixation, 44 of whom were available for follow-up (46 fractures). Their average age on the day of injury was 8.l years. Average follow-up extended for 4 years. The external fixation used was left in place for an average of 67 days. Full range of movement was achieved in 42 children (44 limbs). The longitudinal axis was anatomically correct (<5 degrees angulation) in 40 children (42 limbs). Due to malalignment of the fracture (15 degrees varus) in one child, tibial osteotomy was performed 4 years after fracture healing. There was no leg length discrepancy in 38 children, and shortening of >2 cm was measured in the fractured limbs of 2 children. We found the use of external fixators to be easy, quick, with a short learning curve, and appropriate for comminuted and closed fractures of the long bones, and especially for children with polytrauma.

Adolescent↗
PubMed2003

Concomitant plantar tarsometatarsal (Lisfranc) and metatarsophalangeal joint dislocations.

We report an unusual case of concomitant plantar tarsometatarsal (Lisfranc) and 1st and 2nd metatarsophalangeal (MTP) joint dislocations and fracture of the neck of the third metatarsal bone which has never been reported before. The plantar dislocation of the Lisfranc joint was treated by open reduction and fixation with K-wires; the dislocations of the MTP joints and neck fracture of the third metatarsal bone were treated by closed reduction and percutaneous fixation with K-wires and immobilized with a plaster cast. At the 5 year follow-up examination, our patient had no complaints, but the radiograph showed degenerative changes of the Lisfranc and the 1st MTP joint.

Adult↗
PubMed2004

Dorsal scapholunate ligament reconstruction using a periosteal flap of the iliac crest.

INTRODUCTION: To report a new technique for scapholunate ligament reconstruction, using a periosteal flap of the iliac crest. MATERIALS AND METHODS: In 12 patients with static SL instability, a periosteal flap was harvested from the anterior portion of the iliac crest. Following repositioning of the carpals, the flap was fixed to the scaphoid and lunate between an incompletely osteotomised scale at the dorsal horn of the scaphoid and lunate. Pin fixation of the scapholunate (SL) and CL interval secured postoperative reduction for 8 weeks. A forearm plaster cast was worn for 12 weeks. RESULTS: Eleven patients, all male, were available for follow-up at an average of 29 months. The interval between trauma and surgery averaged 15 months. The preoperative SL angle measured 77 deg, CL angle was -10 deg, and SL gap amounted to 5.2 mm. At follow-up, SL angle was 59 deg, CL angle measured -2 deg, and SL gap was 2.1 mm. SL gap, SL angle, and CL angle improved significantly from preoperative to follow-up values. According to the clinical grading system of Green and O'Brian, 6 patients scored in the excellent and good category and 5 in the fair category. Using the radiologic grading system of Gickel and Millender, 9 patients scored as excellent and good, whereas the 2 poor results were due to failure of the technique. CONCLUSION: The technique enables reduction of the SL angle and SL gap in patients with static reducible scapholunate instability. The initial results are quite encouraging.

Bone Transplantation↗
PubMed2000

The 'mirrored' Bennett fracture of the base of the fifth metacarpal.

Fractures of the base of the metacarpals are usually treated conservatively. The intra-articular fracture of the base of the first metacarpal ('Bennett fracture') is an exception to this rule because inadequate repositioning and fixation of the dislocated radial fragment lead to permanent deformity of the joint and subsequent degenerative joint disease. The dislocated intra-articular fracture of the base of the fifth metacarpal is similar to a Bennett fracture in many aspects. Repositioning of this 'mirrored' Bennett fracture cannot be guaranteed by a plaster cast. Inadequate repositioning will lead to pain, reduced strength and early degenerative joint disease. We present six patients with dislocated intra-articular fractures of the base of the fifth metacarpal to illustrate the necessity of surgical reduction and fixation.

Adult↗
PubMed1999

Loss of correction after lateral closing wedge high tibial osteotomy--a human cadaver study.

In 12 human cadaver tibiae, osteotomies were carried out at two levels (2 and 3 cm from the distal joint line) with three different wedges (5 degrees, 10 degrees, 15 degrees) to evaluate the influence of displacement of the osteotomy fragments on areas of cortical contact. In undisplaced osteotomies (medical cortical edges superposed) cortical contact areas formed 28% (level 2 cm) and 40.5% (level 3 cm) of the cortical circumference of the proximal fragments (NS). Wedge angles and levels of osteotomy displayed no statistical differences. In displaced osteotomies cortical contact decreased significantly (P < 0.05). Displacing the distal fragment laterally, medial cortical contact is lost, and weight-bearing leads to revarisation as cancellous bone sustains only 3 MPa, and the measured compressive stresses at the medial edge amounted to 6 MPa on average. Displacing the distal fragment medially leads to a decrease of total cortical contact, too, but at the medial edge of the osteotomy cortical contact areas are still present. As a result of the study, postoperative weight-bearing without additional plaster cast fixation is recommended only in cases with undisplaced fragments.

Cadaver↗
PubMed2001

Operative treatment in case of a closed rupture of the anterior tibial tendon.

Closed rupture of the tibial anterior tendon is a rare clinical entity. Case reports in the literature reveal a total of only 49 cases up to the year 2000. According to these reports, the age group affected is 50 to 70 years old, and there are more men than women affected. Although the functional limitation is quite considerable, late diagnosis is common. An appropriate clinical examination, including an exact history taking, should lead to the right diagnosis. Ultrasound examination and magnetic resonance imaging (MRI) may be helpful. 'Restitutio ad integrum' can only be achieved by operative treatment. If technically possible, reinsertion of the tendon directly into bone or direct tendon repair is preferred. After delayed diagnosis, a secondary reconstruction through tendon transfer or transplantation is often necessary. A 64-year-old woman presented with pain and swelling in the area of the ankle joint 5 months after falling. She showed insecurity in walking, and the heel-walk could not be demonstrated. The distal neurovascular function was intact. The area of the retinaculum showed a swelling, and the tendon was not palpable in comparison with the other forefoot. An intact tendon could not be seen by ultrasound, and MRI confirmed these findings. A complete rupture was noted during the operative revision. The proximal and the distal tendon stumps were found to be thickened and knotted, the proximal stump was also atrophic. An augmented tenoplasty was performed. Afterwards, the tendon was tense in the neutral position. The lower leg was put in a plaster cast for 6 weeks, followed by physiotherapy. Ten months after the operation, the tendon was palpable in the correct position, the dorsal extension was powerful, and the patient did not experience any difficulty. Rupture of the anterior tibial tendon is a rare clinical entity and should be considered in the differential diagnosis of pain in the area of the ankle joint. An early operative treatment is advantageous.

Ankle Injuries↗
PubMed2002

[3-dimensional image acquisition for analysis of primary, cleft-induced facial deformity with an optoelectronic surface scanner].

BACKGROUND: Anthropometric analysis of the face has been performed with direct facial measurement and photogrammetry. Both methods have disadvantages. The aim of our investigation was to create a three-dimensional image of the primary cleft nasal deformity with a video scanner and to carry out linear measurements. MATERIAL AND METHODS: Facial plaster casts of 19 patients with uni- and bilateral cleft lip and palate before primary lip repair were scanned with digital surface photogrammetry DSP 400. The width of the nose and of the nostril floor, the distance of the alar bases, the length of the ala, and the nasal tip protrusion were measured. RESULTS: Imaging was possible without problems in all models. Direct measurements of the model correlated well with the results of the three-dimensional image. Significant dimensional differences of the nasal parameters examined were noted, depending on the cleft type. DISCUSSION: A video-supported surface scanner allowed immediate three-dimensional imaging of the face. The computer software analyzed the generated surface exactly. The data measured with the presented system resembled other previously published results.

Casts, Surgical↗
PubMed2006

[Lip, jaw, and palate clefts. Analysis of unilateral cleft lip using 3-D laser topometry].

INVESTIGATION: In most cases it is not sufficient to use photographs and plaster casts to document and analyze the three-dimensional morphology of lip, jaw, and palate clefts. The aim of this study was to evaluate the applicability of surface scanning with a 3-D laser topography scanner in patients with unilateral cleft lip. PATIENTS AND METHODS: Three-dimensional surface scans of the face were performed pre- and postoperatively in 20 patients (3-35 years of age) with a 3-D laser topography scanner. All patients were suffering from nonoperated, one-sided cleft lip, cleft lip-jaw, or cleft lip-jaw and palate. The digital data sets were metrically analyzed and expressed on the basis of quotients, independent of size factors. RESULTS: Using this 3-D laser scanner it was possible to acquire good quality three-dimensional data sets. Measurements were in the dimension of millimeters. Based on the data sets it was possible to provide the three-dimensional cleft morphology with reproducible landmarks and analyze the data. The postoperative symmetry of the face was controlled and objectively quantified. It is disadvantageous however that numerous views need to be taken to get the full image of the face and that the scanning process takes about 2 s. CONCLUSION: The presented 3-D laser scanner renders a precise 3-D surface analysis of the lip and nose region in cleft patients. For lively infants or uncooperative adults, the system is suitable only to a limited extent due to the time-consuming scanning process.

Adolescent↗
PubMed1998

[What effect does using the Latham devices have on craniofacial growth in uni- and bilateral lip-jaw-palate clefts].

Primary gingivoperiosteoplasty according to Millard consists of active presurgical orthopedic treatment with the Latham device at the age of 4 months and surgical covering of the alveolar cleft by local mucoperiosteum flaps at the age of 6 months. The aim of this investigation was to evaluate the facial growth following use of the Latham device. Lateral head X-rays and plaster casts from 146 patients with unilateral and bilateral clefts of lip and palate were investigated (follow-up of 16 years). Ninety-one of these patients formed the control group and received no Latham device and no gingivoperiosteoplasty. The same surgeon and orthodontist treated all of the 146 patients. Three-dimensional growth disturbance was observed after application of the Latham device and gingivoperiosteoplasty. Forty-two percent of patients with UCLP and 40% patients with BCLP had an "open bite" following closure of the alveolar cleft (control group 5%-10%): the length of the upper jaw was shorter than in the control group and the frequency of cross-bite was higher. These results demonstrate that treatment with a Latham device followed by gingivoperiosteoplasty disturbs facial growth. Therefore this treatment should be rejected.

Adolescent↗
PubMed2006

Penile entrapment in a plastic bottle - a case for using an oscillating splint saw.

Penile entrapment is a rare but serious urological emergency, which can easily lead to stangulation and infarction. We report a case of penile entrapment in a polyethylene terephthalate (PET) bottle in a 49-year-old male. Attempts to cut the bottle with a scalpel or a glass saw were ineffective. Finally, the bottle neck was cut longitudinally with an oscillating saw intended for cutting plaster casts.

Constriction, Pathologic↗
PubMed1975

Mesiodistal crown dimension of the permanent dentition of American Negroes.

A study of the mesiodistal crown dimension was conducted on the teeth of 162 American Negroes, equally divided between males and females. A total of 3,980 teeth were measured. Teeth were measured from the plaster casts by means of Boley gauges. The sample was drawn from a growth study, private practice, and a dental clinic. The mean width of the teeth of males and females was reported. The teeth of males were larger than those of females for each type of tooth in both arches, although they exhibited a similar pattern of tooth size. The maxillary first premolars were larger than the second premolars, while the mandibular second premolars were larger than the first premolars. The first molars were larger than the second molars in both the maxillary and mandibular arches in both sexes. The ratio of the mandibular dentition ot the maxillary dentition was 94 per cent in both sexes. The ratio of the sum of the widths of the canines and incisors of the mandibular dentition to those of the maxillary dentition was 77 per cent. Also, the ratio of the mandibular incisors to the maxillary incisors was 71 per cent in both sexes.

Black People↗
PubMed1978

Mucogingival changes resulting from mandibular incisor tooth movement.

This study involved a cephalometric analysis of 1,150 fully treated orthodontic cases evaluated by Kodachrome slides, plaster casts, and cephalometric films to determine changes in the width of keratinized gingiva relative to lower incisor tooth movement and to ascertain the incidence of mucogingival problems in orthodontic patients. It was apparent that in a small percentage of cases visible mucogingival changes occurred and could be statistically correlated with the magnitude and direction of tooth movement. In this group of patients 1.3 percent (sixteen) showed a decrease in the width of keratinized gingiva with either minimal movement or some labial movement of the mandibular incisors; 0.69 percent (eight) had an increase in keratinized gingival width concomitant with significant lingual positioning of the lower incisors. The salient point to be made is that with an initial minimal or inadequate width of keratinized gingiva (0 to 2 mm.), mandibular incisor tooth movement over a period of treatment could significantly affect the final quality of gingival health in the critical mandibular anterior region.

Cephalometry↗
PubMed1979

Prediction of lower canine and premolar widths in the mixed dentition.

The purpose of this investigation was to determine whether, with multiple regression analysis, a more accurate method than is now available for predicting the widths of unerupted mandibular canines and premolars of mixed-dentition patients could be developed. Regression analyses were performed on data derived from 83 Caucasian subjects (42 males and 41 females) who participated in the Iowa Growth Study. Measurements were taken on plaster casts of the mandibular incisors, canines, premolars, and first molars. Measurements of the mandibular canines, premolars, and first molars were obtained from periapical radiographs taken with a long-cone technique. Newly developed regression equations for each sex had the highest correlation coefficients and smallest absolute errors of estimate when compared to previously published methods. The new equations and previous prediction methods were tested on a sample of 55 orthodontic patients (23 males and 32 females). The newly developed equations were also the most accurate method of prediction in the orthodontic patient sample.

Adolescent↗