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At least 955 records · Page 53Linked to original sources
PubMed1984

Infra-isthmal longitudinal fractures of the tibial diaphysis: results of treatment using closed intramedullary compression nailing.

A followup study of 103 patients with long spiral or oblique fractures of the shaft of the tibia distal to the isthmus of the intramedullary canal was done. The injuries were caused by indirect violence, and consequently the soft-tissue damage was minimal while the degree of initial displacement and instability varied considerably. The initial management was conservative by closed reduction and long plaster cast. Failure to retain the fragments in an acceptable position occurred in 32 cases, and in these closed intramedullary compression nailing with the Kaessmann rod was undertaken 9 days postinjury on an average. The ultimately nailed 32 fractures had a significantly shorter clinical union time than the 71 conservatively treated fractures in spite of the initially more severe average lateral displacement. Deep infections were not seen. The malunion rate was 9% after compression nailing and 27% after conservative treatment. The functional recovery showed a marked correlation with the anatomic restoration.

Bone Nails↗
PubMed1987

Simultaneous dislocation of the interphalangeal joint of the thumb and the carpal lunate.

A dislocation of the interphalangeal joint of a thumb was treated without problems. The simultaneous dislocation of the lunate was not diagnosed or treated until the plaster cast was removed. Even in cases with an obvious lesion like a finger joint dislocation it is necessary to investigate all other fingers and the wrist to exclude other lesions and to avoid delay in treatment.

Adult↗
PubMed1990

Skeletal transfixation in treatment of comminuted fractures of the distal end of the radius in the elderly.

Ninety-five patients (71 females and 24 males), average age, 69 years (35-92 years), with comminuted distal radial fractures were treated with transfixation wires (Kirschner wires) through the bases of metacarpals II-V and an above-elbow plaster cast. Two cases of early infections and four of Sudeck's dystrophy (4.2%) were encountered. Followup studies which lasted an average of 24 months (9-50 months) could be conducted on 77 patients. Using Sarmiento's ratings 27 patients fell into the very good category, 44, good, eight, fair, and two, poor. Although most of the cases were of the comminuted intra-articular fracture types, good results were achieved with this simple and quite straightforward method.

Adult↗
PubMed1991

Delayed union of fibular fractures accompanying fractures of the tibial shaft.

Among 440 adult patients with tibial shaft fracture and accompanying fibular fracture there were eight cases with radiographically ununited fibulae 4 months after the injury, each with uneventful tibial union. Fractures with severe soft-tissue injuries were excluded from this study. In 293 patients the treatment method of the tibial fracture was conservative, comprising closed reduction and immobilization by long plaster cast. In 147 patients it was intramedullary Küntscher nailing, and all the eight cases with delayed fibular union occurred among these, the frequency being 5.4%. The typical accompanying fibular fracture to develop delayed union was a comminuted one in the middle or distal third of the bone. At a followup examination 5 to 8 years after the original injury four of the eight fractures were found to have ultimately spontaneously united, while three showed a radiographically indisputable nonunion. One patient had undergone segmental fibular ostectomy because of persistent local pain but in the remaining patients the subjective symptoms were negligible. The occurrence of delayed fibular union in association with rigid intramedullary nailing of concomitant tibial shaft fracture is a phenomenon of which trauma surgeons should be aware even if the natural course of the condition often seems to be benign.

Adolescent↗
PubMed1993

Isolated lateral traumatic dislocation of the radial head in a boy: case report.

Lateral traumatic dislocation of the radial head occurred in a 9-year-old boy with cubitus varus. Reduction of the dislocation and immobilization of the arm in flexion and supination in a plaster cast for 4 weeks were done and after 6 months the boy returned to school, with no problems in daily living.

Biomechanical Phenomena↗
PubMed1985

Technique for achievement and maintenance of reduction for severe spondylolisthesis using spinous process traction wiring and external fixation of the pelvis.

A technique is described for achievement and maintenance of reduction for severe spondylolisthesis in conjunction with reconstructive surgery. Spinous-process traction wires exert a posterior and cephalad force on the lumbar spine, while Hoffman pins anchored to the ilium rotate the sacrum in an anterior and caudad direction. Once maximum reduction is achieved, the patient is kept supine for 3 months with pins and traction wires incorporated in a plaster cast. At follow-up, two patients demonstrated excellent correction of slip angle and a solid fusion.

Adult↗
PubMed1996

Transverse stress fracture of the patella: a case report.

PURPOSE: A high index of suspicion is necessary to make the diagnosis of stress fractures in athletes. This is a case report of a soccer player who sustained a transverse stress fracture of the patella. CASE SUMMARY: The soccer player experienced mild discomfort to the patella for 1 month. He then developed severe pain after a twisting motion while playing soccer. Radiological examination showed an undisplaced transverse fracture of the patella. After immobilization in a plaster cast and rehabilitation, he returned to normal activity in 3 months. DISCUSSION: Only six cases have been reported in the literature to date. RELEVANCE: This case illustrates the need to consider a stress fracture when pain in the patella persists.

Adult↗
PubMed2005

Effect of cyclic pneumatic soft tissue compression on simulated distal radius fractures.

We investigated the effect of pneumatic pressure applied to the proximal musculature of the sheep foreleg on load at the site of a transverse osteotomy of the distal radius. The distal radii of 10 fresh sheep foreleg specimens were osteotomized and a pressure sensor was inserted between the two bone fragments. An inflatable cuff, connected to a second pressure sensor, was positioned around the proximal forelimb musculature and the leg then was immobilized in a plaster cast. The inflatable cuff was inflated and deflated repeatedly to various pressures. Measurements of the cuff pressure and corresponding change in pressure at the osteotomy site were recorded. The results indicated that application of pneumatic pressure to the proximal foreleg musculature produced a corresponding increase in load at the osteotomy site. For the cuff pressures tested (109.8-238.4 mm Hg), there was a linear correlation with the load at the osteotomy site with a gradient of 12 mm Hg/N. It is conceivable, based on the results of this study, that a technique could be developed to provide dynamic loading to accelerate fracture healing in the upper limb of humans.

Animals↗
PubMed2007

Bilateral femoral fatigue fracture: an unusual fracture in a military recruit.

We present a case report of a military recruit who had bilateral fatigue fractures of the distal femur. Possible predisposing factors and the long-term outcome of these unusual stress fractures also are presented. A 19-year-old recruit experienced knee pain 2 weeks after starting his military service. Bilateral nondisplaced transverse fatigue fractures were detected radiographically in the supracondylar region on the right side and in the distal 1/3 of the femoral shaft on the left side. The fractures were treated with plaster casts for 5 weeks and healed properly. Osteopenia was seen in further examinations. At followup after 31 months followup the patient had fully resumed his previous athletic activity level and was symptom-free. Osteopenia still could be detected at the final examination. Nonoperative treatment with careful followup resulted in a favorable outcome in the nondisplaced bilateral distal fatigue femoral fractures in this patient.

Adult↗
PubMed2005

Unreduced chronic dislocation of the humeral head with ipsilateral humeral shaft fracture: a case report.

The purpose of reporting this case is to illustrate a treatment plan for a chronically anteriorly dislocated shoulder associated with an ipsilateral humerus fracture, a condition heretofore not addressed in the literature to our knowledge. An 18-year-old female, left hand dominant, injured her left upper extremity and liver in a motor vehicle accident. X-rays at time of injury revealed a diaphyseal facture of her left humerus. No x-rays of the shoulder were taken at time of injury. Treatment consisted of a plaster cast application and discharge at 1 week. The patient was seen again 4 weeks postinjury, at which time only humerus films were taken and the immobilization was continued. At 45 days postinjury, the patient complained of left shoulder pain, and shoulder x-rays at that time revealed an anterior subcoracoid dislocation of the left humeral head. At surgery 52 days postinjury, the humeral shaft fracture was found to be unstable and external fixation of both the fracture (2 pins above and below the fracture) and the reduced but still unstable humeral head was performed (a pin through the humeral head into the glenoid). The external fixator was removed at 3 weeks, and at a 3-year follow-up, the patient had acquired nearly full range of motion of her shoulder without pain and no significant limitations of her arm movements or activities. In conclusion, given a patient with a chronic anteriorly dislocated shoulder and a healing ipsilateral shaft fracture, an external fixation stabilization of both the fracture and the relocated repaired dislocation is a viable treatment option.

Adolescent↗
PubMed2005

A new device for creating and positioning an autogenous cartilage framework during microtia reconstruction.

OBJECTIVE: This paper describes the fabrication and use of a three-dimensional appliance, known as the microtia surgical positioner, to more accurately position and better sculpt the autogenous rib cartilage graft during microtia reconstruction. STUDY DESIGN: The authors introduce a new device design and surgical application. METHODS: An impression and plaster cast were made from the patient's auricular defect. On this cast, the artist then created a wax baseplate and an esthetically pleasing wax sculpture of an ideal ear similar to the patient's normal contralateral ear. The surface contour of the patient's auricular defect locked the wax baseplate into a stable position, the ear sculpture was then properly positioned on the baseplate, and the two pieces were joined. The artist made a silicone mold of the wax prototype and casted the clear acrylic resin surgical positioner using that mold. Finally, an opening along the helical portion was drilled in the positioner. Intraoperatively, the positioner locked into the surface contour of the patient's auricular defect, thus assuring accurate positioning of the cartilage graft. The surgeon marked the correct helix position with the device's helix and helical port and used the positioner as a model to guide the carving and assembly of the cartilage framework. RESULTS: Our group successfully created and used a microtia surgical positioner. The positioner guided accurate superior-inferior, anterior-posterior, and rotational placement of the helical portion of the cartilage graft. The surgical positioner also significantly contributed to detailed sculpting of the graft. CONCLUSIONS: : Medical artists and surgeons may cooperate to fabricate and use a surgical positioner to guide accurate placement of the cartilage framework and assist with sculpting of the graft for total auricular reconstruction.

Adult↗
PubMed2003

A long-term retrospective outcome assessment of facial growth, secondary surgical need, and maxillary lateral incisor status in a surgical-orthodontic protocol for complete clefts.

In 1965, the cleft palate team at Children's Memorial Hospital embarked on a new surgical-orthodontic protocol in the habilitation of newborn complete cleft lip and palate cases. It brought the orthodontic effort into focus at birth and in planned sequence to correspond with the surgical procedures of lip closure, maxillary alveolar stabilization by means of an autogenous graft of the authors' design, and complete palate closure, all within the first year of life. The purpose of this investigation is threefold: first, to review the authors' previous publications and assess growth, secondary surgical need, and lateral incisor status of teeth adjacent to the cleft in a series of patients who have all followed a precise, early surgical/orthodontic protocol; second, to compare these cases with other collaborative studies wherein this protocol was not used; and third, to report on an additional 82 cases with regard to secondary surgical need and the status of teeth adjacent to the cleft. Methods of assessment have included cephalometric radiography, periapical and occlusal dental radiography, computer-assisted tomography, plaster cast analysis, and intraoral and extraoral photography. The authors have demonstrated, along with other collaborative studies, that there is growth as good as other similar samples wherein there was no primary osteoplasty. In addition, the authors found their incidence of orthognathic surgery to be 18.29 percent; pharyngoplasty, 3.65 percent; and oronasal fistulas requiring surgical closure, 29.27 percent. In the case of unilateral complete clefts, 53.13 percent of those lateral incisors present adjacent to the cleft area were usable, and in bilateral cases, 57.77 percent were usable. The authors remain convinced after more than 35 years of following this successful protocol that early maxillary orthopedics and their technique of primary osteoplasty in planned sequence with lip and palate closure can produce a more favorable alignment of maxillary growth potential and, with comprehensive orthodontic treatment, can lead to teeth in a better overall occlusion than if these procedures had not been undertaken.

Adolescent↗
PubMed2006

Comparative study of maxillary growth and occlusal outcome after autogenous rib grafting in complete cleft palate defect.

Cleft palate is a congenital deformity with soft tissue and hard tissue defects. Normal cleft palate repairing surgery only repairs soft tissue defects, whereas bone defects in the hard palate still exist. Therefore, we conducted this study in beagles to observe the influence of bone grafting at primary surgery on craniofacial growth and occlusal relationships in individuals with complete cleft palate and to provide experimental evidence for optimal surgical procedures for cleft palate. Using 60 beagle puppies as subjects, we tested the effects of bone grafting in surgically induced palatal defect. The animals were randomly and equally divided into four groups: (1) unoperated controls; (2) surgically induced unilateral cleft palate, not repaired; (3) two-flap palatoplasty used to close the soft defect of the surgically induced cleft palate; (4) autogenous bone (a piece of rib bone) implanted into the palatal defect before two-flap palatoplasty was performed.Cephalometric roentgenography and plaster casts of the maxillary were taken preoperatively and every 4 weeks after surgery. Sixty metric cranial variables were measured directly from the cleaned skulls after the animals were killed the 34th week postoperatively. The measurement results indicated that bone grafting may reduce the disturbance of maxillary growth caused by the cleft palate and the denuded bone, but it may cause other maxillary deformities. This finding suggests that surgeons should be careful in choosing the method of primary bone grafting in repairing complete cleft palate.

Animals↗
PubMed1995

Imaging strategies in the first 12 months after reduction of developmental dislocation of the hip.

We have reviewed the records of 32 infants whose developmental dislocation of the hip (DDH) was treated by reduction and immobilization in a plaster cast. We examined 50 CT scans from 22 patients. The postreduction radiological studies led to a change of cast in 10 patients and, in five of them, the subluxation shown on CT scan was not seen in an earlier radiograph. Where reduction has been undertaken at the time of arthrography or in an older child, a plain radiograph may be adequate to confirm the position in the cast. In an infant, CT scans give superior information, have acceptable risks, and should be used in association with radiation protection measures.

Arthrography↗
PubMed1996

Orthopaedic treatment and passive motion machine: consequences for the surgical treatment of clubfoot.

The efficacy of orthopaedic treatment and its influence on clubfoot surgery has never been truly demonstrated. In the unsorted mass of clubfeet treated, it is difficult to determine exactly how effective orthopaedic treatment is for severely affected feet. If properly performed, perfectly synchronized, and supported by a Kinetec machine, such treatment can noticeably reduce the rate of operation and, when operation is still required, reduce its extent. In grade II soft > stiff feet with scores of 5-10, Kinetec-supported orthopaedic treatment is extremely effective. Operation is required in 32% of cases only, and posterior surgery is often sufficient. Lateral release, in this category, is never required. In grade III stiff > soft feet, with scores of 10-15, the efficacy of orthopaedic treatment associated with the Kinetec machine is far from negligible and operation most often includes posterior and medial release (PMR), variably associated with plantar release. Lateral release is exceptional (15%), and operation is necessary in 75% of cases. In grade IV stiff = stiff feet, with scores of 15-20, orthopaedic treatment with the Kinetec machine has a true, though limited, effect. In this category, operation is necessary in 90% of cases. Lateral release is performed in 50%. In the postoperative period, orthopaedic treatment combined with use of the Kinetic machine must be continued. Orthopaedic treatment coordinated with use of the machine has considerably shortened the duration of plaster cast immobilization; 2 months when operation included posterolateral-medial (PLMR) release or PMR, and only 1 month when operation was posterior release (PR). The machine has noticeably changed the results and has indisputably influenced operation on the whole.

Clubfoot↗
PubMed1997

Bilateral congenital pseudarthrosis of the olecranon.

A case of bilateral congenital pseudarthrosis of the olecranon is reported in a 15-month-old boy. This abnormality was noted at birth because of a fixed flexion deformity of both elbows. The left side was operated on at the age of 16 months and the right side at 21 months. Surgical exploration showed a mobile pseudarthrosis with a 2-cm gap between the tip of the olecranon and the nucleus, each one covered with cartilage. This cartilage was excised, the triceps tendon was lengthened to allow the lowering of the nucleus, and both fragments were fixed with nylon threads. The elbow was kept extended for 30 days in a plaster cast. Fusion was obtained shortly. At the 2-year follow-up, the function was nearly normal as was the radiological appearance. This abnormality is very rarely reported in the literature, and we emphasize the necessity of an early operation.

Diagnosis, Differential↗
PubMed2005

Focal dome osteotomy for the correction of tibial deformity in children.

Tibial deformity in childhood often combines torsional and angular malalignment. A focal dome osteotomy was performed, proximally or distally, in 39 tibiae in 31 patients. In 33 limbs, the primary deformity was varus (with internal torsion). The osteotomy was held with K-wires and a plaster cast. The mean age at surgery was 10.25 years and the minimum follow-up 24 months. All osteotomies united and no compartment syndrome occurred. Postoperatively, two patients (5%) had temporary neurological deficits. Thirty of 31 patients had good clinical and radiological correction of alignment. Recurrent deformity was seen in one patient with hypophosphataemic rickets.

Adolescent↗
PubMed1984

Physeal, metaphyseal, and diaphyseal injuries of the lower extremities in children with myelomeningocele.

A study of 16 patients with myelomeningocele who sustained 37 fractures revealed that children with diaphyseal and metaphyseal fractures presented with local warmth, redness, swelling, and increased general body temperature, leukocytosis, and sedimentation rate. These fractures were the result of a single stress or trauma and healed uneventfully by splinting for approximately 4 weeks. In physeal injuries, which probably resulted from repetitive stresses, the systemic response was less pronounced. These injuries had to be immobilized more rigidly in plaster casts for a minimum of 8 weeks.

Adolescent↗