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PubMed1981

Three- tier rare-earth imaging system.

The increased efficiency of gadolinium oxysulfide intensifying screens as compared to calcium tungstate screens depends primarily on increased absorption of x-ray photons coupled with a twofold increase in light output. Whether this increased efficiency can be effectively used in a routine diagnostic department to significantly decrease radiation dose was the subject of this study. Consecutive radiographic examinations (5,806) were conducted using these "rare earth" screens. Each radiographic room used three individual rare earth screen/orthochromatic film combinations in order to obtain different speeds. These were labeled A, B, and C and ranged from "par" speed high detail to "ultra high" speed with less detail but correspondingly less patient radiation exposure. The system selected for a particular examination was based on the radiologists' requirements for imaging of anatomic detail. Those examinations requiring less detailed resolution (such as bone alignment through a wet plaster cast) were assigned the fastest speed available. The use of a rare earth/3-tier system resulted in an overall reduction in radiation exposure of about 80%.

Child↗
PubMed1996

The effect of nontraumatic immobilization on ankle dorsiflexion stiffness in rats.

Experimental evidence supports the general conclusion that 6 or more weeks of immobilization will cause joint contractures due to changes in the capsules of animals whose limbs have been traumatized. There is controversy whether contractures will form in 6 weeks in limbs which are free of trauma. The purpose of this study was to determine if range of motion would be lost in ankle joints of rats following nontraumatic immobilization of the hindlimb for 2 or 6 weeks. The right hindlimb of each animal was immobilized in a plaster cast for 2 or 6 weeks with the left hindlimb serving as a matched control (N = 8). Nonimmobilized rats served as additional controls (N = 4). Following 2 or 6 weeks of immobilization, each rat was sacrificed and the lower leg removed at the knee. An electrogoniometer measured the change in dorsiflexion as torque was applied in increasing increments to the ankle. Load-deformation tests were performed to determine: 1) torque to end range of dorsiflexion, 2) joint excursion with application of 3.57 mNm torque for 2.5 seconds, and 3) joint excursion with prolonged application of 3.57 mNm torque. Only the group casted for 6 weeks demonstrated a significant (p < 0.05) decrease in both degrees of dorsiflexion and joint compliance. The group casted for 6 weeks required five times more torque to achieve end range than the other groups and had a 70% decrease in ankle dorsiflexion when a fixed torque of 3.57 mNm was applied. No significant differences were noted among the remaining groups. These findings suggest that in nontraumatically immobilized joints of rats, dense connective tissue remodels in such a way that mobility is unaffected after 2 weeks, but becomes quite limited by 6 weeks.

Animals↗
PubMed1996

Studies on the reduction indices of the deciduous teeth of Chinese living in Taiwan.

The reduction index of deciduous teeth was investigated statistically. Materials used were plaster casts of the deciduous dentition taken from Chinese children living in Taiwan. The reduction indices showed no sexual differences. In the maxillary teeth, reduction indices of the bucco-lingual diameters (BL) had the largest values, followed by those of the mesio-distal diameters (MD), and those of the crown area (AREA) which were the least. In contrast to the maxillary teeth, in the mandibular teeth, the reduction indices of MD and those of BL had nearly the same values although the reduction indices of MD were slightly larger than those of BL in females (p < 0.05). With respect to the difference between the maxilla and the mandible, in deciduous incisors the reduction index of MD in the mandible was larger than that in the maxilla (p < 0.01). While in BL the reverse relation was noted. In the deciduous molars the reduction indices of BL and AREA in the maxilla were larger than those in the mandible (p < 0.01). The reduction indices showed no significant difference among the Mongoloid populations sampled. This result may be explained by the primitiveness of deciduous teeth.

Asian People↗
PubMed1976

Congenital annular constrictions due to amniotic bands.

Amniotic bands which become involved with fetal parts, especially the extremities, are produced by rupture of the amnion during pregnancy with the consequent union of the extra-embryonic mesoderm in fibrous strings. An infant with the amniotic band syndrome, in whom an annular constriction of the left leg and right hand was found, is described. He was treated successfully by multiple Z-plasties and a plaster cast to correct the clubfoot. The oedema of the leg persisted for 5 weeks and then subsided completely. The role of amniotic abnormalities in the production of congenital malformations is reappraised. The microscopic and histological investigation of the placenta and membranes should accompany every case of fetal malformation in abortuses, stillbirths, and affected newborn.

Abnormalities, Multiple↗
PubMed1984

Facet pattern in intact and restored dentitions of young adults. A comparative study.

The attritional dental pattern was studied clinically and on plaster casts in a group of individuals, 17-22 years old, with intact teeth and in a control group with a 'normal' distribution of dental restorations. The following observations were made: 1) all contact areas between occluding teeth exhibited facets; 2) most facets were located on inclines; 3) facets in the fossa bottom occurred oftenest in the control group and often involved fillings; 4) attritional facets on the distal marginal crest of the lower second molars were oftenest found in the control group; 5) denuded dentin in facets occurred oftenest in the control group; and 6) the number of facets and the worn areas were on an average largest in the control group. The findings in this study indicate a difference in the functional activity between the groups and support the hypothesis that dental fillings can induce changes in the neuromuscular pattern of the masticatory system.

Adolescent↗
PubMed1980

Lip-nose morphology and symmetry in unilateral celft lip and palate patients following a two-stage lip closure.

A new method was developed to evaluate more objectively the morphology of the soft tissue lip and nose after treatment of the unilateral cleft lip and palate deformity. Plaster casts of the mid-face of the patients were analysed by use of angular, linear and surface measurements. Thirty cases were studied 4--10 years after the primary surgery of the lip, performed in two stages ad modum Johanson. The results indicated a satisfactory though slightly short lip in the former cleft area. The alar base of the nose was at the same horizontal level on the cleft as the noncleft side. The cleft nostril, however, was significantly greater in surface area and the length of its long axis as well as its angulation, differed between the two sides.

Cleft Lip↗
PubMed1982

Adolescent facial morphology of early bone-grafted cleft lip and palate patients.

A final evaluation of the effect of early bone grafting (EBG) on facial growth was carried out. The sample included 19 bilateral and 42 unilateral cleft lip and palate patients with an age range of 15-20 years, which meant on average 16 years after the EBG procedure. Roentgencephalometric data indicated maxillary retrognathia in both cleft categories and also deficient vertical descent of the maxilla, especially in the anterior part. In about 40% of the bilateral and 50% of the unilateral cleft patients, the mid-facial growth attenuation had reached such magnitude that surgical advancement of the maxilla was necessary. Analysis of plaster casts revealed that in every second cleft area the EBG operation had made it possible to achieve continuity in the dental arch without the need for prosthodontic replacement of teeth. Fusion of the suture between the (pre)maxilla and vomer was suggested as the reason for the typical mid-facial morphology seen in our patients with the most pronounced growth impairment.

Adolescent↗
PubMed1988

Individually adapted lightweight walking aids with moulded handles for patients with severely deforming chronic arthritis.

Patients with severely deforming rheumatoid arthritis and impaired function of the upper extremity are often unable to use conventional walking aids. This report describes 42 such patients who were equipped with altogether 75 individually manufactured, lightweight walking aids (12 crutches, 12 forearm-crutches, 39 crutch-sticks and 12 sticks). A plaster cast of the patient's grip as well as analysis of the integrated function of the shoulder-elbow-wrist was used when preparing the walking aid. It was thereby possible to produce suitable walking aids for all but one patient. At follow-up after 12-18 months, of use, most patients belonging to functional classes II and III were satisfied with their walking aid(s) and 22 considered it/them indispensable. However, in 4 patients, progressive disease with increased disease activity/deteriorating hand function and in 3 patients increasing shoulder pain reduced their usability. Lack of motivation was one reason for low use intensity. Follow-up demonstrated that most patients were able to use these walking aids without detectable negative effects on the upper extremity. The durability of the walking aid was satisfactory. Thus an individually moulded handle on an adapted lightweight walking aid is important helping patients with severely deforming arthritis to maintain independent ambulation, and should be made more widely obtainable.

Activities of Daily Living↗
PubMed1978

Ideas on the suspension of the below-knee prosthesis.

Comparative studies with the PTB-suction prosthesis and the ordinary PTB prosthesis have provided opportunities to analyze and understand some functional differences in the suspension of below-knee prostheses. In a roentgenological study of the stump-socket contact signficantly less vertical displacement in the PTB-suction prosthesis has been shown. A study of the pressure variations in the suction socket verified the theory of the necessary pressure gradient in the PTB-suction socket. Added negative pressure by muscle action was also observed. An electromyographic study suggested a muscular activity pattern in the suction prosthesis similar to that of a normal leg, as a contrast to the ordinary PTB prosthesis where simultaneous contractions of antagonistic muscles seemed to be the usual pattern. The latter is interpreted as a defence reaction. An optimal prosthesis has been deduced. It shall have a soft prosthetic socket with a perfect fit, a suction, adhesion and friction fixation and a pressure gradient between the skin and the socket wall with minimum compression distally. The plaster casting shall be done in a downward modelling manner making available space for soft tissue without compression.

Amputation, Surgical↗
PubMed1989

A reference shape library for computer aided socket design in above-knee prostheses.

A Reference Library of socket shapes for an Above-Knee Computer Aided Socket Design (CASD) System has been created. This library forms part of a more general CASD System (Dean & Saunders, 1985; Novicov & Foort, 1982). It consists of a matrix of reference shapes representing above-knee socket characteristics and is based upon skeletal structure, residuum length and tissue mass. A set of 27 biomechanical reference shapes in the form of male plaster casts were produced by a combination of CNC milling and traditional artisan techniques. Each reference shape was digitized to obtain its cylindrical coordinates. Cross-sectional areas and tissue distributions within each shape and between the shapes were analyzed, modified and then stored numerically within the computer for further implementation of the CASD System for the above-knee amputees. The creation and the analysis of the reference shape data is described.

Artificial Limbs↗
PubMed1993

The neuropathic foot.

The neuropathic foot is described with relation to cause, presentation, dysfunction and identification. The various mechanisms of neuropathic foot lesions are outlined--overload, diabetic gangrene, continuous pressure, direct injury and cutting and temperature effects. The orthotic treatment of the foot is discussed and in particular the importance of proper shoe provision and patient education and indoctrination emphasised. The use of plaster casts and fenestrations to control pressure distribution is described. Finally results of an intensive treatment programme are presented to identify the effect on outcome, as measured by delay in amputation.

Aged↗
PubMed1997

Scoliosis in Duchenne muscular dystrophy: aspects of orthotic treatment.

The x-linked Duchenne muscular dystrophy (DMD) is the most frequent generalized muscle disorder arising from a lack of the sarcolemmic protein "dystrophin". Patients with DMD develop in the majority a progressive scoliosis when they cease walking and/or standing at the age of 10 years and become confined to a wheelchair. Increasing muscle weakness leads to a progression of the curvature, the pelvic tilt and problems in sitting. Together with the simultaneous progressive weakness of the respiratory muscles a restrictive pulmonary insufficiency will occur. Surgical stabilization of the spine (> 20 degrees Cobb, forced vital capacity > 35%) by an adequate multisegmental instrumentation enabling early mobilization is now the treatment of choice. However, orthotic treatment may offer an acceptable compromise in exceptional cases, if the patient rejects surgical intervention or is in the late (inoperable) stages of the disease. Such a treatment is superior to a primary sitting support provision with insufficient possibilities of correction. The authors' experiences with 48 scoliosis orthoses made for 28 patients with DMD are reported. A "double plaster" cast has emerged as the best method to optimize adaption, especially in severe curvatures and the time taken for manufacturing the orthosis. A great deal of experience, patience and the consideration of the patients' individual demands are inevitable for a successful orthotic treatment.

Adolescent↗
PubMed1976

Conservative treatment to Achilles tendon rupture. A follow-up study of 14 cases.

A follow-up study of 14 patients with Achilles tendon rupture is reported. The patients were treated by conservative methods, i.e. with immobilization in a plaster cast for 8 weeks with the foot in the relaxed equinus position. Solid healing of the tendon was obtained in 13 cases. As assessed by the patients, the end result was unsatisfactory in two, fairly satisfactory in one and fully satisfactory in 11 cases.

Achilles Tendon↗
PubMed1977

Below-knee amputation for ischaemic gangrene. Prospective, randomized comparison of a transverse and a sagittal operative technique.

In a prospective, randomized study a comparison was made of the results of primary below-knee amputation for ischaemic gangrene carried out by two methods: In 47 cases by the transverse technique with a long posterior musculo-cutaneous flap and in 41 cases by the sagittal technique using equally large medial and lateral musculo-cutaneous flaps--in both instances followed by 2 weeks in a half-open plaster cast with extended knee. The sex ratio and age distribution were the same in both groups. Minor differences in the vascular condition between the groups, assessed by the duration of rest pain, pulsation findings, extent of gangrene, and frequency of diabetes, wholly or partially equalized each other. The course of healing was the same in both groups, primary healing being attained in 38 per cent and 41 per cent, respectively (0.70 less than P less than 0.80). There was also no difference between the results as regards limb fitting, ambulation, occupational, or social status. It is concluded that the choice between the two methods can be based merely upon surgical skill and the ischaemic changes in the lower leg.

Aged↗
PubMed1980

Congenital posteromedial bowing of the tibia.

Posteromedial bowing of the leg is a rare entity and only a few cases have been described in the literature. A report is made of six patients with this deformity. Except for one severe case requiring anterior soft tissue release, the deformity was corrected in all patients by repeated application of plaster casts. A conservative approach to the management of this condition is advocated.

Casts, Surgical↗
PubMed1980

Fracture of the carpal scaphoid in children. A clinical and roentgenological study of 108 cases.

A series of 108 carpal scaphoid fractures in children was analysed with respect to the site, type and treatment of the fracture. The patients were followed until radiological fusion occurred. All fractures united and healed completely with conservative treatment. Ninety-four fractures, 41 of which were avulsions, were located in the distal third of the scaphoid. There were 13 waist fractures, and one avulsion fracture was located in the proximal pole of the scaphoid. The great number of avulsion fractures and the location of the fractures in the distal third of the scaphoid is very typical in children. In three neglected cases marked bone resorption was seen on the fracture surface 3 weeks after the injury. Because non-union is possible especially in neglected cases of waist fractures, control radiographs should be taken 1 or 2 weeks after the injury if the fracture is not visible on the primary radiographs but is suspected clinically. Immobilization with an adequate plaster cast is mandatory in all transverse fractures of the carpal scaphoid in children.

Adolescent↗
PubMed1982

Valgus deformity following proximal tibial metaphyseal fracture in children.

Seven children with fractures of the proximal tibial metaphysis, with primary valgus angulation and cortical diastasis medially, were seen at follow-up 18 months to 11 years after the accident to assess the trend of the valgus deformity. All the children had been treated non-operatively with a plaster cast. In six patients showing radiological signs of interposition of soft tissues medially in the fracture gap, the valgus angulation had progressed during the first year despite clinical healing. From 1--2 years after the accident the deformity slowly regressed due to corrective longitudinal growth. Routine surgery to remove the interposed soft tissue does not seem to be justified.

Casts, Surgical↗