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At least 1,081 records · Page 60Linked to original sources
PubMed1983

Features resisting primary treatment of congenital club foot.

The aims of this study were: (1) to see whether the number of relapses of hindfoot deformity in congenital club foot in the first year of life could be reduced by operative treatment, and (2) to try by surgery to pinpoint features of congenital club feet that make them resistant to treatment. As compared to treatment of 95 feet with manipulation and plaster cast only or with heel cord tenotomy added, early tenotomy of both the heel cord and the tibialis posterior tendon in 23 feet markedly reduced the number of relapses of hindfoot deformity, and the need for additional treatment. The results indicate that the achilles and the tibialis posterior tendons, and their corresponding muscles, are the main dynamic features that need to be dealt with when treating the hindfoot deformity in congenital club foot.

Achilles Tendon↗
PubMed1984

Closed treatment of Achilles tendon rupture.

In order to minimize rerupture after closed treatment of Achilles tendon rupture, the period of immobilization was prolonged from 8 to 12 weeks and an above-knee plaster cast was used the first 3 weeks. In 37 consecutive patients, followed for an average of 3 years, rerupture had occurred in two patients. It is concluded that modified closed treatment is a good alternative to surgical treatment.

Achilles Tendon↗
PubMed1985

Open reduction of congenital hip dislocation. Advantages of the Ferguson medial approach.

Between 1974 and 1982, 56 hips of 51 children with congenital hip dislocation were treated by open reduction via the medial approach according to Ferguson. The mean age at operation was 7 (3-15) months. After 4 months of plaster cast immobilization, 41 hips had a normal acetabular index. Three hips required supplementary surgery: Salter's pelvic osteotomy in one case and a varus osteotomy in two cases. Of the remaining 53 hips, 26 received supplementary abduction treatment. During the first 2 years after reduction, 19 hips showed slight lateral displacement due to capsular laxity. The follow-up averaged 3 (0.5-8) years. All children older than 3 years now had stable, concentrically reduced hips without special treatment of the lateralization; in 9 of the 56 hips the acetabular roof was still dysplastic at follow-up. There was no difference in anteversion and neck-shaft angle between the treated and the contralateral hips. As vascular lesions were observed in only two hips and lateralization disappeared spontaneously, the Ferguson procedure seems safe.

Female↗
PubMed1985

Fixation of Hohmann's osteotomy for hallux valgus.

We modified Hohmann's (1923) osteotomy for hallux valgus by internal fixation of the metatarsal head with no need for a plaster cast. Five (2-10) years post-operatively, all 20 patients (32 feet) had complete relief and all but one was satisfied with the cosmetic result. However, we now routinely add osteotomies of the second and third metatarsal neck to prevent, albeit asymptomatic, callosities.

Adolescent↗
PubMed1986

Immobilization of operated ankle fractures.

Forty-three patients with stable internal fixation of fresh ankle fractures were treated at random with a plaster cast for 6 weeks without weight bearing or were only immobilized for 3 days, after which active movements were encouraged. The two groups were followed for a year. Only at 6 weeks were there significant differences between the groups.

Adolescent↗
PubMed1988

The effects of function and fixation stiffness on experimental bone healing.

In tibial shaft fractures in the rabbit, the early stage of bone healing after metal-plate fixation was compared with that after treatment with a long or short plaster cast. The animals were killed after 6 weeks. The plate-fixed bones healed more rapidly, with less periosteal callus and less angulation of the fragments, than those treated with a cast. The results indicated that function of the muscles and joints of the injured limb, including weight bearing, promotes bony union, whereas the degree of fixation stiffness is relatively unimportant.

Animals↗
PubMed1989

Bone cement for redislocated Colles' fracture. A prospective comparison with closed treatment.

Colles' fractures (not comminuted or intraarticular) that redislocated after two closed reductions were randomized into two groups. In one group the dorsal bone deficiency was filled with bone cement (methylmethacrylate) at operation; in the other, the fractures were rereduced and immobilized in a plaster cast. All the patients were followed for 2 years and examined with respect to anatomy of the fracture, wrist movement, strength, appearance, pain, and function. The operated on group were better with regard to all objectively measurable characteristics; all operated on fractures had healed radiographically, and the cement was surrounded by cortical bone.

Aged↗
PubMed1989

Repair of the triangular ligament in Colles' fracture. No effect in a prospective randomized study.

We present a prospective and randomized study of two different treatments of extraarticular Colles' fracture with a fractured ulnar styloid. The study comprised 41 patients with 2 years' follow-up; 22 patients were treated with closed manipulation and an above-the-elbow plaster cast, whereas in 19 patients the avulsed ulnar styloid was transfixed and/or the triangular ligament was repaired after closed reduction of the fractured radius. In all the operated on patients, a complete rupture of the triangular ligament was found. Good reduction of all the fractures was achieved primarily according to the radiographic examination. At follow-up the alignment had deteriorated, with no difference between the two treatment groups. Neither did the findings in the wrist arthrograms differ between the two groups nor did the subjective complaints of the patients. We conclude that repair of the ruptured triangular ligament in extraarticular fractures of the distal radius is not better than conventional treatment.

Adolescent↗
PubMed1989

Prediction of instability of Colles' fractures.

The tendency of 267 consecutive Colles' fractures to dislocate during plaster-cast treatment was correlated with several parameters measured from the initial radiographs. Stepwise logistic regression analysis showed that radial axial shortening had the greatest prognostic power. The age of the patient and Lidström's class provided additional prognostic information. Initial radial axial shortening of 5 mm or more generally indicated an unfavorable anatomic end result.

Adult↗
PubMed1989

Early knee mobilization after osteotomy for gonarthrosis.

In a prospective study, 32 knees in 32 patients were randomized to either a cylinder plaster cast (17 knees) or hinged cast-brace (15 knees) after high tibial osteotomy for medial gonarthrosis. At 6 weeks, 3 months, and still 1 year after surgery, the range of motion was better in the cast-brace group. There was no difference in the other clinical results at 3 months and at 1 year after surgery, nor in changes of osseous correction or in the final knee alignment. All the patients in the cast-brace group were satisfied with early motion.

Adult↗
PubMed1989

Brace treatment of Colles' fracture.

Twenty patients with Colles' fractures were treated with a functional brace that allows wrist motion. The result was compared with a similar group of patients treated with a plaster cast. Dorsal displacement of the fracture was less and wrist function was better in the brace group. Swelling of the hand during the early stages was observed in the brace group; and because this may necessitate brace adjustment, increased medical supervision is necessary for this period.

Adult↗
PubMed1994

Closed treatment of Jones fracture. Good results in 40 cases after 11-26 years.

40 patients with transversal or short oblique fractures of the proximal shaft of the fifth metatarsal bone (Jones fracture) were treated with full weight bearing with or without elastic bandage in 39 cases and plaster cast immobilization in one. 24 cases were acute traumatic fractures, 14 stress fractures and 2 refractures. After 17 (11-26) years, 33 of the fractures had healed primarily, evidence of refracture or delayed union was found in 7 and there were no non-unions. All but one of the patients were free of symptoms.

Adolescent↗
PubMed1999

Trans-styloid fixation of fractures of the distal radius. A prospective randomized comparison between 6- and 1-week postoperative immobilization in 60 fractures.

We performed a prospective randomized study on 60 patients with dorsally displaced extra-articular or noncomminuted intraarticular fractures of the distal radius. All 60 fractures were treated by closed reduction and Kirchner wire trans-styloid fixation. 30 patients had 1 weeks' postoperative immobilization and 30 patients had 6 weeks' immobilization. All patients had a clinical and radiographic review at 6 weeks and at 1 year after the operation. Pain, range of movement and grip strength were tested clinically, and changes in dorsal tilt, frontal radial deviation, ulnar variance, and radial shortening were assessed radiographically. Rates of complications were the same in both groups. At follow-up, pain was similar in both groups and range of motion and grip strength were somewhat better after early mobilization--in comparison with the opposite wrist--but this was statistically significant only for ulnar deviation. The postoperative radiographic reductions were similar in both groups, with no differences in loss of reduction after bone healing. Therefore, in Colles' fractures, trans-styloid fixation with two K-wires seems to give a stable osteosynthesis, which does not need additional immobilization with a plaster cast.

Adolescent↗
PubMed1979

Halo immobilization of cervical spine fractures. Indications and results.

Thirty-three patients with a spectrum of cervical spine fractures or subluxations were treated with immobilization by a halo apparatus. All spines were assumed to be unstable because of the nature of the fracture or because of a subluxation noted on spine films. Treatment consisted of immobilization and fracture reduction followed by application of a halo plaster cast or molded halo plastic vest. Patient acceptance was high. Complications were few and minor. No patient experienced neurological deterioration during treatment. Reduction was well maintained during an average halo immobilization period of over 3 months. Use of the halo resulted in healing of bone and ligament and restoration of stability in 85% of the patients. Halo immobilization was efficacious in the treatment of odontoid and hangman's fractures as well as complex fractures involving multiple areas of a single vertebra. It was also used successfully as an adjunct to posterior cervical fusion. Although several patients with subluxations or angulation without bone injury were treated successfully, two of the four therapy failures occurred in this group of patients, and the halo must be used with caution in this clinical setting. Contraindications to the use of the halo include complete cervical spinal cord injury with anesthetic skin, tomographic and/or myelographic evidence of disc or bone within the spinal canal, and unsatisfactorily reduced subluxations. The halo has provided more effective and reliable immobilization than other orthoses. It is an acceptable alternative to cervical fusion for the achievement of stability in a wide variety of cervical spine fractures and dislocations avoiding both the short-term and perhaps long-term complications of spinal fusion.

Adolescent↗
PubMed1976

Primary recognition and treatment of congenital dislocation of the hip.

The pathology associated with congenital dislocation of the hip has been reviewed. The pathophysiology as it affects the development of the hip under treatment makes a strong case for the avoidance of the "frog leg" position with fixed flexion and abduction of the hips in the plaster cast. It is apparent that tightness of the iliopsoas muscle and the underlying capsule makes that flexed abduction position necessary to hold the hip in position. The "frog leg" position is seriously implicated in the development of aseptic necrosis, not only of the dislocated hip but of the normal hip as well. The results seen in patients with surgical division of the iliopsoas tendon and capsular contracture, followed by leg immobilization in a functional position of extension at the hip accompanied by slight abduction and internal rotation, indicate the virtual elimination of the necessity for secondary reconstruction procedures on the hip at a later date. This appears to be the more conservative approach to treatment in children under age two. A period of one to three months in a splint that flexes and abducts the leg but permits changing positons may be tried before the obstruction is relieved. For children with lax capsule and iliopsoas, reduction may be possible by this route. For most the hip will be pressed in slightly improving the x-ray picture--but with the obstruction still before the femoral head. The seating of the femoral head must be exact. If it is not, imperfection in the development of the hip arises and may lead to later malfunction. Obstructions to perfect seating of the femoral head in the acetabulum must be overcome.

Age Factors↗
PubMed1988

Early post-surgical prosthetic limb fitting in dysvascular below-knee amputees with a pre-fabricated temporary limb.

Two consecutive series of patients undergoing below-knee amputation for peripheral vascular insufficiency were compared relative to the length of acute-care hospitalization and rehabilitation. The residual limb control group was treated with soft-surgical dressings and non-weight bearing ambulation with referral to the amputee clinic when the residual limb wound was "ready." The residual limb experimental group was treated with rigid plaster (cast) dressings with early post-surgical prosthetic limb fitting and progressive weight bearing ambulation. Acute-care hospitalization following amputation surgery averaged 27.7 days in the control group, and 23.7 days in the treated group. Patients were either re-admitted or transferred to a rehabilitation unit where hospitalization averaged 42.9 days in the control group and 14.1 days in the treated group. This resulted in a cost savings of almost $15,000 per patient based on present hospital fees. The results of this study suggest that early post-surgical prosthetic limb fitting not only hastens recovery amputation, but can be safe and cost effective.

Adult↗
PubMedDate not supplied

Forearm and distal radius fractures in children.

Pediatric forearm and distal radius fractures are common injuries. Resultant deformities are usually a product of indirect trauma involving angular loading combined with rotational displacement. Fractures are classified by location, completeness, angular and rotational deformity, and fragment displacement. Successful outcomes are based on restoration of adequate pronation and supination and, to a lesser degree, acceptable cosmesis. When several important concepts are kept in mind, these goals are usually met with conservative treatment by reduction and immobilization. Greenstick fractures are reduced by rotating the forearm such that the palm is directed toward the fracture apex. Complete fractures are manipulated and reduced with traction and rotation; extremities are then immobilized in well-molded plaster casts until healing, which usually takes about 6 weeks. Radiographs should be obtained between 1 and 2 weeks after initial reduction to detect early angulation. In fractures in any level in children less than 9 years of age, complete displacement, 15 degrees of angulation, and 45 degrees of malrotation are acceptable. In children 9 years of age or older, 30 degrees of malrotation is acceptable, with 10 degrees of angulation for proximal fractures and 15 degrees for more distal fractures. Complete bayonet apposition is acceptable, especially for distal radius fractures, as long as angulation does not exceed 20 degrees and 2 years of growth remains. Operative intervention is used when the fracture is open and when acceptable alignment cannot be achieved or maintained. Single-bone intramedullary fixation has proven useful.

Anesthesia↗