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At least 1,099 records · Page 61Linked to original sources
PubMed2003

Investigations of the immunoglobulin subtype transformation of anti-heparin-platelet factor 4 antibodies during treatment with a low-molecular-weight heparin (clivarin) in orthopedic patients.

CONTEXT: It is now widely accepted that the pathophysiology of heparin-induced thrombocytopenia (HIT) syndrome is mediated by the generation of a wide array of functional and molecularly heterogeneous anti-heparin-platelet factor 4 (AHPF4) antibodies that may mediate platelet and/or endothelial cell activation/destruction. OBJECTIVE: We investigated the differential prevalence and functionality of AHPF4 immunoglobulin subtypes (IgA, IgG, and IgM) in plasmas obtained from orthopedic patients immobilized with Plaster-Cast and treated with clivarin (a low-molecular-weight heparin) in comparison to a placebo for the prophylaxis of deep-vein thrombosis. DESIGN AND METHODS: Clivarin was administered subcutaneously at a fixed daily dosage of 1750 U without any adjustment or loading dosage. Citrated plasmas were obtained at baseline, at 10 to 14 days, and at postbrace procedure (5-12 weeks). An enzyme-linked immunosorbent assay (ELISA) was used to quantitate the AHPF4 antibody titers. The functionality of the ELISA-positive samples was determined by a 14C-serotonin release assay (SRA). RESULTS: In the ELISA test, 16 of 1073 samples (1.5%; 6 in clivarin and 10 in placebo groups) were positive for AHPF4 antibodies (mean optical density [OD] = 0.46 +/- 0.02). None of the ELISA-positive samples for AHPF4 antibodies could mediate platelet activation responses as determined by the SRA (0%-3% serotonin release, P >.10, n = 16). Through differential immunoglobulin subtype analysis of the samples positive for (cumulative) AHPF4 antibodies, we determined that their relative prevalence in plasma were as follows: IgM (mean OD = 0.71 +/- 0.13) > IgG (0.31 +/- 0.08) > IgA (0.14 +/- 0.02). Although there was no significant difference in the total antibody titers between clivarin and placebo groups, the antibody subtyping data showed conversion trends (ie, IgA [clivarin to placebo], IgG [placebo to clivarin], and IgM [clivarin to placebo]). CONCLUSION: These observations indicate that even at reduced dosages, clivarin can shift the immunogenic up-regulation toward the IgG subpopulation; however, the IgG subtype is of a nonfunctional type of AHPF4 antibody and thus may not cause any HIT-related pathogenic responses.

Adolescent↗
PubMed1998

[The results of treatment of posterior shoulder dislocation].

The paper reports results of treatment for 5 posterior dislocations of the shoulder in 4 patients. Closed reduction was successful in 2 cases (2 days and 14 days after injury). Spontaneous reduction after removal of the Desault plaster cast 3 weeks after injury was observed in one case. Two patients with inveterate dislocation have been operated on. The defect within humeral head was filled with an allogenic bone graft in one patient and by lesser tuberosity transposition in another. Modified Constant score was used for clinical evaluation at the follow-up ranging from 5.5 months to 56 months (mean 30.4 months). Two excellent and one good result were achieved in conservatively treated cases. After surgery one result was rated poor (allograft case) and one good (lesser tuberosity transposition).

Adult↗
PubMed1998

[The methods of treatment for comminuted intra-articular fractures of the tibia in the materials of Department of Orthopedic Injuries at the Military Special Hospital in Lublin].

Twenty-one patients (9 males, 12 females) aged 14-73 years (mean 46 years) with proximal tibia fracture were treated between 1993 and 1995. Surgery was performed in 12 recent cases and in 3 inveterate ones. Non-surgical treatment was used in 5 recent fractures and 1 inveterate. Follow-up ranged from 0.5 to 6 years. "L" plate, "T" plate, spongious screws, Kirchner wires were used for fixation. Lateral condyle depression used to be elevated and supported by bone graft harvested from the iliac crest. Functional treatment or 4 weeks plaster cast immobilization was used postoperatively. In majority of cases pain free knee joint with flexion over 90 degrees was found 3 months after surgery. All patients returned to work. There were 7 excellent results and 5 good ones according to Rasmussen criteria.

Adolescent↗
PubMed1998

Estimation of referent cephalometric parameters in dental prosthetics.

Estimation of the inclination of the occlusal plane and its spatial orientation during the insertion of plaster casts in the articulators space, and control during the clinical phase of the prosthetic work, is one of the key problems in dental prosthetics. The aim of this investigation was to compare the relations of the basic roentgencephalometric parameters applied and to determine their reliability. Five angular variables were analysed: OP-MdP, OP-PP, OP-CP, OP-FP and OP-SNP, on a sample of 86 radiographs of subjects with almost normal occlusion by applying basic statistical parameters and the correlation's analysis. The results gave mean values of the investigated variables with estimation of their variability and level of mutual correlation, which can be used when determining individual inclination of the occlusal plane. Parameters FP and SNP showed significant stability and reliability which can be successfully applied in prosthodontics.

Adolescent↗
PubMed1999

Intramedullary nailing of forearm fractures in children.

Forearm fractures are very common in children. They are usually treated orthopedically. For the last few years, Métaizeau's elastic stable nailing has been used in the authors' hospital. This study is based on 80 children with forearm fractures treated with intramedullary nailing: 64 boys and 16 girls, aged 6 to 16 (23 right sides, 58 left sides: 81 fractures). Nailing was performed 67 times for a displaced fracture, 3 times for a recurrent fracture, 3 times after a secondary displacement, and 7 times in patients with multiple injuries. Sound union was normally achieved in 78 patients, and normal motion in 79. Ten children experienced complications, but only complications involving the skin and sepsis were due to the technique. The seven skin complications (three in the ulnar fractures, and four in the radial fractures) consisted of three major local infections, one radial osteomyelitis, and three minor local nonunion of skin. One patient had limited thumb extension, and two patients fell a second time. One advantage of the method described here is that plaster casts are avoided, allowing children to go back to school early. Sound union is achieved as quickly as with orthopedic treatment, and recovery is excellent.

Adolescent↗
PubMed1999

[Stress fracture of free vascularized bone grafts].

Three cases of stress fracture within free vascularized bone graft were found among 35 patients with completed treatment. In 32 years old male stress fracture of free vascularized fibular graft used for tibial reconstruction occurred after a dozen of one (operated) leg hops. In 29 years old female operated due to tibial pseudoarthrosis with free vascularized iliac wing graft the fracture appeared after couple of days of intense walking. In both cases fracture occurred after incorporation of the graft, several months after removal of the external fixator. Pain and swelling of the limb increased over couple of days. In the last case of 25 years old male vascularized fibula transferred to the femur fractured in the presence of external fixator one year after surgery in the course of remodeling of the graft. In all cases X-ray revealed transverse fracture line in the middle of the graft. Plaster cast immobilization has been used in one case only. Graft remodeling with marked hypertrophy was found 4 month later.

Adult↗
PubMed1999

Healing of Charcot's joint by pamidronate infusion.

Treatment of Charcot's joints remains difficult, and involves prolonged periods without weightbearing, immobilization, and surgical salvage procedures to avoid amputation. We describe the efficacy of pamidronate in treating a patient with Charcot's joint, due to hereditary sensory neuropathy, that caused loss of pain sensation. The bone and joint destruction in our patient's left foot was stopped by bisphosphonate treatment, and signs of a reconstructive healing process were observed on the control radiographs. The treatment was administered intravenously every 4 months for 2 years, without restriction on weightbearing, since the patient had refused a plaster cast and an orthotic device. This observation suggests that treatment with bisphosphonates should be used before, or in combination with, other treatment in such cases.

Adult↗
PubMed1999

[The demonstrative and information values of correlational methods in predicting the mesiodistal dimensions of the crowns of the canine teeth and premolars].

Authors have analyzed the reliability of correlative methods with plaster-casts of 100 examines (50 boys and 50 girls) with permanent dentition, according to Moyers's and author's own methods, and methods of multiple regression analysis according to Bachmann and Traenkmann and collab., while anticipation of mesiodistal crown diameters of canines and premolar (C, P1, P2) in both jaws. The predictable amounts of crown width C, P1, P2 in the maxilla were larger than the measured on the model, according to the method: Moyers in 81% of cases, Legović in 67% of cases, Bachmann in 35% and Traenkmann and collab. in 73% of cases. The predictable amounts of crown width C, P1, P2 in mandible were larger than the one measured on the model: Moyers in 81% of cases, Legović in 80%, Bachmann in 45% and Traenkmann and collab. in 26% of cases, and smaller compared with the measured model: Moyers in 15% of cases, Legović in 18%, Bachmann in 55% and Traenkmann and collab. in 74% of cases.

Bicuspid↗
PubMed1999

[Isolated radiocarpal luxation. A case report and general review of the literature].

PURPOSE OF THE STUDY: We describe a case of an isolated radiocarpal dislocation and review the literature. CASE REPORT: A young 29-year-old male, suffering from a wrist injury after a motor cycle accident, was diagnosed as dorsal radiocarpal joint dislocation with distal radioulnar dislocation and no fracture, close reduction was immediately performed followed by plaster cast immobilisation. After five months satisfactory stability and motion were obtained without signs of carpal instability. DISCUSSION: This pathology is exceptional with less than 15 published cases. Dislocation is due to wrist hyperextension with ulnar motion but without, probably, intracarpal supination. After immediate treatment, this lesion appeared to have a good prognosis without post-traumatic carpal instability, when compared to the poorer result of perilunar dislocation.

Adult↗
PubMed1976

Studies on the volume and the activity of the parathyroid glands in osteoporosis of disuse in the adult rat.

Inactivity of the right hind leg was brought about in adult male Sprague-Dawley rats by a) immobilisation in a plaster cast and b) by resection of the sciatic nerve. Determinations of the volume and the activity of the parathyroid glands by morphological methods showed that the parathyroids were, on the whole, not affected by the treatment. Some significant differences observed in some examined parameters should, however, suggest hypofunction of the glands. The serum-calcium level was significantly higher in the treated than in the control rats in the first experiment. No significant differences in serum calcium between treated and control animals were observed in the second experiment. These observations were considered to indicate that the development of localised osteoporosis in these two forms of inactivity did not depend on hyperactivity of the parathyroids. The observed differences in serum-calcium content between the two experiments may suggest that localised osteoporosis in the two cases developed through different pathomechanisms.

Animals↗
PubMed2000

Posterolateral dislocation of the elbow joint. Relationship to medial instability.

BACKGROUND: Dislocation of the elbow joint is the second most common dislocation in the upper extremity, dislocation of the shoulder being the most common. It has been reported that uncomplicated dislocation of the elbow joint may be associated with a decreased range of motion, degenerative changes in the elbow joint, ectopic calcification, or neurological deficits. As the medial collateral ligament complex can be completely disrupted during dislocation, we evaluated the association between the long-term results of treatment of simple posterolateral dislocation of the elbow and the presence of persistent medial or valgus elbow instability. METHODS: Fifty patients who had a mean age of thirty-three years (range, eighteen to fifty-eight years) had closed reduction of a posterolateral dislocation of the elbow without associated fractures. The extremity was immobilized in an above-the-elbow plaster cast for three weeks. After a mean duration of follow-up of nine years (range, six to thirteen years), forty-one patients were evaluated with an interview, a physical examination, and radiographs made while a valgus load was applied to the elbow. RESULTS: The average score according to the system of The Hospital for Special Surgery was 91 points (range, 49 to 100 points), and thirty-one patients described their elbow function as good or excellent. Twenty-four patients had evidence of medial instability on radiographs made while a valgus load was applied to the elbow. Twenty-one patients had signs of degeneration of the joint, and twenty-five patients had ectopic ossification. Magnetic resonance imaging combined with arthrography was performed for the first twenty patients; eight had evidence of rupture of the medial collateral ligament, seven had generalized degenerative changes of the cartilage, and four had a chondral defect of the capitellum. (The study could not be completed for the remaining patient.) Medial instability on radiographs was correlated with signs of degeneration (p = 0.001), ectopic ossification (p = 0.01), a worse score according to the system of The Hospital for Special Surgery (p = 0.002), and persistent pain (p = 0.04). CONCLUSIONS: Posterolateral dislocation of the elbow joint can lead to persistent valgus instability that is associated with a worse overall clinical and radiographic result.

Adult↗
PubMed1999

[Injuries among 11-15 year old children].

The objective is to describe the one year incidence rate of self-reported injuries, their causes, where they happened, and their consequences within the age group 11-15 years. Four thousand and forty-six students from a random sample of 45 schools answered a standardized questionnaire about health and health behaviour. This report regards injuries treated by a doctor or a nurse. During one year, 28% were injured, 12% more than once; 12% needed medical treatment such as a plaster cast, stitches, surgery or staying in a hospital; 16% missed at least one full day in school. The injury incidence rate increases with age among boys but not among girls. The proportion with more than one injury increases by age among girls but not boys. The proportion who receive hospital treatment is higher among boys than girls. The proportion who stay home from school because of the injury increases with age among both girls and boys. Five percent are injured at home, 5% at school, 9% are injured at a sport facility, and 4% in the street/road. Ten percent report a sports injury, 4% an injury by falling, and 3% by riding a bicycle. Most common injuries are sprain/strain/pull of a muscle (9%), broken or dislocated bone (6%), and cuts (3%). In conclusion, the incidence of self-reported injuries is much higher than the hospital-reported. More research about injury-mechanisms and more preventive efforts are needed.

Accidental Falls↗
PubMed2000

[Results of treatment of traumatic elbow dislocation in children].

Between 1987 and 1997 the authors treated 49 children with traumatic dislocation of the elbow joint. The study presents the results of treatment of 26 children, mean age of 10.7 years (ranging from 5.5 to 14.5 years) at the time of trauma. The mean follow-up time was 4.3 years (ranging from 1 to 10.5 years). In one case an anterior dislocation was observed, while in the remaining cases posterior dislocation was diagnosed. Twenty-five children were treated with closed reduction of the dislocation, followed by immobilization in a plaster cast. One case with a chronic dislocation was treated surgically. Concurrent injuries were observed in 18 (69.2) children. The most common concurrent trauma was a fracture of the medial epicondyle (44% of cases with additional trauma). The following additional fractures were also noted: fracture of the lateral epicondyle, fractures of the forearm, of the neck of the radius, of the olecranon, epiphyseolysis of the distal epiphysis of the radius with a concomitant fracture of the medial epicondyle. In 19 cases very good result was achieved. In 7 cases sequels of the dislocation were noted. These were: in 3 cases flexion contractures (5 degrees, 10 degrees, 15 degrees) of the elbow joint, in two cases periarticular ossification (in 1 case this entity was treated surgically with very good result), in 1 case an asymptomatic non-union of the medial epicondyle with a 30 degrees flexion contracture in the elbow joint, and in 1 case (treated surgically) a 90 degrees flexion contracture with a movement range up to 105 degrees with degenerative changes visible on X-ray in the joint was noted.

Adolescent↗
PubMed2000

[Scaphoid fractures in children].

The scaphoid is the most common carpal bone fractured in adults. In children the fracture is distinctly uncommon. We present our experience with 23 children treated between 1987-1998, 19 of them with fractures in the distal third of the wrist; there were 11 avulsions, 4 waist fractures, and 12 were undisplaced. The mechanism of injury was a direct blow or a fall onto the outstretched hand. Immobilization in a plaster cast led to union in all except 1 case. Based on our experience and study of the literature, it is evident that scaphoid fractures, although uncommon, do occur. Thorough clinical and radiological examination of children with a forearm or wrist injury is important in detecting such fractures.

Accidental Falls↗
PubMed2000

Closed tibial shaft fractures: management and treatment complications. A review of the prospective literature.

OBJECTIVE: To compare the results and complications of the various modalities for treating closed fractures of the tibial shaft described in the prospective literature. DATA SOURCES: A MEDLINE search of the English language literature from 1966 to 1999 was conducted using the MeSH heading "tibial fractures." Studies pertaining to the management of closed tibial shaft fractures were reviewed, and their reference lists were searched for additional articles. STUDY SELECTION: An analysis of the relevant prospective, randomized controlled trials was performed. Studies including confounding data on open fractures or fractures in children were excluded. The 13 remaining studies were reviewed. DATA EXTRACTION: Raw data were extracted and pooled for each method of treatment. DATA SYNTHESIS: The 13 studies described 895 tibial shaft fractures treated by application of a plaster cast, fixation with plate and screws, and reamed or unreamed intramedullary nailing. Although definitions varied, the combined incidence of delayed and nonunion was lower with operative treatment (2.6% with plate fixation, 8.0% with reamed nailing and 16.7% with unreamed nailing) than with closed treatment (17.2%). The incidence of malunion was similarly lower with operative treatment (0% with plate fixation, 3.2% with reamed nailing and 11.8% with unreamed nailing) than with closed treatment (31.7%). Superficial infection was most common with plate fixation (9.0%) compared with 2.9% for reamed nailing, 0.5% for unreamed nailing and 0% for closed treatment. The incidence of osteomyelitis was similar for all groups. Rates of reoperation ranged from 4.7% to 23.1%. CONCLUSIONS: All forms of treatment for tibial shaft fractures are associated with complications. A knowledge of the incidence of each complication facilitates the consent process. To fully resolve the controversy as to the best method of treatment, a large, randomized, controlled trial is required. This review more precisely predicts the expected incidence of complications, allowing the numbers of required patients to be more accurately determined for future randomized controlled studies.

Adult↗
PubMed1975

[Correction osteotomy of tibia for malalignment at the knee and the bone-suture (author's transl)].

Correction osteotomy of the tibia in genu valgum and varum is discussed on the basis of the literature and two cases. After considering critically the well-known techniques of fixation, the almost forgotten bone-suture with silk or Perlon is recalled which may replace osteosynthesis. The advantages of the plaster cast of the leg which permits much earlier weightbearing then osteosynthesis and adds to bony union are emphasized. The author warns against too early mobilization.

Adolescent↗
PubMed1975

The management of infants with scoliosis.

This is a study of children who first attended as infants with either progressive infantile idiopathic scoliosis or congenital scoliosis. All had a pattern of scoliosis in which early and damaging deterioration is inevitable. The infants were treated from before the age of three, initially by plaster casts and then a Milwaukee brace, followed at about the age of ten by correction and fusion. The cases were then observed to the end of growth or near that point. In the main study there were twelve cases, six of progressive infantile idiopathic scoliosis and six of congenital scoliosis, which were followed through this long period. Only one of the twelve had a curve worse at the end of growth compared with the initial radiograph as an infant; this one curve had increased only 16 degrees in almost as many years. Although small, the series does show that it is nearly always possible to control even the most serious scoliosis in an infant, if it is tackled early and unremittingly. There are supportive studies of children who have partially completed this regime, and interim results in a newer group of children with spina bifida and scoliosis.

Braces↗
PubMedDate not supplied

Forearm pseudarthrosis--neurofibromatosis: case report.

A 3 1/2-year-old white girl with neurofibromatosis sustained left radius and ulna fractures. The radius was sclerotic with no medullary canal at the fracture site, and the ulna was hypoplastic distal to the fracture. The fractures failed to unite when immobilized in a long arm plaster cast for 5 months and pseudarthrosis developed. Three subsequent operative attempts to obtain union of the pseudarthrosis by means of internal fixation and bone grafting over the next 30 months were also unsuccessful, and the pseudarthrosis persisted. The forearm was supported in a custom molded leather brace until the child was 13 1/2 years old and had reached skeletal maturity. Osseous union was then operatively obtained using dual onlay tibial cortical and cancellous bone grafts. There has been no recurrence of the pseudarthrosis 3 years and 2 months after bone grafting. The author recommends postponing surgical attempts to achieve union of the forearm bone pseudarthrosis associated with neurofibromatosis until the patient reaches skeletal maturity.

Bone Neoplasms↗