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PubMed1991

Effect of timing of palatal repair on the transverse development of maxillary alveolar arch in complete-cleft cases.

Forty cleft cases in the age range of 5-12 years where the palatal repair had been performed at 16-24 months (17 cases), 24-36 months (15 cases) and 36-72 months (8 cases) were assessed retrospectively, for the status of maxillary arch and were segregated as acceptable and unacceptable. Plaster casts were prepared from alginate impressions and their graphical reproduction using Huddart's technique, were used to measure the alveolar arch. Anterior palatal measurement (C-C') and posterior palatal measurement (P-P') of the cleft subjects were compared with that in the non-cleft matched controls. The 16-24 month group showed 41.2% acceptable and 58.8% unacceptable arch cases. The 24-36 month group showed that 73.4% had acceptable arches and 26.6% had unacceptable arches. In the 36-72 months group the arch was acceptable in 62.5% cases and unacceptable in 37.5% cases. It was concluded that palatal repair performed before 24 months of age adversely affected the maxillary growth, whereas most favourable growth of maxillary arch occurred when the repair was done between 24-36 months.

Age Factors↗
PubMedDate not supplied

[The therapeutic options in tibial plateau fractures].

The authors report their experience in 49 fractures treated in the interval 1984-1988. In this series, 75.5% of the cases were treated by conservative methods (functional treatment-plaster-cast, continuous extension), the remainder of 24.5% benefiting from a surgical intervention (bolting, screws, uni- or bicondylar plates). In both circumstances, rehabilitation was par, of the treatment. The analysis revealed 61% good and very good results.

Accidents, Traffic↗
PubMed1990

[Admission and organization of emergency care for multiple injured patients. The experience of the Strasbourg Center of traumatology and orthopedics].

The admission of patients with severe multiple trauma and the organization of treatment must follow a few basic principles: 1) continuous, uninterrupted management by the various links of the medical chain, 2) single location: the various persons ensuring the treatment must go to the patient's side, and not the opposite, 3) pluridisciplinary, polyvalent care, and lastly, 4) single command: for us, the orthopedist-traumatologist must direct and coordinate care to the severely injured persons, and the so-called general surgeons is in charge of the others. Three structures of admission currently coexist in France: the department of admission, the emergency department and, rarely, the center of traumatology. Carefully planned routes, adapted facilities, plenty of material and staff are essential. The initial management of patients with multiple trauma in both diagnostic and therapeutic at the same time: first aid in case of vital emergency, resuscitation, clinical, radiological and biological assessment, aimed at drawing a complete census of the lesions and establishing their hierarchy. Considering this hierarchy, the treatment must urgently, completely and definitively deal with: In the first place, and in extreme emergency, vital lesions: visceral rupture, internal and external hemorrhages as well as orthopedic priorities: neuromedullary compression, fracture with vascular lesion, open fracture. All the lesions must be treated definitively if this is possible. However, not all fractures must be operated immediately. Only the severe lesions that are a factor of shock (eg. fracture of both femurs) must be reduced and fixed in emergency. The temporary treatment of the other lesions with plaster casts or continuous extension must not be neglected.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergency Medical Services↗
PubMed1990

[Changes of the arch form and occlusion of the deciduous open bite cases: a longitudinal study].

The purpose of this study was to determine the characteristics and longitudinal changes of the arch morphology and occulusion of the deciduous open bite cases. The materials used in this study were the serial plaster casts of 40 Japanese children with deciduous open bite, and they were measured with the three dimentional system. The following results were obtained: 1. The form of dental arch with open bite in the early primary dentition changed remarkably in the maxilla but little in the mandible. In children with open bite, the maxillary intercanine distance was narrower, the maxillary arch length was longer, the palatal height of the front area was higher, but the back one was lower, and the upper central primary incisors were located more forward and upward higher than in children without open bite. 2. In the late primary dentition, the dental arch shape in the spontaneous closure group showed little difference from the control group. However the deciduous upper central incisors of the spontaneous closure group were very remarkably inclined to the palatal side, and the vertical over-jet was larger than that in the control group. The larger the horizontal over-jets were in the early deciduous dentition, the larger the vertical over-jet changed in the late deciduous dentition. 3. In the spontaneous closure group, the point of the dental arch showed a regular changing aspect, in which place marked variation was recognized in the early deciduous dentition as compared with the control group. Because of spontaneous closure, the dental arch shape approached the one of control group rapidly. 4. The result of multivariate analysis indicate that not only discontinuance of thumb-sucking but also many variables of the dental arch shape and occlusal condition may induce spontaneous closure of the open bite within the deciduous dentition term.

Child↗
PubMed1990

[An attempt of introduction to prosthodontics of a non-contact device for measuring small configurations. Determining configurational changes during the individual steps of denture fabrication].

Denture fabrication involves a number of complex operations that have an effect on reproduction accuracy during each step of the process. Traditionally, metal patterns act as the standard for the mechanical properties of the main materials used in denture making. This means that doubts still remain in cases where the mucous membrane, with its complex configurations, is the object of investigation. The non-contact measuring instrument using laser light (known hereafter as "measuring instrument") enabled measuring small configurations. The measuring instrument enabled measurement of physical configurations that up to now were considered impossible to measure. The fabrication process up to creation of a denture base with the mucous membrane as the basic pattern was divided into four steps for measurement: mucous membrane, impression material, plaster and resin. The measuring device simultaneously carried out qualitative and quantitative analysis in three dimensions for all steps. Processing of test materials was unnecessary so that measurements could be accomplished in a very short time. Measurements revealed a variety of features, including those that are not affected by the physical properties of the materials for measurement. It was also possible to systematically investigate the various changes that take place during denture fabrication with the mucous membrane acting as the basic pattern. The following results were obtained: 1. The experiment confirmed possible application in dentistry of a non-contact device that uses laser light to measure extremely small configurations. 2. Results hint at the possibility of quantitative measurement of objects that cannot be directly measured with conventional methods. 3. During fabrication of dentures, it is very easy for changes in the total configuration to occur when taking impressions. Minute changes in the configuration occur on the surface when taking the plaster cast. During the final stage of the resin base, the tiny configurations became flat and resembled the configuration of the impression more than the original configuration of the mucous membrane.

Denture Bases↗
PubMed1990

[Comparative study of the palatal rugae and shape of the hard palatal in Japanese and Indian children].

The materials for study were serial upper jaw plaster casts of 58 Japanese (29 boys and 29 girls) aged 3 to 7 years, and 93 Indians (46 boys and 47 girls) aged 5 to 8 years. I observed and measured the palatal rugae, the papilla incisiva and the shape of the hard palate using the method of Yamazaki, following Lysell's and Hauser's. The differences according to population (1-5), palatal findings (6) and sex (7) are summarized as follows. 1. The number of primary rugae of Japanese children were more than those of Indian children, but the number of transverse palatal rugae were the same. 2. There were differences between Japanese and Indian children in the primary rugae shapes, the posterior limit of the rugae zone, the number and position of the secondary rugae and fragmentary rugae. 3. The papilla incisiva of the Japanese children were a little larger than those of the Indians. Generally the papilla incisiva of the two populations were pear-shaped, but the Indians showed more variability. 4. The palatal raphe of the Japanese were wider than those of the Indians. The number of children with no palatal raphe branch was large for Indian children, but small for Japanese. 5. The frontal view of the hard palate of Japanese children was broad and that of Indian children was narrower than the Japanese. The palatal shape of the two populations was almost trapezoid. The occlusal view of the two populations was broad and U-shaped. 6. There were many transverse palatal rugae in the two populations at the left side. The posterior limit of the ruga zone of the left side was shifted further back than the right side. 7. There were no significant differences between sexes for most of the above points.

Child↗
PubMed1990

[Morphological studies on the dental arch and palate of the Chinese in Fukien Province, Taiwan, using Moiré patterns].

Using Moiré topography, the forms of the dental arch and palate of males and females were compared. This was carried out in Fukien province, Taiwan. The materials used consisted of plaster casts of the upper dentitions of 65 males and 69 females with normal occlusion, aged from 20 to 22 years. The results are as follows: 1. The standard form of the upper dental arch represented by a pentagon is shown in Table 1 and in Fig. 3. 2. The dental arch of the male was larger than that of the female, the difference being significant for the anterior and posterior widths of the arch. 3. The correlation coefficients were generally lower in the female than in the male. This was especially true with regard to the size of the anterior portion of the female dental arch. In the posterior portion, there was no correlation between the dental arch length and dental arch width of either sex. 4. The distance from the origin (F) to the papilla incisiva was 23.47 mm in the male and 23.67 mm in the female. The number of moiré band in the bottom of the palate at the origin from the basal plane was 12.89 in the male and 12.73 in the female. There were no significant differences in these two measurements between sexes. 5. On the vertical section of the palate, the anterior portion of the palate of the female was deeper than the male. However, in the posterior portion the male was deeper and wider in the palate morphology than the female. The vertical section in the palate of the male was similar in form to that of the female at the midpoint between the anterior and posterior portions, the canine and/or first premolar. 6. The horizontal section of the palate showed that the distance from the origin to the canine and/or to the first premolar were similar in both sexes at any palate depth.

Adult↗
PubMed1990

[Meniscal sutures combined with the reconstruction of the anterior cruciate ligament. Comparative results between sutures of chronic and recent lesions: 102 cases].

The authors report the results of 102 meniscal sutures (53 lateral meniscus and 49 medial meniscus) done on 85 persons (86 knees) with laxity of the knee (54 acute laxities and 32 chronic laxities). All the sutures were done by posterior arthrotomy, while reconstruction of anterior cruciate ligament. Among the operations done on anterior cruciate ligaments, we find 45 reconstructions using MacIntosh procedure, 37 CHO method and 3 reconstructions using Lemaire procedure. 78 per cent of the sutures of the recent injuries were placed in a post-operative plaster cast, on the other hand, none of the chronic injuries was splinted. All the knees (except 1) were followed up within an interval of time of 1 year minimum to 4 years maximum. 3 sutures of fresh medial meniscus tear were reoperated on and one suture of old tear was reoperated. None of the lateral meniscus sutures, old or new was reoperated. 27 "objective" controls were done: 5 by arthrography, 4 by arthroscopy and 18 by magnetic resonance imaging (M.R.I.). Of the 18 controlled sutures by M.R.I., 13 (that is, 76, 5 per cent) presented a high signal as if they had a "wound" or persistent injury, this was found within a context of knees without any symptoms. Therefore the sutures of medial meniscus associated with laxity heal very well. It would be even better if they were in the chronic laxity stage (1 did not succeed out of the 22) than in the acute laxity stage (3 failures out of 27). The sutures of lateral meniscus healed very well in the chronic and in the old laxity stages (total success in both stages). The M.R.I controls for the 18 meniscus sutures presented the problem of the sutured meniscus future.

Adolescent↗
PubMed1990

[Giant-cell tumor of the lower end of the radius treated by resection-arthrodesis. Report of 9 cases].

Nine benign giant cell tumors of the lower end of the radius, resulting in arthrodesis of the wrist mostly because of failed curettage-filling treatment, have enabled the authors to describe a resection-arthrodesis technique which allows continued mobility in the medio-carpal joint in some cases. Because this reconstruction is fragile immediately after operation, it must be protected by a plaster cast or better still by an external fixation. The systematic resection of the distal end of the ulna enables subnormal pronosupination to be maintained.

Adult↗
PubMedDate not supplied

Practical applications in idiopathic clubfoot: a retrospective multicentric study in EPOS.

We report a European study of idiopathic clubfoot that was compiled with the aid of a detailed questionnaire. The retrospective study was presented at the seventh meeting of the European Paediatric Orthopaedic Society (EPOS). Most EPOS members treat idiopathic clubfoot at birth with plaster cast, but a few use physiotherapy and splints. The results of this conservative treatment vary. Operation is usually indicated at an age ranging from 4 to 15 months. Some physicians perform extensive procedures, and others limit operation to the medial and posterior parts of the foot. We propose a classification system for idiopathic clubfoot in an attempt to standardize procedures.

Casts, Surgical↗
PubMed1990

[Dimensions of deciduous and permanent incisors in cases with Class II division 1 and 2 malocclusions].

The analysis of mesiodistal dimensions of the upper and lower incisors (in total and separately) has been carried out in order to investigate the interdependence of sizes of the teeth with defined malocclusions. The investigation included 180 cases of both sexes, out of which 90 had deciduous dentition and other 90 examinees had permanent dentition. There were 120 examinees with Class II malocclusion (60 with Class II/1, and 60 with Class II/2), whereas the rest of 60 examinees with normal occlusion were used as the control group. Gnathometric measurements were made on the plaster casts with calipher precision of 0.1 mm and were double checked. Computer analysis of the results obtained emphasized the following: the heterogeneity of findings in the deciduous dentition does not allow hypothesis of a connection between sizes of the deciduous incisors and defined malocclusions; in the permanent dentition the examinees with Class II division 1 malocclusion have significantly the largest incisors, and the smallest the examinees with class II division 2 malocclusion; the greatest difference in the size between the deciduous and permanent incisors was found in the examinees with Class II division 1 malocclusion and the smallest difference was found in the examinees with normal occlusion.

Adult↗
PubMed1990

Open fractures of the tibia in children.

Forty-one children who had forty-two open fractures of the tibial metaphysis or diaphysis were studied retrospectively. Twelve fractures were Type I; eighteen, Type II; six, Type IIIA; four, Type IIIB; and two, Type IIIC, according to the classification of Gustilo et al. All fractures were irrigated and debrided, and antibiotics were given for a minimum of forty-eight hours after the injury. Twenty fractures were initially treated with external fixation and twenty-two, with immobilization in a plaster cast. Three patients had an early infection of the wound, one of which was associated with osteomyelitis; all were successfully treated. The average time to healing of the fracture was five months (range, two to twenty-one months). The time to union was related to the severity of the soft-tissue injury, the pattern of the fracture, the amount of segmental bone loss, the occurrence of infection, and the use of external fixation. There were six delayed unions. Four patients had an angular malunion of more than 10 degrees, which spontaneously corrected in three. One patient who had a proximal metaphyseal-diaphyseal segmental fracture had a progressive valgus deformity. Four patients who had a severe fracture that was treated with external fixation had more than one centimeter of tibial over-growth. There were no amputations. The incidences of compartment syndrome, vascular injury, infection, and delayed union were similar to those reported for open tibial fractures in adults.

Anterior Compartment Syndrome↗
PubMed1990

[Epiphyseal fractures-dislocations of the lower extremity of the tibia].

Ninety six distal tibial epiphyseal fractures were identified and treated in our institution from 1976 to 1988. The average age was twelve years and eight months (range two to seventeen years), but seventy-one were between eleven and fourteen years old. Using the Salter-Harris classification we have found twelve type 1 tibial fractures, fourty-two type 2, thirty type 3 and twelve type 4. Four were triplane fractures and seven were Tillaux fractures. Twenty-six had injuries in the medial corner of the ankle mortise (Mac-Farland). Fifty patients were treated non-operatively with closed reduction and plaster cast. Fourty-six fractures were treated surgically. Seventy patients were available for follow-up evaluation. The average follow-up was thirty-two months (range 6 months to eleven years). The tibial distal epiphyseal cartilage was closed in 48 patients. As short-term complications we have seen three post-operative displacements after closed reduction; all of them were treated surgically. Five incomplete closed reduction needed open reduction needed open reduction and bone fixation. Two infections occurred after a surgical approach. Among late complications we have seen eleven premature epiphyseal cartilage closure (rate 15%). Four were responsible of angular deformities. One child has a tibial osteotomy for varus deformity after a medial closure. Two ankle arthritis occurred: one of them was seen after a post-operative infection. In two cases of fracture of the medial mortise corner, a valgus deformity with hypertrophy of the medial malleolus occurred. Ankle arthritis is the most severe complication of the adolescent articular fractures (Tillaux and triplane fractures).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Postoperative splinting of the pediatric upper extremity.

The protective splint described above provides appropriate immobilization and protection for our postoperative pediatric population. The major advantages of this splint over plaster of paris include direct access to the wound, easy reapplication, and unnecessary use of the plaster-cast saw. In addition, thermoplastic splints are lightweight, less bulky, more durable, water-resistant, and easily remolded. The therapist's approach to the patient and parents is of utmost importance and will affect the outcome of the splint. In conclusion, postoperative pediatric splinting can be a challenging experience that requires a significant amount of patience, knowledge, and creativity on the part of the hand therapist.

Age Factors↗
PubMed1990

[Arthrolysis of the elbow in posttraumatic contracture].

Intra- and periarticular fractures about the elbow joint are treated with open reduction and internal fixation. This allows early functional after-treatment. Nevertheless, the range of motion remains more or less unsatisfactory. In these cases open arthrolysis provides a considerable improvement in joint function. We therefore recommend this operation when the hardware is removed about 9 months after the accident. The reasons for post-traumatic contracture of the elbow could be intrinsic such as interposed fragments, intra-articular adhesions, incongruity of the articular surfaces--or extrinsic--like contractures of the capsule and ligaments, adhesions of different layers, ectopic bone formations. In most cases a combination of both can be found. Important conditions for successful arthrolysis are mostly intact joint surfaces, failure of all conservative efforts to improve the arc of motion, a motivated patient who understands clearly the risks and benefits that could reasonably be expected by the operative procedure and rehabilitation and, last but not least, a skilled, experienced surgeon. The choice of the approach depends on the main location of the post-traumatic changes and on previous incisions. Osteotomy of the radial epicondyle gives a much better view of the joint and should be performed whenever necessary. The exact course of the operation may not be standardized. The main point is to remove scarred adhesions and bony irregularities. An individually modified rehabilitation program is as important as the operative procedure itself to achieve the best results possible. In general, the exercises should not cause pain. In the first few days plaster casts in flexion and extension are used. Physiotherapy is supported by CPM machines as early as possible. Patients must be prepared with the help of drugs and the application of ice bags. Even after months improvement of motion can be obtained. In a retrospective follow-up study, 125 out of 168 patients with arthrolysis of the elbow joint were reviewed. Most patients sustained a fracture of the distal humerus. In 77%, the results were graded as very good, good or satisfactory, i.e., the average relative improvement amounted to at least 40% according to the criteria of W. Blauth. Patients with very severe (preoperative ROM 0-30 degrees) and severe (preoperative ROM 30-60 degrees) contractures profited more (relative improvement 60%) than the others (relative improvement 45%). Overall, the average arc of total motion increased 49 degrees; the relative improvement of motion increased by 58%.

Adult↗
PubMedDate not supplied

Results of physical therapy for idiopathic clubfoot: a long-term follow-up study.

Physical therapy without anesthesia or plaster casts was used to treat 338 cases of clubfoot (CF). Our technique is based on progressive sequential manipulations at birth. We first reduce the varus and later the equinus component of the CF. The gentle stretches used in this technique are complemented by active physiotherapy stimulating the muscles, and then a simple splint is suited to the foot to fix its degree of realignment. When used alone, this technique achieves 77% good and fair results. In resistant cases, complementary surgery was used. We obtained 96% good and fair results.

Adolescent↗
PubMed1990

[Effect of immobilization on the physical properties of cancellous bone: an experimental study].

40 adult new Zealand rabbits were divided into 6 groups, including a control group, which was free from immobilization. The left hind limb of each animal in the experimental groups was immobilized with the knee in extension by plaster cast for different period of time: 2,4,6,8 and 10 weeks for different group. The cancellous bone of upper tibia of each animal was tested systematically. The bone gravity, pointpressing strength, ash ratio and mineral content were measured and compared group by group to investigate their changes under different conditions. Following immobilization, the quantitative reduction of each parameter varied with the length of immobilization, marked in the first 6 weeks but gradually slowed down. It was most obvious in pointpressing strength, then mineral content, and the least the apparent gravity, denoting that the bone strength was most sensitive to immobilization. The reduction of mineral content exceeded that gravity, indicating the main loss was the former. Loss of point-pressing strength and mineral content was more prominent in the posterior part of the plateau, the weight-bearing area, than at the anterior and intercondylar parts. So was the metaphyseal area as compared with the epiphyseal area. In general, changes in bone gravity was directly in proportion with that of bone strength.

Animals↗