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Contact urticaria is a form of immediate hypersensitivity reaction that is being noted with increasing frequency. This report illustrates an unusual presentation of contact urticaria in the form of an immediate reaction to a component of plaster cast material. The substance involved was ortho-phenylphenate, a preservative. It has not been previously implicated in a contact urticaria reaction.
The medical records of 179 patients were reviewed to identify complications related to the use of the halo external skeletal-fixation device. The complications that were identified included pin-loosening in 36 per cent of the patients, pin-site infection in 20 per cent, pressure sores under either a plastic vest or a plaster cast in 11 per cent, nerve injury in 2 per cent, dural penetration in 1 per cent, dysphagia in 2 per cent, cosmetically disfiguring scars in 9 per cent, and severe pin discomfort in 18 per cent. One hundred and eighty (25 per cent) of the 716 pins used had become loose at least once, and an infection had developed at sixty-seven pin sites (9 per cent). Two-thirds of the pins that were loose or associated with infection required change or removal. These complication rates, particularly of pin-loosening and infection, are exceedingly high. Attention to details in pin application, pin maintenance, and proper pin-site care may minimize the number of complications.
The effect of immobilization of a limb on subsequent sensitivity of the diaphragm to d-tubocurarine was examined in the guinea pig. A forelimb was immobilized in a plaster cast for 1 or 3 weeks. An isolated nerve-diaphragm preparation was then set up and the sensitivity to d-tubocurarine measured. Parallel assays on a nerve-lumbrical muscle preparation from the limb in the cast were also examined for comparison. The diaphragm from unimmobilized animals showed the normal decreased sensitivity relative to the lumbrical. After immobilization the sensitivity of the lumbrical decreased, whereas that of the diaphragm did not change. Thus in contrast to previously observed behavior in limb muscles, changes in d-tubocurarine sensitivity produced by immobilization do not involve the diaphragm.
As a result of the lengthy rehabilitation of the non-injured but fixed elbow in the treatment of scaphoid fractures or pseudarthroses in a longarm plaster cast, a modification has been developed, which inhibits supination and pronation of the forearm while the flexion-extension movement of the elbow is permitted by the incorporation of a hinge.
Arthrogryposis of the upper extremity is easy to diagnose. The shoulders, when affected, are adducted and internally rotated; they are thin, and very little girdle muscle is noted. The elbows are usually straight, and extension contractures are present. The hand and wrist are clublike; the wrist is contracted in flexion, with slight ulnar deviation. The thumb is usually adducted and flexed in a palmar direction. The small joints of the fingers are stiff, and frequently the fingers are ulnar deviated. Early treatment consists of passive stretching of the contracted parts by either plaster casts or splints. If successful, this treatment is followed by functional splinting. If stretching is not successful, then surgical release of contracted major joints or parts can be helpful. Tendon transfers are used to give a dynamic force to aid correction of the deformity and provide useful motion. Surgical correction of small joints of the hand has not proved too successful and frequently will decrease mobility even further. The goal in treating upper extremity deformities in arthrogryposis is to provide one extremity that can be brought to the mouth for feeding and hygiene and one that can be used to push up from a sitting position or to be used with a crutch if necessary. Hand function can be improved by careful evaluation and planned procedures that are consistent with the above goals.
I studied the anatomical relationships in thirty-two transitional fractures of the distal part of the tibia by standard radiography and in thirteen of these patients by computerized axial tomography. Three different configurations of fractures could be identified: biplane fractures and two different types of triplane fractures (Type I and Type II). In the biplane lesion the fracture is restricted to the epiphysis, while the triplane fractures are characterized by a wedge of metaphyseal bone. In the Type-I triplane lesion the metaphyseal portion of the fracture ends in the physis, while in the Type-II triplane lesion the metaphyseal portion of the fracture line extends through the physis into the epiphysis and the joint. On the anteroposterior radiograph, the epiphyseal fracture line in both the biplane and the two types of triplane fractures may be found anywhere from the extreme medial to the extreme lateral position. Its location, however, is exclusively dependent on the maturity of the distal tibial physis and is not influenced by the mechanism of injury. The use of computerized axial tomography has revealed the true dimensions of these fractures, and the diagnosis of biplane and triplane fractures can now be made by standard radiography alone. However, the evaluation of undisplaced or only slightly displaced Type-II triplane fractures will still occasionally require the use of computerized axial tomography. Displaced transitional fractures with a fracture gap of more than two millimeters in the weight-bearing portion of the epiphysis require open reduction. If the gap is less than two millimeters, non-operative treatment with a plaster cast is sufficient.
Airstepping, walking-like movements of the hindlimbs, is a commonly observed behavior in chronic spinal animals when they are held vertically. The purpose of this study was to: describe the development of airstepping after spinalization and compare it to the onset of segmental reflexes, characterize the EMG pattern of muscle activity during spontaneous airstepping, and examine the effects of sensory perturbation on the characteristic pattern. Airstepping was analyzed during three conditions of tonic sensory perturbation which included: tail pinching, tape applied to one hindpaw, and immobilization of the ankle and knee in a plaster cast. Seven adult cats were spinalized at T-12, and bipolar electrode wires were surgically implanted in selected hindlimb muscles at the hip, knee, and ankle. Testing began within 48 hr of transection. Segmental reflexes and paw-shake responses were present in the first week; however, the earliest observed airstepping occurred during tail pinching at 2 weeks after surgery, and the average onset of spontaneous airstepping (without exteroceptive stimuli) was at 33 days. The average cycle period of spontaneous airstepping (691 msec) was comparable to the shortest periods reported for fictive rhythms and to treadmill walking between 1 and 2 m/sec. Intralimb coordination was characterized by flexor and extensor synergies typical of locomotion, while interlimb coordination was characterized by alternating cycles similar to that reported for treadmill walking and fictive locomotion. Neither intralimb nor interlimb patterns of coordination were altered by conditions of sensory perturbation, although cycle period and EMG recruitment level were variable. Many characteristics of airstepping are similar to those of treadmill and fictive locomotion.(ABSTRACT TRUNCATED AT 250 WORDS)
Thirty-six cases of tuberculosis of the elbow have been treated by chemotherapy and plaster cast immobilisation followed by rehabilitation. The overall results were satisfactory with restoration of useful mobility and flexion in 26 cases. The ranges of movement in pronation and supination were less satisfactory.
Arthrodesis of metatarsophalangeal joint was performed in 31 cases of severe hallux valgus. With the surgical technique used, which is described in detail, internal fixation and plaster cast immobilization were not necessary. Analysis of the results suggested that the operation is indicated for severe deformities in elderly patients, preferably women. The basic metatarsal deformity was corrected by the procedure.
75 fractures of the calcaneus were followed up in a long-term study in 64 patients. 27 of these patients were older than 10 years. 22 were operated (or reoperated) later. 16 of these received a double arthrodesis. The early and late results were compared. There was no difference between the results obtained with the surgically treated and the conservatively treated patients (functional or closed repositioning and plaster cast). The late operations are discussed. Emphasis is given to the orthopaedicotechnical possibilities which, in the authors' opinion, should be utilised more often.
In experiments involving disuse osteoporosis induced by plaster cast immobilization, 2 commonly used commercial feeds (Wayne Lab Blox and Purina Laboratory Chow) gave different results. Preliminary evidence suggests that this dichotomy of results is due to an interaction between metabolic changes caused by physiologic stress and different levels of manganese in the 2 commercial diets. By feeding the 2 diets to groups of rats under various conditions, and examining the strength, cortical area, and length of their femurs, and by immobilization of a fracture in a cast, and associated physiologic stresses, dietary differences are manifested in the growth and developmental changes in the femur. Under normal, stress-free conditions, however, no such differences occur. Investigators should be wary of such dietary variables when comparing various experimental results. The implications of such effects insofar as human medicine is concerned should be further investigated.
Disuse osteoporosis was produced in dogs by immobilization of the left rear limb in a plaster cast. The trabecular bone volume of the calcaneus was then determined following treatment with 1 alpha,25-dihydroxycholecalciferol for 4 weeks with oral dosages of 60 to 240 ng/kg of body weight. The trabecular bone volume percentage of the immobilized calcaneus was in direct relation to the dosage of 1 alpha,25-dihydroxycholecalciferol.
The below-the-knee removable rigid dressing is a below-the-knee plaster cast held by a suspension stockinette to a supracondylar plastic cuff. It has proved to be an effective method for postoperative, pre-prosthetic, and prosthetic care of below-the-knee amputees. Being removable, it permits frequent observation and progressive shrinkage of the stump (by adding socks), and eliminates the need of elastic stump bandaging. In addition, it still maintains the advantages of immobilization of soft tissue (to reduce pain and facilitate wound healing) and prevention of trauma to the stump as does the conventional rigid dressing. It has significantly reduced the incidence of pre-tibial skin breakdown and distal edema, produced fast stump shrinkage, and shortened time to ambulatory discharge with a temporary prosthesis by ninety days.
The results of treatment of 52 supracondylar fractures of the humerus in children by means of percutaneous transfixation with two Kirschner wires are discussed and compared with the results of other methods of treatment, such as repositioning and immobilization in a plaster cast, and traction by the Baumann or Dunlop techniques. The functional results are equivalent to those of other methods of treatment. Although the number of cases studied was only small, it appears that the cosmetic results are better, while the duration of hospitalization is markedly shorter.
In a collective study of 22 surgical clinics 1235 closed diaphyseal tibial fractures in children from 0 to 14 years were analysed. The incidence of this type of fracture in relation to all fractures in childhood, was 6.2%. In pre-school children isolated tibial fractures and incomplete fractures predominated, while in children from 6 to 14 years tibial plus fibular fractures as well as displaced fractures occurred more frequently. Closed reduction and plaster cast were used as standard treatment. Traction was used only exceptionally. In only 3.0% osteosynthesis was performed under the following indications: irreducible fracture, multiple fractures, concomitant chest or abdominal injury, polytrauma.
The authors analyze the results of Chiari pelvic osteotomy in treatment of sequellae of hip osteochondritis with 11 cases of children 6 to 10 years old, operated and reviewed with an average follow up of 21 months. They used the operative procedure decided by Chiari, on orthopaedic table, followed by plaster cast immobilisation for 3 weeks. The Xray results are specially analyzed as the peroperative functional troubles were absent. This procedure is mainly effective on articular congruence with gain not only in lateral but also in anterior head-coverage. The secondary modelling appears to affect either the head and the acetabulum. But the medialization remains poor, which is explained by an analyze of the lower fragment operative displacement. Actually, this operative procedure may be used in late osteochondritis with a coxa magna and specially when a coxa vara or a short neck contra-indicate a femoral osteotomy.
Experience with treatment of 1885 children with fracture of the forearm bones is reported. Almost 1/3 (28.1%) were patients with epi-osteoepiphysiolysis of the distal end of the radius. In the majority, the method of treatment was conservative: closed manual reposition and immobilization with plaster cast during 3-4 weeks. Closed one-stage reposition is effective only during the first hours of 2-3 days after the trauma. The deformity following an inveterate epi-osteoepiphysiolysis must be corrected surgically before the physiological closure of the growth zones. The pathogenetic problems of posttraumatic deformities in the radiocarpal articulation are discussed and attention is focussed on the "admissible" types of displacement of the epiphysis (meta-epiphysis). The method of bloodless correction of deformities by means of distraction apparatuses is described. The technique was performed in 41 children with good results.
The results of treatment of sixteen patients with unstable thoracolumbar spinal injuries are recorded. Early open reduction, stabilization with Harrington rods, spine fusion, application of a plaster jacket until consolidation, and early mobilization was the treatment. Distraction rods were used in twelve patients and compression rods, in four. Nine patients with incomplete paraplegia showed marked neurological recovery, while five with complete paraplegia regained only some sensation. Two patients had no neurological involvement. Solid fusion was achieved in fifteen patients after a minimum of three months of plaster-cast immobilization. In one patient stabilization failed. There was a loss of 5 degrees on average (range, 2 to 23 degrees) in the correction of the kyphosis. Lateral angulation after surgery did not occur. The treatment allowed easier postoperative nursing and early mobilization of the patient.