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PubMed1983

[Orthopedic problems of vitamin D-resistant rickets (phosphate diabetes)].

Results of the operative treatment of phosphate-diabetes are presented on the basis of our own patients. Deformations of the lower extremities need in case of a disturbed function and disfigurement of the gait picture a surgical correction, by which we should strive as much as possible for physiological axial proportions in both planes. For young children osteoclasis with fixation in plaster cast will suffice, for adolescents and grown-ups we prefer stable osteosynthesis. An adequate straightening, combined with a regular control of the mineral metabolism and an appropriate drug therapy, guarantee good long-term results and absence of recidivity.

Adolescent↗
PubMed1984

Effect of immobilization on some glycolytic enzymes of skeletal muscle.

The effect of immobilization by plaster cast was studied on the activities of phosphoglucomutase (PGM), pyruvate kinase ( PyK ) and cAMP-dependent protein kinase in fast (extensor digitorum longus [EDL]), and slow (soleus) muscles of rats. In control untreated animals, PGM and PyK activities are 3 and 5 fold higher respectively in EDL than in soleus in correlation with the high glycolytic activity of fast muscles. During the four weeks period of immobilization a 20% decrease occurred in PGM activity, to which no limiting role in glycolysis is attributed, while PyK which has a regulatory function, showed a 35% decrease in EDL; at the same time in the soleus the activity of these enzymes did not change. The decrease of PGM and PyK activity in EDL diminished the difference between the slow and fast muscles, and it was evaluated as a tendency to dedifferentiation (transformation). The activity of cAMP-dependent protein kinase, in contrast to the glycolytic enzymes, was higher in the soleus than in the EDL and during immobilization it did not change significantly in either the muscles.

Animals↗
PubMed1984

[Electrotherapy of pain relief using the Tenzcare stimulator. A clinico-experimental study].

Electrotherapy was introduced into the aftercare programme for patients with serial rib fractures in the acute stage, shoulder injuries or fractures of the radius. Electrical stimulation was carried out with the Tenzcare Nr. 6240 apparatus. The results were significantly better in each of the three groups than in the respective control group. Patients after thorax trauma complained less of pain in the acute phase: there was less pulmonary secretion on X-ray and, on average, their blood gas values returned to normal three days earlier. None of them required assisted respiration. Patients with shoulder injuries or fractures of the radius complained less frequently of pain during physio-therapy after removal of their plaster casts. They attained their optimum range of movement on average ten and eight days earlier, respectively than the controls.

Adult↗
PubMedDate not supplied

Growth and maturation of mandibular bone in otherwise totally immobilized rhesus monkeys.

The effects of 14 days of total postcranial body immobilization (in plaster casts) on the mineralization rate and on the maturation of matrix and mineral moieties in the rhesus jaw were studied by tetracycline labeling and by density gradient methods, respectively. Immobilization did not alter the rates of periosteal and endosteal mineralization in the dense cortical bone from the lingular region of the jaw, but it did impair mineralization in osteonal bone. Osteons that continued to show radial closure did so at a normal rate. In the more trabecular cortex (premolar region) in young monkeys (3-6 kg body weight), immobilization impaired bone mineralization, as shown by lower ratios of calcium and inorganic phosphorus to hydroxyproline (Ca/HO-Pr;Pi/HO-Pr), and it reduced the rate at which the newly formed bone and mineral moieties matured. In older monkeys (6-10 kg body weight) immobilization did not alter Ca/HO-Pr and Pi/HO-Pr ratios or impair tissue maturation. These changes tended to normalize within 7 to 14 days after decasting.

Age Factors↗
PubMed1984

Triplane fractures of the distal tibial epiphysis.

Triplane distal tibial fractures can occur as two-, three-, or four-part fractures with or without a fibular fracture. Diagnosis of the particular anatomy of each fracture is ascertained by plain radiographs; if the fracture is displaced 2 mm or more on any view, anteroposterior and lateral tomograms and, if possible, a limited computerized tomography (CT) scan should be done. A plaster cast in situ for non-displaced fractures or closed reduction for displaced fractures should be attempted first by internal rotation and anterior movement of the fibular metaphyseal piece. Failure to obtain and/or maintain an adequate closed reduction (less than 2 mm displacement), determined by plain radiographs, is an indication for operative treatment. Operative treatment consists of screw fixation for the metaphyseal fragment alone in two-part fractures and both metaphyseal and epiphyseal screw fixation in three-part fractures. Associated fibular fractures may also require internal fixation. The prognosis is generally good if adequate reduction has been achieved by closed or open means.

Adolescent↗
PubMed1978

[Aimed partial immobilization (author's transl)].

A method for treating dislocation of the hip is described which is relatively problem-free. The paper also describes how to apply a partly immobilizing plaster cast. Success of the treatment is confirmed by the reduced quota of necroses of the femoral head. Easy care is another remarkable feature of this method.

Casts, Surgical↗
PubMed1984

A new surgical approach to fractures of the lateral tibial plateau.

We are reporting on a previously undescribed surgical approach and postoperative protocol for the treatment of fractures of the lateral tibial plateau in which there is a split pattern and depression of the articular surface. In this approach the anterior horn of the lateral meniscus is incised and detached so that the split fragment can be opened like a book. Detachment and incision of the anterior horn minimizes the need to free the lateral meniscus from its tibial attachment. The postoperative protocol includes continuous passive motion followed by non-weight-bearing in a toe-to-groin plaster cast for three months. Our preliminary results have been encouraging, and arthroscopic examination in the seven knees so studied indicated a healed fracture, restoration of the tibial articular surface, and a healed lateral meniscus.

Adult↗
PubMed1978

Results of treatment of supracondylar fractures of the humerus in children with special reference to the cause and prevention of cubitus varus.

Report and analysis of the results of treatment of 56 children who exhibited a typical supracondylar fracture of the humerus necessitating reposition and treatment by clinical methods. The functional results were good on the whole and they were not clearly dependent on the nature of the treatment. The treatment consisting in manual reposition followed by application of a plaster cast was followed in about 50% of the cases by disfiguring cubitus varus. The causes of this phenomenon are discussed. The typical endorotation of the distal fracture fragment in regard to the proximal fragment plays an important part in causing cubitus varus. Cubitus varus may be prevented by wire traction through the olecranon, even if the rotation displacement persists. For this reason, this treatment is recommended. If the rotation displacement persists in the course of the traction treatment, it is advisable to use Baumann's method of demonstrating and correcting a possible varus tilting during the course of the traction treatment. If development of cubitus varus is still suspected, surgical reposition and fixation are possible, a safe method which gives good results. The surgical treatment should achieve an anatomically correct position of the fragments.

Adolescent↗
PubMed1978

Traumatic dislocation of the radial head in a 5-year-old boy: case report.

A case report of anterior traumatic dislocation of the radial head in a 5-year-old boy without evident injury of the ulna is presented. Reduction and immobilization in flexion and supination in a plaster cast for 2 weeks were carried out. After 2 years the final result is satisfactory and there is no difference between the injured and normal forearms.

Child, Preschool↗
PubMed1984

Use of a bivalved polypropylene orthosis in the postoperative management of idiopathic scoliosis.

Forty-four consecutive patients with idiopathic scoliosis treated by posterior spinal fusion and Harrington rod instrumentation were immobilized after surgery with bivalved polypropylene orthoses. Immediate ambulation was allowed, and the patients wore the orthoses for a mean of 5.9 months. Brace removal was permitted with the patient recumbent for sponge bathing. These patients were followed up for a mean of 2.1 years (range, 1.0-4.3 years). The average final correction for all curves was 45%. The average loss of correction was 2.4 degrees (5.3%). Combined distraction and compression instrumentation was found to improve final correction in all curves by 3 degrees (6.2%) as compared with distraction instrumentation alone. There were no pseudarthroses and no rod breakage. Patients enjoyed the benefits of improved personal hygiene, pleasing cosmetic appearance, and increased life-style flexibility, especially swimming, which was not possible with the conventional Risser plaster cast. Use of the polypropylene orthosis offers significant advantages as compared with previous methods of postoperative management: it not only provides consistently good results but is enthusiastically accepted by patients as well.

Adolescent↗
PubMed1984

Distal tibial physeal fractures in children that may require open reduction.

Fractures of the distal end of the tibia in children often involve the physis. They are of particular importance because partial growth arrest can occur and result in angular deformity, limb-length discrepancy, or incongruity of the joint surface (or a combination of these). We evaluated the cases of thirty-two children who had a fracture leading to established partial growth arrest of the distal end of the tibia. Most of this group had had a Salter-Harris Type-III or Type-IV fracture. Twenty-eight of the fractures had been treated by gentle closed reduction and immobilization in a plaster cast. We also evaluated the cases of thirty-three children who were seen by us for treatment of an acute fracture; most of these were Salter-Harris Type-III or Type-IV fractures of the distal end of the tibia. Nineteen of the twenty acute Type-III or Type-IV fractures that were treated with accurate open reduction of the physis and internal fixation healed without growth disturbance, while five of the nine fractures that were treated by closed means formed a bone bridge, presaging a disturbance in growth. This study suggests that Salter-Harris Type-III and Type-IV, and perhaps Type-II, fractures of the distal end of the tibia commonly cause disturbance of growth in the tibia, and that anatomical reduction of the physis by closed or open means may decrease the incidence of these disturbances of growth, including shortening and varus angulation of the ankle.

Adolescent↗
PubMed1984

Fractures of the intercondylar eminence of the tibia in childhood.

Fracture of the intercondylar eminence of the tibia occurs more frequently in children than in adults. This fracture may occur as an isolated injury without damage to the other structures of the knee joint. X-ray examination of the painful swollen knee of the child is necessary to determine the exact diagnosis. Type I and type II fractures of the intercondylar eminence of the tibia require only immobilisation in a plaster cast after anatomical reposition. Open reduction is often necessary following type III fractures and almost invariably following type IV fractures. Following anatomical reposition of the avulsed fragment the prognosis for complete recovery is excellent.

Adolescent↗
PubMed1984

[Indications for osteosynthesis of metatarsal fractures].

Fractures of metatarsal bones range from 4 to 5% of all fractures and to less than 1% of all injuries occurring. The usual treatment is non-operative by plaster cast. In case of special physical performance (profession, sports) the indication for operative treatment can be extended. This should be taken into consideration in dislocated multiple fractures as well as in single ones of the first and fifth metatarsal bone.

Adolescent↗
PubMed1984

[Fractures of the tarsus and metatarus in children--diagnosis, treatment, results].

Within 4 years (September 1977 to September 1981) 169 closed fractures of the feet were seen at our paediatric-surgical outpatient dept. Special therapeutic problems arose only in fractures of the talus and the calcaneus, although necrosis of the talus were rare. Concerning treatment a plaster cast, sufficient relief and early arch-support are essential. Fractures of the other tarsal bones were mostly without problems, a conservative treatment was used for these cases.

Adolescent↗
PubMed1983

The isolated fracture of the ulnar shaft. Treatment without immobilization.

The isolated fracture of the ulnar shaft is notorious for prolonged healing time. Over a twenty-seven-month period, seventy-one such fractures were treated at our institution. The initial twelve fractures were immobilized with the standard axilla-to-palm plaster cast. They had an average healing time of 10.5 weeks and a non-union rate of 8 per cent. The remaining fifty-nine fractures were treated without a cast or with a cast or splint for no longer than two weeks after injury and then mobilization as tolerated. In this group the average healing time was 6.7 weeks and there were no non-unions. The motion at the wrist and elbow was always regained, and the average loss of forearm rotation was 5 degrees.

Adult↗
PubMed1983

Metatarsus adductus: classification and relationship to outcomes of treatment.

In a retrospective study of results of treatment in 160 children (265 feet) who had metatarsus adductus prospectively defined by severity and flexibility, we found that in 147 patients treated with plaster casts or casts followed by derotation splints the only significant predictor of a good outcome was the age of the patient. Results were statistically significantly better when treatment was begun from ages 1 day to 8 months. No significant correlations with poor results were found using the severity and flexibility grading systems. Given the public attitude toward deformity, it seems wiser to treat in infancy those feet graded "moderate" or "severe." If treatment is not commenced until the child is old enough to preclude conservative treatment, extensive surgery will be necessary to correct a "severe" deformity.

Age Factors↗
PubMed1983

Lisfranc's fracture-dislocations: etiology, radiology, and results of treatment. A review of 20 cases.

Tarsometatarsal fracture-dislocation is an uncommon but severe lesion. Since this diagnosis is over-looked in about 20% of cases, accurate radiographic examination is imperative. In the presence of suggestive clinical signs and negative standard roentgenograms, stress-films in eversion-pronation and inversion-supination are obtained under general anaesthesia. A review of 20 cases shows that plaster cast immobilization without reduction is unsatisfactory, often resulting in Südeck's atrophy and subsequent painful degenerative arthritis. Secondary fusion may be necessary to relieve symptoms. The treatment of choice is anatomic reduction and transfixation with Kirschner wires. The major complication is arterial damage with necrosis of the forefoot. Amputation may be necessary.

Adolescent↗
PubMed1983

[Injuries of the proximal humeral epiphysis. Indications for surgical therapy and results].

Lesions of the proximal humeral epiphyseal plate occur most frequently as epiphysiolysis with metaphyseal fragment between the age of 12 and 16 years. The conservative treatment with Desault plaster cast is recommended for stable fractures. In unstable fractures the percutaneous K-wire osteosynthesis after reduction is the adequate procedure. Hypertrophic scars were found after open reduction in half of all patients treated. Only when closed reduction was impossible, the fracture should be exposed and stabilised with K-wires and/or lag screws. All 21 patients who were followed-up have been free of complains with a full range of motion in shoulder and elbow joints.

Adolescent↗