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In 2 cases of traumatic atlanto-occipital dislocation in the dog, neurologic signs were associated with cranial cervical pain. Treatment consisted of manual reduction, with the dog under general anesthesia, followed by application of a plaster cast to hold the head and neck in flexion. Recovery was complete in both cases.
Comminuted fractures of the base of the first metacarpal are difficult to stabilize with internal fixation or with plaster casts. Use of the external mini-fixator can provide good results. Complications such as pin-infections were not seen after the use of short duration of this apparatus in closed fractures.
Failure of osteosynthesis can be caused by wrong indication, faulty choice of the surgical method and technique or by wound infection. Two factors are always of great importance in treating fractures: stability of the fixation, if necessary realised by reoperation or by an additional plaster cast and-sufficient time for healing. Disregarding these two principles will be followed by failure apart from the method used.
The intra-articular changes in dog knees were studied following repair of the anterior cruciate and medial collateral ligaments under various postoperative managements: early mobilization, immobilization for 6 weeks in a plaster cast, and limited mobilization for 4 weeks in a cast-brace. The animals were sacrificed at 12 weeks after operation and osteoarthritic changes were graded according to the system described by Mankin et al. The osteoarthritic changes of the knee joints in the mobilized group were significantly less than those in the immobilized and in the cast-brace groups. Medial collateral ligaments were found well healed in most animals; however, anterior cruciate ligaments showed poor healing in the animals treated with early unlimited motion. Postoperative immobilization for more than 6 weeks causes considerable damage to the articular cartilage while early unlimited motion appears to compromise healing of the anterior cruciate ligaments.
Sixteen gap non-unions (seven in the radius, eight in the ulna, and one in the humerus) in fifteen patients were treated with a full-thickness corticocancellous iliac-crest graft, 1.2 to 2.5 centimeters in length, to replace the bone loss, and with a compression plate to provide stability. Thirteen of the fifteen fractures with adequate follow-up united and the grafts were incorporated in an average of 13.5 weeks, an 87 per cent success rate. The stability achieved by the compression plate allowed early removal of the plaster cast and institution of active exercises. In the two failures, the graft was not resorbed, and it filled the gap in the bone but failed to unite at one end.
The authors report on a case of fracture of the distal humeral epiphysis sustained at birth. This is extremely rare. The main problem in treatment of this kind of fracture is correct and timely diagnosis. In almost all reported cases the fracture has been confused with elbow dislocation. The reason for this mistake is difficult roentgenological orientation owing to invisible ossification nuclei. Ultrasono und examination is recommended for diagnosis. The treatment of the injury is conservative. Closed reduction and immobilization for 3 weeks in an above-the-elbow plaster cast is advised. The end-results have been very good in all published cases, as they were in the present case, in which the shape of the injured elbow corresponded absolutely to that on the healthy side, mobility was unrestricted and no growth disturbances were observed after 9 months.
Early revascularization of the reconstructed anterior cruciate ligament (ACL) using a patellar tendon autograft was investigated microangiographically and electron microscopically. In sixteen skeletally mature mongrel dogs, the ACL of the right knee was completely excised and tunnels through the tibia and femur were created at the insertion sites using a 3 mm Steinmann pin. The central portion of the patellar tendon (3 mm wide) was pulled through the holes and secured with sutures and buttons. The leg was immobilized with a plaster cast at 90 degrees of knee flexion until sacrifice. Eight dogs divided into four groups (two dogs each) were examined microangiographically at 1, 2, 3 and 4 weeks after the operation. Other eight dogs divided into four groups (two dogs each) were examined with an electron microscope at 3, 5, 7 and 14 days after the operation. The microangiographic study showed capillary buds invaded the graft from the bone tunnels and ran along the graft-bone interface at one week. Newly-formed capillaries were observed near the fat pad, but only at the surface of the graft. At two and three weeks, vascular sprouts anastomosed with each other, forming a network which extended internally into the graft. Although vascularity was present throughout the graft at four weeks, there was little in the midsubstance. The transmission electron microscopy (TEM) demonstrated that mesenchymal cells (undifferentiated fibroblasts) were in the process of migration to the graft in the area of the bone tunnels at five days. At seven days, these cells formed new vascular lumina and differentiated endothelial cells. At fourteen days, the newly-formed vessels had developed basement membrane. Some of mesenchymal cells appeared to differentiate into fibroblast. These results suggest that bone marrow plays an important role in revascularization and remodelling of the reconstructed graft.
Among 231 patients with clinical signs of a fractured carpal scaphoid but negative primary radiographs, only 3 fractures of the scaphoid were finally diagnosed on subsequent radiological and clinical examinations. Two of these could be seen retrospectively in the primary radiographs. After an observation period of two to three weeks in dorsal plaster casts, 88.8% of the patients were discharged from the outpatient department as having soft-tissue injuries. They required no further treatment. This "overkill" is unsatisfactory, as we agree with other studies that almost 100% of factual fractures of the scaphoid bone are visible on initial radiographs of good quality, using 4 or 5 different views and evaluated by a senior radiologist. We propose a more stringent clinical inclusion into the category of "clinical scaphoid fracture" and the use of simple supportive bandages in an observation period.
Reimplantation (when possible) represents today the method of choice when dealing with and attempting to resolve cases of deep infection in total hip arthroplasty. In recent years we have, however, had the chance to treat some cases of infection in cementless arthroplasty (without loosening) by conservative treatment: surgical debridement and specific antibiotic therapy (2 cases), or medical therapy alone (1 case), both associated with immobilization in a plaster cast for 2-3 weeks. The long-term results proved to be quite encouraging: none of the 3 patients treated conservatively showed (after 5-6 years) clinical-radiographic signs of recurrence of the infection.
To understand better the natural history of fractures of the fifth metatarsal, a fracture registry was established consisting of patients who had acute fractures of the fifth metatarsal. The first 100 patients were studied to develop data on the natural history of injuries to this bone, and on the results of standard treatment for those injuries. In this study, 3 fracture subtypes were identified: avulsion, true Jones' fracture, and shaft/neck fracture. Avulsion fractures healed without immobilization, usually in 4 weeks. Shaft/neck fractures healed in plaster casts with weight bearing as tolerated in 4 to 6 weeks. True Jones' fractures required a prolonged time to heal when treated with 8 weeks of nonweight bearing and then weight bearing as tolerated in a cast. This method was, however, successful in 72% of patients (average time until union, 21.2 weeks). For the 7 patients in whom conservative treatment failed, surgical fixation at an average of 25 weeks after injury reliably achieved bony union in half the time required with cast treatment. This low-risk procedure met with higher patient satisfaction than prolonged casting.
Sixty-four displaced tibial shaft fractures were treated using intramedullary nailing, either primarily or after an attempt at conservative treatment, which consisted of closed reduction under anaesthesia and immobilisation in a long-leg plaster cast. There were 37 closed and 27 open fractures. Three patients had a fracture of both tibiae. The median time period from the intramedullary nailing of the closed solitary fractures to union was about the same after primary nailing as after delayed nailing. Although the fractures were different in these groups, it is possible that the time spent in conservative treatment before intramedullary nailing brings no additional benefits. The incidence of deep infection in open fractures after primary nailing was 1/16. The fractures, in which an acceptable position could not be maintained using conservative methods, were mainly spiral in configuration and located in the distal third or at the junction of the middle and distal thirds of the tibia.
In this paper the results of skeletal traction and irrigation therapy (STIT) used for open fracture complicated with large-sized full-thickness skin-deficit and infection wounds (OFIW) were presented. Fourteen patients of OFIW were treated by the plaster cast and wound dressing (PCWD), and 30 patients of OFIW were treated by STIT. The results indicated that after one week of treatment, the white blood cell count in the STIT group, compared to 17.6 +/- 1.0 x 10(9)/L from before treatment, returned to 8.8 +/- 0.8 x 10(9)/L, and in contrast, the cell count of the PCWD group was about 13.0 +/- 1.4 x 10(9)/L. All of wound exudate culture in the STIT group was negative, and those of 7 cases (7/14) in PCWD group were positive (P < 0.01). The symptoms and signs such as pain, fever and septic exudate on the wound in the STIT group were much milder than those in the PCWD group. There were 5 cases (35.7%) of toxicemia and septicemia, 2 cases (14.3%) of osteomyelitis, 2 cases (14.3%) of amputation, 1 case (7.1%) of delayed union and 3 cases (21.4%) of malunion in the PCWD group, and no complications in the STIT group.
In covering amputations of fingertips several methods, including free grafts and local flaps have proven useful. When the amputation is at a more proximal level near the cuticle closure of the wound is often accomplished by further shortening of the distal phalanx and eradication of the nail matrix in order to avoid a claw-like deformity of the nail. This results in a unpleasant stump of poor prehensile quality. Therefore attention is called to the distal thenar flap which offers all the advantages of the palmar flap e. g. adequate subcutaneous tissue for reconstruction of a fingertip, good texture and colour match and a great potential for recovery of sensation. To avoid permanent stiffness of the PIP joint the flap is fashioned well distally on the thenar eminence with the base on the radial side. Immobilisation is secured by means of a plaster cast with the thumb in full palmar abduction and the MP joint of the recipient finger in full flexion. This leaves the PIP joint in but moderate flexion. The base of the flap is severed at two weeks.
Over the period from 1981 to 1991 twenty-eight children were treated for neurovascular posttraumatic complications (Volkman's contracture), in the Centre for rehabilitation and physical medicine of the Children's surgical department in Belgrade. The success of the treatment depended on how a patient was examined for the first time, and how soon a proper diagnosis was established. On the basis of our experience we insist on an early physical treatment, i.e. while the injured segment is immobilized. An early kinesitherapy followed later by electrotherapy, parafino-therapy, vitamin B therapy and use of corrective plaster cast splints is the best way in treating lesions. The treatment lasted from 3 to 6 months depending on the seriousness of an injury. If there was no good result with physical therapy we carried out surgery followed by physical therapy upon the removal of immobilisation devices.
Patterns of the back of the tongue were studied in 80 normal subjects and 200 corpses of both sexes to detect the individual personality characteristics. A technique of impression making using alginate mass and plaster casts has been developed. A chart and arithmetic scheme is offered for accurate presentation of the number and localization of papillae. Study of the patterns of the mucosa of the back of the tongue revealed individual features in the structure of sulcated, foliated, fungiform, and filiform papillae, which may be significant in identification expert evaluation.
Twenty-three patients with severe open tibial fractures complicated by established deep infection and delay or failure of union were treated with posterior tibial bone-grafting. This was followed by immediate ambulation in a plaster cast. Tibial union was achieved in all twenty-three patients. Drainage ceased prior to or simultaneously with union in twenty-one patients, including twelve of fourteen patients who had indolent drainage from the anterior compartment of the leg at the time of posterior tibial bone-grafting.
This article reports preliminary results of treatment in 33 patients with 36 cancellous bone fractures using absorbable rods and screws of self-reinforced polyglycolide (SR-PGA). Plaster cast was used postoperatively for 3 weeks. All fractures but one lateral ankle fracture were fixed until healed without displacement. All of them healed at six weeks after trauma. No wound infection and fluid accumulation occurred. This new device is an ideal implant for fixation of cancellous bone fracture.
INTRODUCTION: This study is a critical analysis of the results in a homogeneous series of 260 cases of congenital clubfoot followed from birth. MATERIAL AND METHODS: This series of congenital club feet was divided in 2 groups: the stiff forms (144 cases) and the supple forms (116 cases). Daily physical therapy and Denis Brown's splints were begun from the first examination. This method did not allow full correction of deformations in 213 cases. A posterior medial surgical release was performed. Its importance depended on the criteria of radio-clinical analysis before surgery. 46 feet were operated twice. RESULTS: Follow up averaged 7 years. 39 per cent of patients had completed growth, only 18 per cent of feet were not operated. With the surgical treatment, the results were ""very good'' and ""good'' in 75.1 per cent of cases, according to an analysis using Seringe's criteria. 21 per cent were operated again, on an average between 3 and 8 years, with poorer results than at first surgery. DISCUSSION: The quality of the results depends on the quality of the functional treatment. Poor control of equinism with Denis-Brown splints can be corrected by using Seringe's articulated splints or by a series of plaster casts. CONCLUSION: Many technical factors influence the results. The quality of post-operative contention is stressed.