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PubMed1998

[One hundred years of orthopedics in the Netherlands. VIII. Pediatric orthopedics].

Orthopaedic disorders in children differ in type from those in adults: most frequent are congenital anomalies and disorders of growth and development. The special nature and relative rarity of these conditions justify the separate development of this branch of the discipline. Fractures almost always heal normally after closed reduction and immobilization in a plaster cast; fractures close to epiphyseal discs and in joints require special attention. Slipping of the upper femoral epiphysis necessitates surgical fixation of the epiphysis. Benign bone tumours occur relatively often and mostly require no surgical intervention. The prognosis of solid malignant bone tumours has improved since the introduction of (neo)adjuvant chemotherapy and limb-sparing surgery. In case of difference in leg length, the length of both legs is predicted with the aid of roentgenological measurements. Inhibition of the growth of the longer leg gives rise to fewer complications than lengthening of the short leg. The essence of the treatment of growth disorders due to abnormal ossification of the cartilage is to monitor the natural repair process and to intervene if permanent malformation threatens.

Bone Diseases, Developmental↗
PubMed1976

[Advances in osteosynthesis of hand fractures].

In recent years stable internal fixation of hand fractures has become more commonly used though the majority of fractures of the hand bones are still treated successfully by other orthopedic means. We feel that in selected fractures internal fixation achieves better results than conservative treatment. Operative methods with less traumatic skin incisions for the fixation of multiple metacarpal fractures are proposed. A retrograde screw fixation technique is presented which permitts application of compression in very small bone fragments, which risk to be crashed by standard screwing. Results of 60 internal fixations of carpometacarpal fractures of the first metacarpal are reported. Follow-up examination of 41 patients between 1-7 years following surgery, revealed posttraumatic arthritis only in 3 joints, although remaining small articular irregularities were frequently seen on X-ray. Secondary angulation occured in four cases in spite fixation. This was due to poor cortical fixation on the palmar side of the fracture, thus in such cases temporary plaster cast should entirely be applied.

Accidents↗
PubMed1976

[Conservative treatment of extensor tendon injuries].

Report on 35 cases of mallet finger treated conservatively: a circular plaster cast was modeled in hyperextension of the distal interphalangeal joint. The immobilisation of the whole finger form the tip to the proximal phalanx was maintained for six weeks. The reported results were good or excellent with the exception of two cases.

Casts, Surgical↗
PubMed1998

[Results of treatment of acute grade III acro-myo-clavicular dislocation by closed reduction and Kirschner wires fixation].

Eight patients with acute, grade III acromioclavicular dislocation were treated by closed reduction and fixation with Kirschner wires introduced through the acromion into distal end of the clavicle. Desault plaster cast was discarded and K-wires removed after 6 weeks (in 3 patients after 4 weeks due to loosening). Minimum follow-up was 2 years. Patients were assessed with a 100 points scale of Kawabe et al., initial and final radiographs were compared. Four results were rated excellent (between 90 and 100 points), 3 results good (between 80 and 89 points) and in one case result was fair. Normal anatomy of acromioclavicular joint has been found in 75% of patients. Partial loss of reduction was found in two patients. It has been concluded, that closed reduction and fixation with Kirschner wires is simple, barely invasive method of treatment for acromioclavicular dislocation and gives good final results.

Acute Disease↗
PubMed1998

[Prevention of thromboembolism with low-molecular-weight heparin in ambulatory surgery and unoperated surgical and orthopedic patients].

Prophylaxis of thromboembolism is now well established in orthopaedic outpatients with plaster cast and after elective hip surgery. The present study was undertaken to evaluate the safety of out-of-hospital prevention of venous thromboembolism and to determine the incidence of thromboembolic complications in orthopaedic and surgical patients with or without surgical intervention on an out-patient basis during prophylaxis of thromboembolism with low-molecular-weight heparin and to study the feasibility of this treatment regimen. The treatment period was 1-4 weeks (mean 17 days). Main indications for prophylaxis of thromboembolism were arthroscopy and surgical or non-surgical intervention of bone fractures of the lower leg. The incidence of clinically diagnosed venous thromboembolism was 11/1604 (0.7%) in operated and 8/1017 (0.8%) in non-operated patients. Pulmonary embolism occurred twice in operated patients (0.1%) and in none of the non-operated patients. Minor bleeding complications were rare and major bleeding complications did not occur. Haematomas at the injection site occurred in only 4% of patients. Thrombocytopenia did not occur in any patient. The present study demonstrates the feasibility and safety to prophylaxis of thromboembolism with low-molecular-weight heparin in orthopaedic operated and non-operated out-patients with various orthopaedic or surgical diseases leading to immobilization. The incidence of clinically apparent thromboembolic complications is low and similar to medical bedridden inpatients.

Adult↗
PubMed1998

[Isolated traumatic anterior dislocation of the radial head].

The authors report 2 cases of isolated traumatic anterior dislocation of the radial head in children. In the first case, with an acute dislocation, closed reduction followed by plaster cast immobilisation for one month gave a good result. In the second case, the dislocation was also traumatic in origin but had remained unreduced for 5 years. Arthrography of the elbow showed the head to be intracapsular. The authors believe that a neocapsule forms in cases of old unreduced dislocation and arthrography is therefore of little help to differentiate a long standing traumatic dislocation from a congenital dislocation. Based on their experience and on the literature, the authors propose closed reduction followed by immobilisation as a treatment for acute dislocation; old unreduced dislocations cannot be reduced by manipulation and with the exception of very symptomatic cases, the authors prefer to avoid open reduction, which carries a risk of joint stiffness.

Adolescent↗
PubMed1998

[Biological osteosynthesis].

A historic review distinguishes three periods in the treatment of fractures: The conservative period (approximate reduction and immobilization in traction or plaster cast), the mechanical and operative period (exact anatomical reduction and stable--even rigid--fracture fixation), and the biological and mechanical period (stability with strict attention to the biological environment of the bone circulation). Biological fracture fixation means: conservation of bone perfusion, protection of the soft tissue envelope and reduction of systemic stress by strengthening the host-defense mechanism. For preoperative planning, the following points have to be considered: choice of fixation method, reduction technique (open, closed, additional aids), surgical tactics (approach), and intra- and postoperative adjuvant therapy.

Combined Modality Therapy↗
PubMed2000

Which displaced spiral tibial shaft fractures can be managed conservatively?

The aim of the present study was to establish a threshold for the initial displacement of a spiral tibial shaft fracture beyond which its retention in an acceptable position cannot be guaranteed by plaster immobilization. We reviewed the records and radiographs of 131 plaster cast-treated patients with spiral tibial shaft fracture, initially displaced 50% or less, for patients whose fracture had either lost its acceptable retention or consolidated in an unacceptable position. The fractures were classified, according to the true initial displacement as measured on the first radiographs, into four pairs of categories using cut-off points of 10, 20, 30 and 40% of the diameter of the tibial diaphysis. Comparison was then made of the proportions of failed treatments between each of these pairs. Plaster cast treatments failed in 28% when the true initial displacement was 30% or less, and in 46% when the true initial displacement was more than 30%. The risk of failed plaster cast treatment increased when true initial displacement exceeded 30%. In all patients whose plaster cast treatment was interrupted the true initial displacement was more than 30%. We therefore conclude that diaphyseal fractures of the tibia for which the initial displacement exceeds 30% are not suitable for plaster cast treatment.

Adolescent↗
PubMed1996

Precision of surface measurements for below-knee residua.

OBJECTIVE: To determine the absolute and relative precision of geometric measurements made of below knee (BK) residua and their BK plaster positive casts using calipers, electromagnetic digitizer, optical surface scanner (OSS), and spiral x-ray computed tomography (SXCT). DESIGN: The experimental measurement protocol for a single measurement session was as follows: Dot markers were placed on the residuum, and volume and distances were measured using water displacement and calipers; residuum was measured using electromagnetic digitizer; residuum was scanned using three-dimensional (3D) OSS; a negative plaster cast of subject's residuum was made; the residuum was scanned using SXCT scanner. These steps were repeated at a second measurement session. Plaster positive casts were constructed and subsequently measured using the same protocol. PARTICIPANTS: Thirteen adult below-knee amputee volunteers (subjects) participated in the study, and nine subjects returned for a second measurement session. The study group consisted of 9 men and 4 women; 10 Caucasians and 3 African Americans. RESULTS: Distance measurements for all measurement devices were repeatable within 1% in vivo and within 0.5% on plaster casts; and volumes were within 1% in vivo and within 0.1% on plaster casts. Distance measurements for each device were precise within 3% in vivo and within 1% on plaster casts; and volumes were within 5% in vivo and within 6% on plaster casts when compared with caliper and water displacement measures. CONCLUSION: These measurement systems were found to be substantially equivalent in terms of repeatability and precision for measurement of lower extremity residua.

Adult↗
PubMedDate not supplied

Cast changes: synthetic versus plaster.

A review of the changes in casting since the introduction of improved synthetic casting materials in the 1970s is presented. There is very little in the literature on nursing implications regarding the newer casting materials. Improvements in synthetic materials used in the casting of children include a fiberglass-free, latex-free casting polymer, with child-friendly prints now available. Though the use of synthetic casting predominates the market, plaster of Paris is still the mainstay for serial casting and casting requiring superior moldability and conformability. The advantages and disadvantages of synthetic and plaster of Paris casting, as well as nursing care of the child in each type of cast are summarized.

Calcium Sulfate↗
PubMed2005

Fiberglass cast application.

Plaster of Paris has been largely superceded for casting in orthopedic departments by synthetic cast materials. Despite its weight, its relative brittleness, its unpopularity with patients, and its messiness in application, plaster of Paris remains the mainstay of casting in the emergency department. This is due to a combination of economic reasons, the belief that synthetic casts leave less room for swelling and its relative ease of application compared to synthetic materials. We present a technique for synthetic cast application that avoids the problems of the rapidly setting cast and therefore allows the time for less experienced hands to produce a well-fitting cast or splint. We believe that this option, which allows the patient to have a lighter synthetic cast, rather than the traditional plaster of Paris cast, will be welcomed by both the patient and physician.

Casts, Surgical↗
PubMed2005

The nest architecture of the ant, Camponotus socius.

The architecture of subterranean nests of the ant Camponotus socius was studied from casts of plaster or metal. Twenty-four such casts are illustrated using stereo pairs of images. After study, plaster casts were dissolved to retrieve the workers embedded in them, providing a census of the ants that excavated the nest. Nests were up to 60 cm deep, and were composed of descending shafts connecting up to about 10 horizontal chambers. Nest volume ranged up to almost 800 cm and total chamber area up to almost 500 cm. Both volume and area were closely and positively related to the number of workers in the nest. Nest enlargement occurred through the simultaneous enlargement of chambers, deepening of the nest and addition of more chambers. Chamber enlargement contributed most to nest growth. Chambers near the surface were elongate and tunnel-like, while deeper chambers were more compact in outline. As chambers were enlarged, their outlines became more complex and lobed. Workers were polymorphic with clearly distinguishable minor and major workers. The headwidth of minors averaged 1.45 to 1.65 mm, and that of majors 2.30 to 2.80 mm. The mean headwidth of minors increased significantly as the proportion of major workers increased, but the trend of major headwidths fell short of significance. The numerical proportion of majors ranged from 3% to 38% and averaged 15% of the workers, while their biomass proportion ranged from 10% to 75%, averaging about 50%. The queen was recovered in 6 of the 14 plaster nests, suggesting that the average colony of this polydomous species has 2.3 nests. Because of the lateness of the season when casts were made (October), only two nests contained significant amounts of brood. The possible functional roles of nest architecture in ants are discussed.

Animals↗
PubMed1981

[Treatment of florid dorsal Scheuermann's disease with two new breathable plaster-of-paris casts and their biomechanical principles of action (author's transl)].

Basing on the experience collected with the breathable plaster-of-Paris jacket described by Koch in 1926 for treating the dorsal type of Scheuermann's disease, we developed two breathable and removable ortheses (Brakeler's jacket and Istanbul jacket). The biomechanical principles action of these jackets were examined both by calculation and clinically as well as roentgenologically.

Biomechanical Phenomena↗
PubMed1999

Occlusal changes from adolescence to adulthood in untreated patients with Class II Division 1 deepbite malocclusion.

A sample of 47 untreated children (M 32:F 15) with Class II Division 1 (II/1) deep-overbite malocclusion was collected from a group of patients who declined orthodontic therapy. Longitudinal records consisted of plaster dental casts and lateral cephalograms at original diagnosis and plaster dental casts at a follow-up observation in adulthood, an average of 11.5 years later. To study retrospectively natural changes in dental occlusion during this interval, plaster-cast millimetric measurements were recorded of sagittal dental relationships (first molar and canine), overjet, overbite, and crowding/spacing at the two registrations. Results showed statistically significant improvements in untreated II/1 deepbite malocclusion from adolescence to adulthood for all measured occlusal variables except development of mild crowding. Therefore, assumptions that untreated II/1 distoclusion will worsen with age appear to be unfounded. The evidence indicates that the absence of orthodontic correction for adolescent patients with Class II Division 1 deepbite malocclusion will not usually lead to measurable occlusal deterioration in young adulthood.

Adolescent↗