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A new thermoplastic casting material. A comparison between plaster of Paris and Hexelite.

Plaster of Paris and Hexelite, a new thermoplastic bandage, were compared in the treatment of 183 patients with malleolar fractures, Colles' fractures or distortions of the finger joints. There were no statistically significant differences between the two types of bandages taking into account the strength of the bandage, the amount of skin damage and the patient's opinion of the bandage. Hexelite is seven times more expensive than plaster of Paris, and, in addition, is more difficult to handle. Hence its use has been discontinued.

Adult↗

[Distal intraarticular humerus fractures in elderly patients. Treatment with combined percutaneous screw fixation and an external fixator].

BACKGROUND: Intra-articular distal humerus fractures are relatively uncommon. Due to osteoporosis in elderly patients, stable fixation still remains a problem despite new implants providing angular stability. MATERIAL AND METHODS: The treatment of choice is open reduction and plate fixation requiring an extended approach with olecranon osteotomy often combined with additional postoperative immobilisation in a long arm cast. We describe a technique using closed reduction and percutaneous osteosynthesis with cannulated screws combined with external fixation. Morbidity due to surgical exposure and potential risks are diminished while functional results are comparable to open reduction and internal fixation . In contrast to plasters or casts, the use of an external fixator allows stable and safety protection of the elbow joint, preserving wrist function as well as forearm rotation and increasing the patient's comfort during immobilisation. RESULTS: We have used this technique on ten patients aged 76.2 years (range 67-88 years). According to the AO classification, there were three B-1/B-2 fractures, four C-1 and three C-2/C-3 fractures without severe comminution. The duration of external fixation was 6.3 weeks (range 4-8 weeks) before fracture union was achieved. This allows the initiation of physiotherapy and motion of the elbow. There was only one revision caused by the necessary replacement of an aseptic loosened Schanz screw. At follow-up 3 months postoperatively, the range of motion of the elbow was 95 degrees (65 degrees-105 degrees ), average extension 25 degrees (10 degrees-35 degrees ) and mean flexion was 115 degrees (100 degrees-120 degrees ) with all patients exhibiting full pro/supination.

Aged↗

Cast-bracing for fractures of the femur. A preliminary report of a modified device.

The second-generation cast-brace system offers some advantages over previous systems of cast-brace treatment for fractures of the femur. Because the thigh section is adjustable, loosening of the cast-brace is not a problem. The device can be applied earlier and need not be reapplied when the girth of the thigh is reduced. Using a roller traction system, the cast-brace can also be used initially for traction and suspension without the complexity of traditional systems. With the use of commercially available plastic knee joints, special skills in alignment of the joints are not necessary, and no specially trained personnel need be on hand. The lightweight thigh section coupled to custom-fit plaster leg section, with the foot and ankle free, are less bulky than a totally plaster cast-brace with metal side joints. Walking may be begun earlier with the device, and in-patient hospital time is reduced. However, this system requires a high level of patient cooperation in that the patient is free to adjust the system himself and, therefore, the system may not be safe for application in all settings.

Adult↗

Re-displacement of paediatric forearm fractures: role of plaster moulding and padding.

Re-displacement of paediatric forearm and wrist fractures following manipulation and cast application is a common complication. Poor plaster application technique is an important risk factor for re-displacement. However, there are no reliable and validated objective radiological measurements to differentiate a well-applied plaster cast from a poorly padded and moulded cast. This study was conducted in the background of this fact. We have attempted to define simple, reliable and objective radiological measurements to determine the quality of moulding and padding of the plaster thereby predicting re-displacement of fractures in this group. The two radiographic measurements used in this study are Cast index and Padding index, which are a guide to plaster moulding and padding, respectively. Case records and radiographs of 142 children who underwent a manipulation for a displaced fracture of forearm or wrist were studied. Angulation, translation displacement, Cast index and Padding index were measured on radiographs. The sum of the Cast index and Padding index was termed as the Canterbury index. Re-displacement was seen in 44 cases (32.3%). Cast index, Padding index and Canterbury index were significantly greater in the re-displacement group as compared to the cases where no re-displacement was seen (p<0.005). Improvement in the plaster application skills as monitored by these indices reduced the re-displacement rate by 50%. We suggest that a high Cast index of more than 0.8, Padding index of more than 0.3 and the combined Canterbury index of 1.1 are important risk factors for re-displacement of these fractures.

Adolescent↗

Congenital dislocation of the knee in Ibadan, Nigeria.

Between January 1996 and December 2001, 41 congenital dislocations of the knee joints (30 patients) were reduced with closed methods by immediate reduction without anaesthesia and serial casting in plaster of Paris immobilization for a period of six to eight weeks. The patients' age ranged from the age of one week to four weeks with a male to female ratio of 1.5:1. The right knee was involved in 46.65% the left in 16.6% and bilateral involvement in 36.65% of patients. Routine check of the hip did not reveal any patient with hip instability. All the patients followed up after 2 years showed excellent results. We conclude that congenital knee dislocation when discovered early and without any other congenital malformation can be managed conservatively with excellent results.

Age Distribution↗

Sexual dimorphism in the relationship between number of emerged permanent teeth and percentage of adult stature.

The relationship between the number of emerged teeth and statural growth was investigated in a sample of 31 boys and 42 girls followed longitudinally from 6-12 years of age. The number of emerged permanent teeth was counted on the total number of plaster dental casts. Percentage of adult stature attained at a given age was calculated on the basis of predicted adult stature at 25 years of age using the BTT model. Percentage of permanent teeth emerged was based upon 28 teeth, the number of all permanent teeth except for the third molars. Girls attained a greater percentage of adult stature at each age, but there was no clear sex difference in the percentage of emerged teeth. However, when expressed on the basis of %adult stature, there was clear sex difference in %emerged teeth. The results suggest a sex difference in %emerged teeth that is specific to the %adult stature that has been attained. Am. J. Hum. Biol. 11:619-626, 1999. Copyright 1999 Wiley-Liss, Inc.

Journal Article↗