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PubMed1986

Safety seat use for children with hip dislocation.

Treatment of children with congenitally dislocated hips requires that an infant be placed into a plaster spica cast for a duration of 3 to 12 months. Because the use of a safety seat is difficult, if not impossible, for children fitted with a brace or spica cast, a solution for safe transportation was developed. A Century child restraint model 100 or the Century model 300 was selected as appropriate for modification. Seat padding was removed from the lower sides of the plastic shell, and the shell was cut. The seat padding was replaced and taped tightly to the outer side of the shell. An impact test of the modified safety seat at the University of Michigan Transportation Research Institute indicated that the modification of the shell did not compromise the performance of the restraint system. Seats with this modification have been loaned to children treated at the James Whitcomb Riley Hospital for Children with satisfactory results.

Casts, Surgical↗
PubMed1985

Effects of head and body restraint on experimental motion-induced sickness in squirrel monkeys.

Each of 16 Bolivian-phenotype squirrel monkeys of mixed sex had a machine bolt mounted on the skull with acrylic cement; 13 were provided with temporary plaster body casts allowing free movement. With eyes open, all were rotated in the horizontal plane at 30 rpm every other day until vomiting occurred or for a maximum duration of 120 min/spin. Latencies for motion-sickness signs were recorded under three experimental conditions: free movement, torso fixed to an aluminum frame and both torso and head restrained by bolting to the frame. Subsequently, 10 monkeys from this sample were rotated while blindfolded with head and torso immobilized. Results partially confirmed human and animal findings reported by others: reduced mobility was accompanied by a reduction in the incidence and an increase in the latency of motion sickness. The importance of optokinetic input for the generation of motion sickness in this species was clear.

Animals↗
PubMed1983

The effect of limb immobilization on muscle function and protein composition.

The treatment of skeletal injuries often requires immobilization for extended periods. Immobilization causes muscle disuse atrophy, which extends the duration of incapacitation following the healing of the skeletal injury. To evaluate the role of immobilization position on the skeletal muscle, an experimental study using an animal model was undertaken. Cats were divided into four groups, with one hind limb immobilized in a plaster spica cast such that the gastrocnemius and soleus muscles were held in either a stretched, shortened, or neutral position. After four weeks of immobilization, functional and quantitative assays of muscle tissue were obtained and correlated. The shortened muscles weighed less, had a lower total content and concentration of myofibrillar proteins (the contractile protein of muscle tissue), and generated less maximum tetanic tension than either the muscles held in neutral or stretched length position. Decreased maximum tetanic tension resulted from the preferential loss of contractile protein. The remaining myofibrillar protein in the shortened muscle showed contractile dysfunction. The ability to maintain initial twitch strength (an endurance function) for five minutes varied with position but was not statistically significant in this study. The data suggest that muscle maintained in a shortened position atrophies more rapidly, with greater loss in contractile function and myofibrillar and sarcoplasmic proteins than the stretched and neutrally positioned muscles.

Animals↗
PubMed1982

Chronic unreduced dislocations of the shoulder.

We evaluated the results of treatment in twenty-three patients with twenty-four shoulder dislocations that had gone unreduced for at least three weeks. Fourteen dislocations were posterior, eight were anterior, and one each was superior and inferior. Seventy-nine per cent of the posterior dislocations had not been recognized by the initial treating physician. Fourteen shoulders (58 per cent) were operated on. Of seven that were treated by open reduction with preservation of the humeral head, the results in two were graded as excellent; in three, as good; and in two, as fair. A Neer total shoulder-replacement prosthesis was used in one patient with an excellent result, and a Neer humeral-head prosthesis was used in two patients with a good and a fair result. In four patients, the humeral head was removed and a Jones procedure was performed, with one good and three fair results. There were no poor results after surgical treatment and it was not necessary to arthrodese any shoulder. We did not find it necessary to transfix the shoulder joint by screws or pins, or to use plaster spica casts to maintain stability of the shoulder following open reduction. Supporting the arm at the side in a position posterior to the coronal plane for a posterior dislocation, and anterior to the coronal plane for an anterior dislocation, proved to be comfortable and effective. There were no postoperative dislocations using this simple method. These results show that the over-all prognosis for surgical treatment of the chronic unreduced dislocation shoulder is more favorable than has previously been reported. A rating system based on 100 units was used to evaluate our final results, and is recommended as a standard system for future comparative studies.

Adult↗
PubMed1995

The VA-Cyberware lower limb prosthetics-orthotics optical laser digitizer.

Characterization of the residual limbs and limb segments of patients for prosthesis and orthosis design has principally been a subjective process, highly dependent upon the skill, level of training, and experience of the prosthetist/orthotist involved. Even with the application of computer-aided design (CAD) and computer-aided manufacturing (CAM) technologies in prosthetics and orthotics, residual limb/limb segment characterization has remained substantially subjective and dependent upon prosthetist/orthotist skill, training, and experience. To eliminate the variations and errors that frequently occur because of this dependence, and to further quantify the patient measurement process, rehabilitation engineering researchers at the New York Department of Veterans Affairs Medical Center developed an optical laser digitizer for quantitative characterization of patients' residual limbs'/limb segments' spatial geometry and surface topography. The optical digitizer developed is described, and results of laboratory and clinical tests with the digitizer are presented. Examples showing the capability of the digitizer to accurately, rapidly, repeatably, and consistently capture the contours over the entire surfaces of the residual limbs of patients with below-knee (BK) and above-knee (AK) amputation, the lower limbs of orthotics patients, and the feet and ankles of pedorthics patients, are given. In addition, results of a comparative clinical study of optical digitization and standard prosthetics CAD plaster wrap cast electromechanical digitization of the residual limbs of subjects with BK and AK amputation are presented. The enhanced accuracy, repeatability, and consistency afforded by optical digitization are shown. Finally, areas for refinement of the optical digitizer's design, identified in the project's laboratory and clinical tests, are discussed.

Amputation Stumps↗
PubMed1996

Urological problems after surgical treatment of scoliosis in children with myelomeningocele.

PURPOSE: We assessed urological problems and complications after scoliosis surgery in children with myelomeningocele. MATERIALS AND METHODS: A total of 16 children with myelodysplasia underwent surgery for scoliosis using different surgical techniques and instrumentation systems. Mean patient age at operation as 11 years and mean postoperative followup was 3 years. All patients had urological assessment before and after surgery, including urodynamics. RESULTS: Urological problems after surgical correction of scoliosis developed in 6 patients (38%). Three girls had difficulty performing clean intermittent self-catheterization postoperatively because of altered body posture, a genital pressure sore and a plaster body cast, respectively. In 4 patients, including 1 girl with problems performing clean intermittent self-catheterization, lower urinary tract function was altered, leading to upper urinary tract deterioration in 1 and worsening of urinary incontinence in 3. CONCLUSIONS: Children with myelomeningocele have a high incidence of urological complications after surgical treatment of scoliosis. Anticipation of the problems and a thorough postoperative urological evaluation, including urodynamics, can reduce morbidity and facilitate appropriate treatment.

Child↗
PubMed1977

Fracture of the neck and intertrochanteric region of the femur in children.

End-result evaluations after an average follow-up of seventeen years are reported in sixty-one cases (sixty patients). There were five Type-1 (transepiphyseal), twenty-seven Type-II (transcervical), twenty-two Type-III (cervicotrochanteric), and seven Type-IV (intertrochanteric) femoral fractures. The majority of Type-I, Type-II, and displaced Type-III fractures were treated with closed or open reduction and Knowles-pin fixation. The majority of undisplaced Type-III and Type-IV fractures were treated with abduction plaster spica casts. Fifty-five per cent were found to have good resultswhile 20% were fair and 25%, poor. The incidence of complications--avascular necrosis, coxa vara, premature epiphyseal closure, infection, and non-union--was compared with that in previously reported series. The use of Knowles-pin fixation appeared to reduce the complications of non-union and coxa vara. Avascular necrosis caused most of the poor results. However, younger children with avascular necrosis obtained better results than did older ones. Some children with results graded as poor roentgenographically were only mildly symptomatic.

Adolescent↗
PubMed1996

Design of a 3-D surface scanner for lower limb prosthetics: a technical note.

A three-dimensional (3-D) noncontact optical surface range sensing imaging system that captures the entire circumferential and distal end surfaces of lower limb residua in less than 1 second has been developed. The optical surface scanner (OSS) consists of four charge injection device (CID) cameras and three white light projectors, mounted on a rigid frame surrounding the subject's residuum, allowing 360 degrees surface coverage of the lower residual limb. Anatomic 3-D computer graphics reconstruction of a residuum surface, recorded with the OSS imaging system, is used for visualization and measurement. One cubical and two spherical calibration test objects were used to obtain a system precision of less than 1 mm. In a study conducted with 13 persons with below knee (BK) amputation, the OSS system was compared to calipers, electromagnetic digitizer, and volumetric computed tomography with better than 1 mm precision on plaster positive casts and approximately 2 mm on the residual limbs.

Amputation, Surgical↗
PubMed1981

Plastering: a combination of old and new.

This study compares the standard plaster-of-Paris cast (Gypsona) with a combination case consisting of plaster-of-Paris covered with a double layer of a polymer casting bandage (Baycast). Thirteen subjects were studied. Each wore concurrently a standard plaster on one leg and a combination plaster on the other. Weight bearing was commenced immediately after application and continued for 8 hours, when they were removed for examination. All the standard plasters cracked, but only one of the combination plasters, and this was due to a technical error.

Bandages↗
PubMed1990

Supracondylar fractures of the humerus in children: analysis of the results in 142 patients.

One hundred forty-two children who had supracondylar humerus fractures and who were treated either by open reduction and internal fixation or by closed methods were reviewed. There were 104 boys and 38 girls. Their ages ranged between 2 and 14 years, with an average age of 8 years. One hundred thirteen of the fractures were of the extension type and 29 were of the flexion type. Sixty-two patients were treated by manipulative reduction and immobilization in a plaster of Paris cast, and 20 were treated by overhead skeletal traction followed by the application of a plaster of Paris cast. The other 60 patients were treated by open reduction and internal fixation. The follow-up period ranged from 4 years to 11 years, with an average of 7.5 years. The results were evaluated based on the range of motion, the subsequent deformity, if any, and the carrying angle. In the overall series we had 72 (50.70%) excellent, 31 (21.83%) good, 13 (9.15%) fair, and 26 (18.30%) poor results.

Adolescent↗
PubMed1991

[Comparative study between conservative and surgical therapy of fibular ligament ruptures of the upper ankle joint].

From January 1985 to February 1987 361 patients with ruptured lateral ankle ligaments were treated at the Department of Trauma and reconstructive Surgery at the University Hospital of Hamburg. 225 patients were included in a retrospective study. They were divided into conservative and operative groups of treatment with subdivision of immobilized treatment (Plaster Paris short-leg-cast for 6 weeks) and functional therapy (special shoe). Clinical-radiological follow-up examinations of 49 operatively and 44 conservative treated patients were carried out 2 to 4 years after cessation of therapy. The clinical results were evaluated according to a questionnaire, X-ray and clinical controls. These results lead to the conclusion that operative treatment combined with conservative plaster cast immobilization yielded better mechanical stability than conservative-functional therapy. Best results were seen after surgical treatment, but conservative immobilization with prevailing good clinical-radiological results seems to be an alternative to operative therapy in carefully elected patients.

Ankle Injuries↗
PubMed2004

The effects of total contact casting materials on plantar pressures.

The plaster-based total contact cast (TCC) is effective at reducing high plantar pressures associated with foot ulceration in the patient with diabetes. However, the weight and the lengthy drying time which require nonweightbearing create an inconvenience for the patient. Fiberglass has been commonly used as a substitute for plaster due to the quicker drying time, although little is known about the effects of fiberglass on plantar pressures. The purpose of the study was to compare a plaster-based TCC (PB-TCC) and an all-fiberglass TCC (AF-TCC) using selected plantar pressure parameters for commonly ulcerated regions of the foot. Using a repeated measures design, 10 healthy subjects consented to walk, for four consecutive trials, along a 25-m corridor while wearing a running shoe, PB-TCC, and AF-TCC. For each of the footwear conditions, parameters of peak pressure, pressure-time integral, and contact time for the forefoot, lateral midfoot, and heel regions were recorded using the Pedar trade mark system of plantar pressure measurement. Both the PB-TCC and AF-TCC produced similar peak plantar pressures that were significantly lower (p =.001) than the running shoe. Pressure-time integrals were similar for all footwear conditions and contact time was not altered with footwear type. In summary, the AF-TCC appears to be an effective alternative to the PB-TCC for plantar pressure reduction in the management of neuropathic foot ulceration.

Adult↗
PubMed1991

Intracast pressure measurements in Colles' fractures.

Intracast pressures were recorded in conventional plaster-of-Paris below-elbow casts and compared with a new prefabricated brace for the functional treatment of Colles' fractures. Interface pressures were consistently higher in the brace than in the conventional plaster cast throughout the treatment period, and demonstrated more specific loading to the fracture site.

Adolescent↗