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Early excision of the burn, immediate autografting, reduction of the fracture, and stabilization with a plaster-of-paris cast is offered as an alternative method for managing burns with associated long-bone fractures. The opportunity to excise and immediately autograft a burn wound requires rethinking of the entire problem of burns associated with a fracture.
Congenital dislocation of the knee (CDK), first described in 1922, is a rare condition sometimes associated with other congenital malformations. There is a total anterior dislocation with recurvatum and upward displacement of the proximal tibia. This review covers our ten year experience at the hospital San Juan de Dios, in Caracas, Venezuela, a children's hospital with three orthopaedic services. We have seen 22 affected knees in 14 patients. Newborn patients were treated on traction until reduction was achieved, followed by serial plaster of Paris casts until, optimally, 90 degrees of flexion was gained. Surgical treatment was used if conservative treatment had failed after six months, or if the patient first presented after the age of 12 months. All our patients were eventually able to walk, three with the assistance of calipers. Some limitation of knee flexion was commonly seen. The best results were achieved when treatment was started early.
This paper describes the use of a rigid polyurethane foam to construct a stump socket for immediate or early prosthetic fitting in 15 patients with amputation through the leg. The foam plaster is poured into a prepared cotton sleeve, with a zip incorporated, and rolled out to a layer 4 mm thick. The filled sleeve is put around the stump and the zip closed, moulding the sleeve firmly to the stump. The closed sleeve hardens into a rigid polyurethane shell within 20 min. Aferwards the skeletal prosthetic components are fixed with the same rigid foam. The polyurethane foam socket is quickly and cleanly prepared, only one third of the weight of a plaster of Paris cast and is easily removed by means of the zip, allowing access to the stump.
This paper presents an experimental study of rabbits immobilized in plaster of paris casts. By means of Tetracycline and 45Ca-labelling an immobilisation over 12 weeks showed a significant diminuition of bone formation. In the first stages of remobilisation the bone formation was found to be increased and became normally in a later stage. The lower dorsal spine was not sufficiently immobilized in our experiments. Therefore significant changes of bone turnover could not be observed.
In order to cope with the frequent lack of adequate and sufficient external fixator systems in Third World countries, the pin-in-plaster technique was adopted and used in the management of open fractures of the femur. It consists of the use of Steinmann and Schanz pins incorporated into a plaster of Paris cast. The technique was successful in 13 of 15 open fracture cases treated at the University Teaching Hospital in Calabar (86.6%). The advantages and disadvantages of the method are discussed. The method is recommended as an effective improvisation of the Hoffman apparatus for use in exceptional circumstances, such as war and adverse socioeconomic conditions as are found in most Third World countries.
During an 18-month period we studied prospectively 63 consecutive patients (42 males, 21 females) with an open fracture of the lower limb. Their mean age was 32 years (range: 4-78 years) and 58 patients with 59 fractures were available until the conclusion of the study. Forty-seven had tibial fractures, 12 had femoral fractures and the majority of the patients were either students or traders. According to Gustilo and Anderson's grading, 21 fractures were of type II and 16 of type IIIA. On arrival all the wounds were irrigated and debrided and the patients also received tetanus prophylaxis and intravenous antibiotics. Of the 47 tibial fractures 39 were managed with an above-knee plaster of Paris cast which was windowed so as to allow wound care. Of the 12 femoral fractures ten were treated with skeletal traction on a Bohler frame. The time taken for soft tissue healing was not significantly different between the tibial and femoral fractures. There were, however, significant differences with respect to (1) the time interval between injury and debridement, (2) the incidence of wound infection, (3) the occurrence of osteomyelitis, (4) fracture union time, and (5) time spent in hospital. The most common complications were wound infections (27 cases) and delayed union (26 cases). The time interval between injury and wound debridement was a major prognostic factor.
Thirty-three children with a total of 35 benign/malignant brain and eye neoplasms were treated with fractionated stereotactic radiotherapy. In the first 11 children immobilization for treatment was achieved with plaster of Paris casts or aquaplast masks. In the remaining 22 children the Laitinen stereoadapter was used. Radiation was delivered with noncoplanar static or rotational beams. The dose fractionation used was 50.4-60 Gy in 28-30 fractions in patients receiving treatment with curative intent, and 10-32 Gy at 2-4 Gy/fraction for reirradiation. The accuracy of daily treatment was < 2 mm. After a median follow-up of 27 months, 22 of the 25 children treated with curative intent achieved local control. One child had progressive brain necrosis following 54 Gy in 30 fractions for a pontine astrocytoma. The exact etiology of this complication is unknown. This series demonstrates that in children fractionated stereotactic radiotherapy using the Laitinen stereoadapter is well tolerated and accurate and results in good local control.
BACKGROUND: In a prospective, randomised study, we compared the results of anterior cruciate ligament reconstruction using the conventional medial patellar tendon strip procedure with the Kennedy ligament augmentation device (LAD) over-the-top augmentation technique. The aim of the study was to see if the addition of this device, with its specific potential complications (infection, synovitis, mechanical failure) and increased costs, gave better functional stability and less donor site morbidity. METHODS: Forty patients ( n=20+20) with high physical demands, anterior cruciate ligament rupture less than 3 weeks old, and positive Lachman and pivot shift tests were included in the study. They were randomised by instructions in a sealed envelope that was randomly chosen. Postoperatively, they were immobilised in a plaster of Paris cast for 2 weeks. Full weight-bearing was not allowed until 6 weeks after the operation. Strength training on the operated side started when movement was restored to nearly normal, usually after 8-10 weeks. Return to full sport activity was allowed 1 year after the operation. Clinical and arthrometric follow-up was performed yearly using the Lysholm functional score, Tegner activity score, KT-1000 testing, Lachman and pivot shift tests. Follow-up lasted 3-9 years (mean 7 years). RESULTS AND CONCLUSIONS: At last follow-up we found no statistical difference in stability tests, functional or activity scores; both groups showed stable improvement concerning scores and arthrometry compared with the preoperative values. No advantages were associated with the use of the Kennedy LAD, and we do not recommend it or a similar device for uncomplicated cases. New augmentation devices are simply launched onto the market, and we recommend caution and thorough evaluation in prospective, randomised studies before they are adopted into use.
In a prospective study from January 1985 to December 1987, 60 consecutive patients with isolated fractures of the shaft of the ulna were divided into two groups. In group I, 28 patients were treated with plaster-of-Paris cast splintage, while in group II, 32 patients were given an elastic crêpe bandage support and were mobilized early. Average time to union in group I was 10.8 weeks while in group II it was 7.8 weeks. Two fractures in group I did not unite, whereas there was no case of non-union in group II. Isolated fractures of the ulna can be treated successfully with minimal support and early mobilization.
PURPOSE: To analyze the effect that immobilization devices used in conjunction with beam modifiers may have on the dose to the skin and build-up region. METHODS AND MATERIALS: Central axis depth dose measurements were made in a polystyrene phantom in the build-up regions using the 6 and 15 MV photon beams, at two different source-to-phantom distances, and various field sizes. The effects of acrylic blocking trays, lead wedges, and cerrobend blocks were assessed in conjunction with the enhancement of dose in the build-up region due to immobilizing devices using plaster and thermoplastic casting materials of different thicknesses. RESULTS: For the 6 MV photons, solid (3 mm) thermoplastic casting material was found to have the greatest effect on surface dose: for a 12 x 12 cm field we measured 79% of maximum dose when treating through the material versus 22% of maximum dose when no beam modifiers or immobilization devices are used. Measurements were also made to evaluate the effect of the immobilization of patients receiving three-dimensional conformal treatments using a 15 MV photon beam. CONCLUSIONS: The relevance of these results to treatments in the pelvis, breast, and head and neck regions is discussed. For 6 MV beams, special consideration should be given if the need arises to treat through the immobilization device, as unacceptable skin reactions may result.
For a period of time after unilateral brain injury, surviving neural tissue surrounding the lesion may be vulnerable to extremely high behavioral demand. Previously, we found that lesions of the forelimb representation area of the sensorimotor cortex (FL-SMC) in rats increase in size substantially when the intact forelimb is immobilized with a plaster of paris cast during the first 15 days after surgery, which forces overuse of the impaired forelimb. The present study was designed to determine whether the adult brain is more vulnerable to forced overuse of the impaired forelimb during the first 7 days post-lesion than during the second 7 days post-lesion. Using behavioral tests of forelimb use and stereological analysis of remaining tissue volume 40 days after FL-SMC lesions, we found that forced overuse of the impaired forelimb during the first 7 days after the initial damage caused expansion of neural injury and greatly interfered with restoration of function. In contrast, forced overuse of the impaired forelimb during the second 7 days had no significant effect on lesion size but nevertheless interfered with restoration of function. Thus, surviving neural tissue in the damaged hemisphere and recovery of function appear to be vulnerable to prolonged forced overuse of the impaired forelimb throughout the first 15 days, but tissue loss was detectable only when the animal was forced to use the impaired forelimb during the first 7 days after injury.
The paper describes a simple and effective practical method of dealing with the fractures of the tibia by means of a long-leg walking plaster-of-Paris cast. The results are assessed in a series of 44 patients, 28 of whom were treated by early weight bearing, while the remaining 16 were treated by traditional closed methods. A simple system of grading tibial fractures is described in order to facilitate valid comparisons. The results conclusively show that the early weight bearing regime results in the fractures uniting in half the time of the late weight bearing series. Details of two cases in each grade of the early weight bearing series are given.
Changes in brain extracellular glutamate during movement stress were studied using in vivo microdialysis. Male Long-Evans rats were placed in a clear cylinder designed to elicit behavioral activation while undergoing microdialysis sampling from either the hippocampus, striatum or sensorimotor cortex. Glutamate levels were determined by high performance liquid chromatography with fluorescence detection in the dialysates taken before, during, and after exposure to the cylinder. Animals were in a behaviorally quiescent state before exposure to the cylinder, but they demonstrated increases in rearing, locomotion, and turning while in the cylinder. Dialysate glutamate levels were significantly enhanced in the samples taken while the rat was in the cylinder compared with samples taken before or after exposure to the cylinder. In a second study, rats were implanted with bilateral probes in the forelimb sensorimotor cortex, and one forelimb was immobilized by means of a plaster of paris cast. Glutamate, aspartate, serine, and taurine levels were quantified in casted animals. In casted animals, dialysate glutamate levels were lower on the side contralateral to the immobilized limb during both quiescence and movement stress. Aspartate and taurine, but not serine levels increased during movement stress in both the side contralateral and the side ipsilateral to the immobilized limb. These results suggest that there is extracellular overflow of glutamate and other neuroactive amino acids during spontaneous movement, and chronic disuse can suppress extracellular glutamate levels.
A case of severe post burns contracture of the wrist, of 43 years duration resulting in recurrent ulceration of the skin was successfully treated by gradual distraction using the Ilizarov method. This method is superior to plaster of Paris cast and is more versatile than other forms of external fixation.
This study was designed to investigate the effects of halothane on the electrical activity of the respiratory muscles in rats. Indeed, halothane is known to reduce end-expiratory lung volume, both in man and in animal; this may be due to altered activity in the respiratory muscles. The electrical activity of the diaphragm, parasternal, intercostal and abdominal muscles were recorded using intramuscular electrodes in ten rats weighing between 400 and 450 g each. The rats were prepared under light halothane anaesthesia (tracheostomy, laparotomy, electrode positioning, plaster of Paris cast to impede leg movements). They were placed prone in a 20 1 plexiglass chamber, and allowed to awake. Thereafter halothane was vaporized in this chamber at a known concentration, until the animals no longer reacted to tail pinching. The measurements were carried out during the awake state, and under 2 vol % halothane. Muscle tone was assessed by the thickness of baseline inspiratory muscle activity at the end of expiration (maximally amplified raw electromyographic signals). The measurement of phasic electrical activity was carried out using peak inspiratory integrated electromyographic signals. Under halothane, phasic activity of the diaphragm was slightly reduced (p less than 0.05), whereas tonic activity remained unchanged. Parasternal intercostal muscle activity, both tonic and phasic, was also decreased during halothane anaesthesia (p less than 0.001). No phasic activity occurred in the abdominal muscles, but muscle tone was reduced during halothane administration (p less than 0.01). In rats, the decrease in intercostal muscle tone under halothane anaesthesia could play a major part in the fall in functional residual capacity.(ABSTRACT TRUNCATED AT 250 WORDS)
The aim of this study was to assess the treatment outcome and changes in mandibular incisor position after extraction of one single incisor in 36 adult orthodontic cases with combined Class III and open bite tendencies. The cases consisted of 21 female and 15 male patients with an average age of 27.8 years (standard deviation [SD], 11.1 years) at the start. Fixed 0.018-inch Edgewise appliances were used in both arches in 19 patients and in the mandibular arch in 17 patients. Average treatment time was 18 months (SD, 7.1 months). Pretreatment ANB was 0.5(o) (SD, 2.7 degrees), overjet 1.4 mm (SD, 1.9 mm), and overbite 1.5 mm (SD, 1.1 mm). The lower incisors were 3.6 mm (SD, 2.8 mm) in front of the APg-line, and the Averaged Irregularity Index was 1.1 mm (SD, 0.6 mm). Records representing pretreatment (T1), posttreatment (T2), and average 4.3 years (SD, 2.3 years) retention (T3) included cephalograms, panoramic films, intraoral and extraoral photographs, and plaster models. All cast measurements were made with digital calipers. On the cephalograms, the lower incisor tips moved posteriorly 1.7 mm (SD, 2.0 mm) and occlusally 1.5 mm (SD, 1.8 mm) from pretreatment to posttreatment. Relative to the x-axis, they tipped lingually 5.9(o) (SD, 5.6 degrees). On the cast analysis, overjet increased 1.0 mm (SD, 1.9 mm) and 1.5 mm (SD, 1.5 mm) for the maxillary central and lateral incisors, respectively, whereas overbite increased 0.6 mm for both the central and lateral incisors. The intercanine width was reduced by 3.3 mm (SD, 2.0 mm), while the intermolar width was unchanged. The Average Irregularity Index was reduced from 1.1 to 0. 2 mm. Arch-length was reduced 3.6 mm from pretreatment to posttreatment, and another 0.3 mm from posttreatment to 4.3-years retention. Other changes from posttreatment to 4.3-years retention were slight. No loss of the interdental gingival papillae was normally observed. It is concluded that the extraction of one mandibular incisor can lead to satisfactory treatment results in adults with mild Class III malocclusion and reduced overbite, particularly when coupled with a large mandibular intercanine width and minor crowding, and some mandibular tooth size excess. However, the orthodontic treatment frequently became more complicated and time-consuming than expected at the start.
Pseudocyst of the auricle is a condition where spontaneous serous fluid collection is seen on the lateral surface of the pinna. The aetiology of this condition is not known. Several methods of treatment have been advocated in the past. We report 10 cases of unilateral pseudocyst who were treated with aspiration and pressure dressing by a plaster of Paris cast over the pinna for two weeks.
In the author's current area of practice the use of either the Bier's block or haematoma block for manipulating distal radial fractures seems to have been based mostly on the A&E consultant's preference. The purpose of this literature review was to determine if there was sufficient evidence on the advantages and disadvantages of each method of regional anaesthesia to advocate the general use of one and the exclusion of the other. When reviewing the literature the author specifically looked in to three key areas to answer this question: 1) the patient's perception of pain experienced during and after the manipulation; 2) patient safety i.e. the documented risks of the anaesthetic type used; and 3) the success of the manipulation as determined by repeat radiographs immediately after the application of a plaster of Paris cast.