1
|
Martin-Diaz P, Perez-Lopez LM, Gutierrez-de la Iglesia D, Miron-Dominguez B, Domínguez E, Perez-Abad M. Trapeziometacarpal Dislocations in Pediatric Age, Is There a Better Treatment? Series of Cases and a Systematic Review. J Clin Med 2024; 13:2197. [PMID: 38673470 PMCID: PMC11050382 DOI: 10.3390/jcm13082197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/24/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Dislocations of the trapeziometacarpal joint (TMC) are uncommon in children and adolescents. Only a few isolated cases are reported in the literature. Therapeutic guidance is minimal and inconclusive. (2) Methods: The authors present four patients treated for this unusual lesion. We evaluated the evolution according to treatment, age, patient activity, and quickDASH. Despite the clear limitation of the small number of patients, it is relevant to try to better understand this lesion and its evolution. A systematic review of the literature was also conducted. (3) Results: This is the largest published series of TMC dislocations in children and adolescents. Patients included a 12-year-old girl treated conservatively with a poor quickDASH; a 9-year-old girl treated surgically with the Eaton-Littler technique for a new dislocation with a partially modified quickDASH; a 13-year-old boy with two necessary closed reductions for a new dislocation and a very good final quickDASH; and a 12-year-old boy treated with closed reduction and percutaneous fixation with excellent final results with quickDASH. (4) Conclusions: In the absence of scientific evidence, conservative treatment and ligament reconstruction did not provide good functionality. In contrast, closed reduction with percutaneous fixation provided excellent results. Therefore, the authors would recommend closed reduction and percutaneous needle fixation as an elective method to treat TMC dislocations in pediatric and adolescent patients.
Collapse
Affiliation(s)
- Pablo Martin-Diaz
- Hospital Sant Joan de Déu Barcelona, Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Spain;
| | - Laura M. Perez-Lopez
- Hospital Sant Joan de Déu Barcelona, Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Spain;
- Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | | | | | - Enric Domínguez
- PSMAR Hospital del Mar, Ciutat Vella, 08003 Barcelona, Spain;
| | - Miguel Perez-Abad
- Kaplan Hand Institute, Av. de Josep Vicenç Foix, 71, 08034 Barcelona, Spain
- Upper Limb Surgery Unit, Orthopaedic and Traumatology Department, Consorci Sanitari del Maresme, Hospital de Mataró, Carretera de la Cirera 230, 08304 Mataro, Spain
| |
Collapse
|
2
|
Bus SA, Armstrong DG, Crews RT, Gooday C, Jarl G, Kirketerp-Moller K, Viswanathan V, Lazzarini PA. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev 2024; 40:e3647. [PMID: 37226568 DOI: 10.1002/dmrr.3647] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/26/2023]
Abstract
AIMS Offloading mechanical tissue stress is arguably the most important of multiple interventions needed to heal diabetes-related foot ulcers. This is the 2023 International Working Group on the Diabetic Foot (IWGDF) evidence-based guideline on offloading interventions to promote healing of foot ulcers in persons with diabetes. It serves as an update of the 2019 IWGDF guideline. MATERIALS AND METHODS We followed the GRADE approach by devising clinical questions and important outcomes in the PICO (Patient-Intervention-Control-Outcome) format, undertaking a systematic review and meta-analyses, developing summary of judgement tables and writing recommendations and rationales for each question. Each recommendation is based on the evidence found in the systematic review, expert opinion where evidence was not available, and a careful weighing of GRADE summary of judgement items including desirable and undesirable effects, certainty of evidence, patient values, resources required, cost effectiveness, equity, feasibility, and acceptability. RESULTS For healing a neuropathic plantar forefoot or midfoot ulcer in a person with diabetes, use a non-removable knee-high offloading device as the first-choice offloading intervention. If contraindications or patient intolerance to non-removable offloading exist, consider using a removable knee-high or ankle-high offloading device as the second-choice offloading intervention. If no offloading devices are available, consider using appropriately fitting footwear combined with felted foam as the third-choice offloading intervention. If such a non-surgical offloading treatment fails to heal a plantar forefoot ulcer, consider an Achilles tendon lengthening, metatarsal head resection, joint arthroplasty, or metatarsal osteotomy. For healing a neuropathic plantar or apex lesser digit ulcer secondary to flexibile toe deformity, use digital flexor tendon tenotomy. For healing rearfoot, non-plantar or ulcers complicated with infection or ischaemia, further recommendations have been outlined. All recommendations have been summarised in an offloading clinical pathway to help facilitate the implementation of this guideline into clinical practice. CONCLUSION These offloading guideline recommendations should help healthcare professionals provide the best care and outcomes for persons with diabetes-related foot ulcers and reduce the person's risk of infection, hospitalisation and amputation.
Collapse
Affiliation(s)
- Sicco A Bus
- Department of Rehabilitation Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Science, Program Rehabilitation & Development, Amsterdam, Netherlands
| | - David G Armstrong
- Department of Surgery, Southwestern Academic Limb Salvage Alliance (SALSA), Keck School of Medicine of University of Southern California (USC), Los Angeles, California, USA
| | - Ryan T Crews
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University, North Chicago, Illinois, USA
| | - Catherine Gooday
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals, Norwich, UK
| | - Gustav Jarl
- Faculty of Medicine and Health, Department of Prosthetics and Orthotics, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Klaus Kirketerp-Moller
- Copenhagen Wound Healing Center, Bispebjerg University Hospital, Copenhagen, Denmark
- Steno Diabetes Center, Copenhagen, Denmark
| | | | - Peter A Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia
| |
Collapse
|
3
|
Knorr IJ, Tix L, Liu W, Talbot SR, Schulz M, Bell L, Kögel B, Tolba R, Ernst L. Refinement in Post-Operative Care for Orthopaedic Models: Implementing a Sheep Walking Cast (SWC) for Effective Tibial Fracture Management. Biomedicines 2024; 12:343. [PMID: 38397945 PMCID: PMC10886840 DOI: 10.3390/biomedicines12020343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024] Open
Abstract
In the healthcare system, lower leg fractures remain relevant, incurring costs related to surgical treatment, hospitalization, and rehabilitation. The duration of treatment may vary depending on the individual case and its severity. Casting as a post-surgical fracture treatment is a common method in human and experimental veterinary medicine. Despite the high importance of sheep in preclinical testing materials for osteosynthesis, there is no standardised cast system ensuring proper stabilisation and functionality of hind limbs during the healing of tibia fractures or defects. Existing treatment approaches for tibial osteosynthesis in laboratory animal science include sling hanging, external fixators, or former Achilles tendon incision. These methods restrict animal movement for 4-6 weeks, limit species-typical behaviour, and impact social interactions. Our pilot study introduces a Standardised Walking Cast (SWC) for sheep, enabling immediate physiological movement post surgery. Seven Rhone sheep (female, 63.5 kg ± 6.45 kg) each with a single tibia defect (6 mm mechanical drilled defect) underwent SWC application for 4 weeks after plate osteosynthesis. The animals bore weight on their operated leg from day one, exhibiting slight lameness (grade 1-2 out of 5). Individual step lengths showed good uniformity (average deviation: 0.89 cm). Group housing successfully started on day three after surgery. Weekly X-rays and cast changes ensured proper placement, depicting the healing process. This study demonstrates the feasibility of using an SWC for up to 72 kg of body weight without sling hanging via ceiling mounting or external fixation techniques. Allowing species-typical movement and social behaviour can significantly improve the physiological behaviour of sheep in experiments, contributing to refinement.
Collapse
Affiliation(s)
- Ivonne Jeanette Knorr
- Institute for Laboratory Animal Science and Experimental Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (I.J.K.); (L.T.); (W.L.); (M.S.); (B.K.); (R.T.)
| | - Leonie Tix
- Institute for Laboratory Animal Science and Experimental Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (I.J.K.); (L.T.); (W.L.); (M.S.); (B.K.); (R.T.)
| | - Wenjia Liu
- Institute for Laboratory Animal Science and Experimental Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (I.J.K.); (L.T.); (W.L.); (M.S.); (B.K.); (R.T.)
| | - Steven R. Talbot
- Institute for Laboratory Animal Science and Central Animal Facility, Hannover Medical School, 30625 Hannover, Germany;
| | - Mareike Schulz
- Institute for Laboratory Animal Science and Experimental Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (I.J.K.); (L.T.); (W.L.); (M.S.); (B.K.); (R.T.)
| | - Laura Bell
- Audiovisual Media Center, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany;
| | - Babette Kögel
- Institute for Laboratory Animal Science and Experimental Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (I.J.K.); (L.T.); (W.L.); (M.S.); (B.K.); (R.T.)
| | - Rene Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (I.J.K.); (L.T.); (W.L.); (M.S.); (B.K.); (R.T.)
| | - Lisa Ernst
- Institute for Laboratory Animal Science and Experimental Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (I.J.K.); (L.T.); (W.L.); (M.S.); (B.K.); (R.T.)
| |
Collapse
|
4
|
Stefanescu K, Timlin CL, Moy AS, Zapotoczny G. Reduced Isocyanate Release Using a Waterproof, Resin-Based Cast Alternative Relative to Fiberglass Casts. Toxics 2023; 11:1002. [PMID: 38133403 PMCID: PMC10747184 DOI: 10.3390/toxics11121002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
The effects of occupational isocyanate exposure range from asthma and contact dermatitis to neurotoxicity and cancer. Respiratory sensitization due to orthopedic cast application has been well documented. This study aims to compare the safety of standard-of-care fiberglass casts and a novel waterproof cast alternative by measuring the amount of isocyanate released during off-gassing over time. A 3D-printed arm simulator with comparable casing material amounts was placed in a sealed chamber. An isocyanate-sensing color-changing (SafeAir) tag was used to measure the levels of toxic exposure. Triplicate trials were conducted across all time periods (15 min, 1 h, and 24 h) and conditions. The bare arm simulator and freshly opened tags served as negative controls. Normalized pixel intensity indexes and isocyanate release estimates in ppb were derived from ImageJ-analyzed SafeAir tag photos. Fiberglass casts exhibited greater isocyanate release than both the waterproof alternative (p = 0.0002) and no-cast controls (p = 0.0006), particularly at 24 h. The waterproof alternative and no-cast control did not statistically differ (p = 0.1603). Therefore, the waterproof alternative released less isocyanate than the fiberglass casts. Waterproof cast alternatives may be safer than fiberglass by limiting medical professionals' exposure to toxic isocyanates and, thus, decreasing their risk of suffering occupational asthma.
Collapse
Affiliation(s)
- Kristen Stefanescu
- Keck School of Medicine of the University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA;
| | | | | | - Grzegorz Zapotoczny
- Consortium for Technology & Innovation in Pediatrics, Lurie Children’s Hospital, 225 E Chicago Ave., Chicago, IL 60611, USA;
| |
Collapse
|
5
|
Mohsen R, Chen YJ, Liu F. A technique to convert a 3D printed cast used in the fabrication of an interim implant-supported crown into a definitive cast capturing the acquired emergence profile. J Prosthodont 2023. [PMID: 37658787 DOI: 10.1111/jopr.13760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023] Open
Abstract
An esthetic peri-implant soft tissue contour is a critical element of the success of implant restorations in the esthetic zone. Once the optimal transmucosal soft tissue profile is formed, it needs to be accurately replicated on the master cast. This clinical technique involves the utilization of a silicone putty positioning index placed in the patient's mouth to accurately duplicate the external contour of teeth and soft tissue. By combining this positioning index with the implant-supported interim crown, the 3D-printed initial cast, which was used to fabricate the interim crown, can be conveniently and efficiently transformed into a definitive master cast.
Collapse
Affiliation(s)
- Rawan Mohsen
- Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Yu-Jen Chen
- Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Fei Liu
- Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| |
Collapse
|
6
|
Yazan H, Girit S, Kut A, Calim M, Çakır FB, Atilla Nursoy M, Çollak A, Çakır E. Clinical and Radiological Evaluation and Follow-Up of Patients with Noncardiac Plastic Bronchitis. Turk Arch Pediatr 2023; 58:515-518. [PMID: 37670550 PMCID: PMC10544299 DOI: 10.5152/turkarchpediatr.2023.23052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/09/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE Plastic bronchitis (PB) is a rare disease characterized by obstruction of the airway by fibrinous mucus plugs. The etiology can be idiopathic or secondary to systematic diseases such as congenital heart diseases. Definitive diagnosis is made by pathological examination of the sputum or bronchial sample taken by bronchoscopy. In this study, the clinical status and treatment status of patients with PB were evaluated. MATERIALS AND METHODS Medical records of the patients diagnosed as PB were reviewed ret- rospectively. Age, gender, clinical symptoms, radiology, bronchoscopic findings, and pathology results were documented. RESULTS Six patients with PB were included in this study (female:male, 2:4). The median age of the diagnosis was 45 months. The most common symptoms are persistent wet cough and short- ness of breath. The duration of symptoms ranged from 30 to 90 days. Atelectasis was the most common radiological finding. Diagnosis was made with pathological examination of the mucus in all patients. All of the patients were treated with bronchoscopic removal of the mucus, and 4 patients required oral prednisolone therapy. Symptoms and radiological findings resolved completely in all patients. CONCLUSION Although PB is a rare disease, it should be kept in mind in relation to patients with persistent radiological and clinical respiratory symptoms.
Collapse
Affiliation(s)
- Hakan Yazan
- Department of Pediatric Pulmonology, Bezmilalem Vakif University, İstanbul, Turkey
| | - Saniye Girit
- Division of Pediatric Pulmonology, Medeniyet University, İstanbul, Turkey
| | - Arif Kut
- Division of Pediatric Pulmonology, Maltepe University, İstanbul, Turkey
| | - Muhittin Calim
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University, İstanbul, Turkey
| | - Fatma Betül Çakır
- Division of Pediatric, Bezmilalem Vakif University, İstanbul, Turkey
| | | | - Abdulhamit Çollak
- Division of Pediatric, Bezmilalem Vakif University, İstanbul, Turkey
| | - Erkan Çakır
- Department of Pediatric Pulmonology, Bezmilalem Vakif University, İstanbul, Turkey
| |
Collapse
|
7
|
Sherry DD, Mondal A, McGill M, Gmuca S. Pediatric Complex Regional Pain Syndrome With and Without a History of Prior Physical Trauma at Onset. Clin J Pain 2023; 39:437-441. [PMID: 37335219 PMCID: PMC10399929 DOI: 10.1097/ajp.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 05/16/2023] [Accepted: 06/09/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To determine whether differences exist between children with complex regional pain syndrome (CRPS) who identify an inciting physical traumatic event (group T) versus those without such history (group NT). METHODS We performed a single-center, retrospective study of children diagnosed with CRPS, 18 years old or younger, presenting between April 2008 and March 2021 and enrolled in a patient registry. Abstracted data included clinical characteristics, pain symptoms, Functional Disability Inventory, psychological history, and Pain Catastrophizing scale for children. Charts were reviewed for outcome data. RESULTS We identified 301 children with CRPS, 95 (64%) reported prior physical trauma. There was no difference between the groups regarding age, sex, duration, pain level, function, psychological symptoms, and scores on the Pain Catastrophizing Scale for Children. However, those in group T were more likely to have had a cast (43% vs 23%, P < 0.001). Those in group T were less likely to experience complete resolution of symptoms (64% vs 76%, P = 0.036). There were no other outcome differences between the groups. DISCUSSION We found minimal differences in children with CRPS who report a prior history of physical trauma to those who do not. Physical trauma may not play as significant a role as immobility, such as casting. The groups mostly had similar psychological backgrounds and outcomes.
Collapse
Affiliation(s)
- David D. Sherry
- Division of Rheumatology, Department of Pediatrics, Children’s Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia
| | - Antara Mondal
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, the Children’s Hospital of Philadelphia
| | - Mackenzie McGill
- Division of Rheumatology, Department of Pediatrics, Children’s Hospital of Philadelphia
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia
- Policy Lab, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA
| | - Sabrina Gmuca
- Division of Rheumatology, Department of Pediatrics, Children’s Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia
- Policy Lab, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA
| |
Collapse
|
8
|
Alzobi OZ, Hantouly AT, Kenawey M, Ibrahim T. Below- versus above-elbow cast treatment of displaced distal forearm fractures in children: A systematic review and meta-analysis of randomized controlled trials. J Child Orthop 2023; 17:249-258. [PMID: 37288051 PMCID: PMC10242373 DOI: 10.1177/18632521231162621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/16/2023] [Indexed: 06/09/2023] Open
Abstract
Objectives Distal forearm fractures are the most common pediatric fractures. This study aimed to investigate the effectiveness of below-elbow cast treatment for displaced distal forearm fractures in children compared to above-elbow cast through meta-analysis of randomized controlled trials. Methods Several databases from January 1, 2000 until October 1, 2021 were searched for randomized controlled trials that assessed below versus above-elbow cast treatment of displaced distal forearm fractures in pediatric patients. The main meta-analysis comparison was based on the relative risk of loss of fracture reduction between children undergoing below versus above-elbow cast treatment. Other outcome measures including re-manipulation and cast-related complications were also investigated. Results Nine studies were eligible of the 156 articles identified, with a total of 1049 children. Analysis was undertaken for all included studies with a sensitivity analysis conducted for studies with high quality. In the sensitivity analysis, the relative risks of loss of fracture reduction (relative risk = 0.6, 95% confidence interval = 0.38, 0.96) and re-manipulation (relative risk = 0.3, 95% confidence interval = 0.19, 0.48) between the below and above-elbow cast groups were in favor of below-elbow cast and statistically significant. Cast-related complications were in favor of below-elbow cast but did not attain statistical significance (relative risk = 0.45, 95% confidence interval = 0.05, 3.99). Loss of fracture reduction was noted in 28.9% of patients treated with above-elbow cast and 21.5% in below-elbow cast. Re-manipulation was attempted in 48.1% versus 53.8% of children who lost fracture reduction in the below-elbow cast and above-elbow cast groups, respectively. Conclusion Below-elbow cast treatment was favored, with statistical significance, in terms of loss of fracture reduction and re-manipulation, and was not associated with a higher risk of cast-related complications. The accumulative evidence currently does not support above-elbow cast treatment and below-elbow cast treatment should be the mainstay for displaced distal forearm fractures in children. Level of evidence Level I, meta-analysis of therapeutic level I studies.
Collapse
Affiliation(s)
- Osama Z Alzobi
- Department of Orthopaedic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf T Hantouly
- Department of Orthopaedic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Kenawey
- Orthopaedic Department, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Orthopaedic Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Talal Ibrahim
- Division of Orthopaedic Surgery, Department of Surgery, Sidra Medicine, Doha, Qatar
| |
Collapse
|
9
|
Zhou P, Zhang J, Dan T, Xu T, Kang X, Hang Y, Zhou Y. Closed reduction and plaster immobilization: an alternative solution for patients with developmental dysplasia of the hip who failed Pavlik harness treatment. ANZ J Surg 2023; 93:663-668. [PMID: 36732905 DOI: 10.1111/ans.18285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/26/2022] [Accepted: 01/08/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND The current study aims to investigate the clinical efficacy of closed reduction and cast immobilization for patients with developmental dysplasia of the hip (DDH) who failed Pavlik harness treatment. METHODS Patients with DDH who underwent cast immobilization under general anaesthesia after the failure of the Pavlik harness or Tübingen brace treatment between January 2015 and December 2020 were retrospectively recruited. General information, including Graf classification of initial diagnosis, initial treatment, age of cast immobilization, IHDI classification, AI index, avascular necrosis (AVN), and residual dysplasia, was collected. The incidence of AVN and late acetabular dysplasia (LACD) was also estimated. Moreover, factors related to AVN and LACD were investigated by multiple logistic regression analysis. RESULTS Thirty-four patients (47 hips) were finally included in the current study. Of these patients, 31 hips (66.0%) were successfully treated with closed reduction and cast immobilization. Open reduction was successfully performed in 16 hips (34.0%). Till the latest follow-up, LACD and AVN were found in 13 (27.7%) and 10 (21.3%) hips, respectively. In the open reduction group, type III and IV of the IHDI classification and type IV of the Ultrasound Graf classification were significantly higher when compared with the closed reduction group. Multiple logistic regression showed that failure of closed reduction was related to the initial types of the Ultrasound Graf and IHDI classifications. CONCLUSIONS Although the success rate of closed reduction after early harness failure in DDH is only 66%, we still advocate closed reduction as a first-line treatment for children who have failed sling treatment. Even if closed reduction fails, open reduction can still achieve acceptable results.
Collapse
Affiliation(s)
- Ping Zhou
- Department of Orthopedics, Kunming Children's Hospital, Kunming, China
| | | | - Tangzi Dan
- Graduate School, Kunming Medical University, Kunming, China
| | - Taotao Xu
- Department of Orthopedics, Kunming Children's Hospital, Kunming, China
| | - Xiaopeng Kang
- Department of Orthopedics, Kunming Children's Hospital, Kunming, China
| | - Yong Hang
- Department of Orthopedics, Kunming Children's Hospital, Kunming, China
| | - You Zhou
- Department of Orthopedics, Kunming Children's Hospital, Kunming, China
| |
Collapse
|
10
|
Li B, Xie J, Zhang Z, Liu Q, Xu J, Yang C. Braces versus casts for post-operational immobilization of ankle fractures: A meta-analysis. Front Surg 2023; 9:1055008. [PMID: 36760670 PMCID: PMC9905617 DOI: 10.3389/fsurg.2022.1055008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/25/2022] [Indexed: 01/26/2023] Open
Abstract
Background and aims Both casts and braces can be used for post-operational immobilization of ankle fractures. This meta-analysis aimed to assess the complications and functional effects of the two types of immobilization. Material and methods PubMed, Embase, Cochrane, and CNKI was searched for randomized controlled trials (published between Jan 1, 1950, and March 2022). Relative risk (RR) or standard mean difference (SMD) with a 95% confidence interval (CI) was used to present the outcomes. The pooled data were assessed by using the fixed-effects model or random-effects model. Results A total of 5 randomized controlled studies involving 930 subjects were included according to our inclusion criteria. On the ankle score at 6w,12w and 52w, there was no statistically significant difference between the two groups. In terms of 6w, the brace group showed better ankle dorsiflexion (MD = 6.78, 95% CI 0.56-13.00, p = 0.03) and plantar flexion (MD = 6.58, 95% CI 1.60-11.55, p = 0.01) than the cast group. The wound complications (RR = 3.49, 95% CI 1.32 to 9.24, p = 0.01) and total complications (RR = 3.54, 95% CI 1.92 to 6.50, p < 0.0001) in the brace group were three times more than that in the cast group. There was no statistically significant difference between the two groups in the non-wound complications. There was no statistically significant difference between the two groups in the time of going back to work, swelling of the ankle, and atrophy of the calf muscle. Conclusion The short-term and long-term functional outcomes after postoperative treatment of adult ankle fractures with braces are similar to those with casts. The usage of braces may cause three times more wound complications than that of casts.
Collapse
|
11
|
Mandelka E, Wikanardi BA, Beisemann N, Gruetzner PA, Franke J, Vetter SY, Privalov M. Comparing Temporary Immobilization Using Cast and External Fixator in Unimalleolar Ankle Fracture Dislocations: A Retrospective Case Series. J Clin Med 2023; 12:jcm12030748. [PMID: 36769397 PMCID: PMC9917604 DOI: 10.3390/jcm12030748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/28/2022] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Studies have reported a high percentage of ankle fracture dislocations with secondary loss of reduction during primary treatment with a splint or cast. This study aimed to assess the rate of secondary loss of reduction in unimalleolar ankle fracture dislocations treated primarily with a cast or external fixator, identify the potential influence of fracture morphology, and investigate the potential implications. Unimalleolar ankle fracture dislocations with and without posterior malleolar fracture between 2011 and 2020 were included. Patients were categorized into two groups, depending on the method of temporary treatment. Fracture morphology, time to definitive surgery, and soft-tissue complications were compared. Of 102 patients, loss of reduction tended to occur more often in the cast group (17.3%) than in the external fixator group (6.0%). The presence of a posterior malleolar fracture did not have a significant influence on loss of reduction in cast immobilization; however, the fragment proved to be significantly bigger in cases with loss of reduction. No statistically significant differences in soft tissue complications or time to definitive surgery were found. Surgeons should consider the application of interval external fixation in the primary treatment of unimalleolar ankle fracture dislocations with additional posterior malleolar fractures.
Collapse
Affiliation(s)
- Eric Mandelka
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Klinik Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
| | - Bernhard A. Wikanardi
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Klinik Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
- Medical Faculty of Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Nils Beisemann
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Klinik Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
| | - Paul A. Gruetzner
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Klinik Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
| | - Jochen Franke
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Klinik Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
| | - Sven Y. Vetter
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Klinik Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
| | - Maxim Privalov
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Klinik Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
- Correspondence:
| |
Collapse
|
12
|
Khojaly R, Rowan FE, Hassan M, Hanna S, Mac Niocail R. Weight-bearing Allowed Following Internal Fixation of Ankle Fractures, a Systematic Literature Review and Meta-Analysis. Foot Ankle Int 2022; 43:1143-1156. [PMID: 35861219 DOI: 10.1177/10711007221102142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Postoperative management regimes vary following open reduction and internal fixation of unstable ankle fractures. Traditional postoperative nonweightbearing cast immobilization may prevent loss of fixation and protect the soft tissue envelope but may also be associated with poorer functional outcomes. This systematic review and meta-analysis aimed to compare the complication rate and functional outcomes of early weightbearing (EWB) vs late weightbearing (LWB) following open reduction and internal fixation of ankle fractures. METHODS We performed a systematic review with a meta-analysis of controlled trials and comparative cohort studies using 3 databases. We included all studies that investigated the effect of weightbearing following internal fixation of ankle fractures in adult patients by any means. Studies that investigated mobilization but not weightbearing, non-English-language publications, and tibial Plafond fractures were excluded from this systematic review. We assessed the risk of bias using ROB 2 tools for randomized controlled trials and ROBINS-1 for cohort studies. Data extraction was performed using Covidence online software and meta-analysis by using RevMan 5.3. RESULTS This systematic review included 10 randomized controlled trials and 4 comparative cohort studies. Most of the included studies were rated as having some concern with regard to the risk of bias. There was no significant difference in the complication rate between the protected EWB and LWB groups (the risk ratio [RR] for infection was 1.30, 95% CI 0.74, 2.30; I² = 0%; P = .36), but better functional outcome scores were detected in the EWB group only at 6 weeks postoperatively (MD =10.08, 95% CI 5.13, 15.02; I² = 0%; P ≤ .0001), with no significant difference seen at 6 or 12 months postoperatively. CONCLUSION Based on the studies reviewed, it appears that early protected weightbearing following open reduction and internal fixation of ankle fractures does not affect surgical incision or fracture healing and is associated with better early functional outcomes at 6 weeks, but not 6 or 12 months, postoperatively.
Collapse
Affiliation(s)
- Ramy Khojaly
- Department of Surgery/Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Trauma and Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland.,Department of Trauma and Orthopaedic Surgery, University Hospitals of North Midland NHS Trust, Stoke-on-Trent, United Kingdom
| | - Fiachra E Rowan
- Department of Trauma and Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland
| | - Mekki Hassan
- Department of Trauma and Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland
| | - Sammy Hanna
- Department of Trauma and Orthopaedic Surgery, The Royal London Hospital, Whitechapel, London, United Kingdom.,Queen Mary University of London, London, United Kingdom
| | - Ruairí Mac Niocail
- Department of Surgery/Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Trauma and Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland
| |
Collapse
|
13
|
Takahara M, Uno T, Maruyama M, Harada M, Mitachi R, Ono H, Satake H, Takagi M. Conservative treatment for stable osteochondritis dissecans of the elbow before epiphyseal closure: effectiveness of elbow immobilization for healing. J Shoulder Elbow Surg 2022; 31:1231-1241. [PMID: 35247573 DOI: 10.1016/j.jse.2022.01.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/13/2022] [Accepted: 01/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Stable lesions of osteochondritis dissecans (OCD) of the capitellum have been treated with activity restriction (AR), and the complete healing requires 1 or 2 years. Little is known about the effectiveness of elbow immobilization. We hypothesized that elbow immobilization would have positive effects on healing of stable OCD. METHODS The study subjects were 43 patients (mean age: 12.2 years) with 43 stable OCD lesions of the prematured elbow (mean skeletal age score: 17.1 points of 0-27 points system). The subjects were divided into 3 groups: group A, AR without elbow immobilization, 22 cases; group B, splint (mean: 8.8 weeks) followed by AR, 9 cases; and group C, cast (mean: 3.7 weeks) followed by splint (mean: 7.3 weeks) and AR, 12 cases. The mean nonoperative observation period was 17.5 months (minimum three months). On anteroposterior radiographs of the elbow at 45 degrees of flexion, 5 observers independently assessed the healing of the capitellum, and the interobserver and intraobserver reliabilities were examined. The differences in outcomes among 3 groups were also examined. RESULTS The interobserver and intraobserver reliabilities of the radiographic assessment were almost perfect (Cohen kappa value: 0.82 and 0.91, respectively). There were no significant differences in age, sports played, or stage of the lesion before the treatment. The proportion of patients returning to sports and the mean period required were 77% and 8.2 months in group A, 78% and 5.7 months in group B, and 83% and 4.4 months in group C, respectively. The proportion of patients showing ossification in the central aspect of the capitellum and the mean period required were 67% and 8.2 months in group A, 63% and 4.9 months in group B, and 91% and 1.9 months in group C, respectively. The proportion of patients showing complete healing and the mean period required were 41% and 16.4 months in group A, 67% and 7.0 months in group B, and 92% and 5.5 months in group C, respectively. Compared to group A, group C showed a significantly earlier return to sports (P = .034), a significantly shorter period required for ossification (P < .001), and significantly higher proportion of patients with complete healing (P = .012) within a significantly shorter period (P = .009). CONCLUSION Elbow immobilization had positive effects on healing and enabled both an early return to sports and complete healing. Cast immobilization is recommended as a first choice of nonoperative treatment for stable OCD lesions of the elbow before epiphyseal closure.
Collapse
Affiliation(s)
- Masatoshi Takahara
- Center for Hand, Elbow, and Sports Medicine, Izumi Orthopaedic Hospital, Sendai, Japan.
| | - Tomohiro Uno
- Center for Hand, Elbow, and Sports Medicine, Izumi Orthopaedic Hospital, Sendai, Japan; Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masahiro Maruyama
- Center for Hand, Elbow, and Sports Medicine, Izumi Orthopaedic Hospital, Sendai, Japan; Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Mikio Harada
- Center for Hand, Elbow, and Sports Medicine, Izumi Orthopaedic Hospital, Sendai, Japan; Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Ryo Mitachi
- Center for Hand, Elbow, and Sports Medicine, Izumi Orthopaedic Hospital, Sendai, Japan
| | - Hidetoshi Ono
- Center for Hand, Elbow, and Sports Medicine, Izumi Orthopaedic Hospital, Sendai, Japan
| | - Hiroshi Satake
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| |
Collapse
|
14
|
London DA, Gluck MJ, Kirschenbaum JD, Hausman MR. Casting Position for Distal Radius Fractures Changes Radiocarpal Joint Forces: A Cadaveric Study. J Hand Surg Am 2022; 47:482.e1-482.e10. [PMID: 34303567 DOI: 10.1016/j.jhsa.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/06/2021] [Accepted: 06/16/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Nonsurgical distal radius fracture treatment requires immobilization and classical teaching suggests varying cast positions. We investigated the effect of cast position on the force and pressure experienced by the articular cartilage in the scaphoid and lunate fossae. METHODS Ten fresh-frozen cadaveric specimens were used. A standardized extra-articular distal radius fracture was made. Force sensors were affixed to the articular cartilage of the scaphoid and lunate fossae. Baseline data were obtained. Specimens were then placed into a short arm cast with the wrist either neutrally aligned or flexed and ulnarly deviated (FUD). Specimens had a standard load applied, and a force profile was obtained. The cast was removed and the other cast type was placed and measurements were repeated. Overall force and pressure values were compared between baseline data and the 2 cast types. Additionally, differences in volar and dorsal scaphoid and lunate fossa forces and pressures were compared pairwise within the 2 cast types. The relative force and pressure values across cast types were also compared. RESULTS Both cast types significantly reduced the median force and pressure experienced by the radiocarpal joint compared with no cast. In the FUD cast, the volar and dorsal lunate fossa experienced significantly greater force, and the dorsal lunate fossa experienced significantly greater pressure compared with the dorsal scaphoid fossa. There were no differences for any fossae in the neutral cast. When comparing between casts, the volar lunate fossa experienced a significantly greater relative force in the FUD cast compared with the neutral cast. CONCLUSIONS Casting a distal radius fracture decreases the forces and pressures in the radiocarpal joint. Placing the wrist in a FUD position results in greater forces and pressures on the lunate fossa compared with the scaphoid fossa. CLINICAL RELEVANCE When immobilization is needed, we advocate for the placement of patients in a relatively neutral short-arm cast with minimal FUD to avoid this increased pressure.
Collapse
Affiliation(s)
- Daniel A London
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY; Department of Orthopaedic Surgery, University of Missouri, Columbia, MO.
| | - Matthew J Gluck
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY
| | - Joshua D Kirschenbaum
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY
| | - Michael R Hausman
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY
| |
Collapse
|
15
|
Golshahi L, Finlay WH, Wachtel H. Use of Airway Replicas in Lung Delivery Applications. J Aerosol Med Pulm Drug Deliv 2022; 35:61-72. [PMID: 35262408 DOI: 10.1089/jamp.2021.29057.lg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The use of extrathoracic airway replicas in optimization of drug delivery to the lungs with nebulizers, dry powder inhalers (DPIs) and pressurized metered-dose inhalers (pMDIs) is discussed. Such airway replicas have been useful in evaluating new pulmonary drug delivery platforms mainly based on the comparison of the total lung dose (TLD) and the aerodynamic particle size distribution (APSD) of the aerosol distal to the physical models. The ability of these in vitro methods to replicate in vivo results has allowed advancements in respiratory drug delivery and in the accuracy and utility of in vitro-in vivo correlations (IVIVCs).
Collapse
Affiliation(s)
- Laleh Golshahi
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Warren H Finlay
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Herbert Wachtel
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| |
Collapse
|
16
|
Coupal S, Lukas K, Plint A, Bhatt M, Cheung K, Smit K, Carsen S. Management of Gartland Type 1 Supracondylar Fractures: A Systematic Review. Front Pediatr 2022; 10:863985. [PMID: 35664877 PMCID: PMC9160664 DOI: 10.3389/fped.2022.863985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Gartland Type 1 supracondylar humerus fractures are stable, non-displaced injuries treated with non-operative management. This systematic review was performed to gather evidence on the optimal form of immobilization to treat these fractures. METHODS The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search was performed in November 2020. Articles were eligible if they included children less than 18 years old, with non-displaced supracondylar fractures, treated non-operatively. Randomized trials, quasi-experimental trials, and prospective cohort studies were included. Outcomes of interest included fracture displacement, pain control, time to return to normal activities, return of range of motion (ROM), child/parent satisfaction, adverse events, and cost. Risk of bias was assessed using the Newcastle-Ottawa scale, Rob-2, and the ROBINS tools. RESULTS After duplicate records were removed, 525 records were evaluated with 9 studies meeting the inclusion criteria and 5 reporting clinical outcomes. The studies were heterogenous, in intervention and outcomes, and all at moderate risk of bias. Within the available evidence there were no cases of fracture displacement. Two small studies suggested that cuff and collar treatment provided inadequate pain control and delay in return to normal activities, compared to posterior splints. Two randomized control trials (RCTs) suggested that soft fiberglass casts reduced appointment time and increased parent satisfaction, compared to traditional casts. No studies directly compared posterior splints to circumferential casts. CONCLUSION There is insufficient high-quality evidence to determine the optimal conservative treatment for patients with Gartland type 1 supracondylar fractures. Level of Evidence Level II systematic review of Level II studies. SYSTEMATIC REVIEW REGISTRATION [PROSPERO], identifier [CRD42020144616].
Collapse
Affiliation(s)
- Stephanie Coupal
- Division of Orthopedic Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Kenneth Lukas
- Division of Orthopedic Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Amy Plint
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Maala Bhatt
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Kevin Cheung
- Division of Plastic Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Kevin Smit
- Division of Orthopedic Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Sasha Carsen
- Division of Orthopedic Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
17
|
Abstract
Cast immobilization is performed in pediatric patients to support fracture healing, provide post-operative protection, or correct congenital deformities. Pediatric dermatologists will likely encounter the casted patients in their practice. These patients may present with cast-related complications that can arise due to the cast application or removal process, the inner cast environment, direct physical effects of the cast, or other external factors. This article provides a review of the dermatologic complications of cast immobilization, as well as useful recommendations for patients and their families.
Collapse
Affiliation(s)
- Manisha Ravi
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Esteban Fernandez Faith
- The Ohio State University College of Medicine, Columbus, Ohio, USA.,Division of Pediatric Dermatology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Amanda Whitaker
- Department of Orthopaedic Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jessica Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
18
|
Stokes MB, Stevens JS. Vancomycin-Associated Cast Nephropathy: Reality or Fantasy? Kidney360 2021; 3:372-375. [PMID: 35373135 PMCID: PMC8967645 DOI: 10.34067/kid.0007282021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/30/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Michael B. Stokes
- Department of Pathology, College of Physicians and Surgeons, New York, New York
| | - Jacob S. Stevens
- Department of Medicine, College of Physicians and Surgeons, New York, New York
| |
Collapse
|
19
|
Abstract
We report on our experience of using a short, moulded metacarpal cast over a 4-year period in the non-surgical management of metacarpal shaft fractures. Between 6 April 2015 and 6 April 2019, 117 patients were treated using this method. The majority were male, and the mean age was 24.6 years. The most common mechanism of injury was a punch injury (73 patients, 62%). Fifteen patients (13%) were treated for multiple metacarpal fractures. Immediately after cast removal, 68% had a full range of finger movement and 68% were pain free. Few required formal hand therapy. Fifteen patients experienced minor complications, primarily soft tissue irritation from the cast and non-limiting extensor lag. The moulded short metacarpal cast is an effective non-surgical treatment for angulated extra-articular metacarpal fractures of the diaphysis and diametaphyseal junction.Level of evidence: IV.
Collapse
Affiliation(s)
- Julia Street
- Department of Trauma and Orthopaedics, University Hospital Wales, Cardiff, UK
| | - Luthfun Nessa
- Department of Trauma and Orthopaedics, University Hospital Wales, Cardiff, UK
| | - Andrew Logan
- Department of Trauma and Orthopaedics, University Hospital Wales, Cardiff, UK
| | - Ryan W Trickett
- Department of Trauma and Orthopaedics, University Hospital Wales, Cardiff, UK
| |
Collapse
|
20
|
Keenan J, Rowswell H, Nokes T. Development of the Plymouth VTE Risk Score for patients treated with lower limb immobilisation in a cast or boot. Injury 2021; 52:3277-85. [PMID: 33838877 DOI: 10.1016/j.injury.2021.03.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/18/2021] [Indexed: 02/02/2023]
Abstract
There is approximately a 2% risk of clinically significant VTE following temporary lower limb immobilisation after injury with an ankle immobilising plaster cast or boot. There is evidence that thromboprophylaxis for lower limb immobilised patients reduces the risk of VTE by approximately 50% but there is no international consensus as to which patients should receive thromboprophylaxis. The Plymouth VTE Risk Score was developed to identify patients at particular risk of VTE, in order to offer chemical prophylaxis to reduce their VTE risk. The score showed high completion rates, reliability and consistency. Using the Plymouth VTE Risk Score Version 3 (2014), we found an incidence of clinical VTE of 0.36% with 37.6% of patients being advised to have thromboprophylaxis. This is a lower VTE incidence than in most other studies of this patient group, which is of the order of 2 to 3%. The optimal RAM to use in clinical practice is yet to be defined, further clinical research is needed to accurately stratify patient risk and to define optimal risk treatment levels. We suggest research should focus on comparative clinical studies of risk assessment models.
Collapse
|
21
|
Canavese F, Mansour M, Souchon L, Samba A, Dimeglio A. The ' Hybrid method' for the treatment of congenital clubfoot. Ann Transl Med 2021; 9:1099. [PMID: 34423011 PMCID: PMC8339846 DOI: 10.21037/atm-20-7526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/23/2020] [Indexed: 11/12/2022]
Abstract
Background The hybrid method combines the advantages of the Ponseti technique and of the French Physical Therapy method. The main goal of this study is to present our results on 139 consecutive newborns with clubfoot (n=212 feet) treated at our Institution with the hybrid method. Methods From May 2010 until August 2020, 139 consecutive newborns with congenital clubfoot (66 unilateral; 73 bilateral) were treated by the hybrid method protocol and were retrospectively reviewed. All patients were admitted via the maternity ward with their family and personal history records, i.e., parental age, parity, gender, birth weight, involved side and presence/absence of associated medical conditions. At birth, all clubfeet were graded in ascending order of severity according to Dimeglio et al.’s classification system. AP and lateral radiographs of each foot are taken every 5 to 6 months from age 6 months to 2 years, then once a year until age 4 years, to assess divergence between talus and calcaneus on both projections Results The cohort counted a total of 100 boys (71.9%) and 39 girls (28.1%). Clubfoot was unilateral in 66 patients (47.5%) and bilateral in 73 (52.5%). All but 10 patients had idiopathic clubfoot deformity (92.8%). Mean number of casts per patient was 8 (range: 4–11). One hundred and thirty patients out of 139 underwent percutaneous Achilles tenotomy under general anesthesia (93.5%). Overall, tibialis anterior transfer was performed in 6/212 feet (2.8%), posterior release in 9/212 (4.2%) and medial release in 1/212 foot (0.05%). Conclusions Our experience with the hybrid method has allowed us to constantly reduce the number of patients requiring surgery over the years, as well as the extent of surgical release. These results are encouraging, but larger cohorts of patients from different institutions and with longer follow up are needed to confirm our findings.
Collapse
Affiliation(s)
- Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Center, Jeanne de Flandre Hospital, Rue Eugène Avinée, Lille, France.,Nord-de-France University, Faculty of Medicine Henri Warembourg, 2 rue Eugène Avinée, Lille, France
| | - Mounira Mansour
- Clermont Ferrand University Center, Estaing Hospital, Department of Pediatric Orthopedic Surgery, Clermont Ferrand, France
| | - Léa Souchon
- Clermont Ferrand University Center, Estaing Hospital, Department of Pediatric Orthopedic Surgery, Clermont Ferrand, France
| | - Antoine Samba
- Clermont Ferrand University Center, Estaing Hospital, Department of Pediatric Orthopedic Surgery, Clermont Ferrand, France
| | - Alain Dimeglio
- University of Montpellier, Faculty of Medicine, 2 Rue de l'École de Médecine, Montpellier, France
| |
Collapse
|
22
|
Zhang XX, Liu JZ, Zou W, Wang M. Diagnostic Testing Using Pterygomaxillary Notches and Retromolar Pads on Casts to Check Horizontal Jaw Relation. Chin J Dent Res 2021; 24:61-66. [PMID: 33890457 DOI: 10.3290/j.cjdr.b1105885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To verify horizontal jaw relations using anatomical marks on a cast and evaluate the efficiency and accuracy of the test on checking the horizontal relation. METHODS A total of 200 patients with a loss of posterior occlusion were recruited. After casts were made and the horizontal jaw relation was recorded, the pterygomaxillary notch and retromolar pad were identified bilaterally on the maxillary and mandibular casts. On each cast, a vertical line was drawn to bisect the anatomical landmarks and the distance between the two vertical lines was measured. Using the result of the wax try-in appointment and the corresponding measurements, a diagnostic test was conducted. A receiver operating curve was created and the maximum horizontal distance between bisecting points that still obtained correct jaw relations was determined to be a criterion. The accuracy of the test to verify horizontal jaw relations was evaluated. RESULTS The area under the curve of the receiver operating curve was 0.833 (P < 0.05). With a maximum Youden index, the d value threshold was 1.0 mm. Using 1.0 mm as a criterion to check the horizontal relation, the sensitivity of the test was 0.76 and the specificity was 0.93. The kappa value for different researchers was calculated to be 0.79 (P < 0.05). The intraexaminer 1 reliability gave a kappa value of 0.76 (P < 0.05), and intraexaminer 2 gave a value of 0.81 (P < 0.05). CONCLUSION The test for verifying the accuracy of horizontal jaw relations is reliable. If horizontal distance is measured as greater than 1.0 mm at the jaw relation record appointment, the recorded horizontal jaw relationship may be wrong and need to be reexamined.
Collapse
|
23
|
Lee HE, Wu JH, Chao CY, Chang YH, Du JK, Chen KK, Chen HM. A Study of Low Young's Modulus Ti-15Ta-15Nb Alloy Using TEM Analysis. Materials (Basel) 2020; 13:ma13245694. [PMID: 33327375 PMCID: PMC7764856 DOI: 10.3390/ma13245694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022]
Abstract
The microstructural characteristics and Young’s modulus of the as-cast Ti–15Ta–15Nb alloy are reported in this study. On the basis of the examined XRD and TEM results, the microstructure of the current alloy is essentially a mixture (α + β+ α′ + α″ + ω + H) phase. The new H phase has not previously been identified as a known phase in the Ti–Ta–Nb alloy system. On the basis of examination of the Kikuchi maps, the new H phase belongs to a tetragonal structural class with lattice parameters of a = b = 0.328 nm and c = 0.343 nm, denoting an optimal presentation of the atomic arrangement. The relationships of orientation between these phases would be {0001}α//{110}β//{1¯21¯0}ω//{101¯}H and (011¯0)α//(11¯2)β//(1¯010)ω//(121)H. Moreover, the Young’s modulus of the as-cast Ti–15Ta–15Nb alloy is approximately E = 80.2 ± 10.66 GPa. It is implied that the Young’s modulus can be decreased by the mixing of phases, especially with the presence of the H phase.
Collapse
Affiliation(s)
- Huey-Er Lee
- Department of Dentistry, Yuan’s General Hospital, Kaohsiung 80249, Taiwan;
| | - Ju-Hui Wu
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan;
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chih-Yeh Chao
- Department of Mechanical Engineering, National Pintung University of Science and Technology, Pingtung 91201, Taiwan; (C.-Y.C.); (H.-M.C.)
| | - Yen-Hao Chang
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Je-Kang Du
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan;
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Correspondence: (J.-K.D.); (K.-K.C.); Tel.: +886-7-3121-101 (ext. 7003) (J.-K.D.)
| | - Ker-Kong Chen
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan;
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Correspondence: (J.-K.D.); (K.-K.C.); Tel.: +886-7-3121-101 (ext. 7003) (J.-K.D.)
| | - Huey-Ming Chen
- Department of Mechanical Engineering, National Pintung University of Science and Technology, Pingtung 91201, Taiwan; (C.-Y.C.); (H.-M.C.)
| |
Collapse
|
24
|
Freislederer F, Berberich T, Erb TO, Mayr J. Pain during Cast Wedging of Forearm Shaft and Distal Forearm Fractures in Children Aged 3 to 12 Years-A Prospective, Observational Study. Children (Basel) 2020; 7:E229. [PMID: 33207721 DOI: 10.3390/children7110229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023]
Abstract
Background: Although fracture displacement in children is easily treated by cast wedging, no data on pain associated with the procedure are available. We hypothesized that there is no clinically relevant difference in pain before and after cast wedging in children between 3 and 12 years of age. Patients and Methods: This international, multicenter, prospective, observational study included 68 children (39 male, 29 female) aged 3 to 12 years (median age 8 years) with forearm fractures. Cast wedging was performed 5 to 10 days after the injury. Before starting the procedure, we administered a single oral dose of sodium metamizole (10 mg/kg body weight), and the children inhaled a nitrous oxide/oxygen mixture (50%/50%) during the wedging procedure. Pain was rated on a visual analog scale (VAS) 5 to 10 min before incision of the cast as well as 3 to 5 min and 30 min (maximum remembered pain) after inhalation stop. The degree of bending was judged either by the surgeon or was determined on the basis of first signs of pain expressed by the patient. We assessed the effectiveness of the procedure by obtaining X-ray images in two planes after 3 to 9 days. Results: Among the 68 patients, median VAS score before cast wedging was 0. This increased to a score of 1 (p = 0.015) at 3 to 5 min after the procedure. Median VAS score for the maximum remembered pain measured after 30 min was 0. Median differences in angulation between proximal and distal bone fragments before and after the intervention were 0° (p < 0.0001) in the a.p. view and 8.4° (p < 0.0001) in the lateral view. Conclusion: Cast wedging improved the position of forearm fracture fragments at the expense of minimal short-term pain.
Collapse
|
25
|
Zheng C, Wang W, Chen R, Liu J, Li Y, Qin X. Diagnostic value of urinary microprotein concentration for patients with negative urinary protein test results and positive urinary casts on microscopic examination. J Clin Lab Anal 2020; 34:e23487. [PMID: 32686106 PMCID: PMC7676179 DOI: 10.1002/jcla.23487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To analyze the association between positive urinary casts on microscopic examination and urinary microprotein concentration in the case of negative urinary protein test results. This study also investigated the diagnostic value of urinary microprotein examination. SUBJECTS A total of 949 samples that were analyzed with a UF-1000i Urine Analyzer and returned cast alarm results were categorized into two groups, a positive and negative group, according to qualitative urinary protein sulfosalicylic acid test results. Then, 54 samples with negative protein test results but positive cast results according to microscopic examination were selected as the study group; 60 normal people with healthy physical examination results were selected as the control group. Both groups underwent urinary microprotein tests, including urinary microalbumin (mAlb), α1-microglobulin (A1M), transferrin (TRU), and immunoglobulin G (IgG). T tests were used to evaluate mean differences between groups and chi-square tests were used to calculate ratio differences between groups. RESULTS (a) Microscopic examinations of the positive and negative protein groups revealed no statistically significant difference in cast detection rate (P = .421). (b) Among the 54 samples in the study group, 37 were found to have abnormal casts, while in the remaining 17 samples, only hyaline casts were detected. (c) The detection levels of mAlb, A1M, and IgG in the study group were significantly higher than the control group (P values < .05). CONCLUSION Urinary microprotein test should be included in the re-examination rules for routine tests for patients with negative protein results and positive casts under microscopic examination.
Collapse
Affiliation(s)
- ChunSheng Zheng
- Department of Laboratory MedicineThe Affiliated People's Hospital of Fujian University of Traditional Chinese MedicineFuzhouChina
| | - WenHua Wang
- Department of Laboratory MedicineThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - RongYan Chen
- Department of Laboratory MedicineThe Affiliated People's Hospital of Fujian University of Traditional Chinese MedicineFuzhouChina
| | - JiLai Liu
- Department of Laboratory MedicineThe Affiliated People's Hospital of Fujian University of Traditional Chinese MedicineFuzhouChina
| | - YangYu Li
- Department of Laboratory MedicineThe Affiliated People's Hospital of Fujian University of Traditional Chinese MedicineFuzhouChina
| | - XueJun Qin
- Department of Laboratory MedicineThe Affiliated People's Hospital of Fujian University of Traditional Chinese MedicineFuzhouChina
| |
Collapse
|
26
|
Chandrashekar V, Tarigopula A, Prabhakar V. How Reliable Is Automated Urinalysis in Acute Kidney Injury? Lab Med 2020; 52:e30-e38. [PMID: 33009810 DOI: 10.1093/labmed/lmaa069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Examination of urine sediment is crucial in acute kidney injury (AKI). In such renal injury, tubular epithelial cells, epithelial cell casts, and dysmorphic red cells may provide clues to etiology. The aim of this study was to compare automated urinalysis findings with manual microscopic analysis in AKI. METHODS Samples from patients diagnosed with AKI and control patients were included in the study. Red blood cells, white blood cells, renal tubular epithelial cells/small round cells, casts, and pathologic (path) cast counts obtained microscopically and by a UF1000i cytometer were compared by Spearman test. Logistic regression analysis was used to assess the ability to predict AKI from parameters obtained from the UF1000i. RESULTS There was poor correlation between manual and automated analysis in AKI. None of the parameters could predict AKI using logistic regression analysis. However, the increment in the automated path cast count increased the odds of AKI 93 times. CONCLUSION Automated urinalysis parameters are poor predictors of AKI, and there is no agreement with manual microscopy.
Collapse
Affiliation(s)
- Vani Chandrashekar
- Department of Hematology, Clinical pathology, Apollo hospitals, Chennai, India
| | - Anil Tarigopula
- Department of Centralised Molecular Diagnostics, Apollo Hospitals, Chennai, India
| | - Vikram Prabhakar
- Department of Hematology, Clinical pathology, Apollo hospitals, Chennai, India
| |
Collapse
|
27
|
Abstract
PURPOSE Forearm and distal radius fractures are among the most common fractures in children. Many fractures are definitively treated with closed reduction and casting, however, the risk for re-displacement is high (7% to 39%). Proper cast application and the three-point moulding technique are modifiable factors that improve the ability of a cast to maintain the fracture reduction. Many providers univalve the cast to accommodate swelling. This study describes how the location of the univalve cut impacts the pressure at three-point mould sites for a typical dorsally displaced distal radius fracture. METHODS We placed nine force-sensing resistors on an arm model to collect pressure data at the three-point mould sites. Sensory inputs were sampled at 15 Hz. Cast padding and a three-point moulded short arm fibreglass cast was applied. The cast was then univalved on the dorsal, volar, radial or ulnar aspect. Pressure recordings were obtained throughout the procedure. RESULTS A total of 24 casts were analyzed. Casts univalved in the sagittal plane (dorsal or volar surface) retained up to 16% more pressure across the three moulding sites compared with casts univalved in the coronal plane (radial or ulnar border). CONCLUSION Maintaining pressure at the three-point mould prevents loss of reduction at the fracture site. This study shows that univalving the cast dorsally or volarly results in less pressure loss at moulding sites. This should improve the chances of maintaining fracture reductions when compared with radial or ulnar cuts in the cast. Sagittal plane univalving of forearm casts is recommended.
Collapse
Affiliation(s)
- Blake K. Montgomery
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA,Lucile Packard Children’s Hospital, Palo Alto, California, USA
| | - Kenneth H. Perrone
- Department of General Surgery, Stanford University, Palo Alto, California, USA
| | - Su Yang
- Department of General Surgery, Stanford University, Palo Alto, California, USA
| | - Nicole A. Segovia
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Lawrence Rinsky
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA,Lucile Packard Children’s Hospital, Palo Alto, California, USA
| | - Carla M. Pugh
- Department of General Surgery, Stanford University, Palo Alto, California, USA
| | - Steven L. Frick
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA,Lucile Packard Children’s Hospital, Palo Alto, California, USA,Correspondence should be sent to Steven Frick, Stanford Children’s Health, Lucile Packard Children’s Hospital, 300 Pasteur Drive, Edwards Bldg R107, Stanford, CA 94305, USA.
| |
Collapse
|
28
|
Montgomery BK, Storaci HW, Segovia NA, Young J. Test of Strength: Figure-of-Eight versus Spiral Wrapping Technique for Fiberglass Casts. Cureus 2020; 12:e7843. [PMID: 32483494 PMCID: PMC7253080 DOI: 10.7759/cureus.7843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pediatric fractures are a common injury, and treatment often includes cast immobilization. For pediatric patients being treated in a cast, cast damage is among the most common reasons patients return to the emergency room. The figure-of-eight wrapping technique interdigitates layers of fiberglass which may create a stronger cast. The aim of this study was to assess the strength of the figure-of-eight wrapping technique in comparison to the spiral wrapping technique. A total of 10 casts were wrapped with a three-inch fiberglass using the spiral technique and 10 casts were wrapped using the figure-of-eight technique. Each cast was then subjected to a three-point bending test and loaded until failure using an Instron machine. The figure-of-eight technique had an average load to failure of 278.2 + 27.6 N/mm which was similar to the spiral technique's load to failure of 281.2 + 25.4 N/mm (p=0.795). Prior to normalizing for thickness, the load to failure of the figure-of-eight technique was 949.8 + 109.5 N, which was significantly higher than the spiral technique of 868.2 + 65.1 N (p=0.038). The figure-of-eight casts were slightly thicker than the spiral casts (average 0.3 mm, p=0.004). This suggests that the thickness of the fiberglass cast may improve the strength. The figure-of-eight wrapping technique had similar biomechanical characteristics to spiral wrapping techniques. Providers should wrap in whichever technique they feel most comfortable performing as there is no difference in strength of the cast. If a stronger cast is desired, then thickness of the cast can be increased.
Collapse
Affiliation(s)
| | | | | | - Jeffrey Young
- Orthopaedic Surgery, Lucile Packard Children's Hospital/Stanford University, Palo Alto, USA
| |
Collapse
|
29
|
Bus SA, Armstrong DG, Gooday C, Jarl G, Caravaggi C, Viswanathan V, Lazzarini PA. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 2020; 36 Suppl 1:e3274. [PMID: 32176441 DOI: 10.1002/dmrr.3274] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/01/2019] [Accepted: 05/20/2019] [Indexed: 12/15/2022]
Abstract
The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the use of offloading interventions to promote the healing of foot ulcers in people with diabetes and updates the previous IWGDF guideline. We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical-scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. For healing a neuropathic plantar forefoot or midfoot ulcer in a person with diabetes, we recommend that a nonremovable knee-high offloading device is the first choice of offloading treatment. A removable knee-high and removable ankle-high offloading device are to be considered as the second- and third-choice offloading treatment, respectively, if contraindications or patient intolerance to nonremovable offloading exist. Appropriately, fitting footwear combined with felted foam can be considered as the fourth-choice offloading treatment. If non-surgical offloading fails, we recommend to consider surgical offloading interventions for healing metatarsal head and digital ulcers. We have added new recommendations for the use of offloading treatment for healing ulcers that are complicated with infection or ischaemia and for healing plantar heel ulcers. Offloading is arguably the most important of multiple interventions needed to heal a neuropathic plantar foot ulcer in a person with diabetes. Following these recommendations will help health care professionals and teams provide better care for diabetic patients who have a foot ulcer and are at risk for infection, hospitalization, and amputation.
Collapse
Affiliation(s)
- Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California (USC), Los Angeles, California
| | - Catherine Gooday
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals, Norwich, UK
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Gustav Jarl
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Carlo Caravaggi
- Diabetic Foot Department, IRCCS Multimedica Group, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | | | - Peter A Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
30
|
Williams BA, Palumbo NE, Phillips SA, Blakemore LC. What They Want - Caregiver and Patient Immobilization Preferences for Pediatric Buckle Fractures of the Wrist. Iowa Orthop J 2020; 40:83-90. [PMID: 32742213 PMCID: PMC7368543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Recent literature supports minimalist approaches such as splinting for pediatric buckle fractures of the wrist. Uptake of this practice, however, has lagged behind the evidence. Barriers to implementation of this strategy necessitate further investigation, and caregiver and patient preferences represent an obstacle that has not been previously evaluated. This study sought to examine caregiver and patient treatment preferences and factors influencing care decisions for buckle fractures of the wrist. We hypothesized that the majority of caregivers and patients prefer cast immobilization for buckle fractures of the wrist. METHODS A 22-item caregiver survey was created to assess demographics, treatment preferences and influential factors. The survey was completed by a convenience sample of caregivers presenting with patients of any diagnosis to our pediatric orthopaedic clinic. RESULTS 297 surveys were collected predominantly from mothers (81.2%) caring for 2.4 (SD 1.3) children. Forty-one percent had previously cared for a child with a fracture. Caregivers accompanied patients who were 9.0+/-5.0-years-old, 34% of whom were actively being treated for an orthopaedic injury. Caregiver immobilization preferences for buckle fractures of the wrist were: no preference (43.1%), cast (32.3%) and splint (24.6%). The doctor's recommendation was the most influential factor on this decision while the child's gender was the least of the factors assessed. Those who rated treatment durability and child's activity level higher were associated with a preference for casting, while those who rated comfort higher were associated with a preference for splinting. DISCUSSION This study is the first to characterize caregiver preferences regarding immobilization devices in the realm of buckle fractures of the wrist. Findings identified that preferences are mixed, with the interest in casting being less than anticipated. Factors influencing caregiver preference include the doctor's recommendation, durability, the patient's activity level, and comfort. Findings can help guide treatment discussions for providers seeking to implement splint-based immobilization strategies.Level of Evidence: III.
Collapse
Affiliation(s)
- Brendan A. Williams
- The Children’s Hospital of Philadelphia, Department of Orthopaedics, Philadelphia, PA
| | - Noel E. Palumbo
- Washington University, Department of Orthopaedic Surgery, Saint Louis, MO
| | - Sarah A. Phillips
- University of Florida, Department of Orthopaedics & Rehabilitation, Gainsville, FL
| | - Laurel C. Blakemore
- University of Florida, Department of Orthopaedics & Rehabilitation, Gainsville, FL
| |
Collapse
|
31
|
Williams BA, Phillips SA, Matthias RC, Blakemore LC. Buckling Down on Torus Fractures - Assessing Treatment Preferences and Perceived Management Barriers at a Single Institution. Iowa Orthop J 2020; 40:12-20. [PMID: 33633503 PMCID: PMC7894062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pediatric buckle fractures of the wrist can be safely managed in 'minimalist' fashion with splinting and limited follow-up; however, traditional means of treatment remain prevalent. The purpose of this study was to 1) evaluate preferences for buckle fracture management among providers at a single institution and 2) identify factors influencing clinical decision-making and barriers to implementation of minimalist practices. METHODS A 13 question survey was developed split into three sections: 1) Demographics, 2) Preferred management, and 3) Influential factors. The survey was distributed to 32 providers within our hospital system involved in buckle fracture management via email over a 1 year period. Descriptive statistics of responses were performed to address study aims. RESULTS The survey participation rate was 72%. Respondents had 12.2+/-12.5 (Range: 1-41) years of experience. Casting of buckle fractures was preferred by 56.5% of providers. Most (77%) were aware of literature supporting minimalist strategies. Family preferences (59.1%) and compliance concerns (54.5%) were cited as the biggest barriers to implementing these practices. Colleague recommendations and patient and caregiver preferences had the strongest influence on providers' practice. Following completion, 88.2% of providers stated they would change or consider changing their practices. DISCUSSION Despite awareness of the evidence base, a casting preference still exists. While other aspects of the minimalist approach were popular, prior work suggests this does not necessarily translate into practice. Commonly cited barriers include family preferences and compliance concerns; however, awareness of these issues may enable change. Level of Evidence: III.
Collapse
Affiliation(s)
- Brendan A Williams
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sarah A Phillips
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Robert C Matthias
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Laurel C Blakemore
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| |
Collapse
|
32
|
Whittier DE, Manske SL, Boyd SK, Schneider PS. The Correction of Systematic Error due to Plaster and Fiberglass Casts on HR-pQCT Bone Parameters Measured In Vivo at the Distal Radius. J Clin Densitom 2019; 22:401-408. [PMID: 30658879 DOI: 10.1016/j.jocd.2018.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
Due to difficulty assessing healing of distal radius fractures using conventional radiography, there is interest in using high resolution peripheral quantitative computed tomography (HR-pQCT) to track healing at the microarchitectural level. Unfortunately, the plaster-of-Paris and fiberglass casts used to immobilize fractures affect HR-pQCT measurements due to beam hardening, and increased noise. The challenge is compounded because casts have variable thickness, and an individual patient will often have their cast changed 2-3 times during the course of treatment. This study quantifies the effect of casts within a clinically relevant range of thicknesses on measured bone parameters at the distal radius, and establishes conversion equations to correct for systematic error in due to cast presence. Eighteen nonfractured participants were scanned by HR-pQCT in three conditions: no cast, plaster-of-Paris cast, and fiberglass cast. Measured parameters were compared between the baseline scan (no cast) and each cast scan to evaluate if systematic error exists due to cast presence. A linear regression model was used to determine an appropriate conversion for parameters that were found to have systematic error. Plaster-of-Paris casts had a greater range of thicknesses (3.2-9.5 mm) than the fiberglass casts (3.0-5.4 mm), and induced a greater magnitude of systematic error overall. Key parameters of interest were bone mineral density (total, cortical, and trabecular) and trabecular bone volume fraction, all of which were found to have systematic error due to presence of either cast type. Linear correlations between baseline and cast scans for these parameters were excellent (R2 > 0.98), and appropriate conversions could be determined within a margin of error less than a ±6% for the plaster-of-Paris cast, and ±4% for the fiberglass cast. We have demonstrated the effects of cast presence on bone microarchitecture measurements, and presented a method to correct for systematic error, in support of future use of HR-pQCT to study fracture healing.
Collapse
Affiliation(s)
- Danielle E Whittier
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary AB, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Sarah L Manske
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary AB, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary AB, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Prism S Schneider
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary AB, Canada; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary AB, Canada.
| |
Collapse
|
33
|
Cornillie P, Casteleyn C, von Horst C, Henry R. Corrosion casting in anatomy: Visualizing the architecture of hollow structures and surface details. Anat Histol Embryol 2019; 48:591-604. [PMID: 31120632 DOI: 10.1111/ahe.12450] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 12/31/2022]
Abstract
Corrosion casting is the technique by which a solid, negative replica is created from a hollow anatomical structure and liberated from its surrounding tissues. For centuries, different types of hardening substances have been developed to create such casts, but nowadays, thermosetting polymers are mostly used as casting medium. Although the principle and initial set-up are relatively easy, producing high-quality casts that serve their intended purpose can be quite challenging. This paper evaluates some of the more popular casting resins that are currently available and provides a step-by-step overview of the corrosion casting procedure, including surface casts of anatomical structures. Hurdles and pitfalls are discussed, along with possible solutions to circumvent them, based on personal experience by the authors.
Collapse
Affiliation(s)
- Pieter Cornillie
- Department of Morphology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Christophe Casteleyn
- Department of Morphology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | | | - Robert Henry
- College of Veterinary Medicine, Lincoln Memorial University, Harrogate, Tennessee
| |
Collapse
|
34
|
Park GY, Kwon DR, Moon YS. Low-intensity microcurrent therapy promotes regeneration of atrophied calf muscles in immobilized rabbits. J Biomed Res 2018; 33:30. [PMID: 30418167 PMCID: PMC6352881 DOI: 10.7555/jbr.32.20180056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/05/2018] [Indexed: 11/03/2022] Open
Abstract
The purpose of this study was to investigate the intensity-specific regenerative effects of microcurrent therapy on gastrocnemius muscle atrophy induced by cast-immobilization in rabbits. Fifteen rabbits were randomly allocated to 3 groups after cast removal: cast-immobilization and sham microcurrent therapy for 2 weeks (group 1); cast-immobilization and microcurrent therapy (25 μA) for 2 weeks (group 2); cast-immobilization and microcurrent therapy (5,000 μA) for 2 weeks (group 3). Clinical parameters [calf circumference, compound muscle action potential (CMAP) of the tibial nerve, thickness of gastrocnemius muscle], cross sectional area of gastrocnemius muscle fibres, and immunohistochemistry was evaluated. The clinical parameters representing mean atrophic changes in group 2 were significantly lower than those in group 3. The cross sectional area of the gastrocnemius muscle fibres and immunohistochemical parameters in group 2 were significantly greater than those in group 3. The results showed that low-intensity microcurrent therapy can more effectively promote regeneration in atrophied gastrocnemius muscle than high-intensity microcurrent therapy.
Collapse
Affiliation(s)
- Gi Young Park
- . Department of Rehabilitation Medicine, Muscle Research Center, Catholic University of Daegu School of Medicine, Daegu 42472, Republic of Korea
| | - Dong Rak Kwon
- . Department of Rehabilitation Medicine, Muscle Research Center, Catholic University of Daegu School of Medicine, Daegu 42472, Republic of Korea
| | - Yong Suk Moon
- . Department of Anatomy, Catholic University of Daegu School of Medicine, Daegu 42472, Republic of Korea
| |
Collapse
|
35
|
Zhu M, Lokino ES, Chan CSH, Gan AJ, Ong LL, Lim KBL. Cast immobilisation for the treatment of paediatric distal radius fracture: fibreglass versus polyolefin. Singapore Med J 2018; 60:183-187. [PMID: 30246214 DOI: 10.11622/smedj.2018118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Stable distal radius fractures in children are frequently treated by immobilisation with a cast and heal readily without complications. This randomised clinical trial aimed to assess patient satisfaction and casting-related clinical outcomes when using polyolefin cast, a new cast material, compared to the conventional fibreglass cast. METHODS A total of 80 patients (age range 7-16 years) with radiograph-confirmed stable distal radius fractures were recruited. They were randomised to either the fibreglass group or polyolefin group, with short arm cast immobilisation for 20-30 days. After cast removal, the incidence of skin rash, growth of hair and cast breakage was recorded along with the administration of patient satisfaction questionnaires. Mann-Whitney U test or Fisher's exact test was applied to compare results. RESULTS Overall, 34 patients from the fibreglass group and 31 patients from the polyolefin group were included in the final analysis. Significantly fewer patients from the polyolefin group reported itchiness during the casting period (p = 0.038). However, significantly more cast breakages were observed for the polyolefin group in the palmar bar region (p = 0.009). Patients from the polyolefin group were overall more satisfied (fibreglass group = 3.15/5 vs. polyolefin group = 3.74/5; p = 0.002). CONCLUSION Polyolefin cast reduces itchiness during casting and provides higher overall patient satisfaction during the treatment of stable distal radius fractures in children in tropical climates. However, patients should be counselled regarding potential cast breakage, which did not compromise safety, and the higher costs involved.
Collapse
Affiliation(s)
- Meng Zhu
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore
| | - Elvin Salioc Lokino
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore
| | - Cheri Su Hui Chan
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore
| | - Arlene Jeremie Gan
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore
| | - Ling Ling Ong
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore
| | - Kevin Boon Leong Lim
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore
| |
Collapse
|
36
|
Grzywna A, McClung A, Sanders J, Sturm P, Karlin L, Glotzbecker M, Children’s Spine Study Group, Growing Spine Study Group. Survey to describe variability in early onset scoliosis cast practices. J Child Orthop 2018; 12:406-412. [PMID: 30154933 PMCID: PMC6090186 DOI: 10.1302/1863-2548.12.170207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To investigate paediatric orthopaedists' cast practices for early onset scoliosis regarding patient selection, cast application, radiographic evaluation, treatment cessation and adjunctive bracing. METHODS A casting survey was distributed to all paediatric orthopaedists in Children's Spine and Growing Spine Study Groups (n = 92). Questions included physician and patient characteristics, technique, treatment, outcomes, radiographic measurements and comparison to other treatments. A total of 55 orthopaedists (60%) responded, and descriptive statistics were calculated on the subset who cast (n = 45). RESULTS A majority of respondents use cast treatment for idiopathic and syndromic scoliosis patients, but not for neuromuscular or congenital scoliosis patients. Major curve angle ranked most important in orthopaedists' decision to commence cast treatment, in comparison with rib-vertebra angle difference or clinical observations. The major curve angle threshold to initiate casting was a median of 30° (20° to 70°), and the minimum patient age was median ten months (3 to 24). First in-cast and out-of-cast radiographs are taken standing, supine, awake, under anesthesia and/or in traction. In all, 58% consistently cast over or under the arm, while 44% vary position by patient. Respondents were divided about the use of a brace after cast treatment: 22% do not prescribe a brace, 31% always do and 36% do in some patients. CONCLUSIONS Future multicentre research studies must standardize radiographic practices and consider age and major curve angle at cast initiation and termination, scoliosis aetiology, shoulder position and treatment duration. Practices need to be aligned or compared in these areas in order to distinguish what makes for the best cast treatment possible.Level of Evidence: V, Expert opinion.
Collapse
Affiliation(s)
- A. Grzywna
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - A. McClung
- Growing Spine Foundation, Milwaukee, Wisconsin, USA
| | - J. Sanders
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York, USA
| | - P. Sturm
- Department of Orthopedic Surgery, Cinncinnati Children’s Hospital, Cinncinnati, Ohio, USA
| | - L. Karlin
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - M. Glotzbecker
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA, Correspondence should be sent to M. Glotzbecker, 300 Longwood Avenue, Hunnewell 2, Boston, Massachussetts 02115, United States. E-mail:
| | | | | |
Collapse
|
37
|
Ayzenberg M, Narvaez M, Raphael J. A simple technique to prolong molding time during application of a fiberglass cast: An in vitro study. Orthop Rev (Pavia) 2018; 10:7314. [PMID: 29770174 PMCID: PMC5937361 DOI: 10.4081/or.2018.7314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 12/18/2017] [Accepted: 12/24/2017] [Indexed: 11/29/2022] Open
Abstract
Casting is routinely used for acute and post-operative immobilization and remains a cornerstone in the non-operative management of fractures and deformities. The application of a properly fitted and wellmolded cast, especially for a trainee, can be challenging. We present a simple method of prolonging cure time of fiberglass cast — placing ice in the dip water. Eight-ply, fiveinch fiberglass cast was circumferentially applied to an aluminum-wrapped cardboard cylinder. An electronic, 2-channel temperature sensor (TR-71wf Temp Logger, T&D Corporation, Matsumoto, Japan), accurate to 0.1ºC and accurate to ±0.3ºC, was placed between the fourth and fifth layers of fiberglass. Thirty total casts were tested using 9±1ºC (cold), 22±1ºC (ambient), and 36±1ºC (warm) dip water. Room temperature was maintained at 24±1ºC. Cast temperatures were measured during the exothermic reaction generated by the cast curing. Peak temperatures and cure times were recorded. Cure time was defined as the point of downward deflection on the timetemperature curve immediately after peak. Cure and peak temperatures were compared among groups using analysis of variance. Mean cure time was 3.5±0.1 minutes for warm water, 5.0±0.4 minutes for ambient water and 7.0±0.5 minutes for cold water. Peak temperature, measured between layers 4 and 5 of the cast material, was 36.6±0.8ºC for warm water, 31.1±1.4ºC for ambient water and 25.2±0.5ºC for cold water. Cold afforded, on average, an additional 2 minutes (40% increase) in cure time compared to ambient water and an additional 3.5 minutes (100% increase) compared to warm water. Cure time differences were significant (P<0.001) for all groups, as were peak temperature differences (P<0.001). Temperatures concerning for development of burns were never reached. Utilizing iced dip water when casting is a simple and effective method to prolong the time available for cast application. Orthopedic residents and trainees may find this useful in learning to fabricate a high quality cast. For the experienced orthopedic surgeon, this method eliminates the need to bridge longlimb casts and facilitates the application of complex casts.
Collapse
|
38
|
Abstract
INTRODUCTION Immobilization causes significant muscle loss. In this study we assessed the regenerative effect of microcurrent electrical stimulation (MES) on gastrocnemius muscle (GCM) atrophy induced by immobilization by cast (IC) in rabbits. METHODS Fifteen rabbits were divided into 3 groups: IC (group 1); IC and free re-ambulation for 2 weeks after cast removal (CR) (group 2); and IC and MES for 2 weeks after CR (group 3). We evaluated clinical parameters (calf circumference, compound muscle action potential of tibial nerve, and thickness of GCM by ultrasound), histomorphometric data (muscle composition and cross-sectional area), and immunohistochemistry. RESULTS Mean atrophic changes in clinical parameters in group 3 were significantly less than those in groups 1 and 2 (P < 0.05). Histomophometric and immunohistochemical parameters in group 3 were significantly greater than those in groups 1 and 2, respectively (P < 0.05). DISCUSSION MES prevents muscle atrophy and facilitates regeneration of muscle. Muscle Nerve 58: 270-276, 2018.
Collapse
Affiliation(s)
- Yong Suk Moon
- Department of Anatomy, Catholic University of Daegu School of Medicine, Daegu, South Korea
| | - Dong Rak Kwon
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil Nam-Gu, Daegu, 42472, South Korea
| | - Yoon-Jin Lee
- Department of Biochemistry, College of Medicine, Soonchunhyang University, Cheonan, South Korea
| |
Collapse
|
39
|
Baig MR, Buzayan MM, Yunus N. Accuracy of a new elastomeric impression material for complete-arch dental implant impressions. ACTA ACUST UNITED AC 2018; 9:e12320. [PMID: 29349910 DOI: 10.1111/jicd.12320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/27/2017] [Indexed: 11/30/2022]
Abstract
AIM The aim of the present study was to assess the accuracy of multi-unit dental implant casts obtained from two elastomeric impression materials, vinyl polyether silicone (VPES) and polyether (PE), and to test the effect of splinting of impression copings on the accuracy of implant casts. METHODS Forty direct impressions of a mandibular reference model fitted with six dental implants and multibase abutments were made using VPES and PE, and implant casts were poured (N = 20). The VPES and PE groups were split into four subgroups of five each, based on splinting type: (a) no splinting; (b) bite registration polyether; (c) bite registration addition silicone; and (d) autopolymerizing acrylic resin. The accuracy of implant-abutment replica positions was calculated on the experimental casts, in terms of interimplant distances in the x, y, and z-axes, using a coordinate measuring machine; values were compared with those measured on the reference model. Data were analyzed using non-parametrical Kruskal-Wallis and Mann-Whitney tests at α = .05. RESULTS The differences between the two impression materials, VPES and PE, regardless of splinting type, were not statistically significant (P>.05). Non-splinting and splinting groups were also not significantly different for both PE and VPES (P>.05). CONCLUSIONS The accuracy of VPES impression material seemed comparable with PE for multi-implant abutment-level impressions. Splinting had no effect on the accuracy of implant impressions.
Collapse
Affiliation(s)
- Mirza R Baig
- Department of Restorative Sciences, Faculty of Dentistry, Kuwait University, Jabriya, Safat, Kuwait
| | - Muaiyed M Buzayan
- Department of Prosthodontics, Faculty of Dentistry, SEGi University, Selangor, Malaysia
| | - Norsiah Yunus
- Department of Restorative Dentistry, Faculty of Dentistry, University Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
40
|
Quiñones-Jurado ZV, Waldo-Mendoza MÁ, Mata-Padilla JM, González-Morones P, Martínez-Colunga JG, Soriano-Corral F, Cruz-Delgado VJ, Ziolo RF, Avila-Orta CA. Transparent Low Electrostatic Charge Films Based on Carbon Nanotubes and Polypropylene. Homopolymer Cast Films. Polymers (Basel) 2018; 10:E55. [PMID: 30966091 DOI: 10.3390/polym10010055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 12/20/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022] Open
Abstract
Use of multi-wall carbon nanotubes (MWCNTs) in external layers (A-layers) of ABA-trilayer polypropylene films was investigated, with the purpose of determining intrinsic and extrinsic factors that could lead to antistatic behavior of transparent films. The incorporation of 0.01, 0.1, and 1 wt % of MWCTNs in the A-layers was done by dilution through the masterbatch method. Masterbatches were fabricated using isotactic polypropylene (iPP) with different melt flow indexes 2.5, 34, and 1200 g/10 min, and using different ultrasound assist methods. It was found that films containing MWCNTs show surface electrical resistivity of 1012 and 1016 Ω/sq, regardless of the iPP melt flow index (MFI) and masterbatch fabrication method. However, electrostatic charge was found to depend upon the iPP MFI, the ultrasound assist method and MWCNT concentration. A percolation electron transport mechanism was determined most likely responsible for this behavior. Optical properties for films containing MWCNTs do not show significant differences compared to the reference film at MWCNT concentrations below 0.1 wt %. However, an enhancement in brightness was observed, and it was attributed to ordered iPP molecules wrapping the MWCNTs. Bright transparent films with low electrostatic charge were obtained even for MWCNTs concentrations as low as 0.01 wt %.
Collapse
|
41
|
Liu DY, Cader FN, Abduo J, Palamara J. Accuracy of Different Implant Impression Techniques: Evaluation of New Tray Design Concept. J Prosthodont 2017; 28:e682-e687. [PMID: 29286181 DOI: 10.1111/jopr.12733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2017] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate implant impression accuracy with a new tray design concept in comparison to nonsplinted and splinted impression techniques for a 2-implant situation. MATERIALS AND METHODS A reference bar titanium framework was fabricated to fit on 2 parallel implants. The framework was used to generate a resin master model with 2 implants that fit precisely against the framework. Three impression techniques were evaluated: (1) nonsplinted, (2) splinted, and (3) nonsplinted with modified tray impressions. All the trays were fabricated from light-cured acrylic resin material with openings that corresponded to the implant impression copings. Ten impressions were taken for each technique using poly(vinyl siloxane) impression material. The impressions were poured with type IV dental stone to generate the test casts. A rosette strain gauge was bonded to the middle of the framework. As the framework retaining screws were tightened on each test cast, the developed strains were recorded until the completion of the tightening to 35 Ncm. The generated strains of the rosette strain gauge were used to calculate the maximum principal strain. RESULTS A statistically significant difference was observed among the different impression techniques. The modified tray design impression technique was associated with the least framework strains, which indicates greater accuracy compared with the other techniques. There was no significant difference between the splinted and the nonsplinted impression techniques. CONCLUSIONS The new tray design concept appeared to produce more accurate implant impressions than the other techniques. Despite the statistical difference among the impression techniques, the clinical significance of this difference is yet to be determined.
Collapse
Affiliation(s)
- David Yu Liu
- Melbourne Dental School, Melbourne University, Carlton, Victoria, Australia
| | | | - Jaafar Abduo
- Melbourne Dental School, Melbourne University, Carlton, Victoria, Australia
| | - Joseph Palamara
- Melbourne Dental School, Melbourne University, Carlton, Victoria, Australia
| |
Collapse
|
42
|
Nepomuceno A, Major MJ, Stine R, Gard S. Effect of foot and ankle immobilization on able-bodied gait as a model to increase understanding about bilateral transtibial amputee gait. Prosthet Orthot Int 2017; 41:556-563. [PMID: 28318394 DOI: 10.1177/0309364617698521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The anatomical foot-ankle complex facilitates advancement of the stance limb through foot rockers and late-stance power generation during walking, but this mechanism is altered for persons with bilateral transtibial amputation when using passive prostheses. OBJECTIVES To study the effects of bilateral foot and ankle immobilization on able-bodied gait to serve as a model for understanding gait of persons with bilateral transtibial amputation and associated compensatory mechanisms. STUDY DESIGN Comparative analysis. METHODS Nine able-bodied persons walked at self-selected slow, normal, and fast speeds. They performed trials unaltered and when fitted with bilateral foot and ankle-immobilizing casts. Data from 10 individuals with bilateral transtibial amputation walking at self-selected fast speeds were used for qualitative comparison. RESULTS The average speeds for the able-bodied fast speed cast and normal speed no-cast trials were similar and were compared with bilateral transtibial amputation data. The able-bodied cast condition data more closely matched bilateral transtibial amputation data than the no-cast data. Ankle range-of-motion and power generation at pre-swing in the cast condition were markedly decreased, while trunk lateral flexion and transverse rotation range-of-motion and peak hip power generation increased. CONCLUSION Results suggest that the absence of active ankle range-of-motion and power generation contributes to the development of characteristic compensatory gait mechanisms displayed by persons with bilateral transtibial amputation. Clinical relevance This study helps to improve understanding of compensatory mechanisms resulting from reduced foot and ankle joint motion to inform lower limb prosthesis design and function for improving gait quality of individuals with bilateral transtibial amputation.
Collapse
Affiliation(s)
- Antonia Nepomuceno
- 1 Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,2 Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA
| | - Matthew J Major
- 2 Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA.,3 Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Rebecca Stine
- 3 Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Steven Gard
- 1 Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,2 Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA.,3 Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL, USA
| |
Collapse
|
43
|
Li H, Song Q, Xu Q, Chen Y, Xu L, Man T. Electrochemical Synthesis of Core-Shell-Structured NbC-Fe Composite Powder for Enforcement in Low-Carbon Steel. Materials (Basel) 2017; 10:ma10111257. [PMID: 29104266 PMCID: PMC5706204 DOI: 10.3390/ma10111257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 11/25/2022]
Abstract
An NbC–Fe composite powder was synthesized from an Nb2O5/Fe/C mixture by electrochemical reduction and subsequent carbonization in molten CaCl2–NaCl. The composite has a core–shell structure, in which NbC acts as the cores distributing in the Fe matrix. A strong bonding between NbC and Fe is benefit from the core–shell structure. The sintering and electrochemical reduction processes were investigated to probe the mechanism for the reactions. The results show that NbC particles about several nanometers were embraced by the Fe shell to form a composite about 100 nm in size. This featured structure can feasibly improve the wettability and sinterability of NbC as well as the uniform distribution of the carbide in the cast steel. By adding the composite into steel in the casting process, the grain size of the casted steel was markedly deceased from 1 mm to 500 μm on average, favoring the hardening of the casted steel.
Collapse
Affiliation(s)
- Hongmei Li
- Liaoning Key Laboratory for Metallurgical Sensor and Technology, School of Metallurgy, Northeastern University, Shenyang 110819, China.
| | - Qiushi Song
- Liaoning Key Laboratory for Metallurgical Sensor and Technology, School of Metallurgy, Northeastern University, Shenyang 110819, China.
| | - Qian Xu
- State Key Laboratory of Advanced Special Steel, School of Materials Science and Engineering, Shanghai University, Shanghai 200072, China.
| | - Ying Chen
- Liaoning Key Laboratory for Metallurgical Sensor and Technology, School of Metallurgy, Northeastern University, Shenyang 110819, China.
| | - Liang Xu
- Liaoning Key Laboratory for Metallurgical Sensor and Technology, School of Metallurgy, Northeastern University, Shenyang 110819, China.
| | - Tiannan Man
- School of Materials Science and Engineering, Northeastern University, Shenyang 110819, China.
| |
Collapse
|
44
|
Abstract
BACKGROUND A person's ability to safely drive while immobilized is not well defined. Steering ability with a spinner knob during immobilization is unknown. The goal of this study is to further clarify the effect of immobilization on steering reaction time and accuracy with and without a steering wheel spinner knob. METHODS Twenty participants were enrolled in this crossover trial using a driving simulator with an automatic transmission. Five conditions were tested in a counterbalanced order. Steering reaction time and accuracy (number of errors on a dynamic steering task at 2 difficulty levels) were measured. Participants were allowed to steer with the immobilized extremity. RESULTS No significant differences in reaction time were observed between any conditions. Both immobilized conditions and difficulty level of the steering task led to diminished accuracy compared with controls, resulting in significantly more errors. The use of a spinner knob significantly improved the accuracy for the condition with the sugar-tong splint during the easier steering task, but this improvement was not observed in the harder steering task. There were no differences between conditions based on gender or observed use of the immobilized arm. CONCLUSIONS Immobilization had a negative effect on steering accuracy for both the wrist splint and the sugar-tong splint condition, which may negatively impact driving ability of immobilized patients. Immobilization, regardless of spinner knob use, did not significantly impact steering reaction time. The steering wheel spinner knob did not consistently improve accuracy, and further study is needed to determine its utility.
Collapse
Affiliation(s)
| | | | | | | | - Kyle J. Jeray
- Greenville Health System, SC, USA
- Kyle J. Jeray, Department of Orthopaedics, Greenville Health System, 2nd Floor Support Tower, 701 Grove Road, Greenville, SC 29605, USA.
| |
Collapse
|
45
|
Agarwal A, Kumar A, Khanna D, Shaharyar A, Bhat MS, Mishra M. Nail changes in casted and braced clubfoot: A preliminary study. Foot Ankle Surg 2016; 22:229-232. [PMID: 27810019 DOI: 10.1016/j.fas.2015.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/20/2015] [Accepted: 09/26/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The study aimed at finding whether there are any nail changes specific to treatment in clubfoot. METHODS Sixty new, 26 undergoing serial corrective casting, and 247 clubfoot patients using foot abduction braces were prospectively studied. The casted and braced group formed the basis of the study to observe nail changes, if any. The new patients and opposite normal foot (in unilateral casted cases) were taken as controls. OBSERVATIONS Acute paronychia, ingrown toe nail, onychoshizia, onychorrhexis, nail plate concavity, latent onychomadesis, and distal onycholysis were observed in feet undergoing corrective casting and bracing. Micronychia, malalignment and thinning of nail plate were the observed congenital nail anomalies. CONCLUSIONS Nail changes in clubfeet are not infrequent. Certain nail changes might be etiologically linked to casting and bracing. Some of nail changes might require urgent medical care.
Collapse
Affiliation(s)
- Anil Agarwal
- Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India.
| | - Anubrat Kumar
- Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India.
| | - Deepshikha Khanna
- Department of Pediatric Dermatology, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India.
| | - Abbas Shaharyar
- Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India.
| | - Mohd Shafi Bhat
- Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India.
| | - Madhusudan Mishra
- Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India.
| |
Collapse
|
46
|
Wang Z. Comparison of Dimensional Accuracies Using Two Elastomeric Impression Materials in Casting Three-dimensional Tool Marks. J Forensic Sci 2016; 61:792-7. [PMID: 27122422 DOI: 10.1111/1556-4029.13012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 05/19/2015] [Accepted: 06/07/2015] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to evaluate two types of impression materials which were frequently used for casting three-dimensional tool marks in China, namely (i) dental impression material and (ii) special elastomeric impression material for tool mark casting. The two different elastomeric impression materials were compared under equal conditions. The parameters measured were dimensional accuracies, the number of air bubbles, the ease of use, and the sharpness and quality of the individual characteristics present on casts. The results showed that dental impression material had the advantage of special elastomeric impression material in casting tool marks in crime scenes; hence, it combined ease of use, dimensional accuracy, sharpness and high quality.
Collapse
Affiliation(s)
- Zhen Wang
- Key Laboratory of Impression Evidence Examination and Identification Technique of MPS, National Police University of China, 83 Ta-wan Street, Huang-gu District, Shenyang, 110035, China
| |
Collapse
|
47
|
Abstract
BACKGROUND Many fractures are treated with casting which can cause complications likely from inability to wash the extremity. Gore-Tex-based waterproof cast liner has been compared with cotton liner and shown to be superior in physician and patient scoring but also has high cost and difficult application. The purpose of this study is to compare newer generation waterproof liners with traditional cotton liner. It is the first study to compare this new waterproof liner and cotton liner in a crossover model, allowing patients to swim in the pool with the cast. METHODS Twenty patients (ages 3-30) with upper extremity injuries were randomized to waterproof-liner or cotton-liner casts made of fiberglass. Patients would switch cast liners halfway between their treatments to fulfill crossover criteria. All fractures were within a 2-week period from original incident. At each clinic visit, patients evaluated comfort parameters through questionnaires, and physicians rated skin condition. Patients were also asked which cast liner they preferred at the end of the study. RESULTS There were no unscheduled cast changes. The waterproof-liner group had better scores for odor (P = .041), sweat (P = .016), and overall physician-rated score (P = .038). There was no significant difference in other patient-rated parameters. Seventy-five percent of patients preferred waterproof casting to the cotton liner. CONCLUSIONS This new waterproof cast liner, compared with cotton cast liner, had better odor, sweat, and overall physician scores. The waterproof liners allow patients to rinse casts daily, and the majority of patients prefer waterproof to cotton liner.
Collapse
Affiliation(s)
| | | | | | - Montri D. Wongworawat
- Loma Linda University Medical Center, Loma Linda, CA, USA,Montri D. Wongworawat, Department of Orthopedic Surgery, Loma Linda University Medical Center, 11406 Loma Linda Drive, Suite 218, Loma Linda, CA 92354, USA.
| |
Collapse
|
48
|
Baker E, Broom YS. Natural History Museum Sound Archive I: Orthoptera: Gryllotalpidae Leach, 1815, including 3D scans of burrow casts of Gryllotalpa gryllotalpa (Linnaeus, 1758) and Gryllotalpa vineae Bennet-Clark, 1970. Biodivers Data J 2016:e7442. [PMID: 26752971 PMCID: PMC4700384 DOI: 10.3897/bdj.3.e7442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 12/18/2015] [Indexed: 11/24/2022] Open
Abstract
Background The Natural History Museum (NHM) sound archive contains recordings of Gryllotalpidae, and the NHM collection holds plaster casts of the burrows of two species. These recordings and burrows have until now not been made available through the NHM's collection database, making it hard for researchers to make use of these resources. New information Eighteen recordings of mole crickets (three identified species) held by the NHM have been made available under open licenses via BioAcoustica. 3D scans of the burrows of Gryllotalpagryllotalpa (Linnaeus, 1758) and Gryllotalpavineae Bennet-Clark, 1970 have been made available via the NHM Data Portal.
Collapse
Affiliation(s)
- Ed Baker
- The Natural History Museum, London, United Kingdom
| | | |
Collapse
|
49
|
Ağır İ, Tunçer N, Küçükdurmaz F, Gümüstaş S, Akgül ED, Akpinar F. Functional Comparison of Immediate and Late Weight Bearing after Ankle Bimalleolar Fracture Surgery. Open Orthop J 2015; 9:188-90. [PMID: 26069513 PMCID: PMC4460215 DOI: 10.2174/1874325001509010188] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/11/2015] [Accepted: 04/20/2015] [Indexed: 11/22/2022] Open
Abstract
AIM The aim of the study is to compare immediate weight bearing with below-knee cast or immobilization with plaster splint in 6 weeks in patients after operative treatment for ankle bimalleolar fractures. METHODS Fifty-three patients with ankle bimalleolar fractures were treated operatively in 2005 to 2010 and then were randomly allocated to two groups. Immediately weight bearing in a below-knee cast (26 patients) and immobilization in a plaster splint for the first six postoperative weeks (27 patients). A mean age 37.9 (min 17; max 72). An average follow-up 26.1 months. (min 14; max 55). All fractures were classified with Lauge-Hansen classification. Functional results of both groups were evaluated with AOFAS for the postoperative one year after surgical treatment. RESULTS According to the AOFAS scoring system, results were excellent and good in 17 patients in group 1. On the other hand, results were excellent and good in 14 patients in group 2. CONCLUSION As a result we think that weight bearing protocol should be advantaged for patients with ankle bimalleolar fractures after surgical treatment immediately.
Collapse
Affiliation(s)
- İsmail Ağır
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, 02040, Adıyaman, Turkey
| | - Nejat Tunçer
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, 34093, İstanbul, Turkey
| | - Fatih Küçükdurmaz
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, 34093, İstanbul, Turkey
| | - Seyitali Gümüstaş
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, 02040, Adıyaman, Turkey
| | - Esra Demirel Akgül
- Department of Orthopaedics and Traumatology, Umraniye Education Research Hospital, 02040, Istanbul, Turkey
| | - Fuat Akpinar
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Abant İzzet Baysal University, 14280, Bolu, Turkey
| |
Collapse
|
50
|
Abstract
Driving with upper extremity immobilization can be potentially dangerous. The aim of this article is to review current medical literature, state laws, and guidelines on driving with upper extremity immobilization and appraise the available evidence. A literature search was conducted to identify citations related to driving with upper extremity immobilization and included a law literature search. Each state's Department of Motor Vehicle handbook was reviewed. Fourteen studies were reviewed and 5 provided subjective and/or objective assessments of upper limb immobilization. Of 2 studies that evaluated only below-elbow immobilization, 1 found driving in a wrist splint had no perceptible effect on driving ability, and the other supported safe driving under normal conditions. The studies that evaluated both below- and above-elbow immobilization recommended against driving with left arm above-elbow immobilization. Two of them found a trend toward worse driving performance in both below- and above-elbow splints. The following organizations' policies on driving are (1) The American Medical Association and National Highway Traffic Association have a joint recommendation for older drivers recommending referral to a rehabilitation specialist, (2) the U.S. Public Health Service recommends normal motor function and adequate mobility of both upper extremities and a performance examination when impaired, and (3) the U.S. Department of Transportation recommends a performance evaluation to determine fitness of commercial motor vehicle drivers. There are no state statutes or multijurisdictional surveys on the topic. This review finds that driving is hindered in some splints, there are substantial variations in physician practice patterns, there are no formal guidelines for physicians and patients to consider, and there is a paucity of published literature on this topic in the United States. Both physicians and patients would benefit from evidence-based recommendations or practice guidelines.
Collapse
|