Adequate Immobilization Research Articles

High-resolution magnetic resonance imaging of the brain in children

Magnetic resonance image quality in infants and children has been improved by the use of spherical receiver coils and age-adjusted sequences allowing use of a high-resolution (256 X 256) image reconstruction matrix, provided adequate immobilisation is maintained. This increased resolution provides more satisfactory demonstration of the cortical mantle and details of sulci, as well as pathological processes such as periventricular oedema, infarction and tumours.

The effect of several different anaesthetics on the blood pressure and heart rate of the mouse and on the radiation response of the mouse sarcoma RIF-1.

Several anaesthetics were tested with mice to study: (a) their ability to immobilize the animal; (b) their effect on blood pressure and heart rate; and (c) their effect on the response to X-irradiation of the mouse sarcoma RIF-1. All anaesthetics which produced adequate immobilization also caused a fall in blood pressure and some radioprotection of tumour cells. Physical restraint of the tumour-bearing leg of an unanaesthetized mouse also caused radioprotection of the tumour cells.

Lunotriquetral sprains

Injuries to the ulnar side of the carpus have not been well defined. Lunotriquetral (LT) sprains have only recently been described and are often unrecognized. They usually occur from hyperextension: and twisting of the wrist. Symptoms include pain, weakness, limitation of motion, and a "click" with lateral motions. The sprain may be associated with dorsal subluxation of the ulnar head and supination of the carpus. Physical examination discloses point tenderness, laxity, and often a snap over the LT joint. Dorsopalmar manipulation of the triquetrum on the lunate demonstrates crepitus and laxity. A radiocarpal arthrogram is helpful in confirming the diagnosis. Palmar-flexion instability patterns represent a more extensive continuation of this injury, which then may be termed an LT dissociation. Treatment with adequate immobilization for acute injuries appears to be useful if the diagnosis is established early. Chronic sprains may require stabilization of the LT joint by ligament repair, reconstruction, or LT fusion. Associated injuries, such as carpometacarpal (CMC) or hamulus fractures, have been noted. Results of treatment have varied considerably and depend in part on the severity and chronicity of the condition at the time of recognition.

Epiphyseal Injuries in Sports.

In brief: About 10% of skeletal trauma in childhood involves epiphyseal injury, which can result in major skeletal growth disturbances. Limb-length discrepancies and joint angle deformities can be prevented by understanding (1) the mechanism and patterns of longitudinal bone growth, (2) the significance of skeletal maturational variances at different ages, (3) the probable locations of epiphyseal injuries, (4) the physical and radiographic signs of epiphyseal injury, and (5) the procedures available for treating deformities that result from epiphyseal injuries. Salter-Harris type I and II injuries are usually successfully treated by closed manipulation and adequate immobilization. Type III, IV, and V injuries often require surgery to achieve satisfactory alignment.

Pulsing Electromagnetic Field Treatment

To the Editor.— The recent article by Bassett and colleagues inThe Journal(1982;247:623) is certainly exciting and encouraging for those of us who are treating fractures. I would advise caution, however, before these conclusions are thought to be final. I am concerned that no controlled studies were performed. A double-blind controlled study for this noninvasive treatment method would be easy to perform. We must remember from past teachings that most fractures with delayed unions, such as those treated in the article, will heal spontaneously with time and continued adequate immobilization. Surely an adequate controlled study should be completed before this noninvasive, but expensive, method is advocated for fracture care.

Nonunion Treatment with Pulsed Electromagnetic Fields

Noninvasive, pulsed electromagnetic field treatment, when properly employed, was effective in securing healing of ununited fractures in 64.4% of 149 patients. The effectiveness of this modality can be ascertained after three months of intensive use in more than 85% of patients, thus enabling the clinician to decide to terminate treatment, continue electrostimulation, or abandon it in favor of another treatment modality. The success of treatment is dependent upon certain variables. Anatomic location of the nonunion is important. Higher healing rates were noted in the tibia than in the femur or humerus. In some conditions, combined electrostimulation and bone grafting was more effective than either measure alone. Young patients healed more rapidly than older patients. Electrostimulation is more effective when instituted within two years of the original fracture than when started at longer intervals after the injury. Infection, either quiescent or actively draining, does not seem to affect the overall results. Of greatest importance is patient adherence to the treatment protocol as outlined, with emphasis placed on adequate immobilization of the fracture and absolute nonweight-bearing during treatment. Considering these factors and in light of the very rare frequency of short-term side effects, the use of pulsed electromagnetic fields appears to be a reasonable choice of treatment in the management of ununited fractures.

The guarded prognosis of physeal injury in paraplegic children.

Unrecognized injury of the physis in neurologically impaired children, followed by repetitive trauma due to lack of sensation, results in a bizarre roentgenographic appearance which may resemble that of osteomyelitis or a malignant tumor (sarcoma or leukemia). The prolonged process of injury and repair in the injured physis and adjacent metaphysis is similar to that seen in Charcot neuroarthropathy. Lack of awareness of these roentgenographic features resulted in unnecessary diagnostic biopsy in two of the nine patients with such fractures reported in this study. Delayed healing is characteristic of this lesion and is a result of inadequate immobilization and failure to restrict weight-bearing. Premature closure of the physis occurred in five of nine patients. Early recognition and adequate immobilization allow more normal healing of this unusual injury.

First Aid on the Ski Slopes

In administering first aid on ski slopes, the principles followed are basic ones: arrest of hemorrhage, adequate immobilization of fractures, prevention of shock, and relief of pain. Respiratory and circulatory complications must of course be given priority, but in my experience such situations have not arisen.

SURGICAL TECHNIQUES UTILIZED IN THE PRESENCE OF INFECTION

SUMMARYThe infected wound must be cleaned physically and appropriate antimicrobial therapy instituted, based on the results of culture and antimicrobial susceptibility testing. Where fluid or necrotic debris is still present, proper drainage should be utilized. Adequate immobilization, physiological dressings, and overall support of patient defense mechanisms will enhance healing and shorten the patient's recovery period.

Mandibular Reconstruction: Current State of the Art

At the present time several techniques of bone grafting for restoration of mandibular defects are being employed. These methods are well established by clinical trials and animal research. Other methods are in the experimental stage. Regardless of the technique utilized it remains paramount that the surgeon plan the initial procedure with great care as each failure results in diminished blood supply to the graft bed and makes subsequent procedures less likely to succeed. The well known principles of bone grafting involve establishing good nutritional status of the patient, proper preparation of the graft bed by insuring adequate soft tissue and adequate blood supply, elimination of infection from the graft bed, provision of adequate fixation and immobilization of the graft, and careful closure of soft tissues to prevent hematoma formation. These principles remain inviolable if the procedure is to succeed.

Peripheral arterial line insertion in neonates and infants: A simplified method of temporal artery cannulation

Summary The temporal artery and its main branches are easily accessible and can be cannulated as many as three times with a 22-gauge flexible catheter. Consistent cannulation of the temporal artery requires minimal mobilization of the vessel, insertion of the catheter using the catheter needle, and adequate immobilization.

Further Progress on Closed Intramedullary Nailing

The desirable conditions for adequate immobilization of fracture-site by the method of osteosynthesis are as follows: trauma of the soft tissue on operation should be minimized as littie as possible, fixation of the fracture should be strong enough for as early exercise and weight-bearing, and it results in solid union and no deficit in the strength of the bone.Television image intensifier faciliates us the closed intramedullary nailing. Our several trials could conquer the weak-points of it. These are: (1) use of two television image intensifiers for reduction of the fracture, (2) employment of the apparatus for dynamic compression of the fracture, exercise of the fracture-site under compressive traction, and transverse fixation of the intramedullary nail with two screws which hold back rotation of the nail in marrow cavity, (3) compressive intramedullary nailing was devised using modified clover-nail with a special bolt for compression at the one-end.Compressive intramedullary nailing could satisfy the desirable conditions for the adequate immobilization of the fracture-site.

Immobilization of tiny hands

Surgery on the hands of small infants and children is frequently delayed until the hand is large enough to permit adequate immobilisation in a plaster cast. A simple, effective method has been devised to immobilise the fingers of even the tiniest hands without the use of complicated and time consuming devices. This method is based on the inability of the hand to flex the metacarpophalangeal joints with the fingers abducted. The ability to fix small fingers in a desired position should increase the range of surgical procedures which were previously limited by difficulties in immobilisation.

Nonunion of the Shafts of the Long Bones

A survey and an analysis of 140 nonunions of the shafts of long bones revealed that 104 (85%) of 123 surgically treated bones united when these four conditions were met: (1) accurate apposition of fragments, (2) adequate immobilization, (3) healthy soft tissue with sufficient blood supply surrounding the site of nonunion, and (4) stimulation of osteogenesis. Factors such as the type and extent of the original injury and initial treatment profoundly influenced the outcome of the nonunited fractures, but ultimate union depended upon restoration of the natural mechanisms of bone repair.

Nonunion of the shafts of the long bones. A review and analysis of 140 cases

A survey and an analysis of 140 nonunions of the shafts of long bones revealed that 104 (85%) of 123 surgically treated bones united when these four conditions were met: (1) accurate apposition of fragments, (2) adequate immobilization, (3) healthy soft tissue with sufficient blood supply surrounding the site of nonunion, and (4) stimulation of osteogenesis. Factors such as the type and extent of the original injury and initial treatment profoundly influenced the outcome of the nonunited fractures, but ultimate union depended upon restoration of the natural mechanisms of bone repair.

INLAY BONE GRAFTING FOR NON-UNION OF THE SCAPHOID BONE BY THE ANTERIOR APPROACH

Cancellous inlay bone grafting for delayed union or non-union of the scaphoid bone gives good results in most cases (Table IV). The operation is easy, does not require radiological control and does not damage the dorsal arterial plexus. The indications for the operation are twofold: firstly for patients complaining of disabling symptoms in the wrist joint with an established pseudarthrosis of the scaphoid bone, with neither arthritic changes nor severe avascularity of the proximal fragment; and, secondly, for delayed union in recent fractures despite adequate immobilisation. Union may still occur if conservative treatment is continued further, but because this may take up to eighteen months (during which time most patients would be unable to work), operation is a reasonable alternative. In this series two scaphoid fractures united after operation with some collapse of the proximal fragment. This probably resulted from removal of too much bone (preliminary to inlaying the graft) from an already small fragment with a poor blood supply. The operation can be performed even in the presence of a small proximal fragment and gave a satisfactory result in two out of three such cases.

Congenital Dislocation of the Hip in Infancy

JBJS Journal Case Connector Reviews JBJS.org Surgical Techniques Open Access JOPA JBJS.org JBJS Journal Case Connector Reviews Surgical Techniques Open Access JOPA

Isolated Traumatic Dislocation of the Distal End of the Ulna or Distal Radio-Ulnar Joint

Three of our five cases and approximately one-half the cases reported were misdiagnosed at the time of original injury. Increased awareness of this lesion and alertness to the relationship of the radius and ulna on lateral roentgenograms of the wrist would probably reduce the incidence of faulty diagnosis markedly.We believe that early closed reduction and adequate immobilization should result in excellent function in most cases. Delay in diagnosis will probably result in protracted disability and the necessity for surgical correction.

Internal Fixation of Fractures of the Forearm

JBJS Journal Case Connector Reviews JBJS.org Surgical Techniques Open Access JOPA JBJS.org JBJS Journal Case Connector Reviews Surgical Techniques Open Access JOPA

The results of treatment of mallet finger.

1. The method of treatment of a mallet finger deformity by immobilisation in a plaster in the position of hyperextension of the distal interphalangeal joint and flexion of the proximal interphalangeal joint is, on the whole, unsatisfactory because the splint is difficult to apply, it may need to be changed frequently, and it is sometimes complicated by pressure sores. 2. In many cases the deformity is still present after six weeks of adequate immobilisation, but gradual improvement from the contraction of fibrous tissue occurs for up to six months. Therefore an assessment of the results of any method of treatment should be made only after an interval of at least six months. 3. The subjective end results at the end of six months are satisfactory whether or not there has been efficient immobilisation in hyperextension. Few patients have any disability and only rarely is this sufficient to cause interference with normal activities. A high proportion of patients show slight persistent deformity and limitation of movement, and this is seemingly uninfluenced appreciably by the type or duration of treatment. 4. The only treatment necessary for most cases of mallet finger is the application of elastic adhesive strapping or a straight spatula splint in order to relieve the initial discomfort from the injury.