Spica Cast Research Articles

Comparison Between Static and Dynamic Spica Cast for Closed Reduction Cases of DDH: A Short-Term Follow-Up

Background: developmental dysplasia of the hip (DDH) is a typical childhood disease that, if left untreated, can lead to early-onset osteoarthritis. Closed reduction and spica casting are the first line of treatment for infants aged 6-18 months. Static and dynamic spica casts are the two primary treatment method used in practice, but the evidence is mixed as to which method provides the best outcomes. Methods: This prospective, randomized, controlled trial compared static and dynamic spica casting in 98 DDH patients from Kurdistan, Iraq. Patients were divided into dynamic and static groups. The hip was follow-up ed by using radiographic parameters such as the acetabular index and Tonnis grade. Treatment success was defined as a favorable hip outcome after one year. Results: There was no significant difference in treatment success between the groups, with 68% of patients in both groups achieving normal hip modification. However, the dynamic cast group had significantly better acetabular indices at 3, 6, and 12 months, and all of them were done under general anesthesia (GA), better hygiene, better caring and more comfortable parents with less cost. Conclusions: Static and dynamic spica casting have similar short-term clinical success rates for DDH, but dynamic casting produces better radiographic outcomes, especially in infants younger than 1. Longer-term studies are needed to determine possible radiographic improvement and whether dynamic type translate into better clinical outcomes since its more comfortable for parent, with less cost.

Comparative Study Between Single-limb Versus One-and-a-Half Hip Spica Cast in Fracture Femur in Young Children.

Femoral fractures account for ∼1% to 2% of all pediatric bone injuries and are a common occurrence in children. The conservative approach, employing either a single or one-and-a-half spica casts, has been traditionally favored, yielding satisfactory outcomes in select cases. This study aims to compare both procedures regarding functional and radiologic outcomes, complications, and parents' satisfaction. In this randomized controlled trial, we enrolled 84 pediatric patients, aged between 2 and 6 years, presenting with femoral fractures. Participants were randomly allocated into 2 groups; one receiving single-limb spica cast fixation (n=42) and the other receiving one-and-a-half spica cast fixation (n=42). We assessed postprocedural functional and radiologic outcomes. Other evaluations focused on parental ease in maintaining hygiene for the casted child, the child's mobility capabilities including standing and crawling, and the incidence of skin complications. No significant variance was observed between the 2 groups concerning the time to bone union, and the overall complication rates. Parental satisfaction was notably higher in the single-limb spica group, particularly regarding the ease of maintaining hygiene for the casted child and the child's mobility while encased in the cast (P<0.001). Furthermore, a significant correlation was identified between the one-and-a-half spica application and the increased occurrence of skin pressure ulcers (P<0.001). Both single-limb and one-and-a-half spica cast applications demonstrated comparable results in functional and radiologic outcomes, as well as in complication rates. However, parents favored the single-limb method due to its facilitation of a more manageable lifestyle for both the child and their parents. These considerations suggest that the single-limb hip spica cast fixation may be preferable in managing pediatric femoral fractures. Level II.

Does postoperative immobilization affect final alignment of pediatric femur fractures treated with flexible intramedullary nailing?

Flexible intramedullary nail (FIN) fixation of pediatric femur fractures is a popular method of fixation in children. Typical immobilization options include spica casting, long leg cast, knee immobilizers, or no immobilization and the decision to use each is usually left to surgeon preference. Our primary aim is to evaluate whether different postoperative immobilization status influences outcomes, namely radiographic alignment at the time of healing. A retrospective chart review was conducted of all patients with femur fractures treated with FIN fixation at a pediatric hospital from April 2018 through July 2022. Postoperative immobilization protocols were recorded and separated into two groups, patients who were immobilized (IMM) and patients who were not immobilized (NoIMM). Radiographs were evaluated for fracture alignment immediately following surgery and at the time of healing. Patients demographic, fracture, and postoperative clinical characteristics were compared between the two groups (NoIMM vs. IMM). A total of 41 patients were treated for diaphyseal femur fractures with FINs at our institution during the study period. No significant difference was observed in alignment at healing. Our results suggest that either immobilization or no immobilization after flexible intramedullary nailing of pediatric femoral shaft fractures are viable options when postoperative immobilization status is left to the surgeon's discretion.

ROTATIONAL AND ANGULAR MALALIGNMENT FOLLOWING TITANIUM ELASTIC NAILING SYSTEM AND HIP SPICA CAST FOR FEMUR DIAPHYSEAL FRACTURES IN FOUR- TO SIX-YEAR-OLD CHILDREN: A RANDOMIZED PROSPECTIVE STUDY

Femoral shaft fractures are fairly common injuries in paediatric age group. The treatment protocols are clear in patients of age less than 4 years and greater than 6 years. The real dilemma lies in the age group of 4–6 years. The aim of this study is to find whether a conservative line should be followed, or a more aggressive surgical intervention can provide significantly better results in these injuries.This study was conducted in a tertiary care hospital in Bhubaneswar, India from January 2020 to March 2021. A total of 40 patients with femur shaft fractures were included and randomly divided in two treatment groups. Group A were treated with a TENS nail while group B were treated with skin traction followed by spica cast. They were regularly followed up with clinical and radiological examination to look out for signs of healing and any complications. TENS was removed at 4–9 months’ time in all Group A patients.Group A patients had a statistically significant less hospital stay, immobilisation period, time to full weight bearing and radiological union. Rotational malunions were significantly lower in Group A (p-value 0.0379) while there was no statistically significant difference in angular malunion in coronal and sagittal plane at final follow up. Complications unique to group A were skin necrosis and infection.We conclude that TENS is better modality for treatment of shaft of femur fractures in patients of 4–6 years age as they significantly reduce the hospital stay, immobilization period and rotational malalignment.

The Efficacy of Thumb Spica Casting With or Without Corticosteroid Injection for De Quervain's Tenosynovitis.

Background and objective De Quervain's tenosynovitis is a highly prevalent wrist pathology primarily caused by chronic thumb overuse. Its management typically begins with conservative methods, progressing to corticosteroid injections or surgery if necessary. This study compares the efficacy of thumb spica casting plus corticosteroid injection versus casting alone for treating De Quervain's tenosynovitis. Materials and methods This quasi-experimental study was conducted at the Department of Orthopaedics, Khyber Teaching Hospital, Peshawar, and enrolled adults aged 18-50 who presented withDe Quervain's tenosynovitis. Patients were assigned to receive either corticosteroid injection plus thumb spica cast (Group A) or thumb spica cast alone (Group B). The primary outcome assessed the treatment success rate, while the secondary outcome evaluated the treatmenteffectiveness using visual analog scale(VAS) scores and Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH). Results Of the initial 65 patients enrolled, 61 completed the study. Group A demonstrated a significantly higher treatment success rate (83.9%, n=26) compared to Group B (40%, n=12) (p<0.001). Pain reduction, as measured by VAS, was markedly greater in Group A (8.4 ± 1.0 to 0.4 ± 0.5) than in Group B (9.0 ± 0.8to 5.9 ± 1.3) (p<0.001). Similarly, functional improvement assessed by QuickDASH favored Group A (89.6 ± 8.2 to 8.9 ± 6.8) over Group B (84.3 ± 10.1 to 49.1 ± 12.3) (p<0.001). No serious adverse effects related to treatments were noted in either of the groups. Conclusions This study supports the superiority of thumb spica casting along with local corticosteroid injection over casting alone for treating De Quervain's tenosynovitis. The combined approach led to significantly better pain relief and functional outcomes, highlighting its effectiveness as a treatment option despite the positive outcomes observed with casting alone.

Multi-Institutional Bladder Exstrophy Consortium After 8 Years: The Short- and Intermediate-Term Outcomes.

Bladder exstrophy (BE) poses challenges both during the surgical repair and throughout follow-up. In 2013, a multi-institutional BE consortium was initiated, which included utilization of unified surgical principles for the complete primary repair of exstrophy (CPRE), real-time coaching, ongoing video capture and review of video footage, prospective data collection, and routine patient data analysis, with the goal of optimizing the surgical procedure to minimize devastating complications such as glans ischemia and bladder dehiscence while maximizing the rate of volitional voiding with continence and long-term protection of the upper tracts. This study reports on our short-term complications and intermediate-term continence outcomes. A single prospective database for all patients undergoing surgery with a BE epispadias complex diagnosis at 3 institutions since February 2013 was used. For this study, data for children with a diagnosis of classic BE who underwent primary CPRE from February 2013 to February 2021 were collected. Data recorded included sex, age at CPRE, adjunct surgeries including ureteral reimplantations and hernia repairs at the time of CPRE, osteotomies, and immobilization techniques, and subsequent surgeries. Data on short-term postoperative outcomes, defined as those occurring within the first 90 days after surgery, were abstracted. In addition, intermediate-term outcomes were obtained for patients operated on between February 2013 and February 2017 to maintain a minimum follow-up of 4 years. Outcomes included upper tract dilation on renal and bladder ultrasound, presence of vesicoureteral reflux, cortical defects on nuclear scintigraphy, and continence status. Bladder emptying was assessed with respect to spontaneous voiding ability, need for clean intermittent catheterization, and duration of dry intervals. All operating room encounters that occurred subsequent to initial CPRE were recorded. CPRE was performed in 92 classic BE patients in the first 8 years of the collaboration (62 boys), including 46 (29 boys) during the first 4 years. In the complete cohort, the median (interquartile range) age at CPRE was 79 (50.3) days. Bilateral iliac osteotomies were performed in 89 (97%) patients (42 anterior and 47 posterior). Of those undergoing osteotomies 84 were immobilized in a spica cast (including the 3 patients who did not have an osteotomy), 6 in modified Bryant's traction, and 2 in external fixation with Buck's traction. Sixteen (17%) patients underwent bilateral ureteral reimplantations at the time of CPRE. Nineteen (21%) underwent hernia repair at the time of CPRE, 6 of which were associated with orchiopexy. Short-term complications within 90 days occurred in 31 (34%), and there were 13 subsequent surgeries within the first 90 days. Intermediate-term outcomes were available for 40 of the 46 patients, who have between 4 and 8 years of follow-up, at a median of 5.7 year old. Thirty-three patients void volitionally, with variable dry intervals. Cumulative efforts of prospective data collection have provided granular data for evaluation. Short-term outcomes demonstrate no devastating complications, that is, penile injury or bladder dehiscence, but there were other significant complications requiring further surgeries. Intermediate-term data show that boys in particular show encouraging spontaneous voiding and continence status post CPRE, while girls have required modification of the surgical technique over time to address concerns with urinary retention. Overall, 40% of children with at least 4 years of follow-up are voiding with dry intervals of > 1 hour.

Predicting neural activity of whole body cast shadow through object cast shadow in dynamic environments.

Shadows, as all other objects that surround us, are incorporated into the body and extend the body mediating perceptual information. The current study investigates the hypothesis according to which the perception of object shadows would predict the perception of body shadows. 38 participants (19 males and 19 females) aged 23 years on average were immersed into a virtual reality environment and instructed to perceive and indicate the coincidence or non coincidence between the movement of a ball shadow with regard to ball movement on the one hand, and between their body shadow and their body position in space on the other. Their brain activity was recording via a 32-channel EEG system, in which beta (13.5-30 Hz) oscillations were analyzed. A series of Multiple Regression Analysis (MRA) revealed that the beta dynamic oscillations patterns of the bilateral occipito-parieto-frontal pathway associated with the perception of ball shadow appeared to be a significant predictor of the increase in beta oscillations across frontal areas related to the body shadow perception and the decrease in beta oscillations across frontal areas connected to the decision making of the body shadow. Taken together, the findings suggest that inferential thinking ability relative to body shadow would be reliably predicted from object shadows and that the bilateral beta oscillatory modulations would be indicative of the formation of predictive neural frontal assemblies, which encode and infer body shadow neural representation, that is, a substitution of the physical body.

Orthopedic cast design and simulation: innovations for improved patient care

Orthopedic cast design and simulation: innovations for improved patient care

Is Immobilization Technique Associated With Postoperative Pubic Rami Diastasis Following Bladder Exstrophy Closure?

Pelvic osteotomies relieve tension of the bladder and fascial closures during bladder exstrophy repair. Multiple techniques for postoperative immobilization of the pelvis and lower extremities have been described. The primary aim of this study was to assess differences in short and long-term changes in pubic rami diastasis when comparing Bryant traction to spica cast immobilization. Secondary aims included a comparison of length of stay, skin-related complications, and urologic outcomes. We performed a single-institutional retrospective review of bladder exstrophy patients younger than 18 months of age who underwent posterior pelvic osteotomy and bladder exstrophy closure from April 2005 to April 2020. Short-term and long-term pubic rami diastasis were defined as postoperative measurements ≤6 months and ≥12 months, respectively. Secondary outcomes included length of stay, pressure ulcer, skin rash/abrasion, urethrocutaneous fistula, and bladder or fascial dehiscence rates. Multivariable logistic regression assessed for an association between immobilization type and degree of diastasis while controlling for age at the time of diastasis measurement and sex. Fifteen patients underwent Bryant traction and 36 patients underwent spica cast immobilization. In both the short-term and long-term, there was a greater reduction in pubic diastasis in the spica cast group ( P = 0.002 and P = 0.05, respectively). After adjustments, there were higher odds of having a greater reduction in pubic rami diastasis in both the short-term (odds ratio: 2.71, 95% CI: 1.52-4.86, P = 0.001) and long-term (odds ratio: 2.41, 95% CI: 1.00-5.80, P = 0.05). Length of stay was significantly higher in Bryant's traction group (26 vs 19 d, P < 0.001). Rates of pressure ulcers were higher in the Bryant traction group (26.7% vs 0%, P = 0.005). Rates of skin rash/abrasions, urethrocutaneous fistula, and bladder/fascial dehiscence did not differ. Spica cast immobilization is a safe and effective immobilization method. Compared with Bryant traction, spica cast immobilization was associated with a greater reduction in postoperative pubic diastasis both short and long-term, along with a shorter length of hospitalization and reduced rate of pressure ulcers. Level III-therapeutic study.

Arthroscopic debridement and reduction is an effective procedure for failed closed reduction in young children with developmental dislocation of the hip.

To assess the efficacy of arthroscopic debridement and reduction through two medial portals for the treatment of developmental dislocation of the hip (DDH) with failure of initial closed reduction and to explore key pathological structures obstructing reduction. Forty-eight children with 58 irreducible dislocated hips treated by arthroscopic reduction between January 2017 and December 2020 were retrospectively evaluated. Arthroscopic reduction was performed via two medial portals located in the superior and inferior adductor longus. All intra-articular obstacles were eliminated via arthroscopy, followed by manual reduction and spica cast immobilization. The surgical duration, extent of improvement in the safe zone, and extent of secondary surgical treatment were noted. All the children were followed up for > 24months. Hip function and radiographic outcomes were evaluated. All 58 hips showed safe zone improvement and concentric reduction after arthroscopic debridement. Hypertrophic ligamentum teres and thickened pulvinars were detected and resected in all hips. Constrictive capsules preventing reduction were observed in 15 hips, which needed to be further released. No inverted labrum was observed. Secondary surgery was performed in four hips with redislocation and seven hips with subluxation during follow-up. The remaining 47 hips (81.03%) maintained their reduction at the last follow-up. Excellent and good clinical outcomes were achieved in 95.74% of patients according to McKay's criteria. Two hips, three hips, and one hip were diagnosed with grade I, II, and III osteonecrosis of the femoral head, respectively. This study demonstrated that arthroscopic debridement and reduction is a safe and feasible choice for treating irreducible DDH.

Transinguinal Ultrasound versus Magnetic Resonance in Spica Cast after Closed Reduction of Unstable Hips in DDH.

During the treatment of unstable hips in developmental hip dysplasia (DDH), the position of the femoral head must be assessed in spica cast (SC) after reduction. A transinguinal sonographic technique (TIT) to the hip joint has been previously described in the literature. The aim of this study is to evaluate the agreement among TIT and MR to identify hip reduction. From 2016 to 2019, 14 consecutive newborns (10 female, 4 males) with a mean age of 2.97 ± 1.29 months were treated with closed reduction in SC. A total of 4/14 children had bilateral unstable DDH. Out of 18 hips, there were 8 hips type IV and 10 hips type IIIA, according to Graf. SC were changed monthly and hips were checked both with TIT and MR, looking for persistent dislocation. Overall, a mean of 2.61 SC/hip (mode = 3) was accomplished, accounting for 47 procedures, with 46 reduced hips and 1 dislocated hip: TIT and MR always agreed on the same result (47/47; Cohen k = 1, CI95 1.00 to 1.00). The inguinal ultrasound technique described by van Douveren showed perfect agreement with MR and might be considered a reliable alternative to check the position of the femoral head during the conservative treatment of hip dysplasia in spica cast.

Follow-up Value of Hip Medial Ultrasound in Infants and Children With Developmental Dysplasia of the Hip Treated With Reduction and Spica Casting.

Closed or open reduction and spica casting are common treatments for children aged 6 to 18 months, as well as infants aged 0 to 6 months whose harness treatment for developmental dysplasia of the hip (DDH) was unsuccessful. The study aimed to quantify the distance between the femoral head and the acetabulum after closed or open reduction and evaluate the dynamic docking progression of the femoral head using serial hip medical ultrasound. We retrospectively reviewed the medical records and hip medial ultrasound images of a consecutive series of patients with DDH who underwent spica casting after reduction and compared images obtained immediately after reduction and at follow-up. The first cast (stage I) was maintained for 2 to 3 months and scheduled for outpatient repeat ultrasound in 4 to 8 weeks. Then the second cast was placed (stage II), lasting for another 2 to 3 months. The triradiate cartilage-femoral head distance (TFD) was measured in the acetabulum coronal mid-sectional plane. The Wilcoxon signed-rank test was used to compare the TFD values. This study included 49 patients. All patients underwent hip medial ultrasound 0 to 3 days after stage I (time 1) and 4 to 8 weeks (time 2) postoperatively, with 24 patients reviewed again 0 to 7 days after stage II. The TFD values in time 1 and time 2 were 6.0 (5.0, 9.0) mm and 5.0 (3.6, 7.0) mm, respectively. There was a statistically significant difference between times 1 and 2 regarding TFD values in 49 close-reduction hips (6.0 vs 5.0mm, P < 0.001). Similar findings were also observed in 13 open-reduction hips (6.0 vs 5.0mm, P = 0.023). Hip medial ultrasonography during the period of cast immobilization after reduction in children with DDH can objectively and quantitatively show the dynamic change of the distance between the femoral head and the acetabulum, and can be used to assess reduction of the hip and progression of femoral head docking. Level II-prognostic study.

Postoperative Cast Immobilization Might Be Unnecessary after Pelvic Osteotomy for Children with Developmental Hip Dysplasia: A Systematic Review

Background: Developmental dysplasia of the hip (DDH) is a common disorder of atypical hip development. Pelvic osteotomy (e.g., according to Salter, Pemberton or Dega) may be indicated for children with DDH at walking age. The most popular postoperative treatment is a hip spica cast. Alternative postoperative options include abduction braces and non-weightbearing protocols combined with physical therapy. The aim of this systematic review was to determine the most effective form of postoperative treatment after unilateral pelvic osteotomy in children with DDH in terms of clinical and radiological outcomes and complications. Methods: A systematic review was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines and registered in the international prospective register of systematic reviews. Articles were selected from PubMed, Embase and Cochrane databases. The quality of all (non-)randomized included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Results: The search strategy yielded 3524 articles. Fourteen articles with 367 total hips were included in this review. A total of 312 hips were treated with spica casts, 49 with abduction braces and 6 with non-weightbearing protocols. The quality of evidence was moderate (MINORS, 3–12 points). All types of postoperative treatments had good clinical outcomes overall, without secondary displacement of the osteotomy. Clinical outcomes for spica casts were reported according to McKay’s criteria in 135 hips, with 123 excellent and 12 good results. Clinical outcomes for abduction braces showed satisfaction for all parents (49 of 49). The radiological outcome was overall well preserved with any postoperative treatment. There was a higher complication rate with the use of hip spica casts, including avascular necrosis, pain complaints and superficial infections. Conclusion: This systematic review showed no benefit of postoperative spica casts compared with abduction braces and avoidance of weightbearing after simple pelvic osteotomy for residual DDH.

The incidence, trends, and costs of treatment of femoral shaft fractures among Finnish children aged 2-12 years between 1998 and 2016.

The purpose of this study was to determine the incidence and trends of both hip spica casting and elastic stable intramedullary nailing in children aged 2-12 years who sustained femoral diaphyseal fracture between 1998 and 2016 in Finland. We also evaluated the actual hospital costs of both treatment methods as well as calculating the length of hospital stay. This study included all 2- to 12-year-old children with femoral diaphyseal fracture who were treated in Finland between 1998 and 2016. Data were collected from the National Hospital Discharge Register of Finland. Children were classified by age into five groups. The annual incidences per 100,000 persons were calculated using annual mid-year population census data obtained from Statistics Finland. Data on the annual actual daily hospital costs were collected from the Finnish Institute for Health and Welfare. In total, 1064 patients aged 2-12 years who had sustained femoral diaphyseal fracture were treated with elastic stable intramedullary nailing or hip spica casting between 1998 and 2016. In children aged 4-5 years, the incidence of elastic stable intramedullary nailing increased during the study period from 5.4 per 100,000 persons in 1998 to 8.1 per 100,000 persons in 2016. The length of hospitalization in patients treated with elastic stable intramedullary nailing was shorter and, therefore, the total costs of hospital treatment were lower than in those children treated with hip spica cast. level III.

Design of gating systems for combined mould casting of thin-walled body products made of light alloys

The basis of calculation procedure for design of gating systems are considered. These methods provide filling with a melt from light alloys of metal mould with sand rods, which form the internal surfaces of thin-walled and stretched walls of body castings. Approval of the developed program based on the presented calculation procedure is carried out using CSoft Development "PoligonSoft".

Mean independent walking time for children with Femoral Shaft fractures using Titanium Elastic Nailing VS Hip Spica Cast treatment

Objective: To investigate the mean amount of time it took children with Hip spica casts versus titanium elastic nailing for the treatment of femoral shaft fractures to walk independently. Design: Retrospective cohort study. Place and Duration of Study: From 1st September 2021 to 31st September 2022 at Department of Orthopedic Surgery, Benazir Bhutto Hospital, Rawalpindi. Methodology: A study on 60 pediatric patients suffering from femoral shaft fractures of both genders aged four till eight years of age using convenient sampling. Results: The patients' average age was 5.58 ±1.24 years. There were 39 (65.0%) male and 21 (35.0%) female patients in the study group with a male to female ratio of 1.9:1. Compared to hip spica casts, children treated with titanium elastic nails had a considerably shorter mean time to walk independently (5.60±1.28 weeks vs. 8.93±1.98 weeks; p-Value = 0.001). Numerous patient subgroups based on age, gender, and weight showed similar statistically significant variations among the cohorts. Conclusion: In terms of considerably reducing the mean time to walk freely, this study found that titanium elastic nailing is preferable to the traditional method of hip spice cast. Future orthopaedic practice should prioritise the titanium elastic nails to be used in the fractures of this kind because to their minimally invasive nature, improved patient hygiene, and aesthetic appearance. Keywords: Shaft of femur, Fracture, Elastic Nailing, Hip Spica Cast, Walking time. How to Cite This: Shahid R, Haider M, Talib A, Butt NS, Mirza AN, Fazal F. Mean independent walking time for Children with Femoral Shaft fractures using Titanium Elastic Nailing VS Hip Spica Cast Treatment. Isra Med J. 2023; 15(2): 47-50. DOI: https://doi.org/10.55282/imj.oa1382

Assessing Methylprednisolone Acetate Injection Adjunct to Casting Versus Casting Alone in De-Quervain’s Tenosynovitis Management: A Comparative Study

Background: De Quervain's tenosynovitis is a prevalent source of wrist pain that results in impaired function of the affected hand. Objective: To assess the efficacy of methylprednisolone acetate injection adjunct to casting versus casting alone in de-quervain’s tenosynovitis management. Study Design: Randomized Controlled Trail. Settings: Department of Orthopedic Nishtar Hospital, Multan Pakistan. Duration: From Nov 2022 to April 2023. Methods: Our study enrolled patients of both genders, aged between 30 to 50 years, who presented with De Quervain’s disease, diagnosed based on operational definitions. Subsequently, these patients were randomly allocated into two groups using a lottery approach. In our study, we divided participants into two groups, Group A: Consisting of 40 cases, participants received treatment with a Thumb Spica cast along with Methylprednisolone acetate injection. Group B: Also comprising 40 cases, participants were treated solely with a Thumb Spica cast without additional medication. Data collected was analyzed using SPSS version 22. Results: The patients' ages ranged from 30 to 50 years, with a mean age of 37.16±5.15 years. The study group comprised 23 male patients, representing 28.8% of the total, and 57 female patients, representing 71.2% of the total. The male to female ratio was 1:2.5. The initial pain VAS score ranged from 1 to 10, with a mean of 5.25±2.40. The rate of successful therapy was markedly greater in patients who had a thumb spica cast combined with an injection of methylprednisolone acetate (85.0% vs. 37.5%; p=0.000) compared to those who only received a thumb spica cast. Conclusion: Patients treated with thumb spica cast along with methylprednisolone acetate injection had a considerably greater success rate of 85.0% compared to 37.5% in patients treatment with thumb spica cast alone (p=0.000). This discrepancy was notable in all age groups, genders, and baseline pain severity categories.

Reduced Isocyanate Release Using a Waterproof, Resin-Based Cast Alternative Relative to Fiberglass Casts.

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.

Does brace treatment following closed reduction of developmental dysplasia of the hip improve acetabular coverage?

Abduction bracing is commonly used to treat developmental dysplasia of the hip (DDH) following closed reduction and spica casting, with little evidence to support or refute this practice. The purpose of this study was to determine the efficacy of abduction bracing after closed reduction in improving acetabular index (AI) and reducing secondary surgery for residual hip dysplasia. We performed a retrospective review of patients treated with closed reduction for DDH at a single tertiary referral centre. Demographic data were obtained including severity of dislocation based on the International Hip Dysplasia Institute (IHDI) classification, age at reduction, and casting duration. Patients were prescribed no abduction bracing, part-time, or full-time wear post-reduction and casting. AI measurements were obtained immediately upon cast removal and from two- and four-year follow-up radiographs. A total of 243 hips underwent closed reduction and 82% (199/243) were treated with abduction bracing. There was no difference between those treated with or without bracing with regard to sex, age at reduction, severity of dislocation, spica duration, or immediate post-casting AI (all p > 0.05). There was no difference in hips treated with or without abduction brace with regard to AI at two years post-reduction (32.4° (SD 5.3°) vs 30.9° (SD 4.6°), respectively; p = 0.099) or at four years post-reduction (26.4° (SD 5.2°) vs 25.4° (SD 5.1°), respectively; p = 0.231). Multivariate analysis revealed only IHDI grade predicted AI at two years post-reduction (p = 0.004). There was no difference in overall rate of secondary surgery for residual dysplasia between hips treated with or without bracing (32% vs 39%, respectively; p = 0.372). However, there was an increased risk of early secondary surgery (< two years post-reduction) in the non-braced group (11.4% vs 2.5%; p = 0.019). Abduction bracing following closed reduction for DDH treatment is not associated with decreased residual dysplasia at two or four years post-reduction but may reduce rates of early secondary surgery. A prospective study is indicated to provide more definitive recommendations.

Transgluteal Ultrasonography in Spica Cast in the Post-reduction Assessment of Hip Developmental Dysplasia

Concentric circle reduction is one of the outcomes after reduction of developmental dysplasia of the hip (DDH). Radiography and magnetic resonance imaging (MRI) are used to confirm the reduction results. In this study, we evaluated the reduction results of the coronal section of the hip using transgluteal ultrasonography. We enrolled 46 children admitted to our hospital for closed or open reduction plaster fixation of DDH between January 2021 and December 2022. Thirty-eight patients had unilateral DDH, and eight patients had bilateral DDH. Transgluteal ultrasonography, radiography and MRI were done on the patients during the 7 d after reduction, and the results were interpreted by different radiologists. The covering of the femoral head and the distance between the medial margin of the femoral head and the acetabulum (HSD) were measured after calculating the maximum coronal surface of the iliac bone. MRI is regarded as the gold standard for determining hip reduction or dislocation. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ultrasound and radiography were determined and compared. The sensitivity, specificity, PPV and NPV of transgluteal ultrasonography were 100% (confidence interval [CI]: 69.2%-100%), 97.7% (CI: 88%-99.9%), 90.9% (CI: 59%-98.6%) and 100%, respectively, higher than those of radiography, which were 50% (CI: 18.7%-81.3%), 86.4% (CI: 72.6%-94.8%), 45.5% (CI: 24%-68.7%) and 88.4% (CI: 80.2%-93.5%), respectively. Ultrasonography had a higher sensitivity (100% vs. 50%, p < 0.01) and positive predictive rate (90.9% vs. 45.5%, p < 0.01) than radiography. Ultrasonography revealed that a distance between the head and socket (HSD) >8 mm indicated a strong suspicion for a poor reduction. Transgluteal coronal ultrasound scan with semiquantitative assessment of acetabular femoral head coverage and measurement of HSD can effectively monitor the reduction relationship between the two in children after DDH reduction.