Cast Removal Research Articles

Time course of changes in corticospinal excitability after short-term forearm/hand immobilization.

The short-term joint immobilization induces a decrease of corticospinal excitability; however, detailed time course of the immobilization-induced central nervous system changes and their extent have not yet been clarified. To evaluate the time course of changes in corticospinal excitability during forearm/hand immobilization for 24 h and investigate the effect on muscle strength, adhesive casting tape was used to immobilize the nondominant forearm/hand. The amplitude of the motor-evoked potential of the flexor pollicis brevis muscle induced by transcranial magnetic stimulation was measured during immobilization and after cast removal. The muscle strength was evaluated after the termination of immobilization. The resting motor-evoked potential recorded from flexor pollicis brevis muscle showed a significant decrease 3 h after initiation of immobilization and gradually declined further until the end of immobilization. It then increased over 2 h after cast removal, but was still significantly below baseline. However, no significant difference from baseline was observed at 3 h. Both pinch power and integrated electromyogram were significantly reduced by immobilization, and then gradually returned to baseline after the cast was removed. These results indicate that short-term forearm/hand immobilization rapidly reduces corticospinal excitability, and this change is rapidly reversed after resumption of movement.

Sole vibration improves locomotion through the recovery of joint movements in a mouse cast model.

We investigated the effects of a vibratory stimulus on the plantar surface of the hind limb for motor, sensory, and locomotive function using a mouse cast model. The right knee joint of C57BL/6 male mice (7 weeks, 20 g, n = 31) was flexed with aluminum splint and tape for 6 weeks. These mice were randomly divided into 2 groups (control group, n = 11 and vibration group, n = 12). The mice in the vibration group received vibration on the sole of the ankle for 15 minutes per day, 5 days per week. After the knee joint cast was removed, we measured the range of motion (ROM) of both knee and ankle joints and the sensory threshold of the sole. Further, both walking and swimming movements were analyzed with a digital video. The sole vibration did not affect the passive ROM of the knee joint and sensory threshold after cast removal. However, it increased the ankle dorsiflexion range and improved free walking, swimming, and active movement of the knee joint. In conclusion, we show that the vibration recovered both walking and swimming movements, which resulted from improvements in both the passive ankle dorsiflexion and active knee movement.

Quengel Casting for the Management of Pediatric Knee Flexion Contractures: A 26-Year Single Institution Experience.

Quengel casting was introduced in 1922 for nonsurgical treatment of knee flexion contractures (KFC) associated with hemophilic arthropathy. It consists of an extension-desubluxation hinge fixed to a cast allowing for gradual correction of a flexion deformity while preventing posterior tibial subluxation. The purpose of this study is to report 1 center's experience with this technique for the treatment of pediatric KFC. A retrospective review was conducted over a 26-year period. All patients with KFC treated with Quengel casting were included. Demographic data, associated medical conditions, adjunctive soft tissue releases, complications, and the need for late surgical intervention were recorded. Tibiofemoral angle measurements in maximal extension were recorded at initiation and termination of casting, 1-year follow-up, and final follow-up. Success was defined as no symptomatic recurrence of KFC or need for subsequent surgery. Eighteen patients (26 knees) were treated for KFC with Quengel casting. Average age at initiation of casting was 8.1 years with average follow-up of 59.9 months. Fifteen knees (58%) underwent soft tissue releases before casting. An average of 1.5 casts per knee were applied over an average of 23.9 days. Average KFC before casting was 50.6 degrees (range, 15 to 100 degrees) which improved to 5.96 degrees (0 to 40 degrees) at cast removal (P<0.00001). Sixteen patients (22 knees) had 1-year follow-up or failed casting before 1 year. Of these, 11 knees (50%) had a successful outcome. Residual KFC of those treated successfully was 6.8 degrees (range, 0 to 30 degrees) at 1 year and 8.2 degrees (range, 0 to 30 degrees) at final follow-up, averaging 71.4 months (P=0.81). Of the 11 knees deemed failures, all had recurrence of deformity within an average of 1 year from cast removal. Surgical release before Quengel casting did not improve the chances for success (P=0.09). Quengel casting can improve pediatric KFC an average of 44.2 degrees with minimal complications. Although 50% of treated patients will demonstrate significant recurrence or need later surgery, the majority of those treated successfully have durable results at intermediate term follow-up. Level IV-therapeutic study.

The Use of Multimedia as a Distraction to Reduce Anxiety Reaction among Paediatric Patients During Cast Removal at Hospital Tengku Ampuan Afzan

Introduction: Cast removal procedures can be a daunting experience for children giving rise to anxiety. The objective of this study is to measure the level of anxiety in children during cast removal at Hospital Tengku Ampuan Afzan. Materials and method: An experimental study was conducted with a sample of 40 paediatric patients with upper limb fractures and cast removal were randomly assigned into two groups: with multimedia distraction or without (control). Patient's heart rate was measured using a pulse oximeter before, during and after cast removal. Results: A total number of 20 children were randomized to multimedia distraction and another 20 to control with no distractions. The mean rise in heart rate between preprocedure and during procedure 5.3 beats/min in multimedia distraction group and 16.35 beats/min in control group (P = 0.001). The mean difference in heart rate between the pre-procedure and during the procedure was 5.64 beats/min in the multimedia distraction group and 13.13 beats/ min in the control group (P = 0.05). Conclusion: There was significant decrease in heart rate during cast removal with multimedia distraction. Therefore multimedia distraction is a useful tool in reducing anxiety among children during cast removal.

Improved Safety and Cost Savings from Reductions in Cast-Saw Burns After Simulation-Based Education for Orthopaedic Surgery Residents.

The purpose of this investigation was to characterize the clinical efficacy and cost-effectiveness of simulation training aimed at reducing cast-saw injuries. Third-year orthopaedic residents underwent simulation-based instruction on distal radial fracture reduction, casting, and cast removal using an oscillating saw. The analysis compared incidences of cast-saw injuries and associated costs before and after the implementation of the simulation curriculum. Actual and potential costs associated with cast-saw injuries included wound care, extra clinical visits, and potential total payment (indemnity and expense payments). Curriculum costs were calculated through time-derived, activity-based accounting methods. The researchers compared the costs of cast-saw injuries and the simulation curriculum to determine overall savings and return on investment. In the 2.5 years prior to simulation, cast-saw injuries occurred in approximately 4.3 per 100 casts cut by orthopaedic residents. For the 2.5-year period post-simulation, the injury rate decreased significantly to approximately 0.7 per 100 casts cut (p = 0.002). The total cost to implement the casting simulation was $2,465.31 per 6-month resident rotation. On the basis of historical data related to cast-saw burns (n = 6), total payments ranged from $2,995 to $25,000 per claim. The anticipated savings from averted cast-saw injuries and associated medicolegal payments in the 2.5 years post-simulation was $27,131, representing an 11-to-1 return on investment. Simulation-based training for orthopaedic surgical residents was effective in reducing cast-saw injuries and had a high theoretical return on investment. These results support further investment in simulation-based training as cost-effective means of improving patient safety and clinical outcomes. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Figure 8 (Heel open) short leg cast

Category: Ankle, Trauma Introduction/Purpose: To report the results of applying heel open (figure 8) short leg cast on foot &amp; ankle trauma or disease patients requiring short leg casts. Methods: 380 patients who were confirmed and treated by diagnosed of foot &amp; ankle trauma or diseases were included between November 2014 and July 2016. Comprised of 222 males and 158 females, their mean age was 46 years old. The bottom of the figure 8 cast covered the metatarsal head to half portion of the medial longitudinal arch, while leg portion covering consisted from the prominence of the both malleolus to halfway of the lower leg, resulting in complete exposure of the heel and distal portion of the achilles tendon. After application of the figure 8 cast, changes in the ROM in active ankle dorsiflexion &amp; plantarflexion, passive foot inversion &amp; eversion, and foot internal &amp; external rotation were measured. Results: In all cases, measurements of active ankle dorsiflexion &amp; plantarflexion was less than 5 degrees, measurements of passive foot inversion &amp; eversion was less than 5 degrees, foot internal &amp; external rotation was less than 0 degrees, and were stably held without skin or soft tissue injury until cast removal. Notable were 22 cases of foot &amp; ankle fractures treated with conservative therapy with figure 8 short leg cast resulting in bone union and stabilization without surgery. VAS discomfort score was an average of 2.6 (0~5) and figure 8 short leg cast was selected in all cases requiring a short leg cast. Conclusion: The use of figure 8 short leg cast in patients of foot &amp; ankle trauma and diseases requiring short leg cast provides safety and prevention of skin necrosis and pressure sores from open heels while providing high patient satisfaction in daily life, such as heel touch. We believe that figure 8 short leg cast could replace the traditional short leg cast, if the safety of the figure 8 cast could be proven through long-term follow up study with various patient and cases.

Serial Mehta Cast Utilization in Infantile Idiopathic Scoliosis: Evaluation of Radiographic Predictors

Mehta cast utilization has gained a considerable momentum as a nonoperative treatment modality for the initial management of infantile idiopathic scoliosis (IIS). Despite its acceptance, there is paucity of data that characterize the radiographic parameters associated with Mehta casting and the factors correlated with a sustained curve correction. A retrospective review of IIS patients who underwent Mehta casting was performed with a mean 2-year follow-up. X-rays were evaluated at each visit for the Cobb angle, focal deformity, rib-vertebral angle difference, and height of concavity and convexity of the apical 3 vertebrae. Concave-to-convex height ratios were calculated and tracked for each patient. Radiographic parameters were compared from precasting to after final casting, and from final casting to most recent follow-up. A total of 45 patients were identified, of whom 18 (40%) were male and 27 (60%) were female, with a mean age of 18.8±9.5 months at first casting and a mean follow-up of 37.7±19.7 months. Following final casting, the mean Cobb angle (25.6 vs. 52.7 degrees), focal deformity (17.4 vs. 30.5 degrees), rib-vertebral angle difference (18 vs. 32.3 degrees), and the concave-to-convex height ratios improved relative to precast parameters, respectively (P<0.001). At final follow-up, mean Cobb angle (16.2 vs. 25.6 degrees) and concave-to-convex height ratios progressively improved when compared with final cast measurements, respectively (P<0.001). Five (11%) patients did not demonstrate sustained curve correction at final follow-up, whereas 4 (9%) required growing-rod placement. Lastly, the regression analysis demonstrated improvements in the focal deformity (17.4 vs. 30.5) and the concave-to-convex height ratios of the +1 and -1 apical vertebrae from the precast to last cast periods (P<0.001). These findings were correlated with sustained Cobb angle correction from cast removal to the most recent follow-up. Radiographic parameters associated with control of progressive deformity for IIS include improvements in focal deformity and concave-to-convex height ratios for +1 and -1 apical vertebrae after final casting. Mehta casting is an effective treatment for symptomatic IIS and continues to provide IIS patients with significant curve correction. Level IV.

Noise Reduction to Reduce Patient Anxiety During Cast Removal: Can We Decrease Patient Anxiety With Cast Removal by Wearing Noise Reduction Headphones During Cast Saw Use?

Noise reduction headphones decrease the sound during cast removal. Their effectiveness in decreasing anxiety has not been studied. Compare pediatric patients' anxiety levels during cast removal with and without utilization of noise reduction headphones combined with use of a personal electronic device. Quality improvement project. Patients randomly assigned to noise reduction headphone group or standard care group during cast removal. Faces, Legs, Activity, Cry, and Consolability Scale and heart rate were evaluated prior to, during, and after cast removal. Data were compared across groups. Fifty patients were included; 25 per group. No difference detected between the 2 groups in Faces, Legs, Activity, Cry, and Consolability Scale score prior to (p = .05) or after cast removal (p = .30). During cast removal, the headphone group had lower FLACC Scale scores (p = .03). Baseline heart rate was lower in the headphone group prior to (p = .02) and after (p = .005) cast removal with no difference during cast removal (p = .24). Utilizing noise reduction headphones and a personal electronic device during the cast removal process decreases patient anxiety.

A novel use of QR code stickers after orthopaedic cast application.

INTRODUCTION We present a novel solution to ensure that information and contact details are always available to patients while in cast. An information sticker containing both telephone numbers and a Quick Response (QR) code is applied to the cast. When scanned with a smartphone, the QR code loads the plaster team's webpage. This contains information and videos about cast care, complications and enhancing recovery. METHODS A sticker was designed and applied to all synthetic casts fitted in our fracture clinic. On cast removal, patients completed a questionnaire about the sticker. A total of 101 patients were surveyed between November 2015 and February 2016. The questionnaire comprised ten binary choice questions. RESULTS The vast majority (97%) of patients had the sticker still on their cast when they returned to clinic for cast removal. Eighty-four per cent of all patients felt reassured by the presence of the QR code sticker. Nine per cent used the contact details on the cast to seek advice. Over half (56%) had a smartphone and a third (33%) of these scanned the QR code. Of those who scanned the code, 95% found the information useful. CONCLUSIONS This study indicates that use of a QR code reassures patients and is an effective tool in the proactive management of potential cast problems. The QR code sticker is now applied to all casts across our trust. In line with NHS England's Five Year Forward View calling for enhanced use of smartphone technology, our trust is continuing to expand its portfolio of patient information accessible via QR codes. Other branches of medicine may benefit from incorporating QR codes as portals to access such information.

Management of isolated shaft femur fractures by traction and single-leg spica cast in children

Background: Objective of the study was to find out the advantages of traction and single-leg spica cast in treatment of isolated femoral shaft fracture in children. Study design was Descriptive and place of the study was Darbhanga Medical College and hospital, Laheriasarai, Darbhanga, Bihar, India.Methods: 24 patients, age below 10 years, with a mean age of 5.37 years range with closed isolated femoral shaft fractures were included in the Study. Patients having compound fractures and those with associated injuries were excluded from the study. Spica cast was applied under sedation after preliminary skin traction, however immediate spica was given in children less than 2 year and those who had less than 2 cm shortening on telescopy. Follow up was done in OPD after 1,4,8,12,24 weeks with check x-rays taken at every visit.Results: 24 children were included in the study, with a mean age of 5.37 years range (2 months to 10 years). Average duration of skin traction was 14.8 days range (0-21) days. Average duration of hospital stay was 16 days range (2-22) days. Average time for fracture union was 7.4 weeks range (4-12) weeks. At final follow-up, 2 patient had Limb -Length Discrepancy (LLD) of 1.5 cm, 2 had LLD of 1 cm, 4 had LLD of 0.5cm, while 18 children had no LLD. None of the patients had short legged gait. None of the patients needed cast removal for any cast related complication.Conclusions: Traction followed by spica cast is a safe and effective method for closed fracture shaft of femur with very low risk of complication and can be done in children in less than 10 years of age.

Ankle Range of Motion After Posterior Subtalar and Ankle Capsulotomy for Relapsed Equinus in Idiopathic Clubfoot.

Posterior capsulotomy can correct residual clubfoot deformity, but has been associated with ankle stiffness. The purpose of this study was to evaluate clinical ankle range of motion (ROM) following posterior capsulotomy immediately postsurgery and during long-term follow-up. A retrospective clinical and radiographic review of 257 patients (398 feet) was performed to evaluate all patients who required a posterior capsulotomy as part of their clubfoot management. Twenty feet (16 patients) were identified with a mean age of 73.3±37.7 months and mean Pirani score of 5.2±0.8 points. Following capsulotomy, a long-leg cast was placed and maintained for a mean of 26 days (range, 21 to 35 d). At cast removal, parents were trained and instructed to immediately begin home physiotherapy. The capsulotomy cohort was age and sex matched to a cohort treated exclusively with the Ponseti method for comparison. Children in the comparison cohort had a mean Pirani score of 5.7±0.8 points. The mean dorsiflexion in the capsulotomy cohort significantly increased comparing the preoperative to the immediate postoperative ROM (from -6.5 to +9.7 degrees). No significant reduction in this gain was observed at latest follow-up (to +8.3 degrees). No significant difference in the plantar-flexion angle was found. Radiographically, a significant improvement in the lateral anterior tibial-calcaneal angle angles was found (P<0.05). If utilizing our protocol for early mobilization, limited use of capsulotomy to treat relapsed clubfoot does not necessarily reduce ankle ROM. Our protocol of placing the feet in casts for a shorter duration of time and providing early physiotherapy helps maintain ankle ROM after a posterior capsulotomy. Level III-therapeutic study.

Early application of the Ponseti casting technique for clubfoot correction in sick infants at the neonatal intensive care unit.

The treatment of congenital clubfoot has been changing rapidly since the mid-1990s with the worldwide use of the Ponseti method for serial casting and limited operative interventions. This method was first applied for isolated clubfeet and later on for other types of clubfoot (teratologic, residual, and neurogenic). Premature babies sustaining clubfoot commonly suffer from additional congenital and acquired medical problems. These may postpone clubfoot management until urgent issues are resolved. The current study describes early initiation of treatment of clubfoot in premature babies at the neonatal intensive care unit (NICU) and their outcomes. The study group included all babies diagnosed with clubfoot and managed in the NICU (for any etiology) between 2006 and 2012. Management was based on the Ponseti protocol for serial casting. We also report on neonates who died in the NICU before or during treatment. We specifically describe adverse events of early casting and situations necessitating removal of casts or termination of treatment. We diagnosed and treated 20 neonates with clubfoot (four females and 16 males, 10 bilateral cases). Gestational age ranged from 27 weeks to term. Eight were identified with clubfoot by prenatal sonographic survey and 10 were diagnosed with a defined syndrome. Seven had respiratory support, including one with a chest drain (50%). Length of stay in the NICU ranged from 3 to 90 days. Four neonates died while in the NICU (all syndromatic). In the remaining 16 cases, treatment began as early as medically possible. The first cast was applied within the first week of life in 14 cases. A total of 75 casts were applied during the study period. Three casts (4%) were removed because of leg edema or a need for venous access. Casts were routinely replaced every 4-7 days. Achilles tenotomies were performed in the NICU for babies achieving satisfactory correction. At last follow-up, 10 children were independent walkers and six were nonambulatory; all showed successful correction of clubfeet. The results of this study show that in most cases, clubfoot treatment is feasible and effective within the first week of life. Instances necessitating immediate cast removal are highlighted. Although while facing acute life-threatening medical problems, the treatment of clubfoot may not be considered a priority, most neonates will grow up into independent individuals; thus, every effort should be made to initiate the best clubfoot management with minimal delay.

Assessment of Ponseti Technique for Clubfoot

Abstract Introduction Clubfoot is a really complicated deformity of the foot. There are 4 components to this deformity which are forefoot varus, adduction, cavus and equinus. The main goal of the treatment is the attainment of a supple plantigrade foot which is cosmetically and functionally acceptable. This study has been done with the aim to present with the authors experience of managing clubfoot using ponseti. Material & Methods This prospective study included 100 children with 137 club feet from January 2015 to December 2016. All children below the age of 2 years with congenital talipes equino-varus (CTEV) were included in this study. The severity of the deformity was assessed with the help of the Pirani's score and clinical evaluation of the foot was taken and noted. In all the cases the Ponseti method was used for the management. After cast removal the foot was kept in a foot abduction brace with the corrected foot kept in a foot abduction brace for 23 hours in a day and this was decreased to night time wearing after 3 months and the parents were advised to continue wearing it till the age of 5 years. All the observations were done by a single observer to prevent any inter-observer variation. Results Out of 100 patients 63 were unilateral clubfoot and 37 were bilateral cases of clubfoot. The mean number of casts was found to be 7.56 (4–9). There was recurrence seen in 7 feet which had to be managed with 2–3 serial manipulations and casting and these resolved. Conclusion Ponseti technique is a very useful method of management of CTEV.

Biochemical and Pharmacological Characterization of a Mice Model of Complex Regional Pain Syndrome.

Complex regional pain syndrome is a challenging disease to treat. Recently, a mouse fracture model of complex regional pain syndrome has been developed that has many signs of the clinical syndrome. However, many aspects of the sensory neuron biochemistry and behavioral and pharmacological characterization of this model remain to be clarified. Mice were randomly assigned to fracture/cast or control (naive) groups. Fracture/cast mice underwent a closed distal tibia facture, with hindlimb wrapped in casting tape for 3 weeks. After cast removal, mice were tested for mechanical allodynia, burrowing behavior, and motor ability over a 12-week period. Protein immunohistochemistry was performed for substance P, calcitonin gene-related peptide, tropomyosin receptor kinase A, nerve growth factor, Nav1.7, and transient receptor potential cation-channel V1, colocalized in neurons, in the ipsilateral lumbar dorsal root ganglia (DRGs). Analgesic drugs were tested for pain-relieving efficacy. Mechanical allodynia was greater in the ipsilateral hindpaw (P = 0.0002) in the fracture/cast group versus the control group, over the 3- to 12-week period. The amount of burrowing material removed was decreased (P = 0.0026), and there were deficits in spontaneous motor-rearing behavior (P = 0.018). Immunostaining of substance P, calcitonin gene-related peptide, Trk A receptor, nerve growth factor, Nav1.7, and transient receptor potential cation-channel V1 all demonstrated up-regulation in the DRGs of fracture mice versus controls (all P < 0.05). Morphine, pregabalin, ketamine, acetaminophen, and dexamethasone transiently increased force withdrawal thresholds on the ipsilateral (fracture) side and improved burrowing activity after injection (all P < 0.05). Ketorolac improved only burrowing. Persistent pain-related behavior was demonstrated in this mouse fracture/cast model with wide-scale DRG up-regulation of pain mediators. Antihyperalgesic drugs reduced mechanical allodynia and improved burrowing.

Bronchial Cast in a Child with Hemoptysis

Bronchial cast is a rare clinical problem that is more often reported in children than in adults. Reported mean ages ranges from 4 to 12.8 years. It is associated with underlying diseases such as asthma, cystic fibrosis, allergic bronchopulmonary aspergillosis, and congenital heart defects. Bronchial casts vary in size, and clinical presentations may differ depending on the size of the casts. Prognosis also depends on the associated disease and the type of cast, ranging from rapid recovery after cast removal to life-threating respiratory impairment. It is generally expectorated spontaneously or with a cough, but sometimes needed bronchoscopy to remove from bronchi. Moreover, the understanding of pathogenesis is still insufficient. There have been reported a few cases of bronchial cast with hemoptysis in patients without an underlying disease. Herein, we report a patient with bronchial cast following hemoptysis, secondary to an aortopulmonary collateral artery, in the absence of a lung or systemic disease.

The Use of Magnetic Resonance Imaging in Management of Minimally Displaced or Nondisplaced Lateral Humeral Condyle Fractures in Children.

Fractures of the lateral humeral condyle are common in children. Nondisplaced fractures are managed with cast immobilization and frequent radiographic follow-up. Possibility of assessing the displacement and stability of such fractures may be helpful in planning the initial treatment and survey. Magnetic resonance imaging (MRI) could be a useful tool in determining the stability of lateral condyle in children. We propose to investigate the use of MRI in such indication. Fourteen patients presenting with a minimally displaced or nondisplaced fracture were initially treated with a long arm cast and had an MRI within 5 days of injury. The MRI showed that 10 patients had an incomplete fracture without disruption of the cartilage hinge and 4 patients had a complete fracture with extension of the fracture through the cartilaginous epiphysis into the elbow joint. Three patients with such complete fracture had no evidence of lateral condyle displacement on MRI, and 1 patient had a displacement of the lateral condyle. The patients with incomplete fractures had a conservative treatment. The patient with a complete and displaced fracture had an open reduction and internal fixation. The 3 patients with a complete fracture and no evidence of lateral condyle displacement on MRI had a control MRI, 6 to 10 days after cast application, to detect a secondary displacement of the fracture. Because it seems difficult in minimally displaced or nondisplaced fractures to detect further displacement with radiographs, MRI was found mandatory to improve complete fracture visualization during the first phase of conservative treatment. In incomplete fractures, initial MRI investigation was consistent with a stable fracture and avoided further early radiographs or clinical survey. In such cases, we recommend a conservative treatment with late radiographs after long arm cast removal. We propose MRI routine use in the early evaluation of minimally displaced or nondisplaced lateral condyle fractures in children.

Percutaneous cannulated screw fixation for pediatric epiphyseal ankle fractures.

BackgroundAnkle injuries are among the most common injuries in children. The aim of this study was to compare the efficacies of two percutaneous fixation methods after closed reduction in physeal ankle fractures.MethodsWe reviewed the cases of 24 patients with a mean age of 12.29 years; 16 were male, and 8 were female. Only patients with fractures of Salter-Harris types 2, 3, and 4 with displacements greater than 2 mm were included in the study. Patients were treated with closed reduction manipulation and percutaneous screw fixation. For each patient, either cannulated or headless full threaded compressive screws were used for percutaneous fixation. Radiological and clinical healing time, range of motion (ROM), American Orthopaedic Foot and Ankle Society (AOFAS) score and physeal arrest were then measured.ResultsThe mean follow-up time was 13 months. The mean time until cast removal was 3.5 weeks (range 2–5). A full ROM was achieved at an average of 5.7 weeks postoperatively (range 4–8). The radiologic healing time was 6.1 weeks (range 4–7). The patients’ clinical healing time averaged 6.8 weeks (range 5–8). Differences in radiologic healing time (p = 0.487), clinical healing time (p = 0.192), AOFAS score (p = 0.467), and complication rate (p = 0.519) between patients who received the headless compressive screw and those who received the cannulated screw for fixation were not statistically significant.ConclusionsWe demonstrate good clinical results with closed reduction and the percutaneous screw fixation method. Both cannulated and headless compressive screws can be used safely as a treatment method in physeal ankle fractures.

Patient Compliance with Postoperative Lower-Extremity Non-Weight-Bearing Restrictions.

A period of non-weight-bearing is prescribed following many orthopaedic injuries and procedures. It is believed that a period of non-weight-bearing is important for proper healing and recovery. The degree to which patients are compliant with non-weight-bearing instructions is unknown. The purpose of this study was to measure patient compliance with a period of prescribed non-weight-bearing. In this single-blinded study, pressure-sensitive film was embedded into short leg casts of 51 consecutive adult orthopaedic patients with unilateral lower-extremity abnormality who had been instructed to be strictly non-weight-bearing. Sensors were retrieved at the time of cast removal (mean, 24.3 days [range, 7 to 48 days]) and then were analyzed for force distribution and magnitude. Noncompliance was defined as maximum detectable pressure exerted on ≥50% of the film. Patient characteristics and the time of year that the casts were worn were also examined to determine if they correlated with weight-bearing. Fourteen (27.5%) of 51 patients were noncompliant with the non-weight-bearing restriction. Six (42.9%) of the 14 noncompliant patients compared with 11 (29.7%) of the 37 compliant patients experienced an adverse event (p = 0.51). Sex, age, language spoken, body mass index, time in the cast, and the treating surgeon did not have a significant influence on weight-bearing performance (p > 0.05). Significantly greater weight-bearing was found (p = 0.04) in warmer months (June to October) than in colder months (November to March) in the United States. The noncompliance rate with the postoperative non-weight-bearing restriction was 27.5% (95% confidence interval, 15.2% to 39.8%) in this patient group, despite explicit instructions and education about possible complications associated with weight-bearing. The only factor found to have a significant effect on weight-bearing compliance was the time of year that the cast was worn. No significant difference was found between the complication rate of the compliant patients and that of the noncompliant patients. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Predictors of Return after Cast Removal in Patients with a Nonoperatively Treated Distal Radius Fracture

Patients with a nonoperatively treated fracture of the distal radius are often scheduled for a follow-up appointment after cast removal to assess function and outcome. Our experience is that, once the cast is off, many patients do not return. The purpose of this study was to determine which variables significantly influence return for a scheduled visit after cast removal. Thirty-seven patients enrolled in a prospective cohort study (27 men and 10 women) with an average age of 49years (range, 19 to 82) had a distal radius fracture immobilized in a cast. During the visit at which the cast was removed, arm-specific disability, misinterpretation of nociception, and symptoms of depression were measured using validated questionnaires. Eleven of 37 patients did not attend the final scheduled office visit and the only predictor of a return visit was older age.

Distal Radius Fractures Do Not Displace following Splint or Cast Removal in the Acute, Postreduction Period: A Prospective, Observational Study.

Background Displacement of distal radius fractures has been previously described in the literature; however, little is known about fracture displacement following splint or cast removal at the initial clinic visit following reduction and immobilization. Purpose The purpose of this study was to evaluate risk factors for fracture displacement following splint or cast removal and physical examination in the acute postinjury period. Methods All patients with a closed distal radius fracture who presented to our orthopedic hand clinic within 3 weeks of injury were prospectively enrolled in our study. Standard wrist radiographs were obtained prior to splint or cast removal. A second wrist series was obtained following physical exam and application of immobilization at the end of the clinic visit. Radiographic parameters for displacement were measured by two independent reviewers and included dorsal angulation, radial inclination, articular step-off, radial height, and ulnar variance. Displacement was assessed using predefined, radiographic criteria for displacement. Results A total of 64 consecutive patients were enrolled over a period of 12 weeks. Of these, 37.5% were classified as operative according to American Academy of Orthopaedic Surgeons guidelines and 37.5% met LaFontaine instability criteria. For each fracture, none of the five measurements exceeded the predefined clinically or statistically significant criteria for displacement. Conclusion Splint removal in the acute postinjury period did not result in distal radius fracture displacement. Clinicians should feel comfortable removing splints and examining underlying soft tissue in the acute setting for patients with distal radius fractures after closed reduction. Level of Evidence Level II, prospective comparative study.