Plaster Fixation Research Articles

REGENERATIVE TREATMENT OF TRAUMAS OF THE HUMERAL JOINT

Damages of a humeral joint and their consequence are the widespread pathology as meet at 1/5 parts of the population, half from which - persons of able-bodied age. It results to significant work-loss and to infringement of quality of a life of patients. Complexity of a structure of humeral joint causes the certain difficulties in diagnostics and treatment of the given category of patients. Existing traditional methods of treatment include the certain term rigid immobilization and the subsequent long rehabilitation. Work is directed on studying of methods of rehabilitation with the purpose of a finding of variants immobilization the hands, allowing to begin movements in a humeral joint already during the period plaster fixation with use of new technologies and elements of ergotherapy.

Immediate Hip Spica for Unstable Femoral Shaft Fractures in Preschool Children: Still an Efficient and Effective Option

Despite the increasing use of flexible intramedullary nailing for the treatment of femoral shaft fractures during growth, the use of acute or delayed plaster fixation is still a widely practised alternative in preschool children. The purpose of this retrospective study was to analyse outcome following acute casting in preschool children with a focus on acceptable initial leg length discrepancy and angulation. A retrospective study was performed of 46 children with femoral shaft fractures treated conservatively. It was possible to verify the outcome in 22 children with an average follow-up time of 7.5 years. We compared initial shortening and mal-angulation to radiographic data at the time of consolidation and clinical outcome. Most children sustained their fracture by falling out of bed or from their parent's arm. A hip spica including the foot of the injured side, a pelvic ring and the thigh of the uninjured leg was applied under sedation and manual traction. Mean time of hospital stay was 1.4 days (range, 2 h-20 days). The average immobilisation time was 16.7 days (range, 0-30 days). At follow-up, on average 7.5 years after trauma, only one patient showed a leg length discrepancy greater than 2 cm. One patient showed a minor valgus and rotational deformity. The long-term outcome for conservatively treated femoral shaft fractures in preschool children is very good, even in severely dislocated fractures. Our data show that even initial shortening of up to 2.5 cm can be treated successfully with a spica cast.

The application of external fixator for complex tissue defect in the forearm

To discuss the curative effect of the external fixator for complex tissue defect in the forearm. From May, 2005 through December, 2008, the external fixators were used in 17 patients to treat the complex tissue defect in the forearm caused by trauma. There were 11 male and 6 female, with a mean age of 25.6. All patients were accompanied with the exposure of tendon, muscle or screw. The skin defect ranged from 7 cm x4 cm to 19 cm x9 cm. All patients underwent pedicle flap repair. The flap ranged from 10 cm x 6 cm to 20 cm x 15 cm. The proximal pedicle of the flap was sutured into a tubular. The position of the pedicle was fixed by the external fixator. The pin was at the ulnar and the iliac (n=5), and the radius and the iliac (n=12). The immobilization lasted 3 to 8 weeks, 5.1 weeks in average. All patients were followed up for 3 to 20 months, 11.3 in average. All pedicle flaps survived with no pressure ulcer, or no erosion in the axilla. No compartment syndrome or osteomyelitis occurred. Four to six week after surgery, the pedicle was cut. Infection occurred at the cutting end in 1 patient. The wound healed after addressing. The wound in the other 16 patients healed successfully. The fracture of the ulnar and the radius healed 8.5 or 15 weeks after surgery, 13.5 weeks in average. Eleven patients underwent second stage reshape and function restoration. The function of the hands and forearms recovered satisfactorily. Eleven patients returned to their work. Six patients can live with basic function for living. The external fixator used for complex tissue defect in the forearm can keep the position of the pedicle, replacing plaster fixation. It can reduce the incidence of flap and vessel spasm, and get good outcomes.

Interexaminer Variance of Median Nerve Compound Muscle Action Potential Measurements in Hand Position With and Without Fixation in Plaster

We examined how hand fixation affects interexaminer variance in measuring compound muscle action potential (CMAP) during nerve conduction studies of the median nerve. Subjects comprised 6 experienced examiners [1 woman and 5 men; mean (SD) age, 38.3 +/- 8.5 years; range, 28-46 years]. The standardized median nerve motor conduction setting was used for electromyography. The mean of 5 serial stimulations was taken as 1 examination for each subject. Distal latency, conduction velocity, and peak-to-peak amplitude of CMAP were measured as parameters. Subjects were examined without hand fixation and with hands fixed in prepared plaster molds. Fixation yielded significantly decreased coefficient of variance for CMAP amplitude (5.0% +/- 3.4%) compared with measurement without fixation (8.4% +/- 3.7%; P = 0.028). No differences in distal latencies or conduction velocities were evident between fixation and nonfixation. This study provides quantitative evidence for empirical observations that hand fixation might decrease CMAP variability in median nerve studies.

THE CLASSIC: Surgical Treatment of Fresh Injuries to the Major Ligaments of the Knee

THE CLASSIC: Surgical Treatment of Fresh Injuries to the Major Ligaments of the Knee

Ankle fracture is associated with prolonged venous dysfunction.

Leg swelling is a significant problem following ankle fracture. Venous pump function and femoral and popliteal venous patency were assessed prospectively in 26 patients with ankle fractures requiring open reduction, internal fixation and immobilization in plaster. Functional venous volume, venous filling index (VFI), ejection volume fraction (EVF) and residual volume fraction (RVF) were measured using air plethysmography at 5 days and at 6, 12 and 18 weeks after fracture. The uninjured leg was used as a control. Popliteal and femoral venous patency was determined using duplex ultrasonography. No patient developed deep vein thrombosis during the study. At 5 days after fracture there was a significant reduction in mean(s.d.) EVF, 18.2(12.1) versus 55.9(19.5) per cent, and increase in RVF, 87.0(14.3) versus 42.5(22.2) per cent (both P < 0.001). Analogous values were similar at 6 weeks, EVF 28.5(21.2) versus 55.6(21.9) per cent, RVF 82.2(16.8) versus 48.5(23.8) per cent (both P < 0.001), and at 12 weeks, EVF 39.1(16.0) versus 60.3(14.9) per cent, RVF 64.7(18.8) versus 38.8(13.2) per cent (both P < 0.001). However, by 18 weeks there was no significant difference in venous function between fractured and control limbs. It is concluded that there is a significant and prolonged impairment in venous pump function following ankle fracture.

両膝高度屈曲拘縮により歩行不能であったＢｅａｌｓ症候群の１例

Beals syndrome (congenital contractural arachnodactyly) is an autosomal dominant disorder characterized by multiple joint contracture, long arms and legs, arachnodactyly, crumpled ears, and scoliosis. We surgically treated a Beals syndrome patient with severe flexion contracture of both knee joints. The patient was a 3-year-old boy who could not walk in an upright position because of severe flexion contracture of both knee joints. Conservative treatment including physical therapy and application of braces was not successful. We performed surgical correction of contracture including skin release, tendon elongation of knee flexors, the posterior thigh flap (6×4 cm for the left popliteal defect) and venoneuroadipofascial flap (6×4 cm for the right popliteal defect). After skin release and tendon elongation, both knees could not be straightened because of tightness of the neurovascular bundle. Pins and plaster fixation were applied in both knees to maintain the flexed position. The Ilizarov external fixator replaced pins and plaster fixation one month after the operation. Both knees were gradually extended with telescopic rods. The Ilizarov external fixators wree removed after 2 months. The quadriceps strength of both knees was weak (MMT1) but gradually improved by rehabilitation. After 1 year and 9 months, he could walk in an upright position without any support. Quadriceps strength improved to MMT4 and the range of motion improved to extention −25 degrees and flexion 115 degrees.

小児とう骨頚部骨折の手術治療成績

Operation was performed on three patients with age ranging from 7 to 15 years. According to Judet’s classification, type 2, type 3, and type 4 were found each in one case. Percutaneous reduction was performed within two days after injury. In case percutaneous reduction was difficult to perform, open reduction was carried out. Internal fixation was not used and plaster fixation was kept for 3 weeks. Sufficient results were obtained by open reduction. In the cases where there was no complicated injury, functional prognosis was also good.

Articular cartilage regeneration of the knee joint after proximal tibial valgus osteotomy: a prospective study of different intra- and extra-articular operative techniques.

In this prospective study high tibial osteotomy for medial gonarthrosis was performed in 95 patients (105 knee joints). The patients underwent simultaneously diagnostic and operative arthroscopic surgery of the knee joint. A follow-up arthroscopic examination could be performed in 75 patients (85 knee joints) at the time of implant removal. In group 1 (20 knee joints), the osteotomy was performed after diagnostic arthroscopy without arthroscopic operation of the knee joint. The fixation of the osteotomy was accomplished by staples, postoperative plaster fixation and physiotherapy. In group 2 (20 knee joints), osteotomy was performed without additional operative arthroscopy after diagnostic arthroscopy, internal fixation by AOT-plate, no external fixation postoperatively and physiotherapy. In group 3 (22 knee joints), osteotomy was performed with additional operative arthroscopy (Pridie drilling), internal fixation by AOT-plate no external fixation postoperatively no external fixation, physiotherapy and continuous passive motion. In group 4 (23 knee joints), osteotomy was performed with additional operative arthroscopy (abrasio-arthroplasty), internal fixation by AOT-plate, no external fixation postoperatively, physiotherapy and continuous passive motion. All patients underwent arthroscopic examination of the knee with cartilage biopsies taken from three different regions of the femoral condyle during the same operative session as the osteotomy. At follow-up arthroscopy cartilage biopsies were taken from the same regions. There was no great difference in clinical outcome after 1 year between all groups. Arthroscopy as well as routine and electron microscopy showed better cartilage regeneration in groups 3 and 4. Groups 1 and 2 showed only regeneration isles, sometimes not well fixed to the underlying bone, while in groups 3 and 4 cartilage regeneration was thicker and more stable, sometimes covering all of the pre-existing erosions. Therefore, we recommend osteotomy of the tibia for osteoarthritis together with operative arthroscopy in the same operative session.

Trapezio-lunate external fixation for scaphoid fractures An experimental and clinical study

Trapezio-lunate external fixation for scaphoid fractures has been investigated experimentally and clinically. Six below-elbow fresh amputation specimens in which proximal, waist and distal scaphoid fractures were created, displaced, reduced and externally fixed were used for an experimental study and after 10,000 extension-flexion movements of the wrist, no displacement was observed. A strain-gauge study confirmed the strains at the fracture site. Seven patients were treated in this way. No immobilization was necessary and all patients returned to their regular employment within 3 days and all fractures were united without displacement. The technique overcomes certain disadvantages of plaster fixation and internal fixation of scaphoid fractures.

The treatment of Colles' fracture. Immobilisation with the wrist dorsiflexed

In a prospective study, 204 consecutive patients with displaced Colles' fractures had closed reduction then plaster immobilisation. Three different positions of the wrist in plaster were randomly allocated: palmar flexion, neutral and dorsiflexion. The results in the three groups were compared. Fractures immobilised with the wrist in dorsiflexion showed the lowest incidence of redisplacement, especially of dorsal tilt, and had the best early functional results. Immobilisation of the wrist in palmar flexion has a detrimental effect on hand function; it is suggested that it is also one of the main causes for redisplacement of the fracture. This is discussed in relation to the functional anatomy of the wrist and the mechanics of plaster fixation.

Functional restitution after lower leg fractures

Twenty-five patients with fractures of the lower leg treated by closed reduction and plaster fixation were examined an average of 7 years and 8 months after trauma. The end result was assessed according to the following: (1) The patient's own opinion; (2) clinical examination including comparing range of motion in knee and ankle in the fractured and non-fractured leg, leg length discrepancy, malrotation of the injured extremity and muscle force analysis; (3) radiological examination. All fractures had healed after a mean of 13.4 weeks. Twelve of the 25 patients had no complaints. Subjective and objective assessment of the end results were in good correlation. Only eight patients had remaining radiological displacement, in only one of which it was severe. The slight remaining malpositionings did not influence the final functional result. The muscle force analysis showed that fractures caused by high-energy trauma also brought permanent reduction of muscular strength to the fractured extremity.

THE EFFECT OF EARLY ANTERIOR APPROACH OPEN REDUCTION WITH FUNCTIONAL POSTOPERATIVE TREATMENT ON THE EARLY DEVELOPMENT OF THE ACETABULUM IN CDH

Between 1980 and 1983, 30 anterior approach open reductions were performed on congenitally dislocated hips of 29 patients after unsuccessful conservative treatment; patients were between 6 and 18 months old. After the removal of the obstruction from the acetabulum, the reduction was performed with preservation of the limbus. Some part of the capsule was removed to constrict and tighten it and to prevent redislocation. This capsuloplasty demonstrates the success of a Pavlik harness and abduction splint postoperatively, without plaster fixation. The accelerated development of the acetabulum could be observed on radiograph by this functional treatment, compared to the control group treated with the usual hip spica postoperatively. The development of the acetabulum on the operated side almost equals the sound side within a year. If the operation was performed earlier, joint development would be quicker.

小児上腕骨外か骨折の治療経験

From 1982 to 1989, we have treated 46 fractures of the lateral humeral condyle in chidren, 38 being boys and 8 girls aged 6 years on an average (1 to 14 years).According to classifications of Wadsworth, Abe and lnoue, 13 cases, which showed non-displacement or slight displacement on the initial X-rays, were treated conservatively, and 33 cases of marked displacement were treated operatively.As delayed dislocation occurred in the plaster fixation within one week in some cases, the classification of Inoue is considered to be adequate to indicate for operative treatment.

Treatment of Leg Length Discrepancy by Subtrochanteric Shortening of the Femur

Shortening by subtrochanteric femoral osteotomy is a simple and safe method of equalization in mild cases of leg length discrepancy. A group of patients especially suited for this procedure are those whose congenital dislocation of the hip (CDH) has been treated by conservative methods, such as closed reduction and plaster fixation during infancy

External fixation of Colles' fracture.

Radiographic and functional results of external fixation of 32 Colles' fractures were compared with the results of plaster fixation of 189 Colles' fractures. Despite the fact that the fractures treated with the external device were more unstable and comminuted, the final results were equal in both groups, and the radiographic outcome of external fixation was superior. Pin loosening decreased with predrilling rather than self-tapping. We recommend external fixation for unstable fractures of the distal forearm.

当院におけるとう骨遠位端関節内骨折の治療と予後の検討

Thirty-five patients with 37 articular fractures of the distal radius were evaluated as to the results of treatment radiologically and subjectively by questionnaire. Three patients complained of discomfort and were graded as poor. Two of them were initially treated by manual reduction and plaster fixation. Re-dislocation of the fragment, however, occurred in the plaster and consequently loss of integrity of the distal radio-ulnar joint remained, presenting ulnar plus variant on radiological antero-posterior view. Ulnar plus variant resulted from either re-dislocation of the fragment or shortening of the radius. To estimate the reduction rate of the fracture and its maintenance, calculation of the dorsal tilting angle and ulnar variance is useful in treatment of the fracture.

Ｚｏｎｅ ＩＩにおける屈筋けん損傷一次修復例の検討

Primary suture for flexor tendon rupture in zone II has become popular and we have experienced 76 fingers of 62 cases in the past 6 years and 6 months. Primary suture has been done by Tsuge's method using 4-0 or 5-0 looped nylon. Postoperatively, either plaster fixation for three weeks or Kleinert's early controlled exercise method has been done.Functional results of flexor tendon suture were assessed in 58 fingers of 46 cases followed over 6 months postoperatively. The results were evaluated with methods of both %TAM (proposed by Evaluation Comittee of the Japanese Society for Surgery of the Hand) and Buck-Gramcko's.Results are as follows:1) Either excellent or good results were obtained in 27.6 %according to the %TAM, and 72.4 %according to the method of Buck-Gramcko.2) Children had better results than infants and adults.3) Rupture on the proximal side had better results than that on the distal side.4) There was no significant difference among the methods of primary, delayed primary and secondary sutures.5) Cases with bone and joint injuries, crush injuries, infections and reruptures had poor results.6) Cases with FDS repair had better results than that without FDS repair.7) Cases performed early exercise had better results.

Internal fixation by percutaneous pinning for the treatment of fracture of surgical neck of humerus.

20 cases of displaced fracture of the surgical neck of humerus treated in the OPD of our hospital from 1978–1983 are reported. Manual reduction, aided by prizing and poking with steel pins, and internal fixation with percutaneous pinning and early functional exercise have been adopted with satisfactory results. The advantages of our method over closed reduction followed by suprashoulder joint fixation by small splints, shoulder {fx236-01} shaped plaster fixation, or open surgical reduction with internal fixation are discussed. The rate of success of reduction reached 100 %. After a follow-up of 6—48 months, the functional recovery returned to normal or nearly normal. The method of closed reduction plus percutaneous internal fixation is presented in detail. The authors have stressed the importance of forward angulation in fracture displacement and the necessity of correction of forward angulation in conjunction with correction of adduction and abduction displacements during reduction.

Direct Tendon Suture of Flexor Tendon Injuries in the Hand

During the period from 1979 to 1982, we have performed 33 operations (involving 30 cases) of the direct tendon suture for the treatment of flexor tendon lacerations in the hand. There were 19 males and 11 females. The average age of patients was twenty-one years old. According to the Verdan's Zone Classification, Zone 1 was seen in 7 digits Zone 2 in 20 digits, Zone 4 in 1 didit and Zone 5 in 5 digits. The operative method was as follows. Skin incision was made using Bruner's zigzag incision and tendon suture was applied by Tsuge's intratendinous tendon suture method in the majority of the cases. Postoperative care was early mobilization of Kleinert's method in 13 cases and plaster fixation for 3 weeks in 20 digits.The evaluation was made according to Boyes- White's method and the results were classified as follows. Eighteen digits were excellent, eight good, three fair and four poor. Of all cases, 78.8% showed excellent or good results. According to the zone, 70% were excellent or good for Zone 2, 92.3% were excellent or good for Zone 1, 4 and 5. We studied the relationship of the results to age, time of operation, causes of injury, operative method (FDS suture or not) and postoperive treatment in those cases.