Plaster Slab Research Articles

Additional improvement of airborne and impact sound insulation of ceilings in prefabricated standard house-buildings

Earlier studies for the improvement on airborne and impact noise insulation of ceilings in prefabricated standard house-buildings has been continued by the support of the German Ministery of Building. The investigated slab blocks were erected in 1987 in Potsdam. The raw ceilings made of solid concrete have a thickness of 140 mm. These realized ceilings have a weighted airborne sound insulation of Rw′=49 dB and a normalized impact-sound pressure level of Ln,w′=77 dB (averaged over nine measurements). A selection of floating floor materials were built in and measured: dry laser constructions (with plaster and compound cement slabs), asphalt applied by melting, and anhydrite layers. The aim of the project was to fulfill the requirements (Rw′=54 dB, Ln,w′=53 dB) of German Standard DIN 4109 from 1989, minimizing construction height and cost. Based on earlier studies (Scholze, DAGA ’94) all floating floors with a height larger than 45 mm (asphalt floor 40 mm) have been improved to reach the requirements of DIN 4109. Using mineral wool as sound insulation material below the floating floor gave results up to Rw′=56 dB (maximum value) and Ln,w′=48 dB.

The dynamic elbow suspension splint

Elevation of the upper extremity after elbow surgery has rarely been advocated and can be difficult to achieve. Usually the extremity is elevated with the elbow at 90° of flexion, so that swelling from the hand drains to the elbow but the elbow remains dependent. Excessive swelling causes discomfort and compromised wound healing, makes early mobilization difficult, and predisposes to joint contracture. We report on a dynamic elbow suspension splint, which is analogous to the Thomas splint used for femoral shaft fractures. The arm is held in full extension with an above-elbow plaster slab and is secured to the Thomas splint with skin traction. The splint is suspended on a Balkan frame at an angle of 60°. We prefer to use the new Zimmer Thomas splint, because it is radiolucent and has self-adhesive sheepskin supports that can be simply applied. It allows the patient to mobilize in bed and is well tolerated by patients and nursing staff. The dynamic elbow suspension splint is a useful adjunct after complex elbow surgery or trauma, because it reduces swelling and maintains the elbow in extension.

La couleur dans la peinture grecque antique de Macédoine

Color in the Paintings of Macedonia during Greek Antiquity. The study of Macedonian paintings of the 4th through the 2nd century b.c. provides the opportunity to understand many of the important characteristics of the paintings of Greek Antiquity and to examine the materials and pictorial techniques used by artists of that period. The funerary paintings of Macedonia were done on two types of supports : on the walls of tombs that were covered with a coat of plaster and marble slabs. The pigments that have been identified are predominately natural and artificial inorganic pigments and, more rarely, organic ones. The techniques used are : alia fresco, distemper, egg or Arabic gum. The monumental paintings of Verghina are painted in highly interesting styles and techniques that distinguish them from other Macedonian paintings of this period and confirm that they were painted in a local, decorative style.

A technique of internal fixation for os calcis fractures

Healing of the fracture in optimal position. Restoration of joint surfaces and function of the subtalar and calcaneocuboid joints. Os calcis fractures of type A2 and B2 of our classification modified after the AO classification published by Muller. Poor skin and soft tissue conditions. Severely comminuted fractures, osteoporosis. Peripheral circular disturbance. Uncooperative or inactive patients. Supine. Tourniquet. Operating table which can be tilted and is radiolucent. General, spinal or epidural anaesthesia. Closed reduction using an external fixator, introduced from the medial side into the calcaneal tuberosity and the first metatarsus. Open reduction of the joint surfaces with the possible use of autogeneous cancellous bone grafts and plate fixation laterally. Posterior plaster slab for the first postoperative days. Elevation of limb. Out of cast physiotherapy of the ankle and subtalar joints starting the first postoperative day. Partial weight bearing of 20 kg using 2 canes is permitted in reliable patients after wound healing. For the other patients partial weight bearing in the plaster slab. Full weight bearing after 8 to 10 weeks depending on radiologic state of consolidation. 37 os calcis fractures were thus treated between 1988 and 1991. Patient age varied between 7 and 74 years, mean age 38.9 years. 12% of the patients suffered of polytrauma. Average time to full weight bearing: 12 weeks. Follow-up of 32 patients after 15 to 64 months, mean 33 months: 24 patients returned to the same occupation, 3 patients retired, 2 patients changed their occupation and 3 are unemployed. Scoring according to the method proposed by Merle d'Aubigne. Fracture types and results are listed in Table 1. The following complications were observed: 6 haematomas needing evacuation. Injury to the dorsal cutaneous nerve in 6 patients, pain at the subtalar joint while walking over uneven ground in 22 patients, 3 patients wear orthopaedic shoes and 12 arch supports. Up to now no subtalar arthrodesis became necessary.

THE MANAGEMENT OF WAR WOUNDS INVOLVING BONE

Over 200 high-velocity missile injuries treated in a low-technology environment were audited under the aegis of the International Committee of the Red Cross Hospitals in Afghanistan and Northern Kenya. Femoral fractures were treated either by traction or external fixation using a uniaxial frame. The results showed that patients treated by external fixation remained in hospital longer than those treated on traction. The positional outcome was identical in both groups. In tibial fractures the external fixator was only of extra benefit in those of the lower third when compared with simple plaster slabs unless more complex procedures such as flaps or vascular repair were to be performed. In complex humeral fractures, external fixation resulted in long stays in hospital and a large number of interventions when compared with simple treatment in a sling. We conclude therefore that in an environment where facilities are limited and surgeons have only general experience very careful initial wound excision is the most important factor determining outcome. The application of complex holding techniques was generally inappropriate.

Die Zugschraubenarthrodese von Fingergelenken

Arthrodesis of proximal and distal interphalangeal joints. Joint destruction after primary or secondary arthritis accompanied by activity related pain. Joint instability interfering with pinch and not amenable to soft tissue procedures. Irreversible contracture in flexion or extension. Acute infection. Lack of bone stock. Unusually large medullary canal precluding safe anchorage of the screw. Supine, hand table. Roll of towel under fingers. Tourniquet at upper arm. Elastic band around base of finger in instances of DIP arthrodesis. Regional: plexus- or ring anaesthesia. Arthrodesis using the lagscrew principle. After resection of the destroyed joint surfaces compression of the fragments using screws of the Martin miniset and applying the lagscrew principle. The screw head will be countersunk. Immobilization on a plaster slab supporting forearm, operated and 1 neigh-bouring finger. Physiotherapy. Scew removal is usually not necessary. The screw head sinks into the medullary canal. Lack of sufficient stability. Lack of bony union. Infection. Gaping at site of arthrodesis. Detachment of the extensor tendon. Countersink hole of insufficient size. Between 1982 and 1992 51 patients had 54 lagscrew arthrodeses. 51 arthrodeses in 48 patients could be reexamined at the end of 1992. Average time of follow-up: 3 1/2 years (6 months to 10 years). No postoperative complication was observed and primary fusion was seen in every patient 4 to 13 weeks postoperatively. In 5 instances the screw had to be removed. The angle of arthrodesis varied between 10° and 54°, a vallue determined preoperatively to accommodate the individual needs. The pinch strength reached 75% of that of the finger of the opposite hand in 2/3 of the patients. Symptom-free were 44 patients, 4 had occasional pain (2 had activity related pain of the entire finger and 2 felt pain with changing weather). 86.8% of the patients assessed their result as good or excellent.

Deformity after internal fixation of fracture separation of the medial epicondyle of the humerus

We reviewed 24 displaced fractures through the physis of the medial epicondyle of the distal humerus. One was a Salter-Harris type-II fracture-separation of the whole distal humeral epiphysis; the others involved only the medial epicondylar centre of ossification. Two cases had presented as pseudarthroses. One fracture had been treated closed in a plaster slab and 21 had had open reduction and internal fixation with sutures, Kirschner wires or Palmer nails. At 2 to 13 years later we found five types of deformity of the epicondyle: pseudarthrosis, an ulnar sulcus, a double-contoured epicondyle, hypoplasia or hyperplasia. Pseudarthrosis had developed after either no treatment, closed reduction and plaster, or open reduction and suturing. Hypoplasia followed nailing, as did a trend to varus tilting of the joint surface. One very young patient, with fracture-separation of the whole distal epiphysis treated by nailing, developed marked cubitus varus.

The volar wrist ganglion: Just a simple cyst?

The results of operation on 71 volar wrist ganglia are reported. The recurrence rate was 28%, occurring between 1 and 144 months (median: 5 months). The highest risk of recurrence is in a male patient, under 30 years of age, in a manual occupation, operated on by a junior surgeon. The use of a post-operative plaster slab seemed to be followed by significant wrist stiffness. 28% of the patients had evidence of damage to the palmar cutaneous branch of the median nerve. It is suggested that this could be avoided by positive identification of this nerve at operation.

The Volar Wrist Ganglion: Just a Simple Cyst?

The results of operation on 71 volar wrist ganglia are reported. The recurrence rate was 28%, occurring between 1 and 144 months (median: 5 months). The highest risk of recurrence is in a male patient, under 30 years of age, in a manual occupation, operated on by a junior surgeon. The use of a post-operative plaster slab seemed to be followed by significant wrist stiffness. 28% of the patients had evidence of damage to the palmar cutaneous branch of the median nerve. It is suggested that this could be avoided by positive identification of this nerve at operation.

The radiation crosslinking process and new products

In 1988 there were over 90 EB accelerators for industrial use in Japan. The number one industrial application was Wire and Cable, the 2nd was PE foam and Curing, and the 3rd was Precure of tyre. R & D has a very high ration of EB accelerator use. Low energy industrial applications were coated steel (white board), plaster slab, coated paper, magnetic tape and floppy disks. As a new application of the radiation crosslinking process, we have studied radiation crosslinking of engineering plastics and succeeded in improving the hea tresistivity without using glass fibers. Many kinds of polyfunctional monomers used as crosslinking reagents of irradiated Nylon and PBT were studied.

Sideswind reinforcement for above-elbow plaster slabs

A method of reinforcing an above-elbow plaster slab is described. The technique prevents the splint becoming tight at the elbow and gives it considerable strength.

Subacute Salmonella osteomyelitis following a greenstick fracture of the radius

CASE REPORT A .5-year-old girl fell off a swing and was brought to the Accident and Emergency department complaining of a painful left forearm. She was tender over the distal radius without abrasion or contusion to the skin. A radiograph confirmed a greenstick fracture of the distal radius (Fig. 1) which did not require manipulation. The forearm was treated in a dorsal plaster slab which was removed after 1 month and the patient discharged with a clinically normal forearm. Two months later the girl was referred back to hospital with a 1 week history of pain and swelling of the left forearm. The forearm was warm and thickened with tenderness along the length of the radius. She had a pyrexia of 37.5. Radiographs taken at this time show enlargement of the whole of the radius with extensive periosteal reaction (Fig. 2). Blood cultures were negative but drilling of the distal radius at the site of maximum radiolucency released pus from which Safmonefla newport was isolated, sensitive to ampicillin. Further investigation included a sickle test which showed a normal haemoglobin and three negative stool cultures. Nine months

Congenital dislocation of the knee: a description of four cases in rural Kenya

Four infants with congenital dislocation of the knee seen in rural Kenya are described. All presented in the first 5 days after birth. Three were treated with a posterior plaster slab, renewed at 2 weekly intervals for 6 weeks. One infant was treated by passive exercises, taught to the mother. At the last follow-up at 6 weeks, all the infants had almost normal knee flexion and hyperextension of the joint was no longer possible. The need for early treatment, which can be quite simple and is highly effective, is emphasized.

Dorsal dislocation of the metacarpal base of the little and ring fingers with ulnar nerve branch compression

CASE REPORT A 40-year-old male tripped and fell on the dorsum of his right hand. Examination in the Accident and Emergency Department showed tender swelling of the carpometacarpal area of the ulnar side of the hand. A malunited fracture of the neck of the metacarpal bone of the little finger was noted on the radiograph but otherwise it was dismissed as normal (Fig. 1). The patient reattended 9 days later, with inability to abduct and adduct his ulnar four fingers and inability to adduct the thumb. At this time a radiologist recognized dislocation of the darpometacarpal joints of the little and ring fingers. Injury of the deep branch of the ulnar nerve was recognized. A control film of the normal (left) hand was taken before treatment started (Fig. 2). The dislocations were reduced by traction and direct pressure on the prominent metacarpal bases. General anaesthesia was employed. The hand was splinted with a dorsal plaster slab in dorsiflexion (Fig. 3). The plaster was discarded 3 weeks later. By then the patient had noted improvement in the intrinsic function of the injured hand, and had returned to work. Four months following injury, the recovery of the nerve and joint lesions was complete. One year following injury he had no disability with the right hand.

Fractures of the metacarpal neck of the little finger

A prospective study of 73 patients with fractures of the metacarpal neck of the little finger is reported. Fifty-seven (78 per cent) of the patients were followed up between 1 and 2 years after the injury. Forty-three (75 per cent) of these patients complained of symptoms, though only one patient considered himself disabled. The normal head/shaft angle at the fifth metacarpal neck measured in 12 control subjects as viewed on an oblique radiograph was 26 °. The importance of allowing for this normal angulation when assessing the angulation at the fracture is discussed. After manipulation, the corrected position of the fracture is not adequately maintained by a volar plaster slab. No definite relationship between the presence of symptoms and the residual angulation at the fracture site was demonstrated. Manipulation of these fractures is thus seldom indicated.

Interphalangeal joint stiffness following claw hand reconstruction

Conventional immobilisation following surgery for claw hand reconstruction necessitates altogether more than six weeks of post-operative physiotherapy. Two to four weeks of physiotherapy was required for re-education of the transferred tendons and an additional period of physiotherapy was needed to overcome the interphalangeal joint stiffness seen in all hands-even those with no pre-operative I.P. stiffness.Fifty hands with no pre-operative I.P. stiffness were immobilised post-operatively following claw hand correction by three different techniques, (Conventional technique 20 hands; Modification type 1, 10 hands and Modification type 2, 20 hands). Modification type 1 produced unsatisfactory results. Modification type 2 however, resulted in near total absence of I.P. stiffness with no additional physiotherapy required to overcome the minimal stiffness, without interfering with the results of reconstructive surgery. Type 2 immobilisation was achieved by a volar plaster slab extending from just below the elbow to the finger tips cirumferential plaster up to just beyond the metacarpophalangeal joints. Modification type 2 is recommended.

On splitting plasters. A useful analogy.

An inner tube was inflated and then surrounded with plaster wool and plaster-of-Paris bandages. The plaster and the wool were next progressively divided. There was no significant reduction of the pressure inside the tube until both the plaster and the wool had been divided and separated from the inner tube along the entire circumference. These findings demonstrated that wool and plaster applied to limbs likely to swell should be split right down to skin and widely separated immediately after their application. A plaster slab is safer still, but the wool must be cut before the crepe bandage is applied.

ANTIBIOTICS IN ACUTE OSTEOMYELITIS IN CHILDREN

1. Continued follow-up of the 113 children with acute osteomyelitis previously reported and a study of a further thirty-eight proven cases has not changed our opinion that the correct management is rest and effective antibiotics. Operation should be undertaken only if pus is detectable clinically. 2. Bacteriological evidence shows that the flora causing this disease are less sensitive to benzylpenicillin than ten years ago and that a proportion are also likely to become resistant to methicillin and cloxacillin. 3. The most effective antibiotic combination used was fusidic acid and erythromycin. This lowered the failure rate to 10·5 per cent in thirty-eight proven cases. Two of the four failures were in haemophilus infections. No staphylococcal infection of a long bone became chronic, and all lesions were healed within three months of onset. 4. The duration of treatment (twenty-one days) and the method of splintage (removable plaster slabs) remained the same as in the previous series. 5. Careful watch must be kept on the incidence of haemophilus infections. If it rises, increasing the erythromycin or adding ampicillin may be necessary. 6. Use of the newer aqueous suspension of fusidic acid may lower the incidence of troublesome vomiting (12 per cent in this series). 7. Only 7 per cent of staphylococcus aureus infections in this hospital, and 17 per cent of such infections in our thirty-eight cases were sensitive to benzylpenicillin. It is thought that this drug has outlived its usefulness in osteomyelitis. 8. It is recommended that, on diagnosis, fusidic acid aqueous suspension 5 millilitres should be given three times a day to children aged one to five, and 10 millilitres twice a day for children aged six to twelve, with erythromycin stearate 30 milligrams per kilogram of body weight each day in divided doses.

The Treatment of Dupuytren Contracture

Summary The operation for Dupuytren contracture by means of a radical block excision of the palmar fascia is described in some detail. A method of post-operative immobilisation of the hand by plaster slabs is recommended with a view to minimising the incidence of the main complications of h˦matoma, œdema, and delayed healing of the palm.

The treatment of dupuytren contracture

Summary The operation for Dupuytren contracture by means of a radical block excision of the palmar fascia is described in some detail. A method of post-operative immobilisation of the hand by plaster slabs is recommended with a view to minimising the incidence of the main complications of h˦matoma, œdema, and delayed healing of the palm.