Short Period Of Immobilization Research Articles

Ununited proximal pole scaphoid fractures. Treatment with a Herbert screw in 16 cases followed for 0.5-8 years.

We treated 16 cases of delayed union and nonunion of proximal one-third scaphoid fractures with cancellous bone grafting and retrograde insertion of a Herbert screw through a dorsal approach. Definite radiographic union was obtained in 13 of 16 patients after a median of 2 (0.5-8) years of follow-up. Using Cooney's clinical scoring system, 5 cases were excellent, 5 good, 5 fair and 1 poor. The treatment of ununited proximal pole scaphoid fractures with retrograde insertion of the Herbert screw offers the advantages of a short period of immobilization and a good function.

Successful Treatment of Chronic Leg Ulcers with Epidermal Equivalents Generated from Cultured Autologous Outer Root Sheath Cells

The outer root sheath cells of hair follicles can substitute for interfollicular epidermal keratinocytes, as during healing of skin wounds when these cells migrate onto the denuded area and contribute to epidermal regeneration. Using improved culture techniques, we generated epidermal equivalents from cultured outer root sheath cells of patients suffering from recalcitrant chronic leg ulcers, primarily of vascular origin. In such epidermal equivalents, tissue organization as well as immunolocalization of epidermal differentiation products (keratin 10, involucrin, filaggrin) and integrins were indistinguishable from normal epidermis. As determined by the number of bromodeoxyuridine-incorporating cells, the basal layer contained a large compartment of proliferative cells irrespective of donor age. FACS analysis of the outer root sheath cells, used to prepare the epidermal equivalents, disclosed a fraction of small cells with enhanced expression of beta1-integrin, a potential stem cell marker. in contrast to acute wounds, a major definitive take of grafted cultured autologous keratinocytes has not been convincingly demonstrated in chronic wounds. In a pilot study, grafting of epidermal equivalents generated in vitro from autologous outer root sheath cells on 11 ulcers in five patients resulted in a definitive take rate of about 80%, with subsequent complete healing within 2 to 3 wk of five out of seven ulcers grafted with densely arranged cultures. This improvement in the treatment of chronic leg ulcers with cultured autologous keratinocytes probably depends on the large compartment of proliferative cells as well as on a well-developed horny layer which prevents disintegration of the grafts. Practical advantages of the new technique are its noninvasiveness, the lack of need for surgical facilities or anesthesia, and a short immobilization period after grafting.

Subtalar joint dislocations.

Dislocations of the subtalar joint are rare injuries. The anatomy, pathophysiology, treatment, and prognosis of subtalar joint dislocations have been well described in the literature. The purpose of this paper is to review the current literature on subtalar joint dislocations, as well as outline those aspects of the anatomy, pathomechanics, and treatment pertinent to care of the patient with subtalar joint dislocation. In addition, complications and obstacles to reduction are described. Subtalar joint dislocations, although not common, have increased in frequency over the last decade. Generally, they can be treated successfully with closed reduction and a short period of cast immobilization. The majority of patients will suffer some disability with subtalar joint stiffness the primary complaint. Associated intra-articular fractures increase the risk of posttraumatic arthrosis.

Distal unicondylar fractures of the proximal phalanx

The records of 38 consecutive patients (38 fractures) who underwent treatment for distal unicondylar fractures of the proximal phalanx were reviewed to evaluate fracture characteristics, mechanism of injury, treatment options, and functional outcomes. Four classes of fracture pattern were defined radiographically. Most fractures occurred during ball sports and involved an axial splitting of extended digits, with the condyle closest to the midline of the hand fracturing most commonly. We believed that the fracture occurred as a result of tension loading due to a distraction force from the collateral ligament. All fractures healed. Follow-up examination averaged 3 years. Five of seven nondisplaced fractures treated with splinting and four of ten displaced fractures treated with reduction and single Kirschner wire fixation displaced. Fractures treated with multiple Kirschner wire fixation had the best final joint motion. Class IV fractures with a small palmar coronal fragment had the poorest final motion. A short period of post-operative immobilization did not adversely affect final proximal interphalangeal joint motion. We recommend multiple Kirschner wire or miniscrew fixation of these fractures as the most predictable method of treatment. Final proximal interphalangeal joint motion is not uniformly excellent in patients with these fractures.

The Pathogenesis of Femoral Head Deformity in Congenital Dislocation of the Hip

An experimental study was conducted based on the hypothesis that articular interpositions such as inverted limbi are major factors influencing deformities of the femoral head and neck that complicate treatment of congenital dislocation of the hip. In 24 neonatal pigs, the hip was fixed in a cast for one to three hours in the frog-leg position after insertion of an allogeneic meniscus into the hip joint. No macroscopic changes were observed immediately and one day after the above procedure, but electron microscopy showed degeneration of the cells in the physis. After 29-39 days, varus deformity and flattening of the femoral head were observed in all animals. After five months, marked deformity of the femoral head and replacement of the physis by fibrous tissue were noted. Angiograms obtained during cast fixation and 30 minutes after removal of the cast showed no circulatory occlusion. A short period of immobilization in the frog-leg position combined with articular interposition plays a major role in degeneration of the physis and predisposes to deformities of the femoral head and neck.

The effects of early mobilisation and immobilisation on the healing process following muscle injuries.

The biological processes following muscle injury include 2 competitive events; regeneration of muscle fibres and the simultaneous production of granulation tissue. We have studied the effects of early mobilisation and immobilisation on the healing of rat gastrocnemius muscle following partial rupture by a controlled contusion mechanism. Muscle fibre regeneration is inhibited by the formation of dense connective tissue scar. Immobilisation following injury limits the size of the connective tissue area formed within the site of injury; the penetration of muscle fibres through the connective tissue is prominent but their orientation is complex and not parallel with the uninjured muscle fibres. Immobilisation for longer than 1 week is followed by marked atrophy of the injured gastrocnemius muscle. Mobilisation started immediately after injury is followed by a dense scar formation in the injury area prohibiting muscle regeneration. When mobilisation is started after a short period of immobilisation a better penetration of muscle fibre through the connective tissue is found and the orientation of regenerated muscle fibres is aligned with the uninjured muscle fibres. Although a little delay in healing processes in muscles mobilised after short immobilisation was found morphologically, the gain in strength and energy absorption capacity was quite similar and as good as that of muscles treated by early mobilisation alone.

Rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb

The results after operations for rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb are reported to be good. Few authors describe the measurements used to assess the postoperative function of the thumb. We review the results of 15 patients, who underwent surgery between 1982 and 1987. We found that the number of patients satisfied with the operation was consistent with that reported in the literature. On the other hand, we found poor agreement between the subjective complaints and the objective findings. We therefore propose and describe a scoring system to assess subjective impressions of the result and the objective findings. Surgical procedures are not discussed. However, the duration of immobilization of the thumb should, perhaps, be reconsidered. Further studies may show that a shorter period of immobilization in plaster, the use of dynamic bandaging, or early starting of physiotherapy produce better results.

Posterior tibial tendon dysfunction

Posterior tibial tendon dysfunction, a common entity, frequently is unrecognized and inappropriately managed. Acutely, pain and swelling are present over the medial ankle and longitudinal arch. Long-standing inflammation can lead to tendon rupture, resulting in a progressive planovalgus or “flat foot” deformity. Plain radiographs illustrate the changes in bony anatomy associated with chronic posterior tibial deficiency, while magnetic resonance imaging scans can identify the three stages of posterior tibial tendon pathology. Most cases are amenable to conservative therapy, including rest and administration of nonsteroidal antiflammatory agents. Often a short period of immobilization in a cast or the use of an orthosis is beneficial. In cases with persistent tenosynovitis, complete tendon rupture, or progressive deformity, surgical intervention is indicated.

Soft-tissue treatment of scaphoid nonunions

Bentzon's surgical technique for treatment of symptomatic scaphoid pseudoarthroses is described. The operation entails conversion of painful nonunions to painless ones by interposition of a capsular flap between the fracture fragments. The operation is attractive because of its simplicity, short period of postoperative immobilization, and good early results. However, the probability of late radiocarpal and intercarpal arthritis due to maintenance of an unstable scaphoid leaves few indications for this procedure at the present time.

Heparin, deep venous thrombosis, and trauma patients

One hundred consecutive patients with multiple trauma, who were admitted to a level I trauma center with an injury severity score of 10 or greater, were studied prospectively. A duplex scan was used to evaluate each patient initially and at set intervals during the hospitalization for the presence of deep vein thrombosis (DVT). The prophylactic regimen for DVT in this study was 5,000 U of subcutaneous heparin every 12 hours. This was used in 50 patients at the discretion of the attending physician, while the remaining 50 patients received no DVT prophylaxis. Fourteen of 50 patients (28%) who were receiving heparin developed DVT, while only 1 patient (2%) of the 50 who did not receive heparin developed DVT. The use of heparin did not provide any significant protection in the susceptible trauma patient. It is believed that those patients with minimal lower extremity injuries, lower injury severity scores, and a shorter period of immobilization do not require any form of DVT prophylaxis. However, those patients at increased risk for DVT are better served with either increased doses of heparin or alternative forms of DVT prophylaxis.

Field immobilization of lions using disassociative anaesthetics in combination with sedatives

SummaryZoletil (CI‐744) proved to be a useful drug combination for lions during 64 immobilizations. The duration of Zoletil immobilizations were dosage dependent, but the onset of immobilization was similar for both low and high dosages. These characteristics were pragmatic in that low dosages of Zoletil were used for the initial dose, which was delivered by dart‐syringe. This practice facilitated either a short duration of immobility, or the possibility of adding an additional dose by hand, which prevented the loss of large amounts of Zoletil in the case of a dart failure. Ketamine and xylazine were used on 120 lions at dosages of 7.5 and 3.5mgkg‐l, respectively, and antagonized with 3.9mg kg‐1 Tolazoline. Disadvantages of the ketamine/xylazine combination were the inability to use lower dosages for short periods of immobilization and the large volumes required. Midazolam served as a practical drug for the capture of retiring and unapproachable lions, and significantly increased trapping success. Additional notes are presented on the use of Ro 15–3505 as an antagonist for Zoletil immobilization in lions.

The effects of short periods of immobilization on the hamster circadian clock

Recent findings indicate that stimuli which induce an acute increase in locomotor activity can induce phase shifts in the circadian clock of hamsters. Support for the actual role of the acute increase in activity in the mediation of these phase shifts is provided by the observation that immobilization can totally block phase shifts in the activity rhythm that are normally induced in response to exposure to two of these stimuli, either a pulse of darkness or an injection of a benzodiazepine. In order to further examine the effects of immobilization on the circadian system of hamsters, 3 studies were carried out. In a first study, the effects of a 3-h period of immobilization procedure on the phase of the free running circadian rhythm of locomotor activity were tested at 8 different circadian times. Immobilization during the highly active part of the animal's activity cycle resulted in phase delays in the activity rhythm, while immobilization at other circadian times had little or no effect on the circadian time-keeping system. In two other studies, we reported that immobilization had no effect on phase shifts normally induced by 3-h pulses of light or injections of the protein synthesis inhibitor, cycloheximide, two stimuli that are clearly not associated with an increase in locomotor activity in hamsters. Thus, the ability of immobilization to block stimulus-induced phase shifts in the circadian clock appears to be specific to those stimuli that induce an acute increase in locomotor activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes induced in growing rat bone by immobilization and remobilization

We studied changes in bone mass and histology in growing rats after different relatively short periods of immobilization and during subsequent remobilization. Immobilization-induced loss of bone weight is mainly due to mineral losses as indicated by changes in wet weight, ash weight, and calcium content. 45Ca 2+ incorporation was found to be decreased in immobilized bones and showed strong dependence upon the age of the rats. Histological examination showed rapid and extensive trabecular bone loss, and external measurements of bone length and diameter confirmed that a substantial part of the decrease in bone mass was due to actual trabecular bone loss and not the reduction of external bone volume. Two of the methods studied, cast immobilization and reversible neurectomy, allow subsequent remobilization and thus enable recovery of the bone to be studied. Bone ash weights were 12.3 ± 1.12% and 13.1 ± 1.82% below the control values in the tibia and the femur, respectively, after three weeks of cast immobilization and 12.0 ± 1.10% and 9.2 ± 0.90% below after three weeks of immobilization by reversible neurectomy. The bone mineral mass recovered by 40% ( p < 0.053) in the femur and 67% ( p < 0.027) in the tibia during the three weeks' remobilization following one week of cast immobilization, and 62% ( p < 0.001) in the tibia but only 38% ( p < 0.073) in the femur after three weeks of cast immobilization. Mobility of the extremity was restored after three weeks of immobilization by reversible neurectomy, whereupon about half of the lost bone mass was recovered in both the tibia and the femur during six weeks of reinnervation. The results indicate that the loss of the bone mass is reversible to a certain extent, and that the recovery depends on the duration of the immobilization period.

A comparison of xylazine and methohexitone for the chemical immobilization of reeves' muntjac ( Muntiacus reevesi)

The advantages and disadvantages of xylazine and methohexitone for immobilizing captive and free-living muntjac were compared. Twenty deer were immobilized with xylazine on 36 occasions, and 19 deer were immobilized with methohexitone on 26 occasions. Xylazine was unpredictable in its effects, particularly with free-living muntjac, and the protracted recovery phase severely restricted its value for field use. In comparison methohexitone was quick acting, the level of anaesthesia induced more controllable, and the recovery phase rapid. For the field biologist, who normally requires a short period of immobilization and a rapid recovery, methohexitone would appear to be preferable to xylazine for use with muntjac. The main disadvantage of methohexitone was that some animals underwent periods of excitatory behaviour during recovery, and so the deer had to be left in an open area clear of obstructions to recover. The extent of the excitatory behaviour could be reduced by avoiding unnecessary stimuli during the recovery period. Xylazine would be more appropriate where calm recovery was essential, such as with captive animals that must recover in a small enclosure or must be transported following sedation.

Treatment of Carpal Scaphoid Fracture

Fracture of the carpal scaphoid bone is the most common fracture of the carpus. Unfortunately. nonunion are common since the symptoms do not alert patients to seek early medical treatment and the diagnosis is easily missed. Fracture of the scaphoid is a common condition whose management remains controversial. The conservative treatment has many complications, these include inability to work while in plaster, stiffness of the wrist afterwards, muscle wasting, weakness and malunion. So various operative treatments of scaphoid fracture have been developed. Open reduction by use of screws suggested by Maclaughlin first in 1954. In 1984 a new and simple operative technique has been developed to provide rigid internal fixation for all types of fractures of the scaphoid by T.J. Herbert. This involves the use of a double-treaded bone screw which provides good fixation that, after operation, a plaster cast is rarely required and most patients are able to return to work within a few weeks. Authors have experienced 10 cases of scaphoid fracture and accomplished good result in all cases by internal fixation using Herbert screw. The results are as follows : Of these 10 fractures, 2 were fresh fractures and 8 were non unions of scaphoid fracture. In nonunion cases, the time interval between fracture and operation was from 5 months to 5 years. The postoperative immobilization period was average of 4 weeks. Short period of immobilization achieved early functional recovery of the wrist. The bony unions in roentgenogram were seen from 3 months to 9 months after operation. In 2 cases the fracture gap was seen after 9 months. But in these cases the symptoms such as pain and range of motion of wrist were improved.

The Effect of Tension Band Wiring in the Treatment of the Olecranon Fracture

Treatment of olecranon fractures by prolonged immobilization often results in limited elbow motion. With the use of tension band wiring, anatomical reduction was obtainable, and only a short period of immobilization was needed. We reviewed the cases of 17 patients who underwent surgical treatment of the olecranon fracture. All patients were treated by tension band wiring. In the over-all series, we were able to obtain 53 per cent excellent, 30 per cent good, and 17 per cent fair results.

Posterior Dislocation of the Radial Head without Fracture of the Ulna

Posterior radial head dislocation without fracture of the ulna in an adult is extremely rare. A case is presented in which immediate closed reduction, a short period of immobilization, and early active range of motion resulted in a very good outcome. Early detection by thorough physical examination and careful radiographic analysis is crucial for a good final result.

Dislocation of the elbow joint.

Although dislocation of the elbow is a common injury, it has been the subject of very few papers in the orthopaedic literature during the last 20 years. The recommendations for treatment have usually been conservative but in later years wider indications for surgical treatment with ligament repair have been recommended. Seventy-two patients with simple elbow dislocations (38) and fracture dislocations (34) treated at the departments of orthopaedic surgery in Göteborg 1975-1980 were reviewed. Results for patients with simple dislocations were excellent and good in 85 per cent and no difference could be recorded between those treated by surgery and those treated conservatively. Results after treatment of fracture-dislocations were generally worse and only 41 per cent achieved excellent or good results. We concluded that most simple dislocations should be treated conservatively with closed reduction followed by a short period of immobilization. In fracture-dislocations surgical repair of the elbow ligaments should be considered especially when the radial head has been excised.

Experience with the McAtee olecranon device in olecranon fractures.

Treatment of olecranon fractures by prolonged immobilization often results in limited elbow motion. With the use of a compression screw apparatus, anatomical reduction was obtainable, and only a short period of immobilization was needed. In a series of eleven fractures there were no non-unions and an average decrease in elbow range of motion of only 8 degrees.

RUSH PIN INTRAMEDULLARY FIXATION FOR FRACTURES OF THE PROXIMAL HUMERUS

We have treated almost 700 proximal humeral fractures, and selected from them a series of 16 cases which required operative intervention in the form of semiclosed reduction and internal fixation with the Rush pin because of the marked amount of displacement and risk on nonunion. We favor the 3/16 inch Rush pin for this operation. Fractures of the surgical neck comprise the vast majority of cases operated upon in this series. They are the easiest to reduce and fix by the Rush pin technique. Certain comminuted severely displaced fractures involving the anatomic neck of the humerus and/or greater and lesser tuberosities also lend themselves to this operation with comparable results to other methods of treatment. There have been no postoperative motalities and minimal morbidity. The operation can be performed rapidly and requires only a short period of immobilization and hospitalization.