Soft Bandage Research Articles

Gelatin Methacrylate as an Enzyme-Controlled Release Vehicle of Hyaluronic Acid for the Treatment of Recurrent Corneal Erosion.

Recurrent corneal erosion (RCE) is a condition where the superficial corneal epithelial cells sporadically shed because of poor attachment to the underlying basement membrane, resulting in pain and discomfort. RCE-afflicted corneas exhibit elevated biological factors and enzymes, such as matrix metalloproteinase (MMP)-9. Soft bandage contact lenses (BCLs) are a commonly recommended treatment as they permit continued vision during recovery. However, they do not outperform alternative treatments as they currently lack active ingredients for ocular surface repair. Development of BCLs with a sustained release of active ingredients to promote RCE wound healing over an extended period of time would be clinically valuable. We fabricated gelatin methacrylate (GelMA) hydrogels with MMP-9-triggered controlled release for further BCL development. GelMA disks were characterized to determine the optimal concentration and methacrylation degree for sustained release in the presence of MMP-9. The chosen active ingredient, 60 kDa hyaluronic acid (HA), was verified to promote wound healing in rabbit corneal epithelial cell and human corneal epithelial cell wound assays. The active ingredient was loaded into GelMA hydrogels, and the bioavailability of the vehicle was determined. The GelMA hydrogels revealed a tunable profile for diffusion and enzyme-mediated controlled release of a model molecule. The 60 kDa HA-loaded GelMA disks showed improvement in wound healing at HA loadings of 150 and 250 μg by improving the wound healing rates by 28% (68.7% wound closure) and 26% (67.9% wound closure), respectively, compared to the control (50.5% wound closure) at 24 h. The HA-loaded GelMA disks with 150 and 250 μg HA also exhibited shortened wound closure time of 75 h compared to >147 h with a bolus daily delivery of HA for wound closure. Overall, we demonstrated that the fabricated GelMA hydrogels offered an enzyme-triggered option as a sustained release material for future RCE treatments.

Cryotherapy Improves Limb Use But Delays Normothermia Early After Stifle Joint Surgery in Dogs.

Objective: To evaluate the short-term efficacy and safety of cold compression therapy (CCT) relative to a soft padded bandage (SPB) in dogs undergoing surgery to manage cranial cruciate ligament injury.Methods:Dogs were randomized into groups that received CCT or SPB after surgery. Weight bearing was measured using a weight distribution platform before and the day after surgery. Stifle joint flexion and extension were measured using a goniometer before and the day after surgery. Rectal temperatures were measured every 15 min for 2 h after surgery and the morning after surgery. Mechanical nociceptive thresholds (MNT) were measured using an algometer the day after surgery. Findings in both groups were compared using a mixed model ANOVA.Results:20 dogs were enrolled: 10 in the CCT and 10 in the SPB group. Dogs undergoing CCT had more stifle joint flexion (P = 0.008) and weight bearing (P < 0.001) after surgery than dogs with SPB. MNT after surgery correlated statistically with stifle joint flexion after surgery (r = −0.315, P = 0.014), extension after surgery (r = 0.310, P = 0.016), and weight bearing after surgery (r = 0.314, P = 0.003). Return to normothermia was delayed in the CCT group, with temperatures ~0.5°C (1.0°F) lower 105 (P = 0.018) and 120 min (P = 0.013) after surgery.Conclusion:Relative to bandaging, CCT had a positive short-term impact on stifle flexion and weight bearing. CCT delayed warming after surgery but dogs were only mildly hypothermic [0.5°C [1.0°F]].

The Forearm Fracture Recovery in Children Evaluation (FORCE) trial: statistical and health economic analysis plan for an equivalence randomized controlled trial of treatment for torus fractures of the distal radius in children.

AimsTorus fractures of the distal radius are the most common fractures in children. The NICE non-complex fracture guidelines recently concluded that bandaging was probably the optimal treatment for these injuries. However, across the UK current treatment varies widely due to a lack of evidence underpinning the guidelines. The Forearm Fracture Recovery in Children Evaluation (FORCE) trial evaluates the effect of a soft bandage and immediate discharge compared with rigid immobilization.MethodsFORCE is a multicentre, parallel group randomized controlled equivalence trial. The primary outcome is the Wong-Baker FACES pain score at three days after randomization and the primary analysis of this outcome will use a multivariate linear regression model to compare the two groups. Secondary outcomes are measured at one and seven days, and three and six-weeks post-randomization and include the Patient Reported Outcome Measurement Information System (PROMIS) upper extremity limb score, EuroQoL EQ-5D-Y, analgesia use, school absence, complications, and healthcare resource use. The planned statistical and health economic analyses for this trial are described here. The FORCE trial protocol has been published separately.ConclusionThis paper provides details of the planned analyses for this trial, and will reduce the risks of outcome reporting bias and data driven results.Cite this article: Bone Joint Open 2020;1-6:205–213.

A multicentre prospective randomized equivalence trial of a soft bandage and immediate discharge versus current treatment with rigid immobilization for torus fractures of the distal radius in children: protocol for the Forearm Fracture Recovery in Children Evaluation (FORCE) trial.

AimsTorus fractures are the most common childhood fracture, accounting for 500,000 UK emergency attendances per year. UK treatment varies widely due to lack of scientific evidence. This is the protocol for a randomized controlled equivalence trial of ‘the offer of a soft bandage and immediate discharge’ versus ‘rigid immobilization and follow-up as per the protocol of the treating centre’ in the treatment of torus fractures .MethodsChildren aged four to 15-years-old inclusive who have sustained a torus/buckle fracture of the distal radius with/without an injury to the ulna are eligible to take part. Baseline pain as measured by the Wong Baker FACES pain scale, function using the Patient-Reported Outcomes Measurement Information System (PROMIS) upper limb, and quality of life (QoL) assessed with the EuroQol EQ-5D-Y will be collected. Each patient will be randomly allocated (1:1, stratified by centre and age group (four to seven years and ≥ eight years) to either a regimen of the offer of a soft bandage and immediate discharge or rigid immobilization and follow-up as per the protocol of the treating centre.ResultsAt day one, three, and seven, data on pain, function, QoL, immobilization, and analgesia will be collected. Three and six weeks after injury, the main outcomes plus data on complications, resource use, and school absence will be collected. The primary outcome is the Wong-Baker FACES pain scale at three days post-randomization. All data will be obtained through electronic questionnaires completed by the participants and/or parents/guardian.Cite this article: Bone Joint Open 2020;1-6:214–221.

The Forearm Fracture Recovery in Children Evaluation (FORCE) trial: statistical and health economic analysis plan for an equivalence randomized controlled trial of treatment for torus fractures of the distal radius in children

AimsTorus fractures of the distal radius are the most common fractures in children. The NICE non-complex fracture guidelines recently concluded that bandaging was probably the optimal treatment for these injuries. However, across the UK current treatment varies widely due to a lack of evidence underpinning the guidelines. The Forearm Fracture Recovery in Children Evaluation (FORCE) trial evaluates the effect of a soft bandage and immediate discharge compared with rigid immobilization.MethodsFORCE is a multicentre, parallel group randomized controlled equivalence trial. The primary outcome is the Wong-Baker FACES pain score at three days after randomization and the primary analysis of this outcome will use a multivariate linear regression model to compare the two groups. Secondary outcomes are measured at one and seven days, and three and six-weeks post-randomization and include the Patient Reported Outcome Measurement Information System (PROMIS) upper extremity limb score, EuroQoL EQ-5D-Y, analgesia use, school absence, complications, and healthcare resource use. The planned statistical and health economic analyses for this trial are described here. The FORCE trial protocol has been published separately.ConclusionThis paper provides details of the planned analyses for this trial, and will reduce the risks of outcome reporting bias and data driven results. Cite this article: Bone Joint Open 2020;1-6:205–213.

A multicentre prospective randomized equivalence trial of a soft bandage and immediate discharge versus current treatment with rigid immobilization for torus fractures of the distal radius in children

Aims Torus fractures are the most common childhood fracture, accounting for 500,000 UK emergency attendances per year. UK treatment varies widely due to lack of scientific evidence. This is the protocol for a randomized controlled equivalence trial of ‘the offer of a soft bandage and immediate discharge’ versus ‘rigid immobilization and follow-up as per the protocol of the treating centre’ in the treatment of torus fractures . Methods Children aged four to 15-years-old inclusive who have sustained a torus/buckle fracture of the distal radius with/without an injury to the ulna are eligible to take part. Baseline pain as measured by the Wong Baker FACES pain scale, function using the Patient-Reported Outcomes Measurement Information System (PROMIS) upper limb, and quality of life (QoL) assessed with the EuroQol EQ-5D-Y will be collected. Each patient will be randomly allocated (1:1, stratified by centre and age group (four to seven years and ≥ eight years) to either a regimen of the offer of a soft bandage and immediate discharge or rigid immobilization and follow-up as per the protocol of the treating centre. Results At day one, three, and seven, data on pain, function, QoL, immobilization, and analgesia will be collected. Three and six weeks after injury, the main outcomes plus data on complications, resource use, and school absence will be collected. The primary outcome is the Wong-Baker FACES pain scale at three days post-randomization. All data will be obtained through electronic questionnaires completed by the participants and/or parents/guardian. Cite this article: Bone Joint Open 2020;1-6:214–221.

Treatment of carpal tunnel syndrome with wrist splinting: study protocol for a randomized placebo-controlled trial

BackgroundCarpal tunnel syndrome (CTS) is a common cause of pain, weakness, sensory loss, and activity limitations. Currently, the most common initial treatment is use of a rigid splint immobilizing the wrist, usually during night-time, for several weeks. Evidence regarding the efficacy and effect durability of wrist splinting is weak. The treatment is associated with costs and may cause discomfort and limit daily and work activities. No placebo-controlled trials have been performed.MethodsThis is a randomized controlled trial designed to assess the efficacy of a rigid wrist splint compared with soft wrist bandage (placebo) in patients with primary idiopathic CTS. The trial will be conducted at an orthopedic department. Patients, 25 to 65 years old, who seek primary health-care with symptoms of CTS will be screened, and potentially eligible patients will be referred to the study center. Patients who fulfill the trial’s eligibility criteria will be invited to participate. A total of 112 patients who provide informed consent will be randomly assigned to treatment with either a rigid wrist splint or a soft bandage to be used initially for 6 weeks at night and, if possible, during the day. The splints and bandages will be fitted with a temperature-monitoring device to measure the total time during which they have actually been worn. The trial participants will complete a questionnaire that includes the 6-item CTS symptoms scale (CTS-6); the 11-item disabilities of the arm, shoulder, and hand (QuickDASH) scale; and the EuroQol 5-dimension (EQ-5D) health status and quality-of-life measure at baseline and at 6, 12, 24, and 52 weeks after treatment start. The participants will undergo physical examination and nerve conduction testing at baseline and at 52 weeks. The trial’s primary outcomes are the change in the CTS-6 score from baseline to 12 weeks and the rate of carpal tunnel release surgery at 52 weeks.DiscussionThis is the first placebo-controlled randomized trial with electronic monitoring of actual splint use and will provide evidence regarding the efficacy of wrist splinting in patients with CTS.Trial registrationISRCTN Registry, ISRCTN81836603. Registered on May 5, 2018.

Study of the Efficacy and Safety of Contact Lens Used in Trabeculectomy.

Purpose To investigate the efficacy and safety of soft bandage contact lens used in trabeculectomy. Methods This was a prospective, randomized study which enrolled 200 glaucoma patients (200 eyes). Patients were randomized into Group 1, using contact lens after trabeculectomy, and Group 2, without contact lens. The primary outcome measurement was the comparison of success rates at 12 months after surgery. Qualified surgical success was defined as a postoperative intraocular pressure (IOP) value of 6–21 mmHg with or without topical antiglaucoma medication use at the last follow-up visit. Complete success was defined as the IOP between 6 and 21 mmHg without any antiglaucoma medication at the last follow-up visit. Postoperative data included IOP values, best-corrected visual acuity (BCVA), number of antiglaucoma medications, complications related to surgery, and bleb characteristics. Results There were statistically significant differences between Groups 1 and 2 in mean IOP values at 3, 6, and 12 months after surgery (P < 0.05). The 12-month life table rates for qualified surgical success were 94.7% and 86.3% in Groups 1 and 2, respectively (P=0.045). The 12-month life table rates for complete surgical success were 89.6% and 80.0% in Groups 1 and 2, respectively (P=0.042). At 12 months after surgery, the mean numbers of antiglaucoma medications were 0.3 ± 0.4 and 0.5 ± 0.6, respectively. (P=0.001). At the 12-month visit, the maximal bleb area was significantly different between groups (P=0.044), with Group 1 exhibiting a more diffused bleb area. Encysted blebs were observed in 7 (7%) eyes in Group 1 and 17 (17%) eyes in Group 2, with statistically significant differences (P=0.030). The 12-month life table rates for qualified surgical success were 94.7% (91 eyes) and 86.3% (82 eyes) in Groups 1 and 2, respectively (P=0.045). Conclusions Bandage contact lens is a safe and effective device after fornix-based trabeculectomy.

Pain management after photorefractive keratectomy

To evaluate the effect of a bandage contact lens soaked in ketorolac ophthalmic 0.45% solution (Acuvail) on pain modulation in patients having transepithelial photorefractive keratectomy (PRK). Prospective case series. Narayana Nethralaya Superspeciality Eye Hospital, Bangalore, India. Eyes of patients were divided into 2 groups. After transepithelial PRK, a regular soft bandage contact lens was placed in Group 1 and a ketorolac-soaked bandage contact lens was placed in Group 2. The patients were matched for age and sex in the 2 groups. Postoperative pain was compared using the validated Wong-Baker pain scale. Before placement of a ketorolac-soaked bandage contact lens in patients' eyes, the safety of the procedure was checked using cultures from the bandage contact lens and measuring the quantity of the drug adsorbed and the elution profile over time with ultra-high-performance liquid chromatography (UHPLC). Each group comprised 35 eyes of 35 patients. The mean pain score was 7.95±2.12 (SD) in Group 1, which was significantly higher than in Group 2 (2.76±0.85), which received the ketorolac-soaked bandage contact lens. The UHPLC results showed that the soaked bandage contact lens acted as a depot for ketorolac, which was released onto the ocular surface over time, providing postoperative pain relief without causing adverse events. A bandage contact lens soaked in ketorolac 0.45% solution can act as a potential drug depot that can reduce pain after transepithelial PRK.

Effects of short-term immobilization of the upper limb on the somatosensory pathway: a study of short-latency somatosensory evoked potentials.

[Purpose] Previous studies have reported that the nervous system is influenced during short-term cast immobilization. However, the effects of short-term inactivity on somatosensory information processing systems are not well understood. This study investigated the effect of 10 h of upper limb immobilization on the somatosensory pathway using short-latency somatosensory evoked potentials. [Participants and Methods] Twenty right-handed healthy participants (mean age 21.7 years) were enrolled in this study. The participants’ left hands and forearms were wrapped in a soft bandage at a 90° elbow flexed position. The participants were instructed not to move their left hand for 10 h. To obtain short-latency somatosensory evoked potentials, we used a multimodal evoked potential system. The left median nerve was electrically stimulated at a rate of 5 Hz for a duration of 0.2 ms. The intensity of the stimulus was adjusted to induce mild twitches of the thumb. The amplitudes and latencies of the short-latency somatosensory evoked potential components (N9, N13, and N20) were measured before and after immobilization. [Results] The amplitude of the N9 component significantly increased after immobilization. [Conclusion] Our results indicated that the changes in the excitability of the peripheral somatosensory nerve were due to 10 h of inactivity.

Making a difference in quality of life with scleral lenses – Two clinical cases with neurotrophic ulcers

The main use for scleral lenses is visual aid in irregular corneas. However, they are also beneficial as bandage lenses in severe ocular surface disease. Following cases illustrate two different ways to improve quality of life in patients with neurotrophic ulcers, a condition associated with hypoesthesia or anaesthesia of the cornea due to damage to the trigeminal nerve. Case 1 is a male patient who, at age 58 had a stroke that among other things resulted in a slow healing corneal ulcer. To shield the cornea a partial tarsorrhaphy was performed and soft bandage lenses were tried with little or no result. At age 71, he presented at the clinic with a central ulcer and BCVA 0.13. A scleral lens was fitted and two months later the ulcer was completely healed and BCVA had recovered to 0.6. The patient has now worn the scleral lens successfully for two years and the tarsorrhaphy has been reversed. Case 2 is a female patient who, at age 40, had an aneurysm causing an oculomotor nerve palsy leading to semi ptosis, inability to close the eyelid and total lagoftalmus. Over time an ulcer with neovascularisation caused by the corneal exposure developed. Not being able to move the eye, she also suffered from double vision and cosmetically the ptosis was disturbing. At age 48, she was referred to the clinic and a scleral lens was fitted. The ulcer healed completely after 6 weeks. Thanks to an excessive sagittal depth, the eyelid was elevated masking the ptosis. There was a possibility of improving BVCA from 0.05 to 0.3 but the vision was blurred intentionally with a high minus power to relief the double vision. The patient has now worn the lens successfully for two years.

Intermediate Term Outcomes of Early Posttrabeculectomy Bleb Leaks Managed by Large Diameter Soft Bandage Contact Lens

To study the outcomes of large diameter soft bandage contact lens (BCL) in managing early trabeculectomy bleb leak. Of 972 eyes that underwent fornix-based trabeculectomy between 2011 and 2015, 19 eyes with bleb leak with at least 1 year follow-up were eligible. Bleb leak was conservatively managed using large diameter BCL (≥15.5 mm in diameter). Success was defined as complete, if bleb leak resolved and the intraocular pressure (IOP) was ≥5 and ≤18 mm Hg with no additional antiglaucoma medication and failure if surgical intervention was needed. Mean age (±SD) of subjects was 43.5±11.9 years. Mitomycin C was used in 15/19 eyes. Median time (interquartile range) from trabeculectomy to bleb leak was 9 days (interquartile range: 8 to 19 d). Bleb leak was treated with 15.5 mm BCL in 16 eyes and 17 mm lens in 3 eyes. Bleb leak resolved with BCL in 17 [89.5%; 95% confidence interval (95% CI), 68.6-97] and 2 eyes (10.5%; 95% CI, 2-31) required bleb resuturing. Mean duration of BCL wear for bleb leak resolution was 23.7±8.9 days. Mean IOP increased from 5.8±2.7 to 12.5±3.1 mm Hg after resolution of bleb leak (P<0.05). At 16 months, complete success probability of trabeculectomy was 89.4% (95% CI, 75.6%-100%). Large diameter BCL was effective in the management of early bleb leak with good intermediate term success for IOP control. We suggest a trial of soft contact lens of appropriate diameter to manage early bleb leaks, before planning any invasive intervention.

Het gebruik van therapeutische zachte verbandcontactlenzen bij de hond en de kat: een reeks van 41 gevallen

De doelstelling van dit overzicht was om, ondersteund door de literatuur, te illustreren in welke gevallen een zachte verbandcontactlens gebruikt kan worden bij de hond en de kat en hoe nuttig ze zijn. Het voordeel van contactlenzen werd bepaald door na te gaan hoe lang de contactlens in het oog bleef en of ze het comfort van de patiënt verbeterden. De gemiddelde tijd dat de lens in het oog bleef, was 9,8 dagen (zowel bij de hond als de kat). Vroegtijdig verlies van de lens werd vastgesteld in een klein aantal gevallen (7% ). De zachte verbandcontactlenzen verleenden comfort en bescherming ofwel in de aanvankelijke genezingsperiode, of tot het cornea ulcus (hoornvlieszweer) genezen was (in geval van een oppervlakkige zweer van het hoornvlies of een beperkt defect van het hoornvlies stroma) of tot op het moment dat chirurgie plaatsvond (voor trichiasis, entropion). In gevallen van corneale dystrofie werd een verbeterd comfort van de patiënt vastgesteld.

Soft bandage versus casting in the treatment of torus fracture of distal radius in children; a prospective randomized study

Background &amp; Objectives: Various methods of immobilization have been recommended for the treatment of torus fracture of distal radius in children. The purpose of this study is to determine if soft bandage is as effective and safe as below elbow circumferential casts in the treatment of torus fracture of the distal radius in the children.Materials &amp; Methods: Children from 4 to 14 years of age, who presented to emergency and outpatient department of orthopaedics and trauma at National Academy of Medical Sciences with an isolated torus fracture of distal radius, were randomized and treated with either soft bandage or below-elbow plaster cast by the same investigators. Patients with associated neurovascular injuries, bilateral torus fractures, concomitant physeal injuries and associated musculoskeletal injuries were excluded. The patients were followed up at weekly interval for 4 weeks and analyzed with VAS, ROM and outcome questionnaire and data were analyzed by using SPSS 18.Results: Among the 114 patients analyzed, 57 patients were kept in soft bandage group and 57 in below-elbow cast group. The mean age in soft bandage group was 8.29 year and the mean age in below-elbow cast group was 8.55 years. There was no significant difference between the two groups with regard to patient demographics, initial fracture characteristics and mechanism of injury.Conclusion: Treatment of distal radius torus fracture with soft bandage is a cost-effective and safe in the children below 14 years of age. These minor fractures are stable and not subject to the risks of late displacement which can be very effectively treated symptomatically to provide pain relief by using soft bandage only and educating the parents about the nature of this paediatrics fracture.Journal of College of Medical Sciences-Nepal, Vol.11(4) 2015: 3-8

Scleral contact lens management of bilateral exposure and neurotrophic keratopathy

We report an interesting case of therapeutic scleral lens management of bilateral exposure and neurotrophic keratopathy resulting from bilateral cranial nerve (CN) palsies including V, VI and VII, which caused lagophthalmos and anaesthetic corneas. Subsequent development of severe exposure keratitis with vascularisation and keratinisation of the inferior cornea was previously treated with intensive ocular lubrication, botulinum toxin injections to the upper eyelid levator muscle, temporary tarsorrhophies, bilateral amniotic membrane grafts, punctal plugs, lid taping, gold eyelid weights and soft bandage contact lenses. Corneal integrity was re-established but visual acuity remained significantly compromised by corneal vascularisation, scarring and keratin deposits. Visions on presentation to the contact lens department were R 1.90 logMAR, L 1.86 logMAR. Therapeutic, high Dk, non-fenestrated, saline filled, scleral lenses were fitted. Daily wear of these lenses have protected and hydrated the cornea, enabling corneal surface recovery whilst retaining visual and social function. The visual acuities 6 months post-scleral fitting with lenses in situ are R 0.90 logMAR and L logMAR 0.70.

Fungal Keratitis With the Type 1 Boston Keratoprosthesis

To report 2 cases of fungal keratitis and endophthalmitis in patients with the type 1 Boston keratoprosthesis (KPro) in India. Two patients underwent type 1 Boston KPro with uneventful intraoperative and early postoperative courses. The patients presented with keratitis and endophthalmitis within a few months after surgery. Both patients had soft bandage contact lenses in place and were on maintenance low-dose topical steroids and antibiotic eyedrops. Culture was positive for fungus in both the cases. Despite aggressive antifungal medical therapy and surgical management, one patient's eye was eviscerated and the other lost the potential for any useful vision. Fungal infection after KPro surgery can be devastating, negating the extraordinary visual recovery these patients achieve immediately after surgery. Chronic use of topical corticosteroids and broad-spectrum antibiotic and bandage contact lens, although indispensable, may enhance the risk of fungal infection especially in the endemic areas like India. The decision for KPro in such tropical climatic conditions should therefore be taken with absolute caution and frequent patient follow-up. A prophylactic antifungal regime may be mandatory when this procedure is undertaken in fungal endemic areas to improve outcomes.

Functional effect of short-term immobilization: Kinematic changes and recovery on reaching-to-grasp

Although previous investigations agree in showing significant cortical modifications related to short-term limb immobilization, little is known about the functional changes induced by non-use. To address this issue, we studied the kinematic effect of 10h of hand immobilization. In order to prevent any movement, right handed healthy participants wore on their dominant hand a soft bandage. They were requested to perform the same reaching-to-grasping task immediately after immobilization, 1day before (baseline 1) and in other two following days without non-use (baseline 2 and baseline 3). While no differences were found among baseline conditions, an increase of the total duration of reaching movement together with an anticipation of the time to peak velocity were observed in the first trial after immobilization. Interestingly, these initial effects decreased quickly trial-by-trial, following an exponential function till reaching values equal to those observed in the control conditions. The present findings show firstly that the transport phase of the reaching-to-grasp task was affected by a temporary reduction of sensory and motor information. Secondly, a trial-by-trial recovery of the immobilization-related changes, likely driven by the sensory inputs and motor outputs associated to the repetition of the movement has been observed. All together these results confirm a fundamental role of a continuous stream of sensorimotor signals in maintaining motor efficiency and in driving recovery process.

Treatment of torus fractures in the forearm in children using bandage therapy

In a torus fracture, there is an intact cortex at the side of the fracture which gives more intrinsic stability than in greenstick fractures, where one side of the cortex is disrupted. Two previously done studies compared soft bandage therapy (BT) with cast therapy in the treatment of torus forearm fractures in children and showed this is safe and does not cause any complications. The aim of our study was to validate these studies by treating all patients presenting to emergency department with a torus fracture with BT and investigate whether any complications occur. At a single-center from January 2009 to June 2009, all patients with an impacted greenstick fracture of the distal radius and/or ulna without exception were treated using BT. Primary endpoint was secondary angulation; secondary endpoint was pain on Visual Analog Score. Seven patients were misdiagnosed as torus fractures but were actually greenstick fractures and had to be excluded. A total of 49 patients with a torus fracture were included in statistical analysis. No fracture displacement was seen. Four patients needed an additional nonsteroidal antiinflammatory drug or an antalgic plaster cast. The overall Visual Analog Score of the patients was lower than in previous studies. Soft BT is safe in all children without risk of further angulation and with a pain score equal to cast therapy. Important is that misdiagnosis of the torus fracture at initial presentation should be minimized.

Transepithelial corneal collagen cross-linking in ultrathin keratoconic corneas

BackgroundThe purpose of this paper was to report the results of transepithelial corneal collagen cross-linking (CXL) with modified riboflavin and ultraviolet A irradiation in patients affected by keratoconus, each with thinnest pachymetry values of less than 400 μm (with epithelium) and not treatable using standard de-epithelialization techniques.MethodsSixteen patients affected by progressive keratoconus with thinnest pachymetry values ranging from 331 μm to 389 μm underwent transepithelial CXL in one eye using a riboflavin 0.1% solution in 15% Dextran T500 containing ethylenediamine tetra-acetic acid 0.01% and trometamol to enhance epithelial penetration. The patients underwent complete ophthalmological examination, including endothelial cell density measurements and computerized videokeratography, before CXL and at one day, one week, and one, 6, and 12 months thereafter.ResultsEpithelial healing was complete in all patients after one day of use of a soft bandage contact lens. No side effects or damage to the limbal region was observed during the follow-up period. All patients showed slightly improved uncorrected and spectacle-corrected visual acuity; keratometric astigmatism showed reductions (up to 5.3 D) and apical ectasia power decreased (Kmax values reduced up to 4.3 D). Endothelial cell density was unchanged.ConclusionApplication of transepithelial CXL using riboflavin with substances added to enhance epithelial permeability was safe, seemed to be moderately effective in keratoconic eyes with ultrathin corneas, and applications of the procedure could be extended to patients with advanced keratoconus.

Muskulärer Schiefhals

Correction of malalignment of the cervical spine with the head tilted to the side of the shortened muscle and rotation to the opposite side due to a contract sternocleidomastoid muscle. Attainment of an increased range of motion of the cervical spine and a better cosmetic appearance. Regression of a facial asymmetry. Contract sternocleidomastoid muscle with deformity intolerable by the patients and their parents. Bony anomalies with consecutive torticollis. Torticollis caused by other muscular contractures (trapezoid muscle). Torticollis due to acute rheumatoid arthritis or other inflammation around the neck. Other forms of torticollis (psychogenic, ocular, vestibular or spasmodic torticollis). In younger children, subcutaneous tenotomy of the distal part of the sternocleidomastoid muscle. At preschool age, additional incision of the deep cervical fascial layer with an open tenotomy. In delayed operations, open distal and proximal tenotomy together with incision of the deep fascial layer or complete excision of the sternocleidomastoid muscle. Until the age of 6 years, application of a Minerva cast after surgery for 6 weeks. Subsequently, physical therapy for 6 months. In children of school age and older people, application of a soft cervical bandage for 6 weeks with functional physiotherapy. In 83 reexamined patients with muscular torticollis, 76 biterminal and seven distal tenotomies had been performed. Regarding the age at the time of operation and the interval to follow-up, an improvement of facial symmetry could be achieved. At the control, 25 patients showed complete recovery of facial asymmetry, 43 had a slight and 15 a severe asymmetry. The complication rate was low with one injury to the external jugular vein and one transient facial nerve paresis. In two patients, passive overcorrection in the cast resulted in transient paresis. Two patients developed a recurrence of muscular torticollis.