Splinting Techniques Research Articles

Influences of Repair Site Tension and Conduit Splinting on Peripheral Nerve Reconstruction.

We investigated the use of a conduit splinting technique to mitigate tension at the coaptation site of a rodent nerve defect model to determine the optimal reconstruction method for segmental nerve defects. A rat sciatic nerve segmental defect model was created by excising 5mm of the sciatic nerve unilaterally. Four groups of 10 rats were each reconstructed using 1 of 4 techniques: primary repair, repair with conduit splinting, reverse isograft with conduit splinting, and reverse isograft without splinting. Functional outcomes were assessed at 6 weeks by measurement of Sciatic Functional Index (SFI), and sciatic nerves were harvested at the nonsurvival surgery. Histomorphologic measurements were reported as a value normalized to the average measurements of the control side. The primary outcomes were assessment of nerve continuity and the proportion of nerve fibers in the regenerating nerve compared with the uninjured side. The number of repair site rupture rates was lower when a conduit splint was used-less than half of the primary repairs under tension remained intact at 6 weeks. No difference was seen in axon number, size, and density between primary repairs and those augmented by conduit splints, but worse functional outcomes and more debris were present compared with the intact primary repairs. Nerve conduit splinting reduced rupture rates, particularly for nerve repairs associated with a segmental defect. No significant difference was seen in the number of axons among techniques. Primary nerve repair under tension that did not rupture demonstrated superior SFI.

Operative fixation of type IV-VI acromioclavicular joint separation: an internal splint technique

<p class="abstract">Treatment of acromioclavicular (AC) joint separation is controversial. Rockwood type I, II, III AC joint injuries generally treated conservatively. In the literature there is various treatment options described for treating type IV - VI injuries with good and poor outcome but no single gold standard method. Rockwood type IV - VI AC joint separation treated with internal splint technique by passing Merselene tape through drill hole at lateral end clavicle, passing it under coracoid process and tied it after reducing vertical displacement of AC joint. Simultaneously horizontal displacement corrected and Merselene tape passed through drill hole of acromian process and tied. Endobuttn supports Merselene tape at superior aspect of clavicle. This study was conducted between April 2015 to March 2019 in KPC Medical College and hospital, Kolkata after taking ethical committee permission. 20 patients undergo surgical fixation of type IV-VI AC joint separation within 3 weeks of injury. Outcome of clinical and radiological parameter assessment was at 6, 12, 24 weeks. Male female ratio was 7:3. Mean age 38.2 years, abduction was less than 100 degree in 2 patients at 6 months follow up due to inadequate compliance to physiotherapy. Other patients develop full Range of motion (ROM) and power of shoulder muscle 5/5. No cosmetic deformity except one painful scar. No postoperative displacement in alignment in Anteroposterior (AP) and axillary lateral view. This technique of interal spilint construct reduces need for rigid implant and biological procedure for acute AC joint dislocation though having excellent fixation strength, good reduction in both coronal and sagittal plane for proper healing of AC and Coracoclavicular (CC) ligaments.</p>

An experimental study using known variants of transport immobilization and comparing them with the original temporary splint for the treatment of jaw fractures

Academician I.P. Pavlov Ryazan state medical University of the Ministry of health of the Russian Federation, 390026, Ryazan, Russian Federation
 Patients with injuries of the maxillofacial region make up about 30% of all patients treated in the in-patient departments of maxillofacial surgery. Meanwhile, fractures of the lower jaw account for about 70%85% of all fractures of the bones of the face. The need for immobilization is due to the risk of pain and complications (bleeding, microbial contamination, asphyxiation, damage to nerves and blood vessels). The article provides a comparative analysis between temporary immobilization of the jaws using well-known designs and a new universal temporary bus with a channel. We conducted the experiment under simulated conditions using the following splinting structures: a smooth splint bar and a patented temporary splint with a channel for treating jaw fractures (Application No. 2020103350/14 (005106) (22) Application submission date 27.01.2020). From the experimental research complex, it was possible to verify that the methods of temporary splinting of the jaws have their own characteristics of superposition and displacement of structures. It is worth noting that the displacement of jaw fragments occurred in each splinting and this should definitely be taken into account at the stage of first aid. The study also revealed that that the splinting technique for the splint has a number of disadvantages, the most significant of which are the negative impact on periodontal disease, a significant decrease in oral hygiene, and the possibility of secondary infection. Among the obvious advantages of a universal temporary bus with a channel, include the simplicity of applying and fixing fragments, the ability to supply the patient, receive fluids and drugs through the probe, as well as ensuring full breathing in the absence of nasal breathing.

Clinical outcomes comparison of distal radius fractures between two conservative treatment methods: Below-arm cast versus reverse sugar tong splint

BackgroundThe purpose of this prospective randomized study was to compare a new reverse sugar tong splint technique with a below-arm cast, in terms of patient radiological and clinical outcomes. MethodsOne hundred and forty patients who presented to our clinic between April 2017 and March 2019 were randomly divided into two groups: 70 received reverse sugar tong (RST group) and 70 received below arm cast (BAC group). Clinical and radiological follow-up was performed 7–10 days, three weeks, 5 or 6 weeks, 12 weeks and one year after the treatment. Clinical outcomes including wrist range of motion, complication rates, Health Assessment Questionnaire (HAQ) score at end of treatment, Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaire and Mayo Elbow Performance score (MEPS) score at 12 weeks and last follow-up. ResultsFinally, sixty-five patients were treated with BAC, and their average age was 58.2 years and sixty-two patients with an average age of 57.4 years were treated with RST were completed the radiological and clinical one-year follow-up. There were no significant differences in range of motion, radiological parameters, the Q-DASH and MEPS scores between the groups the 12th week and last visit; however, the HAQ score was significantly higher in the cast group during the 6th visit (p < 0.001). The BAC group had a higher complication rate (40%) than the RST group (19.3%) (p = 0.01). ConclusionPatient treated with RST had a higher functional status at end of treatment and lower complications when comparing traditional below arm cast. Level of evidenceLevel I prognostic randomized controlled trial.

EVALUATION OF ACCURACY OF TWO DIFFERENT IMPRESSION MATERIALS AND THREE DIFFERENT IMPRESSION TECHNIQUES ON THE VERTICAL MISFIT OF A THREE UNIT IMPLANT SUPPORTED FIXED DENTURE PROSTHESES

&#x0D; &#x0D; &#x0D; AIM: The aim of the study is to evaluate the accuracy of two different impression materials and three different impression techniques on the vertical misfit of a three-unit implant supported fixed denture prostheses.Materials and Methods: A total of 60 casts were fabricated for the present study with a closed tray, open tray and open tray splinted abutment impression technique. Two different commercially available impression materials were used - polyether and addition silicone. Both the materials were used for all the above impression techniques.Results: Accordingtotheresultderivedfromthisstudypolyethershowedleastmarginalgap.On the other hand on the basis of impression techniques open tray impression with splinted transfer coping also exhibited a minimum marginal gap.Conclusion: 1. Higher marginal accuracy was found in impressions made by polyether compared to polyvinyl siloxane. 2. Open tray splinted technique exhibited a minimum marginal gap when used with polyether as impression material compared to open tray non splinted technique and closed tray technique.&#x0D; &#x0D; &#x0D;

COMPARATIVE CHARACTERISTICS OF TRANSFERS SPLINTING TECHNIQUES IN THE PROCESS OF TAKING ONE-STAGE DOUBLE-LAYERED DENTAL IMPRESSIONS BY MEANS OF OPEN TRAY IMPRESSION TECHNIQUE

Abstract. According to conclusions of ITI World Congress (2018), the accuracy of the dental impression determines the quality of the working model and, consequently, the fixation of the prosthetic restorations at the final stage. Inaccurate dental impression will inevitably lead to technical and biological complications (Wolfart S., 2016). According to Lee and co-authors (2019), the accuracy of the dental impression is influenced by the chosen method, namely closed or open tray, the presence or absence of transfers splinting and the choice of impression material type.&#x0D; The most accurate impression has been proved to be an impression taken with the use of an open tray impression technique, by means of polyether impression material with preliminary transfers splinting using internally interfaced implant system.&#x0D; The objective of the research was to evaluate the quality of implants placement transferring to the model by comparative analysis of different methods of clinical transfers splinting in order to take impressions using an open tray impression technique.&#x0D; Twelve clinical situations were studied. Four groups were formed according to the method of transfer splinting. Each group included 3 clinical cases. Impressions were taken with the use of an open tray impression technique in all clinical cases with preliminary custom-made trays with holes in the implants projections.&#x0D; A grading scale was created when assessing the quality of transfer splinting as a key factor in the accuracy of implant placement transferring.&#x0D; Each of the groups received from 1 to 4 points where 1 point was the worst result according to this criterion and 4 points meant the best one. Among the criteria for splinting quality evaluation, 1-3 criteria were considered to be subjective, criterion 4 was considered to be objective. Therefore, criterion 4 received coefficient ×2 in order to increase the objectivity of the results evaluation.&#x0D; There were 4 criteria:&#x0D; &#x0D; The simplicity of the technique and the time spent splinting.&#x0D; The cost of the technique.&#x0D; Passivity when fixing the bridge prosthetic restoration after manufacturing.&#x0D; Radiologically measured distance between the centers of implant analogues on the model relative to each other after an impression taking by means of different splinting techniques and deviation of the value from the position of the centers of implants heads tops after osseointegration according to CT scan.&#x0D; &#x0D; Analyzing the results of the research, splinting techniques were ranked according to the obtained points.&#x0D; Research group 1 scored 6 points using dental floss and flowable compomer. A considerable amount of time was spent splinting with relatively inexpensive technology. The passivity of the fixation was the worst in comparison with other methods and the largest error was determined radiographically.&#x0D; Group 4 scoring 17 points was determined as the best of the chosen techniques. Despite the high cost of the chosen technique, prosthetic restorations made after transfers splinting by means of this technique had the highest fixation accuracy and the lowest deviation of the implants analogues on the model radiographically in comparison with the position of the implants in the upper alveolar ridge and lower alveolar ridge due to the cost of the material based on poly-vinyl siloxane.

The Effects of Splinting on the Initial Stability and Displacement Pattern of Periodontio-Integrated Dental Implants: A Finite Element Investigation

Even though the regeneration of periodontium tissue (PDT) around dental implants was of interest in recent years, this process was not investigated from a biomechanical point of view, to date. The purpose of this finite element study was to assess the impact of splinting technique on the initial stability and movement pattern of a tooth-shaped dental implant surrounded by periodontal ligament stem cells (PDLSCs) and was under occlusal forces. A composite polymeric tooth-shaped dental implant, i.e., an artificial tooth model was constructed and connected to its adjacent teeth by two splints at the buccal and lingual sides. The displacement pattern of natural and artificial teeth under masticatory load, their center of rotation positions, and von Mises stresses for splints were calculated. Results of this study showed that splinting of a tooth-shaped dental implant can provide a tooth-like movement for the implant under masticatory loads, by up to 3.4 µm deviation in mesio-distal, 5.1 µm in bucco-lingual, and 9.5 µm in occluso-apical directions, compared with natural teeth. Also, it was shown that nickel-chrome splints have enough strength to provide the required initial stability for the artificial tooth under occlusal forces. Based on this investigation, the splinting technique can provide enough stability and a tooth-like movement for a tooth-shaped dental implant under masticatory loads. It is speculated that by mimicking the shape and movement pattern of a natural tooth, the implant can transfer proper mechanical stimuli to the PDLSCs around its root, and consequently, would lead to proper regeneration of PDT.

Surgical Pearl: A Novel Technique of Ingrown Nail Splinting

Surgical Pearl: A Novel Technique of Ingrown Nail Splinting

Prospective Study of Military Special Operations Medical Personnel and Lower Extremity Fracture Immobilization in an Austere Environment.

Background:Austere fracture immobilization equipment and techniques are often overlooked, with few studies critically evaluating the process. The purpose of this study was to evaluate current austere splinting techniques and equipment used for lower extremity fractures while field testing a new 1-step spray-on foam splint.Methods:This is a prospective analysis of austere splinting techniques. A cadaveric model with a distal third tibia-fibula fracture was used for testing. The specimens were placed in an austere environment and participants immobilized the injury with standard equipment (structural aluminum malleable [SAM] splint, 6-in. ACE wrap) while being critically evaluated. The specimens were also immobilized with a 1-step in-situ foam splint.Results:Twenty-one military Special Operations medical personnel participated. Each participant was observed and scored by a single orthopedic foot and ankle surgeon using a Likert scale based on 10 splinting criteria. Standard splinting resulted in an average score of 32.2 (range, 5-50), with significant deficiencies in fracture traction (1/5), fracture motion (2.9/5), protection of neurovascular structures (3/5), and soft tissue manipulation (3/5). The average time to completion was 203 seconds, with 1 splint failure. The spray-on foam splinting technique yielded a significantly higher score of 48.5 while completing the task significantly faster (68 seconds), with no failures.Conclusion:Special Operations medical personnel demonstrated success in immobilizing a complex fracture with standard techniques in a cadaveric model. However, testing demonstrated the inherent inability of the SAM splint to provide longitudinal traction while simultaneously allowing excessive fracture motion and potential injury to the soft tissues. In comparison, our spray-on foam proof of concept technique eliminated motion by allowing an in situ application with adequate rigidity.Clinical Relevance:This experiment included a likert scale to critically evaluate splinting techniques and equipment. It reliably tested standard splinting equipment and a 1-step in-situ foam splint for distal third tibia-fibula fractures.

Treating Infant Population Fracture Mandible by Prof. Katpar’s Innovative Splint technique: Reported from Pakistan

Treating Infant Population Fracture Mandible by Prof. Katpar’s Innovative Splint technique: Reported from Pakistan

How many implants are necessary to stabilise an implant-supported maxillary overdenture?

Data sources Pubmed and EMBASE databases were searched from 2000 to 2017 and complemented by manual searching of the references of reviews and the full-text articles assessed for inclusion.Study selection The inclusion criteria were: (i) Randomised clinical trials (RCT), prospective or retrospective studies, and case series or case reports including at least ten totally edentulous patients rehabilitated with maxillary implant-supported overdenture; (ii) analysed one of the following outcomes: survival rate of the implants, survival rate of the overdenture and patient-reported results; (iii) had at least two years of follow-up; (iv) and were written in English language.Data extraction and synthesis The data extraction was performed by two independent reviewers. The comparison of the analysed outcomes was performed by nonparametric Fisher Test for unpaired data according to the number of implants and to the splinting technique. A meta-analysis was performed for the odds ratio (OR) for implant failure between four splinted implants and more than four splinted implants.Results Twenty-eight studies were included in the systematic review. The survival rate of implants appeared to be higher when at least four implants were placed to support the overdenture, compared to less than four implants. The survival rate of overdentures and the patient satisfaction were not influenced by the number of implants.The metanalysis could only be performed to compare the implant survival rate of a four splinted implants group and more than 4 splinted implants group, without significant differences between both groups (OR = 0.39; 95 % CI: 0.14, 1.14; p = 0.09).Conclusions Although the placement of at least four implants to support a maxillary overdenture seems to report higher implant survival rates, further studies are needed to confirm this conclusion. No differences were found for overdenture survival rates or patient satisfaction according to the number of implants.

To evaluate and compare the accuracy of definitive casts using various splinting methods on implant level impressions in All-on-Four treatment: An in vitro study.

Aim:The aim of this study is to evaluate and compare the accuracy of master casts obtained by different splinting techniques for implant level impressions in All-on-Four implant treatment protocol using a coordinate measuring machine.Settings and Design:The study design involves an in vitro study.Materials and Methods:In this in vitro study, a reference clear acrylic resin (AR) model comprising four regular platform implant 3.6 mm × 10.0 mm (Dentium Implant India Pvt. Ltd, Bengaluru, India) which was placed following the All-on-Four implant protocol is prepared. Impressions were categorized into three different groups: Group 1 – impression copings were nonsplinted; Group 2 – impression copings were splinted using AR sectioned 17 min after setting and rewelded with the same resin; and Group 3 – impression copings were splinted by titanium bar using an intraoral welder. A total of 33 (n = 11 in each group) impressions were made to evaluate three different splinting techniques. Impressions were poured with Type 4 dental stone. A coordinate measuring machine was used to record the x, y, and z co-ordinates and angular displacement. The measurements were compared with those obtained from the reference model.Statistical Analysis Used:One-way ANOVA test was used as a test of significance.Results:There was less linear and rotational displacement for the metal-splinted group (P < 0.001) In the x-axis, nonsplinted group showed a statistically significant difference in straight implants (2 and 3 implants) (P = 0.001) of All-on-Four treatment protocol.Conclusion:The splinting methods have a direct effect on the accuracy of definitive casts. The metal-splinted direct technique produced the most accurate casts followed by AR-splinted direct technique and nonsplinted direct technique.

Lower-Extremity Skeletal Traction Following Orthopaedic Trauma: Indications, Techniques, and Evidence.

» Skeletal traction is a fundamental tool for the orthopaedic surgeon caring for patients with traumatic pelvic and lower-extremity injuries.» Immobilization of fractures in the pelvis, acetabulum, and proximal part of the femur can be difficult with traditional splinting techniques. Skeletal traction has proved to be an effective alternative means of immobilization in such cases.» Traction may be utilized for both temporary and definitive treatment of a variety of orthopaedic injuries.» With the appropriate knowledge of regional anatomy, skeletal traction pins can be placed safely and with a low rate of complications.» Several methods for placing skeletal traction have been described, and it is critical for orthopaedic surgeons not only to be proficient in their application but also to understand the appropriate indications for use.

Fracture Immobilization in an Austere Environment: A Comparative Study of Military Special Operations Medical Personnel using a SAM Splint vs a One-Step Spray on Foam

Category:TraumaIntroduction/Purpose:Improved body-armor and mine resistant vehicles have improved battlefield survivability, but now nearly 50% of casualties have a musculoskeletal extremity injury. The purpose of the current study was to evaluate current SAM splint techniques utilized for a distal Tib/Fib fracture verse a new one-step spray on foam immobilization technique.Methods:A cadaveric model with a distal third combined tibia-fibula fracture was used for testing. The specimens were placed in an austere environment and participants immobilized the injury with standard equipment (SAM splint, 6in Ace wrap). The test group immobilized the injury with a one-step in-situ spray on foam splint.Results:Twenty-one military Joint Special Operations Command (JSOC) medical personnel (11 Medics, 4 PAs, 6 Physicians) participated with an average of 7.7 years as a provider and 25.4 months deployed in a combat theater. Each participant was observed and scored by a single orthopedic foot and ankle surgeon using a Likert scale based on 10 splinting criteria. Standard SAM splinting resulted in an average score of 32.2 (range, 5-50), with significant deficiencies in fracture traction (1/5), fracture motion (2.9/5), protection of neurovascular structures (3/5), and soft tissue manipulation (3/5). The average time to completion was (203 sec), with one splint failure. The spray on foam splinting technique yielded a significantly higher score of 48.5 while completing the task significantly faster at 68 sec with no failures.Conclusion:JSOC medical personnel demonstrated overwhelming success in immobilizing a complex extremity fracture with a SAM splint. Testing demonstrated the inherent inability of the SAM splint to provide longitudinal traction while simultaneously allowing excessive fracture motion and potential injury to the soft tissues. In addition, our spray-on foam proof of concept technique eliminated motion and provided traction by allowing in-situ application with adequate rigidity.

New, easier, effective, and stable splinting technique for maxillofacial osteotomy

New, easier, effective, and stable splinting technique for maxillofacial osteotomy

Examination of surgical and conservative treatment effects on depression of patients with moderate carpal tunnel syndrome

Objective: The aim of this study is to examine the outcomes of conservative and surgical treatments of patients with carpal tunnel syndrome as well as the effects of these two treatment options on depressive symptoms of these patients. Methods: A case-control study carried out from June 2015 to Fabruary 2016 and 111 moderate moderate carpal tunnel syndrome patients were included in the study whose diagnosis was confirmed by electroneuromyography (ENMG). The 78 of the patients had surgical treatment and 33 of them, who did not accept the surgery, received steroids via injection and splinting technique was performed for 8 weeks. Boston Carpal Tunnel Questionnaire, quick disabilities of the arm, shoulder and hand score and Beck Depression Invertory scales were applied six months before and after treatments. Results: It was detected that pain functional assessment scores and Beck depression scores significantly recovered the disease in patients who had surgical treatment compared to ones who had the conservative treatment. Conclusions: It can be concluded that surgical treatment plays a more active role in the recovery of depressive symptoms in patients with moderate carpal tunnel syndrome.

Accuracy of multi-implant impressions using 3D-printing custom trays and splinting versus conventional techniques for complete arches.

To assess the three-dimensional (3D) accuracy of multi-implant impressions for complete arches obtained using 3D printing technology, and to determine the clinical feasibility of this approach by comparing the results obtained with those obtained with conventional impression techniques. A maxillary model matrix with four implant analogs was used to fabricate 10 stone reference models (control) to simulate edentulous patients. Ten 3D-printed impressions were made using polylactic acid custom open trays with component splinting (3D-printed group). To make 10 conventional impressions of the reference models, the poly(methyl methacrylate) open trays with splinting technique was used (conventional group). Impressions were poured with a type IV dental stone, which had been digitalized utilizing a high-resolution laboratory scanner after connecting the polymer scan bodies. Standard tessellation language (STL) datasets from the two groups of stone models were superimposed with the corresponding reference models. The interimplant distances and interimplant angulations for each implant pair were measured for the reference models and for the two test groups' definitive models, to assess 3D deviations. In addition, the mechanical properties of polylactic acid and poly(methyl methacrylate) tray materials were compared by means of three-point loading and tensile bond tests. The Student t test was used to compare the differences in implant position and mechanical properties between the two groups, while implant angulations were analyzed with Wilcoxon's rank-sum test, at P = .05. There was less implant-position deviation for the 3D-printed group (mean ± SD: 56.37 ± 12.52 μm) than for the conventional group (71.94 ± 18.86 μm) (P = .014). No significant differences were found in angular deviation between the two groups (P > .05). Flexural strength results suggested that polylactic acid (112.7 ± 1.62 MPa) was stronger than poly(methyl methacrylate) (104.0 ± 2.17 MPa; P < .0001). The tensile bond strength of polylactic acid (0.07 ± 0.005 MPa) was higher than that of poly(methyl methacrylate) (0.03 ± 0.004 MPa; P < .0001). The 3D-printing multi-implant impression technique could be an alternative to conventional impression techniques for complete arches.

Congenital Club Foot Treated By Of Ponseti Method : A Short-Term Results

Background: Congenital club foot is a complex deformity of foot .It is a collection of different abnormalities, with different etiologies. Consequently, Severity varies with difficulties in evaluating treatment strategies with outcome results. The treatment of congenital club foot remains controversial. Usually, the orthopedist's goal is to obtain anatomically and functionally normal feet in all patients. Objective: To asses short term follow up result of conservatively treated club feet in relation to the age of initial casting by Ponseti technique. &#x0D; Methods :A cross sectional observational study with some comparative content done in Al-kindy teaching hospital .A total of 36 patients (44 clubfeet) were treated by Ponseti method during the period of October 2014 to April 2017and were studied prospectively (mean follow up period 6 months, minimum follow-up period of 3 months) . Twenty six patients were male, thus male to female ratio is 2.6 : 1. It involved only patients less than two months. The patients were divided in to two groups: Group (A) included patients less than 4 weeks, while Group (B) between 4-8 weeks of age at the initiation of the treatment. gender, bilateralism, severity of the initial clubfoot deformity measured by Pirani Severity Score System, total numbers of Ponseti casts before the tenotomy, details of tenotomy, compliance with brace were examined. Passive range of movements and look of club foot are evaluated with mean six months follow-up. &#x0D; Results: We followed the functional Pirani Severity Scoring System and got good to excellent results in 32 patients 88.9 % (37 clubfeet – 84.1%) at mean 6 months of follow up. Ten patients 27.8 % (12 clubfeet – 27.3%) had relapse at varying age; out of which 6 patients 60% (8clubfeet 66.7%) were corrected by Ponseti casting method, while 4 patients 40% (4 clubfeet 33.3%) were resistant to Ponseti method. Poor compliance with the Denis Browne splint and poor cast technique was thought to be the main cause of failure in these patients. &#x0D; Conclusion: Good understanding the main pathology of club foot, and the ideal method of conservative treatment for correction of the deformities systematically before starting the treatment. In all types of club foot, we start conservative treatment, either as a definite treatment or to make surgical treatment easier for the surgeon and the patient. So Starting the treatment from the first day of life give excellent results and it will be decreased with delay.

Decompression and gutter splint techniques to prevent recurrence in ingrowing toenails

Ingrowing toenails (IT) is puncture of periungual skin by its surrounding nail plate. IT most frequently occurs in males aged 10-30 years. Pathogenesis of IT is multifactorial. Patients most commonly present with toe pain and may also complain erythema, swelling, or discharge from the nail edge. The clinical presentation of IT has been divided into three stages; stage I or inflammatory stages, stage II or abcess formation, and stage III or granulation tissue formation. IT is a nail disease with high reccurences that commonly seen in daily practice. Several treatment approaches ranging from conservative therapy (gutter splint) to surgical treatment (decompression technique). We report a case of IT in a 13-year-old boy that treated with decompression and gutter splint technique. The combination of this technique provides good results for IT and there was no recurrences after two months of observation.

Assessment of Splints Applied for Pediatric Fractures in an Emergency Department/Urgent Care Environment.

Fractures are common in the pediatric population. The initial evaluation is rarely by an orthopaedic surgeon, but commonly an emergency room or urgent care center physician/extender. This typically involves splint application by a nonorthopaedist to immobilize the extremity and provide stabilization. Iatrogenic injuries from inappropriate splint placement are a potential public health and legal concern that can lead to complications. The primary purpose of this study was to prospectively evaluate the adequacy of all splints placed on patients who presented to a pediatric orthopaedic office; secondary outcomes included assessing prevalence and types of complications that were associated with inadequate splints. Patients aged 0 to 18 years who presented with a splint were prospectively enrolled. Information was obtained regarding demographics of the patient and splint placement. Splints were evaluated for functional position, appropriate length, and presence of elastic bandage on the skin. Photographs were taken of each splint, and the extremity was examined for any soft tissue complications. Splints were not removed in 31 patients who had undergone fracture reduction. In total, 275 patients were prospectively enrolled. Splints were improperly placed in 93%, with application of elastic bandage directly to the skin accounting for 77%. Improper positioning was observed in 59%, and inappropriate splint length was present in 52%. Skin and soft tissue complications were observed in 40%. The most common iatrogenic splint-related complication was excessive edema, seen in 28%. Direct injury to the skin and soft tissue was seen in 6%. Many practitioners incorrectly apply splints, potentially leading to suboptimal results or causing injury. Complications of poor splint placement include excessive swelling, skin breakdown, and poor immobilization. Health care workers who treat pediatric fractures may benefit from more extensive education regarding proper splinting techniques. Level 2-therapeutic study.