Safety and efficacy of waterproof casting for early onset scoliosis.

PURPOSE: The efficacy of traditional Mehta casting in the treatment of early onset scoliosis (EOS) is well-established. However, waterproof casting has not been previously described. Inherent advantages of waterproof casting include clearance for bathing/swimming, avoiding cast holidays, and improved family satisfaction. The purpose of this study was to assess the safety and efficacy of waterproof serial casting at controlling curve progression in EOS. METHODS: The current study is an IRB-approved Level IV retrospective consecutive cohort of EOS patients who underwent a serial 75% body weight traction-elongation-flexion Mehta cast protocol with waterproof cast padding. The addition of 3-point apical translation with stockinettes was utilized during casting. Bracing was initiated after correction < 15° or 1 year of serial casting. RESULTS: Seventeen patients at mean age 21.6 months, with pre-cast Cobb angle 52.3° (R: 35°-82°), underwent serial waterproof casting. In-cast correction index was 64%; for post-cast, Cobb angle was 18.6°. At mean 5.6 years follow-up (R: 2.3-8.9 years), 82% successfully avoided surgical intervention, 53% maintained correction < 25°, and 29% are considered "cured". 3/17 (18%) underwent a 2nd round of casting, and a total of 3/17 (18%) ultimately required surgery at 6.2 years post-casting. No major cast-related complications, decubiti, or cast holidays were encountered. CONCLUSION: Serial waterproof casting is safe and efficacious in EOS when compared to published results of traditional Mehta casting. Of 17 patients with mean pre-cast Cobb 52.3°, 82% successfully avoided surgery and 53% maintained mild curves < 25° magnitude at 5.6 years follow-up. No major complications or skin decubiti occurred, and advantages include clearance for bathing and avoidance of need for cast holidays during treatment. LEVEL OF EVIDENCE: Level IV.

Traditional Versus Water-resistant Short Leg Casting: A Randomized Controlled Pilot Study.

INTRODUCTION: We conducted a randomized controlled trial comparing fiberglass short leg casts with traditional cast padding to similar casts with water-resistant cast padding and recorded the opinion of the patient/caregiver and Orthopaedic Technicians (Ortho Techs) that applied and removed the casts. METHODS: Subjects with an injury that would be treated with a short leg cast were enrolled and randomized into a traditional cast or a water-resistant cast. Following cast application, the Ortho Tech that applied the cast completed a questionnaire asking their opinion on ease of application, moldability, padding level, and time taken for application. Following the removal of the study cast, the Ortho Tech that removed the cast completed a questionnaire that included an assessment of skin condition and evidence of the patient poking items inside the cast, as well as their opinion of ease of padding removal, padding durability and longevity, and an overall quality assessment of the cast padding. Following cast removal, the patient (or caregiver) also completed a questionnaire asking for their assessment of comfort, the weight of the cast, itchiness, heat/sweat, smell, and satisfaction. Patients who were treated with an expanded polytetrafluoroethylene cast were also asked about their happiness with the cast's water resistance and asked how long the cast took to dry. RESULTS: Sixty patients were included in this study, thirty in each group. The water-resistant casts took longer to apply than the traditional casts (12.4±4.0 vs. 8.2±3.2 min, P <0.001). The Ortho Techs favored the traditional cast when it came to ease of application ( P <0.001), moldability ( P =0.003), ease of padding removal ( P <0.001), padding durability ( P =0.006), padding longevity ( P =0.005), and their overall impression ( P =0.014). The patients/caregivers responded similarly among the 2 groups for each survey question. CONCLUSIONS: Patients randomized into each cast type tolerated their cast similarly; however, the Ortho Techs involved in this study preferred the traditional cast.

Biobased polyester versus synthetic fiberglass casts for treating stable upper limb fractures in children: a randomized controlled trial.

BACKGROUND: Stable upper limb fractures, such as radius, ulna, or distal humerus fractures, are common pediatric orthopedic traumas that are traditionally managed with cast immobilization. The commonly used synthetic fiberglass cast is light and water resistant but may promote skin itchiness during casting, which is a common complaint of patients. In addition, these diisocyanate-based casts have been proven to be toxic and may cause asthma. Herein, we introduce a novel biobased polyester cast to compare its clinical outcomes and patient satisfaction with conventional synthetic fiberglass casts. METHODS: From Feb 2022 to Nov 2022, we undertook a single-center prospective randomized trial involving 100 children with cast-immobilized stable upper limb fractures. These patients were randomized into either biobased polyester or synthetic fiberglass groups. All patients were regularly followed up till the cast removal which occurred approximately 3-4 weeks after immobilizing. Objective clinical findings and subjective patient questionnaire were all collected and analyzed. RESULTS: According to the radiographs taken on the day of cast removal, there was no loss of reduction in both groups. The incidence of skin problems was 3.4 times higher in the synthetic fiberglass group than in the biobased polyester group. For the subjective questionnaire, the biobased polyester cast was preferred in every sub-item. CONCLUSIONS: Our study strongly suggested that the novel biobased polyester cast provides matching stability to conventional fiberglass casts and improves patient satisfaction in an eco-friendlier and safer way. TRIAL REGISTRATION: ClinicalTrials.gov Protocol Registration and Results System ( https://www. CLINICALTRIALS: gov/ ; ID: NCT06102603; Date: 26/10/2023).

The Pressure Is on: Dorsal Versus Volar Univalves for Long-arm Casts.

BACKGROUND: Fiberglass casts are routinely used to treat fractures of the upper extremity. When posttraumatic edema is anticipated, the cast is often valved to hopefully prevent potential complications, especially compartment syndrome. Due to volar forearm compartments being most involved with upper extremity compartment syndrome, volar skin surface pressures (SSP) are paramount. Despite past literature showing that a univalved cast will retain a 3-point mold better than a bivalved cast, there is a paucity of information analyzing the effects of univalving on the volar SSP. We hypothesized that a volar univalve technique would have a greater decrease in the volar skin surface pressures compared to a dorsal univalve in long-arm casts. METHODS: A 100-mL saline bag attached to an arterial line pressure transducer was placed between a long-arm cast and the skin along the volar forearm of a single adult volunteer. Fourteen casts were applied by a single certified orthopaedic technologist with 30 years of experience and assigned randomly to receive either a volar or dorsal univalve. We calculated the change in volar forearm SSP on each cast in 4 stages: isolated univalve, with a 3-mm cast spacer, with a 6-mm spacer, and with bivalve. Statistical analysis of the data was performed using a Mann-Whitney U test. RESULTS: When comparing volar versus dorsal univalve, volar SSP significantly dropped by a mean of 32.00 versus 20.43 mm Hg ( P value=0.001) in stage I, 45.14 versus 38.00 mm Hg in stage II ( P value=0.026), and 56.53 versus 49 mm Hg in stage III ( P value=0.001). There was no significant difference between the 2 groups after a bivalve was performed at stage IV ( P value=0.318). CONCLUSION: Our findings support that a volar univalve with a 6-mm spacer will provide the greatest reduction of skin surface pressure while theoretically maintaining the cast's structural integrity and biomechanical properties when compared to a bivalved cast. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Waterproof Hip Spica Casts for Pediatric Femur Fractures.

BACKGROUND: Hip spica casting is the treatment of choice for femur fractures in children ages 6 months to 5 years. Traditional spica (TS) casting utilizes cotton padding that precludes patient bathing. Waterproof (WP) casting has inherent advantages, including clearance for bathing and improved family satisfaction. This study examines the safety and efficacy of WP hip spica casting for the treatment of pediatric femur fractures. METHODS: This is a retrospective, matched cohort study of patients ≤5 years with a femur fracture treated with hip spica casting. Patients with WP casts were matched to patients with TS casts by age, sex, and fracture type. TS casts utilize a Goretex liner and cotton padding, while WP spicas utilize fully WP materials and can be completely submerged in water. RESULTS: Fifty patients were included (25 WP, 25 TS) without differences between cohorts in age, weight, or sex. There were no differences in operative time, length of stay, or length of time in cast. Patient charges were significantly lower in the WP group ($230 vs. $301, P <0.001). At cast-off, coronal/sagittal alignment and shortening were similar, while 9 TS patients had minor skin and/or cast complications that required outpatient repair versus only 1 WP patient ( P <0.001). CONCLUSIONS: In a matched comparison, WP spica casting significantly reduces skin and cast complications traditionally associated with cotton-based spica casting, with significantly lower charges for WP cast materials. Fracture healing rate, alignment, and shortening at cast-off are similar in WP versus TS casts. WP spica casting is safe and efficacious for pediatric femur fractures, with the inherent advantage of clearance for bathing. LEVEL OF EVIDENCE: Level 3.

Back to Basics: Pediatric Casting Techniques, Pearls, and Pitfalls.

Cast application is a critical portion of pediatric orthopaedic surgery training and is being performed by a growing number of non-orthopaedic clinicians including primary care physicians and advanced practice providers (APPs). Given the tremendous remodeling potential of pediatric fractures, correct cast placement often serves as the definitive treatment in this age population as long as alignment is maintained. Proper cast application technique is typically taught through direct supervision from more senior clinicians, with little literature and few resources available for providers to review during the learning process. Given the myriad complications that can result from cast application or removal, including pressure sores and cast saw burns, a thorough review of proper cast technique is warranted. This review and technique guide attempts to illustrate appropriate upper and lower extremity fiberglass cast application (and waterproof casts), including pearls and pitfalls of cast placement. This basic guide may serve as a resource for all orthopaedic and non-orthopaedicproviders, including residents, APPs, and medical students in training. Level of Evidence: IV.

Flexible intramedullary nails with traction versus plaster cast for treating femoral shaft fractures in children: comparative retrospective study / Hastes intramedulares flexíveis com tração versus aparelho gessado para o tratamento de fraturas diafisárias do fêmur em crianças: estudo comparativo retrospectivo

Femoral fractures are common in children between 2 and 12 years of age, and 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as conservative treatment. However, in some situations, a surgical approach is recommended. The objective here was to compare treatments for femoral shaft fractures using intramedullary nails (titanium elastic nails, TEN) versus traction and plaster casts in children. The hypothesis was that TEN might provide better treatment, with good clinical results in comparison with plaster casts.

This retrospective comparative study was conducted in a public university hospital.

Sixty children with femoral fractures were evaluated; 30 of them underwent surgical treatment with TEN and 30 were treated conservatively using plaster casts. The patients' ages ranged from 5 to 13 years (mean of 9 years).

The mean duration of hospitalization was nine days for the surgical group and 20 days for the conservative group. The incidence of overgrowth in the patients treated with TEN was 60.0% and, for those treated conservatively, 13.3%. Partial weight-bearing was allowed after 3.5 weeks in the surgical group and after 9.6 weeks in the conservative group. New hospitalization was required for 90.0% in the surgical group and 16.7% in the conservative group. Patients treated with plaster casts presented higher incidence of complications, such as loss of reduction.

The surgical method presented better results for children. .

Fraturas femorais são comuns em crianças entre 2 e 12 anos de idade, e 75% das lesões acometem a diáfise. Tração seguida de aparelho gessado (“gesso”) é universalmente aceita como tratamento conservador. Entretanto, em algumas situações o tratamento cirúrgico é recomendado. O objetivo foi comparar o tratamento de fraturas diafisárias do fêmur com hastes intramedulares (titanium elastic nails, TEN) com tração e gesso em crianças. A hipótese era de que TEN pode ser melhor tratamento, com bons resultados clínicos em comparação com o gesso.

Este estudo retrospectivo e comparativo foi conduzido num hospital público universitário.

Sessenta crianças com fraturas de fêmur foram avaliadas, 30 delas foram submetidas a tratamento cirúrgico com TEN e 30 foram tratadas de forma conservadora usando gesso. A idade dos pacientes variou de 5 a 13 anos (média de 9 anos).

O tempo médio de internação foi de 9 dias para o grupo cirúrgico e 20 dias para o grupo conservador. A incidência de crescimento excessivo nos pacientes tratados com TEN foi de 60,0% e, para aqueles tratados de forma conservadora, 13,3%. Sustentação parcial de peso foi permitida após 3,5 semanas no grupo cirúrgico e após 9,6 semanas no grupo conservador. Houve 90,0% de novas internações no grupo cirúrgico e 16,7% no grupo conservador. Pacientes tratados com gesso apresentaram maior incidência de complicações, tais como perda de redução.

Influencia del envejecimiento, la marca y la ubicación de las fibras de refuerzos en la resistencia felxural de la resina compuesta Gradia® / Age influence, brand and location of reinforcement fibers in the resistance of the composite resin felxural Gradia®

La incorporación de fibras de refuerzo a resinas compuestas se ha convertido en una alternativa de tratamiento protésico altamente conservador. De esta investigación fue evaluar la resistencia flexural (RF) de una resina compuesta indirecta reforzada con tres diferentes marcas comerciales de fibras de vidrio, variando su ubicación y sometidas a envejecido físico ó químico. Se fabricaron 98 especímenes de resina compuesta Gradia™ (GC-America Inc.) de 22 mm x 2 mm x 3 mm; a 14 muestras no se les colocó fibras (SF), se almacenaron en agua destilada por 60 días, luego se subdividieron en dos grupos de 7 muestras,G1 - SFA y G2 - SFT el cual se sometió a termociclado (3000 ciclos de 5°/55°C en intervalos de 1 min); las otras 84 muestras se reforzaron fibras unidireccionales: 42 muestras para ser almacenadas en agua por 60 días (CFA), divididas en dos sub-grupos de 21, en relación a la ubicación de la fibra en la zona de compresión (CFAC) ó tracción (CFAT); finalmente en tres grupos de 7, dependiendo de la marca; Fibrex-Lab® (Angelus) los grupos G3 - CFACFLab y G6 - CFATFLab, FibreKor® (Jeneric/Penton) los grupos G4 - CFACFKor y G7 - CFATFKor y Vectris® (Ivoclar/Vivadent) los grupos G5 - CFACVectris y G8 - CFATVectris. Las 42 restantes después del almacenamiento en agua se sometieron al termociclado , se dividieron en dos subgrupos de 21, en relación a la ubicación de la fibra en la zona de compresión (CFTC) ó de tracción (CFTT); finalmente se dividió en tres grupos de 7, entonces Fibrex-Lab® conformó los grupos G9 - CFTCFLab y G12 - CFTTFLab, FibreKor® los grupos G10 - CFTCFKor y G13 - CFTTFKor y Vectris® los grupos G11 - CFTCVectris y G14 - CFTTVectris. Las muestras fueron sometidas a la prueba de flexión de tres puntos hasta su fractura, en maquina de pruebas universales (Shimadzu AGS-J) a una velocidad de 1mm/min. Los datos fueron recolectados, tabulados en hoja de cálculo y luego analizados con un estadístico de t de student....

The incorporation of reinforce fibers to composite has turned into an alternative of high conservative prosthetic treatment. The aim of this study was to evaluate the flexure strength (RF) of a indirect reinforce composite using three fiber glass commercial brands, varying the location and submitted to physical o chemical aging. 98 specimen were made of 22 mm x 2 mm x 3 mm Gradia™ resin compound (GC-America Inc.); 14 samples were not reinforce with fiber glass (SF), They were store in distilled water for 60 days then divided in 2 groups of 7 samples, G1 - SFA and G2 - SFT was thermocycled (3000 cycles of 5 °/55°C in intervals of 1 min); the other 82 samples were reinforce with unidirectional fibers: 42 to be stored in distilled water for 60 days (CFA), divided in 2 subgroups of 21, in relation with the localization of the fiber on the compression zone (CFAC) or traction (CFAT); Finally divided in 3 groups of 7, depending on the brand; Fibrex-Lab® (Angelus) the groups G3 - CFACFLab and G6 - CFATFLab, FibreKor® (Jeneric/Penton) the groups G4 - CFACFKor and G7 - CFATFKor and Vectris® (Ivoclar/Vivadent) the groups G5 - CFACVectris and G8 - CFATVectris. The remaining 42 samples after storage in water were submitted to thermocycling, divided in 2 subgroups of 21, in relation with the localization of the fiber on the compression zone (CFTC) or traction (CFTT); Finally divided in 3 groups of 7 then G9 was conformed Fibrex-Lab® CFTCFLab and G12 - CFTTFLab, FibreKor® the groups G10 - CFTCFKor and G13 - CFTTFKor and Vectris® the groups G11 - CFTCVectris and G14 - CFTTVectris. The samples were submitted to the three points flexion test until fracture, in a universal testing machine (Shimadzu AGS-J) to a speed of 1mm/min. The information was gathered, tabulated in spreadsheet and then analyzed with a statistician t of student to determine differences between the groups without fibers and 3 factors ANOVA on the reinforced groups for the varying location...