Clinical and radiographic comparison of single-sugar-tong splint to long-arm cast immobilization for pediatric forearm fractures.

The purpose of this study was to compare the efficacy of a single-sugar-tong splint (SSTS) to a long-arm cast (LAC) in maintaining reduction of pediatric forearm fractures, while avoiding secondary intervention. One hundred patients age 3-15 with a forearm fracture requiring a reduction and immobilization were evaluated (50 LAC and 50 SSTS). Medical records and radiographs were reviewed at injury, postreduction, and at 1, 2, and 4 weeks postinjury. Sagittal and coronal angular deformities were recorded. Any secondary intervention due to loss of reduction was documented. The groups were matched by age (P = 0.19), sex (P = 0.26), mechanism of injury (P = 0.66), average injury sagittal deformity (LAC 27.4°, SSTS 25.4°; P = 0.50), and average injury coronal deformity (LAC 15.5°, SSTS 16°; P = 0.80) At 4 weeks postinjury follow-up, there were no statistically significant differences between use of an SSTS or LAC when comparing postimmobilization sagittal alignment (LAC 10.3 ± 7.2, SSTS 8.4 ± 5.1°; P = 0.46), coronal alignment (LAC 6.9 ± 4.6, SSTS 7.6 ± 9.3°; P = 0.46), or need for repeat manipulation or surgery (LAC 4/50, SSTS 3/50; P = 0.70).

Implantes de altura reduzida devem ser esplintados em região posterior de mandíbula? / Should implants with reduced height be splinted in the posterior mandible?

A reabilitação de pacientes parcialmente desdentados é um tratamento viável e com excelente prognóstico. Todavia, a disponibilidade óssea em altura é um fator crucial para o sucesso desse tratamento. O levantamento de seio maxilar, apesar da baixa qualidade óssea da maxila posterior, é considerado um procedimento bastante previsível. Entretanto, técnicas reconstrutivas em mandíbula não possuem a mesma previsibilidade, além de apresentar maior morbidade pós-operatória. Apesar da alta previsibilidade dos implantes com altura reduzida, poucos são os estudos que avaliam a real necessidade da esplintagem do mesmo em mandíbula posterior atrófica. Dessa forma, o objetivo do presente estudo foi avaliar a necessidade de um implante curto ser esplintado a outro. Após análise criteriosa da literatura concluiu-se que os implantes com altura reduzida unitários apresentam igual previsibilidade em relação ao esplintado. Todavia, a heterogeneidade dos estudos e a falta de ensaios clínicos randomizados justifica a elaboração de novas pesquisas.(AU)

Rehabilitation of partially edentulous patients is a viable treatment with an excellent prognosis. However, bone height availability is a crucial factor in the treatment success. The maxillary sinus lift, despite poor bone quality of posterior maxilla, is considered a predictable procedure. However, reconstructive techniques in the mandible do not have the same predictability and present more postoperative morbidity. Despite the high predictability of short implants, there are few studies evaluating the real necessity for splinting implants in posterior atrophic mandible. Thus, the objective of the present study was to evaluate the need for a short implant to be splinted to another. After analysis of the literature, this review concluded that unitary short implants presented equal predictability compared to splinted implants. However, the heterogeneity of the studies and the lack of randomized clinical trials justify the development of new research.(AU)

[Evidence-based physical therapy of rheumatic diseases]. / Evidenzbasierte physikalische Therapie bei rheumatischen Krankheiten.

New studies increase the evidence, that different applications of physical therapy are effective. In patients with rheumatoid arthritis (RA) physiotherapy of the hands improve strength, joint mobility and activity without increased risk of pain nor inflammation. A theory-based physiotherapy of the hands shows clinical effectiveness and cost-utility. In patients with spondyloarthritides supervised group exercise training is more effective than home exercise programs. Compared with biologics only combined exercise training and tumour necrosis factor alpha inhibitor therapy improve mobility and disease activity more effectively. Aerobic exercise training reduces fatigue in RA. Working wrist splints and static resting splints improve pain and grip strength. Static resting splints reduce the risk of hand deformities. Local and whole body cryotherapy show short term improvement of pain and inflammatory activity. German S3-guidelines recommend enhanced utilisation of physical therapy as well as coordinated multiprofessional team care and rehabilitation.

Luxación aislada del escafoides / Luxation isolée du scaphoïde / Isolated dislocation of the scaphoid

El funcionamiento armónico de la mano desempeña un papel fundamental para el desarrollo de la vida del hombre. En la sociedad moderna las lesiones a este nivel, a pesar de su baja incidencia, son causa frecuente de discapacidad funcional. Se presenta un paciente blanco, masculino, de 38 años, atendido por el Servicio de Urgencias tras un trauma de alta energía con hiperflexión forzada de la muñeca. Se diagnostica una luxación aislada del escafoides que se reduce bajo anestesia con ayuda del intensificador de imágenes. Se inmoviliza por 6 semanas con férula braquial, tomando primer dedo, y posteriormente comienza el proceso de rehabilitación. El tratamiento oportuno y adecuado de la afección mencionada es indispensable para obtener los mejores resultados en la recuperación funcional(AU)

The orderly functioning of the hand plays a key role for the development of human life. In modern society injuries at this level are a frequent cause of functional disability, despite its low incidence. A case of a white, male patient, 38, attended by the emergency department after a high-energy trauma with forced hyperflexion of the wrist is presented here. An isolated dislocation of the scaphoid is diagnosed and it is reduced under anesthesia using the image intensifier. It is immobilized for 6 weeks with brachial splint, taking first finger, and then the rehabilitation process begins. The timely and proper treatment of this condition is essential to obtain the best results in functional recovery(AU)

Le fonctionnement harmonieux de la main joue en rôle essentiel dans le développement de la vie de l'homme. Dans la société moderne, les lésions au niveau de la main, malgré leur faible incidence, sont la cause la plus fréquente d'invalidité fonctionnelle. Un patient, blanc, âgé de 38 ans, traité au service d'urgence dû à un traumatisme à haute énergie qui a été provoqué par une hyperflexion forcée du poignet, est présenté. Une luxation isolée du scaphoïde, corrigée sous anesthésie à l'aide d'un intensificateur d'images, est diagnostiquée. Tout d'abord, le poignet a été immobilisé pendant 6 semaines par une attelle ante-brachiale de poignet avec trou pour le pouce, et puis la rééducation a commencé. Le traitement précoce et approprié de cette affection est indispensable pour obtenir les meilleurs résultats dans la récupération de la fonction(AU)

ED plaster-of-Paris jacket for infantile scoliosis.

BACKGROUND: There are various articles published in last few years which consider surgical methods like growing rod instrumentation and modulation of the growth as a "gold standard" for the treatment of early onset severe scoliosis. We emphasize orthopaedic correction with serial casting as another option for such progressive deformity. The key to the success of this treatment is to understand the strategy and the technique involved in the effective casting. METHODS: The conventional technique of elongation, derotation, flexion cast (named EDF by Cotrel) is described with some modifications like wedging the cast (gypsotomy) in order to produce the flexion component. RESULTS: Serial casting with ED casts for the treatment of progressive idiopathic infantile scoliosis is an effective tool for the benign types of curves (Mehta) and spinal fusion was not necessary in two-third of our cases. CONCLUSION: Surgical option for treatment of early onset scoliosis is not a "gold standard". Orthopaedic treatment with serial elongation, derotation casts remain the centerpiece of this treatment. Each detail to understand the technique must be known in order to obtain the best result.

Night-time splinting after fasciectomy or dermo-fasciectomy for Dupuytren's contracture: a pragmatic, multi-centre, randomised controlled trial.

BACKGROUND: Dupuytren's disease is a progressive fibroproliferative disorder which can result in fixed flexion contractures of digits and impaired hand function. Standard treatment involves surgical release or excision followed by post-operative hand therapy and splinting, however the evidence supporting night splinting is of low quality and equivocal. METHODS: A multi-centre, pragmatic, open, randomised controlled trial was conducted to evaluate the effect of night splinting on self-reported function, finger extension and satisfaction in patients undergoing fasciectomy or dermofasciectomy. 154 patients from 5 regional hospitals were randomised after surgery to receive hand therapy only (n = 77) or hand therapy with night-splinting (n = 77). Primary outcome was self-reported function using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcomes were finger range of motion and patient satisfaction. Primary analysis was by intention to treat. RESULTS: 148 (96%) patients completed follow-up at 12 months. No statistically significant differences were observed on the DASH questionnaire (0-100 scale: adjusted mean diff. 0.66, 95%CI - 2.79 to 4.11, p = 0.703), total extension deficit of operated digits (degrees: adjusted mean diff 5.11, 95%CI -2.33 to 12.55, p = 0.172) or patient satisfaction (0-10 numerical rating scale: adjusted mean diff -0.35, 95%CI -1.04 to 0.34, p = 0.315) at 1 year post surgery. Similarly, in a secondary per protocol analysis no statistically significant differences were observed between the groups in any of the outcomes. CONCLUSIONS: No differences were observed in self-reported upper limb disability or active range of motion between a group of patients who were all routinely splinted after surgery and a group of patients receiving hand therapy and only splinted if and when contractures occurred. Given the added expense of therapists' time, thermoplastic materials and the potential inconvenience to patients having to wear a device, the routine addition of night-time splinting for all patients after fasciectomy or dermofasciectomy is not recommended except where extension deficits reoccur. TRIAL REGISTRATION: The trial was registered as an International Standard Randomised Controlled Trial ISRCTN57079614.

Classification of hand splinting.

The terminology in describing splint or orthosis has been reviewed but there is no one single system adopted universally. Joint efforts by doctors, therapists and orthotists had been set up to review the classification of splint. Four ways of classifying hand splints have been introduced: namely, eponym, acronym, descriptive classification system and the classification system proposed by the American Society of Hand Therapists. These systems include the use of rote memory or logical deduction in grouping of splints. This paper describes the advantages and disadvantages of each classification system. Neither one of the systems stands out to be the best. A combination of the advantages of different systems, such as precision and logical deduction, may be an option for developing a new system. Moreover, communication, documentation and other environmental factors should also be considered.

Device-based change in left ventricular shape: a new concept for the treatment of dilated cardiomyopathy.

OBJECTIVE: We tested a unique new device, the Myosplint device (Myocor, Inc, Maple Grove, Minn), which is designed to change left ventricular shape, reduce left ventricular wall stress, and improve left ventricular systolic function. METHODS: Heart failure was induced in 15 dogs over 27 days by rapid pacing (230 beats/min). Seven animals underwent sham surgery, and 8 animals received 3 transventricular Myosplint devices each. Myosplint devices were tightened to create a symmetric bilobular left ventricular shape and were adjusted to produce a calculated 20% reduction in wall stress. Hemodynamic, 2-dimensional, and 3-dimensional echocardiographic studies were recorded at baseline, immediately after Myosplint placement (acute change), and at 1 month after both groups had a reduced rate (190 beats/min) of pacing designed to maintain heart failure. RESULTS: The Myosplint group had significant sustained improvements in left ventricular ejection fraction from baseline, to the acute change, to 1 month (19% +/- 5%; 36% +/- 8%; 39% +/- 13%) and reductions of left ventricular end-systolic volumes (73 +/- 9 mL; 34 +/- 5 mL; 42 +/- 12 mL) and end-systolic wall stress by 39% (341 +/- 68 10(3) dynes x cm(- 2) to 206 +/- 28 10(3) dynes x cm(-2)) acutely and 31% (372 +/- 83 10(3) dynes x cm(-2) to 250 +/- 40 10(3) dynes x cm(-2)) at 1 month. There were no significant changes in mitral regurgitation. CONCLUSION: Application of a Myosplint device to a dilated impaired left ventricle resulted in reduced wall stress and improved left ventricular systolic function that was sustained at 1 month. Device-based shape change is a promising new opportunity to treat patients with dilated cardiomyopathy.

Good results after treatment with the Frejka pillow for hip dysplasia in newborns: a 3-year to 6-year follow-up study.

Because there is no consensus with regard to the efficiency of the Frejka pillow in the treatment of hip joint dysplasia in newborns, the aim of the present study was to evaluate our results with this device. During the 3-year period 1988 to 1990, the Frejka pillow was used in 108 newborns with clinically unstable hips verified by ultrasonography. There were three treatment failures (2.8%), defined as infants who needed additional treatment with an abduction splint or hip-spica cast. Avascular necrosis of the femoral head occurred in one patient (0.9%). At an age of 3 years to 6 years, 85 of the children attended a follow-up examination. An intoeing gait was observed in 17% and slightly reduced hip mobility in 20% of the patients. Compared with normal children, the patients had somewhat lower coverage of the femoral head by radiography, indicated by a lower centre-edge angle and a higher migration percentage, but the coverage was within the normal range in all cases. The mean anteversion angle was larger than that of normal children but only three patients had abnormally high anteversion angles. In conclusion, the results with the Frejka pillow were good, with few treatment failures and complications, and it is the most simple abduction device for the parents to handle. More rigid devices like the von Rosen splint seem to involve a slightly lower failure rate, but a higher risk of avascular necrosis. Therefore, we recommend the Frejka pillow when treatment is started within a few days of birth.

Treatment of developmental dysplasia of the hip with the Pavlik harness: factors for predicting unsuccessful reduction.

To evaluate the risk factors for unsuccessful reduction, we reviewed 100 hips with developmental dysplasia of the hip treated with the Pavlik harness. We divided them into a successful reduction group (reduced without avascular necrosis) and an unsuccessful reduction group (reduced followed by avascular necrosis or unreduced). We compared Yamamuro's distance A, the acetabular angle and age at initial application of the Pavlik harness between the two groups. Our data suggest that a Yamamuro's distance A of 7 mm or smaller, an acetabular angle of 36 degrees or greater, and an age at initial application of 4 months or older are risk factors.

Quemaduras eléctricas de la cavidad oral. Presentación de un caso clínico tratado con férula de acrílico / Electrical burns of the oral cavity. Presentation of a clinical case treated with acrylic splint

Las quemaduras eléctricas de la cavidad bucal son más comunes de lo que se cree en la sociedad. Debido a la controversia que existe concerniente al tratamiento de estas lesiones, se presenta a continuación una revisión de la literatura y un caso clínico tratado con una férula de acrílico como un método para ayudar al proceso de sanado, y reducir las posibles complicaciones tanto estéticas como funcionales que se podrían presentar

Traumatismos en dientes permanentes jóvenes: oportunidad del uso de férulas / Injuries in young permanent teeth: timing for using splints

Cuando un niño sufre un traumatismo en el que pueden estar involucrados dientes y tejidos de sostén, debe actuarse con rapidez y criterio preventivo a fin de evitar la pérdida del mismo. Nuestros recursos están basados en el empleo de férulas que son de fundamental importancia para la supervivencia del elemento dentario

Por qué, cuándo y cómo ferulizar sobre implantes oseointegrados / Why, when and how to splint on osseointegrated implants

En el presente estudio, producto del trabajo de 5 años en prótesis sobre implantes y especialmente preocupado por el comportamiento biomecánico de los mismos, analizo un aspecto como es la ferulización, la cual tiene una concepción totalmente diferente que en dientes naturales. Como su título indica, se analizan las razones por las cuales puede ser necesario recurrir a la ferulización como una técnica complementaria en prótesis. Además, se explica una forma práctica, efectiva y económica de lograr "estructuras pasivas" que junto con una correcta oclusión serán la clave del éxito prolongado en prótesis oseointegradas

The Kleinert dynamic splint: where it fails and how it can be modified.

After primary tenoraphy of flexor tendons one often finds a hampered function of the DIP-joint. Analysis of the pattern of early mobilization exercised by our patients in the Kleinert splint and analysis of the excursions of the flexor tendons of fresh unembalmed specimens brought us to the conclusion that the Kleinert dynamic splint fails in maintaining a sliding movement of the deep and the superficial flexor tendons along each other because the splint excludes motion at the distal interphalangeal joint. Based on our observations we modified the Kleinert dynamic splint. Our experience with 37 patients shows that this modified splint gives a better function in the DIP-joint.

Severe contractures of the proximal interphalangeal joint in Dupuytren's disease: results of a prospective trial of operative correction and dynamic extension splinting.

In a prospective study, 23 proximal interphalangeal joints that were severely contracted (> or = 45 degrees) as a result of Dupuytren's disease underwent operative correction and 6 months of dynamic extension splinting. Proximal interphalangeal joint extension was measured preoperatively and postoperatively at 3-month intervals for 1 year and at 6-month intervals thereafter. Mean follow-up was 2 years (minimum, 1 year). Overall, at 2 years, 44% improvement in proximal interphalangeal joint extension was noted. Mean improvement of 59% in proximal interphalangeal joint extension was noted in patients who complied with the postoperative dynamic extension splinting program. Patients who were noncomplaint demonstrated a 25% improvement in proximal interphalangeal joint extension. The difference in values between patients who were compliant and those who were not was statistically significant. Other factors--severity of contracture, digit involved, and the necessity for capsular release--were not significantly related to outcome. This study suggests that soft tissue responds to continuous dynamic extension stresses and can be remodeled over time.

[Delayed sternal closure; a simple sternal splint].

A simple and inexpensive sternal splint for delayed sternal closure was described. Sternal edges were splinted open using an edge-cut disposable syringe. This method has been employed successfully in 10 patients (one adult, 9 children). This syringe splint is a simple, inexpensive and effective method for delayed sternal closure.