A Biomechanical Comparison of Fiberglass Casts and 3-Dimensional-Printed, Open-Latticed, Ventilated Casts.

Background: The aim of this study was to quantify the stabilizing properties of a 3-dimensional (3D)-printed short-arm cast and compare those properties with traditional fiberglass casts in a cadaveric subacute distal radius fracture model. Methods: A cadaveric subacute fracture model was created in 8 pairs of forearms. The specimens were equally allocated to a fiberglass cast or 3D-printed cast group. All specimens were subjected to 3 biomechanical testing modalities simulating daily life use: flexion and extension of digits, pronation and supination of the hand, and 3-point bending. Between each loading modality, radiological evaluation of the specimens was performed to evaluate possible interval displacement. Interfragmentary motion was quantified using a 3D motion-tracking system. Results: Radiographic assessment did not reveal statistically significant differences in radiographic parameters between the 2 groups before and after biomechanical testing. A statistically significant difference in interfragmentary motion was calculated with the 3-point bending test, with a mean difference of 0.44 (±0.48) mm of motion. Conclusions: A statistically significant difference in interfragmentary motion between the 2 casting groups was only identified in 3-point bending. However, the clinical relevance of this motion remains unclear as the absolute motion is less than 1 mm. The results of this study show noninferiority of the 3D-printed casts compared with the traditional fiberglass casts in immobilizing a subacute distal radius fracture model. These results support the execution of a prospective randomized clinical trial comparing both casting techniques.

Standing MRI for surgical planning of equine fracture repair.

OBJECTIVE: To report the feasibility of standing MRI (sMRI) and document the value of sMRI in surgical planning for surgical repair of limb fractures in the horse. STUDY DESIGN: Retrospective case series. ANIMALS: Thirty-one horses with preoperative sMRI. METHODS: Medical records were reviewed for fracture type, application of a polyester cast, sMRI sequences performed, technical variables, and image quality. Fracture geometry and concomitant lesions were compared between sMRI and radiography. The relative value of sMRI with regard to surgical planning was classified as minor (sMRI did not provide additional findings), intermediate (additional lesions found or slight modification to surgical plan), or major (sMRI led to significant alternations in surgical plan). RESULTS: Standing MRI provided good studies in all horses. Standing MRI was classified as having major relevance in 12 of 31 horses, intermediate relevance in 14 of 31 horses, and minor relevance in 5 of 31 horses. CONCLUSION: Preoperative sMRI produced good studies in all horses and influenced the surgical planning in the majority of fractures in this study. Application of a polyester cast seemed to improve comfort without appreciable loss of image quality. CLINICAL SIGNIFICANCE: Standing MRI can be considered as an adjunct to plan the repair of equine fractures, and a polyester cast does not impair image quality.

Treatment of Clubfoot With Ponseti Method Using Semirigid Synthetic Softcast.

Randomized controlled clinical trial.The main purpose of the present study was to comparatively analyze the effectiveness, advantages, and the complications of using semirigid synthetic softcast with respect to plaster of Paris (POP) during the treatment of clubfoot deformity.The study group consisted of 196 babies (249 feet). A total of 133 feet treated by an orthopedic referral center using semirigid synthetic softcast were included in group A whereas the other 116 feet treated by another orthopedic clinic using POP cast were included in group B. The Pirani scores, number of cast applications, time period until Achilles tenotomy, any skin problems due to the cast itself, and/or cast removal were recorded. A final parent satisfaction score was also obtained.The mean Pirani sores were significantly improved from the first administration to the time before Achilles tenotomy in both groups. There was no significant difference according to the number of casts applied until tenotomy. The slippage of the cast and skin lesions was significantly more common in group B. Higher parent satisfaction levels were detected in group A.Semirigid softcast has been found as superior to POP in the aspects of parent satisfaction and cast-related complication rates.

[Outcomes of four distinct fixation methods in the conservative treatment of fifth metacarpal neck fractures]. / Dört farkli tespit yöntemi ile konservatif olarak tedavi edilen besinci metakarp boyun kiriklarinin sonuçlari.

BACKGROUND: We evaluated four distinct fixation methods for the conservative treatment of neck fractures of the fifth metacarpal. METHODS: Patients in our clinics who were treated with non-surgical methods following closed reduction between 2008 and 2009 were evaluated prospectively. In this study consisting of 60 male patients, the following fixation methods were applied for four weeks: circular cast extending from the wrist to the distal interphalangeal (DIP) joint (Group A), circular cast covering semiflexed metacarpophalangeal (MCP) and DIP from the wrist to the DIP joint (Group B), circular self-adherent wrap covering metacarpal bones II-V, from the wrist to the DIP joint (Group C), and ulnar gutter splint covering semi-flexed IV-V MCP, proximal (PIP) and DIP joints (Group D). In patients who were followed up with anteroposterior (AP) and oblique radiography, angulations and metacarpal lengths were measured before and after reduction. RESULTS: Fifty-two patients with an average age of 30 (SD: 9) years completed the study. For fractures with radiographic angulation of 17 degrees (SD: 11) and 46 degrees (SD: 11.7) before treatment, union was achieved with an angulation of 5 degrees (SD: 5.9) and 27 degrees (SD: 10.5) after four weeks (p: 0.05). CONCLUSION: No statistically significant difference was found between the non-surgical methods applied for treatment of fifth metacarpal fractures.

Principles of casting and splinting.

The ability to properly apply casts and splints is a technical skill easily mastered with practice and an understanding of basic principles. The initial approach to casting and splinting requires a thorough assessment of the injured extremity for proper diagnosis. Once the need for immobilization is ascertained, casting and splinting start with application of stockinette, followed by padding. Splinting involves subsequent application of a noncircumferential support held in place by an elastic bandage. Splints are faster and easier to apply; allow for the natural swelling that occurs during the acute inflammatory phase of an injury; are easily removed for inspection of the injury site; and are often the preferred tool for immobilization in the acute care setting. Disadvantages of splinting include lack of patient compliance and increased motion at the injury site. Casting involves circumferential application of plaster or fiberglass. As such, casts provide superior immobilization, but they are more technically difficult to apply and less forgiving during the acute inflammatory stage; they also carry a higher risk of complications. Compartment syndrome, thermal injuries, pressure sores, skin infection and dermatitis, and joint stiffness are possible complications of splinting and casting. Patient education regarding swelling, signs of vascular compromise, and recommendations for follow-up is crucial after cast or splint application.

A randomized trial of 'soft cast' for distal radius buckle fractures in children.

A buckle fracture is a stable fracture where there is a dorsal cortex compression of the distal radius. A total of 117 children with buckle fracture treated at our institution were randomised prospectively into two treatment groups: soft cast or rigid cast. The rigid cast group attended clinic after three weeks for removal of the cast. In the soft cast group, the cast was removed by parents at home after three weeks. Telephone follow-up was carried out after 4 to 5 weeks post fracture. Both groups had full recovery as compared to the uninjured side and parents were satisfied with the treatment. Only one patient in the soft cast group had a problem as compared to 5 in the rigid cast group (p = 0.035, using chi square test). When given a choice, parents of children in both groups opted for future treatment with a soft cast (p < 0.01 using chi square test). Our study showed that buckle fractures of the distal radius can safely be treated with a soft cast without the need for more than one fracture clinic appointment.

Synthetic casting tapes: benefits and uses of Delta-Cast Conformable.

Casting is a traditional practice that has changed relatively little over thousands of years. Today, however, with the emphasis on evidence-based medicine, health professionals are examining the practice and investigating ways of improving it for the benefit of both patients and those who perform it. Most fractures and many soft tissue injuries are usually managed in a rigid cast, which brings with it complications and disadvantages. The ideal form of fracture fixation would stabilize the fracture while allowing some movement of the fracture site and soft tissue compression. This article explores the use of Delta-Cast Conformable (Johnson and Johnson), a synthetic casting tape, in both primary and secondary casting. The role of Delta-Cast Conformable with regard to focused rigidity casting, a new philosophy in fracture management, is discussed.

Cast changes: synthetic versus plaster.

A review of the changes in casting since the introduction of improved synthetic casting materials in the 1970s is presented. There is very little in the literature on nursing implications regarding the newer casting materials. Improvements in synthetic materials used in the casting of children include a fiberglass-free, latex-free casting polymer, with child-friendly prints now available. Though the use of synthetic casting predominates the market, plaster of Paris is still the mainstay for serial casting and casting requiring superior moldability and conformability. The advantages and disadvantages of synthetic and plaster of Paris casting, as well as nursing care of the child in each type of cast are summarized.

Parent satisfaction comparing two bandage materials used during serial casting in infants.

Plaster of Paris was compared with semirigid fiberglass casting material during serial casting in 17 infants with clubfoot or rigid metatarsus adductus. Semirigid fiberglass was statistically superior in its durability, convenience, performance, and ease of removal. The average amount of time for home cast removal by the parents was 55 minutes for plaster of Paris and 21 minutes for semirigid fiberglass. Complications such as skin abrasions and cast slip-off were similar for both casting materials. Ninety-four percent of parents strongly preferred semirigid fiberglass rather than plaster of Paris for their child's serial casting.