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1.
Zhongguo Gu Shang ; 34(2): 108-13, 2021 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-33665995

RESUMEN

OBJECTIVE: To explore clinical effects of pulley suspension traction reduction combined with self-made splint fixation in treating extended distal radius fracture. METHODS: From December 2017 to December 2019, 60 patients with extended distal radius fractures were divided into observation group and control group, 30 patients in each group. In observation group, there were 12 males and 18 females, aged from 50 to 75 years old with an average of (59.63±8.08) years old;according to AO classification, 25 patients were type A2 and 5 patients with type A3;fractures were fixed by pulley suspension traction and self-made splint. In control group, there were 11 males and 19 females, aged from 52 to 76 years old with an average of (59.77±8.03) years old;according to AO classification, 24 patients were with type A2 and 6 patients were type A3;fractures were treated by conventional manipulation with self-made splint fixation. The radius height, ulnar angle and palmar angle between two groups were compared before and after treatment, and clinical effects were evaluated by advanced Green and O'Brien wrist joint scoring after treatment. RESULTS: All patients were followed up from 11 to 13 months with an average of (11.90± 0.80) months. The splint was removed for 42 to 60 days with an average of (50.20±4.94) days. After removal of splint, X-rays indicated that all patients obtained bone healing with smooth of joint surface. In observation group, radius height was (4.57± 1.16) mm, ulnar angle was (12.83±3.25) °, palmar angle were (-21.17±3.36) ° respectively before treatment, (10.10± 1.75) mm, (24.30±3.16) °, (9.40±2.13) ° respectively at 8 weeks after treatment;in control group, radius height, ulnar angle, palm angle were (4.50±1.43) mm, (12.83±3.10) °, (-21.50±3.38) ° respectively before treatment, and (8.90±1.24) mm, (21.20±2.91) °, (6.16±2.94) ° respectively at 8 weeks after treatment;there were no significant difference in radius height, ulnar deviation angle and palmar inclination between two groups before treatment (P>0.05);radius height, ulnar deviation angle and palmar inclination angle of between two groups were significantly improved at 8 weeks after treatment(P<0.05), and observation group was significantly better than that of control group (P<0.05). Green and O'Brien wrist score of observation group was 90.97±7.92 at follow-up ranged from 11 to 13 months with an average of (11.90±0.80) months, which was significantly higher than that of control group (84.77±9.14) (t=2.807, P<0.05);in observation group, 18 patients got excellent result, 10 good and 2 fair;in control group, 10 patients got excellent result, 15 good, 3 fair and 2 poor;there was siginifcantly difference between two groups (Z=-2.15, P<0.05). CONCLUSION: Compared with conventional manual traction and reduction, pulley suspension traction reduction combined with self made splint fixation for the treatment of extended distal radius fracture has more advantages with stable and reliable traction, good reduction, and better wrist joint function. It could be selected and applied according to the actual situation of patients.


Asunto(s)
Fracturas del Radio , Anciano , Placas Óseas , Femenino , Fijación Interna de Fracturas , Humanos , Masculino , Persona de Mediana Edad , Fracturas del Radio/cirugía , Férulas (Fijadores) , Tracción , Resultado del Tratamiento
2.
Zhongguo Gu Shang ; 34(2): 153-6, 2021 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-33666003

RESUMEN

OBJECTIVE: To investigate specific technique and clinical effects of closed folding top consolidation maneuver combined with splint fixation maneuver for consolidation and cedar bark external fixation splint for the treatment of double fractures of distal ulna and radius in children. METHODS: From January 2017 to December 2019, 17 children with double fractures of distal ulna and radius were treated with closed folded apex consolidation maneuver, including 13 males and 4 females, aged from 4 to 11 years old with an average of (7.29±2.34) years old. The fractures were fixed with cedar bark splint and followed up for 6 months, and alignment of fracture was evaluated according to the latest X-rays by follow up, and function of the affected limbs was evaluated by Anderson forearm function evaluation criteria. RESULTS: Fifteen of 17 children were successfully reset immediately, and 2 children were successfully reset again. The average fixed time was (25.00±3.35) days. At 6 months of follow up, 12 patients got excellent results, 3 good, 2 fair, and 0 poor according to Anderson forearm function evaluation criteria. The position of all children were larger than 3/4, and 10 children were received anatomical reduction, alignment of 4 children was less than 10°, 3 children was less than 15°. No complications such as fracture displacement, nonunion, compartment syndrome, and forearm rotation dysfunction occurred. CONCLUSION: Restoration of distal radius double fracture in children with the combination of the closed folding and top fixation maneuver and splint fixation maneuver has advantages of higher success rate, lower complications, which could reduce operating difficultyand pain of patients.


Asunto(s)
Fracturas del Radio , Fracturas del Cúbito , Anciano , Niño , Preescolar , Femenino , Fijación de Fractura , Fijación Interna de Fracturas , Humanos , Masculino , Radio (Anatomía) , Fracturas del Radio/terapia , Férulas (Fijadores) , Resultado del Tratamiento , Cúbito
3.
Stomatologiia (Mosk) ; 100(1): 30-33, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33528953

RESUMEN

THE AIM OF THE STUDY: Was to investigate the effectiveness of combined treatment with elastic bands and splints in patients with masticatory muscle hypertension. 103 patients (37 men and 66 women) aged from 21 to 65 years were examined. The diagnosis was made based on clinical and instrumental (electromyography) methods. Pain intensity was determined using a visual-analog scale (VAS). Elimination of masticatory muscle hypertension in patients of the first group (51 people) was carried out using only splints while patients of the second group (52 people) had a combined therapy with elastic bands and splints. In the second group of patients reliable reducing of pain intensity was observed by day 14 from the start of therapy (4.54±0.5 points), while in the first group of patients it was discovered only by day 21 (5.08±0.6 points). Reliable changing of the bioelectrical activity of masticatory muscles in the second group of patients was observed by the beginning of second week from the start of preliminary therapy, while in the first group of patients it was discovered only by the third week. Thus, the proposed method of masticatory muscles hypertension treatment using elastic bands and splints has features, favorably distinguish it from the other methods of the therapy, because it provides sparing functioning condition for masticatory muscles.


Asunto(s)
Hipertensión , Férulas (Fijadores) , Adulto , Anciano , Electromiografía , Femenino , Humanos , Hipertensión/terapia , Masculino , Músculo Masetero , Músculos Masticadores , Persona de Mediana Edad , Adulto Joven
4.
J Hand Surg Asian Pac Vol ; 26(1): 1-9, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33559566

RESUMEN

Metacarpals are unique bones that support the finger to aid hand function. Metacarpals are also the commonest bones to get fractured in the hand. Historically, most metacarpal fractures were managed conservatively. Due to increased patient expectations as well as advancements in diagnosis and osteosynthesis, various surgical options are now available for metacarpal fractures. The goal of operative management of metacarpal management is no longer limited to achieving clinical or radiological union. To restore hand function to a preinjury level, the surgeon must achieve adequate anatomical reduction and stable fixation with minimal soft tissue damage. Similar to tendon repair, to start early active motion should be the goal after metacarpal fracture fixation. Intraoperative consideration should also include minimizing soft tissue damage and avoiding tendon, ligament or capsular entrapment. The aim of this article is to explain the principles of surgical management, the different options available for metacarpal fractures, the techniques, pearls, advantages and disadvantages of each technique, so the surgeon can choose the ideal option to achieve the best result.


Asunto(s)
Fracturas Óseas/terapia , Huesos del Metacarpo/lesiones , Huesos del Metacarpo/cirugía , Clavos Ortopédicos , Placas Óseas , Tornillos Óseos , Reducción Cerrada , Fijadores Externos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Humanos , Inmovilización , Huesos del Metacarpo/anatomía & histología , Férulas (Fijadores)
5.
J Hand Surg Asian Pac Vol ; 26(1): 47-51, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33559583

RESUMEN

Background: Stack splint is commonly used for mallet finger treatment but patients had a tendency to frequently remove it because of skin complications. We hypothesized that a comprehensively instructed splinting regime would increase patients' compliance and lead to favorable outcomes with fewer skin complications. The aims of this study were to assess the patients' compliance and to evaluate outcomes with that particular splinting regime. Methods: Forty-six consecutive patients were enrolled in this prospective study. They were instructed to wear the Stack splint for 24 hours a day every day in the first six weeks and remove it once a day for 10 minutes to vent. They were told to support distal interphalangeal joint volarly both while wearing the splint and when it was removed. Free movement of proximal interphalangeal joint within the splint was checked after each application. Following whole-day regime for 6 weeks, night splinting continued for 2 more weeks. Range of motion, skin complications, patients' compliance and satisfaction were assessed at last follow-up. Results: There were 26 patients with a mean age of 39.8 and mean follow-up period of 6.7 months. No skin complications or proximal interphalangeal joint stiffness were reported. However, nine patients declared that they wore the splint ≤ 4 weeks, the compliance rate to our regime was 65.4% (17/26). In the 17 fully compliant patients, mean distal interphalangeal joint extension lag was 12.4 and nine of them (52.9%) were satisfied with the outcome. Conclusions: Our both hypotheses failed; comprehensive instructions for the splinting regime did not improve patients' compliance satisfactorily, nor did it lead to favorable outcomes. Although Stack splint has practical points, we no longer use it.


Asunto(s)
Traumatismos de los Dedos/terapia , Férulas (Fijadores) , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Satisfacción del Paciente , Estudios Prospectivos , Adulto Joven
6.
J Hand Surg Asian Pac Vol ; 26(1): 65-69, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33559565

RESUMEN

Background: Although extension block pinning for mallet fracture is popular, it occasionally results in poor outcome. We reviewed previous cases to elucidate the factors associated with poor outcome. Methods: From 2012 to 2017, 50 mallet fingers in 50 patients were consecutively repaired by extension block pinning using modified Ishiguro method. Inserted Kirschner-wires (K-wires) were removed at 6 weeks, followed by night splinting in extension. For outcome evaluation, distal interphalangeal (DIP) joint motion was measured and classified as either good or poor. Poor outcome was defined as either > 10° of extension lag or < 40° of active flexion or the presence of DIP joint pain. Associations between outcome and age, affected finger, interval to operation, fragment size (in terms of joint surface and dorsal cortex ratios), and fixation angle were evaluated. Results: 33 fingers (66%) had good outcome and 17 (34%) had poor outcome. Mean age was significantly greater in the poor (50.6 years) than in the good (40.1 years) outcome group (p < 0.05). The dorsal cortex ratio was also significantly larger in the poor than in the good outcome group (p = 0.006), but there was no significant difference between two groups in joint surface ratio. Affected finger, interval to surgery, and fixation angle also did not significantly differ between groups. Conclusions: Fracture fragments with a long dorsal cortex and older age associated with poor outcome following extension block pinning for mallet finger. The dorsal cortex ratio should be evaluated pre-operatively to determine the appropriate treatment method.


Asunto(s)
Hilos Ortopédicos , Traumatismos de los Dedos/cirugía , Fijación Interna de Fracturas/métodos , Fracturas por Avulsión/cirugía , Traumatismos de los Tendones/cirugía , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Deformidades Adquiridas de la Mano/etiología , Deformidades Adquiridas de la Mano/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Férulas (Fijadores) , Traumatismos de los Tendones/complicaciones , Adulto Joven
7.
Clin Oral Investig ; 25(3): 1525-1534, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33409688

RESUMEN

OBJECTIVES: Angle Class II malocclusions including a retrognathic mandible are the most frequent orthodontic problems. Both removable and fixed functional appliances can be used for mandibular advancement. Mandibular advancement after treatment with any fixed functional appliance has numerous therapeutic effects, such as stretching of masticatory muscles, ligaments, membranes and surrounding soft tissues, thus causing positional changes of the hyoid bone and epiglottis. This retrospective study investigates and compares treatment effects upon epiglottis- and hyoid bone position and posterior airway space in class II patients who received mandibular advancement through two different cast splint fixed functional appliances. MATERIAL AND METHODS: Two groups of 21 patients each ('Functional Mandibular Advancer' (FMA) and Herbst appliance) were investigated. The same experienced orthodontist performed the treatment in all patients, employing a single-step advancement protocol. The mandible always received initial protrusion into an edge-to-edge position. Conventional lateral cephalograms were available pre-treatment (T1) and immediately after appliance removal (T2) for all patients. The measurements comprised (I) hyoid bone, (II) epiglottis or (III) posterior airway space. Treatment-related changes were analysed with one-sample Student's t tests for intragroup comparisons and independent Student's t tests for intergroup comparisons. Statistical significance was set at p < 0.05. RESULTS: Measurements of the hyoid bone showed mostly increases for both appliances after treatment. Intergroup comparisons were not significant for FMA patients but significant for selected measurements in Herbst appliance patients. Intergroup comparisons showed insignificant changes. The posterior airway space was always insignificantly increased after treatment. The greatest increase was found caudally. Intergroup comparisons showed insignificant changes. CONCLUSIONS: Both fixed functional appliances cause an anterior and caudal displacement of epiglottis and hyoid bone and enlarge the posterior airway space. The therapeutic effects of the Herbst appliance are slightly larger, although not significantly. CLINICAL RELEVANCE: Treatment with either Herbst appliance of FMA alters the hyoid bone position and enlarges the posterior airway space. Still, long-term data are as yet unavailable; it remains unknown if the effects upon posterior airway space remain stable, and if a resulting posterior airway space enlargement may have clinical influence upon obstructive sleep apnoea syndrome.


Asunto(s)
Maloclusión de Angle Clase II , Aparatos Ortodóncicos Funcionales , Cefalometría , Epiglotis , Humanos , Hueso Hioides , Maloclusión de Angle Clase II/terapia , Mandíbula , Aparatos Ortodóncicos Fijos , Estudios Retrospectivos , Férulas (Fijadores)
9.
Ann Emerg Med ; 77(2): 163-173, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33500115

RESUMEN

STUDY OBJECTIVE: In patients with a distal radius buckle fracture, we determine whether home removal of a splint and physician follow-up as needed (home management) is noninferior to primary care physician follow-up in 1 to 2 weeks with respect to functional recovery. We also compare groups with respect to health care and patient-level costs. METHODS: This was a noninferiority randomized controlled trial conducted at a tertiary care children's hospital. Eligible patients were randomized to home management versus primary care physician follow-up and received telephone contact at 3 and 6 weeks after the index ED visit. Functional recovery was measured with the Activities Scale for Kids-performance, and participants reported wrist-injury-related health care interventions and expenses. The primary outcome was a comparison of the performance score between groups at 3 weeks. RESULTS: We enrolled 149 patients with mean age 9.5 years (SD 2.7 years), and 81 (54.4%) were male patients. Of the 133 patients (89.3%) with completed 3-week follow-up, the mean Activities Scale for Kids-performance score was 95.4% in the home management group (n=66) and 95.9% in the primary care physician follow-up group (n=67) (mean difference -0.4%; lower bound of the 95% confidence interval -2.4%). There was a mean costs savings of -$100.10 (95% confidence interval -$130.0 to -$70.20) in health care and -$28.2 (95% confidence interval -$49.6 to -$7.0) in patient costs in the home management versus primary care physician follow-up group. CONCLUSION: In patients with distal radius buckle fractures, home management is at least as good as primary care physician follow-up with respect to functional recovery. Implementation of the home management strategy also demonstrated significant cost savings.


Asunto(s)
Cuidados Posteriores/economía , Atención Domiciliaria de Salud , Médicos de Atención Primaria , Fracturas del Radio/terapia , Férulas (Fijadores) , Niño , Ahorro de Costo , Femenino , Atención Domiciliaria de Salud/economía , Hospitales Pediátricos , Humanos , Masculino , Recuperación de la Función
10.
Medicine (Baltimore) ; 99(50): e23612, 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33327331

RESUMEN

RATIONALE: Greenstick fractures most commonly occur in the pediatric population, especially in those under 10 years of age. Greenstick fractures are "extremely" rare in adults. This report presents the case of a greenstick fracture of the ulnar shaft in an adult following physical therapy for a radial neck fracture and ulnar shaft fracture post-internal fixation. Greenstick fracture can occur during physical therapy near the drill holes created during surgery. PATIENT CONCERNS: A 23-year-old man without any past medical history had sustained a greenstick fracture of the ulnar shaft after rehabilitation for a left radial and ulnar fracture that had been previously treated with internal fixation. DIAGNOSES: Five months after removal of the implants, the patient complained of left elbow tenderness and a "breaking" sound that occurred during physical therapy. The results of a subsequent X-ray revealed a greenstick fracture of the left ulnar shaft. INTERVENTIONS: Splinting of the fracture. OUTCOMES: After 2 months of splint fixation, the pain and range of motion in the affected arm were improved, and sequential X-rays showed callus formation and increased density of the ulnar shaft. LESSONS: Greenstick fractures occur not only in children but also in adults in specific circumstances. The cortex of long bones may be further weakened by drill holes created during surgery, and fractures may occur during physical therapy. During treatment, physicians, and therapists should pay more attention to the patient who has undergone implant removal to avoid greenstick fractures, especially in the locations near drill holes.


Asunto(s)
Modalidades de Fisioterapia/efectos adversos , Fracturas del Cúbito/diagnóstico , Diagnóstico Diferencial , Fijación Interna de Fracturas/efectos adversos , Humanos , Masculino , Fracturas del Radio/rehabilitación , Fracturas del Radio/cirugía , Rango del Movimiento Articular , Férulas (Fijadores) , Fracturas del Cúbito/diagnóstico por imagen , Fracturas del Cúbito/etiología , Adulto Joven
11.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artículo en Inglés | MEDLINE | ID: mdl-33334764

RESUMEN

Volar plate injuries are typically caused by hyperextension of the proximal interphalangeal joint. These injuries are usually seen in sports where the ball comes in direct contact with the hands. Forceful dorsiflexion of the finger caused by the speeding ball leads to volar plate avulsion. In cricket, such finger injuries predominantly occur in fielders trying to catch or stop the speeding ball with bare hands. We report two unusual cases of volar plate avulsion injury occurring in batsmen that occurred during 'gully cricket' (street-cricket). We propose the possibility of a novel contrecoup-type mechanism causing this type of injury in the two cases. Both were successfully managed with splinting and had excellent recovery without any residual deformity or instability.


Asunto(s)
Cricket/lesiones , Traumatismos de los Dedos/diagnóstico , Placa Palmar/lesiones , Férulas (Fijadores) , Adulto , Traumatismos de los Dedos/etiología , Traumatismos de los Dedos/terapia , Dedos/diagnóstico por imagen , Humanos , Masculino , Placa Palmar/diagnóstico por imagen , Resultado del Tratamiento
12.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4628-4631, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33019025

RESUMEN

This paper demonstrates the design and manufacturing of a smart and connected internet-of-things collar system for the collection of behavioral and environmental information from working canines. The environmental factors of ambient light, ambient temperature, ambient noise levels, barometric pressure and relative humidity are recorded by the smart collar system in addition to behavioral information about barking incidences and activity levels. The data are collected from the sensors and transmitted via Bluetooth to the handler's smartphone where the custom app also acquires GPS positioning using the on-board smartphone sensors. The stored data on the smartphone are uploaded to the IBM Cloud once the user is connected to a WiFi network. The low power design of the smart collar system permits it to be used continuously for 27 hours with a 290 mAh lithium polymer battery. The cost of the system is low enough to let the handlers have multiple collars and exchange it if needed or recharge it overnight when not in use. This system is currently being scaled up to be tested on hundreds of canine puppies by a preeminent guide dog school in the US. As a result, the design emphasis here has been on the cost and power reduction, comfortable ergonomics, user friendliness, and robustness of data streaming. We expect the system to provide continuous quantitative data for improving guide dog training programs in addition to contributing the well-being of other working dogs in the future.


Asunto(s)
Teléfono Inteligente , Animales , Recolección de Datos , Perros , Femenino , Registros , Férulas (Fijadores)
13.
Rev. bras. ortop ; 55(5): 570-578, Sept.-Oct. 2020. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1144217

RESUMEN

Abstract Objective To demonstrate the clinical outcomes and complication rates of the surgical release with a single posterior approach in the treatment of post-traumatic elbow stiffness. Methods A prospective study with patients submitted to surgery between May 2013 and June 2018 in a single center. The access to the elbow was made through the posterior approach. The patients were followed up by an occupational therapy team, and were submitted to a standardized rehabilitation protocol, with static progressive orthoses and dynamic orthoses. The primary outcome was the range of flexion-extension of the elbow after 6 months. Results A total of 26 patients completed the minimum follow-up of 6-months. The mean range of flexion-extension of the elbow at the end of 6 months was of 98.3 ± 22.0°, with an amplitude gain of 40.0 ± 14.0° in relation to the pre-operative period (p< 0.001). The average flexion-extension gain at the end of 6 months was of 51.7% ± 17.1% (p< 0.001). The mean pronosupination at the end of 6 months was of 129.0 ± 42.7° (p< 0.001). Half of the cases had moderate and severe stiffness in the pre-operative period, compared with 7.7% at 6 months post-operatively (p< 0.001). The mean score for the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) instruments was 74.4 ± 16.8 points and 31.7 ± 21.9 points respectively (p< 0.001 for both). The visual analogue scale (VAS) score presented no statistically significant difference compared to the pre-operative period (p= 0.096). Complications were observed in 6 (23%) patients, and no new surgical procedures were necessary. Conclusions The surgical release of the elbow associated with a rehabilitation protocol is a safe technique, with satisfactory results and low rate of complications.


Resumo Objetivo Demonstrar os resultados clínicos e a taxa de complicações da liberação cirúrgica por via única posterior no tratamento da rigidez pós-traumática de cotovelo. Métodos Estudo prospectivo, com pacientes submetidos a cirurgia entre maio de 2013 e junho de 2018 em um único centro. Foi realizado acesso ao cotovelo por via posterior. O seguimento dos pacientes foi feito por uma equipe de terapia ocupacional, e eles foram submetidos a um protocolo de reabilitação padronizado, com órteses estáticas progressivas e dinâmicas. O desfecho primário foi a amplitude de flexoextensão do cotovelo após 6 meses. Resultados Um total de 26 pacientes completaram o seguimento mínimo de 6 meses. A média de flexoextensão do cotovelo, ao final de 6 meses, foi de 98,3° ± 22,0°, com um ganho de amplitude de 40,0° ± 14,0° em relação ao pré-operatório (p< 0,001). A média de ganho relativo de flexoextensão, ao final de 6 meses, foi de 51,7% ± 17,1% (p< 0,001). A média de pronossupinação, ao final de 6 meses, foi de 129,0° ± 42,7° (p< 0,001). Metade dos casos apresentava rigidez moderada e grave no pré-operatório, contra 7,7% aos 6 meses de pós-operatório (p< 0,001). A pontuação nos instrumentos Mayo Elbow Performance Score (MEPS) e Disabilities of the Arm, Shoulder and Hand (DASH) apresentou melhora estatisticamente significativa em relação ao pré-operatório, atingindo 74,4 ± 16,8 pontos e 31,7 ± 21,9 pontos, respectivamente. A escala visual analógica (EVA) não apresentou diferença estatisticamente significativa em relação ao pré-operatório (p= 0,096). Complicações foram observadas em 6 (23%) pacientes, não sendo necessária nova abordagem cirúrgica em nenhum paciente. Conclusões A liberação cirúrgica do cotovelo associada a protocolo de reabilitação é técnica segura, com resultados satisfatórios e baixa taxa de complicações.


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Rehabilitación , Férulas (Fijadores) , Estudios Prospectivos , Contractura , Amplitud , Articulación del Codo , Liberación de la Cápsula Articular
14.
Bone Joint J ; 102-B(10): 1399-1404, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32993325

RESUMEN

AIMS: The study was undertaken to compare the efficacy of Woodcast splints and plaster-of-Paris casts in maintaining correction following sequential manipulation of idiopathic clubfeet. METHODS: In this randomized prospective trial, 23 idiopathic clubfeet were immobilized with plaster-of-Paris casts and 23 clubfeet were immobilized with a splint made of Woodcast that encircled only two-thirds the circumference of the limb. The number of casts or splints needed to obtain full correction, the frequency of cast or splint-related complications, and the time taken for application and removal of the casts and splints were compared. RESULTS: The mean number of casts required to obtain full correction of the deformity (Pirani Score 0) was 4.35 (95% confidence interval (CI) 3.74 to 4.95) when plaster-of-Paris was used and 4.87 (95% CI 4.33 to 5.41) when the Woodcast splint was used (p = 0.190). The time required for application and removal of the Woodcast splint were significantly less than that required for application and removal of plaster-of-Paris casts (p < 0.001). Woodcast splint-related complications were not more frequent than plaster-of-Paris cast related complications. CONCLUSION: Though Woodcast splints covering two-thirds of the circumference of the lower limbs of infants were effective in maintaining the correction of clubfoot deformity during serial manipulation and casting treatment, the superiority of Woodcasts over plaster-of-Paris could not be established. Cite this article: Bone Joint J 2020;102-B(10):1399-1404.


Asunto(s)
Moldes Quirúrgicos , Pie Equinovaro/terapia , Férulas (Fijadores) , Sulfato de Calcio , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Manipulación Ortopédica , Estudios Prospectivos
15.
Bone Joint J ; 102-B(10): 1405-1411, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32993326

RESUMEN

AIMS: This exploratory randomized controlled trial (RCT) aimed to determine the splint-related outcomes when using the novel biodegradable wood-composite splint (Woodcast) compared to standard synthetic fibreglass (Dynacast) for the immobilization of undisplaced upper limb fractures in children. METHODS: An exploratory RCT was performed at a tertiary paediatric referral hospital between 1 June 2018 and 30 September 2019. The intention-to-treat population consisted of 170 patients (mean age 8.42 years (SD 3.42); Woodcast (WCG), n = 84, 57 male (67.9%); Dynacast (DNG), n = 86, 58 male (67.4%)). Patients with undisplaced upper limb fractures were randomly assigned to WCG or DNG treatment groups. Primary outcome was the stress stability of the splint material, defined as absence of any deformations or fractures within the splint during study period. Secondary outcomes included patient satisfaction and medical staff opinion. Additionally, biomechanical and chemical analysis of the splint samples was carried out. RESULTS: Of the initial 170 patients, 168 (98.8%) completed at least one follow-up, and were included for analysis of the primary endpoint. Both treatment groups were well-matched regarding to age, sex, and type and localization of the fracture. Splint breakage occurred in three patients (3.6%; 95% confidence interval (CI), 0.007% to 0.102%) in the WCG and in three children (3.5%, 95% CI 0.007% to 0.09%) in the DNG (p > 0.99). The incidence of splint-related adverse events did not differ between the WCG (n = 21; 25.0%) and DNG (n = 24; 27.9%; p = 0.720). Under experimental conditions, the maximal tensile strength of Dynacast samples was higher than those deriving from Woodcast (mean 15.37 N/mm² (SD 1.37) vs 10.75 N/mm² (SD 1.20); p = 0.002). Chemical analysis revealed detection of polyisocyanate-prepolymer in Dynacast and polyester in Woodcast samples. CONCLUSION: Splint-related adverse events appear similar between WCG and DNG treatment groups during the treatment of undisplaced forearm fractures. Cite this article: Bone Joint J 2020;102-B(10):1405-1411.


Asunto(s)
Traumatismos del Brazo/terapia , Fracturas Óseas/terapia , Férulas (Fijadores) , Adolescente , Niño , Preescolar , Femenino , Vidrio , Humanos , Inmovilización , Lactante , Análisis de Intención de Tratar , Masculino , Diseño de Prótesis , Madera
16.
J Am Dent Assoc ; 151(10): 721, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32979948
18.
Dtsch Arztebl Int ; 117(26): 445-451, 2020 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-32897182

RESUMEN

BACKGROUND: After the surgical management of distal radius fractures (DRF) in older patients, further treatment with a splint often follows. It is unclear whether early mobilization might be superior to splinting in this group of patients, as it is in others. In this prospective, randomized, controlled trial, we attempted to determine whether early mobilization yields better outcomes. METHODS: 50 patients over age 70 with DRF were included in the trial. Group A (the splint group) was treated with postoperative immobilization, group B with early mobilization. Clinical follow-up examinations were performed at 2, 6, and 12 weeks and at 6 and 12 months. X-rays were obtained preoperatively, postoperatively, at 6 weeks, and at 6 months. The primary outcome parameter was the modified Mayo Wrist Score (MMWS) at 6 weeks. RESULTS: At 6 weeks, the functional outcome was better to a statistically significant extent in group B (MMWS; 65/100 vs. 55/100 [q25 : 55/40 - q75 : 70/70; p = 0.025]). No difference between the two groups was demonstrable in their further clinical course. The estimated regression model revealed a statistically significant effect of the method of treatment (p = 0.023). There were no differences in hand strength or in x-ray findings. DISCUSION: Early mobilization is associated with better wrist function on initial follow-up, without any demonstrable disadvantage with respect to secondary dislocation. The psychological benefit and protective function of wrist splinting in patients who are in danger of falling should nonetheless be investigated in further studies.


Asunto(s)
Ambulación Precoz , Fracturas del Radio/rehabilitación , Férulas (Fijadores) , Anciano , Humanos , Estudios Prospectivos , Fracturas del Radio/cirugía , Resultado del Tratamiento
19.
Am J Occup Ther ; 74(5): 7405205050p1-7405205050p15, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32804623

RESUMEN

IMPORTANCE: Spasticity is one of the most common and disabling motor impairments after stroke. OBJECTIVE: To examine the evidence for the effectiveness of stretching interventions, including splinting, on reducing upper extremity spasticity, increasing hand function, and improving functional tasks for adults with poststroke spasticity. DATA SOURCES: Databases searched were MEDLINE, CINAHL, OTseeker, AgeLine, and the Cochrane Library; results were limited to studies published from 2004 to January 2017. STUDY SELECTION AND DATA COLLECTION: Following PRISMA guidelines, we included articles describing Level I-III studies with participants who were adults with upper extremity spasticity and received a stretching intervention. FINDINGS: Eleven articles describing 6 Level I and 5 Level III studies met inclusion criteria. CONCLUSION AND RELEVANCE: For reducing upper extremity spasticity, low strength of evidence was found to support the use of static splinting, strong strength of evidence was found for the use of stretching devices, and low strength of evidence was found to support the use of dynamic splinting; no evidence was found for manual stretching to address spasticity. For increasing hand function, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices. For improving functional tasks, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices. WHAT THIS ARTICLE ADDS: This updated synthesis summarizes the current literature regarding the effectiveness of stretching interventions to improve poststroke spasticity, hand function, and functional tasks.


Asunto(s)
Terapia Ocupacional , Accidente Cerebrovascular/complicaciones , Adulto , Humanos , Espasticidad Muscular , Férulas (Fijadores)
20.
Zhonghua Shao Shang Za Zhi ; 36(8): 751-753, 2020 Aug 20.
Artículo en Chino | MEDLINE | ID: mdl-32829620

RESUMEN

The maintenance of posture and anti-contracture treatment are the critical elements of comprehensive burn rehabilitation in the overall treatment period of pediatric burns. Although domestic experts in burn discipline have formulated guidelines for burn rehabilitation, the maintenance of posture and design and manufacture of splints for anti-scar contractures in children with burns are different from that for adults with burns in many ways. Starting with paying the attention to the rehabilitation problems in pediatric burns, especially considering the anatomical, psychological, and social behavior characteristics of children in developmental period, the author's team effectively applies splints to maximize the prevention of contractures in children and maintain and improve the range of their joint movements. The splints designed to prevent contractures in pediatric burns shall fit the small limb and meet their expected goals of rehabilitation. In each aspect of the production and use of splints, it is necessary to fully evaluate and consider the scar characteristics, growth and development status, activity level, and compliance of children, and adaptability and fixation methods of the splints, so as to select the appropriate splint type and formulate the wearing plan.


Asunto(s)
Quemaduras , Férulas (Fijadores) , Niño , Cicatriz , Contractura , Extremidades , Humanos
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