Articles: casts-standards.
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Casts are used to treat clubfeet, developmental dysplasia of the hip (DDH), forearm fractures, and femur fractures. The ability of a cast to maintain a desired shape is termed moldability. Clinicians use plaster, fiberglass, and soft casts. To our knowledge the biomechanical molding characteristics of these 3 materials have never been reported. We hypothesized that moldability of plaster would be better than fiberglass and fiberglass would be better than soft cast. ⋯ If precise molding is required, plaster has the best moldability. In cases not requiring precise molding, fiberglass and soft cast are lightweight, waterproof, and available in child-friendly colors.
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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. ⋯ 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.
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Ann R Coll Surg Engl · Mar 2013
Comparative StudyEffect of cotton padding on the setting properties of plaster slabs.
Plaster of Paris (PoP) impregnated bandages have been used to maintain the position of bones and joints for over a century. Classically, wool dressing is applied to the limb before the PoP, which can then be moulded to the desired shape. A modification of this practice is to wrap the PoP bandages circumferentially in cotton before wetting and applying to the patient in an attempt to reduce inhalation of plaster dust and reduce mess. However, this may affect the water content of the cast and therefore also its setting properties and strength. This study compared the setting properties of PoP casts when used with and without cotton wrapping. ⋯ The initial decrease in strength and stiffness of the cast wrapped in cotton may comprise the ability of the backslab to hold the joint or bone in an optimal position. Any modification of the standard plaster slab application technique should allow for the potential adverse effects on the plaster setting properties.
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Multicenter Study
Re-displacement of paediatric forearm fractures: role of plaster moulding and padding.
Re-displacement of paediatric forearm and wrist fractures following manipulation and cast application is a common complication. Poor plaster application technique is an important risk factor for re-displacement. However, there are no reliable and validated objective radiological measurements to differentiate a well-applied plaster cast from a poorly padded and moulded cast. ⋯ Cast index, Padding index and Canterbury index were significantly greater in the re-displacement group as compared to the cases where no re-displacement was seen (p<0.005). Improvement in the plaster application skills as monitored by these indices reduced the re-displacement rate by 50%. We suggest that a high Cast index of more than 0.8, Padding index of more than 0.3 and the combined Canterbury index of 1.1 are important risk factors for re-displacement of these fractures.
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The treatment of isolated ulnar fractures remains controversial, with different authors recommending both surgical and non-surgical management. We undertook a systematic review of the current literature in order to assess whether any conclusions can be drawn. A total of 33 series involving 1876 patients were identified as suitable for analysis. ⋯ However, these have not been verified in clinical studies. Compression plate fixation gave reliable results in these cases. Other methods lacked sufficient published data to be recommended.