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Fulltext Are Gap and Cast Indices Predictors of Efficacy of Reduction in Fractures of Both Bones of the Leg? A Cohort Study

Shalabh K, Ajai S, Vineet K, Sabir A

Malays Orthop J, 2018 Jul;12(2):15-19.
PMID: 30112123 DOI: 10.5704/MOJ.1807.003

Introduction: Non-operative management has successfully been practised for long in diaphyseal fractures of both bones of the leg. This study attempts to establish an acceptability criteria for plaster cast in order to predict future loss of reduction and its adequacy. Materials and Methods: A total of forty subjects were included as per inclusion-exclusion criteria. Gap and cast indices were calculated in the immediate post reduction phase and at third week follow-up visit. Results: The mean values of gap and cast indices in the immediate post-reduction phase were 0.35±0.220 and 0.99±0.08 respectively and at the third week follow-up the mean value for both the parameters in those without loss of reduction were 1.11±0.50 and 1.03±0.09 respectively and in those with loss of reduction were 0.84±0.44 and 1.01±0.06 respectively. Conclusion: Gap and cast indices are not informative in assessing adequacy of reduction in diaphyseal fractures of both bones of the leg.

Matched MeSH terms: Casts, Surgical
Fulltext Conservative management of femoral shaft fractures in children

Moses T, Pan KL, Razak M

Med J Malaysia, 1998 Sep;53 Suppl A:22-6.
PMID: 10968179

Thirty-two children with femoral shaft fractures were treated conservatively with initial skin traction followed by an additional period in a spica cast. After 12 to 20 months of follow up, none had any pain and all of them were attending school without problems. Shortening of more than 2 cm occurred in 6 (19%) of the 32 patients. The most important factor associated with shortening was an overlap of more than 2 cm of shortening of the fracture ends at the time of cast fitting. The average compensatory overgrowth at final assessment was 7 mm. Angular deformity did not pose a problem. This is a safe, simple and practical method to treat childhood femoral shaft fractures.

Matched MeSH terms: Casts, Surgical*
Fulltext Femoral shaft fracture in children treated by early hip spica cast: early result of a prospective study

Jamaludin M

Med J Malaysia, 1995 Mar;50(1):72-5.
PMID: 7752980

Twenty-four children under the age of 10 years with femoral shaft fractures were treated by early immobilization of fracture and application of hip spica cast. The average hospital stay was 3.5 days. The average shortening at time of fracture union was 15 mm. The average time of follow up was 6.7 months. All fractures healed, except for one, in an acceptable position. The average shortening at last follow up was 9.5 mm and the average overgrowth up to the time was 6 mm. There was no incidence of refracture, joint stiffness or any pressure sore.

Matched MeSH terms: Casts, Surgical*
Fulltext Can the Pirani Score Predict the Number of Casts and the Need for Tenotomy in the Management of Clubfoot by the Ponseti Method?

Sharma A, Shukla S, Kiran B, Michail S, Agashe M

Malays Orthop J, 2018 Mar;12(1):26-30.
PMID: 29725509 DOI: 10.5704/MOJ.1803.005

Introduction: We assessed the role of the Pirani score in determining the number of casts and its ability to suggest requirement for tenotomy in the management of clubfoot by the Ponseti method. Materials and Methods: Prospective analysis of 66 (110 feet) cases of idiopathic clubfoot up to one year of age was done. Exclusion criteria included children more than one year of age at the start of treatment, non-idiopathic cases and previously treated or operated cases. Results: The initial Pirani score was (5.5±0.7) for the tenotomy group and the initial Pirani score was (3.3±1.6) for the non-tenotomy group. There was a significant difference between the initial Pirani score for the tenotomy and the non-tenotomy group with t= -7.9, df= 64 p<0.0001. The tenotomy group had a significantly higher number of casts (four to seven) compared to non-tenotomy group (two to five) t=-10.4, df=64, p<0.0001. Spearman's rank correlation coefficient was significant and confirmed positive correlation between the initial Pirani score and the number of casts required to correct the deformity (r = 0.931, p<0.0001). Conclusion: Initial high Pirani score suggests the need for greater number of casts to achieve correction and probable need for tenotomy. The number of casts required in achieving complete correction increases with increase in the initial Pirani score. The initial high hindfoot score (2.5-3) signifies the probable need of a minor surgical intervention of percutaneous tendoachilles tenotomy. Based on the initial Pirani score, parents can be informed about the probable duration of treatment and the need for tenotomy.

Matched MeSH terms: Casts, Surgical
Fulltext Early functional and radiological outcomes between plaster cast and fiberglass cast in stable thoracolumbar burst fracture

Zamzuri Z., Ariff M.S., Mohd Fairuz Ad., Mohd Shukrimi A., Nazri My.

International Medical Journal Malaysia, 2018;17(1):121-126.
MyJurnal

Introduction: Burst fracture results from compression failure of both the anterior and middle columns under
substantial axial loads. Conservative treatment was a method of treatment for fractures without
neurological deficit. This cross sectional study was designed to evaluate the functional and radiological
outcome of patient with thoracolumbar burst fracture treated conservatively. Methods: 40 cases were
recruited from January 2013 till December 2015. They were followed-up with minimum period of 1 year and
evaluated for the functional (Oswetry Disbility Index) and radiological outcomes (kyphotic angle deformity
and anterior body compression). Results: 20 patients were treated with body cast made form plaster of
Paris and remaining 20 patients with fiberglass cast. In plaster of Paris group, mean kyphotic angle
deformity at last follow up was 16.60 ± 2.95 with a mean improvement 4.45 degree and anterior body
compression at last follow up was 30.35% ± 10.2 with mean improvement of 9.30%. In fiberglass group, mean
kyphotic angle deformity at last follow up was 15.55 ± 3.38 with a mean improvement 7.25 degree and
anterior body compression at last follow up was 25.90% ± 7.81 with mean improvement of 3.45%. The
functional outcome showed Oswetry Disability Index (ODI) score in plaster of Paris group was 23.70 (SD =
7.82) and in fiberglass group was 18.50 (SD = 5.94). Conclusions: Application of body cast using a fiberglass
material give better radiological outcome hence less pain, more functional and higher patient’s satisfaction
as compared to plaster of Paris.

Matched MeSH terms: Casts, Surgical
Deficient dorsalis pedis flow in severe idiopathic clubfeet: Does Ponseti casting affect the outcome?

Munajat I, Yoysefi M, Nik Mahdi NM

Foot (Edinb), 2017 Aug;32:30-34.
PMID: 28672132 DOI: 10.1016/j.foot.2017.05.003

BACKGROUND: Arterial deficiency in congenital clubfoot or congenital talipes equinovarus (CTEV) was postulated as either the primary cause of deformity or secondary manifestation of other bony and soft tissue abnormalities. The objectives of the study were to find any association between arterial deficiency with severity of CTEV and its treatment.
METHOD: This prospective study conducted on 24 feet with CTEV (18 babies) with Pirani score ranging between 2 to 6. Eighteen normal babies (36 feet) were selected as control. We used Color Doppler Ultrasound to assess dorsalis pedis and posterior tibial arteries before initiating the treatment. Second ultrasound was performed in study group upon completion of Ponseti treatment.
RESULTS: The patients were from one week to 15 weeks of life. Dorsalis pedis arterial flows were absent in 7 clubfeet (29.1%) while the remaining 17 clubfeet (70.8%) had normal flow. There was a significant association between Pirani severity score and vascular status in congenital clubfoot. There was a higher proportion of clubfeet having abnormal vascularity when the Pirani severity score was 5 and more. In study group, posterior tibial arteries were detectable and patent in all feet. All normal feet in control group had normal arterial flow. There was a significant difference in vascular flow before and after the Ponseti treatment (p 0.031).
CONCLUSION: The study concludes that there is an association between Pirani severity score and arterial deficiency in CTEV. Ponseti treatment is safe in CTEV with arterial deficiency and able to reconstitute the arterial flow in majority of cases.

Matched MeSH terms: Casts, Surgical*
Fulltext Contributing factors in non-union of the humeral shaft fracture and the results of treatments

Baba R, Razak M

Med J Malaysia, 1998 Sep;53 Suppl A:42-51.
PMID: 10968182

Out of 218 fractures of humeral shaft treated in the department, 23 (10.5%) of them developed non-union. 14/23 (60.9%) fracture were located in middle third. Transverse (52.2%), short oblique (17.4%) and comminuted fracture (13.0%) constituted about 82% of all initial fracture pattern. Twelve cases (52.5%) were initially treated with hanging cast. Radial nerve palsy occurred in 4/23 (17.4%) of patient and all of them located at lower third of humerus and only one recovered after eight weeks of injury. Factors such as middle third comminuted opened fractures, soft tissue interposition, improper immobilization and poor patient compliance were found to be directly associated with the non-union. All non-unions healed following plating and bone grafting. Overall 17/23 patient (74%) had good results, 4/23 (17%) fair and 2/23 (9%) with poor functional results.

Matched MeSH terms: Casts, Surgical*
Fractures of the tibia and fibula. A follow-up study of the initial 64 patients treated at the University Hospital, Kuala Lumpur, Malaysia

Silva JF

J Trauma, 1972 Dec;12(12):1029-40.
PMID: 4568503
Matched MeSH terms: Casts, Surgical