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Optimum duration of splinting after endopyelotomy.

OBJECTIVE: Endopyelotomy is a well-accepted modality of treatment for pelviureteral junction (PUJ) obstruction, but the time period of stenting is debatable. The present study was aimed at evaluating the optimum duration and effectiveness of splinting after endopyelotomy. PATIENTS AND METHODS: Twenty-nine consecutive patients with primary PUJ obstruction were randomized to have an external splint (for economic reasons) for 2 weeks or 4 weeks. Thirteen patients in each group were available for evaluation. The groups were comparable in age, sex, symptoms, and preoperative glomerular filtration rate (GFR). All patients underwent antegrade endopyelotomy with placement of an 8F-12F polyethylene splint across the PUJ. A nephrostogram was performed after removal of splint at 2 or 4 weeks. Nondraining units were managed by putting in a 6F double-J stent for 6 weeks and considered failures. Patients were evaluated at 3, 6, and 12 months for symptomatic improvement, change in GFR, and drainage pattern on a diuretic renogram. RESULTS: At 1 year, a nonobstructed curve pattern was seen in 70% and improvement in GFR in 54% of the patients in the 2-weeks group, whereas in the 4-weeks group, these values were 54% and 39%, respectively. All patients in the 4-weeks group and 90% of those in the 2-weeks group were symptom free at 1 year of follow-up. Morbidity in terms of tube-related complications was comparable. CONCLUSION: Two weeks of splinting is as effective as 4 weeks in the successful outcome of endopyelotomy.

Adolescent↗

Distal splint bone fractures in the horse: an experimental and clinical study.

An experimental and clinical study to investigate the aetiology of distal splint bone fractures is described. In vitro, extension of the fetlock did not appear to alter the position of the distal ends of the splint bones, although tension in the interosseous tendons increased. Flexion of the fetlock resulted in slight outward displacement of the distal ends of the splint bones. It is suggested that concurrent desmitis of the suspensory ligament can cause movement of the ends of the splint bones thus predisposing to a fatigue fracture. In a clinical study of 87 horses, 114 splint bone fractures were identified. In at least 70 per cent of horses, suspensory desmitis was present. Follow up information was available in 24 horses in which more than 80 per cent of the fractures healed spontaneously. Non-union fractures were not painful and did not cause lameness.

Animals↗

Microscopical splint epididymovasostomy.

Splint epididymovasostomy is a new approach in operative andrology. In 23 rats, a microscopical splint epididymovasostomy was done in two groups 40 days after sterilization using 5/0 polyglactic acid and 5/0 plain-catgut as a splint. 28 anastomoses could be evaluated. 3 months later, in 2 of the 16 animals (12.5%), spermatozoa were detected in the ejaculate after electro-ejaculation. In six of the specimens (27.3%), the methylene blue given from the vas deferens passed into the epididymis. The patency of these was also proved histopathologically. The catgut splints were absorbed within 3 months. Microscopical splint epididymovasostomy shows that this method can lead to a free passage of the spermatozoa.

Animals↗

Optimizing splinted ligation of highly structured small RNAs.

The synthesis of highly structured small RNAs containing nonstandard nucleotides is of high interest for structural and functional investigations. A general approach is the joining, by T4 DNA ligase-mediated splinted ligation, of two or more RNA fragments, each of which may contain its own set of modified nucleotides. The RNA fragments hybridize with a complementary DNA splint to form a ternary ligation-competent-complex (LCC), which is then turned over by the DNA ligase. We studied the formation of the LCC and its precursors using size exclusion chromatography combined with a fluorescence detector. The spatial proximity of two cyanine-dye-labeled RNA fragments in LCCs was detected by monitoring FRET. An observed correlation of LCC formation and ligation yields suggests the use of long splints to stabilize LCCs. Splint oligos of increasing length, which in general appear to reduce the number of different hybridization intermediate species found in a reaction mixture, were applied to the synthesis by T4-DNA-ligation of two highly structured target molecules, one a 73 mer tRNA, the other a 49 mer synthetic ribozyme. A stable LCC could be isolated and turned over with>95% ligation efficiency. In conclusion, the use of long splints presents a generally applicable means to overcome the low propensity of highly structured RNAs for hybridization, and thus to significantly improve ligation efficiencies.

Base Sequence↗

A comparison of splinted and banded Herbst appliances: treatment changes and complications.

The aims of this study were to compare the frequency of clinical problems, such as fracture and dislodgment, and the dentofacial changes in 28 13-year-old Chinese children with Class II, division 1 nalocclusions treated with either cast-metal splinted Herbst appliances or banded Herbst appliances. ne first fourteen children were treated with a maximum anchorage type of banded Herbst appliance for six months, and the remainder were treated with cast-silver splinted Herbst appliances for seven months. The dentofacial form and the treatment changes were assessed with one aid of pre- and post-treatment lateral cephalometric radiographs. The number of visits and the number of fractured and dislodged appliances were recorded. Both appliances had similar effects on the dentofacial structures. There were no statistically significant dentofacial differences between the groups at the conclusion of treatment. During treatment relatively few banded appliances were dislodged and few splinted appliances fractured. However, a large number of banded appliances fractured, and a similar number of splinted Herbst appliances were dislodged. The latter required less clinical and laboratory time to service and/or replace. It was concluded that splinted Herbst appliances are preferable to banded Herbst appliances because of the savings in clinical and laboratory time.

Adolescent↗

Neonatal chest wall suspension splint: a novel and noninvasive method for support of lung volume.

Surfactant and musculoskeletal immaturity results in lower compliance of the lung relative to the chest wall, with clinical manifestations of low lung volume, marked chest wall retractions (CWR), and thoracoabdominal asynchrony. Inspiratory efforts are dissipated on distorting the chest wall inward rather than recruiting lung volumes. The current study tests the hypothesis that a novel neonatal chest wall suspension splint (SP), designed to provide stability to the compliant chest wall, would reduce inspiratory chest wall retractions and improve lung volumes. Nine preterm infants (29 +/- 1 SE weeks of gestation; 1.59 +/- 0.27 SE kg study weight) were studied at 16 +/- 5 SE days of life at baseline (BL) and following application of the front plate (FP) and the full SP (Hug n Snug Neonatal Chest Splint, Respironics, Inc.). Phase angle of thoracoabdominal motion, CWR, functional residual capacity (FRC), and pulmonary function were evaluated during spontaneous breathing. Compared to BL, there was a significant decrease in anterior CWR (2.21 +/- 0.91 SE vs. 0.25 +/- 0.09 SE mm; P < 0.05), an increase in FRC (16.6 +/- 2.8 SE vs. 27.8 +/- 5.5 SE ml/kg; P < 0.05) and tidal volume (4.8 +/- 1.5 SE vs. 7.3 +/- 1.4 SE ml/kg; P < 0.05), minimal effect on pulmonary compliance (1.98 +/- 0.50 SE vs. 1.72 +/- 0.30 SE ml/cmH2O/kg), and a trend for a decrease in phase angle (128.4 +/- 10.9 SE vs. 111.8 +/- 19.3 SE) with the application of the splint. FRC correlated inversely with severity of CWR across all conditions (P < 0.05, r = -0.68). Phase angle was directly correlated to anterior CWR (r = 0.72; P < 0.05) and correlated inversely with FRC (P < 0.005; r = -0.56). We speculate that by improving CW stability, the use of this splint may reduce the energetic requirements of breathing and, potentially, the need for more invasive ventilatory support in the neonate.

Female↗

The usefulness of nocturnal resting splints in the treatment of ulnar deviation of the rheumatoid hand.

Seven patients with definite RA and bilateral ulnar deviation of Fearnley grade I were included in a study of the usefulness of nocturnal resting splints. Each patient used the splint on average 17 months on one hand, randomly chosen, with the free hand as control. Joint mobility, grip strength, pain and radiographic findings were recorded at start and finish of the study. Splint treatment influenced grip strength positively, and most patients stated pain relief during the night. However, all but one patient showed progression of ulnar deviation in both hands, and there was no significant difference in progression between treated and nontreated hands. This study thus supported the use of resting splints at night for pain relief but not for prevention of ulnar deviation.

Aged↗

[The influence of a controlled active motion splint on proprioception after anterior cruciate ligament plasty. A prospective randomized study].

BACKGROUND: A ruptured anterior cruciate ligament (ACL) leads to both mechanical and functional instability. Functional instability is caused by proprioceptive deficit. The aim of this study was to determine whether the proprioceptive deficit can be reduced by using a controlled active motion (CAM) splint postoperatively. PATIENTS AND METHODS: A total of 50 patients with ACL rupture were randomized into two groups. After ACL plasty the PT group received postoperative physiotherapy, while the CAM group were managed with a CAM splint and physiotherapy. Proprioceptive ability was measured with a passive angle-reproduction test. RESULTS: On the day of discharge 80% of the patients in the CAM group and 25% in the PT group had a reduced proprioceptive deficit. Overall the main measured value in the CAM group improved by 83.7%, but deteriorated by 39.3% in the PT group. There was no significant difference between the CAM group and a healthy control group. CONCLUSION: Using a CAM splint in addition to physiotherapy after ACL plasty in comparison to physiotherapy alone decreases the proprioceptive deficit significantly. We recommend the use of a CAM splint in the postoperative management following ACL plasty.

Anterior Cruciate Ligament↗

The maxillary orthopedic splint.

Craniomaxillary orthopedic correction of the skeletal imbalance of Class II malocclusions is often the desired method of treatment in these cases. The ability to apply a "pure" orthopedic force to the maxillary complex has so far eluded research efforts. However, the use of a maxillary splint with a high-pull extraoral traction assembly has been shown to be most effective in reducing Class II skeletal dysplasias through a combination of dentoalveolar and basal bone changes. Force delivery to the maxillary complex in Class II skeletal jaw disharmonies is through the teeth. The philosophy behind the use of the maxillary splint is that if the force delivered to the upper jaw involved the use of all the upper teeth (and hard palate) rather than only the maxillary first molars, as in conventional extraoral orthodontic therapy, the effect on the jaws would be more orthopedic than orthodontic in nature. The advantages of the use of the maxillary splint in the younger patient with a severe Class II malocclusion are that it reduces the vulnerability of the maxillary incisors to accidental fracture, while concomitantly reducing the Class II dysplasia, thereby effectively shortening the later-stage multiband corrective time and procedures. Further advantages of the maxillary splint described are ease of construction and clinical application, which makes it an attractive appliance for use in dental clinics or institutions in which patient volume, infrequent visits, and ecomomic factors are major considerations. This preliminary report on the philosophy of treatment procedure and description of the appliance design is to be followed by a further cephalometric and clinical evaluation of results achieved with its use.

Cephalometry↗

Do babies require arm splints after cleft palate repair?

Traditionally, arm restraints are used in children after cleft surgery to prevent traumatic disruption of the repair. A questionnaire amongst consultant plastic surgeons in the UK that restraints are in common use. However, a prospective randomised trial of 46 children having primary cleft palate repair showed that arm splints did not decrease the incidence of oronasal fistulae. Six of 21 children who had arm splints in the postoperative period and 5 of 25 who did not have splints developed an oronasal fistula. We have therefore abandoned the use of arm splints after cleft palate repair.

Arm↗

Treatment of fractures of the hallux with a simple splint.

Three hundred patients with fractures of the hallux were randomly treated with either a short plantar splint or spica strapping in a prospective crossover trial. The results showed that more patients preferred the splint and the mean pain score was lower in the group treated with a splint (P less than 0.001). It is concluded that the splint is a cheap and effective method of treatment of fractures of the hallux.

Adolescent↗

Cast chromium alloy surgical splints.

A cast chromium alloy surgical splint can be fabricated in less than 6 hours. This splint has the advantages of being well fitted, smooth, rigid, and less bulky than prefabricated splints. Other metals can be utilized in a similar manner to fabricate cast surgical splints.

Chromium Alloys↗

Splinting: a retrospective 17-year follow-up study.

A retrospective 17-year, longitudinal study monitoring 66 patients with fixed partial denture and removable partial denture restorations revealed that perceptive splinting was beneficial and enhanced the longevity of the restoration. The study discussed the advantages and disadvantages of splinting, the survival rate of splints and splinted teeth, and the importance of oral hygiene and a periodic maintenance program.

Acrylic Resins↗

A comparative study of the fit and retention of interocclusal splints constructed from heat-cured and autopolymerized polymethylmethacrylate.

Fifty-three subjects each had a single Michigan splint constructed of either heat-cured or autopolymerized polymethylmethacrylate. The choice of material was decided randomly. A blind assessment for fit and retention was used on a three-point scale. Fit and retention were apparently unaffected by the material used. Thirteen percent of splints were unsatisfactory for clinical use (poor fit or retention) and this was also independent of material. A small number of splints contained structural faults (voids, porosity, or cracks) that may shorten the clinical life of these restorations; 9 of 12 such faults occurred in the autopolymerized group. Previous research has shown that conventional heat-cured polymethyl-methacrylate has superior properties compared with autopolymerized resin. In the absence of differences in accuracy of fit or retention, a heat-cured material is therefore advised where splints are intended for long-term clinical use.

Adult↗

Disk-repositioning onlays in the treatment of temporomandibular joint disk displacement: comparison with a flat occlusal splint and with no treatment.

Sixty-three patients with an arthrographic diagnosis of disk displacement with reduction were randomly assigned to three treatment groups: (I) onlays to maintain disk repositioning, (II) flat occlusal splint, or (III) untreated controls. Guidance for construction of the disk-repositioning onlays was established during arthrography to obtain a recaptured disk position relative to the condyle. The onlays were cemented to the teeth and maintained the new intercuspal position anteriorly and inferiorly. The flat occlusal splint was used at night only and was adjusted to maintain a maximal occlusal contact in centric relation and centric occlusion. Clinical examinations were performed before and after 6 months of treatment. The disk-repositioning onlays improved joint function and reduced joint and muscle pain when compared with the flat occlusal splint and with nontreatment. The signs and symptoms in the flat occlusal splint group were no different from those in the control group. It is concluded that disk-repositioning onlays are effective in reducing pain and dysfunction associated with disk displacement with reduction in patients in whom the disk can be maintained in a normal relationship to the condyle with the aid of such onlays. The symptoms, however, returned when the onlays were removed after 6 months; this raises the question of whether a permanent change in the intercuspal position is necessary for long-term success.

Adolescent↗

The Kleinert modified dorsal finger splint for mallet finger fracture.

Injuries to the hand and digits are commonly seen in the emergency department. Lacerations, contusions, puncture wounds, and fractures comprise the bulk of these injuries. A fracture to the dorsum of the distal phalanx can result in a mallet finger deformity. These fractures must be accurately diagnosed with the proper initial treatment begun. There is some disagreement over the best treatment approach and multiple different splints have been described in the literature. Conservative treatment with a finger splint is most commonly effective. We recommend a modified dorsal finger splint for these injuries. We describe a splint to properly treat the fracture, prevent complications, maximize patient comfort during rehabilitation, and prevent mallet finger deformity.

Emergency Medicine↗

A modified thumb spica splint for thumb injuries in the ED.

There are a significant number of hand and upper extremity injuries treated in US emergency departments (EDs) each year. Many of these involve the thumb and wrist. These injuries encompass the range from fractures, strains, and sprains to more specific injuries such as gamekeeper thumb and de Quervain tenosynovitis. These injuries often require diagnosis, splinting, and referral to a hand or orthopedic surgeon. The splint described in this article is presently being used for patients with de Quervain tenosynovitis, but it may have more widespread application in emergency medicine. It is a safe and simple splint that is underused in EDs for splinting thumb injuries.

Emergency Medicine↗

Indications for splinting implant restorations.

PURPOSE: The purpose of this article was to review the literature concerning the need to splint implants together when restoring them with a provisional restoration immediately after implant placement. METHODS: The literature is reviewed concerning the rationale for splinting teeth and reports concerning the efficacy of splinting implants together. Based on this team's experience with a prospective series of consecutive 2 to 5 unit provisionalization cases, guidelines are included with case examples for understanding the technique. CONCLUSION: As long as canine guidance is present, and occlusion is stable, multiunit single quadrant restorations do not need to be splinted when provisionalized.

Dental Abutments↗