Serial Casting for Early Onset Scoliosis: Comparison of Three Casting Materials.
Location
LSUHSC-NO Lion's Building
Document Type
Presentation
Start Date
16-6-2018 10:35 AM
End Date
16-6-2018 10:45 AM
Publication Date
June 2018
Description
Introduction: Plaster of Paris (POP) is the historic gold standard material for derotational cast application in children with early onset scoliosis (EOS). At our institution, fiberglass has supplanted POP for spinal casting of EOS utilizing two different fiberglass techniques. The first method is done on a Risser-type traction table to facilitate rolling of the traditional fiberglass tape. The second method is done with manual traction on a standard flat-top table using a tubular fiberglass hybrid mesh material (OsteoFx) (Figure). We hypothesized that both fiberglass methods would achieve equivalent cobb angle correction when compared to plaster of Paris.
Methods: This is a retrospective cohort study of all patients with EOS who were managed with serial casting at our institution from 1/2012 to 6/2017.
Results: Twenty-two consecutive children were identified (11 boys and 11 girls). Mean age at first cast was 18.7±8.8 months (3.8 to 38.43 months). All patients were classified as idiopathic except for two syndromic, one congenital, one developmentally delayed, and one with a lipomatus filume terminate. Patients were grouped for analysis based on casting method (9 patients in the rolled fiberglass group, 7 POP, and 6 patients in the tubular fiberglass group). There was no significant difference in age and initial cobb angle between the 3 groups (p>0.05). Curve magnitude significantly reduced from 46.6°±14.7 to 28.3°±18.1 after the first cast application (P<0.0001). Percentage of change in Cobb angle at presentation and after the first casting did not differ between the groups (p>0.05). Three patients are still undergoing casting, 11 children were braced after casting was stopped, 4 improved after casting without bracing, one had growth friendly instrumentation and 3 were lost to follow up.
Discussion: The study shows that both traditional and tubular fiberglass were as effective as POP in Cobb angle reduction. Fiberglass casting material can be molded to adequately achieve Mehta casting elongation-derotation principles similar to POP. Fiberglass has the additional benefit of not only being lighter than POP, it can be made waterproof if appropriate padding is utilized. A major advantage to tubular fiberglass cast is that it can be effectively applied on a flat top table without the need for a specialized traction table.
Recommended Citation
Kadhim, Muayad MD, "Serial Casting for Early Onset Scoliosis: Comparison of Three Casting Materials." (2018). Dept. of Orthopaedics: Robert D. D’Ambrosia Lectureship & Research Day. 7.
https://digitalscholar.lsuhsc.edu/ortho_rd/2018/presentations/7
Serial Casting for Early Onset Scoliosis: Comparison of Three Casting Materials.
LSUHSC-NO Lion's Building
Introduction: Plaster of Paris (POP) is the historic gold standard material for derotational cast application in children with early onset scoliosis (EOS). At our institution, fiberglass has supplanted POP for spinal casting of EOS utilizing two different fiberglass techniques. The first method is done on a Risser-type traction table to facilitate rolling of the traditional fiberglass tape. The second method is done with manual traction on a standard flat-top table using a tubular fiberglass hybrid mesh material (OsteoFx) (Figure). We hypothesized that both fiberglass methods would achieve equivalent cobb angle correction when compared to plaster of Paris.
Methods: This is a retrospective cohort study of all patients with EOS who were managed with serial casting at our institution from 1/2012 to 6/2017.
Results: Twenty-two consecutive children were identified (11 boys and 11 girls). Mean age at first cast was 18.7±8.8 months (3.8 to 38.43 months). All patients were classified as idiopathic except for two syndromic, one congenital, one developmentally delayed, and one with a lipomatus filume terminate. Patients were grouped for analysis based on casting method (9 patients in the rolled fiberglass group, 7 POP, and 6 patients in the tubular fiberglass group). There was no significant difference in age and initial cobb angle between the 3 groups (p>0.05). Curve magnitude significantly reduced from 46.6°±14.7 to 28.3°±18.1 after the first cast application (P<0.0001). Percentage of change in Cobb angle at presentation and after the first casting did not differ between the groups (p>0.05). Three patients are still undergoing casting, 11 children were braced after casting was stopped, 4 improved after casting without bracing, one had growth friendly instrumentation and 3 were lost to follow up.
Discussion: The study shows that both traditional and tubular fiberglass were as effective as POP in Cobb angle reduction. Fiberglass casting material can be molded to adequately achieve Mehta casting elongation-derotation principles similar to POP. Fiberglass has the additional benefit of not only being lighter than POP, it can be made waterproof if appropriate padding is utilized. A major advantage to tubular fiberglass cast is that it can be effectively applied on a flat top table without the need for a specialized traction table.