Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery

NARCIS (Netherlands)

Struijk-Mulder, M. C.; Ettema, H. B.; Verheyen, C. C.; Büller, H. R.

2010-01-01

BACKGROUND: Different guidelines exist regarding the prevention of venous thromboembolism (VTE) in orthopedic surgery. OBJECTIVES: We aimed to compare (inter)national guidelines and analyse differences. Methods: MEDLINE, the Cochrane Library and the internet were searched for guidelines on the

Rivaroxaban for Thromboprophylaxis After Nonelective Orthopedic Trauma Surgery in Switzerland

DEFF Research Database (Denmark)

Hoffmeyer, Pierre; Simmen, Hanspeter; Jakob, Marcel

2017-01-01

This study investigated the effectiveness and the outcomes of rivaroxaban vs the standard of care for venous thromboembolic prophylaxis in patients undergoing fracture-related surgery. A total of 413 patients undergoing fracture-related surgery from 9 Swiss orthopedic and trauma centers were enro...

Computer-assisted surgery in orthopedic oncology : Technique, indications, and a descriptive study of 130 cases

NARCIS (Netherlands)

Gerbers, Jasper G.; Stevens, Martin; Ploegmakers, Joris J. W.; Bulstra, Sjoerd K.; Jutte, Paul C.

2014-01-01

Background and purpose - In orthopedic oncology, computerassisted surgery (CAS) can be considered an alternative to fluoroscopy and direct measurement for orientation, planning, and margin control. However, only small case series reporting specific applications have been published. We therefore

Safety, Efficacy, and Cost-effectiveness of Tranexamic Acid in Orthopedic Surgery.

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Lin, Zilan X; Woolf, Shane K

2016-01-01

Perioperative bleeding and postsurgical hemorrhage are common in invasive surgical procedures, including orthopedic surgery. Tranexamic acid (TXA) is a pharmacologic agent that acts through an antifibrinolytic mechanism to stabilize formed clots and reduce active bleeding. It has been used successfully in orthopedics to reduce perioperative blood loss, particularly in total hip and knee arthroplasty and spine surgery. Numerous research studies have reported favorable safety and efficacy in orthopedic cases, although there is no universal standard on its administration and its use has not yet become the standard of practice. Reported administration methods often depend on the surgeon's preference, with both topical and intravenous routes showing efficacy. The type and anatomic site of the surgery seem to influence the decision making but also result in conflicting opinions. Reported complication rates with TXA use are low. The incidence of both arterial and venous thromboembolic events, particularly deep venous thrombosis and pulmonary embolism, has not been found to be significantly different with TXA use for healthy patients. The route of administration and dosage do not appear to affect complication rates either. However, data on patients with higher-risk conditions are deficient. In addition, TXA has shown potential to reduce blood loss, transfusion rates and volumes, perioperative hemoglobin change, and hospital-related costs at various degrees among the published studies. Conservation of blood products, reduced laboratory costs, and shorter hospital stays are likely the major factors driving the cost savings associated with TXA use. This article reviews current data supporting the safety, efficacy, and cost-effectiveness of TXA in orthopedic surgery. Copyright 2016, SLACK Incorporated.

Perioperative dexketoprofen or lornoxicam administration for pain management after major orthopedic surgery: a randomized, controlled study.

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Sivrikoz, Nükhet; Koltka, Kemalettin; Güresti, Ece; Büget, Mehmet; Sentürk, Mert; Özyalçın, Süleyman

2014-01-01

Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for multimodal postoperative pain management. The purpose of this study was to evaluate the postoperative pain relief and opioid-sparing effects of dexketoprofen and lornoxicam after major orthopedic surgery. After obtaining ethical committee approval and informed consent, 120 patients undergoing elective hip or knee replacement under general anesthesia were randomized to receive two intravenous injections of 50 mg dexketoprofen (GD), 8 mg lornoxicam (GL) or saline as placebo (GP) intravenously. Postoperatively, patient-controlled analgesia (PCA) morphine was started as a 0.01 mg.kg-1 bolus dose, with lockout time of 10 minutes without continuous infusion. Pain assessment was made using the Visual Analogue Scale (VAS) at rest or during movement at postoperative 1, 2, 4, 6, 8, 12, and 24 hours. The three groups were similar in terms of age, gender, American Society of Anesthesiologists (ASA) class, number of patients who underwent hip or knee surgery, weight, height, and operation duration. Patients in GD and GL demonstrated significantly reduced pain scores at rest and active motion compared to GP, with lower scores in the dexketoprofen group. Patients in GD and GL used significantly less morphine in the postoperative period compared to GP. The total morphine consumption of patients in GD was lower than in GL. Intravenous application of 50 mg dexketoprofen twice a day and 8 mg lornoxicam twice a day improved analgesia and decreased morphine consumption following major orthopedic surgery. When the two active drugs were compared, it was found that dexketoprofen was superior to lornoxicam in terms of analgesic efficacy and opioid consumption.

Orthopedic trauma surgery in the morbidly obese patient.

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Bozzio, Anthony E; Gala, Raj J; Villasenor, Mario A; Hao, Jiandon; Mauffrey, Cyril

2014-05-01

The treatment of morbidly obese patients in orthopedic trauma differs in many ways compared to injured patients with normal body mass indices. This paper highlights key differences and ways to overcome obstacles. We present specific tips, as well as considerations for initial planning, positioning for surgery, intra-operative strategies, and a discussion on both anesthesia and imaging. Several treatment strategies have been shown to have better results in morbidly obese patients. Pre-operative planning is necessary for minimizing risk to the patient. The prevalence of morbid obesity has increased in the USA in the past quarter century. Treatment for orthopedic injuries in morbidly obese patients requires a multidisciplinary approach that addresses not only their orthopedic injuries, but also medical co-morbidities. A team of medicine doctors, anesthesiologists, X-ray technicians, physical and occupational therapists, respiratory therapists, and social workers is needed in addition to the orthopedic surgeon. Modifications in both pre-operative planning and intra-operative strategies may be necessary in order to accommodate the patient. This paper presents numerous technical tips that can aid in providing stable fixation for fractures, as well as addressing peri-operative issues specific to the morbidly obese.

How to manage RI venography in pre-orthopedic surgery patients

International Nuclear Information System (INIS)

Terazawa, Kaori; Otsuka, Hideki; Otomi, Yoichi; Morita, Naomi; Takao, Shoichiro; Iwamoto, Seiji; Osaki, Kyosuke; Harada, Masafumi; Nishitani, Hiromu

2010-01-01

The preoperative evaluation of venous thromboembolism (VTE) is important to avoid complications, because VTE is often induced by orthopedic surgery. We focused on radioisotope venography (RIV) using 99m Tc-macroaggregated human serum albumin, examining orthopedic patients. We conducted 34 examinations in 33 patients who were referred for RIV and lung perfusion scintigraphy for the pre-orthopedic operative evaluation of VTE. Two board-certified (one nuclear medicine board-certified) radiologists interpreted the images based on the following: flow defect of the lower extremities; interruption of flow; irregular or asymmetric filling of the deep vein (low flow); presence of collateral vessels; and abnormal RI retention on delayed-phase images. Scoring was based on a 5-point scale, and more than 2 points was considered VTE positive. Abnormal findings were noted in 27 of the 34 examinations performed in the 33 patients and normal findings in the other 7 examinations. According to the RI score, 21 patients were classified into the VTE-positive group and 12 into the VTE-negative group. Surgery was canceled because of advanced age and respiratory dysfunction in 2 of the 21 patients in the VTE-positive group. Of the 19 patients who underwent surgery, an IVH filter was placed before surgery in 2 and anticoagulant treatment with heparin and warfarin was initiated on the day of surgery in 12 to prevent postoperative VTE, and only one of the patients receiving anticoagulant treatment developed PTE after surgery. Surgery was canceled due to advanced age and at patient's request in 2 of 12 patients in the VTE-negative group. Anticoagulant treatment with heparin/warfarin was performed to prevent postoperative VTE in only 3 patients: one with a past medical history of pulmonary infarction, one with atrial fibrillation, and one suspected of having antiphospholipid antibody syndrome. No patient in the VTE-negative group developed VTE after surgery. The preoperative identification of

Questionable Word Choice in Scientific Writing in Orthopedic Surgery

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Casey M. O`Connor

2017-07-01

Full Text Available Background: Given the strong influence of thoughts, emotions, and behaviors on musculoskeletal symptoms andlimitations it’s important that both scientific and lay writing use the most positive, hopeful, and adaptive words andconcepts consistent with medical evidence. The use of words that might reinforce misconceptions about preferencesensitiveconditions (particularly those associated with age could increase symptoms and limitations and might alsodistract patients from the treatment preferences they would select when informed and at ease.Methods: We reviewed 100 consecutive papers published in 2014 and 2015 in 6 orthopedic surgery scientific journals.We counted the number and proportion of journal articles with questionable use of one or more of the following words:tear, aggressive, required, and fail. For each word, we counted the rate of misuse per journal and the number of specificterms misused per article per journalResults: Eighty percent of all orthopedic scientific articles reviewed had questionable use of at least one term. Tearwas most questionably used with respect to rotator cuff pathology. The words fail and require were the most commonquestionably used terms overall.Conclusion: The use of questionable words and concepts is common in scientific writing in orthopedic surgery. It’sworth considering whether traditional ways or referring to musculoskeletal illness merit rephrasing.

Comparison of Intravenous Morphine with Sublingual Buprenorphine in Management of Postoperative Pain after Closed Reduction Orthopedic Surgery

OpenAIRE

Ghasem Soltani; Mahmood Khorsand; ALireza Sepehri Shamloo; Lida Jarahi; Nahid Zirak

2015-01-01

Background: Postoperative pain is a common side effect following surgery that can significantly reduce surgical quality and patient’s satisfaction. Treatment options are morphine and buprenorphine. We aimed to compare the efficacy of a single dose of intravenous morphine with sublingual buprenorphine in postoperative pain control following closed reduction surgery. Methods: This triple blind clinical trial was conducted on 90 patients referred for closed reduction orthopedic surgery. They wer...

Neuraxial anesthesia for orthopedic surgery: systematic review and meta-analysis of randomized clinical trials

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Fabiano Timbó Barbosa

Full Text Available CONTEXT AND OBJECTIVE: Taking the outcome of mortality into consideration, there is controversy about the beneficial effects of neuraxial anesthesia for orthopedic surgery. The aim of this study was to compare the effectiveness and safety of neuraxial anesthesia versus general anesthesia for orthopedic surgery. DESIGN AND SETTING: Systematic review at Universidade Federal de Alagoas. METHODS: We searched the Cochrane Central Register of Controlled Trials (Issue 10, 2012, PubMed (1966 to November 2012, Lilacs (1982 to November 2012, SciELO, EMBASE (1974 to November 2012 and reference lists of the studies included. Only randomized controlled trials were included. RESULTS: Out of 5,032 titles and abstracts, 17 studies were included. There were no statistically significant differences in mortality (risk difference, RD: -0.01; 95% confidence interval, CI: -0.04 to 0.01; n = 1903, stroke (RD: 0.02; 95% CI: -0.04 to 0.08; n = 259, myocardial infarction (RD: -0.01; 95% CI: -0.04 to 0.02; n = 291, length of hospitalization (mean difference, -0.05; 95% CI: -0.69 to 0.58; n = 870, postoperative cognitive dysfunction (RD: 0.00; 95% CI: -0.04 to 0.05; n = 479 or pneumonia (odds ratio, 0.61; 95% CI: 0.25 to 1.49; n = 167. CONCLUSION: So far, the evidence available from the studies included is insufficient to prove that neuraxial anesthesia is more effective and safer than general anesthesia for orthopedic surgery. However, this systematic review does not rule out clinically important differences with regard to mortality, stroke, myocardial infarction, length of hospitalization, postoperative cognitive dysfunction or pneumonia.

Comparison of the effects of lavender and diazepam on the anxiety level of patients before orthopedic surgery

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Javad Shahinfar

2016-03-01

Full Text Available Background: Waiting for surgery is one of the stressful environmental factors for each patient. The anxiety caused by waiting could have adverse effects on the patient treatment and recovery process. Given the complications caused by the management of anxiety through pharmaceutical methods, the application of complementary medicine is of paramount importance. This study aimed to compare the effects of lavender and diazepam on the anxiety level of the patients before orthopedic surgery. Methods: This clinical trial was conducted on the patients undergoing orthopedic surgery, who referred to one of the teaching hospitals of Bojnord, Iran, in 2015. In total, 60 patients were selected through randomized convenience sampling and divided into the intervention and control groups. The intervention group received 300 mg of lavender extract, whereas the control group orally consumed diazepam 5 mg prior to the surgery. The anxiety level of the patients was measured one night and one hour before the surgery using the Spielberger’s State-Trait Anxiety Inventory. The data analysis was performed in the SPSS version 16, using the paired sample t-test, Fisher’s exact test, Chi-square test, and independent t-test. Results: According to the results of the present study, the mean anxiety level of the intervention group varied from 9.8±6.0 to 76.2±5.5 (P<0.001 after the intervention. On the other hand, the mean anxiety level of the participants of the control group decreased from 100.0±5.5 to 80.0±5.7 (P<0.001. However, this difference was not statistically significant between the two groups. Conclusion: As the findings indicated, similar to diazepam, the lavender can diminish the anxiety level in the patients before the orthopedic surgery. It is recommended to use the lavender before the surgeries to decrease the anxiety level since the herbal medicine is associated with less complications, compared to the diazepam.

Alternative procedures for reducing allogeneic blood transfusion in elective orthopedic surgery.

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Kleinert, Kathrin; Theusinger, Oliver M; Nuernberg, Johannes; Werner, Clément M L

2010-09-01

Perioperative blood loss is a major problem in elective orthopedic surgery. Allogeneic transfusion is the standard treatment for perioperative blood loss resulting in low postoperative hemoglobin, but it has a number of well-recognized risks, complications, and costs. Alternatives to allogeneic blood transfusion include preoperative autologous donation and intraoperative salvage with postoperative autotransfusion. Orthopedic surgeons are often unaware of the different pre- and intraoperative possibilities of reducing blood loss and leave the management of coagulation and use of blood products completely to the anesthesiologists. The goal of this review is to compare alternatives to allogeneic blood transfusion from an orthopedic and anesthesia point of view focusing on estimated costs and acceptance by both parties.

Imaging of orthopedic trauma and surgery

International Nuclear Information System (INIS)

Berquist, T.H.

1985-01-01

This book presents papers on imaging techniques for diagnosis of trauma of bones. A comparative evaluation is presented for planning of proper diagnosis and treatment. Various techniques discussed are routine radiography; computerized tomography, NMR imaging, angiography, ultrasonography; and use of radioisotopes. The mechanism of injury of bone joints of upper and lower limbs and spine is discussed after discussing the anatomy of each in the beginning of each paper. Topics titled are healing of fractures; fractures of pelvis; knee; shoulder; foot and ankle; fractures of humerus; stress fractures; and orthopedic radiology. Prosthesis use and plastic surgery of joints is also discussed

Orthopedic radiology in the postoperative patient (practical orthopedic radiology)

International Nuclear Information System (INIS)

Weissman, B.N.; Gelman, M.I.

1987-01-01

This course examines various aspects of the radiologic examination of postoperative orthopedic patients. The operative indications, pertinent aspects of surgical technique, expected postoperative radiographic appearances, and radiographic findings indicating postoperative complications are discussed. The evaluation of total joint replacement surgery, spinal surgery, lower extremity procedures, and failed orthopedic devices and appliances are covered

Urinary protein profiles in ketorolac-associated acute kidney injury in patients undergoing orthopedic day surgery

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Mariano F

2017-09-01

Full Text Available Filippo Mariano,1 Chiara Cogno,1 Fulvia Giaretta,2,3 Ilaria Deambrosis,2,3 Simona Pozza,4 Maurizio Berardino,5 Giuseppe Massazza,6 Luigi Biancone1,3 1Department of General and Specialist Medicine, Nephrology, Dialysis and Transplantation Unit, City of Health and Science, CTO Hospital, Turin, 2Department of General and Specialist Medicine, Laboratory of Nephrology and Immunopathology, City of Health and Science, Molinette Hospital, Turin, 3Department of Medical Sciences, University of Turin, Turin, 4Department of Radiology and Radiotherapy, CTO Radiology, City of Health and Science, CTO Hospital, Turin, 5Department of Anesthesiology and Intensive Care, Anesthesiology and Intensive Care 5, City of Health and Science, CTO Hospital, Turin, 6Department of Orthopedics and Traumatology, Week Hospital Unit, City of Health and Science, CTO Hospital, and University of Turin, Turin, Italy Background: Parenteral administration of ketorolac is very effective in controlling postoperative pain for orthopedic surgery. Ketorolac can induce clinically relevant renal alterations in elderly patients, whereas its short course is considered safe for young adults with normal preoperative renal function. In this study, of a cohort of young adults undergoing elective orthopedic day surgery, we sought cases complicated by readmission due to acute kidney injury (AKI.Patients and methods: Among 1397 young adults, aged 18–32 years who were admitted to undergo orthopedic day surgery from 2013 to 2015, four patients (0.29%, three males/one female treated in postprocedure with ketorolac (from 60 to 90 mg/day for 1–2 days were readmitted for suspected severe AKI. We evaluated functional outcome, urinary protein profiles and kidney biopsy (1 patient.Results: After day surgery discharge, they experienced gastrointestinal disturbances, flank pain and fever. Readmitted on post-surgery days 3–4, they presented with oliguric AKI (creatinine range 158.4–466.4 µmol/L and

[Orthopedic and trauma surgery in the German-DRG-System 2009].

Science.gov (United States)

Franz, D; Windolf, J; Siebert, C H; Roeder, N

2009-01-01

The German DRG-System was advanced into version 2009. For orthopedic and trauma surgery significant changes concerning coding of diagnoses, medical procedures and concerning the DRG-structure were made. Analysis of relevant diagnoses, medical procedures and G-DRGs in the versions 2008 and 2009 based on the publications of the German DRG-institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes for 2009 focussed on the development of DRG-structure, DRG-validation and codes for medical procedures to be used for very complex cases. The outcome of these changes for German hospitals may vary depending in the range of activities. G-DRG-System gained complexity again. High demands are made on correct and complete coding of complex orthopedic and trauma surgery cases. Quality of case-allocation within the G-DRG-System was improved. Nevertheless, further adjustments of the G-DRG-System especially for cases with severe injuries are necessary.

Developments in ambulatory surgery in orthopedics in France in 2016.

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Hulet, C; Rochcongar, G; Court, C

2017-02-01

Under the new categorization introduced by the Health Authorities, ambulatory surgery (AS) in France now accounts for 50% of procedures, taking all surgical specialties together. The replacement of full hospital admission by AS is now well established and recognized. Health-care centers have learned, in coordination with the medico-surgical and paramedical teams, how to set up AS units and the corresponding clinical pathways. There is no single model handed down from above. The authorities have encouraged these developments, partly by regulations but also by means of financial incentives. Patient eligibility and psychosocial criteria are crucial determining factors for the success of the AS strategy. The surgeons involved are strongly committed. Feedback from many orthopedic subspecialties (shoulder, foot, knee, spine, hand, large joints, emergency and pediatric surgery) testify to the rise of AS, which now accounts for 41% of all orthopedic procedures. Questions remain, however, concerning the role of the GP in the continuity of care, the role of innovation and teaching, the creation of new jobs, and the attractiveness of AS for surgeons. More than ever, it is the patient who is "ambulatory", within an organized structure in which surgical technique and pain management are well controlled. Not all patients can be eligible, but the AS concept is becoming standard, and overnight stay will become a matter for medical and surgical prescription. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Medical Crowdfunding for Patients Undergoing Orthopedic Surgery.

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Durand, Wesley M; Johnson, Joseph R; Eltorai, Adam E M; Daniels, Alan H

2018-01-01

Crowdfunding for medical expenses is growing in popularity. Through several websites, patients create public campaign profiles to which donors can contribute. Research on medical crowdfunding is limited, and there have been no studies of crowdfunding in orthopedics. Active medical crowdfunding campaigns for orthopedic trauma, total joint arthroplasty, and spine surgery were queried from a crowdfunding website. The characteristics and outcomes of crowdfunding campaigns were abstracted and analyzed. For this study, 444 campaigns were analyzed, raising a total of $1,443,528. Among the campaigns that received a donation, mean amount raised was $4414 (SE, $611). Multivariate analysis showed that campaigns with unspecified location (odds ratio, 0.26; P=.0008 vs West) and those for total joint arthroplasty (odds ratio, 0.35; P=.0003 vs trauma) had significantly lower odds of receipt of any donation. Description length was associated with higher odds of donation receipt (odds ratio, 1.13 per +100 characters; Pcrowdfunding may be disproportionately available to patients with specific diagnoses, those from specific regions, those who are able to craft a lengthy descriptive narrative, and those with access to robust digital social networks. Clinicians are likely to see a greater proportion of patients turning to crowdfunding as it grows in popularity. Patients may ask physicians for information about crowdfunding or request testimonials to support campaigns. Surgeons should consider their response to such requests individually. These findings shed light on the dynamics of medical crowdfunding and support robust personal and professional deliberation. [Orthopedics. 2018; 41(1):e58-e63.]. Copyright 2017, SLACK Incorporated.

PCA and Postoperative Pain Management After Orthopedic Surgeries

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S.M. Hashemi

2016-08-01

Full Text Available Background: Patients often suffer from inadequate treatment of postoperative pain. The aim of this study was to investigate effect of PCA on postoperative pain management and patients’ satisfaction from use of PCA. Materials and Methods: In this prospective study, between 2010 to 2011, patients presented by orthopedic specialists to acute and chronic pain service of Akhtar Hospital. A satisfaction questionnaire was given on discharge to this patients, were asked to fill out it . Then collected by ward nurse. Results: patients’ satisfaction from pain relief with use of PCA was high ( 94.9% . In this patient pain relief at third day after surgery and require analgesic was low, significantly (p=0.0001. Significant patients’ satisfaction from effect of PCA in pain control and products support was high (p=0.0001.     Conclusion: Patient controlled analgesia is a safe, effective and noninvasive method for post operative pain management and in this study patients’ satisfaction for pain management was high for use of PCA and pain service. 

[Time to bury the adrenaline-myth!--Safe use of adrenaline anesthesia in hand surgery and orthopedics].

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Hagert, Elisabet; Lalonde, Donald

2015-02-03

The epinephrine myth originated in the 1940s, when acidic (pH 1) procaine-epinephrine was injected into fingers, causing finger necrosis. Today, level 1 evidence exists for the safe use of epinephrine in fingers. The ability to use lidocaine-epinephrine in hand surgery and orthopedics eliminates the need for a tourniquet, or "bloodless field". Surgery using Wide Awake, Lidocaine-epinephrine Anesthesia, No Tourniquet (WALANT) reduces patient discomfort, facilitates patient participation in surgery, improves safe outcomes following reconstructions and greatly reduces the cost of medical care. Furthermore, patients regarded as high-risk can be safely treated without risk of cardiac or pulmonary side effects. In this manuscript, the background of the epinephrine myth is described, as well as recommended use of WALANT in hand surgery and orthopedics.

OUTCOMES OF PALLIATIVE ORTHOPEDIC SURGERY FOR HIP DISLOCATION IN PATIENTS WITH CEREBRAL PALSY

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R. R. Bidyamshin

2016-01-01

Full Text Available Introduction. Hip dislocation is the key problem in patients with severe cerebral palsy (GMFCS IV, V older than 10 years that affects life quality and limits functional capabilities. In the present study the authors evaluated the efficiency of the proximal femoral resection arthroplasty (pfra and valgus proximal osteotomy of the femur (VPOF associated with femoral head resection for pain control, improvement of postural management, hygiene and verticalization with total weight-bearing and correction of accompanying orthopaedic deformities. Material and мethods. A retrospective study compared two groups of patients where PFRA (7 cases, 13 hips or VPOF (14 patients, 23 hips were performed. Level V of GMFCS was reported in 10 patients, and level IV of GMFCS – in 11 patients. The mean age at time of surgery was 15.3±3.9 y.o. PFRA was performed in 7 cases (13 joints and VPOF – in 14 patients (23 joints. Results. The authors did not observe any difference between the methods in respect of pain control, postural management, comfortable sitting position and hygiene. The verticalization with total weight-bearing and life quality improvement was achieved only after PVOF with femoral head resection associated with simultaneous knee and foot deformity correction performed according to the principles of Single-Event Multilevel Orthopedic Surgery. Conclusion. Both palliative methods allow to control pain syndrome, to achieve satisfactory postural management, comfortable sitting position and hygiene. But only VPOF with simultaneous knee and foot deformity correction provides possibility to verticalize the patient with weight-bearing using different orthopedic devices.

Intraoperative Secondary Insults During Orthopedic Surgery in Traumatic Brain Injury.

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Algarra, Nelson N; Lele, Abhijit V; Prathep, Sumidtra; Souter, Michael J; Vavilala, Monica S; Qiu, Qian; Sharma, Deepak

2017-07-01

Secondary insults worsen outcomes after traumatic brain injury (TBI). However, data on intraoperative secondary insults are sparse. The primary aim of this study was to examine the prevalence of intraoperative secondary insults during orthopedic surgery after moderate-severe TBI. We also examined the impact of intraoperative secondary insults on postoperative head computed tomographic scan, intracranial pressure (ICP), and escalation of care within 24 hours of surgery. We reviewed medical records of TBI patients 18 years and above with Glasgow Coma Scale score Secondary insults examined were: systemic hypotension (systolic blood pressurehypertension (ICP>20 mm Hg), cerebral hypotension (cerebral perfusion pressure40 mm Hg), hypocarbia (end-tidal CO2hypertension), hyperglycemia (glucose>200 mg/dL), hypoglycemia (glucose38°C). A total of 78 patients (41 [18 to 81] y, 68% male) met the inclusion criteria. The most common intraoperative secondary insults were systemic hypotension (60%), intracranial hypertension and cerebral hypotension (50% and 45%, respectively, in patients with ICP monitoring), hypercarbia (32%), and hypocarbia (29%). Intraoperative secondary insults were associated with worsening of head computed tomography, postoperative decrease of Glasgow Coma Scale score by ≥2, and escalation of care. After Bonferroni correction, association between cerebral hypotension and postoperative escalation of care remained significant (Psecondary insults were common during orthopedic surgery in patients with TBI and were associated with postoperative escalation of care. Strategies to minimize intraoperative secondary insults are needed.

Comparison of Dexmedetomidine and Fentanyl as an Adjuvant to Ropivacaine for Postoperative Epidural Analgesia in Pediatric Orthopedic Surgery.

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Park, Sang Jun; Shin, Seokyung; Kim, Shin Hyung; Kim, Hyun Woo; Kim, Seung Hyun; Do, Hae Yoon; Choi, Yong Seon

2017-05-01

Opioids are commonly used as an epidural adjuvant to local anesthetics, but are associated with potentially serious side effects, such as respiratory depression. The aim of this study was to compare the efficacy and safety of dexmedetomidine with that of fentanyl as an adjuvant to epidural ropivacaine in pediatric orthopedic surgery. This study enrolled 60 children (3-12 years old) scheduled for orthopedic surgery of the lower extremities and lumbar epidural patient-controlled analgesia (PCA). Children received either dexmedetomidine (1 μg/kg) or fentanyl (1 μg/kg) along with 0.2% ropivacaine (0.2 mL/kg) via an epidural catheter at 30 minutes before the end of surgery. Postoperatively, the children were observed for ropivacaine consumption via epidural PCA, postoperative pain intensity, need for rescue analgesics, emergence agitation, and other adverse effects. The mean dose of bolus epidural ropivacaine was significantly lower within the first 6 h after surgery in the dexmedetomidine group, compared with the fentanyl group (0.029±0.030 mg/kg/h vs. 0.053±0.039 mg/kg/h, p=0.012). The median pain score at postoperative 6 h was also lower in the dexmedetomidine group, compared to the fentanyl group [0 (0-1.0) vs. 1.0 (0-3.0), p=0.039]. However, there was no difference in the need for rescue analgesia throughout the study period between groups. The use of dexmedetomidine as an epidural adjuvant had a significantly greater analgesic and local anesthetic-sparing effect, compared to fentanyl, in the early postoperative period in children undergoing major orthopedic lower extremity surgery. © Copyright: Yonsei University College of Medicine 2017

Effect of a preoperative decontamination protocol on surgical site infections in patients undergoing elective orthopedic surgery with hardware implantation.

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Bebko, Serge P; Green, David M; Awad, Samir S

2015-05-01

Surgical site infections (SSIs), commonly caused by methicillin-resistant Staphylococcus aureus (MRSA), are associated with significant morbidity and mortality, specifically when hardware is implanted in the patient. Previously, we have demonstrated that a preoperative decontamination protocol using chlorhexidine gluconate washcloths and intranasal antiseptic ointment is effective in eradicating MRSA in the nose and on the skin of patients. To examine the effect of a decontamination protocol on SSIs in patients undergoing elective orthopedic surgery with hardware implantation. A prospective database of patients undergoing elective orthopedic surgery with hardware implantation at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, was analyzed from October 1, 2012, to December 31, 2013. Cohort groups before and after the intervention were compared. Starting in May 2013, during their preoperative visit, all of the patients watched an educational video about MRSA decontamination and were given chlorhexidine washcloths and oral rinse and nasal povidone-iodine solution to be used the night before and the morning of scheduled surgery. Thirty-day SSI rates were collected according to the definitions of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance. Data on demographics, comorbidities such as chronic obstructive pulmonary disease and coronary artery disease, tobacco use, alcohol use, and body mass index were also collected. Univariate analysis was performed between the 2 groups of patients. Multivariate analysis was used to identify independent predictors of SSI. A total of 709 patients were analyzed (344 controls and 365 patients who were decolonized). Both groups were well matched with no significant differences in age, body mass index, sex, or comorbidities. All of the patients (100%) completed the MRSA decontamination protocol. The SSI rate in the intervention group was significantly lower (1.1%; 4 of

Magnitude and meaningfulness of change in SF-36 scores in four types of orthopedic surgery

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Buchbinder Rachelle

2008-07-01

Full Text Available Abstract Background The Medical Outcomes General Health Survey (SF-36 is a widely used health status measure; however, limited evidence is available for its performance in orthopedic settings. The aim of this study was to examine the magnitude and meaningfulness of change and sensitivity of SF-36 subscales following orthopedic surgery. Methods Longitudinal data on outcomes of total hip replacement (THR, n = 255, total knee replacement (TKR, n = 103, arthroscopic partial meniscectomy (APM, n = 74 and anterior cruciate ligament reconstruction (ACL, n = 62 were used to estimate the effect sizes (ES, magnitude of change and minimal detectable change (sensitivity at the group and individual level. To provide context for interpreting the magnitude of changes in SF-36 scores, we also compared patients' scores with age and sex-matched population norms. The studies were conducted in Sweden. Follow-up was five years in THR and TKR studies, two years in ACL, and three months in APM. Results On average, large effect sizes (ES≥0.80 were found after orthopedic surgery in SF-36 subscales measuring physical aspects (physical functioning, role physical, and bodily pain. Small (0.20–0.49 to moderate (0.50–0.79 effect sizes were found in subscales measuring mental and social aspects (role emotional, vitality, social functioning, and mental health. General health scores remained relatively unchanged during the follow-up. Despite improvements, post-surgery mean scores of patients were still below the age and sex matched population norms on physical subscales. Patients' scores on mental and social subscales approached population norms following the surgery. At the individual level, scores of a large proportion of patients were affected by floor or ceiling effects on several subscales and the sensitivity to individual change was very low. Conclusion Large to moderate meaningful changes in group scores were observed in all SF-36 subscales except General Health

Comparing the use of Memantine with Dextromethorphan and Placebo to Reduce Pain before Orthopedic Surgery

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Mehrdad Taheri

2017-12-01

Full Text Available Introduction: To compare the use of Memantine with Dextromethorphan and placebo to reduce pain after orthopedic surgery.Materials and Methods: The present study was a double-blind clinical trial including180 patients undergoing elective orthopedic surgery of the lower limbs. Patients were divided randomly into three groups of 60 patients each. The first group (Group M received 30 mg Memantine orally, the second group (Group D received 45 mg of Dextromethorphan and the third group (Group P received only placebo, two and a half hours before the operation. The intensity of pain (VAS score, sedation score, and nausea and vomiting were recorded postoperatively.Results: In this study, 60 patients were enrolled in each group. The total VAS (Visual Analogue Scale score was significantly lower among patients receiving Memantine and the satisfaction was significantly higher compared to the Dextromethorphan and placebo groups (P-value <0.001.Conclusion: The present study results indicate that Memantine has a relatively better outcome compared to Dextromethorphan or placebo in reducing the post surgical pain among patients undergoing orthopedic surgeries. It also reduced the need for post surgical opioid use and improved the patients’ satisfaction.  

Adult patient with Becker dystrophy undergoing orthopedic surgery: an anesthesia challenge

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Parish M

2018-02-01

Full Text Available Masoud Parish, Haleh Farzin Anesthesiology Department, Tabriz University of Medical Sciences, Shohada Teaching Hospital, Tabriz, Iran Abstract: Muscular dystrophies are considered to be a series of neuromuscular diseases with genetic causes and are characterized by progressive muscle weakness and degeneration of the skeletal muscle. The case of an adult man with Becker dystrophy referred for repair of the patella tendon tearing and patella fracture is described. He underwent successful surgery using total intravenous anesthesia without any complications. Keywords: Becker dystrophy, orthopedic surgery, adult, intravenous anesthesia

Wholistic orthopedics: Is this the right way to treat geriatric orthopedic patients?

OpenAIRE

John Ebnezar; Yogita Bali; Rakesh John

2017-01-01

Geriatric orthopedic problems poses different challenges in their management. Conventional treatment methods like drugs, physiotherapy and surgeries are inadequate. A Geriatric orthopedic patient suffers as a whole and not in isolation. This article highlights the importance of managing geriatric orthopedic patients as a whole and outlines the various steps of wholistic management.

Wholistic orthopedics: Is this the right way to treat geriatric orthopedic patients?

Directory of Open Access Journals (Sweden)

John Ebnezar

2017-01-01

Full Text Available Geriatric orthopedic problems poses different challenges in their management. Conventional treatment methods like drugs, physiotherapy and surgeries are inadequate. A Geriatric orthopedic patient suffers as a whole and not in isolation. This article highlights the importance of managing geriatric orthopedic patients as a whole and outlines the various steps of wholistic management.

The future of medical reimbursement for orthopedic surgery in Japan from the viewpoint of the health economy.

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Takura, Tomoyuki; Miki, Kenji

2016-05-01

The financial burden of medical insurance on the government of Japan has recently become severe, which has led to the control of outpatient orthopedic reimbursements for common procedures. On the other hand, the overall disease burden for total hip or knee arthroplasty, decompression for cervical myelopathy or lumbar spinal canal stenosis, and new surgical technologies to treat other painful conditions and the post-surgical care related to these procedures has been reduced. Medical insurance systems in Japan are generally influenced by budget-balancing action. Consequently, the further development of interventional evaluation methods should be promoted. From the viewpoint of health economics, the value (meaning) of medical intervention can partly be explained by its cost-effectiveness. In order for appropriate medical reimbursement levels to be set for orthopedic surgery, the financial status of medical institutions needs to be concurrently reviewed. In particular, the relationship between the expense structure and medical reimbursement must be discussed to evaluate its role in community medicine system. Over the past 10 years, medical expenditures have increased by 9.6% in all fields, whereas the monthly medical reimbursements per patient have dropped by an average of 17.5%. Remarkably, surgery-related costs have increased by 36.5%, while other medical costs have decreased by 19.8%. There are a few reports of cost-utility analyses which investigate interventions such as total hip arthroplasty for hip osteoarthritis patients (US$ 4,600-70,500/QALY) and laminectomy for patients with spinal canal stenosis. Interventions may be an inevitable part of relative expense control under the current trend; however, there has been a slight increase in other parameters in response to changes in medical reimbursement evaluations - specifically, in the total income of medical institutions. If medical professionals such as orthopedic surgeons contribute to the economic value of

Regional anesthesia techniques for ambulatory orthopedic surgery.

LENUS (Irish Health Repository)

O'Donnell, Brian D

2012-02-03

PURPOSE OF REVIEW: The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. RECENT FINDINGS: Neuraxial anesthesia: The use of short-acting local anesthetic agents such as mepivacaine, 2-chloroprocaine, and articaine permits rapid onset intrathecal anesthesia with early recovery profiles. Advantages and limitations of these agents are discussed.Peripheral nerve block: Peripheral nerve blocks in limb surgery have the potential to transform this patient cohort into a truly ambulatory, self-caring group. Recent trends and evidence regarding the benefits of regional anesthesia techniques are presented.Continuous perineural catheters permit extension of improved perioperative analgesia into the ambulatory home setting. The role and reported safety of continuous catheters are discussed. SUMMARY: In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.

[Orthopedic and trauma surgery in the German DRG system 2008].

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Franz, D; Kaufmann, M; Siebert, C H; Windolf, J; Roeder, N

2008-04-01

The German DRG (diagnosis-related groups) system has been modified and updated into version 2008. For orthopedic and trauma surgery significant changes concerning coding of diagnoses, medical procedures and the DRG structure were made. The modified version has been analyzed in order to ascertain whether the DRG system is suitably qualified to fulfill the demands of the reimbursement system or whether further improvements are necessary. Analysis of the severity of relevant side-effect diagnoses, medical procedures and G-DRGs in the versions 2007 and 2008 was carried out based on the publications of the German DRG institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes for 2008 focused on the development of DRG structure, DRG validation and codes for medical procedures. The outcome of these changes for German hospitals may vary depending on the range of activities. G-DRG system has become even more complex and the new regulations have also resulted in new problems associated with complications.. High demands are made on correct and complete coding of complex orthopedic and trauma surgery cases. Quality of case allocation within the G-DRG system has been improved. Nevertheless, further improvements of the G-DRG system are necessary, especially for cases with severe injuries.

Traditional Chinese and western medicine for the prevention of deep venous thrombosis after lower extremity orthopedic surgery: a meta-analysis of randomized controlled trials.

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Zhu, Shibai; Song, Yi; Chen, Xi; Qian, Wenwei

2018-04-10

Chinese herbal medicine has traditionally been considered to promote blood circulation to remove obstruction in the channels and clear pathogenic heat to drain dampness effects. We conducted this meta-analysis to evaluate its benefits for the prevention of deep venous thrombosis (DVT) after lower extremity orthopedic surgery. Relevant, published studies were identified using the following keywords: lower extremity orthopedic surgery, arthroplasty, joint replacement, fracture, traditional Chinese and western medicine, Chinese herbal medicine, deep venous thrombosis (DVT), and Venous thromboembolism (VTE). The following databases were used to identify the literature consisting of RCTs with a date of search of 31 May 2017: PubMed, Cochrane Library, Web of knowledge, the Chinese National Knowledge Infrastructure Database, the Chongqing VIP Database, the Chinese Biomedical Database, and the Wanfang Database (including three English and four Chinese databases). All relevant data were collected from studies meeting the inclusion criteria. The outcome variables were the incidence rate of DVT, activated partial thromboplastin time (APTT), prothrombin time (PT), and D-dimer; subcutaneous hematoma; and other reported outcomes. RevMan5.2. software was adopted for the meta-analysis. A total of 20 published studies (1862 cases) met the inclusion criteria. The experimental group, 910 patients (48.87%), received the Chinese herbal medicine or traditional Chinese and western medicine for prevention of DVT; the control group, 952 patients (51.13%), received the standard western treatment. The meta-analysis showed that traditional Chinese and western medicine therapy reduced the incidence rates of DVT significantly when compared with controls (risk ratio [RR] = 0.40; 95% CI, 0.30 to 0.54; P < 0.00001), and the D-dimer was lower in the experimental group (P = 0.01). Besides, the incidence rate of subcutaneous hematoma was lower in the experimental group (P < 0

Current Status of Simulation-based Training Tools in Orthopedic Surgery: A Systematic Review.

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Morgan, Michael; Aydin, Abdullatif; Salih, Alan; Robati, Shibby; Ahmed, Kamran

To conduct a systematic review of orthopedic training and assessment simulators with reference to their level of evidence (LoE) and level of recommendation. Medline and EMBASE library databases were searched for English language articles published between 1980 and 2016, describing orthopedic simulators or validation studies of these models. All studies were assessed for LoE, and each model was subsequently awarded a level of recommendation using a modified Oxford Centre for Evidence-Based Medicine classification, adapted for education. A total of 76 articles describing orthopedic simulators met the inclusion criteria, 47 of which described at least 1 validation study. The most commonly identified models (n = 34) and validation studies (n = 26) were for knee arthroscopy. Construct validation was the most frequent validation study attempted by authors. In all, 62% (47 of 76) of the simulator studies described arthroscopy simulators, which also contained validation studies with the highest LoE. Orthopedic simulators are increasingly being subjected to validation studies, although the LoE of such studies generally remain low. There remains a lack of focus on nontechnical skills and on cost analyses of orthopedic simulators. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Imaging of orthopedic trauma and surgery

International Nuclear Information System (INIS)

Berquist, T.H.

1986-01-01

This book bridges the communication gap, between the radiologist and the orthopedic surgeon in regard to trauma. It also combines ease of use with authoritative information, and includes in each discussion a review of the pertinent anatomy, mechanism of injury, and radiology and orthopedic classification

Update on thromboprophylaxis in orthopedic surgery and critical appraisal of the role of enoxaparin

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Wong JM

2012-05-01

Full Text Available Jan Man Wong, Yoon Kong LokeNorwich Medical School, University of East Anglia, Norwich, United KingdomAbstract: Orthopedic surgery is considered one of the most prominent risk factors for venous thromboembolism (VTE, but the optimal strategy for thromboprophylaxis remains a debatable topic. Consistent and reliable definitions of clinically relevant VTE and major bleeds in orthopedic research are particularly contentious areas, resulting in uncertainty about the actual benefit–harm balance of available interventions. For the newer oral anticoagulants, short-term clinical trials in highly selected patients with asymptomatic VTE (from mandatory radiological screening must be supplemented by long-term efficacy and safety data in real-world settings (such as the Global Orthopedic Registry. The evidence gap leads to visible differences among recent recommendations from bodies such as the American College of Chest Physicians (2012, the American Academy of Orthopedic Surgeons (2011, and the National Institute of Clinical Excellence, England (NICE, 2012. While thromboprophylaxis after hip and knee arthroplasty is clearly recommended by all three bodies, there is no consistent agreement on the optimal agent or the duration of prophylaxis. Differences in opinion stem from subjective judgments on the relative weighting given to asymptomatic as opposed to symptomatic VTE, and the impact of major bleeding. While the newer oral anticoagulants (such as rivaroxaban and apixaban seem to offer significant benefits compared to enoxaparin in the reduction of asymptomatic VTE, the data are limited by the paucity of symptomatic VTE and inconsistencies in capturing major bleeds. The lack of long-term experience in real world patients means that it is too early to judge whether the obvious convenience of newer oral anticoagulants will result in better patient adherence, safety, and quality of life as compared to enoxaparin. Further research should focus on clinically

Orthopedic Surgery Applicants: What They Want in an Interview and How They Are Influenced by Post-Interview Contact.

Science.gov (United States)

Camp, Christopher L; Sousa, Paul L; Hanssen, Arlen D; Karam, Matthew D; Haidukewych, George J; Oakes, Daniel A; Turner, Norman S

2016-01-01

Common strategies for orthopedic residency programs to attract competitive applicants include optimizing the interview day and contacting favorably ranked applicants postinterview. The purpose of this work was to determine (1) applicants' perspectives on the ideal interview day, (2) how frequently applicants are contacted postinterview, and (3) the influence of this contact on rank order lists (ROL). Prospective Comparative Survey Mayo Clinic Department of Orthopedic Surgery, Rochester, MN, USA PARTICIPANTS: A survey was completed by 312 successfully matched orthopedic surgery residency applicants following the 2015 match regarding their views of the ideal interview day, components they valued most, post-interview contact, and how that contact influenced their ROL. Applicants stated they preferred interviews that lasted 15 (55%) minutes, a mean of 1.7 (range: 1-5) interviewers present per interview, 5 total interviews (range: 1-10) in a day, an interview with residents (96%), and interviews days lasting only a half day (88%). The majority (94%) desire a social event attended by only residents (54%) or staff and residents (46%). Few wanted an assessment of surgical skills (36%) or orthopedic knowledge (23%). The interview day was rated very valuable in determining their ROL (4.4 out of 5.0). Applicants told a mean of 1.7 (range: 0-11) programs they were "ranking the program highly" and 0.8 (range: 0-5) programs they were "going to rank them #1." Of the 116 (40%) applicants contacted by programs following interviews, 24 (21%) moved programs higher and 3 (3%) moved programs lower on their ROL. Orthopedic Surgery applicants have clear preferences for what they consider to be the ideal interview day and many alter their ROL following post-interview contact. These data may be beneficial to programs looking to optimize the interview experience for applicants. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Practical X-ray diagnostics orthopedics and trauma surgery. Indication, adjustment technique and radiation protection

International Nuclear Information System (INIS)

Flechtenmacher, Johannes; Sabo, Desiderius

2014-01-01

The book on X-ray diagnostics in orthopedics and trauma surgery includes the following chapters: 1. Introduction: radiation protection, equipment technology radiological diagnostics of skeleton carcinomas, specific aspects of trauma surgery, special aspects of skeleton radiology for children. 2. X-ray diagnostics of different anatomical regions: ankle joint, knee, hips and pelvis, hand and wrist joint, elbow, shoulder, spinal cord. 3. Appendix: radiation protection according to the X-ray regulations.

Alexandros Zaoussis, MD, PhD (1923-2005): An Orthopedic Surgeon and Historian and His Contribution to the Establishment of Hip Surgery.

Science.gov (United States)

Markatos, Konstantinos; Korres, Demetrios

2016-10-01

The purpose of our study was to summarize all the knowledge concerning the innovative pioneer in the field of orthopedic surgery and especially hip replacement, Alexandros Zaoussis (1923-2005). He was a pioneer in hip replacement, and he contributed to several fields of orthopedic surgery with his clinical work and his international publications. He was also an eminent historian of World War II and of the Greek Resistance to the Nazi occupation in which he played a significant part. A thorough study of texts, medical books, and reports in the field of history of medicine, together with a review of the available literature in PubMed, was undertaken. He was an eminent clinical director of orthopedics who had significant contribution in teaching, practicing, and expanding the horizons of orthopedic surgery in the 20th century. A thorough review of medical texts, books, and publications in the Greek academic press was undertaken to summarize his contributions and his turbulent life to commemorate the 10th anniversary of his death. © The Author(s) 2016.

Prevalence and Impact of Self-Citation in Academic Orthopedic Surgery.

Science.gov (United States)

Silvestre, Jason; Kamath, Atul F

2018-03-01

The h-index is a commonly utilized metric for academic productivity. Previous studies have proposed that self-citation may limit the utility of the h-index. The purpose of this study is to evaluate the impact of self-citation on the h-index among orthopedic investigators. The study cohort consisted of program directors, chairpersons, and faculty at orthopedic surgery residency programs in the United States. The Scopus database was used to determine the h-index and number of citations ± self-citations. The total number of publications was correlated with the change in the h-index via self-citation. A total of 463 researchers were included (198 National Institutes of Health-funded faculty, 147 chairpersons, 118 program directors). Of these researchers, 83.8% cited previous work at least once (mean, 123.9 ± 277.6). Self-citations accounted for 5.8% of all citations. Including these citations increased the author h-index from 18.5 ± 14.9 to 19.2 ± 15.6 (P < .001). A minority of researchers (36.3%, P < .001) had increased their h-index via self-citation (range, 0-11). The proportional increase in the h-index via self-citation was positively related to the number of publications (P < .001). While the practice of self-citation is prevalent in orthopedics, its impact on the h-index is minimal for most researchers. With more publications, researchers can increase their h-index to a greater degree via self-citation.

Our experience with orthopedic surgery in hemophiliacs

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Poenaru Dan V.

2006-01-01

Full Text Available Introduction: Patients having severe hemophilia (levels of deficient factor below 1% frequently suffer from disabling chronic arthropathy. An adequate substitution treatment using the coagulation factor VIII or IX concentrates renders an elective surgery feasible. Objective: The objective of the study was to check the results of different surgical procedures in the treatment of hemophilic arthropathies, and to propose the best protocol of their treatment. Methods: This is a retrospective study on 26 hemophilic patients operated in the Orthopedics and Trauma Clinic II, Timisoara, from 2002 to 2005. Elective surgical procedures were mainly performed in the knee (21 arthroscopic procedures, 1 open arthrodesis, elbow (2 open synovectomies, 2 radial head excisions, ankle (1 arthroscopic synovectomy and debridement and thigh (1 giant pseudo tumor excision, other minor procedures. The results after operations on moderate and severe chronic knee, elbow and ankle arthropathy were evaluated, with approximately 24-month follow-up period. Results: Arthroscopic procedures (22 yielded good and satisfactory results with significant improvement according to the evaluation criteria recommended by the World Hemophilia Federation (Gilbert clinical score, Pettersson radiological score, NUSS MRI score. Conclusion: Mini-invasive elective surgery in moderate to severe chronic arthropathy produces good results when performed in a specialized center and with multi-disciplinary approach.

Pediatric orthopedic surgery in humanitarian aid.

Science.gov (United States)

Sales de Gauzy, J; Trinchero, J-F; Jouve, J-L

2017-02-01

Pediatric orthopedic surgery in humanitarian aid is conducted mainly in cooperation with emerging countries. Each mission is different, and depends on numerous parameters such as the country, the frequency of such missions, the pathologies encountered, the local structure and team, and the non-governmental organization (NGO) involved. Pathologies vary in etiology (tuberculosis, poliomyelitis) and severity. Each mission requires the presence of an experienced surgeon. Working conditions are often rudimentary. Surgical indications should be restricted to procedures that are going to be effective, with minimal postoperative complications, without any surgical "acrobatics". Teaching should be in association with the local university, and adapted to local needs. Mission objectives need to be realistic. Surgical indications should be adapted to local conditions, and the surgeon needs to be able to say "no" to procedures involving undue risk. The surgeon on mission should cooperate with local teams and be able to adapt to unusual situations. Assessment of results is essential to improving efficacy and evaluating the success of the mission. Copyright © 2016. Published by Elsevier Masson SAS.

Safety in the operating room during orthopedic trauma surgery-incidence of adverse events related to technical equipment and logistics

NARCIS (Netherlands)

van Delft, E. A. K.; Schepers, T.; Bonjer, H. J.; Kerkhoffs, G. M. M. J.; Goslings, J. C.; Schep, N. W. L.

2017-01-01

Safety in the operating room is widely debated. Adverse events during surgery are potentially dangerous for the patient and staff. The incidence of adverse events during orthopedic trauma surgery is unknown. Therefore, we performed a study to quantify the incidence of these adverse events. Primary

Delayed diagnosis and worsening of pain following orthopedic surgery in patients with complex regional pain syndrome (CRPS).

Science.gov (United States)

Lunden, Lars K; Kleggetveit, Inge P; Jørum, Ellen

2016-04-01

Complex regional pain syndrome (CRPS) is a serious and disabling chronic pain condition, usually occurring in a limb. There are two main types, CRPS 1 with no definite nerve lesion and CRPS 2 with an identified nerve lesion. CRPS 1 and 2 may occur following an injury (frequently following fractures), surgery or without known cause. An early diagnosis and start of adequate treatment is considered desirable for patients with CRPS. From the clinical experience of the principal investigator, it became apparent that CRPS often remained undiagnosed and that the clinical conditions of many patients seemed to be worsened following orthopedic surgery subsequent to the initial eliciting event. The aim of the present retrospective study of 55 patients, all diagnosed with either CRPS 1 or 2, was to evaluate the time from injury until diagnosis of CRPS and the effect on pain of orthopedic surgical intervention subsequent to the original injury/surgery. Clinical symptoms with an emphasis on pain were assessed by going through the patients' records and by information given during the investigation at Oslo University Hospital, where the patients also were examined clinically and with EMG/neurography. Alteration in pain was evaluated in 27 patients who underwent orthopedic surgery subsequent to the eliciting injury. Of a total of 55 patients, 28 women and 27 men (mean age 38.7 (SD 12.3), 38 patients were diagnosed with CRPS type 1, and 17 with CRPS type 2. Mean time before diagnosis was confirmed was 3.9 years (SD1.42, range 6 months-10 years). The eliciting injuries for both CRPS type 1 and type 2 were fractures, squeeze injuries, blunt injuries, stretch accidents and surgery. A total of 27 patients (14 men and 13 women) were operated from one to 12 times at a later stage (from 6 months to several years) following the initial injury or any primary operation because of fracture. A total of 22 patients reported a worsening of pain following secondary surgical events, while four

Surgical simulation training in orthopedics: current insights.

Science.gov (United States)

Kalun, Portia; Wagner, Natalie; Yan, James; Nousiainen, Markku T; Sonnadara, Ranil R

2018-01-01

While the knowledge required of residents training in orthopedic surgery continues to increase, various factors, including reductions in work hours, have resulted in decreased clinical learning opportunities. Recent work suggests residents graduate from their training programs without sufficient exposure to key procedures. In response, simulation is increasingly being incorporated into training programs to supplement clinical learning. This paper reviews the literature to explore whether skills learned in simulation-based settings results in improved clinical performance in orthopedic surgery trainees. A scoping review of the literature was conducted to identify papers discussing simulation training in orthopedic surgery. We focused on exploring whether skills learned in simulation transferred effectively to a clinical setting. Experimental studies, systematic reviews, and narrative reviews were included. A total of 15 studies were included, with 11 review papers and four experimental studies. The review articles reported little evidence regarding the transfer of skills from simulation to the clinical setting, strong evidence that simulator models discriminate among different levels of experience, varied outcome measures among studies, and a need to define competent performance in both simulated and clinical settings. Furthermore, while three out of the four experimental studies demonstrated transfer between the simulated and clinical environments, methodological study design issues were identified. Our review identifies weak evidence as to whether skills learned in simulation transfer effectively to clinical practice for orthopedic surgery trainees. Given the increased reliance on simulation, there is an immediate need for comprehensive studies that focus on skill transfer, which will allow simulation to be incorporated effectively into orthopedic surgery training programs.

Rivaroxaban for venous thromboembolism prevention after major orthopedic surgery: translating trial data into routine clinical practice

Directory of Open Access Journals (Sweden)

Beyer-Westendorf J

2017-01-01

Full Text Available Jan Beyer-Westendorf,1 Patrick Mouret,2 Alexander GG Turpie3 1Thrombosis Research and Angiology, Dresden University Clinic, Dresden, Germany; 2Orthopedic Clinic, Klinikum Frankfurt Höchst GmbH, Frankfurt, Germany; 3Department of Medicine, General Division, Hamilton Health Sciences, Hamilton, ON, Canada Abstract: An established standard of care for the prevention of venous thromboembolism after major orthopedic surgery has been subcutaneous low-molecular-weight heparin. The non-vitamin K antagonist oral anticoagulant rivaroxaban has demonstrated superior efficacy and similar safety to all tested regimens of enoxaparin in large Phase III clinical studies of venous thromboembolism prevention after elective hip and knee arthroplasty. Despite regulatory approval of rivaroxaban for this indication, concerns remain among physicians regarding its optimal and effective use in routine clinical practice. Real-life studies, such as XAMOS and ORTHO-TEP, are providing physicians with more information on the routine use of rivaroxaban for venous thromboembolism prevention after orthopedic surgery, helping to establish its safety and effectiveness in everyday clinical care. Among the most important issues are the risk of bleeding complications, wound healing, timing of first dose, impact of type of anesthesia on thromboprophylaxis effectiveness, patient comorbidities and comedication use, periprocedural management, associated costs, and clinical outcomes in trauma-related fractures. Many of these issues are difficult to study in randomized, double-blind, Phase III trials, and can be assessed more readily using real-life data. In particular, real-life or noninterventional studies lack many of the strict inclusion and exclusion criteria associated with Phase III trials and involve unselected patients who often present with significant comorbidities or comedication use. Keywords: anticoagulants, arthroplasty, orthopedics, rivaroxaban, thrombosis

Waterless Hand Rub Versus Traditional Hand Scrub Methods for Preventing the Surgical Site Infection in Orthopedic Surgery.

Science.gov (United States)

Iwakiri, Kentaro; Kobayashi, Akio; Seki, Masahiko; Ando, Yoshiyuki; Tsujio, Tadao; Hoshino, Masatoshi; Nakamura, Hiroaki

2017-11-15

MINI: Fourteen hundred consecutive patients were investigated for evaluating the utility of waterless hand rub before orthopaedic surgery. The risk in the surgical site infection incidence was the same, but costs of liquids used for hand hygiene were cheaper and the hand hygiene time was shorter for waterless protocol, compared with traditional hand scrub. A retrospective cohort study with prospectively collected data. The aim of this study was to compare SSI incidences, the cost of hand hygiene agents, and hand hygiene time between the traditional hand scrub and the waterless hand rub protocols before orthopedic surgery. Surgical site infections (SSI) prolong hospitalization and are a leading nosocomial cause of morbidity and a source of excess cost. Recently, a waterless hand rub protocol comprising alcohol based chlorhexidine gluconate for use before surgery was developed, but no studies have yet examined its utility in orthopedic surgery. Fourteen hundred consecutive patients who underwent orthopedic surgery (spine, joint replacement, hand, and trauma surgeries) in our hospital since April 1, 2012 were included. A total of 712 cases underwent following traditional hand scrub between April 1, 2012 and April 30, 2013 and 688 cases underwent following waterless hand rub between June 1, 2013 and April 30, 2014. We compared SSI incidences within all and each subcategory between two hand hygiene protocols. All patients were screened for SSI within 1 year after surgery. We compared the cost of hand hygiene agents and hand hygiene time between two groups. The SSI incidences were 1.3% (9 of 712) following the traditional protocol (2 deep and 7 superficial infections) and 1.1% (8 of 688) following the waterless protocol (all superficial infections). There were no significant differences between the two groups. The costs of liquids used for one hand hygiene were about $2 for traditional hand scrub and less than $1 for waterless hand rub. The mean hand hygiene time was 264

Orthopedic surgery-related benign uptake on FDG-PET. Case examples and pitfalls

International Nuclear Information System (INIS)

Liu, Y.

2009-01-01

Orthopedic surgical procedures often create some special postoperative complications, which may demonstrate abnormally increased or focal uptake for an extended period of time on fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT images. The distinction of normal from pathologic, benign from malignant uptake is very important to minimize the number of false positive results. To date, very little data have been published regarding surgical-related benign musculoskeletal uptake on PET-CT imaging. In this paper, we present to the readers some case examples of FDG PET-CT imaging for postoperative fracture, infection or osteomyelitis, metallic implants, aggressive bone edge, heterotopic ossification, granuloma and neuroma. We also discuss potential pitfalls to recognize these orthopedic surgery-related complications and identify benign nature of increased FDG uptake. In all cases, the patient's medical and surgical history would be of paramount importance to the radiologists/nuclear medicine physicians who interprets the scan. It is also crucial to carefully correlate FDG uptake with the anatomy on the co-registered CT images in all transaxial, coronal and sagittal views in order to identify the location and pattern of uptake. (author)

Testing the feasibility and safety of the Nintendo Wii gaming console in orthopedic rehabilitation: a pilot randomized controlled study.

Science.gov (United States)

Ficklscherer, Andreas; Stapf, Jonas; Meissner, Kay Michael; Niethammer, Thomas; Lahner, Matthias; Wagenhäuser, Markus; Müller, Peter E; Pietschmann, Matthias F

2016-12-01

The Nintendo Wii game console is already used as an additional training device for e.g. neurological wards. Still there are limited data available regarding orthopedic rehabilitation. The authors' objective was to examine whether the Nintendo Wii is an appropriate and safe tool in rehabilitation after orthopedic knee surgery. A prospective, randomized, controlled study comparing standard physiotherapy vs. standard physiotherapy plus game console training (Wii group) in patients having anterior cruciate ligament (ACL) repair or knee arthroplasty was conducted. The subjects of the Wii group ( n = 17; mean age: 54 ±19 years) performed simple knee exercises daily under the supervision of a physiotherapist in addition to the normal rehabilitation program. The patients of the control group ( n = 13; 52 ±18 years) were treated with physiotherapy only. The participants of both groups completed a questionnaire including the International Knee Documentation Committee (IKDC) score, the Modified Cincinnati Rating System and the Tegner Lysholm Knee Score prior to the operation, before discharge from hospital and four weeks after treatment. There was no significant difference in the score results between the Wii and the control group ( p > 0.05). We demonstrated that physiotherapy using the Nintendo Wii gaming console after ACL reconstruction and knee arthroplasty does not negatively influence outcome. Because training with the Wii device was highly accepted by patients, we see an opportunity whereby additional training with a gaming console for a longer period of time could lead to even better results, regarding the training motivation and the outcome after orthopedic surgery.

[The implementation of the week surgery in an orthopedic and urology ward and assessment of its impact].

Science.gov (United States)

Mulloni, Giovanna; Petrucco, Stefania; De Marc, Raffaella; Nazzi, Cheti; Petri, Roberto; Guarrera, Giovanni Maria

2015-01-01

The implementation of the week surgery in an orthopedic and urology ward and the assessment of its impact. The week surgery (WS) is one of the models organized according the intensity of care that allows the improvement of the appropriateness of the hospital admissions. To describe the implementation and the impact of the WS on costs and levels of care. The WS was gradually implemented in an orthopedic and urology ward. The planning of the surgeries was modified, the wards where patients would have been transferred during the week-end where identified, the nurses were supported by expert nurses to learn new skills and clinical pathways were implemented. The periods January-June 2012 and 2013 were compared identifying a set of indicators according to the health technology assessment method. The nurses were able to take vacations according to schedule; the cost of outsourcing services were reduced (-4.953 Euros) as well as those of consumables. The nursing care could be guaranteed employing less (-5) full-time nurses; the global clinical performance of the ward did not vary. Unfortunately several urology patients could not be discharged during the week-ends. A good planning of the surgeries according to the patients' length of staying, together with interventions to increase the staff-skill mix, and the clinical pathways allowed an effective and efficient implementation of the WS model without jeopardizing patients' safety.

Efficacy and safety of venous thromboembolism prophylaxis with apixaban in major orthopedic surgery

Directory of Open Access Journals (Sweden)

Werth S

2012-03-01

Full Text Available Sebastian Werth, Kai Halbritter, Jan Beyer-WestendorfCenter for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital “Carl Gustav Carus” Dresden, Dresden, GermanyAbstract: Over the last 15 years, low-molecular-weight heparins (LMWHs have been accepted as the “gold standard” for pharmaceutical thromboprophylaxis in patients at high risk of venous thromboembolism (VTE in most countries around the world. Patients undergoing major orthopedic surgery (MOS represent a population with high risk of VTE, which may remain asymptomatic or become symptomatic as deep vein thrombosis or pulmonary embolism. Numerous trials have investigated LMWH thromboprophylaxis in this population and demonstrated high efficacy and safety of these substances. However, LMWHs have a number of disadvantages, which limit the acceptance of patients and physicians, especially in prolonged prophylaxis up to 35 days after MOS. Consequently, new oral anticoagulants (NOACs were developed that are of synthetic origin and act as direct and very specific inhibitors of different factors in the coagulation cascade. The most developed NOACs are dabigatran, rivaroxaban, and apixaban, all of which are approved for thromboprophylaxis in MOS in a number of countries around the world. This review is focused on the pharmacological characteristics of apixaban in comparison with other NOACs, on the impact of NOAC on VTE prophylaxis in daily care, and on the management of specific situations such as bleeding complications during NOAC therapy.Keywords: major orthopedic surgery, apixaban, dabigatran, edoxaban, rivaroxaban, deep vein thrombosis, venous thromboembolism, VTE prophylaxis

[Financing of inpatient orthopedics and trauma surgery in the G-DRG system 2010].

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Franz, D; Schemmann, F; Roeder, N; Mahlke, L

2010-08-01

The German DRG (diagnosis-related groups) system forms the basis for billing inpatient hospital services. It includes not only the case groups (G-DRGs), but also additional and innovation payments. This paper analyzes and evaluates the relevant developments of the G-DRG System 2010 for orthopedics and traumatology from the medical and classification perspectives. Analyses of relevant diagnoses, medical procedures and G-DRGs in the versions 2009 and 2010 based on the publications of the German DRG institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI) were carried out. The DRG catalog is has grown from 8 to 1,200 G-DRGs. A number of codes for surgical measures have been newly established or modified. Here, the identification and the correct and performance-based mapping of complex and elaborate scenarios was again the focus of the restructuring of the G-DRG system. The G-DRG structure in orthopedics and traumatology has been changed, especially in the areas of spinal surgery and surgery of the upper and lower extremities. The actual impact of the changes may vary depending on the individual hospital services. For the first time since the introduction of the G-DRG system, the pure numerical changes at the level of DRGs themselves are so marginal that only part of the DRG users in the hospitals will register them. The changes implemented not only a high selectivity between complex and less complex scenarios, but partly also unintended and unjustified revaluation of less complex measures. The G-DRG system has gained complexity again. Especially the G-DRG allocation of spinal surgery and multiple surgical interventions of the upper and/or lower extremities have reached such a complexity that only a few DRG users can follow them.

Deep venous thrombosis after orthopedic surgery in adult cancer patients.

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Lin, P P; Graham, D; Hann, L E; Boland, P J; Healey, J H

1998-05-01

Patients with cancer and patients undergoing major orthopedic procedures are two groups at risk of deep venous thrombosis (DVT). The objective was to determine the rate of venous thromboembolic disease in patients with a malignant neoplasm and major orthopaedic surgery of the lower limb. The study included 169 patients. All patients were given knee-high intermittent pneumatic compression devices for prophylaxis. Postoperative surveillance for thrombosis was performed on all patients with venous duplex doppler ultrasonography. Proximal DVT occurred in 24 of 169 patients (14.2%). One patient (0.6%) developed a symptomatic, nonfatal pulmonary embolus (PE). The development of DVT was not associated with age, sex, type of surgery, type of neoplasm, location, or pathologic fracture. The addition of anticoagulant medication such as warfarin did not significantly reduce the rate of DVT in a subset of 54 patients. In three patients, the DVT occurred only in the contralateral limb, and in four patients, there were bilateral DVTs. When intermittent compression boots were used for prophylaxis in conjunction with ultrasound screening, the risk of proximal DVT was substantial (14.2%), but the rate of symptomatic PE was low (0.6%).

Damage control in orthopedics and traumatology

International Nuclear Information System (INIS)

Martinez R, Alfredo

2006-01-01

The damage control allows the clinician to institute a rapid process that avoids early death from over aggressive treatment of an injury and lack of attention to the underlying physiological state of victim. This concept allows rapid control and support of the patients underlying physiological condition in an attempt to avoid the triad of death: bleeding, hypothermia and metabolic acidosis. We revised the several indications to damage control in orthopedics in the patients with polytrauma, isolated extremity injury as femur fracture, and the geriatric patients and crane cephalic trauma

Development of an orthopedic surgery trauma patient handover checklist.

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LeBlanc, Justin; Donnon, Tyrone; Hutchison, Carol; Duffy, Paul

2014-02-01

In surgery, preoperative handover of surgical trauma patients is a process that must be made as safe as possible. We sought to determine vital clinical information to be transferred between patient care teams and to develop a standardized handover checklist. We conducted standardized small-group interviews about trauma patient handover. Based on this information, we created a questionnaire to gather perspectives from all Canadian Orthopaedic Association (COA) members about which topics they felt would be most important on a handover checklist. We analyzed the responses to develop a standardized handover checklist. Of the 1106 COA members, 247 responded to the questionnaire. The top 7 topics felt to be most important for achieving patient safety in the handover were comorbidities, diagnosis, readiness for the operating room, stability, associated injuries, history/mechanism of injury and outstanding issues. The expert recommendations were to have handover completed the same way every day, all appropriate radiographs available, adequate time, all appropriate laboratory work and more time to spend with patients with more severe illness. Our main recommendations for safe handover are to use standardized checklists specific to the patient and site needs. We provide an example of a standardized checklist that should be used for preoperative handovers. To our knowledge, this is the first checklist for handover developed by a group of experts in orthopedic surgery, which is both manageable in length and simple to use.

ANALYSIS OF OTORHINOLARYNGOLOGY, ORTHOPEDICS AND THORACIC SURGERY JOURNALS.

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Lima, Wilma Terezinha Anselmo

2015-01-01

To perform an extensive analysis of journals in Medicine III - CAPES, and specifically those in the areas of Otorhinolaryngology, Orthopedics and Traumatology and Chest Surgery. An active search for the impact factors in the Journal Citation Reports, Scimago, their indexation in Scielo, Lilacs, Scopus and Google Scholar, and their stratification in WebQualis was done. Forty-four journals with measured impact factors ranging from 3.006 to 0.128 were detected in the area of Otorhinolaryngology; however, only 26 of them (60%) had a Qualis measured by CAPES; in the stratification, no journal was detected in A1, three were A2 and nine B1. Three journals were located for Chest Surgery, with only one of them having a measured Qualis (A2) with a mean of 3.61. Sixty-seven journals were detected for Orthopedics and Traumatology, with an impact factor ranging from 4.699 to 0.156; Qualis was measured in only 38 of them (60%); there were three journal stratified as A1, seven as A2 and 25 as B1. The search for journals of higher impact induces authors to not publish in journals related to their area and facing more difficulties than investigators from other areas. Realizar análise ampla dos periódicos da Medicina III - CAPES e, especificamente, os pertencentes à Otorrinolaringologia, Ortopedia e Traumatologia, e Cirurgia Torácica. Busca ativa do fator de impacto dos periódicos das áreas citadas no Journal Citation Report e Scimago, sua indexação no Scielo, Lilacs, Scopus, Google Scholar e sua estratificação no WebQualis. Para a Otorrinolaringologia foram encontrados 44 periódicos, cujo fator de impacto variou de 3.006 a 0.128; entretanto, apenas 26 deles (60%) tinham Qualis medido pela CAPES; nas estratificações encontrou-se nenhuma revista em A1, três em A2 e nove em B1. Para a Cirurgia Torácica foram localizados três periódicos, sendo que apenas um tinha Qualis medido (A2) com média de 3.61. Os resultados da busca para a Ortopedia e Traumatologia permitiu

Nanotechnology: the scope and potential applications in orthopedic surgery.

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Gavaskar, Ashok; Rojas, D; Videla, F

2018-03-30

Nanotechnology involves manipulation of matter measuring 1-100 nm in at least one of its dimensions at the molecular level. Engineering and manipulation of matter at the molecular level has several advantages in the field of medicine (nanomedicine) since most of the biological molecules exist and function at a nanoscale. Though promising, questions still remain on how much of this will ultimately translate into achieving better patient care. Concerns of cost-effectiveness and nanotechnology safety still remain unclear. Orthopedics is an attractive area for the application of nanotechnology since the bone, and its constituents such as hydroxyapatite, Haversian systems, and the collagen fibrils are nanocompounds. The major orthopedic applications of nanotechnology involve around (i) effective drug delivery systems for antibiotics and chemotherapeutic agents, (ii) surface preparation of implants and prosthesis to improve osteointegration and reduce biofilm formation, (iii) controlled drug eluting systems to combat implant-related infections, (iv) tissue engineering for scaffolds preparation to deal with bone and cartilage defects, and (v) diagnostic applications in the field of oncology and musculoskeletal infections.

Patient Attitudes Toward Orthopedic Surgeon Ownership of Related Ancillary Businesses.

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Yi, Paul H; Cross, Michael B; Johnson, Staci R; Rasinski, Kenneth A; Nunley, Ryan M; Della Valle, Craig J

2016-08-01

Physician ownership of businesses related to orthopedic surgery, such as surgery centers, has been criticized as potentially leading to misuse of health care resources. The purpose of this study was to determine patients' attitudes toward surgeon ownership of orthopedic-related businesses. We surveyed 280 consecutive patients at 2 centers regarding their attitudes toward surgeon ownership of orthopedic-related businesses using an anonymous questionnaire. Three surgeon ownership scenarios were presented: (1) owning a surgery center, (2) physical therapy (PT), and (3) imaging facilities (eg, Magnetic Resonance Imaging scanner). Two hundred fourteen patients (76%) completed the questionnaire. The majority agreed that it is ethical for a surgeon to own a surgery center (73%), PT practice (77%), or imaging facility (77%). Most (>67%) indicated that their surgeon owning such a business would have no effect on the trust they have in their surgeon. Although >70% agreed that a surgeon in all 3 scenarios would make the same treatment decisions, many agreed that such surgeons might perform more surgery (47%), refer more patients to PT (61%), or order more imaging (58%). Patients favored surgeon autonomy, however, believing that surgeons should be allowed to own such businesses (78%). Eighty-five percent agreed that patients should be informed if their surgeon owns an orthopedic-related business. Although patients express concern over and desire disclosure of surgeon ownership of orthopedic-related businesses, the majority believes that it is an ethical practice and feel comfortable receiving care at such a facility. Copyright © 2016 Elsevier Inc. All rights reserved.

Epidemiology of malpractice claims in the orthopedic and trauma surgery department of a French teaching hospital: A 10-year retrospective study.

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Agout, C; Rosset, P; Druon, J; Brilhault, J; Favard, L

2018-02-01

Orthopedic and trauma surgery is the specialty for which claims for compensation are most often filed. Little data exists on the subject in France, especially in a teaching hospital. We conducted a retrospective study aimed at (1) identifying the epidemiological characteristics of patients filing claims against the orthopedic surgery and traumatology department of a teaching hospital in France, (2) analyzing the surgical procedures involved, the type of legal proceedings, and the financial consequences. The epidemiological profile of proceedings seeking damages in France is consistent with the data from European and American studies. An observational, retrospective, single-center study of all claims for damages between 2007 and 2016 involving the orthopedic and trauma surgery department of a teaching hospital was carried out. Patients' epidemiological data, the surgical procedure, type of legal proceeding, and financial consequences were analyzed. Of the 51,582 surgical procedures performed, 71 claims (0.0014%) were analyzed (i.e., 1/726 procedures). A significant increase in the number of cases (p=0.040) was found over a 10-year period. Of these, 36/71 (53.7%) were submitted to the French regional conciliation and compensation commission (CRCI), 23/71 (32.8%) were filed with the administrative court, and 12/71 (13.4%) were submitted for an amicable settlement. The most common reason for which patients filed claims was hospital-acquired infections, with 36/71 (50.7%) cases. Twenty-nine complaints (40.8%) resulted in monetary damages being awarded to the patient, with an average award of € 28,301 (€ 2,400-299,508). Damage awards were significantly higher (pClaims against orthopedic surgeons have been increasing significantly over the last 10 years. Although rare, they represent a significant cost to society. Hospital-acquired infections are the main reason for disputes in our specialization. IV, retrospective study. Copyright © 2017 Elsevier Masson SAS. All

Medical photography: principles for orthopedics.

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Uzun, Metin; Bülbül, Murat; Toker, Serdar; Beksaç, Burak; Kara, Adnan

2014-04-05

Medical photography is used clinically for patient evaluation, treatment decisions, and scientific documentation. Although standards for medical photography exist in many branches of medicine, we have not encountered such criteria in publications in the area of orthopedics. This study aims to (1) assess the quality of medical images used in an orthopedic publication and (2) to propose standards for medical photography in this area. Clinical photographs were reviewed from all issues of a journal published between the years 2008 and 2012. A quality of clinical images was developed based on the criteria published for the specialties of dermatology and cosmetic surgery. All images were reviewed on the appropriateness of background, patient preparation, and technique. In this study, only 44.9% of clinical images in an orthopedic publication adhered to the proposed conventions. Standards have not been established for medical photography in orthopedics as in other specialty areas. Our results suggest that photographic clinical information in orthopedic publications may be limited by inadequate presentation. We propose that formal conventions for clinical images should be established.

What expects orthopedic surgeon from bone scan?

International Nuclear Information System (INIS)

Sutter, B.; Cazenave, A.

2003-01-01

The isotope bone scan continues to be one of the 'lost widely performed nuclear medicine investigations. Beyond the common clinical indication like detection of skeletal metastases, bone scan use is increasing in benign orthopedic conditions, and after orthopedic surgery, despite development of new investigations modalities (US, MRI). Three (or two) phase bone scintigraphy, Single Photon Emission Computer Tomography have increased its value and provided new clinical roles. This review emphasizes through some practical clinical examples how to increase diagnostic value of the method and to offer an adapted response to the orthopedic surgeon's attempts. (author)

Physician-Hospital Alignment in Orthopedic Surgery.

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Bushnell, Brandon D

2015-09-01

The concept of "alignment" between physicians and hospitals is a popular buzzword in the age of health care reform. Despite their often tumultuous histories, physicians and hospitals find themselves under increasing pressures to work together toward common goals. However, effective alignment is more than just simple cooperation between parties. The process of achieving alignment does not have simple, universal steps. Alignment will differ based on individual situational factors and the type of specialty involved. Ultimately, however, there are principles that underlie the concept of alignment and should be a part of any physician-hospital alignment efforts. In orthopedic surgery, alignment involves the clinical, administrative, financial, and even personal aspects of a surgeon's practice. It must be based on the principles of financial interest, clinical authority, administrative participation, transparency, focus on the patient, and mutual necessity. Alignment can take on various forms as well, with popular models consisting of shared governance and comanagement, gainsharing, bundled payments, accountable care organizations, and other methods. As regulatory and financial pressures continue to motivate physicians and hospitals to develop alignment relationships, new and innovative methods of alignment will also appear. Existing models will mature and evolve, with individual variability based on local factors. However, certain trends seem to be appearing as time progresses and alignment relationships deepen, including regional and national collaboration, population management, and changes in the legal system. This article explores the history, principles, and specific methods of physician-hospital alignment and its critical importance for the future of health care delivery. Copyright 2015, SLACK Incorporated.

Neurological Complications Related to Elective Orthopedic Surgery: Part 1: Common Shoulder and Elbow Procedures.

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Dwyer, Tim; Henry, Patrick D G; Cholvisudhi, Phantila; Chan, Vincent W S; Theodoropoulos, John S; Brull, Richard

2015-01-01

Many anesthesiologists are unfamiliar with the rate of surgical neurological complications of the shoulder and elbow procedures for which they provide local anesthetic-based anesthesia and/or analgesia. Part 1 of this narrative review series on neurological complications of elective orthopedic surgery describes the mechanisms and likelihood of peripheral nerve injury associated with some of the most common shoulder and elbow procedures, including open and arthroscopic shoulder procedures, elbow arthroscopy, and total shoulder and elbow replacement. Despite the many articles available, the overall number of studied patients is relatively low. Large prospective trials are required to establish the true incidence of neurological complications following elective shoulder and elbow surgery. As the popularity of regional anesthesia increases with the development of ultrasound guidance, anesthesiologists should have a thoughtful understanding of the nerves at risk of surgical injury during elective shoulder and elbow procedures.

Effect of hydromorphone hydrochloride combined with ropivacaine for PCEA after orthopedic surgery on the synthesis of pain mediators, inflammatory mediator and oxygen free radicals

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Liang-Ying Luo

2017-08-01

Full Text Available Objective: To explore the effect of hydromorphone hydrochloride combined with ropivacaine for PCEA after orthopedic surgery on the synthesis of pain mediators, inflammatory mediator and oxygen free radicals. Methods: A total of 120 patients with fracture who underwent operation in the hospital between July 2014 and December 2016 were collected and divided into control group and observation group according to the random number table method, 60 cases in each group. Control group received morphine hydrochloride combined with ropivacaine for analgesia, observation group received hydromorphone hydrochloride combined with ropivacaine for analgesia, and the postoperative analgesia lasted for 48 h. The differences in serum levels of pain mediators, inflammatory mediators and oxidative stress indexes were compared between the two groups. Results: Immediately after operation, the differences in serum levels of pain mediators, inflammatory mediators and oxidative stress indexes were not statistically significant between the two groups. 48 h after operation, serum PGE2, SP, β-EP, IL-6, MCP-1, HMGB-1 and MDA levels of both groups of patients were significantly lower than those immediately after operation while Cu-Zn SOD and GSH-Px levels were significantly higher than those immediately after operation, and serum PGE2, SP, β-EP, IL-6, MCP-1, HMGB-1 and MDA levels of observation group were significantly lower than those of control group while Cu-Zn SOD and GSH-Px levels were significantly higher than those of control group. Conclusion: Hydromorphone hydrochloride combined with ropivacaine for PCEA after orthopedic surgery is effective in alleviating pain and inhibiting systemic inflammatory response.

Robotics in Orthopedics: A Brave New World.

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Parsley, Brian S

2018-02-16

Future health-care projection projects a significant growth in population by 2020. Health care has seen an exponential growth in technology to address the growing population with the decreasing number of physicians and health-care workers. Robotics in health care has been introduced to address this growing need. Early adoption of robotics was limited because of the limited application of the technology, the cumbersome nature of the equipment, and technical complications. A continued improvement in efficacy, adaptability, and cost reduction has stimulated increased interest in robotic-assisted surgery. The evolution in orthopedic surgery has allowed for advanced surgical planning, precision robotic machining of bone, improved implant-bone contact, optimization of implant placement, and optimization of the mechanical alignment. The potential benefits of robotic surgery include improved surgical work flow, improvements in efficacy and reduction in surgical time. Robotic-assisted surgery will continue to evolve in the orthopedic field. Copyright © 2018 Elsevier Inc. All rights reserved.

Evaluation of occupational and patient radiation doses in orthopedic surgery

International Nuclear Information System (INIS)

Sulieman, A.; Habiballah, B.; Abdelaziz, I.; Alzimami, K.; Osman, H.; Omer, H.; Sassi, S. A.

2014-08-01

Orthopedists are exposed to considerable radiation dose during orthopedic surgeries procedures. The staff is not well trained in radiation protection aspects and its related risks. In Sudan, regular monitoring services are not provided for all staff in radiology or interventional personnel. It is mandatory to measure staff and patient exposure in order to radiology departments. The main objectives of this study are: to measure the radiation dose to patients and staff during (i) Dynamic Hip Screw (Dhs) and (i i) Dynamic Cannula Screw (Dcs); to estimate the risk of the aforementioned procedures and to evaluate entrance surface dose (ESD) and organ dose to specific radiosensitive patients organs. The measurements were performed in Medical Corps Hospital, Sudan. The dose was measured for unprotected organs of staff and patient as well as scattering radiation. Calibrated Thermoluminescence dosimeters (TLD-Gr-200) of lithium fluoride (LiF:Mg, Cu,P) were used for ESD measurements. TLD signal are obtained using automatic TLD Reader model (Plc-3). The mean patients doses were 0.46 mGy and 0.07 for Dhs and Dcs procedures, respectively. The mean staff doses at the thyroid and chest were 4.69 mGy and 1.21 mGy per procedure. The mean radiation dose for staff was higher in Dhs compared to Dcs. This can be attributed to the long fluoroscopic exposures due to the complication of the procedures. Efforts should be made to reduce radiation exposure to orthopedic patients, and operating surgeons especially those with high work load. Staff training and regular monitoring will reduce the radiation dose for both patients and staff. (Author)

Evaluation of occupational and patient radiation doses in orthopedic surgery

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Sulieman, A. [Salman bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, P.O. Box 422, Alkharj (Saudi Arabia); Habiballah, B.; Abdelaziz, I. [Sudan Univesity of Science and Technology, College of Medical Radiologic Sciences, P.O. Box 1908, Khartoum (Sudan); Alzimami, K. [King Saud University, College of Applied Medical Sciences, Radiological Sciences Department, P.O. Box 10219, 11433 Riyadh (Saudi Arabia); Osman, H. [Taif University, College of Applied Medical Science, Radiology Department, Taif (Saudi Arabia); Omer, H. [University of Dammam, Faculty of Medicine, Dammam (Saudi Arabia); Sassi, S. A., E-mail: Abdelmoneim_a@yahoo.com [Prince Sultan Medical City, Department of Medical Physics, Riyadh (Saudi Arabia)

2014-08-15

Orthopedists are exposed to considerable radiation dose during orthopedic surgeries procedures. The staff is not well trained in radiation protection aspects and its related risks. In Sudan, regular monitoring services are not provided for all staff in radiology or interventional personnel. It is mandatory to measure staff and patient exposure in order to radiology departments. The main objectives of this study are: to measure the radiation dose to patients and staff during (i) Dynamic Hip Screw (Dhs) and (i i) Dynamic Cannula Screw (Dcs); to estimate the risk of the aforementioned procedures and to evaluate entrance surface dose (ESD) and organ dose to specific radiosensitive patients organs. The measurements were performed in Medical Corps Hospital, Sudan. The dose was measured for unprotected organs of staff and patient as well as scattering radiation. Calibrated Thermoluminescence dosimeters (TLD-Gr-200) of lithium fluoride (LiF:Mg, Cu,P) were used for ESD measurements. TLD signal are obtained using automatic TLD Reader model (Plc-3). The mean patients doses were 0.46 mGy and 0.07 for Dhs and Dcs procedures, respectively. The mean staff doses at the thyroid and chest were 4.69 mGy and 1.21 mGy per procedure. The mean radiation dose for staff was higher in Dhs compared to Dcs. This can be attributed to the long fluoroscopic exposures due to the complication of the procedures. Efforts should be made to reduce radiation exposure to orthopedic patients, and operating surgeons especially those with high work load. Staff training and regular monitoring will reduce the radiation dose for both patients and staff. (Author)

Epidural versus intravenous fentanyl for postoperative analgesia following orthopedic surgery: randomized controlled trial

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Marcelo Soares Privado

Full Text Available CONTEXT AND OBJECTIVE: Controversy exists regarding the site of action of fentanyl after epidural injection. The objective of this investigation was to compare the efficacy of epidural and intravenous fentanyl for orthopedic surgery. DESIGN AND SETTING: A randomized double-blind study was performed in Hospital São Paulo. METHODS: During the postoperative period, in the presence of pain, 29 patients were divided into two groups: group 1 (n = 14 received 100 µg of fentanyl epidurally and 2 ml of saline intravenously; group 2 (n = 15 received 5 ml of saline epidurally and 100 µg of fentanyl intravenously. The analgesic supplementation consisted of 40 mg of tenoxicam intravenously and, if necessary, 5 ml of 0.25% bupivacaine epidurally. Pain intensity was evaluated on a numerical scale and plasma concentrations of fentanyl were measured simultaneously. RESULTS: The percentage of patients who required supplementary analgesia with tenoxicam was lower in group 1 (71.4% than in group 2 (100%: 95% confidence interval (CI = 0.001-0.4360 (P = 0.001, Fisher's exact test; relative risk, RR = 0.07. Epidural bupivacaine supplementation was also lower in group 1 (14.3% than in group 2 (53.3%: 95% CI = 0.06-1.05 (P = 0.03, Fisher's exact test; RR = 0.26. There was no difference in pain intensity on the numerical scale. Mean fentanyl plasma concentrations were similar in the two groups. CONCLUSION: Intravenous and epidural fentanyl appear to have similar efficacy for reducing pain according to the numerical scale, but supplementary analgesia was needed less frequently when epidural fentanyl was used. CLINICAL TRIAL REGISTRATION NUMBER: NCT00635986

 Patient safety in orthopedic surgery: prioritizing key areas of iatrogenic harm through an analysis of 48,095 incidents reported to a national database of errors

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Panesar SS

2013-03-01

Full Text Available  Sukhmeet S Panesar,1 Andrew Carson-Stevens,2 Sarah A Salvilla,1 Bhavesh Patel,3 Saqeb B Mirza,4 Bhupinder Mann51Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK; 2Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK; 3National Patient Safety Agency, London, UK; 4Department of Trauma and Orthopaedic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, Hampshire, UK; 5Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Hospital, Aylesbury, UKBackground: With scientific and technological advances, the practice of orthopedic surgery has transformed the lives of millions worldwide. Such successes however have a downside; not only is the provision of comprehensive orthopedic care becoming a fiscal challenge to policy-makers and funders, concerns are also being raised about the extent of the associated iatrogenic harm. The National Reporting and Learning System (NRLS in England and Wales is an underused resource which collects intelligence from reports about health care error.Methods: Using methods akin to case-control methodology, we have identified a method of prioritizing the areas of a national database of errors that have the greatest propensity for harm. Our findings are presented using odds ratios (ORs and 95% confidence intervals (CIs.Results: The largest proportion of surgical patient safety incidents reported to the NRLS was from the trauma and orthopedics specialty, 48,095/163,595 (29.4%. Of those, 14,482/48,095 (30.1% resulted in iatrogenic harm to the patient and 71/48,095 (0.15% resulted in death. The leading types of errors associated with harm involved the implementation of care and on-going monitoring (OR 5.94, 95% CI 5.53, 6.38; self-harming behavior of patients in hospitals (OR 2.14, 95% CI 1.45, 3.18; and infection control (OR 1.91, 95% CI 1.69, 2.17. We analyze these data to quantify the extent and type of iatrogenic

An advanced simulator for orthopedic surgical training.

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Cecil, J; Gupta, Avinash; Pirela-Cruz, Miguel

2018-02-01

The purpose of creating the virtual reality (VR) simulator is to facilitate and supplement the training opportunities provided to orthopedic residents. The use of VR simulators has increased rapidly in the field of medical surgery for training purposes. This paper discusses the creation of the virtual surgical environment (VSE) for training residents in an orthopedic surgical process called less invasive stabilization system (LISS) surgery which is used to address fractures of the femur. The overall methodology included first obtaining an understanding of the LISS plating process through interactions with expert orthopedic surgeons and developing the information centric models. The information centric models provided a structured basis to design and build the simulator. Subsequently, the haptic-based simulator was built. Finally, the learning assessments were conducted in a medical school. The results from the learning assessments confirm the effectiveness of the VSE for teaching medical residents and students. The scope of the assessment was to ensure (1) the correctness and (2) the usefulness of the VSE. Out of 37 residents/students who participated in the test, 32 showed improvements in their understanding of the LISS plating surgical process. A majority of participants were satisfied with the use of teaching Avatars and haptic technology. A paired t test was conducted to test the statistical significance of the assessment data which showed that the data were statistically significant. This paper demonstrates the usefulness of adopting information centric modeling approach in the design and development of the simulator. The assessment results underscore the potential of using VR-based simulators in medical education especially in orthopedic surgery.

Attitudes and beliefs about placebo surgery among orthopedic shoulder surgeons in the United Kingdom.

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Karolina Wartolowska

Full Text Available To survey surgeons on their beliefs and attitudes towards the use of placebo in surgery.British orthopedic shoulder surgeons, attending a national conference in the United Kingdom, were asked to complete a self-report online questionnaire about their beliefs and attitudes towards the use of placebo related to surgical intervention. The survey included questions about ethical issues, the mechanism of placebo effects, and any concerns regarding its use.100 surgeons who participated in the survey believed that placebo surgery is ethically acceptable (96%, especially as a part of a clinical trial (46%. Respondents thought that a placebo effect in surgery is real i.e. has a scientific basis (92%, that placebo can be therapeutically beneficial (77%, and that it involves psychological mechanisms (96%. Over half of the respondents (58% have used a surgical procedure with a significant placebo component at least once in their professional career. Their main concern about placebo use in surgery was that it might involve an element of deception.Surgeons generally agreed that a placebo component to surgical intervention might exist. They also supported placebo use in clinical trials and considered it ethical, providing it does not involve deception of patients. More studies are needed, particularly among other surgical specialties and with larger numbers of participants, to better understand the use of placebo in surgery.

The application of telemedicine in orthopedic surgery in singapore: a pilot study on a secure, mobile telehealth application and messaging platform.

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Daruwalla, Zubin Jimmy; Wong, Keng Lin; Thambiah, Joseph

2014-06-05

The application of telemedicine has been described for its use in medical training and education, management of stroke patients, urologic surgeries, pediatric laparoscopic surgeries, clinical outreach, and the field of orthopedics. However, the usefulness of a secure, mobile telehealth application, and messaging platform has not been well described. A pilot study was conducted to implement a health insurance portability and accountability act (HIPAA) compliant form of communication between doctors in an orthopedic clinical setting and determine their reactions to MyDoc, a secure, mobile telehealth application, and messaging platform. By replacing current methods of communication through various mobile applications and text messaging services with MyDoc over a six week period, we gained feedback and determined user satisfaction with this innovative system from questionnaires handed to the program director, program coordinator, one trauma consultant, all orthopedic residents, and six non-orthopedic residents at the National University Hospital in Singapore. Almost everyone who completed the questionnaire strongly agreed that MyDoc should replace current systems of peer to peer communication in the hospital. The majority also felt that the quality of images, videos, and sound were excellent. Almost everyone agreed that they could communicate easily with each other and would feel comfortable doing so routinely. The majority felt that virtual consults through MyDoc should be made available to inpatients as well as outpatients to potentially lessen clinic loads and provide a secure manner in which patients can communicate with their primary teams any time convenient to both. It was also agreed by most that the potential of telerounding had advantages, especially on weekends as a supplement to normal rounds. Potential uses of MyDoc in an orthopedic clinical setting include HIPAA-compliant peer to peer communication, clinical outreach in the setting of trauma, supervision

Practical X-ray diagnostics orthopedics and trauma surgery. Indication, adjustment technique and radiation protection; Praktische Roentgendiagnostik Orthopaedie und Unfallchirurgie. Indikation, Einstelltechnik, Strahlenschutz

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Flechtenmacher, Johannes [Ortho-Zentrum am Ludwigsplatz, Karlsruhe (Germany); Sabo, Desiderius [Klinik St. Elisabeth, Heidelberg (Germany). Sportopaedic Heidelberg

2014-07-01

The book on X-ray diagnostics in orthopedics and trauma surgery includes the following chapters: 1. Introduction: radiation protection, equipment technology radiological diagnostics of skeleton carcinomas, specific aspects of trauma surgery, special aspects of skeleton radiology for children. 2. X-ray diagnostics of different anatomical regions: ankle joint, knee, hips and pelvis, hand and wrist joint, elbow, shoulder, spinal cord. 3. Appendix: radiation protection according to the X-ray regulations.

The Quality of Cost-Utility Analyses in Orthopedic Trauma.

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Nwachukwu, Benedict U; Schairer, William W; O'Dea, Evan; McCormick, Frank; Lane, Joseph M

2015-08-01

As health care in the United States transitions toward a value-based model, there is increasing interest in applying cost-effectiveness analysis within orthopedic surgery. Orthopedic trauma care has traditionally underemphasized economic analysis. The goals of this review were to identify US-based cost-utility analysis in orthopedic trauma, to assess the quality of the available evidence, and to identify cost-effective strategies within orthopedic trauma. Based on a review of 971 abstracts, 8 US-based cost-utility analyses evaluating operative strategies in orthopedic trauma were identified. Study findings were recorded, and the Quality of Health Economic Studies (QHES) instrument was used to grade the overall quality. Of the 8 studies included in this review, 4 studies evaluated hip and femur fractures, 3 studies analyzed upper extremity fractures, and 1 study assessed open tibial fracture management. Cost-effective interventions identified in this review include total hip arthroplasty (over hemiarthroplasty) for femoral neck fractures in the active elderly, open reduction and internal fixation (over nonoperative management) for distal radius and scaphoid fractures, limb salvage (over amputation) for complex open tibial fractures, and systems-based interventions to prevent delay in hip fracture surgery. The mean QHES score of the studies was 79.25 (range, 67-89). Overall, there is a paucity of cost-utility analyses in orthopedic trauma; however, the available evidence suggests that certain operative interventions can be cost-effective. The quality of these studies, however, is fair, based on QHES grading. More attention should be paid to evaluating the cost-effectiveness of operative intervention in orthopedic trauma. Copyright 2015, SLACK Incorporated.

[Daily routine in orthopedics and traumatology - results of a nationwide survey of residents].

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Merschin, D; Münzberg, M; Stange, R; Schüttrumpf, J P; Perl, M; Mutschler, M

2014-10-01

The subject orthopedics and traumatology suffers by a loss of attractiveness which results in a lack of young blood. The aim of this study of the Youth Forum of the German Society of Orthopedics and Traumatology (DGOU) is to register the working conditions of residents in orthopedics. In the months September and October 2013 we performed a survey on members of the following German societies: German Society of Orthopedics and Traumatology (DGOU), German Society of Traumatology (DGU) and the German Society of Orthopedics and Orthopedic Surgery (DGOOC), (age working time per week is 55 hours. 73 % of all participants do more than 5 emergency services per month. 52 % are more than 3 times on duty for 24 hours. Only 13 % of all residents have well ordered working hours. Normally working time is divided into three parts: one third for bureaucracy, one for operation theatre and the last for other activities (e.g. ward round). 35,6 % do only one surgery per week, 12 % do not perform any surgeries. An annual report is performed only in 45 %. A structured concept of training only exists in 16 % of all hospitals. In addition to clinical work 45 % are involved in scientific projects, mostly in their spare-time. Finally 58 % of all surgeons would still recommend orthopedics and traumatology. In order to maintain orthopedics and traumatology as an attractive it is necessary to implement flexible working time models and to reorganize and improve training-concepts. Georg Thieme Verlag KG Stuttgart · New York.

Comparison of Intravenous Morphine with Sublingual Buprenorphine in Management of Postoperative Pain after Closed Reduction Orthopedic Surgery

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Ghasem Soltani

2015-09-01

Full Text Available Background: Postoperative pain is a common side effect following surgery that can significantly reduce surgical quality and patient’s satisfaction. Treatment options are morphine and buprenorphine. We aimed to compare the efficacy of a single dose of intravenous morphine with sublingual buprenorphine in postoperative pain control following closed reduction surgery. Methods: This triple blind clinical trial was conducted on 90 patients referred for closed reduction orthopedic surgery. They were older than 18 years and in classes I and II of the American Society of Anesthesiologists (ASA with an operation time of 30-90 minutes. Patients were divided into two groups of buprenorphine (4.5μg/kg sublingually and morphine (0.2mg/kg intravenously. Baseline characteristics, vital signs, pain score, level of sedation and pharmacological side effects were recorded in the recovery room (at 0 and 30 minutes, and in the ward (at 3, 6 and 12 hours. SPSS version 19 software was used for data analysis and the significance level was set at P Results: Ninety patients were studied, 60 males and 30 females with a mean age of 37.7±16.2 years. There was no significant difference between the two groups in terms of baseline characteristics.Pain score in the morphine group was significantly higher than the buprenorphine group with an average score of 2.5 (P

Comparison of Intravenous Morphine with Sublingual Buprenorphine in Management of Postoperative Pain after Closed Reduction Orthopedic Surgery

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Ghasem Soltani

2015-10-01

Full Text Available Background: Postoperative pain is a common side effect following surgery that can significantly reduce surgical quality and patient’s satisfaction. Treatment options are morphine and buprenorphine. We aimed to compare the efficacy of a single dose of intravenous morphine with sublingual buprenorphine in postoperative pain control following closed reduction surgery. Methods: This triple blind clinical trial was conducted on 90 patients referred for closed reduction orthopedic surgery. They were older than 18 years and in classes I and II of the American Society of Anesthesiologists (ASA with an operation time of 30-90 minutes. Patients were divided into two groups of buprenorphine (4.5μg/kg sublingually and morphine (0.2mg/kg intravenously. Baseline characteristics, vital signs, pain score, level of sedation and pharmacological side effects were recorded in the recovery room (at 0 and 30 minutes, and in the ward (at 3, 6 and 12 hours. SPSS version 19 software was used for data analysis and the significance level was set at P Results: Ninety patients were studied, 60 males and 30 females with a mean age of 37.7±16.2 years. There was no significant difference between the two groups in terms of baseline characteristics.Pain score in the morphine group was significantly higher than the buprenorphine group with an average score of 2.5 (P

Postoperative constipation risk assessment in Turkish orthopedic patients.

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Şendir, Merdiye; Büyükıylmaz, Funda; Aştı, Türkinaz; Gürpınar, Şengül; Yazgan, İlknur

2012-01-01

This descriptive, correlational study was conducted to describe constipation risk assessment and the affecting factors of constipation risk of patients who have undergone major orthopedic surgery. Data were collected using a patient information form and the Constipation Risk Assessment Scale (CRAS) on the second postoperative day. Data were analyzed using the SPSS version 11.5 for Windows. The mean age of the 83 patients studied was 53.75 ± 21.29 years. Subjects were hospitalized in the orthopedic wards for 14.39 ± 15.17 days, and their current bowel habit was 2.18 ± 1.80 stools per week. Of the sample, 63.9% were female, 69.9% of the patients had a history of previous surgery, 45.8% had hip/knee arthroplasty surgery, and 55.4% had bowel problems during the hospitalization period. Patients had a medium risk for constipation according to the CRAS subscale (gender, mobility, and pharmacological agents). Total CRAS score was 12.73 ± 4.75 (medium risk) on the second postoperative day. In addition, age, marital status, educational level, having a history of surgery, and bowel elimination problems did have a significant effect on constipation risk. On the basis of the findings from this study, nurses must learn the postoperative constipation risk of orthopedic patients to implement safe and effective interventions.

Polymers as Carriers of Gentamicin in Traumatology and Orthopedic Surgery - Current State Of Knowledge.

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Witkowski, Jarosław; Wnukiewicz, Witold; Reichert, Paweł

2016-01-01

Osteomyelitis in patients undergoing surgery because of injuries and diseases of the musculoskeletal system is a serious clinical, economic and social problem. It is one of the greatest therapeutic challenges in traumatology and orthopedic surgery. To achieve the best results in the treatment of osteomyelitis, surgical debridement and intravenous antibiotic therapy is supported by local antibiotic delivery. Many different substances can be used as drug carriers. In this study we present and compare some polymers used as carriers of gentamicin. Some of them, such as poly(methyl methacrylate), are well known and have been used for 30 years, and others, such as polycaprolactone, polyacrylic acid, polyanhydrides, poly-trimethylene carbonate, polylactide, polyglycolide and poly(trimethylene carbonate), are perspectives for the future. In this study, we have tried to briefly present all of these polymers and compare some of their features. We have concentrated on the pharmacokinetics and bioactivity of such implants, which are important aspects for their potential practical use.

Trends in the orthopedic job market and the importance of fellowship subspecialty training.

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Morrell, Nathan T; Mercer, Deana M; Moneim, Moheb S

2012-04-01

Previous studies have examined possible incentives for pursuing orthopedic fellowship training, but we are unaware of previously published studies reporting the trends in the orthopedic job market since the acceptance of certain criteria for fellowship programs by the Accreditation Council for Graduate Medical Education (ACGME) in 1985. We hypothesized that, since the initiation of accredited postresidency fellowship programs, job opportunities for fellowship-trained orthopedic surgeons have increased and job opportunities for nonfellowship-trained orthopedic surgeons have decreased. We reviewed the job advertisements printed in the Journal of Bone and Joint Surgery, American Volume, for the years 1984, 1994, 2004, and 2009. We categorized the job opportunities as available for either a general (nonfellowship-trained) orthopedic surgeon or a fellowship-trained orthopedic surgeon. Based on the advertisements posted in the Journal of Bone and Joint Surgery, American Volume, a trend exists in the orthopedic job market toward seeking fellowship-trained orthopedic surgeons. In the years 1984, 1994, 2004, and 2009, the percentage of job opportunities seeking fellowship-trained orthopedic surgeons was 16.7% (95% confidence interval [CI], 13.1%-20.3%), 40.6% (95% CI, 38.1%-43.1%), 52.2% (95% CI, 48.5%-55.9%), and 68.2% (95% CI, 65.0%-71.4%), respectively. These differences were statistically significant (analysis of variance, Ptraining is thus a worthwhile endeavor. Copyright 2012, SLACK Incorporated.

Comparison of Intravenous Morphine with Sublingual Buprenorphine in Management of Postoperative Pain after Closed Reduction Orthopedic Surgery.

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Soltani, Ghasem; Khorsand, Mahmood; Shamloo, Alireza Sepehri; Jarahi, Lida; Zirak, Nahid

2015-10-01

Postoperative pain is a common side effect following surgery that can significantly reduce surgical quality and patient's satisfaction. Treatment options are morphine and buprenorphine. We aimed to compare the efficacy of a single dose of intravenous morphine with sublingual buprenorphine in postoperative pain control following closed reduction surgery. This triple blind clinical trial was conducted on 90 patients referred for closed reduction orthopedic surgery. They were older than 18 years and in classes I and II of the American Society of Anesthesiologists (ASA) with an operation time of 30-90 minutes. Patients were divided into two groups of buprenorphine (4.5µg/kg sublingually) and morphine (0.2mg/kg intravenously). Baseline characteristics, vital signs, pain score, level of sedation and pharmacological side effects were recorded in the recovery room (at 0 and 30 minutes), and in the ward (at 3, 6 and 12 hours). SPSS version 19 software was used for data analysis and the significance level was set at P<0.05. Ninety patients were studied, 60 males and 30 females with a mean age of 37.7±16.2 years. There was no significant difference between the two groups in terms of baseline characteristics. Pain score in the morphine group was significantly higher than the buprenorphine group with an average score of 2.5 (P<0.001). Postoperative mean heart rate in the buprenorphine group was four beats lower than the morphine group (P<0.001). Also, in the buprenorphine 48.6% and in the morphine group 86.7% of cases were conscious in recovery (P=0.001) with a higher rate of pruritus in the latter group (P=0.001). Sublingual buprenorphine administration before anesthesia induction in closed reduction surgery can lead to better postoperative pain control in comparison to intravenous morphine. Due to simple usage and longer postoperative sedation, sublingual buprenorphine is recommended as a suitable drug in closed reduction surgery.

Chemoprophylaxis in cardiac and orthopedic surgery: comparison of cephalothin and cephapirin.

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Bryant, R E; Hartstein, A I; Starr, A; Beals, R K

1982-09-01

In a retrospective sequential study we determined the rate of infection occurring despite cephalothin or cephapirin chemoprophylaxis in orthopedic and cardiac surgery done from 1973 to 1977. The incidence of infection after prosthetic hip placement or open reduction of hip fracture was 3.4% and 1.0% in patients receiving cephalothin or cephapirin, respectively. The infection rate after prosthetic heart valve implantation was 3.5% in those receiving cephalothin and 1.6% in those receiving cephapirin. There was no significant difference in infection rate, duration of fever greater than or equal to 38.0 C, or length of postoperative hospitalization. The efficacy of selected antistaphylococcal antibiotics in preventing colonization of human fibrin clots by staphylococci was studied. Although cephapirin was effective at lower concentration, the activity of cephalothin and cephapirin was comparable. Cephalothin and cephapirin have equivalent chemoprophylactic activity by clinical and microbiological criteria, permitting cost to be used as a basis for choosing between these antibiotics.

[How many generalists and how many specialists does orthopedics and traumatology need?].

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Achatz, G; Perl, M; Stange, R; Mutschler, M; Jarvers, J S; Münzberg, M

2013-01-01

The training in orthopedic and trauma surgery has changed significantly with the introduction of the new residency program. The contents taught have already been reduced in breadth and the current developments in the outpatient and particularly in the clinical landscape also contribute to increasing specialization. This trend favors structures in which comprehensive medical care for the population in Germany in orthopedic and trauma surgery appears to be endangered and in which the future efforts for e.g. polytraumatised patients need to be questioned. The Young Forum of the German Society for Orthopedics and Traumatology actively accompanies a discussion about the necessity and value of generalists to ensure the level of care in Germany in addition to the specialists.

Mobile Device Trends in Orthopedic Surgery: Rapid Change and Future Implications.

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Andrawis, John P; Muzykewicz, David A; Franko, Orrin I

2016-01-01

Mobile devices are increasingly becoming integral communication and clinical tools. Monitoring the prevalence and utilization characteristics of surgeons and trainees is critical to understanding how these new technologies can be best used in practice. The authors conducted a prospective Internet-based survey over 7 time points from August 2010 to August 2014 at all nationwide American Council for Graduate Medical Education-accredited orthopedic programs. The survey questionnaire was designed to evaluate the use of devices and mobile applications (apps) among trainees and physicians in the clinical setting. Results were analyzed and summarized for orthopedic surgeons and trainees. During the 48-month period, there were 7 time points with 467, 622, 329, 223, 237, 111, and 134 responses. Mobile device use in the clinical setting increased across all fields and levels of training during the study period. Orthopedic trainees increased their use of Smartphone apps in the clinical setting from 60% to 84%, whereas attending use increased from 41% to 61%. During this time frame, use of Apple/Android platforms increased from 45%/13% to 85%/15%, respectively. At all time points, 70% of orthopedic surgeons believed their institution/hospital should support mobile device use. As measured over a 48-month period, mobile devices have become an ubiquitous tool in the clinical setting among orthopedic surgeons and trainees. The authors expect these trends to continue and encourage providers and trainees to be aware of the limitations and risks inherent with new technology. Copyright 2016, SLACK Incorporated.

Nursing documentation and length of stay in orthopedic surgery

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Paans, Wolter; Krijnen, Wim

2016-01-01

Nursing outcome calculation, and future possibilities. An example in orthopedic specialty nursing. Comparing nursing diagnoses in hip prosthesis patients and knee prosthesis patients in a Dutch hospital.

Comparison between paracetamol, piroxicam, their combination, and placebo in postoperative pain management of upper limb orthopedic surgery (a randomized double blind clinical trial

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Gholamreza Khalili

2016-01-01

Conclusion: IV infusion of 15 mg/kg Paracetamol used as a preventive may provide effective analgesia in comparison with IM 0.4 mg/kg Piroxicam or placebo. Addition of Piroxicam to Paracetamol has not much more benefit than Paracetamol alone, in reducing pain after upper limb orthopedic surgery.

Porous metal for orthopedics implants

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Matassi, Fabrizio; Botti, Alessandra; Sirleo, Luigi; Carulli, Christian; Innocenti, Massimo

2013-01-01

Porous metal has been introduced to obtain biological fixation and improve longevity of orthopedic implants. The new generation of porous metal has intriguing characteristics that allows bone healing and high osteointegration of the metallic implants. This article gives an overview about biomaterials properties of the contemporary class of highly porous metals and about the clinical use in orthopaedic surgery.

Do authors report surgical expertise in open spine surgery related randomized controlled trials? A systematic review on quality of reporting

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van Oldenrijk, Jakob; van Berkel, Youri; Kerkhoffs, Gino M. M. J.; Bhandari, Mohit; Poolman, Rudolf W.

2013-01-01

A systematic review of published trials in orthopedic spine literature. To determine the quality of reporting in open spine surgery randomized controlled trials (RCTs) between 2005 and 2010 with special focus on the reporting of surgical skill or expertise. In technically demanding procedures such

Validity of subjective smoking status in orthopedic patients

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Bender D

2015-08-01

Full Text Available Daniel Bender,* Patrick Haubruck,* Sonja Boxriker, Sebastian Korff, Gerhard Schmidmaier, Arash Moghaddam Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany *These authors contributed equally to this work Purpose: In this level 1 diagnostic study, we analyzed the validity of subjective smoking status and, as secondary research question, the smoking cessation adherence in orthopedic patients during a routine hospital stay of nonunion patients by measuring serum cotinine.  Methods: We included patients undergoing revision surgery due to nonunion of long bones. Patients were interviewed about their smoking status. Blood samples were taken from all the patients prior to surgery and for an additional 6 weeks following surgery. Serum levels of cotinine were measured, and coherence between subjective smoking status and objective cotinine analysis was evaluated.  Results: Between March 2012 and August 2014, we enrolled 136 patients. Six of the 26 “previous smokers” (23% and four of the 65 “nonsmokers” (6% had serum cotinine above cutoff levels. In self-labeled smokers, serum cotinine levels averaged at 2,367.4±14,885.9 ng/mL (with a median of 100 ng/mL, whereas in previous smokers the levels averaged at 4,270±19,619.4 ng/mL (with a median of 0 ng/mL and in the nonsmokers group the levels averaged at 12±53.9 ng/mL (with a median of 0.03 ng/mL. Overall, the subjective smoking status matched serum cotinine testing in 88% of the cases. Sensitivity was 79.6% and specificity was 93.1%. Ninety-one percent of the patients with preoperative positive serum values were still positive at follow-up.  Conclusion: In this study, we could show that subjective smoking status in orthopedic patients is predominantly reliable as validated by objective cotinine measurements; however, patients who declare themselves as “previous smokers” are at elevated risk

[Effects of an oxacephem antibiotic on liver function in orthopedic surgery].

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Kuroyama, M; Otori, K; Yokota, S; Aoto, H; Sawada, M; Yago, K; Fujita, T; Kumagai, Y

1999-07-01

The subjects were 531 patients who underwent orthopedic surgery. Flomoxef was administered, and liver function was examined before and after administration. Abnormal liver function after administration of flomoxef was found in 14.3% of patients. In male patients, a high rate of 18.8% was observed. A particularly high rate of 37.0% was obtained among patients who showed GOT values of more than 40 U/L before treatment with flomoxef. The prevalence of abnormal GOT and GPT values after administration of flomoxef was 3.6% and 13.2%, respectively. These values were significantly higher than those obtained with other cephem antibiotics. These rates of occurrence of abnormally high GOT and GPT are obviously higher than those submitted at the time of approval and reported in the drug use investigation. The prevalence of abnormal liver function values was high in patients receiving flomoxef, and particularly high in male patients and patients whose GOT was high before administration of flomoxef. Therefore, sufficient check of liver function appears important when administration of flomoxef to these types of patients is intended.

Surgical specialty procedures in rural surgery practices: implications for rural surgery training.

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Sticca, Robert P; Mullin, Brady C; Harris, Joel D; Hosford, Clint C

2012-12-01

Specialty procedures constitute one eighth of rural surgery practice. Currently, general surgeons intending to practice in rural hospitals may not get adequate training for specialty procedures, which they will be expected to perform. Better definition of these procedures will help guide rural surgery training. Current Procedural Terminology codes for all surgical procedures for 81% of North Dakota and South Dakota rural surgeons were entered into the Dakota Database for Rural Surgery. Specialty procedures were analyzed and compared with the Surgical Council on Resident Education curriculum to determine whether general surgery training is adequate preparation for rural surgery practice. The Dakota Database for Rural Surgery included 46,052 procedures, of which 5,666 (12.3%) were specialty procedures. Highest volume specialty categories included vascular, obstetrics and gynecology, orthopedics, cardiothoracic, urology, and otolaryngology. Common procedures in cardiothoracic and vascular surgery are taught in general surgical residency, while common procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology are usually not taught in general surgery training. Optimal training for rural surgery practice should include experience in specialty procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology. Copyright © 2012 Elsevier Inc. All rights reserved.

Readability of Spine-Related Patient Education Materials From Leading Orthopedic Academic Centers.

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Ryu, Justine H; Yi, Paul H

2016-05-01

Cross-sectional analysis of online spine-related patient education materials from leading academic centers. To assess the readability levels of spine surgery-related patient education materials available on the websites of academic orthopedic surgery departments. The Internet is becoming an increasingly popular resource for patient education. Yet many previous studies have found that Internet-based orthopedic-related patient education materials from subspecialty societies are written at a level too difficult for the average American; however, no prior study has assessed the readability of spine surgery-related patient educational materials from leading academic centers. All spine surgery-related articles from the online patient education libraries of the top five US News & World Report-ranked orthopedic institutions were assessed for readability using the Flesch-Kincaid (FK) readability test. Mean readability levels of articles amongst the five academic institutions and articles were compared. We also determined the number of articles with readability levels at or below the recommended sixth- or eight-grade levels. Intraobserver and interobserver reliability of readability assessment were assessed. A total of 122 articles were reviewed. The mean overall FK grade level was 11.4; the difference in mean FK grade level between each department varied significantly (range, 9.3-13.4; P Online patient education materials related to spine from academic orthopedic centers are written at a level too high for the average patient, consistent with spine surgery-related patient education materials provided by the American Academy of Orthopaedic Surgeons and spine subspecialty societies. This study highlights the potential difficulties patients might have in reading and comprehending the information in publicly available education materials related to spine. N/A.

Multilevel orthopedic surgery for crouch gait in cerebral palsy: An evaluation using functional mobility and energy cost

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Dhiren Ganjwala

2011-01-01

Full Text Available Background: The evidence for the effectiveness of orthopaedic surgery to correct crouch gait in cerebral diplegic is insufficient. The crouch gait is defined as walking with knee flexion and ankle dorsiflexion through out the stance phase. Severe crouch gait in patients with spastic diplegia causes excessive loading of the patellofemoral joint and may result in anterior knee pain, gait deterioration, and progressive loss of function. We retrospectively evaluated the effect of surgery on the mobility and energy consumption at one year or more with the help of validated scales and scores. Materials and Methods: 18 consecutive patients with mean age of 14.6 years with cerebral diplegia with crouched gait were operated for multilevel orthopaedic surgery. Decisions for surgery were made with the observations on gait analysis and physical examination. The surgical intervention consisted of lengthening of short muscle-tendon units, shortening of long muscles and correction of osseous deformities. The paired samples t test was used to compare values of physical examination findings, walking speed and physiological cost index. Two paired sample Wilcoxon signed rank test was used to compare functional walking scales. Results: After surgery, improvements in functional mobility, walking speed and physiological cost index were found. No patient was able to walk 500 meters before surgery while all were able to walk after surgery. The improvements that were noted at one year were maintained at two years. Conclusions: Multilevel orthopedic surgery for older children and adolescents with crouch gait is effective for improving function and independence.

THE EFFECTS OF INTRATHECAL NEOSTIGMINE ADDED TO BUPIVACAINE ON POSTOPERATIVE ANALGESIC REQUIREMENT IN PATIENTS UNDERGOING LOWER LIMB ORTHOPEDIC SURGERY.

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Kayalha, Hamid; Mousavi, Zinat; Sadat Barikani, Ameneh; Yaghoobi, Siamak; Khezri, Marzieh Beigom

2015-06-01

Several additives have been suggested to enhance analgesic effect of local anesthetic agents to decrease the adverse effects of them and increase the degree of satisfaction. We designed this randomized double-blind controlled study to evaluate the analgesic efficacy of the neostigmine added to bupivacaine using spinal anesthesia in patients undergoing lower limb orthopedic surgery. Sixty patients 18-80 yr old American Society of Anesthesiologists (ASA) physical status I or II, scheduled for femur surgery under spinal anesthesia, were recruited in a prospective, double-blinded, randomized way. The patients were randomly allocated to one of two groups of 30 each. The neostigmine group (group N) received bupivacaine 20 mg combined with 25 µg neostigmine, and the placebo group (group C) received bupivacaine 20 mg combined with 0.5ml distilled water (intrathecally) 5 minutes prior to surgery. The time to the first analgesic request, analgesic requirement in the first 12 hours after surgery, the duration of sensory and motor blockade, the incidence of adverse effects such as nausea,vomiting,hypotension, ephedrine requirements, bradycardia, and hypoxemia were recorded. Patients receiving neostigmine had a significantly prolonged duration of motor block (C95% CI 30.27 to 87.65; P < 0.001) and sensory block (C95% CI 101.04 to 224.64; P < 0.001) compared to the control group. The difference of the mean time to the first analgesic request was also significantly longer in neostigmine group (C95% CI 83.139 to 208.526; P < 0.001). The total analgesic consumption during the first 12 hours after surgery was devoid of any significant difference between groups N and C (p = 0.41).The two groups were not significantly different in terms of intraoperative and postoperative side effects. Intrathecal neostigmine 25 µg with bupivacaine caused a prolonged time to the first analgesic request and its use was not associated with any side effects.

Transferability of economic evaluations of medical technologies: a new technology for orthopedic surgery.

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Steuten, Lotte; Vallejo-Torres, Laura; Young, Terry; Buxton, Martin

2008-05-01

Transferring results of economic evaluations across countries or jurisdictions can potentially save scarce evaluation resources while helping to make market access and reimbursement decisions in a timely fashion. This article points out why transferring results of economic evaluations is particularly important in the field of medical technologies. It then provides an overview of factors that are previously identified in the literature as affecting transferability of economic evaluations, as well as methods for transferring results in a scientifically sound way. As the current literature almost exclusively relates to transferability of pharmacoeconomic evaluations, this article highlights those factors and methodologies that are of particular relevance to transferring medical technology assessments. Considering the state-of-the-art literature and a worked, real life, example of transferring an economic evaluation of a product used in orthopedic surgery, we provide recommendations for future work in this important area of medical technology assessment.

E-learning in orthopedic surgery training: A systematic review.

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Tarpada, Sandip P; Morris, Matthew T; Burton, Denver A

2016-12-01

E-learning is the use of internet-based resources in education. In the field of surgical education, this definition includes the use of virtual patient cases, digital modeling, online tutorials, as well as video recordings of surgical procedures and lectures. In recent years, e-learning has increasingly been considered a viable alternative to traditional teaching within a number of surgical fields. Here we present (1) a systematic review of literature assessing the efficacy of e-learning modules for orthopedic education and (2) a discussion of their relevance. A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted according to the guidelines defined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). The search yielded a total of 255 non-duplicate citations that were screened using predetermined inclusion/exclusion criteria. A total of 9 full text articles met inclusion criteria, which included the use of an objective outcome measure to evaluate an orthopedic e-learning module. Six studies assessed knowledge using a multiple-choice test and 4 assessed skills using a clinical exam. All studies showed positive score improvement pre- to post-intervention, and a majority showed greater score improvement than standard teaching methods in both knowledge (4/6 studies) and clinical skills (3/4 studies). E-learning represents an effective supplement or even alternative to standard teaching techniques within orthopedic education for both medical students and residents. Future work should focus on validating specific e-learning programs using standardized outcome measures and assessing long-term knowledge retention using e-learning platforms.

[Complex surgical procedures in orthopedics and trauma surgery. A contribution to the proposal procedure for the DRG system in 2009].

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Flohé, S; Nabring, J; Luetkes, P; Nast-Kolb, D; Windolf, J

2008-10-01

Since the DRG system was introduced in 2003/2004 the system for remuneration has been continually modified in conjunction with input from specialized medical associations. As part of this development of the payment system, the criteria for classification of a diagnosis-related group were further expanded and new functions were added. This contribution addresses the importance of the complex surgical procedures as criteria for subdivision of the DRG case-based lump sums in orthopedics and trauma surgery.

Proximal spinal muscular atrophy: current orthopedic perspective

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Haaker G

2013-11-01

Full Text Available Gerrit Haaker, Albert Fujak Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Abstract: Spinal muscular atrophy (SMA is a hereditary neuromuscular disease of lower motor neurons that is caused by a defective "survival motor neuron" (SMN protein that is mainly associated with proximal progressive muscle weakness and atrophy. Although SMA involves a wide range of disease severity and a high mortality and morbidity rate, recent advances in multidisciplinary supportive care have enhanced quality of life and life expectancy. Active research for possible treatment options has become possible since the disease-causing gene defect was identified in 1995. Nevertheless, a causal therapy is not available at present, and therapeutic management of SMA remains challenging; the prolonged survival is increasing, especially orthopedic, respiratory and nutritive problems. This review focuses on orthopedic management of the disease, with discussion of key aspects that include scoliosis, muscular contractures, hip joint disorders, fractures, technical devices, and a comparative approach of conservative and surgical treatment. Also emphasized are associated complications including respiratory involvement, perioperative care and anesthesia, nutrition problems, and rehabilitation. The SMA disease course can be greatly improved with adequate therapy with established orthopedic procedures in a multidisciplinary therapeutic approach. Keywords: spinal muscular atrophy, scoliosis, contractures, fractures, lung function, treatment, rehabilitation, surgery, ventilation, nutrition, perioperative management

Prevention of Infection in Orthopedic Prosthetic Surgery.

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Chirca, Ioana; Marculescu, Camelia

2017-06-01

Total joint arthroplasty is a generally safe orthopedic procedure; however, infection is a potentially devastating complication. Multiple risk factors have been identified for development of prosthetic joint infections. Identification of patients at risk and preoperative correction of known risk factors, such as smoking, diabetes mellitus, anemia, malnutrition, and decolonization of Staphylococcus carriers, represent well-established actions to decrease the infection risk. Careful operative technique, proper draping and skin preparation, and appropriate selection and dosing of antimicrobials for perioperative prophylaxis are also very important in prevention of infection. Published by Elsevier Inc.

Prominent ears: the effect of reconstructive surgery on self-esteem and social interaction in children with a minor defect compared to children with a major orthopedic defect.

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Niemelä, Birgitta Johansson; Hedlund, Anders; Andersson, Gerhard; Wahlsten, Viveka Sundelin

2008-11-01

In a prospective study of patients with prominent ears, the effect of reconstructive surgery on self-esteem and social interaction was examined 1 year after surgery. Of 42 patients with prominent ears aged 7 to 15 years, 21 were matched with a comparison group of orthopedic patients (leg lengthening) and a control group of schoolchildren. Psychological measures evaluated self-esteem, depression, anxiety, cognition, parents' ratings of child behavior and symptoms, and parent anxiety. Semistructured interviews with the child and parents were also conducted. The motivation to be operated on was pain, teasing, and feelings of being different. The satisfaction rate with the result of reconstructive surgery was high. The psychological measures of the prominent ears group had results close to those of the control group, although the leg lengthening group had lower self-esteem and higher depression and anxiety scores. With few exceptions, all patients had scores within the normal range on self-rating scales. Parents reported less activity at leisure time in both patient groups than in the control group. After surgery, parents reported improved behavior on the Child Behavior Checklist total problem score. Patients with minor defects had fewer self-reported psychological and behavior problems than the major defect group. Interestingly, prominent ears patients also had low activity levels. Reconstructive surgery had no adverse effect on the prominent ears patients in this interim study but rather resulted in improved well-being. It is important to investigate further the effect of reconstructive surgery on children's self-esteem and social interaction.

The effect of etoricoxib premedication on postoperative analgesia requirement in orthopedic and trauma patients

International Nuclear Information System (INIS)

Siddiqui, Ahsan K.; Al-Ghamdi, Abdulmohsin A.; Mowafi, Hany A.; Ismail, Salah A.; Sadat-Ali, M.; Al-Dakheel, Dakheel A.

2008-01-01

We have hypothesized that etoricoxib premedication would reduce the need for additional opioids following orthopedic trauma surgery. A double blind, controlled study, conducted in King Fahd University Hospital, King Faisal University, Dammam, Kingdom of Saudi Arabia. After obtaining the approval of Research and Ethics Committee and written consent, 200 American Society of Anesthesiology grade I and II patients that underwent elective upper limb or lower limb fracture fixation surgeries during the period from August 2005 to October 2007 were studied. Patients were randomly premedicated using 120 mg of etoricoxib or placebo n=100, each. To alleviate postoperative pain, a patient controlled analgesia device was programmed to deliver one mg of morphine intravenously locked lockout time, 6 minutes. Visual analog scale and total postoperative morphine consumption over 24 hours and the adverse effects were recorded. One hundred patients in each group completed the study period. Etoricoxib premedication provides a statistically significant postoperative morphine sparing effect over 24 hours postoperatively. Total morphine consumption was 44.2 (8.2) in the placebo and 35.17 mg in the etoricoxib groups p<0.001. The incidence of nausea and vomiting requiring treatment was lower in the etoricoxib group. p=0.014. The postoperative blood loss was similar in both groups. Etoricoxib is a suitable premedication before traumatic orthopedic surgery as it enhanced postoperative analgesia and reduced the need for morphine. (author)

Comparison of the isoflurane concentration of using dexketoprofen or methadone at premedication during orthopedic surgery in dogs.

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Navarrete-Calvo, Rocío; Gutiérrez-Bautista, Álvaro J; Granados, María M; Domínguez, Juan M; Fernández-Sarmiento, J Andrés; Quirós-Carmona, Setefilla; Morgaz, J

2016-04-01

Thirty-two dogs were used in this prospective, randomized, clinical and double-blinded study. Dexmedetomidine was administered at 1 μg/kg IV, and randomly each dog received dexketoprofen 1 mg/kg IV (group DK) or methadone 0.2 mg/kg IV (group M). Dogs were induced with propofol and maintained with isoflurane in 100% oxygen. During surgery, the isoflurane concentration was changed depending on clinical signs of depth of anesthesia. Fentanyl and propofol could be used as required. Qualities of sedation and recovery were evaluated. A generalized linear mixed model or Mann-Whiney U test was used, and Pdexketoprofen at 1 mg/kg IV at premedication required a similar isoflurane concentration to maintain anesthesia as methadone at 0.2 mg/kg IV during orthopedic surgery in dogs. Further analgesia is recommended intraoperatively, because of the need of fentanyl and propofol in same animals in both groups. Copyright © 2016 Elsevier Ltd. All rights reserved.

Biological Strategies for Improved Osseointegration and Osteoinduction of Porous Metal Orthopedic Implants

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Riester, Scott M.; Bonin, Carolina A.; Kremers, Hilal Maradit; Dudakovic, Amel; Kakar, Sanjeev; Cohen, Robert C.; Westendorf, Jennifer J.

2015-01-01

The biological interface between an orthopedic implant and the surrounding host tissue may have a dramatic effect upon clinical outcome. Desired effects include bony ingrowth (osseointegration), stimulation of osteogenesis (osteoinduction), increased vascularization, and improved mechanical stability. Implant loosening, fibrous encapsulation, corrosion, infection, and inflammation, as well as physical mismatch may have deleterious clinical effects. This is particularly true of implants used in the reconstruction of load-bearing synovial joints such as the knee, hip, and the shoulder. The surfaces of orthopedic implants have evolved from solid-smooth to roughened-coarse and most recently, to porous in an effort to create a three-dimensional architecture for bone apposition and osseointegration. Total joint surgeries are increasingly performed in younger individuals with a longer life expectancy, and therefore, the postimplantation lifespan of devices must increase commensurately. This review discusses advancements in biomaterials science and cell-based therapies that may further improve orthopedic success rates. We focus on material and biological properties of orthopedic implants fabricated from porous metal and highlight some relevant developments in stem-cell research. We posit that the ideal primary and revision orthopedic load-bearing metal implants are highly porous and may be chemically modified to induce stem cell growth and osteogenic differentiation, while minimizing inflammation and infection. We conclude that integration of new biological, chemical, and mechanical methods is likely to yield more effective strategies to control and modify the implant–bone interface and thereby improve long-term clinical outcomes. PMID:25348836

Level of evidence gap in orthopedic research.

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Baldwin, Keith D; Bernstein, Joseph; Ahn, Jaimo; McKay, Scott D; Sankar, Wudbhav N

2012-09-01

Level of evidence is the most widely used metric for the quality of a publication, but instances exist in which a Level I study is neither feasible nor desirable. The goal of this study was to evaluate the level of evidence gap in current orthopedic research, which the authors defined as the disparity between the level of evidence that would be required to optimally answer the primary research question and the level of evidence that was actually used. Five orthopedic surgeons (K.D.B., J.B., J.A., S.D.M., W.N.S.) evaluated blinded articles from the first 6 months of 2010 in the Journal of Bone and Joint Surgery (American Volume) (JBJS-Am), classifying the study type and design and extracting a primary research question from each article. Each evaluator then defined the study type and method, along with the level of evidence that would ideally be used to address the primary research question. The level of evidence gap was then calculated by subtracting the actual level of evidence of the manuscript from the level of evidence of the idealized study. Of the 64 JBJS-Am manuscripts eligible for analysis, the average level of evidence was between Level II and III (mean, 2.73). The average level of evidence gap was 1.06 compared with the JBJS-Am-designated level of evidence and 1.28 compared with the evaluators' assessment. Because not all questions require Level I studies, level of evidence alone may not be the best metric for the quality of orthopedic surgery literature. Instead, the authors' concept of a level of evidence gap may be a better tool for assessing the state of orthopedic research publications. Copyright 2012, SLACK Incorporated.

The Cost of Getting Into Orthopedic Residency: Analysis of Applicant Demographics, Expenditures, and the Value of Away Rotations.

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Camp, Christopher L; Sousa, Paul L; Hanssen, Arlen D; Karam, Matthew D; Haidukewych, George J; Oakes, Daniel A; Turner, Norman S

2016-01-01

Little is known about the demographics and expenditures of applicants attempting to match into the competitive field of orthopedic surgery. In attempt to better inform potential applicants, the purposes of this work are to (1) better understand the demographics of successfully matched applicants, (2) determine the monetary cost of applying, and (3) assess the value of away rotations for improving chances of a successful match. Prospective comparative survey. Mayo Clinic Department of Orthopedic Surgery, Rochester, MN. A week following the 2015 Orthopedic Surgery Residency Match, a survey was sent to 1,091. The survey focused on applicant demographics, number of programs applied to, cost of applying, and the value of away rotations. A total of 408 applicants completed the survey (response rate = 37%). Of these, 312 (76%) matched and 96 (24%) did not match into a US Orthopedic Surgery Residency. Of the matched applicants, 300 (96%) were from US allopathic medical schools, 9 (3%) US Osteopathic Schools, and 3 (1%) were international graduates. Males comprised 84% of these applicants whereas 16% were female. The mean number of programs applied to was 71 (range: 20-140). On average, applicants were offered 16 interviews (range: 1-53) and they attended 11 (range: 0-12). Completing a rotation at a program increased an applicant׳s chances of matching into that program by a factor of 1.5 (60% vs 40%). Of the applicants who matched, most applicants matched to an orthopedic residency in the same region where the applicant attended medical school (58%). The average cost of the application was $1,664 (range: $100-$5,000) whereas the cost of interviews (travel, food, etc.) was $3,656 (range: $15-$20,000). Total expenditures ranged from $450 to $25,000 (mean = $5,415). Over 8% of matched applicants spent >$10,000. Gaining acceptance into orthopedic surgery residency remains a very competitive process. Away rotations appear to correlate strongly with match status; however, the

Use of Google Scholar public profiles in orthopedics.

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Tetsworth, Kevin; Fraser, Dave; Glatt, Vaida; Hohmann, Erik

2017-01-01

The purpose of this study was to survey the growth of Google Scholar public profiles in orthopedics over a 12-month period and to investigate global patterns. Data was prospectively acquired from June 2013 to June 2014. Google Scholar queries specific to orthopedic surgery were performed at 90-day intervals. Demographic aspects of each user were also compiled, including gender, current location, and primary interests. To determine differences between the growth of Google Scholar public profile registrations and citation counts, as well as differences in growth in different regions, repeated measures of analysis of variance (RMANOVA) were used. RMANOVA revealed statistically significant differences ( p = 0.0001) for regional growth. The largest growth was observed in the United Kingdom ( p = 0.009, 289%), followed by the Asia-Pacific region ( p = 0.004, 177%) and "Other" ( p = 0.006, 172%). The mean growth per 90-day interval is 19.9% ( p = 0.003) and the mean 12-month growth is 107% ( p = 0.05). Statistically significant differences between gender (male vs. female) and basic and clinical sciences ( χ 2 = 22.4, p = 0.0001) were observed. This study suggests an exponential growth in the number of authors in the field of orthopedic surgery creating a Google Scholar public profile, and at the current rate participation doubles every 10.6 months.

Can Orthopedic Oncologists Predict Functional Outcome in Patients with Sarcoma after Limb Salvage Surgery in the Lower Limb? A Nationwide Study

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Sjoerd Kolk

2014-01-01

Full Text Available Accurate predictions of functional outcome after limb salvage surgery (LSS in the lower limb are important for several reasons, including informing the patient preoperatively and, in some cases, deciding between amputation and LSS. This study aimed to elucidate the correlation between surgeon-predicted and patient-reported functional outcome of LSS in the Netherlands. Twenty-three patients (between six months and ten years after surgery and five independent orthopedic oncologists completed the Toronto Extremity Salvage Score (TESS and the RAND-36 physical functioning subscale (RAND-36 PFS. The orthopedic oncologists made their predictions based on case descriptions (including MRI scans that reflected the preoperative status. The correlation between patient-reported and surgeon-predicted functional outcome was “very poor” to “poor” on both scores (r2 values ranged from 0.014 to 0.354. Patient-reported functional outcome was generally underestimated, by 8.7% on the TESS and 8.3% on the RAND-36 PFS. The most difficult and least difficult tasks on the RAND-36 PFS were also the most difficult and least difficult to predict, respectively. Most questions had a “poor” intersurgeon agreement. It was difficult to accurately predict the patient-reported functional outcome of LSS. Surgeons’ ability to predict functional scores can be improved the most by focusing on accurately predicting more demanding tasks.

[Femoral artery pseudoaneurysms encountered in orthopedics and traumatology].

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Raherinantenaina, F; Rajaonanahary, T M A; Rakoto Ratsimba, H N

2015-12-01

Most published articles regarding orthopedic- and trauma-related femoral artery pseudoaneurysms (FAPs) are case reports in English. Reported cases are often associated with a literature review but actually provide little robust data. We wanted to summarize the current knowledge on diagnostic and therapeutic features of these FAPs. A new case of superficial FAP is described followed by a review of the literature. A bibliographic search was performed online (PubMed, ScinceDirect) from 1964 to 2015 using the descriptors "traumatic femoral pseudoaneurysm, orthopedic surgery, osteochondroma". A total of 64 cases of FAPs was analyzed. There were 50 men with an average age of 40.72±26.45 years old. The most common clinical presentation was painful swelling (34%). Arteriography was the commonest radiological investigation used (63%). The main etiologies were orthopedic injuries (47%), surgery of the upper thigh (30%) and femoral osteochondromas (23%). Arterial injuries included superficial femoral (47%) and profunda femoris artery (50%). The treatment was open surgery (56%) or endovascular repair (36%). Deep femoral artery and its branches were embolized (47%) or ligated (38%). Endovascular stenting was performed in 30% of posttraumatic FAPs. All FAPs relating to osteochondromas were repaired surgically. Postoperative courses were uneventful in 95% of patients. Endovascular embolization is preferred in management of postsurgical FAPs which have usually involved the deep femoral artery. Endovascular stenting graft may be proposed for posttraumatic FAPs, for which the superficial femoral trunk is the most often involved vessel. Surgical repair should be performed when endovascular stenting graft is not feasible. Surgical repair is mandatory for all FAPs secondary to traumatic exostoses. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Analysis on Risk Factors of Nosocomial Infection in Orthopedic Patients and Research on Nursing Strategies

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Guo Zhitao

2016-03-01

Full Text Available Orthopedic patients mostly comprise traumatic patients and elderly or sick individuals. More patients with emergency surgery suffer from open wounds and serious pollution, and operation time is relatively long. Thus, orthopedic patients with surgical incision infection account for a large proportion of incidence of hospital infection. Orthopedic patients are also bedridden for long periods, and they receive poor bone tissue blood supply. In surgical incision infections, mild cases suffer from delayed wound healing, whereas severe cases can form osteomyelitis. This study reviews progress of research on risk factors of nosocomial infection among orthopedic patients in recent years.

Glycopeptides versus β-lactams for the prevention of surgical site infections in cardiovascular and orthopedic surgery: a meta-analysis.

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Saleh, Anas; Khanna, Ashish; Chagin, Kevin M; Klika, Alison K; Johnston, Douglas; Barsoum, Wael K

2015-01-01

To compare the efficacy of glycopeptides and β-lactams in preventing surgical site infections (SSIs) in cardiac, vascular, and orthopedic surgery. The cost-effectiveness of switching from β-lactams to glycopeptides for preoperative antibiotic prophylaxis has been controversial. β-Lactams are generally recommended in clean surgical procedures, but they are ineffective against resistant gram-positive bacteria. PubMed, International Pharmaceuticals Abstracts, Scopus, and Cochrane were searched for randomized clinical trials comparing glycopeptides and β-lactams for prophylaxis in adults undergoing cardiac, vascular, or orthopedic surgery. Abstracts and conference proceedings were included. Two independent reviewers performed study selection, data extraction, and assessment of risk of bias. Fourteen studies with a total of 8952 patients were analyzed. No difference was detected in overall SSIs between antibiotic types. However, compared with β-lactams, glycopeptides reduced the risk of resistant staphylococcal SSIs by 48% (relative risk, 0.52; 95% confidence interval, 0.29-0.93; P = 0.03) and enterococcal SSIs by 64% (relative risk, 0.36; 95% confidence interval, 0.16-0.80; P = 0.01), but increased respiratory tract infections by 54% (relative risk, 1.54; 95% confidence interval, 1.19-2.01; P ≤ 0.01). Subgroup analysis of cardiac procedures showed superiority of β-lactams in preventing superficial and deep chest SSIs, susceptible staphylococcal SSIs, and respiratory tract infections. Glycopeptides reduce the risk of resistant staphylococcal SSIs and enterococcal SSIs, but increase the risk of respiratory tract infections. Additional high-quality randomized clinical trials are needed as these results are limited by high risk of bias.

A novel smart navigation system for intramedullary nailing in orthopedic surgery.

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Jaesuk Choi

Full Text Available This paper proposes a novel smart surgical navigation system for intramedullary nailing in orthopedic surgery. Using a handle-integrated laser guidance module, the system can target a drill insertion point onto skin, indicating an accurate target position to perpendicularly access an invisible distal hole. The proposed handle-integration-based fixation of the laser guidance module precisely defines the relative position of the module with respect to the distal hole. Consequently, unlike conventional systems, the proposed system can indicate the target insertion point without any help from bulky and costly external position-tracking equipment that is usually required for compensating disturbances generated by external impacts. After insertion, a correct drilling direction toward the distal hole is guided by real-time drilling angle measurement modules-one integrated with the nail handle and the other with the drill body. Each module contains a 9-axis inertial sensor and a Bluetooth communication device. These two modules work together to provide real-time drilling angle data, allowing calculation of the directional error toward the center of the distal hole in real time. The proposed system removes the need for fluoroscopy and provides a compact and cost-effective solution compared with conventional systems.

Validity, Sensitivity, and Responsiveness of the 11-Face Faces Pain Scale to Postoperative Pain in Adult Orthopedic Surgery Patients.

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Van Giang, Nguyen; Chiu, Hsiao-Yean; Thai, Duong Hong; Kuo, Shu-Yu; Tsai, Pei-Shan

2015-10-01

Pain is common in patients after orthopedic surgery. The 11-face Faces Pain Scale has not been validated for use in adult patients with postoperative pain. To assess the validity of the 11-face Faces Pain Scale and its ability to detect responses to pain medications, and to determine whether the sensitivity of the 11-face Faces Pain Scale for detecting changes in pain intensity over time is associated with gender differences in adult postorthopedic surgery patients. The 11-face Faces Pain Scale was translated into Vietnamese using forward and back translation. Postoperative pain was assessed using an 11-point numerical rating scale and the 11-face Faces Pain Scale on the day of surgery, and before (Time 1) and every 30 minutes after (Times 2-5) the patients had taken pain medications on the first postoperative day. The 11-face Faces Pain Scale highly correlated with the numerical rating scale (r = 0.78, p Scale is appropriate for measuring acute postoperative pain in adults. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Damage Control Orthopedics Management as Vital Procedure in Elderly Patients with Femoral Neck Fractures Complicated with Chronic Renal Failure: A Retrospective Cohort Study

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Dong, Chenhui; Wang, Yunjiao; Wang, Ziming; Wang, Yu; Wu, Siyu; Du, Quanyin; Wang, Aimin

2016-01-01

Background Chronic renal failure (CRF) predisposes to hip fractures in elderly patients, with high subsequent mortality. Selection and timing of the surgical procedure of such patients is a serious challenge. Many clinicians believe in earlier surgery as preferable and providing better outcomes. Damage control orthopedics (DCO) aids to adjust and optimize the overall condition of patients. Methods In 32 patients with femoral neck fractures complicated with CRF, we evaluated how the timing of the surgery determines the mortality rates if the DCO approach is applied. Preoperative ASA grading, POSSUM score, P-POSSUM score and DCO were carried out. Based on the assessment, timing of the surgery was ascertained. Results Of a total of 32 patients, twenty-nine patients were accepted for either early (failures and acute respiratory distress syndrome. There was no significant difference in complication rates and Harris hip score between both groups. Conclusion In patients with femoral neck fracture complicated with CRF, delaying the surgery for several days does not increase the incidence of postoperative adverse events. PMID:27149117

Collaborative multicenter trials in Latin America: challenges and opportunities in orthopedic and trauma surgery.

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Moraes, Vinicius Ynoe de; Belloti, Joao Carlos; Faloppa, Flavio; Bhandari, Mohit

2013-01-01

CONTEXT AND OBJECTIVE Orthopedic research agendas should be considered from a worldwide perspective. Efforts should be planned as the means for obtaining evidence that is valid for health promotion with global outreach. DESIGN AND SETTING Exploratory study conducted at Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil, and McMaster University, Hamilton, Canada. METHODS We identified and analyzed collaborative and multicenter research in Latin America, taking into account American and Canadian efforts as the reference points. We explored aspects of the data available from official sources and used data from traffic accidents as a model for discussing collaborative research in these countries. RESULTS The evaluation showed that the proportion of collaborative and multicenter studies in our setting is small. A brief analysis showed that the death rate due to traffic accidents is very high. Thus, it seems clear to us that initiatives involving collaborative studies are important for defining and better understanding the patterns of injuries resulting from orthopedic trauma and the forms of treatment. Orthopedic research may be an important tool for bringing together orthopedic surgeons, researchers and medical societies for joint action. CONCLUSIONS We have indicated some practical guidelines for initiatives in collaborative research and have proposed some solutions with a summarized plan of action for conducting evidence-based research involving orthopedic trauma.

Evolving trauma and orthopedics training in the UK.

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Inaparthy, Praveen K; Sayana, Murali K; Maffulli, Nicola

2013-01-01

The ever-growing population of the UK has resulted in increasing demands on its healthcare service. Changes have been introduced in the UK medical training system to avoid loss of training time and make it more focused and productive. Modernizing medical careers (MMC) was introduced in 2005. This promised to reduce the training period for a safe trauma specialist, in trauma and orthopedics, to 10 years. At around the same time, the European Working Time Directive (EWTD) was introduced to reduce the working hours for junior doctors in training, to improve patient safety and also work-life balance of junior doctors. Introduction of the assessment tools from Orthopedic Competency assessment project (OCAP) will help tailor the training according to the needs of the trainee. The aim of this article is to review the changes in the UK orthopedic surgical training over the past two decades. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Greening of orthopedic surgery.

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Lee, Rushyuan J; Mears, Simon C

2012-06-01

Every year, 4 billion pounds of waste are produced by health care facilities, and the amount continues to increase annually. In response, a movement toward greening health care has been building, with a particular focus on the operating room. Between 20% and 70% of health care waste originates from a hospital's operating room, and up to 90% of operating room waste is improperly sorted and sent for costly and unneeded hazardous waste processing. Recent successful changes include segregation of hospital waste, substitution of the ubiquitous polypropylene plastic wrap used for the sterilization and handling of surgical equipment with metal cases, and the reintroduction of reusable surgical gowns. Orthopedic-related changes include the successful reprocessing and reuse of external fixators, shavers, blades, burs, and tourniquets. These changes have been shown to be environmentally and economically beneficial. Early review indicates that these changes are feasible, but a need exists for further evaluation of the effect on the operating room and flow of the surgical procedure and of the risks to the surgeons and operating room staff. Other key considerations are the effects of reprocessed and reused equipment on patient care and outcome and the role of surgeons in helping patients make informed decisions regarding surgical care. The goals of this study were to summarize the amount and types of waste produced in hospitals and operating rooms, highlight the methods of disposal used, review disposal methods that have been developed to reduce waste and improve recycling, and explore future developments in greening health care. Copyright 2012, SLACK Incorporated.

Do Astronauts have a Higher Rate of Orthopedic Shoulder Conditions than a Cohort of Working Professionals?

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Laughlin, Mitzi S.; Murray, Jocelyn D.; Young, Millenia; Wear, Mary L.; Tarver, W. J.; Van Baalen, Mary

2016-01-01

Occupational surveillance of astronaut shoulder injuries began with operational concerns at the Neutral Buoyancy Laboratory (NBL) during Extra Vehicular Activity (EVA) training. NASA has implemented several occupational health initiatives during the past 20 years to decrease the number and severity of injuries, but the individual success rate is unknown. Orthopedic shoulder injury and surgery rates were calculated, but classifying the rates as normal, high or low was highly dependent on the comparison group. The purpose of this study was to identify a population of working professionals and compare orthopedic shoulder consultation and surgery rates.

Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: prospective randomized study

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Luiz Eduardo Imbelloni

Full Text Available CONTEXT AND OBJECTIVES: In major orthopedic surgery of the lower limbs, continuous spinal anesthesia (CSA and combined spinal epidural anesthesia (CSE are safe and reliable anesthesia methods. In this prospective randomized clinical study, the blockading properties and side effects of CSA were compared with single interspace CSE, among patients scheduled for major hip or knee surgery. DESIGN AND SETTING: Prospective clinical study conducted at the Institute for Regional Anesthesia, Hospital de Base, São José do Rio Preto. METHODS: 240 patients scheduled for hip arthroplasty, knee arthroplasty or femoral fracture treatment were randomly assigned to receive either CSA or CSE. Blockades were performed in the lateral position at the L3-L4 interspace. Puncture success, technical difficulties, paresthesia, highest level of sensory and motor blockade, need for complementary doses of local anesthetic, degree of technical difficulties, cardiocirculatory changes and postdural puncture headache (PDPH were recorded. At the end of the surgery, the catheter was removed and cerebrospinal fluid leakage was evaluated. RESULTS: Seven patients were excluded (three CSA and four CSE. There was significantly lower incidence of paresthesia in the CSE group. The resultant sensory blockade level was significantly higher with CSE. Complete motor blockade occurred in 110 CSA patients and in 109 CSE patients. Arterial hypotension was observed significantly more often in the CSE group. PDPH was observed in two patients of each group. CONCLUSION: Our results suggest that both CSA and CSE provided good surgical conditions with low incidence of complications. The sensory blockade level and hemodynamic changes were lower with CSA.

Survey of 2582 Cases of Acute Orthopedic Trauma

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Soleymanha, Mehran; Mobayen, Mohammadreza; Asadi, Kamran; Adeli, Alborz; Haghparast-Ghadim-Limudahi, Zahra

2014-01-01

Background: Orthopedic injuries are among the most common causes of mortality, morbidity, hospitalization, and economic burden in societies. Objectives: In this research, we study the prevalence of different types of trauma requiring orthopedic surgery. Patients and Methods: We conducted a cross-sectional study on 2582 patients with acute orthopedic injuries admitted to the orthopedic emergency ward at the Poursina Hospital (a referral center in Guilan province (northern Iran), during December 2010 through September 2011. Patients were examined and the data collection form was filled for each patient. Data were analyzed by SPSS software version 19 and were listed in tables. Results: Of 2582 included cases, 1940 were male and 642 were female, with a mean age of 34.5 years. Most injuries were seen in the 25 to 44 year age group from rural areas. The highest frequency of trauma related to falls. On the other hand, bicycling and shooting had the lowest frequencies. There were 18 cases with limb amputation. Overall, 66.5% of patients had fractures, 5% had soft tissue lacerations, and 10% had dislocations. Conclusions: Identification of risk factors and methods of prevention is one of the most important duties of healthcare systems. Devising plans to minimize these risk factors and familiarizing people with them is prudent. PMID:25717444

Reliability and Validity of 3 Methods of Assessing Orthopedic Resident Skill in Shoulder Surgery.

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Bernard, Johnathan A; Dattilo, Jonathan R; Srikumaran, Uma; Zikria, Bashir A; Jain, Amit; LaPorte, Dawn M

Traditional measures for evaluating resident surgical technical skills (e.g., case logs) assess operative volume but not level of surgical proficiency. Our goal was to compare the reliability and validity of 3 tools for measuring surgical skill among orthopedic residents when performing 3 open surgical approaches to the shoulder. A total of 23 residents at different stages of their surgical training were tested for technical skill pertaining to 3 shoulder surgical approaches using the following measures: Objective Structured Assessment of Technical Skills (OSATS) checklists, the Global Rating Scale (GRS), and a final pass/fail assessment determined by 3 upper extremity surgeons. Adverse events were recorded. The Cronbach α coefficient was used to assess reliability of the OSATS checklists and GRS scores. Interrater reliability was calculated with intraclass correlation coefficients. Correlations among OSATS checklist scores, GRS scores, and pass/fail assessment were calculated with Spearman ρ. Validity of OSATS checklists was determined using analysis of variance with postgraduate year (PGY) as a between-subjects factor. Significance was set at p shoulder approaches. Checklist scores showed superior interrater reliability compared with GRS and subjective pass/fail measurements. GRS scores were positively correlated across training years. The incidence of adverse events was significantly higher among PGY-1 and PGY-2 residents compared with more experienced residents. OSATS checklists are a valid and reliable assessment of technical skills across 3 surgical shoulder approaches. However, checklist scores do not measure quality of technique. Documenting adverse events is necessary to assess quality of technique and ultimate pass/fail status. Multiple methods of assessing surgical skill should be considered when evaluating orthopedic resident surgical performance. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights

Medical Issues: Orthopedics

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... Information Packets Equipment Pool Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily Life At ... curesma.org > support & care > living with sma > medical issues > orthopedics Orthopedics In SMA, muscle weakness can cause ...

[Diagnostic control. Psychiatric comorbidity in patients of technical orthopedic units].

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Lange, C; Heuft, G; Wetz, H H

2001-04-01

Because of the new hospital finance law a DRG (Diagnosis Related Groups) controlled discount liquidation under consideration of the medical impairment becomes necessary. In this paper the importance of a correct and complete description of the psychic comorbidity for the development of German-Refined-DRGs (GR-DRGs) in the orthopedic field is described. Therefore we analysed data of orthopedic in-patients, who are diagnosed by consultation of the clinic for psychosomatics and psychotherapy. A psychic comorbidity (ICD-10 Chapter F (V)) was diagnosed by 95% of the consulted patient. 30% of the patients showed difficulties in coping with their disease. 40% suffered from chronical psychoneurotic patterns and conflicts, which can be explained (a) as consequence of a difficult psychosocial adaptation by chronic disease or after an amputation (b) as basic mental disorders (c) as cause of the orthopaedic complications. Therefore the number of indications for a psychotherapeutic or psychiatric treatment is very high. The knowledge about a psychic comorbidity can--beside financial aspects--help the team on the orthopaedic station in the treatment of difficult patient.

The efficiency of a dedicated staff on operating room turnover time in hand surgery.

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Avery, Daniel M; Matullo, Kristofer S

2014-01-01

To evaluate the effect of orthopedic and nonorthopedic operating room (OR) staff on the efficiency of turnover time in a hand surgery practice. A total of 621 sequential hand surgery cases were retrospectively reviewed. Turnover times for sequential cases were calculated and analyzed with regard to the characteristics of the OR staff being primarily orthopedic or nonorthopedic. A total of 227 turnover times were analyzed. The average turnover time with all nonorthopedic staff was 31 minutes, for having only an orthopedic surgical technician was 32 minutes, for having only an orthopedic circulator was 25 minutes, and for having both an orthopedic surgical technician and a circulator was 20 minutes. Statistical significance was seen when comparing only an orthopedic surgical technician versus both an orthopedic circulator and a surgical technician and when comparing both nonorthopedic staff versus both an orthopedic circulator and a surgical technician. OR efficiency is being increasingly evaluated for its effect on hospital revenue and OR staff costs. Reducing turnover time is one aspect of a multifaceted solution in increasing efficiency. Our study showed that, for hand surgery, orthopedic-specific staff can reduce turnover time. Economic/Decision Analysis III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Orthopedic surgeons’ knowledge regarding risk of radiation exposition: a survey analysis

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Tunçer Nejat

2017-01-01

Full Text Available Introduction: The purpose of this study is to evaluate the knowledge levels of orthopedic surgeons working in Turkey about the uses and possible risks of fluoroscopy and assess methods for preventing radiation damage. Methods: A questionnaire with a total of 12 questions was sent to 1121 orthopedic surgeons working in Turkey. The questionnaire evaluated participants’ knowledge about the uses and risks of fluoroscopy and methods for preventing damage. One thousand and twenty-four orthopedic surgeons were found to be suitable for inclusion in the study. The effects of fluoroscopy on patients were not assessed in our study. Results: The data obtained were statistically evaluated. Of the surveyed surgeons, 313 (30% had used fluoroscopy in over 50% of their operations. The average number of fluoroscopy shots per case was 54.5. A lead apron was the most commonly used (88% protection from the harmful effects of radiation. Fluoroscopy shots were performed with the help of operating room personnel (86%. A dosimeter was used 5% of the time. Conclusion: According to the survey results, the need for fluoroscopy was very high in orthopedic surgery. However, orthopedic surgeons have inadequate knowledge about the uses and risks of fluoroscopy and methods for preventing damage. Therefore, we believe that training on this topic should be provided to all orthopedic surgeons.

Orthopedic surgeons' knowledge regarding risk of radiation exposition: a survey analysis.

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Tunçer, Nejat; Kuyucu, Ersin; Sayar, Şafak; Polat, Gökhan; Erdil, İrem; Tuncay, İbrahim

2017-01-01

The purpose of this study is to evaluate the knowledge levels of orthopedic surgeons working in Turkey about the uses and possible risks of fluoroscopy and assess methods for preventing radiation damage. A questionnaire with a total of 12 questions was sent to 1121 orthopedic surgeons working in Turkey. The questionnaire evaluated participants' knowledge about the uses and risks of fluoroscopy and methods for preventing damage. One thousand and twenty-four orthopedic surgeons were found to be suitable for inclusion in the study. The effects of fluoroscopy on patients were not assessed in our study. The data obtained were statistically evaluated. Of the surveyed surgeons, 313 (30%) had used fluoroscopy in over 50% of their operations. The average number of fluoroscopy shots per case was 54.5. A lead apron was the most commonly used (88%) protection from the harmful effects of radiation. Fluoroscopy shots were performed with the help of operating room personnel (86%). A dosimeter was used 5% of the time. According to the survey results, the need for fluoroscopy was very high in orthopedic surgery. However, orthopedic surgeons have inadequate knowledge about the uses and risks of fluoroscopy and methods for preventing damage. Therefore, we believe that training on this topic should be provided to all orthopedic surgeons. © The Authors, published by EDP Sciences, 2017.

Comparison of the effects and complications of unilateral spinal anesthesia versus standard spinal anesthesia in lower-limb orthopedic surgery

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Seyyed Mostafa Moosavi Tekye

2014-06-01

Full Text Available Introduction: A restricted sympathetic block during spinal anesthesia may minimize hemodynamic changes. This prospective randomized study compared unilateral and bilateral spinal anesthesia with respect to the intra- and postoperative advantages and complications of each technique. Material and methods: Spinal anesthesia was induced with 0.5% hyperbaric bupivacaine and a 25-G Quincke needle (Dr. J in two groups of patients with physical status ASA I-II who had been admitted for orthopedic surgeries. In group A, dural puncture was performed with the patient in a seated position using 2.5 cm3 of hyperbaric bupivacaine. Each patient was then placed in the supine position. In group B, dural puncture was performed with the patient in the lateral decubitus position with 1.5 cm3 of hyperbaric bupivacaine. The lower limb was the target limb. The speed of injection was 1 mL/30 s, and the duration of time spent in the lateral decubitus position was 20 min. Results: The demographic data were similar in both groups. The time to the onset of the sensory and motor block was significantly shorter in group A (p = 0.00. The duration of motor and sensory block was shorter in group B (p < 0.05. The success rate for unilateral spinal anesthesia in group B was 94.45%. In two patients, the spinal block spread to the non-dependent side. The incidence of complications (nausea, headache, and hypotension was lower in group B (p = 0.02. Conclusion: When unilateral spinal anesthesia was performed using a low-dose, low-volume and low-flow injection technique, it provides adequate sensory-motor block and helps to achieve stable hemodynamic parameters during orthopedic surgery on a lower limb. Patients were more satisfied with this technique as opposed to the conventional approach. Furthermore, this technique avoids unnecessary paralysis on the non-operated side.

Prognosis of venous thromboembolism in orthopaedic surgery or trauma patients and use of thromboprophylaxis.

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Gutiérrez Guisado, J; Trujillo-Santos, J; Arcelus, J I; Bertoletti, L; Fernandez-Capitán, C; Valle, R; Hernandez-Hermoso, J A; Erice Calvo-Sotelo, A; Nieto, J A; Monreal, M

2018-06-18

There is scarce evidence about the prognosis of venous thromboembolism in patients undergoing orthopedic surgery and in patients suffering non-surgical trauma. We used the RIETE database (Registro Informatizado de pacientes con Enfermedad Trombo Embólica) to compare the prognosis of venous thromboembolism and the use of thromboprophylaxis in patients undergoing different orthopedic procedures and in trauma patients not requiring surgery. From March 2001 to March 2015, a total of 61,789 patients were enrolled in RIETE database. Of these, 943 (1.52%) developed venous thromboembolism after elective arthroplasty, 445 (0.72%) after hip fracture, 1,045 (1.69%) after non-major orthopedic surgery and 2,136 (3.46%) after non-surgical trauma. Overall, 2,283 patients (50%) initially presented with pulmonary embolism. Within the first 90 days of therapy, 30 patients (0.66%; 95% CI 0.45-0.93) died from pulmonary embolism. The rate of fatal pulmonary embolism was significantly higher after hip fracture surgery (n = 9 [2.02%]) than after elective arthroplasty (n = 5 [0.53%]), non-major orthopedic surgery (n = 5 [0.48%]) or non surgical trauma (n = 11 [0.48%]). Thromboprophylaxis was more commonly used for hip fracture (93%) or elective arthroplasty (94%) than for non-major orthopedic surgery (71%) or non-surgical trauma (32%). Major bleeding was significantly higher after hip fracture surgery (4%) than that observed after elective arthroplasty (1.6%), non-major orthopedic surgery (1.5%) or non-surgical trauma (1.4%). Thromboprophylaxis was less frequently used in lower risk procedures despite the absolute number of fatal pulmonary embolism after non-major orthopedic surgery or non-surgical trauma, exceeded that observed after high risk procedures. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

Regional anesthesia is safe and effective for lower limb orthopedic surgery in patient with renal tubular acidosis and hypokalemia

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Indira Gurajala

2018-01-01

Full Text Available Renal tubular acidosis (RTA with hypokalemia may precipitate acute respiratory failure and potentially fatal arrhythmias like ventricular fibrillation. Though there are random reports of respiratory failure needing mechanical ventilation and sudden death in patients with RTA and hypokalemia, the anesthetic management of these patients has not been clearly elucidated. Acidosis and hypokalemia have significant interactions with both general and local anesthetics and alter their effect substantially. Proper preoperative planning and optimization are required for the safe conduct of anesthesia in this subset of patients. We describe a case of distal RTA, hypokalemia, and metabolic bone disease in whom central neuraxial anesthesia was effectively used for lower limb orthopedic surgery with no complications.

Thromboprophylaxis With Apixaban in Patients Undergoing Major Orthopedic Surgery: Meta-Analysis and Trial-Sequential Analysis

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Daniel Caldeira

2017-05-01

Full Text Available Background: Venous thromboembolism (VTE is a potentially fatal complication of orthopedic surgery, and until recently, few antithrombotic compounds were available for postoperative thromboprophylaxis. The introduction of the non–vitamin K antagonists oral anticoagulants (NOAC, including apixaban, has extended the therapeutic armamentarium in this field. Therefore, estimation of NOAC net clinical benefit in comparison with the established treatment is needed to inform clinical decision making. Objectives: Systematic review to assess the efficacy and safety of apixaban 2.5 mg twice a day versus low-molecular-weight heparins (LMWH for thromboprophylaxis in patients undergoing knee or hip replacement. Data sources: MEDLINE, Embase, and CENTRAL were searched from inception to September 2016, other systematic reviews, reference lists, and experts were consulted. Study eligibility criteria, participants, and intervention: All major orthopedic surgery randomized controlled trials comparing apixaban 2.5 mg twice daily with LMWH, reporting thrombotic and bleeding events. Data extraction: Two independent reviewers, using a predetermined form. Study appraisal and synthesis methods: The Cochrane tool to assess risk bias was used by two independent authors. RevMan software was used to estimate pooled risk ratio (RR and 95% confidence intervals (95% CI using random-effects meta-analysis. Trial sequential analysis (TSA was performed in statistical significant results to evaluate whether cumulative sample size was powered for the obtained effect. Overall confidence in cumulative evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE Working Group methodology. Results: Four studies comparing apixaban 2.5 mg twice daily with LMWH were included, with a total of 11.828 patients (55% undergoing knee and 45% hip replacement. The overall risk of bias across studies was low. In comparison with LMWH (all regimens

Orthopedic resident work-shift analysis: are we making the best use of resident work hours?

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Hamid, Kamran S; Nwachukwu, Benedict U; Hsu, Eugene; Edgerton, Colston A; Hobson, David R; Lang, Jason E

2014-01-01

Surgery programs have been tasked to meet rising demands in patient surgical care while simultaneously providing adequate resident training in the midst of increasing resident work-hour restrictions. The purpose of this study was to quantify orthopedic surgery resident workflow and identify areas needing improved resident efficiency. We hypothesize that residents spend a disproportionate amount of time involved in activities that do not relate directly to patient care or maximize resident education. We observed 4 orthopedic surgery residents on the orthopedic consult service at a major tertiary care center for 72 consecutive hours (6 consecutive shifts). We collected minute-by-minute data using predefined work-task criteria: direct new patient contact, direct existing patient contact, communications with other providers, documentation/administrative time, transit time, and basic human needs. A seventh category comprised remaining less-productive work was termed as standby. In a 720-minute shift, residents spent on an average: 191 minutes (26.5%) performing documentation/administrative duties, 167.0 minutes (23.2%) in direct contact with new patient consults, 129.6 minutes (17.1%) in communication with other providers regarding patients, 116.2 (16.1%) minutes in standby, 63.7 minutes (8.8%) in transit, 32.6 minutes (4.5%) with existing patients, and 20 minutes (2.7%) attending to basic human needs. Residents performed an additional 130 minutes of administrative work off duty. Secondary analysis revealed residents were more likely to perform administrative work rather than directly interact with existing patients (p = 0.006) or attend to basic human needs (p = 0.003). Orthopedic surgery residents spend a large proportion of their time performing documentation/administrative-type work and their workday can be operationally optimized to minimize nonvalue-adding tasks. Formal workflow analysis may aid program directors in systematic process improvements to better align

Recent advances in standing equine orthopedic surgery.

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O'Brien, Thomas; Hunt, Robert J

2014-04-01

In all surgeries with the patient standing under chemical and physical restraint, patient compliance is of the utmost importance. All fractures of the third metacarpal or metatarsal condyles and sagittal fracture of the first phalanx are not amenable to internal fixation with the horse standing, and young unhandled horses may not have a suitable disposition for standing surgical treatment of septic pedal osteitis, or implantation and removal of transphyseal screws. Previous operator experience in performing the procedure or technique under general anesthesia is beneficial. Appreciation of appropriate topographic anatomic landmarks is important, and intraoperative radiographic control is useful. Copyright © 2014 Elsevier Inc. All rights reserved.

[Quality of case allocation of orthopedics and trauma surgery in the 2004 and 2014 versions of the German DRG system. An interim assessment of the development process].

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Franz, D; Schemmann, F; Selter, D D; Auhuber, T; Gehweiler, D; Roeder, N; Siebert, H; Mahlke, L

2014-10-01

Since 2004 the German diagnosis-related groups (DRG) system has been applied nationwide in all German somatic hospitals. The G-DRG system is updated annually in order to increase the quality of case allocation. What developments have occurred since 2004 from the perspective of orthopedics and trauma surgery? This article takes stock of the developments between 2004 and 2014. Analysis of relevant diagnoses, medical procedures and G-DRGs in the versions 2004 and 2014 based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). The number of G-DRGs in the whole system increased by 45.1 % between 2004 and 2014. The number of G-DRGs in the major diagnostic category (MDC) 08 that contains the majority of orthopedic and trauma surgery categories increased in the same period by 61.6 %. The reduction of variance of inlier costs in the MDC 08 category, a statistical measure of the performance of the G-DRG system, was below the corresponding value of the total system in 2004 as well in 2014. However, the reduction of variance of inlier costs in MDC 08 (+ 30.0 %) rose more from 2004 to 2014 than the corresponding value of the overall system (+ 21.5 %). Many modifications of the classification systems of diagnoses (ICD-10-GM) and medical procedures (OPS) and the structures of the G-DRG system could significantly improve the quality of case allocation from the perspective of orthopedics and trauma surgery between 2004 and 2014. Th assignment of cases could be differentiated so that complex cases with more utilization of resources were allocated to higher rated G-DRGs and vice versa. However, further improvements of the G-DRG system are necessary. Only correct and complete documentation and coding can provide a high quality of calculation of costs as a basis for a correct case allocation in future G-DRG systems.

Hospital market concentration, pricing, and profitability in orthopedic surgery and interventional cardiology.

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Robinson, James C

2011-06-01

To examine the association between hospital market concentration and pricing. Hospitals have been merging into systems that potentially wield bargaining power over private health insurers. Concern is growing among policy makers that these systems may respond to provisions of the 2010 health reform legislation by further increasing consolidation and prices. Multivariate statistical methods were used to evaluate the association between hospital market concentration, prices, and profits (contribution margins) for commercially insured patients admitted for any of 6 major cardiac and orthopedic surgery procedures, adjusting for characteristics of the patient (diagnoses, comorbidities,complications) and of the hospital (size, patient volume, teaching status). Data were obtained on 11,330 patients treated in 61 hospitals in 27 markets across 8 states in 2008. Hospital prices for patients in concentrated markets were higher than hospital prices for otherwise-comparable patients in competitive markets by 25.1% for coronary angioplasty, 13.0%for cardiac rhythm management (CRM) device insertion, 19.2% for total knee replacement, 24.1%for total hip replacement, 19.3% for lumbar spine fusion, and 22.7% for cervical spine fusion (P markets by $5259 for angioplasty, $3417 for CRM device insertion, $4123 for total knee replacement, $5889 for total hip replacement, $7931 for lumbar spine fusion, and $4663 for cervical spine fusion (P markets charge significantly higher prices and earn significantly higher margins from private insurers than do hospitals in competitive markets.

Analysis of Orthopedic Resident Ability to Apply Levels of Evidence Criteria to Scientific Articles.

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Grandizio, Louis C; Shim, Stephanie S; Graham, Jove; Costopoulos, Callista; Cush, Gerard; Klena, Joel C

2016-01-01

In the era of evidence-based medicine, understanding study design and levels of evidence (LoE) criteria is an important component of resident education and aids practicing surgeons in making informed clinical decisions. The purpose of this study is to analyze the ability of orthopedic residents to accurately determine LoE criteria for published articles compared with medical students. Basic science article. Geisinger Medical Center (Danville, PA), tertiary referral center. Overall, 25 U.S. orthopedic residents and 15 4th year medical students interviewing for a residency position in orthopedic surgery voluntarily participated and provided baseline demographic information. A total of 15 articles from the American Volume of Journal of Bone and Joint Surgery were identified. Study participants were provided with the article title, the abstract, and the complete methods section. The assigned LoE designation was withheld and access to the LoE criteria used by Journal of Bone and Joint Surgery was provided. Each participant was assigned a study type and LoE designation for each article. There were more correct responses regarding the article type (67%) than for LoE designation (39%). For LoE, the intraclass correlation coefficient was 0.30. The percentage of correct responses for article type and LoE increased with more years of training (p = 0.005 and p = 0.002). Although residents had a higher proportion of correct LoE responses overall than medical students, this difference did not reach statistical significance (42% vs. 35%, p = 0.07). Although improvements in accurately determining both article type and LoE were seen among residents with increasing years of training, residents were unable to demonstrate a statistically significant improvement for determining LoE or article type when compared with medical students. Strategies to improve resident understanding of LoE guidelines need to be incorporated into orthopedic residencies, especially when considering the

Automatic bone detection and soft tissue aware ultrasound-CT registration for computer-aided orthopedic surgery.

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Wein, Wolfgang; Karamalis, Athanasios; Baumgartner, Adrian; Navab, Nassir

2015-06-01

The transfer of preoperative CT data into the tracking system coordinates within an operating room is of high interest for computer-aided orthopedic surgery. In this work, we introduce a solution for intra-operative ultrasound-CT registration of bones. We have developed methods for fully automatic real-time bone detection in ultrasound images and global automatic registration to CT. The bone detection algorithm uses a novel bone-specific feature descriptor and was thoroughly evaluated on both in-vivo and ex-vivo data. A global optimization strategy aligns the bone surface, followed by a soft tissue aware intensity-based registration to provide higher local registration accuracy. We evaluated the system on femur, tibia and fibula anatomy in a cadaver study with human legs, where magnetically tracked bone markers were implanted to yield ground truth information. An overall median system error of 3.7 mm was achieved on 11 datasets. Global and fully automatic registration of bones aquired with ultrasound to CT is feasible, with bone detection and tracking operating in real time for immediate feedback to the surgeon.

Managing orthopedics and neurosciences costs through standard treatment protocols.

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McGinnity, E S; Pluth, T E

1994-06-01

High-cost, high-volume specialty programs such as orthopedics and neurosciences find themselves in a position of evaluating the costs and in some cases the appropriateness of medical practices in response to payer scrutiny and provider selection processes. Orthopedics and neurosciences programs are at a stage of development analogous to that of cardiovascular care several years ago. Many of the same trends have come into play, such as payer "carve-outs" for orthopedic services, payer selection of centers of excellence based on cost and quality, reduction of Medicare reimbursement, greater use of high-cost technology, the decline of profitability due to "older, sicker, and tougher" patients, and the recent emergence of national orthopedic specialty networks oriented to national contracts for care. In an era in which payers demand value on both sides of the cost-plus-quality equation, programs are challenged to maximize the return on a patient population rife with "no-win" situations. In the orthopedic service line these include a high proportion of Medicare patients and chronic conditions such as workers' compensation medical back cases or repetitive motion injuries, which can be elusive to diagnose and expensive to treat. Many hospitals continue to lose money on joint replacement surgeries, the largest-volume orthopedic inpatient service, primarily because of the high Medicare population and the cost of implants. Neuroservices, while still relatively well reimbursed, face a rising proportion of Medicare payments as patients live longer and develop chronic, degenerative conditions. Inpatient days are decreasing due to payer pressures to limit hospital stays and to shift inpatient care to outpatient services. Some hospitals "have lost interest in (the orthopedic) service line during the last five years because of recent trends in orthopedic-related inpatient volume and payment." But by managing costs strategically, both the neurosciences and orthopedics service lines

Development and Evaluation of Polyvinyl Alcohol-Hydrogels as an Artificial Atrticular Cartilage for Orthopedic Implants

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Masanori Kobayashi

2010-04-01

Full Text Available Due to its excellent biocompatibility and mechanical properties, various different applications of polyvinyl alcohol-hydrogels (PVA-H has been attempted in many fields. In the field of orthopedic surgery, we have been engaged for long time in research on the clinical applications of PVA-H as a artificial cartilage, and have performed many basic experiments on the mechanical properties, synthesis of PVA-H, and developed orthopedic implants using PVA-H. From these studies, many applications of artificial articular cartilage, intervertbral disc and artificial meniscus etc. have been developed. This review will present the overview of the applications and recent advances of PVA-H cartilages, and discuss clinical potential of PVA-H for orthopedics implant.

Development and Evaluation of Polyvinyl Alcohol-Hydrogels as an Artificial Atrticular Cartilage for Orthopedic Implants

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Kobayashi, Masanori; Hyu, Hyon Suong

2010-01-01

Due to its excellent biocompatibility and mechanical properties, various different applications of polyvinyl alcohol-hydrogels (PVA-H) has been attempted in many fields. In the field of orthopedic surgery, we have been engaged for long time in research on the clinical applications of PVA-H as a artificial cartilage, and have performed many basic experiments on the mechanical properties, synthesis of PVA-H, and developed orthopedic implants using PVA-H. From these studies, many applications of artificial articular cartilage, intervertbral disc and artificial meniscus etc. have been developed. This review will present the overview of the applications and recent advances of PVA-H cartilages, and discuss clinical potential of PVA-H for orthopedics implant.

Unique Assessment of Hand Surgery Knowledge by Specialty.

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Silvestre, Jason; Lin, Ines C; Chang, Benjamin; Levin, L Scott

2016-03-01

Orthopedic and plastic surgery residents receive unique training yet often compete for similar hand surgery fellowships. This study compared didactic hand surgery training during orthopedic and plastic surgery residency. The Plastic Surgery In-Service Training Exam and Orthopaedic In-Training Examination were analyzed for hand content for the years 2009 to 2013. Topics were categorized with the content outline for the Surgery of the Hand Examination. Differences were elucidated by means of Fisher's exact test. Relative to the Orthopaedic In-Training Examination, the Plastic Surgery In-Service Training Exam had greater hand representation (20.3 percent versus 8.1 percent; p < 0.001) with more annual hand questions (40 ± 3 versus 24 ± 2; p < 0.001). The Plastic Surgery Exam questions had more words, were less often level I-recall type, and were less often image-based. The questions focused more on finger and hand/palm anatomy, whereas the Orthopaedic examination was more wrist-focused. The Plastic Surgery Exam emphasized wound management and muscle/tendon injuries, but underemphasized fractures/dislocations. References differed, but Journal of Hand Surgery (American Volume) and Green's Operative Hand Surgery were common on both examinations. The Plastic Surgery Exam had a greater publication lag for journal references (10.7 ± 0.5 years versus 9.0 ± 0.6; p = 0.035). Differences in didactic hand surgery training are elucidated for plastic surgery and orthopedic residents. Deficiencies in the Plastic Surgery In-Service Training Exam hand curriculum relative to the Orthopaedic In-Training Examination may underprepare plastic surgeons for the Surgery of the Hand Examination. These data may assist future modifications to hand surgery training in the United States.

Semuloparin for prevention of venous thromboembolism after major orthopedic surgery

DEFF Research Database (Denmark)

Lassen, M R; Fisher, W; Mouret, P

2012-01-01

BACKGROUND: Semuloparin is a novel ultra-low-molecular-weight heparin under development for venous thromboembolism (VTE) prevention in patients at increased risk, such as surgical and cancer patients. OBJECTIVES: Three Phase III studies compared semuloparin and enoxaparin after major orthopedic...... was to be performed between days 7 and 11. The primary efficacy endpoint was a composite of any deep vein thrombosis, non-fatal pulmonary embolism or all-cause death. Safety outcomes included major bleeding, clinically relevant non-major (CRNM) bleeding, and any clinically relevant bleeding (major bleeding plus CRNM...

Antibiotic prophylaxis in orthopedic surgeries: the results of an implemented protocol

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Raquel Queiroz

Full Text Available Though the basic principles of antibiotic prophylaxis have been well established, there is still considerable incorrect usage, including how much is prescribed and especially in the duration of treatment, which is generally superior to what is indicated. The adequate use of these drugs contributes towards decreasing the time of internment of the patient, prevents surgical site infection (SSI, decreasing the development of resistant microorganisms, and towards reduced costs for the hospital pharmacy. A protocol for the use of antibiotic prophylaxis in the Orthopedics and Traumatology Service of the Hospital do Servidor Público Estadual de São Paulo was developed. The objectives of the study were to promote rational antibiotic surgical prophylaxis, through the implantation of a protocol for the use of these drugs in a surgical unit, with the direct contribution of a druggist in collaboration with the Infection Control Committee, to evaluate the adhesion of the health team to the protocol during three distinct periods (daily pre-protocol, early post-protocol and late post-protocol and to define the consumption of antimicrobials used, measured as daily defined dose.

Biodegradable Orthopedic Magnesium-Calcium (MgCa Alloys, Processing, and Corrosion Performance

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Yuebin Guo

2012-01-01

Full Text Available Magnesium-Calcium (Mg-Ca alloy has received considerable attention as an emerging biodegradable implant material in orthopedic fixation applications. The biodegradable Mg-Ca alloys avoid stress shielding and secondary surgery inherent with permanent metallic implant materials. They also provide sufficient mechanical strength in load carrying applications as opposed to biopolymers. However, the key issue facing a biodegradable Mg-Ca implant is the fast corrosion in the human body environment. The ability to adjust degradation rate of Mg-Ca alloys is critical for the successful development of biodegradable orthopedic implants. This paper focuses on the functions and requirements of bone implants and critical issues of current implant biomaterials. Microstructures and mechanical properties of Mg-Ca alloys, and the unique properties of novel magnesium-calcium implant materials have been reviewed. Various manufacturing techniques to process Mg-Ca based alloys have been analyzed regarding their impacts on implant performance. Corrosion performance of Mg-Ca alloys processed by different manufacturing techniques was compared. In addition, the societal and economical impacts of developing biodegradable orthopedic implants have been emphasized.

The Effect of Orthopedic Advertising and Self-Promotion on a Naïve Population.

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Mohney, Stephen; Lee, Daniel J; Elfar, John C

2016-01-01

There has been a marked increase in the number of physicians marketing themselves directly to patients and consumers. However, it is unclear how different promotional styles affect patients' perceptions of their physicians. We hypothesized that self-promoting orthopedic surgeons enjoy a more positive impact on nonphysician patients as compared to non-self-promoting surgeons, as well as a corresponding negative impact on their peer-surgeons. Surgeon websites were selected from the 5 largest population centers in the United States. Subjects with varying degrees of familiarity with orthopedic surgery evaluated Internet profiles of surgeons on a forced choice Likert scale to measure the amount of self-promotion. The naïve subjects judged self-promoting surgeons more favorably than the orthopedic surgeons. In contrast, board-certified orthopedic surgeons viewed self-promoting surgeons more negatively than did their nonphysician counterparts. In summary, the present study revealed that the potential for self-promotion to unduly influence potential patients is real and should be a considerable concern to surgeons, patients, and the profession.

Prevalence of internet and social media usage in orthopedic surgery.

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Curry, Emily; Li, Xinning; Nguyen, Joseph; Matzkin, Elizabeth

2014-08-08

Prior studies in other specialties have shown that social networking and Internet usage has become an increasingly important means of patient communication and referral. The purpose of this study is to evaluate the prevalence of Internet or social media usage in new patients referred to a major academic orthopedics center and to identify new avenues to optimize patient recruitment and communication. New patients were surveyed (n=752) between December 2012 to January 2013 in a major academic orthopaedic center to complete a 15-item questionnaire including social media and Internet usage information. Data was collected for all orthopaedic sub-specialties and statistical analysis was performed. Fifty percent of patients use social networking sites, such as Facebook. Sports medicine patients tend to be higher social networking users (35.9%) relative to other services (9.8-17.9%) and was statistically higher when compared to the joints/tumor service (Psocial media. Patients that travelled between 120 to 180 miles from the hospital for their visits were significantly more likely to be social media users, as were patients that did research on their condition prior to their new patient appointment. We conclude that orthopedic patients who use social media/Internet are more likely to be younger, researched their condition prior to their appointment and undergo a longer average day's travel (120-180 miles) to see a physician. In an increasingly competitive market, surgeons with younger patient populations will need to utilize social networking and the Internet to capture new patient referrals.

In vitro investigation of the effects of exogenous sugammadex on coagulation in orthopedic surgical patients.

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Lee, Il Ok; Kim, Young Sung; Chang, Hae Wone; Kim, Heezoo; Lim, Byung Gun; Lee, Mido

2018-05-24

Previous studies have shown that sugammadex resulted in the prolongation of prothrombin time and activated partial thromboplastin time. In this study, we aimed to investigate the in vitro effects of exogenous sugammadex on the coagulation variables of whole blood in healthy patients who underwent orthopedic surgery. The effects of sugammadex on coagulations were assessed using thromboelastography (TEG) in kaolin-activated citrated blood samples taken from 14 healthy patients who underwent orthopedic surgery. The in vitro effects of three different concentrations of sugammadex (42, 193, and 301 μg mL - 1 ) on the TEG profiles were compared with those of the control (0 μg mL - 1 ). Previous studies indicated that these exogenous concentrations correspond to the approximate maximum plasma concentrations achieved after the administration of 4, 16, and 32 mg kg - 1 sugammadex to healthy subjects. Increased sugammadex concentrations were significantly associated with reduced coagulation, as evidenced by increases in reaction time (r), coagulation time, and time to maximum rate of thrombus generation (TMRTG), and decreases in the angle, maximum amplitude, and maximum rate of thrombus generation. Compared with the control, the median percentage change (interquartile range) in the TEG values of the samples treated with the highest exogenous sugammadex concentration was the greatest for r, 53% (26, 67.3%), and TMRTG, 48% (26, 59%). This in vitro study suggests that supratherapeutic doses of exogenous sugammadex might be associated with moderate hypocoagulation in the whole blood of healthy subjects. identifier:  UMIN000029081 , registered 11 September 2017.

Orthopedic Management of Patients with Pompe Disease: A Retrospective Case Series of 8 Patients

Directory of Open Access Journals (Sweden)

Gerrit Haaker

2014-01-01

Full Text Available Introduction. Pompe disease (PD, a lysosomal storage disease as well as a neuromuscular disorder, is a rare disease marked by progressive muscle weakness. Enzyme replacement therapy (ERT in recent years allowed longer survival but brought new problems to the treatment of PD with increasing affection of the musculoskeletal system, particularly with a significantly higher prevalence of scoliosis. The present paper deals with the orthopedic problems in patients with PD and is the first to describe surgical treatment of scoliosis in PD patients. Patients and Methods. The orthopedic problems and treatment of eight patients with PD from orthopedic consultation for neuromuscular disorders are retrospectively presented. We analyzed the problems of scoliosis, hip dysplasia, feet deformities, and contractures and presented the orthopedic treatment options. Results. Six of our eight PD patients had scoliosis and two young patients were treated by operative spine stabilization with benefits for posture and sitting ability. Hip joint surgery, operative contracture release, and feet deformity correction were performed with benefits for independent activity. Conclusion. Orthopedic management gains importance due to extended survival and musculoskeletal involvement under ERT. Surgical treatment is indicated in distinct cases. Further investigation is required to evidence the effect of surgical spine stabilization in PD.

The Incidence of Delirium in Patients After Surgery in Recovery Room

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Leila M juybari

2012-10-01

Full Text Available Background and objective: Delirium is an acute and transient disorder in the function of the brain. Although the main core of this syndrome is consciousness disorder and deficiencies in attention and concentration, the general deficiency is seen in all psychological areas of thinking, temperament, cognition, language, speaking, sleeping, and mental-motional and other cognitive areas. Delirium is often seen in recovery room and is a predictor of post-operative delirium in the general ward. This study was conducted to determine the incidence of delirium in patients after surgery in the recovery room.Materials and Methods: This descriptive cross-sectional study was conducted on 75 patients after general and orthopedic surgery and in the recovery room of the educational-therapeutic center of Gorgan in 1389 using the DESC-Nu nursing delirium screening scale. Data was analyzed using chi-square descriptive and analytical statistics and T-test.Results: Among the 75 studied patients in the recovery room after orthopedic surgery and general surgery, 53.3% were women with a mean age of 48.7. The mean surgery duration was 129.21 minutes. 26.6% had been under spinal anesthesia and 73.3% had been under general anesthesia. Delirium was observed in 30.6% of all the patients. Delirium was observed in 21.3% of patients having orthopedic surgery and 9.3% of the patients having general surgery. Delirium had a significant statistical relation with the variables of age, gender, and type of surgery (p<0.05.Conclusion: This study showed that 30.6% of patients had delirium. Male and older patients having orthopedic surgery were more vulnerable. Therefore, usual assessment of delirium in recovery room to identify patients with delirium can be a guide of nurses’ appropriate care of patients after surgery.

Pediatric spine imaging post scoliosis surgery

International Nuclear Information System (INIS)

Alsharief, Alaa N.; El-Hawary, Ron; Schmit, Pierre

2018-01-01

Many orthopedic articles describe advances in surgical techniques and implants used in pediatric scoliosis surgery. However, even though postoperative spine imaging constitutes a large portion of outpatient musculoskeletal pediatric radiology, few, if any, radiology articles discuss this topic. There has been interval advancement over the last decades of the orthopedic procedures used in the treatment of spinal scoliosis in adolescents with idiopathic scoliosis. The goal of treatment in these patients is to stop the progression of the curve by blocking the spinal growth and correcting the deformity as much as possible. To that end, the authors in this paper discuss postoperative imaging findings of Harrington rods, Luque rods, Luque-Galveston implants and segmental spinal fusion systems. Regarding early onset scoliosis, the guiding principles used for adolescent idiopathic scoliosis do not apply to a growing spine because they would impede lung development. As a result, other devices have been developed to correct the curve and to allow spinal growth. These include spine-based growing rods, vertically expandable prosthetic titanium rods (requiring repetitive surgeries) and magnetically controlled growing rods (with a magnetic locking/unlocking system). Other more recent systems are Shilla and thoracoscopic anterior vertebral body tethering, which allow guided growth of the spine without repetitive interventions. In this paper, we review the radiologic appearances of different orthopedic implants and techniques used to treat adolescent idiopathic scoliosis and early onset scoliosis. Moreover, we present the imaging findings of the most frequent postoperative complications. (orig.)

Pediatric spine imaging post scoliosis surgery

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Alsharief, Alaa N. [IWK Children' s Health Center, Dalhousie University, Diagnostic Imaging Department, Halifax, NS (Canada); The Hospital for Sick Children, University of Toronto, Department of Diagnostic Imaging, Toronto (Canada); King Saud University, Department of Medical Imaging, King Abdul-Aziz Medical City, King Khaled National Guard Hospital-Western Region, Jeddah (Saudi Arabia); El-Hawary, Ron [Dalhousie University, Orthopedic Surgery Department, IWK Children' s Health Center, Halifax, NS (Canada); Schmit, Pierre [IWK Children' s Health Center, Dalhousie University, Diagnostic Imaging Department, Halifax, NS (Canada)

2018-01-15

Many orthopedic articles describe advances in surgical techniques and implants used in pediatric scoliosis surgery. However, even though postoperative spine imaging constitutes a large portion of outpatient musculoskeletal pediatric radiology, few, if any, radiology articles discuss this topic. There has been interval advancement over the last decades of the orthopedic procedures used in the treatment of spinal scoliosis in adolescents with idiopathic scoliosis. The goal of treatment in these patients is to stop the progression of the curve by blocking the spinal growth and correcting the deformity as much as possible. To that end, the authors in this paper discuss postoperative imaging findings of Harrington rods, Luque rods, Luque-Galveston implants and segmental spinal fusion systems. Regarding early onset scoliosis, the guiding principles used for adolescent idiopathic scoliosis do not apply to a growing spine because they would impede lung development. As a result, other devices have been developed to correct the curve and to allow spinal growth. These include spine-based growing rods, vertically expandable prosthetic titanium rods (requiring repetitive surgeries) and magnetically controlled growing rods (with a magnetic locking/unlocking system). Other more recent systems are Shilla and thoracoscopic anterior vertebral body tethering, which allow guided growth of the spine without repetitive interventions. In this paper, we review the radiologic appearances of different orthopedic implants and techniques used to treat adolescent idiopathic scoliosis and early onset scoliosis. Moreover, we present the imaging findings of the most frequent postoperative complications. (orig.)

Comparison between Infusion Pumps: Fentanyl/Ketamine and Fentanyl/Paracetamol in Pain control Following Tight and Leg Surgeries

Directory of Open Access Journals (Sweden)

Behnam Mahmoodiyeh

2016-08-01

Full Text Available Background: Adjuvants such as ketamine, promethazine and paracetamol could bring up patients satisfaction and control harmful effects of opioids besides lessening their needed doses, as seen by fentanyl/paracetamol and fentanyl/ketamine combination before. The current study headed to compare paracetamol and ketamine in addition to fentanyl applied by infusion pumps in order to pain relief following major surgery.Methods: Through a double blinded randomized clinical trial, patients between18 and 65 with elective surgery for tight or leg fractures with ASA Class 1 and 2 referring to a university hospital in Arak, a town in central region of Iran, were recruited and used infusion pump for their postoperative pain control. The participants were divided into cases and controls regarding using ketamine/fentanyl (KF or paracetamol/fentanyl (PF infusion pumps.Results: The mean pain score was totally 3.87 with higher value in KF (5.06 and lower in PF (4.5 immediately after finishing surgery and getting conscious when started using infusion pump. There was no statistical difference between the groups in this regard. Concerning the side effects of the applied medications, blood pressure and heart rate had no differences comparing the groups.Conclusion: This study showed that paracetamol used in infusion pump can be brilliant in pain control after major surgeries like what done in lower extremities and joint replacement while lessens opioid use. Although paracetamol was more effective than ketamine in the current trial, more qualified studies at bigger size and in other fields of surgery beside orthopedic ones would be useful to support the effects if applicable.Keywords: Infusion pump, Ketamine, Paracetamol, Fentanyl, Postoperative pain

Near-miss event assessment in orthopedic surgery: Antimicrobial prophylaxis noncompliance.

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Bonfait, H; Delaunay, C; de Thomasson, E; Charrois, O

2010-09-01

Antimicrobial prophylaxis is one of the main safety measures to be enforced when implanting any medical device; surveys of practice, however, have found poor compliance. This study is based on analysis of 153 dedicated in-depth analysis forms sent to orthopedic surgeons who had reported an antimicrobial prophylaxis-related near-miss event (NME) during the year 2008 as part of their certification report to the official organization, Orthorisq (orthopaedic Patient safety risk management agency). Antimicrobial prophylaxis guidelines exist in 95% of French centers, but in 14% are not available in the right place. 88% of orthopedic surgeons consider them well-adapted to their practice. Most declarations follow fortuitous discovery by the surgeon of an immediate peri-operative malfunction. Human causes were found in 92% of declarations, general organizational causes in 50% and material causes in 28%. Regarding corrective action, 65% of respondents reported implementing a second-order procedure, and only 20% were able to resume truly regular antimicrobial prophylaxis. The main reason for poor or non-performance of antimicrobial prophylaxis was "omission by negligence or oversight", reported in 56% of declarations. Proposals for improvement were: revised antimicrobial prophylaxis guidelines specifying "who does what"; guideline awareness checks on new, temporary and locum-tenens staff; patient involvement in personal data collection; and implementation of a check-list in line with WHO and French Health Authority recommendations. These improvement proposals were taken on board in the antimicrobial prophylaxis consensus update currently being drawn up by the French Society for Anesthesia and Intensive Care. Level IV, Decision Analyses Study. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

CARS 2008: Computer Assisted Radiology and Surgery. Proceedings

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NONE

2008-06-15

The proceedings contain contributions to the following topics: digital imaging, computed tomography, magnetic resonance, cardiac and vascular imaging, computer assisted radiation therapy, image processing and display, minimal invasive spinal surgery, computer assisted treatment of the prostate, the interventional radiology suite of the future, interventional oncology, computer assisted neurosurgery, computer assisted head and neck and ENT surgery, cardiovascular surgery, computer assisted orthopedic surgery, image processing and visualization, surgical robotics, instrumentation and navigation, surgical modelling, simulation and education, endoscopy and related techniques, workflow and new concepts in surgery, research training group 1126: intelligent surgery, digital operating room, image distribution and integration strategies, regional PACS and telemedicine, PACS - beyond radiology and E-learning, workflow and standardization, breast CAD, thoracic CAD, abdominal CAD, brain CAD, orthodontics, dentofacial orthopedics and airways, imaging and treating temporomandibular joint conditions, maxillofacial cone beam CT, craniomaxillofacial image fusion and CBCT incidental findings, image guided craniomaxillofacial procedures, imaging as a biomarker for therapy response, computer aided diagnosis. The Poster sessions cover the topics computer aided surgery, Euro PACS meeting, computer assisted radiology, computer aided diagnosis and computer assisted radiology and surgery.

CARS 2008: Computer Assisted Radiology and Surgery. Proceedings

International Nuclear Information System (INIS)

2008-01-01

The proceedings contain contributions to the following topics: digital imaging, computed tomography, magnetic resonance, cardiac and vascular imaging, computer assisted radiation therapy, image processing and display, minimal invasive spinal surgery, computer assisted treatment of the prostate, the interventional radiology suite of the future, interventional oncology, computer assisted neurosurgery, computer assisted head and neck and ENT surgery, cardiovascular surgery, computer assisted orthopedic surgery, image processing and visualization, surgical robotics, instrumentation and navigation, surgical modelling, simulation and education, endoscopy and related techniques, workflow and new concepts in surgery, research training group 1126: intelligent surgery, digital operating room, image distribution and integration strategies, regional PACS and telemedicine, PACS - beyond radiology and E-learning, workflow and standardization, breast CAD, thoracic CAD, abdominal CAD, brain CAD, orthodontics, dentofacial orthopedics and airways, imaging and treating temporomandibular joint conditions, maxillofacial cone beam CT, craniomaxillofacial image fusion and CBCT incidental findings, image guided craniomaxillofacial procedures, imaging as a biomarker for therapy response, computer aided diagnosis. The Poster sessions cover the topics computer aided surgery, Euro PACS meeting, computer assisted radiology, computer aided diagnosis and computer assisted radiology and surgery

Orthopedic Surgery among Patients with Rheumatoid Arthritis: A Population-based study to Identify Risk factors, Sex differences, and Time trends.

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Richter, Michael; Crowson, Cynthia S; Matteson, Eric L; Makol, Ashima

2017-12-20

To identify risk factors for large joint (LJS) versus small joint surgery (SJS) in rheumatoid arthritis (RA) and evaluate trends in surgery rates over time. A retrospective medical record review was performed of all orthopedic surgeries following first fulfillment of 1987 ACR criteria for adult-onset RA among residents of Olmsted County, Minnesota, USA in 1980-2013. Risk factors were examined using Cox models adjusted for age, sex and calendar year of RA incidence. Trends in incidence of joint surgeries were examined using Poisson regression models. A total of 1077 patients with RA (mean age 56 years, 69% female, 66% seropositive) were followed for a median of 10.7 years during which 112 (90 women) underwent at least one SJS and 204 (141 women) underwent at least one LJS. Risk factors included advanced age, rheumatoid factor and anti-CCP antibody positivity for both SJS and LJS, and BMI≥30 kg/m 2 for LJS. Risk factors for SJS and LJS at any time during follow-up included the presence of radiographic erosions, large joint swelling, and methotrexate use. SJS rates decreased by calendar year of incidence (hazard ratio 0.53; p=0.001), with significant decline in SJS after 1995. The cumulative incidence of SJS was higher in women than men (p=0.008). In recent years, there has been a significant decline in rates of SJS but not LJS in patients with RA. The incidence of SJS is higher among women. Traditional RA risk factors are strong predictors for SJS and LJS. Increasing age and obesity are predictive of LJS. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

[Impact of digital technology on clinical practices: perspectives from surgery].

Science.gov (United States)

Zhang, Y; Liu, X J

2016-04-09

Digital medical technologies or computer aided medical procedures, refer to imaging, 3D reconstruction, virtual design, 3D printing, navigation guided surgery and robotic assisted surgery techniques. These techniques are integrated into conventional surgical procedures to create new clinical protocols that are known as "digital surgical techniques". Conventional health care is characterized by subjective experiences, while digital medical technologies bring quantifiable information, transferable data, repeatable methods and predictable outcomes into clinical practices. Being integrated into clinical practice, digital techniques facilitate surgical care by improving outcomes and reducing risks. Digital techniques are becoming increasingly popular in trauma surgery, orthopedics, neurosurgery, plastic and reconstructive surgery, imaging and anatomic sciences. Robotic assisted surgery is also evolving and being applied in general surgery, cardiovascular surgery and orthopedic surgery. Rapid development of digital medical technologies is changing healthcare and clinical practices. It is therefore important for all clinicians to purposefully adapt to these technologies and improve their clinical outcomes.

Risk assessment of accidental exposure of surgeons to blood during orthopedic surgery. Are we safe in surgical gloves?

Directory of Open Access Journals (Sweden)

Dariusz Timler

2014-03-01

Full Text Available Aim. To analyze tears in sterile surgical gloves used by surgeons in the operating theatre of the Trauma and Orthopedic Surgery Department, Copernicus Memorial Hospital, Łódź, Poland Materials and Method. This study analyzes tears in sterile surgical gloves used by surgeons by ICD-9 and ICD-10 codes. 1,404 gloves were collected from 581 surgical procedures. All gloves were tested immediately following surgery using the test method described in Standard EN455–1 (each glove was inflated with 1,000 ± 50 ml of water and observed for leaks for 2–3 min.. Results. Analysis of tears took into consideration the role of medical personnel (operator, first assistant, second assistant during surgical procedure, the type of procedure according to ICD-9 and ICD-10 codes, and the elective or emergency nature of the procedure. The results of the study show that these factors have a significant influence on the risk of glove tears. Significant differences were observed in tear frequency and tear location depending on the function performed by the surgeon during the procedure. Conclusion. The study proved that the role performed by the surgeon during the procedure (operator, first assistant, second assistant has a significant influence on the risk of glove tearing. The role in the procedure determines exposure to glove tears. Implementing a double gloving procedure in surgical procedures or using single gloves characterized by higher tear resistance should be considered.

Large increase in arthroscopic meniscus surgery in the middle-aged and older population in Denmark from 2000 to 2011

DEFF Research Database (Denmark)

Thorlund, Jonas B; Hare, Kristoffer B; Lohmander, Stefan

2014-01-01

Background - Arthroscopic meniscal surgery is the most common orthopedic procedure, and the incidence has increased in Denmark over the last 10 years. Concomitantly, several randomized controlled trials have shown no benefit of arthroscopic procedures including arthroscopic partial meniscectomy i...

Patient refusal for regional anesthesia in elderly orthopedic population: A cross-sectional survey at a tertiary care hospital.

Science.gov (United States)

Salam, Asma Abdus; Afshan, Gauhar

2016-01-01

Improvements in pain management techniques in the last decade have had a major impact on the practice of orthopedic surgeries, for example, total hip arthroplasty and total knee arthroplasty. Although there are a number of treatment options for postoperative pain, a gold standard has not been established. In our institution, both general anesthesia and regional anesthesia (RA), are being offered to the elderly orthopedic population but RA is not frequently accepted by elderly population. The objective of this study was to determine the frequency of various reasons for refusal of RA in elderly patients undergoing orthopedic surgeries. A prospective study conducted over a period of 1 year, had 549 patients with ages above 60 years who underwent different types of elective orthopedic procedures 182 patients who refused RA were interviewed according to a structured questionnaire designed to assess the reasons of refusal. Most common reason for the refusal of RA was surgeon's choice (38.5%), whereas 20.3% of the patients were unaware about the RA. There was a significant association between female gender and refusing RA due to backache (17.2%) and fear of being awake during the operation (24.1%) respectively. This survey showed that the main reasons among elderly female population were the fear of remaining awake and backache. However, overall it was the surgeon's choice which made patients refuse RA, and the anesthesiologists were the main source of information.

On-the-fly augmented reality for orthopedic surgery using a multimodal fiducial.

Science.gov (United States)

Andress, Sebastian; Johnson, Alex; Unberath, Mathias; Winkler, Alexander Felix; Yu, Kevin; Fotouhi, Javad; Weidert, Simon; Osgood, Greg; Navab, Nassir

2018-04-01

Fluoroscopic x-ray guidance is a cornerstone for percutaneous orthopedic surgical procedures. However, two-dimensional (2-D) observations of the three-dimensional (3-D) anatomy suffer from the effects of projective simplification. Consequently, many x-ray images from various orientations need to be acquired for the surgeon to accurately assess the spatial relations between the patient's anatomy and the surgical tools. We present an on-the-fly surgical support system that provides guidance using augmented reality and can be used in quasiunprepared operating rooms. The proposed system builds upon a multimodality marker and simultaneous localization and mapping technique to cocalibrate an optical see-through head mounted display to a C-arm fluoroscopy system. Then, annotations on the 2-D x-ray images can be rendered as virtual objects in 3-D providing surgical guidance. We quantitatively evaluate the components of the proposed system and, finally, design a feasibility study on a semianthropomorphic phantom. The accuracy of our system was comparable to the traditional image-guided technique while substantially reducing the number of acquired x-ray images as well as procedure time. Our promising results encourage further research on the interaction between virtual and real objects that we believe will directly benefit the proposed method. Further, we would like to explore the capabilities of our on-the-fly augmented reality support system in a larger study directed toward common orthopedic interventions.

[Therapy relevant imaging in modern surgical treatment of arthrosis of the shoulder: interesting facts for orthopedic surgeons].

Science.gov (United States)

Krifter, R M; Zweiger, C; Lick-Schiffer, W; Mattiassich, G; Schüller-Weidekamm, C; Radl, R

2013-03-01

Imaging for shoulder surgery varies a lot nowadays. Advantages and disadvantages of possible imaging methods according to the pathology and treatment options are described. Digital projection radiography in 3 planes, ultrasonography, MRI, CT scanning and scintigrams. Special axial view to visualize the glenoid situation, as well as 3-D CT scanning for larger defects and classification. Imaging of the glenoid situation, the version and erosion in axial view x-ray is mandatory to plan and control glenoid replacement. Useful application of imaging methods for the daily routine of orthopedic surgeons. Digital 3 plane x-ray imaging in arthroplasty surgery is the minimum requirement. For rotator cuff lesions ultrasonography is good. In order to gain information on fatty infiltration of rotator muscles MRI is needed as well as for intra-articular lesions. For bony defects CT and reconstruction 3-D are recommended.

Orthopedic X-ray diagnostics

International Nuclear Information System (INIS)

Bernau, A.

1982-01-01

Positioning techniques have been developed as a means of standardizing skeleton pictures so as to facilitate functional interpretations in orthopedics. Standard positions are described as well as specific orthopedic and traumatological problems. The list of positions must, of course, be incomplete as there are too many. Access to the subject is facilitated by a systematic approach. (orig.) [de

Evaluation of occupational and patient radiation doses in orthopedic surgery

International Nuclear Information System (INIS)

Sulieman, A.; Alzimami, K.; Habeeballa, B.; Osman, H.; Abdelaziz, I.; Sassi, S.A.; Sam, A.K.

2015-01-01

This study intends to measure the radiation dose to patients and staff during (i) Dynamic Hip Screw (DHS) and (ii) Dynamic Cannula Screw (DCS) and to evaluate entrance surface Air kerma (ESAK) dose and organ doses and effective doses. Calibrated Thermoluminescence dosimeters (TLD-GR200A) were used. The mean patients’ doses were 0.46 mGy and 0.07 mGy for DHS and DCS procedures, respectively. The mean staff doses at the thyroid and chest were 4.69 mGy and 1.21 mGy per procedure. The mean organ and effective dose for patients and staff were higher in DHS compared to DCS. Orthopedic surgeons were exposed to unnecessary radiation doses due to the lack of protection measures. The radiation dose per hip procedure is within the safety limit and less than the previous studies

Magnitude and meaningfulness of change in SF-36 scores in four types of orthopedic surgery

DEFF Research Database (Denmark)

Busija, Lucy; Osborne, Richard H; Nilsdotter, Anna

2008-01-01

BACKGROUND: The Medical Outcomes General Health Survey (SF-36) is a widely used health status measure; however, limited evidence is available for its performance in orthopedic settings. The aim of this study was to examine the magnitude and meaningfulness of change and sensitivity of SF-36...

Improving hip surgery patients’ outcomes:

DEFF Research Database (Denmark)

Bagger, Bettan; Poulsen, Dorthe Varning; Taylor Kelly, Hélène

This presentation focuses upon the improvement of hip surgery patients’ outcomes with respect to health promotion and rehabilitation. The overall aims of the EU financed orthopedic nursing project will be introduced. Speakers highlight the project’s contribution to: -the development of nurse...

Increasing medical student exposure to musculoskeletal medicine: the initial impact of the Orthopaedic Surgery and Sports Medicine Interest Group

Directory of Open Access Journals (Sweden)

Mickelson DT

2017-07-01

Full Text Available Dayne T Mickelson,1 Philip K Louie,2 Kenneth R Gundle,3 Alex W Farnand,4 Douglas P Hanel5 1Department of Orthopedic Surgery and Sports Medicine, Duke University, Durham, NC, USA; 2Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA; 3Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA; 4Department of General Surgery, Presence Saint Joseph Hospital – Chicago, Chicago, IL, USA; 5Department of Orthopedic Surgery and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA Purpose: To investigate the impact of the Orthopaedic Surgery and Sports Medicine Interest Group (OSSMIG on medical student interest and confidence in core musculoskeletal (MSK concepts through supplemental education and experiences at a single tertiary, academic institution.Methods: Medical student OSSMIG members at various levels of training were anonymously surveyed at the beginning and end of the 2014–2015 academic year.Results: Eighteen (N=18 medical student interest group members completed the survey. Significant improvement in their level of training was observed with regard to respondents’ self-assessed competence and confidence in MSK medicine (p<0.05. Additionally, respondents’ attitudes toward exposure and support from the interest group were significantly higher than those provided by the institution (p<0.05. Members believed OSSMIG increased interest in MSK medicine, improved confidence in their ability to perform orthopedics-related physical exams, strengthened mentorship with residents and attendings, and developed a connection with the Department of Orthopedic Surgery and its residents (median “Strongly Agree”, interquartile range one and two scale items.Conclusion: Since its inception 8 years ago, OSSMIG has been well received and has positively impacted University of Washington School of Medicine students through various interventions

Pain Control After Surgery: Pain Medicines

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... Emotional Well-Being Mental Health Sex and Birth Control Sex and Sexuality Birth Control Family Health Infants and Toddlers Kids and Teens ... Bracing: What Works? Home Prevention and Wellness Pain Control After Surgery: Pain Medicines Pain Control After Surgery: ...

Antimicrobial efficacy of preoperative skin antisepsis and clonal relationship to postantiseptic skin-and-wound flora in patients undergoing clean orthopedic surgery.

Science.gov (United States)

Daeschlein, G; Napp, M; Layer, F; von Podewils, S; Haase, H; Spitzmueller, R; Assadian, O; Kasch, R; Werner, G; Jünger, M; Hinz, P; Ekkernkamp, A

2015-11-01

Nosocomial surgical site infections (SSI) are still important complications in surgery. The underlying mechanisms are not fully understood. The aim of this study was to elucidate the possible role of skin flora surviving preoperative antisepsis as a possible cause of SSI. We conducted a two-phase prospective clinical trial in patients undergoing clean orthopedic surgery at a university trauma center in northern Germany. Quantitative swab samples were taken from pre- and postantiseptic skin and, additionally, from the wound base, wound margin, and the suture of 137 patients. Seventy-four patients during phase I and 63 during phase II were investigated. Microbial growth, species spectrum, and antibiotic susceptibility were analyzed. In phase two, the clonal relationship of strains was additionally analyzed. 18.0 % of the swab samples were positive for bacterial growth in the wound base, 24.5 % in the margin, and 27.3 % in the suture. Only 65.5 % of patients showed a 100 % reduction of the skin flora after antisepsis. The microbial spectrum in all postantiseptic samples was dominated by coagulase-negative staphylococci (CoNS). Clonally related staphylococci were detected in ten patients [nine CoNS, one methicillin-susceptible Staphylococcus aureus (MSSA)]. Six of ten patients were suspected of having transmitted identical clones from skin flora into the wound. Ethanol-based antisepsis results in unexpected high levels of skin flora, which can be transmitted into the wound during surgery causing yet unexplained SSI. Keeping with the concept of zero tolerance, further studies are needed in order to understand the origin of this flora to allow further reduction of SSI.

Effect of a heat and moisture exchanger on heat loss in isoflurane-anesthetized dogs undergoing single-limb orthopedic procedures.

Science.gov (United States)

Hofmeister, Erik H; Brainard, Benjamin M; Braun, Christina; Figueiredo, Juliana P

2011-12-15

To determine whether a heat and moisture exchange device (HME) prevents a decrease in body temperature in isoflurane-anesthetized dogs undergoing orthopedic procedures. Blinded randomized controlled clinical trial. 60 privately owned dogs weighing at least 15 kg (33 lb). Dogs were randomly assigned to 1 of 3 treatment groups (n = 20/group): HME placed immediately after anesthetic induction with isoflurane, after transfer to the operating room, or not at all. The device consisted of a hygroscopic filter placed between the endotracheal tube and the Y piece of the anesthesia circuit. Each dog was positioned on a circulating warm water blanket and had a forced-air warming blanket placed over its body. Body temperature was monitored after transfer to the operating room with a probe placed in the thoracic aspect of the esophagus. Study groups did not differ significantly with respect to body weight, body condition score, reproductive status, breed, surgical procedure, preoperative sedative and opioid administration, anesthetic induction drug, local nerve block technique, or operating room assignment. There were no significant differences among groups in esophageal temperature variables, interval between anesthetic induction and surgery, surgery duration, anesthesia duration, or oxygen flow rate. However, the relationship between temperature delta and body weight was significant and relevant (R(2) = 0.23), as was the association between temperature nadir and body weight (R(2)= 0.10). As body weight increased, the temperature delta decreased and temperature nadir increased. No other significant relationships were identified. Inclusion of an HME in healthy dogs undergoing anesthesia for an elective orthopedic surgery did not facilitate maintenance of body temperature throughout the procedure.

Computer assisted radiology and surgery. CARS 2010

International Nuclear Information System (INIS)

Anon.

2010-01-01

The conference proceedings include contributions to the following topics: (1) CARS Clinical Day: minimally invasive spiral surgery, interventional radiology; (2) CARS - computer assisted radiology and surgery: ophthalmology, stimulation methods, new approaches to diagnosis and therapy; (3) Computer assisted radiology 24th International congress and exhibition: computer tomography and magnetic resonance, digital angiographic imaging, digital radiography, ultrasound, computer assisted radiation therapy, medical workstations, image processing and display; (4) 14th Annual conference of the International Society for computer aided surgery; ENT-CMF head and neck surgery computer-assisted neurosurgery, cardiovascular surgery, image guided liver surgery, abdominal and laparoscopic surgery, computer-assisted orthopedic surgery, image processing and visualization, surgical robotics and instrumentation, surgical modeling, simulation and education; (5) 28th International EuroPACS meeting: image distribution and integration strategies, planning and evaluation, telemedicine and standards, workflow and data flow in radiology; (6) 11th CARS/SPIE/EuroPACS joint workshop on surgical PACS and the digital operating, management and assessment of OR systems and integration; (7) 12th International workshop on computer-aided diagnosis: special session on breast CAD, special session on thoracic CAD, special session on abdominal brain, lumbar spine CAD; (8) 16th computed Maxillofacial imaging congress: computed maxillofacial imaging in dental implantology, orthodontics and dentofacial orthopedics; approaches to 3D maxillofacial imaging; surgical navigation; (9) 2nd EuroNOTES/CARS workshop on NOTES: an interdisciplinary challenge; (10) 2nd EPMA/CARS workshop on personalized medicine and ICT.; (11)poster sessions.

Computer assisted radiology and surgery. CARS 2010

Energy Technology Data Exchange (ETDEWEB)

Anon.

2010-06-15

The conference proceedings include contributions to the following topics: (1) CARS Clinical Day: minimally invasive spiral surgery, interventional radiology; (2) CARS - computer assisted radiology and surgery: ophthalmology, stimulation methods, new approaches to diagnosis and therapy; (3) Computer assisted radiology 24th International congress and exhibition: computer tomography and magnetic resonance, digital angiographic imaging, digital radiography, ultrasound, computer assisted radiation therapy, medical workstations, image processing and display; (4) 14th Annual conference of the International Society for computer aided surgery; ENT-CMF head and neck surgery computer-assisted neurosurgery, cardiovascular surgery, image guided liver surgery, abdominal and laparoscopic surgery, computer-assisted orthopedic surgery, image processing and visualization, surgical robotics and instrumentation, surgical modeling, simulation and education; (5) 28th International EuroPACS meeting: image distribution and integration strategies, planning and evaluation, telemedicine and standards, workflow and data flow in radiology; (6) 11th CARS/SPIE/EuroPACS joint workshop on surgical PACS and the digital operating, management and assessment of OR systems and integration; (7) 12th International workshop on computer-aided diagnosis: special session on breast CAD, special session on thoracic CAD, special session on abdominal brain, lumbar spine CAD; (8) 16th computed Maxillofacial imaging congress: computed maxillofacial imaging in dental implantology, orthodontics and dentofacial orthopedics; approaches to 3D maxillofacial imaging; surgical navigation; (9) 2nd EuroNOTES/CARS workshop on NOTES: an interdisciplinary challenge; (10) 2nd EPMA/CARS workshop on personalized medicine and ICT.; (11)poster sessions.

Patients' perception about risks and benefits of antithrombotic treatment for the prevention of venous thromboembolism (VTE) after orthopedic surgery: a qualitative study.

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Najafzadeh, M; Kim, S C; Patterson, C; Schneeweiss, S; Katz, J N; Brick, G W; Ready, J E; Polinski, J M; Patorno, E

2015-10-26

The 9th edition of the American College of Chest Physicians' Antithrombotic Therapy and Prevention of Thrombosis guidelines emphasize the importance of considering the risk-benefit ratio of "patient-important" outcomes. However, little is known about patients' perception and understanding regarding the different outcomes of antithrombotic treatment after orthopedic surgery, and the factors that influence their decision to use these treatments. Using a series of semi-structured interviews, we explored patients' understanding and perception concerning the benefits and risks of antithrombotic treatment for the prevention of venous thromboembolism (VTE) after joint replacement surgery. A series of semi-structured interviews were conducted with patients who had undergone knee or hip replacement surgery at a tertiary care hospital (Brigham and Women's Hospital, Boston, MA) in 2014. Discussions were recorded and transcribed. Two investigators independently coded and analyzed the data to identify important themes and concepts using the constant comparative method. Of 64 patients who were invited, 12 patients (19 %) completed the interviews. The majority of patients (92 %) were aware of the benefits of antithrombotic therapy for reducing the risk of blood clots, while less than half of them had a clear understanding of deep vein thrombosis and pulmonary embolism. While all patients were aware of risk of minor bleeding, only 6 patients (50 %) considered the risk of major bleeding as a possible side effect of antithrombotic treatment. Overall, patients perceived bleeding as a less important outcome than a thrombotic event. The lack of awareness about the risk of major bleeding, the assumption that a short-term exposure would not meaningfully affect bleeding risk, and the assumption that bleeding is a controllable event influenced their perception. Most patients (83 %) stated that their decision to use antithrombotic medications was mainly based on the trust in their

Changes in Perceived Supervision Quality After Introduction of Competency-Based Orthopedic Residency Training: A National 6-Year Follow-Up Study.

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van Vendeloo, Stefan N; Brand, Paul L P; Kollen, Boudewijn J; Verheyen, Cees C P M

2018-04-27

To evaluate the perceived quality of the learning environment, before and after introduction of competency-based postgraduate orthopedic education. From 2009 to 2014, we conducted annual surveys among Dutch orthopedic residents. The validated Dutch Residency Educational Climate Test (D-RECT, 50 items on 11 subscales) was used to assess the quality of the learning environment. Scores range from 1 (poor) to 5 (excellent). Dynamic cohort follow-up study. All Dutch orthopedic residents were surveyed during annual compulsory courses. Over the 6-year period, 641 responses were obtained (response rate 92%). Scores for "supervision" (95% CI for difference 0.06-0.28, p = 0.002) and "coaching and assessment" (95% CI 0.11-0.35, p < 0.001) improved significantly after introduction of competency-based training. There was no significant change in score on the other subscales of the D-RECT. After the introduction of some of the core components of competency-based postgraduate orthopedic education the perceived quality of "supervision" and "coaching and assessment" improved significantly. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

[Specificity of the anaerobic bacterial infections in the surgical and orthopedic wards].

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Kierzkowska, Marta; Majewska, Anna; Sawicka-Grzelak, Anna; Młynarczyk, Andrzej; Ładomirska-Pestkowska, Katarzvna; Młynarczyk, Grazyna

2012-01-01

The aim of this study was to estimate the contribution strictly anaerobic bacteria in the etiology of infections in patients on surgery and orthopedic wards. We examined 159 samples taken from patients hospitalized in surgical wards and 179 clinical specimens taken from orthopedic patients. Clinical strains of obligate anaerobes were identified by API 20A biochemical tests (ATB Expression, bioMerieux S.A., France). Susceptibility of the clinical strains was examined by ATB ANA (bioMerieux S.A., France) system. The MIC values were determined by the gradient diffusion method, Etest (AB BIODISK, Sweden i bioMerieux S.A., France). Gram-negative bacteria predominant in the samples taken from surgical patients, Most frequently we isolated rods of the genus Bacteroides (26%): B. fragilis, B. ovatus/B. thetaiotaomicron, and B. distasonis. In 44 samples (28%) we identified only anaerobic bacteria. Multibacterial isolations, with the participation of anaerobic and aerobic flora, dominated among patients in the study. Overall 238 strictly anaerobic bacteria were cultured from patients hospitalized in orthopedic wards. Gram-positive bacteria accounted for 78%. The most frequently were isolated Peptostreptococcus (56%), Propionibacterium (10%) species. In this study all Bacteroides strains were resistant to penicillin G. Some species were resistant to clindamycin, as well. Overall 40% of Bacteroides strains taken from surgical and 50% isolated from orthopedic wards showed no sensitivity to this antibiotic. A similar phenomenon was observed among bacteria of the genus Prevotella. In samples taken from orthopedic patients we observed the predominance of Gram-positive anaerobic bacteria. Some of them were part of the normal flora but they should not be excluded as an etiology agents of infection. The specimens taken from patients treated in surgical wards showed the presence of a mixed microflora, which included aerobic and anaerobic bacteria, primarily Gram-negative rods

Intramuscular Administration of Drotaverine Hydrochloride Decreases Both Incidence of Urinary Retention and Time to Micturition in Orthopedic Patients under Spinal Anesthesia: A Single Blinded Randomized Study

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Dariusz Tomaszewski

2015-01-01

Full Text Available Purpose. Postoperative urinary retention (POUR increases the duration of hospitalization and frequency and risk of urinary bladder catheterization. The objective of this study was to analyze the efficacy of intramuscularly administered drotaverine hydrochloride in the prevention of POUR in orthopedic patients. Methods. Two hundred and thirty patients 17–40 years of age undergoing lower limb orthopedic procedures under spinal anesthesia were enrolled in the study. The study group received 40 mg of drotaverine hydrochloride intramuscularly; the second group was the control. The main outcome measure was (1 the time to micturition and (2 the incidence of urinary bladder catheterization and time to catheterization. Results. Two hundred and one patients of 230 enrolled participants completed the study. Compared to the control group, the male patients in study group exhibited a shorter time to spontaneous micturition (441 versus 563 minutes, 95% CI of the difference of means between 39 and 205 minutes and a lower incidence of urinary bladder catheterization (4/75 versus 10/54 (RR 0.29, 95% CI: 0.1–0.87; P=0.0175. Conclusions. Intramuscular administration of drotaverine hydrochloride decreased the time to spontaneous micturition and decreased the incidence of urinary bladder catheterization in male patients who underwent orthopedic surgery under spinal anesthesia. This trial is registered with NCT02026427.

Robotic aortic surgery.

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Duran, Cassidy; Kashef, Elika; El-Sayed, Hosam F; Bismuth, Jean

2011-01-01

Surgical robotics was first utilized to facilitate neurosurgical biopsies in 1985, and it has since found application in orthopedics, urology, gynecology, and cardiothoracic, general, and vascular surgery. Surgical assistance systems provide intelligent, versatile tools that augment the physician's ability to treat patients by eliminating hand tremor and enabling dexterous operation inside the patient's body. Surgical robotics systems have enabled surgeons to treat otherwise untreatable conditions while also reducing morbidity and error rates, shortening operative times, reducing radiation exposure, and improving overall workflow. These capabilities have begun to be realized in two important realms of aortic vascular surgery, namely, flexible robotics for exclusion of complex aortic aneurysms using branched endografts, and robot-assisted laparoscopic aortic surgery for occlusive and aneurysmal disease.

HBOC-201 as an alternative to blood transfusion: efficacy and safety evaluation in a multicenter phase III trial in elective orthopedic surgery.

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Jahr, Jonathan S; Mackenzie, Colin; Pearce, L Bruce; Pitman, Arkadiy; Greenburg, A Gerson

2008-06-01

The ability of hemoglobin based oxygen carrier-201 (HBOC-201) to safely reduce and/or eliminate perioperative transfusion was studied in orthopedic surgery patients. A randomized, single-blind, packed red blood cell (PRBC)-controlled, parallel-group multicenter study was conducted. Six hundred eighty-eight patients were randomized to treatment with HBOC-201 (H, n = 350) or PRBC (R, n = 338) at the first transfusion decision. Primary endpoints were transfusion avoidance and blinded assessment [Mann-Whitney estimator (MW)] of safety noninferiority. Groups were compared directly and by paired/matching group analyses predicated on a prospectively defined dichotomy [treatment success (HH) vs. failure (HR)] in the H arm and an equivalently defined dichotomy [3 (R3+) units PRBC] in the R arm, based on need (moderate vs. high) for additional oxygen carrying capacity. A total of 59.4% of patients in the H arm avoided PRBC transfusion. Adverse events (8.47 vs. 5.88), and serious adverse events (SAEs) (0.35 vs. 0.25) per patient were higher in the H versus R arms (p 80 years), volume overload and undertreatment contributed to this imbalance. HBOC-201 eliminated transfusion in the majority of subjects. The between arms (H vs. R) safety analysis was unfavorable and likely related to patient age, volume overload, and undertreatment and was isolated to patients that could not be managed by HBOC-201 alone. However, patients transfusion when treated with up to 10 units of HBOC-201.

Comparison between mixed and laminar airflow systems in operating rooms and the influence of human factors: experiences from a Swedish orthopedic center.

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Erichsen Andersson, Annette; Petzold, Max; Bergh, Ingrid; Karlsson, Jón; Eriksson, Bengt I; Nilsson, Kerstin

2014-06-01

The importance of laminar airflow systems in operating rooms as protection from surgical site infections has been questioned. The aim of our study was to explore the differences in air contamination rates between displacement ventilation and laminar airflow systems during planned and acute orthopedic implant surgery. A second aim was to compare the influence of the number of people present, the reasons for traffic flow, and the door-opening rates between the 2 systems. Active air sampling and observations were made during 63 orthopedic implant operations. The laminar airflow system resulted in a reduction of 89% in colony forming units in comparison with the displacement system (P operating rooms offer high-quality air during surgery, with very low levels of colony forming units close to the surgical wound. The continuous maintenance of laminar air flow and other technical systems are crucial, because minor failures in complex systems like those in operating rooms can result in a detrimental effect on air quality and jeopardize the safety of patients. The technical ventilation solutions are important, but they do not guarantee clean air, because many other factors, such as the organization of the work and staff behavior, influence air cleanliness. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Improvement of orthopedic dental treatment of patients suffering post-surgery defects of the maxilla of cancer genesis

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A. S. Arutyunov

2015-01-01

Full Text Available The paper presents a comprehensive study identifying the key issuesand giving the mathematical, and clinical and microbiological substantiation of modern principles of providing orthopedic dental care to patients with acquired defects of the upper jaw of cancer genesis.

Effect of general anesthesia and orthopedic surgery on serum tryptase

DEFF Research Database (Denmark)

Garvey, Lene H; Bech, Birgitte Louise; Mosbech, Holger

2010-01-01

Mast cell tryptase is used clinically in the evaluation of anaphylaxis during anesthesia, because symptoms and signs of anaphylaxis are often masked by the effect of anesthesia. No larger studies have examined whether surgery and anesthesia affect serum tryptase. The aim of this study...... was to investigate the effect of anesthesia and surgery on serum tryptase in the absence of anaphylaxis....

Descriptive study of patients undergoing orthopedic surgery of the upper limb with infra clavicular coracoid block in the Hospital San Juan de Dios during the months of June to August 2012

International Nuclear Information System (INIS)

Aguilar Urena, Ricardo Antonio

2012-01-01

A form was designed for data collection in the Hospital San Juan de Dios; which to was applied to patients subjected to anesthesia for orthopedic surgery of the elbow, arm and hand, who have presented inclusion criteria for the study during the months of June to August 2012. These inclusion criteria have been: gender, age group, type of lock with neurostimulator or neuro and ultrasounds, if has been surgical or not, the need for conversion to general anesthesia, the visual analog scale at O,6 and 12 hours, and the need for opioid rescue medication at 0,6 and 12 h. (author) [es

Nanotechnology-enhanced orthopedic materials fabrications, applications and future trends

CERN Document Server

Yang, Lei

2015-01-01

Nanotechnology-Enhanced Orthopedic Materials provides the latest information on the emergence and rapid development of nanotechnology and the ways it has impacted almost every aspect of biomedical engineering. This book provides readers with a comprehensive overview of the field, focusing on the fabrication and applications of these materials, presenting updated, practical, and systematic knowledge on the synthesis, processing, and modification of nanomaterials, along with the rationale and methodology of applying such materials for orthopedic purposes. Topics covered include a wide range of orthopedic material formulations, such as ceramics, metals, polymers, biomolecules, and self-assemblies. Final sections explore applications and future trends in nanotechnology-enhanced orthopedic materials. Details practical information on the fabrication and modification of new and traditional orthopedic materials Analyzes a wide range of materials, designs, and applications of nanotechnology for orthopedics Investigate...

In vitro characterizations of mesoporous hydroxyapatite as a controlled release delivery device for VEGF in orthopedic applications.

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Poh, Chye Khoon; Ng, Suxiu; Lim, Tee Yong; Tan, Hark Chuan; Loo, Joachim; Wang, Wilson

2012-11-01

Following bone implant surgery, prolonged ischemic conditions at the implant site often result in postsurgical complications like failure of osseointegration at the bone-implant interface which can lead to implant failure. Thus, restoration of the vascular supply is paramount to the proper development of the bone. High surface area mesostructured materials have been shown to be attractive candidates for bone regeneration to enhance cell adhesion and cell proliferation. This study uses hydroxyapatite, a naturally occurring mineral in the bone, fabricated to a range of suitable pore sizes, infused with vascular endothelial growth factor (VEGF), to be progressively released to stimulate revascularization. In this study, several characterizations including nitrogen adsorption analysis, Fourier-transformed infrared spectroscopy, X-ray diffraction, field emission scanning electron microscope, and transmission electron microscope were used to evaluate the synthesized mesoporous hydroxyapatite (MHA). The results showed that MHA can gradually release VEGF for enhancing revascularization, which is beneficial for orthopedic applications. Copyright © 2012 Wiley Periodicals, Inc.

[Research and analysis to Shui nationality medicine treatment orthopedics & traumatology].

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Hu, Jian-Shan; Li, Pu; Yang, Yong; Chen, Xin-Chun; Lin, Li

2013-05-01

To investigated Shui nationality folk medicine's awareness to orthopedics & traumatology, the history of orthopedics & traumatology treatment, Shui nationality folk doctors' practicing medicine, heritage, diagnosis and treatment methods and tools, etc, through investigated drug resources category and distribution characteristics of Shui nationality medicine to orthopedics & traumatology treatment, explored and finished Shui nationality medicine orthopedics & traumatology treatment theoretical system. After more than 5 years' exploration and finishing, preliminarily formed the theoretical system framework and medicine application characteristics of Shui nationality medicine treating orthopedics & traumatology. Shui nationality medicine treatment orthopedics & traumatology has distinctive national style, and worthy to further exploration and research.

Computed tomography-controlled stereotactic surgery

International Nuclear Information System (INIS)

Matsumoto, Keizo; Shichijo, Fumio; Gyoten, Tetsuya; Tomida, Keisuke; Miyake, Hajime

1986-01-01

A single use of coordinate system of computed tomography (CT) scanner is utilized for CT-controlled stereotactic surgery. Depth, direction and readjustment of target trajectory were defined by known values of cursor number in CT images and numbers of the sliding table indicator. We loaded calculation formulas into hand held computer to obtain immediate answers. Stereotactic apparatus consisted two main parts: the patient's head fixation and probe holder. Surgery was performed in cases of hypertensive intracerebral hemorrhage for evacuation of the hematomas successfully. Target accuracy was satisfactory. With further advance of this surgery, automatic stereotactic control with a special robot machine seeing possible. (author)

Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: a randomized controlled trial.

Science.gov (United States)

Poonai, Naveen; Datoo, Natasha; Ali, Samina; Cashin, Megan; Drendel, Amy L; Zhu, Rongbo; Lepore, Natasha; Greff, Michael; Rieder, Michael; Bartley, Debra

2017-10-10

Oral morphine for postoperative pain after minor pediatric surgery, while increasingly popular, is not supported by evidence. We evaluated whether oral morphine was superior to ibuprofen for at-home management of children's postoperative pain. We conducted a randomized superiority trial comparing oral morphine (0.5 mg/kg) with ibuprofen (10 mg/kg) in children 5 to 17 years of age who had undergone minor outpatient orthopedic surgery (June 2013 to September 2016). Participants took up to 8 doses of the intervention drug every 6 hours as needed for pain at home. The primary outcome was pain, according to the Faces Pain Scale - Revised, for the first dose. Secondary outcomes included additional analgesic requirements, adverse effects, unplanned health care visits and pain scores for doses 2 to 8. We analyzed data for 77 participants in each of the morphine and ibuprofen groups. Both interventions decreased pain scores with no difference in efficacy. The median difference in pain score before and after the first dose of medication was 1 (interquartile range 0-1) for both morphine and ibuprofen ( p = 0.2). For doses 2 to 8, the median differences in pain score before and after the dose were not significantly different between groups. Significantly more participants taking morphine reported adverse effects (45/65 [69%] v. 26/67 [39%], p ibuprofen groups, respectively; p = 0.003). Morphine was not superior to ibuprofen, and both drugs decreased pain with no apparent difference in efficacy. Morphine was associated with significantly more adverse effects, which suggests that ibuprofen is a better first-line option after minor surgery. ClinicalTrials.gov, no. NCT01686802. © 2017 Canadian Medical Association or its licensors.

The evidence-based principles of negative pressure wound therapy in trauma & orthopedics.

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A, Novak; Khan, Wasim S; J, Palmer

2014-01-01

Negative pressure wound therapy is a popular treatment for the management of both acute and chronic wounds. Its use in trauma and orthopedics is diverse and includes the acute traumatic setting as well as chronic troublesome wounds associated with pressure sores and diabetic foot surgery. Efforts have been made to provide an evidence base to guide its use however this has been limited by a lack of good quality evidence. The following review article explores the available evidence and describes future developments for its use in trauma and orthopaedic practice.

The improved quality of postoperative analgesia after intrathecal morphine does not result in improved recovery and quality of life in the first 6 months after orthopedic surgery: a randomized controlled pilot study

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Foadi N

2017-05-01

Full Text Available Nilufar Foadi,1,* Matthias Karst,1,* Anika Frese-Gaul,2 Niels Rahe-Meyer,3 Stefan Krömer,1 Christian Weilbach 4 1Department of Anesthesiology and Intensive Care Medicine, Pain Clinic, Hannover Medical School, Hannover, 2Department of Psychosomatic Medicine, AHG Psychosomatische Klinik Bad Pyrmont, Bad Pyrmont, 3Department of Anesthesiology and Operative Intensive Care Medicine, Franziskus Hospital, Bielefeld, 4Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, St. Josefs‑Hospital Cloppenburg, Cloppenburg, Germany *These authors contributed equally to this work Objective: In orthopedic surgery, it is well known that the use of intrathecal morphine (ITM leads to an improved quality of postoperative analgesia. Little is known how this improved analgesia affects the long-term course after surgery.Study design: A randomized, double-blind trial.Setting: Academic medical center.Subjects: Forty-nine patients undergoing total hip or knee replacement surgery in spinal anesthesia.Methods: Patients were randomly assigned to receive either 0.1 mg (n=16 or 0.2 mg (n=16 morphine sulfate intrathecally or physiological saline (n=17 added to 3 mL 0.5% isobaric bupivacaine for spinal anesthesia. As a function of the quality of the short-term postoperative analgesia, the effect on recovery and quality of life was evaluated at various time points up to 26 weeks after surgery.Results: In both ITM groups, the additionally required postoperative systemic morphine dose was significantly reduced compared with the placebo group (P=0.004. One week after operation, patients with ITM reported significantly less pain at rest (P=0.01 compared to the placebo group. At discharge, in comparison with the 0.1 mg ITM and placebo group, the 0.2 mg ITM group showed a higher degree of impairment regarding pain, stiffness, and physical function of the respective joint (P=0.02. Over the further follow-up period of 6 months after surgery

Web-Based Patient Education in Orthopedics: Systematic Review

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Melles, Marijke; Groeneveld, Bob Sander; de Ridder, Huib

2018-01-01

Background Patients with orthopedic conditions frequently use the internet to find health information. Patient education that is distributed online may form an easily accessible, time- and cost-effective alternative to education delivered through traditional channels such as one-on-one consultations or booklets. However, no systematic evidence for the comparative effectiveness of Web-based educational interventions exists. Objective The objective of this systematic review was to examine the effects of Web-based patient education interventions for adult orthopedic patients and to compare its effectiveness with generic health information websites and traditional forms of patient education. Methods CINAHL, the Cochrane Library, EMBASE, MEDLINE, PsycINFO, PUBMED, ScienceDirect, Scopus, and Web of Science were searched covering the period from 1995 to 2016. Peer-reviewed English and Dutch studies were included if they delivered patient education via the internet to the adult orthopedic population and assessed its effects in a controlled or observational trial. Results A total of 10 trials reported in 14 studies involving 4172 patients were identified. Nine trials provided evidence for increased patients’ knowledge after Web-based patient education. Seven trials reported increased satisfaction and good evaluations of Web-based patient education. No compelling evidence exists for an effect of Web-based patient education on anxiety, health attitudes and behavior, or clinical outcomes. Conclusions Web-based patient education may be offered as a time- and cost-effective alternative to current educational interventions when the objective is to improve patients’ knowledge and satisfaction. However, these findings may not be representative for the whole orthopedic patient population as most trials included considerably younger, higher-educated, and internet-savvy participants only. PMID:29685869

Identification of hospitalized elderly patients at risk for adverse in-hospital outcomes in a university orthopedics and trauma surgery environment.

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Janine Gronewold

Full Text Available As a consequence of demographic changes, hospitals are confronted with increasing numbers of elderly patients, who are at high risk of adverse events during hospitalization. Geriatric risk screening followed by comprehensive geriatric assessment (CGA and treatment has been requested by geriatric societies and task forces to identify patients at risk. Since empirical evidence on factors predisposing to adverse hospital events is scarce, we now prospectively evaluated implications of geriatric risk screening followed by CGA in a university hospital department of orthopedics and trauma surgery.Three hundred and eighty-one patients ≥75 years admitted to the Department of Orthopedics and Trauma Surgery of the University Hospital Essen received Identification of Seniors at Risk (ISAR Screening followed by CGA via a geriatric liaison service in case of positive screening results. Associations between ISAR, CGA, comorbid risk factors and diseases, length of hospital stay, number of nursing and physiotherapy hours, and falls during hospital stay were analyzed.Of 381 ISAR screenings, 327 (85.8% were positive, confirming a high percentage of patients at risk of adverse events. Of these, 300 CGAs revealed 82.7% abnormal results, indicating activities of daily living impairment combined with cognitive, emotional or mobility disturbances. Abnormal CGA resulted in a longer hospital stay (14.0±10.3 days in ISAR+/CGA abnormal compared with 7.6±7.0 days in ISAR+/CGA normal and 8.1±5.4 days in ISAR-, both p<0.001, increased nursing hours (3.4±1.1 hours/day in ISAR+/CGA abnormal compared with 2.5±1.0 hours/day in ISAR+/CGA normal and 2.2±0.8 hours/day in ISAR-, both p<0.001, and increased falls (7.3% in ISAR+/CGA abnormal, 0% in ISAR+/CGA normal, 1.9% in ISAR-. Physiotherapy hours were only significantly increased in ISAR+/CGA abnormal (3.0±2.7 hours compared with in ISAR+/CGA normal (1.6±1.4 hours, p<0.001 whereas the comparison with ISAR- (2.4±2

Computer control versus manual control of systemic hypertension during cardiac surgery

NARCIS (Netherlands)

Hoeksel, S.A.A.P.; Blom, J.A.; Jansen, J.R.C.; Maessen, J.G.; Schreuder, J.J.

2001-01-01

Keywords:Cardiac surgery;hypertension;closed-loop controlBackground: We recently demonstrated the feasibility of computer controlled infusion of vasoactive drugs for the control of systemic hypertension during cardiac surgery. The objective of the current study was to investigate the effects of

Fiebre postoperatoria en cirugía ortopédica y urológica Postoperative fever in orthopedic and urologic surgery

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Federico Saavedra

2008-02-01

Full Text Available La incidencia de fiebre en el postoperatorio varía ampliamente. En la cirugía limpia y la limpia-contaminada, la fiebre no infecciosa es más frecuente que la infecciosa. Fueron estudiados prospectivamente 303 pacientes operados en forma programada de cirugía ortopédica y urológica. Se investigó la incidencia de fiebre postoperatoria, su etiología, la relación entre el momento de su aparición y su origen y la utilidad del pedido empírico de estudios para determinar infección postoperatoria. El 14% (42/303 de los pacientes tuvieron fiebre postoperatoria. En el 81% (34/42 su etiología fue no infecciosa y en el 19% (8/42 infecciosa. Su origen fue siempre no infeccioso dentro de las primeras 48 horas del postoperatorio (pPost-operative fever incidence varies widely. In clean and clean-contaminated surgery the non-infectious fever is more frequent than the infectious fever. We performed a prospective study including 303 patients who underwent orthopedic and urologic elective surgery. The aims of our study were to investigate the incidence of post-operative fever, its etiology, the relationship between time of onset and the etiology, and the usefulness of extensive fever work-up to determine post-operative infection. The incidence of post-operative fever was 14% (42/303 of which 81% (34/42 was noninfectious and 19% (8/42 was infectious. The etiology of the fever in the first 48 hours after surgery was always non-infectious (p<0.001. An extensive fever work-up was performed in patients who presented fever only after the initial 48 hours of surgery with normal physical examination (n=19 consisting of chest x-ray, blood (2 and urine cultures. The chest x-ray was normal in all the patients, the urine cultures were positive in four cases (21%, IC 95%: 6-45 and the blood cultures in only one case (5%, IC 95%: 0.1-26. Seven patients had post-operative infections without fever as a clinical sign. The most frequently observed etiology of post

3D-printed patient-specific applications in orthopedics

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Wong KC

2016-10-01

Full Text Available Kwok Chuen Wong Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Abstract: With advances in both medical imaging and computer programming, two-dimensional axial images can be processed into other reformatted views (sagittal and coronal and three-dimensional (3D virtual models that represent a patients’ own anatomy. This processed digital information can be analyzed in detail by orthopedic surgeons to perform patient-specific orthopedic procedures. The use of 3D printing is rising and has become more prevalent in medical applications over the last decade as surgeons and researchers are increasingly utilizing the technology’s flexibility in manufacturing objects. 3D printing is a type of manufacturing process in which materials such as plastic or metal are deposited in layers to create a 3D object from a digital model. This additive manufacturing method has the advantage of fabricating objects with complex freeform geometry, which is impossible using traditional subtractive manufacturing methods. Specifically in surgical applications, the 3D printing techniques can not only generate models that give a better understanding of the complex anatomy and pathology of the patients and aid in education and surgical training, but can also produce patient-specific surgical guides or even custom implants that are tailor-made to the surgical requirements. As the clinical workflow of the 3D printing technology continues to evolve, orthopedic surgeons should embrace the latest knowledge of the technology and incorporate it into their clinical practice for patient-specific orthopedic applications. This paper is written to help orthopedic surgeons stay up-to-date on the emerging 3D technology, starting from the acquisition of clinical imaging to 3D printing for patient-specific applications in orthopedics. It 1 presents the necessary steps to prepare the medical images that are

Characteristics of Orthopedic Publications in High-Impact General Medical Journals.

Science.gov (United States)

Nwachukwu, Benedict U; Kahlenberg, Cynthia A; Lehman, Jason D; Lyman, Stephen; Marx, Robert G

2017-05-01

Orthopedic studies are occasionally published in high-impact general medical journals; these studies are often given high visibility and have significant potential to impact health care policy and inform clinical decision-making. The purpose of this review was to investigate the characteristics of operative orthopedic studies published in high-impact medical journals. The number of orthopedic studies published in high-impact medical journals is relatively low; however, these studies demonstrate methodological characteristics that may bias toward nonoperative treatment. Careful analysis and interpretation of orthopedic studies published in these journals is warranted. [Orthopedics. 2017; 40(3):e405-e412.]. Copyright 2017, SLACK Incorporated.

Road traffic accidents and posttraumatic stress disorder in an orthopedic setting in South-Eastern Nigeria: a controlled study.

Science.gov (United States)

Iteke, Obiora; Bakare, Muideen O; Agomoh, Ahamefule O; Uwakwe, Richard; Onwukwe, Jojo U

2011-06-22

Psychiatric liaison services are rare in trauma units of various hospitals in Nigeria and other sub-Saharan African countries. The occurrence of road traffic accidents (RTAs) resulting from low standard of road construction and inadequate maintenance have been on the increase in Nigeria. While the physical consequences of such RTAs are obvious, the psychological consequences are often not apparent. This study assessed the prevalence of posttraumatic stress disorder (PTSD) among victims of RTAs and compared same with controls drawn from a population who have not experienced RTAs. It also assessed the associated socio-demographic variables. Study population consisted of one hundred and fifty RTA victims and two different control groups drawn from the population consisting of staffs of Federal Neuropsychiatric Hospital, Enugu, Nigeria and that of National Orthopedic Hospital, Enugu, Nigeria, 150 people in each control group were matched for age and sex with the RTA victims and they were interviewed with PTSD module of Mini International Neuropsychiatric Interview (MINI) and their socio-demographic variables obtained with socio-demographic questionnaire. The prevalence of PTSD among RTA victims and the two control groups were 26.7%, 8.0% and 8.7% respectively. The difference in prevalence was statistically significant with RTA victims more likely to experience PTSD compared to the two control groups (X² = 27.23, df = 2, p = 0.001). Gender influenced the prevalence of PTSD among victims of RTAs and the controls, with females more likely to experience PTSD when compared to the males. Among victims of RTAs, being gainfully employed prior to the accidents increased the likelihood of developing PTSD and this was statistically significant (X² = 20.09, df = 1, p = 0.000). There is urgent need to pay more attention to developing consultation-liaison psychiatry services in trauma units of Nigerian hospitals, including orthopedic hospitals located in different geographical

Trends in Medicare Reimbursement for Orthopedic Procedures: 2000 to 2016.

Science.gov (United States)

Eltorai, Adam E M; Durand, Wesley M; Haglin, Jack M; Rubin, Lee E; Weiss, Arnold-Peter C; Daniels, Alan H

2018-03-01

Understanding trends in reimbursement is critical to the financial sustainability of orthopedic practices. Little research has examined physician fee trends over time for orthopedic procedures. This study evaluated trends in Medicare reimbursements for orthopedic surgical procedures. The Medicare Physician Fee Schedule was examined for Current Procedural Terminology code values for the most common orthopedic and nonorthopedic procedures between 2000 and 2016. Prices were adjusted for inflation to 2016-dollar values. To assess mean growth rate for each procedure and subspecialty, compound annual growth rates were calculated. Year-to-year dollar amount changes were calculated for each procedure and subspecialty. Reimbursement trends for individual procedures and across subspecialties were compared. Between 2000 and 2016, annual reimbursements decreased for all orthopedic procedures examined except removal of orthopedic implant. The orthopedic procedures with the greatest mean annual decreases in reimbursement were shoulder arthroscopy/decompression, total knee replacement, and total hip replacement. The orthopedic procedures with the least annual reimbursement decreases were carpal tunnel release and repair of ankle fracture. Rate of Medicare procedure reimbursement change varied between subspecialties. Trauma had the smallest decrease in annual change compared with spine, sports, and hand. Annual reimbursement decreased at a significantly greater rate for adult reconstruction procedures than for any of the other subspecialties. These findings indicate that reimbursement for procedures has steadily decreased, with the most rapid decrease seen in adult reconstruction. [Orthopedics. 2018; 41(2):95-102.]. Copyright 2018, SLACK Incorporated.

Validation of orthopedic postoperative pain assessment methods for dogs: a prospective, blinded, randomized, placebo-controlled study.

Directory of Open Access Journals (Sweden)

Pascale Rialland

Full Text Available In the context of translational research, there is growing interest in studying surgical orthopedic pain management approaches that are common to humans and dogs. The validity of postoperative pain assessment methods is uncertain with regards to responsiveness and the potential interference of analgesia. The hypothesis was that video analysis (as a reference, electrodermal activity, and two subjective pain scales (VAS and 4A-VET would detect different levels of pain intensity in dogs after a standardized trochleoplasty procedure. In this prospective, blinded, randomized study, postoperative pain was assessed in 25 healthy dogs during a 48-hour time frame (T. Pain was managed with placebo (Group 1, n = 10, preemptive and multimodal analgesia (Group 2, n = 5, or preemptive analgesia consisting in oral tramadol (Group 3, n = 10. Changes over time among groups were analyzed using generalized estimating equations. Multivariate regression tested the significance of relationships between pain scales and video analysis. Video analysis identified that one orthopedic behavior, namely 'Walking with full weight bearing' of the operated leg, decreased more in Group 1 at T24 (indicative of pain, whereas three behaviors indicative of sedation decreased in Group 2 at T24 (all p<0.004. Electrodermal activity was higher in Group 1 than in Groups 2 and 3 until T1 (p<0.0003. The VAS was not responsive. 4A-VET showed divergent results as its orthopedic component (4A-VETleg detected lower pain in Group 2 until T12 (p<0.0009, but its interactive component (4A-VETbeh was increased in Group 2 from T12 to T48 (p<0.001. Concurrent validity established that 4A-VETleg scores the painful orthopedic condition accurately and that pain assessment through 4A-VETbeh and VAS was severely biased by the sedative side-effect of the analgesics. Finally, the video analysis offered a concise template for assessment in dogs with acute orthopedic pain. However, subjective pain

Imaging of orthopedic sports injuries

International Nuclear Information System (INIS)

Vanhoenacker, F.M.; Gielen, J.L.; Maas, M.

2007-01-01

This volume provides an updated review of imaging abnormalities in orthopedic sports injuries. The first part of the book contains background information on relevant basic science and general imaging principles in sports traumatology. The second part comprises a topographic discussion of sports injuries. Each chapter highlights the merit of different imaging techniques, focused on a specific clinical problem. In the third part, natural history, monitoring and follow-up by imaging are discussed. This well-illustrated book will be of value for musculoskeletal radiologists, orthopedic surgeons, sports physicians and everyone else involved in sports medicine. (orig.)

Web-Based Patient Education in Orthopedics: Systematic Review.

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Dekkers, Tessa; Melles, Marijke; Groeneveld, Bob Sander; de Ridder, Huib

2018-04-23

Patients with orthopedic conditions frequently use the internet to find health information. Patient education that is distributed online may form an easily accessible, time- and cost-effective alternative to education delivered through traditional channels such as one-on-one consultations or booklets. However, no systematic evidence for the comparative effectiveness of Web-based educational interventions exists. The objective of this systematic review was to examine the effects of Web-based patient education interventions for adult orthopedic patients and to compare its effectiveness with generic health information websites and traditional forms of patient education. CINAHL, the Cochrane Library, EMBASE, MEDLINE, PsycINFO, PUBMED, ScienceDirect, Scopus, and Web of Science were searched covering the period from 1995 to 2016. Peer-reviewed English and Dutch studies were included if they delivered patient education via the internet to the adult orthopedic population and assessed its effects in a controlled or observational trial. A total of 10 trials reported in 14 studies involving 4172 patients were identified. Nine trials provided evidence for increased patients' knowledge after Web-based patient education. Seven trials reported increased satisfaction and good evaluations of Web-based patient education. No compelling evidence exists for an effect of Web-based patient education on anxiety, health attitudes and behavior, or clinical outcomes. Web-based patient education may be offered as a time- and cost-effective alternative to current educational interventions when the objective is to improve patients' knowledge and satisfaction. However, these findings may not be representative for the whole orthopedic patient population as most trials included considerably younger, higher-educated, and internet-savvy participants only. ©Tessa Dekkers, Marijke Melles, Bob Sander Groeneveld, Huib de Ridder. Originally published in the Journal of Medical Internet Research (http

Orthopedic complications of linear morphea: Implications for early interdisciplinary care.

Science.gov (United States)

Schoch, Jennifer J; Schoch, Bradley S; Werthel, Jean David; McIntosh, Amy L; Davis, Dawn M R

2018-01-01

Linear morphea of the limb primarily affects children, and extracutaneous manifestations are common. Orthopedic surgeons are often essential in the care of patients with linear morphea, yet there are few reports outlining specific orthopedic complications in this population. We sought to improve the understanding of orthopedic complications in linear morphea of the limb. Between 1999 and 2014, 51 children were evaluated for linear morphea of an extremity. Twenty-six (51%) had documented orthopedic manifestations. Outcome measures included limb length discrepancy, angular malalignment, limb atrophy, and orthopedic surgical intervention. Joint contractures were most common, affecting 88% of patients, followed by limb atrophy, angular deformity, and limb length discrepancy; 14% required surgical intervention. Despite the use of systemic immunosuppressive therapy in many patients, approximately half of patients with linear morphea of an extremity have orthopedic disease. Early orthopedist involvement is crucial to improve limb alignment and preserve function. © 2017 Wiley Periodicals, Inc.

[Damage control in field surgery].

Science.gov (United States)

Samokhvalov, I M; Manukovskiĭ, V A; Badalov, V I; Severin, V V; Golovko, K P; Denisenko, V V

2011-09-01

Damage control surgery (DCS) is an important option in the store of war surgery and surgery of trauma. The main purpose of our investigation was to specify the percentage of the injured who need DCS. We performed retrospective study of the patients in the combat operations in Chechnya (1994-2002) and in peacetime (2005-2010). Total lethality in group with the standard surgical approach was 62.3%. It was significantly higher than the lethality in group of patients who underwent DCS - 50.0% (p < 0.05). Thus, the experience of DCS in War Surgery Department confirms that DCS is perspective tendency in treatment of patients with severe and extremely severe trauma, and allows decreasing lethality in 12.3%.

Perspectives of Orthopedic Surgeons on Racial/Ethnic Disparities in Care.

Science.gov (United States)

Adelani, Muyibat A; O'Connor, Mary I

2017-08-01

Racial/ethnic disparities in healthcare, including orthopedics, have been extensively documented. However, the level of knowledge among orthopedic surgeons regarding racial/ethnic disparities is unknown. The purpose of this study is to determine the views of orthopedic surgeons on (1) the extent of racial/ethnic disparities in orthopedic care, (2) patient and system factors that may contribute, and (3) the potential role of orthopedic surgeons in the reduction of disparities. Three hundred five members of the American Orthopaedic Association completed a survey to assess their knowledge of racial/ethnic disparities and their perceptions about the underlying causes. Twelve percent of respondents believe that patients often receive different care based on race/ethnicity in healthcare in general, while 9 % believe that differences exist in orthopedic care in general, 3 % believe that differences exist within their hospitals/clinics, and 1 % reported differences in their own practices. Despite this, 68 % acknowledge that there is evidence of disparities in orthopedic care. Fifty-one percent believe that a lack of insurance significantly contributes to disparities. Thirty-five percent believe that diversification of the orthopedic workforce would be a "very effective" strategy in addressing disparities, while 25 % percent believe that research would be "very effective" and 24 % believe that surgeon education would be "very effective." Awareness regarding racial/ethnic disparities in musculoskeletal care is low among orthopedic surgeons. Additionally, respondents were more likely to acknowledge disparities within the practices of others than their own. Increased diversity, research, and education may help improve knowledge of this problem.

Orthopedic injuries associated with backyard trampoline use in children.

Science.gov (United States)

Black, G Brian; Amadeo, Ryan

2003-06-01

Trampolining on an outdoor oval or circular trampoline is a popular activity for children but is associated with a number of orthopedic injuries, especially in children between the ages of 5 and 15 years. In this paper we review the orthopedic injuries in children associated with backyard trampoline use, through our experience with a series of children admitted to the Winnipeg Children's Hospital, the only tertiary care pediatric centre in Manitoba. We reviewed the charts, x-ray films and operative reports for 80 children under 16 years old (mean 9 yr, with 14 [18%] children between 2 and 4 yr) with an orthopedic injury sustained when using a trampoline in the backyard. We noted the mechanism of injury and type and severity of orthopedic injury sustained. Fifty-two (65%) children were injured on the trampoline mat, and 24 (30%) were injured when they were ejected from the trampoline. Sixty (75%) children sustained a fracture or fracture-dislocation. Forty-eight (80%) orthopedic injuries occurred in the upper extremity. No child died as a result of a trampoline injury. The use of the "backyard" trampoline by young children can cause significant orthopedic injury.

Review of fondaparinux sodium injection for the prevention of venous thromboembolism in patients undergoing surgery

Directory of Open Access Journals (Sweden)

David Bergqvist

2006-12-01

Full Text Available David BergqvistDepartment of Surgery, University Hospital, Uppsala, SwedenAbstract: The antithrombin binding sequence of heparin, a pentasaccharide, has been synthesized as fondaparinux, an indirect, selective, and reversible factor Xa inhibitor. It can be administered subcutaneously, is well absorbed, and has a half-life of c. 17 hours permitting once-daily injection. It has been evaluated in an extensive study program in major orthopedic surgery, including hip fracture, and in major abdominal surgery with a large proportion of surgery for cancer. The effect is at least as effective as for low-molecular-weight heparins and it has also been shown effective for extended prophylaxis in hip fracture patients. Several thousands of patients have been studied and the substance is safe, although a slightly higher frequency of bleedings is found than in patients on low-molecular-weight heparins. There is no specific antidote but if necessary, recombinant activated factor VII can be used. Other side-effects are rare. Fondaparinux is cost saving and sometimes cost neutral when compared with enoxaparin. Keywords: fondaparinux, venous thrombosis, venous thromboembolism, surgery, orthopedic surgery, major abdominal surgery, bleeding complications

Síndrome de Ehlers Danlos: ¿subregistro clínico en ortopedia pediátrica? Ehlers Danlos syndrome: a clinical subregister in pediatric orthopedics?

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George N. García Rodríguez

2008-06-01

descriptive study was conducted among all the patients with Ehlers Danlos syndrome that were seen at the Orthopedics and Traumatology department of "José Martí" Teaching Pediatric Hospital (Sancti Spiritus, Cuba from July 2001 to July 2006. A minimum follow-up time of 6 months was considered for the validation of the results. RESULTS. 41 patients affected with 72 diseases of orthopedic origin were studied. The frequency was approximately 1.7 diseases per patient, with a non significant predominance of females (n = 24. One of the most important perinatal antecedents was the presence of diverse hip dysplasia degrees. The presence of other non-orthopedic affections was not remarkable. The main orthopedic findings were the flexible flat foot (37, the genus recurvatum (11 and kyphoscoliosis (9. Aesthetic surgery and the corrective orthopedic surgery were the most used. CONCLUSIONS. The categorization of this disease and its timely treatment is an efficient method of control that would help to prevent the articular degeneration that generally precedes osteoarthritis.

Strategies for achieving orthopedic service line success.

Science.gov (United States)

Lang, Stacey; Powers, Kristi

2013-12-01

Healthcare finance leaders can work with orthopedic surgeons to support better outcomes, clinically and financially, by: Establishing innovative partnerships among hospital leaders, orthopedic surgeons, and implant vendors. Developing and enforcing expectations around contracting and vendor behavior. Establishing a forum for open communication. Building a bundled payment structure. Finding ways to differentiate from the competition.

ANALYSIS OF INA-CBG’S FARE AND GOVERNOR REGULATION FAREON SURGERY AT INPATIENT ROOM OF UNDATA REGIONAL PUBLIC HOSPITAL IN PALU

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Muh. Ryman Napirah

2016-03-01

Full Text Available Aim: In order to determine the fares of surgery, there are two types of fares used by hospitals namely Indonesian Case Based Groups fare (INA-CBG s and Governor Regulation fare. This study aimed to identify and analyze both types of fares in orthopedic surgery, general, eyes, midwifery, mouth, ENT, urology at inpatient room of Undata Regional Public Hospital in Palu during year 2014. Method: This was a quantitative study with descriptive approach with 46 cases as the number of surgery. Data were collected through observation and analysis of secondary data were gotten from medical record, pharmaceutical installation of IBS/IDR, inpatient therapy room (Matahari, Aster, and Teratai pavilions and cashier of inpatient room in form of cost details and patient data from January to December 2014. Data Presentation was formed on tables, where the existing fares are grouped based on the component of each cost then summed and calculated the deviation between the two types of fares. Results: This study indicated that orthopedic surgery with deviation of Rp 11.311.365, general surgery with deviation of Rp 6.438.409, eyes surgery with deviation of Rp 45.173.741, midwifery surgery with deviation of Rp 6.645.765, oral surgery with deviation of Rp 6.105.659, and urological surgery with deviation of Rp. 3.809.959. Conclusion: It can be concluded that INA-CBG's fares are higher than Governor Regulation fares except orthopedic surgery, where the Governor Regulation faresare higher than INA-CBG’s fares.

Patient throughput times for orthopedic outpatients in a department of radiology: results of an interdisciplinary quality management program

International Nuclear Information System (INIS)

Hodler, J.; Zanetti, M.; Strehle, J.; Gerber, C.; Schilling, J.

1999-01-01

The purpose of this project was to employ quality management methods in order to decrease throughput times for orthopedic outpatients sent to the department of radiology. The following intervals were measured at the onset of the study and after 6 and 12 months: (a) between arrivals at outpatient clinic and radiology counter; (b) between arrival at radiology counter and time of last radiograph; and (c) between time of last radiograph and radiology report printing time. After the initial measurement, numerous changes were initiated both in radiology and in orthopedic surgery. The mean interval between arrival at the outpatient clinic and in radiology decreased by one third from 60 min during the first measurement to 40 (p < 0.001) and 41 min during the second and third measurement. The proportion of patients with total radiology times of more than 30 min decreased from 41 to 29 % between the first and third measurements (p < 0.001). The corresponding results for radiology times of more than 45 min were 17 and 11 % (p = 0.03). A standard type of quality management program can be employed successfully in order to reduce radiology throughput times for orthopedic outpatients. (orig.)

Marijuana use and mortality following orthopedic surgical procedures.

Science.gov (United States)

Moon, Andrew S; Smith, Walter; Mullen, Sawyer; Ponce, Brent A; McGwin, Gerald; Shah, Ashish; Naranje, Sameer M

2018-03-20

The association between marijuana use and surgical procedures is a matter of increasing societal relevance that has not been well studied in the literature. The primary aim of this study is to evaluate the relationship between marijuana use and in-hospital mortality, as well as to assess associated comorbidities in patients undergoing commonly billed orthopedic surgeries. The National Inpatient Sample (NIS) database from 2010 to 2014 was used to determine the odds ratios for the associations between marijuana use and in-hospital mortality, heart failure (HF), stroke, and cardiac disease (CD) in patients undergoing five common orthopedic procedures: hip (THA), knee (TKA), and shoulder arthroplasty (TSA), spinal fusion, and traumatic femur fracture fixation. Of 9,561,963 patients who underwent one of the five selected procedures in the four-year period, 26,416 (0.28%) were identified with a diagnosis of marijuana use disorder. In hip and knee arthroplasty patients, marijuana use was associated with decreased odds of mortality compared to no marijuana use (pmarijuana use (0.70%), which was associated with decreased odds of mortality (p = 0.0483), HF (p = 0.0076), and CD (p = 0.0003). For spinal fusions, marijuana use was associated with increased odds of stroke (pMarijuana use in patients undergoing shoulder arthroplasty was associated with decreased odds of mortality (pmarijuana use was associated with decreased mortality in patients undergoing THA, TKA, TSA and traumatic femur fixation, although the significance of these findings remains unclear. More research is needed to provide insight into these associations in a growing surgical population.

Effect of postoperative epidural analgesia on rehabilitation and pain after hip fracture surgery

DEFF Research Database (Denmark)

Foss, Nicolai Bang; Kristensen, Morten Tange; Kristensen, Billy Bjarne

2005-01-01

Hip fracture surgery usually carries a high demand for rehabilitation and a significant risk of perioperative morbidity and mortality. Postoperative epidural analgesia may reduce morbidity and has been shown to facilitate rehabilitation in elective orthopedic procedures. No studies exist...... on the effect of postoperative epidural analgesia on pain and rehabilitation after hip fracture surgery....

Algodystrophy (CRPS) in minor orthopedic surgery.

Science.gov (United States)

Corradini, Costantino; Bosizio, Claudia; Moretti, Antimo

2015-01-01

Algodystrophy or Chronic Regional Pain Syndrome (CRPS) is a painful disorder that develops especially at upper or lower extremities of the limbs after a fracture. This syndrome is probably due to bone microvascular changes with subsequent sympathetic nervous system involvement. The pain that characterizes CRPS is spontaneous, disproportionate to the traumatic event and is associated with hyperalgesia, and a variety of autonomic and trophic disorders. This condition has a variable incidence up to 37% of the cases, increasing along with the severity of the fracture. CRPS has a higher chance of developing in women, in older individuals, in smokers, and in patients with reduced bone strength. Early diagnosis is associated with remission in 80-90% of cases. Since the typical onset of the disease is insidious over 2 weeks after surgery, a diagnostic and therapeutic delay may occur. These are the major causes of a high percentage of chronic and disabling complications leading to impaired functional outcomes. In the acute or subacute phase, infusion of bisphosphonates has proven to be the first-choice of treatment with a high percentage of remissions. Moreover, it has been suggested the utility of vitamin C in prevention of CRPS. Furthermore, in the chronic phase electroanalgesia seems to provide promising results.

Regional variation in acute care length of stay after orthopaedic surgery total joint replacement surgery and hip fracture surgery.

Science.gov (United States)

Fitzgerald, John D; Weng, Haoling H; Soohoo, Nelson F; Ettner, Susan L

2013-01-01

To examine change in regional variations in acute care length of stay (LOS) after orthopedic surgery following expiration of the New York (NY) State exemption to the Prospective Payment System and implementation of the Medicare Short Stay Transfer Policy. Time series analyses were conducted to evaluate change in LOS across regions after policy implementations. Small area analyses were conducted to examine residual variation in LOS. The dataset included A 100% sample of fee-for-service Medicare patients undergoing surgical repair for hip fracture or elective joint replacement surgery between 1996 and 2001. Data files from Centers for Medicare and Medicaid Services 1996-2001 Medicare Provider Analysis and Review file, 1999 Provider of Service file, and data from the 2000 United States Census were used for analysis. In 1996, LOS in NY after orthopedic procedures was much longer than the remainder of the country. After policy changes, LOS fell. However, significant residual variation in LOS persisted. This residual variation was likely partly explained by differences variation in regional managed care market penetration, patient management practices and unmeasured characteristics associated with the hospital location. NY hospitals responded to changes in reimbursement policy, reducing variation in LOS. However, even after 5 years of financial pressure to constrain costs, other factors still have a strong impact on delivery of patient care.

Artificial intelligence for analyzing orthopedic trauma radiographs.

Science.gov (United States)

Olczak, Jakub; Fahlberg, Niklas; Maki, Atsuto; Razavian, Ali Sharif; Jilert, Anthony; Stark, André; Sköldenberg, Olof; Gordon, Max

2017-12-01

Background and purpose - Recent advances in artificial intelligence (deep learning) have shown remarkable performance in classifying non-medical images, and the technology is believed to be the next technological revolution. So far it has never been applied in an orthopedic setting, and in this study we sought to determine the feasibility of using deep learning for skeletal radiographs. Methods - We extracted 256,000 wrist, hand, and ankle radiographs from Danderyd's Hospital and identified 4 classes: fracture, laterality, body part, and exam view. We then selected 5 openly available deep learning networks that were adapted for these images. The most accurate network was benchmarked against a gold standard for fractures. We furthermore compared the network's performance with 2 senior orthopedic surgeons who reviewed images at the same resolution as the network. Results - All networks exhibited an accuracy of at least 90% when identifying laterality, body part, and exam view. The final accuracy for fractures was estimated at 83% for the best performing network. The network performed similarly to senior orthopedic surgeons when presented with images at the same resolution as the network. The 2 reviewer Cohen's kappa under these conditions was 0.76. Interpretation - This study supports the use for orthopedic radiographs of artificial intelligence, which can perform at a human level. While current implementation lacks important features that surgeons require, e.g. risk of dislocation, classifications, measurements, and combining multiple exam views, these problems have technical solutions that are waiting to be implemented for orthopedics.

Hypobaric spinal anesthesia in the operative management of orthopedic emergencies in geriatric patients.

Science.gov (United States)

Sidi, A; Pollak, D; Floman, Y; Davidson, J T

1984-07-01

Hypobaric spinal anesthesia was administered to 40 patients undergoing lower limb surgery. Twenty-nine of the patients were debilitated geriatric patients who presented with orthopedic emergencies, in most cases a fractured hip. Hypobaric spinal anesthesia was found to be a simple and safe procedure that provided adequate analgesia. Due to its inherent nature, hypobaric spinal anesthesia does not necessitate positioning of the patient on the injured, painful side (unlike hyperbaric spinal or epidural anesthesia) and, therefore, facilitates a smooth and painless transfer of the patient to the operating table. Complications encountered were similar to those following hyperbaric anesthesia.

The CJOrtho app: A mobile clinical and educational tool for orthopedics.

Science.gov (United States)

Reina, N; Cognault, J; Ollivier, M; Dagneaux, L; Gauci, M-O; Pailhé, R

2018-04-11

The need for modern patient evaluation tools continues to grow. A dependable and reproducible assessment provides objective follow-up and increases the validity of collected data. This is where mobile apps come into play, as they provide a link between surgeons and patients. They also open the possibility of interacting with other healthcare staff to exchange common scientific reference systems and databases. The CJOrtho app provides fast access to 65 classification systems in orthopedics or trauma surgery, 20 clinical outcome scores and a digital goniometer. The development of free mobile apps is an opportunity for education and better follow-up, while meeting the demands of patients. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Quantitative analysis of the orthodontic and orthopedic effects of maxillary traction.

Science.gov (United States)

Baumrind, S; Korn, E L; Isaacson, R J; West, E E; Molthen, R

1983-11-01

This article analyzes differences in displacement of ANS and of the upper first molar when different vectors of force are delivered to the maxilla in non-full-banded Phase I mixed-dentition treatment of Class II malocclusion. The sample is identical to that for which we have previously reported differences in change in several key measures of mandibular and facial shape. It includes a cervical-traction group, a high-pull-to-upper-molar group, a modified-activator group, and an untreated Class II control group. Using newly developed computer-conducted procedures, which are described, we have been able to partition the orthodontic and orthopedic components of upper molar displacement and also to isolate treatment effects from those attributable to spontaneous growth and development. In the region of ANS, small but statistically significant and clinically meaningful differences were noted between treatments. When the intercurrent effects of growth and development had been factored out (Table III), orthopedic distal displacement of ANS was significantly greater in the high-pull and cervical groups than in the activator group. Orthopedic downward displacement of ANS was seen to be significantly greater in the cervical group than in the high-pull and activator groups. In the region of the first molar cusp, mean distal displacement of the tooth as an orthopedic effect was found to be almost identical in the cervical and high-pull groups (although variability was greater in the cervical group), but the mean orthodontic effect was significantly greater in the high-pull group than in the cervical group. In the cervical group, where relatively light forces were used for relatively long treatment periods on average, more of the total distal displacement of the upper molar was of an orthopedic character than of an orthodontic character. Conversely, in the high-pull group, in which relatively heavier forces tended to be used for briefer treatment periods, most of the distal

The Effect of Listening to Music on Postoperative Pain in Adult Orthopedic Patients.

Science.gov (United States)

Schneider, Melissa A

2018-03-01

Pain is a common occurrence after orthopedic surgery. Patients need additional resources to manage their pain. The purpose of this study was to determine if listening to music has a positive effect on pain scores and satisfaction in the postoperative adult orthopedic patient. There are limited studies demonstrating statistically significant decreases in postoperative pain in this group. A secondary purpose was to expose nurses on a standard medical-surgical unit to an intervention, supported by the holistic nursing model that they could use in their care. This study was a descriptive, comparative, quasi-experimental design. Patients listened to prerecorded music on individual CD players and recorded pre-post pain scores with the intervention. A satisfactory survey was completed at discharge. Results demonstrated a statistically significant reduction in patients' pain scores after listening to music. Length of listening time had no effect. Patients expressed overall satisfaction, and 100% of participants would recommend this intervention to others. Listening to music is beneficial as an adjunct to pain medication and contributes to increased patient satisfaction. It is hoped that the information gained from this study will lead to an enhancement in the standard of care for postoperative patients.

Current concept review: quality and process improvement in orthopedics

Directory of Open Access Journals (Sweden)

Pinney SJ

2015-12-01

Full Text Available Stephen J Pinney,1 Alexandra E Page,2 David S Jevsevar,3 Kevin J Bozic4 1Department of Orthopaedic Surgery, St Mary's Medical Center, San Francisco, CA, USA; 2Orthopaedic Surgery, AAOS Health Care Systems Committee, San Diego, CA, USA; 3Department of Orthopaedics, Geisel School of Medicine, Dartmouth University, Hanover, NH, USA; 4Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas, Austin, TX, USAAbstract: Multiple health care stakeholders are increasingly scrutinizing musculoskeletal care to optimize quality and cost efficiency. This has led to greater emphasis on quality and process improvement. There is a robust set of business strategies that are increasingly being applied to health care delivery. These quality and process improvement tools (QPITs have specific applications to segments of, or the entire episode of, patient care. In the rapidly changing health care world, it will behoove all orthopedic surgeons to have an understanding of the manner in which care delivery processes can be evaluated and improved. Many of the commonly used QPITs, including checklist initiatives, standardized clinical care pathways, lean methodology, six sigma strategies, and total quality management, embrace basic principles of quality improvement. These principles include focusing on outcomes, optimizing communication among health care team members, increasing process standardization, and decreasing process variation. This review summarizes the common QPITs, including how and when they might be employed to improve care delivery. Keywords: clinical care pathway, musculoskeletal care, outcomes, quality management, six sigma, lean thinking

Road traffic accidents and posttraumatic stress disorder in an orthopedic setting in south-eastern Nigeria: a controlled study

Science.gov (United States)

2011-01-01

Background Psychiatric liaison services are rare in trauma units of various hospitals in Nigeria and other sub-Saharan African countries. The occurrence of road traffic accidents (RTAs) resulting from low standard of road construction and inadequate maintenance have been on the increase in Nigeria. While the physical consequences of such RTAs are obvious, the psychological consequences are often not apparent. This study assessed the prevalence of posttraumatic stress disorder (PTSD) among victims of RTAs and compared same with controls drawn from a population who have not experienced RTAs. It also assessed the associated socio-demographic variables. Method Study population consisted of one hundred and fifty RTA victims and two different control groups drawn from the population consisting of staffs of Federal Neuropsychiatric Hospital, Enugu, Nigeria and that of National Orthopedic Hospital, Enugu, Nigeria, 150 people in each control group were matched for age and sex with the RTA victims and they were interviewed with PTSD module of Mini International Neuropsychiatric Interview (MINI) and their socio-demographic variables obtained with socio-demographic questionnaire. Results The prevalence of PTSD among RTA victims and the two control groups were 26.7%, 8.0% and 8.7% respectively. The difference in prevalence was statistically significant with RTA victims more likely to experience PTSD compared to the two control groups (X2 = 27.23, df = 2, p = 0.001). Gender influenced the prevalence of PTSD among victims of RTAs and the controls, with females more likely to experience PTSD when compared to the males. Among victims of RTAs, being gainfully employed prior to the accidents increased the likelihood of developing PTSD and this was statistically significant (X2 = 20.09, df = 1, p = 0.000). Conclusions There is urgent need to pay more attention to developing consultation-liaison psychiatry services in trauma units of Nigerian hospitals, including orthopedic hospitals

Road traffic accidents and posttraumatic stress disorder in an orthopedic setting in south-eastern Nigeria: a controlled study

Directory of Open Access Journals (Sweden)

Uwakwe Richard

2011-06-01

Full Text Available Abstract Background Psychiatric liaison services are rare in trauma units of various hospitals in Nigeria and other sub-Saharan African countries. The occurrence of road traffic accidents (RTAs resulting from low standard of road construction and inadequate maintenance have been on the increase in Nigeria. While the physical consequences of such RTAs are obvious, the psychological consequences are often not apparent. This study assessed the prevalence of posttraumatic stress disorder (PTSD among victims of RTAs and compared same with controls drawn from a population who have not experienced RTAs. It also assessed the associated socio-demographic variables. Method Study population consisted of one hundred and fifty RTA victims and two different control groups drawn from the population consisting of staffs of Federal Neuropsychiatric Hospital, Enugu, Nigeria and that of National Orthopedic Hospital, Enugu, Nigeria, 150 people in each control group were matched for age and sex with the RTA victims and they were interviewed with PTSD module of Mini International Neuropsychiatric Interview (MINI and their socio-demographic variables obtained with socio-demographic questionnaire. Results The prevalence of PTSD among RTA victims and the two control groups were 26.7%, 8.0% and 8.7% respectively. The difference in prevalence was statistically significant with RTA victims more likely to experience PTSD compared to the two control groups (X2 = 27.23, df = 2, p = 0.001. Gender influenced the prevalence of PTSD among victims of RTAs and the controls, with females more likely to experience PTSD when compared to the males. Among victims of RTAs, being gainfully employed prior to the accidents increased the likelihood of developing PTSD and this was statistically significant (X2 = 20.09, df = 1, p = 0.000. Conclusions There is urgent need to pay more attention to developing consultation-liaison psychiatry services in trauma units of Nigerian hospitals

Effects of opium addiction on level of sensory block in spinal anesthesia with bupivacaine for lower abdomen and limb surgery: a case-control study.

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Karbasy, Seyyed Hasan; Derakhshan, Pooya

2014-12-01

In clinical practice, the level of sensory block in spinal anesthesia in opium abusers is lower than that in non-abusers because of adaptive changes caused by opium use. The aim of this study was to investigate the level of sensory block resulting from the intrathecal administration of 0.5% bupivacaine in opium abuser patients undergoing lower extremity and lower abdominal surgeries. A total of 100 patients who were candidates of elective lower extremity orthopedic and lower abdominal surgeries were recruited and assigned to two groups based on their history of opium addiction (Case or control). Both groups underwent the same anesthesia procedure and pinprick test was used to assess the level of anesthesia. No statistically significant difference was observed between groups regarding age, duration of the surgery, and type of surgery. The frequency of addiction was higher in males than in females. The level of sensory block at three minutes was significantly lower in the opium abuser group (P = 0.006). The mean time to achieve T10 sensory block was 10.33 ± 5.79 minutes in the opium abusers and 6.89 ± 3.88 minutes in the controls (P = 0.001). The level of the highest sensory block was lower in the opium abuser group (P = 0.002). The findings of this study suggested that after induction of spinal anesthesia with intrathecal administration of bupivacaine, chronic opium abusers would have a lower level of sensory block in comparison with patients without a history of opium abuse.

SPECT/CT imaging in general orthopedic practice.

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Scharf, Stephen

2009-09-01

The availability of hybrid devices that combine the latest single-photon emission computed tomography (SPECT) imaging technology with multislice computed tomography (CT) scanning has allowed us to detect subtle, nonspecific abnormalities on bone scans and interpret them as specific focal areas of pathology. Abnormalities in the spine can be separated into those caused by pars fractures, facet joint arthritis, or osteophyte formation on vertebral bodies. Compression fractures can be distinguished from severe degenerative disease, both of which can cause intense activity across the spine on either planar or SPECT imaging. Localizing activity in patients who have had spinal fusion can provide tremendous insight into the causes of therapeutic failures. Infections of the spine now can be diagnosed with gallium SPECT/CT, despite the fact that gallium has long been abandoned because of its failure to detect spine infection on either planar or SPECT imaging. Small focal abnormalities in the feet and ankles can be localized well enough to make specific orthopedic diagnoses on the basis of their location. Moreover, when radiographic imaging provides equivocal or inadequate information, SPECT/CT can provide a road map for further diagnostic studies and has been invaluable in planning surgery. Our ability to localize activity within a bone or at an articular surface has allowed us to distinguish between fractures and joint disease. Increased activity associated with congenital anomalies, such as tarsal coalition and Bertolotti's syndrome have allowed us to understand the pathophysiology of these conditions, to confirm them as the cause of the patient's symptoms, and to provide information that is useful in determining appropriate clinical management. As our experience broadens, SPECT/CT will undoubtedly become an important tool in the evaluation and management of a wider variety of orthopedic patients.

Ranking sources of hospital quality information for orthopedic surgery patients: consequences for the system of managed competition.

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Bes, Romy Evelien; van den Berg, Bernard

2013-01-01

Healthcare quality information is crucial for the system of managed competition. Within a system of managed competition, health insurers can selectively contract care providers and are allowed to channel patients towards contracted providers. The idea is that insurers have a stronger bargaining position compared to care providers when they are able to channel patients. In the Dutch system of managed competition that was implemented in 2006, channelling patients to preferred providers has not yet been very successful. Empirical knowledge of which sources of hospital quality information they find important may help us to understand how to channel patients to preferred providers. The objective of this survey was to measure how patients rank various sources of information when they compare hospital quality in a system of managed competition. A written survey was conducted among clients of a large Dutch health insurance company. These clients underwent orthopedic surgery on the hip or knee no longer than 12 months ago. Two major players within a system of managed competition-health insurers and the government-were not seen as important sources of hospital quality information. In contrast, own experience and general practitioners (GPs) were seen as the most important sources of hospital quality information within the Dutch system of managed competition. Health insurers should take the main finding-that GPs are the most important source of hospital quality information-into account when they contract care providers and develop strategies for channeling patients towards preferred providers. A well-functioning system of managed competition will benefit patients, as it involves incentives for care providers to increase healthcare quality and to produce at the lowest cost per unit of quality.

The hand surgery fellowship application process: expectations, logistics, and costs.

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Meals, Clifton; Osterman, Meredith

2015-04-01

To investigate expectations, logistics, and costs relevant to the hand surgery fellowship application process. We sought to discover (1) what both applicants and program directors are seeking, (2) what both parties have to offer, (3) how both parties collect information about each other, and (4) the costs incurred in arranging each match. We conducted on-line surveys of hand surgery fellowship applicants for appointment in 2015 and of current fellowship program directors. Sixty-two applicants and 41 program directors completed the survey. Results revealed applicants' demographic characteristics, qualifications, method of ranking hand fellowship programs, costs incurred (both monetary and opportunity) during the application process, ultimate match status, and suggestions for change. Results also revealed program directors' program demographics, rationale for offering interviews and favorably ranking applicants, application-related logistical details, costs incurred (both monetary and opportunity) during the application process, and suggestions for change. Applicants for hand surgery fellowship training are primarily interested in a potential program's academic reputation, emphasis on orthopedic surgery, and location. The typical, successfully matched applicant was a 30-year-old male orthopedic resident with 3 publications to his credit. Applicants rely on peers and Web sites for information about fellowships. Fellowship directors are primarily seeking applicants recommended by other experienced surgeons and with positive personality traits. The typical fellowship director offers a single year of orthopedic-based fellowship training to 2 fellows per year and relies on a common application and in-person interviews to collect information about applicants. Applicants appear to be more concerned than directors about the current state of the match process. Applicants and directors alike incur heavy costs, in both dollars and opportunity, to arrange each match. A nuanced

Risk of postoperative hypoxemia in ambulatory orthopedic surgery patients with diagnosis of obstructive sleep apnea: a retrospective observational study

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Ma Yan

2010-06-01

Full Text Available Abstract Background It is unclear when it is safe to discharge patients with a diagnosis of Obstructive Sleep Apnea (OSA after ambulatory surgical procedures due to concern for postoperative respiratory compromise and hypoxemia. Our OSA patients undergoing ambulatory-type orthopedic procedures are monitored overnight in the PACU, thus we reviewed patient records to determine incidence of complications. Methods Two hundred and six charts of patients with preoperative diagnosis of OSA based on ICD-9 codes were reviewed for outcomes including episodes of hypoxemia. Univariate analysis followed by logistic regression and propensity analysis was performed to determine independent risk factors for hypoxemia and association with adverse outcomes. Results The majority of patients had regional anesthesia (95%. Thirty four percent of patients had hypoxemia in the PACU. Initial risk factors for hypoxemia identified by univariate analysis were BMI ≥ 35, increased age, history of COPD, upper extremity procedure, and use of peripheral nerve block. Independent risk factors identified by logistic regression were history of COPD (OR 3.64 with 95% CI 1.03-12.88 and upper extremity procedure (2.53, 1.36-4.68. After adjustment with propensity scores, adverse events were rare, and unplanned hospital admission after PACU stay was not increased with hypoxemia (11% vs 16% Conclusions Episodes of postoperative hypoxemia in OSA patients undergoing ambulatory surgery with regional anesthesia are not associated with increased adverse outcomes or unplanned hospital admission.

Awareness campaign. Orthopedic Hospital of Oklahoma launches awareness campaign.

Science.gov (United States)

2007-01-01

The Orthopedic Hospital of Oklahoma is a 25-bed inpatient and outpatient center with one focus: Orthopedics. To acquaint people with its services and build brand awareness to drive market share, the hospital launched a print campaign featuring actual patients.

[Basic concept in computer assisted surgery].

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Merloz, Philippe; Wu, Hao

2006-03-01

To investigate application of medical digital imaging systems and computer technologies in orthopedics. The main computer-assisted surgery systems comprise the four following subcategories. (1) A collection and recording process for digital data on each patient, including preoperative images (CT scans, MRI, standard X-rays), intraoperative visualization (fluoroscopy, ultrasound), and intraoperative position and orientation of surgical instruments or bone sections (using 3D localises). Data merging based on the matching of preoperative imaging (CT scans, MRI, standard X-rays) and intraoperative visualization (anatomical landmarks, or bone surfaces digitized intraoperatively via 3D localiser; intraoperative ultrasound images processed for delineation of bone contours). (2) In cases where only intraoperative images are used for computer-assisted surgical navigation, the calibration of the intraoperative imaging system replaces the merged data system, which is then no longer necessary. (3) A system that provides aid in decision-making, so that the surgical approach is planned on basis of multimodal information: the interactive positioning of surgical instruments or bone sections transmitted via pre- or intraoperative images, display of elements to guide surgical navigation (direction, axis, orientation, length and diameter of a surgical instrument, impingement, etc. ). And (4) A system that monitors the surgical procedure, thereby ensuring that the optimal strategy defined at the preoperative stage is taken into account. It is possible that computer-assisted orthopedic surgery systems will enable surgeons to better assess the accuracy and reliability of the various operative techniques, an indispensable stage in the optimization of surgery.

Trends in Accreditation Council for Graduate Medical Education Accreditation for Subspecialty Fellowship Training in Plastic Surgery.

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Silvestre, Jason; Serletti, Joseph M; Chang, Benjamin

2018-05-01

The purposes of this study were to (1) determine the proportion of plastic surgery residents pursuing subspecialty training relative to other surgical specialties, and (2) analyze trends in Accreditation Council for Graduate Medical Education accreditation of plastic surgery subspecialty fellowship programs. The American Medical Association provided data on career intentions of surgical chief residents graduating from 2014 to 2016. The percentage of residents pursuing fellowship training was compared by specialty. Trends in the proportion of accredited fellowship programs in craniofacial surgery, hand surgery, and microsurgery were analyzed. The percentage of accredited programs was compared between subspecialties with added-certification options (hand surgery) and subspecialties without added-certification options (craniofacial surgery and microsurgery). Most integrated and independent plastic surgery residents pursued fellowship training (61.8 percent versus 49.6 percent; p = 0.014). Differences existed by specialty from a high in orthopedic surgery (90.8 percent) to a low in colon and rectal surgery (3.2 percent). From 2005 to 2015, the percentage of accredited craniofacial fellowship programs increased, but was not significant (from 27.8 percent to 33.3 percent; p = 0.386). For hand surgery, the proportion of accredited programs that were plastic surgery (p = 0.755) and orthopedic surgery (p = 0.253) was stable, whereas general surgery decreased (p = 0.010). Subspecialty areas with added-certification options had more accredited fellowships than those without (100 percent versus 19.2 percent; p < 0.001). There has been slow adoption of accreditation among plastic surgery subspecialty fellowships, but added-certification options appear to be highly correlated.

Autologous blood transfusion in total knee replacement surgery.

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Sarkanović, Mirka Lukić; Gvozdenović, Ljiljana; Savić, Dragan; Ilić, Miroslav P; Jovanović, Gordana

2013-03-01

Total knee replacement (TKR) surgery is one of the most frequent and the most extensive procedures in orthopedic surgery, accompanied with some serious complications. Perioperative blood loss is one of the most serious losses, so it is vital to recognize and treat such losses properly. Autologous blood transfusion is the only true alternative for the allogeneic blood. The aim of this study was to to examine if autologous blood transfusion reduces usage of allogenic blood in total knee replacement surgery, as well as to examine possible effect of autologous blood transfusion on postoperative complications, recovery and hospital stay of patients after total knee replacement surgery. During the controlled, prospective, randomised study we compared two groups of patients (n = 112) with total prosthesis implanted in their knee. The group I consisted of the patients who received the transfusion of other people's (allogeneic) blood (n = 57) and the group II of the patients whose blood was collected postoperatively and then given them [their own (autologous) blood] (n = 55). The transfusion trigger for both groups was hemoglobin level of 85 g/L. In the group of patients whose blood was collected perioperatively only 9 (0.9%) of the patients received transfusion of allogeneic blood, as opposed to the control group in which 98.24% of the patients received the transfusion of allogeneic blood (p blood was collected stayed in hospital for 6.18 days, while the patients of the control group stayed 7.67 days (p blood transfusion is a very effective method for reducing consumption of allogenic blood and thus, indirectly for reducing all complications related to allogenic blood transfusion. There is also a positive influence on postoperative recovery after total knee replacement surgery due to the reduction of hospital stay, and indirectly on the reduction of hospital costs.

Reducing bacterial contamination in an Orthopedic Theatre ventilated by natural ventilation, in a Developing Country.

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Thomas, Stephanie; Palmer, Rish; Phillipo, Edward; Chipungu, Geoffrey

2016-05-31

All surgical procedures have the potential for infection and some of the main sources are contamination from airborne particles, theatre personnel and the theatre environment.  There is strong evidence that the use of ultra-clean air flow systems in orthopedic operating theatres reduces the incidence of deep sepsis after surgery. In the developing world however, this is often an unrealistic solution. The aim of this study was to establish baseline levels of contamination in a working orthopedic theatre, at the Queen Elizabeth Central Hospital, Blantyre, Malawi. To feedback results to the theatre team, promote infection prevention discussion and work with the team to implement workable and realistic goals to improve the intra-operative environment. Samples were collected from theatre equipment available at the time of surgery, from theatre water and theatre air using passive air sampling techniques. Samples were immediately transferred to the Central Microbiology Laboratory for culture on basic culture media. Bacterial contamination of theatre equipment, intra-operative theatre air and water was detected. Results were discussed with the theatre and infection prevention team who were receptive to feedback with regards to infection prevention strategies and keen to develop simple measures which could be put in place to change practice. In this setting, we suggest that implementing workable and realistic goals such as, establishing baseline rates of bacterial contamination and introduction of strict protocols for asepsis and theatre etiquette, may reduce bacterial contamination rates and subsequent intra-operative infection in the absence of expensive engineering solutions.

Declining trends in invasive orthopedic interventions for people with hemophilia enrolled in the Universal Data Collection program (2000–2010)

Science.gov (United States)

TOBASE, P.; LANE, H.; SIDDIQI, A.-E-A.; INGRAM-RICH, R.; WARD, R. S.

2016-01-01

Introduction Recurrent joint hemarthroses due to hemophilia (Factor VIII and Factor IX deficiency) often lead to invasive orthopedic interventions to decrease frequency of bleeding and/or to alleviate pain associated with end-stage hemophilic arthropathy. Aim Identify trends in invasive orthopedic interventions among people with hemophilia who were enrolled in the Universal Data Collection (UDC) program during the period 2000–2010. Methods Data were collected from 130 hemophilia treatment centers in the United States annually during the period 2000–2010, in collaboration with the Centers for Disease Control and Prevention (CDC). The number of visits in which an invasive orthopedic intervention was reported was expressed as a proportion of the total visits in each year of the program. Invasive orthopedic interventions consisted of arthroplasty, arthrodesis, and synovectomy. Joints included in this study were the shoulder, elbow, hip, knee, and ankle. Results A 5.6% decrease in all invasive orthopedic interventions in all joints of people with hemophilia enrolled in the UDC program over the 11-year study period was observed. Conclusions These data reflect a declining trend in invasive orthopedic interventions in people with hemophilia. Further research is needed to understand the characteristics that may influence invasive orthopedic interventions. PMID:27030396

Orthopedic Resident Anatomy Review Course: A Collaboration between Anatomists and Orthopedic Surgeons

Science.gov (United States)

DeFriez, Curtis B.; Morton, David A.; Horwitz, Daniel S.; Eckel, Christine M.; Foreman, K. Bo; Albertine, Kurt H.

2011-01-01

A challenge for new residents and senior residents preparing for board examinations is refreshing their knowledge of basic science disciplines, such as human gross anatomy. The Department of Orthopaedics at the University of Utah School of Medicine has for many years held an annual Orthopedic Resident Anatomy Review Course during the summer months…

Trends in workforce diversity in vascular surgery programs in the United States.

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Kane, Katherine; Rosero, Eric B; Clagett, G Patrick; Adams-Huet, Beverley; Timaran, Carlos H

2009-06-01

U.S. black and Hispanic populations are growing at a steady pace. In contrast, the medical profession lacks the same minority growth and representation. Women are also under-represented in many surgical disciplines. The purpose of this study was to assess trends in the proportion of women, blacks, and Hispanics admitted to vascular surgery (VS) and related specialties, and to compare them with each other and with a surgical specialty, orthopedic surgery (OS), with a formal diversity initiative. Data on the fellowship pool of VS, interventional radiology (IR), and interventional cardiology (IC), as well as the resident pools of general surgery (GS) and orthopedic surgery (OS), were obtained from U.S. graduate medical education reports for 1999 through 2005. Cochrane-Armitage trend tests were used to assess trends in the proportion of females, blacks, and Hispanics in relation to the total physician workforce for each subspecialty. No significant trends in the proportion of females, blacks, or Hispanics accepted into VS and IC fellowship programs occurred during the study period. In contrast, IR, GS, and OS programs revealed significant trends for increasing proportions of at least one of the underrepresented study groups. In particular, OS, which has implemented a diversity awareness program, showed a positive trend in female and Hispanic trainees (P workforce diversity.

The contribution of professor G. I. Turner in pediatric orthopedics and clinical surgery (160th anniversary of birth

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T. Sh Morgoshiya

2018-01-01

Full Text Available The article is devoted to the multifarious activities of Genrikh Ivanovich Turner (1858–1941. It is noted that originally G.I. Turner was interested in problems abstracted from orthopedics: acute purulent processes in the right iliac fossa, etc. In 1895, Turner was appointed Professor of  the Department of Desmurgy and Mechanics of  the Military Medical Academy. He revived the teaching of the subject and transmitted it into “broad practical soil”. Genrikh Ivanovich Turner became one of the founders of the Russian orthopedics, the organizer and the head (since 1900 of the first in Russia department and clinic of orthopedics. G.I. Turner gave a lot of power and energy to render assistance to sick children suffering from physical disabilities, restore the working capacity of children with disabilities. For many years he was in charge of the orphanage in St. Petersburg, which was transformed into the G.I. Turner Research Institute of Child Disability in 1932. This institution became an organizational and methodological center for combating child disability in  the Soviet Union. Genrikh Ivanovich was the first in Russia, who raised his voice in favor of  the disabled child, pointed out the need to provide systematic state assistance to disabled children with diseases of the musculoskeletal system.

From the risk analysis to the development of interventions and training for the prevention and control of healthcare associated infections. The experience of G. Pini Orthopedic Institute.

Science.gov (United States)

Navone, P; Conti, C; Domeniconi, G; Nobile, M

2015-01-01

Health-care associated infections (HAIs) represents a phenomenon of central importance all over Europe. Every year 4,5 millions cases are detected in European Union, with 37.000 related deaths. Surgical-site infections (SSIs) are one of the most common HAIs, that are associated with an increased length of stay, re-operation rate, intensive care admissions rate, and higher mortality rate. G. Pini Orthopedics Institute implemented in the last two years a multimodal strategy for controlling and preventing HAIs, in particular for SSIs. This paper describes the prevention's strategies adopted for prevention of HAIs, at G. Pini Orthopedic Institute. Our findings show that application of a multi modal promotion strategy was associated with an improvement in HAI prevention.

Publication Productivity of Early-Career Orthopedic Trauma Surgeons.

Science.gov (United States)

Hake, Mark E; Lee, John J; Goulet, James A

2016-01-01

The goals of this study were to: (1) define the publication productivity of early-career orthopedic trauma surgeons over time; (2) compare the early-career publication productivity of recent orthopedic trauma fellowship graduates vs their more senior colleagues; and (3) determine the proportion of fellowship graduates who meet the Orthopaedic Trauma Association (OTA) publication criteria for active membership early in their careers. Orthopedic trauma fellowship graduates from 1982 to 2007 were analyzed. A literature search was performed for each fellow's publications for the 6-year period beginning the year of fellowship graduation. Publication productivity was compared between early and recent groups of graduates, 1987 to 1991 and 2003 to 2007, respectively. Fulfillment of OTA publication criteria was determined. Seventy-nine percent of graduates contributed to 1 or more publications. The recent group produced more total publications per graduate (4.06 vs 3.29, P=.01) and more coauthor publications (2.60 vs 2.04, P=.019) than the early group. The number of first-author publications did not differ between groups (1.46 vs 1.25, P=.26). A greater percentage of the recent group met current OTA publication criteria compared with the early group (51% vs 35%, P=.04). The findings showed that recent orthopedic trauma graduates had increased publication productivity compared with their more senior colleagues, although a proportion had not qualified for active OTA membership 6 years into their career. Overall, these data are encouraging and suggest that young orthopedic trauma surgeons remain committed to sustaining a high level of academic excellence. Copyright 2016, SLACK Incorporated.

Value and clinical application of orthopedic metal artifact reduction algorithm in CT scans after orthopedic metal implantation

International Nuclear Information System (INIS)

Hu, Yi; Pan, Shinong; Zhao, Xudong; Guo, Wenli; He, Ming; Guo, Qiyong

2017-01-01

To evaluate orthopedic metal artifact reduction algorithm (O-MAR) in CT orthopedic metal artifact reduction at different tube voltages, identify an appropriate low tube voltage for clinical practice, and investigate its clinical application. The institutional ethical committee approved all the animal procedures. A stainless-steel plate and four screws were implanted into the femurs of three Japanese white rabbits. Preoperative CT was performed at 120 kVp without O-MAR reconstruction, and postoperative CT was performed at 80–140 kVp with O-MAR. Muscular CT attenuation, artifact index (AI) and signal-to-noise ratio (SNR) were compared between preoperative and postoperative images (unpaired t test), between paired O-MAR and non-O-MAR images (paired Student t test) and among different kVp settings (repeated measures ANOVA). Artifacts' severity, muscular homogeneity, visibility of inter-muscular space and definition of bony structures were subjectively evaluated and compared (Wilcoxon rank-sum test). In the clinical study, 20 patients undertook CT scan at low kVp with O-MAR with informed consent. The diagnostic satisfaction of clinical images was subjectively assessed. Animal experiments showed that the use of O-MAR resulted in accurate CT attenuation, lower AI, better SNR, and higher subjective scores (p < 0.010) at all tube voltages. O-MAR images at 100 kVp had almost the same AI and SNR as non-O-MAR images at 140 kVp. All O-MAR images were scored ≥ 3. In addition, 95% of clinical CT images performed at 100 kVp were considered satisfactory. O-MAR can effectively reduce orthopedic metal artifacts at different tube voltages, and facilitates low-tube-voltage CT for patients with orthopedic metal implants

How to Choose between the Implant Materials Steel and Titanium in Orthopedic Trauma Surgery: Part 2 - Biological Aspects.

Science.gov (United States)

Perren, S M; Regazzoni, P; Fernandez, A A

2017-01-01

BIOLOGICAL ASPECTS OF STEEL AND TITANIUM AS IMPLANT MATERIAL IN ORTHOPEDIC TRAUMA SURGERY The following case from the ICUC database, where a titanium plate was implanted into a flourishing infection, represents the clinical experience leading to preferring titanium over steel. (Fig. 1) (6). Current opinions regarding biological aspects of implant function. The "street" opinions regarding the biological aspects of the use of steel versus titanium as a surgical trauma implant material differ widely. Statements of opinion leaders range from "I do not see any difference in the biological behavior between steel and titanium in clinical application" to "I successfully use titanium implants in infected areas in a situation where steel would act as foreign body "sustaining" infection." Furthermore, some comments imply that clinical proof for the superiority of titanium in human application is lacking. The following tries to clarify the issues addressing the different aspects more through a practical clinical approach than a purely scientific one, this includes simplifications. Today's overall biocompatibility of implant materials is acceptable but: As the vast majority of secondary surgeries are elective procedures this allows the selection of implant materials with optimal infection resistance. The different biological reactions of stainless steel and titanium are important for this segment of clinical pathologies. Biological tole - rance (18) depends on the toxicity and on the amount of soluble implant material released. Release, diffusion and washout through blood circulation determine the local concentration of the corrosion products. Alloying components of steel, especially nickel and chromium, are less than optimal in respect to tissue tolerance and allergenicity. Titanium as a pure metal provides excellent biological tolerance (3, 4, 16). Better strength was obtained by titanium alloys like TiAl6V4. The latter found limited application as surgical implants. It

Wishing for deburdening through a sustainable control after bariatric surgery

Directory of Open Access Journals (Sweden)

My Engström

2011-02-01

Full Text Available The aim of this study was an in-depth investigation of the change process experienced by patients undergoing bariatric surgery. A prospective interview study was performed prior to as well as 1 and 2 years after surgery. Data analyses of the transcribed interviews were performed by means of the Grounded Theory method. A core category was identified: Wishing for deburdening through a sustainable control over eating and weight, comprising three related categories: hoping for deburdening and control through surgery, feeling deburdened and practising control through physical restriction, and feeling deburdened and trying to maintain control by own willpower. Before surgery, the participants experienced little or no control in relation to food and eating and hoped that the bariatric procedure would be the first brick in the building of a foundation that would lead to control in this area. The control thus achieved in turn affected the participants’ relationship to themselves, their roles in society, and the family as well as to health care. One year after surgery they reported established routines regarding eating as well as higher self-esteem due to weight loss. In family and society they set limits and in relation to health care staff they felt their concern and reported satisfaction with the surgery. After 2 years, fear of weight gain resurfaced and their self-image was modified to be more realistic. They were no longer totally self-confident about their condition, but realised that maintaining control was a matter of struggle to obtaining a foundation of sustainable control. Between 1 and 2 years after surgery, the physical control mechanism over eating habits started to more or less fade for all participants. An implication is that when this occurs, health care professionals need to provide interventions that help to maintain the weight loss in order to achieve a good long-term outcome.

Wishing for deburdening through a sustainable control after bariatric surgery.

Science.gov (United States)

Engström, My; Forsberg, Anna

2011-02-15

The aim of this study was an in-depth investigation of the change process experienced by patients undergoing bariatric surgery. A prospective interview study was performed prior to as well as 1 and 2 years after surgery. Data analyses of the transcribed interviews were performed by means of the Grounded Theory method. A core category was identified: Wishing for deburdening through a sustainable control over eating and weight, comprising three related categories: hoping for deburdening and control through surgery, feeling deburdened and practising control through physical restriction, and feeling deburdened and trying to maintain control by own willpower. Before surgery, the participants experienced little or no control in relation to food and eating and hoped that the bariatric procedure would be the first brick in the building of a foundation that would lead to control in this area. The control thus achieved in turn affected the participants' relationship to themselves, their roles in society, and the family as well as to health care. One year after surgery they reported established routines regarding eating as well as higher self-esteem due to weight loss. In family and society they set limits and in relation to health care staff they felt their concern and reported satisfaction with the surgery. After 2 years, fear of weight gain resurfaced and their self-image was modified to be more realistic. They were no longer totally self-confident about their condition, but realised that maintaining control was a matter of struggle to obtaining a foundation of sustainable control. Between 1 and 2 years after surgery, the physical control mechanism over eating habits started to more or less fade for all participants. An implication is that when this occurs, health care professionals need to provide interventions that help to maintain the weight loss in order to achieve a good long-term outcome.

Association of decision-making in spinal surgery with specialty and emotional involvement-the Indications in Spinal Surgery (INDIANA) survey.

Science.gov (United States)

Sollmann, Nico; Morandell, Carmen; Albers, Lucia; Behr, Michael; Preuss, Alexander; Dinkel, Andreas; Meyer, Bernhard; Krieg, Sandro M

2018-03-01

Although recent trials provided level I evidence for the most common degenerative lumbar spinal disorders, treatment still varies widely. Thus, the Indications in Spinal Surgery (INDIANA) survey explores whether decision-making is influenced by specialty or personal emotional involvement of the treating specialist. Nationwide, neurosurgeons and orthopedic surgeons specialized in spine surgery were asked to answer an Internet-based questionnaire with typical clinical patient cases of lumbar disc herniation (DH), lumbar spinal stenosis (SS), and lumbar degenerative spondylolisthesis (SL). The surgeons were assigned to counsel a patient or a close relative, thus creating emotional involvement. This was achieved by randomly allocating the surgeons to a patient group (PG) and relative group (RG). We then compared neurosurgeons to orthopedic surgeons and the PG to the RG regarding treatment decision-making. One hundred twenty-two spine surgeons completed the questionnaire (response rate 78.7%). Regarding DH and SS, more conservative treatment among orthopedic surgeons was shown (DH: odds ratio [OR] 4.1, 95% confidence interval [CI] 1.7-9.7, p = 0.001; SS: OR 3.9, CI 1.8-8.2, p emotional involvement (PG vs. RG) did not affect these results for any of the three cases (DH: p = 0.213; SS: p = 0.097; SL: p = 0.924). The high response rate indicates how important the issues raised by this study actually are for dedicated spine surgeons. Moreover, there are considerable variations in decision-making for the most common degenerative lumbar spinal disorders, although there is high-quality data from large multicenter trials available. Emotional involvement, though, did not influence treatment recommendations.

Comparison of Effectiveness of Reflexology and Abdominal Massage on Constipation among Orthopedic Patients: A single-blind Randomized Controlled Trial

Directory of Open Access Journals (Sweden)

Alehe Seyyedrassoli

2016-10-01

Full Text Available Constipation is one of the most common health problems presenting in patients hospitalized within orthopedic settings. This present study was done with the aim of determining the effect of foot reflexology and abdominal massage on constipation severity. This study is a single -blind randomized controlled trial completed using 3 groups comprising a total of 60 patients hospitalized in the orthopedic wards of shohada hospital in the Northwest Azerbaijan- Iran. One of the intervention groups involved the use of foot reflexology and in the other abdominal massage was carried out once daily for 6 days. An assessor blinded to the group allocation measured and recorded constipation severity before the intervention, then daily from day 1 until day 6 post intervention by constipation evaluation scale. For data analysis, ANOVA, ANCOVA and repeated measurement ANOVA tests was used in SPSS version 16. There was no significant difference between the intervention and control groups in constipation severity over the first two days (p>0. 05 built from the 3rd until the 6th days after the intervention, the difference was significant (p0.05. After modification and deleting covariate variables, again, there was a significant difference between intervention groups with a control group from day 3 until day 6 of the intervention(p<0. 05, (effect size from 34% to 50%. Time had a significant effect on constipation severity reduction during the study, meaning that constipation, severe in the intervention groups decreased significantly as the study progressed (p<0. 05. The positive effects of foot reflexology and abdominal massage on the severity of constipation in hospitalized patients means that both can be used as economical and noninvasive nursing interventions for the relief of constipation.

Socioeconomic value of orthopedic devices: evidence and methodological challenges

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Sorenson C

2012-10-01

Full Text Available Corinna Sorenson,1,2 Michael Drummond2,31LSE Health, London School of Economics, London, UK; 2European Health Technology Institute for Socioeconomic Research, Brussels, Belgium; 3Centre for Health Economics, University of York, York, UKAbstract: With continued technological advances in orthopedic devices and increasingly limited health care resources, greater attention will be placed on substantiating the socioeconomic value of these devices. Therefore, this study focused on a systematic review of available economic evaluations of selected orthopedic devices (n = 33 studies to assess their impact on different clinical and economic outcomes. The existing evidence suggests that they have important benefits to patients, including reduced risk of fractures, increased mobility and functioning, and enhanced quality of life, and do so cost effectively or with cost savings. However, we have identified several methodological obstacles to sufficient ascertainment of value, such as a lack of robust information on health economic outcomes and long-term evidence. We also identify areas where additional research is needed to assess more fully the value of orthopedic devices.Keywords: medical devices, orthopedics, health economic evaluation

Frequency of orthopedic diseases in horses: A retrospective study

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Kovač Milomir

2002-01-01

Full Text Available This retrospective study determined the frequency of orthopedic diseases in horses. It was possible to establish 141 specific orthopedic diagnoses in 1955 horses with lameness. In 14.58 % horses, multiple pathologic orthopedic changes were determined. In 61.84 % cases, the pathologic changes were present on the thoracic limb, 28,86 % on the pelvic limb and other parts of the oganism (neck, spine, muscles in 9.29 % cases. Pathologic changes on the tendons, ligaments, tendon sheats, bursae and muscles were determined in 31.51 % cases. Diseases of the hoof were present in 25.82 % cases. According to our investigation the most frequent orthopedic diseases are: podarthritis (acute, chronic, septic (5.04 %, navicular disease (4.69 %, tendinitis m. flexor digitalis superfacialis (4.51 %, kissing spine syndrom (4.30 % periarthritis et osteoarthrosis tarsi (3.30 %, distal metacarpal/metatarzophalengeal tendovaginitis (3.30 % and high suspensory ligament desmitis (3.12 %. Most frequent fractures were diagnosed on the metacarpal/metatarsal bone II and IV (2.56 %. Osteochondrossis dissecans was most frequently determined in the tarsocrural (1.26 % and the metacarpophalengeal joint (1.56 %.

3D-printed patient-specific applications in orthopedics

OpenAIRE

Wong KC

2016-01-01

Kwok Chuen Wong Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Abstract: With advances in both medical imaging and computer programming, two-dimensional axial images can be processed into other reformatted views (sagittal and coronal) and three-dimensional (3D) virtual models that represent a patients’ own anatomy. This processed digital information can be analyzed in detail by orthopedic surgeons to perform p...

iPad apps for orthopedic surgeons.

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Franko, Orrin I; Bhola, Siddharth

2011-12-01

The development and distribution of mobile applications, or apps, designed for medical professionals and patients is quickly expanding, and within this group are apps designed specifically for orthopedic use. Currently, the most popular mobile apps are sponsored by private companies and focus on delivering device-specific information. If this trend toward the use of privately funded educational materials continues, regulations may need to be established to ensure that the information provided is accurate, honest, and supported by peer-reviewed literature. It will likely be the responsibility of the orthopedic community to ensure that the development and use of these apps has appropriate oversight and validation as they are incorporated into clinical practice and training. Copyright © 2011, SLACK Incorporated.

Metallic artifact in MRI after removal of orthopedic implants

International Nuclear Information System (INIS)

Bagheri, Mohammad Hadi; Hosseini, Mehrdad Mohammad; Emami, Mohammad Jafar; Foroughi, Amin Aiboulhassani

2012-01-01

Objective: The aim of the present study was to evaluate the metallic artifacts in MRI of the orthopedic patients after removal of metallic implants. Subjects and methods: From March to August 2009, 40 orthopedic patients operated for removal of orthopedic metallic implants were studied by post-operative MRI from the site of removal of implants. A grading scale of 0–3 was assigned for artifact in MR images whereby 0 was considered no artifact; and I–III were considered mild, moderate, and severe metallic artifacts, respectively. These grading records were correlated with other variables including the type, size, number, and composition of metallic devices; and the site and duration of orthopedic devices stay in the body. Results: Metallic susceptibly artifacts were detected in MRI of 18 of 40 cases (45%). Screws and pins in removed hardware were the most important factors for causing artifacts in MRI. The artifacts were found more frequently in the patients who had more screws and pins in the removed implants. Gender, age, site of implantation of the device, length of the hardware, composition of the metallic implants (stainless steel versus titanium), and duration of implantation of the hardware exerted no effect in producing metallic artifacts after removal of implants. Short TE sequences of MRI (such as T1 weighted) showed fewer artifacts. Conclusion: Susceptibility of metallic artifacts is a frequent phenomenon in MRI of patients upon removal of metallic orthopedic implants.

Metallic artifact in MRI after removal of orthopedic implants.

Science.gov (United States)

Bagheri, Mohammad Hadi; Hosseini, Mehrdad Mohammad; Emami, Mohammad Jafar; Foroughi, Amin Aiboulhassani

2012-03-01

The aim of the present study was to evaluate the metallic artifacts in MRI of the orthopedic patients after removal of metallic implants. From March to August 2009, 40 orthopedic patients operated for removal of orthopedic metallic implants were studied by post-operative MRI from the site of removal of implants. A grading scale of 0-3 was assigned for artifact in MR images whereby 0 was considered no artifact; and I-III were considered mild, moderate, and severe metallic artifacts, respectively. These grading records were correlated with other variables including the type, size, number, and composition of metallic devices; and the site and duration of orthopedic devices stay in the body. Metallic susceptibly artifacts were detected in MRI of 18 of 40 cases (45%). Screws and pins in removed hardware were the most important factors for causing artifacts in MRI. The artifacts were found more frequently in the patients who had more screws and pins in the removed implants. Gender, age, site of implantation of the device, length of the hardware, composition of the metallic implants (stainless steel versus titanium), and duration of implantation of the hardware exerted no effect in producing metallic artifacts after removal of implants. Short TE sequences of MRI (such as T1 weighted) showed fewer artifacts. Susceptibility of metallic artifacts is a frequent phenomenon in MRI of patients upon removal of metallic orthopedic implants. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Value and clinical application of orthopedic metal artifact reduction algorithm in CT scans after orthopedic metal implantation

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Hu, Yi; Pan, Shinong; Zhao, Xudong; Guo, Wenli; He, Ming; Guo, Qiyong [Shengjing Hospital of China Medical University, Shenyang (China)

2017-06-15

To evaluate orthopedic metal artifact reduction algorithm (O-MAR) in CT orthopedic metal artifact reduction at different tube voltages, identify an appropriate low tube voltage for clinical practice, and investigate its clinical application. The institutional ethical committee approved all the animal procedures. A stainless-steel plate and four screws were implanted into the femurs of three Japanese white rabbits. Preoperative CT was performed at 120 kVp without O-MAR reconstruction, and postoperative CT was performed at 80–140 kVp with O-MAR. Muscular CT attenuation, artifact index (AI) and signal-to-noise ratio (SNR) were compared between preoperative and postoperative images (unpaired t test), between paired O-MAR and non-O-MAR images (paired Student t test) and among different kVp settings (repeated measures ANOVA). Artifacts' severity, muscular homogeneity, visibility of inter-muscular space and definition of bony structures were subjectively evaluated and compared (Wilcoxon rank-sum test). In the clinical study, 20 patients undertook CT scan at low kVp with O-MAR with informed consent. The diagnostic satisfaction of clinical images was subjectively assessed. Animal experiments showed that the use of O-MAR resulted in accurate CT attenuation, lower AI, better SNR, and higher subjective scores (p < 0.010) at all tube voltages. O-MAR images at 100 kVp had almost the same AI and SNR as non-O-MAR images at 140 kVp. All O-MAR images were scored ≥ 3. In addition, 95% of clinical CT images performed at 100 kVp were considered satisfactory. O-MAR can effectively reduce orthopedic metal artifacts at different tube voltages, and facilitates low-tube-voltage CT for patients with orthopedic metal implants.

[Orthopedics and patients under national socialism dictatorship].

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Thomann, K D; Rauschmann, M

2001-10-01

The 12-year dictatorship of National Socialism represents a decisive event in the history of orthopedics in Germany. Treatment and care was limited to those patients whose prognosis promised their reintegration into the work force. Those orthopedic patients with mental and psychological handicaps no longer came under the care of orthopedists and were potential candidates for annihilation. Despite concerted efforts to the contrary, as can be gleaned from the lists of topics at the annual meetings, the prevailing political circumstances encumbered scientific activities. The almost total isolation from international contacts had a negative effect. Orthopedists were hindered in their work by the law on sterilization, which provided for sterilization in cases of severe physical deformity. Some orthopedists even considered the presence of hip dysplasia to be an indication. The roles played by Georg Hohmann, Hellmut Eckhardt, Lothar Kreuz, and other leading orthopedists are described in detail. It can be regarded as certain that Hohmann and Eckhardt were able to prevent dire consequences for their orthopedic patients and the profession by cautious tactics. The ethnical problems of involvement with National Socialism are thoroughly discussed.

Computational surgery and dual training computing, robotics and imaging

CERN Document Server

Bass, Barbara; Berceli, Scott; Collet, Christophe; Cerveri, Pietro

2014-01-01

This critical volume focuses on the use of medical imaging, medical robotics, simulation, and information technology in surgery. It offers a road map for computational surgery success,  discusses the computer-assisted management of disease and surgery, and provides a rational for image processing and diagnostic. This book also presents some advances on image-driven intervention and robotics, as well as evaluates models and simulations for a broad spectrum of cancers as well as cardiovascular, neurological, and bone diseases. Training and performance analysis in surgery assisted by robotic systems is also covered. This book also: ·         Provides a comprehensive overview of the use of computational surgery and disease management ·         Discusses the design and use of medical robotic tools for orthopedic surgery, endoscopic surgery, and prostate surgery ·         Provides practical examples and case studies in the areas of image processing, virtual surgery, and simulation traini...

Serious Leisure and People with Orthopedic Impairment: Benefits and Constraints

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Manolya AKSATAN

2017-12-01

Full Text Available There are many people around the world who have different types of disabilities. Understanding their needs is the first step of developing policies to increase their quality of life and satisfaction. Leisure is an essential need of disabled people and it plays an important role in disabled people’s lives. The purpose of this study is to gain a deep understanding on the serious leisure activities of people with orthopedic impairment, and also both benefits and constraints involved with serious leisure. Therefore, semi-structured in-depth interviews were conducted with 17 people who have orthopedic impairment. The data collected through interviews was analyzed by using a coding process. Findings of the study indicate that people with orthopedic impairment pursue many leisure activities. The research revealed that the participants were aware of significant individual and community benefits of serious leisure activities. Although the benefits of leisure for private and community life are obvious for people with orthopedic impairment, it is not always easy for them to pursue serious leisure activities. Disabled people recognize that there are many constraints involved with serious leisure. Based on the findings, these constraints are explained as psychological factors, family support, level of orthopedic impairment, community awareness and environmental factors, work and income.

Molecular imaging promotes progress in orthopedic research.

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Mayer-Kuckuk, Philipp; Boskey, Adele L

2006-11-01

Modern orthopedic research is directed towards the understanding of molecular mechanisms that determine development, maintenance and health of musculoskeletal tissues. In recent years, many genetic and proteomic discoveries have been made which necessitate investigation under physiological conditions in intact, living tissues. Molecular imaging can meet this demand and is, in fact, the only strategy currently available for noninvasive, quantitative, real-time biology studies in living subjects. In this review, techniques of molecular imaging are summarized, and applications to bone and joint biology are presented. The imaging modality most frequently used in the past was optical imaging, particularly bioluminescence and near-infrared fluorescence imaging. Alternate technologies including nuclear and magnetic resonance imaging were also employed. Orthopedic researchers have applied molecular imaging to murine models including transgenic mice to monitor gene expression, protein degradation, cell migration and cell death. Within the bone compartment, osteoblasts and their stem cells have been investigated, and the organic and mineral bone phases have been assessed. These studies addressed malignancy and injury as well as repair, including fracture healing and cell/gene therapy for skeletal defects. In the joints, molecular imaging has focused on the inflammatory and tissue destructive processes that cause arthritis. As described in this review, the feasibility of applying molecular imaging to numerous areas of orthopedic research has been demonstrated and will likely result in an increase in research dedicated to this powerful strategy. Molecular imaging holds great promise in the future for preclinical orthopedic research as well as next-generation clinical musculoskeletal diagnostics.

Tessier No. 3 and No. 4 clefts: Sequential treatment in infancy by pre-surgical orthopedic skeletal contraction, comprehensive reconstruction, and novel surgical lengthening of the ala base-canthal distance.

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Spolyar, John L; Hnatiuk, Mark; Shaheen, Kenneth W; Mertz, Jennifer K; Handler, Lawrence F; Jarial, Ravinder; Roldán, J Camilo

2015-09-01

Repair of facial clefts implies wide tissue mobilization with multi-stage surgical treatment. Authors propose pre-surgical orthopedic correction for naso-oro-ocular clefts and a novel surgical option for Tessier No. 3 cleft. Two male infants, a Tessier No. 3 cleft (age 7 months) and another Tessier No. 4 (age 3 months), were treated with a modified orthopedic Latham device with additional septo-premaxillary molding and observed to age four years. Tessier No. 3 orthopedic measurements were obtained by image corrected cephalometric analysis. Subsequent repair included tissue expansion on Tessier No. 4 and naso-frontal Rieger flap combined with myocutaneous upper lid flap on Tessier No. 3. Orthopedic movements ranged from 18.5 mm in bi-planar to 33 mm in oblique analyses. Tissue margins became aligned with platform normalization. Tissue expansion on Tessier No. 4 improved distances from ala base-lower lid and subalar base-lip. The naso-frontal flap combined with myocutaneous upper lid flap on Tessier No. 3 had similar achievement, but also sufficiently lengthened ala base-canthal distance. Repairs were facilitated by pre-surgical orthopedic correction. The naso-frontal flap combined with an upper lid myocutaneous flap seems viable as a single-stage option to lengthen ala base-canthal distance to advance repair achievement in unilateral Tessier No. 3. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

In-111-labeled leukocyte scintigraphy in suspected orthopedic prosthesis infection: comparison with other imaging modalities

International Nuclear Information System (INIS)

Magnuson, J.E.; Brown, M.L.; Hauser, M.F.; Berquist, T.H.; Fitzgerald, R.H. Jr.; Klee, G.G.

1988-01-01

When infection of prosthetic orthopedic implants is suspected, optimal management requires accurate confirmation or exclusion of infection. The authors retrospectively studied 98 patients with possible infection who underwent scanning with indium-111-labeled white blood cells (WBCs) and subsequently underwent surgery within 14 days. At surgery, 50 patients had infections, as determined by means of culture or histologic results. The diagnostic accuracy of In-111 scanning was compared with that of plain radiography, arthrography, three-phase bone scanning, and various clinical and laboratory findings classically associated with infection. Positive findings on In-111 WBC scans and elevated erythrocyte sedimentation rates were found to be the most predictive variables in the diagnosis of septic prostheses (P less than or equal to .001 and P less than or equal to .002, respectively). Likelihood ratio analysis more clearly demonstrated the superiority of In-111 WBC scanning, with positive and negative scans yielding likelihood ratios of 5.0 and 0.16, respectively

Clinical potential of implantable wireless sensors for orthopedic treatments.

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Karipott, Salil Sidharthan; Nelson, Bradley D; Guldberg, Robert E; Ong, Keat Ghee

2018-04-01

Implantable wireless sensors have been used for real-time monitoring of chemicals and physical conditions of bones, tendons and muscles to diagnose and study orthopedic diseases and injuries. Due to the importance of these sensors in orthopedic care, a critical review, which not only analyzes the underlying technologies but also their clinical implementations and challenges, will provide a landscape view on their current state and their future clinical role. Areas covered: By conducting an extensive literature search and following the leaders of orthopedic implantable wireless sensors, this review covers the battery-powered and battery-free wireless implantable sensor technologies, and describes their implementation for hips, knees, spine, and shoulder stress/strain monitoring. Their advantages, limitations, and clinical challenges are also described. Expert commentary: Currently, implantable wireless sensors are mostly limited for scientific investigations and demonstrative experiments. Although rapid advancement in sensors and wireless technologies will push the reliability and practicality of these sensors for clinical realization, regulatory constraints and financial viability in medical device industry may curtail their continuous adoption for clinical orthopedic applications. In the next five years, these sensors are expected to gain increased interest from researchers, but wide clinical adoption is still unlikely.

Minimally invasive registration for computer-assisted orthopedic surgery: combining tracked ultrasound and bone surface points via the P-IMLOP algorithm.

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Billings, Seth; Kang, Hyun Jae; Cheng, Alexis; Boctor, Emad; Kazanzides, Peter; Taylor, Russell

2015-06-01

We present a registration method for computer-assisted total hip replacement (THR) surgery, which we demonstrate to improve the state of the art by both reducing the invasiveness of current methods and increasing registration accuracy. A critical element of computer-guided procedures is the determination of the spatial correspondence between the patient and a computational model of patient anatomy. The current method for establishing this correspondence in robot-assisted THR is to register points intraoperatively sampled by a tracked pointer from the exposed proximal femur and, via auxiliary incisions, from the distal femur. In this paper, we demonstrate a noninvasive technique for sampling points on the distal femur using tracked B-mode ultrasound imaging and present a new algorithm for registering these data called Projected Iterative Most-Likely Oriented Point (P-IMLOP). Points and normal orientations of the distal bone surface are segmented from ultrasound images and registered to the patient model along with points sampled from the exposed proximal femur via a tracked pointer. The proposed approach is evaluated using a bone- and tissue-mimicking leg phantom constructed to enable accurate assessment of experimental registration accuracy with respect to a CT-image-based model of the phantom. These experiments demonstrate that localization of the femur shaft is greatly improved by tracked ultrasound. The experiments further demonstrate that, for ultrasound-based data, the P-IMLOP algorithm significantly improves registration accuracy compared to the standard ICP algorithm. Registration via tracked ultrasound and the P-IMLOP algorithm has high potential to reduce the invasiveness and improve the registration accuracy of computer-assisted orthopedic procedures.

3D printing in orthopedics and neurosurgery: Presentation held at 3D Printing & Bio-Printing in Healthcare Conference, 12th & 13th October 2017, Düsseldorf, Germany

OpenAIRE

Grunert, Ronny; Rotsch, Christian; Müller, Marcel; Schmidt, Michael; Möbius, Robert; Töppel, Thomas; Prietzel, Torsten; Winkler, Dirk

2017-01-01

Concept of a lightweight tumor endoprosthesis in orthopedic surgery which is created with laser beam melting allows the realization of the original biomechanics • Biopsy target platform for neurosurgery enables the surgeon to remove unknown tissue out of the brain with a high precision for further diagnosis• 3D printing supports the surgeons in patient-individualized therapy

The impact of sarcopenia on the results of lumbar spinal surgery

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Hiroyuki Inose

2018-03-01

Full Text Available Objectives: As the population ages, the number of lumbar spinal surgeries performed on sarcopenic patients will increase. The purpose of this study was to investigate the prevalence of sarcopenia and evaluated its impact on the results of lumbar spinal surgery. Methods: This study included 2 groups: One group consisted of patients who underwent whole-body dual-energy X-ray absorptiometry (DXA scanning before the option of undergoing surgery for lumbar spinal disease (LSD group and a second group consisted of patients underwent DXA scanning for osteoporosis screening under hospital watch at the geriatric medicine department (control group. In order to evaluate the impact of sarcopenia on the clinical outcome of lumbar spinal surgery, the Japanese Orthopedic Association (JOA score, the recovery rate based on the JOA score, and visual analogue scale (VAS scores for lower back pain, lower extremity pain, and lower extremity numbness were compared within the LSD group. Results: The prevalence of sarcopenia showed no statistical difference between groups (control group, 50.7%; LSD group, 46.5%. In the LSD group, while the changes in VAS scores showed no statistical difference between the nonsarcopenia subgroup and sarcopenia subgroup, the sarcopenia subgroup demonstrated inferior JOA scores and recovery rates at the final follow-up when compared with the nonsarcopenia subgroup (P < 0.05. Conclusions: This study demonstrated a high prevalence of sarcopenia among the elderly populations in Japan and a negative impact of sarcopenia on clinical outcomes after lumbar spinal surgery. Keywords: Lumbar canal stenosis, Sarcopenia

Medication Review and Patient Outcomes in an Orthopedic Department

DEFF Research Database (Denmark)

Lisby, Marianne; Bonnerup, Dorthe Krogsgaard; Brock, Birgitte

2015-01-01

OBJECTIVE: We investigated the health-related effect of systematic medication review performed by a clinical pharmacist and a clinical pharmacologist on nonelective elderly orthopedic patients. METHODS: This is a nonblinded randomized controlled study of 108 patients 65 years or older treated...... with at least 4 drugs. For the intervention, the clinical pharmacist reviewed the participants' medication after completion of the usual medication routine. Information was collected from medical charts, interviews with participants, and database registrations of drug purchase. Results were conferred...

Effectiveness of ketamine as an adjuvant to opioid-based therapy in decreasing pain associated with opioid tolerance in adults undergoing orthopedic surgery: a systematic review protocol.

Science.gov (United States)

Bennett, Marsha; Bonanno, Laura; Kuhn, William

2016-10-01

The objective of this systematic review is to examine the best available evidence on the clinical effectiveness of ketamine as an adjuvant to opioid-based therapy versus opioid-based therapy alone in decreasing perioperative pain associated with opioid tolerance in adult patients, aged 18-70 years, undergoing orthopedic surgical procedures.The following question guides the systematic review: does the administration of ketamine as an adjuvant to opioid-based therapy, compared to opioid-based therapy alone, improve perioperative pain relief in opioid-tolerant adult patients undergoing orthopedic surgical procedures?

The Effects of Perioperative Music Interventions in Pediatric Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Science.gov (United States)

van der Heijden, Marianne J E; Oliai Araghi, Sadaf; van Dijk, Monique; Jeekel, Johannes; Hunink, M G Myriam

2015-01-01

Music interventions are widely used, but have not yet gained a place in guidelines for pediatric surgery or pediatric anesthesia. In this systematic review and meta-analysis we examined the effects of music interventions on pain, anxiety and distress in children undergoing invasive surgery. We searched 25 electronic databases from their first available date until October 2014. Included were all randomized controlled trials with a parallel group, crossover or cluster design that included pediatric patients from 1 month to 18 years old undergoing minimally invasive or invasive surgical procedures, and receiving either live music therapy or recorded music. 4846 records were retrieved from the searches, 26 full text reports were evaluated and data was extracted by two independent investigators. Pain was measured with the Visual Analogue Scale, the Coloured Analogue Scale and the Facial Pain Scale. Anxiety and distress were measured with an emotional index scale (not validated), the Spielberger short State Trait Anxiety Inventory and a Facial Affective Scale. Three RCTs were eligible for inclusion encompassing 196 orthopedic, cardiac and day surgery patients (age of 1 day to 18 years) receiving either live music therapy or recorded music. Overall a statistically significant positive effect was demonstrated on postoperative pain (SMD -1.07; 95%CI-2.08; -0.07) and on anxiety and distress (SMD -0.34 95% CI -0.66; -0.01 and SMD -0.50; 95% CI -0.84; - 0.16. This systematic review and meta-analysis indicates that music interventions may have a statistically significant effect in reducing post-operative pain, anxiety and distress in children undergoing a surgical procedure. Evidence from this review and other reviews suggests music therapy may be considered for clinical use.

Improving surgeon utilization in an orthopedic department using simulation modeling

Directory of Open Access Journals (Sweden)

Simwita YW

2016-10-01

Full Text Available Yusta W Simwita, Berit I Helgheim Department of Logistics, Molde University College, Molde, Norway Purpose: Worldwide more than two billion people lack appropriate access to surgical services due to mismatch between existing human resource and patient demands. Improving utilization of existing workforce capacity can reduce the existing gap between surgical demand and available workforce capacity. In this paper, the authors use discrete event simulation to explore the care process at an orthopedic department. Our main focus is improving utilization of surgeons while minimizing patient wait time.Methods: The authors collaborated with orthopedic department personnel to map the current operations of orthopedic care process in order to identify factors that influence poor surgeons utilization and high patient waiting time. The authors used an observational approach to collect data. The developed model was validated by comparing the simulation output with the actual patient data that were collected from the studied orthopedic care process. The authors developed a proposal scenario to show how to improve surgeon utilization.Results: The simulation results showed that if ancillary services could be performed before the start of clinic examination services, the orthopedic care process could be highly improved. That is, improved surgeon utilization and reduced patient waiting time. Simulation results demonstrate that with improved surgeon utilizations, up to 55% increase of future demand can be accommodated without patients reaching current waiting time at this clinic, thus, improving patient access to health care services.Conclusion: This study shows how simulation modeling can be used to improve health care processes. This study was limited to a single care process; however the findings can be applied to improve other orthopedic care process with similar operational characteristics. Keywords: waiting time, patient, health care process

Neuropathic Minimally Invasive Surgeries (NEMESIS):: Percutaneous Diabetic Foot Surgery and Reconstruction.

Science.gov (United States)

Miller, Roslyn J

2016-09-01

Patients with peripheral neuropathy associated with ulceration are the nemesis of the orthopedic foot and ankle surgeon. Diabetic foot syndrome is the leading cause of peripheral neuropathy, and its prevalence continues to increase at an alarming rate. Poor wound healing, nonunion, infection, and risk of amputation contribute to the understandable caution toward this patient group. Significant metalwork is required to hold these technically challenging deformities. Neuropathic Minimally Invasive Surgeries is an addition to the toolbox of management of the diabetic foot. It may potentially reduce the risk associated with large wounds and bony correction in this patient group. Copyright © 2016 Elsevier Inc. All rights reserved.

Review of 5.5 Years' Experience Using E-mail-Based Telemedicine to Deliver Orthopedic Care to Remote Communities.

Science.gov (United States)

Cota, Adam; Tarchala, Magdalena; Parent-Harvey, Caroline; Engel, Victor; Berry, Greg; Reindl, Rudy; Harvey, Edward J

2017-01-01

The use of e-mail-based telemedicine has been demonstrated as an effective and low-cost way of delivering healthcare to patients in remote areas who have limited access to medical services. We established a novel teleorthopedic service for a catchment area encompassing 972,000 km 2 using a commercial off-the-shelf e-mail application. Before the implementation of this program, patients with acute orthopedic injuries were required to travel by air up to 1,900 km for evaluation by an orthopedic surgeon. In the present study, we examined the patient demographics and consultation characteristics and calculated the cost savings associated with patient travel for this teleorthopedic service. We retrospectively reviewed 1,000 consecutive e-mail-based consults and radiographic images received for new patients with acute orthopedic injuries from January 2008 to June 2013. Seventy-nine consults were excluded due to incomplete documentation, leaving 921 available for analysis. The service records were examined to identify patient demographics, orthopedic diagnosis, the percentage of patients managed locally, and the medical indications for patients requiring transfer. As the travel costs for patients requiring transport to the university hospital center are borne by governmental health agencies, the savings accrued from treating patients in their home communities were also calculated. For the 921 consultations, the mean age of patients was 27 years (range, 3 months-88 years), with 40.7% of all patients being younger than 18 years. The most common diagnoses were ankle fractures (15.2%), clavicle fractures (11.2%), distal radius fractures (11.2%), and fractures of the foot (10.2%). One hundred ninety patients (20.6%) required transfer, whereas 731 patients (79.4%) were treated in their home communities. Of the patients who were transferred, 123 (64.7%) required surgery, 55 (28.9%) required clinical evaluation by an orthopedic surgeon, and 12 (6.4%) required CT or MRI. Cost

[The DRG responsible physician in trauma and orthopedic surgery. Surgeon, encoder, and link to medical controlling].

Science.gov (United States)

Ruffing, T; Huchzermeier, P; Muhm, M; Winkler, H

2014-05-01

Precise coding is an essential requirement in order to generate a valid DRG. The aim of our study was to evaluate the quality of the initial coding of surgical procedures, as well as to introduce our "hybrid model" of a surgical specialist supervising medical coding and a nonphysician for case auditing. The department's DRG responsible physician as a surgical specialist has profound knowledge both in surgery and in DRG coding. At a Level 1 hospital, 1000 coded cases of surgical procedures were checked. In our department, the DRG responsible physician who is both a surgeon and encoder has proven itself for many years. The initial surgical DRG coding had to be corrected by the DRG responsible physician in 42.2% of cases. On average, one hour per working day was necessary. The implementation of a DRG responsible physician is a simple, effective way to connect medical and business expertise without interface problems. Permanent feedback promotes both medical and economic sensitivity for the improvement of coding quality.

Comparative evaluation of dexmedetomidine and fentanyl for epidural analgesia in lower limb orthopedic surgeries

Directory of Open Access Journals (Sweden)

Sukhminder Jit Singh Bajwa

2011-01-01

Full Text Available Background and Aims: Opioids as epidural adjunct to local anesthetics (LA have been in use since long and α-2 agonists are being increasingly used for similar purpose. The present study aims at comparing the hemodynamic, sedative, and analgesia potentiating effects of epidurally administered fentanyl and dexmedetomidine when combined with ropivacaine. Methods: A total of one hundred patients of both gender aged 21-56 years, American Society of Anaesthesiologist (ASA physical status I and II who underwent lower limb orthopedic surgery were enrolled into the present study. Patients were randomly divided into two groups: Ropivacaine + Dexmedetomidine (RD and Ropivacaine + Fentanyl (RF, comprising 50 patie nts each. Inj. Ropivacaine, 15 ml of 0.75%, was administered epidurally in both the groups with addition of 1 μg/kg of dexmedetomidine in RD group and 1 μg/kg of fentanyl in RF group. Besides cardio-respiratory parameters and sedation scores, various block characteristics were also observed which included time to onset of analgesia at T10, maximum sensory analgesic level, time to complete motor blockade, time to two segmental dermatomal regressions, and time to first rescue analgesic. At the end of study, data was compiled systematically and analyzed using ANOVA with post-hoc significance, Chi-square test and Fisher′s exact test. Value of P<0.05 is considered significant and P<0.001 as highly significant. Results: The demographic profile of patients was comparable in both the groups. Onset of sensory analgesia at T10 (7.12±2.44 vs 9.14±2.94 and establishment of complete motor blockade (18.16±4.52 vs 22.98±4.78 was significantly earlier in the RD group. Postoperative analgesia was prolonged significantly in the RD group (366.62±24.42 and consequently low dose consumption of local anaesthetic LA (76.82±14.28 vs 104.35±18.96 during epidural top-ups postoperatively. Sedation scores were much better in the RD group and highly significant on

CT and MRI techniques for imaging around orthopedic hardware

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Do, Thuy Duong; Skornitzke, Stephan; Weber, Marc-Andre [Heidelberg Univ. (Germany). Dept. of Clinical Radiology; Sutter, Reto [Uniklinik Balgrist, Zurich (Switzerland). Radiology

2018-01-15

Orthopedic hardware impairs image quality in cross-sectional imaging. With an increasing number of orthopedic implants in an aging population, the need to mitigate metal artifacts in computed tomography and magnetic resonance imaging is becoming increasingly relevant. This review provides an overview of the major artifacts in CT and MRI and state-of-the-art solutions to improve image quality. All steps of image acquisition from device selection, scan preparations and parameters to image post-processing influence the magnitude of metal artifacts. Technological advances like dual-energy CT with the possibility of virtual monochromatic imaging (VMI) and new materials offer opportunities to further reduce artifacts in CT and MRI. Dedicated metal artifact reduction sequences contain algorithms to reduce artifacts and improve imaging of surrounding tissue and are essential tools in orthopedic imaging to detect postoperative complications in early stages.

MRI feedback temperature control for focused ultrasound surgery

International Nuclear Information System (INIS)

Vanne, A; Hynynen, K

2003-01-01

A temperature feedback controller routine using a physical model for temperature evolution was developed for use with focused ultrasound surgery. The algorithm for the controller was a multi-input, single-output linear quadratic regulator (LQR) derived from Pennes' bioheat transfer equation. The controller was tested with simulated temperature data that had the same characteristics as those obtained with magnetic resonance imaging (MRI). The output of the controller was the appropriate power level to be used by the transducer. Tissue parameters estimated prior to the simulated treatments were used to determine the controller parameters. The controller performance was simulated in three dimensions with varying system parameters, and sufficient temperature tracking was achieved. The worst-case overshoot was 7 deg. C and the steady-state error was 5 deg. C. The simulated behaviour of the controller suggests satisfactory performance and that the controller may be useful in controlling the power output during MRI-monitored ultrasound surgery

Qualitative Study of Surgeons Using a Wearable Personal Assistant in Surgeries and Ward Rounds

DEFF Research Database (Denmark)

Jalaliniya, Shahram; Pederson, Thomas

2016-01-01

In this paper, we report on the utility of a wearable personal assistant (WPA) for orthopedic surgeons in hospitals. A prototype of the WPA was developed on the Google Glass platform for supporting surgeons in three different scenarios: 1) touch-less interaction with medical images in surgery roo...

A comparative study of efficacy and safety of flupirtine versus piroxicam in postoperative pain in patients undergoing lower limb surgery

Directory of Open Access Journals (Sweden)

Chinnaiyan S

2017-10-01

Full Text Available Sowmya Chinnaiyan,1 Narayana Sarala,1 Heddur Shanthappa Arun2 1Department of Pharmacology, 2Department of Orthopaedics, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India Background: Effective control of pain postoperatively is essential in providing enhanced patient care and a cost-effective hospital stay. Though many treatment modalities exist for postoperative pain management in orthopedic surgeries they are often accompanied by adverse effects. This study was carried out to assess the efficacy of flupirtine and piroxicam in postoperative pain reduction using visual analog scale (VAS score. Materials and methods: An open-label, parallel group, comparative study was conducted on patients undergoing lower limb orthopedic surgery, randomized into two groups of 38 patients each. They received either flupirtine 100 mg or piroxicam 20 mg 6 hours after surgery and then twice daily orally for 5 days. Pain was measured using VAS score, total pain relief score (TOTPAR24, and patient satisfaction score (PSS; the other scales used were behavioral pain assessment scale (BPAS and functional activity score (FAS. Rescue medication used was tramadol 100 mg intravenously. WHO causality scale was used for assessing adverse effects. Descriptive and inferential statistics were used for assessment of various parameters. Results: A total of 76 patients with mean ± standard deviation age of 35.08±10.3 years were recruited; 34 in the flupirtine and 37 in the piroxicam groups completed the study. Patients in both groups were comparable in baseline characteristics. Flupirtine and piroxicam reduced VAS score 48 hours postoperatively compared to baseline (p=0.006 and 0.001 and piroxicam produced significant reduction in pain at 8, 12, and 120 hours compared to flupirtine (p=0.028, 0.032, 0.021. TOTPAR24 and PSS at 24 hours were comparable between the treatments. BPAS scores at 24 hours were reduced

Adult patient with Becker dystrophy undergoing orthopedic surgery: an anesthesia challenge.

Science.gov (United States)

Parish, Masoud; Farzin, Haleh

2018-01-01

Muscular dystrophies are considered to be a series of neuromuscular diseases with genetic causes and are characterized by progressive muscle weakness and degeneration of the skeletal muscle. The case of an adult man with Becker dystrophy referred for repair of the patella tendon tearing and patella fracture is described. He underwent successful surgery using total intravenous anesthesia without any complications.

Value Added: the Case for Point-of-View Camera use in Orthopedic Surgical Education.

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Karam, Matthew D; Thomas, Geb W; Taylor, Leah; Liu, Xiaoxing; Anthony, Chris A; Anderson, Donald D

2016-01-01

Orthopedic surgical education is evolving as educators search for new ways to enhance surgical skills training. Orthopedic educators should seek new methods and technologies to augment and add value to real-time orthopedic surgical experience. This paper describes a protocol whereby we have started to capture and evaluate specific orthopedic milestone procedures with a GoPro® point-of-view video camera and a dedicated video reviewing website as a way of supplementing the current paradigm in surgical skills training. We report our experience regarding the details and feasibility of this protocol. Upon identification of a patient undergoing surgical fixation of a hip or ankle fracture, an orthopedic resident places a GoPro® point-of-view camera on his or her forehead. All fluoroscopic images acquired during the case are saved and later incorporated into a video on the reviewing website. Surgical videos are uploaded to a secure server and are accessible for later review and assessment via a custom-built website. An electronic survey of resident participants was performed utilizing Qualtrics software. Results are reported using descriptive statistics. A total of 51 surgical videos involving 23 different residents have been captured to date. This includes 20 intertrochanteric hip fracture cases and 31 ankle fracture cases. The average duration of each surgical video was 1 hour and 16 minutes (range 40 minutes to 2 hours and 19 minutes). Of 24 orthopedic resident surgeons surveyed, 88% thought capturing a video portfolio of orthopedic milestones would benefit their education. There is a growing demand in orthopedic surgical education to extract more value from each surgical experience. While further work in development and refinement of such assessments is necessary, we feel that intraoperative video, particularly when captured and presented in a non-threatening, user friendly manner, can add significant value to the present and future paradigm of orthopedic surgical

Cultural Biases in Current Medical Practices with a Specific Attention to Orthopedic Surgery: a Review.

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Etienne, Gracia; Pierce, Todd P; Khlopas, Anton; Chughtai, Morad; Lavernia, Carlos J; Vogelstein, Teva Y; Thomas, Craig M; Modlin, Charles S; Mont, Michael A

2017-07-17

Due to the increasing diversity within the United States population, there is an ever-increasing need for increased education on cultural literacy and tolerance in medical schools and residency programs. The purpose of this article was to review how a person's culture can play a substantive role in effecting and influencing (1) medical diagnosis, (2) patient and health provider medical decision-making, (3) the patient's perception of disease, and (4) the doctor-patient relationships. Many of the decisions we make as orthopedic surgeons must account for the patient's cultural needs, as much of our work impacts patients' daily activities and function. When considering the patient's perception of disease, validated tools have been developed, such as the Patient-Specific Index, which can be used to assess the feelings, goals, and expectations of patients. Cultural competency should be a part of curricula at every level of medical education.

Thoracic damage control surgery.

Science.gov (United States)

Gonçalves, Roberto; Saad, Roberto

2016-01-01

The damage control surgery came up with the philosophy of applying essential maneuvers to control bleeding and abdominal contamination in trauma patients who are within the limits of their physiological reserves. This concept was extended to thoracic injuries, where relatively simple maneuvers can shorten operative time of in extremis patients. This article aims to revise the various damage control techniques in thoracic organs that must be known to the surgeon engaged in emergency care. RESUMO A cirurgia de controle de danos surgiu com a filosofia de se aplicar manobras essenciais para controle de sangramento e contaminação abdominal, em doentes traumatizados, nos limites de suas reservas fisiológicas. Este conceito se estendeu para as lesões torácicas, onde manobras relativamente simples, podem abreviar o tempo operatório de doentes in extremis. Este artigo tem como objetivo, revisar as diversas técnicas de controle de dano em órgãos torácicos, que devem ser de conhecimento do cirurgião que atua na emergência.

The Effects of Perioperative Music Interventions in Pediatric Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

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Marianne J E van der Heijden

Full Text Available Music interventions are widely used, but have not yet gained a place in guidelines for pediatric surgery or pediatric anesthesia. In this systematic review and meta-analysis we examined the effects of music interventions on pain, anxiety and distress in children undergoing invasive surgery.We searched 25 electronic databases from their first available date until October 2014.Included were all randomized controlled trials with a parallel group, crossover or cluster design that included pediatric patients from 1 month to 18 years old undergoing minimally invasive or invasive surgical procedures, and receiving either live music therapy or recorded music.4846 records were retrieved from the searches, 26 full text reports were evaluated and data was extracted by two independent investigators.Pain was measured with the Visual Analogue Scale, the Coloured Analogue Scale and the Facial Pain Scale. Anxiety and distress were measured with an emotional index scale (not validated, the Spielberger short State Trait Anxiety Inventory and a Facial Affective Scale.Three RCTs were eligible for inclusion encompassing 196 orthopedic, cardiac and day surgery patients (age of 1 day to 18 years receiving either live music therapy or recorded music. Overall a statistically significant positive effect was demonstrated on postoperative pain (SMD -1.07; 95%CI-2.08; -0.07 and on anxiety and distress (SMD -0.34 95% CI -0.66; -0.01 and SMD -0.50; 95% CI -0.84; - 0.16.This systematic review and meta-analysis indicates that music interventions may have a statistically significant effect in reducing post-operative pain, anxiety and distress in children undergoing a surgical procedure. Evidence from this review and other reviews suggests music therapy may be considered for clinical use.

RANDOMIZED CONTROLLED TRIALS IN ORTHOPEDICS AND TRAUMATOLOGY: SYSTEMATIC ANALYSIS ON THE NATIONAL EVIDENCE

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de Moraes, Vinícius Ynoe; Moreira, Cesar Domingues; Tamaoki, Marcel Jun Sugawara; Faloppa, Flávio; Belloti, Joao Carlos

2015-01-01

Objective: To assess whether there has been any improvement in the quality and quantity of randomized controlled trials (RCTs) in nationally published journals through the application of standardized and validated scores. Methods: We electronically selected all RCTs published in the two indexed Brazilian journals that focus on orthopedics, over the period 2000-2009: Acta Ortopédica Brasileira (AOB) and Revista Brasileira de Ortopedia (RBO). These RCTs were identified and scored by two independent researchers in accordance with the Jadad scale and the Cochrane Bone, Joint and Muscle Trauma Group score. The studies selected were grouped as follows: 1) publication period (2000-2004 or 2004-2009); 2) journal of publication (AOB or RBO). Results: Twenty-two papers were selected: 10 from AOB and 12 from RBO. No statistically significant differences were found between the proportions (nRCT/nTotal of published papers) of RCTs published in the two journals (p = 0.458), or in the Jadad score (p = 0.722) and Cochrane score (p = 0.630). Conclusion: The relative quality and quantity of RCTs in the journals analyzed were similar. There was a trend towards improvement of quality, but there was no increase in the number of RCTs between the two periods analyzed. PMID:27026971

Antimicrobial delivery systems for local infection prophylaxis in orthopedic- and trauma surgery

NARCIS (Netherlands)

ter Boo, Gert-Jan A.; Grijpma, Dirk W.; Moriarty, Thomas E.; Richards, Robert G.; Eglin, David

Infectious complications occur in a minor but significant portion of the patients undergoing joint replacement surgery or fracture fixation, particularly those with severe open fractures, those undergoing revision arthroplasty or those at elevated risk because of poor health status. Once

Antimicrobial delivery systems for local infection prophylaxis in orthopedic- and trauma surgery

NARCIS (Netherlands)

ter Boo, G.A.; Grijpma, Dirk W.; Moriarty, T.F.; Richards, R.G.; Eglin, D.

2015-01-01

Infectious complications occur in a minor but significant portion of the patients undergoing joint replacement surgery or fracture fixation, particularly those with severe open fractures, those undergoing revision arthroplasty or those at elevated risk because of poor health status. Once

Prosthesis infections after orthopedic joint replacement

DEFF Research Database (Denmark)

Song, Zhijun; Borgwardt, Lotte; Høiby, Niels

2013-01-01

Prosthesis-related infection is a serious complication for patients after orthopedic joint replacement, which is currently difficult to treat with antibiotic therapy. Consequently, in most cases, removal of the infected prosthesis is the only solution to cure the infection. It is, therefore...

Air contamination for predicting wound contamination in clean surgery: A large multicenter study.

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Birgand, Gabriel; Toupet, Gaëlle; Rukly, Stephane; Antoniotti, Gilles; Deschamps, Marie-Noelle; Lepelletier, Didier; Pornet, Carole; Stern, Jean Baptiste; Vandamme, Yves-Marie; van der Mee-Marquet, Nathalie; Timsit, Jean-François; Lucet, Jean-Christophe

2015-05-01

The best method to quantify air contamination in the operating room (OR) is debated, and studies in the field are controversial. We assessed the correlation between 2 types of air sampling and wound contaminations before closing and the factors affecting air contamination. This multicenter observational study included 13 ORs of cardiac and orthopedic surgery in 10 health care facilities. For each surgical procedure, 3 microbiologic air counts, 3 particles counts of 0.3, 0.5, and 5 μm particles, and 1 bacteriologic sample of the wound before skin closure were performed. We collected data on surgical procedures and environmental characteristics. Of 180 particle counts during 60 procedures, the median log10 of 0.3, 0.5, and 5 μm particles was 7 (interquartile range [IQR], 6.2-7.9), 6.1 (IQR, 5.4-7), and 4.6 (IQR, 0-5.2), respectively. Of 180 air samples, 50 (28%) were sterile, 90 (50%) had 1-10 colony forming units (CFU)/m(3) and 40 (22%) >10 CFU/m(3). In orthopedic and cardiac surgery, wound cultures at closure were sterile for 24 and 9 patients, 10 and 11 had 1-10 CFU/100 cm(2), and 0 and 6 had >10 CFU/100 cm(2), respectively (P air microbial counts (P contamination (P = .22). This study suggests that particle counting is a good surrogate of airborne microbiologic contamination in the OR. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The effect and clinical significance of Shuxuetong injection on the changes of plasma TXB2 and 6-Keto-PGF1α levels in patients after hip orthopedic operation

International Nuclear Information System (INIS)

Mao Zhaoguang; Xu Shenggen; Wu Qingxin; Zhu Huihua; Liu Bingsheng; Yu Binwei; Xu Shang'ao; Zheng Yihua

2011-01-01

Objective: To investigate shuxuetong injection on the changes of thromboxane B 2 (TXB 2 ) and 6-keto-prostacyclin(6-Keto-PGF 1α ) levels on the patients after hip orthopedic operation and its clinical significance. Methods: 50 hip orthopedic surgery patients were randomly divided into the shuxuetong group and the low-molecular-weight heparin (LMWH) group. Both groups were treated with conventional therapy. Shuxuetong group were 23 cases, including 7 cases of total hip replacement (THR), 16 patients of internal fixation after hip fracture. Each patient were given Shuxuetong intravenous injection 6 ml once a day, LMWH group contain 27 patients, including 9 cases of total hip replacement(THR), 18 patients of applying internal fixation to hip fracture. Each patient was given LMWH 5000 IU subcutaneously once daily. Both groups were treated for 14 days. In the day of surgery and the morning after therapy,fasting venous blood were collected respectively. The levels of plasma TXB 2 and 6-Keto-PGF 1α were measured by radioimmunoassay. Seven days after the surgery, patients in both groups were given low extremity venography examination. The changes of TXB 2 , 6-Keto-PGF 1α level and the incidence of lower extremity deep vein thrombosis (DVT) between two groups were compared before and after treatment. Results: The levels of TXB 2 and 6-Keto-PGF 1α is not mach significant difference between the two groups before treatment (P>0.05). After treatment,the increased of 6-Keto-PGF 1α and the decreased of TXB 2 were statistically significant difference (P 1α level of LMWH group was significantly higher after the treatment (P 2 had no obvious difference (P>0.05). The levels of TXB 2 and 6-Keto-PGF 1α was significant difference between the two groups after treatment(P 0.05). Two groups were not found more intraoperative and postoperative bleeding and the consequent adverse reactions. Conclusion: Shuxuetong injection adjust the plasma TXB 2 /6-Keto-PGF 1α balance after hip

PREPARATION AND CHARACTERIZATION OF Ti-Al-Nb ALLOYS FOR ORTHOPEDIC IMPLANTS

Directory of Open Access Journals (Sweden)

Oliveira V.

1998-01-01

Full Text Available Pure titanium shows very interesting characteristics such as high strength-to-weight ratio, very good corrosion resistance and excellent biocompatibility, which make this material appropriate for use in orthopedic and dental implants. Due to the mechanical properties of pure titanium, its use in implants is restricted to applications which involve moderate mechanical stress, such as dental implants. In applications where high mechanical strength is necessary, like orthopedic implants, it is appropriate to employ titanium-based alloys, which have better properties than pure titanium. The present work is related to the microstructure and corrosion resistance characterization of the Ti-6Al-7Nb alloy, designed to be used in orthopedic prostheses.

Readability of Orthopedic Trauma Patient Education Materials on the Internet.

Science.gov (United States)

Mohan, Rohith; Yi, Paul H; Morshed, Saam

In this study, we used the Flesch-Kincaid Readability Scale to determine the readability levels of orthopedic trauma patient education materials on the American Academy of Orthopaedic Surgeons (AAOS) website and to examine how subspecialty coauthorship affects readability level. Included articles from the AAOS online patient education library and the AAOS OrthoPortal website were categorized as trauma or broken bones and injuries on the AAOS online library or were screened by study authors for relevance to orthopedic trauma. Subsequently, the Flesch-Kincaid scale was used to determine each article's readability level, which was reported as a grade level. Subspecialty coauthorship was noted for each article. A total of 115 articles from the AAOS website were included in the study and reviewed. Mean reading level was grade 9.1 for all articles reviewed. Nineteen articles (16.5%) were found to be at or below the eighth-grade level, and only 1 article was at or below the sixth-grade level. In addition, there was no statistically significant difference between articles coauthored by the various orthopedic subspecialties and those authored exclusively by AAOS. Orthopedic trauma readability materials on the AAOS website appear to be written at a reading comprehension level too high for the average patient to understand.

Pre: Surgical orthopedic pre-maxillary alignment in bilateral cleft lip and palate patient

Directory of Open Access Journals (Sweden)

Vijaya Prasad Kamavaram Ellore

2012-01-01

Full Text Available Pre-surgical orthopedic appliances are mainly used to retract and align the protruded and deviated pre-maxilla and to facilitate initial lip repair. This article presents a case report of a five year old male child patient with bilateral cleft lip and palate in whom a special custom made pre-surgical orthopedic appliance was delivered. Use of a special custom made presurgical orthopedic appliance for repositioning pre-maxilla in bilateral cleft lip and palate patient is discussed in this article.

Health Literacy Demands of Patient-Reported Evaluation Tools in Orthopedics: A Mixed-Methods Case Study.

Science.gov (United States)

Hadden, Kristie; Prince, Latrina Y; Barnes, C Lowry

In response to an assessment of organizational health literacy practices at a major academic health center, this case study evaluated the health literacy demands of patient-reported outcome measures commonly used in orthopedic surgery practices to identify areas for improvement. A mixed-methods approach was used to analyze the readability and patient feedback of orthopedic patient-reported outcome materials. Qualitative results were derived from focus group notes, observations, recordings, and consensus documents. Results were combined to formulate recommendations for quality improvement. Readability results indicated that narrative portions of sample patient outcome tools were written within or below the recommended eighth-grade reading level (= 5.9). However, document literacy results were higher than the recommended reading level (= 9.8). Focus group results revealed that participants had consensus on 8 of 12 plain language best practices, including use of bullet lists and jargon or technical words in both instruments. Although the typical readability of both instruments was not exceedingly high, appropriate readability formula and assessment methods gave a more comprehensive assessment of true readability. In addition, participant feedback revealed the need to reduce jargon and improve formatting to lessen the health literacy demands on patients. As clinicians turn more toward patient-reported measures to assess health care quality, it is important to consider the health literacy demands that are inherent in the instruments they are given in our health systems.

Neonatal maxillary orthopedics: past to present

NARCIS (Netherlands)

Kuijpers-Jagtman, A.M.; Prahl, C.; Berkowitz, S.

2013-01-01

Neonatal maxillary orthopedics was introduced in the treatment protocol for cleft lip and palate in the 1950s of the last century. A wide range of appliances has been designed with pin-retained active appliances at one end of the spectrum and passive appliances at the other. Although neonatal

High energy devices versus low energy devices in orthopedics treatment modalities

Science.gov (United States)

Schultheiss, Reiner

2003-10-01

The orthopedic consensus group defined in 1997 the 42 most likely relevant parameters of orthopedic shock wave devices. The idea of this approach was to correlate the different clinical outcomes with the physical properties of the different devices with respect to their acoustical waves. Several changes in the hypothesis of the dose effect relationship have been noticed since the first orthopedic treatments. The relation started with the maximum pressure p+, followed by the total energy, the energy density; and finally the single treatment approach using high, and then the multiple treatment method using low energy. Motivated by the reimbursement situation in Germany some manufacturers began to redefine high and low energy devices independent of the treatment modality. The OssaTron as a high energy, single treatment electro hydraulic device gained FDA approval as the first orthopedic ESWT device for plantar fasciitis and, more recently, for lateral epicondylitis. Two low energy devices have now also gained FDA approval based upon a single treatment. Comparing the acoustic data, differences between the OssaTron and the other devices are obvious and will be elaborated upon. Cluster analysis of the outcomes and the acoustical data are presented and new concepts will be suggested.

Evaluation of radiation protection in interventional orthopedic procedures in Khartoum state

International Nuclear Information System (INIS)

Ibrahim, M. Y. A.

2013-06-01

In this study an evaluation of radiation safety and protection in interventional orthopedic procedures for the staff in three theatres in Khartoum state was conducted. To evaluate radiation protection program and staff knowledge with regard to radiation protection a questionnaire was designed and distributed among the staff there. Integrity check was conducted on the available radiation tools ( lead aprons) to ensure that they provide optimal protection when positioned appropriately. Also dose rate was measured around the theatre to evaluate the level of leakage radiation. Finally the absorbed dose to orthopedic specialists was measured during several procedures. The study showed the absence of most of the radiation protection and safety procedures that ensure the protection of of workers and lack of radiation protection program. The integrity check conducted on lead aprons showed uncapable crack in about 24% of the checked aprons. And in spite of this, there was no action taken to withdraw those faulty aprons or to replace them due to the acute shortage of the aprons available in the three centers and this will cause unjustified radiation exposure to the staff. The level of radiation around the theatres was found to fall within the acceptable limit according to the international commission of radiation protection (ICRP) recommendations that -if implemented -could improve the status of radiation protection in interventional orthopedic procedures. The improve. The important recommendations are to establish a single regulatory authority in Sudan independent from any user or promotion of radiation as well as to conduct periodically training courses for orthopedic staff on radiation protection in orthopedic interventional procedures.(Author)

Effectiveness of Standardized Physical Therapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome: Randomized Controlled Trial.

Science.gov (United States)

Christiansen, David Høyrup; Frost, Poul; Falla, Deborah; Haahr, Jens Peder; Frich, Lars Henrik; Andrea, Linda Christie; Svendsen, Susanne Wulff

2016-06-01

Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning to usual activities, special efforts may be needed to improve shoulder function. The purpose of this study was to evaluate the effectiveness at 3 and 12 months of a standardized physical therapy exercise intervention compared with usual care in patients with difficulty returning to usual activities after subacromial decompression surgery. A multicenter randomized controlled trial was conducted. The study was conducted in 6 public departments of orthopedic surgery, 2 departments of occupational medicine, and 2 physical therapy training centers in Central Denmark Region. One hundred twenty-six patients reporting difficulty returning to usual activities at the postoperative clinical follow-up 8 to 12 weeks after subacromial decompression surgery participated. A standardized exercise program consisting of physical therapist-supervised individual training sessions and home training was used. The primary outcome measure was the Oxford Shoulder Score. Secondary outcome measures were the Constant Score and the Fear-Avoidance Beliefs Questionnaire. At 3 and 12 months, follow-up data were obtained for 92% and 83% of the patients, respectively. Intention-to-treat analyses suggested a between-group difference on the Oxford Shoulder Score favoring the exercise group at 3 months, with an adjusted mean difference of 2.0 (95% confidence interval=-0.5, 4.6), and at 12 months, with an adjusted mean difference of 5.8 (95% confidence interval=2.8, 8.9). Significantly larger improvements for the exercise group were observed for most secondary and supplementary outcome measures. The nature of the exercise intervention did not allow blinding of patients and care providers. The standardized physical therapy exercise intervention resulted in statistically significant and clinically relevant improvement in shoulder pain and

Late orthopedic effects in children with Wilms' tumor treated with abdominal irradiation

International Nuclear Information System (INIS)

Rate, W.R.; Butler, M.S.; Robertson, W.W. Jr.; D'Angio, G.J.

1991-01-01

Between 1970 and 1984, 31 children with biopsy-proven Wilms' tumor received nephrectomy, chemotherapy, and abdominal irradiation and were followed beyond skeletal maturity. Three patients (10%) developed late orthopedic abnormalities requiring intervention. Ten children received orthovoltage irradiation, and all cases requiring orthopedic intervention or developing a scoliotic curve of greater than 20 degrees were confined to this group, for a complication frequency of 50%. Those children who developed a significant late orthopedic abnormality (SLOA) as defined were treated to a higher median dose (2,890 cGy) and a larger field size (150 cm2) than those who did not (2,580 cGy and 120 cm2). Age at irradiation, sex, and initial stage of disease did not appear to influence the risk of developing an SLOA. No child who received megavoltage irradiation developed an SLOA despite treatment up to 4,000 cGy or to field sizes of 400 cm2. We conclude that modern radiotherapy techniques rarely lead to significant late orthopedic abnormalities previously associated with abdominal irradiation in children with Wilms' tumor

Academic characteristics of orthopedic team physicians affiliated with high school, collegiate, and professional teams.

Science.gov (United States)

Makhni, Eric C; Buza, John A; Byram, Ian; Ahmad, Christopher S

2015-11-01

We conducted a study to determine the academic involvement and research productivity of orthopedic team physicians at high school, college, and professional levels of sport. Through Internet and telephone queries, we identified 1054 team physicians from 362 institutions, including 120 randomly selected high schools and colleges and 122 professional teams (baseball, basketball, football, hockey). For all physicians included in the study, we performed a comprehensive search of the Internet and of a citation database to determine academic affiliations, number of publications, and h-index values. Of the 1054 physicians, 678 (64%) were orthopedic surgeons. Percentage of orthopedic team physicians affiliated with an academic medical center was highest in professional sports (64%; 173/270) followed by collegiate sports (36%; 98/275) and high school sports (20%; 27/133). Median number of publications per orthopedic team physician was significantly higher in professional sports (30.6) than in collegiate sports (10.7) or high school sports (6). Median number of publications by orthopedic physicians also varied by sport, with the highest number in Major League Baseball (37.9; range, 0-225) followed by the National Basketball Association (32.0; range, 0-227) and the National Football League (30.4; range, 0-460), with the lowest number within the National Hockey League (20.7; range, 0-144). Academic affiliation and research productivity of orthopedic team physicians vary by competition level and professional sporting league.

21 CFR 520.928 - Firocoxib tablets.

Science.gov (United States)

2010-04-01

.... Administer once daily for osteoarthritis. Administer approximately 2 hours before soft-tissue or orthopedic...; and for the control of postoperative pain and inflammation associated with soft-tissue and orthopedic surgery. (3) Limitations. Federal law restricts this drug to use by or on the order of a licensed...

Platelet-rich plasma regenerative medicine sports medicine, orthopedic, and recovery of musculoskeletal injuries

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Santana, Maria; Belangero, William; Luzo, Angela

2014-01-01

Platelet-Rich Plasma (PRP) has gained tremendous popularity in recent years as a treatment option for specialties including Orthopedics, Dentistry, Sports Medicine, Otorhinolaryngology, Neurosurgery, Ophthalmology, Urology, Vascular, Cardiothoracic and Maxillofacial Surgery, and Veterinarian Medicine. Nowadays, PRP and Stem Cell Science have added an exciting dimension to tissue repair. This book begins by giving the reader a broad overview of current progress as well as a discussion of the technical aspects of preparation and therapeutic use of autologous PRP. It is followed by a review of platelet structure, function and major growth factors in PRP (PDGF and TGFβ).The third chapter outlines the basic principles of biochemical cellular metabolism that increases the efficacy of PRP. Analogous to the preparation of soil for a garden, restoring cellular health should be the first consideration in Regenerative Medicine. Standardization of PRP preparation to clinical use still remains a challenging prospect. In ...

The Effect of Additional Virtual Reality Training on Balance in Children with Cerebral Palsy after Lower Limb Surgery: A Feasibility Study.

Science.gov (United States)

Meyns, Pieter; Pans, Liene; Plasmans, Kaat; Heyrman, Lieve; Desloovere, Kaat; Molenaers, Guy

2017-02-01

Impaired balance is disabling for children with cerebral palsy (CPc), especially for CPc who recently underwent lower limb surgery. Positive results of using virtual reality (VR) in balance rehabilitation have been published in several outpatient populations. We investigated the feasibility of applying additional VR training focused on sitting balance in CP inpatients of a rehabilitation center after lower limb surgery. Additionally, we investigated the rate of enjoyment of VR training compared with conventional physiotherapy. Eleven spastic CPc (4/7 males/females) following rehabilitation after lower limb orthopedic surgery were included (5-18 years). The control group received conventional physiotherapy. The intervention group received additional VR training. Balance was measured using the Trunk Control Measurement Scale every 3 weeks of the rehabilitation period. Enjoyment was analyzed using a 10-point Visual Analog Scale. Providing additional VR training was feasible in terms of recruitment, treatment adherence, and assessment adherence. Both groups improved sitting balance after therapy. The current games were not perceived as more enjoyable than conventional physiotherapy. Including additional VR training to conventional physiotherapy is feasible and might be promising to train sitting balance in CPc after lower limb surgery. Future research should take equal patient allocation and training duration between groups into consideration.

INCIDENCE AND CHARACTERIZATION OF ELDERLY IN THE ORTHOPEDIC CLINIC FOR FEMUR FRACTURE, CACERES MT

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Andréia Costa Ferreira

2013-05-01

Full Text Available Introduction:The elderly population is growing gradually in recent years, it increases theincidence of elderly people at risk of falls and hip fractures develop.Objective:To identifythe incidence and characterize elderly patients hospitalized with hip fractures in theOrthopedic Clinic of the Hospital Regional Dr º Antonio Cáceres sources.Methodology:Thisis an epidemiological, descriptive, quantitative and retrospective data collection documentbasis. The study population comprised 105.Results:It was found that the fracture of thefemur showed predominance in females, comprising 40.90% of the cases and the right lowerlimb most affected. As for location, the trochanteric fractures showed 39.04%, followed byfractures of the femoral shaftwith 27.61% of the cases. The treatment applied in 62.85% ofpatients went to surgery.Conclusion:It is concluded that the femur fracture may preclude theelderly in their daily activities.

Variability in Resident Operative Hand Experience by Specialty.

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Silvestre, Jason; Lin, Ines C; Levin, L Scott; Chang, Benjamin

2018-01-01

Recent attention has sought to standardize hand surgery training in the United States. This study analyzes the variability in operative hand experience for orthopedic and general surgery residents. Case logs for orthopedic and general surgery residency graduates were obtained from the American Council of Graduate Medical Education (2006-2007 to 2014-2015). Plastic surgery case logs were not available for comparison. Hand surgery case volumes were compared between specialties with parametric tests. Intraspecialty variation in orthopedic surgery was assessed between the bottom and top 10th percentiles in procedure categories. Case logs for 9605 general surgery residents and 5911 orthopedic surgery residents were analyzed. Orthopedic surgery residents performed a greater number of hand surgery cases than general surgery residents ( P < .001). Mean total hand experience ranged from 2.5 ± 4 to 2.8 ± 5 procedures for general surgery residents with no reported cases of soft tissue repairs, vascular repairs, and replants. Significant intraspecialty variation existed in orthopedic surgery for all hand procedure categories (range, 3.3-15.0). As the model for hand surgery training evolves, general surgeons may represent an underutilized talent pool to meet the critical demand for hand surgeon specialists. Future research is needed to determine acceptable levels of training variability in hand surgery.

Maternal and perinatal outcomes after bariatric surgery: a case control study.

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de Alencar Costa, Laura Arrais Sydrião; Araujo Júnior, Edward; de Lucena Feitosa, Francisco Edson; Dos Santos, Andréa Cavalcante; Moura Júnior, Luiz Gonzaga; Costa Carvalho, Francisco Herlânio

2016-05-01

To compare the results of maternal and perinatal pregnancies of obese women after bariatric surgery. A retrospective cross-sectional study was carried out on 63 women who had undergone bariatric surgery and 73 obese women (control). Demographic data, the characteristics of the bariatric surgery, and the maternal and perinatal results were evaluated. The Student's t-test and chi-square test (χ2) were used to compare the groups. The gestational complications of the prevalence of gestational diabetes mellitus, anemia, and preeclampsia were analyzed using simple and multivariate logistical regression and odd ratios (OD) with their respective confidence intervals (CI) of 95%. The average body mass index (BMI) at the 1st prenatal appointment of the control group was 34.6±3.3 kg/m2 and that of the post-surgical group was 26.5±4.2 kg/m2. The Roux-en-Y Gastric Bypass was used in 100% of cases; no complications were observed during or after the surgeries. The average weight loss in patients with a prior bariatric surgery was statistically significant (P=0.000). The average weight at birth of the control group was significantly higher than in the post-bariatric surgery group (P=0.017). The women who had a prior bariatric surgery had a higher chance of anemia (OR=3.5; CI 95%: 1.5-8.3) and a reduced chance of macrosomia (OR=0.2; CI 95%:0.1-0.5), and prematurity (OR=0.3; CI 95%:0.1-0.7). Those women who had been submitted to bariatric surgery presented better maternal and perinatal results when compared to obese women.

Managing hip fracture and lower limb surgery in the emergency setting: Potential role of non-vitamin K antagonist oral anticoagulants.

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Fisher, William

2017-06-01

Trauma, immobilization, and subsequent surgery of the hip and lower limb are associated with a high risk of developing venous thrombo-embolism (VTE). Individuals undergoing hip fracture surgery (HFS) have the highest rates of VTE among orthopedic surgery and trauma patients. The risk of VTE depends on the type and location of the lower limb injury. Current international guidelines recommend routine pharmacological thromboprophylaxis based on treatment with heparins, fondaparinux, dose-adjusted vitamin K antagonists and acetylsalicylic acid for patients undergoing emergency HFS; however, not all guidelines recommend pharmacological prophylaxis for patients with lower limb injuries. Non-vitamin K antagonist oral anticoagulants (NOACs) are indicated for VTE prevention after elective hip or knee replacement surgery, but at present are not widely recommended for other orthopedic indications despite their advantages over conventional anticoagulants and promising real-world evidence. In patients undergoing HFS or lower limb surgery, decisions on whether to anticoagulate and the most appropriate anti-coagulation strategy can be guided by weighing the risk of thromboprophylaxis against the benefit in relation to each patient's medical history and age. In addition, the nature and location of the fracture, operating times and times before fracture fixation should be considered. The current review discusses the need for anticoagulation in patients undergoing emergency HFS or lower limb surgery together with the current guidelines and available evidence on the use of NOACs in this setting. Appropriate thromboprophylactic strategies and practical advice on the peri-operative management of patients who present to the Emergency Department on a NOAC before emergency surgery are further outlined.

The impact of functional jaw orthopedics in subjects with unfavorable Class II skeletal patterns.

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Baccetti, Tiziano; McNamara, James A

2010-01-01

To evaluate the outcomes of functional jaw orthopedics (FJO) followed by fixed appliances in Class II patients showing cephalometric signs predictive of unfavorable responsiveness to orthopedic treatment. A total of 48 treated subjects (20 males, 28 females) with unfavorable Class II malocclusions were treated with FJO at the adolescent growth spurt, followed by fixed appliances. Treatment outcomes were compared with the growth changes in a matched control group of untreated subjects with "unfavorable" Class II malocclusions. A significant prevalence rate of successful outcome was recorded within the treated group (64.5%). When compared with the untreated controls, both the overall treated group and the successful treated subgroup revealed a significant reduction in maxillary growth and sagittal position, along with a significant enhancement in mandibular length, sagittal advancement of the mandible, and significant improvements in the maxillo-mandibular relationships. Both overjet and molar relation showed significant favorable changes in the treated group. FJO at the pubertal spurt followed by fixed appliances is a viable therapeutical option in patients with "unfavorable" Class II malocclusions, although skeletal changes are of minor entity. Copyright © 2010 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved.

The Orthopedically Disabled Child: Psychological Implications with an Individual Basis. July 1984 Revision.

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Sigmon, Scott B.

This study describes the implications of the Individual Psychology of Alfred Adler and field theory associated with Kurt Lewin in understanding orthopedically disabled children and points out that orthopedically disabled youngsters have a remarkable range of individual differences both in type of disability as well as level of adjustment.…

Open access of evidence-based publications: the case of the orthopedic and musculoskeletal literature.

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Yammine, Kaissar

2015-11-01

The open access model, where researchers can publish their work and make it freely available to the whole medical community, is gaining ground over the traditional type of publication. However, fees are to be paid by either the authors or their institutions. The purpose of this paper is to assess the proportion and type of open access evidence-based articles in the form of systematic reviews and meta-analyses in the field of musculoskeletal disorders and orthopedic surgery. PubMed database was searched and the results showed a maximal number of hits for low back pain and total hip arthroplasty. We demonstrated that despite a 10-fold increase in the number of evidence-based publications in the past 10 years, the rate of free systematic reviews in the general biomedical literature did not change for the last two decades. In addition, the average percentage of free open access systematic reviews and meta-analyses for the commonest painful musculoskeletal conditions and orthopedic procedures was 20% and 18%, respectively. Those results were significantly lower than those of the systematic reviews and meta-analyses in the remaining biomedical research. Such findings could indicate a divergence between the efforts engaged at promoting evidence-based principles and those at disseminating evidence-based findings in the field of musculoskeletal disease and trauma. The high processing fee is thought to be a major limitation when considering open access model for publication. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

Orthopedic Health: Osteoarthritis— What You Should Know (quiz)

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... Bar Home Current Issue Past Issues Orthopedic Health Osteoarthritis— What You Should Know Past Issues / Spring 2009 ... Javascript on. How much do you know about osteoarthritis, its causes, and its therapies? Take this quiz ...

Adult Reconstructive Surgery: A High-Risk Profession for Work-Related Injuries.

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Alqahtani, Saad M; Alzahrani, Mohammad M; Tanzer, Michael

2016-06-01

Adult reconstructive surgery is an orthopedic subspecialty characterized by surgical tasks that are physical, repetitive, and require some degree of stamina from the surgeon. This can result strain and/or injury of the surgeon's musculoskeletal system. This study investigates the prevalence of work-related injuries among arthroplasty surgeons. A modified version of the physical discomfort survey was sent to surgeon members of the Hip Society, the International Hip Society, and the Canadian Orthopedic Arthroplasty via email. One hundred and eighty-three surgeons completed the survey. Overall, 66.1% of the arthroplasty surgeons reported that they had experienced a work-related injury. The most common injuries that occurred were low back pain (28%), lateral epicondylitis of the elbow (14%), shoulder tendonitis (14%), lumbar disc herniation (13%), and wrist arthritis (12%). Overall, 27% of surgeons took time off from work because of the injury. As the number of disorders diagnosed increased, there was a significant increase in the incidence of requiring time off work because of the disorder (P increased the risk of the surgeon requiring time off because of the disorder were age >55 years, practicing for more than >20 years, and performing >100 total hip arthroplasty procedures per year (P < .05). In addition, 31% of the orthopedic surgeons surveyed required surgery for their injury. Although most studies concentrate on the importance of patient safety and thus the quality of the health care system, the surgeon's safety is also considered an integral part of this system's quality. This study highlights a high prevalence of musculoskeletal work-related injuries among arthroplasty surgeons and indicates the need for the identification of preventive measures directed toward improving the operative surgical environment and work ergonomics for the surgeons. Copyright © 2015 Elsevier Inc. All rights reserved.

The (in)stability of 21st century orthopedic patient contact information and its implications on clinical research: A cross-sectional study.

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London, Daniel A; Stepan, Jeffrey G; Goldfarb, Charles A; Boyer, Martin I; Calfee, Ryan P

2017-04-01

In clinical research, minimizing patients lost to follow-up is essential for data validity. Researchers can employ better methodology to prevent patient loss. We examined how orthopedic surgery patients' contact information changes over time to optimize data collection for long-term outcomes research. Patients presenting to orthopedic outpatient clinics completed questionnaires regarding methods of contact: home phone, cell phone, mailing address, and e-mail address. They reported currently available methods of contact, if they changed in the past 5 and 10 years, and when they changed. Differences in the rates of change among methods were assessed via Fisher's exact tests. Whether participants changed any of their contact information in the past 5 and 10 years was determined via multivariate modeling, controlling for demographic variables. Among 152 patients, 51% changed at least one form of contact information within 5 years, and 66% changed at least one form within 10 years. The rate of change for each contact method was similar over 5 (15%-28%) and 10 years (26%-41%). One patient changed all four methods of contact within the past 5 years and seven within the past 10 years. Females and younger patients were more likely to change some type of contact information. The type of contact information least likely to change over 5-10 years is influenced by demographic factors such as sex and age, with females and younger participants more likely to change some aspect of their contact information. Collecting all contact methods appears necessary to minimize patients lost to follow-up, especially as technological norms evolve.

The effect of expedited rotator cuff surgery in injured workers: a case-control study.

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Razmjou, Helen; Lincoln, Sandra; Boljanovic, Dragana; Gallay, Stephen; Henry, Patrick; Richards, Robin R; Holtby, Richard

2017-07-01

Expediting rotator cuff surgery is expected to facilitate recovery and return to work in injured workers. This case-control study examined the effect of expedited rotator cuff surgery on recovery and work status in injured workers. Injured workers who had undergone an expedited rotator cuff surgery funded by parallel-pay insurance (study group) were compared with workers who had used the public health insurance (control group) while adjusting for sex, age, severity of pathology, and follow-up period. Disability was measured by the American Shoulder and Elbow Surgeons (ASES) Standardized Assessment Form score. The percentage of patients who exceeded the minimal clinically important difference of 17 points in the ASES was calculated. The study group waited less time to have surgery than the control group (P workers who underwent expedited rotator cuff surgery reported less disability and had a more successful return to work after surgery than injured workers who waited longer for specialist assessment and surgery within the public health system. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Thirty-Day Readmission Rates in Orthopedics: A Systematic Review and Meta-Analysis

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Bernatz, James T.; Tueting, Jonathan L.; Anderson, Paul A.

2015-01-01

Background Hospital readmission rates are being used to evaluate performance. A survey of the present rates is needed before policies can be developed to decrease incidence of readmission. We address three questions: What is the present rate of 30-day readmission in orthopedics? How do factors such as orthopedic specialty, data source, patient insurance, and time of data collection affect the 30-day readmission rate? What are the causes and risk factors for 30-day readmissions? Methods/Findings A review was first registered with Prospero (CRD42014010293, 6/17/2014) and a meta-analysis was performed to assess the current 30-day readmission rate in orthopedics. Studies published after 2006 were retrieved, and 24 studies met the inclusion criteria. The 30-day readmission rate was extrapolated from each study along with the orthopedic subspecialty, data source, patient insurance, time of collection, patient demographics, and cause of readmission. A sensitivity analysis was completed on the stratified groups. The overall 30-day readmission rate across all orthopedics was 5.4 percent (95% confidence interval: 4.8,6.0). There was no significant difference between subspecialties. Studies that retrieved data from a multicenter registry had a lower 30-day readmission rate than those reporting data from a single hospital or a large national database. Patient populations that only included Medicare patients had a higher 30-day readmission rate than populations of all insurance. The 30-day readmission rate has decreased in the past ten years. Age, length of stay, discharge to skilled nursing facility, increased BMI, ASA score greater than 3, and Medicare/Medicaid insurance showed statistically positive correlation with increased 30-day readmissions in greater than 75 percent of studies. Surgical site complications accounted for 46 percent of 30-day readmissions. Conclusions This meta-analysis shows the present rate of 30-day readmissions in orthopedics. Demonstrable

Palliative surgery for acetabular metastasis with pathological central dislocation of the hip joint after radiation therapy. A case report

International Nuclear Information System (INIS)

Hoshi, Manabu; Takada, Jun; Oebisu, Naoto; Nakamura, Hiroaki; Taguchi, Susumu; Takami, Masatsugu

2012-01-01

Orthopedic surgery for bone metastases is mainly a palliative treatment. Pathological central dislocation of the hip joint secondary to osteonecrosis of acetabular metastasis after radiation therapy brings severe suffering to cancer patients. We performed minimally invasive palliative surgery for an elderly woman, and excellent pain relief was achieved. An 80-year-old female suffering from right hip pain was referred to our hospital. She had undergone surgery for lung cancer 5 years previously and her right acetabulum was subsequently affected by metastasis. With the aim of controlling the metastasis, radiation therapy was performed. Two years later, pathological central dislocation of the hip joint occurred with sudden onset of severe pain, and she was unable to maintain a sitting position and became bedridden. After she was referred to our hospital, we created an intentional pseudarthrosis in the femoral neck for palliation. After the surgery, excellent pain relief and remarkably improved mobility were achieved during her limited remaining lifetime. In this report, we introduce a novel method of producing a pseudarthrosis in the femoral neck for pathological dislocation. This procedure is a minimally invasive treatment and an alternative option for palliative surgery for pathological dislocation of the hip joint due to osteonecrosis after radiation therapy. (author)

The TROJAN Project: Creating a Customized International Orthopedic Training Program for Junior Doctors.

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Kalraiya, Ashish; Buddhdev, Pranai

2015-03-03

Musculoskeletal problems account for a vast proportion of presentations encountered by doctors globally, with figures ranging from 15-36%. However, the time medical schools allocate to learning orthopedics is by no means proportional to this. This study aims to bridge this gap by developing an international orthopedic teaching program tailored to the specific knowledge and skills required by junior doctors in different countries. This prospective study asked fifty junior doctors, who had recently completed an orthopedics job, what three orthopedic teaching topics taught retrospectively would have benefitted their clinical practice. The most requested topics were used to design educational workshops for junior doctors and these consequently comprised the TROJAN (Teaching Requested by Orthopaedic Juniors And Novices) training program. Data was collected from twenty-five junior doctors in KwaZulu-Natale State, South Africa, and twenty-five in London, UK. It is therefore in these two countries that the TROJAN program was subsequently made available. Participants who selected topics were within two years of graduating medical school and had worked an orthopedic or Accident and Emergency job within the last year. 49% of topics chosen by SA doctors were practical skills such as wrist and ankle fracture reduction techniques, and management of open fractures. The most requested topic by UK doctors (11 out of 25) was management of neck of femur fractures. This is rationalized by the fact South African doctors require more hands-on responsibility in their daily practice whereas in the UK greater emphasis is placed on optimizing patients for theatre and making sound management plans. TROJAN currently develops orthopedic skills and knowledge in junior doctors in South Africa and United Kingdom with teaching customized based upon location. Feedback has been exceptionally positive with every candidate thus far rating the usefulness of TROJAN as the highest option, very useful.

Relationship of microstructure to fracture topography in orthopedic alloys

International Nuclear Information System (INIS)

Gilbertson, L.N.

1976-01-01

Two major alloys used for orthopedic implants are 316L stainless steel and a cast cobalt--chromium--molybdenum alloy similar to Haynes Stellite 21. Another alloy that is just being introduced is Ti--6Al--4V. All three of these alloys are used in different conditions with different microstructures. Standard specimens with typical microstructures encountered in orthopedic applications were loaded to fracture in both overload and fatigue modes. Different rates of loading were also used in some cases. The fracture surfaces of these standard samples were analyzed in the Scanning Electron Microscope. An attempt was made to relate the fracture behavior, as evidenced by the fracture typography, to the microstructure of the alloy as revealed by metallography

Contributing risk factors for orthopedic device related infections in sina hospital, tehran, iran.

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Hadadi, A; Zehtab, M J; Babagolzadeh, H; Ashraf, H

2011-02-01

In spite of decreasing incidence of orthopedic device-related infections to 1%, nowadays, device-related infection still remains a diagnostic, therapeutic and cost-related problem. The objective of this study is to evaluate the contributing risk factors for orthopedic device-related infections in Sina Hospital, Tehran, Iran. Three hundred and thirty patients who underwent orthopedic device implantation from 2002-2006 were enrolled; among them, 110 patients were complicated with infection. Descriptive and logistic regression analyses were performed to determine the risk factors for device related infections. Patients with infection were older compared to those without infection. The Staphylococcus aureus was the commonest organism. A correlation was observed between wound infection and external fixation, an underlying health condition, and addiction which were independent risk factors for a device related infection. Orthopedic device-related infection puts a great financial burden on patients and hospital resources and could lead to morbidity and mortality in patients. So, appropriate pre and postoperative wound care for dirty wounds, especially when external fixators are used, and in patients with poor conditions or addiction should be done with more caution.

[Orthopedic management of spina bifida].

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Biedermann, R

2014-07-01

Spina bifida is associated with congenital deformities, such as kyphosis, spinal malformations, teratological hip dislocations, clubfeet, vertical talus and also with acquired deformities due to muscle imbalance and impaired biomechanics. The degree of the acquired deformities and the mobility of the patient depend on the level of the spinal lesion. Neurological symptoms are mostly asymmetric and there is an inconsistent correlation between the anatomical level of the lesion and muscle function. Deficits of sensation are usually one to two levels lower than the motor level. An exact neurological diagnosis should not be made before the second or third year of life and an early prognosis about walking ability should be avoided. The level L3 and therefore function of the quadriceps is a functional milestone after which modified independent ambulation with the use of ankle foot orthoses (AFO) and crutches is possible. The basic principle is to support verticalization and gait even when loss of ambulation is later expected. It is also important to support and maintain sitting ability for high lesions, if necessary with correction of the spinal deformity. Findings in gait analysis have shifted the focus of treatment from radiological criteria to functional improvement, thus maintenance of the flexibility of the hip is the main goal of hip surgery. Reduction of the hip often leads to stiffness and has a high redislocation rate. Clubfoot deformities should be treated early and foot arthrodesis and stiffness have to be avoided. Another focus is the prevention of joint contracture by early prophylactic treatment. The purpose of management is to maximize the functional potential of the child. Subjective well-being, absence of pain, mobility and socialization are the main goals. This does not necessarily imply ambulation; nevertheless, verticalization and associated orthotic management is one major objective of the orthopedic management of spina bifida.

Computer Assisted Orthopaedic Surgery – CAOS

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Enes M. Kanlić

2006-02-01

Full Text Available The use of computer navigation in orthopedic surgery allows for real time intraoperative feedback resulting in higher precision of bone cuts, better alignment of implants and extremities, easier fracture reductions, less radiation and better documentation than what is possible in classical orthopaedic procedures. There is no need for direct and repeated visualization of many anatomical landmarks (classical method in order to have good intraoperative orientation. Navigation technology depicts anatomy and position of "smart tools" on the screen allowing for high surgical precision (smaller number of outliers from desired goal and with less soft tissue dissection (minimally invasive surgery - MIS. As a result, there are more happy patients with less pain, faster recovery, better functional outcome and well positioned, long lasting implants. In general, navigation cases are longer on the average 10 to 20 minutes, special training is required and equipment is relatively expensive. CAOS applications in knee and hip joint replacement are discussed.

Systematic review and meta-analyses of tranexamic acid use for bleeding reduction in prostate surgery.

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Longo, Marcelo A; Cavalheiro, Bárbara T; de Oliveira Filho, Getúlio R

2018-05-01

Prostate cancer and benign prostatic hyperplasia have an increased incidence with aging. The most effective treatments are radical prostatectomy and transurethral resection of the prostate. To reduce perioperative bleeding in these surgeries, an approach is the use of tranexamic acid (TXA). Studies show that TXA is effective in reducing the blood loss and the need for transfusion in cardiac, orthopedic, and gynecological surgeries. In prostate surgeries, its efficacy and safety have not been established yet. To determine whether there are differences between TXA versus placebo in terms of intraoperative blood loss, transfusion requirements, hemoglobin levels and the incidence of thromboembolic events. Systematic review with meta-analyses. Anesthesia for prostate surgery. We searched the Medline, Cochrane, EBSCO, and Web of Science databases up to 2017 for randomized controlled trials that compared TXA administration with a control group in patients who submitted to prostate surgery. The primary outcomes were the intraoperative blood loss and transfusion rate. Data on hemoglobin levels and the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) were also collected. Nine comparative studies were included in the meta-analyses. The estimated blood loss and transfusion rate were lower in patients receiving TXA, with a standardized mean difference of -1.93 (95% CI = -2.81 to -1.05, I 2  = 96%), and a risk ratio of 0.61 (95% CI = 0.47 to 0.80, I 2  = 0%), respectively. The hemoglobin levels and the incidence of DVT and PE did not differ between the groups. TXA reduced intraoperative blood loss and the need for transfusion, without increasing the risk of DVT and PE in prostate surgeries. Due to the limited number of studies and the high heterogeneity of the results, more clinical trials with a large number of patients are necessary to confirm these findings. Copyright © 2018 Elsevier Inc. All rights reserved.

Regional anesthesia for pediatric knee surgery: a review of the indications, procedures, outcomes, safety, and challenges

Directory of Open Access Journals (Sweden)

Muhly WT

2015-11-01

Full Text Available Wallis T Muhly, Harshad G Gurnaney, Arjunan GaneshDepartment of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, PA, USAAbstract: The indications for surgery on the knee in children and adolescents share some similarity to adult practice in that there are an increasing number of sports-related injuries requiring surgical repair. In addition, there are some unique age-related conditions or congenital abnormalities that may present as indications for orthopedic intervention at the level of the knee. The efficacy and safety of peripheral nerve blocks (PNBs for postoperative analgesia following orthopedic surgery has been well established in adults. Recent studies have also demonstrated earlier functional recovery after surgery in patients who received PNBs. In children, PNB is gaining popularity, and increasing data are emerging to demonstrate the feasibility, efficacy, and safety in this population. In this paper, we will review some of the most common indications for surgery involving the knee in children and the anatomy of knee, associated dermatomal and osteotomal innervation, and the PNBs most commonly used to produce analgesia at the level of the knee. We will review the evidence in support of regional anesthesia in children in terms of both the quality conferred to the immediate postoperative care and the role of continuous PNBs in maintaining effective analgesia following discharge. Also we will discuss some of the subtle challenges in utilizing regional anesthesia in the pediatric patient including the use of general anesthesia when performing regional anesthesia and the issue of monitoring for compartment syndrome. Finally, we will offer some thoughts about areas of practice that are in need of further investigation.Keywords: pediatric surgery, regional anesthesia, analgesia, knee surgery

Anesthetic management of a 4-month-old red fox (Vulpes vulpes) for orthopedic surgery.

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Anagnostou, Tilemahos; Flouraki, Eugenia; Kostakis, Charalampos; Komnenou, Anastasia; Prassinos, Nikitas; Raptopoulos, Dimitrios

2015-03-01

A 4-mo-old red fox (Vulpes vulpes) was found recumbent after a vehicular accident. Radiology revealed several limb fractures and the fox underwent surgery after 24 hr of initial stabilization. Premedication consisted of dexmedetomidine and morphine. Anesthesia was induced with ketamine and midazolam and maintained with isoflurane. Lidocaine, bupivacaine, and morphine were administered epidurally and further analgesia was provided with meloxicam. The heart rate and respiratory rate of the fox remained stable during surgery and, except for a mild hypothermia, the recovery from anesthesia was uneventful. The postoperative pain scores were low and the animal was transported to a rehabilitation facility and eventually released to the wild. The low pain scores postoperatively should be attributed to the successful application of epidural anesthesia and analgesia.

A comparison of dexamethasone, ondansetron, and dexamethasone plus ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery.

LENUS (Irish Health Repository)

Szarvas, Szilvia

2012-02-03

In a prospective, double-blinded, randomized trial, we evaluated the efficacy of IV (a) dexamethasone 8 mg, (b) ondansetron 8 mg, and (c) dexamethasone 8 mg plus ondansetron 4 mg for the prevention of postoperative nausea, vomiting (PONV), and pruritus in 130 (ASA physical status I to III) patients undergoing elective major orthopedic surgery after spinal anesthesia with hyperbaric 0.5% bupivacaine and intrathecal morphine. After spinal anesthesia, patients were randomized to one of three groups. Failure of PONV prophylaxis in the 24-h postoperative period occurred more frequently in patients who received dexamethasone alone (29 of 40; 73%) compared with those who received either ondansetron alone (23 of 47; 49%) (P = 0.02) or dexamethasone plus ondansetron together (19 of 43; 44%)(P = 0.01). There was no difference in the incidence of failure of prophylaxis of pruritus (70%, 72%, and 70% in dexamethasone 8 mg, ondansetron 8 mg, and dexamethasone 8 mg plus ondansetron 4 mg, respectively) (P > 0.1) in the 24-h postoperative period. We conclude that the administration of dexamethasone 8 mg with ondansetron 4 mg has no added benefit compared with ondansetron 8 mg alone in the prophylaxis of PONV and pruritus. IMPLICATIONS: Postoperative nausea and vomiting (PONV) and pruritus are common side effects after spinal opioid administration. In this study, dexamethasone 8 mg plus ondansetron 4 mg was as effective as ondansetron 8 mg. The administration of dexamethasone alone was associated with a frequent incidence of PONV, demonstrating a lack of efficacy. This has important cost implications.

Enhanced osteoblast adhesion on nanostructured selenium compacts for anti-cancer orthopedic applications

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Phong Tran

2008-10-01

Full Text Available Phong Tran1, Thomas J Webster21Physics Department; 2Division of Engineering and Department of Orthopedics, Brown University, Providence, USAAbstract: Metallic bone implants possess numerous problems limiting their long-term efficacy, such as poor prolonged osseointegration, stress shielding, and corrosion under in vivo environments. Such problems are compounded for bone cancer patients since numerous patients receive orthopedic implants after cancerous bone resection. Unfortunately, current orthopedic materials were not originally developed to simultaneously increase healthy bone growth (as in traditional orthopedic implant applications while inhibiting cancerous bone growth. The long-term objective of the present research is to investigate the use of nano-rough selenium to prevent bone cancer from re-occurring while promoting healthy bone growth for this select group of cancer patients. Selenium is a well known anti-cancer chemical. However, what is not known is how healthy bone cells interact with selenium. To determine this, selenium, spherical or semispherical shots, were pressed into cylindrical compacts and these compacts were then etched using 1N NaOH to obtain various surface structures ranging from the micron, submicron to nano scales. Changes in surface chemistry were also analyzed. Through these etching techniques, results of this study showed that biologically inspired surface roughness values were created on selenium compacts to match that of natural bone roughness. Moreover, results showed that healthy bone cell adhesion increased with greater nanometer selenium roughness (more closely matching that of titanium. In this manner, this study suggests that nano-rough selenium should be further tested for orthopedic applications involving bone cancer treatment.Keywords: selenium, nano-rough, osteoblast, cancer, chemopreventive

FACTORS ASSOCIATED WITH INFECTIONS IN SPINAL SURGERY

Directory of Open Access Journals (Sweden)

ANA MARÍA MORALES LÓPEZ

Full Text Available ABSTRACT Objective: To identify the factors associated with postoperative infections in spinal surgery. Methods: Descriptive, retrospective, cross-sectional study conducted in the spine surgery department of the Medical Unit of High Specialty (UMAE at the Hospital of Traumatology and Orthopedics Lomas Verdes, Mexican Institute of Social Security (IMSS between January 01, 2013 and June 30, 2014 through medical records of the service and the records of clinical care. Data were gathered in accordance with the records of patients with infection after spinal surgery. The factors considered were age group, etiologic agent, surgical site, type of treatment, bleeding volume and pharmacotherapy. Frequency and descriptive statistic was conducted. The rank sum test with the Wilcoxon test for a single sample was performed in different measurements; Pearson's correlation was calculated and all p<0.05 values were considered significant. Results: The sample was composed of 14 patients of which 11 were female (78.6% and 3 male (21.4% with predominance of surgical area in the lumbar and dorsolumbar region. There was a significant correlation between the surgical time and the amount of bleeding with p<0.001. Conclusions: It was clear that the infections present in patients after spinal surgery are multifactorial. However, in this study the correlation between time of surgery and bleeding amount had the highest importance and relevance.

Endoscopic Camera Control by Head Movements for Thoracic Surgery

NARCIS (Netherlands)

Reilink, Rob; de Bruin, Gart; Franken, M.C.J.; Mariani, Massimo A.; Misra, Sarthak; Stramigioli, Stefano

2010-01-01

In current video-assisted thoracic surgery, the endoscopic camera is operated by an assistant of the surgeon, which has several disadvantages. This paper describes a system which enables the surgeon to control the endoscopic camera without the help of an assistant. The system is controlled using

Web-based patient education in orthopedics : Systematic review

NARCIS (Netherlands)

Dekkers, T.; Melles, M.; Groeneveld, B.S.; de Ridder, H.

2018-01-01

Background: Patients with orthopedic conditions frequently use the internet to find health information. Patient education that is distributed online may form an easily accessible, time- and cost-effective alternative to education delivered through traditional channels such as one-on-one

A randomized controlled trial of cell salvage in routine cardiac surgery.

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Klein, Andrew A; Nashef, Samer A M; Sharples, Linda; Bottrill, Fiona; Dyer, Matthew; Armstrong, Johanna; Vuylsteke, Alain

2008-11-01

Previous trials have indicated that cell salvage may reduce allogeneic blood transfusion during cardiac surgery, but these studies have limitations, including inconsistent use of other blood transfusion-sparing strategies. We designed a randomized controlled trial to determine whether routine cell salvage for elective uncomplicated cardiac surgery reduces blood transfusion and is cost effective in the setting of a rigorous transfusion protocol and routine administration of antifibrinolytics. Two-hundred-thirteen patients presenting for first-time coronary artery bypass grafting and/or cardiac valve surgery were prospectively randomized to control or cell salvage groups. The latter group had blood aspirate during surgery and mediastinal drainage the first 6 h after surgery processed in a cell saver device and autotransfused. All patients received tranexamic acid and were subjected to an algorithm for red blood cell and hemostatic blood factor transfusion. There was no difference between the two groups in the proportion of patients exposed to allogeneic blood (32% in both groups, relative risk 1.0 P = 0.89). At current blood products and cell saver prices, the use of cell salvage increased the costs per patient by a minimum of $103. When patients who had mediastinal re-exploration for bleeding were excluded (as planned in the protocol), significantly fewer units of allogeneic red blood cells were transfused in the cell salvage compared with the control group (65 vs 100 U, relative risk 0.71 P = 0.04). In patients undergoing routine first-time cardiac surgery in an institution with a rigorous blood conservation program, the routine use of cell salvage does not further reduce the proportion of patients exposed to allogeneic blood transfusion. However, patients who do not have excessive bleeding after surgery receive significantly fewer units of blood with cell salvage. Although the use of cell savage may reduce the demand for blood products during cardiac surgery, this

Malnutrition - An underestimated factor in the inpatient treatment of traumatology and orthopedic patients: A prospective evaluation of 1055 patients.

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Ihle, Christoph; Freude, Thomas; Bahrs, Christian; Zehendner, Eva; Braunsberger, Janick; Biesalski, Hans Konrad; Lambert, Christine; Stöckle, Ulrich; Wintermeyer, Elke; Grünwald, Julia; Grünwald, Leonard; Ochs, Gunnar; Flesch, Ingo; Nüssler, Andreas

2017-03-01

Suboptimal nutritional status is often observed among hospitalized patients across all medical specialties. The objective of the present study was to (1) analyze the prevalence of malnutrition in hospitalized orthopedic and trauma patients and (2) to evaluate the relationship between malnutrition and selected clinical outcomes. The prospective field study was conducted between 06/2014 and 06/2015 in a German level I trauma center (Department of Traumatology, Septic Trauma Surgery and Arthroplasty) with a total number of 1055 patients. At hospital admission, patients were checked for malnutrition using the validated Nutritional Risk Screening (NRS). Patients at risk for malnutrition were defined as NRS≥3. Quality of life (SF-36) was assessed to evaluate the physical and mental health status prior to hospitalization. Clinical outcomes under consideration included 1) rate of adverse events, 2) length of hospitalization, and 3) mobilization after operative and conservative treatment. Patients were included independently of surgical intervention or age. 22.3% (235) of our patients were at risk for malnutrition (NRS≥3) while a regular nutritional status (NRSmalnutrition was found in Septic Surgery with 31.0% (106), followed by Traumatology with 19.2% (100) and Arthroplasty with 15.1% (29). Higher prevalence of malnutrition was observed among patients with typical fractures of the elderly, such as lumbar spine and pelvis (47.4%), proximal femur (36.4%) and proximal humeral (26.7%) fractures. Furthermore, patients at risk for malnutrition showed prolonged hospitalization (13.7±11.1 vs. 18.2±11.7days), delayed postoperative mobilization (2.2±2.9 vs. 4.0±4.9days) and delayed mobilization after conservative treatment (1.1±2.7 vs. 1.8±1.9days). A statistically significant correlation of NRS with each parameter (Spearman's rank correlation, pmalnutrition was statistically significantly higher compared to that of patients with a regular nutritional status (37.2% vs. 21

THE N.I. PIROGOV'S CONTRIBUTION TO THE SURGERY OF MUSCULOSKELETAL SYSTEM (ON THE OCCASION OF THE 200-th ANNIVERSARY OF THE BIRTH

Directory of Open Access Journals (Sweden)

R. M. Tikhilov

2010-01-01

Full Text Available Based on the analysis of the scientific heritage the authors presented the contribution of the great Russian surgeon N.I. Pirogov in the development of surgery of the locomotor system. Discussed in detail next lines of activity of N.I. Pirogov being of interest of trauma and orthopedic surgeons, in particular the: anatomical and physiological approach to studying the issues of surgery of extremities, development of scientific and organizational bases in the domestic military-field surgery, the Pirogov's ideas in the field of reconstructive surgery of the extremities, as well as its contribution to the reforming of surgical education in Russia and improvement of the domestic surgical instruments.

The impact of a hospitalist on role boundaries in an orthopedic environment

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Webster F

2012-10-01

Full Text Available Fiona Webster,1 Samantha Bremner,2 Megan Jackson,3 Vikas Bansal,2 Joanna Sale41Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; 2Holland Orthopedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 3Faculty of Social Science, University of Western Ontario, London, ON, Canada; 4Mobility Program Clinical Research Unit, St Michael's Hospital, Toronto, ON, CanadaPurpose: Hospitalists specialize in the management of hospitalized patients. They work with several health care professionals to provide patient care. There has been little research examining the perceived impact of the hospitalist's role on staff working in an orthopedic environment. This study examined the experiences of staff across several professional backgrounds in working with a hospitalist in an orthopedic environment.Participants and methods: A qualitative descriptive approach was taken to investigate the experience of staff working with a hospitalist at a specialized orthopedic hospital. Purposive sampling was used to recruit interview participants including nurses, internists, pharmacists, physiotherapists, anesthetists, senior administration, and orthopedic surgeons to the point of theoretical saturation, which occurred after 12 interviews. Interviews were coded, and these codes were combined into categories and predominant themes were identified.Findings: Overall, staff believed that the hospitalist role was a positive addition to the facility. The role benefitted patients and supported the clinical well-being and education of staff. Many staff felt the hospitalist had no impact on their workload, but others reported that their work had decreased or increased. Several described the potential for role overlap between the hospitalist and other physicians.Conclusion: The importance of interprofessional collaboration in the implementation of the hospitalist role was a recurring theme in our analysis. This study

Elastic Bandaging for Orthopedic- and Sports-Injury Prevention and Rehabilitation: A Systematic Review.

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Fousekis, Konstantinos; Billis, Evdokia; Matzaroglou, Charalampos; Mylonas, Konstantinos; Koutsojannis, Constantinos; Tsepis, Elias

2017-05-01

Elastic bandages are commonly used in sports to treat and prevent sport injuries. To conduct a systematic review assessing the effectiveness of elastic bandaging in orthopedic- and sports-injury prevention and rehabilitation. The researchers searched the electronic databases MEDLINE, CINAHL, SPORTDiscus, EMBASE, and Physiotherapy Evidence Database (PEDro) with keywords elastic bandaging in combination, respectively, with first aid, sports injuries, orthopedic injuries, and sports injuries prevention and rehabilitation. Research studies were selected based on the use of the term elastic bandaging in the abstract. Final selection was made by applying inclusion and exclusion criteria to the full text. Studies were included if they were peer-reviewed clinical trials written in English on the effects of elastic bandaging for orthopedic-injury prevention and rehabilitation. Twelve studies met the criteria and were included in the final analysis. Data collected included number of participants, condition being treated, treatment used, control group, outcome measures, and results. Studies were critically analyzed using the PEDro scale. The studies in this review fell into 2 categories: studies in athletes (n = 2) and nonathletes (n = 10). All included trials had moderate to high quality, scoring ≥5 on the PEDro scale. The PEDro scores for the studies in athletes and nonathletes ranged from 5 to 6 out of 10 and from 5 to 8 out of 10, respectively. The quality of studies was mixed, ranging from higher- to moderate-quality methodological clinical trials. Overall, elastic bandaging can assist proprioceptive function of knee and ankle joint. Because of the moderate methodological quality and insufficient number of clinical trials, further effects of elastic bandaging could not be confirmed.

Use of resources and costs associated with the treatment of Dupuytren’s contracture at an orthopedics and traumatology surgery department in Denia (Spain): collagenase clostridium hystolyticum versus subtotal fasciectomy

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2013-01-01

Background Our purpose was to analyze and compare the use of direct health resources and costs generated in the treatment of Dupuytren's contracture using two different techniques: subtotal fasciectomy and infiltration with Collagenase Clostridium Histolyticum (CCH) in regular clinical practice at the Orthopedic and Traumatology Surgery (OTS) Department at the Hospital de Denia (Spain). Methods Observational, retrospective study based on data from the computerized clinical histories of two groups of patients- those treated surgically using a one or two digit subtotal fasciectomy technique (FSC) and those treated with CCH infiltration, monitored in regular clinical practice from February, 2009 to May, 2012. Demographic (age, sex), clinical (number of digits affected and which ones) and use of resources (hospitalizations, medical visits, tests and drugs) data were collected. Resource use and associated costs, according to the hospital’s accounting department, were compared based on the type of treatment from Spain’s National Health Service. Results 91 patients (48 (52.8%) in the FSC group) were identified. The average age and number of digits affected was 65.9 (9.2) years and 1.33 (0.48) digits affected in the FSC group, and 65.1 (9.7) years and 1.16 (0.4) digits in the CCH group. Overall, the costs of treating Dupuytren's disease with subtotal FSC amount to €1,814 for major ambulatory surgery and €1,961 with hospital stay including admission, surgical intervention (€904), examinations, dressings and physiotherapy. As to collagenase infiltration, costs amount to €952 (including minor surgery admission, vial with product, office examination and dressings). Finally, comparing total costs for treatments, a savings of €388 is estimated in favor of CCH treatment in the best-case scenario (patient under MAS system with no need for physiotherapy) and €1,008 in the worst-case scenario (patient admitted to hospital needing subsequent physiotherapy), implying a

Immediate effect of a single anteroposterior talus mobilization on dorsiflexion range of motion in participants with orthopedic dysfunction of the ankle and foot.

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Teixeira, Luciana Mundim; Pires, Tatiana; Silva, Rafael Duarte; de Resende, Marcos Antônio

2013-01-01

The purpose of this study was to determine the immediate effects of a single anteroposterior mobilization of the talus on the active dorsiflexion range of motion (ROM) in participants with different orthopedic foot and ankle injuries. This study included 30 male and female participants aged 18 to 50 years with unilateral orthopedic foot and ankle dysfunction. All participants underwent 3 sets of active dorsiflexion ROM measurement in both ankles. Measurements included baseline, post-first treatment, and post-second treatment values. Participants received either joint mobilization or manual contact (control) on the affected ankle. Active dorsiflexion ROM was assessed using a biplanar goniometer with participants in the prone position and 90° of knee flexion. Both groups (joint mobilization and manual contact) showed increased active dorsiflexion ROM. However, the mean difference of dorsiflexion measurements before and after mobilization was greater than before and after control treatment. A single session of articular mobilization of the talus did not significantly increase dorsiflexion ROM in participants with orthopedic dysfunctions of the ankle and foot compared with a manual contact procedure. Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Publication bias in oral and maxillofacial surgery journals: an observation on published controlled trials.

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Pitak-Arnnop, Poramate; Sader, Robert; Rapidis, Alexander D; Dhanuthai, Kittipong; Bauer, Ute; Herve, Chistian; Hemprich, Alexander

2010-01-01

Publication bias (PB) diminishes the full distribution of research, distorts and discredits the scientific record, and thus compromises evidence-based practice. The objective of this study was to analyse published controlled trials with regard to PB in leading oral and maxillofacial surgery (OMS) journals. All controlled trials published in the International Journal of Oral and Maxillofacial Surgery, Journal of Cranio-Maxillofacial Surgery, Journal of Oral and Maxillofacial Surgery, and British Journal of Oral and Maxillofacial Surgery in 2008 were analysed for a primary outcome, country of authors, sample size, gender of the first author, funding source and location of the study. Of 952 published articles, 53 controlled trials (5.7%) were identified. The OMS journals preferentially published controlled trials with a positive outcome (77.4%) and from high-income countries (73.6%). Single-centred trials (86.8%) with low sample size (njournals should establish measures to eliminate PB to uphold scientific integrity. However, this study was an observation based on the published articles. An analysis of all submitted manuscripts would provide more accurate estimates of PB. Ethical considerations on PB are also discussed.

Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study.

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Rousseau, Catherine; Jean, Sonia; Gamache, Philippe; Lebel, Stéfane; Mac-Way, Fabrice; Biertho, Laurent; Michou, Laëtitia; Gagnon, Claudia

2016-07-27

 To investigate whether bariatric surgery increases the risk of fracture.  Retrospective nested case-control study.  Patients who underwent bariatric surgery in the province of Quebec, Canada, between 2001 and 2014, selected using healthcare administrative databases.  12 676 patients who underwent bariatric surgery, age and sex matched with 38 028 obese and 126 760 non-obese controls.  Incidence and sites of fracture in patients who had undergone bariatric surgery compared with obese and non-obese controls. Fracture risk was also compared before and after surgery (index date) within each group and by type of surgery from 2006 to 2014. Multivariate conditional Poisson regression models were adjusted for fracture history, number of comorbidities, sociomaterial deprivation, and area of residence.  Before surgery, patients undergoing bariatric surgery (9169 (72.3%) women; mean age 42 (SD 11) years) were more likely to fracture (1326; 10.5%) than were obese (3065; 8.1%) or non-obese (8329; 6.6%) controls. A mean of 4.4 years after surgery, bariatric patients were more susceptible to fracture (514; 4.1%) than were obese (1013; 2.7%) and non-obese (3008; 2.4%) controls. Postoperative adjusted fracture risk was higher in the bariatric group than in the obese (relative risk 1.38, 95% confidence interval 1.23 to 1.55) and non-obese (1.44, 1.29 to 1.59) groups. Before surgery, the risk of distal lower limb fracture was higher, upper limb fracture risk was lower, and risk of clinical spine, hip, femur, or pelvic fractures was similar in the bariatric and obese groups compared with the non-obese group. After surgery, risk of distal lower limb fracture decreased (relative risk 0.66, 0.56 to 0.78), whereas risk of upper limb (1.64, 1.40 to 1.93), clinical spine (1.78, 1.08 to 2.93), pelvic, hip, or femur (2.52, 1.78 to 3.59) fractures increased. The increase in risk of fracture reached significance only for biliopancreatic diversion.  Patients undergoing bariatric

Relation between type and local of orthopedic injuries with physical activity in horses

OpenAIRE

Sousa,Nicole Ruas de; Luna,Stelio Pacca Loureiro; Pizzigatti,Dietrich; Martins,Mayra Teixeira Alas; Possebon,Fabio Sossai; Aguiar,Adriana Cristina Saldanha

2017-01-01

ABSTRACT: Equine sport modalities influence the prevalence and predisposition of musculoskeletal injuries in horses. This study aimed to evaluate the prevalence of location and type of orthopedic injuries of horses undergoing various physical activities. Data from 116 horses of different breeds and ages was analyzed. Physical activities included dressage, racing, polo pony, jumping, work and western performance. All horses had history of orthopedic lameness diagnosed by radiographs and/or ult...

Examination to assess the clinical examination and documentation of spine pathology among orthopedic residents.

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Haglin, Jack M; Zeller, John L; Egol, Kenneth A; Phillips, Donna P

2017-12-01

The Accreditation Council for Graduate Medical Education (ACGME) guidelines requires residency programs to teach and evaluate residents in six overarching "core competencies" and document progress through educational milestones. To assess the progress of orthopedic interns' skills in performing a history, physical examination, and documentation of the encounter for a standardized patient with spinal stenosis, an objective structured clinical examination (OSCE) was conducted for 13 orthopedic intern residents, following a 1-month boot camp that included communications skills and curriculum in history and physical examination. Interns were objectively scored based on their performance of the physical examination, communication skills, completeness and accuracy of their electronic medical record (EMR), and their diagnostic conclusions gleaned from the patient encounter. The purpose of this study was to meaningfully assess the clinical skills of orthopedic post-graduate year (PGY)-1 interns. The findings can be used to develop a standardized curriculum for documenting patient encounters and highlight common areas of weakness among orthopedic interns with regard to the spine history and physical examination and conducting complete and accurate clinical documentation. A major orthopedic specialty hospital and academic medical center. Thirteen PGY-1 orthopedic residents participated in the OSCE with the same standardized patient presenting with symptoms and radiographs consistent with spinal stenosis. Videos of the encounters were independently viewed and objectively evaluated by one investigator in the study. This evaluation focused on the completeness of the history and the performance and completion of the physical examination. The standardized patient evaluated the communication skills of each intern with a separate objective evaluation. Interns completed these same scoring guides to evaluate their own performance in history, physical examination, and communications

Cold and compression in the management of musculoskeletal injuries and orthopedic operative procedures: a narrative review

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Jon E Block

2010-07-01

Full Text Available Jon E BlockJon E Block, PhD., Incorporated, San Francisco, CA, USAAbstract: Cold and compression are routinely applied immediately after acute injury or ­following surgery to alleviate pain, reduce swelling and speed functional recovery. The objective of this literature review is to describe the published clinical findings regarding combined cold and compression therapy in the management of musculoskeletal injuries and after orthopedic operative procedures. Of 33 potential articles triaged, the findings of 21 randomized controlled trials were assessed and summarized. The findings reported by these 21 studies were largely subjective pain outcomes and, to a lesser degree, swelling and range of motion, and were inconsistent and divergent, making it difficult to recommend the most appropriate, effective clinical application of cold and compression. Further, 18 of the 21 reported studies evaluated cold and static compression, where the extent and duration of the compression was not uniform within or across studies. Operative procedures may offer a more controlled environment for rigorous investigations. However, such studies must be powered sufficiently to account for variations in surgical procedure that could affect outcomes. More uniform operative procedures, such as total knee arthroplasty, represent a well circumscribed intervention for studying the clinical utility of cold compression therapy because the operative technique is standardized, surgical tissue damage is extensive, intraoperative blood loss is high, and post-operative edema and pain are severe. Findings from randomized controlled trials of knee arthroplasty generally showed cold compression therapy provides better outcomes such as pain relief than alternative interventions. While the effects of cold and static compression are clearly better than no treatment, they do not appear to be directly additive.Keywords: cryotherapy, injury

Administration of antibiotic agents before intraoperative sampling in orthopedic infections alters culture results.

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Al-Mayahi, Mohamed; Cian, Anais; Lipsky, Benjamin A; Suvà, Domizio; Müller, Camillo; Landelle, Caroline; Miozzari, Hermès H; Uçkay, Ilker

2015-11-01

Many physicians and surgeons think that prescribing antibiotics before intraoperative sampling does not alter the microbiological results. Case-control study of adult patients hospitalized with orthopedic infections. Among 2740 episodes of orthopedic infections, 1167 (43%) had received antibiotic therapy before surgical sampling. Among these, 220 (19%) grew no pathogens while the proportion of culture-negative results in the 2573 who had no preoperative antibiotic therapy was only 6%. By multivariate analyses, pre-operative antibiotic exposure was associated with significantly more culture-negative results (odds ratio 2.8, 95% confidence interval 2.1-3.7), more non-fermenting rods and skin commensals (odds ratio 2.8 and 3.0, respectively). Even a single pre-operative dose of antibiotic was significantly associated with subsequent culture-negative results (19/93 vs. 297/2350; χ²-test, p = 0.01) and skin commensals (17/74 vs. 274/2350; p = 0.01) compared to episodes without preceding prophylaxis. Prior antibiotic use, including single-dose prophylactic administrations, is three-fold associated with culture-negative results, non-fermenting rods and resistant skin commensals. Copyright © 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Intrathecal nalbuphine versus intrathecal fentanyl as adjuvant to 0.5% hyperbaric bupivacaine for orthopedic surgery of lower limbs under subarachnoid block: A comparative evaluation

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Kumkum Gupta

2016-01-01

Full Text Available Background: Subarachnoid block (SAB possesses many benefits with a drawback of short duration of anesthetic action. Intrathecal opioids have been used to enhance the clinical efficiency and duration of action of local anesthetic drugs. The present study was aimed to compare the clinical efficiency of intrathecal fentanyl with nalbuphine as adjuvant to 0.5% hyperbaric bupivacaine for orthopedic surgery of lower limbs. Patients and Methods: Sixty-eight adult patients of American Society of Anesthesiologist physical status I and II of both gender aged 25-65 years were randomized into two groups of 34 each to receive either fentanyl 25 μg (Group I or nalbuphine 2 mg (Group II with 3.5 mL 0.5% hyperbaric bupivacaine, making intrathecal drug volume to 4 mL in each group. Sensory and motor block characteristics and time to first rescue analgesic (intravenous tramadol 100 mg were recorded as the primary end points. Drug-related side effects of pruritus, nausea/vomiting, and respiratory depression were recorded as the secondary outcomes. Results: Both groups were comparable regarding the onset and cephalic extension of block. The time to two dermatome regressions and time for complete motor recovery were significantly prolonged in patients of Group II with statistical significant difference (P < 0.05. Duration of analgesia was also extended in patients of Group II (378.0 ± 35.72 min as compared to Group I (234.0 ± 24.10 min with highly significant difference (P < 0.001. No drug-related side effects were observed in either group. Conclusion: Intrathecal nalbuphine 2 mg as adjuvant to 0.5% bupivacaine was clinically more efficient than fentanyl for enhancing the postoperative analgesia.

The Top 100 Cited Articles in Clinical Orthopedic Sports Medicine.

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Nayar, Suresh K; Dein, Eric J; Spiker, Andrea M; Bernard, Johnathan A; Zikria, Bashir A

2015-08-01

Orthopedic sports medicine continues to evolve, owing much of its clinical management and practice to rigorous academic research. In this review, we identify and describe the top 100 cited articles in clinical sports medicine and recognize the authors and institutions driving the research. We collected articles (excluding basic science, animal, and cadaveric studies) from the 25 highest-impact sports medicine journals and analyzed them by number of citations, journal, publication date, institution, country, topic, and author. Mean number of citations was 408 (range, 229-1629). The articles were published in 7 journals, most in the 1980s to 2000s, and represented 15 countries. Thirty topics were addressed, with a heavy emphasis on anterior cruciate ligament injury and reconstruction, knee rating systems, rotator cuff reconstruction, and chondrocyte transplantation. The 3 most cited articles, by Insall and colleagues, Constant and Murley, and Tegner and Lysholm, addressed a knee, a shoulder, and another knee rating system, respectively. Several authors contributed multiple articles. The Hospital for Special Surgery and the University of Bern contributed the most articles (5 each). This study provides a comprehensive list of the past century's major academic contributions to sports medicine. Residents and fellows may use this list to guide their scholarly investigations.

Postoperative analgesia after major spine surgery: patient-controlled epidural analgesia versus patient-controlled intravenous analgesia.

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Schenk, Michael R; Putzier, Michael; Kügler, Bjoern; Tohtz, Stephan; Voigt, Kristina; Schink, Tania; Kox, Wolfgang J; Spies, Claudia; Volk, Thomas

2006-11-01

Spinal fusion surgery causes severe postoperative pain, hampering reconvalescense. We investigated the efficacy of patient-controlled epidural analgesia (PCEA) in a prospective, double-blind, randomized, controlled comparison with patient-controlled IV analgesia (PCIA). After lumbar anterior-posterior fusion receiving an epidural catheter intraoperatively, 72 patients were given either PCEA (ropivacaine 0.125% and sufentanil 1.0 microg/mL at 14 mL/h; bolus: 5 mL; lockout time: 15 min) and IV placebo or PCIA (morphine 2.0 mg/mL; bolus: 3 mg; lockout time: 15 min) and epidural placebo. Pain levels (visual analog scale 0-10), functional capabilities (turning in bed, standing, and walking), analgesic consumption, and side effects were evaluated until 72 h after surgery. Fourteen patients were excluded by predetermined criteria, leaving 58 patients for data analysis. Pain levels at rest and during mobilization were significantly lower in the PCEA when compared with that in the PCIA group throughout the study period (P turn in bed was achieved earlier in the PCEA group (P Patients in the PCEA group were significantly more satisfied with pain therapy (P patient satisfaction when compared with PCIA after spinal fusion surgery.

The Radiographic Union Score for Hip (RUSH): the use of a checklist to evaluate hip fracture healing improves agreement between radiologists and orthopedic surgeons

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Chiavaras, Mary M. [McMaster University, Department of Radiology, Hamilton, Ontario (Canada); Hamilton General Hospital, Department of Diagnostic Imaging, Hamilton, Ontario (Canada); Bains, Simrit [University of Western Ontario Medical School, London, Ontario (Canada); Choudur, Hema; Parasu, Naveen [McMaster University, Department of Radiology, Hamilton, Ontario (Canada); Jacobson, Jon [University of Michigan, Department of Radiology, Ann Arbor, MI (United States); Ayeni, Olufemi; Petrisor, Brad; Sprague, Sheila; Bhandari, Mohit [McMaster University, Department of Orthopedic Surgery, Hamilton, Ontario (Canada); Chakravertty, Rajesh [University of Toronto, Department of Orthopedic Surgery, Toronto, Ontario (Canada)

2013-08-15

The assessment of fracture healing following intertrochanteric fracture fixation is highly variable with no validated standards. Agreement with respect to fracture healing following surgery is important for optimal patient management. The purpose of this study was to (1) assess reliability of intertrochanteric fracture healing assessment and (2) determine if a novel radiographic scoring system for hip fractures improves agreement between radiologists and orthopedic surgeons. A panel of three radiologists and three orthopedic surgeons assessed fracture healing in 150 cases of intertrochanteric fractures at two separate time points to determine inter-rater and intra-rater agreement. Reviewers, blinded to the time after injury, first subjectively assessed overall healing using frontal and lateral radiographs for each patient at a single time point. Reviewers then scored each fracture using a Radiographic Union Score for Hip (RUSH) form to determine whether this improves agreement regarding hip fracture healing. Inter-rater agreement for the overall subjective impression of fracture healing between reviewer groups was only fair (intraclass coefficient [ICC] = 0.34, 95 % CI: 0.11-0.52). Use of the RUSH score improved overall agreement between groups to substantial (ICC = 0.66, 95 % CI: 0.53-0.75). Across reviewers, healing of the medial cortex and overall RUSH score itself demonstrated high correlations with overall perceptions of healing (r = 0.53 and r = 0.72, respectively).??The RUSH score improves agreement of fracture healing assessment between orthopedic surgeons and radiologists, offers a systematic approach to evaluating intertrochanteric hip fracture radiographs, and may ultimately provide prognostic information that could predict healing outcomes in patients with femoral neck fractures. (orig.)

The Radiographic Union Score for Hip (RUSH): the use of a checklist to evaluate hip fracture healing improves agreement between radiologists and orthopedic surgeons

International Nuclear Information System (INIS)

Chiavaras, Mary M.; Bains, Simrit; Choudur, Hema; Parasu, Naveen; Jacobson, Jon; Ayeni, Olufemi; Petrisor, Brad; Sprague, Sheila; Bhandari, Mohit; Chakravertty, Rajesh

2013-01-01

The assessment of fracture healing following intertrochanteric fracture fixation is highly variable with no validated standards. Agreement with respect to fracture healing following surgery is important for optimal patient management. The purpose of this study was to (1) assess reliability of intertrochanteric fracture healing assessment and (2) determine if a novel radiographic scoring system for hip fractures improves agreement between radiologists and orthopedic surgeons. A panel of three radiologists and three orthopedic surgeons assessed fracture healing in 150 cases of intertrochanteric fractures at two separate time points to determine inter-rater and intra-rater agreement. Reviewers, blinded to the time after injury, first subjectively assessed overall healing using frontal and lateral radiographs for each patient at a single time point. Reviewers then scored each fracture using a Radiographic Union Score for Hip (RUSH) form to determine whether this improves agreement regarding hip fracture healing. Inter-rater agreement for the overall subjective impression of fracture healing between reviewer groups was only fair (intraclass coefficient [ICC] = 0.34, 95 % CI: 0.11-0.52). Use of the RUSH score improved overall agreement between groups to substantial (ICC = 0.66, 95 % CI: 0.53-0.75). Across reviewers, healing of the medial cortex and overall RUSH score itself demonstrated high correlations with overall perceptions of healing (r = 0.53 and r = 0.72, respectively).??The RUSH score improves agreement of fracture healing assessment between orthopedic surgeons and radiologists, offers a systematic approach to evaluating intertrochanteric hip fracture radiographs, and may ultimately provide prognostic information that could predict healing outcomes in patients with femoral neck fractures. (orig.)

A randomized, controlled trial of an intervention promoting cataract surgery acceptance in rural China: the Guangzhou Uptake of Surgery Trial (GUSTO).

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Liu, Tianyu; Congdon, Nathan; Yan, Xixi; Jin, Ling; Wu, Ying; Friedman, David; He, Mingguang

2012-08-13

To evaluate an educational intervention promoting acceptance of cataract surgery in rural China using a randomized controlled design. Patients aged 50 years or older with presenting visual acuity (PVA) less than 6/18 in one or both eyes due to cataract were recruited from 26 screening sessions (13 intervention, 13 control) conducted by five rural hospitals in Guangdong, China. At intervention sessions, subjects were shown a 5-minute informational video, and counseled about cataract, surgery, and surgical cost. During screening, all subjects answered questionnaires on knowledge and attitudes about cataract, their finances, and transportation, and were referred for definitive examination if eligible. Study outcomes were acceptance of surgery (principal outcome) and hospital follow-up. Subjects in the intervention group were younger than controls (P = 0.01), but the groups did not otherwise differ. Among 212 intervention patients and 222 controls, no differences in knowledge and attitude regarding cataract were found. Surgery was accepted by 31.1% of intervention patients and 34.2% of controls (P > 0.50). Predictors of acceptance included younger age, worse logMAR PVA, knowing that cataract can be treated surgically only, greater anticipated loss in income from hospitalization, and greater house floor space per person. Membership in the intervention group was not associated with accepting surgery (odds ratio [OR] = 1.11, 95% confidence interval [CI] 0.67-1.84) or hospital follow-up (OR = 1.03, 95% CI = 0.63-1.67). Educational interventions that successfully impart the knowledge that cataract can be only treated surgically may be more effective in increasing uptake in this setting. (ClinicalTrials.gov number, NCT01123928.).

Orthopedic rehabilitation using the "Rutgers ankle" interface.

Science.gov (United States)

Girone, M; Burdea, G; Bouzit, M; Popescu, V; Deutsch, J E

2000-01-01

A novel ankle rehabilitation device is being developed for home use, allowing remote monitoring by therapists. The system will allow patients to perform a variety of exercises while interacting with a virtual environment (VE). These game-like VEs created with WorldToolKit run on a host PC that controls the movement and output forces of the device via an RS232 connection. Patients will develop strength, flexibility, coordination, and balance as they interact with the VEs. The device will also perform diagnostic functions, measuring the ankle's range of motion, force exertion capabilities and coordination. The host PC transparently records patient progress for remote evaluation by therapists via our existing telerehabilitation system. The "Rutgers Ankle" Orthopedic Rehabilitation Interface uses double-acting pneumatic cylinders, linear potentiometers, and a 6 degree-of-freedom (DOF) force sensor. The controller contains a Pentium single-board computer and pneumatic control valves. Based on the Stewart platform, the device can move and supply forces and torques in 6 DOFs. A proof-of-concept trial conducted at the University of Medicine and Dentistry of New Jersey (UMDNJ) provided therapist and patient feedback. The system measured the range of motion and maximum force output of a group of four patients (male and female). Future medical trials are required to establish clinical efficacy in rehabilitation.

Can povidone-iodine solution be used safely in a spinal surgery?

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Chang, Fang-Yeng; Chang, Ming-Chau; Wang, Shih-Tien; Yu, Wing-Kwang; Liu, Chien-Lin; Chen, Tain-Hsiung

2006-06-01

Intra-operative incidental contamination of surgical wounds is not rare. Povidone-iodine solution can be used to disinfect surgical wounds. Although povidone-iodine is a good broad-spectrum disinfecting agent, it has occasionally been reported to have a negative effect on wound healing and bone union. Therefore, its safety in a spinal surgery is unclear. A prospective, single-blinded, randomized study was accordingly conducted to evaluate the safety of povidone-iodine solution in spinal surgeries. Ascertained herein was the effect of wound irrigation with diluted povidone-iodine solution on wound healing, infection rate, fusion status and clinical outcome of spinal surgeries. From January 2002 to August 2003, 244 consecutive cases undergoing primary instrumented lumbosacral posterolateral fusion due to degenerative spinal disorder with segmental instability had been collected and randomly divided into two groups: the study group (120 cases, 212 fusion levels) and the control group (124 cases, 223 fusion levels). Excluded were those patients with a prior spinal surgery, spinal trauma, malignant tumor, infectious spondylitis, rheumatoid arthritis, ankylosing spondylitis, metabolic bone disease, skeletal immaturity or with an immunosuppressive treatment. In the former group, wounds were irrigated with 0.35% povidone-iodine solution followed by normal saline solution just before the bone-grafting and instrumentation procedure. However, only with normal saline solution in the latter. All the operations were done by the same surgeon with a standard technique. All the patients were treated in the same postoperative fashion as well. Later on, wound healing, infection rate, spinal bone fusion and clinical outcome were evaluated in both groups. A significant improvement of back and leg pain scores, modified Japanese Orthopedic Association function scores (JOA) and ambulatory capacity have been observed in both groups. One hundred and seven patients in the study group and one

Assessment of mechanical properties and dimensions of suture threads utilized in orthopedic surgeries

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Sardenberg Trajano

2003-01-01

Full Text Available Surgical materials of monofilament nylon (0, 3-0 and 4-0, braided polyester (0, 3-0 and 4-0 and monofilament polypropylene (0, 3-0 and 4-0 of 7 trademarks commercialized in Brazil, was submitted to analysis of diameter, length, enchasement resistance, tensile strength of surgery materials knotted and unknotted, according to ABNT. The results show that most of surgical materials was inside of preconizing patterns of ABNT.

Effect of Oral Lactoferrin on Cataract Surgery Induced Dry Eye: A Randomised Controlled Trial.

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Devendra, Jaya; Singh, Sneha

2015-10-01

Cataract surgery is one of the most frequently performed intra-ocular surgeries, of these manual Small Incision Cataract Surgery (SICS) is a time tested technique of cataract removal. Any corneal incisional surgery, including cataract surgery, can induce dry eye postoperatively. Various factors have been implicated, of which oneis the inflammation induced by the surgery. Lactoferrin, a glycoprotein present in tears is said to have anti-inflammatory effects, and promotes cell growth. It has been used orally in patients of immune mediated dry eye to alleviate symptoms. This study was aimed to evaluate the dry eyes induced by manual Small Incision Cataract Surgery, and the effect if any, of oral lactoferrin on the dry eyes. A single centre, prospective randomised controlled trial with a concurrent parallel design. The study was carried out on patients presenting in the OPD of Rohilkhand Medical College hospital for cataract surgery. Sixty four patients of cataract surgery were included in the study. Patients with pre-existing dry eyes, ocular disease or systemic disease predisposing to dry eyes were excluded from the study. The selected patients were assigned into two groups by simple randomisation-Control Group A-32 patients that did not receive oral lactoferrin postoperatively. Group B-32 patients that received oral lactoferrin 350 gm postoperatively from day 1 after SICS. All patients were operated for cataract and their pre and postoperative (on days 7, 14, 30 and 60) dry eye status was assessed using the mean tear film break-up time (tBUT) and Schirmer test 1 (ST 1) as the evaluating parameters. Subjective evaluation of dry eye was done using Ocular Surface Disease Index (OSDI) scoring. Data was analysed for 58 patients, as 6 did not complete the follow up. Unpaired t-test was used to calculate the p-values. There was a statistically significant difference between the tBUT values of the Control and Lactoferrin group from day 14 onwards. The tBUT of control group

Intraoperative tight glucose control using hyperinsulinemic normoglycemia increases delirium after cardiac surgery.

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Saager, Leif; Duncan, Andra E; Yared, Jean-Pierre; Hesler, Brian D; You, Jing; Deogaonkar, Anupa; Sessler, Daniel I; Kurz, Andrea

2015-06-01

Postoperative delirium is common in patients recovering from cardiac surgery. Tight glucose control has been shown to reduce mortality and morbidity. Therefore, the authors sought to determine the effect of tight intraoperative glucose control using a hyperinsulinemic-normoglycemic clamp approach on postoperative delirium in patients undergoing cardiac surgery. The authors enrolled 198 adult patients having cardiac surgery in this randomized, double-blind, single-center trial. Patients were randomly assigned to either tight intraoperative glucose control with a hyperinsulinemic-normoglycemic clamp (target blood glucose, 80 to 110 mg/dl) or standard therapy (conventional insulin administration with blood glucose target, battery. The authors considered patients to have experienced postoperative delirium when Confusion Assessment Method testing was positive at any assessment. A positive Confusion Assessment Method was defined by the presence of features 1 (acute onset and fluctuating course) and 2 (inattention) and either 3 (disorganized thinking) or 4 (altered consciousness). Patients randomized to tight glucose control were more likely to be diagnosed as being delirious than those assigned to routine glucose control (26 of 93 vs. 15 of 105; relative risk, 1.89; 95% CI, 1.06 to 3.37; P = 0.03), after adjusting for preoperative usage of calcium channel blocker and American Society of Anesthesiologist physical status. Delirium severity, among patients with delirium, was comparable with each glucose management strategy. Intraoperative hyperinsulinemic-normoglycemia augments the risk of delirium after cardiac surgery, but not its severity.

Communication with Orthopedic Trauma Patients via an Automated Mobile Phone Messaging Robot.

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Anthony, Chris A; Volkmar, Alexander; Shah, Apurva S; Willey, Mike; Karam, Matt; Marsh, J Lawrence

2017-12-20

Communication with orthopedic trauma patients is traditionally problematic with low response rates (RRs). The purpose of this investigation was to (1) evaluate the feasibility of communicating with orthopedic trauma patients postoperatively, utilizing an automated mobile phone messaging platform; and (2) assess the first 2 weeks of postoperative patient-reported pain and opioid use after lower extremity orthopedic trauma procedures. This was a prospective investigation at a Level 1 trauma center in the United States. Adult patients who were capable of mobile phone messaging and were undergoing common, lower extremity orthopedic trauma procedures were enrolled in the study. Patients received a daily mobile phone message protocol inquiring about their current pain level and amount of opioid medication they had taken in the past 24 h starting on postoperative day (POD) 3 and continuing through POD 17. Our analysis considered (1) Patient completion rate of mobile phone questions, (2) Patient-reported pain level (0-10 scale), and (3) Number and percentage of daily prescribed opioid medication patients reported taking. Twenty-five patients were enrolled in this investigation. Patients responded to 87.5% of the pain and opioid medication inquiries they received over the 2-week study period. There were no differences in RRs by patient age, sex, or educational attainment. Patient-reported pain decreased over the initial 2-week study period from an average of 4.9 ± 1.7 on POD 3 to 3 ± 2.2 on POD 16-17. Patients took an average of 68% of their maximum daily narcotic prescription on POD 3 compared with 35% of their prescribed pain medication on POD 16-17. We found that in orthopedic trauma patients, an automated mobile phone messaging platform elicited a high patient RR that improved upon prior methods in the literature. This method may be used to reliably obtain pain and medication utilization data after trauma procedures.

脑性瘫痪患儿踝足矫形器配戴前后对运动功能的量化评价%Quantitative assessment of motor function on children with cerebral palsy before and after wearing ankle foot orthopedic instruments

Institute of Scientific and Technical Information of China (English)

李润洁

2002-01-01

Objective To assess motor function quantitatively on children with cerebral palsy before and after wearing ankle foot orthopedic instruments.Method Ankle foot orthopedic instruments were made by Dalian Prosthesis Factory.Children' motor function was assessed with self made quantitative assessment scale according to the forth,fifth function area of motor assessment scale of children with cerebral palsy after one week of wearing orthopedic instruments. Result In all 23 patients, orthopedic instruments proved effective in controlling leg muscular tension,correcting equines,genu recurvatum,talips valgus and talipes varus,keeping erect posture and modifying gait.Motor function assessed show significant difference before and one week after wearing orthopedic instruments (P< 0.001).Conclusion Ankle foot orthopedic instruments play a positive role in improving motor function of lower extremity in cerebral palsy patients.

The role of 3-D imaging and computer-based postprocessing for surgery of the liver and pancreas

International Nuclear Information System (INIS)

Grenacher, L.; Kauffmann, G.W.; Richter, G.M.; Thorn, M.; Vetter, M.; Hassenpflug, P.; Meinzer, H.P.; Knaebel, H.P.; Kraus, T.; Buechler, M.W.

2005-01-01

Cross-sectional imaging based on navigation and virtual reality planning tools are well-established in the surgical routine in orthopedic surgery and neurosurgery. In various procedures, they have achieved a significant clinical relevance and efficacy and have enhanced the discipline's resection capabilities. In abdominal surgery, however, these tools have gained little attraction so far. Even with the advantage of fast and high resolution cross-sectional liver and pancreas imaging, it remains unclear whether 3D planning and interactive planning tools might increase precision and safety of liver and pancreas surgery. The inability to simply transfer the methodology from orthopedic or neurosurgery is mainly a result of intraoperative organ movements and shifting and corresponding technical difficulties in the on-line applicability of presurgical cross sectional imaging data. For the interactive planning of liver surgery, three systems partly exist in daily routine: HepaVision2 (MeVis GmbH, Bremen), LiverLive (Navidez Ltd. Slovenia) and OrgaNicer (German Cancer Research Center, Heidelberg). All these systems have realized a half- or full-automatic liver-segmentation procedure to visualize liver segments, vessel trees, resected volumes or critical residual organ volumes, either for preoperative planning or intraoperative visualization. Acquisition of data is mainly based on computed tomography. Three-dimensional navigation for intraoperative surgical guidance with ultrasound is part of the clinical testing. There are only few reports about the transfer of the visualization of the pancreas, probably caused by the difficulties with the segmentation routine due to inflammation or organ-exceeding tumor growth. With this paper, we like to evaluate and demonstrate the present status of software planning tools and pathways for future pre- and intraoperative resection planning in liver and pancreas surgery. (orig.)

John Bingham Roberts and the first American monograph on human brain surgery.

Science.gov (United States)

Stone, J L

2001-10-01

JOHN BINGHAM ROBERTS (1852-1924) of Philadelphia was an active general surgeon in the latter 19th and early 20th centuries. He made pioneering contributions to a number of areas of surgery. From 1880 until the end of his career, he was one of the few American surgeons to advocate an aggressive exploratory approach to cranial fractures in an effort to avoid consequences such as infection, delayed seizures, and insanity. In his 1885 article in the Transactions of the American Surgical Association titled "The Field and Limitation of the Operative Surgery of the Human Brain," he predicted that with antiseptic precautions and the growing knowledge of cerebral localization, operations on the brain would become commonplace. This work predated that of Horsley, Keen, and many others. Roberts had a continuing interest in head injuries, cranial fractures, and the development of trephines and burrs for reconstructive cranial work, but his active enthusiasm for brain surgery diminished in the 1890s. Nevertheless, Roberts was a very prolific teacher and leader in American surgery who is perhaps best remembered for his monographs and textbooks on general, orthopedic, plastic, and reconstructive surgery.

The comparison of combined femoral-sciatic nerve block with spinal anesthesia at lower extremity surgery

Directory of Open Access Journals (Sweden)

Selim Almaz

2014-06-01

Full Text Available Introduction: In this study, we aimed to compare the spinal anesthesia technique with combined femoral-sciatic block technique in patients undergoing lower limb surgery. Methods: In this study, after obtaining the approval of the Dicle University Faculty of Medicine Ethics Committee, scheduled for elective lower extremity surgery, the ASA 1-2 groups, between the ages of 18-65, 60 patients were enrolled. Study was planned as a prospective, randomized and controlled. Patients were randomly divided into 2 groups as the spinal anesthesia (Group S and combined sciatic-femoral nerve block (Group CSF to be. Results: Demographic data similar between the groups (p> 0.05. The implementation period of the technique was long in the Group CSF compared with in the Group S (p <0.001. Surgery delivery time was shorter in the Group S compared with in the Group CSF (p <0.001. The time of motor block occurrence was longer in the Group CSF compared with in the Group S (p <0.001. The duration of motor block was long in the Group CSF compared with in the Group S (p <0.001. Conclusion: The each of two methods is safe and effective in lower extremity orthopedic surgery, but the application of peripheral nerve block to provide the long-term advantages such as postoperative analgesia and reducing postoperative analgesic consumption. J Clin Exp Invest 2014; 5 (2: 443-446

Investigation of incidence and risk factors for surgical glove perforation in small animal surgery.

Science.gov (United States)

Hayes, Galina M; Reynolds, Deborah; Moens, Noel M M; Singh, Ameet; Oblak, Michelle; Gibson, Thomas W G; Brisson, Brigitte A; Nazarali, Alim; Dewey, Cate

2014-05-01

To identify incidence and risk factors for surgical glove perforation in small animal surgery. Observational cohort study. Surgical gloves (n = 2132) worn in 363 surgical procedures. All gloves worn by operative personnel were assessed for perforation at end-procedure using a water leak test. Putative risk factors were recorded by a surgical team member. Associations between risk factors and perforation were assessed using multivariable multi-level random-effects logistic regression models to control for hierarchical data structure. At least 1 glove perforation occurred in 26.2% of procedures. Identified risk factors for glove perforation included increased surgical duration (surgery >1 hour OR = 1.79, 95% CI = 1.12-2.86), performing orthopedic procedures (OR = 1.88; 95% CI = 1.23-2.88), any procedure using powered instruments (OR = 1.93; 95% CI = 1.21-3.09) or surgical wire (OR = 3.02; 95% CI = 1.50-6.05), use of polyisoprene as a glove material (OR = 1.59, 95% CI = 1.05-2.39), and operative role as primary surgeon (OR = 2.01; 95% CI = 1.35-2.98). The ability of the wearer to detect perforations intraoperatively was poor, with a sensitivity of 30.8%. There is a high incidence of unrecognized glove perforations in small animal surgery. © Copyright 2014 by The American College of Veterinary Surgeons.

Effectiveness of a patient blood management protocol on reduction of allogenic red blood cell transfusions in orthopedic surgery.

Science.gov (United States)

Polanco-García, Mauricio; Capielo, Ana María; Miret, Xavier; Chamero, Antonio; Sainz, Julio; Revilla, Elena; Guinjoan, Antoni; Arranz, Teresa

2018-06-07

Patient blood management in orthopaedic surgery reduces transfusion risk. The best protocol is unknown. The effectiveness of a protocol based on the Seville Consensus on the reduction of transfusion risk is evaluated and a predictive transfusion equation is proposed in knee surgery. Cohort study in patients undergoing knee and hip arthroplasty from January 2014 to December 2015 at a second level complexity hospital in Vilafranca del Penedès (Barcelona). Patients with Hb between 10 and 13g/dL were classified as anaemic with or without iron deficiency and received iron or combination of iron and erythropoietin. On the day of surgery, tranexamic acid was administered, the Hb drop was measured the next day and the requirements and the transfusion lintel were measured during the stay. A total of 334 patients were included in the study. The implementation of the programme decreased the transfusion risk from 41.5% to 14.8% at the end of the study. In hip surgery, transfused patients were significantly older, sicker and with lower preoperative Hb. Tranexamic acid did not decrease bleeding. In knee surgery, the administration of tranexamic acid was the variable that most decreased the transfusion risk followed by a high preoperative Hb. The equation predicts transfusion risk with a sensitivity of 55% and specificity of 95.7%. The implementation of the programme reduces transfusion risk. The effectiveness of tranexamic acid varies according to surgery site. The use of iron and recombinant human erythropoietin is necessary to improve Hb. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Factors related to adherence of recommendations for redose administration in clean surgeries

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Cristiane Schmitt

2015-03-01

Full Text Available Surgical site infections (SSIs are one of the main adverse events among surgical patients, being responsible for 20% of healthcare-associated infections (HAIs. Surgical antibiotic prophylaxis is one of the practices used to prevent SSIs, however, compliance with recommendations is low. A retrospective observational cross-sectional study investigated the index of compliance with redose and its relationship to characteristics of the procedures and individuals. A total of 748 records of cardiac, orthopedic and neurological surgeries were assessed. Of these, 90 had an indication of redose, which was administered in 26.6% of the surgeries. Compliance was significantly higher in cardiac surgeries (34.3% and those of greater SSI risk index. In conclusion, compliance with recommendations for redose administration is low and improving the process of surgical antibiotic prophylaxis use is needed. The use of technologies in association with awareness, motivation of the teams and involvement of the nursing staff may constitute alternatives.

Effects of peritoneal ropivacaine nebulization for pain control after laparoscopic gynecologic surgery.

Science.gov (United States)

Somaini, Marta; Brambillasca, Pietro; Ingelmo, Pablo Mauricio; Lovisari, Federica; Catenacci, Stefano Scalia; Rossini, Valeria; Bucciero, Mario; Sahillioglu, Emre; Buda, Alessandro; Signorelli, Mauro; Gili, Mauro; Joshi, Girish; Fumagalli, Roberto; Ferland, Catherine E; Diemunsch, Pierre

2014-01-01

To evaluate the effects of peritoneal cold nebulization of ropivacaine on pain control after gynecologic laparoscopy. Evidence obtained from a properly designed, randomized, double-blind, placebo-controlled trial (Canadian Task Force classification I). Tertiary care center. One hundred thirty-five women with American Society of Anesthesiologists disease classified as ASA I-III who were scheduled to undergo operative laparoscopy. Patients were randomized to receive either nebulization of 30 mg ropivacaine before surgery (preoperative group), nebulization of 30 mg ropivacaine after surgery (postoperative group), instillation of 100 mg ropivacaine before surgery (instillation group), or instillation of saline solution (control group). Nebulization was performed using the Aeroneb Pro device. Pain scores, morphine consumption, and ambulation time were collected in the post-anesthesia care unit and at 4, 6, and 24 hours postoperatively. One hundred eighteen patients completed the study. Patients in the preoperative group reported lower pain Numeric Ranking Scale values compared with those in the control group (net difference 2 points; 95% confidence interval [CI], 0.3-3.1 at 4 hours, 1-3 at 6 hours, and 0.7-3 at 24 hours; p = .01) Patients in the preoperative group consumed significantly less morphine than did those in the control group (net difference 7 mg; 95% CI, 0.7-13; p = .02). More patients who received nebulization walked without assistance within 12 hours after awakening than did those in the instillation and control groups (net difference 15%; 95% CI, 6%-24%; p = .001). Cold nebulization of ropivacaine before surgery reduced postoperative pain and morphine consumption and was associated with earlier walking without assistance. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

Multi-detector CT imaging in the postoperative orthopedic patient with metal hardware

International Nuclear Information System (INIS)

Vande Berg, Bruno; Malghem, Jacques; Maldague, Baudouin; Lecouvet, Frederic

2006-01-01

Multi-detector CT imaging (MDCT) becomes routine imaging modality in the assessment of the postoperative orthopedic patients with metallic instrumentation that degrades image quality at MR imaging. This article reviews the physical basis and CT appearance of such metal-related artifacts. It also addresses the clinical value of MDCT in postoperative orthopedic patients with emphasis on fracture healing, spinal fusion or arthrodesis, and joint replacement. MDCT imaging shows limitations in the assessment of the bone marrow cavity and of the soft tissues for which MR imaging remains the imaging modality of choice despite metal-related anatomic distortions and signal alteration

Rising incidence of Enterococcus species in microbiological specimens from orthopedic patients correlates to increased use of cefuroxime

DEFF Research Database (Denmark)

Siesing, Peter Christian; Alva-Jørgensen, Jens Peter; Brodersen, Jakob

2013-01-01

Enterococci are emerging causes of severe infections, including wound and bone infections in orthopedic patients. The main purpose of this study was to determine whether there was a correlation between the incidence of enterococci in tissue samples (biopsies) from orthopedic patients and consumpt...

Importance of Perioperative Glycemic Control in General Surgery

Science.gov (United States)

Kwon, Steve; Thompson, Rachel; Dellinger, Patchen; Yanez, David; Farrohki, Ellen; Flum, David

2014-01-01

Objective To determine the relationship of perioperative hyperglycemia and insulin administration on outcomes in elective colon/rectal and bariatric operations. Background There is limited evidence to characterize the impact of perioperative hyperglycemia and insulin on adverse outcomes in patients, with and without diabetes, undergoing general surgical procedures. Methods The Surgical Care and Outcomes Assessment Program is a Washington State quality improvement benchmarking-based initiative. We evaluated the relationship of perioperative hyperglycemia (>180 mg/dL) and insulin administration on mortality, reoperative interventions, and infections for patients undergoing elective colorectal and bariatric surgery at 47 participating hospitals between fourth quarter of 2005 and fourth quarter of 2010. Results Of the 11,633 patients (55.4 ± 15.3 years; 65.7% women) with a serum glucose determination on the day of surgery, postoperative day 1, or postoperative day 2, 29.1% of patients were hyperglycemic. After controlling for clinical factors, those with hyperglycemia had a significantly increased risk of infection [odds ratio (OR) 2.0; 95% confidence interval (CI), 1.63–2.44], reoperative interventions (OR, 1.8; 95% CI, 1.41–2.3), and death (OR, 2.71; 95% CI, 1.72–4.28). Increased risk of poor outcomes was observed both for patients with and without diabetes. Those with hyperglycemia on the day of surgery who received insulin had no significant increase in infections (OR, 1.01; 95% CI, 0.72–1.42), reoperative interventions (OR, 1.29; 95% CI, 0.89–1.89), or deaths (OR, 1.21; 95% CI, 0.61–2.42). A dose-effect relationship was found between the effectiveness of insulin-related glucose control (worst 180–250 mg/dL, best adverse outcomes. Conclusions Perioperative hyperglycemia was associated with adverse outcomes in general surgery patients with and without diabetes. However, patients with hyperglycemia who received insulin were at no greater risk than

Readability of Patient Education Materials From the Web Sites of Orthopedic Implant Manufacturers.

Science.gov (United States)

Yi, Meghan M; Yi, Paul H; Hussein, Khalil I; Cross, Michael B; Della Valle, Craig J

2017-12-01

Prior studies indicate that orthopedic patient education materials are written at a level that is too high for the average patient. The purpose of this study was to assess the readability of online patient education materials provided by orthopedic implant manufacturers. All patient education articles available in 2013 from the web sites of the 5 largest orthopedic implant manufacturers were identified. Each article was evaluated with the Flesch-Kincaid (FK) readability test. The number of articles with readability ≤ the eighth-grade level (average reading ability of US adults) and the sixth-grade level (recommended level for patient education materials) was determined. Mean readability levels of each company's articles were compared using analysis of variance (significance set at P articles were reviewed from the 5 largest implant manufacturers. The mean overall FK grade level was 10.9 (range, 3.8-16.1). Only 58 articles (10%) were written ≤ the eighth-grade level, and only 13 (2.2%) were ≤ the sixth-grade level. The mean FK grade level was significantly different among groups (Smith & Nephew = 12.0, Stryker = 11.6, Biomet = 11.3, DePuy = 10.6, Zimmer = 10.1; P education materials from implant manufacturers are written at a level too high to be comprehended by the average patient. Future efforts should be made to improve the readability of orthopedic patient education materials. Copyright © 2017 Elsevier Inc. All rights reserved.

Methods of orthopedic treatment of dentition defects

Directory of Open Access Journals (Sweden)

Konnov V.V.

2016-09-01

Full Text Available The article is devoted to the methods of orthopedic treatment of dentition defects. To restore the functionality and individual aesthetic standards of dental system, with different types of partial loss of teeth, depending on the anatomical and topographical conditions, various kinds of dental prosthesis designs are used in the oral cavity: non-removable (bridges, cantilever, adhesive dentures and removable (laminar and clasp dental prostheses, as well as their combinations.

Personal dosimetry TLD 100 in orthopedic surgeons exposed to ionizing radiation in Bogota - Colombia

International Nuclear Information System (INIS)

Sierra C, B. Y.; Jimenez, Y.; Plazas, M. C.; Eslava S, J.; Groot R, H.

2014-08-01

Orthopedic surgeons should be considered as professionals occupationally exposed to ionizing radiation, for using C arc (fluoroscope) an equipment of X type radiation emission, during surgical procedures for imaging generation. Some health institutes, use of C arc under uncontrolled circumstances, such a lack of dosimetry control, incomplete or absence of personnel protective elements and protective measures, which in turn, lead to a high exposition to the personnel. Materials and methods. Study of double match cohort by age and gender, was conducted, in four health institutions of second and third level of attention in Bogota city. Personal dosimetry measurements with TLD-100 dosimetry crystals in both cohorts and environmental dosimetry in each of operation rooms used for orthopedic procedures, were carry out during six months of follow up. Dosimetry crystals were read in a Harshaw 4500 - Bicron equipment, in the Medical Physics Laboratory of National University of Colombia. Results. Dosimetry measurements are compatibles with those of occupationally exposed personnel 3.44 mSv/6 m CI 95% (1.66-3.99), even does not overpass ICRP recommendations, are higher as were expect at the beginning of the study. The median of effective accumulative dose in thorax is 3,4 mSv CI 95% (1,66-3,99), higher in comparison with neck value 2,7 mSv CI 95% (1,73-3,80) and hand dosimetry 1,42 mSv CI 95% (0,96-2,34). Conclusions: Orthopedic surgeons should be considered occupational exposed to ionizing radiation, who has to accomplish to the radiological protection measures, dosimetric follow up and maintenance of the used X ray equipment. It was confirm throughout this study that dosimetry shows higher levels as expected at the beginning of the study, compatible with occupationally exposed personnel. (Author)

The orthopedic gender gap: trends in authorship and editorial board representation over the past 4 decades.

Science.gov (United States)

Okike, Kanu; Liu, Bella; Lin, Yijie Brittany; Torpey, Jennifer L; Kocher, Mininder S; Mehlman, Charles T; Bhandari, Mohit; Biermann, J Sybil

2012-07-01

The purpose of this study was to quantify the representation of women among the authors and editorial board members of prominent general orthopedics journals and to determine how these proportions have changed over time. Gender was determined for the authors of all original research studies, case reports, and review articles published in 2 prominent general orthopedics journals in 1970, 1980, 1990, 2000, and 2007. Gender was also determined for each individual serving on the editorial boards of these journals during these years. Between 1970 and 2007, the representation of women increased from 0.8% to 6.5% among first authors (P<.001), from 0.0% to 4.3% among last authors (P = .015), and from 1.6% to 5.4% among editorial board members (P = .16). However, the rates of increase observed in orthopedics were lower than those observed in other fields (P<.05). Between 1970 and 2007, female representation increased significantly among physicians publishing in 2 prominent general orthopedics journals, but these rates of increase were lower than those observed in other fields of medicine.

Surveyed opinion of American trauma, orthopedic, and thoracic surgeons on rib and sternal fracture repair.

Science.gov (United States)

Mayberry, John C; Ham, L Bruce; Schipper, Paul H; Ellis, Thomas J; Mullins, Richard J

2009-03-01

Rib and sternal fracture repair are controversial. The opinion of surgeons regarding those patients who would benefit from repair is unknown. Members of the Eastern Association for the Surgery of Trauma, the Orthopedic Trauma Association, and thoracic surgeons (THS) affiliated with teaching hospitals in the United States were recruited to complete an electronic survey regarding rib and sternal fracture repair. Two hundred thirty-eight trauma surgeons (TRS), 97 orthopedic trauma surgeons (OTS), and 70 THS completed the survey. Eighty-two percent of TRS, 66% of OTS, and 71% of THS thought that rib fracture repair was indicated in selected patients. A greater proportion of surgeons thought that sternal fracture repair was indicated in selected patients (89% of TRS, 85% of OTS, and 95% of THS). Chest wall defect/pulmonary hernia (58%) and sternal fracture nonunion (>6 weeks) (68%) were the only two indications accepted by a majority of respondents. Twenty-six percent of surgeons reported that they had performed or assisted on a chest wall fracture repair, whereas 22% of surgeons were familiar with published randomized trials of the surgical repair of flail chest. Of surgeons who thought rib fracture or sternal fracture repair was rarely, if ever, indicated, 91% and 95%, respectively, specified that a randomized trial confirming efficacy would be necessary to change their negative opinion. A majority of surveyed surgeons reported that rib and sternal fracture repair is indicated in selected patients; however, a much smaller proportion indicated that they had performed the procedures. The published literature on surgical repair is sparse and unfamiliar to most surgeons. Barriers to surgical repair of rib and sternal fracture include a lack of expertise among TRS, lack of research of optimal techniques, and a dearth of randomized trials.

Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery

Directory of Open Access Journals (Sweden)

Henning Bay Nielsen

2014-03-01

Full Text Available Near-infrared spectroscopy (NIRS is used to monitor regional cerebral oxygenation (rScO2 during cardiac surgery but is less established during non-cardiac surgery. This systematic review aimed i to determine the non-cardiac surgical procedures that provoke a reduction in rScO2 and ii to evaluate whether an intraoperative reduction in rScO2 influences postoperative outcome. The PubMed and Embase database were searched from inception until April 30, 2013 and inclusion criteria were intraoperative NIRS determined rScO2 in adult patients undergoing non-cardiac surgery. The type of surgery and number of patients included were recorded. There was included 113 articles and evidence suggests that rScO2 is reduced during thoracic surgery involving single lung ventilation, major abdominal surgery, hip surgery, and laparascopic surgery with the patient placed in anti-Tredelenburg’s position. Shoulder arthroscopy in the beach chair and carotid endarterectomy with clamped internal carotid artery also cause pronounced cerebral desaturation. A >20% reduction in rScO2 coincides with indices of regional and global cerebral ischemia during carotid endarterectomy. Following thoracic surgery, major orthopedic and abdominal surgery the occurrence of postoperative cognitive dysfunction might be related to intraoperative cerebral desaturation. In conclusion, certain non-cardiac surgical procedures is associated with an increased risk for the occurrence of regional cerebral oxygenation. Evidence for an association between cerebral desaturation and postoperative outcome parameters other than cognitive dysfunction needs to be established.

Use of next generation sequencing to detect biofilm bacteria in a patient with pedicle screw loosening after spine surgery

DEFF Research Database (Denmark)

Xu, Yijuan; Thomsen, Trine Rolighed; Lorenzen, Jan

2016-01-01

2. Center for Microbial Communities, Department of Biotechnology, Chemistry and Environmental Engineering, Aalborg University, Denmark 3. Otto-von-Guericke University Magdeburg, Department of Orthopedic Surgery, Magdeburg, Germany 4. Eifelklinik St. Brigida, Simmerath, Germany Aim: ”Hidden deep...... implant-related infection is believed to be linked to pedicle screw loosening after spine surgery. Low-grade bacterial infection can be hard to diagnose and may be undetected by conventional culture based methods. Next generation sequencing (NGS) could help to uncover hidden bacterial infections...... as a possible cause for implant loosening. This case report describes the use of NGS in the diagnostic work-up of a patient with pedicle screw loosening after spine surgery.” Method: ”A 60 y/o male had to undergo revision spine surgery for pedicle screw loosening and adjacent segment disease 3 years after...

Clinical evaluation of an automatic blood pressure controller during cardiac surgery

NARCIS (Netherlands)

Meijers, R.H.A.M.; Schmartz, D.; Cantraine, F.R.L.; Barvais, L.; d Hollander, A.A.; Blom, J.A.

1997-01-01

During surgery, computers can be of great use to support the anesthesiologist in providing task automation. In this paper we describe a closed loop blood pressure controller and show the results of its clinical evalua- tion.Methods. The controller is based on a simple and robust

3D printing for orthopedic applications: from high resolution cone beam CT images to life size physical models

Science.gov (United States)

Jackson, Amiee; Ray, Lawrence A.; Dangi, Shusil; Ben-Zikri, Yehuda K.; Linte, Cristian A.

2017-03-01

With increasing resolution in image acquisition, the project explores capabilities of printing toward faithfully reflecting detail and features depicted in medical images. To improve safety and efficiency of orthopedic surgery and spatial conceptualization in training and education, this project focused on generating virtual models of orthopedic anatomy from clinical quality computed tomography (CT) image datasets and manufacturing life-size physical models of the anatomy using 3D printing tools. Beginning with raw micro CT data, several image segmentation techniques including thresholding, edge recognition, and region-growing algorithms available in packages such as ITK-SNAP, MITK, or Mimics, were utilized to separate bone from surrounding soft tissue. After converting the resulting data to a standard 3D printing format, stereolithography (STL), the STL file was edited using Meshlab, Netfabb, and Meshmixer. The editing process was necessary to ensure a fully connected surface (no loose elements), positive volume with manifold geometry (geometry possible in the 3D physical world), and a single, closed shell. The resulting surface was then imported into a "slicing" software to scale and orient for printing on a Flashforge Creator Pro. In printing, relationships between orientation, print bed volume, model quality, material use and cost, and print time were considered. We generated anatomical models of the hand, elbow, knee, ankle, and foot from both low-dose high-resolution cone-beam CT images acquired using the soon to be released scanner developed by Carestream, as well as scaled models of the skeletal anatomy of the arm and leg, together with life-size models of the hand and foot.

Relationship of orthopedic examination, goniometric measurements, and radiographic signs of degenerative joint disease in cats

OpenAIRE

Lascelles, B Duncan X; Dong, Yaa-Hui; Marcellin-Little, Denis J; Thomson, Andrea; Wheeler, Simon; Correa, Maria

2012-01-01

Abstract Background Available information suggests a mismatch between radiographic and orthopedic examination findings in cats with DJD. However, the extent of the discrepancy between clinical and radiographic signs of OA in companion animals has not been described in detail. This study aimed to evaluate the relationship between orthopedic examination findings, joint goniometry, and radiographic signs of DJD in 100 cats, in a prospective observational design. Cat temperament, pain response to...

The impact of cataract surgery on visual functioning, vision-related disability and psychological distress: a randomized controlled trial.

Science.gov (United States)

Walker, Janine G; Anstey, Kaarin J; Hennessy, Michael P; Lord, Stephen R; von Sanden, Chwee

2006-11-01

Determine whether there are changes in visual functioning, vision-related disability, health status and mood after cataract surgery. 45 adults (mean age = 73.7 years) with bilateral cataract needing surgery for the first eye were recruited from public ophthalmology clinics. The Visual Functioning-14 survey assessed visual disability. Minimal angle of resolution tested visual acuity, and the Melbourne Edge Test examined contrast sensitivity. Demographic, psychological, health and medication use variables were examined. Participants were randomized to either an intervention or control arm. Controls were assessed on two occasions at a 3-month interval before having surgery. The intervention group was assessed 1-2 weeks before surgery and then reassessed 3 months after surgery. Visual functioning improved for those who had cataract surgery with better visual acuity in the better (P = 0.010) and worse (P = 0.028) eye compared with controls. The intervention group reported fewer difficulties with overall vision-related disability (P = 0.0001), reading (P = 0.004) and instrumental activities of daily living (P = 0.010) post-surgery compared with controls. People with improved depression scores (P = 0.048) after surgery had less difficulty with reading compared with those with unchanged or worsened depression scores. Cataract surgery did not improve health status. First eye cataract surgery is effective in improving outcomes in visual functioning and disability. Improved mood after surgery was related to less vision-related disability compared with unchanged or worse depression.

Corticobulbar motor evoked potentials from tongue muscles used as a control in cervical spinal surgery

Directory of Open Access Journals (Sweden)

Dong-Gun Kim

Full Text Available Objective: Motor evoked potentials (MEPs changes might be caused to the non-surgically induced factors during cervical spinal surgery. Therefore, control MEPs recorded cranially to the exit of the C5 root are highly recommendable in cervical spinal surgery. We studied whether corticobulbar MEPs (C-MEPs from tongue muscle could be used as a control MEPs in cervical spinal surgery. Methods: Twenty-five consecutive cervical spinal surgeries were analyzed. Stimulation of motor area for tongue was done by subcutaneous electrodes placed at C3/C4 (10–20 EEG System, and recording was done from both sides of tongue. Results: C-MEPs were recorded successfully 24 out of the 25 (96% tested patients. Forty-six out of fifty MEPs (92% from tongue muscles were monitorable from the baseline. In two patients, we could obtain only unilateral C-MEPs. Mean MEPs latencies obtained from the left and right side of the tongue were 11.5 ± 1 ms and 11.5 ± 0.8 ms, respectively. Conclusions: Monitoring C-MEPs from tongue muscles might be useful control in cervical spinal surgery. They were easily elicited and relatively free from phenomenon of peripheral stimulation of the hypoglossal nerves. Significance: This is first study to identify the usefulness of C-MEPs as a control of cervical spinal surgery. Keywords: Intraoperative neurophysiological monitoring, Motor-evoked potential, Corticospinal tract, Corticobulbar MEPs, Hypoglossal nerve

3D force control for robotic-assisted beating heart surgery based on viscoelastic tissue model.

Science.gov (United States)

Liu, Chao; Moreira, Pedro; Zemiti, Nabil; Poignet, Philippe

2011-01-01

Current cardiac surgery faces the challenging problem of heart beating motion even with the help of mechanical stabilizer which makes delicate operation on the heart surface difficult. Motion compensation methods for robotic-assisted beating heart surgery have been proposed recently in literature, but research on force control for such kind of surgery has hardly been reported. Moreover, the viscoelasticity property of the interaction between organ tissue and robotic instrument further complicates the force control design which is much easier in other applications by assuming the interaction model to be elastic (industry, stiff object manipulation, etc.). In this work, we present a three-dimensional force control method for robotic-assisted beating heart surgery taking into consideration of the viscoelastic interaction property. Performance studies based on our D2M2 robot and 3D heart beating motion information obtained through Da Vinci™ system are provided.

Retracted articles in surgery journals. What are surgeons doing wrong?

Science.gov (United States)

Cassão, Bruna Dell'Acqua; Herbella, Fernando A M; Schlottmann, Francisco; Patti, Marco G

2018-03-08

Retraction of previously published scientific articles is an important mechanism to preserve the integrity of scientific work. This study analyzed retractions of previously published articles from surgery journals. We searched for retracted articles in the 100 surgery journals with the highest SJR2 indicator grades. We found 130 retracted articles in 49 journals (49%). Five or more retracted articles were published in 8 journals (8%). The mean time between publication and retraction was 26 months (range 1 to 158 months). The United States, China, Germany, Japan, and the United Kingdom accounted for more than 3 out of 4 of the retracted articles. The greatest number of retractions came from manuscripts about orthopedics and traumatology, general surgery, anesthesiology, cardiothoracic surgery, and plastic surgery. Nonsurgeons were responsible for 16% of retractions in these surgery journals. The main reasons for retraction were duplicate publication (42%), plagiarism (16%), absence of proven integrity of the study (14%), incorrect data (13%), data published without authorization (12%), violation of research ethics (11%), documented fraud (11%), request of an author(s) (5%), and unknown (3%). In 25% of the retracted articles, other publications by the same authors also had been retracted. Retraction of published articles does not occur frequently in surgery journals. Some form of scientific misconduct was present in the majority of retractions, especially duplication of publication and plagiarism. Retractions of previously published articles were most frequent from countries with the greatest number of publications; some authors showed recidivism. Copyright © 2018 Elsevier Inc. All rights reserved.

Developing a minimum data set of the information management system for orthopedic injuries in iran.

Science.gov (United States)

Ahmadi, Maryam; Mohammadi, Ali; Chraghbaigi, Ramin; Fathi, Taimur; Shojaee Baghini, Mahdieh

2014-07-01

Orthopedic injuries are the most common types of injuries. To identify the main causes of injuries, collecting data in a standard manner at the national level are needed, which justifies necessity of making a minimum data set (MDS). The aim of this study was to develop an MDS of the information management system for orthopedic injuries in Iran. This descriptive cross-sectional study was performed in 2013. Data were collected from hospitals affiliated with Tehran University of Medical Sciences that had orthopedic department, medical documents centers, legal medicine centers, emergency centers, internet access, and library. Investigated documents were orthopedic injury records in 2012, documents that retrieved from the internet, and printed materials. Records with Random sampling by S22-S99 categories from ICD-10 were selected and the related internet-sourced data were evaluated entirely. Data were collected using a checklist. In order to make a consensus about the data elements, the decision Delphi technique was applied by a questionnaire. The content validity and reliability of the questionnaire were assessed by expert's opinions and test-retest method, respectively. AN MDS OF ORTHOPEDIC INJURIES WERE ASSIGNED TO TWO CATEGORIES: administrative category with six classes including 142 data elements, and clinical category with 17 classes including 250 data elements. This study showed that some of the essential data elements included in other country's MDS or required for organizations and healthcare providers were not included. Therefore, a complete list of an MDS elements was created. Existence of comprehensive data concerning the causes and mechanisms of injuries informs public health policy-makers about injuries occurrence and enables them to take rationale measures to deal with these problems.

A touch probe method of operating an implantable RFID tag for orthopedic implant identification.

Science.gov (United States)

Liu, Xiaoyu; Berger, J Lee; Ogirala, Ajay; Mickle, Marlin H

2013-06-01

The major problem in operating an implantable radio-frequency identification (RFID) tag embedded on an orthopedic implant is low efficiency because of metallic interference. To improve the efficiency, this paper proposes a method of operating an implantable passive RFID tag using a touch probe at 13.56 MHz. This technology relies on the electric field interaction between two pairs of electrodes, one being a part of the touch probe placed on the surface of tissue and the other being a part of the tag installed under the tissue. Compared with using a conventional RFID antenna such as a loop antenna, this method has a better performance in the near field operation range to reduce interference with the orthopedic implant. Properly matching the touch probe and the tag to the tissue and the implant reduces signal attenuation and increases the overall system efficiency. The experiments have shown that this method has a great performance in the near field transcutaneous operation and can be used for orthopedic implant identification.

[Acute inpatient conservative multimodal treatment of complex and multifactorial orthopedic diseases in the ANOA concept].

Science.gov (United States)

Psczolla, M

2013-10-01

In Germany there is a clear deficit in the non-operative treatment of chronic and complex diseases and pain disorders in acute care hospitals. Only about 20 % of the treatments are carried out in orthopedic hospitals. Hospitals specialized in manual medicine have therefore formed a working group on non-operative orthopedic manual medicine acute care clinics (ANOA). The ANOA has developed a multimodal assessment procedure called the OPS 8-977 which describes the structure and process quality of multimodal and interdisciplinary diagnosis and treatment of the musculoskeletal system. Patients are treated according to clinical pathways oriented on the clinical findings. The increased duration of treatment in the German diagnosis-related groups (DRG) system is compensated for with a supplemental remuneration. Thus, complex and multifactorial orthopedic diseases and pain disorders are conservatively and appropriately treated as inpatient departments of acute care hospitals.

[Normal and pathologic mandible development: practical deductions in maxillo-dento-facial orthopedics].

Science.gov (United States)

Salagnac, Jean-Michel

2016-09-01

The mandible consists of different segments, each of which possess its own specific characteristics regarding emergence, ossification during growth and pathologies. Orthodontists need to be very familiar with these developmental anomalies if they are to avoid failure in their orthopedic or orthodontic treatments and in order to understand the reasons for the lack of success of "conventional" treatments. Each segment must develop correctly if the mandible is to achieve optimal development and occupy a normal position within the cranio-facial complex. The position of the mandible in the cranio-facial block is also conditioned by its attachment to the base of the skull. Combining a detailed semiologic study and a three-dimensional architectural and structural radiologic analysis of clinical cases, this article investigates the various anomalies affecting the mandibular segments and their impact on the craniofacial structure as a whole. An understanding of these anomalies and this analytical method can enable clinicians to perform early diagnosis, avoid undertaking orthopedic and orthodontic treatments which are likely to fail, understand the reasons for unsuccessful "conventional" treatments, provide an orthopedic-surgical guide and make it possible to inform patients correctly. Anomalies affecting the growth of the mandible and its position on the cranial base and their impact on cranio-facial skeletal balance are clearly revealed by structural and architectural analysis, which pinpoints the different clinical elements in skeletal Class II et III cases. In maxilla-dento-facial orthopedics when confronted with a pathology of mandibular origin, it is essential to carefully study the radiographs of each segment of the mandible, to seek out the minor forms of the anomalies and to calculate the position of the mandible on the cranial base relative to the neighboring structures; the skull, the cervical vertebrae and the maxilla. © EDP Sciences, SFODF, 2016.

Disparities in internet use among orthopedic outpatients.

Science.gov (United States)

Walsh, Kenneth P; Rehman, Saqib; Goldhirsh, Jessie

2014-02-01

Internet access has lagged behind for patients with lower incomes and from certain ethnic groups. This study investigated the possible improvement of access to health-related information on the Internet for all patients in an urban outpatient setting, regardless of socioeconomic background. A 28-question survey was completed by 100 orthopedic outpatients evaluating associations between their age, ethnicity, income, or education level and their access to the Internet. The survey also examined how patients used the Internet to obtain information about their medical condition, their privacy concerns when conducting online research, and their use of mobile phones as a primary means of Internet access. The Internet was used by 57% of orthopedic outpatients in this urban setting. Internet access decreased with advancing age but increased with increasing income and education, findings consistent with similar studies. Despite the inability to identify an association between ethnicity and Internet access in this patient population, fewer Latinos (33%) than whites (67%) or African Americans (77%) sought information about their medical condition. Among patients who used a mobile phone as the primary method for online access, 74% were African American or Latino and 26% were white. This difference in mobile phone use for online access suggests that mobile phones have provided ethnic minorities with greater Internet access and thus may have narrowed the digital divide among the races. Copyright 2014, SLACK Incorporated.

The organizational and financial viability of an orthopedic trauma service.

Science.gov (United States)

Harris, Mitchel B; Cayen, Barry

2009-12-01

This study was designed to explore the effect of establishing an Orthopedic Trauma Service (OTS) on departmental revenue within an academic orthopedic department. The effect of the OTS on physician and resident perceptions of job satisfaction, education, and quality of patient care were also evaluated. A proforma financial analysis was undertaken using an optimization model to predict the potential financial performance of an OTS before its implementation. Financial data were then collected prospectively for the first year of the OTS and compared with the preceding year's financial data. All residents and faculty in the department completed visual analog scale surveys after the formation of the service. While maintaining a fixed amount of work production (work relative value units [WRVUs]) per year, our model predicted an $111,000 increase in departmental charges as a result of a shift in the elective case mix. After implementation of the OTS, elective charges/WRVU increased by 7.4% while trauma charges/WRVU increased by 2.6%. This, combined with a minor increase in departmental work volume (115,661 WRVUs pre-OTS vs. 117,577 WRVUs post-OTS) and an improvement in collections/charge (47-48%), yielded a departmental collection increase of 11% ($1.1 million). Resident and faculty job satisfaction improved, as did the perception of the quality of trauma care that was being provided. The organization and implementation of an OTS within an academic orthopedic department can lead to an improved professional experience for residents and faculty, the perception of improved patient care for the trauma patient, and an increase in departmental revenue.

Orthopedic Injuries and Their Treatment in Children During Earthquakes: A Systematic Review.

Science.gov (United States)

Morelli, Ilaria; Sabbadini, Maria Grazia; Bortolin, Michelangelo

2015-10-01

Orthopedic injuries commonly affect children during earthquakes, but reports about them are rare. This setting may lead to different standards of care, but guidelines are still missing in this field. A systematic review was performed to: (1) assess type and body distribution of pediatric earthquake-related injuries, treatment performed, length of stay, and complications; and (2) identify starting points to define standards of care. PubMed database was researched for papers (1999-2014 period) in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Inclusion criteria were: English, French, Spanish, or Italian language and data reported about orthopedic lesions in children (≤18 years old). Reviews, letters, commentaries, editorials, and single case reports were excluded. Two independent reviewers selected articles after abstract and full-text reading. Traumatic injuries caused child hospital admissions ranging from 46.9% to 100.0%; 16% to 53% suffered fractures. Lower limbs mostly were involved. Soft-tissue injuries affected 55% of patients. Debridement and external fixation (EF) were the most frequent surgical treatments. Amputation rates varied from 5% to 11%. This study revealed that field hospitals should be prepared to: (1) treat mainly lower extremities fractures in children; and (2) use especially EF techniques. The presence of orthopedic surgeons familiar with pediatric traumatology should be considered.

Racing performance of Standardbred trotting horses undergoing surgery of the carpal flexor sheath and age- and sex-matched control horses.

Science.gov (United States)

Carmalt, James L; Johansson, Bengt C; Zetterström, Sandra M; McOnie, Rebecca C

2017-07-01

OBJECTIVE To determine factors affecting race speed in Swedish Standardbred horses undergoing surgery of the carpal flexor sheath (CFS), to investigate whether preoperative racing speed was associated with specific intraoperative findings and whether horses returned to racing, and to compare the performance of horses undergoing surgery of the CFS with that of age- and sex-matched control horses. ANIMALS 149 Swedish Standardbred trotters undergoing surgery of the CFS and 274 age- and sex-matched control horses. PROCEDURES Medical records of CFS horses were examined. Racing data for CFS and control horses were retrieved from official online records. Generalizing estimating equations were used to examine overall and presurgery racing speeds and the association of preoperative clinical and intraoperative findings with preoperative and postoperative speeds. Multivariable regression analysis was used to examine career earnings and number of career races. Kaplan-Meier survival analysis was used to compare career longevity between CFS and control horses. RESULTS CFS horses were significantly faster than control horses. The CFS horses that raced before surgery were slower as they approached the surgery date, but race speed increased after surgery. There were 124 of 137 (90.5%) CFS horses that raced after surgery. No intrathecal pathological findings were significantly associated with preoperative racing speed. Career longevity did not differ between CFS and control horses. CONCLUSIONS AND CLINICAL RELEVANCE Horses undergoing surgery of the CFS had a good prognosis to return to racing after surgery. Racing careers of horses undergoing surgery of the CFS were not significantly different from racing careers of control horses.

Indications for CT, MRI, and scintiscanning in orthopedics and traumatology

International Nuclear Information System (INIS)

Hahn, K.; Heine, J.; Thelen, T.

1994-01-01

Successful treatment of disease of the locomotor system requires as exact as possible diagnostic evaluation of the individual conditions, and this in turn can be achieved only by collaborative efforts of experts from a variety of subject fields. The book in hand is the result of such a collaborative approach, presenting the knowledge and experience of orthopedic surgeons, radiologists, and nuclear medicine experts who establish an order of priority and diagnostic value of computed tomography, magnetic resonance imaging, and various scintiscanning methods with respect to the diagnosis of orthopedic lesions. On the basis of this order of priority, specific recommendations are presented and explained for the best possible diagnostic procedure for evaluation of the various cases. The material is arranged into the following chapters: Examination modalities, techniques and cost - Inflammatory lesions of the locomotive system - Specific traumatology - Tumors of the locomotive system - Lesions of the hip joint - Lesions of the knee joint - Lesions of the spine -Lesions of the shoulder. (orig./MG) [de

Sol-Gel Derived Hydroxyapatite Coating on Mg-3Zn Alloy for Orthopedic Application

Science.gov (United States)

Singh, Sanjay; Manoj Kumar, R.; Kuntal, Kishor Kumar; Gupta, Pallavi; Das, Snehashish; Jayaganthan, R.; Roy, Partha; Lahiri, Debrupa

2015-04-01

In recent years, magnesium and its alloys have gained a lot of interest as orthopedic implant constituents because their biodegradability and mechanical properties are closer to that of human bone. However, one major concern with Mg in orthopedics is its high corrosion rate that results in the reduction of mechanical integrity before healing the bone tissue. The current study evaluates the sol-gel-derived hydroxyapatite (HA) coating on a selected Mg alloy (Mg-3Zn) for decreasing the corrosion rate and increasing the bioactivity of the Mg surface. The mechanical integrity of the coating is established as a function of the surface roughness of the substrate and the sintering temperature of the coating. Coating on a substrate roughness of 15-20 nm and sintering at 400°C shows the mechanical properties in similar range of bone, thus making it suitable to avoid the stress-shielding effect. The hydroxyapatite coating on the Mg alloy surface also increases corrosion resistance very significantly by 40 times. Bone cells are also found proliferating better in the HA-coated surface. All these benefits together establish the candidature of sol-gel HA-coated Mg-3Zn alloy in orthopedic application.

Historical contributions from the Harvard system to adult spine surgery.

Science.gov (United States)

Schoenfeld, Andrew J

2011-10-15

Literature review. To document the historical contributions from the Harvard Medical School system to the field of adult spine surgery. Despite the fact that significant contributions to the discipline of spinal surgery have derived from the Harvard system, no prior study documents the history of the Harvard spine services in a cohesive narrative. This historical perspective reviews the history of adult spine surgery within the Harvard system and outlines the significant contributions made by orthopedic and neurosurgical practitioners to the field. Literature reviews were performed from historical works, as well as scientific publications to fashion a cohesive review covering the history of spine surgery at Harvard from the early 19th century to the present. The development of the spine surgical services at the three main Harvard hospitals, and significant spine surgical personalities within the system, are discussed, including W. Jason Mixter, MD, Joseph S. Barr Sr., MD, and Marius N. Smith-Petersen, MD. Substantial developments that have arisen from the Harvard teaching hospitals include the recognition of disc herniation as the cause of radicular symptoms in the lower extremities, the description of lumbar discectomy as a surgical treatment for radicular pain, osteotomy for the correction of spinal deformity, and the first attempt to create a systematic algorithm capable of informing treatment for cervical spine trauma. Despite humble beginnings, the surgeons and scientists at Harvard have influenced nearly every facet of spine surgery over the course of the last two centuries.

Evaluation of usefulness and availability for orthopedic surgery using clavicle fracture model manufactured by desktop 3D printer

International Nuclear Information System (INIS)

Oh, Wang Kyun

2014-01-01

Usefulness and clinical availability for surgery efficiency were evaluated by conducting pre-operative planning with a model manufactured by desktop 3D printer by using clavicle CT image. The patient-customized clavicle fracture model was manufactured by desktop 3D printer of FDM wire laminated processing method by converting the CT image into STL file in Open Source DICOM Viewer Osirix. Also, the model of the original shape before damaged was restored and manufactured by Mirror technique based on STL file of not fractured clavicle of the other side by using the symmetry feature of the human body. For the model, the position and size, degree of the fracture was equally printed out. Using the clavicle model directly manufactured with low cost and less time in Department of Radiology is considered to be useful because it can reduce secondary damage during surgery and increase surgery efficiency with Minimal invasive percutaneous plate osteosynthesis(MIPO)

Evaluation of usefulness and availability for orthopedic surgery using clavicle fracture model manufactured by desktop 3D printer

Energy Technology Data Exchange (ETDEWEB)

Oh, Wang Kyun [Dept. of Diagnostic Radiology, Cheongju Medical Center, Cheongju (Korea, Republic of)

2014-09-15

Usefulness and clinical availability for surgery efficiency were evaluated by conducting pre-operative planning with a model manufactured by desktop 3D printer by using clavicle CT image. The patient-customized clavicle fracture model was manufactured by desktop 3D printer of FDM wire laminated processing method by converting the CT image into STL file in Open Source DICOM Viewer Osirix. Also, the model of the original shape before damaged was restored and manufactured by Mirror technique based on STL file of not fractured clavicle of the other side by using the symmetry feature of the human body. For the model, the position and size, degree of the fracture was equally printed out. Using the clavicle model directly manufactured with low cost and less time in Department of Radiology is considered to be useful because it can reduce secondary damage during surgery and increase surgery efficiency with Minimal invasive percutaneous plate osteosynthesis(MIPO)

Personality characteristics in surgery seeking and non-surgery seeking obese individuals compared to non-obese controls

DEFF Research Database (Denmark)

Stenbæk, Dea S; Hjordt, Liv V; Haahr, Mette E

2014-01-01

It is currently unknown what makes some obese individuals opt for bariatric surgery whereas others choose not to. The aim of this study was to examine whether personality characteristics differed between obese individuals signed up for Roux-en-Y gastric bypass (RYGB) (N=30) and obese individuals...... groups did not differ in terms of personality. The Neuroticism domain and possibly the Extraversion domain may therefore be worthwhile to consider in future studies investigating the outcome of bariatric surgery....... not seeking RYGB (N=30) compared to non-obese controls (N=30). All participants completed the NEO Personality Inventory-Revised. The obese RYGB group displayed higher levels of Neuroticism and borderline lower levels of Extraversion compared to the obese non-RYGB and the non-obese group, while the two latter...

Pericytes for the treatment of orthopedic conditions.

Science.gov (United States)

James, Aaron W; Hindle, Paul; Murray, Iain R; West, Christopher C; Tawonsawatruk, Tulyapruek; Shen, Jia; Asatrian, Greg; Zhang, Xinli; Nguyen, Vi; Simpson, A Hamish; Ting, Kang; Péault, Bruno; Soo, Chia

2017-03-01

Pericytes and other perivascular stem cells are of growing interest in orthopedics and tissue engineering. Long regarded as simple regulators of angiogenesis and blood pressure, pericytes are now recognized to have MSC (mesenchymal stem cell) characteristics, including multipotentiality, self-renewal, immunoregulatory functions, and diverse roles in tissue repair. Pericytes are typified by characteristic cell surface marker expression (including αSMA, CD146, PDGFRβ, NG2, RGS5, among others). Although alone no marker is absolutely specific for pericytes, collectively these markers appear to selectively identify an MSC-like pericyte. The purification of pericytes is most well described as a CD146 + CD34 - CD45 - cell population. Pericytes and other perivascular stem cell populations have been applied in diverse orthopedic applications, including both ectopic and orthotopic models. Application of purified cells has sped calvarial repair, induced spine fusion, and prevented fibrous non-union in rodent models. Pericytes induce these effects via both direct and indirect mechanisms. In terms of their paracrine effects, pericytes are known to produce and secrete high levels of a number of growth and differentiation factors both in vitro and after transplantation. The following review will cover existing studies to date regarding pericyte application for bone and cartilage engineering. In addition, further questions in the field will be pondered, including the phenotypic and functional overlap between pericytes and culture-derived MSC, and the concept of pericytes as efficient producers of differentiation factors to speed tissue repair. Copyright © 2016. Published by Elsevier Inc.

The economic implications of a multimodal analgesic regimen for patients undergoing major orthopedic surgery: a comparative study of direct costs.

Science.gov (United States)

Duncan, Christopher M; Hall Long, Kirsten; Warner, David O; Hebl, James R

2009-01-01

Total knee and total hip arthoplasty (THA) are 2 of the most common surgical procedures performed in the United States and represent the greatest single Medicare procedural expenditure. This study was designed to evaluate the economic impact of implementing a multimodal analgesic regimen (Total Joint Regional Anesthesia [TJRA] Clinical Pathway) on the estimated direct medical costs of patients undergoing lower extremity joint replacement surgery. An economic cost comparison was performed on Mayo Clinic patients (n = 100) undergoing traditional total knee or total hip arthroplasty using the TJRA Clinical Pathway. Study patients were matched 1:1 with historical controls undergoing similar procedures using traditional anesthetic (non-TJRA) techniques. Matching criteria included age, sex, surgeon, type of procedure, and American Society of Anesthesiologists (ASA) physical status (PS) classification. Hospital-based direct costs were collected for each patient and analyzed in standardized inflation-adjusted constant dollars using cost-to-charge ratios, wage indexes, and physician services valued using Medicare reimbursement rates. The estimated mean direct hospital costs were compared between groups, and a subgroup analysis was performed based on ASA PS classification. The estimated mean direct hospital costs were significantly reduced among TJRA patients when compared with controls (cost difference, 1999 dollars; 95% confidence interval, 584-3231 dollars; P = 0.0004). A significant reduction in hospital-based (Medicare Part A) costs accounted for the majority of the total cost savings. Use of a comprehensive, multimodal analgesic regimen (TJRA Clinical Pathway) in patients undergoing lower extremity joint replacement surgery provides a significant reduction in the estimated total direct medical costs. The reduction in mean cost is primarily associated with lower hospital-based (Medicare Part A) costs, with the greatest overall cost difference appearing among patients

Trends and Predictors of National Institutes of Health Funding to Plastic Surgery Residency Programs.

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Silvestre, Jason; Abbatematteo, Joseph M; Chang, Benjamin; Serletti, Joseph M

2017-12-01

Recent studies have demonstrated low levels of National Institutes of Health funding for surgical research. The authors compared the funding in plastic surgery with the funding for other surgical specialties. A query of National Institutes of Health grants awarded to departments of surgical specialties was performed using the National Institutes of Health RePORTER database (2008 to 2016). Trends in funding were compared by specialty and adjusted for the number of active physicians in each specialty. Plastic surgery residency program characteristics were correlated with funding procurement. Eight hundred eighty-nine faculty at 94 plastic surgery residency programs were queried. Forty-eight investigators (5.4 percent) at 23 programs (24.4 percent) had National Institutes of Health funding. From 2008 to 2016, a total of $84,142,138 was awarded through 81 grants. Funding supported translational (44.6 percent), clinical (26.4 percent), basic science (27.2 percent), and educational (1.7 percent) research. In 2016, plastic surgery received the least amount of National Institutes of Health funding per active physician ($1,530) relative to orthopedic surgery ($3124), obstetrics and gynecology ($3885), urology ($5943), otolaryngology ($9999), general surgery ($11,649), ophthalmology ($11,933), and neurologic surgery ($20,874). Plastic surgery residency program characteristics associated with National Institutes of Health funding were high ranking and had more than 10 clinical faculty (p < 0.05). Plastic surgery receives the least National Institutes of Health funding among the surgical specialties. Departments and divisions of plastic surgery should support investigators applying for research grants to increase future National Institutes of Health funding.

Quality of life and educational benefit among orthopedic surgery residents: a prospective, multicentre comparison of the night float and the standard call systems.

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Zahrai, Ali; Chahal, Jaskarndip; Stojimirovic, Dan; Schemitsch, Emil H; Yee, Albert; Kraemer, William

2011-02-01

Given recent evolving guidelines regarding postcall clinical relief of residents and emphasis on quality of life, novel strategies are required for implementing call schedules. The night float system has been used by some institutions as a strategy to decrease the burden of call on resident quality of life in level-1 trauma centres. The purpose of this study was to determine whether there are differences in quality of life, work-related stressors and educational experience between orthopedic surgery residents in the night float and standard call systems at 2 level-1 trauma centres. We conducted a prospective cohort study at 2 level-1 trauma hospitals comprising a standard call (1 night in 4) group and a night float (5 14-hour shifts [5 pm-7 am] from Monday to Friday) group for each hospital. Over the course of a 6-month rotation, each resident completed 3 weeks of night float. The remainder of the time on the trauma service consists of clinical duties from 6:30 am to 5:30 pm on a daily basis and intermittent coverage of weekend call only. Residents completed the Short Form-36 (SF-36) general quality-of-life questionnaire, as well as questionnaires on stress level and educational experience before the rotation (baseline) and at 2, 4 and 6 months. We performed an analysis of covariance to compare between-group differences using the baseline scores as covariates and Wilcoxon signed-rank tests (nonparametric) to determine if the residents' SF-36 scores were different from the age- and sex-matched Canadian norms. We analyzed predictors of resident quality of life using multivariable mixed models. Seven residents were in the standard call group and 9 in the night float group, for a total of 16 residents (all men, mean age 35.1 yr). Controlling for between-group differences at baseline, residents on the night float rotation had significantly lower role physical, bodily pain, social function and physical component scale scores over the 6-month observation period. Compared

Intensive perioperative glucose control does not improve outcomes of patients submitted to open-heart surgery: a randomized controlled trial

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Raquel Pei Chen Chan

2009-01-01

Full Text Available BACKGROUND: The objective of this study was to investigate the relationship between different target levels of glucose and the clinical outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: We designed a prospective study in a university hospital where 109 consecutive patients were enrolled during a six-month period. All patients were scheduled for open-heart surgery requiring cardiopulmonary bypass. Patients were randomly allocated into two groups. One group consisted of 55 patients and had a target glucose level of 80-130 mg/dl, while the other contained 54 patients and had a target glucose level of 160-200 mg/dl. These parameters were controlled during surgery and for 36 hours after surgery in the intensive care unit. Primary outcomes were clinical outcomes, including time of mechanical ventilation, length of stay in the intensive care unit, infection, hypoglycemia, renal or neurological dysfunction, blood transfusion and length of stay in the hospital. The secondary outcome was a combined end-point (mortality at 30 days, infection or length of stay in the intensive care unit of more than 3 days. A p-value of 0.05. CONCLUSIONS: In 109 patients undergoing cardiac surgery with cardiopulmonary bypass, both protocols of glycemic control in an intraoperative setting and in the intensive care unit were found to be safe, easily achieved and not to differentially affect clinical outcomes.

Cirurgia para controle de danos: estado atual Damage control surgery: an update

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Rodrigo Camargo Leão Edelmuth

2013-04-01

Full Text Available A cirurgia de controle de danos é um conceito amplamente aceito atualmente entre os especialistas em trauma abdominal quando se trata de doentes gravemente traumatizados. Nestes pacientes a morte decorre, na maioria das vezes, da instalação da tríade letal (hipotermia, coagulopatia e acidose e não da incapacidade de reparar as graves lesões presentes. Nesta revisão, os autores abordam a tríade letal, em suas três fases, e enfatizam as medidas adotadas para preveni-las. Além de discutirem a indicação e o emprego da cirurgia para o controle de danos em seus vários estágios. A restauração dos padrões fisiológicos do doente na UTI, para que o mesmo possa ser submetido à operação definitiva e ao fechamento da cavidade abdominal, outro desafio no paciente traumatizado grave, também é discutida.The damage control surgery is a widely accepted concept today among abdominal trauma specialists when it comes to the severely traumatized. In these patients, the death is due, in most cases, to the installation of the lethal triad (hypothermia, coagulopathy and acidosis and not the inability to repair the serious initial damage. In this review, the authors address the lethal triad in its three phases and emphasize the measures taken to prevent them, as well as discussing the indication and employment of damage control surgery in its various stages. Restoring the physiological status of the patient in the ICU, so that he/she can be submitted to final operation and closure of the abdominal cavity, another challenge in severe trauma patients, is also discussed.

Effects of obesity on rehabilitation outcomes after orthopedic trauma.

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Vincent, Heather K; Seay, Amanda N; Vincent, Kevin R; Atchison, James W; Sadasivan, Kalia

2012-12-01

This study examined whether differences existed in inpatient rehabilitation outcomes and therapy participation in nonobese and obese patients with orthopedic trauma. This was a retrospective study of 294 consecutive patients admitted to an inpatient rehabilitation hospital. Main outcomes included participation in therapy sessions, Functional Independence Measure (FIM) ratings, walking distance and stair climb, length of stay, FIM efficiency (FIM score gain/length of stay), and discharge to home. Data were stratified by patient body mass index values (nonobese, obese, ≥30 kg/m). There were no differences in therapy participation or length of stay between groups. Both total and motor FIM ratings at discharge were lower in obese patients compared with nonobese patients (P obese than in the nonobese group (2.6 ± 1.5 vs. 3.1 ± 1.5 points gained per day; P = 0.05). Walking distance and stair climb ability were similar between groups by discharge. Even morbidly obese patients attained some improvement with independence in walking. Obese patients make significant functional improvement during rehabilitation, but at a lesser magnitude and rate as their nonobese counterparts. Even with morbid obesity, small but important functional gains can occur during rehabilitation for orthopedic trauma.

Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting

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Vadivelu N

2016-06-01

Full Text Available Nalini Vadivelu,1 Alice M Kai,2 Vijay Kodumudi,3 Jack M Berger4 1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 2Stony Brook University School of Medicine, Stony Brook, NY, 3Department of Molecular and Cell Biology, College of Liberal Arts and Sciences, University of Connecticut, Storrs, CT, 4Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Abstract: Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with

Very-short-term perioperative intravenous iron administration and postoperative outcome in major orthopedic surgery: a pooled analysis of observational data from 2547 patients.

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Muñoz, Manuel; Gómez-Ramírez, Susana; Cuenca, Jorge; García-Erce, José Antonio; Iglesias-Aparicio, Daniel; Haman-Alcober, Sami; Ariza, Daniel; Naveira, Enrique

2014-02-01

Postoperative nosocomial infection (PNI) is a severe complication in surgical patients. Known risk factors of PNI such as allogeneic blood transfusions (ABTs), anemia, and iron deficiency are manageable with perioperative intravenous (IV) iron therapy. To address potential concerns about IV iron and the risk of PNI, we studied a large series of orthopedic surgical patients for possible relations between IV iron, ABT, and PNI. Pooled data on ABT, PNI, 30-day mortality, and length of hospital stay (LHS) from 2547 patients undergoing elective lower-limb arthroplasty (n = 1186) or hip fracture repair (n = 1361) were compared between patients who received either very-short-term perioperative IV iron (200-600 mg; n = 1538), with or without recombinant human erythropoietin (rHuEPO; 40,000 IU), or standard treatment (n = 1009). Compared to standard therapy, perioperative IV iron reduced rates of ABT (32.4% vs. 48.8%; p = 0.001), PNI (10.7% vs. 26.9%; p = 0.001), and 30-day mortality (4.8% vs. 9.4%; p = 0.003) and the LHS (11.9 days vs. 13.4 days; p = 0.001) in hip fracture patients. These benefits were observed in both transfused and nontransfused patients. Also in elective arthroplasty, IV iron reduced ABT rates (8.9% vs. 30.1%; p = 0.001) and LHS (8.4 days vs.10.7 days; p = 0.001), without differences in PNI rates (2.8% vs. 3.7%; p = 0.417), and there was no 30-day mortality. Despite known limitations of pooled observational analyses, these results suggest that very-short-term perioperative administration of IV iron, with or without rHuEPO, in major lower limb orthopedic procedures is associated with reduced ABT rates and LHS, without increasing postoperative morbidity or mortality. © 2013 American Association of Blood Banks.

[On practicability of implementing the speciality "podiatry" in traumatology and orthopedics].

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2011-01-01

The absence of single opinion concerning the classification of foot and ankle joint pathology does not permit to formulate universal and practical approach to the identification of pathological syndromes in case of patient foot lesion. The situation is aggravated by the unsolved issues related to the terminological definition of podiatry as a direction in orthopedics to solve the issues of foot and ankle joint pathology. In actual conditions the implementation of new technologies into the structure of traumatological orthopedics care is needed. This approach permits to combine the qualities of models of effective and optimized care to patients with foot and ankle joint pathology. The study of issue related to the systematization of podiatric pathology revealed that actually no single universal classification easy-to-use in practice exists. Hence the development of original applied working scheme of foot and ankle joint pathology is proposed.

Looking at the Social Activity for Adolescents with Orthopedic Impairments

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Biastro, Leslie; Frank, Heather; Larwin, Karen H.

2015-01-01

Adolescents with identified orthopedic impairments are often less likely to participate in social activities outside of the school setting. However, the adolescents who are able to participate in activities have higher social skills, more academic successes, and show more satisfaction in their roles as family member or friend. The aim of this…

High-strength, surface-porous polyether-ether-ketone for load-bearing orthopedic implants.

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Evans, Nathan T; Torstrick, F Brennan; Lee, Christopher S D; Dupont, Kenneth M; Safranski, David L; Chang, W Allen; Macedo, Annie E; Lin, Angela S P; Boothby, Jennifer M; Whittingslow, Daniel C; Carson, Robert A; Guldberg, Robert E; Gall, Ken

2015-02-01

Despite its widespread clinical use in load-bearing orthopedic implants, polyether-ether-ketone (PEEK) is often associated with poor osseointegration. In this study, a surface-porous PEEK material (PEEK-SP) was created using a melt extrusion technique. The porous layer was 399.6±63.3 μm thick and possessed a mean pore size of 279.9±31.6 μm, strut spacing of 186.8±55.5 μm, porosity of 67.3±3.1% and interconnectivity of 99.9±0.1%. Monotonic tensile tests showed that PEEK-SP preserved 73.9% of the strength (71.06±2.17 MPa) and 73.4% of the elastic modulus (2.45±0.31 GPa) of as-received, injection-molded PEEK. PEEK-SP further demonstrated a fatigue strength of 60.0 MPa at one million cycles, preserving 73.4% of the fatigue resistance of injection-molded PEEK. Interfacial shear testing showed the pore layer shear strength to be 23.96±2.26 MPa. An osseointegration model in the rat revealed substantial bone formation within the pore layer at 6 and 12 weeks via microcomputed tomography and histological evaluation. Ingrown bone was more closely apposed to the pore wall and fibrous tissue growth was reduced in PEEK-SP when compared to non-porous PEEK controls. These results indicate that PEEK-SP could provide improved osseointegration while maintaining the structural integrity necessary for load-bearing orthopedic applications. Copyright © 2014 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

The A-test: Assessment of functional recovery during early rehabilitation of patients in an orthopedic ward - content, criterion and construct validity

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Vukomanović Aleksandra

2014-01-01

Full Text Available Background/Aim. The A-test was designed for assessment of functional recovery during early rehabilitation of patients in an orthopedic ward. This performance-based test consists of 10 items for assessing basic activities by a six level ordinal scale (0-5. Total scores can range from 0 to 50, i.e. from inability to perform any activity despite the help of therapists to complete independence and safety in performing all activities. The aim of this study was to examine the A-test validity. Methods. This prospective study was conducted in an orthopedic ward and included 120 patients [60 patients with hip osteoarthritis that underwent arthroplasty and 60 surgically treated patients with hip fracture (HF] during early inpatient rehabilitation (1st-5th day. Validity was examined through 3 aspects: content validity - floor and ceiling effect, range, skewness; criterion validity - concurrent validity [correlation with the University of Iowa Level of Assistance Scale (ILAS for patients with hip osteoarthritis, and with the Cumulated Ambulation Score (CAS for patients with HF, Spearman rank correlation] and predictive validity [the New Mobility Score (NMS 4 weeks after surgery, Mann-Whitney U test]; construct validity - 4 hypotheses: 1 on the fifth day of rehabilitation in patients underwent arthroplasty due to hip osteoarthritis, the A-test results will strongly correlate with those of ILAS, while the correlation with the Harris hip score will be less strong; 2 in patients with HF, the A-test results will be significantly better in those with allowed weight bearing as compared to patients whom weight bearing is not allowed while walking; 3 results of the A-test will be significantly better in patients with hip osetoarthritis than in those with HF; 4 the A-test results will be significantly better in patients younger than 65 years than in those aged 65 years and older. Results. The obtained results were: low floor (1% and ceiling (2% effect, range 0

Hypomelanosis of Ito presenting with pediatric orthopedic issues: a case report.

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Trägårdh, Malene; Thomsen, Christine Rohr; Thorninger, Rikke; Møller-Madsen, Bjarne

2014-05-19

Hypomelanosis of Ito was originally described as a purely cutaneous disease. Extracutaneous manifestations were described later, forming a neurocutaneous syndrome including skeletal, muscular, ocular and central nervous system symptoms.Hypomelanosis of Ito is characterized by a depigmentation along the lines of Blaschko on the trunk and extremities in certain patterns.The aim of this article was to report another case and give an overview of the related orthopedic symptoms that have been previously described. It was also our wish to contribute with recommendations for consideration with regard to bandages on eczematous rashes, especially on clubfeet. A one-and-a-half-month-old boy of Caucasian background born with talipes equinovarus, or clubfoot, on his right foot presented with an eczematous rash after surgical correction and plaster bandaging. It is the appearance of hypopigmentation, either alone or in combination with a congenital malformation, particularly central nervous system or musculoskeletal anomalies, which should form the basis of a presumptive diagnosis. This should then lead to further investigations and should always include skin biopsies and a test for chromosomal mosaicism.We report the case of a boy with a clinical picture consisting of a depigmented skin pattern, mental retardation, pes cavus, talipes equinovarus, clinodactyly, eczema, inverted cilia of the eye, strabismus, reduced hearing, ventral hernia, glomerulonephritis, missing testicles, leg length discrepancy with scoliosis, back pain and a syrinx.It is perhaps impossible to make any conclusions about extracutaneous symptoms. However, some symptoms such as retardation, cramps and seizures, delayed development and hypotonia cannot be ignored.Because of the possibility of creating an undesirable and long postoperative period with complications, it is very important to have this diagnosis in mind when deciding to do surgery or not if there are signs of dermatological problems before

Pediatric surgeons and anesthesiologists expand the dialogue on the neurotoxicity question, rationale for early and delayed surgeries, and practice changes while awaiting definitive evidence.

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Byrne, Mary W; Casale, Pasquale; Garzon, Maria; Hyman, Joshua E; Lin, Albert Y; Lynch, Lisa R; Schleien, Charles L; Stylianos, Steven

2014-10-01

The Pediatric Anesthesia NeuroDevelopment Assessment team at Columbia University Medical Center Department of Anesthesiology convened its fourth biennial Symposium to address unresolved issues concerning potential neurotoxic effects of anesthetic agents and sedatives on young children and to assess study findings to date. Dialogue initiated at the third Symposium was continued between anesthesiologists, researchers, and a panel of expert pediatric surgeons representing general surgery and dermatology, orthopedic, and urology specialties. The panel explored the need to balance benefits of early surgery using improved technologies against potential anesthetic risks, practice changes while awaiting definitive answers, and importance of continued interprofessional dialogue.

3D gait analysis with and without an orthopedic walking boot.

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Gulgin, H; Hall, K; Luzadre, A; Kayfish, E

2018-01-01

Orthopedic walking boots have been widely used in place of traditional fiberglass casts for a variety of orthopedic injuries and post-surgical interventions. These walking boots create a leg length discrepancy (LLD). LLD has been shown to alter the kinematics and kinetics of gait and are associated with lumbar and lower limb conditions such as: foot over pronation, low back pain, scoliosis, and osteoarthritis of the hip and knee joints. Past gait analyses research with orthopedic boots is limited to findings on the ipsilateral limb. Thus, the purpose of the study was to examine bilateral gait kinematics & kinetics with and without a walking boot. Forty healthy participants (m=20, f=20, age 20.7±1.8 yrs., ht. 171.6±9.5cm, wt. 73.2±11.0kg, BMI 24.8±3.2) volunteered. An eight camera Vicon Motion Capture System with PIG model and two AMTI force plates were utilized to record the walking trial conditions: (1) bilateral tennis shoes (2) boot on right foot, tennis shoe on left foot (3) boot on right foot, barefoot on left foot. Data were processed in Nexus 2.2.3 and exported to Visual 3D for analysis. When wearing the boot, there were significant differences in most joint angles and moments, with larger effects on long limb. The walking boot alters the gait in the same way as those with existing LLD, putting them at risk for development of secondary knee, hip, and low back pain during treatment protocol. Copyright © 2017 Elsevier B.V. All rights reserved.

Clinical Nononcologic Applications of PET/CT and PET/MRI in Musculoskeletal, Orthopedic, and Rheumatologic Imaging.

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Gholamrezanezhad, Ali; Basques, Kyle; Batouli, Ali; Matcuk, George; Alavi, Abass; Jadvar, Hossein

2018-06-01

With improvements in PET/CT and PET/MRI over the last decade, as well as increased understanding of the pathophysiology of musculoskeletal diseases, there is an emerging potential for PET as a primary or complementary modality in the management of rheumatologic and orthopedic conditions. We discuss the role of PET/CT and PET/MRI in nononcologic musculoskeletal disorders, including inflammatory and infectious conditions and postoperative complications. There is great potential for an increased role for PET to serve as a primary or complementary modality in the management of orthopedic and rheumatologic disorders.

Radiation injuries to the skeleton and their orthopedic treatment

International Nuclear Information System (INIS)

Franz, R.; Rahnfeld, R.

1978-01-01

70 patients subjected to orthopedic treatment and radiotherapy for skeletal tumors have been examined. It was found that serious radiation injuries frequently occurred. Above all there were contractures, disordered healing of wounds, ulcerations, and scolioses and kyphoses of the growing skeleton. Therefore, in the case of diseases of the skeleton, it is recommended to restrain radiotherapy. It has to be rejected in child's age

Outcomes of Foot and Ankle Surgery in Diabetic Patients Who Have Undergone Solid Organ Transplantation.

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Zou, Richard H; Wukich, Dane K

2015-01-01

Foot and ankle problems are highly prevalent in patients with diabetes mellitus (DM). Increased rates of surgical site infections and noninfectious complications, such as malunion, delayed union, nonunion, and hardware failure, have also been more commonly observed in diabetic patients who undergo foot and ankle surgery. DM is a substantial contributor of perioperative morbidity in patients with solid organ transplantation. To the best of our knowledge, postoperative foot and ankle complications have not been studied in a cohort of diabetic patients who previously underwent solid organ transplantation. The aim of the present study was to evaluate the outcomes of foot and ankle surgery in a cohort of diabetic transplant patients and to compare these outcomes with those of diabetic patients without a history of transplantation. We compared the rates of infectious and noninfectious complications after foot and ankle surgery in 28 diabetic transplant patients and 56 diabetic patients without previous transplantation and calculated the odds ratios (OR) for significant findings. The diabetic transplant patients who underwent foot and ankle surgery in the present cohort were not at an increased risk of overall complications (OR 0.83, 95% confidence interval [CI] 0.33 to 2.08, p = .67), infectious complications (OR 0.54, 95% CI 0.09 to 3.09, p = .49), or noninfectious complications (OR 1.14, 95% CI 0.41 to 3.15, p = .81). Four transplant patients (14.3%) died of non-orthopedic surgery-related events during the follow-up period; however, no deaths occurred in the control group. Diabetic patients with previous solid organ transplantation were not at an increased risk of developing postoperative complications after foot and ankle surgery, despite being immunocompromised. The transplant patients had a greater mortality rate, but their premature death was unrelated to their foot and ankle surgery. Surgeons treating transplant patients can recommend foot and ankle surgery when

Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States commercial payer population: potential economic implications of a new minimally invasive technology

OpenAIRE

Ackerman, Stacey J; Polly, David W; Knight, Tyler; Schneider, Karen; Holt, Tim; Cummings, John

2014-01-01

Stacey J Ackerman,1 David W Polly Jr,2 Tyler Knight,3 Karen Schneider,4 Tim Holt,5 John Cummings Jr6 1Covance Market Access Services Inc., San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc., Gaithersburg, MD, USA; 4Covance Market Access Services Inc., Sydney, Australia; 5Montgomery Spine Center, Orthopedic Surgery, Montgomery, AL, USA; 6Community Health Network, Neurosurgery, Indianapolis, IN, USA Introduction: Low ba...

Knowledge deficiency of work-related radiation hazards associated with psychological distress among orthopedic surgeons

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Fan, Guoxin; Wang, Yueye; Guo, Changfeng; Lei, Xuefeng; He, Shisheng

2017-01-01

Abstract Knowledge and concern degree about work-related radiation hazards remained unknown among orthopedic surgeons. The aim of the cross-sectional study is to investigate whether the knowledge degree of work-related radiation is associated with psychological distress among orthopedic surgeons. This cross-sectional study sent electronic questionnaire via WeChat to orthopedic surgeons nationwide. Concern and knowing degree over radiation exposure was evaluated by a single self-reported question. Professional evaluation of concern degree was reflected by general psychological distress, which was assessed with the Kessler 10 scale (K10) and depressive symptoms with the Center for Epidemiologic Studies Depression Scale (CES-D). Only 43.23% (115/266) respondents knew well about radiation and a total of 78.20% (208/266) respondents considered radiation exposure as a great concern. Among those who reported concerns about radiation exposure, a total of 57.69% (120/208) respondents reported knowing little about radiation. Respondents who reported concerns over radiation exposure were significantly associated with higher scores on CES-D and K10 (P < .05). Among respondents who reported concerns over radiation exposure, those who have fewer knowledge about radiation, had higher CES-D and K10 scores than those who knew well about radiation (P < .05). Among respondents who reported no concerns over radiation exposure, those who knew little about radiation still had higher CES-D and K10 scores (P < .05). Fewer radiation knowledge tends to induce more radiation concerns associated with higher psychological distress in orthopedic surgeons. Radiation knowledge should be enhanced for surgeons who daily work with radiation-related fluoroscopy. PMID:28538368

Comparison of the Effect of Noise Levels on Stress Response in Two Different Operation Groups in an Orthopedic Surgery Room

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Hasibe Baytan Yildiz

2016-09-01

Full Text Available Aim: The aim of this randomized, single-blinded study was to evaluate the effects of noise on hemodynamic and neuroendocrine stress response by measuring the level of noise in the surgery rooms of patients undergoing knee operations under neuroaxial anesthesia. Gerec ve Yontem: We compared patient responses from two groups of patients: those undergoing knee operations in a surgery room where the noise level (measured in decibels is high, and those undergoing meniscus operations in a surgery room with lower noise levels. The STAI, the State-Trait Anxiety Inventory (STAI-1, and the anxiety test (STAI-2wereperformed at preoperative and postoperative periods. 20 ml of blood sample was taken for basal, intraoperative 30th minute, and postoperative 1st hour measurements. Systolic, diastolic, and mean arterial blood pressures were found to be higher in the high noise level group. ACTH levels were increased during the early postoperative period and became normal during the late postoperative period in the high noise level group whereas ACTH levels were significantly decreased in the low-noise level group. Basal cortisol levels were significantly higher in the high noise level group. HCRP, an inflammatory response mediator was found to be decreased in both groups. Early and late blood glucose levels were significantly higher in the high noise group. There was a greater increase in early and late blood glucose levels in the high noise group. In the postoperative period, although the state-trait anxiety inventory (STAI-2 levels being higher in patients subject to noisier environment determines how people feel independent of the conditions and state they are in, this result made us consider that the noise the patients were subjected to in the intraoperative period may cause a stress response. Discussion: As a result we believe that standard noise levels should be achieved by reducing the factors causing high noise levels in the operating room. This will

Glove perforation rate with orthopedic gloving versus double gloving technique in tibial plateau leveling osteotomy: A randomized trial

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Egeler, Kimberly; Stephenson, Nicole; Stanke, Natasha

2016-01-01

In this randomized, prospective study, perforation rates, glove change rates, and cost between orthopedic gloves (n = 227) and double gloving with standard latex surgical gloves (n = 178) worn in tibial plateau leveling osteotomy procedures were compared. Gloves were collected from the surgeon and surgical resident after procedures and were tested for perforations with a standardized water leak test, as described by the American Society for Testing and Materials International. No statistically significant difference was found between the perforation rate using orthopedic gloving and double gloving techniques (P = 0.629) or the rate at which gloves were changed (P = 0.146). Orthopedic gloving was 2.1 times more costly than double gloving but they may be preferred by surgeons for dexterity and comfort. PMID:27807378

The effect of feedback regarding coping strategies and illness behavior on hand surgery patient satisfaction and communication: a randomized controlled trial.

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Mellema, Jos J; O'Connor, Casey M; Overbeek, Celeste L; Hageman, Michiel G; Ring, David

2015-09-01

Patients and surgeons can feel uncomfortable discussing coping strategies, psychological distress, and stressful circumstances. It has been suggested that patient-reported outcome measures (PROMs) facilitate the discussion of factors associated with increased symptoms and disability. This study assessed the effect of providing feedback to patients regarding their coping strategy and illness behavior on patient satisfaction and patient-physician communication in orthopedic surgery. In a prospective study, 136 orthopedic patients were randomly assigned to either receive feedback about the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference computer-adaptive test (CAT) prior to the visit with the hand surgeon or not. The primary outcome was patient satisfaction with the consultation and secondary outcomes involved patient-physician communication. Bivariate and multivariable analyses were performed to determine the influence of the feedback on patient satisfaction and communication. There was no significant difference in patient satisfaction between patients who received feedback and patients who did not (P = 0.70). Feedback was associated with more frequent discussion of coping strategies (P = 0.045) in bivariate analysis but was not independently associated: in multivariable analysis, only PROMIS Pain Interference CAT and age were identified as independent predictors (odds ratio (OR) 1.1; 95 % confidence interval (CI) 1.0-1.1, P = 0.013, and OR 0.97, 95 % CI 0.94-0.99, P = 0.032, respectively). No factors were associated with discussion of stressors. Discussion of circumstances was independently associated with increased PROMIS Pain Interference CAT, marital status, and work status. We found that feedback regarding coping strategies and illness behavior using the PROMIS Pain Interference CAT did not affect patient satisfaction. Although feedback was associated with increased discussion of illness behavior in bivariate

[Preliminary study on general safe medication regularity of Chinese patent orthopedic medicines based on adverse reaction/event literature analysis].

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Wang, Yu-guang; Shi, Xin-yuan; Jin, Rui; Li, Hong-yan; Kong, Xiang-wen; Qiao, Yan-jiang

2015-03-01

Chinese patent orthopedic medicines feature complex components, mainly including desperate and toxic herbal pieces, narrow safety window, more clinical contraindications and frequent adverse drug reaction/events (ADR/ADE). To study the general safe medication regularity of Chinese patent orthopedic medicines, define key points in the medication education and ensure rational clinical medication, the authors took 80 types of commonly used Chinese patent orthopedic medicines as the study objects, collect 237 cases from 164 ADR/ADE documents through a system retrieval strategy, make a multidimensional literature analysis to determine the common risk factors for safe and rational medication of Chinese patent orthopedic medicines and establish an ADR/ADE prevention regularity. First, in the aspect of clinical symptoms, skin allergy is the most common ADR/ADE and closely related to the toxic ingredients, particularly accumulated liver or kidney damage caused by some drugs. Second, there are three time nodes in the ADR/ADE occurrence; The ADR/ADE occurred in 30 minutes is closely related to the idiosyncrasy; the ADR/ADE occurred between several months and half a year is related to the drug-induced liver and kidney damages; The most common ADR/ADE was observed within 7 days and predictable according to the pharmacological actions; Third, toxicity is an important factor in the occurrence of ADR/ADE of Chinese patent orthopedic medicines. Fourth, emphasis shall be given to the special medication factors, such as the combination with western medicines and Chinese herbal decoctions, overdose and long-course medication and self-medical therapy. In conclusion, the general ADR/ADE prevention regularity for Chinese patent orthopedic medicines was summarized to provide supports for clinicians in safe and rational medication and give the guidance for pharmacist in medication education.

Continuous bilateral thoracic paravertebral blockade for analgesia after cardiac surgery: a randomised, controlled trial.

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Lockwood, Geoff G; Cabreros, Leilani; Banach, Dorota; Punjabi, Prakash P

2017-10-01

Continuous bilateral thoracic paravertebral blockade has been used for analgesia after cardiac surgery, but its efficacy has never been formally tested. Fifty adult patients were enrolled in a double-blind, randomised, controlled study of continuous bilateral thoracic paravertebral infusion of 0.5% lidocaine (1 mg.kg -1 .hr -1 ) for analgesia after coronary surgery. Control patients received a subcutaneous infusion of lidocaine at the same rate through catheters inserted at the same locations as the study group. The primary outcome was morphine consumption at 48 hours using patient-controlled analgesia (PCA). Secondary outcomes included pain, respiratory function, nausea and vomiting. Serum lidocaine concentrations were measured on the first two post-operative days. There was no difference in morphine consumption or in any other outcome measure between the groups. Serum lidocaine concentrations increased during the study, with a maximum of 5.9 mg.l -1 . There were no adverse events as a consequence of the study. Bilateral paravertebral infusion of lidocaine confers no advantage over systemic lidocaine infusion after cardiac surgery. ISRCTN13424423 ( https://www.isrctn.com ).

Regional anesthesia procedures for shoulder and upper arm surgery upper extremity update--2005 to present.

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Sripada, Ramprasad; Bowens, Clifford

2012-01-01

This review of the literature since 2005 assesses developments of RA techniques commonly used for shoulder surgery, and their effectiveness for postoperative analgesia. Advantages of regional techniques include site-specific anesthesia and decreased postoperative opioid use. For shoulder surgeries, the ISB provides effective analgesia with minimal complications, whereas the impacts of IA single-injections remain unclear. When combined with GA, ISB can be used in lower volumes and reducing the complications for shoulder and proximal upper extremity. USG ISB and SCB are both effective and safe for shoulder surgery with a low incidence of complications, especially PONS.53 When compared with intravenous patient-controlled opioid analgesia, a perineural LA infusion using a disposable pump with patient-controlled LA bolus function has led to better pain relief and functional recovery while decreasing the need for rescue analgesics and the number of adverse events after ambulatory orthopedic surgery. The most remarkable advance in RA in the past 5 years is the increased usage of USG. Although there are no large-scale prospective studies to show the safety, efficacy, and success and complication rates for USG blocks, USG RA theoretically could have less risk for neurologic symptoms, except for those induced by LA (less likely perineurally, much more likely intraneurally). The next "quantum leap" lies in reducing LA concentrations and augmenting anesthetic-analgesic effects with perineural additives (including clonidine, buprenorphine, and likely low-dose dexamethasone). Since 2005, perineural catheters have been an analgesic option that offers improved pain relief among other benefits, and are now being used at home. It is clear that patients benefit greatly from a single injection and continuous nerve block for postoperative pain management,but the financial and logistical aspects need to be resolved, not to mention the phrenic hemiparesis coin toss. Whether combined

Severe hepatic trauma: nonoperative management, definitive repair, or damage control surgery?

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Leppäniemi, Ari K; Mentula, Panu J; Streng, Mari H; Koivikko, Mika P; Handolin, Lauri E

2011-12-01

Management of severe liver injuries has evolved to include the options for nonoperative management and damage control surgery. The present study analyzes the criteria for choosing between nonoperative management and early surgery, and definitive repair versus damage control strategy during early surgery. In a retrospective analysis of 144 patients with severe (AAST grade III-V) liver injuries (94% blunt trauma), early laparotomy was performed in 50 patients. Initial management was nonoperative in 94 blunt trauma patients with 8 failures. Uni- and multivariate analyses were used to calculate predictor odds ratios (OR) with 95% confidence intervals (CI). Factors associated with early laparotomy in blunt trauma included shock on admission, associated grade IV-V splenic injury, grade IV-V head injury, and grade V liver injury. Only shock was an independent predictor (OR, 26.1; 95% CI, 8.9-77.1; P < 0.001). The presence of a grade IV-V splenic injury predicted damage control strategy (OR infinite; P = 0.021). Failed nonoperative management was associated with grade IV-V splenic injury (OR, 14.00; 95% CI, 1.67-117.55), and shock (OR, 6.82; 95% CI, 1.49-31.29). The hospital mortality rate was 15%; 8 of 21 deaths were liver-related. Shock (OR, 9.3; 95% CI, 2.4-35.8; P = 0.001) and severe head injury (OR, 9.25; 95% CI, 3.0-28.9; P = 0.000) were independent predictors for mortality. In patients with severe liver injury, associated severe splenic injury favors early laparotomy and damage control strategy. Patients who arrive in shock or have an associated severe splenic injury should not be managed nonoperatively. In addition to severe head injury, uncontrollable bleeding from the liver injury is still a major cause of early death.

Using the Integration of Discrete Event and Agent-Based Simulation to Enhance Outpatient Service Quality in an Orthopedic Department

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Cholada Kittipittayakorn

2016-01-01

Full Text Available Many hospitals are currently paying more attention to patient satisfaction since it is an important service quality index. Many Asian countries’ healthcare systems have a mixed-type registration, accepting both walk-in patients and scheduled patients. This complex registration system causes a long patient waiting time in outpatient clinics. Different approaches have been proposed to reduce the waiting time. This study uses the integration of discrete event simulation (DES and agent-based simulation (ABS to improve patient waiting time and is the first attempt to apply this approach to solve this key problem faced by orthopedic departments. From the data collected, patient behaviors are modeled and incorporated into a massive agent-based simulation. The proposed approach is an aid for analyzing and modifying orthopedic department processes, allows us to consider far more details, and provides more reliable results. After applying the proposed approach, the total waiting time of the orthopedic department fell from 1246.39 minutes to 847.21 minutes. Thus, using the correct simulation model significantly reduces patient waiting time in an orthopedic department.

Using the Integration of Discrete Event and Agent-Based Simulation to Enhance Outpatient Service Quality in an Orthopedic Department.

Science.gov (United States)

Kittipittayakorn, Cholada; Ying, Kuo-Ching

2016-01-01

Many hospitals are currently paying more attention to patient satisfaction since it is an important service quality index. Many Asian countries' healthcare systems have a mixed-type registration, accepting both walk-in patients and scheduled patients. This complex registration system causes a long patient waiting time in outpatient clinics. Different approaches have been proposed to reduce the waiting time. This study uses the integration of discrete event simulation (DES) and agent-based simulation (ABS) to improve patient waiting time and is the first attempt to apply this approach to solve this key problem faced by orthopedic departments. From the data collected, patient behaviors are modeled and incorporated into a massive agent-based simulation. The proposed approach is an aid for analyzing and modifying orthopedic department processes, allows us to consider far more details, and provides more reliable results. After applying the proposed approach, the total waiting time of the orthopedic department fell from 1246.39 minutes to 847.21 minutes. Thus, using the correct simulation model significantly reduces patient waiting time in an orthopedic department.

Pilot prospective study of post-surgery sleep and EEG predictors of post-operative delirium.

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Evans, Joanna L; Nadler, Jacob W; Preud'homme, Xavier A; Fang, Eric; Daughtry, Rommie L; Chapman, Joseph B; Attarian, David; Wellman, Samuel; Krystal, Andrew D

2017-08-01

Delirium is a common post-operative complication associated with significant costs, morbidity, and mortality. We sought sleep/EEG predictors of delirium present prior to delirium symptoms to facilitate developing and targeting therapies. Continuous EEG data were obtained in 12 patients post-orthopedic surgery from the day of surgery until delirium assessment on post-operative day 2 (POD2). Diminished total sleep time (r=-0.68; pdelirium severity. Patients experiencing delirium slept 2.4h less and took 2h longer to fall asleep. Greater waking EEG delta power (r=0.84; pdelirium severity. Loss of sleep on night1 post-surgery is an early predictor of subsequent delirium. EEG Delta Power alterations in waking and sleep appear to be later indicators of impending delirium. Further work is needed to evaluate reproducibility/generalizability and assess whether sleep loss contributes to causing delirium. This first study to prospectively collect continuous EEG data for an extended period prior to delirium onset identified EEG-derived indices that predict subsequent delirium that could aid in developing and targeting therapies. Copyright © 2017. Published by Elsevier B.V.

The Medical Education and Best Practice in Orthopedic Patient Care in Poland.

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Rosiek, Anna; Leksowski, Krzysztof

2012-07-01

The leadership organization focuses on education, teamwork, customer relationship and developing strategy which help in building added value, in managing activities, time and quality. Everyday orthopedic experience shows that medical education is a mixture of: specific knowledge, skills and attitudes of people working together, and that creates effective teamwork in a hospital environment. Apart from the main reason of medical education, teaching about disease treatment and health problem solving, medical education should also concentrate on human factors and behavioral aspects of patient treatment in hospital.Assessment of an organization and medical education process by cultural and teamwork criteria, offers a powerful new way to think about performance at the frontlines of healthcare and in the future it could be gold standard for assessing the success of an organization, and standards in medical education, not only in orthopedics.

Noticeable Variations in the Educational Exposure During Residency in Danish Orthopedic Departments

DEFF Research Database (Denmark)

Brand, Eske; Fridberg, Marie; Knudsen, Ulrik Kragegaard

2016-01-01

. CONCLUSIONS: A large variation in the educational exposure was found among the Danish orthopedic departments. Numbers indicate that Danish residents, compared with their US counterparts, operate considerably less during residency. Most residents work overtime and many of them work for free to participate......OBJECTIVE: The objective of the study was to examine the educational exposure during residency in Danish orthopedic departments. DESIGN: Questionnaire-based cross-sectional study. SETTING: Data were gathered from January 1, 2014 to April 30, 2014 through a nationwide web-based questionnaire...... procedures as primary surgeon was 16 (range: 8-35) per month. In all, 18 of 22 (81%) departments offered the possibility to participate in research facilitated by the department and 38 of 96 (40%) worked for free (an average of 10h a month [range: 3-60]) to increase the amount of surgical procedures...

The Management of Cerebrospinal Fluid Leak After Anterior Cervical Decompression Surgery.

Science.gov (United States)

Zhai, Jiliang; Panchal, Ripul R; Tian, Ye; Wang, Shujie; Zhao, Lijuan

2018-03-01

Cerebrospinal fluid (CSF) leak is a rare but potentially troublesome and occasionally catastrophic complication after anterior cervical decompression surgery. There is limited literature describing this complication, and the management of CSF leak varies. The aim of this study was to retrospectively review the treatment of cases with CSF leak and develop a management algorithm. A series of 14 patients with CSF leak from January 2011 to May 2016 were included in this study. Their characteristics, management of CSF leak, and outcomes were documented. There were 5 male and 9 female patients. Mean age at surgery was 57.1±9.9 years (range, 37-76 years). All instances of CSF leak, except 1 noted postoperatively, were indirectly repaired intraoperatively. A closed straight wound drain was placed for all patients. A lumbar subarachnoid drain was placed immediately after surgery in 4 patients and postoperatively in 7 patients. In 1 patient, lumbar drain placement was unsuccessful. In 2 additional patients, the surgeon decided not to place a lumbar drain. One patient developed meningitis and recovered after antibiotic therapy with meropenem and vancomycin. Another patient had a deep wound infection and required a revision surgery. Wound drains and lumbar drains should be immediately considered when CSF leak is identified. Antibiotics also should be considered to prevent intradural infection. [Orthopedics. 2018; 41(2):e283-e288.]. Copyright 2018, SLACK Incorporated.

In Silico Investigation of a Surgical Interface for Remote Control of Modular Miniature Robots in Minimally Invasive Surgery

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Apollon Zygomalas

2014-01-01

Full Text Available Aim. Modular mini-robots can be used in novel minimally invasive surgery techniques like natural orifice transluminal endoscopic surgery (NOTES and laparoendoscopic single site (LESS surgery. The control of these miniature assistants is complicated. The aim of this study is the in silico investigation of a remote controlling interface for modular miniature robots which can be used in minimally invasive surgery. Methods. The conceptual controlling system was developed, programmed, and simulated using professional robotics simulation software. Three different modes of control were programmed. The remote controlling surgical interface was virtually designed as a high scale representation of the respective modular mini-robot, therefore a modular controlling system itself. Results. With the proposed modular controlling system the user could easily identify the conformation of the modular mini-robot and adequately modify it as needed. The arrangement of each module was always known. The in silico investigation gave useful information regarding the controlling mode, the adequate speed of rearrangements, and the number of modules needed for efficient working tasks. Conclusions. The proposed conceptual model may promote the research and development of more sophisticated modular controlling systems. Modular surgical interfaces may improve the handling and the dexterity of modular miniature robots during minimally invasive procedures.

[Haptic tracking control for minimally invasive robotic surgery].

Science.gov (United States)

Xu, Zhaohong; Song, Chengli; Wu, Wenwu

2012-06-01

Haptic feedback plays a significant role in minimally invasive robotic surgery (MIRS). A major deficiency of the current MIRS is the lack of haptic perception for the surgeon, including the commercially available robot da Vinci surgical system. In this paper, a dynamics model of a haptic robot is established based on Newton-Euler method. Because it took some period of time in exact dynamics solution, we used a digital PID arithmetic dependent on robot dynamics to ensure real-time bilateral control, and it could improve tracking precision and real-time control efficiency. To prove the proposed method, an experimental system in which two Novint Falcon haptic devices acting as master-slave system has been developed. Simulations and experiments showed proposed methods could give instrument force feedbacks to operator, and bilateral control strategy is an effective method to master-slave MIRS. The proposed methods could be used to tele-robotic system.

Specialized traumatological and orthopedic care for children through public-private partnership programs in the Novosibirsk region

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Tamara A Mylnikova

2016-03-01

Conclusions: Implementation of an organizational model of specialized traumatological and orthopedic care for children in the Novosibirsk region using mechanisms associated with public–private partnerships has proved to be very positive. Application of the model allowed improvements in the availability of specialized traumatological and orthopedic care for children to ensure succession in the stages of medical care and to increase the number of cases entering rehabilitation. Therefore, this model demonstrates the viability of providing medical care to the population through the mechanisms of public–private partnership.

Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting.

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Vadivelu, Nalini; Kai, Alice M; Kodumudi, Vijay; Berger, Jack M

2016-01-01

Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with opioids and the pattern and predictive factors for pain in the ambulatory surgical setting is needed.

Treatment of osteoporosis with eldecalcitol, a new vitamin D analog: a comprehensive review and meta-analysis of randomized clinical trials [Corrigendum

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Xu Z

2016-02-01

Full Text Available Zhixing Xu,1 Changchun Fan,2 Xuechun Zhao,3 Hairong Tao11Department of Orthopedic Surgery, The Third People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China; 2Department of Orthopedic Surgery, Jinan Military General Hospital,3Department of Orthopedic Surgery, The Third Hospital of Jinan City, Jinan, People’s Republic of ChinaThe authors wish to advise that article type was incorrectly titled as a “Review” paper. The article type should be corrected as an “Original Research” paper.Read the original article

[Improving the effectiveness of functional jaw orthopedics in Class II malocclusion by appropriate treatment timing].

Science.gov (United States)

Baccetti, Tiziano

2010-12-01

Time can be considered the fourth dimension in dento-facial orthopedics. Treatment timing can play a significant role in the outcomes of treatment aimed to produce an orthopedic effect in the craniofacial structures. The results of methodologically-sound cephalometric studies of both the past and the recent history of orthodontics clearly indicate that optimal treatment timing for Class II skeletal disharmony with a functional appliance (e.g. twin block) is during or slightly after the peak in mandibular growth as revealed by a reliable biologic indicator of individual skeletal maturity such as the cervical vertebral maturation method. © EDP Sciences, SFODF, 2010.

Knee-extension strength, postural control and function are related to fracture type and thigh edema in patients with hip fracture

DEFF Research Database (Denmark)

Kristensen, Morten T; Bandholm, Thomas; Bencke, Jesper

2008-01-01

BACKGROUND: Post-surgery thigh edema, loss of knee-extension strength, and reduced physical performance are common following a hip fracture. It is not known if knee-extension strength and physical performance are related to the edema and fracture type. The aim of this study was to examine...... the influence of fracture type and post-surgery edema on physical performances in patients with hip fracture. METHODS: Fifteen women and five men admitted from their own home to an acute orthopedic hip fracture unit were examined. Ten had cervical and ten had intertrochanteric fractures. Correlations between...... fracture type and thigh edema in the fractured limb (% non-fractured) to physical performances of basic mobility, postural control (sway), and isometric knee-extension strength were examined. All measures, except those of basic mobility, were conducted at the time of discharge, 8.5 days post...

The Incidence of Propionibacterium acnes in Open Shoulder Surgery: A Controlled Diagnostic Study.

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Mook, William R; Klement, Mitchell R; Green, Cynthia L; Hazen, Kevin C; Garrigues, Grant E

2015-06-17

Propionibacterium acnes has arisen as the most common microorganism identified at the time of revision shoulder arthroplasty. There is limited evidence to suggest how frequently false-positive cultures occur. The purpose of this prospective controlled study was to evaluate culture growth from specimens obtained during open shoulder surgery. Patients undergoing an open deltopectoral approach to the shoulder were prospectively enrolled. Patients with a history of shoulder surgery or any concern for active or previous shoulder infection were excluded. Three pericapsular soft-tissue samples were taken from the shoulder for bacterial culture and were incubated for fourteen days. A sterile sponge was also analyzed in parallel with the tissue cultures. In addition, similar cultures were obtained from patients who had undergone previous shoulder surgery. Overall, 20.5% of surgeries (twenty-four of 117) yielded at least one specimen removed for culture that was positive for bacterial growth, and 13.0% of sterile control specimens (seven of fifty-four) had positive culture growth (p = 0.234). P. acnes represented 83.0% of all positive cultures (thirty-nine of forty-seven) at a median incubation time of fourteen days. Among the subjects who had not undergone previous surgery, 17.1% (fourteen of eighty-two) had at least one positive P. acnes culture. Male sex was univariably associated with a greater likelihood of bacterial growth (p surgery and had received two or more preoperative corticosteroid injections had a higher likelihood of bacterial growth (p = 0.047). The clinical importance of positive P. acnes cultures from specimens obtained from open shoulder surgery remains uncertain. Male sex and preoperative corticosteroid injections were associated with a higher likelihood of bacterial growth on culture and are risk factors that merit further investigation. Previously reported incidences of positive P. acnes culture results from specimens from primary and revision shoulder

Albumin and fibrinogen levels′ relation with orthopedics traumatic patients′ outcome after massive transfusion

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Mohammadreza Bazavar

2014-01-01

Full Text Available Background: Severe bleeding is common during limb trauma. It can lead to hemorrhagic shock required to massive blood transfusion. Coagulopathy is the major complication of massive transfusion-induced increased mortality rate. Aim of this study was evaluation of fibrinogen and albumin levels association with orthopedics traumatic patients′ outcome who received massive transfusion. Methods: In a cross sectional study, 23 patients with severe limb injury admitted to orthopedic emergency department were studied. All the patients received massive transfusion, that is, >10 unit blood. Albumin and fibrinogen levels are measured at admission and 24 h later, and compared according to final outcome. Results: Twenty-three traumatic patients with severe limb injuries were studied, out of which ten (43.2% died and 13 (56.8% were alive. There was significant difference between patients outcome in fibrinogen level after 24 h, but no difference was observed in albumin levels. Based on regression model, fibrinogen after 24 h had a significant role in determining the final outcome in traumatic patients who received massive transfusion (odds ratio 0.48, 95% confidence interval 0.15-0.92, P = 0.02. Conclusions: According to our results, fibrinogen level is the most important factor in determination of orthopedics traumatic patients when received massive transfusion. However, serum albumin does not play any role in patients′ outcome.

Negative impact of pretreatment anemia on local control after neoadjuvant chemoradiotherapy and surgery for rectal cancer

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Lee, Hye Bin; Park, Hee Chul; Park, Won [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); and others

2012-09-15

Although anemia is considered to be a contributor to intra-tumoral hypoxia and tumor resistance to ionizing radiation in cancer patients, the impact of pretreatment anemia on local control after neoadjuvant concurrent chemoradiotherapy (NACRT) and surgery for rectal cancer remains unclear. We reviewed the records of 247 patients with locally advanced rectal cancer who were treated with NACRT followed by curative-intent surgery. The patients with anemia before NACRT (36.0%, 89/247) achieved less pathologic complete response (pCR) than those without anemia (p = 0.012). The patients with pretreatment anemia had worse 3-year local control than those without pretreatment anemia (86.0% vs. 95.7%, p = 0.005). Multivariate analysis showed that pretreatment anemia (p = 0.035), pathologic tumor and nodal stage (p = 0.020 and 0.032, respectively) were independently significant factors for local control. Pretreatment anemia had negative impacts on pCR and local control among patients who underwent NACRT and surgery for rectal cancer. Strategies maintaining hemoglobin level within normal range could potentially be used to improve local control in rectal cancer patients.

Negative impact of pretreatment anemia on local control after neoadjuvant chemoradiotherapy and surgery for rectal cancer

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Lee, Hye Bin; Park, Hee Chul; Park, Won

2012-01-01

Although anemia is considered to be a contributor to intra-tumoral hypoxia and tumor resistance to ionizing radiation in cancer patients, the impact of pretreatment anemia on local control after neoadjuvant concurrent chemoradiotherapy (NACRT) and surgery for rectal cancer remains unclear. We reviewed the records of 247 patients with locally advanced rectal cancer who were treated with NACRT followed by curative-intent surgery. The patients with anemia before NACRT (36.0%, 89/247) achieved less pathologic complete response (pCR) than those without anemia (p = 0.012). The patients with pretreatment anemia had worse 3-year local control than those without pretreatment anemia (86.0% vs. 95.7%, p = 0.005). Multivariate analysis showed that pretreatment anemia (p = 0.035), pathologic tumor and nodal stage (p = 0.020 and 0.032, respectively) were independently significant factors for local control. Pretreatment anemia had negative impacts on pCR and local control among patients who underwent NACRT and surgery for rectal cancer. Strategies maintaining hemoglobin level within normal range could potentially be used to improve local control in rectal cancer patients.

Sonication technique improves microbiological diagnosis in patients treated with antibiotics before surgery for prosthetic joint infections.

Science.gov (United States)

Scorzolini, Laura; Lichtner, Miriam; Iannetta, Marco; Mengoni, Fabio; Russo, Gianluca; Panni, Alfredo Schiavone; Vasso, Michele; Vasto, Michele; Bove, Marco; Villani, Ciro; Mastroianni, Claudio M; Vullo, Vincenzo

2014-07-01

Microbiological diagnosis is crucial for the appropriate management of implant-associated orthopedic infections (IAOIs). Sonication of biomaterials for microbiological diagnosis has not yet been introduced in routine clinical practice. Aim of this study was to describe the advantages and feasibility of this procedure in the clinical setting. We prospectively studied 56 consecutive patients undergoing revision because of IAOI and compared the sensitivity of sonication of explanted orthopedic implants with standard cultures. Patients were divided into two groups: those with foreign body infection (FBI, 15 patients) and those with prosthetic joint infection (PJI, 41 patients). Clinical, radiological and microbiological features were recorded. In the PJI group the sensitivity of sonication in detecting bacterial growth was higher than conventional culture (77% vs 34.1% respectively, p0.05). Coagulase-negative Staphylococci accounted for 90% of the bacteria detected by sonication. Moreover, we found that in the PJI group the sensitivity of sonication was not affected by the timing of antibiotic interruption before surgery. Sonication remains an important tool to improve microbiological diagnosis in PJIs, especially in patients who received previous antimicrobial treatment.