Motives for seeking a second opinion in orthopaedic surgery.

NARCIS (Netherlands)

Dalen, I. van; Groothoff, J.; Stewart, R.; Spreeuwenberg, P.; Groenewegen, P.; Horn, J. van

2001-01-01

The number of second opinions in orthopaedic surgery is increading rapidly, yet the grounds on which patients and their doctors decide to seek a second opinion have been little studied. The goal of the study was to identify patient and consultant factors that appeared to contribute to a second

Safety syringes and anti-needlestick devices in orthopaedic surgery.

Science.gov (United States)

Sibbitt, Wilmer L; Band, Philip A; Kettwich, Lawrence G; Sibbitt, Cristina R; Sibbitt, Lori J; Bankhurst, Arthur D

2011-09-07

The American Academy of Orthopaedic Surgery (AAOS), The Joint Commission, the Occupational Safety and Health Administration (OSHA), and the Needlestick Safety and Prevention Act encourage the integration of safety-engineered devices to prevent needlestick injuries to health-care workers and patients. We hypothesized that safety syringes and needles could be used in outpatient orthopaedic injection and aspiration procedures. The study investigated the orthopaedic uses and procedural idiosyncrasies of safety-engineered devices, including (1) four safety needles (Eclipse, SafetyGlide, SurGuard, and Magellan), (2) a mechanical safety syringe (RPD), (3) two automatic retractable syringes (Integra, VanishPoint), (4) three manual retractable syringes (Procedur-SF, Baksnap, Invirosnap), and (5) three shielded syringes (Safety-Lok, Monoject, and Digitally Activated Shielded [DAS] Syringe). The devices were first tested ex vivo, and then 1300 devices were used for 425 subjects undergoing outpatient arthrocentesis, intra-articular injections, local anesthesia, aspiration biopsy, and ultrasound-guided procedures. During the clinical observation, there were no accidental needlesticks (0 needlesticks per 1300 devices). Safety needles could be successfully used on a Luer syringe but were limited to ≤1.5 in (≤3.81 cm) in length and the shield could interfere with sonography. The mechanical safety syringes functioned well in all orthopaedic procedures. Automatic retractable syringes were too small for arthrocentesis of the knee, and the plunger blew out and prematurely collapsed with high-pressure injections. The manual retractable syringes and shielded syringes could be used with conventional needles for most orthopaedic procedures. The most effective and reliable safety devices for orthopaedic syringe procedures are shielded safety needles, mechanical syringes, manual retractable syringes, and shielded syringes, but not automatic retractable syringes. Even when adopting

Computer-assisted Orthopaedic Surgery: Current State and Future Perspective

Directory of Open Access Journals (Sweden)

Guoyan eZheng

2015-12-01

Full Text Available Introduced about two decades ago, computer-assisted orthopaedic surgery (CAOS has emerged as a new and independent area, due to the importance of treatment of musculoskeletal diseases in orthopaedics and traumatology, increasing availability of different imaging modalities, and advances in analytics and navigation tools. The aim of this paper is to present the basic elements of CAOS devices and to review state-of-the-art examples of different imaging modalities used to create the virtual representations, of different position tracking devices for navigation systems, of different surgical robots, of different methods for registration and referencing, and of CAOS modules that have been realized for different surgical procedures. Future perspectives will also be outlined.

99m Tc-labeled heparin test in orthopaedic surgery

International Nuclear Information System (INIS)

Bouvier, J.F.; Lafon, J.C.; Colin, M.; Chatelut, J.; Beaubatie, F.

1983-01-01

99m Tc-labeled heparin test was performed for early detection of phlebitis or pulmonary embolism after orthopaedic prothesis. Heparinic treatment and surgery per se were demonstrated to have no effect on the results. If this test demonstrates a statistical difference for pathologic patients, it is of greater value to consider ratio between rates before and after intervention [fr

Does Residency Selection Criteria Predict Performance in Orthopaedic Surgery Residency?

Science.gov (United States)

Raman, Tina; Alrabaa, Rami George; Sood, Amit; Maloof, Paul; Benevenia, Joseph; Berberian, Wayne

2016-04-01

More than 1000 candidates applied for orthopaedic residency positions in 2014, and the competition is intense; approximately one-third of the candidates failed to secure a position in the match. However, the criteria used in the selection process often are subjective and studies have differed in terms of which criteria predict either objective measures or subjective ratings of resident performance by faculty. Do preresidency selection factors serve as predictors of success in residency? Specifically, we asked which preresidency selection factors are associated or correlated with (1) objective measures of resident knowledge and performance; and (2) subjective ratings by faculty. Charts of 60 orthopaedic residents from our institution were reviewed. Preresidency selection criteria examined included United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores, Medical College Admission Test (MCAT) scores, number of clinical clerkship honors, number of letters of recommendation, number of away rotations, Alpha Omega Alpha (AOA) honor medical society membership, fourth-year subinternship at our institution, and number of publications. Resident performance was assessed using objective measures including American Board of Orthopaedic Surgery (ABOS) Part I scores and Orthopaedics In-Training Exam (OITE) scores and subjective ratings by faculty including global evaluation scores and faculty rankings of residents. We tested associations between preresidency criteria and the subsequent objective and subjective metrics using linear correlation analysis and Mann-Whitney tests when appropriate. Objective measures of resident performance namely, ABOS Part I scores, had a moderate linear correlation with the USMLE Step 2 scores (r = 0.55, p communication skills" subsection of the global evaluations. We found that USMLE Step 2, number of honors in medical school clerkships, and AOA membership demonstrated the strongest correlations with resident performance. Our

Behavioral Economics and Physician Board Meetings: Opportunity Cost, Regret, and Their Mitigation in Orthopaedic Surgery.

Science.gov (United States)

Sinicrope, Brent J; Roberts, Craig S; Sussman, Lyle

2018-01-01

Health care is a business. Health care providers must become familiar with terms such as opportunity costs, the potential loss or gain when one choice is made in lieu of another. The purpose of this study was to calculate the opportunity cost of two orthopaedic surgery society board meetings and discuss these in the context of behavioral economics and regret. A literature search was conducted to determine an orthopaedic surgeon's average yearly salary, hours worked per week, and weeks worked per year. The details of two orthopaedic surgery professional society meetings that one senior author (CSR) attended were used to calculate opportunity cost. Although the true benefits are multifactorial and difficult to objectively quantify, awareness of the cost-benefit ratio can help guide time and resource management to maximize the return on investment while minimizing buyer's remorse and perhaps influence the media by which medical meetings are held in the future. (Journal of Surgical Orthopaedic Advances 27(1):10-13, 2018).

Computer Assisted Orthopaedic Surgery – CAOS

Directory of Open Access Journals (Sweden)

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.

[Clinical safety and professional liability claims in Orthopaedic Surgery and Traumatology].

Science.gov (United States)

Bori, G; Gómez-Durán, E L; Combalia, A; Trilla, A; Prat, A; Bruguera, M; Arimany-Manso, J

2016-01-01

The specialist in orthopaedic and traumatological surgery, like any other doctor, is subject to the current legal provisions while exercising their profession. Mandatory training in the medical-legal aspects of health care is essential. Claims against doctors are a reality, and orthopaedic and traumatological surgery holds first place in terms of frequency of claims according to the data from the General Council of Official Colleges of Doctors of Catalonia. Professionals must be aware of the fundamental aspects of medical professional liability, as well as specific aspects, such as defensive medicine and clinical safety. The understanding of these medical-legal aspects in the routine clinical practice can help to pave the way towards a satisfactory and safe professional career. The aim of this review is to contribute to this training, for the benefit of professionals and patients. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

Canadian Orthopaedic Residents Perception of Their Needs in Elbow Surgery Teaching

Science.gov (United States)

Carroll, Michael; Drosdovech, Darren; Faber, Kenneth J.; Hildebrand, Kevin A.; King, Graham; Pollock, J.; Rouleau, Dominique M.; Sandman, Emilie

2018-01-01

Introduction: The aim of this paper is to guide training program and review course curriculum planning in elbow disorders. To this end, a nationwide email survey was administered to residents' in orthopaedic surgery training programs. Material and Methods: The survey had 12 items that examined learning needs in several domains: assessment of acute…

The available evidence on demineralised bone matrix in trauma and orthopaedic surgery

NARCIS (Netherlands)

J. van der Stok (Johan); Hartholt, K.A.; Schoenmakers, D.A.L.; J.J. Arts (Jacobus J.)

2017-01-01

textabstractObjectives: The aim of this systematic literature review was to assess the clinical level of evidence of commercially available demineralised bone matrix (DBM) products for their use in trauma and orthopaedic related surgery. Methods: A total of 17 DBM products were used as search terms

Pragmatic approach to the clinical work-up of patients with putative allergic disease to metallic orthopaedic implants before and after surgery

DEFF Research Database (Denmark)

Thyssen, J P; Menné, T; Schalock, P C

2011-01-01

on in the work-up of patients with putative allergic complications following surgery. Few studies have investigated whether subjects with metal contact allergy have increased risk of developing complications following orthopaedic implant insertion. Metal allergy might in a minority increase the risk...... testing prior to surgery unless the patient has already had implant surgery with complications suspected to be allergic or has a history of clinical metal intolerance of sufficient magnitude to be of concern to the patient or a health provider. The clinical work-up of a patient suspected of having......Allergic complications following insertion of metallic orthopaedic implants include allergic dermatitis reactions but also extracutaneous complications. As metal-allergic patients and/or surgeons may ask dermatologists and allergologists for advice prior to planned orthopaedic implant surgery...

Understanding how orthopaedic surgery practices generate value for healthcare systems.

Science.gov (United States)

Olson, Steven A; Mather, Richard C

2013-06-01

Orthopaedic surgery practices can provide substantial value to healthcare systems. Increasingly, healthcare administrators are speaking of the need for alignment between physicians and healthcare systems. However, physicians often do not understand what healthcare administrators value and therefore have difficulty articulating the value they create in discussions with their hospital or healthcare organization. Many health systems and hospitals use service lines as an organizational structure to track the relevant data and manage the resources associated with a particular type of care, such as musculoskeletal care. Understanding service lines and their management can be useful for orthopaedic surgeons interested in interacting with their hospital systems. We provide an overview of two basic types of value orthopaedic surgeons create for healthcare systems: financial or volume-driven benefits and nonfinancial quality or value-driven patient care benefits. We performed a search of PubMed from 1965 to 2012 using the term "service line." Of the 351 citations identified, 18 citations specifically involved the use of service lines to improve patient care in both nursing and medical journals. A service line is a structure used in healthcare organizations to enable management of a subset of activities or resources in a focused area of patient care delivery. There is not a consistent definition of what resources are managed within a service line from hospital to hospital. Physicians can positively impact patient care through engaging in service line management. There is increasing pressure for healthcare systems and hospitals to partner with orthopaedic surgeons. The peer-reviewed literature demonstrates there are limited resources for physicians to understand the value they create when attempting to negotiate with their hospital or healthcare organization. To effectively negotiate for resources to provide the best care for patients, orthopaedic surgeons need to claim and

[Financing of inpatient orthopaedics and trauma surgery in the 2011 G-DRG System].

Science.gov (United States)

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

2011-09-01

The German DRG system forms the basis for billing inpatient hospital services. It includes not only the case groups (G-DRGs), but also copayments. This paper analyses and evaluates the relevant developments of the 2011 G-DRG system for orthopaedics and traumatology from the medical and classificatory perspective. An analysis was performed of relevant diagnoses, medical procedures and G-DRGs in the 2010 and 2011 versions based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). A number of codes for surgical measures have been newly established or modified - above all in foot surgery, arthroscopic surgery and wound surgery. 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 orthopaedics and traumatology is changed, especially for polytraumata. The allocation of common cases with a standardized treatment pattern appears to be appropriate and the reimbursement adequate. For the less common and more complex cases the 2011 G-DRG system still shows need for further modification (e.g. polytraumata, joint replacement, spine surgery). The proper integration of the modified OPS classification for foot surgery to the appropriate G-DRGs will be essential to maintain the high quality of the reimbursement structure for the future.

The influence of alcohol and tobacco use in orthopaedic inpatients on complications of surgery.

Science.gov (United States)

Williams, Gerard; Daly, Michelle; Proude, Elizabeth M; Kermode, Steven; Davis, Michelle; Barling, Jan; Haber, Paul S

2008-01-01

Tobacco use and heavy alcohol consumption are associated with increased morbidity and mortality. There is limited research on the correlation between tobacco and risky levels of alcohol use and the possible complications associated with a hospital admission. The underestimation of problem drinking, in particular, has obvious repercussions for the management of patients in hospital. If alcohol-related problems go undetected or unrecorded, treatment may be inadequate or inappropriate. The aims of the project were to assess the prevalence of high-risk alcohol and tobacco use in orthopaedic in-patients and to examine any relationship between alcohol and tobacco use and the number and type of complications, management and length of stay. One hundred and fifty-three consecutive orthopaedic admissions to the Orthopaedic Ward at Lismore Base Hospital were screened using the Drinkcheck questionnaire, which is based on the Alcohol Use Disorders Identification Test (AUDIT), but which also screens for tobacco use. Nursing staff on the ward completed a Complications Evaluation Questionnaire (CEQ). The risk status of the subjects was compared to the number and type of complications, to assess any effects of alcohol and tobacco on post-surgical complications. Significant correlations were found between tobacco use, hazardous and harmful alcohol use and numerous medical complications and behavioural problems. Behavioural problems associated with risky alcohol use included verbal abuse, agitation and sleep disturbances, particularly in men; problems associated with tobacco use included agitation and non-compliance. Orthopaedic patients who smoke and/or drink heavily prior to surgery may have more non-medical complications than non-smokers and light or non-drinkers. All surgery patients should thus be screened for alcohol and tobacco use and alcohol withdrawal, which may cause other symptoms such as behavioural problems, non-compliance and verbal abuse post-surgery.

Variability of Arthroscopy Case Volume in Orthopaedic Surgery Residency.

Science.gov (United States)

Gil, Joseph A; Waryasz, Gregory R; Owens, Brett D; Daniels, Alan H

2016-05-01

To examine orthopaedic surgery case logs for arthroscopy case volume during residency training and to evaluate trends in case volume and variability over time. Publicly available Accreditation Council for Graduate Medical Education surgical case logs from 2007 to 2013 for orthopaedic surgery residency were assessed for variability and case volume trends in shoulder, elbow, wrist, hip, knee, and ankle arthroscopy. The national average number of procedures performed in each arthroscopy category reported was directly compared from 2009 to 2013. The 10th and 90th percentile arthroscopy case volume was compared between 2007 and 2013 for shoulder and knee arthroscopy procedures. Subsequently, the difference between the 10th and 90th percentile arthroscopy case volume in each category in 2007 was compared with the difference between the 10th and 90th percentile arthroscopy case volume in each category in 2013. From 2007 to 2013, shoulder arthroscopy procedures performed per resident increased by 43.1% (P = .0001); elbow arthroscopy procedures increased by 28.0% (P = .00612); wrist arthroscopy procedures increased by 8.6% (P = .05); hip arthroscopy procedures, which were first reported in 2012, increased by 588.9%; knee arthroscopy procedures increased by 8.5% (P = .0435); ankle arthroscopy increased by 27.6% (P = .00149). The difference in knee and shoulder arthroscopy volume between residents in the 10th and 90th percentile in 2007 and residents in the 10th and 90th percentile in 2013 was not significant (P > .05). There was a 3.66-fold difference in knee arthroscopy volume between residents in the 10th and 90th percentile in 2007, whereas the difference was 3.36-fold in 2013 (P = .70). There was a 5.86-fold difference in shoulder arthroscopy case volume between residents in the 10th and 90th percentile in 2007, whereas the difference was 4.96-fold in 2013 (P = .29). The volume of arthroscopy cases performed by graduating orthopaedic surgery residents has

The role of recombinant activated factor VII in the haematological management of elective orthopaedic surgery in haemophilia A patients with inhibitors

Science.gov (United States)

Castaman, Giancarlo

2017-01-01

The clinical profile and expectations of haemophilic patients with inhibitors have changed over the last three decades, mainly because of the prolongation of life-expectancy, often resulting in an increase of the orthopaedic burden. Recombinant activated factor VII (rFVIIa) is the most frequently used bypassing agent in haemophilia patients with inhibitors during elective orthopaedic surgery. For nearly 30 years, rFVIIa has been successfully used to control haemostasis in several major and minor surgical procedures. Clinical trials, case series, reports and surveys were progressively aimed at optimising rFVIIa usage in very demanding conditions managed in highly specialised centres. Recommendations from consensus opinions and guidelines have been provided on the basis of this clinical experience. PMID:28686157

Antibiotic-Impregnated Bone Grafts in Orthopaedic and Trauma Surgery: A Systematic Review of the Literature

Directory of Open Access Journals (Sweden)

Konstantinos Anagnostakos

2012-01-01

Full Text Available There exist several options for local antibiotic therapy in orthopaedic and trauma surgery. Over the past years, the use of antibiotic-impregnated bone grafts (AIBGs has become a popular procedure in the treatment of bone and joint infections. A major advantage of AIBGs involves the possibility of impregnation of various antibiotics depending on the sensitivity profile of the causative organism, whereas an additional surgery with removal of the antibiotic carrier is not necessary, as in the use of antibiotic-loaded bone cement. However, generalized conclusions cannot be clearly drawn from the existing literature due to differences of bone used, impregnation method, antibiotics, their doses, laboratory circumstances, or clinical indications. The present work reviews the literature regarding this topic and sheds some light onto the choice of bone and antibiotics, manufacturing details, and clinical experience.

(Mis)perceptions about intimate partner violence in women presenting for orthopaedic care: a survey of Canadian orthopaedic surgeons.

Science.gov (United States)

Bhandari, Mohit; Sprague, Sheila; Tornetta, Paul; D'Aurora, Valerie; Schemitsch, Emil; Shearer, Heather; Brink, Ole; Mathews, David; Dosanjh, Sonia

2008-07-01

Domestic violence is the most common cause of nonfatal injury to women in North America. In a review of 144 such injuries, the second most common manifestation of intimate partner violence was musculoskeletal injuries (28%). The American Academy of Orthopaedic Surgeons is explicit that orthopaedic surgeons should play a role in the screening and appropriate identification of victims. We aimed to identify the perceptions, attitudes, and knowledge of Canadian orthopaedic surgeons with regard to intimate partner violence. We surveyed members of the Canadian Orthopaedic Association to identify attitudes toward intimate partner violence. With use of a systematic random sample, 362 surgeons were mailed questionnaires. The questionnaire consisted of three sections: (1) the general attitude of the orthopaedic surgeon toward intimate partner violence, (2) the attitude of the orthopaedic surgeon toward victims and batterers, and (3) the clinical relevance of intimate partner violence in orthopaedic surgery. Up to three follow-up mailings were performed to enhance response rates. A total of 186 orthopaedic surgeons responded (a response rate of 51%), and 167 (91%) of them were men. Most orthopaedic surgeons (95%) estimated that <10% of their patients were victims of intimate partner violence, and most respondents (80%) believed that it was exceedingly rare (a prevalence of <1%). The concept of mandatory screening for intimate partner violence was met with uncertainty by 116 surgeons (64%). Misconceptions were perpetuated by surgeons who believed that inquiring about intimate partner violence was an invasion of the victim's privacy, that investigating intimate partner violence was not part of their duty, that victims choose to be a victim, and that victims play a proactive role in causing their abuse. By the completion of the survey, the majority of surgeons (91%) believed that knowledge about intimate partner violence was relevant to their surgical practice. Discomfort with

Types of wear and tear of biomaterials used in orthopaedic surgery

OpenAIRE

L. Klimek; E. Wołowiec; B. Majkowska

2013-01-01

Purpose: Purpose of this paper is presentation of observations on different kinds of wear and tear of biomaterials used in contemporary orthopaedic surgery.Design/methodology/approach: Types of prosthesis damage, encountered in medical practice, and their causes have been described. Results of many clinical studies were analysed to review prosthesis damage from the stage of implanting (such as intrusion of a foreign object between its components) to their natural wear and tear after many year...

Three-dimensional image display by CT data processing and clinical applications in orthopaedics and craniofacial surgery

International Nuclear Information System (INIS)

Zonneveld, F.W.; Akkerveeken, P.F. van; Koornneef, L.

1988-01-01

The methods of generating three-dimensional images from two-dimensional CT data are described. Four cases are reported explaining its use in the planning of orthopaedic and craniofacial surgery. (orig.) [de

Interventions to reduce tourniquet-related ischaemic damage in orthopaedic surgery

DEFF Research Database (Denmark)

Halladin, N L; Zahle, F V; Rosenberg, J

2014-01-01

-related oxidative damage in adults undergoing orthopaedic surgery, and the possible relationship between biochemical oxidative stress markers and postoperative clinical outcomes. Seventeen randomised controlled studies were included in the qualitative synthesis. Most trials were of low methodological quality...... and postoperative clinical outcomes should be further investigated in the future....... and only two studies reported postoperative clinical outcomes. Nine studies tested anaesthetics (propofol, dexmedetomidine, ketamine, and spinal anaesthesia); four studies tested antioxidants (N-acetyl-cysteine, vitamin C, and mannitol); and four studies tested ischaemic pre-conditioning. Fifteen studies...

Increased Academic Productivity of Orthopaedic Surgery Residents Following 2011 Duty Hour Reform.

Science.gov (United States)

Johnson, Joey P; Savage, Kevin; Gil, Joseph A; Eberson, Craig P; Mulcahey, Mary K

2017-12-19

In 2003 and again in 2011, the Accreditation Council for Graduate Medical Education (ACGME) mandated increasingly stringent resident duty hour restrictions. With less time required at the hospital, residents theoretically have more time for other academic activities, such as research. Our study seeks to examine whether the number of research publications by orthopaedic residents increased following implementation of the 2011 ACGME duty hour restrictions. Pubmed was queried using publicly available alumni lists from programs across the United States. The years 2008 to 2011 were included to assess pre-2011 productivity. The years 2012 to 2015 were included in the post 2011 group. Paired t tests were used to assess differences between groups. Statistical significance was set to p care in any meaningful way. In our study, there was a statistically significant increase in publications after 2011; however, the number of publications between NIH funded and non-NIH funded programs did not differ. Our study is the first to demonstrate that with increasing duty hour restrictions, orthopaedic surgery residents may be using more of their free time to conduct research. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Combining Clinical Information and Patient Reported Outcome Measures in Orthopaedic Surgery and Sports Medicine

NARCIS (Netherlands)

Kampen, D.A. van

2013-01-01

In this thesis we investigated the use of clinical information and Patient Reported Outcome Measures (PROMs) for patient evaluation in orthopaedic surgery and sports medicine. In the first part, we showed that the Dutch version of the Simple Shoulder Test (SST) is a valid and reliable

Surgical site infection among patients undergone orthopaedic ...

African Journals Online (AJOL)

Surgical site infection among patients undergone orthopaedic surgery at Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania. ... of surgical site infection at Muhimbili Orthopedic Institute was high. This was associated with more than 2 hours length of surgery, lack of prophylaxis use, and pre-operative hospital stay.

Using Lean Process Improvement to Enhance Safety and Value in Orthopaedic Surgery: The Case of Spine Surgery.

Science.gov (United States)

Sethi, Rajiv; Yanamadala, Vijay; Burton, Douglas C; Bess, Robert Shay

2017-11-01

Lean methodology was developed in the manufacturing industry to increase output and decrease costs. These labor organization methods have become the mainstay of major manufacturing companies worldwide. Lean methods involve continuous process improvement through the systematic elimination of waste, prevention of mistakes, and empowerment of workers to make changes. Because of the profit and productivity gains made in the manufacturing arena using lean methods, several healthcare organizations have adopted lean methodologies for patient care. Lean methods have now been implemented in many areas of health care. In orthopaedic surgery, lean methods have been applied to reduce complication rates and create a culture of continuous improvement. A step-by-step guide based on our experience can help surgeons use lean methods in practice. Surgeons and hospital centers well versed in lean methodology will be poised to reduce complications, improve patient outcomes, and optimize cost/benefit ratios for patient care.

II Italian intersociety consensus statement on antithrombotic prophylaxis in orthopaedics and traumatology: arthroscopy, traumatology, leg immobilization, minor orthopaedic procedures and spine surgery.

Science.gov (United States)

Randelli, F; Romanini, E; Biggi, F; Danelli, G; Della Rocca, G; Laurora, N R; Imberti, D; Palareti, G; Prisco, D

2013-03-01

Pharmacological prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, but few data exist in other fields of orthopaedics and traumatology. Thus, no guidelines or recommendations are available in the literature except for a limited number of weak statements about knee arthroscopy and lower limb fractures. In any case, none of them are a multidisciplinary effort as the one here presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the Association of Orthopaedic Traumatology of Italian Hospitals (OTODI), together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and the Italian Society of General Medicine (SIMG) have set down easy and quick suggestions for VTE prophylaxis in a number of surgical conditions for which only scarce evidence is available. This inter-society consensus statement aims at simplifying the approach to VTE prophylaxis in the single patient with the goal to improve its clinical application.

The available evidence on demineralised bone matrix in trauma and orthopaedic surgery : a systematic review

NARCIS (Netherlands)

van der Stok, J.; Hartholt, K.A.; Schoenmakers, D.A.L.; Arts, J.J.C.

2017-01-01

Objectives: The aim of this systematic literature review was to assess the clinical level of evidence of commercially available demineralised bone matrix (DBM) products for their use in trauma and orthopaedic related surgery. Methods: A total of 17 DBM products were used as search terms in two

Allergies in orthopaedic and trauma surgery.

Science.gov (United States)

Lohmann, C H; Hameister, R; Singh, G

2017-02-01

Hypersensitivity reactions to implants in orthopaedic and trauma surgery are a rare but devastating complication. They are considered as a delayed-type of hypersensitivity reaction (type IV), characterized by an antigen activation of sensitized T-lymphocytes releasing various cytokines and may result in osteoclast activation and bone resorption. Potential haptens are originated from metal alloys or bone-cement. A meta-analysis has confirmed a higher probability of developing a metal hypersensitivity postoperatively and noted a greater risk of failed replacements compared to stable implants. Hypersensitivity to implants may present with a variety of symptoms such as pain, joint effusion, delayed wound/bone healing, persistent secretion, allergic dermatitis (localized or systemic), clicking noises, loss of joint function, instability and failure of the implant. Various diagnostic options have been offered, including patch testing, metal alloy patch testing, histology, lymphocyte transformation test (LTT), memory lymphocyte immunostimulation assay (MELISA), leukocyte migration inhibition test (LIF) and lymphocyte activation test (LAT). No significant differences between in vivo and in vitro methods have been found. Due to unconvincing evidence for screening methods, predictive tests are not recommended for routine performance. Infectious aetiology always needs to be excluded. As there is a lack of evidence on large-scale studies with regards to the optimal treatment option, management currently relies on individual case-by-case decisions. Several options for patients with (suspected) metal-related hypersensitivity exist and may include materials based on ceramic, titanium or oxinium or modified surfaces. Promising results have been reported, but long-term experience is lacking. More large-scaled studies are needed in this context. In patients with bone-cement hypersensitivity, the component suspected for hypersensitivity should be avoided. The development of

Mental imagery and learning: a qualitative study in orthopaedic trauma surgery.

Science.gov (United States)

Ibrahim, Edward F; Richardson, Martin D; Nestel, Debra

2015-09-01

Good preparation for surgical procedures has been linked to better performance and enhanced learning in the operating theatre. Mental imagery is increasingly used to enhance performance in competitive sport and there has been recent interest in applying this in surgery. This study aims to identify the mental imagery components of preoperative preparation in orthopaedic trauma surgery and to locate these practices in existing socio-material theory in order to produce a model useful for surgical skills training. Semi-structured interviews were conducted with nine orthopaedic surgeons. Participants were identified by personal recommendation as regularly performing complex trauma operations to a high standard, and by affiliation to an international instruction course in trauma surgery. Interviews were audio-recorded and transcripts were independently analysed using thematic analysis. Analysis revealed that surgeons interact intensively with multiple colleagues and materials during their preparatory activities. Such interactions stimulate mental imagery in order to build strategy and rehearse procedures, which, in turn, stimulate preparatory interactions. Participants identified the discussion of a preoperative 'plan' as a key engagement tool for training junior surgeons and as a form of currency by which a trainee may increase his or her participation in a procedure. Preoperative preparation can be thought of as a socio-material ontology requiring a surgeon to negotiate imaginal, verbal and physical interactions with people, materials and his or her own mental imagery. Actor-network theory is useful for making sense of these interactions and for allowing surgeons to interrogate their own preparative processes. We recommend supervisors to use a form of preoperative plan as a teaching tool and to encourage trainees to develop their own preparatory skills. The ability of a trainee to demonstrate sound preparation is an indicator of readiness to perform a procedure. �

Effect of the systemic inflammatory response, as provoked by elective orthopaedic surgery, on HbA1c.

Science.gov (United States)

Chadburn, Andrew J; Garman, Elizabeth; Abbas, Raad; Modupe, Anu; Ford, Clare; Thomas, Osmond L; Chugh, Sanjiv; Deshpande, Shreeram; Gama, Rousseau

2017-07-01

Background In acutely ill patients with new onset hyperglycaemia, plasma glucose cannot reliably distinguish between stress hyperglycaemia and undiagnosed diabetes mellitus. We, therefore, investigated the diagnostic reliability of glycated haemoglobin (HbA1c) in acute illness by prospectively evaluating the effect of the systemic inflammatory response, as provoked by elective orthopaedic surgery, on HbA 1c . Methods HbA 1c and serum C-reactive protein concentrations were compared before and two days after elective knee or hip surgery in 30 patients without diabetes. C-reactive protein was used to assess the systemic inflammatory response. Results The mean (standard deviation) serum C-reactive protein increased following surgery (4.8 [7.5] vs. 179.7 [61.9] mg/L; P<0.0001). HbA 1c was similar before and after surgery (39.2 [5.4] vs. 38.1 [5.1] mmol/moL, respectively; P = 0.4363). Conclusions HbA 1c is unaffected within two days of a systemic inflammatory response as provoked by elective orthopaedic surgery. This suggests that HbA 1c may be able to differentiate newly presenting type 2 diabetes mellitus from stress hyperglycaemia in acutely ill patients with new onset hyperglycaemia.

The Core Competencies for General Orthopaedic Surgeons.

Science.gov (United States)

Kellam, James F; Archibald, Douglas; Barber, James W; Christian, Eugene P; D'Ascoli, Richard J; Haynes, Richard J; Hecht, Suzanne S; Hurwitz, Shepard R; Kellam, James F; McLaren, Alexander C; Peabody, Terrance D; Southworth, Stephen R; Strauss, Robert W; Wadey, Veronica M R

2017-01-18

With the changing delivery of orthopaedic surgical care, there is a need to define the knowledge and competencies that are expected of an orthopaedist providing general and/or acute orthopaedic care. This article provides a proposal for the knowledge and competencies needed for an orthopaedist to practice general and/or acute care orthopaedic surgery. Using the modified Delphi method, the General Orthopaedic Competency Task Force consisting of stakeholders associated with general orthopaedic practice has proposed the core knowledge and competencies that should be maintained by orthopaedists who practice emergency and general orthopaedic surgery. For relevancy to clinical practice, 2 basic sets of competencies were established. The assessment competencies pertain to the general knowledge needed to evaluate, investigate, and determine an overall management plan. The management competencies are generally procedural in nature and are divided into 2 groups. For the Management 1 group, the orthopaedist should be competent to provide definitive care including assessment, investigation, initial or emergency care, operative or nonoperative care, and follow-up. For the Management 2 group, the orthopaedist should be competent to assess, investigate, and commence timely non-emergency or emergency care and then either transfer the patient to the appropriate subspecialist's care or provide definitive care based on the urgency of care, exceptional practice circumstance, or individual's higher training. This may include some higher-level procedures usually performed by a subspecialist, but are consistent with one's practice based on experience, practice environment, and/or specialty interest. These competencies are the first step in defining the practice of general orthopaedic surgery including acute orthopaedic care. Further validation and discussion among educators, general orthopaedic surgeons, and subspecialists will ensure that these are relevant to clinical practice. These

Systematic review of a patient care bundle in reducing staphylococcal infections in cardiac and orthopaedic surgery.

Science.gov (United States)

Ma, Ning; Cameron, Alun; Tivey, David; Grae, Nikki; Roberts, Sally; Morris, Arthur

2017-04-01

Surgical site infections (SSIs) are serious adverse events hindering surgical patients' recovery. In Australia and New Zealand, SSIs are a huge burden to patients and healthcare systems. A bundled approach, including pre-theatre nasal and/or skin decolonization has been used to reduce the risk of staphylococcal infection. The aim of this review is to assess the effectiveness of the bundle in preventing SSIs for cardiac and orthopaedic surgeries. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Published literature was searched in PubMed, Embase and Cochrane Library of Systematic reviews. Identified articles were selected and extracted based on a priori defined Population-Intervention-Comparator-Outcome and eligibility criteria. Data of randomized controlled trials (RCTs) and comparative observational studies were synthesized by meta-analyses. Quality appraisal tools were used to assess the evidence quality. The review included six RCTs and 19 observational studies. The bundled treatment regimens varied substantially across all studies. RCTs showed a trend of Staphylococcus aureus SSIs reduction due to the bundle (relative risk = 0.59, 95% confidence interval (CI) = 0.33, 1.06) with moderate heterogeneity. Observational studies showed statistically significant reduction in all-cause and S. aureus SSIs, with 51% (95% CI = 0.41, 0.59) and 47% (95% CI = 0.35, 0.65), respectively. No publication biases were detected. SSIs in major cardiac and orthopaedic surgeries can be effectively reduced by approximately 50% with a pre-theatre patient care bundle approach. © 2017 Royal Australasian College of Surgeons.

Radiologic examination of orthopaedics. Methods and techniques

International Nuclear Information System (INIS)

Hafner, E.; Meuli, H.C.

1976-01-01

This volume describes in detail radiological examinations of the skeleton modern procedures in orthopaedic surgery. Special emphasis is given to functional examination techniques based upon the authors' extensive work on standardized radiological examinations best suited to the needs of orthopaedic surgeons. These techniques were developed at the Radiodiagnostic Department of the Central Radiological Clinic, Bern University, in cooperation with the University Clinic of Orthopaedics and Surgery of the Locomotor System. Exposure techniques are explained concisely, yet with extraordinary precision and attention to detail. They have proved highly successful in teaching programs for X-ray technicians and as standard examination techniques for many hospitals, X-ray departments, orthopaedic units, and private clinics. Recommended for orthopaedic surgeons, radiologists, general surgeons, and X-ray technicians, this definitive treatise, with its superb X-ray reproductions and complementary line drawings, explains how to achieve improved diagnoses and standardized control with the least possible radiation exposure to the patient

A multiple-dose, double-blind comparison of intramuscularly and orally administered ketorolac tromethamine and Ketogan in patients with pain following orthopaedic surgery

DEFF Research Database (Denmark)

Gebuhr, Peter Henrik; Soelberg, M; Strauss, W

1994-01-01

In this multiple-dose, double-blind study 100 patients with moderate, severe or very severe pain following orthopaedic surgery were randomly assigned to receive ketorolac, a non-steroidal anti-inflammatory drug with potent analgesic properties (10 mg), or the standard regimen of Ketogan (a combin......-mg doses of oral ketorolac are as effective as Ketogan for the treatment of pain following orthopaedic surgery. Ketorolac appears to be better tolerated than Ketogan since significantly fewer patients reported adverse events (P = 0.004) when taking ketorolac.......In this multiple-dose, double-blind study 100 patients with moderate, severe or very severe pain following orthopaedic surgery were randomly assigned to receive ketorolac, a non-steroidal anti-inflammatory drug with potent analgesic properties (10 mg), or the standard regimen of Ketogan (a...... combination product containing the narcotic analgesic, ketobemidone, plus a spasmolytic agent) by intramuscular injection every 1-6 h as needed for pain. When patients were able to tolerate an oral diet and were expected to respond to oral analgesic medication, based on overall pain sensitivity, they were...

Computerized Adaptive Tests Detect Change Following Orthopaedic Surgery in Youth with Cerebral Palsy.

Science.gov (United States)

Mulcahey, M J; Slavin, Mary D; Ni, Pengsheng; Vogel, Lawrence C; Kozin, Scott H; Haley, Stephen M; Jette, Alan M

2015-09-16

The Cerebral Palsy Computerized Adaptive Test (CP-CAT) is a parent-reported outcomes instrument for measuring lower and upper-extremity function, activity, and global health across impairment levels and a broad age range of children with cerebral palsy (CP). This study was performed to examine whether the Lower Extremity/Mobility (LE) CP-CAT detects change in mobility following orthopaedic surgery in children with CP. This multicenter, longitudinal study involved administration of the LE CP-CAT, the Pediatric Outcomes Data Collection Instrument (PODCI) Transfer/Mobility and Sports/Physical Functioning domains, and the Timed "Up & Go" test (TUG) before and after elective orthopaedic surgery in a convenience sample of 255 children, four to twenty years of age, who had CP and a Gross Motor Function Classification System (GMFCS) level of I, II, or III. Standardized response means (SRMs) and 95% confidence intervals (CIs) were calculated for all measures at six, twelve, and twenty-four months following surgery. SRM estimates for the LE CP-CAT were significantly greater than the SRM estimates for the PODCI Transfer/Mobility domain at twelve months, the PODCI Sports/Physical Functioning domain at twelve months, and the TUG at twelve and twenty-four months. When the results for the children at GMFCS levels I, II, and III were grouped together, the improvements in function detected by the LE CP-CAT at twelve and twenty-four months were found to be greater than the changes detected by the PODCI Transfer/Mobility and Sports/Physical Functioning scales. The LE CP-CAT outperformed the PODCI scales for GMFCS levels I and III at both of these follow-up intervals; none of the scales performed well for patients with GMFCS level II. The results of this study showed that the LE CP-CAT displayed superior sensitivity to change than the PODCI and TUG scales after musculoskeletal surgery in children with CP. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Ambulatory orthopaedic surgery patients' knowledge with internet-based education.

Science.gov (United States)

Heikkinen, Katja; Leino-Kilpi, H; Salanterä, S

2012-01-01

There is a growing need for patient education and an evaluation of its outcomes. The aim of this study was to compare ambulatory orthopaedic surgery patients' knowledge with Internet-based education and face-to-face education with a nurse. The following hypothesis was proposed: Internet-based patient education (experiment) is as effective as face-to-face education with a nurse (control) in increasing patients' level of knowledge and sufficiency of knowledge. In addition, the correlations of demographic variables were tested. The patients were randomized to either an experiment group (n = 72) or a control group (n = 75). Empirical data were collected with two instruments. Patients in both groups showed improvement in their knowledge during their care. Patients in the experiment group improved their knowledge level significantly more in total than those patients in the control group. There were no differences in patients' sufficiency of knowledge between the groups. Knowledge was correlated especially with patients' age, gender and earlier ambulatory surgeries. As a conclusion, positive results concerning patients' knowledge could be achieved with the Internet-based education. The Internet is a viable method in ambulatory care.

Orthopaedic Surgery Under National Health Reform: An Analysis of Power, Process, Adaptation, and Leadership: AOA Critical Issues.

Science.gov (United States)

Callahan, Charles D; Adair, Daniel; Bozic, Kevin J; Manning, Blaine T; Saleh, Jamal K; Saleh, Khaled J

2014-07-02

Morrison argued that demography, economy, and technology drive the evolution of industries from a formative first-generation state ("First Curve") to a radically different way of doing things ("Second Curve") that is marked by new skills, strategies, and partners. The current health-reform movement in the United States reflects these three key evolutionary trends: surging medical needs of an aging population, dramatic expansion of Medicare spending, and care delivery systems optimized through powerful information technology. Successful transition from a formative first-generation state (First Curve) to a radically different way of doing things (Second Curve) will require new skills, strategies, and partners. In a new world that is value-driven, community-centric (versus hospital-centric), and prevention-focused, orthopaedic surgeons and health-care administrators must form new alliances to reduce the cost of care and improve durable outcomes for musculoskeletal problems. The greatest barrier to success in the Second Curve stems not from lack of empirical support for integrated models of care, but rather from resistance by those who would execute them. Porter's five forces of competitive strategy and the behavioral analysis of change provide insights into the predictable forms of resistance that undermine clinical and economic success in the new environment of care. This paper analyzes the components that will differentiate orthopaedic care provision for the Second Curve. It also provides recommendations for future-focused orthopaedic surgery and health-care administrative leaders to consider as they design newly adaptive, mutually reinforcing, and economically viable musculoskeletal care processes that drive the level of orthopaedic care that our nation deserves-at a cost that it can afford. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

An Osteoconductive, Osteoinductive, and Osteogenic Tissue-Engineered Product for Trauma and Orthopaedic Surgery: How Far Are We?

Directory of Open Access Journals (Sweden)

Wasim S. Khan

2012-01-01

Full Text Available The management of large bone defects due to trauma, degenerative disease, congenital deformities, and tumor resection remains a complex issue for the orthopaedic reconstructive surgeons. The requirement is for an ideal bone replacement which is osteoconductive, osteoinductive, and osteogenic. Autologous bone grafts are still considered the gold standard for reconstruction of bone defects, but donor site morbidity and size limitations are major concern. The use of bioartificial bone tissues may help to overcome these problems. The reconstruction of large volume defects remains a challenge despite the success of reconstruction of small-to-moderate-sized bone defects using engineered bone tissues. The aim of this paper is to understand the principles of tissue engineering of bone and its clinical applications in reconstructive surgery.

An osteoconductive, osteoinductive, and osteogenic tissue-engineered product for trauma and orthopaedic surgery: how far are we?

Science.gov (United States)

Khan, Wasim S; Rayan, Faizal; Dhinsa, Baljinder S; Marsh, David

2012-01-01

The management of large bone defects due to trauma, degenerative disease, congenital deformities, and tumor resection remains a complex issue for the orthopaedic reconstructive surgeons. The requirement is for an ideal bone replacement which is osteoconductive, osteoinductive, and osteogenic. Autologous bone grafts are still considered the gold standard for reconstruction of bone defects, but donor site morbidity and size limitations are major concern. The use of bioartificial bone tissues may help to overcome these problems. The reconstruction of large volume defects remains a challenge despite the success of reconstruction of small-to-moderate-sized bone defects using engineered bone tissues. The aim of this paper is to understand the principles of tissue engineering of bone and its clinical applications in reconstructive surgery.

Multicenter collaborative for orthopaedic research in India: An opportunity for global leadership

Directory of Open Access Journals (Sweden)

Mathew George

2008-01-01

Full Text Available Road traffic accidents are increasing at an alarming rate and have become a major public health concern in India. In addition, there is a lack of trauma research output and reliable data from India. There are several issues and challenges that have presented an opportunity for researchers and surgeons in India to develop a collaborative aimed at improving the quality and productivity of orthopaedic trauma research. Establishing a network of surgical researchers across India is a necessary first step towards global leadership in orthopaedic surgery trials.

Pragmatic approach to the clinical work-up of patients with putative allergic disease to metallic orthopaedic implants before and after surgery.

Science.gov (United States)

Thyssen, J P; Menné, T; Schalock, P C; Taylor, J S; Maibach, H I

2011-03-01

Allergic complications following insertion of metallic orthopaedic implants include allergic dermatitis reactions but also extracutaneous complications. As metal-allergic patients and/or surgeons may ask dermatologists and allergologists for advice prior to planned orthopaedic implant surgery, and as surgeons may refer patients with complications following total joint arthroplasty for diagnostic work-up, there is a continuous need for updated guidelines. This review presents published evidence for patch testing prior to surgery and proposes tentative diagnostic criteria which clinicians can rely on in the work-up of patients with putative allergic complications following surgery. Few studies have investigated whether subjects with metal contact allergy have increased risk of developing complications following orthopaedic implant insertion. Metal allergy might in a minority increase the risk of complications caused by a delayed-type hypersensitivity reaction. At present, we do not know how to identify the subgroups of metal contact allergic patients with a potentially increased risk of complications following insertion of a metal implant. We recommend that clinicians should refrain from routine patch testing prior to surgery unless the patient has already had implant surgery with complications suspected to be allergic or has a history of clinical metal intolerance of sufficient magnitude to be of concern to the patient or a health provider. The clinical work-up of a patient suspected of having an allergic reaction to a metal implant should include patch testing and possibly in vitro testing. We propose diagnostic criteria for allergic dermatitis reactions as well as noneczematous complications caused by metal implants. © 2011 The Authors. BJD © 2011 British Association of Dermatologists.

Web-Based Education Prior to Outpatient Orthopaedic Surgery Enhances Early Patient Satisfaction Scores: A Prospective Randomized Controlled Study.

Science.gov (United States)

van Eck, Carola F; Toor, Aneet; Banffy, Michael B; Gambardella, Ralph A

2018-01-01

A good patient-surgeon relationship relies on adequate preoperative education and counseling. Several multimedia resources, such as web-based education tools, have become available to enhance aspects of perioperative care. The purpose of this study was to evaluate the effect of an interactive web-based education tool on perioperative patient satisfaction scores after outpatient orthopaedic surgery. It was hypothesized that web-based education prior to outpatient orthopaedic surgery enhances patient satisfaction scores. Randomized controlled trial; Level of evidence, 1. All patients undergoing knee arthroscopy with meniscectomy, chondroplasty, or anterior cruciate ligament reconstruction or shoulder arthroscopy with rotator cuff repair were eligible for inclusion and were randomized to the study or control group. The control group received routine education by the surgeon, whereas the study group received additional web-based education. At the first postoperative visit, all patients completed the OAS CAHPS (Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems) survey. Differences in patient satisfaction scores between the study and control groups were determined with an independent t test. A total of 177 patients were included (104 [59%] males; mean age, 42 ± 14 years); 87 (49%) patients were randomized to receive additional web-based education. Total patient satisfaction score was significantly higher in the study group (97 ± 5) as compared with the control group (94 ± 8; P = .019), specifically for the OAS CAHPS core measure "recovery" (92 ± 13 vs 82 ± 23; P = .001). Age, sex, race, workers' compensation status, education level, overall health, emotional health, procedure type and complexity, and addition of a video did not influence patient satisfaction scores. Supplemental web-based patient education prior to outpatient orthopaedic surgery enhances patient satisfaction scores.

Predicting the post-operative length of stay for the orthopaedic trauma patient.

Science.gov (United States)

Chona, Deepak; Lakomkin, Nikita; Bulka, Catherine; Mousavi, Idine; Kothari, Parth; Dodd, Ashley C; Shen, Michelle S; Obremskey, William T; Sethi, Manish K

2017-05-01

Length of stay (LOS) is a major driver of cost and quality of care. A bundled payment system makes it essential for orthopaedic surgeons to understand factors that increase a patient's LOS. Yet, minimal data regarding predictors of LOS currently exist. Using the ACS-NSQIP database, this is the first study to identify risk factors for increased LOS for orthopaedic trauma patients and create a personalized LOS calculator. All orthopaedic trauma surgery between 2006 and 2013 were identified from the ACS-NSQIP database using CPT codes. Patient demographics, pre-operative comorbidities, anatomic location of injury, and post-operative in-hospital complications were collected. To control for individual patient comorbidities, a negative binomial regression model evaluated hospital LOS after surgery. Betas (β), were determined for each pre-operative patient characteristic. We selected significant predictors of LOS (p < 0.05) using backwards stepwise elimination. 49,778 orthopaedic trauma patients were included in the analysis. Deep incisional surgical site infections and superficial surgical site infections were associated with the greatest percent change in predicted LOS (β = 1.2760 and 1.2473, respectively; p < 0.0001 for both). A post-operative LOS risk calculator was developed based on the formula: [Formula: see text]. Utilizing a large prospective cohort of orthopaedic trauma patients, we created the first personalized LOS calculator based on pre-operative comorbidities, post-operative complications and location of surgery. Future work may assess the use of this calculator and attempt to validate its utility as an accurate model. To improve the quality measures of hospitals, orthopaedists must employ such predictive tools to optimize care and better manage resources.

Quality of life during orthopaedic training and academic practice. Part 1: orthopaedic surgery residents and faculty.

Science.gov (United States)

Sargent, M Catherine; Sotile, Wayne; Sotile, Mary O; Rubash, Harry; Barrack, Robert L

2009-10-01

A pilot study of two academic training programs revealed concerning levels of resident burnout and psychological dysfunction. The purpose of the present study was to determine the quality of life of orthopaedic residents and faculty on a national scale and to identify risk factors for decompensation. Three hundred and eighty-four orthopaedic residents and 264 full-time orthopaedic faculty members completed a voluntary, anonymous survey consisting of three validated instruments (the Maslach Burnout Inventory, the General Health Questionnaire-12, and the Revised Dyadic Adjustment Scale) and question sets assessing demographic information, relationship issues, stress reactions/management, and work/life balance. High levels of burnout were seen in 56% of the residents and 28% of the faculty members. Burnout risk was greatest among second-postgraduate-year residents and residents in training programs with six or more residents per postgraduate year. Sixteen percent of residents and 19% of faculty members reported symptoms of psychological distress. Sleep deprivation was common among the residents and correlated positively with every distress measure. Faculty reported greater levels of stress but greater satisfaction with work and work/life balance. A number of factors, such as making time for hobbies and limiting alcohol use, correlated with decreased dysfunction for both residents and faculty. Despite reporting high levels of job satisfaction, orthopaedic residents and faculty are at risk for burnout and distress. Identification of protective factors and risk factors may provide guidance to improve the quality of life of academic orthopaedic surgeons in training and beyond.

An information revolution in orthopaedics.

Science.gov (United States)

Goldberg, A J; MacGregor, A; Spencer, S A

2012-04-01

With the established success of the National Joint Registry and the emergence of a range of new national initiatives for the capture of electronic data in the National Health Service, orthopaedic surgery in the United Kingdom has found itself thrust to the forefront of an information revolution. In this review we consider the benefits and threats that this revolution poses, and how orthopaedic surgeons should marshal their resources to ensure that this is a force for good.

Radiation safety knowledge and practices among Irish orthopaedic trainees.

LENUS (Irish Health Repository)

Nugent, M

2014-04-23

Fluoroscopy is frequently used in orthopaedic surgery, particularly in a trauma setting. Exposure of patients and staff to ionising radiation has been studied extensively; however, little work has been done to evaluate current knowledge and practices among orthopaedic trainees.

Image guidance in orthopaedics and traumatology: A historical perspective.

Science.gov (United States)

Székely, Gabor; Nolte, Lutz-P

2016-10-01

In this note we summarize the history of computer aided surgery in orthopaedics and traumatology from the end of the nineteenth century to currently observable future trends. We concentrate on the two major components of such systems, pre-operative planning and intra-operative execution. The evolution of the necessary technological components, the numerous platforms and components offered commercially as well as their clinical use are surveyed. Copyright © 2016. Published by Elsevier B.V.

Access to Orthopaedic Surgical Care in Northern Tanzania: A Modelling Study.

Science.gov (United States)

Premkumar, Ajay; Ying, Xiaohan; Mack Hardaker, W; Massawe, Honest H; Mshahaba, David J; Mandari, Faiton; Pallangyo, Anthony; Temu, Rogers; Masenga, Gileard; Spiegel, David A; Sheth, Neil P

2018-04-25

The global burden of musculoskeletal disease and resulting disability is enormous and is expected to increase over the next few decades. In the world's poorest regions, the paucity of information defining and quantifying the current state of access to orthopaedic surgical care is a major problem in developing effective solutions. This study estimates the number of individuals in Northern Tanzania without adequate access to orthopaedic surgical services. A chance tree was created to model the probability of access to orthopaedic surgical services in the Northern Tanzanian regions of Arusha, Kilimanjaro, Tanga, Singida, and Manyara, with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. Timeliness was estimated by the proportion of people living within a 4-h driving distance from a hospital with an orthopaedic surgeon, capacity by comparing number of surgeries performed to the number of surgeries indicated, safety by applying WHO Emergency and Essential Surgical Care infrastructure and equipment checklists, and affordability by approximating the proportion of the population protected from catastrophic out-of-pocket healthcare expenditure. We accounted for uncertainty in our model with one-way and probabilistic sensitivity analyses. Data sources included the Tanzanian National Bureau of Statistics and Ministry of Finance, World Bank, World Health Organization, New Zealand Ministry of Health, Google Corporation, NASA population estimator, and 2015 hospital records from Kilimanjaro Christian Medical Center, Machame Hospital, Nkoroanga Hospital, Mt. Meru Hospital, and Arusha Lutheran Medical Center. Under the most conservative assumptions, more than 90% of the Northern Tanzanian population does not have access to orthopaedic surgical services. There is a near absence of access to orthopaedic surgical care in Northern Tanzania. These findings utilize more precise country and region-specific data and are consistent with prior published

Multi-modal imaging, model-based tracking, and mixed reality visualisation for orthopaedic surgery

Science.gov (United States)

Fuerst, Bernhard; Tateno, Keisuke; Johnson, Alex; Fotouhi, Javad; Osgood, Greg; Tombari, Federico; Navab, Nassir

2017-01-01

Orthopaedic surgeons are still following the decades old workflow of using dozens of two-dimensional fluoroscopic images to drill through complex 3D structures, e.g. pelvis. This Letter presents a mixed reality support system, which incorporates multi-modal data fusion and model-based surgical tool tracking for creating a mixed reality environment supporting screw placement in orthopaedic surgery. A red–green–blue–depth camera is rigidly attached to a mobile C-arm and is calibrated to the cone-beam computed tomography (CBCT) imaging space via iterative closest point algorithm. This allows real-time automatic fusion of reconstructed surface and/or 3D point clouds and synthetic fluoroscopic images obtained through CBCT imaging. An adapted 3D model-based tracking algorithm with automatic tool segmentation allows for tracking of the surgical tools occluded by hand. This proposed interactive 3D mixed reality environment provides an intuitive understanding of the surgical site and supports surgeons in quickly localising the entry point and orienting the surgical tool during screw placement. The authors validate the augmentation by measuring target registration error and also evaluate the tracking accuracy in the presence of partial occlusion. PMID:29184659

Aspirin for Prophylaxis Against Venous Thromboembolism After Orthopaedic Oncologic Surgery.

Science.gov (United States)

Mendez, Gregory M; Patel, Yash M; Ricketti, Daniel A; Gaughan, John P; Lackman, Richard D; Kim, Tae Won B

2017-12-06

Patients who undergo orthopaedic oncologic surgical procedures are at increased risk of developing a venous thromboembolism (VTE). Guidelines from surgical societies are shifting to include aspirin as a postoperative VTE prophylactic agent. The purpose of this study was to review our experience using aspirin as postoperative VTE prophylaxis for orthopaedic oncologic surgical procedures. This study was a retrospective review of patients diagnosed with a primary malignant soft-tissue or bone tumor or metastatic carcinoma. Demographic information, histopathologic diagnosis, VTE history, surgical procedure, and VTE prophylaxis were analyzed. VTE rates in the overall and prophylactic-specific cohorts were recorded and compared. A total of 142 distinct surgical procedures in 130 patients were included. VTE prophylaxis with aspirin was used after 103 procedures, and non-aspirin prophylaxis was used after 39. In 33 cases, imaging was used to investigate for VTE because of clinical signs and symptoms. VTE developed after 7 (4.9%) of the 142 procedures. There were 6 deep venous thromboses (DVTs) and 1 pulmonary embolism, and 2 of the VTEs presented in patients with a VTE history. VTE developed in 2.9% (3) of the 103 aspirin cases and 10.3% (4) of the 39 non-aspirin cases. No patient in the aspirin group who had been diagnosed with metastatic carcinoma, malignant soft-tissue sarcoma, lymphoma, or multiple myeloma developed a VTE. Risk factors for VTE development included diabetes mellitus (odds ratio [OR] = 10.40, 95% confidence interval [CI] = 1.61 to 67.30), a history of VTE (OR = 7.26, 95% CI = 1.19 to 44.25), postoperative transfusion (OR = 34.50, 95% CI = 3.94 to 302.01), and estimated blood losses of 250 mL (OR = 1.50, 95% CI = 1.11 to 2.03), 500 mL (OR = 2.26, 95% CI = 1.23 to 4.13), and 1,000 mL (OR = 5.10, 95% CI = 1.52 to 17.04). Aspirin may be a suitable and effective option for VTE chemoprophylaxis in patients treated with orthopaedic oncologic surgery, especially

Hand dominance in orthopaedic surgeons.

LENUS (Irish Health Repository)

Lui, Darren F

2012-08-01

Handedness is perhaps the most studied human asymmetry. Laterality is the preference shown for one side and it has been studied in many aspects of medicine. Studies have shown that some orthopaedic procedures had poorer outcomes and identified laterality as a contributing factor. We developed a questionnaire to assess laterality in orthopaedic surgery and compared this to an established scoring system. Sixty-two orthopaedic surgeons surveyed with the validated Waterloo Handedness Questionnaire (WHQ) were compared with the self developed Orthopaedic Handedness Questionnaire (OHQ). Fifty-eight were found to be right hand dominant (RHD) and 4 left hand dominant (LHD). In RHD surgeons, the average WHQ score was 44.9% and OHQ 15%. For LHD surgeons the WHQ score was 30.2% and OHQ 9.4%. This represents a significant amount of time using the non dominant hand but does not necessarily determine satisfactory or successful dexterity transferable to the operating room. Training may be required for the non dominant side.

Comparison of ropivacaine and bupivacaine as single-shot epidural anaesthesia for orthopaedic surgery

International Nuclear Information System (INIS)

Riaz, A.; Khan, A.S.

2015-01-01

To compare the efficacy and side-effects of 0.5% ropivacaine with that of 0.5% bupivacaine when used for single-shot epidural anaesthesia for orthopaedic surgery. Design: Randomized controlled trial. Place and Duration of Study: Department of Anesthesiology, Combined Military Hospital Rawalpindi, over a period of eight months from June 2013 to January 2014. Patients and Methods: The study was carried out in 60 ASA physical status I, II or III patients undergoing elective lower extremity orthopedic surgery. Two groups of 30 patients each received single-shot epidural anaesthesia either with ropivacaine 0.5% (ropivacaine group) or bupivacaine 0.5% (bupivacaine group). Onset, time for maximum height and median height of sensory block was assessed as well as time to two segment recession. Modified Bromage scale was used for motor blockade. Total duration of motor block and common side effects were also recorded. Results: The patients in both groups were similar in age, height, weight, gender and ASA status. There was no significant difference in onset of sensory block and time for maximum height of sensory block. The median heighest level of sensory block was T6 (T5-T8) for ropivacaine group and T5 (T4-T7) for bupivacaine group. Time for two segment regression and duration of sensory block were also comparable for both groups. The total duration of motor block was significantly more in bupivacaine group (159 min vs 134.2 min, p< 0.001). Modified Bromage scale was also significantly higher in bupivacaine group (2.86 vs 1.96 min, p<0.001). Side effects like hypotension, bradycardia, nausea, vomiting and shivering were similar in both groups. Conclusion: Epidural administration of 0.5% ropivacaine provided effective and good quality anaesthesia. Motor blockade was of less duration as compared to equivalent dose of 0.5% bupivacaine, which may offer potential benefit of early patient mobilization after orthopaedic surgery. (author)

Identifying and exploring physical and psychological morbidity and patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery: a systematic review.

Science.gov (United States)

Ousey, Karen; Edward, Karen-Leigh; Lui, Steve

2015-02-01

The aim of this article was to identify the literature that examined and explored physical and psychological morbidity and patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery. A systematic review of the literature using the databases MEDLINE, CINAHL and EMBASE was undertaken. The papers were examined using title and abstract for relevance to the primary and secondary outcomes. The primary outcome of interest was family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery. The search yielded 275 records after removing any duplicates; eight studies were considered eligible and were reviewed as full text. Following full review, none of the studies was included in this article. To conclude, there were no papers that investigated or examined the concept of resilience in relation to the management of acute post-surgical orthopaedic wounds. Four of the papers identified, following the review process, did discuss quality of life outcomes and how these may be improved following wound development; most papers focused on the management of chronic wounds. It is apparent from the review that there is no evidence currently available that explores patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

What Are the Strength of Recommendations and Methodologic Reporting in Health Economic Studies in Orthopaedic Surgery?

Science.gov (United States)

Makhni, Eric C; Steinhaus, Michael E; Swart, Eric; Bozic, Kevin J

2015-10-01

Cost-effectiveness research is an increasingly used tool in evaluating treatments in orthopaedic surgery. Without high-quality primary-source data, the results of a cost-effectiveness study are either unreliable or heavily dependent on sensitivity analyses of the findings from the source studies. However, to our knowledge, the strength of recommendations provided by these studies in orthopaedics has not been studied. We asked: (1) What are the strengths of recommendations in recent orthopaedic cost-effectiveness studies? (2) What are the reasons authors cite for weak recommendations? (3) What are the methodologic reporting practices used by these studies? The titles of all articles published in six different orthopaedic journals from January 1, 2004, through April 1, 2014, were scanned for original health economics studies comparing two different types of treatment or intervention. The full texts of included studies were reviewed to determine the strength of recommendations determined subjectively by our study team, with studies providing equivocal conclusions stemming from a lack or uncertainty surrounding key primary data classified as weak and those with definitive conclusions not lacking in high-quality primary data classified as strong. The reasons underlying a weak designation were noted, and methodologic practices reported in each of the studies were examined using a validated instrument. A total of 79 articles met our prespecified inclusion criteria and were evaluated in depth. Of the articles included, 50 (63%) provided strong recommendations, whereas 29 (37%) provided weak recommendations. Of the 29 studies, clinical outcomes data were cited in 26 references as being insufficient to provide definitive conclusions, whereas cost and utility data were cited in 13 and seven articles, respectively. Methodologic reporting practices varied greatly, with mixed adherence to framing, costs, and results reporting. The framing variables included clearly defined

The Use of Twitter by the Trauma and Orthopaedic Surgery Journals: Twitter Activity, Impact Factor, and Alternative Metrics.

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Hughes, Hannah; Hughes, Andrew; Murphy, Colin

2017-12-10

Aim Social media (SoMe) platforms have become leading methods of communication and dissemination of scientific information in the medical community. They allow for immediate discussion and widespread engagement around important topics. It has been hypothesized that the activity on Twitter positively correlates with highly cited articles. The purpose of this study was to analyze the prevalence and activity of Trauma and Orthopaedic Surgery journals on Twitter, with the hypothesis that the impact factor is positively associated with the Twitter usage. Methods The top 50 Trauma and Orthopaedic Surgery journals, ranked by 2016 Impact Factor were analyzed. The Twitter profiles of each journal or affiliated society were identified. Other SoMe platforms used were also recorded. The Twitonomy software (Digonomy Pty Ltd, New South Wales, Australia) was used to analyze the Twitter profiles over a one-year period. The Twitter Klout scores were recorded for each journal to approximate the SoMe influence. The Altmetric scores (the total number of mentions via alternative metrics) were also recorded. The statistical analysis was carried out to identify correlations between journal Impact Factors, SoMe activity, Twitter Klout scores and Altmetric scores.  Results Twenty-two journals (44%) were dedicated to the Twitter profiles. Fourteen journals (28%) were associated with societies that had profiles and 14 journals (28%) had no Twitter presence. The mean Impact Factor overall was 2.16 +/- 0.14 (range, 1.07-5.16). The journals with dedicated Twitter profiles had higher Impact Factors than those without (mean 2.41 vs. 1.61; P=0.005). A greater number of Twitter followers were associated with higher Impact Factors (R2 0.317, P=0.03). The journals with higher Twitter Klout scores had higher Impact Factors (R2 0.357, P=0.016). The Altmetric score was positively associated with an Impact Factor (R2 0.310, P=0.015). The journals with higher numbers of retweets (virtual citations in

PCR IN TRAUMATOLOGY AND ORTHOPAEDICS: METHOD DESCRIPTION AND APPLICABILITY

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E. M. Polyakova

2014-01-01

Full Text Available Review brief presents description of polymerase chain reaction method (PCR and its most common variants. Three PCR-based lines of research, carried out in the traumatology and orthopaedics, include identifying a causative agents of the implant-associated infection after orthopaedic surgery; detection of antibiotic resistance genes and biofilm forming genes. It was shown that PCR can be used as additional method for detection of genetic disorders, significant for traumatology and orthopaedics, and for investigation of cartilage and bone regeneration.

State Variation in Medicaid Reimbursements for Orthopaedic Surgery.

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Lalezari, Ramin M; Pozen, Alexis; Dy, Christopher J

2018-02-07

Medicaid reimbursements are determined by each state and are subject to variability. We sought to quantify this variation for commonly performed inpatient orthopaedic procedures. The 10 most commonly performed inpatient orthopaedic procedures, as ranked by the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, were identified for study. Medicaid reimbursement amounts for those procedures were benchmarked to state Medicare reimbursement amounts in 3 ways: (1) ratio, (2) dollar difference, and (3) dollar difference divided by the relative value unit (RVU) amount. Variability was quantified by determining the range and coefficient of variation for those reimbursement amounts. The range of variability of Medicaid reimbursements among states exceeded $1,500 for all 10 procedures. The coefficients of variation ranged from 0.32 (hip hemiarthroplasty) to 0.57 (posterior or posterolateral lumbar interbody arthrodesis) (a higher coefficient indicates greater variability), compared with 0.07 for Medicare reimbursements for all 10 procedures. Adjusted as a dollar difference between Medicaid and Medicare per RVU, the median values ranged from -$8/RVU (total knee arthroplasty) to -$17/RVU (open reduction and internal fixation of the femur). Variability of Medicaid reimbursement for inpatient orthopaedic procedures among states is substantial. This variation becomes especially remarkable given recent policy shifts toward focusing reimbursements on value.

Orthopaedic Patient Information on the World Wide Web: An Essential Review.

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Cassidy, John Tristan; Baker, Joseph F

2016-02-17

Patients increasingly use the Internet to research health-related issues. Internet content, unlike other forms of media, is not regulated. Although information accessed online can impact patients' opinions and expectations, there is limited information about the quality or readability of online orthopaedic information. PubMed, MEDLINE, and Google Scholar were searched using anatomic descriptors and three title keywords ("Internet," "web," and "online"). Articles examining online orthopaedic information from January 1, 2000, until April 1, 2015, were recorded. Articles were assessed for the number of reviewers evaluating the online material, whether the article examined for a link between authorship and quality, and the use of recognized quality and readability assessment tools. To facilitate a contemporary discussion, only publications since January 1, 2010, were considered for analysis. A total of thirty-eight peer-reviewed articles published since 2010 examining the quality and/or readability of online orthopaedic information were reviewed. For information quality, there was marked variation in the quality assessment methods utilized, the number of reviewers, and the manner of reporting. To date, the majority of examined information is of poor quality. Studies examining readability have focused on pages produced by professional orthopaedic societies. The quality and readability of online orthopaedic information are generally poor. For modern practices to adapt to the Internet and to prevent misinformation, the orthopaedic community should develop high-quality, readable online patient information. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Analysis of scientific articles published in two general orthopaedic journals.

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Holzer, Lukas A; Holzer, Gerold

2013-01-01

To give an overview of the behaviour and scientific contributions of the Journal of Bone and Joint Surgery American (JBJS-A) and British Volume (JBJS-B). 480 original articles published in 2009 were identified through a combined comprehensive computer and manual library search. Articles were assigned to 11 orthopaedic categories and by country, type and specialty of the institution. Possible grants and citations were analysed. USA led all countries in published articles (36,87%), followed by UK (20,62%) and South Korea (5,83%). Most studies published were performed at academic institutions (65,83 %), only 4,16% at private practices. Almost half of the articles (46,24%) were published in three categories: hip (19.16%), knee (13.75%) and trauma (13.33%). In both journals 47.15% articles had at least one funding source. A review of articles published in major journals allows to show how research in orthopaedics is distributed worldwide. This study shows that a variety of different journals is neccessary to reflect the broad spectrum of orthopaedics in depth. Level of Evidence III, Retrospective Comparative Study.

Computational radiology for orthopaedic interventions

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Li, Shuo

2016-01-01

This book provides a cohesive overview of the current technological advances in computational radiology, and their applications in orthopaedic interventions. Contributed by the leading researchers in the field, this volume covers not only basic computational radiology techniques such as statistical shape modeling, CT/MRI segmentation, augmented reality and micro-CT image processing, but also the applications of these techniques to various orthopaedic interventional tasks. Details about following important state-of-the-art development are featured: 3D preoperative planning and patient-specific instrumentation for surgical treatment of long-bone deformities, computer assisted diagnosis and planning of periacetabular osteotomy and femoroacetabular impingement, 2D-3D reconstruction-based planning of total hip arthroplasty, image fusion for  computer-assisted bone tumor surgery, intra-operative three-dimensional imaging in fracture treatment, augmented reality based orthopaedic interventions and education, medica...

Twenty years of meta-analyses in orthopaedic surgery: has quality kept up with quantity?

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Dijkman, Bernadette G; Abouali, Jihad A K; Kooistra, Bauke W; Conter, Henry J; Poolman, Rudolf W; Kulkarni, Abhaya V; Tornetta, Paul; Bhandari, Mohit

2010-01-01

As the number of studies in the literature is increasing, orthopaedic surgeons highly depend on meta-analyses as their primary source of scientific evidence. The objectives of this review were to assess the scientific quality and number of published meta-analyses on orthopaedics-related topics over time. We conducted, in duplicate and independently, a systematic review of published meta-analyses in orthopaedics in the years 2005 and 2008 and compared them with a previous systematic review of meta-analyses from 1969 to 1999. A search of electronic databases (MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews) was performed to identify meta-analyses published in 2005 and 2008. We searched bibliographies and contacted content experts to identify additional relevant studies. Two investigators independently assessed the quality of the studies, using the Oxman and Guyatt index, and abstracted relevant data. We included forty-five and forty-four meta-analyses from 2005 and 2008, respectively. While the number of meta-analyses increased fivefold from 1999 to 2008, the mean quality score did not change significantly over time (p = 0.067). In the later years, a significantly lower proportion of meta-analyses had methodological flaws (56% in 2005 and 68% in 2008) compared with meta-analyses published prior to 2000 (88%) (p = 0.006). In 2005 and 2008, respectively, 18% and 30% of the meta-analyses had major to extensive flaws in their methodology. Studies from 2008 with positive conclusions used and described appropriate criteria for the validity assessment less often than did those with negative results. The use of random-effects and fixed-effects models as pooling methods became more popular toward 2008. Although the methodological quality of orthopaedic meta-analyses has increased in the past twenty years, a substantial proportion continues to show major to extensive flaws. As the number of published meta-analyses is increasing, a routine checklist for

The 2007 ABJS Marshall Urist Award: The impact of direct-to-consumer advertising in orthopaedics.

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Bozic, Kevin J; Smith, Amanda R; Hariri, Sanaz; Adeoye, Sanjo; Gourville, John; Maloney, William J; Parsley, Brian; Rubash, Harry E

2007-05-01

Direct-to-consumer advertising (DTCA) has become an influential factor in healthcare delivery in the United States. We evaluated the influence of DTCA on surgeon and patient opinions and behavior in orthopaedics by surveying orthopaedic surgeons who perform hip and knee arthroplasties and patients who were scheduled to have hip or knee arthro-plasty. Respondents were asked for their opinions of and experiences with DTCA, including the influence of DTCA on surgeon and patient decision making. Greater than 98% of surgeon respondents had experience with patients who were exposed to DTCA. The majority of surgeon respondents reported DTCA had an overall negative impact on their practice and their interaction with patients (74%), and their patients often were confused or misinformed about the appropriate treatment for their condition based on an advertisement (77%). Fifty-two percent of patient respondents recalled seeing or hearing advertisements related to hip or knee arthroplasty. These patients were more likely to request a specific type of surgery or brand of implant from their surgeon and to see more than one surgeon before deciding to have surgery. Direct-to-consumer advertising seems to play a substantial role in surgeon and patient decision making in orthopaedics. Future efforts should be aimed at improving the quality and accuracy of information contained in consumer-directed advertisements related to orthopaedic implants and procedures.

Orthopaedic Disorders in Myotonic Dystrophy Type 1: descriptive clinical study of 21 patients

Science.gov (United States)

2013-01-01

Background Myotonic Dystrophy Type 1 (DM1) is the most common form of hereditary myopathy presenting in adults. This autosomal-dominant systemic disorder is caused by a CTG repeat, demonstrating various symptoms. A mild, classic and congenital form can be distinguished. Often the quality of life is reduced by orthopaedic problems, such as muscle weakness, contractures, foot or spinal deformities, which limit patients’ mobility. The aim of our study was to gather information about the orthopaedic impairments in patients with DM1 in order to improve the medical care of patients, affected by this rare disease. Methods A retrospective clinical study was carried out including 21 patients (11 male and 10 female), all diagnosed with DM1 by genetic testing. All patients were seen during our special consultations for neuromuscular diseases, during which patients were interviewed and examined. We also reviewed surgery reports of our hospitalized patients. Results We observed several orthopaedic impairments: spinal deformities (scoliosis, hyperkyphosis, rigid spine), contractures (of the upper extremities and the lower extremities), foot deformities (equinus deformity, club foot, pes cavus, pes planovalgus, pes cavovarus, claw toes) and fractures. Five patients were affected by pulmonary diseases (obstructive airway diseases, restrictive lung dysfunctions). Twelve patients were affected by cardiac disorders (congenital heart defects, valvular heart defects, conduction disturbances, pulmonary hypertension, cardiomyopathy). Our patients received conservative therapy (physiotherapy, logopaedic therapy, ergotherapy) and we prescribed orthopaedic technical devices (orthopaedic custom-made shoes, insoles, lower and upper leg orthoses, wheelchair, Rehab Buggy). We performed surgery for spinal and foot deformities: the scoliosis of one patient was stabilized and seven patients underwent surgery for correction of foot deformities. Conclusions An orthopaedic involvement in DM1

Can the surgical checklist reduce the risk of wrong site surgery in orthopaedics? - can the checklist help? Supporting evidence from analysis of a national patient incident reporting system

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Cleary Kevin

2011-04-01

incidents. Discussion Orthopaedic surgery is a high volume specialty with major technical complexity in terms of equipment demands and staff training and familiarity. There is therefore an increased propensity for errors to occur. Wrong-site surgery still occurs in this specialty and is a potentially devastating situation for both the patient and surgeon. Despite the limitations of inclusion and reporting bias, our study highlights the need to match technical precision with patient safety. Tools such as the WHO surgical checklist can help us to achieve this.

High incidence of hemiarthroplasty for shoulder osteoarthritis among recently graduated orthopaedic surgeons.

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Mann, Tobias; Baumhauer, Judith F; O'Keefe, Regis J; Harrast, John; Hurwitz, Shepard R; Voloshin, Ilya

2014-11-01

Primary glenohumeral osteoarthritis is a common indication for shoulder arthroplasty. Historically, both total shoulder arthroplasty (TSA) and hemi-shoulder arthroplasty (HSA) have been used to treat primary glenohumeral osteoarthritis. The choice between procedures is a topic of debate, with HSA proponents arguing that it is less invasive, faster, less expensive, and technically less demanding, with quality of life outcomes equivalent to those of TSA. More recent evidence suggests TSA is superior in terms of pain relief, function, ROM, strength, and patient satisfaction. We therefore investigated the practice of recently graduated orthopaedic surgeons pertaining to the surgical treatment of this disease. We hypothesized that (1) recently graduated, board eligible, orthopaedic surgeons with fellowship training in shoulder surgery are more likely to perform TSA than surgeons without this training; (2) younger patients are more likely to receive HSA than TSA; (3) patient sex affects the choice of surgery; (4) US geographic region affects practice patterns; and (5) complication rates for HSA and TSA are not different. We queried the American Board of Orthopaedic Surgery's database to identify practice patterns of orthopaedic surgeons taking their board examination. We identified 771 patients with primary glenohumeral osteoarthritis treated with TSA or HSA from 2006 to 2011. The rates of TSA and HSA were compared based on the treating surgeon's fellowship training, patient age and sex, US geographic region, and reported surgical complications. Surgeons with fellowship training in shoulder surgery were more likely (86% versus 72%; OR 2.32; 95% CI, 1.56-3.45, pguidelines for the treatment of glenohumeral osteoarthritis published by the American Academy of Orthopaedic Surgeons. These guidelines favor using TSA over HSA in the treatment of shoulder arthritis. Further investigation is needed to clarify if these practice patterns are isolated to recently graduated board

EXPERIMENTAL AND CLINICAL STUDY OF PHENOTYPIC FEATURES OF S. EPIDERMIDIS STRAINS AND THEIR ROLE IN THE EMERGENCE AND DEVELOPMENT OF IMPLANT-ASSOCIATED INFECTION AFTER ORTHOPAEDIC SURGERY

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S. A. Bozhkova

2014-01-01

Full Text Available S. epidermidis is one of the most common cause of implant-associated infections. Infections due to S. epidermidis rarely develops into life-threatening, however, its prevalence and the difficulties in treating constitute a serious financial burden to the health care system. This study is based on the investigation of phenotypic features (ability to biofilm formation and resistance to antibiotics of S. epidermidis strains isolated from patients with deep surgical site infection after implantation of orthopaedic devices, and on the investigation of the dynamics of clinical and morphological changes during the development of implant-associated infection due to S. epidermidis based on in vivo experimental models. Multidrug-resistance was found in 23% MSSE isolates and 97,3% - MRSE. Vancomycin, linezolid and fosfomycin were the most active in relation to these pathogens. About 40% of the tested isolates were strong biofilm-producing strains. 43,2% of MRSE strains and only 21,4% of MSSE isolates demonstrated strong biofilm production. The proposed experimental model shows that intra-operative infection of implant by multidrug-resistant clinical MRSE strain led to the development of osteomyelitis in rats for 4 weeks after surgery, in spite of the revision operation and installation of antimicrobial cement spacer in the area of bone defect. Thus, S. epidermidis is a clinically significant aetiological factor with high risk of development of infections after major orthopaedic surgery.

Leadership and business education in orthopaedic residency training programs.

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Kiesau, Carter D; Heim, Kathryn A; Parekh, Selene G

2011-01-01

Leadership and business challenges have become increasingly present in the practice of medicine. Orthopaedic residency programs are at the forefront of educating and preparing orthopaedic surgeons. This study attempts to quantify the number of orthopaedic residency programs in the United States that include leadership or business topics in resident education program and to determine which topics are being taught and rate the importance of various leadership characteristics and business topics. A survey was sent to all orthopaedic department chairpersons and residency program directors in the United States via e-mail. The survey responses were collected using a survey collection website. The respondents rated the importance of leadership training for residents as somewhat important. The quality of character, integrity, and honesty received the highest average rating among 19 different qualities of good leaders in orthopaedics. The inclusion of business training in resident education was also rated as somewhat important. The topic of billing and coding received the highest average rating among 14 different orthopaedically relevant business topics. A variety of topics beyond the scope of clinical practice must be included in orthopaedic residency educational curricula. The decreased participation of newly trained orthopaedic surgeons in leadership positions and national and state orthopaedic organizations is concerning for the future of orthopaedic surgery. Increased inclusion of leadership and business training in resident education is important to better prepare trainees for the future.

Infections in orthopaedic surgery : clinical and experimental studies

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Vogely, Henri Charles

2000-01-01

The diagnostic difficulties, variability in outcome and the heterogeinity of the problem of orthopaedic infections stimulated the author to a study of the literature, and several clinical and experimental studies. The diagnosis prosthesis-related infection can only be reached with an acceptable

Etiology of Readmissions Following Orthopaedic Procedures and Medical Admissions. A Comparative Analysis.

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Maslow, Jed; Hutzler, Lorraine; Slover, James; Bosco, Joseph

2015-12-01

The Federal Government, the largest payer of health care, considers readmission within 30 days of discharge an indicator of quality of care. Many studies have focused on causes for and strategies to reduce readmissions following medical admissions. However, few studies have focused on the differences between them. We believe that the causes for readmission following orthopaedic surgery are markedly different than those following medical admissions, and therefore, the strategies developed to reduce medical readmissions will not be as effective in reducing readmissions after elective orthopaedic surgery. All unplanned 30-day readmissions following an index hospitalization for an elective orthopaedic procedure (primary and revision total joint arthroplasty and spine procedure) or for one of the three publicly reported medical conditions (AMI, HF, and pneumonia, which accounted for 11% of readmissions) were identified at our institution from 2010 through 2012. A total of 268 patients and 390 medical patients were identified as having an unplanned 30-day readmission. We reviewed a prospectively collected data base to determine the reason for readmission in each encounter. A total of 233 (86.9%) orthopaedic patients were readmitted for surgical complications, most commonly for a wound infection (56.0%) or wound complication (11.6%). Following an index admission of HF or AMI, the primary reason for readmission was a disease of the circulatory system (55.9% and 57.4%, respectively). Following an index admission for pneumonia, the primary reason for readmission was a disease of the respiratory system (34.5%). The causes of readmissions following orthopaedic surgery and medical admissions are different. Patients undergoing orthopaedic procedures are readmitted for surgical complications, frequently unrelated to aftercare, and medicine patients are readmitted for reasons related to the index diagnosis. Interventions designed to reduce orthopaedic readmissions must focus on

Imaging in scoliosis from the orthopaedic surgeon's point of view

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Thomsen, Marc [Stiftung Orthopaedische Universitaetsklinik Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg (Germany); Abel, Rainer [Stiftung Orthopaedische Universitaetsklinik Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg (Germany)]. E-mail: rainer.abel@ok.uni-heidelberg.de

2006-04-15

For treating patients with scoliosis orthopaedic surgeons need diagnostic imaging procedures in order to provide answers about a possible underlying disease, choice of treatment, and prognosis. Once treatment is instituted, imaging is also critical for monitoring changes of the deformity so as to optimize therapy. The combined effort of orthopaedic surgeons and radiologists helps detect treatable causes of scoliosis at an early stage, define the need and timing for surgery, and ensure that every precaution is taken to minimize the risks of surgery. Neurosurgical causes, with particular reference to spinal cord tumours and syringomyelia, need to be addressed before scoliosis surgery can be contemplated.

Orthopaedic Timing in Polytrauma in a Second Level Emergency Hospital. An Overrated Problem?

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V, Dei Giudici; N, Giampaolini; A, Panfighi; M, Marinelli; R, Procaccini; A, Gigante

2015-01-01

The main concern for orthopaedic treatment in polytrauma has always been the same for almost forty years, which also regards “where” and “when” to proceed; correct surgical timing and correct interpretation of the DCO concept are still being debated. In the last few years, several attempts have been made to classify patients based on their clinical presentation and by trying to figure out which vital parameters are able to predict the patient’s outcome. This study evaluated all patients who presented with code red at the Emergency Department of our Hospital, a level II trauma center. For every patient, the following characteristics were noted: sex, age, day of hospitalization, orthopaedic trauma, time to surgery, presence of an associated surgical condition in the fields of general surgery, thoracic surgery, neurosurgery and vascular surgery, cardiac frequency, blood pressure, oxygen saturation, Glasgow Coma Scale and laboratory data. All patients included were divided into subgroups based on orthopaedic surgical timing. Two other subgroups were also identified and analyzed in detail: deceased and weekend traumas. A total of 208 patients were included. Our primary goal was to identify a correlation between the mortality and surgical timing of the orthopaedic procedures; our secondary goal was to recognize, if present, a statistically relevant association between historical, clinical and laboratory data, and mortality rate, defining any possible risk factor. A correlation between mortality and orthopaedic surgical timing was not found. Analyzing laboratory data revealed an interesting correlation between mortality and: blood pressure, platelet count, cardiac frequency, hematocrit, hemoglobin and age. PMID:26312113

Barriers and strategies for the clinical translation of advanced orthopaedic tissue engineering protocols.

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Madry, H; Alini, M; Stoddart, M J; Evans, C; Miclau, T; Steiner, S

2014-05-06

Research in orthopaedic tissue engineering has intensified over the last decade and new protocols continue to emerge. The clinical translation of these new applications, however, remains associated with a number of obstacles. This report highlights the major issues that impede the clinical translation of advanced tissue engineering concepts, discusses strategies to overcome these barriers, and examines the need to increase incentives for translational strategies. The statements are based on presentations and discussions held at the AO Foundation-sponsored symposium "Where Science meets Clinics 2013" held at the Congress Center in Davos, Switzerland, in September, 2013. The event organisers convened a diverse group of over one hundred stakeholders involved in clinical translation of orthopaedic tissue engineering, including scientists, clinicians, healthcare industry professionals and regulatory agency representatives. A major point that emerged from the discussions was that there continues to be a critical need for early trans-disciplinary communication and collaboration in the development and execution of research approaches. Equally importantly was the need to address the shortage of sustained funding programs for multidisciplinary teams conducting translational research. Such detailed discussions between experts contribute towards the development of a roadmap to more successfully advance the clinical translation of novel tissue engineering concepts and ultimately improve patient care in orthopaedic and trauma surgery.

Barriers and strategies for the clinical translation of advanced orthopaedic tissue engineering protocols

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H Madry

2014-05-01

Full Text Available Research in orthopaedic tissue engineering has intensified over the last decade and new protocols continue to emerge. The clinical translation of these new applications, however, remains associated with a number of obstacles. This report highlights the major issues that impede the clinical translation of advanced tissue engineering concepts, discusses strategies to overcome these barriers, and examines the need to increase incentives for translational strategies. The statements are based on presentations and discussions held at the AO Foundation-sponsored symposium "Where Science meets Clinics 2013" held at the Congress Center in Davos, Switzerland, in September, 2013. The event organisers convened a diverse group of over one hundred stakeholders involved in clinical translation of orthopaedic tissue engineering, including scientists, clinicians, healthcare industry professionals and regulatory agency representatives. A major point that emerged from the discussions was that there continues to be a critical need for early trans-disciplinary communication and collaboration in the development and execution of research approaches. Equally importantly was the need to address the shortage of sustained funding programs for multidisciplinary teams conducting translational research. Such detailed discussions between experts contribute towards the development of a roadmap to more successfully advance the clinical translation of novel tissue engineering concepts and ultimately improve patient care in orthopaedic and trauma surgery.

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

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Minhas, Shobhit V; Goyal, Preeya; Patel, Alpesh A

2016-03-01

Perioperative cerebrovascular accidents (CVAs) are one of the leading causes of patient morbidity, mortality, and medical costs. However, little is known regarding the rates of these events and risk factors for CVA after elective orthopaedic surgery. Our goals were to (1) establish the national, baseline proportion of patients experiencing a 30-day CVA and the timing of CVA; and (2) determine independent risk factors for 30-day CVA rates after common elective orthopaedic procedures. Patients undergoing elective TKA, THA, posterior or posterolateral lumbar fusion, anterior cervical discectomy and fusion, and total shoulder arthroplasty, from 2006 to 2012, were identified from the American College of Surgeons National Surgical Quality Improvement Program(®) database. A total of 42,150 patients met inclusion criteria. Thirty-day CVA rates were recorded for each procedure, and patients were assessed for characteristics associated with CVA through univariate analysis. Multivariate regression models were created to identify independent risk factors for CVA. A total of 55 (0.13%) patients experienced a CVA within 30 days of the procedure, occurring a median of 2 days after surgery (range, 1-30 days) with 0.08% of patients experiencing a CVA after TKA, 0.15% after THA, 0.00% after single-level anterior cervical discectomy and fusion, 0.38% after multilevel anterior cervical discectomy and fusions, 0.20% after single-level posterior or posterolateral lumbar fusion, 0.70% after multilevel posterior or posterolateral lumbar fusion, and 0.22% after total shoulder arthroplasty. Independent risk factors for CVA included age of 75 years or older (odds ratio [OR], 2.50; 95% CI, 1.44-4.35; p = 0.001), insulin-dependent diabetes mellitus (OR, 3.08; CI, 1.47-6.45; p = 0.003), hypertension (OR, 2.71; CI, 1.19-6.13; p = 0.017), history of transient ischemic attack (OR, 2.83; CI, 1.24-6.45; p = 0.013), dyspnea (OR, 2.51; CI, 1.30-4.86; p = 0.006), chronic obstructive pulmonary disease

Enhanced Recovery After Surgery Protocols in Major Urologic Surgery

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Natalija Vukovic

2018-04-01

Full Text Available The purpose of the reviewThe analysis of the components of enhanced recovery after surgery (ERAS protocols in urologic surgery.Recent findingsERAS protocols has been studied for over 20 years in different surgical procedures, mostly in colorectal surgery. The concept of improving patient care and reducing postoperative complications was also applied to major urologic surgery and especially procedure of radical cystectomy. This procedure is technically challenging, due to a major surgical resection and high postoperative complication rate that may reach 65%. Several clinical pathways were introduced to improve perioperative course and reduce the length of hospital stay. These protocols differ from ERAS modalities in other surgeries. The reasons for this are longer operative time, increased risk of perioperative transfusion and infection, and urinary diversion achieved using transposed intestinal segments. Previous studies in this area analyzed the need for mechanical bowel preparation, postoperative nasogastric tube decompression, as well as the duration of urinary drainage. Furthermore, the attention has also been drawn to perioperative fluid optimization, pain management, and bowel function.SummaryNotwithstanding partial resemblance between the pathways in major urologic surgery and other pelvic surgeries, there are still scarce guidelines for ERAS protocols in urology, which is why further studies should assess the importance of preoperative medical optimization, implementation of thoracic epidural anesthesia and analgesia, and perioperative nutritional management.

Orthopaedic podiatry triage: process outcomes of a skill mix initiative.

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Homeming, Lyndon J; Kuipers, Pim; Nihal, Aneel

2012-11-01

The Orthopaedic Podiatry Triage Clinic (OPodTC) is a 'skill mix' model of care developed in Queensland Health to address the problem of lengthy waiting times for orthopaedic surgery on foot and ankle pathologies. It is based on the recognition that many orthopaedic surgery referrals can be identified early and treated conservatively with podiatry, averting the need for more costly and invasive surgical interventions. The model is collaborative and relies on screening and triage by the podiatrist, rather than delegation by the orthopaedic surgeon. Screening and triage through OPodTC was trialled at three Queensland Health hospital facilities during 2009 and 2010 to improve service timeliness. Patients identified by the OPodTC podiatrist as suitable for conservative management were provided with non-surgical podiatry interventions and discharged if appropriate. Those identified as still requiring surgical intervention after the benefit of interim conservative treatment provided by the podiatrist (or who chose to remain on the list) were returned to their previous place on the orthopaedic waiting list. This paper presents a summary and description of waiting list changes in association with this trial. The OPodTC intervention resulted in a reduction in the non-urgent category of the waiting list across the three hospitals of between 23.3% and 49.7%. Indications from wait-list service data demonstrated increased timeliness and improved patient flow, which are core goals of these skill mix initiatives. This study highlights the potential of screening and triage functions in the skill mix debate. In this example, conservative treatment options were considered first, suitable patients did not have to wait long periods to receive timely and appropriate interventions, and those for whom surgery was indicated, were provided with a more targeted service.

Current status and progress of digital orthopaedics in China

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Guo-Xian Pei

2014-07-01

Full Text Available Based on the development of digital medicine and digital anatomy, the concept of “digital orthopaedics” was raised by Pei Guo-Xian in China in 2006. The most striking feature of digital orthopaedics is the combination of basic and clinical orthopaedic knowledge with digital technology. In this review, we summarised the development of digital orthopaedics in China in recent years with respect to: the foundation of the Chinese Association of Digital Orthopedics, virtual human project (VHP, three-dimensional (3D reconstruction, finite element simulation, navigation in orthopaedic operations, and robot-assisted orthopaedic operations. In addition, we briefly reviewed digital orthopaedics in world leading institutes. We also looked into the future of digital orthopaedics in China and proposed the major challenges in digital technology and application in orthopaedics.

The Effectiveness of Nurse-Led Preoperative Assessment Clinics for Patients Receiving Elective Orthopaedic Surgery: A Systematic Review.

Science.gov (United States)

Sau-Man Conny, Chan; Wan-Yim, Ip

2016-12-01

Nurse-led preoperative assessment clinics (POAC) have been introduced in different specialty areas to assess and prepare patients preoperatively in order to avoid last-minute surgery cancellations. Not all patients are referred to POACs before surgery, and the benefits of nurse-led POACs are not well documented in Hong Kong. The purpose of this systemic review was to identify the best available research evidence to inform current clinical practice, guide health care decision making and promote better care. The Joanna Briggs Institute (JBI) approach for conducting systematic review of quantitative research was used. Data bases searched included all published and unpublished studies in Chinese and English. All studies with adult patients who required elective orthopaedic surgery e.g. total knee replacement, total hip replacement, reduction of fracture or reconstruction surgery etc. in a hospital or day surgery center and attended a nurse-led POAC before surgery were included. Ten studies were critically appraised. Results showed that nurse-led POACs can reduce surgery cancellation rates. These studies suggested a reduction in the rate of postoperative mortality and length of hospital stay. In addition, the level of satisfaction towards services provided was significantly high. Although POACs are being increasingly implemented worldwide, the development of clinical guidelines, pathways and protocols was advocated. The best available evidence asserted that nurses in the POAC could serve as effective coordinators, assessors and educators. The nurse-led practice optimized patients' condition before surgery and hence minimized elective surgery cancellations. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Stress and coping among orthopaedic surgery residents and faculty.

Science.gov (United States)

Sargent, M Catherine; Sotile, Wayne; Sotile, Mary O; Rubash, Harry; Barrack, Robert L

2004-07-01

Evaluations of physicians and residents have revealed concerning levels of psychosocial dysfunction. The purposes of this study were to determine the quality of life of orthopaedic residents and faculty and to identify the risk factors for decompensation. Twenty-one orthopaedic residents and twenty-five full-time orthopaedic faculty completed a 102-question voluntary, anonymous survey. The survey consisted of three validated instruments, i.e., the Maslach Burnout Inventory, the General Health Questionnaire-12, and the Revised Dyadic Adjustment Scale; and three novel question sets addressing background and demographic information, stress reaction and management, and the balance between work and home life. Descriptive statistics, pairwise correlations, simple t tests, and Pearson and nonparametric Spearman correlations were calculated. The simple correlation coefficient was used to assess bivariate relationships. The mean overall quality-of-life score, on a scale of 0 to 4 points, was 2.5 points for residents compared with 3.6 points for faculty members. Residents reported considerable burnout, showing a high level of emotional exhaustion and depersonalization and an average level of personal achievement, whereas faculty reported minimal burnout, showing a low level of emotional exhaustion (p burnout and psychiatric morbidity correlated with weekly work hours; conflict between the commitments of work and home life; discord with faculty, nursing staff, and senior residents; debt load; and work-related stress. Protective factors included being a parent, spending time with a spouse, having a physician father, and deriving satisfaction from discussing concerns with colleagues, friends, and family. In pursuit of our goal of determining the quality of life of orthopaedic residents and faculty, we identified a large disparity between the two groups. The resident group reported much greater levels of dysfunction particularly with regard to burnout and psychiatric morbidity

Bone Graft Substitutes : Developed for Trauma and Orthopaedic Surgery

NARCIS (Netherlands)

J. van der Stok (Johan)

2015-01-01

markdownabstract__Abstract__ Bone grafting was established in the 19th century and has become a common procedure in which bone defects are filled with bone grafts or bone graft substitutes. Bone defects that require bone grafting are encountered in approximately 10% of trauma and orthopaedic

Compressed-air power tools in orthopaedic surgery: exhaust air is a potential source of contamination.

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Sagi, H C; DiPasquale, Thomas; Sanders, Roy; Herscovici, Dolfi

2002-01-01

To determine if the exhaust from surgical compressed-air power tools contains bacteria and if the exhaust leads to contamination of sterile surfaces. Bacteriologic study of orthopaedic power tools. Level I trauma center operative theater. None. Part I. Exhaust from two sterile compact air drills was sampled directly at the exhaust port. Part II. Exhaust from the drills was directed at sterile agar plates from varying distances. The agar plates represented sterile surfaces within the operative field. Part III. Control cultures. A battery-powered drill was operated over open agar plates in similar fashion as the compressed-air drills. Agar plates left open in the operative theater served as controls to rule out atmospheric contamination. Random cultures were taken from agar plates, gloves, drills, and hoses. Incidence of positive cultures. In Part I, all filters from both compressed-air drill exhausts were culture negative ( = 0.008). In Part II, the incidence of positive cultures for air drills number one and number two was 73% and 82%, respectively. The most commonly encountered organisms were, coagulase-negative Staphylococcus, and Micrococcus species. All control cultures from agar plates, battery-powered drill, gloves, and hoses were negative ( compressed-air power tools in orthopaedic surgery may contribute to the dissemination of bacteria onto the surgical field. We do not recommend the use of compressed-air power tools that do not have a contained exhaust.

Evaluating the outcomes of a podiatry-led assessment service in a public hospital orthopaedic unit.

Science.gov (United States)

Bonanno, Daniel R; Medica, Virginia G; Tan, Daphne S; Spring, Anita A; Bird, Adam R; Gazarek, Jana

2014-01-01

In Australia, the demand for foot and ankle orthopaedic services in public health settings currently outweighs capacity. Introducing experienced allied health professionals into orthopaedic units to initiate the triage, assessment and management of patients has been proposed to help meet demand. The aim of this study was to evaluate the effect of introducing a podiatry-led assessment service in a public hospital orthopaedic unit. The outcomes of interest were determining: the proportion of patients discharged without requiring an orthopaedic appointment, agreement in diagnosis between the patient referral and the assessing podiatrist, the proportion of foot and ankle conditions presenting to the service, and the proportion of each condition to require an orthopaedic appointment. This study audited the first 100 patients to receive an appointment at a new podiatry-led assessment service. The podiatrist triaged 'Category 3' referrals consisting of musculoskeletal foot and ankle conditions and appointments were provided for those considered likely to benefit from non-surgical management. Following assessment, patients were referred to an appropriate healthcare professional or were discharged. At the initial appointment or following a period of care, patients were discharged if non-surgical management was successful, surgery was not indicated, patients did not want surgery, and if patient's failed to attend their appointments. All other patients were referred for an orthopaedic consultation as indicated. Ninety-five of the 100 patients (69 females and 31 males; mean age 51.9, SD 16.4 years) attended their appointment at the podiatry-led assessment service. The 95 referrals contained a total of 107 diagnoses, of which the podiatrist agreed with the diagnosis stated on the referral in 56 cases (Kappa =0.49, SE = 0.05). Overall, 34 of the 100 patients were referred to an orthopaedic surgeon and the remaining 66 patients were discharged from the orthopaedic waiting

Incidence and root causes of delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years.

Science.gov (United States)

Caesar, Ulla; Karlsson, Jon; Hansson, Elisabeth

2018-01-01

Emergency surgery is unplanned by definition and patients are scheduled for surgery with minimal preparation. Some patients who have sustained emergency orthopaedic trauma or other conditions must be operated on immediately or within a few hours, while others can wait until the hospital's resources permit and/or the patients' health status has been optimised as needed. This may affect the prioritisation procedures for both emergency and elective surgery and might result in waiting lists, not only for planned procedures but also for emergencies. The main purpose of this retrospective, observational, single-centre study was to evaluate and describe for the number and reasons of delays, as well as waiting times in emergency orthopaedic surgery using data derived from the hospital's records and registers. All the emergency patients scheduled for emergency surgery whose procedures were rescheduled and delayed between 1 January 2007 and 31 December 2013 were studied. We found that 24% (8474) of the 36,017 patients scheduled for emergency surgeries were delayed and rescheduled at least once, some several times. Eighty per cent of these delays were due to organisational causes. Twenty-one per cent of all the delayed patients had surgery within 24 h, whilst 41% waited for more than 24 h, up to 3 days. A large number of the clinic's emergency orthopaedic procedures were rescheduled and delayed and the majority of the delays were related to organisational reasons. The results can be interpreted in two ways; first, organisational reasons are avoidable and the potential for improvement is great and, secondly and most importantly, the delays might negatively affect patient outcomes.

The First World War and its influence on the development of orthopaedic surgery.

Science.gov (United States)

Scotland, T

2014-01-01

By December 1914, overwhelming numbers of soldiers with infected musculoskeletal wounds had filled hospitals in France and Britain. Frequently initial management had been inadequate. In 1915, patients with orthopaedic wounds were segregated for the first time when Robert Jones established an experimental orthopaedic unit in Alder Hey Hospital, Liverpool. In 1916 he opened the first of 17 orthopaedic centres in Britain to surgically treat and rehabilitate patients. Henry Gray from Aberdeen emerged as the leading authority in the management of acute musculoskeletal wounds in casualty clearing stations in France and Flanders. Gray had particular expertise in dealing with compound fractures of the femur for which he documented an 80% mortality rate in 1914-15.

Professional liability in orthopaedics and traumatology in Italy.

Science.gov (United States)

Tarantino, Umberto; Giai Via, Alessio; Macrì, Ernesto; Eramo, Alessandro; Marino, Valeria; Marsella, Luigi Tonino

2013-10-01

Interest in medical errors has increased during the last few years owing to the number of medical malpractice claims. Reasons for the increasing number of claims may be related to patients' higher expectations, iatrogenic injury, and the growth of the legal services industry. Claims analysis provides helpful information in specialties in which a higher number of errors occur, highlighting areas where orthopaedic care might be improved. We determined: (1) the number of claims involving orthopaedics and traumatology in Rome; (2) the risk of litigation in elective and trauma surgery; (3) the most common surgical procedures involved in claims and indemnity payments; (4) the time between the adverse medical event and the judgment date; and (5) issues related to informed consent. We analyzed 1925 malpractice judgments decided in the Civil Court of Rome between 2004 and 2010. In total, 243 orthopaedics claims were filed, and in 75% of these cases surgeons were found liable; 149 (61%) of these resulted from elective surgery. Surgical teams were sued in 30 claims and found liable in 22. The total indemnity payment ordered was more than €12,350,000 (USD 16,190,000). THA and spinal surgery were the most common surgical procedures involved. Inadequate informed consent was reported in 5.3% of cases. Our study shows that careful medical examination, accurate documentation in medical records, and adequate informed consent might reduce the number of claims. We suggest monitoring of court judgments would be useful to develop prevention strategies to reduce claims.

Development, implementation and evaluation of a patient handoff tool to improve safety in orthopaedic surgery.

Science.gov (United States)

Gagnier, Joel J; Derosier, Joseph M; Maratt, Joseph D; Hake, Mark E; Bagian, James P

2016-06-01

To develop, implement and test the effect of a handoff tool for orthopaedic trauma residents that reduces adverse events associated with the omission of critical information and the transfer of erroneous information. Components of this project included a literature review, resident surveys and observations, checklist development and refinement, implementation and evaluation of impact on adverse events through a chart review of a prospective cohort compared with a historical control group. Large teaching hospital. Findings of a literature review were presented to orthopaedic residents, epidemiologists, orthopaedic surgeons and patient safety experts in face-to-face meetings, during which we developed and refined the contents of a resident handoff tool. The tool was tested in an orthopaedic trauma service and its impact on adverse events was evaluated through a chart review. The handoff tool was developed and refined during the face-to-face meetings and a pilot implementation. Adverse event data were collected on 127 patients (n = 67 baseline period; n = 60 test period). A handoff tool for use by orthopaedic residents. Adverse events in patients handed off by orthopaedic trauma residents. After controlling for age, gender and comorbidities, testing resulted in fewer events per person (25-27% reduction; P < 0.10). Preliminary evidence suggests that our resident handoff tool may contribute to a decrease in adverse events in orthopaedic patients. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Rapid Prototyping in Orthopaedic Surgery: A User's Guide

OpenAIRE

Frame, Mark; Huntley, James S.

2012-01-01

Rapid prototyping (RP) is applicable to orthopaedic problems involving three dimensions, particularly fractures, deformities, and reconstruction. In the past, RP has been hampered by cost and difficulties accessing the appropriate expertise. Here we outline the history of rapid prototyping and furthermore a process using open-source software to produce a high fidelity physical model from CT data. This greatly mitigates the expense associated with the technique, allowing surgeons to produce pr...

[Final voluntary assessment for Traumatology and Orthopaedic Surgery medical residents: a report on the results and a look at the future].

Science.gov (United States)

Urda, A; Ezquerra, L; Albareda, J; Baeza-Noci, J; Blanco, A; Cáceres, E; Martínez-Grande, M; Nardi, J; Yunta, A; Marco, F

2012-01-01

The idea of establishing an examination that accredits the training of the specialists in orthopaedic surgery at the end of their educational period as residents is subject to controversy. With the aim of encouraging the development of this examination, the present members of the National Commission of the Specialty of Orthopaedics (CNE) have reviewed the results obtained in previous examination. The results of the voluntary final exam for Orthopaedics residents, and of the surveys of participant opinions for the years 2006 to 2011 are presented. The total number of participants was 231, growing from 19 in 2005, to 71 in 2011. The overall mean score in the period reviewed (2006-2011) was 6.72 out of 10 points. In these 6 years, 9 participants failed (4.25%). The mean score for the test was 7.57. The overall mean score of the oral exam was 6.57. The worst results were obtained in the general knowledge section of the oral examination. Nobody has ever failed the section on reconstruction of the lower extremity. The upper extremity section in the oral examination achieves the best average results. The examination has established its place in the structure of orthopaedic resident training in our country, even without making it official by the Administration. We must positively acknowledge those candidates who chose to take the examination and be evaluated by their peers in order to prove their qualification and distinction. This recognition will be the best encouragement for future generations. Copyright © 2011 SECOT. Published by Elsevier Espana. All rights reserved.

A break-even analysis of major ear surgery.

Science.gov (United States)

Wasson, J D; Phillips, J S

2015-10-01

To determine variables which affect cost and profit for major ear surgery and perform a break-even analysis. Retrospective financial analysis. UK teaching hospital. Patients who underwent major ear surgery under general anaesthesia performed by the senior author in main theatre over a 2-year period between dates of 07 September 2010 and 07 September 2012. Income, cost and profit for each major ear patient spell. Variables that affect major ear surgery profitability. Seventy-six patients met inclusion criteria. Wide variation in earnings, with a median net loss of £-1345.50 was observed. Income was relatively uniform across all patient spells; however, theatre time of major ear surgery at a cost of £953.24 per hour varied between patients and was the main determinant of cost and profit for the patient spell. Bivariate linear regression of earnings on theatre time identified 94% of variation in earnings was due to variation in theatre time (r = -0.969; P break-even time for major ear surgery of 110.6 min. Theatre time was dependent on complexity of procedure and number of OPCS4 procedures performed, with a significant increase in theatre time when three or more procedures were performed during major ear surgery (P = 0.015). For major ear surgery to either break-even or return a profit, total theatre time should not exceed 110 min and 36 s. © 2015 John Wiley & Sons Ltd.

International Patients on Operation Vacation – Perspectives of Patients Travelling to Hungary for Orthopaedic Treatments

Directory of Open Access Journals (Sweden)

Eszter Kovacs

2014-11-01

Full Text Available Background The importance of cross-border healthcare, medical and health tourism plays a significant role in the European health policy and health management. After dentistry, orthopaedic treatments are the leading motivation for seeking care in Hungary, as patients with rheumatic and motion diseases are drawn to the thermal spas and well-established orthopaedic centres. This paper aims to gain insight into foreign patients’ perspectives on their experience of having sought medical tourism in orthopaedic care in Hungary. Methods A patient survey was conducted in 2012 on motivations for seeking treatment abroad, orthopaedic care received and overall satisfaction. In addition, health professionals’ interviews, and 17 phone interviews were conducted in 2013 with Romanian patients who had orthopaedic treatment in Hungary. Finally, medical records of foreign patients were analysed. Results The survey was completed by 115 participants – 61.1% females, mean age= 41.9, 87% Romanian origin. Most of the patients came to Hungary for orthopaedic surgeries, e.g. arthroscopy, knee/hip prosthesis or spinal surgery. 72.6% chose Hungary because of related to perceived better quality and longstanding culture of Hungarian orthopaedic care. Over 57% of patients reported being ‘very satisfied’ with care received and 41.6% ‘satisfied’. The follow-up interviews further reflected this level of satisfaction, therefore many respondents stating they have already recommended the Hungarian healthcare to others. Conclusion Based on the findings, patients from neighbouring regions are increasingly seeking orthopaedic care in Hungary. Patients having orthopaedic care are highly satisfied with the quality of care, the whole treatment process from the availability of information to discharge summaries and would consider returning for further treatments.

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

Science.gov (United States)

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.

Customizable orthopaedic oncology implants: one institution's experience with meeting current IRB and FDA requirements.

Science.gov (United States)

Willis, Alexander R; Ippolito, Joseph A; Patterson, Francis R; Benevenia, Joseph; Beebe, Kathleen S

2016-01-01

Customizable orthopaedic implants are often needed for patients with primary malignant bone tumors due to unique anatomy or complex mechanical problems. Currently, obtaining customizable orthopaedic implants for orthopaedic oncology patients can be an arduous task involving submitting approval requests to the Institutional Review Board (IRB) and the Food and Drug Administration (FDA). There is great potential for the delay of a patient's surgery and unnecessary paperwork if the submission pathways are misunderstood or a streamlined protocol is not in place. The objective of this study was to review the existing FDA custom implant approval pathways and to determine whether this process was improved with an institutional protocol. An institutional protocol for obtaining IRB and FDA approval for customizable orthopaedic implants was established with the IRB at our institution in 2013. This protocol was approved by the IRB, such that new patients only require submission of a modification to the existing protocol with individualized patient information. During the two-year period of 2013-2014, eight patients were retrospectively identified as having required customizable implants for various orthopaedic oncology surgeries. The dates of request for IRB approval, request for FDA approval, and total time to surgery were recorded, along with the specific pathway utilized for FDA approval. The average patient age was 12 years old (7-21 years old). The average time to IRB approval of a modification to the pre-approved protocol was 14 days (7-21 days). Average time to FDA approval after submission of the IRB approval to the manufacturer was 12.5 days (7-19 days). FDA approval was obtained for all implants as compassionate use requests in accordance with Section 561 of the Federal Food Drug and Cosmetic Act's expanded access provisions. Establishment of an institutional protocol with pre-approval by the IRB can expedite the otherwise time-consuming and complicated

The older orthopaedic patient: general considerations.

Science.gov (United States)

Potter, Jane F

2004-08-01

People older than 65 years are more likely to need elective and emergent orthopaedic surgery compared with younger persons. They also experience significant benefits. Although age-related changes increase the risk of perioperative complications, understanding those changes allows prevention or at least early recognition and treatment when problems arise. Because of comorbidities, older persons take more medications that need to be managed in the perioperative period. Care could be simplified if patients were to bring their medications to the preoperative evaluation. Central nervous system sensitivity to certain pain medications (meperidine and propoxyphene) means that these drugs are best avoided as good alternatives exist (morphine and oxycodone). Adverse reactions to drugs are an important cause of acute confusion (delirium) that often complicates orthopaedic care. Early mobilization after surgery, avoiding certain drugs, avoiding restraints (including Foley catheters), attending to hydration, promoting normal sleep, compensating for sensory disorders, and stimulating daytime activities can prevent delirium. Patients with dementia are more likely to have delirium develop and, like many older people, will present special challenges in communication and decision making. Including family members in discussions may be helpful in ensuring truly informed consent.

Planning for life after orthopaedics.

Science.gov (United States)

Barr, Joseph S; McCaslin, Michael J; Hinds, Cynthia K

2014-01-01

The word retirement is going out of fashion. Many orthopaedic surgeons want to work in some capacity when they stop performing surgery. Making a smooth transition from a busy orthopaedic practice to alternative work demands advanced planning. The surgeon must consider personal issues that involve how to use human capital (his or her accumulated knowledge and experience). New ventures, hobbies, travel, and spending time with family and friends are some possibilities. Plans for slowing down or leaving the practice should be discussed and agreed on well ahead of time. Agreements for buyouts may be difficult to work out and will require creative thinking. The solo practitioner can close the practice or hire a successor. Financial planning is perhaps the most important consideration and should be started by approximately age 40. It is recommended that the surgeon develop a portfolio of secure investments and annuities to provide adequate income for as long as is needed and then to turn the residual income to one's family, favorite charities, or other desired cause. A team of competent advisors is needed to help develop and achieve one's goals, create financial security, and provide the discipline to carry out the needed planning for life after orthopaedics.

The Impact of Specialty on Cases Performed During Hand Surgery Fellowship Training.

Science.gov (United States)

Silvestre, Jason; Upton, Joseph; Chang, Benjamin; Steinberg, David R

2018-03-07

Hand surgery fellowship programs in the United States are predominately sponsored by departments or divisions of orthopaedic surgery or plastic surgery. This study compares the operative experiences of hand surgery fellows graduating from orthopaedic or plastic surgery hand surgery fellowships. Operative case logs of 3 cohorts of hand surgery fellows graduating during the academic years of 2012-2013, 2013-2014, and 2014-2015 were analyzed. The median case volumes were compared by specialty via Mann-Whitney U tests. An arbitrary 1,000% change between the 90th and 10th percentiles of fellows was used as a threshold to highlight case categories with substantial variability. In this study, 413 orthopaedic hand surgery fellows (87%) and 62 plastic surgery hand surgery fellows (13%) were included. Plastic surgery fellows reported more cases in the following categories: wound closure with graft; wound reconstruction with flap; vascular repair, reconstruction, replantation, or microvascular; closed treatment of fracture or dislocation; nerve injury; and congenital (p < 0.05). Orthopaedic surgery fellows reported more cases in the following categories: wound irrigation and debridement fasciotomy or wound preparation; hand reconstruction or releases; wrist reconstruction, releases, or arthrodesis; forearm, elbow, or shoulder reconstruction or releases; hand fractures, dislocation, or ligament injury; wrist fractures or dislocations; forearm and proximal fractures or dislocations; miscellaneous insertion or removal of devices; shoulder arthroscopy, elbow arthroscopy, and wrist arthroscopy; decompression of tendon sheath, synovectomy, or ganglions; nerve decompression; Dupuytren; and tumor or osteomyelitis (p < 0.05). Plastic surgery fellows reported substantial variability for 12 case categories (range, 1,024% to 2,880%). Orthopaedic surgery fellows reported substantial variability for 9 case categories (range, 1,110% to 9,700%). Orthopaedic and plastic hand surgery

Can Rheumatologists Predict Eventual Need for Orthopaedic Intervention in Patients with Rheumatoid Arthritis? Results of a Systematic Review and Analysis of Two UK Inception Cohorts

OpenAIRE

Nikiphorou, E.; Carpenter, L.; Norton, S.; Morris, S.; MacGregor, A.; Dixey, J.; Williams, P.; Kiely, P.; Walsh, D. A.; Young, A.

2017-01-01

PURPOSE OF REVIEW: The structural damage caused by rheumatoid arthritis (RA) can often be mitigated by orthopaedic surgery in late disease. This study evaluates the value of predictive factors for orthopaedic intervention. METHODS: A systematic review of literature was undertaken to identify papers describing predictive factors for orthopaedic surgery in RA. Manuscripts were selected if they met inclusion criteria of cohort study design, diagnosis of RA, follow-up duration/disease...

Discontinuation of peri-operative gentamicin use for indwelling urinary catheter manipulation in orthopaedic surgery.

Science.gov (United States)

Bond, Stuart E; Boutlis, Craig S; Jansen, Stuart G; Miyakis, Spiros

2017-11-01

Gentamicin has historically been used prior to insertion and removal of indwelling urinary catheters (IDCs) around elective joint replacement surgery to prevent infection; however, this indication is not recognized in the Australian Therapeutic Guidelines: Antibiotic and the paradigm for safe use of gentamicin has shifted. The antimicrobial stewardship team of a 500 bed tertiary regional hospital performed a retrospective clinical study of gentamicin IDC prophylaxis around total hip and knee arthroplasties. Results were presented to the orthopaedic surgeons. A literature review identified no guidelines to support gentamicin prophylaxis and only a very low risk of bacteraemia associated with IDC insertion/removal in patients with established bacteriuria. Consensus was reached with the surgeons to discontinue this practice. Subsequent prospective data collection was commenced to determine effectiveness, with weekly feedback to the Department Head of Orthopaedics. Data from 137 operations pre-intervention (6 months) were compared with 205 operations post-intervention (12 months). The median patient age was 72 years in both groups. Following the intervention, reductions in gentamicin use were demonstrated for IDC insertion (59/137 (42%) to 4/205 (2%), P < 0.01) and removal (39/137 (28%) to 6/205 (3%), P < 0.01). No gentamicin use was observed during the final 40 weeks of the post-intervention period. There were no significant differences between the groups for pre-operative bacteriuria, surgical site infections or acute kidney injury. A collaborative approach using quality improvement methodology can lead to an evidence-based reappraisal of established practice. Regular rolling audits and timely feedback were useful in sustaining change. © 2016 Royal Australasian College of Surgeons.

Transient aphasia following spinal anaesthesia in an orthopaedic ...

African Journals Online (AJOL)

A 50-year-old male [American Society of Anesthesiologists (ASA) grade II] was scheduled for lower limb orthopaedic surgery. The subarachnoid space was localised with difficulty at L3/4 interspace and 3 ml of hyperbaric bupivacaine was given. Within a few minutes, the patient developed aphasia with a very high sensory ...

Unique Assessment of Hand Surgery Knowledge by Specialty.

Science.gov (United States)

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.

Barriers and facilitators experienced in collaborative prospective research in orthopaedic oncology

DEFF Research Database (Denmark)

Rendon, J S; Swinton, M; Bernthal, N

2017-01-01

by orthopaedic oncological surgeons involved or interested in prospective multicentre collaboration. METHODS: All surgeons who were involved, or had expressed an interest, in the ongoing Prophylactic Antibiotic Regimens in Tumour Surgery (PARITY) trial were invited to participate in a focus group to discuss......: The 13 surgeons who participated in the discussion represented orthopaedic oncology practices from seven countries (Argentina, Brazil, Italy, Spain, Denmark, United States and Canada). Four categories and associated themes emerged from the discussion: the need for collaboration in the field...... of orthopaedic oncology due to the rarity of the tumours and the need for high level evidence to guide treatment; motivational factors for participating in collaborative research including establishing proof of principle, learning opportunity, answering a relevant research question and being part...

Annals of African Surgery July 2011 07.12.2011.indd

African Journals Online (AJOL)

andrew

Orth), Schenck R2, MD, FACS Affiliation: 1-Department of Orthopaedics, Makerere University, Kampala,. Uganda /Orthopaedic Surgeon, Orthopaedic Rehabilitation Unit, PCEA Kikuyu Hospital, Kikuyu Kenya 2- Department of Plastic Surgery, ...

Rapid Prototyping in Orthopaedic Surgery: A User's Guide

Science.gov (United States)

Frame, Mark; Huntley, James S.

2012-01-01

Rapid prototyping (RP) is applicable to orthopaedic problems involving three dimensions, particularly fractures, deformities, and reconstruction. In the past, RP has been hampered by cost and difficulties accessing the appropriate expertise. Here we outline the history of rapid prototyping and furthermore a process using open-source software to produce a high fidelity physical model from CT data. This greatly mitigates the expense associated with the technique, allowing surgeons to produce precise models for preoperative planning and procedure rehearsal. We describe the method with an illustrative case. PMID:22666160

Using financial incentives to improve value in orthopaedics.

Science.gov (United States)

Lansky, David; Nwachukwu, Benedict U; Bozic, Kevin J

2012-04-01

A variety of reforms to traditional approaches to provider payment and benefit design are being implemented in the United States. There is increasing interest in applying these financial incentives to orthopaedics, although it is unclear whether and to what extent they have been implemented and whether they increase quality or reduce costs. We reviewed and discussed physician- and patient-oriented financial incentives being implemented in orthopaedics, key challenges, and prerequisites to payment reform and value-driven payment policy in orthopaedics. We searched the MEDLINE database using as search terms various provider payment and consumer incentive models. We retrieved a total of 169 articles; none of these studies met the inclusion criteria. For incentive models known to the authors to be in use in orthopaedics but for which no peer-reviewed literature was found, we searched Google for further information. Provider financial incentives reviewed include payments for reporting, performance, and patient safety and episode payment. Patient incentives include tiered networks, value-based benefit design, reference pricing, and value-based purchasing. Reform of financial incentives for orthopaedic surgery is challenged by (1) lack of a payment/incentive model that has demonstrated reductions in cost trends and (2) the complex interrelation of current pay schemes in today's fragmented environment. Prerequisites to reform include (1) a reliable and complete data infrastructure; (2) new business structures to support cost sharing; and (3) a retooling of patient expectations. There is insufficient literature reporting the effects of various financial incentive models under implementation in orthopaedics to know whether they increase quality or reduce costs. National concerns about cost will continue to drive experimentation, and all anticipated innovations will require improved collaboration and data collection and reporting.

The financial impact of orthopaedic fellowship training.

Science.gov (United States)

Gaskill, Trevor; Cook, Chad; Nunley, James; Mather, R Chad

2009-07-01

Previous reports have compared the expected financial return of a medical education with those expected in other professions. However, we know of no published report estimating the financial return of orthopaedic training. The purpose of this study was to estimate the financial incentives that may influence the decision to invest an additional year of training in each of the major orthopaedic fellowships. With survey data from the American Academy of Orthopaedic Surgeons and using standard financial techniques, we calculated the estimated return on investment of an additional year of orthopaedic training over a working lifetime. The net present value, internal rate of return, and the break-even point were estimated. Eight fellowships were examined and compared with general orthopaedic practice. Investment in an orthopaedic fellowship yields variable returns. Adult spine, shoulder and elbow, sports medicine, hand, and adult arthroplasty may yield positive returns. Trauma yields a neutral return, while pediatrics and foot and ankle have negative net present values. On the basis of mean reported incomes, the break-even point was two years for spine, seven years for hand, eight years for shoulder and elbow, twelve years for adult arthroplasty, thirteen years for sports medicine, and twenty-seven years for trauma. Fellowship-trained pediatric and foot and ankle surgeons did not break even following the initial investment. When working hours were controlled for, the returns for adult arthroplasty and trauma became negative. The financial return of an orthopaedic fellowship varies on the basis of the specialty chosen. While reasons to pursue fellowship training vary widely, and many are not financial, there are positive and negative financial incentives. Therefore, the decision to pursue fellowship training is best if it is not made on the basis of financial incentives. This information may assist policy makers in analyzing medical education economics to ensure the

A pilot study of orthopaedic resident self-assessment using a milestones' survey just prior to milestones implementation.

Science.gov (United States)

Bradley, Kendall E; Andolsek, Kathryn M

2016-01-11

To pilot test if Orthopaedic Surgery residents could self-assess their performance using newly created milestones, as defined by the Accreditation Council on Graduate Medical Education. In June 2012, an email was sent to Program Directors and administrative coordinators of the 154 accredited Orthopaedic Surgery Programs, asking them to send their residents a link to an online survey. The survey was adapted from the Orthopaedic Surgery Milestone Project. Completed surveys were aggregated in an anonymous, confidential database. SAS 9.3 was used to perform the analyses. Responses from 71 residents were analyzed. First and second year residents indicated through self-assessment that they had substantially achieved Level 1 and Level 2 milestones. Third year residents reported they had substantially achieved 30/41, and fourth year residents, all Level 3 milestones. Fifth year, graduating residents, reported they had substantially achieved 17 Level 4 milestones, and were extremely close on another 15. No milestone was rated at Level 5, the maximum possible. Earlier in training, Patient Care and Medical Knowledge milestones were rated lower than the milestones reflecting the other four competencies of Practice Based Learning and Improvement, Systems Based Practice, Professionalism, and Interpersonal Communication. The gap was closed by the fourth year. Residents were able to successfully self-assess using the 41 Orthopaedic Surgery milestones. Respondents' rate improved proficiency over time. Graduating residents report they have substantially, or close to substantially, achieved all Level 4 milestones. Milestone self-assessment may be a useful tool as one component of a program's overall performance assessment strategy.

A pilot study of orthopaedic resident self-assessment using a milestones’ survey just prior to milestones implementation

Science.gov (United States)

Bradley, Kendall E.

2016-01-01

Objectives To pilot test if Orthopaedic Surgery residents could self-assess their performance using newly created milestones, as defined by the Accreditation Council on Graduate Medical Education.  Methods In June 2012, an email was sent to Program Directors and administrative coordinators of the154 accredited Orthopaedic Surgery Programs, asking them to send their residents a link to an online survey. The survey was adapted from the Orthopaedic Surgery Milestone Project. Completed surveys were aggregated in an anonymous, confidential database. SAS 9.3 was used to perform the analyses. Results Responses from 71 residents were analyzed. First and second year residents indicated through self-assessment that they had substantially achieved Level 1 and Level 2 milestones. Third year residents reported they had substantially achieved 30/41, and fourth year residents, all Level 3 milestones. Fifth year, graduating residents, reported they had substantially achieved 17 Level 4 milestones, and were extremely close on another 15. No milestone was rated at Level 5, the maximum possible.  Earlier in training, Patient Care and Medical Knowledge milestones were rated lower than the milestones reflecting the other four competencies of Practice Based Learning and Improvement, Systems Based Practice, Professionalism, and Interpersonal Communication. The gap was closed by the fourth year. Conclusions Residents were able to successfully self-assess using the 41 Orthopaedic Surgery milestones. Respondents’ rate improved proficiency over time. Graduating residents report they have substantially, or close to substantially, achieved all Level 4 milestones.  Milestone self-assessment may be a useful tool as one component of a program’s overall performance assessment strategy. PMID:26752012

The burden of gunshot injuries on orthopaedic healthcare resources in South Africa.

Science.gov (United States)

Martin, Case; Thiart, Gerhard; McCollum, Graham; Roche, Stephen; Maqungo, Sithombo

2017-06-30

Injuries inflicted by gunshot wounds (GSWs) are an immense burden on the South African (SA) healthcare system. In 2005, Allard and Burch estimated SA state hospitals treated approximately 127 000 firearm victims annually and concluded that the cost of treating an abdominal GSW was approximately USD1 467 per patient. While the annual number of GSW injuries has decreased over the past decade, an estimated 54 870 firearm-related injuries occurred in SA in 2012. No study has estimated the burden of these GSWs from an orthopaedic perspective. To estimate the burden and average cost of treating GSW victims requiring orthopaedic interventions in an SA tertiary level hospital. This retrospective study surveyed more than 1 500 orthopaedic admissions over a 12-month period (2012) at Groote Schuur Hospital, Cape Town, SA. Chart review subsequently yielded data that allowed analysis of cost, theatre time, number and type of implants, duration of admission, diagnostic imaging studies performed, blood products used, laboratory studies ordered and medications administered. A total of 111 patients with an average age of 28 years (range 13 - 74) were identified. Each patient was hit by an average of 1.69 bullets (range 1 - 7). These patients sustained a total of 147 fractures, the majority in the lower extremities. Ninety-five patients received surgical treatment for a total of 135 procedures, with a cumulative surgical theatre time of >306 hours. Theatre costs, excluding implants, were in excess of USD94 490. Eighty of the patients received a total of 99 implants during surgery, which raised theatre costs an additional USD53 381 cumulatively, or USD667 per patient. Patients remained hospitalised for an average of 9.75 days, and total ward costs exceeded USD130 400. Individual patient costs averaged about USD2 940 (ZAR24 945) per patient. This study assessed the burden of orthopaedic firearm injuries in SA. It was estimated that on average, treating an orthopaedic GSW patient

The orthopaedic error index: development and application of a novel national indicator for assessing the relative safety of hospital care using a cross-sectional approach.

Science.gov (United States)

Panesar, Sukhmeet S; Netuveli, Gopalakrishnan; Carson-Stevens, Andrew; Javad, Sundas; Patel, Bhavesh; Parry, Gareth; Donaldson, Liam J; Sheikh, Aziz

2013-11-21

The Orthopaedic Error Index for hospitals aims to provide the first national assessment of the relative safety of provision of orthopaedic surgery. Cross-sectional study (retrospective analysis of records in a database). The National Reporting and Learning System is the largest national repository of patient-safety incidents in the world with over eight million error reports. It offers a unique opportunity to develop novel approaches to enhancing patient safety, including investigating the relative safety of different healthcare providers and specialties. We extracted all orthopaedic error reports from the system over 1 year (2009-2010). The Orthopaedic Error Index was calculated as a sum of the error propensity and severity. All relevant hospitals offering orthopaedic surgery in England were then ranked by this metric to identify possible outliers that warrant further attention. 155 hospitals reported 48 971 orthopaedic-related patient-safety incidents. The mean Orthopaedic Error Index was 7.09/year (SD 2.72); five hospitals were identified as outliers. Three of these units were specialist tertiary hospitals carrying out complex surgery; the remaining two outlier hospitals had unusually high Orthopaedic Error Indexes: mean 14.46 (SD 0.29) and 15.29 (SD 0.51), respectively. The Orthopaedic Error Index has enabled identification of hospitals that may be putting patients at disproportionate risk of orthopaedic-related iatrogenic harm and which therefore warrant further investigation. It provides the prototype of a summary index of harm to enable surveillance of unsafe care over time across institutions. Further validation and scrutiny of the method will be required to assess its potential to be extended to other hospital specialties in the UK and also internationally to other health systems that have comparable national databases of patient-safety incidents.

What Provisions Do Orthopaedic Programs Make for Maternity, Paternity, and Adoption Leave?

Science.gov (United States)

Weiss, Jennifer; Teuscher, David

2016-09-01

The process of choosing medical specialty and residency programs is multifaceted. Today's generation of medical students may have an increased interest in work-life balance and time with their families. In considering this factor, medical students may be influenced by policy regarding maternity, paternity, and adoption leave during residency and fellowship training. Current policy among orthopaedic programs regarding maternity, paternity, and adoption leave is not well described. To understand the influence these policies may have on the choices that medical students make in choosing their specialty, the policies must first be better understood. (1) What proportion of orthopaedic programs have formal or unwritten policies regarding maternity, paternity, and adoptive leave? (2) What are the provisions for time away, allotment of time, and makeup options for trainees who take leave? (3) What proportion of orthopaedic programs report utilization of leave, and what proportions of leave are for maternity, paternity, or adoptive reasons? Accredited programs in orthopaedic surgery were identified through the Council of Orthopedic Residency Directors within the American Orthopaedic Association. Current program directors of these accredited programs were surveyed. The survey was emailed to 144 program directors, of which 141 emails were delivered. Responses were received from 45 program directors, representing 31% of programs. The survey focused on maternity, paternity, and adoptive leave, and it consisted of questions designed to explore program policies (formal, unwritten, no policy, or in development), time considerations (amount allowed, allocation of time away, and makeup requirements), and utilization (trainees who took leave and type of leave used). Most respondents have maternity leave policy (formal: 36 of 45 [80%]; unwritten: 17 of 45 [38%]). Sixteen programs (16 of 45 [36%]) reported having both a formal and an unwritten maternity leave policy. Less than half of

Ambulatory surgery and anaesthesia in HUKM, a teaching hospital in Malaysia: the first two years experience.

Science.gov (United States)

Norsidah, A M; Yahya, N; Adeeb, N; Lim, A L

2001-03-01

Ambulatory or day care surgery is still in its infancy in this part of the world. Our newly built university affiliated hospital started its Day Surgery Centre in February 1998. It is the first multidisciplinary ambulatory surgery centre in a teaching hospital in the country. It caters for Orthopaedic surgery, Urology, Plastic surgery, Otorhinolaryngology, General surgery, Paediatric surgery and Ophthalmology. We have done 2,604 cases and our unanticipated admission rate is less than 2%. There has been no major morbidity or mortality. The problems of setting up a multidisciplinary ambulatory centre in a teaching hospital are discussed.

The Libyan civil conflict: selected case series of orthopaedic trauma managed in Malta in 2014.

Science.gov (United States)

Ng, Colin; Mifsud, Max; Borg, Joseph N; Mizzi, Colin

2015-11-20

The purpose of this series of cases was to analyse our management of orthopaedic trauma casualties in the Libyan civil war crisis in the European summer of 2014. We looked at both damage control orthopaedics and for case variety of war trauma at a civilian hospital. Due to our geographical proximity to Libya, Malta was the closest European tertiary referral centre. Having only one Level 1 trauma care hospital in our country, our Trauma and Orthopaedics department played a pivotal role in the management of Libyan battlefield injuries. Our aims were to assess acute outcomes and short term mortality of surgery within the perspective of a damage control orthopaedic strategy whereby aggressive wound management, early fixation using relative stability principles, antibiotic cover with adequate soft tissue cover are paramount. We also aim to describe the variety of war injuries we came across, with a goal for future improvement in regards to service providing. Prospective collection of six interesting cases with severe limb and spinal injuries sustained in Libya during the Libyan civil war between June and November 2014. We applied current trends in the treatment of war injuries, specifically in damage control orthopaedic strategy and converting to definitive treatment where permissible. The majority of our cases were classified as most severe (Type IIIB/C) according to the Gustilo-Anderson classification of open fractures. The injuries treated reflected the type of standard and improved weaponry available in modern warfare affecting both militants and civilians alike with increasing severity and extent of damage. Due to this fact, multidisciplinary team approach to patient centred care was utilised with an ultimate aim of swift recovery and early mobilisation. It also highlighted the difficulties and complex issues required on a hospital management level as a neighbouring country to war zone countries in transforming care of civil trauma to military trauma.

An international survey to identify the intrinsic and extrinsic factors of research studies most likely to change orthopaedic practice.

Science.gov (United States)

Thornley, P; de Sa, D; Evaniew, N; Farrokhyar, F; Bhandari, M; Ghert, M

2016-04-01

Evidence -based medicine (EBM) is designed to inform clinical decision-making within all medical specialties, including orthopaedic surgery. We recently published a pilot survey of the Canadian Orthopaedic Association (COA) membership and demonstrated that the adoption of EBM principles is variable among Canadian orthopaedic surgeons. The objective of this study was to conduct a broader international survey of orthopaedic surgeons to identify characteristics of research studies perceived as being most influential in informing clinical decision-making. A 29-question electronic survey was distributed to the readership of an established orthopaedic journal with international readership. The survey aimed to analyse the influence of both extrinsic (journal quality, investigator profiles, etc.) and intrinsic characteristics (study design, sample size, etc.) of research studies in relation to their influence on practice patterns. A total of 353 surgeons completed the survey. Surgeons achieved consensus on the 'importance' of three key designs on their practices: randomised controlled trials (94%), meta-analyses (75%) and systematic reviews (66%). The vast majority of respondents support the use of current evidence over historical clinical training; however subjective factors such as journal reputation (72%) and investigator profile (68%) continue to influence clinical decision-making strongly. Although intrinsic factors such as study design and sample size have some influence on clinical decision-making, surgeon respondents are equally influenced by extrinsic factors such as investigator reputation and perceived journal quality.Cite this article: Dr M. Ghert. An international survey to identify the intrinsic and extrinsic factors of research studies most likely to change orthopaedic practice. Bone Joint Res 2016;5:130-136. DOI: 10.1302/2046-3758.54.2000578. © 2016 Ghert et al.

Effect of smoking cessation intervention on results of acute fracture surgery: a randomized controlled trial

DEFF Research Database (Denmark)

Nåsell, Hans; Adami, Johanna; Samnegård, Eva

2010-01-01

Tobacco smoking is a major health and economic concern and is also known to have a significant negative effect on surgical outcomes. The benefits of a smoking cessation intervention prior to elective orthopaedic surgery have been evaluated previously. Our aim was to assess whether a smoking...

Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery?

Directory of Open Access Journals (Sweden)

Evrim Eylem Akpinar

2013-06-01

Full Text Available OBJECTIVE: Pulmonary embolism (PE is an important complication of major orthopedic surgery. The aim of this study was to evaluate the incidence of venous thromboembolism (VTE and factors influencing the development of VTE in patients undergoing major orthopedic surgery in a university hospital. METHODS: Patients who underwent major orthopedic surgery (hip arthroplasty, knee arthroplasty, or femur fracture repair between February of 2006 and June of 2012 were retrospectively included in the study. The incidences of PE and deep vein thrombosis (DVT were evaluated, as were the factors influencing their development, such as type of operation, age, and comorbidities. RESULTS: We reviewed the medical records of 1,306 patients. The proportions of knee arthroplasty, hip arthroplasty, and femur fracture repair were 63.4%, 29.9%, and 6.7%, respectively. The cumulative incidence of PE and DVT in patients undergoing major orthopedic surgery was 1.99% and 2.22%, respectively. Most of the patients presented with PE and DVT (61.5% and 72.4%, respectively within the first 72 h after surgery. Patients undergoing femur fracture repair, those aged ≥ 65 years, and bedridden patients were at a higher risk for developing VTE. CONCLUSIONS: Our results show that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis. Clinicians should be aware of VTE, especially during the perioperative period and in bedridden, elderly patients (≥ 65 years of age.

[Orthopaedics' megalomania - myth or mobbing?

Science.gov (United States)

Gundtoft, Per Hviid; Brand, Eske; Klit, Jakob; Weisskirchner, Kristoffer Barfod

2016-12-12

It is a general impression in the world of medicine that orthopaedic surgeons differ from doctors of other specialities in terms of intellect and self-confidence. The purpose of this study was to evaluate the self-confidence of orthopaedics. We asked doctors from 30 different specialities to fill out a questionnaire. In addition to this, the participating orthopaedics were asked to rate their self-perceived surgical skills. In all, 120 orthopaedics and 416 non-orthopaedic doctors completed the questionnaire. There was no difference in GSE scores between orthopaedics and other doctors (p = 0.58). 98% of young orthopaedics estimated that their surgical talent was average or above average when compared with their colleagues on the same level of education. 72% believed that they were "equally talented", "more talented", or "far more talented" than their colleagues on a higher level of education. 76% believed that when assisting a senior surgeon the patients would "sometimes" (60%), "often" (14%) or "always" (2%) be better off if they were the ones performing the operation. More orthopaedics than non-orthopaedics believed that their speciality was regarded as one of the least important specialities in the world of medicine (p = 0.001). Orthopaedic surgeons in general are not more self-confident than other doctors or the average population, but young orthopaedic surgeons have a very high level of confidence in their own operation skills. none. none.

Vitamin D insufficiency in the elderly orthopaedic patient: an epidemic phenomenon.

Science.gov (United States)

Maier, Gerrit Steffen; Horas, Konstantin; Seeger, Jörn Bengt; Roth, Klaus Edgar; Kurth, Andreas Alois; Maus, Uwe

2015-04-01

The purpose of this observational study was to evaluate serum levels of 25-OH-D of elderly patients presenting with orthopaedic illness. Furthermore, we enquired about potential confounders and risk factors of hypovitaminosis D in comorbidities and daily medication of the elderly. Vitamin D levels in 1,083 patients aged >70 years and admitted to an orthopaedic surgery department were measured. Univariate and multivariate analyses were used to assess risk factors for insufficient vitamin D levels. Overall, 86 % of patients had insufficient serum levels of 25-OH-D and >60 % were vitamin D deficient. Serum vitamin D levels were lower during winter and months with fewer sunshine hours. Patients presenting with obesity, hypertension and osteoporosis were more likely to have low vitamin D levels. We found a high prevalence of hypovitaminosis D in elderly, nonhospitalized orthopaedic patients. Given the well-known effects of vitamin D on bone metabolism and muscle health, as well as its nonskeletal effects, vitamin D insufficiency may have a negative impact.

The 2016 American Orthopaedic Association-Japanese Orthopaedic Association Traveling Fellowship.

Science.gov (United States)

Nandi, Sumon; Cho, Samuel K; Freedman, Brett A; Firoozabadi, Reza

2017-06-07

The American Orthopaedic Association-Japanese Orthopaedic Association (AOA-JOA) Traveling Fellowship, which began in 1992 as a collaborative effort between the 2 orthopaedic communities, is aimed at fostering leadership among early-career surgeons through clinical, academic, and cultural exchange. Over 3 weeks, we experienced an extraordinary journey that led us across nearly 800 miles of the picturesque Japanese countryside, with stops at 6 distinguished academic centers. The opportunity to become personally acquainted with orthopaedic leaders in Japan, learn from their experiences, and immerse ourselves in the ancient and storied culture of a beautiful country was one that we will not soon forget. Along the way, we accumulated a wealth of information while enjoying the legendary hospitality of the Japanese people. There is a ubiquitous challenge in delivering cost-effective, accessible health care while maintaining a commitment to education and research. The U.S. orthopaedic community may take solace in the fact that our Japanese colleagues stand with us as partners in this pursuit, and our relationship with them continues to grow stronger through endeavors such as the AOA-JOA Traveling Fellowship. We look forward to honoring our Japanese colleagues in 2017 when we host them in the United States.

Patient Safety in Spine Surgery: Regarding the Wrong-Site Surgery

OpenAIRE

Lee, Seung-Hwan; Kim, Ji-Sup; Jeong, Yoo-Chul; Kwak, Dae-Kyung; Chun, Ja-Hae; Lee, Hwan-Mo

2013-01-01

Patient safety regarding wrong site surgery has been one of the priority issues in surgical fields including that of spine care. Since the wrong-side surgery in the DM foot patient was reported on a public mass media in 1996, the wrong-site surgery issue has attracted wide public interest as regarding patient safety. Despite the many wrong-site surgery prevention campaigns in spine care such as the operate through your initial program by the Canadian Orthopaedic Association, the sign your sit...

Smartphone apps for orthopaedic sports medicine - a smart move?

Science.gov (United States)

Wong, Seng Juong; Robertson, Greg A; Connor, Katie L; Brady, Richard R; Wood, Alexander M

2015-01-01

With the advent of smartphones together with their downloadable applications (apps), there is increasing opportunities for doctors, including orthopaedic sports surgeons, to integrate such technology into clinical practice. However, the clinical reliability of these medical apps remains questionable. We reviewed available apps themed specifically towards Orthopaedic Sports Medicine and related conditions and assessed the level of medical professional involvement in their design and content, along with a review of these apps. The most popular smartphone app stores (Android, Apple, Blackberry, Windows, Samsung, Nokia) were searched for Orthopaedic Sports medicine themed apps, using the search terms; Orthopaedic Sports Medicine, Orthopaedics, Sports medicine, Knee Injury, Shoulder Injury, Anterior Cruciate Ligament Tear, Medial Collateral Ligament Tear, Rotator Cuff Tear, Meniscal Tear, Tennis Elbow. All English language apps related to orthopaedic sports medicine were included. A total of 76 individual Orthopaedic Sports Medicine themed apps were identified. According to app store classifications, there were 45 (59 %) medical themed apps, 28 (37 %) health and fitness themed apps, 1 (1 %) business app, 1 (1 %) reference app and 1 (1 %) sports app. Forty-nine (64 %) apps were available for download free of charge. For those that charged access, the prices ranged from £0.69 to £69.99. Only 51 % of sports medicine apps had customer satisfaction ratings and 39 % had named medical professional involvement in their development or content. We found the majority of Orthopaedic Sports Medicine apps had no named medical professional involvement, raising concerns over their content and evidence-base. We recommend increased regulation of such apps to improve the accountability of app content.

Regenerative orthopaedics: in vitro, in vivo...in silico.

Science.gov (United States)

Geris, Liesbet

2014-09-01

In silico, defined in analogy to in vitro and in vivo as those studies that are performed on a computer, is an essential step in problem-solving and product development in classical engineering fields. The use of in silico models is now slowly easing its way into medicine. In silico models are already used in orthopaedics for the planning of complicated surgeries, personalised implant design and the analysis of gait measurements. However, these in silico models often lack the simulation of the response of the biological system over time. In silico models focusing on the response of the biological systems are in full development. This review starts with an introduction into in silico models of orthopaedic processes. Special attention is paid to the classification of models according to their spatiotemporal scale (gene/protein to population) and the information they were built on (data vs hypotheses). Subsequently, the review focuses on the in silico models used in regenerative orthopaedics research. Contributions of in silico models to an enhanced understanding and optimisation of four key elements-cells, carriers, culture and clinics-are illustrated. Finally, a number of challenges are identified, related to the computational aspects but also to the integration of in silico tools into clinical practice.

Stellate ganglion blockade for analgesia following upper limb surgery.

LENUS (Irish Health Repository)

McDonnell, J G

2012-01-31

We report the successful use of a stellate ganglion block as part of a multi-modal postoperative analgesic regimen. Four patients scheduled for orthopaedic surgery following upper limb trauma underwent blockade of the stellate ganglion pre-operatively under ultrasound guidance. Patients reported excellent postoperative analgesia, with postoperative VAS pain scores between 0 and 2, and consumption of morphine in the first 24 h ranging from 0 to 14 mg. While these are preliminary findings, and must be confirmed in a clinical trial, they highlight the potential for stellate ganglion blockade to provide analgesia following major upper limb surgery.

Hand-arm vibration in orthopaedic surgery: a neglected risk.

Science.gov (United States)

Mahmood, F; Ferguson, K B; Clarke, J; Hill, K; Macdonald, E B; Macdonald, D J M

2017-12-30

Hand-arm vibration syndrome is an occupational disease caused by exposure to hand-arm transmitted vibration. The Health and Safety Executive has set limits for vibration exposure, including an exposure action value (EAV), where steps should be taken to reduce exposure, and an exposure limit value (ELV), beyond which vibrating equipment must not be used for the rest of the working day. To measure hand-arm transmitted vibration among orthopaedic surgeons, who routinely use hand-operated saws. We undertook a cadaveric study measuring vibration associated with a tibial cut using battery-operated saws. Three surgeons undertook three tibial cuts each on cadaveric tibiae. Measurements were taken using a frequency-weighted root mean square acceleration, with the vibration total value calculated as the root of the sums squared in each of the three axes. A mean (SD) vibration magnitude of 1 (0.2) m/s2 in the X-axis, 10.3 (1.9) m/s2 in the Y-axis and 4.2 (1.3) m/s2 in the Z-axis was observed. The weighted root mean squared magnitude of vibration was 11.3 (1.7) m/s2. These results suggest an EAV of 23 min and ELV of 1 h 33 min using this equipment. Our results demonstrate that use of a battery-operated sagittal saw can transmit levels of hand-arm vibration approaching the EAV or ELV through prolonged use. Further study is necessary to quantify this risk and establish whether surveillance is necessary for orthopaedic surgeons. © The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Orthopaedic admissions due to sports and recreation injuries.

LENUS (Irish Health Repository)

Delaney, R A

2009-02-01

The health benefits of exercise may be attenuated by sports and recreation related injury (SRI). Though the majority of SRI are mild and self-limiting, a significant number are serious and require orthopaedic intervention. The aims of this study were to assess the burden of these serious injuries on the orthopaedic inpatient service, and to investigate potential target areas for injury prevention. All 1,590 SRI seen in the ED over a 3-month period were analysed using the Patient Information Management System to determine which patients received inpatient orthopaedic care. The medical records of those 63 patients who required inpatient care under orthopaedics were reviewed and data collected on demographic features, history, operative procedure and theatre resources, and length of hospital stay. Data were analyzed using SPSS. SRI accounted for 12.3% of all ED presentations. The principal activities resulting in injury requiring orthopaedic care were soccer, hurling and informal play e.g. trampoline. Falls made up 37% of the overall mechanism of injury but 68% of the injuries severe enough to require operative management. Most operative procedures were performed as part of a routine day trauma list but 20% were performed out of hours. This group of injuries places a significant burden on a busy trauma service. Injury prevention measures such as public education regarding falls in sport may have a role in reducing this burden.

"Is There An App For That?" Orthopaedic Patient Preferences For A Smartphone Application.

Science.gov (United States)

Datillo, Jonathan R; Gittings, Daniel J; Sloan, Matthew; Hardaker, William M; Deasey, Matthew J; Sheth, Neil P

2017-08-16

Patients are seeking out medical information on the Internet and utilizing smartphone health applications ("apps"). Smartphone use has exponentially increased among orthopaedic surgeons and patients. Despite this increase, patients are rarely directed to specific apps by physicians. No study exists querying patient preferences for a patient-centered, orthopaedic smartphone application. The purpose of this study is to 1) determine Internet use patterns amongst orthopaedic patients; 2) ascertain access to and use of smartphones; and 3) elucidate what features orthopaedic patients find most important in a smartphone application. We surveyed patients in an orthopaedic practice in an urban academic center to assess demographics, access to and patterns of Internet and Smartphone use, and preferences for features in a smartphone app. A total of 310 surveys were completed. Eighty percent of patients reported Internet access, and 62% used the Internet for health information. Seventy-seven percent owned smartphones, 45% used them for health information, and 28% owned health apps. Only 11% were referred to an app by a physician. The highest ranked features were appointment reminders, ability to view test results, communication with physicians, and discharge instructions. General orthopaedic information and pictures or videos explaining surgery were the 2 lowest ranked features. Seventy-one percent of patients felt an app with some of the described features would improve their healthcare experiences, and 40% would pay for the app. The smartphone is an under-utilized tool to enhance patient-physician communication, increase satisfaction, and improve quality of care. Patients were enthusiastic about app features that are often included in patient health portals, but ranked orthopaedic educational features lowest. Further study is required to elucidate how best to use orthopaedic apps as physician-directed educational opportunities to promote patient satisfaction and quality of

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

Spine surgery - discharge

Science.gov (United States)

... milk). This means you should not lift a laundry basket, grocery bags, or small children. You should ... Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. ...

[Differentiation of coding quality in orthopaedics by special, illustration-oriented case group analysis in the G-DRG System 2005].

Science.gov (United States)

Schütz, U; Reichel, H; Dreinhöfer, K

2007-01-01

We introduce a grouping system for clinical practice which allows the separation of DRG coding in specific orthopaedic groups based on anatomic regions, operative procedures, therapeutic interventions and morbidity equivalent diagnosis groups. With this, a differentiated aim-oriented analysis of illustrated internal DRG data becomes possible. The group-specific difference of the coding quality between the DRG groups following primary coding by the orthopaedic surgeon and final coding by the medical controlling is analysed. In a consecutive series of 1600 patients parallel documentation and group-specific comparison of the relevant DRG parameters were carried out in every case after primary and final coding. Analysing the group-specific share in the additional CaseMix coding, the group "spine surgery" dominated, closely followed by the groups "arthroplasty" and "surgery due to infection, tumours, diabetes". Altogether, additional cost-weight-relevant coding was necessary most frequently in the latter group (84%), followed by group "spine surgery" (65%). In DRGs representing conservative orthopaedic treatment documented procedures had nearly no influence on the cost weight. The introduced system of case group analysis in internal DRG documentation can lead to the detection of specific problems in primary coding and cost-weight relevant changes of the case mix. As an instrument for internal process control in the orthopaedic field, it can serve as a communicative interface between an economically oriented classification of the hospital performance and a specific problem solution of the medical staff involved in the department management.

What is the role of autologous blood transfusion in major spine surgery?

Science.gov (United States)

Kumar, Naresh; Chen, Yongsheng; Nath, Chinmoy; Liu, Eugene Hern Choon

2012-06-01

Major spine surgery is associated with significant blood loss, which has numerous complications. Blood loss is therefore an important concern when undertaking any major spine surgery. Blood loss can be addressed by reducing intraoperative blood loss and replenishing perioperative blood loss. Reducing intraoperative blood loss helps maintain hemodynamic equilibrium and provides a clearer operative field during surgery. Homologous blood transfusion is still the mainstay for replenishing blood loss in major spine surgery across the world, despite its known adverse effects. These significant adverse effects can be seen in up to 20% of patients. Autologous blood transfusion avoids the risks associated with homologous blood transfusion and has been shown to be cost-effective. This article reviews the different methods of autologous transfusion and focuses on the use of intraoperative cell salvage in major spine surgery. Autologous blood transfusion is a proven alternative to homologous transfusion in major spine surgery, avoiding most, if not all of these adverse effects. However, autologous blood transfusion rates in major spine surgery remain low across the world. Autologous blood transfusion may obviate the need for homologous transfusion completely. We encourage spine surgeons to consider autologous blood transfusion wherever feasible.

Eponyms in elbow fracture surgery

NARCIS (Netherlands)

Somford, Matthijs P.; Wiegerinck, Johannes I.; Hoornenborg, Daniël; van den Bekerom, Michel P. J.; Eygendaal, Denise

2015-01-01

Eponyms are common in medicine and in orthopaedic surgery. For future reference and historical considerations, we present common eponyms in elbow fracture surgery. We describe in short the biography of the name giver and give, where possible, the original description on which the eponym was based.

Clinical features of anaerobic orthopaedic infections.

Science.gov (United States)

Lebowitz, Dan; Kressmann, Benjamin; Gjoni, Shpresa; Zenelaj, Besa; Grosgurin, Olivier; Marti, Christophe; Zingg, Matthieu; Uçkay, Ilker

2017-02-01

Some patient populations and types of orthopaedic surgery could be at particular risk for anaerobic infections. In this retrospective cohort study of operated adult patients with infections from 2004 to 2014, we assessed obligate anaerobes and considered first clinical infection episodes. Anaerobes, isolated from intra-operative samples, were identified in 2.4% of 2740 surgical procedures, of which half (33/65; 51%) were anaerobic monomicrobial infections. Propionibacterium acnes, a penicillin and vancomycin susceptible pathogen, was the predominantly isolated anaerobe. By multivariate analysis, the presence of fracture fixation plates was the variable most strongly associated with anaerobic infection (odds ratio: 2.1, 95% CI: 1.3-3.5). Anaerobes were also associated with spondylodesis and polymicrobial infections. In contrast, it revealed less likely in native bone or prosthetic joint infections and was not related to prior antibiotic use. In conclusion, obligate anaerobes in our case series of orthopaedic infections were rare, and mostly encountered in infections related to trauma with open-fracture fixation devices rather than clean surgical site infection. Anaerobes were often co-pathogens, and cultures most frequently recovered P. acnes. These observations thus do not support changes in current practices such as broader anaerobe coverage for perioperative prophylaxis.

Corruption in the health care sector: A barrier to access of orthopaedic care and medical devices in Uganda.

Science.gov (United States)

Bouchard, Maryse; Kohler, Jillian C; Orbinski, James; Howard, Andrew

2012-05-03

Globally, injuries cause approximately as many deaths per year as HIV/AIDS, tuberculosis and malaria combined, and 90% of injury deaths occur in low- and middle- income countries. Given not all injuries kill, the disability burden, particularly from orthopaedic injuries, is much higher but is poorly measured at present. The orthopaedic services and orthopaedic medical devices needed to manage the injury burden are frequently unavailable in these countries. Corruption is known to be a major barrier to access of health care, but its effects on access to orthopaedic services is still unknown. A qualitative case study of 45 open-ended interviews was conducted to investigate the access to orthopaedic health services and orthopaedic medical devices in Uganda. Participants included orthopaedic surgeons, related healthcare professionals, industry and government representatives, and patients. Participants' experiences in accessing orthopaedic medical devices were explored. Thematic analysis was used to analyze and code the transcripts. Analysis of the interview data identified poor leadership in government and corruption as major barriers to access of orthopaedic care and orthopaedic medical devices. Corruption was perceived to occur at the worker, hospital and government levels in the forms of misappropriation of funds, theft of equipment, resale of drugs and medical devices, fraud and absenteeism. Other barriers elicited included insufficient health infrastructure and human resources, and high costs of orthopaedic equipment and poverty. This study identified perceived corruption as a significant barrier to access of orthopaedic care and orthopaedic medical devices in Uganda. As the burden of injury continues to grow, the need to combat corruption and ensure access to orthopaedic services is imperative. Anti-corruption strategies such as transparency and accountability measures, codes of conduct, whistleblower protection, and higher wages and benefits for workers could be

Corruption in the health care sector: A barrier to access of orthopaedic care and medical devices in Uganda

Directory of Open Access Journals (Sweden)

Bouchard Maryse

2012-05-01

Full Text Available Abstract Background Globally, injuries cause approximately as many deaths per year as HIV/AIDS, tuberculosis and malaria combined, and 90% of injury deaths occur in low- and middle- income countries. Given not all injuries kill, the disability burden, particularly from orthopaedic injuries, is much higher but is poorly measured at present. The orthopaedic services and orthopaedic medical devices needed to manage the injury burden are frequently unavailable in these countries. Corruption is known to be a major barrier to access of health care, but its effects on access to orthopaedic services is still unknown. Methods A qualitative case study of 45 open-ended interviews was conducted to investigate the access to orthopaedic health services and orthopaedic medical devices in Uganda. Participants included orthopaedic surgeons, related healthcare professionals, industry and government representatives, and patients. Participants’ experiences in accessing orthopaedic medical devices were explored. Thematic analysis was used to analyze and code the transcripts. Results Analysis of the interview data identified poor leadership in government and corruption as major barriers to access of orthopaedic care and orthopaedic medical devices. Corruption was perceived to occur at the worker, hospital and government levels in the forms of misappropriation of funds, theft of equipment, resale of drugs and medical devices, fraud and absenteeism. Other barriers elicited included insufficient health infrastructure and human resources, and high costs of orthopaedic equipment and poverty. Conclusions This study identified perceived corruption as a significant barrier to access of orthopaedic care and orthopaedic medical devices in Uganda. As the burden of injury continues to grow, the need to combat corruption and ensure access to orthopaedic services is imperative. Anti-corruption strategies such as transparency and accountability measures, codes of conduct

Corruption in the health care sector: A barrier to access of orthopaedic care and medical devices in Uganda

Science.gov (United States)

2012-01-01

Background Globally, injuries cause approximately as many deaths per year as HIV/AIDS, tuberculosis and malaria combined, and 90% of injury deaths occur in low- and middle- income countries. Given not all injuries kill, the disability burden, particularly from orthopaedic injuries, is much higher but is poorly measured at present. The orthopaedic services and orthopaedic medical devices needed to manage the injury burden are frequently unavailable in these countries. Corruption is known to be a major barrier to access of health care, but its effects on access to orthopaedic services is still unknown. Methods A qualitative case study of 45 open-ended interviews was conducted to investigate the access to orthopaedic health services and orthopaedic medical devices in Uganda. Participants included orthopaedic surgeons, related healthcare professionals, industry and government representatives, and patients. Participants’ experiences in accessing orthopaedic medical devices were explored. Thematic analysis was used to analyze and code the transcripts. Results Analysis of the interview data identified poor leadership in government and corruption as major barriers to access of orthopaedic care and orthopaedic medical devices. Corruption was perceived to occur at the worker, hospital and government levels in the forms of misappropriation of funds, theft of equipment, resale of drugs and medical devices, fraud and absenteeism. Other barriers elicited included insufficient health infrastructure and human resources, and high costs of orthopaedic equipment and poverty. Conclusions This study identified perceived corruption as a significant barrier to access of orthopaedic care and orthopaedic medical devices in Uganda. As the burden of injury continues to grow, the need to combat corruption and ensure access to orthopaedic services is imperative. Anti-corruption strategies such as transparency and accountability measures, codes of conduct, whistleblower protection, and higher

Feasibility of pre-operative autologous blood donation in Indian patients with elective orthopaedic surgery.

Science.gov (United States)

Saluja, Karan; Marwaha, Neelam; Thakral, Beenu; Goni, Vijay; Sharma, R R; Puri, G D

2006-11-01

Pre-operative autologous blood donation (PABD) in elective orthopaedic surgeries is a well known procedure in the West. We initiated this programme at a tertiary care hospital in north India to study its feasibility in Indian patients. In a prospective case-control study, 144 patients undergoing primary total hip or knee replacement, inter-vertebral discectomy, mal-union and non-union reconstruction were educated and motivated to pre-donate. Patients fulfilling the inclusion criteria and making autologous donation formed the PABD group (n=22). Patients eligible for PABD, but unwilling to participate; age, sex, pre-operative haemoglobin and operative procedure matched acted as controls (n=27). Unit(s) collected was processed like an allogeneic unit. Unit(s) found reactive for infectious markers or not utilized was discarded. Mean blood losses, transfusion trigger, allogeneic exposure and wastage between the two groups were compared. Of the 144 patients motivated, 40 per cent of the eligible subjects pre-deposited. The main motivational factor was fear of getting infection from someone's blood. Cardiac events and anaemia prevented 61.8 per cent patients to participate. Of the 50 units ordered, autologous units with a mean of 1.4 units/patient contributed 62 per cent. For total hip and total knee replacement (THR and TKR), autologous units met 76.2 and 80 per cent respectively of the total blood requirement. A significant decrease in the allogeneic exposure was observed between PABD and control group (18.2 vs 66.7%); 32.3 per cent of the autologous units were discarded. Comprehensive PABD programme may be an effective method for reducing the need for allogeneic transfusion in patients undergoing joint replacement surgeries in our country, where transfusion transmitted infections due to high percentage of replacement donations and lack of sensitive assays for testing are still a cause for concern.

P-Hacking in Orthopaedic Literature: A Twist to the Tail.

Science.gov (United States)

Bin Abd Razak, Hamid Rahmatullah; Ang, Jin-Guang Ernest; Attal, Hersh; Howe, Tet-Sen; Allen, John Carson

2016-10-19

"P-hacking" occurs when researchers preferentially select data or statistical analyses until nonsignificant results become significant. We wanted to evaluate if the phenomenon of p-hacking was evident in orthopaedic literature. We text-mined through all articles published in three top orthopaedic journals in 2015. For anonymity, we cipher-coded the three journals. We included all studies that reported a single p value to answer their main hypothesis. These p values were then charted and frequency graphs were generated to illustrate any evidence of p-hacking. Binomial tests were employed to look for evidence of evidential value and significance of p-hacking. Frequency plots for all three journals revealed evidence of p-hacking. Binomial tests for all three journals were significant for evidence of evidential value (p hacking was significant only for one journal (p = 0.0092). P-hacking is an evolving phenomenon that threatens to jeopardize the evidence-based practice of medicine. Although our results show that there is good evidential value for orthopaedic literature published in our top journals, there is some evidence of p-hacking of which authors and readers should be wary. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Does virtual reality simulation have a role in training trauma and orthopaedic surgeons?

Science.gov (United States)

Bartlett, J D; Lawrence, J E; Stewart, M E; Nakano, N; Khanduja, V

2018-05-01

Aims The aim of this study was to assess the current evidence relating to the benefits of virtual reality (VR) simulation in orthopaedic surgical training, and to identify areas of future research. Materials and Methods A literature search using the MEDLINE, Embase, and Google Scholar databases was performed. The results' titles, abstracts, and references were examined for relevance. Results A total of 31 articles published between 2004 and 2016 and relating to the objective validity and efficacy of specific virtual reality orthopaedic surgical simulators were identified. We found 18 studies demonstrating the construct validity of 16 different orthopaedic virtual reality simulators by comparing expert and novice performance. Eight studies have demonstrated skill acquisition on a simulator by showing improvements in performance with repeated use. A further five studies have demonstrated measurable improvements in operating theatre performance following a period of virtual reality simulator training. Conclusion The demonstration of 'real-world' benefits from the use of VR simulation in knee and shoulder arthroscopy is promising. However, evidence supporting its utility in other forms of orthopaedic surgery is lacking. Further studies of validity and utility should be combined with robust analyses of the cost efficiency of validated simulators to justify the financial investment required for their use in orthopaedic training. Cite this article: Bone Joint J 2018;100-B:559-65.

East African Orthopaedic Journal: Submissions

African Journals Online (AJOL)

Author Guidelines. The East African Orthopaedic Journal is published biannually by the Kenya Orthopaedics Association. Its primary objective is to give researchers in orthopaedics and ... Format should be as follows; Details of authors as for original articles, summary of not more than 200 words, introduction, case report,

The future of robotics in hand surgery.

Science.gov (United States)

Liverneaux, P; Nectoux, E; Taleb, C

2009-10-01

Robotics has spread over many surgical fields over the last decade: orthopaedic, cardiovascular, urologic, gynaecologic surgery and various other types of surgery. There are five different types of robots: passive, semiactive and active robots, telemanipulators and simulators. Hand surgery is at a crossroad between orthopaedic surgery, plastic surgery and microsurgery; it has to deal with fixing all sorts of tissues from bone to soft tissues. To our knowledge, there is not any paper focusing on potential clinical applications in this realm, even though robotics could be helpful for hand surgery. One must point out the numerous works on bone tissue with regard to passive robots (such as fluoroscopic navigation as an ancillary for percutaneous screwing in the scaphoid bone). Telemanipulators, especially in microsurgery, can improve surgical motion by suppressing physiological tremor thanks to movement demultiplication (experimental vascular and nervous sutures previously published). To date, the robotic technology has not yet become simple-to-use, cheap and flawless but in the future, it will probably be of great technical help, and even allow remote-controlled surgery overseas.

The value of comparative research in major day surgery.

Science.gov (United States)

Llop-Gironés, Alba; Vergara-Duarte, Montse; Sánchez, Josep Anton; Tarafa, Gemma; Benach, Joan

2017-05-19

To measure time trends in major day surgery rates according to hospital ownership and other hospital characteristics among the providers of the public healthcare network of Catalonia, Spain. Data from the Statistics of Health Establishments providing Inpatient Care. A generalized linear mixed model with Gaussian response and random intercept and random slopes. The greatest growth in the rate of major day surgery was observed among private for-profit hospitals: 42.9 (SD: 22.5) in 2009 versus 2.7 (SD: 6.7) in 1996. These hospitals exhibited a significant increase in major day surgery compared to public hospitals (coefficient 2; p-value <0.01) CONCLUSIONS: The comparative evaluation of hospital performance is a decisive tool to ensure that public resources are used as rationally and efficiently as possible. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Bone graft materials in fixation of orthopaedic implants in sheep

DEFF Research Database (Denmark)

Babiker, Hassan

2013-01-01

Bone graft is widely used within orthopaedic surgery especially in revision joint arthroplasty and spine fusion. The early implant fixation in the revision situation of loose joint prostheses is important for the long-term survival. Bone autograft has been considered as gold standard in many...... orthopaedic procedures, whereas allograft is the gold standard by replacement of extensive bone loss. However, the use of autograft is associated with donor site morbidity, especially chronic pain. In addition, the limited supply is a significant clinical challenge. Limitations in the use of allograft include...... the risk of bacterial contamination and disease transmission as well as non-union and poor bone quality. Other bone graft and substitutes have been considered as alternative in order to improve implant fixation. Hydroxyapatite and collagen type I composite (HA/Collagen) have the potential in mimicking...

Effect of smoking on early complications after elective orthopaedic surgery

DEFF Research Database (Denmark)

Møller, Ann; Pedersen, Tom Søndergård; Villebro, Nete

2003-01-01

Smoking is an important risk factor for the development of postoperative pulmonary complications after major surgical procedures. We studied 811 consecutive patients who had undergone hip or knee arthroplasty, recording current smoking and drinking habits, any history of chronic disease...... and such intraoperative factors as the type of anaesthesia and the type and duration of surgery. We recorded any postoperative complications occurring before discharge from hospital. There were 232 smokers (28.6%) and 579 non-smokers. We found that smoking was the single most important risk factor for the development...

Audit of Orthopaedic Surgical Documentation

Directory of Open Access Journals (Sweden)

Fionn Coughlan

2015-01-01

Full Text Available Introduction. The Royal College of Surgeons in England published guidelines in 2008 outlining the information that should be documented at each surgery. St. James’s Hospital uses a standard operation sheet for all surgical procedures and these were examined to assess documentation standards. Objectives. To retrospectively audit the hand written orthopaedic operative notes according to established guidelines. Methods. A total of 63 operation notes over seven months were audited in terms of date and time of surgery, surgeon, procedure, elective or emergency indication, operative diagnosis, incision details, signature, closure details, tourniquet time, postop instructions, complications, prosthesis, and serial numbers. Results. A consultant performed 71.4% of procedures; however, 85.7% of the operative notes were written by the registrar. The date and time of surgery, name of surgeon, procedure name, and signature were documented in all cases. The operative diagnosis and postoperative instructions were frequently not documented in the designated location. Incision details were included in 81.7% and prosthesis details in only 30% while the tourniquet time was not documented in any. Conclusion. Completion and documentation of operative procedures were excellent in some areas; improvement is needed in documenting tourniquet time, prosthesis and incision details, and the location of operative diagnosis and postoperative instructions.

International Combined Orthopaedic Research Societies: A model for international collaboration to promote orthopaedic and musculoskeletal research

Directory of Open Access Journals (Sweden)

Theodore Miclau

2014-10-01

Full Text Available In October 2013, the International Combined Orthopaedic Research Societies (ICORS; http://i-cors.org was founded with inaugural member organisations from the previous Combined Orthopaedic Research Society, which had sponsored combined meetings for more than 2 decades. The ICORS is dedicated to the stimulation of orthopaedic and musculoskeletal research in fields such as biomedical engineering, biology, chemistry, and veterinary and human clinical research. The ICORS seeks to facilitate communication with member organisations to enhance international research collaborations and to promote the development of new international orthopaedic and musculoskeletal research organisations. Through new categories of membership, the ICORS represents the broadest coalition of orthopaedic research organisations globally.

Navigation in head and neck oncological surgery: an emerging concept.

Science.gov (United States)

Gangloff, P; Mastronicola, R; Cortese, S; Phulpin, B; Sergeant, C; Guillemin, F; Eluecque, H; Perrot, C; Dolivet, G

2011-01-01

Navigation surgery, initially applied in rhinology, neurosurgery and orthopaedic cases, has been developed over the last twenty years. Surgery based on computed tomography data has become increasingly important in the head and neck region. The technique for hardware fusion between RMI and computed tomography is also becoming more useful. We use such device since 2006 in head and neck carcinologic situation. Navigation allows control of the resection in order to avoid and protect the precise anatomical structures (vessels and nerves). It also guides biopsy and radiofrequency. Therefore, quality of life is much more increased and morbidity is decreased for these patients who undergo major and mutilating head and neck surgery. Here we report the results of 33 navigation procedures performed for 31 patients in our institution.

Internet based patient education improves informed consent for elective orthopaedic surgery: a randomized controlled trial.

Science.gov (United States)

Fraval, Andrew; Chandrananth, Janan; Chong, Yew M; Coventry, Lillian S; Tran, Phong

2015-02-07

Obtaining informed consent is an essential step in the surgical pathway. Providing adequate patient education to enable informed decision making is a continued challenge of contemporary surgical practice. This study investigates whether the use of a patient information website, to augment patient education and informed consent for elective orthopaedic procedures is an effective measure. A randomised controlled trial was conducted comparing the quality of informed consent provided by a standard discussion with the treating surgeon compared to augmentation of this discussion with an online education resource (www.orthoanswer.org). Participants were recruited from orthopaedic outpatient clinics. Patients undergoing five common orthopaedic procedures were eligible to participate in the trial. The primary outcome measure was knowledge about their operation. Satisfaction with their informed consent and anxiety relating to their operation were the secondary outcome measures. There was a statistically significant increase in patient knowledge for the intervention arm as compared to the control arm (p education website as an augment to informed consent improves patient knowledge about their planned operation as well as satisfaction with the consent process whilst not increasing their anxiety levels. We recommend that all patients be directed to web based education tools to augment their consent. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614001058662 .

Quality of online pediatric orthopaedic education materials.

Science.gov (United States)

Feghhi, Daniel P; Komlos, Daniel; Agarwal, Nitin; Sabharwal, Sanjeev

2014-12-03

Increased availability of medical information on the Internet empowers patients to look up answers to questions about their medical conditions. However, the quality of medical information available on the Internet is highly variable. Various tools for the assessment of online medical information have been developed and used to assess the quality and accuracy of medical web sites. In this study we used the LIDA tool (Minervation) to assess the quality of pediatric patient information on the AAOS (American Academy of Orthopaedic Surgeons) and POSNA (Pediatric Orthopaedic Society of North America) web sites. The accessibility, usability, and reliability of online medical information in the "Children" section of the AAOS web site and on the POSNA web site were assessed with use of the LIDA tool. Flesch-Kincaid (FK) and Flesch Reading Ease (FRE) values were also calculated to assess the readability of the pediatric education material. Patient education materials on each web site scored in the moderate range in assessments of accessibility, usability, and reliability. FK and FRE values indicated that the readability of each web site remained at a somewhat higher (more difficult) level than the recommended benchmark. The quality and readability of online information for children on the AAOS and POSNA web sites are acceptable but can be improved further. The quality of online pediatric orthopaedic patient education materials may affect communication with patients and their caregivers, and further investigation and modification of quality are needed. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

Orthopaedic nurses' perception of research utilization - A cross sectional survey

DEFF Research Database (Denmark)

Berthelsen, Connie Bøttcher; Hølge-Hazelton, Bibi

2015-01-01

The call for evidence-based knowledge in clinical nursing practice has increased during recent decades and research in orthopaedic nursing is needed to improve patients' conditions, care and treatment. A descriptive cross-sectional survey was conducted to determine the self-perceived theoretical....... The results indicated that despite the majority of orthopaedic nurses having low self-perceived theoretical knowledge and practical research competencies, their interest and motivation to improve these were high, especially their inner motivation. However, the nurses' inner motivation was inhibited by a lack...

Pre-operative assessment and post-operative care in elective shoulder surgery.

Science.gov (United States)

Akhtar, Ahsan; Macfarlane, Robert J; Waseem, Mohammad

2013-01-01

Pre-operative assessment is required prior to the majority of elective surgical procedures, primarily to ensure that the patient is fit to undergo surgery, whilst identifying issues that may need to be dealt with by the surgical or anaesthetic teams. The post-operative management of elective surgical patients begins during the peri-operative period and involves several health professionals. Appropriate monitoring and repeated clinical assessments are required in order for the signs of surgical complications to be recognised swiftly and adequately. This article examines the literature regarding pre-operative assessment in elective orthopaedic surgery and shoulder surgery, whilst also reviewing the essentials of peri- and post-operative care. The need to recognise common post-operative complications early and promptly is also evaluated, along with discussing thromboprophylaxis and post-operative analgesia following shoulder surgery.

Do Orthopaedic Surgeons Acknowledge Uncertainty?

Science.gov (United States)

Teunis, Teun; Janssen, Stein; Guitton, Thierry G; Ring, David; Parisien, Robert

2016-06-01

Much of the decision-making in orthopaedics rests on uncertain evidence. Uncertainty is therefore part of our normal daily practice, and yet physician uncertainty regarding treatment could diminish patients' health. It is not known if physician uncertainty is a function of the evidence alone or if other factors are involved. With added experience, uncertainty could be expected to diminish, but perhaps more influential are things like physician confidence, belief in the veracity of what is published, and even one's religious beliefs. In addition, it is plausible that the kind of practice a physician works in can affect the experience of uncertainty. Practicing physicians may not be immediately aware of these effects on how uncertainty is experienced in their clinical decision-making. We asked: (1) Does uncertainty and overconfidence bias decrease with years of practice? (2) What sociodemographic factors are independently associated with less recognition of uncertainty, in particular belief in God or other deity or deities, and how is atheism associated with recognition of uncertainty? (3) Do confidence bias (confidence that one's skill is greater than it actually is), degree of trust in the orthopaedic evidence, and degree of statistical sophistication correlate independently with recognition of uncertainty? We created a survey to establish an overall recognition of uncertainty score (four questions), trust in the orthopaedic evidence base (four questions), confidence bias (three questions), and statistical understanding (six questions). Seven hundred six members of the Science of Variation Group, a collaboration that aims to study variation in the definition and treatment of human illness, were approached to complete our survey. This group represents mainly orthopaedic surgeons specializing in trauma or hand and wrist surgery, practicing in Europe and North America, of whom the majority is involved in teaching. Approximately half of the group has more than 10 years

Orthopaedic Sports Medicine Fellowship Interviews: Structure and Organization of the Interview Day.

Science.gov (United States)

Haislup, Brett D; Kraeutler, Matthew J; Baweja, Rishi; McCarty, Eric C; Mulcahey, Mary K

2017-12-01

Over the past few decades, there has been a trend toward an increasing subspecialization in orthopaedic surgery, with orthopaedic sports medicine being one of the most competitive subspecialties. Information regarding the application and interview process for sports medicine fellowships is currently lacking. To survey orthopaedic sports medicine fellowship program directors (PDs) to better define the structure of the sports medicine fellowship interview and to highlight important factors that PDs consider in selecting fellows. Cross-sectional study. A complete list of accredited programs was obtained from the American Orthopaedic Society for Sports Medicine (AOSSM) website. An anonymous survey was distributed to fellowship PDs of all Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic sports medicine fellowships in the United States. The survey included 12 questions about the fellowship interview and selection process. Of the 95 orthopaedic sports medicine fellowship PDs surveyed, 38 (40%) responded. Of these, 16 (42.1%) indicated that they interview between 21 and 30 applicants per year. Eleven of the 38 fellowship programs (28.9%) have only 1 fellow per year at their respective program. Most programs (27/37, 73%) reported that between 0 and 5 faculty members interview applicants, and 29 of the 38 programs (76.3%) arrange for applicants to have ≥4 interviews during their interview day. Large group interviews are conducted at 36 of 38 (94.7%) sports medicine fellowship programs, and most programs (24/38, 63.2%) hold individual interviews that last between 5 and 15 minutes. The most important applicant criterion taken into account by PDs was the quality of the interview, with an average score of 8.68 of 10. The most significant factor taken into account by PDs when deciding how to rank applicants was the quality of the interview. Many orthopaedic sports medicine fellowship programs interview between 21 and 30 applicants per year

Reduced collagen accumulation after major surgery

DEFF Research Database (Denmark)

Jorgensen, L N; Kallehave, F; Karlsmark, T

1996-01-01

.01)). This decline was significantly higher in the six patients who had a postoperative infection (median 3.02 (range -0.06 to 6.14) versus 0.36 (range -1.56 to 12.60) micrograms/cm, P = 0.02). This study shows that major surgery is associated with impairment of subcutaneous collagen accumulation in a test wound...

Orthopaedic research in Australia: a bibliographic analysis of the publication rates in the top 15 journals.

Science.gov (United States)

Hohmann, Erik; Glatt, Vaida; Tetsworth, Kevin

2017-09-01

To investigate the publications rates and characteristics of the authors for manuscripts originating from Australia in the 15 highest ranked orthopaedic journals over a 5-year period. The 15 highest ranked journals in orthopaedics, based on their 2015 impact factor, were used to establish the total number of publications and cumulative impact factor points between January 2010 and December 2014. The affiliations of the primary author and co-authors were used to determine the involvement of Australian trained orthopaedic surgeons. Study location, research topic and anatomic areas were recorded. A total of 478 publications were identified; 110 of these manuscripts were principally authored by Australian trained orthopaedic surgeons or medical professionals affiliated with orthopaedics. In addition, 158 articles were published with orthopaedic surgery involvement where one of the co-authors was an Australian trained surgeon. Australian orthopaedic surgeon (FRACS) involvement was most commonly observed in the knee (n = 90; 33.6%) followed by the hip (n = 69; 25.7%) and basic sciences (n = 27; 10.1%). Surgeons in Sydney had the highest number of publications (n = 95; 35.4%), followed by Adelaide (n = 55; 20.5%) and Melbourne (n = 54; 20.1%). The results of this study demonstrate that the minority (23%) of the publications originating from Australia in the 15 highest-ranking orthopaedic journals were principally authored by either an Australian trained surgeon or a trainee surgeon. A total of 59% of the publications focused on the hip and knee. Sydney was the leading region, followed by Adelaide and Melbourne. These three regions published 76% of all manuscripts identified during the 5-year study period. © 2017 Royal Australasian College of Surgeons.

History of orthopaedics in China: a brief review.

Science.gov (United States)

Li, Jia; Zhang, Yingze

2018-03-01

Chinese orthopaedic surgeons have made a substantial contribution to the development of orthopaedics worldwide, and traditional Chinese medicine (TCM) in orthopaedics has a very long history in China. We make a brief review of the development of orthopaedics in China, intending to pave the way for further understanding of Chinese orthopaedics for scholars all over the world. The description of fractures firstly appeared in 3600 years ago in China, and the theories, experience, and treatment strategies of TCM still play important roles in clinical diagnosis and treatment of orthopaedic disorders in our country. Western orthopaedics was first introduced into China in the early twentieth century. After decades of development, Chinese scholars have made some gratifying achievements in orthopaedics. Orthopaedics is constantly evolving, and we need to strengthen the ability of independent innovation to achieve orthopaedic surgeons' Chinese dream, and better serve our patients.

Bioactive Coatings for Orthopaedic Implants—Recent Trends in Development of Implant Coatings

Directory of Open Access Journals (Sweden)

Bill G. X. Zhang

2014-07-01

Full Text Available Joint replacement is a major orthopaedic procedure used to treat joint osteoarthritis. Aseptic loosening and infection are the two most significant causes of prosthetic implant failure. The ideal implant should be able to promote osteointegration, deter bacterial adhesion and minimize prosthetic infection. Recent developments in material science and cell biology have seen the development of new orthopaedic implant coatings to address these issues. Coatings consisting of bioceramics, extracellular matrix proteins, biological peptides or growth factors impart bioactivity and biocompatibility to the metallic surface of conventional orthopaedic prosthesis that promote bone ingrowth and differentiation of stem cells into osteoblasts leading to enhanced osteointegration of the implant. Furthermore, coatings such as silver, nitric oxide, antibiotics, antiseptics and antimicrobial peptides with anti-microbial properties have also been developed, which show promise in reducing bacterial adhesion and prosthetic infections. This review summarizes some of the recent developments in coatings for orthopaedic implants.

Evaluation of financial burden following complications after major surgery in France: Potential return after perioperative goal-directed therapy.

Science.gov (United States)

Landais, Alain; Morel, Morgane; Goldstein, Jacques; Loriau, Jerôme; Fresnel, Annie; Chevalier, Corinne; Rejasse, Gilles; Alfonsi, Pascal; Ecoffey, Claude

2017-06-01

Perioperative goal-directed therapy (PGDT) has been demonstrated to improve postoperative outcomes and reduce the length of hospital stays. The objective of our analysis was to evaluate the cost of complications, derived from French hospital payments, and calculate the potential cost savings and length of hospital stay reductions. The billing of 2388 patients who underwent scheduled high-risk surgery (i.e. major abdominal, gynaecologic, urological, vascular, and orthopaedic interventions) over three years was retrospectively collected from three French hospitals (one public-teaching, one public, and one private hospital). A relationship between mortality, length of hospital stays, cost/patient, and severity scores, based mainly on postoperative complications but also on preoperative clinical status, were analysed. Statistical analysis was performed using Student's t-tests or Wilcoxon tests. Our analyses determined that a severity score of 3 or 4 was associated with complications in 90% of cases and this represented 36% of patients who, compared with those with a score of 1 or 2, were associated with significantly increased costs (€ 8205±3335 to € 22,081±16,090; Prisk surgeries per year), the potential financial savings ranged from € 40M to € 68M, not including the costs of PGDT and its implementation. Our analysis demonstrates that patients with complications are significantly more expensive to care for than those without complications. In our model, it was projected that implementing PGDT during high-risk surgery may significantly reduce healthcare costs and the length of hospital stays in France while probably improving patient access to care and reducing waiting times for procedures. Copyright © 2017. Published by Elsevier Masson SAS.

Outcomes following major emergency gastric surgery: the importance of specialist surgeons.

Science.gov (United States)

Khan, O A; McGlone, E R; Mercer, S J; Somers, S S; Toh, S K C

2015-01-01

The increasing subspecialisation of general surgeons in their elective work may result in problems for the provision of expert care for emergency cases. There is very little evidence of the impact of subspecialism on outcomes following emergency major upper gastrointestinal surgery. This prospective study investigated whether elective subspecialism of general surgeon is associated with a difference in outcome following major emergency gastric surgery. Between February 1994 and June 2010, the data from all emergency major gastric procedures (defined as patients who underwent laparotomy within 12 hours of referral to the surgical service for bleeding gastroduodenal ulcer and/or undergoing major gastric resection) was prospectively recorded. The sub-specialty interest of operating surgeon was noted and related to post-operative outcomes. Over the study period, a total of 63 major gastric procedures were performed of which 23 (37%) were performed by specialist upper gastrointestinal (UGI) consultants. Surgery performed by a specialist UGI surgeon was associated with a significantly lower surgical complication (4% vs. 28% of cases; p=0.04) and in-patient mortality rate (22% vs. 50%; p=0.03). Major emergency gastric surgery has significantly better clinical outcomes when performed by a specialist UGI surgeon. These results have important implications for provision of an emergency general surgical service. Copyright© Acta Chirurgica Belgica.

What factors influence the production of orthopaedic research in East Africa? A qualitative analysis of interviews.

Science.gov (United States)

Elliott, Iain S; Sonshine, Daniel B; Akhavan, Sina; Slade Shantz, Angelique; Caldwell, Amber; Slade Shantz, Jesse; Gosselin, Richard A; Coughlin, R Richard

2015-06-01

Research addressing the burden of musculoskeletal disease in low- and middle-income countries does not reflect the magnitude of the epidemic in these countries as only 9% of the world's biomedical resources are devoted to addressing problems that affect the health of 90% of the world's population. Little is known regarding the barriers to and drivers of orthopaedic surgery research in such resource-poor settings, the knowledge of which would help direct specific interventions for increasing research capacity and help surgeons from high-income countries support the efforts of our colleagues in low- and middle-income countries. We sought to identify through surveying academic orthopaedic surgeons in East Africa: (1) barriers impeding research, (2) factors that support or drive research, and (3) factors that were identified by some surgeons as barriers and others as drivers (what we term barrier-driver overlap) as they considered the production of clinical research in resource-poor environments. Semistructured interviews were conducted with 21 orthopaedic surgeon faculty members at four academic medical centers in Ethiopia, Kenya, Tanzania, and Uganda. Qualitative content analysis of the interviews was conducted using methods based in grounded theory. Grounded theory begins with qualitative data, such as interview transcripts, and analyzes the data for repeated ideas or concepts which then are coded and grouped into categories which allow for identification of subjects or problems that may not have been apparent previously to the interviewer. We identified and quantified 19 barriers to and 21 drivers of orthopaedic surgery research (mentioned n = 1688 and n = 1729, respectively). Resource, research process, and institutional domains were identified to categorize the barriers (n = 7, n = 5, n = 7, respectively) and drivers (n = 7, n = 8, n = 6, respectively). Resource barriers (46%) were discussed more often by interview subjects compared with the

Multimedia Campaign Enhances Orthopaedic Patient Perceptions of Health Care Quality: A Prospective Analysis of Effect at a Military Treatment Facility.

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Sheean, Andrew J; Foster, James N; Aden, James K; Tubb, Creighton C; Johnson, Anthony E; Stinner, Daniel J

2017-07-01

The importance of patient satisfaction as a measure of quality has grown with initiatives intended to enhance demand for services, refocus reimbursement paradigms, encourage health care efficiencies, and ultimately improve clinical outcomes. The purpose of our performance improvement project was to (1) characterize the effect of a two-pronged multimedia initiative on patient perceptions of health care quality and satisfaction as assessed by the Army Provider Level Satisfaction Survey (APLSS) and (2) assess for differences in APLSS scores between the surgeons that did and did not participate in the program. Baseline APLSS data for our Department of Orthopaedic Surgery were collected and subsequently compared to APLSS results 3 months after the implementation of a department-wide multimedia campaign. The multimedia initiative consisted of two concurrently implemented interventions to the orthopaedic surgery outpatient clinics. One intervention involved placing large-framed posters about the orthopaedic clinic waiting areas on which were written, "We helped write the book," and included pictures of various orthopaedic textbooks of which attending surgeons and/or residents had contributed to as authors. The other intervention provided patients with surgeon "face sheets" upon arrival to their clinic appointments. These sheets included a picture of their attending surgeon, contact information for the surgeon's nurse care coordinator, and a brief biographical sketch of the surgeon's training, clinical interests and expertise, and other information at each surgeon's discretion. Among APLSS survey results for the orthopaedic surgery clinic including all surgeons, significant increases were observed between baseline data and 3-month data for Top 1 and Top 2 responses to the questions, "How satisfied do you feel about your visit?" and "Did your surgeon listen to you carefully about your concerns and questions?" (p = 0.003 and p = 0.004, respectively). The implementation of a

New design of care: Assessment of an interdisciplinary orthopaedic clinic with a pivot nurse in the province of Quebec.

Science.gov (United States)

Poder, Thomas G; Bellemare, Christian; Bédard, Suzanne K; He, Jie; Lemieux, Renald

2010-01-01

New designs of care in orthopaedic clinics are needed to cope with the shortage of orthopaedic surgeons and the lengthening of waiting times. To assess the effectiveness of an interdisciplinary orthopaedic clinic with a pivot nurse in the Canadian province of Quebec with regard to accessibility, quality of care, efficacy and efficiency of the clinic, and patient's quality of life. Two strategies were developed: (1) a selected cohort of new patients attending an orthopaedic service from February to September 2008 were entered into a database recording patient details, source of referral, diagnosis, satisfaction, and quality of life (36-Item Short Form Health Survey version 2). In this setting, 2 sets of questionnaires were administered to the patients: the first one during the first visit and the second one, 2 months later. A total of 243 patients from the case control were compared with 89 patients of the case study, where an interdisciplinary orthopaedic clinic with a pivot nurse has been developed; (2) costs per patient were calculated using the staff timesheets provided by the two orthopaedic clinics. The results showed a significant reduction in the waiting-list duration (accessibility) in the case study clinic owing to a strong decrease in the inappropriate consultations with the orthopaedic consultant. The quality of care remained high, and the target surgeries for total hip and knee replacement were reached, despite a strong shortage of orthopaedic doctors. Interdisciplinary orthopaedic clinic with a pivot nurse is a new approach in the province of Quebec and first results are encouraging.

Evaluation of free or anchored antimicrobial peptides as candidates for the prevention of orthopaedic device-related infections.

Science.gov (United States)

D'Este, Francesca; Oro, Debora; Boix-Lemonche, Gerard; Tossi, Alessandro; Skerlavaj, Barbara

2017-10-01

The prevention of implant-associated infection, one the most feared complications in orthopaedic surgery, remains a major clinical challenge and urges development of effective methods to prevent bacterial colonization of implanted devices. Alpha-helical antimicrobial peptides (AMPs) may be promising candidates in this respect due to their potent and broad-spectrum antimicrobial activity, their low tendency to elicit resistance and possible retention of efficacy in the immobilized state. The aim of this study was to evaluate the potential of five different helical AMPs, the cathelicidins BMAP-27 and BMAP-28, their (1-18) fragments and the rationally designed, artificial P19(9/G7) peptide, for the prevention of orthopaedic implant infections. Peptides were effective at micromolar concentrations against 22 Staphylococcus and Streptococcus isolates from orthopaedic infections, while only BMAP-28 and to a lesser extent BMAP-27 were active against Enterococcus faecalis. Peptides in solution showed activities comparable to those of cefazolin and linezolid, on a molar basis, and also a variable capacity to neutralize bacterial lipopolysaccharide, while devoid of adverse effects on MG-63 osteoblast cells at concentrations corresponding to the MIC. The (1-18) BMAP fragments and P19(9/G7) were selected for further examination, based on better selectivity indices, and showed effectiveness in the presence of hyaluronic acid and in synovial fluid, while human serum affected their activity to variable extents, with BMAP-27(1-18) best retaining activity. This peptide was immobilized on streptavidin-resin beads and retained activity against reference Staphylococcus epidermidis and Staphylococcus aureus strains, with negligible toxicity towards osteoblasts, underlining its potential for the development of infection-resistant biomaterials for orthopaedic application. Copyright © 2017 European Peptide Society and John Wiley & Sons, Ltd. Copyright © 2017 European Peptide Society and

Shared Decision Making, Fast and Slow: Implications for Informed Consent, Resource Utilization, and Patient Satisfaction in Orthopaedic Surgery.

Science.gov (United States)

Bernstein, Joseph; Kupperman, Eli; Kandel, Leonid Ari; Ahn, Jaimo

2016-07-01

Through shared decision making, the physician and patient exchange information to arrive at an agreement about the patient's preferred treatment. This process is predicated on the assumption that there is a single preferred treatment, and the goal of the dialog is to discover it. In contrast, psychology theory (ie, prospect theory) suggests that people can make decisions both analytically and intuitively through parallel decision-making processes, and depending on how the choice is framed, the two processes may not agree. Thus, patients may not have a single preferred treatment, but rather separate intuitive and analytic preferences. The research question addressed here is whether subjects might reveal different therapeutic preferences based on how a decision is framed. Five clinical scenarios on the management of tibial plateau fractures were constructed. Healthy volunteers were asked to select among treatments offered. Four weeks later, the scenarios were presented again; the facts of the scenario were unchanged, but the description was altered to test the null hypothesis that minor changes in wording would not lead the subjects to change their decision about treatment. For example, incomplete improvement after surgery was described first as a gain from the preoperative state and then as a loss from the preinjury state. In all five cases, the variation predicted by psychology theory was detected. Respondents were affected by whether choices were framed as avoided losses versus potential gains; by emotional cues; by choices reported by others (ie, bandwagon effect); by the answers proposed to them in the question (ie, anchors); and by seemingly irrelevant options (ie, decoys). The influence of presentation on preferences can be highly significant in orthopaedic surgery. The presence of parallel decision-making processes implies that the standard methods of obtaining informed consent may require further refinement. Furthermore, if the way that information is

The Effect of an Orthopaedic Surgical Procedure in the National Basketball Association.

Science.gov (United States)

Minhas, Shobhit V; Kester, Benjamin S; Larkin, Kevin E; Hsu, Wellington K

2016-04-01

Professional basketball players have a high incidence of injuries requiring surgical intervention. However, no studies in the current literature have compared postoperative performance outcomes among common injuries to determine high- and low-risk procedures to these athletes' careers. To compare return-to-play (RTP) rates and performance-based outcomes after different orthopaedic procedures in National Basketball Association (NBA) players and to determine which surgeries are associated with the worst postoperative change in performance. Cohort study; Level of evidence, 3. Athletes in the NBA undergoing anterior cruciate ligament reconstruction, Achilles tendon repair, lumbar discectomy, microfracture, meniscus surgery, hand/wrist or foot fracture fixation, and shoulder stabilization were identified through team injury reports and archives on public record. The RTP rate, games played per season, and player efficiency rating (PER) were determined before and after surgery. Statistical analysis was used to compare the change between pre- and postsurgical performance among the different injuries. A total of 348 players were included. The RTP rates were highest in patients with hand/wrist fractures (98.1%; mean age, 27.0 years) and lowest for those with Achilles tears (70.8%; mean age, 28.4 years) (P = .005). Age ≥30 years (odds ratio [OR], 3.85; 95% CI, 1.24-11.91) and body mass index ≥27 kg/m(2) (OR, 3.46; 95% CI, 1.05-11.40) were predictors of not returning to play. Players undergoing Achilles tendon repair and arthroscopic knee surgery had a significantly greater decline in postoperative performance outcomes at the 1- and 3-year time points and had shorter career lengths compared with the other procedures. NBA players undergoing Achilles tendon rupture repair or arthroscopic knee surgery had significantly worse performance postoperatively compared with other orthopaedic procedures. © 2016 The Author(s).

Surgical simulation in orthopaedic skills training.

Science.gov (United States)

Atesok, Kivanc; Mabrey, Jay D; Jazrawi, Laith M; Egol, Kenneth A

2012-07-01

Mastering rapidly evolving orthopaedic surgical techniques requires a lengthy period of training. Current work-hour restrictions and cost pressures force trainees to face the challenge of acquiring more complex surgical skills in a shorter amount of time. As a result, alternative methods to improve the surgical skills of orthopaedic trainees outside the operating room have been developed. These methods include hands-on training in a laboratory setting using synthetic bones or cadaver models as well as software tools and computerized simulators that enable trainees to plan and simulate orthopaedic operations in a three-dimensional virtual environment. Laboratory-based training offers potential benefits in the development of basic surgical skills, such as using surgical tools and implants appropriately, achieving competency in procedures that have a steep learning curve, and assessing already acquired skills while minimizing concerns for patient safety, operating room time, and financial constraints. Current evidence supporting the educational advantages of surgical simulation in orthopaedic skills training is limited. Despite this, positive effects on the overall education of orthopaedic residents, and on maintaining the proficiency of practicing orthopaedic surgeons, are anticipated.

Demographics, nature and treatment of orthopaedic trauma injuries occurring in an agricultural context in the West of Ireland.

LENUS (Irish Health Repository)

Byrne, F J

2011-03-01

Farming is a major industry in the West of Ireland. This prospective study examined the age profile, nature and treatment of orthopaedic injuries occurring in agricultural surroundings presenting at the Orthopaedic Unit of Merlin Park Hospital, Galway.

American Academy of Orthopaedic Surgeons

Science.gov (United States)

... Research Research Tools Research Roadmap Facts and Figures Unified Orthopaedic Research Agenda Sex and Gender in Research ... Career Center Clinician Scholar Career Development Clinician-Patient Communication Leadership Fellows Program Medical Student Resources Postgraduate Orthopaedic ...

Quantification of facial contamination with blood during orthopaedic procedures.

LENUS (Irish Health Repository)

Collins, D

2012-02-03

Operative surgery exposes the surgeon to possible blood-borne infections. Risks include pen-etrating injuries and conjunctival contact with infected blood. Visor masks worn during orthopaedic trauma procedures were assessed for blood contamination using computer analysis. This was found to be present on 86% of masks, of which only 15% was recognized by the surgeon intraoperatively. Of the blood splashes 80% were less than 0.6mm in diameter. We conclude that power instrumentation produces a blood particulate mist causing considerable microscopic, facial contamination which is a significant risk to the surgeon.

Sustainability: orthopaedic surgery wait time management strategies.

Science.gov (United States)

Amar, Claudia; Pomey, Marie-Pascale; SanMartin, Claudia; De Coster, Carolyn; Noseworthy, Tom

2015-01-01

The purpose of this paper is to examine Canadian organizational and systemic factors that made it possible to keep wait times within federally established limits for at least 18 months. The research design is a multiple cases study. The paper selected three cases: Case 1 - staff were able to maintain compliance with requirements for more than 18 months; Case 2 - staff were able to meet requirements for 18 months, but unable to sustain this level; Case 3 - staff were never able to meet the requirements. For each case the authors interviewed persons involved in the strategies and collected documents. The paper analysed systemic and organizational-level factors; including governance and leadership, culture, resources, methods and tools. Findings indicate that the hospital that was able to maintain compliance with the wait time requirements had specific characteristics: an exclusive mandate to do only hip and knee replacement surgery; motivated staff who were not distracted by other concerns; and a strong team spirit. The authors' research highlights an important gradient between three cases regarding the factors that sustain waiting times. The paper show that the hospital factory model seems attractive in a super-specialized surgery context. However, patients are selected for simple surgeries, without complications, and so this cannot be considered a unique model.

Critical roles of orthopaedic surgeon leadership in healthcare systems to improve orthopaedic surgical patient safety.

Science.gov (United States)

Kuo, Calvin C; Robb, William J

2013-06-01

The prevention of medical and surgical harm remains an important public health problem despite increased awareness and implementation of safety programs. Successful introduction and maintenance of surgical safety programs require both surgeon leadership and collaborative surgeon-hospital alignment. Documentation of success of such surgical safety programs in orthopaedic practice is limited. We describe the scope of orthopaedic surgical patient safety issues, define critical elements of orthopaedic surgical safety, and outline leadership roles for orthopaedic surgeons needed to establish and sustain a culture of safety in contemporary healthcare systems. We identified the most common causes of preventable surgical harm based on adverse and sentinel surgical events reported to The Joint Commission. A comprehensive literature review through a MEDLINE(®) database search (January 1982 through April 2012) to identify pertinent orthopaedic surgical safety articles found 14 articles. Where gaps in orthopaedic literature were identified, the review was supplemented by 22 nonorthopaedic surgical references. Our final review included 36 articles. Six important surgical safety program elements needed to eliminate preventable surgical harm were identified: (1) effective surgical team communication, (2) proper informed consent, (3) implementation and regular use of surgical checklists, (4) proper surgical site/procedure identification, (5) reduction of surgical team distractions, and (6) routine surgical data collection and analysis to improve the safety and quality of surgical patient care. Successful surgical safety programs require a culture of safety supported by all six key surgical safety program elements, active surgeon champions, and collaborative hospital and/or administrative support designed to enhance surgical safety and improve surgical patient outcomes. Further research measuring improvements from such surgical safety systems in orthopaedic care is needed.

Complications in ankle fracture surgery

OpenAIRE

Ovaska, Mikko

2015-01-01

Mikko Ovaska. Complications in Ankle Fracture Surgery. Helsinki Bone and Joint Research Group, Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, University of Helsinki, Finland. Helsinki 2014. Ankle fractures are among the most frequently encountered surgically treated fractures. The operative treatment of this fracture may be associated with several complications. The most frequently encountered complications are related wound healing, and deep infection may have d...

Patient compliance and effect of orthopaedic shoes

DEFF Research Database (Denmark)

Philipsen, A B; Ellitsgaard, N; Krogsgaard, M R

1999-01-01

Orthopaedic shoes are individually handmade after a prescription from an orthopaedic surgeon, hence relatively expensive. Bad compliance is mentioned in the literature but not investigated. In order to evaluate patient compliance and the effect of orthopaedic shoes, 85 patients who were prescribed...

SUBSPECIALIZATION IN THE FIELD OF ORTHOPAEDIC SURGERY

African Journals Online (AJOL)

provide comprehensive care of acutely injured patients. ... total hip replacement surgery, that focus on one body part can achieve ... like malnutrition, communicable diseases and trauma. ... for children treated for closed femoral shaft fractures.

Does a Weekly Didactic Conference Improve Resident Performance on the Pediatric Domain of the Orthopaedic In-Training Examination?

Science.gov (United States)

Franklin, Corinna C; Bosch, Patrick P; Grudziak, Jan S; Dede, Ozgur; Ramirez, Rey N; Mendelson, Steven A; Ward, W Timothy; Brooks, Maria; Kenkre, Tanya; Lubahn, John D; Deeney, Vincent F; Roach, James W

2017-03-01

Performance on the Orthopaedic In-training Examination (OITE) has been correlated with performance on the written portion of the American Board of Orthopaedic Surgery examination. Herein we sought to discover whether adding a regular pediatric didactic lecture improved residents' performance on the OITE's pediatric domain. In 2012, a didactic lecture series was started in the University of Pittsburgh Medical Center (UPMC) Hamot Orthopaedic Residency Program (Hamot). This includes all topics in pediatric orthopaedic surgery and has teaching faculty present, and occurs weekly with all residents attending. A neighboring program [UMPC Pittsburgh (Pitt)] shares in these conferences, but only during their pediatric rotation. We sought to determine the effectiveness of the conference by comparing the historic scores from each program on the pediatric domain of the OITE examination to scores after the institution of the conference, and by comparing the 2 programs' scores. Both programs demonstrated improvement in OITE scores. In 2008, the mean examination score was 19.6±4.3 (11.0 to 30.0), and the mean percentile was 57.7±12.6 (32.0 to 88.0); in 2014, the mean examination score was 23.5±4.2 (14.0 to 33.0) and the mean percentile was 67.1±12.1 (40.0 to 94.0). OITE scores and percentiles improved with post graduate year (Pdidactic pediatric lecture improved residents' scores on the OITE and indirectly suggests that more frequent attendance is associated with better scores. Level III-retrospective case-control study.

Patient Perspectives of Midlevel Providers in Orthopaedic Sports Medicine.

Science.gov (United States)

Manning, Blaine T; Bohl, Daniel D; Hannon, Charles P; Redondo, Michael L; Christian, David R; Forsythe, Brian; Nho, Shane J; Bach, Bernard R

2018-04-01

Midlevel providers (eg, nurse practitioners and physician assistants) have been integrated into orthopaedic systems of care in response to the increasing demand for musculoskeletal care. Few studies have examined patient perspectives toward midlevel providers in orthopaedic sports medicine. To identify perspectives of orthopaedic sports medicine patients regarding midlevel providers, including optimal scope of practice, reimbursement equity with physicians, and importance of the physician's midlevel provider to patients when initially selecting a physician. Cross-sectional study; Level of evidence, 3. A total of 690 consecutive new patients of 3 orthopaedic sports medicine physicians were prospectively administered an anonymous questionnaire prior to their first visit. Content included patient perspectives regarding midlevel provider importance in physician selection, optimal scope of practice, and reimbursement equity with physicians. Of the 690 consecutive patients who were administered the survey, 605 (87.7%) responded. Of these, 51.9% were men and 48.1% were women, with a mean age of 40.5 ± 15.7 years. More than half (51.2%) perceived no differences in training levels between physician assistants and nurse practitioners. A majority of patients (62.9%) reported that the physician's midlevel provider is an important consideration when choosing a new orthopaedic sports medicine physician. Patients had specific preferences regarding which services should be physician provided. Patients also reported specific preferences regarding those services that could be midlevel provided. There lacked a consensus on reimbursement equity for midlevel practitioners and physicians, despite 71.7% of patients responding that the physician provides a higher-quality consultation. As health care becomes value driven and consumer-centric, understanding patient perspectives on midlevel providers will allow orthopaedic sports medicine physicians to optimize efficiency and patient

Preliminary analysis of force-torque measurements for robot-assisted fracture surgery.

Science.gov (United States)

Georgilas, Ioannis; Dagnino, Giulio; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja

2015-08-01

Our group at Bristol Robotics Laboratory has been working on a new robotic system for fracture surgery that has been previously reported [1]. The robotic system is being developed for distal femur fractures and features a robot that manipulates the small fracture fragments through small percutaneous incisions and a robot that re-aligns the long bones. The robots controller design relies on accurate and bounded force and position parameters for which we require real surgical data. This paper reports preliminary findings of forces and torques applied during bone and soft tissue manipulation in typical orthopaedic surgery procedures. Using customised orthopaedic surgical tools we have collected data from a range of orthopaedic surgical procedures at Bristol Royal Infirmary, UK. Maximum forces and torques encountered during fracture manipulation which involved proximal femur and soft tissue distraction around it and reduction of neck of femur fractures have been recorded and further analysed in conjunction with accompanying image recordings. Using this data we are establishing a set of technical requirements for creating safe and dynamically stable minimally invasive robot-assisted fracture surgery (RAFS) systems.

Transversus Abdominis Plane Catheter Bolus Analgesia after Major Abdominal Surgery

Directory of Open Access Journals (Sweden)

Nils Bjerregaard

2012-01-01

Full Text Available Purpose. Transversus abdominis plane (TAP blocks have been shown to reduce pain and opioid requirements after abdominal surgery. The aim of the present case series was to demonstrate the use of TAP catheter injections of bupivacaine after major abdominal surgery. Methods. Fifteen patients scheduled for open colonic resection surgery were included. After induction of anesthesia, bilateral TAP catheters were placed, and all patients received a bolus dose of 20 mL bupivacaine 2.5 mg/mL with epinephrine 5 μg/mL through each catheter. Additional bolus doses were injected bilaterally 12, 24, and 36 hrs after the first injections. Supplemental pain treatment consisted of paracetamol, ibuprofen, and gabapentin. Intravenous morphine was used as rescue analgesic. Postoperative pain was rated on a numeric rating scale (NRS, 0–10 at regular predefined intervals after surgery, and consumption of intravenous morphine was recorded. Results. The TAP catheters were placed without any technical difficulties. NRS scores were ≤3 at rest and ≤5 during cough at 4, 8, 12, 18, 24, and 36 hrs after surgery. Cumulative consumption of intravenous morphine was 28 (23–48 mg (median, IQR within the first 48 postoperative hours. Conclusion. TAP catheter bolus injections can be used to prolong analgesia after major abdominal surgery.

A multiple-dose, double-blind comparison of intramuscularly and orally administered ketorolac tromethamine and Ketogan in patients with pain following orthopaedic surgery

DEFF Research Database (Denmark)

Gebuhr, Peter Henrik; Soelberg, M; Strauss, W

1994-01-01

combination product containing the narcotic analgesic, ketobemidone, plus a spasmolytic agent) by intramuscular injection every 1-6 h as needed for pain. When patients were able to tolerate an oral diet and were expected to respond to oral analgesic medication, based on overall pain sensitivity, they were...... and at the end of each day. Both treatments were effective immediately after the first dose and during the subsequent multiple-dose phase. There were no statistically significant differences between ketorolac and Ketogan. The results show that 10-mg doses of ketorolac in intramuscular injections followed by 10......In this multiple-dose, double-blind study 100 patients with moderate, severe or very severe pain following orthopaedic surgery were randomly assigned to receive ketorolac, a non-steroidal anti-inflammatory drug with potent analgesic properties (10 mg), or the standard regimen of Ketogan (a...

Total hip and knee replacement surgery results in changes in leukocyte and endothelial markers

Directory of Open Access Journals (Sweden)

Maclean Kirsty M

2010-01-01

Full Text Available Abstract Background It is estimated that over 8 million people in the United Kingdom suffer from osteoarthritis. These patients may require orthopaedic surgical intervention to help alleviate their clinical condition. Investigations presented here was to test the hypothesis that total hip replacement (THR and total knee replacement (TKR orthopaedic surgery result in changes to leukocyte and endothelial markers thus increasing inflammatory reactions postoperatively. Methods During this 'pilot study', ten test subjects were all scheduled for THR or TKR elective surgery due to osteoarthritis. Leukocyte concentrations were measured using an automated full blood count analyser. Leukocyte CD11b (Mac-1 and CD62L cell surface expression, intracellular production of H2O2 and elastase were measured as markers of leukocyte function. Von Willebrand factor (vWF and soluble intercellular adhesion molecule-1 (sICAM-1 were measured as markers of endothelial activation. Results The results obtained during this study demonstrate that THR and TKR orthopaedic surgery result in similar changes of leukocyte and endothelial markers, suggestive of increased inflammatory reactions postoperatively. Specifically, THR and TKR surgery resulted in a leukocytosis, this being demonstrated by an increase in the total leukocyte concentration following surgery. Evidence of leukocyte activation was demonstrated by a decrease in CD62L expression and an increase in CD11b expression by neutrophils and monocytes respectively. An increase in the intracellular H2O2 production by neutrophils and monocytes and in the leukocyte elastase concentrations was also evident of leukocyte activation following orthopaedic surgery. With respect to endothelial activation, increases in vWF and sICAM-1 concentrations were demonstrated following surgery. Conclusion In general it appeared that most of the leukocyte and endothelial markers measured during these studies peaked between days 1

Orthopaedic research and education foundation and industry.

Science.gov (United States)

Wurth, Gene R; Sherr, Judy H; Coffman, Thomas M

2003-07-01

Members of orthopaedic industry commit a significant amount of funds each year to support research and education programs that are directly related to their product(s). In addition, industry supports organizations such as the Orthopaedic Research and Education Foundation. The relationship between the Orthopaedic Research and Education Foundation and industry began in the early 1980s. The support to the Orthopaedic Research and Education Foundation from industry primarily has come in the form of unrestricted grants. These grants best can be looked at as an investment rather than a contribution. This form of giving, once called corporate philanthropy is more accurately referred to as strategic philanthropy. Members of industry make these investments to enhance their reputations, build brand awareness, market their products and services, improve employee morale, increase customer loyalty, and establish strategic alliances. The specialty of orthopaedics is among the leaders in medicine in the amount of funding raised within the specialty for research and education programs. This is because of the amount of support from members of industry and the surgeons. During the past 15 years, 40% of the annual support to the Orthopaedic Research and Education Foundation has come from industry and the balance has come from surgeons and members of lay public. Future industry support of the Orthopaedic Research and Education Foundation and other organizations within the specialty of orthopaedics will be dependent on the continued demonstration of tangible returns in areas described.

Origins of eponymous orthopaedic equipment.

Science.gov (United States)

Meals, Clifton; Wang, Jeffrey

2010-06-01

Orthopaedists make great use of eponymous equipment, however the origins of these tools are unknown to many users. This history enriches, enlightens, and enhances surgical education, and may inspire modern innovation. We explored the origins of common and eponymous orthopaedic equipment. We selected pieces of equipment named for their inventors and in the broadest use by modern orthopaedists. We do not describe specialized orthopaedic implants and instruments owing to the overwhelming number of these devices. The history of this equipment reflects the coevolution of orthopaedics and battlefield medicine. Additionally, these stories evidence the primacy of elegant design and suggest that innovation is often a process of revision and refinement rather than sudden inspiration. Their history exposes surgical innovators as brilliant, lucky, hardworking, and sometimes odd. These stories amuse, enlighten, and may inspire modern orthopaedists to develop creative solutions of their own. The rich history of the field's eponymous instruments informs an ongoing tradition of innovation in orthopaedics.

The impact of orthopaedic research evidence on health financing in Australia.

Science.gov (United States)

Hua, Martin; Myers, Daniel; Host, Lachlan

2018-05-02

In Australia, approval by the Medical Services Advisory Committee (MSAC) is an important step in the implementation of new health technologies. The MSAC considers health technology assessments (HTA) when submitting a recommendation to the Minister of Health on a new technology's suitability for public funding. Despite being such a critical tool in formulating policy, there has been little scrutiny on the impact of limited evidence on the performance of a national HTA agency's mandate. We aim to determine the proportion of HTAs of orthopaedic technologies prepared for the MSAC that were supported by higher levels of evidence for effectiveness, and whether this affected the MSAC's ability to conclude on efficacy. We also investigated whether the availability of higher level evidence affected the performance of cost-effectiveness analyses. We performed a cohort study of all HTAs prepared for the MSAC from 1998 to 2017 with regards to new technologies in orthopaedic surgery. We identified seven HTAs encompassing nine orthopaedic technologies for inclusion. Higher levels of evidence were available for assessing the technology's effectiveness in six out of the nine technologies. The results did not show a statistically significant relationship between the availability of higher level evidence and MSAC's ability to make a clear conclusion on the assessment of effectiveness (P = 0.5). The proportion of HTAs where a cost-effectiveness analysis was performed was significantly higher (P decision-making.

A review of the use of common antiplatelet agents in orthopaedic practice.

LENUS (Irish Health Repository)

Dineen, P F

2010-09-01

Antiplatelet agents are widely prescribed for the primary and secondary prevention of cardiovascular events. A common clinical problem facing orthopaedic and trauma surgeons is how to manage patients receiving these agents who require surgery, either electively or following trauma. The dilemma is to balance the risk of increased blood loss if the antiplatelet agents are continued peri-operatively against the risk of coronary artery\\/stent thrombosis and\\/or other vascular event if the drugs are stopped. The traditional approach of stopping these medications up to two weeks before surgery appears to pose significant danger to patients and may require review. This paper covers the important aspects regarding the two most commonly prescribed antiplatelet agents, aspirin and clopidogrel.

Comparative Readability of Shoulder and Elbow Patient Education Materials within Orthopaedic Websites.

Science.gov (United States)

Beutel, Bryan G; Danna, Natalie R; Melamed, Eitan; Capo, John T

2015-12-01

There is growing concern that the readability of online orthopaedic patient education materials are too difficult for the general public to fully understand. It is recommended that this information be at the sixth grade reading level or lower. This study compared the readability of shoulder and elbow education articles from the American Academy of Orthopaedic Surgeons (AAOS) and American Society for Surgery of the Hand (ASSH) websites. Seventy-six patient education articles from the AAOS and ASSH concerning shoulder and elbow disorders were evaluated. Each article was assessed for the number of years since its last update, word count, percentage of passive sentences, Flesch Reading Ease score, Flesch-Kincaid grade level, Simple Measure of Gobbledygook (SMOG) grade, and New Dale-Chall grade level. Only one article was at or below the sixth grade reading level. The AAOS and ASSH articles had the following respective scores: a mean Flesch Reading Ease score of 54.3 and 51.8, Flesch-Kincaid grade level of 9.4 and 10.3, SMOG grade of 8.5 and 9.4, and New Dale-Chall grade of 10.4 and 11.0. Articles from the AAOS were longer (p education materials regarding the shoulder and elbow on the AAOS and ASSH websites have readability scores above the recommended reading level. These may be too challenging for the majority of patients to read and consequently serve as a barrier to proper patient education. Reducing the percentage of passive sentences may serve as a novel target for improving readability.

Orthopaedic Footwear Design

Science.gov (United States)

1992-01-01

Although the need for orthopaedic shoes is increasing, the number of skilled shoemakers has declined. This has led to the development of a CAD/CAM system to design and fabricate, orthopaedic footwear. The NASA-developed RIM database management system is the central repository for CUSTOMLAST's information storage. Several other modules also comprise the system. The project was initiated by Langley Research Center and Research Triangle Institute in cooperation with the Veterans Administration and the National Institute for Disability and Rehabilitation Research. Later development was done by North Carolina State University and the University of Missouri-Columbia. The software is licensed by both universities.

Major reduction in 30-day mortality after elective colorectal cancer surgery

DEFF Research Database (Denmark)

Iversen, Lene Hjerrild; Ingeholm, Peter; Gögenur, Ismail

2014-01-01

BACKGROUND: For years, the outcome of colorectal cancer (CRC) surgery has been inferior in Denmark compared to its neighbouring countries. Several strategies have been initiated in Denmark to improve CRC prognosis. We studied whether there has been any effect on postoperative mortality based...... on the information from a national database. METHODS: Patients who underwent elective major surgery for CRC in the period 2001-2011 were identified in the national Danish Colorectal Cancer Group database. Thirty-day mortality rates were calculated and factors with impact on mortality were identified using logistic...... the study period. CONCLUSION: The 30-day mortality rate after elective major surgery for CRC has decreased significantly in Denmark in the past decade. Laparoscopic surgical approach was associated with a reduction in mortality in colon cancer....

Plasma fibronectin in patients undergoing major surgery

International Nuclear Information System (INIS)

Sallam, M.H.M.

2003-01-01

Plasma fibronectin in patients undergoing major surgery had been determined before and after operation. The study was done on 15 patients and 15 normal healthy individuals. The study revealed that patients subjected to major operation, their fibronectin level was normal before operation followed by reduction one day post-operation. After one week, fibronectin level raised again nearly to the pre-operations levels. The probable mechanisms of fibronectin in healing processes were discussed. Fibronectin (FN) is a family of structurally and immunologically related high molecular weight glycoproteins that are present in many cell surfaces, in extracellular fluids, in connective tissues and in most membranes. Interaction with certain discrete extracellular substances, such as a glucosaminoglycans (e.g. heparin), fibrin and collagen and with cell surface structure seem to account for many of its biological activities, among which are regulation of adhesion, spreading and locomotion (Mosesson and amrani, 1980). The concentration of Fn in human plasma decreases after extensive destruction such as that occurs in major surgery, burns or other trauma. This decrease has been generally though to be due to increased consumption of soluble plasma Fn in opsonization of particulate and soluble debris from circulation by the reticuloendothelial (RE) system. Fn rapidly appears in injury areas, in experimentally induced blisters, wounded and epithelium tissues (Petersen et al., 1985). Fn accumulates at times of increased vascular permeability and it is produced by cell of blood vessels in response to injury

[Shoulder surgery using only regional anaesthesia].

Science.gov (United States)

Tilbury, Claire; van Kampen, Paulien M; Offenberg, Tom A M M; Hogervorst, Tom; Huijsmans, Pol E

2011-01-01

Effective intra-operative anaesthesia and peri-operative analgesia are important aspects of patient care in orthopaedic surgery. The interscalene regional anaesthetic block technique, performed with the patient lying in a lateral decubitus position, is new for arthroscopic shoulder surgery conducted in the Netherlands. The combination of the interscalene block (without general anaesthesia) and the lateral decubitus position results in better peri-operative conditions for the patient. Better analgesia, increased patient satisfaction and fewer complications in comparison to general anaesthesia have been reported for these types of surgery.

Safety of intravenous tranexamic acid in patients undergoing majororthopaedic surgery: a meta-analysis of randomised controlled trials

Science.gov (United States)

Franchini, Massimo; Mengoli, Carlo; Marietta, Marco; Marano, Giuseppe; Vaglio, Stefania; Pupella, Simonetta; Mannucci, Pier Mannuccio; Liumbruno, Giancarlo M.

2018-01-01

Among the various pharmacological options to decrease peri-operative bleeding, tranexamic acid appears to be one of the most interesting. Several trials have consistently documented the efficacy of this synthetic drug in reducing the risk of blood loss and the need for allogeneic blood transfusion in patients undergoing total hip and knee arthroplasty. The safety of intravenous tranexamic acid in major orthopaedic surgery, particularly regarding the risk of venous thromboembolism, was systematically analysed in this review. A systematic search of the literature identified 73 randomised controlled trials involving 4,174 patients and 2,779 controls. The raw overall incidence of venous thromboembolism was 2.1% in patients who received intravenous tranexamic acid and 2.0% in controls. A meta-analytic pooling showed that the risk of venous thromboembolism in tranexamic acid-treated patients was not significantly different from that of controls (risk difference: 0.01%, 95% confidence interval [CI]: −0.05%, 0.07%; risk ratio: 1.067, 95% CI: 0.760–1.496). Other severe drug-related adverse events occurred very rarely (0.1%). In conclusion, the results of this systematic review and meta-analysis show that intravenous tranexamic acid is a safe pharmacological treatment to reduce blood loss and transfusion requirements in patients undergoing major orthopaedic surgery. PMID:29337665

Reflections in a time of transition: orthopaedic faculty and resident understanding of accreditation schemes and opinions on surgical skills feedback

Directory of Open Access Journals (Sweden)

Kenneth R. Gundle

2016-04-01

Full Text Available Introduction: Orthopaedic surgery is one of the first seven specialties that began collecting Milestone data as part of the Accreditation Council for Graduate Medical Education's Next Accreditation System (NAS rollout. This transition from process-based advancement to outcome-based education is an opportunity to assess resident and faculty understanding of changing paradigms, and opinions about technical skill evaluation. Methods: In a large academic orthopaedic surgery residency program, residents and faculty were anonymously surveyed. A total of 31/32 (97% residents and 29/53 (55% faculty responded to Likert scale assessments and provided open-ended responses. An internal end-of-rotation audit was conducted to assess timeliness of evaluations. A mixed-method analysis was utilized, with nonparametric statistical testing and a constant-comparative qualitative method. Results: There was greater familiarity with the six core competencies than with Milestones or the NAS (p<0.05. A majority of faculty and residents felt that end-of-rotation evaluations were not adequate for surgical skills feedback. Fifty-eight per cent of residents reported that end-of-rotation evaluations were rarely or never filled out in a timely fashion. An internal audit demonstrated that more than 30% of evaluations were completed over a month after rotation end. Qualitative analysis included themes of resident desire for more face-to-face feedback on technical skills after operative cases, and several barriers to more frequent feedback. Discussion: The NAS and outcome-based education have arrived. Residents and faculty need to be educated on this changing paradigm. This transition period is also a window of opportunity to address methods of evaluation and feedback. In our orthopaedic residency, trainees were significantly less satisfied than faculty with the amount of technical and surgical skills feedback being provided to trainees. The quantitative and qualitative analyses

Bacteriophage Mediated Killing of Staphylococcus aureus In Vitro on Orthopaedic K Wires in Presence of Linezolid Prevents Implant Colonization

Science.gov (United States)

Kaur, Sandeep; Harjai, Kusum; Chhibber, Sanjay

2014-01-01

Background Infections of bone and joint tissues following arthroplasty surgeries remain a major challenge in orthopaedic settings. Methicillin resistant Staphylococcus aureus (MRSA) is recognised as an established pathogen in such infections. Combination therapy using linezolid and bacteriophage impregnated in biopolymer was investigated in the present study as an alternative strategy to prevent MRSA colonisation on the orthopaedic implant surface. Methodology Coating of stainless steel orthopaedic grade K-wires was achieved using hydroxypropylmethlycellulose (HPMC) mixed with phage alone, linezolid alone and phage and linezolid together. The potential of these agents to inhibit adhesion of S.aureus (MRSA) 43300 on K-wires was assessed. Coated and naked wires were analysed by scanning electron microscopy (SEM) and fluorescent staining. Result Significant reduction in bacterial adhesion was achieved on phage/linezolid wires in comparison to naked as well as HPMC coated wires. However, maximum reduction in bacterial adherence (∼4 log cycles) was observed on the wires coated with phage-linezolid combination. The frequency of emergence of resistant mutants was also negligible in presence of both the agents. Conclusion This study provides evidence to confirm that local delivery system employing linezolid (a potent protein synthesis inhibitor) along with a broad spectrum lytic bacteriophage (capable of self-multiplication) is able to attack the adhered as well as surrounding bacteria present near the implant site. Unlike other antibiotic based therapies, this combination has the potential to significantly restrict the emergence of resistant mutants, thus paving the way for effective treatment of MRSA associated infection of medical implants. PMID:24594764

Surgical advances during the First World War: the birth of modern orthopaedics.

Science.gov (United States)

Ramasamy, Arul; Eardley, W G P; Edwards, D S; Clasper, J C; Stewart, M P M

2016-02-01

The First World War (1914-1918) was the first truly industrial conflict in human history. Never before had rifle fire and artillery barrage been employed on a global scale. It was a conflict that over 4 years would leave over 750,000 British troops dead with a further 1.6 million injured, the majority with orthopaedic injuries. Against this backdrop, the skills of the orthopaedic surgeon were brought to the fore. Many of those techniques and systems form the foundation of modern orthopaedic trauma management. On the centenary of 'the War to end all Wars', we review the significant advances in wound management, fracture treatment, nerve injury and rehabilitation that were developed during that conflict. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

High-tech and low-tech orthopaedic surgery in Sub-Saharan Africa

Directory of Open Access Journals (Sweden)

Bauer Heike I

2002-02-01

Full Text Available Abstract Background Zambia's governmental health system suffers from shortage of surgical supplies and poor management skills for the sparse resources at hand. The situation has been worsened by the dual epidemics of HIV disease and tuberculosis. On the other hand the private medical sector has benefited greatly from less bureaucracy under the goverment of the Movement for Multi-party Democracy. Discussion The Zambian-Italian Orthopaedic Hospital in Lusaka is a well organized small unit providing free treatment of physically disabled children. The running costs are met from the fees charged for private consultations, supplemented by donations. State of the art surgical techniques are being used for congenital and acquired musculo-skeletal abnormalities. Last year 513 patients were operated upon free of charge and 320 operations were performed on private patients.

Orthopaedic training in Kenya | Mulimba | East African Orthopaedic ...

African Journals Online (AJOL)

Objective: To do a survey of the current orthopaedic specialists in Kenya's training since their first medical degrees. Determine the duration, facilities and methods of training. Methods: A number of doctors trained under different arrangements were identified, interviewed and where curriculum was available this was read.

1 venous thromboembolism in orthopaedics references

African Journals Online (AJOL)

2008-05-23

2004; 126: 338-400S. 3. American Academy of Orthopaedic Surgeons. American Academy of orthopaedic Surgeons clinical guidelines on prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty.www.aaos.org/Research/ guidelines/PE_guideline. Pdf (accessed May 23, 2008). 4.

Nigerian Journal of Orthopaedics and Trauma

African Journals Online (AJOL)

The Nigerian Journal of Orthopaedics and Trauma publishes original papers, review articles and case reports on pathology, anaesthesia, orthopaedics and trauma. Vol 12, No 1 (2013). DOWNLOAD FULL TEXT Open Access DOWNLOAD FULL TEXT Subscription or Fee Access. Table of Contents. Articles. Management of ...

Biomaterials in orthopaedics

Science.gov (United States)

Navarro, M; Michiardi, A; Castaño, O; Planell, J.A

2008-01-01

At present, strong requirements in orthopaedics are still to be met, both in bone and joint substitution and in the repair and regeneration of bone defects. In this framework, tremendous advances in the biomaterials field have been made in the last 50 years where materials intended for biomedical purposes have evolved through three different generations, namely first generation (bioinert materials), second generation (bioactive and biodegradable materials) and third generation (materials designed to stimulate specific responses at the molecular level). In this review, the evolution of different metals, ceramics and polymers most commonly used in orthopaedic applications is discussed, as well as the different approaches used to fulfil the challenges faced by this medical field. PMID:18667387

Surgery and Anesthesia Exposure Is Not a Risk Factor for Cognitive Impairment After Major Noncardiac Surgery and Critical Illness

NARCIS (Netherlands)

Hughes, Christopher G; Patel, Mayur B; Jackson, James C; Girard, Timothy D; Geevarghese, Sunil K; Norman, Brett C; Thompson, Jennifer L; Chandrasekhar, Rameela; Brummel, Nathan E; May, Addison K; Elstad, Mark R; Wasserstein, Mitzi L; Goodman, Richard B; Moons, Karel G; Dittus, Robert S; Ely, E Wesley; Pandharipande, Pratik P; MIND-ICU, BRAIN-ICU investigators

OBJECTIVE: The aim of this study was to determine whether surgery and anesthesia exposure is an independent risk factor for cognitive impairment after major noncardiac surgery associated with critical illness. SUMMARY OF BACKGROUND DATA: Postoperative cognitive impairment is a prevalent individual

Can Tranexamic Acid Reduce Blood Loss during Major Cardiac Surgery? A Pilot Study.

Science.gov (United States)

Compton, Frances; Wahed, Amer; Gregoric, Igor; Kar, Biswajit; Dasgupta, Amitava; Tint, Hlaing

2017-09-01

We examined the effectiveness of tranexamic acid in preventing intraoperative blood loss during major cardiac surgery. Out of initial 81 patients undergoing major cardiac surgery (both coronary artery bypass and valve repair procedures) at our teaching hospital, sixty-seven patients were selected for this study. We compared estimated blood loss, decrease in percent hemoglobin and hematocrit following surgery between two groups of patients (none of them received any blood product during surgery), one group receiving no tranexamic acid (n=17) and another group receiving tranexamic acid (n=25). In the second study, we combined these patients with patients receiving modest amounts of blood products (1-2 unit) and compared these parameters between two groups of patients (25 patients received no tranexamic acid, 42 patients received tranexamic acid). In patients who received no blood product during surgery, those who received no tranexamic acid showed statistically significant (independent t-test two tailed at p tranexamic acid (mean: 987.2 mL, SD: 459.9, n=25). We observed similar results when the patients receiving no blood products and patients receiving modest amount of blood products were combined based on the use of tranexamic acid or not. No statistically significant difference was observed in percent reduced hemoglobin or hematocrit following surgery in any group of patients. We conclude that intraoperative antifibrinolytic therapy with tranexamic acid does not reduce intraoperative blood loss during major cardiac surgery which contradicts popular belief. © 2017 by the Association of Clinical Scientists, Inc.

Antimicrobial prophylaxis related to otorhinolaryngology elective major surgery

International Nuclear Information System (INIS)

Perez Lopez, Gladys; Morejon Garcia, Moises; Alvarez Cespedes, Belkis

2010-01-01

INTRODUCTION. Antimicrobial prophylaxis decreases the surgical infections, but its indiscriminate use to favors the increment of infection rates and the bacterial resistance is much more probable in presence of antibiotics. The aim of present research was to evaluate the results of antibiotic prophylaxis in the otorhinolaryngology elective major surgery. METHODS. A retrospective-descriptive research was made on the prophylactic use of antibiotics in this type of surgery in the Otorhinolaryngology Service of the ''Comandant Manuel Fajardo'' during 6 years (2001-2006). Sample included 661 patients and the following variables were studied: sex, age and therapeutic response criteria (satisfactory and non-satisfactory). According to the intervention complexity oral antibiotic or parenteral prophylaxis was administered carrying out a surgical hound site culture. RESULTS. There was a predominance of male sex (54,1%) and the 31 and 62 age group. The 41,90% of patients operated on required antibiotic prophylaxis. The was a 7,9% of surgical wound infections. The more frequent microorganisms were Pseudomonas aeruginosa, Enterobacter and Escherichia. In head and neck oncology surgeries infection average was high (42,3%). Torpid course was due to concurrence of infection risk factors. There were neither adverse events nor severe complications. CONCLUSIONS. In Otorhinolaryngology, antimicrobial prophylaxis works against a wide variety of microorganisms but not in the Oncology surgeries. (author)

Fragmentation of Care after Surgical Discharge: Non-Index Readmission after Major Cancer Surgery

Science.gov (United States)

Zheng, Chaoyi; Habermann, Elizabeth B; Shara, Nawar M; Langan, Russell C; Hong, Young; Johnson, Lynt B; Al-Refaie, Waddah B

2017-01-01

BACKGROUND Despite national emphasis on care coordination, little is known about how fragmentation affects cancer surgery outcomes. Our study examines a specific form of fragmentation in post-discharge care—readmission to a hospital different from the location of the operation—and evaluates its causes and consequences among patients readmitted after major cancer surgery. STUDY DESIGN We used the State Inpatient Database of California (2004 to 2011) to identify patients who had major cancer surgery and their subsequent readmissions. Logistic models were used to examine correlates of non-index readmissions and to assess associations between location of readmission and outcomes, measured by in-hospital mortality and repeated readmission. RESULTS Of 9,233 readmissions within 30 days of discharge after major cancer surgery, 20.0% occurred in non-index hospitals. Non-index readmissions were associated with emergency readmission (odds ratio [OR] = 2.63; 95% CI, 2.26–3.06), rural residence (OR = 1.81; 95% CI, 1.61–2.04), and extensive procedures (eg hepatectomy vs proctectomy; OR = 2.77; CI, 2.08–3.70). Mortality was higher during non-index readmissions than index readmissions independent of patient, procedure, and hospital factors (OR = 1.31; 95% CI, 1.03–1.66), but was mitigated by adjusting for conditions present at readmission (OR = 1.24; 95% CI, 0.98–1.58). Non-index readmission predicted higher odds of repeated readmission within 60 days of discharge from the first readmission (OR = 1.16; 95% CI, 1.02–1.32), independent of all covariates. CONCLUSIONS Non-index readmissions constitute a substantial proportion of all readmissions after major cancer surgery. They are associated with more repeated readmissions and can be caused by severe surgical complications and increased travel burden. Overcoming disadvantages of non-index readmissions represents an opportunity to improve outcomes for patients having major cancer surgery. PMID:27016905

Laparoscopy in major abdominal emergency surgery seems to be a safe procedure

DEFF Research Database (Denmark)

Nielsen, Liv Bjerre Juul; Tengberg, Line Toft; Bay-Nielsen, Morten

2017-01-01

INTRODUCTION: Laparoscopy is well established in the majority of elective procedures in abdominal surgery. In contrast, it is primarily used in minor surgery such as appendectomy or cholecystectomy in the emergent setting. This study aimed to analyze the safety and effectiveness of a laparoscopic...

Knowledge on Bone Banking among Participants in an Orthopaedic Conference: A Preliminary Survey

Directory of Open Access Journals (Sweden)

Mohd S

2017-07-01

Full Text Available Despite increasing use of bone graft in Malaysia, there was still lack of data to quantify knowledge level on bone banking among orthopaedic community who are involved in transplantation related work. Therefore, a survey on awareness in tissue banking specifically bone banking, usage and choice of bone grafts was conducted. From 80 respondents, 82.5% were aware about tissue banking however only 12.5% knew of the existence of tissue banks in Malaysia. Femoral head was the bone allograft most often used as a substitute to autograft. Only 34.8% respondents preferred irradiated bone grafts whilst 46.9% preferred nonirradiated, indicating the need to educate the importance of radiation for sterilising tissues. Exhibition was the most preferred medium for awareness programme to disseminate information about bone banking in the orthopaedic community. The professional awareness is necessary to increase the knowledge on the use of bone graft, hence to increase bone transplantation for musculoskeletal surgeries in the country.

Knowledge on Bone Banking among Participants in an Orthopaedic Conference: A Preliminary Survey.

Science.gov (United States)

Mohd, S; Yusof, N; Ramalingam, S; Ng, W M; Mansor, A

2017-07-01

Despite increasing use of bone graft in Malaysia, there was still lack of data to quantify knowledge level on bone banking among orthopaedic community who are involved in transplantation related work. Therefore, a survey on awareness in tissue banking specifically bone banking, usage and choice of bone grafts was conducted. From 80 respondents, 82.5% were aware about tissue banking however only 12.5% knew of the existence of tissue banks in Malaysia. Femoral head was the bone allograft most often used as a substitute to autograft. Only 34.8% respondents preferred irradiated bone grafts whilst 46.9% preferred nonirradiated, indicating the need to educate the importance of radiation for sterilising tissues. Exhibition was the most preferred medium for awareness programme to disseminate information about bone banking in the orthopaedic community. The professional awareness is necessary to increase the knowledge on the use of bone graft, hence to increase bone transplantation for musculoskeletal surgeries in the country.

Myocardial injury after surgery is a risk factor for weaning failure from mechanical ventilation in critical patients undergoing major abdominal surgery.

Directory of Open Access Journals (Sweden)

Shu Li

Full Text Available Myocardial injury after noncardiac surgery (MINS is a newly proposed concept that is common among adults undergoing noncardiac surgery and associated with substantial mortality. We analyzed whether MINS was a risk factor for weaning failure in critical patients who underwent major abdominal surgery.This retrospective study was conducted in the Department of Critical Care Medicine of Peking University People's Hospital. The subjects were all critically ill patients who underwent major abdominal surgery between January 2011 and December 2013. Clinical and laboratory parameters during the perioperative period were investigated. Backward stepwise regression analysis was performed to evaluate MINS relative to the rate of weaning failure. Age, hypertension, chronic renal disease, left ventricular ejection fraction before surgery, Acute Physiologic and Chronic Health Evaluation II score, pleural effusion, pneumonia, acute kidney injury, duration of mechanical ventilation before weaning and the level of albumin after surgery were treated as independent variables.This study included 381 patients, of whom 274 were successfully weaned. MINS was observed in 42.0% of the patients. The MINS incidence was significantly higher in patients who failed to be weaned compared to patients who were successfully weaned (56.1% versus 36.5%; P<0.001. Independent predictive factors of weaning failure were MINS, age, lower left ventricular ejection fraction before surgery and lower serum albumin level after surgery. The MINS odds ratio was 4.098 (95% confidence interval, 1.07 to 15.6; P = 0.04. The patients who were successfully weaned had shorter hospital stay lengths and a higher survival rate than those who failed to be weaned.MINS is a risk factor for weaning failure from mechanical ventilation in critical patients who have undergone major abdominal surgery, independent of age, lower left ventricular ejection fraction before surgery and lower serum albumin levels after

The Clinical Impact of Cardiology Consultation Prior to Major Vascular Surgery.

Science.gov (United States)

Davis, Frank M; Park, Yeo June; Grey, Scott F; Boniakowski, Anna E; Mansour, M Ashraf; Jain, Krishna M; Nypaver, Timothy; Grossman, Michael; Gurm, Hitinder; Henke, Peter K

2018-01-01

To understand statewide variation in preoperative cardiology consultation prior to major vascular surgery and to determine whether consultation was associated with differences in perioperative myocardial infarction (poMI). Medical consultation prior to major vascular surgery is obtained to reduce perioperative risk. Despite perceived benefit of preoperative consultation, evidence is lacking specifically for major vascular surgery on the effect of preoperative cardiac consultation. Patient and clinical data were obtained from a statewide vascular surgery registry between January 2012 and December 2014. Patients were risk stratified by revised cardiac risk index category and compared poMI between patients who did or did not receive a preoperative cardiology consultation. We then used logistic regression analysis to compare the rate of poMI across hospitals grouped into quartiles by rate of preoperative cardiology consultation. Our study population comprised 5191 patients undergoing open peripheral arterial bypass (n = 3037), open abdominal aortic aneurysm repair (n = 332), or endovascular aneurysm repair (n = 1822) at 29 hospitals. At the patient level, after risk-stratification by revised cardiac risk index category, there was no association between cardiac consultation and poMI. At the hospital level, preoperative cardiac consultation varied substantially between hospitals (6.9%-87.5%, P 66%) had a reduction in poMI (OR, 0.52; confidence interval: 0.28-0.98; P cardiology consultation for vascular surgery varies greatly between institutions, and does not appear to impact poMI at the patient level. However, reduction of poMI was noted at the hospitals with the highest rate of preoperative cardiology consultation as well as a variety of medical services, suggesting that other hospital culture effects play a role.

Burnout in Orthopaedic Surgeons: A Challenge for Leaders, Learners, and Colleagues: AOA Critical Issues.

Science.gov (United States)

Ames, S Elizabeth; Cowan, James B; Kenter, Keith; Emery, Sanford; Halsey, David

2017-07-19

Burnout, depression, suicidal ideation, and dissatisfaction with work-life balance have been reported in all medical specialties and at all stages of medical education and practice experience. Burnout consists of progressive emotional, attitudinal, and physical exhaustion. Physicians with burnout may treat patients as objects and feel emotionally depleted. Burnout is characterized by a loss of enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization), and a low sense of personal accomplishment. The most complete study of emotional burnout among different medical specialties demonstrated that orthopaedic surgery is one of the specialties with the highest burnout rate. Qualitative descriptive studies are available. There was a 45.8% burnout rate among physicians in the U.S. in 2012, and a 2014 update suggested even higher rates. Burnout has a correlation with medical education. Burnout rates are similar to those in the general population when medical students enter school, and increase steadily through medical education prior to residency. Burnout rates in residents are high, reported to be between 41% and 74% across multiple specialties. This impacts our young physician workforce in orthopaedics. The purpose of this review is to provide the available information that characterizes burnout and addresses the issues inherent to preventing burnout, and to build awareness in orthopaedic surgeons. Wellness "goes beyond merely the absence of distress and includes being challenged, thriving, and achieving success in various aspects of personal and professional life." The challenge for the orthopaedic community is to develop interventions and strategies that are personalized to the individuals in this specialty.

Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit.

Science.gov (United States)

Fennelly, Orna; Blake, Catherine; FitzGerald, Oliver; Breen, Roisin; Ashton, Jennifer; Brennan, Aisling; Caffrey, Aoife; Desmeules, François; Cunningham, Caitriona

2018-06-01

Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services. Throughout 2014, APPs (n = 22) entered clinical data on a national database. Analysis of these data using descriptive statistics determined patient wait times, Consultant Doctor involvement in clinical decisions, and patient clinical outcomes. Chi square tests were used to compare patient clinical outcomes across orthopaedic and rheumatology clinics. A pilot study at one site identified re-referral rates to orthopaedic/rheumatology services of patients managed by the APPs. In one year, 13,981 new patients accessed specialist orthopaedic and rheumatology consultations via the APP. Median wait time for an appointment was 5.6 months. Patients most commonly presented with knee (23%), lower back (22%) and shoulder (15%) disorders. APPs made autonomous clinical decisions regarding patient management at 77% of appointments, and managed patient care pathways without onward referral to Consultant Doctors in more than 80% of cases. Other onward clinical pathways recommended by APPs were: physiotherapy referrals (42%); clinical investigations (29%); injections administered (4%); and surgical listing (2%). Of those managed by the APP, the pilot study identified that only 6.5% of patients were re-referred within one year. This national evaluation of APP services demonstrated that the majority of patients assessed by an APP did not require onward referral for a Consultant Doctor appointment. Therefore, patients gained earlier access to orthopaedic and rheumatology consultations in secondary care, with most patients conservatively managed.

Circadian distribution of sleep phases after major abdominal surgery

DEFF Research Database (Denmark)

Gogenur, I.; Wildschiotz, G.; Rosenberg, J.

2008-01-01

Background. It is believed that the severely disturbed night-time sleep architecture after surgery is associated with increased cardiovascular morbidity with rebound of rapid eye movement (REM). The daytime sleep pattern of patients after major general surgery has not been investigated before. We...... nights after operation. Sleep was scored independently by two blinded observers and the recordings were reported as awake, light sleep (LS, stages I and II), slow wave sleep (SWS, stages III and IV), and REM sleep. Results. There was significantly increased REM sleep (P=0.046), LS (P=0.020), and reduced...... time awake (P=0.016) in the postoperative daytime period compared with the preoperative daytime period. Five patients had REM sleep during the daytime after surgery. Three of these patients did not have REM sleep during the preceding postoperative night. There was significantly reduced night-time REM...

Communication skills training in orthopaedics.

Science.gov (United States)

Lundine, Kristopher; Buckley, Richard; Hutchison, Carol; Lockyer, Jocelyn

2008-06-01

Communication skills play a key role in many aspects of both medical education and clinical patient care. The objectives of this study were to identify the key components of communication skills from the perspectives of both orthopaedic residents and their program directors and to understand how these skills are currently taught. This study utilized a mixed methods design. Quantitative data were collected with use of a thirty-item questionnaire distributed to all Canadian orthopaedic residents. Qualitative data were collected through focus groups with orthopaedic residents and semistructured interviews with orthopaedic program directors. One hundred and nineteen (37%) of 325 questionnaires were completed, twelve residents participated in two focus groups, and nine of sixteen program directors from across the country were interviewed. Both program directors and residents identified communication skills as being the accurate and appropriate use of language (i.e., content skills), not how the communication was presented (i.e., process skills). Perceived barriers to effective communication included time constraints and the need to adapt to the many personalities and types of people encountered daily in the hospital. Residents rarely have explicit training in communication skills. They rely on communication training implicitly taught through observation of their preceptors and clinical experience interacting with patients, peers, and other health-care professionals. Orthopaedic residents and program directors focus on content and flexibility within communication skills as well as on the importance of being concise. They value the development of communication skills in the clinical environment through experiential learning and role modeling. Education should focus on developing residents' process skills in communication. Care should be taken to avoid large-group didactic teaching sessions, which are perceived as ineffective.

[Benefits of epidural analgesia in major neonatal surgery].

Science.gov (United States)

Gómez-Chacón, J; Encarnación, J; Couselo, M; Mangas, L; Domenech, A; Gutiérrez, C; García Sala, C

2012-07-01

The aim of this paper is to describe and evaluate the benefits of epidural anesthesia in major surgery neonatal. We have performed a matched case-control (2:1) study of patients undergoing neonatal major surgery (NMSs) who received intra-and postoperative epidural anesthesia (EA) and controls with conventional general anesthesia. The matching criteria were age, weight and baseline pathology. EA was administered by caudal puncture and epidural catheter placed with ultrasound support. Levobupivacaine was selected as anesthetic drug. The time to extubation, intestinal transit time, type of analgesia and complications were studied. This study is based on 11 cases (2 esophageal atresia, 2 diaphragmatic hernias, 1 necrotizing enterocolitis, 3 intestinal atresia, 2 anorectal malformation and 1 bladder exstrophy) and 22 controls. We observed statistically significant differences in time to extubation (95% CI OR 12 1.99 to 72.35; Chi2 p = 0.004, Mann U Whytney p = 0.013) and intestinal transit time (Mann Whitney U p analgesia. Therefore we believe that the intra-and postoperative EA helps improve postoperative management in neonates and should be preferred in centers where this technique is available.

No effect of melatonin to modify surgical-stress response after major vascular surgery

DEFF Research Database (Denmark)

Kücükakin, B.; Wilhelmsen, M.; Lykkesfeldt, Jens

2010-01-01

A possible mechanism underlying cardiovascular morbidity after major vascular surgery may be the perioperative ischaemia-reperfusion with excessive oxygen-derived free-radical production and increased levels of circulating inflammatory mediators. We examined the effect of melatonin infusion during...... surgery and oral melatonin treatment for 3 days after surgery on biochemical markers of oxidative and inflammatory stress....

Laser-induced modification of structure and shape of cartilage in otolaryngology and orthopaedics

Science.gov (United States)

Sobol', E. N.; Baum, O. I.; Omel'chenko, A. I.; Soshnikova, Yu. M.; Yuzhakov, A. V.; Kas'yanenko, E. M.; Tokareva, A. V.; Baskov, A. V.; Svistushkin, V. M.; Selezneva, L. V.; Shekhter, A. B.

2017-11-01

We present the results of basic research in laser modification of tissues in otolaryngology (correcting the shape of nasal septum and larynx cartilages), cosmetology (correcting ear and nose shape), orthopaedics and spinal surgery (treatment of diseases of spine disc and joints). The physical processes and mechanisms of laser-induced relaxation of stresses and regeneration of tissues are considered. New results of studies in this fast-developing field of laser surgery are presented, in particular, the results of laser correction of costal cartilage shape in the process of making implants for the treatment of larynx stenosis and controlled regeneration of the hyaline articular cartilage. Presented at the Fundamentals of Laser Assisted Micro- and Nanotechnologies (FLAMN-2016) International Symposium (Pushkin, Leningrad oblast, 27 June to 1 July 2016).

What can we learn from patient claims? - A retrospective analysis of incidence and patterns of adverse events after orthopaedic procedures in Sweden

Directory of Open Access Journals (Sweden)

Öhrn Annica

2012-01-01

Full Text Available Abstract Background Objective data on the incidence and pattern of adverse events after orthopaedic surgical procedures remain scarce, secondary to the reluctance for encompassing reporting of surgical complications. The aim of this study was to analyze the nature of adverse events after orthopaedic surgery reported to a national database for patient claims in Sweden. Methods In this retrospective review data from two Swedish national databases during a 4-year period were analyzed. We used the "County Councils' Mutual Insurance Company", a national no-fault insurance system for patient claims, and the "National Patient Register at the National Board of Health and Welfare". Results A total of 6,029 patient claims filed after orthopaedic surgery were assessed during the study period. Of those, 3,336 (55% were determined to be adverse events, which received financial compensation. Hospital-acquired infections and sepsis were the most common causes of adverse events (n = 741; 22%. The surgical procedure that caused the highest rate of adverse events was "decompression of spinal cord and nerve roots" (code ABC**, with 168 adverse events of 17,507 hospitals discharges (1%. One in five (36 of 168; 21.4% injured patient was seriously disabled or died. Conclusions We conclude that patients undergoing spinal surgery run the highest risk of being severely injured and that these patients also experienced a high degree of serious disability. The most common adverse event was related to hospital acquired infections. Claims data obtained in a no-fault system have a high potential for identifying adverse events and learning from them.

Preoperative Risk Factors for Subsyndromal Delirium in Older Adults Who Undergo Joint Replacement Surgery.

Science.gov (United States)

Denny, Dawn L; Lindseth, Glenda

Older adults with subsyndromal delirium have similar risks for adverse outcomes following joint replacement surgery as those who suffer from delirium. This study examined relationships among subsyndromal delirium and select preoperative risk factors in older adults following major orthopaedic surgery. Delirium assessments of a sample of 62 adults 65 years of age or older were completed on postoperative Days 1, 2, and 3 following joint replacement surgery. Data were analyzed for relationships among delirium symptoms and the following preoperative risk factors: increased comorbidity burden, cognitive impairment, fall history, and preoperative fasting time. Postoperative subsyndromal delirium occurred in 68% of study participants. A recent fall history and a longer preoperative fasting time were associated with delirium symptoms (p ≤ .05). Older adults with a recent history of falls within the past 6 months or a longer duration of preoperative fasting time may be at higher risk for delirium symptoms following joint replacement surgery.

Thromboembolism prophylaxis practices in orthopaedic arthroplasty patients.

LENUS (Irish Health Repository)

Cawley, D

2010-10-01

Thromboembolic events are a post-operative complication of arthroplasty surgery for up to 3 months. The incidence however, is not fully known. Some form of prophylaxis should be provided to all arthroplasty patients. Clinicians are wary of side effects, compliance profile and the associated cost. The objective of this study is to investigate practice patterns and their relevance to 3 risk groups. Ninety questionnaires were sent to orthopaedic surgeons with 3 hypothetical clinical scenarios and 10 prophylaxis regimes for thromboembolism across different risk groups. The response rate was 81\\/90 (90%). The most popular options in all 3 cases were early mobilisation, thrombo-embolism deterrant (TED) stockings and low molecular weight heparin (LMWH) (51\\/81, 62% of all cases). An inconsistent relationship exists between preferred practice and relevant guidelines. Preferred practice does not correlate with each level of risk.

Technical errors and complications in orthopaedic trauma surgery

NARCIS (Netherlands)

Meeuwis, M.A.; de Jongh, M.A.C.; Roukema, J.A.; van der Heijden, F.H.W.M.; Verhofstad, M. H. J.

2016-01-01

Introduction Adverse events and associated morbidity and subsequent costs receive increasing attention in clinical practice and research. As opposed to complications, errors are not described or analysed in literature on fracture surgery. The aim of this study was to provide a description of errors

Predictive Value of C-Reactive Protein for Major Complications after Major Abdominal Surgery: A Systematic Review and Pooled-Analysis.

Directory of Open Access Journals (Sweden)

Jennifer Straatman

Full Text Available Early diagnosis and treatment of complications after major abdominal surgery can decrease associated morbidity and mortality. Postoperative CRP levels have shown a strong correlation with complications. Aim of this systematic review and pooled-analysis was to assess postoperative values of CRP as a marker for major complications and construct a prediction model.A systematic review was performed for CRP levels as a predictor for complications after major abdominal surgery (MAS. Raw data was obtained from seven studies, including 1427 patients. A logit regression model assessed the probability of major complications as a function of CRP levels on the third postoperative day. Two practical cut-offs are proposed: an optimal cut-off for safe discharge in a fast track protocol and another for early identification of patients with increased risk for major complications.A prediction model was calculated for major complications as a function of CRP levels on the third postoperative day. Based on the model several cut-offs for CRP are proposed. For instance, a two cut-off system may be applied, consisting of a safe discharge criterion with CRP levels below 75 mg/L, with a negative predictive value of 97.2%. A second cut-off is set at 215 mg/L (probability 20% and serves as a predictor of complications, indicating additional CT-scan imaging.The present study provides insight in the interpretation of CRP levels after major abdominal surgery, proposing a prediction model for major complications as a function of CRP on postoperative day 3. Cut-offs for CRP may be implemented for safe early-discharge in a fast-track protocol and, secondly as a threshold for additional examinations, such as CT-scan imaging, even in absence of clinical signs, to confirm or exclude major complications. The prediction model allows for setting a cut-off at the discretion of individual surgeons or surgical departments.

Recombinant activated factor VII in the treatment of bleeds and for the prevention of surgery-related bleeding in congenital haemophilia with inhibitors.

Science.gov (United States)

Santagostino, Elena; Escobar, Miguel; Ozelo, Margareth; Solimeno, Luigi; Arkhammar, Per; Lee, Hye Youn; Rosu, Gabriela; Giangrande, Paul

2015-06-01

The availability of recombinant activated factor VII (rFVIIa, eptacog alfa activated) has greatly advanced the care of patients with haemophilia A or B who have developed inhibitors against the infused replacement factor. Recombinant FVIIa is licensed for the on-demand treatment of bleeding episodes and the prevention of bleeding in surgery or invasive procedures in patients with congenital haemophilia with inhibitors. This article attempts to review in detail the extensive evidence of rFVIIa in congenital haemophilia patients with inhibitors. Patients with acute bleeding episodes are best treated on demand at home, to achieve the short- and long-term benefits of rapid bleed control. Key prospective studies have shown that rFVIIa achieves consistently high efficacy rates in the management of acute (including joint) bleeds in inhibitor patients in the home treatment setting. Substantial post-approval data from key registries also support the on-demand efficacy profile of rFVIIa established by the prospective clinical trials. The availability of rFVIIa has allowed major surgery to become a reality for inhibitor patients. Studies in key surgery, including orthopaedic procedures, have found that rFVIIa provides consistently high efficacy rates. Importantly, the wealth of data does not raise any unexpected safety concerns surrounding rFVIIa use; this is likely because rFVIIa is a recombinant product with a localised mechanism of action at the site of vascular injury. In summary, rFVIIa is established as an effective and well-tolerated first-line treatment for on-demand bleeding control and bleed prevention during minor and major (including elective orthopaedic) surgery in inhibitor patients. Use of rFVIIa has been a major step towards narrowing the gap in outcomes between inhibitor patients and non-inhibitor patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

Mentorship in orthopaedic and trauma residency training ...

African Journals Online (AJOL)

Background: Mentorship is important in residency training as it is necessary for personal and professional development of the resident trainees. Objectives: This study documents mentorship in orthopaedic residency training programme in Nigeria by assessing the awareness of orthopaedic residents on the role of a mentor, ...

Burnout and quality of life among orthopaedic trainees in a modern educational programme: importance of the learning climate.

Science.gov (United States)

van Vendeloo, S N; Brand, P L P; Verheyen, C C P M

2014-08-01

We aimed to determine quality of life and burnout among Dutch orthopaedic trainees following a modern orthopaedic curriculum, with strict compliance to a 48-hour working week. We also evaluated the effect of the clinical climate of learning on their emotional well-being. We assessed burnout, quality of life and the clinical climate of learning in 105 orthopaedic trainees using the Maslach Burnout Inventory, linear analogue scale self-assessments, and Dutch Residency Educational Climate Test (D-RECT), respectively. A total of 19 trainees (18%) had poor quality of life and 49 (47%) were dissatisfied with the balance between their personal and professional life. Some symptoms of burnout were found in 29 trainees (28%). Higher D-RECT scores (indicating a better climate of learning) were associated with a better quality of life (r = 0.31, p = 0.001), more work-life balance satisfaction (r = 0.31, p = 0.002), fewer symptoms of emotional exhaustion (r = -0.21, p = 0.028) and depersonalisation (r = -0,28, p = 0.04). A reduced quality of life with evidence of burnout were still seen in a significant proportion of orthopaedic trainees despite following a modern curriculum with strict compliance to a 48-hour working week. It is vital that further work is undertaken to improve the quality of life and reduce burnout in this cohort. ©2014 The British Editorial Society of Bone & Joint Surgery.

Enhanced recovery from surgery in the UK: an audit of the enhanced recovery partnership programme 2009-2012.

Science.gov (United States)

Simpson, J C; Moonesinghe, S R; Grocott, M P W; Kuper, M; McMeeking, A; Oliver, C M; Galsworthy, M J; Mythen, M G

2015-10-01

The UK Department of Health Enhanced Recovery Partnership Programme collected data on 24 513 surgical patients in the UK from 2009-2012. Enhanced Recovery is an approach to major elective surgery aimed at minimizing perioperative stress for the patient. Previous studies have shown Enhanced Recovery to be associated with reduced hospital length of stay and perioperative morbidity. In this national clinical audit, National Health Service hospitals in the UK were invited to submit patient-level data. The data regarding length of stay and compliance with each element of Enhanced Recovery protocols for colorectal, orthopaedic, urological and gynaecological surgery patients were analysed. The relationship between Enhanced Recovery protocol compliance and length of stay was measured. From 16 267 patients from 61 hospital trusts, three out of four surgical specialties showed Enhanced Recovery, compliance being weakly associated with shorter length of stay (correlation coefficients -0.18, -0.14, -0.25 in colorectal, orthopaedics and gynaecology respectively). At a cut-off of 80% compliance, good compliance was associated with two, one and three day reductions in median length of stay respectively in colorectal, orthopaedic and urological surgeries, with no saving in gynaecology. This study is the largest assessment of the relationship between Enhanced Recovery protocol compliance and outcome in four surgical specialties. The data suggest that higher compliance with an Enhanced Recovery protocol has a weak association with shorter length of stay. This suggests that changes in process, resulting from highly protocolised pathways, may be as important in reducing perioperative length of stay as any individual element of Enhanced Recovery protocols in isolation. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Orthopaedic Aspects of Marfan Syndrome: The Experience of a Referral Center for Diagnosis of Rare Diseases

Science.gov (United States)

Fichera, Alessandro; De Luna, Vincenzo; Mancini, Federico; Caterini, Roberto

2016-01-01

Marfan syndrome is caused by mutations in the fibrillin-1 gene (FBN1). The most important features affect the cardiovascular system, eyes, and skeleton. The aim of this study was to report the most frequent musculoskeletal alterations observed in 146 patients affected by Marfan syndrome. Fifty-four patients (37%) underwent cardiac surgery and 11 of them received emergent surgery for acute aortic dissection. Ectopia lentis was found in 68 patients (47%) whereas myopia above 3D occurred in 46 patients (32%). Musculoskeletal anomalies were observed in all patients with Marfan syndrome. In 88 patients (60.2%), the associated “wrist and thumb sign” was present; in 58 patients (39.7%), pectus carinatum deformity; in 44 patients (30.1%), pectus excavatum; in 49 patients (33.5%), severe flatfoot; in 31 patients (21.2%), hindfoot deformity; in 54 patients (36.9%), reduced US/LS ratio or increased arm span-height ratio; in 37 patients (25.3%), scoliosis or thoracolumbar kyphosis; in 22 patients (15%), reduced elbow extension (170° or less). Acetabular protrusion was ascertained on radiographs in 27 patients (18.4%). Orthopaedic aspects of the disease are very important for an early diagnosis; however, we have not observed definite correlations between the extent of orthopaedic involvement and aortic complications. PMID:28050285

Realignment Surgery for Malunited Ankle Fracture.

Science.gov (United States)

Guo, Chang-Jun; Li, Xing-Cheng; Hu, Mu; Xu, Yang; Xu, Xiang-Yang

2017-02-01

To investigate the characteristics and the results of realignment surgery for the treatment of malunited ankle fracture. Thirty-three patients with malunited fractures of the ankle who underwent reconstructive surgery at our hospital from January 2010 to January 2014 were reviewed. The tibial anterior surface angle (TAS), the tibiotalar tilt angle (TTA), the malleolar angle (MA), and the tibial lateral surface angle (TLS) were measured. Clinical assessment was performed with use of the American Orthopaedic Foot and Ankle Society (AOFAS) scale and visual analogue scale (VAS) scores, and the osteoarthritis stage was determined radiographically with the modified Takakura classification system. The Wilcoxon matched-pairs test was used to analyze the difference between the preoperative and the postoperative data. The mean follow-up was 36 months (range, 20-60 months). The mean age at the time of realignment surgery was 37.1 years (range, 18-62 years). Compared with preoperation, the TAS at the last follow-up showed a significant increase (88.50° ± 4.47° vs. 90.80° ± 3.49°, P = 0.0035); similar results were observed in TTA (1.62° ± 1.66° vs. 0.83° ± 0.90°, P ankle osteoarthritis, and was treated by ankle joint distraction. Realignment surgery for a malunited ankle fracture can reduce pain, improve function, and delay ankle arthrodesis or total ankle replacement. Postoperative large talar tilt and advanced stages of ankle arthritis are the risk factors for the surgery. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Readability of sports medicine-related patient education materials from the American Academy of Orthopaedic Surgeons and the American Orthopaedic Society for Sports Medicine.

Science.gov (United States)

Ganta, Abhishek; Yi, Paul H; Hussein, Khalil; Frank, Rachel M

2014-04-01

Although studies have revealed high readability levels of orthopedic patient education materials, no study has evaluated sports medicine-related patient education materials. We conducted a study to assess the readability of sports medicine-related patient education materials from the American Academy of Orthopaedic Surgeons (AAOS) and the American Orthopaedic Society for Sports Medicine (AOSSM). All sports medicine patient education articles available online in 2012 from the AAOS and the AOSSM, including the Stop Sports Injuries Campaign (STOP), were identified, and their readability was assessed with the Flesch-Kinkaid (FK) readability test. Mean overall FK grade level of the 170 articles reviewed (104 from AAOS, 36 from AOSSM, 30 from STOP) was 10.2. Mean FK levels for the 3 sources were 9.5 (AAOS), 11.0 (AOSSM), and 11.5 (STOP) (P = .16). Fifteen (8.8%) of the 170 articles had a readability level at or below eighth grade (average reading level of US adults); only 2 (1.2%) of the 170 articles were at or below the recommended sixth-grade level. The majority of sports medicine-related patient education materials from AAOS and AOSSM had reading levels higher than recommended, indicating that the majority of the patient population may find it difficult to comprehend these articles.

Developmental orthopaedic diseases in foals

International Nuclear Information System (INIS)

Şİrİn, Özlem; Alkan, Zeki

2010-01-01

Developmental Orthopaedic Diseases (DOD) is seen frequently in horses which completed their maturity. Osteochondrosis, physitis, angular limb deformities, flexural deformities, juvenil arthritis, cervical vertebral anomalies, cuboidal bone abnormalities are problems investigated under Developmental Orthopaedic Diseases title. This diseases can develop single or some together in fast growing, heavy animals (especially Arabian and English Thoroughbreds). Multifactorial causes of this diseases etiopathogenesis can be listed as genetic predisposition, trauma, nutrition, vitamins/minerals and endocrine disorders. But the exact causes of these diseases are not known. In this review detailed information are given about the diseases mentioned above

A Clinico- Epidemiological Study Of Filarial Related Orthopaedic Manifestations

Directory of Open Access Journals (Sweden)

Patond K.R

1992-01-01

Full Text Available An epidemiological study was undertaken to study the incidence and distribution of orthopaedic manifestations of filariasis in an endemic area. A total of 207 cases were clinically examined and investigated. Patients were divided into three groups , viz., Group A: Orthopaedic manifestations with no history of filariasis . Group B: Orthopaedic manifestations with history of filariasis such as microfilaraemia or filarial fevers etc., Group C: Orthopaedic manifestations with chronic manifestations such as elephantiasis, hydrocele etc. To confirm filarial etiology, all the cases were examined for the presence of filarial antibody by indirect ELISA using wuchereda bancrofti microfilarial excretory- secretary antigen (wd Mf ESAg . A total of 61 of 102 patients of Group A, 14 of 21 patients of group B, and 73 of 84 patients of Group C were positive for filarial antibody. This study showed the prevalence of filarial antibody in about 71.4% of various orthopaedic manifestations.

Burden of Geriatric Events Among Older Adults Undergoing Major Cancer Surgery.

Science.gov (United States)

Tan, Hung-Jui; Saliba, Debra; Kwan, Lorna; Moore, Alison A; Litwin, Mark S

2016-04-10

Most malignancies are diagnosed in older adults who are potentially susceptible to aging-related health conditions; however, the manifestation of geriatric syndromes during surgical cancer treatment is not well quantified. Accordingly, we sought to assess the prevalence and ramifications of geriatric events during major surgery for cancer. Using Nationwide Inpatient Sample data from 2009 to 2011, we examined hospital admissions for major cancer surgery among elderly patients (ie, age ≥ 65 years) and a referent group age 55 to 64 years. From these observations, we identified geriatric events that included delirium, dehydration, falls and fractures, failure to thrive, and pressure ulcers. We then estimated the collective prevalence of these events according to age, comorbidity, and cancer site and further explored their relationship with other hospital-based outcomes. Within a weighted sample of 939,150 patients, we identified at least one event in 9.2% of patients. Geriatric events were most common among patients age ≥ 75 years, with a Charlson comorbidity score ≥ 2, and who were undergoing surgery for cancer of the bladder, ovary, colon and/or rectum, pancreas, or stomach (P geriatric event had a greater likelihood of concurrent complications (odds ratio [OR], 3.73; 95% CI, 3.55 to 3.92), prolonged hospitalization (OR, 5.47; 95% CI, 5.16 to 5.80), incurring high cost (OR, 4.97; 95% CI, 4.58 to 5.39), inpatient mortality (OR, 3.22; 95% CI, 2.94 to 3.53), and a discharge disposition other than home (OR, 3.64; 95% CI, 3.46 to 3.84). Many older patients who receive cancer-directed surgery experience a geriatric event, particularly those who undergo major abdominal surgery. These events are linked to operative morbidity, prolonged hospitalization, and more expensive health care. As our population ages, efforts focused on addressing conditions and complications that are more common in older adults will be essential to delivering high-quality cancer care. © 2016 by

Differential Effects of Intraoperative Positive End-expiratory Pressure (PEEP) on Respiratory Outcome in Major Abdominal Surgery Versus Craniotomy

DEFF Research Database (Denmark)

de Jong, Myrthe A C; Ladha, Karim S; Melo, Marcos F Vidal

2015-01-01

OBJECTIVES: In this study, we examined whether (1) positive end-expiratory pressure (PEEP) has a protective effect on the risk of major postoperative respiratory complications in a cohort of patients undergoing major abdominal surgeries and craniotomies, and (2) the effect of PEEP is differed......: Within the entire study population (major abdominal surgeries and craniotomies), we found an association between application of PEEP ≥5 cmH2O and a decreased risk of postoperative respiratory complications compared with PEEP 5 cmH2O was associated with a significant lower...... undergoing major abdominal surgery. Our data suggest that default mechanical ventilator settings should include PEEP of 5-10 cmH2O during major abdominal surgery....

Computer-assisted navigational surgery enhances safety in dental implantology.

Science.gov (United States)

Ng, F C; Ho, K H; Wexler, A

2005-06-01

Dental implants are increasingly used to restore missing dentition. These titanium implants are surgically installed in the edentulous alveolar ridge and allowed to osteointegrate with the bone during the healing phase. After osseo-integration, the implant is loaded with a prosthesis to replace the missing tooth. Conventional implant treatment planning uses study models, wax-ups and panoramic x-rays to prefabricate surgical stent to guide the preparation of the implant site. The drilling into the alveolar ridge is invariably a "blind" procedure as the part of the drill in bone is not visible. Stereotactic systems were first introduced into neurosurgery in 1986. Since then, computer-assisted navigational technology has brought major advances to neuro-, midface and orthopaedic surgeries, and more recently, to implant placement. This paper illustrates the use of real-time computer-guided navigational technology in enhancing safety in implant surgical procedures. Real-time computer-guided navigational technology enhances accuracy and precision of the surgical procedure, minimises complications and facilitates surgery in challenging anatomical locations.

Postprandial ghrelin suppression is exaggerated following major surgery; implications for nutritional recovery

Directory of Open Access Journals (Sweden)

Bloom Stephen R

2007-10-01

Full Text Available Abstract Meeting patients' nutritional requirements and preventing malnutrition is a challenge following major surgical procedures. The role of ghrelin in nutritional recovery after non-gastrointestinal major surgery is unknown. We used coronary artery bypass grafting (CABG as an example of anticipated good recovery post major surgery. Seventeen patients undergoing CABG (mean ± SEM: 70.1 ± 2.2 yrs, BMI 29.1 ± 1.4 kg/m2, 15 male underwent fasting and postprandial (45 mins after standard test breakfast blood sampling pre-operatively (day 0, post-operatively (day 6 and at follow-up (day 40. Changes in food intake, biochemical and anthropometric markers of nutritional status were recorded. A comparison was made to 17 matched healthy controls (70.6 ± 2.3 yrs, BMI 28.4 ± 1.3 kg/m2. We observed significantly increased post-operative and follow-up fasting ghrelin concentrations compared with pre-operatively (pre-op. 402 ± 42 pmol/L vs post-op. 642 ± 97 pmol/L vs follow-up 603 ± 94 pmol/L (ANOVA p p Our data support the hypothesis that prolonged changes in fasting and postprandial plasma ghrelin concentrations are associated with impaired nutritional recovery after CABG. These findings reinforce the need to investigate ghrelin in other patients groups undergoing major surgery.

The effect of anesthesia type on the postoperative complications of major lower extremity surgery

OpenAIRE

Murat Bakış; Sinem Sarı; Ayhan Öznur Cillimoğlu; Özgür Özbey; Bakiye Uğur; Mustafa Oğurlu

2014-01-01

Objective: Regional anesthesia is preferred more than general anesthesia in major lower extremity surgery. In our study, we aimed to investigate the relationship incidence of complications between regional anesthesia and general anesthesia in major surgery. Method: A total of 372 patients who underwent total hip or knee replacement from 1 January 2009 to 31 December 2012 were evaluated retrospectively in the study. The number of patients undergoing general anesthesia and regional anesthesi...

The Relationship of Obesity to Increasing Health-Care Burden in the Setting of Orthopaedic Polytrauma.

Science.gov (United States)

Licht, Heather; Murray, Mark; Vassaur, John; Jupiter, Daniel C; Regner, Justin L; Chaput, Christopher D

2015-11-18

With the rise of obesity in the American population, there has been a proportionate increase of obesity in the trauma population. The purpose of this study was to use a computed tomography-based measurement of adiposity to determine if obesity is associated with an increased burden to the health-care system in patients with orthopaedic polytrauma. A prospective comprehensive trauma database at a level-I trauma center was utilized to identify 301 patients with polytrauma who had orthopaedic injuries and intensive care unit admission from 2006 to 2011. Routine thoracoabdominal computed tomographic scans allowed for measurement of the truncal adiposity volume. The truncal three-dimensional reconstruction body mass index was calculated from the computed tomography-based volumes based on a previously validated algorithm. A truncal three-dimensional reconstruction body mass index of obese patients and ≥ 30 kg/m(2) denoted obese patients. The need for orthopaedic surgical procedure, in-hospital mortality, length of stay, hospital charges, and discharge disposition were compared between the two groups. Of the 301 patients, 21.6% were classified as obese (truncal three-dimensional reconstruction body mass index of ≥ 30 kg/m(2)). Higher truncal three-dimensional reconstruction body mass index was associated with longer hospital length of stay (p = 0.02), more days spent in the intensive care unit (p = 0.03), more frequent discharge to a long-term care facility (p obesity on patients with polytrauma. Obese patients were found to have higher total hospital charges, longer hospital stays, discharge to a continuing-care facility, and a higher rate of orthopaedic surgical intervention. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Radiation exposure to the eye lens of orthopaedic surgeons during various orthopaedic procedures

International Nuclear Information System (INIS)

Romanova, K.; Alyakov, M.; Vassileva, J.

2015-01-01

The aim of the present study was to assess the radiation dose to the eye lens of orthopaedic surgeons during various orthopaedic procedures and to make efforts to ensure that radiation protection is optimised. The study was performed for Fractura femoris and Fractura cruris procedures performed in orthopaedic operating theatres, as well as for fractures of wrist, ankle and hand/ shoulder performed in the emergency trauma room. The highest mean value of the eye lens dose of 47.2 μSv and higher mean fluoroscopy time of 3 min, as well as the corresponding highest maximum values of 77.1 μSv and 5.0 min were observed for the Fractura femoris procedure performed with the Biplanar 500e fluoroscopy systems. At a normal workload, the estimated mean annual dose values do not exceed the annual occupational dose limit for the lens of eye, but at a heavy workload in the department, this dose limit could be achieved or exceeded. The use of protective lead glasses is recommended as they could reduce the radiation exposure of the lens of the eye. The phantom measurements demonstrated that the use of half-dose mode could additionally reduce dose to the operator's eye lens. (authors)

Use of the WHO surgical safety checklist in trauma and orthopaedic patients.

Science.gov (United States)

Sewell, Mathew; Adebibe, Miriam; Jayakumar, Prakash; Jowett, Charlie; Kong, Kin; Vemulapalli, Krishna; Levack, Brian

2011-06-01

The World Health Organisation (WHO) recommends routine use of a surgical safety checklist prior to all surgical operations. The aim of this study was to prospectively audit checklist use in orthopaedic patients before and after implementation of an educational programme designed to increase use and correlate this with early complications, mortality and staff perceptions. Data was collected on 480 patients before the educational program and 485 patients after. Pre-training checklist use was 7.9%. The rates of early complications and mortality were 8.5% and 1.9%, respectively. Forty-seven percent thought the checklist improved team communication. Following an educational program, checklist use significantly increased to 96.9% (RR12.2; 95% CI 9.0-16.6). The rate of early complications and mortality was 7.6% (RR 0.89; 95% CI 0.58-1.37) and 1.6% (RR 0.88; 95% CI 0.34-2.26), respectively. Seventy-seven percent thought the checklist improved team communication. Checklist use was not associated with a significant reduction in early complications and mortality in patients undergoing orthopaedic surgery. Education programs can significantly increase accurate use and staff perceptions following implementation.

Effect of an independent-sector treatment centre on provision of elective orthopaedic surgery in east and north Hertfordshire.

Science.gov (United States)

Vanhegan, I; Hakmi, A; de Roeck, N; Rumian, A

2015-10-01

Introduction Independent Sector Treatment Centres (ISTCs) were created to relieve pressure from Acute Hospital Trusts. In October 2011, an ISTC opened on the grounds of a hospital within the East and North Hertfordshire NHS Trust. Most elective orthopaedic procedures were transferred there. We investigated the effect on productivity of operating theatres working in the ISTC compared with those working in the Acute Hospital Trust (AHT). Methods A 3-month period of working at the AHT was compared with the same period 9-months later in the ISTC, which were termed 'pre-' and 'post-ISTC' opening, respectively. Data for upper limb (UL) as well as foot and ankle (F&A) surgery were collected. Differences in the number of lists and patients per list constituted usage analyses. Financial productivity was calculated from the latest Payment by Results (PbR) data. A two-tailed Mann-Whitney U-test at a confidence level of 95% was employed to compare costs between groups. Results The UL surgeon undertook 18 lists in both years with 66 patients (pre-ISTC) and 32 (post-ISTC), eliciting a reduction in productivity of 51.5%. There were 13 lists for F&A surgery pre-ISTC with 67 procedures, and 20 lists with 49 patients post-ISTC. Allowing for the difference in the number of lists, a reduction of 52.5% was noted. PbR analyses confirmed productivity of £169,695 (pre-ISTC) and £95,760 (post-ISTC) at a loss of £73,935 for the UL surgeon. F&A data revealed £97,801 (pre-ISTC) and £91,960 (post-ISTC) at a loss of £54,742 when correcting for the difference in the number of lists. There was a combined reduction in potential financial productivity of £128,677 over 3 months or £514,708 over 1 year. Discussion Implementation of the ISTC was detrimental to departmental efficiency, with <50% of the number of patients being treated and a marked reduction in financial productivity.

CHAracteristics of research studies that iNfluence practice: a GEneral survey of Canadian orthopaedic Surgeons (CHANGES): a pilot survey.

Science.gov (United States)

de Sa, Darren; Thornley, Patrick; Evaniew, Nathan; Madden, Kim; Bhandari, Mohit; Ghert, Michelle

2015-01-01

Evidence Based Medicine (EBM) is increasingly being applied to inform clinical decision-making in orthopaedic surgery. Despite the promotion of EBM in Orthopaedic Surgery, the adoption of results from high quality clinical research seems highly unpredictable and does not appear to be driven strictly by randomized trial data. The objective of this study was to pilot a survey to determine if we could identify surgeon opinions on the characteristics of research studies that are perceived as being most likely to influence clinical decision-making among orthopaedic surgeons in Canada. A 28-question electronic survey was distributed to active members of the Canadian Orthopaedic Association (COA) over a period of 11 weeks. The questionnaire sought to analyze the influence of both extrinsic and intrinsic characteristics of research studies and their potential to influence practice patterns. Extrinsic factors included the perceived journal quality and investigator profiles, economic impact, peer/patient/industry influence and individual surgeon residency/fellowship training experiences. Intrinsic factors included study design, sample size, and outcomes reported. Descriptive statistics are provided. Of the 109 members of the COA who opened the survey, 95 (87%) completed the survey in its entirety. The overall response rate was 11% (95/841). Surgeons achieved consensus on the influence of three key designs on their practices: 1) randomized controlled trials 94 (99%), 2) meta-analysis 83 (87%), and 3) systematic reviews 81 (85%). Sixty-seven percent of surgeons agreed that studies with sample sizes of 101-500 or more were more likely to influence clinical practice than smaller studies (n = design influencing adoption included 1) reputation of the investigators (99%) and 2) perceived quality of the journal (75%). Although study design and sample size (i.e. minimum of 100 patients) have some influence on clinical decision making, surgeon respondents are equally influenced

Dehydration and fluid volume kinetics before major open abdominal surgery.

Science.gov (United States)

Hahn, R G; Bahlmann, H; Nilsson, L

2014-11-01

Assessment of dehydration in the preoperative setting is of potential clinical value. The present study uses urine analysis and plasma volume kinetics, which have both been validated against induced changes in body water in volunteers, to study the incidence and severity of dehydration before open abdominal surgery begins. Thirty patients (mean age 64 years) had their urine analysed before major elective open abdominal surgery for colour, specific weight, osmolality and creatinine. The results were scored and the mean taken to represent a 'dehydration index'. Thereafter, the patients received an infusion of 5 ml/kg of Ringer's acetate intravenously for over 15 min. Blood was sampled for 70 min and the blood haemoglobin concentration used to estimate the plasma volume kinetics. Distribution of fluid occurred more slowly (P dehydrated as compared with euhydrated patients. The dehydration index indicated that the fluid deficit in these patients corresponded to 2.5% of the body weight, whereas the deficit in the others was 1%. In contrast, the 11 patients who later developed postoperative nausea and vomiting had a very short elimination half-life, only 9 min (median, P dehydration before major surgery was modest as evidenced both by urine sampling and volume kinetic analysis. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Inpatient consultations to an orthopaedic service: the hidden workload.

LENUS (Irish Health Repository)

O'Malley, N T

2011-12-01

While the quality and efficiency of out-patient orthopaedic referrals are well documented in the literature, there is little on the standard and appropriateness of inpatient orthopaedic consultations.

Smartphones in orthopaedics.

Science.gov (United States)

Al-Hadithy, Nawfal; Gikas, Panagiotis D; Al-Nammari, Shafic Said

2012-08-01

With the introduction of the European Working Time Directive, surgical trainees are facing limited training opportunities and doctors are required to maximise their training opportunities. Smartphone sales have been rapidly increasing over the last five years and can be used as a training tool for the orthopaedic trainee and surgeon. Common uses include applications (AO, eLogbook and PubMed), Ebooks, online Logbooks, Guidelines and surgical techniques. In addition, smartphones can be used to immediately complete work-based assessments, in the absence of computers, hopefully increasing completion rates and reliability. Some journals now provide podcasts and video tutorials which may be accessed on smartphones, which is useful for higher examinations. Smartphones can also be used in the clinical setting to take photographs of wounds. Smartphones are enjoying increased uptake and application in the workplace and we review their use for orthopaedic surgeons and trainees to allow them to make the most out of their training opportunities.

Complex orthopaedic management of patients with skeletal dysplasias

Directory of Open Access Journals (Sweden)

A. G. Baindurashvili

2014-01-01

Full Text Available Skeletal dysplasias are challenging for diagnostics and treatment. We present a series of fifteen patients with different forms of skeletal dysplasias with age ranged from 6 to 17 years with variable clinical presentations managed as a part of the project of scientific cooperation between Turner Paediatric Orthopaedic Institute and Orthopaedic Hospital Vienna-Speising. The spectrum of diagnoses included multiple epiphyseal dysplasia, spondyloepiphyseal dysplasia congenita, diastrophic dysplasia, metaphyseal dysplasia, spondylometaphyseal dysplasia, Stickler syndrome, Kniest dysplasia, and anauxetic dysplasia. Complex treatment, which included axial correction and juxta-articular realignment, was performed as a single-stage, or consecutive surgery. Surgical techniques included corrective osteotomies with internal fixation, guided growth technique and external fixation devices. Best results (full axial correction, normal alignment of the joint were achieved in 8 patients, including 2 patients with metaphyseal dysplasia, 2 patients with multiple epyphyseal dysplasia, 2 patients with spondyloepyphyseal dysplasia, patient with Stickler syndrome and patient with spondylometaphyseal dysplasia. Good results (partial correction at the present time were seen in 4 patients (2 patients with Kniest dysplasia, 1 - with multiple epyphyseal dysplasia and 1 - with anauxetic dysplasia. Satisfactory results (non-progressive condition in previous progression were obtained in 2 patients with diastrophic dysplasia, and poor results (progression of the deformity - in 1 patient with diastrophic dysplasia. Positive results in most of the cases of our series make promising future for usage of complex approach for orthopedic management of children with skeletal dysplasias; advanced international cooperation is productive and helpful for diagnostics and management of rare diseases.

Major surgery in an osteosarcoma patient refusing blood transfusion: case report.

Science.gov (United States)

Dhanoa, Amreeta; Singh, Vivek A; Shanmugam, Rukmanikanthan; Rajendram, Raja

2010-11-08

We describe an unusual case of osteosarcoma in a Jehovah's Witness patient who underwent chemotherapy and major surgery without the need for blood transfusion. This 16-year-old girl presented with osteosarcoma of the right proximal tibia requiring proximal tibia resection, followed by endoprosthesis replacement. She was successfully treated with neoadjuvant chemotherapy and surgery with the support of haematinics, granulocyte colony-stimulating factor, recombinant erythropoietin and intraoperative normovolaemic haemodilution. This case illustrates the importance of maintaining effective, open communication and exploring acceptable therapeutic alternative in the management of these patients, whilst still respecting their beliefs.

Post-operative rounds by anaesthesiologists after hip fracture surgery: a pilot study

DEFF Research Database (Denmark)

Foss, Nicolai Bang; Christensen, Dorte Stig; Krasheninnikoff, Michael

2006-01-01

BACKGROUND: Efforts to optimize the peri-operative care of hip fracture patients through multidisciplinary intervention have focused on orthopaedic-geriatric liaisons, which have not resulted in significant outcome changes. The early phase of rehabilitation could potentially be optimized through...... a multidisciplinary effort between anaesthesiologists and orthopaedic surgeons. METHODS: During the first 25 weeks of 2004, 98 consecutive community-residing patients admitted to a hip fracture unit received daily rounds by anaesthesiologists during the first four post-operative days, on weekdays only, focusing...... conditions. CONCLUSION: This pilot study, with insufficient power to show significant differences in outcome, supports further evaluation of the concept of intensified orthopaedic-anaesthesiological co-operation after hip fracture surgery. Such a randomized trial should evaluate economic and clinical outcome...

Management of Spinal Tuberculosis - A Metropolitan City Based Survey Among Orthopaedic and Neurosurgeons

International Nuclear Information System (INIS)

Muhammad, T.

2015-01-01

Objective: To explore the core understanding of spinal tuberculosis and its current management plans by orthopaedics and neurosurgeons. Methods: The questionnaire-based study was conducted from July 2011 to November 2012 in Karachi and comprised consultant orthopaedics and neurosurgeons belonging to 4 private and 3 government tertiary care teaching hospitals and having a minimum five years of post-fellowship experience. A pre-designed questionnaire was used to explore the current practice in spinal tuberculosis regarding its clinical presentation, diagnosis and treatment. SPSS 15 was used for statistical analysis. Results: There were 48 subjects in the study; 24(50 percent) orthopaedic surgeons and 24(50 percent) neurosurgeons. According to 44(91.70 percent) respondents, common age for spinal tuberculosis was second and third decades of life, and 37(77.08 percent)reported refractory back pain with or without neurological deficits as the commonest clinical finding. Typical magnetic resonance imaging findings was the uniform observation of all the 48(100 percent) respondents. Diagnosis was made by histopathological findings by 39(81.25 percent) respondents. Anti-tuberculosis therapy was started empirically on the basis of clinical, laboratory and radiological findings by 33(68.75 percent) respondents. Those in favour of giving anti-tuberculosis therapy for 18 months were 32(66.7 percent) respondents, and 33(68.75 percent) thought surgery does not expedite recovery. Conclusion: Extremely variable tools of diagnosis and diversified approaches for the treatment are alarming signs for the possible development of resistant strains and complications of spinal tuberculosis. (author)

Social Media in Pediatric Orthopaedics.

Science.gov (United States)

Lander, Sarah T; Sanders, James O; Cook, Peter C; O'Malley, Natasha T

Internet searches and social media utilization in health care has exploded over the past 5 years, and patients utilize it to gain information on their health conditions and physicians. Social media has the potential to serve as a means for education, communication, and marketing in all health care specialties. Physicians are sometimes reluctant to engage because of concerns of privacy, litigation, and lack of experience with this modality. Many surgical subspecialties have capitalized on social media but no study to date has examined the specific footprint of pediatric orthopaedic surgeons in this realm. We aim to quantify the utilization of individual social media platforms by pediatric orthopaedic surgeons, and identify any differences between private and hospital-based physicians, but also regional differences. Using the Pediatric Orthopaedic Society of North America Member Directory, each active member's social media presence was reviewed through an Internet search. Members were stratified on the basis of practice model and geographic location. Individual Internet searches, social media sites, and number of publications were reviewed for social media presence. Of 987 Pediatric Orthopaedic Society of North America members, 95% had a professional webpage, 14.8% a professional Facebook page, 2.2% a professional Twitter page, 36.8% a LinkedIn profile, 25.8% a ResearchGate profile, 33% at least 1 YouTube. Hospital-based physicians had a lower mean level of utilization of social media compared with their private practice peers, and a higher incidence of Pubmed publications. Private practice physicians had double the social media utilization. Regional differences reveal that practicing Pediatric Orthopaedists in the Northeast had increased utilization of ResearchGate and LinkedIn and the West had the lowest mean social media utilization levels. The rapid expansion of social media usage by patients and their family members is an undeniable force affecting the health

Deep venous thrombosis after orthopedic surgery in adult cancer patients.

Science.gov (United States)

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%).

Longitudinal and Temporal Associations Between Daily Pain and Sleep Patterns After Major Pediatric Surgery.

Science.gov (United States)

Rabbitts, Jennifer A; Zhou, Chuan; Narayanan, Arthi; Palermo, Tonya M

2017-06-01

Approximately 20% of children develop persistent pain after major surgery. Sleep disruption has been implicated as a predictor of children's acute postsurgical pain. However, perioperative sleep patterns have not been longitudinally assessed, and the role of sleep in persistence of postsurgical pain has not been explored. We aimed to examine sleep patterns over 4 months in children having major surgery, and temporal relationships between daily sleep and pain. Sixty children age 10 to 18 (mean = 14.7) years having major surgery completed 7 days of actigraphy sleep monitoring (sleep duration, efficiency), twice daily electronic diaries (sleep quality, pain intensity, medication use), and validated questionnaires at presurgery, 2 weeks, and 4 months postsurgery. Generalized linear models, controlling for age, sex, naps, and medication, showed sleep quality (β [B] = -.88, P sleep quality was significantly associated with greater next day pain intensity (B = -.15, P = .005). Sleep duration and efficiency were not associated with subsequent pain; daytime pain was not associated with subsequent sleep. Findings suggest sleep quality may be an important target for intervention after surgery in children; research is needed to understand how other sleep parameters may relate to recovery. This study assessed longitudinal sleep patterns over 4 months after major pediatric surgery using actigraphy, diaries, and validated measures. Sleep quality and efficiency were significantly reduced at 2 weeks. Poorer sleep quality was associated with greater next day pain intensity suggesting that sleep quality may be an important target for intervention. Copyright © 2017 American Pain Society. Published by Elsevier Inc. All rights reserved.

Impact and alternative metrics for medical publishing: our experience with International Orthopaedics.

Science.gov (United States)

Scarlat, Marius M; Mavrogenis, Andreas F; Pećina, Marko; Niculescu, Marius

2015-08-01

This paper compares the traditional tools of calculation for a journal's efficacy and visibility with the new tools that have arrived from the Internet, social media and search engines. The examples concern publications of orthopaedic surgery and in particular International Orthopaedics. Until recently, the prestige of publications, authors or journals was evaluated by the number of citations using the traditional citation metrics, most commonly the impact factor. Over the last few years, scientific medical literature has developed exponentially. The Internet has dramatically changed the way of sharing and the speed of flow of medical information. New tools have allowed readers from all over the world to access information and record their experience. Web platforms such as Facebook® and Twitter® have allowed for inputs from the general public. Professional sites such as LinkedIn® and more specialised sites such as ResearchGate®, BioMed Central® and OrthoEvidence® have provided specific information on defined fields of science. Scientific and professional blogs provide free access quality information. Therefore, in this new era of advanced wireless technology and online medical communication, the prestige of a paper should also be evaluated by alternative metrics (altmetrics) that measure the visibility of the scientific information by collecting Internet citations, number of downloads, number of hits on the Internet, number of tweets and likes of scholarly articles by newspapers, blogs, social media and other sources of data. This article provides insights into altmetrics and informs the reader about current tools for optimal visibility and citation of their work. It also includes useful information about the performance of International Orthopaedics and the bias between traditional publication metrics and the new alternatives.

Quality and Variability of Online Available Physical Therapy Protocols From Academic Orthopaedic Surgery Programs for Anterior Cruciate Ligament Reconstruction.

Science.gov (United States)

Makhni, Eric C; Crump, Erica K; Steinhaus, Michael E; Verma, Nikhil N; Ahmad, Christopher S; Cole, Brian J; Bach, Bernard R

2016-08-01

To assess the quality and variability found across anterior cruciate ligament (ACL) rehabilitation protocols published online by academic orthopaedic programs. Web-based ACL physical therapy protocols from United States academic orthopaedic programs available online were included for review. Main exclusion criteria included concomitant meniscus repair, protocols aimed at pediatric patients, and failure to provide time points for the commencement or recommended completion of any protocol components. A comprehensive, custom scoring rubric was created that was used to assess each protocol for the presence or absence of various rehabilitation components, as well as when those activities were allowed to be initiated in each protocol. Forty-two protocols were included for review from 155 U.S. academic orthopaedic programs. Only 13 protocols (31%) recommended a prehabilitation program. Five protocols (12%) recommended continuous passive motion postoperatively. Eleven protocols (26%) recommended routine partial or non-weight bearing immediately postoperatively. Ten protocols (24%) mentioned utilization of a secondary/functional brace. There was considerable variation in range of desired full-weight-bearing initiation (9 weeks), as well as in the types of strength and proprioception exercises specifically recommended. Only 8 different protocols (19%) recommended return to sport after achieving certain strength and activity criteria. Many ACL rehabilitation protocols recommend treatment modalities not supported by current reports. Moreover, high variability in the composition and time ranges of rehabilitation components may lead to confusion among patients and therapists. Level II. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Hand transplantation and vascularized composite tissue allografts in orthopaedics and traumatology.

Science.gov (United States)

Schuind, F

2010-05-01

Composite tissue allograft (CTA) is defined as heterologous transplantation of a complex comprising skin and subcutaneous, neurovascular and mesenchymal tissue. Such techniques allow complex reconstruction using matched tissue, without donor site morbidity. The potential indications in orthopaedics-traumatology could in the future be more frequent than the present indications of heart, lung, liver, kidney and pancreas transplantation. International clinical experience clearly demonstrates the feasibility of CTA, both surgically and immunologically. However, immunosuppression remains indispensable, exposing the patient to risks that are not acceptable for purely functional surgery, except in very particular indications. The main hope for the future lies in induction of graft-specific tolerance. Copyright 2010 Elsevier Masson SAS. All rights reserved.

SWOT analysis: The analytical method in the process of planning and its application in the development of orthopaedic hospital department

Directory of Open Access Journals (Sweden)

Terzić Zorica

2010-01-01

Full Text Available Introduction. SWOT analysis is a managerial tool used to evaluate internal and external environment through strengths and weaknesses, opportunities and threats. Objective. The aim was to demonstrate the application of the SWOT analysis on the example of the Department for Paediatric Orthopaedics and Traumatology at the Institute of Orthopaedic Surgery 'Banjica' in Belgrade. Methods. Qualitative research was conducted during December 2008 at the Department for Paediatric Orthopaedics and Traumatology of the Institute of Orthopaedic Surgery 'Banjica' by applying the focus group technique. Participants were members of the medical staff and patients. In the first phase of the focus group brainstorming was applied to collect the factors of internal and external environment, and to identify strengths and weaknesses, opportunities and threats, respectively. In the second phase the nominal group technique was applied in order to reduce the list of factors. The factors were assessed according to their influence on the Department. Factors ranked by the three point Likert scale from 3 (highest impact to 1 (lowest impact. Results. The most important strengths of the Department are competent and skilled staff, high quality of services, average hospital bed utilization, the Department providing the educational basis of the School of Medicine, satisfied patients, pleasant setting, and additional working hours. The weaknesses are: poor spatial organization, personnel unmotivated to refresh knowledge, lack of specifically trained personnel, inadequate sanitary facilities, and uncovered services by the Insurance Fund, long average hospital stay, and low economic status of patients. The opportunities are: legislative regulations, formed paediatric traumatology service at the City level, good regional position of the Institute, and extension of referral areas. The threats are: absent Department autonomy in the personnel policy of the Institute, competitions within

[SWOT analysis: the analytical method in the process of planning and its application in the development of orthopaedic hospital department].

Science.gov (United States)

Terzić, Zorica; Vukasinović, Zoran; Bjegović-Mikanović, Vesna; Jovanović, Vesna; Janicić, Radmila

2010-01-01

SWOT analysis is a managerial tool used to evaluate internal and external environment through strengths and weaknesses, opportunities and threats. The aim was to demonstrate the application of the SWOT analysis on the example of the Department for Paediatric Orthopaedics and Traumatology at the Institute of Orthopaedic Surgery "Banjica" in Belgrade. Qualitative research was conducted during December 2008 at the Department for Paediatric Orthopaedics and Traumatology of the Institute of Orthopaedic Surgery "Banjica" by applying the focus group technique. Participants were members of the medical staff and patients. In the first phase of the focus group brainstorming was applied to collect the factors of internal and external environment, and to identify strengths and weaknesses, opportunities and threats, respectively. In the second phase the nominal group technique was applied in order to reduce the list of factors. The factors were assessed according to their influence on the Department. Factors ranked by the three point Likert scale from 3 (highest impact) to 1 (lowest impact). The most important strengths of the Department are competent and skilled staff, high quality of services, average hospital bed utilization, the Department providing the educational basis of the School of Medicine, satisfied patients, pleasant setting, and additional working hours. The weaknesses are: poor spatial organization, personnel unmotivated to refresh knowledge, lack of specifically trained personnel, inadequate sanitary facilities, and uncovered services by the Insurance Fund, long average hospital stay, and low economic status of patients. The opportunities are: legislative regulations, formed paediatric traumatology service at the City level, good regional position of the Institute, and extension of referral areas. The threats are: absent Department autonomy in the personnel policy of the Institute, competitions within the Institute, impossibility to increase the Department

New Insight in Loss of Gut Barrier during Major Non-Abdominal Surgery.

Directory of Open Access Journals (Sweden)

Joep P M Derikx

Full Text Available Gut barrier loss has been implicated as a critical event in the occurrence of postoperative complications. We aimed to study the development of gut barrier loss in patients undergoing major non-abdominal surgery.Twenty consecutive children undergoing spinal fusion surgery were included. This kind of surgery is characterized by long operation time, significant blood loss, prolonged systemic hypotension, without directly leading to compromise of the intestines by intestinal manipulation or use of extracorporeal circulation. Blood was collected preoperatively, every two hours during surgery and 2, 4, 15 and 24 hours postoperatively. Gut mucosal barrier was assessed by plasma markers for enterocyte damage (I-FABP, I-BABP and urinary presence of tight junction protein claudin-3. Intestinal mucosal perfusion was measured by gastric tonometry (P(rCO2, P(r-aCO2-gap. Plasma concentration of I-FABP, I-BABP and urinary expression of claudin-3 increased rapidly and significantly after the onset of surgery in most children. Postoperatively, all markers decreased promptly towards baseline values together with normalisation of MAP. Plasma levels of I-FABP, I-BABP were significantly negatively correlated with MAP at (1/2 hour before blood sampling (-0.726 (p<0.001, -0.483 (P<0.001, respectively. Furthermore, circulating I-FABP correlated with gastric mucosal P(rCO2, P(r-aCO2-gap measured at the same time points (0.553 (p = 0.040, 0.585 (p = 0.028, respectively.This study shows the development of gut barrier loss in children undergoing major non-abdominal surgery, which is related to preceding hypotension and mesenterial hypoperfusion. These data shed new light on the potential role of peroperative circulatory perturbation and intestinal barrier loss.

New Insight in Loss of Gut Barrier during Major Non-Abdominal Surgery

Science.gov (United States)

Derikx, Joep P. M.; van Waardenburg, Dick A.; Thuijls, Geertje; Willigers, Henriëtte M.; Koenraads, Marianne; van Bijnen, Annemarie A.; Heineman, Erik; Poeze, Martijn; Ambergen, Ton; van Ooij, André; van Rhijn, Lodewijk W.; Buurman, Wim A.

2008-01-01

Background Gut barrier loss has been implicated as a critical event in the occurrence of postoperative complications. We aimed to study the development of gut barrier loss in patients undergoing major non-abdominal surgery. Methodology/Principal Findings Twenty consecutive children undergoing spinal fusion surgery were included. This kind of surgery is characterized by long operation time, significant blood loss, prolonged systemic hypotension, without directly leading to compromise of the intestines by intestinal manipulation or use of extracorporeal circulation. Blood was collected preoperatively, every two hours during surgery and 2, 4, 15 and 24 hours postoperatively. Gut mucosal barrier was assessed by plasma markers for enterocyte damage (I-FABP, I-BABP) and urinary presence of tight junction protein claudin-3. Intestinal mucosal perfusion was measured by gastric tonometry (PrCO2, Pr-aCO2-gap). Plasma concentration of I-FABP, I-BABP and urinary expression of claudin-3 increased rapidly and significantly after the onset of surgery in most children. Postoperatively, all markers decreased promptly towards baseline values together with normalisation of MAP. Plasma levels of I-FABP, I-BABP were significantly negatively correlated with MAP at ½ hour before blood sampling (−0.726 (p<0.001), −0.483 (P<0.001), respectively). Furthermore, circulating I-FABP correlated with gastric mucosal PrCO2, Pr-aCO2-gap measured at the same time points (0.553 (p = 0.040), 0.585 (p = 0.028), respectively). Conclusions/Significance This study shows the development of gut barrier loss in children undergoing major non-abdominal surgery, which is related to preceding hypotension and mesenterial hypoperfusion. These data shed new light on the potential role of peroperative circulatory perturbation and intestinal barrier loss. PMID:19088854

The comparative study of epidural levobupivacaine and bupivacaine in major abdominal surgeries

Directory of Open Access Journals (Sweden)

Ali Uzuner

2011-01-01

Conclusions: The results of our study suggest that same concentration of epidural levobupivacaine and bupivacaine with fentanyl provide stable postoperative analgesia and both were found safe for the patients undergoing major abdominal surgery.

Minimal Clinically Important Differences for American Orthopaedic Foot & Ankle Society Score in Hallux Valgus Surgery.

Science.gov (United States)

Chan, Hiok Yang; Chen, Jerry Yongqiang; Zainul-Abidin, Suraya; Ying, Hao; Koo, Kevin; Rikhraj, Inderjeet Singh

2017-05-01

The American Orthopaedic Foot & Ankle Society (AOFAS) score is one of the most common and adapted outcome scales in hallux valgus surgery. However, AOFAS is predominantly physician based and not patient based. Although it may be straightforward to derive statistical significance, it may not equate to the true subjective benefit of the patient's experience. There is a paucity of literature defining MCID for AOFAS in hallux valgus surgery although it could have a great impact on the accuracy of analyzing surgical outcomes. Hence, the primary aim of this study was to define the Minimal Clinically Important Difference (MCID) for the AOFAS score in these patients, and the secondary aim was to correlate patients' demographics to the MCID. We conducted a retrospective cross-sectional study. A total of 446 patients were reviewed preoperatively and followed up for 2 years. An anchor question was asked 2 years postoperation: "How would you rate the overall results of your treatment for your foot and ankle condition?" (excellent, very good, good, fair, poor, terrible). The MCID was derived using 4 methods, 3 from an anchor-based approach and 1 from a distribution-based approach. Anchor-based approaches were (1) mean difference in 2-year AOFAS scores of patients who answered "good" versus "fair" based on the anchor question; (2) mean change of AOFAS score preoperatively and at 2-year follow-up in patients who answered good; (3) receiver operating characteristic (ROC) curves method, where the area under the curve (AUC) represented the likelihood that the scoring system would accurately discriminate these 2 groups of patients. The distribution-based approach used to calculate MCID was the effect size method. There were 405 (90.8%) females and 41 (9.2%) males. Mean age was 51.2 (standard deviation [SD] = 13) years, mean preoperative BMI was 24.2 (SD = 4.1). Mean preoperative AOFAS score was 55.6 (SD = 16.8), with significant improvement to 85.7 (SD = 14.4) in 2 years ( P value

Intraperitoneal And Incisional Bupivacaine Analgesia For Major Abdominal/Gynecologic Surgery: A Placebocontrolled

Directory of Open Access Journals (Sweden)

R. Azarfarin

2006-05-01

Full Text Available Background:Postoperative pain is an important surgical problem. Recent studies in pain pathophysiology have led to the hypothesis that with perioperative administration of analgesics (pre-emptive analgesia it may be possible to prevent or reduce postoperative pain. This study was planned to investigate the efficacy of pre-emptive analgesia on postoperative pain after major gynecologic abdominal surgeries. Methods: In this prospective, double-blinded, randomized, and placebocontrolled trial, 60 ASA physical status I and II patients undergoing major abdominal gynecologic surgeries were randomized to receive 45 mL of bupivacaine 0.375% or 45mL of normal saline; 30 mL and 15 mL of the treatment solution was administered into the peritoneal cavity and incision, respectively, before wound closure. The pain score of the patients was evaluated by the visual analogue scale (VAS on awakening, and at 6, 12, and 24h after surgery. Time to first analgesia request and total analgesic requirements in the first 24h were recorded. Results: Pain scores were significantly higher in the placebo group than in the bupivacaine group on awakening (5.98±1.01 v.s 1.05±1.05; p<0.001, and at 6h after surgery (5.37±0.85 vs. 2.51±1.02; p<0.001. First request to analgesia was significantly longer in the bupivacaine patients than in the placebo group (5.87±3.04 h vs.1.35±0.36; p<0.001.Meperidine consumption over 24h was 96.00 ±17.53 mg in the placebo group compared with 23.28 ±14.89 mg in the bupivacaine patients (p<0.001.Conclusion:A combination of intraperitoneal and incisional bupivacaine infiltration at the end of abdominal gynecologic surgeries reduces postoperative pain on awakening and for 6 hours after surgery, and provides significant opioidsparing analgesia for 24 h after gynecologic abdominal surgeries.

Mental health treatment after major surgery among Vietnam-era Veterans with posttraumatic stress disorder.

Science.gov (United States)

Tsan, Jack Y; Stock, Eileen M; Greenawalt, David S; Zeber, John E; Copeland, Laurel A

2016-07-01

The purpose of this study was to examine mental health treatment use among Vietnam Veterans with posttraumatic stress disorder and determine whether undergoing major surgery interrupted mental health treatment or increased the risk of psychiatric hospitalization. Using retrospective data from Veterans Health Administration's electronic medical record system, a total of 3320 Vietnam-era surgery patients with preoperative posttraumatic stress disorder were identified and matched 1:4 with non-surgical patients with posttraumatic stress disorder. The receipt of surgery was associated with a decline in overall mental health treatment and posttraumatic stress disorder-specific treatment 1 month following surgery but not during any subsequent month thereafter. Additionally, surgery was not associated with psychiatric admission. © The Author(s) 2014.

Orthopaedic training in Kenya

African Journals Online (AJOL)

Background: Orthopaedic training in Kenya, like in other East, central and .... quite a number of good facilities that would train an ... provide a forum for exchange of ideas and training. (2,3) ... administrators purely interested in service provision,.

Establishing a children's orthopaedic hospital for Malawi: A review ...

African Journals Online (AJOL)

ordinate the MNCP since 2007. At present the program has a total of 29 clinics, which have treated 5748 patients. Furthermore, BCIH has overseen the full or partial training of 5 orthopaedic surgeons and 82 orthopaedic clinical officers in Malawi.

Aesthetic Breast Surgery and Concomitant Procedures: Incidence and Risk Factors for Major Complications in 73,608 Cases.

Science.gov (United States)

Gupta, Varun; Yeslev, Max; Winocour, Julian; Bamba, Ravinder; Rodriguez-Feo, Charles; Grotting, James C; Higdon, K Kye

2017-05-01

Major complications following aesthetic breast surgery are uncommon and thus assessment of risk factors is challenging. To determine the incidence and risk factors of major complications following aesthetic breast surgery and concomitant procedures. A prospective cohort of patients who enrolled into the CosmetAssure (Birmingham, AL) insurance program and underwent aesthetic breast surgery between 2008 and 2013 was identified. Major complications (requiring reoperation, readmission, or emergency room visit) within 30 days of surgery were recorded. Risk factors including age, smoking, body mass index (BMI), diabetes, type of surgical facility, and combined procedures were evaluated. Among women, augmentation was the most common breast procedure (n = 41,651, 58.6%) followed by augmentation-mastopexy, mastopexy, and reduction. Overall, major complications occurred in 1.46% with hematoma (0.99%) and infection (0.25%) being most common. Augmentation-mastopexy had a higher risk of complications, particularly infection (relative risk [RR] 1.74, P procedures. Age was the only significant predictor for hematomas (RR 1.01, P procedures or abdominoplasty performed alone. Among men, correction of gynecomastia was the most common breast procedure (n = 1613, 64.6%) with a complication rate of 1.80% and smoking as a risk factor (RR 2.73, P = 0.03). Incidence of major complications after breast cosmetic surgical procedures is low. Risk factors for major complications include increasing age and BMI. Combining abdominoplasty with any breast procedure increases the risk of major complications. 2. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Effect of general anesthesia and major versus minor surgery on late postoperative episodic and constant hypoxemia

DEFF Research Database (Denmark)

Rosenberg, J; Oturai, P; Erichsen, C J

1994-01-01

STUDY OBJECTIVE: To evaluate the relative contribution of general anesthesia alone and in combination with the surgical procedure to the pathogenesis of late postoperative hypoxemia. DESIGN: Open, controlled study. SETTING: University hospital. PATIENTS: 60 patients undergoing major abdominal...... surgery and 16 patients undergoing middle ear surgery, both with comparable general anesthesia. MEASUREMENTS AND MAIN RESULTS: Patients were monitored with continuous pulse oximetry on one preoperative night and the second postoperative night. Significant episodic or constant hypoxemia did not occur...... on the second postoperative night following middle ear surgery and general anesthesia, but severe episodic and constant hypoxemia did occur on the second postoperative after major abdominal surgery and general anesthesia. CONCLUSIONS: General anesthesia in itself is not an important factor in the development...

Improving consent in patients undergoing surgery for fractured neck of femur.

Science.gov (United States)

Thiruchandran, Gajendiran; McKean, Andrew R; Rudran, Branavan; Imam, Mohamed A; Yeong, Keefai; Hassan, Abdel

2018-05-02

Background Neck of femur fractures and their subsequent operative fixation are associated with high rates of perioperative morbidity and mortality. Consenting in this setting is suboptimal with the Montgomery court ruling changing the perspective of consent. This quality improvement project assessed the adequacy of consenting against British Orthopaedic Association-endorsed guidance and implemented a series of changes to improve the documentation of risks associated with surgery for fractured neck of femur. Methods Seventy consecutive patients who underwent any operative fixation of a neck of femur fracture were included over a 6-month period at a single centre. Patients unable to consent or without electronic notes were excluded. Consent forms were analysed and the documented potential risks or complications associated with surgery were compared to British Orthopaedic Association-endorsed guidance. A series of changes (using the plan, do study, act (PDSA) approach) was implemented to improve the adequacy of consent. Results Documentation of four out of 12 potential risks or complications was recorded in <50% of cases for patients with intracapsular fractures (n=35), and documentation of seven out of 12 potential risks or complications was recorded in <50% of cases for patients with extracapsular fractures (n=35). Re-audit following raising awareness and attaching consent guidance showed 100% documentation of potential risks or complications in patients with intracapsular and extracapsular fractures (n=70). A neck of femur fracture-specific consent form has been implemented which will hopefully lead to sustained improvement. Conclusions Consenting patients with fractured neck of femur for surgery in the authors' unit was suboptimal when compared to British Orthopaedic Association-endorsed consent guidance. This project has shown that ensuring such guidance is readily available has improved the adequacy of consent. The authors hope that introduction of a neck of

The efficacy of an extended scope physiotherapy clinic in paediatric orthopaedics.

LENUS (Irish Health Repository)

O Mir, Marie

2016-04-01

The demand for paediatric orthopaedic care is growing, and providing the service required is an increasingly challenging task. Physiotherapist-led triage clinics are utilised in adult orthopaedics to enable the provision of care to patients who may not require a surgical consult. The Physiotherapy Orthopaedic Triage Clinic (POTC) was established in Our Lady\\'s Children\\'s Hospital Crumlin in response to increasing demands on the paediatric orthopaedic service. The clinic is run by physiotherapists working in an advanced practice role (APP), and is the first paediatric clinic of its type and scale in the Republic of Ireland.

Study protocol for a randomised controlled trial of meniscal surgery compared with exercise and patient education for treatment of meniscal tears in young adults

DEFF Research Database (Denmark)

Skou, Soren Thorgaard; Lind, Martin; Holmich, Per

2017-01-01

INTRODUCTION: Arthroscopic surgery is a very common orthopaedic procedure. While several trials have investigated the effect of knee arthroscopy for middle-aged and older patients with meniscal tears, there is a paucity of trials comparing meniscal surgery with non-surgical treatment for younger...... adults. The aim of this randomised controlled trial (RCT) is to investigate if early arthroscopic surgery is superior to exercise therapy and education, with the option of later surgery if needed, in improving pain, function and quality of life in younger adults with meniscal tears. METHODS AND ANALYSIS......: This is a protocol for a multicentre, parallel-group RCT conducted at six hospitals across all five healthcare regions in Denmark. 140 patients aged 18-40 years with a clinical history and symptoms consistent with a meniscal tear, verified on MRI, found eligible for meniscal surgery by an orthopaedic surgeon...

Femoroacetabular impingement surgery

DEFF Research Database (Denmark)

Reiman, Michael P; Thorborg, Kristian

2015-01-01

both the examination and treatment of FAI does not appear to accommodate this exponential growth. In fact, the direction currently taken for FAI is similar to previously described paths of other orthopaedic and sports medicine pathologies (eg, shoulder impingement, knee meniscus tear) for which we have......Femoroacetabuler impingement (FAI) is becoming increasingly recognised as a potential pathological entity for individuals with hip pain. Surgery described to correct FAI has risen exponentially in the past 10 years with the use of hip arthroscopy. Unfortunately, the strength of evidence supporting...

The Placenta: Applications in Orthopaedic Sports Medicine.

Science.gov (United States)

McIntyre, James Alexander; Jones, Ian A; Danilkovich, Alla; Vangsness, C Thomas

2018-01-01

Placenta has a long history of use for treating burns and wounds. It is a rich source of collagen and other extracellular matrix proteins, tissue reparative growth factors, and stem cells, including mesenchymal stem cells (MSCs). Recent data show its therapeutic potential for orthopaedic sports medicine indications. To provide orthopaedic surgeons with an anatomic description of the placenta, to characterize its cellular composition, and to review the literature reporting the use of placenta-derived cells and placental tissue allografts for orthopaedic sports medicine indications in animal models and in humans. Systematic review. Using a total of 63 keyword combinations, the PubMed and MEDLINE databases were searched for published articles describing the use of placental cells and/or tissue for orthopaedic sports medicine indications. Information was collected on placental tissue type, indications, animal model, study design, treatment regimen, safety, and efficacy outcomes. Results were categorized by indication and subcategorized by animal model. Outcomes for 29 animal studies and 6 human studies reporting the use of placenta-derived therapeutics were generally positive; however, the placental tissue source, clinical indication, and administration route were highly variable across these studies. Fourteen animal studies described the use of placental tissue for tendon injuries, 13 studies for osteoarthritis or articular cartilage injuries, 3 for ligament injuries, and 1 for synovitis. Both placenta-derived culture-expanded cells (epithelial cells or MSCs) and placental tissue allografts were used in animal studies. In all human studies, commercial placental allografts were used. Five of 6 human studies examined the treatment of foot and ankle pathological conditions, and 1 studied the treatment of knee osteoarthritis. A review of the small number of reported studies revealed a high degree of variability in placental cell types, placental tissue preparation, routes

Bone Adaptation Around Orthopaedic Implants of Varying Materials

DEFF Research Database (Denmark)

Bagge, Mette

1998-01-01

The bone adaptation around orthopaedic implants is simulated using a three-dimensional finite element model. The remodeling scheme has its origin in optimization methods, and includes anisotropy and time-dependent loading......The bone adaptation around orthopaedic implants is simulated using a three-dimensional finite element model. The remodeling scheme has its origin in optimization methods, and includes anisotropy and time-dependent loading...

Effect of informational internet web pages on patients' decision-making: randomised controlled trial regarding choice of spinal or general anaesthesia for orthopaedic surgery.

Science.gov (United States)

Groves, N D; Humphreys, H W; Williams, A J; Jones, A

2010-03-01

This study explored whether patients' preference for particular types of anaesthesia could be influenced pre-operatively by giving them the addresses of various relevant websites. Patients at an orthopaedic pre-assessment education clinic completed a questionnaire, which included a short multiple-choice general knowledge quiz about anaesthesia, and also questioned them as to their choice of anaesthesia (general or neuraxial). Patients were randomly assigned to intervention or control groups. Intervention group members were given the addresses of three relevant anaesthesia and health related websites to access at home. All patients were asked to complete the questionnaires on a second occasion, before surgery. Initially, most patients stated a preference for general anaesthesia. Subsequently, the intervention group altered their preference towards neuraxial anaesthesia compared to the control group (p < or = 0.0001). The increase in median (IQR [range]) anaesthesia knowledge test score was greater in the intervention group (from 10.0 (9.0-12.0 [5.0-14.0]) to 13.0 (11.0-14.0 [6.0-14.0])) than in the control group (from 10.0 (9.0-11.5 [3.0-13.0]) to 11.0 (9.0-12.0 [4.0-14.0]); p = 0.0068).

A national survey of UK health libraries investigating the cost of interlibrary loan services and assessing the accessibility to key orthopaedic journals.

Science.gov (United States)

Tahim, Arpan; Stokes, Oliver; Vedi, Vikas

2012-06-01

 NHS Library Services are utilised by NHS staff and junior trainees to locate scientific papers that provide them with the evidence base required for modern medical practice. The cost of accessing articles can be considerable particularly for junior trainees.  This survey looks at variations in cost of journal article loans and investigates access to particular orthopaedic journals across the country.  A national survey of UK Health Libraries was performed. Access to and costs of journals and interlibrary loan services were assessed. Availability of five wide-reaching orthopaedic journals was investigated.  Seven hundred and ten libraries were identified. One hundred and ten libraries completed the questionnaire (16.7%). Of these, 96.2% reported free access to scientific journals for users. 99.1% of libraries used interlibrary loan services with 38.2% passing costs on to the user at an average of £2.99 per article. 72.7% of libraries supported orthopaedic services. Journal of Bone and Joint Surgery (British) had greatest onsite availability.  The study demonstrates fluctuations in cost of access to interlibrary loan services and variation in access to important orthopaedic journals. It provides a reflection of current policy of charging for the acquisition of medical evidence by libraries in the UK. © 2012 The authors. Health Information and Libraries Journal © 2012 Health Libraries Group.

Prevalence and pattern of small animal orthopaedic conditions at ...

African Journals Online (AJOL)

Small animal orthopaedic case records of a 20-year period were surveyed to obtain the prevalence and pattern of orthopaedic conditions presented to the Veterinary Teaching Hospital (VTH), University of Ibadan, Nigeria, with the objective of providing data for planning on small animal healthcare facilities, policy ...

Gender Differences in Pediatric Orthopaedics: What Are the Implications for the Future Workforce?

Science.gov (United States)

Amoli, Marielle A; Flynn, John M; Edmonds, Eric W; Glotzbecker, Michael P; Kelly, Derek M; Sawyer, Jeffrey R

2016-09-01

opportunities (men: 24 of 44 [55%], women: 14 of 18 [78%]). Interestingly, a higher percentage of males reported finances as being important when selecting a job (men: 23 of 44 [52%], women: five of 18 [28%]). For the current POSNA members, the most important reasons when choosing a job for both men and women were quality of partners (men: 168 of 408 [41%], women: 66 of 122 [54%]) and an interesting practice (men: 155 of 408 [38%], women 54 of 122 [44%]. As a result of our small sample size, there was no difference in starting salaries between men and women (women 12 of 18 [67%]; USD 350,000-450,000: men 11 of 44 [25%], women six of 18 [33%]; > USD 450,000: men eight of 44 [18%], women zero of 18 [0%], p = 0.131). When stratified by practice type, for private practice starting salaries, over half of men (seven of 13 [54%]) placed in the highest category of > USD 400,000, whereas the single woman respondent placed in the lowest category of job offers before starting their fellowship (men: 24 of 44 [54%], women: eight of 18 [44%], OR, 0.67 [CI, 0.22-2.0], p = 0.042). Finally, among POSNA members, women reported a lower weekly surgical case volume compared with men. Of the men, 108 of 408 (26%) reported performing more than seven surgeries per week compared with 12 of 122 women (10%; OR, 3.4 [CI, 1.8-6.44], p job opportunities among pediatric orthopaedic surgeons. As more men plan to reduce their workload or retire in the next 5 years, there may be further increases in the percentage of women surgeons in the workforce, so it is important that we begin to understand what effect, if any, gender has on practice patterns, job selection, and opportunities. Also, the finding that among the new graduates more women than men are choosing careers in academic practice over private practice suggests an extraordinary opportunity to develop more female leaders and role models at major pediatric orthopaedic centers.

Improved Safety and Cost Savings from Reductions in Cast-Saw Burns After Simulation-Based Education for Orthopaedic Surgery Residents.

Science.gov (United States)

Bae, Donald S; Lynch, Hayley; Jamieson, Katherine; Yu-Moe, C Winnie; Roussin, Christopher

2017-09-06

The purpose of this investigation was to characterize the clinical efficacy and cost-effectiveness of simulation training aimed at reducing cast-saw injuries. Third-year orthopaedic residents underwent simulation-based instruction on distal radial fracture reduction, casting, and cast removal using an oscillating saw. The analysis compared incidences of cast-saw injuries and associated costs before and after the implementation of the simulation curriculum. Actual and potential costs associated with cast-saw injuries included wound care, extra clinical visits, and potential total payment (indemnity and expense payments). Curriculum costs were calculated through time-derived, activity-based accounting methods. The researchers compared the costs of cast-saw injuries and the simulation curriculum to determine overall savings and return on investment. In the 2.5 years prior to simulation, cast-saw injuries occurred in approximately 4.3 per 100 casts cut by orthopaedic residents. For the 2.5-year period post-simulation, the injury rate decreased significantly to approximately 0.7 per 100 casts cut (p = 0.002). The total cost to implement the casting simulation was $2,465.31 per 6-month resident rotation. On the basis of historical data related to cast-saw burns (n = 6), total payments ranged from $2,995 to $25,000 per claim. The anticipated savings from averted cast-saw injuries and associated medicolegal payments in the 2.5 years post-simulation was $27,131, representing an 11-to-1 return on investment. Simulation-based training for orthopaedic surgical residents was effective in reducing cast-saw injuries and had a high theoretical return on investment. These results support further investment in simulation-based training as cost-effective means of improving patient safety and clinical outcomes. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Ireland's contribution to orthopaedic literature: a bibliometric analysis.

Science.gov (United States)

Kennedy, C; O Sullivan, P; Bilal, M; Walsh, A

2013-10-01

Bibliometric analysis of scientific performance within a country or speciality, facilitate the recognition of factors that may further enhance research activity and performance. Our aim was to illicit the current state of Irelands orthopaedic research output in terms of quantity and quality. We performed a retrospective bibliometric analysis of all Irish orthopaedic publications over the past 5 years, in the top 20 peer-reviewed orthopaedic journals. Utilising the MEDLINE database, each journal was evaluated for articles that were published over the study period. Reviews, editorials, reports and letters were excluded. Each article abstract was analysed for research content, and country of origin. A nation's mean IF was defined by multiplying each journal's IF by the number of articles. Publications per million (PmP) was calculated by dividing the total number of publications by the population of each country. We analysed a total of 25,595 article abstracts. Ireland contributed 109 articles in total (0.42% of all articles), however ranking according to population per million was 10th worldwide. Ireland ranked 18th worldwide in relation to mean impact factor, which was 2.91 over the study period. Ireland published in 16 of the top 20 journals, 9 of these were of European origin, and 1 of the top 5 was of American origin. In total, 61 Irish articles were assignable to clinical orthopaedic units. Clinical based studies (randomised controlled trials, observational, and epidemiology/bibliometric articles) and research based studies (In vivo, In vitro, and biomechanical) numbered 76 (69.7%) and 33 (30.2%) articles, respectively. This study provides a novel overview of current Irish orthopaedic related research, and how our standards translate to the worldwide orthopaedic community. In order to maintain our publication productivity, academic research should continue to be encouraged at post graduate level. Copyright © 2013 Royal College of Surgeons of Edinburgh

Thermal Manifestations and Nanoindentation of Bone Cements for Orthopaedic Surgery

Czech Academy of Sciences Publication Activity Database

Hloch, Sergej; Monka, P.; Hvizdoš, P.; Jakubéczyová, D.; Kozak, D.; Čolič, K.; Kloc, J.; Magurová, D.

2013-01-01

Roč. 17, č. 1 (2013), s. 251-258 ISSN 0354-9836 Institutional support: RVO:68145535 Keywords : bone cement * exothermic behaviour * nanoindentation * porosity * osteonecrosis Subject RIV: FJ - Surgery incl. Transplants Impact factor: 0.962, year: 2013

Are the claims made in orthopaedic print advertisements valid?

Science.gov (United States)

Davidson, Donald J; Rankin, Kenneth S; Jensen, Cyrus D; Moverley, Robert; Reed, Mike R; Sprowson, Andrew P

2014-05-01

Advertisements are commonplace in orthopaedic journals and may influence the readership with claims of clinical and scientific fact. Since the last assessment of the claims made in orthopaedic print advertisements ten years ago, there have been legislative changes and media scrutiny which have shaped this practice. The purpose of this study is to re-evaluate these claims. Fifty claims from 50 advertisements were chosen randomly from six highly respected peer-reviewed orthopaedic journals (published July-December 2011). The evidence supporting each claim was assessed and validated by three orthopaedic surgeons. The assessors, blinded to product and company, rated the evidence and answered the following questions: Does the evidence as presented support the claim made in the advertisement and what is the quality of that evidence? Is the claim supported by enough evidence to influence your own clinical practice? Twenty-eight claims cited evidence from published literature, four from public presentations, 11 from manufacturer "data held on file" and seven had no supporting evidence. Only 12 claims were considered to have high-quality evidence and only 11 were considered well supported. A strong correlation was seen between the quality of evidence and strength of support (Spearman r = 0.945, p advertisements. High-quality evidence is required by orthopaedic surgeons to influence clinical practice and this evidence should be sought by manufacturers wishing to market a successful product.

What Orthopaedic Operating Room Surfaces Are Contaminated With Bioburden? A Study Using the ATP Bioluminescence Assay.

Science.gov (United States)

Richard, Raveesh Daniel; Bowen, Thomas R

2017-07-01

Contaminated operating room surfaces can increase the risk of orthopaedic infections, particularly after procedures in which hardware implantation and instrumentation are used. The question arises as to how surgeons can measure surface cleanliness to detect increased levels of bioburden. This study aims to highlight the utility of adenosine triphosphate (ATP) bioluminescence technology as a novel technique in detecting the degree of contamination within the sterile operating room environment. What orthopaedic operating room surfaces are contaminated with bioburden? When energy is required for cellular work, ATP breaks down into adenosine biphosphate (ADP) and phosphate (P) and in that process releases energy. This process is inherent to all living things and can be detected as light emission with the use of bioluminescence assays. On a given day, six different orthopaedic surgery operating rooms (two adult reconstruction, two trauma, two spine) were tested before surgery with an ATP bioluminescence assay kit. All of the cases were considered clean surgery without infection, and this included the previously performed cases in each sampled room. These rooms had been cleaned and prepped for surgery but the patients had not been physically brought into the room. A total of 13 different surfaces were sampled once in each room: the operating room (OR) preparation table (both pre- and postdraping), OR light handles, Bovie machine buttons, supply closet countertops, the inside of the Bair Hugger™ hose, Bair Hugger™ buttons, right side of the OR table headboard, tourniquet machine buttons, the Clark-socket attachment, and patient positioners used for total hip and spine positioning. The relative light units (RLUs) obtained from each sample were recorded and data were compiled and averaged for analysis. These values were compared with previously published ATP benchmark values of 250 to 500 RLUs to define cleanliness in both the hospital and restaurant industries. All

Antibiotic-impregnated calcium phosphate cement as part of a comprehensive treatment for patients with established orthopaedic infection.

Science.gov (United States)

Niikura, Takahiro; Lee, Sang Yang; Iwakura, Takashi; Sakai, Yoshitada; Kuroda, Ryosuke; Kurosaka, Masahiro

2016-07-01

The treatment of established orthopaedic infection is challenging. While the main focus of treatment is wide surgical debridement, systemic and local antibiotic administration are important adjuvant therapies. Several reports have described the clinical use of antibiotic-impregnated calcium phosphate cement (CPC) to provide local antibiotic therapy for bone infections. However, these were all individual case reports, and no case series have been reported. We report a case series treated by a single surgeon using antibiotic-impregnated CPC as part of a comprehensive treatment plan in patients with established orthopaedic infection. We enrolled 13 consecutive patients with osteomyelitis (n = 6) or infected non-union (n = 7). Implantation of antibiotic-impregnated CPC was performed to provide local antibiotic therapy as part of a comprehensive treatment plan that also included wide surgical debridement, systemic antibiotic therapy, and subsequent second-stage reconstruction surgery. We investigated the rate of successful infection eradication and systemic/local complications. The concentration of antibiotics in the surgical drainage fluids, blood, and recovered CPC (via elution into a phosphate-buffered saline bath) were measured. The mean follow-up period after surgery was 50.4 (range, 27-73) months. There were no cases of infection recurrence during follow-up. No systemic toxicity or local complications from the implantation of antibiotic-impregnated CPC were observed. The vancomycin concentration in the fluid from surgical drainage (n = 6) was 527.1 ± 363.9 μg/mL on postoperative day 1 and 224.5 ± 198.4 μg/mL on postoperative day 2. In patients who did not receive systemic vancomycin therapy (n = 3), the maximum serum vancomycin level was antibiotic-impregnated CPC is an option to provide local antibiotic therapy as part of a comprehensive treatment plan. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights

Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit.

LENUS (Irish Health Repository)

Fennelly, Orna

2018-06-01

Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services.

Imaging of small bowel-related complications following major abdominal surgery

International Nuclear Information System (INIS)

Sandrasegaran, Kumaresan; Maglinte, Dean D.T.

2005-01-01

To recognize and document the small bowel reactions following major abdominal surgery is an important key for a correct diagnosis. Usually, plain abdominal radiography is the initial imaging examination requested in the immediate postoperative period, whereas gastrointestinal contrast studies are used to look for specific complications. In some countries, especially in Europe, sonography is widely employed to evaluate any acute affection of the abdomen. CT is commonly used to assess postoperative abdominal complications; in our institution also CT enteroclysis is often performed, to provide additional important informations. Radiologist should be able to diagnose less common types of obstruction, such as afferent loop, closed loop, strangulating obstruction as well as internal hernia. This knowledge may assume a critical importance for surgeons to decide on therapy. In this article, we focus our attention on the imaging (particularly CT) in small bowel complications following abdominal surgery

[epiDRB--a new minimally invasive concept for referencing in the field of computer-assisted orthopaedic surgery].

Science.gov (United States)

Ohnsorge, J A K; Weisskopf, M; Siebert, C H

2005-01-01

Optoelectronic navigation for computer-assisted orthopaedic surgery (CAOS) is based on a firm connection of bone with passive reflectors or active light-emitting diodes in a specific three-dimensional pattern. Even a so-called "minimally-invasive" dynamic reference base (DRB) requires fixation with screws or clamps via incision of the skin. Consequently an originally percutaneous intervention would unnecessarily be extended to an open procedure. Thus, computer-assisted navigation is rarely applied. Due to their tree-like design most DRB's interfere with the surgeon's actions and therefore are at permanent risk to be accidentally dislocated. Accordingly, the optic communication between the camera and the operative site may repeatedly be interrupted. The aim of the research was the development of a less bulky, more comfortable, stable and safely trackable device that can be fixed truly percutaneously. With engineering support of the industrial partner the radiolucent epiDRB was developed. It can be fixed with two or more pins and gains additional stability from its epicutaneous position. The intraoperative applicability and reliability was experimentally tested. Its low centre of gravity and its flat design allow the device to be located directly in the area of interest. Thanks to its epicutaneous position and its particular shape the epiDRB may perpetually be tracked by the navigation system without hindering the surgeon's actions. Hence, the risk of being displaced by accident is minimised and the line of sight remains unaffected. With the newly developed epiDRB computer-assisted navigation becomes easier and safer to handle even in punctures and other percutaneous procedures at the spine as much as at the extremities without an unproportionate amount of additional trauma. Due to the special design referencing of more than one vertebral body is possible at one time, thus decreasing radiation exposure and increasing efficiency.

The Role of 3D Modelling and Printing in Orthopaedic Tissue Engineering: A Review of the Current Literature.

Science.gov (United States)

Shaunak, Shalin; Dhinsa, Baljinder S; Khan, Wasim S

2017-01-01

Orthopaedic surgery lends itself well to advances in technology. An area of interest and ongoing research is that of the production of scaffolds for use in trauma and elective surgery. 3D printing provides unprecedented accuracy in terms of micro- and macro-structure and geometry for scaffold production. It can also be utilised to construct scaffolds of a variety of different materials and more recently has allowed for the construction of bio-implants which recapitulate bone and cartilage tissue. This review seeks to look at the various methods of 3DP, the materials used, elements of functionality and design, as well as modifications to increase the biomechanics and bioactivity of 3DP scaffolds. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

surgery of the hand in infants with cerebral palsy* 655

African Journals Online (AJOL)

1971-06-19

Jun 19, 1971 ... cerebral palsy is by re-education-physical, occupational, speech and drug therapy."· Orthopaedic surgery is usually considered as an adjunct to therapy'" and is indicated only for its value ... than long-continued postural training and stretching.",13 ... In each child in this series, the hand on the affected side.

Four-fold increase in foot ulcers in type 2 diabetic subjects without an increase in major amputations by a multidisciplinary setting

DEFF Research Database (Denmark)

Hedetoft, Christoffer; Rasmussen, Anne; Fabrin, Jesper

2008-01-01

AIMS: We observed a large increase in type 2 diabetic subjects with foot ulcers in our diabetic outpatient foot clinic and wanted to identify the amputations rate and individuals at risk of amputations by comparing those who had had a regular control in the multidisciplinary foot clinic prior...... to the amputations and those who had not. METHODS: We examined all clinical records from the orthopaedic surgery department and the diabetic outpatient foot clinic of diabetic patients who underwent amputations for 6 years. RESULTS: Eighty-eight patients with type 2 diabetes underwent 142 amputations; 42 major...... and 100 minor amputations. There was no increase in the number of major amputations in this period. In the group not followed in the foot clinic prior to amputations we showed a greater major amputations rate (p

Bio-psychosocial determinants of time lost from work following non life threatening acute orthopaedic trauma.

Science.gov (United States)

Clay, Fiona J; Newstead, Stuart V; Watson, Wendy L; Ozanne-Smith, Joan; McClure, Roderick J

2010-01-05

To determine factors predicting the duration of time away from work following acute orthopaedic non life threatening trauma Prospective cohort study conducted at four hospitals in Victoria, Australia. The cohort comprised 168 patients aged 18-64 years who were working prior to the injury and sustained a range of acute unintentional orthopaedic injuries resulting in hospitalization. Baseline data was obtained by survey and medical record review. Multivariate Cox proportional hazards regression analysis was used to examine the association between potential predictors and the duration of time away from work during the six month study. The study achieved 89% follow-up. Of the 168 participants recruited to the study, 68% returned to work during the six month study. Multivariate Cox proportional hazards regression analysis identified that blue collar work, negative pain attitudes with respect to work, high initial pain intensity, injury severity, older age, initial need for surgery, the presence of co-morbid health conditions at study entry and an orthopaedic injury to more than one region were associated with extended duration away from work following the injury. Participants in receipt of compensation who reported high social functioning at two weeks were 2.58 times more likely to have returned to work than similar participants reporting low social functioning. When only those who had returned to work were considered, the participant reported reason for return to work " to fill the day" was a significant predictor of earlier RTW [RR 2.41 (95% C.I 1.35-4.30)] whereas "financial security" and "because they felt able to" did not achieve significance. Many injury-related and psycho social factors affect the duration of time away from work following orthopaedic injury. Some of these are potentially modifiable and may be amenable to intervention. Further consideration of the reasons provided by participants for returning to work may provide important opportunities for social

A systematic review and meta-analysis of the effect of prophylactic tranexamic acid treatment in major benign uterine surgery

DEFF Research Database (Denmark)

Topsoee, Märta F; Settnes, Annette; Ottesen, Bent

2017-01-01

BACKGROUND: The value of tranexamic acid (TA) treatment as bleeding prophylaxis in major uterine surgery is unclear. OBJECTIVES: To evaluate the antihemorrhagic effect of prophylactic TA treatment in major benign uterine surgery. SEARCH STRATEGY: PubMed, Embase, Cochrane Library, and Web of Science...

Integrating Social Media and Anterior Cruciate Ligament Surgery: An Analysis of Patient, Surgeon, and Hospital Use.

Science.gov (United States)

Ramkumar, Prem N; La, Ton; Fisch, Evan; Fabricant, Peter D; White, Alexander E; Jones, Kristofer J; Taylor, Samuel A

2017-03-01

The purpose of this observational study of social media in sports medicine was to investigate and analyze the presence and shared content of anterior cruciate ligament (ACL) patients, sports surgeons, and top orthopaedic hospitals on popular social media streams. A search of 2 public domains (Instagram and Twitter) was performed over a 6-month period. ACL surgery ("#aclsurgery") was selected for the Instagram-based patient analysis after exclusion of veterinary ACL operations. A binary scoring system was used for media format, time (preoperatively or postoperatively), perioperative period (within 1 week of surgery), tone (positive or negative), return-to-work reference, return-to-play reference, rehabilitation reference, surgical-site reference, satisfaction reference, and dissatisfaction reference; perspective of the media was noted as well. A sample of 97 National Football League team surgeons was used for analysis of physician use in social media outlets and quantified by the number of posts. Hospital analysis categorized a sample of the top 50 orthopaedic hospitals by average number of posts and monthly posting rates with regard to orthopaedics, research, education, and personnel focus. In the patient analysis, 3,145 public posts of human subjects were shared on Instagram. Of these, 92% were personal recovery stories, with an emphasis on postoperative photographs (93%) with a positive tone (88%) more than 1 week after surgery (73%). Posts focused on surgical site (25%), return to play (30%), and postoperative rehabilitation (37%). Of the physicians, 16% had Twitter accounts, with an average of 94 posts per surgeon; none had Instagram accounts. Of the hospitals, 96% had Twitter accounts and 32% had Instagram accounts. Most of the hospital-based Instagram content in the sample was centered on patients or celebrities. Orthopaedic surgery has a large social media presence. Patients emphasize wound appearance, the rehabilitation process, and return to play

A Review of Current Clinical Applications of Three-Dimensional Printing in Spine Surgery.

Science.gov (United States)

Cho, Woojin; Job, Alan Varkey; Chen, Jing; Baek, Jung Hwan

2018-02-01

Three-dimensional (3D) printing is a transformative technology with a potentially wide range of applications in the field of orthopaedic spine surgery. This article aims to review the current applications, limitations, and future developments of 3D printing technology in orthopaedic spine surgery. Current preoperative applications of 3D printing include construction of complex 3D anatomic models for improved visual understanding, preoperative surgical planning, and surgical simulations for resident education. Intraoperatively, 3D printers have been successfully used in surgical guidance systems and in the creation of patient specific implantable devices. Furthermore, 3D printing is revolutionizing the field of regenerative medicine and tissue engineering, allowing construction of biocompatible scaffolds suitable for cell growth and vasculature. Advances in printing technology and evidence of positive clinical outcomes are needed before there is an expansion of 3D printing applied to the clinical setting.

Effect of clinical specialist physiotherapists in orthopaedic diagnostic setting - A systematic review

DEFF Research Database (Denmark)

Trøstrup, Jeanette; Mikkelsen, Lone Ramer; Juhl, Carsten

Relevance: Patients with musculoskeletal complaints are commonly referred to orthopaedic surgeons (OS) with 20 % of patients in primary care being referred to OS consultation. A high proportion of these referrals is not relevant for surgery and can potentially be managed entirely by physiotherapist...... with advanced clinical competencies; Clinical Specialist Physiotherapists (CSP). The use of CSPs instead of OSs to perform diagnostic assessment of patients with musculoskeletal complaints has been implemented in several countries (1). Earlier systematic reviews have evaluated CSPs effectiveness in diagnosing...... patients with musculoskeletal complaints and concluded that CSPs have the ability to diagnose musculoskeletal conditions (2), however since then more new studies have been published. Purpose: To evaluate the effectiveness of assessment of musculoskeletal complaints performed by CSP compared to OS...

Cosmetic surgery volume and its correlation with the major US stock market indices.

Science.gov (United States)

Gordon, Chad R; Pryor, Landon; Afifi, Ahmed M; Benedetto, Paul X; Langevin, C J; Papay, Francis; Yetman, Randall; Zins, James E

2010-01-01

As a consumer-driven industry, cosmetic plastic surgery is subject to ebbs and flows as the economy changes. There have been many predictions about the short, intermediate, and long-term impact on cosmetic plastic surgery as a result of difficulties in the current economic climate, but no studies published in the literature have quantified a direct correlation. The authors investigate a possible correlation between cosmetic surgery volume and the economic trends of the three major US stock market indices. A volume analysis for the time period from January 1992 to October 2008 was performed (n = 7360 patients, n = 8205 procedures). Four cosmetic procedures-forehead lift (FL), rhytidectomy (Rh), breast augmentation (BA), and liposuction (Li)-were chosen; breast reduction (BRd), breast reconstruction (BRc), and carpal tunnel release (CTR) were selected for comparison. Case volumes for each procedure and fiscal quarter were compared to the trends of the S&P 500, Dow Jones (DOW), and NASDAQ (NASD) indices. Pearson correlation statistics were used to evaluate a relationship between the market index trends and surgical volume. P values indices. FL (n =312) only correlated to the NASD (P = .021) and did not reach significance with the S&P 500 (P = .077) or DOW (P = .14). BRd and BRc demonstrated a direct correlation to two of the three stock market indices, whereas CTR showed an inverse (ie, negative) correlation to two of the three indices. This study, to our knowledge, is the first to suggest a direct correlation of four cosmetic and two reconstructive plastic surgery procedures to the three major US stock market indices and further emphasizes the importance of a broad-based plastic surgery practice in times of economic recession.

Platelet Rich Plasma and Knee Surgery

Directory of Open Access Journals (Sweden)

Mikel Sánchez

2014-01-01

Full Text Available In orthopaedic surgery and sports medicine, the knee joint has traditionally been considered the workhorse. The reconstruction of every damaged element in this joint is crucial in achieving the surgeon’s goal to restore the knee function and prevent degeneration towards osteoarthritis. In the last fifteen years, the field of regenerative medicine is witnessing a boost of autologous blood-derived platelet rich plasma products (PRPs application to effectively mimic and accelerate the tissue healing process. The scientific rationale behind PRPs is the delivery of growth factors, cytokines, and adhesive proteins present in platelets and plasma, as well as other biologically active proteins conveyed by the plasma such as fibrinogen, prothrombin, and fibronectin; with this biological engineering approach, new perspectives in knee surgery were opened. This work describes the use of PRP to construct and repair every single anatomical structure involved in knee surgery, detailing the process conducted in ligament, meniscal, and chondral surgery.

The horror of wrong-site surgery continues: report of two cases in a regional trauma centre in Nigeria.

Science.gov (United States)

Nwosu, Arinze

2015-01-01

Wrong- site surgeries are iatrogenic errors encountered in the course of surgical patient management. Despite the 'never do harm' pledge in the 'Hippocratic Oath' drafted in 5(th) century BC, man is after all human, with this limitation manifesting in the physician's art despite his best intention. Beyond the catastrophic consequences of wrong- site surgery on the patient and surgeon, and the opprobrium on the art of medicine, the incidents have come to be regarded as a quality-of-care indicator. Orthopaedic surgery is a specialty with a preponderance of this phenomenon and the attendant medico-legal issues relating to malpractice claims. Consequently the specialty had pioneered institutional initiatives at preventing these 'friendly-fires'. Awareness and implementation of these initiatives however remain low in many parts of the world, hampered by a culture of denial and shame. This report presents two cases of wrong-site surgery following trauma from road-traffic accident. The first case was a closed reduction of the 'wrong' dislocated hip in the trauma/emergency unit under the care of senior residents, while the second case was attempted wrong-site surgery on the right leg in a patient with fracture of the left tibia, in conjunction with bilateral femoral fracture and right radio-ulnar fracture; by an experienced Chief Consultant Orthopaedic Surgeon operating elective list. Both are orthopaedic cases, each with some trauma to both lower extremeties. Neither of the cases was formally mentioned anywhere in clinical discourse in the hospital, much less a formal report or audit. There was no formal, institutionalized process to prevent wrong-site surgery in the health institution and this could have been largely responsible for these incidents. An open, mandatory process of reporting such incidents for relevant audit and awareness is necessary, as a mechanism for prevention rather than blame or punishment.

Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States Medicare population: potential economic implications of a new minimally-invasive technology

OpenAIRE

Ackerman SJ; Polly Jr DW; Knight T; Schneider K; Holt T; Cummings J

2013-01-01

Stacey J Ackerman1, David W Polly Jr2, Tyler Knight3, Karen Schneider4, Tim Holt5, John Cummings61Covance 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, NSW, Australia; 5Montgomery Spine Center, Orthopaedic Surgery, Montgomery, AL, USA; 6Community Health Network, Neurosurgery, Indianapolis, IN, USAIntroduction: The econo...

Ambulatory major surgery of benign tumors of the thyroid gland

International Nuclear Information System (INIS)

Luzardo Silveira, Ernesto Manuel; Eirin Aranno, Juana Elisa

2011-01-01

A descriptive and prospective study on the practice of ambulatory major surgery to eliminate benign tumours of the thyroid gland, was carried out in the General Surgery Service of 'Dr. Joaquin Castillo Duany' Teaching Clinical Surgical Hospital in Santiago de Cuba during the years 1996-2008, both included, through a previous clinical evaluation of 74 patients in the Endocrinology Outpatient Department, where it was decided that they could definitely have a surgical treatment. The female sex, the age groups from 31 to 45 years, the hemithyroidectomy as surgical technique, acupuncture as analgesic procedure and the follicular adenoma as cytohistological result prevailed in the case material. Mild complications occurred in 5 members of the sample, but recovery was absolute in all, so that even 72 of them were discharged before the 24 hours. Due to its good acceptance, this surgical method is beneficial for patient and hospital institutions.(author)

Orthopaedic Rehabilitation Device Actuated with Pneumatic Muscles

Directory of Open Access Journals (Sweden)

Ioana Petre

2014-07-01

Full Text Available Year after year recovery clinics worldwide report significant numbers of lower limb bearing joint disabilities. An effective method for the speedy rehabilitation of patients with such afflictions is Continuous Passive Motion (CPM, drawing upon a range of specific equipment. This paper presents an innovative constructive solution for such orthopaedic rehabilitation equipment, designed to ensure a swift reintegration of patients at as low a cost as possible. The absolute novelty consists in the utilization of the linear pneumatic muscle as actuator of the orthopaedic rehabilitation equipment, thus achieving a light and highly compliant construction that satisfies safety requirements related to man-machine interaction. Pneumatic muscles are bio-inspired actuation systems characterized by a passive variable compliant behaviour. This property, deployed in rehabilitation systems, enables the development of human friendly devices, which are comfortable for the patients, and capable of safe interaction. This paper presents the constructive schematic of the orthopaedic rehabilitation equipment, the structure of the actuation and positioning system, and several of its functional characteristics.

Usefulness of a simple self-administered joint condition assessment sheet to predict the need for orthopaedic intervention in the management of haemophilic arthropathy.

Science.gov (United States)

Masaoka, T; Amano, K; Takedani, H; Suzuki, T; Otaki, M; Seita, I; Tateiwa, T; Shishido, T; Yamamoto, K; Fukutake, K

2017-03-01

Detecting signs of joint deterioration is important for early effective orthopaedic intervention in managing haemophilic arthropathy. We developed a simple, patient self-administered sheet to evaluate the joint condition, and assessed the predictive ability of this assessment sheet for the need for an orthopaedic intervention. This was a single-centre, cross-sectional study. The association between the score of each of the four items of the assessment sheet (bleeding, swelling, pain and physical impairment) and the results of radiological findings and physical examinations based on Haemophilia Joint Health Score 2.1 was assessed. An optimal scoring system was explored by the area under the curve (AUC). The cut-off value for the need for surgery or physiotherapy was determined using the receiver operating characteristic curve procedure. Forty-two patients were included. The 'physical impairment' item showed the highest correlation coefficient with the results of radiographic and physical examinations (range: 0.57-0.76). The AUC of finally adjusted scoring indicates good ability to discriminate between patients with and without a need for orthopaedic intervention. The positive predictive value was the highest at a cut-off value of 4 points for knees (63.0%) and ankles (70.0%), at 5 points for elbows (66.7%) and the highest predictive accuracy at the cut-off value of 4 points for all the joints. The linear trend of the need for an orthopaedic intervention was observed with an increasing score. The joint condition assessment sheet can help clinicians assess the need for orthopaedic intervention for haemophilic arthropathy in Japanese patients with haemophilia. © 2016 John Wiley & Sons Ltd.

Open access publishing: a study of current practices in orthopaedic research.

Science.gov (United States)

Sabharwal, Sanjeeve; Patel, Nirav; Johal, Karanjeev

2014-06-01

Open access (OA) publications have changed the paradigm of dissemination of scientific research. Their benefits to low-income countries underline their value; however, critics question exorbitant publication fees as well as their effect on the peer review process and research quality. This study reports on the prevalence of OA publishing in orthopaedic research and compares benchmark citation indices as well as evidence quality derived from OA journals with conventional subscription based orthopaedic journals. All 63 orthopaedic journals listed in ISI's Web of Knowledge Journal Citation Report (JCR) were examined. Bibliometric data attributed to each journal for the year 2012 was acquired from the JCR. Studies that fulfilled the criteria of level I evidence were identified for each journal within PubMed. Individual journal websites were reviewed to identify their open access policy. A total of 38 (60.3 %) journals did not offer any form of OA publishing; however, 20 (31.7 %) hybrid journals were identified which offered authors the choice to publish their work as OA if a publication fee was paid. Only five (8 %) journals published all their articles as OA. There was variability amongst the different publication fees for OA articles. Journals that published OA articles did not differ from subscription based journals on the basis of 2012 impact factor, citation number, self citation proportion or the volume of level I evidence published (p > 0.05). OA journals are present in orthopaedic research, though in small numbers. Over a third of orthopaedic journals catalogued in the ISI Web of Knowledge JCR® are hybrid journals that provide authors with the opportunity to publish their articles as OA after a publication fee is paid. This study suggests equivalent importance and quality of articles between OA and subscription based orthopaedic journals based on bibliometric data and the volume of level I evidence produced. Orthopaedic researchers must recognize the

Orthopaedic Trauma Care Capacity Assessment and Strategic Planning in Ghana: Mapping a Way Forward.

Science.gov (United States)

Stewart, Barclay T; Gyedu, Adam; Tansley, Gavin; Yeboah, Dominic; Amponsah-Manu, Forster; Mock, Charles; Labi-Addo, Wilfred; Quansah, Robert

2016-12-07

Orthopaedic conditions incur more than 52 million disability-adjusted life years annually worldwide. This burden disproportionately affects low and middle-income countries, which are least equipped to provide orthopaedic care. We aimed to assess orthopaedic capacity in Ghana, describe spatial access to orthopaedic care, and identify hospitals that would most improve access to care if their capacity was improved. Seventeen perioperative and orthopaedic trauma care-related items were selected from the World Health Organization's Guidelines for Essential Trauma Care. Direct inspection and structured interviews with hospital staff were used to assess resource availability and factors contributing to deficiencies at 40 purposively sampled facilities. Cost-distance analyses described population-level spatial access to orthopaedic trauma care. Facilities for targeted capability improvement were identified through location-allocation modeling. Orthopaedic trauma care assessment demonstrated marked deficiencies. Some deficient resources were low cost (e.g., spinal immobilization, closed reduction capabilities, and prosthetics for amputees). Resource nonavailability resulted from several contributing factors (e.g., absence of equipment, technology breakage, lack of training). Implants were commonly prohibitively expensive. Building basic orthopaedic care capacity at 15 hospitals without such capacity would improve spatial access to basic care from 74.9% to 83.0% of the population (uncertainty interval [UI] of 81.2% to 83.6%), providing access for an additional 2,169,714 Ghanaians. The availability of several low-cost resources could be better supplied by improvements in organization and training for orthopaedic trauma care. There is a critical need to advocate and provide funding for orthopaedic resources. These initiatives might be particularly effective if aimed at hospitals that could provide care to a large proportion of the population.

Incidence and Risk Factors for Major Hematomas in Aesthetic Surgery: Analysis of 129,007 Patients.

Science.gov (United States)

Kaoutzanis, Christodoulos; Winocour, Julian; Gupta, Varun; Ganesh Kumar, Nishant; Sarosiek, Konrad; Wormer, Blair; Tokin, Christopher; Grotting, James C; Higdon, K Kye

2017-10-16

Postoperative hematomas are one of the most frequent complications following aesthetic surgery. Identifying risk factors for hematoma has been limited by underpowered studies from single institution experiences. To examine the incidence and identify independent risk factors for postoperative hematomas following cosmetic surgery utilizing a prospective, multicenter database. A prospectively enrolled cohort of patients who underwent aesthetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of major hematomas requiring emergency room visit, hospital admission, or reoperation within 30 days of the index operation. Univariate and multivariate analysis was used to identify potential risk factors for hematomas including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures. Of 129,007 patients, 1180 (0.91%) had a major hematoma. Mean age (42.0 ± 13.0 years vs 40.9 ± 13.9 years, P hematomas. Males suffered more hematomas than females (1.4% vs 0.9%, P Hematoma rates were higher in patients undergoing combined procedures compared to single procedures (1.1% vs 0.8%, P hematoma included age (Relative Risk [RR] 1.01), male gender (RR 1.98), the procedure being performed in a hospital setting rather than an office-based setting (RR 1.68), combined procedures (RR 1.35), and breast procedures rather than the body/extremity and face procedures (RR 1.81). Major hematoma is the most common complication following aesthetic surgery. Male patients and those undergoing breast or combined procedures have a significantly higher risk of developing hematomas. 2. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

The Use of WhatsApp Smartphone Messaging Improves Communication Efficiency within an Orthopaedic Surgery Team.

Science.gov (United States)

Ellanti, Prasad; Moriarty, Andrew; Coughlan, Fionn; McCarthy, Thomas

2017-02-18

Effective and timely communication is important for any surgical specialty to function. The use of smartphones is prevalent amongst doctors. Numerous smartphone applications offer the potential for fast and cost-effective communication. WhatsApp is a commonly used application that is free, easy to use, and capable of text and multimedia messaging. We report on the use of WhatsApp over a six month period in our unit. WhatsApp communication between non-consultant members of an orthopaedic team over a six-month period was analysed. Both the phones and the WhatsApp application were password-protected, and patient details were anonymised. A series of 20 communications using the hospital pager system and the telephone system were also analysed. A total of 5,492 messages were sent during the six-month period and were part of 1,916 separate communication events. The vast majority of messages, 5,090, were related to patient care. A total of 195 multimedia messages were sent and these included images of radiographs and wounds. When using the hospital telephones, the length of time spent on a communication averaged 5.78 minutes and using the hospital pager system averaged 7.45 minutes. Using the WhatsApp messaging system has potentially saved up to 7,664 minutes over the study period. All participants found WhatsApp easy to use and found it to be more efficient than the traditional pager system Conclusion: Compared to the traditional pager systems, the use of WhatsApp is easy, inexpensive, and reliable and can help improve the efficiency of communication within a surgical team.

Correlations of radiological assessment of skeletal maturity and orthopaedic injuries in the standardbred

International Nuclear Information System (INIS)

Pasolini, M.P.; Meomartino, L.; Fatone, G.; Brunetti, A.; Laratta, I.

2003-01-01

The aim of this study was to define a correlation between the incidence of orthopaedic injuries and the skeletal maturity, radiologically assessed, in a group of 23 standardbred horses. Starting at 18 months of age, radiograms of calcaneus and distal radial physis were taken at two months intervals, until X-ray evidence of closure. All the physis were blindly graded as: C: open physis; B-: initial evidence of central closure; B: partially closed physis; B+: full closure of the central portion of the physis; A: closed physis. Based on this classification, the horses were grouped as I (immature subject - C, B- and B), or M (mature subject - B+ and A). Orthopaedic injuries were classified as major lesion, if causing prolonged or definitive interruption of training, or minor, if causing brief or no interruption of training. Estimation of injury incidence in the different groups was calculated using the chi-square test (significance level P0.01). The average ages of physis closure (mean +- SD) were 24.1 +- 2.6 months (range 19-28), for the calcaneal physis, and 28.2 +- 2 months (range 26-33), for the distal radial physis, without significant differences between colts and fillies. In our study, according to a previous report, no correlation between X-ray skeletal maturity and incidence of orthopaedic injuries was demonstrated [it

Smartphones in orthopaedics

OpenAIRE

Al-Hadithy, Nawfal; Gikas, Panagiotis D; Al-Nammari, Shafic Said

2012-01-01

With the introduction of the European Working Time Directive, surgical trainees are facing limited training opportunities and doctors are required to maximise their training opportunities. Smartphone sales have been rapidly increasing over the last five years and can be used as a training tool for the orthopaedic trainee and surgeon. Common uses include applications (AO, eLogbook and PubMed), Ebooks, online Logbooks, Guidelines and surgical techniques. In addition, smartphones can be used to ...

The personal interview: assessing the potential for personality similarity to bias the selection of orthopaedic residents.

Science.gov (United States)

Quintero, Andres J; Segal, Lee S; King, Tonya S; Black, Kevin P

2009-10-01

The selection of medical students for training in orthopaedic surgery consists of an objective screening of cognitive skills to secure interviews for the brightest candidates, followed by subjective measures of candidates to confirm whether applicants are worthy of further consideration. The personal interview and its potential biased impact on the orthopaedic workforce were evaluated. During 2004-2006 at the Penn State College of Medicine, the authors performed a prospective cohort study in which 30 consenting interviewers and 135 interviewees completed the Myers-Briggs Type Indicator before the interviews. Completed surveys were evaluated after submitting the resident selection list to the National Residency Matching Program, and candidate rankings based solely on the personal interview were analyzed. Clinicians ranked candidates more favorably when they shared certain personality preferences (P = .044) and when they shared the preference groupings of the quadrant extrovert-sensing and either the function pair sensing-thinking (P = .007) or the temperament sensing-judging (P = .003), or the function pair sensing-feeling and the temperament sensing-judging (P = .029). No associations existed between personality preferences and interviewee rankings performed by basic scientists and resident interviewers. The results support the hypothesis that, within the department studied, there was a significant association between similarities in personality type and the rankings that individual faculty interviewers assigned to applicants at the completion of each interview session. The authors believe that it is important for the faculty member to recognize that this tendency exists. Finally, promoting diversity within the admission committee may foster a diverse resident body and orthopaedic workforce.

Management of Patients with Orthopaedic Implants Undergoing Dental Procedures.

Science.gov (United States)

Quinn, Robert H; Murray, Jayson N; Pezold, Ryan; Sevarino, Kaitlyn S

2017-07-01

The American Academy of Orthopaedic Surgeons, in collaboration with the American Dental Association, has developed Appropriate Use Criteria (AUC) for the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The Management of Patients with Orthopaedic Implants Undergoing Dental Procedures AUC clinical patient scenarios were derived from indications of patients with orthopaedic implants presenting for dental procedures, as well as from current evidence-based clinical practice guidelines and supporting literature to identify the appropriateness of the use of prophylactic antibiotics. The 64 patient scenarios and 1 treatment were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

[Famous figures of the Poznań orthopaedics of the period of the occupation and post-war years. Coryphees of Polish orthopaedics].

Science.gov (United States)

Barcikowski, Władysław

2008-01-01

In this article author presents, from a perspective of own memories is portraying persons which he met in his professional activity. They participated in forming the orthopaedics in Poznań and different nooks of Poland. He resembles their, often very dramatic, fates and the influence they had on Polish medicine reviving after the II world war. With the special attention he is reminding one of most well-known and valued celebrities of the Polish orthopaedics professor Wiktor Dega.

Social Competence and Temperament in Children with Chronic Orthopaedic Disability

Science.gov (United States)

Yagmurlu, Bilge; Yavuz, H. Melis

2015-01-01

The aim of the study was to investigate social competence in children with orthopaedic disability and its concurrent relations to child's temperament, health condition, and maternal warmth. Participants were 68 Turkish children (mean = 5.94 years) with chronic orthopaedic disability and their mothers coming from disadvantaged backgrounds. Mother…

Battlefield-Acquired Immunogenicity to Metals Affects Orthopaedic Implant Outcome

Science.gov (United States)

2015-10-01

Award Number: W81XWH-10-2-0138 TITLE: Battlefield-Acquired Immunogenicity to Metals Affects Orthopaedic Implant Outcome PRINCIPAL INVESTIGATOR...Immunogenicity to Metals Affects Orthopaedic pla t Outcome 5b. GRANT NUMBER W91ZSQ0135N646 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Nadim James...DISTRIBUTION / AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEM ENTARY NOTES 14. ABSTRACT The effects of battlefield

Orthopaedic Considerations for the Adult With Osteogenesis Imperfecta.

Science.gov (United States)

Roberts, Timothy T; Cepela, Daniel J; Uhl, Richard L; Lozman, Jeffery

2016-05-01

Osteogenesis imperfecta is a heritable group of collagen-related disorders that affects up to 50,000 people in the United States. Although the disease is most symptomatic in childhood, adults with osteogenesis imperfecta also are affected by the sequelae of the disease. Orthopaedic manifestations include posttraumatic and accelerated degenerative joint disease, kyphoscoliosis, and spondylolisthesis. Other manifestations of abnormal collagen include brittle dentition, hearing loss, cardiac valve abnormalities, and basilar invagination. In general, nonsurgical treatment is preferred for management of acute fractures. High rates of malunion, nonunion, and subsequent deformity have been reported with both closed and open treatment. When surgery is necessary, surgeons should opt for load-sharing intramedullary devices that span the entire length of the bone; locking plates and excessively rigid fixation generally should be avoided. Arthroplasty may be considered for active patients, but the procedure frequently is associated with complications in this patient population. Underlying deformities, such as malunion, bowing, rotational malalignment, coxa vara, and acetabular protrusio, pose specific surgical challenges and underscore the importance of preoperative planning.

International survey among orthopaedic trauma surgeons: Lack of a definition of fracture-related infection.

Science.gov (United States)

Morgenstern, M; Moriarty, T F; Kuehl, R; Richards, R G; McNally, M A; Verhofstad, M H J; Borens, O; Zalavras, C; Raschke, M; Kates, S L; Metsemakers, W J

2018-03-01

Fracture-related infection (FRI) is one of the most challenging musculoskeletal complications in orthopaedic-trauma surgery. Although the orthopaedic community has developed and adopted a consensus definition of prosthetic joint infections (PJI), it still remains unclear how the trauma surgery community defines FRI in daily clinical practice or in performing clinical research studies. The central aim of this study was to survey the opinions of a global network of trauma surgeons on the definitions and criteria they routinely use, and their opinion on the need for a unified definition of FRI. The secondary aims were to survey their opinion on the utility of currently used definitions that may be at least partially applicable for FRI, and finally their opinion on the important clinical parameters that should be considered as diagnostic criteria for FRI. An 11-item questionnaire was developed to cover the above-mentioned aims. The questionnaire was administered by SurveyMonkey and was sent via blast email to all registered users of AO Trauma (Davos, Switzerland). Out of the 26'563 recipients who opened the email, 2'327 (8.8%) completed the questionnaire. Nearly 90% of respondents agreed that a consensus-derived definition for FRI is required and 66% of the surgeons also agreed that PJI and FRI are not equal with respect to diagnosis, treatment and outcome. Furthermore, "positive cultures from microbiology testing", "elevation of CRP", "purulent drainage" and "local clinical signs of infection" were voted the most important diagnostic parameters for FRI. This international survey infers the need for a consensus definition of FRI and provides insight into the clinical parameters seen by an international community of trauma surgeons as being critical for defining FRI. Copyright © 2018 Elsevier Ltd. All rights reserved.

Cyclooxygenase-2 inhibitors and knee prosthesis surgery

OpenAIRE

Meunier, Andreas

2008-01-01

Adverse effects of cyclooxygenase (COX) inhibitors on bone healing have previously been demonstrated in diaphyseal fracture models in animals. In spite of that, they are widely used as postoperative analgesics in orthopaedic surgery. After joint replacement, a bone repair process starts at the interface between bone and cement. If this process is disturbed, the prosthesis may never become rigidly fixed to the bone, leading to migration and with time loosening. This thesis investigates the eff...

Advanced practice physiotherapy in paediatric orthopaedics: innovation and collaboration to improve service delivery.

Science.gov (United States)

Ó Mír, M; O'Sullivan, C

2018-02-01

One in eight paediatric primary care presentations is for a musculoskeletal (MSK) disorder. These patients are frequently referred to paediatric orthopaedic surgeons; however, up to 50% of referrals are for normal variants. This results in excessive wait-times and impedes access for urgent surgical cases. Adult MSK medicine has successfully utilised advanced practice physiotherapists (APP) managing non-surgical candidates, with documented benefits both to patients and services. There is a gap in the literature with regard to APP in paediatric orthopaedics. In this review, we investigate demands on paediatric orthopaedic services, examine the literature regarding APP in paediatric orthopaedics and explore the value the role has to offer current outpatient services. Paediatric orthopaedic services are under-resourced with concurrent long wait times. Approximately 50% of referrals are for normal variants, which do not require specialist intervention. Poor musculoskeletal examination skills and low diagnostic confidence amongst primary care physicians have been identified as a cause of inappropriate referrals. APP clinics for normal variants have reported independent management rate and discharge rates of 95% and marked reduction in patient wait times. There is limited evidence to support the APP in paediatric orthopaedics. Further studies are needed investigating diagnostic agreement, patient/stakeholder satisfaction, patient outcomes and economic evaluation. Paediatric orthopaedics is in crisis as to how to effectively manage the overwhelming volume of referrals. Innovative multidisciplinary solutions are required so that the onus is not solely on physicians to provide all services. The APP in paediatric orthopaedics may be part of the solution.

Review of MRSA screening and antibiotics prophylaxis in orthopaedic trauma patients; The risk of surgical site infection with inadequate antibiotic prophylaxis in patients colonized with MRSA.

Science.gov (United States)

Iqbal, H J; Ponniah, N; Long, S; Rath, N; Kent, M

2017-07-01

The primary aim of this study was to determine whether orthopaedic trauma patients receive appropriate antibiotic prophylaxis keeping in view the results of their MRSA screening. The secondary aim was to analyse the risk of developing MRSA surgical site infection with and without appropriate antibiotic prophylaxis in those colonized with MRSA. We reviewed 400 consecutive orthopaedic trauma patient episodes. Preoperative MRSA screening results, operative procedures, prophylactic antibiotics and postoperative course were explored. In addition to these consecutive patients, the hospital MRSA database over the previous 5 years identified 27 MRSA colonized acute trauma patients requiring surgery. Of the 400 consecutive patient episodes, 395(98.7%) had MRSA screening performed on admission. However, in 236 (59.0%) cases, the results were not available before the surgery. Seven patient episodes (1.8%) had positive MRSA colonization. Analysis of 27 MRSA colonized patients revealed that 20(74%) patients did not have the screening results available before the surgery. Only 5(18.5%) received Teicoplanin and 22(81.4%) received cefuroxime for antibiotic prophylaxis before their surgery. Of those receiving cefuroxime, five (22.73%) patients developed postoperative MRSA surgical site infection (SSI) but none of those (0%) receiving Teicoplanin had MRSA SSI. The absolute risk reduction for SSI with Teicoplanin as antibiotic prophylaxis was 22.73% (CI=5.22%-40.24%) and NNT (Number Needed to Treat) was 5 (CI=2.5-19.2) CONCLUSION: Lack of available screening results before the surgery may lead to inadequate antibiotic prophylaxis increasing the risk of MRSA surgical site infection. Glycopeptide (e.g.Teicoplanin) prophylaxis should be considered when there is history of MRSA colonization or MRSA screening results are not available before the surgery. Copyright © 2017. Published by Elsevier Ltd.

Does Orthopaedic Outpatient Care Reduce Emergency Department Utilization After Total Joint Arthroplasty?

Science.gov (United States)

Chaudhary, Muhammad Ali; Lange, Jeffrey K; Pak, Linda M; Blucher, Justin A; Barton, Lauren B; Sturgeon, Daniel J; Koehlmoos, Tracey; Haider, Adil H; Schoenfeld, Andrew J

2018-05-22

Emergency department (ED) visits after elective surgical procedures are a potential target for interventions to reduce healthcare costs. More than 1 million total joint arthroplasties (TJAs) are performed each year with postsurgical ED utilization estimated in the range of 10%. We asked whether (1) outpatient orthopaedic care was associated with reduced ED utilization and (2) whether there were identifiable factors associated with ED utilization within the first 30 and 90 days after TJA. An analysis of adult TRICARE beneficiaries who underwent TJA (2006-2014) was performed. TRICARE is the insurance program of the Department of Defense, covering > 9 million beneficiaries. ED use within 90 days of surgery was the primary outcome and postoperative outpatient orthopaedic care the primary explanatory variable. Patient demographics (age, sex, race, beneficiary category), clinical characteristics (length of hospital stay, prior comorbidities, complications), and environment of care were used as covariates. Logistic regression adjusted for all covariates was performed to determine factors associated with ED use. We found that orthopaedic outpatient care (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.68-0.77) was associated with lower odds of ED use within 90 days. We also found that index hospital length of stay (OR, 1.07; 95% CI, 1.04-1.10), medical comorbidities (OR, 1.16; 95% CI, 1.08-1.24), and complications (OR, 2.47; 95% CI, 2.24-2.72) were associated with higher odds of ED use. When considering that at 90 days, only 3928 patients sustained a complication, a substantial number of ED visits (11,486 of 15,414 [75%]) after TJA may be avoidable. Enhancing access to appropriate outpatient care with improved discharge planning may reduce ED use after TJA. Further research should be directed toward unpacking the situations, outside of complications, that drive patients to access the ED and devise interventions that could mitigate such behavior. Level III

Fracture liaison service in a non-regional orthopaedic clinic--a cost-effective service.

LENUS (Irish Health Repository)

Ahmed, M

2012-01-01

Fracture liaison services (FLS) aim to provide cost-effective targeting of secondary fracture prevention. It is proposed that a dedicated FLS be available in any hospital to which a patient presents with a fracture. An existing orthopaedic clinic nurse was retrained to deliver a FLS. Proformas were used so that different nurses could assume the fracture liaison nurse (FLN) role, as required. Screening consisted of fracture risk estimation, phlebotomy and DXA scanning. 124 (11%) of all patients attending the orthopaedic fracture clinic were reviewed in the FLS. Upper limb fractures accounted for the majority of fragility fractures screened n=69 (55.6%). Two-thirds of patients (n=69) had reduced bone mineral density (BMD). An evidence based approach to both non-pharmacological and pharmacotherapy was used and most patients (76.6%) receiving pharmacotherapy received an oral bisphosphonate (n=46). The FLS has proven to be an effective way of delivering secondary prevention for osteoporotic fracture in a non-regional fracture clinic, without increasing staff costs.

The Impact of Two Different Transfusion Strategies on Patient Immune Response during Major Abdominal Surgery: A Preliminary Report

OpenAIRE

Theodoraki, Kassiani; Markatou, Maria; Rizos, Demetrios; Fassoulaki, Argyro

2014-01-01

Blood transfusion is associated with well-known risks. We investigated the difference between a restrictive versus a liberal transfusion strategy on the immune response, as expressed by the production of inflammatory mediators, in patients subjected to major abdominal surgery procedures. Fifty-eight patients undergoing major abdominal surgery were randomized preoperatively to either a restrictive transfusion protocol or a liberal transfusion protocol (with transfusion if hemoglobin dropped be...

Using simulation to train orthopaedic trainees in non-technical skills: A pilot study.

Science.gov (United States)

Heaton, Samuel R; Little, Zoe; Akhtar, Kash; Ramachandran, Manoj; Lee, Joshua

2016-08-18

To enhance non-technical skills and to analyse participant's experience of a course tailored for orthopaedic surgeons. A Delphi technique was used to develop a course in human factors specific to orthopaedic residents. Twenty-six residents (six per course) participated in total with seven course facilitators all trained in Crisis Resource Management providing structured feedback. Six scenarios recreated challenging real-life situations using high-fidelity mannequins and simulated patients. Environments included a simulated operating suite, clinic room and ward setting. All were undertaken in a purpose built simulation suite utilising actors, mock operating rooms, mock clinical rooms and a high fidelity adult patient simulator organised through a simulation control room. Participants completed a 5-point Likert scale questionnaire (strongly disagree to strongly agree) before and after the course. This assessed their understanding of non-technical skills, scenario validity, relevance to orthopaedic training and predicted impact of the course on future practice. A course evaluation questionnaire was also completed to assess participants' feedback on the value and quality of the course itself. Twenty-six orthopaedic residents participated (24 male, 2 female; post-graduation 5-10 years), mean year of residency program 2.6 out of 6 years required in the United Kingdom. Pre-course questionnaires showed that while the majority of candidates recognised the importance of non-technical (NT) skills in orthopaedic training they demonstrated poor understanding of non-technical skills and their role. This improved significantly after the course (Likert score 3.0-4.2) and the perceived importance of these skills was reported as good or very good in 100%. The course was reported as enjoyable and provided an unthreatening learning environment with the candidates placing particular value on the learning opportunity provided by reflecting on their performance. All agreed that the

Perioperative risk factors for postoperative pneumonia after major oral cancer surgery: A retrospective analysis of 331 cases.

Science.gov (United States)

Xu, Jieyun; Hu, Jing; Yu, Pei; Wang, Weiwang; Hu, Xingxue; Hou, Jinsong; Fang, Silian; Liu, Xiqiang

2017-01-01

Postoperative pneumonia (POP) is common and results in prolonged hospital stays, higher costs, increased morbidity and mortality. However, data on the incidence and risk factors of POP after oral and maxillofacial surgery are rare. This study aims to identify perioperative risk factors for POP after major oral cancer (OC) surgery. Perioperative data and patient records of 331 consecutive subjects were analyzed in the period of April 2014 to March 2016. We individually traced each OC patient for a period to discharge from the hospital or 45 days after surgery, whichever occur later. The incidence of POP after major OC surgery with free flap construction or major OC surgery was 11.6% or 4.5%, respectively. Patient-related risk factors for POP were male sex, T stage, N stage, clinical stage and preoperative serum albumin level. Among the investigated procedure-related variables, incision grade, mandibulectomy, free flap reconstruction, tracheotomy, intraoperative blood loss, and the length of the operation were shown to be associated with the development of POP. Postoperative hospital stay was also significantly related to increased incidence of POP. Using a multivariable logistic regression model, we identified male sex, preoperative serum albumin level, operation time and postoperative hospital stay as independent risk factors for POP. Several perioperative risk factors can be identified that are associated with POP. At-risk oral cancer patients should be subjected to intensified postoperative pulmonary care.

Teleconsultation in paediatric orthopaedics in Djibouti: evaluation of response performance.

Science.gov (United States)

Bertani, A; Launay, F; Candoni, P; Mathieu, L; Rongieras, F; Chauvin, F

2012-11-01

Djibouti has no paediatric orthopaedics department and three options are available for difficult cases: transfer of the patient to another country; overseas mission transfer to Djibouti by a specialised surgical team; and management by a local orthopaedic surgeon receiving guidance from an expert. The extreme poverty of part of the population of Djibouti often precludes the first two options. Telemedecine can allow the local orthopaedic surgeon to receive expert advice. HYPOTHESES AND STUDY DESIGN: We prospectively recorded all the paediatric orthopaedics teleconsultations that occurred between November 2009 and November 2011. Our objective was to assess the performance of the teleconsultations. We hypothetized that this option was influential in decision making. We assessed the influence of the teleconsultation on patient management (i.e., change in the surgical indication and/or procedure). We then used the electronic patient records to compare the actual management to that recommended retrospectively by two independent orthopaedic surgeon consultants who had experience working overseas. Finally, we assessed the clinical outcomes in the patients. Of 48 teleconsultations for 39 patients, 13 dealt with diagnostic problems and 35 with therapeutic problems. The teleconsultation resolved the diagnostic uncertainties in 90% of cases. Advice from the expert modified the management in 37 (77%) teleconsultations; the change was related to the surgical indication in 18 cases, the surgical technique in 13 cases, and both in six cases. Agreement between the advice from the independent consultants and the treatment delivered by the local surgeon was 2.2/3. Clinical outcomes were good or very good in 31 (81%) of the 38 treated patients. This study establishes the feasibility and usefulness of paediatric orthopaedics teleconsultations in Djibouti. The introduction of telemedicine has changed our approach to challenges raised by patients in remote locations or precarious

Pattern of surgical procedures performed in the orthopaedic units of a tertiary hospital in South West Nigeria

Directory of Open Access Journals (Sweden)

Thomas O Adekoya-Cole

2016-01-01

Full Text Available Background: Lagos University Teaching Hospital (LUTH is one of the foremost teaching institutions in Nigeria. It is a recognized training institution for residency training in Nigeria. However, a thorough evaluation of the procedures being undertaken by the orthopaedic teams in this centre and the impact on the type of training being passed on to the resident doctors in training is the focus of this paper. Objectives: To determine the pattern of procedures performed by the orthopaedic units of the Department of Surgery, LUTH with a view to import the findings in re-organizing its structure based on service requirement, manpower allocation and to make recommendation. Methods: We retrospectively reviewed data including age, sex, procedures and leading surgeons retrieved from all our operating theatres over a period from 1st January 2010 to 31st December 2011. The data retrieved was analyzed. Results: A total 741 procedures were performed over the 2 year period. More male patients (58.5% had procedures performed on them than the female patients. The mean age of patients treated was 37.2±15.5 years. Trauma related procedures accounted for 68.8% of the total procedures. Open reduction and internal fixation surgical operations were the most common trauma related procedure while ablative surgical operations following Diabetic Mellitus foot syndrome were the most common non-trauma related procedure performed. Conclusion: Trauma related surgery remains the most common procedures in our teaching hospital. Efforts should be made to increase the number of elective operations like Arthroplasties, Arthroscopic operations and Spinal axis correction operations being performed.

Readability of Orthopaedic Patient-reported Outcome Measures: Is There a Fundamental Failure to Communicate?

Science.gov (United States)

Perez, Jorge L; Mosher, Zachary A; Watson, Shawna L; Sheppard, Evan D; Brabston, Eugene W; McGwin, Gerald; Ponce, Brent A

2017-08-01

Patient-reported outcome measures (PROMs) are increasingly used to quantify patients' perceptions of functional ability. The American Medical Association and NIH suggest patient materials be written at or below 6th to 8th grade reading levels, respectively, yet one recent study asserts that few PROMs comply with these recommendations, and suggests that the majority of PROMs are written at too high of a reading level for self-administered patient use. Notably, this study was limited in its use of only one readability algorithm, although there is no commonly accepted, standard readability algorithm for healthcare-related materials. Our study, using multiple readability equations and heeding equal weight to each, hopes to yield a broader, all-encompassing estimate of readability, thereby offering a more accurate assessment of the readability of orthopaedic PROMS. (1) What proportion of orthopaedic-related PROMs and orthopaedic-related portions of the NIH Patient Reported Outcomes Measurement Information System (PROMIS ® ) are written at or below the 6th and 8th grade levels? (2) Is there a correlation between the number of questions in the PROM and reading level? (3) Using systematic edits based on guidelines from the Centers for Medicare and Medicaid Services, what proportion of PROMs achieved American Medical Association and NIH-recommended reading levels? Eighty-six (86) independent, orthopaedic and general wellness PROMs, drawn from commonly referenced orthopaedic websites and prior studies, were chosen for analysis. Additionally, owing to their increasing use in orthopaedics, four relevant short forms, and 11 adult, physical health question banks from the PROMIS ® , were included for analysis. All documents were analyzed for reading grade levels using 19 unique readability algorithms. Descriptive statistics were performed using SPSS Version 22.0. The majority of the independent PROMs (64 of 86; 74%) were written at or below the 6th grade level, with 81 of 86

Enhanced Recovery Implementation in Major Gynecologic Surgeries: Effect of Care Standardization.

Science.gov (United States)

Modesitt, Susan C; Sarosiek, Bethany M; Trowbridge, Elisa R; Redick, Dana L; Shah, Puja M; Thiele, Robert H; Tiouririne, Mohamed; Hedrick, Traci L

2016-09-01

To examine implementing an enhanced recovery after surgery (ERAS) protocol for women undergoing major gynecologic surgery at an academic institution and compare surgical outcomes before and after implementation. Two ERAS protocols were developed: a full pathway using regional anesthesia for open procedures and a light pathway without regional anesthesia for vaginal and minimally invasive procedures. Enhanced recovery after surgery pathways included extensive preoperative counseling, carbohydrate loading and oral fluids before surgery, multimodal analgesia with avoidance of intravenous opioids, intraoperative goal-directed fluid resuscitation, and immediate postoperative feeding and ambulation. A before-and-after study design was used to compare clinical outcomes, costs, and patient satisfaction. Complications and risk-adjusted length of stay were drawn from the American College of Surgeons' National Surgical Quality Improvement Program database. On the ERAS full protocol, 136 patients were compared with 211 historical controls and the median length of stay was reduced (2.0 compared with 3.0 days; P=.007) despite an increase in National Surgical Quality Improvement Program-predicted length of stay (2.5 compared with 2.0 days; P=.009). Reductions were seen in median intraoperative morphine equivalents (0.3 compared with 12.7 mg; Pcontrols and demonstrated decreased intraoperative and postoperative morphine equivalents (0.0 compared with 13.0 mg; Pcontrol, nurses keeping patients informed, and staff teamwork; 30-day total hospital costs were significantly decreased in both ERAS groups. Implementation of ERAS protocols in gynecologic surgery was associated with a substantial decrease in intravenous fluids and morphine administration coupled with reduction in length of stay for open procedures combined with improved patient satisfaction and decreased hospital costs.

Perioperative factors associated with pressure ulcer development after major surgery

Science.gov (United States)

2018-01-01

Background Postoperative pressure ulcers are important indicators of perioperative care quality, and are serious and expensive complications during critical care. This study aimed to identify perioperative risk factors for postoperative pressure ulcers. Methods This retrospective case-control study evaluated 2,498 patients who underwent major surgery. Forty-three patients developed postoperative pressure ulcers and were matched to 86 control patients based on age, sex, surgery, and comorbidities. Results The pressure ulcer group had lower baseline hemoglobin and albumin levels, compared to the control group. The pressure ulcer group also had higher values for lactate levels, blood loss, and number of packed red blood cell (pRBC) units. Univariate analysis revealed that pressure ulcer development was associated with preoperative hemoglobin levels, albumin levels, lactate levels, intraoperative blood loss, number of pRBC units, Acute Physiologic and Chronic Health Evaluation II score, Braden scale score, postoperative ventilator care, and patient restraint. In the multiple logistic regression analysis, only preoperative low albumin levels (odds ratio [OR]: 0.21, 95% CI: 0.05–0.82; P pressure ulcer development. A receiver operating characteristic curve was used to assess the predictive power of the logistic regression model, and the area under the curve was 0.88 (95% CI: 0.79–0.97; P pressure ulcer development after surgery. PMID:29441175

Age-related postoperative morphine requirements in children following major surgery--an assessment using patient-controlled analgesia (PCA)

DEFF Research Database (Denmark)

Hansen, Tom Giedsing; Henneberg, Steen Winther; Hole, P

1996-01-01

To investigate if small children require less morphine for postoperative analgesia than do older children and adolescents we analysed the morphine consumption pattern of 28 consecutive children on intravenous patient-controlled analgesia (PCA) following major surgery. The median age-specific morp......To investigate if small children require less morphine for postoperative analgesia than do older children and adolescents we analysed the morphine consumption pattern of 28 consecutive children on intravenous patient-controlled analgesia (PCA) following major surgery. The median age...

42 Editorial ADVOCACY IN ORTHOPAEDICS

African Journals Online (AJOL)

2017-09-11

Sep 11, 2017 ... East African Orthopaedic Journal. Advocacy may be ... taxation of medical equipment and implants in Kenya. In 2013 a change ... Asia countries especially India were doing the opposite. They reduced ... Most developing countries have been dealing with communicable ... The role of advocacy is huge here.

Do Orthopaedic Surgeons Acknowledge Uncertainty?

NARCIS (Netherlands)

Teunis, Teun; Janssen, Stein; Guitton, Thierry G.; Ring, David; Parisien, Robert

2016-01-01

Much of the decision-making in orthopaedics rests on uncertain evidence. Uncertainty is therefore part of our normal daily practice, and yet physician uncertainty regarding treatment could diminish patients' health. It is not known if physician uncertainty is a function of the evidence alone or if

No effect of melatonin to modify surgical-stress response after major vascular surgery: a randomised placebo-controlled trial

DEFF Research Database (Denmark)

Kücükakin, B; Wilhelmsen, M; Lykkesfeldt, Jens

2010-01-01

A possible mechanism underlying cardiovascular morbidity after major vascular surgery may be the perioperative ischaemia-reperfusion with excessive oxygen-derived free-radical production and increased levels of circulating inflammatory mediators. We examined the effect of melatonin infusion during...... surgery and oral melatonin treatment for 3 days after surgery on biochemical markers of oxidative and inflammatory stress....

Reading the small print - labelling recommendations for orthopaedic implants.

Science.gov (United States)

Haene, Roger A; Sandhu, Ranbir S; Baxandall, Richard

2009-11-01

There exist, currently, no clear guidelines regarding standards for surgical implant labelling. Dimensions of the laminar flow canopies in orthopaedic use fixes the distance at which implant labels can be read. Mistakes when reading the label on an implant box can pose health risks for patients, and financial consequences for medical institutions. Using scientifically validated tools such as the Snellen Chart Formula, a theoretical minimum standard for text on implant labels was reached. This theoretical standard was then tested under real operating conditions. After discovering a minimum practical standard for implant labels, the authors then audited current labels in use on a wide range of orthopaedic implant packages. Furthermore, other non-text-related labelling problems were also noted. There is a definite minimum standard which should be observed when implant labels are manufactured. Implants in current use bear labels on the packaging that are of an insufficient standard to ensure patient safety in theatre. The authors have established text parameters that will increase the legibility of implant labels. In the interests of improving risk management in theatre, therefore, the authors propose a standard for orthopaedic implant labelling, and believe this will provide a useful foundation for further discussion between the orthopaedic community and implant manufacturers.

American Orthopaedic Society for Sports Medicine

Science.gov (United States)

... Upcoming Meetings Online Education Archived Meetings Faculty Resources Sports Medicine Fellowships Traveling Fellowship Submit an Abstract Submit ... Support AOSSM Research Publications Toggle American Journal of Sports Medicine Sports Health: A Multidisciplinary Approach Orthopaedic Journal ...

A benefit-risk review of systemic haemostatic agents - Part 1 : In major surgery

NARCIS (Netherlands)

Fraser, Ian S.; Porte, Robert J.; Kouides, Peter A.; Lukes, Andrea S.

2008-01-01

Systemic haemostatic agents play an important role in the management of blood loss during major surgery where significant blood loss is likely and their use has increased in recent times as a consequence of demand for blood products outstripping supply and the risks associated with transfusions.

Investigation on Alteration of Compression of Knitted Orthopaedic Supports during Exploitation

Directory of Open Access Journals (Sweden)

Diana ALIŠAUSKIENĖ

2012-12-01

Full Text Available One of the areas of medical textile is the spacer knitted orthopaedic products. The concept of compression therapy of orthopaedic supports lies on a simple and efficient mechanical principle – it consists of applying elastic garment around the limb. Spacer orthopaedic supports are knitted on flat knitting machines equipped with especial elastomeric thread feeder. Compression made by the support depends on the support area, shape and characteristics of knitting. Because of orthopaedic supports are intended for durable wearing and need to vouchsafe compression of fixed value, it is very important to known how processes acting during exploitation influence alteration of compression values. The aim of this study was to establish the alteration of compression of knitted support during exploitation, i. e. after multifold extension, washing and drying. The samples were knitted on a flat double needle bed knitting machine in combined jacquard-laid-in pattern with elastomeric weft threads. It was established that compressive properties of knits after cyclic tensile load changed slightly, i. e. range between margins of error. It was measured that knitted orthopaedic supports dimensions and density after washing and drying cycles changes significant, i. e. knitted supports shrinks and thickens and their compression decreases.DOI: http://dx.doi.org/10.5755/j01.ms.18.4.3097

A basic introduction to statistics for the orthopaedic surgeon.

Science.gov (United States)

Bertrand, Catherine; Van Riet, Roger; Verstreken, Frederik; Michielsen, Jef

2012-02-01

Orthopaedic surgeons should review the orthopaedic literature in order to keep pace with the latest insights and practices. A good understanding of basic statistical principles is of crucial importance to the ability to read articles critically, to interpret results and to arrive at correct conclusions. This paper explains some of the key concepts in statistics, including hypothesis testing, Type I and Type II errors, testing of normality, sample size and p values.

77 FR 66848 - Minimum Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and...

Science.gov (United States)

2012-11-07

...] Minimum Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and Regulation... Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and Regulation.'' FDA is co... (MCID) for patient-reported outcome (PRO) instruments used in orthopaedic extremity device-related...

Perioperative risk factors for postoperative pneumonia after major oral cancer surgery: A retrospective analysis of 331 cases.

Directory of Open Access Journals (Sweden)

Jieyun Xu

Full Text Available Postoperative pneumonia (POP is common and results in prolonged hospital stays, higher costs, increased morbidity and mortality. However, data on the incidence and risk factors of POP after oral and maxillofacial surgery are rare. This study aims to identify perioperative risk factors for POP after major oral cancer (OC surgery.Perioperative data and patient records of 331 consecutive subjects were analyzed in the period of April 2014 to March 2016. We individually traced each OC patient for a period to discharge from the hospital or 45 days after surgery, whichever occur later.The incidence of POP after major OC surgery with free flap construction or major OC surgery was 11.6% or 4.5%, respectively. Patient-related risk factors for POP were male sex, T stage, N stage, clinical stage and preoperative serum albumin level. Among the investigated procedure-related variables, incision grade, mandibulectomy, free flap reconstruction, tracheotomy, intraoperative blood loss, and the length of the operation were shown to be associated with the development of POP. Postoperative hospital stay was also significantly related to increased incidence of POP. Using a multivariable logistic regression model, we identified male sex, preoperative serum albumin level, operation time and postoperative hospital stay as independent risk factors for POP.Several perioperative risk factors can be identified that are associated with POP. At-risk oral cancer patients should be subjected to intensified postoperative pulmonary care.

Skeletal metastases - the role of the orthopaedic and spinal surgeon.

Science.gov (United States)

Eastley, Nicholas; Newey, Martyn; Ashford, Robert U

2012-09-01

Developments in oncological and medical therapies mean that life expectancy of patients with metastatic bone disease (MBD) is often measured in years. Complications of MBD may dramatically and irreversibly affect patient quality of life, making the careful assessment and appropriate management of these patients essential. The roles of orthopaedic and spinal surgeons in MBD generally fall into one of four categories: diagnostic, the prophylactic fixation of metastatic deposits at risk of impending fracture (preventative surgery), the stabilisation or reconstruction of bones affected by pathological fractures (reactive surgery), or the decompression and stabilisation of the vertebral column, spinal cord, and nerve roots. Several key principals should be adhered to whenever operating on skeletal metastases. Discussions should be held early with an appropriate multi-disciplinary team prior to intervention. Detailed pre-assessment is essential to gauge a patient's suitability for surgery - recovery from elective surgery must be shorter than the anticipated survival. Staging and biopsies provide prognostic information. Primary bone tumours must be ruled out in the case of a solitary bone lesion to avoid inappropriate intervention. Prophylactic surgical fixation of a lesion prior to a pathological fracture reduces morbidity and length of hospital stay. Regardless of a lesion or pathological fracture's location, all regions of the affected bone must be addressed, to reduce the risk of subsequent fracture. Surgical implants should allow full weight bearing or return to function immediately. Post-operative radiotherapy should be utilised in all cases to minimise disease progression. Spinal surgery should be considered for those with spinal pain due to potentially reversible spinal instability or neurological compromise. The opinion of a spinal surgeon should be sought early, as delays in referral directly correlate to worse functional recovery following intervention

Changes in lymphocyte subpopulations and adhesion/activation molecules following endotoxemia and major surgery

DEFF Research Database (Denmark)

Toft, P; Hokland, Marianne; Hansen, Tom Giedsing

1995-01-01

Major surgery as well as endotoxin-induced sepsis is accompanied by lymphocytopenia in peripheral blood. The purpose of this study was to investigate the redistribution of lymphocyte subpopulations and adhesion/activation molecules on lymphocytes. Twenty-four rats were included in the investigation....... Eight rats received an intraperitoneal injection of E. coli endotoxin (2 mg kg-1), eight rats had a sham operation performed while eight rats received isotonic saline and served as a control group. Blood samples were obtained by making an incision in the tail before and 2 and 5 h after surgery...... or administration of endotoxin or saline. After isolation of lymphocytes by gradient centrifugation, flow-cytometric immunophenotyping was performed using CD2, CD3, CD4, CD8, CD11/CD18, CD20, CD44 and MHC II monoclonal antibodies. Endotoxemia and surgery were both accompanied by increased serum cortisol...

Orthopaedic complications of osteogenesis imperfecta

International Nuclear Information System (INIS)

Azrak, S.; Ksyar, R.; Ben Rais, N.

2009-01-01

Osteogenesis imperfecta is a genetic disease characterized by bone frailty. It is generally caused by an abnormal production of collagen, which is the main fibrous protein of the bone. Collagen is also present in the skin, tendons, the sclera of the eye and dentin. The most frequent manifestation of osteogenesis imperfecta is the occurrence of multiple fractures without major trauma. Severity and timing of the attack varies widely: some patients sustain a significant number of fractures during early childhood which may have a serious impact on growth, while others will have some fractures separated by a few years. In all cases, the bone strength improves in adulthood. The bone fractures cause pain and bone deformities sometimes result in a smaller size. Scoliosis is frequent and associated with painful vertebral collapses. We present a case of osteogenesis imperfecta in a 40-year-old adult and we describe the various orthopaedic complications of the disease, stressing the role of bone scintigraphy in the diagnosis and monitoring of these complications. (authors)

Prevalence and factors of burnout among Australian orthopaedic trainees: a cross-sectional study.

Science.gov (United States)

Arora, Manit; Diwan, Ashish D; Harris, Ian A

2014-12-01

To assess the prevalence and factors of burnout among Australian orthopaedic trainees. 236 orthopaedic registrars of the Australian Orthopaedic Association were invited to participate in a 32-item survey by email. The questionnaire assessed potential factors associated with burnout, satisfaction with the choice of orthopaedics as a career and work-life balance, and subjective overall health, as well as 3 subscales of the Maslach Burnout Inventory - Human Services Survey for assessing burnout: emotional exhaustion, depersonalisation, and personal accomplishment. Participants with high levels of either emotional exhaustion or depersonalisation were defined as having burnout. Those with and without burnout were compared. 51 (22%) of the 236 trainees completed the questionnaire. Of whom, 88% were satisfied with their choice of orthopaedics as a career, whereas 27% were satisfied with their work-life balance. 27 (53%) respondents were considered burned out. Compared with those who did not burn out, those who burned out were less satisfied with their careers (p=0.004) and work-life balance (p=0.021). 53% of Australian orthopaedic trainees were burned out. Burnout trainees were more likely to be dissatisfied with their career choice and worklife balance. Active interventions to combat burnout and improve work-life balance are needed.

Pediatric Orthopaedic Workforce in 2014: Current Workforce and Projections for the Future.

Science.gov (United States)

Sawyer, Jeffrey R; Jones, Kerwyn C; Copley, Lawson A; Chambers, Stephanie

2017-01-01

The changing nature of the United States (US) health care system has prompted debate concerning the physician supply. The basic questions are: do we have an adequate number of surgeons to meet current demands and are we training the correct number of surgeons to meet future demands? The purpose of this analysis was to characterize the current pediatric orthopaedic workforce in terms of supply and demand, both present and future. Databases were searched (POSNA, SF Match, KID, MGMA) to determine the current pediatric orthopaedic workforce and workforce distribution, as well as pediatric orthopaedic demand. The number of active Pediatric Orthopaedic Society of North America (POSNA) members increased over the past 20 years, from 410 in 1993 to 653 in 2014 (155% increase); however, the density of POSNA members is not equally distributed, but correlates to population density. The number of estimated pediatric discharges, orthopaedic and nonorthopaedic, has remained relatively stable from 6,348,537 in 1997 to 5,850,184 in 2012. Between 2003 and 2013, the number of pediatric orthopaedic fellows graduating from Accreditation Council for Graduate Medical Education and non-Accreditation Council for Graduate Medical Education programs increased from 39 to 50 (29%), with a peak of 67 fellows (71%) in 2009. Although predicting the exact need for pediatric orthopaedic surgeons (POS) is impossible because of the complex interplay among macroeconomic, governmental, insurance, and local factors, some trends were identified: the supply of POS has increased, which may offset the expected numbers of experienced surgeons who will be leaving the workforce in the next 10 to 15 years; macroeconomic factors influencing demand for physician services, driven by gross domestic product and population growth, are expected to be stable in the near future; expansion of the scope of practice for POS is expected to continue; and further similar assessments are warranted. Level II-economic and

Readability of Orthopaedic Oncology-related Patient Education Materials Available on the Internet.

Science.gov (United States)

Shah, Akash K; Yi, Paul H; Stein, Andrew

2015-12-01

A person's health literacy is one of the most important indicators of a patient's health status. According to national recommendations, patient education materials should be written at no higher than the sixth- to eighth-grade reading level. The purpose of our study was to assess the readability of online patient education materials related to orthopaedic oncology on the websites of the American Academy of Orthopaedic Surgeons (AAOS), American Cancer Society (ACS), Bone and Cancer Foundation (BCF), and National Cancer Institute (NCI). We searched the online patient education libraries of the AAOS, ACS, BCF, and NCI for all articles related to orthopaedic oncology. The Flesch-Kincaid (FK) readability score was calculated for each article and compared between sources. A total of 227 articles were identified with an overall mean FK grade level of 9.8. Stratified by source, the mean FK grade levels were 10.1, 9.6, 11.1, and 9.5 for the AAOS, ACS, BCF, and NCI, respectively (P education materials related to orthopaedic oncology appear to be written at a level above the comprehension ability of the average patient. Copyright 2015 by the American Academy of Orthopaedic Surgeons.

Long Sick Leave after Orthopaedic Inpatient Rehabilitation: Treatment Failure or Relapse?

Science.gov (United States)

Mangels, Marija; Schwarz, Susanne; Worringen, Ulrike; Holme, Martin; Rief, Winfried

2011-01-01

We investigated whether short-term versus long-term sick leave after orthopaedic inpatient rehabilitation can be predicted by initial assessment information, the clinical status at discharge, or whether the follow-up interval is crucial for later sick leave. We examined 214 patients from an orthopaedic rehabilitation hospital at admission,…

Health-Related Quality of Life, Cachexia and Overall Survival After Major Upper Abdominal Surgery: A Prospective Cohort Study.

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Aahlin, E K; Tranø, G; Johns, N; Horn, A; Søreide, J A; Fearon, K C; Revhaug, A; Lassen, K

2017-03-01

Major upper abdominal surgery is often associated with reduced health-related quality of life and reduced survival. Patients with upper abdominal malignancies often suffer from cachexia, represented by preoperative weight loss and sarcopenia (low skeletal muscle mass) and this might affect both health-related quality of life and survival. We aimed to investigate how health-related quality of life is affected by cachexia and how health-related quality of life relates to long-term survival after major upper abdominal surgery. From 2001 to 2006, 447 patients were included in a Norwegian multicenter randomized controlled trial in major upper abdominal surgery. In this study, six years later, these patients were analyzed as a single prospective cohort and survival data were retrieved from the National Population Registry. Cachexia was derived from patient-reported preoperative weight loss and sarcopenia as assessed from computed tomography images taken within three months preoperatively. In the original trial, self-reported health-related quality of life was assessed preoperatively at trial enrollment and eight weeks postoperatively with the health-related quality of life questionnaire Short Form 36. A majority of the patients experienced improved mental health-related quality of life and, to a lesser extent, deteriorated physical health-related quality of life following surgery. There was a significant association between preoperative weight loss and reduced physical health-related quality of life. No association between sarcopenia and health-related quality of life was observed. Overall survival was significantly associated with physical health-related quality of life both pre- and postoperatively, and with postoperative mental health-related quality of life. The association between health-related quality of life and survival was particularly strong for postoperative physical health-related quality of life. Postoperative physical health-related quality of life

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.

Antibiotic prophylaxis in dermatologic surgery: advisory statement 2008.

Science.gov (United States)

Wright, Tina I; Baddour, Larry M; Berbari, Elie F; Roenigk, Randall K; Phillips, P Kim; Jacobs, M Amanda; Otley, Clark C

2008-09-01

Antibiotic prophylaxis is an important component of dermatologic surgery, and recommendations in this area should reflect the updated 2007 guidelines of the American Heart Association, the American Dental Association with the American Academy of Orthopaedic Surgeons guidelines, and recent prospective studies on surgical site infection. To provide an update on the indications for antibiotic prophylaxis in dermatologic surgery for the prevention of infective endocarditis, hematogenous total joint infection, and surgical site infection. A literature review was performed, expert consensus was obtained, and updated recommendations were created, consistent with the most current authoritative guidelines from the American Heart Association and the American Dental Association with the American Academy of Orthopaedic Surgeons. For patients with high-risk cardiac conditions, and a defined group of patients with prosthetic joints at high risk for hematogenous total joint infection, prophylactic antibiotics are recommended when the surgical site is infected or when the procedure involves breach of the oral mucosa. For the prevention of surgical site infections, antibiotics may be indicated for procedures on the lower extremities or groin, for wedge excisions of the lip and ear, skin flaps on the nose, skin grafts, and for patients with extensive inflammatory skin disease. These recommendations are not based on multiple, large-scale, prospective trials. There is a strong shift away from administration of prophylactic antibiotics in many dermatologic surgery settings, based on updated authoritative guidelines. These recommendations provide guidance to comply with the most current guidelines, modified to address dermatology-specific considerations. Managing physicians may utilize these guidelines while individualizing their approach based on all clinical considerations.

Factors affecting patient participation in orthopaedic trials comparing surgery to non-surgical interventions

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Rajat Mittal

2016-08-01

Conclusion: Patient non-participation in an RCT comparing surgery to no surgery is related to concern about receiving a treatment through chance and the presence of a strong preference for a particular treatment, particularly a non-surgical one. To avoid protracted recruitment periods, investigators can increase the number of study sites and ensure personnel involved have equipoise and are trained to provide a balanced view of both treatment arms.

NUTRITIONAL ASSESSMENT IN PATIENTS PREDICTED TO MAJOR ABDOMINAL SURGERY AT THE GENERAL HOSPITAL CELJE

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Ernest Novak

2001-12-01

Full Text Available Background. Malnutrition has serious implications for recovery after surgery. Early detection of malnutrition with nutritional support minimizes postoperative complications. Nutritional assessment tools need to be simple and suitable for use in everyday practice. In our study we wanted to determine, how many patients might benefit from nutritional support.Methods. From April to August 1999 fifty consecutively admitted patients predicted to major abdominal surgery have been examined. We used Mini nutritional assessment (MNA, Buzby’s nutrition risk index (NRI, blood albumin level and weight loss in the last 3 months period prior to the examination, to assess nutritional status.Results. We examined 50 patients (27 males and 23 females, age 76.5 ± 16.5 and confirmed malnutrition in 40% of patients with MNA and serum albumin level. The increased risk for nutrition-associated complications was confirmed by NRI and weight loss in 44%.Conclusions. A confident diagnosis of malnutrition and increased risk for nutrition-associated complications can be established by using a combination of simple methods like MNA, NRI, weight loss and serum albumin level. Almost half of the patients admitted for major abdominal surgery in General hospital Celje suffer from malnutrition and they may benefit with early nutritional intervention.

Best practice in major elective rectal/pelvic surgery: enhanced recovery after surgery (ERAS)

OpenAIRE

Segelman, Josefin; Nygren, Jonas

2017-01-01

Within traditional clinical care, the postoperative recovery after pelvic/rectal surgery has been slow with high morbidity and long hospital stay. The enhanced recovery after surgery program is a multimodal approach to perioperative care designed to accelerate recovery and safely reduce hospital stay. This review will briefly summarize optimal perioperative care, before, during and after surgery in this group of patients and issues related to implementation and audit.

Feasibility of real-time location systems in monitoring recovery after major abdominal surgery.

Science.gov (United States)

Dorrell, Robert D; Vermillion, Sarah A; Clark, Clancy J

2017-12-01

Early mobilization after major abdominal surgery decreases postoperative complications and length of stay, and has become a key component of enhanced recovery pathways. However, objective measures of patient movement after surgery are limited. Real-time location systems (RTLS), typically used for asset tracking, provide a novel approach to monitoring in-hospital patient activity. The current study investigates the feasibility of using RTLS to objectively track postoperative patient mobilization. The real-time location system employs a meshed network of infrared and RFID sensors and detectors that sample device locations every 3 s resulting in over 1 million data points per day. RTLS tracking was evaluated systematically in three phases: (1) sensitivity and specificity of the tracking device using simulated patient scenarios, (2) retrospective passive movement analysis of patient-linked equipment, and (3) prospective observational analysis of a patient-attached tracking device. RTLS tracking detected a simulated movement out of a room with sensitivity of 91% and specificity 100%. Specificity decreased to 75% if time out of room was less than 3 min. All RTLS-tagged patient-linked equipment was identified for 18 patients, but measurable patient movement associated with equipment was detected for only 2 patients (11%) with 1-8 out-of-room walks per day. Ten patients were prospectively monitored using RTLS badges following major abdominal surgery. Patient movement was recorded using patient diaries, direct observation, and an accelerometer. Sensitivity and specificity of RTLS patient tracking were both 100% in detecting out-of-room ambulation and correlated well with direct observation and patient-reported ambulation. Real-time location systems are a novel technology capable of objectively and accurately monitoring patient movement and provide an innovative approach to promoting early mobilization after surgery.

The effect of anesthesia type on the postoperative complications of major lower extremity surgery

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Murat Bakış

2014-03-01

Full Text Available Objective: Regional anesthesia is preferred more than general anesthesia in major lower extremity surgery. In our study, we aimed to investigate the relationship incidence of complications between regional anesthesia and general anesthesia in major surgery. Method: A total of 372 patients who underwent total hip or knee replacement from 1 January 2009 to 31 December 2012 were evaluated retrospectively in the study. The number of patients undergoing general anesthesia and regional anesthesia was respectively 118 and 254. If the patient has a history of more than one hip or knee replacements we were included only the first operation in the study. Postoperative complications were investigated over the course of 30 days. Patients' age, sex, type of operation (unilateral, bilateral, whether additional disease, postoperative complications were evaluated. Results: There were no difference for patients' age, sex and in terms of additional diseases. 92 patients general anesthesia and 135 patients regional anesthesia were performed to the patients who underwent total hip replacement, and 26 general anesthesia and 119 regional anesthesia is applied to patients who underwent total knee replacement (p=0.001. Postoperative complications are examined none of patients had no cardiac attack. Pulmonary embolism and death were found 7 in general anesthesia and 2 in regional anesthesia. Surgical site infection was found in 9 patients undergoing general anesthesia and 7 patients undergoing regional anesthesia and difference was statistically significant. Conclusion: In our clinic, regional and general anesthesia in patients undergoing major lower limb surgery applications observe significant difference in terms of complications during the postoperative period of 1 month.

On-Call Communication in Orthopaedic Trauma: "A Picture Is Worth a Thousand Words"--A Survey of OTA Members.

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Molina, Cesar S; Callan, Alexandra K; Burgos, Eduardo J; Mir, Hassan R

2015-05-01

To quantify the effects of varying clinical communication styles (verbal and pictorial) on the ability of orthopaedic trauma surgeons in understanding an injury and formulate an initial management plan. A Research Electronic Data Capture survey was e-mailed to all OTA members. Respondents quantified (5-point Likert scale) how confident they felt understanding an injury and establishing an initial management plan based on the information provided for 5 common orthopaedic trauma scenarios. Three verbal descriptions were created for each scenario and categorized as limited, moderate, or detailed. The questions were repeated with the addition of a radiographic image and then repeated a third time including a clinical photograph. Statistical evaluation consisted of descriptive statistics and Kruskal-Wallis analyses using STATA (version 12.0). Of the 221 respondents, there were a total of 95 who completed the entire survey. Nearly all were currently taking call (92/95 = 96.8%) and the majority were fellowship trained (79/95 = 83.2%). Most practice at a level I trauma center (58/95 = 61.1%) and work with orthopaedic residents (62/95 = 65.3%). There was a significant increase in confidence scores between a limited, moderate, and detailed description in all clinical scenarios for understanding the injury and establishing an initial management plan (P 0.05). The addition of images in the form of radiographs and/or clinical photographs greatly improves the confidence of orthopaedic trauma surgeons in understanding injuries and establishing initial management plans with limited verbal information (P communicating providers.

The Experience and Effectiveness of Nurse Practitioners in Orthopaedic Settings: A Comprehensive Systematic Review.

Science.gov (United States)

Taylor, Anita; Staruchowicz, Lynda

orthopaedic-specific hospital wards are increasingly being absorbed into general surgical units; a trend observed in the United States in the mid 1990's in response to the American experience of 'downsizing' orthopaedic nursing services. Despite a limited evidence base, early citations with specific reference to orthopaedic nurses in the American context in particular started to populate the literature on or around this time. Several proponents of the specialty began to refer to a core nursing skill set that was 'highly orthopaedic' when describing 'specialist' orthopaedic nursing practice. More recently commentators point to differences in certain variables when patients are 'outlied' or managed in a non-orthopaedic ward environment by non-orthopaedic nurses.Despite 'in-principle' support for expanded scopes of practice for various health practitioner roles, the observation exists from within the specialty of orthopaedic nursing that progress in establishing the orthopaedic nurse practitioner role for this group of specialist clinicians has been slow and their journey has not been without challenge. The majority of orthopaedic nurse practitioners in Australia at least have emerged from extended practice roles similar to the generally well established experience of other nurse practitioners emerging from their own practice interest. The orthopaedic nurse practitioner is considered a 'pioneer' as they fill a 'gap' in clinical need and develop an orthopaedic nurse practitioner role. An emerging evidence base suggests that barriers such as a lack of role understanding, lack of 'team' support and a lack of resources at a system, organisational and practice level, constrain nurse practitioner practice and integration of the role into practice settings. Nurse practitioners function in an advanced clinical role. Some attempts have been made at quantifying the work of nurse practitioners. For example, Gardner et al in 2010 divided the work of nurse practitioners into three domains of

[Incidence and risk factors of venous thromboembolism in major spinal surgery with no chemical or mechanical prophylaxis].

Science.gov (United States)

Rojas-Tomba, F; Gormaz-Talavera, I; Menéndez-Quintanilla, I E; Moriel-Durán, J; García de Quevedo-Puerta, D; Villanueva-Pareja, F

2016-01-01

To evaluate the incidence of venous thromboembolism in spine surgery with no chemical and mechanical prophylaxis, and to determine the specific risk factors for this complication. A historical cohort was analysed. All patients subjected to major spinal surgery, between January 2010 and September 2014, were included. No chemical or mechanical prophylaxis was administered in any patient. Active mobilisation of lower limbs was indicated immediately after surgery, and early ambulation started in the first 24-48 hours after surgery. Clinically symptomatic cases were confirmed by Doppler ultrasound of the lower limbs or chest CT angiography. A sample of 1092 cases was studied. Thromboembolic events were observed in 6 cases (.54%); 3 cases (.27%) with deep venous thrombosis and 3 cases (.27%) with pulmonary thromboembolism. A lethal case was identified (.09%). There were no cases of major bleeding or epidural haematoma. The following risk factors were identified: a multilevel fusion at more than 4 levels, surgeries longer than 130 minutes, patients older than 70 years of age, hypertension, and degenerative scoliosis. There is little scientific evidence on the prevention of thromboembolic events in spinal surgery. In addition to the disparity of prophylactic methods indicated by different specialists, it is important to weigh the risk-benefit of intra- and post-operative bleeding, and even the appearance of an epidural haematoma. Prophylaxis should be assessed in elderly patients over 70 years old, who are subjected to surgeries longer than 130 minutes, when 4 or more levels are involved. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

Does sleep deprivation impair orthopaedic surgeons' cognitive and psychomotor performance?

Science.gov (United States)

O'Brien, Michael J; O'Toole, Robert V; Newell, Mary Zadnik; Lydecker, Alison D; Nascone, Jason; Sciadini, Marcus; Pollak, Andrew; Turen, Clifford; Eglseder, W Andrew

2012-11-07

Sleep deprivation may slow reaction time, cloud judgment, and impair the ability to think. Our purpose was to study the cognitive and psychomotor performances of orthopaedic trauma surgeons on the basis of the amount of sleep that they obtained. We prospectively studied the performances of thirty-two orthopaedic trauma surgeons (residents, fellows, and attending surgeons) over two four-week periods at an urban academic trauma center. Testing sessions used handheld computers to administer validated cognitive and psychomotor function tests. We conducted a multivariate analysis to examine the independent association between test performance and multiple covariates, including the amount of sleep the night before testing. Our analysis demonstrated that orthopaedic surgeons who had slept four hours or less the night before the test had 1.43 times the odds (95% confidence interval, 1.04 to 1.95; p = 0.03) of committing at least one error on an individual test compared with orthopaedic surgeons who had slept more than four hours the previous night. The Running Memory test, which assesses sustained attention, concentration, and working memory, was most sensitive to deterioration in performance in participants who had had four hours of sleep or less; when controlling for other covariates, the test demonstrated a 72% increase in the odds of making at least one error (odds ratio, 1.72 [95% confidence interval, 1.02 to 2.90]; p = 0.04). No significant decrease in performance with sleep deprivation was shown with the other three tests. Orthopaedic trauma surgeons showed deterioration in performance on a validated cognitive task when they had slept four hours or less the previous night. It is unknown how performance on this test relates to surgical performance.

An interobserver reliability comparison between the Orthopaedic Trauma Association's open fracture classification and the Gustilo and Anderson classification.

Science.gov (United States)

Ghoshal, A; Enninghorst, N; Sisak, K; Balogh, Z J

2018-02-01

To evaluate interobserver reliability of the Orthopaedic Trauma Association's open fracture classification system (OTA-OFC). Patients of any age with a first presentation of an open long bone fracture were included. Standard radiographs, wound photographs, and a short clinical description were given to eight orthopaedic surgeons, who independently evaluated the injury using both the Gustilo and Anderson (GA) and OTA-OFC classifications. The responses were compared for variability using Cohen's kappa. The overall interobserver agreement was ĸ = 0.44 for the GA classification and ĸ = 0.49 for OTA-OFC, which reflects moderate agreement (0.41 to 0.60) for both classifications. The agreement in the five categories of OTA-OFC was: for skin, ĸ = 0.55 (moderate); for muscle, ĸ = 0.44 (moderate); for arterial injury, ĸ = 0.74 (substantial); for contamination, ĸ = 0.35 (fair); and for bone loss, ĸ = 0.41 (moderate). Although the OTA-OFC, with similar interobserver agreement to GA, offers a more detailed description of open fractures, further development may be needed to make it a reliable and robust tool. Cite this article: Bone Joint J 2018;100-B:242-6. ©2018 The British Editorial Society of Bone & Joint Surgery.

Worldwide orthopaedic research activity 2010-2014: Publication rates in the top 15 orthopaedic journals related to population size and gross domestic product.

Science.gov (United States)

Hohmann, Erik; Glatt, Vaida; Tetsworth, Kevin

2017-06-18

To perform a bibliometric analysis of publications rates in orthopedics in the top 15 orthopaedic journals. Based on their 2015 impact factor, the fifteen highest ranked orthopaedic journals between January 2010 and December 2014 were used to establish the total number of publications; cumulative impact factor points (IF) per country were determined, and normalized to population size, GDP, and GDP/capita, comparison to the median country output and the global leader. Twenty-three thousand and twenty-one orthopaedic articles were published, with 66 countries publishing. The United States had 8149 publications, followed by the United Kingdom (1644) and Japan (1467). The highest IF was achieved by the United States (24744), United Kingdom (4776), and Japan (4053). Normalized by population size Switzerland lead. Normalized by GDP, Croatia was the top achiever. Adjusting GDP/capita, for publications and IF, China, India, and the United States were the leaders. Adjusting for population size and GDP, 28 countries achieved numbers of publications to be considered at least equivalent with the median academic output. Adjusting GDP/capita only China and India reached the number of publications to be considered equivalent to the current global leader, the United States. Five countries were responsible for 60% of the orthopaedic research output over this 5-year period. After correcting for GDP/capita, only 28 of 66 countries achieved a publication rate equivalent to the median country. The United States, United Kingdom, South Korea, Japan, and Germany were the top five countries for both publication totals and cumulative impact factor points.

Assessing readability of patient education materials: current role in orthopaedics.

Science.gov (United States)

Badarudeen, Sameer; Sabharwal, Sanjeev

2010-10-01

Health literacy is the single best predictor of an individual's health status. It is important to customize health-related education material to the individual patient's level of reading skills. Readability of a given text is the objective measurement of the reading skills one should possess to understand the written material. In this article, some of the commonly used readability assessment tools are discussed and guidelines to improve the comprehension of patient education handouts are provided. Where are we now? Several healthcare organizations have recommended the readability of patient education materials be no higher than sixth- to eighth-grade level. However, most of the patient education materials currently available on major orthopaedic Web sites are written at a reading level that may be too advanced for comprehension by a substantial proportion of the population. WHERE DO WE NEED TO GO?: There are several readily available and validated tools for assessing the readability of written materials. While use of audiovisual aids such as video clips, line drawings, models, and charts can enhance the comprehension of a health-related topic, standard readability tools cannot construe such enhancements. HOW DO WE GET THERE?: Given the variability in the capacity to comprehend health-related materials among individuals seeking orthopaedic care, stratifying the contents of patient education materials at different levels of complexity will likely improve health literacy and enhance patient-centered communication.

The effect of balanced analgesia on early convalescence after major orthopaedic surgery

DEFF Research Database (Denmark)

Møiniche, S; Hjortsø, N C; Hansen, B L

1994-01-01

Forty-two patients scheduled for total knee arthroplasty (n = 20) or hip arthroplasty (n = 22) were randomly allocated to receive either continuous epidural bupivacaine/morphine for 48 h postoperatively plus oral piroxicam, or general anaesthesia followed by a conventional intramuscular opioid...

A comparative study of clonidine versus a combination of diazepam and atropine for premedication in orthopaedic patients.

Directory of Open Access Journals (Sweden)

Chaurasia S

1999-07-01

Full Text Available Sixty patients in the age group of 18-60 years of A.S.A. Grade I/II risk, scheduled for elective orthopaedic surgeries under general anaesthesia were studied for pre-medication with either oral clonidine or with combination of effects of diazepam & atropine. Patients in Group A (clonidine group received tablet clonidine 100 mcg (1 tablet if less than 50 kg in weight and 200 mcg if weighing more than 50 kg two hours before surgery. Patients in Group B (Diazepam-atropine group received one tablet of Diazepam (10 mg orally two hours before surgery and injection atropine-sulphate 0.01 mg/kg half an hour preoperatively by intramuscular route. In our study, the sedative and anti-sialogogue effects of clonidine were comparable to those of diazepam-atropine combination, which are commonly used premedicants. The anti-anxiety effect of clonidine was found to be better than that of diazepam-atropine combination. Clonidine also proved to be a better agent for the attenuation of pressor response to laryngoscopy and intubation. Thus, oral clonidine is a better premedicant compared to atropine-diazepam combination. Also, it is a more acceptable agent because of its oral route of administration.

Multifilament Cable Wire versus Conventional Wire for Sternal Closure in Patients Undergoing Major Cardiac Surgery

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You Na Oh

2015-08-01

Full Text Available Background: Stainless steel wiring remains the most popular technique for primary sternal closure. Recently, a multifilament cable wiring system (Pioneer Surgical Technology Inc., Marquette, MI, USA was introduced for sternal closure and has gained wide acceptance due to its superior resistance to tension. We aimed to compare conventional steel wiring to multifilament cable fixation for sternal closure in patients undergoing major cardiac surgery. Methods: Data were collected retrospectively on 1,354 patients who underwent sternal closure after major cardiac surgery, using either the multifilament cable wiring system or conventional steel wires between January 2009 and October 2010. The surgical outcomes of these two groups of patients were compared using propensity score matching based on 18 baseline patient characteristics. Results: Propensity score matching yielded 392 pairs of patients in the two groups whose baseline profiles showed no significant differences. No significant differences between the two groups were observed in the rates of early mortality (2.0% vs. 1.3%, p=0.578, major wound complications requiring reconstruction (1.3% vs. 1.3%, p＞0.99, minor wound complications (3.6% vs. 2.0%, p=0.279, or mediastinitis (0.8% vs. 1.0%, p=1.00. Patients in the multifilament cable group had fewer sternal bleeding events than those in the conventional wire group, but this tendency was not statistically significant (4.3% vs. 7.4%, p=0.068. Conclusion: The surgical outcomes of sternal closure using multifilament cable wires were comparable to those observed when conventional steel wires were used. Therefore, the multifilament cable wiring system may be considered a viable option for sternal closure in patients undergoing major cardiac surgery.

Multifilament Cable Wire versus Conventional Wire for Sternal Closure in Patients Undergoing Major Cardiac Surgery.

Science.gov (United States)

Oh, You Na; Ha, Keong Jun; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

2015-08-01

Stainless steel wiring remains the most popular technique for primary sternal closure. Recently, a multifilament cable wiring system (Pioneer Surgical Technology Inc., Marquette, MI, USA) was introduced for sternal closure and has gained wide acceptance due to its superior resistance to tension. We aimed to compare conventional steel wiring to multifilament cable fixation for sternal closure in patients undergoing major cardiac surgery. Data were collected retrospectively on 1,354 patients who underwent sternal closure after major cardiac surgery, using either the multifilament cable wiring system or conventional steel wires between January 2009 and October 2010. The surgical outcomes of these two groups of patients were compared using propensity score matching based on 18 baseline patient characteristics. Propensity score matching yielded 392 pairs of patients in the two groups whose baseline profiles showed no significant differences. No significant differences between the two groups were observed in the rates of early mortality (2.0% vs. 1.3%, p=0.578), major wound complications requiring reconstruction (1.3% vs. 1.3%, p>0.99), minor wound complications (3.6% vs. 2.0%, p=0.279), or mediastinitis (0.8% vs. 1.0%, p=1.00). Patients in the multifilament cable group had fewer sternal bleeding events than those in the conventional wire group, but this tendency was not statistically significant (4.3% vs. 7.4%, p=0.068). The surgical outcomes of sternal closure using multifilament cable wires were comparable to those observed when conventional steel wires were used. Therefore, the multifilament cable wiring system may be considered a viable option for sternal closure in patients undergoing major cardiac surgery.

Evaluation of the orthopaedics and traumatology resident education in Turkey: A descriptive study.

Science.gov (United States)

Huri, Gazi; Cabuk, Yusuf Sertan; Gursoy, Safa; Akkaya, Mustafa; Ozkan, Secil; Oztuna, Volkan; Aydingoz, Onder; Senkoylu, Alparslan

2016-10-01

The objective of this study is to describe the current situation regarding the training, working conditions, future plans, fields of interest and satisfaction of orthopaedics and traumatology residents in Turkey. A descriptive survey questionnaire consisting of 24 questions was designed to identify the problems and solution suggestions concerning training of orthopaedic residents. All orthopaedics and traumatology residents who took the 2013 Progress Testing for Speciality in Medicine (UEGS) held by Turkish Orthopaedics and Traumatology Education Council (TOTEK) were surveyed in the class at the end thereof as well as the young orthopaedic surgeons who were reached through the email groups of Turkish Society of Orthopaedics and Traumatology - Residents and Young Attendings Council (TOTBID-AGUH). A total of 725 residents and 132 young attendings were surveyed. The most outstanding answers are as follows: 62,7% of the respondents replied to the question "Is there a training program/Is it being applied" as "yes/yes". It was found out that 94,3% of the respondents wanted to be involved in a rotation abroad. The "patient care" was the most common answer, with a ratio of 36,9%, to the question "What's the priority of the department you are studying in?". Regarding work conditions, "many emergency on-calls" was found to be the most important parameter affecting life conditions (p traumatology residents in Turkey face as regards their training, this survey stands as a pioneering study with a high participation rate. Analysis of survey data highlights the importance of several key factors such as the development of training programs and increasing the time spent with academicians as well as spreading and promotion of log book application. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Thoracic epidural analgesia reduces myocardial injury in ischemic patients undergoing major abdominal cancer surgery

Directory of Open Access Journals (Sweden)

Mohamad MF

2017-04-01

Full Text Available Mohamad Farouk Mohamad,1 Montaser A Mohammad,1 Diab F Hetta,1 Eman Hasan Ahmed,2 Ahmed A Obiedallah,3 Alaa Ali M Elzohry1 1Department of Anesthesia, ICU and Pain Relief, 2Department of Clinical Pathology, South Egypt Cancer Institute, 3Department of Internal Medicine, Faculty of Medicine, Assiut University, Arab Republic of Egypt Background and objectives: Major abdominal cancer surgeries are associated with significant perioperative mortality and morbidity due to myocardial ischemia and infarction. This study examined the effect of perioperative patient controlled epidural analgesia (PCEA on occurrence of ischemic cardiac injury in ischemic patients undergoing major abdominal cancer surgery.Patients and methods: One hundred and twenty patients (American Society of Anesthesiologists grade II and III of either sex were scheduled for elective upper gastrointestinal cancer surgeries. Patients were allocated randomly into two groups (60 patients each to receive, besides general anesthesia: continuous intra and postoperative intravenous (IV infusion with fentanyl for 72 h postoperatively (patient controlled intravenous analgesia [PCIA] group or continuous intra and postoperative epidural infusion with bupivacaine 0.125% and fentanyl (PCEA group for 72 h postoperatively. Perioperative hemodynamics were recorded. Postoperative pain was assessed over 72 h using visual analog scale (VAS. All patients were screened for occurrence of myocardial injury (MI by electrocardiography, echocardiography, and cardiac troponin I serum level. Other postoperative complications as arrhythmia, deep venous thrombosis (DVT, pulmonary embolism, pneumonia, and death were recorded.Results: There was a significant reduction in overall adverse cardiac events (myocardial injury, arrhythmias, angina, heart failure and nonfatal cardiac arrest in PCEA group in comparison to PCIA group. Also, there was a significant reduction in dynamic VAS pain score in group PCEA in comparison

The Malaysian Orthopaedic Association humanitarian mission to Indonesia and Sri Lanka.

Science.gov (United States)

Sharaf, I; Saw, A; Hyzan, Y; Sivananthan, K S

2005-07-01

The tsunami which occurred off the west coast of North Sumatra on December 26, 2004 devastated the coastal areas of North Sumatra, South-West Thailand, South-East India and Sri Lanka killing more than a quarter of a million people. The destruction was enormous with many coastal villages destroyed. The other countries affected were Malaysia, Myanmar, Maldives, Bangladesh, Somalia, Kenya, Tanzania and the Seychelles. In January 2005, volunteers went in weekly rotation to Banda Aceh in collaboration with Global Peace Mission. These were Dr Hyzan Yusof, Dr Suryasmi Duski, Dr Sharaf Ibrahim, Dr Saw Aik, Dr Kamariah Nor and Dr Nor Azlin. In Banda Aceh, the surgical procedures that we could do were limited to external fixation of open fractures and debriding infected wounds at the Indonesian Red Crescent field hospital. In February, a team comprising Dato Dr K S Sivananthan, Dr T Kumar and Dr S Vasan spent a week in Sri Lanka. In Sri Lanka, Dato Sivananthan and his team were able to perform elective orthopaedic operations in Dr Poonambalam Memorial Hospital. We appealed for national and international aid and received support from local hospitals and the orthopaedic industry. International aid bound for Banda Aceh arrived in Kuala Lumpur from the Philippine Orthopaedic Association, the Chiba Children's Hospital in Japan and the Chinese Orthopaedic Association. The COA donated 1.5 tons of orthopaedic equipments. A special handing over ceremony from the COA to the Indonesian Orthopaedic Association was held in Putrajaya in March. Malaysia Airlines flew in the donated equipment to Kuala Lumpur while the onward flight to Aceh was provided by the Royal Malaysian Air Force. In April, Dr Saw Aik and Dr Yong Su Mei joined the Tsu-Chi International Medical Association for volunteer services on Batam Island, Indonesia. The MOA acknowledges the many individuals and organizations, both governmental and non-governmental, for their contributions in the humanitarian efforts.

THE SIGNIFICANCE OF CUMULATIVE WATER BALANCE IN THE DEVELOPMENT OF EARLY COMPLICATIONS AFTER MAJOR ABDOMINAL SURGERY.

Science.gov (United States)

Musaeva, T S; Karipidi, M K; Zabolotskikh, I B

2016-11-01

a comprehensive assessment of the water balance on the basis of daily, cumulative balance and 10% of the body weight gain and their role in the development of early complications after major abdominal surgery. A retrospective study of the perioperative period in 150 patients who underwent major abdomi- nal surgery was performed. The physical condition of the patients corresponded to ASA 3 class. The average age was 46 (38-62) years. The following stages ofresearch: an analysis of daily balance and cumulative balance in complicated and uncomplicated group and their role in the development of complications; the timing of development ofcomplications and possible relationship with fluid overload and the development of complications; changes in the level of albumin within 10 days of the postoperative period. The analysis of complications didn't show significant differences between complicated and uncomplicated groups according to the water balance during the surgery and by the end of the first day. When constructing the area under the ROC curve (A UROC) low resolution ofthe balance in intraoperative period and the first day and the balance on the second day to predict complications was shown. Significant diferences according to the cumulative balance was observed from the third day of the postoperative period Also with the third day of the postoperative period there is a good resolution for prediction ofpostoperative complications according to the cumulative balance with the cut-offpoint > of 50,7 ml/kg. the excessive infusion therapy is a predictor of adverse outcome in patients after major abdominal surgery. Therefore, after 3 days of postoperative period it is important to maintain mechanisms for the excretion of excess fluid or limitations of infusion therapy.

Using three-dimensional rapid prototyping in the design and development of orthopaedic screws in standardised pull-out tests.

Science.gov (United States)

Leslie, Laura Jane; Connolly, Ashley; Swadener, John G; Junaid, Sarah; Theivendran, Kanthan; Deshmukh, Subodh C

2018-05-01

The majority of orthopaedic screws are designed, tested and manufactured by existing orthopaedics companies and are predominantly developed with healthy bone in mind. The timescales and costs involved in the development of a new screw design, for example, for osteoporotic bone, are high. In this study, standard wood screws were used to analyse the concept of using three-dimensional printing, or rapid prototyping, as a viable stage of development in the design of a new bone screw. Six wood screws were reverse engineered and printed in polymeric material using stereolithography. Three of the designs were also printed in Ti6Al4V using direct metal laser sintering; however, these were not of sufficient quality to test further. Both the original metal screws (metal) and polymeric rapid prototyping screws were then tested using standard pull-out tests from low-density polyurethane blocks (Sawbones). Results showed the highest pull-out strengths for screws with the longest thread length and the smallest inner diameter. Of the six screw designs tested, five showed no more than a 17% variance between the metal and rapid prototyping results. A similar pattern of results was shown between the screw designs for both the metal and rapid prototyping screws in five of the six cases. While not producing fully comparable pull-out results to orthopaedic screws, the results from this study do provide evidence of the potential usefulness and cost-effectiveness of rapid prototyping in the early stages of design and testing of orthopaedic screws.

Surgical skills simulation in trauma and orthopaedic training.

Science.gov (United States)

Stirling, Euan R B; Lewis, Thomas L; Ferran, Nicholas A

2014-12-19

Changing patterns of health care delivery and the rapid evolution of orthopaedic surgical techniques have made it increasingly difficult for trainees to develop expertise in their craft. Working hour restrictions and a drive towards senior led care demands that proficiency be gained in a shorter period of time whilst requiring a greater skill set than that in the past. The resulting conflict between service provision and training has necessitated the development of alternative methods in order to compensate for the reduction in 'hands-on' experience. Simulation training provides the opportunity to develop surgical skills in a controlled environment whilst minimising risks to patient safety, operating theatre usage and financial expenditure. Many options for simulation exist within orthopaedics from cadaveric or prosthetic models, to arthroscopic simulators, to advanced virtual reality and three-dimensional software tools. There are limitations to this form of training, but it has significant potential for trainees to achieve competence in procedures prior to real-life practice. The evidence for its direct transferability to operating theatre performance is limited but there are clear benefits such as increasing trainee confidence and familiarity with equipment. With progressively improving methods of simulation available, it is likely to become more important in the ongoing and future training and assessment of orthopaedic surgeons.

Computer Assisted Surgery and Current Trends in Orthopaedics Research and Total Joint Replacements

Science.gov (United States)

Amirouche, Farid

2008-06-01

Musculoskeletal research has brought about revolutionary changes in our ability to perform high precision surgery in joint replacement procedures. Recent advances in computer assisted surgery as well better materials have lead to reduced wear and greatly enhanced the quality of life of patients. The new surgical techniques to reduce the size of the incision and damage to underlying structures have been the primary advance toward this goal. These new techniques are known as MIS or Minimally Invasive Surgery. Total hip and knee Arthoplasties are at all time high reaching 1.2 million surgeries per year in the USA. Primary joint failures are usually due to osteoarthristis, rheumatoid arthritis, osteocronis and other inflammatory arthritis conditions. The methods for THR and TKA are critical to initial stability and longevity of the prostheses. This research aims at understanding the fundamental mechanics of the joint Arthoplasty and providing an insight into current challenges in patient specific fitting, fixing, and stability. Both experimental and analytical work will be presented. We will examine Cementless total hip arthroplasty success in the last 10 years and how computer assisted navigation is playing in the follow up studies. Cementless total hip arthroplasty attains permanent fixation by the ingrowth of bone into a porous coated surface. Loosening of an ingrown total hip arthroplasty occurs as a result of osteolysis of the periprosthetic bone and degradation of the bone prosthetic interface. The osteolytic process occurs as a result of polyethylene wear particles produced by the metal polyethylene articulation of the prosthesis. The total hip arthroplasty is a congruent joint and the submicron wear particles produced are phagocytized by macrophages initiating an inflammatory cascade. This cascade produces cytokines ultimately implicated in osteolysis. Resulting bone loss both on the acetabular and femoral sides eventually leads to component instability. As

Putting the baby back in the bathwater: the interpretation of randomised trials in surgery.

Science.gov (United States)

Gandhi, R; Perruccio, A V; Kakar, S; Haddad, F S

2015-11-01

Recently, several high impact randomised controlled trials have been published suggesting no greater benefit from orthopaedic surgery over conservative treatment, or limited surgical intervention. These studies can have profound effects on clinical practice, leading to the abandonment of previously widely-used operations. How do surgeons who believe these operations are beneficial over conservative treatment rationalise these findings, and justify their use with hospital administrators and health care funders who require evidence for the value and efficacy of surgical treatment? ©2015 The British Editorial Society of Bone & Joint Surgery.

The Prevalence of Accidental Needle Stick Injury and their Reporting among Healthcare Workers in Orthopaedic Wards in General Hospital Melaka, Malaysia

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Bhardwaj A

2014-07-01

Full Text Available Accidental needle-stick injuries (NSIs are a hazard for health-care workers and general public health. Orthopaedic surgeons may be more prone to NSIs due to the prevalence of bone spikes in the operative field and the use of sharp orthopaedic instruments such as drills, saws and wires. A hospital-based cross sectional study was conducted in the orthopedic wards of Melaka General Hospital. The prevalence of NSIs was 32 (20.9% and majority of it occurred during assisting in operation theatre 13(37.4%. Among them six (18.8% were specialist, 12(37.5% medical officer, 10 (31.2% house officer and four staff nurses (12.5%. Among the respondents 142 (92.8% had been immunized against Hepatitis B and 148 (96.7% participants had knowledge regarding universal precaution. The incidence of NSI among health care workers at orthopaedics ward was not any higher in comparison with the similar studies and it was found out that the prevalence was more in junior doctors compared with specialist and staff nurses and it was statistically significant.

The peri-operative cytokine response in infants and young children following major surgery

DEFF Research Database (Denmark)

Hansen, Tom Giedsing; Tønnesen, Else Kirstine; Andersen, J B

1998-01-01

The peri-operative cytokine response was studied in 13 infants and young children undergoing major surgery. All children were anaesthetized with a combined general and epidural anaesthetic technique, followed by post-operative epidural analgesia with bupivacaine and fentanyl. Blood samples were...... taken before and after surgery, 24 h post-operatively, and finally, when the children were mobilized and had regained gastrointestinal function. Plasma samples were analysed for tumour necrosis factor-alpha, interleukin-1 alpha, interleukin-1 beta, interleukin-6, interferon-gamma, interleukin-10...... and the interleukin-1 receptor antagonist. The cytokine responses were highly variable. Overall, no significant changes between pre- and post-operative plasma concentrations were found. Tumour necrosis factor-alpha and the interleukin-1 receptor antagonist were detectable in all children, and a trend towards an early...

The spectrum of orthopaedics at Chris Hani Baragwanath Academic Hospital

OpenAIRE

Pillay, J; Ramokgopa, MT

2013-01-01

Chris Hani Baragwanath Academic Hospital (CHBAH) is the third largest hospital in the world and is the largest in the Southern hemisphere, serving a population of more than 3.5 million people.¹ The purpose of this review is to identify the orthopaedic-related health events that occur within the population being serviced by the hospital, and in doing so provide a tool to be used for improving orthopaedic-related patient care and outcomes in public health services.² We also took special interes...

Burnout and quality of life among orthopaedic trainees in a modern educational programme

NARCIS (Netherlands)

van Vendeloo, S. N.; Brand, P. L. P.; Verheyen, C. C. P. M.

We aimed to determine quality of life and burnout among Dutch orthopaedic trainees following a modern orthopaedic curriculum, with strict compliance to a 48-hour working week. We also evaluated the effect of the clinical climate of learning on their emotional wellbeing. We assessed burnout, quality

Decellularized Tissue and Cell-Derived Extracellular Matrices as Scaffolds for Orthopaedic Tissue Engineering

Science.gov (United States)

Cheng, Christina W.; Solorio, Loran D.; Alsberg, Eben

2014-01-01

The reconstruction of musculoskeletal defects is a constant challenge for orthopaedic surgeons. Musculoskeletal injuries such as fractures, chondral lesions, infections and tumor debulking can often lead to large tissue voids requiring reconstruction with tissue grafts. Autografts are currently the gold standard in orthopaedic tissue reconstruction; however, there is a limit to the amount of tissue that can be harvested before compromising the donor site. Tissue engineering strategies using allogeneic or xenogeneic decellularized bone, cartilage, skeletal muscle, tendon and ligament have emerged as promising potential alternative treatment. The extracellular matrix provides a natural scaffold for cell attachment, proliferation and differentiation. Decellularization of in vitro cell-derived matrices can also enable the generation of autologous constructs from tissue specific cells or progenitor cells. Although decellularized bone tissue is widely used clinically in orthopaedic applications, the exciting potential of decellularized cartilage, skeletal muscle, tendon and ligament cell-derived matrices has only recently begun to be explored for ultimate translation to the orthopaedic clinic. PMID:24417915

Trends in Surgical Practices for Lateral Epicondylitis Among Newly Trained Orthopaedic Surgeons.

Science.gov (United States)

Wang, Dean; Degen, Ryan M; Camp, Christopher L; McGraw, Michael H; Altchek, David W; Dines, Joshua S

2017-10-01

Much controversy exists regarding the optimal surgical intervention for lateral epicondylitis because of a multitude of options available and the lack of comparative studies. Knowledge of the current practice trends would help guide the design of comparative studies needed to determine which surgical technique results in the best outcome. To review the latest practice trends for the surgical treatment of lateral epicondylitis among newly trained surgeons in the United States utilizing the American Board of Orthopaedic Surgery (ABOS) database. Cross-sectional study; Level of evidence, 3. The ABOS database was utilized to identify surgical cases for lateral epicondylitis submitted by Part II board certification examination candidates from 2004 through 2013. Inclusion criteria were predetermined using a combination of International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes. Cases were organized by open and arthroscopic treatment groups and by fellowship training and were analyzed to determine differences in surgical techniques, complication rates, and concomitant procedures. In total, 1150 surgeons submitted 2106 surgical cases for the treatment of lateral epicondylitis. The number of surgical cases for lateral epicondylitis performed per 10,000 submitted cases significantly decreased from 26.7 in 2004 to 21.1 in 2013 ( P = .002). Among all cases, 92.2% were open and 7.8% were arthroscopic, with no change in the incidence of arthroscopic surgeries over the study period. Shoulder and elbow (18.1%) and sports medicine (11.4%) surgeons were more likely to perform surgery arthroscopically compared with hand surgeons (6.1%) ( P < .001). There was no difference in overall self-reported complication rates between open (4.4%) and arthroscopic (5.5%) procedures ( P = .666). Percutaneous tenotomy, debridement only, and debridement with tendon repair comprised 6.4%, 46.3%, and 47.3% of open treatment, respectively. Sports

Reduction mammoplasty in a developing country: A 10-year review (2001-2010 at the national orthopaedic hospital, Enugu

Directory of Open Access Journals (Sweden)

Chimaobi Isiguzo

2015-01-01

Full Text Available Context: Large breast is a major problem because of associated symptomatology and aesthetic concerns. Reduction mammoplasty (RM resolves the symptom and at the same time improves the aesthetic appearance of the breast, hence improving self-esteem and social integration. Aims: To describe the pattern of RM in a hospital in the developing world and its impact on postgraduate surgical training. Settings and Design: A retrospective review of all the RMs done in the National Orthopaedic Hospital, Enugu (a major plastic surgery training center in Nigeria over a ten-year period (2001-2010, in the developing country of Nigeria. Subjects and Methods: All RMs done in the hospital were reviewed after retrieving their records from operation register and medical records department. Fifteen (15 cases were retrieved and analyzed. Data Analysis: Data was analyzed with Microsoft excel 2007. Results: Average age of female patients who had RM was 26.5 years and 83.3% were single. The most common complaint was abnormally large breast (macromastia. Inferior pedicle technique was commonly used. Conclusions: The results of RM are remarkable as it impact positively on the quality of life of the patients. However, the level of awareness about the availability of this service is still low in the region as shown by few cases done over the period of review and this impacts negatively on the training. The need for public awareness cannot be overemphasized.

Computer aided planning of orthopaedic surgeries: the definition of generic planning steps for bone removal procedures.

Science.gov (United States)

Putzer, David; Moctezuma, Jose Luis; Nogler, Michael

2017-11-01

An increasing number of orthopaedic surgeons are using computer aided planning tools for bone removal applications. The aim of the study was to consolidate a set of generic functions to be used for a 3D computer assisted planning or simulation. A limited subset of 30 surgical procedures was analyzed and verified in 243 surgical procedures of a surgical atlas. Fourteen generic functions to be used in 3D computer assisted planning and simulations were extracted. Our results showed that the average procedure comprises 14 ± 10 (SD) steps with ten different generic planning steps and four generic bone removal steps. In conclusion, the study shows that with a limited number of 14 planning functions it is possible to perform 243 surgical procedures out of Campbell's Operative Orthopedics atlas. The results may be used as a basis for versatile generic intraoperative planning software.

Reno Orthopaedic Trauma Fellowship business curriculum.

Science.gov (United States)

Althausen, Peter L; Bray, Timothy J; Hill, Austin D

2014-07-01

The Reno Orthopaedic Center (ROC) Trauma Fellowship business curriculum is designed to provide the fellow with a graduate level business practicum and research experience. The time commitments in a typical 12-month trauma fellowship are significant, rendering a traditional didactic master's in business administration difficult to complete during this short time. An organized, structured, practical business education can provide the trauma leaders of tomorrow with the knowledge and experience required to effectively navigate the convoluted and constantly changing healthcare system. The underlying principle throughout the curriculum is to provide the fellow with the practical knowledge to participate in cost-efficient improvements in healthcare delivery. Through the ROC Trauma Fellowship business curriculum, the fellow will learn that delivering healthcare in a manner that provides better outcomes for equal or lower costs is not only possible but a professional and ethical responsibility. However, instilling these values without providing actionable knowledge and programs would be insufficient and ineffective. For this reason, the core of the curriculum is based on individual teaching sessions with a wide array of hospital and private practice administrators. In addition, each section is equipped with a suggested reading list to maximize the learning experience. Upon completion of the curriculum, the fellow should be able to: (1) Participate in strategic planning at both the hospital and practice level based on analysis of financial and clinical data, (2) Understand the function of healthcare systems at both a macro and micro level, (3) Possess the knowledge and skills to be strong leaders and effective communicators in the business lexicon of healthcare, (4) Be a partner and innovator in the improvement of the delivery of orthopaedic services, (5) Combine scientific and strategic viewpoints to provide an evidence-based strategy for improving quality of care in a

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.

[The advancement of robotic surgery--successes, failures, challenges].

Science.gov (United States)

Haidegger, Tamás

2010-10-10

Computer-integrated robotic surgery systems appeared more than twenty years ago and since then hundreds of different prototypes have been developed. Only a fraction of them have been commercialized, mostly to support neurosurgical and orthopaedic procedures.Unquestionably, the most successful one is the da Vinci surgical system, primarily deployed in urology and general laparoscopic surgery. It is developed and marketed by Intuitive Surgical Inc. (Sunnyvale, CA, USA), the only profitable company of the segment. The da Vinci made robotic surgery is known and acknowledged throughout the world, and the great results delivered convinced most of the former critics of the technology. Success derived from the well chosen business development strategy, proficiency of the developers, appropriate timing and a huge pot of luck. This article presents the most important features of the da Vinci system, the history of development along with its medical, economical and financial aspects, and seeks the answer why this particular system became successful.

Management of factor VII-deficient patients undergoing joint surgeries--preliminary results of locally developed treatment regimen.

Science.gov (United States)

Windyga, J; Zbikowski, P; Ambroziak, P; Baran, B; Kotela, I; Stefanska-Windyga, E

2013-01-01

Inherited factor VII (FVII) deficiency is a rare coagulation disorder with variable haemorrhagic manifestations. In severely affected cases spontaneous haemarthroses leading to advanced arthropathy have been observed. Such cases may require surgery. Therapeutic options for bleeding prevention in FVII deficient patients undergoing surgery comprise various FVII preparations but the use of recombinant activated factor VII (rFVIIa) seems to be the treatment of choice. To present the outcome of orthopaedic surgery under haemostatic coverage of rFVIIa administered according to the locally established treatment regimen in five adult patients with FVII baseline plasma levels below 10 IU dL(-1). Two patients required total hip replacement (THR); three had various arthroscopic procedures. Recombinant activated factor VII was administered every 8 h on day of surgery (D0) followed by every 12-24 h for the subsequent 9-14 days, depending on the type of surgery. Factor VII plasma coagulation activity (FVII:C) was determined daily with no predefined therapeutic target levels. Doses of rFVIIa on D0 ranged from 18 to 37 μg kg(-1) b.w. and on the subsequent days--from 13 to 30 μg kg(-1) b.w. Total rFVIIa dose per procedure ranged from 16 to 37.5 mg, and the total number of doses per procedure was 16-31. None of our patients developed excessive bleeding including those in whom FVII:C trough levels returned nearly to the baseline level on the first post-op day. Preliminary results demonstrate that rFVIIa administered according to our treatment regimen is an effective and safe haemostatic agent for hypoproconvertinaemia patients undergoing orthopaedic surgery. © 2012 Blackwell Publishing Ltd.

Research on the Influence of Orthopaedic Inserts on Pressure Distribution in the Foot

Directory of Open Access Journals (Sweden)

Ignas Rutulys

2011-02-01

Full Text Available The article examines the influence of individual orthopaedic inserts on pressure distribution in the foot. Feet deformations, types of orthopaedic inserts, materials and pressure in the foot testing methods are discussed. Experimental computer measurements of pressure in the foot before and after the use of inserts have been done. During research, the inserts made of different kinds of materials selected according to human weight, pathology, skin sensitivity and many other reasons has been used. It has been determinated that orthopaedic inserts have a more noticeable impact on children whose feet is adjusted easier if compared with those of adults.Article in Lithuanian

History of shoulder instability surgery.

Science.gov (United States)

Randelli, Pietro; Cucchi, Davide; Butt, Usman

2016-02-01

The surgical management of shoulder instability is an expanding and increasingly complex area of study within orthopaedics. This article describes the history and evolution of shoulder instability surgery, examining the development of its key principles, the currently accepted concepts and available surgical interventions. A comprehensive review of the available literature was performed using PubMed. The reference lists of reviewed articles were also scrutinised to ensure relevant information was included. The various types of shoulder instability including anterior, posterior and multidirectional instability are discussed, focussing on the history of surgical management of these topics, the current concepts and the results of available surgical interventions. The last century has seen important advancements in the understanding and treatment of shoulder instability. The transition from open to arthroscopic surgery has allowed the discovery of previously unrecognised pathologic entities and facilitated techniques to treat these. Nevertheless, open surgery still produces comparable results in the treatment of many instability-related conditions and is often required in complex or revision cases, particularly in the presence of bone loss. More high-quality research is required to better understand and characterise this spectrum of conditions so that successful evidence-based management algorithms can be developed. IV.

Acute and overuse elbow trauma: radio-orthopaedics overview.

Science.gov (United States)

Nocerino, Elisabetta Antonia; Cucchi, Davide; Arrigoni, Paolo; Brioschi, Marco; Fusi, Cristiano; Genovese, Eugenio A; Messina, Carmelo; Randelli, Pietro; Masciocchi, Carlo; Aliprandi, Alberto

2018-01-19

The correct management of acute, subacute and overuse-related elbow pathologies represents a challenging diagnostic and therapeutic problem. While major trauma frequently requires a rapid surgical intervention, subluxation and minor trauma allow taking more time for diagnostics and planning the correct elective treatment after careful clinical and radiological investigation. In these conditions, communication between orthopaedic surgeon and radiologist allow to create a detailed radiology report, tailored to the patient's and surgeon's needs and optimal to plan proper management. Imaging technique as X-Ray, CT, US, MRI, CTA and MRA all belong to the radiologist's portfolio in elbow diagnostics. Detailed knowledge of elbow pathology and its classification and of the possibilities and limits of each imaging technique is of crucial importance to reach the correct diagnosis efficiently. The aim of this review is to present the most frequent elbow pathologies and suggest a suitable diagnostic approach for each of them.

Intimate partner violence in orthopaedic trauma patients

NARCIS (Netherlands)

Sprague, S.A.

2013-01-01

Intimate partner violence (IPV) or domestic violence is a common and serious public health problem around the globe. Victims of IPV frequently present to health care practitioners including orthopaedic surgeons. Substantial research has been conducted on IPV over the past few decades, but very

A patient-based questionnaire to assess outcomes of foot surgery: validation in the context of surgery for hallux valgus.

Science.gov (United States)

Dawson, Jill; Coffey, Jane; Doll, Helen; Lavis, Grahame; Cooke, Paul; Herron, Mark; Jenkinson, Crispin

2006-09-01

A patient-based outcome measure with good measurement properties is urgently needed for use in clinical trials of foot surgery. We evaluated an existing foot pain and disability questionnaire (the Manchester Foot Pain and Disability Questionnaire) for its suitability as an outcome measure in the context of hallux valgus corrective surgery. Interviews with patients led to initial changes, resulting in 20 candidate questionnaire items with five response categories each. These were tested in a prospective study of 100 patients (representing 138 foot operations) undergoing hallux valgus corrective surgery. Analysis of underlying factor structure, dimensionality, internal reliability, construct validity and responsiveness of the questionnaire items in relation to (i) SF-36 general health survey and (ii) American Orthopaedic Foot & Ankle Society (AOFAS) hallux clinical scale resulted in a final 16 item questionnaire (the 'Manchester-Oxford Foot Questionnaire' (MOXFQ)), consisting of three domains/scales: 'Walking/standing' (seven items), 'Pain' (five items) and 'Social interaction' (four items) each having good measurement properties. All three domains were unidimensional. The new 16-item MOXFQ has good measurement properties in the context of outcomes assessment of surgery for hallux valgus. Future studies should assess the MOXFQ in the context of surgery for other foot and ankle conditions.

Evaluation of Pediatric Questions on the Orthopaedic In-Training Examination-An Update.

Science.gov (United States)

Murphy, Robert F; Nunez, Leah; Barfield, William R; Mooney, James F

2017-09-01

Pediatric orthopaedics is tested frequently on the Orthopaedic In-Training Examination (OITE). The most recent data on the pediatrics section of the OITE were generated from content 10 years old. The purpose of this study is to assess the pediatric orthopaedic questions on the 2011 to 2014 OITE, and to compare question categories and cognitive taxonomy with previous data. Four years (2011 to 2014) of OITE questions, answers, and references were reviewed. The number of pediatric questions per year was recorded, as well as presence of a clinical photo or imaging modality. Each question was categorized and assigned a cognitive taxonomy level. Categories included: knowledge; knowledge-treatment modalities; diagnosis; diagnosis/recognition of associated conditions; diagnosis/further studies; and diagnosis/treatment. Cognitive taxonomy levels included: simple recall, interpretation of data, and advanced problem-solving. The 3 most commonly covered topics were upper extremity trauma (17.4%), scoliosis (10.1%), and developmental dysplasia of the hip (5.7%). Compared with previous data, the percentage of pediatric questions was constant (13% vs. 14%). Categorically, the more recent OITE examinations contained significantly fewer questions testing simple knowledge (19% vs. 39%, P=0.0047), and significantly more questions testing knowledge of treatment modalities (17% vs. 9%, P=0.016) and diagnosis with associated conditions (19% vs. 9%, P=0.0034). Regarding cognitive taxonomy, there was a significant increase in the average number of questions that required advanced problem-solving (57% vs. 46%, P=0.048). Significantly more questions utilized clinical photographs and imaging studies (62% vs. 48%, P=0.012). The most common reference materials provided to support correct responses included Lovell and Winter's Pediatric Orthopaedics (25.7%) and the Journal of Pediatric Orthopaedics (23.4%). Although the percentage of pediatric questions on the OITE has remained essentially

An evaluation of the quality of statistical design and analysis of published medical research: results from a systematic survey of general orthopaedic journals.

Science.gov (United States)

Parsons, Nick R; Price, Charlotte L; Hiskens, Richard; Achten, Juul; Costa, Matthew L

2012-04-25

The application of statistics in reported research in trauma and orthopaedic surgery has become ever more important and complex. Despite the extensive use of statistical analysis, it is still a subject which is often not conceptually well understood, resulting in clear methodological flaws and inadequate reporting in many papers. A detailed statistical survey sampled 100 representative orthopaedic papers using a validated questionnaire that assessed the quality of the trial design and statistical analysis methods. The survey found evidence of failings in study design, statistical methodology and presentation of the results. Overall, in 17% (95% confidence interval; 10-26%) of the studies investigated the conclusions were not clearly justified by the results, in 39% (30-49%) of studies a different analysis should have been undertaken and in 17% (10-26%) a different analysis could have made a difference to the overall conclusions. It is only by an improved dialogue between statistician, clinician, reviewer and journal editor that the failings in design methodology and analysis highlighted by this survey can be addressed.

An evaluation of the quality of statistical design and analysis of published medical research: results from a systematic survey of general orthopaedic journals

Directory of Open Access Journals (Sweden)

Parsons Nick R

2012-04-01

Full Text Available Abstract Background The application of statistics in reported research in trauma and orthopaedic surgery has become ever more important and complex. Despite the extensive use of statistical analysis, it is still a subject which is often not conceptually well understood, resulting in clear methodological flaws and inadequate reporting in many papers. Methods A detailed statistical survey sampled 100 representative orthopaedic papers using a validated questionnaire that assessed the quality of the trial design and statistical analysis methods. Results The survey found evidence of failings in study design, statistical methodology and presentation of the results. Overall, in 17% (95% confidence interval; 10–26% of the studies investigated the conclusions were not clearly justified by the results, in 39% (30–49% of studies a different analysis should have been undertaken and in 17% (10–26% a different analysis could have made a difference to the overall conclusions. Conclusion It is only by an improved dialogue between statistician, clinician, reviewer and journal editor that the failings in design methodology and analysis highlighted by this survey can be addressed.

[Gender-specific evaluation of student's career planning during medical study in terms of orthopaedic trauma].

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Mooij, S C; Antony, P; Ruesseler, M; Pfeifer, R; Drescher, W; Simon, M; Pape, H-C; Knobe, M

2011-08-01

Due to recent changes in the medical licencing act as well as to the introduction of a new model-course programme for medical studies, careers in medicine have become increasingly more attractive. However, there is still a dramatic shortage in younger generation physicians, especially within the surgical fields. The goal of this cross-sectional study was the gender-specific assessment of the ideal career wishes of students during medical school, with a focus being placed in orthopaedic trauma surgery. During the winter semester of 2010/2011 an online questionnaire (www.surveymonkey.com) was created for students enrolled in their 3rd to 12th semester (n=887). The questionnaire consisted of 50 questions [Likert scale (LS); 5 = agree, 1 = disagree] along with 10 free response questions. The scope of these questions ranged from personal career goals, within the context of their learning environment, to general life goals and planning. With regard to career choice, a differentiation was made between students' ideal career choices/subjects (IS), which were based solely on personal affinity, and so-called reality-based subjects (RS), which students considered more practical and to which they were more likely to apply in the future. The response rate was 36,4% (n=323, 23,4 years, 6.3 semesters, 226 [70.0%] female [f] and 97 [30.0%] male [m]). A total of 206 students (63.8%; m=55.7% vs. f=66.7%; p=0.047) were able to pinpoint an IS, this percentage increased with increasing semester number (p=0.048). Overall, 29.1% of students indicated that their IS lay in the field of orthopaedic trauma, while 20.0% of men and 19.1% of women saw it as a realistic career path (RS). Throughout the course of their studies, from the 3rd semester to their practical year, a declining tendency was observed regarding the agreement between ideal and realistic career paths. Particularly evident was a decreasing interest in the field of orthopaedic trauma, beginning around the 9th semester and

Is there an increased risk of post-operative surgical site infection after orthopaedic surgery in HIV patients? A systematic review and meta-analysis.

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Kigera, James W M; Straetemans, Masja; Vuhaka, Simplice K; Nagel, Ingeborg M; Naddumba, Edward K; Boer, Kimberly

2012-01-01

There is dilemma as to whether patients infected with the Human Immunodeficiency Virus (HIV) requiring implant orthopaedic surgery are at an increased risk for post-operative surgical site infection (SSI). We conducted a systematic review to determine the effect of HIV on the risk of post-operative SSI and sought to determine if this risk is altered by antibiotic use beyond 24 hours. We searched electronic databases, manually searched citations from relevant articles, and reviewed conference proceedings. The risk of postoperative SSI was pooled using Mantel-Haenszel method. We identified 18 cohort studies with 16 mainly small studies, addressing the subject. The pooled risk ratio of infection in the HIV patients when compared to non-HIV patients was 1.8 (95% Confidence Interval [CI] 1.3-2.4), in studies in Africa this was 2.3 (95% CI 1.5-3.5). In a sensitivity analysis the risk ratio was reduced to 1.4 (95% CI 0.5-3.8). The risk ratio of infection in patients receiving prolonged antibiotics compared to patients receiving antibiotics for up to 24 hours was 0.7 (95% CI 0.1-4.2). The results may indicate an increased risk in HIV infected patients but these results are not robust and inconclusive after conducting the sensitivity analysis removing poor quality studies. There is need for larger good quality studies to provide conclusive evidence. To better develop surgical protocols, further studies should determine the effect of reduced CD4 counts, viral load suppression and prolonged antibiotics on the risk for infection.

The orthopaedic management of myelomeningocele | Horn | South ...

African Journals Online (AJOL)

The orthopaedic management of myelomeningocele. A Horn, S Dix-Peek, S Mears, EB Hoffman. Abstract. Despite improvement in antenatal care and screening, myelomeningocele remains the most common congenital birth defect, with a reported incidence of 1 - 2.5/1000 patients in the Western Cape, South Africa.

Nigerian Journal of Orthopaedics and Trauma: Submissions

African Journals Online (AJOL)

The Nigerian Journal of Orthopaedics and Trauma is a peer reviewed journal publishing original research articles on all aspects of trauma, musculoskeletal ... initials and surnames of all authors, their highest academic degrees, affiliations / institutions and the name, address and e-mail address of the corresponding author.

Physiotherapy following elective orthopaedic procedures.

Science.gov (United States)

De Kleijn, P; Blamey, G; Zourikian, N; Dalzell, R; Lobet, S

2006-07-01

weeks postoperatively. This may be influenced by the condition of the joints of the lower limbs. Attention should be given to the total chain of motion, of which the shoulder itself is only a part. We conclude that physiotherapy management is of major importance in any invasive or orthopaedic procedure, regardless of which joints are involved. Both pre- and postoperative physiotherapy, as part of comprehensive care is needed to achieve optimal functional outcome and therefore optimal quality of life for people with haemophilia.

Diagnostic value of C-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis.

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Gans, Sarah L; Atema, Jasper J; van Dieren, Susan; Groot Koerkamp, Bas; Boermeester, Marja A

2015-07-01

Infectious complications occur frequently after major abdominal surgery and have a major influence on patient outcome and hospital costs. A marker that can rule out postoperative infectious complications (PICs) could aid patient selection for safe and early hospital discharge. C-reactive protein (CRP) is a widely available, fast, and cheap marker that might be of value in detecting PIC. Present meta-analysis evaluates the diagnostic value of CRP to rule out PIC following major abdominal surgery, aiding patient selection for early discharge. A systematic literature search of Medline, PubMed, and Cochrane was performed identifying all prospective studies evaluating the diagnostic value of CRP after abdominal surgery. Meta-analysis was performed according to the PRISMA statement. Twenty-two studies were included for qualitative analysis of which 16 studies were eligible for meta-analysis, representing 2215 patients. Most studies analyzed the value of CRP in colorectal surgery (eight studies). The pooled negative predictive value (NPV) improved each day after surgery up to 90% at postoperative day (POD) 3 for a pooled CRP cutoff of 159 mg/L (range 92-200). Maximum predictive values for PICs were reached on POD 5 for a pooled CRP cutoff of 114 mg/L (range 48-150): a pooled sensitivity of 86% (95% confidence interval (CI) 79-91%), specificity of 86% (95% CI 75-92%), and a positive predictive value of 64% (95% CI 49-77%). The pooled sensitivity and specificity were significantly higher on POD 5 than on other PODs (p < 0.001). Infectious complications after major abdominal surgery are very unlikely in patients with a CRP below 159 mg/L on POD 3. This can aid patient selection for safe and early hospital discharge and prevent overuse of imaging.

Implementing a pain management nursing protocol for orthopaedic surgical patients: Results from a PAIN OUT project.

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Cui, Cui; Wang, Ling-Xiao; Li, Qi; Zaslansky, Ruth; Li, Li

2018-04-01

To investigate the effect of introducing a standardised pain management nursing protocol in orthopaedic patients undergoing surgery. Postoperative pain is a common phenomenon but is still undertreated in hospitalised patients. Nurses' lack of sufficient knowledge and skills about pain management may be a contributing factor to poor outcomes. An interventional, separate sample pre- and post-test. A pain management nursing protocol was introduced and a handbook and training sessions regarding management of postsurgical pain were provided to the nurses on a Joint Orthopaedic ward at a university-affiliated general hospital in Guangzhou, China. Before and after the intervention, nurses' knowledge about pain management and attitudes were assessed, and perioperative management practices and pain-related patient-reported outcomes were evaluated. Sixteen and 15 registered nurses, and 77 and 71 patients participated in the study before and after the intervention, respectively. Nurses' scores related to knowledge and skills increased significantly after the protocol was introduced but were still insufficient with regard to pharmacological-related items. The proportion of patients receiving a combined opioid and nonopioid increased after the intervention. Clinically significant changes were observed in some patient-reported outcomes, such as worst pain since surgery, percentage of time experiencing severe pain, and pain interference with activities out of bed. There were significant changes in nonpharmacological methods administered by nurses to patients or used by patients to relieve pain. Implementation of a pain management nursing protocol combined with education in one surgical ward was associated with nurses' increased knowledge and attitudes regarding pain, a change in some management practices, and improvement in a number of pain-related patient-reported outcomes. It was feasible to develop and implement a standardised pain management nursing protocol and use it in the

Major League pitching workload after primary ulnar collateral ligament reconstruction and risk for revision surgery.

Science.gov (United States)

Keller, Robert A; Mehran, Nima; Marshall, Nathan E; Okoroha, Kelechi R; Khalil, Lafi; Tibone, James E; Moutzouros, Vasilios

2017-02-01

Literature has attempted to correlate pitching workload with risk of ulnar collateral ligament (UCL) injury; however, limited data are available in evaluating workload and its relationship with the need for revision reconstruction in Major League Baseball (MLB) pitchers. We identified 29 MLB pitchers who underwent primary UCL reconstruction surgery and subsequently required revision reconstruction and compared them with 121 MLB pitchers who underwent primary reconstruction but did not later require revision surgery. Games pitched, pitch counts, and innings pitched were evaluated and compared for the seasons after returning from primary reconstruction and for the last season pitched before undergoing revision surgery. The difference in workload between pitchers who did and did not require revision reconstruction was not statistically significant in games pitched, innings pitched, and MLB-only pitch counts. The one significant difference in workload was in total pitch counts (combined MLB and minor league), with the pitchers who required revision surgery pitching less than those who did not (primary: 1413.6 pitches vs. revision: 959.0 pitches, P = .04). In addition, pitchers who required revision surgery underwent primary reconstruction at an early age (22.9 years vs. 27.3 years, P risk for injury after primary UCL reconstruction. However, correlations of risk may be younger age and less MLB experience at the time of the primary reconstruction. Copyright © 2017. Published by Elsevier Inc.

How does the knowledge environment shape procurement practices for orthopaedic medical devices in Mexico?

Science.gov (United States)

Lingg, Myriam; Wyss, Kaspar; Durán-Arenas, Luis

2016-07-08

In organisational theory there is an assumption that knowledge is used effectively in healthcare systems that perform well. Actors in healthcare systems focus on managing knowledge of clinical processes like, for example, clinical decision-making to improve patient care. We know little about connecting that knowledge to administrative processes like high-risk medical device procurement. We analysed knowledge-related factors that influence procurement and clinical procedures for orthopaedic medical devices in Mexico. We based our qualitative study on 48 semi-structured interviews with various stakeholders in Mexico: orthopaedic specialists, government officials, and social security system managers or administrators. We took a knowledge-management related perspective (i) to analyse factors of managing knowledge of clinical procedures, (ii) to assess the role of this knowledge and in relation to procurement of orthopaedic medical devices, and (iii) to determine how to improve the situation. The results of this study are primarily relevant for Mexico but may also give impulsion to other health systems with highly standardized procurement practices. We found that knowledge of clinical procedures in orthopaedics is generated inconsistently and not always efficiently managed. Its support for procuring orthopaedic medical devices is insufficient. Identified deficiencies: leaders who lack guidance and direction and thus use knowledge poorly; failure to share knowledge; insufficiently defined formal structures and processes for collecting information and making it available to actors of health system; lack of strategies to benefit from synergies created by information and knowledge exchange. Many factors are related directly or indirectly to technological aspects, which are insufficiently developed. The content of this manuscript is novel as it analyses knowledge-related factors that influence procurement of orthopaedic medical devices in Mexico. Based on our results we

Regenerative Medicine Will Make Orthopaedic Implants Obsolete In Our Time Orthopaedic Research Society First Annual Meeting Debate, San Diego, March 21st , 2017.

Science.gov (United States)

Johnstone, Brian; Jacobs, Joshua J; Sandell, Linda J; Wilkinson, J Mark

2018-05-10

The mission of the Orthopaedic Research Society is to promote and advance musculoskeletal research worldwide. With this in mind, the Annual Meeting Program Committee sought to establish a debate as a key component of the meeting. Our purpose was to provoke discussion on topics that are core to our mission and to engage all constituencies within the society by examining questions of broad relevance. To this end, the topic "Regenerative medicine will make orthopaedic implants obsolete in our time" was selected as the title of the inaugural debate. The arguments for and against the motion are presented in this perspectives article. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Find an Orthopaedic Foot and Ankle MD/DO

Science.gov (United States)

... All Site Content AOFAS / FootCareMD / Find a Surgeon Find a Foot & Ankle Orthopaedic Surgeon Page Content Who ... your prescribed treatment (surgical and/or non-surgical) ​ Find a Surgeon ​ Click here to find a foot ...

Differential changes in free and total insulin-like growth factor I after major, elective abdominal surgery

DEFF Research Database (Denmark)

Skjærbæk, Christian; Frystyk, Jan; Ørskov, Hans

1998-01-01

Major surgery is accompanied by extensive proteolysis of insulin-like growth factor (IGF)-binding protein-3 (IGFBP-3). Proteolysis of IGFBP-3 is generally believed to increase IGF bioavailability due to a diminished affinity of the IGFBP-3 fragments for IGFs. We have investigated 18 patients...... undergoing elective ileo-anal J-pouch surgery. Patients were randomized to treatment with GH (12 IU/day; n = 9) or placebo (n = 9) from 2 days before to 7 days after operation. Free IGF-I and IGF-II were measured by ultrafiltration of serum, and IGFBP-3 proteolytic activity was determined by a [125I...

Management of hemodynamically unstable pelvic trauma: results of the first Italian consensus conference (cooperative guidelines of the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology -Section of Vascular and Interventional Radiology- and the World Society of Emergency Surgery)

Science.gov (United States)

2014-01-01

Hemodynamically Unstable Pelvic Trauma is a major problem in blunt traumatic injury. No cosensus has been reached in literature on the optimal treatment of this condition. We present the results of the First Italian Consensus Conference on Pelvic Trauma which took place in Bergamo on April 13 2013. An extensive review of the literature has been undertaken by the Organizing Committee (OC) and forwarded to the Scientific Committee (SC) and the Panel (JP). Members of them were appointed by surgery, critical care, radiology, emergency medicine and orthopedics Italian and International societies: the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology, Section of Vascular and Interventional Radiology and the World Society of Emergency Surgery. From November 2012 to January 2013 the SC undertook the critical revision and prepared the presentation to the audience and the Panel on the day of the Conference. Then 3 recommendations were presented according to the 3 submitted questions. The Panel voted the recommendations after discussion and amendments with the audience. Later on a email debate took place until December 2013 to reach a unanimous consent. We present results on the 3 following questions: which hemodynamically unstable patient needs an extraperitoneal pelvic packing? Which hemodynamically unstable patient needs an external fixation? Which hemodynamically unstable patient needs emergent angiography? No longer angiography is considered the first therapeutic maneuver in such a patient. Preperitoneal pelvic packing and external fixation, preceded by pelvic binder have a pivotal role in the management of these patients

Global incidence and case fatality rate of pulmonary embolism following major surgery: a protocol for a systematic review and meta-analysis of cohort studies.

Science.gov (United States)

Temgoua, Mazou N; Tochie, Joel Noutakdie; Noubiap, Jean Jacques; Agbor, Valirie Ndip; Danwang, Celestin; Endomba, Francky Teddy A; Nkemngu, Njinkeng J

2017-12-04

Pulmonary embolism (PE) is a life-threatening condition common after major surgery. Although the high incidence (0.3-30%) and mortality rate (16.9-31%) of PE in patients undergoing major surgical procedures is apparent from findings of contemporary observational studies, there is a lack of a summary and meta-analysis data on the epidemiology of postoperative PE in this same regard. Hence, we propose to conduct the first systematic review to summarise existing data on the global incidence, determinants and case fatality rate of PE following major surgery. Electronic databases including MEDLINE, EMBASE, SCOPUS, WHO global health library (including LILACS), Web of Science and Google scholar from inception to April 30, 2017, will be searched for cohort studies reporting on the incidence, determinants and case fatality rate of PE occurring after major surgery. Data from grey literature will also be assessed. Two investigators will independently perform study selection and data extraction. Included studies will be evaluated for risk of bias. Appropriate meta-analytic methods will be used to pool incidence and case fatality rate estimates from studies with identical features, globally and by subgroups of major surgical procedures. Random-effects and risk ratio with 95% confidence interval will be used to summarise determinants and predictors of mortality of PE in patients undergoing major surgery. This systematic review and meta-analysis will provide the most up-to-date epidemiology of PE in patients undergoing major surgery to inform health authorities and identify further research topics based on the remaining knowledge gaps. PROSPERO CRD42017065126.

Resources for your career in orthopaedic traumatology: what can the OTA do for you?

Science.gov (United States)

Mehta, Samir; Smith, Jeffrey M

2012-09-01

For those choosing a career in orthopaedic traumatology, several resources have been established by the Orthopaedic Trauma Association to facilitate progression from the years in training to the early years in practice. Young practitioners have access to educational programming, such as preparation for Part II of the Board Examination, web-based resources, such as on-line job postings, advocacy in health policy for the issues that will affect their ability to practice, and public relations efforts to increase their presence in the community. Ultimately, the resources set aside for the young practitioner by the Orthopaedic Trauma Association are intended to facilitate a sense of excellence, service, and community.

Clinical negligence in foot and ankle surgery: A 17-year review of claims to the NHS Litigation Authority.

Science.gov (United States)

Ring, J; Talbot, C L; Clough, T M

2014-11-01

We present a review of litigation claims relating to foot and ankle surgery in the NHS in England during the 17-year period between 1995 and 2012. A freedom of information request was made to obtain data from the NHS litigation authority (NHSLA) relating to orthopaedic claims, and the foot and ankle claims were reviewed. During this period of time, a total of 10 273 orthopaedic claims were made, of which 1294 (12.6%) were related to the foot and ankle. 1036 were closed, which comprised of 1104 specific complaints. Analysis was performed using the complaints as the denominator. The cost of settling these claims was more than £36 million. There were 372 complaints (33.7%) involving the ankle, of which 273 (73.4%) were related to trauma. Conditions affecting the first ray accounted for 236 (21.4%), of which 232 (98.3%) concerned elective practice. Overall, claims due to diagnostic errors accounted for 210 (19.0%) complaints, 208 (18.8%) from alleged incompetent surgery and 149 (13.5%) from alleged mismanagement. Our findings show that the incorrect, delayed or missed diagnosis of conditions affecting the foot and ankle is a key area for improvement, especially in trauma practice. ©2014 The British Editorial Society of Bone & Joint Surgery.

Value of a step-up diagnosis plan: CRP and CT-scan to diagnose and manage postoperative complications after major abdominal surgery

Directory of Open Access Journals (Sweden)

Jennifer Straatman

2014-12-01

Full Text Available Postoperative complications frequently follow major abdominal surgery and are associated with increased morbidity and mortality. Early diagnosis and treatment of complications is associated with improved patient outcome. In this study we assessed the value of a step-up diagnosis plan by C-reactive protein and CT-scan (computed tomography-scan imaging for detection of postoperative complications following major abdominal surgery. An observational cohort study was conducted of 399 consecutive patients undergoing major abdominal surgery between January 2009 and January 2011. Indication for operation, type of surgery, postoperative morbidity, complications according to the Clavien-Dindo classification and mortality were recorded. Clinical parameters were recorded until 14 days postoperatively or until discharge. Regular C-reactive protein (CPR measurements in peripheral blood and on indication -enhanced CT-scans were performed. Eighty-three out of 399 (20.6 % patients developed a major complication in the postoperative course after a median of seven days (IQR 4-9 days. One hundred and thirty two patients received additional examination consisting of enhanced CT-scan imaging, and treatment by surgical reintervention or intensive care observation. CRP levels were significantly higher in patients with postoperative complications. On the second postoperative day CRP levels were on average 197.4 mg/L in the uncomplicated group, 220.9 mg/L in patients with a minor complication and 280.1 mg/L in patients with major complications (p < 0,001. CT-scan imaging showed a sensitivity of 91.7 % and specificity of 100 % in diagnosis of major complications. Based on clinical deterioration and the increase of CRP, an additional enhanced CT-scan offered clear discrimination between patients with major abdominal complications and uncomplicated patients. Adequate treatment could then be accomplished.

Comparison of health literacy in privately insured and public hospital orthopaedic patients.

Science.gov (United States)

Cosic, Filip; Porter, Tabitha; Norsworthy, Cameron; Price, Rohan; Bedi, Harvinder

2018-05-14

Objective The aim of the present study was to quantify and compare patient health literacy between privately insured and public orthopaedic patients. Methods As part of the present cross-sectional study, elective postoperative orthopaedic patients across two sites were recruited and asked to complete a questionnaire at the first postoperative out-patient review. Patients were divided into three groups: (1) a public group (Public); (2) a private group (Private-pre); and (3) a private group that completed the questionnaire immediately after the out-patient review (Private-post). The questionnaire consisted of six questions regarding surgical management, expected recovery time and postoperative instructions. Patients were further asked to grade their satisfaction regarding information received throughout their management. Results In all, 150 patients completed the questionnaire, 50 in each of the three groups. Patients in the Public, Private-pre and Private-post groups answered a mean 2.74, 3.24 and 4.70 of 6 questions correctly respectively. The Private-pre group was 1.46-fold more likely to demonstrate correct health literacy than the Public group, whereas the Private-post group was 2.44-fold more likely to demonstrate improved health literacy than the Private-pre group. Patient satisfaction with information received was not associated with health literacy. Conclusion Limited health literacy in orthopaedic patients continues to be an area of concern. Both private and public orthopaedic patients demonstrated poor health literacy, but private patients demonstrated significant improvement after the out-patient review. What is known about the topic? Limited health literacy is a growing public health issue worldwide, with previous literature demonstrating a prevalence of low health literacy of 26% and marginal health literacy of 20% among all patient populations. Of concern, limited health literacy has been shown to result in a range of adverse health outcomes, including

A history of meniscal surgery: from ancient times to the twenty-first century.

Science.gov (United States)

Di Matteo, B; Moran, C J; Tarabella, V; Viganò, A; Tomba, P; Marcacci, M; Verdonk, R

2016-05-01

The science and surgery of the meniscus have evolved significantly over time. Surgeons and scientists always enjoy looking forward to novel therapies. However, as part of the ongoing effort at optimizing interventions and outcomes, it may also be useful to reflect on important milestones from the past. The aim of the present manuscript was to explore the history of meniscal surgery across the ages, from ancient times to the twenty-first century. Herein, some of the investigations of the pioneers in orthopaedics are described, to underline how their work has influenced the management of the injured meniscus in modern times. Level of evidence V.

Incidence of major vascular events after cardiac surgery: impact of preoperative monitoring with troponin and electrocardiogram

International Nuclear Information System (INIS)

Sandra M Quiroga; Juan C Villar; Luz X, Martinez

2009-01-01

Recent demographic changes have led to an increased risk of major vascular events among patients undergoing non-cardiac surgery. Troponin and electrocardiogram monitoring would further identify these major vascular events. Methods: we prospectively collected data on eligible patients (non-selected individuals aged 45 or older undergoing non-cardiac surgery under general or regional anesthesia in two hospitals in Bucaramanga, with expected length of stay longer than 24 hours) during a time-interrupted series,before and after postoperative diagnostic monitoring (blinded assessment of troponin T and electrocardiograms ignoring clinical data). For the period before the intervention (usual clinical care),two independent reviewers extracted clinical information from clinical histories (of all eligible patients from 3 randomly-selected months of 2005). For the period after diagnostic monitoring, we followed 100 consecutive eligible patients. Primary outcome was a composite of major vascular events within hospital, including myocardial infarction (defined as any troponin elevation associated with electrocardiographic changes suggesting ischemia, regardless of symptoms). Results: we included 534 clinical charts and 100 prospective surgical patients (mean age 62.2, SD 12.9 years; 56% women). The more frequent surgical procedures were orthopedics (26.8%) followed by abdominal (20.2%).The incidence of major vascular events recorded in clinical charts was 2.8%, compared with 7% among monitored patients (p=0,071). All four myocardial infarctions identified among the later group were silent. Conclusion: postoperative monitoring with troponin and electrocardiography identified a higher proportion of major vascular events, mainly silent myocardial infarctions.

Vancouver winters: Environmental influences on inpatient adult orthopaedic trauma demographics

International Nuclear Information System (INIS)

Noordin, S.; Masri, B. A.

2014-01-01

Objective: To compare the pattern of adult inpatient orthopaedic injuries admitted at three Vancouver hospitals following one of the worst winter snowstorms in the region with the preceding control winter period. Methods: The surveillance study was conducted at the University of British Columbia, Vancouver, Canada, 2007 to 2010. Inpatient adult admissions for orthopaedic injuries at three hospitals were recorded, including age, gender, anatomic location of injury, type of fracture (open or closed), fixation method (internal versus external fixation), and length of acute care hospital stay. Comparisons between admissions during this weather pattern and admission during a previous winter with minimal snow were made. SPSS 19 was used for statistical analysis. Results: Of the 511 patients admitted under Orthopaedic trauma service during the significant winter snowstorms of December 2008 - January 2009, 100 (19.6%) (CI: 16.2%-23.2%) were due to ice and snow, whereas in the preceding mild winter only 18 of 415 (4.3%) (CI: 2.5%-6.8%) cases were related to snow (p<0.05). Ankle and wrist fractures were the most frequent injuries during the index snow storm period (p<0.05). At all the three institutions, 97 (96.5%) fractures were closed during the snowstorm as opposed to 17 (95%) during the control winter period. Internal fixation in 06 (89%) fractures as opposed to external fixation in 12 (11%) patients was the predominant mode of fixation across the board during both time periods. Conclusion: The study demonstrated a significantly higher inpatient orthopaedic trauma volume during the snowstorm more rigorous prospective studies need to be designed to gain further insight to solving these problems from a public health perspective. (author)

Effectiveness of autologous transfusion system in primary total hip and knee arthroplasty.

LENUS (Irish Health Repository)

Schneider, Marco M

2014-01-01

Autologous transfusion has become a cost-efficient and useful option in the treatment of patients with high blood loss following major orthopaedic surgery. However, the effectiveness of autologous transfusion in total joint replacement remains controversial.

Competency-based education: a new model for teaching orthopaedics.

Science.gov (United States)

Alman, Benjamin A; Ferguson, Peter; Kraemer, William; Nousiainen, Markku T; Reznick, Richard K

2013-01-01

The current methods used to train residents to become orthopaedic surgeons are based on tradition, not evidence-based models. Educators have only a limited ability to assess trainees for competency using validated tests in various domains. The reduction in resident work hours limits the time available for clinical training, which has resulted in some calls for lengthening the training process. Another approach to address limited training hours is to focus training in a program that allows residents to graduate from a rotation based on demonstrated competency rather than on time on a service. A pilot orthopaedic residency curriculum, which uses a competency-based framework of resident training and maximizes the use of available training hours, has been designed and is being implemented.

Routine aspiration of subglottic secretions after major heart surgery: impact on the incidence of ventilator-associated pneumonia.

Science.gov (United States)

Pérez Granda, M J; Barrio, J M; Hortal, J; Muñoz, P; Rincón, C; Bouza, E

2013-12-01

Aspiration of subglottic secretions (ASS) is recommended in patients requiring mechanical ventilation for ≥48h. We assessed the impact of the introduction of ASS routinely in all patients after major heart surgery in an ecological study comparing ventilator-acquired pneumonia (VAP) incidence, days of mechanical ventilation, and cost of antimicrobial agents before and after the implementation of ASS. Before and after the intervention the results (per 1000 days) were: VAP incidence, 23.92 vs 16.46 (P = 0.04); cost of antimicrobials, €71,384 vs €63,446 (P = 0.002); and days of mechanical ventilation, 507.5 vs 377.5 (P = 0.009). From the moment of induction of anaesthesia all patients undergoing major heart surgery should routinely receive ASS. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Strategic planning in a highly specialized orthopaedic institution

Directory of Open Access Journals (Sweden)

Vukašinović Zoran

2009-01-01

Full Text Available Introduction. The Institute for Orthopaedic Surgery 'Banjica' in Belgrade provides tertiary healthcare services on national level. After decades of constant development, a recent decline coincided with the decade of great social and governmental disturbance, the transition period after the dissociation of former Yugoslavia. Objective. In order to overcome the crisis, we used modern management methods to define problems in the institution management, and to propose appropriate strategies. Methods. A survey that included 100 employees (17.67% was carried out, followed by descriptive statistical analysis, PEST and SWOT analyses. Results The impact of political fluctuations, ageing of population, financing model, obsolete medical technology was evaluated. Various personal and interpersonal factors were assessed: the quality of medical service (3.59±0.76, mark 1-5; relations among health service participants (3.39±0.78; occupational conditions (not good-91%; human, financial and other resources; professional cooperation, stimulation; rivalry and mobbing (declared in 56%; public informing, institution image (rank 3.70±0.88 and PR activities (new to 78%. 93% declared to give maximum effort at work. Conclusion. Using these results, we defined several strategic objectives. These include strengthening scientific activities, general orientation to specific and exclusive pathological conditions and treatment methods, improvement of management transparency, introduction of quality-based stimulation of workers, support of promotional and PR activities.

Computer assisted orthopaedic and trauma surgery. State of the art and future perspectives

NARCIS (Netherlands)

Schep, N. W. L.; Broeders, I. A. M. J.; van der Werken, Chr

2003-01-01

In recent years computer technologies have become more and more integrated in surgical procedures. The potential advantages of computer assisted surgery (CAS) are: increase of accuracy of surgical interventions, less invasive operations, better planning and simulation and reduction of radiation

Orthopaedic traumatology: fundamental principles and current controversies for the acute care surgeon.

Science.gov (United States)

Pharaon, Shad K; Schoch, Shawn; Marchand, Lucas; Mirza, Amer; Mayberry, John

2018-01-01

Multiply injured patients with fractures are co-managed by acute care surgeons and orthopaedic surgeons. In most centers, orthopaedic surgeons definitively manage fractures, but preliminary management, including washouts, splinting, reductions, and external fixations, may be performed by selected acute care surgeons. The acute care surgeon should have a working knowledge of orthopaedic terminology to communicate with colleagues effectively. They should have an understanding of the composition of bone, periosteum, and cartilage, and their reaction when there is an injury. Fractures are usually fixed urgently, but some multiply injured patients are better served with a damage control strategy. Extremity compartment syndrome should be suspected in all critically injured patients with or without fractures and a low threshold for compartment pressure measurements or empiric fasciotomy maintained. Acute care surgeons performing rib fracture fixation and other chest wall injury reconstructions should follow the principles of open fracture reduction and stabilization.

Orthopaedic traumatology: fundamental principles and current controversies for the acute care surgeon

Science.gov (United States)

Pharaon, Shad K; Schoch, Shawn; Marchand, Lucas; Mirza, Amer

2018-01-01

Multiply injured patients with fractures are co-managed by acute care surgeons and orthopaedic surgeons. In most centers, orthopaedic surgeons definitively manage fractures, but preliminary management, including washouts, splinting, reductions, and external fixations, may be performed by selected acute care surgeons. The acute care surgeon should have a working knowledge of orthopaedic terminology to communicate with colleagues effectively. They should have an understanding of the composition of bone, periosteum, and cartilage, and their reaction when there is an injury. Fractures are usually fixed urgently, but some multiply injured patients are better served with a damage control strategy. Extremity compartment syndrome should be suspected in all critically injured patients with or without fractures and a low threshold for compartment pressure measurements or empiric fasciotomy maintained. Acute care surgeons performing rib fracture fixation and other chest wall injury reconstructions should follow the principles of open fracture reduction and stabilization. PMID:29766123

Risk factors for surgical site infections following clean orthopaedic ...

African Journals Online (AJOL)

Risk factors for surgical site infections following clean orthopaedic operations. ... the host and environmental risk factors for surgical site infections following clean ... Materials and Methods: Consecutive patients who satisfied the inclusion ...

European Working Time Directive and the use of simulators and models in Irish orthopaedics.

LENUS (Irish Health Repository)

Egan, C

2011-09-07

OBJECTIVE: To report on the perceptions of a group of orthopaedic trainees and trainers on perceived effects of the proposed introduction of European Working Time Directive (EWTD) restrictions into Ireland and on the use of simulators in training orthopaedic skills. METHODS: A structured questionnaire was developed to evaluate the opinions of a group of orthopaedic surgeons and trainees at the annual national orthopaedic conference. RESULTS: There were 44 participants [12 consultants, 32 trainees (15 specialist registrars, 8 registrars, 9 senior house officers)]. Seventy-five percent of participants felt that both the quality of patient care and training would be negatively affected. A higher proportion of consultants than trainees felt that quality of life would be affected. A high proportion of participants (81.8%) had used a simulator or model to learn a surgical skill and 100% would consider using them again. CONCLUSIONS: While we wait for the full introduction of the EWTD hours the perception is that both quality of patient care and training will be affected. Models and simulators are well perceived as a method of training.

European Working Time Directive and the use of simulators and models in Irish orthopaedics.

Science.gov (United States)

Egan, C; Elliott, R; Fleming, P

2012-03-01

To report on the perceptions of a group of orthopaedic trainees and trainers on perceived effects of the proposed introduction of European Working Time Directive (EWTD) restrictions into Ireland and on the use of simulators in training orthopaedic skills. A structured questionnaire was developed to evaluate the opinions of a group of orthopaedic surgeons and trainees at the annual national orthopaedic conference. There were 44 participants [12 consultants, 32 trainees (15 specialist registrars, 8 registrars, 9 senior house officers)]. Seventy-five percent of participants felt that both the quality of patient care and training would be negatively affected. A higher proportion of consultants than trainees felt that quality of life would be affected. A high proportion of participants (81.8%) had used a simulator or model to learn a surgical skill and 100% would consider using them again. While we wait for the full introduction of the EWTD hours the perception is that both quality of patient care and training will be affected. Models and simulators are well perceived as a method of training.

Mechanical compatibility of sol-gel annealing with titanium for orthopaedic prostheses.

Science.gov (United States)

Greer, Andrew I M; Lim, Teoh S; Brydone, Alistair S; Gadegaard, Nikolaj

2016-01-01

Sol-gel processing is an attractive method for large-scale surface coating due to its facile and inexpensive preparation, even with the inclusion of precision nanotopographies. These are desirable traits for metal orthopaedic prostheses where ceramic coatings are known to be osteoinductive and the effects may be amplified through nanotexturing. However there are a few concerns associated with the application of sol-gel technology to orthopaedics. Primarily, the annealing stage required to transform the sol-gel into a ceramic may compromise the physical integrity of the underlying metal. Secondly, loose particles on medical implants can be carcinogenic and cause inflammation so the coating needs to be strongly bonded to the implant. These concerns are addressed in this paper. Titanium, the dominant material for orthopaedics at present, is examined before and after sol-gel processing for changes in hardness and flexural modulus. Wear resistance, bending and pull tests are also performed to evaluate the ceramic coating. The findings suggest that sol-gel coatings will be compatible with titanium implants for an optimum temperature of 500 °C.

Aarhus Regenerative Orthopaedics Symposium (AROS)

DEFF Research Database (Denmark)

Foldager, Casper B.; Bendtsen, Michael; Berg, Lise C.

2016-01-01

to musculoskeletal pain and disability. The Aarhus Regenerative Orthopaedics Symposium (AROS) 2015 was motivated by the need to address regenerative challenges in an ageing population by engaging clinicians, basic scientists, and engineers. In this position paper, we review our contemporary understanding of societal......, patient-related, and basic science-related challenges in order to provide a reasoned roadmap for the future to deal with this compelling and urgent healthcare problem. © 2017 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation....

A pragmatic multi-centre randomised controlled trial of fluid loading in high-risk surgical patients undergoing major elective surgery--the FOCCUS study.

Science.gov (United States)

Cuthbertson, Brian H; Campbell, Marion K; Stott, Stephen A; Elders, Andrew; Hernández, Rodolfo; Boyers, Dwayne; Norrie, John; Kinsella, John; Brittenden, Julie; Cook, Jonathan; Rae, Daniela; Cotton, Seonaidh C; Alcorn, David; Addison, Jennifer; Grant, Adrian

2011-01-01

Fluid strategies may impact on patient outcomes in major elective surgery. We aimed to study the effectiveness and cost-effectiveness of pre-operative fluid loading in high-risk surgical patients undergoing major elective surgery. This was a pragmatic, non-blinded, multi-centre, randomised, controlled trial. We sought to recruit 128 consecutive high-risk surgical patients undergoing major abdominal surgery. The patients underwent pre-operative fluid loading with 25 ml/kg of Ringer's solution in the six hours before surgery. The control group had no pre-operative fluid loading. The primary outcome was the number of hospital days after surgery with cost-effectiveness as a secondary outcome. A total of 111 patients were recruited within the study time frame in agreement with the funder. The median pre-operative fluid loading volume was 1,875 ml (IQR 1,375 to 2,025) in the fluid group compared to 0 (IQR 0 to 0) in controls with days in hospital after surgery 12.2 (SD 11.5) days compared to 17.4 (SD 20.0) and an adjusted mean difference of 5.5 days (median 2.2 days; 95% CI -0.44 to 11.44; P = 0.07). There was a reduction in adverse events in the fluid intervention group (P = 0.048) and no increase in fluid based complications. The intervention was less costly and more effective (adjusted average cost saving: £2,047; adjusted average gain in benefit: 0.0431 quality adjusted life year (QALY)) and has a high probability of being cost-effective. Pre-operative intravenous fluid loading leads to a non-significant reduction in hospital length of stay after high-risk major surgery and is likely to be cost-effective. Confirmatory work is required to determine whether these effects are reproducible, and to confirm whether this simple intervention could allow more cost-effective delivery of care. Prospective Clinical Trials, ISRCTN32188676.

Compliance in Antibiotic Prophylaxis in Orthopaedics and Trauma ...

African Journals Online (AJOL)

Compliance in Antibiotic Prophylaxis in Orthopaedics and Trauma: Surgical Practice in a Tertiary Hospital, North-West Nigeria. ... or international guide lines, to reap the expected benefit of prophylactic antibiotics and avoid unwanted adverse effects like emergence of resistant bacteria strains and extra cost of healthcare.

Floor Effect of PROMIS Depression CAT Associated With Hasty Completion in Orthopaedic Surgery Patients.

Science.gov (United States)

Guattery, Jason M; Dardas, Agnes Z; Kelly, Michael; Chamberlain, Aaron; McAndrew, Christopher; Calfee, Ryan P

2018-04-01

The Patient Reported Outcomes Measurement Information System (PROMIS) was developed to provide valid, reliable, and standardized measures to gather patient-reported outcomes for many health domains, including depression, independent of patient condition. Most studies confirming the performance of these measures were conducted with a consented, volunteer study population for testing. Using a study population that has undergone the process of informed consent may be differentiated from the validation group because they are educated specifically as to the purpose of the questions and they will not have answers recorded in their permanent health record. (1) When given as part of routine practice to an orthopaedic population, do PROMIS Physical Function and Depression item banks produce score distributions different than those produced by the populations used to calibrate and validate the item banks? (2) Does the presence of a nonnormal distribution in the PROMIS Depression scores in a clinical population reflect a deliberately hasty answering of questions by patients? (3) Are patients who are reporting minimal depressive symptoms by scoring the minimum score on the PROMIS Depression Computer Adaptive Testing (CAT) distinct from other patients according to demographic data or their scores on other PROMIS assessments? Univariate descriptive statistics and graphic histograms were used to describe the frequency distribution of scores for the Physical Function and Depression item banks for all orthopaedic patients 18 years or older who had an outpatient visit between June 2015 and December 2016. The study population was then broken into two groups based on whether they indicated a lack of depressive symptoms and scored the minimum score (34.2) on the Depression CAT assessment (Floor Group) or not (Standard Group). The distribution of Physical Function CAT scores was compared between the two groups. Finally, a time-per-question value was calculated for both the Physical

Biodegradable magnesium alloys for orthopaedic applications: A review on corrosion, biocompatibility and surface modifications

Energy Technology Data Exchange (ETDEWEB)

Agarwal, Sankalp [Centre for Research in Engineering and Surface Technology, FOCAS Institute, Dublin Institute of Technology (Ireland); School of Food Science and Environmental Health, Cathal Brugha Street, Dublin Institute of Technology (Ireland); Curtin, James [School of Food Science and Environmental Health, Cathal Brugha Street, Dublin Institute of Technology (Ireland); Duffy, Brendan [Centre for Research in Engineering and Surface Technology, FOCAS Institute, Dublin Institute of Technology (Ireland); Jaiswal, Swarna, E-mail: swarna.jaiswal@dit.ie [Centre for Research in Engineering and Surface Technology, FOCAS Institute, Dublin Institute of Technology (Ireland)

2016-11-01

Magnesium (Mg) and its alloys have been extensively explored as potential biodegradable implant materials for orthopaedic applications (e.g. Fracture fixation). However, the rapid corrosion of Mg based alloys in physiological conditions has delayed their introduction for therapeutic applications to date. The present review focuses on corrosion, biocompatibility and surface modifications of biodegradable Mg alloys for orthopaedic applications. Initially, the corrosion behaviour of Mg alloys and the effect of alloying elements on corrosion and biocompatibility is discussed. Furthermore, the influence of polymeric deposit coatings, namely sol-gel, synthetic aliphatic polyesters and natural polymers on corrosion and biological performance of Mg and its alloy for orthopaedic applications are presented. It was found that inclusion of alloying elements such as Al, Mn, Ca, Zn and rare earth elements provides improved corrosion resistance to Mg alloys. It has been also observed that sol-gel and synthetic aliphatic polyesters based coatings exhibit improved corrosion resistance as compared to natural polymers, which has higher biocompatibility due to their biomimetic nature. It is concluded that, surface modification is a promising approach to improve the performance of Mg-based biomaterials for orthopaedic applications. - Highlights: • The Mg based alloys are promising candidates for orthopaedic applications. • The rapid corrosion of Mg can affect human cells, and causes infection and implant failure. • The various physiological factors and Mg alloying elements affect the corrosion and mechanical properties of implants. • The polymeric deposit coatings enhance the corrosion resistance and biocompatibility.

Supply and Demand Analysis of the Orthopaedic Trauma Surgeon Workforce in the United States.

Science.gov (United States)

Sielatycki, John A; Sawyer, Jeffrey R; Mir, Hassan R

2016-05-01

To investigate recent trends in the orthopaedic trauma workforce and to assess whether supply of orthopaedic trauma surgeons (OTS) matches the demand for their skills. Supply estimated using Orthopaedic Trauma Association (OTA) membership and American Academy of Orthopaedic Surgeons census data. The annual number of operative pelvic and acetabular fractures reported by American College of Surgeons verified trauma centers in the National Trauma Data Bank (NTDB) was used as a surrogate of demand. Because surrogates were used, the annual rate of change in OTA membership versus rate of change in operative injuries per NTDB center was compared. From 2002 to 2012, reported operative pelvic and acetabular injuries increased by an average of 21.0% per year. The number of reporting trauma centers increased by 27.2% per year. The number of OTA members increased each year except in 2009, with mean annual increase of 9.8%. The mean number of orthopaedic surgeons per NTDB center increased from 7.98 to 8.58, an average of 1.5% per year. The annual number of operative pelvic and acetabular fractures per NTDB center decreased from 27.1 in 2002 to 19.03 in 2012, down 2.0% per year. In the United States, from 2002 to 2012, the number of OTS trended upward, whereas operative pelvic and acetabular cases per reporting NTDB center declined. These trends suggest a net loss of such cases per OTS over this period.

Biodegradable magnesium alloys for orthopaedic applications: A review on corrosion, biocompatibility and surface modifications

International Nuclear Information System (INIS)

Agarwal, Sankalp; Curtin, James; Duffy, Brendan; Jaiswal, Swarna

2016-01-01

Magnesium (Mg) and its alloys have been extensively explored as potential biodegradable implant materials for orthopaedic applications (e.g. Fracture fixation). However, the rapid corrosion of Mg based alloys in physiological conditions has delayed their introduction for therapeutic applications to date. The present review focuses on corrosion, biocompatibility and surface modifications of biodegradable Mg alloys for orthopaedic applications. Initially, the corrosion behaviour of Mg alloys and the effect of alloying elements on corrosion and biocompatibility is discussed. Furthermore, the influence of polymeric deposit coatings, namely sol-gel, synthetic aliphatic polyesters and natural polymers on corrosion and biological performance of Mg and its alloy for orthopaedic applications are presented. It was found that inclusion of alloying elements such as Al, Mn, Ca, Zn and rare earth elements provides improved corrosion resistance to Mg alloys. It has been also observed that sol-gel and synthetic aliphatic polyesters based coatings exhibit improved corrosion resistance as compared to natural polymers, which has higher biocompatibility due to their biomimetic nature. It is concluded that, surface modification is a promising approach to improve the performance of Mg-based biomaterials for orthopaedic applications. - Highlights: • The Mg based alloys are promising candidates for orthopaedic applications. • The rapid corrosion of Mg can affect human cells, and causes infection and implant failure. • The various physiological factors and Mg alloying elements affect the corrosion and mechanical properties of implants. • The polymeric deposit coatings enhance the corrosion resistance and biocompatibility.

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

Directory of Open Access Journals (Sweden)

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.

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

Multilayer scaffolds in orthopaedic tissue engineering.

Science.gov (United States)

Atesok, Kivanc; Doral, M Nedim; Karlsson, Jon; Egol, Kenneth A; Jazrawi, Laith M; Coelho, Paulo G; Martinez, Amaury; Matsumoto, Tomoyuki; Owens, Brett D; Ochi, Mitsuo; Hurwitz, Shepard R; Atala, Anthony; Fu, Freddie H; Lu, Helen H; Rodeo, Scott A

2016-07-01

The purpose of this study was to summarize the recent developments in the field of tissue engineering as they relate to multilayer scaffold designs in musculoskeletal regeneration. Clinical and basic research studies that highlight the current knowledge and potential future applications of the multilayer scaffolds in orthopaedic tissue engineering were evaluated and the best evidence collected. Studies were divided into three main categories based on tissue types and interfaces for which multilayer scaffolds were used to regenerate: bone, osteochondral junction and tendon-to-bone interfaces. In vitro and in vivo studies indicate that the use of stratified scaffolds composed of multiple layers with distinct compositions for regeneration of distinct tissue types within the same scaffold and anatomic location is feasible. This emerging tissue engineering approach has potential applications in regeneration of bone defects, osteochondral lesions and tendon-to-bone interfaces with successful basic research findings that encourage clinical applications. Present data supporting the advantages of the use of multilayer scaffolds as an emerging strategy in musculoskeletal tissue engineering are promising, however, still limited. Positive impacts of the use of next generation scaffolds in orthopaedic tissue engineering can be expected in terms of decreasing the invasiveness of current grafting techniques used for reconstruction of bone and osteochondral defects, and tendon-to-bone interfaces in near future.

Drug delivery options to increase patient adherence and satisfaction in the management of rheumatoid arthritis – focus on subcutaneous tocilizumab

OpenAIRE

Nakashima, Yasuharu; Kondo, Masakazu; Miyahara, Hisaaki; Iwamoto, Yukihide

2014-01-01

Yasuharu Nakashima,1 Masakazu Kondo,2 Hisaaki Miyahara,3 Yukihide Iwamoto11Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan; 2Kondo Clinic of Rheumatology and Orthopaedic Surgery, Fukuoka, Japan; 3Department of Orthopaedic Surgery and Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, JapanAbstract: Rheumatoid arthritis (RA) is a chronic, progressive, inflammatory disease associated with joint destruction. Tocilizumab ...

The Quality of Open-Access Video-Based Orthopaedic Instructional Content for the Shoulder Physical Exam is Inconsistent.

Science.gov (United States)

Urch, Ekaterina; Taylor, Samuel A; Cody, Elizabeth; Fabricant, Peter D; Burket, Jayme C; O'Brien, Stephen J; Dines, David M; Dines, Joshua S

2016-10-01

The internet has an increasing role in both patient and physician education. While several recent studies critically appraised the quality and accuracy of web-based written information available to patients, no studies have evaluated such parameters for open-access video content designed for provider use. The primary goal of the study was to determine the accuracy of internet-based instructional videos featuring the shoulder physical examination. An assessment of quality and accuracy of said video content was performed using the basic shoulder examination as a surrogate for the "best-case scenario" due to its widely accepted components that are stable over time. Three search terms ("shoulder," "examination," and "shoulder exam") were entered into the four online video resources most commonly accessed by orthopaedic surgery residents (VuMedi, G9MD, Orthobullets, and YouTube). Videos were captured and independently reviewed by three orthopaedic surgeons. Quality and accuracy were assessed in accordance with previously published standards. Of the 39 video tutorials reviewed, 61% were rated as fair or poor. Specific maneuvers such as the Hawkins test, O'Brien sign, and Neer impingement test were accurately demonstrated in 50, 36, and 27% of videos, respectively. Inter-rater reliability was excellent (mean kappa 0.80, range 0.79-0.81). Our results suggest that information presented in open-access video tutorials featuring the physical examination of the shoulder is inconsistent. Trainee exposure to such potentially inaccurate information may have a significant impact on trainee education.

Medical opinions, beliefs and prescription of orthopaedic footwear: A survey of Dutch orthopaedists and rehabilitation practitioners.

NARCIS (Netherlands)

Boer, Hendrik; Seydel, E.R.

1998-01-01

Objectives: To get insight into medical opinions about the use of orthopaedic footwear and the medical and social factors related to the prescription of orthopaedic footwear by orthopaedists and rehabilitation practitioners. Methods: In this study 85 orthopaedists and 96 rehabilitation practitioners

Neoprene Orthopaedic Supports: An Underrecognised Cause of Allergic Contact Dermatitis

Directory of Open Access Journals (Sweden)

S. Hawkey

2015-01-01

Full Text Available Thioureas, often contained within neoprene to provide water resistance, are an important cause of allergic contact dermatitis (ACD in those who use neoprene products. We wish to present three cases of thiourea-induced ACD from three different orthopaedic supports containing neoprene. The first case was a 67-year-old woman who developed an itchy rash on her heel three weeks after using a neoprene insole for plantar fasciitis. The second case was a 47-year-old man who developed an itchy rash on his wrist after wearing neoprene wrist splints for psoriatic arthropathy. The third case was a 77-year-old woman who experienced a severe erythematous rash with blistering from a neoprene elbow brace she received following a humeral fracture. All patients were patch tested to the British Society of Cutaneous Allergy Standard and rubber series and a cut piece from all the relevant supports. At 96 hours, all patients had a + reaction to mixed dialkylthiourea, diethylthiourea, and the supports’ material. No other positive patch test reactions were identified. As neoprene is fast becoming one of the most popular materials used for orthopaedic supports, awareness of this reaction and close liaison between dermatologists and orthopaedic surgeons are therefore essential to allow for early recognition of this complication.

Risk factors for postoperative delirium in patients undergoing major head and neck cancer surgery: a meta-analysis.

Science.gov (United States)

Zhu, Yun; Wang, Gangpu; Liu, Shengwen; Zhou, Shanghui; Lian, Ying; Zhang, Chenping; Yang, Wenjun

2017-06-01

Postoperative delirium is common after extensive surgery. This study aimed to collate and synthesize published literature on risk factors for delirium in patients with head and neck cancer surgery. Three databases were searched (MEDLINE, Embase, and Cochrane Library) between January 1987 and July 2016. The Newcastle Ottawa Scale (NOS) was adopted to evaluate the study quality. Pooled odds ratios or mean differences for individual risk factors were estimated using the Mantel-Haenszel and inverse-variance methods. They provided a total of 1940 patients (286 with delirium and 1654 without), and predominantly included patients undergoing head and neck cancer surgery. The incidence of postoperative delirium ranged from 11.50% to 36.11%. Ten statistically significant risk factors were identified in pooled analysis. Old age, age >70 years, male sex, duration of surgery, history of hypertension, blood transfusions, tracheotomy, American Society of Anesthesiologists physical status grade at least III, flap reconstruction and neck dissection were more likely to sustain delirium after head and neck cancer surgery. Delirium is common in patients undergoing major head neck cancer surgery. Several risk factors were consistently associated with postoperative delirium. These factors help to highlight patients at risk of developing delirium and are suitable for preventive action. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Evaluating the use of antibiotic prophylaxis during open reduction and internal fixation surgery in patients at low risk of surgical site infection.

Science.gov (United States)

Xu, Sheng-Gen; Mao, Zhao-Guang; Liu, Bin-Sheng; Zhu, Hui-Hua; Pan, Hui-Lin

2015-02-01

Widespread overuse and inappropriate use of antibiotics contribute to increasingly antibiotic-resistant pathogens and higher health care costs. It is not clear whether routine antibiotic prophylaxis can reduce the rate of surgical site infection (SSI) in low-risk patients undergoing orthopaedic surgery. We designed a simple scorecard to grade SSI risk factors and determined whether routine antibiotic prophylaxis affects SSI occurrence during open reduction and internal fixation (ORIF) orthopaedic surgeries in trauma patients at low risk of developing SSI. The SSI risk scorecard (possible total points ranged from 5 to 25) was designed to take into account a patient's general health status, the primary cause of fractures, surgical site tissue condition or wound class, types of devices implanted, and surgical duration. Patients with a low SSI risk score (≤8 points) who were undergoing clean ORIF surgery were divided into control (routine antibiotic treatment, cefuroxime) and evaluation (no antibiotic treatment) groups and followed up for 13-17 months after surgery. The infection rate was much higher in patients with high SSI risk scores (≥9 points) than in patients with low risk scores assigned to the control group (10.7% vs. 2.2%, Prisk score. Implementation of this scoring system could guide the rational use of perioperative antibiotics and ultimately reduce antibiotic resistance, health care costs, and adverse reactions to antibiotics. Copyright © 2014 Elsevier Ltd. All rights reserved.

Biodegradable magnesium alloys for orthopaedic applications: A review on corrosion, biocompatibility and surface modifications.

Science.gov (United States)

Agarwal, Sankalp; Curtin, James; Duffy, Brendan; Jaiswal, Swarna

2016-11-01

Magnesium (Mg) and its alloys have been extensively explored as potential biodegradable implant materials for orthopaedic applications (e.g. Fracture fixation). However, the rapid corrosion of Mg based alloys in physiological conditions has delayed their introduction for therapeutic applications to date. The present review focuses on corrosion, biocompatibility and surface modifications of biodegradable Mg alloys for orthopaedic applications. Initially, the corrosion behaviour of Mg alloys and the effect of alloying elements on corrosion and biocompatibility is discussed. Furthermore, the influence of polymeric deposit coatings, namely sol-gel, synthetic aliphatic polyesters and natural polymers on corrosion and biological performance of Mg and its alloy for orthopaedic applications are presented. It was found that inclusion of alloying elements such as Al, Mn, Ca, Zn and rare earth elements provides improved corrosion resistance to Mg alloys. It has been also observed that sol-gel and synthetic aliphatic polyesters based coatings exhibit improved corrosion resistance as compared to natural polymers, which has higher biocompatibility due to their biomimetic nature. It is concluded that, surface modification is a promising approach to improve the performance of Mg-based biomaterials for orthopaedic applications. Copyright © 2016 Elsevier B.V. All rights reserved.

Persistently High Hip Circumference after Bariatric Surgery Is a Major Hurdle to Successful Hip Replacement

Directory of Open Access Journals (Sweden)

Menachem M. Meller

2014-01-01

Full Text Available The prevalence of class III obesity (BMI≥40 kg/m2 in black women is 18%. As class III obesity leads to hip joint deterioration, black women frequently present for orthopedic care. Weight loss associated with bariatric surgery should lead to enhanced success of hip replacements. However, we present a case of a black woman who underwent Roux-en-Y gastric bypass with the expectation that weight loss would make her a better surgical candidate for hip replacement. Her gastric bypass was successful as her BMI declined from 52.0 kg/m2 to 33.7 kg/m2. However, her hip circumference after weight loss remained persistently high. Therefore, at surgery the soft tissue tunnel geometry presented major challenges. Tunnel depth and immobility of the soft tissue interfered with retractor placement, tissue reflection, and surgical access to the acetabulum. Therefore a traditional cup placement could not be achieved. Instead, a hemiarthroplasty was performed. After surgery her pain and reliance on external support decreased. But her functional independence never improved. This case demonstrates that a lower BMI after bariatric surgery may improve the metabolic profile and decrease anesthesia risk, but the success of total hip arthroplasties remains problematic if fat mass in the operative field (i.e., high hip circumference remains high.

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