Medical Issues: Orthopedics

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Outpatient parenteral antimicrobial therapy for orthopedic infections – a successful public healthcare experience in Brazil

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Priscila Rosalba Oliveira

2016-05-01

Full Text Available Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42. Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies

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

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

2015-01-01

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

Retinitis due to opportunistic infections in Iranian HIV infected patients.

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Ali Abdollahi

2013-10-01

Full Text Available We tried to evaluate prevalence and characteristics of Iranian HIV infected patients with retinitis due to opportunistic infections. In this cross sectional study, we evaluated 106 HIV infected patients via indirect ophthalmoscopy and slit lamp examination by 90 lens to find retinitis cases. General information and results of ophthalmologic examination were analyzed. Prevalence of retinitis due to opportunistic infections was 6.6%: cytomegalovirus (CMV retinitis 1.88%, toxoplasmosis retinochoroiditis 1.88% and tuberculosis chorioretinitis 2.83%. CD4 count was higher than 50 cell/µlit in both cases with CMV retinitis. Along with increasing survival in the HIV infected patients, the prevalence of complications such as ocular manifestation due to opportunistic infections are increasing and must be more considered.

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

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

2015-05-01

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

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

OpenAIRE

John Ebnezar; Yogita Bali; Rakesh John

2017-01-01

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

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

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John Ebnezar

2017-01-01

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

Orthopedic radiology in the postoperative patient (practical orthopedic radiology)

International Nuclear Information System (INIS)

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

1987-01-01

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

Managing orthopedics and neurosciences costs through standard treatment protocols.

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McGinnity, E S; Pluth, T E

1994-06-01

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

Nanotechnology: the scope and potential applications in orthopedic surgery.

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Gavaskar, Ashok; Rojas, D; Videla, F

2018-03-30

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

Gentamicin-loaded poly(lactic-co-glycolic acid) microparticles for the prevention of maxillofacial and orthopedic implant infections

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Flores, Claudia; Degoutin, Stephanie; Chai, Feng; Raoul, Gwenael; Hornez, Jean-Chritophe; Martel, Bernard; Siepmann, Juergen; Ferri, Joel; Blanchemain, Nicolas

2016-01-01

Trauma and orthopedic surgery can cause infections as any open surgical procedures. Such complications occur in only1 to 5% of the cases, but the treatment is rather complicated due to bacterial biofilm formation and limited drug access to the site of infection upon systemic administration. An interesting strategy to overcome this type of complications is to prevent bacterial proliferation and biofilm formation via the local and controlled release of antibiotic drugs from the implant itself. Obviously, the incorporation of the drug into the implant should not affect the latter's biological and mechanical properties. In this context, we optimized the preparation process for gentamicin-loaded poly(lactic-co-glycolic acid) (PLGA) microparticles, which can be incorporated in the macropores of calcium phosphate-based bone substitutes. Microparticles were prepared using a double emulsion solvent extraction/evaporation technique. The processing parameters were optimized in order to provide an average microparticle size of about 60 μm, allowing for incorporation inside the macropores (100 μm) of the hydroxyapatite scaffold. Gentamicin-loaded PLGA microparticles showed a sustained release for 25–30 days and a rapid antibacterial activity due to a burst effect, the extent of which was controlled by the initial loading of the microparticles. SEM pictures revealed a highly porous microparticle structure, which can help to reduce the micro environmental pH drop and autocatalytic effects. The biological evaluation showed the cytocompatibility and non-hemolytic property of the microparticles, and the antibacterial activity against Staphylococcus aureus under the given conditions. - Highlights: • The optimization of microparticle preparation parameters allows to obtain a size compatible with the bone substitute porosity • PDL% has a direct impact on the burst effect, a control release of gentamicin was obtained • The incorporation of microparticles into the macroporosity

Gentamicin-loaded poly(lactic-co-glycolic acid) microparticles for the prevention of maxillofacial and orthopedic implant infections

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Flores, Claudia [Univ. Lille, 59000 Lille (France); INSERM U1008, Controlled Drug Delivery Systems and Biomaterials, 59000 Lille (France); Degoutin, Stephanie [Univ. Lille, 59000 Lille (France); UMET, Ingénierie des Systèmes Polymères, Université de Lille 1, 59655 Villeneuve d' Ascq (France); Chai, Feng [Univ. Lille, 59000 Lille (France); INSERM U1008, Controlled Drug Delivery Systems and Biomaterials, 59000 Lille (France); Raoul, Gwenael [Univ. Lille, 59000 Lille (France); INSERM U1008, Controlled Drug Delivery Systems and Biomaterials, 59000 Lille (France); Service Chirurgie Maxillo-Faciale, CHRU de Lille, 59000 Lille (France); Hornez, Jean-Chritophe [Laboratoire des Matériaux Céramiques et Procédés Associés (LMCPA), Université de Valenciennes, 59300 Valenciennes (France); Martel, Bernard [Univ. Lille, 59000 Lille (France); UMET, Ingénierie des Systèmes Polymères, Université de Lille 1, 59655 Villeneuve d' Ascq (France); Siepmann, Juergen [Univ. Lille, 59000 Lille (France); INSERM U1008, Controlled Drug Delivery Systems and Biomaterials, 59000 Lille (France); Ferri, Joel [Univ. Lille, 59000 Lille (France); INSERM U1008, Controlled Drug Delivery Systems and Biomaterials, 59000 Lille (France); Service Chirurgie Maxillo-Faciale, CHRU de Lille, 59000 Lille (France); Blanchemain, Nicolas, E-mail: nicolas.blanchemain@univ-lille2.fr [Univ. Lille, 59000 Lille (France); INSERM U1008, Controlled Drug Delivery Systems and Biomaterials, 59000 Lille (France)

2016-07-01

Trauma and orthopedic surgery can cause infections as any open surgical procedures. Such complications occur in only1 to 5% of the cases, but the treatment is rather complicated due to bacterial biofilm formation and limited drug access to the site of infection upon systemic administration. An interesting strategy to overcome this type of complications is to prevent bacterial proliferation and biofilm formation via the local and controlled release of antibiotic drugs from the implant itself. Obviously, the incorporation of the drug into the implant should not affect the latter's biological and mechanical properties. In this context, we optimized the preparation process for gentamicin-loaded poly(lactic-co-glycolic acid) (PLGA) microparticles, which can be incorporated in the macropores of calcium phosphate-based bone substitutes. Microparticles were prepared using a double emulsion solvent extraction/evaporation technique. The processing parameters were optimized in order to provide an average microparticle size of about 60 μm, allowing for incorporation inside the macropores (100 μm) of the hydroxyapatite scaffold. Gentamicin-loaded PLGA microparticles showed a sustained release for 25–30 days and a rapid antibacterial activity due to a burst effect, the extent of which was controlled by the initial loading of the microparticles. SEM pictures revealed a highly porous microparticle structure, which can help to reduce the micro environmental pH drop and autocatalytic effects. The biological evaluation showed the cytocompatibility and non-hemolytic property of the microparticles, and the antibacterial activity against Staphylococcus aureus under the given conditions. - Highlights: • The optimization of microparticle preparation parameters allows to obtain a size compatible with the bone substitute porosity • PDL% has a direct impact on the burst effect, a control release of gentamicin was obtained • The incorporation of microparticles into the

Infections du site Operatoire en Chirurgie Orthopedique ...

African Journals Online (AJOL)

Mots clés: Infection site opératoire chirurgie orthopédique. English Title: Infections of the operative site in orthopedic surgery: clinical presentations, etiologies and management. English Abstract. Introduction: In orthopedic surgery, wound site infections constitute a difficult situation to the surgeon; and for the patient. The aim ...

Impact of a surgical site infection (SSI) surveillance program in orthopedics and traumatology.

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Mabit, C; Marcheix, P S; Mounier, M; Dijoux, P; Pestourie, N; Bonnevialle, P; Bonnomet, F

2012-10-01

Surveillance of surgical site infections (SSI) is a priority. One of the fundamental principles for the surveillance of SSI is based on receiving effective field feedback (retro-information). The aim of this study was to report the results of a program of SSI surveillance and validate the hypothesis that there is a correlation between creating a SSI surveillance program and a reduction in SSI. The protocol was based on the weekly collection of surveillance data obtained directly from the different information systems in different departments. A delay of 3 months was established before extraction and analysis of data and information from the surgical teams. The NNIS index (National Nosocomial Infections Surveillance System) developed by the American surveillance system and the reduction of length of hospital stay index Journées d'hospitalisation évitées (JHE). Since the end of 2009, 7156 surgical procedures were evaluated (rate of inclusion 97.3%), and 84 SSI were registered with a significant decrease over time from 1.86% to 0.66%. A total of 418 days of hospitalization have been saved since the beginning of the surveillance system. Our surveillance system has three strong points: follow-up is continuous, specifically adapted to orthopedic traumatology and nearly exhaustive. The extraction of data directly from hospital information systems effectively improves the collection of data on surgical procedures. The implementation of a SSI surveillance protocol reduces SSI. Level III. Prospective study. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Massive subacromial-subdeltoid bursitis with rice bodies secondary to an orthopedic implant.

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Urruela, Adriana M; Rapp, Timothy B; Egol, Kenneth A

2012-09-01

Both early and late complications following open reduction and internal fixation of proximal humerus fractures have been reported extensively in the literature. Although orthopedic implants are known to cause irritation and inflammation, to our knowledge, this is the first case report to describe a patient with rice bodies secondary to an orthopedic implant. Although the etiology of rice bodies is unclear, histological studies reveal that they are composed of an inner amorphous core surrounded by collagen and fibrin. The differential diagnosis in this case included synovial chondromatosis, infection, and the formation of a malignant tumor. Additional imaging studies, such as magnetic resonance imaging, and more specific tests were necessary to differentiate the rice bodies due to bursitis versus neoplasm, prior to excision. The patient presented 5 years following open reduction and internal fixation of a displaced proximal humerus fracture, with swelling in the area of the previous surgical site. Examination revealed a large, painless tumor-like mass on the anterior aspect of the shoulder. The patient's chief concern was the unpleasant aesthetic of the mass; no pain was reported. Upon excision of the mass, the patient's full, painless range of motion returned.

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

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Oliveira V.

1998-01-01

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

Clinical potential of implantable wireless sensors for orthopedic treatments.

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

2018-04-01

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

Opium and opioid abuse in orthopedic inpatients: a cross sectional study in Urmia University of Medical Sciences.

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Afshar, Ahmadreza; Asadzadeh, Mina; Kargar, Hakimeh; Aghdashi, Mir Mosa; Mirzatolooei, Fardin

2012-01-01

During a cross-sectional study, patients who were admitted to the orthopedic department of the Urmia University of Medical Sciences were asked about opium/opioid abuse. Demographic characteristics, the pattern of consumption, the substance, the duration of the use, the duration of hospital stay and the cause of their injuries were recorded. Among 2,867 patients, 74 (2.5%) patients (71 men and 3 women) with the mean age of 38 were opium/opioid users. Most of the patients used opium through inhalation. The mean duration of the substance use was 7.4 years. The mean duration of hospital stay between the regular orthopedic patients and the opium/opioid abuser orthopedic patients was statistically significant. (P=000). Among four Hepatitis C Virus (HCV) infected patients, three subjects were injection users and Human Immunodeficiency Virus (HIV) also infected two of them. Road traffic accidents (37.8%), and work related injuries (17.5%) were the two most common reasons for the patient's injuries.

Physicians founders of orthopedic surgery in Serbia

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Bumbaširević Marko

2004-01-01

Full Text Available The beginnings of the development of orthopedic surgery in Serbia have been related to the name of Dr Nikola Krstic and his first radiography of the hand in 1908. The foundation of the Orthopedic Ward, led by Dr Nikola Krstic, within the General State Hospital in Belgrade, in 1919, marks the definition of orthopedics as a separate branch of surgery. In addition to Dr Nikola Krstic, Dr Borivoje Lalovic and Temp. Docent Dr Borivoje Gradojevic, who published the first orthopedics textbook in Serbian in 1934, also worked at the orthopedic ward between the two world wars. The work at the orthopedic ward, which grew into a clinic in 1947, was continued by Prof. Dr Milos Simovic, Prof. Dr Svetislav Stojanovic and Prof, dr Ljubisa Boric. Their successors would have high achievements: Prof. Dr Zivojin Bumbasirevic became the only orthopedist who was a regular member of the Serbian Academy of Sciences and Arts, and Chief of Staff Dr Predrag Klisic and Prof. Dr Branko Radulovic provide impetus for further development of orthopedics by founding Specialist Orthopedics Hospital "Banjica".

Medical photography: principles for orthopedics.

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

2014-04-05

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

Orthopedic X-ray diagnostics

International Nuclear Information System (INIS)

Bernau, A.

1982-01-01

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

Improving surgeon utilization in an orthopedic department using simulation modeling

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Simwita YW

2016-10-01

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

Overview of Implant Infections in Orthopaedics Department: Retrospective Study

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Tugrul Bulut

2014-12-01

Full Text Available In this study, our aim was to evaluate the antibiotic susceptibility of bacteria isolated from orthopedic implant infections. Within two years operated 1996 patients in an orthopedics and traumatology clinic were retrospectively investigated. Seventy-six (76/1996, 3.8% orthopedic implant infections were detected. Isolated bacteria and their antibiotic susceptibility patterns were analyzed. The bacteries isolated from implant related infections and antibiotic sensitivity patterns were evaluated retrospectively in our orthopaedics and traumatology clinic. Staphylococcus aureus was the predominant organism (30.3%. Gram negative bacterias were isolated in 65.8% of our patients. No resistance was determined against vancomycin and linezolid in gram positive bacterias. Imipenem, amicasin and cefepim was seen as the most effective antibiotics for gram negative bacterias.

Imaging of orthopedic trauma and surgery

International Nuclear Information System (INIS)

Berquist, T.H.

1986-01-01

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

Evaluation of radiation protection in interventional orthopedic procedures in Khartoum state

International Nuclear Information System (INIS)

Ibrahim, M. Y. A.

2013-06-01

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

Nanotechnology-enhanced orthopedic materials fabrications, applications and future trends

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Yang, Lei

2015-01-01

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

SPECT/CT imaging in general orthopedic practice.

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Scharf, Stephen

2009-09-01

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

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

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

2013-05-01

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

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

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Masanori Kobayashi

2010-04-01

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

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

Science.gov (United States)

Kobayashi, Masanori; Hyu, Hyon Suong

2010-01-01

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

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

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Gerrit Haaker

2014-01-01

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

What expects orthopedic surgeon from bone scan?

International Nuclear Information System (INIS)

Sutter, B.; Cazenave, A.

2003-01-01

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

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

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

1982-09-01

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

How Useful are Orthopedic Surgery Residency Web Pages?

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Oladeji, Lasun O; Yu, Jonathan C; Oladeji, Afolayan K; Ponce, Brent A

2015-01-01

Medical students interested in orthopedic surgery residency positions frequently use the Internet as a modality to gather information about individual residency programs. Students often invest a painstaking amount of time and effort in determining programs that they are interested in, and the Internet is central to this process. Numerous studies have concluded that program websites are a valuable resource for residency and fellowship applicants. The purpose of the present study was to provide an update on the web pages of academic orthopedic surgery departments in the United States and to rate their utility in providing information on quality of education, faculty and resident information, environment, and applicant information. We reviewed existing websites for the 156 departments or divisions of orthopedic surgery that are currently accredited for resident education by the Accreditation Council for Graduate Medical Education. Each website was assessed for quality of information regarding quality of education, faculty and resident information, environment, and applicant information. We noted that 152 of the 156 departments (97%) had functioning websites that could be accessed. There was high variability regarding the comprehensiveness of orthopedic residency websites. Most of the orthopedic websites provided information on conference, didactics, and resident rotations. Less than 50% of programs provided information on resident call schedules, resident or faculty research and publications, resident hometowns, or resident salary. There is a lack of consistency regarding the content presented on orthopedic residency websites. As the competition for orthopedic websites continues to increase, applicants flock to the Internet to learn more about orthopedic websites in greater number. A well-constructed website has the potential to increase the caliber of students applying to a said program. Copyright © 2015 Association of Program Directors in Surgery. Published by

Tourniquets in orthopedic surgery

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Jai Prakash Sharma

2012-01-01

Full Text Available Tourniquets are commonly used in limb surgeries, be it orthopedic or plastic surgeries. But the inflation pressures, the duration, and release guidelines are still not clear. According to a survey, majority of orthopedic surgeons inflate the tourniquet to fixed pressures for the upper and the lower limbs without considering the baseline blood pressure of the patient on whom the tourniquets are being applied. This review was designed to recall and review the safe use of tourniquets and the various techniques that can be employed to minimize the complications of tourniquet use. Google, science direct, and pubmed were searched for appropriate literature and relevant articles were identified.

3D-printed patient-specific applications in orthopedics

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Wong KC

2016-10-01

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

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

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

2016-05-31

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

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

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

2017-05-01

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

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

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

2013-01-01

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

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

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

2018-03-01

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

[Update on congenital and neonatal herpes infections: infection due to cytomegalovirus and herpes simplex].

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Baquero-Artigao, F

2017-05-17

Newborn infants are a population which is especially susceptible to viral infections that frequently affect the central nervous system. Herpes infections can be transmitted to the foetus and to the newborn infant, and give rise to severe clinical conditions with long-term sensory and cognitive deficits. Two thirds of newborn infants with encephalitis due to herpes simplex virus and half of the children with symptomatic congenital infection by cytomegalovirus develop sequelae, which results in high community health costs in the long term. Fortunately, the better knowledge about these infections gained in recent years together with the development of effective antiviral treatments have improved the patients' prognosis. Valganciclovir (32 mg/kg/day in two doses for six months) prevents the development of hypoacusis and improves the neurological prognosis in symptomatic congenital infection due to cytomegalovirus. Acyclovir (60 mg/kg/day in three doses for 2-3 weeks) prevents the development of severe forms in skin-eyes-mouth herpes disease, and lowers the rate of mortality and sequelae when the disease has disseminated and is located in the central nervous system.

Molecular characterization of a prevalent ribocluster of methicillin-sensitiveStaphylococcus aureus from orthopedic implant infections. Correspondencewith MLST CC30

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Lucio eMontanaro

2016-02-01

Full Text Available ABSTRACTStaphylococcus aureus is the leading etiologic agent of orthopedic implant infections. Here a ribocluster of 27 S. aureus strains underwent further molecular characterization and subtyping by multilocus sequence typing (MLST and spa-typing. This cluster had been detected by automated ribotyping (with EcoRI as restriction enzyme of 200 S. aureus isolates from periprosthetic infections come for revision at the Rizzoli Orthopaedic Institute. The ribocluster, consisting of agr type III isolates, with a 74% co-presence of bone sialoprotein-binding (bbp and collagen-binding (cna genes, turned out devoid of mecA and IS256 and exhibited a high prevalence of toxic shock syndrome toxin gene (tst, 85%. Sequences achieved by spa typing and MLST were analyzed by BURP and goeBURST. Two predominant spa types, t012 (32% and t021 (36%, and one predominant sequence type, ST30 (18/27, 67%, a Staphylococcus aureus lineage spread worldwide and regarded as the ancestor of MLST CC30, were identified. Two new sequence types (ST2954, ST2960 and one new spa type (t13129 were detected for the first time. BURP clustered the isolates into two spa clonal complexes, CC021/012 (22/27, 81% and CC166 (4/27, 15%, plus one singleton, while goeBURST recognized solely MLST CC30. Interestingly, the 27-strains cluster detected by ribotyping corresponded exactly to CC30.

Medical students' and interns' interest in orthopedic surgery: the gender factor.

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Schroeder, Joshua E; Zisk-Rony, Rachel Y; Liebergall, Meir; Tandeter, Howard; Kaplan, Leon; Weiss, Yoram G; Weissman, Charles

2014-01-01

There is an extremely small proportion of female medical students choosing to specialize in orthopedic surgery. The aim of the study was to assess medical students' and interns' interests and perceptions of orthopedic surgery and explore why women are not interested in orthopedic surgery. Questionnaires were distributed to final-year medical students and interns assessing their interests and perception of orthopedic surgery. Final-year medical students and interns. Responses were obtained from 317 students and 199 interns. Among the medical students, 15% were interested in orthopedic surgery, but only 2% were women. Both male and female students perceived orthopedics as an "action"-packed, procedure-based profession, providing instant gratification, time in the operating room, high income, and the option for private practice. Female medical students considered it boring. Among interns, 11% were interested in orthopedic surgery; however, only 2% were women. When compared with the interns who were not interested in orthopedic surgery, a greater number of the interns interested in orthopedic surgery rated time with family and a procedure-intensive profession as important. Female students and interns were also interested in other surgical fields. The increasing majority of women among medical students will reshape the future of physician workforce by dictating changes in workforce participation, working conditions, and intercollegial relationships. Orthopedic surgery will need to adapt to these realities. Published by Elsevier Inc.

Orthopedic infections caused by obligatory anaerobic Gram-negative rods: report of two cases.

Science.gov (United States)

Kierzkowska, Marta; Pedzisz, Piotr; Babiak, Ireneusz; Janowicz, Jakub; Kulig, Mateusz; Majewska, Anna; Sawicka-Grzelak, Anna; Mlynarczyk, Grazyna

2017-10-01

Anaerobic bone and joint infections are uncommon, although the number of anaerobic infections is presumably underestimated because of difficulties with isolation and identification of obligate anaerobes. This study describes two cases of complicated Bacteroides fragilis peri-implant infection of the lumbar spine, infection of the hip and osteomyelitis. Bacteria were identified with the use of a mass spectrometer, VITEK MS system. Drug susceptibility was performed with the use of E-test. The EUCAST breakpoints were used for interpretation with B. fragilis ATCC 25285 as a control. In the two described cases clinical samples were collected for microbiological examination intraoperatively and simultaneously empirical treatment was applied. B. fragilis was isolated in monoculture or in a combination with other bacteria. The treatment was continued according to the susceptibility tests. In a case one clindamycin failure was observed and clindamycin resistance of the isolate was likely due to inadequate time of therapy. Difficulties in collecting an adequate samples and culturing anaerobic bacteria cause that not all infections are properly recognized. In a successful therapy, identification and determination of the susceptibility of the pathogen are essential as well as an appropriate surgical debridement.

Imaging of orthopedic sports injuries

International Nuclear Information System (INIS)

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

2007-01-01

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

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

Science.gov (United States)

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

2018-01-01

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

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

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Adelani, Muyibat A; O'Connor, Mary I

2017-08-01

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

Orthopedic injuries associated with backyard trampoline use in children.

Science.gov (United States)

Black, G Brian; Amadeo, Ryan

2003-06-01

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

Prosthetic hip joint infection due to Campylobacter fetus.

OpenAIRE

Bates, C J; Clarke, T C; Spencer, R C

1994-01-01

A case of postoperative prosthetic hip joint infection due to Campylobacter fetus subsp. fetus is described. Difficulties in isolation and antimicrobial susceptibility testing of this organism are discussed.

Strategies for achieving orthopedic service line success.

Science.gov (United States)

Lang, Stacey; Powers, Kristi

2013-12-01

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

First Case Report of a Late Onset Knee Periprosthetic Joint Infection Caused by Lactococcus garvieae

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V.-I. Neagoe

2016-01-01

Full Text Available Lactococcus garvieae is known as a Gram-positive, catalase-negative, and facultatively anaerobic fish pathogen. The association between Lactococcus spp. and human infectious diseases is described as being mainly associated with lumbar osteomyelitis, hepatic abscess, and infective endocarditis. In the literature of orthopedic post-prosthetic infections, L. garvieae was associated with a case of hip prosthetic infection in a fishmonger woman. We present the case of a 79-year-old male patient with multiple comorbidities, who is admitted to our center with a 5-day history of pain, swelling, and motility disorder of the right knee by the presence of a bicondylar knee replacement surgery, which was performed due to gonarthrosis 17 years ago. The radiographies of the right knee revealed no signs of displacement or loosening of the prothesis. After multiple radical debridements including VAC therapy and targeted antibiotic therapy we have managed to defeat the infection without exchange arthroplasty. Although we could not demonstrate the source of infection, we can only presume that in our case the source of infection was represented by the ingestion of possibly contaminated food. The patient had a habit of eating Nile perch fish (Lates niloticus every 4 weeks. We illustrated once more the possibility of a late onset L. garvieae related orthopedic periprosthetic joint infection by multiple comorbidities.

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

Science.gov (United States)

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

2016-01-01

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

Artificial intelligence for analyzing orthopedic trauma radiographs.

Science.gov (United States)

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

2017-12-01

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

The Quality of Cost-Utility Analyses in Orthopedic Trauma.

Science.gov (United States)

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

2015-08-01

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

Infection tracers: past, present and future; Radiotraceurs et recherche d'infection du systeme musculo-squelettique: passe, present et futur

Energy Technology Data Exchange (ETDEWEB)

Turpin MD, S. [Centre Hospitalier Universitaire, Hotel Dieu de Montreal, Dept. de Medecine Nucleaire, Quebec (Canada)

2006-06-15

Clinical and para-clinical findings are still the mainstay for the diagnosis of musculoskeletal infections, especially osteomyelitis. No single complementary imaging technique has 100% specificity and sensitivity for every case of musculoskeletal infection. Depending on the age of the patient, presence of orthopedic hardware, location of infection, underlying bone and systemic conditions, the choice of imaging modalities must be tailored to the patient's condition. Plain radiographs are performed first and may be sufficient. In children, bone scan is highly accurate to diagnose osteomyelitis. Labeled leukocytes with complementary bone or bone marrow studies are recommended for orthopedic hardware or diabetic foot. Finally, gallium scanning is useful for the diagnosis of vertebral osteomyelitis. Current radiopharmaceuticals used for diagnosing infection also label inflammation, which limits specificity. Newer products, as Infecton and {sup 18}F-FDG, are currently under investigation for the differentiation between infection and sterile inflammation. (author)

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

International Nuclear Information System (INIS)

Liu, Y.

2009-01-01

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

Surgical simulation training in orthopedics: current insights.

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

2018-01-01

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

[Influence of serious infections due to Gram-negative bacteria on the hospital economy].

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Martínez, B; Gómez, J; Gómez Vargas, J; Guerra, B; Ruiz Gómez, J; Simarro, E; Baños, V; Canteras, M; Valdes, M

2000-12-01

Nosocomial infections due to Gram-negative bacteria are very important since they are associated with high morbidity and high hospital costs. A prospective study of 250 inpatients was carried out, 200 of whom had Gram-negative bacterial infections. Patients were divided into groups of 50 according to the localization of the infection (urinary, surgical wound, respiratory tract and bacteremia), with a control group of 50 patients with similar characteristics but no infection. We calculated the cost for the different groups by multiplying the average length of hospital stay in days by the daily cost of the stay. Significant differences were observed in the average length of stay per patient according to the type of infection and how it was acquired. In terms of cost, nosocomial infection due to Gram-negative bacteria was 1,049,139 pesetas more expensive than community-acquired infection. The cost of the stay for patients with postsurgical infection due to Gram-negative bacteria was 1,108, 252 pesetas more expensive than for the group of control patients. Nosocomial infection due to Gram-negative bacteria is associated with a prolongation in hospital stay of 9 to 28 days, which is the factor that most reflects the cost that can be attributed to nosocomial infection. Consensual and protocolized measures which allow for better clinical management need to be developed.

Most common surgical mistakes with treatment of prosthetic joint infections

Directory of Open Access Journals (Sweden)

Boštjan Kocjančič

2014-08-01

Full Text Available The treatment of infections of orthopedic implants is often difficult and complex, although the chances of successful treatment with properly selected diagnostics, surgical and antibiotic treatment protocol have recently increased significantly. Surgical treatment is a key stone factor in the treatment of infections of orthopedic implants and any errors in it often lead to worse clinical outcomes. The most important and frequent surgical errors include: conservative treatment of periprothetic infections with antibiotics only, to-late surgical revision, insufficient debridement during surgical revision, inadequate intraoperative samples for bacteriological and histological analysis. It is important to have and to follow proper treatment algorithm for periprosthetic joint infection. In this work we present the listed surgical and most illustrative key errors.

Emotional intelligence in orthopedic surgery residents.

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Chan, Kevin; Petrisor, Brad; Bhandari, Mohit

2014-04-01

Emotional intelligence (EI) is the ability to understand and manage emotions in oneself and others. It was originally popularized in the business literature as a key attribute for success that was distinct from cognitive intelligence. Increasing focus is being placed on EI in medicine to improve clinical and academic performance. Despite the proposed benefits, to our knowledge, there have been no previous studies on the role of EI in orthopedic surgery. We evaluated baseline data on EI in a cohort of orthopedic surgery residents. We asked all orthopedic surgery residents at a single institution to complete an electronic version of the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). We used completed questionnaires to calculate total EI scores and 4 branch scores. Data were analyzed according to a priori cutoff values to determine the proportion of residents who were considered competent on the test. Data were also analyzed for possible associations with age, sex, race and level of training. Thirty-nine residents (100%) completed the MSCEIT. The mean total EI score was 86 (maximum score 145). Only 4 (10%) respondents demonstrated competence in EI. Junior residents (p = 0.026), Caucasian residents (p = 0.009) and those younger than 30 years (p = 0.008) had significantly higher EI scores. Our findings suggest that orthopedic residents score low on EI based on the MSCEIT. Optimizing resident competency in noncognitive skills may be enhanced by dedicated EI education, training and testing.

[Dermatomycoses due to pets and farm animals : neglected infections?].

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Nenoff, P; Handrick, W; Krüger, C; Vissiennon, T; Wichmann, K; Gräser, Y; Tchernev, G

2012-11-01

Dermatomycoses due to contact with pets and livestock frequently affect children and young adults. Zoophilic dermatophytes are the main important causative agents. It has long been known that the often high inflammatory dermatophytoses of the skin and the scalp are caused mostly by Microsporum canis. Due to an absence of an obligation for reporting fungal infections of the skin to the Public Health Office in Germany, an unnoticed but significant change in responsible pathogens has occurred. Today an increasing number of infections due to zoophilic strains of Trichophyton interdigitale (formerly Trichophyton mentagrophytes) and Trichophyton species of Arthroderma benhamiae are found. The latter mentioned dermatophyte is the anamorph species of the teleomorph Arthroderma benhamiae, which originally was isolated in the Far East (Japan). Source of infection of these dermatophytes are small rodents, in particular guinea pigs. These animals are bought in pet shops by the parents of those children who later are affected by the fungal infection. The coincidental purchase of the relevant fungal pathogen is not obvious to the parents. As a consequence, highly contagious dermatophytoses occur, often tinea capitis sometimes with kerion formation. Further dermatophytes should be considered as cause of a zoophilic dermatomycosis. Both Trichophyton verrucosum, the cause of the ringworm in cattle, and Trichophyton erinacei following contact to hedgehogs are worthy of note. Yeasts cannot be ignored as cause of dermatomycosis, especially Malassezia pachydermatis, the only non-lipophilic species within the genus Malassezia, which can be transferred from dog to men. Cryptococcus neoformans also comes from animal sources. The mucous yeast occurs in bird's dropping, and it causes both pulmonary and central nervous system infections, but also primary and secondary cutaneous cryptococcosis in immunocompromised patients (HIV/AIDS) as possible consequence after contact to these animals.

Awareness campaign. Orthopedic Hospital of Oklahoma launches awareness campaign.

Science.gov (United States)

2007-01-01

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

[Skin and Soft Tissue Infections Due to Corynebacterium ulcerans - Case Reports].

Science.gov (United States)

Jenssen, Christian; Schwede, Ilona; Neumann, Volker; Pietsch, Cristine; Handrick, Werner

2017-10-01

History and clinical findings  We report on three patients suffering from skin and soft tissue infections of the legs due to toxigenic Corynebacterium ulcerans strains. In all three patients, there was a predisposition due to chronic diseases. Three patients had domestic animals (cat, dog) in their households. Investigations and diagnosis  A mixed bacterial flora including Corynebacterium ulcerans was found in wound swab samples. Diphtheric toxin was produced by the Corynebacterium ulcerans strains in all three cases. Treatment and course  In all three patients, successful handling of the skin and soft tissue infections was possible by combining local treatment with antibiotics. Diphtheria antitoxin was not administered in any case. Conclusion  Based on a review of the recent literature pathogenesis, clinical symptoms and signs, diagnostics and therapy of skin and soft tissue infections due to Corynebacterium ulcerans are discussed. Corynebacterium ulcerans should be considered as a potential cause of severe skin and soft tissue infections. Occupational or domestic animal contacts should be evaluated. © Georg Thieme Verlag KG Stuttgart · New York.

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.

Femoral Prosthesis Infection by Rhodotorula mucilaginosa▿

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Savini, Vincenzo; Sozio, Federica; Catavitello, Chiara; Talia, Marzia; Manna, Assunta; Febbo, Fabio; Balbinot, Andrea; Di Bonaventura, Giovanni; Piccolomini, Raffaele; Parruti, Giustino; D'Antonio, Domenico

2008-01-01

This case report is a case history of a femoral prosthesis infection caused by Rhodotorula mucilaginosa in a human immunodeficiency virus patient. Though the pathogenicity of this organism for bone tissue has been previously reported, this is the first reported case of an orthopedic prosthesis infection by this species of the genus Rhodotorula. PMID:18753353

[Nosocomial infection due to Trichosporon asahii in a critical burned patient].

Science.gov (United States)

Tamayo Lomas, Luis; Domínguez-Gil González, Marta; Martín Luengo, Ana Isabel; Eiros Bouza, José María; Piqueras Pérez, José María

2015-01-01

Invasive fungal infection is an important cause of morbimortality in patients with severe burns. The advances in burn care therapy have considerably extended the survival of seriously burned patients, exposing them to infectious complications, notably fungal infections, with increased recognition of invasive infections caused by Candida species. However, some opportunistic fungi, like Trichosporon asahii, have emerged as important causes of nosocomial infection. A case of nosocomial infection due to T. asahii in a severely ill burned patient successfully treated with voriconazole is presented. The management of invasive fungal infections in burned patients, from diagnosis to selection of the therapeutic protocol, is often a challenge. Early diagnosis and treatment are associated with a better prognosis. In this case report, current treatment options are discussed, and a review of previously published cases is presented. Due to the difficulty in the diagnosis of invasive mycoses and their high associated mortality rates, it is advisable to keep a high degree of clinical suspicion of trichosporonosis in susceptible patients, including burned patients. The isolation of T. asahii in clinical specimens of this type of host must raise clinical alert, since it may precede an invasive infection. Copyright © 2014 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

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

Science.gov (United States)

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

2011-01-01

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

Orthopedic trauma surgery in the morbidly obese patient.

Science.gov (United States)

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

2014-05-01

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

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

Science.gov (United States)

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

2012-04-01

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

Publication Productivity of Early-Career Orthopedic Trauma Surgeons.

Science.gov (United States)

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

2016-01-01

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

Validity of subjective smoking status in orthopedic patients

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Bender D

2015-08-01

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

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

Science.gov (United States)

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

2018-02-01

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

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

International Nuclear Information System (INIS)

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

2017-01-01

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

Pseudotumor of the Hip due to Fungal Prosthetic Joint Infection

Directory of Open Access Journals (Sweden)

Stefano Artiaco

2013-01-01

Full Text Available Pseudotumors associated with total hip arthroplasty have been associated with metal-on-metal and metal-on-polyethylene total hip arthroplasties due to a granulomatous foreign-body reaction to methyl methacrylate, polyethylene, or metal ion release, but they have not been related to prosthetic joint infections. In this paper, we report an unusual case of Candida albicans total hip arthroplasty infection, causing a large inflammatory pseudotumor of the hip joint. Fungal periprosthetic joint infections are a rare clinical entity and difficult to diagnose, and a pseudotumor may be part of their clinical presentation. They should be suspected in immunodeficient host patients when clinical symptoms of prosthetic joint infections are observed.

Pneumonia due to Enterobacter cancerogenus infection.

Science.gov (United States)

Demir, Tülin; Baran, Gamze; Buyukguclu, Tuncay; Sezgin, Fikriye Milletli; Kaymaz, Haci

2014-11-01

Enterobacter cancerogenus (formerly known as CDC Enteric Group 19; synonym with Enterobacter taylorae) has rarely been associated with human infections, and little is known regarding the epidemiology and clinical significance of this organism. We describe a community-acquired pneumonia case in a 44-year-old female due to E. cancerogenus. Identification and antimicrobial susceptibility of the microorganism was performed by the automatized VITEK 2 Compact system (bioMerieux, France). The clinical case suggests that E. cancerogenus is a potentially pathogenic microorganism in determined circumstances; underlying diseases such as bronchial asthma, empiric antibiotic treatment, wounds, diagnostic, or therapeutic instruments.

Socioeconomic value of orthopedic devices: evidence and methodological challenges

Directory of Open Access Journals (Sweden)

Sorenson C

2012-10-01

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

Frequency of orthopedic diseases in horses: A retrospective study

Directory of Open Access Journals (Sweden)

Kovač Milomir

2002-01-01

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

Survey of 2582 Cases of Acute Orthopedic Trauma

Science.gov (United States)

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

2014-01-01

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

Studies on biodegradation of crosslinked hydroxy terminated-poly(proplyene fumarate) and formation of scaffold for orthopedic applications.

Science.gov (United States)

Shalumon, K T; Jayabalan, M

2009-12-01

Biodegradation of crosslinked-hydroxy terminated-poly(proplyene fumarate) (X-HTPPF) has been studied in simulated physiological media to assess the formation of porous scaffold structure for bone growth and remodeling in load bearing orthopedic applications. Variation in crosslink density and surface hydrophilicity of X-HTPPF are observed due to non-stoichiometric mass of reacting partners. These variations influence absorption of the medium and biodegradation during aging. Though the initial absorption of medium is relatively higher with the crosslinked polymer (PNVP1) having 63.6% HT-PPF and 36.4% comonomer n-vinyl pyrrolidone (NVP) during the initial period of aging, the weight loss due to subsequent degradation with time is relatively lesser. PNVP1 undergo slow degradation with formation of fibril structure on the surface. The present crosslinked material PNVP1 is a candidate for the load bearing orthopedic applications.

3D-printed patient-specific applications in orthopedics

OpenAIRE

Wong KC

2016-01-01

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

iPad apps for orthopedic surgeons.

Science.gov (United States)

Franko, Orrin I; Bhola, Siddharth

2011-12-01

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

Influence of podiatry on orthopedic surgery at a level I trauma center.

Science.gov (United States)

Jakoi, Andre M; Old, Andrew B; O'Neill, Craig A; Stein, Benjamin E; Stander, Eric P; Rosenblatt, Joseph; Herman, Martin J

2014-06-01

Level I trauma centers frequently see trauma at or below the ankle, which requires consultation with the orthopedic surgery department. However, as podiatry programs begin to firmly establish themselves in more Level I trauma centers, their consultations increase, ultimately taking those once seen by orthopedic surgery. A review of the literature demonstrates that this paradigm shift has yet to be discussed. The purpose of this study was to determine how many, if any, lower extremity fracture consultations a newly developed podiatry program would take from the orthopedic surgery department. A retrospective review was performed of emergency department records from January 2007 to December 2011. Seventeen different emergency department diagnoses were used to search the database. Ultimately, each patient's emergency department course was researched. Several trends were noted. First, if trauma surgery was involved, only the orthopedic surgery department was consulted for any injuries at or below the ankle. Second, the emergency department tended to consult the podiatry program only between the hours of 8 am and 6 pm. Third, as the podiatry program became more established, their number of consultations increased yearly, and, coincidentally, the orthopedic surgery department's consultations decreased. Finally, high-energy traumas involved only the orthopedic surgery department. Whether the orthopedic surgery department or podiatry program is consulted regarding trauma surgery is likely hospital dependent. Copyright 2014, SLACK Incorporated.

Metallic artifact in MRI after removal of orthopedic implants

International Nuclear Information System (INIS)

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

2012-01-01

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

Metallic artifact in MRI after removal of orthopedic implants.

Science.gov (United States)

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

2012-03-01

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

Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery?

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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.

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

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

2017-06-15

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

[Orthopedics and patients under national socialism dictatorship].

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Thomann, K D; Rauschmann, M

2001-10-01

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

Serious Leisure and People with Orthopedic Impairment: Benefits and Constraints

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Manolya AKSATAN

2017-12-01

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

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

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Tunçer Nejat

2017-01-01

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

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

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

2017-01-01

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

Molecular imaging promotes progress in orthopedic research.

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Mayer-Kuckuk, Philipp; Boskey, Adele L

2006-11-01

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

An advanced simulator for orthopedic surgical training.

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

2018-02-01

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

Pediatric mortality due to nosocomial infection: a critical approach

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Julia Marcia Maluf Lopes

Full Text Available Nosocomial infection is a frequent event with potentially lethal consequences. We reviewed the literature on the predictive factors for mortality related to nosocomial infection in pediatric medicine. Electronic searches in English, Spanish and Portuguese of the PubMed/MEDLINE, LILACS and Cochrane Collaboration Databases was performed, focusing on studies that had been published from 1996 to 2006. The key words were: nosocomial infection and mortality and pediatrics/neonate/ newborn/child/infant/adolescent. The risk factors found to be associated with mortality were: nosocomial infection itself, leukemia, lymphopenia, neutropenia, corticosteroid therapy, multiple organ failure, previous antimicrobial therapy, catheter use duration, candidemia, cancer, bacteremia, age over 60, invasive procedures, mechanical ventilation, transport out of the pediatric intensive care unit, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Burkholderia cepacia infections, acute physiology and chronic health evaluation (APACHE II scores over 15. Among these factors, the only one that can be minimized is inadequate antimicrobial treatment, which has proven to be an important contributor to hospital mortality in critically-ill patients. There is room for further prognosis research on this matter to determine local differences. Such research requires appropriate epidemiological design and statistical analysis so that pediatric death due to nosocomial infection can be reduced and health care quality improved in pediatric hospitals.

Detection and identification of microbes in prosthetic joint infections by culture and molecular methods

DEFF Research Database (Denmark)

Xu, Yijuan; Schønheyder, Henrik Carl; Ehrlich, Garth

, indicating biofilm formation. In conclusion, this study indicated that to improve the microbiological diagnosis of prosthetic joint infections molecular methods may be useful supplements to routine cultures, and the current intraoperative sampling strategy needs to be optimized.......Bacterial biofilms have been observed in many device-related infections including orthopedic implants. This mode of growth makes the infection difficult to treat and constitutes a challenge to current sampling procedures and culture practices to obtain a reliable diagnosis. The aim of the study...... uncovered many more species including known pathogens and species not previously reported in orthopedic infections, and polymicrobial communities were commonly observed. Additionally the molecular findings suggested the bacterial composition and yield varied depending on the position and type of samples...

Microbiology and management of joint and bone infections due to anaerobic bacteria.

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Brook, Itzhak

2008-03-01

To describes the microbiology, diagnosis, and management of septic arthritis and osteomyelitis due to anaerobic bacteria. The predominant anaerobes in arthritis are anaerobic Gram-negative bacilli (AGNB) including the Bacteroides fragilis group, Fusobacterium spp., Peptostreptococcus spp., and Propionibacterium acnes. Infection with P. acnes is associated with a prosthetic joint, previous surgery, and trauma. B. fragilis group is associated with distant infection, Clostridium spp. with trauma, and Fusobacterium spp. with oropharyngeal infection. Most cases of anaerobic arthritis, in contrast to anaerobic osteomyelitis, involved a single isolate, and most cases are secondary to hematogenous spread. The predominant anaerobes in osteomyelitis are Bacteroides, Peptostreptococcus, Fusobacterium, and Clostridium spp. as well as P. acnes. Conditions predisposing to bone infections are vascular disease, bites, contiguous infection, peripheral neuropathy, hematogenous spread, and trauma. Pigmented Prevotella and Porphyromonas spp. are mostly isolated in skull and bite infections, members of the B. fragilis group in hand and feet infections, and Fusobacterium spp. in skull, bite, and hematogenous long bone infections. Many patients with osteomyelitis due to anaerobic bacteria have evidence of an anaerobic infection elsewhere in the body that is the source of the organisms involved in the osteomyelitis. Treatment of arthritis and osteomyelitis involving anaerobic bacteria includes symptomatic therapy, immobilization in some cases, adequate drainage of purulent material, and antibiotic therapy effective against these organisms. Anaerobic bacteria can cause septic arthritis and osteomyelitis. Correct diagnosis and appropriate therapy are important contributor to successful outcome.

Current trends in local antibacterial therapy of periprosthetic infection and osteomyelitis

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S. A. Bozhkova

2015-01-01

Full Text Available The rational use of antibiotics in the treatment of orthopedic infection still presents a significant problem. Local antibiotic delivery systems enable to achieve effective concentrations of drugs in the focus of bone infection without the development of toxicity. It is the important accompaniment to systemic antibiotics in the treatment of periprosthetic infection and osteomyelitis. The data collected through the PubMed and eLIBRARY databases (http://www.ncbi.nlm. nih.gov/pubmed, 1995-2015; http://elibrary.ru, 2005-2015 years present the information about bone substitutes used for local antibiotic therapy in scientific investigations and in clinical practice. The information is submitted in accordance with the groups of materials: cements based on polymethylmethacrylate, bone grafts, demineralized bone matrix, bioceramics, natural and synthetic polymers, combined antibiotic delivery systems. The majority of these materials have only been studied experimentally and only a limited range of them is registered for use in clinical practice. Informing orthopedic surgeons about current methods of local antibiotic use is the key to the development of a modern integrated approach to the therapy of infectious complications after orthopedic surgery.

Evolving trauma and orthopedics training in the UK.

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

2013-01-01

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

Effectiveness of Thrombolytic Therapy in Acute Embolic Stroke due to Infective Endocarditis

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Siva P. Sontineni

2010-01-01

Full Text Available Objective. To identify the role of thrombolytic therapy in acute embolic stroke due to infective endocarditis. Design. Case report. Setting. University hospital. Patient. A 70-year-old male presented with acute onset aphasia and hemiparesis due to infective endocarditis. His head computerized tomographic scan revealed left parietal sulcal effacement. He was given intravenous tissue plasminogen activator with significant resolution of the neurologic deficits without complications. Main Outcome Measures. Physical examination, National Institute of Health Stroke Scale, radiologic examination results. Conclusions. Thrombolytic therapy in selected cases of stroke due to infective endocarditis manifesting as major neurologic deficits can be considered as an option after careful consideration of risks and benefits. The basis for such favorable response rests in the presence of fibrin as a major constituent of the vegetation. The risk of precipitating hemorrhage with thrombolytic therapy especially with large infarcts and mycotic aneurysms should be weighed against the benefits of averting a major neurologic deficit.

A rare case of urinary tract infection due to Trichosporonasahii in a ...

African Journals Online (AJOL)

Trichosporonasahii is a basidiomycete yeast responsible for white piedra and onychomycosis in the immunocompetent host. In the immunocompromised patients, invasive infections are reported; their diagnosis is difficult and they are associated with high mortality rate. Urinary infection due to Trichosporon Asahi is rare but ...

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

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

2014-10-01

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

A Study of Plazomicin Compared With Colistin in Patients With Infection Due to Carbapenem-Resistant Enterobacteriaceae (CRE)

Science.gov (United States)

2016-10-03

Bloodstream Infections (BSI) Due to CRE; Hospital-Acquired Bacterial Pneumonia (HABP) Due to CRE; Ventilator-Associated Bacterial Pneumonia (VABP) Due to CRE; Complicated Urinary Tract Infection (cUTI) Due to CRE; Acute Pyelonephritis (AP) Due to CRE

Prosthetic Hip Loosening Due to Brucellar Infection: Case Report and Literature Review

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Anis Tebourbi

2016-12-01

Full Text Available Context: Brucellosis is actually considered to be the commonest zoonotic infection worldwide; conversely prosthetic infection due to brucella is extremely rare. Although diagnostic is easily achieved, management of such situations is extremely challenging. Aims: To report the case of prosthetic hip loosening due to brucellar infection, discuss management manners and to summarize data about 19 cases reported in the literature. Methods: We report the case of a 73-year-old woman with brucellar prosthetic hip loosening treated with 2-stage exchange of the prosthesis and prolonged double antibiotherapy Results: At two years follow up the patient is pain free with total functional recovery and no clinical and radiographic signs of prosthetic loosening Conclusions: Brucella should be evocated as a cause of total joint arthroplasty infection especially in patients from endemic regions and with occupational exposure. Antibiotic treatment alone can be followed if there are no signs of implant loosening. Tow stage revision should be considered in other cases.

CT and MRI techniques for imaging around orthopedic hardware

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

2018-01-15

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

First described case of prosthetic joint infection with Clostridium disporicum.

Science.gov (United States)

McBride, Joseph A; Sterkel, Alana K; Rehrauer, William M; Smith, Jeannina A

2017-12-01

An orthopedic hardware infection with Clostridium disporicum is described. C. disporicum is a gram positive anaerobic bacillus which can contain two subterminal spores. C. disporicum had not previously been reported in musculoskeletal infections. Gram stains demonstrating gram positive bacilli with two subterminal spores should alert practitioners to the possibility of C. disporicum infection. Published by Elsevier Ltd.

Human infections due to Salmonella Blockley, a rare serotype in South Africa: a case report

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Gonose Thandubuhle

2012-10-01

Full Text Available Abstract Background Infections due to nontyphoidal Salmonella have increased worldwide over the last couple of decades. Salmonella enterica serotype Blockley (Salmonella Blockley infections is associated with chickens and is a rarely isolated serotype in human infections in most countries. Case presentation We report a case of human infections due to Salmonella Blockley in KwaZulu-Natal, South Africa in 2011. Three African males (aged 4, 14 and 16 presented to a clinic with diarrhoea, stomach cramps and headache. They started experiencing signs of illness a day after they consumed a common meal, consisting of meat, rice and potatoes. Stool specimens from the patients cultured Salmonella Blockley. The strains showed an indistinguishable pulsed-field gel electrophoresis pattern. Conclusion This is the first recorded case of human infections due to Salmonella Blockley in South Africa.

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

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Raquel Queiroz

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

Level of evidence gap in orthopedic research.

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

2012-09-01

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

Possible transmission of HIV Infection due to human bite

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Bandivdekar Atmaram H

2011-03-01

Full Text Available Abstract The potential risk of HIV-1 infection following human bite although epidemiologically insignificant, but it is biologically possible. There are anecdotal reports of HIV transmission by human bites particularly if saliva is mixed with blood. The oral tissues support HIV replication and may serve as a previously unrecognized HIV reservoir. The HIV infected individuals have more viruses in blood than saliva, possibly due to the potent HIV-inhibitory properties of saliva. The case presented here is of a primary HIV infections following a human bite where in the saliva was not blood stained but it got smeared on a raw nail bed of a recipient. The blood and saliva of the source and blood of the recipient showed a detectable viral load with 91% sequence homology of C2-V3 region of HIV gp120 between the two individuals. The recipient did not receive PEP [post exposure prophylaxis] as his family physician was unaware of salivary transmission. The family physician should have taken PEP decision after proper evaluation of the severe and bleeding bite. Hence it is necessary to treat the HIV infected human bites with post exposure prophylaxis.

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

Science.gov (United States)

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

2016-01-01

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

Patient Attitudes Toward Orthopedic Surgeon Ownership of Related Ancillary Businesses.

Science.gov (United States)

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

2016-08-01

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

A case of orbital apex syndrome due to Pseudomonas aeruginosa infection

Directory of Open Access Journals (Sweden)

Takeshi Kusunoki

2011-11-01

Full Text Available Orbital apex syndrome is commonly been thought to have a poor prognosis. Many cases of this syndrome have been reported to be caused by paranasal sinus mycosis. We encountered a very rare case (60-year-old woman of sinusitis with orbital apex syndrome due to Pseudomonas aeruginosa infection. She had received insulin and dialysis for diabtes and diabetic nephropathy, moreover anticoagulants after heart by-pass surgery. She underwent endoscopic sinus operation and was treated with antibiotics, but her loss of left vision did not improve. Recently, sinusitis cases due to Pseudomonas aeruginosa were reported to be a increasing. Therefore, we should consider the possibility of Pseudomonas aeruginosa as well as mycosis as infections of the sinus, especially inpatients who are immunocompromised body.

The diagnostic protocol for evaluation of periprosthetic joint infection

Directory of Open Access Journals (Sweden)

Alen Mlekuž

2015-06-01

Full Text Available Infection is becoming the most important as well as the most devastating mechanism of prosthetic joint failure. The incidence is increasing due to increased sensitivity of orthopedic surgeons for this diagnosis, better diagnostics, and  because the absolute number of operated patients is increasing and because more often very sick, debilitated, and immunocompromised patients are operated on. The trend shows the incidence to further increase in the years to come. The diagnosis may be very easy in case of high grade processes, but also extremely difficult in low grade infections. Misdiagnosing infection leads to repeat early failures and revisions that are distressing for patients as well as for surgeons. To avoid failures related to misdiagnosed prosthetic joint infections a step-wise algorithm of action is proposed and the diagnostic strength of the steps discussed. The key point is to select the potential candidates to define the possibility of an ongoing infection and then to select the tools to strengthen the suspicion. The further procedures base on the analysis of the pseudo-synovial fluid obtained by aspiration. The diagnostic conclusions form the basis for considered treatment decisions.

Febrile status epilepticus due to respiratory syncytial virus infection.

Science.gov (United States)

Uda, Kazuhiro; Kitazawa, Katsuhiko

2017-08-01

Febrile status epilepticus can have neurological sequelae. The type of sequelae, however, depend on the etiology, including infection due to viral agents such as the influenza virus. Respiratory syncytial virus (RSV) infection in childhood may also contribute to this. The aim of this study was therefore to characterize febrile status epilepticus associated with RSV infection, and to determine whether this type of infection is a risk factor for neurological sequelae in febrile status epilepticus. We reviewed the medical records of children aged ≤3 years with febrile status epilepticus who were admitted to a tertiary hospital between January 2007 and December 2011. The differences between the RSV-positive and RSV-negative groups were evaluated according to the demographic and clinical data. A total of 99 patients with febrile status epilepticus who had been tested for RSV infection were identified. Three patients in the RSV-positive group (n = 19) and four in the RSV-negative group (n = 80) presented with bronchiolitis. The incidence of intubation and anti-seizure drug treatment in the RSV-positive group was significantly higher than in the -negative group. While all of the patients in the RSV-negative group recovered completely, six patients in the RSV-positive group developed encephalopathy and profound neurological sequelae. In five of the six patients, diffusion-weighted magnetic resonance imaging showed subcortical white matter lesions. RSV infection in the absence of bronchiolitis can initially present as febrile status epilepticus and subsequently develop into acute encephalopathy with profound neurological sequelae. © 2017 Japan Pediatric Society.

Porous metal for orthopedics implants

OpenAIRE

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

2013-01-01

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

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

Science.gov (United States)

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

2010-09-01

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

Web-Based Patient Education in Orthopedics: Systematic Review

Science.gov (United States)

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

2018-01-01

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

Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery.

Science.gov (United States)

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

2010-04-01

Different guidelines exist regarding the prevention of venous thromboembolism (VTE) in orthopedic surgery. We aimed to compare (inter)national guidelines and analyse differences. MEDLINE, the Cochrane Library and the internet were searched for guidelines on the prevention of VTE in orthopedic surgery. From these, we constructed a table comparing the different antithrombotic regimens during different orthopedic surgical and plaster cast treatments. Eleven guidelines from nine different countries and one international guideline were included. Few guidelines advise on thrombosis prophylaxis after plaster cast immobilization, (prolonged) arthroscopic surgery and isolated lower extremity trauma. Different opinions exist on the sole use of aspirin and mechanical prophylaxis and on the use of vitamin K antagonists after major hip and knee surgery. Based on the same available literature, different guidelines recommend different thromboprophylactic regimens. Ideally, the grade of recommendation should be based on the same level of evidence world-wide. Whilst there is no agreement on the relevance of different endpoints (e.g. asymptomatic DVT), it is very difficult to reach a consensus. Thromboprophylaxis guidelines should be reviewed and updated on a regular basis, because the evidence is evolving rapidly.

Proximal spinal muscular atrophy: current orthopedic perspective

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Haaker G

2013-11-01

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

Readability of Orthopedic Trauma Patient Education Materials on the Internet.

Science.gov (United States)

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

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

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

Directory of Open Access Journals (Sweden)

Vijaya Prasad Kamavaram Ellore

2012-01-01

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

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

Science.gov (United States)

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

2016-01-01

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

Surgical site infections following instrumented stabilization of the spine

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Dapunt U

2017-09-01

Full Text Available Ulrike Dapunt,1 Caroline Bürkle,1 Frank Günther,2 Wojciech Pepke,1 Stefan Hemmer,1 Michael Akbar1 1Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, 2Department for Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University, Heidelberg, Germany Background: Implant-associated infections are still a feared complication in the field of orthopedics. Bacteria attach to the implant surface and form so-called biofilm colonies that are often difficult to diagnose and treat. Since the majority of studies focus on prosthetic joint infections (PJIs of the hip and knee, current treatment options (eg, antibiotic prophylaxis of implant-associated infections have mostly been adapted according to these results. Objective: The aim of this study was to evaluate patients with surgical site infections following instrumented stabilization of the spine with regard to detected bacteria species and the course of the disease. Patients and methods: We performed a retrospective single-center analysis of implant-associated infections of the spine from 2010 to 2014. A total of 138 patients were included in the study. The following parameters were evaluated: C-reactive protein serum concentration, microbiological evaluation of tissue samples, the time course of the disease, indication for instrumented stabilization of the spine, localization of the infection, and the number of revision surgeries required until cessation of symptoms. Results: Coagulase-negative Staphylococcus spp. were most commonly detected (n=69, 50%, followed by fecal bacteria (n=46, 33.3%. In 23.2% of cases, no bacteria were detected despite clinical suspicion of an infection. Most patients suffered from degenerative spine disorders (44.9%, followed by spinal fractures (23.9%, non-degenerative scoliosis (20.3%, and spinal tumors (10.1%. Surgical site infections occurred predominantly within 3

Complicated catheter-associated urinary tract infections due to Escherichia coli and Proteus mirabilis.

Science.gov (United States)

Jacobsen, S M; Stickler, D J; Mobley, H L T; Shirtliff, M E

2008-01-01

Catheter-associated urinary tract infections (CAUTIs) represent the most common type of nosocomial infection and are a major health concern due to the complications and frequent recurrence. These infections are often caused by Escherichia coli and Proteus mirabilis. Gram-negative bacterial species that cause CAUTIs express a number of virulence factors associated with adhesion, motility, biofilm formation, immunoavoidance, and nutrient acquisition as well as factors that cause damage to the host. These infections can be reduced by limiting catheter usage and ensuring that health care professionals correctly use closed-system Foley catheters. A number of novel approaches such as condom and suprapubic catheters, intermittent catheterization, new surfaces, catheters with antimicrobial agents, and probiotics have thus far met with limited success. While the diagnosis of symptomatic versus asymptomatic CAUTIs may be a contentious issue, it is generally agreed that once a catheterized patient is believed to have a symptomatic urinary tract infection, the catheter is removed if possible due to the high rate of relapse. Research focusing on the pathogenesis of CAUTIs will lead to a better understanding of the disease process and will subsequently lead to the development of new diagnosis, prevention, and treatment options.

A complication of meningitis and infective endocarditis due to Streptococcus pyogenes.

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Inoue, Kosuke; Hagiwara, Akiyoshi; Kimura, Akio; Ohmagari, Norio

2017-07-26

We described a rare case of meningitis and infective endocarditis (IE) due to Streptococcus pyogenes. An 80-year-old woman was admitted to our hospital with unconsciousness. Glasgow Coma Scale was E1V3M5. We diagnosed her with acute meningitis due to S. pyogenes and started treatment using ceftriaxone. In spite of the improvement of her unconscious state, she developed a new-onset systolic murmur on day 13, and echocardiography revealed severe mitral valve regurgitation with vegetation. Therefore, we also diagnosed her with IE and continued the antibiotics for 6 weeks after we confirmed the negative blood cultures. The patient was finally transferred to another hospital for rehabilitation 57 days after admission. Considering that the number of S. pyogenes infections has been reported to increase in Japan and worldwide, we need to be more careful about the rare complication of meningitis and IE due to S. pyogenes . © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

Science.gov (United States)

Salam, Asma Abdus; Afshan, Gauhar

2016-01-01

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

Scattering of the radiofrequency electromagnetic field by orthopedic bone support frame implants

International Nuclear Information System (INIS)

Mohsin, S.A.; Sheikh, N.M.

2009-01-01

The interaction of the fields in MRI (Magnetic Resonance Imaging) with orthopedic implants is investigated. The primary interaction is the scattering of the MRI RF (Radiofrequency) field by the implants. As a specific case study, the scattel-cd field due to a bone support frame implant is computed by the finite-element-method. The support frame has steel pins of significant length embedded in tissue. The induced surface current distributions on the steel pins and the spatial electric field distributions in the surrounding tissue have been obtained. (author)

Neonatal maxillary orthopedics: past to present

NARCIS (Netherlands)

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

2013-01-01

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

Capnocytophaga canimorsus - An underestimated cause of periprosthetic joint infection?

Science.gov (United States)

Orth, Marcel; Orth, Patrick; Anagnostakos, Konstantinos

2017-08-01

Periprosthetic joint infection (PJI) is a major clinical problem in orthopedic surgery. Capnocytophaga canimorsus (C. canimorsus) is an unusual and hardly detectable bacterium. A review of the literature indicates that C. canimorsus affects mainly immunocompromised patients. It has not been reported to cause periprosthetic joint infections in immunocompetent patients so far. This case report aims to raise awareness of C. canimorsus in orthopedic surgery with special regard to joint arthroplasty. We report a case of a 54-year-old immunocompetent patient with a late infection after total knee arthroplasty caused by C. canimorsus. The patient underwent two-stage revision with prosthesis explantation, implantation of an antibiotic-impregnated static spacer, intravenous antimicrobial therapy for four weeks with cefuroxime followed by oral antimicrobial therapy with ciprofloxacin for further two weeks and secondary revision total knee arthroplasty. In the present case, we could demonstrate that adequate treatment of C. canimorsus was capable to successfully treat periprosthetic joint infection caused by C. canimorsus in an immunocompetent patient. We feel that C. canimorsus has to be taken into account as a potential pathogen causing periprosthetic joint infection - regardless of the immunological status of the patient and especially when the detection of a pathogen does not succeed. Copyright © 2017 Elsevier B.V. All rights reserved.

Web-Based Patient Education in Orthopedics: Systematic Review.

Science.gov (United States)

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

2018-04-23

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

High energy devices versus low energy devices in orthopedics treatment modalities

Science.gov (United States)

Schultheiss, Reiner

2003-10-01

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

An initially unidentified case of urinary tract infection due to Aerococcus urinae.

Science.gov (United States)

Meletis, Georgios; Chatzidimitriou, Dimitrios; Tsingerlioti, Fani; Chatzopoulou, Fani; Tzimagiorgis, Georgios

2017-07-01

Aerococcus urinae is a microorganism responsible for urinary tract and blood stream infections which are rarely reported in clinical practice. However, it has been proposed that the infrequency of such reports may be partially due to difficulties related to pathogen identification. We present here a case of an elderly male patient with urinary tract infection where A. urinae was initially not identified by a private microbiology laboratory. Our report highlights the need to consider A. urinae as a causative agent of urinary tract infections because if not identified and properly treated it may lead to endocarditis or septicemia.

How to manage RI venography in pre-orthopedic surgery patients

International Nuclear Information System (INIS)

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

2010-01-01

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

Addison's disease due to Histoplasma duboisii infection of the adrenal glands

International Nuclear Information System (INIS)

Mudawi, Hatim M.; Baraka, Omer Z.; El-Hassan, Ahmed M.; El-Amin, Elwaleed M.

2008-01-01

Histoplasmosis is a fungal infection caused by Histoplasma capsulatum. In the normal individual, both disseminated histoplasmosis and symptomatic adrenal histoplasmosis are rare. Herein, we describe the case of a 50-year-old gentleman residing in western Sudan who presented with 7-month history of generalized body weakness, easy fatigue and frequent attacks of vomiting and diarrhea. Physical examination and laboratory investigations confirmed the diagnosis of Addison's disease due to histoplasma capsulatum var duboisii infection of the adrenal glands. He was treated with intravenous hydrocortisone, followed by oral prednisolone and itraconazole. (author)

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

Science.gov (United States)

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

1983-11-01

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

Clostridium Difficile Infection Due to Pneumonia Treatment: Mortality Risk Models.

Science.gov (United States)

Chmielewska, M; Zycinska, K; Lenartowicz, B; Hadzik-Błaszczyk, M; Cieplak, M; Kur, Z; Wardyn, K A

2017-01-01

One of the most common gastrointestinal infection after the antibiotic treatment of community or nosocomial pneumonia is caused by the anaerobic spore Clostridium difficile (C. difficile). The aim of this study was to retrospectively assess mortality due to C. difficile infection (CDI) in patients treated for pneumonia. We identified 94 cases of post-pneumonia CDI out of the 217 patients with CDI. The mortality issue was addressed by creating a mortality risk models using logistic regression and multivariate fractional polynomial analysis. The patients' demographics, clinical features, and laboratory results were taken into consideration. To estimate the influence of the preceding respiratory infection, a pneumonia severity scale was included in the analysis. The analysis showed two statistically significant and clinically relevant mortality models. The model with the highest prognostic strength entailed age, leukocyte count, serum creatinine and urea concentration, hematocrit, coexisting neoplasia or chronic obstructive pulmonary disease. In conclusion, we report on two prognostic models, based on clinically relevant factors, which can be of help in predicting mortality risk in C. difficile infection, secondary to the antibiotic treatment of pneumonia. These models could be useful in preventive tailoring of individual therapy.

Dermatophytosis due to Microsporum nanum infection in a canine

Directory of Open Access Journals (Sweden)

Marilia Avila Valandro

2017-03-01

Full Text Available Miscrosporum nanum is a dermatophyte found in swine that causes non-pruritic lesions with desquamation, alopecia, and circular characteristics. M. nanum infection in dogs is rare and poorly understood in terms of its epidemiological and clinical features, and its therapeutic response. The present report describes a case of dermatophytosis due to M. nanum in a Dogo Argentino breed of dog that was used for wild boar hunting. The dermatophytosis presented with hypotrichosis, erythema, and non-pruritic desquamation in the back of the neck and chest area. The dermatophytosis was responsive to systemic treatment with itraconazole and topical (miconazole 2% for 60 days. Thus, we conclude that the practice of hunting wild boar should be considered as a possible source of infection of M. nanum in the reported dog. The M. nanum infection showed clinical features that were similar to the lesions observed in swine, except for the absence of the circular pattern, and showed a good clinical response to the therapy. Finally, M. nanum should be considered as an etiologic agent of dermatophytosis in dogs that in some manner have had direct contact with domestic or wild swine.

Infective endocarditis case due to streptococcus parasanguinis presented with spondylodiscitis

Directory of Open Access Journals (Sweden)

ismail Necati Hakyemez

2016-09-01

Full Text Available Streptococcus parasanguinis is a natural member of oral flora. It is an opportunistic pathogen, and rarely cause systemic infections due to it's low virulence. Subacute infective endocarditis may present with various clinical manifestations (eg., spondylodiscitis. A sixty-five years old male patient from Northern Iraq has referred to our emergency service with high fever, weight loss, back pain and inability to walk. The patient was a veterinarian. He was operated three years ago for colonic carcinoma and irradiated. In magnetic resonance imaging, spondylodiscitis was detected localized in lumbar 1-2 region. Transthorasic echocardiography demonstrated aortic valve vegetation. S. parasanguinis was identified in the blood cultures. In conclusion; all in all, it's remarkable to isolate S. parasanguinis as a causal agent of infective endocarditis in a patient who is a veterinarian with history of colonic carcinoma presented with clinical manifestation of spondylodiscitis. [Cukurova Med J 2016; 41(3.000: 591-594

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

International Nuclear Information System (INIS)

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

1991-01-01

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

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

Science.gov (United States)

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

2015-11-01

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

Surgical Site Infection among Patients Undergone Orthopaedic ...

African Journals Online (AJOL)

ADMIN

with surgical site infection at Muhimbili Orthopedic Institute. ... Determination of the relationship between outcome and exposure variables ... determined by more than 2 hours length of surgical procedure (AOR= 1.4; 95%CI 1.14-6.69; ... hospital, those with metastatic fractures, back, spine were not included as they fall under.

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

Science.gov (United States)

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

2013-01-01

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

Neutropenia associated with osteomyelitis due to Hepatozoon canis infection in a dog.

Science.gov (United States)

Shimokawa Miyama, Takako; Umeki, Saori; Baba, Kenji; Sada, Kumiko; Hiraoka, Hiroko; Endo, Yasuyuki; Inokuma, Hisashi; Hisasue, Masaharu; Okuda, Masaru; Mizuno, Takuya

2011-10-01

A 4-year-old, intact male Shiba dog was referred to Yamaguchi University Animal Medical Center, Yamaguchi, Japan, for the following complaints: anorexia, lethargy, intermittent fever, gingival bleeding and abdominal purpura. The dog presented with persistent neutropenia. Histopathological examination of a bone marrow sample revealed round to oval structures that resembled Hepatozoon micromerozoites and formed a "wheel-spoke" pattern. Furthermore, mature neutrophils were observed around these structures. PCR and sequencing using bone marrow aspirate confirmed Hepatozoon canis (H. canis) infection. These findings suggest that the neutropenia observed in this case was associated with osteomyelitis due to H. canis infection. This is the first report of neutropenia associated with H. canis infection. H. canis infection can be included in the differential diagnosis in canine cases of neutropenia in areas where the disease is endemic.

Wound infection caused by Lichtheimia ramosa due to a car accident

NARCIS (Netherlands)

Bibashi, Evangelia; de Hoog, G Sybren; Pavlidis, Theodoros E; Symeonidis, Nikolaos; Sakantamis, Athanasios; Walther, Grit

2012-01-01

A 32-year-old immunocompetent man sustained severe traumas contaminated with organic material due to a car accident. An infection caused by Lichtheimia ramosa at the site of contamination was early diagnosed and cured by multiple surgical debridement and daily cleansing with antiseptic solution

Wound infection caused by Lichtheimia ramosa due to a car accident

NARCIS (Netherlands)

Bibashi, E.; de Hoog, G.S.; Pavlidis, T.E.; Symeonidis, N.; Sakantamis, A.; Walther, G.

2013-01-01

A 32-year-old immunocompetent man sustained severe traumas contaminated with organic material due to a car accident. An infection caused by Lichtheimia ramosa at the site of contamination was early diagnosed and cured by multiple surgical debridement and daily cleansing with antiseptic solution

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

Science.gov (United States)

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

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

Prosthetic Joint Infection due to Mycobacterium bovis after Intravesical Instillation of Bacillus Calmette-Guerin (BCG

Directory of Open Access Journals (Sweden)

Eric Gomez

2009-01-01

Full Text Available Intravesical instillation of Bacillus Calmette-Guerin (BCG is a treatment to prevent recurrence of superficial urothelial bladder carcinoma. Complications after bladder instillation of BCG have been reported including locally invasive and systemic infections due to dissemination of Mycobacterium bovis from the bladder. We present an uncommon case and literature review of prosthetic joint infection due to M. bovis after intravesical BCG treatment of bladder cancer.

Dermatophytosis due to Microsporum nanum infection in a canine

OpenAIRE

Marilia Avila Valandro; João Paulo da Exaltação Pascon; Maria Lígia de Arruda Mistieri; Irina Lubeck

2017-01-01

Miscrosporum nanum is a dermatophyte found in swine that causes non-pruritic lesions with desquamation, alopecia, and circular characteristics. M. nanum infection in dogs is rare and poorly understood in terms of its epidemiological and clinical features, and its therapeutic response. The present report describes a case of dermatophytosis due to M. nanum in a Dogo Argentino breed of dog that was used for wild boar hunting. The dermatophytosis presented with hypotrichosis, erythema, and non-pr...

Biomaterials with Antibacterial and Osteoinductive Properties to Repair Infected Bone Defects

OpenAIRE

Lu, Haiping; Liu, Yi; Guo, Jing; Wu, Huiling; Wang, Jingxiao; Wu, Gang

2016-01-01

The repair of infected bone defects is still challenging in the fields of orthopedics, oral implantology and maxillofacial surgery. In these cases, the self-healing capacity of bone tissue can be significantly compromised by the large size of bone defects and the potential/active bacterial activity. Infected bone defects are conventionally treated by a systemic/local administration of antibiotics to control infection and a subsequent implantation of bone grafts, such as autografts and allogra...

[Infections after bite wounds : For example rat bite fever due to Streptobacillus moniliformis].

Science.gov (United States)

Hof, Herbert; Binder, Rudolf; Schäfer, Christian; Stuber, Madeleine; Licht, Andreas; Bozenhardt-Stavrakidis, Iris; Bode, Konrad

2018-04-11

Rat bite fever due to Streptobacillus moniliformis induces typical but not pathognomonic clinical signs, such as local purulent wound infection followed by maculopapular exanthema, myalgia as well as purulent joint infections. Severe complications, such as osteomyelitis and endocarditis are possible. it seems that this infection is rarely diagnosed but this infection could be much more common because the final diagnostic proof is difficult to achieve. Firstly, the culture of these bacteria is critical because the bacteria are fastidious and secondly the exact differentiation of the isolates is hardly possible by standard laboratory methods. Modern techniques such as mass spectroscopy (MALDI-TOF) and molecular biology allow a precise clarification. Surgical cleansing of infection sites in combination with a rational antibiotic therapy, for example with beta-lactam antibiotics, are generally able to cure the infection if treatment is started early enough. In addition, vaccinations, for example against tetanus and rabies have to be considered in this situation as for all other bite wound infections.

Next Generation Tissue Engineering of Orthopedic Soft Tissue-to-Bone Interfaces

Science.gov (United States)

Boys, Alexander J.; McCorry, Mary Clare; Rodeo, Scott; Bonassar, Lawrence J.; Estroff, Lara A.

2017-01-01

Soft tissue-to-bone interfaces are complex structures that consist of gradients of extracellular matrix materials, cell phenotypes, and biochemical signals. These interfaces, called entheses for ligaments, tendons, and the meniscus, are crucial to joint function, transferring mechanical loads and stabilizing orthopedic joints. When injuries occur to connected soft tissue, the enthesis must be re-established to restore function, but due to structural complexity, repair has proven challenging. Tissue engineering offers a promising solution for regenerating these tissues. This prospective review discusses methodologies for tissue engineering the enthesis, outlined in three key design inputs: materials processing methods, cellular contributions, and biochemical factors. PMID:29333332

Applications of Metal Additive Manufacturing in Veterinary Orthopedic Surgery

Science.gov (United States)

Harrysson, Ola L. A.; Marcellin-Little, Denis J.; Horn, Timothy J.

2015-03-01

Veterinary medicine has undergone a rapid increase in specialization over the last three decades. Veterinarians now routinely perform joint replacement, neurosurgery, limb-sparing surgery, interventional radiology, radiation therapy, and other complex medical procedures. Many procedures involve advanced imaging and surgical planning. Evidence-based medicine has also become part of the modus operandi of veterinary clinicians. Modeling and additive manufacturing can provide individualized or customized therapeutic solutions to support the management of companion animals with complex medical problems. The use of metal additive manufacturing is increasing in veterinary orthopedic surgery. This review describes and discusses current and potential applications of metal additive manufacturing in veterinary orthopedic surgery.

Medical Crowdfunding for Patients Undergoing Orthopedic Surgery.

Science.gov (United States)

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

2018-01-01

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

Postoperative constipation risk assessment in Turkish orthopedic patients.

Science.gov (United States)

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

2012-01-01

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

Use of Google Scholar public profiles in orthopedics.

Science.gov (United States)

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

2017-01-01

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

Community-acquired pneumonia due to Staphylococcus cohnii in an HIV-infected patient: case report and review.

Science.gov (United States)

Mastroianni, A; Coronado, O; Nanetti, A; Manfredi, R; Chiodo, F

1995-10-01

Coagulase-negative staphylococci recently have been implicated as a cause of serious infections in immunocompromised individuals. An unusual case of community-acquired pneumonia due to Staphylococcus cohnii in an HIV-infected drug user is described. Results of a study conducted to examine the prevalence of infection due to Staphylococcus cohnii strains and their antibiotic-sensitivity patterns show a low frequency but a high morbidity. These results and a brief review of the literature emphasize the importance of these organisms and other staphylococcal species as emerging opportunistic pathogens in patients with AIDS.

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

Science.gov (United States)

Sigmon, Scott B.

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

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

Science.gov (United States)

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

Prevalence of HIV infection among the patients with an avascular ...

African Journals Online (AJOL)

Objective: To study the prevalence of HIV infection among the risk factors associated with the avascular necrosis of the femoral head in Ouagadougou, Burkina Faso. Design: Multicenter retrospective study. Setting: Rheumatology consultations and Orthopedic-Traumatology Surgery Department Of The University Hospital ...

A Survey on Transfusion Status in Orthopedic Surgery at a Trauma Center

OpenAIRE

Soleimanha, Mehran; Haghighi, Mohammad; Mirbolook, Ahmadreza; Sedighinejad, Abbas; Mardani-Kivi, Mohsen; Naderi-Nabi, Bahram; Chavoshi, Tahereh; Mehrnoosh, Mehrnoosh Ghandili

2016-01-01

Background: Increased costs and mortality associated with inappropriate blood transfusions have led to investigations about blood request and blood transfusion techniques. We investigated the transfusion status in patients who underwent orthopedic surgery in Poursina Hospital (Rasht, Iran) to optimizing blood usage and determine if a scheduled transfusion program for every orthopedic surgery could improve blood transfusion management. Method: In this descriptive-prospective study, all orthop...

Robotics in Orthopedics: A Brave New World.

Science.gov (United States)

Parsley, Brian S

2018-02-16

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

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

Science.gov (United States)

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

2015-01-01

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

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

Science.gov (United States)

Kalraiya, Ashish; Buddhdev, Pranai

2015-03-03

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

Relationship of microstructure to fracture topography in orthopedic alloys

International Nuclear Information System (INIS)

Gilbertson, L.N.

1976-01-01

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

Bacterial infections associated with allogenic bone transplantation

Directory of Open Access Journals (Sweden)

Stepanović Željko Lj.

2015-01-01

Full Text Available Background/Aim. Bone allografts are frequently used in orthopedic reconstructive procedures carrying a high risk for recipients. To assess the nature and frequency of allograft contamination and associated surgical infection the case records from our institutional bone bank were reviewed. Methods. We retrospectively analyzed the microbiology of discarded bone allografts and the surgical site of the recipients. A case series of patients who acquired surgical site infection after allogenic bone transplantation was presented. Swab culturing was conducted on 309 femoral heads from living donors who underwent partial and total hip arthroplasty between January 2007 and December 2013. To prevent potential bone allograft contamination we used saline solution of 2.0 mg/ml of amikacin during thawing. The overall infection rate was analyzed in 197 recipients. Results. Of the 309 donated femoral heads, 37 were discarded due to bacterial contamination, giving the overall contamination rate of 11.97%. The postoperative survey of 213 bone allotransplantations among 197 recipients showed the infection rate of 2.03%. The coagulase-negative Staphylococcus was the most commonly identified contaminant of bone allografts and recipient surgical sites. Conclusion. The allograft contamination rate and the infection rate among recipients in our institution are in accordance with the international standards. The coagulase-negative Staphylococcus was the most commonly identified contaminant of bone allografts and recipient surgical sites. There is no strong evidence that surgical site infections were associated with bone allograft utilization. We plan further improvements in allograft handling and decontamination with highly concentrated antibiotic solutions in order to reduce infection risk for recipients.

Cavitary mass lesion and recurrent pneumothoraces due to Paragonimus kellicotti infection: North American paragonimiasis.

Science.gov (United States)

Castilla, Elias A; Jessen, Robert; Sheck, David N; Procop, Gary W

2003-08-01

North American paragonimiasis is well described in omnivorous and carnivorous animals on this continent. Humans are rarely infected, largely because of dietary customs, but are at risk for infection if raw or undercooked crayfish are consumed. We describe a patient with a pleuropulmonary infection due to Paragonimus kellicotti that presented as recurrent pneumothoraces and a cavitary lesion. This is the first case of North American paragonimiasis in which the diagnosis was based on the morphology of the eggs present in histologic sections.

Nursing documentation and length of stay in orthopedic surgery

NARCIS (Netherlands)

Paans, Wolter; Krijnen, Wim

2016-01-01

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

Questionable Word Choice in Scientific Writing in Orthopedic Surgery

Directory of Open Access Journals (Sweden)

Casey M. O`Connor

2017-07-01

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

Distinct features of trampoline-related orthopedic injuries in children aged under 6 years.

Science.gov (United States)

Choi, Eun Seok; Hong, Jin Heon; Sim, Jae Ang

2018-02-01

Concern has been growing about trampoline-related injuries among young children. Several published policy statements have repeatedly recommended that children younger than 6 years should not use trampolines. However, few studies have investigated the injuries caused by trampoline-related accidents among young children. This study aimed to identify the distinct features of trampoline-related orthopedic injuries in children younger than 6 years. We retrospectively reviewed the medical records of pediatric patients aged between 0 and 16 years who visited our regional emergency center due to trampoline-related orthopedic injuries between 2012 and 2015. Patients were divided into two groups: a preschool group (younger than 6 years) and a school group (older than 6 years). We compared the features of the injuries in the two groups. Among 208 patients, 108 (52%) were male and 100 (48%) were female. The mean age was 5.4 years. The preschool group accounted for 66%. There were no seasonal variations. Fractures were sustained in 96 patients (46%). The anatomical locations of injuries differed significantly between the two age groups. Proximal tibia fractures were more frequent in the preschool group than the school group (34% and 6%, respectively). Distal tibia fractures were more prevalent in the school group than the preschool group (44% vs. 13%, respectively). Surgical treatment was needed more frequently in the school group (p = 0.035, hazard ratio 2.52, 95% confidence interval: 1.03-6.17). Most of the injuries (82%) occurred at trampoline parks. The anatomical locations of trampoline-related orthopedic injuries differed significantly between age groups. Fractures were more common around the knee in younger children and the ankle in older children. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Phong Tran

2008-10-01

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

Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery

NARCIS (Netherlands)

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

2010-01-01

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

Fatal respiratory distress syndrome due to coronavirus infection in a child with severe combined immunodeficiency

OpenAIRE

Szczawinska‐Poplonyk, Aleksandra; Jonczyk‐Potoczna, Katarzyna; Breborowicz, Anna; Bartkowska‐Sniatkowska, Alicja; Figlerowicz, Magdalena

2012-01-01

Please cite this paper as: Szczawinska‐Poplonyk et al. (2012) Fatal respiratory distress syndrome due to coronavirus infection in a child with severe combined immunodeficiency. Influenza and Other Respiratory Viruses DOI: 10.1111/irv.12059. Coronaviruses have been demonstrated to contribute substantially to respiratory tract infections among the child population. Though infected children commonly present mild upper airway symptoms, in high‐risk patients with underlying conditions, particularl...

Hand Hygiene Program Decreases School Absenteeism Due to Upper Respiratory Infections

Science.gov (United States)

Azor-Martinez, Ernestina; Cobos-Carrascosa, Elena; Seijas-Vazquez, Maria Luisa; Fernández-Sánchez, Carmen; Strizzi, Jenna M.; Torres-Alegre, Pilar; Santisteban-Martínez, Joaquin; Gimenez-Sanchez, Francisco

2016-01-01

Background: We assessed the effectiveness of a handwashing program using hand sanitizer to prevent school absenteeism due to upper respiratory infections (URIs). Methods: This was a randomized, controlled, and open study on a sample of 1341 children 4-12 years old, attending 5 state schools in Almería (Spain), with an 8-month follow-up. The…

Infective endocarditis due to Enterobacter cloacae resistant to third- and fourth-generation cephalosporins.

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Yoshino, Yusuke; Okugawa, Shu; Kimura, Satoshi; Makita, Eiko; Seo, Kazunori; Koga, Ichiro; Matsunaga, Naohisa; Kitazawa, Takatoshi; Ota, Yasuo

2015-04-01

We report the case of using a long-term combination of meropenem and amikacin to treat infective endocarditis caused by Enterobacter cloacae resistant to third- and fourth-generation cephalosporins. Multi-drug resistant Gram-negative bacilli, such as the E. cloacae in our study, may become possible pathogens of infective endocarditis. Our experience with this case indicates that long-term use of a combination of β-lactam and aminoglycosides might represent a suitable management option for future infective endocarditis cases due to non-Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella spp. (HACEK group) Gram-negative bacilli such as ours. Copyright © 2012. Published by Elsevier B.V.

Web-based patient education in orthopedics : Systematic review

NARCIS (Netherlands)

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

2018-01-01

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

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

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

2014-06-01

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

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

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

1984-07-01

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

[Mixed invasive fungal infection due to Rhizomucor pusillus and Aspergillus niger in an immunocompetent patient].

Science.gov (United States)

Pozo-Laderas, Juan Carlos; Pontes-Moreno, Antonio; Robles-Arista, Juan Carlos; Bautista-Rodriguez, M Dolores; Candau-Alvarez, Alberto; Caro-Cuenca, Maria Teresa; Linares-Sicilia, María José

2015-01-01

Mucormycosis infections are rare in immunocompetent patients, and very few cases of mucormycosis associated with aspergillosis in non-haematological patients have been reported. A 17-year-old male, immunocompetent and without any previously known risk factors, was admitted to hospital due to a seizure episode 11 days after a motorcycle accident. He had a complicated clinical course as he had a mixed invasive fungal infection with pulmonary involvement due to Aspergillus niger and disseminated mucormycosis due to Rhizomucor pusillus (histopathological and microbiological diagnosis in several non-contiguous sites). He was treated with liposomal amphotericin B for 7 weeks (total cumulative dose >10 g) and required several surgical operations. The patient survived and was discharged from ICU after 5 months and multiple complications. Treatment with liposomal amphotericin B and aggressive surgical management achieved the eradication of a mixed invasive fungal infection. However, we emphasise the need to maintain a higher level of clinical suspicion and to perform microbiological techniques for early diagnosis of invasive fungal infections in non-immunocompromised patients, in order to prevent spread of the disease and the poor prognosis associated with it. Copyright © 2013 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

Bacterial adherence to tantalum versus commonly used orthopedic metallic implant materials.

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Schildhauer, Thomas A; Robie, Bruce; Muhr, Gert; Köller, Manfred

2006-07-01

clinical implant infection, tantalum may offer benefits as an adjunct or alternative material compared with current materials commonly used for orthopedic implants.

Evaluation of Patient Radiation Dose during Orthopedic Surgery

International Nuclear Information System (INIS)

Osman, H; Elzaki, A.; Sam, A.K.; Sulieman, A.

2013-01-01

The number of orthopedic procedures requiring the use of the fluoroscopic guidance has increased over the recent years. Consequently the patient exposed to un avoidable radiation doses. The aim of the current study was to evaluate patient radiation dose during these procedures.37 patients under went dynamic hip screw (DHS) and dynamic cannulated screw (DCS) were evaluated using calibrated Thermolumincent Dosimeters (TLDs), under carm fluoroscopic machines ,in three centers in Khartoum-Sudan. The mean Entrance Skin Dose (ESD) was 7.9 m Gy per procedure. The bone marrow and gonad organ exposed to significant doses. No correlation was found between ESD and Body Mass Index (BMI), or patient weight. Well correlation was found between kilo voltage applied and ESD. Orthopedic surgeries delivered lower radiation dose to patients than cardiac catheterization or hysterosalpingraphy (HSG) procedures. More study should be implemented to follow radiation dose before surgery and after surgery

Preparation Methods for Improving PEEK’s Bioactivity for Orthopedic and Dental Application: A Review

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Davood Almasi

2016-01-01

Full Text Available There is an increased interest in the use of polyether ether ketone (PEEK for orthopedic and dental implant applications due to its elastic modulus close to that of bone, biocompatibility, and its radiolucent properties. However, PEEK is still categorized as bioinert due to its low integration with surrounding tissues. Many studies have reported on methods to increase the bioactivity of PEEK, but there is still one-preparation method for preparing bioactive PEEK implant where the produced implant with desirable mechanical and bioactivity properties is required. The aim of this review is to present the progress of the preparation methods for improvement of the bioactivity of PEEK and to discuss the strengths and weaknesses of the existing methods.

Exit Site Infection due to Mycobacterium chelonae in an Elderly Patient on Peritoneal Dialysis

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Arata Hibi

2018-01-01

Full Text Available Nontuberculous mycobacteria (NTM are rarely isolated from peritoneal dialysis (PD-associated catheter infections. However, NTM infection is usually difficult to treat and leads to catheter loss. Prompt diagnosis is essential for appropriate treatment. A 70-year-old Japanese man who had been on PD for 2 years and with a medical history of 2 episodes of exit site infections (ESIs due to methicillin-resistant Staphylococcus aureus was admitted to the hospital due to suspected ESI recurrence. However, Gram staining of the pus revealed no gram-positive cocci. Instead, weakly stained gram-positive rods were observed after 7 days of incubation, which were also positive for acid-fast staining. Rapidly growing NTM Mycobacterium chelonae was isolated on day 14. Despite administering a combination antibiotic therapy, ESI could not be controlled, and catheter removal surgery was performed on day 21. Although PD was discontinued temporarily, the patient did not require hemodialysis, without any uremic symptoms. The catheter was reinserted on day 48, and PD was reinitiated on day 61. The patient was discharged on day 65. Antibiotic therapy was continued for 3 months after discharge, with no indications of recurrent infections observed. It is important to consider the risk of NTM infections in patients on PD. Acid-fast staining could be a key test for prompt diagnosis and provision of an appropriate treatment.

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

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Webster F

2012-10-01

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

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

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Yuebin Guo

2012-01-01

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

Effect of Helicobacter pylori Infection on Symptoms of Gastroenteritis Due to Enteropathogenic Escherichia coli in Adults

NARCIS (Netherlands)

Chang, Alicia Hsin-Ming; Haggerty, Thomas Dean; de Martel, Catherine; Leung, Cynthia Wai-Mun; Parsonnet, Julie

Helicobacter pylori can cause hypochlorhydria in some hosts and predispose to diarrheal infections. We tested the hypothesis that chronic H. pylori infection increases the risk of diarrheal illness due to an acid-sensitive organism: enteropathogenic Escherichia coli (EPEC). After testing healthy

A Survey on Transfusion Status in Orthopedic Surgery at a Trauma Center

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Mehran Soleimanha

2016-01-01

Full Text Available Background: Increased costs and mortality associated with inappropriate blood transfusions have led to investigations about blood request and blood transfusion techniques. We investigated the transfusion status in patients who underwent orthopedic surgery in Poursina Hospital (Rasht, Iran to optimizing blood usage and determine if a scheduled transfusion program for every orthopedic surgery could improve blood transfusion management. Method: In this descriptive-prospective study, all orthopedic surgeries in Poursina Hospital, Rasht, between April to June 2013 were reviewed. All patient information was recorded, including: demographics, type of surgery, hemoglobin level, cross-match test, duration of surgery, and blood loss, and transfusion. Based on the one-way ANOVA and independent samples test analysis, cross-match to transfusion ratio and transfusion possibility, the transfusion index, and maximal surgical blood order schedule were calculated to determine blood transfusion status. Results: Among 872 selected orthopedic surgery candidates, 318 of them were cross-matched and among those, 114 patients received a blood transfusion. In this study, the cross-match to transfusion ratio was 6.4, transfusion possibility 36.47%, transfusion index 0.6, and maximal surgical blood order schedule 0.9. Conclusion: We found that blood ordering was moderately higher than the standard; so it is highly recommended to focus on the knowledge of evidence based on transfusion and standard guidelines for blood transfusion to avoid over-ordering.

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

Science.gov (United States)

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

2016-01-01

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

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

Science.gov (United States)

Lin, Zilan X; Woolf, Shane K

2016-01-01

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

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

OpenAIRE

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

2017-01-01

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

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

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Mariano F

2017-09-01

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

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

Science.gov (United States)

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

2017-01-01

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

Biomaterials with antibacterial and osteoinductive properties to repair infected bone defects

NARCIS (Netherlands)

Lu, H.; Liu, Y.; Guo, J.; Wu, H.; Wang, J.; Wu, G.

2016-01-01

The repair of infected bone defects is still challenging in the fields of orthopedics, oral implantology and maxillofacial surgery. In these cases, the self-healing capacity of bone tissue can be significantly compromised by the large size of bone defects and the potential/active bacterial activity.

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

Science.gov (United States)

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

2017-12-01

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

[Orthopedic and trauma surgery in the German DRG System 2007].

Science.gov (United States)

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

2007-03-01

The German Diagnosis-Related Groups (DRG) System was further developed into its 2007 version. For orthopedic and trauma surgery, significant changes were made in terms of the coding of diagnoses and medical procedures, as well as in the DRG structure itself. The German Societies for Trauma Surgery and for Orthopedics and Orthopedic Surgery (Deutsch Gesellschaft für Unfallchirurgie, DGU; and Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie, DGOOC) once again cooperated constructively with the German DRG Institute InEK. Among other innovations, new International Classification of Diseases (ICD) codes for second-degree burns were implemented. Procedure codes for joint operations, endoprosthetic-surgery and spine surgery were restructured. Furthermore, a specific code for septic surgery was introduced in 2007. In addition, the DRG structure was improved. Case allocation of patients with more than one significant operation was established. Further DRG subdivisions were established according to the patients age and the Patient Clinical Complexity Level (PCCL). DRG developments for 2007 have improved appropriate case allocation, but once again increased the system's complexity. Clinicians need an ever growing amount of specific coding know-how. Still, further adjustments to the German DRG system are required to allow for a correct allocation of cases and funds.

Acute Bacterial Meningitis and Systemic Abscesses due to Streptococcus dysgalactiae subsp. equisimilis Infection

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M. Jourani

2017-01-01

Full Text Available Disseminated abscesses due to group G β-hemolytic Streptococcus dysgalactiae were observed in a 57-year-old cirrhotic patient with the skin being the putative way of entry for the pathogen. S. dysgalactiae is a rare agent in human infections responsible for acute pyogenic meningitis. The mortality rate associated with S. dysgalactiae bacteraemia and meningitis may be as high as 50%, particularly in the presence of endocarditis or brain abscesses. In our patient, main sites of infections were meningitis and ventriculitis, spondylodiscitis, septic arthritis, and soft-tissue infections. In contrast, no endocarditis was evidenced. Cirrhosis-related immune suppression was considered as a pathophysiological cofactor for the condition. Fortunately, clinical status improved after long-term (3 months antimicrobial therapy.

The Influence of the Route of Antibiotic Administration, Methicillin Susceptibility, Vancomycin Duration and Serum Trough Concentration on Outcomes of Pediatric Staphylococcus aureus Bacteremic Osteoarticular Infection.

Science.gov (United States)

McNeil, J Chase; Kaplan, Sheldon L; Vallejo, Jesus G

2017-06-01

Bacteremia is often one factor used in deciding the need for prolonged intravenous antimicrobial therapy in osteoarticular infections (OAIs). We examined treatment practices and outcomes of Staphylococcus aureus bacteremic osteoarticular infections (BOAIs) evaluated at Texas Children's Hospital. Cases of acute hematogenous OAI in children with positive blood cultures for S. aureus at Texas Children's Hospital between 2011 and 2014 were reviewed. Orthopedic complications included chronic osteomyelitis, growth arrest, pathologic fracture, avascular necrosis and chronic dislocation. Acute kidney injury was defined as a doubling of the baseline creatinine. One hundred and ninety-two cases of S. aureus OAI were identified with 102 cases of BOAI included [35 methicillin-resistant S. aureus (MRSA)]. Twenty-five patients were discharged home on oral antibiotics. Patients discharged on oral antibiotics had a shorter duration of fever, had a more rapid decline in C-reactive protein and were less likely to have MRSA. The frequency of orthopedic complications did not increase in patients who received early transition to oral antibiotics. For patients with MRSA bacteremia, the rates of complications between those who received ≥7 days versus 15 µg/mL were not associated with a decreased duration of fever, bacteremia or hospitalization, need for repeat operation or orthopedic complications but were associated with acute kidney injury. S. aureus BOAIs are associated with substantial morbidity. Early transition to oral therapy may be a safe option for select patients with S. aureus BOAI, including those due to MRSA. Prolonged courses of vancomycin and vancomycin troughs >15 μg/mL were not associated with improved outcomes for MRSA OAI.

[Femoral artery pseudoaneurysms encountered in orthopedics and traumatology].

Science.gov (United States)

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

2015-12-01

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

Evaluation of occupational and patient radiation doses in orthopedic surgery

International Nuclear Information System (INIS)

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

2014-08-01

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

Evaluation of occupational and patient radiation doses in orthopedic surgery

Energy Technology Data Exchange (ETDEWEB)

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

2014-08-15

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

Evaluation of occupational and patient radiation doses in orthopedic surgery

International Nuclear Information System (INIS)

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

2015-01-01

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

[Comparative analysis of the clinical characteristics of orthopedic inpatients in Lushan and Wenchuan earthquakes].

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Shi, Xiao-Jun; Wang, Guang-Lin; Pei, Fu-Xing; Song, Yue-Ming; Yang, Tian-Fu; Tu, Chong-Qi; Huang, Fu-Guo; Liu, Hao; Lin, Wei

2013-10-18

To systematically analyze and compare the clinical characteristics of orthopedic inpatients in Lushan and Wenchuan earthquake, so as to provide useful references for future earthquakes injury rescue. Based on the orthopedic inpatients in Lushan and Wenchuan earthquakes, the data of the age, gender, injury causes, body injured parts and speed of transport were classified and compared. The duration of patients admitted to hospital lasted long and the peak appeared late in Wenchuan earthquake, which is totally opposed to Lushan earthquake. There was no significant difference in the patient's age and gender between the two earthquakes. However, the occurrence rate of crush syndrome, amputation, gas gangrene, vascular injury and multiple organ dysfunction syndrome (MODS) in Wenchuan earthquake was much higher than that in Lushan earthquake. Blunt traumas or crush-related injuries (79.6%) are the major injury cause in Wenchuan earthquake, however, high falling injuries and falls (56.8%) are much higher than blunt trauma or crush-related injuries (39.2%) in Lushan earthquake. The incidence rate of foot fractures, spine fractures and multiple fractures in Lushan earthquake was higher than that in Wenchuan earthquake, but that of open fractures and lower limb fractures was lower than that in Wenchuan earthquake. The rapid rescue scene is the cornerstone of successful treatment, early rescue and transport obviously reduce the incidence of the wound infection, crush syndrome, MODS and amputation. Popularization of correct knowledge of emergency shelters will help to reduce the damage caused by blindly jumping or escaping while earthquake happens.

Splenic infarction associated with acute infectious mononucleosis due to Epstein-Barr virus infection.

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Heo, Dae-Hyuk; Baek, Dae-Youb; Oh, Sang-Min; Hwang, Joo-Hee; Lee, Chang-Seop; Hwang, Jeong-Hwan

2017-02-01

The purpose of this study was to report a case of a previously healthy 20-year-old woman diagnosed with splenic infarction following infectious mononucleosis (IM) by Epstein-Barr virus (EBV) infection and to perform the first systematic review of the clinical characteristics of splenic infarction associated with IM. A systematic review was conducted using English, French, and Japanese literatures of splenic infarction associated with IM due to EBV infection published between 1961 and 2015 in PubMed Medline. A total of 19 cases were extracted from the collected articles. Left upper quadrant (LUQ) pain was observed in 15 (79%) patients. Splenectomy was performed in five (26%) cases, among which four patients presented with stable vital signs. Splenic rupture was accompanied in two (10%) patients. The median time from the onset of IM symptoms to the diagnosis of splenic infarction was 5 days (range, 1-25 days). Fourteen (74%) of 19 patients experienced improvement through medical treatment, and there were no deaths. Splenic infarction associated with IM due to EBV infection can show a favorable clinical outcome after medical treatment. Clinicians should consider the possibility of splenic infarction when patients with IM experience LUQ pain. J. Med. Virol. 89:332-336, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Hemothorax due to Ruptured Mycotic Aneurysm of Intercostal Arteries Associated with Infective Endocarditis

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Eddie Y. Liu

2017-01-01

Full Text Available We present a case of hemothorax due to ruptured mycotic aneurysm in three intercostal arteries in a 40-year-old male with methicillin-resistant Staphylococcus aureus infective endocarditis (IE due to intravenous drug use. Microcoil embolization and thoracotomy successfully achieved hemostasis. Mycotic aneurysm is a rare complication of IE and is usually found in the intracranial vessels. Ruptured mycotic aneurysm in the intercostal arteries can be associated with IE and can present as acute hemothorax.

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

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

2017-12-20

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

Invasive infection due to Saprochaete capitata in a young patient with hematological malignancies

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Ana Maria Rabelo de Carvalho Parahym

2015-06-01

Full Text Available We report a case of invasive infection due to Saprochaete capitata in a patient with hematological malignancies after chemotherapy treatment and empiric antifungal therapy with caspofungin. Although severely immunocompromised the patient survived been treated with amphotericin B lipid complex associated with voriconazole.

Septic Shock due to Cytomegalovirus Infection in Acute Respiratory Distress Syndrome after Falciparum Malaria.

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Harbarth; Meyer; Grau; Loutan; Ricou

1997-09-01

Incidence of falciparum malaria in developed countries has increased in recent years due to tourism to tropical countries and immigration from Asia and Africa. In Switzerland, about 250 cases of malaria were reported in 1994 to the Federal Office of Health, including three cases with fatal outcome.1 The most commonly described complications of plasmodia infection are cerebral malaria, acute renal failure, and severe anemia with disseminated intravascular coagulation. However, pulmonary involvement occurs in 3 to 10% of cases and represents the most serious complication of this infection, with a lethality of 70%.2,3 Furthermore, a pronounced general immunosuppression has been reported in malaria patients, which may predispose them to opportunistic infections.4 We report a case of Plasmodium falciparum infection complicated by severe acute respiratory distress syndrome (ARDS) with development of systemic cytomegalovirus (CMV) infection leading to death. This evolution implies a severe immune deficiency associated with malaria, as previously suggested in the literature.

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

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Wong JM

2012-05-01

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

Orthopedics nursing patients' profile of a public hospital in Salvador-Bahia.

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de Castro, Renata Reis Matutino; Ribeiro, Natália Fonseca; de Andrade, Aline Mendonça; Jaques, Bruno Dórea

2013-07-01

To describe the profile of patients treated in the trauma and orthopedics nursing of a trauma care referral public hospital of in the state of Bahia. Cross-sectional study in which data were collected from medical records of patients in the period from July to December 2008. The profile of the patients involved was formed by subjects mostly male young subjects, victims of trauma from accidents, especially those with motorcycles or car runover. On the other hand,the most frequent traumas associated with urban violence were perforations by gunshot and stab wounds. The primary injury presented by these individuals was exposed fracture of the femur and the most common treatment was external fixation. The most frequent in-hospital complication was wound infection, which required another surgical approach. Most inpatients were discharged and only one death was reported during this period. The results of this study corroborate those from other institutions in the country, which may contribute to elaborate public policies for accidents and violence prevention. Level of Evidence IV, Case Series.

Bloodstream and endovascular infections due to Abiotrophia defectiva and Granulicatella species

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Bille Jacques

2006-01-01

Full Text Available Abstract Background Abiotrophia and Granulicatella species, previously referred to as nutritionally variant streptococci (NVS, are significant causative agents of endocarditis and bacteraemia. In this study, we reviewed the clinical manifestations of infections due to A. defectiva and Granulicatella species that occurred at our institution between 1998 and 2004. Methods The analysis included all strains of NVS that were isolated from blood cultures or vascular graft specimens. All strains were identified by 16S rRNA sequence analysis. Patients' medical charts were reviewed for each case of infection. Results Eleven strains of NVS were isolated during the 6-year period. Identification of the strains by 16S rRNA showed 2 genogroups: Abiotrophia defectiva (3 and Granulicatella adiacens (6 or "para-adiacens" (2. The three A. defectiva strains were isolated from immunocompetent patients with endovascular infections, whereas 7 of 8 Granulicatella spp. strains were isolated from immunosuppressed patients, mainly febrile neutropenic patients. We report the first case of "G. para-adiacens" bacteraemia in the setting of febrile neutropenia. Conclusion We propose that Granulicatella spp. be considered as a possible agent of bacteraemia in neutropenic patients.

PEEK Biomaterials in Trauma, Orthopedic, and Spinal Implants

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Kurtz, S. M.; Devine, J. N.

2007-01-01

Since the 1980s, polyaryletherketones (PAEKs) have been increasingly employed as biomaterials for trauma, orthopedic, and spinal implants. We have synthesized the extensive polymer science literature as it relates to structure, mechanical properties, and chemical resistance of PAEK biomaterials. With this foundation, one can more readily appreciate why this family of polymers will be inherently strong, inert, and biocompatible. Due to its relative inertness, PEEK biomaterials are an attractive platform upon which to develop novel bioactive materials, and some steps have already been taken in that direction, with the blending of HA and TCP into sintered PEEK. However, to date, blended HA-PEEK composites have involved a trade-off in mechanical properties in exchange for their increased bioactivity. PEEK has had the greatest clinical impact in the field of spine implant design, and PEEK is now broadly accepted as a radiolucent alternative to metallic biomaterials in the spine community. For mature fields, such as total joint replacements and fracture fixation implants, radiolucency is an attractive but not necessarily critical material feature. PMID:17686513

Clinical correlates and outcomes in a group of Puerto Ricans with systemic lupus erythematosus hospitalized due to severe infections

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Jordán-González, Patricia; Shum, Lee Ming; González-Sepúlveda, Lorena

2018-01-01

Objective: Infections are a major cause of morbidity and mortality in systemic lupus erythematosus. Clinical outcomes of systemic lupus erythematosus patients hospitalized due to infections vary among different ethnic populations. Thus, we determined the outcomes and associated factors in a group of Hispanics from Puerto Rico with systemic lupus erythematosus admitted due to severe infections. Methods: Records of systemic lupus erythematosus patients admitted to the Adult University Hospital, San Juan, Puerto Rico, from January 2006 to December 2014 were examined. Demographic parameters, lupus manifestations, comorbidities, pharmacologic treatments, inpatient complications, length of stay, readmissions, and mortality were determined. Patients with and without infections were compared using bivariate and multivariate analyses. Results: A total of 204 admissions corresponding to 129 systemic lupus erythematosus patients were studied. The mean (standard deviation) age was 34.7 (11.6) years; 90% were women. The main causes for admission were lupus flare (45.1%), infection (44.0%), and initial presentation of systemic lupus erythematosus (6.4%). The most common infections were complicated urinary tract infections (47.0%) and soft tissue infections (42.0%). In the multivariate analysis, patients admitted with infections were more likely to have diabetes mellitus (odds ratio: 4.20, 95% confidence interval: 1.23–14.41), exposure to aspirin prior to hospitalization (odds ratio: 4.04, 95% confidence interval: 1.03–15.80), and higher mortality (odds ratio: 6.00, 95% confidence interval: 1.01–35.68) than those without infection. Conclusion: In this population of systemic lupus erythematosus patients, 44% of hospitalizations were due to severe infections. Patients with infections were more likely to have diabetes mellitus and higher mortality. Preventive and control measures of infection could be crucial to improve survival in these patients.

Case report: cranioplasty infection due to Roseomonas gilardii at a university hospital in Turkey.

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Ece, Gulfem; Ruksen, Mete; Akay, Ali

2013-01-01

Roseomonas is a pink-pigmented, nonfermentative, oxidative, Gram-negative coccobacilli that has clinical importance as opportunistic pathogen which can lead to infections especially in immunosuppressed individuals. It is relatively less reported in many centers. These microorganisms are detected after several days growth in culture environment, and typical pink, mucoid colonies are detected. We are reported a case of cranioplasty infection that took place in a patient with with cranial abscess formation due to Roseomonas gilardii at Izmir University School of Medicine Medicalpark Hospital.

Urinary retention due to herpes virus infections.

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Yamanishi, T; Yasuda, K; Sakakibara, R; Hattori, T; Uchiyama, T; Minamide, M; Ito, H

1998-01-01

Urinary retention is uncommon in patients with herpes zoster and anogenital herpes simplex. Seven patients (four men, three women) with a mean age of 68.1 years (range, 35-84) with urinary retention due to herpes zoster (n = 6) or anogenital herpes simplex (n = 1) were studied. Six patients had unilateral skin eruption in the saddle area (S2-4 dermatome) and one patient with herpes zoster had a skin lesion in the L4-5 dermatome. All patients had detrusor areflexia without bladder sensation, and two of them had inactive external sphincter on electromyography at presentation. Clean intermittent catheterization was performed, and voiding function was recovered in 4-6 weeks (average, 5.4) in all patients. Urodynamic study was repeated after recovery of micturition in three patients, and they returned to normal on cystometrography and external sphincter electromyography. Acute urinary retention associated with anogenital herpes infection has been thought to occur when the meninges or sacral spinal ganglia were involved, and, in conclusion, this condition may be considered to be reversible.

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

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

2016-12-01

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

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

International Nuclear Information System (INIS)

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

2006-01-01

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

Infective Endocarditis Complicated by Intraventricular Abscesses, Pericarditis, and Mycotic Aneurysm Due to an Emerging Strain of Serotype VI Streptococcus agalactiae.

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Hirai, Nobuyasu; Kasahara, Kei; Uno, Kenji; Ogawa, Yoshihiko; Ogawa, Taku; Yonekawa, Shinsuke; Nakano, Ryuichi; Yano, Hisakazu; Sakagami, Azusa; Uemura, Takayuki; Okura, Hiroyuki; Saito, Yoshihiko; Yoshikawa, Masahide; Mikasa, Keiichi

2017-11-22

An increasing number of invasive infections due to Streptococcus agalactiae in non-pregnant adults have been reported. We report a case of infective endocarditis complicated by intraventricular abscesses, pericarditis, and mycotic aneurysm due to S. agalactiae belonging to ST681 with a capsular serotype VI in a woman with diabetes. The patient also had a myocardial infarction and was treated with percutaneous coronary intervention, pericardiocentesis, and 6 weeks of antibiotic treatment. Invasive infections due to serotype VI S. agalactiae are common in Asian countries such as Taiwan and Japan, so continuous monitoring of invasive S. agalactiae strains is warranted.

Urinary free light chains may help to identify infection in patients with elevated systemic inflammation due to rheumatic disease.

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Bramlage, Carsten P; Froelich, Britta; Wallbach, Manuel; Minguet, Joan; Grupp, Clemens; Deutsch, Cornelia; Bramlage, Peter; Müller, Gerhard A; Koziolek, Michael

2017-04-01

The risk of infection in patients with rheumatic diseases is elevated, but a clear marker to differentiate the cause of the systemic inflammation is missing. We assessed the ability urinary immunoglobulin free light chains (FLCs) to indicate the presence of infection in patients with rheumatic disease. We performed a retrospective analysis of patients with rheumatic disease attending the Georg-August University Hospital in Goettingen, Germany, from January 2011 to December 2013. Subjects were included if they had urine levels of κ and λ FLCs available. A reference group of patients without autoimmune disease, but with documented infection, was constructed. A total of 1500 patients had their urinary FLCs quantified during the study period. Of the 382 patients with rheumatic disease, 172 (45%) displayed no systemic inflammation, 162 (42%) had inflammation due to the underlying disease activity, and 48 (13%) had inflammation due to a confirmed infection. Urinary FLC concentrations were much higher in patients with rheumatic diseases and infection (κ 68.8 ± 81.8 mg/L, λ 31.4 ± 53.5 mg/L) compared to those with inflammation due to rheumatic disease activity (κ 22.7 ± 26.3 mg/L, λ 8.1 ± 9.1 mg/L, κ p rheumatic disease activity from that due to the additional presence of infection. The ability to quantify these proteins in urine provides a simple alternative to the use of blood.

Pediatric Infection and Intestinal Carriage Due to Extended-Spectrum-Cephalosporin-Resistant Enterobacteriaceae

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Qin, Xuan; Oron, Assaf P.; Adler, Amanda L.; Wolter, Daniel J.; Berry, Jessica E.; Hoffman, Lucas; Weissman, Scott J.

2014-01-01

The objective of this study is to describe the epidemiology of intestinal carriage with extended-spectrum-cephalosporin-resistant Enterobacteriaceae in children with index infections with these organisms. Patients with resistant Escherichia coli or Klebsiella bacteria isolated from the urine or a normally sterile site between January 2006 and December 2010 were included in this study. Available infection and stool isolates underwent phenotypic and molecular characterization. Clinical data relevant to the infections were collected and analyzed. Overall, 105 patients were identified with 106 extended-spectrum-cephalosporin-resistant E. coli (n = 92) or Klebsiella (n = 14) strains isolated from urine or a sterile site. Among the 27 patients who also had stool screening for resistant Enterobacteriaceae, 17 (63%) had intestinal carriage lasting a median of 199 days (range, 62 to 1,576). There were no significant differences in demographic, clinical, and microbiological variables between those with and those without intestinal carriage. Eighteen (17%) patients had 37 subsequent resistant Enterobacteriaceae infections identified: 31 urine and 6 blood. In a multivariable analysis, antibiotic intake in the 91 days prior to subsequent urine culture was significantly associated with subsequent urinary tract infection with a resistant organism (hazard ratio, 14.3; 95% confidence interval [CI], 1.6 to 130.6). Intestinal carriage and reinfection were most commonly due to bacterial strains of the same sequence type and with the same resistance determinants as the index extended-spectrum-cephalosporin-resistant Enterobacteriaceae, but carriage and reinfection with different resistant Enterobacteriaceae strains also occurred. PMID:24798269

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

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

2012-07-01

Orthopedics and trauma surgery are subject to continuous medical advancement. The correct and performance-based case allocation by German diagnosis-related groups (G-DRG) is a major challenge. This article analyzes and assesses current developments in orthopedics and trauma surgery in the areas of coding of diagnoses and medical procedures and the development of the 2012 G-DRG system. The relevant diagnoses, medical procedures and G-DRGs in the versions 2011 and 2012 were analyzed based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes were made for the International Classification of Diseases (ICD) coding of complex cases with medical complications, the procedure coding for spinal surgery and for hand and foot surgery. The G-DRG structures were modified for endoprosthetic surgery on ankle, shoulder and elbow joints. The definition of modular structured endoprostheses was clarified. The G-DRG system for orthopedic and trauma surgery appears to be largely consolidated. The current phase of the evolution of the G-DRG system is primarily aimed at developing most exact descriptions and definitions of the content and mutual delimitation of operation and procedures coding (OPS). This is an essential prerequisite for a correct and performance-based case allocation in the G-DRG system.

Risk factors for infections due to carbapenem-resistant Klebsiella pneumoniae after open heart surgery.

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Salsano, Antonio; Giacobbe, Daniele Roberto; Sportelli, Elena; Olivieri, Guido Maria; Brega, Carlotta; Di Biase, Carlo; Coppo, Erika; Marchese, Anna; Del Bono, Valerio; Viscoli, Claudio; Santini, Francesco

2016-11-01

Patients undergoing major surgery are at increased risk of developing infections due to resistant organisms, including carbapenem-resistant Klebsiella pneumoniae (CR-Kp). In this study, we assessed risk factors for CR-Kp infections after open heart surgery in a teaching hospital in northern Italy. A retrospective study was conducted from January to December 2014. The primary outcome measure was postoperative CR-Kp infection, defined as a time-to-event end-point. The effect of potentially related variables was assessed by univariable and multivariable analyses. Secondary end-points were in-hospital mortality and 180-day postoperative mortality. Among 553 patients undergoing open heart surgery, 32 developed CR-Kp infections (6%). In the final multivariable model, CR-Kp colonization [hazard ratio (HR) 227.45, 95% confidence intervals (CI) 67.13-1225.20, P open heart surgery. CR-Kp infection after surgery significantly affected survival. Preventing colonization is conceivably the most effective current strategy to reduce the impact of CR-Kp. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Severe oral infection due to Lactobacillus rhamnosus during induction chemotherapy for acute myeloid leukemia.

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Ishihara, Yuko; Kanda, Junya; Tanaka, Kaori; Nakano, Hirofumi; Ugai, Tomotaka; Wada, Hidenori; Yamasaki, Ryoko; Kawamura, Koji; Sakamoto, Kana; Ashizawa, Masahiro; Sato, Miki; Terasako-Saito, Kiriko; Kimura, Shun-Ichi; Kikuchi, Misato; Nakasone, Hideki; Yamazaki, Rie; Kako, Shinichi; Nishida, Junji; Watanabe, Kunitomo; Kanda, Yoshinobu

2014-12-01

We report a case of severe oral infection with a high fever due to Lactobacillus rhamnosus during induction chemotherapy for acute myeloid leukemia. The patient did not improve on treatment with meropenem, clindamycin, or vancomycin until neutrophil recovery. Since L. rhamnosus GG is used in dairy products, and the patient ingested dairy products daily before starting chemotherapy, we suspected an association between the ingestion of dairy products and the development of infection. Pulsed-field gel electrophoresis using two different restriction enzymes showed that the strain isolated from the patient was identical to the L. rhamnosus GG strain isolated from dairy products and ATCC #53103. This was confirmed by a PCR assay with species-specific L. rhamnosus GG primers. Since Lactobacillus infection, particularly L. rhamnosus infection, can be fatal in immunocompromised hosts, we should consider Lactobacillus as a causative organism when Gram-positive rods are detected during treatment with broad-spectrum antibiotics and vancomycin. The causal association between the ingestion of dairy products containing Lactobacillus and Lactobacillus infection in immunocompromised hosts warrants further study.

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

Science.gov (United States)

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

2017-12-01

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

Bactericidal micron-thin sol-gel films prevent pin tract and periprosthetic infection.

Science.gov (United States)

Qu, Haibo; Knabe, Christine; Burke, Megan; Radin, Shula; Garino, Jonathan; Schaer, Thomas; Ducheyne, Paul

2014-08-01

Orthopedic injuries constitute the majority of wounds sustained by U.S. soldiers in recent conflicts. The risk of infection is considerable with fracture fixation devices. In this pilot study, we examined the use of unique bactericidal micron-thin sol-gel films on fracture fixation devices and their ability to prevent and eradicate infections. External fixation was studied with micron-thin sol-gel coated percutaneous pins releasing triclosan and inserted medially into rabbit tibiae. A total of 11 rabbits received percutaneous pins that were either uncoated or sol-gel/triclosan coated. Internal fracture fixation was also studied using sol-gel coated intramedullary (IM) nails releasing vancomycin in the intramedullary tibiae. Six sheep received IM nails that were coated with a sol-gel film that either contained vancomycin or did not contain vancomycin. All animals were challenged with Staphylococcus aureus around the implant. Animals were euthanized at 1 month postoperative. Rabbits receiving triclosan/sol-gel coated percutaneous pins did not show signs of infection. Uncoated percutaneous pins had a significantly higher infection rate. In the sheep study, there were no radiographic signs of osteomyelitis with vancomycin/sol-gel coated IM nails, in contrast to the observations in the control cohort. Hence, the nanostructured sol-gel controlled release technology offers the promise of a reliable and continuous delivery system of bactericidals from orthopedic devices to prevent and treat infection. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Methods of orthopedic treatment of dentition defects

Directory of Open Access Journals (Sweden)

Konnov V.V.

2016-09-01

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

The orthopedic gender gap: trends in authorship and editorial board representation over the past 4 decades.

Science.gov (United States)

Okike, Kanu; Liu, Bella; Lin, Yijie Brittany; Torpey, Jennifer L; Kocher, Mininder S; Mehlman, Charles T; Bhandari, Mohit; Biermann, J Sybil

2012-07-01

The purpose of this study was to quantify the representation of women among the authors and editorial board members of prominent general orthopedics journals and to determine how these proportions have changed over time. Gender was determined for the authors of all original research studies, case reports, and review articles published in 2 prominent general orthopedics journals in 1970, 1980, 1990, 2000, and 2007. Gender was also determined for each individual serving on the editorial boards of these journals during these years. Between 1970 and 2007, the representation of women increased from 0.8% to 6.5% among first authors (P<.001), from 0.0% to 4.3% among last authors (P = .015), and from 1.6% to 5.4% among editorial board members (P = .16). However, the rates of increase observed in orthopedics were lower than those observed in other fields (P<.05). Between 1970 and 2007, female representation increased significantly among physicians publishing in 2 prominent general orthopedics journals, but these rates of increase were lower than those observed in other fields of medicine.

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

Science.gov (United States)

Silvestre, Jason; Kamath, Atul F

2018-03-01

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

Bacteremia due to Staphylococcus cohnii ssp. urealyticus caused by infected pressure ulcer: case report and review of the literature.

Science.gov (United States)

Soldera, Jonathan; Nedel, Wagner Luis; Cardoso, Paulo Ricardo Cerveira; d'Azevedo, Pedro Alves

2013-01-01

CONTEXT Coagulase-negative staphylococci are common colonizers of the human skin and have become increasingly recognized as agents of clinically significant nosocomial infections. CASE REPORT The case of a 79-year-old male patient with multi-infarct dementia who presented systemic inflammatory response syndrome is reported. This was attributed to bacteremia due to Staphylococcus cohnii ssp. urealyticus, which was grown on blood cultures originating from an infected pressure ulcer. The few cases of Staphylococcus cohnii infection reported in the literature consist of bacteremia relating to catheters, surgical prostheses, acute cholecystitis, brain abscess, endocarditis, pneumonia, urinary tract infection and septic arthritis, generally presenting a multiresistant profile, with nearly 90% resistance to methicillin. CONCLUSIONS The reported case is, to our knowledge, the first case of true bacteremia due to Staphylococcus cohnii subsp. urealyticus caused by an infected pressure ulcer. It shows that this species may be underdiagnosed and should be considered in the differential diagnosis for community-acquired skin infections.

Bacteremia due to Staphylococcus cohnii ssp. urealyticus caused by infected pressure ulcer: case report and review of the literature

Directory of Open Access Journals (Sweden)

Jonathan Soldera

Full Text Available CONTEXTCoagulase-negative staphylococci are common colonizers of the human skin and have become increasingly recognized as agents of clinically significant nosocomial infections.CASE REPORTThe case of a 79-year-old male patient with multi-infarct dementia who presented systemic inflammatory response syndrome is reported. This was attributed to bacteremia due to Staphylococcus cohnii ssp. urealyticus, which was grown on blood cultures originating from an infected pressure ulcer. The few cases of Staphylococcus cohnii infection reported in the literature consist of bacteremia relating to catheters, surgical prostheses, acute cholecystitis, brain abscess, endocarditis, pneumonia, urinary tract infection and septic arthritis, generally presenting a multiresistant profile, with nearly 90% resistance to methicillin.CONCLUSIONSThe reported case is, to our knowledge, the first case of true bacteremia due to Staphylococcus cohnii subsp. urealyticus caused by an infected pressure ulcer. It shows that this species may be underdiagnosed and should be considered in the differential diagnosis for community-acquired skin infections.

Damage control in orthopedics and traumatology

International Nuclear Information System (INIS)

Martinez R, Alfredo

2006-01-01

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

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

Science.gov (United States)

Ryu, Justine H; Yi, Paul H

2016-05-01

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

Sonication technique improves microbiological diagnosis in patients treated with antibiotics before surgery for prosthetic joint infections.

Science.gov (United States)

Scorzolini, Laura; Lichtner, Miriam; Iannetta, Marco; Mengoni, Fabio; Russo, Gianluca; Panni, Alfredo Schiavone; Vasso, Michele; Vasto, Michele; Bove, Marco; Villani, Ciro; Mastroianni, Claudio M; Vullo, Vincenzo

2014-07-01

Microbiological diagnosis is crucial for the appropriate management of implant-associated orthopedic infections (IAOIs). Sonication of biomaterials for microbiological diagnosis has not yet been introduced in routine clinical practice. Aim of this study was to describe the advantages and feasibility of this procedure in the clinical setting. We prospectively studied 56 consecutive patients undergoing revision because of IAOI and compared the sensitivity of sonication of explanted orthopedic implants with standard cultures. Patients were divided into two groups: those with foreign body infection (FBI, 15 patients) and those with prosthetic joint infection (PJI, 41 patients). Clinical, radiological and microbiological features were recorded. In the PJI group the sensitivity of sonication in detecting bacterial growth was higher than conventional culture (77% vs 34.1% respectively, p0.05). Coagulase-negative Staphylococci accounted for 90% of the bacteria detected by sonication. Moreover, we found that in the PJI group the sensitivity of sonication was not affected by the timing of antibiotic interruption before surgery. Sonication remains an important tool to improve microbiological diagnosis in PJIs, especially in patients who received previous antimicrobial treatment.

Surface Functionalization of Orthopedic Titanium Implants with Bone Sialoprotein.

Directory of Open Access Journals (Sweden)

Andreas Baranowski

Full Text Available Orthopedic implant failure due to aseptic loosening and mechanical instability remains a major problem in total joint replacement. Improving osseointegration at the bone-implant interface may reduce micromotion and loosening. Bone sialoprotein (BSP has been shown to enhance bone formation when coated onto titanium femoral implants and in rat calvarial defect models. However, the most appropriate method of BSP coating, the necessary level of BSP coating, and the effect of BSP coating on cell behavior remain largely unknown. In this study, BSP was covalently coupled to titanium surfaces via an aminosilane linker (APTES, and its properties were compared to BSP applied to titanium via physisorption and untreated titanium. Cell functions were examined using primary human osteoblasts (hOBs and L929 mouse fibroblasts. Gene expression of specific bone turnover markers at the RNA level was detected at different intervals. Cell adhesion to titanium surfaces treated with BSP via physisorption was not significantly different from that of untreated titanium at any time point, whereas BSP application via covalent coupling caused reduced cell adhesion during the first few hours in culture. Cell migration was increased on titanium disks that were treated with higher concentrations of BSP solution, independent of the coating method. During the early phases of hOB proliferation, a suppressive effect of BSP was observed independent of its concentration, particularly when BSP was applied to the titanium surface via physisorption. Although alkaline phosphatase activity was reduced in the BSP-coated titanium groups after 4 days in culture, increased calcium deposition was observed after 21 days. In particular, the gene expression level of RUNX2 was upregulated by BSP. The increase in calcium deposition and the stimulation of cell differentiation induced by BSP highlight its potential as a surface modifier that could enhance the osseointegration of orthopedic implants

Relationship of orthopedic examination, goniometric measurements, and radiographic signs of degenerative joint disease in cats

OpenAIRE

Lascelles, B Duncan X; Dong, Yaa-Hui; Marcellin-Little, Denis J; Thomson, Andrea; Wheeler, Simon; Correa, Maria

2012-01-01

Abstract Background Available information suggests a mismatch between radiographic and orthopedic examination findings in cats with DJD. However, the extent of the discrepancy between clinical and radiographic signs of OA in companion animals has not been described in detail. This study aimed to evaluate the relationship between orthopedic examination findings, joint goniometry, and radiographic signs of DJD in 100 cats, in a prospective observational design. Cat temperament, pain response to...

The omni-relevance of surgery: how medical specialization shapes orthopedic surgeons' treatment recommendations.

Science.gov (United States)

Hudak, Pamela L; Clark, Shannon J; Raymond, Geoffrey

2013-01-01

This article examines treatment recommendations in orthopedic surgery consultations and shows how surgery is treated as "omni-relevant" within this activity, providing a context within which the broad range of treatment recommendations proposed by surgeons is offered. Using conversation analysis to analyse audiotaped encounters between orthopedic surgeons and patients, we highlight how surgeons treat surgery as having a special, privileged status relative to other treatment options by (1) invoking surgery (whether or not it is actually being recommended) and (2) presenting surgery as the "last best resort" (in relation to which other treatment options are calibrated, described and considered). This privileged status surfaces in the design and delivery of recommendations as a clear asymmetry: Recommendations for surgery are proposed early, in relatively simple and unmitigated form. In contrast, recommendations not for surgery tend to be delayed and involve significantly more interactional work in their delivery. Possible implications of these findings, including how surgeons' structuring of recommendations may shape patient expectations (whether for surgery or some alternative), and potentially influence the distribution of orthopedic surgery procedures arising from these consultations, are considered.

New biomaterials for orthopedic implants

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Ong KL

2015-09-01

Full Text Available Kevin L Ong, Brian Min Yun, Joshua B WhiteExponent, Inc., Philadelphia, PA, USAAbstract: With the increasing use of orthopedic implants worldwide, there continues to be great interest in the development of novel technologies to further improve the effective clinical performance of contemporary treatment modalities and devices. Continuing research interest also exists in developing novel bulk biomaterials (eg, polycarbonate urethanes, silicon or novel formulations of existing but less widely used biomaterials (eg, polyaryletherketones, polyetheretherketone. There is also growing focus on customizing the material properties of bioabsorbables and composite materials with fillers such as bioactive ceramics. In terms of tissue engineering, more recent developments have focused on basic engineering and biological fundamentals to use cells, signaling factors, and the scaffold material itself to better restore tissue and organ structure and function. There has also been recent controversy with the use of injectables as a nonsurgical approach to treat joint disorders, but more attention is being directed toward the development of newer formulations with different molecular weights. The industry has also continuously sought to improve coatings to supplement the function of existing implants, with the goal of improving their osseointegrative qualities and incorporating antimicrobial properties. These include the use of bone morphogenetic protein, bisphosphonates, calcium phosphate, silicon nitride, and iodine. Due to the widespread use of bone graft materials, recent developments in synthetic graft materials have explored further development of bioactive glass, ceramic materials, and porous titanium particles. This review article provides an overview of ongoing efforts in the above research areas.Keywords: coatings, scaffolds, bioabsorbables, bone graft, injectables

Developing a minimum data set of the information management system for orthopedic injuries in iran.

Science.gov (United States)

Ahmadi, Maryam; Mohammadi, Ali; Chraghbaigi, Ramin; Fathi, Taimur; Shojaee Baghini, Mahdieh

2014-07-01

Orthopedic injuries are the most common types of injuries. To identify the main causes of injuries, collecting data in a standard manner at the national level are needed, which justifies necessity of making a minimum data set (MDS). The aim of this study was to develop an MDS of the information management system for orthopedic injuries in Iran. This descriptive cross-sectional study was performed in 2013. Data were collected from hospitals affiliated with Tehran University of Medical Sciences that had orthopedic department, medical documents centers, legal medicine centers, emergency centers, internet access, and library. Investigated documents were orthopedic injury records in 2012, documents that retrieved from the internet, and printed materials. Records with Random sampling by S22-S99 categories from ICD-10 were selected and the related internet-sourced data were evaluated entirely. Data were collected using a checklist. In order to make a consensus about the data elements, the decision Delphi technique was applied by a questionnaire. The content validity and reliability of the questionnaire were assessed by expert's opinions and test-retest method, respectively. AN MDS OF ORTHOPEDIC INJURIES WERE ASSIGNED TO TWO CATEGORIES: administrative category with six classes including 142 data elements, and clinical category with 17 classes including 250 data elements. This study showed that some of the essential data elements included in other country's MDS or required for organizations and healthcare providers were not included. Therefore, a complete list of an MDS elements was created. Existence of comprehensive data concerning the causes and mechanisms of injuries informs public health policy-makers about injuries occurrence and enables them to take rationale measures to deal with these problems.

A touch probe method of operating an implantable RFID tag for orthopedic implant identification.

Science.gov (United States)

Liu, Xiaoyu; Berger, J Lee; Ogirala, Ajay; Mickle, Marlin H

2013-06-01

The major problem in operating an implantable radio-frequency identification (RFID) tag embedded on an orthopedic implant is low efficiency because of metallic interference. To improve the efficiency, this paper proposes a method of operating an implantable passive RFID tag using a touch probe at 13.56 MHz. This technology relies on the electric field interaction between two pairs of electrodes, one being a part of the touch probe placed on the surface of tissue and the other being a part of the tag installed under the tissue. Compared with using a conventional RFID antenna such as a loop antenna, this method has a better performance in the near field operation range to reduce interference with the orthopedic implant. Properly matching the touch probe and the tag to the tissue and the implant reduces signal attenuation and increases the overall system efficiency. The experiments have shown that this method has a great performance in the near field transcutaneous operation and can be used for orthopedic implant identification.

Preservative Monitoring of a Greek Woman with Hydrops Fetalis due to Parvovirus B19 Infection

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Zacharias Fasoulakis

2017-01-01

Full Text Available Primate erythroparvovirus 1 (parvovirus B19 is a member of the Erythrovirus genus of the Parvoviridae family and it is one of the few members of the family known to be pathogenic in human. B19 infection is common and widespread with the virus being associated with numerous rheumatologic and haematologic manifestations. More specifically, maternal infection with parvovirus B19 during pregnancy can cause severe anemia which may lead to nonimmune hydrops or fetal demise, as a result of fetal erythroid progenitor cells infection with shortened half-life of erythrocytes. We present a rare case reported in the Greek population, of subclinical transient reticulocytopenia due to B19 parvovirus infection, in an asymptomatic pregnant woman, without medical history of hemoglobinopathy, and with the presence of hydrops fetalis during the third trimester of her pregnancy.

[Acute inpatient conservative multimodal treatment of complex and multifactorial orthopedic diseases in the ANOA concept].

Science.gov (United States)

Psczolla, M

2013-10-01

In Germany there is a clear deficit in the non-operative treatment of chronic and complex diseases and pain disorders in acute care hospitals. Only about 20 % of the treatments are carried out in orthopedic hospitals. Hospitals specialized in manual medicine have therefore formed a working group on non-operative orthopedic manual medicine acute care clinics (ANOA). The ANOA has developed a multimodal assessment procedure called the OPS 8-977 which describes the structure and process quality of multimodal and interdisciplinary diagnosis and treatment of the musculoskeletal system. Patients are treated according to clinical pathways oriented on the clinical findings. The increased duration of treatment in the German diagnosis-related groups (DRG) system is compensated for with a supplemental remuneration. Thus, complex and multifactorial orthopedic diseases and pain disorders are conservatively and appropriately treated as inpatient departments of acute care hospitals.

Rivaroxaban for Thromboprophylaxis After Nonelective Orthopedic Trauma Surgery in Switzerland

DEFF Research Database (Denmark)

Hoffmeyer, Pierre; Simmen, Hanspeter; Jakob, Marcel

2017-01-01

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

[Normal and pathologic mandible development: practical deductions in maxillo-dento-facial orthopedics].

Science.gov (United States)

Salagnac, Jean-Michel

2016-09-01

The mandible consists of different segments, each of which possess its own specific characteristics regarding emergence, ossification during growth and pathologies. Orthodontists need to be very familiar with these developmental anomalies if they are to avoid failure in their orthopedic or orthodontic treatments and in order to understand the reasons for the lack of success of "conventional" treatments. Each segment must develop correctly if the mandible is to achieve optimal development and occupy a normal position within the cranio-facial complex. The position of the mandible in the cranio-facial block is also conditioned by its attachment to the base of the skull. Combining a detailed semiologic study and a three-dimensional architectural and structural radiologic analysis of clinical cases, this article investigates the various anomalies affecting the mandibular segments and their impact on the craniofacial structure as a whole. An understanding of these anomalies and this analytical method can enable clinicians to perform early diagnosis, avoid undertaking orthopedic and orthodontic treatments which are likely to fail, understand the reasons for unsuccessful "conventional" treatments, provide an orthopedic-surgical guide and make it possible to inform patients correctly. Anomalies affecting the growth of the mandible and its position on the cranial base and their impact on cranio-facial skeletal balance are clearly revealed by structural and architectural analysis, which pinpoints the different clinical elements in skeletal Class II et III cases. In maxilla-dento-facial orthopedics when confronted with a pathology of mandibular origin, it is essential to carefully study the radiographs of each segment of the mandible, to seek out the minor forms of the anomalies and to calculate the position of the mandible on the cranial base relative to the neighboring structures; the skull, the cervical vertebrae and the maxilla. © EDP Sciences, SFODF, 2016.

Disparities in internet use among orthopedic outpatients.

Science.gov (United States)

Walsh, Kenneth P; Rehman, Saqib; Goldhirsh, Jessie

2014-02-01

Internet access has lagged behind for patients with lower incomes and from certain ethnic groups. This study investigated the possible improvement of access to health-related information on the Internet for all patients in an urban outpatient setting, regardless of socioeconomic background. A 28-question survey was completed by 100 orthopedic outpatients evaluating associations between their age, ethnicity, income, or education level and their access to the Internet. The survey also examined how patients used the Internet to obtain information about their medical condition, their privacy concerns when conducting online research, and their use of mobile phones as a primary means of Internet access. The Internet was used by 57% of orthopedic outpatients in this urban setting. Internet access decreased with advancing age but increased with increasing income and education, findings consistent with similar studies. Despite the inability to identify an association between ethnicity and Internet access in this patient population, fewer Latinos (33%) than whites (67%) or African Americans (77%) sought information about their medical condition. Among patients who used a mobile phone as the primary method for online access, 74% were African American or Latino and 26% were white. This difference in mobile phone use for online access suggests that mobile phones have provided ethnic minorities with greater Internet access and thus may have narrowed the digital divide among the races. Copyright 2014, SLACK Incorporated.

The organizational and financial viability of an orthopedic trauma service.

Science.gov (United States)

Harris, Mitchel B; Cayen, Barry

2009-12-01

This study was designed to explore the effect of establishing an Orthopedic Trauma Service (OTS) on departmental revenue within an academic orthopedic department. The effect of the OTS on physician and resident perceptions of job satisfaction, education, and quality of patient care were also evaluated. A proforma financial analysis was undertaken using an optimization model to predict the potential financial performance of an OTS before its implementation. Financial data were then collected prospectively for the first year of the OTS and compared with the preceding year's financial data. All residents and faculty in the department completed visual analog scale surveys after the formation of the service. While maintaining a fixed amount of work production (work relative value units [WRVUs]) per year, our model predicted an $111,000 increase in departmental charges as a result of a shift in the elective case mix. After implementation of the OTS, elective charges/WRVU increased by 7.4% while trauma charges/WRVU increased by 2.6%. This, combined with a minor increase in departmental work volume (115,661 WRVUs pre-OTS vs. 117,577 WRVUs post-OTS) and an improvement in collections/charge (47-48%), yielded a departmental collection increase of 11% ($1.1 million). Resident and faculty job satisfaction improved, as did the perception of the quality of trauma care that was being provided. The organization and implementation of an OTS within an academic orthopedic department can lead to an improved professional experience for residents and faculty, the perception of improved patient care for the trauma patient, and an increase in departmental revenue.

Imaging of orthopedic trauma and surgery

International Nuclear Information System (INIS)

Berquist, T.H.

1985-01-01

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

Orthopedic Injuries and Their Treatment in Children During Earthquakes: A Systematic Review.

Science.gov (United States)

Morelli, Ilaria; Sabbadini, Maria Grazia; Bortolin, Michelangelo

2015-10-01

Orthopedic injuries commonly affect children during earthquakes, but reports about them are rare. This setting may lead to different standards of care, but guidelines are still missing in this field. A systematic review was performed to: (1) assess type and body distribution of pediatric earthquake-related injuries, treatment performed, length of stay, and complications; and (2) identify starting points to define standards of care. PubMed database was researched for papers (1999-2014 period) in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Inclusion criteria were: English, French, Spanish, or Italian language and data reported about orthopedic lesions in children (≤18 years old). Reviews, letters, commentaries, editorials, and single case reports were excluded. Two independent reviewers selected articles after abstract and full-text reading. Traumatic injuries caused child hospital admissions ranging from 46.9% to 100.0%; 16% to 53% suffered fractures. Lower limbs mostly were involved. Soft-tissue injuries affected 55% of patients. Debridement and external fixation (EF) were the most frequent surgical treatments. Amputation rates varied from 5% to 11%. This study revealed that field hospitals should be prepared to: (1) treat mainly lower extremities fractures in children; and (2) use especially EF techniques. The presence of orthopedic surgeons familiar with pediatric traumatology should be considered.

Update of Clostridium difficile infection due to PCR ribotype 027 in Europe, 2008.

LENUS (Irish Health Repository)

Kuijper, E J

2008-07-31

Outbreaks of Clostridium difficile infections (CDI) with increased severity, high relapse rate and significant mortality have been related to the emergence of a new, hypervirulent C. difficile strain in North America and Europe. This emerging strain is referred to as PCR ribotype 027 (Type 027). Since 2005, individual countries have developed surveillance studies about the spread of type 027.C. difficile Type 027 has been reported in 16 European countries. It has been responsible for outbreaks in Belgium, Germany, Finland, France, Ireland, Luxembourg, The Netherlands, Switzerland and the United Kingdom (England, Wales, Northern Ireland and Scotland). It has also been detected in Austria, Denmark, Sweden, Norway, Hungary, Poland and Spain. Three countries experienced imported patients with CDI due to Type 027 who acquired the infection abroad.The antimicrobial resistance pattern is changing, and outbreaks due to clindamycin-resistant ermB positive Type 027 strains have occurred in three European countries. Ongoing epidemiological surveillance of cases of CDI, with periodic characterisation of the strains involved, is required to detect clustering of cases in time and space and to monitor the emergence of new, highly virulent clones.

Seasonal variation in orthopedic health services utilization in Switzerland: the impact of winter sport tourism.

Science.gov (United States)

Matter-Walstra, Klazien; Widmer, Marcel; Busato, André

2006-03-03

Climate- or holiday-related seasonality in hospital admission rates is well known for many diseases. However, little research has addressed the impact of tourism on seasonality in admission rates. We therefore investigated the influence of tourism on emergency admission rates in Switzerland, where winter and summer leisure sport activities in large mountain regions can generate orthopedic injuries. Using small area analysis, orthopedic hospital service areas (HSAo) were evaluated for seasonality in emergency admission rates. Winter sport areas were defined using guest bed accommodation rate patterns of guest houses and hotels located above 1000 meters altitude that show clear winter and summer peak seasons. Emergency admissions (years 2000-2002, n = 135'460) of local and nonlocal HSAo residents were evaluated. HSAo were grouped according to their area type (regular or winter sport area) and monthly analyses of admission rates were performed. Of HSAo within the defined winter sport areas 70.8% show a seasonal, summer-winter peak hospital admission rate pattern and only 1 HSAo outside the defined winter sport areas shows such a pattern. Seasonal hospital admission rates in HSAo in winter sport areas can be up to 4 times higher in winter than the intermediate seasons, and they are almost entirely due to admissions of nonlocal residents. These nonlocal residents are in general -and especially in winter- younger than local residents, and nonlocal residents have a shorter length of stay in winter sport than in regular areas. The overall geographic distribution of nonlocal residents admitted for emergencies shows highest rates during the winter as well as the summer in the winter sport areas. Small area analysis using orthopedic hospital service areas is a reliable method for the evaluation of seasonality in hospital admission rates. In Switzerland, HSAo defined as winter sport areas show a clear seasonal fluctuation in admission rates of only nonlocal residents, whereas

Human infections due to Staphylococcus pseudintermedius, an emerging zoonosis of canine origin: report of 24 cases.

Science.gov (United States)

Somayaji, R; Priyantha, M A R; Rubin, J E; Church, D

2016-08-01

Staphylococcus pseudintermedius has been recently identified as a novel species within the genus Staphylococcus, and is commonly associated with infections in dogs. Currently, there are few reports of human infections due to this bacterium. To use a population-based approach to describe the characteristics of human S. pseudintermedius infections in a large Canadian healthcare region. All adult cases aged ≥18 years identified at a large regional laboratory from April 1, 2013 to April 1, 2015 who had at least one positive culture for S. pseudintermedius were retrospectively reviewed. A combination of phenotypic methods, mass spectrometry (i.e., MALDI-TOF), and cpn60 sequencing were used to identify S. pseudintermedius. Chart review was conducted, and cases were analysed descriptively. Twenty-seven isolates of S. pseudintermedius from 24 human cases were included for analysis. 58.3% were male with median age of 61 years (IQR 55-70.5). Most patients [22 (92.1%)] had confirmed contact with dogs at time of infection. S. pseudintermedius was isolated in 18 cases (75.0%) of skin and soft tissue infections (SSTI), and 2 invasive cases (8.3%) including a prosthetic joint and bloodstream infection. The other 4 patients were considered to be colonized (skin - 3; lung - 1). Methicillin resistance was identified in 3 cases with 6 total isolates (22.2%); multi-drug resistance was also demonstrated commonly. S. pseudintermedius is most commonly associated with SSTIs in humans. Transmission probably occurs from a pet dog. Species-level identification of S. pseudintermedius is important due to the high prevalence of antibiotic resistance, particularly to methicillin. Copyright © 2016 Elsevier Inc. All rights reserved.

Indications for CT, MRI, and scintiscanning in orthopedics and traumatology

International Nuclear Information System (INIS)

Hahn, K.; Heine, J.; Thelen, T.

1994-01-01

Successful treatment of disease of the locomotor system requires as exact as possible diagnostic evaluation of the individual conditions, and this in turn can be achieved only by collaborative efforts of experts from a variety of subject fields. The book in hand is the result of such a collaborative approach, presenting the knowledge and experience of orthopedic surgeons, radiologists, and nuclear medicine experts who establish an order of priority and diagnostic value of computed tomography, magnetic resonance imaging, and various scintiscanning methods with respect to the diagnosis of orthopedic lesions. On the basis of this order of priority, specific recommendations are presented and explained for the best possible diagnostic procedure for evaluation of the various cases. The material is arranged into the following chapters: Examination modalities, techniques and cost - Inflammatory lesions of the locomotive system - Specific traumatology - Tumors of the locomotive system - Lesions of the hip joint - Lesions of the knee joint - Lesions of the spine -Lesions of the shoulder. (orig./MG) [de

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

Science.gov (United States)

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

2009-01-01

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

Sol-Gel Derived Hydroxyapatite Coating on Mg-3Zn Alloy for Orthopedic Application

Science.gov (United States)

Singh, Sanjay; Manoj Kumar, R.; Kuntal, Kishor Kumar; Gupta, Pallavi; Das, Snehashish; Jayaganthan, R.; Roy, Partha; Lahiri, Debrupa

2015-04-01

In recent years, magnesium and its alloys have gained a lot of interest as orthopedic implant constituents because their biodegradability and mechanical properties are closer to that of human bone. However, one major concern with Mg in orthopedics is its high corrosion rate that results in the reduction of mechanical integrity before healing the bone tissue. The current study evaluates the sol-gel-derived hydroxyapatite (HA) coating on a selected Mg alloy (Mg-3Zn) for decreasing the corrosion rate and increasing the bioactivity of the Mg surface. The mechanical integrity of the coating is established as a function of the surface roughness of the substrate and the sintering temperature of the coating. Coating on a substrate roughness of 15-20 nm and sintering at 400°C shows the mechanical properties in similar range of bone, thus making it suitable to avoid the stress-shielding effect. The hydroxyapatite coating on the Mg alloy surface also increases corrosion resistance very significantly by 40 times. Bone cells are also found proliferating better in the HA-coated surface. All these benefits together establish the candidature of sol-gel HA-coated Mg-3Zn alloy in orthopedic application.

Biochemical and morphological changes associated with macrophages and osteoclasts when challenged with infection - biomed 2011.

Science.gov (United States)

Wiggers, Erin Callie; Johnson, William; Tucci, Michelle; Benghuzzi, Hamed

2011-01-01

Osteomyelitis is a bacterial infection of the bone that occurs frequently as a complication of open fractures and various kinds of orthopedic surgery. This infection can often lead to more extensive surgeries and even death of the patient. In animal models of osteomyelitis, the site of infection by Staphylococcus aureus was observed to have high numbers of both macrophages and osteoclasts, both of which may contribute to large amounts of osteolysis and tissue damage. In order to evaluate the immune response in both types of cells, two cells lines, a macrophage cell line and a macrophage cell line stimulated to become osteoclasts by the addition of receptor activator of nuclear-factor B (RANKL), were exposed to lipopolysaccharides, opsonized S. aureus, and unopsonized S. aureus. The results showed that both cell types activated a biochemical cascade that included the release of cytokines and nitric oxide associated with cell damage and death in response to infection. However, macrophages and osteoclasts differed in response magnitude, most likely due to differences in cell-membrane receptors. This data supports the growing body of research that links the immune and skeletal systems. Further understanding of biochemical pathways shared by the two systems could lead to significant advances in the treatment of osteomyelitis and the success of prostheses.

Trauma-related infections due to cluster munitions.

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Fares, Youssef; El-Zaatari, Mohamad; Fares, Jawad; Bedrosian, Nora; Yared, Nadine

2013-12-01

Trauma-related infections remain a concerning and potentially avoidable complication of conflict-related injuries. During the Israeli conflict in South Lebanon, more than four million sub-munitions were dropped over South Lebanese soil. In this study, we will explore the different types of infection caused by sub-munitions and penetrating agents. This prospective study took place from 2006 to 2012 at the Lebanese University within the Faculty of Medical Sciences' departments. This study sample consisted of 350 injured casualties. Patients suffered from blast injuries with fragmentations targeting the head, face, torso, abdomen, pelvis and extremities. Of the 350 causalities studied, 326 (93.1%) were males, and 24 (6.9%) were females. Ages varied between 10 and 70 years, with the average age being 27 years. Of the 350 patients studied, 68 (19.4%) developed infections. Infections varied between pseudomonas, Escherichia coli, Candida and fungus and sometimes led to necrosis. Vaccinations, antibiotic therapies and proper wound irrigation must be performed at appropriate emergency units. Excision and complete debridement of necrotic and contaminated tissue should also be performed. The Convention on Cluster Munitions of 2008 should be adhered to, as these weapons indiscriminately and disproportionately harm civilians, thereby violating the well-established international principles governing conflict. Copyright © 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Graves' disease associated with infectious mononucleosis due to primary Epstein-Barr virus infection: report of 3 cases.

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Akahori, Hiroshi; Takeshita, Yumie; Saito, Reina; Kaneko, Shuichi; Takamura, Toshinari

2010-01-01

Although the etiology of Graves' disease is still not clear, it is generally suggested that environmental factors such as infections contribute to the development of Graves' disease. We report here three cases of Graves' disease which presented simultaneously with infectious mononucleosis due to primary EBV infection. Acute EBV infection might play an important role in the onset of Graves' disease. These three women complained of a sore throat or neck pain, resembling subacute thyroiditis. In the case of thyrotoxicosis accompanied by sore throat or neck pain, Graves' disease must be distinguished from subacute thyroiditis.

Probiotics and child care absence due to infections

DEFF Research Database (Denmark)

Laursen, Rikke Pilmann; Larnkjær, Anni; Ritz, Christian

2017-01-01

OBJECTIVES: The risk of infections is higher in children attending child care compared with children cared for at home. This study examined the effect of a combination of probiotics on absence from child care because of respiratory and gastrointestinal infections in healthy infants aged 8 to 14...... range: 6-16). Intention-to-treat analysis showed no difference between the probiotics and placebo groups (P = .19). Additionally, there was no difference in any of the secondary outcomes between groups; the number of children with doctor-diagnosed upper or lower respiratory tract infections, the number...

Recurrent Chronic Ambulatory Peritoneal Dialysis-Associated Infection due to Rothia dentocariosa

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Shaun K Morris

2004-01-01

Full Text Available Rothia dentocariosa is a commensal organism of the human oropharynx. Clinical infection due to this organism is rare. A case of recurrent peritoneal dialysis-related peritonitis caused by R dentocariosa and a review of the literature is reported. Isolation of R dentocariosa from dialysate fluid should not be dismissed as a contaminant. Although there are no interpretive criteria for antimicrobial susceptibility testing, R dentocariosa appears to be susceptible to a variety of antibiotics including beta-lactams, vancomycin and aminoglycosides. Optimal therapy of peritoneal dialysis peritonitis caused by this organism may also require removal of the catheter.

CT-Guided Percutaneous Drainage of Infected Collections Due to Gastric Leak After Sleeve Gastrectomy for Morbid Obesity: Initial Experience

International Nuclear Information System (INIS)

Kelogrigoris, M.; Sotiropoulou, E.; Stathopoulos, K.; Georgiadou, V.; Philippousis, P.; Thanos, L.

2011-01-01

This study was designed to evaluate the efficacy and safety of computed tomography (CT)-guided drainage in treating infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity. From January 2007 to June 2009, 21 patients (9 men and 12 women; mean age, 39.2 (range, 26–52) years) with infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity underwent image-guided percutaneous drainage. All procedures were performed using CT guidance and 8- to 12-Fr pigtail drainage catheters. Immediate technical success was achieved in all 21 infected collections. In 18 of 21 collections, we obtained progressive shrinkage of the collection with consequent clinical success (success rate 86%). In three cases, the abdominal fluid collection was not resolved, and the patients were reoperated. Among the 18 patients who avoided surgery, 2 needed replacement of the catheter due to obstruction. No major complications occurred during the procedure. The results of our study support that CT-guided percutaneous drainage is an effective and safe method to treat infected abdominal fluid collections due to gastric leak in patients who had previously underwent laparoscopic sleeve gastrectomy for morbid obesity. It may be considered both as a preparatory step for surgery and a valuable alternative to open surgery. Failure of the procedure does not, however, preclude a subsequent surgical operation.

Pericytes for the treatment of orthopedic conditions.

Science.gov (United States)

James, Aaron W; Hindle, Paul; Murray, Iain R; West, Christopher C; Tawonsawatruk, Tulyapruek; Shen, Jia; Asatrian, Greg; Zhang, Xinli; Nguyen, Vi; Simpson, A Hamish; Ting, Kang; Péault, Bruno; Soo, Chia

2017-03-01

Pericytes and other perivascular stem cells are of growing interest in orthopedics and tissue engineering. Long regarded as simple regulators of angiogenesis and blood pressure, pericytes are now recognized to have MSC (mesenchymal stem cell) characteristics, including multipotentiality, self-renewal, immunoregulatory functions, and diverse roles in tissue repair. Pericytes are typified by characteristic cell surface marker expression (including αSMA, CD146, PDGFRβ, NG2, RGS5, among others). Although alone no marker is absolutely specific for pericytes, collectively these markers appear to selectively identify an MSC-like pericyte. The purification of pericytes is most well described as a CD146 + CD34 - CD45 - cell population. Pericytes and other perivascular stem cell populations have been applied in diverse orthopedic applications, including both ectopic and orthotopic models. Application of purified cells has sped calvarial repair, induced spine fusion, and prevented fibrous non-union in rodent models. Pericytes induce these effects via both direct and indirect mechanisms. In terms of their paracrine effects, pericytes are known to produce and secrete high levels of a number of growth and differentiation factors both in vitro and after transplantation. The following review will cover existing studies to date regarding pericyte application for bone and cartilage engineering. In addition, further questions in the field will be pondered, including the phenotypic and functional overlap between pericytes and culture-derived MSC, and the concept of pericytes as efficient producers of differentiation factors to speed tissue repair. Copyright © 2016. Published by Elsevier Inc.

Transient Pseudohypoaldosteronism due to Urinary Tract Infection in Infancy: A Report of 4 Cases

Directory of Open Access Journals (Sweden)

Kaplowitz Paul

2009-05-01

Full Text Available Hyponatremia with hyperkalemia in infancy is an uncommon but life-threatening occurrence. In the first weeks of life, this scenario is often associated with aldosterone deficiency due to salt-wasting congenital adrenal hyperplasia. However, alternative diagnoses involving inadequate mineralocorticoid secretion or action must be considered, particularly for infants one month of age or older. We report four infants who presented with profound hyponatremia accompanied by urinary tract infection, ultimately leading to the diagnosis of transient pseudohypoaldosteronism. Our cases provide support for the idea that the renal tubular resistance to aldosterone is due to urinary tract infection itself rather than to underlying urinary tract anomalies typically found in these infants. Awareness of this condition is important so that serum aldosterone, urine sodium, and urine cultures may be obtained immediately in any infant presenting with hyponatremia and hyperkalemia in whom a diagnosis of congenital adrenal hyperplasia was not found. Adequate replacement with intravenous saline and antibiotic therapy is sufficient to correct sodium levels over 24–48 hours.

Use of Common Inflammatory Markers in the Long-Term Screening of Total Hip Arthroprosthesis Infections: Our Experience

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Gabriele Falzarano

2017-01-01

Full Text Available Orthopedic implants have become essential components of modern medicine. The risk of infection of total hip arthroplasty (THA is 1.5%−2%. Are the C-reactive protein (CRP, the erythrocyte sedimentation rate (ESR, and procalcitonin (PCT good markers for THA infection screenings? From February 2009 to December 2012 at our Department of Orthopedics and Traumatology, 1248 patients were treated with THA. No prosthesis was cemented. All patients received antibiotic prophylaxis. All patients were discharged approximately 7.4 days after surgery with this clinical and radiographic follow-up program at 15 days and 1, 3, 6, 12, 24, and 36 months after surgery. Blood samples to determine ESR, CRP, and PCT values were taken at 1 hour before surgery and 15 days and 1, 3, 6, 12, 24, and 36 months after surgery. During follow-ups there were 22 cases of THA infections; according the Widmer classification, infections are hematogenous ones in 16 cases, late chronic ones in 5 cases, and early postoperative ones in 1 case. In all cases the three markers were considered positive; in 6 cases there were no radiological signs of septic loosening. ESR, CRP, and PCT proved to have a greater diagnostic accuracy than X-rays in predicting late chronic and early postoperative infections. These markers are valuable support for the surgeon in monitoring the prosthetic implant lifespan.

Pancreatic Abscess in a cat due to Staphylococcus aureus infection.

Science.gov (United States)

Nemoto, Yuki; Haraguchi, Tomoya; Shimokawa Miyama, Takako; Kobayashi, Kosuke; Hama, Kaori; Kurogouchi, Yosuke; Fujiki, Noriyuki; Baba, Kenji; Okuda, Masaru; Mizuno, Takuya

2017-07-07

A 16-year-old spayed female American Shorthair cat was presented with lethargy, anorexia, and wamble. Physical and blood examination did not reveal any remarkable findings. Abdominal ultrasonography identified the presence of a localized anechoic structure with a thick wall in contact with the small intestine and adjacent to the liver. Ultrasound-guided fine-needle aspiration of the structure revealed fluid containing numerous cocci and neutrophils. Two days after antibiotic treatment, exploratory laparotomy was performed and the content of the structure was removed before multiple lavages. The pathological and bacteriological examination results supported a confirmatory diagnosis of pancreatic abscess due to Staphylococcus aureus infection, making this the first such report in a cat. The cat remained healthy thereafter with no disease recurrence.

Long-term outcome of acute prosthetic joint infections due to gram-negative bacilli treated with retention of prosthesis.

Science.gov (United States)

Jaén, N; Martínez-Pastor, J C; Muñoz-Mahamud, E; García-Ramiro, S; Bosch, J; Mensa, J; Soriano, A

2012-09-01

To update the clinical information of the 47 patients with a prosthetic joint infection due to Gram-negative bacilli included in a previous study and to reassess the predictors of failure after a longer follow-up. Using the electronic files of our hospital, all the information regarding readmissions to the hospital, new surgical procedures and the reason for the new surgery (infection, aseptic loosening), and the last visit in the hospital were registered. The medical chart of the 35 patients that were considered in remission in the previous publication was reviewed. In 30 patients no clinical evidence of failure was detected and no additional surgery on the previously infected prosthesis was necessary and they were considered in long-term remission. In 5 cases a late complication was identified. One case had a reinfection due to coagulase-negative staphylococci after 22 months from the open debridement and required a 2-stage revision surgery. The other 4 cases developed an aseptic loosening and it was necessary to perform a 1-stage exchange. Receiving a fluoroquinolone when all the Gram-negatives involved in the infection were susceptible to fluoroquinolones was the only factor associated with remission in the univariate analysis (p=0.002). After a long-term follow-up, our results support the importance of using fluoroquinolones in acute PJI due to Gram-negative bacilli.

Role of F-18 FDG PET/CT in the management of infected abdominal aortic aneurysm due to salmonella

Energy Technology Data Exchange (ETDEWEB)

Choi, Seung Jin; Lee, Jin Soo; Cheong, Moon Hyun; Byun, Sung Su; Hyun, In Young [Inha University College of Medicine, Incheon (Korea, Republic of)

2007-12-15

We present a case of infected abdominal aortic aneurysm due to salmonella enteritidis. F-18 FDG PET/CT was performed to diagnosis and during follow-up after antibiotic treatment. Computed tomography (CT) is considered to be the best diagnostic imaging modality in infected aortic lesions. In this case, a combination of CT and FDG PET/CT provided accurate information for the diagnosis of infected abdominal aortic aneurysm. Moreover, FDG PET/CT made an important contribution of monitoring disease activity during antibiotic treatment.

Effects of obesity on rehabilitation outcomes after orthopedic trauma.

Science.gov (United States)

Vincent, Heather K; Seay, Amanda N; Vincent, Kevin R; Atchison, James W; Sadasivan, Kalia

2012-12-01

This study examined whether differences existed in inpatient rehabilitation outcomes and therapy participation in nonobese and obese patients with orthopedic trauma. This was a retrospective study of 294 consecutive patients admitted to an inpatient rehabilitation hospital. Main outcomes included participation in therapy sessions, Functional Independence Measure (FIM) ratings, walking distance and stair climb, length of stay, FIM efficiency (FIM score gain/length of stay), and discharge to home. Data were stratified by patient body mass index values (nonobese, obese, ≥30 kg/m). There were no differences in therapy participation or length of stay between groups. Both total and motor FIM ratings at discharge were lower in obese patients compared with nonobese patients (P obese than in the nonobese group (2.6 ± 1.5 vs. 3.1 ± 1.5 points gained per day; P = 0.05). Walking distance and stair climb ability were similar between groups by discharge. Even morbidly obese patients attained some improvement with independence in walking. Obese patients make significant functional improvement during rehabilitation, but at a lesser magnitude and rate as their nonobese counterparts. Even with morbid obesity, small but important functional gains can occur during rehabilitation for orthopedic trauma.

Placental abruption possibly due to parvovirus B19 infection.

Science.gov (United States)

Kawabe, Ayaka; Takai, Yasushi; Tamaru, Jun-Ichi; Samejima, Kouki; Seki, Hiroyuki

2016-01-01

There is concern about the development of anemia-associated fetal hydrops associated with maternal parvovirus B19 infection. Parvovirus B19 infection occurs via the globoside (P antigen) receptor, the main glycolipid of erythroid cells, which induces apoptosis. Similar findings have been reported for the P antigen of globoside-containing placental trophoblast cells. A 32-year-old woman was infected with human parvovirus B19 at week 32 of pregnancy, and had severe anemia at week 34. At week 37, an emergency cesarean section was performed because of sudden abdominal pain and fetal bradycardia; placental abruption was found. A live male infant was delivered with no sign of fetal hydrops or fetal infection. Placental tissue was positive for parvovirus B19 according to polymerase chain reaction. Immunohistochemical analysis using caspase-related M30 CytoDEATH monoclonal antibody revealed M30 staining of the placental villous trophoblasts. Placental trophoblasts and erythroid precursor cells have been reported to express globoside (P antigen), which is necessary for parvovirus B19 infectivity, and to show apoptotic activity as a result of infection. Placentas from three other pregnancies with documented abruption showed no M30 staining. The present case strongly suggests an association between placental abruption and apoptosis resulting from parvovirus B19 infection.

[On practicability of implementing the speciality "podiatry" in traumatology and orthopedics].

Science.gov (United States)

2011-01-01

The absence of single opinion concerning the classification of foot and ankle joint pathology does not permit to formulate universal and practical approach to the identification of pathological syndromes in case of patient foot lesion. The situation is aggravated by the unsolved issues related to the terminological definition of podiatry as a direction in orthopedics to solve the issues of foot and ankle joint pathology. In actual conditions the implementation of new technologies into the structure of traumatological orthopedics care is needed. This approach permits to combine the qualities of models of effective and optimized care to patients with foot and ankle joint pathology. The study of issue related to the systematization of podiatric pathology revealed that actually no single universal classification easy-to-use in practice exists. Hence the development of original applied working scheme of foot and ankle joint pathology is proposed.

Looking at the Social Activity for Adolescents with Orthopedic Impairments

Science.gov (United States)

Biastro, Leslie; Frank, Heather; Larwin, Karen H.

2015-01-01

Adolescents with identified orthopedic impairments are often less likely to participate in social activities outside of the school setting. However, the adolescents who are able to participate in activities have higher social skills, more academic successes, and show more satisfaction in their roles as family member or friend. The aim of this…

3D gait analysis with and without an orthopedic walking boot.

Science.gov (United States)

Gulgin, H; Hall, K; Luzadre, A; Kayfish, E

2018-01-01

Orthopedic walking boots have been widely used in place of traditional fiberglass casts for a variety of orthopedic injuries and post-surgical interventions. These walking boots create a leg length discrepancy (LLD). LLD has been shown to alter the kinematics and kinetics of gait and are associated with lumbar and lower limb conditions such as: foot over pronation, low back pain, scoliosis, and osteoarthritis of the hip and knee joints. Past gait analyses research with orthopedic boots is limited to findings on the ipsilateral limb. Thus, the purpose of the study was to examine bilateral gait kinematics & kinetics with and without a walking boot. Forty healthy participants (m=20, f=20, age 20.7±1.8 yrs., ht. 171.6±9.5cm, wt. 73.2±11.0kg, BMI 24.8±3.2) volunteered. An eight camera Vicon Motion Capture System with PIG model and two AMTI force plates were utilized to record the walking trial conditions: (1) bilateral tennis shoes (2) boot on right foot, tennis shoe on left foot (3) boot on right foot, barefoot on left foot. Data were processed in Nexus 2.2.3 and exported to Visual 3D for analysis. When wearing the boot, there were significant differences in most joint angles and moments, with larger effects on long limb. The walking boot alters the gait in the same way as those with existing LLD, putting them at risk for development of secondary knee, hip, and low back pain during treatment protocol. Copyright © 2017 Elsevier B.V. All rights reserved.

Clinical Nononcologic Applications of PET/CT and PET/MRI in Musculoskeletal, Orthopedic, and Rheumatologic Imaging.

Science.gov (United States)

Gholamrezanezhad, Ali; Basques, Kyle; Batouli, Ali; Matcuk, George; Alavi, Abass; Jadvar, Hossein

2018-06-01

With improvements in PET/CT and PET/MRI over the last decade, as well as increased understanding of the pathophysiology of musculoskeletal diseases, there is an emerging potential for PET as a primary or complementary modality in the management of rheumatologic and orthopedic conditions. We discuss the role of PET/CT and PET/MRI in nononcologic musculoskeletal disorders, including inflammatory and infectious conditions and postoperative complications. There is great potential for an increased role for PET to serve as a primary or complementary modality in the management of orthopedic and rheumatologic disorders.

Radiation injuries to the skeleton and their orthopedic treatment

International Nuclear Information System (INIS)

Franz, R.; Rahnfeld, R.

1978-01-01

70 patients subjected to orthopedic treatment and radiotherapy for skeletal tumors have been examined. It was found that serious radiation injuries frequently occurred. Above all there were contractures, disordered healing of wounds, ulcerations, and scolioses and kyphoses of the growing skeleton. Therefore, in the case of diseases of the skeleton, it is recommended to restrain radiotherapy. It has to be rejected in child's age

Snow Catastrophe Conditions: What is its Impact on Orthopedic Injuries?

Directory of Open Access Journals (Sweden)

Mohsen Mardani-Kivi

2014-06-01

Full Text Available Background:   Iran places sixth amongst high risk natural disaster countries and Guilan province of Iran shoulders a large amount of socio-economic burden due to snow catastrophes. The more knowledge of circumstances we have, the more efficient our future encounters will be. Methods: In this retrospective study, of all of the patients admitted to Poursina Hospital due to snow and ice related trauma in the first two weeks of February 2014, 306 cases were found eligible for entry into the present study. Results: Of the 306 eligible patients (383 injuries, there were 175 men (57.2% and 131 women (42.8%. Most patients suffered from orthopedic injuries (81% and the most common fractures were distal radius fractures in the upper extremities and hip fractures in the lower extremities. Slipping was the most common and motor vehicle accidents had the rarest injury mechanisms. It was shown that the frequency of injuries were higher on icy days (67.6% than snowy days (32.4%. Conclusions: Snow crises may lead to increased risk of slipping and falling situations, especially on icy days. The peak of injury rates is a few days after snowfall with the most common injury being distal radius fracture. Providing essential instructions and supporting resource allocation to better handle such catastrophes may improve outcomes.

Knowledge deficiency of work-related radiation hazards associated with psychological distress among orthopedic surgeons

Science.gov (United States)

Fan, Guoxin; Wang, Yueye; Guo, Changfeng; Lei, Xuefeng; He, Shisheng

2017-01-01

Abstract Knowledge and concern degree about work-related radiation hazards remained unknown among orthopedic surgeons. The aim of the cross-sectional study is to investigate whether the knowledge degree of work-related radiation is associated with psychological distress among orthopedic surgeons. This cross-sectional study sent electronic questionnaire via WeChat to orthopedic surgeons nationwide. Concern and knowing degree over radiation exposure was evaluated by a single self-reported question. Professional evaluation of concern degree was reflected by general psychological distress, which was assessed with the Kessler 10 scale (K10) and depressive symptoms with the Center for Epidemiologic Studies Depression Scale (CES-D). Only 43.23% (115/266) respondents knew well about radiation and a total of 78.20% (208/266) respondents considered radiation exposure as a great concern. Among those who reported concerns about radiation exposure, a total of 57.69% (120/208) respondents reported knowing little about radiation. Respondents who reported concerns over radiation exposure were significantly associated with higher scores on CES-D and K10 (P < .05). Among respondents who reported concerns over radiation exposure, those who have fewer knowledge about radiation, had higher CES-D and K10 scores than those who knew well about radiation (P < .05). Among respondents who reported no concerns over radiation exposure, those who knew little about radiation still had higher CES-D and K10 scores (P < .05). Fewer radiation knowledge tends to induce more radiation concerns associated with higher psychological distress in orthopedic surgeons. Radiation knowledge should be enhanced for surgeons who daily work with radiation-related fluoroscopy. PMID:28538368

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

Science.gov (United States)

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

2001-04-01

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

Glove perforation rate with orthopedic gloving versus double gloving technique in tibial plateau leveling osteotomy: A randomized trial

Science.gov (United States)

Egeler, Kimberly; Stephenson, Nicole; Stanke, Natasha

2016-01-01

In this randomized, prospective study, perforation rates, glove change rates, and cost between orthopedic gloves (n = 227) and double gloving with standard latex surgical gloves (n = 178) worn in tibial plateau leveling osteotomy procedures were compared. Gloves were collected from the surgeon and surgical resident after procedures and were tested for perforations with a standardized water leak test, as described by the American Society for Testing and Materials International. No statistically significant difference was found between the perforation rate using orthopedic gloving and double gloving techniques (P = 0.629) or the rate at which gloves were changed (P = 0.146). Orthopedic gloving was 2.1 times more costly than double gloving but they may be preferred by surgeons for dexterity and comfort. PMID:27807378

[Orthopedic management of spina bifida].

Science.gov (United States)

Biedermann, R

2014-07-01

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

Results of single-event multilevel orthopedic surgery in children with cerebral palsy

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Akhmed Tomov

2015-11-01

Full Text Available Background: Single-event multilevel orthopedic surgery is a modern approach in the operative treatment of children with cerebral palsy. Methods: Single-event multilevel orthopedic surgery was carried out in 108 patients with cerebral palsy. Patients’ average age was 11.3±1.7 years. Surgical results were analyzed at follow-up after 18 to 24 months, by way of detailed physical examination, functional assessment, imaging, the Edinburgh Visual Gait Score and Gillette Functional Assessment Questionnaire. Results: In our series, 647 procedures were performed during 141 surgeries. Patients had an average of 4.59 procedures per surgery. Observational gait analysis showed an improvement in stance and swing gait phases in ambulatory children. According to the Gillette Functional Assessment Questionnaire, an increase of functional level was noted in 50 patients but did not change in 32 patients. Conclusions: For children with cerebral palsy, single-event multilevel surgery is defined as two or more surgical procedures of the soft tissue or bone at two or more anatomical levels during one operative procedure. In cases where a large volume of surgery is required, two separate operations with a short break in between, but requiring only one hospital admission and one rehabilitation period, are also included. This approach requires adapted methods of surgical intervention, and appropriate methods of anesthesia and pain control in the postoperative period to the start of rehabilitation. Compliance with the above principles allowed the necessary correction of orthopedic complications to be achieved in all cases.

[Preliminary study on general safe medication regularity of Chinese patent orthopedic medicines based on adverse reaction/event literature analysis].

Science.gov (United States)

Wang, Yu-guang; Shi, Xin-yuan; Jin, Rui; Li, Hong-yan; Kong, Xiang-wen; Qiao, Yan-jiang

2015-03-01

Chinese patent orthopedic medicines feature complex components, mainly including desperate and toxic herbal pieces, narrow safety window, more clinical contraindications and frequent adverse drug reaction/events (ADR/ADE). To study the general safe medication regularity of Chinese patent orthopedic medicines, define key points in the medication education and ensure rational clinical medication, the authors took 80 types of commonly used Chinese patent orthopedic medicines as the study objects, collect 237 cases from 164 ADR/ADE documents through a system retrieval strategy, make a multidimensional literature analysis to determine the common risk factors for safe and rational medication of Chinese patent orthopedic medicines and establish an ADR/ADE prevention regularity. First, in the aspect of clinical symptoms, skin allergy is the most common ADR/ADE and closely related to the toxic ingredients, particularly accumulated liver or kidney damage caused by some drugs. Second, there are three time nodes in the ADR/ADE occurrence; The ADR/ADE occurred in 30 minutes is closely related to the idiosyncrasy; the ADR/ADE occurred between several months and half a year is related to the drug-induced liver and kidney damages; The most common ADR/ADE was observed within 7 days and predictable according to the pharmacological actions; Third, toxicity is an important factor in the occurrence of ADR/ADE of Chinese patent orthopedic medicines. Fourth, emphasis shall be given to the special medication factors, such as the combination with western medicines and Chinese herbal decoctions, overdose and long-course medication and self-medical therapy. In conclusion, the general ADR/ADE prevention regularity for Chinese patent orthopedic medicines was summarized to provide supports for clinicians in safe and rational medication and give the guidance for pharmacist in medication education.

Using the Integration of Discrete Event and Agent-Based Simulation to Enhance Outpatient Service Quality in an Orthopedic Department

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Cholada Kittipittayakorn

2016-01-01

Full Text Available Many hospitals are currently paying more attention to patient satisfaction since it is an important service quality index. Many Asian countries’ healthcare systems have a mixed-type registration, accepting both walk-in patients and scheduled patients. This complex registration system causes a long patient waiting time in outpatient clinics. Different approaches have been proposed to reduce the waiting time. This study uses the integration of discrete event simulation (DES and agent-based simulation (ABS to improve patient waiting time and is the first attempt to apply this approach to solve this key problem faced by orthopedic departments. From the data collected, patient behaviors are modeled and incorporated into a massive agent-based simulation. The proposed approach is an aid for analyzing and modifying orthopedic department processes, allows us to consider far more details, and provides more reliable results. After applying the proposed approach, the total waiting time of the orthopedic department fell from 1246.39 minutes to 847.21 minutes. Thus, using the correct simulation model significantly reduces patient waiting time in an orthopedic department.

Using the Integration of Discrete Event and Agent-Based Simulation to Enhance Outpatient Service Quality in an Orthopedic Department.

Science.gov (United States)

Kittipittayakorn, Cholada; Ying, Kuo-Ching

2016-01-01

Many hospitals are currently paying more attention to patient satisfaction since it is an important service quality index. Many Asian countries' healthcare systems have a mixed-type registration, accepting both walk-in patients and scheduled patients. This complex registration system causes a long patient waiting time in outpatient clinics. Different approaches have been proposed to reduce the waiting time. This study uses the integration of discrete event simulation (DES) and agent-based simulation (ABS) to improve patient waiting time and is the first attempt to apply this approach to solve this key problem faced by orthopedic departments. From the data collected, patient behaviors are modeled and incorporated into a massive agent-based simulation. The proposed approach is an aid for analyzing and modifying orthopedic department processes, allows us to consider far more details, and provides more reliable results. After applying the proposed approach, the total waiting time of the orthopedic department fell from 1246.39 minutes to 847.21 minutes. Thus, using the correct simulation model significantly reduces patient waiting time in an orthopedic department.

The Medical Education and Best Practice in Orthopedic Patient Care in Poland.

Science.gov (United States)

Rosiek, Anna; Leksowski, Krzysztof

2012-07-01

The leadership organization focuses on education, teamwork, customer relationship and developing strategy which help in building added value, in managing activities, time and quality. Everyday orthopedic experience shows that medical education is a mixture of: specific knowledge, skills and attitudes of people working together, and that creates effective teamwork in a hospital environment. Apart from the main reason of medical education, teaching about disease treatment and health problem solving, medical education should also concentrate on human factors and behavioral aspects of patient treatment in hospital.Assessment of an organization and medical education process by cultural and teamwork criteria, offers a powerful new way to think about performance at the frontlines of healthcare and in the future it could be gold standard for assessing the success of an organization, and standards in medical education, not only in orthopedics.

Noticeable Variations in the Educational Exposure During Residency in Danish Orthopedic Departments

DEFF Research Database (Denmark)

Brand, Eske; Fridberg, Marie; Knudsen, Ulrik Kragegaard

2016-01-01

. CONCLUSIONS: A large variation in the educational exposure was found among the Danish orthopedic departments. Numbers indicate that Danish residents, compared with their US counterparts, operate considerably less during residency. Most residents work overtime and many of them work for free to participate......OBJECTIVE: The objective of the study was to examine the educational exposure during residency in Danish orthopedic departments. DESIGN: Questionnaire-based cross-sectional study. SETTING: Data were gathered from January 1, 2014 to April 30, 2014 through a nationwide web-based questionnaire...... procedures as primary surgeon was 16 (range: 8-35) per month. In all, 18 of 22 (81%) departments offered the possibility to participate in research facilitated by the department and 38 of 96 (40%) worked for free (an average of 10h a month [range: 3-60]) to increase the amount of surgical procedures...

Engineered Chimeric Peptides as Antimicrobial Surface Coating Agents toward Infection-Free Implants.

Science.gov (United States)

Yazici, Hilal; O'Neill, Mary B; Kacar, Turgay; Wilson, Brandon R; Oren, E Emre; Sarikaya, Mehmet; Tamerler, Candan

2016-03-02

Prevention of bacterial colonization and consequent biofilm formation remains a major challenge in implantable medical devices. Implant-associated infections are not only a major cause of implant failures but also their conventional treatment with antibiotics brings further complications due to the escalation in multidrug resistance to a variety of bacterial species. Owing to their unique properties, antimicrobial peptides (AMPs) have gained significant attention as effective agents to combat colonization of microorganisms. These peptides have been shown to exhibit a wide spectrum of activities with specificity to a target cell while having a low tendency for developing bacterial resistance. Engineering biomaterial surfaces that feature AMP properties, therefore, offer a promising approach to prevent implant infections. Here, we engineered a chimeric peptide with bifunctionality that both forms a robust solid-surface coating while presenting antimicrobial property. The individual domains of the chimeric peptides were evaluated for their solid-binding kinetics to titanium substrate as well as for their antimicrobial properties in solution. The antimicrobial efficacy of the chimeric peptide on the implant material was evaluated in vitro against infection by a variety of bacteria, including Streptococcus mutans, Staphylococcus. epidermidis, and Escherichia coli, which are commonly found in oral and orthopedic implant related surgeries. Our results demonstrate significant improvement in reducing bacterial colonization onto titanium surfaces below the detectable limit. Engineered chimeric peptides with freely displayed antimicrobial domains could be a potential solution for developing infection-free surfaces by engineering implant interfaces with highly reduced bacterial colonization property.

Premature delivery due to intrauterine Candida infection that caused neonatal congenital cutaneous candidiasis: a case report.

Science.gov (United States)

Ito, Fumitake; Okubo, Tomoharu; Yasuo, Tadahiro; Mori, Taisuke; Iwasa, Koichi; Iwasaku, Kazuhiro; Kitawaki, Jo

2013-01-01

Congenital cutaneous candidiasis is a very rare disease with less than 100 cases published in the medical literature. Neonates having this disease present with systemic skin lesions caused by intrauterine Candida infections. We present a case of threatened premature delivery due to Candida chorioamnionitis, which caused both maternal postpartum endometritis and neonatal congenital cutaneous candidiasis. A 34-year-old woman who was admitted for fetal membrane bulging at 20 weeks of gestation underwent McDonald cervical cerclage. We diagnosed threatened premature delivery due to intrauterine infection; therefore, we terminated the gestation by cesarean section at 24 weeks of gestation. Fungi-like yeast was detected in infantile gastric juice. Histopathological findings of the placenta revealed that Candida albicans mycelium invaded the placenta, chorioamniotic membrane and umbilical cord. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

Specialized traumatological and orthopedic care for children through public-private partnership programs in the Novosibirsk region

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Tamara A Mylnikova

2016-03-01

Conclusions: Implementation of an organizational model of specialized traumatological and orthopedic care for children in the Novosibirsk region using mechanisms associated with public–private partnerships has proved to be very positive. Application of the model allowed improvements in the availability of specialized traumatological and orthopedic care for children to ensure succession in the stages of medical care and to increase the number of cases entering rehabilitation. Therefore, this model demonstrates the viability of providing medical care to the population through the mechanisms of public–private partnership.

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

Science.gov (United States)

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

2016-01-01

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

[Improving the effectiveness of functional jaw orthopedics in Class II malocclusion by appropriate treatment timing].

Science.gov (United States)

Baccetti, Tiziano

2010-12-01

Time can be considered the fourth dimension in dento-facial orthopedics. Treatment timing can play a significant role in the outcomes of treatment aimed to produce an orthopedic effect in the craniofacial structures. The results of methodologically-sound cephalometric studies of both the past and the recent history of orthodontics clearly indicate that optimal treatment timing for Class II skeletal disharmony with a functional appliance (e.g. twin block) is during or slightly after the peak in mandibular growth as revealed by a reliable biologic indicator of individual skeletal maturity such as the cervical vertebral maturation method. © EDP Sciences, SFODF, 2010.

Albumin and fibrinogen levels′ relation with orthopedics traumatic patients′ outcome after massive transfusion

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Mohammadreza Bazavar

2014-01-01

Full Text Available Background: Severe bleeding is common during limb trauma. It can lead to hemorrhagic shock required to massive blood transfusion. Coagulopathy is the major complication of massive transfusion-induced increased mortality rate. Aim of this study was evaluation of fibrinogen and albumin levels association with orthopedics traumatic patients′ outcome who received massive transfusion. Methods: In a cross sectional study, 23 patients with severe limb injury admitted to orthopedic emergency department were studied. All the patients received massive transfusion, that is, >10 unit blood. Albumin and fibrinogen levels are measured at admission and 24 h later, and compared according to final outcome. Results: Twenty-three traumatic patients with severe limb injuries were studied, out of which ten (43.2% died and 13 (56.8% were alive. There was significant difference between patients outcome in fibrinogen level after 24 h, but no difference was observed in albumin levels. Based on regression model, fibrinogen after 24 h had a significant role in determining the final outcome in traumatic patients who received massive transfusion (odds ratio 0.48, 95% confidence interval 0.15-0.92, P = 0.02. Conclusions: According to our results, fibrinogen level is the most important factor in determination of orthopedics traumatic patients when received massive transfusion. However, serum albumin does not play any role in patients′ outcome.

Future Research Opportunities in Peri-Prosthetic Joint Infection Prevention.

Science.gov (United States)

Berbari, Elie; Segreti, John; Parvizi, Javad; Berríos-Torres, Sandra I

Peri-prosthetic joint infection (PJI) is a serious complication of prosthetic joint arthroplasty. A better understanding and reversal of modifiable risk factors may lead to a reduction in the incidence of incisional (superficial and deep) and organ/space (e.g., PJI) surgical site infections (SSI). Recently, the Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) published the Guideline for Prevention of Surgical Site Infection. This targeted update applies evidence-based methodology in drafting recommendations for potential strategies to reduce the risk of SSI both across surgical procedures and specifically in prosthetic joint arthroplasty. A panel of PJI content experts identified nine PJI prevention research opportunities based on both evidence gaps identified through the guideline development process (transfusion, immunosuppressive therapy, anticoagulation, orthopedic space suit, and biofilm) and expert opinion (anesthesia, operative room environment, glycemic control, and Staphylococcus aureus nasal screening and decolonization. This article offers a road map for PJI prevention research.

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

Science.gov (United States)

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

2016-01-01

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

Biosynthetic graft failure to replace infected infrainguinal bypass as developing infection due to Morganella morganii leading to disrupture of the anastomosis. Case report

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Gladiol Zenunaj

Full Text Available Introduction: Biosynthetic prosthesis has become the trend to carry out arterial reconstruction in infected sites since considered to be resistant to infection. Late graft occlusion is the only complication reported in literature so far. We report a case of biosynthetic graft infection which led to early detachment of the femoral anastomosis of a femoral-popliteal above-knee bypass. Material: A 76-year-old man developed groin infection 3 months later after performing an ePTFE femoral-popliteal above-knee bypass for critical limb ischemia. He was re-admitted for groin infection involving the vascular structures. Explantation of the existing bypass and its replacement with a biosynthetic graft (omniflow II was performed. Detachment of the proximal anastomosis occurred 6 days later leading to groin haematoma. Consequently, retroperitoneal access was performed for clamping the external iliac artery so as to control haemorrhage followed by explantation of the biosynthetic graft. An external iliac-popliteal above-knee bypass was tailored in order to save the limb and it was performed using a transobturator approach avoiding the infected site. In both cases bacterial cultures resulted positive for Morganella Morganii. The groin wound was treated separately with negative pressure medication healing definitively within 20 days and after 3-month follow-up the bypass was still patent. Conclusion: This is the first report of biosynthetic graft infection used for infrainguinal reconstruction leading to haemorrhage due to anastomosis disrupture. Using an extra-anatomical access for providing blood inflow to the leg avoiding the infected site and treating safely the groin wound with VAC therapy revealed to be a valid approach. Keywords: Infrainguinal bypass, Graft infection, Biosynthetic material, Graft occlusion, Negative pressure medication, Morganella morgani

Nuclear magnetic resonance imaging in orthopedics

International Nuclear Information System (INIS)

Peters, P.E.; Matthiass, H.H.; Reiser, M.

1990-01-01

NMR imaging (MR tomography) allows the non-invasive diagnostic evaluation of cartilage, ligaments, tendons and muscles of the limbs, joints and the vertebral spine. The images are characterized by a good spatial resolution, and in contrast to the X-ray CT, sectional images can be done in all planes, as well as three-dimensional image reconstructions. The book reviews the current state of the art and foreseeable developments of NMR imaging of the supporting and connective tissue, also discussing the application of paramagnetic contrast media, and the novel NMR spectroscopy as a method pointing into the future. All contributions discussing the clinical aspects have been written jointly by experts in orthopedics and radiology. (orig.) With 153 figs., 8 tabs [de

Presurgical cleft lip and palate orthopedics: an overview

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Alzain I

2017-05-01

Full Text Available Ibtesam Alzain,1 Waeil Batwa,2 Alex Cash,3 Zuhair A Murshid2 1Pediatric Dentistry, 2Orthodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 3Cleft Lip and Palate Orthodontics, Queen Victoria NHS Foundation Trust, South Thames Cleft Service, London, UK Abstract: Patients with cleft lip and/or palate go through a lifelong journey of multidisciplinary care, starting from before birth and extending until adulthood. Presurgical orthopedic (PSO treatment is one of the earliest stages of this care plan. In this paper we provide a review of the PSO treatment. This review should help general and specialist dentists to better understand the cleft patient care path and to be able to answer patient queries more efficiently. The objectives of this paper were to review the basic principles of PSO treatment, the various types of techniques used in this therapy, and the protocol followed, and to critically evaluate the advantages and disadvantages of some of these techniques. In conclusion, we believe that PSO treatment, specifically nasoalveolar molding, does help to approximate the segments of the cleft maxilla and does reduce the intersegment space in readiness for the surgical closure of cleft sites. However, what we remain unable to prove equivocally at this point is whether the reduction in the dimensions of the cleft presurgically and the manipulation of the nasal complex benefit our patients in the long term. Keywords: presurgical orthopedic, nasoalveolar molding, cleft lip and palate

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

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Pascale Rialland

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

Zor İyileşen Alt Ekstremite Yaralarının Tedavisinde Negatif Basınçlı Yara Tedavi Yönteminin Etkinliği ve Sonuçları

OpenAIRE

Aygün, Hayati; Çakar, Albert; Atilla, Atıl; Irlayıcı, Bilgin; Aytekin, Mahmut; Ağır, İsmail; İslam, Cihangir

2014-01-01

Aim: The chronic infected wounds are commonly encountered in the orthopedic practice and occur due to several etiological factors. They are responsible for serious morbidity and mortality. Regardless of the etiology, the underlying factors at these wounds are healing problems and predisposition to infection due to microvascular insufficiency. There are several methods for the treatment of these wounds. One of them is vacuum assisted closure systems (VAC) or negative pressure wound therapy (NP...

Anti-MOG antibody-positive ADEM following infectious mononucleosis due to a primary EBV infection: a case report.

Science.gov (United States)

Nakamura, Yoshitsugu; Nakajima, Hideto; Tani, Hiroki; Hosokawa, Takafumi; Ishida, Shimon; Kimura, Fumiharu; Kaneko, Kimihiko; Takahashi, Toshiyuki; Nakashima, Ichiro

2017-04-19

Anti-Myelin oligodendrocyte glycoprotein (MOG) antibodies are detected in various demyelinating diseases, such as pediatric acute disseminated encephalomyelitis (ADEM), recurrent optic neuritis, and aquaporin-4 antibody-seronegative neuromyelitis optica spectrum disorder. We present a patient who developed anti-MOG antibody-positive ADEM following infectious mononucleosis (IM) due to Epstein-Barr virus (EBV) infection. A 36-year-old healthy man developed paresthesia of bilateral lower extremities and urinary retention 8 days after the onset of IM due to primary EBV infection. The MRI revealed the lesions in the cervical spinal cord, the conus medullaris, and the internal capsule. An examination of the cerebrospinal fluid revealed pleocytosis. Cell-based immunoassays revealed positivity for anti-MOG antibody with a titer of 1:1024 and negativity for anti-aquaporin-4 antibody. His symptoms quickly improved after steroid pulse therapy followed by oral betamethasone. Anti-MOG antibody titer at the 6-month follow-up was negative. This case suggests that primary EBV infection would trigger anti-MOG antibody-positive ADEM. Adult ADEM patients can be positive for anti-MOG antibody, the titers of which correlate well with the neurological symptoms.

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

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Buchbinder Rachelle

2008-07-01

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

Multiorgan involvement due to cytomegalovirus infection in AIDS

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Shounak Majumder

Full Text Available Cytomegalovirus (CMV infection is a relatively late complication of AIDS. Like other viruses contributing to co-morbidity of HIV infection, cytomegalovirus has the propensity to cause multiorgan involvement. We report the case of a 34-year-old seropositive man who presented with bilateral lower limb weakness and symptomatic pallor. He was already on antiretroviral drugs for a month prior to presentation. Detailed clinical examination and laboratory investigations revealed cytomegalovirus polyradiculoneuropathy associated with bone marrow dysplasia. Dysplasia of haematopoeitic cell lines occurs in 30% to 70% of HIV infected patients, and is often indistinguishable from myelodysplastic syndrome. However, in our case, the bone marrow picture reverted back to normal with treatment of the CMV infection, pointing to a possible role of CMV as the causative agent of bone marrow dysplasia. Moreover, CMV has been incriminated as a pathogen producing the immune reconstitution inflammatory syndrome. The onset of the disease in our case one month after initiation of HAART strongly raises the possibility of this being a case of CMV related IRIS. This is the first reported case where IRIS has presented with CMV polyradiculoneuropathy and bone marrow dysplasia. We would like to highlight that in today's era of HIV care, clinicians should be aware of the possibility of multiorgan involvement by CMV, for appropriate management of this disease in the background of AIDS.

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

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Mehrdad Taheri

2017-12-01

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

[Implementation of the eLearning project NESTOR. A network for students in traumatology and orthopedics].

Science.gov (United States)

Back, D A; Haberstroh, N; Hoff, E; Plener, J; Haas, N P; Perka, C; Schmidmaier, G

2012-01-01

Modern internet-based information technologies offer great possibilities to create and improve teaching methods for students. The eLearning tool NESTOR (Network for Students in Traumatology and Orthopedics) presented here was designed to complement the existing clinical teaching in orthopedics and traumatology at the Charité, University Medicine Berlin. Using a learning management system, videos, podcasts, X-ray diagnosis, virtual patients, tests and further tools for learning and study information were combined. After implementation the eLearning project was evaluated by students. The NESTOR project offers various possibilities for knowledge acquisition. Students using the program voluntarily showed a high acceptance whereby 82.4% were very satisfied with the contents offered and 95.3% supported the idea of a future use of NESTOR in teaching. The blended learning approach was positively evaluated by 93.5% of the students. The project received the eLearning seal of quality of the Charité University Medicine Berlin. Using complex eLearning tools, such as the NESTOR project represents a contemporary teaching approach in the teaching of traumatology and orthopedics and should be offered in a blended learning context as they are well accepted by students.

Evaluation of Osseous Integration of PVD-Silver-Coated Hip Prostheses in a Canine Model

Directory of Open Access Journals (Sweden)

Gregor Hauschild

2015-01-01

Full Text Available Infection associated with biomaterials used for orthopedic prostheses remains a serious complication in orthopedics, especially tumor surgery. Silver-coating of orthopedic (megaprostheses proved its efficiency in reducing infections but has been limited to surface areas exposed to soft tissues due to concerns of silver inhibiting osseous integration of cementless stems. To close this gap in the bactericidal capacity of silver-coated orthopedic prostheses extension of the silver-coating on surface areas intended for osseous integration seems to be inevitable. Our study reports about a PVD- (physical-vapor-deposition- silver-coated cementless stem in a canine model for the first time and showed osseous integration of a silver-coated titanium surface in vivo. Radiological, histological, and biomechanical analysis revealed a stable osseous integration of four of nine stems implanted. Silver trace elemental concentrations in serum did not exceed 1.82 parts per billion (ppb and can be considered as nontoxic. Changes in liver and kidney functions associated with the silver-coating could be excluded by blood chemistry analysis. This was in accordance with very limited metal displacement from coated surfaces observed by laser ablation inductively coupled plasma-mass spectrometry (LA-ICP-MS 12 months after implantation. In conclusion our results represent a step towards complete bactericidal silver-coating of orthopedic prostheses.

Evaluation of osseous integration of PVD-silver-coated hip prostheses in a canine model.

Science.gov (United States)

Hauschild, Gregor; Hardes, Jendrik; Gosheger, Georg; Stoeppeler, Sandra; Ahrens, Helmut; Blaske, Franziska; Wehe, Christoph; Karst, Uwe; Höll, Steffen

2015-01-01

Infection associated with biomaterials used for orthopedic prostheses remains a serious complication in orthopedics, especially tumor surgery. Silver-coating of orthopedic (mega)prostheses proved its efficiency in reducing infections but has been limited to surface areas exposed to soft tissues due to concerns of silver inhibiting osseous integration of cementless stems. To close this gap in the bactericidal capacity of silver-coated orthopedic prostheses extension of the silver-coating on surface areas intended for osseous integration seems to be inevitable. Our study reports about a PVD- (physical-vapor-deposition-) silver-coated cementless stem in a canine model for the first time and showed osseous integration of a silver-coated titanium surface in vivo. Radiological, histological, and biomechanical analysis revealed a stable osseous integration of four of nine stems implanted. Silver trace elemental concentrations in serum did not exceed 1.82 parts per billion (ppb) and can be considered as nontoxic. Changes in liver and kidney functions associated with the silver-coating could be excluded by blood chemistry analysis. This was in accordance with very limited metal displacement from coated surfaces observed by laser ablation inductively coupled plasma-mass spectrometry (LA-ICP-MS) 12 months after implantation. In conclusion our results represent a step towards complete bactericidal silver-coating of orthopedic prostheses.

Emergence of Clostridium difficile infection due to a new hypervirulent strain, polymerase chain reaction ribotype 078

NARCIS (Netherlands)

Goorhuis, Abraham; Bakker, Dennis; Corver, Jeroen; Debast, Sylvia B.; Harmanus, Celine; Notermans, Daan W.; Bergwerff, Aldert A.; Dekker, Frido W.; Kuijper, Ed J.

2008-01-01

Since 2005, an increase in the prevalence of Clostridium difficile infection (CDI) due to polymerase chain reaction ribotype 078 has been noticed in The Netherlands. This strain has also been identified as the predominant strain in pigs and calves. CDI caused by type 078 was studied in relation to

Severe prosthetic joint infection in an immunocompetent male patient due to a therapy refractory Pseudallescheria apiosperma.

NARCIS (Netherlands)

Lackner, M.; Man, F.H. de; Eygendaal, D.; Wintermans, R.G.; Kluytmans, J.A.; Klaassen, C.H.; Meis, J.F.G.M.

2011-01-01

Prosthetic joint infections (PJI) are rarely due to fungal agents and if so they are mainly caused by Candida strains. This case represents a PJI caused by a multi-drug resistant Pseudallescheria apiosperma, with poor in vivo response to itraconazole and voriconazole. This case differs also by the

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

Science.gov (United States)

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

2018-04-27

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

Optimal diagnosis, prevention, and management of periprosthetic joint infection

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Tafer N

2015-01-01

Full Text Available Nathalie Tafer,1 Wilson Belaieff,1 Céline Cuérel,1 Matthieu Zingg,1 Pierre Hoffmeyer,1 Ilker Uçkay1,2 1Orthopedic Surgery Department, 2Division of Infectious Diseases, University of Geneva Hospitals and Medical School, Geneva, Switzerland Abstract: The pace of the aging population is steadily rising worldwide with a parallel increase in the demand for joint replacement procedures. With the increasing number of patients undergoing arthroplasty, there is also an increased risk for arthroplasty infection that may lead to severe complications, poorer outcome, and substantial extra costs for health care systems. Current rates of prosthetic joint infection are not dramatically different from the 1960s or 1970s, but some general principles are now better defined, and their management has been studied extensively during the past decades, thus resulting in a change in clinical practice. The purpose of this review is to summarize important principles of prosthetic joint infection to guide the clinician and to contribute to the optimal diagnosis, prevention, and management of periprosthetic joint infections. Keywords: arthroplasty infection, antibiotic therapy, biofilm, surgery, prevention

Infected primary knee arthroplasty: Risk factors for surgical treatment failure

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Joao Gabriel Duarte Paes Pradella

2013-09-01

Full Text Available OBJECTIVE: To present epidemiological data and risk factors associated with surgical out-comes favorable or unfavorable for the treatment of infection in infected total knee arthroplasty. METHODS: We reviewed medical records of 48 patients who underwent treatment of primary total knee arthroplasty for infection between January 1994 and December 2008, in the Orthopedics and Traumatology Department of the Santa Casa de Misericórdia de São Paulo. The variables associated with favorable outcome of surgical treatment (debridement and retention or exchange arthroplasty in two days or unfavorable (arthrodesis or death infection. RESULTS: A total of 39 cases of infection after primary total knee arthroplasty, 22 progressed to 17 for a favorable outcome and unfavorable outcome. Early infections (OR: 14.0, 95% CI 1.5-133.2, p = 0.016 and diabetes (OR: 11.3, 95% CI 1.4-89.3, p = 0.032 were associated with arthrodesis joint and death respectively. CONCLUSION: Patients with early infection had a higher risk of developing surgical procedure with unfavorable outcome (arthrodesis and diabetics had higher odds of death after infection of primary knee arthroplasties.

Patient Satisfaction Is Associated With Time With Provider But Not Clinic Wait Time Among Orthopedic Patients.

Science.gov (United States)

Patterson, Brendan M; Eskildsen, Scott M; Clement, R Carter; Lin, Feng-Chang; Olcott, Christopher W; Del Gaizo, Daniel J; Tennant, Joshua N

2017-01-01

Clinic wait time is considered an important predictor of patient satisfaction. The goal of this study was to determine whether patient satisfaction among orthopedic patients is associated with clinic wait time and time with the provider. The authors prospectively enrolled 182 patients at their outpatient orthopedic clinic. Clinic wait time was defined as the time between patient check-in and being seen by the surgeon. Time spent with the provider was defined as the total time the patient spent in the examination room with the surgeon. The Consumer Assessment of Healthcare Providers and Systems survey was used to measure patient satisfaction. Factors associated with increased patient satisfaction included patient age and increased time with the surgeon (P=.024 and P=.037, respectively), but not clinic wait time (P=.625). Perceived wait time was subject to a high level of error, and most patients did not accurately report whether they had been waiting longer than 15 minutes to see a provider until they had waited at least 60 minutes (P=.007). If the results of the current study are generalizable, time with the surgeon is associated with patient satisfaction in orthopedic clinics, but wait time is not. Further, the study findings showed that patients in this setting did not have an accurate perception of actual wait time, with many patients underestimating the time they waited to see a provider. Thus, a potential strategy for improving patient satisfaction is to spend more time with each patient, even at the expense of increased wait time. [Orthopedics. 2017; 40(1):43-48.]. Copyright 2016, SLACK Incorporated.

A Systematic Review of Early Prognostic Factors for Persistent Pain Following Acute Orthopedic Trauma

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Fiona J Clay

2012-01-01

Full Text Available Persistent or chronic pain is prevalent in many developed countries, with estimates ranging from 10% to higher than 50%, and is a major economic burden to individuals and societies. However, the variation in pain outcomes after acute orthopedic trauma and treatment confronts treating physicians with uncertainty in providing prognostic advice regarding long-term recovery. Although several previous reviews have addressed the determinants of chronic pain outcomes secondary to acute trauma, they have primarily focused on specific injury samples and, furthermore, lack consistency with respect to the important prognostic factors, which limits the generalizability of findings. This review, however, aimed specifically to identify the early prognostic factors associated with variation in persistent pain outcomes following acute orthopedic trauma presenting with a spectrum of pathologies.

Anodization: a promising nano-modification technique of titanium implants for orthopedic applications.

Science.gov (United States)

Yao, Chang; Webster, Thomas J

2006-01-01

Anodization is a well-established surface modification technique that produces protective oxide layers on valve metals such as titanium. Many studies have used anodization to produce micro-porous titanium oxide films on implant surfaces for orthopedic applications. An additional hydrothermal treatment has also been used in conjunction with anodization to deposit hydroxyapatite on titanium surfaces; this is in contrast to using traditional plasma spray deposition techniques. Recently, the ability to create nanometer surface structures (e.g., nano-tubular) via anodization of titanium implants in fluorine solutions have intrigued investigators to fabricate nano-scale surface features that mimic the natural bone environment. This paper will present an overview of anodization techniques used to produce micro-porous titanium oxide structures and nano-tubular oxide structures, subsequent properties of these anodized titanium surfaces, and ultimately their in vitro as well as in vivo biological responses pertinent for orthopedic applications. Lastly, this review will emphasize why anodized titanium structures that have nanometer surface features enhance bone forming cell functions.

Comprehensive clinical and epidemiological assessment of colonisation and infection due to carbapenemase-producing Enterobacteriaceae in Spain.

Science.gov (United States)

Palacios-Baena, Zaira R; Oteo, Jesús; Conejo, Carmen; Larrosa, M Nieves; Bou, Germán; Fernández-Martínez, Marta; González-López, Juan José; Pintado, Vicente; Martínez-Martínez, Luis; Merino, María; Pomar, Virginia; Mora-Rillo, Marta; Rivera, María Alba; Oliver, Antonio; Ruiz-Carrascoso, Guillermo; Ruiz-Garbajosa, Patricia; Zamorano, Laura; Bautista, Verónica; Ortega, Adriana; Morales, Isabel; Pascual, Álvaro; Campos, José; Rodríguez-Baño, Jesús

2016-02-01

Most available information on carbapenemase-producing Enterobacteriaceae (CPE) is usually associated with specific types of infection or patient or with descriptions of outbreaks. The aim of this study was to comprehensively analyse the clinical epidemiology, clinical features and outcomes of colonisation and infections due to CPE in Spain. A multicentre prospective cohort study was carried out in 34 Spanish hospitals from February to May 2013. All new patients testing positive for CPE in clinical samples were included. Logistic regression was used to identify predictors of mortality. Overall, 245 cases were included. The most frequent organism was Klebsiella pneumoniae (74%) and the carbapenemases belonged to the OXA-48 (74%), metallo-β-lactamase (MBL) (24%) and KPC (2%) groups. Acquisition was nosocomial in 145 cases (60%) and healthcare-associated (HCA) in 91 (37%); 42% of the latter were nursing home residents, in whom OXA-48-producing K. pneumoniae ST405 predominated. MBLs and OXA-48 predominated in ICU and medical patients, respectively. Overall, 67% of patients had infections. The most frequent infections identified in this study were urinary tract (43%) and skin structure (21%) infections, and 10% of infections were bacteraemic. Crude mortality was 20%. Inappropriate antibiotic therapy was independently associated with an increased risk of death (OR = 3.30; 95% CI: 1.34-8.11). We found some differences in the epidemiology of CPE depending on the type of carbapenemase produced. Although a low proportion of CPE infections were bacteraemic, active antibiotic therapy was a protective factor for reducing mortality. Copyright © 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

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

Science.gov (United States)

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

2016-01-01

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

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

Science.gov (United States)

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

2014-01-01

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

Tuberculosis due to Mycobacterium bovis in humans in the south-west region of Ireland: is there a relationship with infection prevalence in cattle?

LENUS (Irish Health Repository)

Cotter, T P

2012-02-03

OBJECTIVE: To compare the incidence of tuberculosis due to Mycobacterium bovis in humans to the prevalence of M. bovis infection in cattle in south-west Ireland and discuss possible links between them. SETTING: In the south-west region of Ireland, a mixed urban and rural community (pop. 536,000), there is a residuum of human tuberculosis caused by M. bovis. METHODS: A retrospective analysis of the incidence of culture-positive M. bovis disease in humans in south-west Ireland from 1983 to 1994 and of the results of tuberculin testing in cattle from 1978 to 1994 for the same region. RESULTS: One to five cases of human tuberculosis due to M. bovis were recorded per year while the overall prevalence of bovine infection fell gradually during the period of study from 467 tuberculin-positive animals per 100,000 cattle tested in 1983 to 158 per 100,000 in 1994. CONCLUSION: The low incidence plateau of human tuberculosis due to M. bovis together with the decline in prevalence of animal infection in the overall period studied suggest a cut-off in the animal to human chain of infection at two points; the animal source and the ingestion of (now pasteurized) milk. This would suggest that disease in humans is now due to reactivation of previous foci of infection which were acquired when milk pasteurization was not compulsory. Based on this, we would anticipate a further reduction and possible elimination of human tuberculosis due to M. bovis in this region in the next 10-15 years.

Medication Review and Patient Outcomes in an Orthopedic Department

DEFF Research Database (Denmark)

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

2015-01-01

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

Orthopedic surgery in cerebral palsy: Instructional course lecture

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Deepak Sharan

2017-01-01

Full Text Available Orthopedic surgery (OS plays an important role in the management of cerebral palsy (CP. The objectives of OS are to optimize functions and prevent deformity. Newer developments in OS for CP include emphasis on hip surveillance, minimally invasive procedures, use of external fixators instead of plates and screws, better understanding of lever arm dysfunctions (that can only be corrected by bony OS, orthopedic selective spasticity-control surgery, and single-event multilevel lever arm restoration and anti spasticity surgery, which have led to significant improvements in gross motor function and ambulation, especially in spastic quadriplegia, athetosis, and dystonia. The results of OS can be dramatic and life altering for the person with CP and their caregivers if it is performed meticulously by a specialized surgical team, at the appropriate age, for the correct indications, employing sound biomechanical principles and is followed by physician-led, protocol based, intensive, multidisciplinary, institutional rehabilitation, and long term followup. However, OS can be a double-edged sword, and if performed less than optimally, and without the supporting multidisciplinary medical and rehabilitation team, expertise and infrastructure, it often leads to significant functional worsening of the person with CP, including irretrievable loss of previous ambulatory capacity. OS must be integrated into the long term management of the person with CP and should be anticipated and planned at the optimal time and not viewed as a “last resort” intervention or failure of rehabilitation. This instructional course lecture reviews the relevant contemporary principles and techniques of OS in CP.

Marijuana use and mortality following orthopedic surgical procedures.

Science.gov (United States)

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

2018-03-20

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

Increasing Resistance of Coagulase-Negative Staphylococci in Total Hip Arthroplasty Infections: 278 THA-Revisions due to Infection Reported to the Norwegian Arthroplasty Register from 1993 to 2007

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Olav Lutro

2014-01-01

Full Text Available We investigated bacterial findings from intraoperative tissue samples taken during revision due to infection after total hip arthroplasty (THA. The aim was to investigate whether the susceptibility patterns changed during the period from 1993 through 2007. Reported revisions due to infection in the Norwegian Arthroplasty Register (NAR were identified, and 10 representative hospitals in Norway were visited. All relevant information on patients reported to the NAR for a revision due to infection, including bacteriological findings, was collected from the medical records. A total of 278 revision surgeries with bacterial growth in more than 2 samples were identified and included. Differences between three 5-year time periods were tested by the chi-square test for linear trend. The most frequent isolates were coagulase-negative staphylococci (CoNS (41%, 113/278 and Staphylococcus aureus (19%, 53/278. The proportion of CoNS resistant to the methicillin-group increased from 57% (16/28 in the first period, 1993–1997, to 84% (52/62 in the last period, 2003–2007 (P = 0.003. There was also significant increase in resistance for CoNS to cotrimoxazole, quinolones, clindamycin, and macrolides. All S. aureus isolates were sensitive to both the methicillin-group and the aminoglycosides. For the other bacteria identified no changes in susceptibility patterns were found.

Septic arthritis due to tubercular and Aspergillus co-infection

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Mukesh Kumar

2016-01-01

Full Text Available Aspergillus septic arthritis is a rare and serious medical and surgical problem. It occurs mainly in immunocompromised patients. Aspergillus fumigatus is the most common causative organism followed by Aspergillus flavus. The most common site affected is knee followed by shoulder, ankle, wrist, hip and sacroiliac joint. Debridement and voriconazole are primary treatment of articular aspergilosis. To the best of our knowledge, there are no reported cases of co-infection of tuberculosis (TB and Aspergillus infecting joints. We report a case of co-infection of TB and A. flavus of hip and knee of a 60-year-old male, with type 2 diabetes mellitus. He was treated with debridement, intravenous voriconazole, and antitubercular drugs.

Septic arthritis due to tubercular and Aspergillus co-infection.

Science.gov (United States)

Kumar, Mukesh; Thilak, Jai; Zahoor, Adnan; Jyothi, Arun

2016-01-01

Aspergillus septic arthritis is a rare and serious medical and surgical problem. It occurs mainly in immunocompromised patients. Aspergillus fumigatus is the most common causative organism followed by Aspergillus flavus. The most common site affected is knee followed by shoulder, ankle, wrist, hip and sacroiliac joint. Debridement and voriconazole are primary treatment of articular aspergilosis. To the best of our knowledge, there are no reported cases of co-infection of tuberculosis (TB) and Aspergillus infecting joints. We report a case of co-infection of TB and A. flavus of hip and knee of a 60-year-old male, with type 2 diabetes mellitus. He was treated with debridement, intravenous voriconazole, and antitubercular drugs.

Acquired ventricular septal defect due to infective endocarditis

Directory of Open Access Journals (Sweden)

Randi E Durden

2018-01-01

Full Text Available Acquired intracardiac left-to-right shunts are rare occurrences. Chest trauma and myocardial infection are well-known causes of acquired ventricular septal defect (VSD. There have been several case reports describing left ventricle to right atrium shunt after infective endocarditis (IE. We present here a patient found to have an acquired VSD secondary to IE of the aortic and tricuspid valves in the setting of a known bicuspid aortic valve. This is the first case reported of acquired VSD in a pediatric patient in the setting of IE along with literature review of acquired left-to-right shunts.

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

Science.gov (United States)

Markatos, Konstantinos; Korres, Demetrios

2016-10-01

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

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

Science.gov (United States)

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

2016-01-01

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

Prevalence and antibiotic resistance of 15 minor staphylococcal species colonizing orthopedic implants.

Science.gov (United States)

Arciola, C R; Campoccia, D; An, Y H; Baldassarri, L; Pirini, V; Donati, M E; Pegreffi, F; Montanaro, L

2006-04-01

Several species belonging to Staphylococcus genus (non Sau/ non Sep species) exhibit increasing abilities as opportunistic pathogens in colonisation of periprosthesis tissues. Here we report on antibiotic resistance of 193 strains, belonging to non Sau/ non Sep species, consecutively collected from orthopedic implant infections in a period of about 40 months. The 193 strains (representing 17% of all staphylococci isolated) were analysed for their antibiotic resistance to 16 different drugs. Five species turned out more prevalent, ranging from 1 to 5%: S. hominis (4.2%), S. haemolyticus (3.7%), S. capitis (2.7%), S. warneri (2.6%), and S. cohnii (1.6%). Among these, the prevalence of antibiotic resistance to penicillins was similar, ranging from 51% to 66%. Conversely, significant differences were observed for all the remaining antibiotics. For S. haemolyticus the resistances to oxacillin and imipenem, the four aminoglycosides and erythromycin were at least twice that of the other three species which were compared. S. warneri was on the contrary the species with the lowest occurrence of resistant strains. Ten species appeared only rarely at the infection sites: S. lugdunensis, S. caprae, S. equorum, S. intermedius, S. xylosus, S. simulans, S. saprophyticus, S. pasteuri, S. sciuri, and S. schleiferi. The behaviours of these species, often resistant to penicillins, were individually analysed. Differences in both the frequencies and the panels of antibiotic resistances observed among the non Sau/ non Sep species: i) suggest that horizontal spreading of resistance factors, if acting, was not sufficient per se to level their bio-diversities; ii) highlight and confirm the worrisome appearance within the Staphylococcus genus of emerging "new pathogens", not homogeneous for their virulence and antibiotic resistance prevalence, which deserve to be recognised and treated individually.

[Fungal infectivities of implanted catheters due to Candida sp. Biofilms formation and resistance].

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Seddiki, S M L; Boucherit-Otmani, Z; Boucherit, K; Kunkel, D

2015-06-01

Candidemia are the most common fungal infections in hospitals. However, the catheters are subject to be altered by Candida biofilms which increase the risk of invasive nosocomial infections due to the high resistance to antifungal agents. Therefore, the minimum inhibitory concentrations of planktonic (MIC) and sessile cells (CIMS) were evaluated. To review the in vivo biofilms structures of Candida sp. formed on the inner and/or external surfaces of collected catheters, we used scanning electron microscopy (SEM). The level of biofilm resistance was assessed against two conventional antifungal agents: amphotericin B (AmB), which belongs to the class of polyenes, and fluconazole (FLZ) which is an azole. The SEM observation of biofilms of Candida sp. reveals complex structures. Compared to MICs, the calculation of CIMS showed an increase of 32 times with AmB and of 128 times with FLZ. Catheters offer an ideal surface to Candida sp. to form biofilms. This complex structure induces the increase of the resistance of sessile cells against two antifungal agents, AmB and FLZ. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

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

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

2008-04-01

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

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

Directory of Open Access Journals (Sweden)

Beyer-Westendorf J

2017-01-01

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

COMPARATIVE ANALYSIS OF THE TREATMENT OF THE EOSINOPHILIC GRANULOMA WITH VERTEBRAL INVOLVEMENT USING ORTHOPEDIC CORSET AND SURGICAL OPERATION

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A. I. Snetkov

2010-01-01

Full Text Available The results of treatment of 72 patients with pathological fracture of vertebra bodies against eosinophilic granuloma a spine are analysed. Orthopedic corset technologies are used in treatment of 42 patients, surgical treatment was applied. Orthopedic corset may be used in patients with eosinophilic granuloma of backbone. This method of treatment was used in a case of the absence of spine secondary deformations and neurologic semiology. Orthopedic corset treatment is associated with long immobilization on the average within 1,5-2 years and never leads to a complete recovery of the damaged spine. Surgical treatment consists in use only at loss of height of a body to 30-40%, when destruction of spine more severe it is necessary to use operative treatment in two stages. Absolute indications to surgical treatment are the neurologic deficit and secondary deformations of a spine. Surgical treatment allows to reduce terms of treatment till 3-4 months and quickly to return the patient to an active life.

Application of computer graphics in the design of custom orthopedic implants.

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Bechtold, J E

1986-10-01

Implementation of newly developed computer modelling techniques and computer graphics displays and software have greatly aided the orthopedic design engineer and physician in creating a custom implant with good anatomic conformity in a short turnaround time. Further advances in computerized design and manufacturing will continue to simplify the development of custom prostheses and enlarge their niche in the joint replacement market.

High recurrence rate of lymphadenitis due to nontuberculous mycobacteria and its association with concurrent Salmonella infection in Taiwan.

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Hsiao, Cheng-Hsiang; Lai, Chih-Cheng; Hsueh, Po-Ren

2014-06-01

The objective of this study is to investigate the clinical characteristics of lymphadenitis due to nontuberculous mycobacteria (NTM) in Taiwan. We retrospectively reviewed the medical records of all patients who presented to the National Taiwan University Hospital with culture-positive NTM lymphadenitis during the period 2000-2010. Patients with concurrent extranodal involvement were excluded. From 2000 to 2010, 15 patients with lymphadenitis caused by nontuberculous mycobacteria were identified. Most patients (80%, n = 12) were infected with rapidly growing mycobacteria. Mycobacterium abscessus was the most common infective species (n = 8). Recurrence of infection involving multiple organs occurred 2-7 years after the completion of treatment in 11 (73%) patients. Five (33.3%) patients had concurrent Salmonella infections (4 patients with bacteremia and 1 patient with empyema thoracis) during the course of the disease. In Taiwanese patients, we found a high recurrence rate of NTM lymphadenitis that was closely associated with Salmonella infections. We also noted that the clinical and epidemiological manifestations of NTM lymphadenitis in Taiwan differed from their manifestations in western countries. Copyright © 2012. Published by Elsevier B.V.

Human rabies due to lyssavirus infection of bat origin.

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Johnson, N; Vos, A; Freuling, C; Tordo, N; Fooks, A R; Müller, T

2010-05-19

Rabies is a fatal viral encephalitis and results from infection with viruses belonging to the genus Lyssavirus. Infection usually results from a bite from a dog infected with classical rabies virus. However, a small number of cases result from contact with bats. It is within bats that most lyssavirus variants, referred to as genotypes, are found. The lyssaviruses found in bats have a distinct geographical distribution and are often restricted to specific bat species. Most have been associated with rabies in humans and in some cases spill-over to domestic animals. Many diagnostic techniques are unable to differentiate rabies virus from other genotypes so it is possible that some human and animal cases go unreported. Furthermore, current vaccines have limited efficacy against some genotypes. Crown Copyright 2010. Published by Elsevier B.V. All rights reserved.

Social Networking as a Tool for Lifelong Learning with Orthopedically Impaired Learners

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Ersoy, Metin; Güneyli, Ahmet

2016-01-01

This paper discusses how Turkish Cypriot orthopedically impaired learners who are living in North Cyprus use social networking as a tool for leisure and education, and to what extent they satisfy their personal development needs by means of these digital platforms. The case study described, conducted in North Cyprus in 2015 followed a qualitative…

Hydroxyapatite electrodeposition on anodized titanium nanotubes for orthopedic applications

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Parcharoen, Yardnapar; Kajitvichyanukul, Puangrat; Sirivisoot, Sirinrath; Termsuksawad, Preecha

2014-08-01

Nanotubes modification for orthopedic implants has shown interesting biological performances (such as improving cell adhesion, cell differentiation, and enhancing osseointegration). The purpose of this study is to investigate effect of titanium dioxide (TiO2) nanotube feature on performance of hydroxyapatite-coated titanium (Ti) bone implants. TiO2 nanotubes were prepared by anodization using ammonium fluoride electrolyte (NH4F) with and without modifiers (PEG400 and Glycerol) at various potential forms, and times. After anodization, the nanotubes were subsequently annealed. TiO2 nanotubes were characterized by scanning electron microscope and X-ray diffractometer. The amorphous to anatase transformation due to annealing was observed. Smooth and highly organized TiO2 nanotubes were found when high viscous electrolyte, NH4F in glycerol, was used. Negative voltage (-4 V) during anodization was confirmed to increase nanotube thickness. Length of the TiO2 nanotubes was significantly increased by times. The TiO2 nanotube was electrodeposited with hydroxyapatite (HA) and its adhesion was estimated by adhesive tape test. The result showed that nanotubes with the tube length of 560 nm showed excellent adhesion. The coated HA were tested for biological test by live/dead cell straining. HA coated on TiO2 nanotubes showed higher cells density, higher live cells, and more spreading of MC3T3-E1 cells than that growing on titanium plate surface.

Effects of orthopedic insoles on static balance of older adults wearing thick socks.

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Ma, Christina Zong-Hao; Wong, Duo Wai-Chi; Wan, Anson Hong-Ping; Lee, Winson Chiu-Chun

2018-06-01

The wearing of socks and insoles may affect the ability of the foot to detect tactile input influencing postural balance. The aim of this study was to investigate whether (1) thick socks adversely affected the elderly postural balance and (2) orthopedic insoles could improve the elderly postural balance while wearing thick socks. Repeated-measures study design. In total, 14 healthy older adults were recruited. A monofilament test was conducted to evaluate foot plantar sensation with and without thick socks. Subjects then performed the Romberg tests under three conditions: (1) barefoot, (2) with socks only, and (3) with both socks and insoles. Postural balance was assessed by measuring the center of pressure movement during standing in each experimental condition. Thick socks significantly decreased the monofilament score ( p thick socks ( p thick socks reduces plantar pressure sensitivity and increases postural sway which may increase risk of falls. Orthopedic insoles and footwear with similar design could potentially be a cost-effective method in maintaining postural balance when wearing thick socks.

Serious Leisure and People with Orthopedic Impairment: Benefits and Constraints

OpenAIRE

Manolya AKSATAN; Zehra Gökçe SEL

2017-01-01

There are many people around the world who have different types of disabilities. Understanding their needs is the first step of developing policies to increase their quality of life and satisfaction. Leisure is an essential need of disabled people and it plays an important role in disabled people’s lives. The purpose of this study is to gain a deep understanding on the serious leisure activities of people with orthopedic impairment, and also both benefits and constraints ...

Medical and economic impact of extraintestinal infections due to Escherichia coli: focus on an increasingly important endemic problem.

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Russo, Thomas A; Johnson, James R

2003-04-01

Escherichia coli is probably the best-known bacterial species and one of the most frequently isolated organisms from clinical specimens. Despite this, underappreciation and misunderstandings exist among medical professionals and the lay public alike regarding E. coli as an extraintestinal pathogen. Underappreciated features include (i) the wide variety of extraintestinal infections E. coli can cause, (ii) the high incidence and associated morbidity, mortality, and costs of these diverse clinical syndromes, (iii) the pathogenic potential of different groups of E. coli strains for causing intestinal versus extraintestinal disease, and (iv) increasing antimicrobial resistance. In this era in which health news often sensationalizes uncommon infection syndromes or pathogens, the strains of E. coli that cause extraintestinal infection are an increasingly important endemic problem and underappreciated "killers". Billions of health care dollars, millions of work days, and hundreds of thousands of lives are lost each year to extraintestinal infections due to E. coli. New treatments and prevention measures will be needed for improved outcomes and a diminished disease burden.

Combination antibiotic therapy for the treatment of infective endocarditis due to enterococci.

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Leone, Sebastiano; Noviello, Silvana; Esposito, Silvano

2016-06-01

Enterococci are common causes of infective endocarditis (IE) in both health care and community-based setting. Enterococcal IE requires bactericidal therapy for an optimal outcome. For decades, cell-wall-active antimicrobial agents (penicillins or vancomycin) in combination with aminoglycosides were the cornerstone of the treatment; however, the emergence of antibiotic resistance has significantly reduced the efficacy of these regimens. Data for this review were identified by searches of MEDLINE and references from relevant articles on antibiotic combination regimens for the treatment of enterococcal IE. Abstracts presented in scientific conferences were not searched for. New effective and safe combination treatments, including double-β-lactam and daptomycin/β-lactam combination, are proving useful for the management of IE due to enterococci.

[Deaths due to non-AIDS diseases among HIV infected patients: A 14-year study (1998-2011)].

Science.gov (United States)

López, Cristina; Masiá, Mar; Padilla, Sergio; Aquilino, Ana; Bas, Cristina; Gutiérrez, Félix

2016-04-01

The objective of this study was to analyze the deaths caused by non-AIDS diseases in a cohort of HIV-infected patients treated between 1998 and 2011. Information on the causes of death was collected retrospectively, and then classified according to the deaths code (CoDe) algorithm. Patient characteristics and causes of death were compared for two periods: 1998-2004 and 2005-2011. A total of 159 out of the 1070 patients cared for in study period died, 56 (35%) due to AIDS events and 86 (54%) due to non-AIDS events (NAEs); in 17 (11%) the cause of death could not be determined. Overall, the main causes of death were infections (32%), cancer (17%), and unnatural deaths (17%). There was lower mortality from AIDS-related conditions during the second period (18.5% vs 47%; Pcauses of death in patients with HIV. In recent years the majority of deceased patients are on ART and with virological suppression. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

The comparison of pyrosequencing molecular Gram stain, culture, and conventional Gram stain for diagnosing orthopaedic infections.

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Kobayashi, Naomi; Bauer, Thomas W; Tuohy, Marion J; Lieberman, Isador H; Krebs, Viktor; Togawa, Daisuke; Fujishiro, Takaaki; Procop, Gary W

2006-08-01

We have developed a combined real-time PCR and pyrosequencing assay that successfully differentiated the vast majority of gram-positive and gram-negative bacteria when bacterial isolates were tested. The purpose of this study was to evaluate this assay on clinical specimens obtained from orthopedic surgeries, and to prospectively compare the results of "molecular Gram stain" with culture and conventional direct Gram stain. Forty-five surgical specimens were obtained from patients who underwent orthopedic surgery procedures. The DNA was extracted and a set of broad-range PCR primers that targeted a part of the 16S rDNA gene was used for pan-bacterial PCR. The amplicons were submitted for pyrosequencing and the resulting molecular Gram stain characteristics were recorded. Culture and direct Gram staining were performed using standard methods for all cases. Surgical specimens were reviewed histologically for all cases that had a discrepancy between culture and molecular results. There was an 86.7% (39/45) agreement between the traditional and molecular methods. In 12/14 (85.7%) culture-proven cases of bacterial infection, molecular Gram stain characteristics were in agreement with the culture results, while the conventional Gram stain result was in agreement only for five cases (35.7%). In the 31 culture negative cases, 27 cases were also PCR negative, whereas 4 were PCR positive. Three of these were characterized as gram negative and one as gram positive by this molecular method. Molecular determination of the Gram stain characteristics of bacteria that cause orthopedic infections may be achieved, in most instances, by this method. Further studies are necessary to understand the clinical importance of PCR-positive/culture-negative results.

Corrosion resistance and in vitro response of laser-deposited Ti-Nb-Zr-Ta alloys for orthopedic implant applications.

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Samuel, Sonia; Nag, Soumya; Nasrazadani, Seifollah; Ukirde, Vaishali; El Bouanani, Mohamed; Mohandas, Arunesh; Nguyen, Kytai; Banerjee, Rajarshi

2010-09-15

While direct metal deposition of metallic powders, via laser deposition, to form near-net shape orthopedic implants is an upcoming and highly promising technology, the corrosion resistance and biocompatibility of such novel metallic biomaterials is relatively unknown and warrants careful investigation. This article presents the results of some initial studies on the corrosion resistance and in vitro response of laser-deposited Ti-Nb-Zr-Ta alloys. These new generation beta titanium alloys are promising due to their low elastic modulus as well as due the fact that they comprise of completely biocompatible alloying elements. The results indicate that the corrosion resistance of these laser-deposited alloys is comparable and in some cases even better than the currently used commercially-pure (CP) titanium (Grade 2) and Ti-6Al-4V ELI alloys. The in vitro studies indicate that the Ti-Nb-Zr-Ta alloys exhibit comparable cell proliferation but enhanced cell differentiation properties as compared with Ti-6Al-4V ELI. (c) 2010 Wiley Periodicals, Inc.

Anti-neutrophil cytoplasmic antibody-associated vasculitis associated with infectious mononucleosis due to primary Epstein-Barr virus infection: report of three cases.

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Yamaguchi, Makoto; Yoshioka, Tomoki; Yamakawa, Taishi; Maeda, Matsuyoshi; Shimizu, Hideaki; Fujita, Yoshiro; Maruyama, Shoichi; Ito, Yasuhiko; Matsuo, Seiichi

2014-02-01

Although the aetiology of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis remains unclear, it is generally believed that environmental factors such as infections contribute to its development of ANCA-associated vasculitis. Prior Epstein-Barr virus (EBV) infection is reported to be a trigger of systemic vasculitis. We herein report three cases of ANCA-associated vasculitis presenting with infectious mononucleosis due to primary EBV infection. The causal link between the two pathologies could not be proved, but primary EBV infection may play a role in the initiation or exacerbation of ANCA-associated vasculitis. Future studies are necessary to determine the interaction between these diseases conditions.

Reducing Staphylococcus aureus growth on Ti alloy nanostructured surfaces through the addition of Sn.

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Verissimo, Nathália C; Geilich, Benjamin M; Oliveira, Haroldo G; Caram, Rubens; Webster, Thomas J

2015-12-01

β-type Ti alloys containing Nb are exciting materials for numerous orthopedic and dental applications due to their exceptional mechanical properties. To improve their cytocompatibility properties (such as increasing bone growth and decreasing infection), the surfaces of such materials can be optimized by adding elements and/or nanotexturing through anodization. Because of the increasing prevalence of orthopedic implant infections, the objective of this in vitro study was to add Sn and create unique nanoscale surface features on β-type Ti alloys. Nanotubes and nanofeatures on Ti-35Nb and Ti-35Nb-4Sn alloys were created by anodization in a HF-based electrolyte and then heat treated in a furnace to promote amorphous structures and phases such as anatase, a mixture of anatase-rutile, and rutile. Samples were characterized by SEM, which indicated different morphologies dependent on the oxide content and method of modification. XPS experiments identified the oxide content which resulted in a phase transformation in the oxide layer formed onto Ti-35Nb and Ti-35Nb-4Sn alloys. Most importantly, regardless of the resulting nanostructures (nanotubes or nanofeatures) and crystalline phase, this study showed for the first time that adding Sn to β-type Ti alloys strongly decreased the adhesion of Staphylococcus aureus (S. aureus; a bacteria which commonly infects orthopedic implants leading to their failure). Thus, this study demonstrated that β-type Ti alloys with Nb and Sn have great promise to improve numerous orthopedic applications where infection may be a concern. © 2015 Wiley Periodicals, Inc.

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

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

2014-06-05

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

Intraoperative Secondary Insults During Orthopedic Surgery in Traumatic Brain Injury.

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

2017-07-01

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

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

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

2017-05-01

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

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

Directory of Open Access Journals (Sweden)

Nicole Ruas de Sousa

Full Text Available ABSTRACT: Equine sport modalities influence the prevalence and predisposition of musculoskeletal injuries in horses. This study aimed to evaluate the prevalence of location and type of orthopedic injuries of horses undergoing various physical activities. Data from 116 horses of different breeds and ages was analyzed. Physical activities included dressage, racing, polo pony, jumping, work and western performance. All horses had history of orthopedic lameness diagnosed by radiographs and/or ultrasound scans. The effect of sport on the affected anatomical site and type of lesion was performed using Fisher's exact test. Desmitis was more prevalent in animals that performed western sports than in the working ones. The number of fractures was greater in racing and polo pony animals than in working horses. Stifle lesions were more prevalent in dressage horses than working horses and had lower occurrence of shoulder injuries than jumping horses. Hind limb tendon injuries were lower in jumping than in dressage and western horses. We conclude that there is a relationship between location and type of injury and physical activities. In racing horses there is a predominance of young animals and higher prevalence of orthopedic injuries from traumatic events such as tendonitis, desmitis and fractures. In physical activities that require longer training and that animals were used for longer periods, eg. jumping, polo pony, dressage and work, age-related degenerative, such as joint disease, were predominant. In western sport animals the most common lesion was desmitis. Regarding limbs, forelimb injures were more often observed in racing horses, polo pony, jumping and working animals; whereas, dressage and Western sports horses presented more injuries in hind limbs.

Clinical applicability of nursing outcomes in the evolution of orthopedic patients with Impaired Physical Mobility.

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da Silva, Marcos Barragan; Almeida, Miriam de Abreu; Panato, Bruna Paulsen; Siqueira, Ana Paula de Oliveira; da Silva, Mariana Palma; Reisderfer, Letícia

2015-01-01

to evaluate the clinical applicability of outcomes, according to the Nursing Outcomes Classification (NOC) in the evolution of orthopedic patients with Impaired Physical Mobility longitudinal study conducted in 2012 in a university hospital, with 21 patients undergoing Total Hip Arthroplasty, evaluated daily by pairs of trained data collectors. Data were collected using an instrument containing five Nursing Outcomes, 16 clinical indicators and a five point Likert scale, and statistically analyzed. The outcomes Body Positioning: self-initiated, Mobility, Knowledge: prescribed activity, and Fall Prevention Behavior presented significant increases in mean scores when comparing the first and final evaluations (p<0.001) and (p=0.035). the use of the NOC outcomes makes it possible to demonstrate the clinical progression of orthopedic patients with Impaired Physical Mobility, as well as its applicability in this context.

Knowledge deficiency of work-related radiation hazards associated with psychological distress among orthopedic surgeons: A cross-sectional study.

Science.gov (United States)

Fan, Guoxin; Wang, Yueye; Guo, Changfeng; Lei, Xuefeng; He, Shisheng

2017-05-01

Knowledge and concern degree about work-related radiation hazards remained unknown among orthopedic surgeons. The aim of the cross-sectional study is to investigate whether the knowledge degree of work-related radiation is associated with psychological distress among orthopedic surgeons. This cross-sectional study sent electronic questionnaire via WeChat to orthopedic surgeons nationwide. Concern and knowing degree over radiation exposure was evaluated by a single self-reported question. Professional evaluation of concern degree was reflected by general psychological distress, which was assessed with the Kessler 10 scale (K10) and depressive symptoms with the Center for Epidemiologic Studies Depression Scale (CES-D). Only 43.23% (115/266) respondents knew well about radiation and a total of 78.20% (208/266) respondents considered radiation exposure as a great concern. Among those who reported concerns about radiation exposure, a total of 57.69% (120/208) respondents reported knowing little about radiation. Respondents who reported concerns over radiation exposure were significantly associated with higher scores on CES-D and K10 (P < .05). Among respondents who reported concerns over radiation exposure, those who have fewer knowledge about radiation, had higher CES-D and K10 scores than those who knew well about radiation (P < .05). Among respondents who reported no concerns over radiation exposure, those who knew little about radiation still had higher CES-D and K10 scores (P < .05). Fewer radiation knowledge tends to induce more radiation concerns associated with higher psychological distress in orthopedic surgeons. Radiation knowledge should be enhanced for surgeons who daily work with radiation-related fluoroscopy.

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

Science.gov (United States)

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

2017-07-17

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

Orthopedic specialty hospitals: centers of excellence or greed machines?

Science.gov (United States)

Badlani, Neil; Boden, Scott; Phillips, Frank

2012-03-07

Orthopedic specialty hospitals have recently been the subject of debate. They are patient-centered, physician-friendly health care alternatives that take advantage of the economic efficiencies of specialization. Medically, they provide a higher quality of care and increase patient and physician satisfaction. Economically, they are more efficient and profitable than general hospitals. They also positively affect society through the taxes they pay and the beneficial aspects of the competition they provide to general hospitals. Their ability to provide a disruptive innovation to the existing hospital industry will lead to lower costs and greater access to health care. However, critics say that physician ownership presents potential conflicts of interest and leads to overuse of medical care. Some general hospitals are suffering as a result of unfair specialty hospital practices, and a few drastic medical complications have occurred at specialty hospitals. Specialty hospitals have been scrutinized for increasing the inequality of health care and continue to be a target of government regulations. In this article, the pros and cons are examined, and the Emory Orthopaedics and Spine Hospital is analyzed as an example. Orthopedic specialty hospitals provide excellent care and are great assets to society. Competition between specialty and general hospitals has provided added value to patients and taxpayers. However, physicians must take more responsibility in their appropriate and ethical leadership. It is critical to recognize financial conflicts of interest, disclose ownership, and act ethically. Patient care cannot be compromised. With thoughtful and efficient leadership, specialty hospitals can be an integral part of improving health care in the long term. Copyright 2012, SLACK Incorporated.

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

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Panesar SS

2013-03-01

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

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

Science.gov (United States)

Hagert, Elisabet; Lalonde, Donald

2015-02-03

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

[A case of the myelitis due to Toxocara canis infection complicated with cervical spondylosis].

Science.gov (United States)

Mitsuhashi, Yutaka; Naitou, Kentarou; Yamauchi, Shigeru; Naruse, Hirotsune; Matsuoka, Yoshimi; Nakamura-Uchiyama, Fukumi; Hiromatsu, Kenji

2006-11-01

A 59-year-old male had suffered from numbness of the hands for 7 months. With a diagnosis of cervical spondylosis, he had been treated conservatively at a nearby clinic. After he fell off his bicycle, the numbness intensified and limb weakness developed. Cervical MRI revealed spinal cord compression at the C4/5 and C5/6 levels due to cervical spondylosis with prominent edema in the spinal cord spreading from the C4 to C6 level. The edema was very serious. Therefore, we suspected that the traumatic spinal injury underlying the cervical spondylosis was complicated by another disease. Cervical spinal angiography revealed no apparent vascular disorder. Contrast enhanced MRI showed a small enhanced area in the spinal cord at the C5 level. Because of the rapid progression of gait disturbance, expansive laminoplasty was performed without further examination. Although remarkable amelioration of the symptoms was seen just after the surgery, the symptoms worsened again about 1 month later. The patient's clinical history was reconsidered, revealing that he likes raw bovine liver. Serological examination, because of suspicion of parasitic infection showed elevated titers of anti-Toxocara canis antibody in the serum and cerebrospinal fluid. Administration of albendazole improved the clinical symptoms, and normalized the serological and MRI findings. Myelitis due to T canis infection is a rare disease. For an early and accurate diagnosis, it is important to be fully aware of this disease and to include detailed information on food preferences and pet-keeping in the process of compiling a clinical history.

Annual disease burden due to human papillomavirus 16 and 18 infections in Finland.

Science.gov (United States)

Syrjänen, Kari J

2009-01-01

Apart from cancers of the lower female genital tract, human papillomaviruses (HPV) are associated with a large number of benign, premalignant and malignant lesions at different anatomic sites in both genders. Malignant tumours and their precursors are usually attributed to the oncogenic (high-risk, HR) HPV types, whereas benign lesions (mostly papillomas) are ascribed to the low-risk (LR) HPV types, most notably HPV6 and HPV11. To date, the main interest has been focused on HR-HPV types and their associated pathology, and much less attention has been paid to the lesions caused by the LR-HPV types. The recent licensing of an effective prophylactic vaccine against the 2 most important LR-HPV types (HPV6 and HPV11) has resulted in considerably increased interest in these LR-HPV types as well. This author recently conducted a systematic survey of the annual disease burden due to HPV6/11 infections in Finland. As a rational continuation, the present survey was conducted to estimate the annual disease burden due to HPV16 and HPV18 infections in our country. Together, these 2 documents form the foundation for calculations of the annual costs needed to treat the diseases caused by these 2 most common LR and HR HPV types. Similar to HPV6/11, accurate estimates of disease burden are also mandatory for all modelling of the cost-effectiveness of prophylactic HPV16/18 vaccines. In the first step, the published HPV literature was used to create a list of benign, premalignant and malignant lesions associated with this virus at different anatomic sites. The GLOBOCAN 2004 (IARC; International Agency for Research on Cancer) database was used to derive the global numbers of incident cases for each of these malignancies in 2002, and the Finnish Cancer Registry (FCR) website was used to obtain these numbers for Finland (y 2005). The evidence linking HPV to each individual tumour category was classified as: (1) established, (2) emerging, and (3) controversial. All published evidence was

Mathematical Modeling Predicts that Increased HSV-2 Shedding in HIV-1 Infected Persons Is Due to Poor Immunologic Control in Ganglia and Genital Mucosa.

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Joshua T Schiffer

Full Text Available A signature feature of HIV infection is poor control of herpes virus infections, which reactivate from latency and cause opportunistic infections. While the general mechanism underlying this observation is deficient CD4+T-cell function, it is unknown whether increased severity of herpes virus infections is due primarily to poor immune control in latent or lytic sites of infection, or whether CD4+ immunodeficiency leads to more critical downstream deficits in humoral or cell-mediated immunologic responses. Here we compare genital shedding patterns of herpes simplex virus-2 (HSV-2 in 98 HIV infected and 98 HIV uninfected men matched on length of infection, HSV-1 serostatus and nationality. We demonstrate that high copy HSV-2 shedding is more frequent in HIV positive men, particularly in participants with CD4+ T-cell count <200/μL. Genital shedding is more frequent due to higher rate of shedding episodes, as well as a higher proportion of prolonged shedding episodes. Peak episode viral load was not found to differ between HIV infected and uninfected participants regardless of CD4+ T-cell count. We simulate a mathematical model which recapitulates these findings and identifies that rate of HSV-2 release from neural tissue increases, duration of mucosal cytolytic immune protection decreases, and cell-free viral lifespan increases in HIV infected participants. These results suggest that increased HSV-2 shedding in HIV infected persons may be caused by impaired immune function in both latent and lytic tissue compartments, with deficits in clearance of HSV-2 infected cells and extracellular virus.

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

NARCIS (Netherlands)

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

2014-01-01

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

Interceptive orthopedics for the correction of maxillary transverse and sagittal deficiency in the early mixed dentition period

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Ashok Kumar Talapaneni

2011-01-01

Full Text Available Dentofacial Orthopedics directed to a hypoplastic maxilla in the prepubertal period redirects growth of the maxilla in the vertical, transverse and sagittal planes of space. The orthopedic correction of maxillary hypoplasia in the early mixed dentition period thus intercepts the establishment of permanent structural asymmetry in the mandible and helps in the achievement of optimal dentofacial esthetics. This paper presents the growth redirection in a hypoplastic maxilla of an 8-year-old girl with simultaneous rapid maxillary expansion and protraction headgear therapy for a period of 11 months which corrected the posterior unilateral cross-bite, the positional asymmetry of the mandible and established an orthognathic profile in the individual.

Use of extracorporeal shock waves in the treatment of tendinopathy and other orthopedic diseases

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Dushyant Nadar

2000-01-01

Full Text Available Objective: Use of extracorporeal shock waves in the treatment of tendinopathy and other orthopedic diseases. Patients and methods: 35 patients received shock wave therapy using Econolith 2000 lithotripter 19 patients had isolated lateral epicondylitis, 12 medical epicondylitis and 4 plantar fascitis. A total of 120 shock waves were given in the first sitting. Each patient received a total of three sittings with a gap of one week between each of them. Results: Based on the patients′ self-assessment, about 75% pain relief was observed in 60% of the patients. Fur-ther, in patients having isolated tendinopathies, the pain relief was better. Conclusion: The study indicated that the application of shock waves is not restricted to the fragmentation of urinary calculi. The shock waves can be effectively used for the pain relief in the common orthopedic diseases. Thus, the urologists can widen the application of lithotripters, in a cost-effective manner, to the other medical speciali-ties.

A resorbable antibiotic-eluting polymer composite bone void filler for perioperative infection prevention in a rabbit radial defect model.

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Benjamin D Brooks

Full Text Available Nearly 1.3 million total joint replacement procedures are performed in the United States annually, with numbers projected to rise exponentially in the coming decades. Although finite infection rates for these procedures remain consistently low, device-related infections represent a significant cause of implant failure, requiring secondary or revision procedures. Revision procedures manifest several-fold higher infection recurrence rates. Importantly, many revision surgeries, infected or not, require bone void fillers to support the host bone and provide a sufficient tissue bed for new hardware placement. Antibiotic-eluting bone void fillers (ABVF, providing both osteoconductive and antimicrobial properties, represent one approach for reducing rates of orthopedic device-related infections. Using a solvent-free, molten-cast process, a polymer-controlled antibiotic-eluting calcium carbonate hydroxyapatite (HAP ceramic composite BVF (ABVF was fabricated, characterized, and evaluated in vivo using a bacterial challenge in a rabbit radial defect window model. ABVF loaded with tobramycin eliminated the infectious burden in rabbits challenged with a clinically relevant strain of Staphylococcus aureus (inoculum as high as 10⁷ CFU. Histological, microbiological, and radiographic methods were used to detail the effects of ABVF on microbial challenge to host bone after 8 weeks in vivo. In contrast to the HAP/BVF controls, which provided no antibiotic protection and required euthanasia 3 weeks post-operatively, tobramycin-releasing ABVF animals showed no signs of infection (clinical, microbiological, or radiographic when euthanized at the 8-week study endpoint. ABVF sites did exhibit fibrous encapsulation around the implant at 8 weeks. Local antibiotic release from ABVF to orthopedic sites requiring bone void fillers eliminated the periprosthetic bacterial challenge in this 8-week in vivo study, confirming previous in vitro results.

Prevalence of Invasive Infections Due to Carbapenem-Resistant Enterobacteriaceae among Adult Patients in U.S. Hospitals.

Science.gov (United States)

Lodise, Thomas; Ye, Michael J; Zhao, Qi

2017-08-01

This large-scale retrospective analysis ( n = 60,551) of the Premier inpatient database (1 January 2011 to 31 December 2014) found an overall prevalence of carbapenem-resistant Enterobacteriaceae strains of 2.3% (range, 0.9% to 5.8% by geographic region) among patients with infections due to Enterobacteriaceae Ongoing monitoring and development of decision support tools/algorithms are needed for identification of high-risk patients. Copyright © 2017 American Society for Microbiology.

Developments in ambulatory surgery in orthopedics in France in 2016.

Science.gov (United States)

Hulet, C; Rochcongar, G; Court, C

2017-02-01

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

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

International Nuclear Information System (INIS)

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

1999-01-01

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

Community-acquired pneumonia due to pandemic A(H1N12009 influenzavirus and methicillin resistant Staphylococcus aureus co-infection.

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Ronan J Murray

Full Text Available BACKGROUND: Bacterial pneumonia is a well described complication of influenza. In recent years, community-onset methicillin-resistant Staphylococcus aureus (cMRSA infection has emerged as a contributor to morbidity and mortality in patients with influenza. Since the emergence and rapid dissemination of pandemic A(H1N12009 influenzavirus in April 2009, initial descriptions of the clinical features of patients hospitalized with pneumonia have contained few details of patients with bacterial co-infection. METHODOLOGY/PRINCIPAL FINDINGS: Patients with community-acquired pneumonia (CAP caused by co-infection with pandemic A(H1N12009 influenzavirus and cMRSA were prospectively identified at two tertiary hospitals in one Australian city during July to September 2009, the period of intense influenza activity in our region. Detailed characterization of the cMRSA isolates was performed. 252 patients with pandemic A(H1N12009 influenzavirus infection were admitted at the two sites during the period of study. Three cases of CAP due to pandemic A(H1N12009/cMRSA co-infection were identified. The clinical features of these patients were typical of those with S. aureus co-infection or sequential infection following influenza. The 3 patients received appropriate empiric therapy for influenza, but inappropriate empiric therapy for cMRSA infection; all 3 survived. In addition, 2 fatal cases of CAP caused by pandemic A(H1N12009/cMRSA co-infection were identified on post-mortem examination. The cMRSA infections were caused by three different cMRSA clones, only one of which contained genes for Panton-Valentine Leukocidin (PVL. CONCLUSIONS/SIGNIFICANCE: Clinicians managing patients with pandemic A(H1N12009 influenzavirus infection should be alert to the possibility of co-infection or sequential infection with virulent, antimicrobial-resistant bacterial pathogens such as cMRSA. PVL toxin is not necessary for the development of cMRSA pneumonia in the setting of pandemic

A novel co-culture model of murine K12 osteosarcoma cells and S. aureus on common orthopedic implant materials: 'the race to the surface' studied in vitro.

Science.gov (United States)

McConda, David B; Karnes, Jonathan M; Hamza, Therwa; Lindsey, Brock A

2016-07-01

Infection is a major cause of orthopedic implant failure. There are few studies assessing both tissue cell and bacterial adherence on common orthopedic implant materials in a co-culture environment. An in vitro co-culture model was created using K12 osteosarcoma cells and Staphylococcus aureus in a medium incubated over metal disks for 48 h. The results showed that, in the presence of S. aureus, there were fewer osteosarcoma cells attached to the disks for all substrata tested. There were significantly more osteosarcoma cells adhering to the cobalt chrome than the stainless steel and titanium disks. Overall, in the presence of osteosarcoma cells, there were more bacteria adhering to the disks for all the substrata tested, with significantly more bacteria adhering to the stainless steel disks compared to cobalt chrome and titanium disks. Scanning electron microscopy verified that osteosarcoma cells and bacteria were adherent to the metal disks after incubation for 48 h. Furthermore, the observation that more bacteria were in the co-culture than in the control sample suggests that the osteosarcoma cells serve as a nutrient source for the bacteria. Future models assessing the interaction of osteogenic cells with bacteria on a substratum would be improved if the model accounted for the role of the immune system in secondary bone healing.

The Chemokine CXCL-10 Is a Marker of Infection Stage in Individuals With DNAemia Due to Parvovirus B19.

Science.gov (United States)

Weseslindtner, Lukas; Aberle, Judith H; Hedman, Lea; Hedman, Klaus

2017-01-15

Accurate diagnosis of parvovirus B19 (B19V) infection requires the differentiation between acute and past infection, which is especially important when DNAemia due to B19V (hereafter, "B19V DNAemia") is detected in pregnancy. Here, we explored whether the level of the chemokine CXCL-10, in combination with findings of molecular and serological assays, can discriminate between acute and past B19V infection. B19V DNA-positive serum samples from 222 immunocompetent individuals were analyzed for (1) viral DNA loads, (2) anti-B19V immunoglobulin M (IgM) and immunoglobulin G (IgG), (3) anti-VP1 IgG avidity, (4) anti-VP-2 epitope type specificity (ETS), and (5) CXCL-10 serum levels. Anti-B19V IgM and IgG, avidity, and ETS assays were used to categorize individuals with B19V DNAemia as having acute or past B19V infection. Acute B19V infection caused a significant increase in the serum concentration of CXCL-10, compared with the concentration at baseline, before infection. Higher CXCL-10 serum levels were furthermore detected in acute B19V infection as compared to past infection. As a marker, CXCL-10 serum levels could discriminate between acute and past B19V infection, with an excellent discriminatory capacity when CXCL-10 and B19V DNA levels were used as combined parameters. Acute B19V infection is associated with increased CXCL-10 production, and measurement of CXCL-10 serum levels thus allows for the staging of B19V infection in individuals with B19V DNAemia. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Bioactive glass coatings for orthopedic metallic implants

Energy Technology Data Exchange (ETDEWEB)

Lopez-Esteban, Sonia; Saiz, Eduardo; Fujino, Sigheru; Oku, Takeo; Suganuma, Katsuaki; Tomsia, Antoni P.

2003-06-30

The objective of this work is to develop bioactive glass coatings for metallic orthopedic implants. A new family of glasses in the SiO2-Na2O-K2O-CaO-MgO-P2O5 system has been synthesized and characterized. The glass properties (thermal expansion, softening and transformation temperatures, density and hardness) are in line with the predictions of established empirical models. The optimized firing conditions to fabricate coatings on Ti-based and Co-Cr alloys have been determined and related to the glass properties and the interfacial reactions. Excellent adhesion to alloys has been achieved through the formation of 100-200 nm thick interfacial layers (Ti5Si3 on Ti-based alloys and CrOx on Co-Cr). Finally, glass coatings, approximately 100 mu m thick, have been fabricated onto commercial Ti alloy-based dental implants.

Semuloparin for prevention of venous thromboembolism after major orthopedic surgery

DEFF Research Database (Denmark)

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

2012-01-01

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

Nanoparticulate zinc oxide as a coating material for orthopedic and dental implants.

Science.gov (United States)

Memarzadeh, Kaveh; Sharili, Amir S; Huang, Jie; Rawlinson, Simon C F; Allaker, Robert P

2015-03-01

Orthopedic and dental implants are prone to infection. In this study, we describe a novel system using zinc oxide nanoparticles (nZnO) as a coating material to inhibit bacterial adhesion and promote osteoblast growth. Electrohydrodynamic atomisation (EHDA) was employed to deposit mixtures of nZnO and nanohydroxyapatite (nHA) onto the surface of glass substrates. Nano-coated substrates were exposed to Staphylococcus aureus suspended in buffered saline or bovine serum to determine antimicrobial activity. Our results indicate that 100% nZnO and 75% nZnO/25% nHA composite-coated substrates have significant antimicrobial activity. Furthermore, osteoblast function was explored by exposing cells to nZnO. UMR-106 cells exposed to nZnO supernatants showed minimal toxicity. Similarly, MG-63 cells cultured on nZnO substrates did not show release of TNF-α and IL-6 cytokines. These results were reinforced by both proliferation and differentiation studies which revealed that a substrate coated with exclusively nZnO is more efficient than composite surface coatings. Finally, electron and light microscopy, together with immunofluorescence staining, revealed that all cell types tested, including human mesenchymal cell (hMSC), were able to maintain normal cell morphology when adhered onto the surface of the nano-coated substrates. Collectively, these findings indicate that nZnO can, on its own, provide an optimal coating for future bone implants that are both antimicrobial and biocompatible. © 2014 Wiley Periodicals, Inc.

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

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Fabiano Timbó Barbosa

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

[Nosocomial infections due to human coronaviruses in the newborn].

Science.gov (United States)

Gagneur, A; Legrand, M C; Picard, B; Baron, R; Talbot, P J; de Parscau, L; Sizun, J

2002-01-01

Human coronaviruses, with two known serogroups named 229-E and OC-43, are enveloped positive-stranded RNA viruses. The large RNA is surrounded by a nucleoprotein (protein N). The envelop contains 2 or 3 glycoproteins: spike protein (or protein S), matrix protein (or protein M) and a hemagglutinin (or protein HE). Their pathogen role remains unclear because their isolation is difficult. Reliable and rapid methods as immunofluorescence with monoclonal antibodies and reverse transcription-polymerase chain reaction allow new researches on epidemiology. Human coronaviruses can survive for as long as 6 days in suspension and 3 hours after drying on surfaces, suggesting that they could be a source of hospital-acquired infections. Two prospective studies conducted in a neonatal and paediatric intensive care unit demonstrated a significant association of coronavirus-positive nasopharyngal samples with respiratory illness in hospitalised preterm neonates. Positive samples from staff suggested either a patient-to-staff or a staff-to-patient transmission. No cross-infection were observed from community-acquired respiratory-syncitial virus or influenza-infected children to neonates. Universal precautions with hand washing and surface desinfection could be proposed to prevent coronavirus transmission.

The opinion and experiences of Dutch orthopedic surgeons and radiologists about diagnostic musculoskeletal ultrasound imaging in primary care: a survey.

Science.gov (United States)

Scholten-Peeters, Gwendolijne G M; Franken, Nicole; Beumer, Annechien; Verhagen, Arianne P

2014-04-01

The use of diagnostic musculoskeletal ultrasound (DMUS) in primary health care has increased in the recent years. Nevertheless, there are hardly any data concerning the reliability, accuracy and treatment consequences of DMUS used by physical therapists or general practitioners. Moreover, there are no papers published about how orthopedic surgeons or radiologists deal with the results of DMUS performed in primary care. Therefore, our aim is to evaluate the opinion, possible advantages or disadvantages and experiences of Dutch orthopedic surgeons and radiologists about DMUS in primary care. A cross-sectional survey in which respondents completed a self-developed questionnaire to determine their opinion, experiences, advantages, disadvantages of performing DMUS in primary care. Questionnaires were sent to 838 Dutch orthopedic surgeons and radiologists of which 213 were returned (response rate 25.4%). Our respondents saw no additional value for health care for diagnostic DMUS in primary care. DMUSs were generally repeated in secondary care. They perceived more disadvantages than advantages of performing DMUS in primary care. Mentioned disadvantages were: 'false positive results' (71.4%), 'lack of experience' (70%), 'insufficient education' (69.5%), not able to relate the outcomes of DMUS with other forms of diagnostic imaging' (65.7%), and 'false negative results' (65.3%). Radiologists and orthopedic surgeons sampled in the Netherlands show low trust in DMUS knowledge of physical therapists and general practitioners. The results should be interpreted with caution because of the small response rate and the lack of representativeness to other countries. Published by Elsevier Ltd.

Cerebral infarctions due to CNS infection with Enterobacter sakazakii

International Nuclear Information System (INIS)

Gallagher, P.G.; Ball, W.S.

1991-01-01

Recent reports have implicated Enterobacter sakazakii, a gram-negative enteric bacillus, in neonatal sepsis and meningitis. Cases of severe central nervous system involvement, including ventriculitis, brain abscess, infarction, and cyst formation, have been described. We present serial head CT findings in a case of neonatal E. sakazakii meningitis complicated by a ring enhancing cerebral infarction which mimicked abscess formation. In meningitis secondary to this agent, a recognized pattern of cerebral hypodensity with or without cystic degeneration late in the course of the infection is likely to represent cerebral infarction rather than an abscess especially if there is a lack of culture evidence of a bacterial infection. (orig.)

Novel use of antimicrobial hand sanitizer in treatment of nosocomial acinetobacter infection.

Science.gov (United States)

Donahue, Meghan; Watson, Luke R; Torress-Cook, Alfonso; Watson, Paul A

2009-01-01

Colonization of wounds with multidrug-resistant organisms is a difficult orthopedic problem. Acinetobacter infections are especially difficult because they are resistant to all currently available antibiotics. We present the use of a novel skin sanitizer, Stay Byotrol Clean (Byotrol Inc, Spartanburg, South Carolina), to treat a multidrug-resistant wound infection. A 31-year-old T10 paraplegic man presented with chronic bilateral stage IV decubitus trochanteric ulcers. Cultures grew methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. The ulcers were initially treated with irrigation and debridement and vancomycin, levaquin, and cefepime. After 4 months of aggressive treatment, the cultures continued to be positive for Escherichia coli and Acinetobacter baumannii. The patient was started on amikacin and tigecycline. Despite 1 additional month of aggressive wound care, debridements, and intravenous antibiotics, the cultures continued to grow A baumannii and Pseudomonas aerug. The A baumannii was resistant to all available antibiotics tested. The ulcers were then treated with daily application of Stay Byotrol Clean hand and skin sanitizer. Four days later, cultures were negative for any bacterial growth, with no A baumannii. After 1 week, the ulcers showed new granulation tissue with no visible necrotic tissue. After 3 months of treatment, the ulcers had healed. Stay Byotrol Clean is nonirritating and contains no iodine or alcohol. It is currently being used for decolonization of patients on admission to the hospital, however, there is great potential for its use in wound treatment, preoperative surgical sterilization, and orthopedic devices.

Metal artifact reduction image reconstruction algorithm for CT of implanted metal orthopedic devices: a work in progress

International Nuclear Information System (INIS)

Liu, Patrick T.; Pavlicek, William P.; Peter, Mary B.; Roberts, Catherine C.; Paden, Robert G.; Spangehl, Mark J.

2009-01-01

Despite recent advances in CT technology, metal orthopedic implants continue to cause significant artifacts on many CT exams, often obscuring diagnostic information. We performed this prospective study to evaluate the effectiveness of an experimental metal artifact reduction (MAR) image reconstruction program for CT. We examined image quality on CT exams performed in patients with hip arthroplasties as well as other types of implanted metal orthopedic devices. The exam raw data were reconstructed using two different methods, the standard filtered backprojection (FBP) program and the MAR program. Images were evaluated for quality of the metal-cement-bone interfaces, trabeculae ≤1 cm from the metal, trabeculae 5 cm apart from the metal, streak artifact, and overall soft tissue detail. The Wilcoxon Rank Sum test was used to compare the image scores from the large and small prostheses. Interobserver agreement was calculated. When all patients were grouped together, the MAR images showed mild to moderate improvement over the FBP images. However, when the cases were divided by implant size, the MAR images consistently received higher image quality scores than the FBP images for large metal implants (total hip prostheses). For small metal implants (screws, plates, staples), conversely, the MAR images received lower image quality scores than the FBP images due to blurring artifact. The difference of image scores for the large and small implants was significant (p=0.002). Interobserver agreement was found to be high for all measures of image quality (k>0.9). The experimental MAR reconstruction algorithm significantly improved CT image quality for patients with large metal implants. However, the MAR algorithm introduced blurring artifact that reduced image quality with small metal implants. (orig.)

[Stroke due to infective endocarditis diagnosed by the retrieved thrombus: a case report].

Science.gov (United States)

Nakanishi, Kaoru; Kawano, Hiroyuki; Amano, Tatsuo; Omori, Yoshihiko; Kanma, Hiroshi; Hirano, Teruyuki

2018-01-26

A 80-years-old woman suddenly presented with aphasia, right hemiparesis, and dysesthesia. MRA showed the left middle cerebral artery occlusion. She was diagnosed as hyperacute ischemic stroke. She was treated with intravenous recombinant tissue plasminogen activator and underwent endovascular thrombectomy. On admission, she had a fever and high C reactive protein, and was treated with antibiotic therapy. The pathological diagnosis of the retrieved thrombus revealed the cluster of the gram positive cocci. The blood culture was negative and thransthoracic echocardiogram did not detect the vegetation. She was finally diagnosed as cardioembolic stroke due to infective endocarditis based on the pathological diagnosis of the retrieved thrombus. The pathological diagnosis of the retrieved thrombus was quite important to clarify the cause of ischemic stroke.

Biological Activities of Uric Acid in Infection Due to Enteropathogenic and Shiga-Toxigenic Escherichia coli

Science.gov (United States)

Broome, Jacqueline E.; Lis, Agnieszka

2016-01-01

In previous work, we identified xanthine oxidase (XO) as an important enzyme in the interaction between the host and enteropathogenic Escherichia coli (EPEC) and Shiga-toxigenic E. coli (STEC). Many of the biological effects of XO were due to the hydrogen peroxide produced by the enzyme. We wondered, however, if uric acid generated by XO also had biological effects in the gastrointestinal tract. Uric acid triggered inflammatory responses in the gut, including increased submucosal edema and release of extracellular DNA from host cells. While uric acid alone was unable to trigger a chloride secretory response in intestinal monolayers, it did potentiate the secretory response to cyclic AMP agonists. Uric acid crystals were formed in vivo in the lumen of the gut in response to EPEC and STEC infections. While trying to visualize uric acid crystals formed during EPEC and STEC infections, we noticed that uric acid crystals became enmeshed in the neutrophilic extracellular traps (NETs) produced from host cells in response to bacteria in cultured cell systems and in the intestine in vivo. Uric acid levels in the gut lumen increased in response to exogenous DNA, and these increases were enhanced by the actions of DNase I. Interestingly, addition of DNase I reduced the numbers of EPEC bacteria recovered after a 20-h infection and protected against EPEC-induced histologic damage. PMID:26787720

Biocompatible evaluation of barium titanate foamed ceramic structures for orthopedic applications.

Science.gov (United States)

Ball, Jordan P; Mound, Brittnee A; Nino, Juan C; Allen, Josephine B

2014-07-01

The potential of barium titanate (BT) to be electrically active makes it a material of interest in regenerative medicine. To enhance the understanding of this material for orthopedic applications, the in vitro biocompatibility of porous BT fabricated using a direct foaming technique was investigated. Characterization of the resultant foams yielded an overall porosity between 50 and 70% with average pore size in excess of 30 µm in diameter. A mouse osteoblast (7F2) cell line was cultured with the BT to determine the extent of the foams' toxicity using a LDH assay. After 72 h, BT foams showed a comparable cytotoxicity of 6.4 ± 0.8% to the 8.4 ± 1.5% of porous 45S5 Bioglass®. The in vitro inflammatory response elicited from porous BT was measured as a function of tumor necrosis factor alpha (TNF-α) secreted from a human monocytic leukemia cell line (THP-1). Results indicate that the BT foams do not cause a significant inflammatory response, eliciting a 9.4 ± 1.3 pg of TNF-α per mL of media compared with 20.2 ± 2.3 pg/mL from untreated cells. These results indicate that porous BT does not exhibit short term cytotoxicity and has potential for orthopedic tissue engineering applications. © 2013 Wiley Periodicals, Inc.

Diagnosis and management of the infected total joint arthroplasty

International Nuclear Information System (INIS)

Cuckler, J.M.; Star, A.M.; Alavi, A.; Noto, R.B.

1991-01-01

The preoperative diagnosis of the infected orthopedic implant is complicated by lack of a single precise test to forewarn patient and surgeon of the presence of microorganisms. Given the overall limitation of accuracy of preoperative diagnosis to approximately 80% when 111In scanning, preoperative aspiration, and ESR are considered, it would seem prudent to approach each revision surgery with the possibility in mind of subclinical sepsis as the cause for failure of the implant. The essentials of surgical technique including thorough debridement of the wound and removal of all existing foreign bodies, especially including PMMA bone cement, are critical to minimizing the risk for occurrence or persistence of sepsis. Although the use of antibiotic impregnated bone cement may enhance the treatment of orthopedic sepsis, the data available to date lead to the conclusion that two-stage revision surgery in the face of known sepsis remains the cornerstone of surgical therapy for the infected implant, along with aggressive and rational antibiotic treatment. The surgeon is offered the following guidelines in the management of the septic total hip arthroplasty. 1. Preoperative evaluation including ESR, 111In WBC scan, and aspiration for culture and sensitivity (fluoroscopically guided for the hip) will produce on average approximately 80% accuracy. 2. Intraoperative cultures at the time of revision surgery should be obtained prior to administration of systemic antibiotics; three tissue specimens (hip capsule, femoral membrane, acetabular membrane) should be submitted for culture and sensitivity determination. 3. Careful debridement of the surgical site of granulation tissue and all foreign bodies (e.g., PMMA) should be performed within the limits of patient safety to maximize the likelihood of success. 37 refs

Burden of diarrhea, hospitalization and mortality due to cryptosporidial infections in Indian children.

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Rajiv Sarkar

2014-07-01

Full Text Available Cryptosporidium spp. is a common, but under-reported cause of childhood diarrhea throughout the world, especially in developing countries. A comprehensive estimate of the burden of cryptosporidiosis in resource-poor settings is not available.We used published and unpublished studies to estimate the burden of diarrhea, hospitalization and mortality due to cryptosporidial infections in Indian children. Our estimates suggest that annually, one in every 6-11 children <2 years of age will have an episode of cryptosporidial diarrhea, 1 in every 169-633 children will be hospitalized and 1 in every 2890-7247 children will die due to cryptosporidiosis. Since there are approximately 42 million children <2 years of age in India, it is estimated that Cryptosporidium results in 3.9-7.1 million diarrheal episodes, 66.4-249.0 thousand hospitalizations, and 5.8-14.6 thousand deaths each year.The findings of this study suggest a high burden of cryptosporidiosis among children <2 years of age in India and makes a compelling case for further research on transmission and prevention modalities of Cryptosporidium spp. in India and other developing countries.

Photodynamic inactivation of biofilm: taking a lightly colored approach to stubborn infection

Science.gov (United States)

de Melo, Wanessa CMA; Avci, Pinar; de Oliveira, Milene Nóbrega; Gupta, Asheesh; Vecchio, Daniela; Sadasivam, Magesh; Chandran, Rakkiyappan; Huang, Ying-Ying; Yin, Rui; Perussi, Livia R; Tegos, George P; Perussi, Janice R; Dai, Tianhong; Hamblin, Michael R

2015-01-01

Microbial biofilms are responsible for a variety of microbial infections in different parts of the body, such as urinary tract infections, catheter infections, middle-ear infections, gingivitis, caries, periodontitis, orthopedic implants, and so on. The microbial biofilm cells have properties and gene expression patterns distinct from planktonic cells, including phenotypic variations in enzymic activity, cell wall composition and surface structure, which increase the resistance to antibiotics and other antimicrobial treatments. There is consequently an urgent need for new approaches to attack biofilm-associated microorganisms, and antimicrobial photodynamic therapy (aPDT) may be a promising candidate. aPDT involves the combination of a nontoxic dye and low-intensity visible light which, in the presence of oxygen, produces cytotoxic reactive oxygen species. It has been demonstrated that many biofilms are susceptible to aPDT, particularly in dental disease. This review will focus on aspects of aPDT that are designed to increase efficiency against biofilms modalities to enhance penetration of photosensitizer into biofilm, and a combination of aPDT with biofilm-disrupting agents. PMID:23879608

The effect of education of nurses on preventing catheter-associated urinary tract infections in patients who undergo hip fracture surgery.

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Seyhan Ak, Ezgi; Özbaş, Ayfer

2018-03-01

The aim of the study was to investigate the effect of educating nurses on preventing catheter-associated urinary tract infections in patients who undergo hip fracture surgery. Urinary tract infections after hip fracture surgery are observed at a rate of 12% to 61%, and the most important risk factor associated with urinary tract infection is considered to be the presence of urinary catheters. Nurse education about the use and management of urinary catheters is important to decrease the risk of urinary tract infections. The study was semi-experimental. The study was conducted in an orthopedics and traumatology clinic of a training hospital between January 2014-December 2015. After a power analysis was performed, a total of 60 patients fulfilled the criteria to be included in the study, with n = 30 in the pre-education group and n = 30 in the posteducation group. Nurses who worked in the orthopedics and traumatology clinic of the military hospital were the target population, and 18 nurses who consented to join the study constituted the sample. The "Patient Monitoring Form," "Nurse Information Form" and "Daily Urinary Catheter Assessment Tool" were used as data collection tools. The mean pre-education knowledge score of the nurses was found to be 68.05 ± 10.69, while the mean posteducation score was 95.13 ± 6.27. The mean catheter duration decreased from 11.06 ± 6.34 days-3.83 ± 0.95 days after the education. The catheter-associated urinary tract infection rate decreased by 9.37 per thousand. Educating nurses on preventing catheter-associated urinary tract infections in patients who underwent hip fracture surgery significantly decreased the rate of catheter-associated urinary tract infections and the duration of catheterisation. The systematic and comprehensive education of all healthcare professionals and the development and practice of catheter removal protocols could contribute to the prevention of catheter-associated urinary tract infections. �

The impact of infection on mortality in octogenarians who were admitted due to acute coronary syndrome.

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Keskin, Kudret; Çetinkal, Gökhan; Sığırcı, Serhat; Yıldız, Süleyman Sezai; Çetin, Şükrü; Gürdal, Ahmet; Kocaş, Betül Balaban; Kılıçkesmez, Kadriye Orta

The prevalence of coronary artery disease is on the rise as the life expectancy of the population increases. However, treatment of acute coronary syndrome in the elderly patients has its own problems that have not been thoroughly addressed in the clinical trials. Since these patients are generally fragile and have multiple co-morbidities, the course of acute coronary syndrome can frequently be complicated. Infection, which co-exists either at the initial presentation or is acquired during the hospital stay, is a condition about which there is little published data. Therefore, in our study, we wanted to assess the impact of infection on mortality in octogenarians who have acute coronary syndrome METHODS: We retrospectively analyzed the data of 174 octogenarians who had been admitted to the coronary care unit with acute coronary syndrome. All-cause mortality was defined as the primary endpoint of the study. Overall 53 octogenarian patients (30.5%) had an infection along with acute coronary syndrome. The mean duration of follow-up was 10 months (1-25 months). Both in-hospital and long-term mortality were higher in these patients (18.9% vs 6.6%, p = 0.01; 52.8% vs 27.5%, p < 0.01; respectively). Kaplan-Meier analysis also showed lower cumulative survival. (p [log-rank] = 0.002). In multivariate Cox regression analysis; undergoing coronary angiography, infection (HR 1.96, 95% CI 1.15-3.34, p = 0.01), left ventricular ejection fraction and maximum C reactive protein levels were found as independent predictors of long-term survival. Infection in octogenarians who were admitted due to acute coronary syndrome was frequent and increased their mortality substantially. Copyright © 2018 Elsevier B.V. All rights reserved.

Prevalence of internet and social media usage in orthopedic surgery.

Science.gov (United States)

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

2014-08-08

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

Pediatric orthopedic surgery in humanitarian aid.

Science.gov (United States)

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

2017-02-01

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

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

DEFF Research Database (Denmark)

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

2008-01-01

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

Efficacy of antibiotic treatment of implant-associated Staphylococcus aureus infections with moxifloxacin, flucloxacillin, rifampin, and combination therapy: an animal study

Directory of Open Access Journals (Sweden)

Greimel F

2017-06-01

Full Text Available Felix Greimel,1 Christine Scheuerer,1 Andre Gessner,2 Michaela Simon,2 Thomas Kalteis,1 Joachim Grifka,1 Achim Benditz,1 Hans-Robert Springorum,1 Jens Schaumburger1 1Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, 2Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Bavaria, Germany Abstract: The efficacy of antibiotic monotherapy and combination therapy in the treatment of implant-associated infection by Staphylococcus aureus was evaluated in an animal study. The femoral medullary cavity of 66 male Wistar rats was contaminated with S. aureus (ATCC 29213 and a metal device was implanted, of which 61 could be evaluated. Six treatment groups were studied: flucloxacillin, flucloxacillin in combination with rifampin, moxifloxacin, moxifloxacin in combination with rifampin, rifampin, and a control group with aqua. The treatment was applied for 14 days. After euthanasia, the bacterial counts in the periprosthetic bone, the soft tissue, and the implant-associated biofilm were measured. Both antibiotic combination treatments (moxifloxacin plus rifampin and flucloxacillin plus rifampin achieved a highly significant decrease in microbial counts in the bone and soft tissue and in the biofilm. Mono-antibiotic treatments with either moxifloxacin or flucloxacillin were unable to achieve a significant decrease in microbial counts in bone and soft tissue or the biofilm, whilst rifampin was able to reduce the counts significantly only in the biofilm. Antibiotic resistance was measured in 1/3 of the cases in the rifampin group, whereas no resistance was measured in all other groups. The results show that combinations of both moxifloxacin and flucloxacillin plus rifampin are adequate for the treatment of periprosthetic infections due to infections with S. aureus, whereas monotherapies are not effective or not applicable due to the rapid development of

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

Science.gov (United States)

Schneider, Melissa A

2018-03-01

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

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

International Nuclear Information System (INIS)

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

2014-08-01

Orthopedic surgeons should be considered as professionals occupationally exposed to ionizing radiation, for using C arc (fluoroscope) an equipment of X type radiation emission, during surgical procedures for imaging generation. Some health institutes, use of C arc under uncontrolled circumstances, such a lack of dosimetry control, incomplete or absence of personnel protective elements and protective measures, which in turn, lead to a high exposition to the personnel. Materials and methods. Study of double match cohort by age and gender, was conducted, in four health institutions of second and third level of attention in Bogota city. Personal dosimetry measurements with TLD-100 dosimetry crystals in both cohorts and environmental dosimetry in each of operation rooms used for orthopedic procedures, were carry out during six months of follow up. Dosimetry crystals were read in a Harshaw 4500 - Bicron equipment, in the Medical Physics Laboratory of National University of Colombia. Results. Dosimetry measurements are compatibles with those of occupationally exposed personnel 3.44 mSv/6 m CI 95% (1.66-3.99), even does not overpass ICRP recommendations, are higher as were expect at the beginning of the study. The median of effective accumulative dose in thorax is 3,4 mSv CI 95% (1,66-3,99), higher in comparison with neck value 2,7 mSv CI 95% (1,73-3,80) and hand dosimetry 1,42 mSv CI 95% (0,96-2,34). Conclusions: Orthopedic surgeons should be considered occupational exposed to ionizing radiation, who has to accomplish to the radiological protection measures, dosimetric follow up and maintenance of the used X ray equipment. It was confirm throughout this study that dosimetry shows higher levels as expected at the beginning of the study, compatible with occupationally exposed personnel. (Author)

Improvement on corrosion resistance of NiTi orthopedic materials by carbon plasma immersion ion implantation

International Nuclear Information System (INIS)

Poon, Ray W.Y.; Ho, Joan P.Y.; Luk, Camille M.Y.; Liu Xuanyong; Chung, Jonathan C.Y.; Chu, Paul K.; Yeung, Kelvin W.K.; Lu, William W.; Cheung, Kenneth M.C.

2006-01-01

Nickel-titanium shape memory alloys (NiTi) have potential applications as orthopedic implants because of their unique super-elastic properties and shape memory effects. However, the problem of out-diffusion of harmful Ni ions from the alloys during prolonged use inside a human body must be overcome before they can be widely used in orthopedic implants. In this work, we enhance the corrosion resistance of NiTi using carbon plasma immersion ion implantation and deposition (PIII and D). Our corrosion and simulated body fluid tests indicate that either an ion-mixed amorphous carbon coating fabricated by PIII and D or direct carbon PIII can drastically improve the corrosion resistance and block the out-diffusion of Ni from the materials. Results of atomic force microscopy (AFM) indicate that both C 2 H 2 -PIII and D and C 2 H 2 -PIII do not roughen the original flat surface to an extent that can lead to degradation in corrosion resistance

An evaluation on time status of functional orthopedic treatment in class II skeletal patients with cervical vertebrae maturation stage (CVMS index

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Dalili Z.

2004-08-01

Full Text Available Statement of Problem: Considerable response to functional orthopedic appliances treatment in class II skeletal patients occurs during pubertal growth spurt. Therefore, it seems necessary to investigate indices indicating mandibular growth pattern. It has been proved that analyzing cervical vertebral maturation stage is a more valid index than that of hand wrist. Purpose: The aim of this study was to evaluate the time status of functional orthopedic treatment in class II skeletal patients using CVMS index. Materials and Methods: In this descriptive-inferential study, lateral cephalometric radiographs of 153 class II skeletal patients with mandibular deficiency, before treatment, were studied by an oral and maxillofacial radiologist using the index of cervical vertebral maturation stage (CVMS and were categorized in three phases: CVMS I (desirable phase of treatment, CVMS II (ideal phase, and CVMS III (undesirable phase of treatment. Results: Statistical analysis ranked the prevalence of treatment phases as: 41.8% in desirable phase (CVMS I, 28.1% in ideal phase (CVMA II and 30% in undesirable phase (CVMS III. No significant differences were found between the three phases using Chi-square analysis. Time status of functional orthopedic treatment was also evaluated based on age and sex. The results showed significant differences between two sexes (P=0.032. Conclusion: The present study suggests the analysis of CVMS index, along with clinical criteria, in the determination of an ideal time for functional orthopedic treatment to prevent patients’ exhaustion during treatment Period.

Chitosan for gene delivery and orthopedic tissue engineering applications.

Science.gov (United States)

Raftery, Rosanne; O'Brien, Fergal J; Cryan, Sally-Ann

2013-05-15

Gene therapy involves the introduction of foreign genetic material into cells in order exert a therapeutic effect. The application of gene therapy to the field of orthopaedic tissue engineering is extremely promising as the controlled release of therapeutic proteins such as bone morphogenetic proteins have been shown to stimulate bone repair. However, there are a number of drawbacks associated with viral and synthetic non-viral gene delivery approaches. One natural polymer which has generated interest as a gene delivery vector is chitosan. Chitosan is biodegradable, biocompatible and non-toxic. Much of the appeal of chitosan is due to the presence of primary amine groups in its repeating units which become protonated in acidic conditions. This property makes it a promising candidate for non-viral gene delivery. Chitosan-based vectors have been shown to transfect a number of cell types including human embryonic kidney cells (HEK293) and human cervical cancer cells (HeLa). Aside from its use in gene delivery, chitosan possesses a range of properties that show promise in tissue engineering applications; it is biodegradable, biocompatible, has anti-bacterial activity, and, its cationic nature allows for electrostatic interaction with glycosaminoglycans and other proteoglycans. It can be used to make nano- and microparticles, sponges, gels, membranes and porous scaffolds. Chitosan has also been shown to enhance mineral deposition during osteogenic differentiation of MSCs in vitro. The purpose of this review is to critically discuss the use of chitosan as a gene delivery vector with emphasis on its application in orthopedic tissue engineering.

An unusual double fungal infection of the bladder due to Candida ...

African Journals Online (AJOL)

G.V. KandaSwamy

rarely pathogenic to humans, but may cause skin lesions, keratitis, onychomycosis, sinusitis and pulmonary infections [2]. Candida infection is synonymous with fungal cystitis, but cladosporium involving the bladder has virtually been unheard of. Case report. A 37-year-old diabetic female, mother of one child, presented with ...

Nosocomial Mycobacterium bovis-bacille Calmette-Guérin infections due to contamination of chemotherapeutics: case finding and route of transmission

NARCIS (Netherlands)

Vos, Margreet C.; de Haas, Petra E. W.; Verbrugh, Henri A.; Renders, Nicole H. M.; Hartwig, Nico G.; de Man, Peter; Kolk, Arend H. J.; van Deutekom, Henk; Yntema, J. L.; Vulto, Arnold G.; Messemaker, Marja; van Soolingen, Dick

2003-01-01

We studied nosocomial infections due to Mycobacterium bovis bacille Calmette-Guérin (BCG) Onco-TICE bacteria, transmitted by contamination of medication prepared in BCG Onco-TICE-contaminated hoods in the pharmacy, in 5 immunocompromised patients at 3 hospitals. The BCG strains cultured from the

Sex differences in the malnourished status of Chinese children due to schistosomiasis infections and inadequate dietary intake.

Science.gov (United States)

Zhou, Huan; He, Yongkang; Ohtsuka, Ryutaro

2005-01-01

Based on nutritional and parasitological examinations of 389 children aged 10-13 years in five primary schools in the schistosomiasis endemic Dongting Lake region of China, the causal factors of their retarded growth, represented by height, weight, mid-upper arm circumference and body mass index, were investigated. Among the four parasites, schistosomiasis infection due to Schistosoma japonicum played a significant role, with higher rates in girls than in boys. Praziquantel treatment of schistosomiasis decreased the infection rate and improved the children's growth. For dietary intake factors, the contribution of protein to total energy intake, which was lower in girls than in boys, had the greatest effect on the growth patterns. The sex difference in growth retardation is judged to be attributable to the traditional norms, such as girls spending more time in infested environments and gender discrimination in food distribution.

Orthodontic and dentofacial orthopedic management of juvenile idiopathic arthritis: a systematic review of the literature.

Science.gov (United States)

von Bremen, J; Ruf, S

2011-08-01

To systematically review the literature published on orthodontic treatment principles in patients with juvenile idiopathic arthritis (JIA). Several electronic databases (PubMed, Medpilot, Web of Science, and DIMDI) and orthodontic and rheumatologic literature were systematically searched for studies published until May 2010. The articles were rated by two independent reviewers and included after three selection steps (title-abstract-full text). Articles had to be studies performed on ≥ 5 patients with a disease onset before the age of 16. The selection process resulted in the inclusion of three publications on dentofacial orthopedics and six on combined surgical orthodontic therapy. The three studies on dentofacial orthopedics aimed to improve the mandibular retrusion by means of removable functional appliances (activator). Whereas these orthodontic approaches comprised relatively large and homogeneous patient samples (14, 22, and 72 subjects, aged 6-16), the surgical studies were basically case series with a large age span of the patients (5-12 subjects, aged 10-44). In these surgical treatment approaches, orthodontics was limited to pre-surgical leveling and post-surgical finishing, while the skeletal discrepancy was treated surgically by a variety of techniques (costochondral grafts, bilateral sagittal spilt osteotomy, Le Fort I, and genioplasty). The treatment goals of both approaches were improvement of esthetics and function and/or pain reduction, and both approaches showed satisfactory results. Because of the heterogeneity of the subject material and the low level of evidence of the papers, it is difficult to draw any conclusions on the orthodontic/dentofacial orthopedic management of JIA. It appears as if removable functional appliances may be beneficial in adolescent patients with JIA. © 2011 John Wiley & Sons A/S.

Comparing Written and Planned Training On Anxiety among Patients Undergoing Orthopedic Surgery

Directory of Open Access Journals (Sweden)

maryam tolyat

2017-03-01

Full Text Available Introduction and objectives: The prevalence of preoperative state anxiety is an unavoidable complication. Aside from its type and scope, the surgical operation is considered as a severe stressful situation for patients. Considering the importance of reducing the state anxiety in patients undergoing surgery, there are different methods, one of which is patient education; therefore the aim of the current study was compare the effect of written and planned training on the state anxiety among patients undergoing orthopedic surgery. Method: In this study, 81 patients candidate for orthopedic surgery were selected using convenience sampling and were randomly divided into 3 groups, including planned training, pamphlet and control groups. All patients answered 20 questions-State-Traits Anxiety Inventory (STAI Questionnaire the day before surgery and the intervention was later carried out in the planned training and pamphlet groups. Then the effect of preoperative state anxiety was re-evaluated about half an hour after training in three groups. For data analysis, in addition to mean and standard deviation, independent t-test and ANOVA were used in Spss16. Results: The results of comparing pre- and post-training mean score of the state anxiety in three groups showed that the mean score of state anxiety reached from 50.41 to 41.03, 52.41 to 44.37 and 45.04 to 50.56 in planned, pamphlet and control groups, respectively. ANOVA test showed that there is a significant difference in this comparison. The results of Tukey's test also revealed that the mean score of state anxiety in the planned and pamphlet groups was lower significantly than the control group (p<0.05. Conclusion: Based on research findings, the planned training method was more effective in decreasing state anxiety among patients compared to the pamphlet group before orthopedic surgery. Therefore, considering the fact that nurses play an important role in examining and relieving the state anxiety

Surveillance, Auditing, and Feedback Can Reduce Surgical Site Infection Dramatically: Toward Zero Surgical Site Infection.

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Manivannan, Bhavani; Gowda, Deepak; Bulagonda, Pradeep; Rao, Abhishek; Raman, Sai Suguna; Natarajan, Shanmuga Vadivoo

2018-04-01

We evaluated the Surveillance of Surgical Site Infection (SSI), Auditing, and Feedback (SAF) effect on the rate of compliance with an SSI care bundle and measured its effectiveness in reducing the SSI rate. A prospective cohort study from January 2014 to December 2016 was classified into three phases: pre-SAF, early-SAF, and late-SAF. Pre-operative baseline characteristics of 24,677 patients who underwent orthopedic, cardiovascular thoracic surgery (CTVS) or urologic operations were recorded. Univariable analyses of the SSI rates in the pre-SAF and post-SAF phases were performed. Percentage compliance and non-compliance with each care component were calculated. Correlation between reduction in the SSI rate and increase in compliance with the pre-operative, peri-operative, and post-operative care-bundle components was performed using the Spearman test. There was a significant decrease in the SSI rate in orthopedic procedures that involved surgical implantation and in mitral valve/aortic valve (MVR/AVR) cardiac operations, with a relative risk (RR) ratio of 0.19 (95% confidence interval [CI] 0.12-0.31) and 0.08 (95% CI 0.03-0.22), respectively. The SSI rate was inversely correlated with the rate of compliance with pre-operative (r = -0.738; p = 0.037), peri-operative (r = - 0.802; p = 0.017), and post-operative (r = -0.762; p = 0.028) care bundles. Implementation of the Surveillance of SSI, Auditing, and Feedback bundle had a profound beneficial effect on the SSI rate, thereby reducing healthcare costs and improving patient quality of life.

Negative pressure wound therapy for the treatment of infected wounds with exposed knee joint after patellar fracture.

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Lee, Sang Yang; Niikura, Takahiro; Miwa, Masahiko; Sakai, Yoshitada; Oe, Keisuke; Fukazawa, Takahiro; Kawakami, Yohei; Kurosaka, Masahiro

2011-06-14

Treatment of soft tissue defects with exposed bones and joints, resulting from trauma, infection, and surgical complications, represents a major challenge. The introduction of negative pressure wound therapy has changed many wound management practices. Negative pressure wound therapy has recently been used in the orthopedic field for management of traumatic or open wounds with exposed bone, nerve, tendon, and orthopedic implants. This article describes a case of a patient with a large soft tissue defect and exposed knee joint, in which negative pressure wound therapy markedly improved wound healing. A 50-year-old man presented with an ulceration of his left knee with exposed joint, caused by severe wound infections after open reduction and internal fixation of a patellar fracture. After 20 days of negative pressure wound therapy, a granulated wound bed covered the exposed bones and joint.To our knowledge, this is the first report of negative pressure wound therapy used in a patient with a large soft tissue defect with exposed knee joint. Despite the chronic wound secondary to infection, healing was achieved through the use of the negative pressure wound therapy, thus promoting granulation tissue formation and closing the joint. We suggest negative pressure wound therapy as an alternative option for patients with lower limb wounds containing exposed bones and joints when free flap transfer is contraindicated. Our result added to the growing evidence that negative pressure wound therapy is a useful adjunctive treatment for open wounds around the knee joint. Copyright 2011, SLACK Incorporated.

Polysynovitis in a horse due to [i]Borrelia burgdorferi[/i] sensu lato infection – Case study

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Fabrizio Passamonti

2015-05-01

Full Text Available Lyme borreliosis (LB is a multi-systemic tick-borne disease affecting both humans and animals, including horses, and is caused by a group of interrelated spirochetes classified within the[i] Borrelia burgdorferi [/i]sensu lato (s.l. complex. Despite the high reported seroprevalence in the European equine population for [i]B. burgdorferi[/i] s.l., to-date no documented clinical cases have been described. A 6-year-old Paint gelding was referred with a history of three weeks of fever, intermittent lameness and digital flexor tendon sheath effusion of the right hind limb. Based on a strict diagnostic protocol, which included serological tests for infectious diseases and molecular investigations, a final diagnosis was made of polysynovitis due to [i]B. burgdorferi [/i]s.l. infection. An unreported aspect observed in this case was the absence of the pathogen DNA in two of the affected joints. To the authors’ knowledge, the case described represents the first documented clinical case of equine LB in Italy. Moreover, the absence of pathogen DNA in two of the affected joints observed in this case revealed a possible similarity with the same condition described in humans, where an immunomediated pathogenesis for arthropathy due to [i]B. burgdorferi[/i] s.l. infection is suspected. Since humans and horses share the same habitat, this report supports the role of the horse as potential sentinel for human biological risk.

Nanoscale Topography on Black Titanium Imparts Multi-biofunctional Properties for Orthopedic Applications

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Hasan, Jafar; Jain, Shubham; Chatterjee, Kaushik

2017-01-01

We have developed a chlorine based reactive ion etching process to yield randomly oriented anisotropic nanostructures that render the titanium metal surface ‘black’ similar to that of black silicon. The surface appears black due to the nanostructures in contrast to the conventional shiny surface of titanium. The nanostructures were found to kill bacteria on contact by mechanically rupturing the cells as has been observed previously on wings of certain insects. The etching was optimized to yield nanostructures of ≈1 μm height for maximal bactericidal efficiency without compromising cytocompatibility. Within 4 hours of contact with the black titanium surface, 95% ± 5% of E. coli, 98% ± 2% of P. aeruginosa, 92% ± 5% of M. smegmatis and 22% ± 8% of S. aureus cells that had attached were killed. The killing efficiency for the S. aureus increased to 76% ± 4% when the cells were allowed to adhere up to 24 hours. The black titanium supported the attachment and proliferation of human mesenchymal stem cells and augmented osteogenic lineage commitment in vitro. Thus, the bioinspired nanostructures on black titanium impart multi-biofunctional properties toward engineering the next-generation biomaterials for orthopedic implants.

Eradication of multidrug-resistant Acinetobacter baumannii in a female patient with total hip arthroplasty, with debridement and retention: a case report

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Beieler Alison M

2009-02-01

Full Text Available Abstract Introduction Multidrug-resistant Acinetobacter baumannii has become a significant cause of healthcare-associated infections, but few reports have addressed Acinetobacter baumannii infections associated with orthopedic devices. The current recommended treatment for complicated infections due to orthopedic devices, including resistant gram-negative rods, consists of antimicrobial therapy with debridement and removal of implants. Case presentation The patient, a 47-year-old woman, had previously had a prior total hip arthroplasty at 16 years of age for a complex femoral neck fracture, and multiple subsequent revisions. This time, she underwent a fifth revision secondary to pain. Surgery was complicated by hypotension resulting in transfer to the intensive care unit and prolonged respiratory failure. She received peri-operative cefazolin but postoperatively developed surgical wound drainage requiring debridement of a hematoma. Cultures of this grew ampicillin-sensitive Enterococcus and Acinetobacter baumannii (sensitive only to amikacin and imipenem. The patient was started on imipenem. Removal of the total hip arthroplasty was not recommended because of the recent surgical complications, and the patient was eventually discharged home. She was seen weekly for laboratory tests and examinations and, after 4 months of therapy, the imipenem was discontinued. She did well clinically for 7 months before recurrent pain led to removal of the total hip arthroplasty. Intra-operative cultures grew ampicillin-sensitive Enterococcus and coagulase-negative Staphylococcus but no multidrug-resistant Acinetobacter baumannii. The patient received ampicillin for 8 weeks and had not had recurrent infection at the time of writing, 37 months after discontinuing imipenem. Conclusion We describe the successful treatment of an acute infection from multidrug-resistant Acinetobacter baumannii with debridement and retention of the total hip arthroplasty, using

Prolongation of length of stay and Clostridium difficile infection: a review of the methods used to examine length of stay due to healthcare associated infections

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Mitchell Brett G

2012-04-01

Full Text Available Abstract Background It is believed that Clostridium difficile infection (CDI contributes to a prolongation of length of stay (LOS. Recent literature suggests that models previously used to determine LOS due to infection have overestimated LOS, compared to newer statistical models. The purpose of this review is to understand the impact that CDI has on LOS and in doing so, describe the methodological approaches used. Aim First, to investigate and describe the reported prolongation of LOS in hospitalised patients with CDI. Second, to describe the methodologies used for determining excess LOS. Methods An integrative review method was used. Papers were reviewed and analysed individually and themes were combined using integrative methods. Results Findings from all studies suggested that CDI contributes to a longer LOS in hospital. In studies that compared persons with and without CDI, the difference in the LOS between the two groups ranged from 2.8days to 16.1days. Potential limitations with data analysis were identified, given that no study fully addressed the issue of a time-dependent bias when examining the LOS. Recent literature suggests that a multi-state model should be used to manage the issue of time-dependent bias. Conclusion Studies examining LOS attributed to CDI varied considerably in design and data collected. Future studies examining LOS related to CDI and other healthcare associated infections should consider capturing the timing of infection in order to be able to employ a multi-state model for data analysis.

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

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Parish M

2018-02-01

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

Infection due to Mycobacterium bovis in common variable immunodeficiency

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Diana Andrea Herrera-Sánchez

2015-02-01

Full Text Available Common variable immunodeficiency (CVID is an heterogeneous group of disorders characterized by impaired antibody production. It shows a wide spectrum of manifestations including severe and recurrent respiratory infections (Streptococcus pneumoniae, Haemophilus and gastrointestinal (Campylobacter jejuni, rotavirus and Giardia lamblia. Viral infections caused by herpes zoster, cytomegalovirus (CMV and hepatitis C are rare. The opportunistic agents such as CMV, Pneumocystis jirovecii, cryptococcus and atypical mycobacteria have been reported as isolated cases. This paper reports the case of a 38-year-old female patient, who began six years before with weight loss of 7 kg in six months, fatigue, weakness, sweating, fever and abdominal pain. Furthermore, patient had intestinal obstruction and abdominal CT showed mesenteric lymph growth. The mesenteric lymph node biopsy revealed positives Mycobacterium PCR, Ziehl-Neelsen staining and culture for M. bovis. In the laparotomy postoperative period was complicated with nosocomial pneumonia, requiring mechanical ventilation and tracheostomy. Two years later, she developed right renal abscess that required surgical drainage, once again with a positive culture for Mycobacterium bovis. She was referred to highly specialized hospital and we documented panhypogammaglobulinemia and lymphopenia. Secondary causes of hypogammaglobulinemia were ruled out and common variable immunodeficiency (CVID was confirmed, we started IVIG replacement. Four years later she developed mixed cellularity Hodgkin’s lymphoma. Until today she continues with IVIG and chemotherapy. This report of a patient with CVID and Mycobacterium bovis infection, a unusual association, shows the cellular immunity susceptibility in this immunodeficiency, additional to the humoral defect.

Biomaterials with Antibacterial and Osteoinductive Properties to Repair Infected Bone Defects.

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Lu, Haiping; Liu, Yi; Guo, Jing; Wu, Huiling; Wang, Jingxiao; Wu, Gang

2016-03-03

The repair of infected bone defects is still challenging in the fields of orthopedics, oral implantology and maxillofacial surgery. In these cases, the self-healing capacity of bone tissue can be significantly compromised by the large size of bone defects and the potential/active bacterial activity. Infected bone defects are conventionally treated by a systemic/local administration of antibiotics to control infection and a subsequent implantation of bone grafts, such as autografts and allografts. However, these treatment options are time-consuming and usually yield less optimal efficacy. To approach these problems, novel biomaterials with both antibacterial and osteoinductive properties have been developed. The antibacterial property can be conferred by antibiotics and other novel antibacterial biomaterials, such as silver nanoparticles. Bone morphogenetic proteins are used to functionalize the biomaterials with a potent osteoinductive property. By manipulating the carrying modes and release kinetics, these biomaterials are optimized to maximize their antibacterial and osteoinductive functions with minimized cytotoxicity. The findings, in the past decade, have shown a very promising application potential of the novel biomaterials with the dual functions in treating infected bone defects. In this review, we will summarize the current knowledge of novel biomaterials with both antibacterial and osteoinductive properties.

Infection due to C. difficile ribotype 078: first report of cases in the Republic of Ireland.

LENUS (Irish Health Repository)

Burns, K

2010-08-01

Clostridium difficile is an important healthcare-associated pathogen. Hypervirulent strains such as those belonging to ribotype 027 have been widely reported in recent years. A second strain associated with hypervirulence is ribotype 078 and the prevalence of Clostridium difficile infection (CDI) due to this ribotype appears to be increasing. This report describes an outbreak, in which 15cases of CDI due to ribotype 078 were detected in an Irish hospital and from a nursing home in the hospital\\'s catchment area. C. difficile ribotype 078 accounted for 15% of total isolates submitted for ribotyping. The average age of patients with CDI due to ribotype 078 was 76 years. Forty-six percent of patients experienced recurrence of symptoms within eight weeks of diagnosis and CDI was felt to have directly contributed to five of the eight deaths. Use of enhanced DNA fingerprinting identified clusters within the 15 cases and suggested hitherto unrecognised links between some patients with CDI. Such approaches offer the promise to delineate common sources and transmission routes for C. difficile.

Prevalence and antibiogram of methicillin resistant Staphylococcus aureus isolated from medical device-related infections; a retrospective study in Lahore, Pakistan

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Muhammad Sohail

Full Text Available Abstract INTRODUCTION: With the advancement of medicine and surgery, various types of medical devices have become part of treatment strategies. METHODS: Identification and antimicrobial sensitivity testing were done according to CLSI guidelines following standard microbiological practices. RESULTS: Urinary catheter infections (31% were most frequent followed by central venous catheter (18% and orthopedic implants (15%. Methicillin resistant Staphylococcus aureus (MRSA was a major cause of device-related infection after Escherichia coli (21%; other pathogens were Klebsiella pneumoniae (14%, Pseudomonas spp. (10%, Acinetobacter spp. (8% and Candida species (7%. None of MRSA was resistant to vancomycin (MIC ≥16µg/mL. Resistance rates were 98% and 97% for ofloxacin and ciprofloxacin, respectively. CONCLUSIONS Escherichia coli and MRSA are major pathogens of medical device-related infections.

THE PORTION OF AUTOLOGOUS BLOOD IN ORTHOPEDIC DEPARTMENT OF GENERAL HOSPITAL NOVA GORICA IN FIVE YEARS PERIOD (1996–2000

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Janka Černe-Zavadlav

2002-04-01

Full Text Available Background. The presentation of autologous blood donation with analysis of used blood and the percentage of autologous blood on Orthopedic Department in the years 1996–2000.Methods. From card-index of autologous blood donors we analysed 363 preoperative autologous blood donations.We followed the number of doses in one patient and type of operating procedure.We analysed the usage of blood from transfusion issue protocols and the usage of postoperative autotransfusion from patient protocols.Results. 91% of all preoperative blood donations in our hospital in five years period were from Orthopedic Department. There were 280 operating procedures (hip and knee arthroplasty that needed blood transfusion. 196 of these (70% were included in preoperative blood donation programme. We collected 330 doses: 1 dose in 61 cases, 2 doses in 100, 3 doses in 34 and 4 doses in 1 case or 1.68 doses per patient. The relationship between used autologous and allogenic blood were 46 : 54 (doses or 38 : 62 (mL. Autologous blood represented 38% of all used blood on Orthopedic Department, only 11% of autologous blood were discarded.Conclusions. The program of preoperative blood donation is well organized on The Orthopedic Department of our Hospital. To our experience we make the most of profit of autotransfusion (to avoid risks of allogenic blood, optimal patient colaboration, low percentage of discarded blood with two predonated doses in combination with postoperative autotransfusion. Regard to The Law of Blood supply (may 2000 we are going to introduce this protocol of preoperative blood donation for all programed operating procedures in our Hospital, which need blood transfusion.

Infectious mononucleosis due to epstein-barr virus infection in children: A profile from eastern India

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Madhumita Nandi

2017-01-01

Full Text Available Objective: The objective of this study is to delineate the clinical and laboratory profile of infectious mononucleosis due to Epstein-Barr virus (EBV infection in children admitted to tertiary care teaching hospitals. Materials and Methods: Retrospective observational multicentric analysis of clinical and laboratory features of children between 1 month to 12 years with a diagnosis of infectious mononucleosis due to EBV infection confirmed by positive serology over a 12-month period after seeking approval from the Institutional Ethics Committee. Results: Out of 66 children screened, 53 were included in final analysis. The majority were aged between 5 and 8 years with male: female ratio of 1.2:1. Most presentations were during the monsoon months. The common clinical features were fever (100%, splenomegaly (86.7%, and cervical lymphadenopathy (73.5% in contrast to the classical triad of fever, sore throat, and generalized lymphadenopathy described in the literature. There were no age differences in clinical findings except for generalized and cervical lymphadenopathy and hepatomegaly which were commoner in 9–12 years age band. Although the incidence of common findings matched with previously published studies, there were some notable differences. While frequencies of upper eyelid edema, epitrochlear lymphadenopathy, and splenomegaly were more, those of rash and sore throat were less. Lymphocytosis and presence of atypical lymphocytes were relatively less common in our series. All children recovered. Conclusions: This multicentric study on profiling childhood infectious mononucleosis, possibly first of its kind from Eastern India, has documented clinical and laboratory features associated with this condition. These data can serve as a reference for future studies.

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

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

2010-09-01

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

Machining of a bioactive nanocomposite orthopedic fixation device.

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Sparnell, Amie; Aniket; El-Ghannam, Ahmed

2012-08-01

Bioactive ceramics bond to bone and enhance bone formation. However, they have poor mechanical properties which restrict their machinability as well as their application as load bearing implants. The goal of this study was to machine bioactive fixation screws using a silica-calcium phosphate nanocomposite (SCPC50). The effect of compact pressure, holding time, and thermal treatment on the microstructure, machinability, and mechanical properties of SCPC50 cylinders were investigated. Samples prepared by powder metallurgy technique at compact pressure range of 100-300 MPa and treated at 900°C/1 h scored a poor machinability rating of (1/5) due to the significant formation of amorphous silicate phase at the grain boundaries. On the other hand, lowering of compact pressure and sintering temperature to 30 MPa/3 h and 700°C/2 h, respectively, minimized the formation of the amorphous phase and raised the machinability rating to (5/5). The modulus of elasticity and ultimate strength of machinable SCPC50 were 10.8 ± 2.0 GPa and 72.8 ± 22.8 MPa, respectively, which are comparable to the corresponding values for adult human cortical bone. qRT-PCR analyses showed that bone cells attached to SCPC50 significantly upregulated osteocalcin mRNA expression as compared to the cells on Ti-6Al-4V. Moreover, cells attached to SCPC50 produced mineralized bone-like tissue within 8 days. On the other hand, cells attached to Ti-6Al-4V failed to produce bone mineral under the same experimental conditions. Results of the study suggest that machinable SCPC50 has the potential to serve as an attractive new material for orthopedic fixation devices. Copyright © 2012 Wiley Periodicals, Inc.

Psychological Distress After Orthopedic Trauma: Prevalence in Patients and Implications for Rehabilitation.

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Vincent, Heather K; Horodyski, MaryBeth; Vincent, Kevin R; Brisbane, Sonya T; Sadasivan, Kalia K

2015-09-01

Orthopedic trauma is an unforeseen life-changing event. Serious injuries include multiple fractures and amputation. Physical rehabilitation has traditionally focused on addressing functional deficits after traumatic injury, but important psychological factors also can dramatically affect acute and long-term recovery. This review presents the effects of orthopedic trauma on psychological distress, potential interventions for distress reduction after trauma, and implications for participation in rehabilitation. Survivors commonly experience post-traumatic stress syndrome, depression, and anxiety, all of which interfere with functional gains and quality of life. More than 50% of survivors have psychological distress that can last decades after the physical injury has been treated. Early identification of patients with distress can help care teams provide the resources and support to offset the distress. Several options that help trauma patients navigate their short-term recovery include holistic approaches, pastoral care, coping skills, mindfulness, peer visitation, and educational resources. The long-term physical and mental health of the trauma survivor can be enhanced by strategies that connect the survivor to a network of people with similar experiences or injuries, facilitate support groups, and social support networking (The Trauma Survivors Network). Rehabilitation specialists can help optimize patient outcomes and quality of life by participating in and advocating these strategies. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

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

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

2018-04-01

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

Test and cull of high risk Coxiella burnetii infected pregnant dairy goats is not feasible due to poor test performance.

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Hogerwerf, Lenny; Koop, Gerrit; Klinkenberg, Don; Roest, Hendrik I J; Vellema, Piet; Nielen, Mirjam

2014-05-01

A major human Q fever epidemic occurred in The Netherlands during 2007-2009. In response, all pregnant goats from infected herds were culled before the 2010 kidding season without individual testing. The aim of this study was to assess whether high risk animals from recently infected naive herds can be identified by diagnostic testing. Samples of uterine fluid, milk and vaginal mucus from 203 euthanized pregnant goats were tested by PCR or ELISA. The results suggest that testing followed by culling of only the high risk animals is not a feasible method for protecting public health, mainly due to the low specificity of the tests and variability between herds. The risk of massive bacterial shedding during abortion or parturition can only be prevented by removal of all pregnant animals from naive recently infected herds. Copyright © 2014 Elsevier Ltd. All rights reserved.

Greening of orthopedic surgery.

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Lee, Rushyuan J; Mears, Simon C

2012-06-01

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

Young-infant Sepsis Combined with Urinary Tract Infection Due to Hafnia alvei

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Chia-Hung Liu

2007-01-01

Full Text Available Hafnia alvei infections are uncommon and occur mainly in adult patients featuring underlying illnesses. Its isolation in pediatric cases is even more unusual. We report a rare case of sepsis combined with urinary tract infection caused by H. alvei in a 39-day-old infant who did not appear to feature any underlying disease. The infant was successfully treated with ceftriaxone over a 14-day period. In this case, we want to remind clinicians that the possibility of an extraintestinal invasive infection such as bacteremia or urinary tract infection caused by H. alvei should be taken into account in young infants who feature no apparent underlying disease. [J Formos Med Assoc 2007;106(3 Suppl:S39-S43

Outcome measures and psychomotor skills related to shoulder conditions for clinical orthopedic training.

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Mahomed, Surreya; Al-Obaidi, Saud; Al-Zoabi, Baker

2008-01-01

This study was designed to assess the ability of physical therapy (PT) students to utilize selected outcome measures such as range of motion (ROM), pain and a number of psychomotor skills and to determine the efficacy of treatment they carried out during orthopedic clinical training. The clinical education booklets in orthopedics of all PT students over a 6-year period were reviewed. Students' application of psychomotor skills such as peripheral joint mobilizations (PJM), proprioceptive neuromuscular facilitation (PNF) techniques, therapeutic exercise techniques as well as utilization of basic outcome measures such as ROM and pain were analyzed with descriptive statistics and paired t test. A majority of students used PJM techniques (78.6%) and PNF techniques (58.6%). The paired t test indicated that treatment interventions used by the students were associated with improved shoulder joint ROM and decreased pain levels (p < 0.001). At the same time, therapeutic exercises were employed by the students after PJM and PNF. The most common 'comparable joint sign' was limitation in shoulder abduction ROM, which occurred in 44% of patients seen by the students. PT students' application of PJM, PNF, and therapeutic exercise improved ROM and decreased pain in patients with shoulder pathologies. (c) 2008 S. Karger AG, Basel.

Fighting infections due to multidrug-resistant Gram-positive pathogens.

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Cornaglia, G

2009-03-01

Growing bacterial resistance in Gram-positive pathogens means that what were once effective and inexpensive treatments for infections caused by these bacteria are now being seriously questioned, including penicillin and macrolides for use against pneumococcal infections and-in hospitals-oxacillin for use against staphylococcal infections. As a whole, multidrug-resistant (MDR) Gram-positive pathogens are rapidly becoming an urgent and sometimes unmanageable clinical problem. Nevertheless, and despite decades of research into the effects of antibiotics, the actual risk posed to human health by antibiotic resistance has been poorly defined; the lack of reliable data concerning the outcomes resulting from antimicrobial resistance stems, in part, from problems with study designs and the methods used in resistence determination. Surprisingly little is known, too, about the actual effectiveness of the many types of intervention aimed at controlling antibiotic resistance. New antibiotics active against MDR Gram-positive pathogens have been recently introduced into clinical practice, and the antibiotic pipeline contains additional compounds at an advanced stage of development, including new glycopeptides, new anti-methicillin-resistant Staphylococcus aureus (MRSA) beta-lactams, and new diaminopyrimidines. Many novel antimicrobial agents are likely to be niche products, endowed with narrow antibacterial spectra and/or targeted at specific clinical problems. Therefore, an important educational goal will be to change the current, long-lasting attitudes of both physicians and customers towards broad-spectrum and multipurpose compounds. Scientific societies, such as the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), must play a leading role in this process.

Ilizarov fixator in management of nonunited and infected tibial shaft fractures

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Abhinay Singh

2015-01-01

Full Text Available Background: Management of nonunion with bony defect and infection in long bones is a challenging problem for orthopedic surgeons. Objectives: Evaluation of Ilizarov circular fixation method of treatment for the management of nonunited and infected fractures of tibia. Materials and Methods: This prospective study was conducted in a tertiary care hospital of eastern region of India on 30 subjects in a time span of 3 years after taking clearance of the Institutional Ethical Committee and informed consent of the patients. Results: All the patients had infected nonunion before undergoing Ilizarov procedure. Following initial injury, 22 patients were treated with external fixation and 8 cases were treated with internal fixation. At the time of presentation, 18 patients had infected gap nonunion, 5 patients had infected hypertrophic and 2 patients had atrophic nonunion. The Ilizarov fixator was kept for an average period of 303.7 days. Based on Association for the Study and Application of Methods of Ilizarov scoring system, bony and functional results were assessed. The bony result was excellent in 16 patients, good in eight, fair in four and poor in two. The functional result was excellent in 10 patients, good in 16, fair in two, poor in two. Conclusion: Ilizarov ring fixator still remains an excellent treatment modality for tibial nonunion with a defect, regarding bone union, deformity correction, infection eradication, limb-length achievement, and limb function.

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

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A. S. Arutyunov

2015-01-01

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

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

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Baccetti, Tiziano; McNamara, James A

2010-01-01

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

[Interpersonal competence in orthopedics and traumatology : Why technical and procedural skills alone are not sufficient].

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Seemann, R; Münzberg, M; Stange, R; Rüsseler, M; Egerth, M; Bouillon, B; Hoffmann, R; Mutschler, M

2016-10-01

Patient safety has increasingly gained significance as criterion which clinics and doctors will be measured against in terms of ethics and finances. The "human factor" moved into focus regarding the question of how to reduce treatment errors in clinical daily routine. Nevertheless, systematic mediation of interpersonal competences only plays a minor role in the catalogue of requirements for medical specialization and professional training. This is the case not only in orthopedics and traumatology, but in other medical fields as well. At the insistence of DGOU and in cooperation with Lufthansa Flight Training, a training model was initiated, comparable to training models used in aviation. In aviation, apart from the training of procedural and technical abilities, regular soft skills training has become standard in the training of all Lufthansa staff. Several studies confirm that by improving communication, interaction, and teamwork skills not only a reduction of intolerable incidents is observed, but also a positive economic effect. Interpersonal competences should be firmly anchored in orthopedics and traumatology and thus be implemented as third post in specialist training.

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

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Takura, Tomoyuki; Miki, Kenji

2016-05-01

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

Evaluation the effects of adding ketamine to morphine in intravenous patient-controlled analgesia after orthopedic surgery

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Godrat Akhavanakbari

2014-01-01

Full Text Available Background: Intravenous patient-controlled analgesia (PCA with morphine is commonly used for post-operative pain after major surgery. Ketamine has analgesic property at lower doses, and in combination with opioids it could have synergistic effect. The aim of this study is to determine effects of the addition of ketamine to morphine for PCA after orthopedic surgery. Materials and Methods: In this double-blind randomized clinical trial, 60 patients were randomly allocated to receive PCA consisting: Group 1 (morphine 0.2 mg/ml, Group 2 (morphine 0.2 mg/ml + ketamine 1 mg/ml, and Group 3 (morphine 0.1 mg/ml + ketamine 2 mg/ml. In this, anesthesiologists managed study, patients had orthopedic surgery. Assessments were made at 24 h and 48 h post-operatively. Visual analog scale (VAS was used for recording pain score. PCA morphine use was recorded at 24 h and 48 h. VAS scores over 48 h were analyzed with analysis of variance for repeated measures. Significance level was taken as 0.05. Results: There is no significant difference between demographic information of the three groups ( P > 0.05. Control of pain in Group 2 and Group 3 was better than in Group 1 (only morphine ( P = 0.001 but there was no significant difference between Group 2 and Group 3 ( P > 0.05. Rate of narcotic consumption in groups 2 and 3 was significantly lower than Group 1 ( P < 0.05. Conclusion: After orthopedic surgery, the addition of ketamine to morphine for intravenous PCA was superior to Intravenous PCA opioid alone. The combination induces a significant reduction in pain score and cumulative morphine consumption.

"WhatsApp"ening in orthopedic care: a concise report from a 300-bedded tertiary care teaching center.

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Khanna, Vishesh; Sambandam, Senthil N; Gul, Arif; Mounasamy, Varatharaj

2015-07-01

Smartphones have emerged as essential tools providing assistance in patient care, monitoring, rehabilitation, communication, diagnosis, teaching, research and reference. Among innumerable communication apps, WhatsApp has been widely popular and cost effective. The aim of our study was to report the impact of introduction of a smartphone app "WhatsApp" as an intradepartmental communication tool on (1) awareness of patient-related information, (2) efficiency of the handover process and (3) duration of traditional morning handovers among orthopedic residents in a 300-bedded tertiary care teaching center. Written handovers and paging used for communication at our center led to occasional inefficiencies among residents. Widespread use, low cost, availability and double password protection (phone lock and WhatsApp lock) made WhatsApp's group conversation feature an ideal tool for intradepartmental patient-related communication. Twenty-five consecutive admissions before and after WhatsApp (BW, AW) were included in the study. Eight orthopedic residents attempted fifty randomly arranged questions based on the twenty-five patients in each study period. A null hypothesis that introduction of WhatsApp group would neither increase the awareness of patient-related information nor improve the efficiency of the handovers among residents was assumed. A significant improvement observed in scores obtained by residents in the AW group led to rejection of the null hypothesis. The residents also reported swifter and efficient handovers after the introduction of WhatsApp. Our results indicate that the introduction of a smartphone app "WhatsApp" as an intradepartmental communication tool can bring about an improvement in patient-related awareness, communication and handovers among orthopedic residents.

Proceedings of scientific instructional conference on local antibiotic therapy on prevention and treatment of infections in orthopaedics and traumatology.

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Okapa, Robert; Marczyński, Wojciech; Kolbuszewski, Andrzej

2013-06-13

Proceedings of scientific instructional conference which was held on 7th July 2012 in Józefów near Warsaw. Dring the Conference the cectures were presented by leading experts - Dr. David Jenkins, clinical microbiology consultant from the University Hospital in Leicester, Professor Harald Knaepler, head of the Department of Trauma and Orthopaedics in Wetzlar, Germany, Dr. David Jahoda, head of the department of orthopedic infections, Motol University Hospital, Prague, and Professor Wojciech Marczyński, head of the Department of Orthopaedics, The Centre of Postgraduate Medical Education, Professor Adam Gruca Teaching Hospital in Otwock, who was also the Conference moderator. The meeting was the opportunity to clarify the indications and contraindications to the use of local antibiotic therapy in the treatment of infectious complications after surgical procedures  and focus on practical aspects of clinical microbiology and its important contribution to the identification and resolution of problems with infectious complications in orthopedics and traumatology.  

Gallium-containing hydroxyapatite for potential use in orthopedics

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Melnikov, P.; Teixeira, A.R.; Malzac, A.; Coelho, M. de B.

2009-01-01

A novel material that may be recommended for grafts and implants stimulating bone growth has been obtained by introducing gallium ions (up to 11.0 mass%) into crystalline lattice of hydroxyapatite. The doping was carried out using gallium nitrate and sodium gallate solutions. In both cases, lattice parameters of gallium-doped hydroxyapatite are identical to those of pure synthetic hydroxyapatite. Gallium does not replace calcium as a result of heterovalent substitution and consequently produces no distortions in the framework of hydroxyapatite matrix. It remains strongly fixed in the form of solid solution of intercalation. According to scanning electron microscopy images gallium insertion does not cause any morphological alterations in hydroxyapatite structure and the product developed meets physico-chemical criteria for biomaterial to be employed in orthopedic practice and local handling of traumatic injuries. Its future usage opens the opportunity to enhance osteosynthesis and calcium retention in loco.

Pathological femoral fractures due to osteomalacia associated with adefovir dipivoxil treatment for hepatitis B: a case report

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Tanaka Motoyuki

2012-08-01

Full Text Available Abstract We present a case of a 62-year-old man who underwent total hip arthroplasty for treatment of pathologic femoral neck fracture associated with adefovir dipivoxil-induced osteomalacia. He had a 13-month history of bone pain involving his shoulders, hips, and knee. He received adefovir dipivoxil for treatment of lamivudine-resistant hepatitis B virus infection for 5 years before the occurrence of femoral neck fracture. Orthopedic surgeons should be aware of osteomalacia and pathological hip fracture caused by drug-induced renal dysfunction, which results in Fanconi’s syndrome. Virtual slides The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1600344696739249

Pathological femoral fractures due to osteomalacia associated with adefovir dipivoxil treatment for hepatitis B: a case report

Science.gov (United States)

2012-01-01

We present a case of a 62-year-old man who underwent total hip arthroplasty for treatment of pathologic femoral neck fracture associated with adefovir dipivoxil-induced osteomalacia. He had a 13-month history of bone pain involving his shoulders, hips, and knee. He received adefovir dipivoxil for treatment of lamivudine-resistant hepatitis B virus infection for 5 years before the occurrence of femoral neck fracture. Orthopedic surgeons should be aware of osteomalacia and pathological hip fracture caused by drug-induced renal dysfunction, which results in Fanconi’s syndrome. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1600344696739249 PMID:22906214

Febrile urinary-tract infection due to extended-spectrum beta-lactamase-producing Enterobacteriaceae in children: A French prospective multicenter study.

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Madhi, Fouad; Jung, Camille; Timsit, Sandra; Levy, Corinne; Biscardi, Sandra; Lorrot, Mathie; Grimprel, Emmanuel; Hees, Laure; Craiu, Irina; Galerne, Aurelien; Dubos, François; Cixous, Emmanuel; Hentgen, Véronique; Béchet, Stéphane; Bonacorsi, Stéphane; Cohen, Robert

2018-01-01

To assess the management of febrile urinary-tract infection (FUTIs) due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) in children, the Pediatric Infectious Diseases Group of the French Pediatric Society set up an active surveillance network in pediatric centers across France in 2014. We prospectively analysed data from 2014 to 2016 for all children < 18 years old who received antibiotic treatment for FUTI due to ESBL-E in 24 pediatric centers. Baseline demographic, clinical features, microbiological data and antimicrobials prescribed were collected. 301 children were enrolled in this study. The median age was 1 year (IQR 0.02-17.9) and 44.5% were male. These infections occurred in children with history of UTIs (27.3%) and urinary malformations (32.6%). Recent antibiotic use was the main associated factor for FUTIs due to ESBL-E, followed by a previous hospitalization and travel history. Before drug susceptibility testing (DST), third-generation cephalosporins (3GC) PO/IV were the most-prescribed antibiotics (75.5%). Only 13% and 24% of children received amikacine alone for empirical or definitive therapy, respectively, whereas 88.7% of children had isolates susceptible to amikacin. In all, 23.2% of children received carbapenems in empirical and/or definitive therapy. Cotrimoxazole (24.5%), ciprofloxacin (15.6%) and non-orthodox clavulanate-cefixime combination (31.3%) were the most frequently prescribed oral options after obtaining the DST. The time to apyrexia and length of hospital stay did not differ with or without effective empirical therapy. We believe that amikacin should increasingly take on a key role in the choice of definitive therapy of FUTI due to ESBL-E in children by avoiding the use of carbapenems.

TiZrNbTaMo high-entropy alloy designed for orthopedic implants: As-cast microstructure and mechanical properties.

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Wang, Shao-Ping; Xu, Jian

2017-04-01

Combining the high-entropy alloy (HEA) concept with property requirement for orthopedic implants, we designed a Ti 20 Zr 20 Nb 20 Ta 20 Mo 20 equiatomic HEA. The arc-melted microstructures, compressive properties and potentiodynamic polarization behavior in phosphate buffer solution (PBS) were studied in detail. It was revealed that the as-cast TiZrNbTaMo HEA consisted of dual phases with bcc structure, major bcc1 and minor bcc2 phases with the lattice parameters of 0.3310nm and 0.3379nm, respectively. As confirmed by nanoindentation tests, the bcc1 phase is somewhat harder and stiffer than the bcc2 phase. The TiZrNbTaMo HEA exhibited Young's modulus of 153GPa, Vickers microhardness of 4.9GPa, compressive yield strength of σ y =1390MPa and apparent plastic strain of ε p ≈6% prior to failure. Moreover, the TiZrNbTaMo HEA manifested excellent corrosion resistance in PBS, comparable to the Ti6Al4V alloy, and pitting resistance remarkably superior to the 316L SS and CoCrMo alloys. These preliminary advantages of the TiZrNbTaMo HEA over the current orthopedic implant metals in mechanical properties and corrosion resistance offer an opportunity to explore new orthopedic-implant alloys based on the TiZrNbTaMo concentrated composition. Copyright © 2016 Elsevier B.V. All rights reserved.

The influence of orthopedic corsets on the incidence of pathological fractures in patients with spinal bone metastases after radiotherapy

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Rief, Harald; Förster, Robert; Rieken, Stefan; Bruckner, Thomas; Schlampp, Ingmar; Bostel, Tilman; Debus, Jürgen

2015-01-01

Clinical care of unstable spinal bone metastases in many centers often includes patient immobilization by means of an orthopedic corset in order to prevent pathological fractures. The aim of this retrospective analysis was to evaluate the incidence of pathological fractures after radiotherapy (RT) in patients with and without orthopedic corsets and to assess prognostic factors for pathological fractures in patients with spinal bone metastases. The incidence of pathological fractures in 915 patients with 2.195 osteolytic metastases in the thoracic and lumbar spine was evaluated retrospectively on the basis of computed tomography (CT) scans between January 2000 and January 2012 depending on prescription and wearing of patient—customized orthopedic corsets. In the corset group, 6.8 and 8.0 % in no-corset group showed pathological fractures prior to RT, no significant difference between groups was detected (p = 0.473). After 6 months, patients in the corset group showed pathological fractures in 8.6 % and in no-corset group in 9.3 % (p = 0.709). The univariate and bivariate analyses demonstrated no significant prognostic factor for incidence of pathological fractures in both groups. In this analysis, we could show for the first time in more than 900 patients, that abandoning a general corset supply in patients with spinal metastases does not significantly cause increased rates of pathological fractures. Importantly, the incidence of pathological fracture after RT was small

Effects of external stress on biodegradable orthopedic materials: A review

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Xuan Li

2016-09-01

Full Text Available Biodegradable orthopedic materials (BOMs are used in rehabilitation and reconstruction of fractured tissues. The response of BOMs to the combined action of physiological stress and corrosion is an important issue in vivo since stress-assisted degradation and cracking are common. Although the degradation behavior and kinetics of BOMs have been investigated under static conditions, stress effects can be very serious and even fatal in the dynamic physiological environment. Since stress is unavoidable in biomedical applications of BOMs, recent work has focused on the evaluation and prediction of the properties of BOMs under stress in corrosive media. This article reviews recent progress in this important area focusing on biodegradable metals, polymers, and ceramics.

Power harvesting using PZT ceramics embedded in orthopedic implants.

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Chen, Hong; Liu, Ming; Jia, Chen; Wang, Zihua

2009-09-01

Battery lifetime has been the stumbling block for many power-critical or maintenance-free real-time embedded applications, such as wireless sensors and orthopedic implants. Thus a piezoelectric material that could convert human motion into electrical energy provides a very attractive solution for clinical implants. In this work, we analyze the power generation characteristics of stiff lead zirconate titanate (PZT) ceramics and the equivalent circuit through extensive experiments. Our experimental framework allows us to explore many important design considerations of such a PZT-based power generator. Overall we can achieve a PZT element volume of 0.5 x 0.5 x 1.8 cm, which is considerably smaller than the results reported so far. Finally, we outline the application of our PZT elements in a total knee replacement (TKR) implant.

Very-short-term perioperative intravenous iron administration and postoperative outcome in major orthopedic surgery: a pooled analysis of observational data from 2547 patients.

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Muñoz, Manuel; Gómez-Ramírez, Susana; Cuenca, Jorge; García-Erce, José Antonio; Iglesias-Aparicio, Daniel; Haman-Alcober, Sami; Ariza, Daniel; Naveira, Enrique

2014-02-01

Postoperative nosocomial infection (PNI) is a severe complication in surgical patients. Known risk factors of PNI such as allogeneic blood transfusions (ABTs), anemia, and iron deficiency are manageable with perioperative intravenous (IV) iron therapy. To address potential concerns about IV iron and the risk of PNI, we studied a large series of orthopedic surgical patients for possible relations between IV iron, ABT, and PNI. Pooled data on ABT, PNI, 30-day mortality, and length of hospital stay (LHS) from 2547 patients undergoing elective lower-limb arthroplasty (n = 1186) or hip fracture repair (n = 1361) were compared between patients who received either very-short-term perioperative IV iron (200-600 mg; n = 1538), with or without recombinant human erythropoietin (rHuEPO; 40,000 IU), or standard treatment (n = 1009). Compared to standard therapy, perioperative IV iron reduced rates of ABT (32.4% vs. 48.8%; p = 0.001), PNI (10.7% vs. 26.9%; p = 0.001), and 30-day mortality (4.8% vs. 9.4%; p = 0.003) and the LHS (11.9 days vs. 13.4 days; p = 0.001) in hip fracture patients. These benefits were observed in both transfused and nontransfused patients. Also in elective arthroplasty, IV iron reduced ABT rates (8.9% vs. 30.1%; p = 0.001) and LHS (8.4 days vs.10.7 days; p = 0.001), without differences in PNI rates (2.8% vs. 3.7%; p = 0.417), and there was no 30-day mortality. Despite known limitations of pooled observational analyses, these results suggest that very-short-term perioperative administration of IV iron, with or without rHuEPO, in major lower limb orthopedic procedures is associated with reduced ABT rates and LHS, without increasing postoperative morbidity or mortality. © 2013 American Association of Blood Banks.

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

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

2015-09-01

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

Surgical site infection in orthopedic implants and its common bacteria with their sensitivities to antibiotics, in open reduction internal fixation

International Nuclear Information System (INIS)

Shah, M.Q.; Zardad, M.S.; Khan, A.; Ahmed, S.; Awan, A. S.; Mohammad, T.

2017-01-01

Surgical site infection in orthopaedic implants is a major problem, causing long hospital stay, cost to the patient and is a burden on health care facilities. It increases rate of non-union, osteomyelitis, implant failure, sepsis, multiorgan dysfunction and even death. Surgical site infection is defined as pain, erythema, swelling and discharge from wound site. Surgical site infection in orthopaedic implants is more challenging to the treating orthopaedic surgeon as the causative organism is protected by a biofilm over the implant's surface. Antibiotics cannot cross this film to reach the bacteria's, causing infection. Method: This descriptive case series study includes 132 patients of both genders with ages between 13 years to 60 years conducted at Orthopaedic Unit, Ayub Medical College, Abbottabad from 1st October 2015 to 31st March 2016. Patients with close fractures of long bones were included in the study to determine the frequency of surgical site infection in orthopaedic implants and the type of bacteria involved and their sensitivity to various antibiotics. All implants were of stainless steel. The implants used were Dynamic hip screws, Dynamic compression screws, plates, k-wires, Interlocking nails, SIGN nails, Austin Moore prosthesis and tension band wires. Pre-op and post-op antibiotics used were combination of Sulbactum and Cefoperazone which was given 1 hour before surgery and continued for 72 hours after surgery. Patients were followed up to 4 weeks. Pus was taken on culture stick, from those who developed infection. Results were entered in the pro forma. Results: A total of 132 patients of long bone fractures, who were treated with open reduction and internal fixation, were studied. Only 7 patients developed infection. Staphylococcus Aureus was isolated from all 7 patients. Staphylococcus aureus was sensitive to Linezolid, Fusidic Acid, and vancomycin. Cotrimoxazole, tetracycline, Gentamycin and Clindamycin were partially effective. Conclusion

Neuropsychological Performance and Subjective Symptom Reporting in Military Service Members With a History of Multiple Concussions: Comparison With a Single Concussion, Posttraumatic Stress Disorder, and Orthopedic Trauma.

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Cooper, Douglas B; Curtiss, Glenn; Armistead-Jehle, Patrick; Belanger, Heather G; Tate, David F; Reid, Matthew; Bowles, Amy O; Velez, Carmen S; Kennedy, Jan E; Vanderploeg, Rodney D

To examine differences in objective neurocognitive performance and subjective cognitive symptoms in individuals with a history of a single concussion, multiple concussions, orthopedic injuries, and posttraumatic stress disorder (PTSD). Participants included 116 military service members who sustained a mild traumatic brain injury (mTBI) during combat deployment. Subjects were subdivided into groups based on concussion frequency: a single concussion (n = 42), 2 concussions (n = 21), and 3 or more concussions (n = 53). Eighty-one subjects sustained an orthopedic injury (n = 60) during deployment or were diagnosed with PTSD (n = 21), but had no history of mTBI. Subjects completed a battery of neuropsychological tests and self-report measures of postconcussive symptoms, PTSD symptoms, and psychopathology. No differences were found among the concussion groups on a composite neuropsychological measure. The PTSD group had the highest number of symptom complaints, with the 2-concussion and 3-plus-concussion groups being most similar to the PTSD group. The concussion groups showed a nonsignificant pattern of increasing distress with increasing number of concussions. The current findings are consistent with meta-analytic results showing no differential effect on neuropsychological functioning due to multiple concussions. Results also support the burden of adversity hypothesis suggesting increasing symptom levels with increasing psychological or physically traumatic exposures.

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

International Nuclear Information System (INIS)

Flechtenmacher, Johannes; Sabo, Desiderius

2014-01-01

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

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

Institute of Scientific and Technical Information of China (English)

李润洁

2002-01-01

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

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

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

2014-01-01

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

Osteoblast adhesion on novel machinable calcium phosphate/lanthanum phosphate composites for orthopedic applications.

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Ergun, Celaletdin; Liu, Huinan; Webster, Thomas J

2009-06-01

Lanthanum phosphate (LaPO(4), LP) was combined with either hydroxyapatite (HA) or tricalcium phosphate (TCP) to form novel composites for orthopedic applications. In this study, these composites were prepared by wet chemistry synthesis and subsequent powder mixing. These HA/LP and TCP/LP composites were characterized in terms of phase stability and microstructure evolution during sintering using X-ray diffraction (XRD) and scanning electron microscopy (SEM). Their machinability was evaluated using a direct drilling test. For HA/LP composites, LP reacted with HA during sintering and formed a new phase, Ca(8)La(2)(PO(4))(6)O(2), as a reaction by-product. However, TCP/LP composites showed phase stability and the formation of a weak interface between TCP and LP machinability when sintered at 1100 degrees C, which is crucial for achieving desirable properties. Thus, these novel TCP/LP composites fulfilled the requirements for machinability, a key consideration for manufacturing orthopedic implants. Moreover, the biocompatibility of these novel LP composites was studied, for the first time, in this paper. In vitro cell culture tests demonstrated that the LP and its composites supported osteoblast (bone-forming cell) adhesion similar to natural bioceramics (such as HA and TCP). In conclusion, these novel LP composites should be further studied and developed for more effectively treating bone related diseases or injuries. 2008 Wiley Periodicals, Inc.

Harnessing Nanotopography to Enhance Osseointegration of Clinical Orthopedic Titanium Implants—An in Vitro and in Vivo Analysis

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Vitali Goriainov

2018-04-01

Full Text Available Despite technological advancements, further innovations in the field of orthopedics and bone regeneration are essential to meet the rising demands of an increasing aging population and associated issues of disease, injury and trauma. Nanotopography provides new opportunities for novel implant surface modifications and promises to deliver further improvements in implant performance. However, the technical complexities of nanotopography fabrication and surface analysis have precluded identification of the optimal surface features to trigger osteogenesis. We herein detail the osteoinductive potential of discrete nanodot and nanowire nanotopographies. We have examined the ability of modified titanium and titanium alloy (Ti64 surfaces to induce bone-specific gene activation and extracellular matrix protein expression in human skeletal stem cells (SSCs in vitro, and de novo osteogenic response within a murine calvarial model in vivo. This study provides evidence of enhanced osteogenic response to nanowires 300 surface modifications, with important implications for clinical orthopedic application.

FACTORS ASSOCIATED WITH INFECTIONS IN SPINAL SURGERY

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ANA MARÍA MORALES LÓPEZ

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

Influence of different anesthesia methods on stress reaction and hemodynamics for elderly orthopedics patients during operations

Directory of Open Access Journals (Sweden)

Lin Li

2017-07-01

Full Text Available Objective: To study the influence of general anesthesia, epidural anesthesia and combined spinal and epidural anesthesia method on stress reaction and hemodynamics for elderly orthopedics patients during operations. Methods: A total of 90 cases of elder patients who received orthopedic operations were randomly divided to group A, B and C, with 30 cases per group. Three groups of patients were separately given by general anesthesia, epidural anesthesia and combined spinal and epidural anesthesia for operations; The variations of adrenocorticotrophic hormone (ACTH, Cortisol (Cor, β-endorphin (β-EP, Angiotensin- Ⅱ(Ang-Ⅱ, heart rate (HR and blood pressure (SBP, DBP on patients in three groups before anesthesia (T0, during skin incision (T1, after skin incision (T2 and extubation after operation (T3 were compared and analyzed. Results: During T1, T2, ACTH, Cor, β-EP and Ang-Ⅱlevels in 3 groups of patients were significantly higher than those during T0; SBP and DBP were significantly lower than that during T0; HR during T2 was significantly lower than that during T0; During T3, every index in 3 groups were recovered to levels close to that during T0; During T1, T2, ACTH, Cor, β-EP, Ang-Ⅱ levels in group B and C were significantly lower than that in group A. And levels in C was lower than that in B; SBP and DBP in group B and C were significantly higher than A. No HR statistical significance appeared between each group. Conclusions: During clinical anesthesia, we should choose suitable anesthesia method combined with actual situations of patients. Combined spinal and epidural anesthesia had a slight influence on hemodynamics of elder orthopedics patients during operation, and it could effectively alleviate stress reaction during operation.

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

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

2016-04-01

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

Biomaterials with Antibacterial and Osteoinductive Properties to Repair Infected Bone Defects

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Haiping Lu

2016-03-01

Full Text Available The repair of infected bone defects is still challenging in the fields of orthopedics, oral implantology and maxillofacial surgery. In these cases, the self-healing capacity of bone tissue can be significantly compromised by the large size of bone defects and the potential/active bacterial activity. Infected bone defects are conventionally treated by a systemic/local administration of antibiotics to control infection and a subsequent implantation of bone grafts, such as autografts and allografts. However, these treatment options are time-consuming and usually yield less optimal efficacy. To approach these problems, novel biomaterials with both antibacterial and osteoinductive properties have been developed. The antibacterial property can be conferred by antibiotics and other novel antibacterial biomaterials, such as silver nanoparticles. Bone morphogenetic proteins are used to functionalize the biomaterials with a potent osteoinductive property. By manipulating the carrying modes and release kinetics, these biomaterials are optimized to maximize their antibacterial and osteoinductive functions with minimized cytotoxicity. The findings, in the past decade, have shown a very promising application potential of the novel biomaterials with the dual functions in treating infected bone defects. In this review, we will summarize the current knowledge of novel biomaterials with both antibacterial and osteoinductive properties.

Specific Infectious Organisms Associated With Poor Outcomes in Treatment for Hip Periprosthetic Infection.

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Cunningham, Daniel J; Kavolus, Joseph J; Bolognesi, Michael P; Wellman, Samuel S; Seyler, Thorsten M

2017-06-01

Periprosthetic hip infection treatment remains a significant challenge for orthopedics. Some studies have suggested that methicillin resistance and gram-negative organism type are associated with increased treatment failure. The aim of this research is to determine if specific organisms were associated with poor outcomes in treatment for hip periprosthetic infection. Records were reviewed of all patients between 2005 and 2015 who underwent treatment for infected partial or total hip arthroplasty. Characteristics of each patient's treatment course were determined including baseline characteristics, infecting organism(s), infection status at final follow-up, surgeries for infection, and time in hospital. Baseline characteristics and organisms that were associated with clinical outcomes in univariate analysis were incorporated into multivariable outcomes models. When compared with patients infected with other organism(s), patients infected with the following organisms had significantly decreased infection-free rates: Pseudomonas, methicillin-resistant Staphylococcus aureus (MRSA), and Proteus. Infection with certain organisms was associated with 1.13-2.58 additional surgeries: methicillin-sensitive S aureus, coagulase-negative Staphylococcus, MRSA, Pseudomonas, Peptostreptococcus, Klebsiella, Candida, diphtheroids, Propionibacterium acnes, and Proteus species. Specific organisms were associated with 8.56-24.54 additional days in hospital for infection: methicillin-sensitive S aureus, coagulase-negative Staphylococcus, Proteus, MRSA, Enterococcus, Pseudomonas, Klebsiella, beta-hemolytic Streptococcus, and diphtheroids. Higher comorbidity score was also associated with greater length of hospitalization. MRSA, Pseudomonas, and Proteus were associated with all 3 outcomes of lower infection-free rate, more surgery, and more time in hospital in treatment for hip periprosthetic infection. Organism-specific outcome information may help individualize patient

Characterization of electric discharge machining, subsequent etching and shot-peening as a surface treatment for orthopedic implants

Czech Academy of Sciences Publication Activity Database

Stráský, J.; Havlíková, Jana; Bačáková, Lucie; Harcuba, P.; Mhaede, M.; Janeček, M.

2013-01-01

Roč. 213, Sep 15 (2013), s. 73-78 ISSN 0169-4332 R&D Projects: GA ČR(CZ) GAP107/12/1025 Institutional support: RVO:67985823 Keywords : Ti-6A1-4V * surface treatment * cell proliferation * orthopedics Subject RIV: JG - Metallurgy Impact factor: 2.538, year: 2013

Modulation of flavonoid biosynthetic pathway genes and anthocyanins due to virus infection in grapevine (Vitis vinifera L. leaves

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Gutha Linga R

2010-08-01

Full Text Available Abstract Background Symptoms of grapevine leafroll disease (GLRD in red-fruited wine grape (Vitis vinifera L. cultivars consist of green veins and red and reddish-purple discoloration of inter-veinal areas of leaves. The reddish-purple color of symptomatic leaves may be due to the accumulation of anthocyanins and could reflect an up-regulation of genes involved in their biosynthesis. Results We examined six putative constitutively expressed genes, Ubiquitin, Actin, GAPDH, EF1-a, SAND and NAD5, for their potential as references for normalization of gene expression in reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR. Using the geNorm program, a combination of two genes (Actin and NAD5 was identified as the stable set of reference genes for normalization of gene expression data obtained from grapevine leaves. By using gene-specific RT-qPCR in combination with a reliable normalization factor, we compared relative expression of the flavonoid biosynthetic pathway genes between leaves infected with Grapevine leafroll-associated virus 3 (GLRaV-3 and exhibiting GLRD symptoms and virus-free green leaves obtained from a red-fruited wine grape cultivar (cv. Merlot. The expression levels of these different genes ranged from two- to fifty-fold increase in virus-infected leaves. Among them, CHS3, F3'5'H, F3H1, LDOX, LAR1 and MybA1 showed greater than 10-fold increase suggesting that they were expressed at significantly higher levels in virus-infected symptomatic leaves. HPLC profiling of anthocyanins extracted from leaves indicated the presence of cyanidin-3-glucoside and malvidin-3-glucoside only in virus-infected symptomatic leaves. The results also showed 24% higher levels of flavonols in virus-infected symptomatic leaves than in virus-free green leaves, with quercetin followed by myricetin being the predominant compounds. Proanthocyanidins, estimated as total tannins by protein precipitation method, were 36% higher in virus-infected

Patellar SPECT and planar imaging in orthopedic patients with knee pain

International Nuclear Information System (INIS)

Dehdashti, F.; Collier, B.D.; Johnson, R.P.; Isitman, A.T.; Hellman, R.S.; Carrera, G.F.; Krasnow, A.Z.

1987-01-01

Eighty-five painful knees in 56 patients were independently evaluated clinically, radiographically, and scintigraphically. All patients had an established final diagnosis of osteoarthritis or other predisposing conditions. Results of patellar bone scintigraphy were abnormal in 66 of 85 knees; there were ten isolated findings and 12 cases of medial, nine of lateral, and 35 of triple compartment involvement. Four-quadrant patellar analysis identified nine instances of isolated lateal patellar facet syndrome. Single-photon emission CT was of significant value in localizing patellar abnormalities. Radiographic evaluation disclosed osteoarthritis in 27 of 66 scintigraphically abnormal knees. Patellar bone scintigraphy is more valuable than radiography for evaluating adult orthopedic patients with knee pain

Aromaphytobalneotherapy in Treatment and Prophylaxis of Frequent Respiratory Infections in Children with Chronic and Disabling Diseases

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O. M. Konova

2016-01-01

Full Text Available In children with chronic pathologies, co-occurring frequent respiratory infections of a prolonged course obstructs and reduce the effectiveness of rehabilitation measures, and adversely affect the adaptation reserves. Hydrotherapeutic factors are widely used for the prevention of colds in children from the first days of life. Addition to the water of medicinal and phytoaromatic preparations increases their efficiency. For patients with chronic pathology, when prescribing balneotherapeutic factors for treatment and prophylaxis of respiratory infections, it is important to take into account the potential risk of adverse effects on the symptoms of the underlying disease. Researches in patients with orthopedic, chronic gastroenterological diseases, spastic forms of cerebral palsy, with co-occurring frequent respiratory infections of a prolonged course in history revealed that addition of medicinal baths based on phytoaromatic preparation, containing eucalyptus oil, to the rehabilitation complex is an effective method of preventing and stopping initial symptoms of respiratory infections. It also contributes to the adaptation reserves of the organism, without adversely affecting the course of the underlying disease.

Structural degradation of acrylic bone cements due to in vivo and simulated aging.

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Hughes, Kerry F; Ries, Michael D; Pruitt, Lisa A

2003-05-01

Acrylic bone cement is the primary load-bearing material used for the attachment of orthopedic devices to adjoining bone. Degradation of acrylic-based cements in vivo results in a loss of structural integrity of the bone-cement-prosthesis interface and limits the longevity of cemented orthopedic implants. The purpose of this study is to investigate the effect of in vivo aging on the structure of the acrylic bone cement and to develop an in vitro artificial aging protocol that mimics the observed degradation. Three sets of retrievals are examined in this study: Palacos brand cement retrieved from hip replacements, and Simplex brand cement retrieved from both hip and knee replacement surgeries. In vitro aging is performed using oxidative and acidic environments on three acrylic-based cements: Palacos, Simplex, and CORE. Gel permeation chromatography (GPC) and Fourier transform infrared spectroscopy (FTIR) are used to examine the evolution of molecular weight and chemical species within the acrylic cements due to both in vivo and simulated aging. GPC analysis indicates that molecular weight is degraded in the hip retrievals but not in the knee retrievals. Artificial aging in an oxidative environment best reproduces this degradation mechanism. FTIR analysis indicates that there exists a chemical evolution within the cement due to in vivo and in vitro aging. These findings are consistent with scission-based degradation schemes in the cement. Based on the results of this study, a pathway for structural degradation of acrylic bone cement is proposed. The findings from this investigation have broad applicability to acrylic-based cements and may provide guidance for the development of new bone cements that resist degradation in the body. Copyright 2003 Wiley Periodicals, Inc.

Supra-Acetabular Brown Tumor due to Primary Hyperparathyroidism Associated with Chronic Renal Failure

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Rosaria M. Ruggeri

2010-01-01

Full Text Available A 63-year-old woman presented to the Orthopedic Unit of our hospital complaining of right hip pain of 6 months'duration associated with a worsening limp. Her past medical history included chronic renal insufficiency. Physical examination revealed deep pain in the iliac region and severe restriction of the right hip's articular function in the maximum degrees of range of motion. X-rays and CT scan detected an osteolytic and expansive lesion of the right supra-acetabular region with structural reabsorption of the right iliac wing. 99mTc-MDP whole-body bone scan showed an abnormal uptake in the right iliac region. Bone biopsy revealed an osteolytic lesion with multinucleated giant cells, indicating a brown tumor. Serum intact PTH was elevated (1020 pg/ml; normal values, 12 62 pg/ml, but her serum calcium was normal (total = 9.4 mg/dl, nv 8.5–10.5; ionized = 5.0 mg/dl, nv 4.2–5.4 due to the coexistence of chronic renal failure. 99mTc-MIBI scintigraphy revealed a single focus of sestamibi accumulation in the left retrosternal location, which turned out to be an intrathoracic parathyroid adenoma at surgical exploration. After surgical removal of the parathyroid adenoma, PTH levels decreased to 212 pg/ml. Three months after parathyroidectomy, the imaging studies showed complete recovery of the osteolytic lesion, thus avoiding any orthopedic surgery. This case is noteworthy because (1 primary hyperparathyroidism was not suspected due to the normocalcemia, likely attributable to the coexistence of chronic renal failure; and (2 it was associated with a brown tumor of unusual location (right supra-acetabular region.

Bactericidal activity of the Ti-13Nb-13Zr alloy against different species of bacteria related with implant infection.

Science.gov (United States)

Aguilera-Correa, John-Jairo; Conde, Ana; Arenas, Maria-Angeles; de-Damborenea, Juan-Jose; Marin, Miguel; Doadrio, Antonio L; Esteban, Jaime

2017-08-11

The Ti-6Al-4V alloy is one of the most commonly used in orthopedic surgery. Despite its advantages, there is an increasing need to use new titanium alloys with no toxic elements and improved biomechanical properties, such as Ti-13Nb-13Zr. Prosthetic joint infections (PJI) are mainly caused by Gram-positive bacteria; however, Gram-negative bacteria are a growing problem due to associated multidrug resistance. In this study, the bacterial adherence and viability on the Ti-13Nb-13Zr alloy have been compared to that of the Ti-6Al-4V alloy using 16 collection and clinical strains of bacterial species related to PJI: Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, and Pseudomonas aeruginosa. When compared with the Ti-6Al-4V alloy, bacterial adherence on the Ti-13Nb-13Zr alloy was significantly higher in most staphylococcal and P. aeruginosa strains and lower for E. coli strains. The proportion of live bacteria was significantly lower for both Gram-negative species on the Ti-13Nb-13Zr alloy than on the Ti-6Al-4V alloy pointing to some bactericidal effect of the Ti-13Nb-13Zr alloy. This bactericidal effect appears to be a consequence of the formation of hydroxyl radicals, since this effect is neutralized when dimethylsulfoxide was added to both the saline solution and water used to wash the stain. The antibacterial effect of the Ti-13Nb-13Zr alloy against Gram-negative bacteria is an interesting property useful for the prevention of PJI caused by these bacteria on this potential alternative to the Ti-6Al-4V alloy for orthopedic surgery.

Emergency thyroidectomy in infected thyroid cyst due to spontaneous gas forming organisms

International Nuclear Information System (INIS)

Masood, R.; Chudhary, I.A.; Shaumaila, T.

2008-01-01

We are reporting a case of a young female, who presented to emergency room with sudden increase in thyroid swelling, high fever and acute respiratory distress. Clinical diagnosis of spontaneous infection of thyroid cyst was made. Operative finding was infection of thyroid cyst with gas formation. Systemic antibiotics and operative intervention by subtotal thyroidectomy led to recovery of the patient. (author)

Catheter-free Period Over 2 Days Is Associated with Better Outcome in Catheter-related Bloodstream Infection due to Candida

OpenAIRE

Matsuo, Takahiro; Mori, Nobuyoshi; Hoshino, Eri; Sakurai, Aki; Furukawa, Keiichi

2017-01-01

Abstract Background Regardless of active antifungal drugs, mortality of candidemia remains high. Although it is well-known that central venous catheter (CVC) is one of the most important risk factors of candidemia and should be removed immediately, little is known about optimal timing of CVC replacement after removal. Here, we analyzed contributing risk factors associated with 30-day mortality for catheter-related bloodstream infection (CRBSI) due to candida and optimal timing of CVC replacem...

High-strength, surface-porous polyether-ether-ketone for load-bearing orthopedic implants.

Science.gov (United States)

Evans, Nathan T; Torstrick, F Brennan; Lee, Christopher S D; Dupont, Kenneth M; Safranski, David L; Chang, W Allen; Macedo, Annie E; Lin, Angela S P; Boothby, Jennifer M; Whittingslow, Daniel C; Carson, Robert A; Guldberg, Robert E; Gall, Ken

2015-02-01

Despite its widespread clinical use in load-bearing orthopedic implants, polyether-ether-ketone (PEEK) is often associated with poor osseointegration. In this study, a surface-porous PEEK material (PEEK-SP) was created using a melt extrusion technique. The porous layer was 399.6±63.3 μm thick and possessed a mean pore size of 279.9±31.6 μm, strut spacing of 186.8±55.5 μm, porosity of 67.3±3.1% and interconnectivity of 99.9±0.1%. Monotonic tensile tests showed that PEEK-SP preserved 73.9% of the strength (71.06±2.17 MPa) and 73.4% of the elastic modulus (2.45±0.31 GPa) of as-received, injection-molded PEEK. PEEK-SP further demonstrated a fatigue strength of 60.0 MPa at one million cycles, preserving 73.4% of the fatigue resistance of injection-molded PEEK. Interfacial shear testing showed the pore layer shear strength to be 23.96±2.26 MPa. An osseointegration model in the rat revealed substantial bone formation within the pore layer at 6 and 12 weeks via microcomputed tomography and histological evaluation. Ingrown bone was more closely apposed to the pore wall and fibrous tissue growth was reduced in PEEK-SP when compared to non-porous PEEK controls. These results indicate that PEEK-SP could provide improved osseointegration while maintaining the structural integrity necessary for load-bearing orthopedic applications. Copyright © 2014 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Lung Infections in Systemic Rheumatic Disease: Focus on Opportunistic Infections.

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Di Franco, Manuela; Lucchino, Bruno; Spaziante, Martina; Iannuccelli, Cristina; Valesini, Guido; Iaiani, Giancarlo

2017-01-29

Systemic rheumatic diseases have significant morbidity and mortality, due in large part to concurrent infections. The lung has been reported among the most frequent sites of infection in patients with rheumatic disease, who are susceptible to developing pneumonia sustained both by common pathogens and by opportunistic microorganisms. Patients with rheumatic disease show a peculiar vulnerability to infectious complications. This is due in part to intrinsic disease-related immune dysregulation and in part to the immunosuppressive treatments. Several therapeutic agents have been associated to a wide spectrum of infections, complicating the management of rheumatic diseases. This review discusses the most frequent pulmonary infections encountered in rheumatic diseases, focusing on opportunistic agents, consequent diagnostic challenges and appropriate therapeutic strategies.

Rupture of popliteal arterial aneurysm due to salmonella infection

International Nuclear Information System (INIS)

Kim, Dong Hun; Oh, Hyung Woo; Kim, Dong Hyun; Byun, Joo Nam

2006-01-01

We report here on a case of popliteal aneurysm and rupture that occurred over a 10-day period and this was all secondary to salmonella infection. Computed tomography (CT) angiography of the extremity that was performed before and after aneurysmal rupture showed the aneurysm's rapid evolution to rupture over a short period of time. We also review the pathogenesis, clinical presentation, diagnostic approach and management of salmonella aneurysms

Factors associated with airway colonisation and invasion due to ...

African Journals Online (AJOL)

Factors associated with airway colonisation and invasion due to Klebsiella spp. ... for nosocomial infections which occurred more conunonly with antibiotic-resistant organisms. ... acute community-acquired chest infections, and nosocomial chest infections. Primary acute conununity-acquired pneumonia was unconunon.

Postpartum Aplastic Anemia Presenting as Pancytopenia Due to Malarial Infection

International Nuclear Information System (INIS)

Shah, M. U.; Sundhu, M. A.; Hussain, M. Z.

2013-01-01

Pancytopenia is a condition with decreased numbers of all cell lines. Aplastic anemia is a common cause although malarial infection causing lysis of RBCs may also partly mimic this condition. The infection may also damage the patient's bone marrow resulting in pancytopenia as well. We present the case of a post-partum female patient who reported with fever, body aches and shortness of breath one month after the delivery of her baby. All blood cell counts were decreased and peripheral blood smear showed malarial parasites. Anti-malarial treatment was initiated following which the fever subsided but, despite regular transfusions, the blood counts remained low. Bone marrow biopsy report revealed P. falciparum pigments along with hypocellularity characteristic of severe aplastic anemia. Consequently, bone marrow transplantation was advised as a therapeutic measure. This case report highlights the increased susceptibility of pregnant women to malaria in endemic areas and subsequent aplastic anemia. (author)

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

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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

THE USE OF SPECIALIST SYSTEMS FOR SUPPORT TO ORGANIZATION IN ORTHOPEDICAL EXAMS OF THE HIP, KNEE AND ANKLE

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Jefferson Paixão Cardoso

2005-09-01

Full Text Available This study aims at, mainly, to show that expert systems can be used for support to the systenmatization in orthopedic exams. In that perspective, a prototype of expert system was generated for orthopedic exams of hip, knee and ankle starting from Shell of Artificial Intelligence Expert SINTA, seeking to evaluate as the expert systems can contribute in practice of the professional as well as of the student in Physiotherapy. With that, initially the proposal was divided in two stages: development of the expert system prototype and evaluation of the system for professionals and discentes of the Course of Physiotherapy of the Universidade Estadual do Sudoeste da Bahia - UESB - Campus of Jequié. In that study we will present the results obtained in the first stage, development of the prototype of the expert system. For accomplishment of the work it was necessary the involvement of teachers of the computation area and health and students of the Course of Physiotherapy.

Magnetic resonance imaging findings in fatal primary cerebral infection due to Chaetomium strumarium.

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Aribandi, M; Bazan Iii, C; Rinaldi, M G

2005-04-01

This report describes MRI findings of a rare case of biopsy-proven fatal cerebral infection with Chaetomium strumarium in a 28-year-old man with a history of i.v. drug abuse. Magnetic resonance imaging revealed rapidly progressing lesions with irregular peripheral enhancement, possible central haemorrhage and significant mass effect. Only six cases of cerebral infection with Chaetomium have been reported in the English literature. This is the first report in the radiology literature describing the imaging findings. The previously reported cases of cerebral infection by the Chaetomium species are also reviewed.

Evaluation of Urinary Tract Infections Due to Candida Species

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Yeser Karaca Derici

2016-02-01

Full Text Available Aim: Although urinary tract infections often caused by bacteria, fungal etiology is detected in a significant number of infections in which Candida is the leading cause. In this study we aimed to evaluate the distribution of Candida strains isolated from urine samples in our hospital. Material and Method: Candida species were identified based on germ tube test, colony morphology on chrom agar Candida (Biomerieux, France and API ID32C AUX (Biomerieux, France commercial kit. Data were analyzed with SPSS 15.0 software for data analysis. Results: During March 2011-March 2014 a total of 109662 urine cultures were evaluated and 24364 samples revealed significant growth. Of the significant growth detected 24364 (22% samples 1096 (4.5% were defined as yeasts. The isolates most frequently detected in this study were C. albicans (50.5%, C. tropicalis (15.9%, C. glabrata (12.7%, C. parapsilosis (7.2%, C. kefyr (5.8%, C. krusei (5.5%. The highest yeast growth was observed in anesthesia intensive care unit. Discussion: In our study, the most frequently isolated species of yeast in the urine was C. albicans. Determination of Candida species and their clinical distributions in hospitals is very important in terms of giving direction to the treatment and measures to be taken.

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

Science.gov (United States)

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

2017-03-01

.1%, pMalnutrition is widespread regarding hospitalized patients in the field of orthopedic and trauma surgery and results in suboptimal clinical outcome. It should be considered as an important factor that significantly contributes to delayed recovery. Especially elderly trauma patients and patients suffering from postoperative infections should be monitored carefully during hospitalization. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

Science.gov (United States)

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

2013-01-01

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

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