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[Disk surgery--neurosurgery, orthopedic surgery or both?].

Bibliometric methods have been used to study the distribution of research literature on disc surgery between neurological and orthopaedic departments globally and within each of the Nordic countries. Worldwide, the total number of indexed papers was found to be almost twice as great for neurosurgical as for orthopedic institutions. Though figures for the Nordic countries were lower, they manifested the same trend, except those for Sweden where orthopaedic surgeons appear to do more research than neurosurgeons in this field. Moreover, it was found that a greater proportion of neurosurgeons than orthopaedic surgeons had published papers in journals outside their own field (29 vs 9 per cent respectively), and that 14 per cent of the neurosurgical reports had been published in orthopedic journals, but none of the orthopedic reports had been published in neurosurgical journals. Finally, scrutiny of the reference literature cited in randomly selected samples of papers from neurosurgical and orthopedic departments showed 22 per cent of the references in neurosurgical papers to be to orthopaedic journals or textbooks, but only 4 per cent of those in orthopedic papers to be to neurosurgical texts. The possible implications of these findings are discussed in the article, as are the methodological sources of error.

Humans↗

Is a routine radiological consultation cost-effective for pediatric orthopedic radiographs?

This investigation was undertaken to determine the value of a routine radiological consultation on all examinations taken during the course of evaluation and treatment of children with elective orthopedic problems. Shriners Hospital in Los Angeles treats children with chronic orthopedic problems. All radiographs are ordered by an orthopedic surgeon. Currently all plain examinations are also read and reported by a pediatric radiologist. The study was a retrospective chart review. Three hundred nineteen radiographic examinations (6.7% of the total performed in calendar year 1995) were reviewed. The orthopedic surgeons documented the results of their readings in 69% of the cases, while the radiology staff documented 92% of the studies. The data do not show evidence of significant misinterpretations in the readings by the orthopedic surgeons. Therefore routine radiological consultation for all examinations is unnecessary in that specific setting. If a policy change were instituted, it would represent a major saving in health-care costs.

Child↗

Better osteoblast adhesion on nanoparticulate selenium- A promising orthopedic implant material.

Apart from problems such as poor osseointegration, stress shielding, and wear debris-associated bone cell death, a major concern of metallic orthopedic implants is that they slowly corrode under in vivo environments. It is possible that continuous tissue exposure to metallic corrosion products limits orthopedic implant efficacy; this is especially true for patients receiving implants due to bone cancer. To date, there is no metallic orthopedic implant available in the market that specifically deals with the prevention and/or recurring cancer that may happen in these patients. The objective of this study was to deal with these problems in an integrated way by introducing a new biomaterial to the orthopedic community with anticancer chemistry: selenium (Se). In this study, six types of Se compacts were tested for bone cell (osteoblast) adhesion under in vitro conditions. Two types of cylindrical compacts were made with conventional Se metal particles in the micron (6.539 +/- 1.364-microm diameter) and submicron (0.963 +/- 0.139-microm diameter) range. These two types of compacts were chemically etched with different concentrations of NaOH to create two additional types of Se particles in each category: conventional size particles with nanosurface roughness and nanometer particles (0.204- to 0.264-microm diameter). Results showed for the first time, enhanced osteoblast adhesion on particulate surfaces of the compacts made from conventional Se compared with reference nonparticulate wrought titanium sheets. More importantly, this study provided the first evidence that osteoblast density was further increased on the surfaces of the Se compacts with nanometer particles. These initial findings indicate that there may be a promising future for nanoparticulate Se as an anticancer biocompatible orthopedic material.

Biocompatible Materials↗

A multi-disciplinary study of the ocular, orthopedic, and neurologic causes of abnormal head postures in children.

PURPOSE: To determine the relative frequency that abnormal head postures in children are caused by orthopedic, ophthalmologic, or neurologic disorders, respectively. DESIGN: A prospective, consecutive case series. METHODS: Children found to have an abnormal head posture on routine pediatric examination underwent an evaluation by a pediatric ophthalmologist, pediatric orthopedist, and pediatric neurologist. The study was conducted in northwestern Italy. RESULTS: In the 63 children evaluated, the cause of the abnormal head posture was orthopedic in 35, ocular in 25, and neurologic in 5. In 8 patients, no specific cause could be found. The most common orthopedic cause was congenital muscular torticollis, which accounted for 31 patients. The most common ocular cause was superior oblique muscle palsy, which accounted for 12 patients. In 2 patients neck muscle contracture suggested an orthopedic cause, however, the tight neck muscles were secondary to a head tilt caused by superior oblique muscle palsy. CONCLUSIONS: When the cause of an abnormal head posture is not obvious, a multi-disciplinary approach including ophthalmologic, neurologic, and orthopedic specialists may be helpful.

Child, Preschool↗

Orthopedics in orthodontics: Fiction or reality. A review of the literature--Part II.

This study covers articles dealing with orthopedic treatment of Class III malocclusions, transversal deficiencies, and orthopedically induced changes in animal studies. An attempt has been made to discuss the whole group of orthopedic changes and their effects in the long-term. We want to emphasize that all orthopedic appliances have an important value in clinical orthodontics. There is, however, little scientific evidence so far to support the idea that they have any permanent orthopedic effect.

Animals↗

Measuring the compliance behavior of adolescents wearing orthopedic braces.

This paper reports the observed difference between two measures of compliance in wearing an orthopedic brace among teenagers affected by idiopathic scoliosis. The first measure was obtained with a small device called a "compli-o-meter" that was developed specifically for this purpose. When fastened to an orthopedic brace, this instrument determines the brace's actual wearing time. The second compliance measure was derived from a questionnaire-interview administered to the participants. The subjects were 40 female teenagers aged between 10 and 16 years who had been wearing an orthopedic brace for 18 months or less. While the compliance rate reported by the participants averaged 88%, the actual rate measured by the compli-o-meter was only 33%. Pearson's correlation was r = .33, with a significance of p < .05 between these two measurements. Care should be exerted in assessing the therapeutic efficiency of an orthopedic brace based exclusively on a patient's reported compliance level. In particular, basing a recommendation to change the brace based solely on this information may result in erroneous and serious therapeutic actions. The efficiency of orthopedic braces should be assessed on objective measures of the actual compliance rate wherever possible.

Adolescent↗

Age, physical activity, physical fitness, body composition, and incidence of orthopedic problems.

The incidence of orthopedic problems was examined in 5,582 men and women who attended the Cooper Clinic in Dallas, Texas between 1974 and 1982. The effects of age, physical activity, physical fitness, and body mass index (BMI) on the occurrence of these problems were examined using a proportional hazards approach. The expected risk of orthopedic problems per person-year was 0.045 for men and 0.046 for women. For men, physical fitness, BMI, and physical activity were associated with orthopedic problems, while for women, physical activity was the main predictor. Age was not a factor for either gender. The effect of change in physical fitness, physical activity, and BMI was examined in a subset of 2,325 persons with more than one visit to the clinic. For women, physical activity and a decrease in BMI were associated with orthopedic problems, while for men none of those factors were significant. Again, age was not a factor in either group. The absence of any age effect on the occurrence of problems suggests that with regard to orthopedic problems, moderate amounts of physical activity in generally healthy persons may be recommended without special consideration as to age.

Adolescent↗

Drug and alcohol use in orthopedic trauma patients: a prospective study.

Alcohol has been shown to confound the initial assessment of trauma victims, and cocaine is associated with numerous medical and anesthetic complications. A prospective study was performed to determine the prevalence of alcohol and illicit drug use in orthopedic trauma patients at an inner-city teaching hospital. All patients admitted to the orthopedic service during a 2-year period (January 1993 to December 1994) were prospectively studied. Patients < 14 years old were excluded. Blood alcohol levels were determined, and the urine was screened for cocaine, opiates, marijuana, barbiturates, amphetamines, benzodiazepines, and phencyclidine. Demographic data and a medical history were obtained. Seven hundred sixty-six patients met the study parameters. Of these, 628 (82%) had complete drug and alcohol screens available for review. The data were then sorted by diagnosis, mechanism of injury, type of injury (closed versus open), length of inpatient stay, age, sex, and race, and a statistical analysis was performed. The overall incidence of positive drug or alcohol tests was 56%. Twenty-four percent of patients tested positive for two or more drugs, and 9% for three or more. Alcohol (25%) was the most commonly detected drug, followed by cocaine (22%) and marijuana (21%). The highest incidence of drug use was found in males and in those ages 31-40 years. Hospital stay averaged 1.3 days longer in patients with positive screens. Patients with tibia fractures or open fractures, and those injuries sustained by gunshot, altercation, or pedestrian versus motor vehicle accident had the highest incidence of positive screens. These data show that drug-using patients have more severe orthopedic injuries (i.e., open fractures) and require longer hospitalizations. We conclude that drug and alcohol use is widespread in patients presenting with orthopedic injuries and we make recommendations regarding treatment of these patients. The majority of orthopedic trauma resources in this setting is devoted to treating intoxicated patients. Drug and alcohol use is a major social problem and may have an adverse effect on patient care.

Adolescent↗

Presurgical orthopedics in the surgical management of unilateral cleft lip and palate.

Forty years after its introduction by McNeil and Burston, presurgical orthopedics remains a controversial subject. Although the more extravagant claims for the technique have been dismissed, assessment of its proper place in cleft rehabilitation has been hampered by the poor design of early studies. Furthermore, although the principles of presurgical orthopedics are derived from the venerable tradition of reducing cleft width to facilitate reconstructive surgery, almost all research has focused on matters of dental alignment, cross bites, and maxillary arch form. Not one research paper has ever been published investigating the possible benefits to cleft surgery resulting from presurgical orthopedic treatment. Although it is now generally accepted that presurgical orthopedics does not give significant orthodontic benefits, there are still numerous opinions indicating that presurgical orthopedics does facilitate primary reconstructive surgery for cleft lip and palate. Furthermore, presurgical alignment of the maxillary skeletal base is considered essential to some of the new techniques of primary rhinoplasty.

Cleft Lip↗

Infant orthopedics has no effect on maxillary arch dimensions in the deciduous dentition of children with complete unilateral cleft lip and palate (Dutchcleft).

OBJECTIVE: Evaluation of the effect of infant orthopedics on maxillary arch dimensions in the deciduous dentition in patients with unilateral cleft lip and palate. DESIGN: Prospective two-arm randomized controlled clinical trial with three participating cleft palate centers. SETTING: Cleft palate centers of the Radboud University Nijmegen Medical Center, Academic Center of Dentistry Amsterdam, and University Medical Center Rotterdam, the Netherlands. PATIENTS: Children with complete unilateral cleft lip and palate (n = 54) were included. INTERVENTIONS: Patients were randomly divided into two groups. Half of the patients (IO+) had a presurgical orthopedic plate until surgical closure of the soft palate at the age of 52 weeks; the other half (IO-) did not undergo presurgical orthopedics. MEAN OUTCOME MEASURES: Maxillary arch dimensions were assessed on dental casts at 4 and 6 years of age with measurements for arch width, arch depth, arch length, arch form, and the vertical position of the lesser segment. Contact and collapse were assessed also. RESULTS: There were no clinically significant differences found between IO+ and IO- for any of the variables. CONCLUSIONS: Infant orthopedics had no observable effect on the maxillary arch dimensions or on the contact and collapse scores in the deciduous dentition at the ages of 4 and 6 years. Considering the Dutchcleft results to date, there is no need to perform infant orthopedics for unilateral cleft lip and palate patients.

Alveolar Process↗

Intrathoracic and concurrent orthopedic injury associated with traumatic rib fracture in cats: 75 cases (1980-1998).

OBJECTIVE: To characterize rib, intrathoracic, and concurrent orthopedic injuries, and prognosis associated with traumatic rib fracture in cats. DESIGN: Retrospective study. ANIMALS: 75 cats. PROCEDURE: Medical records from January 1980 to August 1998 were examined for cats with traumatic rib fracture. Signalment, cause of trauma, interval from trauma to evaluation at a veterinary teaching hospital, referral status and date, method of diagnosis, duration of hospitalization, number and location of rib fractures, presence of flail chest, costal cartilage involvement, intrathoracic and concurrent orthopedic injury, and clinical outcome were reviewed. RESULTS: Median age was 3 years. Twenty-five (58%) cats with reported cause of trauma were injured by interaction with another animal. Forty-seven (78%) cats that were treated survived. Cats that died had a median duration of hospitalization of < 1 day. Ten (13%) cats had flail chest. Sixty-five (87%) cats had intrathoracic injury (median, 2 injuries). Nine (100%) cats without detected intrathoracic injury that were treated survived. Thirty-five (47%) cats had concurrent orthopedic injury. Cats with flail chest, pleural effusion, or diaphragmatic hernia were significantly more likely to die than cats without each injury. CONCLUSIONS AND CLINICAL RELEVANCE: Traumatic rib fracture in cats is associated with intrathoracic and concurrent orthopedic injury. Aggressive treatment of cats with traumatic rib fracture is warranted, because the prognosis is generally favorable. Diagnosis and treatment of intrathoracic injury associated with traumatic rib fracture in cats should precede management of concurrent orthopedic injury.

Animals↗

Linezolid therapy for orthopedic infections.

OBJECTIVE: To assess the clinical and bacteriological efficacy and the safety and tolerability profile of linezolid when used as the primary component of a combined surgical and antimicrobial treatment strategy for orthopedic infections. PATIENTS AND METHODS: We retrospectively reviewed medical records to obtain clinical, bacteriological, and safety outcomes of 20 consecutive patients who took linezolid for the treatment of orthopedic infections between April 1, 2000, and November 30, 2002. RESULTS: Twenty patients received linezolid therapy for microbiologically confirmed orthopedic infections due to gram-positive cocci during the 32-month study period. Fifteen patients (75%) had infections involving orthopedic hardware; in 10 of these patients, the hardware was removed. All 20 patients underwent surgical débridement. At a mean follow-up of 276 days, 11 patients (55%) achieved clinical cure, 7 (35%) had clinical improvement but received long-term antimicrobial suppressive therapy, 1 (5%) had clinical relapse after discontinuing linezolid treatment, and 1 (5%) died of a cause unrelated to linezolid treatment. Bacterial persistence was documented in 3 patients (15%), all of whom were Infected with methicillin-resistant Staphylococcus aureus. Eight patients (40%) developed reversible myelosuppression, 1 (5%) had irreversible peripheral neuropathy, and 2 (10%) discontinued linezolid treatment because of pancytopenia or urticaria. CONCLUSION: Oral linezolid may be an effective alternative therapy for orthopedic infections due to linezolid-susceptible gram-positive bacteria in patients who are unable to take other antimicrobial drugs because of drug allergy or Intolerance or antimicrobial resistance.

Acetamides↗

Breastfeeding is early functional jaw orthopedics (an introduction).

Breastfeeding places beneficial orthopedic forces on the jaws, similar to the forces of Functional Jaw Orthopedics--the newest form of orthodontics. To date most breastfeeding benefits have been attributed to the content of mother's milk. The true orthopedic benefits of breastfeeding, suckling, deserve more definitive attention and research. Breastfeeding is early preventive Functional Jaw Orthopedics because breastfeeding forces impact the jaws during a very rapid period of infant jaw growth. Breast suckling aids proper development of the jaws which form the gateway to the human airway. Bottle, pacifier and digit sucking deform jaws and airways. Forward forces of suckling clearly oppose the backward forces of sucking. Dentists who understand the positive impact of forward orthopedic forces on the jaws should support and advocate exclusive breastfeeding for about 6 months.

Biomechanical Phenomena↗

[Orthopedic approach to asymmetry].

Asymmetry being a clinical manifestation of various pathologies, the orthopedic attitude greatly varies from one practitioner to another. Thanks to a better knowledge of the etiopathogenesis, the orthopedic approach in some particular cases reveals very effective, either alone or together with other therapeutics. In mandibular laterodeviations most often consecutive to a maxillary contraction, the best treatment is to expand maxilla which will allow a mandibular centric repositioning. This therapy is often achieved early to limit the asymmetric expression of growth and normalize the dental eruption. In unilateral condylar hypoplasias of variable extension, from a simple defect in condylar growth to a hemifacial microsomia, the therapeutic attitude has mostly evolved. A surgical orthodontic protocol can integrate an increasingly significant orthopedic phase in the course of time. Some authors show that a surgical case may be treated originally only with the help of orthopedics. The devices used are of activator or hyperpropulsor type. In unilateral condylar hyperplasias, orthopedic therapy must be considered with reservations.

Cephalometry↗

Prevalence of nosocomial infections in general surgery, orthopedic surgery and urological departments in the Czech Republic.

Two prevalence studies of Nosocomial Infections carried out in 1987 (based on 4479 patients in 64 general surgery departments and 1603 patients in 29 orthopedic surgery departments) and in 1988 (based on 1263 patients in 32 urological departments) are summarized. The prevalence rate of nosocomial infections (NI) in general surgery departments was 14.0%, in orthopedic surgery departments 8.0% and in urological departments 20.9%. The highest degree of risk of acquiring NI was run by patients above 60 years of age in urological and general surgery departments. Surgical wound infections in departments of general surgery accounted for 60%, in orthopedic surgery departments for 47% and in urological departments for 37% of all NI. The prevalence of wound infections amongst general surgical patients was 8.4%, amongst orthopedic surgical patients 3.8% and in urological patients 7.7%. The prevalence of urinary tract infections in general surgery departments was 14.4%, in orthopedic surgery departments 18.6% and in urological departments 51.6%. The problems discussed include the role of intrinsic and in-hospital risk factors and the involvement of pathogens responsible for the onset of NI.

Cross Infection↗

Technology evolution: the technology spectrum and its application to orthopedic technologies.

The evolution of clinical technologies presents potential adopters with considerations in planning for clinical program development that include the stage and the rate of a technology's evolution. This paper presents a conceptual framework for these considerations and applies the framework to orthopedic technologies. Eight orthopedic surgeons were asked to assess 14 orthopedic technologies and position each of them along a spectrum of research, clinical, and adopted technologies. The distribution of responses for each technology-year combination is presented, and estimates of central tendency, dispersion, and variances provide measures of the change in the distribution of responses over time for each technology and the change in the degree of rater consensus over time for each technology. While orthopedic trauma was chosen to illustrate the technology spectrum model, the model and assessment methodology is applicable to other medical specialties as well. Adoption of this framework in a hospital setting should enable more systematic and effective clinical program development.

Diffusion of Innovation↗

Selfprotective smart orthopedic implants.

In this review, we discuss current advances leading to an exciting change in implant design for orthopedic surgery. The initial biomaterial approaches in implant design are being replaced by cellular-molecular interactions and nanoscale chemistry. New designs address implant complications, particularly loosening and infection. For infection, local delivery systems are an important first step in the process. Selfprotective 'smart' devices are an example of the next generation of orthopedic implants. If proven to be effective, antibiotics or other active molecules that are tethered to the implant surface through a permanent covalent bond and tethering of antibiotics or other biofactors are likely to transform the practice of orthopedic surgery and other medical specialties. This new technology has the potential to eliminate periprosthetic infection, a major and growing problem in orthopedic practice.

Antibiotic Prophylaxis↗

An internet-based referral/consultation system for the U.S.-associated Pacific Islands: its contribution to orthopedic graduate medical education at Tripler Army Medical Center.

To evaluate the benefit of the Pacific Island Health Care Project (PIHCP) to our orthopedic graduate medical education program, we performed a retrospective review of our 8-year operative experience with patients referred through this program. Between July 1994 and June 2002, 69 patients underwent 79 orthopedic operative procedures. Patients were categorized by primary diagnosis, anatomic site involved, and surgical treatment rendered. Because many of the patients referred from the PIHCP with tumors were noted to have either unusually large lesions or advanced-stage disease, further analyses of tumor stage and pathologic grade were made. Seven of the 14 oncologic cases surgically treated in our department in the past 8 years were referrals from the PIHCP. Unique operative procedures performed for these tumor patients included one forequarter amputation, one hip disarticulation, one hemipelvectomy, two partial scapulectomies, and one distal ulna excision. We conclude that the PIHCP referrals provide an important and relatively unique contribution to the clinical and operative experience of our orthopedic residents. These patients from the Pacific basin also enhance our orthopedic graduate medical education program by exposing our residents to the special socioeconomic and cultural issues related to caring for people from developing insular countries.

Adolescent↗