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PubMed1996

Orthopedic trauma surgeons' attitudes and practices towards bloodborne pathogens.

A survey was conducted to determine orthopedic trauma surgeons' attitudes and practices towards occupational exposures to bloodborne pathogens. The survey was distributed to orthopedic trauma surgeons either by mail or through participation at the annual 1993 OTA meeting or the 1994 update meetings. Of the 1,058 surveys distributed, 504 were successfully completed (48%). The majority of respondents were attendings (72%) who performed at least 100 orthopedic procedures annually. Of the respondents, 74% reported they were moderately to very concerned about acquiring HIV at work. Despite their concern, 42% reported not routinely wearing gloves when changing would dressings. Of the 340 respondents who have access to maximum barrier protection, 83% reported not wearing it to nail a femur fracture and 33% reported not wearing it when operating on an HIV+ patient. At an institutional level, almost one-third of those surveyed did not believe their facility promoted safe work practices. Facilities judged by respondents to promote safe practices were significantly more likely to have resources available and infection control policies in place compared to facilities judged not to promote safe practices. Orthopedic trauma surgeons need to improve their compliance with infection control recommendations. Further efforts by individuals and their institutions are warranted.

Blood-Borne Pathogens↗
PubMed2003

The efficacy of anterior spine exposure by an orthopedic surgeon.

This retrospective study was designed to document the incidence and types of perioperative complications that occurred with anterior spinal fusion surgery performed solely by an orthopedic spine surgeon. This study is contrasted to previous studies that document complications from anterior approaches performed by an orthopedic surgeon with the assistance of a general or a vascular surgeon. Specifically, the procedures included thoracotomies, thoracolumbar retroperitoneal, and lumbosacral approaches. Our sample consisted of 450 patients who underwent anterior spinal fusion between levels T1 and S1, from 1985 to 1997. Patient and surgery characteristics included age, sex, diagnosis, levels of fusion, blood loss, operative time, hospitalization time, complications, American Society of Anesthesiologists state, assessment of risk factors, previous surgery, and surgical approach used. Average follow-up was 41.69 months, with a minimum of 12 months and a maximum of 132 months. Our results indicated that anterior procedures performed solely by our senior orthopedic surgeon had a lower incidence of complications, less blood loss, and shorter operative time than anterior procedures performed by an orthopedic surgeon and a vascular or a general surgeon. Our findings suggest that the anterior spinal exposure is a safe approach that may be performed solely by a spinal surgeon who is knowledgeable and experienced.

Abdomen↗
PubMedDate not supplied

Double or single gloves: which is safer in pediatric orthopedic surgery.

BACKGROUND AND AIM: Surgical gloves should form an efficient barrier between surgeons and patients to prevent cross infection. Single gloves (SGs) have long been reported unsafe, and usage of double gloves (DGs) is still not universal. No study has reported the usage of DGs in pediatric orthopedic operations. The aim of this study was to assess the efficacy of DGs versus SGs in prevention of body fluid contact between patients and surgeons during pediatric orthopedic surgery. METHODOLOGY: After 150 pediatric orthopedic operations, DGs and SGs were collected and tested for perforations. Gloves were tested for size, site, and number of perforations among principal surgeons, assistant surgeons, and scrub nurses. Gloves were not changed during long surgical procedures and were changed only if perforations were identified and recorded. The DGs used were Maxitex Duplex, powder-free indicator gloves and the SGs were of Gammex-Ansell. One hundred unused gloves of each group were tested as controls. Medical records of the patients were reviewed for age, sex, type of operation, duration of operation, and any postoperative wound infection. The data were entered in database and analyzed using SPSS package. The data were compared between double and SGs using t test with a level of statistical significance at P less than 0.05. RESULTS: Five hundred twenty-six DGs and 316 SGs were tested. Forty-three perforations were detected in DGs (8.1%). Outer gloves were breached in 7.8% and inner in 0.3% as compared with SGs in which 28 (8.7%) were perforated. In DGs, 4% had multiple perforations compared with 11.9% in SGs. There was a statistical significance (P<0.001) when the perforations of inner gloves were compared with the SGs. None of the inner perforations were recognized during surgery, but the outer gloves of the DGs were recognized in 71% as compared with 9% in SGs (P<0.001). The majority of perforations were seen in the nondominant hand in surgeons and assistants hands, whereas scrub nurses had 85% of perforations in the dominant hand. The index finger was the site of perforations in DGs (53.4%; SGs, 43%). The inner gloves were breached only when the outer glove was found to be perforated. The duration of surgery had a direct impact on the number of perforations. There were no perforations in DGs in less than 60 minutes as compared with 3 (10.7%) in SGs. Between 60 and 120 minutes, the perforations in the DGs were 11, and in SGs, 21. During the study period, 4 patients had surgical site infection. Three were superficial and one deep-seated infection. In 3 patients with infection, the gloves were found to be perforated, and 1 patient with infection had no perforations in the gloves. CONCLUSION: Our study confirms that DGs are safer than SGs during pediatric orthopedic operations. In the event of nonavailability of DGs, SGs should be changed on an hourly basis during long procedures. Lastly, there exists a relationship between surgical site infection and glove perforations.

Equipment Design↗
PubMed1998

Ambulatory treatment of multidrug-resistant Staphylococcus-infected orthopedic implants with high-dose oral co-trimoxazole (trimethoprim-sulfamethoxazole).

We examined the effectiveness and safety of high-dose oral co-trimoxazole (trimethoprim-sulfamethoxazole) for the treatment of orthopedic implants infected with multidrug-resistant Staphylococcus species. The prospective study was conducted between 1989 and 1997 in a university medical center with ambulatory-care services. Patients eligible for the study consisted of those from whom multidrug-resistant Staphylococcus spp. organisms susceptible only to glycopeptides and co-trimoxazole were isolated from their orthopedic implants and for whom there was no contraindication to the treatment. All patients were treated orally with high-dose co-trimoxazole (trimethoprim, 20 mg/kg of body weight/day; sulfamethoxazole, 100 mg/kg/day). Patients with prosthetic hip infections were treated for 6 months, with removal of any unstable prosthesis after 5 months of treatment; patients with prosthetic knee infections were treated for 9 months, with removal of any unstable prosthesis after 6 months of treatment; and patients with infected osteosynthetic devices were treated for 6 months, with removal of the device after 3 months of treatment, if necessary. Monthly clinical evaluations were conducted until the completion of the treatment, and follow-up examinations were conducted regularly for up to 6 years. The overall treatment success rate was 66.7% (26 of 39 patients), with success rates of 62.5% for patients with prosthetic knee infections, 50% for those with prosthetic hip infections, and 78.9% for those with other device infections. Seventeen of the 28 (60.7%) patients who did not have any orthopedic material removed were cured. Eight patients stopped the treatment because of side effects, and one patient was not compliant. In three patients treatment failed because of the appearance of a resistant bacterium. Long-term oral ambulatory treatment with co-trimoxazole appears to be an effective alternative to the conventional medicosurgical treatment of chronic multidrug-resistant Staphylococcus-infected orthopedic implants which includes long-term intravenous antibiotic therapy combined with surgical debridement and removal of foreign material or its subsequent one- or two-stage replacement.

Administration, Oral↗
PubMed2004

[Osteopathic versus orthopedic treatments for chronic epicondylopathia humeri radialis: a randomized controlled trial].

BACKGROUND: The Epicondylopathia humeri radialis is mainly caused by an overload of the extensor muscles of the hand, the afflicted side is generally the dominant hand. There is a multitude of treatment methods, none of them, however, can guarantee success. OBJECTIVE: Can an osteopathic treatment of the chronic Epicondylopathia humeri radialis reduce the pain more effectively than an orthopedic treatment? STUDY DESIGN: Randomized controlled clinical study. MATERIAL AND METHODS: 53 patients were randomly distributed among examination and control group. They were treated for 8 weeks. The osteopathic treatment was done exclusively manually, with parietal, visceral, and craniosacral techniques, individually chosen for each patient. The orthopedic treatment was performed with chiropractic techniques, antiphlogistics, and mostly with injections of cortison. Four common tests were used, all 4 valuing pain and development of power: pressure pain test, Thomsen test, middlefinger extension test, and test for strength. Additionally a questionnaire about the attendant circumstances of the chronic Epicondylopathia humeri radialis was raised. RESULTS: Subjective pain sensation reduced from 50% to 33% (p < 0.01) in the intervention group and from 48% to 32% (p = 0.03) in the orthopedic group. A reduction of pain as well as an increase of power could be measured. The difference between the two treatment methods, however, was not statistically significant. CONCLUSIONS: In this study it was possible to successfully treat the chronic Epicondylopathia humeri radialis with an osteopathic approach. A significant difference to an orthopedic treatment could not be proved.

Adolescent↗
PubMed2006

Estimated annual costs of prophylaxis and treatment of venous thromboembolic events associated with major orthopedic surgery in France.

Venous Thromboembolism (VTE) remains a major complication following orthopedic surgery despite heparin prophylaxis. Clinical consequences associated with this complication are deep vein thrombosis (DVT), pulmonary embolism, and long-term consequences of DVT, especially Postthrombotic syndrome (PTS). The purpose of the present study was to estimate the annual direct costs of VTE following major orthopedic surgery of the lower limb in France. This cost of illness study was performed by using available information from health system databases (1999) and literature and specific surveys (2002). Direct costs were calculated by using estimates of the number of patients with major orthopedic surgery in France during one year. Patients presenting with VTE were identified from the national disease-related group inpatient database. Additional resource consumption was identified by comparison with disease-related groups without the VTE complications. Ambulatory care costs after hospitalization, for recurrences and PTS, were estimated from specific surveys of general practitioners and venous disease specialists. Total annual costs of VTE associated with major orthopedic surgery for the French Sickness Fund were estimated to be approximately 60 million euros over 1 year with 28 million euros for inpatient care and 30 million euros for recurrences and PTS.

Cost of Illness↗
PubMed2005

Aprotinin in major orthopedic surgery: a systematic review of randomized controlled trials.

Aprotinin therapy is a promising strategy for reducing blood loss and blood transfusion requirements. The efficacy and safety of aprotinin in orthopedic surgery, however, remain controversial. We searched electronic databases for randomized controlled trials on the efficacy and safety of the use of aprotinin in orthopedic surgery. Thirteen trials that included a total of 506 patients who underwent major orthopedic surgery were analyzed. The pooled intraoperative and perioperative blood loss was significantly less in the aprotinin-treated patients than in the control patients (weighted mean difference [WMD] for intraoperative blood loss = -229 mL, 95% confidence interval [CI] = -367 to -91 mL, P = 0.0011; WMD for perioperative blood loss = -557 mL; 95% CI = -860 to -254 mL; P < 0.0001). The pooled amounts of red blood cell (RBC) units (U) transfused intraoperatively and perioperatively were significantly less in the aprotinin-treated patients than in the control patients (WMD for intraoperative RBC U = -1.1 U; 95% CI = -1.7 to -0.4 U; P = 0.0001; WMD for perioperative RBC U = -1.1 U; 95% CI = -1.7 to -0.5 U; P < 0.0001). Aprotinin was not associated with an increased incidence of deep vein thrombosis (odds ratio = 0.39; 95% CI = 0.14 to 1.05, P = 0.061). The authors conclude that aprotinin reduces the intraoperative and perioperative blood loss and allogeneic blood transfusion requirement and may not be associated with increased risk of deep vein thrombosis in the presence of pharmacological or mechanical prophylaxis in patients undergoing major orthopedic surgery.

Aprotinin↗
PubMed2006

Dealing with innovation and costs in orthopedics: a conversation with Dane Miller. Interview by Lawton R Burns.

Rob Burns talks with Dane Miller, former CEO of Biomet, about challenges posed by new technology in the orthopedic devices area. One key challenge is the rising cost and use of orthopedic devices at a time when providers are facing decreased profitability and reimbursement for orthopedic services. Another challenge is the long-term time horizon needed to gauge product success that contrasts with payers' and providers' short-term horizon. A third challenge is heightened governmental scrutiny of device makers' relationships with orthopedic surgeons. This interview was conducted before Miller left Biomet in March 2006.

Diffusion of Innovation↗
PubMed2003

Comparison of propofol/fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a pediatric emergency department.

PURPOSE: To compare the effectiveness of 2 medication regimens, propofol/fentanyl (P/F) and ketamine/midazolam (K/M), for brief orthopedic emergency department procedural sedation. This study was powered to compare recovery times (RT) and procedural distress as measured by the Observational Score of Behavioral Distress-revised (OSBD-r; range: 0-23.5 with 23.5 representing maximal distress). METHODS: We conducted a prospective, partially-blinded controlled comparative trial comparing intravenous P/F with K/M in a convenience sample of 113 patients aged 3 to 18 years old undergoing orthopedic procedural sedation. All medications were administered by the intermittent intravenous bolus method. An independent sedation nurse recorded total sedation time and RT. Effectiveness was measured using 6 parameters: 1) patient distress as assessed by independent blinded observers after videotape review using the OSBD-r; 2) orthopedic satisfaction score (Likert scale 1-5); 3) sedation nurse satisfaction score (Likert 1-5); 4) parental perception of procedural pain using a 0 to 100 mm Visual Analog Scale with the upper limit being "most pain"; 5) patient recall of the procedure; and 6) 1 to 3 week follow-up. RESULTS: RT and total sedation time were significantly less in the P/F group than in the K/M group (33.4 minutes vs 23.2 minutes). The mean OSBD-r scores during manipulation were 0.084 and 0.278 for the K/M and P/F groups, respectively. Although this difference was statistically significant (95% confidence interval for the mean difference -0.34 to -0.048), both regimens were successful in keeping the scores low. There was no statistical difference between the groups in the other measures of effectiveness. There was a statistically significant difference between the groups in the occurrence of desaturation and late side effects. CONCLUSIONS: RT with P/F is shorter than with K/M. P/F is comparable to K/M in reducing procedural distress associated with painful orthopedic procedures in the pediatric emergency department. Although propofol has a greater potential of respiratory depression and airway obstruction as compared with ketamine, it offers some unique advantages including a quicker offset and smoother recovery profile.

Adolescent↗
PubMedDate not supplied

Occupational therapy benchmarks within orthopedic (hip) critical pathways.

OBJECTIVE: This study examined patient performance benchmarks for occupational therapy within orthopedic (hip) critical pathways. METHOD: Eight orthopedic (hip) critical pathways gathered from occupational therapy practitioners working in hospital and rehabilitation settings were examined to determine commonalities and differences of occupational therapy benchmarks, disciplines involved, and identified allowable variances. A comparison and contrast matrix was developed to provide a visual means of reviewing the data. RESULTS: Nursing, physical therapy, and occupational therapy were disciplines consistently involved in the pathways. Activities of daily living related to self-care were the most consistently used occupational therapy benchmark within the sample pathways, and functional transfers were the second most-used benchmark. The remaining occupational therapy benchmarks varied, and little commonality was found in their use. Frequency of use also varied among the eight pathways. Five of eight pathways specifically coded variances, with the remaining three providing space for explanation of the variance. CONCLUSION: Although these eight orthopedic (hip) critical pathways included occupational therapy benchmarks, further development and definition of the role of occupational therapy within subsequent orthopedic (hip) critical pathways is needed.

Benchmarking↗
PubMed2004

Orthopedic injuries during carrier battle group deployments.

Orthopedic injuries account for a large number of sick call visits during carrier battle group (CBG) deployments. The purpose of this study was to profile the orthopedic injuries during two CBG deployments to help both the line and medical communities better prepare their personnel and supplies. The current study confirmed that orthopedic injuries resulted in the greatest number of sick call visits to the CBG medical departments. Injury analysis revealed a significant number of hand/wrist and back/neck injuries during both carrier deployments. The groups with the highest number of injuries were the air squadrons and aircrews. These findings support the need for continued increased training and supplies for the care of orthopedic injuries. Emphasis should be placed on the care of hand/wrist and back/neck injuries. In addition, all CBG personnel should continue to improve their safety standards, especially in high-risk areas such as the aviation departments.

Accidents, Occupational↗
PubMed1999

[The prevention of postoperative deep venous thrombosis in orthopedic surgery].

In a non-comparative prospective trial, efficacy was studied of the use of clexane (enoxiparin) in the prophylaxis of the lower limb deep vein thrombosis and the pulmonary artery thromboembolism in orthopedic surgery. Enrolled in the study were 48 orthopedic patients. Kinds of operations performed included total hip arthroplasty (n = 40), total knee arthroplasty (n = 2), other challenging orthopedic operations (n = 6). Analysis of results of the treatment having been undergone by the patients revealed no case of thrombosis of lower limb deep veins or hemorrhagic complications. Thus, clexane is an effective and reliable prophylaxis modality for thromboembolic complications in orthopedic surgery.

Adult↗
PubMed1998

Office visits to orthopedic surgeons: United States, 1995-96.

OBJECTIVES: This report describes the utilization of ambulatory medical care services as provided by nonfederally employed, office-based orthopedic surgeons during the period 1995-96. Statistics are presented on selected physician, patient, and visit characteristics. METHODS: The data presented in this report were collected from the 1995 and 1996 National Ambulatory Medical Care Surveys (NAMCS). NAMCS is a national probability sample survey of visits to nonfederally employed, office-based physicians. Sample data are weighted to produce annual estimates. The survey is a component of the National Health Care Survey, which measures health care utilization across a variety of providers. Data are presented in this report as annual averages, unless otherwise noted. RESULTS: During 1995-96, an estimated 76.5 million office visits were made to orthopedic surgeons, an average of 38.3 million visits per year. The annual average visit rate was 14.5 visits per 100 persons. This represents an increase over the 1975-76 estimate of 11.3 visits per 100 persons. Visits to orthopedic surgeons accounted for 5.3 percent of all office-based ambulatory care visits during 1995-96, but this specialty received 28.3 percent of all injury-related office visits. The most frequent reasons given by patients for visiting orthopedic surgeons were knee symptoms, postoperative visits, back symptoms, and shoulder symptoms.

Adolescent↗
PubMed2000

Practical primary pediatric orthopedics.

Pediatric orthopedic problems often puzzle the primary health provider and worry families. A thorough orthopedic history and examination by the primary care provider is all that is necessary to determine whether a problem requires further evaluation and referral. This article addresses a practical approach to common orthopedic problems, assessment, and management strategies from the specialist perspective. A general description of developmental dysplasia of the hip, foot misalignments, tibial torsion, toe-walking, genu varum (bowlegs), growing pains, sprains and fractures, and the child with a limp is provided. Management strategies before and after orthopedic referral are presented.

Child↗
PubMed2001

A survey study for the development of virtual reality technologies in orthopedics.

Virtual reality (VR) technologies have the potential to support medical education and training. In order to orient the development of medical VR applications towards the actual deficiencies and demands in orthopedics, we performed a survey among 56 orthopedic physicians. They were asked to provide information about the kind of physical joint evaluation tests which they perform most often, the importance of physical joint evaluation in comparison to alternative diagnostic methods, and their opinion about current medical education system as well as the prospects of VR applications in orthopedics. The main conclusion of this survey is that VR applications have the potential to improve the lacking medical education and orthopedic training, e.g. by improving the quality of joint evaluation methods, reducing the high number of unhealthy, risky and expensive alternative diagnostic procedures.

Curriculum↗
PubMed2001

[50 years of the Lódź Branch of the Polish Orthopedics and Traumatology Society].

The Łódź Branch of the Polish Orthopedics and Traumatology Society (PTO i Tr.) was founded an march 10, 1951. The first Board was selected at the plenary PTO i Tr. meeting on May 7, 1951. The aim of the first Board was to make up for the inadequacies of orthopedic and trauma care in our region and assure orthopedic it's due place in the medical sciences. It also encouraged it's members to take-up scientific and social work. In the past years the number of Branch members grew from 18 to 169, proportionately to the number of new orthopedic and trauma care facilities in Łódź and it's surroundings. The members of the Branch participated in local scientific meetings a domestic PTO i Tr. congresses as well in congresses abroad. They delivered on the local meetings near 1401 research reports, which level were high. 81 members received Ph. D. and 9 of them achieve the degree of D. M. Sc. The average frequency at the scientific local meetings was 33%. From 1951 to 2000 members of Łódź Branch presented 192 papers in 23 domestic congresses of PTO i Tr. and published 325 papers as well 15 communications in organ of PTO i Tr. Łódź Branch organised three domestic meetings so called Orthopaedic Days in 1951 and 1960 as well three congresses in 1966, 1984 and 1998. Its members were also included in General Board of PTO i Tr.

History, 20th Century↗
PubMed2001

Regional anesthesia for outpatient orthopedic surgery.

The constant search for increased efficiency and reduction of hospital length of stay has led to an increase number of major orthopedic procedures performed as outpatients and the increase in the associated intensity and duration of acute postoperative pain. Although, it is well established that single peripheral blocks provide adequate anesthesia and excellent immediate postoperative analgesia in patients undergoing minor ambulatory orthopedic surgery, the postoperative acute pain benefit is limited to less than 24 hours. However, many patients required over 24 hours of intensive postoperative analgesia. Furthermore the need for immediate postoperative physical therapy in orthopedics dictates that local anesthetics be chosen on the basis of their safety and ability to produce preferential sensory blocks. As early as 1946, Ansbro proposed the use of continuous nerve blocks to prolong the duration of analgesia of nerve block technique during anesthesia. Continuous nerve blocks have also been used for the acute postoperative pain control of patients undergoing major orthopedic surgery as in-patients. This technique has been proven to be safe and effective in controlling acute postoperative pain and improve functional outcome. The recent introduction of safer local anesthetics producing preferential sensory blocks along with the development of ambulatory pumps has allow to extend the use of these continuous block techniques to ambulatory patients. Recent development also included the use of cox2 inhibitors along with cold maximize postoperative analgesia. This multimodal approach has been proven to be safe and efficacious as much for resting pain than pain associated with exercise.

Ambulatory Surgical Procedures↗
PubMed2001

Sheep model in orthopedic research: a literature review.

The aim of the study reported here was to provide some basic and general information on the suitability of an experimental sheep model for conducting in vivo orthopedic studies. The authors have classified the fundamental aspects that should be carefully evaluated when using sheep as an experimental model in orthopedic research: factors strictly related to bone anatomy and formation; and factors strictly affecting bone physiology, such as gastrointestinal mineral and vitamin absorption, and reproductive cycle. Future investigations should address all of the aspects highlighted, since there is no animal with the same anatomic, biochemical, physiologic, and biological characteristics as those of human beings. Moreover, useful data for treating orthopedic patients are based not only on good planning and study design, but also on perfect knowledge of the animal used and the differences between the model and the human being. The authors hope that this report will contribute to extrapolation of reliable data for use of sheep in the orthopedics field.

Animals↗