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PubMed2004

Atlas-based recognition of anatomical structures and landmarks and the automatic computation of orthopedic parameters.

OBJECTIVE: This paper describes methods for the automatic atlas-based segmentation of bone structures of the hip, the automatic detection of anatomical point landmarks and the computation of orthopedic parameters to avoid the interactive, time-consuming pre-processing steps for the virtual planning of hip operations. METHODS: Based on the CT data of the Visible Human Data Sets, two three-dimensional atlases of the human pelvis have been built. The atlases consist of labeled CT data sets, 3D surface models of the separated structures and associated anatomical point landmarks. The atlas information is transferred to the patient data by a non-linear gray value-based registration algorithm. A surface-based registration algorithm was developed to detect the anatomical landmarks on the patient's bone structures. Furthermore, a software tool for the automatic computation of orthopedic parameters is presented. Finally, methods for an evaluation of the atlas-based segmentation and the atlas-based landmark detection are explained. RESULTS: A first evaluation of the presented atlas-based segmentation method shows the correct labeling of 98.5% of the bony voxels. The presented landmark detection algorithm enables the precise and reliable localization of orthopedic landmarks. The accuracy of the landmark detection is below 2.5 mm. CONCLUSION: The atlas-based segmentation of bone structures, the atlas-based landmark detection and the automatic computation of orthopedic measures are suitable to essentially reduce the time-consuming user interaction during the pre-processing of the CT data for the virtual three-dimensional planning of hip operations.

Algorithms↗
PubMed2005

Rates of proximal deep vein thrombosis as assessed by compression ultrasonography in patients receiving prolonged thromboprophylaxis with low molecular weight heparin after major orthopedic surgery.

Patients undergoing major orthopedic surgery are at an increased risk of thromboembolism even after the acute postoperative phase. Therefore, prolonged thromboprophylaxis is currently recommended and widely used. The length of hospital stay after major orthopedic surgery is steadily decreasing and most patients are transferred to specialized rehabilitation centers in the early postoperative phase. Consequently, thromboprophylaxis is usually given during the rehabilitation period. Previously there have been no systematic studies of how many patients with asymptomatic thrombosis are transferred to a rehabilitation center or how many patients develop deep vein thrombosis (DVT) during rehabilitation. In the present study, 238 patients who had undergone major orthopedic surgery were examined by compression ultrasonography on day 1 or 2 and on day 20 of their rehabilitation phase in order to detect asymptomatic proximal DVT. Sonograms were read centrally with blinding to the clinical course of the patients. All patients received standard thromboprophylaxis during the acute postoperative phase. Prolonged thromboprophylaxis with enoxaparin was given during the rehabilitation phase. The mean duration of thromboprophylaxis was 36.8 days. At admission to the rehabilitation center, proximal DVT was identified in 16 patients (6.7%). New proximal DVT at discharge from the rehabilitation center was identified in 3.2% of patients following prolonged thromboprophylaxis with enoxaparin. In conclusion, a considerable percentage of patients with asymptomatic proximal DVT are transferred to rehabilitation centers following major orthopedic surgery. Using prolonged thromboprophylaxis, new proximal DVTs will still develop during rehabilitation, but at a low rate.

Aged↗
PubMed2006

Criteria used by medical students to rank orthopedic surgery residency programs.

Residency positions orthopedic surgery continue to be highly sought after. There is no published report of the criteria that candidates use to evaluate prospective orthopedic surgery programs. A survey, created to evaluate what these candidates value in a residency program, was sent to all current orthopedic surgery postgraduate year 1 and year 2 residents through their prospective program directors. Responses were analyzed to determine which factors were most and least important in ranking orthopedic surgery residency programs. Early surgical/clinical experience was the most important factor; geography, second most important; program reputation, third most important. Research opportunities were least important; program size, second least important; regional cost of living, third least important. Data from this survey will enable program directors to emphasize their "more desirable" aspects and minimize the "less desirable" in their attempts to attract top candidates. In addition, directors may incorporate these data into their residents' rotation schedule to provide more early surgical experience and a more directed educational program.

Humans↗
PubMed1991

Topical antibiotic irrigation in the prophylaxis of operative wound infections in orthopedic surgery.

1. Although the orthopedic literature on the clinical use of topical antibiotics is sparse, the effectiveness of topical antibiotics has been shown well enough in vitro and in the surgical literature to justify strong consideration of their use in orthopedic procedures. 2. Saline irrigation should not be relied upon to reduce bacterial contamination completely, although it does remove debris, foreign material, and clot, which often contain bacteria, from the surgical wound. 3. Topical antibiotic agents used for irrigation should have a broad spectrum of antimicrobial activity. Triple antibiotic solution (neomycin, polymyxin, and bacitracin) provides the most complete coverage against the organisms most likely to cause infections in both clean and contaminated orthopedic surgical cases. These agents should be allowed to remain in the wound for at least 1 minute before their removal. 4. Further studies of topical antibiotic irrigation in orthopedic surgery are needed to demonstrate the most effective antibiotic(s) and technique of administration. 5. There is evidence to suggest that the more often an irrigant is used, the more effective it is in preventing infection. 6. The use of bacitracin as an irrigant should probably be avoided in patients previously exposed to that agent. 7. Antibiotic-containing solutions should be utilized with pulsatile lavage systems. Saline alone may drive previously administered antibiotics from bone, leaving insufficient local antibiotic levels.

Administration, Topical↗
PubMed1991

Wound infections in orthopedic surgery: effect of extended surveillance on infection rate.

Substantial evidence now exists that ongoing surveillance of surgical wound infections can contribute to reduced infection rates. What is not yet determined is whether surveillance should be limited to the postoperative hospital stay or should be continued after patient discharge. To determine the number of infections occurring after discharge, the authors contacted a random sample of their patients who did not have wound infections during their hospitalization after orthopedic surgery. This was done 30 days after the procedure. The authors selected 273 patients of 1375 who underwent orthopedic surgery over a 7-month period and were able to contact 199 (73%). At the 30-day follow-up 23 patients (11.6%) had wound infections, as judged by wound discharge and physician prescription of antibiotics in 20 and the patient's description of pus issuing from the wound in 3. During the same period postoperative wound infections were found in only 19 (1.5%) of 1278 patients who were subjected to in-hospital surveillance. The authors conclude that, in patients who undergo orthopedic procedures, the majority of wound infections occur after discharge from the hospital and that infection rates based only on in-hospital surveillance greatly under represent true surgical wound infection rates for orthopedic procedures.

Alberta↗
PubMed1990

Orthopedic trauma: a family practice perspective.

It is well documented that residency-trained family physicians can effectively manage the majority of nonsurgical acute orthopedic injuries with a relatively small rate of consultation. The frequency of both fracture location and orthopedic review in our series are remarkably similar to the study from NRMC Charleston reported in 1981. Our program, however, is unique because of the comprehensive management, 3-year continuous training, and multidimensional educational experience. A critical element to the program is the excellent working relationship shared by the family practice and orthopedic departments. A clinic similar to the Davis Grant USAF Medical Center cast clinic could be implemented easily and would better train the family practice resident to manage nonsurgical orthopedic trauma.

Bone and Bones↗
PubMed1979

Orthopedic problems in family practice: incidence, distribution, and curricular implications.

The spectrum of orthopedic problems encountered by family physicians in everyday practice has received little study in the past. This paper presents and analyzes the incidence and distribution of orthopedic problems in general/family practice based on four sources of secondary data. These sources include the National Ambulatory Medical Care Survey, a Family Practice Service in a large military teaching hospital, a state wide study in Virginia, and two community-based family practice settings in Washington State. Orthopedic problems constitute about ten percent of all office visits in family practice. Over one half of these involve chronic, nontraumatic musculoskeletal problems. Major differences are noted in the distribution of sprains, strains, and fractures in adults and children. Fractures of the hand, foot, forearm, lower leg, and clavicle comprise between 50 and 80 percent of fractures seen in the settings under study. This kind of information should be helpful in better defining goals and methods for graduate training of family practice residents in orthopedics.

Family Practice↗
PubMed1979

Orthopedic surgery today.

The history of orthopedic surgery in Canada is briefly reviewed. It appears that the problems which were posed in the 1960s and early 1970s have diminished in importance. They related to the shortage of orthopedic manpower and to the lack of a sound scientific base within universities. There appears now to be an adequate number of orthopedic surgeons to handle the needs of the population, and Canadian training programs are providing replacements at an appropriate rate. Future problems will in all probability relate to the interrelationship between society and the medical profession. Academic freedom and mobility of medical manpower must be preserved at all costs and the orthopedic profession must adapt to an ever-changing situation if future developments are to be as satisfying as our very exciting past.

Canada↗
PubMed1983

Professional behavior in the orthopedic resident. A method for evaluation and development.

The affective behavior of orthopedic residents may be the most important indicator of their ability to function as orthopedic surgeons. Seven years of personal observations were combined with the experience of more than 300 participants in the Basic Course for Orthopaedic Educators, and recorded from the results of a recent questionnaire answered by members of the Association of Orthopaedic Chairmen. The affective domain was found to supply the answers to most of the problems of orthopedic residents. An evaluation of affective behavior early in the residency program may help to determine residents' suitability for a career in orthopedic surgery.

Affect↗
PubMed1982

The management of orthopedic patients with arterial insufficiency.

The identification and management of the orthopedic patient who has chronic arterial insufficiency is presented in four cases in which failure to appreciate marginal arterial supply led to major and costly complications. Every orthopedic surgeon treating elderly patients should be aware of these possibilities. After a through history and physical examination, patients with signs or symptoms of significant arterial compromise should be evaluated by means of Doppler segmental limb pressures. This evaluation should be performed prior to the institution of the indicated orthopedic treatment whenever possible. If the segmental ankle pressure is less than 50 mm Hg, or the ankle brachial pressure index is less than 0.3, the patient should undergo complete vascular evaluation and consideration for revascularization in order to preserve marginal arterial flow and tissue perfusion during and after the orthopedic procedure. Constrictive straps, bandages, or dressings should be scrupulously avoided, as well as decreasing tissue perfusion by unnecessarily elevating the already vascular compromised extremity. The development of pain or ulceration after lower extremity surgery mandates immediate consideration of arterial ischemia and the institution of appropriate diagnostic and therapeutic measures to improve circulation to the extremity.

Aged↗
PubMedDate not supplied

Evaluation of bromfenac and ibuprofen for pain after orthopedic surgery.

STUDY OBJECTIVES: To determine the relative analgesic potency and adverse effect liability of bromfenac 25, 50, and 100 mg, and ibuprofen 200 and 400 mg in the treatment of postoperative pain after orthopedic surgery. DESIGN: Randomized, double-blind, single-dose, parallel-group relative potency assay with evaluations at 30 minutes and then at hourly intervals for up to 6 hours. SETTING: Two wards of the orthopedic surgery department at the Centralsjukhuset (Central Hospital) in Karlstad, Sweden. PATIENTS: Two hundred inpatients with steady, moderate or severe pain within 72 hours after orthopedic surgery. INTERVENTIONS: Patients received a single oral dose of bromfenac 25, 50, or 100 mg, or ibuprofen 200 or 400 mg, when they experienced steady, moderate or severe pain that, in their opinion, required an analgesic. Using a self-rating record, subjects rated their pain and its relief for 6 hours after medicating. MEASUREMENTS AND MAIN RESULTS: The study was a valid relative potency assay with estimates of bromfenac's potency relative to ibuprofen ranging from 10.9 (nurse's global evaluation) to 16.7 (sum of hourly analog pain intensity difference scores). That is, 11-16 times the dose of ibuprofen must be administered to equal the analgesic effect of bromfenac. Patients who had eaten breakfast or lunch within 60 minutes before or 30 minutes after receiving the study medication ("fed" patients) had lower efficacy scores than those who had not ingested food within these time constraints before or after receiving the study medication ("fasted" patients). Furthermore, patients who had eaten before receiving the study medication had significantly lower efficacy scores than those who had eaten after receiving the study medication. CONCLUSIONS: The relative potency of the analgesic effect of bromfenac to ibuprofen is 11-16.7 in patients with pain after orthopedic surgery. Fed patients may have lower analgesic efficacy than fasted patients. Adverse effects for both bromfenac and ibuprofen were transient and consistent with the pharmacologic profiles of the drugs.

Analgesics↗
PubMed1995

[Factors which have an effect on infections in orthopedic surgery].

In orthopedic reconstructive surgery infection is a fatal complication which compromises not only the functional result and worsens the starting, initial state, but sometimes, endangers the patient's life, especially when it is an elder person. In the literature there are data which state that in orthopedic reconstructive surgery there are certain risk factors, but there are no data about the following: which factors affect the infection incidence and how. It gets even a greater problem because various types of described infections are not well defined as characteristics of certain infections (superficial or deep) and they are not described in the same way by certain authors. That is why the goal of this paper was to enlighten these problems and to clear up the connection among risk factors and certain infections. That is how risk factors may be divided into factors typical for 1. infected tissue, 2. patient, 3. applied intervention, 4. direct postoperative period and 5. presence of a foreign body. In the conclusion it may be pointed out that the decrease in percentage of infections in orthopedic surgery cannot be achieved if all mechanisms and factors which affect it are not known. It is the characteristic of bone tissue that if it is once infected it cannot be healed spontaneously. However, there is no guarantee that there will be no relapse after an adequate therapy. Treatment of postoperative infections remains an open and one of the leading problems of the orthopedic septic surgery. First signs of infection should be promptly reacted to, because every deepening of infection and surgery prolongation prolongs the treatment to months and years, often without results.

Humans↗
PubMed1996

Epoetin alfa: new directions in orthopedic surgery.

The introduction of autologous blood (AB) donation programs has led to a decrease in the number of orthopedic surgery patients exposed to allogeneic blood, although there is still room for improvement. For example, some patients may not be able to donate sufficient AB to meet their expected blood requirements. Virtually all nonanemic patients can donate 3 AB units prior to orthopedic surgery before further AB donation is limited by the development of anemia. In preliminary studies, the administration of epoetin alfa (150 IU/kg subcutaneously (s.c.) on alternate days; six doses) following the donation of 3 AB units reversed phlebotomy-induced anemia and enabled a further 2 units of AB to be collected. The ability of this therapeutic approach to increase AB procurement and reduce allogeneic blood requirements is being investigated in an ongoing, placebo-controlled study. An alternative approach may be to combine perisurgical treatment with epoetin alfa and normovolemic hemodilution (NVHD) prior to orthopedic surgery. Although such studies have yet to be initiated, they may demonstrate a reduction in allogeneic blood exposure in patients unable to donate AB prior to orthopedic surgery, a group of patients traditionally at high risk of exposure to allogeneic blood.

Anemia↗
PubMed1976

Orthopedic manpower.

Key statistical information regarding Orthopedic Manpower is present to make orthopedists aware of the detailed information that is currently available. It is clear there is still insufficient data to justify radically altering the numbers or types of practices. Until the scope of orthopedic practice is more clearly defined and generally accepted (by orthopedists, other physicians, health professionals and the public) we must continue to monitor our activities and make adjustments through evolutionary changes rather than revolutionary regulations. Quite clearly there are segments of our country that are orthopedically underserved. Thus, it is vital that we seek new methods to encourage orthopedists to settle in these areas. Clearly, the simple production of more orthopedists in the traditional model will not answer the geographic maldistribution. With the tremendous scope of problems cared for by orthopedists, there does not appear to be an oversupply; however, we are headed in that direction. If we continue to rate operative procedures as the most significant and satisfying aspect of the practice, we certainly have enough, but they are not spread across the country in a uniform manner. Significant increases in numbers will be necessary if the orthopedist is to assume the role of general practitioner of the musculoskeletal system as well as a specialist for diagnosing and treating the more complicated musculoskeletal problems (whether by medical-surgical or physical-medical modalities). Should this be the case adjustments must be made in the selection process of orthopedic residents, in training programs, as well as estimates of the numbers of such specialists necessary for the future.

Allied Health Personnel↗
PubMed1998

Common orthopedic problems of the newborn.

Newborn orthopedic problems are cause for major concern, both economically and emotionally, for the family. Dysplasia of the hip and abnormal feet can be successfully diagnosed and treated with proper assessment and early recognition. This article reviews the orthopedic examination for the newborn infant, discusses the major orthopedic problems encountered in the neonate, and provides guidelines that will impact the course of the condition for both the patient and family for those professionals working in orthopedics.

Brachial Plexus↗
PubMed2004

Occupational hazards of interventional cardiologists: prevalence of orthopedic health problems in contemporary practice.

Invasive cardiologists generally consider radiation to be the chief occupational hazard. Heavy leaded aprons worn to reduce this risk may be associated with orthopedic complications. This study was designed to characterize the prevalence of these occupational health problems. The Interventional Committee of the Society for Cardiac Angiography and Interventions (SCAI) sent to its Internet-registered members a Web-based survey. Inquiries included age, years of invasive practice, and diagnostic/interventional cases/year. Questions (yes/no) focused on orthopedic (spine, hips, knees, and ankles) and radiation-associated problems (cataracts and cancers). The survey was sent to over 1,600 members with 424 responses. Responders were on average busy and experienced, performing catheterization > 10 years in 62% of cases and > 20 years in 24% others. Average annual diagnostic-only case load was > 200/year in 72%, > 300/year in 43%, and > 500/year in 18% of responders. Reported annual interventional caseload was > 100/year in 83%, > 200/year in 37%, and > 300/year in 15% of operators. Orthopedic problems included spine problems in 42% of responders (of these, 70% were lumbosacral and 30% cervical). Hip, knee, or ankle problems were noted in 28% of operators. Spine problems were related to the annual procedural caseload and the number of years in practice. Over one-third reported spine problems had caused them to miss work. The results of the radiation queries were inconclusive. These results document that interventional cardiologists commonly suffer orthopedic disease, frequently leading to lost work days.

Adult↗
PubMed1991

Orthopedic implant devices: prevalence and sociodemographic findings from the 1988 National Health Interview Survey.

National population-based estimates on the magnitude and distribution of orthopedic implant devices in the United States have not been available to date. The Food and Drug Administration's Center for Devices and Radiological Health (FDA/CDRH) collaborated with the Centers for Disease Control's National Center for Health Statistics (CDC/NCHS) in the design and conduct of a nationwide medical device implant survey to generate the first national population-based prevalence estimates of orthopedic implant devices. A Medical Device Implant Supplement to the 1988 National Health Interview Survey was administered in personal household interviews to a national sample of 47,485 households, which included 122,310 individuals. An estimated 6.5 million orthopedic implants were in use in the general US population in 1988, including 1.6 million artificial joints and 4.9 million fixation devices. As a group, orthopedic implants comprised nearly half of all medical device implants in use, 43.4%. The majority of artificial joint recipients were 65 years of age or older, white, and male. The majority of fixation device recipients were less than 45 years of age, white, and male. The limitations and strengths of these population-based estimates are discussed.

Adult↗
PubMed2006

Local delivery of bisphosphonate from coated orthopedic implants increases implants mechanical stability in osteoporotic rats.

Patients with osteoporosis and joint disabilities represent a constant growing and challenging population to be treated in the musculoskeletal clinical field. Especially in the case of total hip arthroplasty, new solutions should be developed to compensate for the double negative factors, peri-implant osteolysis, and osteoporotic bone loss, affecting the quality of implant outcome. The goal of this study was then to establish a proof of concept for orthopedic implant used as Zoledronate delivery in osteoporotic rats, and in particular, to verify if this approach could increase the initial implant stability. Twenty-five female 6-month-old Wistar rats were ovariectomized 6 weeks before the implantation to induce osteoporosis. The animals were randomly separated in five groups representing the different Zoledronate concentrations in the HA coating: 0, 0.2, 2.1, 8.5, and 16 microg/implant. Histomorphometric measures and peri-implant bone volume fraction were assessed and mechanical stability tests were performed. Bone volume fraction and biomechanical results clearly illustrate the positive effect of Zoledronate coated implants in the osteoporotic rats. A remarkable result was to show the existence of a window of Zoledronate content (0.2 to 8.5 microg/implant) in which the mechanical fixation of the implant increased. We were able to establish the proof of concept for orthopedic implants used as a drug delivery system in osteoporotic rats. The local bisphosphonate delivery from a calcium phosphate coating allowed increase of the mechanical fixation of an orthopedic implant. This study shows that orthopedic implants containing bisphosphonates could be beneficial for osteoporotic patients in need of a total joint replacement.

Animals↗