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PubMed2006

Safety of orthopedic implants in magnetic resonance imaging: an experimental verification.

Magnetic resonance imaging (MRI) is an indispensable tool for musculoskeletal imaging. The presence of metal, however, raises concerns. The potential risks are loosening and migration of the implant, heating of the metal with surrounding tissue, causing thermal damage, and artifactual distortion which compromise the diagnostic value of the procedure. The aim of this study was to test experimentally the nature and extent of the first two of these effects in orthopedic implants. The degree of ferromagnetism was evaluated by deflection studies at the portals of a 0.25 Tesla permanent magnet and 1.0 Tesla clinical MRI scanner. None of the orthopedic implants exhibited any attraction. External fixator clamps, however, showed significant ferromagnetism. The heating of implants by "worst-case" scenario imaging sequences was insignificant. Many contemporary nonferromagnetic orthopedic implants can be imaged safely. It is prudent, however, to perform ex vivo deflection studies on a duplicate implant to confirm MR compatibility. With external fixator devices exhibiting strong ferromagnetism, MRI should be avoided. With expanding indications for MRI, orthopedic implants are unlikely to limit the potential of this powerful tool.

Artifacts↗
PubMed1991

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

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.

Adolescent↗
PubMed2002

Initiation of oral anticoagulant therapy in orthopedic and surgical patients: an algorithm compared with routine dosing.

Oral anticoagulant therapy is initiated in most hospitals in The Netherlands by clinicians who routinely dose oral anticoagulants (without using an algorithm). This may explain the low proportion of patients leaving the hospital stabilized. To test this hypothesis this study compared the dosing of acenocoumarol in orthopedic and surgical patients using an algorithm with routine dosing. Because of the routine administration of low molecular weight heparin for at least the first 5 days of acenocoumarol therapy, the study focused on supratherapeutic INR-values during this period. The study included 103 patients and was performed on orthopedic surgery and general surgery wards of a Dutch hospital over 5 months. The patients received acenocoumarol as an oral anticoagulant to prevent venous thromboembolism after general of orthopedic surgery. Patients were randomized into a group routinely dosed by physicians (n=54) and a group dosed using a dosing algorithm (n=49). A patient was defined as stable if he had two consecutive INR values within the range of 2-3 during hospitalization with the first (of the two consecutive INR values within range) having been measured on day 5 or later. The groups did not differ significantly in proportion of patients stabilized, time to stabilization, or length of hospitalization. In the first period (days 1-5) the routine dosing group had significantly more INR values above therapeutic range than the algorithm group, while the algorithm group had more INR values below the therapeutic range. There were two bleeding episodes in the routine dosing group and none in the algorithm group. Despite the lack of differences in stabilization between the two groups, this study suggests an advantage of dosing acenocoumarol using an algorithm in a study population consisting of prophylactically treated, mostly elderly orthopedic patients. The algorithm provides a safe dosing schedule for elderly postoperative patients who use low molecular weight heparin and NSAIDs concomitantly and are thus at high risk for bleeding complications.

Acenocoumarol↗
PubMed2001

Orthopedic applications of gene therapy.

A literature review of the applications of gene therapy for the treatment of orthopedic disorders was conducted, and showed that gene therapy provides us with new possibilities for the clinical management of orthopedic disorders. Most of these disorders, such as failure to obtain spinal fusion, disc degeneration, fracture and segmental bone defects, bone tumor, articular disorders, soft-tissue injury, genetic disorders, and nerve and muscular disorders, are difficult to treat by traditional surgical or medical means, and are under investigation for gene therapy. Many rapid advances have been made in the field of this novel approach. Although a number of obstacles remain to be solved before gene therapy can be applied for clinical use in humans, it is already apparent that gene therapy has the great potential of becoming a valuable clinical treatment for orthopedic disorders in the twenty-first century. With the development of gene transfer techniques, gene therapy will probably have numerous applications in orthopedic disorders.

Animals↗
PubMed2001

Skeletal troponin-I release in orthopedic and soft tissue injuries.

The skeletal isoform of troponin-I (sTnI) is a myofibrillar protein highly specific for myoskeletal injury. We used an indirect immunoenzymometric assay method with high analytical sensitivity to measure sTnI in patients with soft-tissue injury and in orthopedic patients. We assessed 20 soft-tissue injury patients and 16 orthopedic patients for sTnI, cardiac troponin-I (cTnI), creatine kinase (CK), myoglobin, and elastase within 24h of injury, in comparison with 17 control subjects. The mean (SD) ng/ml value for sTnI was higher in orthopedic patients (15.25 +/- 2.4) and in soft-tissue injury patients (10.41 +/- 1.8) than that in controls (2.5 +/- 0.9) P < 0.001, P < 0.05 respectively. Cardiac TnI was not detectable in any subjects (below the assay detectable limit of 0.3ng/ml). CK was significantly higher in orthopedic patients than in controls (P < 0.005) and myoglobin and elastase were not significantly changed in patients samples. The assay appeared to be suitable as a supplementary tool of reliability and relevance, for the study, identification, and diagnosis of skeletal muscle specific injuries in humans.

Adult↗
PubMed1989

Carcinogenicity of metal alloys in orthopedic prostheses: clinical and experimental studies.

Case reports of malignant tumors at sites of metal orthopedic implants in humans and domestic animals reviewed; results of carcinogenesis bioassays of implanted metal alloys and of nickel, chromium, cobalt, and titanium powders in rodents are summarized; mobilization of metals from implanted prostheses is discussed; and in vitro assays for morphological transformation of mammalian cells by metal compounds are surveyed. These considerations suggest that occurrence of sarcoma at the implantation site constitutes a complication, albeit rare, of implanted orthopedic prostheses. The author recommends (a) that orthopedic surgeons select prostheses with minimal susceptibility to metal corrosion and wear and, if feasible, replace implanted prostheses when there is evidence of corrosion or mechanical failure; (b) that epidemiological studies be undertaken to quantify cancer risks in patients with various types of metal implants; (c) that an international registry of implant-associated tumors be established; and (d) that research be focused on improved in vitro assays for carcinogenicity of alloys intended for use in orthopedic prostheses.

Alloys↗
PubMed1994

Fixed low-dose versus adjusted higher-dose warfarin following orthopedic surgery. A randomized prospective trial.

Orthopedic patients are at a high risk for developing venous thromboembolism, yet only a fraction of eligible patients receive anticoagulation prophylaxis after hospital discharge. This pilot study compared the efficacy of a fixed 2 mg/d dose of warfarin versus an adjusted higher dose of warfarin for 1 month after discharge to prevent the development of proximal leg deep venous thrombosis among recently discharged orthopedic patients. After standard inhospital treatment with adjusted higher-dose warfarin and a predischarge leg ultrasound to exclude deep venous thrombosis, 96 orthopedic patients were randomized just prior to discharge to either fixed low-dose (n = 49) or adjusted higher-dose warfarin (n = 47). At the 6-week follow-up evaluation, ultrasonographically confirmed, asymptomatic, proximal leg deep venous thrombosis occurred in two patients (4%). Both patients were randomized to the fixed low-dose group, although one remained on adjusted higher-dose warfarin throughout the trial. No patient in either group developed major bleeding complications. Further studies should be undertaken to further test fixed low-dose warfarin for venous thromboembolic prevention in high-risk orthopedic patients.

Female↗
PubMed2003

[Orthopedic implant infection: prognostic factors and influence of long-term antibiotic treatment on evolution. Prospective study, 1992-1999].

INTRODUCTION: Orthopedic implant infections are significant because of their morbidity, a tendency to serious relapses and an elevated health cost. OBJECTIVES: To study prognostic factors and the influence of long-term antibiotic treatment on the evolution of orthopedic implant infections. METHODS: This prospective study was performed in 110 patients with orthopedic implant infections. Clinical, analytical, and microbiological studies, as well as gammagraphy with Tc, Ga and labeled leukocytes, were performed in all patients. Controls were carried out at 7, 15 and 30 days after starting treatment, every 3 months thereafter until the end of treatment, and every 6 months thereafter up to one year after stopping treatment. Initial antibiotic treatment was prescribed according to the epidemiological characteristic of the type of infection and was modified according to the microorganism isolated. Duration of treatment was established by patient and implant characteristics, severity of infection and evolution of the process, and it was adjusted to criteria of cure, failure and relapse. RESULTS: Among the 110 cases, 63 were women and 37 men, with a mean age of 59.6 years (range 18-79 years). Implants included 72 joint prostheses (42 knee, 29 hip and 1 shoulder) and 38 bone implants. Microbiological documentation was obtained in 60%; among these, 60.6% were gram-positive cocci, with a predominance of staphylococci, 33.3% were gram-negative bacilli and 6.1% were anaerobic microorganims. Prognostic factors significantly associated with failure or relapse included previous joint surgery, previous hospital stay longer than 15 days, diabetes, microbiological isolation and treatment with cefuroxim plus rifampicin. Mean treatment duration was 9.8 months (range 2-17 months). Antibiotic treatment consisted of the following: 61 cases received fluorquinolones or cotrimoxazole plus rifampicin, 29 received cefuroxime-axetil plus rifampicin and the remaining 20 received monotherapy. Among 110 cases, 91 cured (83%). Treatment failures or relapses were observed in 19 (17%) patients; 26.7% of the latter were related to the implants. Tolerance to long-term antibiotic treatment was good.Conclusion. Long-term antibiotic treatment lasting a mean of 9.8 months had a positive influence on the evolution of orthopedic implant infections.

Adult↗
PubMed1998

Stability of orthopedic and surgically assisted rapid palatal expansion over time.

At the present time no reports are available on the stability between orthopedic and surgically assisted rapid palatal expansion. This study was designed to examine and compare the dental and skeletal changes over time for both orthopedic maxillary expansion and surgically assisted palatal expansion. The study was divided into two groups. Group one was orthopedically expanded and consisted of 14 males and 10 females. The ages ranged from 6 years to 12 years with a mean of 8.5 years. Group two received surgically assisted rapid palatal expansion and consisted of 12 males and 16 females with ages ranging from 13 years to 35 years and a mean age of 19.25 years. All 52 subjects were white, from the same geographic area, and were treated by the same two operators. Dental models and posterior anterior cephalograms were obtained immediately before and after expansion, at removal of the expansion device, and 1 year after removal of the appliance. A repeated measures analysis of variance test was applied to assess changes over time between groups. The surgical and nonsurgical techniques displayed similar trends over time although the surgical group contained a greater quantity of expansion. Both the orthopedic and the surgical groups showed stable results.

Adolescent↗
PubMed2001

[Orthopedic problems in older marathon runners].

58 marathon runners with an age average of 44.5 years were examined 6 months before the marathon in Berlin orthopedically. The orthopedic examination shows spinal column faulty burdens, muscular dysbalances as well as overload damages in the area of the knee joints and the achilles tendons. 42 probationers began after a biannual training with the marathon, one had to give up. Occurred during the marathon-training with 27 of the probationers orthopedic problems, especially in the area of the knee joint and the area of the achilles tendon. During the marathon 18 of the participants finished with orthopädic troubles. The examination shows, which orthopedic troubles with older marathon runners appears. Beside a sport medical suitability examination, a premature aimed therapy is necessary with the appearance of troubles since normally chronic overload damages and joint-wear threaten. When keeping the corresponding handicaps, a long-time marathon-training is possible also in the higher age without health risks for overuse injuries.

Adult↗
PubMedDate not supplied

Early self-awareness following traumatic brain injury: comparison of brain injury and orthopedic inpatients using the Functional Self-Assessment Scale (FSAS).

OBJECTIVE: To examine the Functional Self-Assessment Scale (FSAS) in hospitalized orthopedic patients with no brain dysfunction, and compare results to prior self-awareness data collected with brain injury patients. DESIGN: Comparison of patient and staff ratings on FSAS using paired sample t tests. PARTICIPANTS: Thirty-one adult volunteers hospitalized on National Rehabilitation Hospital (NRH) orthopedic treatment unit. MEASURES: FSAS was used to compare patient and staff ratings of patient performance on tasks relevant for inpatient rehabilitation. Subjects were screened to rule out brain impairment. RESULTS: Statistically significant but very small differences were found between orthopedic patients and therapist ratings using the FSAS. However, brain injury patients' ratings show a significantly larger discrepancy between self-therapist ratings than do orthopedic patients. CONCLUSION: Impaired self-awareness is related to brain injury rather than nonspecific factors in rehabilitation inpatients.

Adolescent↗
PubMed1991

Early orthopedic intervention in burn patients with major fractures.

Surgical treatment of concurrent orthopedic trauma in burn patients is controversial. During a 10-year period, 101 patients were treated for major fractures and burn injuries. Twenty-eight patients with 34 fractures were treated with early operative fixation. The mean TBSA burned was 20%. Ten fractures were open (4 grade I, 5 grade II, and 1 grade III) and 24 were closed. Seventy-five percent of patients had a definitive orthopedic procedure within 24 hours of burn. Intramedullary nails were used in 13, ORIF in 15, external fixation in 3, and percutaneous fixation in 4. Ten patients had burns overlying the fracture site and the surgical incision was made through burned tissue. Four were associated with open fractures. Two orthopedic complications occurred: nonunion of a femoral neck fracture and angulation of a tibial plateau fracture. The goal of orthopedic management in the polytrauma burn patient is to achieve early reduction to allow optimal wound care and early patient mobility. A team approach to patient selection and management is mandatory.

Adolescent↗
PubMed1998

Acute psychosocial impact of pediatric orthopedic trauma with and without accompanying brain injuries.

BACKGROUND: The acute psychosocial effects of orthopedic injuries on children and their families are poorly understood. Previous studies have relied on retrospective reports or failed to take into account accompanying brain injuries. The purpose of the present study was to examine prospectively the psychosocial impact of pediatric orthopedic traumatic fractures with and without accompanying brain injuries. METHODS: Participants were 108 children 6 to 12 years old with orthopedic injuries requiring hospitalization: group 1 (n=80) had fractures only, group 2 (n=28) also had moderate or severe brain injuries. Using standardized measures and parent interviews, we obtained preinjury estimates of family functioning and child behavior problems and postinjury measures of parental distress, family stresses, and child behavior. RESULTS: Parents reported significant clinical distress (35% in group 1, 57% in group 2), family burdens (group 2 > group 1), and child behavioral changes (41% in group 1, 89% in group 2). Multiple regression analyses indicated that preinjury family status and brain injuries predicted postinjury parental and family distress. CONCLUSION: Pediatric orthopedic injuries have greater social effects on children with accompanying brain injuries and poorer preinjury family functioning.

Adaptation, Psychological↗
PubMed2006

Endovascular treatment of arterial injury as an uncommon complication after orthopedic surgery.

PURPOSE: To evaluate selective and superselective catheter therapy of serious arterial damage associated with orthopedic surgery of the pelvis, hip joint, femur, and knee. MATERIALS AND METHODS: Between 1989 and 2005, 16 consecutive patients with arterial damage after orthopedic surgery (seven women, nine men; mean age, 62 years; age range, 21-82 y) underwent angiographic exploration. Seven patients were in hemodynamically unstable condition. Initial orthopedic procedures were iliac crest internal fixation (n = 1); total hip prosthesis (n = 3); revision of total hip prosthesis (n = 4); revision of acetabular cup prosthesis (n = 1); gamma-nailing, nail-plate fixation, or intramedullary nailing (n = 3); and total knee prosthesis (n = 4). RESULTS: Angiography showed pseudoaneurysms (n = 11), vascular lacerations with active extravasation (n = 3), and arteriovenous fistulas with extravasation (n = 2). After angiographic documentation of serious arterial injury, 14 patients were treated with a single or coaxial catheter technique in combination with coils alone, coils and polyvinyl alcohol particles, coils and Gelfoam pledgets, or Gelfoam pledgets; or balloon occlusion with isobutyl cyanoacrylate and coils. Two patients were treated with covered stents. In all, bleeding was effectively controlled in a single session in 16 patients, with immediate circulatory stabilization. Major complications included death, pulmonary embolism, and postprocedural hematoma. CONCLUSION: Selective and superselective catheter therapy may be used for effective, minimally invasive management of rare but potentially life-threatening vascular complications after orthopedic surgery.

Adult↗
PubMed1993

Diagnostic value of orthopedic tests in patients with temporomandibular disorders.

For a better definition of diagnostic subgroups of patients with temporomandibular disorders (TMD), clinical orthopedic tests have been developed for the masticatory system, for use together with the commonly used active movement tests and palpation. In the present study, the characteristics and additional diagnostic value of four orthopedic tests--namely, passive opening, the joint play test, compression, and the static pain test--were determined for a patient group, diagnostic subgroups, and a control group. Significant differences among the scores of the tests in the different groups indicated that all six orthopedic tests contributed to the diagnostic process. Because of the close functional relationship of the masticatory system, most information was obtained when patients indicated where pain occurred during the different tests. Logistic regression techniques were used for determination of the relative diagnostic value of each orthopedic test in the diagnostic process. Active movement was the most powerful test for distinguishing the different subgroups. Palpation and passive opening were additionally useful for distinguishing between patients and control subjects and between the subgroups of arthrogenous and myogenous patients. Besides active movement, both compression and the joint play test played a minor role in the distinction of subgroups of arthrogenous patients. It may be concluded that in routine clinical practice, besides history taking and conventional radiography, a functional examination consisting of active movements, passive opening, and palpation provides valuable diagnostic information. In patients with a specific diagnostic problem, one of the other additional tests might be indicated.

Adult↗
PubMed2002

Bone strain patterns of the zygomatic complex in response to simulated orthopedic forces.

Craniofacial bone strain upon orthopedic loading has rarely been characterized, despite its fundamental importance in our understanding of the anabolic and catabolic effects of orthopedic forces. The present study tested the hypothesis that zygomatic bone strain is modulated upon loading by headgear, a device widely used in craniofacial orthopedics. Ramp forces from 0 to 50 Newtons were applied via headgear attached to the permanent maxillary first molars in four juvenile and five adult human skulls. The average peak bone strain of the juvenile temporal articular eminence was significantly higher than the adult articular eminence (p < 0.05). Contrasting bone strain patterns were identified in the zygomatic arch: tensile in its lateral surface but compressive in its medial surface. The peak bone strain of the temporal articular eminence and the zygomatic arch both depend upon loading direction. Thus, headgear-generated orthopedic forces evoke bending of the zygomatic arch and stresses of the temporal articular eminence in vitro, suggesting the need to verify whether bone strain induces in vivo bone modeling and remodeling.

Adolescent↗
PubMed2005

Identifying orthopedic patients at high risk for venous thromboembolism despite thromboprophylaxis.

OBJECTIVE: To evaluate risk factors for venous thromboembolism (VTE) despite thromboprophylaxis in major orthopedic surgery patients at a tertiary care hospital. METHODS: Charts from consecutive patients who underwent total hip replacement (THR), total knee replacement (TKR), or hip fracture surgery (HFS) [hip pinning or hemiarthroplasty] from August 1, 1999, to April 30, 2000, at a large Canadian teaching hospital were abstracted using standardized case report forms. Data were collected on patient characteristics, surgical characteristics, and thromboprophylaxis regimen. Results of tests performed for suspected VTE were documented. Associations between characteristics of interest and objectively confirmed VTE were examined in multivariate analysis. RESULTS: Over the study period, 310 patients underwent major orthopedic surgery and received standard thromboprophylaxis with either dalteparin or enoxaparin (mean duration of prophylaxis, 7 days). Of these, 34% underwent THR, 30% underwent TKR, and 36% underwent HFS. Of 83 suspected cases of VTE, 44 cases (7 proximal and 37 distal deep venous thrombosis [DVT]); 14% of study population) were confirmed with objective testing. Multivariate analyses revealed that knee surgery (odds ratio [OR], 4.8; 95% confidence interval [CI], 2.3 to 10.1) and type of low molecular weight heparin (LMWH) [enoxaparin (more protective): OR, 0.39; 95% CI, 0.20 to 0.80] independently predicted VTE. No patient characteristics (including previous VTE, malignancy, hormonal therapy, postoperative complications) were associated with VTE. CONCLUSION: Despite standard thromboprophylaxis, symptomatic breakthrough VTE, primarily distal DVT, developed in 14% of patients undergoing major orthopedic surgery. Factors that independently predicted VTE in our population were TKR surgery and type of LMWH. TKR patients may warrant more aggressive postoperative physiotherapy and ambulation and adjunctive prophylactic measures such as pneumatic compression. Due to the heterogeneity of different LMWH compounds, direct comparison of the effectiveness of enoxaparin with dalteparin for orthopedic prophylaxis in prospective, randomized trials seems warranted.

Adult↗
PubMed2005

Evaluation of expected response to selection for orthopedic health and performance traits in Hanoverian Warmblood horses.

OBJECTIVE: To determine whether selection schemes accounting for orthopedic health traits were compatible with breeding progress in performance parameters in Hanoverian Warmblood horses. ANIMALS: 5,928 horses. PROCEDURE: Relative breeding values (RBVs) were predicted for osseous fragments in fetlock (metacarpo- and metatarsophalangeal) and tarsal joints, deforming arthropathy in tarsal joints, and pathologic changes in distal sesamoid bones. Selection schemes were developed on the basis of total indices for radiographic findings (TIR), dressage (TID), and jumping (TIJ). Response to selection was traced over 2 generations of horses for dressage and jumping ability and all-purpose breeding. Development of mean RBVs and mean total indices in sires and prevalences of orthopedic health traits in their offspring were used to assess response to selection. RESULTS: Giving equal weight toTIR andTID, TIJ, or a combined index of 60% TID and 40% TIJ, 43% to 53% of paternal grandsires and 70% to 82% of descending sires passed selection. In each case, RBVs and total indices increased by as much as 9% in selected sires, when compared with all sires, and prevalences of orthopedic health traits in offspring of selected sires decreased relatively by as much as 16%. When selection was exclusively based on TID, TIJ, or TID and TIJ, percentages of selected sires were 44% to 66% in the first and 73% to 84% in the second generation and TID and TIJ increased by 9% to 10% and 19% to 23%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Compared with exclusively performance-based selection, percentages of selected sires changed slightly and breeding progress in TID, TIJ, or TID and TIJ was only slightly decreased; however, prevalences of orthopedic health traits decreased in offspring of TIR-selected sires.

Animals↗