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PubMed1983

Early bone grafting in complete cleft lip and palate cases following maxillofacial orthopedics. II. The soft tissue development from seven to thirteen years of age.

The subsequent effect of preoperative maxillofacial orthopedics and early bone grafting on the development of the soft tissue profile of the face was studied with roentgencephalometric analysis on cleft patients between 7 and 13 years of age. They were divided into two unilateral and one bilateral complete-cleft group, all having been bone grafted early with the "four-flap" technique. The two unilateral groups were one group of 39 children operated on between 1960 and 1965 without preoperative orthopedics and one group of 46 children operated on between 1965 and 1972 after preoperative orthopedics ("T-traction"). The bilateral group comprised 19 children operated on between 1960 and 1972 after premaxillary retropositioning pressure, combined when necessary, with outward rotation of the lateral maxillary segments. Comparisons of facial growth were made with U.S. non-grafted clefts and with nonclefts. The effect of the preoperative orthopedic management facilitated the subsequent surgical procedure by a narrowing of the cleft and replacement of the deviated maxillary and nasal structures. The results were within limits of the non-grafted cases, with the exception of the soft tissue overlying the subnasal region. The reduced prominence of that region was explained by the primary surgical procedure, which made the lip adherent to the alveolar crest. In comparison with nonclefts, all parameters indicated a reduced growth capacity.

Adolescent↗
PubMed1996

Analysis of the orthopedic content in an occupational therapy curriculum from a clinical reasoning perspective.

OBJECTIVES: Recent studies have suggested that occupational therapists working with adults with physical disabilities do not use narrative reasoning in practice as much as they use procedural reasoning. This focus on procedural reasoning may be partially shaped by the occupational therapy educational process. The purpose of this analysis was to see whether one accredited occupational therapy curriculum was promoting narrative reasoning relative to its information on adult orthopedics. METHOD: An accredited occupational therapy undergraduate and certificate curriculum was analyzed from both student and faculty perspectives to see what types of clinical reasoning were most emphasized relative to treatment of adults with orthopedic injuries. The student analysis, done by a senior as part of an independent study, looked at the clinical reasoning content of journal articles, an occupational therapy textbook, and occupational therapy lectures relative to adult orthopedic injuries. The faculty analysis, part of a curriculum revision process and independent of the student analysis, looked at the clinical reasoning content of all courses in the curriculum. RESULTS: The student and faculty analyses concurred that although narrative reasoning is taught in this curriculum, narrative reasoning concepts are not well integrated into the adult physical dysfunction course that deals with adult orthopedic injuries. CONCLUSION: Occupational therapy educators may not be integrating narrative reasoning into more procedurally oriented physical dysfunction courses as fully as possible and may, therefore, be fostering procedurally oriented practice in physical dysfunction settings. Curricula evaluations, like the one described in this article, can be a mechanism for examining the types of clinical reasoning emphasized in a given curriculum for a given diagnostic group.

Adult↗
PubMed1999

[Technical orthopedic therapy of diabetic foot].

Prophylaxis and therapy of lesions of the diabetic foot requires a therapy adapted to the clinical picture. Depending on the seriousness and expression of the diabetic foot syndrome, the provision of orthopedic shoes can be carried out by means of adaptations of shoes of normal manufacture, by means of soft foam-rubber inlays or diabetes-adapted foot beds, support shoes, orthopedic made-to-order shoes, orthopedic inlays, and ortheses. The goal of technical orthopedic care is to avoid ulcers or at least aid healing of existing ulcers, in order to halve the rate of amputations according to the declaration of St. Vincent.

Diabetic Foot↗
PubMed2001

[Orthopedic treatment of labio-maxillo-palatal clefts: our approach].

Many authors use a preliminary orthopedic procedure before cleft lip and palate surgical closure in order to prevent possible bone distortion following the rupture of the muscle belts resulting from the cleft. Actually, this is generally not only an orthopedic treatment but rather a surgical orthopedic step which includes lip adhesion before the surgical closure of the clefts. Following the procedures proposed by Georgiade and Latham, we have used since 1996 a treatment based on traction applied with an elastic chain on splints attached by transmaxillary pins for certain types of clefts, namely unilateral complete clefts with endognathy of the small fragment, unilateral complete clefts larger than 7 mm, bilateral wide complete clefts with premaxilla protrusion, and bilateral wide complete clefts with collapsus and premaxillary protrusion. Technical procedures vary with the type of cleft. Standard procedures with or without jacks are used for the other types of complete clefts. These orthopedic procedures with elastic traction are performed between the 3rd and 6th week, before lip adhesion of the upper part of the lip (combined with release of skin and subcutaneous tissues from the underlying alar cartilage). A palatine plate with or without a jack, fitted most of the time with a spring for nostril support, is then inserted until surgical closure.

Bone Nails↗
PubMed1992

[Compensation in leg length inequality with orthopedic shoe measures].

There are three different methods of compensating for differences in leg length. The first is the construction of special shoes, which is adequate for differences of up to about 3 cm. The heels can be either higher or lower, or a cork sole 5-10 mm thick can be incorporated, the shaft made higher, and supplementary features, such as aids to push-off, can also be implemented. The second method is the wearing of the classic orthopedic boot or shoe, in which the necessary compensation for the shorter leg is incorporated as a part of the orthopedic footwear. The third method is the construction of a shoe within a shoe, for which different designs have crystallized out for the five groups presented. All designs incorporate leather, the tried and tested material, next to the skin. Stabilizing components are made of fiberglass-reinforced synthetic resin or Thermoplast. New materials allow aesthetically acceptable orthopedic footwear. On average, such shoes are 25% lighter than conventional orthopedic boots. The stability and wear-resistance allow large perforations and open-toe designs, which has made it possible to solve the problem of ventilation.

Artificial Limbs↗
PubMed2005

[The expression of TGF-beta1 mRNA in the maxillary sutures of puberty rhesus loaded with the class III intermaxillary orthopedic force].

OBJECTIVE: The purpose of the study is to detect the expression of TGF-beta1 mRNA in the maxillary sutures of puberty rhesus during different periods of the loading of intermaxillary class III orthopedic force. METHODS: The animal model was established with 6 puberty female rhesus, which were randomly divided into experimental group (wearing class III twin-block magnet appliance, each 2 rhesus for 3 and 6 month respectively) and control group (not wearing any appliance, each 1 rhesus for 3 and 6 month respectively). Tissue sections were obtained perpendicular to the sutures. In situ hybridization was used to the expression of TGF-beta1 mRNA, and the expression intensity was measured and statistics was performed by SPSS 11.0. RESULTS: There were no statistic differences of cellular density between palatomaxillary suture in vertical group and pterygomaxillary suture in horizontal group, but statistic differences were found between other groups. The expression of TGF-beta1 mRNA was detected in the control group, but the expression intensity was obviously increased after the load of intermaxillary class III orthopedic force. Statistically significant differences were found among all groups except the six months experimental group and control group of temporozygomatic sutures and pterygomaxillary sutures. Experimental groups were more intensive than the control group and three months group was more intensive than the six months group. CONCLUSION: The active tissue remodeling happened in the circummaxillary sutures by the effect of class III intermaxillary orthopedic force. Cell proliferation, extracellular matrix synthesis and bone formation were accelerated. During the different remodeling periods, the expression intensities were different, which may be related to the different force loading manners, the different reaction of sutures to the orthopedic force and the different biological function of TGF-beta1 in the different periods.

Animals↗
PubMed2006

Airport detection of implanted orthopedic devices.

Since the attacks of September 11, 2001, the United States and other countries have increased airport security. Metal detectors (archway and handheld wand) are used to detect potentially dangerous instruments during airport screening. One consequence is that orthopedic implants are sometimes detected, and patients are detained and searched. The orthopedic literature is inconsistent in its reports on airport screening of patients with orthopedic implants. In this article, I review that literature and examine the factors that make detection of orthopedic implants a less than consistent science.

Aviation↗
PubMed1989

[Intercepted orthopedic treatment of skeletal maxillary protrusion deformity].

Maxillary protrusion deformity may be divided into three types: functional, skeletal and their combination. The diagnosis of which should be differentiated carefully. The treatment of skeletal maxillary protrusion is very difficult. It must be diagnosed in the growing stage of children and treated with intercepted orthopedic appliance in time. In order to bring the mandible into harmony with maxilla, the growth of maxilla should be inhibited while the mandible is stimulated. In this article an efficient orthopedic appliance using orthopedic force to inhibit the growth of maxilla was introduced. The factors which influenced the orthopedic effect were introduced by cases report. The use of the roentgenography cephalometric in diagnosing the maxillary protrusion deformity was discussed.

Adolescent↗
PubMed1989

Vascular complications associated with orthopedic procedures.

Damage to vascular structures during orthopedic procedures occurs relatively infrequently; when it does occur, however, recognition and prompt intervention are essential. We report herein 11 vascular injuries secondary to orthopedic procedures encountered between 1978 and 1988. Two injuries occurred as a consequence of lumbar laminectomy, three as a result of total hip replacement, three secondary to open reduction and internal fixation of a fracture of a lower extremity, two secondary to attempted closed reduction of humeral fractures and one injury as a result of hip flexion contracture release. Injury occurred to three iliac arteries, three popliteal arteries, two brachial arteries, one femoral artery, one graft to femoral anastomosis and two iliac veins. Five arterial injuries were repaired primarily, one with a vein patch, while five required bypass grafts. One venous injury was repaired primarily and the other required placement of a Greenfield filter for thrombosis. Major complications were a result of diagnostic delay and subsequent ischemia in most patients. There were no deaths. We conclude that vascular injuries can occur as a result of laceration, compression or traction during orthopedic procedures as a result of the proximity of vascular structures to the spine, joints and long bones. Also, we conclude that injuries manifest themselves primarily as hemorrhage or ischemia; that excellent results can be obtained with prompt recognition and treatment; that angiography is useful in those with mild ischemia in whom diagnosis is delayed, and that preoperative documentation of the vascular status of patients is critical prior to orthopedic procedures.

Adolescent↗
PubMed1989

Orthopedic history and examination in the etiology of overuse injuries.

Overuse injuries, and stress fractures in particular, afflict many runners and military recruits. This investigation sought to identify pretraining factors which may predispose to overuse injuries. Orthopedic and running history questionnaires and an orthopedic examination were administered to 505 trainees entering an intensive military training school. A novel method for evaluating ankle dorsiflexion was developed, and alignment measures, in units of centimeters rather than degrees, were obtained. Over 10% of the trainees were removed from the school for overuse-related injuries, and over half of these were tibial stress fractures. The incidence of clinically diagnosed stress fractures was 6.3%. No single orthopedic history question or combination of questions could discriminate between trainees who did or did not subsequently incur overuse injuries. Results from the running history indicated that those running 25 or more miles.wk-1 (mpw) had a significantly (P less than 0.027) lower incidence of stress fractures (3.0%) than those running 4 or fewer mpw over the previous year (11.5%). The orthopedic examination did not identify any predisposing alignment characteristics, perhaps due to the low incidence of overuse injuries. Population means are presented for future use in comparative studies.

Adolescent↗
PubMed1988

[The clinical use of Hotz-type orthopedic plate].

In the present study a Hotz type orthopedic plate was used to improve feeding and physiological growth. In 2 patients with cleft lip it was used to improve feeding and swallowing. In 4 patients with cleft lip and palate it was used to normalize functions and aid physiological growth. The effects of the Hotz orthopedic plate were determined by recording body weight growth, milk volume per day, feeding time and comparison of the study model between before and after using Hotz orthopedic plate. Good physiological growth and improved feeding, were obtoincdinalmostall the patients who wore the Hotz type orthopedic plate correctly.

Cleft Lip↗
PubMed1993

Bone scintigraphy: Part 2. Orthopedic bone scanning.

Bone scanning provides a functional assessment of skeletal pathology not available with conventional radiography or special radiographic techniques such as CT and MRI. Bone scanning detects osteoblastic activity associated with many forms of orthopedic skeletal disease. Several of the more common orthopedic applications of bone scanning have been described above, while equally important topics such as prothesis loosening, avascular necrosis, and the reflex sympathetic dystrophy syndrome were not considered. Thus, for a great range of benign skeletal pathology, bone scanning can provide the orthopedic surgeon with practical information concerning the cause of the patient's pain, the true significance of otherwise questionable radiographic findings, the extent of disease and the results of orthopedic surgical treatment.

Arthrodesis↗
PubMed1997

The risk of venous thromboembolism in the orthopedic patient: epidemiological and physiological data.

Venous thromboembolism is responsible for 500,000 deaths annually in industrialized countries. It is probably the most common preventable cause of death in elective orthopedic surgery patients. Rates of deep vein thrombosis (DVT) and fatal pulmonary embolism (PE) in unprotected orthopedic patient populations are high. The overall DVT rate is > 40% in patients undergoing hip or knee arthroplasty or suffering from multiple injuries. The proximal DVT rate for these patients is > or = 15%, and the fatal PE rate is > or = 1%. Risk factors associated with venous thromboembolism are related to the vascular injury, activation of blood coagulation, and venous stasis. Lower extremity orthopedic procedures carry a risk greater than that of surgery itself. Thus, orthopedic patients are at high risk for venous thromboembolic conditions. A systematic assessment of this risk should be performed in every patient, and an appropriate management plan should be implemented.

Humans↗
PubMed2003

Human serum opsonization of orthopedic biomaterial particles: protein-binding and monocyte/macrophage activation in vitro.

Wear particles generated after total joint arthroplasty activate monocyte/macrophages and incite formation of a granulomatous periprosthetic tissue associated with bone loss and implant loosening. This study tested the hypothesis that selective opsonization of orthopedic implant biomaterial wear particles by human serum proteins influences monocyte/macrophage activation. Serum protein binding to metallic, polymeric, and ceramic particles was determined by one-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Individual proteins bound to particles were subsequently identified using two-dimensional SDS-PAGE, microsequencing techniques, and SWISS-PROT analysis. Effects of selective protein opsonization on particle-induced monocyte/macrophage activation were assessed by quantification of interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha release. Results from one-dimensional gel analyses revealed distinct serum protein-binding patterns specific for each material tested. Two-dimensional gel analysis together with amino acid sequencing of the prominent protein species confirmed the presence of albumin and alpha-1-antitrypsin bound to all particles tested. In contrast to the metallic particles, apolipoprotein was a major species associated with polymeric particles. Opsonization of PMMA particles with purified preparations of each of the identified proteins showed that albumin significantly enhanced particle-induced monocyte/macrophage activation. These data confirm orthopedic biomaterial specific binding of human serum proteins and demonstrate that albumin exacerbates particle-induced monocyte/macrophage activation. Alterations in the chemical and surface properties of orthopedic biomaterials to modulate protein interactions may improve implant longevity.

Biocompatible Materials↗
PubMed2004

Nanobiotechnology: implications for the future of nanotechnology in orthopedic applications.

Nanotechnology involves the use of materials with components, such as fibers, grains and particles, that have dimensions of less than 100 nm. While numerous advantages of nanomaterials have been elucidated for catalytic, processing, mechanical, electrical, and optical applications, few have been described for orthopedic applications. Better orthopedic biomaterials are needed since the average lifetime of a bone biomaterial is less than 15 years. This review discusses recent studies that have been conducted to determine the efficacy of nanophase materials as bone implants. In doing so, it is suggested that nanophase materials can be synthesized to possess similar nanometer dimensions to components of bone tissue to promote new bone formation, compared with conventional orthopedic implant materials.

Biotechnology↗
PubMed1998

Prevention of infection in the orthopedic surgery patient.

A surgical site infection in an orthopedic surgery is a dreaded and often catastrophic complication. This article provides an overview of the incidence, pathogenesis, financial impact, as well as a discussion of patient and operation-related risk factors for orthopedic surgical site infections. The reader is provided insight into infection control interventions intended to minimize surgical site infections in orthopedic patients. Some of these practices are evidence-based and others exist only because of theoretical benefit.

Humans↗
PubMed2006

Role of single dose antibiotic prophylaxis in clean orthopedic surgery.

OBJECTIVE: To compare the proportion of early postoperative infection in clean orthopedic surgery after single dose of prophylactic antibiotic and multiple doses of prophylactic antibiotic. DESIGN: Interventional quasi-experimental study. PLACE AND DURATION OF STUDY: Department of Orthopedics, Abbasi Shaheed Hospital, Karachi from April 2004 to March 2005. MATERIAL AND METHODS: Two hundred patients of either age and gender, undergoing clean orthopedic surgery were equally divided into two groups A and B. Group A was given single dose of prophylactic antibiotic, while group B was given multiple doses of prophylactic antibiotic. Follow-up period was 28 days. All cases were evaluated for postoperative wound infection. Sampling technique was non-probability convenience. RESULTS: Mean age was 35.51+/-20.79 years in group A and 26.17+/-19.79 years in group B. However, there was a significantly higher proportion of male patients in group B than in group A (p=0.006). Statistical analysis showed no significant difference in the proportion of early postoperative infection cases between the two groups(p=0.270). Staphylococcus aureus was the commonest organism cultured from the wound discharge in our study followed by E. coli. Eight of our cases having postoperative wound infection showed no growth, out of which 7 were superficial and 1 was deep. There was no significant difference between the two groups regarding mean operating time and duration of stay in hospital. CONCLUSION: There was no statistically significant difference in the proportion of early postoperative infection cases between the two groups.

Adolescent↗
PubMed1998

Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group.

CONTEXT: Rifampin-containing regimens are able to cure staphylococcal implant-related infections based on in vitro and in vivo observations. However, this evidence has not been proven by a controlled clinical trial. OBJECTIVE: To evaluate the clinical efficacy of a rifampin combination in staphylococcal infections associated with stable orthopedic devices. DESIGN: A randomized, placebo-controlled, double-blind trial conducted from 1992 through 1997. SETTING: Two infectious disease services in tertiary care centers in collaboration with 5 orthopedic surgeons in Switzerland. PATIENTS: A total of 33 patients with culture-proven staphylococcal infection associated with stable orthopedic implants and with a short duration of symptoms of infection (exclusion limit <1 year; actual experience 0-21 days). INTERVENTION: Initial debridement and 2-week intravenous course of flucloxacillin or vancomycin with rifampin or placebo, followed by either ciprofloxacin-rifampin or ciprofloxacin-placebo long-term therapy. MAIN OUTCOME MEASURES: Cure was defined as (1) lack of clinical signs and symptoms of infection, (2) C-reactive protein level less than 5 mg/L, and (3) absence of radiological signs of loosening or infection at the final follow-up visit at 24 months. Failure was defined as (1) persisting clinical and/or laboratory signs of infection or (2) persisting or new isolation of the initial microorganism. RESULTS: A total of 18 patients were allocated to ciprofloxacin-rifampin and 15 patients to the ciprofloxacin-placebo combination. Twenty-four patients fully completed the trial with a follow-up of 35 and 33 months. The cure rate was 12 (100%) of 12 in the ciprofloxacin-rifampin group compared with 7 (58%) of 12 in the ciprofloxacin-placebo group (P=.02). Nine of 33 patients dropped out due to adverse events (n=6), noncompliance (n=1), or protocol violation (n=2). Seven of the 9 patients who dropped out were subsequently treated with rifampin combinations, and 5 of them were cured without removal of the device. CONCLUSION: Among patients with stable implants, short duration of infection, and initial debridement, patients able to tolerate long-term (3-6 months) therapy with rifampin-ciprofloxacin experienced cure of the infection without removal of the implant.

Aged↗