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PubMed1983

Development of a new orthopedic wire fatigue tester.

Even though orthopedic wire is commonly used in orthopedic surgery, very little is known about its fatigue properties. This article describes the development of a simple, effective testing machine that simulates the in situ fatigue loading of orthopedic wire. A mathematical analysis has predicted the maximum stress that is generated in wires in the fatigue machine. The fatigue resistance of intact monofilament wires made from different materials was studied. It was found that F90 was more resistant than F562, which in turn was more resistant than F138, grade 2. Also studied was the effect of cold-forming different notch sizes on the wire surface. It was found that even the slightest notch (1% of wire diameter) reduced the fatigue life by 63%.

Biomechanical Phenomena↗
PubMed2005

Does endotoxin contribute to aseptic loosening of orthopedic implants?

Aseptic loosening of orthopedic implants caused by wear particles is a major clinical problem. This review examines the hypothesis that bacterial endotoxin contributes to aseptic loosening. Clinical findings support this hypothesis: bacterial biofilms exist on many implants from patients with aseptic loosening and antibiotics in bone cement reduce the rate of aseptic loosening. Three approaches were used to demonstrate that adherent endotoxin increases bioactivity of titanium particles. These experiments measured cytokine production and osteoclast differentiation in vitro and murine calvarial osteolysis in vivo. First, removal of >99.9% of the adherent endotoxin from titanium particles significantly ablates their biological activity. Second, adding lipopolysaccharide back to these "endotoxin-free" particles restores their biological activity. Third, cells or mice that are genetically hyporesponsive to endotoxin are significantly less responsive to titanium particles than are wild-type controls. Other investigators have confirmed and extended these results to include virtually all orthopedically relevant types of particles, including authentic titanium alloy particles retrieved from patients with loosening. Our recent studies suggest that adherent endotoxin on orthopedic implants may also inhibit initial osseointegration of the implants. Taken together, these studies suggest that bacterial endotoxin may have a significant role in induction of aseptic loosening.

Animals↗
PubMed1988

Occurrence of methicillin-resistant Staphylococcus aureus in a department of orthopedic surgery 1970 to 1986.

The incidence of methicillin-resistant (and multiply-resistant) strains of Staphylococcus aureus in the Department of Orthopedic Surgery at Odense University Hospital fell from 15% of all strains in 1970 to less than 0.5% in 1986. This decrease occurred more slowly in the orthopedic department than in the rest of the hospital. A retrospective survey of 30 episodes of infection due to methicillin-resistant Staphylococcus aureus from 1979 to 1986 indicates that this slower decrease may be due to the relatively frequent occurrence of chronic infections in orthopedic surgery.

Anti-Bacterial Agents↗
PubMed1991

The use of a personal computer program for monitoring wound infections and other complications in orthopedics.

A personal computer program to monitor wound infections and other complications after orthopedic operations was developed, adopting international criteria and definitions. The program offers fixed data entry screens, and a free text editor, and produces user-specified variations of seven screen pages comprising most of the epidemiological data needed for surveillance and complication control. Furthermore a number of special lists can be generated for use in the daily work. For all reports and lists it is possible to generate subpopulations with up to twelve criteria. The program was tested in four danish orthopedic departments and serves well as a simple local tool for the operating staff, offering fast information on complication rates. Results consisting 2,583 operations are presented. The overall rates of complications were 1.8% superficial wound infections, 0.6% deep wound infections, 2.6% other infections and 3.8 other complications. The system is lowcost and an effective method of providing a widespread uniform surveillance of surgical wound infections and other complications in the orthopedic wards.

Adolescent↗
PubMed1995

Orthopedic or geriatric rehabilitation of hip fracture patients: a prospective, randomized, clinically controlled study in Malmö, Sweden.

From November 1988 to December 1989, all hip fracture patients in the municipality of Malmö, excluding nursing-home patients and patients who were already hospitalized at the time of the fracture, were postoperatively randomized to rehabilitation at either the orthopedic or the geriatric department in Malmö. The study, which comprised 371 patients, compared the following end points: primary mortality; destination at discharge; total first-year mortality; and the number of hip protheses during the first postoperative year. No significant differences were found between the two regimens. One year after the fracture, patients discharged to their previous living arrangements were invited to a control visit conducted by a physiotherapist; no significant differences between the two groups were found in walking ability, use of walking aids, "walking speed", or absence or presence of pain in the operated hip. Patients in the orthopedic group spent fewer days in the hospital, but had significantly more re-admissions, primarily due to orthopedic-related diagnoses (p = 0.003). The men in the geriatric arm of the trial were on the average 5.5 years older. The types of fracture were not evenly distributed between the two regimens. More patients treated at the geriatric department received technical aids, and more had adjustments made in their homes.

Aged↗
PubMed2004

[Comorbidity of mental and internal medical disorders in inpatients treated at the clinic for technical orthopedics].

Due to the severity of their clinical picture and their shattered sense of physical inviolability that almost always is associated with their condition as well as their changed physical appearance, inpatients being treated at the clinic for technical orthopedics frequently exhibit comorbid mental disorders. This article examines these mental health comorbidities. The proportion of adjustment disorders in this group was shown to be noticeably higher than in a comparative group of outpatients attending a psychosomatic/psychotherapeutic clinic. Furthermore, diabetes mellitus proved to be another statistically significant organic comorbidity in the patients treated at the clinic for technical orthopedics. This article discusses the extent to which the chronicity of this disease affects the psychosomatic diagnoses but also the course of the treatment in the clinic for technical orthopedics. In conclusion, this article emphasizes the need for close interdisciplinary management for this highly selected patient group because of the high rates of comorbidity.

Chi-Square Distribution↗
PubMed2000

[CRIGOS: development of a compact robot for image-guided orthopedic surgery].

In this paper, we present a medical robot system dedicated to support the surgeon during challenging tasks within orthopedic interventions. The main goal of this work is to develop a system as technically simple as the surgical requirements allow to keep its cost and complexity to a minimum. Therefore, we primarily focus on calibrated X-ray imaging for image acquisition, an easy registration procedure and robotic execution using a positioning device with simple parallel kinematics. Examples of different orthopedic interventions using the compact robot system for image-guided orthopedic surgery (CRIGOS) are presented, as well as various modes of execution of the device.

Arthroplasty, Replacement, Knee↗
PubMed2001

[Orthopedics and patients under national socialism dictatorship].

The 12-year dictatorship of National Socialism represents a decisive event in the history of orthopedics in Germany. Treatment and care was limited to those patients whose prognosis promised their reintegration into the work force. Those orthopedic patients with mental and psychological handicaps no longer came under the care of orthopedists and were potential candidates for annihilation. Despite concerted efforts to the contrary, as can be gleaned from the lists of topics at the annual meetings, the prevailing political circumstances encumbered scientific activities. The almost total isolation from international contacts had a negative effect. Orthopedists were hindered in their work by the law on sterilization, which provided for sterilization in cases of severe physical deformity. Some orthopedists even considered the presence of hip dysplasia to be an indication. The roles played by Georg Hohmann, Hellmut Eckhardt, Lothar Kreuz, and other leading orthopedists are described in detail. It can be regarded as certain that Hohmann and Eckhardt were able to prevent dire consequences for their orthopedic patients and the profession by cautious tactics. The ethnical problems of involvement with National Socialism are thoroughly discussed.

Persons with Disabilities↗
PubMed2006

Leflunomide increases the risk of early healing complications in patients with rheumatoid arthritis undergoing elective orthopedic surgery.

The aim of this object is to study whether treatment with biological or leflunomide increases the risk of wound-healing complications after elective orthopedic surgery. Between March 2002 and September 2003, 201 patients participated in this study with the following inclusion criteria: (a) Rheumatoid arthritis (RA) or psoriatic arthritis (psA), (b) therapy with: MTX, leflunomide, etanercept, infliximab, adalimumab, anakinra, (c) undergoing elective orthopedic surgery. The incidence of early postoperative wound-healing complications was compared among the different groups. In comparison with patients who received MTX therapy (n = 59), the risk of postoperative wound-healing complications in patients undergoing leflunomide therapy (n = 32) was significantly higher: 13.6% in the MTX group, 40.6% in the leflunomide group (P = 0.01). It is recommended that leflunomide medication for patients with RA undergoing elective orthopedic surgical procedure is interrupted preoperatively to reduce the risk of early wound-healing complications or infections.

Adult↗
PubMed1999

Patient throughput times for orthopedic outpatients in a department of radiology: results of an interdisciplinary quality management program.

The purpose of this project was to employ quality management methods in order to decrease throughput times for orthopedic outpatients sent to the department of radiology. The following intervals were measured at the onset of the study and after 6 and 12 months: (a) between arrivals at outpatient clinic and radiology counter; (b) between arrival at radiology counter and time of last radiograph; and (c) between time of last radiograph and radiology report printing time. After the initial measurement, numerous changes were initiated both in radiology and in orthopedic surgery. The mean interval between arrival at the outpatient clinic and in radiology decreased by one third from 60 min during the first measurement to 40 (p < 0.001) and 41 min during the second and third measurement. The proportion of patients with total radiology times of more than 30 min decreased from 41 to 29 % between the first and third measurements (p < 0.001). The corresponding results for radiology times of more than 45 min were 17 and 11 % (p = 0.03). A standard type of quality management program can be employed successfully in order to reduce radiology throughput times for orthopedic outpatients.

Ambulatory Care↗
PubMed2005

Immediate postoperative refeeding in orthopedic surgery is safe.

The purpose of this retrospective study was to investigate the morbidity of immediate postoperative refeeding after orthopedic surgery. We included all the 1077 patients who underwent orthopedic surgery between January and December 2003 at our military teaching hospital. General anesthesia was performed in 37% of the patients (n = 398), 24% (n = 259) had combined general and regional anesthesia, and 39% (n = 420) had isolated regional anesthesia (spinal anesthesia and/or peripheral regional anesthesia). After surgery, each patient was allowed free access to solid and liquid food immediately after discharge from the postanesthetic care unit. Although no systematic nausea and vomiting prophylaxis was performed, only 7% (n = 75) of the patients had postoperative nausea and vomiting during the first 48 h. Moreover, neither deglutition trouble nor aspiration syndrome was observed during that period. Our results suggest that immediate postoperative refeeding after orthopedic surgery is safe, does not increase postoperative nausea and vomiting, and probably increases the comfort of patients.

Anesthesia↗
PubMed1983

A survey of finite element analysis in orthopedic biomechanics: the first decade.

The finite element method (FEM), an advanced computer technique of structural stress analysis developed in engineering mechanics, was introduced to orthopedic biomechanics in 1972 to evaluate stresses in human bones. Since then, this method has been applied with increasing frequency for stress analyses of bone and bone-prosthesis structures, fracture fixation devices and various kinds of tissues other than bone. The aims of these investigations were to assess relationship between load carrying functions and morphology of the tissues, and to optimize designs and fixation techniques of implants. Although the amounts of significant findings and useful concepts generated by the FEM during the first decade of its application in this field were limited, many publications have served to illustrate its capabilities and limitations. The method is now well established as a tool for basic research and for design analysis in orthopedic biomechanics, and the number of publications in which it is used is increasing rapidly. In the meantime, following developments in engineering mechanics, the capabilities of the method are augmented which, together with an increasing sophistication of computers, guarantees exciting possibilities for the future. However, the biological structures and the clinical problems concerned are complex. Scientific progress in this area requires a sound understanding of engineering mechanics on the one hand, and a profound appreciation of the complex reality on the other. These features were not always apparent in the FEM work reported during the first ten years. In the following survey, the developments of FEM applications in orthopedic biomechanics during the first decade are discussed. Special problem areas are indicated and future trends anticipated.

Biomechanical Phenomena↗
PubMedDate not supplied

Objectives to direct the training of emergency medicine residents on off-service rotations: orthopedics.

In this third article in a continuing series on objectives for emergency medicine training, orthopedic objectives are presented. Orthopedic complaints are common in emergency medicine. Direction in mastering evaluative, cognitive, and procedural skills are provided utilizing behaviorally based objectives and references. These objectives provide a structure for systematically learning the content of orthopedics through enlightened patient care, questioning of attending physicians and supervisors, and directed reading.

Curriculum↗
PubMed2006

A randomized, controlled trial of i.v. versus i.m. ketamine for sedation of pediatric patients receiving emergency department orthopedic procedures.

STUDY OBJECTIVE: We compare adverse events, efficacy, and length of sedation of intravenous (i.v.) versus intramuscular (i.m.) ketamine procedural sedation and analgesia for orthopedic procedures in the emergency department (ED). METHODS: Pediatric patients receiving ketamine for orthopedic procedures were enrolled in a prospective, randomized, controlled trial in a children's hospital ED. All patients were initially randomized to receive ketamine either 1 mg/kg i.v. or 4 mg/kg i.m. Demographics, adverse events, sedation efficacy, and length of sedation were recorded. RESULTS: Two hundred twenty-five patients were randomized (116 i.v., 109 i.m.). Two hundred eight patients, aged 14 months to 15 years, completed the study, 109 i.v. and 99 i.m. Respiratory adverse events were similar between groups (i.v. 8.3% versus i.m. 4.0%; odds ratio [OR] 0.47; 95% confidence interval [CI] 0.14 to 1.6). Vomiting in the ED was more common in the i.m. group (26.3% versus 11.9%; OR 2.60; 95% CI 1.2 to 5.9). Using the Faces Pain Scale, patients in the i.m. group reported significantly less pain from the procedure. Video observers reported significantly lower distress in the i.m. group during the painful procedure (Observation Score of Behavioral Distress scores 0.35 i.m. versus 0.74 i.v.; mean difference 0.38; 95% CI 0.04 to 0.72). Length of sedation was significantly longer in the i.m. group (median 129 versus 80 minutes). Satisfaction of sedation was high in parents and physicians, with no difference in reported satisfaction between groups. This study was terminated early because of nursing resistance based on the longer recovery times observed in patients receiving ketamine i.m. CONCLUSION: In this study of pediatric sedation for orthopedic procedures, we found that ketamine 4 mg/kg i.m. was more effective than 1 mg/kg i.v. but demonstrated significantly longer recovery times and more vomiting.

Adolescent↗
PubMed2005

The significance of infection related to orthopedic devices and issues of antibiotic resistance.

Over the last 15 years, with the advent of modern standards in the control of sterility within the operating room environment and adequate protocols of peri-operative antibiotic prophylaxis, the incidence of infections associated to orthopedic implants has become very low. Nevertheless, the event of infection still represents one of the most serious and devastating complications which may involve prosthetic devices. It leads to complex revision procedures and, often, to the failure of the implant and the need for its complete removal. In orthopedics, for the enormous number of surgical procedures involving invasive implant materials, even if nowadays rare, infections have a huge impact in terms of morbidity, mortality, and medical costs. The difficult battle to prevent and fight bacterial infections associated to prosthetic materials must be played on different grounds. A winning strategy requires a clear view of the pathogenesis and the epidemiology of implant-related infections, with a special attention on the alarming phenomenon of antibiotic resistance. In this regard staphylococci are the prevalent and most important causative pathogens involved in orthopedic implant-related infections, and, thus, the main enemy to defeat. In this paper, we offer an overview of the complexity of this battleground and of the current and new, in our opinion most promising, strategies in the field of biomaterials to reduce the risks and counteract the establishment of implant infections.

Biocompatible Materials↗
PubMed2006

Gluteus tendon rupture is underrecognized by French orthopedic surgeons: results of a mail survey.

OBJECTIVES: To obtain information on the diagnosis and surgical treatment of hip rotator cuff tears by French orthopedic surgeons. METHODS: Survey conducted in 2003 by mailing questionnaires to 459 orthopedic surgeons practicing in France. RESULTS: Of the 84 respondents, 38 (45%) were not aware that tears could occur in the hip rotator cuff and 11 (13%) had never suspected this diagnosis in any of their patients. The 35 (42%) remaining surgeons had experience with at least one case of gluteal tendon repair; among them, 24 (29%) made the diagnosis fortuitously during surgery for another reason (total hip arthroplasty). Only 11 (13%) surgeons had performed surgery to treat gluteal tendon tears that were diagnosed preoperatively (gluteus medius in 20 cases, gluteus maximus in six cases, and gluteus minimus in three cases; total, 29 cases). Of these 29 cases, only 14 were treated by surgical tendon repair (by six [7%] surgeons); the remaining repair procedures were done during total hip arthroplasty. The retrospective data collection procedure and absence of medium-term follow-up data preclude conclusions about the outcomes of surgical treatment. CONCLUSION: Gluteal tendon tears may be underrecognized by orthopedic surgeons in France, who may have limited experience with repairing these lesions. Autopsy and imaging studies have shown gluteal tendon tears in up to 10% of individuals older than 60 years.

Buttocks↗
PubMed2006

Medical management of patients over 50 years admitted to orthopedic surgery for low-energy fracture.

OBJECTIVE: To develop a cost-effective strategy for improving osteoporosis management in patients admitted to an orthopedic surgery department for low-energy fractures. METHODS: From November 2003 to July 2004, all patients over 50 years admitted to the orthopedics department of the Caen Teaching Hospital (France) for low-energy fractures were identified and evaluated by rheumatology department physicians in the same hospital. RESULTS: During the study period, 313 patients were identified, 257 women (mean age, 79.5+/-10.2 years) and 56 men (mean age, 74.6+/-10.8 years), each with one fracture (proximal femur, 58.9%; wrist, 13%). Among them, 91 (29%) had a previous history of osteoporotic fractures. Mean bone mineral density (BMD) values were lower at the femoral neck than at the total hip or lumbar spine (e.g. in women, -2.3+/-0.9 versus -1.8+/-1.0 and -1.4+/-1.7, respectively). Osteoporosis treatment was given to 88 (28%) patients and consisted of calcium and vitamin D supplements, combined with alendronate in 32 patients. Complete loss of self-sufficiency occurred in 73 patients. Thus, 161 patients (88 with osteoporosis treatment and 73 with loss of self-sufficiency) received optimal treatment. CONCLUSION: Cooperation between the orthopedics and rheumatology departments improved the management of osteoporosis in patients with low-energy fractures. However, appropriate investigation and treatment of osteoporosis proved difficult in the oldest old and in patients with cognitive impairments.

Absorptiometry, Photon↗
PubMed2005

Palliative care and orthopedics: what is on the horizon?

Patient-centered palliative care involves effective and empathetic communication between the physician and patient, with the ultimate goal of providing improved quality of life for individuals who have terminal illnesses. Although several nonoperative and operative treatment options are available to improve the patient's quality of life, providing palliative care requires more than technical expertise and knowledge. Orthopedic surgeons need to be supportive facilitators who inform patients of the available treatments, risks, and benefits and incorporate these treatments into the wishes of patients and their families. Realistic expectations and outcomes of treatment need to be discussed with patients so that they can decide what risks they are willing to accept and what measures of success are meaningful to them. Advances in medical treatments and surgical techniques and principles are available to patients who have metastatic bone disease that were not available less than a decade ago. Although many orthopedic surgeons are involved in the care of patients who have metastatic disease, at times, expertise from an orthopedic oncologist may be required to optimize palliative care.

Bone Neoplasms↗