Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ORTHOPEDICS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 343 records · Page 19Linked to original sources
PubMedDate not supplied

[Construction characteristics of a multi-component force platform for orthopedic problems].

For many orthopedic problems it is very important to know the forces and moments under the feet during walking. In many hospitals commercial force plates measuring several components of force and moments by piezo--force transducers are installed. These equipments have wide ranges and high resonant frequencies allowing to record high forces with high slew rates as e.g. in sports. Such wide ranges and high resonant frequencies are not necessary during the investigation of handicapped patients in orthopedics. However when measuring the small vertical forces e.g. at the end of the stance phase during walking, the resolution of the commercial equipment is insufficient. So it is not possible to determine the exact position of the force vector or the moments. Therefore we developed a low cost force plate according to the wants of orthopedic investigations. It has a high resolution even when measuring small loads, a range up to 2.5 kN in vertical direction and a resonant frequency greater than 140 cycles/s.

Biomechanical Phenomena↗
PubMed1995

Orthopedic disability, conformity, and social support.

The relation between physical disability, social support, and conformist behavior was tested in two studies. The first compared the conforming responses of persons who had orthopedic disabilities with those of able-bodied individuals and correlated perceived social support of those with the disability with their tendency to conform. The second was an experimental study in which university students made choices between actors who had disabilities and actors who were able bodied; orthopedic disability was signified by a person sitting in a wheelchair and social support by the choice of a teammate. Results showed that persons with disabilities (compared with those who were able bodied) reported a significantly higher tendency to conform and that this tendency was negatively related to reported levels of perceived social support. In the experimental study, conforming behaviors of both disabled and able-bodied actors elicited more social support than did assertive behaviors. The actors who had "disabilities" received less social support than those who were "able bodied," but the former were considered more original when they did not conform. The findings imply that individuals with orthopedic disabilities are expected to conform but, although their conforming behavior elicits social support within specific encounters, it does not affect overall social support across encounters.

Activities of Daily Living↗
PubMed2001

The value of suction drainage fluid culture during aseptic and septic orthopedic surgery: a prospective study of 901 patients.

There are no guidelines on the value of suction drainage fluid culture (SDC), and it is difficult to determine whether the organisms cultured from suction drainage fluid samples are pathogenic or simply contaminants. We performed 2989 cultures of suction drainage fluid samples obtained, during a 1-year period, from 901 patients who underwent aseptic or septic orthopedic surgery (946 operations). The culture results were analyzed to evaluate their ability to detect postoperative infection after aseptic operations or to detect either a persistent or new episode of sepsis in patients known to have infection. For aseptic operations, the sensitivity of SDC was 25%, the specificity was 99%, the positive predictive value was 25%, and the negative predictive value was 99%. For septic operations, the sensitivity of SDC was 81%, the specificity was 96%, the positive predictive value was 87%, and the negative predictive value was 94%. We conclude that, for aseptic orthopedic surgery, SDC is not useful in detecting postoperative infection. However, for septic orthopedic surgery, it is of clinical importance.

Adolescent↗
PubMed2004

Similar hematologic effects of long-term linezolid and vancomycin therapy in a prospective observational study of patients with orthopedic infections.

Linezolid is an alternative to vancomycin for the long-term treatment of gram-positive bacterial orthopedic infections because of its antibacterial spectrum and oral bioavailability, but duration-related myelosuppression could offset its advantages. To evaluate the hematologic effects of these agents, we prospectively studied 65 consecutive adults with gram-positive bacterial orthopedic infections requiring > or =2 weeks of vancomycin therapy (n=52) or linezolid therapy (n=20). Trends suggesting higher incidence of hematologic effects among the patients receiving vancomycin were not significant, regardless of whether the end point was lowest cell count during therapy or change from baseline. The only difference was a higher incidence of thrombocytopenia (<150x10(9) platelets/L) in the subset of the linezolid recipients who had received vancomycin within 2 weeks before starting linezolid therapy than in the linezolid recipients who had not received vancomycin (5 [71%] of 7 patients vs. 2 [15%] of 13; P=.02). All hematologic effects were reversible. In conclusion, hematologic effects were detectable through weekly monitoring and were reversible; therefore, concern about myelosuppression need not preclude linezolid use for orthopedic infections requiring long-term therapy.

Acetamides↗
PubMed1999

Risk assessment for surgical-site infections in orthopedic patients.

OBJECTIVE: To assess the relative importance of risk factors for surgical-site infections (SSIs) in orthopedic patients and thereby determine which risk factors to monitor in the national surveillance of SSI in The Netherlands. DESIGN: Reanalysis of data on SSI and associated risk factors from two surveillance projects on nosocomial infections, carried out in 1992 and 1993 in The Netherlands: Project Surveillance Nosocomial Infections in the region of Utrecht (PSZU) and the first Project Surveillance Surgical Wound Infections (SWIFT-1). Odds ratios (ORs) were calculated for age, gender, preoperative stay, and the number of operations. In addition, in PSZU, other nosocomial infections, and, in SWIFT-1, prophylactic antibiotics, acute surgery, and wound contamination were studied. PARTICIPANTS: The study was confined to hospitalized orthopedic patients (PSZU, 4,872; SWIFT-1, 6,437). RESULTS: In PSZU, the following ORs were significant in a multivariate model: age 0-44 years, 1.0; 45-64 years, 1.6; 65-74 years, 4.7; and 75-99 years, 6.0. For a preoperative stay over 4 days, the OR was 3.3 (95% confidence interval [CI95], 2.5-4.0), and for multiple surgery, 2.5 (CI95, 1.9-3.0). For females, the OR was 0.8 (not significant). The same model applied to SWIFT-1 gave similar ORs. Adjustment for additional nosocomial infections (PSZU) decreased the ORs for ages over 65 years remarkably. The OR for additional nosocomial infections in patients under 65 years of age was 15.6 (CI95, 4.3-57.4). Adjustment for prophylactic antibiotics, acute surgery, and wound-contamination class (SWIFT-1) did not influence the ORs of the original model, but showed that wound-contamination class was an important risk factor. CONCLUSIONS: Age, additional nosocomial infections, wound-contamination class, preoperative stay, and the number of operations were identified as important risk factors for SSI in Dutch orthopedic patients.

Adolescent↗
PubMed2004

The value of bacterial culture during clean orthopedic surgery: a prospective study of 1,036 patients.

OBJECTIVE: To determine whether bacterial cultures of the wounds of patients undergoing clean orthopedic surgery would help predict infection. METHODS: During 1 year, 1,256 cultures were performed for 1,102 patients who underwent clean orthopedic surgery. Results were analyzed to evaluate their ability to predict postoperative infection. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value of the cultures were 38%, 92%, 7%, and 99%, respectively. CONCLUSIONS: Cultures performed during clean orthopedic surgery were not useful for predicting postoperative infection.

Adolescent↗
PubMed1995

Pharmacy-managed protocol for warfarin use in orthopedic surgery patients.

A pharmacy-managed protocol for warfarin use in orthopedic surgery patients was studied. In 1990 a protocol designed to accommodate either protocol- or physician-determined dosing of warfarin for orthopedic antithrombotic prophylaxis (OAP) was implemented at a community hospital. A "protocol" group consisting of patients treated entirely under the protocol-determined dosing option was prospectively identified over a two-year period. A "physician" group consisting of patients treated by physicians in the 10 months immediately preceding implementation of the protocol was also identified. The ability of the protocol to achieve laboratory-test and clinical goals was assessed by comparing the two groups. The proportion of patients who received OAP increased from 89% for the physician group to 98% for the protocol group. Mean prothrombin times (PTs) were significantly higher in the protocol group only on postoperative day 2; 66% of all PTs beyond post-operative day 1 in the protocol group were within the targeted range, which reflected an International Normalized Ratio of 1.6-3.2. The frequencies of clinically apparent postoperative thrombotic events and bleeding episodes were low in each group and comparable to literature values. Analysis of protocol-group patients with PTs of > 20 seconds indicated that lower weight, female sex, and blood loss during surgery were associated with an elevated PT. The protocol was revised to provide for a lower initial warfarin dose in elderly women. A pharmacy-managed protocol for dosing warfarin achieved therapeutic goals and promoted nearly universal use of OAP in patients undergoing high-risk orthopedic surgery.

Blood Coagulation Tests↗
PubMed1986

Clinical orthopedic medicine course for physical therapy students. Aligning content with current practice.

The purpose of our study was to obtain information that would help align instruction in a clinical orthopedic medicine course for physical therapy students with the current practice of physical therapists. We sent a questionnaire concerning treatment of orthopedic conditions to 3,000 physical therapists. Of the 1,804 (60%) respondents, 58.8% were in general practice, and 35% combined specialty areas with general practice. The respondents indicated that they treated two distinct groups (four categories each) of musculoskeletal disorders. Of the respondents, 87.6% spent less than five hours a week treating bone infections, tumors, and developmental and congenital disorders, whereas 63.4% worked more than five hours a week with fractures and dislocations, low back and neck pain, ligament and soft tissue injuries, and arthritis. We provide a model that uses survey results and course content analysis for planning critical orthopedic medicine instruction for physical therapy students.

Bone Diseases↗
PubMed1991

Chronic pain--assessment of orthopedic physical therapists' knowledge and attitudes.

Orthopedic physical therapists' knowledge of pain mechanisms and methods of pain management and their attitudes toward working with patients with benign chronic pain were studied. A random sample of 500 members of the American Physical Therapy Association's Section on Orthopaedics received by mail a 36-item questionnaire. Statistical analysis of scores, using frequencies, means, and correlations was performed on the 119 (23.8%) usable returns. All but 4% of the respondents preferred to work with patients who are not likely to have chronic pain. Seventy-two percent believed their entry-level education in pain management and theory was very inadequate or less than adequate to deal with an orthopedic patient population. Pain knowledge scores were low (35.8 out of 46 points), and the scores on positive attitudes toward treating patients with benign chronic pain were lower (20.5 out of 36 points). The study suggests specific deficiencies in orthopedic physical therapists' knowledge of clinical pain mechanisms and management and potentially undesirable attitudes toward treating patients with chronic pain.

Attitude of Health Personnel↗
PubMed2002

Aprotinin versus placebo in major orthopedic surgery: a randomized, double-blinded, dose-ranging study.

UNLABELLED: We conducted a prospective, multicenter, double-blinded, dose-ranging study to compare the risk/benefit ratio of large- and small-dose aprotinin with placebo after major orthopedic surgery. Fifty-eight patients were randomized into three groups: Large-Dose Aprotinin (4 M kallikrein inactivator unit [KIU] bolus before surgery followed by a continuous infusion of 1 M KIU/h until the end of surgery), Small-Dose Aprotinin (2 M KIU bolus plus 0.5 M KIU/h), and Placebo. Bleeding was measured and calculated. Bilateral ascending venography was systematically performed on the third postoperative day. Measured and calculated blood loss decreased in the Large-Dose Aprotinin group (calculated bleeding, whole blood, hematocrit 30%, median [range], 2,023 mL [633-4,113] as compared with placebo, 3,577 mL [1,670-21,758 mL]). The total number of homologous and autologous units was also significantly decreased in the Large-Dose Aprotinin group (2 U [0-5 U] as compared with placebo, 4 U [0-42 U]). No increase in deep vein thrombosis or pulmonary embolism was observed in the aprotinin groups. Large-dose aprotinin was safe and effective in dramatically reducing the measured and calculated bleeding and the amount of transfused red blood cell units after major orthopedic surgery. IMPLICATIONS: Large doses of aprotinin decrease blood loss and transfusion amount in major orthopedic surgery.

Adult↗
PubMed2006

Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery?

Studies have shown that antifibrinolytic (aprotinin, tranexamic acid, epsilon-aminocaproic acid) reduce blood loss in orthopedic surgery. However, most lacked sufficient power to evaluate the efficacy and safety on clinical outcomes. This meta-analysis aims to evaluate whether intravenous antifibrinolytics, when compared with placebo, reduce perioperative allogeneic erythrocyte transfusion requirement in adults undergoing orthopedic surgery and whether it might increase the risk of venous thromboembolism. From MEDLINE, EMBASE, and the Cochrane Controlled Trials Register, the authors identified 43 randomized controlled trials in total hip and knee arthroplasty, spine fusion, musculoskeletal sepsis, or tumor surgery performed to July 2005 (for aprotinin, 23 trials with 1,268 participants; tranexamic acid, 20 with 1,084; epsilon-aminocaproic acid, 4 with 171). Aprotinin and tranexamic acid reduced significantly the proportion of patients requiring allogeneic erythrocyte transfusion according to a transfusion protocol. The odds ratio was 0.43 (95% confidence interval, 0.28-0.64) for aprotinin and 0.17 (0.11-0.24) for tranexamic acid. Results suggest a dose-effect relation with tranexamic acid. Epsilon-aminocaproic acid was not efficacious. Unfortunately, data were too limited for any conclusions regarding safety. Although the results suggest that aprotinin and tranexamic acid significantly reduce allogeneic erythrocyte transfusion, further evaluation of safety is required before recommending the use of antifibrinolytics in orthopedic surgery.

Adult↗
PubMed2001

Have the new drugs relieved the burden of the orthopedic surgeon?

Rheumatoid arthritis (RA) represents a chronic joint inflammation that leads to destructive lesions of joint cartilage and periarticular bone. Increased understanding of the molecular and cellular mechanisms of RA and recent advantages in molecular technology have resulted in new antirheumatic drugs such as tumor necrosis factor-alpha blockers, inhibitors of interleukin-1, and novel disease-modifying antirheumatic drugs such as leflunomide. This review summarizes the important effects of the novel antirheumatic drugs and their potential impact on the work of orthopedic surgeons. The ability of these agents not only to improve the clinical signs and symptoms of RA but also to prevent progressive joint damage promises support to the work of orthopedic surgeons and to the interdisciplinary treatment of RA patients. The challenge, however, will be to conduct studies that show the concrete way in which the single drugs may best relieve the burden of the orthopedic surgeon.

Animals↗
PubMedDate not supplied

Infection in patients after implantation of an orthopedic device.

During the last several decades, the use of appropriate antibiotics has significantly improved our ability to prevent and treat infection that occurs after implantation of an orthopedic device. Despite improved prevention and treatment of this condition, patients who develop an infection secondary to implantation of an orthopedic device face increased mortality, morbidity, and/or delayed recovery. The presence of an orthopedic device significantly reduces the number of bacteria required to produce colonization and decreases the ability of the body's own defense mechanism and antibiotics to resolve this condition. Efforts devoted to prevention of infection are much more effective than those spent treating the condition once it has developed. Pretreatment of patients with antibiotics and the use of ultra clean surgical rooms have been shown effective. Prevention will become increasingly important as antibiotic resistant strains of bacteria become more prevalent and the number of arthroplasty procedures performed also increases.

Anti-Bacterial Agents↗
PubMedDate not supplied

Orthopedic trauma: critical care nursing issues.

Orthopedic trauma is frequently encountered by critical care nurses as trauma team members providing care to the severely injured. Through actual case examples, the role of the critical care nurse and orthopedic trauma management is reviewed. Focus is on unstable pelvic fractures, extremity fractures, compartment syndrome, rhabdomyolysis, mangled extremities, gunshot-wound fractures, and damage-control orthopedics.

Adolescent↗
PubMed1975

Electrodiagnosis in orthopedic surgery.

The electromyogram is gaining importance as a diagnostic tool in the clinical practice of orthopedic surgery. Its uses in the area of kinesiology will undoubtedly be further developed in the future in ways which can be standardized and made available to the practicing orthopedist to improve the results of muscle and tendon surgery and the design of surgical procedures. It should be noted that in either case electromyograms can be utilized to give a great deal of valuable information concerning the competence of the motor unit, the functioning mass of muscle fibers and the phasic relationships of muscle groups. Its value in diagnosis, however, depends directly upon the care with which it is performed, the patience of the electromyographer in sampling an adequate quantity of muscle mass to be certain that nothing has been overlooked and, above all, the specificity of the orthopedic surgeon in delineating exactly what information he wishes to obtain, so that the performance of the electromyogram can be confirmed and aimed directly at producing answers to the questions he is asking. In this regard, the electromyogram is in no sense a screening test or a catchall which the orthopedic surgeon can substitute for a careful clinical evaluation.

Action Potentials↗
PubMed1988

Orthopedic pitfalls in emergency medicine.

Acute orthopedic problems make up a large part of everyday emergency department practice. Misdiagnosis of these injuries often results from failure to consider certain clinical entities as a cause of the patient's complaints, and may result in unnecessary complications for the patient. Indeed, missed orthopedic injuries are the leading cause of malpractice claims in emergency medicine. The orthopedic injuries that most notoriously escape detection by the primary care physician are closed tendon injuries of the hand, carpal bone injuries, occult fractures about the elbow, femoral neck fractures, posterior dislocation of the shoulder, epiphyseal plate injuries, fractures of the pubic ramus, patellar tendon rupture, Lisfranc injuries, compartment syndromes, and multiple injuries. If the physician is unaware of these entities when evaluating the patient, he will not make the diagnosis. This review is designed to heighten the primary care physician's awareness of these injuries, which are a common source of problems in the emergency department.

Aged↗
PubMed2006

Outcomes for older patients with hip fractures: the impact of orthopedic and geriatric medicine cocare.

OBJECTIVES: To assess the impact of a specifically designed model of orthopedic-geriatric cocare on hip fracture (HF) outcomes. SETTING: Tertiary teaching hospital (level I trauma center). DESIGN: Prospective observational study with a retrospective (historical) control. Data on 951 consecutive patients 60 years of age or older admitted to the authors' institution with a nonpathologic HF over a 7-year period (1995 to 2002) were analyzed. Between 1995 and 1997, medical problems were managed by a geriatric medicine (GM) consultation-only service (retrospective audit). In 1998, a GM registrar began overseeing daily medical care with weekly geriatrician consultant review (prospective study). Outcomes for 2 time periods were compared: a 3-year period before (no GM; 504 patients) and a 4-year period after (GM; 447 patients) the introduction of GM cocare. MAIN OUTCOME MEASUREMENTS: Postoperative medical complications, mortality, length of stay, discharge destination, use of thromboprophylaxis, and antiosteoporotic treatment. RESULTS: While comparing 2 periods (GM and no GM), significant reductions in postoperative medical complications and comorbid conditions (in total 49.5% vs. 71.0%, P<0.001) and mortality (4.7% vs. 7.7%, P<0.01) occurred and rehospitalization to medical wards within 6 months decreased (28% vs. 7.6%). However, no differences were observed in median length of hospital stay (10.8 vs. 11.0 days) or in discharge destination. Antiosteoporotic treatment (12% to 69%) and specific thromboprophylaxis (63% to 94%) increased in the GM period. CONCLUSIONS: Orthopedic-geriatric cocare for the older patients with HF was associated with significant reductions in morbidity and mortality, and increases in optimal postoperative care. Options for further improvement of orthopedic-GM cocare need to be investigated.

Aged↗
PubMed2004

Preinjury warfarin and geriatric orthopedic trauma patients: a case-matched study.

BACKGROUND: This study examined the hypothesis that patients on warfarin before sustaining orthopedic injuries will have increased morbidity and mortality compared with matched control patients not on warfarin. METHODS: Records of consecutive trauma patients on warfarin with orthopedic fractures who presented from January 1997 to June 2002 to a Level I trauma center were retrospectively analyzed. Data were evaluated using the chi and Student's t tests and nonparametric tests when appropriate; values of p < 0.05 were considered significant. RESULTS: A study group of 53 patients was available for review. In comparison with the control group, significant differences were found in time delay from admission to surgery (p = 0.005), hospital length of stay (p = 0.03), total units of blood transfused (p = 0.03), and discharge disposition (p < 0.0003). No difference was found in number of intensive care unit days, complications, or mortality. CONCLUSION: Preinjury warfarin impacts outcomes of geriatric trauma patients sustaining orthopedic injuries.

Accidental Falls↗