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At least 433 records · Page 24Linked to original sources
PubMed1996

Recombinant human erythropoietin: effect on the functional performance of anemic orthopedic patients.

OBJECTIVE: To determine whether rapid correction of anemia improves the functional and cognitive performance of postoperative orthopedic patients. DESIGN: A randomized, double-blind, placebo-controlled clinical trial. SETTING: A rehabilitation institute. PATIENTS: Persons having orthopedic surgery at least 2 weeks previously, and a hemoglobin concentration < 10g/dL. INTERVENTIONS: Recombinant human erythropoietin (rH-EPO) or the EPO vehicle for up to 8 weeks. All patients received ferrous sulfate. MEASUREMENTS: Blood counts were performed at weekly intervals, and functional and cognitive tests at baseline and weeks 4 and 8. RESULTS: In patients receiving vehicle only, hemoglobin levels increased from a mean of 9.0 at baseline to 11.0 at 4 weeks and 11.7 at 8 weeks; corresponding values for rH-EPO were 8.8 (p = NS), 12.6 (p = .02), and 13.5 (p = .01). However, functional improvement in dressing, toileting, and mobility was similar between groups, and the results of neuropsychological tests showed no trends favoring rH-EPO. CONCLUSIONS: Although hemoglobin increases more rapidly in anemic orthopedic patients treated with rH-EPO, equally rapid functional improvement occurs in those who receive only iron therapy.

Activities of Daily Living↗
PubMed1998

Adaptive functioning following traumatic brain injury and orthopedic injury: a controlled study.

OBJECTIVE: To study adaptive functioning after severe traumatic brain injury (TBI). DESIGN: Case-control study. SETTING: A university hospital and three regional and four community hospitals. SUBJECTS: A consecutive series (n=24) of children age 5 through 14 years who suffered severe TBI were individually matched to subjects who sustained a mild TBI and to a second group who sustained an orthopedic injury with no evidence of TBI. MAIN OUTCOME MEASURES: Standardized adaptive functioning, intellectual, psychiatric, and neuroimaging assessments were conducted on average 2 years after injury. RESULTS: Severe TBI was associated with significantly (p < .05) lower Vineland Adaptive Behavior composite, communication, and socialization standard scores and lower Child Behavior Checklist parent-rated social competence scores compared with children with orthopedic injury. Severe TBI and mild TBI subjects were significantly (p < .05) more impaired than orthopedic subjects on teacher-rated adaptive function. Family functioning, psychiatric disorder in the child, and IQ were significant variables, explaining between 22% and 47% of the variance in adaptive functioning outcomes. CONCLUSIONS: Severe TBI is associated with significant deficits in child adaptive functioning. This association appears to be mediated by family dysfunction, child psychiatric disorder, and intellectual deficits.

Activities of Daily Living↗
PubMed1996

Orthopedics in orthodontics: Part I, Fiction or reality--a review of the literature.

The purpose of this review is to investigate the orthopedic effect of functional appliances such as activators and Herbst appliances, and the orthopedic effect of extraoral traction appliances. A systematic review of mostly English-language orthodontic articles reporting treatment of Class II malocclusions with different orthopedic appliances was carried out. According to this review, only Herbst therapy was able to change mandibular growth to a clinically significant extent. In part II of this study, the long-term effect of these changes will be evaluated.

Cephalometry↗
PubMed1997

Changes in dental arch dimensions by use of an orthopedic cervical headgear in Class II correction.

Orthopedic cervical headgears are commonly used in Finland for early treatment of the Class II malocclusion, but there is a lack of follow-up studies on the effect of this treatment. We have evaluated the effects of the cervical headgear therapy with an expanded inner bow to treat Class II malocclusion and dental arches. Forty children, 20 boys and 20 girls, with Class II, Division 1 malocclusion, were treated with the orthopedic cervical headgear. No other appliances were used. The mean age of the subjects in the beginning of the treatment was 9.3 +/- 1.3 years (range 6.6 to 12.4 years). The mean treatment time was 1.8 +/- 0.6 years (range 0.8 to 3.1 years). The cervical headgear was used with a 10 mm expanded inner bow and a 15 degrees upward bend of the long outer bow, 12 to 14 hours a day with a force of 500 gm per side. Class I relationships were achieved in all subjects. At the same time, the maxillary and mandibular dental arches were widened. The annual increment in the intercanine and intermolar distances was significantly greater than in healthy control subjects (literature data), except for the mandibular intercanine distance in boys. The maxillary arch lengths were also significantly increased; there were no consistent changes of the mandibular arch lengths. Class II malocclusion may be treated with the orthopedic cervical headgear. The treatment results in increased growth of the dental arch widths by expansion of the inner bow of the headgear. The widening of the maxilla is followed by spontaneous widening of the mandible.

Child↗
PubMed1998

Age limitation on provision of orthopedic therapy and orthognathic surgery.

Canadian orthodontists were surveyed by mail to determine the latest skeletal age at which they would recommend orthopedic therapy and orthognathic surgery and the earliest at which they would recommend orthognathic surgery. For the purposes of this introductory study, orthopedic therapy implied stimulation of physiologic response using appliance force, without specification of appliance type. Response rate from 512 orthodontists was 65% (n = 334), with the response rate by item varying from 92% to 95%. By Greulich and Pyle standards, the latest recommended age for orthopedic therapy was at 97% completion of skeletal growth (females 13.5 years, males 15 years), whereas the earliest recommended age for orthognathic surgery was when skeletal growth is 99% complete (females 14.9 years, males 16.5 years). Surgery would be recommended by 32% of respondents for a patient before the age of 8 years, if deformity is severe. For orthognathic surgery, respondents either perceived no age maximum or recommended 69 years, the maximum age on the questionnaire item. Orthodontists' traits influenced recommendations for timing treatment.

Adolescent↗
PubMed2002

Orthopedic conditions of the avian head.

Orthopedic problems of the avian head generally fall into two main categories: congenital and traumatic. Congenital lesions of the beak are not uncommon in psittacine birds but are extremely rare in raptors. Trauma accounts for most of the remaining orthopedic problems seen in the area of the body. This article discusses the most common conditions and injuries causing orthopedic problems of the beak, eye, and skull of avian patients.

Animals↗
PubMed2002

Diagnosis and management of reptile orthopedic injuries.

As veterinarians expand their understanding of the specific husbandry requirements for captive reptiles, nutritionally associated orthopedic injuries should decrease. Orthopedic injuries in wild reptiles, however, will continue to increase as new infrastructure encroaches on the habitats of these animals. Research should be pursued that focuses on improving our understanding of pain management in reptiles, on developing techniques to expedite bone healing, and on creating new orthopedic techniques that provide rigid stabilization without the use of temperature-sensitive materials.

Animals↗
PubMed2002

Rabbit orthopedic surgery.

Orthopedic surgery in rabbits poses several unique parameters for the veterinary surgeon. It is imperative for the veterinarian to be knowledgeable about the anatomic features of the surgical repair site and to become familiar with a rabbit's pain and discomfort often associated with orthopedic injuries. Handling the perioperative and postoperative pain and potential GI disturbances are crucial for a successful outcome of the surgical case. This article is designed to help the veterinary surgeon prepare for the orthopedic surgical procedure and the peripheral physiologic needs of the rabbit from presentation through recovery.

Animals↗
PubMed1999

Computer assisted outcomes research in orthopedics: total joint replacement.

Long-term studies are needed to determine clinically relevant outcomes within the practice of orthopedic surgery. Historically, the patient's subjective feelings of quality of life have been largely ignored. However, there has been a strong movement toward measuring perceived quality of life through such instruments as the SF-36. In a large database from an orthopedic practice results are presented. First, computerized data entry using touch screen technology is not only cost effective but user friendly. Second, patients undergoing hip or knee arthroplasty surgeries make statistically significant improvements in seven of the eight domains of the SF-36 in the first 3 months after surgery. Additional statistically significant improvements over the next 6 to 12 months are also seen. The data are presented here in detail to demonstrate the benefits of a patient outcomes program, to enhance the understanding and use of outcomes data and to encourage further work in outcomes measurement in orthopedics.

Activities of Daily Living↗
PubMed2002

Feline orthopedics.

Although many aspects of canine care do cross over to the feline patient, the adage "cats are not small dogs" holds more true today than ever. The area of feline orthopedics is no different. The purpose of this article is to familiarize the reader with the more common feline orthopedic problems. Although many nonsurgical aspects are covered, the majority of text discusses surgical orthopedic problems. In addition, situations considered unique to the feline patient are addressed, including preoperative, perioperative, and postoperative concerns. Diagnostics and implant systems are also covered.

Animals↗
PubMed2001

Infection of orthopedic implants and the use of antibiotic-loaded bone cements. A review.

Infections by bacteria are a serious complication following orthopedic implant surgery, that can usually only be cured by removing the implant, since the biofilm mode of growth of infecting bacteria on an implant surface protects the organisms from the host immune system and antibiotic therapy. Over the past few decades, attempts have been made to prevent and cure orthopedic implant infections by incorporating antibiotics in polymethylmethacrylate bone cements, in primary and revision surgery. However, the clinical efficacy of antibiotic-releasing bone cements is not accepted by all and the long-term exposure to low doses from antibiotic-releasing bone cements in patients is strongly related to the emerging threat of antibiotic resistance in medicine today. In this article, we start by reviewing the mechanisms governing the formation of an infectious biofilm on orthopedic implant materials, the release mechanisms and properties of clinically-used, antibiotic-loaded bone cements. The clinical efficacy of antibiotic-loaded bone cements is evaluated analyzing separatedly the prophylactic and therapeutic uses of these products.

Antibiotic Prophylaxis↗
PubMed2003

Occurrence of ica genes for slime synthesis in a collection of Staphylococcus epidermidis strains from orthopedic prosthesis infections.

Staphylococcus epidermidis is a frequent pathogen in infections associated with orthopedic implants. We studied 123 S. epidermidis strains from infections related to orthopedic implants, as regards their ability to express a factor of virulence, namely the slime, an extracellular polysaccharide, which mediates adherence to implants and bacterial colonization. The slime-producing ability was determined by PCR detection of icaA and icaD genes responsible for slime synthesis, and by culture on Congo red agar plates in which slime-producing strains form black colonies, while nonslime-forming ones develop red colonies. 56% of the S. epidermidis isolates were icaA- icaD-positive and grew to become black colonies. In the evaluation of the distribution of slime-forming strains in different sites and types of implants, we found a slight, but not statistically significant, increase in slime-forming strains in total joint prostheses, where tissue compression near the articular faces can form niches in which bacteria crowd, sheltered by the slime. Our findings confirm the role of ica genes as a virulence marker in the pathogenesis of implant-associated orthopedic infections. However, they do not show the existence of a higher frequency of slime-positive strains in a specific type of implant.

Congo Red↗
PubMed1981

Preschool children's understanding of children with orthopedic disabilities and their expectations.

The present study investigated whether preschool children (N = 121) had a realistic understanding of the limitations imposed by various orthopedic disabilities. The results have indicated that the preschoolers were aware that orthopedic disabilities may impose some physical limitations. Ss tended to perceive able-bodied children more capable in performing various tasks than disabled children. This evaluative judgment does not necessarily mean that the preschoolers were discriminating against the disabled children, but it may be a reflection of a sense of realism that the able-bodied children have less trouble in doing these tasks than their disabled counterpart. It was suggested that, with increased understanding of the realistic limitations imposed by orthopedic disabilities, children may be come less biased toward their disabled peers. This change in attitude would have significant impact on the self-concepts of disabled children.

Attitude↗
PubMed1998

Prolonged suppressive antibiotic therapy for infected orthopedic prostheses.

Prolonged suppressive antibiotic therapy may be an alternative to removal of infected orthopedic prostheses in some patients. However, the efficacy of prolonged suppressive antibiotics is not well established. We retrospectively reviewed 18 patients with infected orthopedic prostheses who had been treated with prolonged antimicrobial suppression during the last 10 years. Eighteen episodes of infection were identified in these 18 patients. There were nine men and nine women, and the mean age was 66 years (range, 31-83 years). All patients had a functional prosthesis and were treated with surgical debridement, retention of the prosthesis, and administration of intravenous antibiotics for 6-8 weeks, followed by prolonged oral antibiotic suppression. Fifteen of the 18 patients appear to have had a good response and have been able to retain a functional prosthesis. Complications related to antibiotic suppression occurred in 22% but did not necessitate discontinuation of the antibiotic therapy. Prolonged antibiotic suppression is a reasonable alternative to surgery in selected patients with infected orthopedic prostheses.

Adult↗
PubMed1992

Antimicrobial treatment of orthopedic implant-related infections with rifampin combinations.

The purpose of this prospective clinical study is to evaluate the role of combination chemotherapy with rifampin in the treatment of orthopedic device-related infections in which the implant could not be removed. Eleven patients with orthopedic implant-related infections due to staphylococci or streptococci were treated with the implant in situ. Each antimicrobial regimen included rifampin in combination with a beta-lactam antibiotic or ciprofloxacin. The median duration of treatment with rifampin was 86 days (range, 15-336 days) with a median follow-up of greater than 24 months after cessation of therapy. Treatment was successful for 82% of patients. Failures were associated with documented inappropriate treatment. These preliminary clinical data are supported by data from in vitro studies and animal experiments. Combination therapy with rifampin, in particular rifampin and a quinolone, should be considered for patients with orthopedic implant-related infections if the implant cannot be removed.

Adult↗
PubMed1979

Orthopedic manual therapy--an overview. Part I: the extremities.

Part 1 of an introductory overview of orthopedic manual therapy is presented, covering evaluation and treatment of the extremities. The first section defines introductory concepts about passive movement, including types of movement, limitations of movement, and types of treatment movements. The remaining four sections cover general concepts, evaluation schemes, and treatment procedures of four practitioners belonging to different schools of thought in orthopedic manual therapy: James Cyriax, MD, MRCP; Freddy Kaltenborn, DO, RPT; Geoffrey Maitland, MAPA, FCSP; and John McM Mennell, MD. The conclusion stresses the importance of developing skills in evaluation, as well as treatment, prior to practicing orthopedic manual therapy.

Extremities↗
PubMed2000

Coping strategies and emotional outcome following traumatic brain injury: a comparison with orthopedic patients.

OBJECTIVES: To investigate coping strategies in relation to emotional adjustment in individuals with traumatic brain injury (TBI) 1-5 years postinjury and to compare these with a group of 40 participants who sustained serious orthopedic injuries. DESIGN: Participants completed measures of handicap and coping strategies, and rated their levels of depression, anxiety, and self-esteem on standardized questionnaires. SETTING: Participants had received inpatient rehabilitation at Bethesda Hospital 1-5 years prior to completing questionnaires. They were recruited from a list of consecutive admissions. PARTICIPANTS: 88 TBI individuals were compared with 40 participants who had sustained serious orthopedic injuries without damage to the central nervous system. They had all been involved in motor vehicle or work-related accidents. OUTCOME MEASURES: Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI). RESULTS: Consistent with previous studies; a significant proportion of the current sample displayed high levels of emotional distress. Results showed few differences between the TBI and orthopedic groups. Coping strategies characterized by worry, wishful thinking, and self-blame were associated with higher levels of depression and anxiety in both groups. Strategies focusing on problem solving and having a positive outlook were related to lower anxiety levels, but to a lesser degree. CONCLUSIONS: This study has provided further evidence that coping strategies are associated with emotional outcome in TBI individuals. There is now a growing empirical basis on which preliminary interventions can be based.

Activities of Daily Living↗
PubMed2002

Pediatric orthopedic trauma: principles in management.

Optimal management of pediatric orthopedic trauma requires understanding the unique characteristics of the immature musculoskeletal system. The principles of pediatric orthopedic trauma management include anticipating future growth and bone remodeling potential, minimizing physeal injury, and aggressive treatment of open fractures and compartment syndromes. This article discusses the fundamentals of the pediatric musculoskeletal system and pediatric orthopedic trauma management in general and as they apply to specific injuries.

Adolescent↗