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At least 487 records · Page 27Linked to original sources
PubMed1994

[Orthopedics in orthodontics: fiction or reality? Literature review].

The purpose of this literature review is to investigate the orthopedic effect of functional appliances as activators. Herbst appliances and extraoral traction appliances. The matter on correction of skeletal Class II discrepancies in growing children remains controversial despite extensive research. However most authors agree on the fact that major contributions derive from dento-alveolar changes rather than from skeletal ones. Nevertheless, the authors of this review want to emphasize that the discussed Class II orthopedic appliances have an important value in clinical orthodontics. Due to scientific evidence, their orthopedic effect however, must be questioned so far.

Activator Appliances↗
PubMed1996

Use of a modified toggle pin for repair of coxofemoral luxation in dogs with multiple orthopedic injuries: 14 cases (1986-1994).

OBJECTIVE: To develop modifications of the toggle pin procedure for use as a ligament of the head of the femur (LHF) prosthesis and to assess outcomes when used for coxofemoral luxation (CFL) in dogs with multiple orthopedic injuries. DESIGN: Retrospective case series. SAMPLE POPULATION: 14 dogs with CFL as a component of orthopedic polytrauma. PROCEDURE: Modifications to previous descriptions of the technique for use of a toggle pin for LHF prosthesis included deletion of the osteotomy of the greater trochanter in 12 of 16 joints with CFL, drilling of the femoral tunnel from a distal-to-proximal direction, deletion of a second femoral bone tunnel for suture placement, and use of a 2-hole polypropylene button to secure the LHF prosthetic suture. RESULTS: Mean age at time of injury, weight, and duration between injury and definitive surgery was 4.1 +/- 1.1 years, 19.7 +/- 2.8 kg, and 5.8 +/- 2.7 days, respectively. Weightbearing began 3.0 +/- 0.4 days after surgery. Mean postoperative follow-up period for dogs with maintained coxofemoral reduction of longer than 1 month (n = 13) was 19.5 +/- 6.1 months. Owners reported good or excellent clinical results, which were confirmed by semiquantitative assessment methods. Radiographic signs of degenerative joint disease were minimal. There was no significant difference between hind limbs when comparing mid-thigh limb circumference at the time of follow-up examination. CLINICAL IMPLICATIONS: A modified toggle pin procedure for LHF prosthesis can maintain coxofemoral reduction and allow early weightbearing in dogs with coxofemoral luxation as a component of multiple orthopedic injuries.

Accidents, Traffic↗
PubMed1997

Concomitant orthopedic and vascular injuries as predictors for limb loss in blunt lower extremity trauma.

Lower extremity trauma with concomitant orthopedic and vascular injury is associated with a high degree of limb loss. Despite successful arterial repair, many patients will ultimately require amputations. The effect of associated orthopedic injuries on limb loss in patients with lower extremity arterial injuries is investigated. From 1989 to 1994, 52 infrainguinal arterial injuries were identified among 365 vascular trauma patients. Clinical determinants were retrospectively assessed for the ability to predict postoperative amputations. Femoral artery injuries were present in 23 patients, with 53 per cent the result of blunt trauma. The incidence of lower extremity fractures was 53 per cent (60% open). Seventy-nine per cent of femoral artery injuries were repaired with saphenous vein grafts. Popliteal artery injuries were present in 13 patients, with 77 per cent the result of blunt trauma. The incidence of lower extremity fractures and posterior knee dislocations was 85 per cent (73% open) and 38 per cent, respectively. Ninety-two per cent of injuries were repaired with saphenous vein grafts. Tibial artery injuries were present in 16 patients, with 44 per cent the result of blunt trauma. The incidence of lower extremity fractures was 81 per cent (46% open). Twenty-five per cent of tibial artery injuries were treated with arterial repair, and 31 per cent with arterial ligation. Fourteen above-knee (AKA) and two below-knee amputations were performed. Amputation rates were 26.1 per cent (three AKAs) for femoral, 53.8 per cent (seven AKAs) for popliteal, and 38 per cent (four AKAs, two below-knee amputations) for tibial artery injuries. At the popliteal and femoral locations, greater than two long-bone fractures was predictive of amputation. For tibial arteries, one-vessel (n = 10), two-vessel (n = 3), and three-vessel (n = 3) injuries were associated with 20, 33, and 100 per cent amputations rates, respectively. Blunt injury, pulseless extremity, need for arterial repair (rather than ligation or no therapy), increasing number of injured tibial vessels, and multiple long-bone fractures were predictors of amputation (P < 0.05). Distal vascular injuries combined with complex orthopedic fractures are more likely to result in limb loss. Two or more long-bone fractures is predictive of amputation at all three locations.

Amputation, Surgical↗
PubMed1997

[Early functional treatment of a 5th metatarsal fracture using an orthopedic boot].

The fracture of the base of the fifth metatarsal bone is a common fracture of the foot. We differentiate avulsion fractures of the apophysis from meta-diaphysial of the Jones-Type. In the literature you find many different methods of treatment extending from simple immobilization through functional strapping to osteosynthesis of the fracture. Depending on the method of treatment the results are quite different especially in the period of immobilization and the period of sick-leave. From March 1988 to September 1991 52 patients of the orthopedic clinic Kantonsspital Liestal/Switzerland with a fracture of the base of their fifth metatarsal bone were treated functionally with a special orthopedic shoe and were studied prospectively. This treatment allowed them full weightbearing after approx. 9 days, the average time of sick-leave was 19 days. Longterm results showed no complications. The majority of patients (92%) were satisfied with this treatment. We consider the early functional treatment of a fracture of the base of the fifth metatarsal bone with an orthopedic boot as a reliable and cost effective treatment.

Adolescent↗
PubMed1997

[Orthopedic ward policy in introduction of new types of total hip implants].

The use of different types of total hip implants in medical centers in Israel was surveyed. Questionnaires were sent to all orthopedic ward directors in Israel requesting information on the number of total hip arthroplasties performed between the years 1984-1993, the types of implants used, and whether attending physicians or residents perform the operations. 22 of 24 orthopedic wards responded but 1 ward was excluded because only the results for 1993 were reported. 5 wards reported more and 16 fewer than 50 operations a year. 15 different types of implants were in use in Israel in that period, and in 5 wards 5 or more types of implants were used. Only 1 of the wards performed more than 50 operations a year. We conclude that the indiscriminate use of multiple technologies in wards performing few operations can lead to the long "learning curves" previously associated with poor results. Orthopedic surgeons should resist the impulse to introduce new implants, thus improving results and lowering expenditure. The need for regulating the introduction of new implants is emphasized.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

Surgical release of tethered spinal cord: survivorship analysis and orthopedic outcome.

Between January 1988 and February 1995, 133 tethered spinal cord-release procedures in 88 consecutive patients were performed at our institution and were used to determine survivorship data for surgical release of tethered spinal cord. The diagnoses included spinal dysraphism (67), achondroplasia (nine), isolated tethered cord (nine), cerebral palsy (three), and others (seven). Survivorship data were calculated for the initial and first-revision tethered cord release. There was a 50% revision rate by 5 years after initial tethered-cord release and a 57% revision rate by 2 years after a second release. Thirty-six patients were excluded for having <2 years of clinical follow-up, leaving 97 spinal cord releases in 52 patients available for outcome analysis. At a mean follow-up of 4.4 years (range, 2-11.3), 58% of patients required one or more orthopedic procedures after tethered-cord release. The average number of orthopedic procedures per year before release (0.28/year) was found to increase after initial release (0.39/year; p < 0.05). These data demonstrate the frequent need for operative revision after index tethered-cord release, especially in children with spinal dysraphism. In addition, the need for orthopedic procedures after tethered spinal-cord release frequently persists.

Adolescent↗
PubMed1999

A pilot study on computer-assisted optimal contouring of orthopedic fixation devices.

Bending and shaping of longitudinal orthopedic fixation devices like rods and plates is often a difficult and time-consuming process to perform during surgery under sterile conditions. This study presents a novel device for implant contouring and introduces two strategies to obtain parameters necessary for the bending process. The first strategy is based on surgical navigation techniques as established within the framework of computer-assisted orthopedic surgery. Geometrical landmarks, e.g., the location of pedicle screws in a case of posterior spinal fixation, are collected with a three-dimensional pointing device. Subsequently, the final shape of the implant and the associated contouring parameters are calculated. The alternative strategy utilizes a flexible material intended to be used intra-operatively to enable the optimal shape of the implant to be modeled by hand. Contour parameters are calculated from a depth image of this model obtained using an object scanner. Bending of spinal rod systems is used to illustrate both strategies. A newly designed semi-automatic bending machine is proposed to impose the computed deformation on the implant material once parameters are obtained. Integrating the bending device into a system for computer-assisted surgery allows for the interactive control of the contouring process.

Humans↗
PubMed2001

Virtual reality orthopedic surgery simulator.

This paper describes a highly interactive virtual reality orthopedic surgery simulator. The simulator allows surgeons to use various surgical instruments to operate on virtual rigid anatomic structures, such bones, prostheses and bone grafts, to simulate every procedure on the rigid structures for complex orthopedic surgeries, including arthroplasty, corrective or open osteotomy, open reduction of fractures and amputation. A comparative study of the simulator with paper simulation was performed and showed that interns and residents found the simulator to be a useful learning tool, and that visiting doctors could use it effectively for planning verification and rehearsal of operations.

Amputation, Surgical↗
PubMed1999

Future potentials for using osteogenic stem cells and biomaterials in orthopedics.

Ideal skeletal reconstruction depends on regeneration of normal tissues that result from initiation of progenitor cell activity. However, knowledge of the origins and phenotypic characteristics of these progenitors and the controlling factors that govern bone formation and remodeling to give a functional skeleton adequate for physiological needs is limited. Practical methods are currently being investigated to amplify in in vitro culture the appropriate autologous cells to aid skeletal healing and reconstruction. Recent advances in the fields of biomaterials, biomimetics, and tissue engineering have focused attention on the potentials for clinical application. Current cell therapy procedures include the use of tissue-cultured skin cells for treatment of burns and ulcers, and in orthopedics, the use of cultured cartilage cells for articular defects. As mimicry of natural tissues is the goal, a fuller understanding of the development, structures, and functions of normal tissues is necessary. Practically all tissues are capable of being repaired by tissue engineering principles. Basic requirements include a scaffold conducive to cell attachment and maintenance of cell function, together with a rich source of progenitor cells. In the latter respect, bone is a special case and there is a vast potential for regeneration from cells with stem cell characteristics. The development of osteoblasts, chondroblasts, adipoblasts, myoblasts, and fibroblasts results from colonies derived from such single cells. They may thus, theoretically, be useful for regeneration of all tissues that this variety of cells comprise: bone, cartilage, fat, muscle, tendons, and ligaments. Also relevant to tissue reconstruction is the field of genetic engineering, which as a principal step in gene therapy would be the introduction of a functional specific human DNA into cells of a patient with a genetic disease that affects mainly a particular tissue or organ. Such a situation is pertinent to osteogenesis imperfecta, for example, where in more severely affected individuals any improvements in long bone quality would be beneficial to the patient. In conclusion, the potentials for using osteogenic stem cells and biomaterials in orthopedics for skeletal healing is immense, and work in this area is likely to expand significantly in the future.

Animals↗
PubMed1985

Resorbable materials and composites. New concepts in orthopedic biomaterials.

For the last several decades, research in orthopedic biomaterials has remained focused on homogeneous plastics and metals. Initial research resulted in rapid improvements and a number of standardized materials emerged. With time, development of these materials has become a slower, more deliberate process. Recently, however, investigators have sought to broaden the scope of orthopedic biomaterials research. New materials systems are now under consideration. These systems include natural and synthetic resorbable polymerics and resorbable ceramics. A variety of composite materials are under primary investigation or in clinical trials. Our emerging understanding of these new materials is rapidly leading to new surgical applications not possible with conventional metals and plastics.

Animals↗
PubMed2000

Hepatitis C virus infection: knowledge in the orthopedic community.

A survey with 14 questions pertaining to the natural history, infectiveness, and diagnosis and treatment of hepatitis C viral infection was given to all practicing orthopedic surgeons in Portland, Maine. Possible responses were "true," "false," or "don't know" to the 14 statements. A question regarding any interest in learning more about the hepatitis C virus was also posed. Most (82%, 23/28) surgeons completed the questionnaire. A total of 72% of the responses were either wrong or marked "don't know"; most (83%) of the respondents wanted to know more about the infection about hepatitis C viral infection. Not only are orthopedic surgeons at risk for exposure to this virus, but also they are often the first to notify a patient of a positive result after routine hepatitis C testing of autologous predonated blood. Education programs and journal reviews should be directed toward this goal.

Clinical Competence↗
PubMed2000

[Bone allografts in orthopedic surgery: current concepts].

In the last decade, indications for bone allografting in orthopedic surgery have progressively increased, related to, on the one part, treatment of benign or malignant tumors, but, on another (major) part, to treatment of major bone defects due to loosening of hip or knee total prostheses. In France, legislation and control concerning donated human tissues, safety precautions, and the uses for human tissues have been greatly modified over the last few years. The authors describe the various obligations implicated by these activities and the consequences for tissue banks and surgeons; They describe different processes for bone inactivation and their action on allograft mechanical properties, or the biological capability for integration to the host bone. The authors then discuss different current techniques for bone stock reconstruction and the results in prosthetic or tumoral surgery, as well as their consequences on current surgical indications. In conclusion, they emphasize the optimal conditions for the success of allografts in orthopedic use: stability of the host bone-graft junction, vitality of the bone support, and a favourable mode of constraint of the graft, which have to be protected by osteosynthesis, but should not, however, miss partial bearing.

Bone Transplantation↗
PubMed2003

[Four years on a waiting lists for surgery--an expensive option. Millions in lost production while waiting for an orthopedic intervention].

This study was performed in order to determine the cost to society (in terms of loss of production) of having patients on paid sick-leave while on a waiting list for elective orthopedic surgery. All patients on surgical waiting lists receiving sick-leave benefits for the same diagnosis as for the planned procedure, specifically for lumbar disc herniation, lumbar spinal stenosis, and certain knee and shoulder diagnoses (not including arthritis), were identified at two large Swedish orthopedic clinics. These diagnoses were chosen since there is evidence that surgery can reduce pain and disability and also improve work ability. The number of days on sick-leave was determined individually as was each subject's reimbursement from universal health insurance. These benefits were treated as equal to the production losses caused by their inability to work according to the so-called Human Capital Method. 159 patients on the waiting lists were on sick-leave. The average waiting time varied between one and two years for the diagnoses included. Forty-four of the patients were granted temporary or permanent disability pensions while awaiting surgery. The costs for paid sick-leave together with future costs for those granted permanent disability pensions were almost 90 million SEK (almost 90 million USD). This amount corresponded to the cost of more than 2000 disc operations or more than 1000 total hip replacements. Instead of being spent on sick-leave this money ought to be used to shorten the waiting time for surgery.

Cost of Illness↗
PubMed2006

Damage-control orthopedics: evolution and practical applications.

Evaluation and management of patients who sustain blunt trauma with multiple injuries have changed significantly over the past 50 years. Initially, clinical research supported delayed definitive treatment of the orthopedic subset of injuries in these patients. With the advancement of splinting and fixation techniques, this view changed to one of "early total care." Current developments in classifying trauma patients at risk for deterioration (objective scoring scales) and understanding the posttraumatic immune response have allowed us to stratify patients' clinical severity and treat appropriately. The damage-control philosophy proposes early stabilization, resuscitation, and delayed definitive treatment for polytrauma patients with orthopedic injuries who are most at risk.

Craniocerebral Trauma↗
PubMed1993

Maxillary orthopedics.

Although there may never be uniformity of opinion on the use of maxillary orthopedic appliances or definitive data supporting their universal use in treatment regimens, they are an integral part of cleft lip and palate care. Many appliances, both active and passive, are used by teams of highly skilled specialists to normalize the congenital alveolar defect. The major difficulty in reaching a consensus among care providers is due to maxillary orthopedics being but one interventional aspect of a sequence of events in the habilitation effort. Cleft care begins in infancy and extends throughout the developmental years. The period of assessment of treatment regimens and outcomes extends almost over a researcher's lifetime. By placing the cleft structures in a more favorable oral configuration in concert with the oral environment, the greatest growth potential can be achieved.

Cleft Lip↗
PubMed2002

Fondaparinux vs enoxaparin for the prevention of venous thromboembolism in major orthopedic surgery: a meta-analysis of 4 randomized double-blind studies.

BACKGROUND: Orthopedic surgery remains a condition at high risk of venous thromboembolism (VTE). Fondaparinux, the first of a new class of synthetic selective factor Xa inhibitors, may further reduce this risk compared with currently available thromboprophylactic treatments. METHODS: A meta-analysis of 4 multicenter, randomized, double-blind trials in patients undergoing elective hip replacement, elective major knee surgery, and surgery for hip fracture (N = 7344) was performed to determine whether a subcutaneous 2.5-mg, once-daily regimen of fondaparinux sodium starting 6 hours after surgery was more effective and as safe as approved enoxaparin regimens in preventing VTE. The primary efficacy outcome was VTE up to day 11, defined as deep vein thrombosis detected by mandatory bilateral venography or documented symptomatic deep vein thrombosis or pulmonary embolism. The primary safety outcome was major bleeding. RESULTS: Fondaparinux significantly reduced the incidence of VTE by day 11 (182 [6.8%] of 2682 patients) compared with enoxaparin (371 [13.7%] of 2703 patients), with a common odds reduction of 55.2% (95% confidence interval, 45.8% to 63.1%; P<.001); this beneficial effect was consistent across all types of surgery and all subgroups. Although major bleeding occurred more frequently in the fondaparinux-treated group (P =.008), the incidence of clinically relevant bleeding (leading to death or reoperation or occurring in a critical organ) did not differ between groups. CONCLUSION: In patients undergoing orthopedic surgery, 2.5 mg of fondaparinux sodium once daily, starting 6 hours postoperatively, showed a major benefit over enoxaparin, achieving an overall risk reduction of VTE greater than 50% without increasing the risk of clinically relevant bleeding.

Aged↗
PubMed1999

The perioperative complication rate of orthopedic surgery in sickle cell disease: report of the National Sickle Cell Surgery Study Group.

Orthopedic disease affects the majority of sickle cell anemia patients of which aseptic necrosis of the hip is the most common, occurring in up to 50% of patients. We conducted a multicentered study to determine the perioperative complications among sickle cell patients assigned to different transfusion regimens prior to orthopedic procedures: 118 patients underwent 138 surgeries. The overall serious complication rate was 67%. The most common of these were excessive intraoperative blood loss, defined as in excess of 10% of blood volume. The next most common complication was sickle cell-related events (acute chest syndrome or vaso-occlusive crisis), which occurred in 17% of cases. While preoperative transfusion group assignment did not predict overall complication rates, higher risk procedures were associated with significantly higher rates of overall complications. Transfusion complications were experienced by 12% of the patients. Two patients died following surgery. Both deaths were associated with an acute pulmonary event. The 52 patients undergoing hip replacements experienced the highest rate of complications with excessive intraoperative blood loss occurring in the majority of patients. Sickle cell-related events occurred in 19% of patients, and surgical complications occurred after 15% of hip replacements and included postoperative hemorrhage, dislocated prosthesis, wound abscess, and rupture of the femoral prosthesis. There were twenty-two hip coring procedures. Acute chest syndrome occurred in 14% of the patients. Overall, decompression coring was a safer, shorter operation. A randomized prospective trial to determine the perioperative and long-term efficacy of core decompression for avascular necrosis of the hip in sickle cell disease is needed. In conclusion, this study demonstrates a high rate of perioperative complications despite compliance with sickle cell perioperative care guidelines. Pulmonary complications and transfusion reactions were common. This study supports the results previously published by the National Preoperative Transfusion in Sickle Cell Disease Group. These results stated that a conservative preoperative transfusion regimen to bring hemoglobin concentration to between 9 and 11 g/dl was as effective as an aggressive transfusion regimen in which the hemoglobin S level was lowered to 30%.

Adolescent↗
PubMed1996

Controlled release of antibiotics from coated orthopedic implants.

Chronic osteomyelitis is one of the most serious complications of orthopedic open fracture treatment. The objective of this study was to develop a biodegradable implant coating with impregnated antibiotics as an adjunct to current therapy. We used a polylactic-co-glycolic acid copolymer (PLGA) as the biodegradable carrier and gentamicin as the antibiotic. Our objectives were to establish elution characteristics of the antibiotic from the polymer, and determine if the coated orthopedic implants would inhibit bacterial growth in vitro. In the elution study, coated implants were incubated in phosphate buffered saline (PBS) at 37 degrees C and sampled daily for gentamicin levels. The in vitro model consisted of test tubes containing Mueller-Hinton culture broth inoculated with 5 x 10(6) cfu of Staphylococcus aureus and incubated at 37 degrees C. The implants were switched to a new set of inoculated tubes each day. Tubes were sampled for colony counting to determine bactericidal effects. Implant coatings consisted of 40 mg of gentamicin as a 20% mixture with PLGA. The elution curve showed an average level of 138 micrograms/mL over 15 days. This local concentration would be more than adequate to kill susceptible organisms. The in vitro study showed a significant reduction in bacterial growth in the test tubes containing coated implants. Control tubes averaged 2.5 x 10(8) cfu/mL of S.aureus over 24 days. Coated implant tubes averaged 0.9 cfu/mL. This was a reduction of greater than 99.999% (p < 0.0001). This study showed that a thin biodegradable implant coating can be developed with bactericidal activity against the organisms frequently associated with osteomyelitis in cases of open fractures.

Anti-Bacterial Agents↗