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 577 records · Page 32Linked to original sources
PubMed1983

A preliminary analysis of accreditation criteria for surgical procedures by orthopedic residents.

The study reported here represented a preliminary evaluation of the accreditation criteria for orthopedic operative procedures. Because selection of the criteria has not been guided by empirical data, the extent to which they accurately reflect resident clinical experience is of concern. To examine this question, residents in an orthopedic residency program were tracked for one year, and their activities were compared with the procedure requirements established by the Residency Review Committee (RRC) for Orthopaedic Surgery. The results indicated that the RRC categories unduly emphasized activities for which there was little patient demand and failed to distinguish or require some frequently performed procedures. In their present form, therefore, the designated categories were not found to cover adequately the content of current clinical practice and thus may not appropriately reflect educational needs.

Accreditation↗
PubMed1983

Radiographic workload and use factors for orthopedic facilities.

Observations of technique factors at 9 radiographic installations dedicated to orthopedic radiography have been made. Monthly area radiation measurements with thermoluminescent dosimeters were made at three of these facilities. The results of these observations and measurements suggest that current NCRP recommended assumptions utilized in protective barrier computations result in considerably more shielding than is necessary. We observed an average workload of 224 mA min/wk and a maximum weekly average of 670 mA min/wk. The use factor for the chest wall averaged 5%. That for all other vertical barriers was less than 1%. The average operating potential was 75 kVp. Room radiation measurements confirm the suggestion that at least two of the walls and the control booth barrier in an orthopedic radiographic facility may be considered secondary barriers.

Ambulatory Care Facilities↗
PubMedDate not supplied

Evaluation of CT techniques for reducing artifacts in the presence of metallic orthopedic implants.

Metallic intramedullary orthopedic implants generate artifacts that can markedly degrade transaxial CT images. The artifacts, typically seen as starburst streaking, result primarily from reconstructions involving missing projection data. Two approaches are clinically available to reduce the artifacts around orthopedic implants. These are (a) the imaging of implants with lower attenuation coefficients or smaller path lengths (less attenuating objects) and (b) the planar reformatting of image data. The sizing accuracy of these two approaches was quantified using phantoms and the efficacy using cadaveric femoral specimens. Results demonstrated that metal artifacts may be reduced and accurate bony dimensional data obtained.

Evaluation Studies as Topic↗
PubMed2006

Bacterial adherence to tantalum versus commonly used orthopedic metallic implant materials.

OBJECTIVES: Evaluation of bacterial adhesion to pure tantalum and tantalum-coated stainless steel versus commercially pure titanium, titanium alloy (Ti-6Al-4V), and grit-blasted and polished stainless steel. DESIGN: Experimental in vitro cell culture study using Staphylococcus aureus and Staphylococcus epidermidis to evaluate qualitatively and quantitatively bacterial adherence to metallic implants. METHODS: A bacterial adhesion assay was performed by culturing S. aureus (ATCC 6538) and S. epidermidis (clinical isolate) for one hour with tantalum, tantalum-coated stainless steel, titanium, titanium alloy, grit-blasted and polished stainless steel metallic implant discs. Adhered living and dead bacteria were stained using a 2-color fluorescence assay. Adherence was then quantitatively evaluated by fluorescence microscopy and digital image processing. Qualitative adherence of the bacteria was analyzed with a scanning electron microscope. The quantitative data were related to the implant surface roughness (Pa-value) as measured by confocal laser scanning microscopy. RESULTS: Bacterial adherence of S. aureus varied significantly (p = 0.0035) with the type of metallic implant. Pure tantalum presented with significantly (p < 0.05) lower S. aureus adhesion compared to titanium alloy, polished stainless steel, and tantalum-coated stainless steel. Furthermore, pure tantalum had a lower, though not significantly, adhesion than commercially pure titanium and grit-blasted stainless steel. Additionally, there was a significantly higher S. aureus adherence to titanium alloy than to commercially pure titanium (p = 0.014). S. epidermidis adherence was not significantly different among the tested materials. There was no statistically significant correlation between bacterial adherence and surface roughness of the tested implants. CONCLUSIONS: Pure tantalum presents with a lower or similar S. aureus and S. epidermidis adhesion when compared with commonly used materials in orthopedic implants. CLINICAL IMPLICATION: Because bacterial adhesion is an important predisposing factor in the development of clinical implant infection, tantalum may offer benefits as an adjunct or alternative material compared with current materials commonly used for orthopedic implants.

Alloys↗
PubMed2004

Preparticipation orthopedic screening evaluation.

OBJECTIVE: To review evidence-based support for the preparticipation orthopedic evaluation. DATA SOURCES/METHODS: Articles were reviewed that dealt with the sensitivity, specificity, and predictive value of the components of the standardized preparticipation orthopedic evaluation. In addition, studies describing musculoskeletal conditions/findings predictive of future injuries were sought through a PubMed search. RESULTS: The sensitivity of the evaluation questionnaire appears to be adequate, exceeding 90% in some studies. There is little or no published information documenting that the physical examination (1) approaches the questionnaire in either sensitivity or specificity or (2) identifies elements of value based on their association with future injuries or reinjuries. There are no readily discernible elements even in an expanded examination that are documented as being predictive of future problems. CONCLUSIONS: The current questionnaire and examination appear to fulfill adequately both legal and institutional requirements. Practitioners should be aware of the absence of data linking virtually any of the findings on the examination to either an increase or a decrease in the likelihood of future injuries. There is no evidence that increasing the scope of the examination would enhance its predictive value.

Evidence-Based Medicine↗
PubMed2004

Computer-aided multimedia training in orthopedic rehabilitation.

OBJECTIVE: To compare a computer-aided training program with a conventional training program in orthopedic rehabilitation. DESIGN: The study was a randomized, nonblinded, controlled trial in which follow-up data were obtained at 6 mos. In an inpatient rehabilitation center, a consecutive sample was taken of patients with first total hip replacements or first total knee replacements 23-42 days after surgery. Indication groups were examined separately. The study population included 189 women and 85 men. Mean age was 69 yrs (38-86 yrs). Patients received either computer-aided training (case group) or conventional training (control group) within the framework of their inpatient rehabilitation program. The main outcome measures were levels of acceptance and effectiveness (Harris Hip Score, Hospital for Special Surgery Score, FIM instrument, and Hanover Functional Ability Questionnaire). RESULTS: Both forms of training showed significant improvements until discharge in scores and items used for the result evaluation independent of patient sex, age, and educational level. The 6-mo follow-up showed that between the groups, there was no statistically significant difference in the level of improvement concerning functional capacity. Furthermore, patients displayed their acceptance of the system by rating it with average values between "good" and "very good." CONCLUSIONS: For patients with total hip replacements or total knee replacements, computer-aided training can be regarded as the equivalent to conventional training in relationship to the results of the rehabilitation program. The system is a new tool in orthopedic rehabilitation. To identify the relative importance of the system, further research is needed.

Adult↗
PubMed1981

Use of computed axial tomography in pediatric orthopedics.

The use of the computed tomography has been rapidly expanding in the 7 years it has been clinically available, and there is no doubt that this modality will have an important role in the assessment of many pediatric orthopedic problems. Computed tomography now provides previously unavailable information in cases of tumors, infections, and fractures of the axial skeleton, pelvis, and hips. With the faster scan times, better density and two-point resolution of the newer generation scanners, computed tomography will be useful in other isolated cases and in more situations, but still may not gain wide applicability in pediatric orthopedics.

Adolescent↗
PubMedDate not supplied

Clinical assessment of hip instability in the newborn by an orthopedic surgeon and a pediatrician.

The aim of this study was to improve the rate of detection of hip instability in the neonate. Over a period of 3 years, a pediatric orthopedic surgeon and a neonatal pediatrician both examined 12,891 neonates. During the fourth year, 5,087 newborns were examined by a pediatrician only. Each examiner, working independently, found that 51 babies had neonatal hip instability. In an additional 25 babies, one examiner failed to detect this instability on initial examination. Finally, 36 babies judged to have stable hips at birth later gave cause for orthopedic treatment. These findings strongly suggest that screening should not be restricted to the neonate but should involve several sequential examinations.

Female↗
PubMed2007

Efficacy of warfarin reversal in orthopedic trauma surgery patients.

OBJECTIVES: We determine the efficacy of active reversal of warfarin anticoagulation with intravenous vitamin K compared to withholding warfarin in patients requiring urgent orthopedic trauma surgery. DESIGN: This was a prospective cohort with immediate prehypothesis consecutive retrospective comparative case series conducted at a level 1 university hospital trauma unit. PATIENTS: Forty-eight consecutive patients between 1998 and 2004 in a study composed of a prospective cohort were compared with a retrospective consecutive case series of warfarinized orthopedic trauma patients requiring urgent surgery. The prospective arm directly followed the historic case series from which the hypothesis was generated. INTERVENTION: Vitamin K administration. MAIN OUTCOME MEASURES: Primary outcome was time to surgery. Secondary outcomes were problems with active reversal, length of time for warfarin stabilization after surgery, and complications. RESULTS: The mean time to surgery in warfarinized patients not given vitamin K was 111.9 hours; in the intervention group, it was 67.4 hours, giving a mean difference of 44.5 hours (P = 0.01). Vitamin K reduced the international normalized ratio (INR) to less than 2.0 in 74% of patients within 24 hours. There were no complications of vitamin K administration. A dose of vitamin K costs approximately 1/1000 of a hospital bed day cost. A loading dose of warfarin on the second postoperative day took approximately 1 day longer to reach an INR of greater than 2.0 in the intervention patients than in those who had not been given vitamin K. CONCLUSIONS: Warfarin reversal with vitamin K was successful and facilitated earlier surgery in all patients; the first dose was effective in approximately three quarters of patients. It is cost-effective, with no side effects caused in this study.

Administration, Oral↗
PubMed1998

Efficacy of propacetamol in the treatment of postoperative pain. Morphine-sparing effect in orthopedic surgery. Italian Collaborative Group on Propacetamol.

BACKGROUND: Combined analgesic regimens have been suggested to improve the treatment of postoperative pain. The aim of our study was to evaluate the analgesic efficacy and tolerability of propacetamol, in combination with morphine. METHODS: Four i.v. infusions of propacetamol 2 g or placebo were administered, in a double-blind fashion, after orthopedic surgery (n = 97). Morphine was administered by a patient-controlled analgesia (PCA) device. The total dose of morphine, pain intensity and global efficacy of treatment were evaluated. Tolerability was assessed by monitoring blood pressure, heart and respiratory rate, sedation scores, adverse events, and renal and hepatic parameters. RESULTS: The total dose of morphine was significantly decreased in the propacetamol group compared to placebo (9.4 +/- 8.5 mg vs 17.6 +/- 12 mg; P < 0.001), arriving at a sparing effect of 46%. The evolution of pain intensity showed a similar pattern in the two groups. Global efficacy of treatment was rated significantly better by patients receiving the combination propacetamol + PCA morphine (87% of "good"/"excellent" ratings vs 65%; P = 0.01). Tolerability was comparable in the two groups. Eight patients in the propacetamol and 4 patients in the placebo group reported adverse events, of mild/moderate intensity, most commonly nausea/vomiting. Renal and hepatic parameters were also seen to be comparable. CONCLUSION: These results confirm a significant morphine-sparing effect, significantly better scores in the final assessment by patients, and a good tolerability of propacetamol after orthopedic surgery. The drug may, therefore, represent a useful alternative to NSAIDs, as complementary drug to opioids, in the management of moderate/severe postoperative pain.

Acetaminophen↗
PubMed2005

Epidemiology of venous thromboembolism in Asian patients undergoing major orthopedic surgery without thromboprophylaxis. The SMART study.

BACKGROUND: In Asian patients undergoing surgery, the incidence of venous thromboembolism (VTE) is thought to be low relative to Western patients, and the routine use of thromboprophylaxis is controversial. OBJECTIVES: The aim of this work was to study the epidemiology of VTE in Asian patients undergoing orthopedic surgery without thromboprophylaxis. PATIENTS AND METHODS: We performed a prospective observational study of a cohort of consecutive Asian patients hospitalized for total hip or knee replacement or hip fracture surgery without thromboprophylaxis. The primary study outcome was the incidence of the composite of symptomatic VTE or sudden death at hospital discharge. This outcome was also assessed at 1 month's follow-up. RESULTS: Between April 2001 and July 2002, 2420 patients were enrolled. Median age was 68 years and the median duration of hospital stay was 13 days. The rate of symptomatic VTE or sudden death as notified by investigators was 2.3%[55 patients, 99% confidence interval (CI) 1.6, 3.2] and 1.2% (28 patients, 99% CI 0.7, 1.8) after adjudication by an independent committee. Chronic heart failure, varicose veins and a history of VTE were independent risk factors (P < 0.05) for the occurrence of the primary endpoint. At 1 month's follow-up, the incidence of adjudicated symptomatic VTE or sudden death was 1.5% (35/2264 patients). CONCLUSION: In Asian patients, the incidence of symptomatic VTE after major orthopedic surgery is not low, consistent with the rates observed in Western countries. The use of thromboprophylaxis should be considered in Asian patients undergoing such high-risk surgical procedures.

Aged↗
PubMed2005

Physical characteristics of a low-dose gas microstrip detector for orthopedic x-ray imaging.

A new scanning slit gas detector dedicated to orthopedic x-ray imaging is presented and evaluated in terms of its fundamental imaging characteristics. The system is based on the micromesh gaseous structure detector and achieves primary signal amplification through electronic avalanche in the gas. This feature, together with high quantum detection efficiency and fan-beam geometry, allows for imaging at low radiation levels. The system is composed of 1764 channels spanning a width of 44.8 cm and is capable of imaging an entire patient at speeds of up to 15 cm/s. The resolution was found to be anisotropic and significantly affected by the beam quality in the horizontal direction, but otherwise sufficient for orthopedic studies. As a consequence of line-by-line acquisition, the images contain some ripple components due to mechanical vibrations combined with variations in the x-ray tube output power. The reported detective quantum efficiency (DQE) values are relatively low (0.14 to 0.20 at 0.5 mm(-1)) as a consequence of a suboptimal collimation geometry. The DQE values were found to be unaffected by the exposure down to 7 microGy, suggesting that the system is quantum limited even for low radiation levels. A system composed of two orthogonal detectors is already in use and can produce dual-view full body scans at low doses. This device could contribute to reduce the risk of radiation induced cancer in sensitive clientele undergoing intensive x-ray procedures, like young scoliotic women.

Calibration↗
PubMed1999

Tissue engineering: orthopedic applications.

Because of an aging population and increased occurrence of sports-related injuries, musculoskeletal disorders have become one of the major health concerns in the United States. Current treatments, although fairly successful, do not provide the optimum therapy. These treatments typically rely on donor tissues obtained either from the patient or from another source. The former raises the issue of supply, whereas the latter poses the risk of rejection and disease transfer. This has prompted orthopedic surgeons and scientists to look for viable alternatives. In recent years, tissue engineering has gained increasing support as a method to treat orthopedic disorders. Because it uses principles of engineering, biology, and chemistry, tissue engineering may provide a more effective approach to the treatment of musculoskeletal disorders than traditional methods. This chapter presents a review of current methods and new tissue-engineering techniques for the treatment of disorders affecting bone, ligament, and cartilage.

Animals↗
PubMed1979

99mTc-PP and 67Ga imaging following insertion of orthopedic devices.

Deposition of 67Ga in bone does not explicitly imply osteomyelitis. Osteomyelitis complicating insertion of orthopedic devices is manifested by lack of congruence in the distribution patterns of 99mTc-PP and 67Ga. Congruent patterns can reflect the increased bone reaction to implantation or loosening of the device, not necessarily osteomyelitis. Both (a) nonseptic synovitis secondary to reactive bursa formation and (b) cellulitis exhibit an affinity for 67Ga and virtually none for 99mTc-PP, whereas the reverse is true for heterotopic bone. Thus combined sequential 99mTc-PP/67Ga imaging is necessary for evaluation of complications associated with internal orthopedic devices.

Adult↗
PubMed2005

Orthopedic hardware complications diagnosed with multi-detector row CT.

PURPOSE: To retrospectively evaluate multi-detector row computed tomography (CT) for the depiction of orthopedic hardware complications in the spine and appendicular skeleton. MATERIALS AND METHODS: This HIPAA-compliant study had institutional review board approval; patient informed consent was not required. Results of 114 multi-detector row CT studies performed because of possible hardware complications in 109 patients (57 men, 52 women; mean age, 44 years; age range, 12-82 years) were available for analysis. The CT studies were retrospectively reviewed and compared with clinical or surgical outcomes, which were used as the reference standard. In another experiment, detection of hardware complications on radiographs and multi-detector row CT images was compared between two readers for selected cases (18 positive and 26 negative) by using receiver operating characteristic (ROC) methods. RESULTS: For 91 (80%) of 114 multi-detector row CT studies, the complication status could be determined on the basis of clinical or surgical outcomes. Twenty-three multi-detector row CT studies were confirmed to be positive (revealing 10 cases of nonunion, five cases of hardware malplacement, three cases of hardware loosening, three perihardware fractures, and two chronic infections), and 57 were confirmed to be negative. There were three false-positive and eight false-negative multi-detector row CT studies. With clinical or surgical outcomes as the reference standard, the sensitivity, specificity, and positive and negative predictive values of multi-detector row CT were 74% (23 of 31 studies), 95% (57 of 60 studies), 88% (23 of 26 studies), and 88% (57 of 65 studies), respectively. Results of ROC analysis indicated that detection of hardware complications was much lower with radiography than with multi-detector row CT (area under ROC curve, 0.84 vs 1.00; F = 4.69, df = 1, 43; P < .05). CONCLUSION: Multi-detector row CT is an effective tool for depicting orthopedic hardware complications.

Adolescent↗
PubMedDate not supplied

Modulation of C4b-binding protein isoforms during the acute phase response caused by orthopedic surgery.

Orthopedic surgery is described as an event with a high risk of thromboembolic diseases. This is probably a consequence of a synergistic combination of different risk factors in the patients subjected to this type of surgery, including age, immobilization, anesthesia and different hypercoagulable states. After surgery patients develop an acute-phase response that leads to changes in several plasma proteins. One of these proteins is the complement regulator C4b-binding protein (C4BP). We have recently shown that in some acute-phase patients C4BP is incorrectly controlled (with elevation of the C4BP beta-containing isoforms), leading to a potential hypercoagulable state by decreasing the plasma levels of free (active) protein S. Here we have studied whether patients subjected to orthopedic surgery have an appropriate modulation of the C4BP isoforms during their postoperative acute-phase responses. We have analyzed the evolution of the C4BP isoforms in serial samples from 11 patients who have undergone knee (or hip) prosthesis surgery (mean age 70 years), or scoliosis surgery (mean age 18 years). Our data suggest a similar evolution of C4BP isoforms in all these patients, with an almost exclusive increase of C4BP isoforms lacking C4BP beta polypeptides and steady levels of free protein S.

Acute-Phase Reaction↗
PubMed1993

Perceptions of practice problems encountered by family physicians, pediatricians, and orthopedic surgeons.

Information about physicians' practice problems was solicited through a structured questionnaire mailed to a group of family physicians, pediatricians, and orthopedic surgeons. Overall, a lack of personal time was the major concern across the three groups of physicians. Comparisons among the three types of physicians revealed two patterns: Family physicians reported more concerns in the "interpersonal" dimension, whereas orthopedic surgeons had more concerns in the "legal-economic" dimension. These patterns of differences persisted with two variables controlled: gender and time period in which they completed their residency program. These findings indicate that physicians' concerns in their practice vary among the specialties, and they imply that the changed economy and reimbursement system might have more impact on one than the other. Thus the effectiveness of residency training and continuing education might be improved by emphasizing the specialty-related problems in practice.

Attitude of Health Personnel↗
PubMed2006

Automated ribotyping to distinguish the different non Sau/ non Sep staphylococcal emerging pathogens in orthopedic implant infections.

Several species belonging to Staphylococcus genus, other than Staphylococcus aureus and Staphylococcus epidermidis (non Sau/ non Sep species), exhibit increasing abilities as opportunistic pathogens in the colonisation of periprosthetic tissues. Consequently, the availability of means for accurate identification is crucial to assess the pathogenic characteristics and to clarify clinical relevance of the individual species. Here, 146 clinical staphylococcal isolates belonging to non Sau/ non Sep species from prosthesis-associated orthopedic infections were analyzed by conventional enzymatic galleries and by automated ribotyping. Twelve different species were recognised: S. capitis, S. caprae, S. cohnii, S. equorum, S. haemolyticus, S. hominis, S. lugdunensis, S. pasteuri, S. sciuri, S. simulans, S. warneri, S. xylosus. Ribotype identifications were compared with the phenotypes obtained by the Api 20 Staph system and/or ID 32 Staph system. ID 32 Staph profiles were more consistent with ribotyping results than Api Staph profiles. Across the different staphylococcal species investigated, correct identifications with Api Staph were 45%, while with ID 32 Staph they were 59%. It has, however, to be mentioned that ID 32 Staph was mostly applied to discriminate unmatched ribotyping and Api Staph identifications, thus to a subpopulation of strains with ""atypical"" metabolic profile. Automated ribotyping provided a correct identification for 91% of the isolates. These results confirm automated ribotyping as a convenient rapid technique, still subject to improvements, which will accurately and rapidly recognise the newly emerging staphylococcal pathogens in implant-related orthopedic infections.

Automation↗