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PubMed1999

No influence of large volume blood loss on serum vancomycin concentrations during orthopedic procedures.

We prospectively studied orthopedic patients with either large or small blood loss who also received vancomycin prophylaxis to determine the effect of intraoperative volume shifts on serum vancomycin concentrations. There were 6 index patients in the large blood loss group (greater than 2 L), and 7 in the control group (less than 2 L). Mean estimated blood loss for index and controls was 4.4 L and 1.0 L, respectively. Mean intraoperative fluid resuscitation, excluding blood products, was 12.4 L and 5.1 L, respectively. There was a modest inverse correlation between blood loss and intraoperative serum half-life of vancomycin. Although controls maintained slightly higher intraoperative vancomycin concentrations at each time-point, there was no statistically significant difference between the groups with regard to absolute concentrations or rate of decline. After 8 hours, the serum vancomycin concentration exceeded the MIC-90 for Staphylococcus aureus by approximately eightfold in all but one case patient. This was a morbidly obese patient with massive blood loss. Thus, blood loss during orthopedic procedures has minimal effects on intraoperative kinetics of vancomycin. Redosing is rarely indicated, although a preoperative 1.5 gram-dose should be considered for patients weighing more than 90 kg.

Adult↗

PubMed2003

Detection of ear acupuncture points by measuring the electrical skin resistance in patients before, during and after orthopedic surgery performed under general anesthesia.

The aim was to study the detection of ear acupuncture points (EAP) by measuring the electrical skin resistance under general anesthesia. EAP with lower skin resistance were examined in 25 patients scheduled for elective orthopedic surgery on the day before, during the operative procedure and a few hours after it. EAP, detected in more than 25% of patients were further analyzed using a logistic regression model and compared to those in 15 healthy volunteers. The following EAP were identified in more than 50% of patients: Clavicle, Lung, Shenmen and points corresponding to the site of surgery. Point Clavicle was found in 16 patients (64%) throughout the study period. Shenmen was detected in 15 patients (60%) before surgery, whereas during and after surgery it was represented in 5 (20%) of them. EAP corresponding to the site of surgery were detected in 20 patients (80%) during the operative procedure. These EAP were detected more frequently in patients in comparison with healthy volunteers. The side of examination showed no significant differences throughout the study. The frequently found patterns of EAP with lower skin resistance in patients during orthopedic surgery can be useful for treatment of preoperative anxiety and postoperative pain relief.

Acupuncture Points↗

PubMed1986

The role of the microsurgical laboratory in orthopedic training programs.

A well-organized, efficiently run microsurgical research and training laboratory can be a valuable asset to an orthopedic training program. The three areas in which the laboratory can lend support are teaching, research, and clinical. Organization and utilization of the laboratory as a multifunctional facility can enable it to provide maximum support for the microsurgical aspects of the orthopedic training program.

Humans↗

PubMed1986

The efficacy of intraoperative autologous transfusion in major orthopedic surgery: a regression analysis.

Perioperative blood loss associated with 89 cases of major orthopedic surgery was compared with that of a control group of 89 to determine the effectiveness of intraoperative autologous transfusion. Volume of banked blood transfused and hematocrit change were used to determine total blood loss. The orthopedic cases consisted of cemented "virgin" total hip replacement, cemented virgin tricompartmental knee replacement, and spine fusion. Use of an autotransfusion device (Cell Saver) intraoperatively was associated with significantly smaller volumes of transfused banked blood and significantly smaller hematocrit drops in the groups of patients who underwent total hip replacement or spine fusion, but not in the group of patients who underwent total knee replacement. One potential source of bias in the study stems from the fact that four days were allotted for equilibrium from perioperative blood loss in the hip and knee replacement groups, while, for reasons of data availability, equilibrium time in the spine fusion groups was two days.

Adult↗

PubMed1991

Integrating computers into orthopedic research.

The role of computers in orthopedic research and education is expanding rapidly. Its potential to manipulate large amounts of data and execute multiple complex assignments with great speed and accuracy indeed make the computer an awe-inspiring device. An important instrument in research is the computerized database, a collection of related data arranged so that useful information may be retrieved. Computer models derived from classical physics and fluid mechanics have been used to study motion of both extremities and spinal articulations. Computers also have found usefulness in clinical orthopedic research. The orthopedist of the future will use the computer directly in clinics and private practice for patient evaluation, computer-assisted preoperative planning, and financial recordkeeping.

Biomechanical Phenomena↗

PubMed1992

Orthopedic experience in a MASH unit in postwar Iraq.

The orthopedic experience of a U.S. Army MASH unit deployed in southern Iraq is discussed. Seventy major casualties were surgically treated in a short time span. A high percentage of extremity trauma was observed (69%). Many patients had multiple extremity involvement. The emergency wartime surgical treatment of four specific types of trauma is explored. A new algorithm is presented for the rapid evaluation of penetrating joint injuries. We summarize the current concepts of war surgery as they apply to orthopedic injuries, and add specific observations from this experience.

Hospitals, Military↗

PubMed1993

Use of lasers in orthopedic surgery: current concepts.

A surgical laser is a new, multipurpose tool that can cut, coagulate, and vaporize tissues. It utilizes a low profile handpiece that allows easy access to tight places and small joints. The holmium laser at 2.1 microns wavelength is gaining wide acceptance among orthopedic surgeons as a useful arthroscopic surgical tool. It has a minimal amount of thermal necrosis and is able to cut and ablate tissues with great ease. Current investigation with laser tissue--agglutination and tissue welding--may make it possible to repair torn tissues with laser energy. The future will bring minimally invasive and minimally damaging laser orthopedic surgery.

Arthroscopy↗

PubMed1996

Noise levels of orthopedic instruments and their potential health risks.

Exposure to intense levels of noise has been identified as a potential workplace risk for the development of hearing impairment for health care workers. With this knowledge a noise level survey was performed on selected orthopedic equipment. Several instruments produced threshold levels of 95 dBA to 106 dBA. Often these levels remained as high as 90 dBA at 4 ft from the source. Based on the results of this survey, audiometric tests were conducted on five cast technicians to determine the prevalence of noise-induced hearing loss (NIHL). Audiometric measurements of the cast technicians indicated that, in the absence of other risk factors for hearing loss, there was an association between the presence of NIHL and the years of exposure. NIHL was most evident on the side of the dominant hand used for holding the cast cutter. These findings suggest there may be a risk of NIHL from the occupational exposure to various orthopedic instruments. Further, this level of risk may warrant the use of an individual hearing protection device or the development of quieter instruments.

Adult↗

PubMed1996

Orthopedic surgery residents and the CDC and AAOS HIV precautionary measures.

A randomized national survey of orthopedic surgery residents concerning their knowledge, attitudes, and behaviors of the Centers for Disease Control's and the American Academy of Orthopaedic Surgeons' (AAOS) universal human immunodeficiency virus (HIV) precautionary measures was conducted. The residents' basic knowledge about the HIV precautionary measures was, in general, poor. Thirty-seven percent indicated that they were "uncertain" or "would not" care for HIV positive patients. Further, the residents' practice behaviors in many instances did not fulfill prescribed universal precautions. Sound educational and professional programs, such as those initiated by the AAOS, are needed to increase the knowledge and improve the practice behaviors of orthopedic residents.

Adult↗

PubMed2001

Evaluation of knee consultations to a referral-only orthopedic clinic in a managed care system.

One hundred sixty-five knee consultations to a referral-only orthopedic service over a 2-year period were reviewed to document the gatekeeper diagnosis and initial treatment plan. These data were compared to the orthopedic evaluation. The majority of gatekeeper referral diagnoses were nonspecific or inaccurate. Several misdiagnoses resulted in prolonged patient recovery (delayed quadriceps tendon repair) and reinjury (recurrent instability of unrecognized anterior cruciate ligament-deficient knees). These findings suggest the gatekeeper model may be inadequate to appropriately manage knee disorders.

Adolescent↗

PubMed2004

A direct antifibrinolytic agent in major orthopedic surgery.

Aprotinin is a potent pharmacological agent that reduces bleeding. In current surgical practices, the rate of blood transfusions has decreased with the use of aprotinin. Recently, studies using aprotinin have been conducted in orthopedic surgery. Several trials have been performed in patients undergoing total hip replacement and total knee replacement. Aprotinin moderately decreased blood loss in these patients. When aprotinin was used in patients with a high-risk of bleeding (ie, patients with cancer, sepsis, or undergoing reoperation), potent hemostatic activity occurred and the rate of blood transfusions significantly decreased. No increase in deep vein thrombosis and pulmonary embolism was observed. One adverse effect was the potential occurrence of an anaphylactoid reaction. Prophylactic administration of aprotinin should be considered in extensive spine surgery and in high-risk orthopedic operations. The decision to use aprotinin can be guided by a risk/benefit analysis.

Antifibrinolytic Agents↗

PubMed2006

Microbial colonization of tourniquets used in orthopedic surgery.

This study analyzed tourniquets used for orthopedic surgery in our hospital to determine the frequency and type of microbial contamination. Group A tourniquets were from our main operating room, Group B tourniquets were from our ambulatory surgicenter, Group C tourniquets were unused, prepackaged, sterile tourniquets from our main operating room, and Group D tourniquets were sterilely packed tourniquets from our ambulatory surgicenter. Tourniquets from Groups A, B, C, and D had 100%, 40%, 0%, and 0% microbial growth, respectively. For Group A tourniquets, coagulase-negative staphylococci, Bacillus, and Staphylococcus aureus were present in 100%, 60%, and 20% of tourniquets, respectively. Twenty percent were contaminated either with Streptococcus sanguis, Aerococcus viridans, or Cornyebacterium species. Coagulase-negative staphylococci and Bacillus were present in 40% and 30% of Group B tourniquets, respectively. Tourniquet contamination may be a risk factor for the development of surgical site infection in orthopedic surgery.

Equipment Contamination↗

PubMed2006

Multidisciplinary management of orthopedic patients with sickle cell disease.

With pharmacological treatment, the lifespan of the patient with sickle cell disease can be extended to the sixth decade. Currently the only curative therapy for sickle cell disease is hemopoietic cell transplantation, which is still undergoing technical refinement. Most patients can be expected to undergo at least one orthopedic surgical procedure in their lifetime. Multidisciplinary management of orthopedic patients with sickle cell disease will decrease the overall complication rates and improve clinical outcomes.

Anemia, Sickle Cell↗

PubMedDate not supplied

A comparison of transdermal fentanyl versus epidural morphine for analgesia in dogs undergoing major orthopedic surgery.

Postoperative analgesia provided by transdermal fentanyl was compared with that provided by epidural morphine in dogs undergoing major orthopedic surgery. Dogs randomly were assigned to receive either a 100 microg per hour transdermal fentanyl patch 24 hours prior to surgery (n=8) or epidural morphine (0.1 mg/kg body weight) administered following induction of anesthesia (n=10). Temperature, heart rate, respiratory rate, and pain score were recorded prior to surgery and zero, six, 18, 30, and 42 hours after surgery. Blood samples were collected from the dogs in the transdermal fentanyl group beginning 24 hours preoperatively to 42 hours postoperatively. Fentanyl concentrations were determined by radioimmunoassay. When all time periods after surgery were combined, dogs in the transdermal fentanyl group were experiencing significantly less pain after surgery than dogs given epidural morphine. The transdermal fentanyl provided analgesia after major orthopedic surgery greater than or equivalent to that of epidural morphine.

Administration, Cutaneous↗

PubMed1995

Accuracy of ultrasound for the diagnosis of deep venous thrombosis in asymptomatic patients after orthopedic surgery. A meta-analysis.

OBJECTIVE: To evaluate, by meta-analysis, the accuracy of ultrasound screening for deep venous thrombosis in patients after orthopedic surgery. DATA SOURCES: The MEDLINE database from January 1982 to October 1993. Bibliographies of retrieved articles and recent journal publications were searched independently and using Current Contents. STUDY SELECTION: All articles evaluating the use of venous ultrasound imaging (B-mode, duplex, and color Doppler) compared with standard contrast venography for detecting deep venous thrombosis. We excluded abstracts, early reports of studies later reported in full, and studies in which venography was not done in all patients. Seventeen of 30 identified studies were eligible. DATA EXTRACTION: Eligible articles were reviewed for the presence of three key criteria necessary for evaluating the accuracy of the diagnostic tests: 1) previously established objective criteria for venography and ultrasound, 2) independent blinded comparisons of venography and ultrasound, and 3) prospective evaluations of consecutive patients. Studies including all three key criteria were defined as level 1 (minimized bias) studies; otherwise, they were defined as level 2 studies. DATA SYNTHESIS: In level 1 studies, ultrasonography had a sensitivity of 62% (95 of 153; 95% CI, 54% to 70%), a specificity of 97% (CI, 96% to 98%), and a positive predictive value of 66% (95 of 144; CI, 58% to 74%) for detecting proximal thrombi. For level 2 studies, the sensitivity was 95% (CI, 87% to 99%), the specificity was 100% (CI, 99% to 100%), and the positive predictive value was 100% (CI, 94% to 100%). Differences between level 1 and level 2 studies appeared to be related to bias in study design. CONCLUSIONS: Venous ultrasound imaging has only moderate sensitivity and a moderate positive predictive value when used to screen for deep venous thrombosis in patients after orthopedic surgery; thus, ultrasound imaging may have limitations as a screening test.

Aged↗

PubMed1999

Probable transmission of HIV from an orthopedic surgeon to a patient in France.

BACKGROUND: Transmission of HIV from infected health care workers to patients has been documented in only one cluster involving 6 patients of a dentist in Florida. In October 1995, the French Ministry of Health offered HIV testing to patients who had been operated on by an orthopedic surgeon in whom AIDS was recently diagnosed. OBJECTIVE: To determine whether the surgeon transmitted HIV to patients during operations. DESIGN: Epidemiologic investigation. SETTING: The practice of an orthopedic surgeon in a French public hospital. PARTICIPANTS: 1 surgeon and 983 of his former patients. MEASUREMENTS: 3004 patients who had undergone invasive procedures were contacted by mail for counseling and HIV testing. One HIV-positive patient was interviewed, and DNA sequence analysis was performed to compare the genetic relation of the patient's and the surgeon's viruses. Infection-control precautions and the surgeon's practices were assessed. RESULTS: Of 983 patients in whom serologic status was ascertained, 982 were HIV negative and 1 was HIV positive. The HIV-positive patient, a woman born in 1925, tested negative for HIV before placement of a total hip prosthesis with bone graft (a prolonged operation) performed by the surgeon in 1992. She had no identified risk for HIV exposure. Molecular analysis indicated that the viral sequences obtained from the surgeon and the HIV-infected woman were closely related. Infection-control precautions were in accordance with recommendations, but blood contact between the surgeon and his patients occurred commonly during surgical procedures. CONCLUSIONS: An HIV-infected surgeon may have transmitted HIV to one of his patients during surgery.

Base Sequence↗

PubMed1998

Preliminary experience with an orthopedic teleradiology service at the Alaska Native Medical Center.

The orthopedic service at the Alaska Native Medical Center (ANMC) in Anchorage provides comprehensive orthopedic care to 103,000 Native or "First Nation" peoples in the state of Alaska. From its base at ANMC, a 140-bed general hospital, the service provides outpatient services, inpatient services including surgery, and telephone consultation services to 10 regional medical centers, 15 subregional clinics, and 20 village health centers distributed over a wide geographical area. These outlying centers are staffed by 108 full- and part-time primary care physicians, 74 primary care advanced practice nurses or physicians assistants, and 456 Community Health Aides. In providing telephone consultation service, the current version of "radio clinic," a frequent challenge arises in interpretation of verbal descriptions of x-ray findings. Our primary care clinicians, while highly trained, cannot be expected to interpret x-rays at the same level as a specialist. Discrepancies occur in communicating radiographic detail. This can result in either delayed or unnecessary transfer of patients, inappropriate travel to regional medical centers or home villages, or simply suboptimal medical care. Fortunately, computer technology has evolved to a point at which quality x-ray images can be transmitted relatively inexpensively. This paper will describe our preliminary experience with such a system.

Academic Medical Centers↗

PubMed1996

A desktop image processing system for computer-assisted orthopedic surgery (DISOS).

Within the framework of our research activities in orthopedic surgery a PC-based imageprocessing system for the processing of x-ray computer-tomographic data has been developed. The system is used as a work platform for the investigations concerning interaction modalities, strategies and techniques for an efficient planning and execution of surgical interventions in orthopedic surgery by means of individual templates. The method of individual templates has been presented in /1,2/ and will not be subject of this paper.

Computer Peripherals↗