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PubMed2004

Analgesics for orthopedic postoperative pain.

Postoperative pain management is critical for optimal care of orthopedic surgery patients. Opioids, administered intramuscularly, as epidurals, or IV as patient-controlled analgesia, are effective for severe pain. Adjunctive therapy and preemptive analgesia such as nerve blocks, and methods of delivery such as infusion pumps, may be used after total knee arthroplasty and anterior cruciate ligament (ACL) reconstruction. Oral opioids are effective for moderate to severe pain, and tramadol, with efficacy comparable to morphine but with fewer severe side effects, is selected for moderate to moderately severe pain. Opioid-sparing NSAIDs, such as ketorolac, and COX-2-specific NSAIDS have use in pain management of hip, knee, and ACL procedures. An individualized regimen of appropriate analgesics, combined with nonpharmacologic treatments such as physical therapy or cryotherapy and patient education, can aid orthopedic surgery patients' recovery.

Administration, Oral↗
PubMed2004

Hyperbaric oxygen therapy in orthopedic conditions.

As is well known, the origins and development of hyperbaric medicine are closely tied to the history of diving medicine. Our HBO2 studies stemming from diving medicine date back to 1972. We concentrated our early basic research on dysbaric osteonecrosis. There are now good indications that HBO2 is helpful in a variety of orthopedic conditions. However, hyperbaric medicine in orthopedics is still relatively new and some aspects of it remain controversial.

Congresses as Topic↗
PubMed2004

Our experience with telemedicine in traumatology and orthopedics.

BACKGROUND: Telemedicine widely takes root in all branches of modern medicine including traumatology and orthopedics. The main goal of this work was to present our experience with asynchronic teleconsultation in daily clinical practice, in particular in the treatment of polytrauma patients. METHODS: Throughout 2000 and 2003, we carried out 144 teleconsultations for 92 men and 52 women (age range three months to 80 years). Of these, we were the inquiring party in 51 cases, the consulting one in 88 cases, and the mediator in five cases. Time passed till the completion of consultations ranged from 12 to 24 hours. RESULTS: The number of consultants was one, two, three, and more in 99, 22, 3, and 15 teleconsultations, respectively. The most common questions (n=128) were those of treatment tactics. In the majority of cases, the consultant approved of the diagnosis suggested by the inquirer and formulated or corrected the scheme of the treatment. The majority of teleconsultations were concerned with various problems of traumatology (n=83) and orthopedics (n=31). For each clinical case, we received a mean of 2.6 replies (range 1 to 8). The effectiveness of the suggested treatment methods accounted for approximately 80% in final decision making. Teleconsultations provided considerable benefits in the treatment of polytrauma patients, including decreases in in-hospital treatment necessities (16%), in complication rates (9.2%) and their severity, the relative risk of developing complications (10%), and in the need for re-hospitalization (0.4%). CONCLUSION: In view of our experience, we recommend that asynchronic consultations on the basis of the Internet-technology be more commonly used in the treatment of polytrauma patients.

Adolescent↗
PubMed2004

Parathyroid hormone--possible future drug for orthopedic surgery.

Parathyroid hormone naturally secreted by the parathyroid glands is a potent anabolic agent for bone. Parathyroid hormone is primarily thought of as a catabolic protein involved in the physiologic release of calcium from bone. Whereas during recent years, a number of animal studies and clinical trials have demonstrated that intermittent parathyroid hormone administration induces anabolic effects on both cancellous and cortical bone, enhances bone mass and increases mechanical strength of the bones. Most of the studies, both animal and human, have addressed the treatment of osteoporosis and parathyroid hormone represents an important new advance in the therapy of osteoporosis. Few studies have investigated the effect of intermittent parathyroid hormone treatment in the field of orthopedics on fracture healing and fixation of orthopedic implants. The results of those studies indicated an enhancement of fracture healing, faster bone repair and better fixation of the implant. Recently there were few animal studies started to investigate the effects of parathyroid hormone treatment on bone formation in regenerated and surrounding bone of distracted callus during limb lengthening. Distraction osteogenesis is a technique for bone lengthening that is widely used clinically and experimentally. Newly forming bone during distraction osteogenesis is expected to be an appropriate pattern for parathyroid hormone anabolic effect. Preclinical studies as well as clinical trials suggest that parathyroid hormone might be useful as a stimulator of bone formation whereas a lot of questions regarding parathyroid hormone therapy remain unanswered and require further experimental studies and investigations.

Animals↗
PubMed2005

[Advantage of ropivacaine for postoperative epidural analgesia following leg orthopedic surgery].

BACKGROUND: Epidural administration of local anesthetics may lead to effective pain relief. However, tachyphylaxis or other problems following prolonged epidural anesthesia may develop and in many cases difficulties exist in the maintenance of the similar degree of sensory blockade. The present study was therefore performed to investigate the analgesic effect of continuous postoperative epidural infusion of ropivacaine with fentanyl in comparison with that of bupivacaine or ropivacaine alone. METHODS: After leg orthopedic surgery with lumbar combined spinal-epidural anesthesia, thirty-six patients were randomized to one of the three postoperative epidural infusion groups: bupivacaine 0.125%, ropivacaine 0.2%, or ropivacaine 0.2% with 2.2 microg x ml(-1) (400 microg x 180 ml(-1)) of fentanyl. Continuous epidural infusion was started at a rate of 6 ml x h(-1) with possibility of an additional bolus injection of 3 ml at least every 60 min. Pain was assessed using a 10-cm visual analog scale (VAS) just before and 15 min after epidural bolus injections, and 15-20 h after the start of continuous epidural infusion as the severe at pain through the observation. The spread of analgesia (loss of sharpness in pinprick perception) and motor block (Bromage scale) were evaluated bilaterally. Systolic and diastolic blood pressure and heart rate were also measured. RESULTS: The epidural bolus infusion was associated with a significant decrease of VAS (P < 0.001) and stable blood pressure and heart rate in all groups. The maximal VAS in patients receiving 0.2% ropivacaine+fentanyl was significantly less compared to that in the other two groups. The regression of sensory blockade was significantly prolonged in patients treated with ropivacaine+fentanyl. There was no significant difference in the spread of sensory analgesia between 20 min and 15-20 h after the continuous epidural anesthesia in this group. None of the patients developed adverse effects such as respiratory depression, nausea, and pruritus. CONCLUSIONS: Epidural injection of ropivacaine with fentanyl decreased postoperative pain with stable vital signs in patients undergoing leg orthopedic surgery, as compared to bupivacaine or ropivacaine alone, possibly because of the maintenance of sensory blockade by ropivacaine and enhancement of this sensory blockade by fentanyl.

Adult↗
PubMedDate not supplied

[Malnutrition prevalence in patients admitted to a rehabilitation and orthopedic surgery hospital].

OBJECTIVE: Different studies show the scarce attention granted to the nutritional state in historical and clinical practice, what determines the ignorance of the patient's nutritional status to their entrance in the hospital and, therefore, the impossibility to prevent the hospital malnutrition. The objective of our study has been to determine the prevalence of patients' malnutrition entered in a Hospital of Orthopedic surgery and Rehabilitation. METHODS: Observational and analytical study in 250 randomized patients (60% men and 40% women), who were nutritionally evaluated when entering, the hospital, by means of anthropometry (Weigh, height, BMI, skin-fold, corporal circumferences) and biochemical tests (Albumin, Prealbumin and Transferrin). RESULTS: According to the BMI the prevalence of malnutrition was of 8%, the average of caloric malnutrition was of 2.8% (according to anthropometry) and the prevalence of many-sided malnutrition rises to 54.8% (according to biochemical markers). CONCLUSIONS: The high prevalence of fundamental malnutrition (54.8%) demonstrated in this study, it shows the importance of determining the nutritional status when entering the hospital, particularly surgical type' patiens as is the case of most of those who enter the Orthopedic surgery hospitals.

Adult↗
PubMed2005

Collecting health history information: the accuracy of a patient self-administered questionnaire in an orthopedic outpatient setting.

BACKGROUND AND PURPOSE: The utility of patient self-administered health history questionnaires has been extensively studied in physician practice settings, but little such research has been done in populations germane to physical therapist practice. The purpose of this study was to document the accuracy of a self-administered questionnaire for collecting patients' history of illness, surgery, and medication use. SUBJECTS: Outpatient orthopedic surgery candidates (n=100, 54% female, 46% male; mean age=46.9 years) with common orthopedic disorders were recruited. METHODS: Using the same form, patient health history information was recorded separately by patient self-report and by an experienced health care practitioner. Patient questionnaire responses were compared for accuracy with responses generated by the practitioner and those found in the medical record. RESULTS: The mean percentage of agreement across questionnaire items was 96% (range=57%-100%); the mean kappa value was .69 (range=.154-1.0). Of the total questionnaire responses across all patients (n=9,436), 2.55% (n=241) of the responses were noted "yes" on the practitioner questionnaire, but not on the patient questionnaire; 1.8% of the items (n=174) were noted "yes" on the patient questionnaire, but not on the practitioner questionnaire. DISCUSSION AND CONCLUSION: The results support the accuracy of patient self-administered health history questionnaires in reporting important health history information.

Adult↗
PubMed2006

Stem cells in orthopedics: current concepts and possible future applications.

Stem cells are the cells that have the ability to divide for indefinite periods in culture and to give rise to specialized cells. Sources of these cells include embryo, umbilical cord and certain sites in adults such as the central nervous system [CNS] and bone marrow. Its use hold promise of wide spread applications particularly in areas of spinal cord injury, difficult non-unions, critical bone defects, spinal fusions, augmentation of ligament reconstructions, cartilage repair and degenerative disc disorders. This review article contains current information derived from Medline searches on the use in various orthopedic subspecialties. Some issues remain at the forefront of the controversy involving stem cell research - legislation, ethics and public opinion, cost and concentration methods. As is true with any new technology, the enthusiasm for this technology that has potential to influence virtually every orthopedic case management, must be balanced by subjecting it to stringent clinical and basic research investigations.

Bone Diseases↗
PubMed2006

Thromboprophylaxis in orthopedic surgery.

More than 2 million people undergo major orthopedic surgery each year, and this rate is expected to continue rising as our population ages. Our patients are at particularly high risk for deep vein thrombosis (DVT) and pulmonary embolism. The latest guidelines from the American College of Chest Physicians recommend thromboprophylaxis for high-risk orthopedic surgery patients. Although specific recommendations vary by type of surgery, low-molecular-weight heparin, fondaparinux, warfarin, and sometimes low-dose unfractionated heparin are effective alone or with mechanical prophylaxis. Goals of treatment are to prevent proximal and distal DVT, pulmonary death, chronic pulmonary hypertension, and postthrombotic syndrome.

Anesthesia, Epidural↗
PubMed2006

Orthopedic management of decubitus ulcers around the proximal femur.

Decubitus ulcers, commonly known as pressure ulcers or sores, represent localized areas of tissue necrosis. Despite increased awareness and use of preventive measures, these ulcers remain a major concern in the hospitalized and immobile patient population. When the hip joint becomes infected or the wound remains refractory to nonsurgical treatments, the orthopedic surgeon becomes involved in patient care. In this review, a brief overview of decubitus ulcers and their nonsurgical management is given, followed by a discussion of various flaps used in more extensive repairs. The major orthopedic procedures presented include proximal femoral resection (Girdlestone procedure), hip disarticulation, and hemipelvectomy. These surgeries retain an important position in managing complicated decubitus ulcers around the proximal femur.

Disarticulation↗
PubMed1992

C-reactive protein (CRP) levels after elective orthopedic surgery.

The levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were determined by serial measurements after four types of uncomplicated elective orthopedic surgery. The type of operations chosen for this study were total hip arthroplasty (primary, n = 109; and revisions caused by aseptic loosening, n = 9), unicondylar knee arthroplasty (n = 39), and lumbar microdiskectomy (n = 36). In all patients, CRP levels increased after surgery, reaching peak levels on the third day after hip arthroplasties (primary, 116 +/- 43 mg/l; revisions, 136 +/- 58 mg/l) and on the second day after knee arthroplasties (140 +/- 46 mg/l) and lumbar microdiskectomy (48 +/- 27 mg/l). C-reactive protein levels usually dropped to normal (less than 10 mg/l) within 21 days after surgery. No correlations were found between CRP response and the type of anesthesia, amount of bleeding, transfusion, operation time, administered drugs, age, or gender. Erythrocyte sedimentation rate increased to peak levels about five days after surgery, followed by a slow and irregular decrease. Still, 42 days after uncomplicated operations ESR often remained elevated. In conclusion, the level of CRP must be considered a better diagnostic aid for the early detection of postoperative infections than ESR. It can be assumed that the rapid decline in CRP after uncomplicated orthopedic surgery will be interrupted by a second rise or by a persisting elevated level if infectious complications occur.

Adult↗
PubMed1991

[The effect of Federal Public Health Service guidelines on air, surface and floor germ count in a general surgery and an orthopedic operating room].

In a prospective study the environmental contamination in an old and a new operating theatre was investigated. The old operating rooms were constructed in 1936 whereas the new rooms were built in 1986. The study was conducted in surgical and orthopedic surgical operating rooms. There was a slight increase in floor as well as in surface contamination in the new operating rooms. On the other hand there was a slight decrease in the airborne microorganisms in the orthopedic surgery and nearly identical colony counts in the general surgery operating rooms. All the differences were statistically not significant. The spectrum of microorganisms and the occurrence of Staphylococcus aureus in the old and the new operating rooms showed no difference.

Air Microbiology↗
PubMed1991

[The effect of electroacupuncture analgesia on the plasma levels of cortisol and aldosterone in orthopedic operations].

The effects of electroacupuncture on plasma cortisol and aldosterone levels in patients undergoing orthopedic operations were studied. Plasma cortisol and aldosterone levels were measured at three stages. Moderate activation of the hypothalamo-pituitary-adrenal system is considered an adjustment response of the organism to the operative trauma, with stable hemodynamic parameters. The total amount of analgetic drugs which the patients received during the postoperative period was three times lower than that in the control group given neuroleptanalgesia; during electroacupuncture analgesia (EAPA) opioids were not applied. It is considered that the use of EAPA lowers the degree of the stress reaction in surgical trauma, providing adequate analgesia and neurovegetative protection of patients during orthopedic operations and in the early postoperative period.

Aldosterone↗
PubMed1991

Nutrition: its relationship to orthopedic infections.

The malnutrition of orthopedic surgical patients plays an important role in the development of complications, including infection. A high index of suspicion that malnutrition exists or will soon exist in patients who are subjected to significant stress, trauma, or surgery will lead the clinician to take measures to avoid further protein calorie deficits and replenish the patient's nutritional needs. There are many pathways in which malnutrition causes a propensity for infection, and these have been discussed. Meeting the patient's nutritional needs should avoid some of the complications of infections in orthopedic surgery.

Energy Metabolism↗
PubMedDate not supplied

[Diagnostic ultrasound in orthopedics].

Diagnostic ultrasound of the locomotor system is indispensable in modern orthopedic diagnostic practice. Due to its harmlessness, spatial display and identification of all structures, diagnostic ultrasound has significantly improved diagnostic procedures and has become a method of choice in a number of pathologic processes. Ultrasound enables visualization of the skin, subcutaneous tissue, muscles, tendons, hematomas, abscesses, cysts, bursae of joints, to a certain extent even bones, and the processes taking place in them and how they are related to the surrounding structures. Ultrasound also enables visualization of structures and processes that could not be clearly identified before, thus making its significance in orthopedics equal to its importance in other medical specialties.

Humans↗
PubMed1991

Orthopedic complications. Compartment syndrome, fat embolism syndrome, and venous thromboembolism.

Specialized education in the care of orthopedic patients includes an understanding of the common complications for which patients require monitoring. With a socioeconomic backdrop of decreasing hospital stays and prospective payment, patient care must be managed proactively. For all three complications presented, there are unique sets of risk factors that, when present, contribute to a high index of suspicion for morbidity. Clusters of symptoms have also been discussed representing the expected normal patterns. With this knowledge as a foundation, clinical application is essential to incorporate other salient aspects of individual situations. Nurses diagnose and treat human responses to health problems. The end result of human responses to injury or orthopedic conditions can be the development of complications. Stringent adherence to patient monitoring protocols can promote timely nursing interventions to prevent, minimize, or detect complications or treatment side effects. Although definitive treatment is often physician directed, nurses are in a key role to impact final patient outcomes.

Compartment Syndromes↗
PubMed1991

Pain management in the orthopedic patient.

Pain is a familiar phenomenon to all orthopedic nurses. As Dunwoody said, "Few things we do for patients are more fundamental to the quality of life than relieving pain." We as orthopedic nurses are in a position to contribute to the positive management of pain by using a comprehensive approach to pain management that involves the participation of the patient. We need to believe the patient's pain, try new approaches, and help our patients achieve pain relief.

Analgesics↗
PubMed1991

The current state of traumatology and orthopedics.

The efficacy of treatment for orthopedic trauma patients has improved slowly compared to advances in other areas of orthopedics, e.g., poliomyelitis, bone infection, microvascular surgery, and endoprosthetic devices. Further progress will only be possible by reappraising a number of traditional methods and opinions. In this regard, four proposals are noteworthy: (1) a transfer of attention from predominantly clinical to theoretical research; (2) clarification of terminology to enable effective computerization and development of automated search systems; (3) improvement of the quality of clinical research methodology, including the strict adherence to the requirements of statistical analysis; (4) development of quantitative estimates of locomotor system function and anatomy. A problem-oriented automated information search system and a quantitative method for assessing the anatomic and functional state of the locomotor system has been developed.

Humans↗