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PubMed1991

[Data registration of postoperative complications in connection with orthopedic surgery. A review of 4,346 surgical wounds].

A personal computer program to monitor surgical wound infections and other complications in orthopedics was developed. Internationally accepted definitions were used. The program was tested in four Danish orthopedic wards. The test period was from 1 January 1988 to 30 June 1989. Results from four wards consisting of 4,346 wounds in 3,570 patients are presented. The overall superficial wound infection rate was 2.4%, deep wound infection rate was 0.9%, other infection rate was 3.1%, and other complications were developed in 4.3% of the cases. In contrast to previous computer systems presented, this system also registers other nosocomial infections, and other complications. We found the system easy to use, and during the period, the overall registration rate was over ninety percent. If a registration system is introduced in the ward, a combined system which registers all infections and complications is preferable, instead of a simple wound infection system.

Adolescent↗
PubMed1990

The development of orthopedic certification in the United States.

The development of medical education standards and state licensure requirements occurred simultaneously in the 1900s. The result was that annual state licensure became the physician's certification. Eventually, the explosion of scientific knowledge due to hospital-based clinical practices and stimulation from national societies led to specialization within medicine. Primary specialty boards were organized in the 1930s to issue credentials and define qualifications for specialists. Just as licensure became the certification of a physician, primary boards became the certification of a physician specialist. Certification has become progressively more important in relationship to individual patients, national societies, hospitals, and third-party carriers. Recertification is the recognition by a primary board of a diplomate's continuing qualifications. The majority of primary boards have plans to institute recertification in order to evaluate pertinent cognitive knowledge of a diplomate and to respond to inadequate ongoing peer review. The expansion of scientific and technical knowledge, which led to specialization in the 1930s, inevitably has led to subspecialization. Orthopedic surgeons are using a wide range of fellowships, especially those just completing their residency education. The first certificate of added qualifications for orthopedics was in surgery of the hand.

Certification↗
PubMed1990

[Methodology of the branch program in traumatology and orthopedics in present-day conditions].

The method of targeted programming is just entering the practice of science planning in traumatology and orthopedics as specific branch-oriented scientific and technological programmes. The essence of the methodological maintenance of Programme C.18 is presented; the Programme is aimed at elaborating the therapeutic system to manage patients with fractures of bones of the locomotor apparatus. Its result will present as the data on the structure of the general population of such patients, on the optimal methods of treatment, as well as on the issues of the emergency aid organization. Methods to estimate the future and current need in the traumatological-orthopaedic equipment will be elaborated. The programme is carried out according to the coordinated schedule, involving research institutes and departments of traumatology and orthopedics, the total number of the establishments amounting to 70. The programme implementation covers the period from 1986 to 1999.

Fractures, Bone↗
PubMed1990

Autologous blood transfusion in orthopedic and oral surgical patients.

The procedure for autologous blood transfusion in the orthopedic and oral surgical patients in our university hospital is described. The collection of blood was begun from 3 weeks prior to the scheduled surgery. Each time 200 or 400 ml were collected, making three collections possible. The collected blood was stored in liquid form up to the day of the operation and returned to the same patient. Without any difficulty, 600-1200 ml of blood were collected from many patients. All patients were prescribed an oral iron supplement (200 mg/day). No significant decrease in the serum iron and ferritin levels after two or three collections was observed. Eighty-nine percent of the orthopedic patients and 87% of the oral surgical patients were transfused only with autologous blood during the operation. Homologous blood transfusion was performed in the patients with more than 2,200 ml of blood loss. The autologous blood collection of 800 ml may be sufficient enough in at least 80% of these patients.

Adult↗
PubMed1989

[Gas gangrene after aseptic orthopedic surgery].

Gas gangrene following scheduled orthopedic surgery is not uncommon. In order to assess its frequency and prognosis, identify possible predisposing factors and suggest preventive measures, we reviewed the records of 22 patients (14 males and 8 females, mean age 40 +/- 20 years) admitted between 1969 and 1987 who developed gas gangrene in the wake of orthopedic surgery. In all cases the lower limbs were the site of operation: the knee in 9, the hip in 4, the femur in 4 and the leg in 5 cases. Surgical procedures included on-site foreign material in 19 cases, pneumatic tourniquet in 6 and prolonged vascular stretch in 9. Infection was diagnosed within 1.4 +/- 1.1 days of surgery; local signs, especially crepitants and pain, were prominent for the diagnosis. Pathologic findings consisted of myonecrosis in 18 patients and cellulitis in 4. Local bacteriological studies, carried out in 19 patients, yielded organisms in 14, including 12 with Clostridia perfringens. Four patients (one despite surgical treatment) died within 24 hours of admission. The remainder were treated with a combination of surgery, antimicrobial therapy (18) and hyperbaric oxygen (17). Subsequently, 13 patients had severe functional disability, while 5 recovered without sequelae. In view of the poor prognosis of gas gangrene, several preventive measures are suggested during aseptic surgery of the lower limbs. Careful skin preparation, cleaning of the anal region and short-term prophylactic antibiotic therapy with cefamandole or amoxycillin-clavulanic acid, are among them.

Adult↗
PubMed1989

Radiation exposure from fluoroscopy during orthopedic surgical procedures.

The use of fluoroscopy has enabled orthopedic surgeons to become technically more proficient. In addition, these surgical procedures tend to have less associated patient morbidity by decreasing operative time and minimizing the area of the operative field. The trade-off, however, may be an increased risk of radiation exposure to the surgeon on an annual or lifetime basis. The current study was designed to determine the amount of radiation received by the primary surgeon and the first assistant during selected surgical procedures involving the use of fluoroscopy. Five body sites exposed to radiation were monitored for dosage. The results of this study indicate that with appropriate usage, (1) radiation exposure from fluoroscopy is relatively low; (2) the surgeon's dominant hand receives the most exposure per case; and (3) proper maintenance and calibration of fluoroscopic machines are important factors in reducing exposure risks. Therefore, with proper precautions, the use of fluoroscopy in orthopedic procedures can remain a safe practice.

Fluoroscopy↗
PubMed1988

The performance and usefulness of nerve conduction studies in the orthopedic office.

The ability to determine conduction velocity in peripheral nerves provides the orthopedic surgeon with valuable information, aiding assessment of patients with perplexing problems and atypical clinical findings. Use of the study transcends the evaluation of patients with compression neuropathies. The clinician can more effectively grade and follow the clinical course of nerve injuries, evaluate anomalies of innervation, and graphically confirm the results of nerve repairs and nerve grafts. The digital electroneurometer provides a simple, painless, and inexpensive means for determination of distal motor latency in peripheral nerves. Its advantages relate to its small size, accessibility, and simplicity of operation. The digital electroneurometer does not replace standard testing procedures. The muscle action potential is not visualized; amplitude and duration cannot be measured. Sensory latency determinations cannot be performed. Though its limitations are clear, the digital electroneurometer can provide valuable information to the orthopedic surgeon in his office. Further clinical trials are necessary to confirm the material in this limited study and to investigate its application to a broader range of clinical problems.

Carpal Tunnel Syndrome↗
PubMed1989

Characteristics of successful and unsuccessful applicants to orthopedic residency training programs.

In 1985 there were 288 applicants for the ten postgraduate Year 1 orthopedic residency positions in Galveston and San Antonio, of which 119 (41%) applicants successfully obtained a residency position in one of 76 orthopedic programs approved by the Accreditation Council for Graduate Medical Education. Successful applicants were younger and had higher Medical College Admissions Test scores, National Board of Medical Examiners, Part I (NBME-I) scores, and medical school grade point averages than unsuccessful applicants. Variables that increased acceptance rates were medical student status, an NBME-I score above 500, class rank in the top 40%, and membership in Alpha Omega Alpha honor society. Foreign citizenship and prior residency experience in a different specialty strongly decreased acceptance rates. Variables that did not affect acceptance rates were: gender, military experience, marital status, graduate degree, research, publications, or NBME-II scores.

Adult↗
PubMed1988

Prevention of deep venous thrombosis in orthopedic surgery: effects of defibrotide.

The effectiveness of defibrotide was compared with that of calcium heparin and acetylsalicylic acid (ASA) in the prevention of deep venous thrombosis (DVT) resulting from orthopedic surgery. Sixty-three patients scheduled for elective or traumatological surgery, for the most part involving the hip joint, were recruited. The patients were randomly assigned to one of the following treatment groups: defibrotide (400 mg twice daily), administered intramuscularly (n = 19); calcium heparin (5,000 IU thrice daily), administered subcutaneously (n = 25); and ASA (100 mg on alternate days), administered orally (n = 19). Administration of the drug was started one day before surgery and continued until the seventh day after surgery. Each patient was monitored daily by means of the fibrinogen uptake test. The incidence of increased uptake did not differ significantly in the three groups (defibrotide, ten out of 19; calcium heparin, ten out of 25; ASA, seven out of 19). Conversely, a trend in favor of defibrotide was noted in cases of symptomatic DVT (defibrotide, one out of 19; calcium heparin, two out of 25; ASA, four out of 19) and pulmonary embolism (defibrotide, no cases; calcium heparin, one case; ASA two cases). On the strength of these findings, defibrotide therapy qualifies as a valid alternative to conventional DVT prophylaxis in orthopedic surgery.

Aged↗
PubMed1987

A cost-effectiveness analysis of prophylaxis against deep-vein thrombosis in major orthopedic surgery.

A number of methods of prophylaxis can reduce the likelihood of postoperative deep-vein thrombosis in patients undergoing major orthopedic surgery. Using techniques of decision analysis, we examine the cost-effectiveness of several of these--warfarin sodium, low-dose subcutaneous heparin sodium, graduated compression stockings, intermittent pneumatic compression, heparin plus dihydroergotamine mesylate, and heparin plus stockings--compared with clinical diagnosis and treatment only. Our results show that 153 deaths per 10 000 patients occur when no prophylaxis is used; with most prophylaxis, this number is at least halved, and the most effective methods may reduce the number of deaths by three fourths. In addition, all of the prophylaxis considered are cost saving: average costs of care (including prophylaxis costs) are reduced by +19.40 to +181.60 per patient. Prophylaxis against deep-vein thrombosis in major orthopedic surgery therefore saves both lives and health care dollars.

Cost-Benefit Analysis↗
PubMed1988

Expected contamination of the orthopedic surgeon's conjunctiva.

Likely contamination of a surgeon's conjunctiva by patients' body fluids is surprisingly frequent. Blood and fat are the most common agents but cellular implantation may occur. Possible contamination was documented in 37 of 60 orthopedic procedures. Power tools, hammering and the use of rongeurs are the main culprits in producing a forced spray most likely to cause contamination. Reduction of the hip at the time of replacement arthroplasty is often associated with propulsion of blood. Not a single case of possible contamination resulted from the pumping action of a severed vessel. Since orthopedic surgeons work in a high-risk environment, safety glasses are recommended to prevent contraction of viral diseases such as hepatitis B and acquired immune deficiency syndrome by way of the conjunctiva. The glasses will also protect the surgeon from bacterial and cellular conjunctival contamination, in addition to preventing physical damage secondary to propelled bone and cement.

Body Fluids↗
PubMed1988

The computer. An orthopedic instrument.

The computer has become an important tool in orthopedic practice. Indeed, it is now invaluable and will soon be essential. It is still possible to run an orthopedic office without a computer--just as it is still possible to perform meniscectomy by arthrotomy--but that is not what most of us would do. The computer enhances efficiency, can improve business practice, assists in marketing, and helps store and retrieve medical information. The ultimate impact is not only on "business" functions but also on the quality of care.

Ambulatory Care Information Systems↗
PubMed1986

Computer-aided simulation, analysis, and design in orthopedic surgery.

Three-dimensional computer reconstructions of bony anatomy based on computed tomographic images and radiographs may be used to analyze, simulate, and design certain orthopedic procedures. In osteotomy surgery, the computer-reconstructed models may be used to measure critical angles, surface area, and congruity of the joint surfaces. Computer reconstructions may be used in total joint replacement surgery to simulate the effect of surgical reamers and rasps, to select the geometrically optimum standard implant, or to design a custom implant. In allograft reconstructive surgery, computer reconstructions may be used to measure bony defects and to identify the appropriate allografts for the reconstruction. Plastic models may be sterilized and used as templates to sculpt the allografts immediately preoperatively. In all three applications in orthopedic surgery, three-dimensional, computer-aided reconstructions have the potential to improve results and reduce morbidity.

Bone Transplantation↗
PubMed1985

[Orthopedic aspects of congenital insensitivity to pain].

The congenital insensitivity to pain regroups some rare diseases which are mainly 5: congenital insensitivity to pain; congenital sensitive neuropathies; distal sensitive neuropathies; Riley-Day syndrome or hereditary dysautonomia; at last, miscellaneous troubles. Three different cases are reported in children: true congenital insensitivity to pain; hereditary dysautonomia or Riley-Day syndrome; congenital insensitivity to pain localised to a lower limb joined to amniotic disease and abnormality of this limb. The orthopedic symptoms (osteomyelitis, arthropathies as Charcot type, dislocations, fractures) lead often to diagnosis and they are an important step of the prognosis. Scoliosis seems to be frequent in this disease. The orthopedic and surgical treatment, according to each localization, is difficult and must emphasize the prevention of bones and joints injuries.

Burns↗
PubMed1979

Limb fractures in a defined population. II. Orthopedic treatment and utilization of health care.

This study describes the orthopedic treatment and utilization of health care obtained by 2,333 patients in the population of Rochester, Minnesota, who suffered 2,519 limb fractures during the period 1969 through 1971. Overall, 24% of fracture occurrences required patient hospitalization, the remainder involving care on an ambulatory basis only. The mean number of physician visits was 4.5 per fracture, with the visits occurring during an interval of 103 days from the time of first evaluation. Fifteen percent of limb fractures were subject to at least one surgical operative procedure as part of their orthopedic treatment. The frequency of operative treatment increased markedly with patient age. Seventeen percent of patients with limb fractures received physiotherapy or occupational therapy or both, 4% were ambulatory patients, and the remainder were hospital inpatients. Fractures of the head and neck of the femur constituted only about 7% of fractures in the series, yet utilized an inordinate proportion of health care resources. Hip fractures were responsible for 27% of the hospital admissions, 52% of all bed days utilized, and 56% of the physiotherapy sessions.

Adolescent↗
PubMed1979

[A study on postoperative management and pre-and postoperative changes of blood volume in orthopedic surgery (author's transl)].

In order to apply adequate postoperative management of patients in the orthopedic surgery, the in vivo effects of the operations were investigated in the present study, from various viewpoints such as circulatory functions, metabolism of proteins, and hepatic and renal functions. In addition, the circulating blood volumes were determined in order to know the variations in the amount of blood loss from the operated regions during and after operations so as to improve the operative and postoperative management. On the basis of the results, the countermeasures against the adverse variations in blood volume were also investigated. Pediatric patients were found to be prone to develop more appreciable systemic postoperative reactions than those in adult ages, especially so in those of circulatory system, peripheral blood, hepatic functions, and protein metabolism, and also prone to be more affected by operative procedures. Senile patients were found to be prone to have less reserve capacity in circulation, peripheral blood, renal functions, and protein metabolism, and also prone to show delayed postoperative reactions and slower recoveries. The results of measurement of circulating blood volume in pre- and postoperations revealed that the loss of circulating blood in most patients was greater than the bleeding weight during the operation measured by gause count, and that, on the day following the operation, the blood volume was reduced by about 10-15% than those immediately after the operation. It was concluded that, as a whole, no changes causing serious deviation from the normal physiological ranges occur except in pediatric and senile patients. On the basis of the above findings, most appreciable systemic postoperative reactions of the operative procedures in orthopedic surgery would be attributed to by loss of blood volume during operations and that the postoperative hemorrhage from bone structure (which is usually difficult to control) or the postoperative hemorrhage after removal of air tourniquet would be almost negligible.

Adolescent↗
PubMed1979

[Orthopedic methods used in the treatment of scoliosis].

This paper describes the various technics of orthopedic surgery currently used to correct scoliosis and maintain correction. Among corrective methods they illustrate the use of the Cotrel plaster corset (E.D.F.) preceded by passive bipolar traction and autoelongation. Once correction is achieved, it must be maintained to the end skeletal growth; this is done with various types of orthopedic corsets (Lyonnais, La Padula, Milwaukee), which are used according to the patient's age and anatomical type of deformity. The authors discuss in particular the forces that are applied to the occiput and mandible with the Milwaukee corset (Logan, Cochran and Waugh), the values being recorded in diverse situations including the upright stance, ambulation, sitting position, position, supine position, and sleep (Galante, 1970). The authors also made a comparative study of the conventional Milwaukee corset (with broad chin bearing) versus the Milwaukee with hyoid bearing; and finally they illustrate the results obtained by Andriacchi and his associates in selecting the Milwaukee corset for patients with idiopathic scoliosis on the basis of the mathematical model of the rachis.

Casts, Surgical↗
PubMed1983

Measurement of scoliosis by orthopedic surgeons and radiologists.

Minimum medical standards for USAF flying personnel have been compiled in Air Force Regulation 160-43. This regulation specifies the maximum allowable amount of scoliosis, but does not specify who should read the X-ray film to determine, using the Cobb method, the degree of curvature in scoliotic individuals. In the present study, an X-ray of an individual with mild scoliosis was sent to departments of radiology and orthopedics at major U.S. Armed Forces Medical Centers. Although the mean estimated degree of curvature was the same for both the orthopedists and the radiologists, the variance in the radiologists' replies was considerably higher than normally expected. It is, therefore, recommended that scoliosis films of individuals being screened for flying duties should be reviewed by a qualified orthopedic surgeon.

Aerospace Medicine↗