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At least 703 records · Page 39Linked to original sources
PubMed1996

Moral reasoning and malpractice. A pilot study of orthopedic surgeons.

The relationship between moral reasoning and malpractice claims was studied in 53 orthopedic surgeons. Levels of moral reasoning were defined by the percentage of principled responses (P-score) on Rest's Defining Issues Test, while annualized rates of malpractice claims were computed on the basis of data from a regional, physician-owned, interindemnity/liability protection trust. Orthopedic surgeons with fewer than 0.20 claims per year demonstrated significantly (P = 0.04) higher levels of moral reasoning (mean P-score of 43.8) than did those with claims rates higher than 0.40 claims per year (mean P-score of 38.0). Only 1 of 13 orthopedists with P-scores over 50 was found in the higher claims group, suggesting that high levels of moral reasoning may provide a protective element against malpractice claims.

Ethics, Medical↗
PubMed1996

A safety and efficacy comparison study of two dosing regimens of epoetin alfa in patients undergoing major orthopedic surgery.

Previous studies have demonstrated the efficacy of perioperative Epoetin alfa in decreasing allogeneic transfusion exposure in patients undergoing orthopedic surgery. A randomized, multicenter trial was conducted comparing the safety and efficacy of a weekly Epoetin alfa dosing regimen in patients with hemoglobin levels > or = 10 to < or = 13 g/dL scheduled to undergo major elective orthopedic arthroplasty, with a daily regimen previously shown to be effective. patients on the weekly regimen showed a greater baseline-to-presurgery hemoglobin increase versus the daily regimen group (1.44 +/- 1.029 g/dL versus 0.73 +/- 0.867 g/dL). Moreover, the weekly 600 IU/kg regimen was similar to the daily 300 IU/kg regimen with respect to safety and the avoidance of allogeneic transfusion. These data showed the weekly Epoetin alfa regimen to be at least as efficacious as the daily regimen and more convenient.

Aged↗
PubMed1996

Recovery of unused operating room supplies for overseas orthopedic surgery.

Recovery of surplus operating room (OR) materials may contribute needed supplies to volunteer overseas surgical efforts. However, recovery often generates supplies that are highly heterogeneous in nature. In order to evaluate the nature and quantity of supplies useful to orthopedic surgical missions, the present investigation evaluated the material generated from 381 consecutive orthopedic cases performed during three 3-month assessment periods over 3 years. The amount of recovered material varied markedly within and among procedure types as well as surgeons. Nevertheless, the long-term, OR-wide recovery program at Yale-New Haven Hospital has provided a highly reliable source of usable materials over the 4-year life of the program.

Equipment and Supplies↗
PubMed1996

Latissimus dorsi free flap in orthopedic reconstructive surgery.

In complex musculoskeletal diseases, soft-tissue reconstruction is usually the key to a good clinical result. Selection of an ideal flap is a critical step in successful reconstruction. We performed latissimus dorsi free flap transfers in 52 patients with orthopedic disorders from 1988 to 1993. Recipient sites were the lower extremities (44), upper extremities (six) and buttocks (two). The indications for flap surgery comprised chronic ulcer (seven), osteomyelitis (nine), compound fractures (28), crushing or avulsion injuries (six) and malignancy (two). All of the flaps survived and the therapeutic goals were satisfactorily achieved. One patient had revision of vascular anastomosis and five patients underwent skin regrafting. Of eight patients who complained of bulkiness of the flap, only two patients had debulking surgery. No chronic infection occurred in either skeletal or soft tissue after flap coverage in any patients. Two of five heel flaps had initial ulcers and became endurable after one year. Two patients with malignancy were treated with wide resection and coverage with the flap. The esthetic and functional morbidity of the donor site was minimal. Through several modifications--segmentalization, tailoring, thinning and multiple islanding--the flaps become so versatile that they can be applied to different kinds of tissue defects in different locations of the body. This series of patients revealed the flap to be the most useful armament in the reconstruction of complex musculoskeletal diseases, particularly for orthopedic microsurgeons.

Adolescent↗
PubMedDate not supplied

[Basic plans for the combined orthopedic treatment of patients with rheumatoid arthritis and involvement of the joints of the lower extremities].

The paper focuses on the main principles of multi-modality orthopedic treatment of patients with rheumatoid arthritis (RA) presenting with the lower limbs affection, depending upon stage, activity, as well as particular features of disease course, functional incompetence of the joints and the limb as a whole, with due regard to the patient's volition and psychological status. It is necessary that opportunities for the RA patient's orthopedic rehabilitation be found before declaring him to be an invalid.

Acute Disease↗
PubMed1997

[Immediate orthopedic surgery in multiple trauma].

The increase in mortality and morbidity from multiple trauma due to road accidents, industrial trauma and combat injuries obligates treatment based on emergency systems and trauma centers. Follow-up of the frequency of different types of injury calls attention to increasing involvement of the orthopedic surgeon in primary treatment. This situation calls for appropriate deployment of immediate surgical treatment which will rapidly enable mobility. We present several methods for immediate orthopedic treatment of multiple-trauma patients.

Bone and Bones↗
PubMedDate not supplied

Orthopedic procedures after rhizotomy.

The goal of selective dorsal rhizotomy (SDR) is to reduce surgically abnormal excitatory impulses to the lower extremities and thus to decrease spasticity in patients with cerebral palsy. One hundred thirty-one patients underwent SDR from 1986 to 1994 and were retrospectively reviewed for changes in tone, requirements for orthopedic intervention, and changes in ambulatory status. One hundred twelve patients had adequate follow-up. Postrhizotomy tone was decreased in all of the 112 patients, as measured by the Ashworth scale. No statistically significant change in ambulatory status was found. A total of 71 (65%) of 112 patients required orthopedic intervention for continued contractures and deformity. Of those judged "hypotonic" by the physiatrist postoperatively, 37% required subtalar stabilization for severe planovalgus. Hip subluxation was noted and treated (by femoral or pelvic osteotomy or both) in 27 (25%) of 112. Despite appropriately completed SDR, parents must understand the importance of periodic long-term follow-up and the possible, if not likely, need for additional surgery to alleviate contractures and stabilize subluxation of joints.

Adolescent↗
PubMed1998

Sonography for the office screening of suspected rotator cuff tears: early experience of the orthopedic surgeon.

This study examined the feasibility of orthopedic surgeons performing sonography of the shoulder at the initial office evaluation of the rotator cuff and assessed the sensitivity, specificity, and predictive value of sonography for the detection of tears in the rotator cuff. Initial results in 24 patients suggest that sonography by the orthopedic surgeon is feasible and that it detects tears in the rotator cuff with sufficient accuracy for clinical decision making.

Adult↗
PubMed1997

[The clinical efficacy of imipenem/cilastatin sodium in orthopedic infections and drug levels in the bone tissue].

We evaluated the clinical efficacy of imipenem/cilastatin sodium (IPM/CS--a carbapenem antibiotic) against orthopedic infections, and the drug levels of the bone tissues were determined. The clinical efficacies for 6 patients in the infection group were good in 3 cases, and fair in the other 3; giving an efficacy rate of 50%. Bacteriologically, 8 strains were isolated from patients with the infection and an eradication rate of 87.5% was obtained upon the treatment. In 39 patients that were given the drug prophylactically, no postoperative infections occurred. Mean IPM levels in the bone and the bone marrow at 1 hour after administration in 5 patients of the prophylactic group were 17.3 micrograms/ml and 5.9 micrograms/g, respectively. The ratio of concentrations the bone to those in the bone marrow was 34.6%. The results of this study suggest that IMP/CS reaches to the bone tissue providing sufficient concentrations and that the drug is efficacious for the prophylaxis and the treatment of orthopedic infections.

Adolescent↗
PubMed1998

Considerations for the orthopedic nurse in diagnosis and treatment of adolescent sports injuries.

Injured adolescent athletes are challenging clients for the primary practitioner. Their unique physiological and psychological attributes dictate changes in traditional orthopedic practice and call for a holistic patient focus to address their varied needs. Understanding of common athletic injuries will effectively guide the practitioner's clinical evaluation and assist in recognizing those patients requiring more complex orthopedic diagnosis and care.

Adolescent↗
PubMed1998

Laboratory tests and diagnostic procedures in orthopedic nursing practice.

Orthopedic nurses need to know the clinical significance of their clients' laboratory test because critical analysis of the results is essential for clinical decision making. Nurses are expected to use the results in their own plan of care. Client education about diagnostic tests is also an important role of the orthopedic nurse.

Diagnostic Tests, Routine↗
PubMed2000

Abrasive waterjet peening: a new method of surface preparation for metal orthopedic implants.

Abrasive waterjet (AWJ) peening is a new mechanical surface treatment process envisioned for use on metal orthopedic implants. The process utilizes an abrasive waterjet to simultaneously texture and work harden the surface of a metal substrate through controlled hydrodynamic erosion. In this study, a titanium alloy (Ti6Al4V) was subjected to AWJ peening over a range of parametric conditions. The textured surfaces were quantified in terms of the apparent interdigitation volume (V(i)), the effective stress concentration factor (K(t)) posed by the surface topography, and the magnitude of residual stress (sigma(r) ). Topographical features of the prepared surfaces were determined using contact profilometry, and X-ray diffraction was used in evaluating the in-plane residual stress. It was found that a large range in V(i) (9.4-43.8 microm(3)/microm(2)) and K(t) (1.3-2.7) are available through selection of the AWJ peening process parameters. Furthermore, a compressive residual stress (-409 +/- sigma(r) +/- -33) was found to result within the surface of the Ti6Al4V substrates regardless of treatment conditions. When compared to a titanium plasma spray coating used for cementless fixation, the AWJ peened Ti6Al4V exhibited a surface topography with significantly lower effective stress concentration and higher compressive residual stress. Based on results from this study, AWJ peening may serve as a new method of surface treatment for metal orthopedic implants, which supports the development of stable primary fixation and simultaneously enhances the component fatigue strength.

Alloys↗
PubMed1997

Off-the-shelf orthopedic footwear for people with rheumatoid arthritis.

OBJECTIVES: To assess the effectiveness of off-the-shelf orthopedic footwear for people with rheumatoid arthritis (RA) reporting chronic foot pain, in terms of self-reported pain and physical function, as well as objectively measured gait variables using an electric footswitch walkway. METHODS: A small, randomized, controlled trial followed by a larger repeated measures analysis was used. RESULTS: The control group (n = 15) demonstrated no significant changes over a 2-month period in pain, physical function, or gait scores. In contrast, after supply of the footwear both the original footwear group (n = 15) and the control group demonstrated significant improvements, with small to large effect sizes, in weight-bearing pain scores, physical function, gait velocity, and gait stride length without increases in use of arthritis medications or walking aids. CONCLUSION: These data suggest that off-the-shelf orthopedic footwear is beneficial for people with RA even when subjects were unselected on basis of age, sex, disease duration, or disability as measured by the Stanford Health Assessment Questionnaire.

Activities of Daily Living↗
PubMed2002

An investigation of the cytotoxicity and histocompatibility of in situ forming lactic acid based orthopedic biomaterials.

The cytotoxicity and biocompatibility of polymer networks prefabricated from multifunctional lactic acid based oligomers that are being developed for orthopedic applications were assessed through in vitro cytotoxicity analysis and subcutaneous implantation. After 7 and 14 days, no significant difference was observed in the relative viability or alkaline phosphatase activity of primary rat calvarial osteoblasts cultured in the presence or absence of degrading polymer networks, indicating that the degradation products had no detrimental effect on the function or activity of the cultured cells. The tissue response to preformed lactic acid networks implanted in rats consisted of a mild inflammatory response with an increase in fibrous capsule thickness and inflammation correlating with faster degrading polymer compositions. This relatively neutral response is indicative of a biocompatible, degradable polymer that has potential medical applications. Finally, porous scaffolds were implanted subcutaneously in rats, and vascularized fibrous tissue infiltration was highly dependent on the scaffold porosity and architecture. This finding indicates that an in situ forming porous scaffold of this composition may support the infiltration of surrounding vascularized tissue, and thus be applicable to orthopedic treatments of large bone defects.

Alkaline Phosphatase↗
PubMed1995

Evaluation of poly(DTH carbonate), a tyrosine-derived degradable polymer, for orthopedic applications.

The polymerization of desaminotyrosinetyrosylhexyl ester (DTH) with phosgene gives rise to poly(DTH carbonate), a new pseudopoly(amino acid). To evaluate the performance of this bioabsorbable material in orthopedic applications, the tissue responses elicited by compression-molded pins of poly(DTH carbonate) and clinically used polydioxanone pins (PDS; Orthosorb) were compared. The two types of pins were implanted in the paravertebral muscle and in the metaphyseal proximal tibia and distal femur of 10 White New Zealand Rabbits for 1, 2, 4, and 26 weeks. The tissue response was evaluated using histologic staining of soft- and hard-tissue sections, fluorescent bone marker of incorporation, and backscattered electron imaging. In soft tissue, both poly(DTH carbonate) and PDS elicited a mild inflammatory response resulting in encapsulation. During the disintegration phase, the PDS implants triggered a foreign body response involving the phagocytosis of polymeric debris by histiocytes and giant cells. No such response was observed for poly(DTH carbonate). In hard tissue, close bone apposition was observed throughout the 26-week test period for poly(DTH carbonate) implants. At the 26-week time point, the poly(DTH carbonate) implants exhibited surface erosion and were penetrated by new bone. In contrast, an intervening fibrous tissue layer was always present between the PDS pins and the bone. At 26 weeks, the PDS implants had partially resorbed and a foreign body response characterized by infiltration in several of the implantation sites. This study indicates that poly(DTH carbonate) and PDS exhibit fundamentally different interactions with hard tissue, and that poly(DTH carbonate) is a promising orthopedic implant material.

Absorption↗
PubMed2006

Laser-deposited Ti-Nb-Zr-Ta orthopedic alloys.

The complex quaternary Ti-35Nb-7Zr-5Ta orthopedic alloy has been successfully deposited from a powder feedstock consisting of a blend of elemental titanium, niobium, zirconium, and tantalum powders, using the laser engineered net-shaping (LENStrade mark) process. In the as laser-deposited form, these alloys exhibit a substantially higher tensile strength as compared with more conventionally processed counterparts of similar composition, while maintaining excellent ductility and a low modulus. Furthermore, the as-deposited alloys appear to exhibit a <001> texture, with a substantially large number of grains of the beta phase aligning one of their <001> axes nearly normal to the substrate or parallel to the growth direction. The microstructure of the as-deposited as well as tensile-tested alloys have been characterized in detail using scanning electron microscopy (SEM), orientation microscopy (OM), and transmission electron microscopy (TEM). Formation of a high density of shear bands, possibly arising from slip localization due to precipitates of the omega phase in the beta matrix, is clearly evident in the tensile-tested sample. The enhanced tensile strength and low modulus in these laser-deposited alloys coupled with the ability to form near-net shape components makes LENS an attractive processing technology for orthopedic implants.

Alloys↗
PubMed1981

Efficacy of CT scanning in a group of 174 patients with orthopedic and musculoskeletal problems.

One hundred and seventy-four patients with orthopedic and musculoskeletal problems received computed tomography (CT) scans between January 1979 and July 1980. There were 34 trauma patients, 35 patients with known or suspected primary tumors, 20 patients with metastases, 18 patients with suspected spinal stenosis, 25 patients with disc problems, five patients with infections, 13 children with congenital anomalies, and 24 patients with miscellaneous problems. The CT scans proved useful in all the pediatric cases, 97% of the trauma patients, and in the majority of patients with tumors. It appears that absolute indications for CT scanning in orthopedic patients include acute trauma to the spine, pelvis, hip, and shoulder girdles as well as in children with congenital spinal anomalies. Relative indications include determining the extent of the tumor and also aiding in the correct approach for biopsying a lesion.

Adolescent↗
PubMedDate not supplied

Pharmacokinetics of ampicillin, sulbactam and cefotiam in patients undergoing orthopedic surgery.

As perioperative prophylaxis for major orthopedic operations 81 patients were given the fixed combination of ampicillin (1 g)/sulbactam (0.5 g) or cefotiam (2 g) as short infusions. The three beta-lactams were rapidly distributed into the different tissues and their pharmacokinetic profiles were found to be very similar. It was noteworthy that ampicillin, sulbactam and cefotiam penetrated within minutes, not only into skin, fat and muscles, but also into bone. Thus 0.25 h after starting the infusion the following mean concentrations were measured in bone: 21.8 +/- 10.5 mg/kg ampicillin, 4.9 +/- 2.2 mg/kg sulbactam and 19.4 +/- 10.6 mg/kg cefotiam. For a period of at least 2 h the concentrations measured in serum and in the different tissues affected by the operation (skin, fat, muscle, bone) were above the MICs for pathogens which are involved in postoperative wound infections. On the basis of pharmacokinetic data, ampicillin/sulbactam and cefotiam seem about equally suitable for perioperative prophylaxis in major orthopedic operations.

Adult↗