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At least 739 records · Page 41Linked to original sources
PubMed1999

Does venous microemboli detection add to the interpretation of D-dimer values following orthopedic surgery?

The identification of risk factors for deep venous thrombosis (DVT) following orthopedic surgery remains unclear. We have investigated the relationship between plasma levels of D-dimer (DD), the presence or absence of microemboli 1 day after surgery, and the occurrence of DVT 7 days after total hip or knee replacement. The prevalence of DVT was 25 (13.3%) among 188 patients and was lower in 112 patients with DD < 2808 ng mL(-1) than in the 56 patients with higher DD levels: respectively, 8.0% vs. 21.4% (p < 0.05). D-dimer is not suitable for individual estimation of DVT risk. Microemboli were found in 112 (60%) of 186 subjects. The presence/absence or the frequency of the microemboli showed no relationship with the occurrence of DVT. Last, when evaluating the risk of DVT in orthopedic surgery, microemboli detection does not add to the interpretation of DD concentration.

Aged↗
PubMed1996

Orthopedic conditions of small ruminants. Llama, sheep, goat, and deer.

Diagnosis and treatment of diseases of the foot, infectious arthritis, angular limb deformities, patellar luxation, tendon contracture and injuries, and fractures encountered in sheep, goats, llamas, and deer are reviewed. These species share similar orthopedic problems to cattle, but management conditions, particularly for pet animals, may place special demands on the veterinarian treating these disease conditions. The mild temperament and relatively small body size of these animals make them excellent candidates for treatment of orthopedic problems often not amenable to practical treatment in larger or more fractious animals.

Animals↗
PubMed1992

Dental and orthopedic effects of high-pull headgear in treatment of Class II, division 1 malocclusion.

In the present study a prospective cephalometric investigation was undertaken to examine the skeletal and dental effects of the high-pull extraoral appliance, when the resultant force was directed through the level of trifurcation of the maxillary molars. Twelve adolescent patients with Class II, Division 1 malocclusions were selected for the study. Each patient wore the headgear for a 6-month period, an average of 12 hours a day. A group of untreated adolescent patients with Class II, Division 1 malocclusions who were in a similar age range, as well as skeletal and dental characteristics were chosen as controls. Lateral cephalometric films were taken before and after the 6-month treatment period, and before and after the observation period in the control group of patients. Our data indicate that by directing the force of the headgear approximately through the center of resistance of the maxillary molars, it is possible to accomplish simultaneously a substantial distal movement of the molars (2.6 +/- 0.6 mm), as well as significant intrusion (0.54 +/- 0.54 mm). In addition, our results demonstrate that the applied force of 500 gm was sufficient to initiate maxillary orthopedic changes in the treated patients. These changes include relative restriction of horizontal and vertical maxillary growth, as well as distal movement (mean: 0.8 mm) of the maxillary anterior border in the treatment group relative to an untreated control group. Such orthopedic changes have been previously described only in association with much higher force levels.

Adolescent↗
PubMed1997

Timing for effective application of anteriorly directed orthopedic force to the maxilla.

Class III malocclusion with retrusive maxilla can be orthopedically corrected in the deciduous and mixed dentition, with reverse-pull headgear in combination with rapid palatal expansion. The literature recommends this procedure be carried out before the patient is 8 years old to obtain the optimal orthopedic result. This statement, however, has not been supported by scientific data. The current study examined the treatment effects of patients younger than 8 years old (5 to 8 years) and patients older than 8 years old (9 to 12 years). Thirty patients treated with maxillary protraction and expansion in the Department of Children's Dentistry and Orthodontics, University of Hong Kong were included in this study. Cephalometric radiographs were taken 6 months before the initiation of treatment (T(0)), at the initiation of treatment (T1), and after 6 months of treatment (T2). In this way, (T(2)-T1) represented cephalometric changes during the treatment period and (T1-T0) represented 6 months of growth changes without treatment. Experimental subjects served as their own control in this study. A grid system consisting of maxillary occlusal plane (OL) and a line perpendicular to OL through sella (OLp) was used for linear measurements. A total of 15 linear and 3 angular cephalometric measurements were made. A multivariate analysis of variance (MANOVA), which used age and treatment time as its factors, was used to determine effect of age and/or treatment on each cephalometric parameter. Results indicated strikingly similar therapeutic response between the younger and older age groups. These data suggest that similar skeletal response can be obtained when maxillary protraction was started either before age 8 (5 to 8 years) or after age 8 years (8 to 12 years).

Aging↗
PubMed1997

Angiogenesis and osteogenesis in an orthopedically expanded suture.

The purpose of this study was to examine the angiogenic and the subsequent osteogenic responses during a 96-hour time-course after sutural expansion. Fifty rats were divided into: (1) a control group that received only angiogenic induction through injection of 5 ng/gm recombinant human endothelial cell growth factor (rhECGF); (2) an experimental group that received orthopedic expansion and rhECGF; (3) a sham group that received expansion and sodium chloride (NaCl) injection; and (4) a baseline group that received no expansion or injection. All rats were injected with 3H-thymidine (1.0 microCi/gm) 1 hour before death to label the DNA of S-phase cells. Demineralized sections (4 microm thick) were stained with hematoxylin and eosin. Angiogenesis and cell migration were analyzed with a previously established cell kinetics model. Analysis of variance was used to test the hypothesis that enhancement of angiogenesis stimulates reestablishment of osteogenic capability. Blood vessel number, area, and endothelial cell-labeled index significantly increased in experimental groups, but no difference was found between control and baseline groups. Labeled-pericyte index and activated pericyte numbers in the experimental group were also higher than in the sham groups. These results show that supplemental rhECGF enhances angiogenesis in expanded sutures but not in nonexpanded sutures. Data also suggest that pericytes are the source of osteoblasts in an orthopedically expanded suture.

Analysis of Variance↗
PubMed1998

Effect of early orthopedic intervention on hemifacial microsomia patients: an approach to a cooperative evaluation of treatment results.

The purpose of the present study was to analyze the effects of early orthopedic intervention in patients with hemifacial microsomia, clinically as well as radiologically, by computed tomographic examination to assess soft and hard tissue temporomandibular joint changes. Five patients, one with mandibular dysostosis, one with otomandibular dysostosis, two with Goldenhar syndrome, and one with a surgically revised fibroma of the right mandible that was reconstructed by a costochondral graft, were treated by means of an activator functional appliance. During functional appliance treatment, all patients showed improvement of function and occlusion, and facial asymmetry was reduced. Spiral computed tomographic examination before and during treatment provided data on the bony and muscular deficiencies. The volume and density of the lateral pterygoid muscle was measured with the standard computed tomography software. Evaluation of soft and hard tissue conditions before treatment has shown that the most important factor "lack of soft tissues" can be compensated by excellent cooperation during functional therapy. Pretreatment volume of the affected lateral pterygoid muscle in all patients was significantly smaller than on the unaffected side. In three patients, volume measurements between 4 and 8 years demonstrated that the lateral pterygoid muscle on the affected side had a third, less than a third, and a fifth of the volume of the unaffected side. Although increase, stability, and decrease of the ratio of left and right condylar dimension, muscular volume, and density were found, long-term prognosis cannot be given in the cases with extreme muscular deficiencies after cessation of growth. Prepubertal orthopedic treatment success is a desirable and feasible presurgical or nonsurgical treatment goal for the interdisciplinary team approach. From a study of the pathologic, we learn much about the normal.

Child↗
PubMed2002

Comparison of the morphine-sparing effects of diclofenac sodium and ketorolac tromethamine after major orthopedic surgery.

STUDY OBJECTIVES: To compare the efficacy of diclofenac sodium with ketorolac tromethamine in reducing postoperative morphine use after major orthopedic surgery. DESIGN: Double-blind, randomized, placebo-controlled study. SETTING: Major teaching institution. PATIENTS: 102 ASA physical status II patients undergoing hip and knee replacement with general anesthesia. INTERVENTIONS: Before induction of anesthesia, patients were randomly allocated to receive intravenously either diclofenac sodium 75 mg (Group D), ketorolac tromethamine 60 mg (Group K), or placebo (Group P). Patient-controlled analgesia was supplied postoperatively using morphine. MEASUREMENTS: Visual analog scale (VAS), verbal pain score (VPS), sedation score, frequency of opioid side effects, and morphine consumption were recorded every 4 hours. MAIN RESULTS: There was a highly significant downward trend for VAS, VPS, and sedation scores over time, p = 0.001. The mean VAS and VPS scores were significantly lower in Groups D and K compared with Group P at time 0, p = 0.009 and 8 hours, p = 0.026. The mean (SD) 24-hour morphine requirements were 36.3 mg (16.9), 47.2 mg (34.9), and 51.6 mg (22.2) for Groups D, K, and P, respectively, p = 0.032. Fewer patients suffered from postoperative nausea and vomiting in the treatment groups (Groups D and K) compared with Group P (9, 8, and 19, respectively), p < 0.05. Fewer patients also suffered from pruritus in Groups D and K compared with Group P (3, 4, and 11, respectively), p < 0.01. CONCLUSIONS: Preoperative administration of intravenous diclofenac 75 mg or ketorolac 60 mg significantly reduces morphine requirements and associated side effects after major orthopedic surgery.

Adult↗
PubMed2002

Ferret orthopedics.

Orthopedic conditions requiring surgical intervention and correction frequently occur in the ferret patient. Elbow luxations and long bone fractures are among the most common syndromes affecting the ferret patient, which often presents in an emergency setting. Orthopedic conditions in the ferret, as in other mammalian species, are often the result of trauma. Surgical treatment including reduction and stabilization of the affected bony structure, combined with supervision and the recommended postoperative care, can provide a good prognosis to return to normal function for the ferret.

Animals↗
PubMed2003

Robust registration for computer-integrated orthopedic surgery: laboratory validation and clinical experience.

In order to provide navigational guidance during computer-integrated orthopedic surgery, the anatomy of the patient must first be registered to a medical image or model. A common registration approach is to digitize points from the surface of a bone and then find the rigid transformation that best matches the points to the model by constrained optimization. Many optimization criteria, including a least-squares objective function, perform poorly if the data include spurious data points (outliers). This paper describes a statistically robust, surface-based registration algorithm that we have developed for orthopedic surgery. To find an initial estimate, the user digitizes points from predefined regions of bone that are large enough to reliably locate even in the absence of anatomic landmarks. Outliers are automatically detected and managed by integrating a statistically robust M-estimator with the iterative-closest-point algorithm. Our in vitro validation method simulated the registration process by drawing registration data points from several sets of densely digitized surface points. The method has been used clinically in computer-integrated surgery for high tibial osteotomy, distal radius osteotomy, and excision of osteoid osteoma.

Adolescent↗
PubMed2004

Awareness of activity limitations and prediction of performance in patients with brain injuries and orthopedic disorders.

The aim of this study was to compare the accuracy of performance predictions in experimental tasks with patients' awareness of activity limitations. Participants were 24 patients with brain injuries (i.e., traumatic brain injury and cerebrovascular disorders) and 22 patients with orthopedic disorders. Prediction of performance was examined in a memory task (word list learning) and a motor task (finger tapping). Awareness of activity limitations was measured by comparing patients' self-ratings and staff ratings in the Patient Competency Rating Scale (PCRS). Results for the PCRS showed that patients with orthopedic disorders underestimated and patients with brain injuries (i.e., patients with TBI) overestimated their level of functioning in the total scale and the social/emotional subscale in comparison to staff ratings. Both patient groups agreed with staff ratings in physical/basic self-care items. In the predicted performance tasks a similar pattern could be observed: None of the groups showed an overestimation of performance in the motor task, whereas patients with brain injuries overestimated their competency in the memory task. However, the agreement between both awareness measures (PCRS, predicted performance) was only low, which indicates that they might measure different aspects or levels of self-awareness.

Awareness↗
PubMed2006

From natural products to polymeric derivatives of "eugenol": a new approach for preparation of dental composites and orthopedic bone cements.

Polymers with eugenol moieties covalently bonded to the macromolecular chains were synthesized for potential application in orthopedic and dental cements. First, eugenol was functionalized with polymerizable groups. The synthetic methods employed afforded two different methacrylic derivatives, where the acrylic and eugenol moieties were either directly bonded, eugenyl methacrylate (EgMA), or separated through an oxyethylene group, ethoxyeugenyl methacrylate (EEgMA). A typical Fisher esterification reaction was used for the synthesis of EgMA and EEgMA, affording the desired monomers in 80% yields. Polymerization of each of the novel monomers, at low conversion, provided soluble polymers consisting of hydrocarbon macromolecules with pendant eugenol moieties. At high conversions only cross-linked polymers were obtained, attributed to participation of the allylic double bonds in the polymerization reaction. In addition, copolymers of each eugenol derivative with ethyl methacrylate (EMA) were prepared at low conversion, with the copolymerization reaction studied by assuming the terminal model and the reactivity ratios determined according to linear and nonlinear methods. The values obtained were r(EgMA) = 1.48, r(EMA) = 0.55 and r(EEgMA) = 1.22, r(EMA) = 0.42. High molecular weight polymers and copolymers were obtained at low conversion. Analysis of thermal properties revealed a T(g) of 95 degrees C for PEgMA and of 20 degrees C for PEEgMA and an increase in the thermal stability for the eugenol derivatives polymers and copolymers with respect to that of PEMA. Water sorption of the copolymers was found to decrease with the eugenol derivative content. Both monomers EgMA and EEgMA showed antibacterial activity against Streptococcus mutans, producing inhibition halos of 7 and 21 mm, respectively. Finally, cell culture studies revealed that the copolymers did not leach any toxic eluants and showed good cellular proliferation with respect to PEMA. This study thus indicates that the eugenyl methacrylate derivatives are potentially good candidates for dental and orthopedic cements.

Agar↗
PubMed1997

Masticatory muscle pain before, during, and after treatment with orthopedic protraction headgear: a pilot study.

Protraction headgear has been used in conjunction with a palatal expansion appliance to correct Class III malocclusion with maxillary deficiency and/or mandibular prognathism. In general, 800 gm of orthopedic force is used to protract the maxilla, and 75% of this force is transmitted to the temporomandibular joint (TMJ) area via the mandible. The effect of this heavy intermittent force on the TMJ has not been reported in the literature. The objectives of this study were to determine the level of masticatory muscle pain and EMG activity in patients treated with maxillary protraction headgear. Ten patients with skeletal Class III malocclusion whose treatment plan called for maxillary protraction headgear treatment participated in this study. Nocturnal masticatory muscle activity was determined using a portable electromyographic (EMG) recording device. Subjects wore the EMG device 14 nights before treatment, 14 nights during treatment, and 14 nights 1 month after active treatment. Masticatory muscle pain level was determined by muscle palpation, scored on a scale of 0 to 3 each period, according to the method of Gross and Gale. The examiner followed a sequence outlined by Burch to examine the masticatory muscles. Results showed no significant differences for masticatory muscle activities before, during, and after treatment. Only a few patients experienced level 1 masticatory pain during treatment. None of the patients experienced masticatory muscle pain 1 month after treatment. These results demonstrate no significant increase in masticatory muscle activity or muscle pain associated with orthopedic treatment using maxillary protraction headgear.

Adolescent↗
PubMed1999

Stability of implants as anchorage for orthopedic traction.

The aim of this animal study was to investigate the stability of osseointegrated fixtures when used as anchorage for orthopedic traction with extreme force magnitude. Three Brånemark fixtures were placed in the left zygomatic arch and three in the right of five adult dogs. An orthopedic nonaxial force of 5 N was applied using an intraoral coil system. The initial displacement immediately after force application was measured by means of speckle interferometry. After 2 months of continuous loading, bone adaptation and mineralization around all implants were analyzed. All the loaded implants were immobile. Significant marginal bone loss at the abutment-fixture interface (<1 mm) was observed around each loaded fixture implant. Bone remodeling was significantly more pronounced at the tension side of the implants, irrespective of fixture length. Radiographical and histological analyses showed bone with normal trabecular pattern around the implants.

Adaptation, Physiological↗
PubMed2003

Biomechanics of craniofacial sutures: orthopedic implications.

Sutures are soft connective tissue articulations between craniofacial bones. Suture mechanics deals with patterns of mechanical stress experienced in sutures resulting from natural activities such as mastication and exogenous forces such as orthopedic loading. Patterns of sutural mechanical stress can be delineated readily as sutural strain using strain gages attached over the suture. In mastication, complex sutural strain patterns have been elucidated in a few species. Mechanical stresses are not transmitted in the skull as a continuing gradient, for different sutures are capable of redefining a propagating mechanical force as predominately tensile or compressive strain. Exogenous mechanical forces with engineering waveforms such as static and sine wave at different frequencies induce corresponding waveforms and rates of sutural strain, providing the basis for applying novel mechanical stimuli to engineer sutural growth. The available data on suture mechanics converge to a hypothetical theme that mechanical forces regulate sutural growth by inducing sutural mechanical strain. Various orthopedic therapies, including headgear, facemask, and functional appliances may induce sutural strain, leading to modification of otherwise natural suture growth.

Biomechanical Phenomena↗
PubMed2006

Surgically assisted rapid maxillary expansion compared with orthopedic rapid maxillary expansion.

The objective of this study is to evaluate and compare the dental and skeletal changes occurring during orthopedic rapid maxillary expansion (RME) and surgically assisted RME during the active phase of treatment. The study was divided into two groups. The first group of 10 patients (six males, four females; mean age, 15.51 years) received orthopedic RME. The second group of 10 patients (seven males, three females; average age: 19.01 years) received surgically assisted RME (SARME). All patients underwent maxillary expansion with occlusal-coverage Hyrax-type expanders activated two turns a day (0.25 mm per turn). Preexpansion and postexpansion lateral and posteroanterior cephalograms were obtained for each patient. Statistically significant differences between the SARME and RME groups were found in the N-ANS, SN/ PP (P < .01) and SNA, SNB, mandibular dentoalveolar, and maxillary bony base (P < .05) measurements. Clinically, there is no difference in patient response between the RME and SARME groups. The only difference between the groups was their indication for RME or SARME, which is based on the age and skeletal maturation of the patient.

Adolescent↗
PubMed2006

[Orthopedic expansion of the maxilla].

This paper evaluates maxillary expansion by synthesizing the scientific literature, focusing its role in treatment of maxillary insufficiency, buccal cross bites, and deviations in mandibular closure as well as its effectiveness in correcting a lack of harmony between tooth and jaw size. By its creation of maxillary bone "capital" it facilitates treatment of arch length discrepancies in an environment of periodontal health. And by restoring the maxilla to normal size it improves the orthopedic effectiveness of Class II treatment of mandibular advancement appliances. In a similar fashion rapid palatal expansion, by relaxing circum-maxillary sutures, prepares the way for maxillary advancement in Class III cases with masks of Delaire or Petit. And, by broadening the floor of the nose, palate splitting improves nasal airflow and helps mouth breathers learn how to breathe through their noses. Most authors emphasize the benefits of early intervention through truly orthopedic movement that eliminates tipping of posterior teeth and reduces the risk of buccal fenestration.

Age Factors↗
PubMed1988

An experimental orthopedic treatment of the rat mandible using a functional appliance alters the fibre and myosin types in masticatory muscles.

Masticatory muscles mediate the action of functional orthopedic appliances on mandible growth. When young rats were treated for four weeks with a postural hyperpropulsor of the mandible, an appliance designed to increase condylar cartilage growth rate, the proportion of fast non-fatigable fibres in the lateral pterygoid muscle increased significantly. Concomitantly, the amount of slow-myosin light chains increased in fibre extracts. This slow myosin originated from IIA fibres. By functional orthopedic treatment, the lateral pterygoid muscle was enriched in less fatigable fibres; the changes observed in the lateral pterygoid muscle were close to changes observed in other muscles after training.

Adenosine Triphosphatases↗
PubMed2002

Orthopedic pitfalls in the ED: radiographically occult hip fracture.

Acute hip fracture is among the most commonly encountered orthopedic injuries seen by the emergency physician. The majority of these fractures can be readily diagnosed on the basis of clinical findings and plain radiographs. When initial films are negative or equivocal, but a high clinical suspicion exists for a hip fracture, additional diagnostic studies need to be performed because significant morbidity can result from ambulation on an unrecognized fracture. The emergency physician needs to remain vigilant for this potential orthopedic pitfall. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency practitioner.

Aged↗