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PubMed2005

Reliability of videotaped observational gait analysis in patients with orthopedic impairments.

BACKGROUND: In clinical practice, visual gait observation is often used to determine gait disorders and to evaluate treatment. Several reliability studies on observational gait analysis have been described in the literature and generally showed moderate reliability. However, patients with orthopedic disorders have received little attention. The objective of this study is to determine the reliability levels of visual observation of gait in patients with orthopedic disorders. METHODS: The gait of thirty patients referred to a physical therapist for gait treatment was videotaped. Ten raters, 4 experienced, 4 inexperienced and 2 experts, individually evaluated these videotaped gait patterns of the patients twice, by using a structured gait analysis form. Reliability levels were established by calculating the Intraclass Correlation Coefficient (ICC), using a two-way random design and based on absolute agreement. RESULTS: The inter-rater reliability among experienced raters (ICC = 0.42; 95%CI: 0.38-0.46) was comparable to that of the inexperienced raters (ICC = 0.40; 95%CI: 0.36-0.44). The expert raters reached a higher inter-rater reliability level (ICC = 0.54; 95%CI: 0.48-0.60). The average intra-rater reliability of the experienced raters was 0.63 (ICCs ranging from 0.57 to 0.70). The inexperienced raters reached an average intra-rater reliability of 0.57 (ICCs ranging from 0.52 to 0.62). The two expert raters attained ICC values of 0.70 and 0.74 respectively. CONCLUSION: Structured visual gait observation by use of a gait analysis form as described in this study was found to be moderately reliable. Clinical experience appears to increase the reliability of visual gait analysis.

Adolescent↗
PubMed1994

Impact of postoperative radiation therapy and other perioperative factors on outcome after orthopedic stabilization of impending or pathologic fractures due to metastatic disease.

PURPOSE AND METHODS: We reviewed 64 orthopedic stabilization procedures in 60 consecutive patients diagnosed with metastatic disease to previously unirradiated femurs, acetabula, and humeri with pathologic or impending pathologic fracture. Thirty-five patients who received adjuvant postoperative radiation therapy were compared with 29 patients who were treated with surgery alone. Many potential perioperative and tumor prognostic variables were evaluated. RESULTS: On univariate analysis, surgery plus radiation therapy and prefracture functional status were the only significant predictors of patients who achieved normal use of the extremity (with or without pain) after surgery; on Cox multivariate analysis, only postoperative radiation therapy was significant (P = .02). Surgery-related factors such as use of methylmethacrylate, location of fracture, and type of surgery were not associated with improved functional status. The estimated probability of achieving normal use of the extremity (with or without pain) any time was 53% for postoperative radiation therapy versus 11.5% for surgery alone (P < .01). Second orthopedic procedures to the same site were more frequent in the group that received surgery alone. The actuarial median survival duration of the surgery-alone group was 3.3 months, compared with 12.4 months for the postoperative radiation therapy group (P = .02). CONCLUSION: While this study is limited by possible unaccountable selection biases, only postoperative radiation therapy was associated with patients regaining normal use of their extremity (with or without pain) and undergoing fewer reoperations to the same site. The improved overall survival associated with postoperative radiation therapy may represent selection bias.

Adult↗
PubMed2001

Orthopedic problems in sport climbing.

Sport climbing is associated with unique upper- and lower-limb injuries involving predominantly the hand, elbow, and shoulder, and to a lesser extent the foot. Many pathologic conditions are limited to sport climbing. Physicians treating sport climbers should be aware of these unique injuries and overuse syndromes. This article presents an overview of orthopedic problems (injuries, overuse syndromes, and fractures) resulting from sport climbing. Sport climbing is defined in the context of existing mountain sports, and its characteristics and technical terms are presented. The etiology, diagnosis, and specific treatment for orthopedic problems associated with sport climbing are described.

Athletic Injuries↗
PubMed2005

Role of linezolid in the treatment of orthopedic infections.

Gram-positive organisms, particularly staphylococci and streptococci, are responsible for the majority of bone and joint infections. The rising incidence of antimicrobial resistance among Staphylococcus aureus, coagulase-negative staphylococci and enterococci means that novel antibiotics with unique mechanisms of antimicrobial activity are needed, especially in orthopedic infections. Linezolid is the first of the oxazolidinones, a new class of antibacterial agents particularly effective against Gram-positive infections including methicillin- and vancomycin-resistant strains. With an excellent oral bioavailability and acceptable safety profile, linezolid offers a valuable alternative to more traditional therapies, such as glycopeptides. No large randomized trials have been published on its use in patients with orthopedic infections, but early results are encouraging. Reported adverse events, especially bone marrow suppression and optic neuropathy seen with prolonged administration, mean that treatment of such patients must be undertaken with careful follow-up of laboratory tests. Until now, little resistance has been reported.

Acetamides↗
PubMed2005

Infant orthopedics in UCLP: effect on feeding, weight, and length: a randomized clinical trial (Dutchcleft).

OBJECTIVE: To study the effects of infant orthopedics (IO) on feeding, weight, and length. DESIGN: Prospective two-arm randomized controlled trial in three academic Cleft Palate Centers. Treatment allocation was concealed and performed by means of a computerized balanced allocation method. SETTING: Cleft Palate Centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands. PATIENTS: Infants with complete unilateral cleft lip and palate (UCLP), no other malformations. INTERVENTIONS: One group (IO+) wore passive maxillary plates during the first year of life, but the other group (IO-) did not. All other interventions were the same for both groups. MAIN OUTCOME MEASURES: Bottle feeding velocity (mL/min) at intake, 3, 6, 15, and 24 weeks (T0 to T24); weight-for-age, length-for-age, and weight-for-length using z scores; reference values from the Netherlands' third nationwide survey on growth. RESULTS: Feeding velocity increased with time from 2.9 to 13.2 mL/min in the IO- group and from 2.6 to 13.8 mL/min in the IO+ group; no significant differences were found between groups. Weight-for-age, length-for-age, and weight-for-length (z scores) did not differ significantly between groups, but overall the infants with unilateral cleft lip and palate in both groups had significantly lower mean z scores for weight-for-age and height-for-age than the reference during the first 14 months, and had lower mean values for weight-for-length after soft palate closure. CONCLUSION: Infant orthopedics with the aim of improving feeding and consequent nutritional status in infants with unilateral cleft lip and palate can be abandoned.

Body Height↗
PubMed1993

Morphologic effect of preoperative maxillofacial orthopedics (T-traction) on the maxilla in unilateral cleft lip and palate patients.

Sixty-eight children born with complete unilateral cleft lip and palate were studied using dental casts taken at ages 0-0.1; 0.2-0.4; and 0.5-0.6 years of age. They were all treated with preoperative maxillofacial orthopedics using an external device (T-traction). The treatment was started after the first model was taken. Dental casts were analyzed regarding the morphology of the cleft region and the maxillary segments before and after treatment. The measurements were compared with measurements on dental casts of nontreated cleft children of similar age. The results suggest that a more normal anatomy of the cleft region occurs during the first 6 months of life whether preoperative maxillofacial orthopedics (T-traction) is used or not. However, this normalized growth seems to occur faster with the T-traction.

Cleft Lip↗
PubMed1995

Transverse maxillary arch changes with the use of preoperative orthopedics in unilateral cleft palate infants.

A retrospective clinical study, using a reflex microscope, measured arch widths, palatal shelf widths, cleft widths, and palatal shelf angulation from 26 sets of plaster models of infants' maxillary arches at birth, and at 3 and 6 months. All infants had unilateral clefts of the lip and palate. They were treated with active preoperative orthopedics until lip repair at 3 months and with a passive plate until palate repair. Cleft width significantly decreased during these periods, due to transverse growth, along with relative flattening of the palatal shelves. Arch width contracted slightly anteriorly, but remained stable posteriorly. Preoperative orthopedics may have helped these changes by removing the effects of the tongue action and allowing unrestricted growth of the palatal shelves.

Cephalometry↗
PubMed2003

A randomized prospective clinical trial of the effect of infant orthopedics in unilateral cleft lip and palate: prevention of collapse of the alveolar segments (Dutchcleft).

OBJECTIVE: To study the effect of infant orthopedics (IO) on maxillary arch form and position of the alveolar segments. DESIGN: Prospective two-arm randomized, controlled trial in parallel with three participating academic cleft palate centers. Treatment was assigned by means of a computerized balanced allocation method. SETTING: Cleft palate centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands. PATIENTS, PARTICIPANTS: Infants with complete unilateral cleft lip and palate and no other malformations. INTERVENTIONS: One group (IO+) wore passive maxillary plates during the first year of life; the other group (IO-) did not. All other interventions were the same. MAIN OUTCOME MEASURE(S): The presence of contact and/or overlap (collapse) between the maxillary segments at maxillary casts made shortly after birth, at 15, 24, 48, 58, and 78 weeks. Survival experience of contact and collapse with time as well as the frequencies of different arch forms and severity of collapse were evaluated. RESULTS: Comparable arch forms with no contact or overlap of the maxillary segments were seen at birth in both groups. With time the frequency of collapse increased, with no significant differences between groups. No significant group differences were found with respect to the survival experience of contact and collapse or for the severity of collapse at the end of the observational period. CONCLUSIONS: Infant orthopedics does not prevent collapse and can be abandoned as a tool to improve maxillary arch form.

Alveolar Process↗
PubMed2003

Orthopedically induced condylar growth in a patient with hemifacial microsomia.

OBJECTIVE: Hemifacial microsomia is a congenital abnormality that causes three-dimensional facial asymmetry, affection of the dental occlusion, and failure of growth of the midface in the growing child. This report outlines orthopedically induced condylar growth in a patient with hemifacial microsomia. PATIENT: A 7-year-old girl with hemifacial microsomia, complete absence of the left mandibular condyle, and severe facial asymmetry was treated orthopedically in an early stage by means of a functional appliance. Functional therapy was instituted to stretch the deficient soft tissues to guide and promote skeletal growth and stimulate the affected areas. The treatment was completed with fixed appliances. RESULTS: The effect of the therapy was an excessive change in condylar growth in the affected side. Facial asymmetry was corrected and a symmetric mouth opening was established. CONCLUSIONS: The treatment of patients with hemifacial microsomia should be initiated early enough so that the stimulus could in some degree normalize the deficient tissues and induce bone apposition, and in some cases surgical intervention could be avoided.

Activator Appliances↗
PubMed1983

Enzymatic determination of urinary glycosaminoglycans from orthopedic patients.

Crude glycosaminoglycan (GAG) fraction was directly precipitated with cetylpyridinium chloride without prior dialysis of urine of orthopedic patients. The crude GAG fraction was then fractionated with trichloroacetic acid (TCA). The TCA-insoluble peptide-bound GAG fraction thus obtained was treated with alkali to eliminate the peptide moiety for enzymatic analysis. The GAG compositions of this fraction and the TCA-soluble fraction were determined by digestion with mucopolysaccharidases (chondroitinase AC, chondroitinase B, chondroitinase C, heparitinase and Streptomyces hyaluronidase). When the amount of the crude GAG fraction was small, no significant amount of the TCA-insoluble peptide-bound GAG fraction was obtained. The GAG composition of this case was also determined by the same procedures after direct alkali-treatment of the crude GAG fraction. The data indicated that the proportion of the TCA-insoluble peptide-bound GAG fraction was very small. The alkali-treated TCA-insoluble peptide-bound GAG fraction contained a larger proportion of heparan sulfate than the TCA-soluble GAG fraction. It was clearly demonstrated that the patients with Werner's syndrome and mucopolysaccharidosis I-S (Scheie) excreted large amounts of hyaluronic acid and dermatan sulfate respectively, into urines. It was indicated in most cases that major urinary GAG were chondroitin 4-sulfate, chondroitin 6-sulfate plus chondroitin and heparan sulfate, while minor ones were dermatan sulfate and hyaluronic acid. In addition, the data suggested a wide range of the degree of desulfation or urinary GAG, and the presence of significant amounts of keratan sulfate plus acidic glycopeptides in the urinary GAG fractions. The present data provided more precise information on urinary GAG from orthopedic patients than those reported previously.

Adolescent↗
PubMed1988

The tip of the iceberg: psychiatric consultations on an orthopedic service.

One hundred and one consecutively admitted orthopedic patients with leg fractures participated in a study assessing psychiatric morbidity using the BSI- and SMAST-questionnaires. Patients identified as probable cases of psychopathology were then psychiatrically evaluated to establish diagnoses. It was determined that about 70 percent of the sample met the criteria for psychiatric diagnoses, with substance abuse being the leading group of disorders. The psychiatric consultation-liaison and orthopedic services remained blind to the research activities and continued to refer patients for psychiatric consultation when clinically necessary. Only six (5.9%) of the patients also participating in the study were referred for clinical consultation, and these appeared to have very obvious symptoms or complaints. The large majority of emotional distress remained unnoticed.

Fractures, Bone↗
PubMed1996

Screening for deep venous thrombosis in asymptomatic postoperative orthopedic patients using color Doppler sonography: analysis of prevalence and risk factors.

OBJECTIVE: The purpose of our study was to assess the prevalence and risk factors for sonographically detectable lower extremity deep venous thrombosis (DVT) in asymptomatic patients following major orthopedic surgery. SUBJECTS AND METHODS: We performed color Doppler sonography of the lower extremities in 474 asymptomatic patients following major hip or knee surgery. We determined the prevalence of lower extremity DVT and used stepwise logistic regression to identify factors predictive of DVT. All patients received routine prophylactic measures. RESULTS: The prevalence of DVT was 7%. Laterality of surgery, age, and gender were all independent predictors of DVT (p < or = .01): the odds of having DVT were 20 times higher in the leg that was operated upon than in the leg that was not; the odds of DVT rose by a factor of 1.5 per decade of life; and the odds of DVT were 3.4 times greater in men than in women. DVT was more common in patients who had received general rather than epidural anesthesia, with borderline significance (p = .06). The length of anesthesia and the joint involved (hip or knee) were not predictive of DVT (p > .10). CONCLUSION: Despite prophylaxis, DVT is a relatively common postoperative complication in patients who undergo major orthopedic procedures. Routine screening for DVT is warranted in asymptomatic patients who have undergone hip or knee surgery, and color Doppler sonography, despite its limitations, offers a reasonably accurate noninvasive method for screening these patients. Subsets of patients who are at particular risk include the elderly, male patients, and patients who have undergone general anesthesia. The low prevalence of DVT in limbs not operated upon suggests that routine screening may be limited to evaluating the affected limbs only, thus helping to minimize the cost of screening.

Aged↗
PubMed2006

Evaluation of epidural administration of morphine or morphine and bupivacaine for postoperative analgesia after premedication with an opioid analgesic and orthopedic surgery in dogs.

OBJECTIVE: To evaluate the analgesic efficacy of epidural administration of morphine or a morphine-bupivacaine combination administered before orthopedic surgery in dogs that received opioid premedication. DESIGN: Prospective, randomized, blinded, clinical study. ANIMALS: 36 healthy adult dogs that underwent elective orthopedic surgery on a pelvic limb. PROCEDURES: Each dog received 1 of 3 epidural treatments before surgery. Anesthetic and supportive care protocols were standardized. Dogs under going different surgical procedures were randomly allocated among the 3 treatment groups. Respiratory and cardiovascular variables, end-tidal isoflurane concentration, and requirements for rescue analgesia were monitored. Postsurgical analgesia was evaluated with a multiparametric pain scoring system and by determination of rescue analgesia requirements and cortisolemia. RESULTS: The morphine-bupivacaine combination was associated with lower values than morphine or a saline solution for intraoperative arterial blood pressure; minimum and maximum isoflurane requirements; and postoperative pain scores, rescue analgesia requirements, and plasma cortisol concentrations. Values obtained after administration of morphine alone were not significantly different from those obtained after administration of saline solution for most variables. CONCLUSIONS AND CLINICAL RELEVANCE: The preoperative epidurally administered morphine-bupivacaine combination induced better analgesia than morphine alone and should be considered for use in clinical patients. The degree of hemodynamic depression associated with the combination was considered acceptable for healthy patients undergoing elective surgery.

Analgesia, Epidural↗
PubMed1983

Early bone grafting in complete cleft lip and palate cases following maxillofacial orthopedics. I. The method and the skeletal development from seven to thirteen years of age.

The methods of preoperative orthopedics: a "T-traction" procedure for unilateral clefts and a combined premaxillary pressure and expansion procedure for bilateral clefts and of early alveolar bone grafting: the Nordin's "four-flap" technique, are described in detail. The subsequent effects of treatment according to those methods were studied with roentgencephalometric analysis in cleft patients from 7 to 13 years of age. They were divided into two unilateral and one bilateral complete cleft group, all having been early bone grafted. The unilateral groups were composed of one group of 39 children operated on during the period 1960-65 without preoperative "T-traction", and another group, of 46 children, operated on in 1965-72 after preoperative "T-traction". The bilateral group included 19 children operated on 1960-72 after preoperative orthopedics. The same degree of inhibited development of the facial skeleton as found in another Swedish early bone grafted cleft group was not present in our patients. The development of the skeletal profile in our bone grafted cases, especially those in the "T-traction" group, was well within the limits of non-grafted U.S. cases, but differed from non-clefts.

Adolescent↗
PubMed1990

The lymphocyte response to nickel salt in patients with orthopedic implants.

In this pilot study, 14 patients with different symptoms and signs in relation to orthopedic implants were compared with 12 asymptomatic patients to determine the in vitro lymphocyte response to nickel sulfate. We conclude that nickel allergy may explain some, but not most, of the local and generalized symptoms associated with orthopedic implants.

Adult↗
PubMed1991

Prevention in orthopedics.

Cogent data indicate a continuous increase in the incidence of orthopedic disease and trauma. Primary and secondary preventive measures should, when applicable, be recommended by the orthopedic profession to decision makers in the community, and should be reinforced by the health care programs.

Bone Diseases↗
PubMed1986

Three experimental designs testing orthopedic casting material strength.

Three methods for testing the comparative strength of orthopedic casts have been considered. Two of the tests, three-point-beam-bending and diametral compression, were expected to yield information about "material" strength, and a third simulated an actual cast yielding information about "structural" strength. In one study using these three methods, differences in strength were detected in the material tests, but not in the structural test. Thus, the authors believe that tests of material strength alone are insufficient to establish clinically relevant differences between the strength of orthopedic casts. Adequate testing must include structural tests like the cast-cylinder test described in this article if meaningful and clinically relevant conclusions are to be drawn regarding the comparative strength of the actual cast. Since both the three-point-beam-bending and diametral compression tests produced essentially the same results, both tests are probably not necessary. However, each of these two tests does serve to substantiate the results of the other.

Casts, Surgical↗
PubMed1998

Red blood cell transfusion practices in patients undergoing orthopedic surgery: a multi-institutional analysis.

This retrospective review analyzed and compared transfusion practices in patients undergoing orthopedic surgery in five Massachusetts hospitals with current practice guidelines; opportunities for improvement were identified. Patient-specific clinical information and data about transfusion practices were obtained from the medical records of 384 Medicare patients undergoing orthopedic surgery between January 1992 and December 1993. The number of patients who donated autologous blood preoperatively differed significantly among hospitals as did the number of autologous units that were unused. The number of blood units transfused at each transfusion event also differed significantly; some surgeons transfused > or =2 units in the majority of their patients, while others transfused 1 unit at a time. This variation in practice was not explained by differences in patients' clinical status. The mean pretransfusion hematocrit was higher for autologous versus allogeneic blood, suggesting more liberal criteria to transfuse autologous blood. Nearly half of all transfusion events were determined to have been potentially avoidable. Avoidable transfusions were also three to seven times more likely with autologous than with allogeneic blood. Significant inter-hospital differences existed in the number of elective surgery patients exposed to allogeneic blood. The major determinant of allogeneic blood use in these patients was the availability of autologous blood. Each additional autologous blood unit available decreased the odds of allogeneic blood exposure twofold. Differences in intraoperative and postoperative blood salvage use also were noted. These findings indicate that significant variations in practice exist. Comparative data enabled hospitals to identify and target specific areas for improvement.

Aged↗