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At least 883 records · Page 49Linked to original sources
PubMed1998

Evaluation of orthopedic testing of the low back for nonspecific lower back pain.

OBJECTIVE: To assess the value of some commonly used orthopedic tests used in evaluating nonspecific lower back pain where there are no demonstrable pathological or neurological deficits. DESIGN: Retrospective analysis of patient files. SETTING: Chiropractic teaching clinic, Royal Melbourne Institute of Technology. SUBJECTS: Five hundred sixty-four files of patients presenting to the above clinic with nonspecific lower back pain were analyzed. DATA ANALYSIS: The data were entered into a spreadsheet, contingency tables were created, and the data were analyzed using chi 2 tests. Statistical significance was set at p < .05. RESULTS: Kemp's and Yeoman's tests were most commonly positive, whereas Bonnet's, supported Adams' and axial compression tests showed relatively low positive results. The factors studied that affected the rate of positive responses were age, gender, pain site, duration and cause. The number of previous episodes of lower back pain had no effect on the positive test rates. CONCLUSION: For cases of nonspecific, mechanical lower back pain, orthopedic testing has limited clinical value once nerve root problems and pathologies have been ruled out. Kemp's and Yeoman's tests were the most frequently positive, and seemed to be the most useful in diagnosing nonspecific lower back pain. When selecting the most appropriate tests to use, one needs to take into account the patient profile and history.

Adolescent↗
PubMedDate not supplied

Orthopedic manifestation in a child with hyperimmunoglobulin E syndrome.

We report a 12-year-old girl with hyperimmunoglobulin E (HIE) syndrome who presented with genu vulgus of left knee, joint deformities involving both hands, and frequent fractures. She had had chronic eczema and recurrent skin and soft tissue infections since infancy, and was found to have a pneumatocele during admission. Immunologic abnormalities included extremely elevated serum IgE levels (18989 IU/ml) and cutaneous anergy to candida, purified protein derivative, and tetanus toxoid. The results of polymorphonuclear leukocyte function tests including the nitroblue tetrazolium test and chemotaxis were normal. A high index of suspicion for HIE syndrome should be given in patients with recurrent skin infections and orthopedic complaints. The physician should anticipate orthopedic problems in caring for patients with HIE syndrome, and optimal antibiotics prophylaxis should be used.

Arthrography↗
PubMed1998

Physical abuse of children: a review for orthopedic surgeons.

Statistics show that more than half the victims of child abuse have fractures. The orthopedic surgeon will often be the first person to identify a potentially abused child. In a series at Brenner Children's Hospital, 17% of abused children had a fracture as the initial manifestation of child abuse. For protection of the child, it is essential that the orthopedic surgeon recognize the signs of child abuse and make a referral to the appropriate child protection agency. In this review article, we discuss recognition of common types of child abuse and outline appropriate management of child abuse cases.

Burns↗
PubMedDate not supplied

Orthopedic management of osteopetrosis: results of a survey and review of the literature.

Osteopetrosis or Albers-Schonberg disease is a rare hereditary disorder of osteoclast function in which resorption of bone is diminished, resulting in abnormally dense bones. The condition is known to occur in at least four recognizable clinical patterns, each of which is variable. The optimal treatment of fractures and of bone deformity in these patients has not previously been made clear. To determine appropriate orthopedic management of the condition, we conducted a survey of the membership of the Pediatric Orthopedic Society of North America. The combined experience of 57 surgeons who treated 79 patients with osteopetrosis was compiled. Four femoral neck fractures treated by closed reduction and internal fixation had a satisfactory result, but three treated nonoperatively developed varus and required osteotomy. A total of 20 hips was treated for coxa vara by various means, none of which was free of complications. Valgus osteotomy, when used as the primary treatment for coxa vara, was the most consistently satisfactory procedure, whereas in situ pinning failed in two of three hips. Fourteen subtrochanteric fractures and 31 other fractures of the femur were treated. Good results were reported with traction or casting or both in the majority of those fractures. Twenty-nine tibia fractures were treated successfully, the majority by nonoperative means. Upper extremity fractures healed well with closed reduction and casting. Vertebral fractures, spondylolysis, and back pain were most frequently treated without surgery.

Adolescent↗
PubMed2002

Normalized cDNA libraries from a porcine model of orthopedic implant-associated infection.

Staphylococcal infections that result from an alteration in a patient's immune response at the surgical site are a major problem in procedures that incorporate biomaterials in trauma surgery and joint replacement. Diagnosis of infection based on pathogen detection is difficult and exacerbated by increasing numbers of partially or totally resistant strains of nosocomial pathogens, particularly Staphylococcus aureus. Expression profiling of a host's cellular immune response could facilitate the identification of the pathways involved in pathogen recognition and eradication and could lead to more rational design of drugs and therapies. To this end, we constructed and characterized ten individually tagged and directionally cloned cDNA libraries from peripheral blood cells (PBC), spleen (Sp), thymus (Th), lymph node (LN), and bone marrow (BM) from immunologically naive and challenged pigs as part of an implant-associated orthopedic model of deep infection. Three of these libraries were normalized at C(0)(t) values 5, 10, 20, and 30. The libraries comprise more than 20 million primary transformants with an average insert length >1.4 kb. Cluster analysis of 7620 ESTs revealed 1029 clusters containing an average of 3.6 sequences and 3846 singletons. Gene discovery is estimated to be approximately 64%. Searches of public databases resulted in 49.3% annotated porcine sequences, of which 22.2% had significant homologies to ESTs from a variety of species, and 28.5% were without a significant match in any public database. We also identified 9.1% ESTs as involved in host cell and organism defense and 11.5% related to cell signaling and communication. These sequences, together with the 28.5% appearing as novel, are of specific interest to the infectious disease process.

Amino Acid Sequence↗
PubMed1999

Orthopedic and neurosurgical treatment of severe kyphosis in myelomeningocele.

Kyphosis in myelomeningocele is characterized by a complex pattern of problems during development and therapy. On the one hand, decompensation of upright posture leads to loss of sitting ability and social integration; on the other hand, accompanying malformations and trophic alterations threaten the physical integrity and performance. Neurologic function, cerebrospinal fluid (CSF) circulation, skeletal deformity and the urinary transport system need to be kept in mind and need to be treated with cooperation between the different specialties. Especially during serious surgical interventions such as spinal surgery, neither the nervous system nor the kidneys must be ignored. Sixteen patients underwent kyphectomy in the Orthopedic Department of the University of Mainz between 1993 and 1997, all of them supervised by the Neurosurgical Department. In 13 cases, transversal myelotomy was performed. No insufficiency of CSF circulation was seen; neither were there any CSF fistulae. Particular problems arose from the skin and soft tissue above the gibbus, the lack of muscles and the regeneration deficiency caused by trophic disorders. Therefore, a significantly higher complication rate was found than with other correctional operations.

Adolescent↗
PubMedDate not supplied

Nurses' assessments and management of pain in children having orthopedic surgery.

The specific aims of this research project were to (a) describe selected verbal, nonverbal, and physiological arousal indicators of the child's pain; (b) describe which pain indicators were most influential to nurses in decision-making about interventions for managing the child's pain; (c) describe pain interventions used by nurses; (d) compare postoperative analgesic orders to recommended dosages for the children; and (e) explore relationships between the child's self-report of pain and medication dosages administered. Subjects included 19 children aged 5-17 years who experienced 20 orthopedic surgical procedures (one child had two surgeries one week apart). Data were collected by staff nurses for the first five days after surgery. Pain levels were reported using the Oucher Scale. Postoperative pain was reported at moderate levels and showed only a gradual decrease throughout the hospital stay. Nonverbal pain indicators included crying and tense face. The child's complaint of pain and reported Oucher scores were most influential in influencing nurses to intervene in the child's pain. Nonpharmacological comfort measures included positioning and reassurance. All children received medications for pain; 49% of the orders were within the recommended therapeutic dosage range. A small but significant correlation was found between the child's reported pain level and the morphine equivalents of pain medication received. Recommendations included development of nursing flow charts that provide space to record pain levels and nursing interventions, in-service education for nurses on nonpharmacological interventions, and further research with a larger sample and a single pain rating scale.

Adolescent↗
PubMed2006

Knee immobilization in the immediate post-operative period following ACL reconstruction: a survey of practice patterns of Canadian orthopedic surgeons.

OBJECTIVE: This study was designed to determine the practice patterns and rationale for knee immobilizer use in immediate post-operative period following an anterior cruciate ligament (ACL) reconstruction. DESIGN: Descriptive cross-sectional survey. SETTING: Canada. PARTICIPANTS: A random sample of 50% of Canadian orthopedic surgeons registered with the Canadian Orthopaedic Association (COA). MAIN OUTCOME MEASURE: Self-reported survey responses regarding knee immobilizer use, surgeon characteristics, graft type and type of practice. RESULTS: Complete survey response rate was 36.1% (122/338). There was a lack of consensus regarding knee immobilizer use; 47.7% of responding surgeons use a knee immobilizer in the immediate post-operative period while 52.3% do not. There were no trends in characteristics such as fellowship training, number of years in practice and type of practice between surgeons who use and do not use a knee immobilizer. The reported reasons for immobilization were: pain reduction in the post-operative period (51.6%), graft site protection (38.7%), maintaining full extension (19.4%) and habit (12.9%). The length of time the immobilizer was used ranged from 5-42 days. CONCLUSIONS: The lack of consensus reported in the current study and published literature reflects a lack of scientific evidence in the area of post-operative knee immobilization. The need for a randomized clinical trial to assess the efficacy of knee immobilizer use after ACL reconstruction is evident. The authors recommend using peri-operative pain as an outcome measure in future studies investigating immobilization in the immediate post-operative period.

Anterior Cruciate Ligament↗
PubMed2006

Helicobacter cinaedi cellulitis and bacteremia in immunocompetent hosts after orthopedic surgery.

At various times after orthopedic operations (more than a few weeks, with an average of 29.9 days), 11 patients had a sudden onset of high temperature (average 38.9 degrees C) and local cellulitis at different sites on the operated sides. The wounds had completely healed, without complicated infections, when the cellulitis occurred. The clinical picture of cellulitis in all patients was atypical: diffuse salmon-pink skin color, local heat, swelling, spontaneous pain, and tenderness but no eruptions. No patient had any underlying immunocompromising conditions or had been given immunosuppressive agents. Gram-negative spiral bacteria were isolated from blood cultures and were identified as Helicobacter cinaedi on the basis of 16S rRNA gene sequencing and DNA-DNA hybridization using standard strains. By means of phylogenetic analysis, we divided these clinical isolates into two clones. The H. cinaedi strain isolated via fecal cultures from two patients without intestinal symptoms was the same clone as the blood isolate. All isolates were quite susceptible to various antibiotics, and clinical and inflammatory symptoms of bacteremia and cellulitis improved after treatment with penicillins and cephalosporins. A relatively high incidence of recurrence of the same disease was observed, however. Almost all patients responded immunologically to the infection, as evidenced by the production of serum antibody against H. cinaedi. We thus suggest that H. cinaedi should not be regarded as simply an opportunistic pathogen but that it may be a pathogen in immunocompetent hosts and may cause infections together with bacteremia and cellulitis.

Adult↗
PubMed1992

Rotator cuff disease: current trends in orthopedic management.

Rotator cuff disease is a clinical entity that is frequently encountered in the typical primary care office. Of particular importance to the chiropractic physician is the close proximity of the shoulder joint to the cervical spine. Due to the relatively high level of morbidity in the population, rotator cuff disease should be looked at carefully on both the physical and advanced diagnostic level. Several factors contributing to rotator cuff pathology include subacromial impingement, the relative microvascular pattern of the cuff mechanism and prior trauma. The natural history of attrition and aging also play a role in rotator cuff disease. Advanced disease is successfully diagnosed through the efficient utilization and proper sequencing of advanced orthopedic imaging studies.

Clinical Protocols↗
PubMed1961

Hardware in orthopedic surgery.

Insertion of foreign material into the human body has been performed with increasing frequency during the past 50 years and has received added encouragement in the antimicrobial era. Nevertheless, no matter how rational the utilization of these inflexible foreign bodies may seem, their introduction into the human framework is accompanied by evidence of nature's intolerance to hardware when substituted for living tissue. Numerous surgical complications occur following the use of internal fixation and prosthetic devices in orthopedic surgery.

Fracture Fixation, Internal↗
PubMed1960

Pyogenic infections in orthopedic surgery. Prevention and management.

A problem that confronts surgeons in clinical practice is that a patient may acquire new infections while in the hospital. When such infections occur they are predominantly staphylococcal and these bacteria are often, but not always resistant to penicillin, streptomycin and the tetracycline antibiotics. They are often but neither completely nor uniformly sensitive to the newer or less frequently used antimicrobial agents. The extension of antibiotic usage from proven situations to "routine" prophylaxis has been a widespread practice. There are many reasons to discourage and to reexamine the validity and purpose, as well as the safety of this practice. We now have sufficient background and experience to revert from widespread and indiscriminate use to a practice of discriminate prophylactic therapy. In general, soft tissue lacerations and clean wounds do not require operation under an "antibiotic umbrella." Similarly, elective orthopedic surgical procedures of soft tissues such as muscle biopsy, tenorrhaphy and muscle and tendon transplants as well as plastic surgical procedures can be safely performed without antibiotic therapy if technique is good and operation not prolonged. Operations of major magnitude on the motor-skeletal system, such as open fractures, internal fixation of fractures with bone grafts, and major operations of joints are indication for antibiotic therapy for impending infection postoperatively for five days. Reliance is mainly on antistaphylococcal drugs to which hospital organisms are predominantly sensitive. The two remaining indications for antibiotic therapy against impending infection are: (1) major crush injury-for example, to the thigh-and (2) the need for a patient with a healing fracture to have other surgical procedures such as tooth extraction or excision of an infected area which might predispose to transient bacteremia and embolic infection in bone or joint.

Anti-Bacterial Agents↗
PubMedDate not supplied

[A morbidity study of the Orthopedics and Traumatology Service. Nursing care behavior in the first 3 months of 1986].

A study is made of the morbidity in the Orthopedics service of Sur Children's Hospital in Santiago de Cuba and the results of nursing care during the first trimester of 1986 in 100 randomly selected in-patients. The highest incidence among the diagnosis corresponded to fractures, infectious process of soft tissues and osteomyelitis. By means of the medical history evaluation it was demonstrated that nursing care was appropriate in the period analyzed.

Adolescent↗
PubMed1994

Orthopedic case management in a collaborative practice setting.

An orthopedic practice that consists mainly of total joint replacements is an ideal setting for a case manager. While fixed reimbursement demands that care be cost-effective, an older patient population presents with more complex health problems. Key factors towards achieving successful patient outcomes are thorough preoperative assessment, patient and family education, and the development of critical pathways.

Group Practice↗
PubMed1998

Companion animals: social support for orthopedic clients.

Various definitions, conceptualizations, and measurements of social support exist in literature. Consistently among these variations, the focus is on people. Companion animals are not included; however, reviews of both social support literature and human-animal bond literature shows that the two share a number of common functions. Using two case studies, the author demonstrates that the social support of companion animals is a legitimate and relevant source of support for persons with orthopedic disorders.

Adaptation, Psychological↗
PubMed2003

An improved definition of immune heparin-induced thrombocytopenia in postoperative orthopedic patients.

BACKGROUND: Diagnosis of immune heparin-induced thrombocytopenia (HIT) is usually based on a fall in platelet count below 150 x 109/L (standard definition of thrombocytopenia). However, this definition may be inappropriate for postoperative patients who often develop postoperative thrombocytosis. We sought to determine an improved definition of thrombocytopenia indicating HIT in postoperative orthopedic patients, including its impact on frequency and thrombotic risk of HIT. METHODS: We performed a secondary analysis of a clinical trial of 665 patients who received unfractionated or low-molecular-weight heparin following elective hip arthroplasty. Daily platelet counts and objective studies for deep vein thrombosis were performed in all patients. Laboratory detection of HIT antibodies from a 362-patient subgroup was used to define sensitivity and specificity of various definitions of thrombocytopenia to indicate HIT. RESULTS: The improved definition of HIT was a 50% or greater platelet count fall from the postoperative peak, as this definition had greater sensitivity (50% vs 25%) and similar high specificity (99.1% vs 99.4%) for detecting HIT-IgG compared with the standard definition. Patients with HIT who were identified using the improved definition had a higher frequency of thrombosis than patients without HIT (72.2% vs 17.3%; P<.001). The improved definition showed an even greater absolute difference in frequency of HIT between unfractionated and low-molecular-weight heparin (4.8% vs 0.6%; P<.001) compared with the standard definition (2.7% vs 0%; P =.002). CONCLUSION: A 50% or greater fall in the platelet count from the postoperative peak is a sensitive definition indicating possible HIT that is associated with an increased risk of thrombosis.

Anticoagulants↗
PubMed2001

Musculoskeletal disorders and orthopedic conditions.

Ongoing advances in orthopedics include discoveries of functions of matrix proteins, development of new implant materials that are more durable and more compatible with magnetic resonance imaging, and identification of genes causing musculoskeletal disorders and disease. The Human Genome Project will further clarify the genetic basis of specific musculoskeletal disorders, enhancing risk factor identification, diagnosis, and therapy. Engineered, cell-based materials will replace metals and plastics in implants, and new composite materials will promote bone in-growth.

Animals↗
PubMed1998

Deep venous thrombosis after orthopedic surgery in adult cancer patients.

BACKGROUND AND OBJECTIVES: Patients with cancer and patients undergoing major orthopedic procedures are two groups at risk of deep venous thrombosis (DVT). The objective was to determine the rate of venous thromboembolic disease in patients with a malignant neoplasm and major orthopaedic surgery of the lower limb. METHODS: The study included 169 patients. All patients were given knee-high intermittent pneumatic compression devices for prophylaxis. Postoperative surveillance for thrombosis was performed on all patients with venous duplex doppler ultrasonography. RESULTS: Proximal DVT occurred in 24 of 169 patients (14.2%). One patient (0.6%) developed a symptomatic, nonfatal pulmonary embolus (PE). The development of DVT was not associated with age, sex, type of surgery, type of neoplasm, location, or pathologic fracture. The addition of anticoagulant medication such as warfarin did not significantly reduce the rate of DVT in a subset of 54 patients. In three patients, the DVT occurred only in the contralateral limb, and in four patients, there were bilateral DVTs. CONCLUSIONS: When intermittent compression boots were used for prophylaxis in conjunction with ultrasound screening, the risk of proximal DVT was substantial (14.2%), but the rate of symptomatic PE was low (0.6%).

Adult↗