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At least 937 records · Page 52Linked to original sources
PubMed2005

[Damage control orthopedics].

BACKGROUND: In the management of patients with multiple injuries, the concept of damage control orthopedics (DCO) is still a matter of controversy. Thus, the clinical value of DCO remains unclear and should be evaluated on an evidence-based level by a review of the current literature. RESULTS: The work of various authors has demonstrated an association between injury severity and the clinical immuno-inflammatory response and its prognostic relevance regarding organ dysfunction or organ failure and clinical outcome. Research data published by the authors and other investigators have clearly demonstrated an additional inflammatory response caused by surgical trauma which is significantly higher after primary intramedullary fracture treatment than after external fracture stabilization. In contrast, a generally minor inflammatory response seems to be associated with intramedullary nailing for secondary conversion osteosynthesis. Three retrospective cohort studies have shown a reduction of organ dysfunction and an improvement of survival with the DCO approach. Simultaneously, it was demonstrated that primary external fracture fixation and secondary conversion to definite osteosynthesis is not associated with an increased rate of local or systemic complications. CONCLUSIONS: The advocates of DCO claim that patients with multiple injuries including severe brain and chest injuries as well as those with an unstable cardiopulmonary or circulatory condition are at high risk of developing a severe systemic immuno-inflammatory reaction during early total fracture care. Therefore, they recommend primary minimally invasive external fracture stabilization in these patients to avoid additional surgical trauma and that definitive secondary fracture care should be performed after medical stabilization of the patient in intensive care.

Critical Care↗
PubMed2002

[Office workplace at a computer monitor from an occupational-orthopedic view].

Typical back problems as well as complaints in the shoulder-arm-hand system are increasing as the volume of sedentary office work at the computer screen rises. Various legal rules precisely define preventive measures. However, basic orthopedic-biomechanical principles are not being taken into consideration. Orthopedists as well as occupational physicians are equally challenged to enforce those legal guidelines by beginning to raise awareness of the principles and thus contributing towards improvement of working conditions.

Computer Terminals↗
PubMed2004

[Special aspects of implant-associated infection in orthopedic surgery. From the pathophysiology to custom-tailored prevention strategies].

One of the most important risk factors in orthopedic surgery is implant-associated infection. Adhesion and colonization mediated implant infections are extremely resistant to antibiotics and host defences and frequently persist until the biomaterial or foreign body is removed, which is standard therapy. Tissue damage caused by surgery and foreign body implantation increases the susceptibility to infections, activates host defences and stimulates the generation of inflammatory mediators including radicals that are further aggravated by bacterial activity and toxins. Nearly one third of implant-related infections can be prevented by strictly following established infection control guidelines. However, a significant number of implant-associated infections remains. The escape of bacteria from host defence and antibiotic therapy makes the development of infection-resistant materials as anti-microbial drug delivery systems feasible. This concept consists of the sustained delivery of antimicrobial drugs into the local microenvironment of implants avoiding systemic side effects exceeding usual systemic concentrations by magnitudes of order.

Anti-Bacterial Agents↗
PubMed2004

[The use of regional anesthesia in orthopedics].

Regional anesthesia has its place in the perioperative pain management of orthopedic patients. A reduction in postoperative mortality and morbidity with regional anesthesia is acknowledged for subsets of patient populations. Single shot and continuous applications are techniques for providing regional analgesia. Continuous infusion of local anesthetics with catheter techniques provides for uninterrupted postoperative analgesia. The combination of regional and general anesthesia reduces the consumption of systemic anesthetics. The side effects of opioid therapy are thereby reduced. The inhibition of intraoperative stress reaction, especially with epidural anesthesia, helps to prevent or lower unwanted metabolic changes. Patient contentment with analgesic quality differs with the technique with which the regional anesthesia is applied (PDA, PCEA, IVRA, peripheral block, i.a. injection), and the medication (LA, opioid) used.

Anesthesia, Conduction↗
PubMed2004

[Heparin induced thrombocytopenia. A frequently unrecognised complication after major orthopedic surgery].

The application of unfractioned (UFH) and low molecular weight heparins (LMH) has reduced the incidence of thromboembolic events. However, the frequency of heparin-induced thrombocytopenia (HIT II) in orthopedic patients, particularly susceptible for both thromboembolic complications and HIT II with potentially life threatening complications, is about 0.5% for LMW and 3% UFH. Induced by an immune response, the excessive activation of platelets and endothelial cells causes massive thrombin generation and, as a result, thrombotic vessel occlusion. The rates of mortality and amputation in HIT II are estimated to be 30% and 20%, respectively. The clinical course is highly dependent on early therapeutic intervention, consisting of compatible and adequately dosed anticoagulation drugs. Vitamin K antagonists as well as platelet substitution may lead to disastrous sequelae. We summarize the current state of the pathophysiology, diagnosis and therapy of HIT II and illustrate therapeutic mistakes in a case report.

Aged↗
PubMed2006

[The importance of ultrasonography in orthopedics].

After patient history and clinical evaluation, sonography is a first-line modality in the orthopedic diagnostic algorithm together with laboratory results and standard radiographic findings. As an inexpensive investigation without known adverse effects it is used (and also repeated in the course of the disease) for the dynamic control of joint movements, and especially for imaging soft tissues. Sufficient training in the use of ultrasound in the musculoskeletal system is required; individual investigations are relatively time-consuming. The procedure is especially useful in evaluating the shoulder, hand, and knee regions and rheumatic illnesses.

Bone Diseases↗
PubMed1999

[Computer-based organization and documentation in orthopedics. A 5-year experience].

In the orthopedic department of the University Hospital Homburg/Saar, we use since 1993 a computer-based system for clinics organisation and documentation of operations. Hardware consists of DOS/Windows PC's in a Novell-network. Our software is a combination of database-system for managing patient-data and a special coding program for ICD and IKPM-digits. Our experience shows that computer assisted clinic-management is an effective tool to help the surgeon in planning and documentation. Until now, we used the system for 31,500 patients and 8500 operations. A flexible software can meet the requirements both of the surgeons and administration. Moreover, in the University hospital Homburg/Saar, the different departments are linked by an Intranet with connection to other scientific networks and the Internet.

Documentation↗
PubMed1999

[Importance of computer-based procedures. Planning and documentation in orthopedic surgery].

The demand for efficiency in OR management and increase in the necessity of surgical documentation require the use of software applications in hospitals. A client-server based OP-planning and documentation system has been in use in the department of orthopedic surgery in Giessen University since 1992 and is being continuously further developed. Aside from the lawful requirements, the demands of clinical doctors have been especially considered. The main functions are management of non medical patient data, scheduling and documentation of operations with coding of diagnoses and therapy, tissue banking, implant inventory, on call scheduling, storage of medical video images, clinical word processing and e-mail. With an integrated web-server, MedXS has the capabilities to offer functions accessible over any webbrowser (Netscape, Internet-Explorer) in the internet or intranet. Through the usage of this application clinical procedures could be more efficiently realized and better agreeing positions with the insurance companies could be reached.

Humans↗
PubMed1999

[Standardized computer-based documentation system for diagnoses and medical performance in orthopedics and traumatology. Development and initial application].

INTRODUCTION: Increasing demands on quality assurance und medical performance documentation require an immediate and evaluable documentation in the outpatients' department. Presentation of a new computer-based diagnostic system for reporting and medical performance documentation. METHODS: Development and initial application of the system in three big orthopedical or traumatological hospitals. Judgements about the feasibility of immediate documentation in outpatients' departments. RESULTS: Presentation of an outpatients' departments diagnostic system with textblock-oriented anamnesis or anatomy-related diagnosis through pre-structured examination checklists. Coding of ICD-9/-10 as well as AO-classification and AIS (abbreviated injury scale). Implementation of scorings. Medical performance documentation through forms including pre-defined billing codes. Presentation of the documentation flow and its transfer into other contexts. DISCUSSION: Pure text-based clinical results do not allow sufficient evaluation for quality assurance and medical performance documentation. However, a computer-based and immediate documentation in outpatients' departments should not mean a significantly increased workload for physicians.

Documentation↗
PubMed1999

[Diagnosis and management of coagulation disorders in orthopedic surgery].

Patients suffering from von-Willebrand-disease or hemophilia A or B are the most common patients with coagulation disorders in orthopedic hospitals. Patients suffering from hemophilia A or B are treated with pure factor VIII or IX concentrates. We prefer recombinant products. The goals are normal levels of F VIII or F IX activity during the operation and postoperatively. In order to save costs the continuous infusion is recommended. Approximately 30% of products and costs may be saved. The prevalence of von-Willebrand-disease is very high in Europe and USA (1%). Typical presentation of these patients is the uncontrollable bleeding during an operation; typical is also the bleeding from mucous membranes. Patients with mild disorders are treated with DDAVP. Patients suffering from type 3 need substitution therapy with von-Willebrand-factor containing concentrates (for example Humate P).

Blood Coagulation Disorders↗
PubMed2001

[Holt-Oram syndrome. 3 case reports and their physical therapy, occupational therapy and technical orthopedic treatment].

The combination of organ and skeletal malformation as well as the fact that Holt-Oram syndrome appears in many forms with related functional disturbances and makes it mandatory that the therapy for these patients be determined on an individual basis. Supportive statomotoric therapy of young patients plays a particularly central role, as do development-synchronized treatment aids. Physiotherapy, ergotherapy, and technical orthopedic support oriented toward functionality are all part of the therapeutic concept.

Adult↗
PubMed2001

[Methicillin-resistant Staphylococcus aureus (MRSA). Current status and significance of preventing infection in technical orthopedics].

Many patients of the Clinic for Technical Orthopedics and Rehabilitation of the Munster University are facing several risk factors at the same time, which have to be considered for infection registration and therapy accordingly. The interaction of the known late consequences of diabetes mellitus creates the prerequisites which give way for infections of the soft parts and bones. Very often, patients are only being transferred to special university clinics after long-lasting pre-treatments as day-patients or inpatients. The integrity of patients physiological barriers is often broken through by the already existing morphological damages, and the function of the immune systems defence possibly is affected by already existing basic diseases. Parallel to the increasing importance of Staphylococcus aureus (S. aureus) being the pathogen for nosocomial infections, the resistance situation towards a lot of antibiotics has significantly and increasingly deteriorated. The methicillin resistance of S. aureus, i.e. the resistance of the pathogen towards so-called staphylococcus-effective penicillinase-resistant penicillins (isoxazolylpenicillins), is presently creating the especially for the clinical practice problematic resistance mechanisms. The methicillin (oxacillin)-resistant S. aureus (MRSA, ORSA) stems usually present the phenomenon of multiresistance, i.e. the resistance towards substances of several classes of antibiotics, and, therefore, are not only resistant to all beta-lactamantibiotics (penicillins, cephalosporins, carbapenems). Thus, MRSA infections become a significant risk factor for the respective patients. In many cases there are only a very few options left for an antibiotic therapy. The increasing and often unquestioned use of "reserve substances" is leading to a selection of pathogens creating resistances to the corresponding substances. This results in a resistance spiral which makes an antibiotic therapy more and more difficult.

Cross Infection↗
PubMed2001

[History of orthopedics in Germany 1945-1990].

Presentation of a brief history of the scientific society from the end of World War II until the fall of the Iron Curtain, taking into consideration the milieu inside and outside the field of orthopedics. Throughout, the intention was to provide facts and sufficient references for further reading, with special emphasis on the biographies of the public figures mentioned. Attention should be directed in particular to the history of the society published in 1963.

Congresses as Topic↗
PubMed2001

[Historical development of sports orthopedics].

The history of German sports medicine was decisively influenced by the surgeon August Bier at the beginning of the twentieth century. Initially, general medical and physiological problems were emphasized. Individual treatment of injured athletes played an increasing role at the end of last century. Operative treatment of injured athletes and earlier rehabilitation has changed therapeutic standards of orthopedic treatment. During critical discussion of the historical development of the treatment of ruptured anterior cruciate ligaments and meniscal tears, it becomes evident that treatment methods once rejected may now prove to be useful and correct.

Germany↗
PubMed2006

Usefulness of arterial blood gas analysis and D-dimer measurement in the assessment of pulmonary embolism after orthopedic surgery.

BACKGROUND: Deep venous thrombosis (DVT) and pulmonary embolism (PE) after spinal or lower extremity surgery are well recognized as common complications. Since 1995 we have investigated the incidence of PE after orthopedic surgery using ventilation-perfusion (V/Q) lung scans, and the prevalence of PE was about 10%. With a view to detecting early-stage PE by simple examinations, we evaluated the use of both the blood gas analysis and the D-dimer measurement after spinal or lower extremity surgery. METHODS: Altogether, 85 patients who underwent spinal or lower extremity surgery were eligible for the study. Pneumatic sequential leg compression devices (PSLCDs) were utilized continuously both intra- and postoperatively. Arterial blood gas analysis and D-dimer measurement were performed pre- and postoperatively on days 3 and 7. We set lung scan criteria as follows: postoperative decrease in Pa(O2) (deltaPa(O2) by > or = 10 torr (group G), postoperative D-dimer of > or = 1 microg/ml (group D), or both. Patients with the criteria went on to undergo lung scans, and PE was diagnosed by the existence of any mismatch between ventilation-perfusion (V/Q) lung scans. RESULTS: A total of 44 (51.8%) patients met the lung scan criteria and underwent perfusion lung scans, 10 (11.7%) of whom were diagnosed as PE. In groups G and D, about 30% showed PE. Moreover, six (85.7%) of the seven patients with both criteria showed a significant increase (83.7%) in the prevalence of PE. CONCLUSIONS: Patients with the above criteria showed a high prevalence of PE. Moreover, 10 (11.7%) of the 85 patients were diagnosed as having PE, which corresponded to the prevalence in our former studies where lung scans were performed in all patients. The blood gas analysis and the D-dimer measurement may be utilized as the first screening examinations.

Adolescent↗
PubMed2002

Evidence-based medicine for orthopedic practice.

Evidence-based medicine (EBM) is regarded as a new paradigm in medical practice, equal in enormity to the human genome project. However, there is still much confusion and misunderstanding about the concept and content of EBM. It is often limited to searching the literature and reading papers, serving cost cutters, and suppressing clinical freedom. Some believe that the use of clinical guidelines or the managed care system intimidates doctors' discretion during clinical practice and that EBM is a fashionable tendency of a group of medical academics armed with epidemiological and statistical jargon. Medical practice is a lifelong, continuous process of self-learning, and it requires clinicians to keep up to date on various developments. EBM is our practice for integrating individual clinical expertise with the best available evidence when making decisions about our care for each patient. EBM is one answer for making it possible to cover most of our activities as orthopedic surgeons, from the daily practice of patient care to writing and reading scientific papers.

Decision Making↗
PubMed2006

Usefulness of teicoplanin for preventing methicillin-resistant Staphylococcus aureus infections in orthopedic surgery.

In order to gather more data on the use of teicoplanin for reducing MRSA infections in high-risk populations, the present study was conducted. At a hospital in Barcelona, Spain, there was a high prevalence of MRSA infections among patients who underwent surgery for femoral neck fracture during the first 5 months of 2002 (period A) when cefuroxime was the antibiotic prophylaxis. During the following 12 months (period B) 600 mg of teicoplanin was added to cefuroxime. The rates of overall and MRSA infection during period A were 5.07 and 2.73%, respectively. Pulsed-field gel electrophoresis demonstrated there was no clonal relationship among MRSA strains. No nasal carriers of MRSA were detected among health workers. During period B the rates of overall and MRSA infection were 2.36 and 0.19%, respectively. Both rates were statistically significantly lower than those in period A (p<0.05). These results suggest teicoplanin may be useful in patients undergoing orthopedic surgery when the prevalence of MRSA is high.

Aged, 80 and over↗
PubMed2006

Bone grafts impregnated with antibiotics as a tool for treating infected implants in orthopedic surgery - one stage revision results.

Infection of an orthopedic implant is considered a devastating complication, necessitating its complete removal and thorough debridement of the site. Osseous defects are common in such conditions and need to be addressed before a new implant may be inserted. So far bone grafting has been contraindicated in bacterially contaminated areas and could only be performed as soon as all signs of infection have ceased. Usually long term antibiotic treatment and a multitude of surgical interventions within a period of several months is required until a definitive supply can be achieved. Allograft bone may be impregnated with high loads of antibiotics using special incubation techniques. Based on this technology 48 exchange procedures of infected orthopaedic implants were performed in a single stage, all of them without the use of bone cement. There were 37 infected hips, 8 knees and 3 infected osteosyntheses. Two hips required re-revision because of persisting infection, the remaining 46 patients stayed infect free for a period between 1 and 7 years after surgery. No adverse side effects could be found. Incorporation appeared as after grafting with unimpregnated bone grafts. Antibiotic loaded allograft bone is a powerful tool in septic revision surgery, enabling restoration of bone stock, insertion of a new implant and control of infection in a single operation.

Anti-Bacterial Agents↗