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PubMedDate not supplied

Fever following orthopedic operations in children.

One hundred fifty-three orthopedic operations in 129 children were analyzed for the significance of postoperative fever (POF) as a predictive factor for possible complications. In 72% of the operations, a temperature of greater than 37 degrees C was recorded. In 63 operations (41%), the temperature was greater than 38 degrees C. Sixteen children had positive clinical signs that might explain the fever, and all of them had a temperature of greater than 38 degrees C. Duration of operation of greater than 1 h, clubfoot releases, open reduction of fractures, and spine fusion operations gave higher incidences of POF. POF indicates a complication only when associated with positive physical findings. A postoperative temperature of greater than 38 degrees C, therefore, mandates repeated physical examination, which is the most reliable method of discovering the presence of complications.

Adolescent↗
PubMedDate not supplied

Oral morphine versus injected meperidine (Demerol) for pain relief in children after orthopedic surgery.

This study provides a comparison of two clinical regimens for controlling pain in children for the first 48 h after orthopedic surgery: oral morphine, every 4 h, and injected meperidine (Demerol), every 3-4 h pro re nata. Using Visual Analogue Scale, 25 children between the ages of 7 and 17 years of age, who were randomly divided into two groups, rated the severity of their pain every 1-3 h from 8 a.m. to 8 p.m. Each child's parents and attending nurse also rated the child's pain. The morphine group had a significantly higher number of pain-free children on both day 1 and day 2.

Administration, Oral↗
PubMedDate not supplied

The orthopedic management of conjoined twins: a review of 13 cases and report of 4 cases.

We reviewed 13 pairs of conjoined twins treated at Children's Hospital of Philadelphia between 1957 and 1988. Orthopedic problems were related to the ischiopagus type. These included problems related to separation and to the correction of associated deformities. The technique for separation has evolved through improved preoperative imaging and with increased experience, resulting in preservation of a longer and more functional "shared leg." Better preservation of skin to cover both infants and enough of the "shared leg" to insure a functional knee has been possible with posterior iliac osteotomies to close the pelvic ring, as well as the use of tissue expanders.

Female↗
PubMed2002

Application of synchrotron X-ray imaging to phase objects in orthopedics.

Novel imaging of the fine structures of the ribs of a pig and a specimen of human osteosarcoma utilizing the spatial coherence of X-rays was successfully performed with an incident X-ray energy of 30 keV at SPring-8, Japan. The image contrast appearing at the periphery of trabecular bone, small calcifications and small fractures is caused by the phase shift of the X-rays at the boundary of these objects that have different X-ray refractive indices. The image is recorded on mammography film without an intensifying screen. Comparison of the image contrast using different sample-to-film distances, Z, such as Z = 5 m and Z approximately 0 m, showed that the former images were always more informative, i.e. better in resolution and/or image contrast when imaging trabecular bone, bone marrow and small fractures in compact bone, and for imaging cartilage. Radiography using synchrotron X-rays for phase objects should be a powerful tool for diagnosis in orthopedics, especially for bone disease.

Animals↗
PubMed2000

Virtual reality-based orthopedic telerehabilitation.

Rehabilitation interventions in remote areas are problematic because of distance and available resources. Orthopedic impairments acquired by individuals in remote areas can then lead to permanent disabilities/loss of function because of lack of appropriate rehabilitation. A system being developed by Rutgers and Stanford Universities provides therapy at the patient's home, with remote monitoring and periodic re-assessment. This telerehabilitation system uses virtual reality and haptic interfaces, and a pair of networked PCs. It is intended for rehabilitation of patients with hand, elbow, knee and ankle impairments. Data from the first patient treated with the telerehabilitation system is encouraging.

Exercise Therapy↗
PubMed2006

Self-calibrating 3D-ultrasound-based bone registration for minimally invasive orthopedic surgery.

Intraoperative freehand three-dimensional (3-D) ultrasound (3D-US) has been proposed as a noninvasive method for registering bones to a preoperative computed tomography image or computer-generated bone model during computer-aided orthopedic surgery (CAOS). In this technique, an US probe is tracked by a 3-D position sensor and acts as a percutaneous device for localizing the bone surface. However, variations in the acoustic properties of soft tissue, such as the average speed of sound, can introduce significant errors in the bone depth estimated from US images, which limits registration accuracy. We describe a new self-calibrating approach to US-based bone registration that addresses this problem, and demonstrate its application within a standard registration scheme. Using realistic US image data acquired from 6 femurs and 3 pelves of intact human cadavers, and accurate Gold Standard registration transformations calculated using bone-implanted fiducial markers, we show that self-calibrating registration is significantly more accurate than a standard method, yielding an average root mean squared target registration error of 1.6 mm. We conclude that self-calibrating registration results in significant improvements in registration accuracy for CAOS applications over conventional approaches where calibration parameters of the 3D-US system remain fixed to values determined using a preoperative phantom-based calibration.

Algorithms↗
PubMed1981

Paracetamol, tiaramide and placebo for pain relief after orthopedic surgery.

Eighty patients took part in this double-blind, single-dose group-comparative study, comparing the analgesic efficacy of tiaramide hydrochloride 100 mg and 200 mg, paracetamol 1000 mg, and placebo for pain after orthopedic operations. The four treatment groups were similar on entry to the trial. Pain relief was assessed up to 6 h after treatment, using a visual analogue pain scale and a pain score, both giving similar results. Statistically significant pain relief (mean pain intensity differences and sum of pain intensity differences) was seen in the group receiving paracetamol compared to those receiving placebo or tiaramide from 1 h to 6 h after drug ingestion. There was no significant difference between placebo and tiaramide 100 or 200 mg. No adverse reactions were reported.

Acetaminophen↗
PubMed1992

Prophylactic diclofenac infusions in major orthopedic surgery: effects on analgesia and acute phase proteins.

The influence of diclofenac, given by continuous i.v. infusion starting preoperatively, on postoperative pain and inflammation was assessed in a double-blind, randomized, placebo-controlled study in 40 patients scheduled for major orthopedic surgery. Starting 30 min before induction the patients received either diclofenac (0.35 mg.kg-1 bolus followed by a constant-rate infusion of 90 micrograms.min-1) or placebo for 24 h. The pain intensity (VAS) and the amount of rescue narcotic (piritramide on demand) were significantly lower in the diclofenac group from 4 and 6 h postsurgery, respectively, till end of infusion. Acute phase proteins used as inflammation markers (C-reactive protein, alpha 1-chymotrypsin, alpha 1-acid glycoprotein, haptoglobin and coeruloplasmin) showed similar variations in both groups for 24 h. The diclofenac treatment had no influence on hematological and coagulation profiles, nor on muscle and liver enzymes in comparison with placebo. Both patients and observer rated the diclofenac treatment as significantly superior to the placebo treatment.

Acute-Phase Proteins↗
PubMed1998

No release of cardiac troponin I during major orthopedic surgery after acute normovolemic hemodilution.

BACKGROUND: Normovolemic hemodilution is a well-accepted method for intraoperative blood salvage. However, some controversy exists concerning the possible risk of myocardial fiber injury as consequence of the reduced oxygen content. Laboratory diagnosis of perioperative myocardial fiber injury is difficult, since biochemical markers are elevated postoperatively due to the surgical trauma. Cardiac troponin I (cTnI) is a new, highly sensitive and specific marker for the detection of myocardial injury. The aim of our study was to investigate whether normovolemic hemodilution in patients with major orthopedic surgery (13 hemodiluted patients, 15 control) induces a release of cTnI. METHODS: cTnI as a highly specific and sensitive cardiac parameter, as well as total creatine kinase (CK), creatine kinase isoenzyme MB mass (CKMB mass) and myoglobin were measured after induction of anesthesia, after normovolemic hemodilution, prior to retransfusion of blood components, 3 h after surgery, and on the first and third postoperative days. RESULTS: Prior to retransfusion of blood components the hematocrit was decreased to 25.4 +/- 1.2% (mean +/- SEM; range: 18%-34%) in the control group and to 20.2 +/- 0.8% (mean +/- SEM; range: 17%-24%) in the hemodilution group. Total CK, CKMB mass as well as myoglobin concentration increased significantly in both groups, reaching their maxima within the first day of surgery. In contrast, cTnI was below the detection limit of assay (< 0.5 micrograms/L) at any time. CONCLUSIONS: We suggest that pre- and intraoperative hemodilution to a hematocrit of approximately 20% by maintaining normovolemia does not induce myocardial fiber injury in patients without preexisting cardiac diseases.

Adult↗
PubMed1992

Prevalence and classification of anemia in elective orthopedic surgery patients: implications for blood conservation programs.

We audited 281 consecutive orthopedic patients scheduled for surgery for whom blood type/cross-matching was requested over a 6-month period. One hundred and sixty-two patients predonated autologous blood at University Hospitals of Cleveland, and 34 (21%) of these were anemic [hematocrit (Hct) less than or equal to 39%] at initial donation. Twelve (35%) of these 34 anemic autologous blood donors subsequently received homologous blood. In contrast, 18 (15%) of 128 nonanemic autologous blood donors received homologous blood (p = 0.05). In 119 patients who did not donate autologous blood, 39 (33%) were anemic at admission. Of these, 22 (56%) received homologous blood. In the 80 remaining nonanemic patients, 33 (41%) received homologous blood (p = 0.119). Analysis of discharge Hct indicates that 31 (12%) of 263 evaluable patients were possibly transfused inappropriately. The anemias of a cohort of 30 autologous donors were analyzed: 5 had rheumatoid arthritis without iron deficiency. Nine (30%) others had evidence of iron deficiency. Sixteen (53%) had an unclassified anemia of chronic disease. We conclude: (1) the high rates of homologous blood exposure indicate a need for innovative blood conservation strategies in anemic autologous blood donors; (2) the prevalence of anemia and the high rates of homologous blood exposure in anemic patients who did not donate autologous blood demonstrate a need for early recognition and treatment in order to procure autologous blood and reduce homologous blood exposure; (3) the presence of inappropriate autologous and homologous transfusions demonstrates a need for more effective physician education programs that emphasize 'no blood transfusion' as an alternative to enhance blood conservation effectiveness.

Anemia↗
PubMed1994

Patterns of autologous blood use in elective orthopedic surgery: does the availability of autologous blood change transfusion behavior?

We studied the orthopedic surgery service at our institution to determine whether the mere availability of autologous blood (AB) affected transfusion practice. As a group, patients who had AB available received an average of 1.11 fewer red cell units per hospitalization than did patients with only homologous blood (HB) available. At every transfusion episode, those patients having AB available received fewer red cell units than did patients without AB available. Predeposit of autologous red cells was effective in protecting 77.6% of patients from HB exposure. The availability of autologous red cells resulted in an overall more conservative approach to transfusion.

Aged↗
PubMed1990

The distribution of mental illness found by DIS (Diagnostic Interview Schedule) among internal and orthopedic patients.

In order to understand how psychiatric problems are distributed in general medical departments, we used DIS (Diagnostic Interview Schedule). The subjects are 307 inpatients and outpatients in the Departments in Internal Medicine and Orthopedics of Fukuoka University Hospital, M Hospital and N Hospital. As a result, 53.4% of all the subjects showed some psychiatric problems. These are, in a descending order, tobacco dependence (30.0%), psychosexual dysfunction (14.3%), alcohol abuse/dependence (14.0%), major depressive episode (6.5%), organic brain syndrome (4.9%), obsessive-compulsive disorder (3.9%), dysthymic disorder (2.3%), panic disorder (2.0%) and others. Also, we discussed comparison between internal patients and neurotic patients who visited psychiatrists complaining of physical symptoms, and the incidence of DIS diagnoses in individual physical diseases.

Adolescent↗
PubMed2005

Randomized trial comparing overnight preoperative fasting period Vs oral administration of apple juice at 06:00-06:30 am in pediatric orthopedic surgical patients.

BACKGROUND: We aimed to evaluate the efficacy of clear liquids orally administered at 06:00-06:30 am on the morning of surgery to reduce prolonged preoperative fasting periods. METHODS: After obtaining informed parental consent, 100 children undergoing scheduled orthopedic surgical procedures, ASA I-II, were randomly allocated to two groups. In group 1, children underwent the typical overnight preoperative period and patients in group 2 received a commercial brand of apple juice (glucose 28 g in 250 ml) at 06:00-06:30 am on the day of surgery. Patients <3 years old received 15 ml.kg(-1) and older children 10 ml.kg(-1) to a maximum volume of 250 ml. All patients underwent overnight fasting for milk and solids. RESULTS: Fasting time was 4.8 +/- 2.1 h (ranging from 3 to 11 h) in the group receiving apple juice at 06:00-06:30 am and 13.2 +/- 3.3 h (ranging from 5 to 19 h) in the overnight-fasting group (P < 0.05; 95% CI: -9.6 to -7.4 h). More patients were irritable (odds ratio, OR 4.5; 95% CI: 1.9-10.8) and dehydrated (OR 21.6; 95% CI: 5.9-79.0) in the overnight-fasting group. Glucose levels <2.7 mmol.l(-1) (50 mg.dl(-1)) were not reported in any case. CONCLUSIONS: A 15 ml.kg(-1) of apple juice for patients of <3 years of age or 10 ml.kg(-1) for older children, at 06:00-06:30 am of the surgical morning is a simple procedure to prevent dehydration and to produce positive behavior in low-risk, pediatric surgical patients.

Beverages↗
PubMedDate not supplied

Electroencephalography of detomidine-ketamine-halothane and detomidine-ketamine-isoflurane anesthetized horses during orthopedic surgery. A comparison.

This study was done to compare the electroencephalographic (EEG) response evoked by orthopedic surgery in halothane- and isoflurane-anesthetized horses. Eight horses scheduled for bilateral arthroscopic surgery of the stifle were premedicated with detomidine (20 micrograms/kg) intravenously and five minutes later induced to anesthesia with ketamine (2.2 mg/kg) intravenously. Anesthesia was maintained with either halothane or isoflurane. Assignment of inhalation anesthetic was done randomly. The multiple of minimal alveolar concentration (MAC) of halothane required for anesthesia was significantly higher than the multiple of MAC of isoflurane (p < .05) required. Total amplitude of the EEG with halothane was smaller than with isoflurane (p < .05), but 13.0 to 32.0 Hz high frequency/0.0 to 3.9 Hz low frequency (beta/delta) ratio was greater for halothane (p < .05). Arterial partial pressure of oxygen (PaO2) was significantly (p < .05) higher with isoflurane than with halothane. The differences in EEG frequency shift observed suggest that isoflurane provided better analgesia than halothane for this group of horses.

Anesthesia, Inhalation↗
PubMed2004

The effect of universal leukoreduction on postoperative infections and length of hospital stay in elective orthopedic and cardiac surgery.

BACKGROUND: A before and after study was undertaken to investigate the effect of universal leukoreduction (ULR) in the UK on postoperative length of hospital stay (LOS) and infections. STUDY DESIGN AND METHODS: Consecutive patients undergoing elective coronary artery bypass grafting or total hip and/or knee replacement in 11 hospitals received non-WBC-reduced RBCs before implementation of ULR (T1, n=997) or WBC-reduced RBCs after implementation of ULR (T2, n=1098). RESULTS: Patients in T1 and T2 were comparable except patients in T2 received on average more units of RBCs but had lower discharge Hct levels. Postoperative LOS (T1, 10 +/- 8.9 days; T2, 9.6 +/- 6.9 days) and the proportion of patients with suspected and proven postoperative infections (T1, 21.0%; T2, 20.0%) were unchanged before and after ULR (LOS, hazard ratio 1.01, 95% CI 0.92-1.10; infections, OR 0.83, 95% CI 0.77-1.02). Subgroup analysis showed no significant interaction between storage age or dose of blood on responsiveness of primary outcomes to ULR. Secondary outcomes were unchanged overall. Analysis by surgical procedure gave conflicting results with both increased mortality (p=0.031) and an increased proportion of cardiac patients with proven infections (p=0.004), whereas the proportion of orthopedic patients with proven infections was reduced (p=0.002) after ULR. CONCLUSION: Implementation of ULR had no major impact on postoperative infection or LOS in patients undergoing elective surgical procedures who received transfusion(s). Smaller effects, either detrimental or beneficial of ULR, cannot be excluded.

Blood Transfusion↗
PubMed2005

Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography.

BACKGROUND: The incidence of postsurgical venous thromboembolism is thought to be low in Asian ethnic populations. OBJECTIVE: We studied the incidence of deep-vein thrombosis (DVT) in Asian patients undergoing major orthopedic surgery of the lower limbs. PATIENTS/METHODS: We performed a prospective epidemiological study in 19 centers across Asia (China, Indonesia, South Korea, Malaysia, Philippines, Taiwan, and Thailand) in patients undergoing elective total hip replacement (THR), total knee replacement (TKR) or hip fracture surgery (HFS) without pharmacological thromboprophylaxis. The primary endpoint was the rate of DVT of the lower limbs documented objectively with bilateral ascending venography performed 6-10 days after surgery using a standardized technique and evaluated by a central adjudication committee unaware of local interpretation. RESULTS: Overall, of 837 Asian patients screened for this survey, 407 (48.6%, aged 20-99 years) undergoing THR (n = 175), TKR (n = 136) or HFS (n = 96) were recruited in 19 centers. DVT was diagnosed in 121 of 295 evaluable patients [41.0%, (95% confidence interval (CI): 35.4-46.7)]. Proximal DVT was found in 30 patients [10.2% (7.0-14.2)]. Total DVT and proximal DVT rates were highest in TKR patients (58.1% and 17.1%, respectively), followed by HFS patients (42.0% and 7.2%, respectively), then THR patients (25.6% and 5.8%, respectively). DVT was more frequent in female patients aged at least 65 years. Pulmonary embolism was clinically suspected in 10 of 407 patients (2.5%) and objectively confirmed in two (0.5%). CONCLUSIONS: The rate of venographic thrombosis in the absence of thromboprophylaxis after major joint surgery in Asian patients is similar to that previously reported in patients in Western countries.

Adult↗
PubMedDate not supplied

Development of interactive patient-based multimedia computer programs in veterinary orthopedic radiology.

Three computerized multimedia programs on large and small animal veterinary orthopedic radiology were developed and implemented for the radiology curriculum as an alternative to traditional film-based laboratory learning. Programs utilized "hot words" (colored text words that displayed an overlaid image label that highlighted lesions) and interactive quizzes which responded appropriately to selected answers. "Hot words" helped students develop confidence in accurate lesion detection and the interactive quizzes transformed learning from a passive to an active process. Multiple examples were provided for reinforcement and concepts were incorporated from other clinical disciplines for curriculum integration. Programs were written using a presentation software program, Toolbook for DOS based platform, and contained radiographic images made by laser-scanning digitization. Multiple students could simultaneously access the programs through a network server. These pilot programs were implemented successfully and computerized multimedia presentation proved to be well suited to teaching radiology. Development of the programs required attention to a number of hardware, software, time and cost factors.

Computer Communication Networks↗
PubMedDate not supplied

Managing quality on an orthopedic service: ileus in the lumbar spinal fusion patient.

As healthcare providers, nurses in an acute care setting have the opportunity to review and evaluate the impact of their care delivery. The orthopedic nursing staff at a not-for-profit tertiary care community hospital in Michigan decided to undertake this challenge when they began to pursue a quality management (QM) review of patients admitted to their unit. The QM study targeted the elective surgical candidate admitted for a lumbar decompression with spinal fusion. The quality care issue focused on the complication known as an abdominal ileus. Two basic questions helped the staff to establish the indicators within this project: (1) what common variables could be measured within the high-risk patient population, and (2) by assessing these variables within the plan of care, could a link or association be made to reduce the incidence of the ileus complication?

Adult↗