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At least 1,099 records · Page 61Linked to original sources
PubMed2003

A transcutaneous bone digitizer for minimally invasive registration in orthopedics: a real-time focused ultrasound beam approach.

Computer-guided navigation of surgical tool position in computer-assisted orthopedic systems requires the registration of computer tomographic (CT) images with underlying bone. This process is presently performed by manually digitizing points on bone with a pointer and aligning them to a preoperative CT scan. We propose the use of ultrasound to obtain points on bone transcutaneously. A custom-made A-mode probe features a modular lens focusing system and a one-step calibration method. A stable and precise echo detection algorithm is also implemented. The accuracies of three signal detection algorithms--standard deviation, cross-correlation (XCORR) and short-time Fourier transform--were compared using a known reflected signal. XCORR showed the most accurate and stable operation. To test our method of obtaining bone surface points, a plastic model of the fourth human lumbar vertebra was CT scanned and then immersed in a water bath. Six surface registrations of the vertebra using an accurate pointing device were compared to ten registrations obtained using the US probe (using the XCORR algorithm). Student's T-test showed no significant difference in error between the two methods, proving that ultrasound registration, using our method, is equivalent to the more conventional pointer method.

Algorithms↗
PubMed1989

Roentgen stereophotogrammetry. Review of orthopedic applications.

Roentgen stereophotogrammetry is based on radiographic examinations of calibration cages and object markers implanted in the skeleton. Accurate measurements of radiographs and computer-assisted calculations can provide a three-dimensional motion analysis. Since its introduction 15 years ago, roentgen stereophotogrammetry has found an increasing number of orthopedic applications, which are reviewed here: growth, prosthetic fixation, joint kinematics and stability, fracture stability, and the healing course of spinal fusion and pelvic and tibial osteotomies.

Bone and Bones↗
PubMed1989

Glove perforation in elective orthopedic surgery.

A survey of glove perforation in 16 orthopedic surgeons during a 6-month period was carried out. During this time, the surgeons performed 304 elective operations. In 1,398 pairs of gloves tested, evidence of perforation was found in 26 percent.

Accidents, Occupational↗
PubMed1991

Is DRG useful in orthopedics?

The increasing hospital costs have provoked discussions about Diagnose Related Groups (DRG) and its role in controlling the growth of hospital budgets. The relevance to current operation statistics and the structure of DRG in orthopedics are analyzed. The direct application of DRG to Scandinavian statistics does not appear to be reliable.

Diagnosis-Related Groups↗
PubMed1991

Increasing demands on orthopedic services.

In Finland, waiting lists have been analyzed country-wide several times during the last two decades. In this presentation, the data obtained are reviewed. The orthopedic waiting lists grew threefold from 1969 to 1987, more rapidly than the total waiting list to hospitals in the country. Meanwhile, the average duration of hospitalization decreased. The reliability and problems of data bases available are discussed; it is concluded that especially the studies on waiting lists need new objective methods.

Arthritis, Rheumatoid↗
PubMed1997

Cardiorespiratory and vascular dysfunction related to major reconstructive orthopedic surgery.

Major orthopedic reconstructive surgery is highly traumatic and may be associated with serious peri-operative cardiorespiratory and vascular complications which occasionally may be fatal. These complications are commonest in patients receiving cemented hip prostheses following femoral neck fractures. The etiology is multifactorial. Bone traumatization induces activation of the hemostatic system, i.e., thrombin generation, in venous blood draining the operation area. When this activated blood passes the lung, more thrombin is generated and the blood becomes hypercoagulable and causes fibrin-formation in the lung vessels, with trapping of cellular debris. Thrombin has many hormone-like effects beyond its function in the coagulation cascade system. It may increase vein wall permeability and cause constriction of vessels, which increases blood pressure in the lung. In addition, impaction of bone cement to fill bone cavities or to fix prostheses causes additional mechanical trauma and further release of procoagulant substances into venous blood. Further, release of the cytotoxic chemical methyl-methacrylate monomer into venous blood is superimposed on the thrombin-primed hemostatic disturbances in the lung microvasculature. All these effects may finally induce hemodynamic insufficiency, which occasionally may be fatal. To prevent these adverse reactions, thrombin activity should be reduced and impaction of bone cement minimized.

Arthroplasty, Replacement↗
PubMedDate not supplied

Malignant hyperthermia: a complication of orthopedic surgery.

Although malignant hyperthermia is seen most frequently as a complication of orthopedic surgery, most orthopedists have not encountered this commonly fatal problem. A case report and discussion of the inheritable metabolic defect is given. Immediate treatment concepts are discussed.

Anesthesia↗
PubMed1985

Pulsatile irrigation in orthopedics.

A brief history of the use of irrigation fluids in the management of traumatic and surgical wounds is presented. The development of irrigation fluid as a debridement technique and some of the problems in controlling the fluid dynamic parameters are described. Orthopedics requires varied applications of irrigation devices, and a machine has been developed which combines irrigation lavage or pulsatile debridement technique with the rapid suction removal of effluent. The applications, technique, and precautions in using a Rapid Suction Removal System are described.

Anti-Bacterial Agents↗
PubMed1986

Use of polydioxanone absorbable monofilament sutures in orthopedic surgery.

The safety and efficacy of polydioxanone absorbable monofilament sutures was documented in 57 orthopedic surgery patients (32, dyed sutures; 25, undyed sutures), 55 of whom were followed for at least 42 days postoperatively. The other two patients were lost to follow up prior to 42 days. The final clinical outcome was excellent in all completed study subjects. No suture-related adverse effects were reported. Both dyed and undyed sutures were consistently better than surgical gut with respect to pliability, strength, ease of passage, ease of tying, fraying, knot security, and overall handling. Intraoperative visibility of dyed polydioxanone sutures was consistently superior to that of surgical gut. The visibility of undyed sutures was rated better than surgical gut in 16 cases, equal in 8, and worse in 1. Both the overall handling of the polydioxanone monofilament sutures and performance as it affected wound healing were significantly superior to those of surgical gut.

Adolescent↗
PubMed1988

Three-dimensional computerized reconstruction of histologic serial sections for orthopedic research.

New programs in image processing and computer graphics can now render three-dimensional images from serial tissue slices. Although neuroanatomists have used these techniques most intensively, there are exciting applications of this methodology in orthopedic research and investigative embryology. Three-dimensional reconstructions of histologic sections from newborn clubfeet have been used to determine the rotational alignment of the hindfoot bones. Similar studies could be undertaken to improve understanding of the normal and pathologic perinatal development of the spine, hip, and hand.

Computer Graphics↗
PubMed1989

The use of nickel-titanium alloy in orthopedic surgery in China.

A new biomaterial made of nickel and titanium with its shape-memory characteristics has been manufactured, investigated, and used in Shanghai, China. Since 1981, this biomaterial has been used in 265 cases clinically, among which 71 involved orthopedic surgery. Results are satisfactory without failure in our short-term follow up. This preliminary report of the use of this new biomaterial with the unique characteristic of being able to recover to its original shape with particular transformation temperatures indicates its potential for opening a new field for investigation in surgery. Research to discover appropriate ratios of nickel and titanium for specific usage is underway. The interest and cooperation between the medical and engineering professions may eventually solve the problems through mutual efforts and result in improved shape-memory biomaterials.

Alloys↗
PubMed1994

Practice patterns in prophylaxis of deep vein thrombosis among US orthopedic surgeons.

Thromboembolic disease meets all the criteria of a major public health problem. Some studies have estimated that up to 200,000 Americans die each year as a result of pulmonary embolism. Furthermore, at least 50% of these people had an otherwise very good prognosis and should not have died. Thus, about 100,000 deaths from pulmonary embolism are preventable. This study indicates that, while primary prophylaxis is almost universal among orthopedic surgeons, very few practice secondary prevention, which could be the reason for the large number of deaths attributed to thromboembolic disease.

Anticoagulants↗
PubMed1996

The potential use of human recombinant erythropoietin in orthopedic surgery.

Human recombinant erythropoietin has been approved by the Food and Drug Administration for treatment of anemia due to chronic renal failure or malignancy and in zidovudine-treated patients with the human immunodeficiency virus. It is highly effective in reducing the anemia commonly seen in these patients, with minimal adverse effects. Approximately 20% of patients undergoing elective orthopedic procedures are not able to donate adequate amounts of autologous blood prior to surgery. Additionally, patients who cannot donate 3 or more units of blood prior to large procedures are at increased risk for receiving a homologous transfusion despite the use of intraoperative and postoperative blood conservation techniques. Investigational use of this drug as an adjuvant to autologous blood donation has been shown to increase the amount of blood donated by patients prior to surgery and, therefore, will decrease homologous blood transfusions after surgery. Perioperative use of this drug, dosage, route of administration, and clinical indications are currently being evaluated in multicenter clinical trials.

Anemia↗
PubMed1996

Assessing the expected outcomes of orthopedic surgical care for children.

A sample of 175 parents of children treated operatively for orthopedic problems were interviewed before surgery to ascertain their expectations with regard to specific functional changes postoperatively. They were interviewed about changes from 6 to 12 months after surgery. Medical records of a sample of this group were reviewed for any notes about functional status. Of this group, 54% said a specific function named preoperatively was "much better." Only a third of the parents from Mexico understood the nature of the procedure performed 6 to 12 months postoperatively, and only 40% of medical records contained notes about functional status pre- or postoperatively.

Adolescent↗
PubMed1997

The Bridgeport Hospital experience with autologous transfusion in orthopedic surgery.

The transfusion records of 341 orthopedic patients who donated blood preoperatively in the years 1992 and 1993 were audited to review the transfusion practices associated with the surgical procedures. The study sample underwent 182 total knee (TKA), 123 total hip (THA) arthroplasties, and 33 laminectomies with fusion (LAM) and 3 without. Data used were age, gender, predonation hemoglobin concentration (Hbd), initial (Hbi) and final (Hbf) hemoglobin concentration, surgical procedure, surgical blood order (SBO), and estimated blood loss (EBL). We analyzed for means and associations and differences between covariates. The means of EBL (mL), transfused units, donated units, Hbi, (g/dL), Hbd, and Hbf (g/dL) for the most common procedures were: TKA--272, 1.1, 2.1, 10.4, 13.9, and 10.1; THA--951, 2.3, 2.4, 9.4, 13.8, and 9.9; and LAM--589, 1.5, 2.2, 12.0, 14.6, and 11.2. Phlebotomies for procedures with minimal blood loss, as for total knee arthroplasties, result in wastage. Autodonation under such circumstances takes patients to an unnecessary low hemoglobin concentration prior to either retransfusing the blood taken or discarding part of it. The number of preoperative autologous units donated can be reduced if predonation hemoglobin concentration is > 15 g/dL and expected blood loss is not > 2 g.

Blood Loss, Surgical↗
PubMed2001

Human immunodeficiency virus testing for elective orthopedic procedures: results in a community-based hospital.

Between January 1, 1989 and July 31, 1995, voluntary preoperative screening tests for human immunodeficiency virus (HIV) infection, using an enzyme-linked immunosorbant assay, were completed on 2,727 patients who underwent elective orthopedic surgical procedures. There were 2,719 (99.7%) negative, 4 (0.15%) positive, and 3 (0.11%) false-positive results; 1 test was indeterminate (0.04%). All 4 positive patients were men with a mean age of 32 years (range: 26-43 years). Although the prevalence of positive tests is low in this setting, voluntary testing alerts the surgeon to higher risk patients, does not sacrifice patient care, and enables the incorporation of more extensive precautionary measures in the operating room to minimize occupational risks to the surgical team.

Adult↗
PubMed2001

Pharmacokinetics of antibiotic prophylaxis in major orthopedic surgery and blood-saving techniques.

The pharmacokinetics of cefuroxime, cefotiam, cefamandole, and ampicillin/sulbactam were randomly measured in 40 patients undergoing major orthopedic surgery associated with high blood and volume turnover and intraoperative blood salvage. Serum and bone concentrations and the pharmacokinetics occurring in the context of these procedures were measured. No changes in elimination half-life relative to a normal population occurred with cefuroxime, cefotiam, and ampicillin. Serum and tissue concentrations were slightly lower with cefamandole and sulbactam, but reapplication of the initial dose was required with all antibiotics 4 hours after the first application.

Aged↗
PubMed1989

Management of orthopedic complications of metabolic bone disease.

Orthopedic manifestations of metabolic bone disease are usually related to structural compromise of the skeleton. Fractures due to osteoporosis are the most often encountered problem. In this overview, the authors focus on the commonly encountered fractures related to osteoporosis and discuss concerns and complications related to their management. In addition, they point out the subtle ways in which less commonly encountered metabolic bone diseases, such as osteomalacia, hyperparathyroidism, and Paget's disease, might come to the attention of the orthopedist. Appropriate criteria for medical and surgical management are suggested.

Bone Diseases, Metabolic↗