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PubMed1992

Ceramics in orthopedic surgery.

Ceramics are stable compounds of metals with oxygen or other anions. They have been considered for orthopedic implant applications for nearly three decades because of their wear resistance and biochemical inertness. After numerous efforts to realize this promise, ceramics have not achieved wide acceptance because of their brittleness that carries the risk of unpredictable catastrophic failure in load-bearing applications. Perhaps the brightest prospects for ceramics lie in their use as reinforcing fibers in composite implants and as calcium hydroxylapatite coatings on metal implants where it can induce direct bonding with bone.

Animals↗
PubMed2004

[A survey study on "Turk-Orthopod", a Turkish electronic discussion group in orthopedics and traumatology].

OBJECTIVES: This study evaluated demographic data of Turk-orthopod members, an electronic mailing list organized for communication between Turkish speaking orthopedic surgeons, and the contribution of the mailing list to the academic improvement and education of its members. METHODS: A twenty-seven item questionnaire was prepared for online survey and an e-mail massage was sent to the members of the e-group asking them to respond to the questionnaire. RESULTS: The response rate was 33% (n=225; 224 males, 1 female; mean age 36.5 years; range 25 to 64 years). A great majority of the respondents (74.2%) worked in a teaching hospital as a member of active education; 104 respondents worked in a medical school, and 76 respondents (33.8%) had a faculty membership. Access to scientific information (55.1%) was the most frequent reason for using the Internet. Messages related to case discussions (60.9%) and scientific announcements (27.6%) received the most attention and interest. Of the participants, 56.4% reported to have read all the incoming messages, and 35.1% reported not to have sent any messages to the group. CONCLUSION: Our electronic discussion group, Turk-orthopod, has proved to be a quick communication tool, presenting a considerable potential to contribute to continuous medical education of Turkish orthopedists.

Adult↗
PubMed2004

[Biological coating of implants in trauma and orthopedic surgery].

In spite of improved operation techniques and optimized implants in trauma and orthopedic surgery complications like delayed fracture healing, non-unions or broad osseous infections may occur. This may be explained by more complex patterns of injuries, more extensive operative procedures and more complex fractures in cause of osteoporosis with increasing age. In the last years some growth factors for local application were approved (BMP-2, BMP-7), however not widely accepted. Reasons may be the high quantities of these limited and expensive proteins, which have to be implanted. Furthermore the local release from a bovine collagen carrier in tissue is not evident. The use of coated implants with incorporated active ingredients could release drugs locally and thereby obtain a high concentration in the area of interest without systemic side effects. Possible compounds for the improvement of fracture healing could be growth factors as well as antibiotics for prophylaxis of implant related infections. A biodegradable poly (D,L-lactid)-coating of implants could release incorporated growth factors in a controlled manner directly into the fracture. Furthermore the coated implant remains as a fracture treatment device. Different models are demonstrated (fracture healing--intervertebral fusion--infection model) to prove the efficiency of the coating technology. These findings seem to justify the transfer of this technology into clinic.

Anti-Bacterial Agents↗
PubMed2005

[Ability of leukocyte reduction filters to remove fat particles from blood in experimental models simulating blood salvage in orthopedic surgery].

BACKGROUND: Salvaged autologous blood in orthopedic surgery may contain tissular debris such as fat particles (FP), possibly increasing the risk of fat embolism after bone surgery. Therefore, this study was initiated to ascertain the capacity of leukocyte filters to remove FP using in vitro models. METHODS: All experiments were performed in triplicate using donor blood bags within 15 days of their donation. Five different olive oil volumes were added to blood to obtain 5 oil concentrations (1% to 5%), and blood was subsequently filtered through a PureCell (Pall Biomedical, Portsmouth, UK) leukocyte-reduction filter. In another set of experiments, 5 different oil volumes (1, 2.5, 5, 7.5 or 10 mL) were injected into the line during filtration of oil-free blood. In addition, 3 preparations of blood supplemented with 5% oil were processed in the autotransfusion device OrthoPAT (Haemonetics Corp, Braintree, MA, USA), and the obtained red cell concentrate was subsequently filtered through PureCell. We collected samples for cell counting and analysis and FP detection with a Pentra 120 Retic (ABX, Montpellier, France) flow cytometer. RESULTS: Specific signals corresponding to FP were clearly detected in the white blood cell scattergrams yielded by the cytometer for oil supplemented blood. PureCell removed FP up to an oil concentration of 3% or up to an injected oil volume of less than 10 mL. Addition of a filtration step through a PureCell filter after blood washing by the OrthoPAT device completely removed FP. CONCLUSIONS: Leukocyte filters seem to be useful for removing FP from unprocessed blood with a low degree of fat contamination (less than 10 mL) and to complete FP removal from processed blood. Therefore, using a leukocyte filter in the patient's line should contribute to improving the safety of perioperative autologous blood salvage.

Fats↗
PubMed2005

Femoral and sciatic nerves block (BiBlock) in orthopedic traumatologic lower limbs surgery in patients with multiple sclerosis.

Multiple sclerosis is a progressive demyelinating disease which affects large areas of the brain and of the spinal cord. Stressful events, surgical procedures, general anaesthesia and central blocks seem to be responsible for relapses, with worsening of the disease. So, when we scheduled 2 patients with multiple sclerosis for lower limbs orthopedic traumatologic surgery, we decided to use a peripheral block, and in particular a BiBlock. The patients' evaluation in the immediate postoperative course and 30 days after surgery has shown no relapses of the disease. In the literature, however, data about anaesthesia and multiple sclerosis are few and controversial, sometimes in contrast. Anyway, the use of peripheral blocks has neither anatomic, nor metabolic interferences with the lesion sites of multiple sclerosis. In conclusion, peripheral block is safe and it is the technique of choice for this type of patients, when surgery allows it.

Accidental Falls↗
PubMed2005

[Video-assisted thoracoscopic surgery for migration of an orthopedic fixation wire in the mediastinum: report of a case].

Migration of an orthopedic fixation wire into the thoracic cavity is an uncommon complication. We present a 64-year-old male undergoing intra-thoracic migration of a Kirschner wire. The patient had undergone the treatment of sternoclavicular joint dislocation due to clavicular fracture. Four months after the operation, a chest X-ray revealed a metallic foreign body in the mediastinum. A chest computed tomography (CT) showed the object in the anterior mediastinum adjacent to the aortic arch. An emergency video-assisted thoracoscopic surgery was successfully performed to remove a 60-mm-long Kirschner wire migrated from the mediastinum to the thoracic cavity. The operating time was 45 minutes, and the blood loss was less than 50 ml. His postoperative course was uneventful and he was discharged at the 6th day after surgery. Prompt diagnosis and surgical removal are necessary to prevent serious complications.

Bone Wires↗
PubMed2005

An observational study of duplicate presentation rates between two national orthopedic meetings.

BACKGROUND: National meetings such as those of the American Academy of Orthopaedic Surgeons (AAOS) and the Canadian Orthopaedic Association (COA) are invaluable in the dissemination of new research findings. Given the limits of meeting agendas, investigators who present the same paper at multiple meetings prevent other presentations on potentially important original research. To determine the incidence of duplicate presentation of research between recent COA and AAOS meetings and between national meetings (AAOS and subspecialty), we conducted an observational study. METHODS: We hand-searched all podium papers and posters from the 2001 COA annual meeting for duplicate presentation at the 2001 and 2002 AAOS annual meetings and subspecialty meetings held in the USA. We evaluated summary data abstracted from the duplicate presentations for consistency. RESULTS: Of 148 presentations at the 2001 COA meeting, 29 presentations (paper and poster) were duplicated at the 2001 or 2002 AAOS meeting: effectively 1 paper in 5 (19.5%). Canadian investigators were significantly more likely to present the same paper at both meetings than Americans (79% v. 13%, respectively; p < 0.01). Those who presented papers at COA altered their AAOS presentations in a variety of ways: by changing the wording in the title of their paper (24% of the time), adding or removing authors (38%), changing authorship order (34%) and changing the sample size (31%). Duplicate presentation rates between AAOS and other orthopedic subspecialty meetings averaged 11.4% (range 3.4%-26.4%). CONCLUSIONS: We identified a 20% duplicate presentation rate between the COA and AAOS annual meetings, and an 11% rate between the AAOS and subspecialty meetings. Stricter enforcement of guidelines and improved dissemination of research findings at both national meetings may limit this practice.

Canada↗
PubMedDate not supplied

[Scheduled autotransfusion in orthopedic surgery].

We report the results of a programmed autotransfusion protocol applied to 22 patients undergoing orthopedic surgery. The number of extractions depended on the surgical needs and on the scheduled time for surgery. Among the total amount of blood used in this study, 81.7% corresponded to the volume previously given by the patient. This volume was sufficient for autologous transfusion in 17 patients. The remaining 18.3% of volume corresponded to homologous blood. We compared the hematologic data obtained at the beginning of the protocol and at the immediate pre and postoperative phase. We found statistical differences among hemoglobin levels, hematocrit, mean corpuscular hemoglobin, and mean corpuscular volume. We conclude that programmed autotransfusion constitutes an ideal method to compensate blood losses during surgery. This method may be the future for hemotransfusion in programmed surgery.

Adolescent↗
PubMed2005

Orthopedic-driven ambulatory surgery centers and specialty hospitals--a physician and hospital perspective.

This article provides an overview of several issues facing the orthopedic-driven ambulatory surgery center and specialty hospital development industry. The article specifically then reviews certain key business drivers to industry growth, examines key risks related to ASC and specialty hospital projects, and provides a brief review of certain legal issues related to the same.

Hospital-Physician Relations↗
PubMed2005

[Traumatic lesions of the spinal cord. Management in the hospital: the orthopedic surgeon's point of view].

Initial presurgical management of spinal injuries with spinal cord damage includes cardiorespiratory intensive care, a precise neurologic examination, and a complete radiological work-up with simple films, computed tomography, and also magnetic resonance imaging if there is a conflict between the imaging results and clinical findings. The structural lesion can then be staged, using a reproducible system with prognostic value for instability. Reduction, decompression and stabilization are the three main objectives of orthopedic management. In our unit, reduction is achieved either with external maneuvers (traction applied with cranial tongs for cervical injuries, or placing long cushions under the patient with thoracolumbar injury) or by using internal, surgical techniques. Instead of waiting for decompression by natural remodeling, surgeons should perform decompressive procedures. Surgical stabilization includes osteosynthesis and grafting, which permits more active patient care. The interval between injury and surgery is crucial. It should be as short as possible in case of severe instability or when the lesion cannot be reduced. We recommend the anterior approach to the lower cervical region. The posterior approach is simpler for urgent treatment of thoracolumbar lesions. Spinal cord injuries in children pose two specific problems: that of spinal cord damage with no visible bony lesions; and that of subsequent spinal deformities (scoliosis, hypokyphosis, or hyperlordosis). The most common spinal cord injuries in the elderly involve hyperextension in patients with cervical canal stenosis. The incidence of spinal damage, with or without spinal cord involvement, is increasing Instability being rare in such cases, the primary objectives of surgery are usually decompression and repair.

Decompression, Surgical↗
PubMed2005

Tramadol/acetaminophen tablets in the treatment of postsurgical orthopedic pain.

Tramadol/acetaminophen (APAP) combination tablets were shown effective and safe for postsurgical orthopedic pain in a 6-day, multicenter, randomized, double-blind, active- and placebo-controlled study. Of 305 intent-to-treat (ITT) postsurgical patients, 153 patients undergoing arthroscopy who had at least moderate pain were randomized to receive either tramadol 37.5 mg/APAP 325 mg (mean, 4.3 tablets), or codeine 30 mg/APAP 300 mg (mean, 4.6 tablets), or placebo. Tramadol/APAP was superior to placebo for the following outcome variables: total pain relief (TOTPAR, P = .013), sum of pain intensity differences (SPID, P = .049), sum of total pain relief and sum of pain intensity differences (SPRID, P = .018), and average daily pain relief (P = .031). Similar incidence of adverse events for tramadol/APAP and codeine/APAP was found, except for constipation (0% vs 10.9%) and vomiting (8.2% vs 16.4%).

Acetaminophen↗
PubMedDate not supplied

[Effect of anesthesia and anticoagulant prophylaxis on the occurrence of postoperative thromboembolic complications in orthopedic patients].

Different prevention regimens of venous thromboembolism, by using the low molecular-weight heparin Fraxiparin, were studied in 152 patients who had undergone major orthopedic leg surgery under spinal and general anesthesia. The regimens differed in the time of Fraxiparin administration (before or after surgery). Fraxiparin and spinal anesthesia were found to promote the lower incidence of venous thromboembolism. The preoperative preventive treatment of venous thromboembolism, by using a low molecular-weight heparin in patients undergoing spinal anesthesia is unnecessary because of a high risk of epidural hematomas. If the risk for venous thromboembolism is higher before surgery and remains the same after it, thromboprophylaxis should be prolonged for at least one month.

Adult↗
PubMed2006

Effective thromboprophytaxis administered close to the time of major orthopedic surgery: a review.

As major orthopedic surgery poses a high risk for venous thromboembolic disease, use of thromboprophylaxis has become routine in this setting. Unfortunately, there is still no consensus regarding optimal time to initiate thromboprophylaxis. Results from several studies indicate the importance of timing to the efficacy and safety of thromboprophylaxis. As thrombogenesis is thought to begin perioperatively, "just-in-time" thromboprophylaxis has been proposed-antithrombotic therapy with low-molecular-weight heparins initiated soon before or soon after surgery. Results from our large clinical trial show the efficacy and safety of a modified dalteparin regimen administered close to the time of total hip arthroplasty.

Dose-Response Relationship, Drug↗
PubMed2006

[PDT photodynamic therapy in orthopedic inflammatory conditions?].

The infections in orthopedic surgery and traumatology represents important medical problem. The results of treatment of motor-organs infections in high degree were improved by the introduction of antisepsis and asepsis in XIX century and the antibiotics' discovery in the beginning of XX century. However, widespread usage of antibiotics leaded to the rise of refractory tribes of bacteria on their activity, which caused higher percentage of fails in the therapy. Also the rapid civilization development, which flown on arising of a new invasive methods of operative trauma protection and stabilizations of fractures in motor-organs area increased the number of infectious complications during treatment. These facts gave a reason to look for a more effective therapeutic methods. It seems that photodynamic therapy gives us the new possibilities of infectious treatment, which avails oneself activity of therapeutic light laser with proper wave length on the human tissue with photosensitizer included. Indeed there are known until now splendid results of PDT in neoplasma treatment, however it seems, based on experimental investigations and publications in medical literature, that this method can be a chance of effectual and non-invasive treatment of the soft tissues and bones inflammations.

Animals↗
PubMedDate not supplied

[Short-term hospitalization: experience in Otorhinolaryngology and Orthopedics].

The activation of short-term hospitalization in the Otorhinolaryngology and Orthopedics departments of a medium-sized hospital has led to considerable rationalization of costs, as well as to organization of patient care based on level and intensity of treatment required, less social and psychological discomforts for patients, and to a higher level of integration between hospital and community services. This experience, of 10 months duration, may be taken as a model of a concrete organizational and functional transformation and of adaptation to the demand and supply of healthcare services.

Adolescent↗
PubMed1991

[Prevention of thrombosis in orthopedic surgery].

The high incidence of thromboembolic complications in orthopedic surgery necessitates an effective thromboprophylactic regime. Current methods of prophylaxis are discussed, and principles of thromboprophylaxis with low-molecular weight heparin are presented.

Aspirin↗