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In 114 patients undergoing major orthopedic surgery among which 47 hip replacements, hematocrit was reduced to between 30 and 32% by withdrawing red cells without increasing the blood volume. Deep veinous thrombosis was observed in 4 cases. No pulmonary embolism occurred. Incisional hematoma was noted in 0.9% of the cases.
Orthopedic management of the head trauma patient is divided into 3 phases--acute, recovery and stable. The treatment of bone injury is the main thrust in the acute phase. Guidelines were formulated from a retrospective review of 91 head trauma patients including spine and other fractures. The recovery phase consists of prevention and correction of joint deformities due to spasticity. Position, range of motion and splints are the basic methods employed. Indications and techniques for phenol injection to the posterior tibial and musculocutaneous nerves are reviewed. Heterotopic bone formation will be identified in this phase and treated early. In the final phase, one and one-half years postinjury, surgical treatment is employed to improve extremity function. Procedures proven of value in treatment of stroke patients are applicable. Heterotopic bone can also be definitively treated by excisional surgery supplemented by new medical agents.
The functional or vital prognosis may be affected by the rare vascular accidents resulting from orthopedic operations. During a 10 year period (1970-1980), 55 vascular lesions were observed in 40 patients, and were either arterial (40 cases) or venous (15 cases) in type. Vascular injuries in 9 cases were due to spinal operations (cervical, lumbosacral or herniated disc arthrodesis), in 7 cases to shoulder operations (recurrent dislocation, excision of first rib), in 9 cases to hip surgery (prosthesis, plate and screws, fractured acetabulum), and in 15 cases to operations on the lower limbs (osteosynthesis of femur or tibia, meniscus operations, etc.). Emergency operation was necessary in 18 cases because of a hemorrhagic or ischemic syndrome, all other cases except three requiring secondary surgery for false aneurysms, arteriovenous fistulae, or residual ischemia. Four patients (10%) died, three following hip surgery, and 8 developed complications. The frequency, mechanism, diagnostic and therapy of these lesions are discussed.
Prescribing patterns of physicians on a university-hospital orthopedic unit before, during, and after a clinical pharmacist's intervention were monitored and compared with patterns on a similar unit without clinical pharmacy services at another university hospital. The experimental and control groups consisted of 10% random samples of all patients on the study wards. Mean drug cost, number of doses, and number of courses of therapy for all drugs and for antibiotics were calculated. The data collection period consisted of 9 months (phase 1) before, 12 months (phase 2) during, and 6 months (phase 3) after clinical pharmacy services. Prescribing of postoperative prophylactic antibiotics was evaluated for compliance with guidelines of the experimental hospital's pharmacy and therapeutics committee. In the experimental group there was a consistent reduction from phase 1 to phase 2 in overall and antibiotic drug costs, number of doses, and number of courses of therapy per patient-day, but the differences were not significant. Length of stay decreased from phase 1 to phase 2, but the patterns were not significant over time or between experimental and control groups. For the experimental group, there was a significant reduction during phase 2 in the number of hours of antibiotic prophylaxis after removal of surgical drains, but prescribers' overall compliance with guidelines for postoperative antibiotic prophylaxis did not change significantly over time. In a subgroup receiving antibiotics, drug costs per patient-day at the experimental site were reduced from phase 1 to phase 2 for all drugs and for antibiotics. Of 1196 consultations, 76% were unsolicited; 83% of antibiotic-related problems were identified by the pharmacist.(ABSTRACT TRUNCATED AT 250 WORDS)
Occupational radiation exposure was measured using three film badges and one ring thermoluminescent dosimeter. The radiation dose in the hospital but outside the operating room was measured as zero for the 12-month period. The measured trunk dose in the operating room was 5 mrem, and the measured dose to the head and neck region was 227 mrem. For selected orthopedic procedures a ring thermoluminescent dosimeter was worn on the left ring finger (under a lead glove when appropriate) and measured 0 mrem. The measured occupational radiation exposure to the author was well below the recommendations of the U.S. National Committee on Radiation Protection for maximal permissible dose. However, caution is advised since the long-term biologic effects of exposure to low doses of radiation are not well known. Since many factors influence the amount of radiation to individual surgeons, the data obtained are not necessarily representative.
Eighty-two consecutive orthopedic patients were assessed nutritionally at the time of hospital admission and then at 10-day intervals until hospital dismissal. Forty-eight percent of the patients had one or more abnormal findings suggestive of protein-calorie malnutrition. In spite of this prevalence of abnormal findings, only patients with three abnormal findings or a serum albumin concentration of less than 3.5 g/dl had a longer-than-average hospital stay. During hospitalization, abnormal findings developed on only three patients, whereas one or more abnormal nutrition-related findings improved to reach the normal range in six patients.
The testing of plastics in medicine is regulated by law only for the purpose of implantation. These rules are not including the plastics for skin contact use. In consequence of the increasing offer of the chemical industry, it is necessary to develop specific procedures of testing for these materials, e.g. for the orthopedic engineering.
Powder metal-made orthopedic implants with a porous coating provide an effective means for implant fixation by tissue ingrowth. Additionally, the use of metal alloy powders for forming porous surfaces offers the advantage of uniform coatings on complex part shapes. With proper processing, implants with strong, porous surface layers and good substrate mechanical properties can be formed. The in vivo tests have demonstrated the need for initial implant stability to achieve bony ingrowth. Animal studies indicate an optimum pore size range of 50-400 mu, and human hip prostheses with pores in this range appear to function well. A porous surface integrated with a compatible implant design avoids undesirable bone remodeling with these types of implants.
Orthopedic bioengineering is an example of professionals in distinct disciplines applying their skills to problems that require an interdisciplinary approach. Two current research projects, the development of replacement ligaments and tendons and of an absorbable fracture fixation device, illustrate this integrated approach.
Geriatric patients in orthopedics frequently fail ill of some typical diseases. For clearing up of diagnosis in the clinical investigation the application of Neutral-O-transitional method and of some supplementary investigation (who lead likewise to numerical findings) are recommendable. Selected roentgenograms and laboratory methods are necessary additional for clearing of diagnosis. The application of this "diagnostic standard" is an effective guide for diagnosis and an improvement in the exchange of findings between medical specialists.
The paper is dedicated to the description of a technique now new but also not very used, of regional anesthesia, indicated for surgery of upper limbs: the interscalene brachial plexus block. In Author's experience this type of anesthesia has many indications, related especially to orthopedic and traumatologic surgery, in patients with high anesthesiologic danger. This type of regional anesthesia by interscalene technique is, in Author's opinion, much better than the axillar technique, now moore frequently used.
For the purpose of preventing postoperative orthopedic infections, investigation was carried out on effectiveness and safety of amikacin (AMK) after washing wound surface with its solution. 500 ml saline solution containing 400 mg AMK was used for washing. As the result, no postoperative infections were observed in all the 19 patients operated in our department. Neither abnormal findings to be regarded as abnormalities in blood test nor side-effects caused by washing were also observed. The blood samples obtained after washing did not show measurable AMK in all cases. It is said that use of antibiotics with 1) a wide-range of spectrum, 2) a bactericidal action and 3) low cross resistance against other antibiotics is preferable in washing wound surface in order to prevent postoperative infections. Under these circumstances, administration of aminoglycoside antibiotics is used frequently. Concerning the use of aminoglycoside antibiotics, however, it is necessary to pay attention to auditory and renal impairment. The previous study has revealed that AMK is lower in auditory and renal toxicity than other aminoglycoside antibiotics. AMK is thought, therefore, to be free from fear of auditory and renal impairment after washing and also to be one of effective antibiotics.
This article discusses the current applications of MR imaging in the practice of orthopedic surgery and sports medicine. When is MR imaging helpful to the treating surgeon, and when is it not? In what specific areas will future improvements in technical acquisition and interpretation be helpful in determining appropriate treatment? This article explores these questions.
The authors the scheme of the computerization of their orthopedic-traumatologic department. An everyday work has been markedly advanced.
Outpatient surgery in orthopedics, which ist becoming increasingly popular and is promoted by present-day health care legislation, is associated with a whole range of ifs and buts. Patient-related factors, including age, readiness and ability to cooperate, and home care, need just as much consideration as physician-related factors (experience of the surgeon, anesthesist und surgical team). Architectural and equipment-related facilities need to be investigated. Not every intervention that is theoretically possible on an outpatient basis can be recommended--for example if intensive aftercare, which is better performed on an inpatient basis, should be necessary. The usual postoperative risks (e.g. thrombosis) must be taken into account, and in such cases, proper care must be guaranteed.
Paralysis, muscle imbalance, and spasticity resulting from myelomeningocele produce orthopedic deformities that often require surgical correction. Spinal deformities in myelomeningocele are nearly universal, and are difficult to treat because of the absence of posterior elements. Hip dislocations frequently occur, but rarely require treatment. Severe foot deformities are seen in up to 80% of children.
Nosocomial infection remains a significant problem in modern traumatology and orthopedics. Staphylococcus prevails in its etiological pattern. The activation of microorganisms such as Acinetobacter is noted. In addition to aerobic microorganisms, anaerobic bacteria, nonsporulating ones, play an important etiological role. Anaerobic infection is seedy in 30.4% of patients' blood samples. Great emphasis is placed on microbial adhesiveness in the pathogenesis of an infectious process. The authors' investigations have shown that highly adhesive Staphylococci are common in severe pathological processes. The adhesiveness of the bacteria has been shown to depend on environmental conditions and the patient's status. Among the nonsporulating anaerobes there are bacteroids which are most highly adhesive.
We describe here the basic characteristics and operative modalities of the acute care orthopedic-geriatric unit, an innovative model of health care for elderly trauma patients. This new unit offers several advantages over traditional models: decreased patient mortality and length of hospital stay, a lower incidence of complications, and less need for specialist consultations. No particular organizational or management problems have arisen, and the cost/benefit ratio is very low. This model has also become a valuable teaching tool and a rich source of pathophysiological and clinical data for geriatric research.