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PubMedDate not supplied

Primary care orthopedics and sports medicine in West Virginia.

Previous studies at several family practice residency programs in the U.S. have shown that many family practice graduates feel inadequately prepared to offer fracture care or casting. In order to determine if this was a problem in West Virginia, a survey was sent to all family physicians in the state which asked about their type of practice and residency training, if they provided fracture care or casting services, if they offered sports medicine coverage for teams in their communities, attitudes about their own competency in caring for fractures, as well as other personal and demographic data. Our survey confirmed that only 118 family physicians provide fracture care (42%), and that only 91 provide casting services (32%). The surveys also revealed that rural physicians feel obligated to offer this service, despite the fact that they do not perceive themselves to be very competent in this aspect of patient care, and only 43 rural physicians offer sports medicine coverage (44%). As a result of these findings, we propose that a more adequate orthopedic experience be a part of family practice training, and that there should also be increased emphasis on insuring family practice residents have a basic competency in sports medicine.

Adult↗
PubMed1994

[C-reactive protein as infection parameter in clinically suspected postoperative infection after trauma surgery and orthopedic interventions. 2].

Prospectively the levels of C-reactive protein (CRP) of 40 patients were studied twice within 6-12 hours in case of a suspected infection after different osteosynthetic and orthopedic procedures and compared with the levels of the erythrocyte sedimentation rate (ESR). 16 patients showed an increase of CRP in relation to a wound infection, hematoma or effusion in all but one case. 6 patients showed an increase of ESR, which also could be cleared in all but one case. Those patients with a proved wound infection demonstrated a CRP-rise in 8 cases, a CRP-plateau in 4 cases and no CRP-decrease. The same patients showed an ESR-rise in 3, an ESR-plateau in 7 and an ESR-decrease in even 2 cases. This study indicates that the determination of two CRP-levels with a short interval in case of a clinically suspected infection is another, meaningful criterion in making a decision for an operative revision.

Blood Sedimentation↗
PubMedDate not supplied

The classic: Tendon transplants in orthopedic practice by A Codvilla.

Alessandro Codavilla (1861-1912), Director of the famous Rizzoli Institute of Bologna, was one of the leading figures in orthopedic surgery at the turn of the century. The surgical transplantation of tendons and muscles was being widely practiced in most of the leading centers at that time with very variable success. Codavilla is credited by many of his contemporaries including Bielsalski, Mayer and Steindler for his classic and fundamental studies in the physiological aspects of tendon transfer. Published in 1899, this article generally established the physiologic concepts of modern tendon transplantation surgery.

History, 19th Century↗
PubMed1995

A double-blinded, randomized, controlled clinical trial to compare cefazolin and cefonicid for antimicrobial prophylaxis in clean orthopedic surgery.

A double-blind, prospective randomized study was performed to compare cefazolin and cefonicid given for prophylaxis to 102 patients undergoing orthopedic surgery. Risk factors (e.g., age, sex, type of operation performed) among the two groups were similar. All patients had foreign material (prosthesis or other hardware) inserted at operation. There was a total of 6 infections (3 wound and 3 urinary tract) in 6 patients among the 48 receiving cefazolin (12.5%), whereas no infections were observed among the 54 patients who received cefonicid. Cefonicid, given once daily, provides protection against postoperative infection that is not inferior to cefazolin. A larger study is needed to confirm whether cefonicid is indeed superior to cefazolin.

Adolescent↗
PubMed1976

A history of orthopedics in San Francisco and the West.

The unique development of early medical specialization in the West can be traced to California's geography and economic development. Such early specialization produced men with orthopedic inclinations. Early orthopedists founded the first medical school and the first modern teaching hospital, helped to found Stanford's Lane Medical Library and made the first use of x-rays in the West. In addition many of these orthopedists were prominent in the political and social activities of the time.

California↗
PubMedDate not supplied

[Robert Schumann. From music to orthopedics].

The psychiatric personality of Robert Schumann has notably concerned doctors. On the contrary his right hand orthopedic impairment seems to have been neglected. Relying on some well established facts and the fingering study of certain musical works, the authors put forward a plausible diagnosis and consider a treatment which would have allowed a functional rehabilitation of the great musician and nine-fingers-handed pianist.

Adult↗
PubMed1993

[Prevention of endogenous infectious complications in patients after severe trauma and orthopedic surgery].

The clinical efficacy of a complex procedure for the prophylaxis of purulent septic complications in patients requiring pulmonary artificial ventilation after severe traumata and orthopedic operations, as well as in patients with the endoprosthetic appliance of the hip joint and the resection of bone tumors was studied. The procedure includes a selective decontamination of the gastrointestinal tract and oral cavity, the oral administration of lactic acid bifidum-bacterin (eubiotic) during the entire period of the pulmonary artificial ventilation and a short-term systemic administration of a 3rd generation cephalosporin. The autoflora and microflora of the pathologic foci in the patients were tested. There were observed regularities in the colonization of the mucous membranes and wounds with aerobic opportunistic organisms and the endogenic pattern of the infectious complications in the patients subjected to the pulmonary artificial ventilation. The use of the complex procedure for the prophylaxis resulted in a significant decrease in the number of the patients with purulent septic complications.

Anti-Infective Agents↗
PubMed1994

Holding power of orthopedic screws in the large metacarpal and metatarsal bones of calves.

Holding power was determined for various orthopedic screws in bones of calves. Holding power was defined as maximal tensile force required to remove a screw divided by thickness of bone engaged by the screw (kN/mm). Comparative pull-out tests were performed, using pairs of large metacarpal or metatarsal bones from calves aged 3 to 14 days. Comparisons were made of the holding power of 6.5-mm fully threaded cancellous screws and 5.5-mm cortical screws in the proximal and distal metaphyses, and of 4.5-mm and 5.5-mm cortical screws in the diaphysis. Sixteen repetitions of each comparative trial were performed. There was no statistically significant difference in the holding power of 4.5- and 5.5-mm cortical screws in the diaphysis. There was no significant difference in the holding power of 5.5-mm cortical and 6.5-mm fully threaded cancellous screws in the proximal metaphysis. In the distal metaphysis, 6.5-mm fully threaded cancellous screws had significantly (P < 0.001) greater holding power than did 5.5-mm cortical screws. There was no significant difference between the mean holding power of 5.5-mm cortical screws in the proximal metaphysis and 5.5-mm cortical screws in the distal metaphysis. There was significantly (P < 0.01) greater mean holding power of 6.5-mm cortical, fully threaded cancellous screws in the distal metaphysis, compared with the proximal metaphysis.

Animals↗
PubMedDate not supplied

[Hypotension controlled with ATP in orthopedic surgery: incidence of atrio-ventricular conduction disorders].

Adenosine triphosphate (ATP) has been effectively used for induced hypotension in man. Atrio-Ventricular (A-V) conduction disturbances have been observed after adenosine bolus injection and during continuous ATP i.v. infusion. The present perspective investigation was designed to determine the incidence of A-V conduction disturbances during ATP-induced hypotension. Thirty-five normotensive healthy patients (ASA I-II) with no preoperative therapy were subjected to the same anesthetic technique for orthopedic surgery. Premedication consisted of diazepam and atropine. Anesthesia was induced with thiopental and fentanyl followed by atracurium for intubation. The maintenance anesthesia consisted of isoflurane (1.5% inspired)-N2O (60%) in oxygen and incremental doses of fentanyl; the lungs were mechanically ventilated. Dipyridamole (0.15 mg kg-1) was given 15 min prior to ATP-infusion. ATP was administered by an infusion pump at a dosage of 0.025-0.05 mg kg-1 min-1. The ECG was recorded with a Mingograph 34 tape-recorder using 3 pregelled electrodes positioned to give an effective V6 lead pattern. MAP was reduced by 25% and HR increased by 6%. The mean duration of ATP-induced hypotension was 75 min +/- 50 and the mean dose of ATP infused was 200 mg +/- 161. Six patients (17%) showed A-V conduction disturbances. There was a I A-V Block (AVB) in 2 cases, a II AVB in 2 cases and a III AVB in 2 cases. In every case the arrhythmia disappeared spontaneously or after ATP-infusion suspension.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed1993

Soft-tissue reconstruction in orthopedic surgery. Secondary procedures.

The original consulting microsurgeon should be present to assist in the identification and protection of the vascular pedicle during secondary procedures on microvascular transplants. Flap elevation, trimming, and bone graft placement should be completed during a single tourniquet time, whenever possible. Flaps can easily be resutured on the original bed while the tourniquet is still inflated. Although proximal pedicle transection is possible, it should be avoided by careful planning, because the transplanted tissue cannot be predictably expected to survive, especially with muscle transplants. The distal muscle should be transected only in situations in which the muscle inset is extremely complex. Transection in the extramuscular portion of the main pedicle may require prompt microsurgical repair in immature muscle transplants. The safest approach is to avoid the pedicle whenever additional secondary procedures are necessary following free microvascular tissue transplantation. Placement of vascular pedicles such that the anterior crest of the tibia is avoided if the Ilizarov technique is required permit uncomplicated distraction osteosynthesis. Simultaneous Ilizarov fixation and microvascular tissue transfer are safe, practical procedures for limb salvage. Placement of the Ilizarov fixator at the time of microvascular transplantation provides stable fixation and eliminates the need for a subsequent anesthetic for fixator placement. This form of stabilization, when performed at the time of microvascular tissue transfer, allows the orthopedic surgeon direct visualization of the fracture site as the fixator is placed and eliminates the need for placement of the fixation device through the transplanted tissue. Tissue expansion or suction lipectomy are sometimes needed to optimize the clinical result.

Bone Transplantation↗
PubMed1977

[Sawing and welding with ultrasonics. Experimental investigation to test the applicability of an apparatus for sawing and welding bone tissue with ultrasonics in orthopedics (author's transl)].

An experimental investigation of a procedure for sawing and welding of bone tissue with ultrasonics in the area of orthopedics was reported. The welding of bone with ultrasonic waves, bone meal and a plastic adhesive did not product satisfactory results in terms of stability and tissue reaction. The applicability of the ultrasonic saw is limited by the thickness of the bone on which the osteotomy is to be performed. We saw no advantages over against the oscillating saws which were available to us. In our opinion, an indication for the application of the ultrasonic apparatus could be the removal of inflammatory, tumerous or necrotic bone processes.

Animals↗
PubMed1993

[An evaluation of the analgesic activity and tolerance of ST-679 in patients with pain following orthopedic and traumatological interventions].

The analgesic efficacy and tolerability of ST-679 (administered in a single oral dose of 1200 mg) was evaluated in a double-blind parallel-group study, as compared with paracetamol (administered in a single oral dose of 1000 mg) on 40 patients with pain following orthopedic or traumatological surgery. ST-679 was shown to possess better analgesic qualities with respect to paracetamol, in that the effect establishes itself more quickly and, moreover, both the maximum analgesic activity performed as well as the constant level on which such activity tends to stabilize is greater. No adverse reaction was recorded for either treatment, but ST-679 demonstrated a better tolerability with regard to paracetamol.

Acetaminophen↗
PubMed1993

Laser applications in orthopedics.

The use of lasers has made a significant impact on surgery. Various types of lasers are available for use in orthopedics. A successful laser program identifies perioperative considerations, applications/modalities, and reimbursement issues. As this technology expands, more clinical applications will be utilized.

Humans↗
PubMed1993

Autotransfusion in the postoperative orthopedic patient.

Transfusion of autologous blood has become increasingly important as an alternative to the use of conventional allogeneic products. Some areas of autotransfusion, like predeposit and intraoperative salvage, are well standardized and generally recommended by physicians. In many orthopedic surgical procedures, the postoperative drainage constitutes a significant percentage of the total perioperative blood loss. Recently, reinfusion of this salvaged, unprocessed autologous blood has been widely advocated; however, reports on its quality are infrequent in the literature. This pilot study, based on sophisticated laboratory testing, describes an efficient method whereby postoperatively shed blood can be appropriately processed and returned to the patient as a relatively safe product.

Adult↗
PubMed1977

[Reactive-periodical variations of vegetative parameters following orthopedic operations (author's transl)].

Continuous examinations during 4-6 weeks following various orthopedic operations of circulatory, retinuous improvement of the factors examined. E.g. frequency of resting pulse showed periodic variations with, in parts, regressive tendencies. In individual cases the maxima and minima of these variations showed considerable differences, but had a peak of frequency at 6-7 days. Similar variations of stabilizations of circulation were seen in 7 amputees of the lower limb, at rest and when learning to walk. Such variations with mainly circaseptan periodicity are unspecific accompanying reactions as part of vegetative adaptation, as known elsewhere. Similar investigations on 15 patients, walking after replacement of the hip joint and before the operation, are reported on. During the first 3-5 postoperative weeks circulatory findings were much worse, but 2 years later the values at rest and when walking were much improved, because of better walking economy.

Amputation, Surgical↗
PubMed1995

Knowledge representation in orthopedics: from conceptual modeling to nomenclatures using 'Orthonav'.

Health budget cuts in developed countries have stressed the importance of the valued physician's activity's representation. Therefore, good codification standards have been necessary. Automated translation from information given directly by the physician is our chosen approach. Through conceptual modeling of nomenclatures used in the domain of Orthopedic Surgery in France, the authors show the feasibility, the advantages and the problems encountered using this kind of modeling with Orthonav, an original knowledge base built for codification of patients' records.

Expert Systems↗
PubMed1996

Potential of epoetin alfa in patients in autologous blood donation programs for orthopedic surgery.

The ability of epoetin alfa to increase hematopoiesis in a dose-dependent manner when administered by the intravenous (i.v.) or subcutaneous (s.c.) route has been demonstrated in pharmacokinetic studies in healthy volunteers. Epoetin alfa may therefore be a useful adjunct to autologous blood (AB) donation. By facilitating AB donation, the use of allogeneic blood could be reduced. In patients scheduled to undergo orthopedic surgery, i.v. administration of epoetin alfa 600 IU/kg twice weekly for 3 weeks prior to surgery (in conjunction with oral iron supplementation) significantly increased the number of AB units and total red blood cell (RBC) volume donated and increased the number of patients able to donate > or = 4 AB units. However, there was no difference between epoetin alfa and placebo groups with respect to allogeneic blood exposure.

Anemia↗