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At least 1,279 records · Page 71Linked to original sources
PubMed1996

Epoetin alfa plus autologous blood donation and normovolemic hemodilution in patients scheduled for orthopedic or vascular surgery.

In previous studies, treatment with epoetin alfa facilitated preoperative donation of autologous blood (AB). However, some patients may not be able to donate sufficient AB to meet their surgical blood requirements when the time to surgery is short. In this multicenter, double-blind, placebo-controlled study, the ability of epoetin alfa combined with normovolemic hemodilution (NVHD) to facilitate the collection of > or = 4 AB units within 2 weeks of surgery was investigated in 112 nonanemic patients scheduled for elective orthopedic or vascular surgery. All patients received oral iron supplementation and were treated with three intravenous (i.v.) injections of epoetin alfa (300 or 600 IU/kg) on days 1,4, and 7; surgery, in combination with NVHD, was performed on day 13. A total of 4 units of AB were predeposited if the patient's hemoglobin (Hb) level exceeded 11 g/dL at each donation. Compared with placebo, epoetin alfa dose-dependently increased reticulocyte counts prior to surgery and significantly minimized the decrease in hematocrit (Hct) associated with AB donation, although there were no significant differences between dosages. While significantly more patients treated with epoetin alfa were able to donate > or = 4 AB units compared with placebo, there was no difference between the groups in exposure to allogeneic blood. This effect of epoetin alfa was particularly apparent in female patients. I.v. epoetin alfa 300 IU/kg, administered three times within 1 week, appears to be the optimum dose for facilitating the collection of > or = 4 units of AB in nonanemic patients scheduled for elective surgery and NVHD within 2 weeks.

Administration, Oral↗
PubMed1995

[Pain and tourniquet in orthopedic surgery].

The use of a pneumatic tourniquet to provide a bloodless field in orthopedic surgery is often complicated by tourniquet pain. The mechanism of this pain remains incompletely understood, but it is probably multifactorial. Nerve compression is a common etiologic feature. The use of local anaesthetics may be considered the best choice for avoiding tourniquet pain. Superficial (skin) compression and deep components compression like blood vessels and muscles can both induce tourniquet pain. Central nervous system can also interfere. Release of tourniquet can increase the pain by post-ischaemic oedema due to ischaemia and reperfusion injury.

Blood Vessels↗
PubMedDate not supplied

Cancer risk from orthopedic prostheses.

Permanent replacement of joints damaged by fracture or arthritis has become common over the last 50 years. Vigilance over possible long-term adverse effects of metal prostheses is required. Some of the metal components are potentially carcinogenic. Prolonged contact of metal alloys with body fluids results in gradual corrosion of even the most inert metals. Three cohost studies of persons with a hip prosthesis have been reported; they provide direct, quantitative observations of cancer risk in a human population with hip prosthesis. The design and the results of these studies are similar. Combining the results sharpens the precision of risk estimates. Collectively, the studies examined cancer risk in 40,945 patients followed up for a mean 8.5 years after hip replacement. Overall, the relative risk of cancer was 1.02 (95 percent CI 1.00 to 1.05). There was an 8 percent excess of haemopoietic malignancy (leukaemia and lymphoma), with a total of 347 cases observed (RR 1.08, 95 percent CI 0.97 to 1.20). Significant deficits of cancers of the breast and large bowel were seen in the two smaller studies, but combined results from all three studies suggest the relative risk is close to unity. Cancer risk in the first 10 years after hip replacement was not different from that expected, but there was an excess of borderline statistical significance 10 or more years after surgery, with a relative risk of 1.08 (95 percent CI 1.00 to 1.13) based on 1,005 cases. All three studies were well-designed and executed. Their results are not alarming, but give no cause for complacency, since the number of patients with a prosthesis and the length of time they live with the prosthesis will increase. A register of malignancy complicating joint prosthesis would not help quantify any risk. Instead, a large cohort study of patients with joint prostheses is needed, including information on the type and composition of the prosthesis and on potential confounding exposures for each patient. Measures of corrosion in cancer cases and of tissue levels of relevant metal ions in cases and controls (prosthesis but no cancer) matched for age, sex, and time since insertion would be valuable. Such a study could be done internationally, using orthopedic units with good clinical records for 10 to 15 years in areas with long-term cancer registration.

Cohort Studies↗
PubMed1996

Establishing a universal protocol for deep vein thrombosis following orthopedic surgery: total knee arthroplasty.

The incidence of deep vein thrombosis (DVT) after total knee replacement surgery is reported to occur in 84% of all unprotected patients and may be as high as 68% in patients who receive DVT prophylaxis. Moreover, controversy exists as to which pharmacologic or mechanical agent is most effective. Although the scientific literature provides some answers, many issues of DVT prophylaxis are not completely addressed, especially with regard to the duration of prophylaxis. The most recent report from the American College of Chest Physicians Consensus Conference on Antithrombotic Therapy reconfirms the recommendations offered from previous consensus groups on the importance of establishing and applying a universal protocol for the prevention of DVT in orthopedic surgery.

Humans↗
PubMed1996

Baseline hemoglobin as a predictor of risk of transfusion and response to Epoetin alfa in orthopedic surgery patients.

A multicenter, double-blind, placebo-controlled, parallel-group study was undertaken to determine whether Epoetin alfa can reduce perioperative transfusion requirements. Twenty-six medical centers enrolled 316 patients who were scheduled for major orthopedic surgery and were expected to require > or = 2 units of blood. Patients were stratified according to baseline hemoglobin levels and randomly assigned to receive either Epoetin alfa (300 IU/kg or 100 IU/kg) or placebo for 15 consecutive days starting 10 days prior to, on the day of, and for 4 days after surgery. Epoetin alfa (300 IU/kg) resulted in significantly less exposure to allogeneic blood transfusion compared with placebo (16%) versus 45%) in patients whose baseline hemoglobin level was > 10 to < or = 13 g/dL (P = 0.024). Mean number of units transfused per patient was also lower among those treated with Epoetin alfa (overall, P = 0.027). Epoetin alfa was safe and well tolerated in this population.

Aged↗
PubMed1996

Cigarette smoking and its orthopedic consequences.

Cigarette smoking and its ramifications are coming under increasing scrutiny in the field of orthopedic surgery. Smoking has been implicated in impeding bone metabolism and fracture repair, and increasing the rate of postoperative infection and the incidence of nonunion. This article reviews the current body of knowledge on these topics, as well as the potential adverse effects of smoking on wound healing and microsurgical procedures. An in-depth discussion on the pathophysiologic mechanisms of nicotine is also included.

Humans↗
PubMedDate not supplied

[Patient-controlled postoperative analgesia in orthopedic surgery: epidural PCA versus intravenous PCA].

OBJECTIVE: To evaluate both effectiveness and incidence of side effects of two techniques of postoperative pain treatment: intravenous and epidural PCA. DESIGN: Prospective analysis of data from two groups of randomized patients. SETTINGS: Orthopedic and trauma center. PATIENTS: Figty ASA class II-III patients undergoing total hip replacement under combined Spinal-Epidural Anesthesia. METHODS: Patients were divided into 2 groups who received different postoperative pain treatment. One group (group PCA) received a patient-controlled intravenous analgesia with morphine 30 mg and ketorolac 90 mg in 100 ml of saline (back-ground infusion 2-4 ml, according to body weith, bolus 1 ml, lockout 5 min, 4 h dose limit 40 ml). PCEA group received a patient-controlled epidural analgesia with morphine 4 mg and bupivacaine 0.125% 100 ml, (background infusion 3-4 ml, according to patient' height, bolus 1 ml, lockout 10 min, 4 h dose limit 25 ml). Postoperative pain intensity was evaluated, through 24 postoperative hours, by a verbal analogue scale (VPS = 0 to 3) and a total pain score (TOTPAR) was calculated for each patient at 6 and 24 postoperative hours. Side effects were recorded and their incidence was obtained for each group. Statistical data analysis was performed by one-way ANOVA and non-parametric tests for ordinal data. Nominal data were analyzed by chi 2 test. p < 0.05 was considered significant. RESULTS: Patient receiving PCEA showed a significant (p < 0.005) decrease of incident pain, while VPS at rest was similar in the two groups. TOTPAR VPS was lower (p < 0.05) in PCEA group both at 6 and 24 postoperative hours. Somnolence was observed more often in PCA patients (8% vs 2%; p 0.05), while no significant differences were noted among other side effects incidence. CONCLUSIONS: Our data show a better control of postoperative pain arising from total hip replacement during PCEA when compared to PCA. It should be emphasized that incident pain is far more decreased by PCEA, so that this technique is particularly indicated when an early postoperative mobilization is required.

Aged↗
PubMed1996

[Forensic medical implications of vascular injuries in orthopedic surgery].

The vascular risk in orthopedic surgery results from the close relation between bones and vessel-nerve bundles, the use of sharp cutting and perforating instruments and, in hip surgery, the use of cement. The two main prognosis factors are early diagnosis and the time of treatment. Here we review risks by localizations. For spinal surgery, the great vessels may be damaged by discetomy and can lead to intraperitoneal bleeding and death or arteriovenous fistulization. In the scapular area, pin migrations after surgery involving the clavicle can lead to bleeding or false aneurysms of the subclavian artery. When surgery is performed for thoraco-brachial outlet syndromes, arterial damage is less frequent than nerve damage which can lead to death (one case reported) or severe sequelae. Hip surgery can damage the iliac or femoral vessels with severe sequelae after total hip replacement. Two cases of death related to femoral neck fracture and anticoagulant treatment are reported. Two other cases of lesions to the femoral artery with severe sequelae after treatment of diaphyseal fractures of the femur are also reported. In the knee area, consequences of surgery can be particularly severe, especially unrecognized damage or incorrect treatment of the popliteal artery after osteoarticular injuries, or iatrogenic lesions after knee surgery. Finally two cases of tibial artery lesions are reported. In most of these cases, medicolegal consequences were confirmed by court judgements.

Blood Vessels↗
PubMed1997

Low-molecular-weight heparin: from the bench to the orthopedic patient.

Standard heparin is widely used for the prevention and treatment of venous thromboembolism; however, it has several limitations including variable dose response, dose-dependent clearance and inhibition of platelet function. To overcome these disadvantages, standard heparin, which is composed of glycosaminoglycans of various molecular weights, has been fractionated into its low-molecular-weight component. Low-molecular-weight heparin (LMWH) exhibits less binding to plasma proteins and endothelial cells than standard heparin resulting in a more predictable dose response profile, a dose-independent mechanism of clearance and a longer plasma half-life. LMWH also has a lower binding affinity for platelets and produces less microvascular bleeding. Evidence from randomized clinical trials demonstrates that LMWH is effective in the prevention of deep vein thrombosis (DVT) in high-risk orthopedic patients. There is also considerable evidence of its efficacy and safety in the initial treatment of proximal DVT. Recent studies have demonstrated the feasibility of home treatment with LMWH, which offers the advantage of greater clinical utility compared with current antithrombotic regimens and hence the possibility of cost savings.

Anticoagulants↗
PubMed1997

Orthopedic aspects of child abuse.

Child abuse remains a relatively frequent cause of orthopedic injuries in infants and children, and, although the classic signs of abuse are still useful for identifying victims, more careful observation and more sophisticated diagnostic tests, such as collagen synthesis, may be required to identify less severely injured victims. Recently observed changes in injury patterns and age incidences should be considered in the evaluation of a child suspected of being a child abuse victim.

Adolescent↗
PubMed1977

Energy and protein intake in elderly patients in an orthopedic surgical ward.

A study was made during a 3-month period of the food intake of all patients older than 60 years, who were admitted to a ward of acute orthopedic surgery. This amounted to 31 women and 15 men, whose average age was 74 years. Each patient's diet was studied for 16 days on an average. The mean daily energy intake was 1 163+/-341 kcal (4 868 +/- 1 427 kJ) for women and 1 558+/-539 kcal (6 521+/-2 856 kJ) for men. 44 of 46 patients received fewer calories than is recommended for healthy persons the same age, and 25 of 46 patients consumed less calories per day than the basal metabolism. The mean daily protein intake was 0.7+/-0.3 g/kg/day for both men and women. 28 of the patients received less than 0.8 g/kg/day which is the amount of protein recommended healthy adults and none of our patients received 1.5 g protein/kg/day, the protein intake recommended patients in hospital. The low protein intake was due to a poor intake of energy as well as a high consumption of refreshing drinks and titbits, both a little nourishment.

Age Factors↗
PubMed1997

[Suitable and successful management in preoperative deposit of autologous blood transfusion in cases of orthopedic elective surgeries].

To reveal the suitable and successful management in preoperative deposit of autologous blood, the 307 cases who had autologous blood transfusion during orthopedic elective surgery were studied retrospectively. Light body weight(less than 43 kg), predonative anemic condition(less than 11.3 g/dl in Hb concentration), and the aged(older than 68 yrs) were the main factors causing less deposit than scheduled amount. Less deposit (< 766 ml in THA), when preoperative low Hb concentration and unexpectedly massive bleeding added to it, was responsible for necessity of homologous blood transfusion. Combination of 400 ml-donation with 200 ml-donation, and gradual increase of rhEPO administration, are effective to prevent from unexpectedly less deposit.

Blood Transfusion↗
PubMed1997

Hip fracture surgery in Nova Scotia: a comparison of treatment provided by "generalist" general surgeons and orthopedic surgeons.

OBJECTIVE: To determine quality of hip fracture services provided by "generalist" general surgeons (generalists) in Nova Scotia. DESIGN: Chart review and postoperative, blinded, random-ordered radiologic analysis. SETTING: Three community hospitals and 1 tertiary care hospital in Nova Scotia. PARTICIPANTS: Seven generalists who performed 120 hip fracture repairs and 7 orthopedic surgeons (specialists) who performed 135 hip fracture repairs. OUTCOME MEASURES: Patient demographics, preoperative, perioperative, postoperative and discharge information, technical quality of reduction as determined through postoperative radiologic assessment. RESULTS: There were no differences between patients treated by generalists and those treated by specialists with respect to age, sex, American Society of Anesthesiologists' class, level of function and fracture type. Intraoperatively, the patient groups were similar with respect to type of anesthesia, use of antibiotics, number of transfusions and surgical complications. Significant differences were noted in length of operation (54.4 v. 41.1 minutes), use of C-arm imaging (6.7% v. 85.9%) and management of Garden classes 1 and 2 subcapital fractures. Postoperatively, the 2 groups had similar numbers of medical complications, wound complications, reoperations, readmissions and deaths, and a similar level of function on discharge. Significant differences included the number of intensive care unit admissions (5.8% v. 15.6%) and length of stay there (5.7 v. 2.8 days) and of postoperative stay (14.5 v. 10.7 days). The assessment of radiographs did not demonstrate any significant difference in the quality of reduction. CONCLUSION: In Nova Scotia the outcomes of hip fracture surgery performed by generalists are comparable to those performed by specialists.

Activities of Daily Living↗
PubMed1998

A randomized comparison of sequential-gradient calf compression with intermittent plantar compression for prevention of venous thrombosis in orthopedic trauma patients: preliminary results.

Trauma patients with fractures of the pelvis, acetabulum, or femur are at risk for deep venous thrombosis complicating the treatment of their injuries. This risk can be lessened with anticoagulant medications or with mechanical methods such as sequential pneumatic compression. However, many patients in this population group have contraindications to systemic anticoagulation and cannot use sequential limb compression devices because of leg injuries or appliances. Intermittent pneumatic compression of the plantar venous plexus is able to provide prophylaxis against deep venous thrombosis in many of these patients. We performed a prospective, randomized, controlled comparison between plantar compression and leg compression for prevention of deep venous thrombosis in an orthopedic trauma population of 124 patients. Patients were evaluated with duplex ultrasonagraphy at intervals after surgery. Both methods proved protective in comparison with reported rates in patients not given prophylaxis, and although the numbers were too small to give statistically meaningful results, we observed no significant difference in the thrombosis rate (4% for plantar compression versus 0% for leg compression). We conclude that foot pumps are an effective alternative to calf compression for prevention of deep venous thrombosis after a lower extremity fracture.

Adolescent↗
PubMed1997

Surgical treatment of distal biceps tendon ruptures results of a multicentric BOTA-study and review of the literature. Belgian Orthopedic Trauma Association.

Distal biceps tendon ruptures (DBTR) are relatively uncommon. This multicentric study, conducted on behalf of BOTA (Belgian Orthopedic Trauma Association), documents the complications and results after surgical treatment of 18 DBTR's. In the current series a repair with Mitek anchors was found to be a simple and reliable fixation that could be performed through a single anterior approach with minor risks of radial nerve damage. If a two-incision technique following Boyd and Anderson is used, the ulna should not be exposed in order to avoid a radioulnar synostosis; splitting the extensor muscle mass is preferable to a subperiostal ulna dissection, and the wound should always be drained to decrease the likelihood of hematoma formation.

Adult↗
PubMedDate not supplied

[Knowledge retention. II--Orthopedics and traumatology programs].

The authors present the results of an educational investigation of knowledge retention concerning a Orthopedics and Traumatology program. The research was developed by comparing the marks obtained in the fourth and sixth years. The examinations had the same content but were not identical. Between the two examinations, the loss of knowledge was -17.5% +/- 1.0% (average +/- standard error) and was not influenced by the time between the two examinations.

Analysis of Variance↗
PubMed1998

Overview of a general orthopedic practice.

Records from a 36-year general orthopedic practice were analyzed for patient demographics and clinical findings. Results showed that low back pain was the most frequent chief complaint and that the majority of the cases were treated nonsurgically in the office. A history of trauma was present in 58.8% of cases, and job-related injuries were present in 10.6% of cases. The most frequent diagnoses are reported for all cases and for some subgroups.

Accidents↗
PubMedDate not supplied

[Evaluation of the effectiveness of anecaine in central segmental blockades in orthopedic-traumatologic interventions].

Efficacy of anecaine (A) (bupivacaine, Pliva) and marcaine (M) (bupivacaine, Astra) in central neuroaxial block combined with sedation is compared. In the group with epidural block (n = 167, ASA I-III), 102 patients were given anecaine and 65 marcaine in equivalent doses. In the group with spinal block (n = 82, ASA I-III), anecaine was administered to 52 and marcaine to 30 patients. In the epidural block group a catheter was placed at L2-3 or L3-4 with cranial direction. A test dose of bupivacaine (20 mg) was followed after 5-7 min by the main dose of 2 mg.kg-20 mg. Propofol was given for partial suppression of consciousness at a continuous infusion rate 1.6 mg.kg.hr. In spinal block group, bolus dose of bupivacaine (10-20 mg) was injected through the subarachnoidal approach at L2-3 or L3-4. Diazepam (0.1 mg.kg.hr) was used for sedation. Block onset, duration of sensor and motor block, and of effective analgesia were evaluated in all groups. Hemodynamics and respiratory function were monitored. Moderate hypotension (16-17% decline from basic values) was observed in all patients irrespective of bupivacaine brand. In a comparative non-randomized study anecaine showed a faster onset of block and longer duration of clinical effect than marcaine in epidural and spinal anesthesia for orthopedic surgery on the lower limbs.

Adolescent↗