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PubMed1997

[Peripheral nerve injury as a complication from orthopedic operation].

Nerve injury following operation is one of the main causes of the iatrogenic peripheral nerve injury. In order to learn lessons from these cases, one hundred and seven cases of peripheral nerve injury complicated with the orthopedic operations were analyzed. Forty-four cases were cutting injury during operation, made up 41% of all cases and 27 cases were stretch and compression injury, made up 25%. The involved nerves included 41 radial nerves and 24 common peroneal nerves, composing 60.7% of all nerve injury. The operations responsible were mainly the bone and joint operations, which made up 81%. The cause, prophylaxis, diagnosis and treatment were discussed. The rich appropriate knowledge of anatomy and responsibility of the surgeon were emphasized in order to prevent the occurrence of complication. Once the injury was suspected, diagnosis should be made promptly and effective treatment should be performed in time.

Adolescent↗
PubMed1998

Ensuring early discharge following major surgery: orthopedic surgery.

Managed care, critical pathways, and length of stay issues have a major impact on current hospital policy and patient care. In orthopedic surgery, significant strides have been made in improving efficiency, decreasing costs, and reducing length of stay. Use of vertical pathways, especially the first day of admission, the day of surgery, is important for efficient patient care. As anesthesiologists involved in the process, we must be certain that patient care is not compromised in an attempt to save money or achieve early discharge. In many studies, pain management, type of anesthesia, and amount of blood loss are not significant factors in length of hospital stay. These factors must be approached as quality-of-life issues and appropriate decisions made.

Ambulatory Surgical Procedures↗
PubMed1992

The development of thyroid storm in a child with McCune-Albright syndrome after orthopedic surgery.

OBJECTIVE: To report a case of thyroid storm that developed in a child with McCune-Albright syndrome after orthopedic surgery. The development of thyroid storm has not previously been described after surgery in a child. DESIGN: Descriptive case report. SETTING: Pediatric intensive care unit. PARTICIPANT: Patient with McCune-Albright syndrome who developed thyroid storm. SELECTION PROCEDURES AND INTERVENTIONS: Clinical features and treatment of thyroid storm are described. A highly sensitive immunochemiluminometric thyroid-stimulating hormone assay to help diagnose hyperthyroid states is also described. CONCLUSIONS: Before all operative procedures, children at high risk for thyroid dysfunction, including patients with McCune-Albright syndrome, should be screened and observed closely for the development of thyroid storm.

Child↗
PubMed1989

Limitations to donating adequate autologous blood prior to elective orthopedic surgery.

We reviewed 175 patients who predeposited autologous blood prior to elective orthopedic surgery to define potential limitations of procuring adequate autologous blood. These potential limitations include physician underordering, storage interval, and erythropoietic response. We found that a continuing medical education intervention increased the amount of autologous blood requested by physicians for storage: from 121 U for 50 patients (mean = 2.4) before CME to 195 U for 65 patients (mean = 3.0) afterward; eight (16%) of 50 patients had 4 U or more requested before CME vs 25 (38%) of 65 patients afterward. Continuing medical education had no impact on mean (+/- SD) effective storage interval, 22.6 +/- 9.0 vs 21.6 +/- 9.4 days. Thirty (17%) of 175 patients were deferred (hematocrit less than or equal to 0.34) and were unable to donate units of blood requested; of these, 13 (43%) received homologous blood compared with 19 (13%) of 145 not deferred. We conclude that a significant percentage of patients are deferred from autologous donation because of hematocrit limitations and receive homologous blood. This problem is not related to physician underordering or inappropriate physician transfusion behavior, but rather to the erythropoietic response to serial phlebotomy over a limited storage interval. Future studies should focus on mechanisms to maximize autologous blood procurement.

Blood Banks↗
PubMed1999

Toxicity measurement of orthopedic implant alloy degradation products using a bioluminescent bacterial assay.

The toxicity of aqueous metal solutions representative of ionic degradation products from orthopedic implant alloys was determined using a bacterial bioluminescence assay, Microtox. The toxicity of forms of the individual elements released from ASTM F75 Co-Cr-Mo (Co-Cr-Mo), F138 316L stainless steel (316L), and F136 Ti-6Al-4V (Ti-6Al-4V) was first determined, and a mathematical model was developed to predict the toxicity of mixtures of these ions. Aqueous metal solutions were then mixed according to the proportions of the ions found in these alloys, and their toxicity was measured with Microtox. Mixture behavior was classified as synergistic, antagonistic, or additive by comparing measured toxicity to predicted toxicity. Since relating these tests to actual implant corrosion processes can be confounded by selective leaching, the predicted and measured toxicity of aqueous metal solutions mixed according to proportions representative of selective leaching were next determined, and the mixture behaviors were classified as before. The most toxic individual alloying elements were found to be hexavalent Cr, Ni, and Co, in that order: a finding in accord with prior biocompatibility research. Co-Cr-Mo was found to be the most toxic alloy mixture of both those combined according to alloy composition and those combined to reflect selective leaching. The Ti-6Al-4V mixtures were found to behave synergistically, while the Co-Cr-Mo and 316L mixtures behaved antagonistically. By providing insight into degradation product toxicity and elemental interaction, these experiments demonstrate the utility of employing bioluminescent bacterial assays to investigate biocompatibility of implant materials. Further studies to more closely simulate in vivo conditions, though, are required to fully gauge their potential in this regard.

Algorithms↗
PubMed2000

Fluid sorption of orthopedic grade ultrahigh molecular weight polyethylene in a serum environment is affected by the surface area and sterilization method.

It is shown in this work that lubricant sorption in ultrahigh molecular weight polyethylene (UHMWPE) increases with available surface area of the component. This has clinical relevance, because sliding and articulation experienced in simulator studies can result in changes in surface roughness and the creation of new surfaces. This study compares the fluid sorption of orthopedic grade UHMWPE with different surface areas (but equivalent volume) for different sterilization methods. For both the gamma radiation and nonsterile control samples, the gain in total fluid absorbed scaled proportionately with surface area. For the EtO sterilization treatment, the fluid gain was nonlinear and substantially less than the radiated and control groups. The findings from this study clearly indicate that the sterilization and surface area affect the fluid uptake and weight gain of UHMWPE.

Adsorption↗
PubMed2000

Design and fabrication of cast orthopedic implants with freeform surface textures from 3-D printed ceramic shell.

Three-dimensional printing is a solid freeform fabrication process, which creates parts directly from a computer model. The parts are built by repetitively spreading a layer of powder and selectively joining the powder in the layer by ink-jet printing of a binder material. 3D printing was applied to the fabrication of sub-millimeter surface textures with overhang and undercut geometries for use in orthopedic prostheses as bony ingrowth structures. 3D printing is used to fabricate ceramic molds of alumina powder and silica binder, and these molds are used to cast the bony ingrowth surfaces of Co-Cr (ASTM F75) alloy. Minimum positive feature sizes of the ceramic mold and, therefore, minimum negative feature sizes of castings were determined to be approximately 200 x 200 x 175 microm and were limited by the strength of ceramic needed to withstand handling. Minimum negative feature sizes in the ceramic mold and, therefore, minimum positive features in the casting were found to be approximately 350 x 350 x 175 microm and were determined by limitations on removal of powder from the ceramic and the pressure required to fill these small features with molten metal during casting. Textures were designed with 5 layers of distinct geometric definition, allowing for the design of overhung geometry with overall porosity ranging from 30-70%. Features as small as 350 x 350 x 200 microm were included in these designs and successfully cast.

Ceramics↗
PubMed2002

Acquired von Willebrand disease--hemostatic management of major orthopedic surgery with high-dose immunoglobulin, desmopressin, and continuous factor concentrate infusion.

Acquired von Willebrand disease (aVWD) is a rare bleeding disorder that mimics congenital VWD in previously healthy individuals; it is most frequently associated with monoclonal gammopathy. Hemostatic therapy of aVWD is challenging due to the extremely shortened half-life of endogenous and exogenous VWF. High-dose intravenous immunoglobulin (ivIG) is recommended as the treatment of choice, usually rapidly normalizing coagulation; but in case of failure, alternative treatment options are not well explored. We report successful major orthopedic surgery in a 61-year-old woman with multiple myeloma IgG lambda and aVWD. IvIG alone failed to correct hemostasis. However, ivIG pretreatment improved the VWF ristocetin cofactor (VWF:RCo) half-life from only 1.5 hr to more than 4 hr, allowing desmopressin infusions twice daily to maintain sufficient VWF:RCo levels. Because of diminishing desmopressin effect, we attempted for the first time in aVWD a continuous VWF/FVIII infusion (Haemate HS), 2.1-2.7 FVIII U/kg/hr or 51-64 U/kg/day, respectively 4.6-6.0 VWF:RCo U/kg/hr or 110-145 U/kg/day) to reach constant factor levels. The steady-state clearance was 2.4 mL/kg/hr for FVIII:C and 13.5 mL/kg/hr for VWF:RCo. During surgery, VWF:RCo, FVIII:C, and PFA-100 closure time were normalized. Until day 5, VWF:RCo was kept above 50%, from day 6 to 10 at least 30% activity were attained. FVIII:C levels were always >70%. The clinical course was uneventful without bleeding. Two weeks after hip surgery the patient was discharged from the hospital without complaints. The therapy described can be recommended as safe and feasible for further evaluation in aVWD patients who are hyporesponsive to ivIG treatment alone. Continuous VWF/FVIII infusion can improve substitution therapy in aVWD.

Arthroplasty, Replacement, Hip↗
PubMed1984

Evaluation of comprehensive rehabilitation services for elderly homebound patients with arthritis and orthopedic disability.

Fifty-seven elderly homebound patients with arthritis and orthopedic disabilities were randomized to a goal-oriented outreach rehabilitation program or to usual treatment. Although 64% of patient goals were met, there were no overall significant differences in functional scores, institutionalization, or contentment between treatment and control periods. Twenty-three patients had maintained clinical improvement at the end of the study and some patients were dramatically improved with simple measures. The program's marginal costs were modest and consisted primarily of expenses associated with therapist's visits. The total costs of assistive devices and home modifications amounted to $1,902. Twenty-five percent of the homebound population could benefit from such services but the actual number who would partake is small.

Aged↗
PubMedDate not supplied

Patients as peer preceptors for orthopedic oncology rehabilitation patients.

This article describes a peer preceptor program that trains patients who have experienced limb preservation surgeries and managed long-term rehabilitative therapy to support and teach newly diagnosed patients through their rehabilitation. This preceptor program was designed to complement the professional counseling and support that rehabilitation staff provide to patients and their families. Training includes communication techniques, practice sessions using videotaped scenes of patients and their families, as well as role-playing. Experienced patients who became preceptors as a result of this program were orthopedic oncology patients who had completed limb preservation surgery, chemotherapy, grafting, and physical therapies. After their training, preceptors exhibited improved communication skills in terms of empathy, listening, and voice expressions. Initiatives designed to make the preceptor program self-sustaining by having staff nurses manage the training still have to be tested.

Extremities↗
PubMed2002

A scanning electron microscopy study of human osteoblast morphology on five orthopedic metals.

Despite the long-standing use of metals as orthopedic implants there still are unsolved problems with these materials and open questions about their behavior in a biological environment. Cell-culture studies provide a useful tool for investigations. In addition to the determination of biochemical or molecular biological parameters, the morphology of adhering cells reflects their interaction with the substrata. This article describes an investigation of the morphology of human osteoblasts on stainless steel, cobalt chromium alloy, commercially pure titanium, Ti-6Al-4V, and Ti-6Al-7Nb with surface designs similar to those used as clinical implants. A cell culture plastic surface was used as a control material. The materials were examined by scanning electron microscopy at different points of time. The cells spread, proliferated, and formed nodules on all test substrates in a time-dependent manner, without signs of a disturbing influence from any of the materials. On the smooth surfaces the cells showed a flattened fibroblast-like morphology and only slight differences could be detected. Therefore, the cellular morphology seems not to be markedly affected by the different chemical material compositions. In contrast, the titanium alloy with a rough, sandblasted surface induced a three-dimensional growth. This three-dimensional cellular network could be the basis for the known earlier differentiation of osteoblasts on rough surfaces in vitro and a better osseointegration in vivo.

Bone Substitutes↗
PubMed1975

MP35N: a corrosion resistant, high strength alloy for orthopedic surgical impants: bio-assay results.

A cobalt based alloy, MP35N, with excellent mechanical properties has been recently introduced as a material for surgical orthopedic implants. A study was made of local and systemic host response to this material in two different mammal species. The implantation time ranged from one to 12 months. The result of this study indicated: MP35N produces a degree of local tissue response comparable to that of 316L stainless steel. No systemic side effects were observed during the implantation times included in this study.

Alloys↗
PubMed1977

Tolerance of mouse macrophages in vitro to barium sulfate used in orthopedic bone cement.

Barium sulfate, used as a radio-opaque marker in some orthopedic bone cements, has been shown to escape into the surrounding tissues. This may present a potential hazard. In particular, phagocytic cells may be exposed to relatively high internal levels of barium once the particles have been phagocytosed. Mouse peritoneal macrophages exposed to barium sulfate for periods up to 144 hr showed a marked cytoplasmic vacuolization from which they recovered only partially. Barium sulfate did not appear to damage the cell membrane as judged by lactice dehydrogenase release. In the relatively low doses and with the periods of exposure described here, barium sulfate does not appear to present a serious toxic hazard in the short term. It is possible, however, that longer exposures and larger doses may result in the death of phagocytic cells which have ingested barium sulfate.

Animals↗
PubMed2003

Host protection against deliberate bacterial contamination of an extracellular matrix bioscaffold versus Dacron mesh in a dog model of orthopedic soft tissue repair.

The resistance of two biomaterials, one synthetic and one biologic in origin, to deliberate bacterial infection was compared in a dog model of orthopedic soft tissue reconstruction. Twenty-four adult female dogs were randomly divided into two equal groups and a 2.0-cm-round full-thickness defect was created on the lateral surface of the stifle joint, leaving only the synovium and skin intact. The defect was surgically repaired with either Dacron trade mark mesh or a porcine derived extracellular matrix (ECM) scaffold material. The repair site was inoculated with 1 x 10(8) Staphylococcus aureus at the time of surgery and the dogs were survived for 28 days. Results showed a chronic pyogranulomatous inflammatory response at the Dacron trade mark implant sites versus a constructive tissue-remodeling response without residual inflammation at the ECM implant site. Three dogs in the group receiving the Dacron trade mark mesh were treated with Keflex trade mark (500 mg bid x 7 days) for signs of septicemia. A quantitative bacterial count of the implant sites at the time of sacrifice showed 6.52 x 10(5) +/- 1.2 x 10(6) and 6.5 x 10(2) +/- 1.8 x 10(3) bacteria per gram of tissue for the Dacron trade mark and ECM scaffold sites, respectively (P <.03). The ECM implant material was more resistant than the synthetic implant material to persistent infection following deliberate bacterial contamination and the ECM scaffold supported constructive tissue remodeling.

Animals↗
PubMed1984

Orthopedic surgery for management of tumor pain.

Benign primary bone tumors, tumor-like lesions, and semimalignant bone tumors with pain are in most cases an indication for surgery with marginal or wide excision. In malignant primary bone tumors, the relief of pain does not have primary importance in the therapeutic concept. With en bloc resection or amputation, the cause of cancer pain is eliminated. Limb salvage procedures can be performed by endoprosthetic replacement, and phantom or stump pain will not occur. Skeletal metastases can be very painful owing to bone destruction, expansive growth, and consecutive pathologic fractures. Orthopedic surgery can relieve pain and improve the quality of life. Endoprosthetic replacement and combined osteosynthesis with PMMA and metallic implants are used to achieve early rehabilitation.

Bone Neoplasms↗
PubMed1990

Methods and applications of three-dimensional imaging in orthopedics.

Computed tomography is a commonly used technique for detecting pathological alterations in soft tissues and the skeleton. Three-dimensional images of the skeleton are very useful for planning surgical treatment and monitoring therapy, but unfortunately mental reconstruction of complex three-dimensional anatomical structures from conventional tomography is very difficult. This article describes a process by which automated analysis of the regions of interest in the computed tomographic (CT) images yields the contours of the surfaces which can be presented pseudo-three-dimensionally using Phong's lighting model and Gouraud's shading methods. Three applications in the areas of orthopedics and neurosurgery demonstrate the efficacy of the method.

Bone Diseases↗
PubMed1989

Behavioral strategies for the reduction of pain and anxiety associated with orthopedic trauma.

This study examined the efficacy of behavioral strategies in alleviating pain and anxiety associated with severe orthopedic trauma. Sixty-four patients with multiple fractures were divided into four groups: (1) control, (2) attention only, (3) EMG biofeedback-assisted relaxation, and (4) audiotaped relaxation training. All were measured over at least six sessions, or as long as hospital stay permitted. Significant between group differences were found on the following: systolic blood pressure, peripheral temperature, subjective units of discomfort, state anxiety, with a trend for use of sleep medications. No differences were found on other vital signs, EMG recordings, or other medications. EMG-biofeedback relaxation and relaxation training were relatively equivalent for all measures, and little or no change was observed for those patients who received attention only or served as controls.

Adult↗
PubMed1980

Binding of native and denatured collagen to immunoglobulins and cold insoluble globulin in serum of patients undergoing orthopedic surgery.

Native and denatured 125-I-collagen were reacted with sera from 366 patients undergoing orthopedic surgery. Complexes consisting of native or denatured collagen and immunoglobulins or of denatured collagen and cold insoluble globulin were precipitated with secondary antibodies to either immunoglobulins or CIG. Only approximately 10% of the patients' sera bound more than 5 ng native collagen/10 microliter serum. Binding of denatured collagen to immunoglobulins occurred more frequently and in larger amounts. Binding of denatured collagen to CIG was determined in some of the sera and found to occur in all of them and in substantial amounts. Some of the subjects developed pathergic reactions upon subsequent infusion of a gelatin based plasma substitute. There was no correlation between the severity of such adverse reactions and any of the parameters measured. Therefore, the observed clinical reactions are not likely to be caused by true immunological mechanisms.

Binding Sites, Antibody↗