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PubMedDate not supplied

Quality of life as defined by orthopedic oncology patients.

BACKGROUND: Quality of life (QOL), not just survival, is central to outcomes analysis in musculoskeletal oncology. However, little information exists about the patients' definition of what constitutes QOL. METHODS: Self-administered outcomes questionnaires were given to 201 surgically treated patients with lower extremity tumors. Of these patients, 192 (137 with malignant tumors, 55 with benign tumors) provided a written definition of QOL. Their responses were independently collated and matched with clinical information. RESULTS: For most patients (153, or 80%) the definition of QOL encompassed several attributes. A consistent combination of four major attributes was used in the QOL definition by 44 (32%) of the malignant cases and 19 (35%) of the benign cases. Differences in responses between men and women were idiosyncratic and more common in the benign group. Good family relations and good health were equally important to men and women. Responses varied by patient age. Older patients valued self-sufficiency and freedom from pain, whereas younger patients emphasized happiness, trust in God or church, achieving goals and being successful, and love. Those whose surgery was less extensive cited good family relations, the ability to function physically and emotionally, and having a good job or work. CONCLUSION: The variation in patients' perspectives and definitions of quality of life must be taken into account when assessing QOL in musculoskeletal oncology patients. Patients often emphasize concerns that are not adequately addressed by current outcomes-measures in orthopedics and general oncology.

Adolescent↗
PubMed1988

Anatomic basis for the orthopedic treatment of bladder exstrophy: anatomic study of the sacrosciatic ligaments in the newborn.

Anatomic study of the pelvis of 30 fetuses and newborn children, yielded a precise relationship between the sacrotuberous ligaments and size of the gluteal region. At birth, the distance between the posterior superior iliac spine and the ischium is 40 mm. Closure of the anterior defect in bladder exstrophy sometimes requires an orthopedic surgical procedure. Bilateral posterior iliac osteotomy and section of these ligaments can be easily done by a single medial posterior approach herein described.

Bladder Exstrophy↗
PubMed1984

Local stresses and bone adaption around orthopedic implants.

The severest long-term complications of orthopedic joint-prostheses are associated with loosening of the implant-bone interface, due to adverse reactions in bone and subsequent weakening of the connection between the two materials. Mechanical stresses, caused by joint loading, play a key role in the adaption of interface bone and in the loosening process. In the present study, it is shown how local interface stress patterns can be evaluated using advanced methods of computer-based, engineering stress analyses (the Finite Element Method, FEM). The stress patterns are compared with the local bone structure and bone resorption phenomena as found in animal experiments. The results indicate that loosening and bone resorption is associated with high peak stresses at the interface in the immediate post-operative stage. In addition, there appears to be similarity between the local stress patterns and the bone morphology at the interface if resorption does not occur. Finally, it is found that implants of high local stiffness generate lower peak stresses in bone, as compared with low stiffness implants.

Animals↗
PubMed1985

Digital angiography in evaluation of orthopedic tumors.

Preoperative evaluation of orthopedic tumors using digital subtraction angiography (DSA) proved useful to ascertain the nature of the lesion, its extension to soft tissues and joints, and the presence of arteriovenous (AV) shunts. We report that overall accuracy varied from 89% to 92%, depending on the feature evaluated. The importance of angiographic examination of this entity is discussed as well as the advantages of DSA over conventional angiography.

Angiography↗
PubMed2002

TMJ remodeling after condylar fracture and functional jaw orthopedics a case report.

BACKGROUND: Condylar fractures in childhood are generally treated in a conservative-functional manner. As a rule, very good healing results are achieved by functional orthodontic treatment alone or, after immobilization, by splinting. HISTORY AND TREATMENT: Here we report on a patient who suffered a deep condylar dislocation fracture as a result of trauma at the age of 5. After initial immobilization with Schuchardt splints she underwent functional jaw orthopedics with activators. Subsequent orthodontic treatment with removable and fixed appliances enabled her to be followed up form functional and radiographic aspects over a period of 13 years. The remodeling process of the condylar head and neck could be clearly seen in the panoramic control radiographs. RESULT: Although the traumatized right TMJ was completely pain-free and fully functional after only a short time, the remodeling of the head and neck of the originally traumatized TMJ took 13 years to correspond fully to the healthy TMJ on the opposing side.

Activator Appliances↗
PubMed2004

[Treatment of MRSA infection in orthopedic surgery].

INTRODUCTION: Infection with methicillin-resistant Staphylococcus aureus (MRSA) remains a major challenge both therapeutically and hygienically. METHODS: Between January 2000 and January 2002, 27 patients with MRSA infections were treated and evaluated in a prospective clinical study. For effective wound management, operative revisions were performed every 3rd day. Following debridement, the wounds were vacuum sealed and specific i.v. antibiotics were administered. Wound closure was performed if three consecutive wound samples submitted for bacterial culture remained negative. RESULTS: All patients with MRSA infections were treated successfully until signs of infection disappeared and bacterial cultures were negative. An average of 7.3 operations per patient was required to eradicate MRSA infection. Follow-up of patients revealed recurrence of infection in four patients. CONCLUSION: Prevention of further spreading and successful treatment of MRSA infections in reconstructive orthopedic surgery is possible with appropriate surgical and hygienic concepts. In almost every second patient complex revision procedures were required.

Adolescent↗
PubMed2003

[Surface modifications to improve biocompatibility and mechanical properties of orthopedic implants].

State of the art surface modifications on metallic materials for orthopedic and dental implants permit clinical application if implant design,manufacturing process as well as function and duration of implantation are harmonized with each other. Keeping these prerequisites in mind,hydroxylapatite is suited for closer connection of fixation elements in hard tissue. PVD or PECVD modifications can make gliding surfaces or surfaces of fixation elements abrasion resistant if the pressure-area ratio does not exceed threshold values in cases of surfaces moving relative to each other

Biomechanical Phenomena↗
PubMed2003

[Telecommunication and telepathology in orthopedic oncology. Possibilities in diagnosis and therapy of primary malignant bone tumors].

The rareness of primary malignant bone tumors and the difficulty of differential diagnosis make this field a part of oncology in which the consulting physician must rely on consistent histopathological monitoring of highest quality throughout the diagnostic and therapeutic process. In a pilot project of the Department of Bone Pathology of the University of Hamburg and the Orthopedic Department of the University of Heidelberg, 190 cases of suspected primary bone tumor were the subject of interdisciplinary discussion between July 2001 and March 2003 using a telepathology system established for this purpose. Diligent differential diagnoses were made prior to the biopsy; optimal location and further strategy for the biopsy were discussed and determined according to the guidelines of the international bone tumor centers. This also included the decision if intraoperative pathological examination of frozen sections should be performed. In 51 cases such examinations were performed. Those results immediately influenced the surgical procedure. Telepathology performed as described in this article led to a close interdisciplinary cooperation over a large distance and helped significantly to optimize therapy of patients with malignant bone tumors.

Biopsy↗
PubMed1997

[The use of lasers in surgical orthopedics. A current review].

In laser-assisted arthroscopic knee surgery, clinical outcome and experimental results are quite different. After laser treatment of local chondromalacia, large cartilage lesions with less tendency towards repair were more often seen than after conventional arthroscopic treatment. Therefore, laser treatment of chondromalacia cannot be recommended. Compared with conventional meniscectomy, laser-assisted meniscal surgery has some advantages, but there is also some risk of inducing gonarthrosis. Some studies show a good hemostatic effect of the laser and the feasibility of precise tissue cutting. On the other hand, laser treatment causes alteration of the tissue. The meniscal tissue becomes stiffer, which may promote the manifestation of gonarthrosis. Percutaneous laser disc decompression has been in successful clinical use since 1986 in the treatment of intervertebral disc prolapses. Studies of multiple orthopedic departments worldwide show a success rate of 75%. To guarantee the success the indications must be observed. The use of lasers in the arthroscopic treatment of outlet impingement syndrome have some advantages, too. The outcome is better than that of other arthroscopic techniques and there are fewer complications because of the hemostatic effect and the improved vision. Laser-assisted capsular shrinkage combined with arthroscopic labrum reattachment allows conventional laser use. Capsular shrinkage can be achieved with low-level laser energy. If this treatment is not successful, other operative techniques can be performed without restrictions.

Arthroscopy↗
PubMed1992

Changes in end-tidal CO2 level following tourniquet deflation during orthopedic surgery.

We studied the changes in end-tidal CO(2) (ET(CO)(2)) and systemic responses after tourniquet deflation in spontaneously breathing and ventilation-controlled patients during orthopedic surgery of both the upper and/or the lower extremities. In most patients, increases in ET(CO)(2), heart rate, and Pa(CO)(2), as well as decreases in blood pressure and pH were observed. In every spontaneously breathing patient, the respiratory rate began to increase before the ET(CO)(2) reached a maximum. Arterial blood gas analysis suggested that the increase in ET(CO)(2) closely reflected the increase in Pa(CO)(2). Our study yielded new information on the ET(CO)(2) changes as follows: 1) the time for ET(CO)(2) level to reach a peak (peak time) was almost constant despite the considerable differences in the increases in ET(CO)(2) both in spontaneous breathing and ventilation-controlled groups and the peak time in the former group was shorter than that in the latter group; and 2) it was suggested that the increase in ET(CO)(2) in the spontaneously breathing patients was smaller than that in ventilation-controlled patients when both patients were subjected to the same conditions on tourniquet time and tourniqueted area. Our data showed that the increase in ET(CO)(2) (or Pa(CO)(2)) can be large and prolonged in some situations. Thus, we recommend continuous ET(CO)(2) monitoring and the proper hyperventilation at tourniquet deflation in order to minimize any adverse effects of acidosis.

Journal Article↗
PubMed1985

Aztreonam in the treatment of serious orthopedic infections.

Aztreozam was evaluated in the treatment of a variety of orthopedic infections. Included were 17 patients with osteomyelitis, three with purulent arthropathy with prostheses, and 16 with superficial infections secondary to trauma or surgical procedure. Pathogens were gram-negative bacilli sensitive to aztreonam. Concomitant antibiotics were administered for gram-positive cocci that were present initially or by superinfection. Infecting organisms included Pseudomonas aeruginosa (minimal inhibitory concentration 4 to 16 micrograms/ml), Serratia marcescens, Enterobacter cloacae, Enterobacter sakazakii, Morganella morganii, Citrobacter freundii, Proteus vulgaris, Proteus rettgeri, Acinetobacter calcoaceticus and others (all with minimal inhibitory concentrations less than 1.0 microgram/ml). Dosage of aztreonam was 2 to 8 g per day administered intravenously or intramuscularly for five to 52 days. Clinical and bacteriologic responses were adequate in all instances. Recurrences were observed in two individuals with osteomyelitis and one with purulent arthropathy. Adverse clinical or laboratory observations were infrequent and inconsequential.

Adult↗
PubMed1976

Orthopedic effect of the extraoral chin cup appliance on the mandible.

An anatomic photoelastic model of a human skull was constructed with the use of individual simulants for teeth, bone, and periodontal ligaments. The following effects of extraoral chin cup traction were observed: 1. Stresses were noted in the area of the pterygoid plates of the sphenoid bone due to the insertion of the simulated external pterygoid muscle. 2. Because of direct contact of the condyle against the posterior surface of the glenoid fossa, forces were seen to be transmitted to this anatomic area. 3. Stress trajectories followed the trabecular pattern of the anatomic configuration of the mandible. 4. Beginning at the apices of the incisor teeth, the stresses emanated through the body, the angle and retromolar triangle of the mandible, radiating in a posterosuperior fashion and concentrating at the neck of the condyle. 5. Selected sectioning of the mandibular model showed evidence of stress concentration at the lingual aspect of the angle and retromolar area as well as at the condylar neck at the level of the external pterygoid muscle insertion. The effects of orthopedic forces produced by an extraoral chin cup in this study are correlated with the histologic and clinical observations during the utilization of this appliance in the treatment of Class III malocclusion.

Facial Bones↗
PubMed1982

Observation of orthopedic force distribution produced by maxillary orthodontic appliances.

A three-dimensional anatomic model was duplicated from a human skull, using different birefringent materials to simulate the various craniofacial structures. Individual bones of the midface were fabricated separately and then articulated in their correct sutural relation. One removable and four fixed maxillary appliances were used. The fixed appliances included the Haas, Minne-expander, Hyrax, and quad helix devices. The removable appliance incorporated an expansion screw in a full acrylic palate with appropriate retentive clasps. After the insertion of each appliance, intraoral forces were produced by incremental activation. The model was examined and photographed in the field of a transmission polariscope. Each appliance used produced a different range of load-activation characteristics. This was reflected by the differences in the stresses transmitted through the bones of the craniofacial complex and the effect on the various sutures. Stresses produced by the fixed appliances were concentrated in the anterior region of the palate, progressing posteriorly toward the palatine bone. The Haas, Minne-expander, and Hyrax appliances produced stresses that radiated superiorly along the perpendicular plates of the palatine bone to deeper anatomic structures, such as the lacrimal, nasal, and malar bones, as well as the pterygoid plates of the sphenoid. Similar stress characteristics were seen with the removable appliance. However, increased activation decreased retention of the appliance, thereby lessening the stress. The quad helix appliance proved to be the least effective orthopedic device. Although the effects of palate separation were seen with increased activation, this appliance primarily affected the posterior teeth.

Equipment Design↗
PubMed1983

Functional orthopedics: the "four pieces" and Class II treatment.

The authors describe a new functional appliance called the Chateau four pieces, which is designed for the orthopedic treatment of Class II problems during growth. The versatility of the use of the four pieces simultaneously or separately, enables the practitioner to control treatment in three dimensions. The indications and the prescription are discussed, and the results are shown.

Activator Appliances↗
PubMed1986

An appraisal of growth and reaction to extraoral anchorage. Simulation of orthodontic-orthopedic results.

The purpose of this article was to simulate graphically the probable orthodontic-orthopedic results of different types of extraoral traction applied to the upper dentition. Forces and movements are vectors; apart from individual variation in the amount of reaction to forces, the reactive movement vector at any given site of an influenced hard-tissue unit depends mainly on the position of its center of resistance relative to the force vector and on the amount and time of force application. In growing patients the resulting movement can then be appraised by the addition of reactive movement and average growth-movement vectors. Standardized assumptions have been made to simulate and compare qualitatively the significance and implications of five different types of commonly used extraoral traction on the upper dentition. Biomechanical parameters (such as the system factor describing the reciprocal relation between the lever arm of a force and the corresponding distance between the centers of resistance and rotation) have been arbitrarily assessed. Where cervical gear on the upper dentition is used, the resulting simulations suggest that raising the outer arms of the face-bow means less posterior effect on the upper dentition, less vertical molar control, and an increased tendency to open the bite. Where high-pull traction is applied, graphic simulations using a constant angulation, but different position of the force vector, indicate that moving the force line from a backward to a more forward position would mean a change from posterior to anterior rotation, from pronounced to no vertical molar control, from excessive incisor elongation to complete vertical incisor control, and from considerable distal effects to nearly none on the upper dentition.(ABSTRACT TRUNCATED AT 250 WORDS)

Alveolar Process↗
PubMed1994

Orthopedic wounds.

Whether a fracture will heal without complications depends, to a significant extent, on the condition of the soft tissues surrounding the bone. Among others, fractures can be classified according to degree of soft tissue involvement, thus facilitating the development of management protocols. Traumatic, open fractures are usually contaminated on arrival at the hospital, whereas contamination of incisional orthopedic wounds can occur in the hospital environment. Our studies have shown that the culture results of incisional wounds correlate most often with results obtained when sampling the air above the wound or the nose and skin of the patient. In addition, failure to excise the traumatized tissue after elective surgery often results in wound-healing complications and infection. If primary closure of the wound is not possible, external fixation to immobilize the fracture and meticulous sterile techniques, wound inspection, and debridement may prevent some, but not all, complications related to the healing of fractures. In addition to application of cancellous bone grafts, we have found that using hydrocolloid dressings facilitates granulation tissue formation. Also, the use of these dressings solves many of the practical problems associated with the traditional methods of keeping the metal plates, exposed bone, and tissues moist. Permanent coverage by means of grafting can be considered at a later date, if delayed primary closure is not possible.

Anti-Bacterial Agents↗
PubMed1994

Simulated neural networks to predict outcomes, costs, and length of stay among orthopedic rehabilitation patients.

Our purpose was to develop a set of simulated neural networks that would predict functional outcomes, length of stay, and costs among orthopedic patients admitted to an inpatient rehabilitation hospital. We used retrospective data for a sample of 387 patients between the ages of 60 and 89 who had been admitted to a single rehabilitation facility over a period of 12 months. Using age and data on functional capacity at admission from the Functional Independence Measure, we were successful in constructing networks that were 86%, 87%, and 91% accurate in predicting functional outcome, length of stay, and costs to within +/- 15% of the actual value. In each case the accuracy of the network exceeded that of a multiple regression equation using the same variables. Our results show the feasibility of using simulated neural networks to predict rehabilitation outcomes, and the advantages of neural networks over conventional linear models. Networks of this kind may be of significant value to administrators and clinicians in predicting outcomes and resource usage as rehabilitation hospitals are faced with capitation and prospective payment schemes.

Activities of Daily Living↗