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PubMedDate not supplied

[The German Society of Orthopedics and Traumatology classification of bone defects in total hip endoprostheses revision operations].

PROBLEM: In revision alloarthroplasty the need for bone allografts increased. The documentation of the defects is not done routinely. METHOD: For better documentation the German Society for Orthopedics and Traumatology (DGOT) developed a new and practical defect classification system. It was tested clinically in the last 6 years. RESULTS: In the acetabulum and femoral shaft seven defect types were distinguished and presented in figures. For the acetabulum: 1 cavitary holes, 2-4 unisegmental, 5 bisegmental, 6 trisegmental, 7 pelvic instability. For the femur: 1 intramedullary 2 trochanter 3 calcar 4 med. shaft 5 lat. shaft 6 part. diaphysis 7 total diaphysis. CONCLUSION: With this classification system we could better compared different reconstruction approaches in endoprosthetic surgery.

Acetabulum↗
PubMedDate not supplied

[The Holt-Oram syndrome. Review of the literature and current orthopedic treatment concepts].

PROBLEM: The clinical manifestation of the Holt-Oram-syndrome (HOS) shows congenital heart-disease and anomalies of the upper limb. The inheritance of this syndrome is autosomal dominant. The question arise, as to whether a contemporary orthopedic concept of treatment could developed based on own experiences and data from the literature. METHODS: We revised data from five patients with HOS treated at the Clinic for Orthopaedics of the University of Heidelberg. The review of the literature revealed a comprehensive and detailed picture of the clinical syndrome and, furthermore, information in respect to a comparative analysis of methods of treatments. RESULTS: Our patients showed characteristic cardiac anomalies, i.e. atrio and ventricular septal defects, and persisting Botall's duct (three cases). The types of malformation of the upper limb corresponded with those found in the literature. Furthermore the indication for amputation of rudimentary or hypoplastic fingers in the Heidelberg clinic was in accordance with the clinical treatments described worldwide. CONCLUSION: The type of treatment of the clubhand in cases with HOS depends on (1) the age and (2) the pattern and degree of accompanying malformations of the upper limb. For patients with aplasia of the thumb or amputation of a rudimental one we recommend pollicisation of the index finger to improve its function.

Child↗
PubMedDate not supplied

[Human bone marrow cell culture--a sensitive method for the evaluation of the biocompatibility of materials used in orthopedics].

The objective of the study was to develop a test system to determine the cytotoxicity and biocompatibility of different biomaterials used in orthopedic surgery. This system was based on the use of a human bone marrow cell culture and the purpose was to find a screening method as a alternative to early animal experimental methods. The established human bone marrow cell culture has certain advantages when compared with other cell culture models. The result demonstrated a high conformity with animal experimental results.

Biocompatible Materials↗
PubMedDate not supplied

[The use of a rapid infusion system in orthopedics].

Major orthopedic surgery such as partial resection of the pelvis and subsequent implantation of a prosthesis is highly connected with massive bleeding. Therefore we tested the hypothesis that the use of a rapid infusion device, which was originally designed for liver transplantations, can prevent hypovolemic shock. We studied 20 patients: in one group (n = 10) the iv volume was given in a conventional way (37 degrees C) by use of pressure infusion bags. Patients of the second group (n = 10) received the iv volume via the Rapid Infusion system (Haemonetics Corp., Braintree, MA). We can conclude that with this new device for rapid volume replacement it is possible to keep the patient's vital functions stable even during times of excessive bleeding and to prevent from metabolic consequences following hypovolemic shock.

Adult↗
PubMedDate not supplied

[Serum, knee synovial fluid and joint tissue cefuroxime concentration in perioperative use before orthopedic interventions after tourniquet or in the bloodless field].

A requirement to be met when administering perioperative prophylactic antibiotics as a standard with many orthopedic surgeons in artificial joint replacement is the achievement of sufficient concentrations of substance in the operative field. Following the i.v. short-infusion of 1.5 mg Cefuroxime-Sodium in 65 cases of knee joint surgery using a mid-thigh tourniquet substance levels were measured in samples of blood serum, synovial fluid and knee joint capsule. The Cefuroxime concentration in synovial fluids was found to be an average of 25.3 +/- 15.4 mcg/ml at the beginning and 14.9 +/- 10.7 mcg/ml at the end of the operations. Samples of joint capsule that had been taken during the operation showed substance levels of 20.6 +/- 11.1 mcg/ml. 13% of these samples showed substance levels below 4.0 mcg/ml which is the estimated breakpoint of full sensitivity of potentially infective bacteria. The relation of Cefuroxime concentrations in the synovial fluid to the length of time between the end of the infusion and the application of the tourniquet proved to be statistically nonsignificant (covariance analysis; p = 0.05). Nevertheless the determined differences showed a tendency which agrees with the findings of other authors who conclude, that a minimum exposure time of ten minutes is essential.

Adolescent↗
PubMedDate not supplied

[Orthopedic diagnostics using acoustic phenomena].

The clinical analysis of joint noises has practical significance in orthopedics. It has been attempted from time to time in the past 100 years to amplify, analyse and record joint noises. Despite the increased effort from decade to decade, the method of phonoarthrography has not been able to establish itself, since the measurements are complex and poorly reproducible. Artifacts can easily be confused with pathological findings. Finally, because of the different physical properties of light, the sense of vision has essential advantages compared with the sense of hearing, which can localize a sound source only insufficiently accurately.

Arthrography↗
PubMedDate not supplied

[Indications and complications of surgical treatment of orthopedic diseases in patients over 80].

Due to increasing life expectation the number of elder patients, who need medical care, increases, too. Orthopedic surgery of elder patients especially deals with degenerative changes of locomotor and supporting apparatus, as well as with traumatic lesions. Because of the polymorbidity the rate of complications and risks of operative treatment raises. Representation of a casuistry of 173 operative intervention in patients undergoing operative treatment between 1965 and 1984 (20 years), who where 80 years and older. Most of the cases were operations of choice without any vital indication. Concerning emergency operations traumatological cases were well to the fore. All operative interventions are classified in localisation and intra- and postoperative complications. There was rather a high mortality in these patients compared to the average mortality in our clinic. The indication for operative treatment in high aged patients needs a careful and critical examination of risks and the attainable results. Aesthetic aspects are lesser important. The interdisciplinary collaboration of internal specialists, surgeons, haemostasiologists a.o. is very important to prepare the patients for surgical treatment and to reduce the postoperative complication rate.

Aged↗
PubMedDate not supplied

[Possibilities for the use of a device to measure pressure distribution in anthropometric and orthopedic assessment of foot data].

Based on a quantitative registered picture of the pressure-distribution under the human foot sole the evaluation of anthropometric sizes is described and compared with usual methods. A sectorial evaluation of the pressure-distribution including an analysis of weight, area, maximum pressure and average pressure in the different sectors is reported. It is discussed, how this standardizable method can support an orthopedic diagnosis using static and dynamic pictures of the pressure-distribution of the foot.

Adolescent↗
PubMedDate not supplied

[Effectiveness of rehabilitation measures from the orthopedic viewpoint].

The investigations reported here were prompted by the rapid increase in the amount of rehabilitation treatment performed in recent years and the high costs it incurs. The patients considered had all undergone orthopedic treatment. Rehabilitation treatment lasted between 4 and 6 weeks. On the basis of certain criteria (alleviation of pain, improvement of function) it was attempted to show what degree of success can be achieved with rehabilitation measures following disc operations, total hip and knee-joint replacements and degenerative changes of the spine. In view of their high cost rehabilitation measures would not be justifiable if equally satisfactory results could be achieved by less costly methods. However, a complex therapeutic program generally cannot be carried out adequately on an outpatient basis. While surveys of effectiveness conducted by numerous authors have shown that considerable savings are possible in terms of general and insurance costs (Gercke 1977), accurate indication and careful assessment of the necessity for a cure are essential. The authors' investigations in 4 rehabilitation groups revealed that in a high percentage of the patients not only subjective alleviation of pain but also genuine, measurable functional improvements were achieved. Rehabilitation is one of the most important elements of pension insurance schemes: the dictum here is that "rehabilitation has priority over pensions". Nevertheless, the low chance of success assumed by pension applicants during rehabilitation should be taken into account. These patients, who are only interested in the success of their pension applications, regard the chances of success as practically non-existent.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗
PubMed1980

[Magnification radiography in orthopedics (author's transl)].

A simplified method of 1,5 to 2,0 x radiographic magnification is presented with a focal spot of 0,15 mm. The examination of 358 patients shows a gain in clinical information in 74%, which was decisive in 24%. The place of magnification radiography in orthopedic diagnostic procedures is defined.

Adolescent↗
PubMed2006

Predicting employment outcomes of rehabilitation clients with orthopedic disabilities: a CHAID analysis.

PURPOSE: To examine demographic and service factors affecting employment outcomes of people with orthopedic disabilities in public vocational rehabilitation programs in the United States. METHOD: The sample included 74,861 persons (55% men and 45% women) with disabilities involving the limbs or spinal column who were closed either as rehabilitated or not rehabilitated by their state-run vocational rehabilitation agencies in the fiscal year 2001. Mean age of participants was 41.4 years (SD = 11.2). The dependent variable is employment outcomes. The predictor variables include a set of personal history variables and rehabilitation service variables. RESULTS: The chi-squared automatic interaction detector (CHAID) analysis indicated that job placement services significantly enhanced competitive employment outcomes but were significantly underutilized (only 25% of the clients received this service). Physical restoration and assistive technology services along with support services such as counseling also contributed to positive employment outcomes. Importantly, clients who received general assistance, supplementary security income, and/or social security disability insurance benefits had a significant lower competitive employment rates (45%) than clients without such work disincentives (60%). CONCLUSION: The data mining approach (i.e., CHAID analysis) provided detailed information and insight about interactions among demographic variables, service patterns, and competitive employment rates through the segmentation of the sample into mutually exclusive homogeneous subgroups.

Adult↗
PubMed2005

Cure of multidrug-resistant Acinetobacter baumannii fixation device-related orthopedic infections in two patients with intravenous colistin.

We report our experience with two cases of fixation device-related orthopedic infections due to multidrug-resistant Acinetobacter baumannii strains. Both patients were successfully treated with intravenous administration of colistin, despite the reported poor penetration of this medication to these tissues, in the old literature. No serious colistin-associated toxicity developed and no recurrence of the infection occurred on follow up.

Acinetobacter Infections↗
PubMedDate not supplied

Clinical evaluation of cefoxitin in treatment of infections in 47 orthopedic patients.

Cefoxitin was administered to 47 patients on an orthopedic service; 1 or 2 g of the drug was given intravenously every 4-8 hr. Thirty-one evaluated patients with acute or chronic infections of bone, joint, or muscle and tendon had an overall rate of cure of 84%. Ten patients with spinal cord injuries who had urinary tract infections due to Serratia or indole-positive Proteus were treated, and all 10 were cured. Significant adverse effects of cefoxitin included one case of fever due to the drug and three cases of superinfection. Cefoxitin therapy was successful in a variety of difficult-to-treat infections, including some of polymicrobial etiology.

Adult↗
PubMed1983

Orthopedic strategies in the management of the adult head-injured patient.

The purpose of this paper is to outline a systematic approach to the care of adult patients with traumatic head injury. The orthopedic management of these individuals is divided in three phases. In the acute period after the initial trauma, musculoskeletal injuries should be diagnosed and treated. Delayed diagnoses of fractures and peripheral nerve injuries are common. Fracture care often differs from the care given to patients without head injuries because open reduction and internal fixation are more frequently indicated. The results of fracture treatment are compromised by spasticity and heterotopic ossification. The second phase is the subacute period during which neurologic recovery is occurring. This period may last up to 18 months. While neurologic recovery is proceeding, heterotopic ossification and spasticity with its resulting deformities are treated. Drugs, casting, and phenol blocks of peripheral nerves and motor points are used in the control of spasticity. Drugs and aggressive range-of-motion exercises aid in maintenance of joint motion when heterotopic ossification is present. When neurologic recovery has stabilized, the third phase begins. At this time, residual limb deformities may be surgically corrected and heterotopic bone may be excised.

Adult↗
PubMed1999

A comparison of levobupivacaine 0.125%, fentanyl 4 microg/mL, or their combination for patient-controlled epidural analgesia after major orthopedic surgery.

UNLABELLED: Levobupivacaine, the isolated S(-) isomer of bupivacaine, is less cardiotoxic than racemic bupivacaine in animal studies. We studied the effectiveness of patient-controlled epidural analgesia (PCEA) with either levobupivacaine 0.125% or fentanyl 4 microg/mL alone, or a combination of levobupivacaine and fentanyl in 65 patients after total joint arthroplasty in a prospective, random, double-blinded fashion. Intraoperatively, all patients received 20 mL of 0.75% levobupivacaine. Study medication was infused at an initial rate of 4 mL/h, with additional medication available on patient demand (2 mL/10 min). The combination of levobupivacaine and fentanyl produced better analgesia (longer time to first PCEA request; P = 0.007 combination versus fentanyl and P = 0.006 combination versus levobupivacaine) than either drug alone. Patients in the levobupivacaine groups had appreciable sensory blockade to pinprick with minimal motor impairment. Resting and dynamic visual analog scale pain scores were lower in the combination group than in the plain fentanyl group at 6 (P = 0.022 and 0.036) and 12 h (P = 0.002 and 0.001). The 24-h overall patient- and investigator-rated visual analog scale pain scores were also lower in the combination group (resting P = 0.007, dynamic P = 0.005). There was no significant difference among the groups in the incidence of postoperative nausea (26.2%), pruritus (9.2%), hypotension (23.1%), or sedation (0%). We conclude that the analgesic effects of levobupivacaine 0.125% and fentanyl (4 microg/mL) are additive and beneficial for the management of orthopedic surgical pain by the PCEA method. Patients in this study began demand-dosing later, reported lower pain scores, and had no greater risk of adverse events than those who were given either levobupivacaine or fentanyl alone. IMPLICATIONS: We demonstrated a significant additive effect of the combination of levobupivacaine (0.125%) and fentanyl (4 microg/mL), compared with either drug alone, when using patient-controlled epidural analgesia in patients after total joint arthroplasty.

Adolescent↗
PubMed2002

The efficacy and safety of three concentrations of levobupivacaine administered as a continuous epidural infusion in patients undergoing orthopedic surgery.

UNLABELLED: We evaluated the efficacy and safety of three concentrations of levobupivacaine infused epidurally as analgesia for patients undergoing orthopedic procedures. Patients undergoing elective hip or knee joint replacement were enrolled in the study (n = 105). Sensory blockade was established preoperatively with 10-15 mL of 0.75% levobupivacaine. Patients were then randomized to receive 0.0625%, 0.125%, or 0.25% levobupivacaine as a continuous epidural infusion at 6 mL/h for 24 h. IV morphine patient-controlled analgesia was given as rescue analgesia, and time to first request for analgesia and total dose of morphine consumed were recorded. Sensory blockade, motor blockade, visual analog scale pain score, and cardiovascular variables were also recorded at regular intervals postoperatively. Ninety-one patients were included in the primary intent-to-treat analysis. Total normalized dose of morphine, number of patient-controlled analgesia requests, and overall postoperative visual analog scale pain scores were significantly lower for the 0.25% group compared with the other two groups, and the time to first request for rescue analgesia was longer. There was no significant difference between the 0.125% and 0.25% groups in terms of maximum motor blockade achieved and time to minimal motor blockade. Safety data were equivalent among the three groups. We conclude that levobupivacaine as a continuous epidural infusion provided adequate postoperative analgesia and that the 0.25% concentration provided significantly longer analgesia than 0.125% or 0.0625% levobupivacaine without any significant increase in detectable motor blockade relative to the 0.125% group. IMPLICATIONS: Postoperative epidural infusion of levobupivacaine can provide safe and effective analgesia for patients having hip or knee joint replacement. Of the three concentrations we infused at a constant rate, 0.25% provided significantly better pain relief.

Aged↗
PubMed2000

Epidural infusion of ropivacaine for postoperative analgesia after major orthopedic surgery: pharmacokinetic evaluation.

BACKGROUND: Changing plasma protein concentrations may affect the protein binding and pharmacokinetics of drugs in the postoperative phase. Therefore, the authors evaluated the pharmacokinetics of ropivacaine, administered by 72-h epidural infusion to provide postoperative analgesia. METHODS: Twenty-eight patients, scheduled for major orthopedic surgery during combined epidural and general anesthesia received a bolus dose of ropivacaine (50 or 75 mg), followed by constant-rate (10 ml/h) epidural infusion of ropivacaine 2 mg/ml (group 1) or 3 mg/ml (group 2). Total and unbound plasma concentrations of ropivacaine and pipecoloxylidide and plasma concentrations of alpha1-acid glycoprotein were determined. In addition, the urinary excretion of ropivacaine and major metabolites was measured. RESULTS: Total plasma concentrations of ropivacaine increased steadily during the infusion, reaching 2.7 +/- 0.7 and 2.9 +/- 0.5 mg/l in groups 1 and 2 after 72 h constant-rate infusion. Unbound ropivacaine concentrations reached average steady state levels of approximately 0.06 and 0.07 mg/l. Total and unbound concentrations of pipecoloxylidide increased to 1.0 +/- 0.4 and 0.4 +/- 0.2 mg/l (group 1) and 1.2 +/- 0.4 and 0.5 +/- 0.1 mg/l (group 2) after 72 h infusion. alpha1-Acid glycoprotein concentrations initially decreased, but thereafter increased steadily to approximately twice the baseline values. CONCLUSIONS: Postoperative increases in plasma alpha1-acid glycoprotein concentrations enhance the protein binding of ropivacaine and pipecoloxylidide, causing divergence of total and unbound plasma concentrations.

Adult↗
PubMedDate not supplied

Neuro-orthopedic management of shoulder deformity and dysfunction in brain-injured patients: a novel approach.

Shoulder problems are common in patients with traumatic brain injury. Very little has been written about the evaluation and neuro-orthopedic management of these problems. This is largely because there have not been surgical treatments available other than release of contracted, nonfunctional shoulders. Shoulder problems can be classified and evaluated using several different strategies: bony versus soft tissue restrictions; static versus dynamic deformities; traumatic injuries versus impairments secondary to weakness and spasticity; or problems of active function versus problems of passive function. Regardless of the classification system employed a systematic approach to evaluation and treatment is essential. Shoulder impairments can be corrected leading to significant improvement in functional outcomes. In this paper we report on the novel evaluation and surgical management options developed in our program for the most common shoulder problems encountered in patients with traumatic brain injury.

Brain Injuries↗