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PubMed2003

Language skills of young children with unilateral cleft lip and palate following infant orthopedics: a randomized clinical trial.

OBJECTIVE: To investigate the effects of infant orthopedics (IO) on the language skills of children with complete unilateral cleft lip and palate (UCLP). DESIGN: In a prospective randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed up longitudinally: one group was treated with IO based on a modified Zurich approach in the first year of life (IO group); the other group did not receive this treatment (non-IO group). At the ages of 2, 2(1/2), 3, and 6 years, language development was evaluated in 12 children (six IO and six non-IO). Receptive language skills were assessed using the Reynell test. Expressive language skills of the toddlers were evaluated by calculating mean length of utterance (MLU) and mean length of longest utterances (MLLU); in the 6-year-olds, the expressive language skills were measured using standardized Dutch language tests. PATIENTS: The participants had complete UCLP without soft tissue bands or other malformations. RESULTS: IO did not affect the receptive language skills. However, the expressive language measures MLU and MLLU were influenced by IO. At age 2(1/2) and 3 years, the IO group produced longer utterances than the non-IO group. In the follow-up, the difference in expressive language between the two groups was no longer significant. CONCLUSIONS: Children treated with IO during their first year of life produced longer sentences than non-IO children at the ages of 2(1/2) and 3 years. At 6 years of age, both groups presented similar expressive language skills. Hence, IO treatment did not have long-lasting effects on language development.

Analysis of Variance↗
PubMed2003

Use of a perceptual evaluation instrument to assess the effects of infant orthopedics on the speech of toddlers with cleft lip and palate.

OBJECTIVE: To investigate the effects of infant orthopedics (IO) administered in the first year of life on the speech characteristics of 2.5-year-old children with complete unilateral cleft lip and palate (UCLP) using a perceptual evaluation instrument with equal-appearing interval (EAI) scales. DESIGN: In a prospective randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed longitudinally. One group received IO based on a modified Zurich approach (IO group), and the other group did not (non-IO group). The appliance was used until soft palate closure at age 12 months. Hard palate closure is delayed until 9 years of age. PARTICIPANTS: Three groups of 2.5-year-old toddlers participated in this investigation: 10 IO, 10 non-IO, and 8 noncleft controls matched for age and socioeconomic status. METHOD: Five trained listeners assessed the children's speech in a blinded perceptual rating procedure. They judged 13 specific speech characteristics and indicated their total impression of speech on EAI scales. RESULTS: The reliability and consistency of 11 of the rating scales was good. The intelligibility rating scale was the single speech characteristic that distinguished the IO group from the non-IO group; the IO group was judged to be superior. The cleft groups differed from the noncleft group on 9 of the 11 scales. CONCLUSIONS: Evaluation of speech by means of the present newly developed perceptual rating instrument showed that the IO group obtained significantly higher ratings for intelligibility than the non-IO group. The groups did not differ regarding any of the other speech aspects.

Age Factors↗
PubMed2005

Orthopedic approach in the treatment of a skeletal class II division 1 malocclusion with an anterior open bite.

The patient presented with a skeletal class II malocclusion characterized by an anterior open bite and maxillary midline deviation. This mixed dentition case was treated orthopedically with MRI appliance to rotate and impact the maxilla. A Bionator was used advance the mandible. The case was completed using Occlus-O-Guide. The result showed that the facial bones and teeth appear in the correct position.

Activator Appliances↗
PubMed2004

Emergency department management of pain and anxiety related to orthopedic fracture care: a guide to analgesic techniques and procedural sedation in children.

Orthopedic fractures and joint dislocations are among the most painful pediatric emergencies. Safe and effective management of fracture-related pain and anxiety in the emergency department reduces patient distress during initial evaluation and often allows definitive management of the fracture. No consensus exists on which pharmacologic regimens for procedural sedation/analgesia are safest and most effective. For some children, control of fracture pain is the primary goal, whereas for others, relief from anxiety is an additionally important objective. Furthermore, strategies for the management of fracture pain may vary by fracture location and patient characteristics; thus, no single regimen is likely to provide the best means of analgesia and anxiolysis for all patients. Effective analgesia can be provided by local or regional anesthesia, such as hematoma, Bier, or nerve blocks. Alternatively, induction of deep sedation with analgesic agents such as ketamine or fentanyl, often combined with sedative-anxiolytic agents such as midazolam, may be used to manage distress associated with fracture reduction. A combination of local anesthesia with moderate sedation, for example nitrous oxide, is another attractive option.

Analgesia↗
PubMed2005

Changes in orthodontic cephalometric reference points on application of orthopedic force to jaw: three-dimensional finite element analysis.

The present study investigated the effects of two orthodontic appliances on changes in the cephalometric reference planes using the three-dimensional finite element method. We simulated the use of a headgear and an orthopedic facial mask, two devices for the application of orthodontic force to the jaw. Using a finite element model of the skull, orthodontic force was applied to the maxillary first molar in a posterior or anterior direction. Changes in the maxilla, mandible and cephalometric reference planes were ascertained by the three-dimensional finite element method. The results showed that posterior force caused a slight posterior displacement and clockwise rotation of the reference planes, while anterior force caused anterior displacement and counterclockwise rotation. Since the maxilla was displaced and rotated in the same direction, the degrees of cephalometric displacement and rotation of the maxilla were smaller than the actual values.

Biomechanical Phenomena↗
PubMed2001

[Common orthopedic problems in adolescents]

OBJECTIVE: Orthopedic problems in children and adolescents are quite frequent. For that reason, our aim was to give a remarkable insight into five selected topics: spinal deformities, osteochondritis, growing pains, back pain, and corrective shoes. METHODS: We analyzed general concepts of spinal deformities, including the general definition of scoliosis and its etiologic classification. We also discussed the definition, etiology, diagnosis, and treatment of osteochondritis, growing pains, back pain, and corrective shoes. The data were obtained from review articles, textbooks, and from the Internet. RESULTS: We describe the epidemiology, diagnosis, and treatment of the selected conditions through review of literature and the authorś own experience. CONCLUSIONS: Comments and relevant aspects concerning general pediatric practice are discussed.

Journal Article↗
PubMed2006

Prediction of individual mandibular changes induced by functional jaw orthopedics followed by fixed appliances in Class II patients.

OBJECTIVE: To identify pretreatment cephalometric variables for the prediction of individual mandibular outcomes of functional jaw orthopedics (FJO) followed by fixed appliances in Class II patients treated at the peak in mandibular growth. MATERIALS AND METHODS: The study was performed on 51 subjects (24 females, 27 males) with Class II malocclusion. First-phase therapy was accomplished with a twin block in 16 subjects, a stainless steel crown Herbst in 15 subjects, and an acrylic splint Herbst in 20 subjects. Lateral cephalograms were available at the start of treatment with FJO and at the completion of fixed appliance therapy. All subjects received FJO at the peak in mandibular growth (CS 3 at T1). Individual responsiveness to Class II treatment including FJO was defined on the basis of the T2-T1 increment in total mandibular length (Co-Gn) when compared with untreated Class II subjects. RESULTS: Discriminant analysis identified a single predictive parameter (Co-Go-Me degrees) with a classification power of 80%. Pretreatment vertical and sagittal parameters were not able to improve the prediction based upon the mandibular angle. CONCLUSIONS: A Class II patient at the peak in skeletal maturation (CS 3) with a pretreatment Co-Go-Me degrees smaller than 125.5 degrees is expected to respond favorably to treatment including FJO. A Class II patient at CS 3 with a pretreatment value for Co-Go-Me degrees greater than 125.5 degrees is expected to respond poorly to treatment including FJO.

Adolescent↗
PubMed1987

Endometriosis in the uterosacral ligament giving orthopedic symptoms through compression of the sciatic nerve and surgically treated via an extraperitoneal approach keeping the pelvic organs intact.

Sciatic pain in a young woman was not relieved by orthopedic treatment. The gynecologist found a large hard tumor-like mass in the uterosacral ligament extending to the pelvic wall. Cytologic examination of fine needle aspirate indicated an endometriotic lesion. The large tumor-like mass was extirpated by an extraperitoneal technique and the pain disappeared.

Adult↗
PubMed1984

Time-dependent effects of a 'functional'-type orthopedic appliance on the rat mandible growth.

The modus operandi and the time-dependent variations in the effects of the LSU-activator, an orthopedic appliance currently used in human orthodontic therapy, was experimentally analyzed in growing rats. This appliance causes a forward positioning of the lower jaw and a restriction of mandibular motility. After a 4-week treatment, the following changes were observed: (i) the growth rate of the condylar cartilage was accelerated, this growth-promoting effect being more pronounced when the LSU-activator was worn during the animal's rest span. (ii) the direction of condylar growth became more backward-oriented; no significant difference between day and night treatment, i.e. during the rest and activity spans could be detected; (iii) the supplementary lengthening of the mandible was greater in rats treated during rest than in rats treated during waking and (iv) the number of serial sarcomeres in the lateral pterygoid muscle was smaller. This growth retardation of the muscle was greater in rest-time than in waking-time treated individuals. The LSU-type activator's action implies a two-step effect: during the time of wearing the appliance, the more forward positioning of the mandible causes a reduced growth of the lateral pterygoid muscle; during the time the LSU-type activator is not worn, the mandible is functioning in a more forward position such a way that it stimulates the growth rate of the condylar cartilage and the subperiosteal ossification of the posterior border of the ramus. It is therefore essential, for a few hours every day, that the mandible be allowed to move freely from the appliance in a more forward position.

Activity Cycles↗
PubMedDate not supplied

Animal models of orthopedic implant infection.

Prosthetic infection following total joint replacement can have catastrophic results both physically and psychologically for patients, leading to complete failure of the arthroplasty, possible amputation, prolonged hospitalization, and even death. Although with the use of prophylactic antibiotics and greatly improved operating room techniques the infection rate has decreased markedly during the years, challenges still remain for better preventive and therapeutic measures. In this review the in vivo experimental methods for studies of prosthetic infection are discussed, concentrating on (1) the animal models that have been established and the use of these animal models for studies of pathogenesis of bacteria, behavior of biofilm, effect of biomaterials on prosthetic infection rate, and the effect of infection on biomaterial surfaces, and (2) how to design and conduct an animal model of orthopedic prosthetic infection including animal selection, implant fabrication, bacterial inoculation, surgical technique, and the methods for evaluating the results.

Animals↗
PubMed1979

Porous polysulfone as an attachment vehicle for orthopedic and dental implants.

The mechanical properties of porous polysulfone (PSF) were determined and its performance as a surface coating on orthopedic and dental implants evaluated. Ten coated femoral prostheses were implanted in nine dogs. A second series of four uncoated "control" prostheses and all of the acetabular cups were implanted using conventional bone cement techniques. Six porous PSF coated tooth roots were implanted in healed mandibular premolar extraction sites in three Rhesus monkeys. The shear strength of porous PSF (6 MPa) was comparable to that of trabecular bone. Pushout tests of 1cm. thick sections of the prostheses yielded interfacial shear strength values over 1.4 MPa for the PSF coated hips after 14 weeks and mean values under 0.7 MPa for the bone cemented specimens after 3 and 36 weeks. Bone and fibrous tissue was identified in the pores of coated specimens. Preliminary clinical evaluation of the functioning dental implants revealed zero mobility and other favorable clinical and radiographic indications after 2 months.

Alveolar Process↗
PubMed1998

Analgesic use disorders among orthopedic and chronic pain patients at a rehabilitation clinic.

Interviews were conducted with 265 orthopedic and chronic pain patients, using a structured diagnostic instrument (ADDIS/SUDDS) concerning their use of analgesics. Twenty-two percent of the patients met criteria for analgesic use disorders in accordance with DSM-III-R; 18.5% fulfilled DSM-IV criteria. Dextropropoxyphene was the most common analgesic prescribed and was used by 47% of the patients who met criteria for analgesic use disorders. It is concluded that patients with chronic pain using narcotic analgesics are at considerable risk of developing analgesic use disorders. Assessment of the use of analgesics should be offered to pain patients taking narcotic drugs.

Adult↗
PubMed1985

Aspiration cytology of soft-tissue tumors. The 10-year experience at an orthopedic oncology center.

Since 1972, we have included fine-needle aspiration cytology in the pre-operative evaluation of soft tissue lesions referred to our Orthopedic Oncology Group. In 365 consecutive patients the cytodiagnosis was correctly malignant in 66/74 tumors and correctly benign in 260/271 lesions; cytology was non-diagnostic in four sarcomas and 16 benign lesions. The final pre-operative diagnosis should be based on all pre-operative data to minimize the effect of any misjudgement as regards cytodiagnosis; only two of the 19 false cytodiagnoses were of consequence for the patient. We conclude that aspiration cytology used in this way is a valuable adjunct to determine the further management of soft tissue tumors.

Biopsy, Needle↗
PubMed1991

Bacterial growth on suction drain tips. Prospective study of 489 clean orthopedic operations.

The study included 489 clean orthopedic operations with implantation of major foreign materials (joint replacements and internal fixations of fractures). Specimens for culture were taken from the suction drainage system, either from the drain fluid or from the drain-tube tip or from both. Six superficial and five deep infections were seen following the operations. Only two cultures of drain fluid were positive, and neither of these became infected. Positive drain-tip cultures were seen after 56 operations, and of these, five were followed by infection. The risk of infection was increased if Staphylococcus aureus, Enterobacteriaceae, or Streptococcus faecalis was cultured from drain tips. Drain-tip cultures growing only coagulase-negative staphylococci, nonhemolytic streptococci, and corynebacteria were not correlated with increased risk of infection. There was a not significant tendency towards fewer infections if positive drain-tip cultures with virulent bacteria were treated with specific antibiotics.

Bacteria↗
PubMed1993

Airport metal detectors and orthopedic implants. The responses of arch and hand-held devices.

8 subjects with a variety of orthopedic implants were examined by the security staff at an international airport using arch and hand-held metal detectors. None of the subjects caused activation of the alarm on the arch, although the presence of metal was registered in 2 at a level below the alarm threshold. The hand-held detectors alarmed over the larger superficial implants. A substantial tissue screening effect was noted.

Alloys↗
PubMed1998

Comparison of functional outcomes from orthopedic and neurosurgical interventions in spastic diplegia.

Selective dorsal rhizotomy (SDR) and orthopedic surgery, in the form of muscle-tendon (MT) lengthening surgery are commonly performed in ambulatory children with spastic diplegia to improve their level of motor function. This investigation is a post hoc comparison of the functional effects from each of these surgical options in 30 patients with spastic diplegia who underwent one of these interventions as their initial surgical procedure. Sixteen children underwent SDR and 14 underwent MT surgery in two separate prospective clinical trials. The same functional outcome measures preoperatively and approximately 1 year postoperatively were used in both studies including temporospatial parameters from three-dimensional gait analysis, the total score, and score on each of the five dimensions of the Gross Motor Function Measure (GMFM). Comparisons indicate that patients who underwent SDR had significant improvements in GMFM Dimensions 2, 4, and 5 as well as in total score, although 63% of those studied had a 10% or more reduction in gait velocity. Gait was more predictably improved in the MT group, with only 21% demonstrating reductions in velocity. Conversely, the change in GMFM scores in the MT group was not as pervasive and skewed toward higher skills with only GMFM Dimension 5 and total score improved significantly. Several important hypotheses are derived from these comparisons. Multicenter clinical trials are needed to define more clearly the indications for and to assess more comprehensively the outcomes from each intervention.

Journal Article↗
PubMed1985

An evaluation of cefoxitin in the prevention of postoperative infections following orthopedic surgical procedures.

An open, nonrandomized study of 25 patients was conducted to evaluate the efficacy of cefoxitin in the prevention of postoperative infection following orthopedic surgical procedures. Cefoxitin was administered in a 2 g dose preoperatively and continued postoperatively at a dose of 2 g every six hours for 72 hours. The mean peak serum level achieved ten minutes after the preoperative dose was 153.7 mcg/ml. The mean bone level in samples taken during the procedure was 10.14 mcg/ml. All patients were monitored postoperatively and at intervals of six weeks, four months and six months for signs of early or late morbidity. No signs of major morbidity were observed in the study group.

Adult↗
PubMed1986

The effect of hydration water temperature on orthopedic plaster cast strength.

The effect of hydration water temperature (dip water) on the strength of orthopedic casts is discussed. Three methods of testing are used in an attempt to detect any differences and also to assess their clinical relevance. It was found that warmer water produced stronger casts, however, the differences were not found to be clinically relevant. It is suggested that water temperature be chosen on the basis of considerations other than strength.

Casts, Surgical↗