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PubMed2003

Vascular injuries associated with elective orthopedic procedures.

The objective of this study was to review the diagnosis, management, and outcome of the rare iatrogenic arterial injury associated with elective orthopedic joint procedures. A retrospective review was conducted of all patients presenting to the vascular surgery service with arterial injury after elective orthopedic procedures between 1997 and 2002. Clinical records were reviewed for presentation, type of injury, management, and outcome. During the study period, 20 patients having 21 total orthopedic procedures were identified with 27 arterial injuries. There were 4350 elective orthopedic procedures during this period for an incidence of 0.005%. There were 14 total knee arthroplasties, 4 total hip arthroplasties, and 3 ankle reconstructions in the study group. Presenting signs included acute ischemia with loss-of-limb Doppler-detected arterial flow/pulses (13 patients, 62%), intraoperative arterial bleeding (3 patients, 14%), nonhealing wounds (3 patients, 14%), and limb edema (2 patients, 10%); the diagnosis was delayed >24 hr in 5 patients (25%). Arterial thrombosis was the most common abnormality identified (21 of 27 injuries, 78%), followed by laceration/avulsion (3 injuries, 11%) and pseudoaneurysm development (3 patients, 11%), and involved the iliac ( n = 3), common femoral ( n = 2), profunda ( n = 1), superficial femoral ( n = 4), popliteal ( n = 12), or tibial ( n = 5) arteries. Concomitant popliteal venous injury was present in one patient. Injured arterial segments had preexisting atherosclerotic disease (33%) and 15 patients (71%) had prior surgery in proximity to the arterial injury while an additional 9 (43%) had prior traumatic injury (7 [78%] of whom had revision orthopedic surgery as well). Management consisted of vein bypass grafting ( n = 15, 56%), primary repair ( n = 3, 11%), and thrombectomy with thrombolysis ( n = 2, 7%). One patient (5%) underwent primary above-knee amputation. There was one death from septic shock and there were three limb losses (14%). Arterial injury associated with elective orthopedic joint surgery is more common during redoprocedures and in patients with preexisting atherosclerosis. Despite arterial repair/bypass, limb morbidity is common and related to preexisting occlusive disease or extent of arterial thrombosis.

Aged↗
PubMed2005

Use of orthopedic shoes in patients with degenerative disorders of the foot.

OBJECTIVES: To study the actual use of orthopedic shoes by patients with degenerative foot disorders and to identify factors associated with use and nonuse, based on the parameters of the International Organization for Standardization definition of usability: effectiveness, efficiency, satisfaction, and context of use. DESIGN: Multicenter, prospective cohort study. SETTING: Outpatient clinics of 7 rehabilitation centers in the Netherlands. PARTICIPANTS: One hundred consecutive patients with degenerative foot disorders. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Usability was assessed by means of the Questionnaire for Usability Evaluation of orthopedic shoes. RESULTS: Seventy of 93 patients with degenerative foot disorders wore their orthopedic shoes for more than 3 days a week after 3 months of follow-up. Factors significantly associated with the actual use of orthopedic shoes were (1) increase in stance duration (effectiveness odds ratio [OR]=2.14; 95% confidence interval [CI], 1.19-3.85), (2) decrease in skin abnormalities (effectiveness OR=1.35; 95% CI, 1.02-1.8]), (3) problems experienced with putting on and taking off orthopedic shoes (efficiency OR=.46; 95% CI, .26-.82), and (4) cosmetic appearance of orthopedic shoes (satisfaction OR=1.54; 95% CI, 1.1-2.15). The overall fit of the multiple logistic regression model ( R 2 ) was 56.3%. CONCLUSIONS: By adding efficiency and satisfaction factors and not focusing only on the effectiveness factors, the amount of explained variance increases, and it becomes possible to evaluate and design products for people with special needs more comprehensively.

Aged↗
PubMed2003

Orthopedic injuries related to snowmobile use.

OBJECTIVES: To document the locations of injury, frequency of associated injuries, and need for operative intervention in patients presenting to a tertiary medical center after sustaining an orthopedic injury related to snowmobile use. DESIGN: Retrospective review. SETTING: Tertiary care center with level I trauma designation in southern Minnesota. PATIENTS/PARTICIPANTS: Seventy-eight patients who sustained orthopedic injuries from snowmobile accidents between January 1985 and December 1996 were treated at our institution. Information regarding patient demographics and injury characteristics was collected. These data were stratified into patient populations presenting directly to the emergency department (n = 47) and those referred from outside hospitals (n = 31). RESULTS: A total of 209 injuries (118 fractures, 31 orthopedic soft-tissue injuries, and 60 nonorthopaedic injuries) were diagnosed within the study population. Tibia (n = 20), radius (n = 14), ulna (n = 12), and spine (n = 14) fractures accounted for half of the fractures reported. There were 13 open fractures. Twenty-four fractures were treated operatively. Ligament injuries to the knees (n = 7) and compartment syndrome of the lower extremity (n = 5) represented the most common orthopedic soft-tissue injuries. The acromioclavicular joint was the most frequently dislocated joint (n = 4). Associated injuries commonly involved the head (n = 17), abdomen (n = 13), and chest (n = 9). As compared to patients presenting directly to the emergency department, referred patients on average had a statistically greater number of total injuries, total operations, and operations for fractures. CONCLUSION: Snowmobile accidents represent a frequent cause of orthopedic injuries in northern regions. An understanding of these injuries may help emergency departments prepare for patients injured on these machines. Recognition of the most common orthopedic injuries may help in the design of safer snowmobiles.

Adolescent↗
PubMed2006

A prospective evaluation of patients with isolated orthopedic injuries transferred to a level I trauma center.

PURPOSE: To assess the indications for, the demographics of, and the appropriateness of patient transfers for orthopedic injuries to a level I trauma center. MATERIALS AND METHODS: All patients with isolated orthopedic trauma transferred to our level I trauma center (N = 128) by means of a physician-to-physician referral line during the call period of two surgeons were prospectively evaluated between January 1, 2004 and December 31, 2004. The specific indication for transfer, the specialty of the referring physician, the patient diagnosis, the perceived need for tertiary care referral (as assessed by a visual analog scale [VAS] based on the phone conversation with the transferring physician), and patient insurance status were obtained before the transfer. On patient arrival, each of these factors was reassessed for later comparison. RESULTS: The transferring physician was an emergency department physician in 88 cases (69%), an orthopedic surgeon in 32 cases (25%), and an internist in the other eight cases (6%). In the 77 cases in which we could confirm the presence of an on-call orthopedist, the patient was examined by the orthopedic surgeon before being transferred in only 32 (42%) cases. In 98 cases (76%), the stated indication for transfer was that the case was too complex for care at the referring hospital or that there was a need for a subspecialist. There was no significant difference in pre- versus post-transfer case complexity as assessed by the VAS (P > 0.05). Although the reported insurance data before transfer was inaccurate in 34 patients (27%), the overall payer mixes reported before and after transfers were similar (23% Medicare, 20% HMO/PPO, 14% workers' compensation, 12% uninsured, 5% Medicaid). The insurance type for the transferred patients as a whole was not significantly different from the non-transferred patients treated by our orthopedic trauma service during the same time period (P > 0.05). Twenty transferred patients had a low VAS complexity score (<5), suggesting that their injuries did not necessarily require tertiary care. Fifteen of these 20 had Medicaid, Medicare, or no insurance. This was a significantly different (worse) payer mix than for the typical transferred patient (P < 0.05). CONCLUSIONS: The need for an increased level of care was the predominant stated reason for patient transfer to our level I trauma center. Nonetheless, the orthopedic surgeon on call did not always examine the patient before transfer. Additionally, patients transferred who had a low level of complexity (those believed not to necessarily require tertiary care) had an insurance status that was worse than that of the typical transferred patient.

Adult↗
PubMed1998

Intrathecal baclofen infusion and subsequent orthopedic surgery in patients with spastic cerebral palsy.

UNLABELLED: Intrathecal baclofen infusion (IBI) is an effective treatment for spasticity secondary to cerebral palsy (CP). OBJECT: To assess the need for orthopedic surgery of the lower extremities in such cases, the authors retrospectively reviewed the outcome in 48 patients with spastic CP who were treated with IBI. METHODS: Pumps were placed in 40 patients (84%) suffering from spastic quadriplegia and eight patients (16%) with spastic diplegia. The patients' ages ranged from 5 to 43 years (mean 15 years). The mean follow-up period was 53 months (range 24-94 months). The mean baclofen dosage was 306 microg/day (range 25-1350 microg/day). At the time of pump placement, subsequent orthopedic surgery was planned in 28 patients (58%); however, only 10 (21%) underwent surgery after IBI therapy. In all 10 cases, the surgical procedure was planned at the time of initial evaluation for IBI therapy. In the remaining 18 patients, who did not subsequently undergo their planned orthopedic operation, it was believed that their lower-extremity spasticity had improved to the degree that intervention was no longer indicated. In addition, although six patients had undergone multiple orthopedic operations before their spasticity was treated, no patient required more than one operation after IBI treatment for spasticity. CONCLUSIONS: The authors conclude that IBI for treatment of spastic CP reduces the need for subsequent orthopedic surgery for the effects of lower-extremity spasticity. In patients with spastic CP and lower-extremity contractures, spasticity should be treated before orthopedic procedures are performed.

Adolescent↗
PubMed2003

Orthopedic injuries associated with backyard trampoline use in children.

INTRODUCTION: Trampolining on an outdoor oval or circular trampoline is a popular activity for children but is associated with a number of orthopedic injuries, especially in children between the ages of 5 and 15 years. In this paper we review the orthopedic injuries in children associated with backyard trampoline use, through our experience with a series of children admitted to the Winnipeg Children's Hospital, the only tertiary care pediatric centre in Manitoba. METHODS: We reviewed the charts, x-ray films and operative reports for 80 children under 16 years old (mean 9 yr, with 14 [18%] children between 2 and 4 yr) with an orthopedic injury sustained when using a trampoline in the backyard. We noted the mechanism of injury and type and severity of orthopedic injury sustained. RESULTS: Fifty-two (65%) children were injured on the trampoline mat, and 24 (30%) were injured when they were ejected from the trampoline. Sixty (75%) children sustained a fracture or fracture-dislocation. Forty-eight (80%) orthopedic injuries occurred in the upper extremity. No child died as a result of a trampoline injury. CONCLUSION: The use of the "backyard" trampoline by young children can cause significant orthopedic injury.

Adolescent↗
PubMed2004

[The prevalance of orthopedic disabilities in the district of Cay, Afyon, Turkey].

OBJECTIVES: Data were collected on disabilities from a sample population in order to estimate the prevalence of orthopedic disabilities in the general population. METHODS: A two-stage field study was conducted in Cay, a district of Afyon, Turkey. In the first stage, a list of all individuals with orthopedic disabilities was derived. Then, medical histories were elicited and examinations were made by a team of specialists of orthopedics and traumatology. Radiographic studies were made when necessary. Orthopedic disabilities were defined as any muscle or skeletal abnormality that was associated with a permanent functional loss and were classified as congenital, traumatic, cerebral palsy, poliomyelitis, and other causes. RESULTS: The overall population was 35,571, of whom 189 had orthopedic disabilities (53/10,000). The male-to-female ratio was 1.8. The most common cause was congenital diseases (25.9%; 13.7/10,000), followed by trauma (23.8%; 12.6/10,000), cerebral palsy (21.7%; 11.5/10,000), poliomyelitis (10.1%; 5.3/10,000), and others (18.5%; 9.8/10,000). The lowest mean age (19+/-5 years) was found in those with cerebral palsy, which was associated with the highest degree of functional loss. The mean age in patients with poliomyelitis was 29+/-7 years. It was found that 37% of the disabled could benefit from either a limited or extensive surgical intervention, and 9% could have significant improvement both in functional ability and life quality through physical therapy or the use of a prosthesis/orthosis. Only 18% were under the coverage of a health insurance, though. CONCLUSION: The data of this study may throw some new light on the prevalence and implications of orthopedic disabilities in Turkey.

Abnormalities, Multiple↗
PubMed2006

[Seroprevalences of hepatitis B, hepatitis C, and HIV in patients admitted to orthopedic and traumatology department].

OBJECTIVES: Orthopedic surgeons are at a higher occupational risk for blood-borne infections because of frequent handling of sharp instruments and bone fragments. We investigated the seroprevalences of hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) among patients treated at orthopedic and traumatology department. METHODS: Data on age, sex, diagnoses, and the seroprevalences of HBsAg, anti-HCV and anti-HIV were reviewed in 1,040 patients hospitalized between September 2003 and December 2004. The patients were divided into two groups as orthopedics (n=646; mean age 37.8 years) or trauma (n=394; mean age 38.3 years) according to the initial cause of presentation. The results were compared with those of 28,642 blood donations during the same period. RESULTS: HBsAg positivity was similar in the patients (2.3%) and the controls (2.1%). HBsAg was detected in 16 patients (2.5%) in the orthopedics group and eight patients (2%) in the trauma group (p>0.05), three of whom were younger than one year. Similarly, the prevalences of anti-HCV antibodies were similar in the patient (0.6%) and control (0.3%) groups. Four patients (0.6%) in the orthopedics group and two patients (0.5%) in the trauma group were positive for anti-HCV (p>0.05), and all had a past history of operations. Anti-HIV positivity was not detected in the patient group, whereas it was 0.2% in the control group. CONCLUSION: The similarities between patients admitted to orthopedic and traumatology department and blood donors in the prevalences of HBsAg, and anti-HCV and anti-HIV antibodies suggest that data obtained from blood banks can be used for risk calculations.

Adolescent↗
PubMed1993

[Orthopedic technique following arthrodesis of the Lisfranc joint].

Of the 107 arthrodeses of the forefoot and the metatarsus performed in the 1980's, we controlled 13 arthrodeses of the Lisfranc joint. The mean time of follow-up was 2.3 years. Our postoperative results were excellent for 5 patients, good for 6 patients and fair for 2 patients. We obtained no poor results. As we found few references to the use of orthopedic techniques in the literature, it seemed of interest to study their use in our own sample. It was found that one patient did not require any orthopedic means, one patient needed orthopedic supports, 9 patients required modifications of their shoes, one patient needed an orthopedic shoe and one patient needed an orthosis. Moreover, we attempted to find which factors are associated with more complex orthopedic techniques. Our results seem to indicate that a complete arthrodesis of the Lisfranc joint requires the use of more complex orthopedic techniques than does a partial arthrodesis.

Adolescent↗
PubMed1993

Critical evaluation of the 2-minute orthopedic screening examination.

OBJECTIVE: To determine the sensitivity and specificity of the 2-minute, 12-step, orthopedic screening examination. DESIGN: Prospective, single-blind study. SETTING: National Collegiate Athletic Association Division 1 athletics program. PARTICIPANTS: Two hundred fifty-nine male and female varsity athletes. INTERVENTIONS: The athletes were screened by five primary care physicians who were "blind" to each patient's history. The athletes were then evaluated by a team of orthopedic surgeons who had knowledge of each patient's history. Significant injuries were injuries that would limit participation, predispose to injury, or need further evaluation or rehabilitation. MAIN RESULTS: A total of 120 significant injuries were identified by compiling the results of the history and both physical examinations. Of the significant injuries, 91.6% were detected by history alone. Fourteen of the significant injuries were missed by the detailed orthopedic examination, but they were detected by the screening examination. The overall sensitivity of the screening examination compared with the results of all three methods was 50.8%, with a specificity of 97.5%, positive predictive value of 40.9%, and negative predictive value of 98.3%. Almost half of the false-positive screening findings were shoulder asymmetries. CONCLUSIONS: Even in mass screenings, the screening orthopedic examination should be used only in conjunction with an orthopedic history. Some modifications may improve the sensitivity of the screening examination.

Adolescent↗
PubMed1993

Absence of HIV transmission from an infected orthopedic surgeon. A 13-year look-back study.

OBJECTIVE: To determine the risk of human immunodeficiency virus (HIV) transmission from an HIV-infected orthopedic surgeon to patients undergoing invasive procedures. DESIGN: Retrospective epidemiologic follow-up study. PARTICIPANTS: A total of 2317 former patients on whom the orthopedic surgeon performed invasive procedures between January 1, 1978, and June 30, 1991 [corrected]. MAIN OUTCOME MEASURES: HIV infection or death from an acquired immunodeficiency syndrome (AIDS)-defining tumor or opportunistic infection. RESULTS: An orthopedic surgeon voluntarily withdrew from practice after testing positive for HIV. Testing for HIV was performed on 1174 former patients, representing 50.7% of patients on whom the orthopedic surgeon performed invasive procedures during the 13.5-year period. Patients were tested from each year and from each category of invasive procedure. All patients were HIV-negative by enzyme-linked immunosorbent assay. Two former patients reported known HIV infection prior to surgery. Review of AIDS case registries and vital records failed to detect cases of HIV infection among former surgical patients. The estimated cost of the initial patient notification and testing was $158,500. The patient notification and testing were conducted while maintaining the confidentiality of the orthopedic surgeon who was an active participant in the planning and execution of the study. CONCLUSIONS: The risk of HIV transmission from an HIV-infected surgeon who adheres to recommended infection control practices is extremely low. Notification and HIV testing of former patients in this setting is both disruptive and expensive and is not routinely recommended.

AIDS Serodiagnosis↗
PubMedDate not supplied

Perforation rate using a single pair of orthopedic gloves vs. a double pair of gloves in obstetric cases.

Our purpose was to determine the perforation rate for a single pair of orthopedic gloves vs. a double pair of regular gloves in obstetric cases. Faculty, residents, medical students, and surgical technicians were assigned randomly to use either double gloves or single orthopedic gloves. After each procedure, the gloves were examined by filling with water, occluding the cuff, and observing for streams of water. The perforation rate for the double gloves (both inner and outer glove at the same location) was 7% (12/169), similar to the 7% (12/172) for single orthopedic gloves (P < 0.9). After adjusting for procedure type there was no association between the type of gloves and perforation rate. Fifty-four percent of all perforations were not recognized intraoperatively. Of those individuals with glove perforations, 4/24 (17%) observed blood on the hand at the end of the procedure. Double-gloved users complained more frequently than single-gloved users of loss of dexterity (77/169, 46%, 95% CI 38-53%) vs. (6/172, 3.5%, 95% CI 0.7-6%) (P < 0.001) and numbness (12/169, 7%, 95% CI 3.2-11%) vs (1/172 0.6%, 95% CI 0.55-1.7%) (P < 0.005). Although the use of a single pair of orthopedic gloves is more costly than a double pair of regular gloves ($78 vs. $15 per box), it is as safe and as effective as a double pair of gloves in maintaining a sterile barrier. The primary advantage of a single pair of orthopedic gloves is that surgical dexterity is minimally compromised when compared to double gloves.

Equipment Failure↗
PubMed2001

[The German Orthopedics Society 1918-1932. Developments and trends].

The German Orthopedic Society was founded in 1901. The period between 1918 and 1932 was characterized by the aftermath of World War I. Up to the middle of the 2nd decade, orthopedic surgeons mainly treated soldiers and civilians affected by the war. Almost every congress dealt with amputations and artificial limbs. At the same time, orthopedic surgery became a specialty at the German universities, legitimizing it as a subject of its own. Besides the large number of victims of the First World War who had to be treated by orthopedic surgeons, there was a second group of patients, the so-called cripples. These handicapped people had not previously been treated in general. A new law established in 1920 guaranteed the government's support for treatment and education of these patients. This law was called "Krüppel-Fürsorge-Gesetz," which entailed welfare but also resocialization of the handicapped, including their return to work. The German nation recognized the economic benefit of this law and accepted the financial burden. During this period, German orthopedic surgeons developed many important surgical techniques, diagnostic tests, and technical findings for the production of orthoses and artificial limbs. Some examples of techniques are described in the article: UVirradiation for the treatment of rickets according to K. Huldschinsky, Borggreve's rotationplasty of the leg (Umkehrplastik), hallux valgus arthroplasty according to Brandes, and Bragard's sign.

Artificial Limbs↗
PubMed2001

[History of German orthopedics 1989-2001].

The present article describes essential aspects of the development of German orthopedics from 1989 to 2001. Special attention is given to the unification of the two German orthopedic groups after the political turnaround in the German Democratic Republic and the resultant changes in the landscape of German orthopedics. In addition, further milestones in the development of German orthopedics during the last 10 years are presented, e.g., the formation of the Alliance of German Orthopedists, the establishment of various sections of the DGOT (German Association of Orthopedics and Traumatology) as well as the main focus of scientific activity in the past few years.

Congresses as Topic↗
PubMed2001

[Hand surgery in German orthopedics].

The intention of this report is to present an overview of the development of hand surgery and its status in German orthopedics. An important role was played by orthopedics in the development of hand surgery: many insights and classifications in this field originate from orthopedic surgeons and retain their validity in this century. In the past few decades, traumatologists and plastic surgeons have become increasingly active in the field of hand surgery and have added to their surgical repertoire some fields formerly regarded as part of classic orthopedics, e.g., correction of malformations of the hand. Although microsurgical techniques of hand surgery were primarily developed by plastic surgeons, the past should nevertheless motivate all orthopedists to continue considering hand surgery the "pearl of orthopedics" in the future.

Germany↗
PubMed2002

[Low molecular weight heparins after orthopedic and traumatologic operations in geriatrics].

Deep vein thrombosis and pulmonary embolism are common complications after orthopedic and trauma surgery. To prevent these complications, the use of low-molecular-weight heparins (LMWH) as prophylaxis is well proved and accepted. We reviewed 203 patients undergoing geriatric rehabilitation in our hospital after orthopedic and trauma surgery. Despite a prophylaxis with LMWH, 23 (11.3%) of these patients were diagnosed with having a clinically apparent and sonographically confirmed thromboembolic event. The average age of all patients was 81.8 years; the time between surgical or orthopedic intervention and thrombembolic event was on average 29.4 days. Using evidence-based medicine, a search of the literature showed 34 clinical trials concerning the prophylaxis of thrombembolic events with LMWH after orthopedic or trauma surgery. All studies have been reviewed for age of patients and for duration of prophylaxis with LMWH. The average age of all patients involved is 65.8 years. There are only 4 trials with an average age of 75 years or more, with a total number of less than 250 patients. The mean duration of prophylaxis with LMWH is 12.5 days. Only 6 trials concern thromboprophylaxis given longer than 3 weeks after surgical intervention. We conclude that there are no clear data about safety, efficiency and optimal duration of prophylaxis with LMWH in geriatric patients undergoing orthopedic or trauma surgery.

Aged↗
PubMed2006

Randomized prospective study on prophylactic antibiotics in clean orthopedic surgery in one ward for 1 year.

BACKGROUND: At present in Japan, there are neither reports on antibiotic prophylaxis regardless of underlying diseases nor precise guidelines on prophylactic antibiotics in orthopedic surgery. Therefore, the preventive effect of antimicrobial agents on surgical site infection (SSI) after clean orthopedic surgery was studied to control the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in our ward and to reduce SSI caused by MRSA. METHODS: Regardless of the type of operation or underlying disease, a regimen of prophylaxis that is of shorter duration than before was conducted in 419 patients admitted to our orthopedic ward (one ward) and who underwent clean orthopedic surgery between 2001 and 2002. RESULTS: The annual usage of beta-lactam antibiotics in the ward decreased by 960.9 g, the isolation rate of MRSA in the ward decreased to 50% (the lowest isolation rate in the past 4 years), and SSIs caused by MRSA were found in 3 of 419 (0.71%) patients in one year compared with 6 of 470 (1.28%) during the previous year. Comparison of two antibiotics revealed that SSI caused by MRSA did not occur in any of the 187 patients receiving sulbactam/ampicillin as prophylaxis but did occur in 1.29% (3/232) patients receiving cefazolin. Concerning all SSIs caused by any organisms, they occurred in 0.53% of patients receiving sulbactam/ampicillin and in 2.16% of patients receiving cefazolin. The difference in the SSI rates between the two groups was not statistically significant. CONCLUSIONS: Although there is statistically no significant difference in the incidence of SSI caused by MRSA, we were able to decrease the isolation rates of MRSA and prevent MRSA from spreading owing to the reduced antibiotic usage in this study. Sulbactam/ampicillin can be recommended, as well as cefazolin, for antibiotic prophylaxis in clean orthopedic surgery.

Adolescent↗
PubMed2007

Development of a content-valid standardized orthopedic assessment tool (SOAT).

INTRODUCTION: Content validation of an instrument that measures student performance in OSCE-type practical examinations is a critical step in a tool's overall validity and reliability [Hopkins (1998), Educational and Psychological Measurement and Evaluation (8th ed.). Toronto: Allyn & Bacon]. PURPOSE: The purpose of the paper is to outline the process employed to create a content-valid Standardized Orthopedic Assessment Tool (SOAT). Orthopedic assessment skills are employed by athletic therapists, physiotherapists and physicians. All follow very similar diagnostic algorithms and that system was used to develop the original SOAT [Cyriax (1982). Textbook of Orthopaedic Medicine, (vol. 1) Bailliere Tindall]. METHODS: To validate the tool, the study followed procedures outlined by Violato, Salami, and Muiznieks (2002), Journal of Manipulative Physiological Therapeutics, 25, 111-115, and Butterwick, Paskevich, Vallevand and Lafave (2006), Journal of Allied Health: a modified Ebel procedure. An expert group of athletic therapists from across Canada were chosen to create the content valid tool. Representation from all accredited athletic therapy programs in Canada was sought. Experts participated in three stages of content validation: Stage one consisted of individuals grading tasks on difficulty (hard, medium, easy) and importance (essential, important, not important) for 8 body regions (cervical spine, lumbar spine, shoulder, elbow, wrist/hand/thumb, hip, knee and lower leg/foot/ankle) and three diagnoses for each body region (24 total). If 80% consensus was not achieved in the first stage, then in stage two, face to face discussion is meant to clarify positions and achieved consensus, if possible. RESULTS: The history component, the observation component, scanning exams, clearing joints above and below the lesion site and active range of motion, passive range of motion and isometric resisted testing all yielded 80% consensus in the first two stages of development. A third stage was added to this process because a new model of measurement was conceptualized during the second stage due to a lack of consensus on two orthopedic assessment categories: special testing and palpation. The new model consisted of a ;;clinical reasoning" metric that tied each section of an orthopedic assessment (history; observation; scanning and clearing; examination, special testing; palpation; conclusion) together and would permit the expert rater to evaluate the student performance based on the student's rationale for tests chosen rather than the traditionally rigid checklists. At least 80% consensus was achieved with the new ;;clinical reasoning" metric and the originally contentious special testing and palpation categories. CONCLUSIONS: The new SOAT that underwent content validation may be a hybrid between the traditional OSCE-type checklists and global scales that provide a more realistic and thus more valid depiction of orthopedic assessment clinical competence. Now that content validation has been established, the next steps include inter-rater reliability testing.

Algorithms↗