Ferguson, Robert P; Thomas, Deborah
Eponyms are a long-standing tradition in medicine. Eponyms usually involve honoring a prominent physician scientist who played a major role in the identification of the disease. Under the right circumstances, a disease becomes well known through the name of this individual. There are no rules on eponym development. It may take an extraordinary period of time, be different in different languages and cultures, and evolve as more is known about the physician or the disease. PMID:25147644
Ferguson, Robert P.; Thomas, Deborah
Eponyms are a long-standing tradition in medicine. Eponyms usually involve honoring a prominent physician scientist who played a major role in the identification of the disease. Under the right circumstances, a disease becomes well known through the name of this individual. There are no rules on eponym development. It may take an extraordinary period of time, be different in different languages and cultures, and evolve as more is known about the physician or the disease. PMID:25147644
Vashisht, Deepak; Baveja, Sukriti
Eponym has originated from the Greek word “eponymos” meaning “giving name”. It is a tribute to the pioneers in the field who have significantly contributed towards present understanding of the subject. Syphilis has amazed and plagued mankind since eternity. This disease is a great masquerade and can humble best of physicians with its varied presentations. Keen and immaculate observations of these workers have eased our understanding of many signs and phenomenon associated with this disease. This has led to evolution of number of eponyms, perhaps no other disease has as many eponyms associated with it, as does syphilis. Eponyms such as Kassowitz's law, Clutton's joints, Higoumenaki sign, Argyll-Robertson pupil etc. help in providing easy milieu for remembering. Besides paying tributes to stalwarts in the field, who dedicated their lives for this cause, they also facilitated our current understanding of the great masquerade. PMID:26692628
Vashisht, Deepak; Baveja, Sukriti
Eponym has originated from the Greek word "eponymos" meaning "giving name". It is a tribute to the pioneers in the field who have significantly contributed towards present understanding of the subject. Syphilis has amazed and plagued mankind since eternity. This disease is a great masquerade and can humble best of physicians with its varied presentations. Keen and immaculate observations of these workers have eased our understanding of many signs and phenomenon associated with this disease. This has led to evolution of number of eponyms, perhaps no other disease has as many eponyms associated with it, as does syphilis. Eponyms such as Kassowitz's law, Clutton's joints, Higoumenaki sign, Argyll-Robertson pupil etc. help in providing easy milieu for remembering. Besides paying tributes to stalwarts in the field, who dedicated their lives for this cause, they also facilitated our current understanding of the great masquerade. PMID:26692628
Jindal, Nidhi; Jindal, Pooja; Kumar, Jeevan; Gupta, Sanjeev; Jain, VK
The world of Dermatology is flooded with inflexions among clinical conditions and signs and syndromes; making it interesting, but a tougher subject to remember. Signs and syndromes have always fascinated residents, but simultaneously burdened their minds, as these attractive names are difficult to remember. This work was undertaken to review dermatological conditions and signs based on commonly encountered daily words and objects like animals, etc. Fifty dermatological conditions were found to be based on animal eponyms. For example, the usage of animal terminology in dermatology like leonine facies is present in leprosy, sarcoidosis, mycosis fungoides (MF), and airborne contact dermatitis (ABCD). PMID:25484417
Kutia, S A; Kiselev, V V; Lyashchenko, O I
Eponym--name of the disease, certain structure or method after the person who usually first discovered and described them. Eponyms are widely spread in medicine which appeared to be in the area of a great interest for a lot of scientists. They can serve as a reflection of the evolution of the medical knowledge and making up the majority of anatomical terms. The article describes 12 arterial eponyms of the gastrointestinal tract giving a full anatomical description. It also gives an explanation of why and how those structures were named after certain scientists and what contribution they've made into the development of medicine. PMID:26817114
Somford, Matthijs P; Hoornenborg, Daniël; Wiegerinck, Johannes I; Bolder, Stefan B T; Schreurs, Berend W
After the low friction arthroplasty by John Charnley was no longer confined to specialized hospitals but commonplace in the general orthopedic practice, the issue remained how to most optimally reach the hip. The names of the authors of these approaches remain in a lot of cases connected to the approach. By evaluating the original articles in which the approaches are described we ascertain the original description and technique. By various sources we obtained the (short) biography of the people whose name is connected to the approach. Our research covers the biographies of colleagues Smith-Petersen, Watson-Jones, Hardinge, Charnley, Moore and Ludloff. The eponymous approaches are shown and described after the short biography on each individual. This study shows that without the work of our colleagues we cannot proceed in our profession. An understanding and knowledge of the people who dedicated themselves to developing the orthopedic surgery to the high standard it has today is the least honour we should give them. PMID:27139185
Al Aboud, Ahmad; Al Aboud, Khalid
There are many different eponyms in common use in dermatology today, originating from a variety of countries worldwide. This review discusses a selection of dermatological eponyms that are linked to Japan. PMID:22291476
Vajda, F J E; Davis, S M; Byrne, E
The use of eponyms is controversial. A distinction must be made between those doctors and scientists after whom disorders and syndromes are named in honour of their discoveries, and those whose discoveries were made as a result of maltreatment of defenceless prisoners, utilizing specimens from victims of Nazi extermination policies, and euthanasia victims of racial policies. The second group of scientists should have their names expunged from the historical record, and their deeds brought to the attention of their colleagues. We are not however advocating the abolition of eponyms in general, only tainted ones. PMID:25564271
Man's quest for recognition has not escaped the physician, whose contributions to medicine perpetuate his name in print. It is a final grasp for professional immortality, which for men like Imhotep and Hippocrates, has prevailed for millennia. This fervor was particularly evident in the latter 19th century, which created a flurry of eponyms, often two or more physicians publishing the same clinical observation. This article reviews the eponym epidemic as it relates to lumbar radiculopathy. PMID:6372123
Clinical signs are evolved by clinicians through their careful clinical examination. Medical professionals are generally familiar with these signs because of the emphasis given to them by the teaching faculty while they were students. Some of these signs are eponymously named after the clinicians giving credit to their observation. Eponymous signs in vesiculobullous diseases such as Nikolsky sign and Asboe Hansen sign (Bulla spread sign) are well known and were described during the 19th and 20th century, respectively. Cerebriform tongue in pemphigus vegetans was described by Premalatha (1981) three decades ago and is well recognized and cited in several text books and articles in leading journals. All these signs are revisited below with an emphasis on cerebriform tongue in pemphigus vegetans which could eponymously be called as Premalatha sign. PMID:24470655
The world of dermatology is pieced together by clinical conditions unique in their colors, morphology, and configuration. Dermatological signs and terms are influenced by etymology, language, and history. Eponyms also make dermatology a fascinating but linguistically challenging subject. This article reviews dermatological conditions described in relation to fashion, and what we wear in everyday life from top to toe, demonstrating that dermatology can be inspired even in the most common things. PMID:27057040
The world of dermatology is pieced together by clinical conditions unique in their colors, morphology, and configuration. Dermatological signs and terms are influenced by etymology, language, and history. Eponyms also make dermatology a fascinating but linguistically challenging subject. This article reviews dermatological conditions described in relation to fashion, and what we wear in everyday life from top to toe, demonstrating that dermatology can be inspired even in the most common things. PMID:27057040
Park, W.M.; Hughes, S.P.F.
This book is an account of the principles of modern diagnostic imaging techniques and their applications in orthopedics. The aim is to show radiology as a dynamic subject. Orthopaedic Radiology is divided into two sections with the first part focusing on the principles of diagnostic imaging and interpretation and the second applying this information to practical clinical problems.
Sweet, Frederick; Csapó-Sweet, Rita M
Scientific journals are ethically bound to cite Professor Dr. Carl Clauberg's Nazi medical crimes against humanity whenever the eponym Clauberg is used. Modern articles still publish the eponym citing only the rabbit bioassy used in developing progesterone agonists or antagonists for birth control. Clauberg's Nazi career is traced to his having subjected thousands of Jewish women at the Ravensbruck and Auschwitz-Birkenau death camps to cruel, murderous sterilization experiments that are enthusiastically described by incriminating letters (reproduced here) between him and the notorious Nazi Reichsführer-SS Heinrich Himmler. The experiments were carried out in women's block 10 in Auschwitz-Birkenau where Clauberg's colleague Dr. Josef Mengele worked alongside. After Germany lost World War II in 1945 Mengele fled to South America, where he lived to an old age. Clauberg was caught by Russian soldiers, put on trial in the Soviet Union for his crimes against humanity, and imprisoned in 1948. In 1955 he was repatriated to Germany, once again imprisoned for his crimes, and belatedly expelled from the German Medical Association. To estimate the contemporary usage of the names Mengele and Clauberg, Internet hits were recorded for Clauberg C or Mengele J (with and without adding the term Auschwitz) with the Google and Scirus search engines. The ratios of hits for combinations of these terms reveal that relative to Mengele, Clauberg's name is barely known. We propose that journals and books printing the eponym Clauberg cite its derivation and reference to the convicted Nazi criminal. The present article can serve for such citations. PMID:23393707
Jindal, Nidhi; Jindal, Pooja; Kumar, Jeevan; Gupta, Sanjeev; Jain, VK
Dermatology world is brimming with myriad of interesting clinical conditions, signs and syndromes. It is infinite, which has systemic clinical connotations too. Complicated pronunciations of diagnosis have always placed residents in an intricate state. Each one is trying his best to make this cumbersome subject comparatively more acceptable and convenient. The present paper is an attempt to further simplify the subject by correlating difficult conditions with commonly used and seen things such as fruit and food. A total of 45 dermatological conditions were found to be based on fruit and food eponyms. For example, strawberries can remind us of strawberry gums of Wegener's granulomatosis and strawberry nevus. PMID:25814737
It has been reported that at least 700 anatomical eponyms were in existence at the end of the 19th century, yet the number of eponyms expressly relating to fasciae is unknown, and these anatomical expressions have yet to be described as a group. This study accordingly aimed to assemble a comprehensive-as-possible list of these terms, to investigate their customary usage, and to consider whether their existence might usefully shed light on contemporary fascia-relating terminological development. A search for fascia-relating eponyms incorporated within a range of English language anatomical and medical publications during the past 400 years resulted in the discovery of 44 eponyms that explicitly refer to aspects of fascia. This article outlines and discusses the origin, meaning, and use of these terms, and concludes that an understanding of the history of fascial eponyms may be of value when addressing contemporary concerns with the language used to describe fascia. PMID:26118525
The use of eponyms in medical sciences generally, and in anatomy specifically, remains controversial. In principle, this discussion should have been concluded as far back as 1895 (publication of the first Nomina anatomica): all eponyms should have been removed from the anatomical vocabulary then. In practice, what was believed to be a mere formality proved much more difficult to apply. Most eponyms remain in current use; moreover, their number goes on increasing. Assuming that there's no smoke without fire, we wondered why it seems impossible to get rid of a specific kind of term. The aim of this article and its successor is to weigh up the pros and cons. PMID:24953603
Bunch, Paul M; Zamani, Amir A
Medical eponyms are ubiquitous, numerous, and at times controversial. They are often useful for succinctly conveying complex concepts, and familiarity with eponyms is important for proper usage and appropriate communication. In this historical review, we identify 18 anatomic eponyms used to describe structures of the brain, cerebral vasculature, and calvarium. For each structure, we first offer a biographical sketch of the individual for whom the structure is named. This is followed by a description of the anatomic structure and a brief discussion of its clinical relevance. PMID:26916250
Zegers, Richard H C
From 1977 onwards international appeals have been made to use the descriptive term 'reactive arthritis' instead of the eponym 'Reiter' in medical literature. However, contrary to English publications the Dutch medical literature is not showing any obvious decline in the use of this eponym. As well as the fact that Reiter was not the first to describe the triad of arthritis, urethritis and conjunctivitis, he also was responsible for lethal medical experiments conducted in concentration camps during World War II. Since these two facts do not warrant eponymous regard for Reiter, the author proposes that this eponym no longer should be used in Dutch medical vocabulary and that the descriptive term should be used instead. PMID:25351382
René Leriche accepted the position of President of the Conseil Supérieur de l'Ordre National des médecins, representative institution for the French medical community created by the Vichy government on October 7th 1940. As president of the Conseil Supérieur de l'Ordre National des Médecins until the 28th December 1942, he was responsible for all of the institution's actions of exclusion, repression, spoliation and denunciation of Jewish physicians in France. The question which is now being posed is whether the name Leriche should be dissociated from the two syndromes first described by René Leriche: Leriche's syndrome caused by thrombotic obliteration above or at the bifurcation of the aorta and Sudek-Leriche syndrome due to aseptic necrosis of bone following injury. Actually the René Leriche Prize of the International Society of Surgery is named after him. As Leriche violated principles of confraternity which constitutes a major lack of medical ethical precepts, the question concerning the use of the eponym Leriche's syndrome should be discussed within the scientific community. PMID:17765342
Winkelmann, A; Noack, T
German anatomist Max Clara (1899-1966) described the "Clara cell" of the bronchiolar epithelium in 1937. The present article investigates Clara's relationship with National Socialism, as well as his use of tissue from executed prisoners for research purposes, details about both of which are largely unknown to date. Our methodology for the present study focussed on analysis of material from historical archives and the publications of Clara and his co-workers. Clara was appointed as Chair of Anatomy at Leipzig University (Leipzig, Germany) in 1935. He owed his career, at least in part, to Nazi support. He was an active member of the Nazi party (Nationalsozialistische Deutsche Arbeiterpartei (NSDAP)) and engaged in university politics; this included making anti-Semitic statements about other academics in appointment procedures. Nevertheless, he also supported prosecuted colleagues. Much of Clara's histological research in Leipzig, including his original description of the bronchial epithelium, was based on tissue taken from prisoners executed in nearby Dresden (Germany). Max Clara was an active and outspoken Nazi and his histological research exploited the rising number of executions during the Nazi period. Clara's discovery is thus linked to the Nazi system. The facts given in the present paper invite discussion about the eponym's neglected history and its continued and problematic use in medical terminology. PMID:20223917
Young, Jason David; Gelbs, Jared Craig; Zhu, David Shiyu; Gallacher, Stacey Elisa; Sutton, Karen Michelle; Blaine, Theodore Alton
Background: Despite the common nature of orthopaedic injuries in equestrian sports, there is no published review to specifically characterize orthopaedic injuries in equestrian athletes. Purpose: To characterize orthopaedic injury patterns in equine sports–related injuries and their treatment. Study Design: Systematic review; Level of evidence, 4. Methods: This review was performed through a PubMed, EMBASE, and Scopus query (from 1978 to June 2014) in the English literature using search terms “(equine-related OR equestrian-related OR horse-related OR equestrian OR equestrians) AND (injury OR injuries).” Only full-text studies reporting on orthopaedic injury patterns pertinent to equestrian sports in the United States (US) and the United Kingdom (UK) were included. Orthopaedic injuries were defined as those resulting in a fracture or dislocation. In all, 182 studies were excluded, leaving a total of 27 studies for evaluation. The studies included were analyzed for demographic and epidemiological data for orthopaedic injuries, including fractures and dislocations. Cranial and facial injuries were excluded from analysis. Results: The majority of those injured in the US were female (64.5%). The leading cause of injury in the US was falling from a horse. The use of protective equipment seemed to vary widely, with helmet use ranging from less than 6% up to 66.7%. In the UK, fractures were found to account for 17.4% of reported injures, compared with 33.6% of injuries in the US. The majority of fractures in US riders occurred in the upper extremities (50.7%). Conclusion: This review helps characterize the epidemiology of equestrian injuries based on currently available data. PMID:26535400
Janković, S M; Sokić, D V; Lević, Z M; Susić, V; Drulović, J; Stojsavljević, N; Veskov, R; Ivanus, J
The history of eponyms for epilepsy in the lands of the Eastern globe present the portrait of the attitudes of both the laymen and skilled people towards the disease and patient, as well as to the Nature itself. As opposed to the West which during the Middle ages changed its concepts of epilepsy as the organic brain disease for the sublime 'alchemic' position, the people of the East were more prone to consider from the beginning of their civilization till the XIX century that epilepsy is the consequence of the evanescent spiritual and extracorporal forces which by themselves were out of their reach. As compared to the western civilization, the historical resources are, often as a consequence of a linguistic barriers, more scarce-as consequently is the number of eponyms, but are nevertheless picturesque. The medical science from Babylonian period presumed that epileptic manifestations are the consequence of the demonic or ill spiritual actions. There existed an attitude that at the beginning of an epileptic attack the patient was possessed by a demon (the Akkadic, i.e., Babylonian verb "sibtu" denoting epilepsy, had the meaning "to seize" or "to be obsessed"); at the end of the clonic phase the demon departed from the body. Different demons were responsible for different forms of epilepsy such as nocturnal and children epilepsy, absence epilepsy and pure convulsions, simple and complex automatisms, and gelastic epilepsy. Thus, the doctors from the period of Babylon aside from making primordial classification of epilepsies, knew about their clinical picture (prodromal symptoms and aura, Jackson's epilepsy. Todd's paralysis), postictal phenomena and intericatl emotional instability; provocative factors were also known (sleep deprivation, emotions, as well as alcohol, albeit in a negative sense-as a cure for epilepsy). There is no doubt than in the period of Babylon the clinical picture of serial fits and its progress to status epilepticus were clearly recognized and
Benbassat, Carlos A
Kallmann syndrome is named after Franz Joseph Kallmann, a German-born psychiatrist who described in 1944 twelve subjects from three families who presented with a syndrome of missed puberty, anosmia, and color blindness. Yet, several other eponyms for the same syndrome can be found in the literature. Despite the fact that Kallmann syndrome is the most recognized eponym, very little is known about the man for whom the syndrome is named. A biographical note on Franz Joseph Kallmann and his historical context is presented. PMID:27101217
Benbassat, Carlos A.
Kallmann syndrome is named after Franz Joseph Kallmann, a German-born psychiatrist who described in 1944 twelve subjects from three families who presented with a syndrome of missed puberty, anosmia, and color blindness. Yet, several other eponyms for the same syndrome can be found in the literature. Despite the fact that Kallmann syndrome is the most recognized eponym, very little is known about the man for whom the syndrome is named. A biographical note on Franz Joseph Kallmann and his historical context is presented. PMID:27101217
Over a century after they were removed, at least officially, from anatomical terminology, eponyms remain an obviously controversial topic. In the first part of this paper we acted as their defense counsel, aiming to demonstrate that the 1895 first edition of the Nomina Anatomica and subsequently the Federative Committee on Anatomical Terminology (FCAT) probably put the cart before the horse. However, their authors advanced arguments supporting their decision, and it is now time to develop these arguments. Let us now become the public prosecutor of eponyms. PMID:25067796
In the 1920s, the neurosciences in Germany were world-class. Then came Hitler's regime, and with it 2 distinct changes happened to the research milieus in Berlin and elsewhere. First, the persecution of Jews and others deprived Germany of many of its most outstanding scientists. Second, numerous German and Austrian physicians became active in National Socialist (NS)-euthanasia programs. In recent years, the medical community has become more aware of the ethical burden associated with eponyms derived from scientists of the Third Reich. Yet a list of these eponyms with emphasis on clinical neurology is still missing. This paper therefore reviews 30 neurological eponyms derived from 29 physicians who lived in the Nazi era. Among them are victims who were forced out of the country or murdered in concentration camps, protestors who risked their academic careers and often their lives, beneficiaries who published on brains from 'euthanized' children, and collaborators who were directly involved in the planning and execution of NS-euthanasia programs. PMID:19407456
Tan, S. L. E.
Stereoscopy was used in medicine as long ago as 1898, but has not gained widespread acceptance except for a peak in the 1930's. It retains a use in orthopaedics in the form of Radiostereogrammetrical Analysis (RSA), though this is now done by computer software without using stereopsis. Combining computer assisted stereoscopic displays with both conventional plain films and reconstructed volumetric axial data, we are reassessing the use of stereoscopy in orthopaedics. Applications include use in developing nations or rural settings, erect patients where axial imaging cannot be used, and complex deformity and trauma reconstruction. Extension into orthopaedic endoscopic systems and teaching aids (e.g. operative videos) are further possibilities. The benefits of stereoscopic vision in increased perceived resolution and depth perception can help orthopaedic surgeons achieve more accurate diagnosis and better pre-operative planning. Limitations to currently available stereoscopic displays which need to be addressed prior to widespread acceptance are: availability of hardware and software, loss of resolution, use of glasses, and image "ghosting". Journal publication, the traditional mode of information dissemination in orthopaedics, is also viewed as a hindrance to the acceptance of stereoscopy - it does not deliver the full impact of stereoscopy and "hands-on" demonstrations are needed.
Kondziella, Daniel; Zeidman, Lawrence A
The 1920s were a booming decade for neuroscience, and perhaps nowhere was this truer than in Germany. Following the rise of Hitler's regime and the persecution of Jews and others, however, Germany and Austria lost numerous world-class neuroscientists. Vacant posts were quickly filled with 'Aryan' and academic staff loyal to the Nazis. Indeed, many physicians and scientists went even further and became engaged in National Socialist (NS)-euthanasia programs. In recent years, the medical community has become more aware of the ethical burden associated with eponyms derived from scientists of the Third Reich. This book chapter reviews 53 neurological eponyms derived from physicians who worked in the Nazi era. Among them are victims who were forced out of the country or murdered in concentration camps, protestors who risked their academic careers and often their lives, beneficiaries who published on brains from 'euthanized' children, and collaborators who were directly involved in the planning and execution of NS-euthanasia programs. PMID:27035717
Yan, J.; MacDonald, A.; Baisi, L-P.; Evaniew, N.; Bhandari, M.
Objectives Despite the fact that research fraud and misconduct are under scrutiny in the field of orthopaedic research, little systematic work has been done to uncover and characterise the underlying reasons for academic retractions in this field. The purpose of this study was to determine the rate of retractions and identify the reasons for retracted publications in the orthopaedic literature. Methods Two reviewers independently searched MEDLINE, EMBASE, and the Cochrane Library (1995 to current) using MeSH keyword headings and the ‘retracted’ filter. We also searched an independent website that reports and archives retracted scientific publications (www.retractionwatch.com). Two reviewers independently extracted data including reason for retraction, study type, journal impact factor, and country of origin. Results One hundred and ten retracted studies were included for data extraction. The retracted studies were published in journals with impact factors ranging from 0.000 (discontinued journals) to 13.262. In the 20-year search window, only 25 papers were retracted in the first ten years, with the remaining 85 papers retracted in the most recent decade. The most common reasons for retraction were fraudulent data (29), plagiarism (25) and duplicate publication (20). Retracted articles have been cited up to 165 times (median 6; interquartile range 2 to 19). Conclusion The rate of retractions in the orthopaedic literature is increasing, with the majority of retractions attributed to academic misconduct and fraud. Orthopaedic retractions originate from numerous journals and countries, indicating that misconduct issues are widespread. The results of this study highlight the need to address academic integrity when training the next generation of orthopaedic investigators. Cite this article: J. Yan, A. MacDonald, L-P. Baisi, N. Evaniew, M. Bhandari, M. Ghert. Retractions in orthopaedic research: A systematic review. Bone Joint Res 2016;5:263–268. DOI: 10
Janković, S M; Sokić, D V; Lević, Z M; Susić, V; Stojsavljević, N; Drulović, J
From a historic point of view, epilepsy and its eponyms were in an ontogenetic symbiosis throughout their history. Epilepsy is a disease with a history of eponyms presenting the frame of mind of both streetwise as well as skilled "authors" about its origin and nature. From ancient times the names for epilepsy, archetypal Hippocratic disease, just as rich in number as varied in their implication, reflected the local folkways of thinking. In this article we briefly presented more than 50 eponyms and patrons of epilepsy. As the source of information we used both the apocryphal, canonical and hagiographic as well as heretic literature, legends and iconography from the Middle Ages of domestic and foreign origin. Pre- and post-Hippocratic era, apart from stemming from the oldest written medical sources, point to the position that the disease had organic origin located in the brain. The period of Rome adopted the attitudes set by Galen which remained en vogue throughout the emerging Middle Ages and Renaissance. These eras generated new eponyms which reflected a downfall in the manor, stating that the disease is the consequence of supernatural forces. In the "Age of darkness" eponyms for epilepsy reflected more the relation of men to the Nature than to the disease or a sick man; this is evidenced through the generation of number of patrons for the disease. The most famous patron of patients with epilepsy was St. Valentine (after conversion from pagandom he died in Rome as a martyr, c. 270). He was allotted a patronage either due to the phonic resemblance of his name with the (past participle of the) verb "fallen"-as Martin Luther claimed, or due to a cure of epilepsy of the son of a Roman rhetor who built for him a chapel in which he continued to cure the sick. The emergence of a flamboyant personality of Paracelsus on the historic scene of the XVI century represents a less successful attempt to revoke the way of thinking set by the old Greek doctors; however, it brought
Maniadakis, N; Gray, A
It is becoming widely accepted that research which considers only the outcome and not the costs associated with new technologies in health care, is of limited value in making decisions about the use of scarce resources. Economic evaluation is becoming a standard feature of clinical research but many published economic evaluations fall short of best practice in their methodology. We have described the essential features of economic evaluation, using published studies in orthopaedics, in order to try to improve the ability of orthopaedic surgeons to read, understand and appraise such studies critically, and to encourage them to consider including economic evaluation in future investigations. PMID:10697306
Although the need for orthopaedic shoes is increasing, the number of skilled shoemakers has declined. This has led to the development of a CAD/CAM system to design and fabricate, orthopaedic footwear. The NASA-developed RIM database management system is the central repository for CUSTOMLAST's information storage. Several other modules also comprise the system. The project was initiated by Langley Research Center and Research Triangle Institute in cooperation with the Veterans Administration and the National Institute for Disability and Rehabilitation Research. Later development was done by North Carolina State University and the University of Missouri-Columbia. The software is licensed by both universities.
Teive, Hélio A G; Lima, Plínio M G; Germiniani, Francisco M B; Munhoz, Renato P
The use of eponyms in neurology remains controversial, and important questions have been raised about their appropriateness. Different approaches have been taken, with some eponyms being excluded, others replaced, and new ones being created. An example is Hallervorden-Spatz syndrome, which has been replaced by neurodegeneration with brain iron accuulatium (NBIA). Amiothoplic lateral sclerosys (ALS), for which the eponym is Charcot's disease, has been replaced in the USA by Lou Gehrig's disease. Guillain-Barré syndrome (GBS) is an eponym that is still the subject of controversy, and various different names are associated with it. Finally,restless legs syndrome (RLS), which was for years known as Ekbom's syndrome, has been rechristened as RLS/Willis-Ekbom syndrome. PMID:27191240
Houlden, Henry; Charlton, Paul; Singh, Dishan
Neurology encompasses all aspects of medicine and surgery, but is closer to orthopaedic surgery than many other specialities. Both neurological deficits and bone disorders lead to locomotor system abnormalities, joint complications and limb problems. The main neurological conditions that require the attention of an orthopaedic surgeon are disorders that affect the lower motor neurones. The most common disorders in this group include neuromuscular disorders and traumatic peripheral nerve lesions. Upper motor neurone disorders such as cerebral palsy and stroke are also frequently seen and discussed, as are chronic conditions such as poliomyelitis. The management of these neurological problems is often coordinated in the neurology clinic, and this group, probably more than any other, requires a multidisciplinary team approach. PMID:17308288
Schoch, Peter A; Adair, Lisa
Since 2005, Barwon Health has successfully reformed its orthopaedic outpatient service to address the following issues: increasing number of referrals, inefficient referral management and triage, long waiting times for non-urgent appointments, high 'Did Not Attend' (DNA) rates and poor utilisation of conservative therapies before referral to surgeon. Numerous strategies have been implemented including: waiting list audits, triage guidelines, physiotherapy-led clinics, a DNA policy, an orthopaedic lead nurse role and a patient-focussed booking system. There has been a 66% reduction in the number of patients waiting for their first appointment; an 87% reduction in the waiting time from referral to first appointment; a 10% reduction in new patient DNAs; and more efficient referral management and communication processes. Patients are now seen in clinically appropriate time frames and offered earlier access to a wider range of conservative treatments. PMID:22624648
Kurup, H V; Clark, C I M; Dega, R K
Footwear is the oldest known fashion accessory in use. Footwear is often implicated in orthopaedic problems affecting lower limbs and back. Hence footwear modifications have a major role in management of these pathologies as well. This review explores footwear and its role in causation and management of orthopaedic problems. Based on our observations we recommend that children with flexible flatfeet should be encouraged to walk barefoot to help in developing their arches. Women with risk factors for secondary arthritis of knee or back pain may be advised to avoid heels. Commercial shoes which decrease hind foot loading may be used in symptomatic management of hindfoot and mid foot problems. Similarly shoes which decrease forefoot loading may be useful in managing forefoot pathology. Flip-flops should be avoided by diabetics as they do not protect from injuries. PMID:22443991
Pidgeon, Tyler S; Ramirez, Jose M; Schiller, Jonathan R
Spasticity is a common manifestation of many neurological conditions including multiple sclerosis, stroke, cerebral palsy, traumatic brain injury, and spinal cord injuries. Management of spasticity seeks to reduce its burden on patients and to limit secondary complications. Non-operative interventions including stretching/splinting, postural management, physical therapy/strengthening, anti-spasticity medications, and botulinum toxin injections may help patients with spasticity. Surgical management of these conditions, however, is often necessary to improve quality of life and prevent complications. Orthopaedic surgeons manage numerous sequelae of spasticity, including joint contractures, hip dislocations, scoliosis, and deformed extremities. When combined with the efforts of rehabilitation specialists, neurologists, and physical/occupational therapists, the orthopaedic management of spasticity can help patients maintain and regain function and independence as well as reduce the risk of long-tem complications. PMID:26623452
Navarro, M; Michiardi, A; Castaño, O; Planell, J.A
At present, strong requirements in orthopaedics are still to be met, both in bone and joint substitution and in the repair and regeneration of bone defects. In this framework, tremendous advances in the biomaterials field have been made in the last 50 years where materials intended for biomedical purposes have evolved through three different generations, namely first generation (bioinert materials), second generation (bioactive and biodegradable materials) and third generation (materials designed to stimulate specific responses at the molecular level). In this review, the evolution of different metals, ceramics and polymers most commonly used in orthopaedic applications is discussed, as well as the different approaches used to fulfil the challenges faced by this medical field. PMID:18667387
The first nationwide orthopaedic registry was created in Sweden in 1975 to collect data on total knee arthroplasty (TKA). Since then, several countries have established registries, with varying degrees of success. Managing a registry requires time and money. Factors that contribute to successful registry management include the use of a single identifier for each patient to ensure full traceability of all procedures related to a given implant; a long-term funding source; a contemporary, rapid, Internet-based data collection method; and the collection of exhaustive data, at least for innovative implants. The effects of registries on practice patterns should be evaluated. The high cost of registries raises issues of independence and content ownership. Scandinavian countries have been maintaining orthopaedic registries for nearly four decades (since 1975). The first English-language orthopaedic registry was not created until 1998 (in New Zealand), and both the US and many European countries are still struggling to establish orthopaedic registries. To date, there are 11 registered nationwide registries on total knee and total hip replacement. The data they contain are often consistent, although contradictions occur in some cases due to major variations in cultural and market factors. The future of registries will depend on the willingness of health authorities and healthcare professionals to support the creation and maintenance of these tools. Surgeons feel that registries should serve merely to compare implants. Health authorities, in contrast, have a strong interest in practice patterns and healthcare institution performances. Striking a balance between these objectives should allow advances in registry development in the near future. PMID:25553603
Lu, Dave W; Katz, Kenneth A
The German physician Hans Reiter (1881-1969) is associated eponymously with the syndrome of arthritis, urethritis, and conjunctivitis occurring during or after episodes of diarrhea or urethritis. During World War II, Reiter, a physician leader of the Nazi party, authorized medical experiments on concentration camp prisoners. Because of this, some physicians have argued against further use of the Reiter eponym. We investigated trends in use of the Reiter eponym from 1998 to 2003. We searched MEDLINE to identify English-language articles published between 1998 and 2003. Articles were classified by whether the eponym was used without qualification (ie, without mentioning its disfavored use) or not. Five hundred thirty-nine articles were identified. Use of the eponym without qualification was less common in articles published later (34.0% in 2003 vs 57.0% in 1998; adjusted relative risk [RR], 0.49, 95% confidence interval [CI], 0.27-0.71; P = .001) and in articles published in higher impact journals (36.8% vs 56.8% in journals without calculated impact factors; adjusted RR, 0.51; 95% CI, 0.29-0.73; P = .002). Use without qualification was more common in articles written by US-based authors (60.6% vs 31.1% for European-based authors; adjusted RR, 2.28; 95% CI, 1.58-2.97; P < .001). We concluded that use of the Reiter eponym without qualification decreased from 1998 to 2003. PMID:16198806
Background Globally, injuries cause approximately as many deaths per year as HIV/AIDS, tuberculosis and malaria combined, and 90% of injury deaths occur in low- and middle- income countries. Given not all injuries kill, the disability burden, particularly from orthopaedic injuries, is much higher but is poorly measured at present. The orthopaedic services and orthopaedic medical devices needed to manage the injury burden are frequently unavailable in these countries. Corruption is known to be a major barrier to access of health care, but its effects on access to orthopaedic services is still unknown. Methods A qualitative case study of 45 open-ended interviews was conducted to investigate the access to orthopaedic health services and orthopaedic medical devices in Uganda. Participants included orthopaedic surgeons, related healthcare professionals, industry and government representatives, and patients. Participants’ experiences in accessing orthopaedic medical devices were explored. Thematic analysis was used to analyze and code the transcripts. Results Analysis of the interview data identified poor leadership in government and corruption as major barriers to access of orthopaedic care and orthopaedic medical devices. Corruption was perceived to occur at the worker, hospital and government levels in the forms of misappropriation of funds, theft of equipment, resale of drugs and medical devices, fraud and absenteeism. Other barriers elicited included insufficient health infrastructure and human resources, and high costs of orthopaedic equipment and poverty. Conclusions This study identified perceived corruption as a significant barrier to access of orthopaedic care and orthopaedic medical devices in Uganda. As the burden of injury continues to grow, the need to combat corruption and ensure access to orthopaedic services is imperative. Anti-corruption strategies such as transparency and accountability measures, codes of conduct, whistleblower protection, and higher
Evans, Christopher H.
Orthopaedic injuries are very common and a source of much misery and economic stress. Several relevant tissues, such as cartilage, meniscus and intra-articular ligaments, do not heal. And even bone, which normally regenerates spontaneously, can fail to mend. The regeneration of orthopaedic tissues requires four key components: cells, morphogenetic signals, scaffolds and an appropriate mechanical environment. Although differentiated cells from the tissue in question can be used, most cellular research focuses on the use mesenchymal stem cells (MSCs). These can be retrieved from many different tissues, and one unresolved question is the degree to which the origin of the cells matters. Embryonic and induced, pluripotential stem cells are also under investigation. Morphogenetic signals are most frequently supplied by individual, recombinant growth factors or native mixtures provided by, for instance, platelet-rich plasma; MSCs are also a rich source of trophic factors. Obstacles to the sustained delivery of individual growth factors can be addressed by gene transfer or smart scaffolds, but we still lack detailed, necessary information on which delivery profiles are needed. Scaffolds may be based upon natural products, synthetic materials, or devitalized extracellular matrix. Strategies to combine these components to regenerate tissue can follow traditional tissue engineering practices, but these are costly, cumbersome and not well suited to treating large numbers of individuals. More expeditious approaches make full use of intrinsic biological processes in vivo to avoid the need for ex vivo expansion of autologous cells and multiple procedures. Clinical translation remains a bottleneck. PMID:24182709
The aim of this study is to find out the eponym of the naso-jugal fold and tear trough and to make a suggestion to standardize the terminology.In a PubMed search, the search terms (naso-jugal) and (fold OR groove); (tear trough) and (anatomy) were used, which resulted in 48 and 37 titles, respectively. Eliminating duplicated titles, 80 abstracts were reviewed. Among them, 18 full papers were reviewed. Two papers were excluded and 3 mined papers were added. Finally, 19 papers were reviewed.In a paper published by an ophthalmologist Dr David Miller, "tear trough" was first used for designating the circular trough carved into a scleral contact in 1969. In the remaining 18 papers including 1 conference presentation, 6 terms were used for the same structure; naso-jugal fold (4), naso-jugal groove (4), naso-jugal ditch (1), tear trough (5), tear trough deformity (6), and tear trough depression (1). Whitnall first used "naso-jugal" and 10 other papers stated "naso-jugal." Eight papers cited Whitnall (2), Duke-Elder (2), and Loeb (4) in the origin of the term "naso-jugal." Flowers adapted "tear trough" for the cheek groove and 12 other papers wrote "tear trough." Eleven papers cited Flowers (9), Le Louarn (1), Mendelson (1) when referring to the origin of the term "tear trough."The name of the structure should contain "naso-jugal" rather than "tear trough" because "naso-jugal" was coined earlier and expresses the location of the structure. The recommended term should be "the deepened naso-jugal groove" since it deepens with age. PMID:27315310
Devanathan, D.; Levine, D.
With the increasing demand for superior performance placed on present day orthopaedic devices, there exists a constant demand to look for better materials for construction. Because of their good corrosion resistance, early devices were made from 304 or 316 stainless steels. However, the patient population has broadened to include younger individuals. These patients lead active lives and tend to stress the fracture fixation devices. Another requirement for younger patients is a longer implantable service: up to 20 years. With these requirements in mind, high-performance aerospace metal alloys based on cobalt chromium and titanium are used extensively. This paper discusses the requirements and the deficiencies of new materials; biocompatibility, biofunctionality, and manufacturing costs.
This chapter describes the most important features of capillary electrophoretic equipment. A presentation of the important developments in high voltage power supplies for chip CE is followed by preparation of fused silica capillaries for use in CE. Detection systems that are used in capillary electrophoresis are widely described. Here, UV-Vis absorbance measurements are discussed including different types of detection cells—also those less popular (u-shaped, Z-shaped, mirror-coated). Fluorescence detection and laser-induced fluorescence detection are the most sensitive detection systems. Several LIF setups, such as collinear, orthogonal, confocal, and sheath-flow cuvette, are presented from the point of view of the sensitivity they can provide. Several electrochemical detectors for CE, such as conductivity, amperometric, and potentiometric, are also shown and their constructions discussed. CE-MS and much less known CE (CEC)-NMR systems are also described. The examples of automation and robotized CE systems together with their potential fields of application are also presented.
Sraj, Shafic A
Scant information on healthcare delivery to inmates is available in the medical literature. Healthcare provision to inmates has different rules than that for the general population and presents particular challenges for orthopaedic surgeons because of the nature of this population and restrictions imposed by their confinement. This population is typically of a lower socioeconomic status and is less well educated, has accumulated injuries over a lifetime, and has a considerable prevalence of communicable and blood-borne diseases, along with a high prevalence of smoking and high-risk behavior, such as drug-seeking, abuse, and self-inflicted injury. These variables add levels of complexity of care, including the determination of medical necessity for orthopaedic referral, the logistics of transportation and follow-up, access to durable medical equipment and ancillary services, and the choices the orthopaedic provider must make to optimize care within these limitations. PMID:27479830
Pho, R W; Lim, S Y; Pereira, B P
With the rapid developments in microprocessors, the widespread availability of computers has brought about broad applications in the field of orthopaedics. The present technology enables large quantities of data to be logically processed in a very short span of time. This has led to the development of information management database systems where relevant medical information may be retrieved very quickly and effectively. The analytical power of the computer has also been utilised in expert systems to assist in clinical-decision making process. Computer graphics have revolutionised the visualisation of physical features of internal and external body parts, providing new and improved modalities of diagnosis. In some centres, surgical planning and rehearsals are already being carried out at the computer terminal with the use of animation and computer graphics. Computer technology has also played an active role in the field of prosthetics and rehabilitation. Intelligent robotic systems and microprocessor with functional neuromuscular stimulation have been applied to benefit, and in some cases restore some motor functions to the physically disabled. With more collaboration between engineers, scientists and the medical community, several prototypes of computer-controlled prostheses and prosthesis designed and manufactured by Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) technology are available today to assist the amputees in their daily living and ambulatory activities. PMID:2260826
Althausen, Peter L; Bray, Timothy J; Hill, Austin D
The Reno Orthopaedic Center (ROC) Trauma Fellowship business curriculum is designed to provide the fellow with a graduate level business practicum and research experience. The time commitments in a typical 12-month trauma fellowship are significant, rendering a traditional didactic master's in business administration difficult to complete during this short time. An organized, structured, practical business education can provide the trauma leaders of tomorrow with the knowledge and experience required to effectively navigate the convoluted and constantly changing healthcare system. The underlying principle throughout the curriculum is to provide the fellow with the practical knowledge to participate in cost-efficient improvements in healthcare delivery. Through the ROC Trauma Fellowship business curriculum, the fellow will learn that delivering healthcare in a manner that provides better outcomes for equal or lower costs is not only possible but a professional and ethical responsibility. However, instilling these values without providing actionable knowledge and programs would be insufficient and ineffective. For this reason, the core of the curriculum is based on individual teaching sessions with a wide array of hospital and private practice administrators. In addition, each section is equipped with a suggested reading list to maximize the learning experience. Upon completion of the curriculum, the fellow should be able to: (1) Participate in strategic planning at both the hospital and practice level based on analysis of financial and clinical data, (2) Understand the function of healthcare systems at both a macro and micro level, (3) Possess the knowledge and skills to be strong leaders and effective communicators in the business lexicon of healthcare, (4) Be a partner and innovator in the improvement of the delivery of orthopaedic services, (5) Combine scientific and strategic viewpoints to provide an evidence-based strategy for improving quality of care in a
... AOFAS / FootCareMD / Find a Surgeon Find an Orthopaedic Foot & Ankle Surgeon Page Content The Orthopaedic Distinction Who are Orthopaedic Foot & Ankle Surgeons? Orthopaedic foot and ankle surgeons are ...
Background Manufacturers of implants and materials in the field of orthopaedics use significant amounts of funding to produce informational material to influence the decision-making process of orthopaedic surgeons with regards to choice between novel implants and techniques. It remains unclear how far orthopaedic surgeons are really influenced by the materials supplied by companies or whether other, evidence-based publications have a higher impact on their decision-making. The objective was to evaluate the subjective usefulness and usage of different sources of information upon which orthopaedic surgeons base their decisions when acquiring new implants or techniques. Methods We undertook an online survey of 1174 orthopaedic surgeons worldwide (of whom n = 305 were head of their department). The questionnaire included 34 items. Sequences were randomized to reduce possible bias. Questions were closed or semi-open with single or multiple answers. The usage and relevance of different sources of information when learning about and selecting orthopaedic treatments were evaluated. Orthopaedic surgeons and trainees were targeted, and were only allowed to respond once over a period of two weeks. Baseline information included country of workplace, level of experience and orthopaedic subspecialisation. The results were statistically evaluated. Results Independent scientific proof had the highest influence on decisions for treatment while OEM (Original Equipment Manufacturer) driven activities like newsletters, white papers or workshops had the least impact. Comparison of answers from the three best-represented countries in this study (Germany, UK and USA) showed some significant differences: Scientific literature and congresses are significantly more important in the US than in the UK or Germany, although they are very important in all countries. Conclusions Independent and peer-reviewed sources of information are preferred by surgeons when choosing between methods and
Lang, J E; Mannava, S; Floyd, A J; Goddard, M S; Smith, B P; Mofidi, A; Seyler, T M; Jinnah, R H
Robots have been used in surgery since the late 1980s. Orthopaedic surgery began to incorporate robotic technology in 1992, with the introduction of ROBODOC, for the planning and performance of total hip replacement. The use of robotic systems has subsequently increased, with promising short-term radiological outcomes when compared with traditional orthopaedic procedures. Robotic systems can be classified into two categories: autonomous and haptic (or surgeon-guided). Passive surgery systems, which represent a third type of technology, have also been adopted recently by orthopaedic surgeons. While autonomous systems have fallen out of favour, tactile systems with technological improvements have become widely used. Specifically, the use of tactile and passive robotic systems in unicompartmental knee replacement (UKR) has addressed some of the historical mechanisms of failure of non-robotic UKR. These systems assist with increasing the accuracy of the alignment of the components and produce more consistent ligament balance. Short-term improvements in clinical and radiological outcomes have increased the popularity of robot-assisted UKR. Robot-assisted orthopaedic surgery has the potential for improving surgical outcomes. We discuss the different types of robotic systems available for use in orthopaedics and consider the indication, contraindications and limitations of these technologies. PMID:21969424
Guryel, E; Acton, K; Patel, S
INTRODUCTION Clinical audit plays an important role in the drive to improve the quality of patient care and thus forms a cornerstone of clinical governance. Assurance that the quality of patient care has improved requires completion of the audit cycle. A considerable sum of money and time has been spent establishing audit activity in the UK. Failure to close the loop undermines the effectiveness of the audit process and wastes resources. PATIENTS AND METHODS We analysed the effectiveness of audit in trauma and orthopaedics at a local hospital by comparing audit projects completed over a 6-year period to criteria set out in the NHS National Audit and Governance report. RESULTS Of the 25 audits performed since 1999, half were presented to the relevant parties and only 20% completed the audit cycle. Only two of these were audits against national standards and 28% were not based on any standards at all. Only a third of the audits led by junior doctors resulted in implementation of their action plan compared to 75% implementation for consultant-led and 67% for nurse-led audits. CONCLUSIONS A remarkably large proportion of audits included in this analysis failed to meet accepted criteria for effective audit. Audits completed by junior doctors were found to be the least likely to complete the cycle. This may relate to the lack of continuity in modern medical training and little incentive to complete the cycle. Supervision by permanent medical staff, principally consultants, and involvement of the audit department may play the biggest role in improving implementation of change. PMID:18828963
... education site of the American Orthopaedic Foot & Ankle Society. Patients Visit the official patient education site of the American Orthopaedic Foot & Ankle Society. Patients Visit the official patient education site of ...
Ying, Zhimin; Zhang, Min; Yan, Shigui; Zhu, Zhong
Clostridial myonecrosis is most often seen in settings of trauma, surgery, malignancy, and other underlying immunocompromised conditions. Since 1953 cases of gas gangrene have been reported in orthopaedic patients including open fractures, closed fractures, and orthopaedic surgeries. We present a case of 55-year-old obese woman who developed rapidly progressive gas gangrene in her right leg accompanied by tibial plateau fracture without skin lacerations. She was diagnosed with clostridial myonecrosis and above-the-knee amputation was carried out. This patient made full recovery within three weeks of the initial episode. We identified a total of 50 cases of gas gangrene in orthopaedic patients. Several factors, if available, were analyzed for each case: age, cause of injury, fracture location, pathogen, and outcome. Based on our case report and the literature review, emergency clinicians should be aware of this severe and potentially fatal infectious disease and should not delay treatment or prompt orthopedic surgery consultation. PMID:24288638
Caird, Michelle S
Patients, surgeons, and staff are exposed to ionizing radiation in pediatric orthopaedic surgery from diagnostic studies and imaging associated with procedures. Estimating radiation dose to pediatric patients is based on complex algorithms and dose to surgeons and staff is based on dosimeter monitoring. Surgeons can decrease radiation exposure to patients with careful and thoughtful ordering of diagnostic studies and by minimizing exposure intraoperatively. Surgeon and staff radiation exposure can be minimized with educational programs, proper shielding and positioning intraoperatively, and prudent use of intraoperative imaging. Overall, better awareness among pediatric orthopaedic surgeons of our role in radiation exposure can lead to improvements in radiation safety. PMID:26049299
Tasker, L H; Sparey-Taylor, G J; Nokes, L D M
Nanotechnology is the application of science and engineering at the nanoscale. A diverse range of applications are beginning to emerge in all areas of medicine. We performed a survey from November 2005 to March 2006 using the Internet search engines PubMed, ScienceDirect, ISI Web of Knowledge, and Google Scholar. We report on the role of nanotechnology in orthopaedics, exploring current and potential applications. Nanostructured materials have been proposed as the next generation of orthopaedic implant properties by creating a surface environment more conducive for osteoblast function. Bone substitute materials, whose nanoscale composition emulates the hierarchic organization of natural bone, shows initiation of the desirable formation of an apatite layer. Nanotechnology also has been harnessed to improve the cutting performance and quality of surgical blades. Postoperative infection rates may be reduced by using nanofibrous membrane wound dressings containing antibacterial properties. The most notable application of nanotechnology in orthopaedics may be drug delivery, including nanotherapeutics for treating bone cancer and arthritis. Nanotechnology is being used in orthopaedics, and likely will play a valuable role in future developments. PMID:17224843
This book discusses topics on orthopaedic medicine. Treatments, radiographic findings, and potential complications are provided for the complete scope of musculoskeletal problems. It reviews the latest diagnostic techniques, including arthroscopy and CT scanning and also gives updates on the newest approaches to the management of skeletal infections, the latest on joint replacements, and offers a review of arthroscopic surgery.
Barr, Joseph S; McCaslin, Michael J; Hinds, Cynthia K
The word retirement is going out of fashion. Many orthopaedic surgeons want to work in some capacity when they stop performing surgery. Making a smooth transition from a busy orthopaedic practice to alternative work demands advanced planning. The surgeon must consider personal issues that involve how to use human capital (his or her accumulated knowledge and experience). New ventures, hobbies, travel, and spending time with family and friends are some possibilities. Plans for slowing down or leaving the practice should be discussed and agreed on well ahead of time. Agreements for buyouts may be difficult to work out and will require creative thinking. The solo practitioner can close the practice or hire a successor. Financial planning is perhaps the most important consideration and should be started by approximately age 40. It is recommended that the surgeon develop a portfolio of secure investments and annuities to provide adequate income for as long as is needed and then to turn the residual income to one's family, favorite charities, or other desired cause. A team of competent advisors is needed to help develop and achieve one's goals, create financial security, and provide the discipline to carry out the needed planning for life after orthopaedics. PMID:24720335
Johnson, Anthony E; Gerlinger, Tad L; Born, Christopher T
A disaster is a catastrophic event that disrupts normal infrastructure to such a degree that normal response mechanisms and capabilities cannot manage what is required to respond appropriately to the event. Launched after the largest urban disaster in modern history--the 2010 Haiti Earthquake--the American Academy of Orthopaedic Surgeons/Society of Military Orthopaedic Surgeons/Orthopaedic Trauma Association/Pediatric Orthopaedic Association of North America (AAOS/SOMOS/OTA/POSNA) Disaster Response Course (DRC) is designed to prepare orthopaedic surgeons for service in disaster response and humanitarian assistance efforts in both the acute phases as well as in the recovery and reconstructions phases. To date, 395 orthopaedic surgeons have completed the DRC and 286 (72.4%) have opted to become registered disaster responders. PMID:26356210
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Background Musculoskeletal complaints are probably the most frequent reasons for visiting a doctor. They comprise more than a quarter of the complaints to primary practitioners and are also the most common reason for referral to secondary or tertiary medicine. The clinicians most frequently consulted on musculoskeletal problems, and probably perceived to know most on the topic are orthopaedic surgeons. But in Israel, there is significant ambivalence with various aspects of the consultations provided by orthopaedic surgeons, both among the public and among various groups of clinicians, particularly family practitioners and physiotherapists. Methods In order to understand this problem we integrate new data we have collected with previously published data. New data include the rates of visits to orthopaedic surgeons per annum in one of Israel’s large non-profit HMO’s, and the domains of the visits to an orthopaedic surgeon. Results Orthopaedic surgeons are the third most frequently contracted secondary specialists in one of the Israeli HMO’s. Between 2009 and 2012 there was a 1.7% increase in visits to orthopaedists per annum (P < 0.0001, after correction for population growth). Almost 80% of the domains of the problems presented to an orthopaedic surgeon were in fields orthopaedic surgeons have limited formal training. Discussion While orthopaedic surgeons are clearly the authority on surgical problems of the musculoskeletal system, most musculoskeletal problems are not surgical, and the orthopaedic surgeon often lacks training in these areas which might be termed orthopaedic medicine. Furthermore, in Israel and in many other developed countries there is no accessible medical specialty that studies these problems, trains medical students in the subject and focuses on treating these problems. The neglect of this area which can be called the “Orthopaedic Medicine Lacuna” is responsible for inadequate treatment of non-surgical problems of the
Background Although eponyms are widely used in medicine, they arbitrarily alternate between the possessive and nonpossessive forms. As very little is known regarding extent and distribution of this variation, the present study was planned to assess current use of eponymous term taking "Down syndrome" and "Down's syndrome" as an example. Methods This study was carried out in two phases – first phase in 1998 and second phase in 2008. In the first phase, we manually searched the terms "Down syndrome" and "Down's syndrome" in the indexes of 70 medical books, and 46 medical journals. In second phase, we performed PubMed search with both the terms, followed by text-word search for the same. Results In the first phase, there was an overall tilt towards possessive form – 62(53.4%) "Down's syndrome" versus 54(46.6%) "Down syndrome." However, the American publications preferred the nonpossesive form when compared with their European counterpart (40/50 versus 14/66; P < 0.001). In the second phase, PubMed search showed, compared to "Down syndrome," term "Down's syndrome" yielded approximately 5% more articles. The text-word search of both forms between January 1970 and June 2008 showed a gradual shift from "Down's syndrome" to "Down syndrome," and over the last 20 years, the frequency of the former was approximately halved (33.7% versus 16.5%; P < 0.001). The abstracts having possessive form were mostly published from the European countries, while most American publications used nonpossesive form consistently. Conclusion Inconsistency in the use of medical eponyms remains a major problem in literature search. Because of linguistic simplicity and technical advantages, the nonpossessive form should be used uniformly worldwide. PMID:19272131
Nauth, Aaron; Giles, Erica; Potter, Benjamin K.; Nesti, Leon J.; O’Brien, Frederick P.; Bosse, Michael J.; Anglen, Jeffrey O.; Mehta, Samir; Ahn, Jaimo; Miclau, Theodore; Schemitsch, Emil H.
Heterotopic ossification (HO) can be defined as the pathological formation of bone in extra-skeletal tissues. There has been a substantial amount of recent research on the pathophysiology, prophylaxis and treatment of HO and traumatic conditions associated with the development of HO. This research has advanced our understanding of this disease and helped to clarify evidence-based approaches to both the prophylaxis and treatment of HO. This article reviews the literature on these topics with a focus on their application in orthopaedic trauma. PMID:23010648
Wurth, Gene R; Sherr, Judy H; Coffman, Thomas M
Members of orthopaedic industry commit a significant amount of funds each year to support research and education programs that are directly related to their product(s). In addition, industry supports organizations such as the Orthopaedic Research and Education Foundation. The relationship between the Orthopaedic Research and Education Foundation and industry began in the early 1980s. The support to the Orthopaedic Research and Education Foundation from industry primarily has come in the form of unrestricted grants. These grants best can be looked at as an investment rather than a contribution. This form of giving, once called corporate philanthropy is more accurately referred to as strategic philanthropy. Members of industry make these investments to enhance their reputations, build brand awareness, market their products and services, improve employee morale, increase customer loyalty, and establish strategic alliances. The specialty of orthopaedics is among the leaders in medicine in the amount of funding raised within the specialty for research and education programs. This is because of the amount of support from members of industry and the surgeons. During the past 15 years, 40% of the annual support to the Orthopaedic Research and Education Foundation has come from industry and the balance has come from surgeons and members of lay public. Future industry support of the Orthopaedic Research and Education Foundation and other organizations within the specialty of orthopaedics will be dependent on the continued demonstration of tangible returns in areas described. PMID:12838052
Stirling, Euan R B; Lewis, Thomas L; Ferran, Nicholas A
Changing patterns of health care delivery and the rapid evolution of orthopaedic surgical techniques have made it increasingly difficult for trainees to develop expertise in their craft. Working hour restrictions and a drive towards senior led care demands that proficiency be gained in a shorter period of time whilst requiring a greater skill set than that in the past. The resulting conflict between service provision and training has necessitated the development of alternative methods in order to compensate for the reduction in 'hands-on' experience. Simulation training provides the opportunity to develop surgical skills in a controlled environment whilst minimising risks to patient safety, operating theatre usage and financial expenditure. Many options for simulation exist within orthopaedics from cadaveric or prosthetic models, to arthroscopic simulators, to advanced virtual reality and three-dimensional software tools. There are limitations to this form of training, but it has significant potential for trainees to achieve competence in procedures prior to real-life practice. The evidence for its direct transferability to operating theatre performance is limited but there are clear benefits such as increasing trainee confidence and familiarity with equipment. With progressively improving methods of simulation available, it is likely to become more important in the ongoing and future training and assessment of orthopaedic surgeons. PMID:25523023
Bani-Hani, Kamal E; Bani-Hani, Bayan K
There can be few medical conditions that have been surrounded by as much confusion about their definition or terminology as columnar-lined esophagus (CLE); approximately 30 different terms and eponyms have been used to describe this condition. The history of this condition can be divided into five stages: (i) descriptive stage, 1906-1950; (ii) "argument" stage, 1950-1963; (iii) "significant" stage, 1963-1973; (iv) surveillance stage, 1973-1990; and (v) refined research stage, 1990-present. The use of the eponym "Barrett's" to describe CLE is not justified from a historical point of view. Lining of the lower esophagus by columnar epithelium was termed "Barrett's esophagus" after the presentation by Barrett in 1957. Although this finding has been attributed to Barrett, the work of others, including Tileston, Lortat-Jacob, and Allison and Johnstone, preceded Barrett's description. The historical aspects of CLE were reviewed to show how little Norman Barrett had contributed to the core concept of this condition in comparison to the contributions of other investigators, particularly the contribution of Philip Allison. Based on many discussed historical facts, we are not in favor of retaining the term "Barrett's esophagus" and we propose that CLE be henceforth referred to as "columnar-lined esophagus". PMID:18410605
Buckwalter, Joseph A
Strong traditions of basic research, clinical innovation, teaching and integrating science and evaluation of outcomes into clinical practice have characterized University of Iowa orthopaedics for ninety years. These traditions were brought to Iowa City from Vienna when Iowa City was a town of fewer than 10,000 people in a sparsely populated rural state. In the last third of the 19th century, surgeons at the University of Vienna, led by Theodore Billroth (1829-1894), helped transform the practice of surgery. They developed new more effective procedures, analyzed the results of their operations, promoted the emergence and growth of surgical specialties and sought understanding of tissue structure, physiology and pathophysiology. Their efforts made Vienna one of the world's most respected centers for operative treatment, basic and clinical research and surgical education. Two individuals who followed Billroth, Eduard Albert (1841-1900) and Adolf Lorenz (1854-1946) focused their research and clinical practice on orthopaedics. Their successes in the study and treatment of musculoskeletal disorders led one of their students, Arthur Steindler (1878-1959), a 1902 graduate of the Vienna Medical School, to pursue a career in orthopaedics. Following medical school, he worked in Lorenz's orthopaedic clinic until 1907 when he joined John Ridlon (1852-1936) at the Chicago Home for Crippled Children. In 1910, Steindler became Professor of Orthopaedics at the Drake Medical School in Des Moines, Iowa, and, in 1913, John G. Bowman, the President of the University of Iowa, recruited him to establish an orthopaedic clinical and academic program in Iowa City. For the next third of a century he guided the development of the University of Iowa Orthopaedics Department, helped establish the fields of orthopaedic biomechanics and kinesiology and tirelessly stressed the importance of physiology, pathology and assessment of the outcomes of operations. From the legacy of Billroth, Albert and
Tarantino, Umberto; Buharaja, Rodrigo; Piccirilli, Eleonora; Riccardi, Mariastella; Gasbarra, Elena; Feola, Maurizio; Iolascon, Giovanni
Summary Complex Regional Pain Syndrome (CRPS) describes a diversity of painful conditions following trauma, associated with abnormal regulation of blood flow and sweating, trophic changes, and edema of skin. Epidemiology of this disease is not convincing because of the difficulties and inaccuracies in the diagnosis. Several mechanisms are involved in the genesis of CRPS. The higher incidence of CRPS in women over 65 suggests that some changes involving natural and pathologic processes of aging predispose to onset a CRPS. Many features of the orthopaedic management (surgical time, immobilization, surgical incision, fracture osteosynthesis or prosthetic implants) might influence inflammation status in different way. It is mandatory to improve the understanding of both the pathogenesis of CRPS and the conditions that play a decisive role in its genesis. Furthermore it is important to find some biomarkers that allow early diagnosis before the onset of typical clinical signs. PMID:27134627
Hudak, Pamela L.; Armstrong, Kristy; Braddock, Clarence; Frankel, Richard M.; Levinson, Wendy
Background: As the U.S. population ages, orthopaedic surgeons will increasingly be required to counsel older patients about major surgical procedures. Understanding patient concerns or worries about surgery could help orthopaedic surgeons to assist their patients in making these decisions. The objectives of this study were to explore the nature of patient concerns regarding orthopaedic surgery and to describe how patients raise concerns during visits with orthopaedic surgeons and how orthopaedic surgeons respond. Methods: As part of a study involving audiotaping of 886 visits between patients and orthopaedic surgeons, fifty-nine patients sixty years of age or older who were considering surgery were recruited to participate in semistructured telephone interviews at five to seven days and one month after the visit. Patients were asked about their perceptions of the visit and how they made their decision about surgery. These interviews were analyzed to identify patients' concerns with the use of qualitative content analysis and then compared with the audiotaped visits to determine whether these concerns were actually raised during the visit and, if so, how well the orthopaedic surgeons responded. Analyses based on patient race (black or white) were also performed. Results: One hundred and sixty-four concerns pertaining to (1) the surgery (anticipated quality of life after the surgery, the care facility, the timing of the operation, and the patient's capacity to meet the demands of the surgery) and (2) the surgeons (their competency, communication, and professional practices) were identified. Patients raised only 53% of their concerns with the orthopaedic surgeons and were selective in what they disclosed; concerns about the timing of the operation and about the care facility were frequently raised, but concerns about their capacity to meet the demands of the surgery and about the orthopaedic surgeons were not. Orthopaedic surgeons responded positively to 66% of the
Daniels, Alan H; DePasse, J Mason; Kamal, Robin N
Burnout is a syndrome marked by emotional exhaustion, depersonalization, and low job satisfaction. Rates of burnout in orthopaedic surgeons are higher than those in the general population and many other medical subspecialties. Half of all orthopaedic surgeons show symptoms of burnout, with the highest rates reported in residents and orthopaedic department chairpersons. This syndrome is associated with poor outcomes for surgeons, institutions, and patients. Validated instruments exist to objectively diagnose burnout, although family members and colleagues should be aware of early warning signs and risk factors, such as irritability, withdrawal, and failing relationships at work and home. Emerging evidence indicates that mindfulness-based interventions or educational programs combined with meditation may be effective treatment options. Orthopaedic residency programs, departments, and practices should focus on identifying the signs of burnout and implementing prevention and treatment programs that have been shown to mitigate symptoms. PMID:26885712
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Sharaf, I; Saw, A; Hyzan, Y; Sivananthan, K S
The tsunami which occurred off the west coast of North Sumatra on December 26, 2004 devastated the coastal areas of North Sumatra, South-West Thailand, South-East India and Sri Lanka killing more than a quarter of a million people. The destruction was enormous with many coastal villages destroyed. The other countries affected were Malaysia, Myanmar, Maldives, Bangladesh, Somalia, Kenya, Tanzania and the Seychelles. In January 2005, volunteers went in weekly rotation to Banda Aceh in collaboration with Global Peace Mission. These were Dr Hyzan Yusof, Dr Suryasmi Duski, Dr Sharaf Ibrahim, Dr Saw Aik, Dr Kamariah Nor and Dr Nor Azlin. In Banda Aceh, the surgical procedures that we could do were limited to external fixation of open fractures and debriding infected wounds at the Indonesian Red Crescent field hospital. In February, a team comprising Dato Dr K S Sivananthan, Dr T Kumar and Dr S Vasan spent a week in Sri Lanka. In Sri Lanka, Dato Sivananthan and his team were able to perform elective orthopaedic operations in Dr Poonambalam Memorial Hospital. We appealed for national and international aid and received support from local hospitals and the orthopaedic industry. International aid bound for Banda Aceh arrived in Kuala Lumpur from the Philippine Orthopaedic Association, the Chiba Children's Hospital in Japan and the Chinese Orthopaedic Association. The COA donated 1.5 tons of orthopaedic equipments. A special handing over ceremony from the COA to the Indonesian Orthopaedic Association was held in Putrajaya in March. Malaysia Airlines flew in the donated equipment to Kuala Lumpur while the onward flight to Aceh was provided by the Royal Malaysian Air Force. In April, Dr Saw Aik and Dr Yong Su Mei joined the Tsu-Chi International Medical Association for volunteer services on Batam Island, Indonesia. The MOA acknowledges the many individuals and organizations, both governmental and non-governmental, for their contributions in the humanitarian efforts. PMID
Campbell, Allison A.
During the past century, man-made materials and devices have been developed to the point at which they have been used successfully to replace and/or restore function to diseased or damaged tissues. In the field of orthopaedics, the use of metal implants has significantly improved the quality of life for countless individuals. Critical factors for implant success include proper design, material selection, and biocompatibility. While early research focused on the understanding biomechanical properties of the metal device, recent work has turned toward improving the biological properties of these devices. This has lead to the introduction of calcium phosphate (CaP) bioceramics as a bioactive interface between the bulk metal impart and the surrounding tissue. The first calcium phosphate coatings where produced via vapor phase routes but more recently, there has been the emergence of solution based and biomimetic methods. While each approach has its own intrinsic materials and biological properties, in general CaP coatings have the promise to improve implant biocompatibility and ultimately implant longevity.
Elbeshbeshy, B; Trepman, E
Digital photography has become a practical alternative to film photography for documentation, communication, and education about orthopaedic problems and treatment. Digital cameras may be used to document preoperative and postoperative condition, intraoperative findings, and imaging studies. Digital photographs are captured on the charged coupler device (CCD) of the camera, and processed as digital data. Images may be immediately viewed on the liquid crystal display (LCD) screen of the camera and reshot if necessary. Photographic image files may be stored in the camera in a floppy diskette, CompactFlash card, or SmartMedia card, and transferred to a computer. The images may be manipulated using photo-editing software programs, stored on media such as Zip disks or CD-R discs, printed, and incorporated into digital presentations. The digital photographs may be transmitted to others using electronic mail (e-mail) and Internet web sites. Transparency film slides may be converted to digital format and used in digital presentations. Despite the initial expense to obtain the required hardware, major cost savings in film and processing charges may be realized over time compared with film photography. PMID:11206828
Lim, Hyeung C.; Adie, Sam; Naylor, Justine M.; Harris, Ian A.
We investigated the proportion of orthopaedic procedures supported by evidence from randomised controlled trials comparing operative procedures to a non-operative alternative. Orthopaedic procedures conducted in 2009, 2010 and 2011 across three metropolitan teaching hospitals were identified, grouped and ranked according to frequency. Searches of the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effects (DARE) were performed to identify RCTs evaluating the most commonly performed orthopaedic procedures. Included studies were categorised as “supportive” or “not supportive” of operative treatment. A risk of bias analysis was conducted for included studies using the Cochrane Collaboration's Risk of Bias tool. A total of 9,392 orthopaedic procedures were performed across the index period. 94.6% (8886 procedures) of the total volume, representing the 32 most common operative procedure categories, were used for this analysis. Of the 83 included RCTs, 22.9% (19/83) were classified as supportive of operative intervention. 36.9% (3279/8886) of the total volume of procedures performed were supported by at least one RCT showing surgery to be superior to a non-operative alternative. 19.6% (1743/8886) of the total volume of procedures performed were supported by at least one low risk of bias RCT showing surgery to be superior to a non-operative alternative. The level of RCT support for common orthopaedic procedures compares unfavourably with other fields of medicine. PMID:24927114
OʼHara, Nathan N; OʼBrien, Peter J; Blachut, Piotr A
Uganda, like many low-income countries, has a tremendous volume of orthopaedic trauma injuries. The Uganda Sustainable Trauma Orthopaedic Program (USTOP) is a partnership between the University of British Columbia and Makerere University that was initiated in 2007 to reduce the consequences of neglected orthopaedic trauma in Uganda. USTOP works with local collaborators to build orthopaedic trauma capacity through clinical training, skills workshops, system support, technology development, and research. USTOP has maintained a multidisciplinary approach to training, involving colleagues in anaesthesia, nursing, rehabilitation, and sterile reprocessing. Since the program's inception, the number of trained orthopaedic surgeons practicing in Uganda has more than doubled. Many of these newly trained surgeons provide clinical care in the previously underserved regional hospitals. The program has also worked with collaborators to develop several technologies aimed at reducing the cost of providing orthopaedic care without compromising quality. As orthopaedic trauma capacity in Uganda advances, USTOP strives to continually evolve and provide relevant support to colleagues in Uganda. PMID:26356209
Daniels, Alan H; Ritterman, Scott A; Rubin, Lee E
Paralytic ileus is marked by the cessation of bowel motility. This condition is a major clinical concern that may lead to severe patient morbidity in orthopaedic surgery and trauma patients. Ileus most commonly occurs following spinal surgery, traumatic injury, or lower extremity joint reconstruction, but it may also occur following minor orthopaedic procedures. Possible consequences of ileus include abdominal pain, malnutrition, prolonged hospital stay, hospital readmission, bowel perforation, and death. Therapies used in the treatment of ileus include minimization of opioids, early patient mobilization, pharmacologic intervention, and multidisciplinary care. Orthopaedic surgeons should be aware of the clinical signs and symptoms of paralytic ileus and should understand treatment principles of this relatively common adverse event. PMID:25917235
Brennan, S A; Ní Fhoghlú, C; Devitt, B M; O'Mahony, F J; Brabazon, D; Walsh, A
Implant-associated infection is a major source of morbidity in orthopaedic surgery. There has been extensive research into the development of materials that prevent biofilm formation, and hence, reduce the risk of infection. Silver nanoparticle technology is receiving much interest in the field of orthopaedics for its antimicrobial properties, and the results of studies to date are encouraging. Antimicrobial effects have been seen when silver nanoparticles are used in trauma implants, tumour prostheses, bone cement, and also when combined with hydroxyapatite coatings. Although there are promising results with in vitro and in vivo studies, the number of clinical studies remains small. Future studies will be required to explore further the possible side effects associated with silver nanoparticles, to ensure their use in an effective and biocompatible manner. Here we present a review of the current literature relating to the production of nanosilver for medical use, and its orthopaedic applications. PMID:25922449
Smith, G. L.; Briggs, T. W.; Lavy, C. B.; Nordeen, H.
Modern orthopaedic trauma practice involves increased exposure of the surgeon to ionising radiation. However, there have been no studies to investigate whether the doses received are within limits for non-classified workers. In this study, whole body, eye and extremity, namely hand, doses were measured in six orthopaedic surgeons during trauma cases requiring the use of X-rays in theatre. None of the subjects approached the recommended maximum dose levels for either the whole body, eyes or hands. This finding is reassuring. In orthopaedics, the limiting dose is that to the hands. This differs from previously studied groups, such as radiologists and cardiologists, in whom the limiting factor is the dose to the lens of the eye. Although current precautions appear to be adequate, safe practice in the future will depend on continuing vigilance and repetition of studies similar to this one as techniques and workloads change. PMID:1416705
Mulford, Jonathan; MacKay, N; Babazadeh, S
Objectives: Three dimensional (3D) printing technology has many current and future applications in orthopaedics. The objectives of this article are to review published literature regarding applications of 3D technology in orthopaedic surgery with a focus on knee surgery. Methods: A narrative review of the applications of 3D printing technology in orthopaedic practice was achieved by a search of computerised databases, internet and reviewing references of identified publications. Results: There is current widespread use of 3D printing technology in orthopaedics. 3D technology can be used in education, preoperative planning and custom manufacturing. Custom manufacturing applications include surgical guides, prosthetics and implants. Many future applications exist including biological applications. 3D printed models of anatomy have assisted in the education of patients, students, trainees and surgeons. 3D printed models also assist with surgical planning of complex injuries or unusual anatomy. 3D printed surgical guides may simplify surgery, make surgery precise and reduce operative time. Computer models based on MRI or CT scans are utilised to plan surgery and placement of implants. Complex osteotomies can be performed using 3D printed surgical guides. This can be particularly useful around the knee. A 3D printed guide allows pre osteotomy drill holes for the plate fixation and provides an osteotomy guide to allow precise osteotomy. 3D printed surgical guides for knee replacement are widely available. 3D printing has allowed the emergence of custom implants. Custom implants that are patient specific have been particularly used for complex revision arthroplasty or for very difficult cases with altered anatomy. Future applications are likely to include biological 3D printing of cartilage and bone scaffolds. Conclusion: 3D printing in orthopaedic surgery has and will continue to change orthopaedic practice. Its role is to provide safe, reproducible, reliable models with
Dincyurek, Sibel; Arsan, Nihan; Caglar, Mehmet
Although various studies have been conducted in the field of orthopaedic impairment, research regarding computer education for orthopaedically impaired individuals remains insufficient. This study aimed to evaluate the use of computers by orthopaedically impaired individuals from a wider perspective. The findings of the study emphasise the…
Lippert, Frederick G.; And Others
The course described and evaluated here was developed at the University of Washington School of Medicine to teach 20 orthopaedic residents operative techniques, instrument usage, and safety precautions outside of the operating room without hazard to the patient or regard to time constraints. (JT)
Miller, George E.; And Others
A four year study was initiated to systematically improve the certification procedures of the American Board of Orthopaedic Surgery. Consequently, the immediate research aim was the development of more valid and reliable techniques in assessing professional competence in orthopedics. A definition of professional competence was reached through…
Quick, James Campbell; Sime, Wesley E.; Novicoff, Wendy M.; Einhorn, Thomas A.
Stress, emotional exhaustion, and burnout are widespread in the medical profession in general and in orthopaedic surgery in particular. We attempted to identify variables associated with burnout as assessed by validated instruments. Surveys were sent to 282 leaders from orthopaedic surgery academic departments in the United States by e-mail and mail. Responses were received from 195 leaders for a response rate of 69%. The average surgeon worked 68.3 hours per week and more than ½ of this time was allocated to patient care. Highest stressors included excessive workload, increasing overhead, departmental budget deficits, tenure and promotion, disputes with the dean, and loss of key faculty. Personal-professional life imbalance was identified as an important risk factor for emotional exhaustion. Withdrawal, irritability, and family disagreements are early warning indicators of burnout and emotional exhaustion. Orthopaedic leaders can learn, and potentially model, ways to mitigate stress from other high-stress professions. Building on the strength of marital and family bonds, improving stress management skills and self-regulation, and improving efficiency and productivity can combine to assist the orthopaedic surgery leader in preventing burnout and emotional exhaustion. Electronic supplementary material The online version of this article (doi:10.1007/s11999-008-0622-8) contains supplementary material, which is available to authorized users. PMID:19030943
Kiesau, Carter D; Heim, Kathryn A; Parekh, Selene G
Leadership and business challenges have become increasingly present in the practice of medicine. Orthopaedic residency programs are at the forefront of educating and preparing orthopaedic surgeons. This study attempts to quantify the number of orthopaedic residency programs in the United States that include leadership or business topics in resident education program and to determine which topics are being taught and rate the importance of various leadership characteristics and business topics. A survey was sent to all orthopaedic department chairpersons and residency program directors in the United States via e-mail. The survey responses were collected using a survey collection website. The respondents rated the importance of leadership training for residents as somewhat important. The quality of character, integrity, and honesty received the highest average rating among 19 different qualities of good leaders in orthopaedics. The inclusion of business training in resident education was also rated as somewhat important. The topic of billing and coding received the highest average rating among 14 different orthopaedically relevant business topics. A variety of topics beyond the scope of clinical practice must be included in orthopaedic residency educational curricula. The decreased participation of newly trained orthopaedic surgeons in leadership positions and national and state orthopaedic organizations is concerning for the future of orthopaedic surgery. Increased inclusion of leadership and business training in resident education is important to better prepare trainees for the future. PMID:21838073
Tait, Mark Adam; Petrus, Cara; Barnes, C Lowry
The purpose of this study was to determine the publication rate of manuscripts presented at the Southern Orthopaedic Association's (SOA) annual meetings. An extensive literature search was performed using Google Scholar and PubMed search engines and all accepted abstracts (posters or podium presentations) presented at an SOA annual meeting from 2005 to 2011 were evaluated. A total of 568 abstracts were presented at SOA meetings between 2005 and 2011. Of these, 234 (41%) were published in the peer-reviewed literature. The publication rate was 66% in 2005 and 28% in 2010. The average time from presentation to peer-reviewed publication was 1.6 ± 0.24 years (range, 2 years in 2006 to 1 year in 2011). The SOA publication rate was comparable with other major orthopaedic conference publication rates, yet more than half of all abstracts remain unpublished. SOA attendees should be aware that approximately 40% of all accepted presentations will go unpublished. PMID:27518291
ten Have, Isha A; van den Bekerom, Michel PJ; van Deurzen, Derek FP; Hageman, Michel GJS
Medical treatment of patients inherently entails the risk of undesired complication or side effects. It is essential to inform the patient about the expected outcomes, but also the possible undesired outcomes. The patients preference and values regarding the potential outcomes should be involved in the decision making process. Even though many orthopaedic surgeons are positive towards shared decision-making, it is minimally introduced in the orthopaedic daily practice and decision-making is still mostly physician based. Decision aids are designed to support the physician and patient in the shared- decision-making process. By using decision aids, patients can learn more about their condition and treatment options in advance to the decision-making. This will reduce decisional conflict and improve participation and satisfaction. PMID:26716082
Mauffrey, Cyril; Scarlat, Marius M; Pećina, Marko
Once the privilege of few clinical scholars in the field of orthopaedics, medical writing has become a must for career advancement. The number of papers submitted and published yearly has increased steadily, and with the development of the Internet, manuscript and journals have become easily accessible. Medical writing has risen to become a discipline in itself, with rules and standards. However, heterogeneity in the quality of papers submitted still prevails, with large variations in both form and content. With countries such as China and India submitting an exponential number of manuscripts, it is important and helpful that standards of medical writing be emphasised to help writers who do not always have the required support to produce an outstanding manuscript. In this paper, we summarise what may become standards for medical writing in the field of orthopaedics. PMID:24297610
Evans, C.H.; Ghivizzani, S.C.; Robbins, P.D.
Orthopaedic gene therapy has been the topic of considerable research for two decades. The preclinical data are impressive and many orthopaedic conditions are well suited to genetic therapies. But there have been few clinical trials and no FDA-approved product exists. This paper examines why this is so. The reasons are multifactorial. Clinical translation is expensive and difficult to fund by traditional academic routes. Because gene therapy is viewed as unsafe and risky, it does not attract major funding from the pharmaceutical industry. Start-up companies are burdened by the complex intellectual property environment and difficulties in dealing with the technology transfer offices of major universities. Successful translation requires close interactions between scientists, clinicians and experts in regulatory and compliance issues. It is difficult to create such a favourable translational environment. Other promising fields of biological therapy have contemplated similar frustrations approximately 20 years after their founding, so there seem to be more general constraints on translation that are difficult to define. Gene therapy has noted some major clinical successes in recent years, and a sense of optimism is returning to the field. We hope that orthopaedic applications will benefit collaterally from this upswing and move expeditiously into advanced clinical trials. PMID:21948071
Hansen, Erik; Bozic, Kevin J
The US healthcare system is currently facing daunting demographic and economic challenges. Because musculoskeletal disorders and disease represent a substantial and growing portion of this healthcare burden, novel approaches will be needed to continue to provide high-quality, affordable, and accessible orthopaedic care to our population. The concept of "disruptive innovations," which has been studied and popularized by Harvard Business School Professor Clayton Christensen, may offer a potential framework for developing strategies to improve quality and control costs associated with musculoskeletal care. The introduction of mobile fluoroscopic imaging systems, the development of the Surgical Implant Generation Network intramedullary nail for treatment of long bone fractures in the developing world, the expanding role and contributions of physician assistants and nurse practitioners to the orthopaedic team, and the rise of ambulatory surgery centers are all examples of disruptive innovations in the field of orthopaedics. Although numerous cultural and regulatory barriers have limited the widespread adoption of these "disruptive innovations," we believe they represent an opportunity for clinicians to regain leadership in health care while at the same time improving quality and access to care for patients with musculoskeletal disease. PMID:19415405
Issar, Neil M; Jahangir, A Alex
The Affordable Care Act has resulted in a dramatic governmental restructuring of the healthcare insurance market and delivery system. Orthopaedic traumatologists must be aware of the law's impact on their clinical practice, finances, and overall business model. This includes the effect of accountable care organizations, the Independent Payment Advisory Board, and the Physician Value-Based Payment Modifier program, as well as the impact of the Affordable Care Act's grace period provision, medical device excise tax, and cuts to funding for the Disproportionate Share Hospital program. PMID:25229683
CATLEDGE, S.A.; THOMAS, V.; VOHRA, Y.K.
With increasing numbers of orthopaedic devices being implanted, greater emphasis is being placed on ceramic coating technology to reduce friction and wear in mating total joint replacement components, in order to improve implant function and increase device lifespan. In this chapter, we consider ultra-hard carbon coatings, with emphasis on nanostructured diamond, as alternative bearing surfaces for metallic components. Such coatings have great potential for use in biomedical implants as a result of their extreme hardness, wear resistance, low friction and biocompatibility. These ultra-hard carbon coatings can be deposited by several techniques resulting in a wide variety of structures and properties. PMID:25285213
Tintle, Scott M; Levin, L Scott
Since the advent of the operating microscope by Julius Jacobson in 1960, reconstructive microsurgery has become an integral part of extremity reconstruction and orthopaedics. During World War I, with the influx of severe extremity trauma Harold Gillies introduced the concept of the reconstructive ladder for wound closure. The concept of the reconstructive ladder goes from simple to complex means of attaining wound closure. Over the last half century microsurgery has continued to evolve and progress. We now have a microsurgical reconstructive ladder. The microsurgical reconstruction ladder is based upon the early work on revascularization and replantation extending through the procedures that are described in this article. PMID:23352571
Richardson, Dean W
Complications are a price all surgeons eventually pay. Experience and increasing skill will decrease many of them but certainly not all. The most important thing is for the surgeon to react correctly to a complication. Acknowledge the mistake (or bad luck) quickly and take whatever steps you can to correct the problem. Because so many equine orthopaedic cases have the potential for complications, recognizing and responding properly to these complications are imperative for successful outcomes. Discussion of the most common complications, their prevention and corrections, is presented. PMID:19203703
Afolaranmi, G.A.; Tettey, J; Meek, R.M.D; Grant, M.H
Many orthopaedic implants are composed of alloys containing chromium. Of particular relevance is the increasing number of Cobalt Chromium bearing arthroplasies being inserted into young patients with osteoarthritis. Such implants will release chromium ions. These patients will be exposed to the released chromium for over 50 years in some cases. The subsequent chromium ion metabolism and redistribution in fluid and tissue compartments is complex. In addition, the potential biological effects of chromium are also controversial, including DNA and chromosomal damage, reduction in CD8 lymphocyte levels and possible hypersensitivity reactions (ALVAL). The establishment of these issues and the measurement of chromium in biological fluids is the subject of this review. PMID:19461924
Wang, W; Lee, E H; Wong, H K
The Department of Orthopaedic Surgery at the University of Malaya (in Singapore) was established in 1952. Prior to this, the teaching of Orthopaedic Surgery at the University was undertaken by the Department of Surgery under the Professor of Surgery and Professor of Clinical Surgery. From a course consisting of 15 weekly classes on fractures for 18 undergraduates in the late 1930s, and the clinical postings in orthopaedic surgery for over 40 students in 1952, the programme now encompasses an exposure to musculoskeletal diseases and trauma in all 5 years of the undergraduate course. Over this time, the spectrum of clinical conditions has also changed, and with it the emphasis on the conditions to be taught; from that dealing primarily with tuberculosis of bones and joints, poliomyelitis, and childhood deformity, to those resulting from degenerative disorders, sports injuries, industrial and motor vehicle accidents, and cancer. The students are now taught orthopaedic surgery in all the major public hospitals. Local postgraduate training programmes for orthopaedic surgery started in the 1980s. From 1993, a more structured training and assessment programme was introduced for basic and advanced training in surgery and orthopaedics. Advanced trainees rotate through the various teaching hospitals to expose them to a wider range of orthopaedic problems as well as teachers. The postgraduate training programme is now well established, and Singapore is accredited by the Royal College of Surgeons of Edinburgh as an orthopaedic training centre for higher surgical training. PMID:16010393
Yagmurlu, Bilge; Yavuz, H. Melis
The aim of the study was to investigate social competence in children with orthopaedic disability and its concurrent relations to child's temperament, health condition, and maternal warmth. Participants were 68 Turkish children (mean = 5.94 years) with chronic orthopaedic disability and their mothers coming from disadvantaged backgrounds.…
Poenaru, Dan V
The historical and geographical territory of Banat is part of present-day Romania. Timisoara's history, the capital city of Banat region, dates back to the second century B.C. Medical life in Banat was re-organised after the promulgation of the Aulic Laws in the eighteenth century. Thorough research was undertaken through historic manuscripts, old newspapers, biographies and other papers about the history of Romanian medicine. The eighteenth century witnessed the building of three hospitals in Timisoara. In that period, Banat region benefited from the expertise and professionalism of doctors who graduated and were trained mainly in Central and Western European universities. By the beginning of the twentieth century, many medical clinics or sanatoriums specialising in orthopaedics and traumatology were offering their services to the population. Banat region had many good orthopaedists, and one of them was Prof. Dr. Doc. Berceanu, who graduated from the University of Medicine Bucharest and further specialised in Paris, France. He is the founder of the Orthopaedics and Traumatology Clinic in Timisoara. PMID:26227921
Fetrow, K O
The three general methods of treating pain are pharmacologic, physical and psychological. The goal of medical management of the patient with pain and inflammation is to relieve these symptoms with minimal side effects and inconvenience. Pain associated with inflammation may be relieved with nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin. All NSAIDs relieve pain and stiffness in a similar manner; their primary action appears to be the inhibition of the cyclo-oxygenase system in the arachidonic acid cascade. When prescribing NSAIDs for orthopaedic pain and inflammation, it seems sensible to start with aspirin because of its low cost and safety at analgesic doses. However, if safety and low incidence of side effects are the most important factors in determining appropriate therapy, newer NSAIDs such as ketoprofen will be preferred. The relief of pain is an important aspect of postoperative care. Parenteral and oral opiates serve as the standard against which other therapies for severe pain are compared. When pain cannot be adequately controlled with intramuscular or subcutaneous opiates, intravenous opiates controlled by the patient (patient-controlled analgesia) are often useful. Relatively small doses of epidural or intrathecal opiates can also be used to achieve postoperative pain relief. Thus, treatment for orthopaedic pain begins with NSAIDs, followed by an oral opiate combined with acetaminophen, aspirin, or another NSAID. If these regimens are ineffective, oral opiates followed by parenteral opiates may be tried. PMID:2520438
Hickok, Noreen J; Shapiro, Irving M
Many surgical procedures require the placement of an inert or tissue-derived implant deep within the body cavity. While the majority of these implants do not become colonized by bacteria, a small percentage develops a biofilm layer that harbors invasive microorganisms. In orthopaedic surgery, unresolved periprosthetic infections can lead to implant loosening, arthrodeses, amputations and sometimes death. The focus of this review is to describe development of an implant in which an antibiotic tethered to the metal surface is used to prevent bacterial colonization and biofilm formation. Building on well-established chemical syntheses, studies show that antibiotics can be linked to titanium through a self-assembled monolayer of siloxy amines. The stable metal-antibiotic construct resists bacterial colonization and biofilm formation while remaining amenable to osteoblastic cell adhesion and maturation. In an animal model, the antibiotic modified implant resists challenges by bacteria that are commonly present in periprosthetic infections. While the long-term efficacy and stability is still to be established, ongoing studies support the view that this novel type of bioactive surface has a real potential to mitigate or prevent the devastating consequences of orthopaedic infection. PMID:22512927
Background Various procedures, especially minimal invasive techniques using fluoroscopy, pose a risk of radiation exposure to orthopaedic staff. Anatomical sites such as the eyes, thyroid glands and hands are more vulnerable to radiation considering the limited use of personal protective devices in the workplace. The objective of the study is to assess the annual mean cumulative and per procedure radiation dose received at anatomical locations like eyes, thyroid glands and hands in orthopaedic staff using systematic review. Methods The review of literature was conducted using systematic search of the database sources like PUBMED and EMBASE using appropriate keywords. The eligibility criteria and the data extraction of literature were based on study design (cohort or cross-sectional study), study population (orthopaedic surgeons or their assistants), exposure (doses of workplace radiation exposure at hands/fingers, eye/forehead, neck/thyroid), language (German and English). The literature search was conducted using a PRISMA checklist and flow chart. Results Forty-two articles were found eligible and included for the review. The results show that radiation doses for the anatomical locations of eye, thyroid gland and hands were lower than the dose levels recommended. But there is a considerable variation of radiation dose received at all three anatomical locations mainly due to different situations including procedures (open and minimally invasive), work experience (junior and senior surgeons),distance from the primary and secondary radiation, and use of personal protective equipments (PPEs). The surgeons receive higher radiation dose during minimally invasive procedures compared to open procedures. Junior surgeons are at higher risk of radiation exposure compared to seniors. PPEs play a significant role in reduction of radiation dose. Conclusions Although the current radiation precautions appear to be adequate based on the low dose radiation, more in-depth studies
Wallace, D J; Weisman, M
The combination of arthritis, urethritis, conjunctivitis, often associated with a psoriasiform rash has been termed Reiter's syndrome, particularly if the patient is HLA-B27 positive. In this report, the history of "Reiter's syndrome" is investigated by reviewing descriptions of the syndrome and the life and times of Hans Reiter from source materials and recent publications that shed new light on medicine and clinical research in the Nazi regime. The description of the syndrome clearly antedates Reiter's work by several hundred years. Numerous other investigators accurately described a reactive cutaneo-arthropathy before Reiter. Hans Reiter gave his imprimatur to some of the most horrific experiments conducted on concentration camp internees during World War II. We conclude that Reiter does not deserve eponymous distinction. The disorder should be renamed "reactive cutaneo-arthropathy," or a "reactive arthritis" syndrome. PMID:19078450
Woo, Savio L-Y
Biomechanics is a field that has a very long history. It was described in ancient Chinese and Greek literature as early as 400-500 BC. The foundation of biomechanics, however, was laid during a period between the 1500's to 1700's by renowned personalities, da Vinci, Galileo, Borelli, Hooke, Newton, and so (Fung, Y.C., Biomechanics: Mechanical Properties of Living Tissues, 2nd Ed. Springer Verlag, Chapter 1, 1993). Beginning in the 1950's, Muybridge, Steindler, Inman, Lissner, and Hirsch performed the pioneering work on musculoskeletal biomechanics and the foundation of orthopaedic biomechanics was formed. For the following two decades, the field has blossomed and significant contributions in the biomechanics of bone, articular cartilage, soft tissues, upper and lower extremities, spine and so on has been made. More sophisticated equipment, coupled with mathematical modeling and better engineering design, has enabled us to make great strides. Bioengineers, in collaboration with orthopaedic surgeons, have translated many laboratory discoveries into clinical practice, leading to improved patient treatment and outcome. In the past 30 years, my colleagues and I have focused our research on the biomechanics of musculoskeletal soft tissues, ligaments and tendons, in particular. Therefore, in this lecture, the function of knee ligaments, the associated homeostatic responses secondary to immobilization and exercise, and healing of the ligaments will be reviewed. Examples of scientific findings that help to guide the surgical management of injury to ligaments will be given. New ideas on functional tissue engineering to improve the healing of knee ligaments and tendons will be presented. We have learned that tendons and ligaments are indeed complex biological tissues. To fully understand their behavior, healing and remodelling processes, this author advocates major efforts be made to bring molecular biologists, morphologists, biochemists, bioengineers, physical therapists and
Romanova, K; Vassileva, J; Alyakov, M
The aim of the present study was to assess the radiation dose to the eye lens of orthopaedic surgeons during various orthopaedic procedures and to make efforts to ensure that radiation protection is optimised. The study was performed for Fractura femoris and Fractura cruris procedures performed in orthopaedic operating theatres, as well as for fractures of wrist, ankle and hand/shoulder performed in the emergency trauma room. The highest mean value of the eye lens dose of 47.2 μSv and higher mean fluoroscopy time of 3 min, as well as the corresponding highest maximum values of 77.1 μSv and 5.0 min were observed for the Fractura femoris procedure performed with the Biplanar 500e fluoroscopy systems. At a normal workload, the estimated mean annual dose values do not exceed the annual occupational dose limit for the lens of eye, but at a heavy workload in the department, this dose limit could be achieved or exceeded. The use of protective lead glasses is recommended as they could reduce the radiation exposure of the lens of the eye. The phantom measurements demonstrated that the use of half-dose mode could additionally reduce dose to the operator's eye lens. PMID:25944961
Ponnusamy, Karthikeyan E; Kim, Thomas J; Khanuja, Harpal S
Blood transfusion after orthopaedic surgery accounts for 10% of all packed red blood-cell transfusions, but use varies substantially across hospitals and surgeons. Transfusions can cause systemic complications, including allergic reactions, transfusion-related acute lung injury, transfusion-associated circulatory overload, graft-versus-host disease, and infections. Tranexamic acid is a new cost-effective blood management tool to reduce blood loss and decrease the risk of transfusion after total joint arthroplasty. Current clinical evidence does not justify transfusions for a hemoglobin level of >8 g/dL in the absence of symptoms. Studies have also supported the use of this trigger in patients with a history or risk of cardiovascular disease. PMID:25378512
Pigeon behavioural conditioning methods are similar to the processes that orthopaedic surgeons use to evaluate new surgical procedures. Alternatively, evidence-based orthopaedics is a tool for surgeons to evaluate procedures in a systematic, patient-centred way that is less instinctive than pigeon behaviour. The objective of this article is to describe evidence-based orthopaedics, and then propose changes to surgical culture with the aim of refining the interpretation of the current literature and improving the quality of future research. The proposals are 'institutional' changes rather than calls for increased funding and more randomised controlled trials. PMID:19750292
Beall, McPherson S; Beall, M Scott; Greenfield, Mary Lou VH; Biermann, J Sybil
This study evaluated Internet use among orthopaedic patients in a private practice general orthopaedic setting. Of 154 respondents, twenty percent had used the Internet to research their orthopaedic diagnosis. Search rates were lowest for patients with arthritis and highest for patients with disorders of the spine or back. Seventy percent of these patients who had searched had found their searches helpful, and over 50% of patients who had searched had questions raised that they planned to address with their physicians. Of those patients who did search the Internet, none reported concern regarding the credibility of Internet retrieved material. PMID:12180601
Boulay, C; Finidori, G
Although the clinical picture and the natural progression of Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) differ, borderline forms exist. Classical orthopaedic treatment is based on self-rehabilitation (by the parents and the patient), physical therapy, posture alignment with orthotics, ergotherapy to set up technical aides, notably positioning in an electric wheelchair to provide more satisfactory autonomy. The functional aspect predominates over pure orthopaedics. Although surgical indications have evolved for the lower limbs, pelvic-spinal arthrodesis for treatment of scoliosis remains the reference treatment, but the methods have evolved since the advent of corticotherapy for DMD. Corticotherapy slows the progression of motor deficits, the age at which walking ability is lost is delayed (shifting from 10 years to 13-14 years depending on the studies), scoliosis progresses later, respiratory insufficiency is better controlled, and therefore survival is prolonged (between 20 and 40 years). However, although this functional aspect seems to respond better to the progress in overall treatment, it also results from a multidisciplinary approach to the disease. Nevertheless, assessment is required, not at a time t as reflected by the scales currently in use, but during daily activities as proposed by qualitative and quantitative monitoring seeking to model nyctohemeral functional motor skills. The principle is to characterize the type of activity (sitting, standing, lying down, walking), its duration, its intensity (walking speed), its frequency (number of activity changes, number of walking episodes), and their sequence (temporal sequence, organization of activity variation). The goal is to identify the variety of functional motor skills and their occurrence over time to determine whether treatment contributes a functional benefit and whether this benefit is put into practice daily. PMID:26773586
It has been hypothesised that AM is ideal for patient specific orthopaedic implants such as those used in bone cancer treatment, that can rapidly build structures such as lattices for bone and tissues to in-grow, that would be impossible using current conventional subtractive manufacturing techniques. The aim of this study was to describe the adoption of AM (direct metal laser sintering and electron beam melting) into the design manufacturing and post-manufacturing processes and the early clinical use. Prior to the clinical use of AM implants, extensive metallurgical and mechanical testing of both laser and electron beam fabrications were undertaken. Concurrently, post-manufacturing processes evaluated included hipping, cleaning and coating treatments. The first clinical application of a titanium alloy mega-implant was undertaken in November 2010. A 3D model of the pelvic wing implant was designed from CT scans. Novel key features included extensive lattice structures at the bone interfaces and integral flanges to fix the implant to the bone. The pelvic device was implanted with the aid of navigation and to date the patient remains active. A further 18 patient specific mega-implants have now been implanted. The early use of this advanced manufacturing route for patient specific implants has been very encouraging enabling the engineer to produce more advanced and anatomical conforming implants. However, there are a new set of design, manufacturing and regulatory challenges that require addressing to permit this technique to be used more widely. This technology is changing the design and manufacturing paradigm for the fabrication of specialised orthopaedic implants.
Wadey, V M R; Dev, P; Buckley, R; Walker, D; Hedden, D
We have developed a list of 281 competencies deemed to be of importance in the training of orthopaedic surgeons. A stratified, randomised selection of non-university orthopaedic surgeons rated each individual item on a scale 1 to 4 of increasing importance. Summary statistics across all respondents were given. The mean scores and sds were computed. Secondary analyses were computed in general orthopaedics, paediatrics, trauma and adult reconstruction. Of the 156 orthopaedic surgeons approached 131 (84%) responded to the questionnaire. They rated 240 of the 281 items greater than 3.0 suggesting that competence in these was necessary by completion of training. Complex procedures were rated to be less important. The structure, delivery and implementation of the curriculum needs further study. Learning activities are 'driven' by the evaluation of competencies and thus competency-based learning may soon be in the forefront of training programmes. PMID:19949127
Goodman, Stuart B.; Yao, Zhenyu; Keeney, Michael; Yang, Fan
Implants are widely used for othopaedic applications such as fixing fractures, repairing nonunions, obtaining a joint arthrodesis, total joint arthroplasty, spinal reconstruction, and soft tissue anchorage. Previously, orthopaedic implants were designed simply as mechanical devices; the biological aspects of the implant were a byproduct of stable internal/external fixation of the device to the surrounding bone or soft tissue. More recently, biologic coatings have been incorporated into orthopaedic implants in order to modulate the surrounding biological environment. This opinion article reviews current and potential future use of biologic coatings for orthopaedic implants to facilitate osseointegration and mitigate possible adverse tissue responses including the foreign body reaction and implant infection. While many of these coatings are still in the preclinical testing stage, bioengineers, material scientists and surgeons continue to explore surface coatings as a means of improving clinical outcome of patients undergoing orthopaedic surgery. PMID:23391496
Kozin, Scott H; Zlotolow, Dan A; Ratner, Joshua A
There is an overlap between pediatric orthopaedic surgery and hand surgery. A pediatric orthopaedic surgeon is accustomed to the intricacies of the immature skeleton, whereas a hand surgeon is more familiar with the regional anatomy and finer surgical techniques. Many hand diagnoses and surgical techniques are appropriate for the pediatric orthopaedic surgeon, including straightforward duplicated thumb reconstruction of a trigger thumb. Many pediatric diagnoses are more suitable for treatment by a hand surgeon, including simple syndactyly release and complex duplicated thumb reconstruction. Other procedures, such as pollicization, cleft hand reconstruction, synpolydactyly release, and macrodactyly management, require more advanced expertise for successful treatment. It is helpful for pediatric orthopaedic surgeons and hand surgeons to be familiar with the indications, surgical techniques, outcomes, and complications of pediatric hand surgery. PMID:24720302
Downes, Jessica; Rauk, Philip N; Vanheest, Ann E
Pregnant or lactating staff working in the orthopaedic operating room may be at risk of occupational exposure to several hazards, including blood-borne pathogens, anesthetic gases, methylmethacrylate, physical stress, and radiation. Because the use of proper personal protective equipment is mandatory, the risk of contamination with blood-borne pathogens such as hepatitis B, hepatitis C, and HIV is low. Moreover, effective postexposure prophylactic regimens are available for hepatitis B and HIV. In the 1960s, concerns were raised about occupational exposure to harmful chemicals in the operating room such as anesthetic gases and methylmethacrylate. Guidelines on safe levels of exposure to these chemicals and the use of personal protective equipment have helped to minimize the risks to pregnant or lactating staff. Short periods of moderate physical activity are beneficial for pregnant women, but prolonged strenuous activity can lead to increased pregnancy complications. The risk of prenatal radiation exposure during orthopaedic procedures is of concern, as well. However, proper lead protection and contamination control can minimize the risk of occupational exposure to radiation. PMID:24788448
Patel, Alpesh A; Cheng, Ivan; Yao, Jeffrey; Huffman, G Russell
We started this journey excited by the prospects of visiting Japan, a country with a proud and historic past. We ended the fellowship accomplishing those goals, and we left with a great deal of admiration for our orthopaedic colleagues halfway around the world for their excellence in education, clinical care, and research. Their hospitality and attention to the details of our visit were exemplary and a lesson to us as we host visiting fellows in the future. Japan reflects its past, but it also offers a preview into our own nation's future: an aging population, a shrinking workforce, a stagnant economy, nationalized health care, and a mushrooming national debt. Of all of these factors, it is the aging population that we, as orthopaedic surgeons, will be most acutely aware of and involved with. The degenerative disorders that affect elderly patients dominate the landscape of surgical care in Japan. Osteoporosis and osteopenia permeate many aspects of care across orthopaedic subspecialties. The surgeons in Japan are developing innovative and cost-effective means of treating the large volume of older patients within the fiscal constraints of a nationalized health-care system. We learned, and will continue to learn more, from Japan about the management of this growing patient population with its unique pathologies and challenges. With the recent natural disaster and ongoing safety concerns in Japan, the character and will of the people of Japan have been on display. Their courage and resolve combined with order and compassion are a testament to the nation's cultural identity. The seeds of the Traveling Fellowship were planted shortly after Japan's last wide-scale reconstruction, and the ties that have bound the JOA and the AOA together are strengthened through this trying time. We strongly urge our colleagues in the U.S. to help support the people, the physicians, and the health-care system of Japan through its most recent tribulations and offer them the same care and
Pretell-Mazzini, Juan; Subhawong, Ty; Hernandez, Victor H; Campo, Rafael
➤Advances in combined antiretroviral therapy (cART) in recent years have transformed HIV infection into a chronic disease when treatment is available, increasing a patient's life expectancy and the chances that orthopaedic surgeons will encounter such patients in their clinical practice.➤Musculoskeletal manifestations in patients with HIV infection are common and sometimes are the initial presentation of the disease. Knowledge about neoplasms and associated conditions affecting muscle, bones, and joints is essential for successful management.➤Since the advent of cART, total joint arthroplasty has been shown to be a safe procedure; however, perioperative infection is still a small risk in patients with uncontrolled viral loads or CD4 counts of <400 cells/mm(3).➤With regard to trauma surgery, the rates of early and late infection around implants, as well as union rates, are comparable with those in the HIV-negative population; however, there is an increased risk of pulmonary, renal, and infectious or septic complications in the polytrauma setting.➤Factors such as CD4 count, nutritional status, cART therapy, viral load count, and other comorbidities (hemophilia, infection among intravenous drug users, etc.) should be considered when treating these patients in order to optimize their clinical outcomes. PMID:27147691
Lansky, David; Milstein, Arnold
While all of medicine is under pressure to increase transparency and accountability, joint replacement subspecialists will face special scrutiny. Disclosures of questionable consulting fees, a demographic shift to younger patients, and uncertainty about the marginal benefits of product innovation in a time of great cost pressure invite a serious and progressive response from the profession. Current efforts to standardize measures by the National Quality Forum and PQRI will not address the concerns of purchasers, payors, or policy makers. Instead, they will ask the profession to document its commitment to appropriateness, stewardship of resources, coordination of care, and patient-centeredness. One mechanism for addressing these expectations is voluntary development of a uniform national registry for joint replacements that includes capture of preoperative appropriateness indicators, device monitoring information, revision rates, and structured postoperative patient followup. A national registry should support performance feedback and quality improvement activity, but it must also be designed to satisfy payor, purchaser, policymaker, and patient needs for information. Professional societies in orthopaedics should lead a collaborative process to develop metrics, infrastructure, and reporting formats that support continuous improvement and public accountability. PMID:19641973
White, A A
America is founded on high humanitarian, democratic ideals. The historic facts of slavery, discrimination, and segregation challenge and taint these democratic principles. Although progress has been made, serious racial problems remain. In 1997, the United States had 474 active hate groups, up 20% from 1996. African American males who have the same education as white males doing the same work earn approximately 75% of what their white counterparts earn. America, as predicted by the Kerner Commission Report, is two societies: black and white, separate, and unequal. Some astonishing disparities in healthcare exist. Peer reviewed medical literature documents that African Americans have higher infant mortality rates, shorter life expectancies, fewer joint replacements, and more amputations than whites. Communications within a diverse group of students and teachers enriches the educational experience. The late Supreme Court Justice Lewis Powell, LLD, asserted that a medical student from a particular background may enrich classmates' understanding of people whose cultures are different from their own, and improve their ability to serve a heterogeneous patient population. Diversity on clinical teams can enhance rapport between patient and physician, and can diminish unthinking insults to patients, born of physician ethnic insensitivity. Healthcare facilities with diverse staffs are more likely than homogeneous facilities to attract and successfully serve the nation's diverse population. A University of California at Davis School of Medicine study showed that diversity can be achieved without compromising quality of patient care. Clinically and ideologically, diversity in orthopaedics is good for patients and for the country. PMID:10335274
Bills, P.; Brown, L.; Jiang, X.; Blunt, L.
Total joint replacement is one of the most common elective surgical procedures performed worldwide, with an estimate of 1.5 million operations performed annually. Currently joint replacements are expected to function for 10-15 years, however, with an increase in life expectancy, and a greater call for knee replacement due to increased activity levels, there is a requirement to improve their function to offer longer term improved quality of life for patients. The amount of wear that a joint incurs is seen as a good indicator of performance, with higher wear rates typically leading to reduced function and premature failure. New technologies and materials are pushing traditional wear assessment methods to their limits, and novel metrology solutions are required to assess wear of joints following in vivo and in vitro use. This paper presents one such measurement technique; a scanning co-ordinate metrology machine for geometrical assessment. A case study is presented to show the application of this technology to a real orthopaedic measurement problem: the wear of components in total knee replacement. This technique shows good results and provides a basis for further developing techniques for geometrical wear assessment of total joint replacements.
Plastering is one of the most ancient of the building handicrafts. Plaster is the common name for calcium sulphate hemi hydrate made by heating the mineral gypsum, the common name for sulphate of lime. In the tenth century the Arabs used liquid plaster in orthopaedic treatment. At the beginning of the nineteenth century, patients with fractures of the lower extremities-and often of the upper extremities as well-were treated in bed with restriction of all activity for many weeks until the fractures united. It was the practice of surgeons to dress wounds and fractures at frequent intervals. The bandages, pads, and splints were removed, the fractures manipulated, and the dressings reapplied. The search for simpler, less cumbersome methods of treatment led to the development of occlusive dressings, stiffened at first with starch and later with plaster of Paris. The ambulatory treatment of fractures was the direct result of these innovations. Two military surgeons, Antonius Mathijsen of the Netherlands, and Nikolai Ivanovitch Pirogov of Russia, were responsible for the introduction of the new plaster bandage technique. At the beginning of the twentieth century the technique was improved by Jean-François Calot, a French surgeon, who invented the hand manufacture of plaster bandage as a roll. During the twentieth century, walking cast and ambulation for fresh fractures were developed with plaster and pin incorporated in plaster; the open fracture care concept was introduced with plaster of Paris by Trueta before the external fixation. PMID:27055448
Payumo, Francis C.; Kim, Hyun D.; Sherling, Michael A.; Smith, Lee P.; Powell, Courtney; Wang, Xiao; Keeping, Hugh S.; Valentini, Robert F.; Vandenburgh, Herman H.
With current technology, tissue-engineered skeletal muscle analogues (bioartificial muscles) generate too little active force to be clinically useful in orthopaedic applications. They have been engineered genetically with numerous transgenes (growth hormone, insulinlike growth factor-1, erythropoietin, vascular endothelial growth factor), and have been shown to deliver these therapeutic proteins either locally or systemically for months in vivo. Bone morphogenetic proteins belonging to the transforming growth factor-beta superfamily are osteoinductive molecules that drive the differentiation pathway of mesenchymal cells toward the chondroblastic or osteoblastic lineage, and stimulate bone formation in vivo. To determine whether skeletal muscle cells endogenously expressing bone morphogenetic proteins might serve as a vehicle for systemic bone morphogenetic protein delivery in vivo, proliferating skeletal myoblasts (C2C12) were transduced with a replication defective retrovirus containing the gene for recombinant human bone morphogenetic protein-6 (C2BMP-6). The C2BMP-6 cells constitutively expressed recombinant human bone morphogenetic protein-6 and synthesized bioactive recombinant human bone morphogenetic protein-6, based on increased alkaline phosphatase activity in coincubated mesenchymal cells. C2BMP-6 cells did not secrete soluble, bioactive recombinant human bone morphogenetic protein-6, but retained the bioactivity in the cell layer. Therefore, genetically-engineered skeletal muscle cells might serve as a platform for long-term delivery of osteoinductive bone morphogenetic proteins locally.
Isaac, A; Gwilym, SE; Reilly, IN; Kilmartin, TE; Ribbans, WJ
INTRODUCTION The first comprehensive report on the interprofessional relationships between foot and ankle surgeons in the UK is presented. MATERIALS AND METHODS A questionnaire was sent to orthopaedic surgeons with membership of the British Foot and Ankle Surgery Society (BOFAS), orthopaedic surgeons not affiliated to the specialist BOFAS and podiatrists specialising in foot surgery. The questionnaire was returned by 77 (49%) of the BOFAS orthopaedic consultant surgeons, 66 (26%) of non-foot and ankle orthopaedic consultant surgeons and 99 (73%) of the podiatric surgeons. RESULTS While most respondents have experience of surgeons working in the other specialty in close geographical proximity, the majority do not believe that this has adversely affected their referral base. The experience of podiatrists of the outcomes of orthopaedic surgery has been more positive than orthopaedic surgeons of podiatric interventions. Podiatrists are more welcoming of future orthopaedic involvement in future foot and ankle services than in reverse. However, there are a sizeable number of surgeons in both professions who would like to see closer professional liaisons. The study has identified clear divisions between the professions but has highlighted areas where there is a desire from many clinicians to work more harmoniously together, such as in education, training and research. CONCLUSIONS While major concerns exist over issues such as surgery by non-registered medical practitioners and the suitable spectrum of surgery for each profession, many surgeons, in both professions, are willing to provide training for juniors in both specialties and there is a wish to have closer working relationships and common educational and research opportunities than exists at present. PMID:18796189
Manning, Blaine T; Callahan, Charles D; Robinson, Brooke S; Adair, Daniel; Saleh, Khaled J
The future of orthopaedic surgery will be shaped by unprecedented demographic and economic challenges, necessitating movement to so-called "second curve" innovations in the delivery of care. Implementation of integrated care pathways (ICPs) may be one solution to imminent cost and access pressures facing orthopaedic patients in this era of health-care accountability and reform. ICPs can lower costs and the duration of hospital stay while facilitating better outcomes through enhanced interspecialty communication. As with any innovation at the crossroads of paradigm change, implementation of integrated care pathways for orthopaedics may elicit surgeons' concern on a variety of grounds and on levels ranging from casual questioning to vehement opposition. No single method is always effective in promoting cooperation and adoption, so a combination of strategies offers the best chance of success. With a special focus on total joint replacement, we consider general patterns of resistance to change, styles of conflict, and specific issues that may underlie orthopaedic surgeon resistance to implementation of integrated care pathways. Methods to facilitate and sustain orthopaedic surgeon engagement in implementation of such pathways are discussed. PMID:23864183
Orr, Justin D; Hoffmann, Jeffrey D; Arrington, Edward D; Gerlinger, Tad L; Devine, John G; Belmont, Philip J
Factors associated with successful selection in U.S. Army orthopaedic surgical programs are unreported. The current analysis includes survey data from all Army orthopaedic surgery residency program directors (PDs) to determine these factors. PDs at all Army orthopaedic surgery residency programs were provided 17 factors historically considered critical to successful selection and asked to rank order the factors as well as assign a level of importance to each. Results were collated and overall mean rankings are provided. PDs unanimously expressed that performance during the on-site orthopaedic surgery rotation at the individual program director's institution was most important. Respondents overwhelmingly reported that Steps 1 and 2 licensing exam scores were next most important, respectively. Survey data demonstrated that little importance was placed on letters of recommendation and personal statements. PDs made no discriminations based on allopathic or osteopathic degrees. The most important factors for Army orthopaedic surgery residency selection were clerkship performance at the individual PD's institution and licensing examination score performance. Army PDs consider both USMLE and COMLEX results, because Army programs have a higher percentage of successful osteopathic applicants. PMID:25988694
Zywiel, Michael G; Johnson, Aaron J; Mont, Michael A
There is continued pressure for the development of innovative orthopaedic surgical devices and techniques to meet the demands of increasingly younger and more active patients. However, as demonstrated by several recent orthopaedic implant withdrawals and recalls, clinically important unknown modes of failure for newly introduced devices may not become apparent for several years after widespread adoption, affecting a large number of patients. Different reasons have been implicated for this problem, including weaknesses in the United States medical device approval process, as well as deficiencies in mechanisms for post approval implant performance monitoring. Several remedies have been proposed over the past decades. We aim to stimulate discussion concerning the adoption of orthopaedic technology by describing the concept of a graduated implant approval process for orthopaedic devices that builds on recommendations previously made by other authors; by explaining how this will benefit patients, surgeons, and device manufacturers; and by clarifying why the time has come for the orthopaedic community to reconsider the adoption of such a process. PMID:23138245
Wukich, Dane K
An estimated 285 million adults (aged 20-79 years) worldwide were diagnosed to have diabetes mellitus (DM) in 2010, and this number is projected to grow to 439 million adults by the year 2030. Orthopaedic surgeons, regardless of their subspecialty interest, will encounter patients with DM during their career since this epidemic involves both developed and emerging countries. Diabetes results in complications affecting multiple organ systems, potentially resulting in adverse outcomes after orthopaedic surgery. The purpose of this review is to discuss the pathophysiology of DM and its potential for impacting orthopaedic surgery patients. Diabetes adversely affects the outcome of all orthopaedic surgery subspecialties including foot and ankle, upper extremity, adult reconstructive, pediatrics, spine surgery and sports medicine. Poorly controlled diabetes negatively impacts bone, soft tissue, ligament and tendon healing. It is the complications of diabetes such as neuropathy, peripheral artery disease, and end stage renal disease which contributes to adverse outcomes. Well controlled diabetic patients without comorbidities have similar outcomes to patients without diabetes. Orthopaedic surgeons should utilize consultants who will assist in inpatient glycemic management as well as optimizing long term glycemic control. PMID:25893176
Brinker, M R; Pierce, P; Siegel, G
The purpose of the current investigation was to present a standard method by which an orthopaedic practice can analyze its practice expenses. To accomplish this, a five-step process was developed to analyze practice expenses using a modified version of activity-based costing. In this method, general ledger expenses were assigned to 17 activities that encompass all the tasks and processes typically performed in an orthopaedic practice. These 17 activities were identified in a practice expense study conducted for the American Academy of Orthopaedic Surgeons. To calculate the cost of each activity, financial data were used from a group of 19 orthopaedic surgeons in Houston, Texas. The activities that consumed the largest portion of the employee work force (person hours) were service patients in office (25.0% of all person hours), maintain medical records (13.6% of all person hours), and resolve collection disputes and rebill charges (12.3% of all person hours). The activities that comprised the largest portion of the total expenses were maintain facility (21.4%), service patients in office (16.0%), and sustain business by managing and coordinating practice (13.8%). The five-step process of analyzing practice expenses was relatively easy to perform and it may be used reliably by most orthopaedic practices. PMID:10738440
Qureshi, Ammar T; Terrell, Lekeith; Monroe, W Todd; Dasa, Vinod; Janes, Marlene E; Gimble, Jeffrey M; Hayes, Daniel J
Nationally, nearly 1.5 million patients in the USA suffer from ailments requiring bone grafts and hip and other joint replacements. Infections following internal fixation in orthopaedic trauma can cause osteomyelitis in 22-66% of cases and, if uncontrolled, the mortality rate can be as high as 2%. We characterize a procedure for the synthesis of antimicrobial and biocompatible poly-l-lactic acid (PLLA) and poly-ethyleneglycol (PEG) bioscaffolds designed to degrade and absorb at a controlled rate. The bioscaffold architecture aims to provide a suitable substrate for the controlled release of silver nanoparticles (SNPs) to reduce bacterial growth and to aid the proliferation of human adipose-derived stem cells (hASCs) for tissue-engineering applications. The fabricated bioscaffolds were characterized by scanning transmission microscope (SEM) and it showed that the addition of tncreasing concentrations of SNPs results in the formation of dendritic porous channels perpendicular to the axis of precipitation. The antimicrobial properties of these porous bioscaffolds were tested according to a modified ISO 22196 standard across varying concentrations of biomass-mediated SNPs to determine an efficacious antimicrobial concentration. The bioscaffolds reduced the Staphylococcus aureus and Escherichia coli viable colony-forming units by 98.85% and 99.9%, respectively, at an antimicrobial SNPs concentration of 2000 ppm. Human ASCs were seeded on bioscaffolds and cultured in vitro for 20 days to study the effect of SNPs concentration on the viability of cells. SEM analysis and the metabolic activity-based fluorescent dye, AlamarBlue®, demonstrated the growth of cells on the efficacious antimicrobial bioscaffolds. The biocompatibility of in vitro leached silver, quantified by inductively coupled plasma optical emission spectroscopy (ICP-OES), proved non-cytotoxic when tested against hASCs, as evaluated by MTT assay. PMID:22700366
... the Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee. Submit... INFORMATION: Name of Committee: Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory... with or considering hip replacement (...
Inacio, Maria C S; Paxton, Elizabeth W; Dillon, Mark T
Orthopaedic registries are valuable for monitoring patient outcomes in real-world settings. Registries are useful for identifying procedure incidence and device utilization, evaluating outcomes, determining patients at risk for complications and reoperations, identifying devices in recall situations, assessing comparative effectiveness of procedures and devices, and providing data for research studies. In the present report, we describe how orthopaedic registries can be used to conduct research and how they compare with randomized controlled trials (RCTs) in regard to methodology. Using an example, a comparison of the performance of mobile and fixed bearings in total knee arthroplasty, we evaluate the differences between, and the similarities of, RCTs and registry cohort studies with regard to how they are conducted and how their findings are reported. Orthopaedic registry studies differ from RCTs in many ways and offer certain advantages. The strengths and limitations of registry cohort studies and RCTs must be understood to properly evaluate the literature. PMID:26738910
Siboni, S M; Biguzzi, E; Solimeno, L P; Pasta, G; Mistretta, C; Mannucci, P M; Peyvandi, F
Patients with von Willebrand disease (VWD) may need orthopaedic surgery because of disabling chronic arthropathy due to recurrent joint bleeding. They may also require this surgery independently of their haemostasis disorder. Knowledge regarding the management of orthopaedic surgery in VWD is limited. Description of management of orthopaedic surgery in patients with VWD, based upon retrospective data collection and analysis of 32 orthopaedic procedures carried out over a period of 33 years in 23 patients was the aim of this study. Of 32 procedures, six were minor (three hand surgery, one foot surgery, two others) and 26 were major (seven joint replacements, nine arthroscopic procedures, two foot surgery, eight others). Twenty-two procedures were performed using replacement therapy with plasma-derived concentrates containing both factor VIII (FVIII) and von Willebrand factor (VWF). Two procedures in patients with acquired von Willebrand syndrome (AWVS) were performed using FVIII-VWF concentrates associated with intravenous immunoglobulins, or desmopressin plus tranexamic acid. Seven procedures were performed using desmopressin alone and one using intravenous immunoglobulins in AVWS. Bleeding complications occurred in seven procedures (22%). In one patient, an anti-VWF antibody was diagnosed after surgery. Anticoagulant prophylaxis of venous thromboembolism was implemented in four cases only and in two instances there was excessive bleeding. In conclusion, control of surgical haemostasis was achieved in most patients with VWD undergoing orthopaedic surgery. The control of haemostasis combined with an adequate surgical technique and early post-operative rehabilitation are warranted for the successful performance of orthopaedic surgery in VWD, which requires the involvement of specialized haemophilia centres. PMID:23992395
O'Hara, Nathan N.; Mugarura, Rodney; Slobogean, Gerard P.; Bouchard, Maryse
The disability adjusted life years (DALYs) associated with injuries have increased by 34% from 1990 to 2010, making it the 10th leading cause of disability worldwide, with most of the burden affecting low-income countries. Although disability from injuries is often preventable, limited access to essential surgical services contributes to these increasing DALY rates. Similar to many other low- and middle-income countries (LMIC), Uganda is plagued by a growing volume of traumatic injuries. The aim of this study is to explore the orthopaedic trauma patient's experience in accessing medical care in Uganda and what affects the injury might have on the socioeconomic status for the patient and their dependents. We also evaluate the factors that impact an individual's ability to access an appropriate treatment facility for their traumatic injury. Semi-structured interviews were conducted with patients 18 year of age or older admitted with a fractured tibia or femur at Mulago National Referral Hospital in Kampala, Uganda. As limited literature exists on the socioeconomic impacts of disability from trauma, we designed a descriptive qualitative case study, using thematic analysis, to extract unique information for which little has been previously been documented. This methodology is subject to less bias than other qualitative methods as it imposes fewer preconceptions. Data analysis of the patient interviews (n = 35) produced over one hundred codes, nine sub-themes and three overarching themes. The three overarching categories revealed by the data were: 1) the importance of social supports; 2) the impact of and on economic resources; and 3) navigating the healthcare system. Limited resources to fund the treatment of orthopaedic trauma patients in Uganda leads to reliance of patients on their friends, family, and hospital connections, and a tremendous economic burden that falls on the patient and their dependents. PMID:25360815
Veney, Amy J
Orthopaedic patients with obstructive sleep apnea are at risk for postoperative complications related to administration of pain medications, anxiolytics, and antiemetics. They are more likely to experience respiratory and cardiac complications, be transferred to an intensive care unit, or have an increased length of stay in the hospital. This informational article is for nurses who care for postoperative orthopaedic patients with obstructive sleep apnea. The focus is on promoting patient safety through communication, vigilant postoperative sedation assessment, and nursing interventions that include appropriate patient positioning, patient education, and involving patients and their families in care. PMID:24247310
Thomsen, Marc; Abel, Rainer
For treating patients with scoliosis orthopaedic surgeons need diagnostic imaging procedures in order to provide answers about a possible underlying disease, choice of treatment, and prognosis. Once treatment is instituted, imaging is also critical for monitoring changes of the deformity so as to optimize therapy. The combined effort of orthopaedic surgeons and radiologists helps detect treatable causes of scoliosis at an early stage, define the need and timing for surgery, and ensure that every precaution is taken to minimize the risks of surgery. Neurosurgical causes, with particular reference to spinal cord tumours and syringomyelia, need to be addressed before scoliosis surgery can be contemplated. PMID:16439089
Bara, Jennifer J; Herrmann, Marietta; Evans, Christopher H; Miclau, Theodore; Ratcliffe, Anthony; Richards, R Geoff
There is a clear discrepancy between the growth of cell therapy and tissue engineering research in orthopaedics over the last two decades and the number of approved clinical therapies and products available to patients. At the 2015 annual meeting of the Orthopaedic Research Society, a workshop was held to highlight important considerations from the perspectives of an academic scientist, clinical researcher, and industry representative with the aim of helping researchers to successfully translate their ideas into clinical and commercial reality. Survey data acquired from workshop participants indicated an overall positive opinion on the future potential of cell-based therapies to make a significant contribution to orthopaedic medicine. The survey also indicated an agreement on areas requiring improvement in the development of new therapies, specifically; increased support for fundamental research and education and improved transparency of regulatory processes. This perspectives article summarises the content and conclusions of the workshop and puts forward suggestions on how translational success of cell-based therapies in orthopaedics may be achieved. PMID:26403666
Kamal, Syed A.; Lindseth, Richard E.
Moire topography is applied for the follow-up of scoliosis patients. The results are then compared with the X-rays. A special lamp and scale arrangement is utilized for patient alignment. It is suggested that this technique will be used for the detection of all orthopaedic defects.
As an orthopaedic surgeon who has treated numerous cases of clubfoot in his career, the author knows that it takes exceptional parents to deal with the challenges of having a child born with a clubfoot. However, it should be noted that a clubfoot diagnosis does not mean a life of pain, deformity, and disability for a child. Today's treatment…
Joskowicz, Leo; Hazan, Eric J
Computer Aided Orthopaedic Surgery (CAOS) is now about 25 years old. Unlike Neurosurgery, Computer Aided Surgery has not become the standard of care in Orthopaedic Surgery. In this paper, we provide the technical and clinical context raised by this observation in an attempt to elucidate the reasons for this state of affairs. We start with a brief outline of the history of CAOS, review the main CAOS technologies, and describe how they are evaluated. We then identify some of the current publications in the field and present the opposing views on their clinical impact and their acceptance by the orthopaedic community worldwide. We focus on total knee replacement surgery as a case study and present current clinical results and contrasting opinions on CAOS technologies. We then discuss the challenges and opportunities for research in medical image analysis in CAOS and in musculoskeletal radiology. We conclude with a suggestion that while CAOS acceptance may be more moderate than that of other fields in surgery, it still has a place in the arsenal of useful tools available to orthopaedic surgeons. PMID:27407004
Haene, Roger A; Sandhu, Ranbir S; Baxandall, Richard
INTRODUCTION There exist, currently, no clear guidelines regarding standards for surgical implant labelling. Dimensions of the laminar flow canopies in orthopaedic use fixes the distance at which implant labels can be read. Mistakes when reading the label on an implant box can pose health risks for patients, and financial consequences for medical institutions. SUBJECTS AND METHODS Using scientifically validated tools such as the Snellen Chart Formula, a theoretical minimum standard for text on implant labels was reached. This theoretical standard was then tested under real operating conditions. After discovering a minimum practical standard for implant labels, the authors then audited current labels in use on a wide range of orthopaedic implant packages. Furthermore, other non-text-related labelling problems were also noted. RESULTS There is a definite minimum standard which should be observed when implant labels are manufactured. Implants in current use bear labels on the packaging that are of an insufficient standard to ensure patient safety in theatre. CONCLUSIONS The authors have established text parameters that will increase the legibility of implant labels. In the interests of improving risk management in theatre, therefore, the authors propose a standard for orthopaedic implant labelling, and believe this will provide a useful foundation for further discussion between the orthopaedic community and implant manufacturers. PMID:19686615
Rosier, Randy N
The clinician-scientist faces many career barriers that changes in medicine over the past two decades have accentuated. Political, socioeconomic, and cultural changes in medicine have increased financial pressures on physicians and hospitals, negatively impacting the ability of clinicians to pursue research activities. Examples of institutional barriers include pressure on physicians to increase clinical productivity to help offset rising costs and declining reimbursements, inadequate resources and structures to protect research time, a lack of consideration of the importance of spatial colocalization of interacting researchers and clinicians, insufficient focus on integrating clinician-scientists into research teams, and inadequate accessibility of administrative research infrastructure. Lack of mentorship and role models in orthopaedics also contributes to the barriers confronting the clinician-scientist. A number of steps could be taken by institutions to positively influence orthopaedic clinician-scientist career development. Creation of research teams in which orthopaedic clinician-scientists can collaborate effectively with other researchers is a critical step, as is providing protected time free of clinical responsibilities to be devoted to research. Increased attention to physical co-localization of the research activities of clinicians and scientists, and provision of research infrastructure at the department level are additional approaches that can be taken to ameliorate the institutional barriers to the orthopaedic clinician-scientist. PMID:16888531
Roberts, Craig S; Cannada, Lisa K
Your first job in orthopaedic surgery is the culmination of years of training and hard work. This article will cover strategies for your first job search and your future career. We discuss job searching strategies prioritizing what is important. And once you start your first job, we discuss tips for how to make a good first impression and begin a successful career. PMID:25147996
Rivera, Jessica C; Greer, Renee M; Wenke, Joseph C; Ficke, James R; Johnson, Anthony E
The Military Orthopaedic Trauma Registry (MOTR) orginally began as part of the Department of Defense Trauma Registry (DoDTR) and became a live registry in 2013. As a quality improvement process, this study examined MOTR data for 20 female amputees compared with DoDTR data. The DoDTR provided diagnosis and procedure codes as a list but no details. The MOTR provided additional data, including specific limb, fracture classifications, and associated injuries per limb. The MOTR allowed for construction of a treatment time line for each limb, including number and timing of debridements, antibiotics, and implant types. Orthopaedic-specific complications were also coded more frequently in the MOTR and clearly identified with a specific injury and treatment. During initial quality control checks, the MOTR provides a greater volume and granularity of detail for orthopaedic-specific injury and treatment information, indicating that the MOTR is on track to provide a valuable repository for data-driven orthopaedic management of combat injury. PMID:27518292
Madke, Bhushan; Nayak, Chitra
Clinical signs reflect the sheer and close observatory quality of an astute physician. Many new dermatological signs both in clinical and diagnostic aspects of various dermatoses are being reported and no single book on dermatology literature gives a comprehensive list of these “signs” and postgraduate students in dermatology finds it difficult to have access to the description, as most of these resident doctor do not have access to the said journal articles. “Signs” commonly found in dermatologic literature with a brief discussion and explanation is reviewed in this paper. PMID:23189246
[Dr. Michiharu Matsuoka, founder of the Department of Orthopaedic Surgery, Kyoto University, and his achievements (Part 6: Studying abroad of Dr. Matsuoka and opening to public, reputation and achievement of the department)].
Dr. Michiharu Matsuoka studied orthopaedic surgery in Germany, Austria and other countries during the period from August, 1902 to May, 1906. He visited many university pathological institutes and surgical and orthopaedic clinics to study pathology and to learn the practice of orthopaedic surgery. After that, he started his practice at the newly established Department of Orthopaedic Surgery in the Medical School of Kyoto Imperial University in June, 1906. The department was opened in 1907 and in 1911 it was opened to all citizens and practical doctors in Kyoto City and exhibited many orthopaedic specimens and instruments. In particular, the x-ray apparatus of the Department was so well equipped that a German radiologist who visited the Department admired it in his article that was published in the journal of radiology in 1911. The Department was not surpassed by others for the number of patients with the dislocation of the hip and tuberculous spondylitis as well as the advanced quality and variety of roentgenological and pathological researches on these diseases. PMID:21797054
Elfar, John; Menorca, Ron Martin Garcia; Reed, Jeffrey Douglas; Stanbury, Spencer
Composite bone models are increasingly used in orthopaedic biomechanics research and surgical education-applications that traditionally relied on cadavers. Cadaver bones are suboptimal for many reasons, including issues of cost, availability, preservation, and inconsistency between specimens. Further, cadaver samples disproportionately represent the elderly, whose bone quality may not be representative of the greater orthopaedic population. The current fourth-generation composite bone models provide an accurate reproduction of the biomechanical properties of human bone when placed under bending, axial, and torsional loads. The combination of glass fiber and epoxy resin components into a single phase has enabled manufacturing by injection molding. The high level of anatomic fidelity of the cadaver-based molds and negligible shrinkage properties of the epoxy resin results in a process that allows for excellent definition of anatomic detail in the cortical wall and optimized consistency of features between models. Recent biomechanical studies of composites have validated their use as a suitable substitute for cadaver specimens. PMID:24486757
Born, Christopher T; Monchik, Keith O; Hayda, Roman A; Bosse, Michael J; Pollak, Andrew N
Disaster preparedness and management education is essential for allowing orthopaedic surgeons to play a valuable, constructive role in responding to disasters. The National Incident Management System, as part of the National Response Framework, provides coordination between all levels of government and uses the Incident Command System as its unified command structure. An "all-hazards" approach to disasters, whether natural, man-made, intentional, or unintentional, is fundamental to disaster planning. To respond to any disaster, command and control must be established, and emergency management must be integrated with public health and medical care. In the face of increasing acts of terrorism, an understanding of blast injury pathophysiology allows for improved diagnostic and treatment strategies. A practical understanding of potential biologic, chemical, and nuclear agents and their attendant clinical symptoms is also prerequisite. Credentialing and coordination between designated organizations and the federal government are essential to allow civilian orthopaedic surgeons to access systems capable of disaster response. PMID:21553757
Evarts, C McCollister
Recognizing the challenges presented in the process of resident selection, in 1981 the American Orthopaedic Association formed a Steering Committee on Resident Selection. This Committee was charged with studying the processes involved in the selection of orthopaedic residents and developing guidelines and making suggestions to program directors. The activities of the Committee focused on five areas: (1) the mechanics of resident selection; (2) the assessment of cognitive skills; (3) the assessment of motor ability; (4) the assessment of noncognitive factors (the affective domain); (5) the assessment of "dropouts." The Committee made the following recommendations to help program directors in the selection of residents: (1) use of a standardized application form; (2) full disclosure to applicants; (3) careful selection of candidates to be interviewed; (4) careful planning and implementation of the interview and visit; (5) broad faculty representation and discussion at time of selection; (6) due diligence when necessary. We still believe these criteria important in resident selection. PMID:16788399
Matzon, Jonas L; Lutsky, Kevin F; Ricci, Emily K; Beredjiklian, Pedro K
Radiographic imaging of the pregnant patient represents a diagnostic and management dilemma for the orthopaedic surgeon. Imaging is often necessary in the setting of trauma; however, in utero radiation exposure can result in deleterious developmental effects in the embryo and fetus. The likelihood of a negative effect is proportional to the radiation dose and the gestational age of the embryo or fetus at the time of exposure. Ionizing radiation doses >100 mGy in the first trimester of pregnancy may lead to spontaneous abortion, malformation, and mental retardation. Whereas plain radiographs of the extremities and cervical spine expose the fetus to minimal doses of radiation of <10 mGy, other commonly performed orthopaedic diagnostic studies, such as CT of the pelvis, emit significantly higher exposure doses of approximately 35 mGy. Non-emitting modalities, such as ultrasonography and MRI, are alternatives for evaluation in the clinical setting. PMID:26116850
Elfar, John; Stanbury, Spencer; Menorca, Ron Martin Garcia; Reed, Jeffrey Douglas
Composite bone models are increasingly used in orthopaedic biomechanics research and surgical education—applications that traditionally relied on cadavers. Cadaver bones are suboptimal for myriad reasons, including issues of cost, availability, preservation, and inconsistency between specimens. Further, cadaver samples disproportionately represent the elderly, whose bone quality may not be representative of the greater orthopaedic population. The current fourth-generation composite bone models provide an accurate reproduction of the biomechanical properties of human bone when placed under bending, axial, and torsional loads. The combination of glass fiber and epoxy resin components into a single phase has enabled manufacturing by injection molding. The high anatomic fidelity of the cadaver-based molds and negligible shrinkage properties of the epoxy resin results in a process that allows for excellent definition of anatomic detail in the cortical wall and optimized consistency of features between models. Recent biomechanical studies of composites have validated their use as a suitable substitute for cadaver specimens. PMID:24486757
Yeung, S H
With the blooming of minimally invasive procedures in surgical specialties, many orthopaedic subspecialties have been evolving along such lines. Despite the apparent paradox that many orthopaedic implants are quite bulky to start off with, different methods have been adopted to insert them safely with the least possible trauma. Altering time-honoured incisions and surgical techniques has often been helpful. The industry is also very keen to re-design implants for this purpose and has contributed substantial momentum in this direction. Coupled with the use of operating microscopes, endoscopes, and imaging modalities, operations can be performed with greater precision and lesser trauma. The advent of computer-assisted technology is another step forward. It is through constant attention to minimising tissue trauma and a combination of different methods available, that surgeons can achieve the ultimate goals of minimally invasive surgery. PMID:18685164
Low-level laser therapy (LLLT) has been actively used for nearly 40 yr, during which time it has been known to reduce pain, inflammation, and edema. It also has the ability to promote healing of wounds, including deep tissues and nerves, and prevent tissue damage through cell death. Much of the landmark research was done by the National Aeronautics and Space Administration (NASA), and these studies provided a springboard for many additional basic science studies. Few current clinical studies in orthopaedics have been performed, yet only in the past few years have basic science studies outlined the mechanisms of the effect of LLLT on the cell and subsequently the organism. This article reviews the basic science of LLLT, gives a historical perspective, and explains how it works, exposes the controversies and complications, and shows the new immediately applicable information in orthopaedics. PMID:25541589
Rhea, E B; Rogers, T H; Riehl, J T
In many orthopaedic operating rooms, anaesthesia providers routinely wear lead aprons for protection from radiation, but some studies have questioned whether this is needed. We conducted a systematic review to identify studies that measured the amount of radiation that anaesthetists were exposed to in the orthopaedic operating room. Multiple studies have shown that at 1.5 m from the source of radiation, anaesthetists received no radiation, or amounts so small that a person would have to be present in an unreasonable number of operations to receive cumulative doses of any significance. Radiation doses at this distance were often at the limits of the sensitivity of the measuring dosimeter. We question the need to wear lead protection for anaesthesia providers who are routinely at 1.5 m or a greater distance from standard fluoroscopy units. PMID:26874074
Specialist in the design and construction of modular healthcare buildings MTX Contracts has recently completed, on time and on budget, Stockport NHS Foundation Trust's impressive new four-storey orthopaedic and surgical facility at Stepping Hill Hospital. The company claims the new facility offers a quality of build and finish "as close to that of traditional build as is possible using modular construction techniques". Jonathan Baillie reports. PMID:19452799
Székely, Gabor; Nolte, Lutz-P
In this note we summarize the history of computer aided surgery in orthopaedics and traumatology from the end of the nineteenth century to currently observable future trends. We concentrate on the two major components of such systems, pre-operative planning and intra-operative execution. The evolution of the necessary technological components, the numerous platforms and components offered commercially as well as their clinical use are surveyed. PMID:27377330
Murphy, Laurie A.; Murphy, James E.
The Accreditation Council of Graduate Medical Education’s (ACGME) Data Accreditation System indicates 124 of 152 orthopaedic surgery residency program directors have 5 or fewer years of tenure. The qualifications and responsibilities of the position based on the requirements of orthopaedic surgery residency programs, the institutions that support them, and the ACGME Outcome Project have evolved the role of the program coordinator from clerical to managerial. To fill the void of information on the coordinators’ expanding roles and responsibilities, the 2006 Association of Residency Coordinators in Orthopaedic Surgery (ARCOS) Career survey was designed and distributed to 152 program coordinators in the United States. We had a 39.5% response rate for the survey, which indicated a high level of day-to-day managerial oversight of all aspects of the residency program; additional responsibilities for other department or division functions for fellows, rotating medical students, continuing medical education of the faculty; and miscellaneous business functions. Although there has been expansion of the role of the program coordinator, challenges exist in job congruence and position reclassification. We believe use of professional groups such as ARCOS and certification of program coordinators should be supported and encouraged. PMID:18196362
Kearney, Sean P; Bluman, Eric M; Lonergan, Keith T; Arrington, Edward D; Ficke, James R
Over 220 U.S. Army orthopaedic surgeons have deployed during the Global War on Terrorism (GWOT). This study documents the orthopaedic procedures performed during the GWOT and identifies training that prepared surgeons for deployment. It reveals deficiencies in surgeons' preparedness and intends to improve predeployment training. All surgeons deployed during the GWOT from 2001 to 2007 were surveyed. Questions fit 4 general categories: deployment demographics, medical and surgical experiences, predeployment preparation, and self-perceived preparedness during deployment. Response rate was 70%. Surgeons averaged 138 adult operative cases and 26 pediatric cases per deployment. All surgeons performed irrigation and debridement, 94% external fixation, 93% amputations, 89% arthrotomies, 86% open reduction and internal fixation, and 76% soft-tissue coverage procedures. Residency and fellowship contributed most to surgeon preparedness for deployment. Surgeons generally reported high levels of preparedness, but nearly 1 in 6 reported low levels of medical, surgical and physical preparedness. More reported low levels of mental preparedness. Soft-tissue coverage was the most frequently reported surgical deficiency. This study documents the number and types of orthopaedic procedures performed during the GWOT and identifies the self-perceived preparedness deficiencies of surgeons in a combat environment. Improvements in predeployment training are needed to better prepare surgeons for managing battlefield causalities. PMID:23025135
Hawkey, S; Ghaffar, S
Thioureas, often contained within neoprene to provide water resistance, are an important cause of allergic contact dermatitis (ACD) in those who use neoprene products. We wish to present three cases of thiourea-induced ACD from three different orthopaedic supports containing neoprene. The first case was a 67-year-old woman who developed an itchy rash on her heel three weeks after using a neoprene insole for plantar fasciitis. The second case was a 47-year-old man who developed an itchy rash on his wrist after wearing neoprene wrist splints for psoriatic arthropathy. The third case was a 77-year-old woman who experienced a severe erythematous rash with blistering from a neoprene elbow brace she received following a humeral fracture. All patients were patch tested to the British Society of Cutaneous Allergy Standard and rubber series and a cut piece from all the relevant supports. At 96 hours, all patients had a + reaction to mixed dialkylthiourea, diethylthiourea, and the supports' material. No other positive patch test reactions were identified. As neoprene is fast becoming one of the most popular materials used for orthopaedic supports, awareness of this reaction and close liaison between dermatologists and orthopaedic surgeons are therefore essential to allow for early recognition of this complication. PMID:26236520
Byrd, J. W. Thomas; Jones, Kay S.; Chin, Paul C.
Successful hip arthroscopy depends on proper patient selection and reasonable patient expectations. The purpose of this study is to report the results of hip arthroscopy in orthopaedic surgeons who represent the most informed cohort. This report is based on a retrospective review of prospectively collected data among 24 orthopaedic surgeons (1 bilateral). Follow-up averaged 48 months (range 12–120 months). They were all males with an average age of 45 years (range 30–64 years). All improved with an average of 18 points (preoperative 75; post-operative 93); although one underwent repeat arthroscopy and one was converted to total hip arthroplasty at 54 months. There were numerous diagnoses and procedures performed and one complication (acute coronary artery occlusion). They resumed seeing patients at an average of 1.6 weeks (range 2 days–4 weeks) and operating at an average of 3.1 weeks (range 6 days–8 weeks). This report spans three decades, thus representing a heterogeneous population in terms of diagnoses and treatment. Nonetheless, successful results are noted. As a cohort, orthopaedic surgeons possess the greatest insight into hip arthroscopy, but as patients, often they must modulate their expectations in order to match the understanding of the realities of the procedure. PMID:27583146
Slobogean, Gerard; Sprague, Sheila; Furey, Andrew; Pollak, Andrew
The dire challenges faced in Haiti, both preearthquake and postearthquake, highlight the need for developing surgical infrastructure to care for traumatic musculoskeletal injuries. The proposed Orthopaedic Trauma Care Specialist (OTCS) residency program aims to close the critical human resource gap that limits the appropriate care of musculoskeletal trauma in Haiti. The OTCS program is a proposal for a 2-year residency program that will focus primarily on the management of orthopaedic trauma. The proposed program will be a comprehensive approach for implementing affordable and sustainable strategies to improve orthopaedic trauma care. Its curriculum will be tailored to the injuries seen in Haiti, and the treatments that can be delivered within their health care system. Its long-term sustainability will be based on a "train-the-trainers" approach for developing local faculty to continue the program. This proposal outlines the OTCS framework specifically for Haiti; however, this concept is likely applicable to other low- and middle-income environments in a similar need for improved trauma and fracture care. PMID:26356211
Najibi, S; Banglmeier, R; Matta, JM; Tannast, M
Suture materials in orthopaedic surgery are used for closure of wounds, repair of fascia, muscles, tendons, ligaments, joint capsules, and cerclage or tension band of certain fractures. The purpose of this study was to compare the biomechanical properties of eleven commonly used sutures in orthopaedic surgery. Three types of braided non-absorbable and one type of braided absorbable suture material with different calibers (n=77) underwent biomechanical testing for maximum load to failure, strain, and stiffness. All samples were tied by one surgeon with a single SMC (Seoul Medical Center) knot and three square knots. The maximum load to failure and strain were highest for #5 FiberWire and lowest for #0 Ethibond Excel (p<0.001). The stiffness was highest for #5 FiberWire and lowest for #2-0 Vicryl (p<0.001). In all samples, the failure of the suture material occurred at the knot There was no slippage of the knot in any of the samples tested. This data will assist the orthopaedic surgeon in selection and application of appropriate suture materials and calibers to specific tasks. PMID:21045977
Manhart, J; Dietze, A; Büttner, A
Internal fracture fixation represents a widespread concept for the treatment of fractures. As the number of implants increases, person tracking may be possible. In spring 2010 near Rostock (Germany), human remains including a stainless steel nail were found. Forensic analysis considered the parts of skeleton to belong to a man of medium height, exposed to outdoor conditions for several years to a few decades. The tibial nail was analysed and according to the product identification number possible hospitals of implant placement and transportation paths were determined and screened. Furthermore a match analysis of the database of missing individuals of the last 15 years was undertaken and a DNA match analysis identified a local individual who had been missing since winter 2003. Equipped with the actual patient's identity, out of academic interest a survey of clinical documents such as discharge letters and operative reports was performed, but was inconclusive. Although technically feasible, tracking the patient in this case based on the implant product number itself was unsuccessful. In this case report, the feasibility, validity and efficiency of this option are presented and discussed. PMID:24458026
Malin, Andrew S.; Brannan, Patrick S
Orthopaedic surgeons deployed to Afghanistan are primarily responsible for the provision of care to injured Us and coalition soldiers. A vast and well-coordinated system of echeloned care has evolved to rapidly treat and evacuate injured soldiers. Orthopaedic care of injured Afghan civilians represents a common secondary mission performed by deployed orthopaedic surgeons. In this article, I describe my experiences while deployed to Afghanistan in 2011 as part of the special Operations surgical team. PMID:23576947
Goveia, Vania Regina; Pinto, Flavia Morais Gomes; Machoshvili, Irene Alexeevna; Penna, Thereza Christina Vessoni; Graziano, Kazuko Uchikawa
It is estimated that electric drills (ED) have been used in orthopaedic surgeries for bone drilling for more than 50 years in Brazilian hospitals. It is an electric, thermosensitive equipment, not indicated for surgical use, which has not been previously evaluated regarding the sterilization efficacy, being suspect of infection risk. This study evaluated the efficacy of sterilization by ethylene oxide (EtO) of new drills that were intentionally contaminated with Bacillus atrophaeus spores. An experimental, laboratory, randomized applied research was developed, where 16 electric drills were analyzed, in addition to positive and negative controls. All the previously cleaned and sterilized equipment were submitted to contamination by spores. The experimental group was submitted to cleaning and sterilization by EtO and test of sterility by filtration through a 0.45 >m membrane. The membranes were cultivated and Gram and Wirtz-Conklin staining were carried out in positive results for spore visualization. An efficacy of 99.99999881% of the process of sterilization by EtO was confirmed, with a probability of survival of 1.19 x 10 -8. Under the development conditions of the experiment, the efficacy of the sterilization of ED by EtO was confirmed. PMID:24031397
Frame, Mark; Huntley, James S.
Rapid prototyping (RP) is applicable to orthopaedic problems involving three dimensions, particularly fractures, deformities, and reconstruction. In the past, RP has been hampered by cost and difficulties accessing the appropriate expertise. Here we outline the history of rapid prototyping and furthermore a process using open-source software to produce a high fidelity physical model from CT data. This greatly mitigates the expense associated with the technique, allowing surgeons to produce precise models for preoperative planning and procedure rehearsal. We describe the method with an illustrative case. PMID:22666160
Lourie, J.; Hamid, K.
Despite many reports of injuries to surgeons during operative procedures, there is no record of an eye injury caused by a foreign body. Orthopaedic surgeons are particularly vulnerable to such injury. An instance in which a penetrating eye injury occurred while hammering a rasp into the femur during a hip replacement is described. There is a potential oblique trajectory for a foreign body to reach the eye from the operative field despite the use of a visor for eye protection. Images Figure 1 Figure 2 PMID:8659981
Timely and well-planned discharge improves the patient's experience, contributes to patient safety and reduces the length of hospital stays. The role of orthopaedic discharge sister was developed at James Cook University Hospital in 2007 to provide safe, timely and efficient discharge for patients from the trauma and theatre centre, and to improve patient experience and flow. This article gives an overview of the role and describes how the sister works with colleagues to plan patient discharges from pre-assessment and emergency department admission through their hospital stay until their departure. PMID:26948225
Olson, Carl J.; And Others
Phase two of the Orthopaedic Training Study was designed to examine time, sequence, and content requirements of existing orthopaedic programs. Specifically, the proposal was designed to achieve the following objectives: (1) to provide a model of individualized graduate education in medicine in which the demonstration of individual competence marks…
Mangels, Marija; Schwarz, Susanne; Worringen, Ulrike; Holme, Martin; Rief, Winfried
We investigated whether short-term versus long-term sick leave after orthopaedic inpatient rehabilitation can be predicted by initial assessment information, the clinical status at discharge, or whether the follow-up interval is crucial for later sick leave. We examined 214 patients from an orthopaedic rehabilitation hospital at admission,…
... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone; Michigan Orthopaedic Society 50th... Society 50th Anniversary Fireworks display, June 19, 2010. This temporary safety zone is necessary to... vessels during the setup and launching of fireworks in conjunction with the Michigan Orthopaedic...
Cross, Jessica D; Ficke, James R; Hsu, Joseph R; Masini, Brendan D; Wenke, Joseph C
Extremity injuries make up 54% of combat wounds sustained in Operation Iraqi Freedom and Operation Enduring Freedom. In a cohort of war-wounded service members, we identified the conditions secondary to battle injury that result in disqualification from continued service. The Army Physical Evaluation Board records of 464 wounded service members who were injured between October 2001 and January 2005 were reviewed to determine the codes indicating unfitting conditions. Sixty-nine percent of these conditions were orthopaedic. Fifty-seven percent of the injured had unfitting conditions that were orthopaedic only. Of those evacuated from theater with a primary diagnosis of injury to the head, thorax, or abdomen and who suffered an orthopaedic injury as well, 76% had an orthopaedic diagnosis as the primary unfitting condition. Orthopaedic-related disability has a significant impact on the affected patient, the health care system, and, in the case of wounded service members, on military strength and readiness. PMID:21304041
Collier, John P; Currier, Barbara H; Kennedy, Francis E; Currier, John H; Timmins, Graham S; Jackson, Simon K; Brewer, Robin L
Cross-linked polyethylenes are being marketed by orthopaedic manufacturers to address the problem of osteolysis caused by polyethylene particulate wear debris. Wear testing of these cross-linked polyethylenes in hip simulators has shown dramatic reduction in wear rate compared with standard ultrahigh molecular weight polyethylene, either gamma irradiated in air or nitrogen - or ethylene oxide-sterilized. However, this reduction in wear rate is not without cost. The cross-linking processes can result in materials with lower mechanical properties than standard ultrahigh molecular weight polyethylene. To evaluate the effect of the various cross-linking processes on physical and mechanical properties of ultrahigh molecular weight polyethylene, commercially available cross-linked polyethylenes from six orthopaedic manufacturers were tested. This study was the culmination of collaboration with these manufacturers, who provided cross-linked polyethylene for this study, wear characteristics of the material they provided, and review of the physical and mechanical properties measure for their polyethylene. Cross-linked materials were evaluated as received and after an accelerated aging protocol. Free radical identity and concentration, oxidation, crystallinity, melt temperature, ultimate tensile strength, elongation at break, tensile stress at yield, and toughness are reported for each material. By comparing these physical and mechanical properties, surgeons can evaluate the trade-off that results from developing materials with substantially lower wear rates. PMID:12966304
Athanasiou, K A; Agrawal, C M; Barber, F A; Burkhart, S S
Biodegradable polymers, especially those belonging to the family of polylactic acid (PLA) and polyglycolic acid (PGA), play an increasingly important role in orthopaedics. These polymers degrade by hydrolysis and enzymatic activity and have a range of mechanical and physical properties that can be engineered appropriately to suit a particular application. Their degradation characteristics depend on several parameters including their molecular structure, crystallinity, and copolymer ratio. These biomaterials are also rapidly gaining recognition in the fledging field of tissue engineering because they can be fashioned into porous scaffolds or carriers of cells, extracellular matrix components, and bioactive agents. Although their future appears to be bright, several questions regarding the biocompatibility of these materials linger and should be addressed before their wide-scale use. In the context of musculoskeletal tissue, this report provides a comprehensive review of properties and applications of biodegradable PLA/PGA polymers and their copolymers. Of special interest are orthopaedic applications, biocompatibility studies, and issues of sterilization and storage of these versatile biomaterials. Also discussed is the fact that terms such as PLA, PGA, or PLA-PGA do not denote one material, but rather a large family of materials that have a wide range of differing bioengineering properties and concomitant biological responses. An analysis of some misconceptions, problems, and potential solutions is also provided. PMID:9788368
Brehm, Walter; Burk, Janina; Delling, Uta; Gittel, Claudia; Ribitsch, Iris
Regenerative medicine is one of the most intensively researched medical branches, with enormous progress every year. When it comes to translating research from bench to bedside, many of the pioneering innovations are achieved by cooperating teams of human and veterinary medical scientists. The veterinary profession has an important role to play in this new and evolving technology, holding a great scientific potential, because animals serve widely as models for human medicine and results obtained from animals may serve as preclinical results for human medicine. Regenerative veterinary medicine utilizing mesenchymal stromal cells (MSC) for the treatment of acute injuries as well as chronic disorders is gradually turning into clinical routine. As orthopaedic disorders represent a major part of all cases in veterinary clinical practice, it is not surprising that they are currently taking a leading role in MSC therapies. Therefore, the purpose of this paper is to give an overview on past and current achievements as well as future perspectives in stem cell-based tissue engineering in veterinary orthopaedics. PMID:22287044
Gofton, Wade T; Solomon, Michael; Gofton, Tyson; Pagé, Alex; Kim, Paul R; Netting, Caleb; Bhandari, Mohit; Beaulé, Paul E
Practicing orthopaedic surgeons must assess the effects of the learning curve on patient safety and surgical outcomes if a new implant, technique, or approach is being considered; however, it remains unclear how learning curves reported in the literature should be interpreted and to what extent their results can be generalized. Learning curve reports from other surgical specialties and from orthopaedic surgery can be analyzed to identify the strengths and weaknesses of learning curve reporting. Single-surgeon series and registry data can be analyzed to understand learning challenges and to develop a personalized learning plan. Learning curve reports from single-surgeon series have several limitations that result from the limited dataset reported and inconsistencies in the way data are reported. Conversely, learning curve reports from registry data are likely to have greater generalizability, but are largely beneficial retrospectively, after data from a sufficient number of surgeons are assessed. There is a pressing need for surgeons to develop improved and consistent standards for learning curve reporting. Although registry data may provide better prospective measures in the future, the implementation of such registries faces several challenges. Despite substantial limitations, single-surgeon series remain the most effective way for practicing surgeons to assess their learning challenge and develop an appropriate learning plan. PMID:27049229
Over years of practice, many beliefs and practices become entrenched as tried and tested, and we subconsciously believe they are based on scientific evidence. We identified nine such beliefs by interviewing orthopaedic surgeons in which studies (or lack thereof) apparently do not support such practices. These are: changing the scalpel blade after the skin incision to limit contamination; bending the patient’s knee when applying a thigh tourniquet; bed rest for treatment of deep vein thrombosis; antibiotics in irrigation solution; routine use of hip precautions; routine use of antibiotics for the duration of wound drains; routine removal of hardware in children; correlation between operative time and infection; and not changing dressings on the floor before scrubbing. A survey of 186 practicing orthopaedic surgeons in academic and community settings was performed to assess their routine practice patterns. We present the results of the survey along with an in-depth literature review of these topics. Most surgeon practices are based on a combination of knowledge gained during training, reading the literature, and personal experience. The results of this survey hopefully will raise the awareness of the selected literature for common practices. PMID:18726654
Tejwani, Nirmal C; Immerman, Igor
Over years of practice, many beliefs and practices become entrenched as tried and tested, and we subconsciously believe they are based on scientific evidence. We identified nine such beliefs by interviewing orthopaedic surgeons in which studies (or lack thereof) apparently do not support such practices. These are: changing the scalpel blade after the skin incision to limit contamination; bending the patient's knee when applying a thigh tourniquet; bed rest for treatment of deep vein thrombosis; antibiotics in irrigation solution; routine use of hip precautions; routine use of antibiotics for the duration of wound drains; routine removal of hardware in children; correlation between operative time and infection; and not changing dressings on the floor before scrubbing. A survey of 186 practicing orthopaedic surgeons in academic and community settings was performed to assess their routine practice patterns. We present the results of the survey along with an in-depth literature review of these topics. Most surgeon practices are based on a combination of knowledge gained during training, reading the literature, and personal experience. The results of this survey hopefully will raise the awareness of the selected literature for common practices. PMID:18726654
Donaldson, Lachlan H; Brooke, Kathryn; Faux, Steven G
A file review of patients presenting to the Emergency Department of St Vincent's Hospital with fractures sustained in a road crash was completed to describe patterns of orthopaedic injury, acute intervention and separation as well as the cost of care for adult road crash victims. One-hundred and eighty-seven patients were included. 65.8% were male; 48.1% were pedestrians. Differing patterns of injury corresponded to the role of the patient in the road crash (eg, pedestrian, driver of vehicle, etc). The mean length of stay was 8.8 days. 35.2% of patients were prescribed a different analgesic at discharge to that which they had received in the previous 24 hours. 35.8% had a documented discussion regarding insurance matters, usually with a social worker. 11.9% were discharged to inpatient rehabilitation. 56.2% had orthopaedic follow-up arranged at discharge, while 4.8% were discharged to an outpatient rehabilitation clinic. The mean overall cost was $13 336, with patients aged over 65 costing the most. The quality of acute care for fractures sustained in road crashes could be improved with evidence-based analgesia management, increased screening for psychiatric sequelae, enhanced assistance with insurance matters and vocational issues, and closer follow-up. Further research into the impact of these factors on long-term recovery is warranted. PMID:19203336
De Lorenzo, Danilo; De Momi, Elena; Beretta, Elisa; Cerveri, Pietro; Perona, Franco; Ferrigno, Giancarlo
Computer Assisted Orthopaedic Surgery (CAOS) systems improve the results and the standardization of surgical interventions. Anatomical landmarks and bone surface detection is straightforward to either register the surgical space with the pre-operative imaging space and to compute biomechanical parameters for prosthesis alignment. Surface points acquisition increases the intervention invasiveness and can be influenced by the soft tissue layer interposition (7-15mm localization errors). This study is aimed at evaluating the accuracy of a custom-made A-mode ultrasound (US) system for non invasive detection of anatomical landmarks and surfaces. A-mode solutions eliminate the necessity of US images segmentation, offers real-time signal processing and requires less invasive equipment. The system consists in a single transducer US probe optically tracked, a pulser/receiver and an FPGA-based board, which is responsible for logic control command generation and for real-time signal processing and three custom-made board (signal acquisition, blanking and synchronization). We propose a new calibration method of the US system. The experimental validation was then performed measuring the length of known-shape polymethylmethacrylate boxes filled with pure water and acquiring bone surface points on a bovine bone phantom covered with soft-tissue mimicking materials. Measurement errors were computed through MR and CT images acquisitions of the phantom. Points acquisition on bone surface with the US system demonstrated lower errors (1.2mm) than standard pointer acquisition (4.2mm).
Lynch, T. Sean; Parker, Richard D.; Patel, Ronak M.; Andrish, Jack T.; Spindler, Kurt P.
With an estimated 200,000 anterior cruciate ligament reconstructions performed annually in the United States, there is an emphasis on determining patient-specific information to help educate patients on expected clinically relevant outcomes. The Multicenter Orthopaedic Outcomes Network consortium was created in 2002 to enroll and longitudinally follow a large population cohort of anterior cruciate ligament reconstructions. The study group has enrolled >4,400 anterior cruciate ligament reconstructions from seven institutions to establish the large level I prospective anterior cruciate ligament reconstruction outcomes cohort. The group has become more than a database with information regarding anterior cruciate ligament injuries; it has helped to establish a new benchmark for conducting multicenter, multisurgeon orthopaedic research. The changes in anterior cruciate ligament reconstruction practice resulting from the group include the use of autograft for high school, college, and competitive athletes in their primary anterior cruciate ligament reconstructions. Other modifications include treatment options for meniscus and cartilage injuries, as well as lifestyle choices made after anterior cruciate ligament reconstruction. PMID:25667401
Kovacs, Eszter; Szocska, Gabor; Knai, Cécile
Background: The importance of cross-border healthcare, medical and health tourism plays a significant role in the European health policy and health management. After dentistry, orthopaedic treatments are the leading motivation for seeking care in Hungary, as patients with rheumatic and motion diseases are drawn to the thermal spas and well-established orthopaedic centres. This paper aims to gain insight into foreign patients’ perspectives on their experience of having sought medical tourism in orthopaedic care in Hungary. Methods: A patient survey was conducted in 2012 on motivations for seeking treatment abroad, orthopaedic care received and overall satisfaction. In addition, health professionals’ interviews, and 17 phone interviews were conducted in 2013 with Romanian patients who had orthopaedic treatment in Hungary. Finally, medical records of foreign patients were analysed. Results: The survey was completed by 115 participants – 61.1% females, mean age= 41.9, 87% Romanian origin. Most of the patients came to Hungary for orthopaedic surgeries, e.g. arthroscopy, knee/hip prosthesis or spinal surgery. 72.6% chose Hungary because of related to perceived better quality and longstanding culture of Hungarian orthopaedic care. Over 57% of patients reported being ‘very satisfied’ with care received and 41.6% ‘satisfied’. The follow-up interviews further reflected this level of satisfaction, therefore many respondents stating they have already recommended the Hungarian healthcare to others. Conclusion: Based on the findings, patients from neighbouring regions are increasingly seeking orthopaedic care in Hungary. Patients having orthopaedic care are highly satisfied with the quality of care, the whole treatment process from the availability of information to discharge summaries and would consider returning for further treatments. PMID:25396209
Levinson, Harry J.
Until recently, lithography capability evolved consistently with Moore's law. It appears that semiconductor manufacturers are now deviating from Moore's law, which has implications for lithography equipment. DUV lithography is moving into production in a mix-and-match environment. Step- and-scan technology is the wave of the near-future, as a way to contend with the difficulty of manufacturing wide-field lenses. Resist processing equipment will undergo few fundamental changes, but will often be integrated with steppers, particularly for DUV applications. Metrology is being stretched beyond its limits for technologies below 250 nm. The move is on to 300 m diameter wafers, and 193 nm lithography is under consideration.
Frank, M; Mathieu, L
The extremities continue to be the most frequent sites of wounding during armed conflicts despite the change of combat tactics, soldier armour and battlefield medical support. Due to the advances in prehospital care and timely transport to the hospital, orthopaedic surgeons deal with severe and challenging injuries of the limbs. In contrast to civilian extremity trauma, the most combat-related injuries are open wounds that often have infection-related complications. Data from two recent large armed conflicts (Iraq, Afghanistan) show that extremity injuries are associated with a high complication rate, morbidity and healthcare utilization. A systematic approach that consists of sequential surgical care and good transport capabilities can reduce the complication rate of these injuries. New medical technologies have been implemented in the treatment strategy during the last decade. This article reviews the published scientific data and current opinions on combat-related extremity injuries. Key words: extremity, combat, trauma, medical support system. PMID:23777944
Phillips, Donna P; Zuckerman, Joseph D; Kalet, Adina; Egol, Kenneth A
The Accreditation Council of Graduate Medical Education requires that residency programs teach and assess trainees in six core competencies. Assessments are imperative to determine trainee competence and to ensure that excellent care is provided to all patients. A structured, direct observation program is feasible for assessing nontechnical core competencies and providing trainees with immediate constructive feedback. Direct observation of residents in the outpatient setting by trained faculty allows assessment of each core competency. Checklists are used to document residents' basic communication skills, clinical reasoning, physical examination methods, and medical record keeping. Faculty concerns regarding residents' professionalism, medical knowledge, fatigue, or ability to self-assess are tracked. Serial observations allow for the reinforcement and/or monitoring of skills and attitudes identified as needing improvement. Residents who require additional coaching are identified early in training. Progress in educational milestones is recorded, allowing an individualized educational program that ensures that future orthopaedic surgeons excel across all domains of medical and surgical competence. PMID:27479831
Di Matteo, Berardo; Tarabella, Vittorio; Filardo, Giuseppe; Tomba, Patrizia; Viganò, Anna; Kon, Elizaveta; Marcacci, Maurilio
The First World War was a very harsh conflict and statistics recorded a great number of victims, both soldiers and civilians. One hundred years later, the whole world is commemorating the Great War by celebrating people and events that contributed to shaping the XX century. Beyond remembering political figures, war heroes or even famous battles, it is also important to underline the contribution of those who devoted their efforts to improve the living conditions during war campaigns. This is the case of Sir Robert Jones, one of the fathers of XX century orthopaedics, who contributed to re-organize the military medical assistance during war times and whose teachings, coming directly from his "on the field" experience, inspired an entire generation of European surgeons. PMID:25435061
In Japan, the treatment of soft tissue sarcomas (STS) has been performed mainly by orthopaedic surgeons. The standard therapy for all cases of STS is surgical resection of the tumor. The prognosis of patients with unresectable tumors or distant metastases is poor despite treatment with intensive chemotherapy. Adjuvant chemotherapy is indicated for patients with resectable tumors. Round-cell STS, including extraskeletal Ewing sarcoma and rhabdomyosarcoma, have high sensitivity to chemotherapy. The standard treatment for round-cell STS is multimodal therapy with surgery and chemotherapy, with or without radiotherapy. On the other hand, non-round cell STS, including leiomyosarcoma, synovial sarcoma, and liposarcoma, have low sensitivity to chemotherapy. Thus, the standard treatment for non-round cell STS is essentially, surgery. Large and high-grade non-round cell STS are also treated using adjuvant chemotherapy along with surgery. In this review, the standard therapies for STS and the future perspective in Japan are discussed. PMID:26809525
Recent progress in orthopaedic treatment of osteoporosis-related fractures was reviewed. In the treatment of femoral neck fractures, impacted or nondisplaced type is treated by three cannulated cancellous pins. Displaced type of femoral neck fracture is treated by bipolar prosthesis. Results of femoral neck fractures are influenced by the complications of each patients. Osteoporotic spine fractures are commonly healed within 2 or 3 months. Spinal compression with paraparesis or paraplegia is unusual complication in burst type of spine fractures. Surgical decompression, bone grafting and stabilization with instrumentation can result in some correction of deformity and neurogenic recovery. Distal radius fractures are common fractures in the eldery. Recently advances includes external fixation and plate fixation for the comminuted fractures in the distal radius. Treatments of osteoporosis-related fractures are still difficult problems to be resolved. PMID:21774371
Aksakal, B; Yildirim, O S; Okur, A
Biocompatibility of orthopaedic surgical implants with bone tissue allows adequate osseointegration between the bone and implant. To achieve this, implants are coated with biocompatible materials. The costly plasma spray procedure is routinely used to coat implants but uses high temperatures (over 16,000 degrees C), which affect the surface quality and microstructure of the implant. We analysed the effect of sintering temperature, time and rate on coated and uncoated implants using a dipping method. The effectiveness of synthetic hydrated calcium silicate compound as an interlayer was also investigated, using the dipping method and electrophoretic deposition. Sintering temperature, time and rate all affected the quality of the bond with the coating, but the interlayer bonded effectively with both implant and biocompatible coating. Electrophoretic deposition resulted in imperfect bonding and some irregularity on the substrate surface was seen. This technique may be improved by using coating particles of a smaller size. PMID:14587310
Savage, P E; d'A Fearn, C B; Groom, A F; Heatley, F W
In preparation for the introduction of the specialist registrar grade the specialist advisory committee (SAC) in orthopaedics developed a six-year structured training programme leading to the award of the Certificate of Completion of Specialist Training (CCST). A team comprising the regional adviser in orthopaedics, the two regional programme directors and an associate dean of postgraduate medicine visited all the departments of orthopaedics in the South East Thames Region in order to evaluate the training opportunities they provided. This paper describes the methodology used during these visits, the lessons learned and the conclusions drawn. PMID:9496169
Lundy, Douglas W
Orthopaedic trauma has been associated with the history of medical liability all the way back to the dark ages and the bubonic plague. Caps on noneconomic damages and other reforms have been challenged in many states, and an innovative approach to medical liability reform must be developed within the medical profession and the various legislatures. Orthopaedic trauma surgeons have a unique perspective in that they perform a critical service to the community, however they are often deprived of the benefit of preoperative risk reduction best practices because of the critical needs of the patients. Orthopaedic trauma surgeons must advocate for effective medical liability reforms. PMID:25229679
Boiadjiev, George; Kastelov, Rumen; Boiadjiev, Tony; Delchev, Kamen; Zagurski, Kazimir
Bone drilling manipulation often occurs in the orthopaedic surgery. By statistics, nowadays, about one million people only in Europe need such an operation every year, where bone implants are inserted. Almost always, the drilling is performed handily, which cannot avoid the subjective factor influence. The question of subjective factor reduction has its answer - automatic bone drilling. The specific features and problems of orthopaedic drilling manipulation are considered in this work. The automatic drilling is presented according the possibilities of robotized system Orthopaedic Drilling Robot (ODRO) for assuring the manipulation accuracy, precision, reliability and safety.
Trampuz, Andrej; Zimmerli, Werner
The pathogenesis of implant-associated infection involves interaction between the microorganisms (biofilm formation), the implant and the host. Despite improvement of perioperative prophylaxis, orthopaedic implants still remain highly susceptible to bacterial or fungal contamination, generally resulting in persistent implant-associated infection. Therefore, perioperative and life-long prevention of infection is important. For perioperative prophylaxis, a first- or second-generation cephalosporin is recommended, which should be administered between 60 and 30 minutes before incision. The duration of prophylaxis should not exceed 1 day. In centres with a low incidence of infection, a single dose is sufficient. Treatment of infections associated with orthopaedic devices usually requires appropriate surgical intervention combined with prolonged antimicrobial therapy. The choice of the antimicrobial regimen depends on the duration and pathogenesis of infection, stability of the implant, antimicrobial susceptibility of the pathogen and condition of the surrounding soft tissue. The role of rifampicin (rifampin), which has excellent activity on adherent staphylococci, in combination with beta-lactams, glycopeptides, fluoroquinolones, minocycline, cotrimoxazole or fusidic acid, in the treatment of staphylococcal infections is outlined. Increasing antimicrobial resistance requires the use of alternative agents, such as quinupristin/dalfopristin, linezolid and daptomycin, but results of clinical trials with these agents are limited. Also reviewed are potential new antimicrobial agents currently undergoing investigation, such as the novel oxazolidinone RWJ-416457, the new glycopeptide dalbavancin, the glycylcycline compound tigecycline, the new carbacephem BP-102 and novel rifamycin derivatives. Vaccination against Staphylococcus aureus with StaphVAX induced specific antibodies potentially preventing bacteraemia; however, there are no studies on efficacy in the prophylaxis of
Friedman, R J; Schiff, C F; Bromberg, J S
It is commonly thought that patients receiving exogenous glucocorticoids have suppression of the hypothalamic-pituitary-adrenal axis and need high supplemental doses of exogenous glucocorticoids (so-called stress steroids) to meet the demands of operative stress. Several reports have suggested that clinically important suppression of the hypothalamic-pituitary-adrenal axis is extremely uncommon and that the levels of glucocorticoids required for stress are much lower than previously believed. A prospective study of twenty-eight patients who had thirty-five major orthopaedic operations was conducted. No patient received stress steroids; they were given only the baseline immunosuppressive doses of glucocorticoids (mean dose, ten milligrams of prednisone). Clinical information (based on regular physical examinations for signs and symptoms of hypotension, myalgia, arthralgia, ileus, and fever) and laboratory data (serum sodium levels, eosinophil count, and twenty-four-hour urinary free-cortisol levels, determined at perioperative and non-stress postoperative time-periods) were obtained to document any evidence of adrenocortical insufficiency. There was no such evidence in any of the patients, who were monitored during their entire hospitalization. The levels of twenty-four-hour urinary free cortisol showed that all patients had endogenous adrenocortical function and, when this information was considered together with the clinical outcome, it was concluded that this level of function was sufficient to meet the demands of operative stress. Adrenocortical insufficiency in patients who have orthopaedic operations without receiving supplemental stress steroids appears to be much less common than previously thought. While biochemical testing of the function of the hypothalamic-pituitary-adrenal axis may sometimes reveal evidence of adrenal insufficiency, these tests do not predict the clinical outcome and may be too sensitive to guide decisions regarding treatment
New, Steve; Hadi, Mohammed; Pickering, Sharon; Robertson, Eleanor; Morgan, Lauren; Griffin, Damian; Collins, Gary; Rivero-Arias, Oliver; Catchpole, Ken; McCulloch, Peter
Objectives To examine the effectiveness of a “systems” approach using Lean methodology to improve surgical care, as part of a programme of studies investigating possible synergy between improvement approaches. Setting A controlled before-after study using the orthopaedic trauma theatre of a UK Trust hospital as the active site and an elective orthopaedic theatre in the same Trust as control. Participants All staff involved in surgical procedures in both theatres. Interventions A one-day “lean” training course delivered by an experienced specialist team was followed by support and assistance in developing a 6 month improvement project. Clinical staff selected the subjects for improvement and designed the improvements. Outcome Measures We compared technical and non-technical team performance in theatre using WHO checklist compliance evaluation, “glitch count” and Oxford NOTECHS II in a sample of directly observed operations, and patient outcome (length of stay, complications and readmissions) for all patients. We collected observational data for 3 months and clinical data for 6 months before and after the intervention period. We compared changes in measures using 2-way analysis of variance. Results We studied 576 cases before and 465 after intervention, observing the operation in 38 and 41 cases respectively. We found no significant changes in team performance or patient outcome measures. The intervention theatre staff focused their efforts on improving first patient arrival time, which improved by 20 minutes after intervention. Conclusions This version of “lean” system improvement did not improve measured safety processes or outcomes. The study highlighted an important tension between promoting staff ownership and providing direction, which needs to be managed in “lean” projects. Space and time for staff to conduct improvement activities are important for success. PMID:27124012
A medical refrigeration and a water pump both powered by solar cells that convert sunlight directly into electricity are among the line of solar powered equipment manufactured by IUS (Independent Utility Systems) for use in areas where conventional power is not available. IUS benefited from NASA technology incorporated in the solar panel design and from assistance provided by Kerr Industrial Applications Center.
For the last decade, quality and safety have been the ardent focus of healthcare improvement. Many agencies provide resources to healthcare providers to assist their endeavors. The Quality and Safety Education for Nurses (QSEN) Collaboration developed competencies that define the concepts of quality and safety in relation to nursing practice and education. These concepts are not new to orthopaedic nursing; they are better defined through the QSEN competencies so that nurses can develop practice behaviors that ensure quality and safety for the patients they care for. The QSEN competencies guide the processes that support the Orthopaedic Core Competencies: Across the Lifespan. Together, they enhance the orthopaedic specialty by deepening the focus on patient safety and high-quality care. Preceptors are in a unique position to influence new nurses and those transitioning into orthopaedic nursing to adopt these practices as they develop skills to meet the requirements of the specialty. PMID:23518753
Jäger, M.; Zilkens, C.; Zanger, K.; Krauspe, R.
Cell-surface interactions play a crucial role for biomaterial application in orthopaedics. It is evident that not only the chemical composition of solid substances influence cellular adherence, migration, proliferation and differentiation but also the surface topography of a biomaterial. The progressive application of nanostructured surfaces in medicine has gained increasing interest to improve the cytocompatibility and osteointegration of orthopaedic implants. Therefore, the understanding of cell-surface interactions is of major interest for these substances. In this review, we elucidate the principle mechanisms of nano- and microscale cell-surface interactions in vitro for different cell types onto typical orthopaedic biomaterials such as titanium (Ti), cobalt-chrome-molybdenum (CoCrMo) alloys, stainless steel (SS), as well as synthetic polymers (UHMWPE, XLPE, PEEK, PLLA). In addition, effects of nano- and microscaled particles and their significance in orthopaedics were reviewed. The significance for the cytocompatibility of nanobiomaterials is discussed critically. PMID:18274618
... any natural person, corporation, firm, company, sole proprietorship, partnership, joint venture... Idaho Orthopaedic Society (``IOS'') is a non-profit corporation organized and doing business under the....A. (``ISMI''), an orthopedic practice group consisting of four physicians, is a...
Markatos, Konstantinos; Efstathopoulos, Nikolaos; Kaseta, Kiriaki Maria; Nikolaou, Vasileios; Tsoucalas, Gregory; Sgantzos, Markos
The purpose of our study was to summarize all the knowledge concerning the innovative pioneer in the field of orthopaedic surgery, Nicholas J. Giannestras (1908-1978). A thorough study of texts, medical books and reports, in the field of history of medicine, together with a review of the available literature in PubMed, was undertaken. Giannestras left his mark in the history of orthopaedics with his clinical work and his publications, mainly his treatise "Foot Disorders: Medical and Surgical Management" (1973), while his name lingers in Greece with the introduction of spine fusion with the use of metallic implants. He was an eminent university clinical professor of orthopaedics who had harmonically combined academic writing, teaching and clinical research in every field of orthopaedic surgery. PMID:26255057
Zhang, Bill G. X.; Myers, Damian E.; Wallace, Gordon G.; Brandt, Milan; Choong, Peter F. M.
Joint replacement is a major orthopaedic procedure used to treat joint osteoarthritis. Aseptic loosening and infection are the two most significant causes of prosthetic implant failure. The ideal implant should be able to promote osteointegration, deter bacterial adhesion and minimize prosthetic infection. Recent developments in material science and cell biology have seen the development of new orthopaedic implant coatings to address these issues. Coatings consisting of bioceramics, extracellular matrix proteins, biological peptides or growth factors impart bioactivity and biocompatibility to the metallic surface of conventional orthopaedic prosthesis that promote bone ingrowth and differentiation of stem cells into osteoblasts leading to enhanced osteointegration of the implant. Furthermore, coatings such as silver, nitric oxide, antibiotics, antiseptics and antimicrobial peptides with anti-microbial properties have also been developed, which show promise in reducing bacterial adhesion and prosthetic infections. This review summarizes some of the recent developments in coatings for orthopaedic implants. PMID:25000263
Hsu, J D
Rancho Los Amigos Medical Center, initially a poor farm in the County of Los Angeles, CA became a world renown medical institution because of the polio epidemics in the 1950s. Responding to the need for day to day inpatient care were an overflow of victims of polio who had spine and extremity weakness and were dependent on respirators. Team care, developed at the institution, was used by Vernon L. Nickel, chief orthopaedic surgeon so that maximum use of the limited staff's efforts would be to take care of patients. This need spawned many innovative developments through clinical observations and trials, basic research, and engineering innovations that resulted in the patient's functional improvement and helped return many victims of polio to independence and to their communities. Subsequently, orthopaedic surgeons, Jacquelin Perry, and Alice Garrett joined the full-time staff as the workload increased. Stabilizing the spine using fascial supports, spinal fusion, spinal instrumentation, orthoses, and seating systems allowed those patients who were not totally dependent on respirators to be upright and mobilized. When polio was eradicated, newer programs were established for physically disabled persons with musculoskeletal disorders affecting the spine and extremities and for those patients with congenital, acquired, neurologic, and neuromuscular disorders. In formal graduate residency affiliations, fellowships, and continuing medical education programs orthopaedic surgeons from around the world have been taught the basic principles of "categorical care" for physically disabled people for 50 years. Orthopaedic care given through these programs formed the basis of a new orthopaedic subspecialty, Orthopaedic Rehabilitation. PMID:10818973
Rohman, Lebur; Hadi, Saifullah; Whitwell, George
PURPOSE. To investigate consultant surgeons' knowledge about the costs of implants for various joint surgeries. METHODS. Questionnaires were distributed to consultant orthopaedic surgeons at 2 hospitals. Respondents were asked to estimate the implant costs of any brand for low-demand and high-demand total hip replacement (THR), total knee replacement (TKR), uni-compartmental knee replacement, arthroscopy shaver blade, total anterior cruciate ligament (ACL) fixation, and meniscal repair. The actual cost of each implant was obtained from the manufacturer. RESULTS. 16 consultant surgeons completed the questionnaires. The respective mean estimated and actual costs for a low-demand THR implant were £1714 (range, £600-3000) and £1448 (range, £985- 2335), with an overestimation of 18.4%. The respective costs for a high-demand THR implant were £2172 (range, £600-6000) and £1737 (range, £1192-2335), with an overestimation of 25%. The respective costs for a TKR implant were £1550 (range, £600-6000) and £1316 (range, £995-1535), with an overestimation of 17.8%. The respective costs for a uni-compartmental knee replacement implant were £1040 (range, £600-2000) and £1296 (range, £698-1470), with an underestimation of 19.7%. The respective costs for an arthroscopy shaver blade were £110 (range, £75-150) and £94 (range, £80-100), with an overestimation of 16.6%. The respective costs for a total ACL fixation implant were £246 (range, £80-500) and £306 (range, £272-335), with an underestimation of 19.4%. The respective costs for a meniscal repair implant were £153 (range, £50-250) and £242 (range, £170-260), with an underestimation of 37%. CONCLUSION. The knowledge among consultant orthopaedic surgeons about implant costs was poor. To reduce implant costs, cooperation between surgeons and hospital managers and measures to increase surgeons' awareness about cost-reduction programmes are needed. PMID:25163960
The Lifeshear cutter, a rescue tool for freeing accident victims from wreckage, was developed under the Clinton Administration's Technology Reinvestment Program. Prior cutting equipment was cumbersome and expensive; the new cutter is 50 percent lighter and 70 percent cheaper. The cutter is pyrotechnically-actuated, using a miniature version of the power cartridges used for separation devices on the Space Shuttle and other NASA spacecraft. Hi-Shear Technology Corporation developed the cutter with the Jet Propulsion Laboratory and input from the City of Torrance (California) Fire Department.
Jakuscheit, Axel; Rudert, Maximilian
Wuerzburg in the centre of Germany claims to be a cradle of modern orthopaedics. Under the leadership of Johann Georg Heine (1771-1831) the first German orthopaedic hospital, the Carolinum, was established in 1816. Johann Georg Heine's legacy was continued by his son Joseph (1803-1877) and his nephew Bernhard Heine (1800-1846), before Albert Hoffa (1859-1907) put the clinical practice of orthopaedics on a strict scientific basis and further promoted a worldwide exchange of knowledge. In 1916, Albert Hoffa's successor Jakob Riedinger (1861-1917) founded the Koenig-Ludwig-Haus, which hosts the Orthopaedic Hospital and the Centre for Musculoskeletal Research of the University of Wuerzburg. On the occasion of the bicentenary and centenary anniversaries of the founding of the two orthopaedic hospitals, we provide a short view on the development of orthopaedics in Wuerzburg. PMID:27283104
Cerciello, Simone; Rossi, Silvio; Visonà, Enrico; Corona, Katia; Oliva, Francesco
Summary Background Vibration therapy (VT) has been proposed as an option to improve physical performance and reduce the negative effects of ageing on bone, muscles and tendons. Several discrepancies exist on the type of applications, frequency and magnitude. These differences reflex on the contradictory clinical results in literature. Aim of the present study is to carry on an exhaustive review to focus on technical options on the market, clinical applications in orthopaedic practice and expected outcomes. Methods a literature review using the key words “vibration therapy” and “whole-body vibration” and “orthopaedics” was performed. After checking the available abstracts 71 full text articles were evaluated. Results fifty-one articles focused on the effects of VT on muscles and tendons reporting ways of action and clinical outcomes. In a similar way 20 studies focused on the influence of VT on bone tissue with regard on ways of action and clinical trials. Conclusions VT provides anabolic mechanical signals to bone and musculo-tendinous system. The best effects seem to be achieved with devices that deliver low-intensity stimuli at high frequencies providing linear horizontal displacement. PMID:27331044
Bumbasirević, M; Lesić, A; Sudjić, V; Zagorac, S
Richard von Volkman was one of the most famous and important surgeons in the 19th century. He pioneered antiseptic procedures and was especially known for his achivements in orthopedic surgery. Von Volkmann was born in Leipzig, Germany and attended medical schools in Giessen, Halle, and Berlin. Starting in 1867, he worked as a professor of surgery at the University of Halle, also leading its surgical clinic. He was active as a surgeon during Seven Weeks' War with Austria in 1866 and the Franco-Prussian war 1870/1871, in the latter as consulting Generalarzt. He was important in the introduction of antiseptic wound treatment in Germany, and through it to the United States of America. Two observations in orthopaedic surgery bear his name to these days: Volkmans contracture and Heuter-Volkmans low. Volkmann also wrote poetry under the name Richard Leander and his book entitled "Dreams by French Firesides" which still has a place in literature. He died of paralysis due to a chronic spinal disease, following a prolonged illness, in the Binswanger institution in Jena in 1889, at the top of his careere. PMID:20954309
Daugaard, Henrik; Søballe, Kjeld
The objective of this study was to directly measure the radiation exposure to the orthopaedic surgeon and to measure dose points to the surgeon’s fingers, thyroid gland, and forehead during intraoperative fluoroscopy in periacetabular osteotomy (PAO). In a series of 23 consecutive periacetabular osteotomy procedures, exposure monitoring was carried out using thermo luminescent dosimeters. The effective dose received by the operating surgeon was 0.008 mSv per operation which adds up to a yearly dose of 0.64 mSv from PAO. The median point equivalent dose (mSv) exposure under PAO was 0.009 for the forehead and thyroid gland, 0.045 for the right index finger, and 0.039 for the left index finger. The effective estimated yearly dose received by the operating surgeon was very low. Wearing a lead collar reduces radiation exposure to the thyroid gland while the lead gloves did not protect the surgeon’s fingers. PMID:18958467
MacAvelia, Troy; Ghasempoor, Ahmad; Janabi-Sharifi, Farrokh
The advent of haptic simulation systems for orthopaedic surgery procedures has provided surgeons with an excellent tool for training and preoperative planning purposes. This is especially true for procedures involving the drilling of bone, which require a great amount of adroitness and experience due to difficulties arising from vibration and drill bit breakage. One of the potential difficulties with the drilling of bone is the lack of consistent material evacuation from the drill's flutes as the material tends to clog. This clogging leads to significant increases in force and torque experienced by the surgeon. Clogging was observed for feed rates greater than 0.5 mm/s and spindle speeds less than 2500 rpm. The drilling simulation systems that have been created to date do not address the issue of drill flute clogging. This paper presents force and torque prediction models that account for this phenomenon. The two coefficients of friction required by these models were determined via a set of calibration experiments. The accuracy of both models was evaluated by an additional set of validation experiments resulting in average R² regression correlation values of 0.9546 and 0.9209 for the force and torque prediction models, respectively. The resulting models can be adopted by haptic simulation systems to provide a more realistic tactile output. PMID:23167723
Wang, Guocheng; Lu, Zufu; Liu, Xuanyong; Zhou, Xiaming; Ding, Chuanxian; Zreiqat, Hala
Glass–ceramics have attracted much attention in the biomedical field, as they provide great possibilities to manipulate their properties by post-treatments, including strength, degradation rate and coefficient of thermal expansion. In this work, hardystonite (HT; Ca2ZnSi2O7) and sphene (SP; CaTiSiO5) glass–ceramic coatings with nanostructures were prepared by a plasma spray technique using conventional powders. The bonding strength and Vickers hardness for HT and SP coatings are higher than the reported values for plasma-sprayed hydroxyapatite coatings. Both types of coatings release bioactive calcium (Ca) and silicon (Si) ions into the surrounding environment. Mineralization test in cell-free culture medium showed that many mushroom-like Ca and phosphorus compounds formed on the HT coatings after 5 h, suggesting its high acellular mineralization ability. Primary human osteoblasts attach, spread and proliferate well on both types of coatings. Higher proliferation rate was observed on the HT coatings compared with the SP coatings and uncoated Ti-6Al-4V alloy, probably due to the zinc ions released from the HT coatings. Higher expression levels of Runx2, osteopontin and type I collagen were observed on both types of coatings compared with Ti-6Al-4V alloy, possibly due to the Ca and Si released from the coatings. Results of this study point to the potential use of HT and SP coatings for orthopaedic applications. PMID:21292725
Devanathan, D.; King, R.; Swarts, D.; Lin, S.; Ramani, K.; Tagle, J.
The orthopaedics industry has witnessed tremendous growth in recent years primarily due to the introduction of high performance, porous coated implants. These devices have eliminated the need for the use of bone cement for in vivo implant fixation, replacing it with the ingrowth of bone into the porous surfaces. The metallurgical bonding processes used for attaching the porous to the implant body introduce some undesirable effect i.e., the reduction of the fatigue strength of the implant due to the ``notches`` created and also due to the high temperature exposure during the sintering operations. This paper describes the development of a thermoplastic polymeric adhesive based structural bonding technique. The high performance polymeric adhesive is fully characterized with respect to its intended application. The design of the porous layer is optimized to achieve a reliable bond to the implant. A thermal heating/cooling process was developed to control the final polymer morphology. Static and fatigue tests were conducted to fully characterize the adhesive bond strength. A ring shear test method was developed to determine the shear strength of the bond interface. Besides the characterization of the adhesive bond, the joints will be analyzed using finite element models. The correlation between the analytical models and the
Adhikari, Raju; Gunatillake, Pathiraja A; Griffiths, Ian; Tatai, Lisa; Wickramaratna, Malsha; Houshyar, Shadi; Moore, Tim; Mayadunne, Roshan T M; Field, John; McGee, Margaret; Carbone, Tania
Biodegradable polyurethanes offer advantages in the design of injectable or preformed scaffolds for tissue engineering and other medical implant applications. We have developed two-part injectable prepolymer systems (prepolymer A and B) consisting of lactic acid and glycolic acid based polyester star polyols, pentaerythritol (PE) and ethyl lysine diisocyanate (ELDI). This study reports on the formulation and properties of a series of cross linked polyurethanes specifically developed for orthopaedic applications. Prepolymer A was based on PE and ELDI. Polyester polyols (prepolymer B) were based on PE and dl-lactic acid (PEDLLA) or PE and glycolic acid (PEGA) with molecular weights 456 and 453, respectively. Several cross linked porous and non-porous polyurethanes were prepared by mixing and curing prepolymers A and B and their mechanical and thermal properties, in vitro (PBS/37 degrees C/pH 7.4) and in vivo (sheep bi-lateral) degradation evaluated. The effect of incorporating beta-tricalcium phosphate (beta-TCP, 5 microns, 10 wt.%) was also investigated. The cured polymers exhibited high compressive strength (100-190 MPa) and modulus (1600-2300 MPa). beta-TCP improved mechanical properties in PEDLLA based polyurethanes and retarded the onset of in vitro and in vivo degradation. Sheep study results demonstrated that the polymers in both injectable and precured forms did not cause any surgical difficulties or any adverse tissue response. Evidence of new bone growth and the gradual degradation of the polymers were observed with increased implant time up to 6 months. PMID:18632149
DiNucci, Ellen M
Complementary and alternative therapies continue to grow in popularity among healthcare consumers. Among those modalities is energy healing (EH) (Eisenberg et al., 1998). EH is an adjunctive treatment that is noninvasive and poses little downside risk to patients. Well more than 50 major hospitals and clinics throughout the United States offer EH to patients (DiNucci, research table on healthcare facilities that offer Reiki, unpublished data, 2002). The National Institutes of Health is funding numerous EH studies that are examining its effects on a variety of conditions, including temporomandibular joint disorders, wrist fractures, cardiovascular health, cancer, wound healing, neonatal stress, pain, fibromyalgia, and AIDS (National Institutes of Health, 2004a). Several well-designed studies to date show significant outcomes for such conditions as wound healing (Grad, 1965) and advanced AIDS (Sicher, Targ, Moore, & Smith, 1998), and positive results for pain and anxiety (Aetna IntelliHealth, 2003a; Wardell, Weymouth, 2004), among others (Gallob, 2003). It is also suggested that EH may have positive effects on various orthopaedic conditions, including fracture healing, arthritis, and muscle and connective tissue (Prestwood, 2003). Because negative outcomes risk is at or near zero throughout the literature, EH is a candidate for use on many medical conditions. PMID:16056170
Namavar, F.; Rubinstein, A.; Sabirianov, R.; Thiele, G.; Sharp, J.; Pokharel, U.; Namavar, R.; Garvin, K.
Osseointegration failure of the prosthesis prevents long-term stability, which contributes to pain, implant loosening, and infection that usually necessitates revision surgery. Cell attachment and spreading in vitro is generally mediated by adhesive proteins such as fibronectin and vitronectin. We designed and produced pure cubic zirconia (ZrO2) ceramic coatings by ion beam assisted deposition (IBAD) with nanostructures comparable to the size of proteins. Our ceramic coatings exhibit high hardness and a zero contact angle with serum. In contrast to Hydroxyapatite (HA), nano-engineered zirconia films possess excellent adhesion to all orthopaedic materials. Adhesion and proliferation experiments were performed with a bona fide mesenchymal stromal cells cell line (OMA-AD). Our experimental results indicated that nano-engineered cubic zirconia is superior in supporting growth, adhesion, and proliferation. We performed a comparative analysis of adsorption energies of the FN fragment using quantum mechanical calculations and Monte Carlo simulation on both types of surfaces: smooth and nanostructured. We have found that the initial FN fragment adsorbs significantly stronger on the nanostructured surface than on the smooth surface.
Beaussier, M; Sciard, D; Sautet, A
Postoperative pain relief is one of the cornerstones of success of orthopaedic surgery. Development of new minimally-invasive surgical procedures, as well as improvements in pharmacological and local and regional techniques should result in optimal postoperative pain control for all patients. The analgesic strategy has to be efficient, with minimal side effects, and be easy to manage at home. Multimodal analgesia allows for a reduction of opiate use and thereby its side effects. Local and regional analgesia is a major component of this multimodal strategy, associated with optimal pain relief, even upon mobilization, and it has beneficial effects on postoperative recovery. Ultrasound guidance improves the success rate of distal nerve blocks and makes distal selective blockade possible, helping to preserve the limb's motility. Besides peripheral nerve blocks, local infiltration (incisional and/or intra-articular) is also important to consider. Duration of the nerve blockade is limited after a single injection. This must be taken into consideration to avoid the recurrence of pain when the patient returns home. Continuous perineural blocks using catheters are an option that can be easily managed at home with monitoring by home-care nurses. Extended-release liposomal bupivacaine and adjuvants such as dexamethasone could significantly enhance the duration of the sensory block, thereby reducing the indications for pain pumps. Non-pharmacological approaches, such as cryotherapy, hypnosis and acupuncture should not be ignored. PMID:26803223
Katchky, Ryan N; McLachlin, Stewart D; Wong, Edwin K Y; Finkelstein, Joel; Kreder, Hans J; Whyne, Cari M
Thermal cycling is a temperature modulation process developed to improve the performance, durability and longevity of materials. This process has been successfully utilized in the automotive, aeronautic and manufacturing industries. Surgical cutting tools undergo cyclical loading and generally fail by dulling, suggesting that thermal cycling may improve their performance and longevity. Ten 2.5 mm orthopaedic drill bits were randomized, with five undergoing thermal cycling within their sterile packaging and five serving as untreated controls. Using a servohydraulic testing machine, 100 drilling cycles were performed with each drill bit into the diaphyseal region of bovine femurs. After every 25 cycles, data was collected by performing identical drilling cycles into simulated human cortical bone material. Maximum force, maximum normalized torque and drilling work were measured, and a scanning electron microscope was used to measure outer corner wear. After 100 drilling cycles, the maximum drilling force, maximum normalized torque, drilling work and microscopic outer corner wear were all significantly lower for the treated drill bits (p < 0.05). Thermal cycling has the potential to decrease operating room costs and thermal necrosis associated with dull cutting tools. Application of this technology may also be relevant to surgical cutting tools such as saw blades, burrs and reamers. PMID:26296244
Lawrence, John E; Khanduja, Vikas
AIM: To compare the trauma experience gained by a trainee at a United Kingdom major trauma centre and a secondary level hospital in South Africa. METHODS: A profile of inpatient trauma cases during a five-week period in Addenbrooke’s Hospital, Cambridge and Somerset Hospital, Cape Town was created. This was achieved by recording various parameters for each patient admitted including age, gender, injury, mechanism of injury and postal/area code. This, together with details of the departments themselves, allows a comparison of the amount and variety of orthopaedic trauma cases experienced by an individual trainee in each setting. RESULTS: The trauma profiles differed significantly. Patients in Cape Town were younger and more likely to be male. In the young, injury in Cape Town was more likely to occur due to assault or being struck by a vehicle, whilst patients in Cambridge were more likely to be injured whilst in a vehicle or in high energy falls. In older patients, trauma at both centres was almost exclusively due to mechanical falls. In a given age group, injuries at the two centres were similar, however the majority of patients admitted to Addenbrooke’s were elderly, resulting in less variation in the overall injury profile. CONCLUSION: The trauma profile of a major trauma centre in the United Kingdom is less varied than that of a South African secondary centre, with significantly fewer cases per surgeon. This suggests a more varied training experience in the developing world with a greater caseload. PMID:27190759
Magnavox Government & Electronics Company originally used the NASTRAN program in the design stage of heavy aluminum fixtures for vibration testing. Program also used to compare the resonant frequencies of the circuitry to predict whether failures may occur because of high vibration levels. The company engineers can then make design alterations to improve the equipment's vibration resistance. Method allows Magnavox to insure reliability and reduce any possibility of vibration-caused failure in critical defense products they manufacture. Magnavox uses another COSMIC software package called GENOPTICS in the development of a Digital Optical Recorder, and also in research and development of other optical systems. This enables use of an optically recorded disc to store and retrieve digital data. It is reported that this program provides accurate results and that its use saved six man-months of time that would have been needed to develop a comparable software package.
Hofstede, Stefanie N.; Marang-van de Mheen, Perla J.; Vliet Vlieland, Thea P. M.; van den Ende, Cornelia H. M.; Nelissen, Rob G. H. H.; van Bodegom-Vos, Leti
Introduction International evidence-based guidelines for the management of patients with hip and knee osteoarthritis (OA) recommend to start with (a combination of) non-surgical treatments, and using surgical intervention only if a patient does not respond sufficiently to non-surgical treatment options. Despite these recommendations, there are strong indications that non-surgical treatments are not optimally used in orthopaedic practice. To improve the adoption of non-surgical treatments, more insight is needed into barriers and facilitators of these treatments. Therefore, this study assessed which barriers and facilitators are associated with the use and prescription of different non-surgical treatments before hip and knee OA in orthopaedic practice among patients and orthopaedic surgeons in the Netherlands. Materials and Methods We performed two internet-based surveys among 172 orthopaedic surgeons and 174 OA patients. Univariate association and multivariable regression techniques are used to identify barriers and facilitators associated with the use of non-surgical treatments. Results Most barriers and facilitators among patients were associated with the use of physical therapy, lifestyle advice and dietary therapy. Among orthopaedic surgeons, most were associated with prescription of acetaminophen, dietary therapy and physical therapy. Examples of barriers and facilitators among patients included “People in my environment had positive experiences with a surgery” (facilitator for education about OA), and “Advice of people in my environment to keep on moving” (facilitator for lifestyle and dietary advice). For orthopaedic surgeons, examples were “Lack of knowledge about guideline” (barrier for lifestyle advice), “Agreements/ deliberations with primary care” and “Easy communication with a dietician” (facilitators for dietary therapy). Also the belief in the efficacy of these treatments was associated with increased prescription. Conclusions
Patel, Alpesh A; Singh, Kern; Nunley, Ryan M; Minhas, Shobhit V
The drive for evidence-based decision-making has highlighted the shortcomings of traditional orthopaedic literature. Although high-quality, prospective, randomized studies in surgery are the benchmark in orthopaedic literature, they are often limited by size, scope, cost, time, and ethical concerns and may not be generalizable to larger populations. Given these restrictions, there is a growing trend toward the use of large administrative databases to investigate orthopaedic outcomes. These datasets afford the opportunity to identify a large numbers of patients across a broad spectrum of comorbidities, providing information regarding disparities in care and outcomes, preoperative risk stratification parameters for perioperative morbidity and mortality, and national epidemiologic rates and trends. Although there is power in these databases in terms of their impact, potential problems include administrative data that are at risk of clerical inaccuracies, recording bias secondary to financial incentives, temporal changes in billing codes, a lack of numerous clinically relevant variables and orthopaedic-specific outcomes, and the absolute requirement of an experienced epidemiologist and/or statistician when evaluating results and controlling for confounders. Despite these drawbacks, administrative database studies are fundamental and powerful tools in assessing outcomes on a national scale and will likely be of substantial assistance in the future of orthopaedic research. PMID:26836377
Dei Giudici, L; Giampaolini, N; Panfighi, A; Marinelli, M; Procaccini, R; Gigante, A
The main concern for orthopaedic treatment in polytrauma has always been the same for almost forty years, which also regards "where" and "when" to proceed; correct surgical timing and correct interpretation of the DCO concept are still being debated. In the last few years, several attempts have been made to classify patients based on their clinical presentation and by trying to figure out which vital parameters are able to predict the patient's outcome. This study evaluated all patients who presented with code red at the Emergency Department of our Hospital, a level II trauma center. For every patient, the following characteristics were noted: sex, age, day of hospitalization, orthopaedic trauma, time to surgery, presence of an associated surgical condition in the fields of general surgery, thoracic surgery, neurosurgery and vascular surgery, cardiac frequency, blood pressure, oxygen saturation, Glasgow Coma Scale and laboratory data. All patients included were divided into subgroups based on orthopaedic surgical timing. Two other subgroups were also identified and analyzed in detail: deceased and weekend traumas. A total of 208 patients were included. Our primary goal was to identify a correlation between the mortality and surgical timing of the orthopaedic procedures; our secondary goal was to recognize, if present, a statistically relevant association between historical, clinical and laboratory data, and mortality rate, defining any possible risk factor. A correlation between mortality and orthopaedic surgical timing was not found. Analyzing laboratory data revealed an interesting correlation between mortality and: blood pressure, platelet count, cardiac frequency, hematocrit, hemoglobin and age. PMID:26312113
Furey, Andrew; Rourke, James; Larsen, Hans
Providing trauma care in an austere environment is very challenging, especially when the country is faced with a natural disaster. Unfortunately the combination of these elements highlights the deficiencies in managing orthopaedic trauma both in a developing country and in the face of a natural disaster, exponentially amplifying the effects of each. When considering the implementation and practice of orthopaedic trauma care in such an environment, one must consider the initial phase of program development and look further to the future in the development of a resilient program, which is sustainable. Through the use of the example of Haiti and a specific Non-Governmental Organization, we discuss the evidence for and thoughts behind developing orthopaedic trauma care program immediately after a natural disaster. This program aims to build capacity and empower a developing nation's health professionals to advance the care of orthopaedic trauma patients. We describe a model of capacity building that serves as a framework to highlight the strengths and weaknesses of low-to middle-income countries in providing orthopaedic trauma care when faced with such a challenge. PMID:26356206
Vaughan, Neil; Dubey, Venketesh N; Wainwright, Thomas W; Middleton, Robert G
This review presents current virtual reality based training simulators for hip, knee and other orthopaedic surgery, including elective and trauma surgical procedures. There have not been any reviews focussing on hip and knee orthopaedic simulators. A comparison of existing simulator features is provided to identify what is missing and what is required to improve upon current simulators. In total 11 hip replacements pre-operative planning tools were analysed, plus 9 hip trauma fracture training simulators. Additionally 9 knee arthroscopy simulators and 8 other orthopaedic simulators were included for comparison. The findings are that for orthopaedic surgery simulators in general, there is increasing use of patient-specific virtual models which reduce the learning curve. Modelling is also being used for patient-specific implant design and manufacture. Simulators are being increasingly validated for assessment as well as training. There are very few training simulators available for hip replacement, yet more advanced virtual reality is being used for other procedures such as hip trauma and drilling. Training simulators for hip replacement and orthopaedic surgery in general lag behind other surgical procedures for which virtual reality has become more common. Further developments are required to bring hip replacement training simulation up to date with other procedures. This suggests there is a gap in the market for a new high fidelity hip replacement and resurfacing training simulator. PMID:26751581
Background To investigate the characteristics of editors and criteria used by orthopaedic journal editors in assessing submitted manuscripts. Methods Between 2008 to 2009 all 70 editors of Medline listed orthopaedic journals were approached prospectively with a questionnaire to determine the criteria used in assessing manuscripts for publication. Results There was a 42% response rate. There was 1 female editor and the rest were male with 57% greater than 60 years of age. 67% of the editors worked in university teaching hospitals and 90% of publications were in English. The review process differed between journals with 59% using a review proforma, 52% reviewing an anonymised manuscript, 76% using a routine statistical review and 59% of journals used 2 reviewers routinely. In 89% of the editors surveyed, the editor was able to overrule the final decision of the reviewers. Important design factors considered for manuscript acceptance were that the study conclusions were justified (80%), that the statistical analysis was appropriate (76%), that the findings could change practice (72%). The level of evidence (70%) and type of study (62%) were deemed less important. When asked what factors were important in the manuscript influencing acceptance, 73% cited an understandable manuscript, 53% cited a well written manuscript and 50% a thorough literature review as very important factors. Conclusions The editorial and review process in orthopaedic journals uses different approaches. There may be a risk of language bias among editors of orthopaedic journals with under-representation of non-English publications in the orthopaedic literature. PMID:21527007
Ruso, Juan M; Sartuqui, Javier; Messina, Paula V
Bone is a biologically and structurally sophisticated multifunctional tissue. It dynamically responds to biochemical, mechanical and electrical clues by remodelling itself and accordingly the maximum strength and toughness are along the lines of the greatest applied stress. The challenge is to develop an orthopaedic biomaterial that imitates the micro- and nano-structural elements and compositions of bone to locally match the properties of the host tissue resulting in a biologically fixed implant. Looking for the ideal implant, the convergence of life and materials sciences occurs. Researchers in many different fields apply their expertise to improve implantable devices and regenerative medicine. Materials of all kinds, but especially hierarchical nano-materials, are being exploited. The application of nano-materials with hierarchical design to calcified tissue reconstructive medicine involve intricate systems including scaffolds with multifaceted shapes that provides temporary mechanical function; materials with nano-topography modifications that guarantee their integration to tissues and that possesses functionalized surfaces to transport biologic factors to stimulate tissue growth in a controlled, safe, and rapid manner. Furthermore materials that should degrade on a timeline coordinated to the time that takes the tissues regrow, are prepared. These implantable devices are multifunctional and for its construction they involve the use of precise strategically techniques together with specific material manufacturing processes that can be integrated to achieve in the design, the required multifunctionality. For such reasons, even though the idea of displacement from synthetic implants and tissue grafts to regenerative-medicine-based tissue reconstruction has been guaranteed for well over a decade, the reality has yet to emerge. In this paper, we examine the recent approaches to create enhanced bioactive materials. Their design and manufacturing procedures as well
Hou, M; Friedrich, K
The present study was focused on the development of a special thermoforming technique for manufacturing of continuous fibre reinforced thermoplastic composite parts with complex surface contours. In particular, a stamp forming process was modified to investigate the potential manufacturing advantages of thermoplastic composites in orthopaedic applications. An apparatus was designed which allowed the thermoforming procedure to be fully automatic, i.e. a cold pre-consolidated laminate panel, as the feed material, was heated up in an infrared heating zone and then transferred into a cold mould system, where it was stamp formed. Both halves of the mould were made of many tiny round metal sticks in a metal frame. This needle-bed mould allowed one to copy any contour by pushing it slightly on spring fixed sticks. The desired position of these sticks could then be adjusted by forcing the side plates of the metal frame together. To prevent any press mark of stick-tops on the composite, i.e. to achieve smooth surfaces of the themoformed composite parts, flexible rubber pads were needed to cover the mould surfaces. Experimental results showed that the surface profile of CF/PP and GF/PP composites formed by the needle-bed mould reproduced fairly well the contour of a saddle shaped, complex model sample. Unique properties of this needle-bed mould are that it can be repeatedly used, and that it can copy any complex surface contours, for example a bone surface, by simply adjusting the stick positions according to the special surface requirements. PMID:15348912
Huang, Jiahua; Zhou, Hai; Zhang, Binbin; Ding, Biao
This article develops a new failure database software for orthopaedics implants based on WEB. The software is based on B/S mode, ASP dynamic web technology is used as its main development language to achieve data interactivity, Microsoft Access is used to create a database, these mature technologies make the software extend function or upgrade easily. In this article, the design and development idea of the software, the software working process and functions as well as relative technical features are presented. With this software, we can store many different types of the fault events of orthopaedics implants, the failure data can be statistically analyzed, and in the macroscopic view, it can be used to evaluate the reliability of orthopaedics implants and operations, it also can ultimately guide the doctors to improve the clinical treatment level. PMID:26904871
Fuller, Brian C; Dowd, Thomas C; Masini, Brendan D; Gerlinger, Tad L
Previous studies have reported publication rates of abstracts presented at orthopaedic meetings from 22 to 68 percent. The objective of this study was to determine the publication rate of papers presented at the Society of Military Orthopaedic Surgeons (SOMOS) meetings from 1999 to 2003. A database was created including all abstracts presented at SOMOS meetings from 1999 to 2003 as listed in official program books. To assess whether each abstract resulted in publication in a peer-reviewed journal, a computerized PubMed search of the presenting author and appropriate keywords from the title was conducted. Overall, 191 of the 435 abstracts presented at SOMOS from 1999 to 2003 were published in a peer-reviewed journal, giving a publication rate of 44%. The publication rate of abstract presentations at annual SOMOS meetings compares favorably with the rates for other orthopaedic meetings. However, less than 50% result in peer-reviewed publication. PMID:22995357
O'Dowd, J K; Spencer, J D
An audit of undergraduate trauma and orthopaedic surgery teaching was carried out in 24 of the 27 medical schools in Great Britain and major differences were found between the medical schools. The range of time spent in teaching trauma and orthopaedic surgery for undergraduates varied from 3 weeks to 12 weeks and in five out of 27 medical schools trauma and orthopaedic surgery tuition was split between various years of the clinical curriculum. In some schools there were 30 students on a firm and in others only one. The opportunity for undergraduates to give feedback to their teachers, the use of objective assessment at the end of such an appointment by the teachers, varied between medical schools. To avoid some of these very basic differences between our medical schools, the teaching of clinical subjects to undergraduates in medicine should be reviewed nationally and minimum standards set. PMID:1433062
Ramasamy, Arul; Eardley, W G P; Edwards, D S; Clasper, J C; Stewart, M P M
The First World War (1914-1918) was the first truly industrial conflict in human history. Never before had rifle fire and artillery barrage been employed on a global scale. It was a conflict that over 4 years would leave over 750,000 British troops dead with a further 1.6 million injured, the majority with orthopaedic injuries. Against this backdrop, the skills of the orthopaedic surgeon were brought to the fore. Many of those techniques and systems form the foundation of modern orthopaedic trauma management. On the centenary of 'the War to end all Wars', we review the significant advances in wound management, fracture treatment, nerve injury and rehabilitation that were developed during that conflict. PMID:25512441
Ring, Gavin; O'Mullane, John; O'Riordan, Alan; Furey, Ambrose
In utilising metal surfaces that are in constant contact with each other, metal-on-metal (MoM) surgical implants present a unique challenge, in the sense that their necessity is accompanied by the potential risk of wear particle generation, metal ion release and subsequent patient toxicity. This is especially true of orthopaedic devices that are faulty and subject to failure, where the metal surfaces undergo atypical degradation and release even more unwanted byproducts, as was highlighted by the recent recall of orthopaedic surgical implants. The aim of this review is to examine the area of metallosis arising from the wear of MoM articulations in orthopaedic devices, including how the surgical procedures and detection methods have advanced to meet growing performance and analytical needs, respectively. PMID:26794632
[Prof. Michiharu Matsuoka, founder of the Department of Orthopaedic Surgery at Kyoto University and his achievements in orthopaedic surgery in the Meiji era of Japan (Part 5, Faculty members and training of doctors from Nagoya)].
During the years when Dr. M. Matsuoka was professor of the Department of Orthopaedic Surgery, Kyoto Medical School, Kyoto Imperial University (June, 1907-January, 1914), seven doctors worked as his faculty members and founded the base of the current development and reputation of the Department. After resignation from their academic positions, they served in orthopaedic practice in several areas in Japan where orthopaedic surgery was not well recognized. In addition, Prof. Matsuoka trained three doctors from the Aichi Prefectural Medical College (School of Medicine, Nagoya University) in the orthopaedic practice, including x-ray technique and they contributed to the development of orthopaedic surgery in the areas of Nagoya city and Tokai. Backgrounds and achievements of these ten doctors are described. PMID:21560319
Colì, Giuseppe; Abatelillo, Massimo; Cataldi, Giuseppe; De Caro, Francesco; Esposito, Diego; Mega, Walter; Perrone, Vinicio; Piscitelli, Prisco; Manno, Luigia
Considering that to international level it has put in evidence that often the diagnosis of osteoporosis is underestimated and that diagnostic and therapeutic attention of the same one are often neglected, the authors have assessed the degree of care provided by orthopaedic surgeons about the problem of osteoporosis, considering the medical files of orthopaedics department. Then corrective behaviour were proposed. PMID:22461253
McClurg, Ronald B.
An analysis of survey responses from a sample of orthopaedic physician's assistants on competency characteristics for their occupation is presented in this document. (Orthopaedic physician's assistant is one of seventeen occupation groups included in this research.) The competencies are reported in five categories: (1) those competencies selected…
Covassin, Tracey; Crutcher, Bryan; Bleecker, Alisha; Heiden, Erin O.; Dailey, Alexander; Yang, Jingzhen
Context: When an athlete is injured, the primary focus of the sports medicine team is to treat the physical effects of the injury. However, many injured athletes experience negative psychological responses, including anxiety, regarding their injury. Objective: To compare the anxiety and social support of athletes with concussions and a matched group of athletes with orthopaedic injuries. Design: Cross-sectional study. Setting: Athletic training room. Patients or Other Participants: A total of 525 injuries among athletes from 2 Big Ten universities were observed. Of these, 63 concussion injuries were matched with 63 orthopaedic injuries for the athlete's sex, sport, and time loss due to injury. Main Outcome Measure(s): Clinical measures included the State-Trait Anxiety Inventory (which measures both state and trait anxiety) and the modified 6-item Social Support Questionnaire. Results: The group with concussions relied on their family for social support 89% of the time, followed by friends (78%), teammates (65%), athletic trainers (48%), coaches (47%), and physicians (35%). The group with orthopaedic injuries relied on their family for social support 87% of the time, followed by friends (84%), teammates (65%), athletic trainers (57%), coaches (51%), and physicians (36%). We found no differences for the State-Trait Anxiety Inventory (t = −1.38, P = .193) between the concussed and orthopaedic-injury groups. Social Support Questionnaire scores were significant predictors for postinjury state anxiety. Specifically, increased scores were associated with decreased postinjury state anxiety (β = −4.21, P = .0001). Conclusions: Both the concussed athletes and those with orthopaedic injuries experienced similar state and trait anxiety and relied on similar sources of social support postinjury. However, athletes with orthopaedic injuries reported greater satisfaction with support from all sources compared with concussed athletes. In contrast, concussed athletes showed
LaPrade, Robert F; Dragoo, Jason L; Koh, Jason L; Murray, Iain R; Geeslin, Andrew G; Chu, Constance R
Strategies that seek to enhance musculoskeletal tissue regeneration and repair by modulating the biologic microenvironment at the site of injury have considerable therapeutic potential. Current and emerging biologic approaches include the use of growth factors, platelet-rich plasma, stem cell therapy, and scaffolds. The American Academy of Orthopaedic Surgeons hosted a research symposium in November 2015 to review the current state-of-the-art biologic treatments of articular cartilage, muscle, tendon, and bone injuries and identify knowledge gaps related to these emerging treatments. This review outlines the findings of the symposium and summarizes the consensus reached on how best to advance research on biologic treatment of orthopaedic injuries. PMID:27227987
Barlow, I W; Flynn, N A; Britton, J M
The accuracy of a computerised audit system custom produced for the Orthopaedic Department has been validated by comparison with operating theatre records and patients' case notes. The study revealed only 2.5 per cent missed entries; of the recorded entries information regarding the nature of the operation was found to be 92.5 per cent complete and 98 per cent accurate. The high percentage accuracy reflects the high degree of medical input in operation of the system. The Basingstoke Orthopaedic Database is flexible, cheap and easy to maintain. Data is stored in a form that is readily applicable to standard software packages. PMID:7598401
Wasko, Marcin K.; Kaminski, Rafal
Since the first description in 2002 by Paley and Herzenberg, antibiotic bone cement nails (ACNs) have become an effective tool in the orthopaedic trauma surgeons' hands. They simultaneously elute high amounts of antibiotics into medullary canal dead space and provide limited stability to the debrided long bone. In this paper, we perform a systematic review of current evidence on ACNs in orthopaedic trauma and provide an up-to-date review of the indications, operative technique, failure mechanisms, complications, outcomes, and outlooks for the ACNs use in long bone infection. PMID:26509153
Shirley, Eric D; Sabharwal, Sanjeev; Schwend, Richard M; Cabral, Cristina; Spiegel, David
The burden of musculoskeletal conditions, especially injuries, is increasing in low-income and middle-income countries. Road traffic injuries have become epidemic. There are multiple barriers to accessing surgical services at both the individual (utilization) and the health system (availability) levels, and deficiencies in education and training of health providers. Specialty societies such as the Pediatric Orthopaedic Society of North America (POSNA) have an opportunity to play an important role through teaching and training. The POSNA Children's Orthopedics in Underserved Regions (COUR) committee has supported the Visiting Scholars Program, which invites surgeons from the developing world to attend a scientific meeting and facilitates the scholar's visit to North American pediatric orthopaedic centers. POSNA members have held global educational courses that support an educational exchange between lecturers and attendees. The COUR web site allows for submission of trip reports that document successes and obstacles experienced by members performing overseas clinical care and teaching. The web site also provides educational resources relevant to providing care in these environments. POSNA collaborates with other societies, such as the American Academy of Orthopaedic Surgeons and the Society of Military Orthopaedic Surgeons, to provide education in disaster management. In addition to increasing member involvement, specialty societies have the opportunity for continued data collection from overseas care, application of US registry data to disease processes in the developing world, and further collaboration with one another. PMID:26296220
Tekin, Fatma; Findik, Ummu Yildiz
Lately, individualized nursing care and patient satisfaction are important and current issues being discussed. But there is not enough information for patients undergoing orthopaedic surgery. The aim of this study was to determine the individualized care perception and satisfaction in nursing care levels in orthopaedic surgery patients. This descriptive cross-sectional study was conducted with 156 patients who underwent orthopaedic surgery. Data were collected using the personal information form, the Individualized Care Scale, and the Newcastle Satisfaction With Nursing Scale. The Spearman correlation analysis and descriptive statistics were performed. The mean individualized care and satisfaction with nursing care scores were found to be close to the preset maximum value, and it was determined that an increase in the level of awareness about nursing interventions and the level of perceived individualized care caused an increase in satisfaction levels regarding nursing care. Nurses should recognize the importance of performing individualized care in order to increase the level of satisfaction with nursing care in orthopaedic surgery patients. PMID:26575511
Markatos, Konstantinos; Tsoucalas, Gregory; Sgantzos, Markos
This manuscript represents an attempt to review orthopaedic implants and reconstructive orthopaedic surgery for lower limbs lesions or trauma mainly in the 20th century. We emphasized on the type of implants, the biomaterials and their evolution, and we also engaged in a special reference for the pioneers of orthopaedic implant surgery and the innovative designers of those implants, in such a way to understand the ways and the stages through which they evolved to their present forms, as well as the scientific principles that affected their design and progress. A correlation between the evolution of implants and several relevant disciplines (biomaterial chemists and engineers, biomechanics) that developed simultaneously with orthopaedic reconstructive joint surgery is present since the first attempts to reconstruct a damaged joint. In the future, further progress is anticipated in the use of biomaterials, more compatible towards human biology, with minimally invasive applications and a perpetually increased life span. This progress depicts a phenomenon directly related to a multilevel, multifactorial and interdisciplinary scientific and technological field with many expectations. PMID:27598960
Hill, Austin; Althausen, Peter L; O'Mara, Timothy J; Bray, Timothy J
The financial realities of providing trauma care to injured patients can make it difficult to produce an accurate assessment of the cumulative value orthopaedic trauma surgeons provide to healthcare and university institutions. As with many political battles in the field of medicine, physicians who have been diligently focused on providing patient care were completely unaware of the impending upheaval around them. Whether orthopaedic trauma surgeons are employed or in some type of partnership with hospitals, too often surgeons find the relationship one-sided. In order to effectively negotiate with hospitals, surgeons must demonstrate the comprehensive value they provide to their respective healthcare institutions and universities. Orthopaedic trauma surgeons make direct and indirect financial contributions to the hospital in addition to educational and community services. The sum total of these valued contributions helps fund non-revenue generating programs, provides marketing opportunities, and improves the regional and national reputation of the healthcare institution. This paper provides a comprehensive review of the value contributed to healthcare institutions by orthopaedic trauma surgeons and will serve as a blueprint for all surgeons to accurately account for and demonstrate their value to hospitals while providing efficient and compassionate care to our patients. PMID:23571292
... Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee scheduled for April 5, 2013. The meeting was announced in the Federal Register of November 29, 2012 (77 FR 71195). The meeting... Devices Advisory Committee: Notice of Postponement of Meeting AGENCY: Food and Drug Administration,...
Sheibani-Rad, Shahin; Arnoczky, Steven Paul; Walter, Norman E
Since 1963, the Orthopaedic In-Training Examination (OITE) has been administered to orthopedic residents to assess residents' knowledge and measure the quality of teaching within individual programs. The OITE currently consists of 275 questions divided among 12 domains. This study analyzed all OITE basic science questions between 2006 and 2010. The following data were recorded: number of questions, question taxonomy, category of question, type of imaging modality, and recommended journal and book references. Between 2006 and 2010, the basic science section constituted 12.2% of the OITE. The assessment of taxonomy classification showed that recall-type questions were the most common, at 81.4%. Imaging modalities typically involved questions on radiographs and constituted 6.2% of the OITE basic science section. The majority of questions were basic science questions (eg, genetics, cell replication, and bone metabolism), with an average of 26.4 questions per year. The Journal of Bone & Joint Surgery (American Volume) and the American Academy of Orthopaedic Surgeons' Orthopaedic Basic Science were the most commonly and consistently cited journal and review book, respectively. This study provides the first review of the question content and recommended references of the OITE basic science section. This information will provide orthopedic trainees, orthopedic residency programs, and the American Academy of Orthopaedic Surgeons Evaluation Committee valuable information related to improving residents' knowledge and performance and optimizing basic science educational curricula. PMID:22868614
Olson, Carl J.; And Others
This document, as a supplement to the final report of the Orthopaedic Training Study, contains the documents considered to be important in providing the background for the study. The materials are organized into four major areas: initial correspondence, instrumentation, special reports, and psychomotor skills. See also HE 003 275 and HE 003 276.…
Olson, Carl J.; And Others
This document, as a supplement to the final report of the Orthopaedic Training Study, presents a discussion of the rationale behind the implementation of a laboratory course in psychomotor skills development for medical students. Medical educators examined resident training in terms of 3 components of cognitive elements of learning: cognitive,…
Ostir, Glenn V.; Berges, Ivonne-Marie; Smith, Pamela M.; Smith, David; Rice, Janida L.; Ottenbacher, Kenneth J.
Background and Purpose: Examine the association between change in functional status and quality of life for individuals with orthopaedic impairments approximately 90 days after discharge from in-patient medical rehabilitation. Methods: A retrospective study from 2001 to 2002 using information from the IT HealthTrack database. The study included…
Mankin, H J
Since the early part of the nineteenth century, physicians from Boston have had a major impact on orthopaedics in America. Initially, the general surgeons such as John Ball Brown and his son, Buckminster had an impact on orthopaedics, but contributors such as Henry Bigelow and Charles Scudder added greatly to the knowledge and capacity for care. The first orthopaedic ward, Ward I, was located at the Massachusetts General Hospital and began the new era. Surgical treatment by orthopaedists began in the twentieth century with such contributors as Philip Wilson, EA Codman, Robert B. Osgood, Joel Goldthwait, Elliot Brackett, Robert Lovett, and Edward Bradford. These physicians not only treated patients at the Children's, Tufts University, Boston City, the Beth Israel, and the Massachusetts General Hospitals, but assumed the academic responsibilities of a major educational center. More recently the contributors to orthopaedics have included Marius Smith-Petersen, Otto Aufranc, Henry Banks, Edward Cave, Carter Rowe, Joseph Barr, and others who have created a spectacular program for education, research, and clinical care. PMID:10818968
Agarwal, Sankalp; Curtin, James; Duffy, Brendan; Jaiswal, Swarna
Magnesium (Mg) and its alloys have been extensively explored as potential biodegradable implant materials for orthopaedic applications (e.g. Fracture fixation). However, the rapid corrosion of Mg based alloys in physiological conditions has delayed their introduction for therapeutic applications to date. The present review focuses on corrosion, biocompatibility and surface modifications of biodegradable Mg alloys for orthopaedic applications. Initially, the corrosion behaviour of Mg alloys and the effect of alloying elements on corrosion and biocompatibility is discussed. Furthermore, the influence of polymeric deposit coatings, namely sol-gel, synthetic aliphatic polyesters and natural polymers on corrosion and biological performance of Mg and its alloy for orthopaedic applications are presented. It was found that inclusion of alloying elements such as Al, Mn, Ca, Zn and rare earth elements provides improved corrosion resistance to Mg alloys. It has been also observed that sol-gel and synthetic aliphatic polyesters based coatings exhibit improved corrosion resistance as compared to natural polymers, which has higher biocompatibility due to their biomimetic nature. It is concluded that, surface modification is a promising approach to improve the performance of Mg-based biomaterials for orthopaedic applications. PMID:27524097
Bozic, Kevin J; Smith, Amanda R; Hariri, Sanaz; Adeoye, Sanjo; Gourville, John; Maloney, William J; Parsley, Brian; Rubash, Harry E
Direct-to-consumer advertising (DTCA) has become an influential factor in healthcare delivery in the United States. We evaluated the influence of DTCA on surgeon and patient opinions and behavior in orthopaedics by surveying orthopaedic surgeons who perform hip and knee arthroplasties and patients who were scheduled to have hip or knee arthro-plasty. Respondents were asked for their opinions of and experiences with DTCA, including the influence of DTCA on surgeon and patient decision making. Greater than 98% of surgeon respondents had experience with patients who were exposed to DTCA. The majority of surgeon respondents reported DTCA had an overall negative impact on their practice and their interaction with patients (74%), and their patients often were confused or misinformed about the appropriate treatment for their condition based on an advertisement (77%). Fifty-two percent of patient respondents recalled seeing or hearing advertisements related to hip or knee arthroplasty. These patients were more likely to request a specific type of surgery or brand of implant from their surgeon and to see more than one surgeon before deciding to have surgery. Direct-to-consumer advertising seems to play a substantial role in surgeon and patient decision making in orthopaedics. Future efforts should be aimed at improving the quality and accuracy of information contained in consumer-directed advertisements related to orthopaedic implants and procedures. PMID:17353799
Hall, Gillian; Gregory, Julie
The management of pain is an important aspect of an orthopaedic nurse's role. The aim of this paper is to use an individual case study to demonstrate the role of an out-patient orthopaedic nurse in the identification, assessment and management of pain. This paper describes how pain was identified and managed for a patient in the orthopaedic outpatient department, highlighting that pain and its management are not isolated to the in-patient setting. The case study illustrates the importance of recognising pain and taking into account the numerous factors that can influence pain perception. The assessment of an individual patient's pain led to obtaining help from the Acute Pain Team which led to improvement in the patient's pain management and quality of life. The nursing team reflected and discussed the issues identified by this case study which led to changes in practice being introduced. This has resulted in an increased knowledge of and confidence in pain management within the nursing team and development and improvement of pain management practice within the orthopaedic out-patient department. PMID:26711709