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Sample records for orthopaedic trauma literature

  1. Antibiotic-Impregnated Bone Grafts in Orthopaedic and Trauma Surgery: A Systematic Review of the Literature

    PubMed Central

    Anagnostakos, Konstantinos; Schröder, Katrin

    2012-01-01

    There exist several options for local antibiotic therapy in orthopaedic and trauma surgery. Over the past years, the use of antibiotic-impregnated bone grafts (AIBGs) has become a popular procedure in the treatment of bone and joint infections. A major advantage of AIBGs involves the possibility of impregnation of various antibiotics depending on the sensitivity profile of the causative organism, whereas an additional surgery with removal of the antibiotic carrier is not necessary, as in the use of antibiotic-loaded bone cement. However, generalized conclusions cannot be clearly drawn from the existing literature due to differences of bone used, impregnation method, antibiotics, their doses, laboratory circumstances, or clinical indications. The present work reviews the literature regarding this topic and sheds some light onto the choice of bone and antibiotics, manufacturing details, and clinical experience. PMID:22899933

  2. Heterotopic Ossification in Orthopaedic Trauma

    PubMed Central

    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.

    2012-01-01

    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

  3. Developing Orthopaedic Trauma Capacity in Uganda: Considerations From the Uganda Sustainable Trauma Orthopaedic Program.

    PubMed

    OʼHara, Nathan N; OʼBrien, Peter J; Blachut, Piotr A

    2015-10-01

    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

  4. The Orthopaedic Trauma Patient Experience: A Qualitative Case Study of Orthopaedic Trauma Patients in Uganda

    PubMed Central

    O'Hara, Nathan N.; Mugarura, Rodney; Slobogean, Gerard P.; Bouchard, Maryse

    2014-01-01

    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

  5. Reno Orthopaedic Trauma Fellowship business curriculum.

    PubMed

    Althausen, Peter L; Bray, Timothy J; Hill, Austin D

    2014-07-01

    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

  6. The American Academy of Orthopaedic Surgeons/Society of Military Orthopaedic Surgeons/Orthopaedic Trauma Associations/Pediatric Orthopaedic Association Disaster Response and Preparedness Course.

    PubMed

    Johnson, Anthony E; Gerlinger, Tad L; Born, Christopher T

    2015-10-01

    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

  7. Orthopaedic Trauma Care Specialist Program for Developing Countries.

    PubMed

    Slobogean, Gerard; Sprague, Sheila; Furey, Andrew; Pollak, Andrew

    2015-10-01

    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

  8. The Affordable Care Act and orthopaedic trauma.

    PubMed

    Issar, Neil M; Jahangir, A Alex

    2014-10-01

    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

  9. Military Orthopaedic Trauma Registry: Quality Data Now Available.

    PubMed

    Rivera, Jessica C; Greer, Renee M; Wenke, Joseph C; Ficke, James R; Johnson, Anthony E

    2016-01-01

    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

  10. From Cape Town to Cambridge: Orthopaedic trauma in contrasting environments

    PubMed Central

    Lawrence, John E; Khanduja, Vikas

    2016-01-01

    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

  11. Global access to literature on trauma.

    PubMed

    Noordin, Shahryar; Wright, James G; Howard, Andrew W

    2008-10-01

    The trauma pandemic disproportionately kills and maims citizens of low-income countries although the immediate cause of the trauma is often an industrial export of a high income country, such as a motor vehicle. Addressing the trauma pandemic in low-income countries requires access to relevant research information regarding prevention and treatment of injuries. Such information is also generally produced in high income countries. We explored various means of making scientific information available to low-income country surgeons using the internet. If orthopaedic surgeons want to maximize their global impact, they should focus on writing about trauma questions relevant to their colleagues in low-income countries and ensuring these same colleagues have access to the literature. PMID:18663552

  12. Medical liability and orthopaedic trauma: history and current state of affairs.

    PubMed

    Lundy, Douglas W

    2014-10-01

    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

  13. Risk Factors for Deep Venous Thrombosis Following Orthopaedic Trauma Surgery: An Analysis of 56,000 patients

    PubMed Central

    Whiting, Paul S.; White-Dzuro, Gabrielle A.; Greenberg, Sarah E.; VanHouten, Jacob P.; Avilucea, Frank R.; Obremskey, William T.; Sethi, Manish K.

    2016-01-01

    Background: Deep venous thrombosis (DVT) and pulmonary embolism (PE) are recognized as major causes of morbidity and mortality in orthopaedic trauma patients. Despite the high incidence of these complications following orthopaedic trauma, there is a paucity of literature investigating the clinical risk factors for DVT in this specific population. As our healthcare system increasingly emphasizes quality measures, it is critical for orthopaedic surgeons to understand the clinical factors that increase the risk of DVT following orthopaedic trauma. Objectives: Utilizing the ACS-NSQIP database, we sought to determine the incidence and identify independent risk factors for DVT following orthopaedic trauma. Patients and Methods: Using current procedural terminology (CPT) codes for orthopaedic trauma procedures, we identified a prospective cohort of patients from the 2006 to 2013 ACS-NSQIP database. Using Wilcoxon-Mann-Whitney and chi-square tests where appropriate, patient demographics, comorbidities, and operative factors were compared between patients who developed a DVT within 30 days of surgery and those who did not. A multivariate logistic regression analysis was conducted to calculate odds ratios (ORs) and identify independent risk factors for DVT. Significance was set at P < 0.05. Results: 56,299 orthopaedic trauma patients were included in the analysis, of which 473 (0.84%) developed a DVT within 30 days. In univariate analysis, twenty-five variables were significantly associated with the development of a DVT, including age (P < 0.0001), BMI (P = 0.037), diabetes (P = 0.01), ASA score (P < 0.0001) and anatomic region injured (P < 0.0001). Multivariate analysis identified several independent risk factors for development of a DVT including use of a ventilator (OR = 43.67, P = 0.039), ascites (OR = 41.61, P = 0.0038), steroid use (OR = 4.00, P < 0.001), and alcohol use (OR = 2.98, P = 0.0370). Compared to patients with upper extremity trauma, those with lower

  14. Lean Participative Process Improvement: Outcomes and Obstacles in Trauma Orthopaedics

    PubMed Central

    New, Steve; Hadi, Mohammed; Pickering, Sharon; Robertson, Eleanor; Morgan, Lauren; Griffin, Damian; Collins, Gary; Rivero-Arias, Oliver; Catchpole, Ken; McCulloch, Peter

    2016-01-01

    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

  15. Building the Capacity to Manage Orthopaedic Trauma After a Catastrophe in a Low-Income Country.

    PubMed

    Furey, Andrew; Rourke, James; Larsen, Hans

    2015-10-01

    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

  16. An audit of university education in trauma and orthopaedic surgery in Great Britain.

    PubMed Central

    O'Dowd, J K; Spencer, J D

    1992-01-01

    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

  17. Custom-Made Antibiotic Cement Nails in Orthopaedic Trauma: Review of Outcomes, New Approaches, and Perspectives

    PubMed Central

    Wasko, Marcin K.; Kaminski, Rafal

    2015-01-01

    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

  18. Why veteran orthopaedic trauma surgeons are being fired and what we can do about it?

    PubMed

    Hill, Austin; Althausen, Peter L; O'Mara, Timothy J; Bray, Timothy J

    2013-06-01

    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

  19. Your first job in orthopaedic trauma: strategies for your career.

    PubMed

    Roberts, Craig S; Cannada, Lisa K

    2014-09-01

    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

  20. Surgical skills simulation in trauma and orthopaedic training.

    PubMed

    Stirling, Euan R B; Lewis, Thomas L; Ferran, Nicholas A

    2014-01-01

    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

  1. Orthopaedic trauma from road crashes: is enough being done?

    PubMed

    Donaldson, Lachlan H; Brooke, Kathryn; Faux, Steven G

    2009-02-01

    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

  2. Comparison of published orthopaedic trauma trials following registration in Clinicaltrials.gov

    PubMed Central

    2011-01-01

    Background After the Food and Drug Administration Modernization Act of 1997, the registration of all clinical trials became mandatory prior to publication. Our primary objective was to determine publication rates for orthopaedic trauma trials registered with ClinicalTrials.gov. We further evaluated methodological consistency between registration and publication. Methods We searched Clinical Trials.gov for all trials related to orthopaedic trauma. We excluded active trials and trials not completed by July 2009, and performed a systematic search for publications resulting from registered closed trials. Information regarding primary and secondary outcomes, intervention, study sponsors, and sample size were extracted from registrations and publications. Results Of 130 closed trials, 37 eligible trials resulted in 16 publications (43.2%). We found no significant differences in publication rates between funding sources for industry sponsored studies and nongovernment/nonindustry sponsored studies (p > 0.05). About half the trials (45%) did not include the NCT ID in the publication. Two (10%) publications had major changes to the primary outcome measure and ten (52.6%) to sample size. Conclusions Registration of orthopaedic trauma trials does not consistently result in publication. When trials are registered, many do not cite NCT ID in the publication. Furthermore, changes that are not reflected in the registry of the trial are frequently made to the final publication. PMID:22151841

  3. Defining reference levels for intra-operative radiation exposure in orthopaedic trauma: A retrospective multicentre study.

    PubMed

    Hardman, J; Elvey, M; Shah, N; Simson, N; Patel, S; Anakwe, R

    2015-12-01

    There is currently limited data to define reference levels for the use of ionising radiation in orthopaedic trauma surgery. In this multicentre study, we utilise methodology employed by the Health Protection Agency in establishing reference levels for diagnostic investigations in order to define analogous levels for common and reproducible orthopaedic trauma procedures. Four hundred ninety-five procedures were identified across four Greater London hospitals over a 1-year period. Exposure was defined in terms of both time and dose area product (DAP). Third quartile mean values for either parameter were used to define reference levels. Variations both between centres and grades of lead surgeon were analysed as secondary outcomes. Reference levels; dynamic hip screw (DHS) 1.9225000 Gycm(2)/70.50 s, intramedullary (IM) femoral nail 1.5837500 Gycm(2)/126.00 s, open reduction internal fixation (ORIF) clavicle 0.2042500 Gycm(2)/21.50 s, ORIF lateral malleolus 0.32250500 Gycm(2)/35.00 s, ORIF distal radius 0.1300000 Gycm(2)/56.00 s. Grade of surgeon did not influence exposure in dynamic hip screw, and was inversely related to exposure in intramedullary femoral nails. Less variation was observed with exposure time than with DAP. This study provides the most comprehensive reference to guide fluoroscopy use in orthopaedic trauma to date, and is of value both at the point of delivery and for audit of local practice. PMID:26604035

  4. Hallmarks in the history of orthopaedic implants for trauma and joint replacement.

    PubMed

    Markatos, Konstantinos; Tsoucalas, Gregory; Sgantzos, Markos

    2016-08-01

    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

  5. Use of negative-pressure wound therapy in orthopaedic trauma.

    PubMed

    Streubel, Philipp N; Stinner, Daniel J; Obremskey, William T

    2012-09-01

    Negative-pressure wound therapy (NPWT) has become an important adjunct to the management of traumatic wounds and surgical incisions related to musculoskeletal trauma. On the battlefield, this adjunct therapy allows early wound management and safe aeromedical evacuation. NPWT mechanisms of action include stabilization of the wound environment, reduction of wound edema, improvement of tissue perfusion, and stimulation of cells at the wound surface. NPWT stimulates granulation tissue and angiogenesis and may improve the likelihood of primary closure and reduce the need for free tissue transfer. In addition, NPWT reduces the bacterial bioburden of wounds contaminated with gram-negative bacilli. However, an increased risk of colonization of gram-positive cocci (eg, Staphylococcus aureus) exists. Although NPWT facilitates wound management, further research is required to determine conclusively whether this modality is superior to other management options. Ongoing research will continue to define the indications for and benefits of NPWT as well as establish the role of combination therapy, in which NPWT is used with instillation of antibiotic solutions, placement of antibiotic-laden cement beads, or silver-impregnated sponges. PMID:22941799

  6. The TONK score: a tool for assessing quality in trauma and orthopaedic note-keeping

    PubMed Central

    Khan, Zeeshan; Sayers, Adele E.; Khattak, Mohammad Usman; Chambers, Iain Richard

    2015-01-01

    Introduction: Medical case notes are the only lasting interpretation of a patient-physician interaction and are important for good quality patient care. Accurate, legible and contemporaneous note-keeping is important however it can be substandard. This can lead to errors in handover of patients and to medicolegal vulnerability. We present a comprehensive auditing tool for Trauma & Orthopaedics medical case notes and our experience in using it over the last 12 months. Patients and Methods: The TONK score was developed from a pre-existing system with some additions for Trauma & Orthopaedic case notes, with the incorporation of a legibility scoring system. An initial audit was carried out evaluating the case notes for each team against the TONK score. In order to evaluate the reproducibility of this score, we employed the Cohen’s Kappa coefficient and noted substantial agreement. The individual team scores were analysed and the audit cycle completed four months later with the provision of feedback. Results: Our first audit revealed a mean of 81 with a range from 70 to 90. Subsequent audits over the next two quarters revealed mean scores in excess of 90. Significant improvement has been noted in all areas of documentation and it has been decided to conduct this audit every six months in our department. Conclusions: The TONK score is an easy, quick and reproducible tool, which aims to eliminate the weaknesses in Trauma & Orthopaedic medical note-keeping. It emphasises the medicolegal importance of accurate medical note-keeping to doctors at all levels of training. PMID:27163084

  7. Towards a National Pediatric Musculoskeletal Trauma Outcomes Registry: the Pediatric Orthopaedic Trauma Outcomes Research Group (POTORG) experience.

    PubMed

    Vitale, Michael G; Vitale, Mark A; Lehmann, Charles L; Hyman, Joshua E; Roye, David P; Skaggs, David L; Schmitz, Michael L; Sponseller, Paul D; Flynn, John M

    2006-01-01

    This study is a pilot effort towards the broader implementation of a national pediatric musculoskeletal trauma outcomes registry. The primary goal of this project is to explore the feasibility of a web-based data acquisition and management platform and to identify catalysts and obstacles to multi-center collaboration. A prospective cohort of children presenting to the Pediatric Emergency Departments with ankle, femur, supracondylar humerus, tibial spine, or open fractures at five clinical centers between October 2001 and March 2003 comprised the study population. Patients were enrolled via the treating orthopaedic resident, using a web-based data acquisition and management system. Orthopaedic attendees were sent an automated reminder to complete a follow-up form one week after treatment, and parents of enrolled children were sent child and parent health questionnaires by e-mail and mail in order to capture health-related quality of life and post-traumatic stress symptoms. A total of 299 patients were enrolled in the study with an average age of 7.3 years. Post-treatment follow-up questionnaires were completed by 39% of the attending orthopaedic surgeons, and by 43% of the enrolled patients or patient's parents. Children old enough to complete health questionnaires scored lower in 5 of 12 functional domains including Physical Function, Role/Social Emotional/Behavioral, Parental Impact-Emotional, Family Activities, and Family Cohesion. Within the subset of patients sustaining femur fractures whose parents completed health questionnaires, 9.5% reported significant post-traumatic stress symptoms. This study demonstrates the potential of a multi-center web-based registry to facilitate the collection of a rich array of pediatric trauma, treatment and patient-based outcomes data, although new regulatory issues regarding patient privacy pose challenges to such an approach. PMID:16557126

  8. Does Illicit Drug Use Influence Inpatient Adverse Events, Death, Length of Stay, and Discharge After Orthopaedic Trauma?

    PubMed

    Babatunde, Victor D; Menendez, Mariano E; Ring, David

    2016-01-01

    Illicit drug use among adults is increasing, but its associated risk following orthopaedic trauma remains largely unexplored. This study assessed the relationship of illicit drug use with inpatient adverse events, in-hospital mortality, prolonged length of stay, and nonroutine discharge. With the use of the Nationwide Inpatient Sample database, 7,118,720 orthopaedic trauma inpatients from 2002 to 2011 were identified and separated into illicit drug users (1.5%) and non-illicit drug users (98.5%). Multivariable regression modeling was used to determine the association between illicit drug use and each outcome variable. Illicit drug use was associated with higher odds of inpatient adverse events, but not greater likelihood of inpatient death. Illicit drug users were also more likely to experience prolonged hospital stay and nonroutine discharge. Prompt recognition and effective treatment interventions for orthopaedic trauma patients with a history of illicit drug use may improve inpatient outcomes. PMID:27082887

  9. Use of bone marrow derived stem cells in trauma and orthopaedics: A review of current concepts

    PubMed Central

    Pastides, Philip S; Welck, Matthew J; Khan, Wasim S

    2015-01-01

    There is a considerable amount of interest in the future role of bone marrow-derived stem cells (BMDSCs) and tissue engineering techniques to manage conditions within the musculoskeletal system. Repair of soft tissue and bone defects, in the early stages of injury, may lead to a reduction in progression of symptoms. Furthermore, troublesome soft tissue injuries that are notoriously fraught with problems either in healing or function, could be augmented with such techniques. The aim of this review paper is to look at the advances in such strategies to tackle these problems and assess how BMDSCs, with the aid of growth factors and scaffolds, are being used in vitro, animal and even human models to treat problems within the field of trauma and orthopaedics. There is plenty of evidence that the results are encouraging and thus gaining momentum toward their use in human studies. PMID:26191493

  10. [Sense and content of care pathways in orthopaedic and trauma surgery].

    PubMed

    Quint, U; Greiling, M

    2010-08-01

    The aim of the study was to find the best possible methodology to evaluate the perioperative processes in the main diagnosis-related groups in an orthopaedic and trauma centre. A model in five phases was followed to develop the care pathways. Optimization potentials were derived from estimated problems and their origin. Cases of missing objectives led to re-organization and the necessary quality in treatment could be prepared as a new work flow management. The cost-effectiveness of treatment procedures and the costs of processes conditionally led to a change in management. The advantages of the study were increased knowledge of the processes involved in diagnosis and therapy with regard to the evoked costs. So the limited budget became more calculable. PMID:20644909

  11. The link between texting and motor vehicle collision frequency in the orthopaedic trauma population

    PubMed Central

    Issar, Neil M.; Kadakia, Rishin J.; Tsahakis, James M.; Yoneda, Zachary T.; Sethi, Manish K.; Mir, Hassan R.; Archer, Kristin; Obremskey, William T.; Jahangir, Amir A.

    2013-01-01

    Abstract: Background: This study will evaluate whether or not texting frequency while driving and/or texting frequency in general are associated with an increased risk of incurring a motor vehicle collision (MVC) resulting in orthopaedic trauma injuries. Methods: All patients who presented to the Vanderbilt University Medical Center Orthopaedic Trauma Clinic were administered a questionnaire to determine background information, mean phone use, texting frequency, texting frequency while driving, and whether or not the injury was the result of an MVC in which the patient was driving. Results: 237 questionnaires were collected. 60 were excluded due to incomplete date, leaving 57 questionnaires in the MVC group and 120 from patients with non-MVC injuries. Patients who sent more than 30 texts per week (“heavy texters”) were 2.22 times more likely to be involved in an MVC than those who texted less frequently. 84% of respondents claimed to never text while driving. Dividing the sample into subsets on the basis of age (25 years of age or below considered “young adult,” and above 25 years of age considered “adult”),young, heavy texters were 6.76 times more likely to be involved in an MVC than adult non-heavy texters (p = 0.000). Similarly, young adult, non-heavy texters were 6.65 (p = 0.005) times more likely to be involved in an MVC, and adult, heavy texters were 1.72 (p = 0.186) times more likely to be involved in an MVC. Conclusions: Patients injured in an MVC sent more text messages per week than non-MVC patients. Additionally, controlling for age demonstrated that young age and heavy general texting frequency combined had the highest increase in MVC risk, with the former being the variable of greatest effect. PMID:23416747

  12. The Champions League - Improving the quality of in-patient antibiotic prescription in Trauma and Orthopaedics

    PubMed Central

    Evans, Jonathan; Saxby, Clair; Armstrong, Alexander

    2014-01-01

    A Trust level audit demonstrated that the trauma and orthopaedic department did not reach its own standards in adhering to Trust antibiotic prescribing guidelines. Junior doctors are the main prescribers of antibiotics during inpatient stays. Local policy states that for all inpatients on antibiotics, the start date, duration, and indication for antibiotics must be documented on the drug card. Each patient drug card was reviewed by the department pharmacist and it was recorded whether the documentation was in line with Trust policy. A monthly league table, coined ‘The Champions League’, was created. It was published monthly and displayed in the doctors' office and other clinical areas to highlight which doctors had or had not adhered to the prescribing guidelines. In August 2012 the monthly audit for the trauma and orthopaedic department included 74 patients. The total number of antibiotic courses prescribed was 28; of these courses only 15 (53.5%) had an indication documented and 15 (53.5%) had a review/stop date documented. In December 2012, after two published league tables, 61 patients were reviewed. A total of 19 antibiotic courses were prescribed; 18 (94.7%) had the indication documented and 16 (84.2%) had the review/stop date documented. The standards of prescribing improved within the department and good prescribing practice became ingrained into each doctor's practice. The league table proved to be a novel tool that helped to raise the profile of antibiotic prescribing and change doctor prescribing habits. It created a competitive spirit within the department which improved morale. Doctors responded positively to feedback if they were not achieving the desirable standards, and enjoyed the challenge of improving the standard of prescribing. PMID:26734266

  13. Readability of Trauma-Related Patient Education Materials From the American Academy of Orthopaedic Surgeons

    PubMed Central

    Eltorai, Adam E. M.; P. Thomas, Nathan; Yang, Heejae; Daniels, Alan H.; Born, Christopher T.

    2016-01-01

    Context: According to the american medical association (AMA) and the national institutes of health (NIH), the recommended readability of patient education materials should be no greater than a sixth-grade reading level. The online patient education information produced by the american academy of orthopaedic surgeons (AAOS) may be too complicated for some patients to understand. This study evaluated whether the AAOS’s online trauma-related patient education materials meet recommended readability guidelines for medical information. Evidence Acquisition: Ninety-nine articles from the “Broken Bones and Injuries” section of the AAOS-produced patient education website, orthoinfo.org, were analyzed for grade level readability using the Flesch-Kincaid formula, a widely-used and validated tool to evaluate the text reading level. Results for each webpage were compared to the AMA/NIH recommended sixth-grade reading level and the average reading level of U.S. adults (eighth-grade). Results: The mean (SD) grade level readability for all patient education articles was 8.8 (1.1). All but three of the articles had a readability score above the sixth-grade level. The readability of the articles exceeded this level by an average of 2.8 grade levels (95% confidence interval, 2.6 - 3.0; P < 0.0001). Furthermore, the average readability of the articles exceeded the average reading skill level of U.S. adults (eighth grade) by nearly an entire grade level (95% confidence interval, 0.6-1.0; P < 0.0001). Conclusions: The majority of the trauma-related articles from the AAOS patient education website have readability levels that may make comprehension difficult for a substantial portion of the patient population. PMID:27218045

  14. Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care

    PubMed Central

    Morton, A.; Anderson, G.; Van Der Meer, R. B.; Rymaszewski, L. A.

    2016-01-01

    Objectives “Virtual fracture clinics” have been reported as a safe and effective alternative to the traditional fracture clinic. Robust protocols are used to identify cases that do not require further review, with the remainder triaged to the most appropriate subspecialist at the optimum time for review. The objective of this study was to perform a “top-down” analysis of the cost effectiveness of this virtual fracture clinic pathway. Methods National Health Service financial returns relating to our institution were examined for the time period 2009 to 2014 which spanned the service redesign. Results The total staffing costs rose by 4% over the time period (from £1 744 933 to £1 811 301) compared with a national increase of 16%. The total outpatient department rate of attendance fell by 15% compared with a national fall of 5%. Had our local costs increased in line with the national average, an excess expenditure of £212 705 would have been required for staffing costs. Conclusions The virtual fracture clinic system was associated with less overall use of staff resources in comparison to national cost data. Adoption of this system nationally may have the potential to achieve significant cost savings. Cite this article: P. J. Jenkins. Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care. Bone Joint Res 2016;5:33–36. DOI: 10.1302/2046-3758.52.2000506 PMID:26851287

  15. Education and training opportunities in trauma and orthopaedics in SE Thames Region.

    PubMed

    Savage, P E; d'A Fearn, C B; Groom, A F; Heatley, F W

    1997-11-01

    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

  16. Titanium-Nitride Coating of Orthopaedic Implants: A Review of the Literature

    PubMed Central

    van Hove, Ruud P.; Sierevelt, Inger N.; van Royen, Barend J.; Nolte, Peter A.

    2015-01-01

    Surfaces of medical implants can be enhanced with the favorable properties of titanium-nitride (TiN). In a review of English medical literature, the effects of TiN-coating on orthopaedic implant material in preclinical studies were identified and the influence of these effects on the clinical outcome of TiN-coated orthopaedic implants was explored. The TiN-coating has a positive effect on the biocompatibility and tribological properties of implant surfaces; however, there are several reports of third body wear due to delamination, increased ultrahigh molecular weight polyethylene wear, and cohesive failure of the TiN-coating. This might be due to the coating process. The TiN-coating process should be optimized and standardized for titanium alloy articulating surfaces. The clinical benefit of TiN-coating of CoCrMo knee implant surfaces should be further investigated. PMID:26583113

  17. Titanium-Nitride Coating of Orthopaedic Implants: A Review of the Literature.

    PubMed

    van Hove, Ruud P; Sierevelt, Inger N; van Royen, Barend J; Nolte, Peter A

    2015-01-01

    Surfaces of medical implants can be enhanced with the favorable properties of titanium-nitride (TiN). In a review of English medical literature, the effects of TiN-coating on orthopaedic implant material in preclinical studies were identified and the influence of these effects on the clinical outcome of TiN-coated orthopaedic implants was explored. The TiN-coating has a positive effect on the biocompatibility and tribological properties of implant surfaces; however, there are several reports of third body wear due to delamination, increased ultrahigh molecular weight polyethylene wear, and cohesive failure of the TiN-coating. This might be due to the coating process. The TiN-coating process should be optimized and standardized for titanium alloy articulating surfaces. The clinical benefit of TiN-coating of CoCrMo knee implant surfaces should be further investigated. PMID:26583113

  18. Gas Gangrene in Orthopaedic Patients

    PubMed Central

    Ying, Zhimin; Zhang, Min; Yan, Shigui; Zhu, Zhong

    2013-01-01

    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

  19. Improving the outcome of paediatric orthopaedic trauma: an audit of inpatient management in Southampton.

    PubMed

    Cox, P J; Clarke, N M

    1997-11-01

    The patterns, management and outcome of non-fatal orthopaedic injury in childhood was audited over a 1 year period in Southampton. A computer-based audit (1 September 1993 to 31 August 1994) was conducted of all children aged under 15 years who were admitted to the orthopaedic unit after accidental injury. Management was audited by studying the primary conservative and operative treatment methods employed. Treatment outcome was evaluated in terms of need for secondary operative treatment, salvage internal fixation, length of hospital stay and unplanned readmission. In all, 398 children, representing 50/10,000 of the local paediatric population, were admitted with a traumatic injury. There was a significant (P < 0.001, Kolmogorov-Smirnov) seasonal variation in admission rate. There were 87.3% admissions required for fractures, 8.5% after soft tissue injury and 2.2% after joint injury. The following areas were identified where management and outcome could be improved: 1 A 12.1% readmission rate (47/346) in children with fractures owing to a 16% incidence of loss of position after closed reduction of distal radial, forearm shaft and distal humeral fractures. 2 In all, 24% of internal fixation procedures were performed as 'salvage' after failure of conservative treatment, entailing either reoperation during the initial admission or a further unplanned readmission. 3 A prolonged inpatient stay for patients with femoral fractures owing to a wide variation in treatment method. The outcome of non-fatal orthopaedic injury can be improved through the selective use of primary internal fixation of distal radial and humeral fractures and the close adherence to a management algorithm in femoral fractures. There may be a role for more specialised supervision of primary treatment of these particular fractures. PMID:9422873

  20. Rapid prototyping for patient-specific surgical orthopaedics guides: A systematic literature review.

    PubMed

    Popescu, Diana; Laptoiu, Dan

    2016-06-01

    There has been a lot of hype surrounding the advantages to be gained from rapid prototyping processes in a number of fields, including medicine. Our literature review aims objectively to assess how effective patient-specific surgical guides manufactured using rapid prototyping are in a number of orthopaedic surgical applications. To this end, we carried out a systematic review to identify and analyse clinical and experimental literature studies in which rapid prototyping patient-specific surgical guides are used, focusing especially on those that entail quantifiable outcomes and, at the same time, providing details on the guides' design and type of manufacturing process. Here, it should be mentioned that in this field there are not yet medium- or long-term data, and no information on revisions. In the reviewed studies, the reported positive opinions on the use of rapid prototyping patient-specific surgical guides relate to the following main advantages: reduction in operating times, low costs and improvements in the accuracy of surgical interventions thanks to guides' personalisation. However, disadvantages and sources of errors which can cause patient-specific surgical guide failures are as well discussed by authors. Stereolithography is the main rapid prototyping process employed in these applications although fused deposition modelling or selective laser sintering processes can also satisfy the requirements of these applications in terms of material properties, manufacturing accuracy and construction time. Another of our findings was that individualised drill guides for spinal surgery are currently the favourite candidates for manufacture using rapid prototyping. Other emerging applications relate to complex orthopaedic surgery of the extremities: the forearm and foot. Several procedures such as osteotomies for radius malunions or tarsal coalition could become standard, thanks to the significant assistance provided by rapid prototyping patient-specific surgical

  1. Safety and efficacy of use of demineralised bone matrix in orthopaedic and trauma surgery.

    PubMed

    Dinopoulos, Haralampos T H; Giannoudis, Peter V

    2006-11-01

    Demineralised bone matrix (DBM) acts as an osteoconductive, and possibly as an osteoinductive, material. It is widely used in orthopaedic, neurosurgical, plastic and dental areas. More than 500,000 bone grafting procedures with DBM are performed annually in the US. It does not offer structural support, but it is well suited for filling bone defects and cavities. The osteoinductive nature of DBM is presumably attributed to the presence of matrix-associated bone morphogenetic proteins (BMPs) and growth factors, which are made available to the host environment by the demineralisation process. Clinical results have not been uniformly favourable; however, a variable clinical response is attributed partly to nonuniform processing methods found among numerous bone banks and commercial suppliers. DBMs remain reasonably safe and effective products. The ultimate safe bone-graft substitute, one that is osteoconductive, osteoinductive, osteogenic and mechanically strong, remains elusive. PMID:17044811

  2. Transforming US Army trauma care: an evidence-based review of the trauma literature.

    PubMed

    Remick, Kyle N; Dickerson, James A; Nessen, Shawn C; Rush, Robert M; Beilman, Greg J

    2010-01-01

    The US Army has been charged to transform to meet the demands of current and anticipated near-future combat needs, covering a full spectrum of military operations. The US Army combat trauma care system was created to deliver combat casualty care in a variety of situations and has been adapted to meet the needs of such care in both Operations Enduring Freedom and Iraqi Freedom. Questions related to our current system include the use and positioning of medical evacuation assets, the type of training for our trauma care providers, the positioning of these providers in proximity to the battlefield, and the type of units most suited to the wide variety of medical operations required of today's military medical team. The review was performed to evaluate available information in light of anticipated future needs to ensure preparedness. We reviewed trauma literature regarding the areas of civilian trauma systems, military trauma systems, presurgical trauma care, medical evacuation times, and the medical evacuation system. Among the conclusions drawn from the reviewed data include the following: regional trauma systems improve outcomes in significantly-injured patients; rural trauma care as part of a trauma system yields improved results compared to nontrauma hospitals and comparable results to those at a higher level center; and delivery of advanced trauma life support care has the potential to extend the period of time of safe medical evacuation to surgical capabilities. These lessons are used to discuss components of an improved system of trauma care, flexible for the varied needs of modern battlefield trauma and adaptable to provide support for anticipated future conflicts. PMID:21181650

  3. Handover in Trauma and Orthopaedic Surgery – A Human Factors Assessment

    PubMed Central

    Agha, Riaz A.

    2012-01-01

    Handovers permeate healthcare delivery systems. They are critical for patient safety and continuity of care, but also for logistics and clinical efficiency. Poor handovers can cause reduced efficiency, delayed discharge or time to operation, and contributes to patient harm. The Objective was to conduct a human factors assessment (HFA) using a systems approach to study the handover process at an Orthopaedic unit, determine barriers to information transfer, and suggest improvements. A direct observation model was used to help provide insights on the evening handover process. A Systems Engineering Initiative for Patient Safety (SEIPS) model was used to provide a framework. A total of ten handover sessions were observed and the junior doctors were interviewed using a semi-structured approach. Participants had two chief centres of complaint: workspace and environmental issues (such as a small, hot, uncomfortable room), and the lack of the junior house officer at handover leading to ‘signal loss’ with respect to sick patients who may not be handed over fully. The process also lacked standardisation and structure compounding the potential loss of information. Conclusion Good handover remains a cornerstone of safe and effective clinical practice and continuity of care. This study has shown how an HFA can be useful in determining problems with the handover process locally. It suggests an approach for improvement and recommends better training at all levels in this aspect of patient care. PMID:26257904

  4. Epidemiology of Orthopaedic Trauma Admissions Over One Year in a District General Hospital in England

    PubMed Central

    Taylor, A; Young, A

    2015-01-01

    Introduction : Admission to district general hospitals in England has undergone change in recent years due to both an aging population and the reconfiguration of the major trauma network throughout the United Kingdom. Methods : We utilised a retrospective cohort study to analyse the epidemiology over a 12-month period at a district general hospital. Data was collected and divided into groups: upper limb, lower limb, vertebral disc disease, vertebral fracture, cellulitis without bone involvement and deep infection including metalwork. Results : 2817 patients were admitted over the 12-month period. There were 893 upper limb fractures, 1511 lower limb fractures, 126 vertebral disc disease, 55 vertebral fractures, 108 cellulitis without bone involvement and 124 deep infections with 19 admissions not specified due to coding. AN average of 242 patients were admitted each month with the majority admitted during the summer months. Conclusion : Although fractures make up the majority of the reason for which a person is admitted, there are also many other injuries/morbidities, which may necessitate admission. There is an increasing incidence of elderly osteoporotic fractures in females, which is balancing out the previously more common fractures seen in younger adults and adolescents. PMID:26069514

  5. Blood tests: One too many? Evaluating blood requesting guidance developed for acute patients admitted to trauma and orthopaedic units.

    PubMed

    Faulkner, Alastair; Reidy, Mike; Scicluna, Gabrielle; Love, Gavin J; Joss, Judith

    2016-03-01

    In a recently published report from the Academy of Medical Royal Colleges, around 20% of clinical practice which encompasses blood science investigations is considered wasteful. Blood tests including liver function tests (LFTs), C-reactive protein (CRP), coagulation screens, and international normalising ratios (INR) are frequently requested for patients who undergo emergency hospital admission. The paucity of guidance available for blood requesting in acute trauma and orthopaedic admissions can lead to inappropriate requesting practices and over investigation. Acute admissions over a period of one month were audited retrospectively for the frequency and clinical indications of requests for LFTs, coagulation screens/INR, and CRP. The total number of blood tests requested for the duration of the patient's admission was recorded. Initial auditing of 216 admissions in January 2014 demonstrated a striking amount of over-investigation. Clinical guidelines were developed with multidisciplinary expert input and implemented within the department. Re-audit of 233 admissions was carried out in September 2014. Total no. of LFTs requested: January 895, September 336 (-62.5%); coagulation screens/INR requested: January 307, September 210 (-31.6%); CRPs requested: January 894, September 317 (-64.5%). No. of blood requests per patient: January (M=4.81, SD 4.75), September (M=3.60, SD=4.70). Approximate combined total cost of LFT, coagulation/INR, CRP in January £2674.14 and September £1236.19 (-£1437.95, -53.77%). A large decrease was observed in admission requesting and subsequent monitoring (p<0.01) following the implementation. This both significantly reduced cost and venepuncture rates. PMID:26696248

  6. Predicting Non Return to Work after Orthopaedic Trauma: The Wallis Occupational Rehabilitation RisK (WORRK) Model

    PubMed Central

    Luthi, François; Deriaz, Olivier; Vuistiner, Philippe; Burrus, Cyrille; Hilfiker, Roger

    2014-01-01

    Background Workers with persistent disabilities after orthopaedic trauma may need occupational rehabilitation. Despite various risk profiles for non-return-to-work (non-RTW), there is no available predictive model. Moreover, injured workers may have various origins (immigrant workers), which may either affect their return to work or their eligibility for research purposes. The aim of this study was to develop and validate a predictive model that estimates the likelihood of non-RTW after occupational rehabilitation using predictors which do not rely on the worker’s background. Methods Prospective cohort study (3177 participants, native (51%) and immigrant workers (49%)) with two samples: a) Development sample with patients from 2004 to 2007 with Full and Reduced Models, b) External validation of the Reduced Model with patients from 2008 to March 2010. We collected patients’ data and biopsychosocial complexity with an observer rated interview (INTERMED). Non-RTW was assessed two years after discharge from the rehabilitation. Discrimination was assessed by the area under the receiver operating curve (AUC) and calibration was evaluated with a calibration plot. The model was reduced with random forests. Results At 2 years, the non-RTW status was known for 2462 patients (77.5% of the total sample). The prevalence of non-RTW was 50%. The full model (36 items) and the reduced model (19 items) had acceptable discrimination performance (AUC 0.75, 95% CI 0.72 to 0.78 and 0.74, 95% CI 0.71 to 0.76, respectively) and good calibration. For the validation model, the discrimination performance was acceptable (AUC 0.73; 95% CI 0.70 to 0.77) and calibration was also adequate. Conclusions Non-RTW may be predicted with a simple model constructed with variables independent of the patient’s education and language fluency. This model is useful for all kinds of trauma in order to adjust for case mix and it is applicable to vulnerable populations like immigrant workers. PMID:24718689

  7. Antibacterial coating of implants in orthopaedics and trauma: a classification proposal in an evolving panorama.

    PubMed

    Romanò, Carlo Luca; Scarponi, Sara; Gallazzi, Enrico; Romanò, Delia; Drago, Lorenzo

    2015-01-01

    Implanted biomaterials play a key role in current success of orthopedic and trauma surgery. However, implant-related infections remain among the leading reasons for failure with high economical and social associated costs. According to the current knowledge, probably the most critical pathogenic event in the development of implant-related infection is biofilm formation, which starts immediately after bacterial adhesion on an implant and effectively protects the microorganisms from the immune system and systemic antibiotics. A rationale, modern prevention of biomaterial-associated infections should then specifically focus on inhibition of both bacterial adhesion and biofilm formation. Nonetheless, currently available prophylactic measures, although partially effective in reducing surgical site infections, are not based on the pathogenesis of biofilm-related infections and unacceptable high rates of septic complications, especially in high-risk patients and procedures, are still reported.In the last decade, several studies have investigated the ability of implant surface modifications to minimize bacterial adhesion, inhibit biofilm formation, and provide effective bacterial killing to protect implanted biomaterials, even if there still is a great discrepancy between proposed and clinically implemented strategies and a lack of a common language to evaluate them.To move a step forward towards a more systematic approach in this promising but complicated field, here we provide a detailed overview and an original classification of the various technologies under study or already in the market. We may distinguish the following: 1. Passive surface finishing/modification (PSM): passive coatings that do not release bactericidal agents to the surrounding tissues, but are aimed at preventing or reducing bacterial adhesion through surface chemistry and/or structure modifications; 2. Active surface finishing/modification (ASM): active coatings that feature pharmacologically active

  8. Missed injuries in trauma patients: A literature review

    PubMed Central

    Pfeifer, Roman; Pape, Hans-Christoph

    2008-01-01

    Background Overlooked injuries and delayed diagnoses are still common problems in the treatment of polytrauma patients. Therefore, ongoing documentation describing the incidence rates of missed injuries, clinically significant missed injuries, contributing factors and outcome is necessary to improve the quality of trauma care. This review summarizes the available literature on missed injuries, focusing on overlooked muscoloskeletal injuries. Methods Manuscripts dealing with missed injuries after trauma were reviewed. The following search modules were selected in PubMed: Missed injuries, Delayed diagnoses, Trauma, Musculoskeletal injuires. Three time periods were differentiated: (n = 2, 1980–1990), (n = 6, 1990–2000), and (n = 9, 2000-Present). Results We found a wide spread distribution of missed injuries and delayed diagnoses incidence rates (1.3% to 39%). Approximately 15 to 22.3% of patients with missed injuries had clinically significant missed injuries. Furthermore, we observed a decrease of missed pelvic and hip injuries within the last decade. Conclusion The lack of standardized studies using comparable definitions for missed injuries and clinically significant missed injuries call for further investigations, which are necessary to produce more reliable data. Furthermore, improvements in diagnostic techniques (e.g. the use of multi-slice CT) may lead to a decreased incidence of missed pelvic injuries. Finally, the standardized tertiary trauma survey is vitally important in the detection of clinically significant missed injuries and should be included in trauma care. PMID:18721480

  9. Silver nanoparticles and their orthopaedic applications.

    PubMed

    Brennan, S A; Ní Fhoghlú, C; Devitt, B M; O'Mahony, F J; Brabazon, D; Walsh, A

    2015-05-01

    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

  10. Peri-operative blood management in elective orthopaedic surgery. A critical review of the literature.

    PubMed

    Moonen, A F C M; Neal, T D; Pilot, P

    2006-12-01

    Blood loss during orthopaedic procedures can be extensive and the need for allogeneic blood is a common requirement. However, blood transfusion conceals a number of well-recognised risks and complications and blood products have become more expensive because of their specific preparation procedure. Surgical technique, awareness of the problem and restriction of transfusion triggers are important factors affecting the management of blood loss. Several studies have additionally shown the efficacy of epoetin injections in increasing the pre-operative haemoglobin level. On the other hand, the true benefit of pre-operative autologous donation, acute normovolemic haemodilution and COX-2 selective NSAIDs remains under dispute. Regarding the role of platelet rich plasmapheresis, fibrin sealing and anti-fibinolytic drugs more data are needed. Hypotensive epidural anaesthesia seems to be an advantageous method in minimising peri-operative blood loss. However, this is not a widely performed technique in orthopaedic surgery. In addition, post-operative blood cell saving systems after total knee or hip arthroplasty have been reported to significantly minimise allogeneic blood transfusions when compared to control groups. It can be concluded that many interventions diminish more or less allogeneic blood transfusion in elective orthopaedic surgery. Nevertheless more prospective studies are needed and appropriate algorithms should be applied in peri-operative blood loss management. This review presents an overview of the available interventions which aim to diminish the use of allogeneic blood in elective orthopaedic surgery. PMID:17338906

  11. Animal-Assisted Intervention for trauma: a systematic literature review

    PubMed Central

    O'Haire, Marguerite E.; Guérin, Noémie A.; Kirkham, Alison C.

    2015-01-01

    Animals have a long history of inclusion in psychiatric treatment. There has been a recent growth in the empirical study of this practice, known as Animal-Assisted Intervention (AAI). We conducted a systematic review of the empirical literature on AAI for trauma, including posttraumatic stress disorder (PTSD). Ten studies qualified for inclusion, including six peer-reviewed journal articles and four unpublished theses. Participants were predominantly survivors of child abuse, in addition to military veterans. The presentation of AAI was highly variable across the studies. The most common animal species were dogs and horses. The most prevalent outcomes were reduced depression, PTSD symptoms, and anxiety. There was a low level of methodological rigor in most studies, indicating the preliminary nature of this area of investigation. We conclude that AAI may provide promise as a complementary treatment option for trauma, but that further research is essential to establish feasibility, efficacy, and manualizable protocols. PMID:26300817

  12. Trauma research in Qatar: a literature review and discussion of progress after establishment of a trauma research centre.

    PubMed

    El-Menyar, A; Asim, M; Zarour, A; Abdelrahman, H; Peralta, R; Parchani, A; Al-Thani, H

    2016-11-01

    A structured research programme is one of the main pillars of a trauma care system. Despite the high rate of injury-related mortalities, especially road traffic accidents, in Qatar, little consideration has been given to research in trauma. This review aimed to analyse research publications on the subject of trauma published from Qatar and to discuss the progress of clinical research in Qatar and the Gulf Cooperation Council countries with special emphasis on trauma research. A literature search using PubMed and Google Scholar search engines located 757 English-language articles within the fields of internal medicine, surgery and trauma originating from Qatar between the years 1993 and 2013. A steep increase in the number of trauma publications since 2010 could be linked to the setting up of a trauma research centre in Qatar in 2011. We believe that establishing a research unit has made a major impact on research productivity, which ultimately benefits health care. PMID:26857718

  13. Prevention of abusive head trauma: a literature review.

    PubMed

    Stoll, Bethany; Anderson, Judy K

    2013-01-01

    Abusive head trauma, formerly known as shaken baby syndrome, is a condition with physical, psychosocial, and fiscal implications presenting opportunities for nurses to intervene with prevention strategies. This integrative review of the literature explored the empirical evidence to identify prevention strategies effective in decreasing abusive head trauma. Education, medical, and nursing databases yielded 14 quality research studies providing the basis for the review. Multiple facets of prevention strategies were identified with patterns in the literature of community involvement, early detection and involvement by health professionals, and parental education programming. A five-component model of prevention strategies is proposed to provide nurses with a comprehensive approach to the issue. These components consist of a) completion of personal inventory, b) involvement in multi-modal parental education, c) commitment to a prevention program, d) participation of the family and community, and e) connection to a spiritual element. Through these components, it is hoped there is enhancement of the quality of life for parents and infants, and a discouragement of situations that increase the risk of infant injury. PMID:24640317

  14. Lessons From the Boston Marathon Bombing: An Orthopaedic Perspective on Preparing for High-Volume Trauma in an Urban Academic Center.

    PubMed

    Tobert, Daniel; von Keudell, Arvind; Rodriguez, Edward K

    2015-10-01

    The 2013 Boston Marathon bombing resulted in a mass casualty event that tested the limits of Boston-area trauma centers. The explosions, 12 seconds apart, led to the rapid influx of 124 patients with primarily lower extremity injuries in 5 different adult level 1 trauma centers. This study aimed to examine the existing hospital systems in place for disaster scenarios at the time of the event and identify areas for improvement. Preparation before the Boston Marathon bombing included coordinating the delivery of patients to area facilities and creating a framework for response at an institutional level. These simulations, coupled with the fact that the explosions occurred at a nexus of medical facilities, helped provide impactful care preventing any fatalities in patients who arrived at a Boston hospital that day. The experience at our institution led to the implementation of a more robust communication infrastructure and reinforced the value of preparatory drills. Within the Orthopaedic Surgery Department, we developed a more robust organizational hierarchy for mass casualty events and implemented a multitrauma follow-up clinic. We believe that it is the responsibility of every hospital to have systems in place to handle the rapid arrival of patients with multiple-trauma, and we hope that others can learn from our experience. PMID:26356215

  15. The Impact of Childhood Trauma on Brain Development: A Literature Review and Supporting Handouts

    ERIC Educational Resources Information Center

    Kirouac, Samantha; McBride, Dawn Lorraine

    2009-01-01

    This project provides a comprehensive overview of the research literature on the brain and how trauma impacts brain development, structures, and functioning. A basic exploration of childhood trauma is outlined in this project, as it is essential in making associations and connections to brain development. Childhood trauma is processed in the…

  16. [How to become a trauma surgeon: analysis of the current situation and concepts for career development in the new common field of orthopaedics and trauma surgery--part I].

    PubMed

    Mittlmeier, T; Bonnaire, F; Grützner, P A; Lill, H; Matthes, G; Prokop, A; Seifert, J; Voigt, C; Walcher, F; Wölfl, C; Siebert, H

    2010-06-01

    The lack of clinical residents especially in the surgical domains, including orthopaedics and trauma surgery, is not only omnipresent but also a topic of lively discussions. This lack originates from sociopolitical and healthcare policy issues as well as from a loss of attractiveness of all surgical disciplines. The loss is caused by the high workload and disadvantageous working hours especially in those disciplines with a high rate of emergencies, e.g. trauma surgery. Moreover, it is caused by the poorly structured and unpredictable period of residency. In order to anticipate the bottleneck in supply due to the lack of trainees, a number of structural and contextual measures have to be taken to improve both undergraduate und postgraduate surgical training. Due to the numerous facets of the topic the first part of this analysis refers to the period until the trainee decides on the field of training.A basic insight into the field of orthopaedics and trauma surgery can already be offered far before the period of medical studies itself. During undergraduate medical education the existing structures should be modified, the characteristics of the discipline should be emphasized and the charm of combining theory and practical skills should be highlighted in order to enhance student's perception of the discipline. This might begin during preclinical training and should be continued throughout clinical training and elective courses (basic wound care, TEAM approach, AO course for students and seminars for M.D. candidates). Contextual and structural improvements of the practical year are indispensable to arouse students' interest in our discipline. These options conjoined with the actual offers for students provided by our scientific society, such as guided tours during the annual congress, travelling grants and the recently inaugurated summer school, might provide the basis for clearly structured information and offer a distinct stimulus to apply for residency in our field

  17. Hip arthroscopy for the management of trauma: a literature review

    PubMed Central

    Newman, Justin T.; Saroki, Adriana J.; Philippon, Marc J.

    2015-01-01

    The first descriptions of the use of hip arthroscopy for traumatic injuries were presented in 1980. One paper described arthroscopy for the removal of a bullet fragment while others reported using hip arthroscopy to remove fragments following total hip arthroplasty. With the application of traction and modification of arthroscopic instruments, hip arthroscopy has become a useful tool in treating trauma to the hip. Most of the literature describes traumatic hip dislocation. Several studies have documented the successful use of arthroscopy for removal of loose bodies, but it has also been used to treat labral tears, chondral defects and acetabular rim fractures. Complications reported include fluid extravasation, the lowering of the patient's body temperature using cool saline irrigation and further injury due to unrecognized concomitant pathology. PMID:27011845

  18. Abusive head trauma in Spanish language medical literature.

    PubMed

    Cooper, M Townsend; Szyld, Edgardo; Darden, Paul M

    2016-08-01

    Anecdotal experiences raise concerns that abusive head trauma (AHT) is significantly underdiagnosed and perhaps poorly recognized in Latin American settings. With increasing interest in international collaboration in pediatrics, differences in perspectives regarding complex diagnoses should be explored to facilitate a productive exchange of knowledge and ideas. The purpose of this study was to describe the medical literature pertaining to AHT available to physicians who read only in Spanish. In this review, LILACS, SciELO (major Spanish language databases) and Pubmed were searched with appropriate terms and filters in English, Spanish, and Portuguese for Spanish language articles on AHT. Identified articles' reference lists were then examined for possible additional articles on AHT. All relevant articles were sorted by country and examined for article type and content. Thirty-four unique articles were located for review from 8 of 21 countries. Most of the articles identified were case reports, case series, or educational, and there were no studies regarding overall incidence or prevalence of AHT. Some scientific information contained in the articles varied considerably from that in the English language literature in the areas of etiology and preventive strategies. This survey highlights that the Spanish language literature regarding AHT is sparse and variable. This must be considered when working collaboratively in a global setting. Additionally, identification of this gap presents an opportunity for education and information exchange among global medical communities. PMID:27434224

  19. Stereoscopy in orthopaedics

    NASA Astrophysics Data System (ADS)

    Tan, S. L. E.

    2005-03-01

    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.

  20. Radiation dose from initial trauma assessment and resuscitation: review of the literature

    PubMed Central

    Hui, Catherine M.; MacGregor, John H.; Tien, Homer C.; Kortbeek, John B.

    2009-01-01

    Background Trauma care benefits from the use of imaging technologies. Trauma patients and trauma team members are exposed to radiation during the continuum of care. Knowledge of exposure amounts and effects are important for trauma team members. Methods We performed a review of the published literature; keywords included “trauma,” “patients,” “trauma team members,” “wounds,” “injuries,” “radiation,” “exposure,” “dose” and “computed tomography” (CT). We also reviewed the Board on Radiation Effects Research (BEIR VII) report, published in 2005 and 2006. Results We found no randomized controlled trials or studies. Relevant studies demonstrated that CT accounts for the single largest radiation exposure in trauma patients. Exposure to 100 mSv could result in a solid organ cancer or leukemia in 1 of 100 people. Trauma team members do not exceed the acceptable occupation radiation exposure determined by the National Council of Radiation Protection and Management. Modern imaging technologies such as 16- and 64-slice CT scanners may decrease radiation exposure. Conclusion Multiple injured trauma patients receive a substantial dose of radiation. Radiation exposure is cumulative. The low individual risk of cancer becomes a greater public health issue when multiplied by a large number of examinations. Though CT scans are an invaluable resource and are becoming more easily accessible, they should not replace careful clinical examination and should be used only in appropriate patients. PMID:19399211

  1. Retractions in orthopaedic research

    PubMed Central

    Yan, J.; MacDonald, A.; Baisi, L-P.; Evaniew, N.; Bhandari, M.

    2016-01-01

    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

  2. Liver Hydatid Cyst Rupture Into the Peritoneal Cavity After Abdominal Trauma: Case Report and Literature Review

    PubMed Central

    Yilmaz, Mehmet; Akbulut, Sami; Kahraman, Aysegul; Yilmaz, Sezai

    2012-01-01

    The aim of this study was to review the literature regarding the rupture of hydatid cysts into the abdominal cavity after trauma. We present both a new case of hydatid cyst rupture that occurred after blunt abdominal trauma and a literature review of studies published in the English language about hydatid cyst rupture after trauma; studies were accessed from PubMed, Google Scholar, EBSCO, EMBASE, and MEDLINE databases. We identified 22 articles published between 2000 and 2011 about hydatid cyst rupture after trauma. Of these, 5 articles were excluded because of insufficient data, duplication, or absence of intra-abdominal dissemination. The other 17 studies included 68 patients (38 males and 30 females) aged 8 to 76 years who had a ruptured hydatid cyst detected after trauma. The most common trauma included traffic accidents and falls. Despite optimal surgical and antihelmintic therapy, 7 patients developed recurrence. Complications included biliary fistula in 5 patients, incisional hernia in 2 patients, and gastrocutaneous fistula in 1 patient. Death occurred from intraoperative anaphylactic shock in 1 patient and gastrointestinal bleeding and pulmonary failure in 1 patient. Rupture of a hydatid cyst into the peritoneal cavity is rare and challenging for the surgeon. This condition is included in the differential diagnosis of the acute abdomen in endemic areas, especially in young patients. PMID:23113853

  3. Dental trauma prevention during endotracheal intubation--review of literature.

    PubMed

    Mańka-Malara, Katarzyna; Gawlak, Dominika; Hovhannisyan, Anahit; Klikowska, Marta; Kostrzewa-Janicka, Jolanta

    2015-01-01

    Endotracheal intubation is a procedure performed during general anaesthesia with the use of an endotracheal tube in order to maintain a patent airway. This routinely used procedure is connected with a risk of complications within the region of the masticatory system. Trauma of teeth, their surrounding structures and the soft tissue of the oral cavity is observed in app. 1.38 per 1000 procedures. The main causes of this damage are the surgical skills and experience of the surgeon, the anatomical conditions present and the mode of conducting the procedure. In order to reduce the risk of postoperative complications, patients with a high risk of sustaining an injury during endotracheal intubation should be equipped with elastic mouthguards, which reduces the possibility of damage. The scoring in a scale of endotracheal intubation difficulty should be used for qualification for the use of such mouthguards. PMID:26401748

  4. Literature Evidence on Live Animal Versus Synthetic Models for Training and Assessing Trauma Resuscitation Procedures.

    PubMed

    Hart, Danielle; McNeil, Mary Ann; Hegarty, Cullen; Rush, Robert; Chipman, Jeffery; Clinton, Joseph; Reihsen, Troy; Sweet, Robert

    2016-01-01

    There are many models currently used for teaching and assessing performance of trauma-related airway, breathing, and hemorrhage procedures. Although many programs use live animal (live tissue [LT]) models, there is a congressional effort to transition to the use of nonanimal- based methods (i.e., simulators, cadavers) for military trainees. We examined the existing literature and compared the efficacy, acceptability, and validity of available models with a focus on comparing LT models with synthetic systems. Literature and Internet searches were conducted to examine current models for seven core trauma procedures. We identified 185 simulator systems. Evidence on acceptability and validity of models was sparse. We found only one underpowered study comparing the performance of learners after training on LT versus simulator models for tube thoracostomy and cricothyrotomy. There is insufficient data-driven evidence to distinguish superior validity of LT or any other model for training or assessment of critical trauma procedures. PMID:27450602

  5. Orthopaedic radiology

    SciTech Connect

    Park, W.M.; Hughes, S.P.F.

    1987-01-01

    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.

  6. Israeli School and Community Response to War Trauma: A Review of Selected Literature

    ERIC Educational Resources Information Center

    Abel, Rachel M.; Friedman, Howard A.

    2009-01-01

    This article presents a review of literature focusing on mental health clinicians who have responded to war trauma in their work with children in Israeli schools. The review provides a brief introduction to the country's war history and inception of school psychological and counselling services. Within this framework, results of empirical…

  7. A systematic literature review on first aid provided by laypeople to trauma victims

    PubMed Central

    Tannvik, T D; Bakke, H K; Wisborg, T

    2012-01-01

    Death from trauma is a significant and international problem. Outcome for patients suffering out-of-hospital cardiac arrests is significantly improved by early cardiopulmonary resuscitation. The usefulness of first aid given by laypeople in trauma is less well established. The aim of this study was to review the existing literature on first aid provided by laypeople to trauma victims and to establish how often first aid is provided, if it is performed correctly, and its impact on outcome. A systematic review was carried out, according to preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, of all studies involving first aid provided by laypeople to trauma victims. Cochrane, Embase, Medline, Pubmed, and Google Scholar databases were systematically searched. Ten eligible articles were identified involving a total of 5836 victims. Eight studies were related to patient outcome, while two studies were simulation based. The proportion of patients who received first aid ranged from 10.7% to 65%. Incorrect first aid was given in up to 83.7% of cases. Airway handling and haemorrhage control were particular areas of concern. One study from Iraq investigated survival and reported a 5.8% reduction in mortality. Two retrospective autopsy-based studies estimated that correct first aid could have reduced mortality by 1.8–4.5%. There is limited evidence regarding first aid provided by laypeople to trauma victims. Due to great heterogeneity in the studies, firm conclusions can not be drawn. However, the results show a potential mortality reduction if first aid is administered to trauma victims. Further research is necessary to establish this. PMID:22897491

  8. Management of hemodynamically unstable pelvic trauma: results of the first Italian consensus conference (cooperative guidelines of the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology -Section of Vascular and Interventional Radiology- and the World Society of Emergency Surgery)

    PubMed Central

    2014-01-01

    Hemodynamically Unstable Pelvic Trauma is a major problem in blunt traumatic injury. No cosensus has been reached in literature on the optimal treatment of this condition. We present the results of the First Italian Consensus Conference on Pelvic Trauma which took place in Bergamo on April 13 2013. An extensive review of the literature has been undertaken by the Organizing Committee (OC) and forwarded to the Scientific Committee (SC) and the Panel (JP). Members of them were appointed by surgery, critical care, radiology, emergency medicine and orthopedics Italian and International societies: the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology, Section of Vascular and Interventional Radiology and the World Society of Emergency Surgery. From November 2012 to January 2013 the SC undertook the critical revision and prepared the presentation to the audience and the Panel on the day of the Conference. Then 3 recommendations were presented according to the 3 submitted questions. The Panel voted the recommendations after discussion and amendments with the audience. Later on a email debate took place until December 2013 to reach a unanimous consent. We present results on the 3 following questions: which hemodynamically unstable patient needs an extraperitoneal pelvic packing? Which hemodynamically unstable patient needs an external fixation? Which hemodynamically unstable patient needs emergent angiography? No longer angiography is considered the first therapeutic maneuver in such a patient. Preperitoneal pelvic packing and external fixation, preceded by pelvic binder have a pivotal role in the management of these patients

  9. Life-threatening complications of ascariasis in trauma patients: a review of the literature

    PubMed Central

    Li, Quan-yue; Zhao, Dong-hai; Qu, Hai-yan; Zhou, Chuan-nong

    2014-01-01

    BACKGROUND: Ascariasis is one of the most common human parasitic infections worldwide. In some rare cases, ascariasis may cause serious consequences even sudden death. This study was undertaken to review the life-threatening complications of ascariasis in trauma patients reported in the literature. DATA SOURCES: Relevant articles about ascariasis and trauma were searched from Pubmed, Google scholar, Scirus, and Wanfang databases. RESULTS: Twenty-four patients with ascariasis were collected from 21 articles searched. Most of these patients were from tropical and subtropical countries. Of the 24 patients, 12 were children. Their major complications occurred in the airway passage and digestive tract. There were 3 fatal cases in these patients. Twelve of the 24 patients described in 10 articles were reported in the last 10 years. CONCLUSIONS: Early diagnosis and prompt intervention are essential to minimize the high morbidity and mortality of these serious complications in trauma patients. Physicians should be aware of the possibility of Ascaris infection in a trauma patient from endemic area of ascariasis. History of Ascaris infection and routine examination of feces for Ascaris eggs may be helpful to make a correct diagnosis. PMID:25225578

  10. The use of a virtual learning environment in promoting virtual journal clubs and case-based discussions in trauma and orthopaedic postgraduate medical education: the Leicester experience.

    PubMed

    Palan, J; Roberts, V; Bloch, B; Kulkarni, A; Bhowal, B; Dias, J

    2012-09-01

    The use of journal clubs and, more recently, case-based discussions in order to stimulate debate among orthopaedic surgeons lies at the heart of orthopaedic training and education. A virtual learning environment can be used as a platform to host virtual journal clubs and case-based discussions. This has many advantages in the current climate of constrained time and diminishing trainee and consultant participation in such activities. The virtual environment model opens up participation and improves access to journal clubs and case-based discussions, provides reusable educational content, establishes an electronic record of participation for individuals, makes use of multimedia material (including clinical imaging and photographs) for discussion, and finally, allows participants to link case-based discussions with relevant papers in the journal club. The Leicester experience highlights the many advantages and some of the potential difficulties in setting up such a virtual system and provides useful guidance for those considering such a system in their own training programme. As a result of the virtual learning environment, trainee participation has increased and there is a trend for increased consultant input in the virtual journal club and case-based discussions. It is likely that the use of virtual environments will expand to encompass newer technological approaches to personal learning and professional development. PMID:22933486

  11. Trauma.

    PubMed

    Huisman, Thierry A G M; Poretti, Andrea

    2016-01-01

    Traumatic brain and spine injury (TBI/TSI) is a leading cause of death and lifelong disability in children. The biomechanical properties of the child's brain, skull, and spine, the size of the child, the age-specific activity pattern, and variance in trauma mechanisms result in a wide range of age-specific traumas and patterns of brain and spine injuries. A detailed knowledge about the various types of primary and secondary pediatric head and spine injuries is essential to better identify and understand pediatric TBI/TSI, which enhances sensitivity and specificity of diagnosis, will guide therapy, and may give important information about the prognosis. The purposes of this chapter are to: (1) discuss the unique epidemiology, mechanisms, and characteristics of TBI/TSI in children; (2) review the anatomic and functional imaging techniques that can be used to study common and rare pediatric TBI/TSI and their complications; (3) comprehensively review frequent primary and secondary brain injuries; and (4) to give a short overview of two special types of pediatric TBI/TSI: birth-related and nonaccidental injuries. PMID:27430465

  12. [Periodontal disease and occlusal trauma: a still debated controversy? A review of the literature].

    PubMed

    Sbordone, L; Bortolaia, C

    2002-03-01

    In the "Glossary of Periodontics Terms" written by the American Academy of Periodontology, the occlusal trauma is defined as "an injury to the attachment apparatus as a result of excessive occlusal forces". Nowadays, the effects of occlusal trauma on tooth support tissues, the onset and the progression of periodontal disease are still debated: many commonplaces have been disproved, but some doubts and not yet clear points remain, even owing to the difficult diagnosis of the presence and the real clinical impact of a traumatic occlusion. Then, ethical reasons prevent researchers from prospective clinical trials. At the beginning of the last century occlusal trauma has been supposed to be an etiologic factor of "alveolar pyorrhea", but several studies attending more strict scientific criteria failed to prove such correlation. On the basis of the bacterial genesis of periodontal disease, researchers started evaluating the possible effects of occlusal discrepancies on incidence, progression and treatment outcomes of periodontitis, but all the results underlined the more relevant role played by micro-organisms. The present review of the literature runs through this controversy again, analysing the most significant studies published. PMID:11887077

  13. Ionising radiation: are orthopaedic surgeons at risk?

    PubMed Central

    Smith, G. L.; Briggs, T. W.; Lavy, C. B.; Nordeen, H.

    1992-01-01

    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

  14. Cognitive Impairment in Schizophrenia: Interplay of BDNF and Childhood Trauma? A Review of Literature.

    PubMed

    Sahu, Geetanjali; Malavade, Kishor; Jacob, Theresa

    2016-09-01

    Cognitive impairment is a core feature of schizophrenia. These deficits can also serve as an endophenotype for the illness in genetic studies. There is evidence that suggests that cognition can be considered a reasonable target for intervention in both schizophrenia and bipolar disorder. One of the most studied genetic phenotypes for psychosis is brain-derived neurotrophic factor (BDNF) Val66Met polymorphisms. BDNF has an established role in neuronal development and cell survival in response to stress and is abnormally expressed in schizophrenia. Studies have shown that childhood trauma is associated with poor prognosis of schizophrenic patients. BDNF-Val66Met polymorphism has been shown to moderate the impact of childhood adversity on later expression of affective symptoms, suggesting the possibility of gene environment interactions. Considering the recent advances of neuroscience an up to date review of relevant literature is warranted in this field. This article reviews the current literature available regarding associations between the Val66Met polymorphism, childhood trauma and cognitive dysfunction in schizophrenia. PMID:26603624

  15. Orthopaedic Injuries in Equestrian Sports

    PubMed Central

    Young, Jason David; Gelbs, Jared Craig; Zhu, David Shiyu; Gallacher, Stacey Elisa; Sutton, Karen Michelle; Blaine, Theodore Alton

    2015-01-01

    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

  16. Trauma-related mental health problems among national humanitarian staff: a systematic review of the literature

    PubMed Central

    Strohmeier, Hannah; Scholte, Willem F.

    2015-01-01

    Background Working in humanitarian crisis situations is dangerous. National humanitarian staff in particular face the risk of primary and secondary trauma exposure which can lead to mental health problems. Despite this, research on the mental health of national staff is scarce, and a systematic analysis of up-to-date findings has not been undertaken yet. Objective This article reviews the available literature on trauma-related mental health problems among national humanitarian staff. It focuses on the prevalence of selected mental health problems in relation to reference groups; sex and/or gender as predictive factors of mental health problems; and the influence of organization types on mental health problems. Method Three databases were systematically searched for relevant studies published in the English language in peer-reviewed journals. Results Fourteen articles matched the inclusion criteria. Findings suggest that national staff experience mental health problems and the prevalence of posttraumatic stress disorder, depression, and anxiety among this occupation group is mostly similar to or higher than among reference groups. Research on both substance use disorder and suicidal behavior among national staff is particularly scarce. The relation between sex and/or gender and mental health problems among national staff appears to be complex, and organizational staff support seems to be an important determinant for mental health. Conclusion All findings call for increased attention from the humanitarian community and further research on the topic. PMID:26589256

  17. Paralytic ileus in the orthopaedic patient.

    PubMed

    Daniels, Alan H; Ritterman, Scott A; Rubin, Lee E

    2015-06-01

    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

  18. Global trauma: the great divide

    PubMed Central

    Paniker, Jayanth; Graham, Simon Matthew; Harrison, James William

    2015-01-01

    Road trauma is an emergent global issue. There is huge disparity between the population affected by road trauma and the resource allocation. If the current trend continues, a predicted extra 5 million lives will be lost in this decade. This article aims to create an awareness of the scale of the problem of road trauma and the inequality in the resources available to address this problem. It also describes the responses from the international organisations and the orthopaedic community in dealing with this issue. The International Orthopaedic community has a unique opportunity and moral obligation to play a part in changing this trend of global trauma. PMID:27163075

  19. A report of three cases and review of the literature on rectal disruption following abdominal seatbelt trauma.

    PubMed

    El Kafsi, J; Kraus, R; Guy, R

    2016-02-01

    Seatbelt associated blunt trauma to the rectum is a rare but well recognised injury. The exact mechanism of hollow visceral injury in blunt trauma is unclear. Stress and shear waves generated by abdominal compression may in part account for injury to gas containing structures. A 'seatbelt sign' (linear ecchymosis across the abdomen in the distribution of the lap belt) should raise the suspicion of hollow visceral injuries and can be more severe with disruption of the abdominal wall musculature. Three consecutive cases of rectal injury following blunt abdominal trauma, requiring emergency laparotomy and resection, are described. Lumbar spine injury occurred in one case and in the other two cases, there was injury to the iliac wing of the pelvis; all three cases sustained significant abdominal wall contusion or muscle disruption. Abdominal wall reconstruction and closure posed a particular challenge, requiring a multidisciplinary approach. The literature on this topic is reviewed and potential mechanisms of injury are discussed. PMID:26741660

  20. Auditing Orthopaedic Audit

    PubMed Central

    Guryel, E; Acton, K; Patel, S

    2008-01-01

    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

  1. A Review of Recent Literature on Trauma among Individuals Living with HIV

    PubMed Central

    Reif, Susan; Sullivan, Kristen; Murray, Kate; Barlow, Morgan L.; Whetten, Kathryn

    2016-01-01

    Persons living with HIV (PLWH) report disproportionately high levels of exposure to traumatic events in childhood and adulthood. Traumatic experiences are associated with negative health and behavioral outcomes. Current research in this area seeks to further explicate the myriad health effects of trauma on PLWH and the pathways through which trauma operates. In this paper, we review articles published in English between January 2014 and June 2015 that examine traumatic experiences among PLWH, including intimate partner violence (IPV), domestic abuse, child abuse, and other forms of violence. A selection of studies examining trauma among PLWH and its associations with mental health, antiretroviral medication adherence, clinical outcomes, HIV disclosure, and sexual risk behaviors were included. Studies describing trauma coping strategies and interventions were also included. We conclude with recommendations for care of trauma-exposed PLWH and directions for future research. PMID:26419376

  2. A Review of Recent Literature on Trauma Among Individuals Living with HIV.

    PubMed

    LeGrand, Sara; Reif, Susan; Sullivan, Kristen; Murray, Kate; Barlow, Morgan L; Whetten, Kathryn

    2015-12-01

    Persons living with HIV (PLWH) report disproportionately high levels of exposure to traumatic events in childhood and adulthood. Traumatic experiences are associated with negative health and behavioral outcomes. Current research in this area seeks to further explicate the myriad health effects of trauma on PLWH and the pathways through which trauma operates. In this paper, we review articles published in English between January 2014 and June 2015 that examine traumatic experiences among PLWH, including intimate partner violence (IPV), domestic abuse, child abuse, and other forms of violence. A selection of studies examining trauma among PLWH and its associations with mental health, antiretroviral medication adherence, clinical outcomes, HIV disclosure, and sexual risk behaviors were included. Studies describing trauma coping strategies and interventions were also included. We conclude with recommendations for care of trauma-exposed PLWH and directions for future research. PMID:26419376

  3. One hundred years of orthopaedic education in Singapore.

    PubMed

    Wang, W; Lee, E H; Wong, H K

    2005-07-01

    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

  4. Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery

    PubMed Central

    Karlakki, S.; Brem, M.; Giannini, S.; Khanduja, V.; Stannard, J.; Martin, R.

    2013-01-01

    Objectives The period of post-operative treatment before surgical wounds are completely closed remains a key window, during which one can apply new technologies that can minimise complications. One such technology is the use of negative pressure wound therapy to manage and accelerate healing of the closed incisional wound (incisional NPWT). Methods We undertook a literature review of this emerging indication to identify evidence within orthopaedic surgery and other surgical disciplines. Literature that supports our current understanding of the mechanisms of action was also reviewed in detail. Results A total of 33 publications were identified, including nine clinical study reports from orthopaedic surgery; four from cardiothoracic surgery and 12 from studies in abdominal, plastic and vascular disciplines. Most papers (26 of 33) had been published within the past three years. Thus far two randomised controlled trials – one in orthopaedic and one in cardiothoracic surgery – show evidence of reduced incidence of wound healing complications after between three and five days of post-operative NPWT of two- and four-fold, respectively. Investigations show that reduction in haematoma and seroma, accelerated wound healing and increased clearance of oedema are significant mechanisms of action. Conclusions There is a rapidly emerging literature on the effect of NPWT on the closed incision. Initiated and confirmed first with a randomised controlled trial in orthopaedic trauma surgery, studies in abdominal, plastic and vascular surgery with high rates of complications have been reported recently. The evidence from single-use NPWT devices is accumulating. There are no large randomised studies yet in reconstructive joint replacement. Cite this article: Bone Joint Res 2013;2:276–84. PMID:24352756

  5. Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach

    PubMed Central

    Barak, Michal; Bahouth, Hany; Leiser, Yoav; Abu El-Naaj, Imad

    2015-01-01

    According to the Advanced Trauma Life Support recommendations for managing patients with life-threatening injuries, securing the airway is the first task of a primary caregiver. Airway management of patients with maxillofacial trauma is complex and crucial because it can dictate a patient's survival. Securing the airway of patients with maxillofacial trauma is often extremely difficult because the trauma involves the patient's airway and their breathing is compromised. In these patients, mask ventilation and endotracheal intubation are anticipated to be difficult. Additionally, some of these patients may not yet have been cleared of a cervical spine injury, and all are regarded as having a full stomach and having an increased risk of regurgitation and pulmonary aspiration. The requirements of the intended maxillofacial operation may often preclude the use of an oral intubation tube, and alternative methods for securing the airway should be considered before the start of the surgery. In order to improve the clinical outcome of patients with maxillofacial trauma, cooperation between maxillofacial surgeons, anesthesiologists, and trauma specialists is needed. In this review, we discuss the complexity and difficulties of securing the airway of patients with maxillofacial trauma and present our approach for airway management of such patients. PMID:26161411

  6. Use of a pedicled fillet foot flap for knee preservation in severe lower extremity trauma: A case report and literature review

    PubMed Central

    Jensson, David; Audolfsson, Thorir; Mani, Maria; Rodriguez-Lorenzo, Andres

    2015-01-01

    We report the sequential use of a pedicled fillet foot flap in a clinical case of complex bilateral lower extremity trauma to achieve stable wound closure, maximizing length preservation and gait rehabilitation. In addition, we perform a literature review of the use of fillet foot flaps in lower extremity trauma. PMID:27252976

  7. Algodystrophy in major orthopaedic surgery

    PubMed Central

    Tarantino, Umberto; Buharaja, Rodrigo; Piccirilli, Eleonora; Riccardi, Mariastella; Gasbarra, Elena; Feola, Maurizio; Iolascon, Giovanni

    2015-01-01

    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

  8. Peripheral cytokines as a chemical mediator for postconcussion like sickness behaviour in trauma and perioperative patients: literature review.

    PubMed

    Rehman, Yasir; Rehman, Nadia; Rehman, Riaz

    2014-01-01

    Besides brain injury and systemic infection, cognitive and concussion like sickness behaviour is associated with muscular trauma and perioperative patients, which represents a major obstacle to daily activities and rehabilitation. The neuroinflammatory response triggers glial activation and consequently the release of proinflammatory cytokines within the hippocampus. We review clinical studies that have investigated neurocognitive and psychosomatic symptoms related to muscular trauma and in perioperative conditions. These include impaired attention and executive and general cognitive functioning. The purpose of this literature review is to focus on the systemic inflammation and the role of proinflammatory cytokines IL1, IL6,and TNF and other inflammatory mediators which mediates the cognitive impairment and induces sickness behaviour. Moreover, this review will also help to determine if some patients could have long-term cognitive changes associated with musculoskeletal injuries or as a consequence of surgery and thereby will lead to efforts in reducing that risk. PMID:24876960

  9. Peripheral Cytokines as a Chemical Mediator for Postconcussion Like Sickness Behaviour in Trauma and Perioperative Patients: Literature Review

    PubMed Central

    Rehman, Riaz

    2014-01-01

    Besides brain injury and systemic infection, cognitive and concussion like sickness behaviour is associated with muscular trauma and perioperative patients, which represents a major obstacle to daily activities and rehabilitation. The neuroinflammatory response triggers glial activation and consequently the release of proinflammatory cytokines within the hippocampus. We review clinical studies that have investigated neurocognitive and psychosomatic symptoms related to muscular trauma and in perioperative conditions. These include impaired attention and executive and general cognitive functioning. The purpose of this literature review is to focus on the systemic inflammation and the role of proinflammatory cytokines IL1, IL6,and TNF and other inflammatory mediators which mediates the cognitive impairment and induces sickness behaviour. Moreover, this review will also help to determine if some patients could have long-term cognitive changes associated with musculoskeletal injuries or as a consequence of surgery and thereby will lead to efforts in reducing that risk. PMID:24876960

  10. Competencies for a Canadian orthopaedic surgery core curriculum.

    PubMed

    Wadey, V M R; Dev, P; Buckley, R; Walker, D; Hedden, D

    2009-12-01

    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

  11. Pericardio-diaphragmatic rupture following blunt abdominal trauma: Case report and review of literature

    PubMed Central

    Abou Hussein, Bassem; Khammas, Ali; Kaiyasah, Hadiel; Swaleh, Abeer; Al Rifai, Nazim; Al-Mazrouei, Alya; Badri, Faisal

    2015-01-01

    Introduction Traumatic diaphragmatic rupture (TDR) occurs in 0–5% of patients with major blunt thoraco-abdominal trauma, in most of them on the left side, and an early correct diagnosis is made in less than half of the cases (Meyers and McCabe, 1993; Ball et al., 1982). Presentation of the case We report a case of a forty-eight years old man who had a pericardio-diaphragmatic rupture after a high-velocity blunt abdominal trauma that was diagnosed and treated successfully. Discussion Pericardio-diaphragmatic rupture (PDR) is an uncommon problem that poses a diagnostic challenge to surgeons. The incidence of PDR is between 0.2% and 3.3% of cases with TDR (Sharma, 1999 [3]). Conclusion PDR should be suspected in any patient with high velocity thoraco-abdominal trauma. Early diagnosis is essential and needs a high index of suspicion. Early Management is important in decreasing morbidity and mortality. PMID:26773877

  12. Acute Subdural Hematoma in Infants with Abusive Head Trauma: A Literature Review

    PubMed Central

    KARIBE, Hiroshi; KAMEYAMA, Motonobu; HAYASHI, Toshiaki; NARISAWA, Ayumi; TOMINAGA, Teiji

    2016-01-01

    The number of cases with child abuse is increasing in Japan, and abusive head trauma (AHT) is a major cause of death in abused children. Child abuse has been recognized by the late 19th century, and widely accepted as battered child syndrome in the middle of the 20th century. As terms, there had been considerable mechanistic controversies between shaken-baby and -impact syndrome until the beginning of the 21st century. In recent years, AHT has been utilized as a less mechanistic term. Most of the characteristics of AHT in Japan have been similar to those in the United States as follows: infant is the most common victim, acute subdural hematoma (SDH) is the most common intracranial lesion, and retinal hemorrhage is often complicated. On the other hand, several characteristics have been different as follows: mother is the most common perpetrators, impact is a more common mechanism of trauma than shaking, and external trauma is more common reflecting the existence of impact. Since AHT as well as child abuse is a social pathological phenomenon influenced by victims, perpetrators, socioeconomic circumstances, and so on, various aspects of AHT as well as child abuse can be changed with times. Actually, a recent paper suggests such changes in infants with acute SDH due to AHT. In this review article, AHT, abusive infantile acute SDH in particular, are reviewed from the aspect of neurosurgical perspectives, including its mechanisms of trauma, biomechanics, clinical features, management, and prognosis, to update the trend in Japan. PMID:26960448

  13. Acute Subdural Hematoma in Infants with Abusive Head Trauma: A Literature Review.

    PubMed

    Karibe, Hiroshi; Kameyama, Motonobu; Hayashi, Toshiaki; Narisawa, Ayumi; Tominaga, Teiji

    2016-05-15

    The number of cases with child abuse is increasing in Japan, and abusive head trauma (AHT) is a major cause of death in abused children. Child abuse has been recognized by the late 19th century, and widely accepted as battered child syndrome in the middle of the 20th century. As terms, there had been considerable mechanistic controversies between shaken-baby and -impact syndrome until the beginning of the 21st century. In recent years, AHT has been utilized as a less mechanistic term. Most of the characteristics of AHT in Japan have been similar to those in the United States as follows: infant is the most common victim, acute subdural hematoma (SDH) is the most common intracranial lesion, and retinal hemorrhage is often complicated. On the other hand, several characteristics have been different as follows: mother is the most common perpetrators, impact is a more common mechanism of trauma than shaking, and external trauma is more common reflecting the existence of impact. Since AHT as well as child abuse is a social pathological phenomenon influenced by victims, perpetrators, socioeconomic circumstances, and so on, various aspects of AHT as well as child abuse can be changed with times. Actually, a recent paper suggests such changes in infants with acute SDH due to AHT. In this review article, AHT, abusive infantile acute SDH in particular, are reviewed from the aspect of neurosurgical perspectives, including its mechanisms of trauma, biomechanics, clinical features, management, and prognosis, to update the trend in Japan. PMID:26960448

  14. Health economics and orthopaedics.

    PubMed

    Maniadakis, N; Gray, A

    2000-01-01

    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

  15. Orthopaedic Footwear Design

    NASA Technical Reports Server (NTRS)

    1992-01-01

    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.

  16. The reconstructive microsurgery ladder in orthopaedics.

    PubMed

    Tintle, Scott M; Levin, L Scott

    2013-03-01

    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

  17. Minimally invasive surgery in orthopaedics. Small is beautiful?

    PubMed

    Yeung, S H

    2008-08-01

    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

  18. Three Dimensional Printing in Orthopaedic Surgery

    PubMed Central

    Mulford, Jonathan; MacKay, N; Babazadeh, S

    2016-01-01

    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

  19. Evidence-based orthopaedics or 'superstition in the pigeon'.

    PubMed

    Evans, R

    2009-01-01

    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

  20. Scapulothoracic dissociation: An emerging high-energy trauma in medical literature

    PubMed Central

    McCague, Andrew; Schulte, Adam; Davis, Joseph Vivian

    2012-01-01

    Scapulothoracic dissociation (STD) is a devastating consequence of high-energy trauma sustained by the shoulder girdle that can easily result in rapid mortality. Since described by Oreck et al. in 1984, STD has been reported in a handful of journals and individual case series, though is still considered a rare occurrence in the context of shoulder injuries. In this report, we examine the case of a 25-year-old female involved in a high-speed rollover auto accident. Unique to this case was the discovery of a completely transected axillary artery and vein with intracorporeal bleeding and complete avulsion of the ipsilateral brachial plexus requiring immediate ligation of the vessels followed by interval above-elbow-amputation and later glenohumeral disarticulation. PMID:23248512

  1. Southern Orthopaedic Association Abstract Publication Rate.

    PubMed

    Tait, Mark Adam; Petrus, Cara; Barnes, C Lowry

    2016-01-01

    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

  2. Successfully reforming orthopaedic outpatients.

    PubMed

    Schoch, Peter A; Adair, Lisa

    2012-05-01

    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

  3. Footwear and orthopaedics.

    PubMed

    Kurup, H V; Clark, C I M; Dega, R K

    2012-06-01

    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

  4. Biomaterials in orthopaedics

    PubMed Central

    Navarro, M; Michiardi, A; Castaño, O; Planell, J.A

    2008-01-01

    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

  5. Neurology and orthopaedics

    PubMed Central

    Houlden, Henry; Charlton, Paul; Singh, Dishan

    2007-01-01

    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

  6. Orthopaedic Management of Spasticity.

    PubMed

    Pidgeon, Tyler S; Ramirez, Jose M; Schiller, Jonathan R

    2015-12-01

    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

  7. Registries in orthopaedics.

    PubMed

    Delaunay, C

    2015-02-01

    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

  8. The role of biofilm on orthopaedic implants: the "Holy Grail" of post-traumatic infection management?

    PubMed

    Mauffrey, C; Herbert, B; Young, H; Wilson, M L; Hake, M; Stahel, P F

    2016-08-01

    The development of post-traumatic infection is potentially a limb threatening condition. The orthopaedic trauma literature lags behind the research performed by our arthroplasty colleagues on the topic of implant-related infections. Surgical site infections in the setting of a recent ORIF are notoriously hard to eradicate due to biofilm formation around the implant. This bacteria-friendly, dynamic, living pluri-organism structure has the ability to morph and adapt to virtually any environment with the aim to maintain the causative organism alive. The challenges are twofold: establishing an accurate diagnosis with speciation/sensitivity and eradicating the infection. Multiple strategies have been researched to improve diagnostic accuracy, to prevent biofilm formation on orthopaedic implants, to mobilize/detach or weaken the biofilm or to target specifically bacteria embedded in the biofilm. The purpose of our paper is to review the patho-physiology of this mysterious pluri-cellular structure and to summarize some of the most pertinent research performed to improve diagnostic and treatment strategies in biofilm-related infections. PMID:27262848

  9. Radiation exposure to the eye lens of orthopaedic surgeons during various orthopaedic procedures.

    PubMed

    Romanova, K; Vassileva, J; Alyakov, M

    2015-07-01

    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

  10. The olivocochlear system and protection from acoustic trauma: a mini literature review

    PubMed Central

    Fuente, Adrian

    2015-01-01

    Large intersubject variability in the susceptibility to noise-induced hearing loss (NIHL) is known to occur in both humans and animals. It has been suggested that the olivocochlear system (OCS) plays a significant role in protecting the cochlea from exposure to high levels of noise. A mini literature review about the scientific evidence from animal and human studies about the association between the function of the OCS and susceptibility to NIHL was carried out. Animal data consistently show that de-efferented ears exhibit larger temporary threshold shift (TTS) and permanent threshold shift (PTS) than efferented ears. Data from human studies do not consistently show a correlation between the strength of the OCS function and amount of TTS. Further research on human subjects is required to determine how the OCS function could be used to predict susceptibility to NIHL in individual subjects. PMID:26157366

  11. A positive correlation between occlusal trauma and peri-implant bone loss: literature support.

    PubMed

    Misch, Carl E; Suzuki, Jon B; Misch-Dietsh, Francine M; Bidez, Martha W

    2005-06-01

    The relationship between occlusal overload and peri-implant bone loss remains a controversial topic in implant dentistry. A causal relationship between the incidence of marginal bone loss next to an implant and occlusal overload implies a treatment plan and occlusal scheme would benefit from a force management approach. A MEDLINE-assisted and hand search of peer-reviewed English literature and relative textbooks were used for a selective review of articles addressing biomechanical stress and bone loss in cellular biomechanics, engineering principles, mechanical properties of bone, animal studies, clinical reports, bone physiology, and implant design biomechanics. These papers demonstrate occlusal overload on implants may increase the incidence of marginal bone loss. PMID:15968181

  12. Young, male, road traffic victims: a systematic review of the published trauma registry literature from low and middle income countries

    PubMed Central

    Boughton, Oliver; Jones, Gareth G.; Lavy, Christopher B.D.; Grimes, Caris E.

    2015-01-01

    Background: Trauma contributes significantly to the global burden of disease. We analysed published trauma registries to assess the demographics of those most affected in low and middle-income countries (LMICs). Methods: We performed a systematic review of published trauma registry studies according to PRISMA guidelines. We included published full-text articles from trauma registries in low and middle-income countries describing the demographics of trauma registry patients. Articles from military trauma registries, articles using data not principally derived from trauma registry data, articles describing patients of only one demographic (e.g. only paediatric patients), or only one mechanism of injury, trauma registry implementation papers without demographic data, review papers and conference proceedings were excluded. Results: The initial search retrieved 1868 abstracts of which 1324 remained after duplicate removal. After screening the abstracts, 78 full-text articles were scrutinised for their suitability for inclusion. Twenty three papers from 14 countries, including 103,327 patients, were deemed eligible and included for analysis. The median age of trauma victims in these articles was 27 years (IQR 25–29). The median percentage of trauma victims who were male was 75 (IQR 66–84). The median percentage of road traffic injuries (RTIs) as a percentage of total injuries caused by trauma was 46 (IQR 21–71). Conclusions: Young, male, road traffic victims represent a large proportion of the LMIC trauma burden. This information can inform and be used by local and national governments to implement road safety measures and other strategies aimed at reducing the injury rate in young males. PMID:27163066

  13. Advances in Regenerative Orthopaedics

    PubMed Central

    Evans, Christopher H.

    2013-01-01

    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

  14. Dental fragment embedded in the lower lip after facial trauma: Brief review literature and report of a case

    PubMed Central

    Lauritano, Dorina; Petruzzi, Massimo; Sacco, Gerardo; Campus, Guglielmo; Carinci, Francesco; Milillo, Lucio

    2012-01-01

    Upper incisors are the most frequently involved teeth in traumatic dental injuries. Soft tissues (lips and/or oral mucosa) adjacent to incisal edge can receive direct and/or indirect traumas. Laceration of the lower lip is a not rare eventuality and teeth fragments could be embedded in labial soft tissue. The reattachment of these fragments, if possible, is the elective treatment choice, thanks to the modern adhesive and restorative techniques. The authors present a case of a white Caucasian 10-year-old child, who attended the dental clinic for the treatment of both upper central incisors’ crown fractures. The fragment of the left incisor was retrieved embedded in the lower lip. It was successfully surgically removed and reattached using a composite adhesive technique. A careful clinical and radiographic examination with the surgical removal of tooth fragments could prevent undesirable foreign body reaction, infection and scarring. The authors also reviewed the most relevant literature concerning tooth fragment reattachment after removal from oral soft tissues. PMID:23814592

  15. Preventive interventions among children exposed to trauma of armed conflict: a literature review.

    PubMed

    Peltonen, Kirsi; Punamäki, Raija-Leena

    2010-01-01

    Increasing research is available on the preconditions for child mental health and optimal development in traumatic conditions, whereas less is known how to translate the findings into effective interventions to help traumatized children. This literature review analyses the effectiveness of psychosocial preventive interventions and treatments and their theoretical bases among children traumatized in the context of armed conflicts (war, military violence, terrorism and refugee). The first aim is to evaluate the effectiveness of preventive interventions in preventing emotional distress and impairment and promoting optimal emotional-cognitive and social development. The second task is to analyze the nature of the underlying mechanisms for the success of preventive interventions, and the theoretical premises of the choice of intervention techniques, procedures and tools. We found 16 relevant published studies, but an examination of them revealed that only four of them had experimental designs strong enough that they could be included in the meta-analysis. While the subjective reports of the researchers suggested that systematic preventive interventions were effective in decreasing PTSD and depressive symptoms among children traumatized due to armed conflict, the more objective results of the meta-analysis and the weaknesses in designs uncovered during the meta-analysis undermine such a conclusion. Additionally, a majority of the reported preventive interventions focused only on children's biased cognitive processes and negative emotions, while only a few aimed at influencing multiple domains of child development and improving developmental functioning on emotional, social and psychophysiological levels. It is concluded that substantial additional work needs to be done in developing effective preventive interventions and treatments for children traumatized by exposure to war and violence. PMID:19998393

  16. Composites in orthopaedics

    SciTech Connect

    Devanathan, D.; Levine, D.

    1986-01-01

    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.

  17. A review of virtual reality based training simulators for orthopaedic surgery.

    PubMed

    Vaughan, Neil; Dubey, Venketesh N; Wainwright, Thomas W; Middleton, Robert G

    2016-02-01

    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

  18. Orthopaedic Timing in Polytrauma in a Second Level Emergency Hospital. An Overrated Problem?

    PubMed

    Dei Giudici, L; Giampaolini, N; Panfighi, A; Marinelli, M; Procaccini, R; Gigante, A

    2015-01-01

    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

  19. Avoidable mortality from giving tranexamic acid to bleeding trauma patients: an estimation based on WHO mortality data, a systematic literature review and data from the CRASH-2 trial

    PubMed Central

    2012-01-01

    Background The CRASH-2 trial showed that early administration of tranexamic acid (TXA) safely reduces mortality in bleeding in trauma patients. Based on data from the CRASH-2 trial, global mortality data and a systematic literature review, we estimated the number of premature deaths that might be averted every year worldwide through the use of TXA. Methods We used CRASH-2 trial data to examine the effect of TXA on death due to bleeding by geographical region. We used WHO mortality data (2008) and data from a systematic review of the literature to estimate the annual number of in-hospital trauma deaths due to bleeding. We then used the relative risk estimates from the CRASH-2 trial to estimate the number of premature deaths that could be averted if all hospitalised bleeding trauma patients received TXA within one hour of injury, and within three hours of injury. Sensitivity analyses were used to explore the effect of uncertainty in the parameter estimates and the assumptions made in the model. Results There is no evidence that the effect of TXA on death due to bleeding varies by geographical region (heterogeneity p = 0.70). Based on WHO data and our systematic literature review, we estimate that each year worldwide there are approximately 400,000 in-hospital trauma deaths due to bleeding. If patients received TXA within one hour of injury then approximately 128,000 (uncertainty range [UR] ≈ 72,000 to 172,000) deaths might be averted. If patients received TXA within three hours of injury then approximately 112,000 (UR ≈ 68,000 to 148,000) deaths might be averted. Country specific estimates show that the largest numbers of deaths averted would be in India and China. Conclusions The use of TXA in the treatment of traumatic bleeding has the potential to prevent many premature deaths every year. A large proportion of the potential health gains are in low and middle income countries. PMID:22380715

  20. The use of plots in orthopaedic literature.

    PubMed

    Cool, P; Ockendon, M

    2015-12-01

    Plots are an elegant and effective way to represent data. At their best they encourage the reader and promote comprehension. A graphical representation can give a far more intuitive feel to the pattern of results in the study than a list of numerical data, or the result of a statistical calculation. The temptation to exaggerate differences or relationships between variables by using broken axes, overlaid axes, or inconsistent scaling between plots should be avoided. A plot should be self-explanatory and not complicated. It should make good use of the available space. The axes should be scaled appropriately and labelled with an appropriate dimension. Plots are recognised statistical methods of presenting data and usually require specialised statistical software to create them. The statistical analysis and methods to generate the plots are as important as the methodology of the study itself. The software, including dates and version numbers, as well as statistical tests should be appropriately referenced. Following some of the guidance provided in this article will enhance a manuscript. PMID:26637671

  1. Vascular trauma in civilian practice.

    PubMed Central

    Golledge, J.; Scriven, M. W.; Fligelstone, L. J.; Lane, I. F.

    1995-01-01

    Vascular trauma is associated with major morbidity and mortality, but little is known about its incidence or nature in Britain. A retrospective study of 36 patients requiring operative intervention for vascular trauma under one vascular surgeon over a 6-year period was undertaken. Twenty-four patients suffered iatrogenic trauma (median age 61 years); including cardiological intervention (19), radiological intervention (2), varicose vein surgery (1), umbilical vein catherisation (1) and isolated hyperthermic limb perfusion (1). There were 23 arterial and three venous injuries. Twelve patients had accidental trauma (median age 23 years). Three of the ten patients with blunt trauma were referred for vascular assessment before orthopaedic intervention, two after an on-table angiogram and five only after an initial orthopaedic procedure (range of delay 6 h to 10 days). Injuries were arterial in nine, venous in two and combined in one. Angiography was obtained in six patients, and in two patients with multiple upper limb fractures identified the site of injury when clinical localisation was difficult. A variety of vascular techniques were used to treat the injuries. Two patients died postoperatively and one underwent major limb amputation. Thirty-two (89%) remain free of vascular sequelae after a median follow-up of 48 months (range 3-72 months). Vascular trauma is uncommon in the United Kingdom. To repair the injuries a limited repertoire of vascular surgery techniques is needed. Therefore, vascular surgical assessment should be sought at an early stage to prevent major limb loss. PMID:8540659

  2. Computer applications in orthopaedics.

    PubMed

    Pho, R W; Lim, S Y; Pereira, B P

    1990-09-01

    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

  3. Verruciform xanthoma in the setting of cutaneous trauma and chronic inflammation: report of a patient and a brief review of the literature.

    PubMed

    Cumberland, Lara; Dana, Ali; Resh, Brooke; Fitzpatrick, James; Goldenberg, Gary

    2010-08-01

    We report a rare case of multiple, co-exisitng verruciform xanthomas (VXs) of the anogenital region in the setting of cutaneous trauma. VX is a rare benign mucocutaneous neoplasm that typically presents as a solitary lesion with a predilection for the oral cavity, although extra-oral lesions have been reported involving the vulva, scrotum, penis, anal region and extremities. The etiology and pathogenesis of VX have yet to be determined; however, recent literature has reported that multifocal cutaneous VX are frequently associated with pre-existing inflammatory processes. A significant number of VXs of the skin have been found to co-exist with cutaneous disorders including graft vs. host disease, discoid lupus erythematosus, pemphigus vulgaris, and recessive dystrophic epidermolysis bullosa. Therefore, we speculate severe cutaneous trauma and chronic inflammation may induce epithelial keratinocytes to respond aberrantly leading to epidermal hyperplasia and foamy cell formation characterizing the VX lesion. PMID:19958440

  4. Understanding Orthopaedic Registry Studies: A Comparison with Clinical Studies.

    PubMed

    Inacio, Maria C S; Paxton, Elizabeth W; Dillon, Mark T

    2016-01-01

    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

  5. Providing Orthopaedic Care for the Incarcerated: Obstacles and Challenges.

    PubMed

    Sraj, Shafic A

    2016-09-01

    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

  6. Considerations in the Radiologic Evaluation of the Pregnant Orthopaedic Patient.

    PubMed

    Matzon, Jonas L; Lutsky, Kevin F; Ricci, Emily K; Beredjiklian, Pedro K

    2015-08-01

    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

  7. Find an Orthopaedic Foot and Ankle MD/DO

    MedlinePlus

    ... 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 ...

  8. Robotic systems in orthopaedic surgery.

    PubMed

    Lang, J E; Mannava, S; Floyd, A J; Goddard, M S; Smith, B P; Mofidi, A; Seyler, T M; Jinnah, R H

    2011-10-01

    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

  9. Addressing Sequelae of Trauma and Interpersonal Violence in Military Children: A Review of the Literature and Case Illustration

    ERIC Educational Resources Information Center

    Campbell, Carole L.; Brown, Elissa J.; Okwara, Leonore

    2011-01-01

    Research has documented increases in child maltreatment at times when caregivers are deployed and rates have increased among military families since 2002, despite remaining stable among civilian families. Military youth also are susceptible to traumatic events that are nonmilitary related. Despite the prevalence of various forms of trauma exposure…

  10. American Orthopaedic Foot and Ankle Society

    MedlinePlus

    ... 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 ...

  11. Sources of information influencing decision-making in orthopaedic surgery - an international online survey of 1147 orthopaedic surgeons

    PubMed Central

    2013-01-01

    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

  12. Lower limb trauma: primary treatment and reconstruction.

    PubMed Central

    Godfrey, A. M.

    1989-01-01

    The requirements of lower limb trauma reconstruction are discussed with comment on the availability of plastic surgery services. The significance of early efficient soft tissue management is stressed and a plea is made for better cooperation between plastic and orthopaedic surgery in both training and practice. Images fig. 1 PMID:2589787

  13. Radiation Safety in Pediatric Orthopaedics.

    PubMed

    Caird, Michelle S

    2015-01-01

    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

  14. Improving patient flow: role of the orthopaedic discharge sister.

    PubMed

    Tytler, Beverley

    2016-03-01

    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

  15. Traumatic rupture of gastric pull-up after apparent mild thoracic trauma: a case report and literature review.

    PubMed

    Valle, Joaquin; Srinivasrao, Hanumantha; Snow, David; Asbitt, Mike

    2016-05-01

    While elderly patients account for only 10-12% of all trauma victims, they consume 25% of trauma-related health care resources, with higher rates of mortality and complication. Presently described is the case of an elderly patient who presented to the emergency department (ED) following mild thoracic trauma, with previous history of gastric pull-up surgery. The patient had consulted another facility 48 hours earlier and was prescribed analgesia and x-ray follow-up for a mechanical fall and pain in the lower rib cage. At arrival, the patient complained of increasing dyspnea and pain at the right hemithorax. X-ray showed right hemithorax effusion, and contrast computed tomography (CT) demonstrated a large amount of contrast filling the pleural space and a relatively small point of gastric pull-up rupture in the stomach. The patient was referred to the cardiothoracic unit, but was unresponsive upon arrival and died. The aim of the present report was to raise the index of clinical suspicion of traumatic rupture of the gastric pull-up following traumatic chest injury, and to affirm that contrast CT should be the gold standard for diagnosis. PMID:27598597

  16. Fundamentals of orthopaedics. Fourth edition

    SciTech Connect

    Gartland, J.J.

    1986-01-01

    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.

  17. Applications of nanotechnology in orthopaedics.

    PubMed

    Tasker, L H; Sparey-Taylor, G J; Nokes, L D M

    2007-03-01

    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

  18. Hyperbaric Oxygen in Lower Limb Trauma (HOLLT); protocol for a randomised controlled trial

    PubMed Central

    Millar, Ian L; McGinnes, Rosemary A; Williamson, Owen; Lind, Folke; Jansson, Karl-Åke; Hajek, Michal; Smart, David; Fernandes, Tiago; Miller, Russell; Myles, Paul; Cameron, Peter

    2015-01-01

    Introduction Open fractures with significant soft tissue injury are associated with high rates of complications, such as non-union, infection, chronic pain and disability. Complications often require further inpatient care, and in many cases, multiple operations and prolonged rehabilitation. Use of hyperbaric oxygen therapy as an adjunct to standard orthopaedic trauma care has the potential to reduce the complications of musculoskeletal injury and thus improve outcomes. Two previous randomised trials have suggested some positive effect, but neither functional measures nor long-term outcomes were reported. Methods and analysis An international, multicentre, randomised, open-label, clinical trial. Patients with trauma with an acute open fracture of the tibia with severe soft tissue injury (Gustilo grade 3) and high risk of injury-related complications were recruited from participating major trauma hospitals with hyperbaric facilities. Patients were enrolled with the expectation of commencing 12 sessions of hyperbaric oxygen therapy within 48 h of injury. The primary outcome measure is the incidence of acute complications of the open fracture wound at 14 days. Other short-term outcome measures include amputation, need for fasciotomy, time until wound closure, breakdown of closed wounds, time until definitive orthopaedic fixation, number of operative procedures, intensive care stay and hospital stay. Long-term follow-up will continue for 2 years postinjury. Ethics and dissemination Ethics approval was given by The Alfred Health Human Ethics Committee (206/04) and the Monash University Human Research Ethics Committee (CF07/4208). Approval was also obtained from the institutional research ethics committee at each participating site. This study will make a significant contribution to the trauma literature and should answer the question of whether hyperbaric oxygen therapy can significantly improve outcomes in severe lower limb trauma. Collective study results will

  19. [Management of war orthopaedic injuries in recent armed conflicts].

    PubMed

    Frank, M; Mathieu, L

    2013-01-01

    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

  20. HIV and Orthopaedics: Musculoskeletal Manifestations and Outcomes.

    PubMed

    Pretell-Mazzini, Juan; Subhawong, Ty; Hernandez, Victor H; Campo, Rafael

    2016-05-01

    ➤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

  1. Surgical advances during the First World War: the birth of modern orthopaedics.

    PubMed

    Ramasamy, Arul; Eardley, W G P; Edwards, D S; Clasper, J C; Stewart, M P M

    2016-02-01

    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

  2. Planning for life after orthopaedics.

    PubMed

    Barr, Joseph S; McCaslin, Michael J; Hinds, Cynthia K

    2014-01-01

    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

  3. Disclosure and silencing: A systematic review of the literature on patterns of trauma communication in refugee families

    PubMed Central

    Montgomery, Edith

    2015-01-01

    This systematic review aimed to explore the effects of different degrees of parental disclosure of traumatic material from the past on the psychological well-being of children in refugee families. A majority of studies emphasize the importance of the timing of disclosure and the manner in which it takes place, rather than the effects of open communication or silencing strategies per se. A pattern emerged in which the level of parental disclosure that promotes psychological adjustment in refugee children depends on whether the children themselves have been directly exposed to traumatic experiences, and whether the children are prepubescent or older. The process of trauma disclosure is highly culturally embedded. Future research needs to address the culturally shaped variations in modulated disclosure and further explore how modulated disclosure can be facilitated in family therapy with traumatized refugee families. PMID:25656844

  4. Inverted ductal papilloma of the oral cavity secondary to lower lip trauma. A case report and literature review

    PubMed Central

    Sala-Pérez, Sergi; España-Tost, Antoni; Vidal-Bel, August

    2013-01-01

    Inverted ductal papilloma of the oral cavity is an infrequent benign neoplasm of papillary appearance that originates in the secretory duct of a salivary gland. The etiology is unknown, though some authors have related it to human papillomavirus (HPV) infection. We present the case of a 40-year-old woman with a tumor of the lower lip mucosa. Histopathological study of the lesion diagnosed inverted ductal papilloma of the oral cavity. Human papillomavirus DNA detection and typing based on tumor lesion DNA amplification and posterior hybridization, revealed no presence of viral DNA. The antecedents of trauma reported by the patient could have played an important role in the development of this tumor. Key words:Inverted ductal papilloma, intraductal papilloma, oral papilloma, papillary epidermoid adenoma. PMID:24455058

  5. Disclosure and silencing: A systematic review of the literature on patterns of trauma communication in refugee families.

    PubMed

    Dalgaard, Nina Thorup; Montgomery, Edith

    2015-10-01

    This systematic review aimed to explore the effects of different degrees of parental disclosure of traumatic material from the past on the psychological well-being of children in refugee families. A majority of studies emphasize the importance of the timing of disclosure and the manner in which it takes place, rather than the effects of open communication or silencing strategies per se. A pattern emerged in which the level of parental disclosure that promotes psychological adjustment in refugee children depends on whether the children themselves have been directly exposed to traumatic experiences, and whether the children are prepubescent or older. The process of trauma disclosure is highly culturally embedded. Future research needs to address the culturally shaped variations in modulated disclosure and further explore how modulated disclosure can be facilitated in family therapy with traumatized refugee families. PMID:25656844

  6. Nicholas J. Giannestras (1908-1978): a distinguished orthopaedic surgeon, his work, life and times.

    PubMed

    Markatos, Konstantinos; Efstathopoulos, Nikolaos; Kaseta, Kiriaki Maria; Nikolaou, Vasileios; Tsoucalas, Gregory; Sgantzos, Markos

    2015-11-01

    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

  7. American Orthopaedic Society for Sports Medicine

    MedlinePlus

    ... Support AOSSM Research Publications Toggle American Journal of Sports Medicine Sports Health: A Multidisciplinary Approach Orthopaedic Journal of Sports Medicine Journal Apps Sports Medicine Update Other Professional Resources ...

  8. Infected Subgaleal Hematoma Following Blunt Head Trauma in a Child: Case Report and Review of the Literature.

    PubMed

    Barry, James; Fridley, Jared; Sayama, Christina; Lam, Sandi

    2015-01-01

    Subgaleal hematoma (SGH), an uncommon but potentially dangerous complication, has been reported to occur with delivery in newborns, as well as in young patients following head trauma. Infection of a SGH is extremely rare, especially in cases where no disruption of the skin barrier occurs. We report a case of an infected SGH in an 8-month-old following closed skull fracture. The patient presented with scalp swelling 1 day after falling 3 feet. Initial evaluation found a nondisplaced skull fracture on computed tomography. She was discharged following an uneventful 23-hour observation. Three days later, she developed symptoms concerning for a viral upper respiratory tract infection and received symptomatic treatment. Nine days after injury, she returned with continued fevers, irritability, and significant increase in scalp swelling. Magnetic resonance imaging showed a subgaleal abscess with osteomyelitis. Needle aspiration revealed an infected hematoma with cultures positive for Streptococcus pneumoniae, treated with intravenous ampicillin. Purulent drainage from an enlarging necrotic needle aspiration site required subsequent surgical debridement of the subgaleal abscess with drain placement. She recovered well following surgery and intravenous antibiotics. Physicians should be aware that SGH carries a risk of serious morbidity and mortality. SGH can serve as a nidus for infection, typically from skin barrier breakdown or, as in this case, hematogenous spread. Early recognition, appropriate antibiotic therapy, and surgical debridement are critical in treating infected SGH. PMID:26088299

  9. Literature.

    ERIC Educational Resources Information Center

    Verner, Zenobia, Ed.

    1977-01-01

    This issue provides a selection of articles about literature and the teaching of literature. Titles include "Sin, Salvation, and Grace in 'The Scarlet Letter,'""'The Road Not Taken': A Study in Ambiguity,""In Search of Shakespeare: The Essential Years,""Right Deeds for Wrong Reasons: Teaching the Bible as Literature,""A Southern Author's Fight for…

  10. Endovascular stent grafting of a posterior tibial artery pseudoaneurysm secondary to penetrating trauma: case report and review of the literature.

    PubMed

    de Troia, Alessandro; Biasi, Lukla; Iazzolino, Luigi; Azzarone, Matteo; Tecchio, Tiziano; Rossi, Cristina; Salcuni, Pierfranco

    2014-10-01

    Endovascular treatment of posttraumatic pseudoaneurysms has become a viable less-invasive option when compared with open repair. In this study, we present a case of a posttraumatic pseudoaneurysm of the posterior tibial artery in a 34-year-old man treated with endovascular stent grafting. An extensive review of the literature has been performed. PMID:24530718

  11. The case for orthopaedic medicine in Israel

    PubMed Central

    2013-01-01

    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

  12. Demystifying damage control in musculoskeletal trauma.

    PubMed

    Bates, P; Parker, P; McFadyen, I; Pallister, I

    2016-05-01

    Trauma care has evolved rapidly over the past decade. The benefits of operative fracture management in major trauma patients are well recognised. Concerns over early total care arose when applied broadly. The burden of additional surgical trauma could constitute a second hit, fuelling the inflammatory response and precipitating a decline into acute respiratory distress syndrome, sepsis and multiple organ dysfunction syndrome. Temporary external fixation aimed to deliver the benefits of fracture stabilisation without the risk of major surgery. This damage control orthopaedics approach was advocated for those in extremis and a poorly defined borderline group. An increasing understanding of the physiological response to major trauma means there is now a need to refine our treatment options. A number of large scale retrospective reviews indicate that early definitive fracture fixation is beneficial in the majority of major trauma patients. It is recommended that patients are selected appropriately on the basis of their response to resuscitation. The hope is that this approach (dubbed 'safe definitive fracture surgery' or 'early appropriate care') will herald an era when care is individualised for each patient and their circumstances. The novel Damage Control in Orthopaedic Trauma Surgery course at The Royal College of Surgeons of England aims to equip senior surgeons with the insights and mindset necessary to contribute to this key decision making process as well as also the technical skills to provide damage control interventions when needed, relying on the improved techniques of damage control resuscitation and advances in the understanding of early appropriate care. PMID:27023640

  13. Orthopaedic research and education foundation and industry.

    PubMed

    Wurth, Gene R; Sherr, Judy H; Coffman, Thomas M

    2003-07-01

    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

  14. Antimicrobial biocompatible bioscaffolds for orthopaedic implants.

    PubMed

    Qureshi, Ammar T; Terrell, Lekeith; Monroe, W Todd; Dasa, Vinod; Janes, Marlene E; Gimble, Jeffrey M; Hayes, Daniel J

    2014-05-01

    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

  15. [Frey's sydrome secondary to an obstetrics trauma: Presntation of 2 cases and a review of the literature].

    PubMed

    Martínez-Baylach, J; Aragó, T; Galdós, H; Herrera, C; Rubio de Abajo, I

    2010-04-01

    Frey's Syndrome is a little known condition and is probably under diagnosed in children. It consists of recurrent episodes of facial flushing and sweating triggered by gustatory stimulation. Although the exact etiology is unknown, an aberrant regeneration of the nerve fibers of the auriculotemporal nerve due to nerve injury, has been proposed as a pathophysiological mechanism. We report two new cases of Frey's syndrome secondary to obstetric forceps injury at birth and review the existing literature to date (37 articles describing 68 cases). PMID:20188641

  16. Facial trauma

    MedlinePlus

    Maxillofacial injury; Midface trauma; Facial injury; LeFort injuries ... Kellman RM. Maxillofacial trauma. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: ...

  17. Facial trauma

    MedlinePlus

    Kellman RM. Maxillofacial trauma. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 23. Mayersak RJ. Facial trauma. In: Marx JA, Hockberger RS, ...

  18. The Vienna Heritage of Iowa Orthopaedics

    PubMed Central

    Buckwalter, Joseph A

    2003-01-01

    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

  19. Does Admission to Medicine or Orthopaedics Impact a Geriatric Hip Patient’s Hospital Length of Stay?

    PubMed Central

    Greenberg, Sarah E.; VanHouten, Jacob P.; Lakomkin, Nikita; Ehrenfeld, Jesse; Jahangir, Amir Alex; Boyce, Robert H.; Obremksey, William T.; Sethi, Manish K.

    2016-01-01

    Objectives The aim of our study was to determine the association between admitting service, medicine or orthopaedics, and length of stay (LOS) for a geriatric hip fracture patient. Design Retrospective. Setting Urban level 1 trauma center. Patients/Participants Six hundred fourteen geriatric hip fracture patients from 2000 to 2009. Interventions Orthopaedic surgery for geriatric hip fracture. Main Outcome Measurements Patient demographics, medical comorbidities, hospitalization length, and admitting service. Negative binomial regression used to determine association between LOS and admitting service. Results Six hundred fourteen geriatric hip fracture patients were included in the analysis, of whom 49.2% of patients (n = 302) were admitted to the orthopaedic service and 50.8% (3 = 312) to the medicine service. The median LOS for patients admitted to orthopaedics was 4.5 days compared with 7 days for patients admitted to medicine (P < 0.0001). Readmission was also significantly higher for patients admitted to medicine (n = 92, 29.8%) than for those admitted to orthopaedics (n = 70, 23.1%). After controlling for important patient factors, it was determined that medicine patients are expected to stay about 1.5 times (incidence rate ratio: 1.48, P < 0.0001) longer in the hospital than orthopaedic patients. Conclusions This is the largest study to demonstrate that admission to the medicine service compared with the orthopaedic service increases a geriatric hip fractures patient’s expected LOS. Since LOS is a major driver of cost as well as a measure of quality care, it is important to understand the factors that lead to a longer hospital stay to better allocate hospital resources. Based on the results from our institution, orthopaedic surgeons should be aware that admission to medicine might increase a patient’s expected LOS. PMID:26371621

  20. Older Patients' Unexpressed Concerns About Orthopaedic Surgery

    PubMed Central

    Hudak, Pamela L.; Armstrong, Kristy; Braddock, Clarence; Frankel, Richard M.; Levinson, Wendy

    2008-01-01

    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

  1. Justifications and needs for diversity in orthopaedics.

    PubMed

    White, A A

    1999-05-01

    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

  2. Administrative Databases in Orthopaedic Research: Pearls and Pitfalls of Big Data.

    PubMed

    Patel, Alpesh A; Singh, Kern; Nunley, Ryan M; Minhas, Shobhit V

    2016-03-01

    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

  3. A survey of orthopaedic journal editors determining the criteria of manuscript selection for publication

    PubMed Central

    2011-01-01

    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

  4. Computer-assisted trauma surgery.

    PubMed

    Atesok, Kivanc; Schemitsch, Emil H

    2010-05-01

    Computer-assisted orthopaedic surgery (CAOS) is performed by digitizing the patient's anatomy, combining the images in a computerized system, and integrating the surgical instruments into the digitized image background. This allows the surgeon to navigate the surgical instruments and the bone in an improved, virtual visual environment. CAOS in traumatology is performed with images obtained by fluoroscopy, CT, or three-dimensional fluoroscopy. CAOS is used in basic trauma procedures for preoperative planning, fracture reduction, intramedullary nailing, percutaneous screw or plate fixation, and hardware or shrapnel removal. Potential benefits of CAOS include minimal invasiveness, increased accuracy, and decreased radiation exposure. Limitations include a significant learning curve, increased surgical time, requirements for special setup and equipment handling in the operating room, specialized technical support, and cost. Current evidence shows no advantage with CAOS in trauma cases compared with conventional methods. Prospective randomized trials and clinical outcomes are lacking. PMID:20435875

  5. Imaging in orbital trauma

    PubMed Central

    Lin, Ken Y.; Ngai, Philip; Echegoyen, Julio C.; Tao, Jeremiah P.

    2012-01-01

    Orbital trauma is one of the most common reasons for ophthalmology specialty consultation in the emergency department setting. We survey the literature from 1990 to present to describe the role of computed tomography (CT), magnetic resonance imaging (MRI) and their associated angiography in some of the most commonly encountered orbital trauma conditions. CT orbit can often detect certain types of foreign bodies, lens dislocation, ruptured globe, choroidal or retinal detachments, or cavernous sinus thrombosis and thus complement a bedside ophthalmic exam that can sometimes be limited in the setting of trauma. CT remains the workhorse for acute orbital trauma owing to its rapidity and ability to delineate bony abnormalities; however MRI remains an important modality in special circumstances such as soft tissue assessment or with organic foreign bodies. PMID:23961028

  6. Systemic trauma.

    PubMed

    Goldsmith, Rachel E; Martin, Christina Gamache; Smith, Carly Parnitzke

    2014-01-01

    Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering. PMID:24617751

  7. Orthopaedic Surgeon Burnout: Diagnosis, Treatment, and Prevention.

    PubMed

    Daniels, Alan H; DePasse, J Mason; Kamal, Robin N

    2016-04-01

    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

  8. American Academy of Neurological and Orthopaedic Surgeons

    MedlinePlus

    ... Orthopaedic Surgeons Navigation Menu Home Who We Are Board of Directors Executive Committee Standing Committees Contact Us Membership Our ... gratitude, as well as congratulations from the entire Board of Directors, is extended to Dr. Zamorano for her invaluable ...

  9. Myths and Legends in Orthopaedic Practice: Are We All Guilty?

    PubMed Central

    Immerman, Igor

    2008-01-01

    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

  10. Myths and legends in orthopaedic practice: are we all guilty?

    PubMed

    Tejwani, Nirmal C; Immerman, Igor

    2008-11-01

    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

  11. Bioceramic Coatings for Orthopaedic Implants

    SciTech Connect

    Campbell, Allison A.

    2003-11-02

    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.

  12. Digital photography in orthopaedic surgery.

    PubMed

    Elbeshbeshy, B; Trepman, E

    2001-01-01

    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

  13. Geriatric Trauma.

    PubMed

    Reske-Nielsen, Casper; Medzon, Ron

    2016-08-01

    Within the next 15 years, 1 in 5 Americans will be over age 65. $34 billion will be spent yearly on trauma care of this age group. This section covers situations in trauma unique to the geriatric population, who are often under-triaged and have significant injuries underestimated. Topics covered include age-related pathophysiological changes, underlying existing medical conditions and certain daily medications that increase the risk of serious injury in elderly trauma patients. Diagnostic evaluation of this group requires liberal testing, imaging, and a multidisciplinary team approach. Topics germane to geriatric trauma including hypothermia, elder abuse, and depression and suicide are also covered. PMID:27475011

  14. Prevalence of musculoskeletal disorders among orthopedic trauma surgeons: an OTA survey

    PubMed Central

    AlQahtani, Saad M.; Alzahrani, Mohammad M.; Harvey, Edward J.

    2016-01-01

    Background Occupational injuries and hazards have gained increased attention in the surgical community in general and in the orthopedic literature specifically. The aim of this study was to assess prevalence and characteristics of musculoskeletal disorders among orthopedic trauma surgeons and the impact of these injuries on the surgeons’ practices. Methods We sent a modified version of the physical discomfort survey to surgeon members of the Orthopaedic Trauma Association (OTA) via email. Data were collected and descriptive statistics were analyzed. Results A total of 86 surgeons completed the survey during the period of data collection; 84.9% were men, more than half were 45 years or older and 40.6% were in practice for 10 years or more. More than 66% of respondents reported a musculoskeletal disorder that was related to work; the most common was low back pain (29.3%). The number of body regions involved and disorders diagnosed was associated with increasing age and number of years in practice (p = 0.033). Time off work owing to these disorders was associated with working in a private setting (p = 0.045) and working in more than 1 institute (p = 0.009). Conclusion To our knowledge, our study is the first to report a high percentage of orthopedic trauma surgeons sustaining occupational injuries some time in their careers. The high cost of management and rehabilitation of these injuries in addition to the related number of missed work days indicate the need for increased awareness and implementation of preventive measures. PMID:26812408

  15. What is the role of the orthopaedic surgeon in management of fragility fractures?

    PubMed

    Sharif, Khalid M; Dimitriou, Rozalia; Giannoudis, Peter V

    2011-06-01

    Fragility fractures are the most prevalent trauma condition that orthopaedic surgeons face today. Osteoporosis and susceptibility to falls are the key predisposing factors. Despite evidence supporting the impact of treating osteoporosis on reducing the incidence of fragility fractures, it is often left untreated. Orthopaedic surgeons are often the first physicians to assess and treat the patient after a fragility fracture. Their role therefore does not end in the skillful fixation of the fractures, but they have a unique opportunity to ensure that preventive measures are implemented. This includes falls prevention, investigation of possible causes underlying osteoporosis, attention to diet, exercise, calcium, and vitamin D supplementation as well as prescription of anti-resorptive and anabolic medication. The need for a dedicated multidisciplinary team needs to be emphasized and therefore effective communication between the different parties is of paramount importance. PMID:21566474

  16. Does Video Gaming Affect Orthopaedic Skills Acquisition? A Prospective Cohort-Study

    PubMed Central

    Khatri, Chetan; Sugand, Kapil; Anjum, Sharika; Vivekanantham, Sayinthen; Akhtar, Kash; Gupte, Chinmay

    2014-01-01

    Introduction Previous studies have suggested that there is a positive correlation between the extent of video gaming and efficiency of surgical skill acquisition on laparoscopic and endovascular surgical simulators amongst trainees. However, the link between video gaming and orthopaedic trauma simulation remains unexamined, in particular dynamic hip screw (DHS) stimulation. Objective To assess effect of prior video gaming experience on virtual-reality (VR) haptic-enabled DHS simulator performance. Methods 38 medical students, naïve to VR surgical simulation, were recruited and stratified relative to their video gaming exposure. Group 1 (n = 19, video-gamers) were defined as those who play more than one hour per day in the last calendar year. Group 2 (n = 19, non-gamers) were defined as those who play video games less than one hour per calendar year. Both cohorts performed five attempts on completing a VR DHS procedure and repeated the task after a week. Metrics assessed included time taken for task, simulated flouroscopy time and screw position. Median and Bonett-Price 95% confidence intervals were calculated for seven real-time objective performance metrics. Data was confirmed as non-parametric by the Kolmogorov-Smirnov test. Analysis was performed using the Mann-Whitney U test for independent data whilst the Wilcoxon signed ranked test was used for paired data. A result was deemed significant when a two-tailed p-value was less than 0.05. Results All 38 subjects completed the study. The groups were not significantly different at baseline. After ten attempts, there was no difference between Group 1 and Group 2 in any of the metrics tested. These included time taken for task, simulated fluoroscopy time, number of retries, tip-apex distance, percentage cut-out and global score. Conclusion Contrary to previous literature findings, there was no correlation between video gaming experience and gaining competency on a VR DHS simulator. PMID:25333959

  17. Randomised Trial Support for Orthopaedic Surgical Procedures

    PubMed Central

    Lim, Hyeung C.; Adie, Sam; Naylor, Justine M.; Harris, Ian A.

    2014-01-01

    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

  18. Myositis ossificans traumatica of the deltoid ligament in a 34 year old recreational ice hockey player with a 15 year post-trauma follow-up: a case report and review of the literature

    PubMed Central

    Muir, Brad

    2010-01-01

    Myositis ossificans traumatica is a relatively common injury associated with sports especially those involving contact. It continues to frustrate both athlete and health practitioner alike due to its continued lack of treatment options and a lengthy natural history. This case study chronicles the observation of a 34 year old recreational ice hockey player who presented 7 years post-trauma, was diagnosed with myositis ossificans traumatica and was followed up on 8 years later (15 years post-trauma). This case report is suspected to be the first published case study of its kind. The literature review outlines the various types of myositis ossificans, its incidence, pathogenesis, differential diagnoses including osteosarcoma, and the various methods/modalities reported in its treatment. PMID:21120014

  19. A Patient With Blunt Trauma and Cardiac Arrest Arriving Pulseless at the Emergency Department; is that Enough Reason to Stop Resuscitation? Review of Literature and Case Report

    PubMed Central

    Hamidian Jahromi, Alireza; Northcutt, Ashley; Youssef, Asser M

    2013-01-01

    The decision to stop or continue resuscitation in a patient with blunt trauma and cardiac arrest arriving pulseless to the hospital has always been controversial. While many authors still believe that it is a futile effort, with no chance of success for complete neurological recovery, some recent reports have challenged the idea. Here we report complete recovery of a severely injured patient following a motor vehicle accident who lost vital signs completely before arrival at our trauma center. No cardiac motion was detected on ultrasound examination on arrival. Emergency department thoracotomy, open cardiac massage, massive blood transfusion, damage control laparotomy with abdominal and pelvic packing, followed by angio-embolization of pelvic bleeding, and staged abdominal exploration were performed. This case is an example showing that resuscitation of patients with blunt trauma and cardiac arrest arriving pulseless to the hospital is not always futile. PMID:24693385

  20. [Chest trauma].

    PubMed

    Freixinet Gilart, Jorge; Ramírez Gil, María Elena; Gallardo Valera, Gregorio; Moreno Casado, Paula

    2011-01-01

    Chest trauma is a frequent problem arising from lesions caused by domestic and occupational activities and especially road traffic accidents. These injuries can be analyzed from distinct points of view, ranging from consideration of the most severe injuries, especially in the context of multiple trauma, to the specific characteristics of blunt and open trauma. In the present article, these injuries are discussed according to the involvement of the various thoracic structures. Rib fractures are the most frequent chest injuries and their diagnosis and treatment is straightforward, although these injuries can be severe if more than three ribs are affected and when there is major associated morbidity. Lung contusion is the most common visceral lesion. These injuries are usually found in severe chest trauma and are often associated with other thoracic and intrathoracic lesions. Treatment is based on general support measures. Pleural complications, such as hemothorax and pneumothorax, are also frequent. Their diagnosis is also straightforward and treatment is based on pleural drainage. This article also analyzes other complex situations, notably airway trauma, which is usually very severe in blunt chest trauma and less severe and even suitable for conservative treatment in iatrogenic injury due to tracheal intubation. Rupture of the diaphragm usually causes a diaphragmatic hernia. Treatment is always surgical. Myocardial contusions should be suspected in anterior chest trauma and in sternal fractures. Treatment is conservative. Other chest injuries, such as those of the great thoracic and esophageal vessels, are less frequent but are especially severe. PMID:21640287

  1. The Orthopaedically Handicapped and Computer Usage: The Case of TRNC

    ERIC Educational Resources Information Center

    Dincyurek, Sibel; Arsan, Nihan; Caglar, Mehmet

    2011-01-01

    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…

  2. How to get the most out of your orthopaedic fellowship: thinking about practice-based learning.

    PubMed

    Templeman, David

    2012-09-01

    Practice-based learning and improvement is an important skill set to develop during an orthopaedic trauma fellowship and is 1 of the 6 core competencies stated by the ACGME. The review of clinic cases is best done using a few simple models to develop a structured approach for studying cases. Three common sense and easy-to-use strategies to improve clinical practice are as follows: performing each case three times, studying the 4 quadrants of patient outcomes, and the application of the Pareto 80/20 rule. These principles help to develop a structured approach for analyzing and thinking about practice-based experiences. PMID:22732864

  3. What Do Reported Learning Curves Mean for Orthopaedic Surgeons?

    PubMed

    Gofton, Wade T; Solomon, Michael; Gofton, Tyson; Pagé, Alex; Kim, Paul R; Netting, Caleb; Bhandari, Mohit; Beaulé, Paul E

    2016-01-01

    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

  4. Tailbone trauma

    MedlinePlus

    Choi SB, Cwinn AA. Pelvic trauma. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 55. Vora ...

  5. A Psychomotor Skills Course for Orthopaedic Residents

    ERIC Educational Resources Information Center

    Lippert, Frederick G.; And Others

    1975-01-01

    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)

  6. The Orthopaedic Training Study. Final Report.

    ERIC Educational Resources Information Center

    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…

  7. Recognizing and Preventing Burnout among Orthopaedic Leaders

    PubMed Central

    Quick, James Campbell; Sime, Wesley E.; Novicoff, Wendy M.; Einhorn, Thomas A.

    2008-01-01

    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

  8. Elderly trauma.

    PubMed

    Holleran, Renee Semonin

    2015-01-01

    Across the world, the population is aging. Adults 65 years and older make up one of the fastest growing segments of the US population. Trauma is a disease process that affects all age groups. The mortality and morbidity that result from an injury can be influenced by many factors including age, physical condition, and comorbidities. The management of the elderly trauma patient can present some unique challenges. This paper addresses the differences that occur in the management of elderly patient who has been injured. This paper also includes a discussion of how to prevent injury in the elderly. PMID:26039652

  9. Leadership and business education in orthopaedic residency training programs.

    PubMed

    Kiesau, Carter D; Heim, Kathryn A; Parekh, Selene G

    2011-01-01

    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

  10. Setting standards for medical writing in orthopaedics.

    PubMed

    Mauffrey, Cyril; Scarlat, Marius M; Pećina, Marko

    2014-01-01

    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

  11. Role of decision aids in orthopaedic surgery

    PubMed Central

    ten Have, Isha A; van den Bekerom, Michel PJ; van Deurzen, Derek FP; Hageman, Michel GJS

    2015-01-01

    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

  12. Systematic Review of the Literature and Evidence-Based Recommendations for Antibiotic Prophylaxis in Trauma: Results from an Italian Consensus of Experts

    PubMed Central

    Poole, Daniele; Chieregato, Arturo; Langer, Martin; Viaggi, Bruno; Cingolani, Emiliano; Malacarne, Paolo; Mengoli, Francesca; Nardi, Giuseppe; Nascimben, Ennio; Riccioni, Luigi; Turriziani, Ilaria; Volpi, Annalisa; Coniglio, Carlo; Gordini, Giovanni

    2014-01-01

    Background Antibiotic prophylaxis is frequently administered in severe trauma. However, the risk of selecting resistant bacteria, a major issue especially in critical care environments, has not been sufficiently investigated. The aim of the present study was to provide guidelines for antibiotic prophylaxis for four different trauma-related clinical conditions, taking into account the risks of antibiotic-resistant bacteria selection, thus innovating previous guidelines in the field. Methods The MEDLINE database was searched for studies comparing antibiotic prophylaxis to controls (placebo or no antibiotic administration) in four clinical traumatic conditions that were selected on the basis of the traumatic event frequency and/or infection severity. The selected studies focused on the prevention of early ventilator associated pneumonia (VAP) in comatose patients with traumatic brain injury, of meningitis in severe basilar skull fractures, of wound infections in long-bone open fractures. Since no placebo-controlled study was available for deep surgical site-infections prevention in abdominal trauma with enteric contamination, we compared 24-hour and 5-day antibiotic prophylaxis policies. A separate specific research focused on the question of antibiotic-resistant bacteria selection caused by antibiotic prophylaxis, an issue not adequately investigated by the selected studies. Randomised trials, reviews, meta-analyses, observational studies were included. Data extraction was carried out by one author according to a predefined protocol, using an electronic form. The strength of evidence was stratified and recommendations were given according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Results Uncertain evidence deserving further studies was found for two-dose antibiotic prophylaxis for early VAP prevention in comatose patients. In the other cases the risk of resistant-bacteria selection caused by antibiotic administration

  13. The impact of disruptive innovations in orthopaedics.

    PubMed

    Hansen, Erik; Bozic, Kevin J

    2009-10-01

    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

  14. ORTHOPAEDIC GENE THERAPY – LOST IN TRANSLATION?

    PubMed Central

    Evans, C.H.; Ghivizzani, S.C.; Robbins, P.D.

    2011-01-01

    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

  15. Shock trauma.

    PubMed

    Trunkey, D D

    1984-09-01

    Trauma - accidental or intentional injury - is a major health and social problem. It is still the chief cause of death in people between the ages of 1 and 38 years. In the United States, the mortality due to trauma between the ages of 15 and 24 years increased by 13% from 1960 to 1978. During the same period, the mortality for people aged 25 to 64 years declined by 16%. Murders have increased from 8464 in 1960, to 26 000 in 1982. The overall death rate of American teenagers and young adults is 50% higher than that of their counterparts in Britain, Sweden and Japan. Trauma affects young, productive citizens, and the estimated costs for death, disability and loss of productivity exceed $230 million a day. The most tragic statistic is that at least 40% of the deaths are needless and preventable if better treatment and prevention programs were available. Trauma deaths that might be prevented are those due to motor vehicle accidents, homicide, burns, and alcohol and drug abuse. In this paper suggestions for prevention are made. They include improved crash worthiness of motor vehicles, revocation of drunk drivers' licences, use of devices that limit drunk drivers, increased tax on alcohol and random breathalyser tests, and the use of seat belts and motorcycle helmets. Control of hand-guns and burn characteristics of cigarettes could also reduce deaths. The problems and issues in trauma care can be divided into two broad categories: system and professional. System problems include prehospital care, in-hospital care, rehabilitation and prevention. Professional problems include education, research, economics, and quality.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6478325

  16. Demonstrating the value of orthopaedic surgery through multicenter trials: AOA critical issues.

    PubMed

    Hilibrand, Alan S; Spindler, Kurt; O'Keefe, Regis J

    2015-04-01

    Orthopaedic surgery is expensive and will be carefully scrutinized in the U.S. under health-care reform. Unfortunately, although the orthopaedic literature is replete with clinical outcomes studies, there is still a paucity of meaningful clinical outcomes data that are free from bias. It is possible that orthopaedic procedures may be among the most cost-effective medical treatments for the aging population. However, it is only through the collection of patient-generated outcomes data in prospective randomized and observational studies that orthopaedic surgery can be shown to provide high value (defined as high-quality outcomes at a relatively low cost) to society.The burden of musculoskeletal disease in the U.S. is high; nearly half of all adults describe themselves as having a chronic musculoskeletal condition, and approximately one-quarter of all health-care dollars are spent treating musculoskeletal disease. For this reason, treatment for osteoarthritis, the costliest condition in the elderly population, has drawn great scrutiny from insurers and the government. In the absence of clinical outcomes data that prove the value of orthopaedic interventions, there will be pressure to reduce payments or even deny treatments for these conditions if they are perceived to be too expensive or lack outcomes data supporting their use.Multicenter trials are expensive; this paper analyzes challenges to, and opportunities for, funding. Although National Institutes of Health (NIH) funding has dropped nearly 20% over the past ten years in inflation-adjusted dollars, it has begun a gradual reorientation toward clinical research, which comprised almost 50% of its budget in 2013. The Patient Protection and Affordable Care Act focused more attention on clinical outcomes research, with the establishment of the Patient-Centered Outcomes Research Institute (PCORI), which will ultimately fund $750 million of comparative effectiveness research annually. Another new funding source within

  17. Radiation exposure of eyes, thyroid gland and hands in orthopaedic staff: a systematic review

    PubMed Central

    2012-01-01

    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

  18. Maxillofacial trauma scoring systems.

    PubMed

    Sahni, Vaibhav

    2016-07-01

    The changing complexity of maxillofacial fractures in recent years has created a situation where classical systems of classification of maxillofacial injuries fall short of defining trauma particularly that observed with high-velocity collisions where more than one region of the maxillofacial skeleton is affected. Trauma scoring systems designed specifically for the maxillofacial region are aimed to provide a more accurate assessment of the injury, its prognosis, the possible treatment outcomes, economics, length of hospital stay, and triage. The evolution and logic of such systems along with their merits and demerits are discussed. The author also proposes a new system to aid users in quickly and methodically choosing the system best suited to their needs without having to study a plethora of literature available in order to isolate their choice. PMID:26971084

  19. The use of damage control orthopaedics to minimize negative sequelae of surgery delay in elderly comorbid patients with hip fracture.

    PubMed

    Dong, C-H; Wang, Z-M; Zhao, X-L; Wang, A-M

    2016-06-01

    Hip surgeries count to the most frequent orthopaedic operations in older patients. Nonelective surgeries for hip fractures cause substantial economic burden because of high costs of medical treatment and high associated mortality. Surgery for hip fracture in the elderly comorbid patient still presents a challenge to orthopaedic surgeons. It is recommended that this surgery is performed within 48 hours after sustaining the hip fracture to decrease mortality. Yet the recommended early surgery (i.e. 48 hours after the incident) is not always feasible due to the frequent overall frailty of the patients or conditions of concomitant disease. The care of patients unfit for early surgery has been not adequately addressed in the literature. We have previously introduced an algorithm based on ASA-PS and P-POSSUM scores to stratify elderly comorbid patients for early vs delayed hip surgery, and used principles of Damage Control Orthopaedics to minimized negative sequelae of surgery delay (Dong C et al., PLoS One 2016). In this paper, we elaborate on Damage Control Orthopaedics and the proposed approach in the context of frequent comorbidities in the elderly orthopaedic patients. Further studies on this subject are urgently needed to establish international consensus on hip fracture surgery delayed due to overall patient frailty or extensive comorbidities. PMID:27383299

  20. Trauma care systems in Spain.

    PubMed

    Queipo de Llano, E; Mantero Ruiz, A; Sanchez Vicioso, P; Bosca Crespo, A; Carpintero Avellaneda, J L; de la Torre Prado, M V

    2003-09-01

    Trauma care systems in Spain are provided by the Nacional Health Service in a decentralized way by the seventeen autonomous communities whose process of decentralization was completed in January 2002. Its organisation is similar in all of them. Public sector companies of sanitary emergencies look after the health of citizens in relation to medical and trauma emergencies with a wide range of up to date resources both technical and human. In the following piece there is a description of the emergency response teams divided into ground and air that are responsible for the on site care of the patients in coordination with other public services. They also elaborate the prehospital clinical history that is going to be a valuable piece of information for the teams that receive the patient in the Emergency Hospital Unit (EHU). From 1980 to 1996 the mortality rate per 10.000 vehicles and the deaths per 1.000 accidents dropped significantly: in 1980 6.4 and 96.19% and in 1996, 2.8 and 64.06% respectively. In the intrahospital organisation there are two differentiated areas to receive trauma patients the casualty department and the EHU. In the EHU the severe and multiple injured patients are treated by the emergency hospital doctors; first in the triage or resuscitation areas and after when stabilised they are passed too the observation area or to the Intensive Care Unit (ICU) and from there the EHU or ICU doctors call the appropriate specialists. There is a close collaboration and coordination between the orthopaedic surgeon the EHU doctors and the other specialists surgeons in order to comply with treatment prioritization protocols. Once the patient has been transferred an entire process of assistance continuity is developed based on interdisciplinary teams formed in the hospital from the services areas involved in trauma assistance and usually coordinated by the ICU doctors. There is also mentioned the assistance registry of trauma patients, the ICU professional training

  1. Mortality as an indicator of patient safety in orthopaedics: lessons from qualitative analysis of a database of medical errors

    PubMed Central

    2012-01-01

    Background Orthopaedic surgery is a high-risk specialty in which errors will undoubtedly occur. Patient safety incidents can yield valuable information to generate solutions and prevent future cases of avoidable harm. The aim of this study was to understand the causative factors leading to all unnecessary deaths in orthopaedics and trauma surgery reported to the National Patient Safety Agency (NPSA) over a four-year period (2005–2009), using a qualitative approach. Methods Reports made to the NPSA are categorised and stored in the database as free-text data. A search was undertaken to identify the cases of all-cause mortality in orthopaedic and trauma surgery, and the free-text elements were used for thematic analysis. Descriptive statistics were calculated based on the incidents reported. This included presenting the number of times categories of incidents had the same or similar response. Superordinate and subordinate categories were created. Results A total of 257 incident reports were analysed. Four main thematic categories emerged. These were: (1) stages of the surgical journey – 118/191 (62%) of deaths occurred in the post-operative phase; (2) causes of patient deaths – 32% were related to severe infections; (3) reported quality of medical interventions – 65% of patients experienced minimal or delayed treatment; (4) skills of healthcare professionals – 44% of deaths had a failure in non-technical skills. Conclusions Most complications in orthopaedic surgery can be dealt with adequately, provided they are anticipated and that risk-reduction strategies are instituted. Surgeons take pride in the precision of operative techniques; perhaps it is time to enshrine the multimodal tools available to ensure safer patient care. PMID:22682470

  2. Short-Lasting Unilateral Neuralgiform Headache with Conjunctival Injection and Tearing Secondary to Head and Neck Trauma: Literature Review and Case Report.

    PubMed

    Rojas-Ramirez, Marcia V; Bertoli, Elizangela; Smith, Jonathan H

    2016-01-01

    This article reports a case of secondary short-lasting unilateral neuralgiform headache with conjunctival injection and tearing following head and neck trauma due to a violent assault. Following the incident, the patient began experiencing 4 to 30 shooting/sharp pain attacks per day in the left anterior temporal and supraorbital areas, with an intensity of 10/10 on a numeric rating scale. Each attack lasted between 10 and 60 seconds. These attacks were accompanied by ipsilateral conjunctival injection, tearing, ptosis of the left eye, blurry vision, and occasional rhinorrhea. Significant improvements in sleep, autonomic symptoms, and pain were observed with a combination of melatonin 10 mg per day, gabapentin 300 mg twice daily, physical therapy, and psychotherapy. This case highlights the relevance of a multidisciplinary approach in the treatment of challenging cases when there is evidence of more than one contributing factor, with the aim of reducing pain and improving the patient's quality of life. PMID:26817035

  3. Penetrating trauma

    PubMed Central

    Kuhajda, Ivan; Zarogoulidis, Konstantinos; Kougioumtzi, Ioanna; Huang, Haidong; Li, Qiang; Dryllis, Georgios; Kioumis, Ioannis; Pitsiou, Georgia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Papaiwannou, Antonis; Lampaki, Sofia; Zaric, Bojan; Branislav, Perin; Dervelegas, Konstantinos; Porpodis, Konstantinos

    2014-01-01

    Pneumothorax occurs when air enters the pleural space. Currently there is increasing incidence of road traffic accidents, increasing awareness of healthcare leading to more advanced diagnostic procedures, and increasing number of admissions in intensive care units are responsible for traumatic (non iatrogenic and iatrogenic) pneumothorax. Pneumothorax has a clinical spectrum from asymptomatic patient to life-threatening situations. Diagnosis is usually made by clinical examination and imaging techniques. In our current work we focus on the treatment of penetrating trauma. PMID:25337403

  4. Penetrating trauma.

    PubMed

    Kuhajda, Ivan; Zarogoulidis, Konstantinos; Kougioumtzi, Ioanna; Huang, Haidong; Li, Qiang; Dryllis, Georgios; Kioumis, Ioannis; Pitsiou, Georgia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Papaiwannou, Antonis; Lampaki, Sofia; Zaric, Bojan; Branislav, Perin; Dervelegas, Konstantinos; Porpodis, Konstantinos; Zarogoulidis, Paul

    2014-10-01

    Pneumothorax occurs when air enters the pleural space. Currently there is increasing incidence of road traffic accidents, increasing awareness of healthcare leading to more advanced diagnostic procedures, and increasing number of admissions in intensive care units are responsible for traumatic (non iatrogenic and iatrogenic) pneumothorax. Pneumothorax has a clinical spectrum from asymptomatic patient to life-threatening situations. Diagnosis is usually made by clinical examination and imaging techniques. In our current work we focus on the treatment of penetrating trauma. PMID:25337403

  5. Retention of Skills After Simulation-based Training in Orthopaedic Surgery.

    PubMed

    Atesok, Kivanc; Satava, Richard M; Van Heest, Ann; Hogan, MaCalus V; Pedowitz, Robert A; Fu, Freddie H; Sitnikov, Irena; Marsh, J Lawrence; Hurwitz, Shepard R

    2016-08-01

    Simulation-based surgical skills training has become essential in orthopaedic practice because of concerns about patient safety and an increase in technically challenging procedures. Surgical skills training in specifically designed simulation laboratories allows practice of procedures in a risk-free environment before they are performed in the operating room. The transferability of acquired skills to performance with patients is the most effective measure of the predictive validity of simulation-based training. Retention of the skills transferred to clinical situations is also critical. However, evidence of simulation-based skill retention in the orthopaedic literature is limited, and concerns about sustainability exist. Solutions for skill decay include repeated practice of the tasks learned on simulators and reinforcement of areas that are sensitive to decline. Further research is required to determine the retention rates of surgical skills acquired in simulation-based training as well as the success of proposed solutions for skill decay. PMID:27348146

  6. Nanostructured diamond coatings for orthopaedic applications

    PubMed Central

    CATLEDGE, S.A.; THOMAS, V.; VOHRA, Y.K.

    2013-01-01

    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

  7. Complications of orthopaedic surgery in horses.

    PubMed

    Richardson, Dean W

    2008-12-01

    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

  8. Release of Chromium from Orthopaedic Arthroplasties

    PubMed Central

    Afolaranmi, G.A.; Tettey, J; Meek, R.M.D; Grant, M.H

    2008-01-01

    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

  9. Social Competence and Temperament in Children with Chronic Orthopaedic Disability

    ERIC Educational Resources Information Center

    Yagmurlu, Bilge; Yavuz, H. Melis

    2015-01-01

    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.…

  10. Clinical applications of vibration therapy in orthopaedic practice

    PubMed Central

    Cerciello, Simone; Rossi, Silvio; Visonà, Enrico; Corona, Katia; Oliva, Francesco

    2016-01-01

    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

  11. Hereditary Hemochromatosis: A Literature Review and Case Report

    PubMed Central

    2010-01-01

    ABSTRACT Purpose: To improve understanding in the physical therapy (PT) community of hereditary hemochromatosis (HH), a common but little-known iron overload disorder, symptoms of which may mimic other orthopaedic conditions. Medical management typically involves phlebotomy to remove excess iron; however, there is little specific information in the literature on PT management of patients with HH after trauma. Case description: The patient was a 65-year-old woman with multiple fall-related traumas, including right wrist, thumb, and patellar fractures and left thigh muscle strain with significant ecchymosis and effusion. Medical history included HH. Iron-related lab values had been analyzed 9 days prior to the fall and had demonstrated a steady increase over the previous 4 months since her last phlebotomy. Outcomes: As the level of exercise and activity increased during the course of PT treatment, the patient developed shortness of breath and increased fatigue. The exercise level in therapy was reduced to accommodate the change in the patient's response. Blood values analyzed 7 weeks after the fall demonstrated a drop in haemoglobin and hematocrit values, while serum ferritin levels had risen. Implications: Understanding early symptoms and management of a patient with manifestations of HH will better enable physical therapists to consider this disorder as a differential diagnosis or co-morbidity that affects treatment considerations. PMID:21629607

  12. The management of pain in orthopaedics.

    PubMed

    Fetrow, K O

    1989-01-01

    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

  13. About the beginnings of orthopaedics in Timisoara.

    PubMed

    Poenaru, Dan V

    2015-12-01

    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

  14. Immobilized antibiotics to prevent orthopaedic implant infections.

    PubMed

    Hickok, Noreen J; Shapiro, Irving M

    2012-09-01

    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

  15. Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis

    PubMed Central

    Sexton, Debbie; Mann, Charles; Donell, Simon

    2010-01-01

    Objective To compare the clinical outcomes of staples versus sutures in wound closure after orthopaedic surgery. Design Meta-analysis. Data sources Medline, CINAHL, AMED, Embase, Scopus, and the Cochrane Library databases were searched, in addition to the grey literature, in all languages from 1950 to September 2009. Additional studies were identified from cited references. Selection criteria Two authors independently assessed papers for eligibility. Included studies were randomised and non-randomised controlled trials that compared the use of staples with suture material for wound closure after orthopaedic surgery procedures. All studies were included, and publications were not excluded because of poor methodological quality. Review methods Two authors independently reviewed studies for methodological quality and extracted data from each paper. Final data for analysis were collated through consensus. The primary outcome measure was the assessment of superficial wound infection after wound closure with staples compared with sutures. Relative risk and mean difference with 95% confidence intervals were calculated and pooled with a random effects model. Heterogeneity was assessed with I2 and χ2 statistical test. Results Six papers, which included 683 wounds, were identified; 332 patients underwent suture closure and 351 staple closure. The risk of developing a superficial wound infection after orthopaedic procedures was over three times greater after staple closure than suture closure (relative risk 3.83, 95% confidence interval 1.38 to 10.68; P=0.01). On subgroup analysis of hip surgery alone, the risk of developing a wound infection was four times greater after staple closure than suture closure (4.79, 1.24 to 18.47; P=0.02). There was no significant difference between sutures and staples in the development of inflammation, discharge, dehiscence, necrosis, and allergic reaction. The included studies had several major methodological limitations, including the

  16. The Aftermath of Road Trauma: Survivors' Perceptions of Trauma and Growth

    ERIC Educational Resources Information Center

    Harms, Louise; Talbot, Michelle

    2007-01-01

    For many survivors of serious road trauma, the physical and psychological consequences are complex and lifelong. The longer-term psychosocial recovery experience for survivors, however, is rarely documented in the social work literature. This article reports on findings from a study of road trauma recovery experiences. The findings are presented…

  17. Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines.

    PubMed

    Goodnough, L T; Maniatis, A; Earnshaw, P; Benoni, G; Beris, P; Bisbe, E; Fergusson, D A; Gombotz, H; Habler, O; Monk, T G; Ozier, Y; Slappendel, R; Szpalski, M

    2011-01-01

    Previously undiagnosed anaemia is common in elective orthopaedic surgical patients and is associated with increased likelihood of blood transfusion and increased perioperative morbidity and mortality. A standardized approach for the detection, evaluation, and management of anaemia in this setting has been identified as an unmet medical need. A multidisciplinary panel of physicians was convened by the Network for Advancement of Transfusion Alternatives (NATA) with the aim of developing practice guidelines for the detection, evaluation, and management of preoperative anaemia in elective orthopaedic surgery. A systematic literature review and critical evaluation of the evidence was performed, and recommendations were formulated according to the method proposed by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. We recommend that elective orthopaedic surgical patients have a haemoglobin (Hb) level determination 28 days before the scheduled surgical procedure if possible (Grade 1C). We suggest that the patient's target Hb before elective surgery be within the normal range, according to the World Health Organization criteria (Grade 2C). We recommend further laboratory testing to evaluate anaemia for nutritional deficiencies, chronic renal insufficiency, and/or chronic inflammatory disease (Grade 1C). We recommend that nutritional deficiencies be treated (Grade 1C). We suggest that erythropoiesis-stimulating agents be used for anaemic patients in whom nutritional deficiencies have been ruled out, corrected, or both (Grade 2A). Anaemia should be viewed as a serious and treatable medical condition, rather than simply an abnormal laboratory value. Implementation of anaemia management in the elective orthopaedic surgery setting will improve patient outcomes. PMID:21148637

  18. Toxic trauma.

    PubMed

    Moles, T M; Baker, D J

    2001-01-01

    Hazardous materials (HAZMAT) carry many inherent dangers. Such materials are distributed widely in industrial and military sites. Toxic trauma (TT) denotes the complex of systemic and organ injury caused by toxic agents. Often, TT is associated with other injuries that also require the application of life-support techniques. Rapid onset of acute respiratory failure and consequent cardiovascular failure are of primary concern. Management of TT casualties is dependent upon the characteristics of the toxic agents involved and on the demographics surrounding the HAZMAT incident. Agents that can produce TT possess two pairs of salient characteristics: (1) causality (toxicity and latency), and (2) EMS system (persistency and transmissibility). Two characteristics of presentations are important: (1) incident presentation, and (2) casualty presentation. In addition, many of these agents complicate the processes associated with anaesthesia and must be dealt with. Failure of recognition of these factors may result in the development of respiratory distress syndromes and multiorgan system failure, or even death. PMID:11513285

  19. Perioperative blood transfusions in orthopaedic surgery.

    PubMed

    Ponnusamy, Karthikeyan E; Kim, Thomas J; Khanuja, Harpal S

    2014-11-01

    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

  20. Patient Internet Use in a Community Outpatient Orthopaedic Practice

    PubMed Central

    Beall, McPherson S; Beall, M Scott; Greenfield, Mary Lou VH; Biermann, J Sybil

    2002-01-01

    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

  1. Fabricating specialised orthopaedic implants using additive manufacturing

    NASA Astrophysics Data System (ADS)

    Unwin, Paul

    2014-03-01

    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.

  2. [Functional and orthopaedic aspects of dystrophinopathies].

    PubMed

    Boulay, C; Finidori, G

    2015-12-01

    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

  3. Energy healing: a complementary treatment for orthopaedic and other conditions.

    PubMed

    DiNucci, Ellen M

    2005-01-01

    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

  4. [Richard von Volkmann, one career of orthopaedic surgeon and poet].

    PubMed

    Bumbasirević, M; Lesić, A; Sudjić, V; Zagorac, S

    2010-01-01

    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

  5. The study of psychic trauma.

    PubMed

    Bacciagaluppi, Marco

    2011-01-01

    This article starts from the DSM definition of psychic trauma. A central source in this field is the 1992 book by Judith Herman. One line of investigation is the sexual abuse of women and children. In an early phase, both Janet and Freud described dissociation as a reaction to trauma. In 1897, Freud disputed the reality of sexual trauma, a position countered later by Ferenczi. In a later phase, this subject was investigated by the American feminist movement. Studies of physical abuse are then described, followed by mental abuse and neglect. Another line of investigation is combat neurosis. The two lines converged in the definition of PTSD and its incorporation into the DSM in 1980. The views on trauma of John Bowlby and Alice Miller are also discussed. The integration of the relational model in psychoanalysis with the trauma literature is presented. The most recent advances are located in neurobiology. The discussion makes a preliminary investigation of the remote causes of war and sexual violence. PMID:21902510

  6. Contribution of biomechanics to clinical practice in orthopaedics.

    PubMed

    Woo, Savio L-Y

    2004-01-01

    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

  7. Severe craniocerebral trauma with sequelae caused by Flash-Ball® shot, a less-lethal weapon: Report of one case and review of the literature.

    PubMed

    Hiquet, Jean; Gromb-Monnoyeur, Sophie

    2016-07-01

    The use of Flash-Ball® as a non-lethal weapon by several special units within the police and police forces started in France in 1995. Little literature is available concerning injuries caused by Flash-Ball® shooting. However, we report the case of a healthy 34-year-old male victim of a Flash-Ball® shooting during a riot following a sports event. This young man presented serious craniocerebral injuries with a left temporal fracture, moderate cerebral oedema, fronto-temporal haemorrhagic contusion along with an extra-dural hematoma and subarachnoid hemorrhage requiring neurological and rehabilitation care for two months leaving important sequelae. Although the risk is obviously lower than with firearms, Flash-Ball® is nonetheless potentially lethal and may cause serious physical injuries, particularly after a shot to the head. PMID:26130748

  8. The effect of introducing a Trauma Network on patient flow, hospital finances and trainee operating.

    PubMed

    Hipps, Daniel; Jameson, Simon; Murty, An; Gregory, Rob; Large, David; Gregson, Jackie; Refaie, Ramsay; Reed, Mike

    2015-02-01

    In April 2012 the National Health Service in England introduced the Trauma Network system with the aim of improving the quality of trauma care. In this study we wished to determine how the introduction of the Trauma network has affected patient flow, hospital finances and orthopaedic trauma training across our region. The overall pattern of trauma distribution was not greatly affected, reflecting the relative rarity of major trauma in the UK. A small decrease in the total number of operations performed by trainees was noted in our region. Trainees at units designated as Major Trauma Centres gained slightly more operative experience in trauma procedures overall, and specifically in those associated with high energy, such as long bone nail insertion and external fixation procedures. However, there have been no significant changes in this pattern since the introduction of the Trauma Networks. Falling operative numbers presents a challenge for delivering high quality training within a surgical training programme, and each case should be seen as a vital educational opportunity. Best practice tariff targets for trauma were delivered for 99% of cases at our MTCs. Future audit and review to analyse the evolving role of the MTCs is desirable. PMID:25697735

  9. The effects on bone cells of metal ions released from orthopaedic implants. A review

    PubMed Central

    Sansone, Valerio; Pagani, Davide; Melato, Marco

    2013-01-01

    Summary The increasing use of orthopedic implants and, in particular, of hip and knee joint replacements for young and active patients, has stimulated interest and concern regarding the chronic, long-term effects of the materials used. This review focuses on the current knowledge of the adverse biologic reactions to metal particles released from orthopaedic implants in vivo and in vitro. More specifically, the purpose of this article is to provide an overview of the current literature about the adverse effects of metal particles on bone cells and peri-implant bone. PMID:23858309

  10. The Future of Biologic Coatings for Orthopaedic Implants

    PubMed Central

    Goodman, Stuart B.; Yao, Zhenyu; Keeney, Michael; Yang, Fan

    2013-01-01

    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

  11. Venturing into the overlap between pediatric orthopaedics and hand surgery.

    PubMed

    Kozin, Scott H; Zlotolow, Dan A; Ratner, Joshua A

    2014-01-01

    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

  12. Biomechanics of penetrating trauma.

    PubMed

    Yoganandan, N; Pintar, F A

    1997-01-01

    It is well known that injuries and deaths due to penetrating projectiles have become a national and an international epidemic in Western society. The application of biomedical engineering to solve day-to-day problems has produced considerable advances in safety and mitigation/prevention of trauma. The study of penetrating trauma has been largely in the military domain where war-time specific applications were advanced with the use of high-velocity weapons. With the velocity and weapon caliber in the civilian population at half or less compared with the military counterpart, wound ballistics is a largely different problem in today's trauma centers. The principal goal of the study of penetrating injuries in the civilian population is secondary prevention and optimized emergency care after occurrence. A thorough understanding of the dynamic biomechanics of penetrating injuries quantifies missile type, caliber, and velocity to hard and soft tissue damage. Such information leads to a comprehensive assessment of the acute and long-term treatment of patients with penetrating injuries. A review of the relevant military research applied to the civilian domain and presentation of new technology in the biomechanical study of these injuries offer foundation to this field. Relevant issues addressed in this review article include introduction of the military literature, the need for secondary prevention, environmental factors including projectile velocity and design, experimental studies with biological tissues and physical models, and mathematical simulations and analyses. Areas of advancement are identified that enables the pursuit of biomechanics research in order to arrive at better secondary prevention strategies. PMID:9719858

  13. Management of Colorectal Trauma

    PubMed Central

    2011-01-01

    Although the treatment strategy for colorectal trauma has advanced during the last part of the twentieth century and the result has improved, compared to other injuries, problems, such as high septic complication rates and mortality rates, still exist, so standard management for colorectal trauma is still a controversial issue. For that reason, we designed this article to address current recommendations for management of colorectal injuries based on a review of literature. According to the reviewed data, although sufficient evidence exists for primary repair being the treatment of choice in most cases of nondestructive colon injuries, many surgeons are still concerned about anastomotic leakage or failure, and prefer to perform a diverting colostomy. Recently, some reports have shown that primary repair or resection and anastomosis, is better than a diverting colostomy even in cases of destructive colon injuries, but it has not fully established as the standard treatment. The same guideline as that for colonic injury is applied in cases of intraperitoneal rectal injuries, and, diversion, primary repair, and presacral drainage are regarded as the standards for the management of extraperitoneal rectal injuries. However, some reports state that primary repair without a diverting colostomy has benefit in the treatment of extraperitoneal rectal injury, and presacral drainage is still controversial. In conclusion, ideally an individual management strategy would be developed for each patient suffering from colorectal injury. To do this, an evidence-based treatment plan should be carefully developed. PMID:21980586

  14. Vascular Radiology in Trauma: A Review

    SciTech Connect

    Nicholson, Anthony A.

    2004-03-15

    It's been 30 years since an endovascular technique to control traumatic hemorrhage was first described. Despite major technical advances in both diagnostic and therapeutic technology, and a great deal of experience since then, endovascular techniques are rarely considered as part of frontline management for vascular trauma. This review considers the literature and calls for better planning and implementation of diagnostic and image=guided therapeutic facilities. Endovascular techniques should be an essential part of vascular trauma management along with endovascular specialists, partners in trauma teams.

  15. Classification and management of mild head trauma

    PubMed Central

    Andrade, Almir F; Paiva, Wellingson S; Soares, Matheus S; De Amorim, Robson LO; Tavares, Wagner M; Teixeira, Manoel J

    2011-01-01

    Mild head trauma had been defined in patients with direct impact or deceleration effect admitted with a Glasgow Coma Scale score of 13–15. It is one of the most frequent causes of morbidity in emergency medicine. Although common, several controversies persist about its clinical management. In this paper, we describe the Brazilian guidelines for mild head trauma, based on a critical review of the relevant literature. PMID:21475628

  16. Dental and General Trauma in Team Handball.

    PubMed

    Petrović, Mateja; Kühl, Sebastian; Šlaj, Martina; Connert, Thomas; Filippi, Andreas

    2016-01-01

    Handball has developed into a much faster and high-impact sport over the past few years because of rule changes. Fast sports with close body contact are especially prone to orofacial trauma. Handball belongs to a category of sports with medium risk for dental trauma. Even so, there is only little literature on this subject. The aim of this study was to examine the prevalence and the type of injuries, especially the occurrence of orofacial trauma, habits of wearing mouthguards, as well as degree of familiarity with the tooth rescue box. For this purpose, 77.1% (n=542/703) of all top athletes and coaches from the two highest Swiss leagues (National League A and National League B), namely 507 professional players and 35 coaches, were personally interviewed using a standardized questionnaire. 19.7% (n=100/507) of the players experienced dental trauma in their handball careers, with 40.8% (n=51/125) crown fractures being the most frequent by far. In spite of the relatively high risk of lip or dental trauma, only 5.7% (n=29/507) of the players wear mouthguards. The results of this study show that dental trauma is common among Swiss handball players. In spite of the high risk of dental trauma, the mouthguard as prevention is not adequately known, and correct procedure following dental trauma is rarely known at all. PMID:27622524

  17. Rural trauma management.

    PubMed

    Wayne, R

    1989-05-01

    Rural trauma is a major problem in the United States. Up to 70 percent of trauma fatalities occur in rural areas, even though 70 percent of the population live in urban areas. Over the past 3 decades, numerous studies have defined the concept of preventable trauma death in both rural and urban populations. With the development of a regional trauma care system in Oregon, preventable trauma mortality should decrease. An effort was made to improve the quality of trauma care in Clatsop County, Oregon, a community of 30,000 people with 2 small rural hospitals. To obtain this goal, four steps were taken: (1) physician and nurse education was improved, (2) trauma protocols promoting prompt resuscitation and stabilization of patients were established, (3) regular trauma case reviews were conducted, and (4) emergency medical technician and prehospital management were coordinated. This study reviews the trail from sporadic, uncoordinated rural trauma care to the designation process. PMID:2712202

  18. The American Orthopaedic Association-Japanese Orthopaedic Association 2010 traveling fellowship.

    PubMed

    Patel, Alpesh A; Cheng, Ivan; Yao, Jeffrey; Huffman, G Russell

    2011-12-21

    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

  19. Relationship between trauma narratives and trauma pathology.

    PubMed

    Amir, N; Stafford, J; Freshman, M S; Foa, E B

    1998-04-01

    In this study we examined the relationship between posttrauma pathology and the level of articulation (complexity) in rape narratives recounted by victims shortly after the assault. Degree of articulation was operationalized as the reading level of the narrative as determined by a computer program. Shortly after the trauma, reading level was correlated with severity of anxiety but not with posttraumatic stress disorder (PTSD) symptoms. Degree of the narrative articulation shortly after the trauma, however, was related to severity of later PTSD. These results are consistent with the hypothesis that the less developed trauma narratives hinder recovery from trauma. PMID:9565923

  20. Vascular Injury in Orthopedic Trauma.

    PubMed

    Mavrogenis, Andreas F; Panagopoulos, George N; Kokkalis, Zinon T; Koulouvaris, Panayiotis; Megaloikonomos, Panayiotis D; Igoumenou, Vasilios; Mantas, George; Moulakakis, Konstantinos G; Sfyroeras, George S; Lazaris, Andreas; Soucacos, Panayotis N

    2016-07-01

    Vascular injury in orthopedic trauma is challenging. The risk to life and limb can be high, and clinical signs initially can be subtle. Recognition and management should be a critical skill for every orthopedic surgeon. There are 5 types of vascular injury: intimal injury (flaps, disruptions, or subintimal/intramural hematomas), complete wall defects with pseudoaneurysms or hemorrhage, complete transections with hemorrhage or occlusion, arteriovenous fistulas, and spasm. Intimal defects and subintimal hematomas with possible secondary occlusion are most commonly associated with blunt trauma, whereas wall defects, complete transections, and arteriovenous fistulas usually occur with penetrating trauma. Spasm can occur after either blunt or penetrating trauma to an extremity and is more common in young patients. Clinical presentation of vascular injury may not be straightforward. Physical examination can be misleading or initially unimpressive; a normal pulse examination may be present in 5% to 15% of patients with vascular injury. Detection and treatment of vascular injuries should take place within the context of the overall resuscitation of the patient according to the established principles of the Advanced Trauma Life Support (ATLS) protocols. Advances in the field, made mostly during times of war, have made limb salvage the rule rather than the exception. Teamwork, familiarity with the often subtle signs of vascular injuries, a high index of suspicion, effective communication, appropriate use of imaging modalities, sound knowledge of relevant technique, and sequence of surgical repairs are among the essential factors that will lead to a successful outcome. This article provides a comprehensive literature review on a subject that generates significant controversy and confusion among clinicians involved in the care of trauma patients. [Orthopedics. 2016; 39(4):249-259.]. PMID:27322172

  1. A metrology solution for the orthopaedic industry

    NASA Astrophysics Data System (ADS)

    Bills, P.; Brown, L.; Jiang, X.; Blunt, L.

    2005-01-01

    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.

  2. Plaster of Paris: the orthopaedic surgeon heritage.

    PubMed

    Hernigou, Philippe

    2016-08-01

    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

  3. Tissue engineering skeletal muscle for orthopaedic applications

    NASA Technical Reports Server (NTRS)

    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.

    2002-01-01

    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.

  4. Quality measurement in orthopaedics: the purchasers' view.

    PubMed

    Lansky, David; Milstein, Arnold

    2009-10-01

    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

  5. Interprofessional Relationships between Orthopaedic and Podiatric Surgeons in the UK

    PubMed Central

    Isaac, A; Gwilym, SE; Reilly, IN; Kilmartin, TE; Ribbans, WJ

    2008-01-01

    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

  6. Helping Youth Overcome Trauma

    ERIC Educational Resources Information Center

    Chambers, Jamie C.

    2005-01-01

    The effects of trauma can roll on unchecked like a spirit of death. In its path are strewn its once vibrant victims. Human bonds are rent asunder by the disgrace of trauma. These are the youngsters who have been verbally bashed, physically battered, sexually assaulted, and spiritually exploited. Other traumas of childhood neglect include: (1)…

  7. Army orthopaedic surgery residency program directors' selection criteria.

    PubMed

    Orr, Justin D; Hoffmann, Jeffrey D; Arrington, Edward D; Gerlinger, Tad L; Devine, John G; Belmont, Philip J

    2015-01-01

    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

  8. Graduated introduction of orthopaedic implants: encouraging innovation and minimizing harm.

    PubMed

    Zywiel, Michael G; Johnson, Aaron J; Mont, Michael A

    2012-11-01

    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

  9. Overcoming resistance to implementation of integrated care pathways in orthopaedics.

    PubMed

    Manning, Blaine T; Callahan, Charles D; Robinson, Brooke S; Adair, Daniel; Saleh, Khaled J

    2013-07-17

    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

  10. Development of a method to analyze orthopaedic practice expenses.

    PubMed

    Brinker, M R; Pierce, P; Siegel, G

    2000-03-01

    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

  11. Diabetes and its negative impact on outcomes in orthopaedic surgery

    PubMed Central

    Wukich, Dane K

    2015-01-01

    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

  12. Abusive head trauma: past, present, and future.

    PubMed

    Narang, Sandeep; Clarke, Jennifer

    2014-12-01

    Abusive head trauma has a robust and interesting scientific history. Recently, the American Academy of Pediatrics has endorsed a change in terminology to a term that is more general in describing the vast array of abusive mechanisms that can result in pediatric head injury. Simply defined, abusive head trauma is "child physical abuse that results in injury to the head or brain." Abusive head trauma is a relatively common cause of childhood neurotrauma, with an estimated incidence of 16 to 33 cases per 100,000 children per year in the first 2 years of life. Clinical findings are variable; AHT should be considered in all children with neurologic signs and symptoms, especially if no or only mild trauma is described. Subdural and retinal hemorrhages are the most common findings. The current best evidence-based literature has identified some features--apnea and severe retinal hemorrhages--that reliably discriminate abusive from accidental injury. Longitudinal studies of outcomes in abusive head trauma patients demonstrate that approximately one-third of the children are severely disabled, one third of them are moderately disabled, and one third have no or only mild symptoms. Abusive head trauma cases are complex cases that require a rigorous, multidisciplinary team approach. The clinician can establish this diagnosis with confidence if he/she maintains a high index of suspicion for the diagnosis, has knowledge of the signs, symptoms, and risk factors of abusive head trauma, and reasonably excludes other etiologies on the differential diagnosis. PMID:25316728

  13. Evaluating trauma center process performance in an integrated trauma system with registry data

    PubMed Central

    Moore, Lynne; Lavoie, André; Sirois, Marie-Josée; Amini, Rachid; Belcaïd, Amina; Sampalis, John S

    2013-01-01

    Background: The evaluation of trauma center performance implies the use of indicators that evaluate clinical processes. Despite the availability of routinely collected clinical data in most trauma systems, quality improvement efforts are often limited to hospital-based audit of adverse patient outcomes. Objective: To identify and evaluate a series of process performance indicators (PPI) that can be calculated using routinely collected trauma registry data. Materials and Methods: PPI were identified using a review of published literature, trauma system documentation, and expert consensus. Data from the 59 trauma centers of the Quebec trauma system (1999, 2006; N = 99,444) were used to calculate estimates of conformity to each PPI for each trauma center. Outliers were identified by comparing each center to the global mean. PPI were evaluated in terms of discrimination (between-center variance), construct validity (correlation with designation level and patient volume), and forecasting (correlation over time). Results: Fifteen PPI were retained. Global proportions of conformity ranged between 6% for reduction of a major dislocation within 1 h and 97% for therapeutic laparotomy. Between-center variance was statistically significant for 13 PPI. Five PPI were significantly associated with designation level, 7 were associated with volume, and 11 were correlated over time. Conclusion: In our trauma system, results suggest that a series of 15 PPI supported by literature review or expert opinion can be calculated using routinely collected trauma registry data. We have provided evidence of their discrimination, construct validity, and forecasting properties. The between-center variance observed in this study highlights the importance of evaluating process performance in integrated trauma systems. PMID:23723617

  14. Computed tomography in trauma

    SciTech Connect

    Toombs, B.D.; Sandler, C.M.

    1987-01-01

    This book begins with a chapter dealing with the epidemiology and mechanisms of trauma. Trauma accounts for more lives lost in the United States than cancer and heart disease. The fact that 30%-40% of trauma-related deaths are caused by improper or delayed diagnoses or treatment emphasizes the importance of rapid and accurate methods to establish a diagnosis. Acute thoracic, abdominal, and pelvic trauma and their complications are discussed. A chapter on high-resolution CT of spinal and facial trauma and the role of three-dimensional reconstruction images is presented.

  15. Ionising Radiation Exposure to Orthopaedic Trainees: The Effect of Sub-Specialty Training

    PubMed Central

    Oddy, MJ; Aldam, CH

    2006-01-01

    INTRODUCTION We monitored image intensifier use by orthopaedic trainees to assess their exposure to ionising radiation and to investigate the influence of sub-specialty training. MATERIALS AND METHODS Five different orthopaedic registrars recorded their monthly image intensifier screening times and exposure doses for all cases (trauma and elective), for a combined total of 12 non-consecutive months. Radiation exposure was monitored using shoulder and waist film badges worn both by surgeons and radiographers screening their cases. RESULTS Registrars in spinal sub-specialties were exposed to significantly higher doses per case and cumulative doses per month than non-spinal trainees (P < 0.05), but significantly lower screening times per case (P < 0.05). There were no significant differences in cumulative screening times per month (P > 0.05). Regression analysis for all surgeons showed a significant relationship between shoulder film badge reading and cumulative dose exposed per month (P < 0.05), but not for cumulative screening time. Shoulder film badge recordings were significantly higher for spinal compared with non-spinal registrars (P < 0.05), although all badges were below the level for radiation reporting. Only one radiographer badge recorded a dose above threshold. CONCLUSIONS Whilst the long-term effects of sub-reporting doses of radiation are not fully understood, we consider that this study demonstrates that trainees should not be complacent in accepting inadequate radiation protection. The higher doses encountered with spinal imaging means that sub-specialty trainees should be alerted to the risk of their increased exposure. The principle of minimising radiation exposure must be maintained by all trainees at all times. PMID:16720002

  16. 77 FR 19293 - Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-30

    ... 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 (...

  17. Trauma system development.

    PubMed

    Lendrum, R A; Lockey, D J

    2013-01-01

    The word 'trauma' describes the disease entity resulting from physical injury. Trauma is one of the leading causes of death worldwide and deaths due to injury look set to increase. As early as the 1970s, it became evident that centralisation of resources and expertise could reduce the mortality rate from serious injury and that organisation of trauma care delivery into formal systems could improve outcome further. Internationally, trauma systems have evolved in various forms, with widespread reports of mortality and functional outcome benefits when major trauma management is delivered in this way. The management of major trauma in England is currently undergoing significant change. The London Trauma System began operating in April 2010 and others throughout England became operational this year. Similar systems exist internationally and continue to be developed. Anaesthetists have been and continue to be involved with all levels of trauma care delivery, from the provision of pre-hospital trauma and retrieval teams, through to chronic pain management and rehabilitation of patients back into society. This review examines the international development of major trauma care delivery and the components of a modern trauma system. PMID:23210554

  18. Planned reoperation for severe trauma.

    PubMed Central

    Hirshberg, A; Mattox, K L

    1995-01-01

    OBJECTIVE: The authors review the physiologic basis, indications, techniques, and results of the planned reoperation approach to severe trauma. SUMMARY BACKGROUND DATA: Multivisceral trauma and exsanguinating hemorrhage lead to hypothermia, coagulopathy, and acidosis. Formal resections and reconstructions in these unstable patients often result in irreversible physiologic insult. A new surgical strategy addresses these physiologic concerns by staged control and repair of the injuries. METHOD: The authors review the literature. RESULTS: Indications for planned reoperation include avoidance of irreversible physiologic insult and inability to obtain direct hemostasis or formal abdominal closure. The three phases of the strategy include initial control, stabilization, and delayed reconstruction. Various techniques are used to obtain rapid temporary control of bleeding and hollow visceral spillage. Hypothermia, coagulopathy, and the abdominal compartment syndrome are major postoperative concerns. Definitive repair of the injuries is undertaken after stabilization. CONCLUSION: Planned reoperation offers a simple and effective alternative to the traditional surgical management of complex or multiple injuries in critically wounded patients. PMID:7618965

  19. Orthopaedic surgery in patients with von Willebrand disease.

    PubMed

    Siboni, S M; Biguzzi, E; Solimeno, L P; Pasta, G; Mistretta, C; Mannucci, P M; Peyvandi, F

    2014-01-01

    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

  20. Practicing What We Teach: Trauma-Informed Educational Practice

    ERIC Educational Resources Information Center

    Carello, Janice; Butler, Lisa D.

    2015-01-01

    This article presents the starting case for applying the elements of trauma-informed care (TIC) to education and outlines the authors' initial efforts to develop guidelines for what they call trauma-informed educational practice. To this end, the article starts with a literature review related to the potential for vicarious traumatization and…

  1. Therapeutic Doll Making in Art Psychotherapy for Complex Trauma

    ERIC Educational Resources Information Center

    Stace, Sonia M.

    2014-01-01

    Therapeutic doll making can hold diverse functions for clients in therapy, particularly for those clients who are working through complex trauma histories. Recent literature pertaining to the treatment of complex trauma suggests that talking treatments have their limits; supplementary therapeutic approaches that focus on sensory, physical,…

  2. The Three Pillars of Trauma-Informed Care

    ERIC Educational Resources Information Center

    Bath, Howard

    2008-01-01

    The past decade has brought with it a greatly increased awareness about the impact of trauma on children, which has, in turn, led to a focus on the treatment of trauma-related conditions. Much of the recent literature describes different approaches to therapy. However, there are a few consistent propositions arising from the research and clinical…

  3. Bone beveling caused by blunt trauma: a case report.

    PubMed

    Quatrehomme, Gérald; Piercecchi-Marti, Marie-Dominique; Buchet, Luc; Alunni, Véronique

    2016-05-01

    The authors report a fatal case of blunt trauma to the skull caused by a rib of a beach umbrella. The skull displayed a round hole in the right temporal bone with typical internal beveling. Blunt trauma mimicking a gunshot wound (round perforation of the skull with internal beveling) is very rarely reported in the forensic literature. PMID:26585737

  4. Psychotherapy with College Student Survivors of War and Political Trauma

    ERIC Educational Resources Information Center

    Jackson, Kathryn; Seeman, David

    2009-01-01

    The purpose of this article is to bring to the fore a topic that has received little mention in the college student literature: conducting psychotherapy with survivors of war and political trauma who seek treatment at college and university counseling centers. Following a discussion of political trauma in relation to typical developmental…

  5. Potentially perilous pedagogies: teaching trauma is not the same as trauma-informed teaching.

    PubMed

    Carello, Janice; Butler, Lisa D

    2014-01-01

    This article explores why and how trauma theory and research are currently used in higher education in nonclinical courses such as literature, women's studies, film, education, anthropology, cultural studies, composition, and creative writing. In these contexts, traumatic material is presented not only indirectly in the form of texts and films that depict traumatic events but also directly in the form of what is most commonly referred to in nonclinical disciplines as trauma studies, cultural trauma studies, and critical trauma studies. Within these areas of study, some instructors promote potentially risky pedagogical practices involving trauma exposure or disclosure despite indications that these may be having deleterious effects. After examining the published rationales for such methods, we argue that given the high rates of trauma histories (66%-85%), posttraumatic stress disorder (9%-12%), and other past event-related distress among college students, student risk of retraumatization and secondary traumatization should be decreased rather than increased. To this end, we propose that a trauma-informed approach to pedagogy-one that recognizes these risks and prioritizes student emotional safety in learning-is essential, particularly in classes in which trauma theories or traumatic experiences are taught or disclosed. PMID:24313321

  6. Promoting safety of postoperative orthopaedic patients with obstructive sleep apnea.

    PubMed

    Veney, Amy J

    2013-01-01

    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

  7. Imaging in scoliosis from the orthopaedic surgeon's point of view.

    PubMed

    Thomsen, Marc; Abel, Rainer

    2006-04-01

    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

  8. The role of pain management in recovery following trauma and orthopaedic surgery.

    PubMed

    Buckenmaier, Chester C

    2012-01-01

    War often serves as a catalyst for medical innovation and progressive change. The current conflicts are no exception, particularly in the area of pain management of wounded warriors. Morphine administration has served as the primary method of battlefield pain management since the American Civil War. Although traditional opioid-based pain management is effective, it has significant side effects that can complicate recovery and rehabilitation following injury. These side effects (eg, sedation, nausea and vomiting, ileus, respiratory depression) can be fatal to persons wounded in combat. This fact, along with recent research findings indicating that pain itself may constitute a disease process, points to the need for significant improvements in pain management in order to adequately address current battlefield realities. The US Army Pain Management Task Force evaluated pain medicine practices at 28 military and civilian institutions and provided several recommendations to enhance pain management in wounded warriors. PMID:22865134

  9. Consensus statement on decision making in junctional trauma care.

    PubMed

    Parker, P

    2011-09-01

    Improvised explosive devices (IEDs) cause 60% of all UK fatalities in the current campaign in Afghanistan. Shorter evacuation timelines now deliver patients at the edge of the physiological envelope of survivability meaning that the available time period for haemorrhage control and initial wound surgery is short--often no more than 75 minutes. The concepts and practise of 'right turn resuscitation', damage control general and orthopaedic surgery, on-table 'ITU' pause/catch-up and then further resuscitative surgery are commonplace. In Helmand in 2011, multiple team operating is now the norm on these casualties with up to seven surgeons and three anaesthetists simultaneously involved in the operative care of one patient. This usually involves one consultant orthopaedic surgeon and trainee per lower limb, a plastic surgeon on the upper limb or faceleyes and two general surgeons obtaining proximal vascular control or in-cavity haemorrhage control. A combined meeting in 2010 of the Lower Limb and Torso Trauma Working Groups of the Academic Department of Military Surgery and Trauma produced 25 clear, didactic statements to provide advice to the consultant team. The fundamental message is that bleeding is always a surgical problem. Some adjuncts are available; pressure (direct and indirect), compressive bandaging, haemostatic dressings and tourniquets. However, only formal surgical control, by whatever means is definitive. Early proximal control is mandatory: in all cases, rapidly obtain the most distally appropriate proximal control above the zone of injury. PMID:22053391

  10. Contribution of biomechanics, orthopaedics and rehabilitation: the past present and future.

    PubMed

    Woo, S L Y; Thomas, M; Chan Saw, S S

    2004-06-01

    Biomechanics is a field that has a very long history. From its beginnings in ancient Chinese and Greek literature, the field of orthopaedic biomechanics has grown in the areas of biomechanics of bone, articular cartilage, soft tissues, upper extremities, spine and so on. Bioengineers in collaboration with orthopaedic surgeons have applied biomechanical principles to study clinically relevant problems, improving 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 review article, the function of the knee ligaments and the associated homeostatic responses secondary to immobilisation and exercise will be described. Research on healing of the medial collateral ligament (MCL) of the knee and possible future approaches in improving the healing of the knee ligaments will be presented. Finally, improvement of the understanding of ligament reconstruction, specifically of the anterior cruciate ligament (ACL), through the use of robotics technology will be included. Throughout the manuscript, specific scientific findings that have guided or changed the clinical management of injury to these soft tissues will be emphasised. PMID:15570813

  11. Trauma as a Contributor to Violence in Autism Spectrum Disorder.

    PubMed

    Im, David S

    2016-06-01

    In examining contributors to violence among individuals with autism spectrum disorder (ASD), one factor that has received little attention is a history of psychological trauma. This study's purpose was to explore the possible mechanisms for an association between trauma and violence in persons with ASD. The literature regarding the neurobiology and theoretical underpinnings of ASD is reviewed and compared with the literature on the neurobiology and theoretical underpinnings of trauma as a risk factor for violence in individuals without ASD. Information from this comparison is then used to formulate possible mechanisms for a trauma-violence association in ASD. Individuals with ASD may possess sensitized prefrontal-cortical-limbic networks that are overloaded in the face of trauma, leading to unchecked limbic output that produces violent behavior, and/or cognitive dysfunction (including deficits in theory of mind, central coherence, and executive function) that impacts trauma processing in ways that portend violence. While these mechanisms for a trauma-violence association in ASD may have case-based support, more research is needed to confirm these mechanisms and clarify whether in fact trauma increases violence risk in ASD. To facilitate the investigation, it would be helpful for clinical and forensic evaluators to obtain a careful trauma history when evaluating all individuals, including those with ASD. PMID:27236173

  12. A Systematic Review of HIV Risk Behaviors and Trauma Among Forced and Unforced Migrant Populations from Low and Middle-Income Countries: State of the Literature and Future Directions.

    PubMed

    Michalopoulos, Lynn Murphy; Aifah, Angela; El-Bassel, Nabila

    2016-02-01

    The aim of the current systematic review is to examine the relationship between trauma and HIV risk behaviors among both forced and unforced migrant populations from low and middle income countries (LMIC). We conducted a review of studies published from 1995 to 2014. Data were extracted related to (1) the relationship between trauma and HIV risk behaviors, (2) methodological approach, (3) assessment methods, and (4) differences noted between forced and unforced migrants. A total of 340 records were retrieved with 24 studies meeting inclusion criteria. Our review demonstrated an overall relationship between trauma and HIV risk behaviors among migrant populations in LMIC, specifically with sexual violence and sexual risk behavior. However, findings from 10 studies were not in full support of the relationship. Findings from the review suggest that additional research using more rigorous methods is critically needed to understand the nature of the relationship experienced by this key-affected population. PMID:25662963

  13. Computer Aided Orthopaedic Surgery: Incremental shift or paradigm change?

    PubMed

    Joskowicz, Leo; Hazan, Eric J

    2016-10-01

    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

  14. Reading the Small Print – Labelling Recommendations for Orthopaedic Implants

    PubMed Central

    Haene, Roger A; Sandhu, Ranbir S; Baxandall, Richard

    2009-01-01

    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

  15. Clubfoot: An Orthopaedic Surgeon Describes Clubfoot and Current Treatment Methods

    ERIC Educational Resources Information Center

    Vitale, Michael

    2007-01-01

    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…

  16. Moire Topography For The Detection Of Orthopaedic Defects

    NASA Astrophysics Data System (ADS)

    Kamal, Syed A.; Lindseth, Richard E.

    1981-02-01

    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.

  17. Institutional barriers to the orthopaedic clinician-scientist.

    PubMed

    Rosier, Randy N

    2006-08-01

    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

  18. Improving translation success of cell-based therapies in orthopaedics.

    PubMed

    Bara, Jennifer J; Herrmann, Marietta; Evans, Christopher H; Miclau, Theodore; Ratcliffe, Anthony; Richards, R Geoff

    2016-01-01

    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

  19. Perioperative management of pediatric trauma patients

    PubMed Central

    Ivashkov, Yulia; Bhananker, Sanjay M

    2012-01-01

    Pediatric trauma presents significant challenges to the anesthesia provider. This review describes the current trends in perioperative anesthetic management, including airway management, choice of anesthesia agents, and fluid administration. The review is based on the PubMed search of literature on perioperative care of severely injured children. PMID:23181208

  20. Survivors of early childhood trauma: evaluating a two-dimensional diagnostic model of the impact of trauma and neglect

    PubMed Central

    Wildschut, Marleen; Langeland, Willemien; Smit, Jan H.; Draijer, Nel

    2014-01-01

    Background A two-dimensional diagnostic model for (complex) trauma-related and personality disorders has been proposed to assess the severity and prognosis of the impact of early childhood trauma and emotional neglect. An important question that awaits empirical examination is whether a distinction between trauma-related disorders and personality disorders reflects reality when focusing on survivors of early childhood trauma. And, is a continuum of trauma diagnoses a correct assumption and, if yes, what does it look like? Objective We describe the design of a cross-sectional cohort study evaluating this two-dimensional model of the impact of trauma and neglect. To provide the rationale of our study objectives, we review the existing literature on the impact of early childhood trauma and neglect on trauma-related disorders and personality disorders. Aims of the study are to: (1) quantify the two-dimensional model and test the relation with trauma and neglect; and (2) compare the two study groups. Method A total of 200 consecutive patients referred to two specific treatment programs (100 from a personality disorder program and 100 from a trauma-related disorder program) in the north of Holland will be included. Data are collected at the start of treatment. The assessments include all DSM-5 trauma-related and personality disorders, and general psychiatric symptoms, trauma history, and perceived emotional neglect. Discussion The results will provide an evaluation of the model and an improvement of the understanding of the relationship between trauma-related disorders and personality disorders and early childhood trauma and emotional neglect. This may improve both diagnostic as well as indication procedures. We will discuss possible strengths and limitations of the design. PMID:24711888

  1. The relationship between eating disorders and sexual trauma.

    PubMed

    Madowitz, Jennifer; Matheson, Brittany E; Liang, June

    2015-09-01

    Research aimed at understanding the causes and comorbidities of eating disorders (ED) identifies sexual trauma as one potential pathway to the development and maintenance of eating disorders. Based on current literature, there are two main etiological pathways between sexual trauma and ED-body perceptions and psychological difficulties. However, previously published reviews on this topic are outdated and have not yielded consistent findings. Therefore, authors completed a literature review covering years 2004-2014 to examine the relationship between sexual trauma and ED according to both proposed pathway models. Authors utilized PubMed, GoogleScholar, and PsychINFO as search engines. Search terms included "sexual assault", "sexual abuse", "sexual trauma", and "rape" in conjunction with relevant ED terminology. Thirty-two studies met inclusion criteria for this review. Current data indicate an increased prevalence of sexual trauma for individuals with ED. Although limited, recent evidence suggests that sexual trauma precedes and contributes to the development of ED. Existing literature indicates that the body perceptions pathway may impact ED through body dissatisfaction, shame, sexual dysfunction, and fear of future sexual trauma. The psychological difficulties pathway indicates a link between ED and the desire to cope with the failure of the average expected environment, psychological diagnoses, the need for control, and the regulation of emotions. However, further research is needed to assess the potential causal role that sexual trauma may play in the etiology of ED. PMID:25976911

  2. Caring for Trauma Survivors.

    PubMed

    Antai-Otong, Deborah

    2016-06-01

    Although trauma exposure is common, few people develop acute and chronic psychiatric disorders. Those who develop posttraumatic stress disorder likely have coexisting psychiatric and physical disorders. Psychiatric nurses must be knowledgeable about trauma responses, implement evidence-based approaches to conduct assessments, and create safe environments for patients. Most researchers assert that trauma-focused cognitive-behavioral approaches demonstrate the most efficacious treatment outcomes. Integrated approaches, offer promising treatment options. This article provides an overview of clinical factors necessary to help the trauma survivor begin the process of healing and recovery and attain an optimal level of functioning. PMID:27229285

  3. Blunt thoracic trauma.

    PubMed

    Weyant, Michael J; Fullerton, David A

    2008-01-01

    Blunt thoracic trauma represents a significant portion of trauma admissions to hospitals in the United States. These injuries are encountered by physicians in many specialities such as emergency medicine, pediatrics, general surgery and thoracic surgery. Accurate diagnosis and treatment improves the chances of favorable outcomes and it is desirable for all treating physicians to have current knowledge of all aspects of blunt thoracic trauma. Cardiothoracic surgeons often treat the most severe forms of blunt thoracic injuries and we review the aspects of blunt thoracic trauma that are pertinent to the practicing cardiothoracic surgeon. PMID:18420123

  4. TEFTOM: A Promising General Trauma Expectation/Outcome Measure—Results of a Validation Study on Pan-American Ankle and Distal Tibia Trauma Patients

    PubMed Central

    Suk, Michael; Buckley, Richard E.; Paccola, Cleber A. J.; Lorich, Dean G.; Helfet, David L.; Hanson, Beate

    2013-01-01

    Background. In orthopedics, there is no instrument specifically designed to assess patients' expectations of their final surgery outcome in general trauma populations. We developed the Trauma Expectation Factor Trauma Outcome Measure (TEFTOM) to investigate the fulfilment of patients' expectations one year after surgery as a measure of general trauma surgical outcomes. The aim of this paper was to assess the psychometric characteristics of this new general trauma outcome measure. Methods. The questionnaire was tested in 201 ankle and distal tibia fracture patients scheduled for surgery. Patients were followed up for twelve months. The TEFTOM questionnaire was evaluated for its criterion validity, internal consistency, reproducibility, and responsiveness. Results. TOM showed good criterion validity against the American Academy of Orthopaedic Surgeons Foot and Ankle Scale (Pearson's correlation coefficient = 0.69–0.77). Internal consistency was acceptable for TEF (Cronbach's alpha = 0.65–0.76) and excellent for TOM (Cronbach's alpha = 0.76–0.85). Reproducibility was moderate to very good (intraclass coefficient correlation (ICC) ≥0.67) for TEF and very good (ICC ≥0.92) for TOM. TOM also proved to be responsive to changes in patients' condition over time (Wald test; P < 0.001). Conclusions. TEFTOM is a promising tool for measuring general trauma outcomes in terms of patients' expectation fulfilment that proved to be valid, internally consistent, reproducible, and responsive to change. PMID:24967116

  5. Virtual interactive musculoskeletal system (VIMS) in orthopaedic research, education and clinical patient care

    PubMed Central

    Chao, Edmund YS; Armiger, Robert S; Yoshida, Hiroaki; Lim, Jonathan; Haraguchi, Naoki

    2007-01-01

    The ability to combine physiology and engineering analyses with computer sciences has opened the door to the possibility of creating the "Virtual Human" reality. This paper presents a broad foundation for a full-featured biomechanical simulator for the human musculoskeletal system physiology. This simulation technology unites the expertise in biomechanical analysis and graphic modeling to investigate joint and connective tissue mechanics at the structural level and to visualize the results in both static and animated forms together with the model. Adaptable anatomical models including prosthetic implants and fracture fixation devices and a robust computational infrastructure for static, kinematic, kinetic, and stress analyses under varying boundary and loading conditions are incorporated on a common platform, the VIMS (Virtual Interactive Musculoskeletal System). Within this software system, a manageable database containing long bone dimensions, connective tissue material properties and a library of skeletal joint system functional activities and loading conditions are also available and they can easily be modified, updated and expanded. Application software is also available to allow end-users to perform biomechanical analyses interactively. Examples using these models and the computational algorithms in a virtual laboratory environment are used to demonstrate the utility of these unique database and simulation technology. This integrated system, model library and database will impact on orthopaedic education, basic research, device development and application, and clinical patient care related to musculoskeletal joint system reconstruction, trauma management, and rehabilitation. PMID:17343764

  6. Avascular Necrosis of the Metacarpal Head: A Case of Dietrich’s Disease and Review of the Literature

    PubMed Central

    McGoldrick, Niall P.; McGoldrick, Fergal J.

    2015-01-01

    Patient: Male, 36 Final Diagnosis: Dietrich’s disease Symptoms: — Medication: — Clinical Procedure: — Specialty: Orthopaedics Objective: Rare disease Background: Isolated avascular necrosis of the metacarpal head, also known as Dietrich’s disease, is a rare entity with few cases reported previously in the literature. It has been associated with steroid use, lupus, and trauma. We describe the clinical presentation, pathogenesis, and treatment options associated with this uncommon condition. Case Report: A 36-year-old man presented with a 1-year history of a painful right middle finger metacarpophalangeal joint (MCPJ). There was no preceding history of trauma. Routine blood investigations and plain-film imaging were unremarkable. Magnetic resonance imaging (MRI) revealed a focus of osteonecrosis in the middle finger MCPJ consistent with Dietrich’s disease. Given the patient’s excellent functional status, conservative therapy was been successfully undertaken. Conclusions: Dietrich’s disease, although a rare entity, must be considered in the differential diagnosis of painful MCPJ, where routine blood investigations and plain-film imaging studies are unremarkable. PMID:25594915

  7. Developing and organizing a trauma system and mass casualty management: some useful observations from the israeli trauma model.

    PubMed

    Borgohain, B; Khonglah, T

    2013-01-01

    A trauma system is a chain of arrangements and preparedness to provide quality response to injured from the site of injury to the appropriate hospital for the full range of care. Israel has a unique trauma system developed from the experience gained in peace and in war. The system is designed to fit the state's current health system, which is different from the European and American systems. An effective trauma system may potentially manage mass casualty incidence better. The aim of this paper is to discuss learning points to develop a trauma system based on the Israeli trauma model. After participating in a course on developing a trauma system organized by a top Israeli trauma center, a literature search on the topic on the Internet was done using relevant key words like trauma system and disaster management in Israel using the Google search engine in the pubmed, open access journals and websites of trauma organizations. Israel has a unique trauma system of organizing and managing an emergency event, characterized by a central national organization responsible for management, coordination and ongoing quality control. Because of its unique geopolitical situation, the armed forces has a significant role in the system. Investing adequate resources on continuous education, manpower training, motivation, team-work and creation of public volunteers through advocacy is important for capacity building to develop a trauma system. Wisdom, motivation and pragmatism of the Israeli model may be useful to streamline work in skeletal trauma services of developing countries having fewer resources to bring consistency and acceptable standards in trauma care. PMID:23634336

  8. Developing and Organizing a Trauma System and Mass Casualty Management: Some Useful Observations from the Israeli Trauma Model

    PubMed Central

    Borgohain, B; Khonglah, T

    2013-01-01

    A trauma system is a chain of arrangements and preparedness to provide quality response to injured from the site of injury to the appropriate hospital for the full range of care. Israel has a unique trauma system developed from the experience gained in peace and in war. The system is designed to fit the state's current health system, which is different from the European and American systems. An effective trauma system may potentially manage mass casualty incidence better. The aim of this paper is to discuss learning points to develop a trauma system based on the Israeli trauma model. After participating in a course on developing a trauma system organized by a top Israeli trauma center, a literature search on the topic on the Internet was done using relevant key words like trauma system and disaster management in Israel using the Google search engine in the pubmed, open access journals and websites of trauma organizations. Israel has a unique trauma system of organizing and managing an emergency event, characterized by a central national organization responsible for management, coordination and ongoing quality control. Because of its unique geopolitical situation, the armed forces has a significant role in the system. Investing adequate resources on continuous education, manpower training, motivation, team-work and creation of public volunteers through advocacy is important for capacity building to develop a trauma system. Wisdom, motivation and pragmatism of the Israeli model may be useful to streamline work in skeletal trauma services of developing countries having fewer resources to bring consistency and acceptable standards in trauma care. PMID:23634336

  9. Clinical results of linezolid in arthroplasty and trauma MRSA related infections

    PubMed Central

    Joel, James; Graham, Simon Matthew; Peckham-Cooper, Adam; Korres, Nectarios; Tsouchnica, Helen; Tsiridis, Eleftherios

    2014-01-01

    AIM: To analyse the management of patients treated with linezolid for orthopaedic infections. METHODS: Twenty-two patients with orthopaedic related infections receiving a course of linezolid were reviewed retrospectively. Patients were classified into either post trauma, post arthroplasty and non trauma related infections. A diagnosis of infection was based on clinical findings, positive microbiological specimens, and positive signs of infection on radiological imaging and raised inflammatory markers. Pathogens isolated, inflammatory markers both at presentation and at final follow up, length of linezolid treatment, adverse drug reactions, concomitant anti-microbial therapy, length of hospital stay and any surgical interventions were recorded. RESULTS: Infections were classified as post arthroplasty (n = 10), post trauma surgery (n = 8) or non-trauma related infections (n = 4). Twenty patients (91%) underwent surgical intervention as part of their treatment. The number of required surgical procedures ranged from 1 to 6 (mean = 2.56). Mean total length of stay per admission was 28.5 d (range 1-160 d). Furthermore, the mean duration of treatment with linezolid of patients who had resolution of symptoms was 31 d (range 10-84 d). All patients within this group were discharged on oral linezolid. Pathogens isolated included methicillin resistant Staphylococcus aureus, coagulase negative staphylococci, coliforms, enterococcus, Staphylococcus epidermidis, streptococcus viridans, Escherichia coli, group B streptococcus and pseudomonas. An overall 77% of patients demonstrated resolution of infections at follow-up, with mean C-reactive protein reducing from 123 mg/L to 13.2 mg/L. CONCLUSION: This study demonstrates that the use of linezolid offers excellent efficacy in orthopaedic related infections when used alongside appropriate surgical management. PMID:24829878

  10. A NASA discovery has current applications in orthopaedics

    PubMed Central

    2015-01-01

    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

  11. Essentials of disaster management: the role of the orthopaedic surgeon.

    PubMed

    Born, Christopher T; Monchik, Keith O; Hayda, Roman A; Bosse, Michael J; Pollak, Andrew N

    2011-01-01

    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

  12. Resident selection: a key to the future of orthopaedics.

    PubMed

    Evarts, C McCollister

    2006-08-01

    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

  13. Composite Bone Models in Orthopaedic Surgery Research and Education

    PubMed Central

    Elfar, John; Stanbury, Spencer; Menorca, Ron Martin Garcia; Reed, Jeffrey Douglas

    2014-01-01

    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

  14. Composite bone models in orthopaedic surgery research and education.

    PubMed

    Elfar, John; Menorca, Ron Martin Garcia; Reed, Jeffrey Douglas; Stanbury, Spencer

    2014-02-01

    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

  15. Radiation safety for anaesthesia providers in the orthopaedic operating room.

    PubMed

    Rhea, E B; Rogers, T H; Riehl, J T

    2016-04-01

    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

  16. Reviewing for clinical orthopaedics and related research.

    PubMed

    Brand, Richard A

    2012-09-01

    Peer review in science was established in the 17th Century and while not without detractors and some controversy, has been a mainstay of high-quality scientific publications ever since. Most believe peer review adds substantially to the value of papers that achieve publication. However, in practice, peer review can be practiced with varying degrees of rigor and the value of the review depends on rigor. The two primary tasks of a reviewer are to determine whether the manuscript makes a substantial contribution (in an age of information overload) and to determine whether there are any "fatal" flaws. If the reviewer recommends rejection, then he or she need only note the major flaws. If, however, the material is sufficiently novel and would substantially add to the literature, the reviewer's secondary task is to ensure completeness and clarity by noting information that should be added and identifying unclear points; in these cases more detailed reviews are merited. To achieve this task, the reviewer must ask numerous questions related to the background and rationale, questions or purposes, study design and methods, findings, and synthesis with the literature. In this brief review I outline such key questions. An invitation to review is an honor and reflects the confidence of the editor in the reviewer's expertise and accomplishments. Given proper reviews and recommendations, the majority of authors believe peer review adds great value to their papers and the reviewer makes contributions to the community and their own knowledge. PMID:22752799

  17. An expanding role for cardiopulmonary bypass in trauma

    PubMed Central

    Chughtai, Talat S.; Gilardino, Miroslav S.; Fleiszer, David M.; Evans, David C.; Brown, Rea A.; Mulder, David S.

    2002-01-01

    Objectives To analyze experience at the McGill University Health Centre with cardiopulmonary bypass (CPB) in trauma, complemented by a review of the literature to define its role globally and outline indications for its expanded use in trauma management. Data sources All available published English-language articles from peer reviewed journals, located using the MEDLINE database. Chapters from relevant, current textbooks were also utilized. Study selection Nine relevant case reports, original articles or reviews pertaining to the use of CPB in trauma. Data extraction Original data as well as authors’ opinions pertinent to the application of CPB to trauma were extracted, incorporated and appropriately referenced in our review. Data synthesis Overall mortality in the selected series of CPB used in the trauma setting was 44.4%. Four of 5 survivors had CPB instituted early (first procedure in operative management) whereas 3 of 4 deaths involved late institution of CPB. Conclusions Although CPB has traditionally been used in the setting of cardiac trauma alone, a better understanding of its potential benefit in noncardiac injuries will likely make for improved outcomes in the increasingly diverse number of severely injured patients seen in trauma centres today. Further studies by other trauma centres will allow for standardized indications for the use of CPB in trauma. PMID:11939667

  18. Imaging of head trauma.

    PubMed

    Rincon, Sandra; Gupta, Rajiv; Ptak, Thomas

    2016-01-01

    Imaging is an indispensable part of the initial assessment and subsequent management of patients with head trauma. Initially, it is important for diagnosing the extent of injury and the prompt recognition of treatable injuries to reduce mortality. Subsequently, imaging is useful in following the sequelae of trauma. In this chapter, we review indications for neuroimaging and typical computed tomography (CT) and magnetic resonance imaging (MRI) protocols used in the evaluation of a patient with head trauma. We review the role of CT), the imaging modality of choice in the acute setting, and the role of MRI in the evaluation of patients with head trauma. We describe an organized and consistent approach to the interpretation of imaging of these patients. Important topics in head trauma, including fundamental concepts related to skull fractures, intracranial hemorrhage, parenchymal injury, penetrating trauma, cerebrovascular injuries, and secondary effects of trauma, are reviewed. The chapter concludes with advanced neuroimaging techniques for the evaluation of traumatic brain injury, including use of diffusion tensor imaging (DTI), functional MRI (fMRI), and MR spectroscopy (MRS), techniques which are still under development. PMID:27432678

  19. Step up in orthopaedic care for Stockport Trust.

    PubMed

    Baillie, Jonathan

    2009-04-01

    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

  20. Image guidance in orthopaedics and traumatology: A historical perspective.

    PubMed

    Székely, Gabor; Nolte, Lutz-P

    2016-10-01

    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

  1. The coagulopathy of trauma.

    PubMed

    Maegele, M

    2014-04-01

    Trauma is a leading cause of death, with uncontrolled hemorrhage and exsanguination being the primary causes of preventable deaths during the first 24 h following trauma. Death usually occurs quickly, typically within the first 6 h after injury. One out of four patients arriving at the Emergency Department after trauma is already in hemodynamic and hemostatic depletion. This early manifestation of hemostatic depletion is referred to as the coagulopathy of trauma, which may distinguished as: (i) acute traumatic coagulopathy (ATC) and (ii) iatrogenic coagulopathy (IC). The principle drivers of ATC have been characterized by tissue trauma, inflammation, hypoperfusion/shock, and the acute activation of the neurohumoral system. Hypoperfusion leads to an activation of protein C with cleavage of activated factors V and VIII and the inhibition of plasminogen activator inhibitor-1 (PAI-1), with subsequent fibrinolysis. Endothelial damage and activation results in Weibel-Palade body degradation and glycocalyx shedding associated with autoheparinization. In contrast, there is an IC which occurs secondary to uncritical volume therapy, leading to acidosis, hypothermia, and hemodilution. This coagulopathy may, then, be an integral part of the "vicious cycle" when combined with acidosis and hypothermia. The awareness of the specific pathophysiology and of the principle drivers underlying the coagulopathy of trauma by the treating physician is paramount. It has been shown that early recognition prompted by appropriate and aggressive management can correct coagulopathy, control bleeding, reduce blood product use, and improve outcome in severely injured patients. This paper summarizes: (i) the current concepts of the pathogenesis of the coagulopathy of trauma, including ATC and IC, (ii) the current strategies available for the early identification of patients at risk for coagulopathy and ongoing life-threatening hemorrhage after trauma, and (iii) the current and updated European

  2. Neoprene Orthopaedic Supports: An Underrecognised Cause of Allergic Contact Dermatitis.

    PubMed

    Hawkey, S; Ghaffar, S

    2015-01-01

    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

  3. Hip arthroscopy: a report on a cohort of orthopaedic surgeons

    PubMed Central

    Byrd, J. W. Thomas; Jones, Kay S.; Chin, Paul C.

    2016-01-01

    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

  4. Preparedness of orthopaedic surgeons for modern battlefield surgery.

    PubMed

    Kearney, Sean P; Bluman, Eric M; Lonergan, Keith T; Arrington, Edward D; Ficke, James R

    2012-09-01

    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

  5. Expansion of the Coordinator Role in Orthopaedic Residency Program Management

    PubMed Central

    Murphy, Laurie A.; Murphy, James E.

    2008-01-01

    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

  6. MATERIAL PROPERTIES OF COMMON SUTURE MATERIALS IN ORTHOPAEDIC SURGERY

    PubMed Central

    Najibi, S; Banglmeier, R; Matta, JM; Tannast, M

    2010-01-01

    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

  7. Trauma and Mobile Radiography

    SciTech Connect

    Drafke, M.W.

    1989-01-01

    Trauma and Mobile Radiography focuses on the radiography of trauma patients and of patients confined to bed. This book offers students a foundation in the skills they need to produce quality radiograms without causing additional injury or pain to the patient. Features of this new book include: coverage of the basics of radiography and patient care, including monitoring of heavily sedated, immobile, and accident patients. Information on the injuries associated with certain types of accidents, and methods for dealing with these problems. Detailed explanation of the positioning of each anatomical area. A Quick Reference Card with information on evaluating, monitoring and radiographing trauma patients.

  8. Comparing premodern melancholy/mania and modern trauma: an argument in favor of historical experiences of trauma.

    PubMed

    Trembinski, Donna

    2011-02-01

    Historians and psychiatrists have repeatedly looked to both real and imagined individuals of the past, like Achilles and Samuel Pepys, and found evidence that they were suffering from symptoms of trauma and posttraumatic stress disorder. The assumptions that allow such historical "diagnoses" have, however, recently been called into question by philosophers such as lan Hacking, anthropologists like Allan Young and psychiatrists such as Patrick Bracken. These scholars have all suggested in various ways that experiences of trauma could not have occurred until the diagnosis of trauma and its symptoms had been formalized and the language of trauma had been developed in the late 19th century. This article attempts to resolve this bifurcation of opinion on the universality of the mind and historical experiences of trauma in two ways. First, it argues for the necessity of applying modern categories of analysis to further present understandings of the past. Second, it considers discussions of"melancholia" and "mania" in premodern medical literature and argues that there are enough similarities between the causes and symptoms of these premodern disorders and modern trauma to suggest that experiences of trauma may not be wholly culturally bound to the modern world, as the above scholars have suggested. While melancholy or mania cannot simply be understood as premodern names for trauma, and it is not always correct to "diagnose" a premodern person who exhibits symptoms of these illnesses with trauma, such an assumption is not always ahistorical or incorrect either. PMID:21688753

  9. The Deployed Military Orthopaedic Surgeon: Experiences of a Recent Iowa Graduate in Afghanistan

    PubMed Central

    Malin, Andrew S.; Brannan, Patrick S

    2012-01-01

    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

  10. Trauma program development.

    PubMed

    Althausen, Peter L

    2014-07-01

    The development of a strong trauma program is clearly one of the most important facets of successful business development. Several recent publications have demonstrated that well run trauma services can generate significant profits for both the hospital and the surgeons involved. There are many aspects to this task that require constant attention and insight. Top notch patient care, efficiency, and cost-effective resource utilization are all important components that must be addressed while providing adequate physician compensation within the bounds of hospital financial constraints and the encompassing legal issues. Each situation is different but many of the components are universal. This chapter addresses all aspects of trauma program development to provide the graduating fellow with the tools to create a new trauma program or improve an existing program in order to provide the best patient care while optimizing financial reward and improving care efficiency. PMID:24918830

  11. Basic trauma life support.

    PubMed

    Werman, H A; Nelson, R N; Campbell, J E; Fowler, R L; Gandy, P

    1987-11-01

    The impact of traumatic injuries on modern society in terms of morbidity, mortality, and economic cost is enormous. Studies have shown that both advanced life support skills and rapid stabilization and transport of the trauma victim have a beneficial effect on the patient's ultimate outcome. The Basic Trauma Life Support (BTLS) course was designed to provide pre-hospital care providers with the skills necessary to provide a thorough assessment, initial resuscitation, and rapid transportation of the trauma victim. Early studies suggest that the material is easily learned by prehospital care providers and that the on-scene time for trauma cases is reduced following training in BTLS. More widespread training in BTLS may have a significant effect on the mortality and morbidity associated with traumatic injuries. PMID:3662184

  12. Imaging of Abusive Trauma.

    PubMed

    Shekdar, Karuna

    2016-06-01

    "Shaken baby syndrome" is a term often used by the physicians and public to describe abusive trauma inflicted on infants and young children. Advances in the understanding of the mechanisms and the associated clinical spectrum of injury has lead us to modify our terminology and address it as "abusive trauma" (AT). Pediatric abusive head trauma is defined as an injury to the skull or intracranial contents of an infant or a young child (< 5 y age) due to inflicted blunt impact and/or violent shaking. This chapter focuses on the imaging aspects of childhood abusive trauma along with a brief description of the mechanism and pathophysiology of abusive injury. The diagnosis of AT is not always obvious, and abusive injuries in many infants may remain unrecognized. Pediatricians should be cognizant of AT since pediatricians play a crucial role in the diagnosis, management and prevention of AT. PMID:26882906

  13. Fibromyalgia and physical trauma: the concepts we invent.

    PubMed

    Wolfe, Frederick; Häuser, Winfried; Walitt, Brian T; Katz, Robert S; Rasker, Johannes J; Russell, Anthony S

    2014-09-01

    Despite weak to nonexistent evidence regarding the causal association of trauma and fibromyalgia (FM), literature and court testimony continue to point out the association as if it were a strong and true association. The only data that appear unequivocally to support the notion that trauma causes FM are case reports, cases series, and studies that rely on patients' recall and attribution - very low-quality data that do not constitute scientific evidence. Five research studies have contributed evidence to the FM-trauma association. There is no scientific support for the idea that trauma overall causes FM, and evidence in regard to an effect of motor vehicle accidents on FM is weak or null. In some instances effect may be seen to precede cause. Alternative causal models that propose that trauma causes "stress" that leads to FM are unfalsifiable and unmeasurable. PMID:25086080

  14. The role of trauma symptoms in nonsuicidal self-injury.

    PubMed

    Smith, Noelle B; Kouros, Chrystyna D; Meuret, Alicia E

    2014-01-01

    Reports of traumatic events by individuals who engage in nonsuicidal self-injury (NSSI) are common; yet, evidence for the relation between traumatic events and NSSI is inconclusive. This review explores the thesis that trauma symptoms, rather than the experience of a traumatic event per se, underlie this relation, specifically suggesting that trauma symptoms might serve as a mediator. The literature indicates that self-injury plays an important functional role in coping with trauma symptoms such that self-injury can provide an escape from intrusive thoughts and aversive emotional states, as well as end dissociation and periods of numbness through the generation of feelings. Additionally, trauma symptoms have been shown to mediate the relation between the occurrence of traumatic events and NSSI. Taken together, trauma symptoms may play an important role in the development and maintenance of NSSI. The review concludes with treatment implications and future directions for research. PMID:23878145

  15. Trauma registry reengineered.

    PubMed

    Wargo, Christina; Bolig, Nicole; Hixson, Heather; McWilliams, Nate; Rummerfield, Heather; Stratton, Elaine; Woodruff, Tracy

    2014-01-01

    A successful trauma registry balances accuracy of abstraction and timeliness of case submissions to achieve quality performance. Staffing to achieve quality performance is a challenge at times based on competitive institutional need. The aim of this performance improvement timing study was to identify trauma registry job responsibilities and redesign the responsibilities to create increased abstraction time and maintain accuracy of data abstraction. The outcome is measured by case submission rates with existing staffing and interrater reliability outcomes. PMID:25397337

  16. Penetrating extremity trauma.

    PubMed

    Ivatury, Rao R; Anand, Rahul; Ordonez, Carlos

    2015-06-01

    Penetrating extremity trauma (PET) usually becomes less important when present along with multiple truncal injuries. The middle eastern wars documented the terrible mortality and morbidity resulting from PET. Even in civilian trauma, PET can lead to significant morbidity and mortality. There are now well-established principles in the evaluation and management of vascular, bony, soft tissue, and neurologic lesions that will lead to a reduction of the poor outcomes. This review will summarize some of these recent concepts. PMID:25413177

  17. Noninvasive ventilation in trauma.

    PubMed

    Karcz, Marcin K; Papadakos, Peter J

    2015-02-01

    Trauma patients are a diverse population with heterogeneous needs for ventilatory support. This requirement depends mainly on the severity of their ventilatory dysfunction, degree of deterioration in gaseous exchange, any associated injuries, and the individual feasibility of potentially using a noninvasive ventilation approach. Noninvasive ventilation may reduce the need to intubate patients with trauma-related hypoxemia. It is well-known that these patients are at increased risk to develop hypoxemic respiratory failure which may or may not be associated with hypercapnia. Hypoxemia in these patients is due to ventilation perfusion mismatching and right to left shunt because of lung contusion, atelectasis, an inability to clear secretions as well as pneumothorax and/or hemothorax, all of which are common in trauma patients. Noninvasive ventilation has been tried in these patients in order to avoid the complications related to endotracheal intubation, mainly ventilator-associated pneumonia. The potential usefulness of noninvasive ventilation in the ventilatory management of trauma patients, though reported in various studies, has not been sufficiently investigated on a large scale. According to the British Thoracic Society guidelines, the indications and efficacy of noninvasive ventilation treatment in respiratory distress induced by trauma have thus far been inconsistent and merely received a low grade recommendation. In this review paper, we analyse and compare the results of various studies in which noninvasive ventilation was applied and discuss the role and efficacy of this ventilator modality in trauma. PMID:25685722

  18. Airway management in trauma.

    PubMed

    Langeron, O; Birenbaum, A; Amour, J

    2009-05-01

    Maintenance of a patent and prevention of aspiration are essential for the management of the trauma patient, that requires experienced physicians in airway control techniques. Difficulties of the airway control in the trauma setting are increased by the vital failures, the risk of aspiration, the potential cervical spine injury, the combative patient, and the obvious risk of difficult tracheal intubation related to specific injury related to the trauma. Endotracheal intubation remains the gold standard in trauma patient airway management and should be performed via the oral route with a rapid sequence induction and a manual in-line stabilization maneuver, to decrease the risks previously mentioned. Different techniques to control the airway in trauma patients are presented: improvement of the laryngoscopic vision, lighted stylet tracheal intubation, retrograde technique for orotracheal intubation, the laryngeal mask and the intubating laryngeal mask airways, the combitube and cricothyroidotomy. Management of the airway in trauma patients requires regular training in these techniques and the knowledge of complementary techniques allowing tracheal intubation or oxygenation to overcome difficult intubation and to prevent major complications as hypoxemia and aspiration. PMID:19412149

  19. Innovations in Implementation of Trauma-Informed Care Practices in Youth Residential Treatment: A Curriculum for Organizational Change

    ERIC Educational Resources Information Center

    Hummer, Victoria Latham; Dollard, Norin; Robst, John; Armstrong, Mary I.

    2010-01-01

    Children in the child welfare system frequently experience trauma within the caregiving relationship. These traumatic experiences may be compounded by system trauma and place these children at high risk of emotional disorders and placement in out-of-home (OOH) mental health treatment programs. This article reviews the literature on trauma and…

  20. Controversies in the Management of the Trauma Patient.

    PubMed

    Rodman, Regina E; Kellman, Robert M

    2016-08-01

    Facial trauma is a significant cause of morbidity in the United States. Despite the large volume of trauma surgeries at most academic institutions, there is still controversy regarding management of many traumatic injuries. The literature lacks clear-cut best practices for most fractures. In orbital trauma, there is debate about the optimal timing of repair, preferred biomaterial to be used, and the utility of evaluation afterward with intraoperative computed tomographic scan. In repair of mandible fractures, there is debate regarding open versus closed reduction of subcondylar fractures, or alternatively, endoscopic repair. PMID:27400843

  1. Trauma and violence: are women the weaker sex?

    PubMed

    Pratchett, Laura C; Pelcovitz, Michelle R; Yehuda, Rachel

    2010-06-01

    Posttraumatic stress disorder (PTSD) as a response to trauma is repeatedly found to be more common among women than men. This article explores prevalence rates and gender differences. Explanations for this gender bias and examined and the literature on trauma types and resulting PTSD is reviewed. Other disorders that may result from trauma that also have gender biases are considered as a potential way to understand this difference. Risk and resilience can perhaps more appropriately be considered specific to symptom picture rather than merely development of pathology. PMID:20385347

  2. Use of Prophylactic Inferior Vena Cava Filters in Trauma

    PubMed Central

    Naiem, Ahmed A.; Al-Hinai, Alreem K.; Al-Sukaiti, Rashid; Al-Qadhi, Hani

    2016-01-01

    Venous thromboembolisms, specifically pulmonary embolisms (PEs), represent a significant burden on healthcare systems worldwide, particularly within the setting of trauma. According to the literature, PEs are the most common cause of in-hospital death; however, this condition can be prevented with a variety of prophylactic and therapeutic measures. This article aimed to examine current evidence on the use, indications for prophylaxis, outcomes and complications of prophylactic inferior vena cava filters in trauma patients. PMID:26909219

  3. Occult Congenital Ureteropelvic Junction Obstruction in Two Adults Presenting with Collecting System Rupture After Blunt Renal Trauma: A Case Report Series

    PubMed Central

    Hoffner, Haley E.; Dagrosa, Lawrence M.; Pais, Vernon M.

    2015-01-01

    Abstract We report two adult cases of congenital ureteropelvic junction obstruction detected incidentally in the setting of blunt abdominal trauma. CT images are provided to describe the presentation, while review of the literature and management of renal trauma are discussed.

  4. Pitfalls in penetrating trauma.

    PubMed

    van Vugt, A B

    2003-08-01

    In Western Europe the most frequent cause of multiple injuries is blunt trauma. Only few of us have experience with penetrating trauma, without exception far less than in the USA or South-Africa. In Rotterdam, the Erasmus Medical Centre is a level I trauma centre, situated directly in the town centre. All penetrating traumas are directly presented to our emergency department by a well organized ambulance service supported by a mobile medical team if necessary. The delay with scoop and run principles is very short for these cases, resulting in severely injured reaching the hospital alive in increasing frequency. Although the basic principles of trauma care according to the guidelines of the Advanced Trauma Life Support (ATLS) (1-2) are the same for blunt and penetrating trauma with regard to priorities, diagnostics and primary therapy, there are some pitfalls in the strategy of management in penetrating trauma one should be aware of. Simple algorithms can be helpful, especially in case of limited experience (3). In case of life-saving procedures, the principles of Damage Control Surgery (DCS) must be followed (4-5). This approach is somewhat different from "traditional" surgical treatment. In the Ist phase prompt interventions by emergency thoracotomy and laparotomy are carried out, with only two goals to achieve: surgical control of haemorrhage and contamination. After temporary life-saving procedures, the 2nd phase is characterized by intensive care treatment, dealing with hypothermia, metabolic acidosis and clotting disturbances. Finally in the 3rd phase, within 6-24 hours, definitive surgical care takes place. In this overview, penetrating injuries of neck, thorax, abdomen and extremities will be outlined. Penetrating cranial injuries, as a neurosurgical emergency with poor prognosis, are not discussed. History and physical examination remain the corner stones of good medical praxis. In a work-up according to ATLS principles airway, breathing and circulation

  5. Classification of Liver Trauma

    PubMed Central

    Rizoli, Sandro B.; Brenneman, Frederick D.; Hanna, Sherif S.; Kahnamoui, Kamyar

    1996-01-01

    The classification of liver injuries is important for clinical practice, clinical research and quality assurance activities. The Organ Injury Scaling (OIS) Committee of the American Association for the Surgery of Trauma proposed the OIS for liver trauma in 1989. The purpose ofthe present study was to apply this scale to a cohort ofliver trauma patients managed at a single Canadian trauma centre from January 1987 to June 1992.170 study patients were identified and reviewed. The mean age was 30, with 69% male and a mean ISS of 33.90% had a blunt mechanism ofinjury. The 170 patients were categorized into the 60IS grades ofliver injury. The number of units of blood transfused, the magnitude of the operative treatment required, the liver-related complications and the liver-related mortality correlated well with the OIS grade. The OIS grade was unable to predict the need for laparotomy or the length of stay in hospital. We conclude that the OIS is a useful, practical and important tool for the categorization of liver injuries, and it may prove to be the universally accepted classification scheme in liver trauma. PMID:8809585

  6. Epidemiology of severe trauma.

    PubMed

    Alberdi, F; García, I; Atutxa, L; Zabarte, M

    2014-12-01

    Major injury is the sixth leading cause of death worldwide. Among those under 35 years of age, it is the leading cause of death and disability. Traffic accidents alone are the main cause, fundamentally in low- and middle-income countries. Patients over 65 years of age are an increasingly affected group. For similar levels of injury, these patients have twice the mortality rate of young individuals, due to the existence of important comorbidities and associated treatments, and are more likely to die of medical complications late during hospital admission. No worldwide, standardized definitions exist for documenting, reporting and comparing data on severely injured trauma patients. The most common trauma scores are the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS) and the Trauma and Injury severity Score (TRISS). Documenting the burden of injury also requires evaluation of the impact of post-trauma impairments, disabilities and handicaps. Trauma epidemiology helps define health service and research priorities, contributes to identify disadvantaged groups, and also facilitates the elaboration of comparable measures for outcome predictions. PMID:25241267

  7. Male genital trauma

    SciTech Connect

    Jordan, G.H.; Gilbert, D.A.

    1988-07-01

    We have attempted to discuss genital trauma in relatively broad terms. In most cases, patients present with relatively minimal trauma. However, because of the complexity of the structures involved, minimal trauma can lead to significant disability later on. The process of erection requires correct functioning of the arterial, neurologic, and venous systems coupled with intact erectile bodies. The penis is composed of structures that are compliant and distensible to the limits of their compliance. These structures therefore tumesce in equal proportion to each other, allowing for straight erection. Relatively minimal trauma can upset this balance of elasticity, leading to disabling chordee. Likewise, relatively minimal injuries to the vascular erectile structures can lead to significantly disabling spongiofibrosis. The urethra is a conduit of paramount importance. Whereas the development of stricture is generally related to the nature of the trauma, the extent of stricture and of attendant complications is clearly a function of the immediate management. Overzealous debridement can greatly complicate subsequent reconstruction. A delicate balance between aggressive initial management and maximal preservation of viable structures must be achieved. 38 references.

  8. One in the eye for an orthopaedic surgeon.

    PubMed Central

    Lourie, J.; Hamid, K.

    1996-01-01

    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

  9. Rapid Prototyping in Orthopaedic Surgery: A User's Guide

    PubMed Central

    Frame, Mark; Huntley, James S.

    2012-01-01

    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

  10. The Orthopaedic Training Study, Phase II 1968-1972. Final Report, Volume I.

    ERIC Educational Resources Information Center

    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…

  11. Long Sick Leave after Orthopaedic Inpatient Rehabilitation: Treatment Failure or Relapse?

    ERIC Educational Resources Information Center

    Mangels, Marija; Schwarz, Susanne; Worringen, Ulrike; Holme, Martin; Rief, Winfried

    2011-01-01

    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,…

  12. 75 FR 33995 - Safety Zone; Michigan Orthopaedic Society 50th Anniversary Fireworks, Lake Huron, Mackinac Island...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-16

    ... 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...

  13. Paediatric Blunt Torso Trauma

    PubMed Central

    Bhatti, Khalid M.; Taqi, Kadhim M.; Al-Harthy, Ahmed Z. S.; Hamid, Rana S.; Al-Balushi, Zainab N.; Sankhla, Dilip K.; Al-Qadhi, Hani A.

    2016-01-01

    Objectives: Trauma is the greatest cause of morbidity and mortality in paediatric/adolescent populations worldwide. This study aimed to describe trauma mechanisms, patterns and outcomes among children with blunt torso trauma admitted to the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman. Methods: This retrospective single-centre study involved all children ≤12 years old with blunt torso trauma admitted for paediatric surgical care at SQUH between January 2009 and December 2013. Medical records were analysed to collect demographic and clinical data. Results: A total of 70 children were admitted with blunt torso trauma during the study period, including 39 (55.7%) male patients. The mean age was 5.19 ± 2.66 years. Of the cohort, 35 children (50.0%) received their injuries after having been hit by cars as pedestrians, while 19 (27.1%) were injured by falls, 12 (17.1%) during car accidents as passengers and four (5.7%) by falling heavy objects. According to computed tomography scans, thoracic injuries were most common (65.7%), followed by abdominal injuries (42.9%). The most commonly involved solid organs were the liver (15.7%) and spleen (11.4%). The majority of the patients were managed conservatively (92.9%) with a good outcome (74.3%). The mortality rate was 7.1%. Most deaths were due to multisystem involvement. Conclusion: Among children with blunt torso trauma admitted to SQUH, the main mechanism of injury was motor vehicle accidents. As a result, parental education and enforcement of infant car seat/child seat belt laws are recommended. Conservative management was the most successful approach. PMID:27226913

  14. Trauma-Focused CBT for Youth who Experience Ongoing Traumas

    PubMed Central

    Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura A.

    2011-01-01

    Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will this in some way impair their responding to current or ongoing trauma? The paper addresses practical strategies for implementing one evidence-based treatment, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth with ongoing traumas. Collaboration with local therapists and families participating in TF-CBT community and international programs elucidated effective strategies for applying TF-CBT with these youth. These strategies included: 1) enhancing safety early in treatment; 2) effectively engaging parents who experience personal ongoing trauma; and 3) during the trauma narrative and processing component focusing on a) increasing parental awareness and acceptance of the extent of the youths’ ongoing trauma experiences; b) addressing youths’ maladaptive cognitions about ongoing traumas; and c) helping youth differentiate between real danger and generalized trauma reminders. Case examples illustrate how to use these strategies in diverse clinical situations. Through these strategies TF-CBT clinicians can effectively improve outcomes for youth experiencing ongoing traumas. PMID:21855140

  15. Trauma-Focused CBT for Youth Who Experience Ongoing Traumas

    ERIC Educational Resources Information Center

    Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura K.

    2011-01-01

    Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will…

  16. Assuring optimal trauma care: the role of trauma centre accreditation

    PubMed Central

    Simons, Richard; Kirkpatrick, Andrew

    2002-01-01

    Optimal care of the injured patient requires the delivery of appropriate, definitive care shortly after injury. Over the last 30 to 40 years, civilian trauma systems and trauma centres have been developed in the United States based on experience gained in military conflicts, particularly in Korea and Vietnam. A similar process is evolving in Canada. National trauma committees in the US and Canada have defined optimal resources to meet the goal of rapid, appropriate care in trauma centres. They have introduced programs (verification or accreditation) to externally audit trauma centre performance based on these guidelines. It is generally accepted that implementing trauma systems results in decreased preventable death and improved survival after trauma. What is less clear is the degree to which each facet of trauma system development contributes to this improvement. The relative importance of national performance guidelines and trauma centre audit as integral steps toward improved outcomes following injury are reviewed. Current Trauma Association of Canada guidelines for trauma centres are presented and the process of trauma centre accreditation is discussed. PMID:12174987

  17. Battlefield orthopaedic injuries cause the majority of long-term disabilities.

    PubMed

    Cross, Jessica D; Ficke, James R; Hsu, Joseph R; Masini, Brendan D; Wenke, Joseph C

    2011-01-01

    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

  18. Advances in prehospital trauma care

    PubMed Central

    Williamson, Kelvin; Ramesh, Ramaiah; Grabinsky, Andreas

    2011-01-01

    Prehospital trauma care developed over the last decades parallel in many countries. Most of the prehospital emergency medical systems relied on input or experiences from military medicine and were often modeled after the existing military procedures. Some systems were initially developed with the trauma patient in mind, while other systems were tailored for medical, especially cardiovascular, emergencies. The key components to successful prehospital trauma care are the well-known ABCs of trauma care: Airway, Breathing, Circulation. Establishing and securing the airway, ventilation, fluid resuscitation, and in addition, the quick transport to the best-suited trauma center represent the pillars of trauma care in the field. While ABC in trauma care has neither been challenged nor changed, new techniques, tools and procedures have been developed to make it easier for the prehospital provider to achieve these goals in the prehospital setting and thus improve the outcome of trauma patients. PMID:22096773

  19. Stem cell-based tissue engineering in veterinary orthopaedics.

    PubMed

    Brehm, Walter; Burk, Janina; Delling, Uta; Gittel, Claudia; Ribitsch, Iris

    2012-01-28

    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

  20. Orthopaedic applications for PLA-PGA biodegradable polymers.

    PubMed

    Athanasiou, K A; Agrawal, C M; Barber, F A; Burkhart, S S

    1998-10-01

    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

  1. Comparison of cross-linked polyethylene materials for orthopaedic applications.

    PubMed

    Collier, John P; Currier, Barbara H; Kennedy, Francis E; Currier, John H; Timmins, Graham S; Jackson, Simon K; Brewer, Robin L

    2003-09-01

    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

  2. A Regional Assessment of Medicaid Access to Outpatient Orthopaedic Care: The Influence of Population Density and Proximity to Academic Medical Centers on Patient Access

    PubMed Central

    Patterson, Brendan M.; Draeger, Reid W.; Olsson, Erik C.; Spang, Jeffrey T.; Lin, Feng-Chang; Kamath, Ganesh V.

    2014-01-01

    Background: Access to care is limited for patients with Medicaid with many conditions, but data investigating this relationship in the orthopaedic literature are limited. The purpose of this study was to investigate the relationship between health insurance status and access to care for a diverse group of adult orthopaedic patients, specifically if access to orthopaedic care is influenced by population density or distance from academic teaching hospitals. Methods: Two hundred and three orthopaedic practices within the state of North Carolina were randomly selected and were contacted on two different occasions separated by three weeks. An appointment was requested for a fictitious adult orthopaedic patient with a potential surgical problem. Injury scenarios included patients with acute rotator cuff tears, zone-II flexor tendon lacerations, and acute lumbar disc herniations. Insurance status was reported as Medicaid at the time of the first request and private insurance at the time of the second request. County population density and the distance from each practice to the nearest academic hospital were recorded. Results: Of the 203 practices, 119 (59%) offered the patient with Medicaid an appointment within two weeks, and 160 (79%) offered the patient with private insurance an appointment within this time period (p < 0.001). Practices in rural counties were more likely to offer patients with Medicaid an appointment as compared with practices in urban counties (odds ratio, 2.25 [95% confidence interval, 1.16 to 4.34]; p = 0.016). Practices more than sixty miles from academic hospitals were more likely to accept patients with Medicaid than practices closer to academic hospitals (odds ratio, 3.35 [95% confidence interval, 1.44 to 7.83]; p = 0.005). Conclusions: Access to orthopaedic care was significantly decreased for patients with Medicaid. Practices in less populous areas were more likely to offer an appointment to patients with Medicaid than practices in more

  3. Comparing sutures versus staples for skin closure after orthopaedic surgery: systematic review and meta-analysis

    PubMed Central

    Krishnan, Rohin; MacNeil, S Danielle; Malvankar-Mehta, Monali S

    2016-01-01

    Objective To determine whether there still remains a significant advantage in the use of sutures to staples for orthopaedic skin closure in adult patients. Design Systematic Review/ Meta-Analysis. Data sources MEDLINE-OVID, EMBASE-OVID, CINAHL and Cochrane Library. Grey and unpublished literature was also explored by searching: International Clinical Trial Registry, Grey Matters BIOSIS Previews, Networked Digital Library of Theses and Dissertations, ClinicalTrials.gov, UK Clinical Trials Gateway, UK Clinical Research Network Study Portfolio, Open Grey, Grey Literature Report, and Web of Science. Selection criteria Articles were from any country, written in English and published after 1950. We included all randomised control trials and observational studies comparing adults (≥18 years) undergoing orthopaedic surgery who either received staples or sutures for skin closure. The primary outcome was the incidence of surgical site infection. Secondary outcomes included closure time, inflammation, length of stay, pain, abscess formation, necrosis, discharge, wound dehiscence, allergic reaction and health-related quality of life. Results 13 studies were included in our cumulative meta-analysis conducted using Review Manager V.5.0. The risk ratio was computed as a measure of the treatment effect taking into account heterogeneity. Random-effect models were applied. There was no significant difference in infection comparing sutures to staples. The cumulative relative risk was 1.06 (0.46 to 2.44). In addition, there was no difference in infection comparing sutures to staples in hip and knee surgery, respectively. Lastly, except for closure time, there was no significant difference in secondary outcomes comparing sutures to staples. Conclusions Except for closure time, there was no significant difference in superficial infection and secondary outcomes comparing sutures to staples was found. Given that there may in fact be no difference in effect between the two skin closure

  4. Structured Sensory Trauma Interventions

    ERIC Educational Resources Information Center

    Steele, William; Kuban, Caelan

    2010-01-01

    This article features the National Institute of Trauma and Loss in Children (TLC), a program that has demonstrated via field testing, exploratory research, time series studies, and evidence-based research studies that its Structured Sensory Intervention for Traumatized Children, Adolescents, and Parents (SITCAP[R]) produces statistically…

  5. Pediatric head trauma

    PubMed Central

    Alexiou, George A; Sfakianos, George; Prodromou, Neofytos

    2011-01-01

    Head injury in children accounts for a large number of emergency department visits and hospital admissions. Falls are the most common type of injury, followed by motor-vehicle-related accidents. In the present study, we discuss the evaluation, neuroimaging and management of children with head trauma. Furthermore, we present the specific characteristics of each type of pediatric head injury. PMID:21887034

  6. Trauma Induced Myocardial Infarction

    PubMed Central

    Lolay, Georges A.; Abdel-Latef, Ahmed K.

    2016-01-01

    Chest Trauma in athletes is a common health problem. However, myocardial infarction secondary to coronary dissection in the setting of blunt chest trauma is extremely rare. We report a case of acute inferior wall myocardial infarction following blunt chest trauma. A 32-year-old male with no relevant medical problems was transferred to our medical center for retrosternal chest pain after being elbowed in the chest during a soccer game. Few seconds later, he started experiencing sharp retrosternal chest pain that was severe to that point where he called the emergency medical service. Upon arrival to the Trauma department patient was still complaining of chest pain. ECG demonstrated ST segment elevation in the inferior leads with reciprocal changes in the lateral leads all consistent with active ischemia. After rolling out Aortic dissection, patient was loaded with ASA, ticagerlor, heparin and was emergently taken to the cardiac catheterization lab. Coronary angiography demonstrated 100% thrombotic occlusion in the distal right coronary artery with TIMI 0 flow distally. After thrombus aspiration, a focal dissection was noted on the angiogram that was successfully stented. Two days after admission patient was discharged home. Echocardiography prior to discharge showed inferior wall akinesis, normal right ventricular systolic function and normal overall ejection fraction. PMID:26490501

  7. Early Childhood Trauma

    ERIC Educational Resources Information Center

    National Child Traumatic Stress Network, 2010

    2010-01-01

    Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0-6. Because infants' and young children's reactions may be different from older children's, and because they may not be able to verbalize their reactions to threatening or dangerous events, many people assume that young age protects children from the…

  8. Corruption in the health care sector: A barrier to access of orthopaedic care and medical devices in Uganda

    PubMed Central

    2012-01-01

    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

  9. The Impact of the Multicenter Orthopaedic Outcomes Network (MOON) Research on Anterior Cruciate Ligament Reconstruction and Orthopaedic Practice

    PubMed Central

    Lynch, T. Sean; Parker, Richard D.; Patel, Ronak M.; Andrish, Jack T.; Spindler, Kurt P.

    2015-01-01

    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

  10. Pain and trauma in negative pressure wound therapy: a review.

    PubMed

    Upton, Dominic; Andrews, Abbye

    2015-02-01

    Negative pressure wound therapy (NPWT) is considered an effective wound treatment, but there are a number of issues that need to be addressed for improvements to be made. This review aimed to explore the literature relating to the pain and skin trauma that may be experienced during NPWT. A literature search was carried out using the following databases: Academic Search Complete, CINAHL, PsychINFO, MEDLINE and PsyARTICLES. A total of 30 articles were reviewed. Studies reported varying levels of pain in patients undergoing NPWT, with certain treatment factors affecting the level of pain, such as the NPWT system and the dressing/filler used. Similarly, although there is much less research exploring NPWT-related trauma, findings suggest that dressing and filler type may impact on whether trauma occurs. However, further research needs to consider the different stages of NPWT and how pain and trauma can be minimised during the whole procedure. As both pain and skin trauma impact on the patient's well-being and on wound healing, it is essential that research further explores the factors that may affect the experience of pain and trauma, so as to inform developments in wound care. PMID:23489350

  11. Imaging in spinal trauma.

    PubMed

    Van Goethem, Johan W M; Maes, Menno; Ozsarlak, Ozkan; van den Hauwe, Luc; Parizel, Paul M

    2005-03-01

    Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

  12. Hardware Removal in Craniomaxillofacial Trauma

    PubMed Central

    Cahill, Thomas J.; Gandhi, Rikesh; Allori, Alexander C.; Marcus, Jeffrey R.; Powers, David; Erdmann, Detlev; Hollenbeck, Scott T.; Levinson, Howard

    2015-01-01

    Background Craniomaxillofacial (CMF) fractures are typically treated with open reduction and internal fixation. Open reduction and internal fixation can be complicated by hardware exposure or infection. The literature often does not differentiate between these 2 entities; so for this study, we have considered all hardware exposures as hardware infections. Approximately 5% of adults with CMF trauma are thought to develop hardware infections. Management consists of either removing the hardware versus leaving it in situ. The optimal approach has not been investigated. Thus, a systematic review of the literature was undertaken and a resultant evidence-based approach to the treatment and management of CMF hardware infections was devised. Materials and Methods A comprehensive search of journal articles was performed in parallel using MEDLINE, Web of Science, and ScienceDirect electronic databases. Keywords and phrases used were maxillofacial injuries; facial bones; wounds and injuries; fracture fixation, internal; wound infection; and infection. Our search yielded 529 articles. To focus on CMF fractures with hardware infections, the full text of English-language articles was reviewed to identify articles focusing on the evaluation and management of infected hardware in CMF trauma. Each article’s reference list was manually reviewed and citation analysis performed to identify articles missed by the search strategy. There were 259 articles that met the full inclusion criteria and form the basis of this systematic review. The articles were rated based on the level of evidence. There were 81 grade II articles included in the meta-analysis. Result Our meta-analysis revealed that 7503 patients were treated with hardware for CMF fractures in the 81 grade II articles. Hardware infection occurred in 510 (6.8%) of these patients. Of those infections, hardware removal occurred in 264 (51.8%) patients; hardware was left in place in 166 (32.6%) patients; and in 80 (15.6%) cases

  13. Vascular access, fluid resuscitation, and blood transfusion in pediatric trauma.

    PubMed

    Greene, Nathaniel; Bhananker, Sanjay; Ramaiah, Ramesh

    2012-09-01

    Trauma care in the general population has largely become protocol-driven, with an emphasis on fast and efficient treatment, good team communication at all levels of care including prehospital care, initial resuscitation, intensive care, and rehabilitation. Most available literature on trauma care has focused on adults, allowing the potential to apply concepts from adult care to pediatric care. But there remain issues that will always be specific to pediatric patients that may not translate from adults. Several new devices such as intraosseous (IO) needle systems and techniques such as ultrasonography to cannulate central and peripheral veins have become available for integration into our pre-existing trauma care system for children. This review will focus specifically on the latest techniques and evidence available for establishing intravenous access, rational approaches to fluid resuscitation, and blood product transfusion in the pediatric trauma patient. PMID:23181207

  14. Isolated posterior capsular rupture following blunt head trauma

    PubMed Central

    Mansour, Ahmad M; Jaroudi, Mahmoud O; Hamam, Rola N; Maalouf, Fadi C

    2014-01-01

    Closed-globe traumatic cataract is not uncommon in males in the pediatric age group. However, there is a relative paucity of literature on isolated posterior lens capsule rupture associated with closed-globe traumatic cataract. We report a case of a 6-year-old boy who presented with white cataract 1 day after blunt trauma to the forehead associated with posterior capsular rupture that was detected by B-scan ultrasonography preoperatively. No stigmata of trauma outside the posterior capsule could be detected by slit-lamp exam, funduscopy, and optical coherence tomography. Phacoemulsification with posterior chamber intraocular lens implant was performed 24 hours after trauma, with the patient achieving 6/6 visual acuity 1 week and 6 months after surgery. Our case is unique, being the youngest (amblyogenic age) to be reported, with prompt surgical intervention, and with no signs of trauma outside the posterior capsule. PMID:25506201

  15. Risk Factors for Vertebral Artery Injuries in Cervical Spine Trauma

    PubMed Central

    Dabke, Harshad V.

    2014-01-01

    Blunt cerebrovascular injuries (i.e. involvement of carotid and vertebral arteries) are increasingly being recognized in setting of cervical spine trauma/fractures and are associated with high incidence of stroke/morbidity and mortality. The incidence of vertebral artery injuries (VAI) is more common than previously thought and regular screening is seldom performed. However there exists no screening criteria and conflicting reports exists between spine and trauma literature. Many clinicians do not routinely screen/evaluate patients presenting with cervical spine trauma for potential VAI. This article provides a brief summary of existing evidence regarding the incidence of VAI in the background of cervical trauma/fractures. The type and fracture pattern that is associated with a high risk of VAI warranting mandatory screening/further work-up is discussed. A brief overview of diagnostic modalities and their respective sensitivity/specificity along with available treatment options is also summarized. PMID:25317310

  16. Motivated forgetting and misremembering: perspectives from betrayal trauma theory.

    PubMed

    DePrince, Anne P; Brown, Laura S; Cheit, Ross E; Freyd, Jennifer J; Gold, Steven N; Pezdek, Kathy; Quina, Kathryn

    2012-01-01

    Individuals are sometimes exposed to information that may endanger their well-being. In such cases, forgetting or misremembering may be adaptive. Childhood abuse perpetrated by a caregiver is an example. Betrayal trauma theory (BTT) proposes that the way in which events are processed and remembered will be related to the degree to which a negative event represents a betrayal by a trusted, needed other. Full awareness of such abuse may only increase the victim's risk by motivating withdrawal or confrontation with the perpetrator, thus risking a relationship vital to the victim's survival. In such situations, minimizing awareness of the betrayal trauma may be adaptive. BTT has implications for the larger memory and trauma field, particularly with regard to forgetting and misremembering events. This chapter reviews conceptual and empirical issues central to the literature on memory for trauma and BTT as well as identifies future research directions derived from BTT. PMID:22303768

  17. Biology, childhood trauma, and murder: rethinking justice.

    PubMed

    Heide, Kathleen M; Solomon, Eldra P

    2006-01-01

    This article reviews recent findings in the developmental neurophysiology of children subjected to psychological trauma. Studies link extreme neglect and abuse with long-term changes in the nervous and endocrine systems. A growing body of research literature indicates that individuals with severe trauma histories are at higher risk of behaving violently than those without such histories. This article links these two research areas by discussing how severe and protracted child abuse and/or neglect can lead to biological changes, putting these individuals at greater risk for committing homicide and other forms of violence than those without child maltreatment histories. The implications of these biological findings for forensic evaluations are discussed. Based on new understanding of the effects of child maltreatment, the authors invite law and mental health professionals to rethink their notions of justice and offender accountability, and they challenge policymakers to allocate funds for research into effective treatment and for service delivery. PMID:16516292

  18. Thirty-Year Study Links Neuroscience, Specific Trauma, PTSD, Image Conversion, and Language Translation

    ERIC Educational Resources Information Center

    Spring, Dee

    2004-01-01

    Despite voluminous literature on trauma, studies on specific trauma and art expression remain sparse. Recurring graphic forms produced by sexual abuse victims have appeared in art therapy publications dating back to Naumburg (1958), but links between sexual abuse-assault and recurring graphic forms were not considered. In 1973, this author began a…

  19. The Mediating Effect of World Assumptions on the Relationship between Trauma Exposure and Depression

    ERIC Educational Resources Information Center

    Lilly, Michelle M.; Valdez, Christine E.; Graham-Bermann, Sandra A.

    2011-01-01

    The association between trauma exposure and mental health-related challenges such as depression are well documented in the research literature. The assumptive world theory was used to explore this relationship in 97 female survivors of intimate partner violence (IPV). Participants completed self-report questionnaires that assessed trauma history,…

  20. Female Gambling, Trauma, and the Not Good Enough Self: An Interpretative Phenomenological Analysis

    ERIC Educational Resources Information Center

    Nixon, Gary; Evans, Kyler; Kalischuk, Ruth Grant; Solowoniuk, Jason; McCallum, Karim; Hagen, Brad

    2013-01-01

    A gap exists within current literature regarding understanding the role that trauma may play in the initiation, development, and progression of female problem and pathological gambling. The purpose of this study is to further illustrate the relationship between trauma and the development problem and pathological gambling by investigating the lived…

  1. International patients on operation vacation – perspectives of patients travelling to Hungary for orthopaedic treatments

    PubMed Central

    Kovacs, Eszter; Szocska, Gabor; Knai, Cécile

    2014-01-01

    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

  2. Direct Mouse Trauma/Burn Model of Heterotopic Ossification.

    PubMed

    Peterson, Jonathan R; Agarwal, Shailesh; Brownley, R Cameron; Loder, Shawn J; Ranganathan, Kavitha; Cederna, Paul S; Mishina, Yuji; Wang, Stewart C; Levi, Benjamin

    2015-01-01

    Heterotopic ossification (HO) is the formation of bone outside of the skeleton which forms following major trauma, burn injuries, and orthopaedic surgical procedures. The majority of animal models used to study HO rely on the application of exogenous substances, such as bone morphogenetic protein (BMP), exogenous cell constructs, or genetic mutations in BMP signaling. While these models are useful they do not accurately reproduce the inflammatory states that cause the majority of cases of HO. Here we describe a burn/tenotomy model in mice that reliably produces focused HO. This protocol involves creating a 30% total body surface area partial thickness contact burn on the dorsal skin as well as division of the Achilles tendon at its midpoint. Relying solely on traumatic injury to induce HO at a predictable location allows for time-course study of endochondral heterotopic bone formation from intrinsic physiologic processes and environment only. This method could prove instrumental in understanding the inflammatory and osteogenic pathways involved in trauma-induced HO. Furthermore, because HO develops in a predictable location and time-course in this model, it allows for research to improve early imaging strategies and treatment modalities to prevent HO formation. PMID:26274052

  3. Trauma Tactics: Rethinking Trauma Education for Professional Nurses.

    PubMed

    Garvey, Paula; Liddil, Jessica; Eley, Scott; Winfield, Scott

    2016-01-01

    According to the National Trauma Institute (2015), trauma accounts for more than 180,000 deaths each year in the United States. Nurses play a significant role in the care of trauma patients and therefore need appropriate education and training (L. ). Although several courses exist for trauma education, many nurses have not received adequate education in trauma management (B. ; L. ). Trauma Tactics, a 2-day course that focuses on high-fidelity human patient simulation, was created to meet this educational need. This descriptive study was conducted retrospectively to assess the effectiveness of the Trauma Tactics course. Pre- and postsurveys, tests, and simulation performance were used to evaluate professional nurses who participated in Trauma Tactics over a 10-month period. Fifty-five nurses were included in the study. Pre- and postsurveys revealed an increase in overall confidence, test scores increased by an average of 2.5 points, and simulation performance scores increased by an average of 16 points. Trauma Tactics is a high-quality course that provides a valuable and impactful educational experience for nurses. Further research is needed to evaluate the long-term effects of Trauma Tactics and its impacts on quality of care and patient outcomes. PMID:27414143

  4. A review of ureteral injuries after external trauma

    PubMed Central

    2010-01-01

    Introduction Ureteral trauma is rare, accounting for less than 1% of all urologic traumas. However, a missed ureteral injury can result in significant morbidity and mortality. The purpose of this article is to review the literature since 1961 with the primary objective to present the largest medical literature review, to date, regarding ureteral trauma. Several anatomic and physiologic considerations are paramount regarding ureteral injuries management. Literature review Eighty-one articles pertaining to traumatic ureteral injuries were reviewed. Data from these studies were compiled and analyzed. The majority of the study population was young males. The proximal ureter was the most frequently injured portion. Associated injuries were present in 90.4% of patients. Admission urinalysis demonstrated hematuria in only 44.4% patients. Intravenous ureterogram (IVU) failed to diagnose ureteral injuries either upon admission or in the operating room in 42.8% of cases. Ureteroureterostomy, with or without indwelling stent, was the surgical procedure of choice for both trauma surgeons and urologists (59%). Complications occurred in 36.2% of cases. The mortality rate was 17%. Conclusion The mechanism for ureteral injuries in adults is more commonly penetrating than blunt. The upper third of the ureter is more often injured than the middle and lower thirds. Associated injuries are frequently present. CT scan and retrograde pyelography accurately identify ureteral injuries when performed together. Ureteroureterostomy, with or without indwelling stent, is the surgical procedure of choice of both trauma surgeons and urologists alike. Delay in diagnosis is correlated with a poor prognosis. PMID:20128905

  5. Alcohol abusive use increases facial trauma?

    PubMed Central

    Soares-Carneiro, Suzana-Célia-de-Aguiar; Matos da-Silva, Gessyca-Suielly-Melo; de-Barros-Caldas, Luciano-Cruz; Porto, Gabriela-Granja; Leal, Jefferson-Figueiredo; Catunda, Ivson

    2016-01-01

    Background Trauma is among the main death causes and morbidity in the world and is often related to the use of alcohol and its abuse has reached massive proportions, no matter if the country is developed or not, being considered as public health problem. Since there are very few randomized and prospective studies in literature about the association of facial trauma and the use of alcohol, this study aims to investigate the impact of alcohol use in facial trauma. Material and Methods This was a prospective and cross sectional study, involving facial trauma patients attended at Oral Maxillofacial Surgery Division of a State Hospital. Variables included patient´s profile, trauma etiology, facial region involved, type of injury and treatment and days of hospitalization. AUDIT test was applied to identify risks and damages of alcohol use and chemical dependence. Absolute distribution, uni and mutilvaried percentages were made for data evaluation. Pearson´s qui-squared and Fisher´s Exact tests were also used. Results One hundred patients were evaluated. The patient´s mean age was 33.50 years-old, 48% had between 17 and 29 years old, 28% had 30 to 39, and 24% 40 or more. Most of them were male (86%). The most frequent etiology was traffic accident (57%), the extraoral area was most committed (62%), the most frequent type of injury was fractures (78%) and the most affected bone was the mandible (36%). More than half of the patients (53%) had surgical treatment. 38% had their discharge from hospital right after the first attendance. The AUDIT most frequent answer was “moderate use” (46%) and use at risk (39%). There was significant difference between the use of alcohol (AUDIT) and hematoma (0.003) and number of days of hospitalization (p=0.005). Conclusions In this study it was not observed association between alcohol consumption using the AUDIT and trauma etiology, but patient victims of traffic accidents were classified as with risk in the scale. Most of the

  6. Sir Robert Jones: orthopaedic surgeon and war hero.

    PubMed

    Di Matteo, Berardo; Tarabella, Vittorio; Filardo, Giuseppe; Tomba, Patrizia; Viganò, Anna; Kon, Elizaveta; Marcacci, Maurilio

    2015-05-01

    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

  7. [Treatments of Soft Tissue Sarcomas by Orthopaedic Surgeons in Japan].

    PubMed

    Tanaka, Kazuhiro

    2016-01-01

    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

  8. Direct Observation: Assessing Orthopaedic Trainee Competence in the Ambulatory Setting.

    PubMed

    Phillips, Donna P; Zuckerman, Joseph D; Kalet, Adina; Egol, Kenneth A

    2016-09-01

    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

  9. Coating analysis of implant materials used in orthopaedic surgery.

    PubMed

    Aksakal, B; Yildirim, O S; Okur, A

    2003-01-01

    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

  10. [Recent progress in orthopaedic managements of osteoporosis-related fractures].

    PubMed

    Yamamoto, Seizo

    2011-07-01

    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

  11. Automatic Bone Drilling - More Precise, Reliable and Safe Manipulation in the Orthopaedic Surgery

    NASA Astrophysics Data System (ADS)

    Boiadjiev, George; Kastelov, Rumen; Boiadjiev, Tony; Delchev, Kamen; Zagurski, Kazimir

    2016-06-01

    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.

  12. Use of supplemental steroids in patients having orthopaedic operations.

    PubMed

    Friedman, R J; Schiff, C F; Bromberg, J S

    1995-12-01

    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

  13. Antimicrobial agents in orthopaedic surgery: Prophylaxis and treatment.

    PubMed

    Trampuz, Andrej; Zimmerli, Werner

    2006-01-01

    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

  14. The World Hip Trauma Evaluation Study 3

    PubMed Central

    Parsons, N.; Achten, J.; Griffin, X. L.; Costa, M. L.; Reed, M. R.

    2016-01-01

    Background Approximately half of all hip fractures are displaced intracapsular fractures. The standard treatment for these fractures is either hemiarthroplasty or total hip arthroplasty. The recent National Institute for Health and Care Excellence (NICE) guidance on hip fracture management recommends the use of ‘proven’ cemented stem arthroplasty with an Orthopaedic Device Evaluation Panel (ODEP) rating of at least 3B (97% survival at three years). The Thompsons prosthesis is currently lacking an ODEP rating despite over 50 years of clinical use, likely due to the paucity of implant survival data. Nationally, adherence to these guidelines is varied as there is debate as to which prosthesis optimises patient outcomes. Design This study design is a multi-centre, multi-surgeon, parallel, two arm, standard-of-care pragmatic randomised controlled trial. It will be embedded within the WHiTE Comprehensive Cohort Study (ISRCTN63982700). The main analysis is a two-way equivalence comparison between Hemi-Thompson and Hemi-Exeter polished taper with Unitrax head. Secondary outcomes will include radiological leg length discrepancy measured as per Bidwai and Willett, mortality, re-operation rate and indication for re-operation, length of index hospital stay and revision at four months. This study will be supplemented by the NHFD (National Hip Fracture Database) dataset. Discussion Evidence on the optimum choice of prosthesis for hemiarthroplasty of the hip is lacking. National guidance is currently based on expert opinion rather than empirical evidence. The incidence of hip fracture is likely to continue to increase and providing high quality evidence on the optimum Cite this article: A. L. Sims. The World Hip Trauma Evaluation Study 3: Hemiarthroplasty Evaluation by Multicentre Investigation – WHITE 3: HEMI – An Abridged Protocol. Bone Joint Res 2016;5:18–25. DOI: 10.1302/2046-3758.51.2000473 PMID:26825319

  15. Needle Thoracotomy in Trauma.

    PubMed

    Rottenstreich, Misgav; Fay, Shmuel; Gendler, Sami; Klein, Yoram; Arkovitz, Marc; Rottenstreich, Amihai

    2015-12-01

    Tension pneumothorax is one of the leading causes of preventable death in trauma patients. Needle thoracotomy (NT) is the currently accepted first-line intervention but has not been well validated. In this review, we have critically discussed the evidence for NT procedure, re-examined the recommendations by the Advanced Trauma Life Support organization and investigated the safest and most effective way of NT. The current evidence to support the use of NT is limited. However, when used, it should be applied in the 2nd intercostal space at midclavicular line using a catheter length of at least 4.5 cm. Alternative measures should be studied for better prehospital management of tension pneumothorax. PMID:26633663

  16. Properties of open-cell porous metals and alloys for orthopaedic applications.

    PubMed

    Lewis, Gladius

    2013-10-01

    One shortcoming of metals and alloys used to fabricate various components of orthopaedic systems, such as the femoral stem of a total hip joint replacement and the tibial plate of a total knee joint replacement, is well-recognized. This is that the material modulus of elasticity (E') is substantially larger than that of the contiguous cancellous bone, a consequence of which is stress shielding which, in turn, has been postulated to be implicated in a cascade of events that culminates in the principal life-limiting phenomenon of these systems, namely, aseptic loosening. Thus, over the years, a host of research programs have focused on the synthesis of metallic biomaterials whose E' can be tailored to match that of cancellous bone. The present work is a review of the extant large volume of literature on these materials, which are called open-cell porous metals/alloys (or, sometimes, metal foams or cellular materials). As such, its range is wide, covering myriad aspects such as production methods, characterization studies, in vitro evaluations, and in vivo performance. The review also includes discussion of seven areas for future research, such as parametric studies of the influence of an assortment of process variables (such as the space holder material and the laser power in the space holder method and the laser-engineered net-shaping process, respectively) on various properties (notably, permeability, fatigue strength, and corrosion resistance) of a given porous metal/alloy, innovative methods of determining fatigue strength, and modeling of corrosion behavior. PMID:23851927

  17. Current status of presurgical infant orthopaedic treatment for cleft lip and palate patients: A critical review

    PubMed Central

    Niranjane, P. Priyanka; Kamble, R. H.; Diagavane, S. Pallavi; Shrivastav, S. Sunita; Batra, Puneet; Vasudevan, S. D.; Patil, Pushkar

    2014-01-01

    Rehabilitation of cleft lip and palate (CLP) patients is a challenge for all the concerned members of the cleft team, and various treatment modalities have been attempted to obtain aesthetic results. Presurgical infant orthopaedics (PSIO) was introduced to reshape alveolar and nasal segments prior to surgical repair of cleft lip. However, literature reports lot of controversy regarding the use of PSIO in patients with CLP. Evaluation of long-term results of PSIO can provide scientific evidence on the efficacy and usefulness of PSIO in CLP patients. The aim was to assess the scientific evidence on the efficiency of PSIO appliances in patients with CLP and to critically analyse the current status of PSIO. A PubMed search was performed using the terms PSIO, presurgical nasoalveolar moulding and its long-term results and related articles were selected for the review. The documented studies report no beneficial effect of PSIO on maxillary arch dimensions, facial aesthetics and in the subsequent development of dentition and occlusion in CLP patients. Nasal moulding seems to be more beneficial and effective in unilateral cleft lip and palate patients with better long-term results. PMID:25593413

  18. Substance Abuse and Trauma.

    PubMed

    Simmons, Shannon; Suárez, Liza

    2016-10-01

    There is a strong, bidirectional link between substance abuse and traumatic experiences. Teens with cooccurring substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) have significant functional and psychosocial impairment. Common neurobiological foundations point to the reinforcing cycle of trauma symptoms, substance withdrawal, and substance use. Treatment of teens with these issues should include a systemic and integrated approach to both the SUD and the PTSD. PMID:27613348

  19. Rethinking historical trauma.

    PubMed

    Kirmayer, Laurence J; Gone, Joseph P; Moses, Joshua

    2014-06-01

    Recent years have seen the rise of historical trauma as a construct to describe the impact of colonization, cultural suppression, and historical oppression of Indigenous peoples in North America (e.g., Native Americans in the United States, Aboriginal peoples in Canada). The discourses of psychiatry and psychology contribute to the conflation of disparate forms of violence by emphasizing presumptively universal aspects of trauma response. Many proponents of this construct have made explicit analogies to the Holocaust as a way to understand the transgenerational effects of genocide. However, the social, cultural, and psychological contexts of the Holocaust and of post-colonial Indigenous "survivance" differ in many striking ways. Indeed, the comparison suggests that the persistent suffering of Indigenous peoples in the Americas reflects not so much past trauma as ongoing structural violence. The comparative study of genocide and other forms of massive, organized violence can do much to illuminate both common mechanisms and distinctive features, and trace the looping effects from political processes to individual experience and back again. The ethics and pragmatics of individual and collective healing, restitution, resilience, and recovery can be understood in terms of the self-vindicating loops between politics, structural violence, public discourse, and embodied experience. PMID:24855142

  20. [The Trauma Network of the German Society for Trauma 2009].

    PubMed

    Kühne, C A; Mand, C; Sturm, J; Lackner, C K; Künzel, A; Siebert, H; Ruchholtz, S

    2009-10-01

    In 2009, 3 years after the foundation of the Trauma Network of the German Society for Trauma (TraumaNetzwerkD DGU), the majority of German hospitals participating in the treatment of seriously injured patients is registered in regional trauma networks (TNW). Currently there are 41 trauma networks with more than 660 hospitals in existence, 18 more are registered but are still in the planning phase. Each Federal State has an average of 39 trauma centres of different levels taking part in the treatment of seriously injured patients and every trauma network has an average catchment area of 8708 km(2). The most favourable geographical infrastructure conditions exist in Nordrhein-Westfalen, the least favourable in Sachsen-Anhalt and Mecklenburg-Vorpommern. A total of 95 hospitals have already fulfilled the first audit of the structural, personnel and qualitative requirements by the certification bodies. Examination of the check lists of 26 hospitals showed shortcomings in the clinical structure so that these hospitals must be rechecked after correction of the shortcomings. A total of 59 hospitals throughout Germany were successfully audited and only one failed to fulfil the requirements. Because of the varying sizes of the trauma networks there are differences in the areas covered by each trauma network and trauma centre. Concerning the process of certification and auditing (together with the company DIOcert) it could be seen that by careful examination of the check lists of each hospital unforeseen problems during the audit could be avoided. The following article will present the current state of development of the Trauma Network of the German Society for Trauma and describe the certification and auditing process. PMID:19756455

  1. Free vascular fibular transfer in congenital pseudoarthrosis of the tibia: results of the EPOS multicenter study. European Paediatric Orthopaedic Society (EPOS).

    PubMed

    Romanus, B; Bollini, G; Dungl, P; Fixsen, J; Grill, F; Hefti, F; Ippolito, E; Tudisco, C; Wientroub, S

    2000-04-01

    This paper presents a review of the literature, describes the principal author's (B.R.) personal experience and provides the results of the European Paediatric Orthopaedic Society (EPOS) multicenter study. The objective is to evaluate the present status and future role of free vascular fibular transfer in treating congenital pseudoarthrosis of the tibia. Variables such as the selection of cases, age at operation, technical surgical details and postoperative results will be considered. The data on the EPOS study were incomplete at the time of writing, but the considerable amount of information already amassed is a valuable contribution to this updated report. PMID:10868357

  2. Application of the quality and safety education for nurses competencies in orthopaedic nursing: implications for preceptors.

    PubMed

    Altmiller, Gerry

    2013-01-01

    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

  3. Significance of Nano- and Microtopography for Cell-Surface Interactions in Orthopaedic Implants

    PubMed Central

    Jäger, M.; Zilkens, C.; Zanger, K.; Krauspe, R.

    2007-01-01

    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

  4. 75 FR 32210 - United States v. Idaho Orthopaedic Society, Timothy Doerr, Jeffrey Hessing, Idaho Sports Medicine...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-07

    ... 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...

  5. Bioactive Coatings for Orthopaedic Implants—Recent Trends in Development of Implant Coatings

    PubMed Central

    Zhang, Bill G. X.; Myers, Damian E.; Wallace, Gordon G.; Brandt, Milan; Choong, Peter F. M.

    2014-01-01

    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

  6. Psychological Trauma Reconsidered: Overview and Proposed Psychotherapy for Survivors.

    ERIC Educational Resources Information Center

    Elbedour, Salman

    1997-01-01

    Establishes a conceptual approach to the etiology of psychological trauma. Reviews the literature and includes a case study to exemplify how the disruption of social relationships can interfere with the normal functioning of personality in the posttraumatic state until an appropriate therapeutic intervention or experience occurs. (RJM)

  7. Family Therapy of Terroristic Trauma: Psychological Syndromes and Treatment Strategies.

    ERIC Educational Resources Information Center

    Miller, Laurence

    2003-01-01

    Reviews pertinent literature on terroristic trauma and combines this information with the author's experience in treating adults, children, and family victims and survivors of recent terrorist attacks. Describes the psychological syndromes resulting from terrorism and discusses the relevant individual and family therapy modalities for treating…

  8. Preventing Childhood Trauma Resulting from Exposure to Domestic Violence.

    ERIC Educational Resources Information Center

    Fisher, Dave

    1999-01-01

    This review of the literature on the prevention of childhood trauma resulting from domestic violence lists usually short-term effects of domestic violence on children and discusses the possibility of post traumatic stress disorder and prevention of adjustment problems through immediate intervention. Suggestions for intervention with children who…

  9. Trauma in the geriatric population.

    PubMed

    Maxwell, Cathy A

    2015-06-01

    Injury in older adults is a looming public health crisis. This article provides a broad overview of geriatric trauma across the continuum of care. After a review of the epidemiology of geriatric trauma, optimal approaches to patient care are presented for triage and transport, trauma team activation and initial assessment, inpatient management, and injury prevention. Special emphasis is given to assessment of frailty, advanced care planning, and transitions of care. PMID:25981722

  10. Historical trauma as public narrative: A conceptual review of how history impacts present-day health

    PubMed Central

    Mohatt, Nathaniel Vincent; Thompson, Azure B.; Thai, Nghi D.; Tebes, Jacob Kraemer

    2014-01-01

    Theories of historical trauma increasingly appear in the literature on individual and community health, especially in relation to racial and ethnic minority populations and groups that experience significant health disparities. As a consequence of this rapid growth, the literature on historical trauma comprises disparate terminology and research approaches. This critical review integrates this literature in order to specify theoretical mechanisms that explain how historical trauma influences the health of individuals and communities. We argue that historical trauma functions as a public narrative for particular groups or communities that connects present-day experiences and circumstances to the trauma so as to influence health. Treating historical trauma as a public narrative shifts the research discourse away from an exclusive search for past causal variables that influence health to identifying how present-day experiences, their corresponding narratives, and their health impacts are connected to public narratives of historical trauma for a particular group or community. We discuss how the connection between historical trauma and present-day experiences, related narratives, and health impacts may function as a source of present-day distress as well as resilience. PMID:24561774

  11. Examining cultural, social, and self-related aspects of stigma in relation to sexual assault and trauma symptoms.

    PubMed

    Deitz, Mandi F; Williams, Stacey L; Rife, Sean C; Cantrell, Peggy

    2015-05-01

    The current study investigated a model explaining sexual assault victims' severity of trauma symptoms that incorporated multiple stigma constructs. Integrating the sexual assault literature with the stigma literature, this study sought to better understand trauma-related outcomes of sexual assault by examining three levels of stigma-cultural, social, and self. Results showed self-stigma was significantly and positively related to trauma symptom severity. Thus, results revealed that the internalized aspect of stigma served as a mechanism in the relation between sexual assault severity and increased levels of trauma symptom severity, highlighting the importance of assessing self-stigma in women reporting sexual assault experiences. PMID:25732041

  12. [Major Burn Trauma Management and Nursing Care].

    PubMed

    Lo, Shu-Fen

    2015-08-01

    Major burn injury is one of the most serious and often life-threatening forms of trauma. Burn patients not only suffer from the physical, psychological, social and spiritual impacts of their injury but also experience considerable changes in health-related quality of life. This paper presents a review of the literature on the implications of previous research and clinical care guidelines related to major burn injuries in order to help clinical practice nurses use evidence-based care guidelines to respond to initial injury assessments, better manage the complex systemic response to these injuries, and provide specialist wound care, emotional support, and rehabilitation services. PMID:26242439

  13. Segmental Renal Infarction due to Blunt Trauma

    PubMed Central

    Alevizopoulos, Aristeidis; Hamilton, Lauren; Stratu, Natalia; Rix, Gerald

    2016-01-01

    Segmental renal infarction is a rare situation which has been reported so far in the form of case reports. It's caused usually by cardiac conditions, such as atrial fibrillation, and systemic diseases (e.g. systemic lupus erythematous). We are presenting a case of a 31 year old healthy male, who sustained a left segmental renal infarction, following a motorbike accident. We report his presentation, management and outcome. We also review the literature in search of the optimal diagnostic and treatment pathway. To our knowledge, this is the first report of segmental renal infarction due to blunt trauma. PMID:27175338

  14. Trauma, attentional biases, and revictimization among young adults.

    PubMed

    Reichert, Elizabeth; Segal, Caroline; Flannery-Schroeder, Ellen

    2015-01-01

    Individuals with previous histories of trauma are at increased risk for subsequent victimization and the development of posttraumatic stress disorder, depression, and anxiety disorders. Attentional biases to threat-related stimuli are thought to impact one's ability to recognize future risk in his or her environment and may explain high rates of revictimization. Although the literature has identified three possible types of attentional biases among victims of trauma (i.e., interference, facilitation, and avoidance), findings are mixed. The current study examined attentional biases to threats among a sample of men and women with no, some, and multiple incident interpersonal and non-interpersonal trauma histories. It was hypothesized that those with multiple incident interpersonal trauma histories would demonstrate an interference effect (i.e., slower response times to threat-related words). Participants (N = 309) were 18- to 29-year-old college students. Self-report measures assessed trauma history, posttraumatic stress, and other psychological sequelae. Attentional biases were assessed using a dot probe computer task. Contrary to hypotheses, no significant differences in response times in the presence of threat-related words or neutral words were found among groups. Results suggest that multiple traumatized individuals do not exhibit attentional bias to threats compared to individuals with some or no trauma. PMID:25734365

  15. Selective nonoperative management of high grade splenic trauma.

    PubMed

    Branco, Bernardino C; Tang, Andrew L; Rhee, Peter; Fraga, Gustavo Pereira; Nascimento, Bartolomeu; Rizoli, Sandro; O'Keeffe, Terence

    2013-01-01

    The "Evidence-based Telemedicine - Trauma & Acute Care Surgery" (EBT-TACS) Journal Club performed a critical review of the literature and selected three up-to-date articles on the management of splenic trauma. Our focus was on high-grade splenic injuries, defined as AAST injury grade III-V. The first paper was an update of the 2003 Eastern Association for the Surgery of Trauma (EAST) practice management guidelines for nonoperative management of injury to the spleen. The second paper was an American Association for the Surgery of Trauma (AAST) 2012 plenary paper evaluating the predictive role of contrast blush on CT scan in AAST grade IV and V splenic injuries. Our last article was from Europe and investigates the effects of angioembolization of splenic artery on splenic function after high-grade splenic trauma (AAST grade III-V). The EBT-TACS Journal Club elaborated conclusions and recommendations for the management of high-grade splenic trauma. PMID:23912375

  16. Gluteal Compartment Syndrome Secondary to Pelvic Trauma.

    PubMed

    Diaz Dilernia, Fernando; Zaidenberg, Ezequiel E; Gamsie, Sebastian; Taype Zamboni, Danilo E R; Carabelli, Guido S; Barla, Jorge D; Sancineto, Carlos F

    2016-01-01

    Gluteal compartment syndrome (GCS) is extremely rare when compared to compartment syndrome in other anatomical regions, such as the forearm or the lower leg. It usually occurs in drug users following prolonged immobilization due to loss of consciousness. Another possible cause is trauma, which is rare and has only few reports in the literature. Physical examination may show tense and swollen buttocks and severe pain caused by passive range of motion. We present the case of a 70-year-old man who developed GCS after prolonged anterior-posterior pelvis compression. The physical examination revealed swelling, scrotal hematoma, and left ankle extension weakness. An unstable pelvic ring injury was diagnosed and the patient was taken to surgery. Measurement of the intracompartmental pressure was measured in the operating room, thereby confirming the diagnosis. Emergent fasciotomy was performed to decompress the three affected compartments. Trauma surgeons must be aware of the possibility of gluteal compartment syndrome in patients who have an acute pelvic trauma with buttock swelling and excessive pain of the gluteal region. Any delay in diagnosis or treatment can be devastating, causing permanent disability, irreversible loss of gluteal muscles, sciatic nerve palsy, kidney failure, or even death. PMID:27579205

  17. Gluteal Compartment Syndrome Secondary to Pelvic Trauma

    PubMed Central

    Taype Zamboni, Danilo E. R.; Carabelli, Guido S.; Barla, Jorge D.; Sancineto, Carlos F.

    2016-01-01

    Gluteal compartment syndrome (GCS) is extremely rare when compared to compartment syndrome in other anatomical regions, such as the forearm or the lower leg. It usually occurs in drug users following prolonged immobilization due to loss of consciousness. Another possible cause is trauma, which is rare and has only few reports in the literature. Physical examination may show tense and swollen buttocks and severe pain caused by passive range of motion. We present the case of a 70-year-old man who developed GCS after prolonged anterior-posterior pelvis compression. The physical examination revealed swelling, scrotal hematoma, and left ankle extension weakness. An unstable pelvic ring injury was diagnosed and the patient was taken to surgery. Measurement of the intracompartmental pressure was measured in the operating room, thereby confirming the diagnosis. Emergent fasciotomy was performed to decompress the three affected compartments. Trauma surgeons must be aware of the possibility of gluteal compartment syndrome in patients who have an acute pelvic trauma with buttock swelling and excessive pain of the gluteal region. Any delay in diagnosis or treatment can be devastating, causing permanent disability, irreversible loss of gluteal muscles, sciatic nerve palsy, kidney failure, or even death. PMID:27579205

  18. Rancho Los Amigos Medical Center. A unique orthopaedic resource and teaching institution.

    PubMed

    Hsu, J D

    2000-05-01

    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

  19. Neuroimaging in repetitive brain trauma

    PubMed Central

    2014-01-01

    Sports-related concussions are one of the major causes of mild traumatic brain injury. Although most patients recover completely within days to weeks, those who experience repetitive brain trauma (RBT) may be at risk for developing a condition known as chronic traumatic encephalopathy (CTE). While this condition is most commonly observed in athletes who experience repetitive concussive and/or subconcussive blows to the head, such as boxers, football players, or hockey players, CTE may also affect soldiers on active duty. Currently, the only means by which to diagnose CTE is by the presence of phosphorylated tau aggregations post-mortem. Non-invasive neuroimaging, however, may allow early diagnosis as well as improve our understanding of the underlying pathophysiology of RBT. The purpose of this article is to review advanced neuroimaging methods used to investigate RBT, including diffusion tensor imaging, magnetic resonance spectroscopy, functional magnetic resonance imaging, susceptibility weighted imaging, and positron emission tomography. While there is a considerable literature using these methods in brain injury in general, the focus of this review is on RBT and those subject populations currently known to be susceptible to RBT, namely athletes and soldiers. Further, while direct detection of CTE in vivo has not yet been achieved, all of the methods described in this review provide insight into RBT and will likely lead to a better characterization (diagnosis), in vivo, of CTE than measures of self-report. PMID:25031630

  20. Surgeons' knowledge about the costs of orthopaedic implants.

    PubMed

    Rohman, Lebur; Hadi, Saifullah; Whitwell, George

    2014-08-01

    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

  1. Rural Trauma: Is Trauma Designation Associated with Better Hospital Outcomes?

    ERIC Educational Resources Information Center

    Bowman, Stephen M.; Zimmerman, Frederick J.; Sharar, Sam R.; Baker, Margaret W.; Martin, Diane P.

    2008-01-01

    Context: While trauma designation has been associated with lower risk of death in large urban settings, relatively little attention has been given to this issue in small rural hospitals. Purpose: To examine factors related to in-hospital mortality and delayed transfer in small rural hospitals with and without trauma designation. Methods: Analysis…

  2. Trauma-Focused CBT for Youth with Complex Trauma

    ERIC Educational Resources Information Center

    Cohen, Judith A.; Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.

    2012-01-01

    Objectives: Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive…

  3. Trauma-focused CBT for youth with complex trauma

    PubMed Central

    Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.

    2013-01-01

    Objectives Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth with complex trauma. Methods TF-CBT treatment phases are described and modifications of timing, proportionality and application are described for youth with complex trauma. Practical applications include a) dedicating proportionally more of the model to the TF-CBT coping skills phase; b) implementing the TF-CBT Safety component early and often as needed throughout treatment; c) titrating gradual exposure more slowly as needed by individual youth; d) incorporating unifying trauma themes throughout treatment; and e) when indicated, extending the TF-CBT treatment consolidation and closure phase to include traumatic grief components and to generalize ongoing safety and trust. Results Recent data from youth with complex trauma support the use of the above TF-CBT strategies to successfully treat these youth. Conclusions The above practical strategies can be incorporated into TF-CBT to effectively treat youth with complex trauma. Practice implications Practical strategies include providing a longer coping skills phase which incorporates safety and appropriate gradual exposure; including relevant unifying themes; and allowing for an adequate treatment closure phase to enhance ongoing trust and safety. Through these strategies therapists can successfully apply TF-CBT for youth with complex trauma. PMID:22749612

  4. Radiology of skeletal trauma

    SciTech Connect

    Rogers, L.F.

    1982-01-01

    This 1000-page book contains over 1700 illustrations, is presented in two volumes and subdivided into 23 chapters. After brief chapters of Introduction and General Anatomy, a section on Skeletal Biomechanics is presented. The Epidemiology of Fractures chapter examines, among other things, the effects of age on the frequency and distribution of fractures. In the chapter on Classifications of Fractures, the author describes the character of traumatic forces such as angulating, torsional, avulsive, and compressive, and then relates these to the resultant fracture configurations. The Fracture Treatment chapter presents an overview of treatment principles. Other chapters deal with specific problems in pediatric trauma, fracture healing and nonhealing, and fracture complications.

  5. Management of Pediatric Trauma.

    PubMed

    2016-08-01

    Injury is still the number 1 killer of children ages 1 to 18 years in the United States (http://www.cdc.gov/nchs/fastats/children.htm). Children who sustain injuries with resulting disabilities incur significant costs not only for their health care but also for productivity lost to the economy. The families of children who survive childhood injury with disability face years of emotional and financial hardship, along with a significant societal burden. The entire process of managing childhood injury is enormously complex and varies by region. Only the comprehensive cooperation of a broadly diverse trauma team will have a significant effect on improving the care of injured children. PMID:27456509

  6. Trauma Associated Sleep Disorder: A Proposed Parasomnia Encompassing Disruptive Nocturnal Behaviors, Nightmares, and REM without Atonia in Trauma Survivors

    PubMed Central

    Mysliwiec, Vincent; O'Reilly, Brian; Polchinski, Jason; Kwon, Herbert P.; Germain, Anne; Roth, Bernard J.

    2014-01-01

    Study Objectives: To characterize the clinical, polysomnographic and treatment responses of patients with disruptive nocturnal behaviors (DNB) and nightmares following traumatic experiences. Methods: A case series of four young male, active duty U.S. Army Soldiers who presented with DNB and trauma related nightmares. Patients underwent a clinical evaluation in a sleep medicine clinic, attended overnight polysomnogram (PSG) and received treatment. We report pertinent clinical and PSG findings from our patients and review prior literature on sleep disturbances in trauma survivors. Results: DNB ranged from vocalizations, somnambulism to combative behaviors that injured bed partners. Nightmares were replays of the patient's traumatic experiences. All patients had REM without atonia during polysomnography; one patient had DNB and a nightmare captured during REM sleep. Prazosin improved DNB and nightmares in all patients. Conclusions: We propose Trauma associated Sleep Disorder (TSD) as a unique sleep disorder encompassing the clinical features, PSG findings, and treatment responses of patients with DNB, nightmares, and REM without atonia after trauma. Citation: Mysliwiec V, O'Reilly B, Polchinski J, Kwon HP, Germain A, Roth BJ. Trauma associated sleep disorder: a proposed parasomnia encompassing disruptive nocturnal behaviors, nightmares, and REM without atonia in trauma survivors. J Clin Sleep Med 2014;10(10):1143-1148. PMID:25317096

  7. Computer-assisted orthopaedic surgery and robotic surgery in total hip arthroplasty.

    PubMed

    Sugano, Nobuhiko

    2013-03-01

    Various systems of computer-assisted orthopaedic surgery (CAOS) in total hip arthroplasty (THA) were reviewed. The first clinically applied system was an active robotic system (ROBODOC), which performed femoral implant cavity preparation as programmed preoperatively. Several reports on cementless THA with ROBODOC showed better stem alignment and less variance in limb-length inequality on radiographic evaluation, less incidence of pulmonary embolic events on transesophageal cardioechogram, and less stress shielding on the dual energy X-ray absorptiometry analysis than conventional manual methods. On the other hand, some studies raise issues with active systems, including a steep learning curve, muscle and nerve damage, and technical complications, such as a procedure stop due to a bone motion during cutting, requiring re-registration and registration failure. Semi-active robotic systems, such as Acrobot and Rio, were developed for ease of surgeon acceptance. The drill bit at the tip of the robotic arm is moved by a surgeon's hand, but it does not move outside of a milling path boundary, which is defined according to three-dimensional (3D) image-based preoperative planning. However, there are still few reports on THA with these semi-active systems. Thanks to the advancements in 3D sensor technology, navigation systems were developed. Navigation is a passive system, which does not perform any actions on patients. It only provides information and guidance to the surgeon who still uses conventional tools to perform the surgery. There are three types of navigation: computed tomography (CT)-based navigation, imageless navigation, and fluoro-navigation. CT-based navigation is the most accurate, but the preoperative planning on CT images takes time that increases cost and radiation exposure. Imageless navigation does not use CT images, but its accuracy depends on the technique of landmark pointing, and it does not take into account the individual uniqueness of the anatomy

  8. Computer-Assisted Orthopaedic Surgery and Robotic Surgery in Total Hip Arthroplasty

    PubMed Central

    2013-01-01

    Various systems of computer-assisted orthopaedic surgery (CAOS) in total hip arthroplasty (THA) were reviewed. The first clinically applied system was an active robotic system (ROBODOC), which performed femoral implant cavity preparation as programmed preoperatively. Several reports on cementless THA with ROBODOC showed better stem alignment and less variance in limb-length inequality on radiographic evaluation, less incidence of pulmonary embolic events on transesophageal cardioechogram, and less stress shielding on the dual energy X-ray absorptiometry analysis than conventional manual methods. On the other hand, some studies raise issues with active systems, including a steep learning curve, muscle and nerve damage, and technical complications, such as a procedure stop due to a bone motion during cutting, requiring re-registration and registration failure. Semi-active robotic systems, such as Acrobot and Rio, were developed for ease of surgeon acceptance. The drill bit at the tip of the robotic arm is moved by a surgeon's hand, but it does not move outside of a milling path boundary, which is defined according to three-dimensional (3D) image-based preoperative planning. However, there are still few reports on THA with these semi-active systems. Thanks to the advancements in 3D sensor technology, navigation systems were developed. Navigation is a passive system, which does not perform any actions on patients. It only provides information and guidance to the surgeon who still uses conventional tools to perform the surgery. There are three types of navigation: computed tomography (CT)-based navigation, imageless navigation, and fluoro-navigation. CT-based navigation is the most accurate, but the preoperative planning on CT images takes time that increases cost and radiation exposure. Imageless navigation does not use CT images, but its accuracy depends on the technique of landmark pointing, and it does not take into account the individual uniqueness of the anatomy

  9. Two hundred years of orthopaedics in Wuerzburg-one hundred years of the Koenig-Ludwig-Haus.

    PubMed

    Jakuscheit, Axel; Rudert, Maximilian

    2016-08-01

    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

  10. Radiation exposure to the orthopaedic surgeon during periacetabular osteotomy

    PubMed Central

    Daugaard, Henrik; Søballe, Kjeld

    2008-01-01

    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

  11. Force and torque modelling of drilling simulation for orthopaedic surgery.

    PubMed

    MacAvelia, Troy; Ghasempoor, Ahmad; Janabi-Sharifi, Farrokh

    2014-01-01

    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

  12. Nanostructured glass–ceramic coatings for orthopaedic applications

    PubMed Central

    Wang, Guocheng; Lu, Zufu; Liu, Xuanyong; Zhou, Xiaming; Ding, Chuanxian; Zreiqat, Hala

    2011-01-01

    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

  13. Thermoplastic polymeric adhesive for structural bonding applications for orthopaedic devices

    SciTech Connect

    Devanathan, D.; King, R.; Swarts, D.; Lin, S.; Ramani, K.; Tagle, J.

    1994-12-31

    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

  14. Biodegradable injectable polyurethanes: synthesis and evaluation for orthopaedic applications.

    PubMed

    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

    2008-10-01

    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

  15. New modalities of pain treatment after outpatient orthopaedic surgery.

    PubMed

    Beaussier, M; Sciard, D; Sautet, A

    2016-02-01

    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

  16. Thermal cycling can extend tool life in orthopaedic operating rooms.

    PubMed

    Katchky, Ryan N; McLachlin, Stewart D; Wong, Edwin K Y; Finkelstein, Joel; Kreder, Hans J; Whyne, Cari M

    2016-03-01

    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

  17. Nano-Engineered Cubic Zirconia for Orthopaedic Implant Applications

    NASA Astrophysics Data System (ADS)

    Namavar, F.; Rubinstein, A.; Sabirianov, R.; Thiele, G.; Sharp, J.; Pokharel, U.; Namavar, R.; Garvin, K.

    2012-02-01

    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.

  18. Sexual Trauma, Spirituality, and Psychopathology

    ERIC Educational Resources Information Center

    Krejci, Mark J.; Thompson, Kevin M.; Simonich, Heather; Crosby, Ross D.; Donaldson, Mary Ann; Wonderlich, Stephen A.; Mitchell, James E.

    2004-01-01

    This study assessed the association between spirituality and psychopathology in a group of sexual abuse victims and controls with a focus on whether spirituality moderated the association between sexual trauma and psychopathology. Seventy-one sexual trauma victims were compared to 25 control subjects on spiritual well-being, the Eating Disorder…

  19. Coagulopathy after severe pediatric trauma.

    PubMed

    Christiaans, Sarah C; Duhachek-Stapelman, Amy L; Russell, Robert T; Lisco, Steven J; Kerby, Jeffrey D; Pittet, Jean-François

    2014-06-01

    Trauma remains the leading cause of morbidity and mortality in the United States among children aged 1 to 21 years. The most common cause of lethality in pediatric trauma is traumatic brain injury. Early coagulopathy has been commonly observed after severe trauma and is usually associated with severe hemorrhage and/or traumatic brain injury. In contrast to adult patients, massive bleeding is less common after pediatric trauma. The classical drivers of trauma-induced coagulopathy include hypothermia, acidosis, hemodilution, and consumption of coagulation factors secondary to local activation of the coagulation system after severe traumatic injury. Furthermore, there is also recent evidence for a distinct mechanism of trauma-induced coagulopathy that involves the activation of the anticoagulant protein C pathway. Whether this new mechanism of posttraumatic coagulopathy plays a role in children is still unknown. The goal of this review is to summarize the current knowledge on the incidence and potential mechanisms of coagulopathy after pediatric trauma and the role of rapid diagnostic tests for early identification of coagulopathy. Finally, we discuss different options for treating coagulopathy after severe pediatric trauma. PMID:24569507

  20. Blood Transfusion Strategies for Hemostatic Resuscitation in Massive Trauma.

    PubMed

    McGrath, Caroline

    2016-03-01

    Massive transfusion practices were transformed during the 1970s without solid evidence supporting the use of component therapy. A manual literature search was performed for all references to the lethal triad, acute or early coagulopathy of trauma, fresh whole blood, and component transfusion therapy in massive trauma, and damage control resuscitation. Data from recent wars suggest traditional component therapy causes a nonhemostatic resuscitation worsening the propagation of the lethal triad hastening death. These same studies also indicate the advantage of fresh whole blood over component therapy even when administered in a 1:1:1 replacement ratio. PMID:26897426

  1. Severe Cranioencephalic Trauma: Prehospital Care, Surgical Management and Multimodal Monitoring

    PubMed Central

    Moscote-Salazar, Luis Rafael; M. Rubiano, Andres; Alvis-Miranda, Hernando Raphael; Calderon-Miranda, Willem; Alcala-Cerra, Gabriel; Blancas Rivera, Marco Antonio; Agrawal, Amit

    2016-01-01

    Traumatic brain injury is a leading cause of death in developed countries. It is estimated that only in the United States about 100,000 people die annually in parallel among the survivors there is a significant number of people with disabilities with significant costs for the health system. It has been determined that after moderate and severe traumatic injury, brain parenchyma is affected by more than 55% of cases. Head trauma management is critical is the emergency services worldwide. We present a review of the literature regarding the prehospital care, surgical management and intensive care monitoring of the patients with severe cranioecephalic trauma.  PMID:27162922

  2. An uncommon cause of pneumobilia: blunt abdominal trauma.

    PubMed

    Yıldız, Fahrettin; Coban, Sacit; Terzi, Alpaslan; Cece, Hasan; Uzunkoy, Ali

    2011-07-01

    Pneumobilia is described as occurrence of free air in the gallbladder or biliary tree. There are a number of causes of pneumobilia, including surgically created biliary enteric fistula, instrumentation of the bile duct on endoscopic retrograde cholangiopancreatography, emphysematous cholecystitis, and pyogenic cholangitis. Pneumobilia has also occurred following blunt abdominal trauma, but to date, no more than five cases of such injury have been reported in the literature. In this report, we present a patient struck by a motor vehicle with traumatic pneumobilia following blunt trauma to the abdomen, which was managed conservatively. PMID:21935838

  3. Prehospital Trauma Care in Singapore.

    PubMed

    Ho, Andrew Fu Wah; Chew, David; Wong, Ting Hway; Ng, Yih Yng; Pek, Pin Pin; Lim, Swee Han; Anantharaman, Venkataraman; Hock Ong, Marcus Eng

    2015-01-01

    Prehospital emergency care in Singapore has taken shape over almost a century. What began as a hospital-based ambulance service intended to ferry medical cases was later complemented by an ambulance service under the Singapore Fire Brigade to transport trauma cases. The two ambulance services would later combine and come under the Singapore Civil Defence Force. The development of prehospital care systems in island city-state Singapore faces unique challenges as a result of its land area and population density. This article defines aspects of prehospital trauma care in Singapore. It outlines key historical milestones and current initiatives in service, training, and research. It makes propositions for the future direction of trauma care in Singapore. The progress Singapore has made given her circumstances may serve as lessons for the future development of prehospital trauma systems in similar environments. Key words: Singapore; trauma; prehospital emergency care; emergency medical services. PMID:25494913

  4. Barriers and Facilitators Associated with Non-Surgical Treatment Use for Osteoarthritis Patients in Orthopaedic Practice

    PubMed Central

    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

    2016-01-01

    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

  5. Penetrating abdominal trauma.

    PubMed

    Henneman, P L

    1989-08-01

    The management of patients with penetrating abdominal trauma is outlined in Figure 1. Patients with hemodynamic instability, evisceration, significant gastrointestinal bleeding, peritoneal signs, gunshot wounds with peritoneal violation, and type 2 and 3 shotgun wounds should undergo emergency laparotomy. The initial ED management of these patients includes airway management, monitoring of cardiac rhythm and vital signs, history, physical examination, and placement of intravenous lines. Blood should be obtained for initial hematocrit, type and cross-matching, electrolytes, and an alcohol level or drug screen as needed. Initial resuscitation should utilize crystalloid fluid replacement. If more than 2 liters of crystalloid are needed to stabilize an adult (less in a child), blood should be given. Group O Rh-negative packed red blood cells should be immediately available for a patient in impending arrest or massive hemorrhage. Type-specific blood should be available within 15 minutes. A patient with penetrating thoracic and high abdominal trauma should receive a portable chest x-ray, and a hemo- or pneumothorax should be treated with tube thoracostomy. An unstable patient with clinical signs consistent with a pneumothorax, however, should receive a tube thoracostomy prior to obtaining roentgenographic confirmation. If time permits, a nasogastric tube and Foley catheter should be placed, and the urine evaluated for blood (these procedures can be performed in the operating room). If kidney involvement is suspected because of hematuria or penetrating trauma in the area of a kidney or ureter in a patient requiring surgery, a single-shot IVP should be performed either in the ED or the operating room. An ECG is important in patients with possible cardiac involvement and in patients over the age of 40 going to the operating room. Tetanus status should be updated, and appropriate antibiotics covering bowel flora should be given. Operative management should rarely be delayed

  6. Computer-assisted trauma care prototype.

    PubMed

    Holzman, T G; Griffith, A; Hunter, W G; Allen, T; Simpson, R J

    1995-01-01

    Each year, civilian accidental injury results in 150,000 deaths and 400,000 permanent disabilities in the United States alone. The timely creation of and access to dynamically updated trauma patient information at the point of injury is critical to improving the state of care. Such information is often non-existent, incomplete, or inaccurate, resulting in less than adequate treatment by medics and the loss of precious time by medical personnel at the hospital or battalion aid station as they attempt to reassess and treat the patient. The Trauma Care Information Management System (TCIMS) is a prototype system for facilitating information flow and patient processing decisions in the difficult circumstances of civilian and military trauma care activities. The program is jointly supported by the United States Advanced Research Projects Agency (ARPA) and a consortium of universities, medical centers, and private companies. The authors' focus has been the human-computer interface for the system. We are attempting to make TCIMS powerful in the functions it delivers to its users in the field while also making it easy to understand and operate. To develop such a usable system, an approach known as user-centered design is being followed. Medical personnel themselves are collaborating with the authors in its needs analysis, design, and evaluation. Specifically, the prototype being demonstrated was designed through observation of actual civilian trauma care episodes, military trauma care exercises onboard a hospital ship, interviews with civilian and military trauma care providers, repeated evaluation of evolving prototypes by potential users, and study of the literature on trauma care and human factors engineering. This presentation at MedInfo '95 is still another avenue for soliciting guidance from medical information system experts and users. The outcome of this process is a system that provides the functions trauma care personnel desire in a manner that can be easily and

  7. Vascular trauma historical notes.

    PubMed

    Rich, Norman M

    2011-03-01

    This article provides a brief historical review of treatment of vascular trauma. Although methods for ligation came into use in the second century, this knowledge was lost during the Dark Ages and did not come back until the Renaissance. Many advances in vascular surgery occurred during the Balkan Wars, World War I, and World War II, although without antibiotics and blood banking, the philosophy of life over limb still ruled. Documenting and repairing both arteries and veins became more common during the Korean and Vietnam conflicts. Increased documentation has revealed that the current conflicts have resulted in more arterial injuries than in previous wars, likely because of improved body armor, improvised explosive device attacks, tourniquet use, and improved medical evacuation time. This brief review emphasizes the great value of mentorship and the legacy of the management of arterial and venous injuries to be passed on. PMID:21502112

  8. [MUSCULOSKELETAL MARKERS, ARTHROPATY, TRAUMAS].

    PubMed

    Caldarini, Carla; Zavaroni, Federica; Benassi, Valentina

    2015-01-01

    The bone tissue remodeling due to strong physical/working activity is defined as ergonomic markers or MSM (Muscoloskeletal Stress Markers) (Capasso et al. 1999) and MOS (Markers of Occupational Stress). Among them we can find: enthesopaties, arthropaties, non metrical stress and traumas markers. In the present study, the analysis of these traits has been used to clarify habitual activity patterns of four imperial populations from Suburbium: Castel Malnome, Casal Bertone area Q, Via Padre Semeria e Quarto Cappello del Prete. The very high prevalence of activity-induced stress lesions occurred among the individuals of Castel Malnome and Casal Bertone area Q suggests that these groups were involved in strenuous occupations such as, respectively: the processing and storage of salt and the dyeing of textiles and hides discernible from the archaeological context. For the individuals of Via Padre Semeria and Quarto Cappello del Prete the alterations, instead, could be compatibles with agricultural work. PMID:27348990

  9. Lightweight Trauma Module - LTM

    NASA Technical Reports Server (NTRS)

    Hatfield, Thomas

    2008-01-01

    Current patient movement items (PMI) supporting the military's Critical Care Air Transport Team (CCATT) mission as well as the Crew Health Care System for space (CHeCS) have significant limitations: size, weight, battery duration, and dated clinical technology. The LTM is a small, 20 lb., system integrating diagnostic and therapeutic clinical capabilities along with onboard data management, communication services and automated care algorithms to meet new Aeromedical Evacuation requirements. The Lightweight Trauma Module is an Impact Instrumentation, Inc. project with strong Industry, DoD, NASA, and Academia partnerships aimed at developing the next generation of smart and rugged critical care tools for hazardous environments ranging from the battlefield to space exploration. The LTM is a combination ventilator/critical care monitor/therapeutic system with integrated automatic control systems. Additional capabilities are provided with small external modules.

  10. Trauma and religiousness.

    PubMed

    Gostečnik, Christian; Repič Slavič, Tanja; Lukek, Saša Poljak; Cvetek, Robert

    2014-06-01

    Victims of traumatic events who experience re-traumatization often develop a highly ambivalent relationship to God and all religiosity as extremely conflictual. On the one hand, they may choose to blame God for not having protected them, for having left them to feel so alone, for having been indifferent to them or they may even turn their wrath upon God, as the source of cruelty. Often though, the traumas experienced by individuals prompt them to turn to God and religion in search of help. This gives reason for the need of new and up-to-date research that can help elucidate why some people choose to seek help in religion and others turn away from it. PMID:23187617

  11. Intraosseous access in trauma by air medical retrieval teams.

    PubMed

    Sheils, Mark; Ross, Mark; Eatough, Noel; Caputo, Nicholas D

    2014-01-01

    Trauma accounts for a significant portion of overall mortality globally. Hemorrhage is the second major cause of mortality in the prehospital environment. Air medical retrieval services throughout the world have been developed to help improve the outcomes of patients suffering from a broad range of medical conditions, including trauma. These services often utilize intraosseous (IO) devices as an alternative means for access of both medically ill and traumatically injured patients in austere environments. However, studies have suggested that IO access cannot reach acceptable rates for massive transfusion. We review the subject to find the answer of whether IO access should be performed by air medical teams in the prehospital setting, or would central venous (CVC) access be more appropriate? We decided to assess the literature for capacity of IO access to meet resuscitation requirements in the prehospital management of trauma. We also decided to compare the insertion and complication characteristics of IO and CVC access. PMID:25049187

  12. Transcatheter Embolization for Delayed Hemorrhage Caused by Blunt Splenic Trauma

    SciTech Connect

    Krohmer, Steven J. Hoffer, Eric K.; Burchard, Kenneth W.

    2010-08-15

    Although the exact benefit of adjunctive splenic artery embolization (SAE) in the nonoperative management (NOM) of patients with blunt splenic trauma has been debated, the role of transcatheter embolization in delayed splenic hemorrhage is rarely addressed. The purpose of this study was to evaluate the effectiveness of SAE in the management of patients who presented at least 3 days after initial splenic trauma with delayed hemorrhage. During a 24-month period 4 patients (all male; ages 19-49 years) presented with acute onset of pain 5-70 days after blunt trauma to the left upper quadrant. Two had known splenic injuries that had been managed nonoperatively. All had computed axial tomography evidence of active splenic hemorrhage or false aneurysm on representation. All underwent successful SAE. Follow-up ranged from 28 to 370 days. These cases and a review of the literature indicate that SAE is safe and effective for NOM failure caused by delayed manifestations of splenic arterial injury.

  13. Adjustable forming of thermoplastic composites for orthopaedic applications.

    PubMed

    Hou, M; Friedrich, K

    1998-02-01

    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

  14. Multiscale Inorganic Hierarchically Materials: Towards an Improved Orthopaedic Regenerative Medicine.

    PubMed

    Ruso, Juan M; Sartuqui, Javier; Messina, Paula V

    2015-01-01

    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

  15. Spleen volume on CT and the effect of abdominal trauma.

    PubMed

    Cruz-Romero, Cinthia; Agarwal, Sheela; Abujudeh, Hani H; Thrall, James; Hahn, Peter F

    2016-08-01

    The aim of this study is to determine the magnitude of change in spleen volume on CT in subjects sustaining blunt abdominal trauma without hemorrhage relative to patients without disease and how the spleen volumes are distributed. Sixty-seven subjects with blunt abdominal trauma and 101 control subjects were included in this retrospective single-center, IRB-approved, and HIPAA-compliant study. Patients with an injured spleen were excluded. Using a semiautomatic segmentation program, two readers computed spleen volumes from CT. Spleen volume distribution in male and female trauma and control cohorts were compared nonparametrically. Spleen volume plotted against height, weight, and age were analyzed by linear regression. The number of females and males are, respectively, 35 and 32 in trauma subjects and 69 and 32 among controls. Female trauma patients (49.6 years) were older than males (39.8 years) (p = 0.02). Distributions of spleen volume were not normal, skewed above their means, requiring a nonparametric comparison. Spleen volumes in trauma patients were smaller than those in controls with medians of 230 vs 294 mL in males(p < 0.006) and 163 vs 191 mL in females(p < 0.04). Spleen volume correlated positively with weight in females and with height in male controls, and negatively with age in male controls (p < 0.01). Variation in reproducibility and repeatability was acceptable at 1.5 and 4.9 %, respectively. Reader variation was 1.7 and 4.6 % for readers 1 and 2, respectively. The mean spleen volume in controls was 245 mL, the largest ever reported. Spleen volume decreases in response to blunt abdominal trauma. Spleen volumes are not normally distributed. Our population has the largest spleen volume reported in the literature, perhaps a consequence of the obesity epidemic. PMID:27166964

  16. An ecological view of psychological trauma and trauma recovery.

    PubMed

    Harvey, M R

    1996-01-01

    This paper presents an ecological view of psychological trauma and trauma recovery. Individual differences in posttraumatic response and recovery are the result of complex interactions among person, event, and environmental factors. These interactions define the interrelationship of individual and community and together may foster or impede individual recovery. The ecological model proposes a multidimensional definition of trauma recovery and suggests that the efficacy of trauma-focused interventions depends on the degree to which they enhance the person-community relationship and achieve "ecological fit" within individually varied recovery contexts. In attending to the social, cultural and political context of victimization and acknowledging that survivors of traumatic experiences may recover without benefit of clinical intervention, the model highlights the phenomenon of resiliency, and the relevance of community intervention efforts. PMID:8750448

  17. Immunohistochemical alterations after muscle trauma.

    PubMed

    Fechner, G; Bajanowski, T; Brinkmann, B

    1993-01-01

    The proteins fibrin, fibrinogen, fibronectin and complement C5b-9 were investigated in mechanically damaged skeletal muscle. An accumulation of fibrin, fibrinogen and fibronectin could be observed immediately after intra-vital trauma in damaged fibre zones, later an accumulation at the torn edges of the fibres. The accumulation of complement C5b-9 began one hour after trauma. After post mortem trauma no positive reactions could be observed for any of the proteins. The degree of expression of these proteins can therefore be used to differentiate between vital and postmortem muscle damage as well as the estimation of wound age in the early antemortem time period. PMID:8431399

  18. ACR Appropriateness Criteria Head Trauma.

    PubMed

    Shetty, Vilaas S; Reis, Martin N; Aulino, Joseph M; Berger, Kevin L; Broder, Joshua; Choudhri, Asim F; Kendi, A Tuba; Kessler, Marcus M; Kirsch, Claudia F; Luttrull, Michael D; Mechtler, Laszlo L; Prall, J Adair; Raksin, Patricia B; Roth, Christopher J; Sharma, Aseem; West, O Clark; Wintermark, Max; Cornelius, Rebecca S; Bykowski, Julie

    2016-06-01

    Neuroimaging plays an important role in the management of head trauma. Several guidelines have been published for identifying which patients can avoid neuroimaging. Noncontrast head CT is the most appropriate initial examination in patients with minor or mild acute closed head injury who require neuroimaging as well as patients with moderate to severe acute closed head injury. In short-term follow-up neuroimaging of acute traumatic brain injury, CT and MRI may have complementary roles. In subacute to chronic traumatic brain injury, MRI is the most appropriate initial examination, though CT may have a complementary role in select circumstances. Advanced neuroimaging techniques are areas of active research but are not considered routine clinical practice at this time. In suspected intracranial vascular injury, CT angiography or venography or MR angiography or venography is the most appropriate imaging study. In suspected posttraumatic cerebrospinal fluid leak, high-resolution noncontrast skull base CT is the most appropriate initial imaging study to identify the source, with cisternography reserved for problem solving. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:27262056

  19. Computed tomography in trauma: An atlas approach

    SciTech Connect

    Toombs, B.D.; Sandler, C.

    1986-01-01

    This book discussed computed tomography in trauma. The text is organized according to mechanism of injury and site of injury. In addition to CT, some correlation with other imaging modalities is included. Blunt trauma, penetrating trauma, complications and sequelae of trauma, and use of other modalities are covered.

  20. Secondary Trauma in Children and School Personnel

    ERIC Educational Resources Information Center

    Motta, Robert W.

    2012-01-01

    A review of childhood secondary trauma is presented. Secondary trauma involves the transfer and acquisition of negative affective and dysfunctional cognitive states due to prolonged and extended contact with others, such as family members, who have been traumatized. As such, secondary trauma refers to a spread of trauma reactions from the victim…

  1. Effects of psychological and biomechanical trauma on brain and behavior

    PubMed Central

    McAllister, Thomas W.; Stein, Murray B.

    2011-01-01

    The current conflicts in Iraq and Afghanistan have resulted in a large cohort of military personnel exposed to combat-related psychological trauma as well as biomechanical trauma, including proximity to blast events. Historically, the long-term effects of both types of trauma have been viewed as having different neural substrates, with some controversy over the proper attribution of such symptoms evident after each of the major conflicts of the last century. Recently, great effort has been directed toward distinguishing which neuropsychiatric sequelae are due to which type of trauma. Of interest, however, is that the chronic effects of exposure to either process are associated with a significant overlap in clinical symptoms. Furthermore, similar brain regions are vulnerable to the effects of either psychological or biomechanical trauma, raising the possibility that shared mechanisms may underlie the clinically observed overlap in symptom profile. This paper reviews the literature on the neural substrate of biomechanical and psychological injury and discusses the implications for evaluation and treatment of the neuropsychiatric sequelae of these processes. PMID:20955325

  2. Reduced default mode network connectivity following combat trauma.

    PubMed

    DiGangi, Julia A; Tadayyon, Armin; Fitzgerald, Daniel A; Rabinak, Christine A; Kennedy, Amy; Klumpp, Heide; Rauch, Sheila A M; Phan, K Luan

    2016-02-26

    Recent studies show decreased functional connectivity in the default mode network (DMN) in PTSD; however, few have directly examined combat trauma specifically. There is limited understanding of how combat itself may affect the DMN. Some literature suggests that trauma exposure, rather than PTSD, can disrupt the DMN. To further elucidate the effect of trauma and PTSD on the DMN, we investigated DMN functional connectivity during the resting-state in veterans with PTSD, combat-exposed controls, and never-traumatized healthy controls. Results revealed that DMN connectivity was reduced in veterans exposed to combat trauma with and without PTSD compared to healthy civilian controls. Specifically, both groups of veterans demonstrated weaker connectivity within a network involving the precuneus, medial prefrontal cortex (mPFC) and right superior parietal lobule regardless of whether the mPFC or precuneus was chosen as a seed region. Findings suggest that the experience of trauma, rather than the pathology of PTSD, may be related to DMN changes. PMID:26797653

  3. An Inquiry of the Lived Experiences and Contextual Understandings of Early Childhood Special Educators Related to Children's Trauma

    ERIC Educational Resources Information Center

    DuBois, Alison L.

    2010-01-01

    Secondary trauma stress, compassion fatigue, and vicarious trauma are terms rarely found in educational literature. Studies have shown the significant and lasting ramifications of these constructs within the realm of counseling and psychology. Professionals working in educational settings with high risk populations encounter multiple exposures to…

  4. [The Development and Application of the Orthopaedics Implants Failure Database Software Based on WEB].

    PubMed

    Huang, Jiahua; Zhou, Hai; Zhang, Binbin; Ding, Biao

    2015-09-01

    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

  5. Publication rates of abstracts presented at the annual meeting of the Society of Military Orthopaedic Surgeons.

    PubMed

    Fuller, Brian C; Dowd, Thomas C; Masini, Brendan D; Gerlinger, Tad L

    2012-01-01

    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

  6. Trace metal determination as it relates to metallosis of orthopaedic implants: Evolution and current status.

    PubMed

    Ring, Gavin; O'Mullane, John; O'Riordan, Alan; Furey, Ambrose

    2016-05-01

    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

  7. [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)].

    PubMed

    Hirotani, Hayato

    2010-09-01

    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

  8. Western Trauma Association Critical Decisions in Trauma: Diagnosis and management of esophageal injuries.

    PubMed

    Biffl, Walter L; Moore, Ernest E; Feliciano, David V; Albrecht, Roxie A; Croce, Martin; Karmy-Jones, Riyad; Namias, Nicholas; Rowell, Susan; Schreiber, Martin; Shatz, David V; Brasel, Karen

    2015-12-01

    This is a recommended management algorithm from the Western Trauma Association addressing the diagnostic evaluation and management of esophageal injuries in adult patients. Because there is a paucity of published prospective randomized clinical trials that have generated Class I data, the recommendations herein are based primarily on published observational studies and expert opinion of Western Trauma Association members. The algorithms and accompanying comments represent a safe and sensible approach that can be followed at most trauma centers. We recognize that there will be patient, personnel, institutional, and situational factors that may warrant or require deviation from the recommended algorithm. We encourage institutions to use this guideline to formulate their own local protocols.The algorithm contains letters at decision points; the corresponding paragraphs in the text elaborate on the thought process and cite pertinent literature. The annotated algorithm is intended to (a) serve as a quick bedside reference for clinicians; (b) foster more detailed patient care protocols that will allow for prospective data collection and analysis to identify best practices; and (c) generate research projects to answer specific questions concerning decision making in the management of adults with esophageal injuries. PMID:26680145

  9. Building Agency Capacity for Trauma-Informed Evidence-Based Practice and Field Instruction.

    PubMed

    Strand, Virginia; Popescu, Marciana; Abramovitz, Robert; Richards, Sean

    2016-01-01

    Through this article the authors describe how schools of social work offering a child and adolescent trauma specialization actively partnered with their community-based field placement agencies to achieve a dual purpose: help agencies sustain the capacity for evidence-based trauma treatment (EBTT) and provide sufficient EBTT MSW student field placement sites that support preparation of trauma-informed practitioners by schools of social work. Development and description of the specific conceptual framework used to inform the trauma-informed organizational change initiative is described. Results of an Organizational Readiness assessment undertaken at six agencies reflect a strong alignment between implementation drivers identified in the literature (Fixsen, Blase, Naoom, & Wallace, 2009) and the conceptual framework. The manner in which these results are being used by schools of social work and their agency partners in sustaining the implementation of evidence-based trauma treatment is reviewed, and implications for future research, education, and practice is discussed. PMID:26083452

  10. Parenting practices as potential mechanisms for child adjustment following mass trauma.

    PubMed

    Gewirtz, Abigail; Forgatch, Marion; Wieling, Elizabeth

    2008-04-01

    Trauma research has identified a link between parental adjustment and children's functioning and the sometimes ensuing intergenerational impact of traumatic events. The effects of traumatic events on children have been demonstrated to be mediated through their impact on children's parents. However, until now, little consideration has been given to the separate and more proximal mechanism of parenting practices as potential mediators between children's adjustment and traumatic events. To shed some light in this arena, we review literature on trauma, adversity, and resilience, and discuss how parenting practices may mediate trauma and adverse environmental contexts. Using a social interaction learning perspective (Forgatch & Knutson, 2002; Patterson, 2005), we propose a prevention research framework to examine the role that parenting practices may play in influencing children's adjustment in the wake of trauma exposure. The article concludes by providing a specific model and role for evidence-based parenting interventions for children exposed to mass trauma. PMID:18412825

  11. Management of bleeding following major trauma: an updated European guideline

    PubMed Central

    2010-01-01

    Introduction Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient, which when implemented may improve patient outcomes. Methods The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document presents an updated version of the guideline published by the group in 2007. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature. Results Key changes encompassed in this version of the guideline include new recommendations on coagulation support and monitoring and the appropriate use of local haemostatic measures, tourniquets, calcium and desmopressin in the bleeding trauma patient. The remaining recommendations have been reevaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies. Conclusions This guideline provides an evidence-based multidisciplinary approach to the management of critically injured bleeding trauma patients. PMID:20370902

  12. Common Intra-Cluster Competencies Needed in Selected Occupational Clusters. Final Report. Supplemental Volume XIV: Orthopaedic Physician's Assistant.

    ERIC Educational Resources Information Center

    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…

  13. Retrospective survey of clinical attention taken to osteoporosis in patients admitted in orthopaedic department for fragility fractures

    PubMed Central

    Colì, Giuseppe; Abatelillo, Massimo; Cataldi, Giuseppe; De Caro, Francesco; Esposito, Diego; Mega, Walter; Perrone, Vinicio; Piscitelli, Prisco; Manno, Luigia

    2009-01-01

    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

  14. The Malaysian Orthopaedic Association humanitarian mission to Indonesia and Sri Lanka.

    PubMed

    Sharaf, I; Saw, A; Hyzan, Y; Sivananthan, K S

    2005-07-01

    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

  15. Postinjury Anxiety and Social Support Among Collegiate Athletes: A Comparison Between Orthopaedic Injuries and Concussions

    PubMed Central

    Covassin, Tracey; Crutcher, Bryan; Bleecker, Alisha; Heiden, Erin O.; Dailey, Alexander; Yang, Jingzhen

    2014-01-01

    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

  16. Trauma and the wise baby.

    PubMed

    Kilborne, Benjamin

    2011-09-01

    This paper expands upon Ferenczi's concept of the wise baby and explores the dynamics of ignorance and compensatory ideals of wisdom as reactions to trauma and as manifestations of "double conscience," shame dynamics and Oedipal shame. Focusing on feelings of ignorance, of knowing and not knowing and their relation to trauma, the author elaborates on the dynamics of fantasies of wisdom, adumbrating implications for psychoanalytic technique. PMID:21818096

  17. AAOS Research Symposium Updates and Consensus: Biologic Treatment of Orthopaedic Injuries.

    PubMed

    LaPrade, Robert F; Dragoo, Jason L; Koh, Jason L; Murray, Iain R; Geeslin, Andrew G; Chu, Constance R

    2016-07-01

    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

  18. The Basingstoke Orthopaedic Database: a high quality accurate information system for audit.

    PubMed

    Barlow, I W; Flynn, N A; Britton, J M

    1994-11-01

    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

  19. Thyroid gland rupture: a rare finding after a blunt neck trauma.

    PubMed

    Zawawi, Faisal; Varshney, Rickul; Payne, Richard J; Manoukian, John J

    2013-05-01

    This is a case report of a 13 years old boy with a thyroid rupture secondary to a hockey stick blunt trauma to his neck and a literature review focused on diagnosis and management. There are 14 other cases in the literature, 7 of which required surgical intervention mainly to evacuate a hematoma. The case in this review did not develop any complications. This is the first reported case in the literature of thyroid gland rupture due to a blunt trauma in a child. Patients with thyroid gland rupture should be monitored closely for developing a hematoma or thyroid storm. PMID:23522054

  20. Complications of pediatric trauma.

    PubMed

    Czerwinski, S J

    1991-09-01

    MSOF is a life-threatening complication of trauma. The body is a dynamic interrelated group of systems that work together efficiently. Changes in one system generally have a widespread impact, and soon the entire system is changed. In children with MSOF, the normal equilibrium that is maintained between organ systems does not exist. Generalized disruption of organ functions occur, and the body attempts to compensate and regain its homeostasis. This activity will often benefit certain organs and harm others. If the disruption continues and compensation fails, organ dysfunction occurs and general chaos reigns. Medical and nursing interventions are directed toward supporting individual organ systems before failure occurs. Attempts to provide this support for one system can cause adverse effects to occur in other systems. Although this is a potential result of medical and nursing interventions, often there is no other choice. It is essential that nurses be aware of the systemic consequences of these interventions and carefully evaluate them. Although overall mortality rates are high, children have a better chance for survival than adults. Expert nursing assessments, interventions, and evaluations are essential to maximize this outcome. More research in the area of MSOF in children is necessary, with specific attention to nursing management and the effect on patient outcome. PMID:1883588

  1. [Major respiratory tract traumas].

    PubMed

    Petrov, D; Obretenov, E; Kalaĭdzhiev, G; Plochev, M; Kostadinov, D

    2002-01-01

    Between 1988 and 2000 a total of 33 patients with traumatic tracheobronchial lesions were diagnosed and treated. The trauma was penetrating in 7 (stab and gun-shot), blunt in 10 (car accidents, compression and falling from heights) and iatrogenic in 16 of them (postintubational--15, after foreign body extraction--1). The main clinical and radiological features were subcutaneous emphysema, hemoptysis, respiratory insufficiency, pneumomediastinum and pneumothorax. The diagnosis was confirmed in all patients by early fiberoptic bronchoscopy. "Watch and see" tactics with massive antibiotics therapy was followed in 4 (12%) patients. A surgical treatment was carried out in 29 (88%) patients as follows: simple repair--19 (58%), left pneumonectomy--2 (6%), tracheal resection and anastomosis "end to end"--2 (6%), tracheostomy--1 (3%), thoracocenthesis and drainage--3 (9%) and cervical mediastinotomy--2 (6%). The operative mortality was 9%. The cause of death in these 3 patients were associated brain and spinal cord injuries. In the rest of patients the early and long-term postoperative results were considered very good. PMID:12515032

  2. Abdominal trauma by ostrich

    PubMed Central

    Usurelu, Sergiu; Bettencourt, Vanessa; Melo, Gina

    2015-01-01

    Introduction Ostriches typically avoid humans in the wild, since they correctly assess humans as potential predators, and, if approached, often run away. However, ostriches may turn aggressive rather than run when threatened, especially when cornered, and may also attack when they feel the need to defend their offspring or territories. Presentation of case A 71-year-old male patient presented with intra abdominal injury sustained from being kicked in the abdominal wall by an ostrich. During laparotomy, were found free peritoneal effusion and perforation of the small intestine. Discussion The clinical history and physical examination are extremely important for diagnostic and therapeutic decision making. CT-scan is the most accurate exam for making diagnosis. Surgery is the treatment of choice, and is always indicated when there is injury to the hollow viscera. In general it is possible to suture the defect. Conclusion In cases of blunt abdominal trauma by animals is necessary to have a low threshold of suspicion for acute abdomen. PMID:25685344

  3. Trauma of the midface

    PubMed Central

    Kühnel, Thomas S.; Reichert, Torsten E.

    2015-01-01

    Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair. PMID:26770280

  4. [Trauma of the midface].

    PubMed

    Kühnel, T S; Reichert, T E

    2015-03-01

    Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygoma fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialisation seem to decrease in numbers.Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate.Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair. PMID:25860490

  5. 2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth

    PubMed Central

    2012-01-01

    Background The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS). Methods All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting. Results The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D. Conclusion These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific

  6. Childhood Reactions to Terrorism-Induced Trauma: A Review of the Past 10 Years

    ERIC Educational Resources Information Center

    Fremont, Wanda P.

    2004-01-01

    Objective: To summarize the literature about the clinical presentation and treatment interventions of childhood reactions to terrorism-induced trauma. Method: The literature on children's responses to terrorist activities was reviewed. Results: Over the past 10 years, more research has emerged on the subject of terrorism in children. Many of the…

  7. Mucormycosis of the Forehead and Sinuses in a Trauma Patient

    PubMed Central

    Lee, Nathan; Kimbrough, Mary K.

    2016-01-01

    Summary: Mucormycosis is a rare fungal infection in immunocompetent patients. It is not commonly seen in trauma patients who sustain multisystem injuries and are often exposed to numerous infectious sources. A multidisciplinary approach between medical and surgical specialties is crucial to ensuring timely diagnosis and treatment as morbidity and mortality can be high once acquired. In addition to antifungal therapy, radical debridement and reconstruction by plastic surgery is often necessary. Review of the literature shows that there is no definitive reconstructive technique for mucormycosis of the forehead and sinuses because the amount of tissue destruction may be varied in location and depth, therefore requiring varying extents of debridement. However, other reconstructive techniques commonly used for oncologic and trauma reconstructions can be used to achieve functionality and a satisfactory cosmetic result. Few facial reconstructions after infection with mucormycosis have been documented in the literature. PMID:27536497

  8. Management of thoracolumbar spine trauma: An overview

    PubMed Central

    Rajasekaran, S; Kanna, Rishi Mugesh; Shetty, Ajoy Prasad

    2015-01-01

    Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Controversies exist regarding the appropriate radiological investigations, the indications for surgical management and the timing, approach and type of surgery. This review provides an overview of the epidemiology, biomechanical principles, radiological and clinical evaluation, classification and management principles. Literature review of all relevant articles published in PubMed covering thoracolumbar spine fractures with or without neurologic deficit was performed. The search terms used were thoracolumbar, thoracic, lumbar, fracture, trauma and management. All relevant articles and abstracts covering thoracolumbar spine fractures with and without neurologic deficit were reviewed. Biomechanically the thoracolumbar spine is predisposed to a higher incidence of spinal injuries. Computed tomography provides adequate bony detail for assessing spinal stability while magnetic resonance imaging shows injuries to soft tissues (posterior ligamentous complex [PLC]) and neurological structures. Different classification systems exist and the most recent is the AO spine knowledge forum classification of thoracolumbar trauma. Treatment includes both nonoperative and operative methods and selected based on the degree of bony injury, neurological involvement, presence of associated injuries and the integrity of the PLC. Significant advances in imaging have helped in the better understanding of thoracolumbar fractures, including information on canal morphology and injury to soft tissue structures. The ideal classification that is simple, comprehensive and guides management is still elusive. Involvement of three columns, progressive neurological deficit, significant kyphosis and canal compromise with neurological deficit are accepted indications for surgical stabilization through anterior, posterior or combined approaches. PMID:25593358

  9. Women, war and trauma: a study description.

    PubMed

    Bell, P; Oruc, L; Cerić, I; Pojskić, N; Isabel, B; Licanin, I

    2001-01-01

    The last few decades have seen a sharp increase in research into the psychological, psychiatric and social consequences of war. However the bulk of this research relates to male veterans and refugees. There is a serious dearth of literature on female civilians, particularly where the research is being performed in the country of trauma origin. This study aims to explore the psychosocial effects of war on women. One hundred and fifty female civilians participated in this study, conducted in the city of Sarajevo and surrounding refugee settlements in Bosnia. The subjects were divided into three groups: domestic women residing in Sarajevo during and after the war, displaced: women forced to leave their homes, and staying in refugee settlements, returness: women who have returned to Sarajevo from exile. Each woman was interviewed extensively by local psychiatrists. This interview contained the Harvard Trauma Scale for the screening of PTSD and Social Functioning, and the Hopkins Checklist for Anxiety and Depression. Both these tests have been revised, translated and validated for the Bosnian population. The Rosenberg Self-Esteem Scale and the Lazarus Coping scale examine psychological aspects of self-esteem and coping. A questionnaire containing demographic information was devised for the purposes of this study. PMID:11795191

  10. Trauma-Informed Care in the Massachusetts Child Trauma Project.

    PubMed

    Bartlett, Jessica Dym; Barto, Beth; Griffin, Jessica L; Fraser, Jenifer Goldman; Hodgdon, Hilary; Bodian, Ruth

    2016-05-01

    Child maltreatment is a serious public health concern, and its detrimental effects can be compounded by traumatic experiences associated with the child welfare (CW) system. Trauma-informed care (TIC) is a promising strategy for addressing traumatized children's needs, but research on the impact of TIC in CW is limited. This study examines initial findings of the Massachusetts Child Trauma Project, a statewide TIC initiative in the CW system and mental health network. After 1 year of implementation, Trauma-Informed Leadership Teams in CW offices emerged as key structures for TIC systems integration, and mental health providers' participation in evidence-based treatment (EBT) learning collaboratives was linked to improvements in trauma-informed individual and agency practices. After approximately 6 months of EBT treatment, children had fewer posttraumatic symptoms and behavior problems compared to baseline. Barriers to TIC that emerged included scarce resources for trauma-related work in the CW agency and few mental providers providing EBTs to young children. Future research might explore variations in TIC across service system components as well as the potential for differential effects across EBT models disseminated through TIC. PMID:26564909

  11. Liver trauma grading and biochemistry tests.

    PubMed

    Arslan, Gozde; Gemici, Aysegul Akdogan; Yirgin, Inci Kizildag; Gulsen, Esma; Inci, Ercan

    2013-10-01

    Among solid organ blunt traumas, the liver and spleen are mostly subject to injury. In addition, the liver is also commonly injured in penetrating traumas because of its size, location, and the ease of injury to the "Glisson Capsule". Several enzymes are known to be elevated following trauma. In our study, we evaluated the correlation between the levels of serum aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and gamma-glutamyl transpeptidase in 57 patients with blunt trauma to the liver and compared these values to the American Association for the Surgery of Trauma trauma grading system. Additionally, we compared the enzyme level elevations in these patients to the enzyme levels of 29 healthy subjects. As expected, we found significant elevations in enzyme levels of trauma patients compared to the control group. The calculated point estimates were not significantly different between grades 1 and 2 trauma. However, grade 3 trauma group showed a significant increase in enzyme levels. PMID:23793528

  12. Leadership and Teamwork in Trauma and Resuscitation

    PubMed Central

    Ford, Kelsey; Menchine, Michael; Burner, Elizabeth; Arora, Sanjay; Inaba, Kenji; Demetriades, Demetrios; Yersin, Bertrand

    2016-01-01

    followed by simulations. Although programs differed in length, intensity, and training level of participants, all programs demonstrated improved team performance. Conclusion Despite the relative paucity of literature on leadership in resuscitations, this review found leadership improves processes of care in trauma and can be enhanced through dedicated training. Future research is needed to validate leadership assessment scales, develop optimal training mechanisms, and demonstrate leadership’s effect on patient-level outcome. PMID:27625718

  13. Facial Soft Tissue Trauma

    PubMed Central

    Kretlow, James D.; McKnight, Aisha J.; Izaddoost, Shayan A.

    2010-01-01

    Traumatic facial soft tissue injuries are commonly encountered in the emergency department by plastic surgeons and other providers. Although rarely life-threatening, the treatment of these injuries can be complex and may have significant impact on the patient's facial function and aesthetics. This article provides a review of the relevant literature related to this topic and describes the authors' approach to the evaluation and management of the patient with facial soft tissue injuries. PMID:22550459

  14. Trauma Ultrasound in Civilian Tactical Medicine

    PubMed Central

    Whelan, Lori; Justice, William; Goodloe, Jeffrey M.; Dixon, Jeff D.; Thomas, Stephen H.

    2012-01-01

    The term “tactical medicine” can be defined in more than one way, but in the nonmilitary setting the term tactical emergency medical services (TEMS) is often used to denote medical support operations for law enforcement. In supporting operations involving groups such as special weapons and tactics (SWAT) teams, TEMS entail executing triage, diagnosis, stabilization, and evacuation decision-making in challenging settings. Ultrasound, now well entrenched as a part of trauma evaluation in the hospital setting, has been investigated in the prehospital arena and may have utility in TEMS. This paper addresses potential use of US in the tactical environment, with emphasis on the lessons of recent years' literature. Possible uses of US are discussed, in terms of both specific clinical applications and also with respect to informing triage and related decision making. PMID:23243509

  15. Delta Alerts: Changing Outcomes in Geriatric Trauma.

    PubMed

    Wiles, Lynn L; Day, Mark D; Harris, LeAnna

    2016-01-01

    Geriatric trauma patients (GTPs) suffering minor injuries have suboptimal outcomes compared with younger populations. Patients 65 years or older account for 10% of all traumas but 28% of all trauma deaths. This trauma center established a third tier trauma alert specifically targeting GTPs at risk for poor outcomes. A Delta Alert is activated when GTPs suffer injuries that fall outside traditional trauma alert guidelines. Early identification and treatment of injuries and expedited referral to specialty groups have improved our GTPs' outcomes including decreased mortality and length of stay and increased percentage of GTPs who are discharged home. PMID:27414140

  16. Video recording of emergency department trauma resuscitations.

    PubMed

    Brown, Debra M

    2003-01-01

    Although hospitals are faced with the challenges of appropriately informing the public regarding health care and protecting the privacy of patients, a comprehensive policy concerning videotaping of trauma resuscitations can be developed to comply with regulatory bodies. Video recording of trauma team resuscitations can be utilized as an effective quality improvement tool to evaluate trauma team performance, psychomotor skills and techniques, and to identify educational needs related to specific trauma populations. Video recording of Trauma resuscitations is an effective tool for improving trauma team performance by educating clinical staff regarding roles and responsibilities. PMID:16265920

  17. The Orthopaedic Training Study, Phase II 1968-1972. Final Report Supplement, Part A.

    ERIC Educational Resources Information Center

    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.…

  18. The Orthopaedic Training Study, Phase II 1968-1972. Final Report Supplement, Psychomotor Skills, Part B.

    ERIC Educational Resources Information Center

    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,…

  19. Does Change in Functional Performance Affect Quality of Life in Persons with Orthopaedic Impairment?

    ERIC Educational Resources Information Center

    Ostir, Glenn V.; Berges, Ivonne-Marie; Smith, Pamela M.; Smith, David; Rice, Janida L.; Ottenbacher, Kenneth J.

    2006-01-01

    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…

  20. Boston's contributions to the development of orthopaedics in the United States. A brief history.

    PubMed

    Mankin, H J

    2000-05-01

    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

  1. Level of Perception of Individualized Care and Satisfaction With Nursing in Orthopaedic Surgery Patients.

    PubMed

    Tekin, Fatma; Findik, Ummu Yildiz

    2015-01-01

    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

  2. 78 FR 20328 - Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee: Notice of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-04

    ... 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,...

  3. Analysis of the basic science section of the orthopaedic in-training examination.

    PubMed

    Sheibani-Rad, Shahin; Arnoczky, Steven Paul; Walter, Norman E

    2012-08-01

    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

  4. The 2007 ABJS Marshall Urist Award: The impact of direct-to-consumer advertising in orthopaedics.

    PubMed

    Bozic, Kevin J; Smith, Amanda R; Hariri, Sanaz; Adeoye, Sanjo; Gourville, John; Maloney, William J; Parsley, Brian; Rubash, Harry E

    2007-05-01

    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

  5. The assessment and management of pain in an orthopaedic out-patient setting: A case study.

    PubMed

    Hall, Gillian; Gregory, Julie

    2016-08-01

    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

  6. Biodegradable magnesium alloys for orthopaedic applications: A review on corrosion, biocompatibility and surface modifications.

    PubMed

    Agarwal, Sankalp; Curtin, James; Duffy, Brendan; Jaiswal, Swarna

    2016-11-01

    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

  7. Addressing the Global Disparities in the Delivery of Pediatric Orthopaedic Services: Opportunities for COUR and POSNA.

    PubMed

    Shirley, Eric D; Sabharwal, Sanjeev; Schwend, Richard M; Cabral, Cristina; Spiegel, David

    2016-01-01

    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

  8. Decellularized Tissue and Cell-Derived Extracellular Matrices as Scaffolds for Orthopaedic Tissue Engineering

    PubMed Central

    Cheng, Christina W.; Solorio, Loran D.; Alsberg, Eben

    2014-01-01

    The reconstruction of musculoskeletal defects is a constant challenge for orthopaedic surgeons. Musculoskeletal injuries such as fractures, chondral lesions, infections and tumor debulking can often lead to large tissue voids requiring reconstruction with tissue grafts. Autografts are currently the gold standard in orthopaedic tissue reconstruction; however, there is a limit to the amount of tissue that can be harvested before compromising the donor site. Tissue engineering strategies using allogeneic or xenogeneic decellularized bone, cartilage, skeletal muscle, tendon and ligament have emerged as promising potential alternative treatment. The extracellular matrix provides a natural scaffold for cell attachment, proliferation and differentiation. Decellularization of in vitro cell-derived matrices can also enable the generation of autologous constructs from tissue specific cells or progenitor cells. Although decellularized bone tissue is widely used clinically in orthopaedic applications, the exciting potential of decellularized cartilage, skeletal muscle, tendon and ligament cell-derived matrices has only recently begun to be explored for ultimate translation to the orthopaedic clinic. PMID:24417915

  9. Factors Associated with the Use of Helicopter Inter-facility Transport of Trauma Patients to Tertiary Trauma Centers within an Organized Rural Trauma System

    PubMed Central

    Stewart, Kenneth; Garwe, Tabitha; Bhandari, Naresh; Danford, Brandon; Albrecht, Roxie

    2016-01-01

    Objective A review of the literature yielded little information regarding factors associated with the decision to use ground (GEMS) or helicopter (HEMS) emergency medical services for trauma patients transferred inter-facility. Furthermore, studies evaluating the impact of inter-facility transport mode on mortality have reported mixed findings. Since HEMS transport is generally reserved for more severely injured patients, this introduces indication bias, which may explain the mixed findings. Our objective was to identify factors at referring non-tertiary trauma centers (NTC) influencing transport mode decision. Methods This was a case-control study of trauma patients transferred from a Level III or IV NTC to a tertiary trauma center (TTC) within 24-hours reported to the Oklahoma State Trauma Registry between 2005 and 2012. Multivariable logistic regression was used to determine clinical and non-clinical factors associated with the decision to use HEMS. Results A total of 7380 patients met the study eligibility. Of these, 2803(38%) were transported inter-facility by HEMS. Penetrating injury, prehospital EMS transport, severe torso injury, hypovolemic shock, and TBI were significant predictors (p<0.05) of HEMS use regardless of distance to a TTC. Association between HEMS use and male gender, Level IV NTC, and local ground EMS resources varied by distance from the TTC. Many HEMS transported patients had minor injuries and normal vital signs. Conclusions Our results suggest that while distance remains the most influential factor associated with HEMS use, significant differences exist in clinical and non-clinical factors between patients transported by HEMS versus GEMS. To ensure comparability of study groups, studies evaluating outcome differences between HEMS and GEMS should take factors determining transport mode into account. The findings will be used to develop propensity scores to balance baseline risk between GEMS and HEMS patients for use in subsequent studies

  10. Ventilatory strategies in trauma patients.

    PubMed

    Arora, Shubhangi; Singh, Preet Mohinder; Trikha, Anjan

    2014-01-01

    Lung injury in trauma patients can occur because of direct injury to lung or due to secondary effects of injury elsewhere for example fat embolism from a long bone fracture, or due to response to a systemic insult such as; acute respiratory distress syndrome (ARDS) secondary to sepsis or transfusion related lung injury. There are certain special situations like head injury where the primary culprit is not the lung, but the brain and the ventilator strategy is aimed at preserving the brain tissue and the respiratory system takes a second place. The present article aims to delineate the strategies addressing practical problems and challenges faced by intensivists dealing with trauma patients with or without healthy lungs. The lung protective strategies along with newer trends in ventilation are discussed. Ventilatory management for specific organ system trauma are highlighted and their physiological base is presented. PMID:24550626

  11. Management of Carotid Artery Trauma

    PubMed Central

    Lee, Thomas S.; Ducic, Yadranko; Gordin, Eli; Stroman, David

    2014-01-01

    With increased awareness and liberal screening of trauma patients with identified risk factors, recent case series demonstrate improved early diagnosis of carotid artery trauma before they become problematio. There remains a need for unified screening criteria for both intracranial and extracranial carotid trauma. In the absence of contraindications, antithrombotic agents should be considered in blunt carotid artery injuries, as there is a significant risk of progression of vessel injury with observation alone. Despite CTA being used as a common screening modality, it appears to lack sufficient sensitivity. DSA remains to be the gold standard in screening. Endovascular techniques are becoming more widely accepted as the primary surgical modality in the treatment of blunt extracranial carotid injuries and penetrating/blunt intracranial carotid lessions. Nonetheless, open surgical approaches are still needed for the treatment of penetrating extracranial carotid injuries and in patients with unfavorable lesions for endovascular intervention. PMID:25136406

  12. Trauma--the malignant epidemic.

    PubMed

    Muckart, D J

    1991-01-19

    Trauma is the commonest cause of death in children and young adults in the USA and the UK and the incidence of both accidental and non-accidental injury continues to increase. In the Western world more pre-retirement years of life are lost annually from trauma than malignant disease, heart disease, and AIDS combined, and by the beginning of the last decade injury deaths outnumbered deaths from all other causes combined in those under 35 years of age. In South Africa, although infectious diseases continue to exact their toll, a similar pattern is emerging. Alcohol and speed are responsible for the majority of motor vehicle accidents, while the increasing ownership of firearms directly parallels the homicide rates from these weapons. Stricter application of the legislation governing alcohol, driving and firearm control is required and a regionalised trauma care programme is desperately needed to contain this epidemic. PMID:1989097

  13. Transfusion medicine in trauma patients

    PubMed Central

    Murthi, Sarah B; Dutton, Richard P; Edelman, Bennett B; Scalea, Thomas M; Hess, John R

    2011-01-01

    Injured patients stress the transfusion service with frequent demands for uncrossmatched red cells and plasma, occasional requirements for large amounts of blood products and the need for new and better blood products. Transfusion services stress trauma centers with demands for strict accountability for individual blood component units and adherence to indications in a clinical field where research has been difficult, and guidance opinion-based. New data suggest that the most severely injured patients arrive at the trauma center already coagulopathic and that these patients benefit from prompt, specific, corrective treatment. This research is clarifying trauma system requirements for new blood products and blood-product usage patterns, but the inability to obtain informed consent from severely injured patients remains an obstacle to further research. PMID:21083009

  14. A Consensus-Based Criterion Standard Definition for Pediatric Patients Who Needed the Highest-Level Trauma Team Activation

    PubMed Central

    Lerner, E. Brooke; Drendel, Amy L.; Falcone, Richard A.; Weitze, Keith C.; Badawy, Mohamed K.; Cooper, Arthur; Cushman, Jeremy T.; Drayna, Patrick C.; Gourlay, David M.; Gray, Matthew P.; Shah, Manish I.; Shah, Manish N.

    2014-01-01

    Background Verbal prehospital reports on an injured patient’s condition are typically used by trauma centers to determine if a trauma team should be present in the emergency department prior to patient arrival (i.e., trauma team activation). Efficacy studies of trauma team activation protocols cannot be conducted without a criterion standard definition for which pediatric patients need a trauma team activation. Objective To develop a consensus-based criterion standard definition for pediatric patients who needed the highest-level trauma team activation. Methods Ten local and national experts in emergency medicine, emergency medical services, and trauma were recruited to participate in a Modified Delphi survey process. The initial survey was populated based on outcomes that had been used in previously published literature on trauma team activation. The criterion standard definition for trauma team activation was refined iteratively based on survey responses until at least 80% agreement was achieved for each criterion. Results After five voting rounds a consensus-based definition for pediatric trauma team activation was developed. Twelve criteria were identified along with a corresponding time interval in which each criterion had to occur. The criteria include receiving specific surgery types, interventional radiology, advanced airway management, thoracostomy, blood products, spinal injury, emergency cesarean section, vasopressors, burr hole or other procedure to relieve intracranial pressure, pericardiocentesis, thoracotomy, and death in the emergency department. All expert panel members voted in all 5 voting rounds, except 1 member missed rounds 1 and 2. Each criterion had greater than 80% agreement from the panel. Conclusion A criterion standard definition for the highest-level pediatric trauma team activation was developed. This criterion standard definition will advance trauma research by allowing investigators to determine the accuracy and effectiveness of

  15. Trauma-Informed or Trauma-Denied: Principles and Implementation of Trauma-Informed Services for Women

    ERIC Educational Resources Information Center

    Elliott, Denise E.; Bjelajac, Paula; Fallot, Roger D.; Markoff, Laurie S.; Reed, Beth Glover

    2005-01-01

    In this article, we attempt to bridge the gap between practice (service delivery) and philosophy (trauma theory, empowerment, and relational theory). Specifically, we identify 10 principles that define trauma-informed service, discuss the need for this type of service, and give some characteristics of trauma-informed services in eight different…

  16. Resuscitative thoracotomy in penetrating trauma.

    PubMed

    Fairfax, Lindsay M; Hsee, Li; Civil, Ian D

    2015-06-01

    The resuscitative thoracotomy (RT) is an important procedure in the management of penetrating trauma. As it is performed only in patients with peri-arrest physiology or overt cardiac arrest, survival is low. Experience is also quite variable depending on volume of penetrating trauma in a particular region. Survival ranges from 0% to as high as 89% depending on patient selection, available resources, and location of RT (operating or emergency rooms). In this article, published guidelines are reviewed as well as outcomes. Technical considerations of RT and well as proper training, personnel, and location are also discussed. PMID:25342073

  17. Component separation in abdominal trauma.

    PubMed

    Rawstorne, Edward; Smart, Christopher J; Fallis, Simon A; Suggett, Nigel

    2014-01-01

    Component separation is established for complex hernia repairs. This case presents early component separation and release of the anterior and posterior sheath to facilitate closure of the abdominal wall following emergency laparotomy, reinforcing the repair with a biological mesh. On Day 11 following an emergency laparotomy for penetrating trauma, this patient underwent component separation and release of the anterior and posterior sheath. An intra-abdominal biological mesh was secured, and the fascia and skin closed successfully. Primary abdominal closure can be achieved in patients with penetrating abdominal trauma with the use of component separation and insertion of intra-abdominal biological mesh, where standard closure is not possible. PMID:24876334

  18. Acoustic trauma caused by lightning.

    PubMed

    Mora-Magaña, I; Collado-Corona, M A; Toral-Martiñòn, R; Cano, A

    1996-03-01

    Lesions produced by exposure to noise are frequent in everyday life. Injuries may be found in all systems of the human body, from the digestive to the endocrine, from the cardiovascular to the nervous system. Many organs may be damaged, the ear being one of them. It is known that noise produced by factories, airports, musical instruments and even toys can cause auditory loss. Noises in nature can also cause acoustic trauma. This report is the case history of acoustic trauma caused by lightning. The patient was studied with CAT scan, electroencephalogram, and brain mapping, impedance audiometry with tympanogram and acoustic reflex, audiometry and evoked otoacoustics emissions: distortion products and transients. PMID:8882110

  19. [Polyvagal theory and emotional trauma].

    PubMed

    Leikola, Anssi; Mäkelä, Jukka; Punkanen, Marko

    2016-01-01

    According to the polyvagal theory, the autonomic nervous system can, in deviation from the conventional theory, be divided in three distinct parts that are in hierarchical relationship with each other. The most-primitive autonomic control results in depression of vital functions, the more evolved one in fighting or escape and the most evolved one in social involvement. Practical application of the polyvagal theory has resulted in positive results above all in the treatment of emotional trauma. in Finland, therapy of complex trauma is founded on the theory of structural dissociation of the personality, which together with the polyvagal theory forms a practical frame of reference for psychotherapeutic work. PMID:27044181

  20. Thromboembolic Disease After Orthopedic Trauma.

    PubMed

    Whiting, Paul S; Jahangir, A Alex

    2016-04-01

    Orthopedic trauma results in systemic physiologic changes that predispose patients to venous thromboembolism (VTE). In the absence of prophylaxis, VTE incidence may be as high as 60%. Mechanical and pharmacologic thromboprophylaxis are effective in decreasing rates of VTE. Combined mechanical and pharmacologic thromboprophylaxis is more efficacious for decreasing VTE incidence than either regimen independently. If pharmacologic thromboprophylaxis is contraindicated, mechanical prophylaxis should be used. Patients with isolated lower extremity fractures who are ambulatory, or those with isolated upper extremity trauma, do not require pharmacologic prophylaxis in the absence of other VTE risk factors. PMID:26772942