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Sample records for orthopaedic trauma literature

  1. 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

  2. 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

  3. 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

  4. 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

  5. Types of gowns used in trauma and orthopaedic theatres.

    PubMed

    Karagkevrekis, B; Madhavan, P; Leslie, I

    1997-04-01

    Trauma and orthopaedic surgeons are at an increased risk of acquiring viral blood-borne infections during elective and especially trauma surgery. The British Orthopaedic Association (BOA) published guidelines in 1991 for the prevention of cross-infection between patients and staff. It was recommended that only waterproof gowns be used in orthopaedic and trauma theatres. The aim of this study was to determine the compliance with the BOA recommendations. A telephone survey of 79 hospitals in England shows that only a minority (41 per cent) of hospitals use waterproof gowns exclusively.

  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.

  7. Orthopaedic trauma and the evolution of healthcare policy in America.

    PubMed

    Mitchell, Phillip M; Thakore, Rachel; Obremskey, Alexandra; Sethi, Manish K

    2014-10-01

    Healthcare policy has changed drastically, and with the 50-year anniversary of the passage of Medicare approaching in 2015, the authors evaluate the development of the current healthcare system and its relationship to the development of modern orthopaedic trauma. With more changes in healthcare policy forthcoming, it is increasingly important for the orthopaedic traumatologist to understand how changes in policy will affect practice. Historically, the motivators for change have remained largely the same over the past 50 years. The development of diagnosis-related groups, the resource-based relative value scale, and the sustainable growth rate are 3 defining policies that were designed to control costs, but which had an unexpected effect on those caring for the trauma population. Healthcare reform has a unique effect on those systems where care is dictated by a defining event or injury. Evaluating the development of trauma systems, the authors find that legislation directed toward the trauma population has been driven by the study of patient outcomes, providing an opportunity for orthopaedic traumatologists to contribute to future changes in policy. As healthcare policy changes begin to take effect, having a thorough understanding of reform and its drivers will be increasingly important in taking an active role in advocating for the field of orthopaedic trauma and its patients.

  8. Orthopaedic outcomes: combat and civilian trauma care.

    PubMed

    Rispoli, Damian M; Mackenzie, Ellen J

    2012-01-01

    Important advances have been made in the management of complex trauma through careful scientific analysis of outcomes. Outcomes analysis in combat extremity trauma is exemplified and highlighted by scholarly work in the treatment of catastrophic lower extremity trauma. The success of this line of research in civilian trauma is exemplified by the Lower Extremity Assessment Project (LEAP) study on the outcomes of civilian lower extremity trauma. This highly successful effort was followed by the Military Extremity Trauma Amputation/Limb Salvage (METALS) study. Current ongoing analysis of both the LEAP and METALS studies by the Major Extremity Trauma Research Consortium seeks to compare and contrast the similarities and differences of both studies and to advance evidence-based patient-centered care. The effects of psychological trauma on the injured individual underscore the global effect of severe trauma and the need for a multidisciplinary approach to trauma care. Statistical modeling is being used to analyze outcomes to further the ability to scientifically and definitively determine the best practices for patient care.

  9. [Representatives of orthopaedic and trauma surgery residents in Germany].

    PubMed

    Merschin, D; Doepfer, A-K; Wenzel, L; Mutschler, M

    2016-08-01

    In most German hospitals there are resident representatives to stand in for the rights and interests of residents. The precise number of representatives in orthopaedic and trauma surgery is unknown, as well as the field of duty and the rights of this position.The Junges Forum O&U presents survey data, which were collected from members of the German Society for Trauma Surgery (DGU), the German Society for Orthopaedics and Orthpaedic Surgery (DGOOC) and the German Society for Orthopaedics and Trauma (DGOU). All had an age below 40 years. The Survey was carried out in a period between 27th of January 2015 and 26th of March 2015.These data allowed the Junges Forum O&U to analyse the duties and numbers of representatives for residents in orthopaedic and trauma surgery in Germany. Questionnaires from 316 representatives were fully analysed. Of these, 92 % work at university hospitals. The conditions of election and the duties are not defined. The activity as representative was mainly fulfilled in spare time. The major aspect was conflict resolution between colleagues.The Junge Forum O&U presents the recommendation for election, field of duty and meetings on a regular basis with the other residents or even the first-line management. PMID:27277936

  10. 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

  11. The impact of snow on orthopaedic trauma referrals.

    PubMed

    Weston-Simons, John; Jack, Christopher M; Doctor, Cyrus; Brogan, Kit; Reed, Daniel; Ricketts, David

    2012-07-01

    Adverse weather has been shown to increase orthopaedic referrals and place strain on services. This retrospective study undertaken at a teaching hospital concerned referrals between April 2009 and April 2010 comparing days when snow fell to days when it did not. Referrals increased significantly on snow days (to 74.9 per day) in comparison to normal weather days (33.5 per day). During snow days there were significant increases in the number of distal radius and ankle fractures referred but not of fractured necks of femur. Complications during the snow fall period were related to procedures performed outside of the trauma unit with further difficulties related to a lack of operating equipment and implant availability. As a result of our study, we recommend that during periods of heavy snow fall orthopaedic and trauma units should place senior orthopaedic trainees in Accident and Emergency to review patients as a triage service, organise trauma lists related to surgeon specific expertise and avoid sending trauma patients outside the unit for operation.

  12. 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

  13. Robotic surgery in trauma and orthopaedics: a systematic review.

    PubMed

    Karthik, K; Colegate-Stone, T; Dasgupta, P; Tavakkolizadeh, A; Sinha, J

    2015-03-01

    The use of robots in orthopaedic surgery is an emerging field that is gaining momentum. It has the potential for significant improvements in surgical planning, accuracy of component implantation and patient safety. Advocates of robot-assisted systems describe better patient outcomes through improved pre-operative planning and enhanced execution of surgery. However, costs, limited availability, a lack of evidence regarding the efficiency and safety of such systems and an absence of long-term high-impact studies have restricted the widespread implementation of these systems. We have reviewed the literature on the efficacy, safety and current understanding of the use of robotics in orthopaedics. PMID:25737510

  14. Interrater reliability in grading abstracts for the orthopaedic trauma association.

    PubMed

    Bhandari, Mohit; Templeman, David; Tornetta, Paul

    2004-06-01

    Only a small proportion of submitted abstracts to the annual meeting of the Orthopaedic Trauma Association can be accepted for podium presentation. Annual program committee members must ensure that the selection of abstracts is free from bias and transparent to investigators. The objectives of this study are to examine the consistency of reviewers in grading abstracts submitted for podium presentations at the 2001 and 2002 Annual Meetings of the Orthopaedic Trauma Association and to evaluate whether the grades of the actual podium presentations at the meeting are consistent with the grades based on abstracts only. Reviewers independently graded all abstracts submitted to the Orthopaedic Trauma Association for presentation in a blinded manner. Abstracts submitted by members of the review panel were independently adjudicated by six reviewers who were not members of the committee. Before final decision-making, all reviewers met to discuss the abstracts submitted for oral presentation. Among the 440 papers reviewed in 2001 and 438 papers reviewed in 2002, the interreviewer reliability for abstract review was 0.23 and 0.27, respectively. Despite disagreements in the quality of the abstracts, reviewers achieved consensus by discussions to determine the final program. Agreement among unblinded reviewers of the 67 and 73 podium presentations during the 2001 and 2002 meetings, respectively, did not improve interreviewer agreement. Of the papers of the 2002 meeting that ultimately ranked in the top 20 after the full presentation of the papers, 15 papers originally had been ranked less than 20 in the initial grading. Only one of the top three papers of the meeting originally was ranked in the top three before the meeting.

  15. Consenting operative orthopaedic trauma patients: challenges and solutions.

    PubMed

    Kheiran, Amin; Banerjee, Purnajyoti; Stott, Philip

    2014-01-01

    Guidelines exist to obtain informed consent before any operative procedure. We completed an audit cycle starting with retrospective review of 50 orthopaedic trauma procedures (Phase 1 over three months to determine the quality of consenting documentation). The results were conveyed and adequate training of the staff was arranged according to guidelines from BOA, DoH, and GMC. Compliance in filling consent forms was then prospectively assessed on 50 consecutive trauma surgeries over further three months (Phase 2). Use of abbreviations was significantly reduced (P = 0.03) in Phase 2 (none) compared to 10 (20%) in Phase 1 with odds ratio of 0.04. Initially, allocation of patient's copy was dispensed in three (6% in Phase 1) cases compared to 100% in Phase 2, when appropriate. Senior doctors (registrars or consultant) filled most consent forms. However, 7 (14%) consent forms in Phase 1 and eleven (22%) in Phase 2 were signed by Core Surgical Trainees year 2, which reflects the difference in seniority amongst junior doctors. The requirement for blood transfusion was addressed in 40% of cases where relevant and 100% cases in Phase 2. Consenting patients for trauma surgery improved in Phase 2. Regular audit is essential to maintain expected national standards.

  16. 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

  17. 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

  18. 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.

  19. 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

  20. Novel Strategies for the Diagnosis of Posttraumatic Infections in Orthopaedic Trauma Patients.

    PubMed

    Firoozabadi, Reza; Alton, Timothy; Wenke, Joseph

    2015-07-01

    Orthopaedic infections that occur after trauma are common. Clinical examination, laboratory markers, imaging modalities, and culture and molecular technologies are used to aid the diagnosis of infection. Culture methods comprise the backbone of diagnostic systems used in hospital laboratory settings; however, several studies have questioned the ability of these techniques to adequately identify infections, particularly in cases where orthopaedic implants were used or when the presence of biofilm bacteria is suspected. Advances in imaging and molecular diagnostics can provide orthopaedic surgeons with an improved means of diagnosing and treating infections.

  1. 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

  2. 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.

  3. 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

  4. 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.

  5. Surgical skills simulation in trauma and orthopaedic training.

    PubMed

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

    2014-12-19

    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.

  6. 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

  7. Assessment of an electronic mailing list for orthopaedic and trauma surgery.

    PubMed

    McLauchlan, G J; Cadogan, M; Oliver, C W

    1999-02-01

    Medical electronic mailing lists have grown rapidly with the evolution of the Internet. The purpose of this paper was to assess the content and academic quality and of an electronic mail discussion list "Orthopod" dedicated to research in orthopaedic and trauma surgery. A retrospective analysis was undertaken of four months of web-based archive of communication through the Orthopod mailing list http:(/)/www.mailbase.ac.uk/lists/Orthopod. At the end of this study period there were 505 members of the Orthopod list. The main outcome measures of this paper were number of messages, type of messages, number of contributors, designation of contributor and number of topics referenced. On average 276 messages were posted each month. The mean number of messages per contributor per month only varied between 2.3 and 2.5. On average 54% of message threads contained at least one reference. At least 77% of the patient history and general threads had input from senior orthopaedic staff. The quantity of information on the Internet need not be a substitute for quality in orthopaedic and trauma surgery mailing lists. The Orthopod Electronic mail discussion list is another medium for the circulation of good quality surgical information. Orthopod provides a unique international electronic forum list for trauma and orthopaedic surgeons worldwide.

  8. 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

  9. Improvement of research quality in the fields of orthopaedics and trauma: a global perspective.

    PubMed

    Fayaz, Hangama C; Haas, Norbert; Kellam, James; Bavonratanavech, Suthorn; Parvizi, Javad; Dyer, George; Pohlemann, Tim; Jerosch, Jörg; Prommersberger, Karl-Josef; Pape, Hans Christoph; Smith, Malcolm; Vrahas, Marc; Perka, Carsten; Siebenrock, Klaus; Elhassan, Bassem; Moran, Christopher; Jupiter, Jesse B

    2013-07-01

    The international orthopaedic community aims to achieve the best possible outcome for patient care by constantly modifying surgical techniques and expanding the surgeon's knowledge. These efforts require proper reflection within a setting that necessitates a higher quality standard for global orthopaedic publication. Furthermore, these techniques demand that surgeons acquire information at a rapid rate while enforcing higher standards in research performance. An international consensus exists on how to perform research and what rules should be considered when publishing a scientific paper. Despite this global agreement, in today's "Cross Check Era", too many authors do not give attention to the current standards of systematic research. Thus, the purpose of this paper is to describe these performance standards, the available choices for orthopaedic surgeons and the current learning curve for seasoned teams of researchers and orthopaedic surgeons with more than three decades of experience. These lead to provide an accessible overview of all important aspects of the topics that will significantly influence the research development as we arrive at an important globalisation era in orthopaedics and trauma-related research. PMID:23689761

  10. Improvement of research quality in the fields of orthopaedics and trauma: a global perspective.

    PubMed

    Fayaz, Hangama C; Haas, Norbert; Kellam, James; Bavonratanavech, Suthorn; Parvizi, Javad; Dyer, George; Pohlemann, Tim; Jerosch, Jörg; Prommersberger, Karl-Josef; Pape, Hans Christoph; Smith, Malcolm; Vrahas, Marc; Perka, Carsten; Siebenrock, Klaus; Elhassan, Bassem; Moran, Christopher; Jupiter, Jesse B

    2013-07-01

    The international orthopaedic community aims to achieve the best possible outcome for patient care by constantly modifying surgical techniques and expanding the surgeon's knowledge. These efforts require proper reflection within a setting that necessitates a higher quality standard for global orthopaedic publication. Furthermore, these techniques demand that surgeons acquire information at a rapid rate while enforcing higher standards in research performance. An international consensus exists on how to perform research and what rules should be considered when publishing a scientific paper. Despite this global agreement, in today's "Cross Check Era", too many authors do not give attention to the current standards of systematic research. Thus, the purpose of this paper is to describe these performance standards, the available choices for orthopaedic surgeons and the current learning curve for seasoned teams of researchers and orthopaedic surgeons with more than three decades of experience. These lead to provide an accessible overview of all important aspects of the topics that will significantly influence the research development as we arrive at an important globalisation era in orthopaedics and trauma-related research.

  11. 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

  12. Orthopaedic Approaches to Proximal Humeral Fractures Following Trauma

    PubMed Central

    Mafi, Reza; Khan, Wasim; Mafi, Pouya; Hindocha, Sandip

    2014-01-01

    Proximal humeral fractures have been a topic of discussion in medical literature dating back as far as 3rd century BC. Today, these fractures are the most common type of humeral fractures and account for about 5-6% of all fractures in adults with the incidence rising rapidly with age. In broad terms the management of proximal humeral fractures can be divided into two categories: conservative versus surgical intervention. The aim of treatment is to stabilize the fracture, aid better union and reduce pain during the healing process. Failure to achieve this can result in impairment of function, and significantly weaken the muscles inserting onto the proximal humerus. With the rising incidence of proximal humeral fractures, especially among the elderly, the short and long term burden for patients as well as the wider society is increasing. Furthermore, there is a lack of consistency in the definitive treatment and management of displaced fractures. This systematic review of literature compares the surgical treatment of proximal humeral fractures with their conservative management, by evaluating the available randomised controlled trials on this topic. PMID:25408786

  13. 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

  14. 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.

  15. 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

  16. 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

  17. Using PubMed effectively to access the orthopaedic literature.

    PubMed

    Clough, J F Myles; Hitchcock, Kristin; Nelson, David L

    2011-01-01

    PubMed is the free public Internet interface to the US National Library of Medicine's MEDLINE database of citations to medical scientific articles. Many orthopaedic surgeons use PubMed on a regular basis, but most orthopaedic surgeons have received little or no training in how to use PubMed effectively and express frustration with the experience. Typical problems encountered are data overload with very large numbers of returns to look through, failure to find a specific article, and a concern that a search has missed important papers. It is helpful to understand the system used to enter journal articles into the database and the classification of the common types of searches and to review suggestions for the best ways to use the PubMed interface and find sources for search teaching and assistance. PMID:21553803

  18. 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

  19. Improving Peripherally Inserted Central Catheter (PICC) care on a Trauma and Orthopaedics ward.

    PubMed

    Piorkowska, Marta; Al-Raweshidy, Zahra; Yeong, Keefai

    2013-01-01

    Peripherally Inserted Central Catheter (PICC) blockage rate was audited over a two month period on the Trauma & Orthopaedics ward at our District General Hospital. A 70% (five out of seven) PICC blockage rate was observed. High blockage rates lead to potential treatment complications, delays in delivery of treatment, increase in costs, and reduction in patient satisfaction. The factors contributing to the significant blockage rate include, long and contradictory PICC care guidelines, no information sheets in the patient notes, lack of training and awareness about care of, and flushing of, PICC lines, and lack of accountability for PICC flushing. Our project aimed to achieve a greater rate of PICC patency. We produced one succinct and comprehensive PICC care guideline, carried out staff training sessions, introduced a sticker reminding staff to flush the PICC line after use, and introduced a prescription of weekly heparin saline and PRN saline flushes (for monitoring and accountability). We used questionnaires to assess competency of hospital staff pre-teaching (doctors 6%, nurses 0%), and post-teaching (doctors 70%, nurses 38%). Blockage rate data post-intervention is pending. Education improved awareness of guidelines amongst staff and we anticipate that the proposed interventions will translate into reduced blockage rates, improving patient outcomes and reducing costs.

  20. 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

  1. 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

  2. Speedy skeletal prototype production to help diagnosis in orthopaedic and trauma surgery. Methodology and examples of clinical applications.

    PubMed

    Debarre, E; Hivart, P; Baranski, D; Déprez, P

    2012-09-01

    As a medical imaging complement, a real 3D replica of the anatomical area of interest can be of substantial advantage in orthopaedic and trauma surgery. Unlike the 3D virtual, it makes palpable the notion of scale and volume, and apparent hidden or ambiguous details and thus enhance or facilitate the diagnosis and eventual surgical solutions. CT data of patients, in DICOM3 standard, were used for digital 3D reconstruction followed by rapid prototyping (fused deposition modelling) of acrylonitrile-butadiene-styrene (ABS) replicas of the areas of interest. Three applications were realized: osteotomy for epiphyseal malunion, shoulder arthroplasty and femoral trochleoplasty. The actual size replicas (obtained in less than thirty hours) provided excellent spatial representation with estimation of available bone stock and materialization of relief. The process has proven to be appropriate (and economically reasonable), including for common cases, when it comes to complex spatial geometry and objective representation of the scale of volumes.

  3. A standardized treatment regimen for patients with severe haemophilia A undergoing orthopaedic or trauma surgery: a single centre experience.

    PubMed

    Hart, Christina; Heindl, Bernhard; Spannagl, Michael; Lison, Susanne

    2015-06-01

    Recommendations on the administration of clotting factor concentrates in patients with severe haemophilia undergoing surgery are usually determined by monitoring target clotting factor levels. In this retrospective cohort study, we enrolled patients with severe haemophilia A who underwent major orthopaedic or trauma surgery. We wanted to evaluate the feasibility and the safety of a standardized medical treatment procedure. Further on, we wanted to assess whether our standardized treatment regimen enables surgical procedures in certain situations in which measuring clotting factor VIII (FVIII) activity is not available. We created a standardized medical treatment procedure that included a medical protocol and close cooperation with the Haemophilic Treatment Centre. Thirteen surgical procedures in nine patients were examined. The feasibility and safety of this standardized treatment concept were assessed by identifying perioperative complications and by means of a questionnaire. Depending on the surgery, the amount of FVIII administered within the first 10 days ranged between 653 and 1027 units/kg body weight. No allogeneic blood transfusion was required. The measurement of FVIII activity was performed repeatedly in five patients. In all patients activated partial thromboplastin time monitoring was performed during the hospital stays. The surgeons and patients were satisfied with our treatment concept and adhered to the medical regimen protocol. By means of a detailed, standardized medical protocol and by ensuring close cooperation between the patient, the surgeons and the Haemophilic Treatment Centre, we could show that elective and emergency operations can be safely performed even in situations in which FVIII activity could not be monitored.

  4. A literature review of sports-related orofacial trauma.

    PubMed

    Kumamoto, David P; Maeda, Yoshinobu

    2004-01-01

    This literature review evaluates the significance of dental injuries and their relationship to specific sports activities. Many studies have been published on individual sports or groups of sports but most pertain to specific age groups or levels of competition. Research suggests that many sports that do not require mouthguards should encourage male and female participants to use orofacial protectors. Athletes, coaches, athletic directors, athletic trainers, parents, and members of the dental community should be aware of how individuals who participate in sporting activities are at risk for dental trauma. Any sport where the potential for dental trauma can exist (such as basketball, soccer, or wrestling) should consider utilizing mouthguards to protect the competitors. The establishment of mouthguard programs for athletes of all ages, genders, and sports may help to reduce the incidence of dental trauma. A sports-related, orofacial/dental trauma reporting system is considered.

  5. 'Damage control orthopaedics' in patients with delayed referral to a tertiary care center: experience from a place where Composite Trauma Centers do not exist

    PubMed Central

    Dhar, Shabir Ahmed; Bhat, Masood Iqbal; Mustafa, Ajaz; Mir, Mohammed Ramzan; Butt, Mohammed Farooq; Halwai, Manzoor Ahmed; Tabish, Amin; Ali, Murtaza Asif; Hamid, Arshiya

    2008-01-01

    Background Management of orthopaedic injuries in polytrauma cases continues to challenge the orthopaedic traumatologist. Mass disasters compound this challenge further due to delayed referral. Recently there has been increasing evidence showing that damage control surgery has advantages that are absent in the early total care modality. We studied the damage control modality in the management of polytrauma cases with orthopaedic injuries who had been referred to our hospital after more than 24 hours of sustaining their injuries in an earthquake. This study was conducted on 51 cases after reviewing their records and complete management one year after the trauma. Results At one year, out of the 62 fractures, 3 were still under treatment, while the others had united. As per the radiological and functional scoring there were 20 excellent, 29 good, 5 fair and 5 poor results. In spite of the delayed referral there was no mortality. Conclusion In situations of delayed referral in areas where composite trauma centers do not exist the damage control modality provides an acceptable method of treatment in the management of polytrauma cases. PMID:18271951

  6. 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.

  7. 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

  8. 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

  9. Robotics and computer-assisted orthopaedic surgery.

    PubMed

    Specht, L M; Koval, K J

    These are just a few representative applications of the synergistic use of computer and robotic technology assisting the orthopaedic surgeon. While the individual systems are certain to change over time, the basic principles of correlating radiographic and anatomic data through a registration process, and displaying additional instrument or implant information through smart tools and surgical navigation are certain to become an increasingly important aspect of joint arthroplasty, deformity correction, and spinal and trauma surgery. Only the orthopaedic surgeon who clearly understands the goals, applications, and limitations of these systems can decide which are appropriate for his patients, his hospital, and his practice. Determining the cost and time benefits, both before and after an obligatory "learning curve" requires a complex interaction of capital investments, time savings, and outcome research on both safety and efficacy issues. The orthopaedist who understands and applies these technologies will help his patients to achieve the best possible care. Excellent resources in the literature on this topic include the September, 1998, issue of Clinical Orthopaedics and Related Research, a symposium on "Computer-Assisted Orthopaedic Surgery: Medical Robots and Image Guided Surgery"; Guest editor, Anthony M. DiGioia, III, MD. Also, the January, 2000, issue of Operative Techniques in Orthopaedics, "Medical Robotics and Computer-Assisted Orthopaedic Surgery. Guest editors: Anthony M. DiGioia, III, M.D. and Branislav Jaramaz, Ph.D. Additional Internet based information is available from the Journal of Computer Aided Surgery (formerly: Journal of Image Guided Surgery), at http://journals.wiley.com/.

  10. Dentofacial orthopaedic correction of maxillary retrusion with the protraction facemask--a literature review.

    PubMed

    GekKiow, G; Kaan, S K

    1992-10-01

    The retruded maxilla in the Class III skeletal pattern could be effectively corrected with the protraction facemask in selected cases. A review of the different types of orthopaedic appliances used in Class III treatment, the rationale for facemask therapy, the effect of this treatment and the factors affecting stability is presented.

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

    PubMed

    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.

  12. 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

  13. [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

  14. 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…

  15. 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

  16. 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.

  17. Lacunar stroke in a teenager after minor head trauma: case report and literature review.

    PubMed

    Zwank, Michael D; Dummer, Benjamin W; Danielson, Levi T; Haake, Bret C

    2014-09-01

    Ischemic strokes in children and young adults are fortunately rare. Contrasted with adult ischemic strokes, pediatric stroke etiologies vary greatly and are often unknown. Childhood lacunar strokes and trauma-induced strokes represent particularly uncommon subsets and have been reported infrequently in the literature. It is unique to find a combination of the 2-a lacunar stroke induced by trauma. Underreporting of these trauma-induced ischemic strokes could be responsible for perpetuating the lack of recognition. Here we present a lacunar stroke in a young woman associated with a water sport accident and explore relevant literature encircling deep brain ischemia coinciding with trauma.

  18. The World Health Organization's action plan on the road traffic injury pandemic: is there any action for orthopaedic trauma surgeons?

    PubMed

    Moroz, Paul J; Spiegel, David A

    2014-01-01

    Road traffic crash-related death, injury, and chronic disability continue to be a major worldwide burden to drivers, pedestrians, and users of mass transit, especially in low- and middle-income countries (LMIC). Projections predict worsening of this burden, and while motorization of LMIC increases exponentially, a corresponding improvement in prehospital and acute in-hospital trauma care has not been seen. The WHO now has 2 programs that address different elements of this challenge, namely, the Violence and Injury Prevention department (prevention) and the Emergency and Essential Surgical Care project (treatment). Activities of Violence and Injury Prevention have included developing guidelines for prehospital and essential trauma care, whereas activities of the Emergency and Essential Surgical Care have included developing the Integrated Management of Emergency and Essential Surgical Care toolkit and a textbook, "Surgical Care at the District Hospital." Organized surgical institutions in high-income countries-trauma associations, university departments, surgical nongovernmental organizations, etc.-can benefit from the infrastructure and tools the WHO has developed to better address the deficits in surgical services to improve the equitable distribution of surgical care services and resources to LMIC.

  19. Do Politics Matter to an Orthopaedic Surgeon? (They Should!).

    PubMed

    Lee, Adam K; Sethi, Manish K

    2015-11-01

    Orthopaedic trauma care is intimately tied with health policy, and current changes with health care reform may change how trauma care is delivered. This article offers a brief history of modern health care and the implications of new policies on the practice of orthopaedic trauma.

  20. Predictors of the accuracy of quotation of references in peer-reviewed orthopaedic literature in relation to publications on the scaphoid.

    PubMed

    Buijze, G A; Weening, A A; Poolman, R W; Bhandari, M; Ring, D

    2012-02-01

    Using inaccurate quotations can propagate misleading information, which might affect the management of patients. The aim of this study was to determine the predictors of quotation inaccuracy in the peer-reviewed orthopaedic literature related to the scaphoid. We randomly selected 100 papers from ten orthopaedic journals. All references were retrieved in full text when available or otherwise excluded. Two observers independently rated all quotations from the selected papers by comparing the claims made by the authors with the data and expressed opinions of the reference source. A statistical analysis determined which article-related factors were predictors of quotation inaccuracy. The mean total inaccuracy rate of the 3840 verified quotes was 7.6%. There was no correlation between the rate of inaccuracy and the impact factor of the journal. Multivariable analysis identified the journal and the type of study (clinical, biomechanical, methodological, case report or review) as important predictors of the total quotation inaccuracy rate. We concluded that inaccurate quotations in the peer-reviewed orthopaedic literature related to the scaphoid were common and slightly more so for certain journals and certain study types. Authors, reviewers and editorial staff play an important role in reducing this inaccuracy.

  1. Scientific research output in orthopaedics from China and other top-ranking countries: a 10-year survey of the literature

    PubMed Central

    Zou, Yuming; Li, Quan; Xu, Weidong

    2016-01-01

    Objectives Orthopaedics-related diseases and conditions are a significant burden worldwide. In this study, we aimed to compare the quantity and quality of research output in the field of orthopaedics from Mainland China (MC), USA, UK, Japan and Germany. Setting The USA, UK, Japan, Germany and MC. Participants We selected orthopaedics journals from the subject category ‘orthopedics’ from the Science Citation Index Expanded (SCIE). Outcome measures The number of publications, the number of publications in the surveyed publication types, impact factor (IF) and citations from the corresponding country from 2005 to 2014 were collected for quantity and quality comparisons. Results A total of 128 895 articles were published worldwide in orthopaedics-related journals from 2005 to 2014. The USA contributed the largest proportion (31 190 (24.20%)), followed by the UK (6703 (5.20%)), Japan (5718 (4.41%)), Germany (4701 (3.66%)) and MC (3389 (2.63%)). Publications from MC represented the fewest, but this quantity is rapidly increasing. The quantity of annual publications from MC has exceeded that of Germany since 2012. The USA plays a predominant role in all kinds of publication types under investigation in the study, except in the category of meta-analysis. MC was in the last place for cumulative IFs, and the average IF actually decreased from the beginning of the study. For total and average citations, MC still lags behind the other countries in the study. Conclusions The USA has occupied the dominant place in orthopaedics-related research for the last 10 years. Although MC has made great progress in the number of published works in the field of orthopaedics over the last 10 years, the quality of these publishing efforts needs further improvement. PMID:27638493

  2. 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

  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. Redundant publications in the orthopedic literature.

    PubMed

    Eck, Jason C; Nachtigall, Dean; Hodges, Scott D; Humphreys, S Craig

    2007-01-01

    Rates of redundant publications in the general surgery literature are approximately 14%. This article identifies the rate of redundant publications in the orthopedic literature. All original articles published during the year 2000 in The Journal of Bone and Joint Surgery (American Volume), Journal of Orthopaedic Trauma, Journal of Spinal Disorders, and Spine were searched using PubMed. Redundancy rate was 4 (3.15%) of 127 for The Journal of Bone and Joint Surgery (American volume), zero (0%) of 70 for Journal of Orthopaedic Trauma, 2 (2.90%) of 69 for Journal of Spinal Disorders, and 11 (3.12%) of 353 for Spine.

  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. Blood Component Therapy and Coagulopathy in Trauma: A Systematic Review of the Literature from the Trauma Update Group

    PubMed Central

    Poole, Daniele; Cortegiani, Andrea; Chieregato, Arturo; Russo, Emanuele; Pellegrini, Concetta; De Blasio, Elvio; Mengoli, Francesca; Volpi, Annalisa; Grossi, Silvia; Gianesello, Lara; Orzalesi, Vanni; Fossi, Francesca; Chiara, Osvaldo; Coniglio, Carlo; Gordini, Giovanni

    2016-01-01

    Background Traumatic coagulopathy is thought to increase mortality and its treatment to reduce preventable deaths. However, there is still uncertainty in this field, and available literature results may have been overestimated. Methods We searched the MEDLINE database using the PubMed platform. We formulated four queries investigating the prognostic weight of traumatic coagulopathy defined according to conventional laboratory testing, and the effectiveness in reducing mortality of three different treatments aimed at contrasting coagulopathy (high fresh frozen plasma/packed red blood cells ratios, fibrinogen, and tranexamic acid administration). Randomized controlled trials were selected along with observational studies that used a multivariable approach to adjust for confounding. Strict criteria were adopted for quality assessment based on a two-step approach. First, we rated quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Then, this rating was downgraded if other three criteria were not met: high reporting quality according to shared standards, absence of internal methodological and statistical issues not detailed by the GRADE system, and absence of external validity issues. Results With few exceptions, the GRADE rating, reporting and methodological quality of observational studies was “very low”, with frequent external validity issues. The only two randomized trials retrieved were, instead, of high quality. Only weak evidence was found for a relation between coagulopathy and mortality. Very weak evidence was found supporting the use of fibrinogen administration to reduce mortality in trauma. On the other hand, we found high evidence that the use of 1:1 vs. 1:2 high fresh frozen plasma/packed red blood cells ratios failed to obtain a 12% mortality reduction. This does not exclude lower mortality rates, which have not been investigated. The use of tranexamic acid in trauma was supported by

  8. Thyroid gland rupture after blunt neck trauma: A case report and review of the literature

    PubMed Central

    Arana-Garza, Sebastian; Juarez-Parra, Marco; Monterrubio-Rodríguez, Jeronimo; Cedillo-Alemán, Enrique; Orozco-Agüet, David; Zamudio-Vázquez, Zaire; Garza-Jasso, Tanya

    2015-01-01

    Introduction Soft tissue injuries are relatively common after blunt neck trauma, because of its complex anatomy, many vital structures can be compromised. Isolated trauma to the thyroid is highly uncommon and there are few cases reported in the literature. Presentation of case A 19 year-old female patient with no known pathologies who sustained direct blunt trauma to the right frontal half of the neck after falling down from a stair case. She arrived at the ER with moderate neck swelling and pain. There were no visible hematomas and no respiratory compromise was noted. Contrast enhanced CT-scan showed rupture and hematoma of the right thyroid lobe; she underwent surgical exploration with hemi thyroidectomy and recovered uneventfully. Discussion Despite soft tissue injuries are relatively common after blunt neck trauma, isolated thyroid gland injury is extremely rare and is present in about 1–2% of the cases and in most of the cases there is an underlining pathology within the gland. Most patients arrived at the emergency room hemodynamically stable, presenting neck swelling, pain, respiratory distress, dysphagia and hoarseness. Diagnosis strategy should be focused to rule out respiratory or vascular compromise. Surgical exploration remains the most common treatment strategy. Conclusions Although the rarity of this condition, physicians should take in mind the possibility of thyroid injury after blunt neck trauma. Early detection and prompt treatment, can reduce life threatening complications. Management should be individualized to patient’s characteristics and surgeon’s experience. PMID:26001363

  9. 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

  10. 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

  11. 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.

  12. 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

  13. Orthopaedics in the Buddhist kingdom of Bhutan.

    PubMed

    Regan, Elizabeth A; Stein, Robert E

    2002-03-01

    Volunteering as the only orthopaedic surgeon in the small Asian country of Bhutan provided a fascinating introduction to international work. The orthopaedic work predominantly was trauma and osteomyelitis. Treatment of most problems was complicated by patient delays in obtaining medical care, usually related to transportation difficulties in a steep mountainous land with few roads. The complexities of enhancing orthopaedic care in developing countries include patient access to care, availability of adequate sterility for implantation of fixation devices, and determining in concert with the local government what is a sustainable level of care that can be taught to interested physicians in the country. Among the developing nations, Bhutan is one with a strong interest in the welfare of its people and has an economy that can afford to invest in healthcare. Despite these strengths, there remain interesting challenges for the orthopaedic volunteer. Exposure of the volunteer to the people and their culture enhanced the experience and provides a lure to continue volunteering. PMID:11859218

  14. Air reduction of intussusception after abdominal blunt trauma and a literature review

    PubMed Central

    Kwon, So Ra; Ha, Sang Ook; Oh, Young Taeck; Sohn, You Dong

    2016-01-01

    The typical presentation of intussusception includes intermittent severe abdominal pain, vomiting, rectal bleeding, and the presence of an abdominal mass. We present a case of intussusception after abdominal blunt trauma along with a literature review. A 4-year-old girl was admitted to the emergency department after a bicycle accident. She complained of progressively worsening abdominal pain, but there was no vomiting, fever, bloody stool, or abdominal mass. She was finally diagnosed with traumatic intussusception by ultrasonography and treated with air reduction. Because the typical symptoms are unusual in traumatic intussusception, close attention must be paid to avoid a delayed diagnosis. PMID:27752618

  15. [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.

  16. 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

  17. 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

  18. Review of orthopaedic manipulator arms.

    PubMed

    Hurst, K S; Phillips, R; Viant, W J; Mohsen, A M; Sherman, K P; Bielby, M

    1998-01-01

    Trajectory planning and implementation forms a substantial part of current and future orthopaedic practice. This type of surgery is governed by a basic orthopaedic principle [1] which involves the placement of a surgical tool at a specific site within a region, via a trajectory which is planned from X-ray based 2D images and governed by 3D anatomical constraints. The accuracy and safety of procedures utilising the basic orthopaedic principle depends on the surgeon's judgement, experience, ability to integrate images, utilisation of intra-operative X-ray, knowledge of anatomical-biomechanical constraints and eye hand dexterity. The surgeon must remain as the responsible medical expert in charge of the overall system. At the same time the surgeon covets the accuracy offered by Computer Assisted Surgery including a manipulator. A summary of current inadequacies of manipulators indicates that the main drivers for future work are that accuracy is critical in close contact with the environment, safety concerns dictate manipulator geometry and technological limitations are many. In any effort to develop an optimal manipulator to guide surgical instruments and tools it is an obvious first step to review and categorise current manipulators. The aim of this paper is to review all aspects of manipulator design against the five main criteria of ergonomics; safety; accuracy; sterility and measurable benefits such as reduced operative time, reduced surgical trauma and improved clinical results.

  19. Global trauma: the great divide.

    PubMed

    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.

  20. 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

  1. Orthopaedic surgeons in Yorkshire--are we ATLS positive?

    PubMed Central

    Kelley, S. P.; McMurray, D. H. M.; Hinsche, A. F.; Deacon, P.

    2005-01-01

    INTRODUCTION: In 1993, the Major Trauma Working Group of Yorkshire proposed that hospitals should be accredited as Trauma Reception Hospitals with a policy for the response to the arrival of a trauma patient. These requirements include specific criteria for orthopaedics. METHODS: To evaluate if these criteria are being fulfilled, we carried out an audit comparing the response in the hospitals within the Yorkshire deanery to the arrival of major trauma. All consultant and middle-grade orthopaedic surgeons on call for trauma were contacted and questioned as to their ATLS provider status and involvement in the "trauma call". RESULTS: 16 hospitals were included of which 13 have a "trauma team". 191 surgeons (96% response) were included. 175 have completed an ATLS course. Of these, 72 (41%) had out-of-date qualifications. Only 9 (13%) were waiting to revalidate. Variation was seen in the frequency of accident and emergency department attendance by different grades of surgeon for major trauma. DISCUSSION: All hospitals have a response for major trauma although variations occur. The vast majority of orthopaedic surgeons in Yorkshire have been adequately trained in ATLS management (more so than any study has previously shown), particularly the middle grades, who are usually first to attend. The level of revalidation is low and reasons for this are discussed with recommendations for revalidation in the future. PMID:15720907

  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. 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

  4. 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

  5. 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

  6. 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

  7. 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

  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. 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

  10. Left main dissection complicating blunt chest trauma: case report and review of literature.

    PubMed

    Colombo, Federico; Zuffi, Andrea; Lupi, Alessandro

    2014-01-01

    Coronary artery injury after blunt chest trauma is rare, but can be life-threatening, resulting in severe myocardial ischaemia and acute myocardial infarction. We report a case of a 56-year-old male who presented a few days after a blunt chest trauma with crescendo unstable angina. Coronary angiography demonstrated left main coronary artery dissection that was fixed with stent implantation. After a blunt chest trauma symptoms and electrocardiographic findings of a coronary dissection can be nonspecific and confounded by the chest tenderness. In such cases careful evaluation to rule out traumatic coronary injuries is warranted and early intervention should not be delayed in the presence of clear evidence of myocardial ischemia.

  11. 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

  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. 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.

  14. 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.

  15. 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

  16. 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.

  17. Evidence of dissociative amnesia in science and literature: culture-bound approaches to trauma in Pope, Poliakoff, Parker, Boynes, and Hudson (2007).

    PubMed

    Goldsmith, Rachel E; Cheit, Ross E; Wood, Mary E

    2009-01-01

    The current culture of traumatic stress studies includes research that identifies the ways in which stress and trauma impair learning and memory in both humans and animals. Yet it also contains health professionals who argue that individuals cannot forget traumatic events. Many accounts present differences among these positions as a legitimate debate despite the substantial forensic, survey, and neurological evidence that both demonstrates the capacity for people to exhibit impaired memory for trauma and highlights specific mechanisms. In a recent article, H. G. Pope, M. B. Poliakoff, M. P. Parker, M. Boynes, and J. I. Hudson (2007) hypothesized that if individuals could forget trauma, the phenomenon would appear in world literature prior to 1800. They conducted a contest to generate submissions of examples and determined that dissociative amnesia is a culture-bound syndrome. Their report fails to provide a thorough account of all submissions and the process through which they were all rejected, offers highly questionable literary analyses, and includes several misrepresentations of the state of the science regarding memory for trauma. This response addresses methodological problems with the contest, explores examples of forgetting trauma from literature written before 1800, examines social and historical aspects of the issue, and summarizes the extensive cognitive and neurological data that Pope et al. did not consider. The present article conceptualizes the premise of the contest and the authors' conclusion as symptomatic of a culture affected by biases that include the denial of trauma and its effects.

  18. A basic introduction to statistics for the orthopaedic surgeon.

    PubMed

    Bertrand, Catherine; Van Riet, Roger; Verstreken, Frederik; Michielsen, Jef

    2012-02-01

    Orthopaedic surgeons should review the orthopaedic literature in order to keep pace with the latest insights and practices. A good understanding of basic statistical principles is of crucial importance to the ability to read articles critically, to interpret results and to arrive at correct conclusions. This paper explains some of the key concepts in statistics, including hypothesis testing, Type I and Type II errors, testing of normality, sample size and p values. PMID:22523921

  19. 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

  20. 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

  1. 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

  2. Smartphones in orthopaedics.

    PubMed

    Al-Hadithy, Nawfal; Gikas, Panagiotis D; Al-Nammari, Shafic Said

    2012-08-01

    With the introduction of the European Working Time Directive, surgical trainees are facing limited training opportunities and doctors are required to maximise their training opportunities. Smartphone sales have been rapidly increasing over the last five years and can be used as a training tool for the orthopaedic trainee and surgeon. Common uses include applications (AO, eLogbook and PubMed), Ebooks, online Logbooks, Guidelines and surgical techniques. In addition, smartphones can be used to immediately complete work-based assessments, in the absence of computers, hopefully increasing completion rates and reliability. Some journals now provide podcasts and video tutorials which may be accessed on smartphones, which is useful for higher examinations. Smartphones can also be used in the clinical setting to take photographs of wounds. Smartphones are enjoying increased uptake and application in the workplace and we review their use for orthopaedic surgeons and trainees to allow them to make the most out of their training opportunities.

  3. 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

  4. 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

  5. Major ablative procedures in orthopaedic surgery.

    PubMed

    Soucacos, P N; Dailiana, Z H; Beris, A E; Xenakis, T H; Malizos, K N; Chrisovitsinos, J

    1996-01-01

    In the presence of the notable progress in limb-sparing techniques afforded by the developments in microsurgery and musculoskeletal oncology, major ablative surgery of the extremities still remains a last-resort, yet powerful tool in managing patients with primary tumors in whom wide excision is not possible, as well as in cases with severe trauma to the limbs. During the last thirteen years, eight major ablative procedures were performed at the Department of Orthopaedic Surgery of the University of Ioannina Medical School. Seven out of the eight procedures were performed in patients with primary malignant tumors either because the anatomical location or multiple recurrences of the tumor did not allow removal by wide local excision or by amputation at a lower level. In one patient, the procedure was related to a severe, mangling trauma. Four illustrative cases of the eight major ablative procedures performed are reported to highlight the current indications of this rarely used, complex, and extensive surgery. The characteristic cases presented are: hemipelvectomy in a patient with chondrosarcoma of the pelvis, disarticulation of the hip in a patient with a malignant histiocytoma of the supracondylar area of the knee, forequarter amputation in a patient with a basal cell carcinoma of the axilla, and disarticulation of the shoulder in a patient with an incomplete nonviable amputation at the level of the shoulder girdle associated with severe damage to the brachial plexus and axillary artery. After a five to over a ten year follow-up, six of the eight patients who where subjected to major ablative procedures are doing well and are satisfactorily active. These cases reflect the dilemma that orthopaedic surgeons geons still face in selecting limb salvage or major ablative surgery in cases of aggressive malignant tumors to severe trauma. PMID:8771355

  6. Pharmacological prevention of venous thromboembolism in orthopaedic surgery

    PubMed Central

    Prisco, Domenico; Cenci, Caterina; Silvestri, Elena; Emmi, Giacomo; Ciucciarelli, Lucia

    2014-01-01

    Summary The prophylaxis of venous thromboembolism (VTE) with anticoagulant drugs is a long-established practice in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, while there are few data regarding the prevention of VTE in other fields of orthopaedic surgery and traumatology. In order to provide practical recommendations for daily management of VTE prophylaxis in orthopaedic patients, recently the Italian Societies of Thrombosis and Haemostasis, Orthopaedics and Traumatology and Anaesthesia have drawn up a first Intersociety Consensus on antithrombotic prophylaxis in total hip and knee replacement surgery, and in the treatment of femoral neck fracture, then updated in 2013, and a subsequent Intersocietary Consensus, in cooperation also with the Society of general practitioners, concerning antithrombotic prophylaxis in other types of orthopaedic surgery and traumatology. Before starting any prophylactic treatment it is of crucial importance the assessment of both thrombotic and bleeding risk of patients undergoing surgery. Thromboembolic prophylaxis is recommended with low molecular weight heparins (LMWH), fondaparinux (FON) or with the new oral anticoagulants (NOA) in patients undergoing hip and knee replacement surgery while patients undergoing treatment of femoral neck fracture should be treated with LMWH or FON. Regarding the non-prosthetic orthopaedic surgery and traumatology, it is recommended prophylaxis with LMWH or FON in situations of high thromboembolic risk or in the case of interventions or trauma involving pelvis, acetabulum or knee. PMID:25568652

  7. 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.

  8. 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

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

    PubMed

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

    2012-12-01

    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

  10. 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.

  11. 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

  12. American Academy of Orthopaedic Surgeons

    MedlinePlus

    ... Portfolio Examination & ResStudy Center Education by Area of Interest Adult Reconstruction Foot and Ankle Hand and Wrist ... October, 2016 Volume 24, Number 11 Item Response Theory and Computerized Adaptive Testing for Orthopaedic Outcomes Measures ...

  13. An information revolution in orthopaedics.

    PubMed

    Goldberg, A J; MacGregor, A; Spencer, S A

    2012-04-01

    With the established success of the National Joint Registry and the emergence of a range of new national initiatives for the capture of electronic data in the National Health Service, orthopaedic surgery in the United Kingdom has found itself thrust to the forefront of an information revolution. In this review we consider the benefits and threats that this revolution poses, and how orthopaedic surgeons should marshal their resources to ensure that this is a force for good.

  14. 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

  15. 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

  16. 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

  17. What is orthopaedic triage? A systematic review

    PubMed Central

    Morris, Joanne H; James, Rebecca E; Davey, Rachel; Waddington, Gordon

    2015-01-01

    Rationale, aims and objectives Complex and chronic disease is placing significant pressure on hospital outpatient departments. Novel ways of delivering care have been developed recently and are often described as ‘triage’ services. This paper reviews the literature pertaining to definitions and descriptions of orthopaedic/musculoskeletal triage processes, in order to provide information on ‘best practice’ to assist health care facilities. Method A comprehensive open-ended search was conducted using electronic databases to identify studies describing models of triage clinics for patients with a musculoskeletal/orthopaedic complaint, who have been referred to hospital outpatient clinics for a surgical consultation. Studies were critically appraised using the McMaster quality appraisal tool and ranked using the National Health and Medical Research Council hierarchy of evidence. A thematic analysis of the definitions, processes and procedures of triage described within the literature was undertaken. Results 1930 studies were identified and 45 were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from I to IV; however, the majority were at low levels of evidence and scored poorly on the critical appraisal tool. Three broad themes of triage were identified: presence of a referral, configuration of the triage (who, how and where) and the aim of triage. However, there were significant inconsistencies across these themes. Conclusions This systematic review highlighted the need for standardization of the definition of triage, the procedures of assessment and management and measures of outcome used in orthopaedic/musculoskeletal triage to ensure best-practice processes, procedures and outcomes for triage clinics. PMID:25410703

  18. 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

  19. Abdominal wall hernia and aortic injury secondary to blunt trauma: Case report and review of the literature

    PubMed Central

    Ballard, David H.; Kaskas, Nadine M.; Hamidian Jahromi, Alireza; Skweres, Justin; Youssef, Asser M.

    2014-01-01

    INTRODUCTION Traumatic abdominal wall hernia (TAWH) and traumatic abdominal aortic injury (TAAI) are two uncommon complications secondary to blunt trauma. In both TAWH and TAAI, reported cases are often associated with poly-trauma. TAWH may be initially missed if more pressing issues are identified during the patient's primary survey. TAAI may be an incidental finding on imaging or, if severe, a cause of an acute abdomen and hemodynamic abnormality. PRESENTATION OF CASE A 54-year-old white male suffered a TAWH and TAAI (pseudoaneurysm) due to severe blunt trauma. TAWH was apparent on physical exam and the TAAI was suspected on computed tomography (CT). The patient's TAWH was managed with a series of abdominal explorations and the TAAI was repaired with endovascular stenting. DISCUSSION TAWH and TAAI are commonly due to severe blunt trauma from motor vehicle collisions. Diagnosis is made through physical exam, imaging studies, or surgical exploration. A variety of surgical techniques achieve technical success. CONCLUSION The patient with blunt trauma to the abdomen is at risk for TAWH and TAAI, which are often associated with other injuries. Investigations should include thorough clinical exam through secondary survey and radiologic imaging in the hemodynamically normal patient. PMID:25437685

  20. 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 ...

  1. 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.

  2. 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

  3. Evolution of acute orthopaedic care.

    PubMed

    Mamczak, Christiaan N; Born, Christopher T; Obremskey, William T; Dromsky, David M

    2012-01-01

    Current combat battlefield injuries are among the most complex and challenging orthopaedic cases. These injuries carry high risks for exsanguination and global contamination of extensive soft-tissue and complicated bony injuries. Military orthopaedic surgeons must employ the latest advances in acute combat casualty care to achieve favorable outcomes. Adaptive changes over the past 10 years of war have given today's surgeons the armamentarium to optimize patient care. Innovative methods of damage control resuscitation and surgery have led to increased survival. However, the fundamentals of surgical hemostasis and decontamination remain critical to successful management. The acute treatment of combat casualties involves a continuum of care from the point of injury through transport out of theater. Future research and education are paramount to better prepare military orthopaedic surgeons to further increase survivability and enhance the outcomes of service members with complex wounds.

  4. Orthopaedic service lines-revisited.

    PubMed

    Patterson, Cheryl

    2008-01-01

    This article revisits the application of orthopaedic service lines from early introduction and growth of this organizational approach in the 1980s, through the 1990s, and into the current decade. The author has experienced and worked in various service-line structures through these three decades, as well as the preservice-line era of 1970s orthopaedics. Past lessons learned during earlier phases and then current trends and analysis by industry experts are summarized briefly, with indication given of the future for service lines. Variation versus consistency of certain elements in service-line definitions and in operational models is discussed. Main components of service-line structures and typical processes are described briefly, along with a more detailed section on the service-line director/manager role. Current knowledge contained here will help guide the reader to more "out-of-the-box" thinking toward comprehensive orthopaedic centers of excellence.

  5. 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…

  6. Social Media and Orthopaedics: Opportunities and Challenges.

    PubMed

    Suryavanshi, Tanishq; Geier, C David; Leland, J Martin; Silverman, Lance; Duggal, Naven

    2016-01-01

    Social media presents unique opportunities and challenges for practicing orthopaedic surgeons. Social media, such as blogging, Facebook, and Twitter, provides orthopaedic surgeons with a new and innovative way to communicate with patients and colleagues. Social media may be a way for orthopaedic surgeons to enhance communication with patients and healthcare populations; however, orthopaedic surgeons must recognize the limitations of social media and the pitfalls of increased connectedness in patient care.

  7. Social Media and Orthopaedics: Opportunities and Challenges.

    PubMed

    Suryavanshi, Tanishq; Geier, C David; Leland, J Martin; Silverman, Lance; Duggal, Naven

    2016-01-01

    Social media presents unique opportunities and challenges for practicing orthopaedic surgeons. Social media, such as blogging, Facebook, and Twitter, provides orthopaedic surgeons with a new and innovative way to communicate with patients and colleagues. Social media may be a way for orthopaedic surgeons to enhance communication with patients and healthcare populations; however, orthopaedic surgeons must recognize the limitations of social media and the pitfalls of increased connectedness in patient care. PMID:27049230

  8. Publication Productivity of Early-Career Orthopedic Trauma Surgeons.

    PubMed

    Hake, Mark E; Lee, John J; Goulet, James A

    2016-01-01

    The goals of this study were to: (1) define the publication productivity of early-career orthopedic trauma surgeons over time; (2) compare the early-career publication productivity of recent orthopedic trauma fellowship graduates vs their more senior colleagues; and (3) determine the proportion of fellowship graduates who meet the Orthopaedic Trauma Association (OTA) publication criteria for active membership early in their careers. Orthopedic trauma fellowship graduates from 1982 to 2007 were analyzed. A literature search was performed for each fellow's publications for the 6-year period beginning the year of fellowship graduation. Publication productivity was compared between early and recent groups of graduates, 1987 to 1991 and 2003 to 2007, respectively. Fulfillment of OTA publication criteria was determined. Seventy-nine percent of graduates contributed to 1 or more publications. The recent group produced more total publications per graduate (4.06 vs 3.29, P=.01) and more coauthor publications (2.60 vs 2.04, P=.019) than the early group. The number of first-author publications did not differ between groups (1.46 vs 1.25, P=.26). A greater percentage of the recent group met current OTA publication criteria compared with the early group (51% vs 35%, P=.04). The findings showed that recent orthopedic trauma graduates had increased publication productivity compared with their more senior colleagues, although a proportion had not qualified for active OTA membership 6 years into their career. Overall, these data are encouraging and suggest that young orthopedic trauma surgeons remain committed to sustaining a high level of academic excellence.

  9. Fatal Massive Cerebral Infarction in a Child after Mild Brain Trauma: A Case Report and Literature Review.

    PubMed

    Calderon-Miranda, Willen Guillermo; Alvis-Miranda, Hernando Raphael; M Rubiano, Andres; Moscote-Salazar, Luis Rafael

    2014-04-01

    Traumatic brain injury is a common entity. However cerebral infarction in infants is a rare entity while the diagnosis of this pathology in the pediatric population is usually difficult. The mild head trauma is rarely accompanied by intracranial injury and even less, with cerebral infarction. We herein report the first case of cerebral infarction after a mild brain trauma in a 2-year-old Latin-American male patient, in which brain computed tomography (CT) scan was performed on the first day of the accident, showed right hemispheric cerebral ischemia compromising the fronto-parieto-occipital region. Conservative management was established. The patient died at day 5. So Brain CT scan may be beneficial to reveal any hemispheric infarction due to a probable mass effect.

  10. Fatal Massive Cerebral Infarction in a Child after Mild Brain Trauma: A Case Report and Literature Review

    PubMed Central

    Calderon-Miranda, Willen Guillermo; Alvis-Miranda, Hernando Raphael; M. Rubiano, Andres; Moscote-Salazar, Luis Rafael

    2014-01-01

    Traumatic brain injury is a common entity. However cerebral infarction in infants is a rare entity while the diagnosis of this pathology in the pediatric population is usually difficult. The mild head trauma is rarely accompanied by intracranial injury and even less, with cerebral infarction. We herein report the first case of cerebral infarction after a mild brain trauma in a 2-year-old Latin-American male patient, in which brain computed tomography (CT) scan was performed on the first day of the accident, showed right hemispheric cerebral ischemia compromising the fronto-parieto-occipital region. Conservative management was established. The patient died at day 5. So Brain CT scan may be beneficial to reveal any hemispheric infarction due to a probable mass effect. PMID:27162874

  11. 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

  12. 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

  13. Acute ischemic stroke in a 19 month old following minor head trauma: case report and review of the literature.

    PubMed

    Garla, Vishnu; Pino, Eduardo; Coulon, Richard; Wolfer, Rebecca

    2014-01-01

    Minor head trauma is a very rare cause of ischemic stroke in the pediatric population. We describe a nineteen month old patient who developed left hemiparesis and subsequently left facial palsy after a fall. MRI of the brain showed hypodensities in the basal ganglia, internal capsule and caudate nucleus consistent with stroke. Echocardiogram and MRA were normal. Hypercoaguable work up showed that the patient was a carrier for a single MTHFR gene. The patient was treated conservatively. On follow up two weeks later his facial palsy had resolved and strength in the extremities improved. Although a rare condition awareness about this is necessary as there can be considerable delay in its recognition.

  14. Prophylactic antibiotics in orthopaedic surgery.

    PubMed

    Prokuski, Laura; Clyburn, Terry A; Evans, Richard P; Moucha, Calin S

    2011-01-01

    The use of prophylactic antibiotics in orthopaedic surgery has been proven effective in reducing surgical site infections after hip and knee arthroplasty, spine procedures, and open reduction and internal fixation of fractures. To maximize the beneficial effect of prophylactic antibiotics, while minimizing any adverse effects, the correct antimicrobial agent must be selected, the drug must be administered just before incision, and the duration of administration should not exceed 24 hours.

  15. 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.

  16. 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.

  17. 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

  18. 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

  19. 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.

  20. 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

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

    PubMed

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

    2013-04-01

    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

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

    PubMed

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

    2013-04-01

    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.

  3. Trauma-informed Care and the Research Literature: How Can the Mental Health Nurse Take the Lead to Support Women Who Have Survived Sexual Assault?

    PubMed

    Cleary, Michelle; Hungerford, Catherine

    2015-05-01

    Many women who access mental health services have been subjected to violent acts, including childhood sexual abuse and adult sexual assault, often at the hands of family members and partners. The vulnerability of these women can be further complicated when health professionals lack sensitivity to the issues involved; and the treatment received by the women is insensitive, leading to experiences of re-traumatisation. This article considers the principles of trauma-informed care and practice, as represented in the literature; and explains how mental health nurses can lead the way in multidisciplinary environments to ensure that women who have experienced violence receive the most appropriate health care, and are thereby supported to attain the best possible outcome.

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

    PubMed Central

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

    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

  5. American Orthopaedic Society for Sports Medicine

    MedlinePlus

    ... 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 ...

  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.

  7. Burn injuries and soft tissue traumas complicated by mucormycosis infection: a report of six cases and review of the literature

    PubMed Central

    Kyriopoulos, E.J.; Kyriakopoulos, A.; Karonidis, A.; Gravvanis, A.; Gamatsi, I.; Tsironis, C.; Tsoutsos, D.

    2015-01-01

    Summary Mucor fungus infection is a rare opportunistic infection, rapidly progressive and often fatal in immunocompromised patients, or in patients with chronic debilitating diseases. We report six cases of trauma patients with mucormycosis. Three had severe thermal burns, one of them with a medical history of diabetes mellitus. The other three patients suffered from severe soft tissue injuries caused by traffic accidents. In all cases there had been spontaneous exposure and contact of the wounds with soil. During hospitalization, fungi cultures and/or biopsies of all wounds were performed and all resulted positive. The patients were treated with Amphotericin B (AmB) and surgical debridement. Two of them died and the other four were fully healed and discharged. Mucormycosis should be considered in any case of aggressive skin tissue necrosis with a history of soiled wounds. We suggest that mucormycosis is treated by intravenous and local administration of AmB, extensive and repeated debridement and cautious coverage of the wound. The plastic surgeon must wait for negative swab cultures and biopsies before covering the defects with skin grafts or flaps. Reconstruction may be challenging, depending on the extent, depth, location and special indications of the affected site and the donor site availability. PMID:27777549

  8. 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

  9. 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

  10. 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

  11. 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.

  12. [Orthopaedic footwear against foot ulcers in diabetes].

    PubMed

    Bus, Sicco A

    2014-01-01

    In people with diabetes mellitus, foot ulcers are a major problem because they increase the risk of a foot infection and amputation and reduce quality of life. After a foot ulcer has healed, the risk of recurrence is high. Orthopaedic shoes and orthotics are often prescribed to high risk patients and aim to reduce the mechanical pressure on the plantar surface of the foot. Orthopaedic footwear that is modified to reduce pressure is not much more effective in preventing foot ulcer recurrence than orthopaedic footwear that did not undergo such modification, unless the shoes are worn as recommended. In that case, the risk of ulcer recurrence is reduced by 46%. In patients with a history of ulceration, compliance in wearing orthopaedic shoes at home is low, while these patients walk more inside the house than outside the house. Foot pressure measurements should be part of the prescription and evaluation of orthopaedic footwear for patients at high risk for foot ulceration.

  13. Facial trauma

    MedlinePlus

    Kellman RM. Maxillofacial trauma. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . ... Facial trauma. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and ...

  14. [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

  15. Ear trauma.

    PubMed

    Eagles, Kylee; Fralich, Laura; Stevenson, J Herbert

    2013-04-01

    Understanding basic ear anatomy and function allows an examiner to quickly and accurately identify at-risk structures in patients with head and ear trauma. External ear trauma (ie, hematoma or laceration) should be promptly treated with appropriate injury-specific techniques. Tympanic membrane injuries have multiple mechanisms and can often be conservatively treated. Temporal bone fractures are a common cause of ear trauma and can be life threatening. Facial nerve injuries and hearing loss can occur in ear trauma.

  16. 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…

  17. Complete transection of common bile duct due to blunt abdominal trauma: a case report and literature review.

    PubMed

    Chung, Y C; Lee, P H; Huang, M T; Chang, C N

    1993-01-01

    A case of complete transection of the common bile duct due to abdominal blunt injury in a 49-year-old man is presented. The rarity of this injury and its initial presentation as a pancreatic pseudocyst warrant its description. This patient was diagnosed as having bile duct injury following ascites aspiration. Common bile duct transection was documented and a choledochostomy was done. However, bile leaked into the peritoneal cavity one week after the operation. A Roux-en-Y choledochojejunostomy was done successfully in a second operation. Delayed diagnosis is common in these kinds of injuries, but it should be considered when a patient has bile ascites, abdominal distention and jaundice after a blunt abdominal injury. A review of the literature, methods of diagnosis and the technique of surgical repair are described.

  18. Publication rate of presentations at an annual military orthopaedic meeting.

    PubMed

    Schoenfeld, Andrew J; Carey, Paul A; Frye, Brandon D; Weaver, Courtney R; Belmont, Philip J

    2012-01-01

    Many research abstracts presented at orthopaedic conferences do not undergo a formal editorial, or peer-review process; however, abstracts are frequently referenced in textbooks and influence clinical practice. The purpose of this study was to determine the publication rate of abstracts formally presented at the Society of Military Orthopaedic Surgeons (SOMOS) annual meetings from 1998 to 2006 that went to full-text publication. Using Google Scholar and PubMed, a literature search was performed for each abstract presented at the annual SOMOS meeting in the years 1998-2006, to calculate the overall full-text publication rate, the average duration from presentation to publication, and the distribution of publications in the various journals. A total of 770 abstracts were presented at the annual SOMOS meetings. The overall full-text publication rate at a minimum of 3 years was 45.7% (352 publications). The average time from presentation to publication was 2.7 years. The published articles appeared in 65 peer-reviewed journals, with notable distribution in Spine (10.0%), The American Journal of Sports Medicine (9.4%), and The Journal of Bone and Joint Surgery (9.4%). The full-text publication rate of abstracts presented at the annual SOMOS meetings compares favorably with that of other major orthopaedic conferences in the United States. Nonetheless, more than half of abstracts presented at the SOMOS meetings remain unpublished. PMID:23327844

  19. 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.

  20. 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

  1. 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

  2. Orthopaedic perspective on bone metastasis

    PubMed Central

    Molloy, Alan P; O’Toole, Gary C

    2013-01-01

    The incidence of cancer is increasing worldwide, with the advent of a myriad of new treatment options, so is the overall survival of these patients. However, from an orthopaedic perspective, there comes the challenge of treating more patients with a variety of metastatic bone lesions. The consequences of such lesions can be significant to the patient, from pain and abnormal blood results, including hypercalcemia, to pathological fracture. Given the multiple options available, the treatment of bone metastasis should be based on a patient-by patient manner, as is the case with primary bone lesions. It is imperative, given the various lesion types and locations, treatment of bone metastasis should be performed in an individualised manner. We should consider the nature of the lesion, the effect of treatment on the patient and the overall outcome of our decisions. The dissemination of primary lesions to distant sites is a complex pathway involving numerous cytokines within the tumour itself and the surrounding microenvironment. To date, it is not fully understood and we still base a large section of our knowledge on Pagets historic “seed and soil” theory. As we gain further understanding of this pathway it will allow us develop more medical based treatments. The treatment of primary cancers has long been provided in a multi-disciplinary setting to achieve the best patient outcomes. This should also be true for the treatment of bone metastases. Orthopaedic surgeons should be involved in the multidisciplinary treatment of such patients given that there are a variety of both surgical fixation methods and non-operative methods at our disposal. PMID:23878778

  3. Review of pancreatic trauma.

    PubMed Central

    Glancy, K E

    1989-01-01

    In reviewing the literature on pancreatic trauma (1,984 cases), I found that it resulted from penetrating trauma in 73% and blunt trauma in 27% of cases. Associated injuries were common (average 3.0 per patient). Increased mortality was associated with shotgun wounds, an increasing number of associated injuries, the proximity of the injury to the head of the pancreas, preoperative shock, and massive hemorrhage. High mortality was found for total pancreatectomy, duct reanastomosis, and lack of surgical treatment, with lower mortality for Roux-en-Y anastomoses, suture and drainage, distal pancreatectomy, and duodenal exclusion and diverticulization techniques. Most patients required drainage only. The preoperative diagnosis of pancreatic trauma is difficult, with the diagnosis usually made during surgical repair for associated injuries. Blood studies such as amylase levels, diagnostic peritoneal lavage, and plain radiographs are not reliable. Computed tomographic scanning may be superior, but data are limited. PMID:2669347

  4. [CT-findings in penetrating captive bolt injuries to the head and brain: analysis of the trauma-related CT-findings and review of the literature].

    PubMed

    Bula-Sternberg, J; Laniado, M; Kittner, T; Bonnaire, F; Lein, T; Bula, P

    2011-11-01

    Penetrating gunshot injuries to the head and brain are rare in Germany and the rest of Western Europe. Due to the small number of cases over here no consistent diagnostic and therapeutic standards exist in this respect. Thus these kinds of injuries present a great challenge to the attending physicians. Most of these violations are a result of a suicidal attempt or an accident. Beside violations by firearms also penetrating injuries to the head and brain due to captive bolt devices, as used in slaughtery business for the "humane" killing of animals, occur from time to time. The impact on the head differs from that caused by firearms because no projectile is leaving the barrel and the used bolt, as a fix part of the device, does not remain in the affected tissue. That implies characteristic results within the radiological imaging that might be pathbreaking for the further treatment, because the origin of such a head injury is often unknown during primary care. Consequently the knowledge of these specific findings is central to the radiologist to make the appropriate diagnosis. Based on some clinical examples the trauma-related CT-findings are introduced and a short overview of the relevant literature is also given.

  5. Implications of humanitarian orthopaedic surgery in a combat zone: Operation Enduring Freedom and Iraqi Freedom experience.

    PubMed

    Robins, R Judd; Porta, C Rees; Eastridge, Brian J; Holcomb, John B; Martin, Matthew J

    2014-01-01

    The primary mission of deployed military orthopaedic surgeons in a combat zone is to treat musculoskeletal battlefield trauma and associated wartime injuries. The role of humanitarian surgical care during combat operations has not been defined. An anonymous online survey was sent to databases containing all U.S. military active-duty orthopaedic surgeons as well as to members of the Society of Military Orthopaedic Surgeons. Inclusion criteria for the study were defined as at least one deployment to Iraq (Operation Iraqi Freedom, OIF) or Afghanistan (Operation Enduring Freedom, OEF). Three hundred fifty-six invitations were sent with 107 orthopaedic surgeons completing the survey. Respondents reported approximately 3,000 humanitarian surgeries performed in the combat zone, with 70% to 80% involving chronic deformity and nonunion surgeries. Seventy-nine percent of the respondents believed that humanitarian surgery was a key component of the mission, improved skills (73%), benefited population (76%), and improved security (61%). A significant amount of humanitarian surgery in the combat zone has been performed in OEF/OIF. PMID:25153810

  6. 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

  7. Surgical simulation in orthopaedic skills training.

    PubMed

    Atesok, Kivanc; Mabrey, Jay D; Jazrawi, Laith M; Egol, Kenneth A

    2012-07-01

    Mastering rapidly evolving orthopaedic surgical techniques requires a lengthy period of training. Current work-hour restrictions and cost pressures force trainees to face the challenge of acquiring more complex surgical skills in a shorter amount of time. As a result, alternative methods to improve the surgical skills of orthopaedic trainees outside the operating room have been developed. These methods include hands-on training in a laboratory setting using synthetic bones or cadaver models as well as software tools and computerized simulators that enable trainees to plan and simulate orthopaedic operations in a three-dimensional virtual environment. Laboratory-based training offers potential benefits in the development of basic surgical skills, such as using surgical tools and implants appropriately, achieving competency in procedures that have a steep learning curve, and assessing already acquired skills while minimizing concerns for patient safety, operating room time, and financial constraints. Current evidence supporting the educational advantages of surgical simulation in orthopaedic skills training is limited. Despite this, positive effects on the overall education of orthopaedic residents, and on maintaining the proficiency of practicing orthopaedic surgeons, are anticipated. PMID:22751160

  8. 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

  9. Distal humerus fractures in the elderly: osteosynthesis or endoprosthesis? Review of the literature.

    PubMed

    Dietz, S O; Burkhart, K E; Nowak, T E; Rommens, P M; Müller, L P

    2012-12-01

    Fractures of the distal humerus in adults are rare but challenging for the orthopaedic trauma surgeon. The bimodal distribution reflects the trauma mechanism. While distal humerus fractures are caused by high-energy traumata in young male adults, a fall from a standing height is the most common reason for humerus fractures among elderly females. As a rule, fractures of the distal humerus are treated surgically. In young patients, open reduction and internal fixation (ORIF) with anatomic locking plates are the gold standard. In elderly patients, reconstruction is not always possible, and total elbow arthroplasty (TEA) becomes necessary. The present article provides an overview of the current diagnostic and treatment recommendations. The current literature is reviewed and the results discussed. PMID:26814545

  10. 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

  11. Acoustic trauma

    MedlinePlus

    Acoustic trauma is a common cause of sensory hearing loss . Damage to the hearing mechanisms within the inner ... Symptoms include: Partial hearing loss that most often involves ... The hearing loss may slowly get worse. Noises, ringing in ...

  12. Implementation of a Comprehensive Orthopaedic Registry System.

    PubMed

    Tokish, John M; Alexander, Thomas C

    2016-01-01

    Advances in information technology have allowed for improvements in the collection and analysis of large-scale outcomes data. These data can be used in the practice of orthopaedics for benchmarking, value analysis, and comparative effectiveness research. The implementation of registries within a busy surgical practice can be challenging, costly, and inefficient. Content, platform, and characteristics are the key elements required to successfully implement a patient-based orthopaedic outcomes data registry. Specific barriers to implementing registries are discussed, and solutions are proposed, to provide an example for optimal integration within clinical practices that may have varying goals.

  13. 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…

  14. Epidemiology, trends, and disparities in regional anaesthesia for orthopaedic surgery.

    PubMed

    Cozowicz, C; Poeran, J; Memtsoudis, S G

    2015-12-01

    Recent studies have linked the use of regional anaesthesia to improved outcomes. Epidemiological research on utilization, trends, and disparities in this field is sparse; however, large nationally representative database constructs containing anaesthesia-related data, demographic information, and multiyear files are now available. Together with advances in research methodology and technology, these databases provide the foundation for epidemiological research in anaesthesia. We present an overview of selected studies that provide epidemiological data and describe current anaesthetic practice, trends, and disparities in orthopaedic surgery in particular. This literature suggests that that even among orthopaedic surgical procedures, which are highly amenable to regional anaesthetic techniques, neuraxial anaesthetics and peripheral nerve blocks are used in only a minority of procedures. Trend analyses show that peripheral nerve blocks are gaining in popularity, whereas use of neuraxial anaesthetics is remaining relatively unchanged or even declining over time. Finally, significant disparities and variability in anaesthetic care seem to exist based on demographic and health-care-related factors. With anaesthesia playing an increasingly important part in population-based health-care delivery and evidence indicating improved outcome with use of regional anaesthesia, more research in this area is needed. Furthermore, prevalent disparities and variabilities in anaesthesia practice need to be specified further and addressed in the future.

  15. 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.

  16. "Orthobot, to your station!" The application of the remote presence robotic system in orthopaedic surgery in Ireland: a pilot study on patient and nursing staff satisfaction.

    PubMed

    Daruwalla, Zubin J; Collins, D Ronan; Moore, David P

    2010-09-01

    The remote presence robotic system (RPRS) enables an individual to "be in two places at once". Its application includes various uses in medicine and surgery. However, its usefulness in the field of orthopaedic surgery has not been described. The objective of our pilot study was to determine patient and nursing staff satisfaction with the RPRS in an orthopaedic clinical setting in Ireland. We performed evening and weekend ward rounds to gain feedback and determine patient and nursing staff satisfaction with this innovative system. Questionnaires were handed to all patients and staff nurses involved. Both patients and nursing staff had very positive reactions to the RPRS in an orthopaedic postoperative care setting. Potential uses in orthopaedic surgery include clinical outreach in the setting of trauma, supervision in theatre, or watching theatre cases from outside the hospital, providing both patient and parent reassurance in paediatric orthopaedic cases, and, finally, in the setting of outpatient departments. Integration of the RPRS in an orthopaedic clinical setting has exciting and limitless potential. More so in this era in which it would allow trainees to benefit from teaching and training while also cutting down their in-house time and thus hospitals costs.

  17. 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

  18. 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)

  19. 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…

  20. Regulatory authorities and orthopaedic clinical trials on expanded mesenchymal stem cells.

    PubMed

    Gómez-Barrena, Enrique; Solá, Cristina Avendaño; Bunu, Carmen Painatescu

    2014-09-01

    Skeletal injuries requiring bone augmentation techniques are increasing in the context of avoiding or treating difficult cases with bone defects, bone healing problems, and bone regeneration limitations. Musculoskeletal severe trauma, osteoporosis-related fractures, and conditions where bone defect, bone collapse or insufficient bone regeneration occur are prone to disability and serious complications. Bone cell therapy has emerged as a promising technique to augment and promote bone regeneration. Interest in the orthopaedic community is considerable, although many aspects related to the research of this technique in specific indications may be insufficiently recognised by many orthopaedic surgeons. Clinical trials are the ultimate research in real patients that may confirm or refute the value of this new therapy. However, before launching the required trials in bone cell therapy towards bone regeneration, preclinical data is needed with the cell product to be implanted in patients to ensure safety and efficacy. These preclinical studies support the end-points that need to be evaluated in clinical trials. Orthopaedic surgeons are the ultimate players that, through their research, would confirm in clinical trials the benefit of bone cell therapies. To further foster this research, the pathway to eventually obtain authorisation from the National Competent Authorities and Research Ethics Committees under the European regulation is reviewed, and the experience of the REBORNE European project offers information and important clues about the current Voluntary Harmonization Procedure and other opportunities that need to be considered by surgeons and researchers on the topic.

  1. Trauma Ultrasound.

    PubMed

    Wongwaisayawan, Sirote; Suwannanon, Ruedeekorn; Prachanukool, Thidathit; Sricharoen, Pungkava; Saksobhavivat, Nitima; Kaewlai, Rathachai

    2015-10-01

    Ultrasound plays a pivotal role in the evaluation of acute trauma patients through the use of multi-site scanning encompassing abdominal, cardiothoracic, vascular and skeletal scans. In a high-speed polytrauma setting, because exsanguinations are the primary cause of trauma morbidity and mortality, ultrasound is used for quick and accurate detection of hemorrhages in the pericardial, pleural, and peritoneal cavities during the primary Advanced Trauma Life Support (ATLS) survey. Volume status can be assessed non-invasively with ultrasound of the inferior vena cava (IVC), which is a useful tool in the initial phase and follow-up evaluations. Pneumothorax can also be quickly detected with ultrasound. During the secondary survey and in patients sustaining low-speed or localized trauma, ultrasound can be used to help detect abdominal organ injuries. This is particularly helpful in patients in whom hemoperitoneum is not identified on an initial scan because findings of organ injuries will expedite the next test, often computed tomography (CT). Moreover, ultrasound can assist in detection of fractures easily obscured on radiography, such as rib and sternal fractures.

  2. Venous thromboembolism (VTE) risk assessment and prophylaxis in acute orthopaedic admissions: improving compliance with national guidelines.

    PubMed

    Watts, Laura; Grant, David

    2014-01-01

    "Each year over 25,000 people die from Venous Thromboembolism (VTE) contracted in hospital. This is more than the combined total of deaths from breast cancer, AIDS and traffic accidents". (1) Orthopaedic patients are at particular risk of VTE. In 2011, the project team carried out an audit into compliance with national VTE assessment guidelines on all acute trauma and orthopaedic admissions during a two week period at a District General Hospital. The study demonstrated that compliance was initially low, but showed a large improvement following the implementation of simple measures. The measures included: asking consultants to remind junior doctors, putting posters up in the trauma doctors office, asking nursing staff to check for a VTE assessment on admission to the ward, and putting reminders on the patient name board. The project team subsequently recommended an alteration to the hospital's computer system to incorporate a check of VTE assessment and prophylaxis. A second assessment using the same methodology sought to assess whether the previous improvements were sustained and the impact of this computer system alteration. Overall, compliance with national VTE guidance improved further.

  3. 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

  4. 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.

  5. Nationwide Databases in Orthopaedic Surgery Research.

    PubMed

    Bohl, Daniel D; Singh, Kern; Grauer, Jonathan N

    2016-10-01

    The use of nationwide databases to conduct orthopaedic research has expanded markedly in recent years. Nationwide databases offer large sample sizes, sampling of patients who are representative of the country as a whole, and data that enable investigation of trends over time. The most common use of nationwide databases is to study the occurrence of postoperative adverse events. Other uses include the analysis of costs and the investigation of critical hospital metrics, such as length of stay and readmission rates. Although nationwide databases are powerful research tools, readers should be aware of the differences between them and their limitations. These include variations and potential inaccuracies in data collection, imperfections in patient sampling, insufficient postoperative follow-up, and lack of orthopaedic-specific outcomes. PMID:27579813

  6. 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.

  7. Cervical spine trauma

    PubMed Central

    Torretti, Joel A; Sengupta, Dilip K

    2007-01-01

    Cervical spine trauma is a common problem with a wide range of severity from minor ligamentous injury to frank osteo-ligamentous instability with spinal cord injury. The emergent evaluation of patients at risk relies on standardized clinical and radiographic protocols to identify injuries; elucidate associated pathology; classify injuries; and predict instability, treatment and outcomes. The unique anatomy of each region of the cervical spine demands a review of each segment individually. This article examines both upper cervical spine injuries, as well as subaxial spine trauma. The purpose of this article is to provide a review of the broad topic of cervical spine trauma with reference to the classic literature, as well as to summarize all recently available literature on each topic. Identification of References for Inclusion: A Pubmed and Ovid search was performed for each topic in the review to identify recently published articles relevant to the review. In addition prior reviews and classic references were evaluated individually for inclusion of classic papers, classifications and previously unidentified references. PMID:21139776

  8. 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.

  9. Tissue engineering principles in orthopaedic surgery.

    PubMed

    Jackson, D W; Simon, T M

    1999-10-01

    Advances in the fields of biotechnology and biomaterials offer the orthopaedic surgeon the exciting possibility of repair or regeneration of tissue lost to injury, disease, or aging. The promising area of tissue engineering represents a multidisciplinary approach aimed at solving some of the most perplexing biologic problems, namely, the creation of new tissues and organs similar to the original tissues and organs. In addition, strategies using new synthetic polymer formulations can facilitate tissue replacement and represent alternatives to tissue regeneration in certain conditions. Although biotechnology has broad application over many medical specialties, orthopaedics is receiving a large focus of the research effort devoted to techniques for developing bone, articular cartilage, ligaments, and tendons. Because bioengineered tissue and/or techniques to stimulate tissue regeneration soon may be used clinically, orthopaedic surgeons should have a working knowledge of the basic concepts involved. Terms, such as biomaterial, biotechnology, matrices of synthetic or biologic polymers or both, adhesion, cohesion, porosity, induction, conduction, stem cell, progenitor cell, mesenchymal cell, tissue growth factor, bone morphogenetic protein, mitogenic and chemotactic factors, and numerous other terms will become part of the working language of clinicians of the twenty-first century.

  10. Veteran player tips the scale - V/Q SPECT-CT proves decisive in blunt chest trauma. Case report and brief literature review.

    PubMed

    Witkowska-Patena, Ewa; Mazurek, Andrzej; Dziuk, Mirosław

    2016-01-01

    A 29-year-old patient after blunt chest trauma with right lung atelectasis and pulmonary empyema was referred for lung ventilation and perfusion scintigraphy before right-sided pneumonectomy. Radionuclide imaging revealed severely reduced perfusion and lack of ventilation in the collapsed right lung. Additionally, it showed a matching lobar perfusion-ventilation defect in the lower left lobe, which, apart from consolidation area in posterior basal segment, appeared normal in computed tomography. A normal perfusion and ventilation pattern was observed in the upper left lobe. Since it was found to be the only functioning lobe, pneumonectomy was excluded from possible treatment options. PMID:26838945

  11. 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

  12. Suspension trauma

    PubMed Central

    Lee, Caroline; Porter, Keith M

    2007-01-01

    Suspension trauma (also known as “harness‐induced pathology” or “orthostatic shock while suspended”) is the development of presyncopal symptoms and loss of consciousness if the human body is held motionless in a vertical position for a period of time. It has been described in experiments of personal fall protection, and has been implicated in causes of death in mountaineering accidents, but it seems neither to be widely known about nor to have been presented to the medical profession. This article highlights the potential existence of suspension trauma and suggests that more robust medical research using modern harnesses and healthy volunteers would be beneficial to assess whether this is purely a theoretical risk. PMID:17384373

  13. A novel technique for the treatment of infected metalwork in orthopaedic patients using skin closure over irrigated negative pressure wound therapy dressings

    PubMed Central

    Chapman, AWP; Krikler, S; Krkovic, M

    2013-01-01

    Introduction There has been recent interest in the use of negative pressure wound therapy (NWPT) as an adjunct to parenteral antibiotics in the treatment of infection in orthopaedic patients with metalwork in situ. To address some of the limitations of standard NPWT in this situation, the senior author has developed a modified method of treatment for infected metalwork (excluding arthroplasty) in orthopaedic patients that includes irrigation and skin closure over the standard NPWT dressing. Methods This retrospective study examined the outcome of a case series of 16 trauma and orthopaedic patients with deep infection involving metalwork in whom this modified form of NPWT was used. In conjunction with standard parenteral antibiotic therapy and a multidisciplinary approach, this modified technique included serial debridements in theatre, irrigation and negative pressure dressings over a white polyvinyl alcohol foam (KCI, Kidlington, UK) as well as closure of the skin over the foam. Results Among the 16 patients, there was a variety of upper and lower limb as well as spinal trauma and elective cases. In all 16 patients, there was successful resolution of the infection with no early or unplanned removal of any metalwork required. Conclusions Patients with infected metalwork are a heterogeneous group, and often suffer high morbidity and mortality. The modified NPWT technique shows potential as an adjunct in the treatment of complex orthopaedic patients with infected metalwork. PMID:23484994

  14. 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

    ... Antitrust Division United States v. Idaho Orthopaedic Society, Timothy Doerr, Jeffrey Hessing, Idaho Sports.... Idaho Orthopaedic Society, Timothy Doerr, Jeffrey Hessing, Idaho Sports Medicine Institute, John Kloss..., Plaintiffs, vs. Idaho Orthopaedic Society, Timothy Doerr, Jeffrey Hessing, Idaho Sports Medicine...

  15. 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

  16. 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

  17. 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.…

  18. What do trainees think about advanced trauma life support (ATLS)?

    PubMed Central

    Campbell, B.; Heal, J.; Evans, S.; Marriott, S.

    2000-01-01

    Advanced trauma life support (ATLS) has become a desirable or even essential part of training for many surgeons and anaesthetists, but aspects of the ATLS course have attracted criticism. In the absence of published data on the views of trainees, this study sought their opinions in a structured questionnaire, which was completed by trainees in accident and emergency (A & E) (26), anaesthetic (82), general surgical (26), orthopaedic (42) and other (5) posts in different hospitals (response rate 66%). Of the trainees, 78% had done an ATLS course and, of these, 83% considered ATLS a 'major advantage' or 'essential' for practising their proposed specialty--100% for A & E, 94% for orthopaedics, 92% for general surgery, and 75% for anaesthetics. ATLS was considered a major curriculum vitae (CV) advantage by 94%, 85%, 50%, and 45%, respectively. Over 90% had positive attitudes towards ATLS, and 74% selected 'genuine improvement of management of trauma patients' as the most important reason for doing the course: 93% thought ATLS saved lives. Of the respondents, 83% thought that all existing consultants dealing with trauma patients should have done the course, and 41% thought it offered major advantages to doctors not involved in trauma. Funding problems for ATLS courses had been experienced by 14% trainees. This survey has shown that most trainees view ATLS positively. They believe that it provides genuine practical benefit for patients, and very few regard ATLS primarily as a career advantage or mandate. PMID:10932661

  19. 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

  20. 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.

  1. [Pathological fragmentation of the sesamoid bone of the index due to repetitive micro trauma: a case report and review of the literature].

    PubMed

    Moreel, P; Nanhekhan, L V; Le Viet, D

    2005-10-01

    Pathology of the sesamoid bones have been rarely described in the literature especially those of the index. We present the case of a 45 years old amateur tennis player who presented with pain on the radial border of the index finger at the level of the metacarpophalangeal joint. The clinical examination and the operative findings allow us to conclude that the symptoms were due to tendinitis of the flexors of the index associated with fracture of the sesamoid and cartilaginous degenerative changes. We also present a review of the literature.

  2. Massive pneumorrhachis, pneumocephalus and pneumoopticus following thoracic trauma and avulsion of the brachial plexus: case report and review of the literature.

    PubMed

    Derner, M; Drugová, B; Hořejší, L; Skvára, D; Druga, R

    2011-01-01

    A 41-year-old man with injury of right half of the thorax, fractures of the left crural bones and paralysis of the right upper limb was admitted to our hospital. A CT examination at admission revealed bilateral pulmonary contusion and bilateral fluid- and pneumothorax. In addition pneumomediastinum, pneumopericardium, subcutaneous emphysema and pneumorrhachis at the cervicothoracic transition was demonstrated. Abnormal findings in the skull and brain were not revealed. The fifth day after admission repeated CT examination demonstrated extensive frontal pneumocephalus on the right, presence of air in several cisterns and in the right optic nerve sheaths (pneumoopticus). Right frontal craniotomy was performed, dura mater was incised and air was evacuated. Rapid regression of pneomocephalus was evident postoperatively. The tenth day after admission MRI of the cervical spine and brachial plexus was performed. At the level of the C7 and C8, nerve roots pneumomenigocele and a nerve retracting ball indicating the presence of a nerve root injury were discernible. This case demonstrated that severe thoracic blunt trauma leads to acute increase of intrathoracic pressure with concomitant fluid- and pneumothorax, pneumomediastinum and pneumopericard. From the mediastinum air propagated subcutaneously. Disrupted cervical dural sheaths resulted in leakage of cerebrospinal fluid and entry of air from mediastinum to subdural and subarachnoid spinal and cranial space and to the subarachnoid space of the optic nerve.

  3. 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…

  4. 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

  5. Exploring trauma associated appraisals in trauma survivors from collectivistic cultures.

    PubMed

    Engelbrecht, Alberta; Jobson, Laura

    2016-01-01

    Appraisals are a key feature in understanding an individual's experience; this is especially important when the experience is a traumatic one. However, research is diminutive when looking at the interaction between trauma appraisals and culture in relation to posttraumatic stress disorder using qualitative methodologies. This study explored cultural differences in perceptions and appraisals of trauma using three qualitative focus groups with community members (n = 11) from collectivistic cultures who had experienced a traumatic event and three qualitative individual key informant interviews with mental health practitioners (n = 3) routinely working with trauma survivors. Using template analysis, eight emergent themes were highlighted from the data sets [(1) trauma and adjustment; (2) cultural and social roles; (3) traumatised self; (4) relationships; (5) external attribution; (6) future; (7) education; (8) language] that potentially have significant consequences for posttrauma psychological adjustment and recovery. Cumulatively, while a number of themes are similar to that which is emphasised in current literature (e.g. damaged self, negative appraisals of the world, others, future) a number of themes were also resonant and warrant further scrutiny. For instance, the importance and interconnectedness of the group to the individual and the impact trauma has on this; the importance of social roles, cultural appropriateness and violations of cultural values and norms; findings and implications are discussed. PMID:27652138

  6. Is it worth screening elective orthopaedic patients for carriage of Staphylococcus aureus? A part-retrospective case–control study in a Scottish hospital

    PubMed Central

    Dancer, Stephanie J; Christison, Fraser; Eslami, Attaolah; Gregori, Alberto; Miller, Roslyn; Perisamy, Kumar; Robertson, Chris; Graves, Nick

    2016-01-01

    Background With recent focus on methicillin-resistant Staphylococcus aureus (MRSA) screening, methicillin-susceptible S. aureus (MSSA) has been overlooked. MSSA infections are costly and debilitating in orthopaedic surgery. Methods We broadened MRSA screening to include MSSA for elective orthopaedic patients. Preoperative decolonisation was offered if appropriate. Elective and trauma patients were audited for staphylococcal infection during 2 6-month periods (A: January to June 2013 MRSA screening; B: January to June 2014 MRSA and MSSA screening). Trauma patients are not screened presurgery and provided a control. MSSA screening costs of a modelled cohort of 500 elective patients were offset by changes in number and costs of MSSA infections to demonstrate the change in total health service costs. Findings Trauma patients showed similar infection rates during both periods (p=1). In period A, 4 (1.72%) and 15 (6.47%) of 232 elective patients suffered superficial and deep MSSA infections, respectively, with 6 superficial (2%) and 1 deep (0.3%) infection among 307 elective patients during period B. For any MSSA infection, risk ratios were 0.95 (95% CI 0.41 to 2.23) for trauma and 0.28 (95% CI 0.12 to 0.65) for elective patients (period B vs period A). For deep MSSA infections, risk ratios were 0.58 (95% CI 0.20 to 1.67) for trauma and 0.05 (95% CI 0.01 to 0.36) for elective patients (p=0.011). There were 29.12 fewer deep infections in the modelled cohort of 500 patients, with a cost reduction of £831 678 for 500 patients screened. Conclusions MSSA screening for elective orthopaedic patients may reduce the risk of deep postoperative MSSA infection with associated cost-benefits. PMID:27601492

  7. Osteoporosis and the orthopaedic surgeon: basic concepts for successful co-management of patients' bone health.

    PubMed

    Farmer, Ryan P; Herbert, Benoit; Cuellar, Derly O; Hao, Jiandong; Stahel, Philip F; Yasui, Robin; Hak, David J; Mauffrey, Cyril

    2014-08-01

    Osteoporosis has been recognised as a public health concern for at least three decades but it has been relatively recent that the push has been for orthopaedic surgeons to take a more active role in the diagnosis and treatment of patients with decreased bone mineral density (BMD). Most often these patients are encountered after they have suffered a fracture making secondary prevention the area where orthopaedists may exert the greatest influence on patient care. The purpose of this article is to provide a succinct framework for the diagnosis and treatment of patients with decreased BMD. Patients are deemed to have decreased BMD if they have suffered a fragility fracture, a fracture caused by a low-energy traumatic event. These patients are often encountered in the emergency department and admitted for further treatment of their fractures or recommended for follow-up in the clinic. Regardless of treatment course these are opportunities for the orthopaedic surgeon to intervene in the osteoporotic disease process and positively affect a patient's bone health. This article compiles the available literature on osteoporosis and presents it succinctly with the incorporation of both a diagnosis algorithm and treatment profile table. With the use of these two tools, orthopaedic surgeons everywhere should be able to take a more active role in their patients' bone health.

  8. Multiple myeloma: diagnosis and orthopaedic implications.

    PubMed

    Scharschmidt, Thomas J; Lindsey, Joshua D; Becker, Pamela S; Conrad, Ernest U

    2011-07-01

    Multiple myeloma is a hematologic malignancy that commonly affects the skeletal system. The disease is primarily managed medically with chemotherapeutic agents. Pathologic fractures are common in patients with diagnosed and undiagnosed disease. The number of patients diagnosed with multiple myeloma is increasing, as is the incidence of associated pathologic fractures. Novel chemotherapeutic agents and radiation therapy protocols have been used to extend the average life span of patients with this disease. Various methods that allow for restoration of function and pain reduction can be used to stabilize and manage fractures associated with multiple myeloma. The orthopaedic surgeon and oncology team must work together to develop an individualized treatment plan to improve patient quality of life and provide pain relief.

  9. Incidence of surgical site infections and accompanying risk factors in Vietnamese orthopaedic patients.

    PubMed

    Thu, L T A; Dibley, M J; Ewald, B; Tien, N P; Lam, L D

    2005-08-01

    A cohort study of surgical site infections (SSIs) was conducted in 582 orthopaedic surgical patients at Cho Ray Hospital, a reference hospital in Ho Chi Minh City, Vietnam, in order to determine the incidence and analyse risk factors for SSIs in this population. The SSI incidence rate was 12.5% (73 of 582); 3.6% incisional SSIs, 6.8% deep incisional SSIs and 2.1% organ/space SSIs. The incidence increased from 2% in clean wounds to 44.6% in dirty wounds, or 1.3% in patients with a National Nosocomial Infections Surveillance (NNIS) risk index of 0 to 75% in patients with an NNIS risk ratio of 3. In multi-variate analysis, having a dirty wound [odds ratio (OR) 8.7; 95% confidence intervals (CI) 4.6--16.4], American Society of Anesthesiologists' score >2 (OR 3.9; 95%CI 1.8-8.8), procedures with external fixation (OR 2.9; 95%CI 1.4-5.9), emergency surgery with motor-vehicle-related trauma (OR 2.1; 95%CI 1.2-3.9), or duration of procedure >2h (OR 2.1; 95%CI 1.1-4.2) were independent risk factors for SSI. Lack of appropriate prophylaxis was of borderline significance (OR 3.2; 95%CI 0.9-11.1, P=0.06). Among 76 patients with SSIs, 22 patients were discovered during postdischarge follow-up. These late SSIs had age as an additional risk factor (OR 2.8; 95%CI 1.1-7.2). Our data show that SSIs were frequent and differed widely by wound class. The NNIS risk index was predictive of SSI for this population. With a high number of motor vehicle accidents in Vietnam, the majority of orthopaedic operations are trauma related. Emergency surgery for injuries sustained in these accidents, and procedures with external fixation were especially prone to infections.

  10. 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.

  11. [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

  12. Orthopaedic implant removal at Royal Naval Hospital Stonehouse: a three-year review.

    PubMed

    Howell, G E; Hand, C J; Dodenhoff, R

    1995-01-01

    A recent study stated that 11% of all elective orthopaedic procedures performed at a Regional Orthopaedic Unit involved removal of orthopaedic implants. Indications for certain orthopaedic implant removal remain unclear. As budgets are squeezed even tighter throughout all branches of the Royal Navy, we looked at each operation performed for orthopaedic implant removal at Royal Naval Hospital Stonehouse and questioned their effectiveness with respect to finance and working days lost for serving personnel. PMID:7562705

  13. Orthopaedic implant removal at Royal Naval Hospital Stonehouse: a three-year review.

    PubMed

    Howell, G E; Hand, C J; Dodenhoff, R

    1995-01-01

    A recent study stated that 11% of all elective orthopaedic procedures performed at a Regional Orthopaedic Unit involved removal of orthopaedic implants. Indications for certain orthopaedic implant removal remain unclear. As budgets are squeezed even tighter throughout all branches of the Royal Navy, we looked at each operation performed for orthopaedic implant removal at Royal Naval Hospital Stonehouse and questioned their effectiveness with respect to finance and working days lost for serving personnel.

  14. 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

  15. A systems approach to managing conflict in orthopaedic nursing.

    PubMed

    Maher, C A

    1991-01-01

    Conflict management is considered from a psychologic perspective. Therein, a systems approach to managing conflict is described with particular reference to orthopaedic nursing practice. Within that context, conflict management is portrayed as a process that is applied by orthopaedic nurses to particular conflict situations by means of separate, yet interrelated phases: clarification of the conflict situation; design of a conflict resolution plan; implementation of the plan; and evaluation of the extent to which conflict has been resolved. Application of this systems approach by orthopaedic nursing managers or by staff nurses may be valuable in focusing their attention and that of other health care providers on important behaviors, tasks, and accomplishments rather than on personality constructs and other noncontrollable correlates of managing conflict effectively. Directions for empirical inquiry relating to conflict management in orthopaedic nursing are briefly considered. PMID:2052411

  16. Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures.

    PubMed

    Watters, William; Rethman, Michael P; Hanson, Nicholas Buck; Abt, Elliot; Anderson, Paul A; Carroll, Karen C; Futrell, Harry C; Garvin, Kevin; Glenn, Stephen O; Hellstein, John; Hewlett, Angela; Kolessar, David; Moucha, Calin; O'Donnell, Richard J; O'Toole, John E; Osmon, Douglas R; Evans, Richard Parker; Rinella, Anthony; Steinberg, Mark J; Goldberg, Michael; Ristic, Helen; Boyer, Kevin; Sluka, Patrick; Martin, William Robert; Cummins, Deborah S; Song, Sharon; Woznica, Anne; Gross, Leeaht

    2013-03-01

    The Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures evidence-based clinical practice guideline was codeveloped by the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association. This guideline replaces the previous AAOS Information Statement, "Antibiotic Prophylaxis in Bacteremia in Patients With Joint Replacement," published in 2009. Based on the best current evidence and a systematic review of published studies, three recommendations have been created to guide clinical practice in the prevention of orthopaedic implant infections in patients undergoing dental procedures. The first recommendation is graded as Limited; this recommendation proposes that the practitioner consider changing the long-standing practice of routinely prescribing prophylactic antibiotic for patients with orthopaedic implants who undergo dental procedures. The second, graded as Inconclusive, addresses the use of oral topical antimicrobials in the prevention of periprosthetic joint infections. The third recommendation, a Consensus statement, addresses the maintenance of good oral hygiene.

  17. 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.

  18. Enhanced recovery after surgery (ERAS): an orthopaedic perspective.

    PubMed

    White, Jonathan J E; Houghton-Clemmey, Robert; Marval, Paul

    2013-10-01

    Enhanced recovery after surgery (ERAS) is a programme that aims to improve the care of elective surgical patients. Accelerated care pathways are delivered using a multidisciplinary approach, leading to reduced lengths of hospital stay, improved quality of treatment, and better outcomes. These programmes have gained considerable popularity in orthopaedics recently, however their widespread adoption remains to be seen. This article highlights the key evidence concerning ERAS in orthopaedic surgery. PMID:24279038

  19. 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

  20. Basal ganglia stroke due to mild head trauma in pediatric age - clinical and therapeutic management: a case report and 10 year literature review

    PubMed Central

    2011-01-01

    Ischemia of the basal ganglia as an immediate consequence of minor head injury in children is rare (< 2% of all ischemic stroke in childhood) and is due to vasospasm of the lenticulostriate arteries. The clinical history of these lesions is particularly favourable because they are usually small, and also because the facial-brachial-crural hemiparesis typical of this pathology usually regresses after a period ranging from several weeks to several months, despite the persistence of an ischemic area on MRI. This is due to the well known neuronal plasticity of the CNS, in particular, of the primary motor cortex. The most effective therapeutic approach appears to be the conservative one, although the best treatment regimen is still not well defined. Young patients should be closely monitored and treated conservatively with osmotic diuretics to reduce perilesional edema. At the same time, however, it is very important to exclude, by means of instrumental and laboratory studies, conditions that could favour the onset of ischemia, including emboligen heart disease, thrombophilia and acute traumatic arterial dissections. Generally speaking, the prognosis in these cases is good. The authors describe their experience treating a 10-month old baby girl, with a left lenticular nucleus ischemia and report a literature review. PMID:21210991

  1. Basal ganglia stroke due to mild head trauma in pediatric age - clinical and therapeutic management: a case report and 10 year literature review.

    PubMed

    Landi, Alessandro; Marotta, Nicola; Mancarella, Cristina; Marruzzo, Daniele; Salvati, Maurizio; Delfini, Roberto

    2011-01-06

    Ischemia of the basal ganglia as an immediate consequence of minor head injury in children is rare (< 2% of all ischemic stroke in childhood) and is due to vasospasm of the lenticulostriate arteries. The clinical history of these lesions is particularly favourable because they are usually small, and also because the facial-brachial-crural hemiparesis typical of this pathology usually regresses after a period ranging from several weeks to several months, despite the persistence of an ischemic area on MRI. This is due to the well known neuronal plasticity of the CNS, in particular, of the primary motor cortex. The most effective therapeutic approach appears to be the conservative one, although the best treatment regimen is still not well defined.Young patients should be closely monitored and treated conservatively with osmotic diuretics to reduce perilesional edema. At the same time, however, it is very important to exclude, by means of instrumental and laboratory studies, conditions that could favour the onset of ischemia, including emboligen heart disease, thrombophilia and acute traumatic arterial dissections. Generally speaking, the prognosis in these cases is good. The authors describe their experience treating a 10-month old baby girl, with a left lenticular nucleus ischemia and report a literature review.

  2. Preoperative Planning in Orthopaedic Surgery. Current Practice and Evolving Applications.

    PubMed

    Atesok, Kivanc; Galos, David; Jazrawi, Laith M; Egol, Kenneth A

    2015-12-01

    Preoperative planning is an essential prerequisite for the success of orthopaedic procedures. Traditionally, the exercise has involved the written down, step by step "blueprint" of the surgical procedure. Preoperative planning of the technical aspects of the orthopaedic procedure has been performed on hardcopy radiographs using various methods such as copying the radiographic image on tracing papers to practice the planned interventions. This method has become less practical due to variability in radiographic magnification and increasing implementation of digital imaging systems. Advances in technology along with recognition of the importance of surgical safety protocols resulted in widespread changes in orthopaedic preoperative planning approaches. Nowadays, perioperative "briefings" have gained particular importance and novel planning methods have started to integrate into orthopaedic practice. These methods include using software that enables surgeons to perform preoperative planning on digital radiographs and to construct 3D digital models or prototypes of various orthopaedic pathologies from a patient's CT scans to practice preoperatively. Evidence-to-date suggests that preoperative planning and briefings are effective means of favorably influencing the outcomes of orthopaedic procedures.

  3. Orthopaedic management in a mega mass casualty situation. The Israel Defence Forces Field Hospital in Haiti following the January 2010 earthquake.

    PubMed

    Bar-On, Elhanan; Lebel, Ehud; Kreiss, Yitshak; Merin, Ofer; Benedict, Shaike; Gill, Amit; Lee, Evgeny; Pirotsky, Anatoly; Shirov, Taras; Blumberg, Nehemia

    2011-10-01

    Following the January 2010 earthquake in Haiti, the Israel Defence Forces (IDF) established a field hospital in Port au Prince. The hospital started operating 89 h after the earthquake. We describe the experience of the orthopaedic department in a field hospital operating in an extreme mass casualty situation. The hospital contained 4 operating table and 72 hospitalization beds. The orthopaedic department included 8 orthopaedic surgeons and 3 residents. 1111 patients were treated in the hospital, 1041 of them had adequate records for inclusion. 684 patients were admitted due to trauma with a total of 841 injuries. 320 patients sustained 360 fractures, 18 had joint dislocations and 22 patients were admitted after amputations. 207 patients suffered 315 soft tissue injuries. 221 patients were operated on under general or regional anaesthesia. External fixation was used for stabilization of 48 adult femoral shaft fractures, 24 open tibial fractures and 1 open humeral fracture. All none femoral closed fractures were treated non-operatively. 18 joint reductions and 23 amputations were performed. Appropriate planning, training, operational versatility, and adjustment of therapeutic guidelines according to a constantly changing situation, enabled us to deliver optimal care to the maximal number of patients, in an overwhelming mass trauma situation.

  4. 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

  5. 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.

  6. 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

  7. 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.

  8. Trauma Facts for Educators

    ERIC Educational Resources Information Center

    National Child Traumatic Stress Network, 2008

    2008-01-01

    This paper offers facts which can help educators deal with children undergoing trauma. These include: (1) One out of every 4 children attending school has been exposed to a traumatic event that can affect learning and/or behavior; (2) Trauma can impact school performance; (3) Trauma can impair learning; (4) Traumatized children may experience…

  9. Orthopaedic inpatient rehabilitation conducted by nursing staff in acute orthopaedic wards in Taiwan.

    PubMed

    Lin, Pi-Chu; Wang, Ching-Hui; Liu, Yo-Yi; Chen, Chyang-Shiong

    2013-12-01

    The purpose of this study was to understand the postoperative rehabilitation patterns of orthopaedic patients and to explore factors which affected the patients' functional recovery. A descriptive study with convenience sampling was performed. Study participants included orthopaedic inpatients from two hospitals in Taipei. In total, 100 patients were selected with an average age of 60.88 ± 17.61 years, of which the most common type of surgery was a total knee replacement (49.0%). Among these participants, 79.0% received rehabilitation guided by nursing staff, while only 6.0% were instructed by a physical therapist. The predictive factor for the time to first ambulation was the intensity of pain experienced on the second day after the operation, which accounted for 4.5% of the total variance. As for the functional status prior to discharge, predictive factors included the time to first ambulation and whether nursing staff provided instructions on rehabilitation, which accounted for 11.2% of the total variance. We recommend that professional staff should promote patient guidance toward postoperative rehabilitation, assistance in achieving the first ambulation and a resolution of obstacles to rehabilitation.

  10. 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.

  11. 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.

  12. 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

  13. Current diversity in orthopaedics. Issues of race, ethnicity, and gender.

    PubMed

    England, S P; Pierce, R O

    1999-05-01

    The size and diversity of the United States orthopaedic workforce continues to interest academic graduate medical education analysts. Numerous medical groups have expressed the need for diversity in orthopaedics and in general medicine. The Association of American Medical Colleges has had two policies since the early 1970s concerning minorities in medicine. It was thought that special attention should be given to minority groups underrepresented in medicine and that the minority groups should be represented in medicine in the same proportion as in the population as a whole. The purpose of this paper was to examine the selection of orthopaedic residents during the past 12 years based on the candidates documented race, ethnicity, and gender. The diversity of orthopaedic residents changed minimally during the period of the study. The percentage of African American, Hispanic, Native American, Puerto Rican, and Mexican American orthopaedic residents essentially has remained unchanged. The percentage of Asian and Pacific Islander women has remained unchanged whereas the percentage of Asian and Pacific Islander men has quadrupled (2.2% in 1983 to 9.8% in 1995) during the 12 years of the study. The percentage of white women has remained virtually unchanged whereas that of white men has declined in direct relation to the increase in Asian or Pacific Islander men.

  14. 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

  15. The orthopaedic profession and industry: conflict or convergence of interests.

    PubMed

    Crowninshield, Roy

    2003-07-01

    Many improvements in orthopaedic care have been enabled by the relationship that exists between the orthopaedic profession and the orthopaedic industry. This relationship is multifactorial and includes new technology development, medical education, orthopaedic research, and patient education. Acting individually and collectively, the profession and the industry advance their standing by focusing on improved patient care. Although the industry, the profession, and the patient have many shared interests, they also may have real or potential conflicts of interests. The patient's interest in the quality of treatment outcome is shared by the profession and industry. However, the interests of the profession may include issues related to the success of their practices, management of their time, and advancement of their skills. Industry's interests, in turn, include the support of their customers and the success of their businesses. Conflicts of interest between these parties are potentially neither avoidable nor undesirable. Managed well, the relationship of the orthopaedic profession and the industry achieves the goals of each while advancing patient care. As the profession and the industry each experience change, continued attention should be directed to ensuring that the interest of each is advanced only in the context of serving the interest of the patient with musculoskeletal disorders.

  16. 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.

  17. 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

  18. 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.

  19. 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

  20. OASYS: a computerized auditing system for orthopaedic surgery.

    PubMed

    Stoodley, M A; Sikorski, J M

    1991-11-01

    Medical auditing based on individual diagnoses or specific therapies is well established. Auditing of all medical activity has an expanding role in quality assurance and research. In an attempt to overcome the limitations of existing auditing systems, a fundamentally different, flexible, high quality and easily accessible orthopaedic auditing system has been developed. This records a description of each component of patients' orthopaedic diagnoses, records treatment and complications, produces discharge letters and surgical log books and allows flexible and comprehensive audits. It has been in use in an orthopaedic service since January 1990 and has been successful in identifying problems and monitoring the effectiveness of changes. It is anticipated that the system will become more widely used and provide the basis for a 'user group' which will share the accumulated data and further development costs. PMID:1757163

  1. Orthopaedic implications of multiple gestation pregnancy with triplets.

    PubMed

    Bielski, Robert J; Gesell, Mark W; Teng, Andelle L; Cooper, Daniel H; Muraskas, Jonathan K

    2006-01-01

    Intrauterine crowding has been implicated as a risk factor in several orthopaedic conditions, such as developmental dysplasia of the hip (DDH), metatarsus adductus, and torticollis. The goal of this study was to see whether orthopaedic conditions associated with intrauterine crowding were more frequent in multiple gestation pregnancies, specifically in triplets. The authors reviewed their experience over a 10-year period with 261 children who were products of triplet pregnancies. They surveyed 13 orthopaedic conditions and found only one condition, torticollis, that had a greater incidence than that reported in single gestation pregnancies. A 0% incidence of DDH was found in these patients. Routine ultrasound screening cannot be recommended in these patients based on these results.

  2. [Stem cell-based therapy in orthopaedics and trauma surgery - current concepts].

    PubMed

    Randau, T M; Gravius, S; Nüssler, A

    2014-08-01

    Over the last few years, numerous new treatment methods have been developed for musculoskeletal diseases. Some of these new methods are based on the targeted use of stem cells to initiate healing processes, to compensate for deficits or to activate the regeneration of tendons, muscles, bones and cartilage. This goal can be achieved through the direct use of stem cells on or in a carrier material or through a combination with tissue engineering. In this article, we give a short overview of the possible fields of application of inducible pluripotent haematopoietic, and adult stem cells as well as on their use in musculoskeletal tissue. Furthermore, we provide a summary of the current legal situation concerning the application of stem cells in humans.

  3. 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

  4. 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…

  5. 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…

  6. 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…

  7. An Application of Art Therapy to the Trauma of Rape.

    ERIC Educational Resources Information Center

    Hargrave-Nykaza, Karen

    1994-01-01

    Explores rape in terms of specific trauma usually experienced after rape: posttraumatic stress disorder, rape trauma syndrome, and permanent life changes. Explores ways in which art therapy can help rape victim engage in healing. Reviews study of one rape victim and current literature as example of life-altering effects of rape and importance of…

  8. 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,…

  9. 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.

  10. 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

  11. Preceding trauma in childhood hematogenous bone and joint infections.

    PubMed

    Pääkkönen, Markus; Kallio, Markku J T; Lankinen, Petteri; Peltola, Heikki; Kallio, Pentti E

    2014-03-01

    Preceding trauma may play a role in the etiology and pathogenesis of hematogenous bone and joint infections. Among 345 children with an acute hematogenous bone and/or joint infection, 20% reported trauma during a 2-week period leading to infection. Blunt impact, bruises, or excoriations were commonly reported. The rate was similar to that in the general pediatric population obtained from the literature. In the study group, patients with and without trauma were similar in age, serum C-reactive protein and erythrocyte sedimentation rate, length of hospitalization, and late sequelae. Preceding minor trauma did not prove to be significant as an etiological or as a prognostic factor.

  12. [Diagnostics and therapy for periprosthetic joint infection in Germany - A survey of 450 hospitals and a comparison with the literature].

    PubMed

    Höll, S; Rieckesmann, B; Gosheger, G; Daniilidis, K; Dieckmann, R; Schulz, D

    2012-09-01

    The diagnosis and treatment of periprosthetic joint infections is a difficult situation for the attending physician. From the extensive literature, algorithms for diagnosis and therapy can be created. The aim of this study was to collect a representative survey of current concepts in the Federal States of the former West Germany and to compare them with those in the current literature. In 2011 orthopaedic and trauma clinics were surveyed anonymously in western Germany about diagnosis and treatment of periprosthetic infections. 450 questionnaires could be evaluated. Septic hip arthroplasty revisions were performed on average 12 (± 20)/year, septic knee arthroplasty revisions were performed on average 9 (± 17)/year. On average 205 (± 178) primary hip and 167 (± 155) primary knee arthroplasties were implanted/year. The analysis of the collected parameters is summarised in three tables. In the field of diagnostics, parameters such as CRP are determined. The interpretation, however, differs in more than 50 % of the hospitals on the relevant literature. Some important diagnostic parameters are not used. Therapy concepts are largely consistent with the literature. To a non-negligible extent, the vacuum-assisted therapy (approximately 30 % of hospitals) is used. In the literature it is described only for early infection. But even for use in early infection, there are very few data available. A unified diagnostic algorithm would be desirable. PMID:22918827

  13. Snowmobile trauma: 10 years' experience at Manitoba's tertiary trauma centre

    PubMed Central

    Stewart, Rena L.; Black, G. Brian

    2004-01-01

    Introduction According to the literature, the increased recreational use of the snowmobile has resulted in an increasing number of musculoskeletal injuries. We wished to examine whether previously described risk factors continue to be associated with snowmobile trauma and to identify previously unrecognized risks and specific patterns of injury. Methods We carried out a chart review of all snowmobile-related injuries over a 10-year period at the Health Sciences Centre in Winnipeg, the only level 1 trauma centre serving the Province of Manitoba, with particular attention to the risk factors of suboptimal lighting, excessive speed and alcohol consumption. Results We identified 480 injuries in 294 patients, and 81 (27.6%) of these patients died. Collisions accounted for 72% of the injury mechanisms. Of the injuries sustained, 31% occurred on roads. Excessive speed was a risk factor in 54% of patients, suboptimal lighting in 86% and a blood alcohol level greater than 0.08 in 70%. Musculoskeletal injuries accounted for 57% of those recorded. There were also brachial plexus injuries (3%) and knee dislocations (2%). To our knowledge, this is the largest study detailing injury associated with recreational use of snowmobiles in Canada. Conclusions Because snowmobile trauma is caused principally by human errors, it is potentially preventable. Efforts aimed at prevention must focus on the driver, who controls the common risk factors. The danger of snowmobiling while intoxicated must be emphasized. Trail-side monitoring is likely to be ineffective, as the majority of accidents do not occur on designated snowmobile trails. PMID:15132460

  14. 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

  15. Ventilation in chest trauma

    PubMed Central

    Richter, Torsten; Ragaller, Maximilian

    2011-01-01

    Chest trauma is one important factor for total morbidity and mortality in traumatized emergency patients. The complexity of injury in trauma patients makes it challenging to provide an optimal oxygenation while protecting the lung from further ventilator-induced injury to it. On the other hand, lung trauma needs to be treated on an individual basis, depending on the magnitude, location and type of lung or chest injury. Several aspects of ventilatory management in emergency patients are summarized herein and may give the clinician an overview of the treatment possibilities for chest trauma victims. PMID:21769213

  16. 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

  17. 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

  18. 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.

  19. Complex M&E for new orthopaedic centre.

    PubMed

    Briars, Paul

    2016-03-01

    Paul Briars, North West regional director for independent engineering, IT, and facilities services business, NG Bailey (pictured), discusses the company's part in a major redevelopment at one of the UK's top orthopaedic hospitals, Wrightington Hospital in Lancashire --famous as the site, in the early 1960s, of first ever hip replacement operations, by pioneering surgeon, Professor Sir John Charnley (HEJ --April 2013).

  20. 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

  1. 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.

  2. 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…

  3. 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.

  4. Treating childhood trauma.

    PubMed

    Terr, Lenore C

    2013-01-01

    This review begins with the question "What is childhood trauma?" Diagnosis is discussed next, and then the article focuses on treatment, using 3 basic principles-abreaction, context, and correction. Treatment modalities and complications are discussed, with case vignettes presented throughout to illustrate. Suggestions are provided for the psychiatrist to manage countertransference as trauma therapy proceeds.

  5. 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

  6. 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

  7. 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

  8. Maxillofacial trauma resulting from terror in Israel.

    PubMed

    Ringler, Doron; Einy, Shmuel; Giveon, Adi; Goldstein, Liab; Peleg, Kobi

    2007-01-01

    During a 33 month period, maxillofacial injuries resulting from terrorist attacks in Israel were compared with non-terror trauma maxillofacial injuries. Files of patients hospitalized from October 1, 2000 to June 30, 2003 were obtained from the Israel National Trauma Registry. Data were evaluated and compared with a hospitalized non-terror related trauma population within the same period. A literature survey was also conducted. Terror casualties totaled 1,811. In 493 patients with facial injuries, 322 had soft facial tissue injuries (excluding eyes and ears), and 104 had hard tissue injuries of the maxillofacial complex. A significantly higher prevalence was found in terror casualties (explosions and gunshots) compared with non-terror related casualties. Most suffered multiple injuries. Maxillofacial terror casualties experience a unique epidemiology, with more severe injuries and higher prevalence of soft and hard tissue injuries. Preparedness and awareness to the unique pattern of injuries are needed when terrorists strike.

  9. 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

  10. 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.

  11. 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.

  12. 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

  13. Bone and metal: an orthopaedic perspective on osseointegration of metals.

    PubMed

    Goriainov, Vitali; Cook, Richard; M Latham, Jeremy; G Dunlop, Douglas; Oreffo, Richard O C

    2014-10-01

    The area of implant osseointegration is of major importance, given the predicted significant rise in the number of orthopaedic procedures and an increasingly ageing population. Osseointegration is a complex process involving a number of distinct mechanisms affected by the implant bulk properties and surface characteristics. Our understanding and ability to modify these mechanisms through alterations in implant design is continuously expanding. The following review considers the main aspects of material and surface alterations in metal implants, and the extent of their subsequent influence on osseointegration. Clinically, osseointegration results in asymptomatic stable durable fixation of orthopaedic implants. The complexity of achieving this outcome through incorporation and balance of contributory factors is highlighted through a clinical case report.

  14. 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.

  15. 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

  16. Competency-based education: a new model for teaching orthopaedics.

    PubMed

    Alman, Benjamin A; Ferguson, Peter; Kraemer, William; Nousiainen, Markku T; Reznick, Richard K

    2013-01-01

    The current methods used to train residents to become orthopaedic surgeons are based on tradition, not evidence-based models. Educators have only a limited ability to assess trainees for competency using validated tests in various domains. The reduction in resident work hours limits the time available for clinical training, which has resulted in some calls for lengthening the training process. Another approach to address limited training hours is to focus training in a program that allows residents to graduate from a rotation based on demonstrated competency rather than on time on a service. A pilot orthopaedic residency curriculum, which uses a competency-based framework of resident training and maximizes the use of available training hours, has been designed and is being implemented.

  17. Improving theatre efficiency and utilisation through early identification of trauma patients and enhanced communication between teams.

    PubMed

    Roberts, Simon; Saithna, Adnan; Bethune, Rob

    2015-01-01

    Surgical departments are increasingly put under pressure to improve services, cut waiting lists, increase efficiency and save money. At a district general hospital in the west-midlands we approached the challenge of improving efficiency and optimising the services available in our orthopaedic theatres. Data was collected on: anaesthetic start times, operation start and finish times, and reasons for delay in our trauma theatre over a period from October 2014 to January 2015. During this period a change was implemented to improve the start time of the first operation of each day in the trauma theatre. Through adaptation of a method developed by Javed S et al, a patient was pre-selected by the on-call team and given the name the "golden patient" the day before they were due to be operated upon. This nominated patient would then be fixed at the start of the trauma theatre list the following day. The list would only then change if a "life or limb threatening" case was admitted overnight. The on-call team would prioritise that this patient was optimised for theatre and the theatre staff would ensure the surgical instruments were prepared. A PDSA cycle method was used, collecting data on 80 orthopaedic trauma cases during the period, and demonstrated a 59 minute (95% CI 45-72) improvement in start times from 10:49 AM to 9:50 AM with a p-value of 0.00024 with the intervention of early allocation of the first patient on the trauma list. A relatively simple intervention tool designed to improve communication within and between health-care teams can have a significant impact on the efficiency of a complex environment such as a trauma theatre.

  18. Improving theatre efficiency and utilisation through early identification of trauma patients and enhanced communication between teams

    PubMed Central

    Roberts, Simon; Saithna, Adnan; Bethune, Rob

    2015-01-01

    Surgical departments are increasingly put under pressure to improve services, cut waiting lists, increase efficiency and save money. At a district general hospital in the west-midlands we approached the challenge of improving efficiency and optimising the services available in our orthopaedic theatres. Data was collected on: anaesthetic start times, operation start and finish times, and reasons for delay in our trauma theatre over a period from October 2014 to January 2015. During this period a change was implemented to improve the start time of the first operation of each day in the trauma theatre. Through adaptation of a method developed by Javed S et al, a patient was pre-selected by the on-call team and given the name the “golden patient” the day before they were due to be operated upon. This nominated patient would then be fixed at the start of the trauma theatre list the following day. The list would only then change if a “life or limb threatening” case was admitted overnight. The on-call team would prioritise that this patient was optimised for theatre and the theatre staff would ensure the surgical instruments were prepared. A PDSA cycle method was used, collecting data on 80 orthopaedic trauma cases during the period, and demonstrated a 59 minute (95% CI 45-72) improvement in start times from 10:49 AM to 9:50 AM with a p-value of 0.00024 with the intervention of early allocation of the first patient on the trauma list. A relatively simple intervention tool designed to improve communication within and between health-care teams can have a significant impact on the efficiency of a complex environment such as a trauma theatre. PMID:26734340

  19. 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

  20. Orthopaedic applications of nanoparticle-based stem cell therapies

    PubMed Central

    2012-01-01

    Stem cells have tremendous applications in the field of regenerative medicine and tissue engineering. These are pioneering fields that aim to create new treatments for disease that currently have limited therapies or cures. A particularly popular avenue of research has been the regeneration of bone and cartilage to combat various orthopaedic diseases. Magnetic nanoparticles (MNPs) have been applied to aid the development and translation of these therapies from research to the clinic. This review highlights contemporary research for the applications of iron-oxide-based MNPs for the therapeutic implementation of stem cells in orthopaedics. These MNPs comprise of an iron oxide core, coated with a choice of biological polymers that can facilitate the uptake of MNPs by cells through improving endocytic activity. The combined use of these oxides and the biological polymer coatings meet biological requirements, effectively encouraging the use of MNPs in regenerative medicine. The association of MNPs with stem cells can be achieved via the process of endocytosis resulting in the internalisation of these particles or the attachment to cell surface receptors. This allows for the investigation of migratory patterns through various tracking studies, the targeting of particle-labelled cells to desired locations via the application of an external magnetic field and, finally, for activation stem cells to initiate various cellular responses to induce the differentiation. Characterisation of cell localisation and associated tissue regeneration can therefore be enhanced, particularly for in vivo applications. MNPs have been shown to have the potential to stimulate differentiation of stem cells for orthopaedic applications, without limiting proliferation. However, careful consideration of the use of active agents associated with the MNP is suggested, for differentiation towards specific lineages. This review aims to broaden the knowledge of current applications, paving the way to

  1. Orthodontic/orthopaedic adjunct of fixed orthodontic appliances.

    PubMed

    Loh, K W

    1986-07-01

    In the treatment of malocclusion more emphasis is now placed on obtaining an excellent facial result as well as a set of teeth which is well aligned and in good function. The use of dento facial orthopaedic appliances have made these objectives possible. Not only can cases be finished better, they can also be completed in a shorter period of time. This paper reviews some of such appliances and case reports will also be presented.

  2. 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

  3. 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

  4. [Bilateral Dislocation Fracture of the Humeral Head (Right AO 11C3.3; Left AO 11A1.3) without Direct Trauma Due to First Clinical Manifestation of Seizure - a Case Report and Review of the Literature].

    PubMed

    Ploeger, M M; Pennekamp, P H; Müller, M C; Kabir, K; Burger, C; Wirtz, D C; Schmolders, J

    2015-12-01

    The incidence of fractures among epileptics is frequent and mostly occurs by direct trauma due to falls caused by seizures. The risk of fractures is estimated to be 50 % higher in epileptics than in the general population. Most of the fractures affect the proximal femora and the hip joint. Dorsal shoulder dislocations occur frequently in epileptics. If they occur bilaterally, this is pathognomonic for seizuring. Besides this, shoulder dislocation and bilateral dislocation fractures of the humeral head, however, are far more rare even among epileptics but pathognomonic for seizure. In this case report we present a female patient with bilateral dislocation fracture of the humeral head due to first clinical manifestation of a tonic-clonic seizure without direct trauma.

  5. Nuances in pediatric trauma.

    PubMed

    Kenefake, Mary Ella; Swarm, Matthew; Walthall, Jennifer

    2013-08-01

    Pediatric trauma evaluation mimics adult stabilization in that it is best accomplished with a focused and systematic approach. Attention to developmental differences, anatomic and physiologic nuances, and patterns of injury equip emergency physicians to stabilize and manage pediatric injury.

  6. Acquired Cerebral Trauma: Epilogue.

    ERIC Educational Resources Information Center

    Bigler, Erin D., Ed.

    1988-01-01

    The article summarizes a series of articles concerning acquired cerebral trauma. Reviewed are technological advances, treatment, assessment, potential innovative therapies, long-term outcome, family impact of chronic brain injury, and prevention. (DB)

  7. Trauma-Informed Schools.

    PubMed

    Wiest-Stevenson, Courtney; Lee, Cindy

    2016-01-01

    Violence has impacted every aspect of daily life. These tragedies have shocked the world. This has resulted in school communities being fractured. Additionally, The National Survey of Children Exposed to Violence found that 60% of the children surveyed have been exposed to some form of trauma, either in or out of school. Traumatology research has shown most people respond to a wide range of traumatic events in similar ways. The common responses include traumatic responses, posttraumatic stress responses, and posttraumatic stress disorder (PTSD). In this article the authors outline the impact of trauma on children within school systems; discuss the mental health services schools are providing; present a trauma-informed school model; identifies tools which can be utilized in schools; and provide resources needed for a trauma-informed school, along with additional tools and resources. The authors discuss future recommendations for the community and schools as traumatic events continue to grow and impact a large number of children.

  8. Management of orthopaedic surgery in rare bleeding disorders.

    PubMed

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

    2014-09-01

    Knowledge regarding the management of orthopaedic surgery in patients with rare bleeding disorders (RBDs) is limited. Retrospective data collection and analysis of 35 orthopaedic procedures (6 minor and 29 major) carried out in 22 patients with RBD between 1982 and 2013. These surgeries were performed using heterogeneous regimens of hemostatic therapy, except for seven procedures performed with no hemostatic treatment in four patients with mild factor deficiency. Of the 28 procedures carried out with hemostatic treatment, nine (32%) were performed using replacement therapy with dosages of concentrates of the deficient factor aimed to achieve perioperative plasma levels judged to be compatible with hemostasis; three (11%) using factor replacement therapy associated with fresh frozen plasma (FFP); four (14%) using recombinant activated factor VII; four (14%) using virus inactivated plasma alone; three (11%) using virus inactivated plasma associated with desmopressin; one (4%) using FFP alone; and four (14%) procedures using tranexamic acid alone. Bleeding complications occurred in 7 of 35 procedures (20%) involving five patients. Prophylaxis of venous thromboembolism was performed only in one case with no excessive bleeding, but two patients not on thromboprophylaxis developed superficial thrombophlebitis. A satisfactory control of hemostasis was achieved in most patients. In some of those characterized by mild factor deficiency (FVII, FXI) hemostatic treatment could be avoided in some instances. The control of hemostasis combined with an adequate surgical technique is needed for the successful outcome of orthopaedic surgery in RBDs that requires the involvement of specialized haemophilia centres.

  9. 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

  10. 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

  11. Regenerative orthopaedics: in vitro, in vivo...in silico.

    PubMed

    Geris, Liesbet

    2014-09-01

    In silico, defined in analogy to in vitro and in vivo as those studies that are performed on a computer, is an essential step in problem-solving and product development in classical engineering fields. The use of in silico models is now slowly easing its way into medicine. In silico models are already used in orthopaedics for the planning of complicated surgeries, personalised implant design and the analysis of gait measurements. However, these in silico models often lack the simulation of the response of the biological system over time. In silico models focusing on the response of the biological systems are in full development. This review starts with an introduction into in silico models of orthopaedic processes. Special attention is paid to the classification of models according to their spatiotemporal scale (gene/protein to population) and the information they were built on (data vs hypotheses). Subsequently, the review focuses on the in silico models used in regenerative orthopaedics research. Contributions of in silico models to an enhanced understanding and optimisation of four key elements-cells, carriers, culture and clinics-are illustrated. Finally, a number of challenges are identified, related to the computational aspects but also to the integration of in silico tools into clinical practice.

  12. Musculoskeletal ultrasound education: orthopaedic resident ability following a multimedia tutorial.

    PubMed

    Piposar, Jonathan R; Easley, Mark; Nunley, James A; DeOrio, James K; Talusan, Paul G; Gubler, Kyle E; Reach, John S

    2015-01-01

    Musculoskeletal ultrasound (MSK-US) is a quick and effective imaging tool that can be utilized by orthopaedic surgeons to identify common musculoskeletal pathology such as ankle tendinopathy. This study evaluated the ability of 15 orthopaedic surgery residents to identify and measure ankle tendons after attending a multimedia tutorial on MSK-US. Afterwards, proficiency of usage was assessed by identification and quantification of three ankle tendons (Achilles, tibialis posterior, and flexor hallucis longus) in a cadaver limb. Resident comfort level and plan for future use were also assessed. After completing the tutorial, accuracy measuring the Achilles, tibialis posterior, and flexor hallucis longus tendons was 94.8%, 90.2%, and 90.1%, respectively. Resident comfort level improved from a level of 2.3 before the tutorial to 6.8 afterwards. Seventy-one percent of residents plan to use ultrasound in clinical practice. These results show that orthopaedic surgery residents can identify and assess tendon size via MSK-US with sufficient accuracy after a multimedia tutorial. PMID:25830266

  13. Material properties of common suture materials in orthopaedic surgery.

    PubMed

    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

  14. 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

  15. 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.

  16. Quality of trauma care and trauma registries.

    PubMed

    Pino Sánchez, F I; Ballesteros Sanz, M A; Cordero Lorenzana, L; Guerrero López, F

    2015-03-01

    Traumatic disease is a major public health concern. Monitoring the quality of services provided is essential for the maintenance and improvement thereof. Assessing and monitoring the quality of care in trauma patient through quality indicators would allow identifying opportunities for improvement whose implementation would improve outcomes in hospital mortality, functional outcomes and quality of life of survivors. Many quality indicators have been used in this condition, although very few ones have a solid level of scientific evidence to recommend their routine use. The information contained in the trauma registries, spread around the world in recent decades, is essential to know the current health care reality, identify opportunities for improvement and contribute to the clinical and epidemiological research.

  17. Noninvasive ventilation in trauma

    PubMed Central

    Karcz, Marcin K; Papadakos, Peter J

    2015-01-01

    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. Pediatric trauma care in Africa: the evolution and challenges.

    PubMed

    Abdur-Rahman, Lukman O; van As, A B Sebastian; Rode, Heinz

    2012-05-01

    Childhood trauma is one of the major health problems in the world. Although pediatric trauma is a global phenomenon in low- and middle-income countries, sub-Saharan countries are disproportionally affected. We reviewed the available literature relevant to pediatric trauma in Africa using the MEDLINE database, local libraries, and personal contacts. A critical review of all cited sources was performed with an emphasis on the progress made over the past decades as well as the ongoing challenges in the prevention and management of childhood trauma. After discussing the epidemiology and spectrum of pediatric trauma, we focus on the way forward to reduce the burden of childhood injuries and improve the management and outcome of injured children in Africa.

  20. Global Musculoskeletal Health: Inaugural Meeting of the International Society of Orthopaedic Centers

    PubMed Central

    Sculco, Thomas P.

    2008-01-01

    The International Society of Orthopaedic Centers (ISOC) was founded in 2006 to function as a think tank for leading international orthopaedic academic centers. ISOC’s mission is to facilitate the exchange of ideas and cutting edge practices among these centers and to work together on patient care, education, and research in order to make global improvements in orthopaedic care. The inaugural meeting, hosted by Hospital for Special Surgery on May 17–19, 2007, is described here. PMID:18958528

  1. Trauma systems and the costs of trauma care.

    PubMed Central

    Goldfarb, M G; Bazzoli, G J; Coffey, R M

    1996-01-01

    OBJECTIVE. This study examines the cost of providing trauma services in trauma centers organized by publicly administered trauma systems, compared to hospitals not part of a formal trauma system. DATA SOURCES AND STUDY SETTING. Secondary administrative discharge abstracts for a national sample of severely injured trauma patients in 44 trauma centers and 60 matched control hospitals for the year 1987 were used. STUDY DESIGN. Retrospective univariate and multivariate analyses were conducted to examine the impact of formal trauma systems and trauma center designation on the costs of treating trauma patients. Key dependent variables included length of stay, charge per day per patient, and charge per hospital stay. Key impact variables were type of trauma system and level of trauma designation. Control variables included patient, hospital, and community characteristics. DATA COLLECTION/EXTRACTION METHODS. Data were selected for hospitals based on (1) a large national hospital discharge database, the Hospital Cost and Utilization Project, 1980-1987 (HCUP-2) and (2) a special survey of trauma systems and trauma designation undertaken by the Hospital Research and Educational Trust of the American Hospital Association. PRINCIPAL FINDINGS. The results show that publicly designated Level I trauma centers, which are the focal point of most trauma systems, have the highest charge per case, the highest average charge per day, and similar or longer average lengths of stay than other hospitals. These findings persist after controlling for patient injury and health status, and for demographic characteristics and hospital and community characteristics. CONCLUSIONS. Prior research shows that severely injured trauma patients have greater chances of survival when treated in specialized trauma centers. However, findings here should be of concern to the many states developing trauma systems since the high costs of Level I centers support limiting the number of centers designated at this

  2. Systemic inflammation after trauma.

    PubMed

    Lenz, Andreas; Franklin, Glen A; Cheadle, William G

    2007-12-01

    Trauma is still one of the main reasons for death among the population worldwide. Mortality occurring early after injury is due to "first hits", including severe organ injury, hypoxia, hypovolaemia or head trauma. Massive injury leads to activation of the immune system and the early inflammatory immune response after trauma has been defined as systemic inflammatory response syndrome (SIRS). "Second hits" such as infections, ischaemia/reperfusion or operations can further augment the pro-inflammatory immune response and have been correlated with the high morbidity and mortality in the latter times after trauma. SIRS can lead to tissue destruction in organs not originally affected by the initial trauma with subsequent development of multi-organ dysfunction (MOD). The initial pro-inflammatory response is followed by an anti-inflammatory response and can result in immune suppression with high risk of infection and sepsis. Trauma causes activation of nearly all components of the immune system. It activates the neuroendocrine system and local tissue destruction and accumulation of toxic byproducts of metabolic respiration leads to release of mediators. Extensive tissue injury may result in spillover of these mediators into the peripheral bloodstream to further maintain and augment the pro-inflammatory response. Hormones like ACTH, corticosteroids and catecholamines as well as cytokines, chemokines and alarmins play important roles in the initiation and persistence of the pro-inflammatory response after severe injury. The purpose of this review is therefore to describe the immunological events after trauma and to introduce important mediators and pathways of the inflammatory immune response.

  3. 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…

  4. Myofascial Release as a Treatment for Orthopaedic Conditions: A Systematic Review

    PubMed Central

    McKenney, Kristin; Elder, Amanda Sinclair; Elder, Craig; Hutchins, Andrea

    2013-01-01

    Objective: To critically analyze published literature to determine the effectiveness of myofascial release therapy as a treatment for orthopaedic conditions. Data Sources: We searched the following electronic databases: MEDLINE, CINAHL, Academic Search Premier, Cochrane Library, and Physiotherapy Evidence Database (PEDro), with key words myofascial release, myofascial release therapy, myofascial release treatment, musculoskeletal, and orthopedic. No date limitations were applied to the searches. Study Selection: Articles were selected based upon the use of the term myofascial release in the abstract or key words. Final selection was made by applying the inclusion and exclusion criteria to the full text. Studies were included if they were English-language, peer-reviewed studies on myofascial release for an orthopaedic condition in adult patients. Ten studies were eligible. Data Extraction: Data collected were number of participants, condition being treated, treatment used, control group, outcome measures and results. Studies were analyzed using the PEDro scale and the Center for Evidence-Based Medicine's Levels of Evidence Scale. Data Synthesis: Study scores on the PEDro scale ranged from 6 of 10 to 8 of 10. Based on the Levels of Evidence Scale, the case studies (n = 6) were of lower quality, with a rank of 4. Three of the 4 remaining studies were rated at 2b, and the final study was rated at 1b. Conclusions: The quality of studies was mixed, ranging from higher-quality experimental to lower-quality case studies. Overall, the studies had positive outcomes with myofascial release, but because of the low quality, few conclusions could be drawn. The studies in this review may serve as a good foundation for future randomized controlled trials. PMID:23725488

  5. 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.

  6. Critical decisions in trauma of the thoracic aorta.

    PubMed

    Degiannis, E; Boffard, K

    2002-05-01

    Trauma to the thoracic aorta is a significant injury with a high mortality. This mortality is partly due to the delayed recognition of the condition. The increase of motor vehicle accidents and the use of firearms worldwide has resulted in an increase of the incidence of trauma to the thoracic aorta. Certain new developments in diagnosis and management have resulted in traditional methods being questioned. This review analyses current literature and data which we attempt to evaluate.

  7. 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.

  8. 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

  9. 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.

  10. Transfusion practices in trauma.

    PubMed

    Ramakrishnan, V Trichur; Cattamanchi, Srihari

    2014-09-01

    Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs) and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury. PMID:25535424

  11. Transfusion practices in trauma

    PubMed Central

    Ramakrishnan, V Trichur; Cattamanchi, Srihari

    2014-01-01

    Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs) and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury. PMID:25535424

  12. 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

  13. Sonography of scrotal trauma.

    PubMed

    Rao, Meka Srinivasa; Arjun, Kalyanpur

    2012-10-01

    The purpose of this article is to depict the spectrum of scrotal injuries in blunt trauma. Scrotal injuries are not very common and are mostly due to blunt trauma from direct injury, sports injuries or motor vehicle accidents. To minimize complications and ensure testicular salvage, rapid and accurate diagnosis is necessary. High-resolution USG is the investigation of choice, as it is readily available, accurate and has been seen to improve outcomes. An understanding of and familiarity with the sonographic appearance of scrotal injuries on the part of the radiologist/sonographer is therefore of key importance. PMID:23833421

  14. 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…

  15. 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

  16. Renal and Gastrointestinal Considerations in Patients Undergoing Elective Orthopaedic Surgery.

    PubMed

    Pyrko, Peter; Parvizi, Javad

    2016-01-01

    To minimize perioperative complications after orthopaedic procedures, patients may undergo medical optimization, which includes an assessment of their renal function and gastrointestinal (GI) system. The GI and renal systems are complex, and their proper optimization in the preoperative period can influence the success of any procedure. Several factors can prevent complications and reduce morbidity, mortality, and the cost of care, including a thorough evaluation and screening, with particular emphasis on anemia and its renal and GI causes; management of medications that are metabolized by the liver and excreted by the kidneys; and careful attention to the patient's nutritional status.

  17. 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

  18. Trauma sonography for use in microgravity.

    PubMed

    Kirkpatrick, Andrew W; Jones, Jeffrey A; Sargsyan, Ashot; Hamilton, Douglas R; Melton, Shannon; Beck, George; Nicolau, Savvas; Campbell, Mark; Dulchavsky, Scott

    2007-04-01

    Sonography is the only medical imaging modality aboard the ISS, and is likely to remain the leading imaging modality in future human spaceflight programs. While trauma sonography (TS) has been well recognized for terrestrial trauma settings, the technique had to be evaluated for suitability in spaceflight prior to adopting it as an operational capability. The authors found the following four-phased evaluative approach applicable to this task: 1) identifying standard or novel terrestrial techniques for potential use in space medicine; 2) developing and testing these techniques with suggested modifications on the ground (1 G) either in clinical settings or in animal models, as appropriate; 3) evaluating and refining the techniques in parabolic flight (0 G); and 4) validating and implementing for clinical use in space. In Phase I of the TS project, expert opinion and literature review suggested TS to be a potential screening tool for trauma in space. In Phase II, animal models were developed and tested in ground studies, and clinical studies were carried out in collaborating trauma centers. In Phase III, animal models were flight-tested in the NASA KC-135 Reduced Gravity Laboratory. Preliminary results of the first three phases demonstrated the potential clinical utility of TS in microgravity. Phase IV studies have begun to address crew training issues, onboard imaging protocols, and data transfer procedures necessary to offer the modified TS technique for space use.

  19. 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…

  20. 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,…

  1. Trauma and the endocrine system.

    PubMed

    Mesquita, Joana; Varela, Ana; Medina, José Luís

    2010-12-01

    The endocrine system may be the target of different types of trauma with varied consequences. The present article discusses trauma of the hypothalamic-pituitary axes, adrenal glands, gonads, and pancreas. In addition to changes in circulating hormone levels due to direct injury to these structures, there may be an endocrine response in the context of the stress caused by the trauma.

  2. Quality of operation notes in orthopaedic hip arthroplasty surgery: are we complying with British Orthopaedic Association's guide to good practice?

    PubMed

    Menakaya, C U; Ingoe, H; Malhotra, R; Shah, M; Boddice, T; Mohsen, A

    2013-12-01

    This retrospective audit evaluates the compliance of our operation notes with the British Orthopaedic Society Primary Hip Arthroplasty 'A guide to good practice' using a 24-data point question (BOA 2006). Ninety-nine notes reviewed, of which 94% had patient identifiers, the surgical team was documented in 92.5%, post-operative instruction in 97%, and prosthesis stability in 97% of cases. Despite high standards, we did not achieve the 100% gold standard. We suggest that increased awareness of the 24-point BOA guideline via education and proformas would help to ensure better practice

  3. Pediatric spinal trauma.

    PubMed

    Huisman, Thierry A G M; Wagner, Matthias W; Bosemani, Thangamadhan; Tekes, Aylin; Poretti, Andrea

    2015-01-01

    Pediatric spinal trauma is unique. The developing pediatric spinal column and spinal cord deal with direct impact and indirect acceleration/deceleration or shear forces very different compared to adult patients. In addition children are exposed to different kind of traumas. Moreover, each age group has its unique patterns of injury. Familiarity with the normal developing spinal anatomy and kind of traumas is essential to correctly diagnose injury. Various imaging modalities can be used. Ultrasound is limited to the neonatal time period; plain radiography and computer tomography are typically used in the acute work-up and give highly detailed information about the osseous lesions. Magnetic resonance imaging is more sensitive for disco-ligamentous and spinal cord injuries. Depending on the clinical presentation and timing of trauma the various imaging modalities will be employed. In the current review article, a summary of the epidemiology and distribution of posttraumatic lesions is discussed in the context of the normal anatomical variations due to progressing development of the child. PMID:25512255

  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. Minimizing Promotion Trauma.

    ERIC Educational Resources Information Center

    Darling, LuAnn W.; McGrath, Loraine

    1983-01-01

    Nursing administrators can minimize promotion trauma and its unnecessary cost by building awareness of the transition process, clarifying roles and expectations, and attending to the promoted employee's needs. This article will help nursing administrators develop a concept of manager care combined with programs for orientation of new managers,…

  6. 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…

  7. Trauma induced myocardial infarction.

    PubMed

    Lolay, Georges A; Abdel-Latif, Ahmed K

    2016-01-15

    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.

  8. Nanobiotechnology Perspectives on Prevention and Treatment of Ortho-paedic Implant Associated Infection.

    PubMed

    Borse, Vivek; Pawar, Vaishali; Shetty, Gautam; Mullaji, Arun; Srivastava, Rohit

    2016-01-01

    Implants are an inevitable part of orthopaedic surgery. However, implant associated infection remains a major challenge for orthopaedic surgeons and researchers. This review focuses on current options available for prevention of implant associated infection, their drawbacks and future promising applications of nanotechnology-based approaches. Nanobiotechnology has shown remarkable progress in recent years especially in biomaterials, diagnostics, and drug delivery system. Although several applications of nanobiotechnology in orthopaedics have been described, few have elaborated their role in the prevention of implant related infection in orthopaedics. Novel "smart" drug delivery systems that release antibiotics locally in response to stimuli such as pH, temperature, enzymes or antigens; implant surface modification on a nanoscale to inhibit bacterial adhesion and propagation at the surgical site and biological approaches such as gene therapy to neutralize bacterial virulence and biomolecules to inhibit the quorum sensing adhesion of bacteria and disruption of biofilms can be used effectively to prevent orthopaedic implant related bacterial infection. PMID:26263909

  9. 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

  10. The need for research training in orthopaedic residency education.

    PubMed

    Anderson, Robert W

    2006-08-01

    Orthopaedic surgery residents should be exposed during their clinical training to the processes of creativity and innovation that are the basis of research. The definition of a research experience for surgery residents should be broad and include not only traditional bench research in a basic science environment but also translational and clinical research to move innovation from bench to bedside and validate its value in a scientific manner. Additionally, there are enormous opportunities for surgeons to study healthcare delivery and policy and to develop new approaches to educating colleagues, other medical personnel, and patients. The question that must be addressed is how can the knowledge and human resources residing in orthopaedic surgery best be used to meet the challenges future residents will face as healthcare undergoes profound changes? How these issues are managed in a rapidly changing environment is the critical issue and the challenge faced by surgical training programs wishing to remain viable and provide trainees with the opportunity to adapt and be successful in the future. What is state of the art today will not be tomorrow and unless trainees are encouraged and taught to be creative and innovative they risk becoming surgical dinosaurs.

  11. 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

  12. Nanotechnology: current concepts in orthopaedic surgery and future directions.

    PubMed

    Sullivan, M P; McHale, K J; Parvizi, J; Mehta, S

    2014-05-01

    Nanotechnology is the study, production and controlled manipulation of materials with a grain size < 100 nm. At this level, the laws of classical mechanics fall away and those of quantum mechanics take over, resulting in unique behaviour of matter in terms of melting point, conductivity and reactivity. Additionally, and likely more significant, as grain size decreases, the ratio of surface area to volume drastically increases, allowing for greater interaction between implants and the surrounding cellular environment. This favourable increase in surface area plays an important role in mesenchymal cell differentiation and ultimately bone-implant interactions. Basic science and translational research have revealed important potential applications for nanotechnology in orthopaedic surgery, particularly with regard to improving the interaction between implants and host bone. Nanophase materials more closely match the architecture of native trabecular bone, thereby greatly improving the osseo-integration of orthopaedic implants. Nanophase-coated prostheses can also reduce bacterial adhesion more than conventionally surfaced prostheses. Nanophase selenium has shown great promise when used for tumour reconstructions, as has nanophase silver in the management of traumatic wounds. Nanophase silver may significantly improve healing of peripheral nerve injuries, and nanophase gold has powerful anti-inflammatory effects on tendon inflammation. Considerable advances must be made in our understanding of the potential health risks of production, implantation and wear patterns of nanophase devices before they are approved for clinical use. Their potential, however, is considerable, and is likely to benefit us all in the future.

  13. Computer assisted orthopaedic surgery. Image guided and robotic assistive technologies.

    PubMed

    DiGioia, A M; Jaramaz, B; Colgan, B D

    1998-09-01

    Technologies are emerging that will influence the way in which orthopaedic surgery is planned, simulated, and performed. Recent advances in the fields of medical imaging, computer vision, and robotics have provided the enabling technologies to permit computer aided surgery to become an established area which can address clinical needs. Although these technologies have been applied in industry for more than 20 years, the field of computer assisted orthopaedic surgery is still in its infancy. Image guided and surgical navigation systems, robotic assistive devices, and surgical simulators have begun to emerge from the laboratory and hold the potential to improve current surgical practice and patients' outcomes. The goals of these new clinically focused technologies are to develop interactive, patient specific preoperative planners to optimize the performance of surgery and the postoperative biologic response, and develop more precise and less invasive interactive smart tools and sensors to assist in the accurate and precise performance of surgery. The medical community is beginning to see the benefit of these enabling technologies which can be realized only through the collaboration and combined expertise of engineers, roboticists, computer scientists, and surgeons.

  14. Palliative care: a challenge for orthopaedic nursing care.

    PubMed

    Watters, Carol L; Harvey, Carol V; Meehan, Anita J; Schoenly, Lorry

    2005-01-01

    Patients who face chronic, incurable, or life-ending musculoskeletal conditions often receive inadequate care either due to a lack of caregiver awareness or inattention to maintaining the highest quality at the end of life. Palliative care focuses on the comprehensive physical, psychological, social, spiritual, and existential needs of patients with life-threatening or debilitating illness. Orthopaedic nurses and all nurses in general are challenged to incorporate palliative care principles into care planned with patients and families facing end-of-life issues. This article addresses the leadership role the National Association of Orthopaedic Nurses (NAON) has taken to develop a consensus document which endorses the Last Acts Precepts of Palliative Care and affirms the need for palliative care with patients who experience life-threatening illness. A case study is used to illustrate the opportunity a multidisciplinary team has to center care on the individual, while remaining sensitive to the holistic needs of the patient for self-determination at the end of life.

  15. The prevention of orthopaedic implant and vascular graft infections.

    PubMed

    Strachan, C J

    1995-06-01

    The infection rate for any surgical prosthesis insertion should be less than 1% in the first postoperative year. If infection occurs the patients will lose their new found mobility, lose their independence, be hospitalized with sepsis, both local and systemic, and perhaps die. Preoperative and intraoperative measures to prevent infection are well established in orthopaedic surgery but less scientifically applied in peripheral vascular surgery. In both specialties the problem of late infection has promoted research on the protection of the peri-prosthetic environment against both bacteria and biofilm. In orthopaedics, the incorporation of various antibiotics into bone cement is well accepted in revision surgery, but still debated for the primary operation. On-going research on bioresorbable ceramics and the incorporation of antibiotics more effective against coagulase-negative staphylococci should eventually counter late infections. As HIV-positive patients increasingly present with sepsis around implanted prostheses this need will increase. In vascular surgery as the risk factors for biomaterial infection are better understood, new generations of protein-sealed grafts are permitting ionically compatible antibiotic coatings. Large well-designed clinical trials have begun and are needed to confirm the forecast of improved long-term clinical outcomes.

  16. Clinical presentation and treatment of orthopaedic implant-associated infection.

    PubMed

    Zimmerli, W

    2014-08-01

    Orthopaedic implants are highly susceptible to infection. The aims of treatment of infection associated with internal fixation devices are fracture consolidation and prevention of chronic osteomyelitis. Complete biofilm eradication is not the primary goal, as remaining adherent microorganisms can be removed with the device after fracture consolidation. By contrast, in periprosthetic joint infection (PJI), biofilm elimination is required. Surgical treatment of PJI includes debridement with retention, one- or two-stage exchange and removal without reimplantation. In addition, prolonged antibiotic treatment, preferably with an agent that is effective against biofilm bacteria, is required. Rifampicin is an example of an antibiotic with these properties against staphylococci. However, to avoid the emergence of resistance, rifampicin must always be combined with another antimicrobial agent. With this novel treatment approach, orthopaedic implant-associated infection is likely to be eradicated in up to 80-90% of patients. Because most antibiotics have a limited effect against biofilm infections, novel prophylactic and therapeutic options are needed. Surface coating with antimicrobial peptides that reduce bacterial attachment and biofilm formation can potentially prevent implant-associated infection. In addition, quorum-sensing inhibitors are a novel therapeutic option against biofilm infections.

  17. Intranet-based multi-purpose medical records in orthopaedics.

    PubMed

    Dugas, M; Bosch, R; Paulus, R; Lenz, T

    1999-01-01

    Quality assurance in orthopaedics--as in any medical speciality--relies on precise medical records. Data quality is crucial for statistical evaluation; missing values cannot be avoided but must be minimized. The quality assurance system must be accessible from many locations within the clinic; given the complex and heterogeneous computing infrastructure this is a technological challenge. Intranet technology--the application of internet-tools in local networks--can help to solve the technical problems. A generic Intranet-based quality assurance system in orthopaedics was designed, implemented and evaluated. The basic concept is an intranet data entry form which is generated semi-automatically from the data definition. This form is adapted according to the individual needs of the doctors (intelligent data entry). By flexible data transformation the same data set is used for clinical reports as well as scientific evaluations. The first use was for ultrasound examinations of neonatal hips. A report form consisting of 56 items was designed. Within the first 9-month period 1303 cases have been documented.

  18. 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

  19. 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

  20. 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.

  1. 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

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

    PubMed

    Lynch, T Sean; Parker, Richard D; Patel, Ronak M; Andrish, Jack T; Spindler, Kurt P; Amendola, Annunziata; Brophy, Robert H; Dunn, Warren R; Flanigan, David C; Huston, Laura J; Jones, Morgan H; Kaeding, Christopher C; Marx, Robert G; Matava, Matthew J; McCarty, Eric C; Pedroza, Angela D; Reinke, Emily K; Wolf, Brian R; Wright, Rick W

    2015-03-01

    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.

  3. 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

  4. 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

  5. Contingent leadership and effectiveness of trauma resuscitation teams.

    PubMed

    Yun, Seokhwa; Faraj, Samer; Sims, Henry P

    2005-11-01

    This research investigated leadership and effectiveness of teams operating in a high-velocity environment, specifically trauma resuscitation teams. On the basis of the literature and their own ethnographic work, the authors proposed and tested a contingency model in which the influence of leadership on team effectiveness during trauma resuscitation differs according to the situation. Results indicated that empowering leadership was more effective when trauma severity was low and when team experience was high. Directive leadership was more effective when trauma severity was high or when the team was inexperienced. Findings also suggested that an empowering leader provided more learning opportunities than did a directive leader. The major contribution of this article is the linkage of leadership to team effectiveness, as moderated by relatively specific situational contingencies.

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

    PubMed Central

    Greene, Nathaniel; Bhananker, Sanjay; Ramaiah, Ramesh

    2012-01-01

    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

  7. Current Concepts in Orthopedic Management of Multiple Trauma

    PubMed Central

    Kucukdurmaz, Fatih; Alijanipour, Pouya

    2015-01-01

    Multiple trauma patients frequently present challenging clinical scenarios with musculoskeletal injuries being the most common indications for surgical procedures in these patients. Despite our substantial knowledge, a universally approved objective definition for “multiple trauma” is yet to be delineated. Several controversial aspects of economics, pathophysiology, animal models, diagnosis, management and outcome of patients with multiple trauma have recently been explored and although some progress has been made, it seems that the available evidence is still inconclusive in some occasions. This manuscript revisits several current concepts of multiple trauma that have been the focus of recent investigation. We aim to provide the reader with an updated perspective based on the most recently published literature in the field of multiple trauma. PMID:26312111

  8. 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

  9. 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

  10. 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

  11. Training in Trauma Surgery

    PubMed Central

    Reilly, Patrick M.; Schwab, C William; Haut, Elliott R.; Gracias, Vicente H.; Dabrowski, G Paul; Gupta, Rajan; Pryor, John P.; Kauder, Donald R.

    2003-01-01

    Objective: To describe outcomes from a clinical trauma surgical education program that places the board-eligible/board-certified fellow in the role of the attending surgeon (fellow-in-exception [FIE]) during the latter half of a 2-year trauma/surgical critical care fellowship. Summary Background Data: National discussions have begun to explore the question of optimal methods for postresidency training in surgery. Few objective studies are available to evaluate current training models. Methods: We analyzed provider-specific data from both our trauma registry and performance improvement (PI) databases. In addition, we performed TRISS analysis when all data were available. Registry and PI data were analyzed as 2 groups (faculty trauma surgeons and FIEs) to determine experience, safety, and trends in errors. We also surveyed graduate fellows using a questionnaire that evaluated perceptions of training and experience on a 6-point Likert scale. Results: During a 4-year period 7,769 trauma patients were evaluated, of which 46.3% met criteria to be submitted to the PA Trauma Outcome Study (PTOS, ie, more severe injury). The faculty group saw 5,885 patients (2,720 PTOS); the FIE group saw 1,884 patients (879 PTOS). The groups were similar in respect to mechanism of injury (74% blunt; 26% penetrating both groups) and injury severity (mean ISS faculty 10.0; FIEs 9.5). When indexed to patient contacts, FIEs did more operations than the faculty group (28.4% versus 25.6%; P < 0.05). Death rates were similar between groups (faculty 10.5%; FIEs 10.0%). Analysis of deaths using PI and TRISS data failed to demonstrate differences between the groups. Analysis of provider-specific errors demonstrated a slightly higher rate for FIEs when compared with faculty when indexed to PTOS cases (4.1% versus 2.1%; P < 0.01). For both groups, errors in management were more common than errors in technique. Twenty-one (91%) of twenty-three surveys were returned. Fellows’ feelings of preparedness

  12. 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

  13. 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

  14. 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…

  15. 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…

  16. 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,…

  17. [Immunonutrition after trauma].

    PubMed

    Felbinger, T W; Sachs, M; Richter, H P

    2011-11-01

    Immunonutrition may be superior to standard clinical nutrition in specific clinical situations. After severe trauma, an enteral immuno-enhancing diet, enriched with arginine, omega-3 fatty acids, and nucleotides, decreases infectious complications. During acute respiratory distress syndrome, a continuous enteral diet with high-dose omega-3 fatty acids, gamma-linolenic acid, and antioxidants improved clinical outcome. Glutamine should be administered enterally or parenterally whenever total parenteral nutrition is indicated.

  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. Physiotherapy screening of patients referred for orthopaedic consultation in primary healthcare - a randomised controlled trial.

    PubMed

    Samsson, Karin; Larsson, Maria E H

    2014-10-01

    A large proportion of patients who consult primary healthcare for musculoskeletal pain are referred for orthopaedic consultation, but only a small number of these patients are appropriate for orthopaedic intervention. Experienced physiotherapists have the appropriate knowledge to manage musculoskeletal disorders. The primary aim of this randomised study was therefore to evaluate a screening by a physiotherapist of patients referred for orthopaedic consultation compared to standard practice in primary care. Patients referred for orthopaedic consultation (n=203) were randomised to physiotherapy screening or standard practice. Selection accuracy for orthopaedic intervention and other referrals were analysed with proportion analysis. Patient views of the quality of care were analysed with Mann-Whitney U-test, waiting time with Independent t-test. There was higher selection accuracy for orthopaedic intervention in the physiotherapy screening group (p=0.002). A smaller proportion of patients in the screening group were referred back to their general practitioner (GP) (p<0.001) and a larger proportion to the physiotherapy clinic (p<0.001) compared to standard practice. The proportion of patients referred for further investigations was significantly lower in the physiotherapy screening group (p<0.039). Waiting time was shorter in the screening group (p<0.001). A large proportion of the patients reported no hesitation to attend the clinic for future care, no difference between the groups (p<0.95). The findings in this study suggest that an experienced physiotherapist effectively can screen patients referred for orthopaedic consultation in primary healthcare.

  20. 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

  1. Imaging of laryngeal trauma.

    PubMed

    Becker, Minerva; Leuchter, Igor; Platon, Alexandra; Becker, Christoph D; Dulguerov, Pavel; Varoquaux, Arthur

    2014-01-01

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed.

  2. Imaging of laryngeal trauma.

    PubMed

    Becker, Minerva; Leuchter, Igor; Platon, Alexandra; Becker, Christoph D; Dulguerov, Pavel; Varoquaux, Arthur

    2014-01-01

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed. PMID:24238937

  3. 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

  4. The trauma team--a system of initial trauma care.

    PubMed Central

    Adedeji, O. A.; Driscoll, P. A.

    1996-01-01

    Trauma remains the leading cause of death under the age of 35 years. England and Wales lost 252,000 working years from accidental deaths, including poison, in 1992. In this country, preventable deaths from trauma are inappropriately high. In many hospitals there are not enough personnel; in the majority, there are no recognisable trauma care systems, which can reduce preventable deaths to a minimum. The appropriateness of trauma centres for this country is being assessed in Stoke-on-Trent, and a report is due out later this year. Even if the recommendation is made to establish such centres, it is unlikely that many will be set up. Consequently most hospitals will have to rely on their own resources to set up and run a trauma team. This type of trauma care system is the subject of this article. PMID:8977939

  5. 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

  6. Nonspinal orthopaedic problems in familial dysautonomia (Riley-Day syndrome).

    PubMed

    Laplaza, F J; Turajane, T; Axelrod, F B; Burke, S W

    2001-01-01

    Familial dysautonomia (FD) is a rare autosomal recessive disease occurring in Ashkenazi Jews. It affects the autonomic, central, and peripheral nervous systems. The purpose of this study was to assess the prevalence and characteristics of orthopedic deformities, other than spinal deformities, in this population. A retrospective review of the medical records and radiographs of 182 patients was made. Three main groups of orthopaedic conditions were evaluated: (a) Fractures: 60% of the patients had one or more fractures; the average fracture rate was 1.4/patient. (b) Neuropathic joints: 11% of the cases had one or more neuropathic joints, the knee being the most common. (c) Other musculoskeletal deformities: 26% of the patients had one or more deformities. Lower extremity rotational problems and foot anomalies accounted for most of these deformities. Patients with FD have a higher prevalence of fractures and neuropathic joints than do their peers. The fracture pattern also is different, with a higher incidence of proximal femoral fractures.

  7. [Success factors of work-related orthopaedic rehabilitation].

    PubMed

    Bethge, M

    2011-06-01

    Work-related rehabilitation has for several years been gaining greater importance in orthopaedic rehabilitation. High-quality studies have confirmed that work-related medical rehabilitation has favourable effects on earning capacity and work-life participation. This does however not hold true for all work-related rehabilitation programmes. In this context, 5 theses concerning success factors of work-related medical rehabilitation are developed. It is set out that the effects of work-related medical rehabilitation on work ability and work-life participation can be improved if programmes realize a needs-oriented assignment, include cognitive-behavioural components, follow a multimodal approach, step up treatment intensity, and if treatments are manualized.

  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. Perioperative Vision Loss in Spine Surgery and Other Orthopaedic Procedures.

    PubMed

    Su, Alvin W; Lin, Shuai-Chun; Larson, A Noelle

    2016-10-01

    Perioperative vision loss is a rare complication of orthopaedic surgery and has been documented after spine, knee, hip, and shoulder procedures. It is associated with several ophthalmologic diagnoses, most commonly ischemic optic neuropathy. Although the pathophysiology remains unclear, current evidence suggests that systemic hemodynamic compromise and altered balance of intraocular perfusion contribute to the development of ischemic optic neuropathy. Although vision recovery has been reported, the prognosis of perioperative vision loss is poor, and no proven effective treatment is available. Perioperative vision loss is unpredictable and can occur in healthy patients. Associated risk factors include pediatric or elderly age, male sex, obesity, anemia, hypotension or hypertension, perioperative blood loss, prolonged surgical time, and prone positioning. Preventive strategies include avoiding direct pressure to the eye, elevating the head, optimizing perioperative hemodynamic status, and minimizing surgical time with staged surgical procedures as appropriate. PMID:27564793

  10. 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.

  11. Scoring the SF-36 in Orthopaedics: A Brief Guide

    PubMed Central

    Laucis, Nicholas C.; Hays, Ron D.; Bhattacharyya, Timothy

    2015-01-01

    Abstract: The Short Form-36 (SF-36) is the most widely used health-related quality-of-life measure in research to date. There are currently two sources for the SF-36 and scoring instructions: licensing them from Optum, Inc., or obtaining them from publicly available documentation from the RAND Corporation. The SF-36 yields eight scale scores and two summary scores. The physical component summary (PCS) and mental component summary (MCS) scores were derived using an orthogonal-factor analytic model that forced the PCS and MCS to be uncorrelated, and it has been shown to contribute to an inflation of the MCS in patients with substantial physical disability. Oblique scoring can reduce this inflation of the MCS in orthopaedic studies. Spreadsheets to score the SF-36, along with a copy of the questionnaire, are provided. PMID:26446970

  12. Biodegradable metallic materials for orthopaedic implantations: A review.

    PubMed

    Yeung, Kelvin W K; Wong, Karen H M

    2012-09-01

    Non-degradable metals such as stainless steel, cobalt-chromium-based alloys, titanium and its alloys may lead to stress shielding effect after fractured bone has healed. This complication may attribute to the non-degradability and the mismatch of the mechanical properties between these metallic implants and human bone. Biodegradable metallic materials have been therefore studied as alternative implantable metals in orthopaedics for some years. Magnesium is a potential candidate, as its mechanical properties are similar to human. Additionally, it is degradable and its ions are essential for cell functions. However, rapid degradation and release of hydrogen gas may inhibit its applications clinically. Hence, this paper reviews the development of the biodegradable metallic implants and various methods to improve the degradation of magnesium alloys.

  13. Perioperative Vision Loss in Spine Surgery and Other Orthopaedic Procedures.

    PubMed

    Su, Alvin W; Lin, Shuai-Chun; Larson, A Noelle

    2016-10-01

    Perioperative vision loss is a rare complication of orthopaedic surgery and has been documented after spine, knee, hip, and shoulder procedures. It is associated with several ophthalmologic diagnoses, most commonly ischemic optic neuropathy. Although the pathophysiology remains unclear, current evidence suggests that systemic hemodynamic compromise and altered balance of intraocular perfusion contribute to the development of ischemic optic neuropathy. Although vision recovery has been reported, the prognosis of perioperative vision loss is poor, and no proven effective treatment is available. Perioperative vision loss is unpredictable and can occur in healthy patients. Associated risk factors include pediatric or elderly age, male sex, obesity, anemia, hypotension or hypertension, perioperative blood loss, prolonged surgical time, and prone positioning. Preventive strategies include avoiding direct pressure to the eye, elevating the head, optimizing perioperative hemodynamic status, and minimizing surgical time with staged surgical procedures as appropriate.

  14. Scoring the SF-36 in Orthopaedics: A Brief Guide.

    PubMed

    Laucis, Nicholas C; Hays, Ron D; Bhattacharyya, Timothy

    2015-10-01

    The Short Form-36 (SF-36) is the most widely used health-related quality-of-life measure in research to date. There are currently two sources for the SF-36 and scoring instructions: licensing them from Optum, Inc., or obtaining them from publicly available documentation from the RAND Corporation. The SF-36 yields eight scale scores and two summary scores. The physical component summary (PCS) and mental component summary (MCS) scores were derived using an orthogonal-factor analytic model that forced the PCS and MCS to be uncorrelated, and it has been shown to contribute to an inflation of the MCS in patients with substantial physical disability. Oblique scoring can reduce this inflation of the MCS in orthopaedic studies. Spreadsheets to score the SF-36, along with a copy of the questionnaire, are provided.

  15. Biodegradable metallic materials for orthopaedic implantations: A review.

    PubMed

    Yeung, Kelvin W K; Wong, Karen H M

    2012-09-01

    Non-degradable metals such as stainless steel, cobalt-chromium-based alloys, titanium and its alloys may lead to stress shielding effect after fractured bone has healed. This complication may attribute to the non-degradability and the mismatch of the mechanical properties between these metallic implants and human bone. Biodegradable metallic materials have been therefore studied as alternative implantable metals in orthopaedics for some years. Magnesium is a potential candidate, as its mechanical properties are similar to human. Additionally, it is degradable and its ions are essential for cell functions. However, rapid degradation and release of hydrogen gas may inhibit its applications clinically. Hence, this paper reviews the development of the biodegradable metallic implants and various methods to improve the degradation of magnesium alloys. PMID:23949163

  16. [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

  17. Effects of a modified maxillary orthopaedic splint: a cephalometric evaluation.

    PubMed

    Uner, O; Yücel-Eroğlu, E

    1996-06-01

    Taking the presence of an interplay between the vertical and sagittal components of craniofacial development into consideration, the beneficial therapeutic potential impacts of controlling vertical development on the correction of Class II discrepancies has been previously investigated. In the present study, a modified maxillary orthopaedic splint combined with an anterior high-pull headgear was used for early correction of the vertical and consequently sagittal dentoskeletal discrepancy as the initial stage of treatment. The aim was to evaluate its effects on the maxillary and mandibular dentoskeletal development, as well as rotational growth pattern. In order to compare with and distinguish from the uninterrupted growth changes, a control group was formed by matching each one of the control subjects to a subject in the treatment group according to certain criteria. The initial and second standardized lateral cephalograms of each subject was evaluated by means of an adopted and biologically more substantial cephalometric analysis. Evaluation of the changes induced by the splint in comparison with the uninterrupted growth changes revealed that the splint had both orthopaedic and orthodontic effects on the growth pattern of the dentoskeletal structures. There seemed to exist a relationship between the direction of total mandibular and maxillary rotations. In addition, it was believed that in order to cause a forward mandibular rotation, i.e. to change the rotational mandibular growth pattern from a backward into a forward direction, the posterior vertical maxillary development should be restrained, but anterior vertical maxillary development should be relatively more restrained or reversed and, thereby, the rotational growth pattern of the maxilla should be changed from a backward into a forward direction. Moreover, the bite block effect of the splint seemed to cause a favourable change in the condylar growth direction from a backward to an upward direction.

  18. 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.

  19. 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

  20. 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.

  1. The case of the missing testicle: blunt scrotal trauma in the pediatric emergency department.

    PubMed

    Pesch, Megan H; Bradin, Stuart

    2014-11-01

    Serious blunt scrotal trauma in the pediatric population is rare and can pose significant danger to the viability of the testes. The following case describes an adolescent boy who presented with a single testis in his scrotum after low-impact perineal trauma, consistent with testicular dislocation. The literature regarding scrotal trauma includes few cases of testicular dislocation from low-impact perineal trauma. Included is a brief review of the most recent data including epidemiology, differential diagnosis, acute management, and complications pertinent to the pediatric emergency clinician.

  2. 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

  3. [Compound odontoma with history of trauma: report of a case].

    PubMed

    Sámano Iturría, G; Cedeño Pacheco, E

    1988-08-01

    Clinical and roentgenographical features are described for a compound odontoma in a ten-year old male with a history of trauma in the anterior region of the face. Diagnostical methods and surgical handling are discussed, with a review of the pertinent literature.

  4. Transdiaphragmatic Intercostal Herniation following Blunt Trauma

    PubMed Central

    Sarkar, Debkumar; Warta, Melissa; Solomon, Jason

    2012-01-01

    Intercostal herniation is very rarely and sporadically reported in the literature. Intercostal hernia can occur following blunt trauma and may be associated with rib fractures. We present a case of a patient who presented with rib fractures, diaphragmatic rupture, and intrathoracic herniation of abdominal contents with subsequent herniation of both lung and abdominal contents through an intercostal defect. The patient was successfully treated with primary surgical repair of the diaphragm and intercostal hernia. The presentation, pathophysiology, and management of this rare clinical entity are discussed. PMID:23198242

  5. 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

  6. Injuries to the cervix in sexual trauma.

    PubMed

    Keller, Patricia; Nelson, Jenenne P

    2008-01-01

    Research on genital injury in sexual assault is limited and few articles have documented injuries to the cervix in sexual assault victims. This review focuses on reviewing and critically evaluating available literature on injuries of the cervix associated with rape, sexual trauma, and some other circumstances. Based on this evaluation, topics for future research are suggested. Nursing and medical studies were examined for this review. The collective studies date from 1991 to 2004. Although multiple articles were identified pertaining to sexual assault and genital injury, only six articles that specifically referred to injuries associated with genital and cervical tissue were included.

  7. Segmental Renal Infarction due to Blunt Trauma.

    PubMed

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

    2016-05-01

    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.

  8. Complex Psychological Trauma and Self-Dysregulation: A Theory Synthesis for Nursing.

    PubMed

    Choi, Kristen R

    2016-01-01

    Complex psychological trauma is a phenomenon resulting from severe interpersonal trauma that can negatively affect how individuals experience health care. However, few theories conceptualizing complex trauma exist, and it has received only limited attention in the nursing literature. The purpose of this theory synthesis was to organize two theories of (a) self-regulation and (b) self-dysregulation following complex psychological trauma into a single conceptual framework for use in nursing practice. This article used the theory synthesis approach described by Walker and Avant. The theory has potential to advance nursing science by helping nurses and other health professionals understand how trauma can alter self-regulatory processes and result in unique challenges in care delivery. It also has potential to prevent retraumatization of trauma survivors at the hands of health care providers.

  9. 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

  10. 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

  11. Bioactive coatings for orthopaedic implants-recent trends in development of implant coatings.

    PubMed

    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.

  12. 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

  13. A Review of THE ROLE OF SIMULATION IN DEVELOPING AND ASSESSING ORTHOPAEDIC SURGICAL SKILLS

    PubMed Central

    Thomas, Geb W; Johns, Brian D; Marsh, J Lawrence; Anderson, Donald D

    2014-01-01

    Orthopaedic surgical skill is traditionally acquired during training in an apprenticeship model that has been largely unchanged for nearly 100 years. However, increased pressure for operating room efficiency, a focus on patient safety, work hour restrictions, and a movement towards competency-based education are changing the traditional paradigm. Surgical simulation has the potential to help address these changes. This manuscript reviews the scientific background on skill acquisition and surgical simulation as it applies to orthopaedic surgery. It argues that simulation in orthopaedics lags behind other disciplines and focuses too little on simulator validation. The case is made that orthopaedic training is more efficient with simulators that facilitate deliberate practice throughout resident training and more research should be focused on simulator validation and the refinement of skill definition. PMID:25328480

  14. 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

  15. 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

  16. 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

  17. Acute brain trauma.

    PubMed

    Martin, G T

    2016-01-01

    In the 20th century, the complications of head injuries were controlled but not eliminated. The wars of the 21st century turned attention to blast, the instant of impact and the primary injury of concussion. Computer calculations have established that in the first 5 milliseconds after the impact, four independent injuries on the brain are inflicted: 1) impact and its shockwave, 2) deceleration, 3) rotation and 4) skull deformity with vibration (or resonance). The recovery, pathology and symptoms after acute brain trauma have always been something of a puzzle. The variability of these four modes of injury, along with a variable reserve of neurones, explains some of this problem.

  18. 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.

  19. 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

  20. 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

  1. Are acute subdural hematomas possible without head trauma?

    PubMed Central

    Garbossa, D.; Altieri, R.; Specchia, F. M. Calamo; Agnoletti, A.; Pilloni, G.; Lanotte, M.; Spaziante, R.; Ducati, A.

    2014-01-01

    Acute subdural hematomas (ASDHs) are rarely reported in the literature. In general, it is due to head trauma, but if the traumatic event is very mild, it is inadequate to explain the ASDH occurrence. Risk factors for the development of spontaneous ASDH include hypertension, vascular abnormalities and deficit of coagulation. We present two cases of ASDH in patients with the coagulation deficit and review of the literature to understand the coagulation factors role and platelet role in the management of ASDHs. PMID:25685219

  2. Are acute subdural hematomas possible without head trauma?

    PubMed

    Garbossa, D; Altieri, R; Specchia, F M Calamo; Agnoletti, A; Pilloni, G; Lanotte, M; Spaziante, R; Ducati, A

    2014-01-01

    Acute subdural hematomas (ASDHs) are rarely reported in the literature. In general, it is due to head trauma, but if the traumatic event is very mild, it is inadequate to explain the ASDH occurrence. Risk factors for the development of spontaneous ASDH include hypertension, vascular abnormalities and deficit of coagulation. We present two cases of ASDH in patients with the coagulation deficit and review of the literature to understand the coagulation factors role and platelet role in the management of ASDHs.

  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. 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…

  5. Bone graft materials in fixation of orthopaedic implants in sheep.

    PubMed

    Babiker, Hassan

    2013-07-01

    Bone graft is widely used within orthopaedic surgery especially in revision joint arthroplasty and spine fusion. The early implant fixation in the revision situation of loose joint prostheses is important for the long-term survival. Bone autograft has been considered as gold standard in many orthopaedic procedures, whereas allograft is the gold standard by replacement of extensive bone loss. However, the use of autograft is associated with donor site morbidity, especially chronic pain. In addition, the limited supply is a significant clinical challenge. Limitations in the use of allograft include the risk of bacterial contamination and disease transmission as well as non-union and poor bone quality. Other bone graft and substitutes have been considered as alternative in order to improve implant fixation. Hydroxyapatite and collagen type I composite (HA/Collagen) have the potential in mimicking skeletal bones. The osteoconductive properties of the composite might be improved by adding bone marrow aspirate (BMA), which can be harvested during surgery. Other alternatives to bone graft are demineralised bone matrix (DBM) and human cancellous bone (CB). DBM is prepared by acid extraction of human bone and includes bone collagen, morphogenetic proteins and growth factors. The combination of DBM with CB and with allograft might improve the healing potential of these grafts around non-cemented orthopaedic implants and thereby the implant fixation. Study I investigates the effect of HA/Collagen composite alone and in combination with BMA on the early fixation of porous coated titanium implants. In addition, the study compares also the effect of autograft with the gold standard allograft. By using a sheep model, the implants were inserted in the trabecular bone of femoral condyles. The test biomaterials were placed in a well defined peri-implant gap. After the observation period, the bone-implant specimens were harvested and evaluated mechanically by a destructive push

  6. A comprehensive analysis of craniofacial trauma.

    PubMed

    Hussain, K; Wijetunge, D B; Grubnic, S; Jackson, I T

    1994-01-01

    A review of the literature identified a need for a prospective study of the complete range of craniofacial trauma. The aims of this study were to determine the incidence, etiology, and mechanisms of craniofacial and associated injuries, enabling a greater understanding of their range and magnitude. Nine hundred fifty consecutive patients seen at an urban university hospital with any degree of craniofacial trauma were prospectively investigated. Craniofacial trauma was found to be very common at all ages. The causes were directly related to age, sex, and alcohol consumption, and determine the type and severity of injury. The commonest cause of soft-tissue injury was falls, whereas that of fractures was interpersonal violence. Falls accounted for most of the injuries in children and the elderly, whereas interpersonal violence was mainly responsible for those occurring in patients aged 15 to 50 years. Interpersonal violence mostly involved young male adults: fights occurring mainly between strangers who had consumed excessive amounts of alcohol. Women were usually assaulted by assailants known to them, their partners. Pedestrians showed a propensity to sustain cranial fractures, whereas motor vehicle occupants tended to sustain midfacial fractures and bicyclists mandibular fractures. Pedestrians incurred the severest injuries of all road users, and a significant proportion of road user collisions involved bicyclists. Sports were responsible for a significant proportion of craniofacial injuries in youths and young adults. Craniofacial soft-tissue injuries overall occurred most frequently on the forehead, nose, lips, and chin, and a method for their classification is proposed. The commonest craniofacial fracture was that of the nasal bones (45%), followed by cranial bones (24%), mandible (13%), zygoma (13%), orbital blow-out (3%), and maxilla (2%). The incidence of craniofacial trauma can be greatly reduced by improvements in interior home design, school education in

  7. 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

  8. Haemodynamic changes in trauma.

    PubMed

    Kirkman, E; Watts, S

    2014-08-01

    Trauma is the leading cause of death during the first four decades of life in the developed countries. Its haemodynamic response underpins the patient's initial ability to survive, and the response to treatment and subsequent morbidity and resolution. Trauma causes a number of insults including haemorrhage, tissue injury (nociception) and, predominantly, in military casualties, blast from explosions. This article discusses aspects of the haemodynamic responses to these insults and subsequent treatment. 'Simple' haemorrhage (blood loss without significant volume of tissue damage) causes a biphasic response: mean arterial blood pressure (MBP) is initially maintained by the baroreflex (tachycardia and increased vascular resistance, Phase 1), followed by a sudden decrease in MAP initiated by a second reflex (decrease in vascular resistance and bradycardia, Phase 2). Phase 2 may be protective. The response to tissue injury attenuates Phase 2 and may cause a deleterious haemodynamic redistribution that compromises blood flow to some vital organs. In contrast, thoracic blast exposure augments Phase 2 of the response to haemorrhage. However, hypoxaemia from lung injury limits the effectiveness of hypotensive resuscitation by augmenting the attendant shock state. An alternative strategy ('hybrid resuscitation') whereby tissue perfusion is increased after the first hour of hypotensive resuscitation by adopting a revised normotensive target may ameliorate these problems. Finally, morphine also attenuates Phase 2 of the response to haemorrhage in some, but not all, species and this is associated with poor outcome. The impact on human patients is currently unknown and is the subject of a current physiological investigation.

  9. 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

  10. 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…

  11. Neurosurgery: Skull Base Craniofacial Trauma.

    PubMed

    Donald, Paul J

    2016-10-01

    Much of craniofacial trauma involves the frontal sinuses. Because of its response to injury, the frontal sinus mucosa has an innate ability to develop mucoceles, and if infected, mucopyocoeles. This article presents a therapeutic algorithm for all forms of craniofacial trauma with concentration on the most severe injury-the through and through fracture and its surgical remediation. PMID:27648398

  12. 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.

  13. Maternal mortality due to trauma.

    PubMed

    Romero, Vivian Carolina; Pearlman, Mark

    2012-02-01

    Maternal mortality is an important indicator of adequacy of health care in our society. Improvements in the obstetric care system as well as advances in technology have contributed to reduction in maternal mortality rates. Trauma complicates up to 7% of all pregnancies and has emerged as the leading cause of maternal mortality, becoming a significant concern for the public health system. Maternal mortality secondary to trauma can often be prevented by coordinated medical care, but it is essential that caregivers recognize the unique situation of providing simultaneous care to 2 patients who have a complex physiologic relationship. Optimal management of the pregnant trauma victim requires a multidisciplinary team, where the obstetrician plays a central role. This review focuses on the incidence of maternal mortality due to trauma, the mechanisms involved in traumatic injury, the important anatomic and physiologic changes that may predispose to mortality due to trauma, and finally, preventive strategies that may decrease the incidence of traumatic maternal death.

  14. 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

  15. Traumatic pseudocyst due to blunt trauma: Case report.

    PubMed

    Becel, Sinan; Oztok, Beliz; Kurtoglu Celik, Gulhan; Icme, Ferhat; Sener, Alp; Pamukcu Gunaydin, Gul

    2015-09-01

    Damage to lung parenchyma due to blunt thoracic trauma often appears as contusion or hematoma. Cavitary lung lesions or pseudocyst formation due to trauma is a rare phenomenon. In the literature traumatic pseudocysts are also known as pseudocystic hematomas, traumatic lung cavity and traumatic pneumotocel. Traumatic pseudocysts usually have good clinical prognosis, recover spontaneously with supportive treatment and do not require surgery. In this article, we present the case of 52 year old male who was brought to the emergency department after a fall from height and was diagnosed with lung contusions and traumatic cyst. PMID:27239612

  16. Complex fracture of the clivus after head trauma.

    PubMed

    Buyukkaya, Ramazan; Buyukkaya, Ayla; Ozturk, Beyhan; Sarıtas, Ayhan

    2014-05-01

    Clivus fracture (CF), which is usually reported to accompany with head trauma, has high mortality rates. Early diagnosis of CF is rare because of high mortality rates and inadequate urgent radiologic techniques; however, diagnosis rates are increasing with computed tomography images obtained in high resolution and thin sections. In this article, radiologic and clinical features of 2 patients who were detected to have longitudinal CF after head trauma are presented and accompanying pathologies and its importance for prognosis are discussed under the light of literature data composed of a small number of reports.

  17. Childhood trauma and personality disorder: toward a biological model.

    PubMed

    Lee, Royce

    2006-02-01

    Cross-sectional and prospective associations of personality disorder with childhood trauma provide an important clue regarding the biological mechanism of personality disorder. In this review, empirical literature from several domains is summarized. These include relevant findings from behavioral genetics, preclinical models of early life parental care, and clinical translational studies of personality disorder. Identification of the biological mechanism by which childhood trauma exerts an effect on personality disorder may require modification of the conceptualization of personality disorder, either as a set of categories or dimensions.

  18. Nanostructured glass-ceramic coatings for orthopaedic applications.

    PubMed

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

    2011-08-01

    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.

  19. 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

  20. 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

  1. [Regenerative medicine: orthopaedical applications and medico legal questions].

    PubMed

    Ricci, S; Ricci, O; Tucci, C E; Massoni, F; Sarra, M V; Ricci, S

    2012-01-01

    Over the last decades, the increase in the global population's mean age has implied a corresponding increase in degenerative disease affecting various anatomical areas and tissues, including bones and cartilages, thus provoking a rising number of disabilities and a wider usage of drugs, mostly anti-inflammatory and cortisone. New developments in technologic and biomedical fields gave birth to new subjects, such as tissue engineering, cell therapy, gene therapy that, by and large, create a knowledge network falling under the concept of Regenerative Medicine. This science is essentially based on the usage of stem cells that can replicate and renovate themselves originating, if adequately stimulated, a number of cell types. Inter alia, in orthopaedic field a particular type of adult stem cells is used, the mesenchymal stem cells (MSCs). If combined with synthetic material produced in laboratories, the usage of these cells has provided inspiration for new study interests; today, it can be applied in various degenerative and post-traumatic pathologies, with great therapeutic benefits for the patient. Actually, many studies write about an improvement in patients' life quality. In this sense appear significant reflections on legal medicine, both in accidents and insurance, of this innovative therapeutic alternative and is hopefully an equally valid process of improvement of regulatory and case law.

  2. 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.

  3. 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.

  4. Diversity of patients microflora on orthopaedic and dental implants.

    PubMed

    Obst, Ursula; Marten, Silke-Mareike; Niessner, Christoph; Hartwig, Erich; Korsch, Michael; Walther, Winfried

    2012-10-01

    The aim of this study was to compare the diversity of microbial colonization on implant material from different individuals. Eubacterial DNA was extracted, separated and sequenced from orthopaedic metallic implant material, tissues or body fluids, and skin of 4 patients as well as from identical dental cement material from 10 individuals after revision and routine removal. Additionally, the composition of the bacterial population of the dental cement and the oral swab sample from one individual after direct extraction of bacterial DNA was compared to extraction after conventional microbiological enrichment. The latter investigation proved that the commonly used cultivation technique gave different results than direct extraction of DNA, especially as regards the detection of anaerobes. Comparing the bacterial colonization of implant materials from different patients showed significant individual diversity. The common focus on a constricted pathogen spectrum may have to be expanded toward a multispecies population. Moreover, the dependence of the bacterial population on the individual host has to be integrated in discussing implant colonization and infection.

  5. Tissue Engineering Strategies for the Regeneration of Orthopaedic Interfaces

    PubMed Central

    Lu, Helen H.; Subramony, Siddarth D.; Boushell, Margaret K.; Zhang, Xinzhi

    2013-01-01

    A major focus in the field of orthopaedic tissue engineering is the development of tissue engineered bone and soft tissue grafts with biomimetic functionality to allow for their translation to the clinical setting. One of the most significant challenges of this endeavor is promoting the biological fixation of these grafts with each other as well as the implant site. Such fixation requires strategic biomimicry to be incorporated into the scaffold design in order to re-establish the critical structure-function relationship of the native soft tissue-to-bone interface. The integration of distinct tissue types (e.g. bone and soft tissues such as cartilage, ligaments, or tendons), requires a multi-phased or stratified scaffold with distinct yet continuous tissue regions accompanied by a gradient of mechanical properties that mimics that of the multi-tissue transition between bone and soft tissues. This review discusses tissue engineering strategies for regenerating common tissue-to-tissue interfaces (ligament-to-bone, tendon-to-bone or cartilage-to-bone), and the strategic biomimicry implemented in stratified scaffold design for multi-tissue regeneration. Potential challenges and future directions in this emerging field will also be presented. It is anticipated that interface tissue engineering will enable integrative soft tissue repair, and will be instrumental for the development of complex musculoskeletal tissue systems with biomimetic complexity and functionality. PMID:20422291

  6. 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

  7. 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.

  8. Skiing and spinal trauma.

    PubMed

    Frymoyer, J W; Pope, M H; Kristiansen, T

    1982-07-01

    Spinal injury in skiers can either be acute or chronic. Acute spinal injury accounts for 3 to 3.6 per cent of all injuries occurring in Alpine skiing. Fewer acute injuries occur in cross-country skiing, and those that do usually are the result of a sudden, compressive force from a seated fall. The prevalence of chronic spinal trauma in skiing is unknown. Both cross-country and Alpine skiers appear to have greater complaints of mild to moderate low back pain as compared with their nonskiing counterparts. These differences may be the result of a complex interaction between recreational and occupational activities. Theoretical analyses suggest a risk for low-grade torsional injury to the Alpine skier's spine, whereas in cross-country skiing significant shear forces are applied to lumbar discs during the kick but not the double-poling phase.

  9. 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.

  10. 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

  11. 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

  12. 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

  13. Vascular emergencies in liver trauma.

    PubMed

    Taourel, P; Vernhet, H; Suau, A; Granier, C; Lopez, F M; Aufort, S

    2007-10-01

    The use of CT in the diagnosis and management of liver trauma is responsible for the shift from routine surgical versus non-surgical treatment in the management of traumatic liver injuries, even when they are of high grade. The main cause of complication and of death in liver trauma is related to vascular injury. The goal of this review focussed on the vascular complications of liver trauma is to describe the elementary lesions shown by CT in liver trauma including laceration, parenchymal hematoma and contusions, partial devascularisation, subcapsular hematomas, hemoperitoneum, active bleeding, pseudoaneurysm of the hepatic artery, bile leak, and periportal oedema, to illustrate the possible pitfalls in CT diagnosis of liver trauma and to underline the key-points which may absolutely be present in a CT report of liver trauma. Then we will remind the grading system based on the CT features and we will analyze the interest and limitations of such grading systems. Last we will discuss the diagnostic strategy at the early phase in patients with suspected liver trauma according to their clinical conditions and underline the conditions of arterial embolization, and then we will discuss the diagnosis strategy at the delayed phase according to the suspected complications. PMID:17851012

  14. Individual Differences in Trauma Disclosure

    PubMed Central

    Bedard-Gilligan, Michele; Jaeger, Jeff; Echiverri-Cohen, Aileen; Zoellner, Lori A.

    2011-01-01

    Background and Objectives Findings on disclosure and adjustment following traumatic events have been mixed. Better understanding of individual differences in disclosure may help us better understand reactions following trauma exposure. In particular, studying disclosure patterns for those with and without psychopathology and for different types of emotional experiences may help clarify the relationship between disclosure, event emotionality, trauma exposure, and PTSD. Methods In this study, 143 men and women with (n = 67) and without (n = 43) chronic PTSD and without trauma exposure (n = 33) provided information on disclosure for a traumatic/severe life event, a negative event, and a positive event. Results Individuals with PTSD reported greater difficulty disclosing their traumatic event compared to those with trauma exposure no PTSD and those with no-trauma exposure. However, individuals with PTSD reported disclosing the traumatic event a similar number of times and with similar levels of detail to those with trauma exposure but no PTSD. Both sexual and childhood trauma were associated with greater disclosure difficulty. Limitations Although control event types (positive, negative) were selected to control for the passage of time and for general disclosure style, they do not control for salience of the event and results may be limited by control events that were not highly salient. Conclusions The present findings point to a dynamic conceptualization of disclosure, suggesting that the differential difficulty of disclosing traumatic events seen in individuals with PTSD is not simply a function of the amount of disclosure or the amount of details provided. PMID:22080869

  15. Impact of trauma on children.

    PubMed

    Lubit, Roy; Rovine, Deborah; DeFrancisci, Lea; Eth, Spencer

    2003-03-01

    Millions of children are affected by physical and sexual abuse, natural and technological disasters, transportation accidents, invasive medical procedures, exposure to community violence, violence in the home, assault, and terrorism. Unfortunately, the emotional impact of exposure to trauma on children is often unappreciated and therefore untreated, and yet the impact of exposures to disaster and violence is profound and long-lasting. This article first briefly discusses the epidemiology of trauma in children, and then reviews the psychiatric and neurodevelopmental impact of trauma on children as well as the effects of trauma on children's emotional development. Trauma in children can lead to the development of posttraumatic stress disorder as well as to a variety of other psychiatric disorders, including depression, generalized anxiety disorder, panic attacks, borderline personality disorder, and substance abuse in adult survivors of trauma. Research has found that early exposure to stress and trauma causes physical effects on neurodevelopment which may lead to changes in the individual's long-term response to stress and vulnerability to psychiatric disorders. Exposure to trauma also affects children's ability to regulate, identify, and express emotions, and may have a negative effect on the individual's core identity and ability to relate to others. The authors also discuss what has been learned, based on recent experiences such as the World Trade Center catastrophe, about the role of television viewing in increasing the effects of traumatic events. The last section of the article provides guidance concerning the identification and clinical treatment of children and adolescents who are having emotional problems as a result of exposure to trauma.

  16. 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.

  17. 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

  18. Trauma in sub-Saharan Africa: review of cost, estimation methods, and interventions.

    PubMed

    Smigelsky, Melissa A; Aten, Jamie D; Gerberich, Stacy; Sanders, Mark; Post, Rachael; Hook, Kimberly; Ku, Angie; Boan, David M; Monroe, Phil

    2014-01-01

    Trauma is a widely acknowledged problem facing individuals and communities in developing countries. In sub-Saharan Africa-a region that is home to some of the world's worst human rights violations, ethnic and civil conflicts, disease epidemics, and conditions of poverty-trauma is an all-too-common experience in citizens' daily lives. In order to address these conditions effectively, the impact of trauma must be understood. The authors reviewed recent literature on the cost and consequences of psychological trauma in sub-Saharan Africa to provide a substantive perspective on how trauma affects individuals, communities, and organizations and to inform the effort to determine a method for measuring the impact of trauma in sub-Saharan Africa and the efficacy of trauma interventions in the region. Several recommendations are offered to help broaden and deepen the current approaches to conceptualizing trauma, evaluating its cost, and intervening on behalf of those impacted by trauma in sub-Saharan Africa. PMID:25585491

  19. 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

  20. 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

  1. 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.

  2. 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.

  3. 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…

  4. 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

  5. Stanley Paris Award Lecture. Reflections on the history and future of orthopaedic physical therapy.

    PubMed

    Wadsworth, C

    1998-09-01

    Carolyn Wadsworth, MS, PT, CHT, OCS, deliver the 1998 Paris Distinguished Service Award Lecture at the Combined Sections Meeting in Boston in February. Wadsworth is the fifth recipient of the Paris Award, which is the Orthopaedic Section's highest honor given to commemorate a member's exceptional and enduring service. The Paris Distinguished Service Award was established in 1990 and is named after Stanley V. Paris, PhD, PT, founder and first president of the Orthopaedic Section. Born in Dunedin, New Zealand, Paris immigrated to the U.S. in 1966. He developed physical therapy practices in Boston, Hamilton, Bermuda, and Atlanta; established the Institute of Graduate Health Sciences in Atlanta, GA; and is currently president of the University of St. Augustine, St. Augustine, FL. Paris is a strong advocate of assertive professional practice, clinical specialization, and strengthening leadership in physical therapy. He also champions wellness, exemplified by his personal achievements in sailing the Atlantic Ocean, swimming the English Channel, and completing the Ironman Triathlon. Carolyn Wadsworth, recipient of the 1998 Paris Award, has served as secretary and president of the Orthopaedic Section and is currently editor of the Orthopaedic Section's Home Study Course. She owns a private practice, teaches nationally, and has written two books, Examination and Mobilization of the Spine and Extremities (1988) and Orthopedic Review for Physical Therapists (1998). Major components of the speech she presented at the Orthopaedic Section Awards Ceremony are highlighted in this article.

  6. Possible sequelae of trauma and somatic disorder in early life.

    PubMed

    Weinberger, J L; Kantor, M

    All children experience trauma. The age, state of development and constitutional factors will determine whether some children will have a traumatic effect. Trauma occurring before the age of three, at a time when the ego has not developed its synthetic and integrative functions, may be reproduced in later life as an isolated symptom, by selected sensations involved in a sensory imprint or screen sensation of the trauma as a simple recording. After the age of three, under the influence of a more mature ego, excessive traumatic stimuli will be integrated and elaborated in symptom formations as phobias or other conditions and extended as part of the total personality. Recurrence in later life is triggered by events related not only to the original experience, but also to the content of its elaboration. The earlier in life the trauma occurs, the more likely that somatic imprints of primitive physiological symptoms would result as an archaic, biological defense or screen sensations. Recurrent sensory imprints or screens may appear as organic illness or functional somatic symptoms. Diagnostically, a detailed early life history is necessary to uncover the presence of a sensory screen memory of a trauma and so avoid diagnostic medical search for organic causation. Case material illustrating the two groups are presented. Indications for psychoanalysis and for supportive psychotherapy are discussed from our theoretical framework as well as from the literature. PMID:1052208

  7. 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

  8. 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

  9. Management of midface maxillofacial trauma.

    PubMed

    Gentile, Michael A; Tellington, Andrew J; Burke, William J; Jaskolka, Michael S

    2013-03-01

    The management of midface trauma continues to challenge maxillofacial surgeons. The complex local anatomy and functional and cosmetic importance of the region make precise surgical correction and reconstruction essential to success.

  10. 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…

  11. 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.

  12. 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

  13. Trauma of the midface.

    PubMed

    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

  14. [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

  15. 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

  16. 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

  17. 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.

  18. [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.

  19. Design and management of an orthopaedic bone bank in The Netherlands.

    PubMed

    Zwitser, Eline W; Jiya, Timothy U; George Licher, H; van Royen, Barend J

    2012-03-01

    The design and management of an orthopaedic bone bank is a complex process in which medical organisation and legislation intertwine. Neither in the Netherlands, nor in any other European country, there are official guidelines for the organisation and management of an orthopaedic bone bank. In the Netherlands, the recently modified 'law of security and quality for using human materials' (WVKL) dictates requirements for technical and organisational aspects for the use of human tissue and cells. The bone bank procedures include a thorough questionnaire for donor selection, extensive serological, bacteriological and histopathological examination, as well as standard procedures for registration, processing, preservation, storage and distribution of bone allografts. This article describes the organisation of an accredited bone bank and can be used as a proposition for an official guideline or can be useful as an example for other orthopaedic bone banks in Europe.

  20. The First World War and its influence on the development of orthopaedic surgery.

    PubMed

    Scotland, T

    2014-01-01

    By December 1914, overwhelming numbers of soldiers with infected musculoskeletal wounds had filled hospitals in France and Britain. Frequently initial management had been inadequate. In 1915, patients with orthopaedic wounds were segregated for the first time when Robert Jones established an experimental orthopaedic unit in Alder Hey Hospital, Liverpool. In 1916 he opened the first of 17 orthopaedic centres in Britain to surgically treat and rehabilitate patients. Henry Gray from Aberdeen emerged as the leading authority in the management of acute musculoskeletal wounds in casualty clearing stations in France and Flanders. Gray had particular expertise in dealing with compound fractures of the femur for which he documented an 80% mortality rate in 1914-15.

  1. A distributed health data network analysis of survival outcomes: the International Consortium of Orthopaedic Registries perspective.

    PubMed

    Banerjee, Samprit; Cafri, Guy; Isaacs, Abby J; Graves, Stephen; Paxton, Elizabeth; Marinac-Dabic, Danica; Sedrakyan, Art

    2014-12-17

    The International Consortium for Orthopaedic Registries is a multinational initiative established by the United States Food and Drug Administration to develop a health data network aimed at providing a robust infrastructure to facilitate evidence-based decision-making on performance of medical devices. Through the International Consortium for Orthopaedic Registries, individual data holders have complete control of their data and can choose to participate in studies of their choice. In this article, we present an overview of the data extraction process and the analytic strategy employed to answer several device performance-related questions in total hip arthroplasty and total knee arthroplasty. In the process, we discuss some nuances pertinent to International Consortium for Orthopaedic Registries data that pose certain statistical challenges, and we briefly suggest strategies to be adopted to address them. PMID:25520413

  2. 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

  3. 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.

  4. 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…

  5. Isolated hepatic artery injury in blunt abdominal trauma presenting as upper gastrointestinal bleeding: treatment with transcatheter embolisation.

    PubMed

    Taslakian, Bedros; Ghaith, Ola; Al-Kutoubi, Aghiad

    2012-11-15

    Liver injury in blunt abdominal trauma is common. However, not often does blunt trauma cause injury to the anatomical structures of the porta hepatis. Isolated injury of the hepatic artery has been rarely reported in the literature. Such injury may be lethal and requires immediate diagnosis and management. This report describes an unusual case of blunt abdominal trauma resulting in hepatic and gastroduodenal artery dissection, with pseudoaneurysm formation complicated by active upper gastrointestinal bleeding. The injury was managed by transcatheter embolisation. Awareness of this diagnosis should facilitate management of similar trauma cases.

  6. Isolated hepatic artery injury in blunt abdominal trauma presenting as upper gastrointestinal bleeding: treatment with transcatheter embolisation

    PubMed Central

    Taslakian, Bedros; Ghaith, Ola; Al-Kutoubi, Aghiad

    2012-01-01

    Liver injury in blunt abdominal trauma is common. However, not often does blunt trauma cause injury to the anatomical structures of the porta hepatis. Isolated injury of the hepatic artery has been rarely reported in the literature. Such injury may be lethal and requires immediate diagnosis and management. This report describes an unusual case of blunt abdominal trauma resulting in hepatic and gastroduodenal artery dissection, with pseudoaneurysm formation complicated by active upper gastrointestinal bleeding. The injury was managed by transcatheter embolisation. Awareness of this diagnosis should facilitate management of similar trauma cases. PMID:23162032

  7. Skeletal metastases - the role of the orthopaedic and spinal surgeon.

    PubMed

    Eastley, Nicholas; Newey, Martyn; Ashford, Robert U

    2012-09-01

    Developments in oncological and medical therapies mean that life expectancy of patients with metastatic bone disease (MBD) is often measured in years. Complications of MBD may dramatically and irreversibly affect patient quality of life, making the careful assessment and appropriate management of these patients essential. The roles of orthopaedic and spinal surgeons in MBD generally fall into one of four categories: diagnostic, the prophylactic fixation of metastatic deposits at risk of impending fracture (preventative surgery), the stabilisation or reconstruction of bones affected by pathological fractures (reactive surgery), or the decompression and stabilisation of the vertebral column, spinal cord, and nerve roots. Several key principals should be adhered to whenever operating on skeletal metastases. Discussions should be held early with an appropriate multi-disciplinary team prior to intervention. Detailed pre-assessment is essential to gauge a patient's suitability for surgery - recovery from elective surgery must be shorter than the anticipated survival. Staging and biopsies provide prognostic information. Primary bone tumours must be ruled out in the case of a solitary bone lesion to avoid inappropriate intervention. Prophylactic surgical fixation of a lesion prior to a pathological fracture reduces morbidity and length of hospital stay. Regardless of a lesion or pathological fracture's location, all regions of the affected bone must be addressed, to reduce the risk of subsequent fracture. Surgical implants should allow full weight bearing or return to function immediately. Post-operative radiotherapy should be utilised in all cases to minimise disease progression. Spinal surgery should be considered for those with spinal pain due to potentially reversible spinal instability or neurological compromise. The opinion of a spinal surgeon should be sought early, as delays in referral directly correlate to worse functional recovery following intervention

  8. 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…

  9. 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

  10. 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

  11. 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

  12. Early maladaptive schemas in adult survivors of interpersonal trauma: foundations for a cognitive theory of psychopathology

    PubMed Central

    Karatzias, Thanos; Jowett, Sally; Begley, Amelie; Deas, Suzanne

    2016-01-01

    Background Although the association between psychological trauma and early maladaptive schemas (EMS) is well established in the literature, no study to date has examined the relationship of EMS to PTSD and psychopathologies beyond depression and anxiety in a sample of adult survivors of interpersonal trauma. This information may be useful in helping our understanding on how to best treat interpersonal trauma. Objective We set out to investigate the association between EMS and common forms of psychopathology in a sample of women with a history of interpersonal trauma (n=82). We have hypothesised that survivors of interpersonal trauma will present with elevated EMS scores compared to a non-clinical control group (n=78). We have also hypothesised that unique schemas will be associated with unique psychopathological entities and that subgroups of interpersonal trauma survivors would be present in our sample, with subgroups displaying different profiles of schema severity elevations. Method Participants completed measures of trauma, psychopathology, dissociation, self-esteem, and the Young Schema Questionnaire. Results It was found that survivors of interpersonal trauma displayed elevated EMS scores across all 15 schemas compared to controls. Although the pattern of associations between different psychopathological features and schemas appears to be rather complex, schemas in the domains of Disconnection and Impaired Autonomy formed significant associations with all psychopathological features in this study. Conclusions Our findings support the usefulness of cognitive behavioural interventions that target schemas in the domains of Disconnection and Impaired Autonomy in an effort to modify existing core beliefs and decrease subsequent symptomatology in adult survivors of interpersonal trauma. Highlights of the article Interpersonal trauma survivors are distinguished primarily by a generalised elevation of their maladaptive schemas, rather than a unique schema profile

  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. Traumatic aortic regurgitation combined with descending aortic pseudoaneurysm secondary to blunt chest trauma.

    PubMed

    Kim, Siho; Park, Joon Suk; Yoo, Seung Min; Kim, Kyung Ho; Yang, Woo-In; Sung, Jung-Hoon; Kim, In Jai; Lim, Sang-Wook; Cha, Dong-Hun; Moon, Jae-Youn

    2014-09-23

    Rupture of the aorta is a relatively rare complication of blunt chest trauma, and traumatic rupture of the aortic valve is even rarer. Even though both result from blunt chest trauma, the causative mechanisms of aortic valve injury differ from those of descending aortic rupture. There are no previous reports in the literature of simultaneous injuries to both the descending aorta and the aortic valve. We report a case of a 70-year-old man who presented with traumatic aortic regurgitation combined with traumatic pseudoaneurysm of the aortic isthmus following blunt chest trauma, and its successful repair with a hybrid surgical strategy.

  15. 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

  16. 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.

  17. The prevalence and impact of trauma history in eating disorder patients

    PubMed Central

    Backholm, Klas; Isomaa, Rasmus; Birgegård, Andreas

    2013-01-01

    Background Early experiences of traumatic events (TEs) may be associated with subsequent eating disturbance. However, few studies have investigated overall exposure and trauma-type frequency in various types of eating disorders (EDs). Objective This study aimed to investigate the prevalence and type of TEs in a nationally representative sample of Swedish ED patients. Method Data from a database (Stepwise) for specialized ED care were used. Trauma history was assessed as a part of the routine, initial assessment. Participants over the age of 18 with a diagnosed DSM-IV ED were included (N=4,524). Results The number of patients having experienced at least one TE was 843 (18.6%), and 204 (24.2%) reported at least one additional trauma. Sexual trauma was the most common form of TE (6.3%). There was no difference in overall traumatic exposure or in type of experienced trauma between the ED diagnostic subgroups (AN, BN, EDNOS, and BED). Overall traumatic exposure was linked to self-reported severity of ED symptoms, more secondary psychosocial impairment, psychiatric comorbidity, and negative self-image. Conclusions Trauma history in ED patients merits attention. Results are partly in line with and partly in contrast to previous research. Measurement of trauma history has varied substantially in research on EDs, and this study adds to the indistinct literature on trauma history in ED. PMID:24273636

  18. Ventilatory strategies in trauma patients

    PubMed Central

    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

  19. 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

  20. Pancreatic trauma: A concise review

    PubMed Central

    Debi, Uma; Kaur, Ravinder; Prasad, Kaushal Kishor; Sinha, Saroj Kant; Sinha, Anindita; Singh, Kartar

    2013-01-01

    Traumatic injury to the pancreas is rare and difficult to diagnose. In contrast, traumatic injuries to the liver, spleen and kidney are common and are usually identified with ease by imaging modalities. Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities, and these injuries are often overlooked in cases with extensive multiorgan trauma. The most evident findings of pancreatic injury are post-traumatic pancreatitis with blood, edema, and soft tissue infiltration of the anterior pararenal space. The alterations of post-traumatic pancreatitis may not be visualized within several hours following trauma as they are time dependent. Delayed diagnoses of traumatic pancreatic injuries are associated with high morbidity and mortality. Imaging plays an important role in diagnosis of pancreatic injuries because early recognition of the disruption of the main pancreatic duct is important. We reviewed our experience with the use of various imaging modalities for diagnosis of blunt pancreatic trauma. PMID:24379625

  1. 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

  2. 76 FR 17422 - Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-29

    ... HUMAN SERVICES Food and Drug Administration Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. This notice announces a forthcoming meeting of a public advisory committee of the Food and...

  3. 77 FR 71195 - Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-29

    ... July 6, 2012 (77 FR 39953), FDA issued a proposed rule which, if made final, would make Shortwave... HUMAN SERVICES Food and Drug Administration Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION:...

  4. 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.

  5. Can the orthopaedic surgeon forget the proctoscope? The proctoscope as tissue protector during intra medullary nailing.

    PubMed

    Devadoss, V G; Howell, F R

    1999-06-01

    We report the value and usefulness of the proctoscope in one of the modern orthopaedic procedures. We have found the proctoscope more effective than the currently available instruments as tissue protector during intramedullary nailing. We briefly describe our technique of using the proctoscope and discuss its advantages.

  6. 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..., alcohol use, and debris falling into the water presents a significant risk of serious injuries...

  7. 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

  8. 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…

  9. 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,…

  10. 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.…

  11. A Physiotherapy Triage Service for Orthopaedic Surgery: An Effective Strategy for Reducing Wait Times

    PubMed Central

    McCormack, Robert G.; Hunt, Michael A.; Brooks-Hill, Alexandra

    2013-01-01

    ABSTRACT Purpose: To investigate the effectiveness of a physiotherapy triage service for orthopaedic surgery referrals from primary-care physicians. Methods: A prospective, observational design was used with patients referred to an orthopaedic surgeon based out of two small urban centres in British Columbia. The level of agreement between the physiotherapist and surgeon was determined using a weighted kappa statistic (κw) with 95% CI. A patient satisfaction questionnaire was administered, and the surgical conversion rate (SCR) was calculated to assess the level of appropriate referrals. Results: The analysis found substantial agreement (κw=0.77; 95% CI, 0.60–0.94) between surgeon and physiotherapist for surgical management decisions. All patients reported being “satisfied” or “very satisfied” with the overall care they received from the physiotherapist. The SCR of patients referred by the physiotherapist to the surgeon was 91%, versus 22% among patients referred by a general practitioner or emergency physician. Conclusion: More than three-fourths of patients referred by primary-care physicians did not need to see a surgeon and were able to be managed by an experienced orthopaedic physiotherapist. This triage model could have considerable impact on orthopaedic wait times in Canada by minimizing unnecessary referrals; the model could also promote timely and conservative management of non-surgical conditions by physiotherapists. PMID:24396164

  12. Telling: An Orthopaedic Resident’s Review of a New Book about Physician-Patient Communication

    PubMed Central

    Potter, Michael Q.

    2012-01-01

    Former Iowa Orthopaedics residency graduate Kevin b. Jones has written a book about the challenges of uncertainty in medicine and their impact on every individual’s interaction with the healthcare system. In What Doctors Cannot Tell You, Jones seeks to open a new conversation between physicians and patients about the unknowns in delivering medical care.

  13. 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

  14. 75 FR 36660 - Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-28

    ... HUMAN SERVICES Food and Drug Administration Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. This notice announces a forthcoming meeting of a public advisory committee of the Food and...

  15. 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

  16. [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

  17. Trauma from a global perspective.

    PubMed

    Ray, Susan L

    2008-01-01

    Trauma from widespread collective violence such as genocide and ethnic cleansing has not been discussed from a global perspective. It will be argued that the Western medical model of diagnostic labeling is inadequate for understanding victims of collective violence from around the world. Phenomenology and liberation philosophy will be discussed as alternatives to understanding trauma from collective violence that move beyond the Western medical model of diagnostic labeling. The insights gained from these alternative approaches will contribute to the development of nursing education, research, and practice relevant to the health of victims of collective violence around the globe.

  18. 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…

  19. Acoustic Trauma - Hearing Loss in Teenagers

    MedlinePlus

    ... Issues Listen Español Text Size Email Print Share Acoustic Trauma - Hearing Loss in Teenagers Page Content Article ... temporary or permanent hearing loss. This is called acoustic trauma. How loud is 85 decibels? Surprisingly, not ...

  20. Management of ocular, orbital, and adnexal trauma

    SciTech Connect

    Spoor, T.C.; Nesi, F.A.

    1988-01-01

    This book contains 20 chapters. Some of the chapter titles are: The Ruptured Globe: Primary Care; Corneal Trauma, Endophthalmitis; Antibiotic Usage; Radiology of Orbital Trauma; Maxillofacial Fractures; Orbital Infections; and Basic Management of Soft Tissue Injury.