Science.gov

Sample records for orthopedic fixation devices

  1. Design and Optimization of Resorbable Silk Internal Fixation Devices

    NASA Astrophysics Data System (ADS)

    Haas, Dylan S.

    Limitations of current material options for internal fracture fixation devices have resulted in a large gap between user needs and hardware function. Metal systems offer robust mechanical strength and ease of implantation but require secondary surgery for removal and/or result in long-term complications (infection, palpability, sensitivity, etc.). Current resorbable devices eliminate the need for second surgery and long-term complications but are still associated with negative host response as well as limited functionality and more difficult implantation. There is a definitive need for orthopedic hardware that is mechanically capable of immediate fracture stabilization and fracture fixation during healing, can safely biodegrade while allowing complete bone remodeling, can be resterilized for reuse, and is easily implantable (self-tapping). Previous work investigated the use of silk protein to produce resorbable orthopedic hardware for non- load bearing fracture fixation. In this study, silk orthopedic hardware was further investigated and optimized in order to better understand the ability of silk as a fracture fixation system and more closely meet the unfulfilled market needs. Solvent-based and aqueous-based silk processing formulations were cross-linked with methanol to induce beta sheet structure, dried, autoclaved and then machined to the desired device/geometry. Silk hardware was evaluated for dry, hydrated and fatigued (cyclic) mechanical properties, in vitro degradation, resterilization, functionalization with osteoinductive molecules and implantation technique for fracture fixation. Mechanical strength showed minor improvements from previous results, but remains comparable to current resorbable fixation systems with the advantages of self-tapping ability for ease of implantation, full degradation in 10 months, ability to be resterilized and reused, and ability to release molecules for osteoinudction. In vivo assessment confirmed biocompatibility, showed

  2. 21 CFR 886.1290 - Fixation device.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1290 Fixation device. (a) Identification. A fixation device is an AC-powered device intended for use as a fixation target for the patient during ophthalmological examination. The patient directs his or her gaze so that the visual image of the object falls...

  3. 21 CFR 886.1290 - Fixation device.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1290 Fixation device. (a) Identification. A fixation device is an AC-powered device intended for use as a fixation target for the patient during ophthalmological examination. The patient directs his or her gaze so that the visual image of the object falls...

  4. 21 CFR 886.1290 - Fixation device.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1290 Fixation device. (a) Identification. A fixation device is an AC-powered device intended for use as a fixation target for the patient during ophthalmological examination. The patient directs his or her gaze so that the visual image of the object falls...

  5. 21 CFR 886.1290 - Fixation device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1290 Fixation device. (a) Identification. A fixation device is an AC-powered device intended for use as a fixation target for the patient during ophthalmological examination. The patient directs his or her gaze so that the visual image of the object falls...

  6. 21 CFR 886.1290 - Fixation device.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1290 Fixation device. (a) Identification. A fixation device is an AC-powered device intended for use as a fixation target for the patient during ophthalmological examination. The patient directs his or her gaze so that the visual image of the object falls...

  7. Application of magnetic rods for fixation in orthopedic treatments.

    PubMed

    Shelyakova, Tatiana; Russo, Alessandro; Visani, Andrea; Dediu, Valentin Alek; Marcacci, Maurilio

    2015-06-01

    Achieving an efficient fixation for complicated fractures and scaffold application treatments is a challenging surgery problem. Although many fixation approaches have been advanced and actively pursued, the optimal solution for long bone defects has not yet been defined. This paper promotes an innovative fixation method based on application of magnetic forces. The efficiency of this approach was investigated on the basis of finite element modeling for scaffold application and analytical calculations for diaphyseal fractures. Three different configurations have been analyzed including combinations of small cylindrical permanent magnets or stainless steel rods, inserted rigidly in the bone intramedullary canals and in the scaffold. It was shown that attractive forces as high as 75 N can be achieved. While these forces do not reach the strength of mechanical forces in traditional fixators, the employment of magnetic rods is expected to be beneficial by reducing considerably the interface micromotions. It can additionally support magneto-mechanical stimulations as well as enabling a magnetically assisted targeted delivery of drugs and other bio-agents.

  8. Deep Infections After Syndesmotic Fixation With a Suture Button Device.

    PubMed

    Fantry, Amanda J; O'Donnell, Seth W; Born, Chris T; Hayda, Roman A

    2017-05-01

    Suture button devices such as the TightRope (Arthrex, Naples, Florida) have been increasingly used for syndesmotic fixation of ankle fractures. Despite proposed advantages, prior studies have shown equivalent outcomes, with a theoretical decreased need for removal of hardware. Complications of suture button fixation of syndesmotic instability may be underreported and include lateral suture knot inflammation with or without granuloma formation, infection, aseptic osteolysis with widening of the tibial drill tunnels, heterotopic ossification, and osteomyelitis. In this case series, the authors review the current literature and describe 3 patients with TightRope fixation for syndesmotic instability who developed deep infection. The authors believe that braided suture within suture button devices may provide an environment conducive to the propagation of infection across the syndesmotic fixation tract. Evidence of suture button migration or osteolysis of the TightRope tract should prompt an infectious workup and removal of hardware. If there is concern for infection associated with the TightRope, the authors recommend removing both metallic buttons and the entirety of the suture to prevent harboring a nidus for further infection. [Orthopedics. 2017; 40(3):e541-e545.]. Copyright 2017, SLACK Incorporated.

  9. 21 CFR 868.5770 - Tracheal tube fixation device.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Tracheal tube fixation device. 868.5770 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5770 Tracheal tube fixation device. (a) Identification. A tracheal tube fixation device is a device used to hold a tracheal tube...

  10. 21 CFR 868.5770 - Tracheal tube fixation device.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Tracheal tube fixation device. 868.5770 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5770 Tracheal tube fixation device. (a) Identification. A tracheal tube fixation device is a device used to hold a tracheal tube...

  11. 21 CFR 868.5770 - Tracheal tube fixation device.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Tracheal tube fixation device. 868.5770 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5770 Tracheal tube fixation device. (a) Identification. A tracheal tube fixation device is a device used to hold a tracheal tube...

  12. 21 CFR 868.5770 - Tracheal tube fixation device.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Tracheal tube fixation device. 868.5770 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5770 Tracheal tube fixation device. (a) Identification. A tracheal tube fixation device is a device used to hold a tracheal tube...

  13. 21 CFR 868.5770 - Tracheal tube fixation device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Tracheal tube fixation device. 868.5770 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5770 Tracheal tube fixation device. (a) Identification. A tracheal tube fixation device is a device used to hold a tracheal tube...

  14. ATTITUDES OF ORTHOPEDIC SPECIALISTS TOWARD EFFECTS OF MEDICAL DEVICE PURCHASING.

    PubMed

    Lingg, Myriam; Merida-Herrera, Everth; Wyss, Kaspar; Durán-Arenas, Luis

    2017-01-01

    The aim of this study was to assess viewpoints of end-users concerning the purchasing process of high-risk medical devices and to discuss the relevance of health technology assessments (HTAs) at the hospital level and other potential areas for improvement of purchasing processes. We used a cross-sectional study and assessed the attitudes and thoughts of orthopedic specialists. The study took place between June and October 2015 in Mexico. We collected data from 187 orthopedic surgeons. Involvement of orthopedic specialists in purchasing was reported by 86 percent. However, clinical practice was perceived as negatively influenced by purchasing outcomes by 92 percent. The problems were described as: material failure; effectiveness of medical devices; obsolete medical device technology; incomplete provision of implant / instrument sets; delayed provision of implants and instruments. To prevent sub-standard outcomes of purchasing decisions, this study and the current literature suggest that technologies should be assessed during the purchasing process, end-users should be adequately involved, and decisions should be based on multiple criteria including clinical impact in the short-term (e.g., primary stability of implant) and long-term (e.g., survival of implant). The focus on Mexico is particularly novel and provides insights into a health system where HTA is mainly present at the macro level and can be used for the listing of medical device technologies in the standard list. This study concludes that Mexican stakeholders of the purchasing process underestimate the contribution of HTAs at the level of purchasing decisions. HTA in Mexico has improved over the past years but still requires more advancement.

  15. High energy devices versus low energy devices in orthopedics treatment modalities

    NASA Astrophysics Data System (ADS)

    Schultheiss, Reiner

    2003-10-01

    The orthopedic consensus group defined in 1997 the 42 most likely relevant parameters of orthopedic shock wave devices. The idea of this approach was to correlate the different clinical outcomes with the physical properties of the different devices with respect to their acoustical waves. Several changes in the hypothesis of the dose effect relationship have been noticed since the first orthopedic treatments. The relation started with the maximum pressure p+, followed by the total energy, the energy density; and finally the single treatment approach using high, and then the multiple treatment method using low energy. Motivated by the reimbursement situation in Germany some manufacturers began to redefine high and low energy devices independent of the treatment modality. The OssaTron as a high energy, single treatment electro hydraulic device gained FDA approval as the first orthopedic ESWT device for plantar fasciitis and, more recently, for lateral epicondylitis. Two low energy devices have now also gained FDA approval based upon a single treatment. Comparing the acoustic data, differences between the OssaTron and the other devices are obvious and will be elaborated upon. Cluster analysis of the outcomes and the acoustical data are presented and new concepts will be suggested.

  16. [Orthopedic devices for footwear in flatness of the anterior part of the foot].

    PubMed

    Kudriavtsev, V A; Kiselev, A L; Kozlov, D I; Kaluzhskaia, M O; Matveeva, E G

    1991-09-01

    The work is dedicated to the problem of orthopedic supply of patients with flatness of the anterior part of foot. There is proposed a number of footwear orthopedic devices made of foam rubber. There is described the technology of their production with application of modern polymeric materials. There has been studied prosthetics of 50 patients with flatness of foot and revealed the positive result of application of footwear orthopedic devices made of foam rubber.

  17. Principles for awarding and fitting orthopedic devices and current views on terminology and classification.

    PubMed

    Bogucki, A

    2000-12-30

    This article presents excerpts from statues and regulations governing the legal aspects of providing orthopedic devices. The author suggests that the rules of the Committee on Prosthetics and Orthotics of the American Academy of Orthopaedic Surgeons be applied for the classification and terminology of orthopedic devices.

  18. 78 FR 17940 - Certain Computerized Orthopedic Surgical Devices, Software, Implants, and Components Thereof...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-25

    ... COMMISSION Certain Computerized Orthopedic Surgical Devices, Software, Implants, and Components Thereof..., Software, Implants, and Components Thereof, DN 2945; the Commission is soliciting comments on any public... devices, software, implants, and components thereof. The complaint names as respondents Stanmore...

  19. Co-precipitation of tobramycin into biomimetically coated orthopedic fixation pins employing submicron-thin seed layers of hydroxyapatite.

    PubMed

    Sörensen, Jan H; Lilja, Mirjam; Åstrand, Maria; Sörensen, Torben C; Procter, Philip; Strømme, Maria; Steckel, Hartwig

    2014-01-01

    The migration, loosening and cut-out of implants and nosocomial infections are current problems associated with implant surgery. New innovative strategies to overcome these issues are emphasized in today's research. The current work presents a novel strategy involving co-precipitation of tobramycin with biomimetic hydroxyapatite (HA) formation to produce implant coatings that control local drug delivery to prevent early bacterial colonization of the implant. A submicron- thin HA layer served as seed layer for the co-precipitation process and allowed for incorporation of tobramycin in the coating from a stock solution of antibiotic concentrations as high as 20 mg/ml. Concentrations from 0.5 to 20 mg/ml tobramycin and process temperatures of 37 °C and 60 °C were tested to assess the optimal parameters for a thin tobramycin- delivering HA coating on discs and orthopedic fixation pins. The morphology and thickness of the coating and the drug-release profile were evaluated via scanning electron microscopy and high performance liquid chromatography. The coatings delivered pharmaceutically relevant amounts of tobramycin over a period of 12 days. To the best of our knowledge, this is the longest release period ever observed for a fast-loaded biomimetic implant coating. The presented approach could form the foundation for development of combination device/antibiotic delivery vehicles tailored to meet well-defined clinical needs while combating infections and ensuring fast implant in-growth.

  20. 21 CFR 888.3010 - Bone fixation cerclage.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Bone fixation cerclage. 888.3010 Section 888.3010...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3010 Bone fixation cerclage. (a) Identification. A bone fixation cerclage is a device intended to be implanted that is made of alloys, such as...

  1. 21 CFR 888.3010 - Bone fixation cerclage.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bone fixation cerclage. 888.3010 Section 888.3010...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3010 Bone fixation cerclage. (a) Identification. A bone fixation cerclage is a device intended to be implanted that is made of alloys, such as...

  2. 21 CFR 888.3010 - Bone fixation cerclage.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Bone fixation cerclage. 888.3010 Section 888.3010...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3010 Bone fixation cerclage. (a) Identification. A bone fixation cerclage is a device intended to be implanted that is made of alloys, such as...

  3. 21 CFR 888.3010 - Bone fixation cerclage.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Bone fixation cerclage. 888.3010 Section 888.3010...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3010 Bone fixation cerclage. (a) Identification. A bone fixation cerclage is a device intended to be implanted that is made of alloys, such as...

  4. 21 CFR 888.3010 - Bone fixation cerclage.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Bone fixation cerclage. 888.3010 Section 888.3010...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3010 Bone fixation cerclage. (a) Identification. A bone fixation cerclage is a device intended to be implanted that is made of alloys, such as...

  5. Compliance of patients wearing an orthotic device or orthopedic shoes: A systematic review.

    PubMed

    Swinnen, Eva; Kerckhofs, Eric

    2015-10-01

    Alongside the positive effects of use of orthotic devices for the lower extremities (ODLE) and orthopedic shoes, complaints and criticism by users possibly lead to non-compliance. The purpose is to determine the compliance of patients wearing an ODLE or orthopedic shoes and to describe the main reasons for using and not using. Different online databases were searched for articles about patients' compliance with regard to an ODLE or orthopedic shoes. A methodological quality control was conducted. Ten studies (1576 patients) were included. The data revealed between 6 and 80% not users. Several reasons for not using the orthotic device were described (e.g. pain, discomfort and cosmetically unacceptable). The high percentage of patients who are not wearing the prescribed orthotic devices leads to a high financial loss for society and a waste of therapeutic effort. These results should be taken into account during the design, construction and selection process of orthotic devices. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Mobile Device Trends in Orthopedic Surgery: Rapid Change and Future Implications.

    PubMed

    Andrawis, John P; Muzykewicz, David A; Franko, Orrin I

    2016-01-01

    Mobile devices are increasingly becoming integral communication and clinical tools. Monitoring the prevalence and utilization characteristics of surgeons and trainees is critical to understanding how these new technologies can be best used in practice. The authors conducted a prospective Internet-based survey over 7 time points from August 2010 to August 2014 at all nationwide American Council for Graduate Medical Education-accredited orthopedic programs. The survey questionnaire was designed to evaluate the use of devices and mobile applications (apps) among trainees and physicians in the clinical setting. Results were analyzed and summarized for orthopedic surgeons and trainees. During the 48-month period, there were 7 time points with 467, 622, 329, 223, 237, 111, and 134 responses. Mobile device use in the clinical setting increased across all fields and levels of training during the study period. Orthopedic trainees increased their use of Smartphone apps in the clinical setting from 60% to 84%, whereas attending use increased from 41% to 61%. During this time frame, use of Apple/Android platforms increased from 45%/13% to 85%/15%, respectively. At all time points, 70% of orthopedic surgeons believed their institution/hospital should support mobile device use. As measured over a 48-month period, mobile devices have become an ubiquitous tool in the clinical setting among orthopedic surgeons and trainees. The authors expect these trends to continue and encourage providers and trainees to be aware of the limitations and risks inherent with new technology. Copyright 2016, SLACK Incorporated.

  7. A Review of the Design Process for Implantable Orthopedic Medical Devices

    PubMed Central

    Aitchison, G.A; Hukins, D.W.L; Parry, J.J; Shepherd, D.E.T; Trotman, S.G

    2009-01-01

    The design process for medical devices is highly regulated to ensure the safety of patients. This paper will present a review of the design process for implantable orthopedic medical devices. It will cover the main stages of feasibility, design reviews, design, design verification, manufacture, design validation, design transfer and design changes. PMID:19662153

  8. Stress corrosion cracking of an aluminum alloy used in external fixation devices.

    PubMed

    Cartner, Jacob L; Haggard, Warren O; Ong, Joo L; Bumgardner, Joel D

    2008-08-01

    Treatment for compound and/or comminuted fractures is frequently accomplished via external fixation. To achieve stability, the compositions of external fixators generally include aluminum alloy components due to their high strength-to-weight ratios. These alloys are particularly susceptible to corrosion in chloride environments. There have been several clinical cases of fixator failure in which corrosion was cited as a potential mechanism. The aim of this study was to evaluate the effects of physiological environments on the corrosion susceptibility of aluminum 7075-T6, since it is used in orthopedic external fixation devices. Electrochemical corrosion curves and alternate immersion stress corrosion cracking tests indicated aluminum 7075-T6 is susceptible to corrosive attack when placed in physiological environments. Pit initiated stress corrosion cracking was the primary form of alloy corrosion, and subsequent fracture, in this study. Anodization of the alloy provided a protective layer, but also caused a decrease in passivity ranges. These data suggest that once the anodization layer is disrupted, accelerated corrosion processes occur.

  9. In-vivo orthopedic implant diagnostic device for sensing load, wear, and infection

    DOEpatents

    Evans, III, Boyd McCutchen; Thundat, Thomas G.; Komistek, Richard D.; Dennis, Douglas A.; Mahfouz, Mohamed

    2006-08-29

    A device for providing in vivo diagnostics of loads, wear, and infection in orthopedic implants having at least one load sensor associated with the implant, at least one temperature sensor associated with the implant, at least one vibration sensor associated with the implant, and at least one signal processing device operatively coupled with the sensors. The signal processing device is operable to receive the output signal from the sensors and transmit a signal corresponding with the output signal.

  10. [Applied researches on polylactide internal fixation devices].

    PubMed

    Duan, H; Song, Y

    2001-03-01

    Nowadays, more and more basic and clinical researches on polylactide internal fixators were carried out in China. In this paper are reviewed the researches of polylactide acid(PLA), including its physical and chemical characters, biodegradation, absorption and mechanical properties, effects on fracture healing, and clinical application. Some problems that have not been solved are high-lighted and discussed. Also dealt with are some researches of PLA in future.

  11. The role of external fixation and emergency fracture management in bovine orthopedics.

    PubMed

    Adams, S B

    1985-03-01

    External fixation is a very useful method of treating selected fractures in cattle. The economics of therapy and the availability of the techniques to all veterinarians will continue to make external fixation the most frequently used method of fracture repair in cattle.

  12. The use of silk-based devices for fracture fixation

    NASA Astrophysics Data System (ADS)

    Perrone, Gabriel S.; Leisk, Gary G.; Lo, Tim J.; Moreau, Jodie E.; Haas, Dylan S.; Papenburg, Bernke J.; Golden, Ethan B.; Partlow, Benjamin P.; Fox, Sharon E.; Ibrahim, Ahmed M. S.; Lin, Samuel J.; Kaplan, David L.

    2014-03-01

    Metallic fixation systems are currently the gold standard for fracture fixation but have problems including stress shielding, palpability and temperature sensitivity. Recently, resorbable systems have gained interest because they avoid removal and may improve bone remodelling due to the lack of stress shielding. However, their use is limited to paediatric craniofacial procedures mainly due to the laborious implantation requirements. Here we prepare and characterize a new family of resorbable screws prepared from silk fibroin for craniofacial fracture repair. In vivo assessment in rat femurs shows the screws to be self-tapping, remain fixed in the bone for 4 and 8 weeks, exhibit biocompatibility and promote bone remodelling. The silk-based devices compare favourably with current poly-lactic-co-glycolic acid fixation systems, however, silk-based devices offer numerous advantages including ease of implantation, conformal fit to the repair site, sterilization by autoclaving and minimal inflammatory response.

  13. Nanomaterials and synergistic low-intensity direct current (LIDC) stimulation technology for orthopedic implantable medical devices.

    PubMed

    Shirwaiker, Rohan A; Samberg, Meghan E; Cohen, Paul H; Wysk, Richard A; Monteiro-Riviere, Nancy A

    2013-01-01

    Nanomaterials play a significant role in biomedical research and applications because of their unique biological, mechanical, and electrical properties. In recent years, they have been utilized to improve the functionality and reliability of a wide range of implantable medical devices ranging from well-established orthopedic residual hardware devices (e.g., hip implants) that can repair defects in skeletal systems to emerging tissue engineering scaffolds that can repair or replace organ functions. This review summarizes the applications and efficacies of these nanomaterials that include synthetic or naturally occurring metals, polymers, ceramics, and composites in orthopedic implants, the largest market segment of implantable medical devices. The importance of synergistic engineering techniques that can augment or enhance the performance of nanomaterial applications in orthopedic implants is also discussed, the focus being on a low-intensity direct electric current (LIDC) stimulation technology to promote the long-term antibacterial efficacy of oligodynamic metal-based surfaces by ionization, while potentially accelerating tissue growth and osseointegration. While many nanomaterials have clearly demonstrated their ability to provide more effective implantable medical surfaces, further decisive investigations are necessary before they can translate into medically safe and commercially viable clinical applications. The article concludes with a discussion about some of the critical impending issues with the application of nanomaterials-based technologies in implantable medical devices, and potential directions to address these. Copyright © 2013 Wiley Periodicals, Inc.

  14. Comparison of CT imaging artifacts from craniomaxillofacial internal fixation devices.

    PubMed

    Fiala, T G; Novelline, R A; Yaremchuk, M J

    1993-12-01

    This study compares the artifacts caused by craniomaxillofacial internal fixation devices in CT images. Mandibular reconstruction and "mini" titanium, Vitallium, and stainless steel systems, "micro" titanium and Vitallium systems, and stainless steel wires were evaluated. The hardware was placed on a nylon grid and submerged in water. CT images were obtained with both bone and soft-tissue window settings. All artifacts were compared and graded after a minimum of five observations each. The severity of "starburst" artifact was found to be related to the physical size of the fixation hardware and its composition. Titanium hardware caused the least amount of artifact. Vitallium and stainless steel fixation devices, with the exception of interfragmentary wiring, produced significantly more artifact. These results agree with theoretical predictions. The data indicate that when postoperative imaging is an important clinical consideration, (1) the least amount of implant material necessary to achieve stable fixation should be used, (2) the proximity of implant material to the area of interest should be considered, and (3) titanium implants produce less artifact than Vitallium or stainless steel implants.

  15. Olecranon osteotomy fixation using a novel device: the olecranon sled.

    PubMed

    Iorio, Timothy; Wong, Justin C; Patterson, John D; Rekant, Mark S

    2013-09-01

    A posterior approach to the elbow utilizing an olecranon osteotomy has been shown to provide excellent visualization of the distal humerus articular surface. However, many bony stabilization and fixation methods for the olecranon osteotomy are usually prominent, frequently symptomatic, and often require a second operation for removal. This paper evaluates the use of an innovative device, the olecranon sled, in fixation of olecranon osteotomies for exposure of intra-articular distal humerus fractures and provides follow-up results. A retrospective review of all patients with intra-articular distal humerus fracture treated through an olecranon osteotomy approach and fixed with an olecranon sled, between September 2008 and December 2011 was conducted. Charts and radiographs were reviewed to determine olecranon union or nonunion, presence of symptomatic hardware, and need for secondary surgery to remove symptomatic olecranon fixation. Fourteen patients were included in the study. Average clinical follow-up was 33.5 weeks (range, 6 to 118 wk). There were no olecranon nonunions. One patient underwent additional surgery for symptomatic hardware removal (7.1%). Two additional procedures were performed; 1 for revision open reduction and internal fixation of distal humerus fracture nonunion (7.1%) and 1 for release of elbow contracture (7.1%). Although follow-up is limited, the use of this device has been associated with excellent rates of olecranon union with a low rate of symptomatic hardware requiring removal.

  16. Fixation Release and the Bone Bandaid: A New Bone Fixation Device Paradigm

    PubMed Central

    Shayesteh Moghaddam, Narges; Jahadakbar, Ahmadreza; Amerinatanzi, Amirhesam; Skoracki, Roman; Miller, Michael; Dean, David; Elahinia, Mohammad

    2017-01-01

    The current gold standard of care for mandibular segmental defeat reconstruction is the use of Ti-6Al-4V immobilization hardware and fibular double barrel graft. This method is often successful immediately at restoring mandible function, however the highly stiff fixation hardware causes stress shielding of the grafted bone and stress concentration in the fixation device over time which can lead to fixation device failure and revision surgery. The purpose of reconstructive surgery could be to create normal stress trajectories in the mandible following engraftment. We investigate the use of a two stage mechanism which separates the immobilization/healing and regenerative phases of mandibular segmental defect treatment. The device includes the use of a very stiff, Ti-6Al-4V, releasable mechanism which assures bone healing. Therefore it could be released once the reconstructed boney tissue and any of its ligamentous attachments have completely healed. Underneath the released Ti-6Al-4V plate would be a pre-loaded nitinol (NiTi) wire-frame apparatus that facilitates the normal stress-strain trajectory through the engrafted bone after the graft is healed in place and the Ti-6Al-4V fixation device has been released. Due to the use of NiTi wires forming a netting that connects vascularized bone and possibly bone chips, bone grafts are also more likely to be incorporate rather than to resorb. We first evaluated a healthy adult mandible during normal mastication to obtain the normal stress-strain distribution. Then, we developed the finite element (FE) model of the mandibular reconstruction (in the M1-3 region) with the proposed fixation device during the healing (locked state) and post-healing (released state) periods. To recreate normal stress trajectory in the reconstructed mandible, we applied the Response Surface Methodology (RMS) to optimize the Bone Bandaid geometry (i.e., wire diameters and location). The results demonstrate that the proposed mechanism immobilizes the

  17. Biomechanical Comparison of Fixation Devices for First Metatarsocuneiform Joint Arthrodesis.

    PubMed

    Knutsen, Ashleen R; Fleming, John F; Ebramzadeh, Edward; Ho, Nathan C; Warganich, Tibor; Harris, Thomas G; Sangiorgio, Sophia N

    2017-08-01

    Common surgical treatment of first tarsal-metatarsal arthritis is by first metatarsocuneiform joint arthrodesis. While crossed-screw and locking plate fixation are the most widely used methods, a novel construct was designed to alleviate soft tissue irritation while still providing stable fixation. Using anatomic first metatarsal and medial cuneiform composites, we compared 3 arthrodesis implants (crossed-screw, dorsal locking plate, and IO Fix) under 2 cyclic bending loading scenarios (cantilever and 4-point bending). Additionally, the optimal orientation (plantar-dorsal or dorsal-plantar) of the IO Fix construct was determined. Failure load, diastasis, joint space angle, and axial and angular stiffness were determined. Both crossed-screw fixation and the IO Fix constructs experienced significantly higher failure loads than the dorsal locking plate during both loading scenarios. Additionally, they had lower plantar diastasis and joint space angle at failure than the plate. Moreover, the plantar-dorsal IO Fix construct was significantly stiffer than the crossed-screw during cantilever bending. Finally, the plantar-dorsal orientation of the IO Fix device had higher failure load and lower diastasis and angle at failure than in the dorsal-plantar orientation. The results suggest that the IO Fix system can reduce motion at the interfragmentary site and ensure compression for healing comparable to that of the crossed-screw fixation. Level V: Bench testing.

  18. Staphylococcus epidermidis in orthopedic device infections: the role of bacterial internalization in human osteoblasts and biofilm formation.

    PubMed

    Valour, Florent; Trouillet-Assant, Sophie; Rasigade, Jean-Philippe; Lustig, Sébastien; Chanard, Emmanuel; Meugnier, Hélène; Tigaud, Sylvestre; Vandenesch, François; Etienne, Jérome; Ferry, Tristan; Laurent, Frédéric

    2013-01-01

    Staphylococcus epidermidis orthopedic device infections are caused by direct inoculation of commensal flora during surgery and remain rare, although S. epidermidis carriage is likely universal. We wondered whether S. epidermidis orthopedic device infection strains might constitute a sub-population of commensal isolates with specific virulence ability. Biofilm formation and invasion of osteoblasts by S. aureus contribute to bone and joint infection recurrence by protecting bacteria from the host-immune system and most antibiotics. We aimed to determine whether S. epidermidis orthopedic device infection isolates could be distinguished from commensal strains by their ability to invade osteoblasts and form biofilms. Orthopedic device infection S. epidermidis strains (n = 15) were compared to nasal carriage isolates (n = 22). Osteoblast invasion was evaluated in an ex vivo infection model using MG63 osteoblastic cells co-cultured for 2 hours with bacteria. Adhesion of S. epidermidis to osteoblasts was explored by a flow cytometric approach, and internalized bacteria were quantified by plating cell lysates after selective killing of extra-cellular bacteria with gentamicin. Early and mature biofilm formations were evaluated by a crystal violet microtitration plate assay and the Biofilm Ring Test method. No difference was observed between commensal and infective strains in their ability to invade osteoblasts (internalization rate 308+/-631 and 347+/-431 CFU/well, respectively). This low internalization rate correlated with a low ability to adhere to osteoblasts. No difference was observed for biofilm formation between the two groups. Osteoblast invasion and biofilm formation levels failed to distinguish S. epidermidis orthopedic device infection strains from commensal isolates. This study provides the first assessment of the interaction between S. epidermidis strains isolated from orthopedic device infections and osteoblasts, and suggests that bone cell invasion is

  19. The impact of orthopedic device associated with carbonated hydroxyapatite on the oxidative balance: experimental study of bone healing rabbit model.

    PubMed

    Jebahi, Samira; Nsiri, Riadh; Boujbiha, Mohammed; Bouroga, Ezedine; Rebai, Tarek; Keskes, Hassib; El Feki, Abdelfattah; Oudadesse, Hassane; El Feki, Hafed

    2013-10-01

    Orthopedic devices are used in pathologic disorder as an adjunct to bone grafts to provide immediate structural stability. Unfortunately, the use of metallic devices has some complications. This study aimed to characterize the oxidative stress biomarker and the antioxidant enzyme profiles during bone regeneration. New Zealand White rabbits were divided into 4 groups: Group (I) was used as control (T), Groups II, III, and IV were used, respectively, as implanted tissue with carbonated hydroxyapatite (CHA), carbonated hydroxyapatite associated with external fixator (CHA + EF), and presenting empty defects (ED). Grafted bone tissues were carefully removed to measure malondialdehyde (MDA) concentration, superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase activities (GPx). Our results showed that 4 weeks after operation, treatment of rabbits with CHA + EF showed a significantly higher malondialdehyde (MDA) concentration when compared to that of control group. The SOD, CAT, and GPx in CHA + EF group showed significantly lower activities when compared to those in control group. Eight weeks after surgery, the CHA + EF group presented a lower concentration of MDA as compared to those seen after the first 4 weeks after surgery. On the other hand, the SOD, CAT, and GPx showed a higher activity when compared with the same group. Consequently, MDA concentration and the antioxidant enzyme activities were not significant (p > 0.05) when compared to those in control group rabbits. Histologic sampling has demonstrated successful time-patterned resorption accompanied by bone replacement and remodeling. These results suggest that there was a temporary increase in the oxidative marker level in CHA + EF healing bone and the 8-week period was sufficient to re-establish oxidant-antioxidant balance accompanied by bone repair in the tibia rabbit model.

  20. Doctors and the Etiquette of Mobile Device Use in Trauma and Orthopedics

    PubMed Central

    Hayden, Lydia; Bullock, Alison

    2015-01-01

    Background The etiquette surrounding the use of mobile devices, so-called "mobiquette," has been previously identified as a barrier to use in an educational context. Objective To investigate the influence of mobile device use on patient and staff opinions in the trauma and orthopedics department at a teaching hospital in Wales. Methods A survey of patients at the bedside and staff in their work environment was undertaken. Data included age, frequency of observed use, suspected main reason for use, and whether doctors’ use of a mobile device positively or negatively influenced participants' opinions of them as a professional and as a person. Results A total of 59 patients and 35 staff responded. The modal age range was 40 to 54 years old. Most patients (78%) never see doctors using mobile devices in the workplace, compared with 3% of staff. The main reason for use was thought to be "communicating with colleagues" (48%) followed by "Internet use/applications for work reasons" (40%). Approximately 40% of patients' opinions of doctors were positively influenced by device use, compared with 82% of staff. This difference between patient and staff opinions was statistically significant for both professional (P<.001) and personal (P=.002) opinions. Conclusions Patients are likely to have a negative opinion of doctors using mobile devices in the workplace. This can be balanced by the more positive opinions of colleagues. We advise doctors to remember "mobiquette" around patients. PMID:26116061

  1. Doctors and the Etiquette of Mobile Device Use in Trauma and Orthopedics.

    PubMed

    Blocker, Oliver; Hayden, Lydia; Bullock, Alison

    2015-06-26

    The etiquette surrounding the use of mobile devices, so-called "mobiquette," has been previously identified as a barrier to use in an educational context. To investigate the influence of mobile device use on patient and staff opinions in the trauma and orthopedics department at a teaching hospital in Wales. A survey of patients at the bedside and staff in their work environment was undertaken. Data included age, frequency of observed use, suspected main reason for use, and whether doctors' use of a mobile device positively or negatively influenced participants' opinions of them as a professional and as a person. A total of 59 patients and 35 staff responded. The modal age range was 40 to 54 years old. Most patients (78%) never see doctors using mobile devices in the workplace, compared with 3% of staff. The main reason for use was thought to be "communicating with colleagues" (48%) followed by "Internet use/applications for work reasons" (40%). Approximately 40% of patients' opinions of doctors were positively influenced by device use, compared with 82% of staff. This difference between patient and staff opinions was statistically significant for both professional (P<.001) and personal (P=.002) opinions. Patients are likely to have a negative opinion of doctors using mobile devices in the workplace. This can be balanced by the more positive opinions of colleagues. We advise doctors to remember "mobiquette" around patients.

  2. A novel internal fixator device for peripheral nerve regeneration.

    PubMed

    Chuang, Ting-Hsien; Wilson, Robin E; Love, James M; Fisher, John P; Shah, Sameer B

    2013-06-01

    Recovery from peripheral nerve damage, especially for a transected nerve, is rarely complete, resulting in impaired motor function, sensory loss, and chronic pain with inappropriate autonomic responses that seriously impair quality of life. In consequence, strategies for enhancing peripheral nerve repair are of high clinical importance. Tension is a key determinant of neuronal growth and function. In vitro and in vivo experiments have shown that moderate levels of imposed tension (strain) can encourage axonal outgrowth; however, few strategies of peripheral nerve repair emphasize the mechanical environment of the injured nerve. Toward the development of more effective nerve regeneration strategies, we demonstrate the design, fabrication, and implementation of a novel, modular nerve-lengthening device, which allows the imposition of moderate tensile loads in parallel with existing scaffold-based tissue engineering strategies for nerve repair. This concept would enable nerve regeneration in two superposed regimes of nerve extension--traditional extension through axonal outgrowth into a scaffold and extension in intact regions of the proximal nerve, such as that occurring during growth or limb-lengthening. Self-sizing silicone nerve cuffs were fabricated to grip nerve stumps without slippage, and nerves were deformed by actuating a telescoping internal fixator. Poly(lactic co-glycolic) acid (PLGA) constructs mounted on the telescoping rods were apposed to the nerve stumps to guide axonal outgrowth. Neuronal cells were exposed to PLGA using direct contact and extract methods, and they exhibited no signs of cytotoxic effects in terms of cell morphology and viability. We confirmed the feasibility of implanting and actuating our device within a sciatic nerve gap and observed axonal outgrowth following device implantation. The successful fabrication and implementation of our device provides a novel method for examining mechanical influences on nerve regeneration.

  3. Mechanical testing of a device for subcutaneous internal anterior pelvic ring fixation versus external pelvic ring fixation

    PubMed Central

    2014-01-01

    Background Although useful in the emergency treatment of pelvic ring injuries, external fixation is associated with pin tract infections, the patient’s limited mobility and a restricted surgical accessibility to the lower abdomen. In this study, the mechanical stability of a subcutaneous internal anterior fixation (SIAF) system is investigated. Methods A standard external fixation and a SIAF system were tested on pairs of Polyoxymethylene testing cylinders using a universal testing machine. Each specimen was subjected to a total of 2000 consecutive cyclic loadings at 1 Hz with sinusoidal lateral compression/distraction (+/−50 N) and torque (+/− 0.5 Nm) loading alternating every 200 cycles. Translational and rotational stiffness were determined at 100, 300, 500, 700 and 900 cycles. Results There was no significant difference in translational stiffness between the SIAF and the standard external fixation when compared at 500 (p = .089), 700 (p = .081), and 900 (p = .266) cycles. Rotational stiffness observed for the SIAF was about 50 percent higher than the standard external fixation at 300 (p = .005), 500 (p = .020), and 900 (p = .005) cycles. No loosening or failure of the rod-pin/rod-screw interfaces was seen. Conclusions In comparison with the standard external fixation system, the tested device for subcutaneous internal anterior fixation (SIAF) in vitro has similar translational and superior rotational stiffness. PMID:24684828

  4. Antibiotic-eluting orthopedic device to prevent early implant associated infections: Efficacy, biocompatibility and biodistribution studies in an ovine model.

    PubMed

    Gimeno, Marina; Pinczowski, Pedro; Mendoza, Gracia; Asín, Javier; Vázquez, Francisco J; Vispe, Eugenio; García-Álvarez, Felícito; Pérez, Marta; Santamaría, Jesús; Arruebo, Manuel; Luján, Lluís

    2017-10-04

    Infection of orthopedic devices is a major complication in the postsurgical period generating important health issues and economic consequences. Prevention strategies could be based on local release of antibiotics from the orthopedic device itself to avoid adhesion and growth of bacteria. The purpose of this work is to demonstrate the efficiency to prevent these infections by a cefazolin-eluting, perforated stainless steel implant in an in vivo ovine model. The device was placed in the tibia of sheep, one group receiving cefazolin-loaded implants whereas the control group received empty implants. All implants were experimentally infected by direct inoculation of Staphylococcus aureus ATCC 6538. In vitro cytotoxicological studies were also performed to check the effect of antibiotic on cell viability, integrity, and cycle. Results showed that sheep receiving cefazolin-loaded devices were able to avoid implant-associated infections, with normal tissue healing process. The antibiotic release followed a local concentric pattern as demonstrated by high-performance liquid chromatography detection in tissues. The in vitro results indicate the lack of relevant cytotoxic effects for the maximum antibiotic concentration released by the device. These results demonstrate the efficiency and safety of cefazolin-eluting implants in an ovine model to prevent early postsurgical infections of orthopedic devices. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2017. © 2017 Wiley Periodicals, Inc.

  5. Orthopedic intrusion of premaxilla with distraction devices before alveolar bone grafting in patients with bilateral cleft lip and palate.

    PubMed

    Liou, Eric Jein-Wein; Chen, Philip K T; Huang, C Shing; Chen, Y Ray

    2004-03-01

    Surgical repositioning of the downward displaced premaxilla in bilateral cleft lip and palate patients remains a controversial and perplexing issue because of its detrimental effects on the growth of the premaxilla. The purpose of this prospective clinical study was to introduce and evaluate the treatment results of an innovative technique for nonsurgically intruding the downward displaced premaxilla. Eight consecutive cases of bilateral cleft lip and palate at the age of mixed dentition were included for the correction of their premaxillary deformities. A pair of intraoral tooth-borne distraction devices was used for the orthopedic intrusion. Serial lateral and posteroanterior cephalometric radiographs were taken periodically for evaluating the growth of the premaxilla 1 year before the intrusion, changes during the intrusion, and growth/relapse up to 1 year after the intrusion. There was no overgrowth of the premaxilla or overeruption of the maxillary incisors during the 1-year observing period before the orthopedic intrusion. The treatment results revealed that the downward displaced premaxillae were all corrected within 1 month. Cephalometrically, 46 percent of the correction resulted from a true orthopedic intrusion and another 54 percent from a dentoalveolar effect in which the maxillary incisors were intruded and the premaxillary dentoalveolus was shortened. The cephalometric evaluations also implied that what occurred during the orthopedic intrusion was mostly the sutural contraction osteogenesis/osteolysis in the vomeropremaxillary suture combined with slightly mechanical upward displacement of the vomeronasal septum complex and nasal bones. The orthopedic intrusion of the premaxilla with distraction devices is an effective nonsurgical method for correcting the downward displaced premaxilla before alveolar bone grafting in patients with bilateral cleft lip and palate, and the results remained stable after 1 year.

  6. A Technique of Superficial Medial Collateral Ligament Reconstruction Using an Adjustable-Loop Suspensory Fixation Device.

    PubMed

    Deo, Shaneel; Getgood, Alan

    2015-06-01

    This report describes superficial medial collateral ligament reconstruction of the knee using a novel method of graft fixation with the ACL Tightrope RT (Arthrex, Naples, FL). After tibial fixation with either a standard interference screw or staple, femoral fixation of the semitendinosus tendon is performed with the adjustable-loop suspensory fixation device, which allows for both initial graft tensioning and re-tensioning after cyclical knee range of motion. This provides the ability for the graft to accommodate for resultant soft-tissue creep and stress relaxation, thereby allowing for optimal soft-tissue tension and reduction in laxity at the end of the procedure.

  7. 21 CFR 888.3050 - Spinal interlaminal fixation orthosis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... (a dislocation of the spinal column), and lower back syndrome. (b) Classification. Class II. ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Spinal interlaminal fixation orthosis. 888.3050... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3050 Spinal interlaminal...

  8. 21 CFR 888.3050 - Spinal interlaminal fixation orthosis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... (a dislocation of the spinal column), and lower back syndrome. (b) Classification. Class II. ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Spinal interlaminal fixation orthosis. 888.3050... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3050 Spinal interlaminal...

  9. 21 CFR 888.3050 - Spinal interlaminal fixation orthosis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... (a dislocation of the spinal column), and lower back syndrome. (b) Classification. Class II. ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Spinal interlaminal fixation orthosis. 888.3050... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3050 Spinal interlaminal...

  10. 21 CFR 888.3050 - Spinal interlaminal fixation orthosis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... (a dislocation of the spinal column), and lower back syndrome. (b) Classification. Class II. ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Spinal interlaminal fixation orthosis. 888.3050... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3050 Spinal interlaminal...

  11. 21 CFR 888.3050 - Spinal interlaminal fixation orthosis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... (a dislocation of the spinal column), and lower back syndrome. (b) Classification. Class II. ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Spinal interlaminal fixation orthosis. 888.3050... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3050 Spinal interlaminal...

  12. [Biomechanical performance of different wires and cable fixation devices in posterior instrumentation for atlantoaxial instability].

    PubMed

    Liu, Tie-long; Yan, Wang-jun; Han, Yu; Ye, Xiao-jian; Jia, Lian-shun; Li, Jia-shun; Yuan, Wen

    2010-05-01

    To compare the biomechanical performances of different wires and cable fixation devices in posterior instrumentation for atlantoaxial instability, and test the effect of different fixation strengths and fixation approaches on the surgical outcomes. Six specimens of the atlantoaxial complex (C0-C3) were used to establish models of the normal complex, unstable complex (type II odontoid fracture) and fixed complex. On the wd-5 mechanical testing machine, the parameters including the strength and rigidity of anti-rotation, change and strength of stress, and stability were measured for the normal complex, atlantoaxial instability complex, the new type titanium cable fixation system, Atlas titanium cable, Songer titanium cable, and stainless wire. The strength and rigidity of anti-rotation, change and strength of stress, stability of flexion, extension and lateral bending of the unstable atlantoaxial complex fixed by the new double locking titanium cable fixation system were superior to those of the Songer or Atlas titanium cable (P<0.05) and medical stainless wire (P<0.05). Simultaneous cable fastening on both sides resulted in better fixation effect than successive cable fastening (P<0.05). Better fixation effect was achieved by fastening the specimen following a rest (P<0.05). The fixation effects can be enhanced by increased fastening strengths. The new type double locking titanium cable fixation system has better biomechanical performance than the conventional Songer and Atlas titanium cables. Fastening the unstable specimens after a rest following simultaneous fastening of the specimen on both sides produces better fixation effect.

  13. Porous orthopedic steel implant as an antibiotic eluting device: prevention of post-surgical infection on an ovine model.

    PubMed

    Gimeno, Marina; Pinczowski, Pedro; Vázquez, Francisco J; Pérez, Marta; Santamaría, Jesús; Arruebo, Manuel; Luján, Lluís

    2013-08-16

    Traumatology and orthopedic surgery can benefit from the use of efficient local antibiotic-eluting systems to avoid bacterial contamination of implanted materials. In this work a new percutaneous porous-wall hollow implant was successfully used as a local antibiotic-eluting device both in vitro and in vivo. The implant is a macroporous 316 L stainless steel filter tube with a nominal filtration cut-off size of 200 nm with one open end which was used to load the synthetic antibiotic linezolid and an opposite blind end. The antibiotic release kinetics from the device on a simulated biological fluid under in vitro conditions demonstrated an increased concentration during the first five days that subsequently was sustained for at least seven days, showing a kinetic close to a zero order release. Antibiotic-loaded implants were placed in the tibia of four sheep which were trans-surgically experimentally infected with a biofilm forming strain of Staphylococcus aureus. After 7 and 9 days post infection, sheep did not show any evidence of infection as demonstrated by clinical, pathological and microbiological findings. These results demonstrate the capability of such an antibiotic-loaded implant to prevent infection in orthopedic devices in vivo. Further research is needed to assess its possible use in traumatology and orthopedic surgery.

  14. A device for continuous monitoring of true central fixation based on foveal birefringence.

    PubMed

    Gramatikov, Boris; Irsch, Kristina; Müllenbroich, Marie; Frindt, Nicole; Qu, Yinhong; Gutmark, Ron; Wu, Yi-Kai; Guyton, David

    2013-09-01

    A device for continuous monitoring of central fixation utilizes birefringence, the property of the Henle fibers surrounding the human fovea, to change the polarization state of light. A circular scan of retinal birefringence, where the scanning circle encompasses the fovea, allows identification of true central fixation-an assessment much needed in various applications in ophthalmology, psychology, and psychiatry. The device allows continuous monitoring for central fixation over an extended period of time in the presence of fixation targets and distracting stimuli, which may be helpful in detecting attention deficit hyperactivity disorder, autism spectrum disorders, and other disorders characterized by changes in the subject's ability to maintain fixation. A proof-of-concept has been obtained in a small study of ADHD patients and normal control subjects.

  15. Molecular Diagnosis of Orthopedic-Device-Related Infection Directly from Sonication Fluid by Metagenomic Sequencing

    PubMed Central

    Sanderson, Nicholas D.; Atkins, Bridget L.; Brent, Andrew J.; Cole, Kevin; Foster, Dona; McNally, Martin A.; Oakley, Sarah; Peto, Leon; Taylor, Adrian; Peto, Tim E. A.; Crook, Derrick W.; Eyre, David W.

    2017-01-01

    ABSTRACT Culture of multiple periprosthetic tissue samples is the current gold standard for microbiological diagnosis of prosthetic joint infections (PJI). Additional diagnostic information may be obtained through culture of sonication fluid from explants. However, current techniques can have relatively low sensitivity, with prior antimicrobial therapy and infection by fastidious organisms influencing results. We assessed if metagenomic sequencing of total DNA extracts obtained direct from sonication fluid can provide an alternative rapid and sensitive tool for diagnosis of PJI. We compared metagenomic sequencing with standard aerobic and anaerobic culture in 97 sonication fluid samples from prosthetic joint and other orthopedic device infections. Reads from Illumina MiSeq sequencing were taxonomically classified using Kraken. Using 50 derivation samples, we determined optimal thresholds for the number and proportion of bacterial reads required to identify an infection and confirmed our findings in 47 independent validation samples. Compared to results from sonication fluid culture, the species-level sensitivity of metagenomic sequencing was 61/69 (88%; 95% confidence interval [CI], 77 to 94%; for derivation samples 35/38 [92%; 95% CI, 79 to 98%]; for validation samples, 26/31 [84%; 95% CI, 66 to 95%]), and genus-level sensitivity was 64/69 (93%; 95% CI, 84 to 98%). Species-level specificity, adjusting for plausible fastidious causes of infection, species found in concurrently obtained tissue samples, and prior antibiotics, was 85/97 (88%; 95% CI, 79 to 93%; for derivation samples, 43/50 [86%; 95% CI, 73 to 94%]; for validation samples, 42/47 [89%; 95% CI, 77 to 96%]). High levels of human DNA contamination were seen despite the use of laboratory methods to remove it. Rigorous laboratory good practice was required to minimize bacterial DNA contamination. We demonstrate that metagenomic sequencing can provide accurate diagnostic information in PJI. Our findings

  16. Biomechanical testing of two devices for internal fixation of fractured ribs.

    PubMed

    Campbell, Nicole; Richardson, Martin; Antippa, Phillip

    2010-05-01

    An intramedullary screw (Portland Orthopaedics, St. Clair, MI) and Inion (Tampere, Finland) Orthopaedic Trauma Plating System (OTPS) mesh for use for internal fixation of fractured ribs have not previously undergone biomechanical testing. The aim of this study is to compare the biomechanics of intact ribs undergoing four-point bending to the biomechanics of fractured ribs fixed with each of the two devices to determine which device provides superior fixation. Thirty fresh-frozen porcine ribs (ribs 6-8) were submitted to four-point bending to failure, at a rate of 2.5 mm/min, to determine stiffness and force at failure. The ribs were then randomized to receive fixation with either Inion OTPS mesh or an intramedullary screw. The fixated ribs were again submitted to four-point bending to failure. Ribs fixated with OTPS mesh were significantly stiffer and failed at a significantly higher load than ribs fixated with intramedullary screws (p = 0.0001). Ribs fixated with OTPS mesh were less stiff than intact ribs but failed at a similar force to intact ribs. The Inion OTPS mesh system provides superior fixation of fractured ribs compared with an intramedullary screw when tested with four-point bending. The OTPS mesh system also has the added advantage of being absorbable. The intramedullary screw needs to undergo modification and further testing before use in humans. Future studies should focus on more physiologic methods of loading.

  17. Fixation of external drainage device with injectable shape-memory alloy clips.

    PubMed

    Olson, Jeffrey L; Erlanger, Michael

    2013-09-01

    To describe a novel surgical technique and novel surgical instrumentation for fixating an extraocular drainage device used for glaucoma-filtering surgery. The technique was performed in a laboratory setting using ex-vivo porcine eyes. We describe the surgical technique of using injectable, 25-gauge shape-memory clip system to fixate an Ahmed drainage device. The use of an injectable, shape-memory alloy clip provides the advantages of rapid, easy deployment and decreased risk of late suture failure. Importantly, the injectable, shape-memory clips can be used in surgical situations where suturing is difficult and time intensive, such as those encountered during glaucoma drainage device placement. The use of an injectable, shape-memory alloy clip is a promising new surgical tool and technique for fixating an extraocular drainage device used for glaucoma surgery.

  18. Clamping stiffness and its influence on load distribution between paired internal spinal fixation devices.

    PubMed

    Rohlmann, A; Calisse, J; Bergmann, G; Radvan, J; Mayer, H M

    1996-06-01

    The load distribution between two internal spinal fixation devices depends, besides other factors, on their stiffness. The stiffness ranges were determined experimentally for the clamps of the AO internal fixator with lateral nut and with posterior nut as well as for the clamps of the SOCON fixator. The stiffness of eight devices each differed by a factor of 3.1 for the clamp with lateral nut, by a factor of 1.5 for the clamp with posterior nut, and by a factor of 1.4 for the clamp of the SOCON fixator. For the AO clamp with lateral nut, the influence of the nut-tightening torque on the stiffness was determined. Using instrumented internal spinal fixation devices mounted to plastic vertebrae and simulating a corpectomy, the load distribution between the implants was measured for different tightening torques. It could be shown that, for the AO internal fixator whose clamps have a lateral nut, a nut-tightening torque > 5 Nm has only a negligible influence on load-sharing between the implants. Tooth damage occurs when the teeth of the clamp body and clamping jaw of the clamp with lateral nut do not gear together exactly, which leads to changes in the clamping stiffness and load-sharing between the two implants.

  19. Evaluation and comparison of clinical results of femoral fixation devices in arthroscopic anterior cruciate ligament reconstruction.

    PubMed

    Aydin, Deniz; Ozcan, Mert

    2016-03-01

    Several femoral fixation devices are available for hamstring tendon autograft in anterior cruciate ligament (ACL) reconstruction, but the best technique is debatable. We hypothesised that different suspensory femoral fixation techniques have no superiority over each other. The aim of this study was to evaluate and compare the clinical results of different suspensory femoral fixation devices in arthroscopic ACL reconstruction. This was a Level III, retrospective, comparative study. A total of 100 consecutive patients who underwent arthroscopic ACL reconstruction in a single institution with a mean follow-up time of 40 months (12-67 months) were divided into three groups according to femoral fixation devices as 'Endobutton' (n=34), 'Transfix' (n=35) and 'Aperfix' (n=31). The length of painful period after surgery, time to return to work and sporting activities, final range of motion, anterior drawer and Lachman tests, knee instability symptoms, International Knee Documentation Committee (IKDC) subjective knee evaluation score, Short Form 36 (SF-36) score, Lysholm knee score and Tegner point of the patients were evaluated and compared between groups. There were no significant differences between the groups. All techniques led to significant recovery in knee instability tests and symptoms. In this study, the clinical results of different suspensory femoral fixation techniques were found to be similar. We believe that different femoral fixation techniques have no effect on clinical results provided that the technique is correctly applied. The surgeon must choose a technique appropriate to his or her experience. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. Attention attraction in an ophthalmic diagnostic device using sound-modulated fixation targets.

    PubMed

    Gramatikov, Boris I; Rangarajan, Shreya; Irsch, Kristina; Guyton, David L

    2016-08-01

    This study relates to eye fixation systems with combined optical and audio systems. Many devices for eye diagnostics and some devices for eye therapeutics require the patient to fixate on a small target for a certain period of time, during which the eyes do not move and data from substructures of one or both eyes are acquired and analyzed. With young pediatric patients, a monotonously blinking target is not sufficient to retain attention steadily. We developed a method for modulating the intensity of a point fixation target using sounds appropriate to the child's age and preference. The method was realized as a subsystem of a Pediatric Vision Screener which employs retinal birefringence scanning for detection of central fixation. Twenty-one children, age 2-18, were studied. Modulation of the fixation target using sounds ensured the eye fixated on the target, and with appropriate choice of sounds, performed significantly better than a monotonously blinking target accompanied by a plain beep. The method was particularly effective with children of ages up to 10, after which its benefit disappeared. Typical applications of target modulation would be as supplemental subsystems in pediatric ophthalmic diagnostic devices, such as scanning laser ophthalmoscopes, optical coherence tomography units, retinal birefringence scanners, fundus cameras, and perimeters.

  1. Combined orthodontic-orthopedic treatment of an adolescent Class II Division 2 patient with extreme deepbite using the Forsus Fatigue Resistant Device.

    PubMed

    Bayram, Mehmet

    2017-09-01

    Class II Division 2 malocclusion is often characterized by severe, traumatic deepbite with lingually inclined and overerupted incisors. Combined orthodontic-orthopedic treatment of this malocclusion is a challenging issue for orthodontists. This case report describes the combined orthodontic-orthopedic treatment of an adolescent Class II Division 2 patient with an extreme deepbite and a retrognathic mandible using the Forsus Fatigue Resistant Device. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  2. Mechanical design optimization of bioabsorbable fixation devices for bone fractures.

    PubMed

    Lovald, Scott T; Khraishi, Tariq; Wagner, Jon; Baack, Bret

    2009-03-01

    Bioabsorbable bone plates can eliminate the necessity for a permanent implant when used to fixate fractures of the human mandible. They are currently not in widespread use because of the low strength of the materials and the requisite large volume of the resulting bone plate. The aim of the current study was to discover a minimally invasive bioabsorbable bone plate design that can provide the same mechanical stability as a standard titanium bone plate. A finite element model of a mandible with a fracture in the body region is subjected to bite loads that are common to patients postsurgery. The model is used first to determine benchmark stress and strain values for a titanium plate. These values are then set as the limits within which the bioabsorbable bone plate must comply. The model is then modified to consider a bone plate made of the polymer poly-L/DL-lactide 70/30. An optimization routine is run to determine the smallest volume of bioabsorbable bone plate that can perform and a titanium bone plate when fixating fractures of this considered type. Two design parameters are varied for the bone plate design during the optimization analysis. The analysis determined that a strut style poly-L-lactide-co-DL-lactide plate of 690 mm2 can provide as much mechanical stability as a similar titanium design structure of 172 mm2. The model has determined a bioabsorbable bone plate design that is as strong as a titanium plate when fixating fractures of the load-bearing mandible. This is an intriguing outcome, considering that the polymer material has only 6% of the stiffness of titanium.

  3. Pin site infection in orthopaedic external fixation devices.

    PubMed

    Walker, Jennie

    External fixation is a well-established mode of treatment within orthopaedics; however, despite continued research, pin site infection is still a problem. Pin site infection may cause pain and discomfort to the patient, and result in osteomyelitis or sepsis if minor infection is not managed in a timely and appropriate manner. Fundamental issues such as the assessment and reporting of infection are important in dealing with pin site infection, as is the ongoing management of the pin site itself. Many types of care are evident, with varying evidence to support their use in clinical practice. This article will discuss the identification and classification of pin site infection and the methods of care.

  4. A case series review of spinal cord stimulation migration rates with a novel fixation device.

    PubMed

    Justiz, Rafael; Bentley, Ishmael

    2014-01-01

    A retrospective review of a consecutive case series of 66 permanent spinal cord stimulation implants utilizing a novel tissue fixation device was performed. The purpose of this case series review is to examine the impact of a novel lead anchor to tissue fixation system and determine if it is a viable alternative to standard tissue fixation methods. Sixty-six cases were performed utilizing a novel method of lead anchor tissue fixation. Cases performed included cervical and thoracolumbar. For the majority of the 66 cases, two spinal cord stimulator leads and two SwiftLock lead anchors in conjunction with the novel method of tissue fixation were utilized. A retrospective review indicated no reports of lead migration during this case series, the mean follow-up time being 38 weeks (range 10-68 weeks). In addition, there were zero reported complications or untoward effects due to use of the novel device and technique. Overall complication rates for SCS have been reported in the range of 30-40%, with hardware-related complications contributing a significant percentage to the overall complication rate. Lead anchoring techniques still rely heavily on the experience and skill of the implanting physician. The novel device and method utilized in this case series to aid in anchoring leads demonstrated good results with no observed postoperative complications. These data suggest this novel method of tissue fixation may be a viable alternative for fixation of spinal cord stimulator leads to soft tissue. In this case series there were no reported incidents of migration or complications related to the novel device. © 2013 International Neuromodulation Society.

  5. Maintenance of reduction with suture button fixation devices for ankle syndesmosis repair.

    PubMed

    Peterson, Kyle S; Chapman, W Drew; Hyer, Christopher F; Berlet, Gregory C

    2015-06-01

    Malreduction of the syndesmosis can lead to increased peak pressures and subsequent arthritis. The purpose of this study was to evaluate the initial syndesmotic reduction and radiographic maintenance when using a knotless suture button fixation device for treatment of syndesmotic injury. A retrospective chart and radiographic review was performed to identify patients who underwent open reduction internal fixation of ankle syndesmosis ruptures treated with a knotless, suture button fixation system. Radiographic measurements included medial clear space, tibiofibular overlap, tibiofibular clear space, and the distance between buttons. Fifty-six patients underwent repair of an ankle fracture with syndesmotic rupture over a 3-year period, with a mean follow-up of 160.9 days. The tibiofibular clear space and tibiofibular overlap significantly improved from pre- to first postoperative, but also demonstrated some loss of fixation at final follow-up (P < .001). The distance between the buttons increased on average 1.1 mm from immediate postoperative to final follow-up, demonstrating some postoperative creep and loss of fixation in the system. A low complication rate and need for a revision operation was found in our patient cohort. Some loss of reduction did occur postoperatively, although this did not correlate to adverse patient outcomes. Syndesmotic stabilization, using a knotless suture button fixation device demonstrated adequate initial syndesmotic reduction, but also exhibited an increase in the tibiofibular clear space and tibiofibular overlap, relative to initial postfixation position, at short-term follow-up. Level IV, retrospective case series. © The Author(s) 2015.

  6. Orthobiologics in Pediatric Orthopedics.

    PubMed

    Murphy, Robert F; Mooney, James F

    2017-07-01

    Orthobiologics are biologic devices or products used in orthopedic surgery to augment or enhance bone formation. The use of orthobiologics in pediatric orthopedics is less frequent than in other orthopedic subspecialties, mainly due to the naturally abundant healing potential and bone formation in children compared with adults. However, orthobiologics are used in certain situations in pediatric orthopedics, particularly in spine and foot surgery. Other uses have been reported in conjunction with specific procedures involving the tibia and pelvis. The use of bioabsorable implants to stabilize children's fractures is an emerging concept but has limited supporting data. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. NiTiNol Hernia Device Stability in Inguinal Hernioplasty Without Fixation

    PubMed Central

    2011-01-01

    Background and Objective: To determine whether the NiTiNol frame of a novel hernia repair device utilizing polypropylene mesh for inguinal hernioplasty remains stable and intransient without fixation after a minimum of 6 months. Methods: Twenty patients had 27 inguinal hernias repaired using a novel hernia repair device that has a NiTiNol frame without any fixation. Initial single-view, postoperative X-rays were compared with a second X-ray obtained at least 6 months later. The NiTiNol frame, which can be easily visualized on a plain X-ray, was measured in 2 dimensions, as were anatomic landmarks. The measurements obtained and the appearances of the 2 X-rays were compared to determine the percentage of change in device size and device stability with regard to device location and shape. Results: There were minimal changes noted between the 2 sets of measurements obtained with an overall trend towards a slight increase in the size of the hernia repair device. The devices demonstrated intransience of position and stability of shape. Conclusions: The NiTiNol frame of a novel hernia repair device utilizing polypropylene mesh exhibits radiographic evidence of size and shape stability and intransience of position without fixation when used in inguinal hernioplasty after a minimum follow-up of 6 months. PMID:21902967

  8. Numerical investigations of MRI RF field induced heating for external fixation devices

    PubMed Central

    2013-01-01

    Background The magnetic resonance imaging (MRI) radio frequency (RF) field induced heating on external fixation devices can be very high in the vicinity of device screws. Such induced RF heating is related to device constructs, device placements, as well as the device insertion depth into human subjects. In this study, computational modeling is performed to determine factors associated with such induced heating. Methods Numerical modeling, based on the finite-difference time-domain (FDTD) method, is used to evaluate the temperature rises near external device screw tips inside the ASTM phantom for both 1.5-T and 3-T MRI systems. The modeling approach consists of 1) the development of RF coils for 1.5-T and 3-T, 2) the electromagnetic simulations of energy deposition near the screw tips of external fixation devices, and 3) the thermal simulations of temperature rises near the tips of these devices. Results It is found that changing insertion depth and screw spacing could largely affect the heating of these devices. In 1.5-T MRI system, smaller insertion depth and larger pin spacing will lead to higher temperature rise. However, for 3-T MRI system, the relation is not very clear when insertion depth is larger than 5 cm or when pin spacing became larger than 20 cm. The effect of connection bar material on device heating is also studied and the heating mechanism of the device is analysed. Conclusions Numerical simulation is used to study RF heating for external fixation devices in both 1.5-T and 3-T MRI coils. Typically, shallower insertion depth and larger pin spacing with conductive bar lead to higher RF heating. The heating mechanism is explained using induced current along the device and power decay inside ASTM phantom. PMID:23394173

  9. Monitoring the use of halo fixation device through an assessment form.

    PubMed

    Ho, Chin-Hung; Li, Ka-Kin; Chin, Raymond Ping-Hong; Lee, Helen Wai-Man; Kwong, William Yan-Yee; Kwan, Hung-Hei

    2011-12-01

    To compare the use of the halo fixation device in our hospital before and after implementation of a new compliance protocol. From 2003 to 2008, 17 (47%) of 36 patients had dislodgement of their halo fixation device. All rings and vests and some of the pins were reused. Documentation of poundage assessment and change of skull pins before dislodgement was lacking. There was no protocol for assessing superstructure throughout the course of the application. To improve the standard of care, knowledge about the application of the halo fixation device in orthopaedic and orthotic departments was reinforced and compliance documented. From September 2008 to April 2010, 15 patients used the halo fixation device for cervical immobilisation. Patients were reminded to minimise shoulder shrugging and report any discomfort. Poundage checking was strictly observed during and after application. The integrity of the device was regularly checked by orthotists. The conditions of the skull pins, halo ring, and vest were also documented after removal. Two (13%) of the 15 patients had ring dislodgement. One occurred a day after application owing to malposition of a posterior skull pin, and the other was related to a fall in a toilet at week 4. Both involved reused skull pins. 45% of the skull pins were new, whereas 44% were found defective after removal of rings. Compliance with the new assessment form was satisfactory. Clinical audit improved outcome achieved with the halo fixation device. Reuse of titanium skull pins should be avoided. Re-torquing of the pin should be avoided when the tip is blunted or hooked. The new assessment form enabled compliance with the principle of application by orthotists and patients.

  10. Are there any complications with bioabsorbable fixation devices? A 10 year review in orthognathic surgery.

    PubMed

    Laine, P; Kontio, R; Lindqvist, C; Suuronen, R

    2004-04-01

    Bioabsorbable fixation devices have been used in our departments between November 1991 and November 2001 in orthognathic surgery. The aim of this retrospective study was to assess all complications experienced during this time period, when we have operated 163 patients who have undergone 329 orthognathic osteotomies fixated with bioresorbable devices. No postoperative intermaxillary fixation was used. Light guiding elastics were used for 5 to 7 weeks. Patients' acceptance was generally excellent and very few complications occurred during this follow-up of 10 years. The complications were minor and did not affect the end results of the operations. Minor complications occurred in 14 patients (8.6%). Only one patient (0.6%) had a postoperative infection with elevated infection parameters. The other minor complications consisted mainly of dehiscence of the wound and plate exposure together with granulation tissue in the operation field. The rest of the complications occurred in the beginning of our study, when large screw heads on top of the bone irritated the patient and had to be removed. Insufficient fixation resulted in open bite in three patients (1.8%) in the beginning of the trial use of new devices, which no longer are used. Based on our experience, bioresorbable devices are safe to be used in orthognathic procedures. However, there is a learning curve, as there is with all new methods introduced.

  11. COMPARISON OF VOLUMES OCCUPIED BY DIFFERENT INTERNAL FIXATION DEVICES FOR FEMORAL NECK FRACTURES

    PubMed Central

    Lauxen, Daniel; Schwartsmann, Carlos Roberto; Silva, Marcelo Faria; Spinelli, Leandro de Freitas; Strohaecker, Telmo Roberto; Souza, Ralf Wellis de; Zimmer, Cinthia Gabriely; Boschin, Leonardo Carbonera; Gonçalves, Ramiro Zilles; Yépez, Anthony Kerbes

    2015-01-01

    Objective: The objective of this paper is to measure the volume occupied by the most widely used internal fixation devices for treating femoral neck fractures, using the first 30, 40 and 50 mm of insertion of each screw as an approximation. The study aimed to observe which of these implants caused least bone aggression. Methods: Five types of cannulated screws and four types of dynamic hip screws (DHS) available on the Brazilian market were evaluated in terms of volume differences through water displacement. Results: Fixation with two cannulated screws presented significantly less volume than shown by DHS, for insertions of 30, 40 and 50 mm (p=0.01, 0.012 and 0.013, respectively), fixation with three screws did not show any statistically significant difference (p= 0.123, 0.08 and 0.381, respectively) and fixation with four cannulated screws presented larger volumes than shown by DHS (p=0.072, 0.161 and 0.033). Conclusions: Fixation of the femoral neck with two cannulated screws occupied less volume than DHS, with a statistically significant difference. The majority of screw combinations did not reach statistical significance, although fixation with four cannulated screws presented larger volumes on average than those occupied by DHS. PMID:27047886

  12. Titanium alloys as fixation device material for cranioplasty and its safety in electroconvulsive therapy.

    PubMed

    Kaido, Takanobu; Noda, Takamasa; Otsuki, Taisuke; Kaneko, Yuu; Takahashi, Akio; Nakai, Tetsuji; Nabatame, Maki; Tani, Mariko

    2011-03-01

    Here, we report the case of a patient successfully treated by a series of electroconvulsive therapy (ECT) who had implanted skull fixation devices made of titanium alloy. The patient was a 57-year-old man with bipolar I disorder. He was hospitalized for the treatment of manic symptoms of bipolar I disorder with pharmacotherapy and ECT. He sustained a fall and hit his head hard on the ground. Acute subdural hematoma developed, and emergent surgery to remove the hematoma was carried out. Cranioplasty was performed using fixation devices made of titanium alloy (Ti 6Al-4V). In order to control his manic symptoms, a series of ECT was readministered from 1 week after surgery. No adverse effects occurred. Devices must be investigated and chosen very carefully for permanent implantation, especially in patients during a course of ECT.

  13. Intra-cesarean insertion and fixation of frameless intrauterine devices

    PubMed Central

    Karateke, Ateş; Turgut, Abdulkadir; Özdamar, Özkan; Wildemeersch, Dirk

    2017-01-01

    Various contraceptive methods are available to postpartum women including hormonal and nonhormonal barriers, as well as injectable forms. Of all the available birth control methods, intrauterine devices (IUD) are felt by many to be the near-ideal form of contraception, and are recommended by advocacy groups, physicians, and gynecological organizations worldwide. Immediate postpartum IUD insertion deserves greater attention because it can provide immediate contraception, prevents repeat unintended pregnancies, and may serve to reduce the incidence or need for secondary cesarean delivery; however, insertion of conventional T-shape IUDs immediately post placenta delivery is limited by their high expulsion and displacement rates. Anchoring of frameless-design IUDs that lack conventional cross-arms to the uterine fundal surfaces has been medically and commercially available throughout Europe for many years. The placement technique is simple, has minimal patient discomfort, and high long-term patient acceptance due to its high degree of uterine compatibility as a consequence of its small size and segmented design. Frameless-design IUD implantation appears to represent a major advance, suitable for general use, due to its lack of timing restraints and its simplicity of attachment, which only requires limited training. PMID:28913137

  14. Intra-cesarean insertion and fixation of frameless intrauterine devices.

    PubMed

    Karateke, Ateş; Turgut, Abdulkadir; Özdamar, Özkan; Wildemeersch, Dirk

    2017-03-01

    Various contraceptive methods are available to postpartum women including hormonal and nonhormonal barriers, as well as injectable forms. Of all the available birth control methods, intrauterine devices (IUD) are felt by many to be the near-ideal form of contraception, and are recommended by advocacy groups, physicians, and gynecological organizations worldwide. Immediate postpartum IUD insertion deserves greater attention because it can provide immediate contraception, prevents repeat unintended pregnancies, and may serve to reduce the incidence or need for secondary cesarean delivery; however, insertion of conventional T-shape IUDs immediately post placenta delivery is limited by their high expulsion and displacement rates. Anchoring of frameless-design IUDs that lack conventional cross-arms to the uterine fundal surfaces has been medically and commercially available throughout Europe for many years. The placement technique is simple, has minimal patient discomfort, and high long-term patient acceptance due to its high degree of uterine compatibility as a consequence of its small size and segmented design. Frameless-design IUD implantation appears to represent a major advance, suitable for general use, due to its lack of timing restraints and its simplicity of attachment, which only requires limited training.

  15. A pedicle screw bridging device for posterior segmental fixation of the spine: preliminary mechanical testing results.

    PubMed

    Rahmatalla, A T; Hastings, G W; Dove, J; Crawshaw, A H

    1991-03-01

    Mechanical assessment of a new pedicle screw bridge device for spinal surgery is reported. Results are given for a series of single tests to failure and a fatigue cyclical loading test. Comparative testing of torsional and lateral bending resistance on three surgical spinal fixation systems was carried out: Luque, wired Hartshill rectangle and pedicle screwed bridge with Hartshill rectangle and pedicle screwed bridge with Hartshill rectangle. The results show the superiority of the bridged Hartshill in both rotational and lateral bending resistance. The new bridge device could also improve the versatility of the Hartshill system to cover a wider spectrum of spinal fixations. A test to determine the axial pull-out strength of three screw designs was undertaken. The differences between the forces needed were insignificant. At failure a cylinder of bone tissues greater than the major diameter of the screw was pulled out without breaking the bone.

  16. IMF Screw: An Ideal Intermaxillary Fixation Device During Open Reduction of Mandibular Fracture.

    PubMed

    Sahoo, N K; Mohan, Ritu

    2010-06-01

    Intermaxillary fixation (IMF) is conventionally used for treatment of fractures involving maxillomandibular complex both for closed reduction and as an adjuvant to open reduction. To overcome the cumbersome procedure of tooth borne appliances cortical bone screws were introduced in the year of 1989 to achieve IMF which is essentially a bone borne appliance. In our institution we treated 45 cases of mandibular fracture both single and multiple fractures by open reduction over a period of 24 months. IMF screws were used to achieve dental occlusion in all the cases. Various advantages, disadvantages and complications are discussed. In our institutional experience we found that the IMF screws are an ideal device for temporary intermaxillary fixation for the cases having only mandibular fracture.

  17. Comparative Genomics Study of Staphylococcus epidermidis Isolates from Orthopedic-Device-Related Infections Correlated with Patient Outcome.

    PubMed

    Post, Virginia; Harris, Llinos G; Morgenstern, Mario; Mageiros, Leonardos; Hitchings, Matthew D; Méric, Guillaume; Pascoe, Ben; Sheppard, Samuel K; Richards, R Geoff; Moriarty, T Fintan

    2017-10-01

    Staphylococcus epidermidis has emerged as an important opportunistic pathogen causing orthopedic-device-related infections (ODRI). This study investigated the association of genome variation and phenotypic features of the infecting S. epidermidis isolate with the clinical outcome for the infected patient. S. epidermidis isolates were collected from 104 patients with ODRI. Their clinical outcomes were evaluated, after an average of 26 months, as either "cured" or "not cured." The isolates were tested for antibiotic susceptibility and biofilm formation. Whole-genome sequencing was performed on all isolates, and genomic variation was related to features associated with "cured" and "not cured." Strong biofilm formation and aminoglycoside resistance were associated with a "not-cured" outcome (P = 0.031 and P < 0.001, respectively). Based on gene-by-gene analysis, some accessory genes were more prevalent in isolates from the "not-cured" group. These included the biofilm-associated bhp gene, the antiseptic resistance qacA gene, the cassette chromosome recombinase-encoding genes ccrA and ccrB, and the IS256-like transposase gene. This study identifies biofilm formation and antibiotic resistance as associated with poor outcome in S. epidermidis ODRI. Whole-genome sequencing identified specific genes associated with a "not-cured" outcome that should be validated in future studies. (The study has been registered at ClinicalTrials.gov with identifier NCT02640937.). Copyright © 2017 American Society for Microbiology.

  18. Correction of Hammertoe Deformity With Novel Intramedullary PIP Fusion Device Versus K-Wire Fixation.

    PubMed

    Richman, Seth H; Siqueira, Marcelo Bogliolo Piancastelli; McCullough, Kirk A; Berkowitz, Mark J

    2017-02-01

    K-wire fixation has been the most common method of fixation for hammertoe deformity. However intramedullary devices are gaining ground in both number of available choices and in procedures performed. This study aimed to compare the outcomes of hammertoe correction performed with K-wire fixation versus a novel intramedullary fusion device (CannuLink). A retrospective review of hammertoe correction by a single surgeon was performed from June 2011 to December 2013. Sixty patients (95 toes) underwent K-wire fixation and 39 patients (54 toes) underwent fusion with the CannuLink implant. Average age was 61.7 years and 61.4 years, respectively. Average length of follow-up was 12.9 and 12.3 months, respectively. Patients were evaluated for medical comorbidities, smoking status, inflammatory arthritis, peripheral vascular disease, peripheral neuropathy, pre- and postoperative visual analog pain scale, bony union percentage, revision rate, complications (hardware and surgery-related), and persistent symptoms at last follow-up. There was no significant difference in demographics or comorbidities between the 2 groups ( P > .05). In the K-wire group, 16 patients (18 toes) remained symptomatic at last follow-up (27%). Nine toes (9.5%) had recurrent deformity, 3 toes (3%) developed a late infection because of the recurrent deformity, and 1 toe (1%) developed partial numbness. One patient suffered a calf deep vein thrombosis (DVT) and peroneal nerve neuritis, 1 patient developed foot drop, and 3 patients continued to complain of pain. Five toes required revision surgery (5.3%). In the intramedullary group, 3 (7.7%) patients remained symptomatic and all were associated with a complication. One patient developed chronic regional pain syndrome in the foot, a calf DVT, and a nonfatal pulmonary embolus. A second patient developed a painless recurrent deformity. A third patient had wound dehiscence. Nobody had hardware failure or required a second operation. The CannuLink intramedullary

  19. Negative pressure wound therapy and external fixation device: a simple way to seal the dressing.

    PubMed

    Bulla, Antonio; Farace, Francesco; Uzel, André-Pierre; Casoli, Vincent

    2014-07-01

    Negative pressure therapy is widely applied to treat lower limb trauma. However, sealing a negative pressure dressing in the presence of an external fixation device may be difficult and time consuming. Therefore, screws, pins, wires, etc, may preclude the vacuum, preventing the plastic drape to perfectly adhere to the foam. To maintain the vacuum, we tried to prevent air leaking around the screws putting bone wax at the junction between the pins and the plastic drape. This solution, in our hands, avoids air leakage and helps maintain vacuum in a fast and inexpensive way.

  20. Implantable Subcutaneous Venous Access Devices: Is Port Fixation Necessary? A Review of 534 Cases

    SciTech Connect

    McNulty, Nancy J. Perrich, Kiley D.; Silas, Anne M.; Linville, Robert M.; Forauer, Andrew R.

    2010-08-15

    Conventional surgical technique of subcutaneous venous port placement describes dissection of the port pocket to the pectoralis fascia and suture fixation of the port to the fascia to prevent inversion of the device within the pocket. This investigation addresses the necessity of that step. Between October 8, 2004 and October 19, 2007, 558 subcutaneous chest ports were placed at our institution; 24 cases were excluded from this study. We performed a retrospective review of the remaining 534 ports, which were placed using standard surgical technique with the exception that none were sutured into the pocket. Mean duration of port use, total number of port days, indications for removal, and complications were recorded and compared with the literature. Mean duration of port use was 341 days (182,235 total port days, range 1-1279). One port inversion/flip occurred, which resulted in malfunction and necessitated port revision (0.2%). Other complications necessitating port removal included infection 26 (5%), thrombosis n = 2 (<1%), catheter fracture/pinch n = 1 (<1%), pain n = 2 (<1%), and skin erosion n = 3 (1%). There were two arrhythmias at the time of placement; neither required port removal. The overall complication rate was 7%. The 0.2% incidence of port inversion we report is concordant with that previously published, although many previous reports do not specify if suture fixation of the port was performed. Suture fixation of the port, in our experience, is not routinely necessary and may negatively impact port removal.

  1. Vacuum sealing drainage therapy in the presence of an external fixation device

    PubMed Central

    Sun, Dahui; Ju, Weina; Wang, Tiejun; Yu, Tiecheng; Qi, Baochang

    2016-01-01

    Abstract Rationale: Vacuum sealing drainage (VSD) is widely utilized for treating traumatic wounds. Patient concerns: It is particularly difficult and time consuming to use in combination with an external fixator. Diagnoses: This is because the hardware or pins used for fixation interfere with maintaining a seal, resulting in poor adhesion and subsequent air leakage. Interventions: To resolve this problem, we have devised a new method for sealing the wound dressing, while maintaining the required vacuum.When using this technique, a rubber strip is wrapped around each pin in 3 circles outside the plastic drape, and then tightly tied. Outcomes: After completing this procedure, a vacuum is obtained, and any air leakage stops. We employed this technique to treat a cohort of patients in our department over a period of two years, and obtained good healing of soft tissue without air leakage, as well as good clinical outcomes. Lessons: We have observed that patients treated with this method experienced good clinical outcomes without air leakage, and we recommend its use in treating cases where an external fixation device is present. PMID:27861393

  2. Comparison of Outcomes of Two Femoral Fixation Devices in Hamstring Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Sánchez-Carrasco, Miguel Angel; Abellán, Juan Francisco; Qudsi-Sinclair, Salima; Ruiz-Merino, Guadalupe; Carrillo-Juliá, Francisco Javier; Bo-Rueda, David

    2017-01-01

    Background: Tear of the anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. Reconstruction of this ligament is often required to restore functional stability of the knee. Outcome of ACL reconstruction is significantly affected by how the graft is fixed to the bone. This study is to determine if there is a different clinical outcome after cortical versus cortical-cancellous suspension femoral fixation in hamstring based anterior cruciate ligament (ACL) reconstruction. Materials and Methods: This is a retrospective comparative study conducted between 2006 and 2010. We enrolled patients who underwent arthroscopic ACL reconstruction. Sixty two patients met inclusion criteria and 41 agreed to come for followup assessment. Median age was of 28 years (range 18–39 years). Demographic baseline profile of both groups was similar. The femoral fixation devices were cortical (n = 16) and cortical-cancellous suspension techniques (n = 25). The average period of evolution at the time of assessment was 40 months (range 12-72 months). The patients were examined according to Lachman test (using Rolimeter knee tester), anterior drawer test, pivot shift test, International Knee Documentation Committee questionnaire, and Tegner-Lysholm knee scoring scale. Results: The objective evaluation of the patients (Lachman test) showed better results in terms of stability in the group of patients who underwent the cortical-cancellous suspension method. These differences were not reflected in the assessment of activity level (Tegner-Lysholm), where both groups showed the same results. Conclusions: ACL reconstruction with both cortical and cortical-cancellous suspension femoral fixation techniques show the same clinical results at medium long followup. However, cortical-cancellous fixations seem to provide greater stability to the reconstruction. PMID:28966371

  3. Effect of hydroxyapatite concentration on high-modulus composite for biodegradable bone-fixation devices.

    PubMed

    Heimbach, Bryant; Grassie, Kevin; Shaw, Montgomery T; Olson, James R; Wei, Mei

    2017-10-01

    There are over 3 million bone fractures in the United States annually; over 30% of which require internal mechanical fixation devices to aid in the healing process. The current standard material used is a metal plate that is implanted onto the bone. However, metal fixation devices have many disadvantages, namely stress shielding and metal ion leaching. This study aims to fix these problems of metal implants by making a completely biodegradable material that will have a high modulus and exhibit great toughness. To accomplish this, long-fiber poly-l-lactic acid (PLLA) was utilized in combination with a matrix composed of polycaprolactone (PCL) and hydroxyapatite (HA) nano-rods. Through single fibril tensile tests, it was found that the PLLA fibers have a Young's modulus of 8.09 GPa. Synthesized HA nanorods have dimensions in the nanometer range with an aspect ratio over 6. By dip coating PLLA fibers in a suspension of PCL and HA and hot pressing the resulting coated fibers, dense fiber-reinforced samples were made having a flexural modulus up to 9.2 GPa and a flexural strength up to 187 MPa. The flexural modulus of cortical bone ranges from 7 to 25 GPa, so the modulus of the composite material falls into the range of bone. The typical flextural strength of bone is 130 MPa, and the samples here greatly exceed that with a strength of 187 MPa. After mechanical testing to failure the samples retained their shape, showing toughness with no catastrophic failure, indicating the possibility for use as a fixation material. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1963-1971, 2017. © 2016 Wiley Periodicals, Inc.

  4. Evaluation of body image and self-esteem in patients with external fixation devices: a Turkish perspective.

    PubMed

    Büyükyilmaz, Funda; Sendir, Merdiye; Salmond, Susan

    2009-01-01

    This descriptive study aimed to describe the body image and self-esteem of patients with external fixation devices. Fifty patients with external fixation devices who came for follow-up to the Ilizarov Outpatient Clinic of a university hospital in Turkey were included in this study. Data were collected by using a Demographic Questionnaire Form, Multidimensional Body-Self Relations Questionnaire (MBSRQ), and Coppersmith Self-Esteem Inventory. The perceived body image (197.58 +/- 25.14) and self-esteem (65.28 +/- 17.97) of the patients with external fixation devices were in the moderate range. There was no significant correlation between body image and self-esteem. Self-esteem was correlated with one's perception of whether external fixation impacted one's appearance and whether one wanted to avoid being seen by certain individuals because of the appearance of the external fixator. The study highlighted that body image disturbance and threats to self-esteem are not universal with the use of external fixation and need to be assessed individually.

  5. Orthopedic evaluation

    NASA Technical Reports Server (NTRS)

    Walden, T.

    1978-01-01

    The clinical performance of the Lixiscope in orthopedics was compared with routine radiography. Portability and size were the major advantages of the Lixiscope. The main disadvantage at this point in time was the Lixiscope's inability to study large areas.

  6. An application of principal component analysis to the clavicle and clavicle fixation devices

    PubMed Central

    2010-01-01

    Background Principal component analysis (PCA) enables the building of statistical shape models of bones and joints. This has been used in conjunction with computer assisted surgery in the past. However, PCA of the clavicle has not been performed. Using PCA, we present a novel method that examines the major modes of size and three-dimensional shape variation in male and female clavicles and suggests a method of grouping the clavicle into size and shape categories. Materials and methods Twenty-one high-resolution computerized tomography scans of the clavicle were reconstructed and analyzed using a specifically developed statistical software package. After performing statistical shape analysis, PCA was applied to study the factors that account for anatomical variation. Results The first principal component representing size accounted for 70.5 percent of anatomical variation. The addition of a further three principal components accounted for almost 87 percent. Using statistical shape analysis, clavicles in males have a greater lateral depth and are longer, wider and thicker than in females. However, the sternal angle in females is larger than in males. PCA confirmed these differences between genders but also noted that men exhibit greater variance and classified clavicles into five morphological groups. Discussion And Conclusions This unique approach is the first that standardizes a clavicular orientation. It provides information that is useful to both, the biomedical engineer and clinician. Other applications include implant design with regard to modifying current or designing future clavicle fixation devices. Our findings support the need for further development of clavicle fixation devices and the questioning of whether gender-specific devices are necessary. PMID:20346123

  7. Fixation of displaced femoral neck fractures in young adults: Fixed-angle devices or Pauwel screws?

    PubMed

    Hoshino, C M; Christian, M W; O'Toole, R V; Manson, T T

    2016-08-01

    We sought to compare the incidence of complications after fixation of displaced femoral neck fractures in young adults treated with fixed-angle devices versus multiple cancellous screws and a trochanteric lag screw (Pauwel screw). We conducted a retrospective cohort study at a level I trauma centre. Sixty-two skeletally mature patients (age range, 16-60 years) with displaced femoral neck fractures were included in the study. Forty-seven were treated with a fixed-angle device (sliding hip plate with screw or helical blade) and 15 with multiple cancellous screws placed in a Pauwel configuration. The main outcome measure was postoperative complication of osteonecrosis or nonunion treated with a surgical procedure. Significantly fewer failures occurred in the fixed-angle group (21%) than in the screws group (60%) (p=0.008). Osteonecrosis was rare in the fixed-angle group, occurring in 2% of cases versus 33% of cases in the screws group (p=0.002). Consistent with previous studies, good to excellent reductions were associated with a failure rate of 25% and fair to poor reductions were associated with a failure rate of 55% (p=0.07). The best-case scenario of a good to excellent reduction stabilised with a fixed-angle device yielded a success rate of 85%. In young patients with displaced high-energy femoral neck fractures, fixed-angle devices resulted in fewer treatment failures than did Pauwel screws. Copyright © 2016. Published by Elsevier Ltd.

  8. Analysis of a Lane-plate internal fixation device after 64 years in vivo.

    PubMed

    McAuley, J P; Gow, K V; Covert, A; McDermott, A G; Yabsley, R H

    1987-11-01

    A patient presented for an above-knee amputation 64 years after successful internal fixation of a femoral fracture with a Lane plate. Chemical analyses of the plate and corrosion products were done using atomic absorption spectrophotometry, x-ray energy spectroscopy and x-ray diffraction. Mechanical properties of the fixation devices were measured using Rockwell-type instruments and metallographic analyses were also performed. In addition, pathologic and radiologic investigations of the underlying bone were carried out. Results disclosed that extensive corrosion had weakened the plate by 50%. The metallosis of the surrounding soft tissues and abnormal morphologic features of underlying bone were analysed. No appreciable cellular inflammatory or dysplastic reaction of adjacent tissues was identified. The underlying bone showed a persistent lack of mature compact bone and no evidence of remodelling. The products of corrosion were mainly ferrous carbonate and some ferrous chloride. The mechanism of the corrosion was the formation of a galvanic cell between the iron carbide and surrounding iron, with dissolution of the iron and formation of the corrosion products.

  9. Spontaneous locking of the knee after anterior cruciate ligament reconstruction as a result of a broken tibial fixation device.

    PubMed

    Metcalfe, Andrew J; James, Stuart H; Fairclough, John A

    2008-10-01

    The Intrafix device (DePuy Mitek, Raynham, MA) is one of a number of recently developed products whose aim is to improve fixation of quadrupled hamstring grafts when used for anterior cruciate ligament reconstruction. We present a case of failure and intra-articular migration of the sleeve of an Intrafix device causing locking of the knee 10 weeks after anterior cruciate ligament reconstruction. We were unable to identify the cause of the failure or migration of the device. Rehabilitation had been progressing normally and without incident. The broken fragments were removed arthroscopically, and the reconstruction was found to be intact and healing well. Presumably, the device retained enough mechanical function to allow healing to progress, despite failure of the sleeve. This is, to our knowledge, the first reported case of such an event occurring with the new generation of hamstring graft fixation devices.

  10. Characterization of short-fibre reinforced thermoplastics for fracture fixation devices.

    PubMed

    Brown, S A; Hastings, R S; Mason, J J; Moet, A

    1990-10-01

    This study focuses on determining the effects of clinically relevant procedures on the flexural and fracture toughness properties of three short-fibre thermoplastic composites for potential application as fracture fixation devices. The procedures included sterilization, heat contouring and saline soaking. The three materials tested were polysulphone, polybutylene terephthalate and polyetheretherketone, all reinforced with 30% short carbon fibres. The polysulphone composite showed significant degradation in mechanical properties due to saline soaking. The polybutylene terephthalate exhibited significant degradation of mechanical properties following both contouring and saline soaking. The polyetheretherketone composite, however, exhibited no degradation in mechanical properties. The results demonstrated that flexion and fracture toughness testing were effective for determining the response of the composites to different applied conditions and demonstrated the stability of polyetheretherketone subjected to these treatments. Scanning electron microscopy demonstrated the most effective fibre-matrix bonding to be in the polyetheretherketone.

  11. Digital arthrodesis with a one-piece memory nitinol intramedullary fixation device: a retrospective review.

    PubMed

    Sandhu, Jaytinder S; DeCarbo, William T; Hofbauer, Mark H

    2013-10-01

    A 1-piece memory Nitinol intramedullary fixation device (Smart Toe; Stryker Corporation, Kalamazoo, MI) was used for proximal interphalangeal joint arthrodesis for correction of painful hammertoes in digits 2, 3, and 4. Sixty-five implants were placed in 35 patients. The mean age of our patients was 62.2 years (range = 27-82; standard deviation = 12.5). Mean follow-up time was 27 months (range = 12-40 months; standard deviation = 7). Overall, a 93.8% fusion rate was noted. Complications were noted in 4 patients (6.1%): 1 asymptomatic nonunion (1.5%), 2 hardware failures (3%), and 1 implant displacement (1.5%). To date, no patients required revisional surgery or hardware removal. V.

  12. Treatment of malar and midfacial fractures with osteoconductive forged unsintered hydroxyapatite and poly-L-lactide composite internal fixation devices.

    PubMed

    Landes, Constantin; Ballon, Alexander; Ghanaati, Sharam; Tran, Andreas; Sader, Robert

    2014-07-01

    To evaluate the internal fixation of malar and midfacial fractures, long-term results, and biocompatibility of osteoconductive internal fixation devices composed of a forged composite of unsintered hydroxyapatite and poly-L-lactide (F-u-HA/PLLA). From January 2006 to June 2010, 29 patients (24 males and 5 females; age 33 ± 15 years) were included in the present prospective study. The fracture type was malar in 24 patients, midfacial in 5, isolated orbital floor blowout in 2, and frontal sinus, cranial base in 2 patients. The fractures were fixed with internal fixation devices; these were plates and screws composed of F-u-HA/PLLA. The 24 patients with malar fractures were treated with a single 4-hole L-plate or a straight plate at the infrazygomatic crest. All fractures with internal fixation using devices composed of F-u-HA/PLLA healed well. All malar and midfacial fractures had satisfactory long-term stability. The follow-up examinations at 12 to 67 months after surgery showed that most patients had no complaints, although 2 patients (15%) had a foreign body reaction that was treated by implant removal, with complete symptom resolution. At 5 years after fracture fixation, 2 patients had ultrasound and 2 had radiographic evidence of residual material. An exemplar biopsy showed direct bone growth into the material. In patients with malar and midfacial fractures, hardware composed of the F-u-HA/PLLA composite provided reliable and satisfactory internal fixation, intraoperative handling, long-term stability, and biocompatibility. Direct bone growth into the material could be histopathologically exemplified, in contrast to previous polymer fixations that were resorbed and surrounded by a connective tissue layer. This finding indicates that long-term F-u-HA/PLLA residual material will be included into the remodeled bone, which was confirmed on long-term follow-up radiographs. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by

  13. In Vitro Evaluation of Inflow Cannula Fixation Techniques in Left Ventricular Assist Device Surgery.

    PubMed

    Hanke, Jasmin S; Krabatsch, Thomas; Rojas, Sebastian V; Deniz, Ezin; Ismail, Issam; Martens, Andreas; Shrestha, Malakh; Haverich, Axel; Netuka, Ivan; Schmitto, Jan D

    2017-03-01

    The therapy of terminal heart failure with left ventricular assist devices has become a standard in cardiac surgery. Yet the surgical implantation technique is not standardized and differs from center to center. Complications associated with left ventricular assist device (LVAD) inflow cannula placement are thrombosis, suction events, and flow disturbances. Within this in vitro study we aimed to investigate if the fixation technique of the sewing ring has an impact on the position of the inflow cannula. For this in vitro study the HeartMate III LVAD (Thoratec Corporation, Pleasanton, CA, USA) was used. In five sessions, two approaches were considered for coring of the ventricle for LVAD inflow cannula insertion: "sew-then-core" and "core-then-sew." In the "sew-then-core" technique, the sewing cuff is first affixed to the heart, usually with 8-16 interrupted pledgeted mattress sutures. Subsequently, a cylindrical knife is used to resect a cylindrical core of myocardium to permit cannula insertion. In the "core-then-sew" technique, the sequence is reversed such that the knife is used before the suture ring is affixed. When the "sew-then-core" technique is used, the mattress sutures may be placed with full-thickness bites that penetrate the endocardium (i.e., transmural stitching) or partial-thickness bites that do not penetrate the endocardium (i.e., epicardial stitching). When the "core-then-sew" technique is used, the suture is passed fully into the ventricular lumen and fed back through the cored hole, at which point the needle may be reinserted into the freshly cored myocardium such that it exits the epicardium (i.e., transmural stitching with back stitch) or not (i.e., transmural stitching without back stitch). These four different sewing ring fixation suturing techniques were tested by experienced surgeons to affix the sewing ring: transmural stitching, epicardial stitching, transmural stitching with back stitch, and transmural stitching without back stitch

  14. Comparison of theoretical fixation stability of three devices employed in medial opening wedge high tibial osteotomy: a finite element analysis

    PubMed Central

    2014-01-01

    Background Medial open wedge high tibial osteotomy is a well-established procedure for the treatment of unicompartmental osteoarthritis and symptomatic varus malalignment. We hypothesized that different fixation devices generate different fixation stability profiles for the various wedge sizes in a finite element (FE) analysis. Methods Four types of fixation were compared: 1) first and 2) second generation Puddu plates, and 3) TomoFix plate with and 4) without bone graft. Cortical and cancellous bone was modelled and five different opening wedge sizes were studied for each model. Outcome measures included: 1) stresses in bone, 2) relative displacement of the proximal and distal tibial fragments, 3) stresses in the plates, 4) stresses on the upper and lower screw surfaces in the screw channels. Results The highest load for all fixation types occurred in the plate axis. For the vast majority of the wedge sizes and fixation types the shear stress (von Mises stress) was dominating in the bone independent of fixation type. The relative displacements of the tibial fragments were low (in μm range). With an increasing wedge size this displacement tended to increase for both Puddu plates and the TomoFix plate with bone graft. For the TomoFix plate without bone graft a rather opposite trend was observed. For all fixation types the occurring stresses at the screw-bone contact areas pulled at the screws and exceeded the allowable threshold of 1.2 MPa for at least one screw surface. Of the six screw surfaces that were studied, the TomoFix plate with bone graft showed a stress excess of one out of twelve and without bone graft, five out of twelve. With the Puddu plates, an excess stress occurred in the majority of screw surfaces. Conclusions The different fixation devices generate different fixation stability profiles for different opening wedge sizes. Based on the computational simulations, none of the studied osteosynthesis fixation types warranted an intransigent full

  15. Orthopedic Prosthetic Infections: Diagnosis and Orthopedic Salvage

    PubMed Central

    Kaufman, Matthew G.; Meaike, Jesse D.; Izaddoost, Shayan A.

    2016-01-01

    Orthopedic hardware infections are much feared and costly complications that can occur when these devices are implemented both in traumatic cases as well as in joint replacement surgery. Because these infections can lead to great morbidity, it is important to understand their pathophysiology as well as the principles behind their diagnosis and initial treatment. Plastic surgeons are frequently consulted as part of a multidisciplinary team to provide stable soft tissue coverage of the associated defects that result from these infections. A review of the existing literature was performed to identify the potential causes of these infections, to provide established diagnostic criteria guidelines, and to explain how these prosthetic infections are managed from an orthopedic surgery perspective prior to consulting the plastic surgery team. PMID:27152098

  16. Anterior cruciate ligament reconstruction using the Bio-TransFix femoral fixation device and anteromedial portal technique.

    PubMed

    Hantes, Michael E; Dailiana, Zoe; Zachos, Vasilios C; Varitimidis, Sokratis E

    2006-05-01

    The cross-pin femoral fixation technique for soft tissue grafts is a popular option in anterior cruciate ligament (ACL) reconstruction. One of these devices is the Bio-TransFix (Arthrex Inc., Naples, FL, USA) which provides high fixation strength. According to the manufacturer, the femoral tunnel is created by placing the femoral aiming device through the tibial tunnel (transtibial technique). However, using this technique it is very difficult or even impossible to place the graft at the anatomical ACL attachment site at the "10 o'clock" position. In this report, we describe the use of the Bio-TransFix device with an anteromedial portal technique. Using this technique, the surgeon has more freedom to place the graft in an anatomical position, while combining the advantages of the excellent biomechanical properties of this device.

  17. Complications after arthroscopic coracoclavicular reconstruction using a single adjustable-loop-length suspensory fixation device in acute acromioclavicular joint dislocation.

    PubMed

    Shin, Sang-Jin; Kim, Nam-Ki

    2015-05-01

    The purpose of this study was to evaluate clinical and radiological outcomes after arthroscopically assisted coracoclavicular (CC) fixation using a single adjustable-loop-length suspensory fixation device for acute acromioclavicular dislocation and to report intraoperative and postoperative complications. Eighteen consecutive patients with acute acromioclavicular dislocation underwent arthroscopically assisted CC fixation using a single TightRope (Arthrex, Naples, FL). Using the Rockwood classification, 3 patients had grade III dislocations, one patient had a grade IV dislocation, and 14 patients had grade V dislocations. The preoperative CC distance of the injured shoulder was 16.1 ± 2.7 mm (range, 11.2 to 21.0 mm), and it increased by 99% ± 36% (range, 17% to 153%) on average compared with the contralateral shoulder. The average CC distance was 10.5 ± 2.5 mm (range, 7.7 to 15.5 mm), and it increased by 30% ± 30% (range, -9.4% to 90%) at the final follow-up. Compared with immediate postoperative radiographs, the CC distance was maintained in 12 patients, increased between 50% and 100% in 4 patients, and increased more than 100% in 2 patients at final follow-up. However, there was no statistical difference in Constant scores between 6 patients with reduction loss (95.6 ± 4.5) and 12 patients with reduction maintenance (98.4 ± 2.5; P = .17). Perioperative complications occurred in 8 patients, including one case of acromioclavicular arthritis, one case of delayed distal clavicular fracture at the clavicular hole of the device, 3 cases of clavicular or coracoid button failures, and 3 cases of clavicular bony erosion. Satisfactory clinical outcomes were obtained after CC fixation using the single adjustable-loop-length suspensory fixation device for acute acromioclavicular joint dislocation. However, CC fixation failure of greater than 50% of the unaffected side in radiological examinations occurred in 33% of the patients within 3 months after the operation

  18. Effects of rigidity of an internal fixation device. A comprehensive biomechanical investigation.

    PubMed

    Goel, V K; Lim, T H; Gwon, J; Chen, J Y; Winterbottom, J M; Park, J B; Weinstein, J N; Ahn, J Y

    1991-03-01

    Internal fixation with instrumentation often accompanies surgical fusion to augment spinal stability, provide temporary fixation while the surgical fusion mass unites, and enhance postoperative mobilization of a patient. Some surgeons, however, feel that the existing plate-screw designs are too rigid and are the primary cause of "iatrogenic" adverse effects clinically observed. A three-part study, involving in vitro experimental protocol, analytical finite-element-based models, and an in vivo canine investigation, was undertaken to study the role of decreasing rigidity of a device on the biomechanical response of the stabilized segments. Two alternatives--the use of one variable screw placement (Steffee plate [unilateral, 1VSP model]) as opposed to two VSP plates (bilateral, 2VSP model) and two VSP plates with polymer washers placed in between the integral nut and plate (2MVSP model)--were considered for achieving a reduction in the rigidity of the conventional VSP system. The load-displacement data obtained from the in vitro experiments and the stress distributions within the stabilized and intact models predicted by the finite-element models revealed that the unilateral VSP system is less rigid and is likely to reduce stress shielding of the vertebral bodies compared with the 2VSP model. The undesirable effects associated with the use of the 1VSP plate system are the presence of coupled motions due to the inherent asymmetry and the likely inability to provide enough rigidity for decompression procedures requiring a complete excision of the disc. The use of two MVSP plates overcomes these deficiencies.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Orthopedic services

    MedlinePlus

    ... MedlinePlus GO GO About MedlinePlus Site Map FAQs Customer Support Health Topics Drugs & Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Orthopedic services URL of this page: //medlineplus.gov/ency/article/ ...

  20. An analysis of the biomechanics of interference screw fixation and sheathed devices for biceps tenodesis.

    PubMed

    Saithna, Adnan; Chizari, Mahmoud; Morris, Guy; Anley, Cameron; Wang, Bin; Snow, Martyn

    2015-07-01

    This study aimed to evaluate the differences in biomechanical properties of biceps tenodesis when performed with sheathed versus unsheathed screws and also to investigate the effect of altering the pre-tension. Tenodesis was performed in an in vitro model using biomechanical test blocks and ovine tendons. Blocks were allocated to 1 of 5 groups which varied by method of tenodesis and cyclical loading protocol: Group A, Biosure PK screw (10-100 N), Group B: 7-8 mm Biosure Sync and Biosure PK screw (10-100 N), Group C: Biosure PK screw (10-70 N), Group D: Biosure PK (20-100 N), and Group E: custom sheath and Biosure PK screw (10-100 N). If tenodeses remained intact after 500 cycles maximum load to failure testing was performed. 30% of tenodeses in Group A failed prior to 500 cycles whereas none failed in the sheathed device groups (P=0.02). Using a sheathed device prevented mal-rotation. However, tenodeses in Group B were more likely to fail immediately distal to the tenodesis at a load below the anticipated maximum load to failure suggesting tendon damage during fixation. Using the custom sheath, which did not have sharp edges, resulted in a statistically significant increased maximum load to failure in Group E (348 N) when compared to Group A (228 N, mean difference 120 N, P=0.01) and Group B (253N, mean difference 95 N, P=0.0007). Sheathed devices prevent mal-rotation and increase stiffness and maximum load to failure. This is further improved by reducing tendon damage at the time of tenodesis. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Open-wedge high tibial osteotomy: incidence of lateral cortex fractures and influence of fixation device on osteotomy healing.

    PubMed

    Dexel, Julian; Fritzsche, Hagen; Beyer, Franziska; Harman, Melinda K; Lützner, Jörg

    2017-03-01

    Open-wedge high tibial osteotomy (HTO) is an established treatment for young and middle-aged patients with medial compartment knee osteoarthritis and varus malalignment. Although not intended, a lateral cortex fracture might occur during this procedure. Different fixation devices are available to repair such fractures. This study was performed to evaluate osteotomy healing after fixation with two different locking plates. Sixty-nine medial open-wedge HTO without bone grafting were followed until osteotomy healing. In patients with an intact lateral hinge, no problems were noted with either locking plate. A fracture of the lateral cortex occurred in 21 patients (30.4 %). In ten patients, the fracture was not recognized during surgery but was visible on the radiographs at the 6-week follow-up. Lateral cortex fracture resulted in non-union with the need for surgical treatment in three out of eight (37.5 %) patients using the newly introduced locking plate (Position HTO Maxi Plate), while this did not occur with a well-established locking plate (TomoFix) (0 out of 13, p = 0.023). With regard to other adverse events, no differences between both implants were observed. In cases of lateral cortex fracture, fixation with a smaller locking plate resulted in a relevant number of non-unions. Therefore, it is recommended that bone grafting, another fixation system, or an additional lateral fixation should be used in cases with lateral cortex fracture. III.

  2. Mechanical testing of a flexible fixation device for the lumbar spine.

    PubMed

    Leahy, J C; Mathias, K J; Hukins, D W; Shepherd, D E; Deans, W F

    2000-01-01

    The aim of this study was to test mechanically a new flexible fixation system for the lumbar spine. This device incorporates loops of polyester braid which are secured by a crimped titanium sleeve. In tensile tests, all loops failed, by slippage through the crimped sleeve, at 434 +/- 25 N (mean +/- standard deviation from five loops) for a single crimp and 415 +/- 15 N (from five loops) for two crimps. The intact system was then tested according to the ASTM standard. In a static test, all five specimens failed by slippage of the braid through the sleeve. Initial slippage occurred between 600 and 700 N, but the mean maximum load sustained was 1090 +/- 140 N. Dynamic tests were performed on ten constructs at a frequency of 5 Hz, under a range of loading conditions. The maximum load applied in any of the tests was 825 N. Two constructs did not complete the required 5 x 10(6) test cycles because of fracture of their spinous process hooks. However, other tests, under the same conditions, showed no signs of failure. Fracture occurred as a result of fretting damage from the recommended stainless steel roll pins.

  3. A new method for osteosynthesis using dielectric (non-conductive) fixation devices.

    PubMed

    Dobrev, R P; Vladimirov, B J

    1984-01-01

    Investigation in the field of electrophysiology shows that bioelectric phenomena of different origin are present in bone, the most important being the bioelectric potential connected with bone viability and metabolism. The negative biopotential is high at the fracture site where metabolism is also increased. During healing the negative values decrease and when it is complete the configuration of biopotentials along the length of the bone regains the pattern characteristic of intact bone. Negative biopotentials are needed to achieve callus formation and they disappear when healing has occurred. A metal device is used for osteosynthesis to obtain stable fixation of the fragments, but the electroconductive metal produces a 'short-circuit' of biopotentials along its length, so depriving the bone of necessary negative biopotential. Consequently the intensity of the metabolic processes is also reduced, leading to a relative delay in callus formation. Although a plaster cast may fail to provide adequate stability the natural electrophysiological conditions are preserved, and the period of callus formation is shortened. The negative biopotentials required for fracture union may be preserved by using non-conductive (dielectric) implants to achieve stable osteosynthesis.

  4. Fixation filter, device for the rapid in situ preservation of particulate samples

    NASA Astrophysics Data System (ADS)

    Taylor, C. D.; Edgcomb, V. P.; Doherty, K. W.; Engstrom, I.; Shanahan, T.; Pachiadaki, M. G.; Molyneaux, S. J.; Honjo, S.

    2015-02-01

    Niskin bottle rosettes have for years been the workhorse technology for collection of water samples used in biological and chemical oceanography. Studies of marine microbiology and biogeochemical cycling that aim to analyze labile organic molecules including messenger RNA, must take into account factors associated with sampling methodology that obscure an accurate picture of in situ activities/processes. With Niskin sampling, the large and often variable times between sample collection and preservation on deck of a ship, and the sometimes significant physico-chemical changes (e.g., changes in pressure, light, temperature, redox state, etc.) that water samples and organisms are exposed to, are likely to introduce artifacts. These concerns are likely more significant when working with phototrophs, deep-sea microbes, and/or organisms inhabiting low-oxygen or anoxic environments. We report here the development of a new technology for the in situ collection and chemical preservation of particulate microbial samples for a variety of downstream analyses depending on preservative choice by the user. The Fixation Filter Unit, version 3 (FF3) permits filtration of water sample through 47 mm diameter filters of the user's choice and upon completion of filtration, chemically preserves the retained sample within 10's of seconds. The stand-alone devices can be adapted to hydrocasting or mooring-based platforms.

  5. A Novel Technique Using Customized Headgear for Fixation of Rigid External Distraction Device in an Infant With Crouzon Syndrome.

    PubMed

    Hariri, Firdaus; Rahman, Zainal Ariff Abdul; Mahdah, Saridah; Mathaneswaran, Vickneswaran; Ganesan, Dharmendra

    2015-11-01

    Rigid external distraction device is often indicated for superior midfacial advancement in pediatric syndromic craniosynostosis patients. Even though the technique is proven reliable to treat the functional issues related to the craniofacial deformity, major complications associated with its fixation, such as intracranial pin perforation and migration have been reported. We report a novel technique of using a customized headgear to prevent intracranial pin perforation over a very thin temporal bone region in an 8-month-old infant with Crouzon syndrome who underwent monobloc Le Fort III distraction osteogenesis using a combination of bilateral internal and a rigid external distraction device. The customized headgear provides a protective platform at the temporal region thus preventing intracranial pin perforation and allows stable fixation during the early phase of consolidation period to prevent central component relapse. The headgear can be used short term when rigid external distractor is indicated in infant patient but requires close monitoring because of risks of skin necrosis and temporal region indentation.

  6. EVALUATION OF THE KNOWLEDGE ON COST OF ORTHOPEDIC IMPLANTS AMONG ORTHOPEDIC SURGEONS

    PubMed Central

    Arliani, Gustavo Gonçalves; Sabongi, Rodrigo Guerra; Batista, Alysson Ferreira; Astur, Diego Costa; Falotico, Guilherme Guadagnini; Cohen, Moises

    2016-01-01

    ABSTRACT Objective: To determine the knowledge of Brazilian Orthopedic Surgeons on the costs of orthopedic surgical devices used in surgical implants. Methods: A questionnaire was applied to Brazilian Orthopedic Surgeons during the 46th Brazilian Congress on Orthopedics and Traumatology. Results: Two hundred and one Orthopedic Surgeons completely filled out the questionnaire. The difference between the average prices estimated by the surgeons and the average prices provided by the supplier companies was 47.1%. No differences were found between the orthopedic specialists and other subspecialties on the prices indicated for specific orthopedic implants. However, differences were found among orthopedic surgeons who received visits from representatives of implant companies and those who did not receive those visits on prices indicated for shaver and radiofrequency device. Correlation was found between length of orthopedic experience and prices indicated for shaver and interference screw, and higher the experience time the lower the price indicated by Surgeons for these materials. Conclusion: The knowledge of Brazilian Orthopedic Surgeons on the costs of orthopedic implants is precarious. Reduction of cost of orthopedics materials depends on a more effective communication and interaction between doctors, hospitals and supplier companies with solid orientation programs and awareness for physicians about their importance in this scenario.Level of Evidence III, Cross-Sectional Study. PMID:28243178

  7. Imaging near orthopedic hardware.

    PubMed

    Koff, Matthew F; Burge, Alissa J; Koch, Kevin M; Potter, Hollis G

    2017-07-01

    Over one million total joint replacement surgeries were performed in the US in 2013 alone, and this number is expected to more than double by 2030. Traditional imaging techniques for postoperative evaluation of implanted devices, such as radiography, computerized tomography, or ultrasound, utilize ionizing radiation, suffer from beam hardening artifact, or lack the inherent high contrast necessary to adequately evaluate soft tissues around the implants, respectively. Magnetic resonance imaging (MRI), due to its ability to generate multiplanar, high-contrast images without the use of ionizing radiation is ideal for evaluating periprosthetic soft tissues but has traditionally suffered from in-plane and through-plane data misregistration due to the magnetic susceptibility of implanted materials. A recent renaissance in the interest of imaging near arthroplasty and implanted orthopedic hardware has led to the development of new techniques that help to mitigate the effects of magnetic susceptibility. This article describes the challenges of performing imaging near implanted orthopedic hardware, how to generate clinically interpretable images when imaging near implanted devices, and how the images may be interpreted for clinical use. We will also describe current developments of utilizing MRI to evaluate implanted orthopedic hardware. 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:24-39. © 2017 International Society for Magnetic Resonance in Medicine.

  8. [Digital panoramic radiography in patients with rigid internal fixations devices after maxillofacial surgery].

    PubMed

    Nessi, R; Ottolina, P; Lazzerini, F; Giannì, A B

    1998-01-01

    Digital techniques have found promising applications in dental radiology in the recent past, namely with radiovisiography and digital panoramic radiography. These images present some features making them particularly interesting for alveolar bone studies. Digital panoramic radiography with light-emitting phosphors was performed on 16 patients during postoperative follow-up. The patients were previously submitted to multiple maxillofacial osteosynthesis with rigid internal fixation devices (32 miniplates, 12 microplates, 14 screws). Digital images were always observed and printed with analogic-like and Xeroradiographic-like post-processing. Digital panoramic radiographs yielded clear and effective images of the maxillary and mandibular arches and of surgical osteosynthesis, as demonstrated by a retrospective evaluation performed by three independent observers on a blind basis (score 3: 60.42%), with no major interobserver differences (p = .7286). Xeroradiographic-like images were the most effective in depicting bone structures and osteosynthesis materials, thanks to their better detailing and typically lower overall contrast. Among the drawbacks of the digital technique, reduced cassette size may prevent the full view of the mandibular arch from the symphysis to both condylar regions. The edge effect, which is typical of Xeroradiographic images, may mask useful details within the trabecular bone close to metal implants. This effect was present in some of our cases, but it was seldom disturbing according to our retrospective evaluation (score 3: 53.40%), with good interobserver agreement (p = .1117). Digital panoramic radiography proves to be a useful tool to study metal implants after maxillofacial surgery as well as alveolar bone structure. The digital technique markedly reduces the radiation dose to the patient, which is very important for an X-ray examination that must be repeated several times, often in young subjects.

  9. Investigation of metallic and carbon fibre PEEK fracture fixation devices for three-part proximal humeral fractures.

    PubMed

    Feerick, Emer M; Kennedy, Jim; Mullett, Hannan; FitzPatrick, David; McGarry, Patrick

    2013-06-01

    A computational investigation of proximal humeral fracture fixation has been conducted. Four devices were selected for the study; a locking plate, intramedullary nail (IM Nail), K-wires and a Bilboquet device. A 3D model of a humerus was created using a process of thresholding based on the grayscale values of a CT scan of an intact humerus. An idealised three part fracture was created in addition to removing a standard volume from the humeral head as a representation of bone voids that occur as a result of the injury. All finite element simulations conducted represent 90° arm abduction. Simulations were conducted to investigate the effect of filling this bone void with calcium phosphate cement for each device. The effect of constructing devices from carbon fibre polyetheretherketone (CFPEEK) was investigated. Simulations of cement reinforced devices predict greater stability for each device. The average unreinforced fracture line opening (FLO) is reduced by 48.5% for metallic devices with a lesser effect on composite devices with FLO reduced by 23.6%. Relative sliding (shear displacement) is also reduced between fracture fragments by an average of 58.34%. CFPEEK device simulations predict reduced stresses at the device-bone interface. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

  10. Importance of additional temporary pin fixation combined coracoclavicular augmentation using a suture button device for acute acromioclavicular joint dislocation.

    PubMed

    Cho, Chul-Hyun; Kim, Beom-Soo; Kwon, Doo-Hyun

    2016-06-01

    We evaluated the outcomes of coracoclavicular (CC) augmentation using a suture button device with additional temporary pin fixation for acute acromioclavicular (AC) joint dislocation. Thirty-six consecutive cases who underwent CC augmentation using TightRope™ (Arthrex, Naples, FL, USA) were included. We temporarily fixed trans-articular pins in the first 10 cases (TA group) and a trans-spine pin in the next 26 cases (TS group). The radiological and clinical outcomes were evaluated at minimum 2 years postoperatively. The mean follow-up period was 56.7 months (range, 24-84 months). At the final follow-up evaluation, reduction status showed anatomical reduction in 25 cases (69.4 %), slight loss of reduction in seven cases (19.4 %), partial loss of reduction in two cases (5.6 %), and total loss of reduction in two cases (5.6 %). The mean ASES score, UCLA score, and subjective shoulder value were 92.3, 32.9, and 91.6 %, respectively. There were no significant differences between the two groups with respect to the outcomes. Intraoperative complications occurred in three cases (8.3 %) including two cases of failed reduction and one case of technical failure of the implant. Postoperative complications occurred in three cases (8.3 %) including one case of pin tract infection and distal clavicle fracture at the clavicle-hole, one case of reduction loss by severe subsidence of the clavicular button, and one case of shoulder stiffness. CC augmentation using a suture button device with temporary pin fixation yielded satisfactory radiological and clinical outcomes. These results support that temporary pin fixation for the AC joint may help to protect the AC reduction in the early phase of healing and rigid scar formation when performing CC fixation using a suture button device. Level-IV, Retrospective Case Series, Treatment Study.

  11. Superelastic Orthopedic Implant Coatings

    NASA Astrophysics Data System (ADS)

    Fournier, Eric; Devaney, Robert; Palmer, Matthew; Kramer, Joshua; El Khaja, Ragheb; Fonte, Matthew

    2014-07-01

    The demand for hip and knee replacement surgery is substantial and growing. Unfortunately, most joint replacement surgeries will fail within 10-25 years, thereby requiring an arduous, painful, and expensive revision surgery. To address this issue, a novel orthopedic implant coating material ("eXalt") has been developed. eXalt is comprised of super elastic nitinol wire that is knit into a three-dimensional spacer fabric structure. eXalt expands in vivo to conform to the implantation site and is porous to allow for bone ingrowth. The safety and efficacy of eXalt were evaluated through structural analysis, mechanical testing, and a rabbit implantation model. The results demonstrate that eXalt meets or exceeds the performance of current coating technologies with reduced micromotion, improved osseointegration, and stronger implant fixation in vivo.

  12. Development of a fixation device for robot assisted fracture reduction of femoral shaft fractures: a biomechanical study.

    PubMed

    Weber-Spickschen, T S; Oszwald, M; Westphal, R; Krettek, C; Wahl, F; Gosling, T

    2010-01-01

    Robot assisted fracture reduction of femoral shaft fractures provides precise alignment while reducing the amount of intraoperative imaging. The connection between the robot and the fracture fragment should allow conventional intramedullary nailing, be minimally invasive and provide interim fracture stability. In our study we tested three different reduction tools: a conventional External Fixator, a Reposition-Plate and a Three-Point-Device with two variations (a 40 degrees and a 90 degrees version). We measured relative movements between the tools and the bone fragments in all translation and rotation planes. The Three-Point-Device 90 degrees showed the smallest average relative displacement and was the only device able to withstand the maximum applied load of 70 Nm without failure of any bone fragment. The Three-Point-Device 90 degrees complies with all the stipulated requirements and is a suitable interface for robot assisted fracture reduction of femoral shaft fractures.

  13. Finite element analysis of three commonly used external fixation devices for treating Type III pilon fractures.

    PubMed

    Ramlee, Muhammad Hanif; Kadir, Mohammed Rafiq Abdul; Murali, Malliga Raman; Kamarul, Tunku

    2014-10-01

    Pilon fractures are commonly caused by high energy trauma and can result in long-term immobilization of patients. The use of an external fixator i.e. the (1) Delta, (2) Mitkovic or (3) Unilateral frame for treating type III pilon fractures is generally recommended by many experts owing to the stability provided by these constructs. This allows this type of fracture to heal quickly whilst permitting early mobilization. However, the stability of one fixator over the other has not been previously demonstrated. This study was conducted to determine the biomechanical stability of these external fixators in type III pilon fractures using finite element modelling. Three-dimensional models of the tibia, fibula, talus, calcaneus, navicular, cuboid, three cuneiforms and five metatarsal bones were reconstructed from previously obtained CT datasets. Bones were assigned with isotropic material properties, while the cartilage was assigned as hyperelastic springs with Mooney-Rivlin properties. Axial loads of 350 N and 70 N were applied at the tibia to simulate the stance and the swing phase of a gait cycle. To prevent rigid body motion, the calcaneus and metatarsals were fixed distally in all degrees of freedom. The results indicate that the model with the Delta frame produced the lowest relative micromovement (0.03 mm) compared to the Mitkovic (0.05 mm) and Unilateral (0.42 mm) fixators during the stance phase. The highest stress concentrations were found at the pin of the Unilateral external fixator (509.2 MPa) compared to the Mitkovic (286.0 MPa) and the Delta (266.7 MPa) frames. In conclusion, the Delta external fixator was found to be the most stable external fixator for treating type III pilon fractures. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

  14. Composites of poly(DL-lactide-co-glycolide) and calcium carbonate: in vitro evaluation for use in orthopedic applications.

    PubMed

    Cotton, Nicholas J; Egan, Melissa J; Brunelle, John E

    2008-04-01

    Biodegradable materials utilized in current orthopedic sports medicine fixation devices are required to maintain mechanical properties for at least 12 weeks to facilitate tissue healing and then ideally degrade with eventual replacement by surrounding tissue (bone). Current materials exhibit excessive longevity, which limit the potential for bone replacement, an ideal outcome in clinical procedures where revisions are a possibility. This study investigates material property modification of poly(DL-lactide-co-glycolide) (PLGA) by calcium carbonate. Modification of the degradation rate of PLGA by calcium carbonate (16, 36, 51% w/w) was demonstrated and the percentage of calcium carbonate within the polymer optimized at 36% (w/w). The optimized formulation was molded into a fixation screw and in vitro degradation demonstrated a gradual loss in molecular weight but with a pull-out strength retention beyond 12 weeks. Significant mass loss then occurred after 26 weeks. Physical testing, insertion torque, and failure torque indicated that this composite also had sufficient initial mechanical properties required for screw in type fixation devices. The combination of mechanical properties and degradation behavior suggests that this material may have potential to be utilized in orthopedic fixation devices that are placed in bone.

  15. The future of academic innovation in the field of medical devices: is innovation still possible in orthopedics?

    PubMed

    Courvoisier, Aurélien

    2016-09-01

    Academic research is essential to bring disruptive innovation on medical devices market because the risk-taking is too high for companies and their investors. Performing clinical trials is essential to technical files but no one wants to accept responsibility for implanted off-label devices. The paper explains the academic process for innovation. We see that academic research depends, at the end, on the motivation of companies to develop a product. The key to innovation stands in the early collaboration between the surgeons, the research teams and the companies in a project. Innovation is a good idea supported by the expertise of the right people at the right moment. In orthopaedics, we need, more than ever, to stay focused on the patient benefits.

  16. Operative Cost Comparison: Plating Versus Intramedullary Fixation for Clavicle Fractures.

    PubMed

    Hanselman, Andrew E; Murphy, Timothy R; Bal, George K; McDonough, E Barry

    2016-09-01

    Although clavicle fractures often heal well with nonoperative management, current literature has shown improved outcomes with operative intervention for specific fracture patterns in specific patient types. The 2 most common methods of midshaft clavicle fracture fixation are intramedullary and plate devices. Through retrospective analysis, this study performed a direct cost comparison of these 2 types of fixation at a single institution over a 5-year period. Outcome measures included operative costs for initial surgery and any hardware removal surgeries. This study reviewed 154 patients (157 fractures), and of these, 99 had intramedullary fixation and 58 had plate fixation. A total of 80% (79 of 99) of intramedullary devices and 3% (2 of 58) of plates were removed. Average cost for initial intramedullary placement was $2955 (US dollars) less than that for initial plate placement (P<.001); average cost for removal was $1874 less than that for plate removal surgery (P=.2). Average total cost for all intramedullary surgeries was $1392 less than the average cost for all plating surgeries (P<.001). Average cost for all intramedullary surgeries requiring plate placement and removal was $653 less than the average cost for all plating surgeries that involved only placement (P=.04). Intramedullary fixation of clavicle fractures resulted in a statistically significant cost reduction compared with plate fixation, despite the incidence of more frequent removal surgeries. [Orthopedics.2016; 39(5):e877-e882.].

  17. Cost effectiveness of total hip arthroplasty in osteoarthritis: comparison of devices with differing bearing surfaces and modes of fixation.

    PubMed

    Pulikottil-Jacob, R; Connock, M; Kandala, N-B; Mistry, H; Grove, A; Freeman, K; Costa, M; Sutcliffe, P; Clarke, A

    2015-04-01

    Many different designs of total hip arthroplasty (THA) with varying performance and cost are available. The identification of those which are the most cost-effective could allow significant cost-savings. We used an established Markov model to examine the cost effectiveness of five frequently used categories of THA which differed according to bearing surface and mode of fixation, using data from the National Joint Registry for England and Wales. Kaplan-Meier analyses of rates of revision for men and women were modelled with parametric distributions. Costs of devices were provided by the NHS Supply Chain and associated costs were taken from existing studies. Lifetime costs, lifetime quality-adjusted-life-years (QALYs) and the probability of a device being cost effective at a willingness to pay £20 000/QALY were included in the models. The differences in QALYs between different categories of implant were extremely small (< 0.0039 QALYs for men or women over the patient's lifetime) and differences in cost were also marginal (£2500 to £3000 in the same time period). As a result, the probability of any particular device being the most cost effective was very sensitive to small, plausible changes in quality of life estimates and cost. Our results suggest that available evidence does not support recommending a particular device on cost effectiveness grounds alone. We would recommend that the choice of prosthesis should be determined by the rate of revision, local costs and the preferences of the surgeon and patient.

  18. A new device for internal fixation of thoracolumbar and lumbar spine fractures: the 'fixateur interne'.

    PubMed

    Dick, W; Kluger, P; Magerl, F; Woersdörfer, O; Zäch, G

    1985-08-01

    A new system of operative fixation of thoracolumbar and lumbar spine fractures is presented: the 'fixateur interne' (F.I.). From a posterior approach long Schanz screws are inserted through the pedicles into the body of the two vertebrae just adjacent to the lesion and connected by th threaded F.I. rods. By tightening the nuts the Schanz screws are fixed in all directions. The advantages of the F.I. system are: excellent reposition by the long lever-arm of the Schanz screws, immobilization of only two segments and therefore good mobility of the residual spine, stability against flexion forces better than is obtained with Harrington distraction rods, additional rotational stability, and fixation in lordosis or kyphosis as is desired. The F.I. does not act as a four point bending system like all other dorsal spine instrumentation systems, but provides stability in flexion by itself. Therefore it can be Used independently of the condition of all ligaments (including the anterior longitudinal ligament) and of the posterior wall of the fractured vertebrae, and there is no need to fix more than the two immediately adjacent vertebrae, thus avoiding the often painful and cumbersome iatrogenic loss of lumbar lordosis and of mobility and permitting early mobilization of the patient. Experience with the first 45 patients is very promising.

  19. [Psychosomatic aspects in orthopedics].

    PubMed

    Köllner, V; Rupp, S

    2012-02-01

    Psychosomatic disease patterns are a common differential diagnosis for orthopedic symptoms. Furthermore, mental factors, such as the method of disease processing or mental comorbidities, such as depression or somatization disorders have a great influence on the chronification of orthopedic complaints and the outcome following orthopedic interventions. The aim of this article is to present the psychosomatic pathomechanisms and disease patterns relevant for orthopedics and to derive recommendations for physician-patient communication, diagnostics, therapy and assessment.

  20. Influence of stability and mechanical properties of a spinal fixation device on production of wear debris particles in vivo.

    PubMed

    Mochida, Y; Bauer, T W; Nitto, H; Kambic, H E; Muschler, G F

    2000-01-01

    A prospective and quantitative animal study was performed to evaluate the production of wear particles from a spinal fixation device, and to test the hypothesis that the concentration of wear debris particles adjacent to spinal fixation hardware is correlated with the stiffness of the spinal fusion construct and local bone formation at the fusion site. An established canine segmental spinal fusion model with three interfacet fusions was used in this study. Several bone substitute materials were grafted to the area of the interfacet fusion. Internal fixation was performed on both sides of the spinous processes at each site using a stainless steel plate system in 19 dogs. After 12 weeks, spinal segments were excised, then 3-dimensional computerized tomography was used to measure bone volume and bone area of the individual fusion sites. The stiffness of each segment was tested using a servohydraulic materials testing machine. Biopsies were obtained from the soft tissues immediately around the plate system, and wear particles were collected and characterized using an electrical resistance particle analyzer, light and scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDX). Biopsies from para-spinal tissue from adjacent, unoperated spinal levels served as negative controls. Histologically, 24 of 57 specimens (42.1%) showed only fibrous tissue with no recognizable macrophages, inflammation, or debris. Fourteen of 57 specimens (24.6%), however, contained many particles that were composed of Fe, Cr, and Ni, corresponding to elements found in the fixation hardware. Another 19 specimens showed only occasional particles. The mean concentration of particles from the tissue around the plate system was 2.8 x 10(9) per gram dry tissue weight, compared to 0.5 x 10(9) particles per gram for controls (p < 0.05). Statistical analyses showed significant inverse correlation between the log particle number and stiffness (r = -0.41, p < 0.01), bone volume (r

  1. Core Concepts: Orthopedic Intern Curriculum Boot Camp.

    PubMed

    Seeley, Mark A; Kazarian, Erick; King, Brandon; Biermann, Janet S; Carpenter, James E; Caird, Michelle S; Irwin, Todd A

    2016-01-01

    Orthopedic surgical interns must gain a broad array of clinical skills in a short time. However, recent changes in health care have limited resident-patient exposures. With the reported success of simulation training in the surgical literature, the American Board of Orthopaedic Surgery (ABOS) and Residency Review Committee for Orthopaedic Surgery have required that surgical simulation training be a component of the intern curricula in orthopedic surgical residencies. This study examined the short-term effectiveness of an orthopedic "intern boot camp" covering 7 of 17 simulation training concept modules published by the ABOS. Eight orthopedic post-graduate year 1 (PGY-1) residents (study group) completed a structured 3-month curriculum and were compared with 7 post-graduate year 2 (PGY-2) residents (comparison group) who had just completed their orthopedic surgical internship. Seven core skills were assessed using both task-specific and global rating scales. The PGY-1 residents demonstrated a statistically significant improvement in all 7 modules with respect to their task-specific pre-test scores: sterile technique (P=.001), wound closure (P<.001), knot tying (P=.017), casting and splinting (P<.001), arthrocentesis (P=.01), basics of internal fixation (P<.001), and compartment syndrome evaluation (P=.004). After the camp, PGY-1 and -2 scores in task-specific measures were not significantly different. A 3-month simulation-based boot camp instituted early in orthopedic internship elevated a variety of clinical skills to levels exhibited by PGY-2 residents. Copyright 2016, SLACK Incorporated.

  2. Greening of orthopedic surgery.

    PubMed

    Lee, Rushyuan J; Mears, Simon C

    2012-06-01

    Every year, 4 billion pounds of waste are produced by health care facilities, and the amount continues to increase annually. In response, a movement toward greening health care has been building, with a particular focus on the operating room. Between 20% and 70% of health care waste originates from a hospital's operating room, and up to 90% of operating room waste is improperly sorted and sent for costly and unneeded hazardous waste processing. Recent successful changes include segregation of hospital waste, substitution of the ubiquitous polypropylene plastic wrap used for the sterilization and handling of surgical equipment with metal cases, and the reintroduction of reusable surgical gowns. Orthopedic-related changes include the successful reprocessing and reuse of external fixators, shavers, blades, burs, and tourniquets. These changes have been shown to be environmentally and economically beneficial. Early review indicates that these changes are feasible, but a need exists for further evaluation of the effect on the operating room and flow of the surgical procedure and of the risks to the surgeons and operating room staff. Other key considerations are the effects of reprocessed and reused equipment on patient care and outcome and the role of surgeons in helping patients make informed decisions regarding surgical care. The goals of this study were to summarize the amount and types of waste produced in hospitals and operating rooms, highlight the methods of disposal used, review disposal methods that have been developed to reduce waste and improve recycling, and explore future developments in greening health care.

  3. Self-dissolution assisted coating on magnesium metal for biodegradable bone fixation devices

    NASA Astrophysics Data System (ADS)

    Khakbaz, Hadis; Walter, Rhys; Gordon, Timothy; Bobby Kannan, M.

    2014-12-01

    An attempt was made to develop a self-dissolution assisted coating on a pure magnesium metal for potential bone fixation implants. Magnesium phosphate cement (MPC) was coated successfully on the magnesium metal in ammonium dihydrogen phosphate solution. The in vitro degradation behaviour of the MPC coated metal was evaluated using electrochemical techniques. The MPC coating increased the polarisation resistance (RP) of the metal by ˜150% after 2 h immersion in simulated body fluid (SBF) and reduced the corrosion current density (icorr) by ˜80%. The RP of the MPC coated metal remained relatively high even after 8 h immersion period. However, post-degradation analysis of the MPC coated metal revealed localized attack. Hence, the study suggests that MPC coating alone may not be beneficial, but this novel coating could provide additional protection if used as a precursor for other potential coatings such as biodegradable polymers or calcium phosphates.

  4. Carbon nanostructures for orthopedic medical applications.

    PubMed

    Yang, Lei; Zhang, Lijuan; Webster, Thomas J

    2011-09-01

    Carbon nanostructures (including carbon nanofibers, nanostructured diamond, fullerene materials and so forth) possess extraordinary physiochemical, mechanical and electrical properties attractive to bioengineers and medical researchers. In the past decade, numerous developments towards the fabrication and biological studies of carbon nanostructures have provided opportunities to improve orthopedic applications. Therefore, the aim of this article is to provide an up-to-date review on carbon nanostructure advances in orthopedic research. Orthopedic medical device applications of carbon nanotubes/carbon nanofibers and nanostructured diamond (including particulate nanodiamond and nanocrystalline diamond coatings) are emphasized here along with other carbon nanostructures that have promising potential. In addition, widely used fabrication techniques for producing carbon nanostructures in both the laboratory and in industry are briefly introduced. In conclusion, carbon nanostructures have demonstrated tremendous promise for orthopedic medical device applications to date, and although some safety, reliability and durability issues related to the manufacturing and implantation of carbon nanomaterials remain, their future is bright.

  5. Minimal fixation in the treatment of open hand and foot bone fractures caused by explosive devices: case series.

    PubMed

    Has, B; Jovanović, S; Wertheimer, B; Kondza, G; Grdić, P; Leko, K

    2001-12-01

    To evaluate minimal fixation method with Kirschner's wires in the treatment of open fractures of the hand and foot short bones, caused by explosive devices. There were 270 wounded persons with open fractures of hand and foot short bones, who were surgically treated at the Department of Surgery at the Osijek University Hospital. The stabilization of an unstable open fracture was performed with intramedullary positioned Kirschner's wires. In a few cases, satisfactory stabilization was achieved with Kirschner's wires positioned percutaneously alongside the wound and perpendicularly through the fracture. In the rest of the wounded, plaster immobilization was sufficient after surgical treatment and fracture reposition. Among 270 persons with 412 open hand and foot bone fractures, 49% had fracture only in the feet, 27% only in the hands, and 24% in both hands and feet. Unstable short bone fractures were found in 56 patients (21%). Such fractures were stabilized with Kirschner's wires (n=71). In 58 patients (21%) partial hand and foot amputations had to be performed. Reconstructive operations to improve pseudarthrosis after minimal osteosynthesis were performed on 5 short bones (7%). Osteitis was found on four short bones (6%) after minimal osteosynthesis. Minimal osteosynthesis with Kirschner's wires is a reliable and adequate method of the treatment of open unstable short bone fractures caused by explosive devices.

  6. In vitro and in vivo evaluation of a polylactic acid-bioactive glass composite for bone fixation devices.

    PubMed

    Vergnol, Gwenaelle; Ginsac, Nathalie; Rivory, Pascaline; Meille, Sylvain; Chenal, Jean-Marc; Balvay, Sandra; Chevalier, Jérôme; Hartmann, Daniel J

    2016-01-01

    Poly(lactic acid) is nowadays among the most used bioabsorbable materials for medical devices. To promote bone growth on the material surface and increase the degradation rate of the polymer, research is currently focused on organic-inorganic composites by adding a bioactive mineral to the polymer matrix. The purpose of this study was to investigate the ability of a poly(L,DL-lactide)-Bioglass® (P(L,DL)LA-Bioglass(®) 45S5) composite to be used as a bone fixation device. In vitro cell viability testing of P(l,dl)LA based composites containing different amounts of Bioglass(®) 45S5 particles was investigated. According to the degradation rate of the P(L,DL)LA matrix and the cytocompatibility experiments, the composite with 30 wt % of Bioglass® particles seemed to be the best candidate for further investigation. To study its behavior after immersion in simulated physiological conditions, the degradation of the composite was analyzed by measuring its weight loss and mechanical properties and by proceeding with X-ray tomography. We demonstrated that the presence of the bioactive glass significantly accelerated the in vitro degradation of the polymer. A preliminary in vivo investigation on rabbits shows that the addition of 30 wt % of Bioglass(®) in the P(L,DL)LA matrix seems to trigger bone osseointegration especially during the first month of implantation. This composite has thus strong potential interest for health applications.

  7. A double button adjustable loop device is biomechanically equivalent to tension band wire in the fixation of transverse patellar fractures-A cadaveric study.

    PubMed

    Han, Fucai; Pearce, Christopher Jon; Ng, David Q K; Ramruttun, Amit K; Chong, Desmond Y R; Murphy, Diarmuid; Lim, Chin Tat; Lee, Bernard C S

    2017-02-01

    Tension-band wire fixation of patellar fractures is associated with significant hardware-related complications and infection. Braided polyester suture fixation is an alternative option. However, these suture fixations have higher failure rates due to the difficulty in achieving rigid suture knot fixation. The Arthrex syndesmotic TightRope, which is a double-button adjustable loop fixation device utilizing a 4-point locking system using FibreWire, may not only offer stiff rigid fixation using a knotless system, but may also obviate the need for implant removal due to hardware related problems. The aim of our study is to compare the fixation rigidity of patella fractures using Tightrope versus conventional tension-band wiring (TBW) in a cadaveric model. TBW fixation was compared to TightRope fixation of transverse patella fractures in 5 matched pairs of cadaveric knees. The knees were cyclically brought through 0-90° of motion for a total of 500 cycles. Fracture gapping was measured before the start of the cycling, and at 50, 100, 200 and 500 cycles using an extensometer. The mean maximum fracture gapping was derived. Failure of the construct was defined as a displacement of more than 3mm, patella fracture or implant breakage. All but one knee from each group survived 500 cycles. The two failures were due to a fracture gap of more than 3mm during cycling. There was no significant difference in the mean number of cycles tolerated. There was no implant breakage. There was no statistical significant difference in mean maximum fracture gap between the TBW and TightRope group at all cyclical milestones after 500 cycles (0.3026±0.4091mm vs 0.3558±0.7173mm, p=0.388). We found no difference between the TBW and Tightrope fixation in terms of fracture gapping and failure. With possible lower risk of complications such as implant migration and soft tissue irritation, we believe tightrope fixation is a feasible alternative in fracture management of transverse patella

  8. Applications of finite element simulation in orthopedic and trauma surgery

    PubMed Central

    Herrera, Antonio; Ibarz, Elena; Cegoñino, José; Lobo-Escolar, Antonio; Puértolas, Sergio; López, Enrique; Mateo, Jesús; Gracia, Luis

    2012-01-01

    Research in different areas of orthopedic and trauma surgery requires a methodology that allows both a more economic approach and the ability to reproduce different situations in an easy way. Simulation models have been introduced recently in bioengineering and could become an essential tool in the study of any physiological unity, regardless of its complexity. The main problem in modeling with finite elements simulation is to achieve an accurate reproduction of the anatomy and a perfect correlation of the different structures, in any region of the human body. Authors have developed a mixed technique, joining the use of a three-dimensional laser scanner Roland Picza captured together with computed tomography (CT) and 3D CT images, to achieve a perfect reproduction of the anatomy. Finite element (FE) simulation lets us know the biomechanical changes that take place after hip prostheses or osteosynthesis implantation and biological responses of bone to biomechanical changes. The simulation models are able to predict changes in bone stress distribution around the implant, so allowing preventing future pathologies. The development of a FE model of lumbar spine is another interesting application of the simulation. The model allows research on the lumbar spine, not only in physiological conditions but also simulating different load conditions, to assess the impact on biomechanics. Different degrees of disc degeneration can also be simulated to determine the impact on adjacent anatomical elements. Finally, FE models may be useful to test different fixation systems, i.e., pedicular screws, interbody devices or rigid fixations compared with the dynamic ones. We have also developed models of lumbar spine and hip joint to predict the occurrence of osteoporotic fractures, based on densitometric determinations and specific biomechanical models, including approaches from damage and fracture mechanics. FE simulations also allow us to predict the behavior of orthopedic splints

  9. Applications of finite element simulation in orthopedic and trauma surgery.

    PubMed

    Herrera, Antonio; Ibarz, Elena; Cegoñino, José; Lobo-Escolar, Antonio; Puértolas, Sergio; López, Enrique; Mateo, Jesús; Gracia, Luis

    2012-04-18

    Research in different areas of orthopedic and trauma surgery requires a methodology that allows both a more economic approach and the ability to reproduce different situations in an easy way. Simulation models have been introduced recently in bioengineering and could become an essential tool in the study of any physiological unity, regardless of its complexity. The main problem in modeling with finite elements simulation is to achieve an accurate reproduction of the anatomy and a perfect correlation of the different structures, in any region of the human body. Authors have developed a mixed technique, joining the use of a three-dimensional laser scanner Roland Picza captured together with computed tomography (CT) and 3D CT images, to achieve a perfect reproduction of the anatomy. Finite element (FE) simulation lets us know the biomechanical changes that take place after hip prostheses or osteosynthesis implantation and biological responses of bone to biomechanical changes. The simulation models are able to predict changes in bone stress distribution around the implant, so allowing preventing future pathologies. The development of a FE model of lumbar spine is another interesting application of the simulation. The model allows research on the lumbar spine, not only in physiological conditions but also simulating different load conditions, to assess the impact on biomechanics. Different degrees of disc degeneration can also be simulated to determine the impact on adjacent anatomical elements. Finally, FE models may be useful to test different fixation systems, i.e., pedicular screws, interbody devices or rigid fixations compared with the dynamic ones. We have also developed models of lumbar spine and hip joint to predict the occurrence of osteoporotic fractures, based on densitometric determinations and specific biomechanical models, including approaches from damage and fracture mechanics. FE simulations also allow us to predict the behavior of orthopedic splints

  10. Clinical Evaluation of an Unsintered Hydroxyapatite/Poly-L-Lactide Osteoconductive Composite Device for the Internal Fixation of Maxillofacial Fractures.

    PubMed

    Sukegawa, Shintaro; Kanno, Takahiro; Katase, Naoki; Shibata, Akane; Takahashi, Yuka; Furuki, Yoshihiko

    2016-09-01

    OSTEOTRANS MX (Takiron Co, Ltd, Osaka, Japan) is a resorbable osteosynthetic material composed of an unsintered hydroxyapatite/poly-L-lactide composite, and its osteoconductive capacity has been documented. The authors here report their clinical experience using OSTEOTRANS MX. The authors treated 35 patients (19 men, 16 women; age, 14-88 years; mean ± standard deviation, 38.4 ± 19.9 years) with maxillofacial fractures. The authors used standard surgery to stabilize fractures in all patients, fitting resorbable plates (thickness, 1.0 or 1.4 mm) and screws (diameter, 2 mm) according to Arbeitsgemeinschaft für Osteosynthesefragen/Association (AO) for the Study of Internal Fixation guidelines. All patients eventually achieved satisfactory healing with favorable restoration of form and function without foreign body reaction. Complications occurred in 3 patients-plate exposure in 2 and discomfort in 1. However, fracture sites healed in all patients. Scanning electron microscopy revealed that the devices bonded directly to the bone without interposition of nonmineralized tissue. OSTEOTRANS MX is a useful material with few complications. Its osteoconductive bioactivity is advantageous for the early functional improvement of maxillofacial fractures.

  11. Clinical Evaluation of an Unsintered Hydroxyapatite/Poly-L-Lactide Osteoconductive Composite Device for the Internal Fixation of Maxillofacial Fractures

    PubMed Central

    Sukegawa, Shintaro; Kanno, Takahiro; Katase, Naoki; Shibata, Akane; Takahashi, Yuka; Furuki, Yoshihiko

    2016-01-01

    Introduction: OSTEOTRANS MX (Takiron Co, Ltd, Osaka, Japan) is a resorbable osteosynthetic material composed of an unsintered hydroxyapatite/poly-l-lactide composite, and its osteoconductive capacity has been documented. The authors here report their clinical experience using OSTEOTRANS MX. Methods: The authors treated 35 patients (19 men, 16 women; age, 14–88 years; mean ± standard deviation, 38.4 ± 19.9 years) with maxillofacial fractures. The authors used standard surgery to stabilize fractures in all patients, fitting resorbable plates (thickness, 1.0 or 1.4 mm) and screws (diameter, 2 mm) according to Arbeitsgemeinschaft für Osteosynthesefragen/Association (AO) for the Study of Internal Fixation guidelines. Results: All patients eventually achieved satisfactory healing with favorable restoration of form and function without foreign body reaction. Complications occurred in 3 patients—plate exposure in 2 and discomfort in 1. However, fracture sites healed in all patients. Scanning electron microscopy revealed that the devices bonded directly to the bone without interposition of nonmineralized tissue. Conclusion: OSTEOTRANS MX is a useful material with few complications. Its osteoconductive bioactivity is advantageous for the early functional improvement of maxillofacial fractures. PMID:27428913

  12. Spring-action Apparatus for Fixation of Eyeball (SAFE): a novel, cost-effective yet simple device for ophthalmic wet-lab training.

    PubMed

    Ramakrishnan, Seema; Baskaran, Prabu; Fazal, Romana; Sulaiman, Syed Mohammad; Krishnan, Tiruvengada; Venkatesh, Rengaraj

    2016-10-01

    Achieving a formed and firm eyeball which is stably fixed in a holding device is a major challenge of surgical wet-lab training. Our innovation, the 'Spring-action Apparatus for Fixation of Eyeball (SAFE)' is a robust, simple and economical device to solve this problem. It consists of a hollow iron cylinder to which a spring-action syringe is attached. The spring-action syringe generates vacuum and enables reliable fixation of a human or animal cadaveric eye on the iron cylinder. The rise in intraocular pressure due to vacuum fixation can be varied as per need or nature of surgery being practised. A mask-fixed version of this device is also designed to train surgeons for appropriate hand positioning. An experienced surgeon performed various surgeries including manual small incision cataract surgery (MSICS), phacoemulsification, laser in situ keratomileusis (LASIK), femtosecond LASIK docking, Descemet's stripping endothelial keratoplasty, deep anterior lamellar keratoplasty, penetrating keratoplasty and trabeculectomy on this device, while a trainee surgeon practised MSICS and wound suturing. Skill-appropriate comfort level was much higher with SAFE than with conventional globe holders for both surgeons. Due to its stability, pressure adjustability, portability, cost-efficiency and simplicity, we recommend SAFE as the basic equipment for every wet lab.

  13. New bone formation in nongrafted sinus lifting with space-maintaining management: a novel technique using a titanium bone fixation device.

    PubMed

    Kaneko, Takahiro; Masuda, Issei; Horie, Norio; Shimoyama, Tetsuo

    2012-03-01

    Sinus lifting without graft materials allows new bone formation in the sinus, but the amount of bone formation varies. This study aimed to investigate whether nongrafted sinus lifting using a titanium bone fixation device can promote bone formation in the sinus. Patients with atrophic posterior maxillae jeopardizing implant stability were included. After nongrafted sinus lifting in combination with implant placement, repositioning of the bone window and additional space-maintaining management were performed by use of the bone fixation device. The primary variables recorded retrospectively included implant survival and preoperative and postoperative alveolar crest height with and without Schneiderian membrane perforation. Independent variables included patient demographics, position and dimension of the implants, complications, and follow-up period. The t test was used for comparing differences in bone levels. The implant survival rate was estimated by uses of Kaplan-Meier statistics. The study included 11 patients (4 men and 7 women) and a total of 21 implants. Radiographically, new bone formation around the implant was generally observed in accordance with the implant apex. Postoperative alveolar crest height (mean, 10.9 ± 2.2 mm) was significantly higher compared with residual alveolar crest height (mean, 4.7 ± 1.4 mm), and no significant difference in bone formation was seen according to membrane perforation. The cumulative survival rate was 95.2%. This nongrafted sinus-lifting procedure using a bone fixation device could attain predictable bone formation. Additional space-maintaining management using a bone fixation device in a nongrafted sinus lift offers a useful technique for promoting bone formation in the sinus. Copyright © 2012. Published by Elsevier Inc.

  14. Nanotechnology in orthopedics.

    PubMed

    Garimella, Roja; Eltorai, Adam E M

    2017-03-01

    Nanotechnology has revolutionized science and consumer products for several decades. Most recently, its applications to the fields of medicine and biology have improved drug delivery, medical diagnostics, and manufacturing. Recent research of this modern technology has demonstrated its potential with novel forms of disease detection and intervention, particularly within orthopedics. Nanomedicine has transformed orthopedics through recent advances in bone tissue engineering, implantable materials, diagnosis and therapeutics, and surface adhesives. The potential for nanotechnology within the field of orthopedics is vast and much of it appears to be untapped, though not without accompanying obstacles.

  15. Rabbit orthopedic surgery.

    PubMed

    Rich, Gregory A

    2002-01-01

    Orthopedic surgery in rabbits poses several unique parameters for the veterinary surgeon. It is imperative for the veterinarian to be knowledgeable about the anatomic features of the surgical repair site and to become familiar with a rabbit's pain and discomfort often associated with orthopedic injuries. Handling the perioperative and postoperative pain and potential GI disturbances are crucial for a successful outcome of the surgical case. This article is designed to help the veterinary surgeon prepare for the orthopedic surgical procedure and the peripheral physiologic needs of the rabbit from presentation through recovery.

  16. Locking mechanism for orthopedic braces

    NASA Technical Reports Server (NTRS)

    Chao, J. I.; Epps, C. H., Jr.

    1981-01-01

    An orthopedic brace locking mechanism is described which under standing or walking conditions cannot be unlocked, however under sitting conditions the mechanism can be simply unlocked so as to permit bending of the patient's knee. Other features of the device include: (1) the mechanism is rendered operable, and inoperable, dependent upon the relative inclination of the brace with respect to the ground; (2) the mechanism is automatically locked under standing or walking conditions and is manually unlocked under sitting conditions; and (3) the mechanism is light in weight and is relatively small in size.

  17. Locking mechanism for orthopedic braces

    NASA Technical Reports Server (NTRS)

    I-Lechao, J.; Epps, C. H., Jr. (Inventor)

    1976-01-01

    A locking mechanism for orthopedic braces is described which automatically prevents or permits the relative pivotable movement between a lower brace member and an upper brace member. The upper and lower brace members are provided with drilled bores within which a slidable pin is disposed, and depending upon the inclination of the brace members with respect to a vertical plane, the slidable pin will be interposed between both brace members. The secondary or auxiliary latching device includes a spring biased, manually operable lever bar arrangement which is manually unlatched and automatically latched under the influence of the spring.

  18. [Thermoformed orthopedic splints].

    PubMed

    Amoric, M

    1990-12-01

    Initially used to make simple splints, thermoforming has led to the development of a new means of application of orthopedic forces. Here we have presented splints which allow the treatment of Class III, Class II and cases of endomaxillitis.

  19. The role of ring external fixation in Charcot foot arthropathy.

    PubMed

    Pinzur, Michael S

    2006-12-01

    These two morbidly obese patients with severe Charcot foot arthropathy were treated successfully with percutaneous correction of their deformity followed by a stepwise application of a pre-assembled neutrally aligned multiplane ring external fixator. This technique transfers well to the trauma environment in which alignment can be maintained without further violation within the zone of injury. The application of the fine wire ring external fixation has been used for many years to accomplished leg lengthening and correction of deformity. Historically it has required a great deal of experience to apply to complex frames and implement the required daily adjustments. The patient experience often has been an unpleasant ordeal with a high potential for associated morbidity. This negative exposure has prompted practicing orthopedic surgeons to avoid this technique, feeling that it best be left to those in tertiary care setting who are equipped to handle the morbidity and complications. Taking this technology from the domain of the deformity surgeon to the general orthopedic community will require the suppression of bad memories from residency. Using the device solely as a method of maintaining alignment eliminates many of the dynamic attributes that contributes to pain and morbidity. The bone and soft tissues are not stretched, eliminating much of the pain and decreasing the rate of traction-associated pin tract morbidity. Because there is no dynamic of the treatment, the simplified frame can be pre-assembled and have no adjustable components. The experience derived from this application has the potential of expanding the role of ring external fixation. Where the ring has been used previously as method of both obtaining and maintaining alignment, this application uses a simplified neutral version of a complex device to simply maintain alignment in a high risk patient population. Correction of deformity and achieving alignment/reduction of fractures is well within the

  20. Does a tensioning device pinned to the tibia improve knee anterior-posterior load-displacement compared to manual tensioning of the graft following anterior cruciate ligament reconstruction? A cadaveric study of two tibial fixation devices.

    PubMed

    Thompson, Dustin M; Hull, M L; Howell, S M

    2006-09-01

    Devices that are pinned to the tibia to tension an anterior cruciate ligament (ACL) graft produce joint reaction loads that in turn can affect the maintenance of graft initial tension after tibial fixation and hence knee anterior-posterior (AP) load-displacement. However, the effect of these devices on AP load-displacement is unknown. Our objectives were to determine whether tensioning by device versus tensioning by hand causes differences in AP load-displacement and intraarticular graft tension for two commonly used tibial fixation devices: a bioresorbable interference screw and a WasherLoc. AP load-displacement and intraarticular graft tension were measured in 20 cadaveric knees using a custom arthrometer. An initial tension of 110 N was applied to a double-looped tendon graft with the knee at extension using a tensioning device pinned to the tibia and a simulated method of tensioning by hand. After inserting the tibial fixation device, the 134 N anterior limit (i.e., anterior position of the tibia with respect to the femur with a 134 N anterior force applied to the tibia) and 0 N posterior limit (i.e., AP position of the tibia relative to the femur with a 0 N force applied to the tibia) were measured with the knee in 25 degrees flexion. Intraarticular graft tension was measured at extension. These limits and intraarticular graft tension were also measured after cyclically loading the knee 300 times. Compared to a simulated method of tensioning by hand, tensioning with a device pinned to the tibia did not decrease the 134 N anterior limit and did not cause posterior tibial translation. However, intraarticular graft tension was maintained better with a tensioning device pinned to the tibia for the Washerloc, but not the interference screw. For two commonly used tibial fixation devices, a tensioning device pinned to the tibia does not improve AP load-displacement at 25 degrees flexion over tensioning by hand when the graft is tensioned at full extension, but does

  1. Monitoring of Postoperative Bone Healing Using Smart Trauma-Fixation Device With Integrated Self-Powered Piezo-Floating-Gate Sensors.

    PubMed

    Borchani, Wassim; Aono, Kenji; Lajnef, Nizar; Chakrabartty, Shantanu

    2016-07-01

    Achieving better surgical outcomes in cases of traumatic bone fractures requires postoperative monitoring of changes in the growth and mechanical properties of the tissue and bones during the healing process. While current in-vivo imaging techniques can provide a snapshot of the extent of bone growth, it is unable to provide a history of the healing process, which is important if any corrective surgery is required. Monitoring the time evolution of in-vivo mechanical loads using existing technology is a challenge due to the need for continuous power while maintaining patient mobility and comfort. This paper investigates the feasibility of self-powered monitoring of the bone-healing process using our previously reported piezo-floating-gate (PFG) sensors. The sensors are directly integrated with a fixation device and operate by harvesting energy from microscale strain variations in the fixation structure. We show that the sensors can record and store the statistics of the strain evolution during the healing process for offline retrieval and analysis. Additionally, we present measurement results using a biomechanical phantom comprising of a femur fracture fixation plate; bone healing is emulated by inserting different materials, with gradually increasing elastic moduli, inside a fracture gap. The PFG sensor can effectively sense, compute, and record continuously evolving statistics of mechanical loading over a typical healing period of a bone, and the statistics could be used to differentiate between different bone-healing conditions. The proposed sensor presents a reliable objective technique to assess bone-healing progress and help decide on the removal time of the fixation device.

  2. Resorbable bone fixation alloys, forming, and post-fabrication treatments.

    PubMed

    Ibrahim, Hamdy; Esfahani, Sajedeh Nasr; Poorganji, Behrang; Dean, David; Elahinia, Mohammad

    2017-01-01

    Metallic alloys have been introduced as biodegradable metals for various biomedical applications over the last decade owing to their gradual corrosion in the body, biocompatibility and superior strength compared to biodegradable polymers. Mg alloys possess advantageous properties that make them the most extensively studied biodegradable metallic material for orthopedic applications such as their low density, modulus of elasticity, close to that of the bone, and resorbability. Early resorption (i.e., <3months) and relatively inadequate strength are the main challenges that hinder the use of Mg alloys for bone fixation applications. The development of resorbable Mg-based bone fixation hardware with superior mechanical and corrosion performance requires a thorough understanding of the physical and mechanical properties of Mg alloys. This paper discusses the characteristics of successful Mg-based skeletal fixation hardware and the possible ways to improve its properties using different methods such as mechanical and heat treatment processes. We also review the most recent work pertaining to Mg alloys and surface coatings. To this end, this paper covers (i) the properties and development of Mg alloys and coatings with an emphasis on the Mg-Zn-Ca-based alloys; (ii) Mg alloys fabrication techniques; and (iii) strategies towards achieving Mg-based, resorbable, skeletal fixation devices.

  3. The Meniscus Arrow® as a fixation device for the treatment of mallet fractures: results of 50 cases.

    PubMed

    Aarts, Fenne L M; Derks, Rosalie; Wouters, Diederick B

    2014-12-01

    The treatment of mallet fractures is a controversial and challenging problem. Generally, mallet fractures are treated conservatively except those involving more than one third of the base of the distal phalanx. Many different surgical fixation techniques have been published. This paper describes a new fixation procedure using ultimate bioresorbable meniscal fixation nails (Meniscus Arrows®). Mallet fractures in 50 digits of 49 patients were fixed with this nail in an outpatient surgical procedure, mostly under local (Oberst-block) anaesthesia. The average operation time was 21 min. According to the Crawford criteria, patient outcome was graded as excellent in 48 %, good in 22 %, and fair in 28 %. In one patient, the outcome was graded as poor, but the fracture was in a pre-existent arthritic joint. All fractures were consolidated without recurrent dislocation. Complications included one wound infection, which was successfully treated with antibiotics and without further consequences. No nail deformities occurred. Two times, the nail spontaneously and gradually dislocated during intensive use of the hand after, respectively, 3 and 6 months and could easily be removed under local anaesthesia without any functional sequelae. The bioresorbable meniscal nail fixation technique provides a fast and successful surgical treatment for mallet fractures with a minimum of adverse events.

  4. Lasers in orthopedics

    NASA Astrophysics Data System (ADS)

    Sherk, Henry H.; Rhodes, Anthony L.; Meller, Menachem M.

    1990-06-01

    Orthopedic Surgery is that surgical discipline which deals with the musculoskeletal system. Orthopedists therefore operate on joints, the spine and long bones and engage in such subsecialities as sports medicine, hand surgery, trauma surgery, and joint replacements. Since they must cut and shape bone, cartilage, tendon, and ligament, orthopedists have developed a number of mechanical techniques to achieve these ends and surgical lasers have found few applications in orthopedics because until now they have not been useful for cutting bone. In the past several years, however, there has been considerable interest in several areas within the field of orthopedic surgery that do not entail actual bone surgery and it is expected that as newer and more powerful lasers become available laser osteotomy may become feasible and even routine.

  5. Orthopedic management in myelomeningocele.

    PubMed

    Karol, L A

    1995-04-01

    Paralysis, muscle imbalance, and spasticity resulting from myelomeningocele produce orthopedic deformities that often require surgical correction. Spinal deformities in myelomeningocele are nearly universal, and are difficult to treat because of the absence of posterior elements. Hip dislocations frequently occur, but rarely require treatment. Severe foot deformities are seen in up to 80% of children.

  6. Medical Issues: Orthopedics

    MedlinePlus

    ... About Us News Facebook Twitter YouTube Learn About SMA About SMA Types of SMA Causes & Diagnosis Genetics Testing Carriers What Diagnosis Means ... Care Packages Information Packets Equipment Pool Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily ...

  7. A controlled antibiotic release system to prevent orthopedic-implant associated infections: An in vitro study

    PubMed Central

    Gimeno, Marina; Pinczowski, Pedro; Pérez, Marta; Giorello, Antonella; Martínez, Miguel Ángel; Santamaría, Jesús; Arruebo, Manuel; Luján, Lluís

    2015-01-01

    A new device for local delivery of antibiotics is presented, with potential use as a drug-eluting fixation pin for orthopedic applications. The implant consists of a stainless steel hollow tubular reservoir packed with the desired antibiotic. Release takes place through several orifices previously drilled in the reservoir wall, a process that does not compromise the mechanical properties required for the implant. Depending on the antibiotic chosen and the number of orifices, the release profile can be tailored from a rapid release of the load (ca. 20 h) to a combination of rapid initial release and slower, sustained release for a longer period of time (ca. 200 h). An excellent bactericidal action is obtained, with 4-log reductions achieved in as little as 2 h, and total bacterial eradication in 8 h using 6-pinholed implants filled with cefazolin. PMID:26297104

  8. A controlled antibiotic release system to prevent orthopedic-implant associated infections: An in vitro study.

    PubMed

    Gimeno, Marina; Pinczowski, Pedro; Pérez, Marta; Giorello, Antonella; Martínez, Miguel Ángel; Santamaría, Jesús; Arruebo, Manuel; Luján, Lluís

    2015-10-01

    A new device for local delivery of antibiotics is presented, with potential use as a drug-eluting fixation pin for orthopedic applications. The implant consists of a stainless steel hollow tubular reservoir packed with the desired antibiotic. Release takes place through several orifices previously drilled in the reservoir wall, a process that does not compromise the mechanical properties required for the implant. Depending on the antibiotic chosen and the number of orifices, the release profile can be tailored from a rapid release of the load (ca. 20h) to a combination of rapid initial release and slower, sustained release for a longer period of time (ca. 200h). An excellent bactericidal action is obtained, with 4-log reductions achieved in as little as 2h, and total bacterial eradication in 8h using 6-pinholed implants filled with cefazolin.

  9. An antibacterial and absorbable silk-based fixation material with impressive mechanical properties and biocompatibility

    PubMed Central

    Shi, Chenglong; Pu, Xiaobing; Zheng, Guan; Feng, Xinglong; Yang, Xuan; Zhang, Baoliang; Zhang, Yu; Yin, Qingshui; Xia, Hong

    2016-01-01

    Implant-associated infections and non-absorbing materials are two important reasons for a second surgical procedure to remove internal fixation devices after an orthopedic internal fixation surgery. The objective of this study was to produce an antibacterial and absorbable fixation screw by adding gentamicin to silk-based materials. The antibacterial activity was assessed against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) in vitro by plate cultivation and scanning electron microscopy (SEM). We also investigated the properties, such as the mechanical features, swelling properties, biocompatibility and degradation, of gentamicin-loaded silk-based screws (GSS) in vitro. The GSS showed significant bactericidal effects against S. aureus and E. coli. The antibacterial activity remained high even after 4 weeks of immersion in protease solution. In addition, the GSS maintained the remarkable mechanical properties and excellent biocompatibility of pure silk-based screws (PSS). Interestingly, after gentamicin incorporation, the degradation rate and water-absorbing capacity increased and decreased, respectively. These GSS provide both impressive material properties and antibacterial activity and have great potential for use in orthopedic implants to reduce the incidence of second surgeries. PMID:27869175

  10. An antibacterial and absorbable silk-based fixation material with impressive mechanical properties and biocompatibility

    NASA Astrophysics Data System (ADS)

    Shi, Chenglong; Pu, Xiaobing; Zheng, Guan; Feng, Xinglong; Yang, Xuan; Zhang, Baoliang; Zhang, Yu; Yin, Qingshui; Xia, Hong

    2016-11-01

    Implant-associated infections and non-absorbing materials are two important reasons for a second surgical procedure to remove internal fixation devices after an orthopedic internal fixation surgery. The objective of this study was to produce an antibacterial and absorbable fixation screw by adding gentamicin to silk-based materials. The antibacterial activity was assessed against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) in vitro by plate cultivation and scanning electron microscopy (SEM). We also investigated the properties, such as the mechanical features, swelling properties, biocompatibility and degradation, of gentamicin-loaded silk-based screws (GSS) in vitro. The GSS showed significant bactericidal effects against S. aureus and E. coli. The antibacterial activity remained high even after 4 weeks of immersion in protease solution. In addition, the GSS maintained the remarkable mechanical properties and excellent biocompatibility of pure silk-based screws (PSS). Interestingly, after gentamicin incorporation, the degradation rate and water-absorbing capacity increased and decreased, respectively. These GSS provide both impressive material properties and antibacterial activity and have great potential for use in orthopedic implants to reduce the incidence of second surgeries.

  11. Presurgical orthopedic premaxillary alignment in cleft lip and palate reconstruction.

    PubMed

    Papay, F A; Morales, L; Motoki, D S; Yamashiro, D K

    1994-11-01

    Premaxillary malposition is a difficult problem in cleft lip and palate repair. Orthopedic palatal devices are excellent in positioning the premaxilla, though they are somewhat cumbersome and require complex techniques in adjusting precisely the position of the premaxilla prior to repair. A new technique has been developed for premaxillary repositioning in conjunction with palatal shelf expansion and obturation. The procedure implements microplate fixation anterior to the premaxillary segment and linked to a palatal splint by adjustable elastics. The microplate is inserted through a nasal floor incision and secured by a tight submucosal tunnel through minimal dissection between the prolabium and premaxilla. The last hole of each microplate protrudes through the mucosa and is attached to a pin-retained palatal splint by an elastic chain. Differential tension is applied to the chains to allow gradual repositioning of the protruding maxilla while the splint expands and maintains positioning of the lateral palatal segments. These elastic retractors can be adjusted by staff in the outpatient office. During the past 2 years, this technique has been used successfully in 21 consecutive patients with unilateral or bilateral cleft lip and palate. Its technical ease and design allows simple adjustments to control premaxillary positioning and growth before definitive surgical closure.

  12. A Novel Guidewire Aiming Device to Improve the Accuracy of Guidewire Insertion in Femoral Neck Fracture Surgery Using Cannulated Screw Fixation

    PubMed Central

    Yin, Wenjing; Xu, Haitao; Xu, Peijun; Hu, Tu; An, Zhiquan; Zhang, Changqing; Sheng, Jiagen

    2016-01-01

    Background The aim of this study was to improve the accuracy of guidewire insertion in the femoral neck fracture surgery using cannulated screw fixation. Material/Methods A novel aiming device was designed and manufactured. Between January 2010 and June 2012, 64 femoral neck fracture patients were included into the study. All 64 patients were divided into 2 groups randomly. The aiming device was used during the operation for patients in the experimental group, but not in the control group. Results There were no statistically significant differences in operative time or bleed volume between the groups (P>0.05). The frequency of guidewire drilling was significantly lower in the experimental group than in the control group (P<0.05). The angle between the first cannulated screw and the central axis of the femoral neck in coronal plane and sagittal plane, and the distance between the bottom cannulated screw and the medial calcar femorale rim, were significantly smaller in the experimental group than in the control group (P<0.05). Conclusions The aiming device is simple in structure and easy to use. It could help surgeons to accurately insert cannulated screw guidewires. The aiming device is suitable for broad clinical use. PMID:27529374

  13. Homo quintadus, computers and ROOMS (repetitive ocular orthopedic motion stress).

    PubMed

    Grant, A H

    1990-04-01

    Inherent conflict exists between computer systems and ocular physiology of Homo quintadus. Adverse ocular side effects of excessive saccades, excyclotorsion, supraduction, excessive field-of-fixation usage, capitas extension, astigmatic changes, otostatic reflex mismatching, and needless orthopedic malfunctions are imposed upon computer operators. Although the orthopedic dysfunctions are commonly grouped under the heading of Repetitive Strain Injuries (RSI), the inextricable linkage to poor ocular-neurological function argues for postulation of a broader schema entitled Repetitive Ocular Orthopedic Motion Stress (ROOMS). Concepts of good tool usage, total tactile familiarity, total proprioceptive familiarity, and visual cone-of-comfort clash with the installed-equipment base and indicate need for an integrated computer work station to facilitate near covisualization of screen/keyboard and to afford freedom-of-choice for optimal hand/eye synchronicity. The advocacy of computer operators' needs by user-welfare groups, universities, labor unions, and government agencies are portents for achieving genuine improvements.

  14. Regional alterations in long bone /sup 85/Sr clearance produced by internal fixation devices. Part II. Histomorphometry

    SciTech Connect

    Simmons, D.J.; Daum, W.J.; Calhoun, J.H.

    1988-01-01

    The effects of each of the surgical stages involved in compression plating on the development of cortical thinning and porosity were assessed in the intact midshaft, stress-shielded femoral segments of adult mongrel dogs 6 months postoperatively. The data were evaluated in terms of a postsurgical tetracycline-based measure of remodeling and terminal /sup 85/Sr clearance (SrC) values for the plated segments of bone. Drilling had no effect on any parameter. Screw application was associated with minimal cortical thinning (p less than 0.05), while plate fixation clearly promoted thinning (p less than 0.01) and porosity (p less than 0.05). The percentage of labeled osteons, a measure of remodeling activity, increased only after plate fixation (p less than 0.05), and the labeling patterns suggested that most osteons had formed during the first 4 postsurgical months. That none of these changes were correlated with the 6-month SrC values suggests that the development of plate-induced osteopenia involves disparate histomorphometric time constants, rather than lack of any association.

  15. Spatial stress distribution analysis by thermoelastic stress measurement and evaluation of effect of stress concentration on durability of various orthopedic implant devices.

    PubMed

    Okazaki, Yoshimitsu; Ishii, Daisuke; Ogawa, Atsushi

    2017-06-01

    Toward the development of highly durable devices, we investigated the effect of the thermoelastic constants of implantable raw metals and the surface stress distribution on the durability of various types of implant device by thermoelastic stress measurement and by evaluating the effect of the stress concentration. Surface stress was dynamically calculated from the bending moment, and the modulus of a section of a device was found to be consistent with the surface stress obtained by thermoelastic stress measurement. The durability limits of various types of bone plate and compression hip screw (CHS) calculated from maximum load vs number of cycles data (L-N data) were close to the notch fatigue strength of the raw material. The concentration factor of an artificial hip stem surface was estimated by comparing the L-N data of the stem and the S-N curve of the raw material. The dynamic analysis of durability by thermoelastic stress measurement is useful for selecting the worst case (a product deteriorating to the most severe state) in medical device design. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Orthopedic trauma in pregnancy.

    PubMed

    Desai, Pratik; Suk, Michael

    2007-11-01

    Trauma sustained during pregnancy can trigger uncertainty and anxiety for patient and orthopedic surgeon alike. In particular, orthopedic-related injuries raise concerns about preoperative, intraoperative, and postoperative care. In this article, we review common concerns about radiation exposure, leukemia, pain management, anticoagulation, and anesthesia. One finding is that radiation risk is minimal when obtaining x-rays for operative planning, provided that the cumulative dose is within 5 rad. We also address safety concerns about patient positioning and staff radiation exposure. In addition, we found that most anesthetics used in pregnancy are category C (ie, safe). Perioperative opioid use for pain management is recommended with little risk. Regarding anticoagulation, low-molecular-weight heparin and fondaparinux are the safest choices. Last, pregnancy is not a contraindication to operative management of pelvic and acetabular fractures.

  17. In vitro characterization and mechanical properties of β-calcium silicate/POC composite as a bone fixation device.

    PubMed

    Shirazi, F S; Moghaddam, E; Mehrali, M; Oshkour, A A; Metselaar, H S C; Kadri, N A; Zandi, K; Abu, N A

    2014-11-01

    Calcium silicate (CS, CaSiO3 ) is a bioactive, degradable, and biocompatible ceramic and has been considered for its potential in the field of orthopedic surgery. The objective of this study is the fabrication and characterization of the β-CS/poly(1.8-octanediol citrate) (POC) biocomposite, with the goals of controlling its weight loss and improving its biological and mechanical properties. POC is one of the most biocompatible polymers, and it is widely used in biomedical engineering applications. The degradation and bioactivity of the composites were determined by soaking the composites in phosphate-buffered saline and simulated body fluid, respectively. Human osteoblast cells were cultured on the composites to determine their cell proliferation and adhesion. The results illustrated that the flexural and compressive strengths were significantly enhanced by a modification of 40% POC. It was also concluded that the degradation bioactivity and amelioration of cell proliferation increased significantly with an increasing β-CS content. © 2014 Wiley Periodicals, Inc.

  18. 21 CFR 872.4880 - Intraosseous fixation screw or wire.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Intraosseous fixation screw or wire. 872.4880... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Surgical Devices § 872.4880 Intraosseous fixation screw or wire. (a) Identification. An intraosseous fixation screw or wire is a metal device intended to be...

  19. 21 CFR 872.4880 - Intraosseous fixation screw or wire.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Intraosseous fixation screw or wire. 872.4880... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Surgical Devices § 872.4880 Intraosseous fixation screw or wire. (a) Identification. An intraosseous fixation screw or wire is a metal device intended to be...

  20. Engineering Orthopedic Tissue Interfaces

    PubMed Central

    Yang, Peter J.

    2009-01-01

    While a wide variety of approaches to engineering orthopedic tissues have been proposed, less attention has been paid to the interfaces, the specialized areas that connect two tissues of different biochemical and mechanical properties. The interface tissue plays an important role in transitioning mechanical load between disparate tissues. Thus, the relatively new field of interfacial tissue engineering presents new challenges—to not only consider the regeneration of individual orthopedic tissues, but also to design the biochemical and cellular composition of the linking tissue. Approaches to interfacial tissue engineering may be distinguished based on if the goal is to recreate the interface itself, or generate an entire integrated tissue unit (such as an osteochondral plug). As background for future efforts in engineering orthopedic interfaces, a brief review of the biology and mechanics of each interface (cartilage–bone, ligament–bone, meniscus–bone, and muscle–tendon) is presented, followed by an overview of the state-of-the-art in engineering each tissue, including advances and challenges specific to regenerating the interfaces. PMID:19231983

  1. Sarcopenia in Orthopedic Surgery.

    PubMed

    Bokshan, Steven L; DePasse, J Mason; Daniels, Alan H

    2016-01-01

    Sarcopenia is a loss of skeletal muscle mass in the elderly that is an independent risk factor for falls, disability, postoperative complications, and mortality. Although its cause is not completely understood, sarcopenia generally results from a complex bone-muscle interaction in the setting of chronic disease and aging. Sarcopenia cannot be diagnosed by muscle mass alone. Diagnosis requires 2 of the following 3 criteria: low skeletal muscle mass, inadequate muscle strength, and inadequate physical performance. Forty-four percent of elderly patients undergoing orthopedic surgery and 24% of all patients 65 to 70 years old are sarcopenic. Although dual-energy x-ray absorptiometry and bioelectrical impedance analysis may be used to measure sarcopenia and are relatively inexpensive and accessible, they are generally considered less specific for sarcopenia compared with computed tomography and magnetic resonance imaging. Sarcopenia has been shown to predict poor outcomes within the medical and surgical populations and has been directly correlated with increases in taxpayer costs. Strengthening therapy and nutritional supplementation have become the mainstays of sarcopenia treatment. Specifically, the American Medical Directors Association has released guidelines for nutritional supplementation. Although sarcopenia frequently occurs with osteoporosis, it is an independent predictor of fragility fractures. Initiatives to diagnose, treat, and prevent sarcopenia in orthopedic patients are needed. Further investigation must also explore sarcopenia as a predictor of surgical outcomes in orthopedic patients.

  2. A new femoral fixation device for anterior cruciate ligament reconstruction using the outside-in technique and hamstring tendon graft: A comparison between two devices in cadaveric human knee models.

    PubMed

    Chong, Suri; Kwak, Dai-Soon; Balasubramanian, Dhanasekaraprabu; Song, Young Dong; Na, Young Gon; Kim, Tae Kyun

    2017-10-01

    A new device (T-anchor) was developed for ACL reconstruction and is implanted via the outside-in technique using hamstring grafts. The purpose of this study was to compare the T-anchor with the EndoButton Direct. This study was conducted on 30 cadaveric knees (15 matched pairs). There were two groups of 15 each in the T-anchor and EndoButton Direct groups. After the harvest of grafts, fixation site profile and graft length were measured by loading the grafts onto both devices. They were then tested on a universal testing machine to assess elongation after cyclic loading, load to failure, ultimate load, and mode of failure. The fixation site profile was lower in the T-anchor group than in the EndoButton Direct group (2.3±0.4mm vs. 4.7±1.0mm, P<0.001). The length of the graft-device complex of the T-anchor specimens was longer than that of the EndoButton Direct specimens (125.0±8.9mm vs. 115.0±8.7mm, P<0.001). The mean cyclic elongation was lower for the T-anchor group when compared with the EndoButton Direct group (2.4±0.6mm vs. 3.9±2.6mm, P=0.015). There was no statistically significant difference in ultimate load and load to failure between the T-anchor and EndoButton Direct groups. For mode of failure, the T-anchor fared better (P=0.013) with all failures attributed to specimens. In this cadaveric study, the new device, T-anchor, performed better than the EndoButton Direct with respect to the above-mentioned study parameters except for ultimate load and load to failure. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. A New Culture of Transparency: Industry Payments to Orthopedic Surgeons.

    PubMed

    Lopez, Joseph; Ahmed, Rizwan; Bae, Sunjae; Hicks, Caitlin W; El Dafrawy, Mostafa; Osgood, Greg M; Segev, Dorry L

    2016-11-01

    Under the Physician Payments Sunshine Act, "payments or transfers of value" by biomedical companies to physicians must be disclosed through the Open Payments Program. Designed to provide transparency of financial transactions between medication and device manufacturers and health care providers, the Open Payments Program shows financial relationships between industry and health care providers. Awareness of this program is crucial because its interpretation or misinterpretation by patients, physicians, and the general public can affect patient care, clinical practice, and research. This study evaluated nonresearch payments by industry to orthopedic surgeons. A retrospective cross-sectional review of the first wave of Physician Payments Sunshine Act data (August through December 2013) was performed to characterize industry payments to orthopedic surgeons by subspecialty, amount, type, origin, and geographic distribution. During this 5-month period, orthopedic surgeons (n=14,828) received $107,666,826, which included 3% of those listed in the Open Payments Program and 23% of the total amount paid. Of orthopedic surgeons who received payment, 45% received less than $100 and 1% received $100,000 or more. Median payment (interquartile range) was $119 ($34-$636), and mean payment was $7261±95,887. The largest payment to an individual orthopedic surgeon was $7,849,711. The 2 largest payment categories were royalty or license fees (68%) and consulting fees (13%). During the study period, orthopedic surgeons had substantial financial ties to industry. Of orthopedic surgeons who received payments, the largest proportion (45%) received less than $100 and only 1% received large payments (≥$100,000). The Open Payments Program offers insight into industry payments to orthopedic surgeons. [Orthopedics. 2016; 39(6):e1058-e1062.].

  4. [Current trends and problems in the measurement of limb loading parameters during transosseous osteosynthesis using external fixation devices].

    PubMed

    Shuts, S A; Dzhafarova, O A; Shuts, B S

    1999-01-01

    The problem in question is whether it is reasonable to equip a conventional limb external fixation apparatus with means for the diagnosis of loading parameters: the forces and displacement of the opposite supporting elements of the apparatus. It is assumed that during distraction osteogenesis it is expedient to apply load to the limb by the load rate only at the initial stage of callus regeneration (the plastic or slightly elastic mechanical state) while the most effective way to do so is to act force at later stages. A number of functions derived from the modified parameters which might aid a physician to choose the optimum limb loading parameters at different stages of treatment were considered by using as example a hypothetical ring-type apparatus equipped with means for continuous measurement of current forces applied to the apparatus and current displacements of opposite ring blocks. Specifications for the measuring system of loading parameters were defined by using an Ilizarov apparatus as an example and why possible rough measurement errors may occur is revealed. The paper shows it necessary to develop methods for calculation of parasitic deformations, i.e. those of the loaded elements of the apparatus for the evaluation of the reciprocal displacement of bone fragments.

  5. Residual position errors of lymph node surrogates in breast cancer adjuvant radiotherapy: Comparison of two arm fixation devices and the effect of arm position correction

    SciTech Connect

    Kapanen, Mika; Laaksomaa, Marko; Skyttä, Tanja; Haltamo, Mikko; Pehkonen, Jani; Lehtonen, Turkka; Kellokumpu-Lehtinen, Pirkko-Liisa; Hyödynmaa, Simo

    2016-04-01

    Residual position errors of the lymph node (LN) surrogates and humeral head (HH) were determined for 2 different arm fixation devices in radiotherapy (RT) of breast cancer: a standard wrist-hold (WH) and a house-made rod-hold (RH). The effect of arm position correction (APC) based on setup images was also investigated. A total of 113 consecutive patients with early-stage breast cancer with LN irradiation were retrospectively analyzed (53 and 60 using the WH and RH, respectively). Residual position errors of the LN surrogates (Th1-2 and clavicle) and the HH were investigated to compare the 2 fixation devices. The position errors and setup margins were determined before and after the APC to investigate the efficacy of the APC in the treatment situation. A threshold of 5 mm was used for the residual errors of the clavicle and Th1-2 to perform the APC, and a threshold of 7 mm was used for the HH. The setup margins were calculated with the van Herk formula. Irradiated volumes of the HH were determined from RT treatment plans. With the WH and the RH, setup margins up to 8.1 and 6.7 mm should be used for the LN surrogates, and margins up to 4.6 and 3.6 mm should be used to spare the HH, respectively, without the APC. After the APC, the margins of the LN surrogates were equal to or less than 7.5/6.0 mm with the WH/RH, but margins up to 4.2/2.9 mm were required for the HH. The APC was needed at least once with both the devices for approximately 60% of the patients. With the RH, irradiated volume of the HH was approximately 2 times more than with the WH, without any dose constraints. Use of the RH together with the APC resulted in minimal residual position errors and setup margins for all the investigated bony landmarks. Based on the obtained results, we prefer the house-made RH. However, more attention should be given to minimize the irradiation of the HH with the RH than with the WH.

  6. Feasibility study of a non-invasive eye fixation and monitoring device using a right-angle prism mirror for intensity-modulated radiotherapy for choroidal melanoma.

    PubMed

    Inoue, Toshihiko; Masai, Norihisa; Shiomi, Hiroya; Oh, Ryoong-Jin; Uemoto, Kenji; Hashida, Noriyasu

    2016-11-03

    We aimed to describe the feasibility and efficacy of a novel non-invasive fixation and monitoring (F-M) device for the eyeballs (which uses a right-angle prism mirror as the optic axis guide) in three consecutive patients with choroidal melanoma who were treated with intensity-modulated radiotherapy (IMRT). The device consists of an immobilization shell, a right-angle prism mirror, a high magnification optical zoom video camera, a guide lamp, a digital voice recorder, a personal computer, and a National Television System Committee standard analog video cable. Using the right-angle prism mirror, the antero-posterior axis was determined coincident with the optic axis connecting the centers of the cornea and pupil. The axis was then connected to the guide light and video camera installed on the couch top on the distal side. Repositioning accuracy improved using this method. Furthermore, the positional error of the lens was markedly reduced from ±1.16, ±1.68 and ±1.11 mm to ±0.23, ±0.58 and ±0.26 mm in the horizontal direction, and from ±1.50, ±1.03 and ±0.48 mm to ±0.29, ±0.30 and ±0.24 mm in the vertical direction (Patient #1, #2 and #3, respectively). Accordingly, the F-M device method decreased the planning target volume size and improved the dose-volume histogram parameters of the organ-at-risk via IMRT inverse planning. Importantly, the treatment method was well tolerated.

  7. Dealing with innovation and costs in orthopedics: a conversation with Dane Miller. Interview by Lawton R Burns.

    PubMed

    Miller, Dane

    2006-01-01

    Rob Burns talks with Dane Miller, former CEO of Biomet, about challenges posed by new technology in the orthopedic devices area. One key challenge is the rising cost and use of orthopedic devices at a time when providers are facing decreased profitability and reimbursement for orthopedic services. Another challenge is the long-term time horizon needed to gauge product success that contrasts with payers' and providers' short-term horizon. A third challenge is heightened governmental scrutiny of device makers' relationships with orthopedic surgeons. This interview was conducted before Miller left Biomet in March 2006.

  8. Orthopedic Injury in Pregnancy.

    PubMed

    Gross, Gilad A; George, James W

    2016-09-01

    There are many reasons why a woman's pregnancy can put her at risk for orthopedic pain and injury. Given the high percentage of pregnant patients experiencing some degree of musculoskeletal pain, it is surprising that this is not an area of wider study. This chapter takes an evidence based approach to help the reader understand the implications of the numerous anatomic and physiologic changes associated with the gravid state, and how they act to promote both discomfort and injury. One-third of pregnant women in America are obese, further increasing risk. Exercise in most pregnancies is recommended and regarded as safe and thus obstetric care providers need to understand risk, diagnostic techniques and treatments.

  9. Advances in regenerative orthopedics.

    PubMed

    Evans, Christopher H

    2013-11-01

    Orthopedic injuries are common and a source of much misery and economic stress. Several relevant tissues, such as cartilage, meniscus, and intra-articular ligaments, do not heal. And even bone, which normally regenerates spontaneously, can fail to mend. The regeneration of orthopedic tissues requires 4 key components: cells, morphogenetic signals, scaffolds, and an appropriate mechanical environment. Although differentiated cells from the tissue in question can be used, most cellular research focuses on the use of mesenchymal stem cells. These can be retrieved from many different tissues, and one unresolved question is the degree to which the origin of the cells matters. Embryonic and induced pluripotent stem cells are also under investigation. Morphogenetic signals are most frequently supplied by individual recombinant growth factors or native mixtures provided by, for example, platelet-rich plasma; mesenchymal stem cells are also a rich source of trophic factors. Obstacles to the sustained delivery of individual growth factors can be addressed by gene transfer or smart scaffolds, but we still lack detailed, necessary information on which delivery profiles are needed. Scaffolds may be based on natural products, synthetic materials, or devitalized extracellular matrix. Strategies to combine these components to regenerate tissue can follow traditional tissue engineering practices, but these are costly, cumbersome, and not well suited to treating large numbers of individuals. More expeditious approaches make full use of intrinsic biological processes in vivo to avoid the need for ex vivo expansion of autologous cells and multiple procedures. Clinical translation remains a bottleneck. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  10. Military Curricula for Vocational & Technical Education. Orthopedic Specialist, Classroom Course 10-13.

    ERIC Educational Resources Information Center

    Brooke Army Medical Center, Fort Sam Houston, TX. Health Care Research Div.

    These military-developed curriculum materials for a course for orthopedic specialists are targeted for students from grades 11 through the adult level. The course is designed to provide a working knowledge of the application of casts, traction, and splints to orthopedic patients and the removal of these devices; a working knowledge of assisting in…

  11. Clinical application of subdermal areolar tissue and superficial fascia graft as a new material for coverage of small exposure of bone cortex or orthopaedic fixation device.

    PubMed

    Gondo, Masahide; Matsumura, Hajime; Watanabe, Katsueki

    2017-08-01

    The presence of cortical bone, tendon that has been exposed by defects, may result in infection or osteomyelitis. In such cases, perifascial areolar tissue grafting (PATG) may be performed as a minimally invasive surgical procedure. However, perifascial areolar tissue (PAT) is located deep in the subcutaneous layer. It was considered that grafting of the superficial vascular network might enable less invasive surgery. This study reports use of subdermal areolar tissue (SAT) and superficial fascia (SF) to close avascular areas. This study treated eight areas of exposed bone, tendon, or orthopaedic fixation device in seven patients treated in the department between 2010-2013. The patients included five men and two women aged 15-80 years. Subdermal areolar tissue grafting (SATG) was performed on four areas, and superficial fascia grafting (SFG) on the remaining four areas. In all cases, split thickness skin graft (STSG) was used to cover the grafted tissue in a single procedure. The tissue grafted successfully in seven areas, and primary engraftment of the skin grafts was also achieved in three areas treated with SATG and one area treated with SFG. Additional skin grafting was performed to achieve closure in one site treated with SATG and two sites treated with SFG. The tissue graft became necrotic in one site treated with SFG. There were no problems at any donor sites and no graft site infections or other complications. SATG and SFG achieved good clinical results for the closure of exposed avascular tissue or artifacts.

  12. Clinical and Analytical Evaluation of a Single-Vial Stool Collection Device with Formalin-Free Fixative for Improved Processing and Comprehensive Detection of Gastrointestinal Parasites.

    PubMed

    Couturier, Brianne A; Jensen, Ryan; Arias, Nora; Heffron, Michael; Gubler, Elyse; Case, Kristin; Gowans, Jason; Couturier, Marc Roger

    2015-08-01

    Microscopic examination of feces is a standard laboratory method for diagnosing gastrointestinal parasite infections. In North America, the ovum and parasite (O&P) examination is typically performed using stool that is chemically fixed in polyvinyl alcohol (PVA) and formalin, after which the stool is concentrated by filtration to enhance sensitivity. Mini Parasep solvent-free (SF) tubes allow collection and concentration within a single collection vial. The goal of the study was to determine whether consolidated processing and concentration with the Parasep tubes using an alcohol-based fixative (Alcorfix) provide O&P examinations equivalent to or better than those done by processing of PVA-formalin-fixed stool using a SpinCon concentration device. Parasep tubes revealed filtration performance equivalent to that of the SpinCon concentration device using PVA-formalin-fixed stool containing protozoa. Specimens cocollected in Parasep tubes containing PVA-formalin and Alcorfix revealed comparable morphology and staining for various protozoa. Alcorfix effectively fixed live Cryptosporidium and microsporidia such that morphology and staining were conserved for modified acid-fast and modified trichrome stains. A work flow analysis revealed significant time savings for batches of 10 or 30 O&P specimens in tubes with Alcorfix compared to the amount of time that it took to analyze the same number of specimens in tubes with PVA-formalin. The direct hands-on time savings with Mini Parasep tubes were 17 min and 41 s and 32 min and 1 s for batches of 10 and 30 specimens, respectively. Parasep tubes containing Alcorfix provide significant work flow advantages to laboratories that process medium to high volumes of O&P specimens by streamlining processing and converting to a single tube. These improvements in work flow, reduction of the amount of formalin used in the laboratory, and equivalent microscopy results are attractive advancements in O&P testing for North American

  13. Clinical and Analytical Evaluation of a Single-Vial Stool Collection Device with Formalin-Free Fixative for Improved Processing and Comprehensive Detection of Gastrointestinal Parasites

    PubMed Central

    Couturier, Brianne A.; Jensen, Ryan; Arias, Nora; Heffron, Michael; Gubler, Elyse; Case, Kristin; Gowans, Jason

    2015-01-01

    Microscopic examination of feces is a standard laboratory method for diagnosing gastrointestinal parasite infections. In North America, the ovum and parasite (O&P) examination is typically performed using stool that is chemically fixed in polyvinyl alcohol (PVA) and formalin, after which the stool is concentrated by filtration to enhance sensitivity. Mini Parasep solvent-free (SF) tubes allow collection and concentration within a single collection vial. The goal of the study was to determine whether consolidated processing and concentration with the Parasep tubes using an alcohol-based fixative (Alcorfix) provide O&P examinations equivalent to or better than those done by processing of PVA-formalin-fixed stool using a SpinCon concentration device. Parasep tubes revealed filtration performance equivalent to that of the SpinCon concentration device using PVA-formalin-fixed stool containing protozoa. Specimens cocollected in Parasep tubes containing PVA-formalin and Alcorfix revealed comparable morphology and staining for various protozoa. Alcorfix effectively fixed live Cryptosporidium and microsporidia such that morphology and staining were conserved for modified acid-fast and modified trichrome stains. A work flow analysis revealed significant time savings for batches of 10 or 30 O&P specimens in tubes with Alcorfix compared to the amount of time that it took to analyze the same number of specimens in tubes with PVA-formalin. The direct hands-on time savings with Mini Parasep tubes were 17 min and 41 s and 32 min and 1 s for batches of 10 and 30 specimens, respectively. Parasep tubes containing Alcorfix provide significant work flow advantages to laboratories that process medium to high volumes of O&P specimens by streamlining processing and converting to a single tube. These improvements in work flow, reduction of the amount of formalin used in the laboratory, and equivalent microscopy results are attractive advancements in O&P testing for North American

  14. Mechanical properties and cytocompatibility of oxygen-modified β-type Ti-Cr alloys for spinal fixation devices.

    PubMed

    Liu, Huihong; Niinomi, Mitsuo; Nakai, Masaaki; Cho, Ken; Narita, Kengo; Şen, Mustafa; Shiku, Hitoshi; Matsue, Tomokazu

    2015-01-01

    In this study, various amounts of oxygen were added to Ti-10Cr (mass%) alloys. It is expected that a large changeable Young's modulus, caused by a deformation-induced ω-phase transformation, can be achieved in Ti-10Cr-O alloys by the appropriate oxygen addition. This "changeable Young's modulus" property can satisfy the otherwise conflicting requirements for use in spinal implant rods: high and low moduli are preferred by surgeons and patients, respectively. The influence of oxygen on the microstructures and mechanical properties of the alloys was examined, as well as the bending springback and cytocompatibility of the optimized alloy. Among the Ti-10Cr-O alloys, Ti-10Cr-0.2O (mass%) alloy shows the largest changeable Young's modulus following cold rolling for a constant reduction ratio. This is the result of two competing factors: increased apparent β-lattice stability and decreased amounts of athermal ω phase, both of which are caused by oxygen addition. The most favorable balance of these factors for the deformation-induced ω-phase transformation occurred at an oxygen concentration of 0.2mass%. Ti-10Cr-0.2O alloy not only exhibits high tensile strength and acceptable elongation, but also possesses a good combination of high bending strength, acceptable bending springback and great cytocompatibility. Therefore, Ti-10Cr-0.2O alloy is a potential material for use in spinal fixture devices.

  15. Conversion from temporary external fixation to definitive fixation: shaft fractures.

    PubMed

    Dougherty, Paul J; Silverton, Craig; Yeni, Yener; Tashman, Scott; Weir, Robb

    2006-01-01

    Temporary external fixation is the most common method of initial stabilization of diaphyseal fractures in forward surgical hospitals. Once the patient arrives at a stable environment, usually the United States, the fracture is managed with intramedullary nailing, small-pin external fixation, or a modified external fixator. Future research should be directed toward improving methods of care. It is not precisely known when is the best time to convert to definitive fixation without increasing the risk of infection. The risk factors leading to infection and nonunion are not well-established, making that determination even more difficult. Clinical studies of a suitable size should provide insight into these problems. Although temporary external fixation is commonly used, an optimal construct has not been determined. Data from studies of in vivo fracture-site motion after application of the temporary external fixator should be compared with biomechanical testing of similar constructs. These data could be used to recommend optimal temporary external fixation constructs of tibia, femur, and humerus fractures using currently available devices as well as to provide groundwork for the next generation of fixators.

  16. Plasma Biomedicine in Orthopedics

    NASA Astrophysics Data System (ADS)

    Hamaguchi, Satsohi

    2012-10-01

    Various effects of plasmas irradiation on cells, tissues, and biomaterials relevant for orthopedic applications have been examined. For direct application of plasmas to living cells or tissues, dielectric barrier discharges (DBDs) with helium flows into ambient air were used. For biomaterial processing, on the other hand, either helium DBDs mentioned above or low-pressure discharges generated in a chamber were used. In this presentation, plasma effects on cell proliferation and plasma treatment for artificial bones will be discussed. First, the conditions for enhanced cell proliferation in vitro by plasma applications have been examined. The discharge conditions for cell proliferation depend sensitively on cell types. Since cell proliferation can be enhanced even when the cells are cultured in a plasma pre-treated medium, long-life reactive species generated in the medium by plasma application or large molecules (such as proteins) in the medium modified by the plasma are likely to be the cause of cell proliferation. It has been found that there is strong correlation between (organic) hydroperoxide generation and cell proliferation. Second, effects of plasma-treated artificial bones made of porous hydroxyapatite (HA) have been examined in vitro and vivo. It has been found that plasma treatment increases hydrophilicity of the surfaces of microscopic inner pores, which directly or indirectly promotes differentiation of mesenchymal stem cells introduced into the pores and therefore causes faster bone growth. The work has been performed in collaboration with Prof. H. Yoshikawa and his group members at the School of Medicine, Osaka University.

  17. Nanomedicine applications in orthopedic medicine: state of the art

    PubMed Central

    Mazaheri, Mozhdeh; Eslahi, Niloofar; Ordikhani, Farideh; Tamjid, Elnaz; Simchi, Abdolreza

    2015-01-01

    The technological and clinical need for orthopedic replacement materials has led to significant advances in the field of nanomedicine, which embraces the breadth of nanotechnology from pharmacological agents and surface modification through to regulation and toxicology. A variety of nanostructures with unique chemical, physical, and biological properties have been engineered to improve the functionality and reliability of implantable medical devices. However, mimicking living bone tissue is still a challenge. The scope of this review is to highlight the most recent accomplishments and trends in designing nanomaterials and their applications in orthopedics with an outline on future directions and challenges. PMID:26451110

  18. Nanomedicine applications in orthopedic medicine: state of the art.

    PubMed

    Mazaheri, Mozhdeh; Eslahi, Niloofar; Ordikhani, Farideh; Tamjid, Elnaz; Simchi, Abdolreza

    2015-01-01

    The technological and clinical need for orthopedic replacement materials has led to significant advances in the field of nanomedicine, which embraces the breadth of nanotechnology from pharmacological agents and surface modification through to regulation and toxicology. A variety of nanostructures with unique chemical, physical, and biological properties have been engineered to improve the functionality and reliability of implantable medical devices. However, mimicking living bone tissue is still a challenge. The scope of this review is to highlight the most recent accomplishments and trends in designing nanomaterials and their applications in orthopedics with an outline on future directions and challenges.

  19. Biomechanical comparison of odontoid plate fixation versus odontoid screw fixation.

    PubMed

    Platzer, Patrick; Eipeldauer, Stefan; Leitgeb, Johannes; Aldrian, Silke; Vécsei, Vilmos

    2011-05-01

    Randomized controlled trial with statistically significant difference or statistically no significant difference (Level I). The purpose of this study was to measure the mechanical stability of odontoid plate fixation, using a specially designed plate construct and to compare the results with those after odontoid single-screw and double-screw fixation. Plate fixation of the odontoid process without C1-C2 is a possible option for the management of odontoid fractures that are not suitable for conventional screw fixation. Although earlier biomechanical works have evaluated the effectiveness of different odontoid screw fixation techniques, no study has quantified the mechanical stability of odontoid fixation by a plate device. The second cervical vertebra was removed from 15 fresh human spinal columns. The specimens were fixed to the experimental apparatus with the load cell at the articular surface of the odontoid process. In the first test series, stiffness and failure load of the intact odontoid were measured. Type II odontoid fractures were created by a 45 degree oblique extension loading at the articular surface of the odontoid process. Afterward, the specimens were randomly assigned to 1 of the following 3 groups: in group I (n=5), the fractures were stabilized, using a specially designed plate construct, in group II, the fractures were fixed, using two 3.5 mm cortical screws, and in group III, we used 1 regular 4.5 mm cortical screw. In the second test series, stiffness and failure load of the stabilized odontoid fractures were assessed for comparison and statistical analysis. Group I (plate device) showed a significantly higher mean failure load than group II and group III. The mean failure load of group I, after fixation of the odontoid fracture, was 84% of the mean failure load that was necessary to create a type II odontoid fracture initially. Comparing group II (double screw technique) and group III (single screw technique), there was no significant

  20. Evaluation of long-term results and quality of life in patients who underwent rib fixation with titanium devices after trauma.

    PubMed

    Billè, Andrea; Okiror, Lawrence; Campbell, Aideen; Simons, Jason; Routledge, Tom

    2013-06-01

    To describe the long-term results, quality of life and chronic pain after chest wall fixation for traumatic rib fracture using a quality of life (QOL) score and a numeric pain score. Retrospective analysis of 10 consecutive patients who underwent surgery for rib fractures after trauma and reconstruction between October 2010 and March 2012. Chest rib fractures were fixed with titanium clips and bars or titanium plates and screws through a posterolateral thoracotomy. Pain was assessed with a numeric pain scale 0-10 and quality of life (QOL) with the EORTC questionnaire QLQ-C30. There were 5 males and 5 females. The median age was 58 years (range 21-80). There were no postoperative deaths. The only postoperative complication observed was a contralateral pleural effusion requiring drainage. Median length of stay of the drain and median length of hospital stay were 2 days (range 0-8) and 4 days (range 1-42 days), respectively. The average follow-up period of operatively managed patients was 14 months (range 8-23.5 months). Seven patients scored the pain as 0, one as 1 (mild), one as 4 (moderate) and one as 8 (severe). Only two patients are taking occasionally pain killers. Only one patient presents severe limitation in his life scoring his QOL as poor. Titanium devices (clips and bars; screws and plates) are effective and safe for repair of rib fractures and showed good long-term results in terms of pain and quality of life after the operation.

  1. Klebsiella pneumoniae carrying bla NDM-1 gene in orthopedic practice.

    PubMed

    Gupta, Varsha; Bansal, Neha; Gupta, Ravi; Chander, Jagdish

    2014-09-01

    Emergence and spread of carbapenemases in Enterobacteriaceae is a cause of concern worldwide, the latest threat being New Delhi metallo-β-lactamase (NDM-1). This report is of an orthopedic case with fracture femur managed with internal fixation and bone grafting, who subsequently developed secondary infection with Klebsiella pneumoniae harboring bla NDM-1 gene. Minimum inhibitory concentration (MIC) of imipenem was ≥8 μg/ml by E-test, suggestive of carbapenemase production. Phenotypic and further genotypic detection confirmed the presence of bla NDM-1 gene. The isolate remained susceptible only to tigecycline, colistin, and polymyxin B.

  2. Improved orthopedic arm joint

    NASA Technical Reports Server (NTRS)

    Dane, D. H.

    1971-01-01

    Joint permits smooth and easy movement of disabled arm and is smaller, lighter and less expensive than previous models. Device is interchangeable and may be used on either arm at the shoulder or at the elbow.

  3. Medical photography: principles for orthopedics

    PubMed Central

    2014-01-01

    Background Medical photography is used clinically for patient evaluation, treatment decisions, and scientific documentation. Although standards for medical photography exist in many branches of medicine, we have not encountered such criteria in publications in the area of orthopedics. Purpose This study aims to (1) assess the quality of medical images used in an orthopedic publication and (2) to propose standards for medical photography in this area. Methods Clinical photographs were reviewed from all issues of a journal published between the years 2008 and 2012. A quality of clinical images was developed based on the criteria published for the specialties of dermatology and cosmetic surgery. All images were reviewed on the appropriateness of background, patient preparation, and technique. Results In this study, only 44.9% of clinical images in an orthopedic publication adhered to the proposed conventions. Conclusions Standards have not been established for medical photography in orthopedics as in other specialty areas. Our results suggest that photographic clinical information in orthopedic publications may be limited by inadequate presentation. We propose that formal conventions for clinical images should be established. PMID:24708703

  4. Medical photography: principles for orthopedics.

    PubMed

    Uzun, Metin; Bülbül, Murat; Toker, Serdar; Beksaç, Burak; Kara, Adnan

    2014-04-05

    Medical photography is used clinically for patient evaluation, treatment decisions, and scientific documentation. Although standards for medical photography exist in many branches of medicine, we have not encountered such criteria in publications in the area of orthopedics. This study aims to (1) assess the quality of medical images used in an orthopedic publication and (2) to propose standards for medical photography in this area. Clinical photographs were reviewed from all issues of a journal published between the years 2008 and 2012. A quality of clinical images was developed based on the criteria published for the specialties of dermatology and cosmetic surgery. All images were reviewed on the appropriateness of background, patient preparation, and technique. In this study, only 44.9% of clinical images in an orthopedic publication adhered to the proposed conventions. Standards have not been established for medical photography in orthopedics as in other specialty areas. Our results suggest that photographic clinical information in orthopedic publications may be limited by inadequate presentation. We propose that formal conventions for clinical images should be established.

  5. Moral Dilemmas in Pediatric Orthopedics.

    PubMed

    Mercuri, John J; Vigdorchik, Jonathan M; Otsuka, Norman Y

    2015-12-01

    All orthopedic surgeons face moral dilemmas on a regular basis; however, little has been written about the moral dilemmas that are encountered when providing orthopedic care to pediatric patients and their families. This article aims to provide surgeons with a better understanding of how bioethics and professionalism apply to the care of their pediatric patients. First, several foundational concepts of both bioethics and professionalism are summarized, and definitions are offered for 16 important terms within the disciplines. Next, some of the unique aspects of pediatric orthopedics as a subspecialty are reviewed before engaging in a discussion of 5 common moral dilemmas within the field. Those dilemmas include the following: (1) obtaining informed consent and assent for either surgery or research from pediatric patients and their families; (2) performing cosmetic surgery on pediatric patients; (3) caring for pediatric patients with cognitive or physical impairments; (4) caring for injured pediatric athletes; and (5) meeting the demand for pediatric orthopedic care in the United States. Pertinent considerations are reviewed for each of these 5 moral dilemmas, thereby better preparing surgeons for principled moral decision making in their own practices. Each of these dilemmas is inherently complex with few straightforward answers; however, orthopedic surgeons have an obligation to take the lead and better define these kinds of difficult issues within their field. The lives of pediatric patients and their families will be immeasurably improved as a result.

  6. Value Added: the Case for Point-of-View Camera use in Orthopedic Surgical Education.

    PubMed

    Karam, Matthew D; Thomas, Geb W; Taylor, Leah; Liu, Xiaoxing; Anthony, Chris A; Anderson, Donald D

    2016-01-01

    Orthopedic surgical education is evolving as educators search for new ways to enhance surgical skills training. Orthopedic educators should seek new methods and technologies to augment and add value to real-time orthopedic surgical experience. This paper describes a protocol whereby we have started to capture and evaluate specific orthopedic milestone procedures with a GoPro® point-of-view video camera and a dedicated video reviewing website as a way of supplementing the current paradigm in surgical skills training. We report our experience regarding the details and feasibility of this protocol. Upon identification of a patient undergoing surgical fixation of a hip or ankle fracture, an orthopedic resident places a GoPro® point-of-view camera on his or her forehead. All fluoroscopic images acquired during the case are saved and later incorporated into a video on the reviewing website. Surgical videos are uploaded to a secure server and are accessible for later review and assessment via a custom-built website. An electronic survey of resident participants was performed utilizing Qualtrics software. Results are reported using descriptive statistics. A total of 51 surgical videos involving 23 different residents have been captured to date. This includes 20 intertrochanteric hip fracture cases and 31 ankle fracture cases. The average duration of each surgical video was 1 hour and 16 minutes (range 40 minutes to 2 hours and 19 minutes). Of 24 orthopedic resident surgeons surveyed, 88% thought capturing a video portfolio of orthopedic milestones would benefit their education. There is a growing demand in orthopedic surgical education to extract more value from each surgical experience. While further work in development and refinement of such assessments is necessary, we feel that intraoperative video, particularly when captured and presented in a non-threatening, user friendly manner, can add significant value to the present and future paradigm of orthopedic surgical

  7. Value Added: the Case for Point-of-View Camera use in Orthopedic Surgical Education

    PubMed Central

    Thomas, Geb W.; Taylor, Leah; Liu, Xiaoxing; Anthony, Chris A.; Anderson, Donald D.

    2016-01-01

    Abstract Background Orthopedic surgical education is evolving as educators search for new ways to enhance surgical skills training. Orthopedic educators should seek new methods and technologies to augment and add value to real-time orthopedic surgical experience. This paper describes a protocol whereby we have started to capture and evaluate specific orthopedic milestone procedures with a GoPro® point-of-view video camera and a dedicated video reviewing website as a way of supplementing the current paradigm in surgical skills training. We report our experience regarding the details and feasibility of this protocol. Methods Upon identification of a patient undergoing surgical fixation of a hip or ankle fracture, an orthopedic resident places a GoPro® point-of-view camera on his or her forehead. All fluoroscopic images acquired during the case are saved and later incorporated into a video on the reviewing website. Surgical videos are uploaded to a secure server and are accessible for later review and assessment via a custom-built website. An electronic survey of resident participants was performed utilizing Qualtrics software. Results are reported using descriptive statistics. Results A total of 51 surgical videos involving 23 different residents have been captured to date. This includes 20 intertrochanteric hip fracture cases and 31 ankle fracture cases. The average duration of each surgical video was 1 hour and 16 minutes (range 40 minutes to 2 hours and 19 minutes). Of 24 orthopedic resident surgeons surveyed, 88% thought capturing a video portfolio of orthopedic milestones would benefit their education Conclusions There is a growing demand in orthopedic surgical education to extract more value from each surgical experience. While further work in development and refinement of such assessments is necessary, we feel that intraoperative video, particularly when captured and presented in a non-threatening, user friendly manner, can add significant value to the

  8. Prevention of VTE in Orthopedic Surgery Patients

    PubMed Central

    Francis, Charles W.; Johanson, Norman A.; Curley, Catherine; Dahl, Ola E.; Schulman, Sam; Ortel, Thomas L.; Pauker, Stephen G.; Colwell, Clifford W.

    2012-01-01

    Background: VTE is a serious, but decreasing complication following major orthopedic surgery. This guideline focuses on optimal prophylaxis to reduce postoperative pulmonary embolism and DVT. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: In patients undergoing major orthopedic surgery, we recommend the use of one of the following rather than no antithrombotic prophylaxis: low-molecular-weight heparin; fondaparinux; dabigatran, apixaban, rivaroxaban (total hip arthroplasty or total knee arthroplasty but not hip fracture surgery); low-dose unfractionated heparin; adjusted-dose vitamin K antagonist; aspirin (all Grade 1B); or an intermittent pneumatic compression device (IPCD) (Grade 1C) for a minimum of 10 to 14 days. We suggest the use of low-molecular-weight heparin in preference to the other agents we have recommended as alternatives (Grade 2C/2B), and in patients receiving pharmacologic prophylaxis, we suggest adding an IPCD during the hospital stay (Grade 2C). We suggest extending thromboprophylaxis for up to 35 days (Grade 2B). In patients at increased bleeding risk, we suggest an IPCD or no prophylaxis (Grade 2C). In patients who decline injections, we recommend using apixaban or dabigatran (all Grade 1B). We suggest against using inferior vena cava filter placement for primary prevention in patients with contraindications to both pharmacologic and mechanical thromboprophylaxis (Grade 2C). We recommend against Doppler (or duplex) ultrasonography screening before hospital discharge (Grade 1B). For patients with isolated lower-extremity injuries requiring leg immobilization, we suggest no thromboprophylaxis (Grade 2B). For patients undergoing knee arthroscopy without a history

  9. Diagnostic imaging in bovine orthopedics.

    PubMed

    Kofler, Johann; Geissbühler, Urs; Steiner, Adrian

    2014-03-01

    Although a radiographic unit is not standard equipment for bovine practitioners in hospital or field situations, ultrasound machines with 7.5-MHz linear transducers have been used in bovine reproduction for many years, and are eminently suitable for evaluation of orthopedic disorders. The goal of this article is to encourage veterinarians to use radiology and ultrasonography for the evaluation of bovine orthopedic disorders. These diagnostic imaging techniques improve the likelihood of a definitive diagnosis in every bovine patient but especially in highly valuable cattle, whose owners demand increasingly more diagnostic and surgical interventions that require high-level specialized techniques.

  10. [Orthopedic aspects of Rett syndrome].

    PubMed

    Tanguy, A

    1993-04-01

    Rett syndrome is a degenerative neurological disorder with onset between 6 and 18 months of age. Severity of motor impairment is variable; some patients lose the ability to walk whereas others walk nearly normally. Orthopedic problems, which mainly involve the lower limbs and spine, can increase functional impairment and cause discomfort. Abnormal joint alignment in the lower limbs due to muscle contractures requires physiotherapy and orthopedic appliances. Surgery may be necessary, in particular to prevent dislocation of the hip or to correct talipes equinus. Scoliosis is common and unresponsive to conservative therapy and should be treated surgically if severe.

  11. CORRELATIONS BETWEEN OPHTHALMOLOGY AND ORTHOPEDICS.

    PubMed

    Cazac, Cristian

    2015-01-01

    Although orthopedics and ophthalmology seem to be two different medical specialties, numerous studies that have been conducted in the past 35 years have shown a tight connection between several ocular pathologies and an increased risk of hip fractures due to falling. This article aims to review the ocular pathologies that have been proven to be associated with an increased risk of falling, to integrate the results of several studies showing a direct relationship between ocular pathologies and an increased risk of falling and finally to suggest ways in which the incidence of traumatic orthopedic injuries can be reduced by applying ophthalmologic principles.

  12. Treatment of severe orthopedic infections.

    PubMed

    Dernell, W S

    1999-09-01

    Severe infections are uncommon following orthopedic surgery, yet they can be frustrating for the veterinarian and owner to treat and can result in devastating consequences for the patient. This article reviews the common causes for postoperative infection, reviews established treatment, and introduces newer methods for treatment and control. A thorough understanding of the pathogenesis, application of appropriate diagnostic procedures, the institution of aggressive treatment regimens, with adherence to established principles, will often result in satisfactory outcomes even with severe orthopedic infections. For those more refractory to treatment, the use of newer treatment methods, specifically locally implantable materials for sustained release of antimicrobials can improve success in the treatment of these more difficult cases.

  13. Decision making in ruminant orthopedics.

    PubMed

    Fessler, J F; Adams, S B

    1996-03-01

    Decision making in ruminant orthopedics is determined by many factors, the most of important of which is age, size, and value of the patient, the nature of the injury, the prognosis for effective treatment and satisfactory healing, the intentions of the client, and the experiences of the veterinarian. Ruminant orthopedics currently is expanding to include the treatment of llamas and small ruminants as companion animals in addition to the treatment of valuable livestock. The future promises increasing sophistication in treatments and an ever higher quality of patient care.

  14. Novel posterior fixation keratoprosthesis

    NASA Astrophysics Data System (ADS)

    Lacombe, Emmanuel

    1992-08-01

    The keratoprosthesis is the last solution for corneally blind patients that cannot benefit from corneal transplants. Keratoprostheses that have been designed to be affixed anteriorly usually necessitate multi-step surgical procedures and are continuously subjected to the extrusion forces generated by the positive intraocular pressure; therefore, clinical results in patients prove inconsistent. We proposed a novel keratoprosthesis concept that utilizes posterior corneal fixation which `a priori' minimizes the risk of aqueous leakage and expulsion. This prosthesis is implanted in a single procedure thereby reducing the number of surgical complications normally associated with anterior fixation devices. In addition, its novel design makes this keratoprosthesis implantable in phakic eyes. With an average follow-up of 13 months (range 3 to 25 months), our results on 21 cases are encouraging. Half of the keratoprostheses were implanted in severe burn cases, with the remainder in cases of pseudo- pemphigus. Good visual results and cosmetic appearance were obtained in 14 of 21 eyes.

  15. The use of a circular external skeletal fixation device for the management of long bone osteotomies in large ruminants: an experimental study.

    PubMed

    Aithal, H P; Singh, G R; Hoque, M; Maiti, S K; Kinjavdekar, P; Pawde, A M; Setia, H C

    2004-08-01

    The study was undertaken to evaluate the feasibility of a simple, inexpensive model of circular external fixator (CEF) for use in large ruminants. A simple model of CEF frames consisting of four full rings (13-19 cm diameter, 4 cm wide and 4 mm thick with 18-24 holes) connected by threaded rods (8 mm diameter, 10-15 cm long) and nuts was developed using mild (low carbon) steel and were nickel-plated. In the first phase of the study, three male cow calves were utilized to study the feasibility of application of the fixators in the metatarsus, tibia and radius, in reference of adaptation and tolerance by animals. In the second phase, the fixators were tested in osteotomized bones. Six bull calves of 1.5-2 years of age weighing about 200-250 kg were utilized for this purpose. After preparing the area for aseptic surgery, under xylazine (at 0.1 mg/kg, i.m.)-ketamine (i.v. till effect) general anaesthesia, the test bone (metatarsus, radius and tibia in two animals each) was approached through the medial surface and an osteotomy was created with a saw and chisel at the mid-diaphysis. The pre-constructed 4-ring CEF was mounted on the limb around the test bone in such a way that it formed a cylinder with the axis of the limb at the centre. Each ring was then fixed to the bone with a pair of beaded wires (316 SS) of 3.5 mm diameter. During the post-operative period, the animals were observed for any change in behaviour, tolerance of the fixators, the weight bearing on the test limb, the status of the fixator, and the level of reduction of the osteotomy, alignment and healing at different intervals. The fixation of CEF was easier in the metatarsus and radius than in the tibia. The inner ring diameters found adequate for metatarsus, radius and tibia were 13-15 cm, 15-17 cm and 17-19 cm, respectively. The fixators applied to different bones were well-tolerated, and the animals could lay down, stand and walk freely with the fixator without any problems. All the animals showed

  16. Metal Hypersensitivity and Orthopedic Implants: Survey of Orthopedic Surgeons.

    PubMed

    Hallock, Katherine; Vaughn, Natalie H; Juliano, Paul; Marks, James G

    There is no clear consensus among orthopedic surgeons concerning metal hypersensitivity screening and orthopedic implants. This study investigated practices and opinions about metal hypersensitivity and orthopedic implants via a survey administered to practicing orthopedists. A questionnaire was sent to members of the Pennsylvania Orthopaedic Society electronically. Respondents were asked about preoperative and postoperative screening habits concerning metal hypersensitivity and implants. Forty-four physicians completed the survey. Only 11% of respondents reported that they always or often screen patients for metal hypersensitivity. Fifty percent of respondents stated that they only rarely refer patients for patch testing (and the remainder never do). If, however, patients were found to have a positive patch test, most providers were very likely to use a different implant. Other respondents were skeptical of the relationship between metal hypersensitivity and implant failure. Dermatitis, pain, and loosening were common reasons for postoperative testing. Seventy percent of respondents said that patch testing rarely or never changed their decision making. This study is reflective of the lack of consensus between orthopedists regarding patch testing. It demonstrates the diversity of opinions among orthopedists, the need for additional dialogue between orthopedic and dermatology specialties, and the need for larger studies investigating outcomes and metal hypersensitivity.

  17. Internal fixation: a historical review.

    PubMed

    Greenhagen, Robert M; Johnson, Adam R; Joseph, Alison

    2011-08-01

    Internal fixation has become a pillar of surgical specialties, yet the evolution of these devices has been relatively short. The first known description of medical management of a fracture was found in the Edwin Smith Papyrus of Ancient Egypt (circa 2600 bc). The first description of internal fixation in the medical literature was in the 18th century. The advancement of techniques and technology over the last 150 years has helped to preserve both life and function. The pace of advancement continues to accelerate as surgeons continue to seek new technology for osseous fixation. The authors present a thorough review of the history of internal fixation and the transformation into a multibillion dollar industry.

  18. [Meaning of living with external fixation for grade III open fracture of lower limbs: patient view].

    PubMed

    Lopez, Catia Cristina Gomes; Gamba, Mônica Antar; Matheus, Maria Clara Cassuli

    2013-06-01

    The present study is aimed to understand the meaning of living with an external fixation device for grade III open fractures of the lower limbs from the perspective of the patient. The data were collected with six young adults who were undergoing outpatient orthopedic treatment in a public hospital in the city of São Paulo, through semi-structured interviews with open questions, between June and August 2010. Seeking to understand the meaning of this experience, we have maintained a phenomenological attitude during the analysis, which made it possible to reveal the phenomenon "try to live in spite of feeling trapped in a cage." Patients said that their personal desire and support from others helped them reorganize their lives, despite the several challenges they had to overcome to adapt to the fastener attached to their body and the fear of the future and doubts about the success of treatment.

  19. Orthopedic Management of Spina Bifida

    ERIC Educational Resources Information Center

    Thomson, Jeffrey D.; Segal, Lee S.

    2010-01-01

    The management of orthopedic problems in spina bifida has seen a dramatic change over the past 10 years. The negative effects of spasticity, poor balance, and the tethered cord syndrome on ambulatory function are better appreciated. There is less emphasis on the hip radiograph and more emphasis on the function of the knee and the prevention of…

  20. Orthopedic Management of Spina Bifida

    ERIC Educational Resources Information Center

    Thomson, Jeffrey D.; Segal, Lee S.

    2010-01-01

    The management of orthopedic problems in spina bifida has seen a dramatic change over the past 10 years. The negative effects of spasticity, poor balance, and the tethered cord syndrome on ambulatory function are better appreciated. There is less emphasis on the hip radiograph and more emphasis on the function of the knee and the prevention of…

  1. Orthopedic rehabilitation using the "Rutgers ankle" interface.

    PubMed

    Girone, M; Burdea, G; Bouzit, M; Popescu, V; Deutsch, J E

    2000-01-01

    A novel ankle rehabilitation device is being developed for home use, allowing remote monitoring by therapists. The system will allow patients to perform a variety of exercises while interacting with a virtual environment (VE). These game-like VEs created with WorldToolKit run on a host PC that controls the movement and output forces of the device via an RS232 connection. Patients will develop strength, flexibility, coordination, and balance as they interact with the VEs. The device will also perform diagnostic functions, measuring the ankle's range of motion, force exertion capabilities and coordination. The host PC transparently records patient progress for remote evaluation by therapists via our existing telerehabilitation system. The "Rutgers Ankle" Orthopedic Rehabilitation Interface uses double-acting pneumatic cylinders, linear potentiometers, and a 6 degree-of-freedom (DOF) force sensor. The controller contains a Pentium single-board computer and pneumatic control valves. Based on the Stewart platform, the device can move and supply forces and torques in 6 DOFs. A proof-of-concept trial conducted at the University of Medicine and Dentistry of New Jersey (UMDNJ) provided therapist and patient feedback. The system measured the range of motion and maximum force output of a group of four patients (male and female). Future medical trials are required to establish clinical efficacy in rehabilitation.

  2. Nanotechnology and orthopedics: a personal perspective.

    PubMed

    Laurencin, Cato T; Kumbar, Sangamesh G; Nukavarapu, Syam Prasad

    2009-01-01

    Bone is a nanocomposite material comprised of hierarchically arranged collagen fibrils, hydroxyapatite and proteoglycans in the nanometer scale. Cells are accustomed to interact with nanostructures, thus providing the cells with a natural bone-like environment that potentially enhance bone tissue regeneration/repair. In this direction, nanotechnology provides opportunities to fabricate as well as explore novel properties and phenomena of functional materials, devices, and systems at the nanometer-length scale. Recent studies have provided significant insights into the influence of topographical features in regulating cell behavior. Topographical features provide essential chemical and physical cues that cells can recognize and elicit desired cellular functions including preferential adhesion, migration, proliferation, and expression of specific cell phenotype to bring desired effects. The current article will address some of the nanotechnology implications in addressing issues related to orthopedic implants performance and tissue engineering approach to bone repair/regeneration.

  3. Current state and use of biological adhesives in orthopedic surgery.

    PubMed

    Shah, Neil V; Meislin, Robert

    2013-12-01

    Bone and tissue adhesives are common and beneficial supplements to standard methods of musculoskeletal tissue suture repair. Knowledge and development of biologically derived or inspired adhesives useful in orthopedic surgery are rapidly advancing. Recent literature demonstrates the increased adjunct or primary use of biological adhesives in the repair of musculoskeletal soft tissues, chondral fractures, and osteochondral fractures. Adhesives offer more benefits and enhancements to tissue healing than current fixation methods afford, including improved biocompatibility, resorbability, and non-immunogenicity. Further investigation is required to determine the extent of the role that these bioadhesives can play in orthopedic surgery. The largest group of biologically derived adhesives and sealants is fibrin sealants, which include first- and second-generation commercially available fibrin sealants, autologous fibrin sealants, and variants. Other groups include gelatin-resorcin aldehydes, protein-aldehyde systems, collagen-based adhesives, polysaccharide- based adhesives, mussel adhesive proteins, and various biologically inspired or biomimetic glues. Potential uses include applications in orthopedic-related blood conservation, arthroplasty, articular cartilage disorders, sports medicine, spine surgery, trauma, and tumors. The development of an adhesive with universal application is likely unfeasible, given the unique characteristics of various musculoskeletal tissues. However, the literature demonstrates the overall underuse of adhesives and indicates the rising probability of the development of a successful variety of bioadhesives for use in orthopedic surgery. As a result of reading this article, physicians should be able to: 1. Describe the difference between adhesives and sealants. 2. Recognize fibrin adhesives commonly used in practice today and identify other biological adhesives with rising potential. 3. Analyze how fibrin sealants work relative to fibrin and

  4. A novel smart navigation system for intramedullary nailing in orthopedic surgery

    PubMed Central

    Hwang, Jae Youn; Je, Minkyu; Kim, Jun-Young; Kim, Shin-Yoon

    2017-01-01

    This paper proposes a novel smart surgical navigation system for intramedullary nailing in orthopedic surgery. Using a handle-integrated laser guidance module, the system can target a drill insertion point onto skin, indicating an accurate target position to perpendicularly access an invisible distal hole. The proposed handle-integration-based fixation of the laser guidance module precisely defines the relative position of the module with respect to the distal hole. Consequently, unlike conventional systems, the proposed system can indicate the target insertion point without any help from bulky and costly external position-tracking equipment that is usually required for compensating disturbances generated by external impacts. After insertion, a correct drilling direction toward the distal hole is guided by real-time drilling angle measurement modules–one integrated with the nail handle and the other with the drill body. Each module contains a 9-axis inertial sensor and a Bluetooth communication device. These two modules work together to provide real-time drilling angle data, allowing calculation of the directional error toward the center of the distal hole in real time. The proposed system removes the need for fluoroscopy and provides a compact and cost-effective solution compared with conventional systems. PMID:28414721

  5. A novel smart navigation system for intramedullary nailing in orthopedic surgery.

    PubMed

    Choi, Jaesuk; Kim, Jihun; Hwang, Jae Youn; Je, Minkyu; Kim, Jun-Young; Kim, Shin-Yoon

    2017-01-01

    This paper proposes a novel smart surgical navigation system for intramedullary nailing in orthopedic surgery. Using a handle-integrated laser guidance module, the system can target a drill insertion point onto skin, indicating an accurate target position to perpendicularly access an invisible distal hole. The proposed handle-integration-based fixation of the laser guidance module precisely defines the relative position of the module with respect to the distal hole. Consequently, unlike conventional systems, the proposed system can indicate the target insertion point without any help from bulky and costly external position-tracking equipment that is usually required for compensating disturbances generated by external impacts. After insertion, a correct drilling direction toward the distal hole is guided by real-time drilling angle measurement modules-one integrated with the nail handle and the other with the drill body. Each module contains a 9-axis inertial sensor and a Bluetooth communication device. These two modules work together to provide real-time drilling angle data, allowing calculation of the directional error toward the center of the distal hole in real time. The proposed system removes the need for fluoroscopy and provides a compact and cost-effective solution compared with conventional systems.

  6. The Application of Virtual Planning and Navigation Devices for Mandible Reconstruction and Immediate Dental Implantation

    PubMed Central

    Rahimov, Chingiz R.; Farzaliyev, Ismayil M.; Fathi, Hamid Reza; Davudov, Mahammad M.; Aliyev, Anar; Hasanov, Emin

    2015-01-01

    Routine reconstruction of subtotal defects of the mandible and orthopedic rehabilitation supported by dental implants is achieved by means of detailed planning and lasts over a year. This article shows the outcomes of single-stage surgical treatment and immediate orthopedic rehabilitation performed with the help of preoperative virtual computer simulation. 3D investigation of pathological and donor sites, virtual simulation of tumor resection, positioning of the dental implants into fibula, virtual flap bending and transfer, virtual bending of fixing reconstruction plates, and fabrication of navigation templates and bridge prosthesis supported by dental implants were done preoperatively. The surgery included tumor resection, insertion of dental implants into fibula, elevation of fibula osteocutaneous free flap, rigid fixation within recipient site, and immediate loading by bridge orthopedic device. On 10-month follow-up, functional and esthetic results were asses as reasonable. Radiography showed dental implants to be integrated and positioned appropriately. We found that successful rehabilitation of the patients with extensive defects of the jaws could be achieved by ablative tumor resection, dental implants insertion prior to flap elevation guided by navigation templates, further osteotomy, modeling of the flap based on navigation template, flap transfer, and rigid fixation within recipient site by prebended plates, with application of prefabricated prosthesis. PMID:27162568

  7. Computer-Assisted Orthopedic Surgery: Current State and Future Perspective

    PubMed Central

    Zheng, Guoyan; Nolte, Lutz P.

    2015-01-01

    Introduced about two decades ago, computer-assisted orthopedic surgery (CAOS) has emerged as a new and independent area, due to the importance of treatment of musculoskeletal diseases in orthopedics and traumatology, increasing availability of different imaging modalities, and advances in analytics and navigation tools. The aim of this paper is to present the basic elements of CAOS devices and to review state-of-the-art examples of different imaging modalities used to create the virtual representations, of different position tracking devices for navigation systems, of different surgical robots, of different methods for registration and referencing, and of CAOS modules that have been realized for different surgical procedures. Future perspectives will also be outlined. PMID:26779486

  8. Computer-Assisted Orthopedic Surgery: Current State and Future Perspective.

    PubMed

    Zheng, Guoyan; Nolte, Lutz P

    2015-01-01

    Introduced about two decades ago, computer-assisted orthopedic surgery (CAOS) has emerged as a new and independent area, due to the importance of treatment of musculoskeletal diseases in orthopedics and traumatology, increasing availability of different imaging modalities, and advances in analytics and navigation tools. The aim of this paper is to present the basic elements of CAOS devices and to review state-of-the-art examples of different imaging modalities used to create the virtual representations, of different position tracking devices for navigation systems, of different surgical robots, of different methods for registration and referencing, and of CAOS modules that have been realized for different surgical procedures. Future perspectives will also be outlined.

  9. Erythromycin Seromadesis in Orthopedic Surgery

    PubMed Central

    Salgado, Martin; Fernández, Felipe; Avilés, Carolina; Cordova, Cecilia

    2016-01-01

    Introduction: The presence of postoperative seromadesis is common, corresponding to the presence of serum in the subcutaneous tissue post a surgical event. Erythromycin has been reported as sclerosing, although not in orthopedic surgery. We report a case of erythromycin seromadesis in orthopedic surgery. Case Presentation: We present a case of a 63-year-old woman having undergone femoral prosthesis surgery and total hip replacement with a subfacial seroma without findings of infection, refractory to standard treatment of compression bandages, massage and cleaning surgery in two oportunities. A literature review was undertaken to obtain the therapeutic alternatives where erythromycin seromadesis is chosen with excellent response. Conclusion: Erythromycin sclerotherapy should be considered as an effective and safe option in the treatment of seroma in general surgery and traumatology. More studies are necessary to get a better evidence. We believe that this is the first study of use of erythromycin as sclerotherapy in a traumatology case. PMID:27703947

  10. Orthopedic aspects of competitive swimming.

    PubMed

    Richardson, A B

    1987-07-01

    Orthopedic problems related to competitive swimming are rarely disabling, but can be problematic in preventing training and competition. Most problems are related to the shoulder and knee. Treatment is primarily nonsurgical and directed at relieving symptoms and allowing the athlete to continue with swimming practice. Treatment aids such as ice packing, anti-inflammatory medications, muscle stimulation and electrogalvanic stimulation, strengthening exercises, and static stretching are encouraged; upper arm bands and patellar-stabilizing supports can be adapted to training routines.

  11. Orthopedic Gene Therapy in 2008

    PubMed Central

    Evans, Christopher H; Ghivizzani, Steven C; Robbins, Paul D

    2008-01-01

    Orthopedic disorders, although rarely fatal, are the leading cause of morbidity and impose a huge socioeconomic burden. Their prevalence will increase dramatically as populations age and gain weight. Many orthopedic conditions are difficult to treat by conventional means; however, they are good candidates for gene therapy. Clinical trials have already been initiated for arthritis and the aseptic loosening of prosthetic joints, and the development of bone-healing applications is at an advanced, preclinical stage. Other potential uses include the treatment of Mendelian diseases and orthopedic tumors, as well as the repair and regeneration of cartilage, ligaments, and tendons. Many of these goals should be achievable with existing technologies. The main barriers to clinical application are funding and regulatory issues, which in turn reflect major safety concerns and the opinion, in some quarters, that gene therapy should not be applied to nonlethal, nongenetic diseases. For some indications, advances in nongenetic treatments have also diminished enthusiasm. Nevertheless, the preclinical and early clinical data are impressive and provide considerable optimism that gene therapy will provide straightforward, effective solutions to the clinical management of several common debilitating disorders that are otherwise difficult and expensive to treat. PMID:19066598

  12. Brandon Research, Inc. Orthopedic Implant Cooperative Research and Development Agreement (CRADA) Final Report

    SciTech Connect

    Freeman, W.R.

    1999-04-22

    The project was a joint research effort between the U. S. Department of Energy's (DOE) Kansas City Plant (KCP) and Brandon Research, Inc. to develop ways to improve implants used for orthopedic surgery for joint replacement. The primary product produced by this study is design information, which may be used to develop implants that will improve long-term fixation and durability in the host bone environment.

  13. Comparison of double dynamic compression plating versus two configurations of an internal veterinary fixation device: Results of in vitro mechanical testing using a bone substitute.

    PubMed

    Haerdi-Landerer, Christina; Steiner, Adrian; Linke, Berend; Wahl, Dieter; Schneider, Erich; Hehli, Markus; Frei, Reto; Auer, Jörg A

    2002-01-01

    To compare the mechanical properties of 2 configurations of a veterinary fixation system (VFS) for large animal long bones with dynamic compression plating (DCP). Eighteen pairs of Canevasit tubes (Canevasit; Amsler und Frei, Schinznach Dorf, Switzerland) (length, 170 mm; diameter, 47.5 mm; cortex thickness, 10 mm), aligned with a 10-mm gap, and stabilized with 2 DCP or 2 VFS implants. Three groups (n = 6) were compared. Group 1 Canevasit tubes were stabilized with two 10-hole, broad 4.5-mm stainless steel DCP applied with both plates centered over the gap, in orthogonal planes parallel to the long axis of the tubes and staggered to allow bicortical fixation with ten 4.5-mm, 52-mm-long cortex screws each. Group 2 tubes were stabilized similarly with 2 VFS implants, each composed of a stainless steel rod (length, 167 mm; diameter, 8 mm), and 10 clamps were applied in alternating fashion left and right on the rod and fixed bicortically with ten 4.5-mm, 52-mm-long, cortex screws. Group 3 tubes were stabilized similarly, but using only 6 clamps/rod. All groups were tested initially in torsion within elastic limits and subsequently in 4-point bending, with 1 implant on the tension side, until gap closure occurred. None of the constructs failed, but all had plastic deformation after 4-point bending. No statistically significant differences were found among the 3 groups in torsional stiffness. Double DCP fixation was significantly stiffer and stronger in 4-point bending, compared with both configurations of double VFS fixation. The plate design was favored in this study. The VFS system may have to be adapted before further tests are conducted. Test modalities have to be chosen closer to clinical conditions (real bone, cyclic loading, closed gap). The veterinary fixation system has not yet proven its advantages for large animal long bone fracture repair. From the pure mechanical point of view, double DCP is the favored method for the treatment mentioned. Copyright 2002 by

  14. Principles of intramedullary pin and wire fixation.

    PubMed

    Howard, P E

    1991-02-01

    Knowledge and experience in the proper use of IM pins, K-wires, and orthopedic wire is a valuable asset to the veterinarian's ability to successfully repair a variety of long bone fractures. Most long bone fractures are amenable to repair with this form of fixation. When the principles of application are violated or the implants are used when contraindicated, complications often occur. Proper use of these implants results in the successful management of complex fractures to the satisfaction of both the animal owner and the veterinarian (Fig 10).

  15. Orthopedic conditions of the avian head.

    PubMed

    Wheler, Colette L

    2002-01-01

    Orthopedic problems of the avian head generally fall into two main categories: congenital and traumatic. Congenital lesions of the beak are not uncommon in psittacine birds but are extremely rare in raptors. Trauma accounts for most of the remaining orthopedic problems seen in the area of the body. This article discusses the most common conditions and injuries causing orthopedic problems of the beak, eye, and skull of avian patients.

  16. Diagnosis and management of reptile orthopedic injuries.

    PubMed

    Mitchell, Mark A

    2002-01-01

    As veterinarians expand their understanding of the specific husbandry requirements for captive reptiles, nutritionally associated orthopedic injuries should decrease. Orthopedic injuries in wild reptiles, however, will continue to increase as new infrastructure encroaches on the habitats of these animals. Research should be pursued that focuses on improving our understanding of pain management in reptiles, on developing techniques to expedite bone healing, and on creating new orthopedic techniques that provide rigid stabilization without the use of temperature-sensitive materials.

  17. The dedicated orthopedic trauma operating room.

    PubMed

    Min, William; Wolinsky, Philip R

    2011-08-01

    The development and implementation of a dedicated orthopedic trauma operating room (OTOR) that is used for the treatment of orthopedic trauma patients has changed and improved the practice of orthopedic trauma surgery. Advantages noted with OTOR implementation include improvements in morbidity and complication rates, enhancements in the professional and personal lifestyles of the on-call surgeon, and increased physician recruitment and retention in orthopedic traumatology. However, the inappropriate use of the OTOR, which can waste valuable resources and delay the treatment of emergent cases, must be monitored and avoided.

  18. Wholistic orthopedics: Is this the right way to treat geriatric orthopedic patients?

    PubMed Central

    Ebnezar, John; Bali, Yogita; John, Rakesh

    2017-01-01

    Geriatric orthopedic problems poses different challenges in their management. Conventional treatment methods like drugs, physiotherapy and surgeries are inadequate. A Geriatric orthopedic patient suffers as a whole and not in isolation. This article highlights the importance of managing geriatric orthopedic patients as a whole and outlines the various steps of wholistic management. PMID:28149067

  19. Vascular Injury in Orthopedic Trauma.

    PubMed

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

    2016-07-01

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

  20. [Diagnosis and treatment of headache combined with orthopedic disorders in children and adolescents].

    PubMed

    Gaiduk, A A; Korostovtsev, D D; Gaiduk, Yu V; Ageeva, L Ya

    2013-01-01

    To study characteristics of headache combined with orthopedic disorders in children and adolescents and to develop treatment approaches, we examined 116 patients aged from 5 to 17 years. Headache of tension was found in 89 (77%) and chronic headache in 27 (23%) patients. Along with clinical/neurological and orthopedic examination, all patients were studied using a special device that allowed to quantitatively measure the bearing (in three dimensions) and biomechanic body balance. Electroencephalography, Doppler ultrasound and transcranial tests of neck vessels and ophthalmological examination were carried out. Based on the features of headache characteristic of some groups of patients, the authors suggest using a multidiscipline approach including the day-to-day interaction between neurologist and orthopedist, pharmacological therapy, therapeutic physical training, specific orthopedic inner sole and other rehabilitation methods. This treatment has led to better recovery of patients compared to the treatment using only neurological or orthopedic techniques.

  1. [Hypersensitivity to metals in patients with orthopedic implants].

    PubMed

    Sánchez Olivas, Manuel Anastacio; Valencia Zavala, Martha Patricia; Sánchez Olivas, Jesús Alberto; Sepúlveda Velázquez, Guadalupe

    2010-01-01

    All metals in contact with biological systems suffer corrosion, which is an electrochemical process that causes metallic ions formation, known as haptens, which link with endogenous or exogenous proteins, therefore inducing an immune response. A hypersensitivity response to an implanted material should be suspected when cutaneous lesions or inflammatory reactions occur proximal to or surrounding the site of the metallic orthopedic implant. At present there is no a reliable diagnostic test for the determination of hypersensitivity to implanted metallic devices. It has been shown that the products of corrosive degradation are associated with dermatitis, urticaria and vasculitis. Cutaneous lesions in patients with unsuccessful metallic implants are more frequent than in non-rejected implants or the general population. Although the cellular and humoral hypersensitivity response in metallic orthopedic implants has been clearly identified, the risk is very low. Nowadays the importance of hypersensitivity to metals as a contributing factor in the failure of implants is unknown.

  2. Latarjet Fixation

    PubMed Central

    Alvi, Hasham M.; Monroe, Emily J.; Muriuki, Muturi; Verma, Rajat N.; Marra, Guido; Saltzman, Matthew D.

    2016-01-01

    Background: Attritional bone loss in patients with recurrent anterior instability has successfully been treated with a bone block procedure such as the Latarjet. It has not been previously demonstrated whether cortical or cancellous screws are superior when used for this procedure. Purpose: To assess the strength of stainless steel cortical screws versus stainless steel cannulated cancellous screws in the Latarjet procedure. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen matched-pair shoulder specimens were randomized into 2 separate fixation groups: (1) 3.5-mm stainless steel cortical screws and (2) 4.0-mm stainless steel partially threaded cannulated cancellous screws. Shoulder specimens were dissected free of all soft tissue and a 25% glenoid defect was created. The coracoid process was osteomized, placed at the site of the glenoid defect, and fixed in place with 2 parallel screws. Results: All 10 specimens failed by screw cutout. Nine of 10 specimens failed by progressive displacement with an increased number of cycles. One specimen in the 4.0-mm screw group failed by catastrophic failure on initiation of the testing protocol. The 3.5-mm screws had a mean of 274 cycles (SD, ±171 cycles; range, 10-443 cycles) to failure. The 4.0-mm screws had a mean of 135 cycles (SD, ±141 cycles; range, 0-284 cycles) to failure. There was no statistically significant difference between the 2 types of screws for cycles required to cause failure (P = .144). Conclusion: There was no statistically significant difference in energy or cycles to failure when comparing the stainless steel cortical screws versus partially threaded cannulated cancellous screws. Clinical Relevance: Latarjet may be performed using cortical or cancellous screws without a clear advantage of either option. PMID:27158630

  3. Orthopedics

    SciTech Connect

    Stoker, D.J.; Tilley, E.A.

    1988-01-01

    This book presents a method of assessing a variety of entities with pathologic impact on the skeleton. The book covers 97 skeletal abnormalities or diseases. Each case is presented as a question (consisting of a radiography followed by a short clinical history and a query such as What is the abnormality '') followed by an answer (consisting of additional radiographs, an explanation of the radiographic abnormality and causative disease process, and one or two references).

  4. Orthopedic surgery in ancient Egypt

    PubMed Central

    Blomstedt, Patric

    2014-01-01

    Background — Ancient Egypt might be considered the cradle of medicine. The modern literature is, however, sometimes rather too enthusiastic regarding the procedures that are attributed an Egyptian origin. I briefly present and analyze the claims regarding orthopedic surgery in Egypt, what was actually done by the Egyptians, and what may have been incorrectly ascribed to them. Methods — I reviewed the original sources and also the modern literature regarding surgery in ancient Egypt, concentrating especially on orthopedic surgery. Results — As is well known, both literary sources and the archaeological/osteological material bear witness to treatment of various fractures. The Egyptian painting, often claimed to depict the reduction of a dislocated shoulder according to Kocher’s method, is, however, open to interpretation. Therapeutic amputations are never depicted or mentioned in the literary sources, while the specimens suggested to demonstrate such amputations are not convincing. Interpretation — The ancient Egyptians certainly treated fractures of various kinds, and with varying degrees of success. Concerning the reductions of dislocated joints and therapeutic amputations, there is no clear evidence for the existence of such procedures. It would, however, be surprising if dislocations were not treated, even though they have not left traces in the surviving sources. Concerning amputations, the general level of Egyptian surgery makes it unlikely that limb amputations were done, even if they may possibly have been performed under extraordinary circumstances. PMID:25140982

  5. Strategies for achieving orthopedic service line success.

    PubMed

    Lang, Stacey; Powers, Kristi

    2013-12-01

    Healthcare finance leaders can work with orthopedic surgeons to support better outcomes, clinically and financially, by: Establishing innovative partnerships among hospital leaders, orthopedic surgeons, and implant vendors. Developing and enforcing expectations around contracting and vendor behavior. Establishing a forum for open communication. Building a bundled payment structure. Finding ways to differentiate from the competition.

  6. Using Aerospace Technology To Design Orthopedic Implants

    NASA Technical Reports Server (NTRS)

    Saravanos, D. A.; Mraz, P. J.; Davy, D. T.

    1996-01-01

    Technology originally developed to optimize designs of composite-material aerospace structural components used to develop method for optimizing designs of orthopedic implants. Development effort focused on designing knee implants, long-term goal to develop method for optimizing designs of orthopedic implants in general.

  7. ORTHOPEDICALLY HANDICAPPED CHILDREN IN OHIO PUBLIC SCHOOLS.

    ERIC Educational Resources Information Center

    MENAPACE, HERMAN N.; AND OTHERS

    THE HISTORY OF PROGRAMS FOR ORTHOPEDICALLY HANDICAPPED CHILDREN IS REVIEWED, INCLUDING KINDS AND EXTENT OF SERVICES. GUIDELINES FOR ESTABLISHING AN ORTHOPEDIC PROGRAM ARE GIVEN AND THE TEAM APPROACH IS DISCUSSED. CHANGES IN THE HANDICAPPED POPULATION AND IN THE NEEDS FOR APPROPRIATE SERVICES ARE NOTED. THE APPENDIXES INCLUDE INFORMATION ABOUT…

  8. Using Aerospace Technology To Design Orthopedic Implants

    NASA Technical Reports Server (NTRS)

    Saravanos, D. A.; Mraz, P. J.; Davy, D. T.

    1996-01-01

    Technology originally developed to optimize designs of composite-material aerospace structural components used to develop method for optimizing designs of orthopedic implants. Development effort focused on designing knee implants, long-term goal to develop method for optimizing designs of orthopedic implants in general.

  9. Sawbones laboratory in orthopedic surgical training

    PubMed Central

    Hetaimish, Bandar M.

    2016-01-01

    Sawbones are artificial bones designed to simulate the bone architecture, as well as the bone’s physical properties. The incorporation of sawbones simulation laboratories in many orthopedic training programs has provided the residents with flexibility in learning and scheduling that align with their working hour limitations. This review paper deliberates the organization of sawbones simulation in orthopedic surgical training to enhance trainee’s future learning. In addition, it explores the implications of sawbones simulation in orthopedic surgical teaching and evaluation. It scrutinizes the suitability of practicing on sawbones at the simulation laboratory to improve orthopedic trainee’s learning. This will be followed with recommendations for future enhancement of sawbones simulation-based learning in orthopedic surgical training. PMID:27052276

  10. [Bone grafts in orthopedic surgery].

    PubMed

    Zárate-Kalfópulos, Barón; Reyes-Sánchez, Alejandro

    2006-01-01

    In orthopedic surgery the demand for the use of bone grafts increases daily because of the increasing quantity and complexity of surgical procedures. At present, the gold standard is the autologous bone graft but the failure rate, morbidity of the donor site and limited availability have stimulated a proliferation for finding materials that work as bone graft substitutes. In order to have good success, we must know the different properties of these choices and the environment where the graft is going to be used. As bone graft substitutes and growth factors become clinical realities, a new gold standard will be defined. Tissue engineering and gene therapy techniques have the objective to create an optimum bone graft substitute with a combination of substances with properties of osteconduction, osteogenesis and osteoinduction.

  11. A robot-assisted orthopedic telesurgery system.

    PubMed

    Kong, M; Du, Z; Sun, L; Fu, L; Jia, Z; Wu, D

    2005-01-01

    A robot-assisted orthopedic telesurgery system, named HIT-RAOTS, has been developed according to Chinese conventional operation method. Its main function includes obtaining images with information of position and orientation of fracture, providing fracture information for doctors, assisting the doctors to complete the reposition of fracture and locking operation of intramedullary nail. In this system, a 6-dof force-reflecting master device, with a pantographic parallelogram mechanisms driven by harmonic DC servomotors, is used to control the slave manipulator movement and to translate the force from the operating room to the surgeon console; A slave robot system integrated a 6-dof force sensor, with a parallel manipulator actuated by six AC servomotors, is applied for the accurate repositioning; A virtual simulation system and human-machine interface are also developed. PI controller based on local network is used to realize the teleoperation. Only little irradiation is issued during the reposition. It can assist surgeons to perform bone-setting more safely by reducing irradiation damage to both surgeries and patients, more easily by releasing the surgeons from the heavy operation and more perfect by improving accuracy of reposition.

  12. Arthroscopic Control for Safe and Secure Seating of Suspensory Devices for Femoral Fixation in Anterior Cruciate Ligament Reconstruction Using Three Different Techniques

    PubMed Central

    Kang, Seo Goo; Lee, Yong Seuk

    2017-01-01

    Purpose The purpose of this study was to evaluate the efficacy of our technique that allows direct visualization of seating of suspensory devices in anterior cruciate ligament (ACL) reconstruction. Materials and Methods Three different suspensory devices (TightRope RT, RetroButton, and EndoButton) were used in ACL reconstruction using 3 different techniques (outside-in, anteromedial [AM] portal, and transtibial techniques). Positioning of a guiding material and seating pattern of the suspensory devices were evaluated according to the surgical technique and suspensory device used. Results On the transtibial technique, 21 of total 26 cases (81%) of single bundle reconstructions and 22 of total 22 cases (100%) of double bundle reconstructions required superolateral capsulotomy where buttons were found in 21 of total 21 cases (100%) and 17 of 22 cases (77%), respectively. On the AM portal technique, all patients required capsulotomy and the button was found in only 18 of total 32 cases (56%) even after capsulotomy. On the outside-in technique, all patients required capsulotomy and the button was found in 86 of total 86 cases (100%). Conclusions Our technique for direct visualization of seating of the suspensory devices was more effective in outside-in and single bundle transtibial ACL reconstruction. However, it was less effective in double bundle transtibial and AM portal ACL reconstructions. PMID:28231646

  13. Tissue engineering strategies for the regeneration of orthopedic interfaces.

    PubMed

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

    2010-06-01

    A major focus in the field of orthopedic 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), necessitates a multi-phased or stratified scaffold with distinct yet continuous tissue regions accompanied by a gradient of mechanical properties. 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.

  14. Development of thermo-mechanical processing for fabricating highly durable β-type Ti-Nb-Ta-Zr rod for use in spinal fixation devices.

    PubMed

    Narita, Kengo; Niinomi, Mitsuo; Nakai, Masaaki; Hieda, Junko; Oribe, Kazuya

    2012-05-01

    The mechanical strength of a beta titanium alloy such as Ti-Nb-Ta-Zr alloy (TNTZ) can be improved significantly by thermo-mechanical treatment. In this study, TNTZ was subjected to solution treatment, cold caliber rolling, and cold swaging before aging treatment to form a rod for spinal fixation. The {110}(β) are aligned parallel to the cross-section with two strong peaks approximately 180° apart, facing one another, in the TNTZ rods subjected to cold caliber rolling and six strong peaks at approximately 60° intervals, facing one another, in the TNTZ rods subjected to cold swaging. Therefore, the TNTZ rods subjected to cold swaging have a more uniform structure than those subjected to cold caliber rolling. The orientation relationship between the α and β phases is different. A [110](β)//[121](α), (112)(β)//(210)(α) orientation relationship is observed in the TNTZ rods subjected to aging treatment at 723 K after solution treatment and cold caliber rolling. On the other hand, a [110](β)//[001](α), (112)(β)//(200)(α) orientation relationship is observed in TNTZ rod subjected to aging treatment at 723 K after cold swaging. A high 0.2% proof stress of about 1200 MPa, high elongation of 18%, and high fatigue strength of 950 MPa indicate that aging treatment at 723 K after cold swaging is the optimal thermo-mechanical process for a TNTZ rod. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. Transpedicular vertebral body augmentation reinforced with pedicle screw fixation in fresh traumatic A2 and A3 lumbar fractures: comparison between two devices and two bone cements.

    PubMed

    Korovessis, Panagiotis; Vardakastanis, Konstantinos; Repantis, Thomas; Vitsas, Vasilios

    2014-07-01

    This retrospective study compares efficacy and safety of balloon kyphoplasty (BK) with calcium phosphate (Group A) versus KIVA implant with PMMA (Group B) reinforced with three vertebrae pedicle screw constructs for A2 and A3 single fresh non-osteoporotic lumbar (L1-L4) fractures in 38 consecutive age- and diagnosis-matched patient populations. Extracanal leakage of both low-viscosity PMMA and calcium phosphate (CP) as well as the following roentgenographic parameters: segmental kyphosis (SKA), anterior (AVBHr) and posterior (PVBHr) vertebral body height ratio, spinal canal encroachment (SCE) clearance, and functional outcome measures: VAS and SF-36, were recorded and compared between the two groups. All patients in both groups were followed for a minimum 26 (Group A) and 25 (Group B) months. Extracanal CP and PMMA leakage was observed in four (18 %) and three (15 %) vertebrae/patients of group A and B, respectively. Hybrid fixation improved AVBHr, SKA, SCE, but PVBHr only in group B. VAS and SF-36 improved postoperatively in the patients of both groups. Short-segment construct with the novel KIVA implant restored better than BK-fractured lumbar vertebral body, but this had no impact in functional outcome. Since there was no leakage difference between PMMA and calcium phosphate and no short-term adverse related to PMMA use were observed, we advice the use of PMMA in fresh traumatic lumbar fractures.

  16. Improved Diagnosis of Infection Associated with Osteosynthesis by Use of Sonication of Fracture Fixation Implants

    PubMed Central

    Yano, Maysa Harumi; Klautau, Giselle Burlamaqui; da Silva, Cely Barreto; Nigro, Stanley; Avanzi, Osmar; Mercadante, Marcelo Tomanink

    2014-01-01

    Previous studies have shown that sonication fluid cultures from removed orthopedic devices improved the microbiological diagnosis of orthopedic implant-associated infections; however, few of these investigations have applied sonication to the removed fracture fixation devices to evaluate its utility for the diagnosis of osteosynthesis-associated infection (OAI). We compared sonication fluid to conventional tissue cultures from 180 subjects with different sizes of plates and screws (n = 156), spinal implants (n = 26), and intramedullary nails (n = 3), of whom 125 and 55 subjects had OAI and noninfected osteosynthesis (NIO), respectively. The sensitivity for detecting OAI was 90.4% for sonication fluid culture and 56.8% for periprosthetic tissue cultures (P < 0.05), and the specificities were 90.9% and 96.4%, respectively. Sonication fluid culture detected more pathogens than peri-implant tissue culture (113 versus 71; P < 0.001), while polymicrobial infections were diagnosed by sonication fluid cultures and tissue cultures in 20.8% and 8% (P < 0.001), respectively. Microbiological diagnosis was achieved exclusively by sonication fluid cultures for 47 (90.4%) subjects, and among them, 18 (38.3%) had previously received antibiotics, whereas in five (9.6%) infected subjects, tissue culture was positive and the sonication fluid culture was negative. Among 39 (31.2%) OAI cases receiving antibiotics, the identification of the organisms occurred in 38.5% and 82.1% of the tissue and sonication fluid cultures, respectively (P < 0.049). We demonstrated that sonication fluid culture from removed osteosyntheses has the potential for improving the microbiological diagnosis of OAI. PMID:25232155

  17. Physical modification of polyetheretherketone for orthopedic implants

    NASA Astrophysics Data System (ADS)

    Du, Ya-Wei; Zhang, Li-Nan; Hou, Zeng-Tao; Ye, Xin; Gu, Hong-Sheng; Yan, Guo-Ping; Shang, Peng

    2014-12-01

    Polyetheretherketone (PEEK) is regarded as one of the most potential candidates for replacing current implant applications. To obtain good bone-implant interfaces, many modification methods have been developed to enable PEEK and PEEK-based composites from bio-inert to bioactive. Among them, physical methods have aroused significant attention and been widely used to modify PEEK for orthopedic implants. This review summarizes current physical modification techniques of PEEK for orthopedic applications, which include composite strategies, surface coating methods and irradiation treatments. The positive consequences of those modification methods will encourage continuing investigations and stimulate the wide range of applications of PEEK-based implants in orthopedics.

  18. Applied Nanotechnology and Nanoscience in Orthopedic Oncology.

    PubMed

    Savvidou, Olga D; Bolia, Ioanna K; Chloros, George D; Goumenos, Stavros D; Sakellariou, Vasileios I; Galanis, Evanthia C; Papagelopoulos, Panayiotis J

    2016-09-01

    Nanomedicine is based on the fact that biological molecules behave similarly to nanomolecules, which have a size of less than 100 nm, and is now affecting most areas of orthopedics. In orthopedic oncology, most of the in vitro and in vivo studies have used osteosarcoma or Ewing sarcoma cell lineages. In this article, tumor imaging and treatment nanotechnology applications, including nanostructure delivery of chemotherapeutic agents, gene therapy, and the role of nano-selenium-coated implants, are outlined. Finally, the potential role of nanotechnology in addressing the challenges of drug and radiotherapy resistance is discussed. [Orthopedics. 2016; 39(5):280-286.].

  19. 3D scaffold alters cellular response to graphene in a polymer composite for orthopedic applications.

    PubMed

    Kumar, Sachin; Azam, Dilkash; Raj, Shammy; Kolanthai, Elayaraja; Vasu, K S; Sood, A K; Chatterjee, Kaushik

    2016-05-01

    Graphene-based polymer nanocomposites are being studied for biomedical applications. Polymer nanocomposites can be processed differently to generate planar two-dimensional (2D) substrates and porous three-dimensional (3D) scaffolds. The objective of this work was to investigate potential differences in biological response to graphene in polymer composites in the form of 2D substrates and 3D scaffolds. Polycaprolactone (PCL) nanocomposites were prepared by incorporating 1% of graphene oxide (GO) and reduced graphene oxide (RGO). GO increased modulus and strength of PCL by 44 and 22% respectively, whereas RGO increased modulus and strength by 22 and 16%, respectively. RGO increased the water contact angle of PCL from 81° to 87° whereas GO decreased it to 77°. In 2D, osteoblast proliferated 15% more on GO composites than on PCL whereas RGO composite showed 17% decrease in cell proliferation, which may be attributed to differences in water wettability. In 3D, initial cell proliferation was markedly retarded in both GO (36% lower) and RGO (55% lower) composites owing to increased roughness due to the presence of the protruding nanoparticles. Cells organized into aggregates in 3D in contrast to spread and randomly distributed cells on 2D discs due to the macro-porous architecture of the scaffolds. Increased cell-cell contact and altered cellular morphology led to significantly higher mineralization in 3D. This study demonstrates that the cellular response to nanoparticles in composites can change markedly by varying the processing route and has implications for designing orthopedic implants such as resorbable fracture fixation devices and tissue scaffolds using such nanocomposites.

  20. Standards of external fixation in prolonged applications to allow safe conversion to definitive extremity surgery: the Aachen algorithm for acute ex fix conversion.

    PubMed

    Horst, Klemens; Andruszkow, Hagen; Weber, Christian; Dienstknecht, Thomas; Hildebrand, Frank; Tarkin, Ivan; Pape, Hans-Christoph

    2015-09-01

    External fixation has become an important tool in orthopedic surgery. Technology has improved the design and material as well as the construct of the fixator. As most patients are converted from external fixation to definite stabilization during later clinical course, prevention of complications such as infection is of high importance. Based on the current literature, principles of temporary external fixation were summarized. We focused on minimizing the risk of infection and introduce a standardized algorithm how to proceed when converting from external to internal fixation, which also was examined for effectiveness.

  1. Finite element analysis of posterior cervical fixation.

    PubMed

    Duan, Y; Wang, H H; Jin, A M; Zhang, L; Min, S X; Liu, C L; Qiu, S J; Shu, X Q

    2015-02-01

    Despite largely, used in the past, biomechanical test, to investigate the fixation techniques of subaxial cervical spine, information is lacking about the internal structural response to external loading. It is not yet clear which technique represents the best choice and whether stabilization devices can be efficient and beneficial for three-column injuries (TCI). The different posterior cervical fixation techniques (pedicle screw PS, lateral mass screw LS, and transarticular screw TS) have respective indications. A detailed, geometrically accurate, nonlinear C3-C7 finite element model (FEM) had been successfully developed and validated. Then three FEMs were reconstructed from different fixation techniques after C4-C6 TCI. A compressive preload of 74N combined with a pure moment of 1.8 Nm in flexion, extension, left-right lateral bending, and left-right axial rotation was applied to the FEMs. The ROM results showed that there were obvious significant differences when comparing the different fixation techniques. PS and TS techniques can provide better immediate stabilization, compared to LS technique. The stress results showed that the variability of von Mises stress in the TS fixation device was minimum and LS fixation device was maximum. Furthermore, the screws inserted by TS technique had high stress concentration at the middle part of the screws. Screw inserted by PS and LS techniques had higher stress concentration at the actual cap-rod-screw interface. The research considers that spinal surgeon should first consider using the TS technique to treat cervical TCI. If PS technique is used, we should eventually prolong the need for external bracing in order to reduce the higher risk of fracture on fixation devices. If LS technique is used, we should add anterior cervical operation for acquire a better immediate stabilization. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  2. A systematic review on dynamic versus static distal tibiofibular fixation.

    PubMed

    Inge, S Y; Pull Ter Gunne, A F; Aarts, C A M; Bemelman, M

    2016-12-01

    In the last couple of years dynamic fixation for syndesmosis injuries, using a suture-button technique, raised more interest due to its advantages over the static fixation. In the current systematic review suture-button fixation is compared to the traditionally applied static fixation in unstable ankle fractures accompanied with distal tibiofibular syndesmosis injury, including the functional outcome, post-operative complications, reoperation rate, recurrent diastasis and financial aspects. A computerized literature search using PubMed/MEDLINE and EMBASE was conducted in search of suitable articles between January 2006 and February 2016. A total of 4 suture-button studies, 5 suture-button vs. static fixation studies and 1 study discussing the financial aspects were identified. The AOFAS of 104 patients treated with the suture-button device was 91.08 points with an average study-follow up of 24.85 months. The AOFAS of 106 patients treated with a static fixation device was 87.95 with an average follow-up of 24.78 months. Removal of the suture-button device was reported in 10.5% of 229 patients and removal of the screws in 38.5%. Dynamic fixation demonstrated to be a viable alternative to the static fixation device, with lower reoperation rates and less complications. They can accurately stabilize the ruptured syndesmosis without device breakage or loss of reduction. 1A economic/decision. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Exploring the reasons for orthopedic implant failure in traumatic fractures of the lower limb.

    PubMed

    Peivandi, Mohammad Taghi; Yusof-Sani, Mohammad Reza; Amel-Farzad, Hossein

    2013-08-01

    A damaged orthopedic implant in the body can cause problems for the patient and disrupt the therapeutic process. This study investigates various factors for orthopedic implant failures in patients with traumatic lower limb fractures who referred to a trauma center in Mashhad, Iran. This was a prospective study of 23 patients referred to Kamyab University Hospital with failed orthopedic implants in 2009. We included any patient with an orthopedic device previously implanted secondary to a traumatic lower limb fracture who later presented to Kamyab University Hospital because of a failed implant. For all patients, a thorough history was taken and the necessary investigations that included radiographic studies were performed. We investigated the quality of the failed devices by chemical analysis, metal hardness testing and metallography. The results were statistically analyzed.  The mean age of the patients was 33 ± 19 years. There were 19 (82.5%) male and 4 (17.4%) female patients. In 14 (60.9%) cases, there were failed femoral implants and 9 (39.1%) cases had failed implants for tibial fractures. We compared the implants against ASTM standards. According to chemical analysis, all internally produced devices and one of the leading international brands were within the expected standard. However, in 3 cases chemical analysis showed a deviation from the standards. These were manufactured by "miscellaneous" companies. In one (4.3%) case the device failure was iatrogenic, in 14 (60.9%) it was due to faulty implants and in 8 (34.8%) cases, the patients were non-compliant with instructions. Hardness testing was satisfactory in all cases and metallographic studies showed good quality for the leading international brands, satisfactory quality for the internally produced devices and poor quality for the miscellaneous devices. The implants classified as miscellaneous were of poor quality. Thus, we cannot recommend their use in orthopedic surgeries. We recommend using credible

  4. Antimicrobial technology in orthopedic and spinal implants

    PubMed Central

    Eltorai, Adam EM; Haglin, Jack; Perera, Sudheesha; Brea, Bielinsky A; Ruttiman, Roy; Garcia, Dioscaris R; Born, Christopher T; Daniels, Alan H

    2016-01-01

    Infections can hinder orthopedic implant function and retention. Current implant-based antimicrobial strategies largely utilize coating-based approaches in order to reduce biofilm formation and bacterial adhesion. Several emerging antimicrobial technologies that integrate a multidisciplinary combination of drug delivery systems, material science, immunology, and polymer chemistry are in development and early clinical use. This review outlines orthopedic implant antimicrobial technology, its current applications and supporting evidence, and clinically promising future directions. PMID:27335811

  5. Antimicrobial technology in orthopedic and spinal implants.

    PubMed

    Eltorai, Adam Em; Haglin, Jack; Perera, Sudheesha; Brea, Bielinsky A; Ruttiman, Roy; Garcia, Dioscaris R; Born, Christopher T; Daniels, Alan H

    2016-06-18

    Infections can hinder orthopedic implant function and retention. Current implant-based antimicrobial strategies largely utilize coating-based approaches in order to reduce biofilm formation and bacterial adhesion. Several emerging antimicrobial technologies that integrate a multidisciplinary combination of drug delivery systems, material science, immunology, and polymer chemistry are in development and early clinical use. This review outlines orthopedic implant antimicrobial technology, its current applications and supporting evidence, and clinically promising future directions.

  6. Failure Analysis of Some Orthopedic Implants (Analyse de Rupture de Quelques Protheses Orthopediques)

    DTIC Science & Technology

    1980-05-01

    Osteosynthesefragen (AO) plate, used to correct a subtrochanteric fracture of the femur. The part was removed because it fractured in service only 4...Failures in Orthopedic Surgery, Biomat. Med. Devices Art. Org., 1979, 7 (2), 243-255. -48- 217 Hemminger, W. and Lange, G. - Osteotomy Plates which

  7. Statistical fallacies in orthopedic research.

    PubMed

    Indrayan, Abhaya

    2007-01-01

    A large number of statistical fallacies occur in medical research literature. These are mostly inadvertent and occur due to lack of understanding of the statistical concepts and terminologies. Many researchers do not fully appreciate the consequence of such fallacies on the credibility of their report. This article provides a general review of the issues that could give rise to statistical fallacies with focus on orthopedic research. Some of this is based on real-life literature and some is based on the actual experiences of the author in dealing with medical research over the past three decades. The text is in teaching mode rather than research mode. Statistical fallacies occur due to inadequate sample that is used for generalized conclusion; incomparable groups presented as comparable; mixing of two or more distinct groups that in fact require separate consideration; misuse of percentages, means and graphs; incomplete reporting that suppresses facts; ignoring reality and depending instead on oversimplification; forgetting baseline values that affect the outcome; misuse of computer packages and use of black-box approach; misuse of P-values that compromises conclusions; confusing correlation with cause-effect; and interpreting statistical significance as medical significance. Mere awareness of the situations where statistical fallacies can occur may be adequate for researchers to sit up and take note while trying to provide a credible report.

  8. When femoral fracture fixation fails: salvage options.

    PubMed

    Petrie, J; Sassoon, A; Haidukewych, G J

    2013-11-01

    Most hip fractures treated with modern internal fixation techniques will heal. However, failures occasionally occur and require revision procedures. Salvage strategies employed during revision are based on whether the fixation failure occurs in the femoral neck, or in the intertrochanteric region. Patient age and remaining bone stock also influence decision making. For fractures in young patients, efforts are generally focused on preserving the native femoral head via osteotomies and repeat internal fixation. For failures in older patients, some kind of hip replacement is usually selected. Disuse osteopenia, deformity, bone loss, and stress-risers from previous internal fixation devices all pose technical challenges to successful reconstruction. Attention to detail is important in order to minimise complications. In the majority of cases, good outcomes have been reported for the various salvage strategies.

  9. Biofilms in periprosthetic orthopedic infections

    PubMed Central

    McConoughey, Stephen J; Howlin, Rob; Granger, Jeff F; Manring, Maurice M; Calhoun, Jason H; Shirtlif, Mark; Kathju, Sandeep; Stoodley, Paul

    2015-01-01

    As the number of total joint arthroplasty and internal fixation procedures continues to rise, the threat of infection following surgery has significant clinical implications. These infections may have highly morbid consequences to patients, who often endure additional surgeries and lengthy exposures to systemic antibiotics, neither of which are guaranteed to resolve the infection. Of particular concern is the threat of bacterial biofilm development, since biofilm-mediated infections are difficult to diagnose and effective treatments are lacking. Developing therapeutic strategies have targeted mechanisms of biofilm formation and the means by which these bacteria communicate with each other to take on specialized roles such as persister cells within the biofilm. In addition, prevention of infection through novel coatings for prostheses and the local delivery of high concentrations of antibiotics by absorbable carriers has shown promise in laboratory and animal studies. Biofilm development, especially in an arthoplasty environment, and future diagnostic and treatment options are discussed. PMID:25302955

  10. Mouse tissue fixation.

    PubMed

    Cardiff, Robert D; Miller, Claramae H; Munn, Robert J

    2014-05-01

    One of the primary goals of fixation is to stop postmortem changes that degrade the tissue and allow optimal preservation of morphologic and cytological detail as well as nucleic acid integrity. Following death, tissues soon undergo autolysis, and if organisms from the gastrointestinal, urinary, or respiratory tracts are present, their colonization can soon cause putrefaction. Time is of the essence because warmer temperatures accelerate both types of degradation. Placing the tissue into a fixative stops the postmortem changes. Fixatives have their effect on tissue by cross-linking, coagulation, or a combination of both. This article outlines the basic tissue fixation procedure and offers guidance on choosing an appropriate fixative, the timing and duration of fixation, sample storage, and quality issues.

  11. Orthopedic surgery at a MASH deployed to the former Yugoslavia in support of the United Nations Protection Force.

    PubMed

    Hrutkay, J M; Hirsch, E; Hockenbury, T

    1995-04-01

    From November 1992 to April 1993, the 212th Mobile Army Surgical Hospital (MASH) was deployed from Germany to Zagreb, Croatia, to provide medical support for the United Nations Protection Force serving in the former Yugoslavia. A 60-bed deployable medical systems hospital was established. The usual MASH 72-hour evacuation policy was extended to 30 days; the orthopedic equipment inventory and surgical capability were increased significantly. Eighty-three orthopedic surgical procedures were performed during a 5-month period on soldiers from 14 nations. Sixty-two (75%) of these procedures were non-emergent, including internal fixation of fractures, bone and skin grafting, and arthroscopy. There were no documented early infections; the complication rate was acceptable. Orthopedic aftercare was supplemented by physical therapy and the capability of prosthetic fitting for amputees. The majority of soldiers (60%) received definitive orthopedic surgical care in theater. The feasibility of performing non-emergent orthopedic procedures in a field environment was demonstrated. Expanded medical support for other similar missions may be required in the future.

  12. Biological Strategies for Improved Osseointegration and Osteoinduction of Porous Metal Orthopedic Implants

    PubMed Central

    Riester, Scott M.; Bonin, Carolina A.; Kremers, Hilal Maradit; Dudakovic, Amel; Kakar, Sanjeev; Cohen, Robert C.; Westendorf, Jennifer J.

    2015-01-01

    The biological interface between an orthopedic implant and the surrounding host tissue may have a dramatic effect upon clinical outcome. Desired effects include bony ingrowth (osseointegration), stimulation of osteogenesis (osteoinduction), increased vascularization, and improved mechanical stability. Implant loosening, fibrous encapsulation, corrosion, infection, and inflammation, as well as physical mismatch may have deleterious clinical effects. This is particularly true of implants used in the reconstruction of load-bearing synovial joints such as the knee, hip, and the shoulder. The surfaces of orthopedic implants have evolved from solid-smooth to roughened-coarse and most recently, to porous in an effort to create a three-dimensional architecture for bone apposition and osseointegration. Total joint surgeries are increasingly performed in younger individuals with a longer life expectancy, and therefore, the postimplantation lifespan of devices must increase commensurately. This review discusses advancements in biomaterials science and cell-based therapies that may further improve orthopedic success rates. We focus on material and biological properties of orthopedic implants fabricated from porous metal and highlight some relevant developments in stem-cell research. We posit that the ideal primary and revision orthopedic load-bearing metal implants are highly porous and may be chemically modified to induce stem cell growth and osteogenic differentiation, while minimizing inflammation and infection. We conclude that integration of new biological, chemical, and mechanical methods is likely to yield more effective strategies to control and modify the implant–bone interface and thereby improve long-term clinical outcomes. PMID:25348836

  13. Artificial intelligence for analyzing orthopedic trauma radiographs.

    PubMed

    Olczak, Jakub; Fahlberg, Niklas; Maki, Atsuto; Razavian, Ali Sharif; Jilert, Anthony; Stark, André; Sköldenberg, Olof; Gordon, Max

    2017-07-06

    Background and purpose - Recent advances in artificial intelligence (deep learning) have shown remarkable performance in classifying non-medical images, and the technology is believed to be the next technological revolution. So far it has never been applied in an orthopedic setting, and in this study we sought to determine the feasibility of using deep learning for skeletal radiographs. Methods - We extracted 256,000 wrist, hand, and ankle radiographs from Danderyd's Hospital and identified 4 classes: fracture, laterality, body part, and exam view. We then selected 5 openly available deep learning networks that were adapted for these images. The most accurate network was benchmarked against a gold standard for fractures. We furthermore compared the network's performance with 2 senior orthopedic surgeons who reviewed images at the same resolution as the network. Results - All networks exhibited an accuracy of at least 90% when identifying laterality, body part, and exam view. The final accuracy for fractures was estimated at 83% for the best performing network. The network performed similarly to senior orthopedic surgeons when presented with images at the same resolution as the network. The 2 reviewer Cohen's kappa under these conditions was 0.76. Interpretation - This study supports the use for orthopedic radiographs of artificial intelligence, which can perform at a human level. While current implementation lacks important features that surgeons require, e.g. risk of dislocation, classifications, measurements, and combining multiple exam views, these problems have technical solutions that are waiting to be implemented for orthopedics.

  14. Arthroscopic training resources in orthopedic resident education.

    PubMed

    Koehler, Ryan; John, Tamara; Lawler, Jeffrey; Moorman, Claude; Nicandri, Gregg

    2015-02-01

    The purpose of this study was to determine the frequency of use, perceived effectiveness, and preference for arthroscopic surgical skill training resources. An electronic survey was sent to orthopedics residents, residency program directors, and orthopedic sports medicine attending physicians in the United States. The frequency and perceived effectiveness of 10 types of adjunctive arthroscopic skills training was assessed. Residents and faculty members were asked to rate their confidence in resident ability to perform common arthroscopic procedures. Surveys were completed by 40 of 152 (26.3%) orthopedic residency program directors, 70 of 426 (16.4%) sports medicine faculty, and 235 of 3,170 (7.4%) orthopedic residents. The use of adjunctive methods of training varied from only 9.8% of programs with virtual reality training to 80.5% of programs that used reading of published materials to develop arthroscopic skill. Practice on cadaveric specimens was viewed as the most effective and preferred adjunctive method of training. Residents trained on cadaveric specimens reported increased confidence in their ability to perform arthroscopic procedures. The resources for developing arthroscopic surgical skill vary considerably across orthopedic residency programs in the United States. Adjunctive training methods were perceived to be effective at supplementing traditional training in the operating room. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  15. Blood utilization in orthopedic and trauma practice

    PubMed Central

    Tayara, Bader Kamal; Al-Faraidy, Moaad Hatim; Al-Sayel, Faisal Abdullah; Al-Omran, Abdallah S; Sadat-Ali, Mir

    2015-01-01

    Objectives: Very little is known about blood utilization in orthopedic and trauma surgery and there is no definite policy in this regard. Our objective is to perform an audit on our practice of blood utilization in the orthopedic department. Methods: We have retrospectively analyzed the data of patients who were admitted between January 2011 and December 2012 to the orthopedic male, female and pediatric wards for which blood products were requested. Results: Three hundred and eight patients were admitted for surgery during the study period. The average age was 35.12 ± 20.4 years and postsurgery they stayed in the hospital for 25.60 ± 10.5 days. Blood products were requested for 223 trauma surgeries. In elective orthopedic procedures, only 42.78% of the blood requested was utilized while in trauma patients it was 55.25%. Conclusions: A substantial amount of blood and its product was used in trauma and elective orthopedic surgeries. There was a major discrepancy between the blood requested and utilized and secondly in the majority single unit transfusion was utilized, which is not within the fundamentals of blood transfusion. PMID:26097818

  16. Bibliometric analysis of the orthopedic literature.

    PubMed

    Hui, Zhaoyang; Yi, Zhongmei; Peng, Jun

    2013-10-01

    Bibliometric indicators are used to assess research performance. The goal of this study was to explore publication output to construct a picture of orthopedics that may be beneficial to researchers and orthopedic specialists. All orthopedics articles published in 61 journals from 2000 to 2011 were retrieved from the Science Citation Index Expanded database. The numbers of articles, citations, authors, institutions, and journals were analyzed and subjected to quantitative and qualitative comparisons. The number of published orthopedics articles increased between 2000 and 2011. Articles published by authors from the United States always ranked first in number, although the United States' share is decreasing in the world literature. Authors from the United States published the most-cited articles and the most articles in journals with top-10 impact factors; moreover, the United States also had the greatest share of experts and highly ranked institutions. The United Kingdom, Germany, and Japan were always within the world's top 4 in terms of numbers of articles and citations. The shares of Germany, South Korea, and China among total orthopedics articles increased, especially that of China. In 2011, China ranked the fifth in the world, with its world share increasing from 0.64% in 2000 to 5.05% in 2011. However, China lags behind in average citations per article, top research institutions, and most prolific authors. According to the total citations per article, the University of Pittsburgh, Harvard University, and the Hospital for Special Surgery were the most prolific institutions. Copyright 2013, SLACK Incorporated.

  17. [Research and analysis to Shui nationality medicine treatment orthopedics & traumatology].

    PubMed

    Hu, Jian-Shan; Li, Pu; Yang, Yong; Chen, Xin-Chun; Lin, Li

    2013-05-01

    To investigated Shui nationality folk medicine's awareness to orthopedics & traumatology, the history of orthopedics & traumatology treatment, Shui nationality folk doctors' practicing medicine, heritage, diagnosis and treatment methods and tools, etc, through investigated drug resources category and distribution characteristics of Shui nationality medicine to orthopedics & traumatology treatment, explored and finished Shui nationality medicine orthopedics & traumatology treatment theoretical system. After more than 5 years' exploration and finishing, preliminarily formed the theoretical system framework and medicine application characteristics of Shui nationality medicine treating orthopedics & traumatology. Shui nationality medicine treatment orthopedics & traumatology has distinctive national style, and worthy to further exploration and research.

  18. External skeletal fixation of fractures in cattle.

    PubMed

    Vogel, Susan R; Anderson, David E

    2014-03-01

    External skeletal fixation (ESF) is a versatile method for rigid immobilization of long bone fractures in cattle. Traditional ESF devices may be used in young calves for clinical management of open fractures. Transfixation pinning and casting is an adaptation of ESF principles to improve versatility and clinical management of selected fractures. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Limits of internal fixation in long-bone fracture.

    PubMed

    Nieto, H; Baroan, C

    2017-02-01

    Alternatives to internal fixation of long-bone fracture comprise, depending on location, external fixation or joint replacement. Limitations comprise risk of infection and functional outcome quality, which vary according to technique. The present study examines these limitations, based on comparative or large-scale studies from which certain significant results emerge. Four main questions are dealt with: (1) the present role of locking plates; (2) conditions for intramedullary nailing in Gustilo grade IIIb open fracture; (3) the limitations of conversion from external fixation to intramedullary nailing in open lower leg fracture; (4) and the limitations of definitive anterograde femoral nailing in multiple trauma. Locking plate fixation has yet to prove clinical superiority in any of the anatomic sites for which good-quality comparative analyses are available. Infection risk in Gustilo grade IIIb open lower leg fracture is equivalent when treated by intramedullary nailing or external fixation, if wound care and debridement are effective, antibiotherapy is initiated rapidly and skin cover is restored within 7days. Conversion from primary external fixation to intramedullary nailing is possible if the external fixator was fitted less than 28days previously and skin cover was restored within 7days. The pulmonary and systemic impact of peripheral lesions or definitive anterograde intramedullary nailing of femoral fracture in multiple trauma calls for caution and what is known as "damage-control orthopedics" (DCO), a term covering the general consequences of both the initial trauma and its treatment. Femoral intramedullary nailing is thus contraindicated in case of hemorrhagic shock (blood pressure<90mmHg), hypothermia (<33°C), coagulation disorder (platelet count<90,000) or peripheral lesions such as multiple long-bone fractures, crushed limb or primary pulmonary contusion. In such cases, external fixation or retrograde nailing with a small-diameter nail and without

  20. Fixation: A Bibliography.

    ERIC Educational Resources Information Center

    Pedrini, D. T.; Pedrini, Bonnie C.

    Fixation and regression were considered complementary by Freud. You tend to regress to a point of fixation. They are both opposed to progression. In the general area, Anna Freud has written (The Ego and the Mechanisms of Defence. London: Hogarth and the Psycho-Analytic Institute, 1937), Sears has evaluated (Survey of Objective Studies of…

  1. 21 CFR 888.3030 - Single/multiple component metallic bone fixation appliances and accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Single/multiple component metallic bone fixation....3030 Single/multiple component metallic bone fixation appliances and accessories. (a) Identification. Single/multiple component metallic bone fixation appliances and accessories are devices intended to be...

  2. 21 CFR 888.3030 - Single/multiple component metallic bone fixation appliances and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Single/multiple component metallic bone fixation....3030 Single/multiple component metallic bone fixation appliances and accessories. (a) Identification. Single/multiple component metallic bone fixation appliances and accessories are devices intended to be...

  3. 21 CFR 888.3030 - Single/multiple component metallic bone fixation appliances and accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Single/multiple component metallic bone fixation....3030 Single/multiple component metallic bone fixation appliances and accessories. (a) Identification. Single/multiple component metallic bone fixation appliances and accessories are devices intended to be...

  4. Guide to radiation fixatives

    SciTech Connect

    Tawil, J.J.; Bold, F.C.

    1983-11-01

    This report identifies and then characterizes a variety of substances available in the market place for potential effectiveness as a fixative on radiologically contaminated surfaces. The substances include both generic chemicals and proprietary products. In selecting a fixative for a particular application, several attributes of the fixative may be relevant to the choice. These attributes include: toxicity, durability, and cleanliness and removability. In addition to the attributes of the fixative, one should also take into account certain characteristics of the site to be treated. These characteristics relate to climate, nature of the surface, use to which the treated surface will be put, subsequent cleanup operations, and type of neighboring surfaces. Finally, costs and potential environmental effects may influence the decision. A variety of fixatives are evaluated with respect to these various attributes and summarized in a reference table.

  5. Cell fixatives for immunostaining.

    PubMed

    Jamur, Maria Célia; Oliver, Constance

    2010-01-01

    Fixation is one of the most critical steps in immunostaining. The object of fixation is to achieve good morphological preservation, while at the same time preserving antigenicity. Tissue blocks, sections, cell cultures or smears are usually immersed in a fixative solution, while in other situations, whole body perfusion of experimental animals is preferable. Fixation can be accomplished by either chemical or physical methods. The chemical methods include cross-linking agents such as formaldehyde, glutaraldehyde and succinimide esters as well as solvents such as acetone and methanol, which precipitate proteins. Of the physical methods, freezing tissue and air drying are most widely used. This chapter deals with the chemical fixation methods most commonly used for light microscopy.

  6. ORTHOPEDIC SURGERY AMONG THE ELDERLY: CLINICAL CHARACTERISTICS

    PubMed Central

    Leme, Luiz Eugênio Garcez; Sitta, Maria do Carmo; Toledo, Manuella; da Silva Henriques, Simone

    2015-01-01

    Care for elderly patients undergoing orthopedic surgery, particularly for those requiring emergency surgery, needs to take into account an analysis of physical capacity and risks specific to elderly individuals, in an attempt to reduce the risks. Nevertheless, these remain high in this group. Despite the risks, procedures developed promptly have a positive effect on these patients’ evolution. Coordinated care, composed of teams of specialists within clinical medicine, geriatrics, orthopedics, anesthesiology and critical care, along with other healthcare professionals, may be highly beneficial for this group of patients. PMID:27027017

  7. Injectable biodegradable materials for orthopedic tissue engineering.

    PubMed

    Temenoff, J S; Mikos, A G

    2000-12-01

    The large number of orthopedic procedures performed each year, including many performed arthroscopically, have led to great interest in injectable biodegradable materials for regeneration of bone and cartilage. A variety of materials have been developed for these applications, including ceramics, naturally derived substances and synthetic polymers. These materials demonstrate overall biocompatibility and appropriate mechanical properties, as well as promote tissue formation, thus providing an important step towards minimally invasive orthopedic procedures. This review provides a comparison of these materials based on mechanical properties, biocompatibility and regeneration efficacy. Advantages and disadvantages of each material are explained and design criteria for injectable biodegradable systems are provided.

  8. [The metal tantalum in orthopedic applications].

    PubMed

    Deng, Juncai; Wang, Yue

    2011-04-01

    This paper describes the biological characteristics of the metal tantalum (Ts) and the application status of tantalum in artificial joints, bone necrosis, spine, defects of bone and other aspects of bone. The early clinical application results of tantalum in bone diseases were satisfactory, but it is necessary to do further study of tantalum in a deep going way, and further detailed comparison between the tantalum with other metals as orthopedics implants. The advantage of tantalum materials as orthopedic implants still needs to be verified by a great deal of clinical cases for a long period of time.

  9. Fixation of supracondylar femoral fractures following total knee arthroplasty: is there any difference comparing angular stable plate fixation versus rigid interlocking nail fixation?

    PubMed

    Aldrian, Silke; Schuster, Rupert; Haas, Nicole; Erhart, Jochen; Strickner, Markus; Blutsch, Beate; Wernhart, Simon; Leitgeb, Johannes; Platzer, Patrick

    2013-07-01

    Literature does not provide any reliable comparison between angular stable plate fixation and rigid nail fixation for stabilization of supracondylar periprosthetic femoral fractures. Thus, the purpose of this study was to compare these two implants in clinical practice relating to fracture healing, functional results and treatment-related complications. In this retrospective study (level IV), clinical and radiographic records of 86 patients (62 female and 24 male, average age: 75.6) with supracondylar periprosthetic femoral fractures between 1996 and 2010 were analyzed. 48 patients underwent lateral plate fixation by an angular stable plate system (LISS), whereas 38 patients were stabilized by a rigid interlocking nail device. Sixty-four (76 %) patients returned to their pre-injury activity level and were satisfied with their clinical outcome. We had an overall Oxford outcome score of 2.21, with patients following angular stable plate fixation of 2.22, and patients after rigid nail fixation of 2.20. Successful fracture healing within 6 months was achieved in 74 (88 %) patients. Comparing between plate fixation and nail fixation, statistical analysis did not reveal any significant differences. Overall, we had a relatively high rate of fracture healing and a satisfactory functional outcome with both implants. Both methods of fixation showed similar results relating to the functional outcome and individual satisfaction of the patients. However, with regards to fracture healing and treatment-related complications, intramedullary nail fixation showed slight advantages.

  10. 21 CFR 878.3250 - External facial fracture fixation appliance.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false External facial fracture fixation appliance. 878.3250 Section 878.3250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices §...

  11. 21 CFR 878.3250 - External facial fracture fixation appliance.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false External facial fracture fixation appliance. 878.3250 Section 878.3250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices §...

  12. 21 CFR 878.3250 - External facial fracture fixation appliance.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false External facial fracture fixation appliance. 878.3250 Section 878.3250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3250...

  13. An Overview of the History of Orthopedic Surgery.

    PubMed

    Swarup, Ishaan; O'Donnell, Joseph F

    Orthopedic surgery has a long and rich history. While the modern term orthopedics was coined in the 1700s, orthopedic principles were beginning to be developed and used during primitive times. The Egyptians continued these practices, and described ways to recognize and manage common orthopedic conditions. The Greeks and Romans subsequently began to study medicine in a systematic manner, and greatly improved our understanding of orthopedic anatomy and surgical technique. After a period of little progress during the Middle Ages, rapid advancement was noted during the Renaissance, including the description of various injuries, improvements in surgical technique, and development of orthopedic hospitals. Collectively, these advances provided the foundation for modern orthopedics. Currently, orthopedic surgery is a rapidly developing field that has benefited from the works of numerous scholars and surgeons. It is important to recognize the successes and failures of the past, in order to advance research and practice as well as improve patient care and clinical outcomes.

  14. Awareness campaign. Orthopedic Hospital of Oklahoma launches awareness campaign.

    PubMed

    2007-01-01

    The Orthopedic Hospital of Oklahoma is a 25-bed inpatient and outpatient center with one focus: Orthopedics. To acquaint people with its services and build brand awareness to drive market share, the hospital launched a print campaign featuring actual patients.

  15. Tibial Fixation of Anterior Cruciate Ligament Allograft Tendons. Comparison of 1-, 2-, and 4-Stranded Constructs

    DTIC Science & Technology

    2009-01-01

    2009 to 00-00-2009 4. TITLE AND SUBTITLE Tibial Fixation of Anterior Cruciate Ligament Allograft Tendons 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c...2009 The Author(s) Tibial Fixation of Anterior Cruciate Ligament Allograft Tendons Comparison of 1-, 2-, and 4-Stranded Constructs Daniel K. Park,* MD...4-stranded allografts are used for soft tissue anterior cruciate ligament reconstruction; however, the fixation properties of fixation devices are

  16. Concepts of orthopedic disorders in Avicenna's Canon of Medicine.

    PubMed

    Afshar, Ahmadreza

    2011-03-01

    This manuscript offers a brief review of the orthopedic subjects in the Canon of Medicine. Highlights include, but are not limited to, the anatomy of the musculoskeletal system, fractures and dislocations, nerve and tendon injuries, different types of wounds and ulcers, and bone infections. Some of the concepts regarding musculoskeletal disorders remain relevant to current orthopedic knowledge. Reviewing the orthopedic subjects in the Canon of Medicine reveals that Avicenna has made a significant contribution to the evolution of orthopedic knowledge.

  17. Orthopedic Injuries and Their Treatment in Children During Earthquakes: A Systematic Review.

    PubMed

    Morelli, Ilaria; Sabbadini, Maria Grazia; Bortolin, Michelangelo

    2015-10-01

    Orthopedic injuries commonly affect children during earthquakes, but reports about them are rare. This setting may lead to different standards of care, but guidelines are still missing in this field. A systematic review was performed to: (1) assess type and body distribution of pediatric earthquake-related injuries, treatment performed, length of stay, and complications; and (2) identify starting points to define standards of care. PubMed database was researched for papers (1999-2014 period) in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Inclusion criteria were: English, French, Spanish, or Italian language and data reported about orthopedic lesions in children (≤18 years old). Reviews, letters, commentaries, editorials, and single case reports were excluded. Two independent reviewers selected articles after abstract and full-text reading. Traumatic injuries caused child hospital admissions ranging from 46.9% to 100.0%; 16% to 53% suffered fractures. Lower limbs mostly were involved. Soft-tissue injuries affected 55% of patients. Debridement and external fixation (EF) were the most frequent surgical treatments. Amputation rates varied from 5% to 11%. This study revealed that field hospitals should be prepared to: (1) treat mainly lower extremities fractures in children; and (2) use especially EF techniques. The presence of orthopedic surgeons familiar with pediatric traumatology should be considered.

  18. Tilt table recovery of horses after orthopedic surgery: fifty-four cases (1994-2005).

    PubMed

    Elmas, Colette R; Cruz, Antonio M; Kerr, Carolyn L

    2007-04-01

    To describe an assisted anesthetic recovery technique using a tilt table for horses after high-risk orthopedic-related procedures and to evaluate outcome. Retrospective study. Anesthetic recoveries (n=54) for 36 horses. Medical records (April 1994-October 2005) for horses that had high-risk orthopedic surgery and recovery from general anesthesia on a tilt table were reviewed. Information about the surgical procedure, anesthetic and recovery period was analyzed. Of 54 anesthetic recoveries, 1 horse (1.9%) had complete failure of internal fixation during recovery and was euthanatized. Six (11% recoveries) horses failed to adapt to the tilt table system, which necessitated transfer to a conventional recovery room. Complications without important consequences for clinical outcome (skin abrasions, myositis, cast breakage, partial implant failure) occurred during 8 (15%) recoveries. A tilt table recovery system was associated with minimal incidence of serious complications. Potential disadvantages of the system are the number of personnel required, longer recovery time, and the need for a specialized table. A tilt table is a useful system for recovering horses believed to be at increased risk of injury during anesthetic recovery after high-risk orthopedic-related procedures.

  19. Biomechanical analyses of static and dynamic fixation techniques of retrograde interlocking femoral nailing using nonlinear finite element methods.

    PubMed

    Shih, Kao-Shang; Hsu, Ching-Chi; Hsu, Tzu-Pin; Hou, Sheng-Mou; Liaw, Chen-Kun

    2014-02-01

    Femoral shaft fractures can be treated using retrograde interlocking nailing systems; however, fracture nonunion still occurs. Dynamic fixation techniques, which remove either the proximal or distal locking screws, have been used to solve the problem of nonunion. In addition, a surgical rule for dynamic fixation techniques has been defined based on past clinical reports. However, the biomechanical performance of the retrograde interlocking nailing systems with either the traditional static fixation technique or the dynamic fixation techniques has not been investigated by using nonlinear numerical modeling. Three-dimensional nonlinear finite element models were developed, and the implant strength, fixation stability, and contact area of the fracture surfaces were evaluated. Three types of femoral shaft fractures (a proximal femoral shaft fracture, a middle femoral shaft fracture, and a distal femoral shaft fracture) fixed by three fixation techniques (insertion of all the locking screws, removal of the proximal locking screws, or removal of the distal locking screws) were analyzed. The results showed that the static fixation technique resulted in sufficient fixation stability and that the dynamic fixation techniques decreased the failure risk of the implant and produced a larger contact area of the fracture surfaces. The outcomes of the current study could assist orthopedic surgeons in comprehending the biomechanical performances of both static and dynamic fixation techniques. In addition, the surgeons could also select a fixation technique based on the specific patient situation using the numerical outcomes of this study.

  20. Early lower extremity fracture fixation and the risk of early pulmonary embolus: filter before fixation?

    PubMed

    Forsythe, Raquel M; Peitzman, Andrew B; DeCato, Thomas; Rosengart, Matthew R; Watson, Gregory A; Marshall, Gary T; Ziembicki, Jenny A; Billiar, Timothy R; Sperry, Jason L

    2011-06-01

    Venous thromboembolism is a major cause of morbidity and mortality after injury. Prophylactic anticoagulation is often delayed as a result of injuries or required procedures. Those patients at highest risk in this early vulnerable window postinjury are not well characterized. We sought to determine those patients at highest risk for an early pulmonary embolism (PE) after injury. A retrospective analysis using data derived from a large state wide trauma registry (1997-2007) was performed. Patients with a documented PE and time of occurrence were selected (n = 712). Patients with fat emboli and lower extremity vascular injuries were excluded. Patients with a PE within the first 72 hours of admission (EARLY, n = 122) were compared with those with DELAYED presentation. Kaplan-Meier survival analysis was used to characterize the timing of death between the two groups. Backward stepwise logistic regression was used to determine independent risk factors for EARLY PE relative to those with DELAYED PE. EARLY and DELAYED groups were similar in age, gender, Glasgow Coma Scale, emergency department systolic blood pressure, and injury mechanism. The EARLY PE group had a lower Injury Severity Score but injuries more commonly included femur fracture. Kaplan-Meier analysis revealed that EARLY PE patients have a significantly higher risk of early mortality relative to DELAYED PE patients (p = 0.012). Regression analysis revealed that the only independent risk factor for EARLY PE was lower extremity/pelvic orthopedic fixation (<48 hours from injury). The risk of EARLY PE was more than threefold higher (odds ratios, 3.85; 95% CI, 1.9-7.6; p < 0.001) for those who underwent early lower extremity orthopedic fixation versus those who did not. Early lower extremity/pelvis orthopedic fixation is the single independent predictor of EARLY PE in this patient cohort. Venous thromboembolism/PE prevention strategies should be made a priority in this group of patients, including early

  1. PEEK Biomaterials in Trauma, Orthopedic, and Spinal Implants

    PubMed Central

    Kurtz, S. M.; Devine, J. N.

    2007-01-01

    Since the 1980s, polyaryletherketones (PAEKs) have been increasingly employed as biomaterials for trauma, orthopedic, and spinal implants. We have synthesized the extensive polymer science literature as it relates to structure, mechanical properties, and chemical resistance of PAEK biomaterials. With this foundation, one can more readily appreciate why this family of polymers will be inherently strong, inert, and biocompatible. Due to its relative inertness, PEEK biomaterials are an attractive platform upon which to develop novel bioactive materials, and some steps have already been taken in that direction, with the blending of HA and TCP into sintered PEEK. However, to date, blended HA-PEEK composites have involved a trade-off in mechanical properties in exchange for their increased bioactivity. PEEK has had the greatest clinical impact in the field of spine implant design, and PEEK is now broadly accepted as a radiolucent alternative to metallic biomaterials in the spine community. For mature fields, such as total joint replacements and fracture fixation implants, radiolucency is an attractive but not necessarily critical material feature. PMID:17686513

  2. Massive subacromial-subdeltoid bursitis with rice bodies secondary to an orthopedic implant.

    PubMed

    Urruela, Adriana M; Rapp, Timothy B; Egol, Kenneth A

    2012-09-01

    Both early and late complications following open reduction and internal fixation of proximal humerus fractures have been reported extensively in the literature. Although orthopedic implants are known to cause irritation and inflammation, to our knowledge, this is the first case report to describe a patient with rice bodies secondary to an orthopedic implant. Although the etiology of rice bodies is unclear, histological studies reveal that they are composed of an inner amorphous core surrounded by collagen and fibrin. The differential diagnosis in this case included synovial chondromatosis, infection, and the formation of a malignant tumor. Additional imaging studies, such as magnetic resonance imaging, and more specific tests were necessary to differentiate the rice bodies due to bursitis versus neoplasm, prior to excision. The patient presented 5 years following open reduction and internal fixation of a displaced proximal humerus fracture, with swelling in the area of the previous surgical site. Examination revealed a large, painless tumor-like mass on the anterior aspect of the shoulder. The patient's chief concern was the unpleasant aesthetic of the mass; no pain was reported. Upon excision of the mass, the patient's full, painless range of motion returned.

  3. Billing and coding knowledge: a comparative survey of professional coders, practicing orthopedic surgeons, and orthopedic residents.

    PubMed

    Wiley, Kevin F; Yousuf, Tariq; Pasque, Charles B; Yousuf, Khalid

    2014-06-01

    Medical knowledge and surgical skills are necessary to become an effective orthopedic surgeon. To run an efficient practice, the surgeon must also possess a basic understanding of medical business practices, including billing and coding. In this study, we surveyed and compared the level of billing and coding knowledge among current orthopedic residents PGY3 and higher, academic and private practice attending orthopedic surgeons, and orthopedic coding professionals. According to the survey results, residents and fellows have a similar knowledge of coding and billing, regardless of their level of training or type of business education received in residency. Most residents would like formal training in coding, billing, and practice management didactics; this is consistent with data from previous studies.

  4. Orthopedically Handicapped Children in Ohio Public Schools.

    ERIC Educational Resources Information Center

    Naples, Victor J.; Todd, Joseph H.

    The historical development of programs for orthopedically handicapped children, class units and hospital classes approved during 1967-68, and the number of therapy units established are presented. Tables give data on program population: enrollment for years 1962-68, percent of handicaps enrolled, and IQ distributions. Aspects of occupational…

  5. Emotional intelligence in orthopedic surgery residents.

    PubMed

    Chan, Kevin; Petrisor, Brad; Bhandari, Mohit

    2014-04-01

    Emotional intelligence (EI) is the ability to understand and manage emotions in oneself and others. It was originally popularized in the business literature as a key attribute for success that was distinct from cognitive intelligence. Increasing focus is being placed on EI in medicine to improve clinical and academic performance. Despite the proposed benefits, to our knowledge, there have been no previous studies on the role of EI in orthopedic surgery. We evaluated baseline data on EI in a cohort of orthopedic surgery residents. We asked all orthopedic surgery residents at a single institution to complete an electronic version of the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). We used completed questionnaires to calculate total EI scores and 4 branch scores. Data were analyzed according to a priori cutoff values to determine the proportion of residents who were considered competent on the test. Data were also analyzed for possible associations with age, sex, race and level of training. Thirty-nine residents (100%) completed the MSCEIT. The mean total EI score was 86 (maximum score 145). Only 4 (10%) respondents demonstrated competence in EI. Junior residents (p = 0.026), Caucasian residents (p = 0.009) and those younger than 30 years (p = 0.008) had significantly higher EI scores. Our findings suggest that orthopedic residents score low on EI based on the MSCEIT. Optimizing resident competency in noncognitive skills may be enhanced by dedicated EI education, training and testing.

  6. Program Guidelines for Severely Orthopedically Impaired Individuals.

    ERIC Educational Resources Information Center

    Bachmann, Winnie

    This document contains California's guidelines for serving students with severe orthopedic impairments in the public schools. Elements characteristic of well-designed programs are described in the guide's three chapters, and each description is followed by a series of questions for program evaluation. The first chapter addresses approaches to…

  7. Medical and orthopedic conditions and sports participation.

    PubMed

    Diokno, Eugene; Rowe, Dale

    2010-06-01

    The presence of certain medical or orthopedic conditions need not preclude adolescents from being physically active and participating in sports. The benefits of continued physical activity far outweigh any concerns for potential complications for most such conditions. This article reviews sport participation guidelines for adolescents with conditions that include juvenile chronic arthritis, eye injures, solitary kidney, skin conditions, scoliosis, and spondylolysis.

  8. 21 CFR 888.3080 - Intervertebral body fusion device.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Intervertebral body fusion device. 888.3080... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3080 Intervertebral body fusion device. (a) Identification. An intervertebral body fusion device is an implanted single or multiple...

  9. The Rotterdam Palatal Distractor: introduction of the new bone-borne device and report of the pilot study.

    PubMed

    Koudstaal, M J; van der Wal, K G H; Wolvius, E B; Schulten, A J M

    2006-01-01

    Transverse maxillary hypoplasia, in adolescents and adults, is frequently seen as an acquired deformity and in congenital deformities patients and can be corrected by means of surgically assisted rapid maxillary expansion. Traditionally, the distractors for expansion are tooth-borne devices, i.e. hyrax appliances, which may have some serious disadvantages such as tooth tipping, cortical fenestration, skeletal relapse and loss of anchorage. In contrast, with bone-borne distractors most of the maxillary expansion is orthopedic and at a more mechanically desired level with less dental side effects. A new bone-borne palatal distractor has been developed. By activation the nails of the abutments plates automatically stabilizes the device and no screw fixation is necessary anymore. This new distractor is presented and the data of five acquired deformity and eight congenital deformity patients that were treated with this distractor are reported.

  10. Outcomes of ACL Reconstruction With Fixed Versus Variable Loop Button Fixation.

    PubMed

    Wise, Brent T; Patel, Nick N; Wier, Garrison; Labib, Sameh A

    2017-03-01

    Suspensory femoral fixation of anterior cruciate ligament (ACL) grafts with fixed loop button and variable loop button devices has gained popularity for ACL reconstruction. This study examined these 2 methods of fixation to determine their effect on graft laxity and patient-reported outcome scores. A database search was performed to identify patients who had undergone ACL reconstruction with either a fixed loop or a variable loop button technique performed by the primary surgeon. Lysholm, Tegner, and 12-Item Short Form Health Survey scores were obtained, and KT-1000 knee ligament arthrometer (MEDmetric, San Diego, California) mechanical knee testing was performed. Results were compared with the uninjured knee. Of the 112 patients who were identified, 91 met the study criteria. Of these patients, 57 completed KT-1000 knee testing, 33 in the variable group and 24 in the fixed group. The average KT-1000 value for the variable group was 0.38 mm, and the average for the closed group was 0.92 mm (P=.19; 95% confidence interval, -0.28 to 1.35). Among the 19 patients in the variable group and the 13 in the closed group who completed the subjective outcomes questionnaires, no statistically significant difference was found. Clinically lax knees (KT-1000>3 mm) were found in 6.1% and 12.5% of patients in the variable group and the fixed group, respectively (P=.2). The variable group had a rerupture rate of 4.7%, whereas the fixed group had a rerupture rate of 8.7% (P=.21). The study found no statistical difference in ACL graft laxity or postoperative functional outcomes between grafts fixed with the variable loop or fixed loop button technique. [Orthopedics. 2017; 40(2):e275-e280.]. Copyright 2016, SLACK Incorporated.

  11. Proximal humeral fracture fixation: multicenter study with carbon fiber peek plate.

    PubMed

    Rotini, R; Cavaciocchi, M; Fabbri, D; Bettelli, G; Catani, F; Campochiaro, G; Fontana, M; Colozza, A; De Biase, C F; Ziveri, G; Zapparoli, C; Stacca, F; Lupo, R; Rapisarda, S; Guerra, E

    2015-09-01

    Locking plate fixation is a reliable treatment for many displaced proximal humeral fractures. Carbon fiber-reinforced-poly-ether-ether-ketone (CFR-PEEK) plates have recently been introduced as an alternative to traditional metallic plates. In a multicenter study involving the Orthopedic Services of 6 Italian hospitals, 182 patients with a proximal humeral fracture were treated with a Diphos H (Lima Corporate, San Daniele del Friuli, Italy) CFR-PEEK plate, 160 of whom were followed clinically and radiographically for 2 years or more. Fractures were classified by Neer's system. The functional results were assessed by Constant and DASH scores. The average time to radiographic healing was 5.6 months in 158 of 160 cases. Mean Constant score was 76, and mean DASH score was 28 at 2 years. There were two nonunions (one septic and one aseptic) and 13 cases of partial (9) or massive (4) humeral head necrosis. In three of the 78 patients treated with the first-generation plates, hardware breakage happened during the operation and the plate was replaced. There was no failure among the cases treated with the thicker second-generation plate. In eight cases, there was a perforation of the humeral head by the cephalic screws. CFR-PEEK plates proved as reliable as metallic plates in the treatment of proximal humeral fractures. The advantages of these new devices include a better visualization of fracture reduction during intraoperative fluoroscopic assessment and easy hardware removal due to the absence of screw-plate cold fusion.

  12. The halo fixator.

    PubMed

    Bono, Christopher M

    2007-12-01

    The halo fixator may be used for the definitive treatment of cervical spine trauma, preoperative reduction in the patient with spinal deformity, and adjunctive postoperative stabilization following cervical spine surgery. Halo fixation decreases cervical motion by 30% to 96%. Absolute contraindications include cranial fracture, infection, and severe soft-tissue injury at the proposed pin sites. Relative contraindications include severe chest trauma, obesity, advanced age, and a barrel-shaped chest. In children, a computed tomography scan of the head should be obtained before pin placement to determine cranial bone thickness. Complications of halo fixation include pin loosening, pin site infection, and skin breakdown. A concerning rate of life-threatening complications, such as respiratory distress, has been reported in elderly patients. Despite a paucity of contemporary data, recent retrospective studies have demonstrated acceptable results for halo fixation in managing some upper and lower cervical spine injuries.

  13. Photographic fixative poisoning

    MedlinePlus

    Photographic fixatives are chemicals used to develop photographs. This article discusses poisoning from swallowing such chemicals. This article is for information only. DO NOT use it to treat or manage an ...

  14. Fixation-based filtering

    NASA Astrophysics Data System (ADS)

    Olson, Thomas J.; Lockwood, Robert J.

    1992-11-01

    Fixation and visual attention are central themes in active vision research, and are closely related. In this paper we discuss one of several ways in which they interact. We describe filtering methods that allow an agent to selectively extract features of the object it is fixating and suppress features of foreground and background objects. The methods are essentially depth filters; they use disparity or motion information to suppress image features that are far from the fixation point in depth. They share a simple computational structure based on the Laplacian pyramid, and are readily amenable to hardware implementation. We present the filters and the properties of fixation geometry that allow them to work, and discuss their behavior. We present methods of implementing them in real time and describe ways of extending them to other features besides depth.

  15. Regulatory perspective on characterization and testing of orthopedic bone cements.

    PubMed

    Demian, H W; McDermott, K

    1998-09-01

    This paper provides a general regulatory background of acrylic bone cements, chemical composition information on several commercially available bone cements, physical and chemical methods of analyses, mechanical test methods, and risks and failure mechanisms of acrylic bone cements. Suggestions and recommendations presented in Tables 2 and 3 are not mandatory requirements but reflect data and methodologies which the FDA's Orthopedic Devices Branch (ORDB) believes to be acceptable to evaluate most pre-clinical data. FDA may require information in addition to that contained in this paper. In some instances, a sponsor may be able to sufficiently justify the omission of some tests. Although this paper describes certain administrative requirements, it does not take the place of the requirements contained in Title 21 of the Code of Federal Regulations (21 CFR) Parts 801, 807, 812, and 814 or those found in the statute.

  16. Operative delay for orthopedic patients on clopidogrel (plavix): a complete lack of consensus.

    PubMed

    Lavelle, William F; Demers Lavelle, Elizabeth A; Uhl, Richard

    2008-04-01

    : Because of its irreversible nature, Plavix (clopidogrel) has become a double edged sword in the care of some of our sickest patients, particularly when surgical intervention is required. Platelets exposed to a single dose of clopidogrel are affected for the remainder of their lifespan and recover normal platelet function at a rate consistent with platelet turnover, which is within 5 days to 7 days (1-3) with the generation of new platelets not influenced by the drug; however, delay of surgical fixation for orthopedic patients, particularly patients with hip fractures may lead to increased morbidity and mortality. : A Web-based survey was created and administered to the program directors of academic orthopedic surgery programs. : Seventy-three percent of orthopedic residency programs responded that waiting 3 days or less for urgent but nonemergent operative interventions on patients on clopidogrel is acceptable with 23% feeling that no delay at all is necessary. For emergent surgery, the vast majority of programs 66 (89%) reported no delay to the operating room for patients on clopidogrel. : The majority of orthopedic surgery residency programs who responded to the survey wait less than 3 days for urgent surgery and do not delay surgery for emergency cases for patients on clopidogrel. At this point we feel that an early intervention that occurs within approximately 2 days, with the acceptance of the possibility of increased blood loss is in the patient's best interest. Based on the reviewed physiology, a perioperative platelet transfusion may be of some benefit as the transfused platelets would be effective in forming a viable plug.

  17. Treatment Options for Orthopedic Device-related Infections.

    PubMed

    Toubes, Edna; Segreti, John

    2002-10-01

    Though uncommon, prosthetic joint infections are a devastating complication of total joint replacement surgeries and are a cause of significant morbidity. Although complete removal of all foreign material followed by a prolonged course of directed antibiotic therapy is the optimal treatment for such infections, many factors, such as patient health, cost, available bone stock, and timing of infection influence the type of treatment that is chosen. We review the different treatment options for prosthetic joint infections, including surgical modalities and antibiotic choice, duration, and suppression.

  18. Role of Suppressive Oral Antibiotics in Orthopedic Hardware Infections for Those Not Undergoing Two-Stage Replacement Surgery.

    PubMed

    Keller, Sara C; Cosgrove, Sara E; Higgins, Yvonne; Piggott, Damani A; Osgood, Greg; Auwaerter, Paul G

    2016-10-01

    Background.  The use of suppressive antibiotics in treatment of orthopedic hardware infections (OHIs), including spinal hardware infections, prosthetic joint infections, and infections of internal fixation devices, is controversial. Methods.  Over a 4-year period at 2 academic medical centers, patients with OHI who were treated with debridement and retention of hardware components, with single-stage exchange, or without surgery were studied to determine whether use of oral antibiotics for at least 6 months after diagnosis impacts successful treatment of the infection at 1 year after diagnosis. Results.  Of 89 patients in the study, 42 (47.2%) were free of clinical infection 1 year after initial diagnosis. Suppressive antibiotics used for at least 6 months after diagnosis was not associated with being free of clinical infection (adjusted odds ratio [aOR], 5.29; 95% confidence interval [CI], .74-37.80), but being on suppressive antibiotics at least 3 months after diagnosis was associated with being free of clinical infection (OR, 3.50; 95% CI, 1.30-9.43). Causative organisms impacted the likelihood of success; patients with methicillin-resistant Staphylococcus aureus as well as with Gram-negative rods were both less likely to have achieved clinical success at 1 year after surgery (aOR = 0.018, 95% CI = .0017-.19 and aOR = 0.20, 95% CI = .039-.99, respectively). Conclusions.  Oral suppressive antibiotic therapy in treatment of OHI with retention of hardware for 3 months, but not 6 months, postdiagnosis increases the likelihood of treatment success. The organisms implicated in the infection directly impact the likelihood of treatment success.

  19. Role of Suppressive Oral Antibiotics in Orthopedic Hardware Infections for Those Not Undergoing Two-Stage Replacement Surgery

    PubMed Central

    Keller, Sara C.; Cosgrove, Sara E.; Higgins, Yvonne; Piggott, Damani A.; Osgood, Greg; Auwaerter, Paul G.

    2016-01-01

    Background. The use of suppressive antibiotics in treatment of orthopedic hardware infections (OHIs), including spinal hardware infections, prosthetic joint infections, and infections of internal fixation devices, is controversial. Methods. Over a 4-year period at 2 academic medical centers, patients with OHI who were treated with debridement and retention of hardware components, with single-stage exchange, or without surgery were studied to determine whether use of oral antibiotics for at least 6 months after diagnosis impacts successful treatment of the infection at 1 year after diagnosis. Results. Of 89 patients in the study, 42 (47.2%) were free of clinical infection 1 year after initial diagnosis. Suppressive antibiotics used for at least 6 months after diagnosis was not associated with being free of clinical infection (adjusted odds ratio [aOR], 5.29; 95% confidence interval [CI], .74–37.80), but being on suppressive antibiotics at least 3 months after diagnosis was associated with being free of clinical infection (OR, 3.50; 95% CI, 1.30–9.43). Causative organisms impacted the likelihood of success; patients with methicillin-resistant Staphylococcus aureus as well as with Gram-negative rods were both less likely to have achieved clinical success at 1 year after surgery (aOR = 0.018, 95% CI = .0017–.19 and aOR = 0.20, 95% CI = .039–.99, respectively). Conclusions. Oral suppressive antibiotic therapy in treatment of OHI with retention of hardware for 3 months, but not 6 months, postdiagnosis increases the likelihood of treatment success. The organisms implicated in the infection directly impact the likelihood of treatment success. PMID:27747252

  20. Biomaterials and Biomedical Devices

    NASA Astrophysics Data System (ADS)

    Hanker, Jacob S.; Giammara, Beverly L.

    1988-11-01

    This review discusses the factors important in the incorporation or integration of biomaterials and devices by tissue. Methods for surface modification and surface-sensitive techniques for analysis are cited. In vitro methods to evaluate the biocompatibility or efficacy of certain biomaterials and devices are presented. Present and future directions in neural prostheses, cardiovascular materials, blood or bone substitutes, controlled drug delivery, orthopedic prostheses, dental materials, artificial organs, plasma- and cytapheresis, and dialysis are discussed.

  1. An Overview of Internal Fixation Implant Metallurgy and Galvanic Corrosion Effects.

    PubMed

    Koh, Justin; Berger, Aaron; Benhaim, Prosper

    2015-08-01

    Orthopedic and hand surgery implants for internal fixation of fractures have evolved substantially over the past 50 years. Newer metal compositions have been used, and new standards have been applied to older alloys, resulting in modern implants with unique physical properties and better clinical performances. Conventional wisdom has long dictated that implanting different metals should be avoided, but few guidelines exist regarding the safety of using in proximity implant systems of dissimilar metals. To better characterize the landscape of internal fixation implant metallurgy, we have compiled the recommendations and conclusions of the currently available and pertinent literature.

  2. Intrapelvic Protrusion of a Broken Guide Wire Fragment during Fixation of a Femoral Neck Fracture

    PubMed Central

    Afshar, Ahmadreza

    2017-01-01

    During fixation of a femoral neck fracture in a 23-year-old male patient with cannulated screws, a broken guide wire fragment inadvertently advanced through the hip joint and protruded into the pelvis. A second surgical approach was needed to remove the broken fragment from the pelvis. Awareness of such a potentially devastating complication will make surgeons more cautious during implementation of orthopedic instruments and increases patient’s safety during surgery.

  3. Intramedullary Tibial Nail Fixation of Simple Intraarticular Distal Tibia Fractures.

    PubMed

    Scolaro, John A; Broghammer, Francis H; Donegan, Derek J

    2016-11-01

    The optimal treatment strategy for distal tibia fractures, especially those with intraarticular extension, remains controversial. Although open reduction and internal fixation with a plate and screw device is commonly performed for these injuries, the risk of soft tissue complications using this approach is significant. Staged treatment protocols and alternative means of fixation have been proposed to address these undesired events. Although potentially more technically demanding than fixation of diaphyseal or extraarticular tibial fractures, intramedullary nail (IMN) fixation of simple intraarticular distal tibia fractures is a viable treatment alternative with unique advantages. This article presents a review of the literature and rationale for intramedullary tibial nail fixation of simple intraarticular distal tibia fractures and a surgical approach commonly utilized for successful implementation.

  4. Surgical Revision after Sacroiliac Joint Fixation or Fusion

    PubMed Central

    Holt, Timothy

    2017-01-01

    Background Minimally invasive sacroiliac joint (SIJ) fusion has been shown to be safe and effective for the treatment of SIJ dysfunction. Multiple devices are available to perform SIJ fixation or fusion. Surgical revision rates after these procedures have not been directly compared. Methods We retrospectively identified all patients in our practice who underwent SIJ fixation or fusion between 2003 and 2015. Using both chart review and focused contact with individual patients, we determined the likelihood of surgical revision. Revision rates were compared using Kaplan-Meier survival analysis. Results Thirty-eight patients underwent SIJ fixation with screws and 274 patients underwent SIJ fusion using triangular titanium implants. Four-year cumulative revision rates were 30.8% for fixation and 5.7% for fusion. Conclusions In our study, SIJ fixation with screws had a much higher revision rate compared to SIJ fusion with triangular titanium implants designed for bone adherence.

  5. [Orthopedic Problems in Overweight and Obese Children].

    PubMed

    Hoffmann, S; Stücker, R; Rupprecht, M

    2016-03-01

    Overweight and obesity in children and adolescents is a growing problem with an increasing number of patients presenting with comorbidities to pediatricians and orthopedic surgeons. This overview summarizes the most common orthopedic problems in overweight children and obesity and highlights the treatment options in addition to weight reduction and physiotherapy leaded activation. In early infancy a persitent genu varum may be seen as a sign of Blount disease. In the school ages flat feet or persistent knock-knees has a higher incidence in overweight children. The incidence for back pain and osteoporosis are related with overweight and obese. At puberty, the slipped capital epiphysis, which always needs a surgical management, is mostly related to overweight/obese. A symptomatic retroversion of the femur can cause discomfort and lead to a surgical therapy himself.

  6. Occupational injuries among pediatric orthopedic surgeons

    PubMed Central

    Alsiddiky, Abdulmonem M.; Alatassi, Raheef; Altamimi, Saad M.; Alqarni, Mahdi M.; Alfayez, Saud M.

    2017-01-01

    Abstract In this cross-sectional study, we surveyed all pediatric orthopedic surgeons in Saudi Arabia using an anonymous electronic questionnaire composed of 23 items to identify the rate of occupational injuries and obtain other relevant information. Thirty-nine participants completed the questionnaire (response rate: 83%). Participants who sustained occupational injuries throughout their careers represented 82.5%. The most injured areas were the hands, eyes, and back by 54.5%, 24.2%, and 15.2%, respectively. Approximately 11.1% were injured while operating on infected patients. Approximately 30.3% reported their injuries to their institution. We concluded that the rate of occupational injuries among pediatric orthopedic surgeons is very high and underreported. PMID:28640103

  7. Orthopedic problems in geriatric dogs and cats.

    PubMed

    Beale, Brian S

    2005-05-01

    Senior dogs and cats with orthopedic injuries and diseases often require a treatment plan that differs from that of younger patients. Injured bone and soft tissues tend to heal more slowly in the geriatric patient. The older animal is likely to have a less competent immune system and may have compromised metabolic and endocrine function. Pre-existing musculoskeletal problems may make ambulation difficult for an animal convalescing from a new orthopedic problem. Special attention is often needed when treating these patients for fractures, joint instability, infection, and neoplasia. In general, issues that should be addressed in the geriatric patient include reducing intraoperative and anesthesia time, enhancing bone and soft tissue healing, return to early function, control of postoperative pain, physical therapy, and proper nutrition.

  8. Orthopedic Implant Waste: Analysis and Quantification.

    PubMed

    Payne, Ashley; Slover, James; Inneh, Ifeoma; Hutzler, Lorraine; Iorio, Richard; Bosco, Joseph A

    2015-12-01

    The steadily increasing demand for orthopedic surgeries and declining rates of reimbursement by Medicare and other insurance providers have led many hospitals to look for ways to control the cost of these surgeries. We reviewed administrative records for a 1-year period and recorded total number of surgical cases, number of cases in which an implant was wasted, and cost of each wasted implant. We determined cost incurred because of implant waste, percentage of cases that involved waste, percentage of total implant cost wasted, and average cost of waste per case. We then analyzed the data to determine if case volume or years in surgical practice affected amount of implant waste. Results showed implant waste represents a significant cost for orthopedic procedures within all subspecialties and is an important factor to consider when developing cost-reduction strategies.

  9. Three-Dimensional Printing in Orthopedic Surgery.

    PubMed

    Eltorai, Adam E M; Nguyen, Eric; Daniels, Alan H

    2015-11-01

    Three-dimensional (3D) printing is emerging as a clinically promising technology for rapid prototyping of surgically implantable products. With this commercially available technology, computed tomography or magnetic resonance images can be used to create graspable objects from 3D reconstructed images. Models can enhance patients' understanding of their pathology and surgeon preoperative planning. Customized implants and casts can be made to match an individual's anatomy. This review outlines 3D printing, its current applications in orthopedics, and promising future directions.

  10. Orthopedic workforce planning in Germany – an analysis of orthopedic accessibility

    PubMed Central

    Müller, Peter; Maier, Werner; Groneberg, David A.

    2017-01-01

    In Germany, orthopedic workforce planning relies on population-to-provider-ratios represented by the ‘official degree of care provision’. However, with geographic information systems (GIS), more sophisticated measurements are available. By utilizing GIS-based technologies we analyzed the current state of demand and supply of the orthopedic workforce in Germany (orthopedic accessibility) with the integrated Floating Catchment Area method. The analysis of n = 153,352,220 distances revealed significant geographical variations on national scale: 5,617,595 people (6.9% of total population) lived in an area with significant low orthopedic accessibility (average z-score = -4.0), whereas 31,748,161 people (39.0% of total population) lived in an area with significant high orthopedic accessibility (average z-score = 8.0). Accessibility was positively correlated with the degree of urbanization (r = 0.49; p<0.001) and the official degree of care provision (r = 0.33; p<0.001) and negatively correlated with regional social deprivation (r = -0.47; p<0.001). Despite advantages of simpler measures regarding implementation and acceptance in health policy, more sophisticated measures of accessibility have the potential to reduce costs as well as improve health care. With this study, significant geographical variations were revealed that show the need to reduce oversupply in less deprived urban areas in order to enable adequate care in more deprived rural areas. PMID:28178335

  11. Orthopedic disability, conformity, and social support.

    PubMed

    Orr, E; Thein, R D; Aronson, E

    1995-03-01

    The relation between physical disability, social support, and conformist behavior was tested in two studies. The first compared the conforming responses of persons who had orthopedic disabilities with those of able-bodied individuals and correlated perceived social support of those with the disability with their tendency to conform. The second was an experimental study in which university students made choices between actors who had disabilities and actors who were able bodied; orthopedic disability was signified by a person sitting in a wheelchair and social support by the choice of a teammate. Results showed that persons with disabilities (compared with those who were able bodied) reported a significantly higher tendency to conform and that this tendency was negatively related to reported levels of perceived social support. In the experimental study, conforming behaviors of both disabled and able-bodied actors elicited more social support than did assertive behaviors. The actors who had "disabilities" received less social support than those who were "able bodied," but the former were considered more original when they did not conform. The findings imply that individuals with orthopedic disabilities are expected to conform but, although their conforming behavior elicits social support within specific encounters, it does not affect overall social support across encounters.

  12. [Orthopedics and patients under national socialism dictatorship].

    PubMed

    Thomann, K D; Rauschmann, M

    2001-10-01

    The 12-year dictatorship of National Socialism represents a decisive event in the history of orthopedics in Germany. Treatment and care was limited to those patients whose prognosis promised their reintegration into the work force. Those orthopedic patients with mental and psychological handicaps no longer came under the care of orthopedists and were potential candidates for annihilation. Despite concerted efforts to the contrary, as can be gleaned from the lists of topics at the annual meetings, the prevailing political circumstances encumbered scientific activities. The almost total isolation from international contacts had a negative effect. Orthopedists were hindered in their work by the law on sterilization, which provided for sterilization in cases of severe physical deformity. Some orthopedists even considered the presence of hip dysplasia to be an indication. The roles played by Georg Hohmann, Hellmut Eckhardt, Lothar Kreuz, and other leading orthopedists are described in detail. It can be regarded as certain that Hohmann and Eckhardt were able to prevent dire consequences for their orthopedic patients and the profession by cautious tactics. The ethnical problems of involvement with National Socialism are thoroughly discussed.

  13. Orthopedic gene therapy--lost in translation?

    PubMed

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

    2012-02-01

    Orthopedic gene therapy has been the topic of considerable research for two decades. The preclinical data are impressive and many orthopedic conditions are well suited to genetic therapies. But there have been few clinical trials and no FDA-approved product exists. This paper examines why this is so. The reasons are multifactorial. Clinical translation is expensive and difficult to fund by traditional academic routes. Because gene therapy is viewed as unsafe and risky, it does not attract major funding from the pharmaceutical industry. Start-up companies are burdened by the complex intellectual property environment and difficulties in dealing with the technology transfer offices of major universities. Successful translation requires close interactions between scientists, clinicians and experts in regulatory and compliance issues. It is difficult to create such a favorable translational environment. Other promising fields of biological therapy have contemplated similar frustrations approximately 20 years after their founding, so there seem to be more general constraints on translation that are difficult to define. Gene therapy has noted some major clinical successes in recent years, and a sense of optimism is returning to the field. We hope that orthopedic applications will benefit collaterally from this upswing and move expeditiously into advanced clinical trials. Copyright © 2011 Wiley Periodicals, Inc.

  14. Fixation of a human rib by an intramedullary telescoping splint anchored by bone cement.

    PubMed

    Liovic, Petar; Šutalo, Ilija D; Marasco, Silvana F

    2016-09-01

    A novel concept for rib fixation is presented that involves the use of a bioresorbable polymer intramedullary telescoping splint. Bone cement is used to anchor each end of the splint inside the medullary canal on each side of the fracture site. In this manner, rib fixation is achieved without fixation device protrusion from the rib, making the splint completely intramedullary. Finite element analysis is used to demonstrate that such a splint/cement composite can preserve rib fixation subjected to cough-intensity force loadings. Computational fluid dynamics and porcine rib experiments were used to study the anchor formation process required to complete the fixation.

  15. Improving Carbon Fixation Pathways

    PubMed Central

    Ducat, Daniel C.

    2012-01-01

    A recent resurgence in basic and applied research on photosynthesis has been driven in part by recognition that fulfilling future food and energy requirements will necessitate improvements in crop carbon-fixation efficiencies. Photosynthesis in traditional terrestrial crops is being reexamined in light of molecular strategies employed by photosynthetic microbes to enhance the activity of the Calvin cycle. Synthetic biology is well-situated to provide original approaches for compartmentalizing and enhancing photosynthetic reactions in a species independent manner. Furthermore, the elucidation of alternative carbon-fixation routes distinct from the Calvin cycle raises possibilities that alternative pathways and organisms can be utilized to fix atmospheric carbon dioxide into useful materials. PMID:22647231

  16. Improving carbon fixation pathways

    SciTech Connect

    Ducat, DC; Silver, PA

    2012-08-01

    A recent resurgence in basic and applied research on photosynthesis has been driven in part by recognition that fulfilling future food and energy requirements will necessitate improvements in crop carbon-fixation efficiencies. Photosynthesis in traditional terrestrial crops is being reexamined in light of molecular strategies employed by photosynthetic microbes to enhance the activity of the Calvin cycle. Synthetic biology is well-situated to provide original approaches for compartmentalizing and enhancing photosynthetic reactions in a species independent manner. Furthermore, the elucidation of alternative carbon-fixation routes distinct from the Calvin cycle raises possibilities that novel pathways and organisms can be utilized to fix atmospheric carbon dioxide into useful materials.

  17. Intraoperative Hypothermia During Surgical Fixation of Hip Fractures.

    PubMed

    Frisch, Nicholas B; Pepper, Andrew M; Jildeh, Toufic R; Shaw, Jonathan; Guthrie, Trent; Silverton, Craig

    2016-11-01

    Hip fractures are common orthopedic injuries and are associated with significant morbidity/mortality. Intraoperative normothermia is recommended by national guidelines to minimize additional morbidity/mortality, but limited evidence exists regarding hypothermia's effect on orthopedic patients. The purpose of this study was to determine the incidence of intraoperative hypothermia in patients with operatively treated hip fractures and evaluate its effect on complications and outcomes. Retrospective chart review was performed on clinical records from 1541 consecutive patients who sustained a hip fracture and underwent operative fixation at the authors' institution between January 2005 and October 2013. A total of 1525 patients were included for analysis, excluding those with injuries requiring additional surgical intervention. Patient demographic data, surgery-specific data, postoperative complications, length of stay, and 30-day readmission were recorded. Patients with a mean intraoperative temperature less than 36°C were identified as hypothermic. Statistical analysis with univariate and multivariate logistic regression modeling evaluated associations with hypothermia and effect on complications/outcomes. The incidence of intraoperative hypothermia in operatively treated hip fractures was 17.0%. Hypothermia was associated with an increase in the rate of deep surgical-site infection (odds ratio, 3.30; 95% confidence interval, 1.19-9.14; P=.022). Lower body mass index and increasing age demonstrated increased association with hypothermia (P=.004 and P=.005, respectively). To the authors' knowledge, this is the first and largest study analyzing the effect of intraoperative hypothermia in orthopedic patients. In patients with hip fractures, the study's findings confirm evidence found in other surgical specialties that hypothermia may be associated with an increased risk of deep surgical-site infection and that lower body mass index and increasing age are risk factors

  18. Force relaxation and sprinback of novel elastic orthopedic cables.

    PubMed

    Canet, Fanny; Baril, Yannick; Brailovski, Vladimir; Petit, Yvan; Bissonnette, Guillaume; Laflamme, G-Yves

    2011-01-01

    Cerclage cables have proven to be very useful in the orthopedic field for bones stabilization and plate fixation but the initial enthusiasm for metallic cables has declined with their high complication rates. Metal materials provide limited elastic deformation compromising their ability to maintain compression. This study compares the mechanical properties of new elastic cables with cobalt-chrome and stainless-steel cables. Stainless-steel, cobalt-chrome, nylon and nickel-titanium cables were first loaded up to 356 N, then elongation was maintained for 12 hours, next unloaded and finally reloaded to failure. Initial elongation (%), Relative force relaxation (% loss of initial load after a 12h), elastic springback (%) and force to failure (N) were extracted from force-elongation curves. Initial elongation was the highest for nylon cables (9%), followed by the nickel-titanium (4%) and both metallic cables (0.3%). During 12 hours, no relaxation was observed for the nickel-titanium and the cobalt-chrome cables, whereas 28 and 45% of the tension was lost respectively for the stainless-steel and the nylon cables. The elastic springback of the nickel-titanium and nylon cables (4.4 and 4.7% respectively) was 20 times higher than that of the stainless-steel and cobalt-chrome cables (0.12 and 0.16% respectively). The force to failure of the stainless steel and cobalt-chrome cables was twice that of the nickel-titanium cables. Multi-braided stainless-steel and cobalt-chrome cables have a high-stiffness with limited ability to tolerate displacement, leading to early cable loosening. Novel low-stiffness cables made of nylon or nickel-titanium offer significant elastic springback improving binding stability.

  19. Update: Biological Nitrogen Fixation.

    ERIC Educational Resources Information Center

    Wiseman, Alan; And Others

    1985-01-01

    Updates knowledge on nitrogen fixation, indicating that investigation of free-living nitrogen-fixing organisms is proving useful in understanding bacterial partners and is expected to lead to development of more effective symbioses. Specific areas considered include biochemistry/genetics, synthesis control, proteins and enzymes, symbiotic systems,…

  20. The Fixation of Nitrogen.

    ERIC Educational Resources Information Center

    Andrew, S. P. S.

    1978-01-01

    Discusses the fixation of atmospheric nitrogen in the form of ammonia as one of the foundations of modern chemical industry. The article describes ammonia production and synthesis, purifying the hydrogen-nitrogen mix, nitric acid production, and its commericial plant. (HM)

  1. The Fixation of Nitrogen.

    ERIC Educational Resources Information Center

    Andrew, S. P. S.

    1978-01-01

    Discusses the fixation of atmospheric nitrogen in the form of ammonia as one of the foundations of modern chemical industry. The article describes ammonia production and synthesis, purifying the hydrogen-nitrogen mix, nitric acid production, and its commericial plant. (HM)

  2. Fixation of displaced subcapital femoral fractures. Compression screw fixation versus double divergent pins.

    PubMed

    Christie, J; Howie, C R; Armour, P C

    1988-03-01

    One hundred and twenty-seven consecutive patients with displaced subcapital fractures of the femoral neck (Garden Grade III or IV) all under 80 years of age and independently mobile, were randomly allocated to fixation with either double divergent pins or a single sliding screw-plate device. The incidence of non-union and infection in the sliding screw-plate group was significantly higher, and we believe that when internal fixation is considered appropriate multiple pinning should be used. Mobility after treatment was disappointing in about half of the patients, and we feel that internal fixation can only be justified in patients who are physiologically well preserved and who maintain a high level of activity.

  3. Impact of a Musculoskeletal Clerkship on Orthopedic Surgery Applicant Diversity.

    PubMed

    London, Daniel A; Calfee, Ryan P; Boyer, Martin I

    Orthopedic surgery lacks racial and sexual diversity, which we hypothesized stems from absence of exposure to orthopedics during medical school. We conducted a study to determine whether diversity of matched orthopedic surgery residency applicants increased after introduction of a required third-year rotation. We compared 2 groups: precurriculum and postcurriculum. The postcurriculum group was exposed to a required 1-month musculoskeletal rotation during the third year of medical school. Comparisons were made of percentage of total students exposed to orthopedics, percentage who applied to and matched to orthopedic surgery, and proportion of women and underrepresented minorities. A prospective survey was used to determine when students chose orthopedics and what influenced their decisions. The required rotation increased the percentage of third-year students rotating on orthopedics (25%) with no change in application rate (6%). It also led to an 81% relative increase in the proportion of female applicants and a 101% relative increase in underrepresented minority applicants. According to survey data, 79% of students chose orthopedics during their third year, and 88% thought they were influenced by their rotation. A required third-year rotation exposes more medical students to orthopedics and increases the diversity of matching students.

  4. [The clinical use of Hotz-type orthopedic plate].

    PubMed

    Kamegai, A; Matsuoka, Y; Shimamura, N; Muramatsu, Y; Tanabe, T; Kurenuma, S; Kimura, Y; Shibata, K; Naitoh, K; Kitajima, T

    1988-12-01

    In the present study a Hotz type orthopedic plate was used to improve feeding and physiological growth. In 2 patients with cleft lip it was used to improve feeding and swallowing. In 4 patients with cleft lip and palate it was used to normalize functions and aid physiological growth. The effects of the Hotz orthopedic plate were determined by recording body weight growth, milk volume per day, feeding time and comparison of the study model between before and after using Hotz orthopedic plate. Good physiological growth and improved feeding, were obtoincdinalmostall the patients who wore the Hotz type orthopedic plate correctly.

  5. [Study on the application of Aconitum in clinical orthopedics].

    PubMed

    Jin, Hong-Ting; Shen, Yan; Xiao, Lu-Wei; Tong, Pei-Jian

    2008-12-01

    Aconitum is important in clinical orthopedics. From ancient times to the present day,there were many famous doctors who used this herb to cure many diseases in orthopedics. However, the toxicity always connect with its effect. This will limit its application in clinics. So now the important thing is how to use this herb correctly. This article will give some suggestions about how to use aconitum in orthopedics and to make sure it can be used correctly in future. It has four parts: application in orthopedics, pharmacology, factors related to toxicity and the prospect of the use of aconitum.

  6. Mini-plate fixation versus suture suspensory fixation in cervical laminoplasty

    PubMed Central

    Liu, Feng-Yu; Ma, Lei; Huo, Li-Shuang; Cao, Yan-Xiang; Yang, Da-Long; Wang, Hui; Yang, Si-Dong; Ding, Wen-Yuan

    2017-01-01

    Abstract Background: Both the mini-plate fixation and suture suspensory fixation techniques are extensively applied in cervical laminoplasty, but which technique is superior has not been ascertained. The purpose of this meta-analysis is to compare the results between mini-plate fixation and suture suspensory fixation in cervical laminoplasty for the patients with multilevel cervical compressive myelopathy. Methods: PubMed, Embase, the Cochrane library, CNKI, and WANFANG were searched for studies that compared mini-plate fixation and suture suspensory fixation in cervical laminoplasty up to November 1, 2016. We calculated odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes and mean difference (MD) with 95% CI for continuous outcomes. Review Manager 5.3 was used for the statistical analyses. Results: A total of 25 studies, involving 1603 participants, were included in this review. The results of this meta-analysis indicated that there were statistically significant differences in postoperative Japanese Orthopedic Association (JOA) scores (MD = 0.67, 95% CI: 0.34–0.99, P < 0.001), JOA scores improvement rate (MD = 4.00, 95% CI: 2.51–5.50, P < 0.001), postoperative Visual Analogue Score (VAS) (MD = −0.81, 95% CI: −1.36 to −0.26, P = 0.004), postoperative range of motion (ROM) (MD = 4.15, 95% CI: 2.06–6.23, P < 0.001), postoperative cervical lordosis (MD = 3.1, 95% CI: 2.02–4.18, P < 0.001), postoperative anteroposterior diameter of the spinal canal (MD = 1.53, 95% CI: 0.11–2.95, P = 0.03), postoperative open angle (MD = 1.93, 95% CI: 0.14–3.71, P = 0.03), postoperative cross-sectional area of the spinal canal (MD = 37.10, 95% CI: 26.92–47.29, P < 0.001), axial symptoms (OR = 0.28, 95% CI: 0.20–0.37, P < 0.001), operation time (MD = 4.46, 95% CI: 0.74–8.19, P = 0.02), and blood loss (MD = 9.24, 95% CI: 6.86–11.62, P < 0.001). However

  7. Diabetic foot: the orthopedic surgery angle.

    PubMed

    Besse, J-L; Leemrijse, T; Deleu, P-A

    2011-05-01

    As diabetes takes on pandemic proportions, it is crucial for the orthopedic surgeon to be aware of the issues involved in diabetic foot. Ulceration is related to neuropathy and to arterial disease, a vital prognostic factor for healing; infection plays an aggravating role, increasing the risk of amputation. At-risk feet need to be screened for. Ulcer classification is essential, to set treatment strategy and determine prognosis. Before any treatment is decided on, neuropathy, vascular insufficiency and infection should individually be assessed by clinical examination and appropriate additional work-up. Despite the International Consensus on the Diabetic Foot recommendations, management of diabetic foot in Europe still varies greatly from country to country, very few of which have established reference centers. Management of diabetic foot remains multidisciplinary; but it has been shown that the orthopedic surgeon should play a central role, providing a biomechanical perspective so as to avoid complications recurrence. Strategy notably includes prevention of at-risk foot, revascularization surgery (which should systematically precede orthopedic surgery in case of critical vascular insufficiency), and treatment of ulcers, whether these latter are associated with osteitis or not. Indications for "minor" amputation should be adequate, and meticulously implemented. "Acute foot" is a medical emergency, entailing massive empirically selected I.V. antibiotics to "cool" the lesion. Prophylactic surgery to limit further risks of ulceration is to be indicated with caution and only when clearly justified. France urgently requires accredited specialized multidisciplinary centers to manage severe lesions: deep and infected ulceration, advanced arteriopathy, and Charcot foot arthropathy. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  8. Orthopedic Resident Anatomy Review Course: A Collaboration between Anatomists and Orthopedic Surgeons

    ERIC Educational Resources Information Center

    DeFriez, Curtis B.; Morton, David A.; Horwitz, Daniel S.; Eckel, Christine M.; Foreman, K. Bo; Albertine, Kurt H.

    2011-01-01

    A challenge for new residents and senior residents preparing for board examinations is refreshing their knowledge of basic science disciplines, such as human gross anatomy. The Department of Orthopaedics at the University of Utah School of Medicine has for many years held an annual Orthopedic Resident Anatomy Review Course during the summer months…

  9. Orthopedic resident anatomy review course: a collaboration between anatomists and orthopedic surgeons.

    PubMed

    DeFriez, Curtis B; Morton, David A; Horwitz, Daniel S; Eckel, Christine M; Foreman, K Bo; Albertine, Kurt H

    2011-01-01

    A challenge for new residents and senior residents preparing for board examinations is refreshing their knowledge of basic science disciplines, such as human gross anatomy. The Department of Orthopaedics at the University of Utah School of Medicine has for many years held an annual Orthopedic Resident Anatomy Review Course during the summer months for all of its residents. The primary purpose of the course is to renew competencies in basic science disciplines so that incoming residents more quickly reach a level of functional proficiency and to afford senior residents a platform to teach their junior colleagues. Before 2005, this course was conducted with minimal participation from anyone outside of the Department of Orthopaedics. Many of the residents voiced concerns that the educational benefits were not proportionate to the time invested. To improve the teaching of orthopedic-related anatomy, an educational collaboration between the Departments of Neurobiology and Anatomy and Orthopaedics was established in 2004 and continues to the present time. The major objectives of refining the course pedagogy, developing a Course Manual and Dissection Guide, and evaluating the results by administering a course survey questionnaire are described in this article. Implementation of all facets of the revised course has resulted in better participation by orthopedic faculty and more favorable reviews by the participating residents. Based on current levels of interest and positive comments from course participants, the Anatomy and Orthopedic faculty course directors plan to continue to develop course materials and pedagogy.

  10. Orthopedic Resident Anatomy Review Course: A Collaboration between Anatomists and Orthopedic Surgeons

    ERIC Educational Resources Information Center

    DeFriez, Curtis B.; Morton, David A.; Horwitz, Daniel S.; Eckel, Christine M.; Foreman, K. Bo; Albertine, Kurt H.

    2011-01-01

    A challenge for new residents and senior residents preparing for board examinations is refreshing their knowledge of basic science disciplines, such as human gross anatomy. The Department of Orthopaedics at the University of Utah School of Medicine has for many years held an annual Orthopedic Resident Anatomy Review Course during the summer months…

  11. Hunting stand-related injuries in orthopedics.

    PubMed

    Lebus, George F; Krueger, Chad A; Stinner, Daniel J; Mir, Hassan R

    2014-09-01

    Hunting remains an extremely popular recreational activity, with nearly 15 million Americans receiving a hunting license annually. Precautions have helped decrease accidents, but hunting-related injuries remain relatively common. The majority of severe, hunting-related accidents involve either a fall from a hunting platform or an accidental shooting. Both of these mechanisms frequently result in orthopedic injuries, many of which require operative care. Although firearms-associated injury has seemingly decreased, hunting platform falls and their sequelae are increasing. Understanding the mechanisms of these injuries and increasing awareness of them may minimize their morbidity and mortality or help prevent them altogether.

  12. Imaging of orthopedic trauma and surgery

    SciTech Connect

    Berquist, T.H.

    1985-01-01

    This book presents papers on imaging techniques for diagnosis of trauma of bones. A comparative evaluation is presented for planning of proper diagnosis and treatment. Various techniques discussed are routine radiography; computerized tomography, NMR imaging, angiography, ultrasonography; and use of radioisotopes. The mechanism of injury of bone joints of upper and lower limbs and spine is discussed after discussing the anatomy of each in the beginning of each paper. Topics titled are healing of fractures; fractures of pelvis; knee; shoulder; foot and ankle; fractures of humerus; stress fractures; and orthopedic radiology. Prosthesis use and plastic surgery of joints is also discussed.

  13. The efficient delivery of elective orthopedic care.

    PubMed

    Jacofsky, David; Lyman, Jeff

    2007-10-01

    The reality of the modern orthopedic practice is that rising fixed business costs, rising malpractice premiums, and decreasing reimbursement make efficiency not just a matter of prosperity, but in some markets, one of practice survival. As physicians, we have been trained to deliver medical advice to our patients and offer plans of care catered to the patient's specific needs, goals, and lifestyle. Terms such as practice efficiency may initially seem to conflict with the concept of optimizing patient outcomes. This article introduces some of the strategies that can be integrated into a practice model to increase volumes, productivity, and efficiency while simultaneously controlling costs and improving patient outcomes.

  14. Economic analysis of athletic team coverage by an orthopedic practice.

    PubMed

    Lombardi, Nicholas; Freedman, Kevin; Tucker, Brad; Austin, Luke; Eck, Brandon; Pepe, Matt; Tjoumakaris, Fotios

    2015-11-01

    Coverage of high school football by orthopedic sports medicine specialists is considered standard of care in many localities. Determining the economic viability of this endeavor has never been investigated. The primary purpose of the present investigation was to perform an economic analysis of local high school sports coverage by an orthopedic sports medicine practice. From January 2010 to June 2012, a prospective injury report database was used to collect sports injuries from five high school athletic programs covered by a single, private orthopedic sports medicine practice. Patients referred for orthopedic care were then tracked to determine expected cost of care (potential revenue). Evaluation and management codes and current procedure terminology codes were obtained to determine the value of physician visits and surgical care rendered. Overhead costs were calculated based on historical rates within our practice and incorporated to determine estimated profit. 19,165 athletic trainer contacts with athletes playing all sports, including both those 'on-field' and in the training room, resulted in 473 (2.5%) physician referrals. The covering orthopedic practice handled 89 (27.9%) of the orthopedic referrals. Of orthopedic physician referrals, 26 (5.4%) required orthopedic surgical treatment. The covering team practice handled 17/26 (65%) surgical cases. The total revenue collected by the covering team practice was $26,226.14. The overhead cost of treatment was $9441.41. Overall estimated profit of orthopedic visits and treatment during this period for the covering practice was $16,784.73. The covering team practice handled 28% of the orthopedic referrals, 65% of the surgical cases and captured 59% of the potential profit. An increase in physician referrals could increase the benefit for orthopedic surgeons.

  15. Surface modification of magnesium alloys developed for bioabsorbable orthopedic implants: a general review.

    PubMed

    Wang, Jiali; Tang, Jian; Zhang, Peng; Li, Yangde; Wang, Jue; Lai, Yuxiao; Qin, Ling

    2012-08-01

    As a bioabsorbable metal with mechanical properties close to bone, pure magnesium or its alloys have great potential to be developed as medical implants for clinical applications. However, great efforts should be made to avoid its fast degradation in vivo for orthopedic applications when used for fracture fixation. Therefore, how to decease degradation rate of pure magnesium or its alloys is one of the focuses in Research and Development (R&D) of medical implants. It has been recognized that surface modification is an effective method to prevent its initial degradation in vivo to maintain its desired mechanical strength. This article reviews the recent progress in surface modifications for prevention of fast degradation of magnesium or its alloys using in vitro testing model, a fast yet relevant model before moving towards time-consuming and expensive in vivo testing. Pros and cons of various surface modifications are also discussed for the goal to design available products to be applied in clinical trials.

  16. Atypical femur fractures: a survey of current practices in orthopedic surgery.

    PubMed

    Schneider, P S; Wall, M; Brown, J P; Cheung, A M; Harvey, E J; Morin, S N

    2017-08-02

    The results of a self-administered online survey demonstrate that orthopedic surgeons' management practices for AFF are variable. These data will inform the development of clinical practice guidelines. We aimed to determine current AFF treatment practices of orthopedic surgeons to inform clinical practice guideline development. A self-administered online survey was developed and sequentially posted on the Orthopaedic Trauma Association (OTA) website from July to August 2015 and the Canadian Orthopaedic Association (COA) website from December 2015 to January 2016. Level of confidence in diagnosis and treatment as well as treatment preferences between respondents who self-identified as trauma surgeons vs. non-trauma surgeons were compared. A total of 172 completed surveys were obtained (OTA, N = 100, 58%; COA, N = 72, 8%). Seventy-eight percent of respondents had treated ≥1 AFF in the previous 6 months. Seventy-six percent reported feeling extremely or very confident in diagnosing AFF (trauma 84% vs. non-trauma surgeons 70%, p = 0.04), and 63% reported feeling extremely or very confident in treating AFF (trauma 82%, non-trauma surgeons 50%, p < 0.01). Preferred management for complete and symptomatic incomplete AFFs was surgical fixation with a cephalomedullary nail (CMN) by 88 and 79%, respectively, while close follow-up was preferred for asymptomatic incomplete AFFs in 72% of respondents. Trauma surgeons used the CMN more frequently than non-trauma surgeons (90 vs. 76% p = 0.03). In patients with bilateral AFFs, with one side surgically treated, 56% were extremely likely to surgically treat the contralateral side, if symptomatic. Most felt guidelines (81%) and educational resources (73%) would be valuable. Current orthopedic treatment practices for AFFs are variable. The results of this survey will inform the development of practice guidelines and educational resources.

  17. Electrolyte disorders and aging: risk factors for delirium in patients undergoing orthopedic surgeries.

    PubMed

    Wang, Li-Hong; Xu, Dong-Juan; Wei, Xian-Jiao; Chang, Hao-Teng; Xu, Guo-Hong

    2016-11-23

    At present, the exact mechanism of postoperative delirium has not been elucidated. The purpose of this study was to analyze the incidence of delirium in patients undergoing orthopedic surgeries and to explore possible related factors. This is a retrospective study. We used 582 patients who had undergone orthopedic surgery between January 2011 and December 2014. The surgeries consisted of 155 cases of internal fixation for intertrochanteric fracture (IFIF), 128 cases of femoral head replacement (FHR), 169 cases of total hip arthroplasty (THA) and 130 cases of total knee arthroplasty (TKA). Among the 582 patients, 75 developed postoperative delirium (an incidence of 12.9%). The demographics of the patients, which included age, gender, operation duration and blood loss, were statistically analyzed with univariate logistic regression analysis and then multivariate logistic regression. To investigate the influences of different electrolytes disorders for postoperative delirium, the Chi-square test was used. Multivariate logistic regression analysis indicated that postoperative delirium incidence in patients aged 70-79 years and in patients aged ≥80 years was higher than that in patients aged <70 years, odds ratio (OR) values were 6.33 and 26.37, respectively. In addition, the incidence of postoperative delirium in the group of patients with electrolyte disorders was higher than that in the normal group (OR, 2.38). There were statistically significant differences between the delirium group and the non-delirium group in the incidences of the sodium and calcium disorders. Aging and postoperative electrolyte disorders (hyponatremia and hypocalcemia) are risk factors for postoperative delirium in patients undergoing orthopedic surgeries.

  18. Blog and Podcast Watch: Orthopedic Emergencies.

    PubMed

    Grock, Andrew; Rezaie, Salim; Swaminathan, Anand; Min, Alice; Shah, Kaushal H; Lin, Michelle

    2017-04-01

    The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing ALiEM Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of orthopedic emergencies from the AIR series. The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight AIR board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27-29 receive an honorable mention label, if the executive board agrees that the post is accurate and educationally valuable. A total of 87 blog posts and podcasts were evaluated. Key educational pearls from the three AIR posts and the 14 honorable mentions are summarized. The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on orthopedic emergencies.

  19. RAPID MANUFACTURING SYSTEM OF ORTHOPEDIC IMPLANTS

    PubMed Central

    Relvas, Carlos; Reis, Joana; Potes, José Alberto Caeiro; Fonseca, Fernando Manuel Ferreira; Simões, José Antonio Oliveira

    2015-01-01

    This study, aimed the development of a methodology for rapid manufacture of orthopedic implants simultaneously with the surgical intervention, considering two potential applications in the fields of orthopedics: the manufacture of anatomically adapted implants and implants for bone loss replacement. This work innovation consists on the capitation of the in situ geometry of the implant by direct capture of the shape using an elastomeric material (polyvinylsiloxane) which allows fine detail and great accuracy of the geometry. After scanning the elastomeric specimen, the implant is obtained by machining using a CNC milling machine programmed with a dedicated CAD/CAM system. After sterilization, the implant is able to be placed on the patient. The concept was developed using low cost technology and commercially available. The system has been tested in an in vivo hip arthroplasty performed on a sheep. The time increase of surgery was 80 minutes being 40 minutes the time of implant manufacturing. The system developed has been tested and the goals defined of the study achieved enabling the rapid manufacture of an implant in a time period compatible with the surgery time. PMID:27004181

  20. Disparities in internet use among orthopedic outpatients.

    PubMed

    Walsh, Kenneth P; Rehman, Saqib; Goldhirsh, Jessie

    2014-02-01

    Internet access has lagged behind for patients with lower incomes and from certain ethnic groups. This study investigated the possible improvement of access to health-related information on the Internet for all patients in an urban outpatient setting, regardless of socioeconomic background. A 28-question survey was completed by 100 orthopedic outpatients evaluating associations between their age, ethnicity, income, or education level and their access to the Internet. The survey also examined how patients used the Internet to obtain information about their medical condition, their privacy concerns when conducting online research, and their use of mobile phones as a primary means of Internet access. The Internet was used by 57% of orthopedic outpatients in this urban setting. Internet access decreased with advancing age but increased with increasing income and education, findings consistent with similar studies. Despite the inability to identify an association between ethnicity and Internet access in this patient population, fewer Latinos (33%) than whites (67%) or African Americans (77%) sought information about their medical condition. Among patients who used a mobile phone as the primary method for online access, 74% were African American or Latino and 26% were white. This difference in mobile phone use for online access suggests that mobile phones have provided ethnic minorities with greater Internet access and thus may have narrowed the digital divide among the races.

  1. Piriformis fossa - an anatomical and orthopedics consideration.

    PubMed

    Lakhwani, O P; Mittal, P S; Naik, D C

    2014-03-01

    Piriformis fossa is an important anatomical landmark having significant clinical value in orthopedic surgery; but its location and anatomical relationship with surrounding structures are not clearly defined. Hence it is necessary to clearly describe it in respect to anatomical and orthopedic aspect. Fifty Cadaveric dry femoral bones and Dissection of the four hip specimens were used to study the Piriformis fossa in respect to location and its relationship with surrounding structures. Clinical importance of piriformis fossa was determined in reference to antegrade femoral nail insertion. Piriformis muscle and so called piriformis fossa are unrelated entities. Piriformis fossa is anatomical site of insertion of obturator externus. In dry cadaveric femora; fossa was not always located in the direction of femoral shaft. It was located in the direction of femoral shaft in 24% cases only. In 68% cases femoral canal was aligned lateral and in 8% cases, it lies medial to the fossa. Piriformis fossa should be named as Trorchanteric fossa or Obturator fossa for better anatomical description. So called Piriformis fossa does not found to be universally corresponding to femoral shaft hence selection of entry site should be based on variable proximal femur and area on femur which corresponds to femoral shaft.

  2. A Novel Fixation Method for Variable-Sized Endoscopic Submucosal Dissection Specimens: An In Vitro Animal Experiment.

    PubMed

    Kim, Seung Han; Choi, Hyuk Soon; Chun, Hoon Jai; Yoo, In Kyung; Lee, Jae Min; Kim, Eun Sun; Keum, Bora; Seo, Yeon Seok; Jeen, Yoon Tae; Lee, Hong Sik; Um, Soon Ho; Kim, Chang Duck

    2016-01-01

    Endoscopic submucosal dissection is considered a curative and minimally invasive treatment for early gastric cancer; however, precise pathologic assessment of resected specimens is required to develop further treatment plans. Human error during specimen handling can affect objective assessment of resected specimens. In this study, we investigated whether a novel tissue fixation device offered more objective and standardized pathologic evaluation than conventional manual tissue fixation. We developed a novel tissue fixation device for endoscopic submucosal dissection specimens. Two circular tissue samples 2, 3, and 4 cm in diameter were obtained from the body of 45 porcine stomachs. One specimen sample was placed in a fixation device; the other was manually fixed on corkboard. We used a pressure indicator to ensure constant pressure in the resected specimens in the fixation device. We measured submucosal diameter and thickness after 24 hr. The diameters for 2, 3, and 4 cm resected tissue samples were 23.85, 32.30, and 45.0 mm and 21.0, 32.0, and 44.50 mm for the fixation device and manual pinning groups, respectively. The submucosal thicknesses in the fixation device group were 397.09, 381.43, and 415.51 μm and 393.76, 529.69, and 603.82 μm by manual pinning for 2, 3, and 4 cm tissue samples, respectively. Analysis of standard deviation revealed that the submucosal thickness in the manual fixation group was much more variable than in the fixation device group (p = 0.012, 0.042, and 0.001 for 2, 3, and 4 cm tissue specimens, respectively; Fligner-Killeen test of homogeneity of variances). Among variously sized resected tissue specimens, submucosal thicknesses were more variable in the conventional fixation group, while the thicknesses were comparatively consistent in the fixation device group. After endoscopic submucosal dissection, pathologic preparation using this fixation device could offer more objective assessment of specimens.

  3. CARBON DIOXIDE FIXATION.

    SciTech Connect

    FUJITA,E.

    2000-01-12

    Solar carbon dioxide fixation offers the possibility of a renewable source of chemicals and fuels in the future. Its realization rests on future advances in the efficiency of solar energy collection and development of suitable catalysts for CO{sub 2} conversion. Recent achievements in the efficiency of solar energy conversion and in catalysis suggest that this approach holds a great deal of promise for contributing to future needs for fuels and chemicals.

  4. Influence of orthopedic reinforced gloves versus double standard gloves on contamination events during small animal orthopedic surgery.

    PubMed

    Hayes, Galina; Singh, Ameet; Gibson, Tom; Moens, Noel; Oblak, Michelle; Ogilvie, Adam; Reynolds, Debbie

    2017-07-08

    To determine the influence of orthopedic reinforced gloves on contamination events during small animal orthopedic surgery. Prospective randomized controlled trial SAMPLE POPULATION: Two hundred and thirty-seven pairs of orthopedic gloves (474 gloves) and 203 pairs of double standard gloves (812 gloves) worn during 193 orthopedic procedures. Primary and assistant surgeons were randomized to wear either orthopedic reinforced gloves or double gloves. Gloves were leak tested to identify perforations at the end of procedures. Perforations detected intraoperatively or postoperatively were recorded. A contamination event was defined as at least one perforation on either hand for orthopedic reinforced gloves, or a perforation of both the inner and outer glove on the same hand for double gloves. Baseline characteristics between the 2 intervention groups were similar. There was no difference in contamination events between the double-gloved and orthopedic gloved groups (OR = 0.95, 95% CI = 0.49-1.87, P = .89). The same percentage of contamination events (8% glove pairs used) occurred in the double gloved group (17 contamination events) and in the orthopedic gloved group (19 contamination events). The odds of a contamination event increased by 1.02 (95% CI 1.01-1.03, P < .001) with each additional minute of surgery. Orthopedic reinforced gloves and double standard gloving were equally effective at preventing contamination events in small animal orthopedic procedures. Surgeons reluctant to double glove due to perceptions of decreased dexterity and discomfort may safely opt for wearing orthopedic gloves, which may improve their compliance. © 2017 The American College of Veterinary Surgeons.

  5. Strategies for reducing the complication of orthopedic pain perioperatively.

    PubMed

    Goodrich, Laurie R

    2008-12-01

    Equine orthopedic pain management has become a growing area of interest. Its importance has been emphasized in many studies showing that better pain management results in decreased postoperative complications such as chronic pain, support-limb laminitis, gastric ulceration, and gastrointestinal disease. This review is meant for the surgeon managing orthopedic pain pre-, peri-, and postoperatively.

  6. Improving Response Rates among Students with Orthopedic and Multiple Disabilities

    ERIC Educational Resources Information Center

    Wilkens, Christian P.; Kuntzler, Patrice M.; Cardenas, Shaun; O'Malley, Eileen; Phillips, Carolyn; Singer, Jacqueline; Stoeger, Alex; Kindler, Keith

    2014-01-01

    One challenge teachers of students with orthopedic and multiple disabilities face is providing sufficient time and opportunity to communicate. This challenge is universal across countries, schools, and settings: teachers want students to communicate because communication lies at the core of what makes us human. Yet students with orthopedic and…

  7. Improving Response Rates among Students with Orthopedic and Multiple Disabilities

    ERIC Educational Resources Information Center

    Wilkens, Christian P.; Kuntzler, Patrice M.; Cardenas, Shaun; O'Malley, Eileen; Phillips, Carolyn; Singer, Jacqueline; Stoeger, Alex; Kindler, Keith

    2014-01-01

    One challenge teachers of students with orthopedic and multiple disabilities face is providing sufficient time and opportunity to communicate. This challenge is universal across countries, schools, and settings: teachers want students to communicate because communication lies at the core of what makes us human. Yet students with orthopedic and…

  8. Young Children's Attitudes toward Orthopedic and Sensory Disabilities.

    ERIC Educational Resources Information Center

    DeGrella, Lanier H.; Green, Virginia P.

    1984-01-01

    Attitudes of 64 nondisabled children (three to seven years old) toward orthopedic and sensory disabilities were examined via the Test of Early Attitudes toward Disability. Responses indicated that bias against orthopedic and sensory disabilities increases with age but is not present among three-year-olds. (Author/CL)

  9. Delay to orthopedic consultation for isolated limb injury

    PubMed Central

    Rouleau, Dominique M.; Feldman, Debbie Ehrmann; Parent, Stefan

    2009-01-01

    ABSTRACT OBJECTIVE To describe referral mechanisms for referral to orthopedic surgery for isolated limb injuries in a public health care system and to identify factors affecting access. DESIGN Cross-sectional survey. SETTING Orthopedic surgery service in a level 1 trauma centre in Montreal, Que. PARTICIPANTS We conducted a prospective study of 166 consecutive adults (mean age 48 years) referred to orthopedic surgery for isolated limb injuries during a 4-month period. MAIN OUTCOME MEASURES Self-reported data on the nature of the trauma, the elapsed time between injury and orthopedic consultation, the number and type of previous primary care consultations, sociodemographic characteristics, and the level of satisfaction with care. RESULTS Average time between the injury and orthopedic consultation was 89 hours (range 3 to 642), with an average of 68 hours (range 0 to 642) for delay between primary care consultation and orthopedic consultation. A total of 36% of patients with time-sensitive diagnoses had unacceptable delays to orthopedic consultation according to the Quebec Orthopaedic Association guidelines. Lower limb injury, consulting first at another hospital, living far from the trauma centre, patient perception of low severity, and having a soft tissue injury were associated with longer delays. CONCLUSION Identifying gaps and risk factors for slower access might help improve referral mechanisms for orthopedic consultation. PMID:19826162

  10. Breastfeeding is early functional jaw orthopedics (an introduction).

    PubMed

    Page, D C

    2001-01-01

    Breastfeeding places beneficial orthopedic forces on the jaws, similar to the forces of Functional Jaw Orthopedics--the newest form of orthodontics. To date most breastfeeding benefits have been attributed to the content of mother's milk. The true orthopedic benefits of breastfeeding, suckling, deserve more definitive attention and research. Breastfeeding is early preventive Functional Jaw Orthopedics because breastfeeding forces impact the jaws during a very rapid period of infant jaw growth. Breast suckling aids proper development of the jaws which form the gateway to the human airway. Bottle, pacifier and digit sucking deform jaws and airways. Forward forces of suckling clearly oppose the backward forces of sucking. Dentists who understand the positive impact of forward orthopedic forces on the jaws should support and advocate exclusive breastfeeding for about 6 months.

  11. Evaluation of the translational and rotational forces acting on a highly ferromagnetic orthopedic spinal implant in magnetic resonance imaging.

    PubMed

    McComb, Christie; Allan, David; Condon, Barrie

    2009-02-01

    To assess the translational and rotational forces acting on a highly ferromagnetic orthopedic spinal implant in 1.5T and 3.0T magnetic resonance (MR) systems. The translational forces and rotational forces, or torques, acting on the implant were measured using existing methods and assessed using the guidelines produced by the American Society for Testing and Materials (ASTM). The measured translational forces were many times greater than for any other orthopedic implant previously recorded in the literature and, based on deflection angle criteria, would be considered unsafe in both MR systems. However, due to the rigid fixation of orthopedic implants in bone, implant migration is considered highly unlikely. Several constituent components of the implant were subjected to large torques, in some cases an order of magnitude greater than the corresponding torque due to gravity. However, the counterbalancing effect of the configuration of the combined implant results in a net torque that is less than the torque due to gravity. The translational and rotational forces acting on the implant in both 1.5T and 3.0T MR systems are substantial, but based on theoretical considerations are unlikely to result in implant migration or rotation.

  12. Biomaterial systems for orthopedic tissue engineering

    NASA Astrophysics Data System (ADS)

    Spoerke, Erik David

    2003-06-01

    The World Health Organization has estimated that one out of seven Americans suffers from a musculoskeletal impairment, annually incurring 28.6 million musculoskeletal injuries---more than half of all injuries. Bone tissue engineering has evolved rapidly to address this continued health concern. In the last decade, the focus of orthopedic biomaterials design has shifted from the use of common engineering metals and plastics to smart materials designed to mimic nature and elicit favorable bioresponse. Working within this new paradigm, this thesis explores unique chemical and materials systems for orthopedic tissue engineering. Improving on current titanium implant technologies, porous titanium scaffolds were utilized to better approximate the mechanical and structural properties of natural bone. These foam scaffolds were enhanced with bioactive coatings, designed to enhance osteoblastic implant colonization. The biopolymer poly(L-lysine) was incorporated into both hydroxypatite and octacalcium phosphate mineral phases to create modified organoapatite and pLys-CP coatings respectively. These coatings were synthesized and characterized on titanium surfaces, including porous structures such as titanium mesh and titanium foam. In addition, in vitro osteoblastic cell culture experiments probed the biological influences of these coatings. Organoapatite (OA) accelerated preosteoblastic colonization of titanium mesh and improved cellular ingrowth into titanium foam. Alternatively, the thin, uniform pLys-CP coating demonstrated significant potential as a substrate for chemically binding biological molecules and supramolecular assemblies. Biologically, pLys-CP demonstrated enhanced cellular attachment over titanium and inorganic calcium phosphate controls. Supramolecular self-assembled nanofiber assemblies were also explored both as stand-alone tissue engineering gels and as titanium coatings. Self-supporting nanofiber gels induced accelerated, biomimetic mineralization

  13. Ilizarov hybrid external fixation for fractures of the distal radius: Part II. Internal fixation versus Ilizarov hybrid external fixation: Stability as assessed by cadaveric simulated motion testing.

    PubMed

    Dunning, C E; Lindsay, C S; Bicknell, R T; Johnson, J A; King, G J; Patterson, S D

    2001-03-01

    The in vitro stability of an Ilizarov hybrid external fixator was compared with that of a dorsal 3.5-mm AO T-plate in 8 unpaired, fresh-frozen upper extremities. A specially designed testing device that used computer-controlled pneumatic actuators was used to simulate active finger, wrist, and forearm motions by applying loads to relevant tendons. A comminuted extra-articular distal radius fracture was modelled using a dorsally based wedge osteotomy. Fracture stability was assessed using an electromagnetic tracking device to measure motion across the fracture site after randomized application of the plate and the hybrid fixator. During simulated finger and wrist motions with the forearm pronated or supinated, motion of the distal fragment with the hybrid fixator applied was comparable to or statistically less than with the AO plate applied. During simulated forearm rotation, the stability provided by the 2 fixation types was similar, although the plate allowed statistically less radial-ulnar deviation of the fragment. In this model of a 2-part extra-articular distal radius fracture, the clinically meaningful stability of the Ilizarov hybrid external fixator was comparable to that of the dorsal AO plate.

  14. Biomechanical study on surgical fixation methods for minimally invasive treatment of hallux valgus.

    PubMed

    Mao, Rui; Guo, Junchao; Luo, Chenyu; Fan, Yubo; Wen, Jianmin; Wang, Lizhen

    2017-08-01

    Hallux valgus (HV) was one of the most frequent female foot deformities. The aim of this study was to evaluate mechanical responses and stabilities of the Kirschner, bandage and fiberglass fixations after the distal metatarsal osteotomy in HV treatment. Surface traction of different forefoot regions in bandage fixation and the biomechanical behavior of fiberglass bandage material were measured by a pressure sensor device and a mechanical testing, respectively. A three-dimensional foot finite element (FE) model was developed to simulate the three fixation methods (Kirschner, bandage and fiberglass fixations) in weight bearing. The model included 28 bones, sesamoids, ligaments, plantar fascia, cartilages and soft tissue. The peak Von Mises stress (MS) and compression stress (CS) of the distal fragment were predicted from the three fixation methods: Kirschner fixation (MS=6.71MPa, CS=1.232MPa); Bandage fixation (MS=14.90MPa, CS=9.642MPa); Fiberglass fixation (MS=15.83MPa, CS=19.70MPa). Compared with the Kirschner and bandage fixation, the fiberglass fixation reduced the relative movement of osteotomy fragments and obtained the maximum CS. We concluded that fiberglass fixation in HV treatment was helpful to the bone healing of distal fragment. The findings were expected to guide further therapeutic planning of HV patient. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

  15. The Use of Carbon-Fiber-Reinforced (CFR) PEEK Material in Orthopedic Implants: A Systematic Review

    PubMed Central

    Li, Chuan Silvia; Vannabouathong, Christopher; Sprague, Sheila; Bhandari, Mohit

    2015-01-01

    Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) has been successfully used in orthopedic implants. The aim of this systematic review is to investigate the properties, technical data, and safety of CFR-PEEK biomaterial and to evaluate its potential for new innovation in the design of articulating medical devices. A comprehensive search in PubMed and EMBASE was conducted to identify articles relevant to the outcomes of CFR-PEEK orthopedic implants. The search was also expanded by reviewing the reference sections of selected papers and references and benchmark reports provided by content experts. A total of 23 articles were included in this review. There is limited literature available assessing the performance of CFR-PEEK, specifically as an implant material for arthroplasty systems. Nevertheless, available studies strongly support CFR-PEEK as a promising and suitable material for orthopedic implants because of its biocompatibility, material characteristics, and mechanical durability. Future studies should continue to investigate CFR-PEEK’s potential benefits. PMID:25780341

  16. Orthopedic applications of silicon nitride ceramics.

    PubMed

    Bal, B S; Rahaman, M N

    2012-08-01

    Silicon nitride (Si(3)N(4)) is a ceramic material developed for industrial applications that demand high strength and fracture resistance under extreme operating conditions. Recently, Si(3)N(4) has been used as an orthopedic biomaterial, to promote bone fusion in spinal surgery and to develop bearings that can improve the wear and longevity of prosthetic hip and knee joints. Si(3)N(4) has been implanted in human patients for over 3 years now, and clinical trials with Si(3)N(4) femoral heads in prosthetic hip replacement are contemplated. This review will provide background information and data relating to Si(3)N(4) ceramics that will be of interest to engineering and medical professionals. Copyright © 2012 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  17. Animal models of orthopedic implant infection.

    PubMed

    An, Y H; Friedman, R J

    1998-01-01

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

  18. Enhancing orthopedic implant bioactivity: refining the nanotopography.

    PubMed

    Wang, Guocheng; Moya, Sergio; Lu, ZuFu; Gregurec, Danijela; Zreiqat, Hala

    2015-01-01

    Advances in nanotechnology open up new possibilities to produce biomimetic surfaces that resemble the cell in vivo growth environment at a nanoscale level. Nanotopographical changes of biomaterials surfaces can positively impact the bioactivity and ossointegration properties of orthopedic and dental implants. This review introduces nanofabrication techniques currently used or those with high potential for use as surface modification of biomedical implants. The interactions of nanotopography with water, proteins and cells are also discussed, as they largely determine the final success of the implants. Due to the well-documented effects of surface chemistry and microtopography on the bioactivity of the implant, we here elaborate on the ability of the nanofabrication techniques to combine the dual (multi) modification of surface chemistry and/or microtopography.

  19. Distraction osteogenesis: application to dentofacial orthopedics.

    PubMed

    Yen, S L

    1997-12-01

    Distraction osteogenesis is a surgical-orthopedic method for lengthening bone by separating or distracting a fracture callus. This technique has a long history in limb lengthening and has recently been used to lengthen mandibles and maxillae in human patients. Distraction osteogenesis represents a powerful method of producing unlimited quantities of living bone which can be formed along any plane of space. Because this method uses local host tissue, it offers many advantages over bone grafting. In the author's experience, large (10-22 mm) antero-posterior and vertical corrections of mandibles can be achieved using this technique. The purpose of this article is to review its biological basis and discuss recent clinical applications. This article reviews the history, theory, current management, and limitations of distraction osteogenesis in treating craniofacial anomalies.

  20. Correct coding for the orthopedic surgeon.

    PubMed

    Malek, M Mike; Friedman, Melvin M; Beach, William

    2002-04-01

    Coding accurately is one of the main principles of a successful practice. Some changes that we will see shortly include deletion of the term "separate procedure," deletion of the term "with and/or without," deletion of the term "any method," revision of the criteria for choosing E/M levels, and 52 new and revised Hand Surgery codes. Some other changes to come will be category II and category III codes. More changes are occurring as this is written, and the best advice is to stay tuned. It is obvious to the authors that coding is mainly for reimbursement purposes. The orthopedic surgeon must remain vigilant and must not pass this task on to someone else. Ignorance of coding methods is not an excuse [2]. We must all watch carefully and speak up when necessary. In this day of decreasing reimbursement, we can all increase our revenue stream without working any harder if we code our work properly, completely, and promptly.

  1. Application of Stem Cells in Orthopedics

    PubMed Central

    Schmitt, Andreas; van Griensven, Martijn; Imhoff, Andreas B.; Buchmann, Stefan

    2012-01-01

    Stem cell research plays an important role in orthopedic regenerative medicine today. Current literature provides us with promising results from animal research in the fields of bone, tendon, and cartilage repair. While early clinical results are already published for bone and cartilage repair, the data about tendon repair is limited to animal studies. The success of these techniques remains inconsistent in all three mentioned areas. This may be due to different application techniques varying from simple mesenchymal stem cell injection up to complex tissue engineering. However, the ideal carrier for the stem cells still remains controversial. This paper aims to provide a better understanding of current basic research and clinical data concerning stem cell research in bone, tendon, and cartilage repair. Furthermore, a focus is set on different stem cell application techniques in tendon reconstruction, cartilage repair, and filling of bone defects. PMID:22550505

  2. Bioactive glass coatings for orthopedic metallic implants

    SciTech Connect

    Lopez-Esteban, Sonia; Saiz, Eduardo; Fujino, Sigheru; Oku, Takeo; Suganuma, Katsuaki; Tomsia, Antoni P.

    2003-06-30

    The objective of this work is to develop bioactive glass coatings for metallic orthopedic implants. A new family of glasses in the SiO2-Na2O-K2O-CaO-MgO-P2O5 system has been synthesized and characterized. The glass properties (thermal expansion, softening and transformation temperatures, density and hardness) are in line with the predictions of established empirical models. The optimized firing conditions to fabricate coatings on Ti-based and Co-Cr alloys have been determined and related to the glass properties and the interfacial reactions. Excellent adhesion to alloys has been achieved through the formation of 100-200 nm thick interfacial layers (Ti5Si3 on Ti-based alloys and CrOx on Co-Cr). Finally, glass coatings, approximately 100 mu m thick, have been fabricated onto commercial Ti alloy-based dental implants.

  3. Blog and Podcast Watch: Orthopedic Emergencies

    PubMed Central

    Grock, Andrew; Rezaie, Salim; Swaminathan, Anand; Min, Alice; Shah, Kaushal H.; Lin, Michelle

    2017-01-01

    Introduction The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing ALiEM Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of orthopedic emergencies from the AIR series. Methods The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight AIR board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27–29 receive an honorable mention label, if the executive board agrees that the post is accurate and educationally valuable. Results A total of 87 blog posts and podcasts were evaluated. Key educational pearls from the three AIR posts and the 14 honorable mentions are summarized. Conclusion The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on orthopedic emergencies. PMID:28435507

  4. Orthopedic surgical analyzer for percutaneous vertebroplasty

    NASA Astrophysics Data System (ADS)

    Tack, Gye Rae; Choi, Hyung Guen; Lim, Do H.; Lee, Sung J.

    2001-05-01

    Since the spine is one of the most complex joint structures in the human body, its surgical treatment requires careful planning and high degree of precision to avoid any unwanted neurological compromises. In addition, comprehensive biomechanical analysis can be very helpful because the spine is subject to a variety of load. In case for the osteoporotic spine in which the structural integrity has been compromised, it brings out the double challenges for a surgeon both clinically and biomechanically. Thus, we have been developing an integrated medical image system that is capable of doing the both. This system is called orthopedic surgical analyzer and it combines the clinical results from image-guided examination and the biomechanical data from finite element analysis. In order to demonstrate its feasibility, this system was applied to percutaneous vertebroplasty. Percutaneous vertebroplasty is a surgical procedure that has been recently introduced for the treatment of compression fracture of the osteoporotic vertebrae. It involves puncturing vertebrae and filling with polymethylmethacrylate (PMMA). Recent studies have shown that the procedure could provide structural reinforcement for the osteoporotic vertebrae while being minimally invasive and safe with immediate pain relief. However, treatment failures due to excessive PMMA volume injection have been reported as one of complications. It is believed that control of PMMA volume is one of the most critical factors that can reduce the incidence of complications. Since the degree of the osteoporosis can influence the porosity of the cancellous bone in the vertebral body, the injection volume can be different from patient to patient. In this study, the optimal volume of PMMA injection for vertebroplasty was predicted based on the image analysis of a given patient. In addition, biomechanical effects due to the changes in PMMA volume and bone mineral density (BMD) level were investigated by constructing clinically

  5. The orthopedic diseases of ancient Egypt.

    PubMed

    Fritsch, Klaus O; Hamoud, Heshem; Allam, Adel H; Grossmann, Alexander; Nur El-Din, Abdel-Halim; Abdel-Maksoud, Gomaa; Soliman, Muhammad Al-Tohamy; Badr, Ibrahim; Sutherland, James D; Sutherland, M Linda; Akl, Mahmoud; Finch, Caleb E; Thomas, Gregory S; Wann, L Samuel; Thompson, Randall C

    2015-06-01

    CT scanning of ancient human remains has the potential to provide insights into health and diseases. While Egyptian mummies have undergone CT scans in prior studies, a systematic survey of the orthopedic conditions afflicting a group of these ancient individuals has never been carried out. We performed whole body CT scanning on 52 ancient Egyptian mummies using technique comparable to that of medical imaging. All of the large joints and the spine were systematically examined and osteoarthritic (OA) changes were scored 0-4 using Kellgren and Lawrence classification. The cruciate ligaments and menisci could be identified frequently. There were much more frequent OA changes in the spine (25 mummies) than in the large joints (15 cases of acromioclavicular and/or glenohumeral joint OA changes, five involvement of the ankle, one in the elbow, four in the knee, and one in the hip). There were six cases of scoliosis. Individual mummies had the following conditions: juvenile aseptic necrosis of the hip (Perthes disease), stage 4 osteochondritis dissecans of the knee, vertebral compression fracture, lateral patella-femoral joint hyper-compression syndrome, severe rotator cuff arthropathy, rotator cuff impingement, hip pincer impingement, and combined fracture of the greater trochantor and vertebral bodies indicating obvious traumatic injury. This report includes the most ancient discovery of several of these syndromes. Ancient Egyptians often suffered painful orthopedic conditions. The high frequency of scoliosis merits further study. The pattern of degenerative changes in the spine and joints may offer insights into activity levels of these people. © 2015 Wiley Periodicals, Inc.

  6. Comparison of polyvinyl alcohol fixative with three less hazardous fixatives for detection and identification of intestinal parasites.

    PubMed

    Jensen, B; Kepley, W; Guarner, J; Anderson, K; Anderson, D; Clairmont, J; De L'aune, W; Austin, E H; Austin, G E

    2000-04-01

    Polyvinyl alcohol (PVA) containing the fixative mercuric chloride is considered the "gold standard" for the fixation of ova and parasites in the preparation of permanently stained smears of stool specimens. However, mercuric chloride is potentially hazardous to laboratory personnel and presents disposal problems. We compared three new alternative, nontoxic fixatives with PVA, analyzing ease of sample preparation and quality of smears. Sixty-eight fresh stool specimens were divided into aliquots and placed in each of four different fixatives: PARASAFE (PS) (Scientific Devices Laboratory, Inc., Des Plaines, Ill.), ECOFIX (EC) (Meridian Diagnostics, Inc., Cincinnati, Ohio), Proto-Fix (PF) (Alpha-Tec Systems, Inc., Vancouver, Wash.), and low-viscosity PVA fixative (PVA) (Meridian). Specimens were processed and stained according to each manufacturer's directions. Parasites were found in 31 of 68 slide preparations with PVA, 31 with PF, 30 with EC, and 30 with PS. Blastocystis hominis and Iodamoeba bütschlii were preserved in a readily identifiable state by all methods of fixation. However, some parasites were more easily identified with some of the fixatives because of differences in parasite distortion. For example, Entamoeba histolytica (Entamoeba dispar) was detected in 13 stools fixed with PF, 7 with PVA, and 6 with EC but none with PS. Likewise, Chilomastix mesnili was identified in 13 specimens fixed with PF, 8 with EC, and 5 with PVA but only 1 with PS, while Entamoeba coli was seen much less frequently with PS than with the other three fixatives. A dirty background was observed in 41% of specimens prepared with PS, whereas background quality was acceptable with other fixatives. Sample preparation was most rapid with PS, although the EC method involved the fewest steps. In conclusion, PVA and PF produced the least parasite distortion, while PS proved unsatisfactory for the identification of E. histolytica, E. coli, and C. mesnili. Both PF and EC appear to be

  7. Comparison of Polyvinyl Alcohol Fixative with Three Less Hazardous Fixatives for Detection and Identification of Intestinal Parasites

    PubMed Central

    Jensen, B.; Kepley, W.; Guarner, J.; Anderson, K.; Anderson, D.; Clairmont, J.; De l'aune, William; Austin, E. H.; Austin, G. E.

    2000-01-01

    Polyvinyl alcohol (PVA) containing the fixative mercuric chloride is considered the “gold standard” for the fixation of ova and parasites in the preparation of permanently stained smears of stool specimens. However, mercuric chloride is potentially hazardous to laboratory personnel and presents disposal problems. We compared three new alternative, nontoxic fixatives with PVA, analyzing ease of sample preparation and quality of smears. Sixty-eight fresh stool specimens were divided into aliquots and placed in each of four different fixatives: PARASAFE (PS) (Scientific Devices Laboratory, Inc., Des Plaines, Ill.), ECOFIX (EC) (Meridian Diagnostics, Inc., Cincinnati, Ohio), Proto-Fix (PF) (Alpha-Tec Systems, Inc., Vancouver, Wash.), and low-viscosity PVA fixative (PVA) (Meridian). Specimens were processed and stained according to each manufacturer's directions. Parasites were found in 31 of 68 slide preparations with PVA, 31 with PF, 30 with EC, and 30 with PS. Blastocystis hominis and Iodamoeba bütschlii were preserved in a readily identifiable state by all methods of fixation. However, some parasites were more easily identified with some of the fixatives because of differences in parasite distortion. For example, Entamoeba histolytica (Entamoeba dispar) was detected in 13 stools fixed with PF, 7 with PVA, and 6 with EC but none with PS. Likewise, Chilomastix mesnili was identified in 13 specimens fixed with PF, 8 with EC, and 5 with PVA but only 1 with PS, while Entamoeba coli was seen much less frequently with PS than with the other three fixatives. A dirty background was observed in 41% of specimens prepared with PS, whereas background quality was acceptable with other fixatives. Sample preparation was most rapid with PS, although the EC method involved the fewest steps. In conclusion, PVA and PF produced the least parasite distortion, while PS proved unsatisfactory for the identification of E. histolytica, E. coli, and C. mesnili. Both PF and EC appear to be

  8. Nitrogen fixation apparatus

    DOEpatents

    Chen, Hao-Lin

    1984-01-01

    A method and apparatus for achieving nitrogen fixation includes a volumetric electric discharge chamber. The volumetric discharge chamber provides an even distribution of an electron beam, and enables the chamber to be maintained at a controlled energy to pressure (E/p) ratio. An E/p ratio of from 5 to 15 kV/atm of O.sub.2 /cm promotes the formation of vibrationally excited N.sub.2. Atomic oxygen interacts with vibrationally excited N.sub.2 at a much quicker rate than unexcited N.sub.2, greatly improving the rate at which NO is formed.

  9. Colored Indicator Undergloves Increase the Detection of Glove Perforations by Surgeons During Small Animal Orthopedic Surgery: A Randomized Controlled Trial

    PubMed Central

    Gilman, Oliver P.; Parsons, Kevin J.; Burton, Neil J.; Langley‐Hobbs, Sorrel J.

    2016-01-01

    Objective To determine whether use of colored indicator gloves affects perforation detection rate and to identify risk factors for glove perforation during veterinary orthopedic surgery. Study Design Prospective randomized controlled trial. Sample Population 574 double pairs of gloves worn during 300 orthopedic surgical procedures (2,296 gloves). Methods Primary and assistant surgeons double‐gloved for all orthopedic surgical procedures. Type of inner glove (standard or colored indicator) was randomized for the first 360 double pairs of gloves worn by surgeons during 180 procedures. Perforations detected by surgeons were recorded and gloves changed if requested. For a further 120 procedures, indicator gloves were used exclusively. All gloves were leak‐tested after surgery to identify perforations. Association between potential risk factors and perforation was explored using multivariate logistical regression analysis. Results Glove perforations occurred during 43% of surgeries with a mean of 2.3 holes/surgery. Inner gloves were intact in 63% of glove pairs where an outer perforation occurred. Intraoperative perforation detection was improved when colored indicator gloves were worn (83% sensitivity) vs. standard gloves (34% sensitivity; P<.001). Independent risk factors for perforation were placement of plates and/or screws (P=.001; OR=2.4; 95% CI, 1.4–4.0), placement of an external skeletal fixator (P=.002; OR=7.0; 95% CI, 2.1–23.8), use of orthopedic wire (P=.011; OR=2.4; 95% CI, 1.2–4.7), and primary surgeon being board‐certified (P=.016; OR=1.9; 95% CI, 1.1–3.1). Conclusion Increased surgeon recognition of glove perforations through use of colored indicator gloves enables prompt change of gloves if perforation occurs and may reduce potential contamination of the surgical site. PMID:27412490

  10. Use of Hardware Battery Drill in Orthopedic Surgery.

    PubMed

    Satish, Bhava R J; Shahdi, Masood; Ramarao, Duddupudi; Ranganadham, Atmakuri V; Kalamegam, Sundaresan

    2017-03-01

    Among the power drills (Electrical/Pneumatic/Battery) used in Orthopedic surgery, battery drill has got several advantages. Surgeons in low resource settings could not routinely use Orthopedic battery drills (OBD) due to the prohibitive cost of good drills or poor quality of other drills. "Hardware" or Engineering battery drill (HBD) is a viable alternative to OBD. HBD is easy to procure, rugged in nature, easy to maintain, durable, easily serviceable and 70 to 75 times cheaper than the standard high end OBD. We consider HBD as one of the cost effective equipment in Orthopedic operation theatres.

  11. Insights into Avicenna's knowledge of the science of orthopedics.

    PubMed

    Dalfardi, Behnam; Yarmohammadi, Hassan; Meibodi, Mohammad Kalantari

    2014-01-18

    The art of orthopedics traces its history back to ancient civilizations like those of the Egyptians. The evolution of this branch of medicine is indebted to investigations of many scientists, including Greek, Roman and Persian scholars. The Persian physician Avicenna (980-1037 AD) is one such scientist who investigated different aspects of orthopedics. It is possible to analyze Avicenna's knowledge of orthopedics and his contributions to this branch of medicine by an examination of his epic encyclopedia of medicine, Al-Qanun fi al-Tibb (The Canon of Medicine).

  12. External fixators in haemophilia.

    PubMed

    Lee, V; Srivastava, A; PalaniKumar, C; Daniel, A J; Mathews, V; Babu, N; Chandy, M; Sundararaj, G D

    2004-01-01

    External fixators (EF) are not commonly used for patients with haemophilia. We describe the use of EF (Ilizarov, AO- uni- and bi-planar fixators and Charnley clamp) in nine patients (mean age: 19.2 years; range: 9-37) with haemophilia for the following indications - arthrodesis of infected joints, treatment of open fractures and osteoclasis. EF required an average of nine skin punctures [range: 4-17 were maintained for a period of 15 weeks (range: 8-29.5), without regular factor replacement, till bone healing was adequate and were removed with a single dose of factor infusion]. The mean preoperative factor level achieved was 85% (range: 64-102%). Much lower levels were subsequently maintained till wound healing. The average total factor consumption was 430 IU kg(-1) (range: 240-870), administered over a period of 17 days (range: 9-44). There were no major complications related to EF except in a patient who developed inhibitors. In conclusion, EF can be used safely in haemophilic patients who do not have inhibitors and does not require prolonged factor replacement.

  13. The Sequoia circular fixator for limb lengthening.

    PubMed

    Hardy, J M; Tadlaoui, A; Wirotius, J M; Saleh, M

    1991-10-01

    With the Sequoia fixator, lengthenings can be achieved based on the clinical facts of the case. The device is a modular apparatus that can perform corrections in several planes, and, if necessary, in a septic environment. In our opinion, a "lengthener surgeon" is one who can foresee problems and take appropriate steps to prevent them. Likewise, the surgeon must act as the coordinator of an entire team. A successful lengthening is 5% surgery and 95% postoperative nursing and physiotherapy care. In the future, a number of changes will simplify postoperative management: 1. Composite carbon rings will make the frames radiolucent and one third lighter than those made of stainless steel. Automatic tensioners will help maintain steady tension on the wires. 2. Digital analysis of the callus will provide norms of consolidation, allowing faster fixator removal and conversion to an orthosis. 3. Incorporating the foot in the frame to overcome equinus will eliminate the need for tenotomy. We believe that monolateral and ring fixators can work together in certain locations. That is why we proposed, at the 18th Societé Internationale de Chirurgie Orthopédique et Traumatologique meeting, a combined monolateral-ring construct that can be used for lengthening throughout the proximal femoral metaphysis.

  14. Closed Reduction and Percutaneous Fixation of Calcaneal Fractures in Children.

    PubMed

    Feng, Yongzeng; Yu, Yang; Shui, Xiaolong; Ying, Xiaozhou; Cai, Leyi; Hong, Jianjun

    2016-07-01

    Open reduction and internal fixation has been widely used to treat displaced intra-articular calcaneus fractures in children. However, the complications of surgical trauma and the wound created through the extended lateral approach cannot be ignored. This study analyzed the outcomes of displaced intra-articular calcaneal fractures in children treated with closed reduction and percutaneous fixation. Medical records of pediatric patients who had displaced intra-articular calcaneus fractures and underwent closed reduction and percutaneous fixation at the study institution between January 2008 and January 2013 were reviewed. Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. Clinical outcomes and radiographic findings were assessed at postoperative follow-up. The study included 14 displaced intra-articular calcaneal fractures in 11 patients (7 boys and 4 girls). Mean patient age was 11.18 years (range, 6-16 years), and average follow-up time was 42.8 months postoperatively (range, 12-72 months). There were 6 tongue-type fractures and 8 joint depression-type fractures, based on the Essex-Lopresti classification, and there were 11 type II and 3 type III fractures, based on the Sanders classification. Average Böhler angle was 8.00° (range, -5° to 18°) preoperatively and 30.79° (range, 26° to 40°) postoperatively (P<.001). Average subjective American Orthopaedic Foot and Ankle Society hindfoot score was 65.7 (range, 52-68). No patients had wound breakdown or infection. In the treatment of displaced intra-articular calcaneal fractures in pediatric patients, closed reduction and percutaneous fixation achieved good outcomes, with few complications. [Orthopedics. 2016; 39(4):e744-e748.]. Copyright 2016, SLACK Incorporated.

  15. 21 CFR 872.4880 - Intraosseous fixation screw or wire.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Section 872.4880 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES.... (a) Identification. An intraosseous fixation screw or wire is a metal device intended to be inserted into fractured jaw bone segments to prevent their movement. (b) Classification. Class II. ...

  16. 21 CFR 872.4880 - Intraosseous fixation screw or wire.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Section 872.4880 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES.... (a) Identification. An intraosseous fixation screw or wire is a metal device intended to be inserted into fractured jaw bone segments to prevent their movement. (b) Classification. Class II. ...

  17. 21 CFR 872.4880 - Intraosseous fixation screw or wire.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Section 872.4880 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES.... (a) Identification. An intraosseous fixation screw or wire is a metal device intended to be inserted into fractured jaw bone segments to prevent their movement. (b) Classification. Class II. ...

  18. Recent advances in standing equine orthopedic surgery.

    PubMed

    O'Brien, Thomas; Hunt, Robert J

    2014-04-01

    In all surgeries with the patient standing under chemical and physical restraint, patient compliance is of the utmost importance. All fractures of the third metacarpal or metatarsal condyles and sagittal fracture of the first phalanx are not amenable to internal fixation with the horse standing, and young unhandled horses may not have a suitable disposition for standing surgical treatment of septic pedal osteitis, or implantation and removal of transphyseal screws. Previous operator experience in performing the procedure or technique under general anesthesia is beneficial. Appreciation of appropriate topographic anatomic landmarks is important, and intraoperative radiographic control is useful. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. 21 CFR 888.3030 - Single/multiple component metallic bone fixation appliances and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., such as screws and nails, or bolts, nuts, and washers. These devices are used for fixation of fractures..., supracondylar, or condylar fractures of the femur; for fusion of a joint; or for surgical procedures that...

  20. 21 CFR 888.3030 - Single/multiple component metallic bone fixation appliances and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., such as screws and nails, or bolts, nuts, and washers. These devices are used for fixation of fractures..., supracondylar, or condylar fractures of the femur; for fusion of a joint; or for surgical procedures that...

  1. Eighth international congress on nitrogen fixation

    SciTech Connect

    Not Available

    1990-01-01

    This volume contains the proceedings of the Eighth International Congress on Nitrogen Fixation held May 20--26, 1990 in Knoxville, Tennessee. The volume contains abstracts of individual presentations. Sessions were entitled Recent Advances in the Chemistry of Nitrogen Fixation, Plant-microbe Interactions, Limiting Factors of Nitrogen Fixation, Nitrogen Fixation and the Environment, Bacterial Systems, Nitrogen Fixation in Agriculture and Industry, Plant Function, and Nitrogen Fixation and Evolution.

  2. [Orthopedic shoes: Still in touch with the times?].

    PubMed

    Greitemann, B

    2015-11-01

    Deformities of the foot due to rheumatic disease, particularly rheumatoid arthritis, occur in 85-95% of patients during the course of their disease. This study investigates whether treatment with orthopedic shoes still has a place in modern therapies. Foot orthotics and technical orthopedic shoes can play an important role in purely conservative treatment as well as postoperative therapy. Due to a lack of knowledge concerning modern orthopedic shoe techniques, this treatment option has slipped out of focus--in part because of its association with the old-fashioned unshapely black orthopedic shoes. Nevertheless, these shoes can contribute significantly to maintenance of patient mobility; a factor of extreme importance to the individuals who already suffer considerably from the disease per se.

  3. Orthopedic Health: Joint Health and Care: Prevention, Symptoms, Diagnosis & Treatment

    MedlinePlus

    ... Past Issues Orthopedic Health Joint Health and Care: Prevention, Symptoms, Diagnosis & Treatment Past Issues / Spring 2009 Table ... version of this page please turn Javascript on. Prevention Regular exercise, a balanced diet, and a healthful ...

  4. Orthopedic Health: Osteoarthritis— What You Should Know (quiz)

    MedlinePlus

    ... Bar Home Current Issue Past Issues Orthopedic Health Osteoarthritis— What You Should Know Past Issues / Spring 2009 ... Javascript on. How much do you know about osteoarthritis, its causes, and its therapies? Take this quiz ...

  5. The Effects of Standardized Feedback on Orthopedic Patient Evaluation Skills.

    ERIC Educational Resources Information Center

    DaRosa, Debra A.; And Others

    1984-01-01

    A study examined whether there are performance differences between surgery clerks provided corrective reinforcement on orthopedic history and physical examination write-ups and those assessed by traditional feedback means when both groups are exposed to the feedback instrument. (MLW)

  6. 45 CFR 1308.12 - Eligibility criteria: Orthopedic impairment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... affect a child's learning. An orthopedic impairment involves muscles, bones, or joints and is... gross motor activities, or to perform self-help skills and by adversely affected educational performance...

  7. 45 CFR 1308.12 - Eligibility criteria: Orthopedic impairment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... affect a child's learning. An orthopedic impairment involves muscles, bones, or joints and is... gross motor activities, or to perform self-help skills and by adversely affected educational performance...

  8. 45 CFR 1308.12 - Eligibility criteria: Orthopedic impairment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... affect a child's learning. An orthopedic impairment involves muscles, bones, or joints and is... gross motor activities, or to perform self-help skills and by adversely affected educational performance...

  9. 45 CFR 1308.12 - Eligibility criteria: Orthopedic impairment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... affect a child's learning. An orthopedic impairment involves muscles, bones, or joints and is... gross motor activities, or to perform self-help skills and by adversely affected educational performance...

  10. 45 CFR 1308.12 - Eligibility criteria: Orthopedic impairment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... affect a child's learning. An orthopedic impairment involves muscles, bones, or joints and is... gross motor activities, or to perform self-help skills and by adversely affected educational performance...

  11. Rehabilitation of orthopedic and rheumatologic disorders. 4. Musculoskeletal disorders.

    PubMed

    Kaelin, D L; Oh, T H; Lim, P A; Brander, V A; Biundo, J J

    2000-03-01

    This self-directed learning module highlights assessment and therapeutic options in the rehabilitation of patients with orthopedic and musculoskeletal disorders. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses new advances in such topics as idiopathic scoliosis, nontraumatic shoulder pain, rotator cuff tendinitis, and Dupuytren's disease.

  12. Battlefield Acquired Immunogenicity to Metals Affects Orthopedic Implant Outcome

    DTIC Science & Technology

    2011-10-01

    Award Number: W81XWH-10-2-0138 TITLE: Battlefield Acquired Immunogenicity to Metals Affects Orthopedic Implant Outcome PRINCIPAL INVESTIGATOR...September 2011 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Battlefield Acquired Immunogenicity to Metals Affects Orthopedic Implant Outcome 5b. GRANT NUMBER...of immune cells isolated during a typical blood draw (6 regular blood draw tubes totaling 60mL) from soldiers exposed to metals in battle and

  13. Orthopedic surgery postgraduate year 1 intern curriculum improves initial orthopedic in-training examination performance.

    PubMed

    Roberts, Craig S; Nyland, John; Broome, Brandon

    2012-04-01

    To determine the efficacy of an educational curriculum designed for orthopedic surgery postgraduate year 1 (PGY-1) interns to improve initial Orthopedic In-Training Examination (OITE) performance. A retrospective cohort study was performed that evaluated the PGY-1 intern OITE performance of one residency training program (n = 55) during 7-year periods before (1996-2002) and after structured curriculum implementation (2003-2009). Linear regression analysis revealed insignificant changes in median PGY-1 intern OITE percentile rank during the precurriculum period (R = 0.08, P = 0.53). Postcurriculum period comparisons revealed significantly improving PGY-1 intern OITE percentile rank (R = 0.46, P = 0.048). Pre- and postcurriculum median US Medical Licensing Examination (USMLE) Step I scores did not display statistically significant differences (218.2 ± 6.6 vs 229.1 ± 13.8, Mann-Whitney U test, z = -1.5, P = 0.10). Spearman rho correlations revealed a moderate relation (r = 0.61) between postcurriculum PGY-1 intern OITE percentile rank and USMLE Step I score, but not during the precurriculum period. A moderate relation (r = 0.50) also was observed between postcurriculum USMLE Step I score and average OITE percentile rank during the 5-year residency program, but not during the precurriculum period. PGY-1 intern OITE percentile rank improved significantly with the addition of a specially designed educational curriculum. The stronger USMLE Step I score and PGY-1 intern OITE percentile rank relation observed during the postcurriculum period suggests that interns who participated in the educational curriculum were better prepared to translate general medical and patient care knowledge into orthopedic surgery knowledge.

  14. [External fixator: surgical technique, pinless fixator, change in procedure].

    PubMed

    Oberli, H; Frigg, R; Schenk, R

    1994-12-01

    External Fixation-Technique: The advantages of external over internal fixation are as follows: a) endosteal and periosteal blood supply is undisturbed, b) "low-tech" equipment may be used, c) secondary adjustments are possible and d) easy implant removal. These benefits however are outweighed by the main disadvantages of long term external fixation i.e. pin complications and delayed union of fractures. Better understanding of postoperative management and careful application of screws of improved design will lead to better results. Today's standard applications of external fixation for tibial fractures is a unilateral fixator, using Schanz screws. The pin-bone interface is the most critical site of all external fixation. By avoiding heat necrosis (low temperature drilling) and preventing micro motion at the pin-bone interface (by applying bending- or more recently radial-preload), pin complications such as infection and loosening can be reduced. Two Schanz screws are inserted into each main fragment and are connected with one short tube per fragment. The fracture is then reduced by using these tubes as handles. After reduction a third tube connects the first two by means of two tube-to-tube clamps. This type of fixation will easily allow for three dimensional secondary corrections of alignment. Approximately three weeks following the injury some motion at the fracture site will stimulate callus formation. This can be achieved by destabilisation, dynamisation or "active stimulation" of the fracture site [2]. Pinless fixator: The pinless external fixator holds the fragments firmly with pointed clamps that penetrate about one millimeter into cortical bone without entering and contaminating the medullary canal.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Orthopedic surgery and its complication in systemic lupus erythematosus

    PubMed Central

    Mak, Anselm

    2014-01-01

    Systemic lupus erythematosus (SLE) is a multi-systemic immune-complex mediated autoimmune condition which chiefly affects women during their prime year. While the management of the condition falls into the specialty of internal medicine, patients with SLE often present with signs and symptoms pertaining to the territory of orthopedic surgery such as tendon rupture, carpal tunnel syndrome, osteonecrosis, osteoporotic fracture and infection including septic arthritis, osteomyelitis and spondylodiscitis. While these orthopedic-related conditions are often debilitating in patients with SLE which necessitate management by orthopedic specialists, a high index of suspicion is necessary in diagnosing these conditions early because lupus patients with potentially severe orthopedic conditions such as osteomyelitis frequently present with mild symptoms and subtle signs such as low grade fever, mild hip pain and back tenderness. Additionally, even if these orthopedic conditions can be recognized, complications as a result of surgical procedures are indeed not uncommon. SLE per se and its various associated pharmacological treatments may pose lupus patients to certain surgical risks if they are not properly attended to and managed prior to, during and after surgery. Concerted effort of management and effective communication among orthopedic specialists and rheumatologists play an integral part in enhancing favorable outcome and reduction in postoperative complications for patients with SLE through thorough pre-operative evaluation, careful peri-operative monitoring and treatment, as well as judicious postoperative care. PMID:24653977

  16. The 50 most cited articles in pediatric orthopedic surgery.

    PubMed

    Baldwin, Keith D; Kovatch, Kevin; Namdari, Surena; Sankar, Wudbhuv; Flynn, John M; Dormans, John P

    2012-09-01

    Quantity of citation is often used as a surrogate measurement of an article's importance or relevance in a given field. To date, there has been no study on citation quantity or density in pediatric orthopedics. We present such an analysis. We reviewed all articles in the ISI web of science under the subheading 'orthopedics' to find articles of relevance to pediatric orthopedic surgeons. We subsequently analyzed the characteristics of the most cited articles in terms of the level of evidence, journal of publication, and subcategory of pediatric orthopedics. The majority of the top 50 articles in pediatric orthopedics were from the 1970s and 1980s. All the articles were in English. Uncontrolled case series comprised the largest single level of evidence (level IV). We describe the top 50 articles in pediatric orthopedics by citation and citation density. The level of evidence for highly cited papers was low. Although many of these articles were written by the great thinkers of our field, a need exists for more rigorous methodology.

  17. Biofilm Disrupting Technology for Orthopedic Implants: What's on the Horizon?

    PubMed

    Connaughton, Alexander; Childs, Abby; Dylewski, Stefan; Sabesan, Vani J

    2014-01-01

    The use of orthopedic implants in joints has revolutionized the treatment of patients with many debilitating chronic musculoskeletal diseases such as osteoarthritis. However, the introduction of foreign material into the human body predisposes the body to infection. The treatment of these infections has become very complicated since the orthopedic implants serve as a surface for multiple species of bacteria to grow at a time into a resistant biofilm layer. This biofilm layer serves as a protectant for the bacterial colonies on the implant making them more resistant and difficult to eradicate when using standard antibiotic treatment. In some cases, the use of antibiotics alone has even made the bacteria more resistant to treatment. Thus, there has been surge in the creation of non-antibiotic anti-biofilm agents to help disrupt the biofilms on the orthopedic implants to help eliminate the infections. In this study, we discuss infections of orthopedic implants in the shoulder then we review the main categories of anti-biofilm agents that have been used for the treatment of infections on orthopedic implants. Then, we introduce some of the newer biofilm disrupting technology that has been studied in the past few years that may advance the treatment options for orthopedic implants in the future.

  18. [Technical orthopedics. Importance in an increasingly operatively oriented faculty].

    PubMed

    Greitemann, B; Maronna, U

    2013-10-01

    The foundation of the German Society for Orthopedics in 1901 was due to a separation from the faculty of surgery because a surgical approach alone did not adequately deal with the symptoms. Orthopedists were initially considered as a fringe group. The conservative treatment approach was initially at the forefront and operative measures were a side line. The main aim was the rehabilitation of patients into a normal life as best as possible. In the conservative area treatment with orthopedic technical aids and appliances rapidly came to play an important role and a great multitude of technical appliances were developed with sometimes very different possible applications. Despite the clearly improved operative treatment approaches in orthopedics and trauma surgery, technical orthopedics still plays a substantial role even today. Healing and supportive aids and appliances are of decisive importance for the treatment of a multitude of diseases and handicaps. They stabilize and improve operative treatment results and often result in new approaches. This depends on cooperation between technicians, therapists and physicians in a team, even in the scientific field. Evidence-based studies on the effectiveness of technical aids are currently still uncommon but recently some clear evidence for effectiveness could be shown. Scientifically this is a very varied field of work. The demographic development presents new requirements which must be dealt with. Technical solutions are often very promising especially in this field. Technical orthopedics remains an important component of the specialty of orthopedics and trauma surgery and with an increasing tendency due to more recent research and development.

  19. Preferred use of polyhexanide in orthopedic surgery.

    PubMed

    Röhner, Eric; Seeger, Jörn B; Hoff, Paula; Pfitzner, Tilman; Preininger, Bernd; Andreas, Kristin; Buttgereit, Frank; Perka, Carsten; Matziolis, Georg

    2011-10-05

    In orthopedic and trauma surgery, the most frequently used antiseptic is polyhexanide. Its favored application is based on prepossessing tissue compatibility in contrast to various antiseptics and a high antimicrobiological effect. Recent studies showed toxic effects of this antiseptic on human chondrocytes. The aim of this study was to further analyze the toxic and apoptotic effects of polyhexanide on primary human chondrocytes. The hypothesis of this study was that polyhexanide induces apoptosis on human chondrocytes. Primary human chondrocytes were isolated and cultured from human donors with osteoarthritis of the knee who underwent total arthroplasty and had no indication of infection. Polyhexanide at a standard concentration of 0.04% was added to the monolayer cultures. Early and late apoptotic cells were analyzed by flow cytometric detection of annexin V, active caspases, and 7AAD, and by fluorescence microscopy using annexin V and propidium iodide staining. Flow cytometric analysis demonstrated an increase of annexin V and active caspases expression of human chondrocytes after incubation with polyhexanide. Fluorescence microscopy demonstrated a high number of annexin V positive and propidium iodide negative early apoptotic cells. The data show that polyhexanide promotes apoptosis on primary human chondrocytes in vitro, which may indicate the use of polyhexanide in septic joint surgery. Copyright 2011, SLACK Incorporated.

  20. Computer-assisted surgery in orthopedic oncology

    PubMed Central

    Gerbers, Jasper G; Stevens, Martin; Ploegmakers, Joris JW; Bulstra, Sjoerd K; Jutte, Paul C

    2014-01-01

    Background and purpose — In orthopedic oncology, computer-assisted surgery (CAS) can be considered an alternative to fluoroscopy and direct measurement for orientation, planning, and margin control. However, only small case series reporting specific applications have been published. We therefore describe possible applications of CAS and report preliminary results in 130 procedures. Patients and methods — We conducted a retrospective cohort study of all oncological CAS procedures in a single institution from November 2006 to March 2013. Mean follow-up time was 32 months. We categorized and analyzed 130 procedures for clinical parameters. The categories were image-based intralesional treatment, image-based resection, image-based resection and reconstruction, and imageless resection and reconstruction. Results — Application to intralesional treatment showed 1 inadequate curettage and 1 (other) recurrence in 63 cases. Image-based resections in 42 cases showed 40 R0 margins; 16 in 17 pelvic resections. Image-based reconstruction facilitated graft creation with a mean reconstruction accuracy of 0.9 mm in one case. Imageless CAS was helpful in resection planning and length- and joint line reconstruction for tumor prostheses. Interpretation — CAS is a promising new development. Preliminary results show a high number of R0 resections and low short-term recurrence rates for curettage. PMID:25140984

  1. The white blood cell scan in orthopedics

    SciTech Connect

    Propst-Proctor, S.L.; Dillingham, M.F.; McDougall, I.R.; Goodwin, D.

    1982-08-01

    A new nuclear scanning technique was found more specific for bone, joint, and soft tissue infections than any previously described scanning technique. The leukocyte scan, whereby a patient's own cells are labeled with a radioactive tagging agent (/sup 111/In oxine), can distinguish an active infectious process from other pain-inducing conditions. Ninety-seven /sup 111/In labeled autologous leukocyte scans were performed in 88 patients. The findings in 17 of 40 patients scanned for possible acute osteomyelitis, six of nine for suspected septic arthritis, and six for possible soft tissue infections, were positive. Subsequent clinical courses verified the infectious nature of these processes in all patients. Patients who had chronic osteomyelitis (14), bony metastases (four patients), heterotopic ossification (three), and degenerative arthritis (two) demonstrated negative findings. Of the seven patients scanned for acute long-bone fractures, one demonstrated positive findings. Nine scans demonstrated positive findings without determined causes. The leukocyte scan is a useful addition to the diagnostic tools of the orthopedic surgeon.

  2. Functionally graded materials for orthopedic applications - an update on design and manufacturing.

    PubMed

    Sola, Antonella; Bellucci, Devis; Cannillo, Valeria

    2016-01-01

    Functionally graded materials (FGMs) are innovative materials whose composition and/or microstructure gradually vary in space according to a designed law. As a result, also the properties gradually vary in space, so as to meet specific non-homogeneous service requirements without any abrupt interface at the macroscale. FGMs are emerging materials for orthopedic prostheses, since the functional gradient can be adapted to reproduce the local properties of the original bone, which helps to minimize the stress shielding effect and, at the same time, to reduce the shear stress between the implant and the surrounding bone tissue, two critical prerequisites for a longer lifespan of the graft. After a brief introduction to the origin of the FGM concept, the review surveys some representative examples of graded systems which are present in nature and, in particular, in the human body, with a focus on bone tissue. Then the rationale for using FGMs in orthopedic devices is discussed more in detail, taking into account both biological and biomechanical requirements. The core of the paper is dedicated to two fundamental topics, which are essential to benefit from the use of FGMs for orthopedic applications, namely (1) the computational tools for materials design and geometry optimization, and (2) the manufacturing techniques currently available to produce FGM-based grafts. This second part, in its turn, is structured to consider the production of functionally graded coatings (FGCs), of functionally graded 3D parts, and of special devices with a gradient in porosity (functionally graded scaffolds). The inspection of the literature on the argument clearly shows that the integration of design and manufacturing remains a critical step to overpass in order to achieve effective FGM-based implants. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Comparison of outcome of tibial plafond fractures managed by hybrid external fixation versus two-stage management with final plate fixation

    PubMed Central

    Cisneros, Luis Natera; Gómez, Mireia; Alvarez, Carlos; Millán, Angélica; De Caso, Julio; Soria, Laura

    2016-01-01

    Background: Tibial platfond fractures are usually associated with massive swelling of the foot and ankle, as well as with open wounds. This swelling may cause significant decrease of the blood flow, so the state of the soft tissue is determinant for the surgical indication and the type of implant. This retrospective study compares the union times in cases of tibial plafond fractures managed with a hybrid external fixation as a definitive procedure versus those managed with a two stage strategy with final plate fixation. Materials and Methods: A retrospective study in a polytrauma referral hospital was performed between 2005 and 2011. Patients with a tibial plafond fracture, managed with a hybrid external fixation as a definitive procedure or managed with a two stage strategy with the final plate fixation were included in the study. Postoperative radiographs were evaluated by two senior surgeons. Fracture healing was defined as callus bridging of one cortex, seen on both lateral and anteroposterior X-ray. The clinical outcome was evaluated by means of 11 points Numerical Rating Scale for pain and The American Orthopedic Foot and Ankle Society ankle score, assessed at the last followup visit. Thirteen patients had been managed with a hybrid external fixation and 18 with a two-stage strategy with the final plate fixation. There were 14 males and 17 females with a mean age of 48 years (range 19–82 years). The mean followup was 24 months (range 24–70 months). Results: The mean time from surgery to weight bearing was 7 ± 6.36 days for the hybrid fixation group and 57.43 ± 15.46 days for the plate fixation group (P < 0.0001); and the mean time from fracture to radiological union was 133.82 ± 37.83) and 152.8 ± 72.33 days respectively (P = 0.560). Conclusion: Besides the differences between groups regarding the baseline characteristics of patients, the results of this study suggest that in cases of tibial plafond fractures, the management with a hybrid external

  4. New percutaneously inserted spinal fixation system.

    PubMed

    Teitelbaum, George P; Shaolian, Samuel; McDougall, Cameron G; Preul, Mark C; Crawford, Neil R; Sonntag, Volker K H

    2004-03-15

    We describe a new percutaneous minimally invasive spinal fixation system based on pedicle screws and inflatable rods. The rods are inserted in a flexible state and harden following deployment. We test this system in terms of biocompatibility, ferromagnetism, magnetic resonance artifact production, bench top mechanical testing, ease of insertion within cadavers, potential thermal damage to paraspinous muscles in pigs, and long-term device tolerability in sheep. To determine the safety and utility of this system before its use in human subjects. Composite materials and epoxy compounds have been used safely in a variety of implanted medical devices for years with no signs of systemic toxicity or significant device failures. Long-term biocompatibility test of system components was conducted according to International Standards Organization 10993 and Food and Drug Administration Blue Book Memorandum #G95-1 standards. Device components were assessed for magnetic deflection and torque and imaged in a 1.5 Tesla magnetic resonance unit. Full constructs of the system were tested for compression strength, torque, and fatigue per American Society for Testing and Materials F1717 standards. The system was deployed using C-arm fluoroscopic guidance in 11 cadavers and 2 live sheep. Further, the inflatable rods were tested for exothermic damage to paraspinous musculature in 2 pigs. All system components were found to be biocompatible, nonferromagnetic, and produce little magnetic resonance artifact. Compression and torque results for the new system were found to be comparable to standard metallic pedicle screw and rod fixation systems. However, the new system displayed a superior modulus of elasticity relative to standard surgical systems. The new system endured 5 million cycles of repetitive compressions without breakage or significant wear. All cadaver and sheep insertions were performed successfully. Sheep suffered no complications, and minimal blood loss occurred during device

  5. Pullout strength of a novel hybrid fixation technique (Tape Locking Screw™) in soft-tissue ACL reconstruction: A biomechanical study in human and porcine bone.

    PubMed

    Ayzenberg, M; Arango, D; Gershkovich, G E; Samuel, P S; Saing, M

    2017-06-01

    A novel hybrid anterior cruciate ligament (ACL) reconstruction technique known as Tape Locking Screw™ (TLS) is gaining popularity. Utilizing a suspension-type construct in conjunction with an interference screw, this technique has demonstrated successful initial clinical results with the use of quadruple hamstring graft. However, there is currently limited data available on the biomechanical strength of this fixation. This study investigates the pullout strength of the construct in human distal femora as well as in a porcine model. The construct is tested in isolation, without the use of any graft. We hypothesized that the pullout strength of this construct would be similar to or better than current fixation systems available. The Tape Locking Screw hybrid fixation system was implanted into twenty-two fresh frozen human distal femora (50-89 years old) randomized to 10×20mm titanium or polyether ether ketone (PEEK) screws by a single sports fellowship trained orthopedic surgeon. Given that the graft is secured to polyethylene terephthalate tape within the construct, the construct was implanted without any graft in order to isolate the device for biomechanical testing. After implantation, a tensile force was applied directly to the loop of tape at a loading rate of 5mm/min using an electromechanical testing system. The failure load was calculated from the resultant load-displacement curve. Specimens were then visually examined for mode of failure. Similar biomechanical tests were performed on sixteen porcine femora. In the human model, the mean pullout strength was 523±269N with the PEEK screw and 578±245N with the titanium screw. In the porcine femur model, mean strength was 616±177N with PEEK, 584±245N with titanium. There was no statistically significant difference in failure loads between these four groups. Tape slippage at the screw bone interface was the primary mode of failure in all the groups tested. Our results demonstrate that the hybrid technique

  6. Microwave fixation versus formalin fixation of surgical and autopsy tissue.

    PubMed

    Login, G R

    1978-05-01

    Microwave irradiation of surgical and autopsy tissue penetrates, fixes, and hardens the tissue almost immediately (the fluid media used in the microwave consisted of saline, ten percent phosphate buffered formalin, and distilled water). Tissue sections from a representative sample of organs were tested. Comparable sections were simultaneously fixed in a phosphate buffered ten percent formalin bath in a vaccum oven as a control. Hematoxylin and eosin were used to stain the sections. Results equal to and superior to the control method were obtained. Saline microwave fixation was superior to formalin microwave fixation. Tissues placed in Zenker's solution and fixed in standard microwave oven (for approximately one minute) yielded results at least equal to conventional Zenker fixation (approximately two hours). No tissue hardening resulted from Zenker microwave fixation. A unique time versus temperature graph (microwave heating curve) reduces individual variation with this technique.

  7. The Institute for Global Orthopedics and Traumatology: A Model for Academic Collaboration in Orthopedic Surgery.

    PubMed

    Conway, Devin James; Coughlin, Richard; Caldwell, Amber; Shearer, David

    2017-01-01

    In 2006, surgeons at the University of California, San Francisco (UCSF) established the Institute for Global Orthopedics and Traumatology (IGOT), an initiative within the department of orthopedic surgery. The principal aim of IGOT is to create long-term, sustainable solutions to the growing burden of musculoskeletal injury in low- and middle-income countries (LMICs) through academic partnership. IGOT currently has relationships with teaching hospitals in Ghana, Malawi, Tanzania, Nicaragua, and Nepal. The organizational structure of IGOT is built on four pillars: Global Surgical Education (GSE), Global Knowledge Exchange (GKE), Global Research Initiative (GRI), and Global Leadership and Advocacy. GSE focuses on increasing surgical knowledge and technical proficiency through hands-on educational courses. The GKE facilitates the mutual exchange of surgeons and trainees among IGOT and its partners. This includes a global resident elective that allows UCSF residents to complete an international rotation at one of IGOT's partner sites. The GRI strives to build research capacity and sponsor high-quality clinical research projects that address questions relevant to local partners. The fourth pillar, Global Leadership and Advocacy aims to increase awareness of the global impact of musculoskeletal injury through national and international courses and events, such as the Bay Area Global Health Film Festival. At the core of each tenet is the collaboration among IGOT and its international partners. Over the last decade, IGOT has experienced tremendous growth and maturation in its partnership model based on cumulative experience and the needs of its partners.

  8. The Institute for Global Orthopedics and Traumatology: A Model for Academic Collaboration in Orthopedic Surgery

    PubMed Central

    Conway, Devin James; Coughlin, Richard; Caldwell, Amber; Shearer, David

    2017-01-01

    In 2006, surgeons at the University of California, San Francisco (UCSF) established the Institute for Global Orthopedics and Traumatology (IGOT), an initiative within the department of orthopedic surgery. The principal aim of IGOT is to create long-term, sustainable solutions to the growing burden of musculoskeletal injury in low- and middle-income countries (LMICs) through academic partnership. IGOT currently has relationships with teaching hospitals in Ghana, Malawi, Tanzania, Nicaragua, and Nepal. The organizational structure of IGOT is built on four pillars: Global Surgical Education (GSE), Global Knowledge Exchange (GKE), Global Research Initiative (GRI), and Global Leadership and Advocacy. GSE focuses on increasing surgical knowledge and technical proficiency through hands-on educational courses. The GKE facilitates the mutual exchange of surgeons and trainees among IGOT and its partners. This includes a global resident elective that allows UCSF residents to complete an international rotation at one of IGOT’s partner sites. The GRI strives to build research capacity and sponsor high-quality clinical research projects that address questions relevant to local partners. The fourth pillar, Global Leadership and Advocacy aims to increase awareness of the global impact of musculoskeletal injury through national and international courses and events, such as the Bay Area Global Health Film Festival. At the core of each tenet is the collaboration among IGOT and its international partners. Over the last decade, IGOT has experienced tremendous growth and maturation in its partnership model based on cumulative experience and the needs of its partners. PMID:28713803

  9. Accuracy study of new computer-assisted orthopedic surgery software.

    PubMed

    Sidon, Eli; Steinberg, Ely L

    2012-12-01

    The new computerized system is based on image analysis and designed to aid in orthopedic surgeries by virtual trajectory of the guide wire, intra-operative planning and various measurements. Validation of the accuracy and safety of any computer-aided surgery system is essential before implementing it clinically. We examined the accuracy of guide-wire length and angle measurements and fusion of multiple adjacent images (panoramic view image, PVI(®)) of the new software. This is a 2-part study. Part I: twenty guide wires were drilled to various depths in a synthetic femur model and the results obtained by the software measurements were compared with manual measurements by a caliper and a depth gauge. Part II: a sawbone femur shaft was osteotomized and various inclinations of > 10° to the varus or valgus angles were tested. The manually obtained measurements of angles and lengths were compared to the new computerized system software PVI. There was a significant positive linear correlation between all groups of the computerized length and the control measurements (r>0.983, p<0.01). There was no significant difference among different distances, angles or positions from the image intensifier. There was a significant positive linear correlation between the angle and length measurement on the PVI and the control measurement (r>0.993, p<0.01). The new computerized software has high reliability in performing measurements of length using an aiming, positioning and referring device intra-operatively. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  10. The Use of Intermittent Pneumatic Compression in Orthopedic and Neurosurgical Postoperative Patients: A Systematic Review and Meta-analysis.

    PubMed

    O'Connell, Sandra; Bashar, Khalid; Broderick, Barry J; Sheehan, James; Quondamatteo, Fabio; Walsh, Stewart R; ÓLaighin, Gearoid; Quinlan, Leo R

    2016-05-01

    The objective of this systematic review and meta-analysis was to carry out an up-to-date evaluation on the use of compression devices as deep vein thrombosis (DVT) prophylaxis methods in orthopedic and neurological patients. There is an increased risk of DVT with surgery, particularly in patients who are not expected to mobilize soon after their procedures, such as orthopedic and neurosurgical patients. Compression devices are often employed for DVT prophylaxis in these patients. However, the true efficacy of these devices and the standardization of use with these devices are yet to be established. Medline, CINAHL, Embase, Google Scholar, and the Cochrane library electronic databases were searched to identify randomized controlled trials and observational studies reporting on the use of compression devices for DVT prevention. Nine studies were included for review and meta-analysis. Use of an intermittent pneumatic compression device alone is neither superior nor inferior to chemoprophylaxis. In the absence of large randomized multicenter trials comparing the use of intermittent pneumatic compression or chemoprophylaxis alone to a combination of both treatments, the current evidence supports the use of a combined approach in high-risk surgical patients.

  11. Neuronal control of fixation and fixational eye movements

    PubMed Central

    2017-01-01

    Ocular fixation is a dynamic process that is actively controlled by many of the same brain structures involved in the control of eye movements, including the superior colliculus, cerebellum and reticular formation. In this article, we review several aspects of this active control. First, the decision to move the eyes not only depends on target-related signals from the peripheral visual field, but also on signals from the currently fixated target at the fovea, and involves mechanisms that are shared between saccades and smooth pursuit. Second, eye position during fixation is actively controlled and depends on bilateral activity in the superior colliculi and medio-posterior cerebellum; disruption of activity in these circuits causes systematic deviations in eye position during both fixation and smooth pursuit eye movements. Third, the eyes are not completely still during fixation but make continuous miniature movements, including ocular drift and microsaccades, which are controlled by the same neuronal mechanisms that generate larger saccades. Finally, fixational eye movements have large effects on visual perception. Ocular drift transforms the visual input in ways that increase spatial acuity; microsaccades not only improve vision by relocating the fovea but also cause momentary changes in vision analogous to those caused by larger saccades. This article is part of the themed issue ‘Movement suppression: brain mechanisms for stopping and stillness’. PMID:28242738

  12. [Postoperative fever in orthopedic and urologic surgery].

    PubMed

    Saavedra, Federico; Myburg, Cristina; Lanfranconi, Marisa B; Urtasun, Martin; De Oca, Luis Montes; Silberman, Andres; Lambierto, Alberto; Gnocchi, Cesar A

    2008-01-01

    Post-operative fever incidence varies widely. In clean and clean-contaminated surgery the non-infectious fever is more frequent than the infectious fever. We performed a prospective study including 303 patients who underwent orthopedic and urologic elective surgery. The aims of our study were to investigate the incidence of post-operative fever, its etiology, the relationship between time of onset and the etiology, and the usefulness of extensive fever work-up to determine post-operative infection. The incidence of post-operative fever was 14% (42/303) of which 81% (34/42) was noninfectious and 19% (8/42) was infectious. The etiology of the fever in the first 48 hours after surgery was always non-infectious (p < 0.001). An extensive fever work-up was performed in patients who presented fever only after the initial 48 hours of surgery with normal physical examination (n = 19) consisting of chest x-ray, blood (2) and urine cultures. The chest x-ray was normal in all the patients, the urine cultures were positive in four cases (21%, IC 95%: 6-45) and the blood cultures in only one case (5%, IC 95%: 0.1-26). Seven patients had post-operative infections without fever as a clinical sign. The most frequently observed etiology of post-operative fever was non-infectious, related to the normal inflammatory host response to surgery. Based on the present results, the extensive fever work-up performed to investigate post-operative infection does not seem to be a useful tool. The diagnosis of post-operative infection was based on clinical follow up and the correct interpretation of the patient's symptoms and signs.

  13. Transit fixatives: an innovative study.

    PubMed

    M, Rajanikanth; A, Ravi Prakash; G, Sreenath; Jk, Sonia Bai; Ndvn, Shyam

    2015-03-01

    Universally accepted fixative is 10% formalin which has been used for preserving the tissues and their architecture. In certain conditions, formalin might not be readily available for immediate fixation. We here by explore more economical, eco-friendly and easily available solutions that can be used as transit media/ transporting media for tissue specimens. The study included commonly available solutions like Spirit, Saline, Betadine solution, Hydrogen peroxide (H2O2), Local anesthesia (L.A), Rose water, Coconut oil, Coconut water, Ice cold water, Honey and Milk while keeping formalin as control. The fresh tissue sample was cut into multiple bits and placed in different containers for a period of 8 hours before transferring to formalin solution. Transit fixatives are very important in certain situations where formalin is not readily available. These fixatives can be used to fix the tissues for a period of at least 8 hours without causing any damage or distortion before they are fixed in formalin solution.

  14. Molecular Biology of Nitrogen Fixation

    ERIC Educational Resources Information Center

    Shanmugam, K. T.; Valentine, Raymond C.

    1975-01-01

    Reports that as a result of our increasing knowledge of the molecular biology of nitrogen fixation it might eventually be possible to increase the biological production of nitrogenous fertilizer from atmospheric nitrogen. (GS)

  15. Molecular Biology of Nitrogen Fixation

    ERIC Educational Resources Information Center

    Shanmugam, K. T.; Valentine, Raymond C.

    1975-01-01

    Reports that as a result of our increasing knowledge of the molecular biology of nitrogen fixation it might eventually be possible to increase the biological production of nitrogenous fertilizer from atmospheric nitrogen. (GS)

  16. Finite Element Analysis of Sacroiliac Joint Fixation under Compression Loads

    PubMed Central

    Bruna-Rosso, Claire; Arnoux, Pierre-Jean; Bianco, Rohan-Jean; Godio-Raboutet, Yves; Fradet, Léo

    2016-01-01

    Background Sacroiliac joint (SIJ) is a known chronic pain-generator. The last resort of treatment is the arthrodesis. Different implants allow fixation of the joint, but to date there is no tool to analyze their influence on the SIJ biomechanics under physiological loads. The objective was to develop a computational model to biomechanically analyze different parameters of the stable SIJ fixation instrumentation. Methods A comprehensive finite element model (FEM) of the pelvis was built with detailed SIJ representation. Bone and sacroiliac joint ligament material properties were calibrated against experimentally acquired load-displacement data of the SIJ. Model evaluation was performed with experimental load-displacement measurements of instrumented cadaveric SIJ. Then six fixation scenarios with one or two implants on one side with two different trajectories (proximal, distal) were simulated and assessed with the FEM under vertical compression loads. Results The simulated S1 endplate displacement reduction achieved with the fixation devices was within 3% of the experimentally measured data. Under compression loads, the uninstrumented sacrum exhibited mainly a rotation motion (nutation) of 1.38° and 2.80° respectively at 600 N and 1000 N, with a combined relative translation (0.3 mm). The instrumentation with one screw reduced the local displacement within the SIJ by up to 62.5% for the proximal trajectory vs. 15.6% for the distal trajectory. Adding a second implant had no significant additional effect. Conclusion A comprehensive finite element model was developed to assess the biomechanics of SIJ fixation. SIJ devices enable to reduce the motion, mainly rotational, between the sacrum and ilium. Positioning the implant farther from the SIJ instantaneous rotation center was an important factor to reduce the intra-articular displacement. Clinical relevance Knowledge provided by this biomechanical study enables improvement of SIJ fixation through optimal implant

  17. The pathologist's guide to fixatives.

    PubMed

    Qidwai, Kiran; Afkhami, Michelle; Day, Christina E

    2014-01-01

    Proper tissue fixation is essential to ensure the highest level of specimen evaluation. Pathologists and laboratory staff are frequently consulted by clinical counterparts regarding what fixative should be used for different tissues or to enable a diagnosis of a specific condition. It is vital for the patient that the pathologist provides accurate information to ensure proper fixation. Frequently, once a tissue has been fixed inadequately or inappropriately, remedial changes may no longer be possible. Most often formalin is an adequate choice, if not the optimal one; however, there are certain situations when placing the tissue in formalin may limit the ability to reach a definitive diagnosis. It is imperative for pathologists to have the knowledge to communicate which fixative is optimal. Furthermore, as we move into a world of personalized medicine, where ancillary testing has both diagnostic and specific therapeutic implications, knowledge about how different fixatives affect immunohistochemistry, cytogenetics, and molecular studies becomes even more significant. This chapter provides practical information regarding common fixatives, their mechanism of action and optimal uses.

  18. Managing orthopedics and neurosciences costs through standard treatment protocols.

    PubMed

    McGinnity, E S; Pluth, T E

    1994-06-01

    High-cost, high-volume specialty programs such as orthopedics and neurosciences find themselves in a position of evaluating the costs and in some cases the appropriateness of medical practices in response to payer scrutiny and provider selection processes. Orthopedics and neurosciences programs are at a stage of development analogous to that of cardiovascular care several years ago. Many of the same trends have come into play, such as payer "carve-outs" for orthopedic services, payer selection of centers of excellence based on cost and quality, reduction of Medicare reimbursement, greater use of high-cost technology, the decline of profitability due to "older, sicker, and tougher" patients, and the recent emergence of national orthopedic specialty networks oriented to national contracts for care. In an era in which payers demand value on both sides of the cost-plus-quality equation, programs are challenged to maximize the return on a patient population rife with "no-win" situations. In the orthopedic service line these include a high proportion of Medicare patients and chronic conditions such as workers' compensation medical back cases or repetitive motion injuries, which can be elusive to diagnose and expensive to treat. Many hospitals continue to lose money on joint replacement surgeries, the largest-volume orthopedic inpatient service, primarily because of the high Medicare population and the cost of implants. Neuroservices, while still relatively well reimbursed, face a rising proportion of Medicare payments as patients live longer and develop chronic, degenerative conditions. Inpatient days are decreasing due to payer pressures to limit hospital stays and to shift inpatient care to outpatient services. Some hospitals "have lost interest in (the orthopedic) service line during the last five years because of recent trends in orthopedic-related inpatient volume and payment." But by managing costs strategically, both the neurosciences and orthopedics service lines

  19. The Current Perspectives of Stem Cell Therapy in Orthopedic Surgery

    PubMed Central

    Akpancar, Serkan; Tatar, Oner; Turgut, Hasan; Akyildiz, Faruk; Ekinci, Safak

    2016-01-01

    Context Musculoskeletal injuries may be painful, troublesome, life limiting and also one of the global health problems. There has been considerable amount of interest during the past two decades to stem cells and tissue engineering techniques in orthopedic surgery, especially to manage special and compulsive injuries within the musculoskeletal system. Evidence Acquisition The aim of this study was to present a literature review regarding the most recent progress in stem cell procedures and current indications in orthopedics clinical care practice. The Medline and PubMed library databases were searched for the articles related with stem cell procedures in the field of orthopedic surgery and additionally the reference list of each article was also included to provide a comprehensive evaluation. Results Various sources of stem cells have been studied for orthopedics clinical care practice. Stem cell therapy has successfully used for major orthopedic procedures in terms of bone-joint injuries (fractures-bone defects, nonunion, and spinal injuries), osteoarthritis-cartilage defects, ligament-tendon injuries, femoral head osteonecrosis and osteogenesis imperfecta. Stem cells have also used in bone tissue engineering in combining with the scaffolds and provided faster and better healing of tissues. Conclusions Large amounts of preclinical studies have been made of stem cells and there is an increasing interest to perform these studies within the human population but preclinical studies are insufficient; therefore, much more and efficient studies should be conducted to evaluate the efficacy and safety of stem cells. PMID:28144608

  20. The Economic Burden of Orthopedic Surgery Residency Interviews on Applicants.

    PubMed

    Fogel, Harold A; Finkler, Elissa S; Wu, Karen; Schiff, Adam P; Nystrom, Lukas M

    2016-01-01

    The intense competition for orthopedic surgery residency positions influences the interview process. The financial impact on residency applicants is less well understood. The purpose of the present study was to define the economic burden of the orthopedic surgery residency interview process while additionally describing how applicants finance the expense. We distributed surveys to 48 nonrotating applicants at our institution's residency interview days for the 2015 match year. The survey consisted of eleven questions specific to the costs of interviewing for orthopedic surgery residency positions. The survey response rate was 90% (43/48). Applicants applied to a median of 65 orthopedic surgery residency programs (range 21-88) and targeted a median of 15 interviews (range 12-25). The mean cost estimate for a single interview was $450 (range $200-800) and the cost estimate for all interviews was $7,119 (range $2,500-15,000). Applicants spent a mean of $344 (range $0-750) traveling to our interview. Seventy-two percent borrowed money to finance their interview costs and 28% canceled interviews for financial reasons. The financial cost of interviewing for orthopedic surgery is substantial and a majority of applicants add to their educational debt by taking out loans to finance interviews. Future considerations should be made to minimize these costs for an already financially burdened population.

  1. Orthopedic injury in electric bicycle-related collisions.

    PubMed

    Li, Xiaoxuan; Yun, Zhe; Li, Xiaoxiang; Wang, Yucai; Yang, Tongtao; Zheng, Lianhe; Qian, Jixian

    2017-05-19

    Although electric bicycle-related injuries have become the most common reason for hospitalization due to a road crash in China, no study has comprehensively investigated electric bicycle collisions and their impact on orthopedic injuries; such a study may provide evidence to support a new road safety policy. A retrospective review of orthopedic injuries from electric bicycle collisions was performed in an urban trauma center. We collected variables including age, gender, location of fracture, presence of open or closed fractures, concomitant vascular, and neurologic injuries. A total of 2,044 cases were involved in electric bicycle collisions. The orthopedic injury victims were predominantly male and middle aged. The most common orthopedic injury was a femur fracture. Open fractures frequently involved the forearm and tibia/fibula. Male patients were more likely to suffer from multiple fractures and associated injuries than female patients. Fewer patients age 60 years old or older wore helmets at the time of the accident compared to those in other age groups. Orthopedic injuries from electric bicycle-related accidents cause patients substantial suffering that could lead to serious social consequences. Helmet use and protective clothing or similar safety gear, especially for electric bicycle users, should be required to provide greater protection.

  2. Desktop teleradiology in support of rural orthopedic trauma care.

    PubMed Central

    Reid, J. G.; McGowan, J. J.; Ricci, M. A.; McFarlane, G.

    1997-01-01

    Research has shown that diagnostic quality images for most teleradiology applications requires a sophisticated telemedicine system and access to a large amount of bandwidth. While the ideal standards have been set by those involved in evaluating teleradiology, these standards are impractical for many small rural health centers which deliver routine trauma care. While there is no disagreement about the ultimate need for this level of teleradiology support, the purpose of this research was to determine whether Orthopedists would be able to read plain radiographs of orthopedic trauma injuries using a desktop teleradiology system in support of rural trauma care. METHOD: Two radiology residents and two orthopedic residents viewed forty radiographs, twenty through a desktop teleradiology system and twenty in person. Diagnostic findings and certainty of diagnosis were recorded. FINDINGS: There was no statistically significant difference between modalities in orthopedic residents' ability to correctly diagnose orthopedic trauma injuries. Further, for those instances when the diagnosis was imprecise, the residents were aware of their inability to make an accurate diagnosis. CONCLUSION: Although the study was relatively limited and further research needs to be done, the use of desktop teleradiology in support of rural orthopedic trauma consultation is a promising alternative to the more expensive forms of telemedicine technology. PMID:9357657

  3. The effects of maitland orthopedic manual therapy on improving constipation

    PubMed Central

    Koo, Ja-Pung; Choi, Jung-Hyun; Kim, Nyeon-Jun

    2016-01-01

    [Purpose] This study aimed to examine the effects of interventions on constipation and to provide basic data for physical therapy in internal medicine. [Subjects and Methods] The colon transit times of 30 subjects were measured and after the interventions. Fifteen subjects were assigned to a Maitland orthopedic manual therapy group, and 15 subjects were assigned to a dietary fiber group. [Results] The analysis of changes in colon transit time showed statistically significant differences in left colon transit time, rectosigmoid colon transit time, and total colon transit time for the Maitland orthopedic manual therapy group and statistically significant differences in rectosigmoid colon transit time and total colon transit time for the dietary fiber group. An analysis of group differences in the effects of Maitland orthopedic manual therapy and dietary fiber showed that the Maitland orthopedic manual therapy group achieved statistically significantly larger declines in rectosigmoid colon transit time and total colon transit time compared with the dietary fiber group. [Conclusion] This study confirmed that Maitland orthopedic manual therapy can be an effective treatment method for internal conditions such as functional constipation by almost normalizing the colon transit time, not only by improving the symptoms of constipation but also by facilitating intestinal movements. PMID:27821950

  4. The effects of maitland orthopedic manual therapy on improving constipation.

    PubMed

    Koo, Ja-Pung; Choi, Jung-Hyun; Kim, Nyeon-Jun

    2016-10-01

    [Purpose] This study aimed to examine the effects of interventions on constipation and to provide basic data for physical therapy in internal medicine. [Subjects and Methods] The colon transit times of 30 subjects were measured and after the interventions. Fifteen subjects were assigned to a Maitland orthopedic manual therapy group, and 15 subjects were assigned to a dietary fiber group. [Results] The analysis of changes in colon transit time showed statistically significant differences in left colon transit time, rectosigmoid colon transit time, and total colon transit time for the Maitland orthopedic manual therapy group and statistically significant differences in rectosigmoid colon transit time and total colon transit time for the dietary fiber group. An analysis of group differences in the effects of Maitland orthopedic manual therapy and dietary fiber showed that the Maitland orthopedic manual therapy group achieved statistically significantly larger declines in rectosigmoid colon transit time and total colon transit time compared with the dietary fiber group. [Conclusion] This study confirmed that Maitland orthopedic manual therapy can be an effective treatment method for internal conditions such as functional constipation by almost normalizing the colon transit time, not only by improving the symptoms of constipation but also by facilitating intestinal movements.

  5. The Economic Burden of Orthopedic Surgery Residency Interviews on Applicants

    PubMed Central

    Fogel, Harold A.; Finkler, Elissa S.; Wu, Karen; Schiff, Adam P.; Nystrom, Lukas M.

    2016-01-01

    Background The intense competition for orthopedic surgery residency positions influences the interview process. The financial impact on residency applicants is less well understood. The purpose of the present study was to define the economic burden of the orthopedic surgery residency interview process while additionally describing how applicants finance the expense. Methods We distributed surveys to 48 nonrotating applicants at our institution’s residency interview days for the 2015 match year. The survey consisted of eleven questions specific to the costs of interviewing for orthopedic surgery residency positions. Results The survey response rate was 90% (43/48). Applicants applied to a median of 65 orthopedic surgery residency programs (range 21-88) and targeted a median of 15 interviews (range 12-25). The mean cost estimate for a single interview was $450 (range $200-800) and the cost estimate for all interviews was $7,119 (range $2,500-15,000). Applicants spent a mean of $344 (range $0-750) traveling to our interview. Seventy-two percent borrowed money to finance their interview costs and 28% canceled interviews for financial reasons. Conclusions The financial cost of interviewing for orthopedic surgery is substantial and a majority of applicants add to their educational debt by taking out loans to finance interviews. Future considerations should be made to minimize these costs for an already financially burdened population. PMID:27528831

  6. Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery?*,**

    PubMed Central

    Akpinar, Evrim Eylem; Hosgün, Derya; Akan, Burak; Ates, Can; Gülhan, Meral

    2013-01-01

    OBJECTIVE: Pulmonary embolism (PE) is an important complication of major orthopedic surgery. The aim of this study was to evaluate the incidence of venous thromboembolism (VTE) and factors influencing the development of VTE in patients undergoing major orthopedic surgery in a university hospital. METHODS: Patients who underwent major orthopedic surgery (hip arthroplasty, knee arthroplasty, or femur fracture repair) between February of 2006 and June of 2012 were retrospectively included in the study. The incidences of PE and deep vein thrombosis (DVT) were evaluated, as were the factors influencing their development, such as type of operation, age, and comorbidities. RESULTS: We reviewed the medical records of 1,306 patients. The proportions of knee arthroplasty, hip arthroplasty, and femur fracture repair were 63.4%, 29.9%, and 6.7%, respectively. The cumulative incidence of PE and DVT in patients undergoing major orthopedic surgery was 1.99% and 2.22%, respectively. Most of the patients presented with PE and DVT (61.5% and 72.4%, respectively) within the first 72 h after surgery. Patients undergoing femur fracture repair, those aged ≥ 65 years, and bedridden patients were at a higher risk for developing VTE. CONCLUSIONS: Our results show that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis. Clinicians should be aware of VTE, especially during the perioperative period and in bedridden, elderly patients (≥ 65 years of age). PMID:23857692

  7. Orthostetrics: Management of Orthopedic Conditions in the Pregnant Patient.

    PubMed

    Matthews, Leslie J; McConda, David B; Lalli, Trapper A J; Daffner, Scott D

    2015-10-01

    Managing orthopedic conditions in pregnant patients leads to challenges that must be carefully considered so that the safety of both the mother and the fetus is maintained. Both perioperative and intraoperative considerations must be made based on physiologic changes during pregnancy, risks of radiation, and recommendations for monitoring. Operative timing, imaging, and medication selection are also factors that may vary based on trimester and clinical scenario. Pregnancy introduces unique parameters that can result in undesirable outcomes for both mother and fetus if not handled appropriately. Ultimately, pregnant patients offer a distinct challenge to the orthopedic surgeon in that the well-being of 2 patients must be considered in all aspects of care. In addition, not only does pregnancy affect the management of orthopedic conditions but the pregnant state also causes physiologic changes that may actually induce various pathologies. These pregnancy-related orthopedic conditions can interfere with an otherwise healthy pregnancy and should be recognized as possible complications. Although the management of orthopedic conditions in pregnancy is often conservative, pregnancy does not necessarily preclude safely treating pathologies operatively. When surgery is considered, regional anesthesia provides less overall drug exposure to the fetus and less variability in fetal heart rate. Intraoperative fluoroscopy can be used when appropriate, with 360° fetal shielding if possible. Lateral decubitus positioning is ideal to prevent hypotension associated with compression of the inferior vena cava.

  8. Comparison of the biomechanics and histology of two soft-tissue fixators composed of bioabsorbable copolymers.

    PubMed

    Powers, D L; Sonawala, M; Woolf, S K; An, Y H; Hawkins, R; Pietrzak, W S

    2001-01-01

    The purpose of this study was to assess the dynamic in vitro and in vivo characteristics of two different bioabsorbable copolymer soft-tissue fixation devices and to determine their efficacy in reattaching soft tissue to bone. Suretac fixators (Smith & Nephew/Acufex MicroSurgical Inc., Northwood, MA), made of polyglyconate (2:1 glycolic acid:trimethylene carbonate), and Pop Rivets (Arthrotek, Warsaw, IN), made of LactoSorb (82% poly L-lactic acid, 18% polyglycolic acid), were anchored into synthetic bone, and their pull-out strengths were evaluated. The devices were also evaluated with the use of an in vivo goat model in which the medial collateral ligament (MCL) was elevated from the tibia and directly reattached. In the in vitro biomechanical study, the Suretac fixators had negligible strength remaining by four weeks, whereas the Pop Rivets retained 50% of their strength at 4 weeks, 20% at 8 weeks, and negligible strength at 12 weeks. The in vivo strength of MCL repairs affected by each implant was not statistically different at any of the time points. Histologically, both implants were absorbed by 52 weeks, and there was no appreciable adverse tissue response. In conclusion, both copolymer fixators were found to be biocompatible. The Pop Rivet fixators demonstrated in vivo performance comparable to the Suretac fixators, although the Pop Rivets retained strength longer in vitro. Our results suggest that both devices provide adequate strength of fixation before degrading to allow the healing soft tissues to reach or surpass their native strength.

  9. Biomechanics of external fixation and limb lengthening.

    PubMed

    Younger, Alastair S E; Morrison, James; MacKenzie, William G

    2004-09-01

    Surgeons who use external fixators for foot and ankle conditions need to understand the biomechanical principles to ensure good outcomes. Fixators can be used for fracture fixation, correction of contractures, distraction osteogenesis, and distraction arthroplasty. A two-ring fixator with wire fixation remains the gold standard with which all other frames are compared. Small changes in mechanical characteristics can have major implications on new bone or cartilage formation.

  10. Is orthopedics more competitive today than when my attending matched? An analysis of National Resident Matching Program data for orthopedic PGY1 applicants from 1984 to 2011.

    PubMed

    Karnes, Jonathan M; Mayerson, Joel L; Scharschmidt, Thomas J

    2014-01-01

    This study evaluated supply and demand trends for orthopedic postgraduate year 1 (PGY1) positions from 1984 to 2011 for the purpose of estimating national intercandidate competition over time. National Resident Matching Program (NRMP) data for orthopedic surgery from 1984 to 2011 were collected. Proxy variables including (total number of orthopedic applicants/number of orthopedic PGY1 positions), (number of US senior applicants to orthopedics/number of orthopedic PGY1 positions), (number of US seniors matching into orthopedics/number of US senior orthopedic applicants), (total number of matched orthopedic applicants/total number of orthopedic applicants), and (total number of US applicants who fail to match into orthopedics/total number of US senior applicants into orthopedics) as well as average United States Medical Licensing Examination Step 1 scores were used to gauge the level of competition between candidates and were compared over time. Academic medical center in the Midwestern United States. Medical professors and medical students. The NRMP data suggested that the number of positions per applicant decreased or remained stable since 1984 and that the percentage of applicants who did not match was no higher now than in the past. This finding was primarily because of the relative decrease in the ratio of applicants to available PGY1 positions, which stems from the number of positions increasing more rapidly than the number of applicants. The NRMP data from 1984 to 2011 supported our hypothesis that intercandidate competition intensity for orthopedic PGY1 positions has not increased over time. The misconception that orthopedics is becoming more competitive likely arises from the increased number of applications submitted per candidate and the resulting relative importance placed on objective criteria such as United States Medical Licensing Examination Step 1 scores when programs select interview cohorts. Copyright © 2014 Association of Program Directors in

  11. Mesenchymal stem cell therapy in horses: useful beyond orthopedic injuries?

    PubMed

    De Schauwer, Catharina; Van de Walle, Gerlinde R; Van Soom, Ann; Meyer, Evelyne

    2013-12-01

    In the past decade, mesenchymal stem cells (MSC) have received much attention in equine veterinary medicine. The first therapeutic use of equine MSC was reported in 2003. Since then, the clinical application of MSC has been exploding with thousands of horses now treated worldwide. At present, MSC are mainly used in veterinary medicine to treat musculoskeletal diseases based on their ability to differentiate into various tissues of mesodermal origin. This is in marked contrast to human medicine, where MSC therapies are primarily focused on immune-mediated, inflammatory, and ischemic diseases. In this review, both orthopedic as well as non-orthopedic clinical applications of equine MSC are discussed. A brief overview is provided on the potential of MSC for non-orthopedic injuries with emphasis on those diseases, which occur in both humans and horses.

  12. Orthopedic Manifestations of Mobius Syndrome: Case Series and Survey Study

    PubMed Central

    McClure, Philip; Booy, David; Katarincic, Julia; Eberson, Craig

    2016-01-01

    Background. Mobius Syndrome is a rare disease defined by bilateral congenital 7th nerve palsy. We focus on reporting the prevalence of orthopedic disease in this population. Methods. Twenty-three individuals with Mobius Syndrome underwent orthopedic physical examination, and additional 96 patients filled out a survey for self-reported orthopedic diagnoses. Results. Clubfoot was present in 60% of individuals in the physical exam series and 42% of those in the survey. Scoliosis was present in 26% and 28%, respectively. Poland's Syndrome was present in 17% and 30%. In addition to these findings, 27% of patients reported having difficulty with anesthesia, including difficulty in intubation and airway problems. Conclusion. An increased prevalence of scoliosis, clubfoot, transverse limb deficiencies, and Poland's Syndrome is identified in the setting of Mobius Syndrome. In the setting of several deformities often requiring surgical correction, a high incidence of anesthetic difficulty is noted and should be discussed with patients and other providers during surgical planning. PMID:26977161

  13. Computer assisted outcomes research in orthopedics: total joint replacement.

    PubMed

    Arslanian, C; Bond, M

    1999-06-01

    Long-term studies are needed to determine clinically relevant outcomes within the practice of orthopedic surgery. Historically, the patient's subjective feelings of quality of life have been largely ignored. However, there has been a strong movement toward measuring perceived quality of life through such instruments as the SF-36. In a large database from an orthopedic practice results are presented. First, computerized data entry using touch screen technology is not only cost effective but user friendly. Second, patients undergoing hip or knee arthroplasty surgeries make statistically significant improvements in seven of the eight domains of the SF-36 in the first 3 months after surgery. Additional statistically significant improvements over the next 6 to 12 months are also seen. The data are presented here in detail to demonstrate the benefits of a patient outcomes program, to enhance the understanding and use of outcomes data and to encourage further work in outcomes measurement in orthopedics.

  14. Evolving trauma and orthopedics training in the UK.

    PubMed

    Inaparthy, Praveen K; Sayana, Murali K; Maffulli, Nicola

    2013-01-01

    The ever-growing population of the UK has resulted in increasing demands on its healthcare service. Changes have been introduced in the UK medical training system to avoid loss of training time and make it more focused and productive. Modernizing medical careers (MMC) was introduced in 2005. This promised to reduce the training period for a safe trauma specialist, in trauma and orthopedics, to 10 years. At around the same time, the European Working Time Directive (EWTD) was introduced to reduce the working hours for junior doctors in training, to improve patient safety and also work-life balance of junior doctors. Introduction of the assessment tools from Orthopedic Competency assessment project (OCAP) will help tailor the training according to the needs of the trainee. The aim of this article is to review the changes in the UK orthopedic surgical training over the past two decades. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  15. External fixation in war traumatology: report from the Rwandese war (October 1, 1990 to August 1, 1993)

    PubMed

    Labeeu, F; Pasuch, M; Toussaint, P; Van Erps, S

    1996-03-01

    1, 1993 (Arusha's agreement). A Belgian medical team from the Military Cooperation had to cope with 4,646 different casualties. We treated 1,129 fractures, and among them 115 fractures of the arm, 122 fractures of the forearm, 80 fractures of the femur (including the neck and the condylae), and 148 fractures of the leg. We had to cope with 315 fractures of the hand, of which 220 fractures were of the metacarpal bone. "Strangely," there were always more lesions of the left hand (9.5%) than the right hand (5.8%), sometimes up to five times (the only exception was met in August 1993). We placed 209 external fixators (of which 20 bridging the joint in case of important impairment), including those used for an arthrodesis. In the majority fo the cases (93.3%), we used the French device Fixateur Externe du Service de Sante des Armees (FESSA). Until March 1993, we had no "orthopedic table." Since March 1988, we had an Image Intensifier, but not very appropriate to an operating room (no mobile C-arm). A more accurate one was lent by the Belgian Medical Service and set up in September 1992. The average time to place an external fixator was about 30 minutes. General practitioners were also trained to handle external fixators. According to the importance of mass casualties, an external fixator was used immediately upon arrival of the wounded or at revision day (5th day after debridement). The only exception were femoral fractures that were at first time-treated by traction for 10 days. Sometimes we had precarious supplying because the supplies had to be ordered in Europe. Sometimes one patient had to wait until material became available from another patient. External fixation was also used for reconstructive surgery, mainly for ankle arthrodesis. In conclusion, it was possible for a very small surgical team, on its own for 18 months, to cope with a lot of difficulties caused by lack of readiness of the Rwandan Armed Forces, lack of organization, and lack of discipline of the R

  16. Applications of Metal Additive Manufacturing in Veterinary Orthopedic Surgery

    NASA Astrophysics Data System (ADS)

    Harrysson, Ola L. A.; Marcellin-Little, Denis J.; Horn, Timothy J.

    2015-03-01

    Veterinary medicine has undergone a rapid increase in specialization over the last three decades. Veterinarians now routinely perform joint replacement, neurosurgery, limb-sparing surgery, interventional radiology, radiation therapy, and other complex medical procedures. Many procedures involve advanced imaging and surgical planning. Evidence-based medicine has also become part of the modus operandi of veterinary clinicians. Modeling and additive manufacturing can provide individualized or customized therapeutic solutions to support the management of companion animals with complex medical problems. The use of metal additive manufacturing is increasing in veterinary orthopedic surgery. This review describes and discusses current and potential applications of metal additive manufacturing in veterinary orthopedic surgery.

  17. The practicing orthopedic surgeon's guide to managing long bone metastases.

    PubMed

    Cheung, Felix H

    2014-01-01

    Long bone skeletal metastases are common in the United States, with more than 280,000 new cases every year. Most of these will be managed by the on-call orthopedic surgeon. A practical primer is offered for the evaluation and surgical management for the practicing orthopedist, including questions to ask during the history, pertinent physical examination findings, appropriate imaging requests, proper laboratory work, and biopsy options. Finally, 7 scenarios are presented to encompass most situations a practicing orthopedic surgeon will encounter, and guidelines for treatment and referral are offered.

  18. Orthopedic conditions of small ruminants. Llama, sheep, goat, and deer.

    PubMed

    Kaneps, A J

    1996-03-01

    Diagnosis and treatment of diseases of the foot, infectious arthritis, angular limb deformities, patellar luxation, tendon contracture and injuries, and fractures encountered in sheep, goats, llamas, and deer are reviewed. These species share similar orthopedic problems to cattle, but management conditions, particularly for pet animals, may place special demands on the veterinarian treating these disease conditions. The mild temperament and relatively small body size of these animals make them excellent candidates for treatment of orthopedic problems often not amenable to practical treatment in larger or more fractious animals.

  19. Novel nanostructured hydroxyapatite coating for dental and orthopedic implants

    NASA Astrophysics Data System (ADS)

    Liu, Huinan; Jiang, Wenping; Malshe, Ajay

    2009-09-01

    A novel hybrid coating process, combining NanoSpray® (built on electrostatic spray coating) technology with microwave sintering process, was developed for synthesizing hydroxyapatite- (HA-) based nanostructured coating with favorable properties for dental and orthopedic implants. Specifically, HA nanoparticles were deposited on commercially pure titanium substrates using NanoSpray technique to produce the HA coating, which was then sintered in a microwave furnace under controlled conditions. The study showed that the use of NanoSpray followed by microwave sintering results in nanoscale HA coating for dental/orthopedic application.

  20. Patient-controlled sedation in orthopedic surgery under regional anesthesia: a new approach in procedural sedation.

    PubMed

    Ekin, Abdulselam; Donmez, Ferah; Taspinar, Vildan; Dikmen, Bayazit

    2013-01-01

    Regional anesthesia is a commonly used technique in orthopedic procedures. Sedation should reduce the patient's anxiety and fear while increasing regional anesthesia quality. This study evaluated the hemodynamic changes, level of sedation, both patients' and surgeons' levels of satisfaction and potential side effects in patient-controlled sedation using propofol. This randomized clinical trial studied sixty ASA physical class I-III patients scheduled for total knee replacement surgery under combined spinal-epidural anesthesia. Patients in Group P (n = 30) received propofol via a patient-controlled analgesia device with the following settings: intravenous propofol bolus dose 400 μg.kg(-1), 5-minute lockout interval and no basal infusion. In Group S, we infused saline 150 using the same settings. To determine the level of sedation, we used BIS and Observer's Assessment of Alertness/ Sedation Scale. For all patients, we recorded the number of requests. As the fi nal evaluation, we scored surgeons' and patients' satisfaction on 4-point scales. Both BIS values and OAA/S scores were lower in Group P than in Group S. Patients' satisfaction was higher in Group P, although there was no significant difference with respect to surgeons' satisfaction between the groups. The number of requests for sedation was significantly higher in Group S. However, most requests were considered unsuccessful. This study suggests that patient-controlled sedation with propofol can be used efficiently in orthopedic procedures.

  1. Exposure of the surgical team to ionizing radiation during orthopedic surgical procedures☆☆☆

    PubMed Central

    Palácio, Evandro Pereira; Ribeiro, André Araújo; Gavassi, Bruno Moreira; Di Stasi, Gabriel Guimarães; Galbiatti, José Antônio; Junior, Alcides Durigam; Mizobuchi, Roberto Ryuiti

    2014-01-01

    Objective the aim of this study was to assess the degree of exposure of the orthopedic surgical team to fluoroscopic ionizing radiation. Methods the ionizing radiation to which the orthopedic surgical team (R1, R2 and R3) was exposed was assayed using thermoluminescent dosimeters that were distributed in target anatomical regions (regions with and without protection using a lead apron). This was done during 45 hip osteosynthesis procedures to treat transtrochanteric fractures that were classified as 31-A2.1 (AO). Results the radioactive dose received by R3 was 6.33 mSv, R2 4.51 mSv and R3 1.99 mSv (p = 0.33). The thyroid region received 0.86 mSv of radiation, the thoracic region 1.24 mSv and the gonadal region 2.15 mSv (p = 0.25). There was no record of radiation at the dosimeters located below the biosafety protectors or on the team members’ backs. Conclusions the members of the surgical team who were located closest to the fluoroscope received greater radiation doses than those located further away. The anatomical regions located below the waistline were the ones that received most ionizing radiation. These results emphasize the importance of using biosafety devices, since these are effective in preventing radiation from reaching the vital organs of the medical team. PMID:26229805

  2. Brain Abscess After Halo Fixation for the Cervical Spine.

    PubMed

    Lopes, Arthur; Andrade, Almir; Silva, Igor; Paiva, Wellingson; Brock, Roger; Teixeira, Manoel

    2017-08-01

    Halo fixation is one of the possible treatments for cervical spine fractures. However, improper use of these devices may lead to many complications, such as pin loosening, halo dislocation, pin site infection, and intradural penetration. We report the case of a 43-year-old man who first presented with a seizure and an altered level of consciousness 5 months after halo-vest placement for an odontoid fracture. Brain imaging showed a brain abscess, under the previous left parietal pin. The patient underwent abscess drainage and antibiotics were administered for 12 weeks. On hospital discharge, he presented with only mild impairments. Misapplication of halo fixation devices may lead to serious complications, including intracranial pin penetration and brain abscesses. Proper use of the recommended technique may decrease the risk for complications related to the procedure. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Minimally invasive dynamic hip screw for fixation of hip fractures

    PubMed Central

    Ho, Michael; Garau, Giorgio; Walley, Gayle; Oliva, Francesco; Panni, Alfredo Schiavone; Longo, Umile Giuseppe

    2008-01-01

    We compared a minimally invasive surgical technique to the conventional (open approach) surgical technique used in fixation of hip fractures with the dynamic hip screw (DHS) device. Using a case-control design (44 cases and 44 controls), we tested the null hypothesis that there is no difference between the two techniques in the following outcome measures: duration of surgery, time to mobilisation and weight bearing postoperatively, length of hospital stay, mean difference of pre- and postoperative haemoglobin levels, position of the lag screw of the DHS device in the femoral head, and the tip–apex distance. The minimally invasive DHS technique had significantly shorter duration of surgery and length of hospital stay. There was also less blood loss in the minimally invasive DHS technique. The minimally invasive DHS technique produces better outcome measures in the operating time, length of hospital stay, and blood loss compared to the conventional approach while maintaining equal fixation stability. PMID:18478227

  4. A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation

    PubMed Central

    Ozkan, Korhan; Türkmen, İsmail; Sahin, Adem; Yildiz, Yavuz; Erturk, Selim; Soylemez, Mehmet Salih

    2015-01-01

    Background: The incidence of fractures in the trochanteric area has risen with the increasing numbers of elderly people with osteoporosis. Although dynamic hip screw fixation is the gold standard for the treatment of stable intertrochanteric femur fractures, treatment of unstable intertrochanteric femur fractures still remains controversial. Intramedullary devices such as Gamma nail or proximal femoral nail and proximal anatomic femur plates are in use for the treatment of intertrochanteric femur fractures. There are still many investigations to find the optimal implant to treat these fractures with minimum complications. For this reason, we aimed to perform a biomechanical comparison of the proximal femoral nail and the locking proximal anatomic femoral plate in the treatment of unstable intertrochanteric fractures. Materials and Methods: Twenty synthetic, third generation human femur models, obtained for this purpose, were divided into two groups of 10 bones each. Femurs were provided as a standard representation of AO/Orthopedic Trauma Associationtype 31-A2 unstable fractures. Two types of implantations were inserted: the proximal femoral intramedullary nail in the first group and the locking anatomic femoral plate in the second group. Axial load was applied to the fracture models through the femoral head using a material testing machine, and the biomechanical properties of the implant types were compared. Result: Nail and plate models were locked distally at the same level. Axial steady load with a 5 mm/m velocity was applied through the mechanical axis of femur bone models. Axial loading in the proximal femoral intramedullary nail group was 1.78-fold greater compared to the plate group. All bones that had the plate applied were fractured in the portion containing the distal locking screw. Conclusion: The proximal femoral intramedullary nail provides more stability and allows for earlier weight bearing than the locking plate when used for the treatment of

  5. Orthopedics nursing patients' profile of a public hospital in Salvador-Bahia.

    PubMed

    de Castro, Renata Reis Matutino; Ribeiro, Natália Fonseca; de Andrade, Aline Mendonça; Jaques, Bruno Dórea

    2013-07-01

    To describe the profile of patients treated in the trauma and orthopedics nursing of a trauma care referral public hospital of in the state of Bahia. Cross-sectional study in which data were collected from medical records of patients in the period from July to December 2008. The profile of the patients involved was formed by subjects mostly male young subjects, victims of trauma from accidents, especially those with motorcycles or car runover. On the other hand,the most frequent traumas associated with urban violence were perforations by gunshot and stab wounds. The primary injury presented by these individuals was exposed fracture of the femur and the most common treatment was external fixation. The most frequent in-hospital complication was wound infection, which required another surgical approach. Most inpatients were discharged and only one death was reported during this period. The results of this study corroborate those from other institutions in the country, which may contribute to elaborate public policies for accidents and violence prevention. Level of Evidence IV, Case Series.

  6. Bisphosphonate-Based Strategies for Bone Tissue Engineering and Orthopedic Implants

    PubMed Central

    Cattalini, Juan Pablo; Boccaccini, Aldo R.; Lucangioli, Silvia

    2012-01-01

    Bisphosphonates (BPs) are a group of well-established drugs that are applied in the development of metabolic bone disorder-related therapies. There is increasing interest also in the application of BPs in the context of bone tissue engineering, which is the topic of this review, in which an extensive overview of published studies on the development and applications of BPs-based strategies for bone regeneration is provided with special focus on the rationale for the use of different BPs in three-dimensional (3D) bone tissue scaffolds. The different alternatives that are investigated to address the delivery and sustained release of these therapeutic drugs in the nearby tissues are comprehensively discussed, and the most significant published approaches on bisphosphonate-conjugated drugs in multifunctional 3D scaffolds as well as the role of BPs within coatings for the improved fixation of orthopedic implants are presented and critically evaluated. Finally, the authors' views regarding the remaining challenges in the fields and directions for future research efforts are highlighted. PMID:22440082

  7. Flexion type supracondylar humerus fractures: 12 year experience of a pediatric orthopedics clinic.

    PubMed

    Turgut, Ali; Kalenderer, Önder; Bozoğlan, Muhammet; Bacaksız, Tayfun; Ağuş, Haluk

    2015-01-01

    This study aims to review flexion type supracondylar humerus fractures in children and treatment options. Forty-seven patients (26 males, 21 females; mean age 8.6±3.2 years; range 4 to 15 years) who admitted to and were hospitalized in a pediatric orthopedics clinic between January 2002 and January 2014 due to flexion type supracondylar humerus fracture were included in this retrospective study. Fractures were classified according to Wilkins modification of Gartland system. Closed reduction and percutaneous pinning (CRPP) were administered in all patients with type 2 and 3 fractures. An overhead traction or open reduction was applied when closed reduction could not be achieved with three manipulations. Patients were evaluated clinically and radiologically. The results were graded according to Flynn criteria. Four patients with type 1 fracture were treated conservatively. Of the remaining patients, we were able to perform CRPP successfully in 36 (83.7%). While six patients (14%) were treated with open reduction and internal fixation, one patient (2.1%) was treated with overhead traction. The results were excellent or good in 44 patients (93.7%). Compared with extension type fractures, these fractures are seen in older children and are rarer. One should be prepared to perform open reduction especially for type 3 fractures. In our study, results of patients with type 3 fractures treated with CRPP were superior.

  8. Orthopedics nursing patients' profile of a public hospital in Salvador-Bahia

    PubMed Central

    de Castro, Renata Reis Matutino; Ribeiro, Natália Fonseca; de Andrade, Aline Mendonça; Jaques, Bruno Dórea

    2013-01-01

    OBJECTIVES: To describe the profile of patients treated in the trauma and orthopedics nursing of a trauma care referral public hospital of in the state of Bahia. METHODS: Cross-sectional study in which data were collected from medical records of patients in the period from July to December 2008. RESULTS: The profile of the patients involved was formed by subjects mostly male young subjects, victims of trauma from accidents, especially those with motorcycles or car runover. On the other hand,the most frequent traumas associated with urban violence were perforations by gunshot and stab wounds. The primary injury presented by these individuals was exposed fracture of the femur and the most common treatment was external fixation. The most frequent in-hospital complication was wound infection, which required another surgical approach. Most inpatients were discharged and only one death was reported during this period. CONCLUSION: The results of this study corroborate those from other institutions in the country, which may contribute to elaborate public policies for accidents and violence prevention. Level of Evidence IV, Case Series. PMID:24453666

  9. 21 CFR 888.5850 - Nonpowered orthopedic traction apparatus and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nonpowered orthopedic traction apparatus and accessories. 888.5850 Section 888.5850 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... orthopedic traction apparatus and accessories. (a) Identification. A nonpowered orthopedic traction...

  10. 21 CFR 888.5850 - Nonpowered orthopedic traction apparatus and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonpowered orthopedic traction apparatus and accessories. 888.5850 Section 888.5850 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... orthopedic traction apparatus and accessories. (a) Identification. A nonpowered orthopedic traction...

  11. Two-Pin Fixation of Proximal Interphalangeal Joint Fusion for Hammertoe Correction.

    PubMed

    Boffeli, Troy J; Thompson, Jonathan C; Tabatt, Jessica A

    2016-01-01

    Single-pin external Kirschner wire (K-wire) fixation has traditionally been a mainstay in proximal interphalangeal joint fusion for central hammertoe repair. Concerns over cosmesis, inconvenience, pin tract infection, hardware failure, nonunion, and early hardware removal have led to the development of implantable internal fixation devices. Although numerous implantable devices are now available and represent viable options for hammertoe repair, they are costly and often pose a challenge in the event removal becomes necessary. An alternative fixation option not typically used is a 2-pin K-wire fixation technique. The perceived advantage of obtaining 2 points of fixation compared with 1 across the fusion site is improved stability against the rotational and bending forces, thus decreasing the potential for pin-related complications. A retrospective assessment of 91 consecutive hammertoe repairs consisting of proximal interphalangeal joint fusion with 2-pin fixation in 60 patients was performed. The K-wires were removed at 6 weeks postoperatively, and the overall postoperative follow-up duration was 28.56 (range 1.40 to 86.83) months. Of the 91 digits, 89 (98%) did not encounter a complication postoperatively and 2 (2.20%) had sustained loosened or broken hardware. No postoperative infection was encountered. The low incidence of complications observed supports the 2-pin K-wire fixation technique as a low-cost and viable construct for proximal interphalangeal joint fusion hammertoe repair.

  12. Percutaneous fixation of scaphoid fractures.

    PubMed

    Slade, J F; Jaskwhich, D

    2001-11-01

    The scaphoid proximal pole and waist fractures presented here were treated by a novel dorsal percutaneous technique with arthroscopic assistance. All fractures healed, with good final functional results and no complications. The advantages of the dorsal percutaneous approach to scaphoid fixation are: (1) the proximal-to-distal placement of the guide pin and screw allow for more precise placement along the central axis of the scaphoid, which decreases healing time and reduces risk of screw thread exposure. (2) The dorsal approach avoids injuring the vulnerable volar ligament anatomy. And (3) the insertion of the screw from the proximal to distal direction allows the more rigid fixation of proximal scaphoid fractures. Arthroscopy allows confirmation of fracture reduction and screw implantation as well as evaluation of concurrent ligament injuries not detected with standard imaging. Percutaneous K-wires act as joysticks to reduce and compress fracture fragments prior to fixation. The presented technique allows for early, rigid internal fixation with minimal associated morbidity. Patients successfully treated with this technique include those with stable and unstable acute fractures of the scaphoid at all locations, including the proximal pole. Nondisplaced fractures that present with delayed or fibrous union without evidence of avascular necrosis, cyst formation, or bony sclerosis may also be treated with this technique. This technique allows for faster rehabilitation and an earlier return to work or avocation without restriction once CT scan confirms a solid union. Some articles document extraordinary rapid healing by standard radiographs; however, we caution that scaphoid bone healing cannot accurately be determined without CT scan. Percutaneous, arthroscopically assisted internal fixation by a dorsal approach may be considered in all acute scaphoid fractures selected for surgical fixation. The dorsal guidewire permits dorsal and volar implantation of a cannulated

  13. Carbon-carbon composites for orthopedic prosthesis and implants. CRADA final report

    SciTech Connect

    Burchell, T D; Klett, J W; Strizak, J P; Baker, C

    1998-01-21

    The prosthetic implant market is extensive. For example, because of arthritic degeneration of hip and knee cartilage and osteoporotic fractures of the hip, over 200,000 total joint replacements (TJRs) are performed in the United States each year. Current TJR devices are typically metallic (stainless steel, cobalt, or titanium alloy) and are fixed in the bone with polymethylacrylate (PMMA) cement. Carbon-carbon composite materials offer several distinct advantages over metals for TJR prosthesis. Their mechanical properties can be tailored to match more closely the mechanical properties of human bone, and the composite may have up to 25% porosity, the size and distribution of which may be controlled through processing. The porous nature of carbon-carbon composites will allow for the ingrowth of bone, achieving biological fixation, and eliminating the need for PMMA cement fixation.

  14. Pathophysiology of infections after internal fixation of fractures.

    PubMed

    Schmidt, A H; Swiontkowski, M F

    2000-01-01

    Infection complicating internal fixation of fractures is a serious complication that is difficult to treat. Whenever metallic devices are implanted in vivo, successful biointegration requires that host cells colonize the highly reactive implant surface. Bacteria such as staphylococci can also become adherent to metallic or polymeric implants and will compete with host cells for colonization of the implant surface. Once adherent, these bacteria form a biofilm and undergo phenotypic changes that make them resistant to the normal host immune response as well as to antibiotics. Furthermore, metallic implants themselves cause specific deficits in the function of the local immune system that may render the host response to infection inadequate. Any associated soft-tissue injury causes even greater impairment of local immune function. Despite the potentially detrimental impact of internal fixation, fracture stability is of paramount importance in achieving fracture union and in preventing infection. It has been demonstrated in animal models that contaminated fractures without internal fixation develop clinical infection more commonly than similar fractures treated with internal fixation at the time of colonization. Because of the potential for infection whenever internal fixation is utilized, appropriate prophylactic antibiotic coverage for staphylococci and Gram-negative organisms should be provided. Open wounds and severely damaged soft tissues require aggressive management so that a viable soft-tissue envelope is maintained around the implant. Host factors such as smoking and malnourishment should be corrected. Early diagnosis and aggressive treatment of implant-related infection with antibiotics, debridement, and maintenance of stable internal fixation are essential to successful treatment.

  15. Looking at the Social Activity for Adolescents with Orthopedic Impairments

    ERIC Educational Resources Information Center

    Biastro, Leslie; Frank, Heather; Larwin, Karen H.

    2015-01-01

    Adolescents with identified orthopedic impairments are often less likely to participate in social activities outside of the school setting. However, the adolescents who are able to participate in activities have higher social skills, more academic successes, and show more satisfaction in their roles as family member or friend. The aim of this…

  16. The Special Orthopedic Hospital—Past and Present

    PubMed Central

    Platt, Harry

    1964-01-01

    Pioneer orthopedic institutions established in Europe in the late 18th and early 19th centuries, and in the U.S.A. in the second half of the 19th and the first decade of the 20th century, can trace their ancestry in ideas back to the practice and teachings of Hippocrates. Experience in treatment of great numbers of injured soldiers in the First World War opened a new era in reconstructive surgery of the locomotor system. After the Second World War, in advanced nations the pattern of crippling diseases showed a spectacular change. Problems that justify the existence of large special orthopedic hospitals are, in children, the more complex congenital deformities, cerebral palsies, and the increasing number of injuries due to hazards of modern life; in the adult, the reconstructive surgery of trauma and of arthritis. In modern orthopedic hospitals physicians have joined orthopedic surgeons in the study of the natural history of the various forms of arthritis. These centres provide facilities for biomechanical research and postgraduate training which acute general hospitals cannot offer. PMID:14228224

  17. [Application of platelet-rich plasma in clinical orthopedics].

    PubMed

    Fu, Weili; Li, Qi; Li, Jian

    2014-10-01

    To summarize the application status and progress of platelet-rich plasma (PRP) in clinical orthopedics. The recent related literature concerning the application of PRP in clinical orthopedics was extensively reviewed and analyzed. Recently, a large number of clinical studies on PRP have been carried out, which are applied in bone defects or nonunion, spinal fusion, osteoarthritis and cartilage injuries, ligament reconstruction, muscle strain, tendon terminal diseases, and a variety of acute and chronic soft tissue injuries. Some results show certain effectiveness, while others demonstrate invalid. Easily drawing, achieving autologous transplantation, and the biological repair potential of the musculoskeletal tissues make PRP to be widely used in clinical orthopedics. However, there are still no uniform standards accepted and reliable clinical guidelines about the application of PRP. Furthermore, a variety of PRP products and their respective indications are also different. The clinical evidences with the greater sample size and higher quality are still needed to further support the safety and effectiveness of PRP in clinical orthopedics.

  18. Supporting the Educational Needs of Students with Orthopedic Impairments.

    ERIC Educational Resources Information Center

    Heller, Kathryn Wolff; Swinehart-Jones, Dawn

    2003-01-01

    This article provides information on orthopedic impairments and the unique knowledge and skills required to provide these students with an appropriate education. Information on current practice is provided, as well as training and technical assistance models that can be used to help provide teachers with the necessary training. (Contains…

  19. Higher Education and Students with Orthopedic Disabilities: A Survey Instrument.

    ERIC Educational Resources Information Center

    Singh, Delar K.

    A survey instrument is presented that was used in a national survey of 160 colleges and universities to explore facilities and services to students with orthopedic disabilities. The survey contains 33 items that focus on the following areas: structural accessibility, academic accessibility, dorm-living, and recreational opportunities. The total…

  20. Measuring dwell time percentage from head-mounted eye-tracking data--comparison of a frame-by-frame and a fixation-by-fixation analysis.

    PubMed

    Vansteenkiste, Pieter; Cardon, Greet; Philippaerts, Renaat; Lenoir, Matthieu

    2015-01-01

    Although analysing software for eye-tracking data has significantly improved in the past decades, the analysis of gaze behaviour recorded with head-mounted devices is still challenging and time-consuming. Therefore, new methods have to be tested to reduce the analysis workload while maintaining accuracy and reliability. In this article, dwell time percentages to six areas of interest (AOIs), of six participants cycling on four different roads, were analysed both frame-by-frame and in a 'fixation-by-fixation' manner. The fixation-based method is similar to the classic frame-by-frame method but instead of assigning frames, fixations are assigned to one of the AOIs. Although some considerable differences were found between the two methods, a Pearson correlation of 0.930 points out a good validity of the fixation-by-fixation method. For the analysis of gaze behaviour over an extended period of time, the fixation-based approach is a valuable and time-saving alternative for the classic frame-by-frame analysis.

  1. A Novel Biodegradable Polycaprolactone Fixator for Osteosynthesis Surgery of Rib Fracture: In Vitro and in Vivo Study

    PubMed Central

    Yu, Yi-Hsun; Fan, Chin-Lung; Hsu, Yung-Heng; Chou, Ying-Chao; Ueng, Steve W. N.; Liu, Shih-Jung

    2015-01-01

    Osteosynthesis surgery for rib fractures is controversial and challenging. This study developed a noval poly(ε-caprolactone) (PCL)-based biodegradable “cable-tie” fixator for osteosynthesis surgery for rib fractures. A biodegradable fixator specifically for fractured ribs was designed and fabricated by a micro-injection molding machine in our laboratory. The fixator has three belts that could be passed through matching holes individually. The locking mechanism allows the belt movement to move in only one direction. To examine the in vitro biomechanical performance, ribs 3–7 from four fresh New Zealand rabbits were employed. The load to failure and stress-strain curve was compared in the three-point bending test among native ribs, titanium plate-fixed ribs, and PCL fixator-fixed ribs. In the in vivo animal study, the sixth ribs of New Zealand rabbits were osteotomized and osteosynthesis surgery was performed using the PCL fixator. Outcomes were assessed by monthly X-ray examinations, a final micro-computed tomography (CT) scan, and histological analysis. The experimental results suggested that the ribs fixed with the PCL fixator were significantly less stiff than those fixed with titanium plates (p < 0.05). All ribs fixed with the PCL fixators exhibited union. The bridging callus was confirmed by gross, radiographic micro-three-dimensional (3D) CT, and histological examinations. In addition, there was no significant inflammatory response of the osteotomized ribs or the PCL-rib interface during application. The novel PCL fixator developed in this work achieves satisfactory results in osteosynthesis surgery for rib fractures, and may provide potential applications in other orthopedic surgeries. PMID:28793672

  2. Treatment of Unicameral Bone Cysts of the Proximal Femur With Internal Fixation Lessens the Risk of Additional Surgery.

    PubMed

    Wilke, Benjamin; Houdek, Matthew; Rao, Rameshwar R; Caird, Michelle S; Larson, A Noelle; Milbrandt, Todd

    2017-08-17

    Little data exist to guide the treatment of unicameral bone cysts in the proximal femur. Methods of treatment include corticosteroid injections, curettage and bone grafting, and internal fixation. The authors completed a multi-institutional, retrospective review to evaluate their experience with proximal femoral unicameral bone cysts. They posed the following questions: (1) Does internal fixation reduce the risk of further procedures for the treatment of a unicameral bone cyst? (2) Is radiographic healing faster with internal fixation? Following institutional review board approval, the authors conducted a retrospective review of 36 patients treated for a unicameral bone cyst of the proximal femur at their institutions between 1974 and 2014. Medical records and radiographs were reviewed to identify patient demographics and treatment outcomes. Tumor locations included femoral neck (n=13), intertrochanteric (n=16), and subtrochanteric (n=7). Initial treatment included steroid injection (n=2), curettage and bone grafting (n=9), and internal fixation with curettage and bone grafting (n=25). Mean time was 9 months to radiographic healing and 15 months to return to full activity. The number of patients requiring additional surgeries was increased among those who did not undergo internal fixation. There was no difference in time to radiographic healing. However, time to return to normal activities was reduced if patients had received internal fixation. A significant reduction in additional procedures was observed when patients had been treated with internal fixation. Although this did not influence time to radiographic healing, patients did return to normal activities sooner. Internal fixation should be considered in the treatment of proximal femoral unicameral bone cysts. [Orthopedics. 201x; xx(x):xx-xx.]. Copyright 2017, SLACK Incorporated.

  3. Spinal fixation. Part 3. Complications of spinal instrumentation.

    PubMed

    Slone, R M; MacMillan, M; Montgomery, W J

    1993-07-01

    Spinal fixation devices can be used to form a rigid construct with the spine to replace bone, restore alignment, maintain position, and prevent motion in the treatment of fractures, degenerative disease, neoplasm, and congenital deformities. Because most spinal constructs will eventually fail if bone fusion does not occur, bone graft material is often used along with the implant to promote fusion. Conventional radiographs, obtained in two projections, remain the mainstay of implant evaluation, demonstrating the position of the spinal elements, hardware, graft material, and evidence of complication. Possible complications connected with use of fixation devices include intraoperative soft-tissue injuries, postoperative hematomas, and infection. The components (through incorrect use, malpositioning at surgery, and later dislodgment or fracture) may also contribute to complications such as instability; failure of fusion; or pain, with possible resultant neurologic damage. Bone graft material can migrate or hypertrophy, resulting in impingement on the spinal canal or neural foramen. Radiologists should be familiar with the various spinal fixation devices and techniques to better identify evolving complications.

  4. External fixator frames as interim damage control for limb injuries: experience in the 2010 Haiti earthquake.

    PubMed

    Lebel, Ehud; Blumberg, Nehemia; Gill, Amit; Merin, Ofer; Gelfond, Reuven; Bar-On, Elhanan

    2011-12-01

    An earthquake occurred in Haiti on January 12, 2010. The center of earthquake and the most extensive damage occurred near the capital Port-au-Prince. There were an estimated 230,000 deaths with more than 250,000 others injured. The Israeli Defense Forces Field Hospital (IDF hospital) is a military unit composed of army-recruited (volunteer) medical personnel that was sent to Haiti to serve as a stand-alone center for early response until larger medical missions could become functional and take on the task of more sophisticated and long-lasting medical support. This study describes the use of external fixator frames for orthopedic damage control whereby bone stabilization in conjunction with soft tissue care serves as a stopgap until more comprehensive therapy is forthcoming. Data were collected from patients' files (generated at the IDF hospital) regarding the use and immediate outcome of limbs stabilized by external fixator frames. During the 10 days of the IDF hospital's activity, a total of 1,111 patients were admitted; 244 surgical procedures were performed under general or regional anesthesia and of these, the orthopedists performed 221 (90%) surgical procedures. Seventy-three fractures were stabilized operatively by application of an external fixator. Most of the frames were applied on fractures (closed and open) of the lower limbs (48 on femur and 24 on tibia/fibula). All procedures were performed in a field-style operating room. Sterile technique was possible only for elements actually inserted into the patient. Limb alignment was based on manual palpation: intraoperative fluoroscopy was not available; soft tissue care followed bone stabilization. No patient died. All patients completed urgent stabilization at the IDF hospital and were transferred to other facilities or discharged for home care. We describe "orthopedic damage control" using external fixator frames for bone stabilization and soft tissue care as a viable approach in the context of a mass

  5. A Comprehensive, High-Quality Orthopedic Intern Surgical Skills Program.

    PubMed

    Ford, Samuel E; Patt, Joshua C; Scannell, Brian P

    2016-01-01

    To design and implement a month-long, low-cost, comprehensive surgical skills curriculum built to address the needs of orthopedic surgery interns with high satisfaction among both interns and faculty. The study design was retrospective and descriptive. The study was conducted at tertiary care referral center with a medium sized orthopedic residency surgery program (5 residents/year). Totally 5 orthopedic surgery residents and 16 orthopedic surgery faculty participated. A general mission was established-to orient the resident to the postgraduate year 1 and prepare them for success in residency. The basic tenets of the American Board of Orthopaedic Surgeons surgical skills program framework were built. Curricular additions included anatomic study, surgical approaches, joint-specific physical examination, radiographic interpretation, preoperative planning, reduction techniques, basic emergency and operating room procedures, cadaveric procedure practice, and introduction to arthroplasty. The program was held in August during protected time for intern participants. In total, 16 orthopedic surgeons instructed 85% of the educational sessions. One faculty member did most of the preparation and organization to facilitate the program. The program ran for a cumulative 89 hours, including 14.5 hours working with cadaveric specimens. The program cost a total of $8100. The average module received a 4.15 rating on a 5-point scale, with 4 representing "good" and 5 representing "excellent." The program was appropriately timed and addressed topics relevant to the intern without sacrificing clinical experience or burdening inpatient services with interns' absence. The program received high satisfaction ratings from both the interns as well as the faculty. Additionally, the program fostered early relationships between interns and faculty-an unforeseen benefit. In the future, our program plans to better integrate validated learning metrics and improve instruction pertaining to both

  6. Orthopedic surgery core curriculum hip and knee reconstruction.

    PubMed

    Wadey, Veronica M R; Maloney, William J; Dev, Parvati; Walker, Decker

    2008-04-01

    To develop a core curriculum for orthopedic surgery and to conduct a national survey to assess the importance of 281 curriculum items. Attention was focused on 55 topics pertaining to hip and knee reconstruction. A 281-item curriculum was developed. We completed a content review and cross-sectional survey of a random selection of orthopedic surgeons whose primary affiliation was nonuniversity. We analyzed the data descriptively and quantitatively, using histograms, a modified Hotelling's T2 statistic with the p value determined by a permutation test, and the Benjamini- Hochberg/Yekutieli procedure. Our analyses assumed that each respondent answered questions independently of the answers of any other respondent but that the answers to different questions by the same respondent might be dependent. Of 156 orthopedic surgeons, 131 (84%) participated in this study. Of 55 items ranked by all respondents, 42 received an average mean score greater than 3.5/4.0, and 51 received an average mean score equal to or greater than 3.0/40 (the standard deviation for each item ranged from 0.00 to 0.08), suggesting that 92.7% of the items are important or probably important to know by the end of residency. This study demonstrates agreement that it is important to include 92.7% of the items that pertain to hip and knee reconstruction in a core curriculum for orthopedic surgery. Residency training programs may need to ensure that appropriate educational opportunities focusing on complex primary and revision surgery are available to meet the future needs of orthopedic surgeons whose primary affiliation is nonuniversity.

  7. Missing nitrogen fixation in the Benguela region

    NASA Astrophysics Data System (ADS)

    Wasmund, Norbert; Struck, Ulrich; Hansen, Anja; Flohr, Anita; Nausch, Günther; Grüttmüller, Annett; Voss, Maren

    2015-12-01

    Opposing opinions on the importance of nitrogen fixation in the northern Benguela upwelling region provoked us to investigate the magnitude of nitrogen fixation in front of northern Namibia and southern Angola. Measurements of nitrogen fixation rates using the 15N method at 66 stations during seven cruises from 2008 to 2014 showed that, in general, the 15N content in the biomass did not increase after tracer incubation with 15N2, indicating that no nitrogen fixation occurred. Correspondingly, the filamentous nitrogen-fixing cyanobacterium Trichodesmium was almost not present. The abundant picocyanobacteria did obviously not perform nitrogen fixation to a significant degree. The artificial improvement of conditions for nitrogen fixation in mesocosm experiments, including phosphate and iron additions and a warmer temperature, failed to induce nitrogen fixation. A plausible explanation of these findings is a lack of conditioned cells for nitrogen fixation in the Benguela region.

  8. Mini external fixation in the hand.

    PubMed

    Ugwonali, Obinwanne Fidelis C; Jupiter, Jesse B

    2006-09-01

    External fixation is an effective means of addressing several pathologies of the hand. The advantages of its use include the ability to achieve stable fixation, minimize soft tissue trauma at the site of injury, and allow wound care and mobilization of adjacent joints. External fixators can be constructed from material readily available in the operating room or obtained from a commercial source. Sufficient rigidity can be achieved by any of these means. Improper placement, although achieving rigid fixation, may compromise motion and overall function if basic principles of external fixation are not followed or if the anatomy of the hand is not taken into consideration. The objective of this article is to describe the technique of application of mini external fixation, emphasizing the basic principles of external fixation as they relate to the specific anatomy of the hand. In addition to fracture fixation, various other uses are described including distraction lengthening, arthrodesis, treatment of nonunion, and infection.

  9. Complement fixation test to C. burnetii

    MedlinePlus

    ... ency/article/003520.htm Complement fixation test to C burnetii To use the sharing features on this ... JavaScript. The complement fixation test to Coxiella burnetii ( C burnetti ) is a blood test that checks for ...

  10. The Orthopedic Trauma Symposium: improving care of orthopedic injuries in Haiti.

    PubMed

    Normore, Ryan; Greene, Helena; DeLong, Allison; Furey, Andrew

    2017-08-01

    Although single-trip volunteer medical teams can provide much-needed acute trauma care following natural disasters, their ability to leave a legacy of improved care in the region is often limited. One way to improve treatment of traumatic injuries is through conference-based teaching, such as the Orthopedic Trauma Symposium (OTS), which took place in Haiti in 2014. However, there is little research evaluating the effectiveness of such teaching tools. We evaluated the OTS and the potential benefits of future iterations of the course. A survey consisting of 5-point Likert scale questions as well as qualitative open feedback assessed respondents' opinions regarding the value, content and delivery of the OTS. Respondents were classified dichotomously in terms of their role in the OTS (instructor v. participant) to measure any meaningful difference in feedback. In total, 84% of all participants agreed that course content was clearly communicated, and 98% agreed that instructors were knowledgeable in the topics covered. Moreover, 87% of all participants responded that they would apply the training in their medical practices going forward. Haitian physicians, residents and medical students responded favourably to the OTS. Open-ended questions offered concise, attainable improvements for future iterations of the course. Organizations committed to improving medical care in low- and middle-income countries should take note of these findings while continuing to develop the OTS and similar initiatives globally.

  11. Mainstreaming Preschoolers: Children with Orthopedic Handicaps. A Guide for Teachers, Parents, and Others Who Work with Orthopedically Handicapped Preschoolers.

    ERIC Educational Resources Information Center

    Kieran, Shari Stokes; And Others

    This guide to mainstreaming preschoolers with orthopedic handicaps is one of a series of eight manuals on mainstreaming preschoolers developed by Project Head Start. The guide is addressed to parents, teachers, and other professionals and paraprofessionals. Chapter I presents information on the meaning, benefits and implementation of…

  12. Mainstreaming Preschoolers: Children with Orthopedic Handicaps. A Guide for Teachers, Parents, and Others Who Work with Orthopedically Handicapped Preschoolers.

    ERIC Educational Resources Information Center

    Kieran, Shari Stokes; And Others

    This guide to mainstreaming preschoolers with orthopedic handicaps is one of a series of eight manuals on mainstreaming preschoolers developed by Project Head Start. The guide is addressed to parents, teachers, and other professionals and paraprofessionals. Chapter I presents information on the meaning, benefits and implementation of…

  13. Transit Fixatives: An Innovative Study

    PubMed Central

    A, Ravi Prakash; G, Sreenath; JK, Sonia Bai; NDVN, Shyam

    2015-01-01

    Background: Universally accepted fixative is 10% formalin which has been used for preserving the tissues and their architecture. In certain conditions, formalin might not be readily available for immediate fixation. We here by explore more economical, eco-friendly and easily available solutions that can be used as transit media/ transporting media for tissue specimens. Materials and Methods: The study included commonly available solutions like Spirit, Saline, Betadine solution, Hydrogen peroxide (H2O2), Local anesthesia (L.A), Rose water, Coconut oil, Coconut water, Ice cold water, Honey and Milk while keeping formalin as control. The fresh tissue sample was cut into multiple bits and placed in different containers for a period of 8 hours before transferring to formalin solution. Conclusion: Transit fixatives are very important in certain situations where formalin is not readily available. These fixatives can be used to fix the tissues for a period of at least 8 hours without causing any damage or distortion before they are fixed in formalin solution. PMID:25954725

  14. The effect of patch testing on surgical practices and outcomes in orthopedic patients with metal implants.

    PubMed

    Atanaskova Mesinkovska, Natasha; Tellez, Alejandra; Molina, Luciana; Honari, Golara; Sood, Apra; Barsoum, Wael; Taylor, James S

    2012-06-01

    To determine the effect of patch testing on surgical decision making and outcomes in patients evaluated for suspected metal hypersensitivity related to implants in bones or joints. Medical chart review. Tertiary care academic medical center. All patients who had patch testing for allergic contact dermatitis related to orthopedic implants. Patch testing. The surgeon's preoperative choice of metal implant alloy compared with patch testing results and the presence of hypersensitivity complications related to the metal implant on postsurgical follow-up. Patients with potential metal hypersensitivity from implanted devices (N = 72) were divided into 2 groups depending on timing of their patch testing: preimplantation (n = 31) and postimplantation (n = 41). History of hypersensitivity to metals was a predictor of positive patch test results to metals in both groups. Positive patch test results indicating metal hypersensitivity influenced the decision-making process of the referring surgeon in all preimplantation cases (n = 21). Patients with metal hypersensitivity who received an allergen-free implant had surgical outcomes free of hypersensitivity complications (n = 21). In patients who had positive patch test results to a metal in their implant after implantation, removal of the device led to resolution of associated symptoms (6 of 10 patients). The findings of this study support a role for patch testing in patients with a clinical history of metal hypersensitivity before prosthetic device implantation. The decision on whether to remove an implanted device after positive patch test results should be made on a case-by-case basis, as decided by the surgeon and patient.

  15. Understanding Nitrogen Fixation

    SciTech Connect

    Paul J. Chirik

    2012-05-25

    synthesis of ammonia, NH{sub 3}, from its elements, H{sub 2} and N{sub 2}, via the venerable Haber-Bosch process is one of the most significant technological achievements of the past century. Our research program seeks to discover new transition metal reagents and catalysts to disrupt the strong N {triple_bond} N bond in N{sub 2} and create new, fundamental chemical linkages for the construction of molecules with application as fuels, fertilizers and fine chemicals. With DOE support, our group has discovered a mild method for ammonia synthesis in solution as well as new methods for the construction of nitrogen-carbon bonds directly from N{sub 2}. Ideally these achievements will evolve into more efficient nitrogen fixation schemes that circumvent the high energy demands of industrial ammonia synthesis. Industrially, atmospheric nitrogen enters the synthetic cycle by the well-established Haber-Bosch process whereby N{sub 2} is hydrogenated to ammonia at high temperature and pressure. The commercialization of this reaction represents one of the greatest technological achievements of the 20th century as Haber-Bosch ammonia is responsible for supporting approximately 50% of the world's population and serves as the source of half of the nitrogen in the human body. The extreme reaction conditions required for an economical process have significant energy consequences, consuming 1% of the world's energy supply mostly in the form of pollution-intensive coal. Moreover, industrial H{sub 2} synthesis via the water gas shift reaction and the steam reforming of methane is fossil fuel intensive and produces CO{sub 2} as a byproduct. New synthetic methods that promote this thermodynamically favored transformation ({Delta}G{sup o} = -4.1 kcal/mol) under milder conditions or completely obviate it are therefore desirable. Most nitrogen-containing organic molecules are derived from ammonia (and hence rely on the Haber-Bosch and H{sub 2} synthesis processes) and direct synthesis from

  16. Negative Pressure Wound Therapy With Instillation and Dwell Time Used to Treat Infected Orthopedic Implants: A 4-patient Case Series.

    PubMed

    Dettmers, Robert; Brekelmans, Wouter; Leijnen, Michiel; van der Burg, Boudewijn; Ritchie, Ewan

    2016-09-01

    Infection following orthopedic implants for bone fixation or joint replacement is always serious and may require removal of the osteosynthetic material. Negative pressure wound therapy with instillation and dwell time (NPWTi-d) is an emerging therapy for the treatment of complex wounds, including infected wounds with osteosynthetic material. The purpose of this case study was to evaluate the outcomes of 4 patients (1 man, 3 women; age range 49 to 71 years) with a postoperative wound infection (POWI) following fracture repair and internal fixation. All patients were at high risk for surgical complications, including infections. Standard infection treatments (antibiotics) had been unsuccessful. Based on the available literature, a NPWTi-d protocol was developed. Following surgical debridement, wounds were instilled with polyhexanide biguanide with a set dwell time of 15 minutes, followed by continuous NPWTi-d of -125 mm Hg for 4 hours. The system was changed every 3 to 4 days until sufficient granulation tissue was evident and negative pressure without instillation could be used. Systemic antibiotics were continued in all patients. Granulation tissue was found to be sufficient in 12 to 35 days in the 4 cases, no recurrence of infection was noted, and the osteosynthesis material remained in place. No adverse events were observed. Research is needed to compare the safety and effectiveness of this adjunct treatment in the management of challenging wounds to other patient and wound management approaches.

  17. Characteristics of Orthopedic Publications in High-Impact General Medical Journals.

    PubMed

    Nwachukwu, Benedict U; Kahlenberg, Cynthia A; Lehman, Jason D; Lyman, Stephen; Marx, Robert G

    2017-05-01

    Orthopedic studies are occasionally published in high-impact general medical journals; these studies are often given high visibility and have significant potential to impact health care policy and inform clinical decision-making. The purpose of this review was to investigate the characteristics of operative orthopedic studies published in high-impact medical journals. The number of orthopedic studies published in high-impact medical journals is relatively low; however, these studies demonstrate methodological characteristics that may bias toward nonoperative treatment. Careful analysis and interpretation of orthopedic studies published in these journals is warranted. [Orthopedics. 2017; 40(3):e405-e412.]. Copyright 2017, SLACK Incorporated.

  18. Binocular Fixation Disparity in Single Word Displays

    ERIC Educational Resources Information Center

    Paterson, Kevin B.; Jordan, Timothy R.; Kurtev, Stoyan

    2009-01-01

    It has been claimed that the recognition of words displayed in isolation is affected by the precise location at which they are fixated. However, this putative role for fixation location has yet to be reconciled with the finding from reading research that binocular fixations are often misaligned and, therefore, more than 1 location in a word is…

  19. Successful treatment of nonunion with an Ilizarov ring fixator after ankle fracture for Charcot arthropathy: a case report

    PubMed Central

    2014-01-01

    Background Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to orthopedic surgeons. Nonunion and lengthy wound healing in high-risk patients with diabetes, particularly patients with peripheral arterial disease and renal failure, occur secondary to several clinical conditions and are often fraught with complications. Whether diabetic ankle fractures are best treated noninvasively or surgically is controversial. Case presentation A 53-year-old Japanese man fractured his right ankle. The fractured ankle was treated nonsurgically with a plaster cast. Although he remained non-weight-bearing for 3 months, radiography at 3 months showed nonunion. The nonunion was treated by Ilizarov external fixation of the ankle. The external fixator was removed 99 days postoperatively, at which time the patient exhibited anatomical and functional recovery and was able to walk without severe complications. Conclusion In patients with diabetes mellitus, severe nonunion of ankle fractures with Charcot arthropathy in which the fracture fragment diameter is very small and the use of internal fixation is difficult is a clinical challenge. Ilizarov external fixation allows suitable fixation to be achieved using multiple Ilizarov wires. PMID:25103697

  20. Tissue fixation and the effect of molecular fixatives on downstream staining procedures.

    PubMed

    Howat, William J; Wilson, Beverley A

    2014-11-01

    It is impossible to underplay the importance of fixation in histopathology. Whether the scientist is interested in the extraction of information on lipids, proteins, RNA or DNA, fixation is critical to this extraction. This review aims to give a brief overview of the current "state of play" in fixation and focus on the effect fixation, and particularly the effect of the newer brand of "molecular fixatives" have on morphology, histochemistry, immunohistochemistry and RNA/DNA analysis. A methodology incorporating the creation of a fixation tissue microarray for the study of the effect of fixation on histochemistry is detailed. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  1. The incidence of nonunion after Lapidus arthrodesis using staple fixation.

    PubMed

    Mallette, Jason P; Glenn, Courtney L; Glod, Douglas J

    2014-01-01

    Today's foot and ankle surgeon has multiple options when choosing a fixation device for Lapidus arthrodesis, many of which have well-documented nonunion rates. The present study aimed to fill a void in the current foot and ankle literature by establishing a nonunion rate for staple fixation for the Lapidus procedure. The present retrospective analysis of the medical record focused on nickel-titanium staples that were inserted in a delta configuration to yield a stable construct for first metatarsal-cuneiform fusion. The patients were kept strictly non-weightbearing for the first 6 weeks postoperatively. Weightbearing progressed at that point according to the radiographic findings of each case. The data from 35 consecutive patients were analyzed (25 females, 10 males; mean age 43.1 [range 15 to 72] years in whom a Lapidus arthrodesis was performed using staple fixation in 36 feet. The patients were followed until fusion was noted and pain had resolved. Pain resolution occurred at 6 weeks in the earliest cases and several years in others. The incidence of nonunion was 3 (8.3%) of 36 when staple fixation was used for first metatarsal-medial cuneiform arthrodesis. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Low profile halo head fixation in non-human primates.

    PubMed

    Azimi, Kousha; Prescott, Ian A; Marino, Robert A; Winterborn, Andrew; Levy, Ron

    2016-08-01

    We present a new halo technique for head fixation of non-human primates during electrophysiological recording experiments. Our aim was to build on previous halo designs in order to create a simple low profile system that provided long-term stability. Our design incorporates sharp skull pins that are directly threaded through a low set halo frame and are seated into implanted titanium foot plates on the skull. The inwardly directed skull pins provide an easily calibrated force against the skull. This device allowed for head fixation within 1 week after implantation surgery. The low-profile design maximized the area of the skull available and potential implant orientations for electrophysiological experiments. It was easily maintained and was stable in 2 animals for the 6-8 months of testing. The quality of single unit neural recordings collected while using this device to head fix was indistinguishable from traditional head-post fixation. The foot plates used in this system did not result in significant MRI distortion in the location of deep brain targets (∼0.5mm) of a 3D printed phantom skull. The low profile design of this halo design allows greater access to the majority of the frontal, parietal, and occipital skull. It has fewer parts and can hold larger animals than previous halo designs. Given the stability, simplicity, immediate usability, and low profile of our head fixation device, we propose that it is a practical and useful means for performing electrophysiological recording experiments on non-human primates. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. Antibiotic Use and Kirschner Wire Fixation in Forefoot Surgery: A National Survey.

    PubMed

    Pace, Gregory; Dellenbaugh, Samuel; Stapinski, Brian; Aydogan, Umur; Bustillo, Jorge; Juliano, Paul

    2017-07-01

    In foot and ankle patients, the use of Kirschner wires is common, and the population in the typical foot and ankle practice has higher rates of comorbidities associated with infection. This study assessed national trends regarding the use of postoperative prophylactic antibiotic therapy in patients undergoing foot and ankle surgery treated with percutaneous Kirschner wires. Attending physicians at foot and ankle fellowships were mailed a questionnaire that included 3 clinical vignettes containing questions on the use of postoperative antibiotics in patients treated with percutaneous Kirschner wires. A total of 112 physicians were identified; 64 physicians (57%) returned the survey. In the first case of a nondiabetic patient, 16 physicians (25%) indicated they would place the patient on postoperative antibiotics for an average of 9.4 days with an average duration of Kirschner wire fixation of 35.1 days. In the second case of a non-neuropathic diabetic patient, 18 surgeons (28%) indicated they would place the patient on postoperative antibiotics for an average of 13.8 days with an average duration of Kirschner wire fixation of 35.4 days. In the third case of a diabetic patient with neuropathy, 19 physicians (32%) indicated they would place the patient on postoperative antibiotics for an average of 14.5 days with an average duration of Kirschner wire fixation of 36.7 days. Few attending physicians at orthopedic foot and ankle fellowships placed their patients treated with percutaneous Kirschner wires on postoperative antibiotic prophylaxis, even in diabetic patients for whom an increased risk of infection has been documented. [Orthopedics. 2017; 40(4):e594-e597.]. Copyright 2017, SLACK Incorporated.

  4. Attitudes toward chiropractic: a survey of North American orthopedic surgeons.

    PubMed

    Busse, Jason W; Jacobs, Craig; Ngo, Trung; Rodine, Robert; Torrance, David; Jim, Janey; Kulkarni, Abhaya V; Petrisor, Brad; Drew, Brian; Bhandari, Mohit

    2009-12-01

    Questionnaire survey. To elicit orthopedic surgeons' attitudes toward chiropractic. Orthopedic surgeons and chiropractors often attend to similar patient populations, but little is known about the attitudes of orthopedic surgeons toward chiropractic. We administered a 43-item cross-sectional survey to 1000 Canadian and American orthopedic surgeons that inquired about demographic variables and their knowledge and use of chiropractic. Imbedded in our survey was a 20-item chiropractic attitude questionnaire (CAQ). 487 surgeons completed the survey (response rate, 49%). North American orthopedic surgeons' attitudes toward chiropractic were diverse, with 44.5% endorsing a negative impression, 29.4% holding favorable views, and 26.1% being neutral. Approximately half of respondents referred patients for chiropractic care each year, mainly due to patient request.The majority of surgeons believed that chiropractors provide effective therapy for some musculoskeletal complaints (81.8%), and disagreed that chiropractors could provide effective relief for nonmusculoskeletal conditions (89.5%). The majority endorsed that chiropractors provide unnecessary treatment (72.7%), engage in overly-aggressive marketing (63.1%) and breed dependency in patients on short-term symptomatic relief (52.3%). In our adjusted generalized linear model, older age (-2.62 points on the CAQ for each 10 year increment; 95% confidence interval [CI] = -3.74 to -1.50), clinical interest in foot and ankle (-2.77; 95% CI = -5.43 to -0.10), and endorsement of the research literature (-4.20; 95% CI = -6.29 to -2.11), the media (-3.05; 95% CI = -5.92 to -0.19), medical school (-7.42; 95% CI = -10.60 to -4.25), or 'other' (-4.99; 95% CI = -8.81 to -1.17) as a source of information regarding chiropractic were associated with more negative attitudes; endorsing a relationship with a specific chiropractor (5.05; 95% CI = 3.00 to 7.10) or residency (3.79;95% CI = 0.17 to 7.41) as sources of information regarding

  5. Mechanical Comparison of Headless Screw Fixation and Locking Plate Fixation for Talar Neck Fractures.

    PubMed

    Karakasli, Ahmet; Hapa, Onur; Erduran, Mehmet; Dincer, Cemal; Cecen, Berivan; Havitcioglu, Hasan

    2015-01-01

    For talar neck fractures, open reduction and internal fixation have been thought to facilitate revascularization and prevent osteonecrosis. Newer screw systems allow for placement of cannulated headless screws, which provide compression by virtue of a variable pitch thread. The present study compared the biomechanical fixation strength of cannulated headless variable-pitch screw fixation and locking plate fixation. A reproducible talar neck fracture was created in 14 fresh cadaver talar necks. Talar head fixation was then performed using 2 cannulated headless variable-pitch 4-mm/5-mm diameter (4/5) screws (Acutrak; Acumed, Hillsboro, OR) and locking plate fixation. Headless variable-pitch screw fixation had lower failure displacement than did locking plate fixation. No statistically significant differences were found in failure stiffness, yield stiffness (p = .655), yield load (p = .142), or ultimate load between the 2 fixation techniques. Cannulated headless variable-pitch screw fixation resulted in better failure displacement than locking plate fixation in a cadaveric talus model and could be considered a viable option for talus fracture fixation. Headless, fully threaded, variable-pitch screw fixation has inherent advantages compared with locking plate fixation, because it might cause less damage to the articular surface and can compress the fracture for improved reduction. Additionally, plate fixation can increase the risk of avascular necrosis owing to the wider incision and dissection of soft tissues.

  6. Effect of induced aniseikonia on fixation performance.

    PubMed

    Remole, A

    1988-01-01

    The purpose of the study was to determine to what extent induced aniseikonia affects fixation performance. Aniseikonia was induced in the vertical meridian only, whereas fixation alignment was monitored in the horizontal meridian. A previously developed technique based on the dependency of border enhancement bandwidth on fixation eccentricity was used to monitor deviations from central fixation during fusion. Stress on the fusion mechanism was supplied by controlled increments of forced horizontal vergence. It was found that deviation from central fixation in the horizontal meridian generally increases with increasing amounts of vertical aniseikonia. The effect is particularly pronounced for small amounts of aniseikonia.

  7. Treatment results of bicondylar tibial fractures using hybrid external fixator.

    PubMed

    Sales, Jafar Ganjpour; Soleymaopour, Jafar; Ansari, Maroof; Afaghi, Farhad; Goldust, Mohamad

    2013-05-15

    Tibial condyle fractures affect knee stability and motion. Treatment of bicondylar type of tibial plateau fracture is a challenging problem. This study aimed at evaluating the application of hybrid external fixators with minimum deformation in these patients and the resulted outcomes. In this descriptive analytical study, 28 patients with bicondylar tibial plateau fractures treated by HEF device were evaluated. The surgeon used a semicircular and one circular wire instead of the one or two loop of conventional HEF device for a better range of motion of the knee joint. Treatment outcomes including quality of walking, union condition, knee range of motion, complications and the final outcome according to the knee score (rusmussen) were checked. Twenty-eight male patients, with the mean age of 40.54 +/- 13.83 years were enrolled in the study. Complications occurred in 8 (28.6%) patients; 7 cases with superficial infection and 1 patient with deep vein thrombosis. All complications were managed medically with no significant consequences left. All the patients were able to walk with no aid except in one case. In 96.4% and 89.3% of the cases, the clinical and radiological outcomes were good to excellent, respectively according to the knee score. In 85.7% of the patients, the knee range of motion was in normal limits. Application of hybrid external fixator using one and half ring instead of one or two fixator rings in treating bicondylar tibial fractures was associated with desired clinical and radiological results.

  8. Hepatitis C virus infection: knowledge in the orthopedic community.

    PubMed

    Flowerdew, J M; McGrory, B J

    2000-04-01

    A survey with 14 questions pertaining to the natural history, infectiveness, and diagnosis and treatment of hepatitis C viral infection was given to all practicing orthopedic surgeons in Portland, Maine. Possible responses were "true," "false," or "don't know" to the 14 statements. A question regarding any interest in learning more about the hepatitis C virus was also posed. Most (82%, 23/28) surgeons completed the questionnaire. A total of 72% of the responses were either wrong or marked "don't know"; most (83%) of the respondents wanted to know more about the infection about hepatitis C viral infection. Not only are orthopedic surgeons at risk for exposure to this virus, but also they are often the first to notify a patient of a positive result after routine hepatitis C testing of autologous predonated blood. Education programs and journal reviews should be directed toward this goal.

  9. Radiation exposure from fluoroscopy during orthopedic surgical procedures

    SciTech Connect

    Riley, S.A. )

    1989-11-01

    The use of fluoroscopy has enabled orthopedic surgeons to become technically more proficient. In addition, these surgical procedures tend to have less associated patient morbidity by decreasing operative time and minimizing the area of the operative field. The trade-off, however, may be an increased risk of radiation exposure to the surgeon on an annual or lifetime basis. The current study was designed to determine the amount of radiation received by the primary surgeon and the first assistant during selected surgical procedures involving the use of fluoroscopy. Five body sites exposed to radiation were monitored for dosage. The results of this study indicate that with appropriate usage, (1) radiation exposure from fluoroscopy is relatively low; (2) the surgeon's dominant hand receives the most exposure per case; and (3) proper maintenance and calibration of fluoroscopic machines are important factors in reducing exposure risks. Therefore, with proper precautions, the use of fluoroscopy in orthopedic procedures can remain a safe practice.

  10. Potential utility of liposome bupivacaine in orthopedic surgery.

    PubMed

    Lonner, Jess H; Scuderi, Giles R; Lieberman, Jay R

    2015-03-01

    Management of postsurgical analgesia is an important consideration in orthopedic procedures, including joint arthroplasty. Inadequate postsurgical analgesia is associated with increased hospital length of stay, delayed ambulation, and reduced exercise capacity. In this article, we review the potential contribution of a prolonged-release liposomal formulation of bupivacaine as part of a multimodal analgesic regimen after orthopedic surgery. Controlled studies across multiple surgical settings have demonstrated that, compared with placebo and bupivacaine HCl, liposome bupivacaine in a single administration provides postsurgical analgesia for up to 72 hours, delays use of rescue medication, and reduces postsurgical opioid consumption. Liposome bupivacaine has been well tolerated in clinical studies and has had a low rate of treatment-related adverse events. To date, there has been no signal of cardiac toxicity, chondrolysis, or delayed wound healing associated with liposome bupivacaine.

  11. Early definitive fracture fixation is safely performed in the presence of an open abdomen in multiply injured patients.

    PubMed

    Glass, Nina E; Burlew, Clay Cothren; Hahnhaussen, Jens; Weckbach, Sebastian; Pieracci, Fredric M; Moore, Ernest E; Stahel, Philip F

    2017-08-15

    To investigate the safety and feasibility of performing definitive fracture fixation in multiply injured patients in the presence of an open abdomen after laparotomy. Retrospective observational cohort study. Level-I academic trauma center. Adult polytrauma patients with presence of an open abdomen after "damage control" laparotomy and associated major fractures of long bones, acetabulum, pelvis or spine, requiring surgical repair (n=81). Timing of definitive fracture fixation in relation to the timing of abdominal wall closure. Incidence of orthopedic surgical site infections. In During a 15-year time-window from January 1, 2000 until December 31, 2014, we identified a cohort of 294 consecutive polytrauma patients with an open abdomen after laparotomy. Surgical fixation of associated fractures was performed after the index laparotomy in 81 patients. In group 1 (n=32), fracture fixation occurred significantly sooner despite a concurrent open abdomen, compared to group 2 (n=49) with abdominal wall closure prior to fixation (mean 4.4 vs 11.8 days; P=0.01). The incidence of orthopaedic surgical site infections requiring a surgical revision was significantly lower in group 1 (3.1%) compared to group 2 (30.6%; P=0.002). Definitive fracture fixation in the presence of an open abdomen is performed safely and associated with a significant decrease in clinically relevant surgical site infections, compared to delaying fracture fixation until abdominal wall closure. These data suggest that the strategy of imposing a time delay in orthopaedic procedures while awaiting abdominal wall closure is unjustified. Therapeutic level III.

  12. Mending injured athletes: a track record of orthopedic advances.

    PubMed

    Schnirring, Lisa

    2003-09-01

    Physicians have long been closely allied with competitive sports. In 157 AD, Galen served as a physician to Greek gladiators.(1) Severe musculoskeletal trauma certainly shortened the careers of ancient pugilists who survived their matches. However, modern gladiators-from pick-up basketball players to football professionals-often get to "play another day" because of advances in orthopedic surgery, particularly those of the last 30 years.

  13. Assessment of coagulation utilizing thromboelastometry in dogs undergoing orthopedic surgery.

    PubMed

    Bruno, Barbara; Maurella, Cristiana; Falco, Sara; Tarducci, Alberto; Zanatta, Renato; Gianella, Paola; D'Angelo, Antonio; Piras, Lisa; Di Bella, Andrea; Borrelli, Antonio

    2015-01-01

    To evaluate blood coagulation using thromboelastometry in dogs following orthopedic surgery. Longitudinal observational study. University veterinary teaching hospital. Thirty-four adult client-owned dogs. Dogs undergoing elective or emergency orthopedic surgery had whole blood collected before (T0), at 24 hours (T1), and 1 week (T2) after surgery. Whole blood from each dog was collected by jugular venipuncture using a 20-Ga needle and minimum venous stasis. The blood was placed into tubes containing 3.8% trisodium citrate (1 part citrate: 9 parts blood) and rested at 37°C. Coagulation was evaluated by means of thromboelastometry using the in-TEM, ex-TEM, and fib-TEM assays. Statistically significant increases (P < 0.05) in maximum clot firmness (MCF) from T0 to T1 in the in-TEM and fib-TEM profiles (both P = 0.0001), from T0 to T2 in the in-TEM, ex-TEM, and fib-TEM profiles (P = 0.012, P = 0.037, and P = 0.0001, respectively), and from T1 to T2 in the fib-TEM profile (P = 0.039) were noted. The α angle increased from T0 to T2 in the in-TEM and ex-TEM profiles (P = 0.019 and P = 0.036, respectively). All results were, however, within the institutional reference ranges. In this study, unlike the hypercoagulability observed in human orthopedic patients, a hypercoagulable state as measured by thromboelastometry did not develop in dogs following orthopedic surgery. © Veterinary Emergency and Critical Care Society 2015.

  14. Blood conservation strategies in orthopedic surgeries: A review

    PubMed Central

    Sambandam, Balaji; Batra, Sahil; Gupta, Rajat; Agrawal, Nidhi

    2013-01-01

    In orthopedics management of surgical blood loss is an important aspect which has evolved along with modern surgeries. Replacement of lost blood by transfusion alone is not the answer as was considered earlier. Complications like infection and immune reaction due to blood transfusion are a major concern. Today numerous techniques are available in place of allogenic blood transfusion which can be employed safely and effectively. In this article we have reviewed these techniques, their merits and demerits. PMID:26403876

  15. What factors influence follow-up in orthopedic trauma surgery?

    PubMed

    Whiting, Paul S; Greenberg, Sarah E; Thakore, Rachel V; Alamanda, Vignesh K; Ehrenfeld, Jesse M; Obremskey, William T; Jahangir, Alex; Sethi, Manish K

    2015-03-01

    Among surgical patients, follow-up visits are essential for monitoring post-operative recovery and determining ongoing treatment plans. Non-adherence to clinic follow-up appointments has been associated with poorer outcomes in many different patient populations. We sought to identify factors associated with non-attendance at follow-up appointments for orthopedic trauma patients. A retrospective chart review at a level I trauma center identified 2,165 patients who underwent orthopedic trauma surgery from 2008 to 2009. Demographic data including age, sex, race, tobacco use, American Society of Anesthesiologist (ASA) score, insurance status, distance from the hospital, and follow-up time were collected. Injury characteristics including fracture type, anatomic location of the operation, length of hospital stay, living situation and employment status were recorded. Attendance at the first scheduled follow-up visit was recorded. Multivariable log-binomial regression analyses were used with statistical significance maintained at p < 0.05. Of the 2,165 patients included in the analysis, 1,449 (66.9 %) attended their first scheduled post-operative clinic visit. 33.1 % (717) were not compliant with keeping their first clinic appointment after surgery. Patients who used tobacco, lived more than 100 miles from the clinic site, did not have private insurance, had an ASA score >2, or had a fracture of the hip or pelvis were significantly less likely to follow-up. Age, sex, and race were not significantly associated with failure to follow-up. Follow-up appointments are essential for preventing complications among orthopedic trauma patients. By identifying patients at risk of failure to follow-up, orthopedic surgeons can appropriately design and implement long-term treatment plans specifically targeted for high-risk patients.

  16. [History of orthopedics in Germany 1945-1990].

    PubMed

    Holfelder, G

    2001-10-01

    Presentation of a brief history of the scientific society from the end of World War II until the fall of the Iron Curtain, taking into consideration the milieu inside and outside the field of orthopedics. Throughout, the intention was to provide facts and sufficient references for further reading, with special emphasis on the biographies of the public figures mentioned. Attention should be directed in particular to the history of the society published in 1963.

  17. Pediatric orthopedic surgical simulation at Boston Children's Hospital.

    PubMed

    Bae, Donald S; Waters, Peter M

    2016-07-01

    Orthopedic surgical simulation has become an increasing valuable means for optimizing patient care, promoting patient safety, improving education, and fostering clinical research. The purpose of this review was to discuss the rationale for simulation training, describe current simulation efforts within the Department of Orthopaedic Surgery at Boston Children's Hospital, and provide an example of how these simulation efforts touch both patient care and clinical research.

  18. Implant fixation by bone ingrowth.

    PubMed

    Kienapfel, H; Sprey, C; Wilke, A; Griss, P

    1999-04-01

    The term osseointegration referred originally to an intimate contact of bone tissue with the surface of a titanium implant; the term bone ingrowth refers to bone formation within an irregular (beads, wire mesh, casting voids, cut grooves) surface of an implant. The section dealing with the historical background describes the development of macroporous, microporous, and textured surfaces with an emphasis on the evolution of porous and textured metal surfaces. The principal requirements for osseointegration and bone ingrowth are systematically reviewed as follows: i) the physiology of osseointegration and bone ingrowth, including biomaterial biocompatibility with respect to cellular and matrix response at the interface; ii) the implant surface geometry characteristics; iii) implant micromotion and fixation modes; and iv) the implant-bone interface distances. Based on current methods of bone ingrowth assessment, this article comparatively reviews and discusses the results of experimental studies with the objective of determining local and systemic factors that enhance bone ingrowth fixation.

  19. Tailor's bunion. Is fixation necessary?

    PubMed

    Pontious, J; Brook, J W; Hillstrom, H J

    1996-02-01

    Tailor's bunion or bunionette are terms that describe a pathologic enlargement occurring laterally on the fifth metatarsophalangeal joint. Regardless of the etiology that precipitates the deformity, the resulting abnormal protrusion of soft tissue or bone can result in pain for the patient. Symptoms can range from mild discomfort to severe, debilitating pain. The patient may present with pain dorsolaterally, laterally, or plantarly. The symptoms are mechanically induced, and are often associated with hyperkeratotic lesions and adventitious bursae. Patients complain most often that they cannot find comfortable shoes. The authors compare the effectiveness of fixated versus nonfixated distal osteotomies of the fifth metatarsal for the correction of tailor's bunion. This study shows that fixation can help control postoperative dorsal displacement of the fifth metatarsal capital fragment (p < 0.0001) and produce less shortening of the metatarsal resulting in fewer complications.

  20. Nitrogen fixation by marine cyanobacteria.

    PubMed

    Zehr, Jonathan P

    2011-04-01

    Discrepancies between estimates of oceanic N(2) fixation and nitrogen (N) losses through denitrification have focused research on identifying N(2)-fixing cyanobacteria and quantifying cyanobacterial N(2) fixation. Previously unrecognized cultivated and uncultivated unicellular cyanobacteria have been discovered that are widely distributed, and some have very unusual properties. Uncultivated unicellular N(2)-fixing cyanobacteria (UCYN-A) lack major metabolic pathways including the tricarboxylic acid cycle and oxygen-evolving photosystem II. Genomes of the oceanic N(2)-fixing cyanobacteria are highly conserved at the DNA level, and genetic diversity is maintained by genome rearrangements. The major cyanobacterial groups have different physiological and ecological constraints that result in highly variable geographic distributions, with implications for the marine N-cycle budget.