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Sample records for orthopedic procedures

  1. Preoperative Planning of Orthopedic Procedures using Digitalized Software Systems.

    PubMed

    Steinberg, Ely L; Segev, Eitan; Drexler, Michael; Ben-Tov, Tomer; Nimrod, Snir

    2016-06-01

    The progression from standard celluloid films to digitalized technology led to the development of new software programs to fulfill the needs of preoperative planning. We describe here preoperative digitalized programs and the variety of conditions for which those programs can be used to facilitate preparation for surgery. A PubMed search using the keywords "digitalized software programs," "preoperative planning" and "total joint arthroplasty" was performed for all studies regarding preoperative planning of orthopedic procedures that were published from 1989 to 2014 in English. Digitalized software programs are enabled to import and export all picture archiving communication system (PACS) files (i.e., X-rays, computerized tomograms, magnetic resonance images) from either the local working station or from any remote PACS. Two-dimension (2D) and 3D CT scans were found to be reliable tools with a high preoperative predicting accuracy for implants. The short learning curve, user-friendly features, accurate prediction of implant size, decreased implant stocks and low-cost maintenance makes digitalized software programs an attractive tool in preoperative planning of total joint replacement, fracture fixation, limb deformity repair and pediatric skeletal disorders.

  2. Preoperative Planning of Orthopedic Procedures using Digitalized Software Systems.

    PubMed

    Steinberg, Ely L; Segev, Eitan; Drexler, Michael; Ben-Tov, Tomer; Nimrod, Snir

    2016-06-01

    The progression from standard celluloid films to digitalized technology led to the development of new software programs to fulfill the needs of preoperative planning. We describe here preoperative digitalized programs and the variety of conditions for which those programs can be used to facilitate preparation for surgery. A PubMed search using the keywords "digitalized software programs," "preoperative planning" and "total joint arthroplasty" was performed for all studies regarding preoperative planning of orthopedic procedures that were published from 1989 to 2014 in English. Digitalized software programs are enabled to import and export all picture archiving communication system (PACS) files (i.e., X-rays, computerized tomograms, magnetic resonance images) from either the local working station or from any remote PACS. Two-dimension (2D) and 3D CT scans were found to be reliable tools with a high preoperative predicting accuracy for implants. The short learning curve, user-friendly features, accurate prediction of implant size, decreased implant stocks and low-cost maintenance makes digitalized software programs an attractive tool in preoperative planning of total joint replacement, fracture fixation, limb deformity repair and pediatric skeletal disorders. PMID:27468530

  3. Concurrent orthopedic and neurosurgical procedures in pediatric patients with spinal deformity.

    PubMed

    Mooney, James F; Glazier, Stephen S; Barfield, William R

    2012-11-01

    The management of pediatric patients with complex spinal deformity often requires both an orthopedic and a neurosurgical intervention. The reasons for multiple subspecialty involvement include, but are not limited to, the presence of a tethered cord requiring release or a syrinx requiring decompression. It has been common practice to perform these procedures in a staged manner, although there is little evidence in the literature to support separate interventions. We reviewed a series of consecutive patients who underwent spinal deformity correction and a neurosurgical intervention concurrently in an attempt to assess the safety, efficacy, and possible complications associated with such an approach. Eleven patients were reviewed who underwent concurrent orthopedic and neurosurgical procedures. Data were collected for patient demographics, preoperative diagnosis, procedures performed, intraoperative and perioperative complications, as well as any unexpected return to the operating room for any reason. Operative notes and anesthesia records were reviewed to determine estimated blood loss, surgical time, and the use of intraoperative neurological monitoring. Patient diagnoses included myelodysplasia (N=6), congenital scoliosis and/or kyphosis (N=4), and scoliosis associated with Noonan syndrome (N=1). Age at the time of surgery averaged 9 years 2 months (range=14 months to 17 years 2 months). Estimated blood loss averaged 605 ml (range=50-3000 ml). The operative time averaged 313 min (range=157-477 min). There were no intraoperative complications, including incidental dural tears or deterioration in preoperative neurological status. One patient developed a sore associated with postoperative cast immobilization that led to a deep wound infection. It appears that concurrent orthopedic and neurosurgical procedures in pediatric patients with significant spinal deformities can be performed safely and with minimal intraoperative and postoperative complications when utilizing

  4. [Interpersonal competence in orthopedics and traumatology : Why technical and procedural skills alone are not sufficient].

    PubMed

    Seemann, R; Münzberg, M; Stange, R; Rüsseler, M; Egerth, M; Bouillon, B; Hoffmann, R; Mutschler, M

    2016-10-01

    Patient safety has increasingly gained significance as criterion which clinics and doctors will be measured against in terms of ethics and finances. The "human factor" moved into focus regarding the question of how to reduce treatment errors in clinical daily routine. Nevertheless, systematic mediation of interpersonal competences only plays a minor role in the catalogue of requirements for medical specialization and professional training. This is the case not only in orthopedics and traumatology, but in other medical fields as well. At the insistence of DGOU and in cooperation with Lufthansa Flight Training, a training model was initiated, comparable to training models used in aviation. In aviation, apart from the training of procedural and technical abilities, regular soft skills training has become standard in the training of all Lufthansa staff. Several studies confirm that by improving communication, interaction, and teamwork skills not only a reduction of intolerable incidents is observed, but also a positive economic effect. Interpersonal competences should be firmly anchored in orthopedics and traumatology and thus be implemented as third post in specialist training.

  5. Regional anesthesia or patient-controlled analgesia and compartment syndrome in orthopedic surgical procedures: a systematic review

    PubMed Central

    Driscoll, Elizabeth BS; Maleki, Ana Hosseinzadeh; Jahromi, Leila; Hermecz, Brittany Nelson; Nelson, Lauren E; Vetter, Imelda L; Evenhuis, Spencer; Riesenberg, Lee Ann

    2016-01-01

    A systematic review of the literature on the use of regional anesthesia (RA) and patient-controlled analgesia (PCA) was conducted in patients who require orthopedic extremity procedures to determine whether either analgesic technique contributes to a delayed diagnosis of compartment syndrome (CS). A total of 34 relevant articles (28 case reports and six research articles) were identified. Of all case report articles published after 2009, the majority (75%) concluded that RA does not put the patient at an increased risk of a delayed diagnosis of CS. Of these, only two relevant prospective research studies focusing on RA or PCA and their relationship to CS were identified. Neither study resulted in any cases of CS. However, both had relatively small sample sizes. Given the lack of evidence identified in this systematic review, prospective studies or large-scale retrospective data reviews are needed to more strongly advocate the use of one modality of analgesia over the other in this patient population. PMID:27785097

  6. Case series describing an outbreak of highly resistant vancomycin Staphylococcus aureus (possible VISA/VRSA) infections in orthopedic related procedures in Guatemala.

    PubMed

    Antony, Suresh J

    2014-01-01

    This is a case series describing an outbreak of VRSA/VISA associated infections in orthopedic related procedures that occurred on a medical mission trip in Antigua, Guatemala. The paper describes the clinical features, microbiology and treatment options available to treat such infections in a Third World country. It also highlights the difficulty in making an accurate diagnosis with suboptimal microbiological support.

  7. [Orthopedic treatment of scoliosis: new technique using impression by optic procedure].

    PubMed

    Cottalorda, J; Kohler, R; Garin, C; Lecante, P

    1997-05-01

    The authors present a new procedure for acquiring the whole external trunk shape. The construction of braces starts with corrected a positive mold using computer-assisted design software connected to a digital tooling machine. The computer-assisted design and construction of braces enable the determination, measurement, and modification of a three-dimensional image of the trunk, which allows the positive to be corrected. The outer-trunk can be re-balanced, derotated or rectified in the sagittal or frontal plane and the inner modeling of the spine and chest can be rectified. Moreover, in the case of scoliosis or kyphosis, the software produces automatic correction. This rapid (acquisition time < 2 seconds), non invasive, safe and painless procedure can also be used to detect and follow mild spinal deformities.

  8. 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.

  9. Medical Issues: Orthopedics

    MedlinePlus

    ... support & care > living with sma > medical issues > orthopedics Orthopedics In SMA, muscle weakness can cause several complications. ... difficulty sitting, standing, or performing normal daily activities. Orthopedic Considerations Doctors and therapists classify individuals with SMA ...

  10. 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.

  11. A Bariatric Surgery Primer for Orthopedic Surgeons.

    PubMed

    Kingsberg, Jessica G; Halpern, Alan A; Hill, Brian C

    2016-01-01

    Increasing numbers of patients who have undergone bariatric surgery are now presenting to orthopedic surgeons for elective arthroplasties. In addition, orthopedic surgeons themselves are referring more patients for consideration of bariatric surgery in anticipation of future elective procedures. Although the full effects of bariatric surgery on metabolism are not yet known, the altered digestion associated with these surgeries poses several issues for orthopedic surgeons. In this article, we address 3 aspects of care of this class of patient: review of the most commonly performed procedures and their metabolic consequences; suggested preoperative assessment of bariatric patients for any conditions that should be corrected before surgery; and evaluation of outcomes of elective procedures performed after bariatric surgery. Awareness of the unique characteristics of this group of patients helps minimize the potential for complications of planned orthopedic surgeries.

  12. Damage Control Orthopedics Management as Vital Procedure in Elderly Patients with Femoral Neck Fractures Complicated with Chronic Renal Failure: A Retrospective Cohort Study

    PubMed Central

    Dong, Chenhui; Wang, Yunjiao; Wang, Ziming; Wang, Yu; Wu, Siyu; Du, Quanyin; Wang, Aimin

    2016-01-01

    Background Chronic renal failure (CRF) predisposes to hip fractures in elderly patients, with high subsequent mortality. Selection and timing of the surgical procedure of such patients is a serious challenge. Many clinicians believe in earlier surgery as preferable and providing better outcomes. Damage control orthopedics (DCO) aids to adjust and optimize the overall condition of patients. Methods In 32 patients with femoral neck fractures complicated with CRF, we evaluated how the timing of the surgery determines the mortality rates if the DCO approach is applied. Preoperative ASA grading, POSSUM score, P-POSSUM score and DCO were carried out. Based on the assessment, timing of the surgery was ascertained. Results Of a total of 32 patients, twenty-nine patients were accepted for either early (< 48 hours; n = 18) or delayed (3–10 days; n = 10) surgery. Hip arthroplasty (total hip arthroplasty and hemiarthroplasty) was the principal surgery option. All patients survived operation and were followed up postoperatively with the average time of 30 days. Postoperative complications tended to occur at higher rates in the early vs. delayed surgery group (7/18 vs. 5/10). During follow up, a total of 3 patients died in both groups (2/18 in the early surgery and 1/10 in the delayed surgery group), mostly from multi-organ failures and acute respiratory distress syndrome. There was no significant difference in complication rates and Harris hip score between both groups. Conclusion In patients with femoral neck fracture complicated with CRF, delaying the surgery for several days does not increase the incidence of postoperative adverse events. PMID:27149117

  13. 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.

  14. Orthopedic anesthesia in haiti.

    PubMed

    Osteen, Kristie D

    2011-01-01

    Healthcare practitioners from around the world responded almost immediately in the aftermath of the 2010 earthquake in Haiti. This article reports on the efforts of an orthopedic trauma team in Haiti and its efforts in providing surgery without general anesthesia.

  15. [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.

  16. 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.

  17. 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

  18. 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

  19. Use of computers to test orthopedic knowledge.

    PubMed

    Buckwalter, J A

    1986-10-01

    Valid, reliable evaluation of orthopedic knowledge is an essential part of our efforts to maintain a high quality of orthopedic practice and education. Current methods of evaluation have made important contributions to the field of orthopedics and will continue to do so, but they have limitations. Computers currently help score and interpret test results as well as evaluate test items. With the development of item banks, computers can aid in test and item construction. Development of a central computer item bank with appropriate programming for specialized test construction would allow computerized test administration on home computers. The most exciting potential contribution of computers to evaluation of orthopedic knowledge will be in the development of computer simulations. Computer simulations can closely replicate the processes of making a diagnosis, directing treatment, or planning and guiding the performance of a procedure and thereby overcome some limitations of current tests. Developing methods of measuring student performance on simulations and establishing the validity and reliability of simulations as evaluation instruments will require considerable effort, but they offer the promise of providing an important method of assessing orthopedic knowledge.

  20. 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.

  1. Tourniquets in orthopedic surgery

    PubMed Central

    Sharma, Jai Prakash; Salhotra, Rashmi

    2012-01-01

    Tourniquets are commonly used in limb surgeries, be it orthopedic or plastic surgeries. But the inflation pressures, the duration, and release guidelines are still not clear. According to a survey, majority of orthopedic surgeons inflate the tourniquet to fixed pressures for the upper and the lower limbs without considering the baseline blood pressure of the patient on whom the tourniquets are being applied. This review was designed to recall and review the safe use of tourniquets and the various techniques that can be employed to minimize the complications of tourniquet use. Google, science direct, and pubmed were searched for appropriate literature and relevant articles were identified. PMID:22912509

  2. [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. PMID:16875525

  3. [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.

  4. Tissue engineering: orthopedic applications.

    PubMed

    Laurencin, C T; Ambrosio, A M; Borden, M D; Cooper, J A

    1999-01-01

    Because of an aging population and increased occurrence of sports-related injuries, musculoskeletal disorders have become one of the major health concerns in the United States. Current treatments, although fairly successful, do not provide the optimum therapy. These treatments typically rely on donor tissues obtained either from the patient or from another source. The former raises the issue of supply, whereas the latter poses the risk of rejection and disease transfer. This has prompted orthopedic surgeons and scientists to look for viable alternatives. In recent years, tissue engineering has gained increasing support as a method to treat orthopedic disorders. Because it uses principles of engineering, biology, and chemistry, tissue engineering may provide a more effective approach to the treatment of musculoskeletal disorders than traditional methods. This chapter presents a review of current methods and new tissue-engineering techniques for the treatment of disorders affecting bone, ligament, and cartilage.

  5. 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

  6. 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. PMID:26913764

  7. Redefining the Economics of Geriatric Orthopedics

    PubMed Central

    Nacca, Christopher; Paller, David; Daniels, Alan H

    2014-01-01

    Introduction: The heath care system in the United States is in the midst of a transition, in large part to help accommodate an older and more medically complex population. Central to the current evolution is the reassessment of value based on the cost utility of a particular procedure compared to alternatives. The existing contribution of geriatric orthopedics to the societal burden of disease is substantial, and literature focusing on the economic value of treating elderly populations with musculoskeletal injuries is growing. Materials and Methods: A literature review of peer-reviewed publications and abstracts related to the cost-effectiveness of treating geriatric patients with orthopedic injuries was carried out. Results: In our review, we demonstrate that while cost-utility studies generally demonstrate net society savings for most orthopedic procedures, geriatric populations often contribute to negative net society savings due to decreased working years and lower salaries while in the workforce. However, the incremental cost-effective ratio for operative intervention has been shown to be below the financial willingness to treat threshold for common procedures including joint replacement surgery of the knee (ICER US$8551), hip (ICER US$17 115), and shoulder (CE US$957) as well as for spinal procedures and repair of torn rotator cuffs (ICER US$12 024). We also discuss the current trends directed toward improving institutional value and highlight important complementary next steps to help overcome the growing demands of an older, more active society. Conclusion: The geriatric population places a significant burden on the health care system. However, studies have shown that treating this demographic for orthopedic-related injuries is cost effective and profitable for providers under certain scenarios. PMID:26246943

  8. [Dynamic measurement of pressure distribution with flexible measuring mats--an innovative measuring procedure in sports orthopedics and traumatology. Development--use--value].

    PubMed

    Schaff, P; Hauser, W

    1987-12-01

    The results of this study provide the basis for an on-target use of measurement of pressure distribution with flexible mats in sports orthopaedics and traumatology and adjacent overlapping fields. Dynamic measurement of pressure distribution using a flexible mat as a capacitor can yield valuable additional information not available so far in this form, on the static and dynamic stress acting on the human locomotor system. In the future this method can be used to prevent injuries and to optimise performance in many disciplines of sport and will make a significant contribution to optimised treatment concepts with pressure-adjusted shoes or insoles, as well as to the control of functional surgery results in traumatology. The fundamentals are presented via a detailed description of the development, standardization and testing of this innovative measuring method. The questions of applicability, practicability and information supplied are discussed on the basis of extensive studies on reproducibility, on the amount of time and technical effort required for each measurement, and on a critical comparison with other methods. For the two fields of application presented here it was possible to standardize the working procedure enabling a largely problem-free application in practice. The first useful results were obtained in sports orthopaedics (alpine ski boots and sportshoe design). By applying the measuring of pressure distribution in alpine ski sports the influence the construction of ski boots on the stress exercised on the human leg could be objectively quantified in man for the first time. Marked differences were found between models where the heel can be turned down on entering, to conventionally fastened ski boots. This, as well as the results on the influence temperature, height of shaft and shaft stability or rigidity on the pressure distribution along the tibia, provide the basis for a new guideline for the testing of ski boots. A new method was developed for the

  9. 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. PMID:27403586

  10. 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.

  11. [Ambulatory operations in orthopedics].

    PubMed

    Roth, P

    1995-07-20

    Outpatient surgery in orthopedics, which ist becoming increasingly popular and is promoted by present-day health care legislation, is associated with a whole range of ifs and buts. Patient-related factors, including age, readiness and ability to cooperate, and home care, need just as much consideration as physician-related factors (experience of the surgeon, anesthesist und surgical team). Architectural and equipment-related facilities need to be investigated. Not every intervention that is theoretically possible on an outpatient basis can be recommended--for example if intensive aftercare, which is better performed on an inpatient basis, should be necessary. The usual postoperative risks (e.g. thrombosis) must be taken into account, and in such cases, proper care must be guaranteed. PMID:7557801

  12. 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.

  13. Proximal spinal muscular atrophy: current orthopedic perspective

    PubMed Central

    Haaker, Gerrit; Fujak, Albert

    2013-01-01

    Spinal muscular atrophy (SMA) is a hereditary neuromuscular disease of lower motor neurons that is caused by a defective “survival motor neuron” (SMN) protein that is mainly associated with proximal progressive muscle weakness and atrophy. Although SMA involves a wide range of disease severity and a high mortality and morbidity rate, recent advances in multidisciplinary supportive care have enhanced quality of life and life expectancy. Active research for possible treatment options has become possible since the disease-causing gene defect was identified in 1995. Nevertheless, a causal therapy is not available at present, and therapeutic management of SMA remains challenging; the prolonged survival is increasing, especially orthopedic, respiratory and nutritive problems. This review focuses on orthopedic management of the disease, with discussion of key aspects that include scoliosis, muscular contractures, hip joint disorders, fractures, technical devices, and a comparative approach of conservative and surgical treatment. Also emphasized are associated complications including respiratory involvement, perioperative care and anesthesia, nutrition problems, and rehabilitation. The SMA disease course can be greatly improved with adequate therapy with established orthopedic procedures in a multidisciplinary therapeutic approach. PMID:24399883

  14. 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

  15. 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.

  16. Roentgen Stereophotogrammetry In Orthopedics

    NASA Astrophysics Data System (ADS)

    Selvik, Goran

    1983-07-01

    A system for roentgen stereophotogrammetry has been used in Lund, Sweden, since August 1972 and by August 1982 ten thousand stereo films have been evaluated using this method. Patient investigations started March 1973 and of the more than 500 patients investigated 300 have been referred by orthopedic surgeons. The skeletal parts investigated had been permanently marked with tantalum balls 0.5 or 0.8 mm in diameter. The causes for the investigation have been bone growth disorders in the Lower extremity (134 patients), spinal fusions (35 patients), high tibial osteotomies for gonarthrosis (21 patients) and endoprosthetic replacement of the knee (68 patients) or hip (42 patients) joint. By the roentgen stereophotogrammetric analysis (RSA), information on for instance the development of angular deformities and staple loosening in the leg, the healing process of the intended fusion in the spine or at the knee, and on the migration and stability of prosthetic components have been obtained. RSA is of value both for prognostic and followup purposes, and is versatile enough in proper setting to be used as a routine clinical investigation.

  17. 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

  18. 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.

  19. 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. PMID:26652336

  20. Regenerative treatments to enhance orthopedic surgical outcome.

    PubMed

    Murrell, William D; Anz, Adam W; Badsha, Humeira; Bennett, William F; Boykin, Robert E; Caplan, Arnold I

    2015-04-01

    In orthopedic surgery there has been a never-ending quest to improve surgical outcome and the patient's experience. Progression has been marked by the refinement of surgical techniques and instruments and later by enhanced diagnostic imaging capability, specifically magnetic resonance. Over time implant optimization was achieved, along with the development of innovative minimally invasive arthroscopic technical skills to leverage new versions of classic procedures and implants to improve short-term patient morbidity and initial, mid-term, and long-term patient outcomes. The use of regenerative and/or biological adjuncts to aid the healing process has followed in the drive for continual improvement, and major breakthroughs in basic science have significantly unraveled the mechanisms of key healing and regenerative pathways. A wide spectrum of primary and complementary regenerative treatments is becoming increasingly available, including blood-derived preparations, growth factors, bone marrow preparations, and stem cells. This is a new era in the application of biologically active material, and it is transforming clinical practice by providing effective supportive treatments either at the time of the index procedure or during the postoperative period. Regenerative treatments are currently in active use to enhance many areas of orthopedic surgery in an attempt to improve success and outcome. In this review we provide a comprehensive overview of the peer-reviewed evidence-based literature, highlighting the clinical outcomes in humans both with preclinical data and human clinical trials involving regenerative preparations within the areas of rotator cuff, meniscus, ligament, and articular cartilage surgical repair.

  1. Growth factors in orthopedic surgery

    PubMed Central

    Zaharia, C; Despa, N; Simionescu, M; Jinga, V; Fleseriu, I

    2010-01-01

    Growth factors have represented an essential issue of interest for the researchers and clinicians in orthopedics and trauma over the last 40 years. In the last 10 to 15 years, the advances registered in this field have permitted the identification of the most active cellular and humoral factors as well as the improvement of their use in the orthopedic and trauma surgery. Their domain of application has been continuously enlarged and the results have been visible from the beginning. The authors present their appreciation on the actual state of this subject as well as their experience with results and related conclusions. PMID:20302195

  2. 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.

  3. 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.

  4. Porous metal for orthopedics implants

    PubMed Central

    Matassi, Fabrizio; Botti, Alessandra; Sirleo, Luigi; Carulli, Christian; Innocenti, Massimo

    2013-01-01

    Summary Porous metal has been introduced to obtain biological fixation and improve longevity of orthopedic implants. The new generation of porous metal has intriguing characteristics that allows bone healing and high osteointegration of the metallic implants. This article gives an overview about biomaterials properties of the contemporary class of highly porous metals and about the clinical use in orthopaedic surgery. PMID:24133527

  5. 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…

  6. Financial debt of orthopedic residents.

    PubMed

    Hwang, John S; Beebe, Kathleen S; Benevenia, Joseph; Karanfilian, Briette; Berberian, Wayne S

    2012-04-01

    Many orthopedic residents accrue considerable debt by residency graduation. These debts for graduating medical students continue to increase due to the yearly increase of medical school tuition. The purpose of this study was to examine the causes of financial debt, as well the effects of debt on orthopedic residents.Orthopedic residents from postgraduate years 1 to 5 (N=27) completed an anonymous, optional financial survey. The survey asked questions regarding the characteristics of the residents' debt and their concern caused by their debt. All residents from our institute (N=27) voluntarily participated in the survey. The residents consisted of 4 (15%) women and 23 (85%) men, with 14 (56%) single residents and 12 (44%) married residents. No statistically significant difference existed in total debt >$100,000 between single and married residents or men and women. Forty-eight percent (n=13) of the residents had medical educational debt >$100,000, whereas 45% (n=12) had total debt >$200,000. Residents with total debt >$100,000 were concerned about their debt, whereas 1 of 4 residents with <$100,000 of total debt reported concern (P<.001).Debts affect orthopedic residents financially and may cause stress and hinder their medical training. Appropriate measures should be taken to help residents properly manage their debt and to provide supplemental assistance with their financial struggles. PMID:22495858

  7. Financial debt of orthopedic residents.

    PubMed

    Hwang, John S; Beebe, Kathleen S; Benevenia, Joseph; Karanfilian, Briette; Berberian, Wayne S

    2012-04-01

    Many orthopedic residents accrue considerable debt by residency graduation. These debts for graduating medical students continue to increase due to the yearly increase of medical school tuition. The purpose of this study was to examine the causes of financial debt, as well the effects of debt on orthopedic residents.Orthopedic residents from postgraduate years 1 to 5 (N=27) completed an anonymous, optional financial survey. The survey asked questions regarding the characteristics of the residents' debt and their concern caused by their debt. All residents from our institute (N=27) voluntarily participated in the survey. The residents consisted of 4 (15%) women and 23 (85%) men, with 14 (56%) single residents and 12 (44%) married residents. No statistically significant difference existed in total debt >$100,000 between single and married residents or men and women. Forty-eight percent (n=13) of the residents had medical educational debt >$100,000, whereas 45% (n=12) had total debt >$200,000. Residents with total debt >$100,000 were concerned about their debt, whereas 1 of 4 residents with <$100,000 of total debt reported concern (P<.001).Debts affect orthopedic residents financially and may cause stress and hinder their medical training. Appropriate measures should be taken to help residents properly manage their debt and to provide supplemental assistance with their financial struggles.

  8. 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.

  9. 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

  10. 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

  11. Orthopedics coding and funding.

    PubMed

    Baron, S; Duclos, C; Thoreux, P

    2014-02-01

    The French tarification à l'activité (T2A) prospective payment system is a financial system in which a health-care institution's resources are based on performed activity. Activity is described via the PMSI medical information system (programme de médicalisation du système d'information). The PMSI classifies hospital cases by clinical and economic categories known as diagnosis-related groups (DRG), each with an associated price tag. Coding a hospital case involves giving as realistic a description as possible so as to categorize it in the right DRG and thus ensure appropriate payment. For this, it is essential to understand what determines the pricing of inpatient stay: namely, the code for the surgical procedure, the patient's principal diagnosis (reason for admission), codes for comorbidities (everything that adds to management burden), and the management of the length of inpatient stay. The PMSI is used to analyze the institution's activity and dynamism: change on previous year, relation to target, and comparison with competing institutions based on indicators such as the mean length of stay performance indicator (MLS PI). The T2A system improves overall care efficiency. Quality of care, however, is not presently taken account of in the payment made to the institution, as there are no indicators for this; work needs to be done on this topic.

  12. Orthopedic disorders of the knee in hemophilia: A current concept review.

    PubMed

    Rodriguez-Merchan, E Carlos; Valentino, Leonard A

    2016-06-18

    The knee is frequently affected by severe orthopedic changes known as hemophilic arthropathy (HA) in patients with deficiency of coagulation factor VIII or IX and thus this manuscript seeks to present a current perspective of the role of the orthopedic surgeon in the management of these problems. Lifelong factor replacement therapy (FRT) is optimal to prevent HA, however adherence to this regerous treatment is challenging leading to breakthrough bleeding. In patients with chronic hemophilic synovitis, the prelude to HA, radiosynovectomy (RS) is the optimal to ameliorate bleeding. Surgery in people with hemophilia (PWH) is associated with a high risk of bleeding and infection, and must be performed with FRT. A coordinated effort including orthopedic surgeons, hematologists, physical medicine and rehabilitation physicians, physiotherapists and other team members is key to optimal outcomes. Ideally, orthopedic procedures should be performed in specialized hospitals with experienced teams. Until we are able to prevent orthopedic problems of the knee in PWH will have to continue performing orthopedic procedures (arthrocentesis, RS, arthroscopic synovectomy, hamstring release, arthroscopic debridement, alignment osteotomy, and total knee arthroplasty). By using the aforementioned procedures, the quality of life of PWH will be improved. PMID:27335812

  13. Orthopedic disorders of the knee in hemophilia: A current concept review

    PubMed Central

    Rodriguez-Merchan, E Carlos; Valentino, Leonard A

    2016-01-01

    The knee is frequently affected by severe orthopedic changes known as hemophilic arthropathy (HA) in patients with deficiency of coagulation factor VIII or IX and thus this manuscript seeks to present a current perspective of the role of the orthopedic surgeon in the management of these problems. Lifelong factor replacement therapy (FRT) is optimal to prevent HA, however adherence to this regerous treatment is challenging leading to breakthrough bleeding. In patients with chronic hemophilic synovitis, the prelude to HA, radiosynovectomy (RS) is the optimal to ameliorate bleeding. Surgery in people with hemophilia (PWH) is associated with a high risk of bleeding and infection, and must be performed with FRT. A coordinated effort including orthopedic surgeons, hematologists, physical medicine and rehabilitation physicians, physiotherapists and other team members is key to optimal outcomes. Ideally, orthopedic procedures should be performed in specialized hospitals with experienced teams. Until we are able to prevent orthopedic problems of the knee in PWH will have to continue performing orthopedic procedures (arthrocentesis, RS, arthroscopic synovectomy, hamstring release, arthroscopic debridement, alignment osteotomy, and total knee arthroplasty). By using the aforementioned procedures, the quality of life of PWH will be improved. PMID:27335812

  14. 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

  15. 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.

  16. 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.

  17. 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

  18. 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).

  19. 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.

  20. 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. PMID:26779486

  1. 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

  2. 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.

  3. 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

  4. [Tranexamic acid in orthopedic surgery].

    PubMed

    Aguilera-Roig, X; Jordán-Sales, M; Natera-Cisneros, L; Monllau-García, J C; Martínez-Zapata, M J

    2014-01-01

    Perioperative bleeding may require blood transfusions, which are sometimes not without complications and risks, with the subsequent increase in health care costs. Among other prevention methods, treatment with tranexamic acid (ATX) has shown to be effective in reducing surgical blood loss, especially in the immediate postoperative period. In this regard, studies evaluating ATX in orthopedic surgery show that it is effective and safe when administered intravenously or intra-articularly. The usual evaluated intravenous doses range between 10mg/Kg and 20mg/kg or a fixed dose of 1g to 2g; while intra-articularly, it varies between 250 mg and 3g. ATX, as an anti-fibrinolytic has a potential thrombotic effect, thus it is contraindicated in those patients at risk or with a history of thrombosis. Its topical administration may be safer, but studies are needed to confirm this. PMID:24126146

  5. 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.]. PMID:27636683

  6. 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.

  7. 21 CFR 888.4540 - Orthopedic manual surgical instrument.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Orthopedic manual surgical instrument. 888.4540... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.4540 Orthopedic manual surgical instrument. (a) Identification. An orthopedic manual surgical instrument is a nonpowered hand-held...

  8. 21 CFR 888.4540 - Orthopedic manual surgical instrument.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Orthopedic manual surgical instrument. 888.4540... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.4540 Orthopedic manual surgical instrument. (a) Identification. An orthopedic manual surgical instrument is a nonpowered hand-held...

  9. 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

  10. 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.

  11. Surface evaluation of orthopedic hip implants marketed in Brazil

    NASA Astrophysics Data System (ADS)

    Souza, M. M.; Trommer, R. M.; Maru, M. M.; Roesler, C. R. M.; Barros, W. S.; Dutra, M. S.

    2016-07-01

    One of the factors that contribute to the quality of total hip prostheses is the degree of accuracy in the manufacturing of the joint surfaces. The dimensional control of joint components is important because of its direct influence on the durability and, consequently, in the patients’ life quality. This work presents studies on the form and roughness of orthopedic hip prostheses marketed in Brazil. The results provide data for quality control of the surfaces of the femoral heads and acetabular components of hip prostheses and indicate the need of improvement in the procedures used to this control.

  12. RANDOMIZED CONTROLLED CLINICAL TRIALS IN ORTHOPEDICS: DIFFICULTIES AND LIMITATIONS

    PubMed Central

    Malavolta, Eduardo Angeli; Demange, Marco Kawamura; Gobbi, Riccardo Gomes; Imamura, Marta; Fregni, Felipe

    2015-01-01

    Randomized controlled clinical trials (RCTs) are considered to be the gold standard for evidence-based medicine nowadays, and are important for directing medical practice through consistent scientific observations. Steps such as patient selection, randomization and blinding are fundamental for conducting a RCT, but some additional difficulties are presented in trials that involve surgical procedures, as is common in orthopedics. The aim of this article was to highlight and discuss some difficulties and possible limitations on RCTs within the field of surgery. PMID:27027037

  13. High Reliability of Care in Orthopedic Surgery: Are We There Yet?

    PubMed

    Anoushiravani, Afshin A; Sayeed, Zain; El-Othmani, Mouhanad M; Wong, Peter K; Saleh, Khaled J

    2016-10-01

    As health care reimbursement models shift from volume-based to value-based models, orthopedic surgeons must provide patients with highly reliable care, while consciously minimizing cost, maintaining quality, and providing timely interventions. An established means of achieving these goals is by implementing a highly reliable care model; however, before such a model can be initiated, a safety culture, robust improvement strategies, and committed leadership are needed. This article discusses interdependent and critical changes required to implement a highly reliable care system. Specific operative protocols now mandated are discussed as they pertain to high reliability of orthopedic care and elimination of wrong-site procedures. PMID:27637655

  14. 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.

  15. [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.

  16. [Application and research advances of metabolomics in the field of orthopedics].

    PubMed

    Sun, Zhijian; Qiu, Guixing; Zhao, Yu

    2015-06-01

    Metabolomics is a subject of systematic, qualitative and quantitative analysis of all metabolites in all organisms, which is applied to finding biomarkers and studying pathogenesis of diseases. Study procedures of metabolomics include data acquisition by spectroscopic/spectrometric techniques, multivariate statistical analysis and projection of the acquired metabolomic information. In recent years, metabolomics have gained popularity in orthopedic field. Metabolomic study of osteoarthritis was firstly conducted and widely developed. Metabolite profiles of different samples, including serum/plasma, urine, synovial fluid and synovial tissue, were studied and dozens of differential metabolites and several disturbed metabolic pathways were found. In addition, metabolomic studies of osteoporosis, ankylosing spondylitis and bone tumors were also conducted, which identified many potential biomarkers and made further understanding of pathogenesis of corresponding disease. However, metabolomic studies in orthopedic field just begin. More orthopedic diseases will be researched thank to the satisfactory results of previous reports.

  17. [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.

  18. E-learning in orthopedic surgery training: A systematic review.

    PubMed

    Tarpada, Sandip P; Morris, Matthew T; Burton, Denver A

    2016-12-01

    E-learning is the use of internet-based resources in education. In the field of surgical education, this definition includes the use of virtual patient cases, digital modeling, online tutorials, as well as video recordings of surgical procedures and lectures. In recent years, e-learning has increasingly been considered a viable alternative to traditional teaching within a number of surgical fields. Here we present (1) a systematic review of literature assessing the efficacy of e-learning modules for orthopedic education and (2) a discussion of their relevance. A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted according to the guidelines defined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). The search yielded a total of 255 non-duplicate citations that were screened using predetermined inclusion/exclusion criteria. A total of 9 full text articles met inclusion criteria, which included the use of an objective outcome measure to evaluate an orthopedic e-learning module. Six studies assessed knowledge using a multiple-choice test and 4 assessed skills using a clinical exam. All studies showed positive score improvement pre- to post-intervention, and a majority showed greater score improvement than standard teaching methods in both knowledge (4/6 studies) and clinical skills (3/4 studies). E-learning represents an effective supplement or even alternative to standard teaching techniques within orthopedic education for both medical students and residents. Future work should focus on validating specific e-learning programs using standardized outcome measures and assessing long-term knowledge retention using e-learning platforms.

  19. E-learning in orthopedic surgery training: A systematic review.

    PubMed

    Tarpada, Sandip P; Morris, Matthew T; Burton, Denver A

    2016-12-01

    E-learning is the use of internet-based resources in education. In the field of surgical education, this definition includes the use of virtual patient cases, digital modeling, online tutorials, as well as video recordings of surgical procedures and lectures. In recent years, e-learning has increasingly been considered a viable alternative to traditional teaching within a number of surgical fields. Here we present (1) a systematic review of literature assessing the efficacy of e-learning modules for orthopedic education and (2) a discussion of their relevance. A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted according to the guidelines defined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). The search yielded a total of 255 non-duplicate citations that were screened using predetermined inclusion/exclusion criteria. A total of 9 full text articles met inclusion criteria, which included the use of an objective outcome measure to evaluate an orthopedic e-learning module. Six studies assessed knowledge using a multiple-choice test and 4 assessed skills using a clinical exam. All studies showed positive score improvement pre- to post-intervention, and a majority showed greater score improvement than standard teaching methods in both knowledge (4/6 studies) and clinical skills (3/4 studies). E-learning represents an effective supplement or even alternative to standard teaching techniques within orthopedic education for both medical students and residents. Future work should focus on validating specific e-learning programs using standardized outcome measures and assessing long-term knowledge retention using e-learning platforms. PMID:27688638

  20. 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. PMID:24945481

  1. 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.

  2. 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…

  3. Imaging of orthopedic trauma and surgery

    SciTech Connect

    Berquist, T.H.

    1986-01-01

    This book discusses imaging of orthopedia trauma and surgery. A review of the pertinent anatomy, mechanism of injury, and radiology and orthopedic classification is provided for each topic discussed. The book employs recent advances in technique and focuses on adult skeletal trauma, and joint replacement.

  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. Characteristics of highly successful orthopedic surgeons: a survey of orthopedic chairs and editors

    PubMed Central

    Klein, Guy; Hussain, Nasir; Sprague, Sheila; Mehlman, Charles T.; Dogbey, Godwin; Bhandari, Mohit

    2013-01-01

    Background Highly successful orthopedic surgeons are a small group of individuals who exert a large influence on the orthopedic field. However, the characteristics of these leaders have not been well-described or studied. Methods Orthopedic surgeons who are departmental chairs, journal editors, editorial board members of the Journal of Bone and Joint Surgery (British edition), or current or past presidents of major orthopedic associations were invited to complete a survey designed to provide insight into their motivations, academic backgrounds and accomplishments, emotional and physical health, and job satisfaction. Results In all, 152 surgeons completed the questionnaire. We identified several characteristics of highly successful surgeons. Many have contributed prolific numbers of publications and book chapters and obtained considerable funding for research. They were often motivated by a “desire for personal development (interesting challenge, new opportunities),” whereas “relocating to a new institution, financial gain, or lack of alternative candidates” played little to no role in their decisions to take positions of leadership. Most respondents were happy with their specialty choice despite long hours and high levels of stress. Despite challenges to their time, successful orthopedic surgeons made a strong effort to maintain their health; compared with other physicians, they exercise more, are more likely to have a primary care physician and feel better physically. Conclusion Departmental chairs, journal editors and presidents of orthopedic associations cope with considerable demands of clinical, administrative, educational and research duties while maintaining a high level of health, happiness and job satisfaction. PMID:23706848

  6. 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

  7. 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.

  8. [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.

  9. Nanotechnology and biomaterials for orthopedic medical applications.

    PubMed

    Balasundaram, Ganesan; Webster, Thomas J

    2006-08-01

    Future prospects for nanotechnology and biomaterials in medical applications appear to be excellent. In orthopedic applications, there is a significant need and demand for the development of a bone substitute that is bioactive and exhibits material properties (mechanical and surface) comparable with those of natural, healthy bone. Particularly, in bone tissue engineering, nanometer-sized ceramics, polymers, metals and composites have been receiving much attention recently. This is a result of current conventional materials (or those materials with constituent dimensions >1 microm) that have not invoked suitable cellular responses to promote adequate osteointegration to enable these devices to be successful for long periods. By contrast, owing to their ability to mimic the dimensions of constituent components of natural bone (e.g., proteins and hydroxyapatite), nanophase materials may be an exciting successful alternative orthopedic implant material. In this article, the ability of novel nanomaterials that promote osteointegration is discussed. Potential pitfalls or undesirable side effects associated with the use of nanomaterials in orthopedic applications are also reviewed.

  10. Perioperative coagulation assessment of patients undergoing major elective orthopedic surgery.

    PubMed

    Spiezia, Luca; Vasques, Francesco; Behr, Astrid; Campello, Elena; Maggiolo, Sara; Berizzi, Antonio; Gavasso, Sabrina; Woodhams, Barry; Biancari, Fausto; Simioni, Paolo

    2016-09-01

    Traditional coagulative parameters are of limited use in identifying perioperative coagulopathy occurring in patients undergoing major elective orthopedic surgery (MEOS). The aim of our study was to evaluate the coagulation changes in patients undergoing MEOS and to facilitate an early detection of perioperative coagulopathy in patients experiencing major intraoperative bleeding. We enrolled 40 consecutive patients (M/F 10/30, age range 34-90 years) who underwent MEOS at the Orthopedic Unit of the Padua University Hospital, Italy, between January 2014 and January 2015. Blood samples were obtained at the following time points: T0-pre: 30 min before surgery; T0-post: 30 min after the end of the procedure; T1: morning of the first postoperative day; T2: 7 ± 2 days after surgery. Patients who experienced an intraoperative blood loss ≥250 mL/h were considered as cases. Routine coagulative parameters, thromboelastometry and thrombin generation (TG) profiles were evaluated. At baseline, a significantly lower platelet count and FIBTEM MCF/AUC were observed in patents with excessive bleeding (p < 0.05 and 0.02/0.01, respectively). At T0-post and T1 intervals, cases showed hypocoagulation characterized by a significantly low platelet count (p = 0.001), prolonged CFT INTEM/EXTEM, reduction of alpha-angle and MaxV INTEM/EXTEM, MCF and AUC INTEM/EXTEM/FIBTEM (p < 0.05 in all comparisons). The only TG parameter standing out between study groups was time to peak at T0-pre. A low platelet count and fibrinogen activity were associated with significant intraoperative bleeding in patients undergoing MEOS. Thromboelastometry performed by ROTEM(®) identifies patients with coagulopathy. PMID:26951189

  11. 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

  12. 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…

  13. 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. PMID:21786430

  14. Redundant publications in the orthopedic literature.

    PubMed

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

    2007-01-01

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

  15. 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. PMID:25188622

  16. 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. PMID:26558661

  17. Applications of Local Antibiotics in Orthopedic Trauma.

    PubMed

    Cancienne, Jourdan M; Burrus, M Tyrrell; Weiss, David B; Yarboro, Seth R

    2015-10-01

    Local antibiotics have a role in orthopedic trauma for both infection prophylaxis and treatment. They provide the advantage of high local antibiotic concentration without excessive systemic levels. Nonabsorbable polymethylmethacrylate (PMMA) is a popular antibiotic carrier, but absorbable options including bone graft, bone graft substitutes, and polymers have gained acceptance. Simple aqueous antibiotic solutions continue to be investigated and appear to be clinically effective. For established infections, such as osteomyelitis, a combination of surgical debridement with local and systemic antibiotics seems to represent the most effective treatment at this time. Further investigation of more effective local antibiotic utilization is ongoing.

  18. Factors Contributing to Satisfaction with Changes in Physical Function after Orthopedic Surgery for Musculoskeletal Dysfunction in Patients with Cerebral Palsy

    PubMed Central

    Kusumoto, Yasuaki; Nitta, Osamu; Matsuo, Atsushi; Takaki, Kenji; Matsuda, Tadamitsu

    2016-01-01

    Background The recognition of required treatments for cerebral palsy (CP) patients, including orthopedic surgery, differs according to region. This study was performed to identify factors associated with satisfactory changes in physical function after orthopedic surgery. Methods 358 patients were selected for the questionnaire survey. The following information was collected: gender, primary disease, age of initial surgery, total procedural count, operated sites, satisfaction of postoperative rehabilitation frequency, ideal amount of postoperative rehabilitation sessions per week, frequency of voluntary home training per week, satisfaction of the timing of surgery and the current satisfaction with the changes in physical function after the orthopedic surgery. We classified the patients into the satisfied and dissatisfied group according to satisfactory changes in physical function after the surgery. We performed unpaired t-tests and chi-square tests to determine the variables that differed significantly between the groups. Variables with a p value of <0.2 were included in the multivariate logistic regression analysis. Results The logistic model was revised and summed up to two potential predictors of postsurgical satisfaction with physical function: satisfaction with the frequency of postoperative rehabilitation sessions and the orthopedic surgery of the hip (distinction hit ratio, 75.4%). Conclusions This study demonstrated that the frequency of postoperative rehabilitation and history of hip surgery seemed to be related to the satisfaction with the changes in physical function after orthopedic surgery. PMID:27135609

  19. Biomechanics of craniofacial sutures: orthopedic implications.

    PubMed

    Mao, Jeremy J; Wang, Xin; Kopher, Ross A

    2003-04-01

    Sutures are soft connective tissue articulations between craniofacial bones. Suture mechanics deals with patterns of mechanical stress experienced in sutures resulting from natural activities such as mastication and exogenous forces such as orthopedic loading. Patterns of sutural mechanical stress can be delineated readily as sutural strain using strain gages attached over the suture. In mastication, complex sutural strain patterns have been elucidated in a few species. Mechanical stresses are not transmitted in the skull as a continuing gradient, for different sutures are capable of redefining a propagating mechanical force as predominately tensile or compressive strain. Exogenous mechanical forces with engineering waveforms such as static and sine wave at different frequencies induce corresponding waveforms and rates of sutural strain, providing the basis for applying novel mechanical stimuli to engineer sutural growth. The available data on suture mechanics converge to a hypothetical theme that mechanical forces regulate sutural growth by inducing sutural mechanical strain. Various orthopedic therapies, including headgear, facemask, and functional appliances may induce sutural strain, leading to modification of otherwise natural suture growth.

  20. Osteoanabolic Implant Materials for Orthopedic Treatment.

    PubMed

    Ding, Yun-Fei; Li, Rachel W; Nakai, Masaaki; Majumdar, Trina; Zhang, Dong-Hai; Niinomi, Mitsuo; Birbilis, Nick; Smith, Paul N; Chen, Xiao-Bo

    2016-07-01

    Osteoporosis is becoming more prevalent due to the aging demographics of many populations. Osteoporotic bone is more prone to fracture than normal bone, and current orthopedic implant materials are not ideal for the osteoporotic cases. A newly developed strontium phosphate (SrPO4 ) coating is reported herein, and applied to Ti-29Nb-13Ta-4.6Zr (wt%), TNTZ, an implant material with a comparative Young's modulus to that of natural bone. The SrPO4 coating is anticipated to modulate the activity of osteoblast (OB) and osteoclast (OC) cells, in order to promote bone formation. TNTZ, a material with excellent biocompatibility and high bioinertness is pretreated in a concentrated alkaline solution under hydrothermal conditions, followed by a hydrothermal coating growth process to achieve complete SrPO4 surface coverage with high bonding strength. Owing to the release of Sr ions from the SrPO4 coating and its unique surface topography, OB cells demonstrate increased proliferation and differentiation, while the cellular responses of OC are suppressed, compared to the control case, i.e., bare TNTZ. This TNTZ implant with a near physiologic Young's modulus and a functional SrPO4 coating provides a new direction in the design and manufacture of implantable devices used in the management of orthopedic conditions in osteoporotic individuals.

  1. 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

  2. Osteoanabolic Implant Materials for Orthopedic Treatment.

    PubMed

    Ding, Yun-Fei; Li, Rachel W; Nakai, Masaaki; Majumdar, Trina; Zhang, Dong-Hai; Niinomi, Mitsuo; Birbilis, Nick; Smith, Paul N; Chen, Xiao-Bo

    2016-07-01

    Osteoporosis is becoming more prevalent due to the aging demographics of many populations. Osteoporotic bone is more prone to fracture than normal bone, and current orthopedic implant materials are not ideal for the osteoporotic cases. A newly developed strontium phosphate (SrPO4 ) coating is reported herein, and applied to Ti-29Nb-13Ta-4.6Zr (wt%), TNTZ, an implant material with a comparative Young's modulus to that of natural bone. The SrPO4 coating is anticipated to modulate the activity of osteoblast (OB) and osteoclast (OC) cells, in order to promote bone formation. TNTZ, a material with excellent biocompatibility and high bioinertness is pretreated in a concentrated alkaline solution under hydrothermal conditions, followed by a hydrothermal coating growth process to achieve complete SrPO4 surface coverage with high bonding strength. Owing to the release of Sr ions from the SrPO4 coating and its unique surface topography, OB cells demonstrate increased proliferation and differentiation, while the cellular responses of OC are suppressed, compared to the control case, i.e., bare TNTZ. This TNTZ implant with a near physiologic Young's modulus and a functional SrPO4 coating provides a new direction in the design and manufacture of implantable devices used in the management of orthopedic conditions in osteoporotic individuals. PMID:27113724

  3. RAPID MANUFACTURING SYSTEM OF ORTHOPEDIC IMPLANTS.

    PubMed

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

    2009-01-01

    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.

  4. Infection Mitigation Efficacy of Photoactive Titania on Orthopedic Implant Materials

    PubMed Central

    Azad, Abdul-Majeed; Hershey, Ryan; Aboelzahab, Asem; Goel, Vijay

    2011-01-01

    In order to impede infection and achieve accelerated wound healing in the postorthopaedic surgery patients, a simple and benign procedure for creating nanotubular or nanofibrillar structure of photoactive TiO2 on the surface of Ti plates and wires is described. The nanoscale TiO2 films on titanium were grown by hydrothermal processing in one case and by anodization in the presence of dilute mineral acids under mild and benign conditions in the other. Confocal microscopy results demonstrated at least 50% reduction in the population of E. coli colonies (concentration 2.15 × 107 cells/mL) on TiO2-coated implants upon an IR exposure of up to 30 s; it required ∼20 min of exposure to UV beam for the same effect. These findings suggest the probability of eliminating wound infection during and after orthopedic surgical procedures by brief illumination of photoactive titania films on the implants with an IR beam. PMID:21994891

  5. Priming the Surface of Orthopedic Implants for Osteoblast Attachment in Bone Tissue Engineering.

    PubMed

    Chan, Kiat Hwa; Zhuo, Shuangmu; Ni, Ming

    2015-01-01

    The development of better orthopedic implants is incessant. While current implants can function reliably in the human body for a long period of time, there are still a significant number of cases for which the implants can fail prematurely due to poor osseointegration of the implant with native bone. Increasingly, it is recognized that it is extremely important to facilitate the attachment of osteoblasts on the implant so that a proper foundation of extracellular matrix (ECM) can be laid down for the growth of new bone tissue. In order to facilitate the osseointegration of the implant, both the physical nanotopography and chemical functionalization of the implant surface have to be optimized. In this short review, however, we explore how simple chemistry procedures can be used to functionalize the surfaces of three major classes of orthopedic implants, i.e. ceramics, metals, and polymers, so that the attachment of osteoblasts on implants can be facilitated in order to promote implant osseointegration.

  6. Priming the Surface of Orthopedic Implants for Osteoblast Attachment in Bone Tissue Engineering

    PubMed Central

    Chan, Kiat Hwa; Zhuo, Shuangmu; Ni, Ming

    2015-01-01

    The development of better orthopedic implants is incessant. While current implants can function reliably in the human body for a long period of time, there are still a significant number of cases for which the implants can fail prematurely due to poor osseointegration of the implant with native bone. Increasingly, it is recognized that it is extremely important to facilitate the attachment of osteoblasts on the implant so that a proper foundation of extracellular matrix (ECM) can be laid down for the growth of new bone tissue. In order to facilitate the osseointegration of the implant, both the physical nanotopography and chemical functionalization of the implant surface have to be optimized. In this short review, however, we explore how simple chemistry procedures can be used to functionalize the surfaces of three major classes of orthopedic implants, i.e. ceramics, metals, and polymers, so that the attachment of osteoblasts on implants can be facilitated in order to promote implant osseointegration. PMID:26392807

  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. 45 CFR 1308.12 - Eligibility criteria: Orthopedic impairment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... DISABILITIES Health Services Performance Standards § 1308.12 Eligibility criteria: Orthopedic impairment. (a) A... gross motor activities, or to perform self-help skills and by adversely affected educational performance... 45 Public Welfare 4 2010-10-01 2010-10-01 false Eligibility criteria: Orthopedic impairment....

  11. 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

  12. 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.

  13. 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. PMID:25955126

  14. Orthopedic manifestations of the Lowe (oculocerebrorenal) syndrome.

    PubMed

    Holtgrewe, J L; Kalen, V

    1986-01-01

    Lowe oculocerebrorenal syndrome (OCRS), as previously described in the literature, consists of a well-defined constellation of clinical findings involving the eyes, cerebrum, and kidneys. However, the only musculoskeletal abnormalities reported in patients with OCRS have been joint hypermobility, recurrent fractures, rickets, tenosynovitis, and joint effusions. No other specific orthopedic problems have been described. This study presents new clinical findings of scoliosis, kyphosis, platyspondyly, dislocated and/or subluxed hips, and cervical spine abnormalities in six patients with OCRS treated at Carrie Tingley Hospital (Albuquerque, NM, U.S.A.). This study further supports an X-linked recessive mode of inheritance and adds clinical support to the published work that suggests that Lowe syndrome may be due to biochemical abnormalities in glycosaminoglycan metabolism.

  15. 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.

  16. Co-Management Arrangements in Orthopedic Surgery.

    PubMed

    Bushnell, Brandon D

    2015-06-01

    A co-management arrangement (CMA) is a contractual relationship between physicians and a hospital that results in a shared-responsibility management structure for a specific service line. In orthopedic surgery, CMAs are becoming increasingly popular as stakeholders in the health care market seek increased value (ie, higher-quality care at lower costs). A CMA can significantly improve the efficiency and the outcomes of a musculoskeletal service line if it adheres to the basic principles of a focus on the patient, evidence-based decision-making, physician leadership, appropriate physician compensation, transparency, reasonable and modifiable goals, and accountability. While the specifics of each CMA will vary, all CMAs have common operational elements that include the arrangement's legal structure, legal compliance, leadership and reporting structure, facilities management, personnel management, clinical data management, financial data management, and quality and effectiveness reporting. PMID:26047000

  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. Co-Management Arrangements in Orthopedic Surgery.

    PubMed

    Bushnell, Brandon D

    2015-06-01

    A co-management arrangement (CMA) is a contractual relationship between physicians and a hospital that results in a shared-responsibility management structure for a specific service line. In orthopedic surgery, CMAs are becoming increasingly popular as stakeholders in the health care market seek increased value (ie, higher-quality care at lower costs). A CMA can significantly improve the efficiency and the outcomes of a musculoskeletal service line if it adheres to the basic principles of a focus on the patient, evidence-based decision-making, physician leadership, appropriate physician compensation, transparency, reasonable and modifiable goals, and accountability. While the specifics of each CMA will vary, all CMAs have common operational elements that include the arrangement's legal structure, legal compliance, leadership and reporting structure, facilities management, personnel management, clinical data management, financial data management, and quality and effectiveness reporting.

  19. Perioperative management of patients with severe pulmonary hypertension in major orthopedic surgery: experience-based recommendations

    PubMed Central

    Seyfarth, Hans-Jürgen; Gille, Jochen; Sablotzki, Armin; Gerlach, Stefan; Malcharek, Michael; Gosse, Andreas; Gahr, Ralf H.; Czeslick, Elke

    2015-01-01

    Introduction: It is known that pulmonary hypertension is associated with worse outcome in both cardiac and non-cardiac surgery. The aims of our retrospective analysis were to evaluate the outcomes of our patients with pulmonary hypertension undergoing major orthopedic surgery and to give experience-based recommendations for the perioperative management. Material and methods: From 92 patients with pulmonary hypertension undergoing different kinds of surgical procedures from 2011–2014 in a tertiary academic hospital we evaluated 16 patients with major orthopedic surgery for perioperative morbidity and mortality. Results: Regarding the in-hospital morbidity and mortality, one patient died postoperatively due to pulmonary infection and right heart failure (6.25%) and 6 patients suffered significant postoperative complications (37.5%; bleeding = 1, infection = 1, wound healing deficits = 3; dysrhythmia = 1). Conclusion: Our data show that major orthopedic surgery is feasible with satisfactory outcome even in cases of severe pulmonary hypertension by an individualized, disease-adapted interdisciplinary treatment concept. PMID:26504732

  20. 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 ...

  1. 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)

  2. Postoperative patient falls on an orthopedic inpatient unit.

    PubMed

    Ackerman, Duncan B; Trousdale, Robert T; Bieber, Patti; Henely, Joan; Pagnano, Mark W; Berry, Daniel J

    2010-01-01

    We are not aware of any data looking specifically at inpatient falls in an orthopedic ward. We reviewed all postoperative orthopedic patients who fell during 2003 and 2005 on a single postoperative orthopedic unit. Seventy patients (1%) fell, resulting in 2.5 falls per 1000 musculoskeletal inpatient days. Most (n = 45, 64%) were bathroom related, were unassisted (n = 54, 77%), and occurred during the evening or night shift (n = 46, 66%). Thirteen (19%) patients acquired an injury as a consequence. Female sex (odds ratio [OR] = 1.9), patient age greater than 65 years (OR = 1.7), prolonged admission (OR = 1.7), and admission for primary or revision knee arthroplasty (OR = 5.0) were all significant risk factors for a postoperative inpatient fall. This information has provided us with some insight to direct the development of a fall prevention program specific to postoperative orthopedic patients.

  3. Modern Orthopedic Inpatient Care of the Orthopedic Patient With Diabetic Foot Disease.

    PubMed

    Bateman, Antony H; Bradford, Sara; Hester, Thomas W; Kubelka, Igor; Tremlett, Jennifer; Morris, Victoria; Pendry, Elizabeth; Kavarthapu, Venu; Edmonds, Michael E

    2015-12-01

    In this article, we describe emergency and elective pathways within our orthopedic multidisciplinary inpatient care of patients with diabetic foot problems. We performed a retrospective cohort review of 19 complex patients requiring orthopedic surgical treatment of infected ulceration or Charcot feet or deformity at our institution. A total of 30 admissions (19 emergency, 11 elective) were included. The pathways were coordinated by a multidisciplinary team and comprised initial assessment and investigation and a series of key events, which consisted of emergency and elective surgery together with the introduction, and change of intravenous antibiotics when indicated. Patients had rigorous microbiological assessment, in the form of deep ulcer swabs, operative tissue specimens, joint aspirates, and blood cultures according to their clinical presentation as well as close clinical and biochemical surveillance, which expedited the prompt institution of key events. Outcomes were assessed using amputation rates and patient satisfaction. In the emergency group, there were 5.6 ± 3.0 (mean ± SD) key events per admission, including 4.2 ± 2.1 antibiotic changes. In the elective group, there were 4.8 ± 1.4 key events per inpatient episode, with 3.7 ± 1.3 antibiotic changes. Overall, there were 3 minor amputations, and no major amputations. The podiatric and surgical tissue specimens showed a wide array of Gram-positive, Gram-negative, aerobic and anaerobic isolates and 15% of blood cultures showed bacteremia. When 9 podiatric specimens were compared with 9 contemporaneous surgical samples, there was concordance in 2 out of 9 pairs. We have described the successful modern care of the orthopedic diabetic foot patient, which involves close clinical, microbiological, and biochemical surveillance by the multidisciplinary team directing patients through emergency and elective pathways. This has enabled successful surgical intervention involving debridement, pressure relief, and

  4. Are academic orthopedic surgeons interested in global health?

    PubMed

    Makhni, Melvin C; Miao, Diana; Zurakowski, David; Day, Charles S

    2014-03-01

    Two thirds of the world's population lack orthopedic services. Natural disasters such as the 2010 Haiti earthquake temporarily increased volunteering, but the decision to volunteer regularly is likely multifactorial. In the study reported here, we investigated whether academic orthopedic surgeons are interested in volunteering abroad and identified factors that influence participation. Academic orthopedic surgeons were identified through the faculty listings of all 154 orthopedic residency programs listed by the Association of American Medical Colleges (AAMC) Electronic Residency Application Service and were sent surveys by e-mail. Of the 3,697 eligible academic orthopedic surgeons, 600 were randomly selected, and 109 completed the survey. Of the 109 respondents, 52% had volunteered abroad previously, and 62% said they were highly likely to volunteer abroad in the future. The most common barriers were scheduling, and family and social commitments (65% and 66%, respectively), followed by lack of specialty-specific opportunities (40%). In a multivariate model, the only barrier significantly decreasing likelihood to volunteer abroad was concern for medical safety (P = .015). Altruistic motivations (P = .005), religious sentiments (P = .006), international networking (P = .004), and fulfilling the true medical creed (P = .015) significantly increased likelihood. Academic orthopedic surgeons are interested in volunteering abroad. Addressing common motivations and barriers may help improve care in the developing world.

  5. [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.

  6. Perioperative substance use disorder, opioid diversion, and opioid misuse by a medical professional undergoing orthopedic surgery.

    PubMed

    Maher, Dermot P; Kissen, Michael; Danovitch, Itai; Yumul, Roya; Louy, Charles

    2014-01-01

    Patients with substance use disorders can present challenges for effective perioperative pain management. Healthcare professionals with substance abuse disorders requiring medical treatment and pain management represent a unique subpopulation. The authors present a case of a nurse undergoing an orthopedic surgical procedure who was found with two large, organized tackle boxes of opioid medication in her hospital room. Although the incidence of substance use disorders in healthcare professionals is thought to be equivalent to the general population, the presentation, substances of choice, and inciting factors are unique. Further, treatment options available to such individuals have been established and proven successful. PMID:25531961

  7. Investigation of fatigue failure of a stainless steel orthopedic implant device

    NASA Astrophysics Data System (ADS)

    Sivakumar, M.; Kamachi Mudali, U.; Rajeswari, S.

    1994-02-01

    An orthopedic implant (rush nail) fractured in a patient at a location that corresponded to the site of a prior fracture of the bone (right femur). The crack propagation in the implant proceeded from both sides of the nail, and the final fracture occurred by ductile shear in the midsection of the nail. Dimple structures and tear ridges between fatigue striation patches were observed on the fractured surface. Moreover, the device fractured within a short period of use. Contrary to post-procedure instructions, the patient placed the body’s full weight on the implanted leg at least once, perhaps twice, causing overload-induced fatigue failure of the implant.

  8. Plasma engineered surfaces for orthopedic devices.

    PubMed

    Farhat, Susan; Gilliam, Mary; Samaniego, Cheryl; Dwarshuis, Nate; Carson, Julia; Peterson, Benjamin; Zand, Ali

    2016-06-01

    Atmospheric pressure plasma was used to graft various biocompatible polymers to the surface of ultra-high molecular weight polyethylene (UHMWPE). Polymers used as grafts in this study were poly(2-hydroxyethylmethacrylate) (PHEMA) and polyethylene glycol (PEG). A significant decrease in contact angle was noted for grafted surfaces, indicating increased hydrophilicity. Surface functionalities were verified using Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy. The wear properties of the coatings were determined by weight loss under conditions of a random motion pin-on-plate apparatus with the coated polyethylene plaques immersed in DI water. Based on these tests, the grafted surfaces exhibited an improved resistance to wear, compared to UHMWPE. Cell viability studies were used to confirm that the plasma treatment had no negative effects on the surface bio-toxicity. Based on the results, it is anticipated that the incorporation of these biocompatible polymer-grafted UHMWPE surfaces in metal-on-plastic orthopedic implants should improve their performance and longevity. PMID:26999407

  9. Orthopedic Injuries Following the East Azerbaijan Earthquake

    PubMed Central

    Elmi, Asghar; Ganjpour Sales, Jafar; Tabrizi, Ali; Soleimanpour, Jafar; Mohseni, Mohammad Ali

    2013-01-01

    Background Evaluating demographic characteristics, distribution and types of orthopedic injuries following major earthquakes may be helpful in future planning for disasters. Objectives This study aimed to analyze data from trauma patients with extremity injury resulting from the earthquakes of East Azerbaijan, Iran. Patients and Methods Medical records of 686 patients admitted to Shohada hospital, Trauma Center of Tabriz University of Medical Sciences were reviewed. There were 200 patients with extremity injury assessed. Demographic characteristics and patterns of injuries in these patients were evaluated. Results In this study, there were 105 females (52.5%) and 95 males (47.5%), out of which, 6 (3%) patients with associated severe head injuries died. The most common sites of injury were lower extremities (81 patients, 41.5% of total victims) while 32 patients (16%) suffered from both upper and lower extremity injuries. Open Fractures were seen in lower extremities of 26 (13%) patients. Compartment syndrome was observed in 3 (1.5%) patients with lower limb fractures. Also, 42 (21%) patients living in Tabriz were injured while they were running away (falling down the stairs and jumping out of windows). Conclusions Extremity injuries especially open fractures of lower limbs account for the majority of hospitalized victims. Compartment syndrome is one of the main problems that should be addressed. Our study demonstrates that people still need more education regarding earthquakes and the government should direct more attention to this issue. PMID:24350141

  10. 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.

  11. Physician-Hospital Alignment in Orthopedic Surgery.

    PubMed

    Bushnell, Brandon D

    2015-09-01

    The concept of "alignment" between physicians and hospitals is a popular buzzword in the age of health care reform. Despite their often tumultuous histories, physicians and hospitals find themselves under increasing pressures to work together toward common goals. However, effective alignment is more than just simple cooperation between parties. The process of achieving alignment does not have simple, universal steps. Alignment will differ based on individual situational factors and the type of specialty involved. Ultimately, however, there are principles that underlie the concept of alignment and should be a part of any physician-hospital alignment efforts. In orthopedic surgery, alignment involves the clinical, administrative, financial, and even personal aspects of a surgeon's practice. It must be based on the principles of financial interest, clinical authority, administrative participation, transparency, focus on the patient, and mutual necessity. Alignment can take on various forms as well, with popular models consisting of shared governance and comanagement, gainsharing, bundled payments, accountable care organizations, and other methods. As regulatory and financial pressures continue to motivate physicians and hospitals to develop alignment relationships, new and innovative methods of alignment will also appear. Existing models will mature and evolve, with individual variability based on local factors. However, certain trends seem to be appearing as time progresses and alignment relationships deepen, including regional and national collaboration, population management, and changes in the legal system. This article explores the history, principles, and specific methods of physician-hospital alignment and its critical importance for the future of health care delivery.

  12. Patient refusal for regional anesthesia in elderly orthopedic population: A cross-sectional survey at a tertiary care hospital

    PubMed Central

    Salam, Asma Abdus; Afshan, Gauhar

    2016-01-01

    Background and Aims: Improvements in pain management techniques in the last decade have had a major impact on the practice of orthopedic surgeries, for example, total hip arthroplasty and total knee arthroplasty. Although there are a number of treatment options for postoperative pain, a gold standard has not been established. In our institution, both general anesthesia and regional anesthesia (RA), are being offered to the elderly orthopedic population but RA is not frequently accepted by elderly population. The objective of this study was to determine the frequency of various reasons for refusal of RA in elderly patients undergoing orthopedic surgeries. Material and Methods: A prospective study conducted over a period of 1 year, had 549 patients with ages above 60 years who underwent different types of elective orthopedic procedures 182 patients who refused RA were interviewed according to a structured questionnaire designed to assess the reasons of refusal. Results: Most common reason for the refusal of RA was surgeon's choice (38.5%), whereas 20.3% of the patients were unaware about the RA. There was a significant association between female gender and refusing RA due to backache (17.2%) and fear of being awake during the operation (24.1%) respectively. Conclusion: This survey showed that the main reasons among elderly female population were the fear of remaining awake and backache. However, overall it was the surgeon's choice which made patients refuse RA, and the anesthesiologists were the main source of information. PMID:27006550

  13. 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

  14. Characteristics and Trends of Orthopedic Publications between 2000 and 2009

    PubMed Central

    Lee, Kyoung Min; Ryu, Mi Sun; Chung, Chin Youb; Choi, In Ho; Kwon, Dae Gyu; Kim, Tae Won; Sung, Ki Hyuk; Seo, Sang Gyo

    2011-01-01

    Background This study was undertaken to investigate the trends of orthopedic publications during the last decade, and to document the country of origin, journal, funding source, and language of contribution using PubMed. Methods Orthopedic articles published between 2000 and 2009 were retrieved from PubMed using the following search terms: "orthopaedic[Affiliation] AND ("2000/1/1"[PDAT]: "2009/12/31"[PDAT])" and "orthopedic[Affiliation] AND ("2000/1/1"[PDAT]: "2009/12/31"[PDAT])." The articles were downloaded in XML file format, which contained the following information: article title, author names, journal names, publication dates, article types, languages, authors' affiliations and funding sources. These information was extracted, sorted, and rearranged using the database's management software. We investigated the annual number of published orthopedic articles worldwide and the annual rate of increase. Furthermore, the country of publication origin, journal, funding source, and language of contribution were also investigated. Results A total of 46,322 orthopedic articles were published and registered in PubMed in the last 10 years. The worldwide number of published orthopedic articles increased from 2,889 in 2000 to 6,909 in 2009, showing an annual increase of 384.6 articles, or an annualized compound rate of 10.2%. The United States ranked highest in the number of published orthopedic articles, followed by Japan, the United Kingdom, Germany, and the Republic of Korea. Among the orthopedic articles published worldwide during the last 10 years, 37.9% pertained studies performed in the United States. Fifty-seven point three percent (57.3%) of articles were published in journals established in the United States. Among the published orthopaedic articles, 4,747 articles (10.2%) disclosed financial support by research funds, of which 4,688 (98.8%) articles utilized research funds from the United States. Most articles were published in English (97.2%, 45,030 articles

  15. Corrosion behavior of a welded stainless-steel orthopedic implant.

    PubMed

    Reclaru, L; Lerf, R; Eschler, P Y; Meyer, J M

    2001-02-01

    The corrosion behavior of combinations of materials used in an orthopedic implant: the spherical part (forged or forged and annealed) constituting the head, the weld (tungsten inert gas (TIG) or electron beam (EB) techniques), and the cylindrical part (annealed) constituting the shaft of a femoral prosthesis - has been investigated. Open-circuit potentials, potentiodynamic curves, Tafel slope, mixed potential theory and susceptibility to intergranular attack are electrochemical and chemical procedures selected for this work. Electrochemical measurements using a microelectrode have been made in the following zones: spherical part, cylindrical part, weld, and weld/sphere, and weld/shaft interfaces. To detect intergranular attack, the Strauss test has been used. At the interfaces, corrosion currents, measured (Icorr) and predicted (Icouple) are low, in the order of the pico- to nanoampere. The electrochemical behavior of the electron beam (EB) weld is better than that of the tungsten inert gas (TIG). Welds at interfaces can behave either anodically or cathodically. It is better if welds, which are sensitive parts of the femoral prosthesis, behave cathodically. In this way, the risk of starting localized corrosion (pitting, crevice or intergranular corrosion) from a galvanic couple, remains low. From this point of view, the sample with the EB weld offers the best behavior. All the other samples containing a TIG type of weld exhibit a less favorable behavior. The mechanical treatments (forged, and forged and annealed) of the steel sphere did not show any difference in the corrosion behavior. No intergranular corrosion has been observed at the weld/steel interface for unsensitized samples. With sensitized samples, however, a TIG sample has exhibited some localized intergranular corrosion at a distance of 500 microm along the weld/stainless steel (sphere) interface. PMID:11197502

  16. Online ratings of orthopedic surgeons: analysis of 2185 reviews.

    PubMed

    Bakhsh, Wajeeh; Mesfin, Addisu

    2014-08-01

    Online ratings of orthopedic surgeons have not been studied. We conducted a study to evaluate the online ratings of orthopedic surgeons in a major metropolitan region, to identify trends in ratings of orthopedic surgeons, and to analyze ratings to identify variables of significance in determining overall rating. Website traffic was used to identify the 8 busiest physician rating websites: AngiesList.com, EverydayHealth.com, Thirdage.com, Yelp.com, HealthGrades.com, Vitals.com, UCompareHealthcare.com, and RateMDs.com. These websites were consulted for data regarding orthopedic surgeons in a major metropolitan region with a population of 1.3 million in September 2012. Surgeon ratings were scaled from 0 to 100 for homogeneity. Of the 8 websites considered, 4 were excluded because of inaccessible or unreliable data. The qualifying sites were HealthGrades.com, Vitals.com, UCompareHealthcare.com, and RateMDs.com, with 2185 reviews total. Across these websites, mean overall rating of orthopedic surgeons was 81.8 (between 100, definitely recommend, and 80, mostly recommend). Five variables were statistically significant (Ps < .01) for higher ratings: ease of scheduling, time spent with patient, wait time, surgeon proficiency/knowledge, and bedside manner.

  17. 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

  18. 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. PMID:26488781

  19. [Continuing peripheral nerve blocks - benefit for orthopedic patients with diabetes mellitus?].

    PubMed

    Doležal, David; Saleh, Abdo Islam

    2015-06-01

    There is increasing incidence of diabetes mellitus in population of developed countries. And there is also, together with this fact, an increasing frequency of surgical not only orthopedic procedures for diabetic complications or for other reasons. However, thanks to modern sophisticated perioperative approaches, diabetes itself is no longer main risk factor for worsening of perioperative morbidity and mortality. The organ complications of diabetes still remain the crucial for patients outcome. The individual approach to each patient is important when we are plann-ing anesthesiological perioperative strategy. Assessment of long term diabetes compensation before elective surgical procedures, assessment and optimization of organ functions with searching for possible secondary complications of diabetes is also crucial. Generally, it is necessary to maintain compensation of diabetes through the whole perioperative period, avoid episodes of hypotension and tissue hypoperfusion and all anesthesiological interventions have to be targeted to rapid recovery (chronic medication, oral feeding and early rehabilitation). Technics of regional anesthesia and peripheral nerve blocks particularly, may be very useful for the objective especially for ortho-pedic patients.Key words: anesthesia - diabetes mellitus - perioperative period - peripheral nerve blocks.

  20. Computer assisted 3D pre-operative planning tool for femur fracture orthopedic surgery

    NASA Astrophysics Data System (ADS)

    Gamage, Pavan; Xie, Sheng Quan; Delmas, Patrice; Xu, Wei Liang

    2010-02-01

    Femur shaft fractures are caused by high impact injuries and can affect gait functionality if not treated correctly. Until recently, the pre-operative planning for femur fractures has relied on two-dimensional (2D) radiographs, light boxes, tracing paper, and transparent bone templates. The recent availability of digital radiographic equipment has to some extent improved the workflow for preoperative planning. Nevertheless, imaging is still in 2D X-rays and planning/simulation tools to support fragment manipulation and implant selection are still not available. Direct three-dimensional (3D) imaging modalities such as Computed Tomography (CT) are also still restricted to a minority of complex orthopedic procedures. This paper proposes a software tool which allows orthopedic surgeons to visualize, diagnose, plan and simulate femur shaft fracture reduction procedures in 3D. The tool utilizes frontal and lateral 2D radiographs to model the fracture surface, separate a generic bone into the two fractured fragments, identify the pose of each fragment, and automatically customize the shape of the bone. The use of 3D imaging allows full spatial inspection of the fracture providing different views through the manipulation of the interactively reconstructed 3D model, and ultimately better pre-operative planning.

  1. 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

  2. Therapists, Trainers, and Acupuncturists: Focused Review for the Orthopedic Surgeon.

    PubMed

    Domes, Christopher M; Kruger, Cori L

    2015-12-01

    Effective treatment of orthopedic injuries requires a multidisciplinary team, including physical and occupational therapists, athletic trainers, massage therapists, and acupuncturists. Orthopedic surgeons commonly encounter these practitioners but may not be familiar with the training, credentialing, and most importantly, the appropriate use of members of this team. There are general similarities in practice locations as well as types of symptoms addressed by the providers discussed, which include the treatment of physical pain, evaluation and treatment of physical impairment, and some facilitation of adaptation to the limitations caused by injuries. Across the 5 types of providers discussed there are widely varying training and licensing requirements, specializations, and continuing education requirements to maintain licensure. This article provides a focused review of these members of the multidisciplinary team and highlights the current American Academy of Orthopaedic Surgeons recommendations for the use of occupational and physical therapists for orthopedic conditions, including hip fractures, total hip arthroplasty, and anterior cruciate ligament reconstruction.

  3. 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.

  4. Evidence-based orthopedic surgery: is it possible?

    PubMed

    Suk, Michael; Hanson, Beate; Helfet, David L

    2010-04-01

    The promise of evidence-based medicine is to integrate the highest levels of clinical data with patient outcomes. After framing the question and identifying appropriate studies, evaluating their relevance to clinical practice is highly dependent on the instruments and measures selected to demonstrate outcomes. Currently, there are hundreds of outcomes measures available in the orthopedic literature evaluating these treatments, and it is not uncommon for different measures to produce conflicting results. Consequently, the ability to evaluate an outcomes measure is critical in determining the value of a specific treatment intervention. Similarly, selecting the appropriate outcomes measure for research or clinical purposes is an important decision that may have far reaching implications on reimbursement, surgeon reputation, and patient treatment success. Evidence-based orthopedic surgery is indeed possible, but demands a detailed understanding of why appropriate outcomes selection is important, the difference between clinician-based and patient-reported outcomes (PROs), and potential future directions in orthopedics outcomes research. PMID:20399353

  5. Orthopedic Manifestations of Mobius Syndrome: Case Series and Survey Study.

    PubMed

    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

  6. 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.

  7. Autograft, allograft and bone substitutes in reconstructive orthopedic surgery.

    PubMed

    Chiarello, Eugenio; Cadossi, Matteo; Tedesco, Giuseppe; Capra, Paola; Calamelli, Carlotta; Shehu, Alba; Giannini, Sandro

    2013-10-01

    Reconstruction of bone defects is a challenge for all orthopedic surgeons worldwide; to overcome this problem there are different options: the use of autografts, allografts and bone substitutes (BSs) to enhance and accelerate bone repair. Autografts have excellent biological properties but are associated with morbidity of the donor site and are restricted in volume. Allografts are available in adequate quantity but concerns still remain about the risk of infections, moreover they do not have osteogenetic properties. Bone substitutes have different indications and are very attractive for orthopedic surgeons. The present paper briefly reviews the advantages and disadvantages of autografts, allografts and BSs for bone reconstruction.

  8. 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. PMID:26451110

  9. 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

  10. Risk of Orthopedic Surgical Site Infections in Patients with Rheumatoid Arthritis Treated with Antitumor Necrosis Factor Alfa Therapy

    PubMed Central

    da Cunha, Bernardo Matos; Maria Henrique da Mota, Licia; dos Santos-Neto, Leopoldo Luiz

    2012-01-01

    Introduction. International guidelines recommend interruption of anti-TNF medications in the perioperative period, but there are no randomized trials to support such recommendation. Objectives. To study literature evidence assessing the risk of surgical site infections in orthopedic surgery patients with RA using anti-TNF drugs, compared to untreated patients or those using conventional DMARD. Methods. Systematic review of cohort studies is concerning surgical site infections in orthopedic procedures in patients with RA. Results. Three studies were selected. Only one was considered of high-quality, albeit with low statistical power. The review resulted in inconclusive data, since the best quality study showed no significant differences between groups, while others showed increased risk of infections in patients using anti-TNF medications. Conclusion. It is unclear whether patients with RA using anti-TNF medications are at increased risk of surgical site infections. Randomized controlled trials or new high quality observational studies are needed to clarify the issue. PMID:22500176

  11. The Use of Finite Element Analysis to Enhance Research and Clinical Practice in Orthopedics.

    PubMed

    Pfeiffer, Ferris M

    2016-02-01

    Finite element analysis (FEA) is a very powerful tool for the evaluation of biomechanics in orthopedics. Finite element (FE) simulations can effectively and efficiently evaluate thousands of variables (such as implant variation, surgical techniques, and various pathologies) to optimize design, screening, prediction, and treatment in orthopedics. Additionally, FEA can be used to retrospectively evaluate and troubleshoot complications or failures to prevent similar future occurrences. Finally, FE simulations are used to evaluate implants, procedures, and techniques in a time- and cost-effective manner. In this work, an overview of the development of FE models is provided and an example application is presented to simulate knee biomechanics for a specimen with medial meniscus insufficiency. FE models require the development of the geometry of interest, determination of the material properties of the tissues simulated, and an accurate application of a numerical solver to produce an accurate solution and representation of the field variables. The objectives of this work are to introduce the reader to the application of FEA in orthopedic analysis of the knee joint. A brief description of the model development process as well as a specific application to the investigation of knee joint stability in geometries with normal or compromised medial meniscal attachment is included. Significant increases in stretch of the anterior cruciate ligament were predicted in specimens with medial meniscus insufficiency (such behavior was confirmed in corresponding biomechanical testing). It can be concluded from this work that FE analysis of the knee can provide significant new information with which more effective clinical decisions can be made.

  12. Health-related quality of life (EQ-5D) before and after orthopedic surgery

    PubMed Central

    2011-01-01

    Background and purpose Population data on mortality and life expectancy are generally available for most countries. However, no longitudinal data based on the health-related quality of life outcome from the EQ-5D instrument have been reported for orthopedic patients. We assessed the effect of orthopedic surgery as measured by EQ-5D. Methods We analyzed EQ-5D data from 2,444 patients who were operated at the Department of Orthopedic Surgery at Karolinska University Hospital, 2001–2005. We also made a comparison between results from this cohort and those from a Swedish EQ-5D population survey. Results The mean EQ-5D index score improved from 0.54 to 0.72. Hip and knee arthroplasty, operations related to previous surgery, trauma-related procedures, and rheumatoid arthritis surgeries had preoperative EQ-5D index scores of 0.48 to 0.52. All of these groups showed substantial improvement in scores (0.63 to 0.80). Patients with tumors or diseases of the elbow/hand showed higher preoperative scores (0.66 to 0.77), which were similar postoperatively. In most patients, the EQ-5D index score improved but did not reach the level reported for an age- and sex-matched population sample (mean difference = 0.11). Interpretation Our results can be used as part of the preoperative patient information to increase the level of patient awareness and cooperation, and to facilitate rehabilitation. In future it will be possible—but not easy—to use the EQ-5D instrument as a complementary consideration in clinical priority assessment. PMID:21189112

  13. The Use of Finite Element Analysis to Enhance Research and Clinical Practice in Orthopedics.

    PubMed

    Pfeiffer, Ferris M

    2016-02-01

    Finite element analysis (FEA) is a very powerful tool for the evaluation of biomechanics in orthopedics. Finite element (FE) simulations can effectively and efficiently evaluate thousands of variables (such as implant variation, surgical techniques, and various pathologies) to optimize design, screening, prediction, and treatment in orthopedics. Additionally, FEA can be used to retrospectively evaluate and troubleshoot complications or failures to prevent similar future occurrences. Finally, FE simulations are used to evaluate implants, procedures, and techniques in a time- and cost-effective manner. In this work, an overview of the development of FE models is provided and an example application is presented to simulate knee biomechanics for a specimen with medial meniscus insufficiency. FE models require the development of the geometry of interest, determination of the material properties of the tissues simulated, and an accurate application of a numerical solver to produce an accurate solution and representation of the field variables. The objectives of this work are to introduce the reader to the application of FEA in orthopedic analysis of the knee joint. A brief description of the model development process as well as a specific application to the investigation of knee joint stability in geometries with normal or compromised medial meniscal attachment is included. Significant increases in stretch of the anterior cruciate ligament were predicted in specimens with medial meniscus insufficiency (such behavior was confirmed in corresponding biomechanical testing). It can be concluded from this work that FE analysis of the knee can provide significant new information with which more effective clinical decisions can be made. PMID:26745731

  14. 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...

  15. 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...

  16. Survey of 2582 Cases of Acute Orthopedic Trauma

    PubMed Central

    Soleymanha, Mehran; Mobayen, Mohammadreza; Asadi, Kamran; Adeli, Alborz; Haghparast-Ghadim-Limudahi, Zahra

    2014-01-01

    Background: Orthopedic injuries are among the most common causes of mortality, morbidity, hospitalization, and economic burden in societies. Objectives: In this research, we study the prevalence of different types of trauma requiring orthopedic surgery. Patients and Methods: We conducted a cross-sectional study on 2582 patients with acute orthopedic injuries admitted to the orthopedic emergency ward at the Poursina Hospital (a referral center in Guilan province (northern Iran), during December 2010 through September 2011. Patients were examined and the data collection form was filled for each patient. Data were analyzed by SPSS software version 19 and were listed in tables. Results: Of 2582 included cases, 1940 were male and 642 were female, with a mean age of 34.5 years. Most injuries were seen in the 25 to 44 year age group from rural areas. The highest frequency of trauma related to falls. On the other hand, bicycling and shooting had the lowest frequencies. There were 18 cases with limb amputation. Overall, 66.5% of patients had fractures, 5% had soft tissue lacerations, and 10% had dislocations. Conclusions: Identification of risk factors and methods of prevention is one of the most important duties of healthcare systems. Devising plans to minimize these risk factors and familiarizing people with them is prudent. PMID:25717444

  17. 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…

  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. Left-Handed Preschool Children with Orthopedic Disabilities.

    ERIC Educational Resources Information Center

    Banham, Katharine M.

    1983-01-01

    The mental development of 332 preschool-age children with orthopedic disabilities was assessed at a children's hospital over a 10-year period, and comparisons were made for right-handed and left-handed. The left-handed children were slower than right-handed children in learning speech and language skills (Author/SEW)

  1. Open access of evidence-based publications: the case of the orthopedic and musculoskeletal literature.

    PubMed

    Yammine, Kaissar

    2015-11-01

    The open access model, where researchers can publish their work and make it freely available to the whole medical community, is gaining ground over the traditional type of publication. However, fees are to be paid by either the authors or their institutions. The purpose of this paper is to assess the proportion and type of open access evidence-based articles in the form of systematic reviews and meta-analyses in the field of musculoskeletal disorders and orthopedic surgery. PubMed database was searched and the results showed a maximal number of hits for low back pain and total hip arthroplasty. We demonstrated that despite a 10-fold increase in the number of evidence-based publications in the past 10 years, the rate of free systematic reviews in the general biomedical literature did not change for the last two decades. In addition, the average percentage of free open access systematic reviews and meta-analyses for the commonest painful musculoskeletal conditions and orthopedic procedures was 20% and 18%, respectively. Those results were significantly lower than those of the systematic reviews and meta-analyses in the remaining biomedical research. Such findings could indicate a divergence between the efforts engaged at promoting evidence-based principles and those at disseminating evidence-based findings in the field of musculoskeletal disease and trauma. The high processing fee is thought to be a major limitation when considering open access model for publication.

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

    PubMed

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

    2016-01-01

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

  3. Geriatric High-Energy Polytrauma With Orthopedic Injuries

    PubMed Central

    Abdelfattah, Adham; Core, Michael Del; Watson, J. Tracy

    2014-01-01

    Background: The impact of orthopedic injuries in the elderly patient with multi-trauma and the effect of operative fixation on these injuries have not been thoroughly evaluated. Methods: We reviewed geriatric patients (aged 65 and older) between 2004 and 2010 at a level 1 trauma center who sustained high-energy polytrauma (injury and severity score [ISS] ≥ 16) with associated orthopedic injuries. Patients were excluded if they had severe head and spine injuries, died on arrival, or had low-energy mechanisms of injury. Logistic regression was conducted to identify factors that predict mortality. Results: There were 154 patients who comprised our study group with an average age of 76 years and an ISS of 23. There were 96 males and 58 females. Overall, 52 patients died within 1 year of their admission: 21 patients during their initial hospital stay and 31 patients within 1 year following admission. In all, 64 (42%) patients underwent operative stabilization of their orthopedic injuries. Increased mortality was seen (P < .05) in female patients, those with lower admission Glasgow coma score, and those who underwent orthopedic surgery. Patients had worse outcomes if they sustained femur (P = .014), clavicle, or scapular fractures (P = .027). Other factures associated with higher mortality included pelvic/acetabular injury requiring surgery (P = .019) or spine fractures treated nonoperatively (P = .014). Conclusion: The effect of orthopedic injuries on this geriatric polytrauma group contribute to worse outcomes when they included clavicle, scapula, and femur fractures. We also found that pelvic/acetabular fractures treated operatively and nonoperative spine fractures were associated with higher mortality rates. Risk/benefit consideration is suggested when contemplating operative intervention in these patients. PMID:26246939

  4. 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…

  5. Biomarkers of Brain Damage and Postoperative Cognitive Disorders in Orthopedic Patients: An Update

    PubMed Central

    Tomaszewski, Dariusz

    2015-01-01

    The incidence of postoperative cognitive dysfunction (POCD) in orthopedic patients varies from 16% to 45%, although it can be as high as 72%. As a consequence, the hospitalization time of patients who developed POCD was longer, the outcome and quality of life were worsened, and prolonged medical and social assistance were necessary. In this review the short description of such biomarkers of brain damage as the S100B protein, NSE, GFAP, Tau protein, metalloproteinases, ubiquitin C terminal hydrolase, microtubule-associated protein, myelin basic protein, α-II spectrin breakdown products, and microRNA was made. The role of thromboembolic material in the development of cognitive decline was also discussed. Special attention was paid to optimization of surgical and anesthetic procedures in the prevention of postoperative cognitive decline. PMID:26417595

  6. [Medical controlling as medical economical service center. Successful concept for orthopedics and trauma surgery centers?].

    PubMed

    Auhuber, T C; Hoffmann, R

    2015-01-01

    The management of patients from administrative admission through the orthopedic-surgical treatment to completion of the billing is complex. Additional challenges originate from the necessity to treat patients in both outpatient and inpatient departments and in more than one medical sector. A superior coordination is essential for a successful cooperation of the various procedures of controlling. The model of a medical controlling department as a service center with effective competence in the management of service and cost, functions as a successful solution to the problem. Central elements of a successful medical economical case management are a well-defined assignment of tasks and definitions of intersections, the integration of health professionals and administrative employees, the utilization of software for process control and the implementation of inlier controlling.

  7. Comparison of Three Virtual Reality Arthroscopic Simulators as Part of an Orthopedic Residency Educational Curriculum

    PubMed Central

    Martin, Kevin D; Amendola, Annunziato; Phisitkul, Phinit

    2016-01-01

    Abstract Purpose Orthopedic education continues to move towards evidence-based curriculum in order to comply with new residency accreditation mandates. There are currently three high fidelity arthroscopic virtual reality (VR) simulators available, each with multiple instructional modules and simulated arthroscopic procedures. The aim of the current study is to assess face validity, defined as the degree to which a procedure appears effective in terms of its stated aims, of three available VR simulators. Methods Thirty subjects were recruited from a single orthopedic residency training program. Each subject completed one training session on each of the three leading VR arthroscopic simulators (ARTHRO mentor-Symbionix, ArthroS-Virtamed, and ArthroSim-Toltech). Each arthroscopic session involved simulator-specific modules. After training sessions, subjects completed a previously validated simulator questionnaire for face validity. Results The median external appearances for the ARTHRO Mentor (9.3, range 6.7-10.0; p=0.0036) and ArthroS (9.3, range 7.3-10.0; p=0.0003) were statistically higher than for Arthro- Sim (6.7, range 3.3-9.7). There was no statistical difference in intraarticular appearance, instrument appearance, or user friendliness between the three groups. Most simulators reached an appropriate level of proportion of sufficient scores for each categor y (≥70%), except for ARTHRO Mentor (intraarticular appearance-50%; instrument appearance- 61.1%) and ArthroSim (external appearance- 50%; user friendliness-68.8%). Conclusion These results demonstrate that ArthroS has the highest overall face validity of the three current arthroscopic VR simulators. However, only external appearance for ArthroS reached statistical significance when compared to the other simulators. Additionally, each simulator had satisfactory intraarticular quality. This study helps further the understanding of VR simulation and necessary features for accurate arthroscopic representation

  8. Functional Imaging in Diagnostic of Orthopedic Implant-Associated Infections

    PubMed Central

    Potapova, Inga

    2013-01-01

    Surgeries’ sterile conditions and perioperative antibiotic therapies decrease implant associated infections rates significantly. However, up to 10% of orthopedic devices still fail due to infections. An implant infection generates a high socio-economic burden. An early diagnosis of an infection would significantly improve patients’ outcomes. There are numerous clinical tests to diagnose infections. The “Gold Standard” is a microbiological culture, which requires an invasive sampling and lasts up to several weeks. None of the existing tests in clinics alone is sufficient for a conclusive diagnosis of an infection. Meanwhile, there are functional imaging modalities, which hold the promise of a non-invasive, quick, and specific infection diagnostic. This review focuses on orthopedic implant-associated infections, their pathogenicity, diagnosis and functional imaging. PMID:26824928

  9. Learning blood management in orthopedic surgery through gameplay.

    PubMed

    Qin, Jing; Chui, Yim-Pan; Pang, Wai-Man; Choi, Kup-Sze; Heng, Pheng-Ann

    2010-01-01

    Orthopedic surgery treats the musculoskeletal system, in which bleeding is common and can be fatal. To help train future surgeons in this complex practice, researchers designed and implemented a serious game for learning orthopedic surgery. The game focuses on teaching trainees blood management skills, which are critical for safe operations. Using state-of-the-art graphics technologies, the game provides an interactive and realistic virtual environment. It also integrates game elements, including task-oriented and time-attack scenarios, bonuses, game levels, and performance evaluation tools. To study the system's effect, the researchers conducted experiments on player completion time and off-target contacts to test their learning of psychomotor skills in blood management.

  10. Health economics and health preference concepts to orthopedics practitioners

    PubMed Central

    Araújo, Carlos Delano Mundim; Veiga, Daniela Francescato; Hochman, Bernardo; Abla, Luiz Eduardo Felipe; Novo, Neil Ferreira; Ferreira, Lydia Masako

    2014-01-01

    The aim of this study was to describe concepts of health economics in order to update and provide the orthopedic practitioner decision making parameters based on preferences. Four basic types of studies of economical evaluation were presented (cost minimization analysis, cost-benefit, cost-effectiveness and cost-utility), as well as the origin, the concept, advantages and disadvantages of using QALY and utility. It was discussed the importance of costs and of SF-6D, an instrument able to get through the utility data from the Medical Outcomes Study 36-item Short Form Health Survey (SF-36). Physicians, especially orthopedic practitioners, are increasingly using technologies which are progressively expensive, thus, they should be able to understand health economics concepts, the importance of utility in clinical decision making process and economic analysis in health.09+ PMID:24868190

  11. Online reviews of orthopedic surgeons: an emerging trend.

    PubMed

    Frost, Chelsea; Mesfin, Addisu

    2015-04-01

    Various websites are dedicated to rating physicians. The goals of this study were to: (1) evaluate the prevalence of orthopedic surgeon ratings on physician rating websites in the United States and (2) evaluate factors that may affect ratings, such as sex, practice sector (academic or private), years of practice, and geographic location. A total of 557 orthopedic surgeons selected from the 30 most populated US cities were enrolled. The study period was June 1 to July 31, 2013. Practice type (academic vs private), sex, geographic location, and years since completion of training were evaluated. For each orthopedic surgeon, numeric ratings from 7 physician rating websites were collected. The ratings were standardized on a scale of 0 to 100. Written reviews were also collected and categorized as positive or negative. Of the 557 orthopedic surgeons, 525 (94.3%) were rated at least once on 1 of the physician rating websites. The average rating was 71.4. The study included 39 female physicians (7.4%) and 486 male physicians (92.6%). There were 204 (38.9%) physicians in academic practice and 321 (61.1%) in private practice. The greatest number of physicians, 281 (50.4%), practiced in the South and Southeast, whereas 276 (49.6%) practiced in the West, Midwest, and Northeast. Those in academic practice had significantly higher ratings (74.4 vs 71.1; P<.007). No significant difference based on sex (72.5 male physicians vs 70.2 female physicians; P=.17) or geographic location (P=.11) were noted. Most comments (64.6%) were positive or extremely positive. Physicians who were in practice for 6 to 10 years had significantly higher ratings (76.9, P<.01) than those in practice for 0 to 5 years (70.5) or for 21 or more years (70.7).

  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. Immobilized antibiotics to prevent orthopedic implant infections

    PubMed Central

    Hickok, Noreen J.; Shapiro, Irving M.

    2012-01-01

    Many surgical procedures require the placement of an inert or tissue-derived implant deep within the body cavity. While the majority of these implants do not become colonized by bacteria, a small percentage develops a biofilm layer that harbors invasive microorganisms. In orthopaedic surgery, unresolved periprosthetic infections can lead to implant loosening, arthrodeses, amputations and sometimes death. The focus of this review is to describe development of an implant in which an antibiotic tethered to the metal surface is used to prevent bacterial colonization and biofilm formation. Building on well-established chemical syntheses, studies show that antibiotics can be linked to titanium through a self-assembled monolayer of siloxy amines. The stable metal-antibiotic construct resists bacterial colonization and biofilm formation while remaining amenable to osteoblastic cell adhesion and maturation. In an animal model, the antibiotic modified implant resists challenges by bacteria that are commonly present in periprosthetic infections. While the long-term efficacy and stability is still to be established, ongoing studies support the view that this novel type of bioactive surface has a real potential to mitigate or prevent the devastating consequences of orthopaedic infection. PMID:22512927

  14. Orthopedic cellular therapy: An overview with focus on clinical trials

    PubMed Central

    Noh, Moon Jong; Lee, Kwan Hee

    2015-01-01

    In this editorial, the authors tried to evaluate the present state of cellular therapy in orthopedic field. The topics the authors try to cover include not only the clinical trials but the various research areas as well. Both the target diseases for cellular therapy and the target cells were reviewed. New methods to activate the cells were interesting to review. Most advanced clinical trials were also included because several of them have advanced to phase III clinical trials. In the orthopedic field, there are many diseases with a definite treatment gap at this time. Because cellular therapies can regenerate damaged tissues, there is a possibility for cellular therapies to become disease modifying drugs. It is not clear whether cellular therapies will become the standard of care in any of the orthopedic disorders, however the amount of research being performed and the number of clinical trials that are on-going make the authors believe that cellular therapies will become important treatment modalities within several years. PMID:26601056

  15. Overview of ultrasound usage trends in orthopedic and sports physiotherapy

    PubMed Central

    2012-01-01

    Background The purpose of this study is to examine current beliefs about the use, the clinical importance, the theoretical fundamentals and the utilization criteria of therapeutic ultrasound (TUS) among physical therapists on the clinical practice in orthopedic and sports physiotherapy in Brazil. Methods A brief survey was developed based on previous studies and was sent to 55 physical therapists with advanced competency in orthopedics and sports physiotherapy. The questions addressed general topics about the professional profile and ultrasound usage and dosage. Results Our data show the wide availability and frequent use of TUS in this sample of physical therapists. TUS is used in distinct musculoskeletal injuries and/or disorders in both acute and chronic conditions. Muscles, tendons and ligaments represented the major structures where TUS is used. Questions on the basic theory of TUS demonstrated a lack of knowledge of the ultrasound physiological effects as well as its interaction with biological tissues and TUS absolute contraindication. Conclusion A Brazilian profile about the US usage and dosage in orthopedic and sports physiotherapy is presented and highlights the need for a continuous upgrading process and further research into its effects. PMID:22871050

  16. Clinical conundrums and challenges during geriatric orthopedic emergency surgeries

    PubMed Central

    Bajwa, Sukhminder Jit Singh

    2015-01-01

    Despite so many advancements and innovations in anesthetic techniques, expectations and challenges have also grown in plenty. Cardiac, pediatric, obstetric and neuro-anesthesia have perfectly developed to fulfill the desired needs of respective patient population. However, geriatric anesthesia has been shown a lesser interest in teaching and clinical practices over the years as compared with other anesthetic sub-specialties. The large growing geriatric population globally is also associated with an increase number of elderly patients presenting for orthopedic emergency surgeries. Orthopedic emergency surgery in geriatric population is not only a daunting clinical challenge but also has numerous socio-behavioral and economic ramifications. Decision making in anesthesia is largely influenced by the presence of co-morbidities, neuro-cognitive functions and the current socio-behavioral status. Pre-anesthetic evaluation and optimization are extremely important for a better surgical outcome but is limited by time constraints during emergency surgery. The current review aims to highlight comprehensively the various clinical, social, behavioral and psychological aspects during pre-anesthetic evaluation associated with emergency orthopedic surgery in geriatric population. PMID:25810963

  17. Business and Practice Management Knowledge Deficiencies in Graduating Orthopedic Residents.

    PubMed

    Miller, D Joshua; Throckmorton, Thomas W; Azar, Frederick M; Beaty, James H; Canale, S Terry; Richardson, David R

    2015-10-01

    We conducted a study to determine the general level of knowledge that orthopedic residents have on business and practice management topics at graduation and to evaluate the level of knowledge that practicing orthopedic surgeons need in order to function effectively in a medical practice. Residency graduates from a single training program were asked to complete a survey that gathered demographic information and had surgeons rate their understanding of 9 general business and practice management skills and the importance of these skills in their current practice situation. The amount of necessary business knowledge they lacked at graduation was defined as a functional knowledge deficiency (FKD) and was calculated as the difference between the reported importance of a topic in current practice and the level of understanding of that topic at graduation (larger FKD indicates greater deficiency). Those in physician-managed practices reported significantly higher levels of understanding of economic analytical tools than those in nonphysician-managed practices. There were no other statistically significant differences among groups. Hospital-employed physicians had the lowest overall FKD (4.0), followed by those in academic practices (5.1) and private practices (5.9). Graduating orthopedic surgeons appear to be inadequately prepared to effectively manage business issues in their practices, as evidenced by the low overall knowledge levels and high FKDs.

  18. Prophylaxis against venous thromboembolism in orthopedic surgery.

    PubMed

    Liu, Lin-tao; Ma, Bao-tong

    2006-08-01

    Venous thromboembolism (VTE), which is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a significant cause of death, disability, and discomfort. They are frequent complications of various surgical procedures. The aging population and the survival of more severely injured patients may suggest an increasing risk of thromboembolism in the trauma patients. Expanded understanding of the population at risk challenges physicians to carefully examine risk factors for VTE to identify high-risk patients who can benefit from prophylaxis. An accurate knowledge of evidence-based risk factors is important in predicting and preventing postoperative DVT, and can be incorporated into a decision support system for appropriate thromboprophylaxis use. Standard use of DVT prophylaxis in a high-risk trauma population leads to a low incidence of DVT. The incidence of VTE is common in Asia. The evaluation includes laboratory tests, Doppler test and phlebography. Screening Doppler sonography should be performed for surveillance on all critically injured patients to identify DVT. D-Dimer is a useful marker to monitor prophylaxis in trauma surgery patients. The optimal time to start prophylaxis is between 2 hours before and 10 hours after surgery, but the risk of PE continues for several weeks. Thromboprophylaxis includes graduated compression stockings and anticoagulants for prophylaxis. Anticoagulants include Warfarin, which belongs to Vitamin K antagonists, unfractionated heparin, low molecular weight heparins, factor Xa indirect inhibitor Fondaparinux, and the oral IIa inhibitor Melagatran and ximelagatran. Recombinant human soluble thrombomodulin is a new and highly effective antithrombotic agent. Prophylactic placement of vena caval filters in selected trauma patients may decrease the incidence of PE. The indications for prophylactic inferior vena cava filter insertion include prolonged immobilization with multiple injuries, closed head injury, pelvic

  19. Patient-specific geometrical modeling of orthopedic structures with high efficiency and accuracy for finite element modeling and 3D printing.

    PubMed

    Huang, Huajun; Xiang, Chunling; Zeng, Canjun; Ouyang, Hanbin; Wong, Kelvin Kian Loong; Huang, Wenhua

    2015-12-01

    We improved the geometrical modeling procedure for fast and accurate reconstruction of orthopedic structures. This procedure consists of medical image segmentation, three-dimensional geometrical reconstruction, and assignment of material properties. The patient-specific orthopedic structures reconstructed by this improved procedure can be used in the virtual surgical planning, 3D printing of real orthopedic structures and finite element analysis. A conventional modeling consists of: image segmentation, geometrical reconstruction, mesh generation, and assignment of material properties. The present study modified the conventional method to enhance software operating procedures. Patient's CT images of different bones were acquired and subsequently reconstructed to give models. The reconstruction procedures were three-dimensional image segmentation, modification of the edge length and quantity of meshes, and the assignment of material properties according to the intensity of gravy value. We compared the performance of our procedures to the conventional procedures modeling in terms of software operating time, success rate and mesh quality. Our proposed framework has the following improvements in the geometrical modeling: (1) processing time: (femur: 87.16 ± 5.90 %; pelvis: 80.16 ± 7.67 %; thoracic vertebra: 17.81 ± 4.36 %; P < 0.05); (2) least volume reduction (femur: 0.26 ± 0.06 %; pelvis: 0.70 ± 0.47, thoracic vertebra: 3.70 ± 1.75 %; P < 0.01) and (3) mesh quality in terms of aspect ratio (femur: 8.00 ± 7.38 %; pelvis: 17.70 ± 9.82 %; thoracic vertebra: 13.93 ± 9.79 %; P < 0.05) and maximum angle (femur: 4.90 ± 5.28 %; pelvis: 17.20 ± 19.29 %; thoracic vertebra: 3.86 ± 3.82 %; P < 0.05). Our proposed patient-specific geometrical modeling requires less operating time and workload, but the orthopedic structures were generated at a higher rate of success as compared with the conventional method. It is expected to benefit the surgical planning of orthopedic

  20. Selective laser sintering of calcium phosphate materials for orthopedic implants

    NASA Astrophysics Data System (ADS)

    Lee, Goonhee

    Two technologies, Solid Freeform Fabrication (SFF) and bioceramics are combined in this work to prepare bone replacement implants with complex geometry. SFF has emerged as a crucial technique for rapid prototyping in the last decade. Selective Laser Sintering (SLS) is one of the established SFF manufacturing processes that can build three-dimensional objects directly from computer models without part-specific tooling or human intervention. Meanwhile, there have been great efforts to develop implantable materials that can assist in regeneration of bone defects and injuries. However, little attention has been focused in shaping bones from these materials. The main thrust of this research was to develop a process that can combine those two separate efforts. The specific objective of this research is to develop a process that can construct bone replacement material of complex geometry from synthetic calcium phosphate materials by using the SLS process. The achievement of this goal can have a significant impact on the quality of health care in the sense that complete custom-fit bone and tooth structures suitable for implantation can be prepared within 24--48 hours of receipt of geometric information obtained either from patient Computed Tomographic (CT) data, from Computer Aided Design (CAD) software or from other imaging systems such as Magnetic Resonance Imaging (MRI) and Holographic Laser Range Imaging (HLRI). In this research, two different processes have been developed. First is the SLS fabrication of porous bone implants. In this effort, systematic procedures have been established and calcium phosphate implants were successfully fabricated from various sources of geometric information. These efforts include material selection and preparation, SLS process parameter optimization, and development of post-processing techniques within the 48-hour time frame. Post-processing allows accurate control of geometry and of the chemistry of calcium phosphate, as well as

  1. [Evaluation of surgical skills of French ophthalmology, orthopedic and gastrointestinal surgery residents: Current status and perspectives].

    PubMed

    Tranchart, H; Aurégan, J C; Gaillard, M; Giocanti-Aurégan, A

    2015-10-01

    The purpose of this study was to evaluate the need for nationwide assessment of surgical skills during residency, and to define ideal methods for assessment in three surgical disciplines: ophthalmology, orthopedics and gastrointestinal surgery. Three online questionnaires were sent by e-mail to 784 residents, fellows and hospital practitioners, and 119 university hospital physican-professors. Questionnaires focused on current assessment methods at the regional level, the roles of the surveyed population in these evaluations, potential obstacles to their development and the most relevant methods for practical evaluations. Nine hundred and three questionnaires were sent; 355 participants replied (response rate: 39%). The establishment of systematic assessment seemed necessary to over 90% of the survey population, and this opinion was equitably distributed among all three specialties. Over 60% of respondents felt that current assessment procedures were not satisfactory. In all three specialties, the ideal evaluation method proposed was a real patient procedure. This "in vivo" evaluation was considered applicable in 80% of cases, potential barriers to its development being the resident's anxiety, medical-legal reasons and the lack of objective criteria. The ideal timing of these assessments was bi-annual. Implementation of surgical skills assessment during residency seems necessary. The survey population appears dissatisfied with current arrangements. A step-by-step evaluation combining surgical simulations, animal training and live patient procedures may be appropriate.

  2. Hospital Cost of Staphylococcal Infection after Cardiothoracic or Orthopedic Operations in France: A Retrospective Database Analysis

    PubMed Central

    Bénard, Stève; Cyr, Sonya

    2015-01-01

    Abstract Background: Staphylococcal infections (SI) after cardiothoracic (CT) or orthopedic (OP) surgery are associated with extended length of stay (LOS), a considerable mortality rate, and high cost. No data on these consequences have been published in France. Therefore, a study was conducted to describe the epidemiologic, clinical, and economic outcomes of SI following these operations in France based on a hospital discharge database. Methods: Patients who underwent the most common types of CT or OP operations in 2009 were identified and followed for one year. Staphylococcal infections occurring in the three following months were identified. Results: In 2009, 21,543 patients underwent one of the selected CT procedures (62% coronary artery bypass grafting; 38% cardiac valve replacement) and 175,518 patients underwent one of the selected OP procedures (64% hip arthroplasty; 36% knee arthroplasty). Among the patients, 4.4% (n=955) and 0.9% (n=1,515) developed SI after CT and OP surgery, respectively. Staphylococcal infection led to approximately 1.0 and 1.4 additional hospitalizations per patient, 22.1 and 24.1 additional hospital days, and an excess cost of €15,475 and €13,389 after an CT or OP procedure, respectively. The in-hospital mortality rate was 2.6 times and 6 times greater in infected patients than in non-infected patients for CT and OP. Hospital cost reached €505 million for these two CT procedures and €1.9 billion for the two OP procedures, of which €15 million and €20 million were related directly to patients having developed SI. Conclusions: Staphylococcal infections after common CT or OP operations were associated with greater mortality rates and hospital costs secondary to the additional procedures and greater LOS. PMID:26207403

  3. Trends in the orthopedic job market and the importance of fellowship subspecialty training.

    PubMed

    Morrell, Nathan T; Mercer, Deana M; Moneim, Moheb S

    2012-04-01

    Previous studies have examined possible incentives for pursuing orthopedic fellowship training, but we are unaware of previously published studies reporting the trends in the orthopedic job market since the acceptance of certain criteria for fellowship programs by the Accreditation Council for Graduate Medical Education (ACGME) in 1985. We hypothesized that, since the initiation of accredited postresidency fellowship programs, job opportunities for fellowship-trained orthopedic surgeons have increased and job opportunities for nonfellowship-trained orthopedic surgeons have decreased. We reviewed the job advertisements printed in the Journal of Bone and Joint Surgery, American Volume, for the years 1984, 1994, 2004, and 2009. We categorized the job opportunities as available for either a general (nonfellowship-trained) orthopedic surgeon or a fellowship-trained orthopedic surgeon. Based on the advertisements posted in the Journal of Bone and Joint Surgery, American Volume, a trend exists in the orthopedic job market toward seeking fellowship-trained orthopedic surgeons. In the years 1984, 1994, 2004, and 2009, the percentage of job opportunities seeking fellowship-trained orthopedic surgeons was 16.7% (95% confidence interval [CI], 13.1%-20.3%), 40.6% (95% CI, 38.1%-43.1%), 52.2% (95% CI, 48.5%-55.9%), and 68.2% (95% CI, 65.0%-71.4%), respectively. These differences were statistically significant (analysis of variance, P<.05). Fellowship training is thus a worthwhile endeavor.

  4. Minocycline-Induced Cutaneous Hyperpigmentation in an Orthopedic Patient Population

    PubMed Central

    Hanada, Yuri; Berbari, Elie F.; Steckelberg, James M.

    2016-01-01

    Background. The objectives of this study were to estimate the incidence and evaluate risk factors for development of minocycline-induced cutaneous hyperpigmentation in patients with orthopedic infections. Methods. Patients with orthopedic infections evaluated at Mayo Clinic (Rochester, MN) and treated with minocycline from 1 January 2002 to 31 December 2011 were retrospectively identified. Long-term minocycline suppression was defined as daily minocycline use for at least 3 months. A proportional hazards model was used to evaluate potential risk factors. Results. Of 291 patients receiving long-term minocycline suppression, 54% (156 of 291) developed hyperpigmentation after a mean follow-up of 4.8 years (range, 0.3–13.2 years); 88% involved blue-gray pigmentation of normal skin that appeared most commonly in the lower (75%) and upper extremities (44%). The mean duration of minocycline therapy before hyperpigmentation was 1.5 years (range, 0.1–9 years) with a mean cumulative dosage of 107.3 g (range, 8.6–657 g). Notable risk factors include a history of vitamin D deficiency (relative risk [RR], 6.29; 95% confidence interval [CI], 1.91–15.27; P = .0052), presence of a shoulder prosthesis (RR, 3.2; 95% CI, 1.23–6.56; P = .0062), noncirrhotic liver pathology (RR, 3.63; 95% CI, 1.11–8.75; P = .0359), and use of a concurrent medication also known to cause hyperpigmentation (RR, 4.75; 95% CI, 1.83–10.1; P = .0029). Conclusions. Hyperpigmentation associated with the use of long-term minocycline suppression in patients with orthopedic infections is common. PMID:26835479

  5. Management of open wounds: lessons from orthopedic oncology.

    PubMed

    Siegel, Herrick J

    2014-01-01

    The management of complex wounds remains a challenge, and although there have been many promising advances, patients often undergo a morbid and lengthy process to obtain sufficient, satisfactory healing. Sarcoma patients are especially vulnerable to soft tissue wound-healing complications. These patients are often treated with neoadjuvant radiation and/or chemotherapy and have compromised local vascularity to healing tissue. The advent and refinement of wound vacuum-assisted closure technology have been shown to have a tremendous impact. This article reviews the benefits of some novel technologies currently undergoing investigation in orthopedic oncology that will likely have applications in wound management from other causes.

  6. A History of Orthopedics in San Francisco and the West

    PubMed Central

    Mandell, Peter; Raih, Thomas; Taylor, Lloyd W.

    1976-01-01

    The unique development of early medical specialization in the West can be traced to California's geography and economic development. Such early specialization produced men with orthopedic inclinations. Early orthopedists founded the first medical school and the first modern teaching hospital, helped to found Stanford's Lane Medical Library and made the first use of x-rays in the West. In addition many of these orthopedists were prominent in the political and social activities of the time. ImagesFigure 1.Figure 2.Figure 3.Figure 4. PMID:795165

  7. Use of bisphosphonates in orthopedic surgery: pearls and pitfalls.

    PubMed

    Lozano-Calderon, Santiago A; Colman, Matthew W; Raskin, Kevin A; Hornicek, Francis J; Gebhardt, Mark

    2014-07-01

    Bisphosphonates are medications known to decrease bone resorption by inhibiting osteoclastic activity. They are the first-line therapy for the treatment of osteoporosis because a significant body of literature has proved their efficacy in reducing the risk of fracture in the hip, spine and other nonvertebral osseous sites. In addition, the use of bisphosphonates has significantly decreased morbidity and increased survival, and they have also proved to be cost-effective. Unexpected adverse effects have been reported recently, but the benefit of bisphosphonates use outweighs the risks. This article reviews the current use of bisphosphonates in orthopedic surgery.

  8. Tecnological standards of teleradiology function in orthopedics and trauma care.

    PubMed

    Glinkowski, Wojciech; Kornacki, Maciej

    2002-12-30

    Digital Image is a relatively new quality in orthopedic diagnostics, which allows transmitting the image instead of the patient. Digital or digitized image can be transmitted via Internet, e-mail or local net. Observations derived form literature and own experience indicate that teleradiology may effectively provide radiologic consultation or even improve the detailed radiologic evaluation. This article describes sufficiently the technologic problems of teleradiology and explains terminology used for this branch, what allows understanding the fundamentals of teleradiology even for person having little technical and informatics knowledge. Authors describe equipment demands and standards of function for teleradiologic services. PMID:18034103

  9. The Early Years of Organized Chiropractic Orthopedics, 1954–1973: A Social History

    PubMed Central

    Green, Bart N.; Johnson, Claire D.

    2009-01-01

    Objective: This paper presents the origins and development of the organized chiropractic orthopedics movement in the United States from 1954–1973. Methods: Hand searches of early periodicals were performed and information was organized chronologically to create a timeline. Context for the timeline was provided by extracting pertinent information from audio recordings of interviews. Relevant background information was located using the cumulative index of the journal Chiropractic History and searching the MANTIS database. Historical Features: After World War I, The advent of third party reimbursement for health care created a new environment for health care practitioners. For doctors of chiropractic, this event provided the impetus to begin the postgraduate chiropractic orthopedics program over 50 years ago. In 1954, Alvin A. Hancock, DC and F. Maynard Lipe, DC successfully launched an active orthopedics movement after several earlier attempts failed during the 1940s and early 1950s. The movement generated from the desire to train and certify chiropractors to manage personal injury and workers’ compensation low back injuries. In addition to developing interdisciplinary educational programs, the chiropractic orthopedics group was responsible for producing a research agenda, some of the profession’s early orthopedic-focused research, and for starting the National Council on Chiropractic Orthopedics of the National Chiropractic Association, which later became the American Chiropractic Association Council on Orthopedics. These organizations produced thousands of specialists in chiropractic orthopedics, later known as Diplomates of the American Board of Chiropractic Orthopedists. Conclusion: Several orthopedics interest groups were formed and credentialing processes were created to qualify doctors as recognized chiropractic orthopedics specialists. The popularity of this movement resulted in the inclusion of orthopedics into core chiropractic college curricula and

  10. Angiogenesis and osteogenesis in an orthopedically expanded suture

    NASA Technical Reports Server (NTRS)

    Chang, H. N.; Garetto, L. P.; Potter, R. H.; Katona, T. R.; Lee, C. H.; Roberts, W. E.

    1997-01-01

    The purpose of this study was to examine the angiogenic and the subsequent osteogenic responses during a 96-hour time-course after sutural expansion. Fifty rats were divided into: (1) a control group that received only angiogenic induction through injection of 5 ng/gm recombinant human endothelial cell growth factor (rhECGF); (2) an experimental group that received orthopedic expansion and rhECGF; (3) a sham group that received expansion and sodium chloride (NaCl) injection; and (4) a baseline group that received no expansion or injection. All rats were injected with 3H-thymidine (1.0 microCi/gm) 1 hour before death to label the DNA of S-phase cells. Demineralized sections (4 microm thick) were stained with hematoxylin and eosin. Angiogenesis and cell migration were analyzed with a previously established cell kinetics model. Analysis of variance was used to test the hypothesis that enhancement of angiogenesis stimulates reestablishment of osteogenic capability. Blood vessel number, area, and endothelial cell-labeled index significantly increased in experimental groups, but no difference was found between control and baseline groups. Labeled-pericyte index and activated pericyte numbers in the experimental group were also higher than in the sham groups. These results show that supplemental rhECGF enhances angiogenesis in expanded sutures but not in nonexpanded sutures. Data also suggest that pericytes are the source of osteoblasts in an orthopedically expanded suture.

  11. Orthopedic tissue regeneration: cells, scaffolds, and small molecules.

    PubMed

    Jeon, Ok Hee; Elisseeff, Jennifer

    2016-04-01

    Orthopedic tissue regeneration would benefit the aging population or patients with degenerative bone and cartilage diseases, especially osteoporosis and osteoarthritis. Despite progress in surgical and pharmacological interventions, new regenerative approaches are needed to meet the challenge of creating bone and articular cartilage tissues that are not only structurally sound but also functional, primarily to maintain mechanical integrity in their high load-bearing environments. In this review, we discuss new advances made in exploiting the three classes of materials in bone and cartilage regenerative medicine--cells, biomaterial-based scaffolds, and small molecules--and their successes and challenges reported in the clinic. In particular, the focus will be on the development of tissue-engineered bone and cartilage ex vivo by combining stem cells with biomaterials, providing appropriate structural, compositional, and mechanical cues to restore damaged tissue function. In addition, using small molecules to locally promote regeneration will be discussed, with potential approaches that combine bone and cartilage targeted therapeutics for the orthopedic-related disease, especially osteoporosis and osteoarthritis.

  12. Dynamic Patterns of Expertise: The Case of Orthopedic Medical Diagnosis.

    PubMed

    Assaf, Dan; Amar, Eyal; Marwan, Norbert; Neuman, Yair; Salai, Moshe; Rath, Ehud

    2016-01-01

    The aim of this study was to analyze dynamic patterns for scanning femoroacetabular impingement (FAI) radiographs in orthopedics, in order to better understand the nature of expertise in radiography. Seven orthopedics residents with at least two years of expertise and seven board-certified orthopedists participated in the study. The participants were asked to diagnose 15 anteroposterior (AP) pelvis radiographs of 15 surgical patients, diagnosed with FAI syndrome. Eye tracking data were recorded using the SMI desk-mounted tracker and were analyzed using advanced measures and methodologies, mainly recurrence quantification analysis. The expert orthopedists presented a less predictable pattern of scanning the radiographs although there was no difference between experts and non-experts in the deterministic nature of their scan path. In addition, the experts presented a higher percentage of correct areas of focus and more quickly made their first comparison between symmetric regions of the pelvis. We contribute to the understanding of experts' process of diagnosis by showing that experts are qualitatively different from residents in their scanning patterns. The dynamic pattern of scanning that characterizes the experts was found to have a more complex and less predictable signature, meaning that experts' scanning is simultaneously both structured (i.e. deterministic) and unpredictable. PMID:27414794

  13. Dynamic Patterns of Expertise: The Case of Orthopedic Medical Diagnosis

    PubMed Central

    Marwan, Norbert; Neuman, Yair; Salai, Moshe; Rath, Ehud

    2016-01-01

    The aim of this study was to analyze dynamic patterns for scanning femoroacetabular impingement (FAI) radiographs in orthopedics, in order to better understand the nature of expertise in radiography. Seven orthopedics residents with at least two years of expertise and seven board-certified orthopedists participated in the study. The participants were asked to diagnose 15 anteroposterior (AP) pelvis radiographs of 15 surgical patients, diagnosed with FAI syndrome. Eye tracking data were recorded using the SMI desk-mounted tracker and were analyzed using advanced measures and methodologies, mainly recurrence quantification analysis. The expert orthopedists presented a less predictable pattern of scanning the radiographs although there was no difference between experts and non-experts in the deterministic nature of their scan path. In addition, the experts presented a higher percentage of correct areas of focus and more quickly made their first comparison between symmetric regions of the pelvis. We contribute to the understanding of experts’ process of diagnosis by showing that experts are qualitatively different from residents in their scanning patterns. The dynamic pattern of scanning that characterizes the experts was found to have a more complex and less predictable signature, meaning that experts’ scanning is simultaneously both structured (i.e. deterministic) and unpredictable. PMID:27414794

  14. An orthopedic tissue adhesive for targeted delivery of intraoperative biologics.

    PubMed

    Simson, Jacob; Crist, Joshua; Strehin, Iossif; Lu, Qiaozhi; Elisseeff, Jennifer H

    2013-03-01

    Tissue adhesives can bind together damaged tissues and serve as tools to deliver and localize therapeutics to facilitate regeneration. One emerging therapeutic trend in orthopedics is the use of intraoperative biologics (IOB), such as bone marrow (BM) and platelet-rich plasma (PRP), to stimulate healing. Here, we introduce the application of the biomaterial chondroitin sulfate succinimidyl succinate (CS-NHS) to deliver IOB in a hydrogel adhesive. We demonstrate the biomaterial's ability to bind various tissue types and its cellular biocompatibility with encapsulated human mesenchymal stem cells (hMSCs). Further, we examine in detail the CS-NHS adhesive combined with BM aspirate for use in bone applications. hMSCs were encapsulated in CS-BM and cultured for 5 weeks in osteogenic medium. Quantitative RT-PCR demonstrated osteogenesis via upregulation of the osteogenic transcription factor Runx2 and bone markers alkaline phosphatase and osteocalcin. Significant deposition of calcium and osteocalcin was detected using biochemical, histological, and immunohistochemical techniques. Shear testing demonstrated that the CS-BM adhesive exhibited an adhesive strength approximately an order of magnitude stronger than fibrin glue and approaching that of a cyanoacrylate adhesive. These results indicate that CS-NHS is a promising delivery tool for IOB in orthopedic applications requiring a strong, degradable, and biocompatible adhesive that supports bone growth. PMID:23097279

  15. Hemodynamic and oxidative mechanisms of tourniquet-induced muscle injury: near-infrared spectroscopy for the orthopedics setting

    NASA Astrophysics Data System (ADS)

    Shadgan, Babak; Reid, W. Darlene; Harris, R. Luke; Jafari, Siavash; Powers, Scott K.; O'Brien, Peter J.

    2012-08-01

    During orthopedic procedures, the tourniquets used to maintain bloodless surgical fields cause ischemia and then reperfusion (I/R), leading to oxidative muscle injury. Established methods exist neither for monitoring orthopedic I/R nor for predicting the extent of tourniquet-associated oxidative injury. To develop a predictive model for tourniquet-associated oxidative muscle injury, this study combined real-time near-infrared spectroscopy (NIRS) monitoring of I/R with Western blotting (WB) for oxidized proteins. We hypothesized strong correlations between NIRS-derived I/R indices and muscle protein oxidation. In 17 patients undergoing ankle fracture repair, a thigh tourniquet was inflated on the injured limb (300 mmHg). Using a continuous-wave (CW) NIRS setup, oxygenated (O2Hb), deoxygenated (HHb), and total (tHb) hemoglobin were monitored bilaterally (tourniquet versus control) in leg muscles. Leg muscle biopsies were collected unilaterally (tourniquet side) immediately after tourniquet inflation (pre) and before deflation (post). Average ischemia duration was 43.2±14.6 min. In post-compared to pre-biopsies, muscle protein oxidation (quantified using WB) increased 172.3%±145.7% (P<0.0005). Changes in O2Hb and tHb were negatively correlated with protein oxidation (respectively: P=0.040, R2=0.25 and P=0.003, R2=0.58). Reoxygenation rate was positively correlated with protein oxidation (P=0.041, R2=0.25). These data indicate that using CW NIRS, it is possible to predict orthopedic tourniquet-associated muscle oxidative injury noninvasively.

  16. A qualitative and quantitative needs assessment of pain management for hospitalized orthopedic patients.

    PubMed

    Cordts, Grace A; Grant, Marian S; Brandt, Lynsey E; Mears, Simon C

    2011-08-08

    Despite advances in pain management, little formal teaching is given to practitioners and nurses in its use for postoperative orthopedic patients. The goal of our study was to determine the educational needs for orthopedic pain management of our residents, nurses, and physical therapists using a quantitative and qualitative assessment. The needs analysis was conducted in a 10-bed orthopedic unit at a teaching hospital and included a survey given to 20 orthopedic residents, 9 nurses, and 6 physical therapists, followed by focus groups addressing barriers to pain control and knowledge of pain management. Key challenges for nurses included not always having breakthrough pain medication orders and the gap in pain management between cessation of patient-controlled analgesia and ordering and administering oral medications. Key challenges for orthopedic residents included treating pain in patients with a history of substance abuse, assessing pain, and determining when to use long-acting vs short-acting opioids. Focus group assessments revealed a lack of training in pain management and the need for better coordination of care between nurses and practitioners and improved education about special needs groups (the elderly and those with substance abuse issues). This needs assessment showed that orthopedic residents and nurses receive little formal education on pain management, despite having to address pain on a daily basis. This information will be used to develop an educational program to improve pain management for postoperative orthopedic patients. An integrated educational program with orthopedic residents, nurses, and physical therapists would promote understanding of issues for each discipline.

  17. Patterns of costs and spending among orthopedic surgeons across the United States: a national survey.

    PubMed

    Sathiyakumar, Vasanth; Jahangir, A Alex; Mir, Hassan R; Obremskey, William T; Lee, Young M; Thakore, Rachel V; Sethi, Manish K

    2014-01-01

    Due to rising medical costs, the purpose of this study was to investigate the spending patterns of orthopedic surgeons across the United States and the financial implications of such behavior. Overall, 2,000 randomly chosen orthopedic surgeons from the American Academy of Orthopedic Surgeons (AAOS) were invited to answer web-based surveys on their utilization of healthcare resources; 1,214 (61%) completed the survey. There was a significant difference (P < .001) in monthly expenditure based on 8 domains of orthopedic care for the average orthopedist: x-ray costs were $7,536, computed tomography costs were $2,340, magnetic resonance imaging costs were $14,975, ultrasound costs were $686, laboratory test costs were $969, specialty referral costs were $1,389, biopsy costs were $1,314, and hospital admission costs were $6,808. Significant differences in monthly expenditure existed based on orthopedist practice setting (P < .001), subspecialty (P < .001), gender (P < .001), and age (P < .001). Demographics with the highest monthly spending included orthopedic private group setting ($36,278), orthopedic oncology subspecialty ($41,795), male gender ($33,843), and age 50 to 59 ($35,559). The average monthly expenditure for orthopedists nationally was calculated to be $33,436 per physician. Given there are approximately 20,400 practicing orthopedists, the annual United States expenditure in orthopedic surgery was calculated to be $8.2 billion. Orthopedic spending is a significant component of national healthcare expenditure.

  18. Guidelines for the Implementation of Programs for Pupils Who Are Orthopedically Handicapped.

    ERIC Educational Resources Information Center

    Black, Robert S.; Fusco, Carol B.

    Guidelines are provided for the development of programs in South Carolina for orthopedically handicapped (OH) pupils. Basic information is given concerning the definition of orthopedic handicap, the legal mandates on the education of OH pupils, funding sources, authorized programs (whether self-contained programs, resource rooms, or itinerant…

  19. Dance for Students with Orthopedic Conditions--Popular, Square, Folk, Modern, [and] Ballet.

    ERIC Educational Resources Information Center

    Harris, Cordelia Graves

    1979-01-01

    Preparation for teaching dance to orthopedically handicapped students is discussed in addition to specific suggestions for teaching popular dance, square dance, folk dance, modern dance, and ballet. Dancing is seen as a way to give orthopedically handicapped students physical education success without competition. Recommended music for each type…

  20. 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…

  1. Age, Physical Activity, Physical Fitness, Body Composition, and Incidence of Orthopedic Problems.

    ERIC Educational Resources Information Center

    Research Quarterly for Exercise and Sport, 1989

    1989-01-01

    Effects of age, physical activity, physical fitness, and body mass index (BMI) on the occurrence of orthopedic problems were examined. For men, physical fitness, BMI, and physical activity were associated with orthopedic problems; for women, physical activity was the main predictor. Age was not a factor for either gender. (JD)

  2. The Orthopedically Disabled Child: Psychological Implications with an Individual Basis. July 1984 Revision.

    ERIC Educational Resources Information Center

    Sigmon, Scott B.

    This study describes the implications of the Individual Psychology of Alfred Adler and field theory associated with Kurt Lewin in understanding orthopedically disabled children and points out that orthopedically disabled youngsters have a remarkable range of individual differences both in type of disability as well as level of adjustment.…

  3. Level of billing as a function of resident documentation and orthopedic subspecialty at an academic multispecialty orthopedic surgery practice.

    PubMed

    Dezfuli, Bobby; Smith, Jordan L

    2012-11-01

    Documentation, coding, and billing for physician-patient encounters have evolved over time and have significant variability. Appropriate and complete documentation of these encounters can contribute to the financial viability of private and academic medical centers. The objectives of this study were to assess the financial effect of documentation on billing and to compare the authors' institution's distribution of billing level compared with Medicare normative data. Four orthopedic surgery subspecialty clinics were evaluated at a university outpatient clinic over a 1-year period. A single full-day clinic per week was used for each subspecialty. Residents dictated the majority of the reports. All reports were transcribed by medical transcriptionists and coded by certified professional coders. The sports medicine subspecialty generated the highest volume of patient clinic visits, followed by foot and ankle, trauma, and spine (P<.01). The majority of the reports were billed at level 3 (P<.05). Significant differences existed between subspecialty and percentage distribution of billing level (P<.05). Compared with Medicare normative data, a significantly greater percentage of level 3 reports and a lower percentage of level 2 and 4 reports existed in the orthopedic practice (P<.01). The estimated loss of revenue from the fewer level 4 reports was $81,281.11 for 1 year. These findings highlight the need for greater educational interventions to improve provider documentation, coding, and billing. The effect of new electronic medical record systems that prompt providers to include key evaluation and management components will likely affect practices and warrant further analysis.

  4. Factors affecting interest in orthopedics among female medical students: a prospective analysis.

    PubMed

    Baldwin, Keith; Namdari, Surena; Bowers, Andrea; Keenan, Mary Ann; Levin, L Scott; Ahn, Jaimo

    2011-12-01

    The field of orthopedics has a limited ability to recruit high-quality female applicants. The purpose of this study was to determine whether early exposure to the field affects a woman's decision to pursue orthopedics. We performed a prospective, nonrandomized cohort study between academic years 2005 and 2009 and compared interest in orthopedic surgery among female (n=271) and male (n=71) medical students at 2 urban teaching institutions. Elective lectures and orthopedic literature were distributed via e-mail to the study participants. These materials included articles published in the medical literature, materials produced and distributed by the American Academy of Orthopaedic Surgeons, and Web sites providing educational materials. The primary outcome was the likelihood of application for orthopedic residency. We studied the influence of demographics, exposure, and attitudes on interest in pursuing an orthopedic career. Men had a significantly higher baseline level of interest in orthopedic surgery than women (P=.005). Younger age (P<.001) and personal (P<.001), independent (P<.001), and school (P=.023) exposures to orthopedics were significantly related to interest among women. At final follow-up, total personal exposures (P=.003) and total independent exposures (P<.001) in the form of our literature and lectures were correlated with final interest in women. Female interest was decreased by the long hours, physical demands, and predominantly male nature of the field. Early exposure to orthopedic educational resources may be useful in generating female interest. Perceptions and attitudes regarding orthopedic surgery must to be changed to attract the best and brightest minds, regardless of sex. PMID:22146211

  5. Factors affecting interest in orthopedics among female medical students: a prospective analysis.

    PubMed

    Baldwin, Keith; Namdari, Surena; Bowers, Andrea; Keenan, Mary Ann; Levin, L Scott; Ahn, Jaimo

    2011-12-01

    The field of orthopedics has a limited ability to recruit high-quality female applicants. The purpose of this study was to determine whether early exposure to the field affects a woman's decision to pursue orthopedics. We performed a prospective, nonrandomized cohort study between academic years 2005 and 2009 and compared interest in orthopedic surgery among female (n=271) and male (n=71) medical students at 2 urban teaching institutions. Elective lectures and orthopedic literature were distributed via e-mail to the study participants. These materials included articles published in the medical literature, materials produced and distributed by the American Academy of Orthopaedic Surgeons, and Web sites providing educational materials. The primary outcome was the likelihood of application for orthopedic residency. We studied the influence of demographics, exposure, and attitudes on interest in pursuing an orthopedic career. Men had a significantly higher baseline level of interest in orthopedic surgery than women (P=.005). Younger age (P<.001) and personal (P<.001), independent (P<.001), and school (P=.023) exposures to orthopedics were significantly related to interest among women. At final follow-up, total personal exposures (P=.003) and total independent exposures (P<.001) in the form of our literature and lectures were correlated with final interest in women. Female interest was decreased by the long hours, physical demands, and predominantly male nature of the field. Early exposure to orthopedic educational resources may be useful in generating female interest. Perceptions and attitudes regarding orthopedic surgery must to be changed to attract the best and brightest minds, regardless of sex.

  6. Peer-assisted teaching student tutors as examiners in an orthopedic surgery OSCE station – pros and cons

    PubMed Central

    Melcher, Peter; Zajonz, Dirk; Roth, Andreas; Heyde, Christoph-E.; Ghanem, Mohamed

    2016-01-01

    Background: The OSCE (objective structured clinical examination) is composed of oral and practical examination in order to examine students’ abilities to imply clinical examination techniques and to interact with patients. The examiners for this procedure can be either lecturers or peers. The aim of this work is to evaluate the peer-assisted teaching student tutors as examiners in an orthopedic surgery OSCE station. Methods: We analyzed the OSCE data from 2013 to 2015. During this period over 300 medical students were examined each year. An evaluation was conducted at an orthopedic station and examined by peer students to assess the advantages and disadvantages of peer-assisted teaching student tutors as examiners. Results: We have noticed that student peers are more flexible regarding their schedule and they have been well trained for OSCE. Concerning the economic aspects, student peers are clearly of major economic advantage. Disadvantages were not reported in our study probably because peers were well trained and the checklists are monitored regularly. Conclusion: Student peers in OSCE are of major advantage due to their flexible time schedule and relatively low costs. They must be well trained and the checklists are to be monitored regularly. Our study shows that peer tutor examiners conducted the examination as competent as lecture examiners. However, legal restrictions on the employment of students should be considered. PMID:27500078

  7. Photopolymers in orthopedics: characterization of novel crosslinked polyanhydrides.

    PubMed

    Young, J S; Gonzales, K D; Anseth, K S

    2000-06-01

    Novel, high modulus, degradable polymers were prepared from methacrylated anhydride monomers of tricarballylic acid (MTCA) and pyromellitylimidoalanine (MPMA-ala). Kinetic studies indicate that the time scale of photopolymerization of MTCA (< 30 s) is suitable for in vivo applications. Additionally, the tensile modulus of copolymers of these novel monomers with methacrylic anhydride (MA) ranged from 0.8 to 2.1 GPa, which lies between the modulus of trabecular and cortical bone. Degradation studies indicate that the copolymers of MTCA and MPMA-ala with MA are initially surface degrading, which is important to maintaining polymer strength through the degradation process. Monomers such as these that can be rapidly polymerized using ultraviolet or blue light into high modulus degradable materials have great potential in orthopedics.

  8. ADVANCES IN THE USE OF STEM CELLS IN ORTHOPEDICS

    PubMed Central

    Cristante, Alexandre Fogaça; Narazaki, Douglas Kenji

    2015-01-01

    Primordial cells or stem cells are multipotent undifferentiated cells with the capacity to originate any type of cell in the organism. They may have their origins in the blastocyst and thus are classified as embryonic, or tissues developed in fetuses, newborns or adults and thus are known as somatic stem cells. Bone marrow is one of the main locations for isolating primordial cells, and there are two lineages: hematopoietic and mesenchymal progenitor cells. There are several uses for these undifferentiated cells in orthopedics, going from cartilaginous lesions in osteoarthrosis, osteochondritis dissecans and patellar chondromalacia, to bone lesions like in pseudarthrosis or bone losses, or nerve lesions like in spinal cord trauma. Studying stem cells is probably the most promising field of study of all within medicine, and this is shortly going to revolutionize all medical specialties (both clinical and surgical) and thus provide solutions for diseases that today are difficult to deal with. PMID:27027022

  9. 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.

  10. Power harvesting using PZT ceramics embedded in orthopedic implants.

    PubMed

    Chen, Hong; Liu, Ming; Jia, Chen; Wang, Zihua

    2009-09-01

    Battery lifetime has been the stumbling block for many power-critical or maintenance-free real-time embedded applications, such as wireless sensors and orthopedic implants. Thus a piezoelectric material that could convert human motion into electrical energy provides a very attractive solution for clinical implants. In this work, we analyze the power generation characteristics of stiff lead zirconate titanate (PZT) ceramics and the equivalent circuit through extensive experiments. Our experimental framework allows us to explore many important design considerations of such a PZT-based power generator. Overall we can achieve a PZT element volume of 0.5 x 0.5 x 1.8 cm, which is considerably smaller than the results reported so far. Finally, we outline the application of our PZT elements in a total knee replacement (TKR) implant. PMID:19812004

  11. 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. PMID:9830987

  12. Barriers to the clinical translation of orthopedic tissue engineering.

    PubMed

    Evans, Christopher H

    2011-12-01

    Tissue engineering and regenerative medicine have been the subject of increasingly intensive research for over 20 years, and there is concern in some quarters over the lack of clinically useful products despite the large sums of money invested. This review provides one perspective on orthopedic applications from a biologist working in academia. It is suggested that the delay in clinical application is not atypical of new, biologically based technologies. Some barriers to progress are acknowledged and discussed, but it is also noted that preclinical studies have identified several promising types of cells, scaffolds, and morphogenetic signals, which, although not optimal, are worth advancing toward human trials to establish a bridgehead in the clinic. Although this transitional technology will be replaced by more sophisticated, subsequent systems, it will perform valuable pioneering functions and facilitate the clinical development of the field. Some strategies for achieving this are suggested. PMID:21682607

  13. Prevalence of internet and social media usage in orthopedic surgery.

    PubMed

    Curry, Emily; Li, Xinning; Nguyen, Joseph; Matzkin, Elizabeth

    2014-08-01

    Prior studies in other specialties have shown that social networking and Internet usage has become an increasingly important means of patient communication and referral. The purpose of this study is to evaluate the prevalence of Internet or social media usage in new patients referred to a major academic orthopedics center and to identify new avenues to optimize patient recruitment and communication. New patients were surveyed (n=752) between December 2012 to January 2013 in a major academic orthopaedic center to complete a 15-item questionnaire including social media and Internet usage information. Data was collected for all orthopaedic sub-specialties and statistical analysis was performed. Fifty percent of patients use social networking sites, such as Facebook. Sports medicine patients tend to be higher social networking users (35.9%) relative to other services (9.8-17.9%) and was statistically higher when compared to the joints/tumor service (P<0.0001). Younger age was the biggest indicator predicting the use of social media. Patients that travelled between 120 to 180 miles from the hospital for their visits were significantly more likely to be social media users, as were patients that did research on their condition prior to their new patient appointment. We conclude that orthopedic patients who use social media/Internet are more likely to be younger, researched their condition prior to their appointment and undergo a longer average day's travel (120-180 miles) to see a physician. In an increasingly competitive market, surgeons with younger patient populations will need to utilize social networking and the Internet to capture new patient referrals. PMID:25317312

  14. 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

  15. 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

  16. Orthopedic correction of growing hyperdivergent, retrognathic patients with miniscrew implants.

    PubMed

    Buschang, Peter H; Carrillo, Roberto; Rossouw, P Emile

    2011-03-01

    Traditional orthodontic treatments do not adequately address the skeletal problems of retrognathic, hyperdivergent, Class II adolescents; the few approaches that do address them require long-term patient compliance. This article introduces a novel approach using miniscrew implants (MSIs) and growth to treat retrognathic, hyperdivergent adolescents. Nine consecutive patients were evaluated at the start of treatment (aged 13.2 ± 1.1 years) and again at the end of the orthopedic phase (after 1.9 ± 0.3 years). Each patient had 2 MSIs placed in either side of the palate. Coil springs (150 g) extended from the MSIs to a rapid palatal expander, which served as a rigid segment for intruding the maxillary premolar and molars. Two additional MSIs were placed between the first mandibular molars and second premolars; coil spring (150 g) extended from the MSIs to hold or intrude the mandibular molars. Before treatment, the patients exhibited substantial and significant mandibular retrusion (Z score = -1.0), facial convexity (Z score = 0.7), and hyperdivergence (Z score = 1.6). Treatment produced consistent and substantial orthopedic effects. The chin was advanced by a mean of 2.4 mm, the sella-nasion-basion (SNB) angle increased by 2.1°, the mandibular plane angle decreased by 3.9°, and facial convexity decreased by approximately 3.2°. Questionnaires showed that this treatment approach was not painful or uncomfortable; the majority of the patients indicated that they were very likely to recommend the treatment to others. Treatment was accomplished by titrating the amount of orthodontic intrusion performed based on the individual's growth potential. PMID:21236539

  17. Hydroxyapatite-nanotube composites and coatings for orthopedic applications

    NASA Astrophysics Data System (ADS)

    Lahiri, Debrupa

    Hydroxyapatite (HA) has received wide attention in orthopedics, due to its biocompatibility and osseointegration ability. Despite these advantages, the brittle nature and low fracture toughness of HA often results in rapid wear and premature fracture of implant. Hence, there is a need to improve the fracture toughness and wear resistance of HA without compromising its biocompatibility. The aim of the current research is to explore the potential of nanotubes as reinforcement to HA for orthopedic implants. HA- 4 wt.% carbon nanotube (CNT) composites and coatings are synthesized by spark plasma sintering and plasma spraying respectively, and investigated for their mechanical, tribological and biological behavior. CNT reinforcement improves the fracture toughness (>90%) and wear resistance (>66%) of HA for coating and free standing composites. CNTs have demonstrated a positive influence on the proliferation, differentiation and matrix mineralization activities of osteoblasts, during in-vitro biocompatibility studies. In-vivo exposure of HA-CNT coated titanium implant in animal model (rat) shows excellent histocompatibility and neobone integration on the implant surface. The improved osseointegration due to presence of CNTs in HA is quantified by the adhesion strength measurement of single osteoblast using nano-scratch technique. Considering the ongoing debate about cytotoxicity of CNTs in the literature, the present study also suggests boron nitride nanotube (BNNT) as an alternative reinforcement. BNNT with the similar elastic modulus and strength as CNT, were added to HA. The resulting composite having 4 wt.% BNNTs improved the fracture toughness (˜85%) and wear resistance (˜75%) of HA in the similar range as HA-CNT composites. BNNTs were found to be non-cytotoxic for osteoblasts and macrophages. In-vitro evaluation shows positive role of BNNT in osteoblast proliferation and viability. Apatite formability of BNNT surface in ˜4 days establishes its osseointegration

  18. Prevalence of Internet and Social Media Usage in Orthopedic Surgery

    PubMed Central

    Curry, Emily; Nguyen, Joseph; Matzkin, Elizabeth

    2014-01-01

    Prior studies in other specialties have shown that social networking and Internet usage has become an increasingly important means of patient communication and referral. The purpose of this study is to evaluate the prevalence of Internet or social media usage in new patients referred to a major academic orthopedics center and to identify new avenues to optimize patient recruitment and communication. New patients were surveyed (n=752) between December 2012 to January 2013 in a major academic orthopaedic center to complete a 15-item questionnaire including social media and Internet usage information. Data was collected for all orthopaedic sub-specialties and statistical analysis was performed. Fifty percent of patients use social networking sites, such as Facebook. Sports medicine patients tend to be higher social networking users (35.9%) relative to other services (9.8-17.9%) and was statistically higher when compared to the joints/tumor service (P<0.0001). Younger age was the biggest indicator predicting the use of social media. Patients that travelled between 120 to 180 miles from the hospital for their visits were significantly more likely to be social media users, as were patients that did research on their condition prior to their new patient appointment. We conclude that orthopedic patients who use social media/Internet are more likely to be younger, researched their condition prior to their appointment and undergo a longer average day’s travel (120-180 miles) to see a physician. In an increasingly competitive market, surgeons with younger patient populations will need to utilize social networking and the Internet to capture new patient referrals. PMID:25317312

  19. Orthopedic Correction of Growing Hyperdivergent, Retrognathic, Patients with Miniscrew Implants

    PubMed Central

    Buschang, Peter H.; Carrillo, Roberto; Rossouw, P. Emile

    2010-01-01

    Traditional orthodontic treatments do not adequately address the skeletal problems of retrognathic, hyperdivergent, Class II adolescents; the few approaches that do require long-term patient compliance. This paper introduces a novel approach using miniscrew implants (MSIa) and growth to treat retrognathic hyperdivergent adolescents. Nine consecutive patients were evaluated at the start of treatment (13.2 ±1.1 years of age) and again at the end of the orthopedic phase (after 1.9 ±0.3 years). Each patient had two MSIs placed in either side of the palate. Coil springs (150 g) extended from the MSIs to a RPE, which served as a rigid segment for intruding the maxillary premolar and molars. Two additional MSIs were placed between the first mandibular molars and second premolars; coil spring (150 g) extended from the MSIs to hold or intrude the mandibular molars. Prior to treatment, the patients exhibited substantial and significant mandibular retrusion (Z-score=−1.0), facial convexity (Z-score=0.7), and hyperdivergence (Z-score=1.6). Treatment produced consistent and substantial orthopedic effects. The chin was advanced an average of 2.4 mm, the SNB angle increased by 2.1°, the mandibular plane angle decreased 3.9°, and facial convexity decreased by approximately 3.2°. Questionnaires showed that this treatment approach was not painful or uncomfortable; the majority of the patients indicated that they were very likely to recommend the treatment to others. Treatment was accomplished by titrating the amount of orthodontic intrusion performed based on the individuals’ growth potential. PMID:21236539

  20. Surface Functionalization of Orthopedic Titanium Implants with Bone Sialoprotein

    PubMed Central

    Ritz, Ulrike; Ackermann, Angelika; Anthonissen, Joris; Kaufmann, Kerstin B.; Brendel, Christian; Götz, Hermann; Rommens, Pol M.; Hofmann, Alexander

    2016-01-01

    Orthopedic implant failure due to aseptic loosening and mechanical instability remains a major problem in total joint replacement. Improving osseointegration at the bone-implant interface may reduce micromotion and loosening. Bone sialoprotein (BSP) has been shown to enhance bone formation when coated onto titanium femoral implants and in rat calvarial defect models. However, the most appropriate method of BSP coating, the necessary level of BSP coating, and the effect of BSP coating on cell behavior remain largely unknown. In this study, BSP was covalently coupled to titanium surfaces via an aminosilane linker (APTES), and its properties were compared to BSP applied to titanium via physisorption and untreated titanium. Cell functions were examined using primary human osteoblasts (hOBs) and L929 mouse fibroblasts. Gene expression of specific bone turnover markers at the RNA level was detected at different intervals. Cell adhesion to titanium surfaces treated with BSP via physisorption was not significantly different from that of untreated titanium at any time point, whereas BSP application via covalent coupling caused reduced cell adhesion during the first few hours in culture. Cell migration was increased on titanium disks that were treated with higher concentrations of BSP solution, independent of the coating method. During the early phases of hOB proliferation, a suppressive effect of BSP was observed independent of its concentration, particularly when BSP was applied to the titanium surface via physisorption. Although alkaline phosphatase activity was reduced in the BSP-coated titanium groups after 4 days in culture, increased calcium deposition was observed after 21 days. In particular, the gene expression level of RUNX2 was upregulated by BSP. The increase in calcium deposition and the stimulation of cell differentiation induced by BSP highlight its potential as a surface modifier that could enhance the osseointegration of orthopedic implants. Both

  1. What opportunities are available for resident involvement in national orthopedic and subspecialty societies?

    PubMed

    Dy, Christopher J; Cross, Michael B; Osbahr, Daryl C; Parks, Michael L; Green, Daniel W

    2011-10-01

    As physician involvement in health policy grows, there will be an increasing need for future leaders in orthopedics. Interested orthopedic residents may be unaware of opportunities for leadership involvement in professional and subspecialty organizations. This article investigates whether national and subspecialty organizations offer membership to residents, allow residents to participate in committees, and provide opportunities for scholarly activity and mentorship. The authors surveyed 20 national orthopedic professional and subspecialty societies to evaluate the availability and cost of resident membership, meeting attendance and participation, research funding, committee membership, and mentorship opportunities. Each society's Web site was reviewed, and societies were contacted by phone if further inquiry was needed. Of the 20 orthopedic societies surveyed, 11 allowed resident membership. Five of 20 societies allowed residents to serve on committees, with a total of 14 total positions for residents. Four organizations provided formalized mentorship programs to residents. Although opportunities for resident involvement in subspecialty and professional societies are available in the majority of groups surveyed, the Orthopaedic Trauma Association and American Society for Surgery of the Hand provided the most comprehensive collection of opportunities. Residents should also pursue involvement in other organizations that may be more readily accessible, such as local, state, and regional orthopedic and medical societies. Increased resident participation in these organizations may help in increasing the 14 nationally available committee positions for orthopedic residents. Our orthopedic profession and societies should encourage motivated residents to pursue involvement and leadership at the national level.

  2. Anatomy and physical examination of the knee menisci: a narrative review of the orthopedic literature

    PubMed Central

    Chivers, Michael D.; Howitt, Scott D.

    2009-01-01

    Objective: The objective of this study was to review the physical examination tests available to a practitioner in order to arrive at a clinical diagnosis or suspicion of a meniscal lesion. Background: The menisci transmit weight bearing forces and increase stability of the knee. The menisci also facilitate nutrition, provide lubrication and shock absorption for the articular cartilage and promote knee proprioception. The combinations of torsional and axial loading appear to be the cause of most meniscal injuries. Diagnosis of acute knee injuries has long been a topic for discussion throughout the orthopedic literature. Many clinical tests and diagnostic studies have been developed to increase the clinician’s ability to accurately diagnose these types of disorders of the knee. Conclusion: The accuracy of all diagnostic tests is thought to be dependant upon the skill of the examiner, and the severity and location of the injury. The multitude of tests described to assess meniscal lesions suggests that none are consistently reliable. However, recent research has focused on a composite score to accurately predict meniscus lesions. The combination of a comprehensive history, multiple physical tests and diagnostic imaging for confirmation is typical for a clinical meniscal lesion diagnosis while the gold standard remains the arthroscopic procedure itself. PMID:20037697

  3. Concentration In Orthopedic Markets Was Associated With A 7 Percent Increase In Physician Fees For Total Knee Replacements.

    PubMed

    Sun, Eric; Baker, Laurence C

    2015-06-01

    Physician groups are growing larger in size and fewer in number. Although this consolidation could result in improved patient care, the resulting increase in market concentration also could allow larger groups to negotiate higher physician fees from private insurers. We examined the association between market concentration and physician fees in the case of total knee arthroplasty by calculating market concentration for orthopedic groups practicing in a given market and by analyzing administrative claims data from Marketscan. In the period 2001-10 the average professional fee for total knee arthroplasty was $2,537. During this time, in markets that moved from the bottom quartile of concentration to the top quartile, physician fees paid by private payers increased by $168 per procedure. The increase nearly offset the $261 decline in fees that we observed, absent changes in market concentration. These findings suggest that caution should be used in implementing policies designed to encourage further group concentration, which could produce similar effects. PMID:26056195

  4. Office-based rapid prototyping in orthopedic surgery: a novel planning technique and review of the literature.

    PubMed

    Schwartz, Adam; Money, Kyle; Spangehl, Mark; Hattrup, Steven; Claridge, Richard J; Beauchamp, Christopher

    2015-01-01

    Three-dimensional (3-D) prototyping, based on high-quality axial images, may allow for more accurate and extensive preoperative planning and may even allow surgeons to perform procedures as part of preoperative preparation. In this article, we describe 7 cases of complex orthopedic disorders that were surgically treated after preoperative planning that was based on both industry-provided models and use of our in-house 3-D printer. Commercially available 3-D printers allow for rapid in-office production of a high-quality realistic prototype at relatively low per-case cost. Using this technique, surgeons can assess the accuracy of their original surgical plans and, if necessary, correct them preoperatively. The ability to "perform surgery preoperatively" adds another element to surgeons' perceptions of the potential issues that may arise. PMID:25566552

  5. 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...

  6. Biomechanical and bioactivity concepts of polyetheretherketone composites for use in orthopedic implants-a review.

    PubMed

    Abdullah, Mohamed Ruslan; Goharian, Amirhossein; Abdul Kadir, Mohammed Rafiq; Wahit, Mat Uzir

    2015-11-01

    The use of polyetheretherketone (PEEK) composites in the trauma plating system, total replacement implants, and tissue scaffolds has found great interest among researchers. In recent years (2008 afterward), this type of composites has been examined for suitability as substitute material over stainless steel, titanium alloys, ultra high molecular weight polyethylene, or even biodegradable materials in orthopedic implant applications. Biomechanical and bioactivity concepts were contemplated for the development of PEEK orthopedic implants and a few primary clinical studies reported the clinical outcomes of PEEK-based orthopedic implants. This study aims to review and discuss the recent concepts and contribute further concepts in terms of biomechanical and bioactivity challenges for the development of PEEK and PEEK composites in orthopedic implants.

  7. Rational design of nanofiber scaffolds for orthopedic tissue repair and regeneration

    PubMed Central

    Ma, Bing; Xie, Jingwei; Jiang, Jiang; Shuler, Franklin D; Bartlett, David E

    2013-01-01

    This article reviews recent significant advances in the design of nanofiber scaffolds for orthopedic tissue repair and regeneration. It begins with a brief introduction on the limitations of current approaches for orthopedic tissue repair and regeneration. It then illustrates that rationally designed scaffolds made up of electrospun nanofibers could be a promising solution to overcome the problems that current approaches encounter. The article also discusses the intriguing properties of electrospun nanofibers, including control of composition, structures, orders, alignments and mechanical properties, use as carriers for topical drug and/or gene sustained delivery, and serving as substrates for the regulation of cell behaviors, which could benefit musculoskeletal tissue repair and regeneration. It further highlights a few of the many recent applications of electrospun nanofiber scaffolds in repairing and regenerating various orthopedic tissues. Finally, the article concludes with perspectives on the challenges and future directions for better design, fabrication and utilization of nanofiber scaffolds for orthopedic tissue engineering. PMID:23987110

  8. Global research coaching in orthopedic surgery: seeding for an international network

    PubMed Central

    Ferreira, Ana Paula Bonilauri; Rajgor, Dimple; Shah, Jatin; Shah, Anand; Pietrobon, Ricardo

    2012-01-01

    Despite the importance of delivering evidence-based health care, orthopedic surgeons have directed fewer efforts towards the generation of such evidence. Even when present, published evidence lacks methodological rigor and is known to be inaccurate. One of the main reasons for the lack of generation of quality evidence, and the low involvement in research among orthopedic surgeons, is the lack of structured research coaching environments where they can learn concepts and hone their research skills. There is a palpable need for a pragmatic and outcome-oriented approach that can equip orthopedic surgeons with effective ways of communicating their research in writing. We describe a pragmatic research coaching program, designed and developed by the Research on Research group, which aims to build a global network of orthopedic researchers trained in streamlined and standardized research methods. We also provide a brief overview of the course principles and tools, and the platforms used in this program. PMID:24453591

  9. University of Washington orthopedic resident experience and interest in developing an international humanitarian rotation.

    PubMed

    Jense, Ryan J; Howe, Christopher R; Bransford, Richard J; Wagner, Theodore A; Dunbar, Peter J

    2009-01-01

    An academic orthopedic residency program can have a significant impact on the burden of musculoskeletal disease in low- and middle-income countries. Such an exposure may also enhance the education of a resident. A 17-question electronic survey was developed to quantify the interest of orthopedic residents in pursuing an elective international rotation. The survey, which gathered resident demographic data and interest in pursuing an elective international orthopedic rotation, was sent to (and completed by) all 38 University of Washington orthopedic residents during academic year 2007-2008. More than 60% (23/38) of residents indicated they would be willing to commit to an international rotation; an additional 24% (9/38) indicated they would be very interested. Almost 40% of residents had participated in international medical volunteerism before entering residency. Among residents, there is a clear interest in pursuing an international rotation to complement their education in the United States. PMID:19238270

  10. Craniomaxillary orthopedic correction with en masse dental control.

    PubMed

    Thurow, R C

    1975-12-01

    Craniomaxillary (high-pull) traction is a well-established part of today's orthodontic armamentarium. It is useful in a wide range of problems involving excessive anterior and/or downward displacement of one or more components of the maxillary complex. Such growth-related problems are most amenable to correction during the active growing period; in fact, optimum improvement is often attainable only during this period. Attachment of these devices by means of cemented orthodontic appliances is limited in some developmental stages by the teeth available for banding. It is limited at all ages by the tolerance of the periodontal ligament of the attachment teeth. In terms of over-all maxillary change, the locations of the banded teeth further restrict the orientation and application of therapeutic forces. A rigid splint precisely engaging all or part of the upper dentition expands the potential applications of this form of traction in terms of age range, force levels, and force orientation. This is basically an orthopedic applicance with concurrent orthodontic effects. In contrast to the gross destructive effects experienced in early applications of the Milwaukee brace, the application of force with this appliance can be planned to redirect maxillary growth and occlusal relationships from often progressively dysplastic patterns to a more harmonious over-all functional relationship among all facial structures. The resultant interplay of orthopedic and orthodontic effects makes close orthodontic supervision and care essential throughout the treatment and post-treatment periods. This is especially important because some of the orthodontic side effects may be unfavorable. Failure to anticipate and plan for control of these effects could be disastrous. Occasions for its use as the sole therapeutic measure are rare. The nature of treatment with this appliance is such that in most cases it must be used as a discrete stage of a comprehensive treatment plan, either before or

  11. Nanophase hydroxyapatite coatings for dental and orthopedic applications

    NASA Astrophysics Data System (ADS)

    Sato, Michiko

    In order to improve dental and orthopedic implant performance, the objective of this study was to synthesize nanocrystalline hydroxyapatite (HA) powders to coat metals (specifically, titanium and tantalum). Precipitated HA powders were either sintered in order to produce UltraCaP HA (or microcrystalline size HA) or were treated hydrothermally to produce nanocrystalline HA. Some of the UltraCaP and nanocrystalline HA powders were doped with yttrium (Y) since previous in vitro studies demonstrated that Y-doped HA in bulk improved osteoblast (or bone-forming cell) function over undoped HA. The nanocrystalline HA powders were also mixed with nanophase titania powders because previous studies demonstrated that titania/HA composite coatings increased coating adhesive strength and HA nucleation. These powders were then deposited onto titanium by a novel room-temperature process, called IonTiteT(TM). The results demonstrated that the chemical properties and crystallite size of the original HA powders were maintained in the coatings. More importantly, in vitro studies showed increased osteoblast (bone-forming cell) adhesion on the single phase nanocrystalline HA and nano-titania/HA coatings compared to traditionally used plasma-sprayed HA coatings and uncoated metals. Results further demonstrated greater amounts of calcium deposition by osteoblasts cultured on nanocrystalline HA coatings compared to UltraCaP coatings and conventionally used plasma-sprayed HA coatings. To elucidate mechanisms that influenced osteoblast functions on the HA coatings, the amount of proteins (fibronectin and vitronectin) onto the HA powders and the adsorbed fibronectin conformation were investigated. Exposure of cell integrin binding domains (in fibronectin III10 segments) was greater in fibronectin adsorbed onto 1.2 mole% Y-doped UltraCaP HA coatings compared to nanocrystalline HA coatings tested. However, 1.2 mole% Y-doped UltraCaP HA coatings did not increase mineralization by osteoblasts

  12. Making your orthopedic office profitable through the addition of ancillary services.

    PubMed

    Bert, Jack M

    2002-04-01

    With the precipitous decline of orthopedic reimbursement over the past six years, it will be critical to the success of the majority of orthopedic groups to improve their revenue stream in the future. This will involve improving management, reducing overhead, and adding ancillary services to obtain facility fee revenue. Ancillary service possibilities for the orthopedist include an in-office surgicenter with a pain center, MRI, physical therapy with orthotics and braces, occupational health department, pharmacy, and independent medical examination company.

  13. Do Astronauts Havbe a Higher Rate of Orthopedic Shoulder Conditions Than a Cohort of Working Professionals

    NASA Technical Reports Server (NTRS)

    Laughlin, M. S.; Murray, J. D.; Young, M.; Wear, M. L.; Van Baalen, M.; Tarver, W. J.

    2016-01-01

    Occupational surveillance of astronaut shoulder injuries began with operational concerns at the Neutral Buoyancy Laboratory (NBL) during Extra Vehicular Activity (EVA) training. Orthopedic shoulder injury and surgery rates were calculated [1], but classifying the rates as normal, high or low was highly dependent on the comparison group. Thus, the purpose of this study was to identify a population of working professionals and compare orthopedic shoulder consultation and surgery rates.

  14. Academic characteristics of orthopedic team physicians affiliated with high school, collegiate, and professional teams.

    PubMed

    Makhni, Eric C; Buza, John A; Byram, Ian; Ahmad, Christopher S

    2015-11-01

    We conducted a study to determine the academic involvement and research productivity of orthopedic team physicians at high school, college, and professional levels of sport. Through Internet and telephone queries, we identified 1054 team physicians from 362 institutions, including 120 randomly selected high schools and colleges and 122 professional teams (baseball, basketball, football, hockey). For all physicians included in the study, we performed a comprehensive search of the Internet and of a citation database to determine academic affiliations, number of publications, and h-index values. Of the 1054 physicians, 678 (64%) were orthopedic surgeons. Percentage of orthopedic team physicians affiliated with an academic medical center was highest in professional sports (64%; 173/270) followed by collegiate sports (36%; 98/275) and high school sports (20%; 27/133). Median number of publications per orthopedic team physician was significantly higher in professional sports (30.6) than in collegiate sports (10.7) or high school sports (6). Median number of publications by orthopedic physicians also varied by sport, with the highest number in Major League Baseball (37.9; range, 0-225) followed by the National Basketball Association (32.0; range, 0-227) and the National Football League (30.4; range, 0-460), with the lowest number within the National Hockey League (20.7; range, 0-144). Academic affiliation and research productivity of orthopedic team physicians vary by competition level and professional sporting league.

  15. Biofilm Disrupting Technology for Orthopedic Implants: What’s on the Horizon?

    PubMed Central

    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. PMID:25705632

  16. Academic characteristics of orthopedic team physicians affiliated with high school, collegiate, and professional teams.

    PubMed

    Makhni, Eric C; Buza, John A; Byram, Ian; Ahmad, Christopher S

    2015-11-01

    We conducted a study to determine the academic involvement and research productivity of orthopedic team physicians at high school, college, and professional levels of sport. Through Internet and telephone queries, we identified 1054 team physicians from 362 institutions, including 120 randomly selected high schools and colleges and 122 professional teams (baseball, basketball, football, hockey). For all physicians included in the study, we performed a comprehensive search of the Internet and of a citation database to determine academic affiliations, number of publications, and h-index values. Of the 1054 physicians, 678 (64%) were orthopedic surgeons. Percentage of orthopedic team physicians affiliated with an academic medical center was highest in professional sports (64%; 173/270) followed by collegiate sports (36%; 98/275) and high school sports (20%; 27/133). Median number of publications per orthopedic team physician was significantly higher in professional sports (30.6) than in collegiate sports (10.7) or high school sports (6). Median number of publications by orthopedic physicians also varied by sport, with the highest number in Major League Baseball (37.9; range, 0-225) followed by the National Basketball Association (32.0; range, 0-227) and the National Football League (30.4; range, 0-460), with the lowest number within the National Hockey League (20.7; range, 0-144). Academic affiliation and research productivity of orthopedic team physicians vary by competition level and professional sporting league. PMID:26566551

  17. [Prophylaxis of venous thromboembolic disease in high-risk orthopedic surgery].

    PubMed

    Meza Reyes, Gilberto Eduardo; Esquivel Gómez, Ricardo; Martínez del Campo Sánchez, Antonio; Espinosa-Larrañaga, Francisco; Martínez Guzmán, Miguel Ángel Enrique; Torres González, Rubén; de la Fuente Zuno, Juan Carlos; Méndez Huerta, Juan Vicente; Villalobos Garduño, Enrique; Cymet Ramírez, José; Ibarra Hirales, Efrén; Díaz Borjón, Efraín; Aguilera Zepeda, José Manuel; Valles Figueroa, Juan Francisco; Majluf-Cruz, Abraham

    2012-01-01

    Venous thromboembolism (VTE) is a worldwide public health problem, with an annual incidence of 1-2 cases/1,000 individuals in the general population and a 1-5% associated mortality. Orthopedic surgery is a major surgical risk factor for VTE, but the problem is more important for patients with hip and knee joint replacement, multiple traumatisms, severe damage to the spine, or large fractures. Thromboprophylaxis is defined as the strategy and actions necessary to diminish the risk of VTE in high-risk orthopedic surgery. Antithrombotics may prevent VTE. At the end of this paper, we describe a proposal of thromboprophylaxis actions for patients requiring high-risk orthopedic surgery, based on the opinion of specialists in Orthopedics and Traumatology who work with high-risk orthopedic surgery patients. A search for evidence about this kind of surgery was performed and a 100-item inquiring instrument was done in order to know the opinions of the participants. Then, recommendations and considerations were built. In conclusion, this document reviews the problem of VTE in high-risk orthopedic surgery patients and describes the position of the Colegio Mexicano de Ortopedia y Traumatología related to VTE prevention in this setting.

  18. Greater osteoblast functions on multiwalled carbon nanotubes grown from anodized nanotubular titanium for orthopedic applications

    NASA Astrophysics Data System (ADS)

    Sirivisoot, Sirinrath; Yao, Chang; Xiao, Xingcheng; Sheldon, Brian W.; Webster, Thomas J.

    2007-09-01

    Titanium (Ti) is the most widely implanted orthopedic material. However, current formulations of Ti have an average orthopedic implant functional lifetime of only 10-15 years. While there are many reasons why orthopedic implants fail, one is a lack of initial and sustained integration into juxtaposed bone. To improve the cytocompatibility properties of Ti for orthopedic applications, parallel multiwalled carbon nanotubes (CNTs) were grown from the pores of anodized nanotubular Ti by a chemical vapor deposition process in the present study. The results of this study provided evidence, for the first time, that osteoblast (bone forming cell) functions (specifically, alkaline phosphatase activity and calcium deposition) were significantly greater on CNTs grown from anodized Ti than on anodized Ti without CNTs and currently-used Ti in orthopedics for up to 21 days. In summary, this study showed that bone growth could possibly be enhanced on currently-used Ti implants with protruding CNTs and, thus, they should be further studied for orthopedic applications.

  19. [Sawing and welding with ultrasonics. Experimental investigation to test the applicability of an apparatus for sawing and welding bone tissue with ultrasonics in orthopedics (author's transl)].

    PubMed

    Picht, U; Schumpe, G; Milachowski, K

    1977-02-01

    An experimental investigation of a procedure for sawing and welding of bone tissue with ultrasonics in the area of orthopedics was reported. The welding of bone with ultrasonic waves, bone meal and a plastic adhesive did not product satisfactory results in terms of stability and tissue reaction. The applicability of the ultrasonic saw is limited by the thickness of the bone on which the osteotomy is to be performed. We saw no advantages over against the oscillating saws which were available to us. In our opinion, an indication for the application of the ultrasonic apparatus could be the removal of inflammatory, tumerous or necrotic bone processes.

  20. Novel osteoblast-adhesive peptides for dental/orthopedic biomaterials.

    PubMed

    Dettin, Monica; Conconi, Maria Teresa; Gambaretto, Roberta; Pasquato, Antonella; Folin, Marcella; Di Bello, Carlo; Parnigotto, Pier Paolo

    2002-06-01

    Next generation dental/orthopedic biomaterials must be designed to enhance and support osteoblast adhesion. The osteoblasts use different ways to adhere, that is, integrin- and proteoglycan-mediated mechanisms. The present study reports on the synthesis and osteoblast-adhesive properties of peptides carrying RGD motifs and of sequences mapped on human vitronectin. Our data suggest that osteoblast adhesion on polystyrene plates modified with a linear peptide, in which the GRGDSP sequence is repeated four times, was significantly higher when compared to the adhesion obtained using branched peptides, interestingly containing the same motif. Osteoblast adhesion assays on acellular bone matrix using this active peptide gave very promising results. We also demonstrated that a novel peptide, carrying the X-B-B-B-X-B-B-X motif (where B is a basic amino acid and X is a nonbasic residue), promotes proteoglycan-mediated osteoblast adhesion more efficiently with respect to the KRSR sequence that was recently proposed as heparan-sulfate binding peptide. PMID:11920671

  1. Why medical students choose orthopedic surgery as a specialty?

    PubMed Central

    Erraji, Moncef; Kharraji, Abdessamad; Abbasi, Najib; Najib, Abdeljawad; Yacoubi, Hicham

    2015-01-01

    Before the crisis announced the Moroccan surgery, the objectives of this study were to analyze the choice of specialties newly appointed to the internal review and the guidance of medical students and to determine the factors influencing this choice. Data on specialty choice students were analyzed and a questionnaire was offered to students of Morocco at the beginning of academic year 2013-20014 The form consisted of questions on the year of study. sex, professional guidelines and reasons for choice. candidates were male, the average age of our residents was 28 years. We also noted the importance of the passage as well as external service trauma. Care provided to patients, lifestyle and income reported by 85% of respondents to be the most important factors to pursue orthopedics as a career. The TR-Orth is now a specialty that responds to a positive choice. The choice of TR-Orth by students at the end of medical school curriculum is reinforced by teaching and practicing the specialty during the internship. The overall training is unsatisfactory overall. Students would deepen in some areas. This study confirms that there is currently a shift in trauma surgery, mostly induced by an a priori negative for particular workloads. PMID:26185556

  2. 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

  3. 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.

  4. The Top 100 Cited Articles in Clinical Orthopedic Sports Medicine.

    PubMed

    Nayar, Suresh K; Dein, Eric J; Spiker, Andrea M; Bernard, Johnathan A; Zikria, Bashir A

    2015-08-01

    Orthopedic sports medicine continues to evolve, owing much of its clinical management and practice to rigorous academic research. In this review, we identify and describe the top 100 cited articles in clinical sports medicine and recognize the authors and institutions driving the research. We collected articles (excluding basic science, animal, and cadaveric studies) from the 25 highest-impact sports medicine journals and analyzed them by number of citations, journal, publication date, institution, country, topic, and author. Mean number of citations was 408 (range, 229-1629). The articles were published in 7 journals, most in the 1980s to 2000s, and represented 15 countries. Thirty topics were addressed, with a heavy emphasis on anterior cruciate ligament injury and reconstruction, knee rating systems, rotator cuff reconstruction, and chondrocyte transplantation. The 3 most cited articles, by Insall and colleagues, Constant and Murley, and Tegner and Lysholm, addressed a knee, a shoulder, and another knee rating system, respectively. Several authors contributed multiple articles. The Hospital for Special Surgery and the University of Bern contributed the most articles (5 each). This study provides a comprehensive list of the past century's major academic contributions to sports medicine. Residents and fellows may use this list to guide their scholarly investigations.

  5. PEEK biomaterials in trauma, orthopedic, and spinal implants.

    PubMed

    Kurtz, Steven M; Devine, John N

    2007-11-01

    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

  6. Amino acid containing glass-ionomer cement for orthopedic applications

    NASA Astrophysics Data System (ADS)

    Wu, Wei

    Amino acid containing glass-ionomer cements were synthesized, formulated, and evaluated for orthopedic application. The formulation of different amino acid containing glass-ionomer bone cements was optimized, and conventional and resin-modified glass-ionomer bone cements were compared. Properties of interest included handling characteristics, physical and chemical properties, and mechanical strength of the bone cement. The study was based on the synthesis of different vinyl containing amino acids, different polyelectrolytes containing these amino acid residues, and different resin-modified polyelectrolytes, as well as formulation and evaluation of conventional and resin-modified glass-ionomer bone cements using these polyelectrolytes. Systematic preparation of polyelectrolytes and formulation of glass-ionomer bone cements were essential features of this work, since we anticipated that the mechanical properties of the glass-ionomer bone cements could be strongly affected by the nature of the polyelectrolytes and formulation. Mechanical properties were evaluated in a screw driven mechanical testing machine, and structure-property relationships were determined by scanning electron microscopic (SEM) observation of the fracture surface of the specimens. How the structure of polyelectrolytes, such as different amino acid residues, molecular weight, different modifying resin, and formulation of glass-ionomer bone cement, affected the mechanical properties was also studied.

  7. Traumatic Finger Injuries: What the Orthopedic Surgeon Wants to Know.

    PubMed

    Wieschhoff, Ged G; Sheehan, Scott E; Wortman, Jeremy R; Dyer, George S M; Sodickson, Aaron D; Patel, Ketan I; Khurana, Bharti

    2016-01-01

    Traumatic finger injuries account for a substantial number of emergency visits every year. Imaging plays an important role in diagnosis and in directing management of these injuries. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. Accurate diagnosis of finger injuries can often be difficult, given the complicated soft-tissue anatomy of the hand and the diverse spectrum of injuries that can occur. To best serve the patient and the treating physician, radiologists must have a working knowledge of finger anatomy, the wide array of injury patterns that can occur, the characteristic imaging findings of different finger injuries, and the most appropriate treatment options for each type of injury. This article details the intricate anatomy of the hand as it relates to common finger injuries, illustrates the imaging findings of a range of injuries, presents optimal imaging modalities and imaging parameters for the diagnosis of different injury types, and addresses which findings have important management implications for the patient and the orthopedic surgeon. With this fund of knowledge, radiologists will be able to recommend the most appropriate imaging studies, make accurate diagnoses, convey clinically relevant imaging findings to the referring physician, and suggest appropriate follow-up examinations. In this way, the radiologist will help improve patient care and outcomes. Online supplemental material is available for this article. (©)RSNA, 2016. PMID:27399238

  8. [Joint position statement of the Mexican College of Orthopedics and Traumatology: prophylaxis for venous thromboembolic disease in high-risk orthopedic surgery].

    PubMed

    Meza-Reyes, G E; Cymet-Ramírez, J; Esquivel-Gómez, R; del Campo-Sánchez, Martínez A; Martínez-Guzmán, M A E; Espinosa-Larrañaga, F; Majluf-Cruz, A; Torres-González, R; De la Fuente-Zuno, J C; Villalobos-Garduño, E; Méndez-Huerta, J V; Ibarra-Hirales, E; Valles-Figueroa, J F; Aguilera-Zepeda, J M; Díaz-Borjón, E

    2011-01-01

    Venous thromboembolic disease (VTED) is a public health problem worldwide. In the United States it causes 2 million annual cases. Its annual incidence is 1-2 cases per 1,000 individuals in the general population. It is a disease frequently associated with life threatening complications and its mortality rate is 1-5% of cases. Due to its high complication rate, its slow recovery, and the need for prolonged disability, it is considered as a high-cost disease. VTED may occur in both surgical and medical patients; the known associated risk factors include prolonged rest, active cancer, congestive heart failure, atrial fibrillation, and stroke, among the major medical conditions. Orthopedic surgery represents the main surgical risk factor for VTED, including mainly hip and knee replacements, as well as polytraumatized patients with severe spinal lesions, and major fractures. VTED may be prevented with the appropriate use of antithrombotics. The participants in this consensus defined thromboprophylaxis as the strategy and actions undertaken to reduce the risk of VTED in patients undergoing high risk orthopedic surgery. The position of the Mexican College of Orthopedics and Traumatology regarding the prevention of VTED in orthopedic surgery is described herein.

  9. Orthopedic manifestations in patients with mucopolysaccharidosis type II (Hunter syndrome) enrolled in the Hunter Outcome Survey

    PubMed Central

    Link, Bianca; de Camargo Pinto, Louise Lapagesse; Giugliani, Roberto; Wraith, James Edmond; Guffon, Nathalie; Eich, Elke; Beck, Michael

    2010-01-01

    Mucopolysaccharidosis type II (MPS II or Hunter syndrome) is a rare, inherited disorder caused by deficiency of the lysosomal enzyme iduronate-2-sulfatase. As a result of this deficiency, glycosaminoglycans accumulate in lysosomes in many tissues, leading to progressive multisystemic disease. The cardiopulmonary and neurological problems associated with MPS II have received considerable attention. Orthopedic manifestations are common but not as well characterized. This study aimed to characterize the prevalence and severity of orthopedic manifestations of MPS II and to determine the relationship of these signs and symptoms with cardiovascular, pulmonary and central nervous system involvement. Orthopedic manifestations of MPS II were studied using cross-sectional data from the Hunter Outcome Survey (HOS). The HOS is a global, physician-led, multicenter observational database that collects information on the natural history of MPS II and the long-term safety and effectiveness of enzyme replacement therapy. As of January 2009, the HOS contained baseline data on joint range of motion in 124 males with MPS II. In total, 79% of patients had skeletal manifestations (median onset, 3.5 years) and 25% had abnormal gait (median onset, 5.4 years). Joint range of motion was restricted for all joints assessed (elbow, shoulder, hip, knee and ankle). Extension was the most severely affected movement: the exception to this was the shoulder. Surgery for orthopedic problems was rare. The presence of orthopedic manifestations was associated with the presence of central nervous system and pulmonary involvement, but not so clearly with cardiovascular involvement. Orthopedic interventions should be considered on an individual-patient basis. Although some orthopedic manifestations associated with MPS II may be managed routinely, a good knowledge of other concurrent organ system involvement is essential. A multidisciplinary approach is required. PMID:21808707

  10. Biocompatibility evaluation of porous ceria foams for orthopedic tissue engineering.

    PubMed

    Ball, Jordan P; Mound, Brittnee A; Monsalve, Adam G; Nino, Juan C; Allen, Josephine B

    2015-01-01

    Ceria ceramics have the unique ability to protect cells from free radical-induced damage, making them materials of interest for biomedical applications. To expand upon the understanding of the potential of ceria as a biomaterial, porous ceria, fabricated via direct foaming, was investigated to assess its biocompatibility and its ability to scavenge free radicals. A mouse osteoblast (7F2) cell line was cultured with the ceria foams to determine the extent of the foams' toxicity. Toxicity assessments indicate that mouse osteoblasts cultured directly on the ceria scaffold for 72 h did not show a significant (p > 0.05) increase in toxicity, but rather show comparable toxicity to cells cultured on porous 45S5 Bioglass. The in vitro inflammatory response elicited from porous ceria foams was measured as a function of tumor necrosis factor alpha (TNF-α) secreted from a human monocytic leukemia cell line. Results indicate that the ceria foams do not cause a significant inflammatory response, eliciting a response of 27.1 ± 7.1 pg mL(-1) of TNF-α compared to 36.3 ± 5.8 pg mL(-1) from cells on Bioglass, and 20.1 ± 2.9 pg mL(-1) from untreated cells. Finally, we report cellular toxicity in response to free radicals from tert-butyl hydroperoxide with and without foamed ceria. Our preliminary results show that the foamed ceria is able to decrease the toxic effect of induced oxidative stress. Collectively, this study demonstrates that foamed ceria scaffolds do not activate an inflammatory response, and show potential free radical scavenging ability, thus they have promise as an orthopedic biomaterial.

  11. Chitosan for gene delivery and orthopedic tissue engineering applications.

    PubMed

    Raftery, Rosanne; O'Brien, Fergal J; Cryan, Sally-Ann

    2013-01-01

    Gene therapy involves the introduction of foreign genetic material into cells in order exert a therapeutic effect. The application of gene therapy to the field of orthopaedic tissue engineering is extremely promising as the controlled release of therapeutic proteins such as bone morphogenetic proteins have been shown to stimulate bone repair. However, there are a number of drawbacks associated with viral and synthetic non-viral gene delivery approaches. One natural polymer which has generated interest as a gene delivery vector is chitosan. Chitosan is biodegradable, biocompatible and non-toxic. Much of the appeal of chitosan is due to the presence of primary amine groups in its repeating units which become protonated in acidic conditions. This property makes it a promising candidate for non-viral gene delivery. Chitosan-based vectors have been shown to transfect a number of cell types including human embryonic kidney cells (HEK293) and human cervical cancer cells (HeLa). Aside from its use in gene delivery, chitosan possesses a range of properties that show promise in tissue engineering applications; it is biodegradable, biocompatible, has anti-bacterial activity, and, its cationic nature allows for electrostatic interaction with glycosaminoglycans and other proteoglycans. It can be used to make nano- and microparticles, sponges, gels, membranes and porous scaffolds. Chitosan has also been shown to enhance mineral deposition during osteogenic differentiation of MSCs in vitro. The purpose of this review is to critically discuss the use of chitosan as a gene delivery vector with emphasis on its application in orthopedic tissue engineering. PMID:23676471

  12. Initial Reliability of The Standardized Orthopedic Assessment Tool (SOAT)

    PubMed Central

    Lafave, Mark R; Katz, Larry; Donnon, Tyrone; Butterwick, Dale J

    2008-01-01

    Context: Orthopaedic assessment skills are critical to the success of athletic therapists and trainers. The Standardized Orthopedic Assessment Tool (SOAT) has been content validated. Objective: To establish interrater reliability of the SOAT. Patients or Other Participants: Thirty-two college students, 10 raters, and 2 standardized patients (SPs) from Calgary, Alberta, Canada. Design: Randomized observational study. Intervention(s): Students were allowed 30 minutes to complete a mock orthopaedic assessment of an SP with an injury specific to a region of the body (shoulder, knee, or ankle). Using the region-specific SOAT, raters and SPs evaluated students' orthopaedic assessment skills. Main Outcome Measure(s): The sum totals of the SOAT for 2 raters and 1 SP were used to calculate each student's performance scores for respective scenarios. Scale reliability analysis (Cronbach α) was completed on the SOAT for each of the 3 body-region examinations. Results: The mean overall reliability of 3 SOATs (ie, ankle, knee, and shoulder) was positive: α  =  .85 with the SP scores factored into the equation and α  =  .86 without the SP scores factored into the equation. Reliability for the ankle region was highest (α  =  .91), followed by the knee (α  =  .83) and the shoulder (α  =  .82). Conclusions: The study sample size was small, but the results will enable further study with generalization to a broader audience of athletic therapists and athletic trainers. Because a baseline measure of reliability was established using a robust statistical analysis, future researchers can employ more stringent statistical analysis and focus on the effects of various pedagogical techniques to teach and learn the underlying construct of clinical competence in orthopaedic assessment. PMID:18833311

  13. Updating Memory after Mild Traumatic Brain Injury and Orthopedic Injuries

    PubMed Central

    Li, Xiaoqi; Ibarra, Alyssa; Wilde, Elisabeth A.; Barnes, Amanda; McCauley, Stephen R.; McCarthy, James; Hoxhaj, Shkelzen; Mendez, Donna; Hunter, Jill V.; Levin, Harvey S.; Smith, Douglas H.

    2013-01-01

    Abstract Few studies have examined the trajectory of recovery of executive function (EF) after mild TBI (mTBI). Therefore, consensus has not been reached on the incidence and extent of EF impairment after mTBI. The present study investigated trajectory of change in executive memory over 3 months after mTBI on 59 right-handed participants with mTBI, as defined by Centers for Disease Control criteria, ages 14–30 years, recruited within 96 hours post-injury and tested <1 week (baseline), 1 month, and 3 months after injury. Also included were 58 participants with orthopedic injury (OI) and 27 typically developing (TD) non-injured participants with similar age, socioeconomic status, sex, and ethnicity. MRI data were acquired at baseline and 3 months. Although criteria included a normal CT scan, lesions were detected by MRI in 19 mTBI patients. Participants completed the KeepTrack task, a verbal recall task placing demands on goal maintenance, semantic memory, and memory updating. Scores reflected items recalled and semantic categories maintained. The mTBI group was divided into two groups: high (score ≥12) or low (score <12) symptoms based on the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). Mixed model analyses revealed the trajectory of change in mTBI patients (high and low RPQ), OI patients, and TD subjects were similar over time (although the TD group differed from other groups at baseline), suggesting no recovery from mTBI up to 90 days. For categories maintained, differences in trajectory of recovery were discovered, with the OI comparison group surprisingly performing similar to those in the mTBI group with high RPQ symptoms, and different from low RPQ and the TD groups, bringing up questions about utility of OIs as a comparison group for mTBI. Patients with frontal lesions (on MRI) were also found to perform worse than those without lesions, a pattern that became more pronounced with time. PMID:23227898

  14. A simple strategy to reduce stereotype threat for orthopedic residents

    PubMed Central

    Gomez, Everlyne; Wright, James G.

    2014-01-01

    Background Stereotype threat, defined as the predicament felt by people in either positive or negative learning experiences where they could conform to negative stereotypes associated with their own group membership, can interfere with learning. The purpose of this study was to determine if a simple orientation session could reduce stereotype threat for orthopedic residents. Methods The intervention group received an orientation on 2 occasions focusing on their possible responses to perceived poor performance in teaching rounds and the operating room (OR). Participants completed a survey with 7 questions typical for stereotype threat evaluating responses to their experiences. The questions had 7 response options with a maximum total score of 49, where higher scores indicated greater degree of experiences typical of stereotype threat. Results Of the 84 eligible residents, 49 participated: 22 in the nonintervention and 27 in the intervention group. The overall scores were 29 and 29.4, and 26.2 and 25.8 in the nonintervention and intervention groups for their survey responses to perceived poor performance in teaching rounds (p = 0.85) and the OR (p = 0.84), respectively. Overall, responses typical of stereotype threat were greater for perceived poor performance at teaching rounds than in the OR (p = 0.001). Conclusion Residents experience low self-esteem following perceived poor performance, particularly at rounds. A simple orientation designed to reduce stereotype threat was unsuccessful in reducing this threat overall. Future research will need to consider longer-term intervention as possible strategies to reduce perceived poor performance at teaching rounds and in the OR. PMID:24666454

  15. A citric acid-based hydroxyapatite composite for orthopedic implants.

    PubMed

    Qiu, Hongjin; Yang, Jian; Kodali, Pradeep; Koh, Jason; Ameer, Guillermo A

    2006-12-01

    We describe a novel approach to process bioceramic microparticles and poly(diol citrates) into bioceramic-elastomer composites for potential use in orthopedic surgery. The composite consists of the biodegradable elastomer poly(1,8-octanediol-citrate) (POC) and the bioceramic hydroxyapatite (HA). The objective of this work was to characterize POC-HA composites and assess the feasibility of fabricating tissue fixation devices using machining and molding techniques. The mechanical properties of POC-HA composites with HA (40, 50, 60, 65wt.%) were within the range of values reported for tissue fixation devices (for POC-HA 65wt.%, S(b)=41.4+/-3.1, E(b)=501.7+/-40.3, S(c)=74.6+/-9.0, E(c)=448.8+/-27.0, S(t)=9.7+/-2.3, E(t)=334.8+/-73.5, S(s)=27.7+/-2.4, T(s)=27.3+/-4.9, all values in MPa). At 20 weeks, the weight loss of POC-HA composites ranged between 8 and 12wt.%, with 65wt.% HA composites degrading the slowest. Exposure of POC-HA to simulated body fluid resulted in extensive mineralization in the form of calcium phosphate with Ca/P of 1.5-1.7 similar to bone. POC-HA supported osteoblast adhesion in vitro and histology results from POC-HA samples that were implanted in rabbit knees for 6 weeks suggest that the composite is biocompatible. Synthesis of POC-HA is easy and inexpensive, does not involve harsh solvents or initiators, and the mechanical properties of POC-HA with 65wt.% HA are suitable for the fabrication of potentially osteoconductive bone screws.

  16. Chitosan for gene delivery and orthopedic tissue engineering applications.

    PubMed

    Raftery, Rosanne; O'Brien, Fergal J; Cryan, Sally-Ann

    2013-05-15

    Gene therapy involves the introduction of foreign genetic material into cells in order exert a therapeutic effect. The application of gene therapy to the field of orthopaedic tissue engineering is extremely promising as the controlled release of therapeutic proteins such as bone morphogenetic proteins have been shown to stimulate bone repair. However, there are a number of drawbacks associated with viral and synthetic non-viral gene delivery approaches. One natural polymer which has generated interest as a gene delivery vector is chitosan. Chitosan is biodegradable, biocompatible and non-toxic. Much of the appeal of chitosan is due to the presence of primary amine groups in its repeating units which become protonated in acidic conditions. This property makes it a promising candidate for non-viral gene delivery. Chitosan-based vectors have been shown to transfect a number of cell types including human embryonic kidney cells (HEK293) and human cervical cancer cells (HeLa). Aside from its use in gene delivery, chitosan possesses a range of properties that show promise in tissue engineering applications; it is biodegradable, biocompatible, has anti-bacterial activity, and, its cationic nature allows for electrostatic interaction with glycosaminoglycans and other proteoglycans. It can be used to make nano- and microparticles, sponges, gels, membranes and porous scaffolds. Chitosan has also been shown to enhance mineral deposition during osteogenic differentiation of MSCs in vitro. The purpose of this review is to critically discuss the use of chitosan as a gene delivery vector with emphasis on its application in orthopedic tissue engineering.

  17. Machining of a bioactive nanocomposite orthopedic fixation device.

    PubMed

    Sparnell, Amie; Aniket; El-Ghannam, Ahmed

    2012-08-01

    Bioactive ceramics bond to bone and enhance bone formation. However, they have poor mechanical properties which restrict their machinability as well as their application as load bearing implants. The goal of this study was to machine bioactive fixation screws using a silica-calcium phosphate nanocomposite (SCPC50). The effect of compact pressure, holding time, and thermal treatment on the microstructure, machinability, and mechanical properties of SCPC50 cylinders were investigated. Samples prepared by powder metallurgy technique at compact pressure range of 100-300 MPa and treated at 900°C/1 h scored a poor machinability rating of (1/5) due to the significant formation of amorphous silicate phase at the grain boundaries. On the other hand, lowering of compact pressure and sintering temperature to 30 MPa/3 h and 700°C/2 h, respectively, minimized the formation of the amorphous phase and raised the machinability rating to (5/5). The modulus of elasticity and ultimate strength of machinable SCPC50 were 10.8 ± 2.0 GPa and 72.8 ± 22.8 MPa, respectively, which are comparable to the corresponding values for adult human cortical bone. qRT-PCR analyses showed that bone cells attached to SCPC50 significantly upregulated osteocalcin mRNA expression as compared to the cells on Ti-6Al-4V. Moreover, cells attached to SCPC50 produced mineralized bone-like tissue within 8 days. On the other hand, cells attached to Ti-6Al-4V failed to produce bone mineral under the same experimental conditions. Results of the study suggest that machinable SCPC50 has the potential to serve as an attractive new material for orthopedic fixation devices.

  18. Sarcopenia and Sarcopenic Obesity in Patients Undergoing Orthopedic Surgery

    PubMed Central

    Ji, Hyung-Min; Han, Jun; Jin, Dong San; Suh, Hyunseok; Chung, Yoon-Sok

    2016-01-01

    Background The purpose of this retrospective study was to determine the prevalence of sarcopenia and sarcopenic obesity among patients who underwent orthopedic surgery (OS). Methods A total of 222 patients were reviewed immediately after or prior to OS. In the control group, 364 patients from outpatient departments (OPDs) who did not have any OS were enrolled. Whole-body dual-energy X-ray absorptiometry was used to analyze body composition. Skeletal muscle mass was adjusted for height squared, total body weight, and height and fat mass (residuals). Obesity was defined as body mass index (BMI) > 25.0 kg/m2. Results The prevalence of sarcopenia in the OS group was 25.7%, 44.1%, and 26.6%, respectively, according to the 3 different criteria. The prevalence was significantly lower in the OPD group (6.0%, 33.1%, and 14.8%, respectively). The highest rates of sarcopenia with height-adjusted definition were seen in patients with a femoral neck fracture. In the multivariate analysis, factors associated with sarcopenia were male gender, older age, and lower BMI (odds ratio [OR]: 28.38, 1.03, and 1.83, respectively) when muscle mass was adjusted for height, whereas male gender, older age, and higher BMI were associated with sarcopenia (OR: 1.04, 2.57, and 1.83, respectively) when adjusted for weight. When residuals were used as a cutoff, decreased BMI and total hip bone mineral density (0.1 g/cm2) were independent risk factors associated with sarcopenia (OR: 1.09 and 1.05). The prevalence of sarcopenic obesity ranged from 1.8% to 21.2%. Conclusions Our study demonstrated a high prevalence of sarcopenia among OS patients. PMID:27247746

  19. Interpretation time in an ethnically diverse pediatric orthopedic clinic.

    PubMed

    Lee, Moon; Sobralske, Mary; Raney, Ellen; Carino, Brian

    2016-06-20

    Purpose - The purpose of this paper is to determine whether there were differences in clinical encounter time between patients who speak English and those who require an interpretation service in an ethnically diverse pediatric clinic. Design/methodology/approach - Encounter time with patients requiring interpretation was compared to encounter time with patients who spoke English. The sample consisted of 310 encounters at a pediatric orthopedic clinic where patients spoke over 18 primary languages. Data were analyzed using ANOVA to compare four types of encounters. Findings - Approximately 12 percent (n=38) required interpretation and encounters requiring interpretation took 30 percent (nine minutes) longer than those that did not, p < 0.01(25 vs 16 minutes). Furthermore, this difference was mainly among new patients: Approximately, 53 percent increase in time for new patient encounters requiring interpretation (36 vs 23 minutes) while only 25 percent increase in encounter time for established patients (20 vs 16 minutes) was detected. Research limitations/implications - Preventing problems due to language barriers requires time for interpretation which places demands on staff resources and presents clinical challenges. However, long-term benefits of quality health care outweigh the costs associated with interpretation service. Originality/value - To the knowledge, this is the first study to investigate actual encounter time differences in a pediatric clinical setting. The authors found that clinical encounters requiring interpretation took approximately nine minutes longer in general and four minutes longer for established patients. These findings could give much needed information for hospital administrators to allocate appropriate amounts of time and resources to care for those who need interpretation services. However, they also indicate a broader concern of the reduction of clinical encounter time for overall health care system in the country that might need

  20. Methyl methacrylate levels in orthopedic surgery: comparison of two conventional vacuum mixing systems.

    PubMed

    Jelecevic, Jasmin; Maidanjuk, Stanislaw; Leithner, Andreas; Loewe, Kai; Kuehn, Klaus-Dieter

    2014-05-01

    Poly-methyl methacrylate bone cements contain methyl methacrylate (MMA), which is known for its sensitizing and toxic properties. Therefore, in most European countries and in the USA, guidelines or regulations exist for occupational exposures. The use of vacuum mixing systems can significantly reduce airborne MMA concentrations during bone setting. Our goal was to test two commonly used vacuum mixing systems (Palamix(®) and Optivac(®)) using Palacos(®) R bone cement for their effectiveness at preventing MMA vapor release in a series of standardized trials in a laboratory as well as in an operating theatre. MMA was quantified every second over a period of 3 min using a photoionization detector (MiniRAE(®) 3000) device positioned in the breathing area of the user. Significant differences in MMA mean vapor concentrations over 180 s were observed in the two experimental spaces, with the highest mean concentrations (7.61 and 7.98 ppm for Palamix(®) and Optivac(®), respectively) observed in a laboratory with nine air changes per hour and the lowest average concentrations (1.06 and 1.12 ppm for Palamix(®) and Optivac(®), respectively) in an operating theatre with laminar flow ventilation and 22 air changes per hour. No significant differences in overall MMA concentrations were found between the two vacuum mixing systems in either location. Though, differences were found between both systems during single mixing phases. Thus, typical handling of MMA in orthopedic procedures must be seen as not harmful as concentrations do not reach the short-term exposure limit of 100 ppm. Additionally, laminar airflow seems to have an influence on lowering MMA concentrations in operation theatres.

  1. OrthoEvidence™: A Clinical Resource for Evidence-Based Orthopedics

    PubMed Central

    Sprague, Sheila; Smith, Chris; Bhandari, Mohit

    2015-01-01

    The prevalence of musculoskeletal issues in clinical practice, and the limited focus placed upon musculoskeletal conditions by current electronic summary resources, highlights the need for a resource that provides access to simple and concise summaries of top-quality orthopedic literature for orthopedic surgeons and allied healthcare professionals. OrthoEvidence™ is an online clinical resource that addresses the paucity of adequate evidence-based summary tools in the field of orthopedic surgery. OrthoEvidence™ uses a rigorous, transparent, and unique process to review, evaluate, and summarize high quality research studies and their implications for orthopedic clinical practice. Randomized controlled trials and meta-analyses are identified and reviewed by an expert medical writing team, who prepare Advanced Clinical Evidence (ACETM) reports: one or two detailed pages including critical appraisals and synopses of key research. These timely and targeted reports provide a clear understanding about the quality of evidence associated with each summarized study, and can be organized by users to identify trending information. OrthoEvidence™ allows members to use their time efficiently and to stay current by having access to a breadth of timely, high-quality research output. OrthoEvidence™ is easily accessible through the internet and is available at the point-of-care, which allows treating orthopedic surgeons and allied health professionals to easily practice the principles of evidence-based medicine within their clinical practices.. PMID:26330990

  2. 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.

  3. 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

  4. [Hopes for future practice of junior orthopedic surgeons in France: a sociological study].

    PubMed

    Grégory, T; Gaillard, R; Grenier, A

    2007-09-01

    Medical demographics have become a major public health issue in France since the publication of the Berlan report in 2002 which announced an upcoming shortage in the next 20 years. But demographic projections cannot be limited to an accounting of training and retirement figures. Other factors such as demographic distribution, changing societal aspirations (free time), modes and sites of occupational activities, the influence of feminization, and initial training and its effects on professional practice must be taken into consideration. The purpose of this work was to study these parameters in orthopedic and traumatology surgery. This was a sociological study designed to ascertain the aspirations of junior orthopedic surgeons. Forty-seven interns in orthopedic surgery in the Paris area were invited to complete a questionnaire in March 2003. Forty-two responded. The choice of orthopedics was an intellectual choice. The attractiveness of the specialty was particularly important during the final years of medical school. Fewer junior surgeons would rather practice in a university hospital setting, more preferring a mixed setting with a private (fees) and a public (salary) component. The desire for "free time" was particularly important. Fewer juniors wanted to practice in general hospitals. For orthopedic surgeons, private practice and payment by fees are the cornerstones of medical practice.

  5. Frequency of Recidivism in Patients With Orthopedic Trauma.

    PubMed

    Koleszar, Juliann C; Childs, Benjamin R; Vallier, Heather A

    2016-09-01

    The goals of this study were to determine the frequency of trauma recidivism and to identify risk factors. The authors hypothesized that substance abuse and mental illness would be associated with recidivism. They performed a retrospective review of 879 patients who were treated surgically for high-energy fractures over a period of 4 years. Recidivism was defined as presentation to the trauma center for a new, unrelated injury. A recurrent recidivist was a repeat patient who returned for more than 1 additional injury. The study identified 164 (18.7%) patients who returned with a new injury. Mean age of recidivists was 37.1 years vs 40.7 years for nonrecidivists (P=.025). Of the recidivists, 80% were male, and this group was more likely to be unmarried (76.2% vs 67.2%, P=.044) and unemployed (40.4% vs 19.6%, P<.0001). Recidivists were also more likely to be uninsured (33.5% vs 17.8%, P<.0001) or to have Medicaid coverage (33.5% vs 23.2%, P<.0001). Recidivists were more likely to have used alcohol (47.2% vs 32.0%, P=.0007) or to be intoxicated (32.4% vs 21.2%, P=.005) and to use tobacco (66.2% vs 50.2%, P=.0003) or recreational drugs (59.1% vs 43.2%, P=.0004) at baseline. The rate of documented mental illness was also higher in repeat patients than in nonrepeat patients (28.1% vs 20.0%, P=.03). These findings showed that recidivism is common, occurring overall in 18.7% of the study sample within a mean of 2.9 years. Factors associated with recidivism included age younger than 40 years, unmarried status, substance use, unemployment, and lack of insurance coverage. The greatest independent risk factors for recidivism were Medicaid insurance or no insurance and a history of a gunshot wound or assault. [Orthopedics. 2016; 39(5):300-306.].

  6. Frequency of Recidivism in Patients With Orthopedic Trauma.

    PubMed

    Koleszar, Juliann C; Childs, Benjamin R; Vallier, Heather A

    2016-09-01

    The goals of this study were to determine the frequency of trauma recidivism and to identify risk factors. The authors hypothesized that substance abuse and mental illness would be associated with recidivism. They performed a retrospective review of 879 patients who were treated surgically for high-energy fractures over a period of 4 years. Recidivism was defined as presentation to the trauma center for a new, unrelated injury. A recurrent recidivist was a repeat patient who returned for more than 1 additional injury. The study identified 164 (18.7%) patients who returned with a new injury. Mean age of recidivists was 37.1 years vs 40.7 years for nonrecidivists (P=.025). Of the recidivists, 80% were male, and this group was more likely to be unmarried (76.2% vs 67.2%, P=.044) and unemployed (40.4% vs 19.6%, P<.0001). Recidivists were also more likely to be uninsured (33.5% vs 17.8%, P<.0001) or to have Medicaid coverage (33.5% vs 23.2%, P<.0001). Recidivists were more likely to have used alcohol (47.2% vs 32.0%, P=.0007) or to be intoxicated (32.4% vs 21.2%, P=.005) and to use tobacco (66.2% vs 50.2%, P=.0003) or recreational drugs (59.1% vs 43.2%, P=.0004) at baseline. The rate of documented mental illness was also higher in repeat patients than in nonrepeat patients (28.1% vs 20.0%, P=.03). These findings showed that recidivism is common, occurring overall in 18.7% of the study sample within a mean of 2.9 years. Factors associated with recidivism included age younger than 40 years, unmarried status, substance use, unemployment, and lack of insurance coverage. The greatest independent risk factors for recidivism were Medicaid insurance or no insurance and a history of a gunshot wound or assault. [Orthopedics. 2016; 39(5):300-306.]. PMID:27359281

  7. Nanostructured materials for inhibition of bacterial adhesion in orthopedic implants: a minireview.

    PubMed

    Montanaro, L; Campoccia, D; Arciola, C R

    2008-09-01

    Orthopedic implants may fail owing to different reasons: poor osseointegration at the tissue-implant interface, generation of wear debris, stress and strain imbalance between implant and surrounding tissues, and infections. To ensure success in orthopedics, implant materials must not evoke an undesirable inflammatory response, they must be habitable by bone-forming cells (favoring adhesion of osteoblasts), hinder formation of soft connective tissue (hindering adhesion of fibroblasts), and be anti-infective (discouraging bacterial adhesion). Recent studies have suggested that nanophase materials have a better efficacy as bone implants in favoring osseointegration compared to conventional orthopedic implant materials. This minireview discusses studies on nanophase materials as bone implants, focusing on the effect of these materials in inhibiting bacterial adhesion for the prevention of implant infections.

  8. Orthopedic injuries in U.S. casualties treated on a hospital ship during Operation Iraqi Freedom.

    PubMed

    Enad, Jerome G; Headrick, Jeff D

    2008-10-01

    From March to May 2003, the USNS Comfort was deployed to the Persian Gulf in support of combat operations for Operation Iraqi Freedom. The onboard orthopedic service treated 58 U.S. casualties during that period. Eighty-seven percent of the injuries were to the appendicular skeleton. Twenty-four percent were battle injuries, and 72% were nonbattle injuries. Patients with battle injuries tended to be younger and required more orthopedic operations than did patients with nonbattle injuries. Moreover, all patients with battle injuries were evacuated to higher echelons for further care, whereas 19% of patients with nonbattle injuries returned to duty in the short term. Complications were few, with no infections, amputations, or deaths. A descriptive review of the types of injuries, orthopedic care, and eventual disposition is presented.

  9. The TROJAN Project: Creating a Customized International Orthopedic Training Program for Junior Doctors.

    PubMed

    Kalraiya, Ashish; Buddhdev, Pranai

    2015-03-01

    Musculoskeletal problems account for a vast proportion of presentations encountered by doctors globally, with figures ranging from 15-36%. However, the time medical schools allocate to learning orthopedics is by no means proportional to this. This study aims to bridge this gap by developing an international orthopedic teaching program tailored to the specific knowledge and skills required by junior doctors in different countries. This prospective study asked fifty junior doctors, who had recently completed an orthopedics job, what three orthopedic teaching topics taught retrospectively would have benefitted their clinical practice. The most requested topics were used to design educational workshops for junior doctors and these consequently comprised the TROJAN (Teaching Requested by Orthopaedic Juniors And Novices) training program. Data was collected from twenty-five junior doctors in KwaZulu-Natale State, South Africa, and twenty-five in London, UK. It is therefore in these two countries that the TROJAN program was subsequently made available. Participants who selected topics were within two years of graduating medical school and had worked an orthopedic or Accident and Emergency job within the last year. 49% of topics chosen by SA doctors were practical skills such as wrist and ankle fracture reduction techniques, and management of open fractures. The most requested topic by UK doctors (11 out of 25) was management of neck of femur fractures. This is rationalized by the fact South African doctors require more hands-on responsibility in their daily practice whereas in the UK greater emphasis is placed on optimizing patients for theatre and making sound management plans. TROJAN currently develops orthopedic skills and knowledge in junior doctors in South Africa and United Kingdom with teaching customized based upon location. Feedback has been exceptionally positive with every candidate thus far rating the usefulness of TROJAN as the highest option, very useful.

  10. High Disparity Between Orthopedic Resident Interest and Participation in International Health Electives.

    PubMed

    Zhang, Steven; Shultz, Paul; Daniels, Alan; Ackelman, Edward; Kamal, Robin N

    2016-07-01

    Few orthopedic surgical residency programs offer international health electives (IHEs). Efforts to expand these programs have been increasing across medical disciplines. Whether orthopedic residents will participate remains unknown. This study quantified and characterized orthopedic resident interest and barriers to IHEs in US residency programs. A web-based survey was administered to residents from 154 US orthopedic residency programs accredited by the Accreditation Council for Graduate Medical Education 2014 to 2015. Questions assessed demographics and program background, previous medical experience abroad, barriers to participation, and level of interest in participating in an international health elective during their training and beyond. Twenty-seven (17.5%) residency programs responded. Chi-square analysis showed that residents who expressed interest in participating were significantly more likely to have experience abroad compared with those who expressed no interest (P<.004). Analysis using Mann-Whitney U test suggested that those who expressed interest were more likely to believe IHEs are important to resident training (P<.0011; mean Likert scale score of 3.7 vs 2.6), provide valuable experience (P<.001; mean Likert scale score of 4.2 vs 3.2), and should be required for orthopedic residencies (P<.001; mean Likert scale score of 2.8 vs 1.9). Residents are strongly interested in participating in IHEs during their training, and many may integrate global health into future practices. Residents perceive lack of funding and scheduling flexibility as barriers preventing them from participating. Prior experience abroad influences level of interest, and international clinical experience may enhance future perception of its value. [Orthopedics. 2016; 39(4):e680-e686.]. PMID:27111074

  11. Oral orthopedics and movement of maxillary segments. A roentgen stereophotogrammetric study.

    PubMed

    Rune, B; Sarnäs, K V; Selvik, G

    1979-10-01

    An infant with a complete unilateral cleft of the lip and palate underwent maxillary expansion treatment using an oral orthopedic appliance. Movement of the maxillary bone segments was studied by means of metallic implants and roentgen stereophotogrammetry, and intra-oral changes were recorded by measuring transverse dimensions on casts. Expansion treatment had almost no influence on the positions of the maxillary segments, and movements of the segments showed little agreement with measures on casts. The findings suggest that the appropriate use of the term oral orthopedics and the evaluation of treatment effects would benefit from evaluating the movement of the segments by methods other than measurements of casts.

  12. Do Astronauts have a Higher Rate of Orthopedic Shoulder Conditions than a Cohort of Working Professionals?

    NASA Technical Reports Server (NTRS)

    Laughlin, Mitzi S.; Murray, Jocelyn D.; Young, Millenia; Wear, Mary L.; Tarver, W. J.; Van Baalen, Mary

    2016-01-01

    Occupational surveillance of astronaut shoulder injuries began with operational concerns at the Neutral Buoyancy Laboratory (NBL) during Extra Vehicular Activity (EVA) training. NASA has implemented several occupational health initiatives during the past 20 years to decrease the number and severity of injuries, but the individual success rate is unknown. Orthopedic shoulder injury and surgery rates were calculated, but classifying the rates as normal, high or low was highly dependent on the comparison group. The purpose of this study was to identify a population of working professionals and compare orthopedic shoulder consultation and surgery rates.

  13. In vitro and in vivo evaluation of orthopedic interface repair using a tissue scaffold with a continuous hard tissue-soft tissue transition

    PubMed Central

    2013-01-01

    Tendon tears produce pain and decrease joint stability; each year, over 1.1 million rotator cuff tendon surgical procedures are performed worldwide. However, surgical success is highly variable, and the inability of the procedure to drive the regeneration of the normal tendon-bone interface has been identified as a key factor in surgical failure. This study focuses on the development, in vitro evaluation, and in vivo assessment of a tissue scaffold derived from bovine cancellous bone with the potential to direct regeneration of a bone-soft tissue interface. The scaffold is a highly porous scaffold with a continuous hard tissue-soft tissue transition that facilitates load transfer across the interface and contains all of the extracellular matrix components of the orthopedic interface. This study demonstrated the in vitro characterization of the mechanical properties and successful in vivo assessment using an ovine model. PMID:23782505

  14. [The construction of a medical discipline and its challenges: Orthopedics in Switzerland during the 19th and 20th centuries].

    PubMed

    Kaba, Mariama

    2015-07-01

    During the 19th century, numerous figures, with different qualifications, claimed to practice orthopedics: doctors, surgeons, inventors of equipment and instruments, and other empiricists. They performed certain types of techniques, massages, surgical operationsand/or fitted prostheses. The polysemous notion of orthopedics had created conflicts of interest that would reach their height at the end of the 19th century. The integration of orthopedics into the training at the university level enhanced its proximity to surgery, a discipline that has dominated the so-called modern medicine. During the 20th century, various medical branches defend the legitimacy of certain orthopedic practices, thereby threating to a degree the title itself of this specialization. By examining the challenges that have shaped the history of orthopedics in Switzerland, this article also seeks to shed light on the strategies that were implemented in adopting a medical and technical discipline within a transforming society.

  15. A Survey on Transfusion Status in Orthopedic Surgery at a Trauma Center

    PubMed Central

    Soleimanha, Mehran; Haghighi, Mohammad; Mirbolook, Ahmadreza; Sedighinejad, Abbas; Mardani-Kivi, Mohsen; Naderi-Nabi, Bahram; Chavoshi, Tahereh; Mehrnoosh, Mehrnoosh Ghandili

    2016-01-01

    Background: Increased costs and mortality associated with inappropriate blood transfusions have led to investigations about blood request and blood transfusion techniques. We investigated the transfusion status in patients who underwent orthopedic surgery in Poursina Hospital (Rasht, Iran) to optimizing blood usage and determine if a scheduled transfusion program for every orthopedic surgery could improve blood transfusion management. Method: In this descriptive-prospective study, all orthopedic surgeries in Poursina Hospital, Rasht, between April to June 2013 were reviewed. All patient information was recorded, including: demographics, type of surgery, hemoglobin level, cross-match test, duration of surgery, and blood loss, and transfusion. Based on the one-way ANOVA and independent samples test analysis, cross-match to transfusion ratio and transfusion possibility, the transfusion index, and maximal surgical blood order schedule were calculated to determine blood transfusion status. Results: Among 872 selected orthopedic surgery candidates, 318 of them were cross-matched and among those, 114 patients received a blood transfusion. In this study, the cross-match to transfusion ratio was 6.4, transfusion possibility 36.47%, transfusion index 0.6, and maximal surgical blood order schedule 0.9. Conclusion: We found that blood ordering was moderately higher than the standard; so it is highly recommended to focus on the knowledge of evidence based on transfusion and standard guidelines for blood transfusion to avoid over-ordering. PMID:26894223

  16. A Compilation of Perceptual Motor Activities to Aid in the Development of the Orthopedically Handicapped Child.

    ERIC Educational Resources Information Center

    Howell, Michelle; And Others

    Provided is information on games, activities, and resources for enhancing perceptual motor development in the orthopedically handicapped child. Compiled are materials which include the following: an explanation of bilateral, alternating lateral, and integrated lateral games and activities for developing awareness of the two sides of the body; a…

  17. Social Networking as a Tool for Lifelong Learning with Orthopedically Impaired Learners

    ERIC Educational Resources Information Center

    Ersoy, Metin; Güneyli, Ahmet

    2016-01-01

    This paper discusses how Turkish Cypriot orthopedically impaired learners who are living in North Cyprus use social networking as a tool for leisure and education, and to what extent they satisfy their personal development needs by means of these digital platforms. The case study described, conducted in North Cyprus in 2015 followed a qualitative…

  18. Orthopedic Surgery in Rural American Hospitals: A Survey of Rural Hospital Administrators

    ERIC Educational Resources Information Center

    Weichel, Derek

    2012-01-01

    Rural American residents prefer to receive their medical care locally. Lack of specific medical services in the local community necessitates travel to a larger center which is less favorable. This study was done to identify how rural hospitals choose to provide orthopedic surgical services to their communities. Methods: All hospitals in 5 states…

  19. Aging and orthopedics: how a lifespan development model can inform practice and research.

    PubMed

    Gautreau, Sylvia; Gould, Odette N; Forsythe, Michael E

    2016-08-01

    Orthopedic surgical care, like all health care today, is in flux owing to an aging population and to chronic medical conditions leading to an increased number of people with illnesses that need to be managed over the lifespan. The result is an ongoing shift from curing acute illnesses to the management and care of chronic illness and conditions. Theoretical models that provide a useful and feasible vision for the future of health care and health care research are needed. This review discusses how the lifespan development model used in some disciplines within the behavioural sciences can be seen as an extension of the biopsychosocial model. We posit that the lifespan development model provides useful perspectives for both orthopedic care and research. We present key concepts and recommendations, and we discuss how the lifespan development model can contribute to new and evolving perspectives on orthopedic outcomes and to new directions for research. We also offer practical guidelines on how to implement the model in orthopedic practice.

  20. The Effectiveness of Active and Traditional Teaching Techniques in the Orthopedic Assessment Laboratory

    ERIC Educational Resources Information Center

    Nottingham, Sara; Verscheure, Susan

    2010-01-01

    Active learning is a teaching methodology with a focus on student-centered learning that engages students in the educational process. This study implemented active learning techniques in an orthopedic assessment laboratory, and the effects of these teaching techniques. Mean scores from written exams, practical exams, and final course evaluations…

  1. 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.

  2. Stem Cells in Orthopedics: A Comprehensive Guide for the General Orthopedist.

    PubMed

    Saltzman, Bryan M; Kuhns, Benjamin D; Weber, Alexander E; Yanke, Adam; Nho, Shane J

    2016-01-01

    The use of biologic adjuvants in the treatment of operative and nonoperative orthopedic injuries continues to expand in concert with our understanding of the acute and chronic healing process of musculoskeletal injuries. Stem cell treatments in orthopedics are among the most commonly explored options, and have found varying levels of success in promoting osseous and soft tissue healing. Basic science and translational studies have demonstrated the potential for broad application of stem cells in the treatment of a growing number of musculoskeletal injuries. Emerging clinical studies have also provided promising results, although the vast majority of studies have featured small sample sizes and limited duration of follow-up. In addition, a number of important questions remain regarding the clinical safety, treatment delivery, and overall efficacy of stem cell augmentation of injured tissue in orthopedics. The objective of the current review is to present a broad overview of the current state of stem cell treatments in orthopedic surgery, with an emphasis on soft tissue healing. This review of stem cell treatment covers the basic science behind biologic augmentation, advantages of the various stem cell sources, preclinical results, and current and future clinical applications.

  3. A Prototype Robotic Arm for Use by Severely Orthopedically Handicapped Students. Final Report.

    ERIC Educational Resources Information Center

    Howell, Richard

    This 18-month pilot project, which ran from October 1, 1987 to March 31, 1989, developed a prototype robotic arm for educational use by students with severe orthopedic disabilities in the Columbus (Ohio) Public Schools. The developmental effort was intended first, to provide direct access to currently available instructional materials and, second,…

  4. The Physical Fitness of Sensory and Orthopedically Impaired Youth: Project UNIQUE. Final Report.

    ERIC Educational Resources Information Center

    Winnick, Joseph P.; Short, Francis X.

    The report summarizes findings from an examination of the physical fitness of orthopedically and sensory impaired students (10-17 years old). Physical fitness was hypothesized to include six areas: body composition, muscular strength/endurance, speed, agility, flexibility, and cardiorespiratory endurance. A chapter on methods details subject…

  5. Aging and orthopedics: how a lifespan development model can inform practice and research

    PubMed Central

    Gautreau, Sylvia; Gould, Odette N.; Forsythe, Michael E.

    2016-01-01

    Orthopedic surgical care, like all health care today, is in flux owing to an aging population and to chronic medical conditions leading to an increased number of people with illnesses that need to be managed over the lifespan. The result is an ongoing shift from curing acute illnesses to the management and care of chronic illness and conditions. Theoretical models that provide a useful and feasible vision for the future of health care and health care research are needed. This review discusses how the lifespan development model used in some disciplines within the behavioural sciences can be seen as an extension of the biopsychosocial model. We posit that the lifespan development model provides useful perspectives for both orthopedic care and research. We present key concepts and recommendations, and we discuss how the lifespan development model can contribute to new and evolving perspectives on orthopedic outcomes and to new directions for research. We also offer practical guidelines on how to implement the model in orthopedic practice. PMID:27240129

  6. Late orthopedic effects in children with Wilms' tumor treated with abdominal irradiation

    SciTech Connect

    Rate, W.R.; Butler, M.S.; Robertson, W.W. Jr.; D'Angio, G.J. )

    1991-01-01

    Between 1970 and 1984, 31 children with biopsy-proven Wilms' tumor received nephrectomy, chemotherapy, and abdominal irradiation and were followed beyond skeletal maturity. Three patients (10%) developed late orthopedic abnormalities requiring intervention. Ten children received orthovoltage irradiation, and all cases requiring orthopedic intervention or developing a scoliotic curve of greater than 20 degrees were confined to this group, for a complication frequency of 50%. Those children who developed a significant late orthopedic abnormality (SLOA) as defined were treated to a higher median dose (2,890 cGy) and a larger field size (150 cm2) than those who did not (2,580 cGy and 120 cm2). Age at irradiation, sex, and initial stage of disease did not appear to influence the risk of developing an SLOA. No child who received megavoltage irradiation developed an SLOA despite treatment up to 4,000 cGy or to field sizes of 400 cm2. We conclude that modern radiotherapy techniques rarely lead to significant late orthopedic abnormalities previously associated with abdominal irradiation in children with Wilms' tumor.

  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. Thou shalt not fall! Decreasing falls in the postoperative orthopedic patient with a femoral nerve block.

    PubMed

    Foisy, Kimberly

    2013-01-01

    A Transforming Care at the Bedside model was used to decrease falls in the femoral nerve block (FNB) patient population on a 32-bed orthopedic/neurologic unit in a community hospital setting. A multifaceted, strategic practice and educational bundle was implemented, resulting in a 75% decrease in falls among patients with FNB.

  9. Factors influencing the number of applications submitted per applicant to orthopedic residency programs

    PubMed Central

    Finkler, Elissa S.; Fogel, Harold A.; Kroin, Ellen; Kliethermes, Stephanie; Wu, Karen; Nystrom, Lukas M.; Schiff, Adam P.

    2016-01-01

    Background From 2002 to 2014, the orthopedic surgery residency applicant pool increased by 25% while the number of applications submitted per applicant rose by 69%, resulting in an increase of 109% in the number of applications received per program. Objective This study aimed to identify applicant factors associated with an increased number of applications to orthopedic surgery residency programs. Design An anonymous survey was sent to all applicants applying to the orthopedic surgery residency program at Loyola University. Questions were designed to define the number of applications submitted per respondent as well as the strength of their application. Of 733 surveys sent, 140 (19.1%) responses were received. Setting An academic institution in Maywood, IL. Participants Fourth-year medical students applying to the orthopedic surgery residency program at Loyola University. Results An applicant's perception of how competitive he or she was (applicants who rated themselves as ‘average’ submitted more applications than those who rated themselves as either ‘good’ or ‘outstanding’, p=0.001) and the number of away rotations (those who completed >2 away rotations submitted more applications, p=0.03) were significantly associated with an increased number of applications submitted. No other responses were found to be associated with an increased number of applications submitted. Conclusion Less qualified candidates are not applying to significantly more programs than their more qualified counterparts. The increasing number of applications represents a financial strain on the applicant, given the costs required to apply to more programs, and a time burden on individual programs to screen increasing numbers of applicants. In order to stabilize or reverse this alarming trend, orthopedic surgery residency programs should openly disclose admission criteria to prospective candidates, and medical schools should provide additional guidance for candidates in this process

  10. Developing a Minimum Data Set of the Information Management System for Orthopedic Injuries in Iran

    PubMed Central

    Ahmadi, Maryam; Mohammadi, Ali; Chraghbaigi, Ramin; Fathi, Taimur; Shojaee Baghini, Mahdieh

    2014-01-01

    Background: Orthopedic injuries are the most common types of injuries. To identify the main causes of injuries, collecting data in a standard manner at the national level are needed, which justifies necessity of making a minimum data set (MDS). Objectives: The aim of this study was to develop an MDS of the information management system for orthopedic injuries in Iran. Materials and Methods: This descriptive cross-sectional study was performed in 2013. Data were collected from hospitals affiliated with Tehran University of Medical Sciences that had orthopedic department, medical documents centers, legal medicine centers, emergency centers, internet access, and library. Investigated documents were orthopedic injury records in 2012, documents that retrieved from the internet, and printed materials. Records with Random sampling by S22-S99 categories from ICD-10 were selected and the related internet-sourced data were evaluated entirely. Data were collected using a checklist. In order to make a consensus about the data elements, the decision Delphi technique was applied by a questionnaire. The content validity and reliability of the questionnaire were assessed by expert’s opinions and test-retest method, respectively. Results: An MDS of orthopedic injuries were assigned to two categories: administrative category with six classes including 142 data elements, and clinical category with 17 classes including 250 data elements. Conclusions: This study showed that some of the essential data elements included in other country’s MDS or required for organizations and healthcare providers were not included. Therefore, a complete list of an MDS elements was created. Existence of comprehensive data concerning the causes and mechanisms of injuries informs public health policy-makers about injuries occurrence and enables them to take rationale measures to deal with these problems. PMID:25237576

  11. Effect of the Mandibular Orthopedic Repositioning Appliance on Trunk and Upper Limb Muscle Activation during Maximum Isometric Contraction

    PubMed Central

    Lee, Sang-Yeol; Hong, Min-Ho; Park, Min-Chull; Choi, Sung-Min

    2013-01-01

    [Purpose] The purpose of this study was to measure the muscle activities of the trunk muscles and upper limb muscles during maximum isometric contraction when temporomandibular joint alignment was achieved with a mandibular orthopedic repositioning appliance in order provide basic data on the effects of mandibular orthopedic repositioning appliance on the entire body. [Subjects] The present study was conducted with healthy Korean adults in their 20s (males=10, females=10). [Methods] An 8 channel surface electromyography system was used to measure the muscle activities of the upper limb muscles and neck muscles of the subjects during maximum isometric contraction with and without use of a mandibular orthopedic repositioning appliance. [Results] The maximum isometric contractions of the trunk and upper limb muscles when mandibular orthopedic repositioning appliance were used were compared with those when no mandibular orthopedic repositioning appliance was used. The results showed that the sternocleidomastoid muscle, cervical and lumbar erector spinae, upper trapezius, biceps, triceps, rectus abdominis and internal oblique and external oblique muscles all showed significant increases in maximum isometric contractions with a mandibular orthopedic repositioning appliance. [Conclusion] The use of a mandibular orthopedic repositioning appliance is considered to be a method for normal adults to improve the stability of the entire body with the improvement of the stability of the TMJ. The proximal improvement in stability improves of the proximal thereby improving not only muscle strength with increased muscle activation but also stability during exercises. PMID:24396194

  12. [Extracorporeal shockwave therapy (ESWT) in orthopedic indications: a selective review].

    PubMed

    Fritze, J

    1998-10-01

    A search of Medline concerning the efficacy of shock wave therapy for pseudarthritis (nonunion), calcifying tendinitis of the shoulder, lateral epicondylitis and painful heel identified 25 publications describing 31 investigations. These investigations cannot be accepted as confirmative. The effects in pseudarthritis appear most promising but the cases reported need a reanalysis and thorough description before efficacy can be accepted as granted. Moreover, the indication as well as the stimulus parameters have to be specified and standardized. Published data on the other indications justify prospective, randomized, double-blind, placebo-controlled (sham treatment) trials to confirm efficacy where again the procedure and dosing of shock wave therapy need data-based, rational standardization.

  13. The promising application of graphene oxide as coating materials in orthopedic implants: preparation, characterization and cell behavior.

    PubMed

    Zhao, Changhong; Lu, Xiuzhen; Zanden, Carl; Liu, Johan

    2015-02-01

    To investigate the potential application of graphene oxide (GO) in bone repair, this study is focused on the preparation, characterization and cell behavior of graphene oxide coatings on quartz substrata. GO coatings were prepared on the substrata using a modified dip-coating procedure. Atomic force microscopy (AFM), scanning electron microscopy (SEM) and Raman spectroscopy results demonstrated that the as-prepared coatings in this study were homogeneous and had an average thickness of ~67 nm. The rapid formation of a hydroxyapatite (HA) layer in the simulated body fluid (SBF) on GO coated substrata at day 14, as proved by SEM and x-ray diffraction (XRD), strongly indicated the bioactivity of coated substrata. In addition, MC3T3-E1 cells were cultured on the coated substrata to evaluate cellular activities. Compared with the non-coated substrata and tissue culture plates, no significant difference was observed on the coated substrata in terms of cytotoxicity, viability, proliferation and apoptosis. However, interestingly, higher levels of alkaline phosphatase (ALP) activity and osteocalcin (OC) secretion were observed on the coated substrata, indicating that GO coatings enhanced cell differentiation compared with non-coated substrata and tissue culture plates. This study suggests that GO coatings had excellent biocompatibility and more importantly promoted MC3T3-E1 cell differentiation and might be a good candidate as a coating material for orthopedic implants. PMID:25668049

  14. Adipose-Derived Cells (Stromal Vascular Fraction) Transplanted for Orthopedical or Neurological Purposes: Are They Safe Enough?

    PubMed Central

    Zolocinska, Aleksandra; Stepien, Karolina; Lubina-Dabrowska, Natalia; Maciagowska, Marzena; Mazur, Slawomir; Zdanowicz, Urszula; Smigielski, Robert; Stepien, Adam

    2016-01-01

    Although mesenchymal stem cells are used in numerous clinical trials, the safety of their application is still a matter of concern. We have analysed the clinical results of the autologous adipose-derived stem cell treatment (stromal vascular fraction (SVF) containing adipose-derived stem cells, endothelial progenitors, and blood mononuclear cells) for orthopedic (cartilage, bone, tendon, or combined joint injuries) and neurologic (multiple sclerosis) diseases. Methods of adipose tissue collection, cell isolation and purification, and resulting cell numbers, viability, and morphology were considered, and patient's age, sex, disease type, and method of cell administration (cell numbers per single application, treatment numbers and frequency, and methods of cell implantation) were analysed and searched for the unwanted clinical effects. Results of cellular therapy were compared retrospectively to those obtained with conventional medication without SVF application. SVF transplantation was always the accessory treatment of patients receiving “standard routine” therapies of their diseases. Clinical experiments were approved by the Bioethical Medical Committees supervising the centers where patients were hospitalised. The conclusion of the study is that none of the treated patients developed any serious adverse event, and autologous mesenchymal stem (stromal) cell clinical application is a safe procedure resulting in some beneficial clinical effects (not analysed in this study).

  15. Adipose-Derived Cells (Stromal Vascular Fraction) Transplanted for Orthopedical or Neurological Purposes: Are They Safe Enough?

    PubMed Central

    Zolocinska, Aleksandra; Stepien, Karolina; Lubina-Dabrowska, Natalia; Maciagowska, Marzena; Mazur, Slawomir; Zdanowicz, Urszula; Smigielski, Robert; Stepien, Adam

    2016-01-01

    Although mesenchymal stem cells are used in numerous clinical trials, the safety of their application is still a matter of concern. We have analysed the clinical results of the autologous adipose-derived stem cell treatment (stromal vascular fraction (SVF) containing adipose-derived stem cells, endothelial progenitors, and blood mononuclear cells) for orthopedic (cartilage, bone, tendon, or combined joint injuries) and neurologic (multiple sclerosis) diseases. Methods of adipose tissue collection, cell isolation and purification, and resulting cell numbers, viability, and morphology were considered, and patient's age, sex, disease type, and method of cell administration (cell numbers per single application, treatment numbers and frequency, and methods of cell implantation) were analysed and searched for the unwanted clinical effects. Results of cellular therapy were compared retrospectively to those obtained with conventional medication without SVF application. SVF transplantation was always the accessory treatment of patients receiving “standard routine” therapies of their diseases. Clinical experiments were approved by the Bioethical Medical Committees supervising the centers where patients were hospitalised. The conclusion of the study is that none of the treated patients developed any serious adverse event, and autologous mesenchymal stem (stromal) cell clinical application is a safe procedure resulting in some beneficial clinical effects (not analysed in this study). PMID:27698672

  16. Current Concepts in Orthopedic Management of Multiple Trauma

    PubMed Central

    Kucukdurmaz, Fatih; Alijanipour, Pouya

    2015-01-01

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

  17. ICD 10: "what orthopedic surgeons should know, how it will affect them and the cost of implementation?".

    PubMed

    Henley, M Bradford

    2013-09-01

    Orthopedic surgeons will be required to use ICD-10-CM codes for reimbursement and to substantiate the medical necessity for their services beginning October 1, 2014. Implementation of ICD10 will require significant changes in the clinical and administrative processes of orthopedic offices and hospital practices. As in other countries, implementation added costs and resulted in disruptions in physician practices with concomitant decreases in productivity and practice revenue. Through education and planning, orthopedic surgeons can mitigate the anticipated changes and reduce the potential impact these changes will have on their practices. Changes anticipated in the diagnostic part of the ICD10 coding system are reviewed with examples pertinent to orthopedic surgeons. Many will need to improve the accuracy and specificity of their documentation by using anatomically precise nomenclature and obtaining a more detailed history and physical examination. This will require eliciting external causes of patients' problems, the precise activity of causation, and the place of occurrence.

  18. Hope versus hype: what can additive manufacturing realistically offer trauma and orthopedic surgery?

    PubMed

    Gibbs, David M R; Vaezi, Mohammad; Yang, Shoufeng; Oreffo, Richard O C

    2014-01-01

    Additive manufacturing (AM) is a broad term encompassing 3D printing and several other varieties of material processing, which involve computer-directed layer-by-layer synthesis of materials. As the popularity of AM increases, so to do expectations of the medical therapies this process may offer. Clinical requirements and limitations of current treatment strategies in bone grafting, spinal arthrodesis, osteochondral injury and treatment of periprosthetic joint infection are discussed. The various approaches to AM are described, and the current state of clinical translation of AM across these orthopedic clinical scenarios is assessed. Finally, we attempt to distinguish between what AM may offer orthopedic surgery from the hype of what has been promised by AM.

  19. [Extracorporeal shockwave therapy in orthopedics. Positive results in tennis elbow and tendinosis calcarea of the shoulder].

    PubMed

    Rompe, J D; Eysel, P; Hopf, C; Krischek, O; Vogel, J; Bürger, R; Jage, J; Heine, J

    1997-06-30

    Since the beginning of the 1990s scientific investigations on the use of extracorporeal shock wave therapy (ESWT) in the field of orthopedics have been carried out at the Orthopedic Department of the University of Mainz. Prospective studies demonstrated beneficial effects in chronic lateral humeral epicondylitis (tennis elbow), and in calcifying tendinitis of the shoulder in more than 50% of the cases. Additional indications for which positive results of prospective studies have been published during the past 2 years are plantar calcaneodynea and pseudoarthrosis. On the basis of the results achieved, it may be concluded that, for specific indications, extracorporeal shock wave therapy may now be taken out of the clinical testing stage and introduced into routine practice.

  20. Clinical applicability of nursing outcomes in the evolution of orthopedic patients with Impaired Physical Mobility 1

    PubMed Central

    da Silva, Marcos Barragan; Almeida, Miriam de Abreu; Panato, Bruna Paulsen; Siqueira, Ana Paula de Oliveira; da Silva, Mariana Palma; Reisderfer, Letícia

    2015-01-01

    AIM: to evaluate the clinical applicability of outcomes, according to the Nursing Outcomes Classification (NOC) in the evolution of orthopedic patients with Impaired Physical Mobility METHOD: longitudinal study conducted in 2012 in a university hospital, with 21 patients undergoing Total Hip Arthroplasty, evaluated daily by pairs of trained data collectors. Data were collected using an instrument containing five Nursing Outcomes, 16 clinical indicators and a five point Likert scale, and statistically analyzed. RESULTS: The outcomes Body Positioning: self-initiated, Mobility, Knowledge: prescribed activity, and Fall Prevention Behavior presented significant increases in mean scores when comparing the first and final evaluations (p<0.001) and (p=0.035). CONCLUSION: the use of the NOC outcomes makes it possible to demonstrate the clinical progression of orthopedic patients with Impaired Physical Mobility, as well as its applicability in this context. PMID:25806631

  1. Hope versus hype: what can additive manufacturing realistically offer trauma and orthopedic surgery?

    PubMed

    Gibbs, David M R; Vaezi, Mohammad; Yang, Shoufeng; Oreffo, Richard O C

    2014-01-01

    Additive manufacturing (AM) is a broad term encompassing 3D printing and several other varieties of material processing, which involve computer-directed layer-by-layer synthesis of materials. As the popularity of AM increases, so to do expectations of the medical therapies this process may offer. Clinical requirements and limitations of current treatment strategies in bone grafting, spinal arthrodesis, osteochondral injury and treatment of periprosthetic joint infection are discussed. The various approaches to AM are described, and the current state of clinical translation of AM across these orthopedic clinical scenarios is assessed. Finally, we attempt to distinguish between what AM may offer orthopedic surgery from the hype of what has been promised by AM. PMID:25159068

  2. The changes produced by presurgical orthopedic treatment of bilateral cleft lip and palate.

    PubMed

    Robertson, N; Shaw, W; Volp, C

    1977-01-01

    A serial cephalometric analysis (with the aid of metallic implants) and an analysis of the models of 10 children with complete bilateral clefts, who received presurgical orthopedic treatment, was done. It revealed that such therapy can successfully reduce the protrusive deformity of the premaxilla, when forward growth of this structure is restrained so as to allow the remainder of the face to "catch up." Our other observations include the accentuation of the columella during treatment, but an absence of growth at the cleft margins. Orthopedic treatment which fails to achieve the desired aims in 12 weeks of active therapy should be discontinued then in favor of such surgical setback as may be necessary to allow a satisfactory lip repair.

  3. Recent advances in the design of titanium alloys for orthopedic applications.

    PubMed

    Guillemot, Fabien

    2005-11-01

    To increase an orthopedic implant's lifetime, research trends have included the development of new titanium alloys made of nontoxic elements with suitable mechanical properties (low Young's modulus - high fatigue strength), good workability and corrosion resistance. In accordance with the background on titanium and metallic biomaterials, recent interesting developments in titanium-based biomaterials are reported in this review, with a special emphasis on the design of new metastable beta-titanium alloys for orthopedic applications. In addition, as the concept of titanium alloys can now be regarded as relatively old, having emerged at the beginning of the 1980s, the author suggests some future directions that would permit the emergence of a new generation of titanium implants.

  4. Societal impacts of regenerative medicine: reflections on the views of orthopedic professionals.

    PubMed

    Niemansburg, Sophie L; Tempels, Tjidde H; Dhert, Wouter J A; van Delden, Johannes J M; Bredenoord, Annelien L

    2015-01-01

    As the amount of clinical studies in orthopedic regenerative medicine (RM) is increasing, it is time to take into account its impact on society. A total of 36 biomedical professionals working at the front row of orthopedic RM were interviewed to explore their attitudes, opinions and expectations regarding the societal impacts of RM. Professionals mainly recognized the societal impacts of counteraction of aging, prevention of disease and social justice. The 'soft' sides of these impacts were hardly mentioned. Whereas they did not perceive themselves in the position to mitigate these impacts, professionals should take up their role as actor and become involved in the societal debate. This is important as they can co-shape the societal impacts during the developmental process of technologies and thereby stimulate responsible innovation.

  5. The Medical Education and Best Practice in Orthopedic Patient Care in Poland.

    NASA Astrophysics Data System (ADS)

    Rosiek, Anna; Leksowski, Krzysztof

    2012-07-01

    The leadership organization focuses on education, teamwork, customer relationship and developing strategy which help in building added value, in managing activities, time and quality. Everyday orthopedic experience shows that medical education is a mixture of: specific knowledge, skills and attitudes of people working together, and that creates effective teamwork in a hospital environment. Apart from the main reason of medical education, teaching about disease treatment and health problem solving, medical education should also concentrate on human factors and behavioral aspects of patient treatment in hospital.Assessment of an organization and medical education process by cultural and teamwork criteria, offers a powerful new way to think about performance at the frontlines of healthcare and in the future it could be gold standard for assessing the success of an organization, and standards in medical education, not only in orthopedics.

  6. Design and implementation of a visual and haptic simulator in a platform for a TEL system in percutaneuos orthopedic surgery.

    PubMed

    Luengo, Vanda; Larcher, Aurelie; Tonetti, Jérôme

    2011-01-01

    Within a research project whose aim is to promote the learning of percutaneous operation in orthopedic surgery we design a Technological Enhanced Learning (TEL) system. This project belongs to a multidisciplinary field including computer, orthopedic surgery, medical imaging, didactic and cognitive sciences. The article presents the design principles of TEL with a particular interest in the development of a simulator. This simulator allows a virtual exercise interacting with the learner in visual, temporal and haptic dimension. PMID:21335812

  7. 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.

  8. Orthopedic emergencies: a practical emergency department classification (US-VAGON) in pelvic fractures.

    PubMed

    Wang, Hao; Coppola, Paolo T; Coppola, Marco

    2015-05-01

    Trauma is one of the leading causes of death before the age of 40 years and approximately 5% of patients with trauma who require hospital admission have pelvic fractures. This article updates the emergency department classification of pelvic fractures first described in 2000. This information is of practical value to emergency physicians in identifying the potential vascular, genitourinary, gastrointestinal, orthopedic, and neurologic complications and further assists them in the initial evaluation and treatment of patients with pelvic fractures.

  9. Differences in the Clinical Outcome of Osteomyelitis by Treating Specialty: Orthopedics or Infectology.

    PubMed

    Arias Arias, Carolina; Tamayo Betancur, Maria Carolina; Pinzón, Miguel Alejandro; Cardona Arango, Doris; Capataz Taffur, Cesar Antonio; Correa Prada, Edgar

    2015-01-01

    Osteomyelitis is a heterogeneous infection with regard to etiology and treatment, and currently no single management protocol exists. Management of the condition is typically an interdisciplinary approach between orthopedics and infectious disease; however, the orthopedist is often the person who manages treatment. The aim of the study was to determine differences in the outcome of osteomyelitis according to its treating specialty and to identify factors associated with the recurrence of the disease. An ambispective cohort study of 129 patients with osteomyelitis was conducted and the proportions for qualitative variables and central tendency and dispersion measures for quantitative variables were calculated; the latter were tested for normality using the Shapiro-Wilk test. A bivariate analysis was conducted with measures of association based on the chi square test and crude relative risk. A logistic regression model was applied and statistical significance was set at p < 0.05, including the model of relevant clinical variables that fit the Hosmer-Lemeshow test. We found that 70% of patients were treated either by orthopedics or infectious disease. Patients who were treated by an orthopedist alone presented a greater risk of relapse or reinfection (RR = 4.6; 95% CI 2.3;8.9). Risk factors of osteomyelitis recurrence as determined in the regression model included the following: age of 57 years or older (RR = 1.3; 95% 0.3;5.2), long bones (RR = 1.9; 95% CI 0.5;7.1), fracture (RR = 5.0; 95% CI 0.4;51.4), monotherapy (RR = 3.0; 95% CI 0.6;14.5), receiving less than 4 weeks of antibiotics (RR = 1.5; 95% CI 0.2;10.1), inadequate treatment (RR = 3.1; 95% CI 0.4;20.1), and receiving orthopedics treatment (RR = 5.5; 95% CI 1.6;18.2). Most patients evaluated jointly by orthopedics and infectious disease received adequate treatment for osteomyelitis and had fewer relapses.

  10. [Clinical observation of traumatic ankle arthritis with orthopedics lotion on 60 cases].

    PubMed

    Zhang, Hui; Yu, Jie

    2014-02-01

    Observing the clinical curative effect of orthopedics lotion to treat traumatic ankle arthritis, the outpatient department of orthopedics in Guang'anmen Hospital collected 60 cases who were diagnosed as traumatic ankle arthritis. The cases who already met the inclusion criteria, were randomly divided into the treatment group (30 cases) and control group (30 cases). Thirty patients in treatment group were received fumigation treatment with orthopedics lotion; 30 patients in control group were treated by intra-articular injection of sodium hyaluronate. After 5 weeks treatment, the effects on the both groups would be observed and analysed. Baird-Jackson scoring system was used to assess the overall curative effect. Visual analogue scales (VAS) was used to assess analgesic effect. BJ scores of pre-treatment and post-treatment in both the treatment group and the control group were compared, P <0O. 01, significantly different; and the BJ scores after treatment of two groups were compared by paired t-test, the t value is 1. 76, there was no significant difference between two groups. Both of the treatments were effective, but there was no significant difference in overall curative effect between the two kinds of treatment. The VAS scores after treatment of two groups were compared by paired t-test, the t value was 2. 282, and there was a significant difference between two groups (P <0. 05). The analgesic effect shown in treatment group was better than the control group. The results suggest that: orthopedics lotion is a effective way to treat traumatic ankle arthritis, and it has significant effect on analgesic.

  11. 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.

  12. Melior Via: A Better Way to Integrate and Restore Movement into Orthopedic Rehabilitation.

    PubMed

    Hetzler, Brandon; Mahaffey, Brian

    2016-01-01

    Movement develops uniformly and predictably in all normal newborns and infants. The genetic roadmap for every complex movement that will ever be performed is written intoevery infant's nervous system and develops from these basic ingredients: unlimited mobility, an undeveloped nervous system, primal reflexes, and breathing. Following an injury, surgery or trauma, restoring movement is the same as learning movement only with slightly differing parameters. The principles, however, remain the same and can be used to improve orthopedic rehabilitation. PMID:27443044

  13. Adaptation of NASA technology for the optimum design of orthopedic knee implants.

    PubMed

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

    1991-03-01

    NASA technology originally developed for designing aircraft turbine-engine blades has been adapted and applied to orthopedic knee implants. This article describes a method for tailoring an implant for optimal interaction with the environment of the tibia. The implant components are designed to control stresses in the bone for minimizing bone degradation and preventing failures. Engineers expect the tailoring system to improve knee prosthesis design and allow customized implants for individual patients. PMID:10150099

  14. [Use of extracorporeal shockwave therapy (ESWT)in sports orthopedics].

    PubMed

    Steinacker, T; Steuer, M

    2001-06-01

    From 11/97 to 10/99 409 patients have been treated with the extracorporal shockwave therapy (ESWT) in the sport orthopaedic ambulance. An ultrasound controlled treatment was applied in the low and middle energy range, using energy densities of 0.09 to 0.36 mJ/mm2. The ESWT came into application as an operation avoiding procedure after exhausting the conventional conservative therapy measures. Among the 409 patients, 65 persons were competitive sportsmen. Besides the established indications for the application of the shock wave therapy, this method also has been applied with specific sport orthopaedic indications like achillodynia, patella-top-syndrome, medial shin-syndrome, morbus Schlatter or tendinosis of the shoulder. The results were collected three months after the application of the ESWT using a standardized questionnaire. The performed examination exhibits that for conservatively treated tendinoses of the competitive sportsmen, similarly good therapy results concerning the application of ESWT can be reached compared with the classical orthopaedic shockwave therapy. Therefore, for the treatment of a tendinosis, a shock wave therapy should always be taken into account to avoid long exercise and competition breaks due to operative interventions.

  15. Feasibility of a braided composite for orthopedic bone cast.

    PubMed

    Evans, Katherine R; Carey, Jason P

    2013-01-01

    A tubular braided composite bone cast for improving the efficiency and quality of bone fracture treatment is investigated. Finite element analysis was used to evaluate stress concentrations in fracture sites supported with plate and tubular casts. The stress in a plated bone is 768 % of that in a whole bone at the same location, while it is only 47 % in a bone with a tubular cast. Three unbroken synthetic humeri were mechanically tested using an in-vitro long bone testing procedure developed in-house to find their stiffness at 20° and 60° abduction; these were found to be 116.8 ± 1.5 N/mm and 20.63 ± 0.02 N/mm, respectively. A 2 cm gap osteotomy was cut through the diaphysis in each bone. The bones were casted with a Kevlar/Cold cure composite, with calculated braid angles and thicknesses that Closely matched bone propoerties. The stiffness tests were repeated, and the results were within 10 % of the unbroken bone. This novel method of bone casting is promising if other clinical challenges can be minimized. PMID:23459455

  16. Feasibility of a braided composite for orthopedic bone cast.

    PubMed

    Evans, Katherine R; Carey, Jason P

    2013-01-01

    A tubular braided composite bone cast for improving the efficiency and quality of bone fracture treatment is investigated. Finite element analysis was used to evaluate stress concentrations in fracture sites supported with plate and tubular casts. The stress in a plated bone is 768 % of that in a whole bone at the same location, while it is only 47 % in a bone with a tubular cast. Three unbroken synthetic humeri were mechanically tested using an in-vitro long bone testing procedure developed in-house to find their stiffness at 20° and 60° abduction; these were found to be 116.8 ± 1.5 N/mm and 20.63 ± 0.02 N/mm, respectively. A 2 cm gap osteotomy was cut through the diaphysis in each bone. The bones were casted with a Kevlar/Cold cure composite, with calculated braid angles and thicknesses that Closely matched bone propoerties. The stiffness tests were repeated, and the results were within 10 % of the unbroken bone. This novel method of bone casting is promising if other clinical challenges can be minimized.

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

    PubMed Central

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

    2016-01-01

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

  18. 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. PMID:26286704

  19. LASER Additive Manufacturing of Titanium-Tantalum Alloy Structured Interfaces for Modular Orthopedic Devices

    NASA Astrophysics Data System (ADS)

    Fuerst, Jacob; Medlin, Dana; Carter, Michael; Sears, James; Vander Voort, George

    2015-04-01

    Tantalum is recognized to have better biocompatibility and osseointegrative properties than other more commonly used orthopedic grade alloys. There are several novel methods that tantalum or tantalum-titanium could be used to augment orthopedic implants. A tantalum or tantalum-titanium alloy at the bone/implant or modular component interfaces would substantially increase the longevity and performance of modular devices. Bonding a functional tantalum coating to a titanium orthopedic device is inherently difficult because of the small difference between the melting temperature of tantalum, 3017°C, and the boiling point of titanium, 3287°C. LASER powder deposition (LPD) is a fusion operation using an Nd:YAG to melt a small volume of substrate into which metal powder is sprayed achieving high temperature with a high solidification rate. LPD of Ti-Ta onto a Ti-6Al-4V substrate produced both a solid surface and structured coating with a pore size in the optimal 350-500 μm range.

  20. Sol-Gel Derived Hydroxyapatite Coating on Mg-3Zn Alloy for Orthopedic Application

    NASA Astrophysics Data System (ADS)

    Singh, Sanjay; Manoj Kumar, R.; Kuntal, Kishor Kumar; Gupta, Pallavi; Das, Snehashish; Jayaganthan, R.; Roy, Partha; Lahiri, Debrupa

    2015-04-01

    In recent years, magnesium and its alloys have gained a lot of interest as orthopedic implant constituents because their biodegradability and mechanical properties are closer to that of human bone. However, one major concern with Mg in orthopedics is its high corrosion rate that results in the reduction of mechanical integrity before healing the bone tissue. The current study evaluates the sol-gel-derived hydroxyapatite (HA) coating on a selected Mg alloy (Mg-3Zn) for decreasing the corrosion rate and increasing the bioactivity of the Mg surface. The mechanical integrity of the coating is established as a function of the surface roughness of the substrate and the sintering temperature of the coating. Coating on a substrate roughness of 15-20 nm and sintering at 400°C shows the mechanical properties in similar range of bone, thus making it suitable to avoid the stress-shielding effect. The hydroxyapatite coating on the Mg alloy surface also increases corrosion resistance very significantly by 40 times. Bone cells are also found proliferating better in the HA-coated surface. All these benefits together establish the candidature of sol-gel HA-coated Mg-3Zn alloy in orthopedic application.

  1. Endovascular Treatment in Emergency Setting of Acute Arterial Injuries After Orthopedic Surgery

    SciTech Connect

    Carrafiello, Gianpaolo Fontana, Federico Mangini, Monica Ierardi, Anna Maria Lagana, Domenico; Piacentino, Filippo Vizzari, Francesco Alberto Spano, Emanuela Fugazzola, Carlo

    2012-06-15

    Purpose: To assess the feasibility and effectiveness of emergency endovascular treatment of acute arterial injuries after orthopedic surgery. Materials and Methods: Fifteen patients (mean age 68.3 years) with acute arterial injuries after orthopedic surgery were observed, in particular, 5 patients with pseudoaneurysm, 9 patients with active bleeding, and 1 patient with arterial dissection. Transarterial embolization (TAE) and positioning of covered and noncovered stents were the treatments performed. Follow-up after stent implantation (mean 36 months) was performed with color Doppler US (CDU) at 1, 3, 6, and 12 months and yearly thereafter. Plain X-ray was performed to evidence dislodgment or fracture of the graft. A minimum of 12 months' follow-up is available after TAE. Results: Immediate technical success was obtained in all cases. No major complications occurred. Overall clinical success rate was 100%. During mean follow-up, stent-graft occlusions did not occurred. No recurrence and/or consequence of TAE was registered during a minimum follow-up of 12 months. Conclusions: Percutaneous treatment is a feasible and safe tool for treating arterial injuries because it can provide fast and definitive resolution of the damage. This low-invasiveness approach can be proposed as first-line treatment in patients with acute injuries after orthopedic surgery.

  2. A touch probe method of operating an implantable RFID tag for orthopedic implant identification.

    PubMed

    Liu, Xiaoyu; Berger, J Lee; Ogirala, Ajay; Mickle, Marlin H

    2013-06-01

    The major problem in operating an implantable radio-frequency identification (RFID) tag embedded on an orthopedic implant is low efficiency because of metallic interference. To improve the efficiency, this paper proposes a method of operating an implantable passive RFID tag using a touch probe at 13.56 MHz. This technology relies on the electric field interaction between two pairs of electrodes, one being a part of the touch probe placed on the surface of tissue and the other being a part of the tag installed under the tissue. Compared with using a conventional RFID antenna such as a loop antenna, this method has a better performance in the near field operation range to reduce interference with the orthopedic implant. Properly matching the touch probe and the tag to the tissue and the implant reduces signal attenuation and increases the overall system efficiency. The experiments have shown that this method has a great performance in the near field transcutaneous operation and can be used for orthopedic implant identification.

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

    PubMed

    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

  4. 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

  5. Intravenous Paracetamol Reduces Postoperative Opioid Consumption after Orthopedic Surgery: A Systematic Review of Clinical Trials

    PubMed Central

    Khanna, Puneet

    2013-01-01

    Postoperative pain management is one of the most challenging jobs in orthopedic surgical population as it comprises of patients from extremes of ages and with multiple comorbidities. Though effective, opioids may contribute to serious adverse effects particularly in old age patients. Intravenous paracetamol is widely used in the postoperative period with the hope that it may reduce opioid consumption and produce better pain relief. A brief review of human clinical trials where intravenous paracetamol was compared with placebo or no treatment in postoperative period in orthopedic surgical population has been done here. We found that four clinical trials reported that there is a significant reduction in postoperative opioid consumption. When patients received an IV injection of 2 g propacetamol, reduction of morphine consumption up to 46% has been reported. However, one study did not find any reduction of opioid requirement after spinal surgery in children and adolescent. Four clinical trials reported better pain scores when paracetamol has been used, but other three trials denied. We conclude that postoperative intravenous paracetamol is a safe and effective adjunct to opioid after orthopedic surgery, but at present there is no data to decide whether paracetamol reduces opioid related adverse effects or not. PMID:24307945

  6. Intravenous paracetamol reduces postoperative opioid consumption after orthopedic surgery: a systematic review of clinical trials.

    PubMed

    Jebaraj, Bright; Maitra, Souvik; Baidya, Dalim Kumar; Khanna, Puneet

    2013-01-01

    Postoperative pain management is one of the most challenging jobs in orthopedic surgical population as it comprises of patients from extremes of ages and with multiple comorbidities. Though effective, opioids may contribute to serious adverse effects particularly in old age patients. Intravenous paracetamol is widely used in the postoperative period with the hope that it may reduce opioid consumption and produce better pain relief. A brief review of human clinical trials where intravenous paracetamol was compared with placebo or no treatment in postoperative period in orthopedic surgical population has been done here. We found that four clinical trials reported that there is a significant reduction in postoperative opioid consumption. When patients received an IV injection of 2 g propacetamol, reduction of morphine consumption up to 46% has been reported. However, one study did not find any reduction of opioid requirement after spinal surgery in children and adolescent. Four clinical trials reported better pain scores when paracetamol has been used, but other three trials denied. We conclude that postoperative intravenous paracetamol is a safe and effective adjunct to opioid after orthopedic surgery, but at present there is no data to decide whether paracetamol reduces opioid related adverse effects or not. PMID:24307945

  7. Is the orthopedic fellowship interview process broken? A survey of program directors and residents.

    PubMed

    Oladeji, Lasun O; Pehler, Stephen F; Raley, James A; Khoury, Joseph G; Ponce, Brent A

    2015-11-01

    Most orthopedic surgery residents pursue fellowship training. The fellowship interview process requires considerable time and financial investment from residents and residency programs. We conducted a study of the time, financial, and program disruption impact the fellowship interview process has on residents and residency programs. Two mixed-response questionnaires were sent to orthopedic surgery residency directors and postgraduate year 4 and 5 residents. Responses were received from 45 program directors and 129 residents. Sixty-two percent of the directors thought the interview process was extremely disruptive to their program. On average, the residents applied to 19 programs, received 14 interview offers, attended 11 interviews, were away from residency training 11 days, and spent $5875 on travel. About 70% of directors and residents wanted changes made to the orthopedic fellowship interview process. Sixty percent of the directors wanted interviews conducted in a central location. Our results highlight that time away from residency training, financial costs associated with the fellowship interview process, and disruption of the residency program are substantial.

  8. Orthopedic surgery and bone fracture pain are both significantly attenuated by sustained blockade of nerve growth factor.

    PubMed

    Majuta, Lisa A; Longo, Geraldine; Fealk, Michelle N; McCaffrey, Gwen; Mantyh, Patrick W

    2015-01-01

    The number of patients suffering from postoperative pain due to orthopedic surgery and bone fracture is projected to dramatically increase because the human life span, weight, and involvement in high-activity sports continue to rise worldwide. Joint replacement or bone fracture frequently results in skeletal pain that needs to be adequately controlled for the patient to fully participate in needed physical rehabilitation. Currently, the 2 major therapies used to control skeletal pain are nonsteroidal anti-inflammatory drugs and opiates, both of which have significant unwanted side effects. To assess the efficacy of novel therapies, mouse models of orthopedic and fracture pain were developed and evaluated here. These models, orthopedic surgery pain and bone fracture pain, resulted in skeletal pain-related behaviors that lasted 3 weeks and 8 to 10 weeks, respectively. These skeletal pain behaviors included spontaneous and palpation-induced nocifensive behaviors, dynamic weight bearing, limb use, and voluntary mechanical loading of the injured hind limb. Administration of anti-nerve growth factor before orthopedic surgery or after bone fracture attenuated skeletal pain behaviors by 40% to 70% depending on the end point being assessed. These data suggest that nerve growth factor is involved in driving pain due to orthopedic surgery or bone fracture. These animal models may be useful in developing an understanding of the mechanisms that drive postoperative orthopedic and bone fracture pain and the development of novel therapies to treat these skeletal pains.

  9. Orthopedic surgery and bone fracture pain are both significantly attenuated by sustained blockade of nerve growth factor

    PubMed Central

    Majuta, Lisa A.; Longo, Geraldine; Fealk, Michelle N.; McCaffrey, Gwen; Mantyh, Patrick W.

    2015-01-01

    The number of patients suffering from postoperative pain due to orthopedic surgery and bone fracture is projected to dramatically increase because the human life span, weight, and involvement in high-activity sports continue to rise worldwide. Joint replacement or bone fracture frequently results in skeletal pain that needs to be adequately controlled for the patient to fully participate in needed physical rehabilitation. Currently, the 2 major therapies used to control skeletal pain are nonsteroidal anti-inflammatory drugs and opiates, both of which have significant unwanted side effects. To assess the efficacy of novel therapies, mouse models of orthopedic and fracture pain were developed and evaluated here. These models, orthopedic surgery pain and bone fracture pain, resulted in skeletal pain–related behaviors that lasted 3 weeks and 8 to 10 weeks, respectively. These skeletal pain behaviors included spontaneous and palpation-induced nocifensive behaviors, dynamic weight bearing, limb use, and voluntary mechanical loading of the injured hind limb. Administration of anti–nerve growth factor before orthopedic surgery or after bone fracture attenuated skeletal pain behaviors by 40% to 70% depending on the end point being assessed. These data suggest that nerve growth factor is involved in driving pain due to orthopedic surgery or bone fracture. These animal models may be useful in developing an understanding of the mechanisms that drive postoperative orthopedic and bone fracture pain and the development of novel therapies to treat these skeletal pains. PMID:25599311

  10. Educational impact of a clinical anatomy workshop on 1st-year orthopedic and rheumatology fellows in Mexico City.

    PubMed

    Saavedra, M A; Villaseñor-Ovies, P; Harfush, L A; Navarro-Zarza, J E; Canoso, J J; Cruz-Domínguez, P; Vargas, A; Hernández-Díaz, C; Chiapas-Gasca, K; Camacho-Galindo, J; Alvarez-Nemegyei, J; Kalish, R A

    2016-05-01

    We aim to study the educational impact of a clinical anatomy workshop in 1st-year orthopedic and rheumatology fellows. First-year rheumatology fellows (N = 17) and a convenience sample of 1st-year orthopedic fellows (N = 14) from Mexico City in the 9th month of training participated in the study. The pre- and the post- workshop tests included the same 20 questions that had to be answered by identification or demonstration of relevant anatomical items. The questions, arranged by anatomical regions, were asked in five dynamic stations. Overall, the 31 participants showed an increase of correct answers, from a median of 6 (range 1 to 12) in the pre-workshop test, to a median of 14 (range 7 to 19) in the post-workshop test. In the pre-workshop test, the correct median answers were 7 (range 2 to 12) in the orthopedic fellows and 5 (range 1 to 10) in the rheumatology fellows (p = 0.297). Corresponding scores in the post-workshop were 15 (range 10 to 19) and 12 (range 7 to 18) (p = 0.026) showing a significant difference favoring the orthopedic group. Our clinical anatomy workshop was efficacious, in the short term, as a teaching instrument for 1st-year orthopedic and rheumatology fellows. The post-workshop scores, although significantly improved in both groups, particularly in the orthopedic fellows, were still suboptimal. Further refinements of our workshop might yield better results.

  11. Tranexamic Acid in Anesthetic Management of Surgical Procedures.

    PubMed

    Mayeux, Jessica; Alwon, Kathy; Collins, Shawn; Hewer, Ian

    2016-06-01

    Blood loss during surgical procedures poses a grave risk to the patient, but transfusion is costly and associated with adverse outcomes. Antifibrinolytics, however, offer an economical and effective means of decreasing blood loss associated with surgical procedures. Tranexamic acid (TXA) is an antifibrinolytic that blocks lysine-binding sites of fibrinogen and fibrin, preventing the breakdown of existing clots. This journal course reviews extensive research demonstrating that antifibrinolytics such as TXA decrease blood loss and in some studies reduce allogeneic transfusion requirements. In addition, this journal course addresses concerns that use of antifibrinolytics increases embolic events, reviews research that demonstrates TXA does not increase the incidence of vascular occlusive events, and describes methods of TXA use in cardiac and orthopedic surgical procedures, neurosurgery, and obstetrics. The Certified Registered Nurse Anesthetist should consider the possibility, on a case-by-case basis, of using TXA in surgical procedures to reduce blood loss with minimal adverse effects. PMID:27501656

  12. Noninvasive CT to Iso-C3D registration for improved intraoperative visualization in computer assisted orthopedic surgery

    NASA Astrophysics Data System (ADS)

    Rudolph, Tobias; Ebert, Lars; Kowal, Jens

    2006-03-01

    Supporting surgeons in performing minimally invasive surgeries can be considered as one of the major goals of computer assisted surgery. Excellent intraoperative visualization is a prerequisite to achieve this aim. The Siremobil Iso-C 3D has become a widely used imaging device, which, in combination with a navigation system, enables the surgeon to directly navigate within the acquired 3D image volume without any extra registration steps. However, the image quality is rather low compared to a CT scan and the volume size (approx. 12 cm 3) limits its application. A regularly used alternative in computer assisted orthopedic surgery is to use of a preoperatively acquired CT scan to visualize the operating field. But, the additional registration step, necessary in order to use CT stacks for navigation is quite invasive. Therefore the objective of this work is to develop a noninvasive registration technique. In this article a solution is being proposed that registers a preoperatively acquired CT scan to the intraoperatively acquired Iso-C 3D image volume, thereby registering the CT to the tracked anatomy. The procedure aligns both image volumes by maximizing the mutual information, an algorithm that has already been applied to similar registration problems and demonstrated good results. Furthermore the accuracy of such a registration method was investigated in a clinical setup, integrating a navigated Iso-C 3D in combination with an tracking system. Initial tests based on cadaveric animal bone resulted in an accuracy ranging from 0.63mm to 1.55mm mean error.

  13. Gentamicin-loaded poly(lactic-co-glycolic acid) microparticles for the prevention of maxillofacial and orthopedic implant infections.

    PubMed

    Flores, Claudia; Degoutin, Stephanie; Chai, Feng; Raoul, Gwenael; Hornez, Jean-Chritophe; Martel, Bernard; Siepmann, Juergen; Ferri, Joel; Blanchemain, Nicolas

    2016-07-01

    Trauma and orthopedic surgery can cause infections as any open surgical procedures. Such complications occur in only1 to 5% of the cases, but the treatment is rather complicated due to bacterial biofilm formation and limited drug access to the site of infection upon systemic administration. An interesting strategy to overcome this type of complications is to prevent bacterial proliferation and biofilm formation via the local and controlled release of antibiotic drugs from the implant itself. Obviously, the incorporation of the drug into the implant should not affect the latter's biological and mechanical properties. In this context, we optimized the preparation process for gentamicin-loaded poly(lactic-co-glycolic acid) (PLGA) microparticles, which can be incorporated in the macropores of calcium phosphate-based bone substitutes. Microparticles were prepared using a double emulsion solvent extraction/evaporation technique. The processing parameters were optimized in order to provide an average microparticle size of about 60μm, allowing for incorporation inside the macropores (100μm) of the hydroxyapatite scaffold. Gentamicin-loaded PLGA microparticles showed a sustained release for 25-30days and a rapid antibacterial activity due to a burst effect, the extent of which was controlled by the initial loading of the microparticles. SEM pictures revealed a highly porous microparticle structure, which can help to reduce the micro environmental pH drop and autocatalytic effects. The biological evaluation showed the cytocompatibility and non-hemolytic property of the microparticles, and the antibacterial activity against Staphylococcus aureus under the given conditions.

  14. Gentamicin-loaded poly(lactic-co-glycolic acid) microparticles for the prevention of maxillofacial and orthopedic implant infections.

    PubMed

    Flores, Claudia; Degoutin, Stephanie; Chai, Feng; Raoul, Gwenael; Hornez, Jean-Chritophe; Martel, Bernard; Siepmann, Juergen; Ferri, Joel; Blanchemain, Nicolas

    2016-07-01

    Trauma and orthopedic surgery can cause infections as any open surgical procedures. Such complications occur in only1 to 5% of the cases, but the treatment is rather complicated due to bacterial biofilm formation and limited drug access to the site of infection upon systemic administration. An interesting strategy to overcome this type of complications is to prevent bacterial proliferation and biofilm formation via the local and controlled release of antibiotic drugs from the implant itself. Obviously, the incorporation of the drug into the implant should not affect the latter's biological and mechanical properties. In this context, we optimized the preparation process for gentamicin-loaded poly(lactic-co-glycolic acid) (PLGA) microparticles, which can be incorporated in the macropores of calcium phosphate-based bone substitutes. Microparticles were prepared using a double emulsion solvent extraction/evaporation technique. The processing parameters were optimized in order to provide an average microparticle size of about 60μm, allowing for incorporation inside the macropores (100μm) of the hydroxyapatite scaffold. Gentamicin-loaded PLGA microparticles showed a sustained release for 25-30days and a rapid antibacterial activity due to a burst effect, the extent of which was controlled by the initial loading of the microparticles. SEM pictures revealed a highly porous microparticle structure, which can help to reduce the micro environmental pH drop and autocatalytic effects. The biological evaluation showed the cytocompatibility and non-hemolytic property of the microparticles, and the antibacterial activity against Staphylococcus aureus under the given conditions. PMID:27127034

  15. Dental Procedures.

    PubMed

    Ramponi, Denise R

    2016-01-01

    Dental problems are a common complaint in emergency departments in the United States. There are a wide variety of dental issues addressed in emergency department visits such as dental caries, loose teeth, dental trauma, gingival infections, and dry socket syndrome. Review of the most common dental blocks and dental procedures will allow the practitioner the opportunity to make the patient more comfortable and reduce the amount of analgesia the patient will need upon discharge. Familiarity with the dental equipment, tooth, and mouth anatomy will help prepare the practitioner for to perform these dental procedures. PMID:27482994

  16. Between psychology and pedagogy: "moral orthopedics" and case studies of children in fin-de-siècle French medicine.

    PubMed

    Rose, Anna Christina

    2011-02-01

    In the latter decades of the 19th century, European physicians debated a controversial practice that mixed placebos with suggestion therapy to treat children diagnosed with neurotic disorders and behavioral problems. Designed to optimize suggestibility in juvenile patients, this "moral orthopedics" offered parents and therapists the message that children could be saved from becoming victims of their own personalities, of familial neuroses, or even of public health problems. Case studies, published in medical journals and books, circulated accounts of innovative strategies to treat childhood hysteria and to change habits that were considered destructive. Moral orthopedics actualized the insight that suggestibility could be therapeutically productive for juvenile subjects. However, because its adherents sought to manipulate patients' behavior and health by influencing unconscious thought, moral orthopedics provoked questions of expertise and disciplinary propriety among domains of medicine, law, and philosophy. This article reconstructs the controversy surrounding moral orthopedics by examining case studies. I argue that adherents of moral orthopedics did overcome philosophical objections raised against the method, and that they did so through what physician Edgar B6rillon referred to as "education of the will."

  17. Active Ankle Movements Prevent Formation of Lower-Extremity Deep Venous Thrombosis After Orthopedic Surgery

    PubMed Central

    Li, Ye; Guan, Xiang-Hong; Wang, Rui; Li, Bin; Ning, Bo; Su, Wei; Sun, Tao; Li, Hong-Yan

    2016-01-01

    Background The aim of this study was to assess the preventive value of active ankle movements in the formation of lower-extremity deep venous thrombosis (DVT), attempting to develop a new method for rehabilitation nursing after orthopedic surgery. Material/Methods We randomly assigned 193 patients undergoing orthopedic surgery in the lower limbs into a case group (n=96) and a control group (n=97). The control group received routine nursing while the case group performed active ankle movements in addition to receiving routine nursing. Maximum venous outflow (MVO), maximum venous capacity (MVC), and blood rheology were measured and the incidence of DVT was recorded. Results On the 11th and 14th days of the experiment, the case group had significantly higher MVO and MVC than the control group (all P<0.05). The whole-blood viscosity at high shear rate and the plasma viscosity were significantly lower in the case group than in the control group on the 14th day (both P<0.05). During the experiment, a significantly higher overall DVT incidence was recorded in the control group (8 with asymptomatic DVT) compared with the case group (1 with asymptomatic DVT) (P=0.034). During follow-up, the case group presented a significantly lower DVT incidence (1 with symptomatic DVT and 4 with asymptomatic DVT) than in the control group (5 with symptomatic DVT and 10 with asymptomatic DVT) (P=0.031). Conclusions Through increasing MVO and MVC and reducing blood rheology, active ankle movements may prevent the formation of lower-extremity DVT after orthopedic surgery. PMID:27600467

  18. Low-power circuits for the bidirectional wireless monitoring system of the orthopedic implants.

    PubMed

    Hong Chen; Ming Liu; Wenhan Hao; Yi Chen; Chen Jia; Chun Zhang; Zihua Wang

    2009-12-01

    This paper proposes an architecture of the wireless monitoring system for the real-time monitoring of the orthopedic implants, which monitors the implant duty cycle, detects abnormal asymmetry, high amounts of force, and other conditions of the orthopedic implants. Data for diagnosis are communicated wirelessly by the radio-frequency (RF) signal between the embedded chip and the remote circuit. In different working modes, the system can be powered by the RF signal or stiff lead zirconate-titanate (PZT) ceramics which are able to convert mechanical energy inside the orthopedic implant into electrical energy. The power circuits with a variable ratio switched-capacitor (SC) dc-dc converter have been taped out with 0.35-mum complementary metal-oxide semiconductor (CMOS) technology. The test results show that the SC converter can transfer the input voltage that ranges from 5 V to 14 V from the PZT ceramics into the voltage ranging from 2 V to 2.5 V which will be dealt with by a low drop-out circuit in the future work. The total efficiency of the SC converter is from 28% to 42% at full-time working mode. The analog-to-digital converter (ADC) circuits have been fabricated in a 0.18-mum 1P6M CMOS process. The test results show that the ADC chip consumes only 12.5 muW in working mode and 150 nW in the sleep mode. The circuits, including RF circuits, ADC, and the microcontrol unit, have been implemented in a 0.18-mu m CMOS process. Future work includes some clinical experiments test in the application where PZT elements are used for power generation in total knee-replacement implants. PMID:23853291

  19. Low-power circuits for the bidirectional wireless monitoring system of the orthopedic implants.

    PubMed

    Hong Chen; Ming Liu; Wenhan Hao; Yi Chen; Chen Jia; Chun Zhang; Zihua Wang

    2009-12-01

    This paper proposes an architecture of the wireless monitoring system for the real-time monitoring of the orthopedic implants, which monitors the implant duty cycle, detects abnormal asymmetry, high amounts of force, and other conditions of the orthopedic implants. Data for diagnosis are communicated wirelessly by the radio-frequency (RF) signal between the embedded chip and the remote circuit. In different working modes, the system can be powered by the RF signal or stiff lead zirconate-titanate (PZT) ceramics which are able to convert mechanical energy inside the orthopedic implant into electrical energy. The power circuits with a variable ratio switched-capacitor (SC) dc-dc converter have been taped out with 0.35-mum complementary metal-oxide semiconductor (CMOS) technology. The test results show that the SC converter can transfer the input voltage that ranges from 5 V to 14 V from the PZT ceramics into the voltage ranging from 2 V to 2.5 V which will be dealt with by a low drop-out circuit in the future work. The total efficiency of the SC converter is from 28% to 42% at full-time working mode. The analog-to-digital converter (ADC) circuits have been fabricated in a 0.18-mum 1P6M CMOS process. The test results show that the ADC chip consumes only 12.5 muW in working mode and 150 nW in the sleep mode. The circuits, including RF circuits, ADC, and the microcontrol unit, have been implemented in a 0.18-mu m CMOS process. Future work includes some clinical experiments test in the application where PZT elements are used for power generation in total knee-replacement implants.

  20. 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.

  1. Prevalence of Vitamin D Deficiency and Its Association With Metabolic Disease in Korean Orthopedic Patients.

    PubMed

    Kim, Ki-Tack; Kang, Kyung-Chung; Shin, Dong-Eun; Lee, Sang-Hoon; Lee, Jung-Hee; Kwon, Tae-Yoon

    2015-10-01

    Vitamin D is considered essential for bone and muscle health, and some studies have demonstrated the positive effects of vitamin D on metabolic diseases and cancer. Nevertheless, a high prevalence of vitamin D deficiency has been reported in various populations, regardless of country or race. However, no studies regarding the prevalence of vitamin D deficiency in Korean orthopedic patients currently exist. This cross-sectional study included 272 male and 937 female patients aged 50 years and older who were consecutively admitted to the authors' orthopedic department. Vitamin D (25-hydroxy vitamin D), bone turnover markers (osteocalcin, c-telopeptide), and bone mineral density were measured. The prevalence of vitamin D deficiency and its association with other factors were evaluated. Mean patient age was 67.2 ± 8.9 years, and mean level of vitamin D was 16.1 ± 9.1 ng/mL. Overall, 91.2% of patients had deficient (<20 ng/mL; 70.6%) or insufficient (20-30 ng/mL; 20.6%) levels of vitamin D. Vitamin D level did not vary by age group or sex. The level of vitamin D was significantly associated with osteocalcin, c-telopeptide, calcium, alkaline phosphatase, total cholesterol, triglycerides, low-density lipoprotein cholesterol, and glucose (P<.01). Vitamin D level in Korean orthopedic patients of this region was extremely low, regardless of sex and age. Although vitamin D was not directly associated with bone mineral density, there were significant associations between vitamin D and other factors related to bone health and metabolic diseases.

  2. Active Ankle Movements Prevent Formation of Lower-Extremity Deep Venous Thrombosis After Orthopedic Surgery.

    PubMed

    Li, Ye; Guan, Xiang-Hong; Wang, Rui; Li, Bin; Ning, Bo; Su, Wei; Sun, Tao; Li, Hong-Yan

    2016-01-01

    BACKGROUND The aim of this study was to assess the preventive value of active ankle movements in the formation of lower-extremity deep venous thrombosis (DVT), attempting to develop a new method for rehabilitation nursing after orthopedic surgery. MATERIAL AND METHODS We randomly assigned 193 patients undergoing orthopedic surgery in the lower limbs into a case group (n=96) and a control group (n=97). The control group received routine nursing while the case group performed active ankle movements in addition to receiving routine nursing. Maximum venous outflow (MVO), maximum venous capacity (MVC), and blood rheology were measured and the incidence of DVT was recorded. RESULTS On the 11th and 14th days of the experiment, the case group had significantly higher MVO and MVC than the control group (all P<0.05). The whole-blood viscosity at high shear rate and the plasma viscosity were significantly lower in the case group than in the control group on the 14th day (both P<0.05). During the experiment, a significantly higher overall DVT incidence was recorded in the control group (8 with asymptomatic DVT) compared with the case group (1 with asymptomatic DVT) (P=0.034). During follow-up, the case group presented a significantly lower DVT incidence (1 with symptomatic DVT and 4 with asymptomatic DVT) than in the control group (5 with symptomatic DVT and 10 with asymptomatic DVT) (P=0.031). CONCLUSIONS Through increasing MVO and MVC and reducing blood rheology, active ankle movements may prevent the formation of lower-extremity DVT after orthopedic surgery. PMID:27600467

  3. Orthopedic Practice Patterns Relating to Anterior Cruciate Ligament Reconstruction in Elite Athletes.

    PubMed

    Erickson, Brandon J; Harris, Joshua D; Fillingham, Yale A; Cvetanovich, Gregory L; Bush-Joseph, Charles; Cole, Brian J; Bach, Bernard R; Verma, Nikhil N

    2015-12-01

    We conducted an online survey of National Hockey League (NHL), Major League Soccer (MLS), and US Olympic/World Cup Ski/Snowboard (Olympic) team orthopedic surgeons to determine practice patterns relating to anterior cruciate ligament (ACL) reconstruction in elite athletes. Of the 94 team orthopedic surgeons surveyed, 47 (50%) responded. Mean (SD) experience as a team physician was 7.73 (5.33) years for NHL, 6.77 (6.64) years for MLS, and 1.14 (0.36) years for Olympic. Mean (SD) number of ACL reconstructions performed in 2012 was 101 (51) for NHL, 78 (38) for MLS, and 110 (105) for Olympic. Overall, 33 surgeons (70.2%) indicated they would use bone-patellar tendon-bone (BPTB) autograft to treat their starting athletes. Twenty-one (44.7%) drilled the femoral tunnel through a transtibial portal, 36.2% through an anteromedial portal, and 12.8% by a 2-incision technique. All the surgeons used a single-bundle technique. Thirty-three (70.2%) did not recommend a brace for their elite athletes during play on return to sport (RTS). Twenty-seven NHL and MLS surgeons (81.8%) recommended RTS only after an athlete has passed a series of RTS tests (eg, Vail, single-leg hop). Most of the NHL, MLS, and Olympic team orthopedic surgeons who were surveyed perform their ACL reconstructions using BPTB autograft, using a single-bundle technique, and through a transtibial portal, and do not require bracing for their athletes returning to sport. Most required their athletes to complete a series of RTS tests before resuming competitive play. PMID:26665248

  4. Non-Osteotomy and Osteotomy Large Animal Fracture Models in Orthopedic Trauma Research

    PubMed Central

    Decker, Sebastian; Reifenrath, Janin; Omar, Mohamed; Krettek, Christian; Müller, Christian W.

    2014-01-01

    Large animal fracture models are important in the field of orthopedic trauma research. New implants are tested in animals before being implanted into humans. Large animals like sheep or swine often are more properly to simulate conditions in humans, e.g. biomechanical demands, compared to rodents. Cited articles mainly analyze shock or fracture healing. Both osteotomy and non-osteotomy fracture models have been used in the past. However, comparative studies are rare and clear recommendation when to use which model are missing. This review will summarize large animal fracture models putting special emphasis on non-osteotomy fracture models. PMID:25568730

  5. Orthopedic and orthodontic treatment in central giant cell granuloma treated with calcitonin.

    PubMed

    Romero, Martín; Romance, Ana; Garcia-Recuero, José Ismael; Fernández, Álvaro

    2011-09-01

    Central giant cell granuloma of the jaw is a benign lesion of unknown etiology that occurs with very low frequency. It mainly occurs in children and young adults and is more common in the mandible. The most common treatment is surgical removal; however, alternative therapies (intralesional injections of corticosteroids, interferon alpha, and calcitonin) have been used in order to avoid undesirable damage to the jaws and teeth. The lesion may cause root resorption, tooth germ displacement, and other dental problems, as well as malocclusion that must be treated orthodontically. The orthodontic, orthopedic, and calcitonin-based treatments of one of these cases is presented.

  6. Osteoanabolic Implants: Osteoanabolic Implant Materials for Orthopedic Treatment (Adv. Healthcare Mater. 14/2016).

    PubMed

    Ding, Yun-Fei; Li, Rachel W; Nakai, Masaaki; Majumdar, Trina; Zhang, Dong-Hai; Niinomi, Mitsuo; Birbilis, Nick; Smith, Paul N; Chen, Xiao-Bo

    2016-07-01

    On page 1740, Xiao-Bo Chen and co-workers report an orthopedic implant material specifically designed for osteoporotic bone fractures. A newl strontium phosphate coating applied to a bone-mimicking low elastic titanium alloy with a comparative Young's modulus to that of natural bone results in upregulating the growth of osteoblasts and downregulating that of osteoclasts. Such a promising osteoanabolic effect reveals a suitability in particular for patients who suffer from low quality bone organism and slow fracture recovery. PMID:27436105

  7. Differences in the Clinical Outcome of Osteomyelitis by Treating Specialty: Orthopedics or Infectology.

    PubMed

    Arias Arias, Carolina; Tamayo Betancur, Maria Carolina; Pinzón, Miguel Alejandro; Cardona Arango, Doris; Capataz Taffur, Cesar Antonio; Correa Prada, Edgar

    2015-01-01

    Osteomyelitis is a heterogeneous infection with regard to etiology and treatment, and currently no single management protocol exists. Management of the condition is typically an interdisciplinary approach between orthopedics and infectious disease; however, the orthopedist is often the person who manages treatment. The aim of the study was to determine differences in the outcome of osteomyelitis according to its treating specialty and to identify factors associated with the recurrence of the disease. An ambispective cohort study of 129 patients with osteomyelitis was conducted and the proportions for qualitative variables and central tendency and dispersion measures for quantitative variables were calculated; the latter were tested for normality using the Shapiro-Wilk test. A bivariate analysis was conducted with measures of association based on the chi square test and crude relative risk. A logistic regression model was applied and statistical significance was set at p < 0.05, including the model of relevant clinical variables that fit the Hosmer-Lemeshow test. We found that 70% of patients were treated either by orthopedics or infectious disease. Patients who were treated by an orthopedist alone presented a greater risk of relapse or reinfection (RR = 4.6; 95% CI 2.3;8.9). Risk factors of osteomyelitis recurrence as determined in the regression model included the following: age of 57 years or older (RR = 1.3; 95% 0.3;5.2), long bones (RR = 1.9; 95% CI 0.5;7.1), fracture (RR = 5.0; 95% CI 0.4;51.4), monotherapy (RR = 3.0; 95% CI 0.6;14.5), receiving less than 4 weeks of antibiotics (RR = 1.5; 95% CI 0.2;10.1), inadequate treatment (RR = 3.1; 95% CI 0.4;20.1), and receiving orthopedics treatment (RR = 5.5; 95% CI 1.6;18.2). Most patients evaluated jointly by orthopedics and infectious disease received adequate treatment for osteomyelitis and had fewer relapses. PMID:26678551

  8. [Surface modifications to improve biocompatibility and mechanical properties of orthopedic implants].

    PubMed

    Thull, R

    2003-01-01

    State of the art surface modifications on metallic materials for orthopedic and dental implants permit clinical application if implant design,manufacturing process as well as function and duration of implantation are harmonized with each other. Keeping these prerequisites in mind,hydroxylapatite is suited for closer connection of fixation elements in hard tissue. PVD or PECVD modifications can make gliding surfaces or surfaces of fixation elements abrasion resistant if the pressure-area ratio does not exceed threshold values in cases of surfaces moving relative to each other

  9. iPhone and iPad Use in Orthopedic Surgery

    PubMed Central

    Duncan, Scott F. M.; Hendawi, Tariq K.; Sperling, John; Kakinoki, Ryosuke; Hartsock, Landon

    2015-01-01

    Background Thousands of healthcare mobile applications (apps) are available, and physicians are increasingly recognizing that mobile technology can improve their workflow and allow them to practice medicine in a better and/or more efficient manner. Methods This article highlights apps compatible with the iPhone and iPad and their utility to the busy orthopedic surgeon. Results Currently available apps address every aspect of healthcare: patient management, reference, education, and research. Conclusion Key aspects of helpful apps include low cost (preferably free), a user-friendly interface, and simplicity. PMID:25829881

  10. The effect of pharmacy restriction of clindamycin on Clostridium difficile infection rates in an orthopedics ward.

    PubMed

    Cruz-Rodríguez, Nora Cecilia; Hernández-García, Raúl; Salinas-Caballero, Ana Gabriela; Pérez-Rodríguez, Edelmiro; Garza-González, Elvira; Camacho-Ortiz, Adrián

    2014-06-01

    A high consumption of clindamycin was noted in an orthopedics ward with high rates of Clostridium difficile infection (CDI). We restricted clindamycin for the entire ward. A reduction of 88% in CDI (1.07 to 0.12 × 1,000 patients-days, P = .056) and 84% for all-cause diarrhea (2.40 to 0.38 × 1,000 patients-days, P = .021) was achieved. Clindamycin was reduced 92.61% without an increase in other antibiotics. We identified high consumption of clindamycin as a risk factor for CDI.

  11. Orthopedic and orthodontic treatment in central giant cell granuloma treated with calcitonin.

    PubMed

    Romero, Martín; Romance, Ana; Garcia-Recuero, José Ismael; Fernández, Álvaro

    2011-09-01

    Central giant cell granuloma of the jaw is a benign lesion of unknown etiology that occurs with very low frequency. It mainly occurs in children and young adults and is more common in the mandible. The most common treatment is surgical removal; however, alternative therapies (intralesional injections of corticosteroids, interferon alpha, and calcitonin) have been used in order to avoid undesirable damage to the jaws and teeth. The lesion may cause root resorption, tooth germ displacement, and other dental problems, as well as malocclusion that must be treated orthodontically. The orthodontic, orthopedic, and calcitonin-based treatments of one of these cases is presented. PMID:20815718

  12. Sudden Sensorineural Hearing Loss after Orthopedic Surgery under Combined Spinal and Epidural Anesthesia

    PubMed Central

    Vilhena, Ditza; Pereira, Luís; Duarte, Delfim; Oliveira, Nuno

    2016-01-01

    Postoperative hearing loss following nonotologic surgery is rare. For patients undergoing subarachnoid anesthesia, the loss of cerebral spinal fluid and hence the drop in intracranial pressure can result in hearing loss and cranial nerve palsy. We report a case in which a patient sustained orthopedic surgery under combined spinal and epidural anesthesia complicated by severe and persistent sensorineural hearing loss. This report is a reminder that postoperative sudden sensorineural hearing loss is a poorly understood complication. A high index of suspicion is required for early diagnosis of this complication, although prompt treatment does not guarantee a good outcome. PMID:26904339

  13. Differences in the Clinical Outcome of Osteomyelitis by Treating Specialty: Orthopedics or Infectology

    PubMed Central

    Cardona Arango, Doris; Capataz Taffur, Cesar Antonio; Correa Prada, Edgar

    2015-01-01

    Osteomyelitis is a heterogeneous infection with regard to etiology and treatment, and currently no single management protocol exists. Management of the condition is typically an interdisciplinary approach between orthopedics and infectious disease; however, the orthopedist is often the person who manages treatment. The aim of the study was to determine differences in the outcome of osteomyelitis according to its treating specialty and to identify factors associated with the recurrence of the disease. An ambispective cohort study of 129 patients with osteomyelitis was conducted and the proportions for qualitative variables and central tendency and dispersion measures for quantitative variables were calculated; the latter were tested for normality using the Shapiro-Wilk test. A bivariate analysis was conducted with measures of association based on the chi square test and crude relative risk. A logistic regression model was applied and statistical significance was set at p < 0.05, including the model of relevant clinical variables that fit the Hosmer-Lemeshow test. We found that 70% of patients were treated either by orthopedics or infectious disease. Patients who were treated by an orthopedist alone presented a greater risk of relapse or reinfection (RR = 4.6; 95% CI 2.3;8.9). Risk factors of osteomyelitis recurrence as determined in the regression model included the following: age of 57 years or older (RR = 1.3; 95% 0.3;5.2), long bones (RR = 1.9; 95% CI 0.5;7.1), fracture (RR = 5.0; 95% CI 0.4;51.4), monotherapy (RR = 3.0; 95% CI 0.6;14.5), receiving less than 4 weeks of antibiotics (RR = 1.5; 95% CI 0.2;10.1), inadequate treatment (RR = 3.1; 95% CI 0.4;20.1), and receiving orthopedics treatment (RR = 5.5; 95% CI 1.6;18.2). Most patients evaluated jointly by orthopedics and infectious disease received adequate treatment for osteomyelitis and had fewer relapses. PMID:26678551

  14. Adaptation of NASA technology for the optimization of orthopedic knee implants

    NASA Technical Reports Server (NTRS)

    Saravanos, D. A.; Mraz, P. J.; Hopkins, D. A.

    1991-01-01

    The NASA technology originally developed for the optimization of composite structures (engine blades) is adapted and applied to the optimization of orthopedic knee implants. A method is developed enabling the tailoring of the implant for optimal interaction with the environment of the tibia. The shape of the implant components are optimized, such that the stresses in the bone are favorably controlled to minimize bone degradation and prevent failures. A pilot tailoring system is developed and the feasibility of the concept is elevated. The optimization system is expected to provide the means for improving knee prosthesis and individual implant tailoring for each patient.

  15. [THE USE OF THE METHOD FOR DETERMINING THE "ORTHOPEDIC INDEX" IN THE TREATMENT OF PATIENTS WITH FEMORAL NECK FRACTURE].

    PubMed

    Brizhan', L K; Buriachenko, B P; Varfolomeev, D I; Maksimov, B I; Mantserov, K M; Davydov, D V

    2015-01-01

    The choice of surgical strategy for the treatment of femoral neck fracture is a serious challenge to modern traumatology and orthopedics. Group I of this study was comprised of patients in whom orthopedic age was determined by our original method including assessment of the quality of life based on the SF-36 questionnaire. The somatic state of the patients was evaluated from the Charlson index and bone quality in the surgical area by densitometry. Patients of the control group were treated by the standard methods adopted in this country and abroad. It was shown that the difference between orthopedic and calendar ages results in the increase of the frequency of complications. The clinical and statistical results of the study indicate that the new method permits to reduce the number of revision interventions, decrease postoperative lethality, and improve the patients' quality of life. PMID:26117924

  16. Orthopedic services

    MedlinePlus

    ... Sports medicine physicians are doctors with experience in sports medicine. They have a primary specialty in family practice, internal medicine, emergency medicine, pediatrics, or physical medicine and rehabilitation. Most have 1 to 2 years of additional ...

  17. [Orthopedic biomaterials].

    PubMed

    Sedel, L; Nizard, R; Meunier, A

    1995-03-01

    It is very challenging to insure long term security and effectiveness for joint arthroplasties, artificial ligaments, extensive bone replacement and some other orthopaedic biomaterials. How can we predict the long term security and efficacy of such an implant? Only an interdisciplinary approach can provide a satisfactory answer. The surgeon must define the needs, he must find the appropriate surgical techniques and conduct the clinical trial. The material scientist must elaborate safe and secure materials with regards to their biotolerance and mechanical resistance. This has to be performed in close connection with the biomechanics lab. Biomechanic Science must predict the expected stresses. It has to design special simulator to quantify in vitro material toughness, wear characteristics, lubrication, behaviour and surface deformation. Biological and mechanical standardized tests have to be carried on. Then it is possible to conduct a clinical trial, prospectively in comparison to another already developed material. Clinical studies could serve to measure efficacy and radiological modification. After failure, it is possible to analyse retrieved specimen, to measure the material degradation in real environment, to perform biological studies on retrieved tissues i.e. : macrophagic activities, tissue response, bone ingrowth, inflammatory or immunological reaction. For more than twenty years we worked on alumina against alumina total hips. The idea was to develop a low debris system to enhance long term longevity of the prosthesis. The Charnley design has proven its effectiveness for more than fifteen years, but polyethylene wear is responsible for late failures. This is specially crucial for young patients, male sex and high activity level patients. At the beginning, biological studies and mechanical tests were performed, it appeared that the biological tolerance of alumina ceramic was excellent, the fracture toughness was adequate, but there were some problems related to alumina fixation in the body and also alumina head fixation on metallic stem. Alumina material improved with time. It was possible to diminish the fracture risks and to increase the safety. Parallel information from the first period was used to increase the material quality, the surgical techniques and also to define indication in the use of such material. It is now clear and it also has been published that alumina against alumina system has proved to be as safe as Charnley total hips. It has been proved to give better results in the young age population. Then it is now possible to operate on very young patients, to allow these patients to perform heavy work, sports and regular daily activity for their demand.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:7648297

  18. [Preliminary study on general safe medication regularity of Chinese patent orthopedic medicines based on adverse reaction/event literature analysis].

    PubMed

    Wang, Yu-guang; Shi, Xin-yuan; Jin, Rui; Li, Hong-yan; Kong, Xiang-wen; Qiao, Yan-jiang

    2015-03-01

    Chinese patent orthopedic medicines feature complex components, mainly including desperate and toxic herbal pieces, narrow safety window, more clinical contraindications and frequent adverse drug reaction/events (ADR/ADE). To study the general safe medication regularity of Chinese patent orthopedic medicines, define key points in the medication education and ensure rational clinical medication, the authors took 80 types of commonly used Chinese patent orthopedic medicines as the study objects, collect 237 cases from 164 ADR/ADE documents through a system retrieval strategy, make a multidimensional literature analysis to determine the common risk factors for safe and rational medication of Chinese patent orthopedic medicines and establish an ADR/ADE prevention regularity. First, in the aspect of clinical symptoms, skin allergy is the most common ADR/ADE and closely related to the toxic ingredients, particularly accumulated liver or kidney damage caused by some drugs. Second, there are three time nodes in the ADR/ADE occurrence; The ADR/ADE occurred in 30 minutes is closely related to the idiosyncrasy; the ADR/ADE occurred between several months and half a year is related to the drug-induced liver and kidney damages; The most common ADR/ADE was observed within 7 days and predictable according to the pharmacological actions; Third, toxicity is an important factor in the occurrence of ADR/ADE of Chinese patent orthopedic medicines. Fourth, emphasis shall be given to the special medication factors, such as the combination with western medicines and Chinese herbal decoctions, overdose and long-course medication and self-medical therapy. In conclusion, the general ADR/ADE prevention regularity for Chinese patent orthopedic medicines was summarized to provide supports for clinicians in safe and rational medication and give the guidance for pharmacist in medication education.

  19. [Principles of the EOS™ X-ray machine and its use in daily orthopedic practice].

    PubMed

    Illés, Tamás; Somoskeöy, Szabolcs

    2012-02-26

    The EOS™ X-ray machine, based on a Nobel prize-winning invention in Physics in the field of particle detection, is capable of simultaneously capturing biplanar X-ray images by slot scanning of the whole body in an upright, physiological load-bearing position, using ultra low radiation doses. The simultaneous capture of spatially calibrated anterioposterior and lateral images allows the performance of a three-dimensional (3D) surface reconstruction of the skeletal system by a special software. Parts of the skeletal system in X-ray images and 3D-reconstructed models appear in true 1:1 scale for size and volume, thus spinal and vertebral parameters, lower limb axis lengths and angles, as well as any relevant clinical parameters in orthopedic practice could be very precisely measured and calculated. Visualization of 3D reconstructed models in various views by the sterEOS 3D software enables the presentation of top view images, through which one can analyze the rotational conditions of lower limbs, joints and spine deformities in horizontal plane and this provides revolutionary novel possibilities in orthopedic surgery, especially in spine surgery. PMID:22330840

  20. Cell-Derived Extracellular Matrix: Basic Characteristics and Current Applications in Orthopedic Tissue Engineering.

    PubMed

    Zhang, Weixiang; Zhu, Yun; Li, Jia; Guo, Quanyi; Peng, Jiang; Liu, Shichen; Yang, Jianhua; Wang, Yu

    2016-06-01

    The extracellular matrix (ECM) is a dynamic and intricate microenvironment with excellent biophysical, biomechanical, and biochemical properties, which can directly or indirectly regulate cell proliferation, adhesion, migration, and differentiation, as well as plays key roles in homeostasis and regeneration of tissues and organs. The ECM has attracted a great deal of attention with the rapid development of tissue engineering in the field of regenerative medicine. Tissue-derived ECM scaffolds (also referred to as decellularized tissues and whole organs) are considered a promising therapy for the repair of musculoskeletal defects, including those that are widely used in orthopedics, although there are a few shortcomings. Similar to tissue-derived ECM scaffolds, cell-derived ECM scaffolds also have highly advantageous biophysical and biochemical properties, in particular their ability to be produced in vitro from a number of different cell types. Furthermore, cell-derived ECM scaffolds more closely resemble native ECM microenvironments. The products of cell-derived ECM have a wide range of biomedical applications; these include reagents for cell culture substrates and biomaterials for scaffolds, hybrid scaffolds, and living cell sheet coculture systems. Although cell-derived ECM has only just begun to be investigated, it has great potential as a novel approach for cell-based tissue repair in orthopedic tissue engineering. This review summarizes and analyzes the various types of cell-derived ECM products applied in cartilage, bone, and nerve tissue engineering in vitro or in vivo and discusses future directions for investigation of cell-derived ECM.

  1. The Chop and Lift Reconsidered: Integrating Neuromuscular Principles into Orthopedic and Sports Rehabilitation.

    PubMed Central

    Hoogenboom, Barbara J; Cook, Gray

    2008-01-01

    The upper extremity bilateral PNF patterns, better known as the “chop and lift” are well known to physical therapists. These patterns which utilize spiral and diagonal motions of the upper extremity can be used for both assessment and treatment of sports and orthopedic injuries. Half kneeling and tall kneeling postures fall between low-level postures such as rolling and 4-point, and high-level postures of standing and walking. Half kneeling and tall kneeling can be considered transitional postures. When the chop and lift patterns are used in conjunction with the half and tall kneeling developmental postures, the techniques are an excellent assessment of core stability/instability. Combinations of the upper extremity patterns and the developmental postures can be powerful corrective training techniques. The combined experience of the three authors is used to describe techniques for equipment setup, testing, assessment, and treatment of athletic imbalances. These techniques require and promote instantaneous local muscular activity as developmental postures and balance reactions are incorporated. The therapeutic use of both PNF and developmental patterns has been a hallmark of rehabilitation of patients with neurologic dysfunction, but can be equally and effectively applied in the sports and orthopedic rehabilitation setting. PMID:21509127

  2. The Impact of Pain Management with Opioids among Older Adults Post Orthopedic Trauma.

    PubMed

    Resnick, Barbara; Galik, Elizabeth; Wells, Chris L; Boltz, Marie; Renn, Cynthia L; Dorsey, Susan G

    2016-10-01

    Pain has a significant effect on physical and psychological outcomes for older adults post orthopedic trauma. The purpose of this study was to describe the management of pain among older trauma patients and consider differences between those who received 3 or more dosages daily of opioids versus those who did not. This was a secondary data analysis using data from an intervention study testing the effect of Function Focused Care among older orthopedic trauma patients (FFC-AC). The FFC-AC study was done on trauma units in two acute care settings designated as Level I or II trauma centers from September 2014 to September 2015. All participants from the parent FFC-AC study were included. Data collection for the parent study was done within 24 hours of admission and within 24 hours of discharge and included demographics, medications, assessment of function, physical activity, mood, physical resilience, and whether the patient had pain and their pain intensity. Patient records included all 89 individuals from the parent study, 59 (66%) of whom were female and 82 (92%) were white. Records indicated that those who received more than three dosages per day of opioids had a shorter length of stay, were younger, had more intense pain, and were more resilient compared with those who received less than three dosages per day. This secondary data analysis provides support for the importance of considering pain and pain management among older adults post trauma. PMID:27567095

  3. Short-Term and Long-Term Effects of Orthopedic Biodegradable Implants

    PubMed Central

    Amini, Ami R.; Wallace, James S.; Nukavarapu, Syam P.

    2012-01-01

    Presently, orthopedic and oral/maxillofacial implants represent a combined $2.8 billion market, a figure expected to experience significant and continued growth. Although traditional permanent implants have been proved clinically efficacious, they are also associated with several drawbacks, including secondary revision and removal surgeries. Non-permanent, biodegradable implants offer a promising alternative for patients, as they provide temporary support and degrade at a rate matching tissue formation, and thus, eliminate the need for secondary surgeries. These implants have been in clinical use for nearly 25 years, competing directly with, or maybe even exceeding, the performance of permanent implants. The initial implantation of biodegradable materials, as with permanent materials, mounts an acute host inflammatory response. Over time, the implant degradation profile and possible degradation product toxicity mediate long-term biodegradable implant-induced inflammation. However, unlike permanent implants, this inflammation is likely to cease once the material disappears. Implant-mediated inflammation is a critical determinant for implant success. Thus, for the development of a proactive biodegradable implant that has the ability to promote optimal bone regeneration and minimal detrimental inflammation, a thorough understanding of short- and long-term inflammatory events is required. Here, we discuss an array of biodegradable orthopedic implants, their associated short- and long- term inflammatory effects, and methods to mediate these inflammatory events. PMID:22043969

  4. Venous thromboembolism prophylaxis after total hip or knee arthroplasty: a survey of Canadian orthopedic surgeons

    PubMed Central

    Gross, Michael; Anderson, David R.; Nagpal, Seema; O’Brien, Bernie

    1999-01-01

    Objective To determine the pharmacologic and physical modalities used by orthopedic surgeons in Canada to prevent venous thromboembolism (deep venous thrombosis and pulmonary embolism) after total hip or knee arthroplasty. Design Mail survey sent to all members of the Canadian Orthopaedic Association. Setting A nation-wide study. Methods A total of 828 questionnaires, designed to identify the type and frequency of prophylaxis against venous thromboembolism that were used after hip and knee arthroplasty were mailed to orthopedic surgeons. Outcome measures Demographic data and the frequency and type of thromboprophylaxis. Results Of the 828 surveys mailed 445 (54%) were returned, and 397 were included in this analysis. Of the respondents, 97% used prophylaxis routinely for patients who undergo total hip or knee arthroplasty. Three of the 397 (0.8%) did not use any method of prophylaxis. Warfarin was the most common agent used (46%), followed by low-molecular-weight heparin (LMWH) (36%). Combination therapy with both mechanical and pharmacologic methods were used in 39% of patients. Objective screening tests were not frequently performed before discharge. Extended prophylaxis beyond the duration of hospitalization was used by 36% of physicians. Conclusion Prophylaxis for venous thromboembolism with warfarin or LMWH has become standard care after total hip or knee arthroplasty in Canada. PMID:10593248

  5. Improvement on corrosion resistance of NiTi orthopedic materials by carbon plasma immersion ion implantation

    NASA Astrophysics Data System (ADS)

    Poon, Ray W. Y.; Ho, Joan P. Y.; Luk, Camille M. Y.; Liu, Xuanyong; Chung, Jonathan C. Y.; Chu, Paul K.; Yeung, Kelvin W. K.; Lu, William W.; Cheung, Kenneth M. C.

    2006-01-01

    Nickel-titanium shape memory alloys (NiTi) have potential applications as orthopedic implants because of their unique super-elastic properties and shape memory effects. However, the problem of out-diffusion of harmful Ni ions from the alloys during prolonged use inside a human body must be overcome before they can be widely used in orthopedic implants. In this work, we enhance the corrosion resistance of NiTi using carbon plasma immersion ion implantation and deposition (PIII&D). Our corrosion and simulated body fluid tests indicate that either an ion-mixed amorphous carbon coating fabricated by PIII&D or direct carbon PIII can drastically improve the corrosion resistance and block the out-diffusion of Ni from the materials. Results of atomic force microscopy (AFM) indicate that both C2H2-PIII&D and C2H2-PIII do not roughen the original flat surface to an extent that can lead to degradation in corrosion resistance.

  6. Predicting postoperative vomiting among orthopedic patients receiving patient-controlled epidural analgesia using SVM and LR.

    PubMed

    Wu, Hsin-Yun; Gong, Cihun-Siyong Alex; Lin, Shih-Pin; Chang, Kuang-Yi; Tsou, Mei-Yung; Ting, Chien-Kun

    2016-01-01

    Patient-controlled epidural analgesia (PCEA) has been applied to reduce postoperative pain in orthopedic surgical patients. Unfortunately, PCEA is occasionally accompanied by nausea and vomiting. The logistic regression (LR) model is widely used to predict vomiting, and recently support vector machines (SVM), a supervised machine learning method, has been used for classification and prediction. Unlike our previous work which compared Artificial Neural Networks (ANNs) with LR, this study uses a SVM-based predictive model to identify patients with high risk of vomiting during PCEA and comparing results with those derived from the LR-based model. From January to March 2007, data from 195 patients undergoing PCEA following orthopedic surgery were applied to develop two predictive models. 75% of the data were randomly selected for training, while the remainder was used for testing to validate predictive performance. The area under curve (AUC) was measured using the Receiver Operating Characteristic curve (ROC). The area under ROC curves of LR and SVM models were 0.734 and 0.929, respectively. A computer-based predictive model can be used to identify those who are at high risk for vomiting after PCEA, allowing for patient-specific therapeutic intervention or the use of alternative analgesic methods. PMID:27247165

  7. Improving patient satisfaction with time spent in an orthopedic outpatient clinic

    PubMed Central

    Levesque, Jerry; Bogoch, Earl R.; Cooney, Barb; Johnston, Brenda; Wright, James G.

    2000-01-01

    Objective To determine if patient satisfaction can be improved by changing patients’ expectations of the clinic visit and by decreasing the total time spent in the clinic. Design A prospective comparative analysis carried out in 4 phases. Setting An university-affiliated orthopedic outpatient clinic. Patients All patients seen in the orthopedic outpatient clinic were eligible. Phase 1 determined the total clinic time required by patient type; phase 2 assessed baseline satisfaction; phase 3 altered patients’ expectations; and phase 4 altered patients’ expectations and scheduled visits by patient type. Intervention Patient questionnaires. Main outcome measure Patient satisfaction with time spent in the clinic. Results Of 708 distributed questionnaires, 622 (88%) were completed (547 totally complete, 75 partially complete). Total time spent in the clinic decreased across phases 2, 3 and 4 (mean 99.2, 94.7 and 85.2 minutes, respectively, but was significantly different only between phases 3 and 4; p = 0.05, Duncan’s multiple range test). The percentage of patients who rated their waiting time as “excellent” increased across phases 2, 3 and 4 (14.6%, 18.8% and 31.1%, respectively; p = 0.0004, χ2 test). Conclusion Patient satisfaction can be improved by altering patient expectations and by decreasing the total time spent in clinic. PMID:11129831

  8. Influence of preoperative emotional state on postoperative pain following orthopedic and trauma surgery

    PubMed Central

    Robleda, Gemma; Sillero-Sillero, Amalia; Puig, Teresa; Gich, Ignasi; Baños, Josep-E

    2014-01-01

    OBJECTIVES: to analyze the relationship between preoperative emotional state and the prevalence and intensity of postoperative pain and to explore predictors of postoperative pain. METHOD: observational retrospective study undertaken among 127 adult patients of orthopedic and trauma surgery. Postoperative pain was assessed with the verbal numeric scale and with five variables of emotional state: anxiety, sweating, stress, fear, and crying. The Chi-squared test, Student's t test or ANOVA and a multivariate logistic regression analysis were used for the statistical analysis. RESULTS: the prevalence of immediate postoperative pain was 28%. Anxiety was the most common emotional factor (72%) and a predictive risk factor for moderate to severe postoperative pain (OR: 4.60, 95% CI 1.38 to 15.3, p<0.05, AUC: 0.72, 95% CI: 0.62 to 0.83). Age exerted a protective effect (OR 0.96, 95% CI: 0.94-0.99, p<0.01). CONCLUSION: preoperative anxiety and age are predictors of postoperative pain in patients undergoing orthopedic and trauma surgery. PMID:25493674

  9. Pitfalls in MR image interpretation prompting referrals to an orthopedic oncology clinic.

    PubMed

    Stacy, Gregory Scott; Dixon, Larry B

    2007-01-01

    Patients referred to the authors' hospital for evaluation on suspicion of a bone or soft-tissue malignancy frequently present to the Orthopaedic Oncology Clinic with magnetic resonance (MR) images that show typical features of nonmalignant or nonneoplastic entities. The purpose of this article is to review the benign entities that may be mistaken by the radiologist for a malignancy and thus lead to needless referral to an orthopedic oncologist. Normal hematopoietic marrow and marrow edema due to a stress reaction may mimic a neoplasm at MR imaging, but knowledge of the typical patterns and locations of these features allows an accurate radiologic interpretation. The MR imaging appearance of osteonecrosis, Paget disease, benign bone lesions, and rheumatologic conditions may be confusing; in such circumstances, radiographic findings may help formulate a correct diagnosis. Knowledge of the common locations and appearances of bursae and ganglia is necessary so that radiologists do not misinterpret these benign entities as soft-tissue sarcomas. Soft-tissue trauma and inflammation also may mimic tumors at MR imaging, but a familiarity with the imaging patterns of nonneoplastic change in muscle allows the avoidance of misinterpretation. The clinical history, as always, is an important component of proper diagnosis. The radiologist can be especially useful to both the clinician and the patient by recognizing entities that are highly unlikely to represent malignancy and by confidently reporting those entities as benign, thereby sparing the patient an unnecessary trip to the orthopedic oncologist.

  10. Predicting postoperative vomiting among orthopedic patients receiving patient-controlled epidural analgesia using SVM and LR

    PubMed Central

    Wu, Hsin-Yun; Gong, Cihun-Siyong Alex; Lin, Shih-Pin; Chang, Kuang-Yi; Tsou, Mei-Yung; Ting, Chien-Kun

    2016-01-01

    Patient-controlled epidural analgesia (PCEA) has been applied to reduce postoperative pain in orthopedic surgical patients. Unfortunately, PCEA is occasionally accompanied by nausea and vomiting. The logistic regression (LR) model is widely used to predict vomiting, and recently support vector machines (SVM), a supervised machine learning method, has been used for classification and prediction. Unlike our previous work which compared Artificial Neural Networks (ANNs) with LR, this study uses a SVM-based predictive model to identify patients with high risk of vomiting during PCEA and comparing results with those derived from the LR-based model. From January to March 2007, data from 195 patients undergoing PCEA following orthopedic surgery were applied to develop two predictive models. 75% of the data were randomly selected for training, while the remainder was used for testing to validate predictive performance. The area under curve (AUC) was measured using the Receiver Operating Characteristic curve (ROC). The area under ROC curves of LR and SVM models were 0.734 and 0.929, respectively. A computer-based predictive model can be used to identify those who are at high risk for vomiting after PCEA, allowing for patient-specific therapeutic intervention or the use of alternative analgesic methods. PMID:27247165

  11. Perioperative complications of orthopedic surgery for lower extremity in patients with cerebral palsy.

    PubMed

    Lee, Seung Yeol; Sohn, Hye-Min; Chung, Chin Youb; Do, Sang-Hwan; Lee, Kyoung Min; Kwon, Soon-Sun; Sung, Ki Hyuk; Lee, Sun Hyung; Park, Moon Seok

    2015-04-01

    Because complications are more common in patients with cerebral palsy (CP), surgeons and anesthesiologists must be aware of perioperative morbidity and be prepared to recognize and treat perioperative complications. This study aimed to determine the incidence of and risk factors for perioperative complications of orthopedic surgery on the lower extremities in patients with CP. We reviewed the medical records of consecutive CP patients undergoing orthopedic surgery. Medical history, anesthesia emergence time, intraoperative body temperature, heart rate, blood pressure, immediate postoperative complications, Gross Motor Function Classification System (GMFCS) level, Cormack-Lehane classification, and American Society of Anesthesiologists physical status classification were analyzed. A total of 868 patients was included. Mean age at first surgery was 11.8 (7.6) yr. The incidences of intraoperative hypothermia, absolute hypotension, and absolute bradycardia were 26.2%, 4.4%, and 20.0%, respectively. Twenty (2.3%) patients had major complications, and 35 (4.0%) patients had minor complications postoperatively. The incidences of intraoperative hypothermia, absolute hypotension, and major postoperative complications were significantly higher in patients at GMFCS levels IV and V compared with patients at GMFCS levels I to III (P<0.001). History of pneumonia was associated with intraoperative absolute hypotension and major postoperative complications (P<0.001). These results revealed that GMFCS level, patient age, hip reconstructive surgery, and history of pneumonia are associated with adverse effects on intraoperative body temperature, the cardiovascular system, and immediate postoperative complications.

  12. The Impact of Pain Management with Opioids among Older Adults Post Orthopedic Trauma.

    PubMed

    Resnick, Barbara; Galik, Elizabeth; Wells, Chris L; Boltz, Marie; Renn, Cynthia L; Dorsey, Susan G

    2016-10-01

    Pain has a significant effect on physical and psychological outcomes for older adults post orthopedic trauma. The purpose of this study was to describe the management of pain among older trauma patients and consider differences between those who received 3 or more dosages daily of opioids versus those who did not. This was a secondary data analysis using data from an intervention study testing the effect of Function Focused Care among older orthopedic trauma patients (FFC-AC). The FFC-AC study was done on trauma units in two acute care settings designated as Level I or II trauma centers from September 2014 to September 2015. All participants from the parent FFC-AC study were included. Data collection for the parent study was done within 24 hours of admission and within 24 hours of discharge and included demographics, medications, assessment of function, physical activity, mood, physical resilience, and whether the patient had pain and their pain intensity. Patient records included all 89 individuals from the parent study, 59 (66%) of whom were female and 82 (92%) were white. Records indicated that those who received more than three dosages per day of opioids had a shorter length of stay, were younger, had more intense pain, and were more resilient compared with those who received less than three dosages per day. This secondary data analysis provides support for the importance of considering pain and pain management among older adults post trauma.

  13. A differential scanning calorimetry study of retrieved orthopedic implants made of ultrahigh molecular weight polyethylene.

    PubMed

    Witkiewicz, H; Deng, M; Vidovszky, T; Bolander, M E; Rock, M G; Morrey, B F; Shalaby, S W

    1996-01-01

    Differential scanning calorimetry (DSC) was used to examine thermal and thermooxidative properties of ultrahigh molecular weight polyethylene (UHMW-PE) of five acetabular components of failed orthopedic implants retrieved at revision of total hip arthoplasty. The results were compared with controls (unimplanted acetabular cups, a 20-year-old slab of UHMW-PE, and raw material). Profiles of exothermic peaks indicated increased levels of oxidation in all retrieved cups. In three retrieved cups, DSC revealed an additional peak of endotherm that was not seen in control samples. The additional endotherm peaks were not artifacts due to oxidation during scanning, heat buildup during cutting of the samples, or the sterilization method after retrieval. The additional peak was associated with the bulk of the polymer that was extracted with hexane. It varied in relative area, depending on its original location of the sample in a cup, implicating local variability in the extent of changes in material property. The distribution of the changes suggests that, during implantation, tissue exposure and friction affected the level of oxidation and degree of crystallinity in the UHMW-PE to a greater degree than did loading alone. Overall results showed that DSC may be a useful tool in evaluating changes in the properties of UHMW-PE orthopedic components in vivo. PMID:8736025

  14. Modified technique of presurgical infant maxillary orthopedics for complete unilateral cleft lip and palate.

    PubMed

    Choo, Hyeran; Maguire, Meg; Low, David W

    2012-01-01

    This article introduces a modified device fabrication and facial taping method that increases the efficiency and efficacy of presurgical infant maxillary orthopedic therapy for babies born with complete cleft lip and palate. Interarch and intra-arch relationships of the maxillary and mandibular dental arches were evaluated on mounted stone models before and after treatment. The palatal plate device was custom-fabricated in a manner that bypassed the need for periodic acrylic addition and removal, thereby eliminating the risk of natural maxillary growth restriction during therapy. Elastic labial tapes were fabricated and applied in a configuration that mimicked normal function of the orbicularis oris muscle. A nasal stent wire was utilized from the initiation of therapy to enhance intraoral retention and stability of the device. Examples of infants undergoing a unilateral complete cleft lip and palate treatment protocol are presented. Treatment objectives were achieved within 7 to 8 weeks of therapy for patients who had an initial alveolar cleft size more than 10 to 12 mm. The modified protocol of presurgical infant maxillary orthopedic therapy is an effective and efficient treatment modality in reversing the pre-existing orofacial dysmorphism by redirecting the infant's natural growth.

  15. Interceptive orthopedics for the correction of maxillary transverse and sagittal deficiency in the early mixed dentition period

    PubMed Central

    Talapaneni, Ashok Kumar; Kumar, Karnati Praveen; Kommi, Pradeep Babu; Nuvvula, Sivakumar

    2011-01-01

    Dentofacial Orthopedics directed to a hypoplastic maxilla in the prepubertal period redirects growth of the maxilla in the vertical, transverse and sagittal planes of space. The orthopedic correction of maxillary hypoplasia in the early mixed dentition period thus intercepts the establishment of permanent structural asymmetry in the mandible and helps in the achievement of optimal dentofacial esthetics. This paper presents the growth redirection in a hypoplastic maxilla of an 8-year-old girl with simultaneous rapid maxillary expansion and protraction headgear therapy for a period of 11 months which corrected the posterior unilateral cross-bite, the positional asymmetry of the mandible and established an orthognathic profile in the individual. PMID:22346162

  16. Estimated annual costs of prophylaxis and treatment of venous thromboembolic events associated with major orthopedic surgery in France.

    PubMed

    Tilleul, Patrick; LaFuma, Antoine; Colin, Xavier; Ozier, Yves

    2006-10-01

    Venous Thromboembolism (VTE) remains a major complication following orthopedic surgery despite heparin prophylaxis. Clinical consequences associated with this complication are deep vein thrombosis (DVT), pulmonary embolism, and long-term consequences of DVT, especially Postthrombotic syndrome (PTS). The purpose of the present study was to estimate the annual direct costs of VTE following major orthopedic surgery of the lower limb in France. This cost of illness study was performed by using available information from health system databases (1999) and literature and specific surveys (2002). Direct costs were calculated by using estimates of the number of patients with major orthopedic surgery in France during one year. Patients presenting with VTE were identified from the national disease-related group inpatient database. Additional resource consumption was identified by comparison with disease-related groups without the VTE complications. Ambulatory care costs after hospitalization, for recurrences and PTS, were estimated from specific surveys of general practitioners and venous disease specialists. Total annual costs of VTE associated with major orthopedic surgery for the French Sickness Fund were estimated to be approximately 60 million euros over 1 year with 28 million euros for inpatient care and 30 million euros for recurrences and PTS.

  17. An Intelligibility Assessment of Toddlers with Cleft Lip and Palate Who Received and Did Not Receive Presurgical Infant Orthopedic Treatment.

    ERIC Educational Resources Information Center

    Konst, Emmy M.; Weersink-Braks, Hanny; Rietveld, Toni; Peters, Herman

    2000-01-01

    The influence of presurgical infant orthopedic treatment (PIO) on speech intelligibility was evaluated with 10 toddlers who used PIO during the first year of life and 10 who did not. Treated children were rated as exhibiting greater intelligibility, however, transcription data indicated there were not group differences in actual intelligibility.…

  18. Laser speckle technology in stomatology. diagnostics of stresses and strains of hard biotissues and orthodontic and orthopedic structures

    NASA Astrophysics Data System (ADS)

    Denisova, Yu. L.; Bazylev, N. B.; Rubnikovich, S. P.; Fomin, N. A.

    2013-07-01

    We have investigated the formation and dynamics of speckle biofi elds formed by hard biotissues of the oral cavity irradiated with low-intensity radiation. We present experimental methods for diagnosing the stressed-strained state of the maxillodental system and orthodontic and orthopedic structures based on speckle technologies and crosscorrelation analysis of speckle biofi elds.

  19. The Living Stage Improvisational Theatre Demonstration Project for Orthopedically Handicapped Children, Ages 4-8. Overview, 1978-1981.

    ERIC Educational Resources Information Center

    Alexander, Robert; Haynes, Wendy

    The Living Stage Improvisational Theatre Demonstration Project (Washington, D.C.) conducts weekly workshops to enhance the creative expression and self esteem of orthopedically handicapped children, aged 4 to 8 years. The Living Stage program is designed to demonstrate that methods of improvisational theatre can have a positive impact on parental…

  20. Using the Integration of Discrete Event and Agent-Based Simulation to Enhance Outpatient Service Quality in an Orthopedic Department.

    PubMed

    Kittipittayakorn, Cholada; Ying, Kuo-Ching

    2016-01-01

    Many hospitals are currently paying more attention to patient satisfaction since it is an important service quality index. Many Asian countries' healthcare systems have a mixed-type registration, accepting both walk-in patients and scheduled patients. This complex registration system causes a long patient waiting time in outpatient clinics. Different approaches have been proposed to reduce the waiting time. This study uses the integration of discrete event simulation (DES) and agent-based simulation (ABS) to improve patient waiting time and is the first attempt to apply this approach to solve this key problem faced by orthopedic departments. From the data collected, patient behaviors are modeled and incorporated into a massive agent-based simulation. The proposed approach is an aid for analyzing and modifying orthopedic department processes, allows us to consider far more details, and provides more reliable results. After applying the proposed approach, the total waiting time of the orthopedic department fell from 1246.39 minutes to 847.21 minutes. Thus, using the correct simulation model significantly reduces patient waiting time in an orthopedic department. PMID:27195606

  1. Youth Categorized as Orthopedically Impaired, Statistical Almanac, Volume 8. The National Longitudinal Transition Study of Special Education Students.

    ERIC Educational Resources Information Center

    Valdes, Kathryn A.; And Others

    This volume of the National Longitudinal Transition Study of Special Education Students (NLTS) offers statistical data relating to 764 students with orthopedic impairments (ages 13-21). The study design involved a survey of parents/guardians, examination of school records, and a survey of school programs. The 43 tables describe: youths' individual…

  2. Procedural knowledge

    SciTech Connect

    Georgeff, M.P.; Lansky, A.L.

    1986-10-01

    Much of commonsense knowledge about the real world is in the form of procedures or sequences of actions for achieving particular goals. In this paper, a formalism is presented for representing such knowledge using the notion of process. A declarative semantics for the representation is given, which allows a user to state facts about the effects of doing things in the problem domain of interest. An operational semantics is also provided, which shows how this knowledge can be used to achieve particular goals or to form intentions regarding their achievement. Given both semantics, our formalism additionally serves as an executable specification language suitable for constructing complex systems. A system based on this formalism is described, and examples involving control of an autonomous robot and fault diagnosis for NASA's space shuttle are provided.

  3. 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

  4. Written orthopedic patient education materials from the point of view of empowerment by education.

    PubMed

    Johansson, Kirsi; Salanterä, Sanna; Katajisto, Jouko; Leino-Kilpi, Helena

    2004-02-01

    Written patient education materials are one way of supporting patient empowerment. The aim of this study was to evaluate written orthopedic patient education materials (n = 25) drawn from a university hospital's electronic databank. In the absence of suitable tools for evaluation, an analytic framework was developed by a panel of nursing scientists and clinical experts. The materials were evaluated from the point of view of empowerment by their external appearance, content and instructiveness. In terms of their external appearance the materials were well prepared, but much was left to be desired with regard to contents and instructiveness. Development needs to focus on making better use of methods of visual representation, on increasing the coverage of content areas that so far have received less attention, like social, experiential, ethical and financial empowerment, and on providing a more focused perspective on the patient.

  5. Safety and Efficacy of Moxifloxacin Monotherapy for Treatment of Orthopedic Implant-Related Staphylococcal Infections ▿

    PubMed Central

    San Juan, Rafael; Garcia-Reyne, Ana; Caba, Pedro; Chaves, Fernando; Resines, Carlos; Llanos, Fernando; López-Medrano, Francisco; Lizasoain, Manuel; Aguado, Jose Maria

    2010-01-01

    The rifampin-ciprofloxacin combination is recommended for treatment of orthopedic implant-related staphylococcal infections to avoid the emergence of ciprofloxacin resistance; however, the efficacy of this combination is limited by the tolerability problems associated with the use of rifampin. Moxifloxacin is a quinolone up to 10 times more active against staphylococci than ciprofloxacin and the risk of resistance development during monotherapy against staphylococci is theoretically lower for moxifloxacin, but information regarding its use in bone infections is lacking. The aim of the present study was to evaluate the safety and clinical efficacy of moxifloxacin monotherapy in patients with orthopedic implant-related staphylococcal infections. From June 2006 to April 2009, all patients with culture-proven infection by quinolone-sensitive staphylococcal strains associated with orthopedic implants at our institution were included in a management protocol that mostly included specific surgery, 1 to 2 weeks of an intravenous course of cloxacillin-cefazolin or vancomycin, and long-term therapy with moxifloxacin (400 mg/day for 3 months). Cure was defined as (i) a lack of clinical signs and symptoms of infection, (ii) a C-reactive protein level less than 5 mg/liter, and (iii) absence of radiological signs of loosening or infection at the latest follow-up visit. Failure was defined as (i) persisting clinical and/or laboratory signs of infection or (ii) persisting or new isolation of the initial microorganism. A total of 48 patients with a median follow-up of 716 days (range, 102 to 1,613 days) were included in the study. Complete drug compliance was achieved in all but two patients (4.2%), who required drug discontinuation because of side effects (diarrhea and dizziness). No moxifloxacin-induced arrhythmia was reported. Twenty patients had joint prosthesis infections (5 acute-onset infections and 15 chronic infections), and 28 patients had osteosynthesis material

  6. ‘Old Drugs for New Applications’: Can Orthopedic Research Benefit from This Strategy?

    PubMed Central

    Pan, Xiaohua; Cheng, Wenxiang; Wang, Jiali; Qin, Ling; Lai, Yuxiao; Tang, Jian; Shang, Peng; Ren, Peigen; Zhang, Peng

    2011-01-01

    New drug exploration is difficult in a clinical setting and the development of new drugs may be costly and time consuming. With further research into the pathological mechanisms and etiology of diseases as well as the rapid development of biological techniques, many ‘old drugs’ that have been applied in clinics may have new therapeutic functions which may shed light on clinical management. Based on this, we have investigated the ‘old drugs for new applications’ strategy in pharmacology which may be less expensive and more efficient in the clinical setting. In this paper we have explored and illustrated the potential applications of ‘old drugs’ for the treatment of orthopedic diseases, especially in arthritis and osteoporosis therapy. PMID:22870479

  7. Ion beam sputter etching of orthopedic implanted alloy MP35N and resulting effects on fatigue

    NASA Technical Reports Server (NTRS)

    Wintucky, E. G.; Christopher, M.; Bahnuik, E.; Wang, S.

    1981-01-01

    The effects of two types of argon ion sputter etched surface structures on the tensile stress fatigue properties of orthopedic implant alloy MP35N were investigated. One surface structure was a natural texture resulting from direct bombardment by 1 keV argon ions. The other structure was a pattern of square holes milled into the surface by a 1 keV argon ion beam through a Ni screen mask. The etched surfaces were subjected to tensile stress only in fatigue tests designed to simulate the cyclic load conditions experienced by the stems of artificial hip joint implants. Both types of sputter etched surface structures were found to reduce the fatigue strength below that of smooth surface MP35N.

  8. Orthopedic application of spikenard herbal rhizome decorated microstructured polymer biocomposites and their in vitro cytotoxicity.

    PubMed

    Priya, Sahariya; Jeya Jothi, Gabriel

    2016-09-01

    The present study explores the synthesis of highly potential polymer biocomposite from Nardostachys jatamansi rhizome extract. The polymer biocomposites were synthesized from methyl methacrylate by free radical polymerization. ATR-IR enunciate the functional groups attributed at 956 cm(-1) (aromatic), a peak appeared at 1685 cm(-1) (-C 000000000000 000000000000 000000000000 111111111111 000000000000 111111111111 000000000000 000000000000 000000000000 O), 1186 cm(-1) (-O-CH3), 1149 cm(-1) (-C-O-C) framework and 1279 cm(-1) (-C-O), which are good agreement for the formation composites. The quantitative evaluations of antimicrobial studies were analyzed by serial dilution method and also improved activity in orthopedic infection pathogens. Cytocompatibility was analyzed by keratinocyte cell lines and it may be used for various biomedical applications. PMID:27408493

  9. Quaternized Chitosan as an Antimicrobial Agent: Antimicrobial Activity, Mechanism of Action and Biomedical Applications in Orthopedics

    PubMed Central

    Tan, Honglue; Ma, Rui; Lin, Chucheng; Liu, Ziwei; Tang, Tingting

    2013-01-01

    Chitosan (CS) is a linear polysaccharide with good biodegradability, biocompatibility and antimicrobial activity, which makes it potentially useful for biomedical applications, including an antimicrobial agent either alone or blended with other polymers. However, the poor solubility of CS in most solvents at neutral or high pH substantially limits its use. Quaternary ammonium CS, which was prepared by introducing a quaternary ammonium group on a dissociative hydroxyl group or amino group of the CS, exhibited improved water solubility and stronger antibacterial activity relative to CS over an entire range of pH values; thus, this quaternary modification increases the potential biomedical applications of CS in the field of anti-infection. This review discusses the current findings on the antimicrobial properties of quaternized CS synthesized using different methods and the mechanisms of its antimicrobial actions. The potential antimicrobial applications in the orthopedic field and perspectives regarding future studies in this field are also considered. PMID:23325051

  10. Potential of epoetin alfa in patients in autologous blood donation programs for orthopedic surgery.

    PubMed

    McClelland, B

    1996-04-01

    The ability of epoetin alfa to increase hematopoiesis in a dose-dependent manner when administered by the intravenous (i.v.) or subcutaneous (s.c.) route has been demonstrated in pharmacokinetic studies in healthy volunteers. Epoetin alfa may therefore be a useful adjunct to autologous blood (AB) donation. By facilitating AB donation, the use of allogeneic blood could be reduced. In patients scheduled to undergo orthopedic surgery, i.v. administration of epoetin alfa 600 IU/kg twice weekly for 3 weeks prior to surgery (in conjunction with oral iron supplementation) significantly increased the number of AB units and total red blood cell (RBC) volume donated and increased the number of patients able to donate > or = 4 AB units. However, there was no difference between epoetin alfa and placebo groups with respect to allogeneic blood exposure.

  11. [Correspondence among care prescriptions for patients with orthopedic problems and the Nursing Interventions Classification].

    PubMed

    Almeida, Miriam de Abreu; Longaray, Vanessa Kenne; De Cezaro, Paula; Barilli, Sofia Louise Santin

    2007-12-01

    The objective of this work was to compare the care prescribed by nurses for orthopedic surgery patients after surgery with the interventions and activities proposed by the Nursing Interventions Classification (NIC), in order to verify its agreement. The study was carried out at the Hospital de Clinicas de Porto Alegre (a University hospital in the south of Brazil), using the mapping technique. Data on the 170 studied patients were obtained by the Computerized Nursing Prescription System. The 52 care forms related to nursing diagnosis (ND) Self-Care Deficit--bath and/or hygiene, Impaired Physical Mobility and Risk of Infection--were mapped with 33 nursing interventions, contained in 14 classes and 4 Domains. The comparison between nursing prescriptions and the interventions proposed by the NIC for the 3 ND studied evidenced there is agreement among them. We considered that the NIC may become an important source of consultation to improve and to base nursing care.

  12. Preparation Methods for Improving PEEK's Bioactivity for Orthopedic and Dental Application: A Review

    PubMed Central

    Almasi, Davood; Iqbal, Nida; Sadeghi, Maliheh; Sudin, Izman; Abdul Kadir, Mohammed Rafiq; Kamarul, Tunku

    2016-01-01

    There is an increased interest in the use of polyether ether ketone (PEEK) for orthopedic and dental implant applications due to its elastic modulus close to that of bone, biocompatibility, and its radiolucent properties. However, PEEK is still categorized as bioinert due to its low integration with surrounding tissues. Many studies have reported on methods to increase the bioactivity of PEEK, but there is still one-preparation method for preparing bioactive PEEK implant where the produced implant with desirable mechanical and bioactivity properties is required. The aim of this review is to present the progress of the preparation methods for improvement of the bioactivity of PEEK and to discuss the strengths and weaknesses of the existing methods. PMID:27127513

  13. Fabrication aspects of PLA-CaP/PLGA-CaP composites for orthopedic applications: a review.

    PubMed

    Zhou, Huan; Lawrence, Joseph G; Bhaduri, Sarit B

    2012-07-01

    For several decades, composites made of polylactic acid-calcium phosphates (PLA-CaP) and polylactic acid-co-glycolic acid-calcium phosphates (PLGA-CaP) have seen widespread uses in orthopedic applications. This paper reviews the fabrication aspects of these composites, following the ubiquitous materials science approach by studying "processing-structure-property" correlations. Various fabrication processes such as microencapsulation, phase separation, electrospinning, supercritical gas foaming, etc., are reviewed, with specific examples of their applications in fabricating these composites. The effect of the incorporation of CaP materials on the mechanical and biological performance of PLA/PLGA is addressed. In addition, this paper describes the state of the art on challenges and innovations concerning CaP dispersion, incorporation of biomolecules/stem cells and long-term degradation of the composites. PMID:22342596

  14. Control of a Multi-Drug-Resistant Acinetobacter baumannii Outbreak after Orthopedics Department Relocation

    PubMed Central

    Gogou, Vasiliki; Meletis, Georgios; Tsitouras, Dimosthenis

    2013-01-01

    Acinetobacter baumannii clinical isolates have the ability to survive in the hospital niche for prolonged time periods and to develop resistance against multiple antimicrobial agents. Therefore, A. baumannii has emerged as an important cause of nosocomial outbreaks worldwide, especially in critical-care environments such as intensive care units. In the present communication, we report a multi-drug-resistant A. baumannii outbreak that occurred in an orthopedics department in Greece after the admission of a patient previously hospitalized in the intensive care unit of a Greek tertiary care hospital. Despite the implementation of infection control measures, 29 patients were infected, significantly raising their hospitalization periods and treatment costs. Interestingly, the outbreak was put under control after the department’s previously programmed relocation.

  15. Dominance of foreign citations in Brazilian orthopedics journals☆☆☆

    PubMed Central

    Teixeira, Renan Kleber Costa; Yamaki, Vitor Nagai; Rosa, Rita de Cássia Rodrigues; de Barros, Rui Sergio Monteiro; Botelho, Nara Macedo

    2014-01-01

    Objective To evaluate whether there is any preference for citing journals from other countries to the detriment of Brazilian journals, in three Brazilian orthopedics journals. Methods All the references of articles published in 2011 by the journals Acta Ortopédica Brasileira, Coluna/Columna and Revista Brasileira de Ortopedia were evaluated to as certain how many of these came from Brazilian journals and how many from foreign journals. Results 3813 references distributed among 187 articles were analyzed. Out of this total, 306 (8.02%) were from Brazilian journals. There was no difference between the three journals analyzed. There were 76 articles (40.64%) without any citations of articles in Brazilian journals and only two articles (1%) cited more Brazilian articles than articles published elsewhere. Conclusion There is a need for Brazilian researchers to cite articles from Brazilian journals more often. PMID:26229879

  16. 3D Bioprinting of Cartilage for Orthopedic Surgeons: Reading between the Lines

    PubMed Central

    Di Bella, Claudia; Fosang, Amanda; Donati, Davide M.; Wallace, Gordon G.; Choong, Peter F. M.

    2015-01-01

    Chondral and osteochondral lesions represent one of the most challenging and frustrating scenarios for the orthopedic surgeon and for the patient. The lack of therapeutic strategies capable to reconstitute the function and structure of hyaline cartilage and to halt the progression toward osteoarthritis has brought clinicians and scientists together, to investigate the potential role of tissue engineering as a viable alternative to current treatment modalities. In particular, the role of bioprinting is emerging as an innovative technology that allows for the creation of organized 3D tissue constructs via a “layer-by-layer” deposition process. This process also has the capability to combine cells and biomaterials in an ordered and predetermined way. Here, we review the recent advances in cartilage bioprinting and we identify the current challenges and the directions for future developments in cartilage regeneration. PMID:26322314

  17. The distribution of mental illness found by DIS (Diagnostic Interview Schedule) among internal and orthopedic patients.

    PubMed

    Nishioka, Y; Nishizono, M; Yamamoto, J

    1990-03-01

    In order to understand how psychiatric problems are distributed in general medical departments, we used DIS (Diagnostic Interview Schedule). The subjects are 307 inpatients and outpatients in the Departments in Internal Medicine and Orthopedics of Fukuoka University Hospital, M Hospital and N Hospital. As a result, 53.4% of all the subjects showed some psychiatric problems. These are, in a descending order, tobacco dependence (30.0%), psychosexual dysfunction (14.3%), alcohol abuse/dependence (14.0%), major depressive episode (6.5%), organic brain syndrome (4.9%), obsessive-compulsive disorder (3.9%), dysthymic disorder (2.3%), panic disorder (2.0%) and others. Also, we discussed comparison between internal patients and neurotic patients who visited psychiatrists complaining of physical symptoms, and the incidence of DIS diagnoses in individual physical diseases. PMID:2362392

  18. [Massive pulmonary thromboembolism during an orthopedic surgery in an obese patient].

    PubMed

    Endoh, Masahiro; Yamanaka, Ikuo; Munetsugu, Yumi

    2013-10-01

    Deep venous thrombosis (DVT) and the consequent pulmonary embolism (PE) are devastating complications in orthopedic surgery. We report a 45-year-old male patient who developed PE during an operation of proximal tibia fracture under general anesthesia. On mobilization of knee joint, end-tidal CO2 suddenly decreased from 28 to 18 mmHg. Sp(O2) decreased from 99 to 92%, but blood pressure was maintained. Postoperatively Sp(O2) was maintained 94-95% in room air, but sinus tachycardia over 120 beats x min(-1) continued. On postoperative day 1, the patient experienced dyspnea. In the chest CT scan, massive embolism was found in the bilateral main pulmonary arteries and both middle lobe as well as lower lobe arteries in the right lung. DVT was detected by enhanced CT scan of the lower extremity. This patient had many risk factors for PE such as obesity, smoking, immobilization and lack of thromboprophylaxis.

  19. Evaluation of low-level controllers for an orthopedic surgery robotic system.

    PubMed

    Barkana, Duygun Erol

    2010-07-01

    In this paper, a computed-torque control and disturbance-observer-based control were evaluated for an orthopedic surgery robotic system called OrthoRoby, to track bone-cutting trajectory. Robust motion control is required to control a medical robotic system in an environment where model uncertainty and disturbances exist. Experiments were performed to demonstrate the performance of the tracking of the desired cutting trajectory when a computed-torque controller and disturbance-observer-based controller were used for OrthoRoby. It was observed that a computed-torque controller can become unstable with inexact cancellation due to parameter uncertainties and unmodeled dynamics. A disturbance-observer-based control was shown to ensure stability with inexact cancellation due to parameter uncertainties and unmodeled dynamics.

  20. 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. PMID:26297104

  1. Therapeutic approach to Class II, Division 1 malocclusion with maxillary functional orthopedics

    PubMed Central

    de Bittencourt, Aristeu Corrêa; Saga, Armando Yukio; Pacheco, Ariel Adriano Reyes; Tanaka, Orlando

    2015-01-01

    INTRODUCTION: Interceptive treatment of Class II, Division 1 malocclusion is a challenge orthodontists commonly face due to the different growth patterns they come across and the different treatment strategies they have available. OBJECTIVE: To report five cases of interceptive orthodontics performed with the aid of Klammt's elastic open activator (KEOA) to treat Class II, Division 1 malocclusion. METHODS: Treatment comprehends one or two phases; and the use of functional orthopedic appliances, whenever properly recommended, is able to minimize dentoskeletal discrepancies with consequent improvement in facial esthetics during the first stage of mixed dentition. The triad of diagnosis, correct appliance manufacture and patient's compliance is imperative to allow KEOA to contribute to Class II malocclusion treatment. RESULTS: Cases reported herein showed significant improvement in skeletal, dental and profile aspects, as evinced by cephalometric analysis and clinical photographs taken before, during and after interceptive orthodontics. PMID:26352852

  2. [Contribution of the cervical vertebral maturation (CVM) method to dentofacial orthopedics: update].

    PubMed

    Elhaddaoui, R; Benyahia, H; Azaroual, F; Zaoui, F

    2014-11-01

    The successful orthopedic treatment of skeletal Class II malocclusions is closely related to the reasoned determination of the optimal time to initiate the treatment. This is why various methods have been proposed to assess skeletal maturation, such as a hand-wrist radiograph or the cervical vertebral maturation (CVM) method. The hand-wrist radiograph was up to now the most frequently used method to assess skeletal maturation. However, the clinical and biological limitations of this technique, as well as the need to perform an additional radiograph, were reasons to develop another method to explore the maturation stages of visible cervical vertebrae on a simple lateral cephalometric radiograph. The authors compare the 2 methods and prove the greater contribution of the CVM method compared to the hand-wrist radiograph.

  3. Wear Properties of Porous NiTi Orthopedic Shape Memory Alloy

    NASA Astrophysics Data System (ADS)

    Wu, Shuilin; Liu, Xiangmei; Yeung, K. W. K.; Xu, Z. S.; Chung, C. Y.; Chu, Paul K.

    2012-12-01

    Porous NiTi shape memory alloy (SMA) scaffolds have great potential to be used as orthopedic implants because of their porous structure and superior physical properties. Its metallic nature provides it with better mechanical properties and Young's modulus close to that of natural bones. Besides allowing tissue ingrowth and transfer of nutrients, porous SMA possesses unique pseudoelastic properties compatible to natural hard tissues like bones and tendons, thus expediting in vivo osseointegration. However, the nickel release from debris and the metal surface may cause osteocytic osteolysis at the interface between the artificial implants and bone tissues. Subsequent mobilization may finally lead to implant failure. In this study, the wear properties of porous NiTi with different porosities processed at different treatment temperatures are determined. The results of the study show that the porosity, phase transformation temperature, and annealing temperature are major factors influencing the wear characteristics of porous NiTi SMA.

  4. Development of interactive patient-based multimedia computer programs in veterinary orthopedic radiology.

    PubMed

    Kraft, S L; Hoskinson, J J; Mussman, J M; Michaels, W E; McLaughlin, R; Gaughan, E M; Roush, J K

    1998-01-01

    Three computerized multimedia programs on large and small animal veterinary orthopedic radiology were developed and implemented for the radiology curriculum as an alternative to traditional film-based laboratory learning. Programs utilized "hot words" (colored text words that displayed an overlaid image label that highlighted lesions) and interactive quizzes which responded appropriately to selected answers. "Hot words" helped students develop confidence in accurate lesion detection and the interactive quizzes transformed learning from a passive to an active process. Multiple examples were provided for reinforcement and concepts were incorporated from other clinical disciplines for curriculum integration. Programs were written using a presentation software program, Toolbook for DOS based platform, and contained radiographic images made by laser-scanning digitization. Multiple students could simultaneously access the programs through a network server. These pilot programs were implemented successfully and computerized multimedia presentation proved to be well suited to teaching radiology. Development of the programs required attention to a number of hardware, software, time and cost factors.

  5. Mechanical properties of dispersed ceramic nanoparticles in polymer composites for orthopedic applications

    PubMed Central

    Liu, Huinan; Webster, Thomas J

    2010-01-01

    Ceramic/polymer composites have been considered as third-generation orthopedic biomaterials due to their ability to closely match properties (such as surface, chemistry, biological, and mechanical) of natural bone. It has already been shown that the addition of nanophase compared with conventional (or micron-scale) ceramics to polymers enhances bone cell functions. However, in order to fully take advantage of the promising nanometer size effects that nanoceramics can provide when added to polymers, it is critical to uniformly disperse them in a polymer matrix. This is critical since ceramic nanoparticles inherently have a strong tendency to form larger agglomerates in a polymer matrix which may compromise their properties. Therefore, in this study, model ceramic nanoparticles, specifically titania and hydroxyapatite (HA), were dispersed in a model polymer (PLGA, poly-lactic-co-glycolic acid) using high-power ultrasonic energy. The mechanical properties of the resulting PLGA composites with well-dispersed ceramic (either titania or HA) nanoparticles were investigated and compared with composites with agglomerated ceramic nanoparticles. Results demonstrated that well-dispersed ceramic nanoparticles (titania or HA) in PLGA improved mechanical properties compared with agglomerated ceramic nanoparticles even though the weight percentage of the ceramics was the same. Specifically, well-dispersed nanoceramics in PLGA enhanced the tensile modulus, tensile strength at yield, ultimate tensile strength, and compressive modulus compared with the more agglomerated nanoceramics in PLGA. In summary, supplemented by previous studies that demonstrated greater osteoblast (bone-forming cell) functions on well-dispersed nanophase ceramics in polymers, the present study demonstrated that the combination of PLGA with well-dispersed nanoceramics enhanced mechanical properties necessary for load-bearing orthopedic/dental applications. PMID:20463945

  6. Life satisfaction and health in cancer patients, orthopedic patients and healthy individuals.

    PubMed

    Kreitler, S; Chaitchik, S; Rapoport, Y; Kreitler, H; Algor, R

    1993-02-01

    Life satisfaction (LS) is one of a set of constructs defining quality of life. Previous studies showed that LS was sometimes related to health and sometimes not. The study was designed to examine the relation of LS as a general construct to satisfaction in specific domains. We assumed that there is a tendency to maintain an acceptable level of LS even under stressful and threatening conditions, that it is related to optimism and that the likelihood of attaining satisfaction in a particular domain affected the selection of domains on which LS is based. We expected that in cancer patients LS would be related to more domains but not to health. The study was done with 55 head-and-neck cancer patients, of all stages and grades of tumor; 51 orthopedic patients, victims of accidents with good recovery chances; and 55 healthy individuals. The healthy individuals and orthopedic patients were matched (in terms of group values) to the cancer patients in age, gender and education. Single-item measures of LS and optimism, and a questionnaire with 49 multiple-choice items assessing adjustment in 13 domains were administered to all subjects. The results showed that in cancer patients LS was related to most domains but not to health and not to optimism, whereas in the other groups it was related to few domains including health, and also to optimism. The findings support the tendency to maintain LS with the materials available to the individual, and show that health is related to LS only if its maintenance or attainment are realistic goals. Thus, both bottom-up and top-down theories of LS are supported.

  7. Clinics in Orthopedic Surgery's Evolution into an International Journal Based on Journal Metrics

    PubMed Central

    2016-01-01

    This article is aimed at providing evidence of increased international recognition of Clinics in Orthopedic Surgery (CiOS) based on journal metrics. Since 7 years have passed since its launch in 2009, it is time to reflect on the journal's efforts to be recognized as a top-notch journal. The following journal metrics were analyzed from the journal's homepage and Web of Science Core Collection database: number of citable and noncitable articles; number of original articles supported by grants; editorial board members' countries; authors' countries; citing authors' countries; source titles of citing articles; impact factor; total citations; comparison of impact factor with 3 Science Citation Index Expanded journals; and Hirsch index (H-index). Of the total 392 articles, 378 were citable articles (96.4%). Of the total 282 original articles, 52 (18.4%) were supported by research grants. The editorial board members were from 13 countries. Authors were from 20 countries. The number of countries of citing authors was 66. The number of source titles of citing articles was more than 100. The total citations of CiOS have increased from 0 in 2009 to 374 in 2015. The impact factors without self-citations of CiOS were the greatest among 4 Asian journals in 2013 and 2014. The 2015 impact factor was calculated as 0.79 in January 2016. The H-index was 13. CiOS can be considered to have reached the level of top-notch journal in the orthopedic field based on journal metrics. The inclusion of the journal in PubMed Central appears to have increased international relevance of the journal. PMID:27247735

  8. Relationship of orthopedic examination, goniometric measurements, and radiographic signs of degenerative joint disease in cats

    PubMed Central

    2012-01-01

    Background Available information suggests a mismatch between radiographic and orthopedic examination findings in cats with DJD. However, the extent of the discrepancy between clinical and radiographic signs of OA in companion animals has not been described in detail. This study aimed to evaluate the relationship between orthopedic examination findings, joint goniometry, and radiographic signs of DJD in 100 cats, in a prospective observational design. Cat temperament, pain response to palpation, joint crepitus, effusion and thickening were graded. Radiographs of appendicular joints and the axial skeleton were made under sedation. Joint motion was measured by use of a plastic goniometer before and after sedation. Associations between radiographic degenerative joint disease (DJD) and examination findings were assessed to determine sensitivity, specificity and likelihood estimations. Results Pain response to palpation was elicited in 0-67% of the joints with DJD, with a specificity ranging from 62-99%; crepitus was detected in 0-56% of the joints and its specificity varied between 87 and 99%; for effusion, values ranged between 6 and 38% (specificity, 82-100%), and thickening, 0-59% (specificity, 74-99%). Joints with DJD tended to have a decreased range of motion. The presence of pain increased the odds of having DJD in the elbow (right: 5.5; left: 4.5); the presence of pain in the lower back increased the odds of spinal DJD being present (2.97 for lumbar; 4.67 for lumbo-sacral). Conclusions Radiographic DJD cannot be diagnosed with certainty using palpation or goniometry. However, negative findings tend to predict radiographically normal joints. Palpation and goniometry may be used as a tool to help to screen cats, mostly to rule out DJD. PMID:22281125

  9. Outpatient parenteral antimicrobial therapy for orthopedic infections - a successful public healthcare experience in Brazil.

    PubMed

    Oliveira, Priscila Rosalba; Felix, Cassia da Silva; Carvalho, Vladimir Cordeiro de; Giovani, Arlete Mazzini; Reis, Rosangela Suarti Dos; Beraldo, Marisa; Albuquerque, Edmir Peralta; Ferreira, Walter Cintra; Silva, Jorge Dos Santos; Lima, Ana Lucia Lei

    2016-01-01

    Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT) started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42). Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies in other regions

  10. Outpatient parenteral antimicrobial therapy for orthopedic infections - a successful public healthcare experience in Brazil.

    PubMed

    Oliveira, Priscila Rosalba; Felix, Cassia da Silva; Carvalho, Vladimir Cordeiro de; Giovani, Arlete Mazzini; Reis, Rosangela Suarti Dos; Beraldo, Marisa; Albuquerque, Edmir Peralta; Ferreira, Walter Cintra; Silva, Jorge Dos Santos; Lima, Ana Lucia Lei

    2016-01-01

    Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT) started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42). Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies in other regions

  11. Mechanical properties of dispersed ceramic nanoparticles in polymer composites for orthopedic applications.

    PubMed

    Liu, Huinan; Webster, Thomas J

    2010-04-15

    Ceramic/polymer composites have been considered as third-generation orthopedic biomaterials due to their ability to closely match properties (such as surface, chemistry, biological, and mechanical) of natural bone. It has already been shown that the addition of nanophase compared with conventional (or micron-scale) ceramics to polymers enhances bone cell functions. However, in order to fully take advantage of the promising nanometer size effects that nanoceramics can provide when added to polymers, it is critical to uniformly disperse them in a polymer matrix. This is critical since ceramic nanoparticles inherently have a strong tendency to form larger agglomerates in a polymer matrix which may compromise their properties. Therefore, in this study, model ceramic nanoparticles, specifically titania and hydroxyapatite (HA), were dispersed in a model polymer (PLGA, poly-lactic-co-glycolic acid) using high-power ultrasonic energy. The mechanical properties of the resulting PLGA composites with well-dispersed ceramic (either titania or HA) nanoparticles were investigated and compared with composites with agglomerated ceramic nanoparticles. Results demonstrated that well-dispersed ceramic nanoparticles (titania or HA) in PLGA improved mechanical properties compared with agglomerated ceramic nanoparticles even though the weight percentage of the ceramics was the same. Specifically, well-dispersed nanoceramics in PLGA enhanced the tensile modulus, tensile strength at yield, ultimate tensile strength, and compressive modulus compared with the more agglomerated nanoceramics in PLGA. In summary, supplemented by previous studies that demonstrated greater osteoblast (bone-forming cell) functions on well-dispersed nanophase ceramics in polymers, the present study demonstrated that the combination of PLGA with well-dispersed nanoceramics enhanced mechanical properties necessary for load-bearing orthopedic/dental applications.

  12. Clinics in Orthopedic Surgery's Evolution into an International Journal Based on Journal Metrics.

    PubMed

    Huh, Sun

    2016-06-01

    This article is aimed at providing evidence of increased international recognition of Clinics in Orthopedic Surgery (CiOS) based on journal metrics. Since 7 years have passed since its launch in 2009, it is time to reflect on the journal's efforts to be recognized as a top-notch journal. The following journal metrics were analyzed from the journal's homepage and Web of Science Core Collection database: number of citable and noncitable articles; number of original articles supported by grants; editorial board members' countries; authors' countries; citing authors' countries; source titles of citing articles; impact factor; total citations; comparison of impact factor with 3 Science Citation Index Expanded journals; and Hirsch index (H-index). Of the total 392 articles, 378 were citable articles (96.4%). Of the total 282 original articles, 52 (18.4%) were supported by research grants. The editorial board members were from 13 countries. Authors were from 20 countries. The number of countries of citing authors was 66. The number of source titles of citing articles was more than 100. The total citations of CiOS have increased from 0 in 2009 to 374 in 2015. The impact factors without self-citations of CiOS were the greatest among 4 Asian journals in 2013 and 2014. The 2015 impact factor was calculated as 0.79 in January 2016. The H-index was 13. CiOS can be considered to have reached the level of top-notch journal in the orthopedic field based on journal metrics. The inclusion of the journal in PubMed Central appears to have increased international relevance of the journal.

  13. How many orthopedic surgeons does it take to write a research article? 50 years of authorship proliferation in and internationalization of the orthopedic surgery literature.

    PubMed

    Rahman, Luthfur; Muirhead-Allwood, Sarah K

    2010-07-13

    Publications are considered to indicate academic achievement and can lead to various rewards, including job opportunities and research funding. Recent years have seen a rising trend in the number of articles published, multiple authorship, and internationalization of the biomedical literature. The goal of this study was to analyze the trends in authorship over the past 50 years to determine whether the orthopedic literature parallels trends seen in other areas of the biomedical literature. We performed an observational study with analysis of the number of authors and geographic origin of articles published in the Journal of Bone and Joint Surgery British Volume (JBJS) and Clinical Orthopaedics and Related Research (CORR). We analyzed 2776 articles (CORR, n=1809; JBJS, n=967) published between 1958 and 2008 at 10-year intervals. There has been a significant increase in the mean number of authors per article from 1.638 to 4.08 (P<.0001) and 1.633 to 4.540 (P<.0001) for CORR and JBJS, respectively between 1958 and 2008. There has been a significant increase in the international contribution to both journals (P<.0001). The number of countries contributing to articles increased from 5 to 39 and from 17 to 33 for CORR and JBJS, respectively. These findings are similar to other areas of the biomedical literature. The reasons for this proliferation are multifactorial, including multicenter trials and inappropriate authorship. Guidelines for authorship and preparation of manuscripts from the International Committee of Medical Journal Editors or from individual journals are widely available, and every effort should be made to adhere to them to prevent inappropriate authorship proliferation in the future.

  14. [Victims of traffic occurrence submitted to surgery procedures: characteristics and perioperative complications].

    PubMed

    Reiniger, Lívia Ortiz; de Sousa, Regina Marcia Cardoso; Nogueira, Lilia de Souza; Costa, Ana Lucia Siqueira

    2012-10-01

    This study aimed to characterize the victims of traffic occurrence submitted to anesthetic-surgical procedures according to demographics and clinical data and identify the predictors of complications during the perioperative period (hemorrhagic shock and death). A cross-longitudinal analysis developed from the consultations of patients´ records submitted to surgery at a hospital in São Paulo city. There was predominance of young, male, and motorcycle/cyclist accident victims who received prehospital support in 69 analyzed patients. The abdomen as the most severely injured region, Injury Severity Score, general and orthopedic surgeries variables showed statistically significant association with shock and death. Age was only associated with shock. In the final model, the Injury Severity Score was predictor for shock and death, and general surgery only for shock. Orthopedic surgery was a protection factor for death. These findings subsidize the surgical team in strategic planning that aims to decrease undesirable outcomes. PMID:23250259

  15. [X-ray in trauma and orthopedic surgery. Physical and biological impact, reasonable use, and radiation protection in the operating room].

    PubMed

    Dresing, K

    2011-02-01

    Orthopedic and especially trauma surgeons' use of x-rays during operations vary extensively, especially in minimally invasive osteosynthesis procedures. Radiation hazards often are neglected. In this paper, a short overview of physical and biological effects of radiation are given. In addition, practical information about how to lower radiation exposure in the daily work in the operating room (OR) is given. The operating team is exposed mainly to scattered radiation. The radiation exposure is 10 times higher on the tube side than on the amplifier side. The distance between tube and surgeon must be as great as possible. The tube should be positioned under the OR table, and the distance between tube and patient should be as short as possible. The positioning of the C-arm device without radiation is important. The use of patient landmarks is used to position the C-arm over the region of interest, but the preoperative training of surgeons and team with virtual learning tools, e.g., virtX, is very effective in reducing radiation hazards.

  16. Surgical Outcomes and Correlation of the Copenhagen Neck Functional Disability Scale and Modified Japanese Orthopedic Association Assessment Scales in Patients with Cervical Spondylotic Myelopathy

    PubMed Central

    Azhari, Shirzad; Shazadi, Sohrab; Khayat Kashany, Hamid; Nayeb Aghaei, Hossein; Mohammadi, Hassan Reza

    2016-01-01

    Study Design Cross-sectional. Purpose Clinical outcome study comparing the Copenhagen Neck Functional Disability Scale (CNFDS) and modified Japanese orthopedic association (mJOA) assessment scales in patients with cervical spondylotic myelopathy (CSM). Overview of Literature Comparison of instruments that measure patient-reported outcomes is needed. Methods A cross-sectional analysis was conducted. Ninety five patients with CSM were entered into the study and completed the CNFDS and the mJOA preoperatively and postoperatively. Correlation between the CNFDS and the mJOA was evaluated preoperatively and at the end of follow-up. Responsiveness to change of CNFDS and mJOA was also assessed. Clinical outcomes were also measured with the recovery rate of mJOA score at end of follow-up. Results The mean age of patients was 58.2 (standard deviation, SD=8.7) years. Mean follow-up was 2.1 years (range, 1 to 4 years). The mJOA correlated strongly with the CNFDS score preoperatively and postoperatively (r=–0.81 and –0.82, respectively; p<0.001). The CNFDS and the mJOA were able to detect changes after the surgery (p<0.001). The mean mJOA recovery rate was 51.8% (SD=13.1%). Conclusions Surgery for the treatment of patients with CSM is an efficacious procedure. CNFDS and mJOA scores have a strong correlation in measuring disability among CSM patients. PMID:27340528

  17. Using an admittance algorithm for bone drilling procedures.

    PubMed

    Accini, Fernando; Díaz, Iñaki; Gil, Jorge Juan

    2016-01-01

    Bone drilling is a common procedure in many types of surgeries, including orthopedic, neurological and otologic surgeries. Several technologies and control algorithms have been developed to help the surgeon automatically stop the drill before it goes through the boundary of the tissue being drilled. However, most of them rely on thrust force and cutting torque to detect bone layer transitions which has many drawbacks that affect the reliability of the process. This paper describes in detail a bone-drilling algorithm based only on the position control of the drill bit that overcomes such problems and presents additional advantages. The implication of each component of the algorithm in the drilling procedure is analyzed and the efficacy of the algorithm is experimentally validated with two types of bones. PMID:26516110

  18. Tribological characterization of zirconia coatings deposited on Ti6Al4V components for orthopedic applications.

    PubMed

    Berni, M; Lopomo, N; Marchiori, G; Gambardella, A; Boi, M; Bianchi, M; Visani, A; Pavan, P; Russo, A; Marcacci, M

    2016-05-01

    One of the most important issues leading to the failure of total joint arthroplasty is related to the wear of the plastic components, which are generally made of ultra high molecular weight polyethylene (UHMWPE). Therefore, the reduction of joint wear represents one of the main challenges the research in orthopedics is called to address nowadays. Surface treatments and coatings have been recognized as innovative methods to improve tribological properties, also in the orthopedic field. This work investigated the possibility to realize hard ceramic coatings on the metal component of a prosthesis, by means of Pulsed Plasma Deposition, in order to reduce friction and wear in the standard coupling against UHMWPE. Ti6Al4V substrates were coated with a 2 μm thick yttria-stabilized zirconia (YSZ) layer. The mechanical properties of the YSZ coatings were assessed by nanoindentation tests performed on flat Ti6Al4V substrates. Tribological performance was evaluated using a ball-on-disk tribometer in dry and lubricated (i.e. with fetal bovine serum) highly-stressing conditions, up to an overall distance of 10 km. Tribology was characterized in terms of coefficient of friction (CoF) and wear rate of the UHMWPE disk. After testing, specimens were analyzed through optical microscopy and SEM images, in order to check the wear degradation mechanisms. Progressive loading scratch tests were also performed in dry and wet conditions to determine the effects of the environment on the adhesion of the coating. Our results supported the beneficial effect of YSZ coating on metal components. In particular, the proposed solution significantly reduced UHMWPE wear rate and friction. At 10 km of sliding distance, a wear rate reduction of about 18% in dry configuration and of 4% in presence of serum, was obtained by the coated group compared to the uncoated group. As far as friction in dry condition is concerned, the coating allowed to maintain low CoF values until the end of the tests, with an

  19. Tribological characterization of zirconia coatings deposited on Ti6Al4V components for orthopedic applications.

    PubMed

    Berni, M; Lopomo, N; Marchiori, G; Gambardella, A; Boi, M; Bianchi, M; Visani, A; Pavan, P; Russo, A; Marcacci, M

    2016-05-01

    One of the most important issues leading to the failure of total joint arthroplasty is related to the wear of the plastic components, which are generally made of ultra high molecular weight polyethylene (UHMWPE). Therefore, the reduction of joint wear represents one of the main challenges the research in orthopedics is called to address nowadays. Surface treatments and coatings have been recognized as innovative methods to improve tribological properties, also in the orthopedic field. This work investigated the possibility to realize hard ceramic coatings on the metal component of a prosthesis, by means of Pulsed Plasma Deposition, in order to reduce friction and wear in the standard coupling against UHMWPE. Ti6Al4V substrates were coated with a 2 μm thick yttria-stabilized zirconia (YSZ) layer. The mechanical properties of the YSZ coatings were assessed by nanoindentation tests performed on flat Ti6Al4V substrates. Tribological performance was evaluated using a ball-on-disk tribometer in dry and lubricated (i.e. with fetal bovine serum) highly-stressing conditions, up to an overall distance of 10 km. Tribology was characterized in terms of coefficient of friction (CoF) and wear rate of the UHMWPE disk. After testing, specimens were analyzed through optical microscopy and SEM images, in order to check the wear degradation mechanisms. Progressive loading scratch tests were also performed in dry and wet conditions to determine the effects of the environment on the adhesion of the coating. Our results supported the beneficial effect of YSZ coating on metal components. In particular, the proposed solution significantly reduced UHMWPE wear rate and friction. At 10 km of sliding distance, a wear rate reduction of about 18% in dry configuration and of 4% in presence of serum, was obtained by the coated group compared to the uncoated group. As far as friction in dry condition is concerned, the coating allowed to maintain low CoF values until the end of the tests, with an

  20. Reduced Length of Hospitalization in Primary Total Knee Arthroplasty Patients Using an Updated Enhanced Recovery After Orthopedic Surgery (ERAS) Pathway.

    PubMed

    Auyong, David B; Allen, Cindy Jo; Pahang, Joshuel A; Clabeaux, Jonathan J; MacDonald, Kevin M; Hanson, Neil A

    2015-10-01

    Decreasing hospital length of stay may attenuate costs associated with total knee arthroplasty. The purpose of this study was to determine if updates to an existing orthopedic enhanced recovery after surgery (ERAS) pathway would improve length of hospitalization. Clinical and demographic data were collected on 252 primary total knee arthroplasties between January 2012 and July 2013. Pre-updated and post-updated ERAS pathway cohorts were analyzed for length of stay, clinical outcomes, and re-admissions. The mean length of stay decreased from 76.6 hours to 56.1 hours after implementation of the evidence-based orthopedic enhanced recovery after surgery pathway (P<0.001). This improvement was possible without a concomitant increase in readmission rates.

  1. [Time to bury the adrenaline-myth!--Safe use of adrenaline anesthesia in hand surgery and orthopedics].

    PubMed

    Hagert, Elisabet; Lalonde, Donald

    2015-01-01

    The epinephrine myth originated in the 1940s, when acidic (pH 1) procaine-epinephrine was injected into fingers, causing finger necrosis. Today, level 1 evidence exists for the safe use of epinephrine in fingers. The ability to use lidocaine-epinephrine in hand surgery and orthopedics eliminates the need for a tourniquet, or "bloodless field". Surgery using Wide Awake, Lidocaine-epinephrine Anesthesia, No Tourniquet (WALANT) reduces patient discomfort, facilitates patient participation in surgery, improves safe outcomes following reconstructions and greatly reduces the cost of medical care. Furthermore, patients regarded as high-risk can be safely treated without risk of cardiac or pulmonary side effects. In this manuscript, the background of the epinephrine myth is described, as well as recommended use of WALANT in hand surgery and orthopedics.

  2. Studies on biodegradation of crosslinked hydroxy terminated-poly(proplyene fumarate) and formation of scaffold for orthopedic applications.

    PubMed

    Shalumon, K T; Jayabalan, M

    2009-12-01

    Biodegradation of crosslinked-hydroxy terminated-poly(proplyene fumarate) (X-HTPPF) has been studied in simulated physiological media to assess the formation of porous scaffold structure for bone growth and remodeling in load bearing orthopedic applications. Variation in crosslink density and surface hydrophilicity of X-HTPPF are observed due to non-stoichiometric mass of reacting partners. These variations influence absorption of the medium and biodegradation during aging. Though the initial absorption of medium is relatively higher with the crosslinked polymer (PNVP1) having 63.6% HT-PPF and 36.4% comonomer n-vinyl pyrrolidone (NVP) during the initial period of aging, the weight loss due to subsequent degradation with time is relatively lesser. PNVP1 undergo slow degradation with formation of fibril structure on the surface. The present crosslinked material PNVP1 is a candidate for the load bearing orthopedic applications.

  3. The business side of medicine for orthopedic residents and fellows: when were we supposed to learn this?

    PubMed

    Gum, Jeffrey L

    2014-08-01

    CPT, CMS, RAC, ICD-10, ACA, RVU, ACO-these are a few of the 3-letter acronyms I find myself swimming in while completing my final years of orthopedic training. It has suddenly become clear that this aspect of my future career, the business side, has lacked appropriate preparation. From countless hours buried in textbooks as a first-year medical student to late nights in the operating room as a fellow, I realize that I have had no formal business training, not even a single course, while nearing the completion of, effectively, the 28th grade. All while just days away from running my own business-my clinical practice as an orthopedic surgeon. PMID:25136878

  4. Nutritional risk, malnutrition and nutritional support among hospitalized patients in orthopedics/spinal surgery of a Hohhot teaching hospital.

    PubMed

    Wang, Nannan; Dong, Yalin; Huo, Ting; Shao, Yanqing; Xing, Wenhua; Li, Shuwen

    2016-01-01

    The evolution of nutritional status (the prevalence of nutritional risk, malnutrition, overweight and obesity) and the nutritional support of the hospitalized patients from admission to discharge or over a two-week period in orthopedics/ spinal surgery of a teaching hospital in Hohhot were investigated. 432 patients from two wards of the orthopedics/spinal surgery from Jan to Dec 2013, the traditional spinal surgery and the minimally invasive spinal surgery, were selected and detected in this study. The Nutritional Risk Score 2002 (NRS 2002) was used to determine the patients' nutritional status within 48 h after admission and during their hospitalization. The overall prevalence of nutritional risk, malnutrition, overweight and obesity at admission was 11.6%, 12.7%, 35.9% and 7.41%, respectively. Overall, there were 88.0% of the patients who were at nutritional risk received nutritional support, while 14.1% of non-risk patients received a redundant nutritional support. The overall prevalence of nutritional risk changed from 11.6% at admission to 19.4% upon discharge (p<0.05), and the prevalence of malnutrition changed from 12.7% to 20.6% (p<0.05). The prevalence of overweight and obesity, which changed from 35.9% to 31.0% and from 7.41% to 5.79% respectively, didn't experience statistically significant evolution. NRS 2002 was a feasible nutritional risk screening tool for patients in spinal surgery of orthopedics department. Patients' prevalence of nutritional risk and malnutrition increased significantly in spinal surgery of this hospital. Some inappropriate uses of nutritional support were observed in orthopedics/spinal surgery, and nutritional support guidelines or protocols should be promoted by a professional committee.

  5. Characterization of aerosols produced by surgical procedures

    SciTech Connect

    Yeh, H.C.; Muggenburg, B.A.; Lundgren, D.L.; Guilmette, R.A.; Snipes, M.B.; Jones, R.K.; Turner, R.S.

    1994-07-01

    In many surgeries, especially orthopedic procedures, power tools such as saws and drills are used. These tools may produce aerosolized blood and other biological material from bone and soft tissues. Surgical lasers and electrocautery tools can also produce aerosols when tissues are vaporized and condensed. Studies have been reported in the literature concerning production of aerosols during surgery, and some of these aerosols may contain infectious material. Garden et al. (1988) reported the presence of papilloma virus DNA in the fumes produced from laser surgery, but the infectivity of the aerosol was not assessed. Moon and Nininger (1989) measured the size distribution and production rate of emissions from laser surgery and found that particles were generally less than 0.5 {mu}m diameter. More recently there has been concern expressed over the production of aerosolized blood during surgical procedures that require power tools. In an in vitro study, the production of an aerosol containing the human immunodeficiency virus (HIV) was reported when power tools were used to cut tissues with blood infected with HIV. Another study measured the size distribution of blood aerosols produced by surgical power tools and found blood-containing particles in a number of size ranges. Health care workers are anxious and concerned about whether surgically produced aerosols are inspirable and can contain viable pathogens such as HIV. Other pathogens such as hepatitis B virus (HBV) are also of concern. The Occupational Safety and Health funded a project at the National Institute for Inhalation Toxicology Research Institute to assess the extent of aerosolization of blood and other tissues during surgical procedures. This document reports details of the experimental and sampling approach, methods, analyses, and results on potential production of blood-associated aerosols from surgical procedures in the laboratory and in the hospital surgical suite.

  6. Opium and opioid abuse in orthopedic inpatients: a cross sectional study in Urmia University of Medical Sciences.

    PubMed

    Afshar, Ahmadreza; Asadzadeh, Mina; Kargar, Hakimeh; Aghdashi, Mir Mosa; Mirzatolooei, Fardin

    2012-01-01

    During a cross-sectional study, patients who were admitted to the orthopedic department of the Urmia University of Medical Sciences were asked about opium/opioid abuse. Demographic characteristics, the pattern of consumption, the substance, the duration of the use, the duration of hospital stay and the cause of their injuries were recorded. Among 2,867 patients, 74 (2.5%) patients (71 men and 3 women) with the mean age of 38 were opium/opioid users. Most of the patients used opium through inhalation. The mean duration of the substance use was 7.4 years. The mean duration of hospital stay between the regular orthopedic patients and the opium/opioid abuser orthopedic patients was statistically significant. (P=000). Among four Hepatitis C Virus (HCV) infected patients, three subjects were injection users and Human Immunodeficiency Virus (HIV) also infected two of them. Road traffic accidents (37.8%), and work related injuries (17.5%) were the two most common reasons for the patient's injuries.

  7. Effect of work-hour restrictions and resident turnover in orthopedic trauma.

    PubMed

    Aynardi, Michael; Miller, Adam G; Orozco, Fabio; Ong, Alvin

    2012-11-01

    The resident 80-hour workweek and the July phenomenon have raised concern regarding the continuity of care of orthopedic patients in teaching institutions and its effect on postoperative complications and mortality. This study examined the effect of resident work-hour restrictions and the July phenomenon on patient outcomes after hip fracture at a large academic institution. Seven hundred twenty-two patients (mean age, 76.7 years) sustaining 319 femoral neck fractures and 403 intertrochanteric fractures between 2000 and 2010 were identified. Analysis was performed before and after July 1, 2003, as well as for the month of treatment. No difference existed in the postoperative outcome measures of delay of surgery (P=.061), complications (P=.904), and mortality (P=.981) between patients treated before and after July 1, 2003. Patients treated after July 1, 2003, had a significantly higher median number of preoperative comorbidities (4 vs 3, respectively; P<.0005). Turnover months, July and August, showed no difference in the outcome measures of delay of surgery (P=.171), complications (P=.776), and mortality (P=.524) compared with other months. This study suggests that 80-hour workweek restrictions or resident turnover months have no effect on patient care with respect to in-hospital time to surgery, complications, and mortality. This success can be attributed to ancillary staff support, physician extenders, and well-designed patient care protocols. PMID:23127459

  8. Attribute dimensions that distinguish master and novice physical therapy clinicians in orthopedic settings.

    PubMed

    Jensen, G M; Shepard, K F; Gwyer, J; Hack, L M

    1992-10-01

    The purpose of this qualitative case study was to further investigate the work of master and novice clinicians within the practice setting. The sample consisted of three master clinicians and three novice clinicians practicing in orthopedic outpatient physical therapy settings in three different regions of the United States. Data collection by three researchers included observation of each clinician treating at least three patients, audiotaping of all treatment sessions, interviews with clinicians and patients, and a review of patient records. Analysis of the data within and across cases revealed five attribute dimensions that distinguished the master clinician from the novice clinician. One attribute dimension (ie, confidence in predicting patient outcomes) related to knowledge, and four attribute dimensions (ie, ability to control the environment, evaluation and use of patient illness and disease data, focus of verbal and nonverbal communication with patients, and importance of teaching to hands-on care) related to improvisational performance. Further investigations are needed to confirm these findings and add to the body of knowledge concerning the parameters of physical therapy that may affect the efficacy and quality of patient care.

  9. Ica-expression and gentamicin susceptibility of Staphylococcus epidermidis biofilm on orthopedic implant biomaterials.

    PubMed

    Nuryastuti, Titik; Krom, Bastiaan P; Aman, Abu T; Busscher, Henk J; van der Mei, Henny C

    2011-02-01

    Ica-expression by Staphylococcus epidermidis and slime production depends on environmental conditions such as implant material and presence of antibiotics. Here, we evaluate biofilm formation and ica-expression of S. epidermidis strains on biomaterials involved in total hip- and knee arthroplasty [polyethylene (PE), polymethylmethacrylate (PMMA), stainless steel (SS)]. Ica-expression, assayed using real-time RT-PCR, was highest on PE as confirmed using confocal laser scanning microscopy. Yet biofilm formation by S. epidermidis was most extensive on SS, with less slime production. Ica-expression and slime production were minimal on PMMA. After 3 h of continued growth of 24 h old biofilms in the presence of gentamicin, biofilms on PE showed lower susceptibility to gentamicin, relative to the other materials, presumably as a result of the stronger ica-expression. A higher gentamicin concentration further decreased metabolic activity on all biomaterials. It is concluded that the level of biomaterial-induced ica-expression does not correlate with the amount of biofilm formed, but initially aids bacteria in surviving antibiotic attacks. Once antibiotic treatment has started however, also the antibiotic itself induces slime production and only if its concentration is high enough, killing results. Results suggest that biomaterial-associated infections in orthopedics by S. epidermidis on PE may be more difficult to eradicate than on PMMA or SS.

  10. Development of interactive patient-based multimedia computer programs in veterinary orthopedic radiology.

    PubMed

    Kraft, S L; Hoskinson, J J; Mussman, J M; Michaels, W E; McLaughlin, R; Gaughan, E M; Roush, J K

    1998-01-01

    Three computerized multimedia programs on large and small animal veterinary orthopedic radiology were developed and implemented for the radiology curriculum as an alternative to traditional film-based laboratory learning. Programs utilized "hot words" (colored text words that displayed an overlaid image label that highlighted lesions) and interactive quizzes which responded appropriately to selected answers. "Hot words" helped students develop confidence in accurate lesion detection and the interactive quizzes transformed learning from a passive to an active process. Multiple examples were provided for reinforcement and concepts were incorporated from other clinical disciplines for curriculum integration. Programs were written using a presentation software program, Toolbook for DOS based platform, and contained radiographic images made by laser-scanning digitization. Multiple students could simultaneously access the programs through a network server. These pilot programs were implemented successfully and computerized multimedia presentation proved to be well suited to teaching radiology. Development of the programs required attention to a number of hardware, software, time and cost factors. PMID:9548135

  11. Isocyanate Exposure Assessment Combining Industrial Hygiene Methods with Biomonitoring for End Users of Orthopedic Casting Products

    PubMed Central

    Pearson, Ronald L.; Logan, Perry W.; Kore, Anita M.; Strom, Constance M.; Brosseau, Lisa M.; Kingston, Richard L.

    2013-01-01

    Previous studies have suggested a potential risk to healthcare workers applying isocyanate-containing casts, but the authors reached their conclusions based on immunological or clinical pulmonology test results alone. We designed a study to assess potential exposure to methylene diphenyl diisocyanate (MDI) among medical personnel applying orthopedic casts using two different application methods. Air, dermal, surface, and glove permeation sampling methods were combined with urinary biomonitoring to assess the overall risk of occupational asthma to workers handling these materials. No MDI was detected in any of the personal and area air samples obtained. No glove permeation of MDI was detected. A small proportion of surface (3/45) and dermal wipe (1/60) samples were positive for MDI, but were all from inexperienced technicians. Urinary metabolites of MDI [methylenedianiline (MDA)] were detected in three of six study participants prior to both a ‘dry’ and ‘wet’ application method, five of six after the dry method, and three of six after the wet method. All MDA results were below levels noted in worker or general populations. Our conclusion is that the risk of MDI exposure is small, but unquantifiable. Because there is some potential risk of dermal exposure, medical personnel are instructed to wear a minimum of 5-mil-thick (5 mil = 0.005 inches) nitrile gloves and avoid contact to unprotected skin. This could include gauntlets, long sleeves, and/or a laboratory coat. PMID:23680587

  12. High hydrostatic pressure, a novel approach in orthopedic surgical oncology to disinfect bone, tendons and cartilage.

    PubMed

    Diehl, Peter; Schauwecker, Johannes; Mittelmeier, Wolfram; Schmitt, Manfred

    2008-01-01

    High hydrostatic pressure (HHP) is widely used in the food processing industry, for example to inactivate vegetative microorganisms in meat products, milk and juice, thereby avoiding the addition of any chemical preservatives. Besides this, HHP is also an attractive novel approach to effectively kill vegetative microorganisms or tumor cells in bone, cartilage and tendon ex vivo while leaving the tissues' mechanical properties unimpaired, thus allowing reimplantation of the resected tissue explants. In contrast, sterilization by gamma irradiation and thermal or chemical inactivation of potentially infected autografts, allografts and other biomaterials considered for tissue regeneration and reconstruction is often associated with deterioration of the mechanical, physical and biological properties of the implant. HHP technology is now in preclinical testing with the aim of disinfecting/devitalizing grafts in order to inactivate both vegetative microorganisms and tumor cells in resected bone tissue segments, eventually allowing reimplantation of resected bone segments initially afflicted with osteomyelitis or tumors. The technical advantages, state-of-the-art, and potential application of HHP in orthopedic surgery are reviewed.

  13. 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

  14. Analysis of the Korean Orthopedic In-Training Examination: The Hip and Pelvis Section

    PubMed Central

    Cho, Yohan; Kim, Joon Yub

    2016-01-01

    Purpose The purpose of this study was to analyze the questions in the hip and pelvis section of the Korean Orthopaedic In-Training Examination (KOITE). Materials and Methods We analyzed all KOITE questions pertaining to hip and pelvis surgery between 2010 and 2014. A thorough analysis of the contents was performed after categorizing as tested topics, imaging modalities used, taxonomic classification, and recommended references. We also analyzed the scores of the hip and pelvis section of the KOITE. Results Seventy-five of five-hundred questions (weight, 15.0%) were related to the hip and pelvis. Trauma including fracture and dislocation (26/75, 34.7%) was asked more commonly than disease and basics. The description-only questions (65/75, 86.7%) were the most frequently asked. According to taxonomic classification, taxonomy 3 (decision; 39/75, 52.0%) was most frequently asked. Campbell's Operative Orthopedics (52/75, 69.3%) was the reference that covered most of the questions. Conclusion This analysis of the hip and pelvis section of KOITE could be used for resident training programs in teaching hospitals. PMID:27777918

  15. An overview of recent advances in designing orthopedic and craniofacial implants.

    PubMed

    Mantripragada, Venkata P; Lecka-Czernik, Beata; Ebraheim, Nabil A; Jayasuriya, Ambalangodage C

    2013-11-01

    Great deal of research is still going on in the field of orthopedic and craniofacial implant development to resolve various issues being faced by the industry today. Despite several disadvantages of the metallic implants, they continue to be used, primarily because of their superior mechanical properties. In order to minimize the harmful effects of the metallic implants and its by-products, several modifications are being made to these materials, for instance nickel-free stainless steel, cobalt-chromium and titanium alloys are being introduced to eliminate the toxic effects of nickel being released from the alloys, introduce metallic implants with lower modulus, reduce the cost of these alloys by replacing rare elements with less expensive elements etc. New alloys like tantalum, niobium, zirconium, and magnesium are receiving attention given their satisfying mechanical and biological properties. Non-oxide ceramics like silicon nitride and silicon carbide are being currently developed as a promising implant material possessing a combination of properties such as good wear and corrosion resistance, increased ductility, good fracture and creep resistance, and relatively high hardness in comparison to alumina. Polymer/magnesium composites are being developed to improve mechanical properties as well as retain polymer's property of degradation. Recent advances in orthobiologics are proving interesting as well. This paper thus deals with the latest improvements being made to the existing implant materials and includes new materials being introduced in the field of biomaterials.

  16. An overview of recent advances in designing orthopedic and craniofacial implants.

    PubMed

    Mantripragada, Venkata P; Lecka-Czernik, Beata; Ebraheim, Nabil A; Jayasuriya, Ambalangodage C

    2013-11-01

    Great deal of research is still going on in the field of orthopedic and craniofacial implant development to resolve various issues being faced by the industry today. Despite several disadvantages of the metallic implants, they continue to be used, primarily because of their superior mechanical properties. In order to minimize the harmful effects of the metallic implants and its by-products, several modifications are being made to these materials, for instance nickel-free stainless steel, cobalt-chromium and titanium alloys are being introduced to eliminate the toxic effects of nickel being released from the alloys, introduce metallic implants with lower modulus, reduce the cost of these alloys by replacing rare elements with less expensive elements etc. New alloys like tantalum, niobium, zirconium, and magnesium are receiving attention given their satisfying mechanical and biological properties. Non-oxide ceramics like silicon nitride and silicon carbide are being currently developed as a promising implant material possessing a combination of properties such as good wear and corrosion resistance, increased ductility, good fracture and creep resistance, and relatively high hardness in comparison to alumina. Polymer/magnesium composites are being developed to improve mechanical properties as well as retain polymer's property of degradation. Recent advances in orthobiologics are proving interesting as well. This paper thus deals with the latest improvements being made to the existing implant materials and includes new materials being introduced in the field of biomaterials. PMID:23766134

  17. Microimplant-assisted rapid palatal expansion appliance to orthopedically correct transverse maxillary deficiency in an adult.

    PubMed

    Carlson, Chuck; Sung, Jay; McComb, Ryan W; Machado, Andre Wilson; Moon, Won

    2016-05-01

    This case report describes the use of a microimplant-assisted rapid palatal expansion (MARPE) appliance to orthopedically correct a transverse maxillary deficiency in an adult patient. Expansion forces transmitted through the teeth in traditional rapid palatal expansion appliances create unwanted dental effects rather than true skeletal expansion, particularly in older patients with more rigid interdigitation of the midpalatal suture. This 19-year-old patient had maxillary constriction with a unilateral posterior crossbite. A MARPE appliance secured to the palatal bones with 4 microimplants was expanded by 10 mm. Pre-MARPE and post-MARPE cone-beam computed tomography cross sections demonstrated 4 to 6 mm of expansion of the maxillofacial structures, including the zygoma and nasal bone area, and widening of the circummaxillary sutures. Minor buccal tipping of the dentition was observed, but the integrity of the alveolar bone was preserved. This report demonstrates that careful design and application of the MARPE appliance can achieve successful transverse expansion of the maxilla and the surrounding structures in a patient beyond the age typically considered acceptable for traditional rapid palatal expansion.

  18. Isocyanate exposure assessment combining industrial hygiene methods with biomonitoring for end users of orthopedic casting products.

    PubMed

    Pearson, Ronald L; Logan, Perry W; Kore, Anita M; Strom, Constance M; Brosseau, Lisa M; Kingston, Richard L

    2013-07-01

    Previous studies have suggested a potential risk to healthcare workers applying isocyanate-containing casts, but the authors reached their conclusions based on immunological or clinical pulmonology test results alone. We designed a study to assess potential exposure to methylene diphenyl diisocyanate (MDI) among medical personnel applying orthopedic casts using two different application methods. Air, dermal, surface, and glove permeation sampling methods were combined with urinary biomonitoring to assess the overall risk of occupational asthma to workers handling these materials. No MDI was detected in any of the personal and area air samples obtained. No glove permeation of MDI was detected. A small proportion of surface (3/45) and dermal wipe (1/60) samples were positive for MDI, but were all from inexperienced technicians. Urinary metabolites of MDI [methylenedianiline (MDA)] were detected in three of six study participants prior to both a 'dry' and 'wet' application method, five of six after the dry method, and three of six after the wet method. All MDA results were below levels noted in worker or general populations. Our conclusion is that the risk of MDI exposure is small, but unquantifiable. Because there is some potential risk of dermal exposure, medical personnel are instructed to wear a minimum of 5-mil-thick (5 mil = 0.005 inches) nitrile gloves and avoid contact to unprotected skin. This could include gauntlets, long sleeves, and/or a laboratory coat.

  19. Nanoparticulate zinc oxide as a coating material for orthopedic and dental implants.

    PubMed

    Memarzadeh, Kaveh; Sharili, Amir S; Huang, Jie; Rawlinson, Simon C F; Allaker, Robert P

    2015-03-01

    Orthopedic and dental implants are prone to infection. In this study, we describe a novel system using zinc oxide nanoparticles (nZnO) as a coating material to inhibit bacterial adhesion and promote osteoblast growth. Electrohydrodynamic atomisation (EHDA) was employed to deposit mixtures of nZnO and nanohydroxyapatite (nHA) onto the surface of glass substrates. Nano-coated substrates were exposed to Staphylococcus aureus suspended in buffered saline or bovine serum to determine antimicrobial activity. Our results indicate that 100% nZnO and 75% nZnO/25% nHA composite-coated substrates have significant antimicrobial activity. Furthermore, osteoblast function was explored by exposing cells to nZnO. UMR-106 cells exposed to nZnO supernatants showed minimal toxicity. Similarly, MG-63 cells cultured on nZnO substrates did not show release of TNF-α and IL-6 cytokines. These results were reinforced by both proliferation and differentiation studies which revealed that a substrate coated with exclusively nZnO is more efficient than composite surface coatings. Finally, electron and light microscopy, together with immunofluorescence staining, revealed that all cell types tested, including human mesenchymal cell (hMSC), were able to maintain normal cell morphology when adhered onto the surface of the nano-coated substrates. Collectively, these findings indicate that nZnO can, on its own, provide an optimal coating for future bone implants that are both antimicrobial and biocompatible.

  20. An overview of recent advances in designing orthopedic and craniofacial implants

    PubMed Central

    Mantripragada, Venkata P.; Lecka-Czernik, Beata; Ebraheim, Nabil A.; Jayasuriya, Ambalangodage C.

    2016-01-01

    Great deal of research is still going on in the field of orthopedic and craniofacial implant development to resolve various issues being faced by the industry today. Despite several disadvantages of the metallic implants, they continue to be used, primarily because of their superior mechanical properties. In order to minimize the harmful effects of the metallic implants and its by-products, several modifications are being made to these materials, for instance nickel-free stainless steel, cobalt-chromium and titanium alloys are being introduced to eliminate the toxic effects of nickel being released from the alloys, introduce metallic implants with lower modulus, reduce the cost of these alloys by replacing rare elements with less expensive elements etc. New alloys like tantalum, niobium, zirconium, and magnesium are receiving attention given their satisfying mechanical and biological properties. Non-oxide ceramics like silicon nitride and silicon carbide are being currently developed as a promising implant material possessing a combination of properties such as good wear and corrosion resistance, increased ductility, good fracture and creep resistance, and relatively high hardness in comparison to alumina. Polymer/magnesium composites are being developed to improve mechanical properties as well as retain polymer’s property of degradation. Recent advances in orthobiologics are proving interesting as well. This paper thus deals with the latest improvements being made to the existing implant materials and includes new materials being introduced in the field of biomaterials. PMID:23766134

  1. Box-Behnken Design of Experiments Investigation of Hydroxyapatite Synthesis for Orthopedic Applications

    NASA Astrophysics Data System (ADS)

    Kehoe, S.; Stokes, J.

    2011-03-01

    Physicochemical properties of hydroxyapatite (HAp) synthesized by the chemical precipitation method are heavily dependent on the chosen process parameters. A Box-Behnken three-level experimental design was therefore, chosen to determine the optimum set of process parameters and their effect on various HAp characteristics. These effects were quantified using design of experiments (DoE) to develop mathematical models using the Box-Behnken design, in terms of the chemical precipitation process parameters. Findings from this research show that the HAp possessing optimum powder characteristics for orthopedic application via a thermal spray technique can therefore be prepared using the following chemical precipitation process parameters: reaction temperature 60 °C, ripening time 48 h, and stirring speed 1500 rpm using high reagent concentrations. Ripening time and stirring speed significantly affected the final phase purity for the experimental conditions of the Box-Behnken design. An increase in both the ripening time (36-48 h) and stirring speed (1200-1500 rpm) was found to result in an increase of phase purity from 47(±2)% to 85(±2)%. Crystallinity, crystallite size, lattice parameters, and mean particle size were also optimized within the research to find desired settings to achieve results suitable for FDA regulations.

  2. Extracorporeal shock wave therapy in orthopedics, basic research, and clinical implications

    NASA Astrophysics Data System (ADS)

    Hausdorf, Joerg; Jansson, Volkmar; Maier, Markus; Delius, Michael

    2005-04-01

    The molecular events following shock wave treatment of bone are widely unknown. Nevertheless patients with osteonecrosis and non unions are already treated partly successful with shock waves. Concerning the first indication, the question of the permeation of the shock wave into the bone was addressed. Therefore shockwaves were applied to porcine femoral heads and the intraosseous pressure was measured. A linear correlation of the pressure to the intraosseous distance was found. Approximately 50% of the pressure are still measurable 10 mm inside the femoral head. These findings should encourage continued shock wave research on this indication. Concerning the second indication (non union), osteoblasts were subjected to 250 or 500 shock waves at 25 kV. After 24, 48, and 72 h the levels of the bone and vascular growth factors bFGF, TGFbeta1, and VEGF were examined. After 24 h there was a significant increase in bFGF levels (p<0.05) with significant correlation (p<0.05) to the number of impulses. TGFbeta1, and VEGF showed no significant changes. This may be one piece in the cascade of new bone formation following shock wave treatment and may lead to a more specific application of shock waves in orthopedic surgery.

  3. X-ray image calibration and its application to clinical orthopedics.

    PubMed

    Schumann, Steffen; Thelen, Benedikt; Ballestra, Steven; Nolte, Lutz-P; Büchler, Philippe; Zheng, Guoyan

    2014-07-01

    X-ray imaging is one of the most commonly used medical imaging modality. Albeit X-ray radiographs provide important clinical information for diagnosis, planning and post-operative follow-up, the challenging interpretation due to its 2D projection characteristics and the unknown magnification factor constrain the full benefit of X-ray imaging. In order to overcome these drawbacks, we proposed here an easy-to-use X-ray calibration object and developed an optimization method to robustly find correspondences between the 3D fiducials of the calibration object and their 2D projections. In this work we present all the details of this outlined concept. Moreover, we demonstrate the potential of using such a method to precisely extract information from calibrated X-ray radiographs for two different orthopedic applications: post-operative acetabular cup implant orientation measurement and 3D vertebral body displacement measurement during preoperative traction tests. In the first application, we have achieved a clinically acceptable accuracy of below 1° for both anteversion and inclination angles, where in the second application an average displacement of 8.06±3.71 mm was measured. The results of both applications indicate the importance of using X-ray calibration in the clinical routine.

  4. 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

  5. Anesthetic Considerations of Sporadic Inclusion Body Myositis in an Elderly Man With Orthopedic Trauma

    PubMed Central

    Steck, Dominik T; Choi, Christine; Gollapudy, Suneeta; Pagel, Paul S

    2016-01-01

    Introduction Sporadic inclusion body myositis (IBM) is an inflammatory myopathy characterized by progressive asymmetric extremity weakness, oropharyngeal dysphagia, and the potential for exaggerated sensitivity to neuromuscular blockers and respiratory compromise. The authors describe their management of a patient with IBM undergoing urgent orthopedic surgery. Case Presentation An 81-year-old man with IBM suffered a left intertrochanteric femoral fracture after falling down stairs. His IBM caused progressive left proximal lower extremity, bilateral distal upper extremity weakness (left > right), and oropharyngeal dysphagia (solid food, pills). He denied dyspnea, exercise intolerance, and a history of aspiration. Because respiratory insufficiency resulting from diaphragmatic dysfunction and prolonged duration of action of neuromuscular blockers may occur in IBM, the authors avoided using a neuromuscular blocker. After applying cricoid pressure, anesthesia was induced using intravenous lidocaine, propofol, remifentanil followed by manual ventilation with inhaled sevoflurane in oxygen. Endotracheal intubation was accomplished without difficulty; anesthesia was then maintained using remifentanil and sevoflurane. The fracture was repaired with a trochanteric femoral nail. The patient was extubated without difficulty and made an uneventful recovery. Conclusions In summary, there is a lack of consensus about the use of neuromuscular blockers in patients with IBM. The authors avoided these drugs and were able to easily secure the patient’s airway and maintain adequate muscle relaxation using a balanced sevoflurane-remifentanil anesthetic. Clinical trials are necessary to define the pharmacology of neuromuscular blockers in patients with IBM and determine whether use of these drugs contributes to postoperative respiratory insufficiency in these vulnerable patients. PMID:27247916

  6. RANDOMIZED CONTROLLED TRIALS IN ORTHOPEDICS AND TRAUMATOLOGY: SYSTEMATIC ANALYSIS ON THE NATIONAL EVIDENCE

    PubMed Central

    de Moraes, Vinícius Ynoe; Moreira, Cesar Domingues; Tamaoki, Marcel Jun Sugawara; Faloppa, Flávio; Belloti, Joao Carlos

    2015-01-01

    Objective: To assess whether there has been any improvement in the quality and quantity of randomized controlled trials (RCTs) in nationally published journals through the application of standardized and validated scores. Methods: We electronically selected all RCTs published in the two indexed Brazilian journals that focus on orthopedics, over the period 2000-2009: Acta Ortopédica Brasileira (AOB) and Revista Brasileira de Ortopedia (RBO). These RCTs were identified and scored by two independent researchers in accordance with the Jadad scale and the Cochrane Bone, Joint and Muscle Trauma Group score. The studies selected were grouped as follows: 1) publication period (2000-2004 or 2004-2009); 2) journal of publication (AOB or RBO). Results: Twenty-two papers were selected: 10 from AOB and 12 from RBO. No statistically significant differences were found between the proportions (nRCT/nTotal of published papers) of RCTs published in the two journals (p = 0.458), or in the Jadad score (p = 0.722) and Cochrane score (p = 0.630). Conclusion: The relative quality and quantity of RCTs in the journals analyzed were similar. There was a trend towards improvement of quality, but there was no increase in the number of RCTs between the two periods analyzed. PMID:27026971

  7. Synthesis of spherical calcium phosphate particles for dental and orthopedic applications

    PubMed Central

    Bohner, Marc; Tadier, Solène; van Garderen, Noémie; de Gasparo, Alex; Döbelin, Nicola; Baroud, Gamal

    2013-01-01

    Calcium phosphate materials have been used increasingly in the past 40 years as bone graft substitutes in the dental and orthopedic fields. Accordingly, numerous fabrication methods have been proposed and used. However, the controlled production of spherical calcium phosphate particles remains a challenge. Since such particles are essential for the synthesis of pastes and cements delivered into the host bone by minimally-invasive approaches, the aim of the present document is to review their synthesis and applications. For that purpose, production methods were classified according to the used reagents (solutions, slurries, pastes, powders), dispersion media (gas, liquid, solid), dispersion tools (nozzle, propeller, sieve, mold), particle diameters of the end product (from 10 nm to 10 mm), and calcium phosphate phases. Low-temperature calcium phosphates such as monetite, brushite or octacalcium phosphate, as well as high-temperature calcium phosphates, such as hydroxyapatite, β-tricalcium phosphate or tetracalcium phosphate, were considered. More than a dozen production methods and over hundred scientific publications were discussed. PMID:23719177

  8. Development of nanofluorapatite polymer-based composite for bioactive orthopedic implants and prostheses

    PubMed Central

    Hu, Gangfeng; Wang, Hui; Yao, Xiaocong; Bi, Dawei; Zhu, Gang; Tang, Songchao; Wei, Jie; Yang, Lili; Tong, Peijian; Xiao, Luwei

    2014-01-01

    Fluorapatite with low solubility is a promising biomaterial due to its structure, which is similar to hydroxyapatite. In this study a bioactive composite of nanofluorapatite (n-FA) and polyamide 12 (PA12) was fabricated. The results revealed that the mechanical properties (such as compressive strength and elastic modulus), hydrophilicity, and antibacterial properties of n-FA/PA12 composite were obviously improved by adding n-FA into PA12 as compared with PA12. In addition, cell proliferation of MC3T3-E1 cells cultured on n-FA/PA12 composite was significantly higher than with PA12, and alkaline phosphatase activity of MC3T3-E1 cells on the n-FA/PA12 composite was expressed at obviously higher levels as compared with PA12. The results suggest that n-FA/PA12 composite could support cell proliferation and differentiation, showing good cytocompatibility. Histological evaluation indicates that n-FA/PA12 composite enhances the efficiency of new bone formation with the introduction of n-FA into PA12, and the quantity of the newly formed bone for n-FA/PA12 composite is significantly higher than with PA12. In conclusion, n-FA/PA12 composite exhibits good biocompatibility and osteogenesis, which might be used for various orthopedic prostheses and dental implants. PMID:25143735

  9. Effect of Porosity on the Properties of Open Cell Titanium Foams Intended for Orthopedic Applications

    NASA Astrophysics Data System (ADS)

    Lefebvre, L. P.; Baril, E.

    2010-05-01

    Porous metals have been used in various orthopedic applications as coating to promote implant fixation or as scaffolds for bone reconstruction. Since these materials were up to recently only used as thin coating (i.e. sintered beads or mesh) and not available into shapes adequate for detailed characterization, the effect of the structure on the static and dynamic properties of these materials has not been widely reported in the literature. This paper presents the effect of the porosity (49.3-66.7%) on the static and dynamic properties of titanium foams produced with a powder metallurgy process. All materials exhibited compression curves with three stages, typical of ductile porous materials. When the porosity level increases, the materials become more brittle. The compression yield strength increases while the modulus is more or less unaffected when the porosity increases from 49.3 to 66.7% and does not follow the power law model accepted for porous medium. The shear strength/adhesion with dense substrates increases with density and is proportional to the compression yield strength. The fatigue limit is not directly link with the porosity. The discrepancies observed are attributed to differences in the structure as the porosity increases.

  10. Development of porous Ti6Al4V/chitosan sponge composite scaffold for orthopedic applications.

    PubMed

    Guo, Miao; Li, Xiang

    2016-01-01

    A novel composite scaffold consisting of porous Ti6Al4V part filled with chitosan sponge was fabricated using a combination of electron beam melting and freeze-drying. The mechanical properties of porous Ti6Al4V part were examined via compressive test. The ultimate compressive strength was 85.35 ± 8.68 MPa and the compressive modulus was 2.26 ± 0.42 GPa. The microstructure of composite scaffold was characterized using scanning electron microscopy. The chitosan sponge filled in Ti6Al4V part exhibited highly porous and well-interconnected micro-pore architecture. The osteoblastic cells were seeded on scaffolds to test their seeding efficiency and biocompatibility. Significantly higher cell seeding efficiency was found on composite scaffold. The biological response of osteoblasts on composite scaffolds was superior in terms of improved cell attachment, higher proliferation, and well-spread morphology in relation to porous Ti6Al4V part. These results suggest that the Ti6Al4V/chitosan composite scaffold is potentially useful as a biomedical scaffold for orthopedic applications. PMID:26478418

  11. Biomaterial Co-Cr-Mo Alloys Nano Coating Calcium Phosphate Orthopedic Treatment

    NASA Astrophysics Data System (ADS)

    Palaniappan, N.; Inwati, Gajendra Kumar; Singh, Man

    2014-08-01

    The modem study a thermal martensitic transformation of biomedical Co-Cr-Mo alloys and ultimately offers large elongation to failure while maintaining high strength. In the future study, structural evolution and dislocation slip as an elementary process in the martensitic transformation in Co-Cr-Mo alloys were investigated to reveal the origin of their enhanced phase stability due to nitrogen addition and coating of calcium phosphate specimens with and without nitrogen addition were prepared. The N-doped alloys had a single-phase matrix, whereas the N-free alloys had a duplex microstructure. Irrespective of the nitrogen content, dislocations frequently dissociated into Shockley partial dislocations with stacking faults. The Nano range coating of calcium phosphate function as obstacles to the glide of partial dislocations and consequently significantly affect the kinetics of the martensitic transformation. As a result, the formation of marten site plays a crucial role in plastic deformation and wear behavior, the developed nanostructures modification associated with nitrogen addition must be a promising strategy for highly durable orthopedic implants.

  12. Attribute dimensions that distinguish master and novice physical therapy clinicians in orthopedic settings.

    PubMed

    Jensen, G M; Shepard, K F; Gwyer, J; Hack, L M

    1992-10-01

    The purpose of this qualitative case study was to further investigate the work of master and novice clinicians within the practice setting. The sample consisted of three master clinicians and three novice clinicians practicing in orthopedic outpatient physical therapy settings in three different regions of the United States. Data collection by three researchers included observation of each clinician treating at least three patients, audiotaping of all treatment sessions, interviews with clinicians and patients, and a review of patient records. Analysis of the data within and across cases revealed five attribute dimensions that distinguished the master clinician from the novice clinician. One attribute dimension (ie, confidence in predicting patient outcomes) related to knowledge, and four attribute dimensions (ie, ability to control the environment, evaluation and use of patient illness and disease data, focus of verbal and nonverbal communication with patients, and importance of teaching to hands-on care) related to improvisational performance. Further investigations are needed to confirm these findings and add to the body of knowledge concerning the parameters of physical therapy that may affect the efficacy and quality of patient care. PMID:1528964

  13. Review of the regulations for the use of stainless steels for orthopedic implants in Argentina

    NASA Astrophysics Data System (ADS)

    Daga, Bernardo; Rivera, Graciela; Boeri, Roberto

    2007-11-01

    Motivated by the relatively high rate of failure of orthopedic implants in Argentina, the authors review the current normative regulating the use of stainless steels in the fabrication of these metallic parts in the country, and compare it with the regulations currently in use in other countries. The analysis shows that several standards in effect in the country do not comply with broadly recognized international standards. This situation is aggravated by a recent revision of the normative that failed to improve the quality standards to reach levels similar to those applied in developed countries or even in MERCOSUR associates. The national organization in charge of implant certification in Argentina, complying with the law, accepts the applicability of IRAM standards to certify stainless steels implants. In the opinion of the authors, the current practice used to certify implants does not guarantee the structural stability and biocompatibility of the devices, increasing the risk of failure in service, and escalating the cost of the public health care system.

  14. Development of nanofluorapatite polymer-based composite for bioactive orthopedic implants and prostheses.

    PubMed

    Hu, Gangfeng; Wang, Hui; Yao, Xiaocong; Bi, Dawei; Zhu, Gang; Tang, Songchao; Wei, Jie; Yang, Lili; Tong, Peijian; Xiao, Luwei

    2014-01-01

    Fluorapatite with low solubility is a promising biomaterial due to its structure, which is similar to hydroxyapatite. In this study a bioactive composite of nanofluorapatite (n-FA) and polyamide 12 (PA12) was fabricated. The results revealed that the mechanical properties (such as compressive strength and elastic modulus), hydrophilicity, and antibacterial properties of n-FA/PA12 composite were obviously improved by adding n-FA into PA12 as compared with PA12. In addition, cell proliferation of MC3T3-E1 cells cultured on n-FA/PA12 composite was significantly higher than with PA12, and alkaline phosphatase activity of MC3T3-E1 cells on the n-FA/PA12 composite was expressed at obviously higher levels as compared with PA12. The results suggest that n-FA/PA12 composite could support cell proliferation and differentiation, showing good cytocompatibility. Histological evaluation indicates that n-FA/PA12 composite enhances the efficiency of new bone formation with the introduction of n-FA into PA12, and the quantity of the newly formed bone for n-FA/PA12 composite is significantly higher than with PA12. In conclusion, n-FA/PA12 composite exhibits good biocompatibility and osteogenesis, which might be used for various orthopedic prostheses and dental implants. PMID:25143735

  15. Bibliometric Analysis of Orthopedic Literature on Total Knee Arthroplasty in Asian Countries: A 10-year Analysis

    PubMed Central

    Eom, Sang Hwa; Bamne, Ankur B.; Chowdhry, Madhav; Chae, Ihn Seok

    2015-01-01

    Purpose We aimed to determine the quantity and quality of research output of selected Asian countries in the field of total knee arthroplasty (TKA) in the last 10 years. Materials and Methods Top 15 Asian countries were selected according to their gross domestic product. The Science Citation Index Expanded database was used to search for the literature published between 2004 and 2013 using "Total Knee Arthroplasty". The numbers of articles, journals and citations and the contribution of each country were analyzed. The articles were classified according to the type of study and the relative proportion of each type was analyzed. Results Asian surgeons have increasingly contributed to orthopedic literature on TKA for the past 10 years, but the dominant contribution came from only a few countries. The total number of articles published by Asian countries increased by 261%, with Japan producing most of the studies and China showing the maximum growth rate. The majority of studies were published in low impact factor journals. Korea published the highest proportion of articles in high impact factor journals. Clinical papers were most frequent. Conclusions Our identification of research productivity pertaining to TKA among Asian countries gives a unique insight into the level of academic research in the field of TKA in these countries. There is a need to improve the quality of research to enhance the publishing power in high impact journals as well as the need for more basic research and epidemiological studies considering the unique differences among Asian patients undergoing TKA. PMID:26389067

  16. Comparison of functional network integrity in TBI and orthopedic controlpatientsusing graph-theoretical analysis.

    PubMed

    Karmonik, Christof; Clark, Jessica; Fung, Steve H; Grossman, Robert G; High, Walter; Jiang, Yang

    2013-01-01

    The integrity of functional brain networks inpatients (n=12) diagnosed with traumatic brain injury (TBI) was compared to age-matched subjects (n=12) with orthopedic injury (OI) during a working memory task. A graph-theoretical analysis algorithm was developed and integrated into the AFNI software. Functional networks with correlations between time courses as edge-weights were automatically created and their integrity was quantified by determining the statistical significance of the following network parameters: diameter, density, clustering coefficient, average path length, two largest eigenvalues, spectral density, and minimum eccentricity. Network graphs using a spring-embedded layout (Cytoscape) and a 3D layout integrated into the anatomical space (Paraview) were created. Functional images were composed by color-coding the degree of each voxel (network node) and transformed into Talairach space. Using the AFNI Talairach atlas, degrees of distinct brain regions were quantified. Reduced averaged BOLD responses were found for the TBI group with a higher network integrity potentially as a compensatory mechanism. Regions of high functional connectivity varied in between groups with largest differences in the cerebellum, the temporal lobes and deep brain structures including the lentiform nucleus, caudate and thalamus.

  17. Development of porous Ti6Al4V/chitosan sponge composite scaffold for orthopedic applications.

    PubMed

    Guo, Miao; Li, Xiang

    2016-01-01

    A novel composite scaffold consisting of porous Ti6Al4V part filled with chitosan sponge was fabricated using a combination of electron beam melting and freeze-drying. The mechanical properties of porous Ti6Al4V part were examined via compressive test. The ultimate compressive strength was 85.35 ± 8.68 MPa and the compressive modulus was 2.26 ± 0.42 GPa. The microstructure of composite scaffold was characterized using scanning electron microscopy. The chitosan sponge filled in Ti6Al4V part exhibited highly porous and well-interconnected micro-pore architecture. The osteoblastic cells were seeded on scaffolds to test their seeding efficiency and biocompatibility. Significantly higher cell seeding efficiency was found on composite scaffold. The biological response of osteoblasts on composite scaffolds was superior in terms of improved cell attachment, higher proliferation, and well-spread morphology in relation to porous Ti6Al4V part. These results suggest that the Ti6Al4V/chitosan composite scaffold is potentially useful as a biomedical scaffold for orthopedic applications.

  18. 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

  19. Use of an Irrigation Pump System in Arthroscopic Procedures.

    PubMed

    Hsiao, Mark S; Kusnezov, Nicholas; Sieg, Ryan N; Owens, Brett D; Herzog, Joshua P

    2016-05-01

    Since its inception, arthroscopic surgery has become widely adopted among orthopedic surgeons. It is therefore important to have an understanding of the basic principles of arthroscopy. Compared with open techniques, arthroscopic procedures are associated with smaller incisions, less structural damage, improved intra-articular visualization, less pain in the immediate postoperative period, and faster recovery for patients. Pump systems used for arthroscopic surgery have evolved over the years to provide improved intraoperative visualization. Gravity flow systems were described first and are still commonly used today. More recently, automated pump systems with pressure or dual pressure and volume control have been developed. The advantages of automated irrigation systems over gravity irrigation include a more consistent flow, a greater degree of joint distention, improved visualization especially with motorized instrumentation, decreased need for tourniquet use, a tamponade effect on bleeding, and decreased operative time. Disadvantages include the need for additional equipment with increased cost and maintenance, the initial learning curve for the surgical team, and increased risk of extra-articular fluid dissection and associated complications such as compartment syndrome. As image quality and pump systems improve, so does the list of indications including diagnostic and treatment modalities to address intra-articular pathology of the knee, shoulder, hip, wrist, elbow, and ankle joints. This article reviews the current literature and presents the history of arthroscopy, basic science of pressure and flow, types of irrigation pumps and their functions, settings, applications, and complications. [Orthopedics. 2016; 39(3):e474-e478.].

  20. Use of an Irrigation Pump System in Arthroscopic Procedures.

    PubMed

    Hsiao, Mark S; Kusnezov, Nicholas; Sieg, Ryan N; Owens, Brett D; Herzog, Joshua P

    2016-05-01

    Since its inception, arthroscopic surgery has become widely adopted among orthopedic surgeons. It is therefore important to have an understanding of the basic principles of arthroscopy. Compared with open techniques, arthroscopic procedures are associated with smaller incisions, less structural damage, improved intra-articular visualization, less pain in the immediate postoperative period, and faster recovery for patients. Pump systems used for arthroscopic surgery have evolved over the years to provide improved intraoperative visualization. Gravity flow systems were described first and are still commonly used today. More recently, automated pump systems with pressure or dual pressure and volume control have been developed. The advantages of automated irrigation systems over gravity irrigation include a more consistent flow, a greater degree of joint distention, improved visualization especially with motorized instrumentation, decreased need for tourniquet use, a tamponade effect on bleeding, and decreased operative time. Disadvantages include the need for additional equipment with increased cost and maintenance, the initial learning curve for the surgical team, and increased risk of extra-articular fluid dissection and associated complications such as compartment syndrome. As image quality and pump systems improve, so does the list of indications including diagnostic and treatment modalities to address intra-articular pathology of the knee, shoulder, hip, wrist, elbow, and ankle joints. This article reviews the current literature and presents the history of arthroscopy, basic science of pressure and flow, types of irrigation pumps and their functions, settings, applications, and complications. [Orthopedics. 2016; 39(3):e474-e478.]. PMID:27135450

  1. Time-dependent effects of a 'functional'-type orthopedic appliance on the rat mandible growth.

    PubMed

    Oudet, C; Petrovic, A; Stutzmann, J

    1984-01-01

    The modus operandi and the time-dependent variations in the effects of the LSU-activator, an orthopedic appliance currently used in human orthodontic therapy, was experimentally analyzed in growing rats. This appliance causes a forward positioning of the lower jaw and a restriction of mandibular motility. After a 4-week treatment, the following changes were observed: (i) the growth rate of the condylar cartilage was accelerated, this growth-promoting effect being more pronounced when the LSU-activator was worn during the animal's rest span. (ii) the direction of condylar growth became more backward-oriented; no significant difference between day and night treatment, i.e. during the rest and activity spans could be detected; (iii) the supplementary lengthening of the mandible was greater in rats treated during rest than in rats treated during waking and (iv) the number of serial sarcomeres in the lateral pterygoid muscle was smaller. This growth retardation of the muscle was greater in rest-time than in waking-time treated individuals. The LSU-type activator's action implies a two-step effect: during the time of wearing the appliance, the more forward positioning of the mandible causes a reduced growth of the lateral pterygoid muscle; during the time the LSU-type activator is not worn, the mandible is functioning in a more forward position such a way that it stimulates the growth rate of the condylar cartilage and the subperiosteal ossification of the posterior border of the ramus. It is therefore essential, for a few hours every day, that the mandible be allowed to move freely from the appliance in a more forward position.

  2. Impact of a weekly reading program on orthopedic surgery residents' in-training examination.

    PubMed

    Weglein, Daniel G; Gugala, Zbigniew; Simpson, Suzanne; Lindsey, Ronald W

    2015-05-01

    In response to a decline in individual residents' performance and overall program performance on the Orthopaedic In-Training Examination (OITE), the authors' department initiated a daily literature reading program coupled with weekly tests on the assigned material. The goal of this study was to assess the effect of the reading program on individual residents' scores and the training program's OITE scores. The reading program consisted of daily review articles from the Journal of the American Academy of Orthopaedic Surgeons, followed by a weekly written examination consisting of multiple-choice or fill-in-the-blank questions. All articles were selected and all questions were written by the departmental chair. A questionnaire was given to assess residents' perceptions of the weekly tests. As a result of implementing the reading program for a 10-month period, residents' subsequent performance on the OITE significantly improved (mean score increase, 4, P<.0001; percentile score increase, 11, P=.0007). The difference in mean score was significant for residents in postgraduate years 3, 4, and 5. A statistically significant correlation was found between weekly test scores and performance on the OITE, with a significant correlation between weekly test scores and OITE percentile ranking. The study results also showed a positive correlation between reading test attendance and weekly test scores. Residents' anonymous questionnaire responses also demonstrated the reading program to be a valuable addition to the residency training curriculum. In conclusion, the study strongly supports the benefits of a weekly reading and examination program in enhancing the core knowledge of orthopedic surgery residents.

  3. Investigating the structure and biocompatibility of niobium and titanium oxides as coatings for orthopedic metallic implants.

    PubMed

    Pradhan, D; Wren, A W; Misture, S T; Mellott, N P

    2016-01-01

    Applying sol gel based coatings to orthopedic metallic implant materials can significantly improve their properties and lifespan in vivo. For this work, niobium (Nb2O5) and titanium (TiO2) oxides were prepared via solution processing in order to determine the effect of atomic arrangement (amorphous/crystalline) on bioactivity. Thermal evaluation on the synthesized materials identified an endotherm for Nb2O5 at 75 °C with 40% weight loss below 400 °C, and minimal weight loss between 400 and 850 °C. Regarding TiO2 an endotherm was present at 92 °C with 25% weight loss below 400 °C, and 4% between 400 and 850 °C. Phase evolution was determined using High Temperature X-ray Diffraction (HT-XRD) where amorphous-Nb2O5 (450 °C), hexagonal-Nb2O5 (525 °C), orthorhombic-Nb2O5 (650 °C), amorphous-TiO2 (275 °C) and tetragonal TiO2 (500 °C) structures were produced. Simulated body fluid (SBF) testing was conducted over 1, 7 and 30 days and resulted in positive chemical and morphological changes for crystalline Nb2O5 (525 °C) and TiO2 (500 °C) after 30 days of incubation. Rod-like CaP deposits were observed on the surfaces using Scanning Electron Microscopy (FE-SEM) and Grazing Incidence-X-ray Diffraction (GI-XRD) shows that the deposits were X-ray amorphous. Cell viability was higher with the TiO2 (122%) samples when compared to the growing cell population while Nb2O5 samples exhibited a range of viability (64-105%), partially dependent on materials atomic structure. PMID:26478387

  4. Investigating the structure and biocompatibility of niobium and titanium oxides as coatings for orthopedic metallic implants.

    PubMed

    Pradhan, D; Wren, A W; Misture, S T; Mellott, N P

    2016-01-01

    Applying sol gel based coatings to orthopedic metallic implant materials can significantly improve their properties and lifespan in vivo. For this work, niobium (Nb2O5) and titanium (TiO2) oxides were prepared via solution processing in order to determine the effect of atomic arrangement (amorphous/crystalline) on bioactivity. Thermal evaluation on the synthesized materials identified an endotherm for Nb2O5 at 75 °C with 40% weight loss below 400 °C, and minimal weight loss between 400 and 850 °C. Regarding TiO2 an endotherm was present at 92 °C with 25% weight loss below 400 °C, and 4% between 400 and 850 °C. Phase evolution was determined using High Temperature X-ray Diffraction (HT-XRD) where amorphous-Nb2O5 (450 °C), hexagonal-Nb2O5 (525 °C), orthorhombic-Nb2O5 (650 °C), amorphous-TiO2 (275 °C) and tetragonal TiO2 (500 °C) structures were produced. Simulated body fluid (SBF) testing was conducted over 1, 7 and 30 days and resulted in positive chemical and morphological changes for crystalline Nb2O5 (525 °C) and TiO2 (500 °C) after 30 days of incubation. Rod-like CaP deposits were observed on the surfaces using Scanning Electron Microscopy (FE-SEM) and Grazing Incidence-X-ray Diffraction (GI-XRD) shows that the deposits were X-ray amorphous. Cell viability was higher with the TiO2 (122%) samples when compared to the growing cell population while Nb2O5 samples exhibited a range of viability (64-105%), partially dependent on materials atomic structure.

  5. Hydrogen release from titanium hydride in foaming of orthopedic NiTi scaffolds.

    PubMed

    Wu, Shuilin; Liu, Xiangmei; Yeung, K W K; Hu, Tao; Xu, Zushun; Chung, Jonathan C Y; Chu, Paul K

    2011-03-01

    Titanium hydride powders are utilized to enhance the foaming process in the formation of orthopedic NiTi scaffolds during capsule-free hot isostatic pressing. In order to study the formation mechanism, the thermal behavior of titanium hydride and hydrogen release during the heating process are systematically investigated in air and argon and under vacuum by X-ray diffraction (XRD), thermal analysis, including thermogravimetric analysis and differential scanning calorimetry, energy dispersive X-ray spectroscopy, and transmission electron microscopy. Our experiments reveal that hydrogen is continuously released from titanium hydride as the temperature is gradually increased from 300 to 700 °C. Hydrogen is released in two transitions: TiH1.924→TiH1.5/TiH1.7 between 300 °C and 400 °C and TiH1.5/TiH1.7→α-Ti between 400 °C and 600 °C. In the lower temperature range between 300 °C and 550 °C the rate of hydrogen release is slow, but the decomposition rate increases sharply above 550 °C. The XRD patterns obtained in air and under vacuum indicate that the surface oxide layer can deter hydrogen release. The pressure change is monitored in real time and the amount of hydrogen released is affected by the processing temperature and holding time. Holding processes at 425 °C, 480 °C, 500 °C, 550 °C, and 600 °C are found to significantly improve the porous structure in the NiTi scaffolds due to the stepwise release of hydrogen. NiTi scaffolds foamed by stepwise release of hydrogen are conducive to the attachment and proliferation of osteoblasts and the resulting pore size also favor in-growth of cells. PMID:20965283

  6. An Investigation of Siloxane Cross-linked Hydroxyapatite-Gelatin/Copolymer Composites for Potential Orthopedic Applications†

    PubMed Central

    Dyke, Jason Christopher; Knight, Kelly Jane; Zhou, Huaxing; Chiu, Chi-Kai; Ko, Ching-Chang; You, Wei

    2012-01-01

    Causes of bone deficiency are numerous, but biomimetic alloplastic grafts provide an alternative to repair tissue naturally. Previously, a hydroxyapatite-gelatin modified siloxane (HAp-Gemosil) composite was prepared by cross-linking (N, N′-bis[(3-trimethoxysilyl)propyl]ethylene diamine (enTMOS) around the HAp-Gel nanocomposite particles, to mimic the natural composition and properties of bone. However, the tensile strength remained too low for many orthopedic applications. It was hypothesized that incorporating a polymer chain into the composite could help improve long range interaction. Furthermore, designing this polymer to interact with the enTMOS siloxane cross-linked matrix would provide improved adhesion between the polymer and the ceramic composite, and improve mechanical properties. To this end, copolymers of L-Lactide (LLA), and a novel alkyne derivatized trimethylene carbonate, propargyl carbonate (PC), were synthesized. Incorporation of PC during copolymerization affects properties of copolymers such as molecular weight, Tg, and % PC incorporation. More importantly, PC monomers bear a synthetic handle, allowing copolymers to undergo post-polymerization functionalization with graft monomers to specifically tailor the properties of the final composite. For our investigation, P(LLA-co-PC) copolymers were functionalized by an azido-silane (AS) via copper catalyzed azide-alkyne cycloaddition (CuAAC) through terminal alkyne on PC monomers. The new functionalized polymer, P(LLA-co-PC)(AS) was blended with HAp-Gemosil, with the azido-silane linking the copolymer to the silsesquioxane matrix within the final composite. These HAp-Gemosil/P(LLA-co-PC)(AS) composites were subjected to mechanical and biological testing, and the results were compared with those from the HAp-Gemosil composites. This study revealed that incorporating a cross-linkable polymer served to increase the flexural strength of the composite by 50%, while maintaining the biocompatibility of

  7. [Hypotension controlled with ATP in orthopedic surgery: incidence of atrio-ventricular conduction disorders].

    PubMed

    Colì, A; Fabbri, G; Lari, S; Ballati, S; Cipressi, M; Lari, F

    1994-01-01

    Adenosine triphosphate (ATP) has been effectively used for induced hypotension in man. Atrio-Ventricular (A-V) conduction disturbances have been observed after adenosine bolus injection and during continuous ATP i.v. infusion. The present perspective investigation was designed to determine the incidence of A-V conduction disturbances during ATP-induced hypotension. Thirty-five normotensive healthy patients (ASA I-II) with no preoperative therapy were subjected to the same anesthetic technique for orthopedic surgery. Premedication consisted of diazepam and atropine. Anesthesia was induced with thiopental and fentanyl followed by atracurium for intubation. The maintenance anesthesia consisted of isoflurane (1.5% inspired)-N2O (60%) in oxygen and incremental doses of fentanyl; the lungs were mechanically ventilated. Dipyridamole (0.15 mg kg-1) was given 15 min prior to ATP-infusion. ATP was administered by an infusion pump at a dosage of 0.025-0.05 mg kg-1 min-1. The ECG was recorded with a Mingograph 34 tape-recorder using 3 pregelled electrodes positioned to give an effective V6 lead pattern. MAP was reduced by 25% and HR increased by 6%. The mean duration of ATP-induced hypotension was 75 min +/- 50 and the mean dose of ATP infused was 200 mg +/- 161. Six patients (17%) showed A-V conduction disturbances. There was a I A-V Block (AVB) in 2 cases, a II AVB in 2 cases and a III AVB in 2 cases. In every case the arrhythmia disappeared spontaneously or after ATP-infusion suspension.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8208448

  8. Elastomeric high-mineral content hydrogel-hydroxyapatite composites for orthopedic applications

    PubMed Central

    Song, Jie; Xu, Jianwen; Filion, Tera; Saiz, Eduardo; Tomsia, Antoni P.; Lian, Jane B.; Stein, Gary S.; Ayers, David C.; Bertozzi, Carolyn R.

    2009-01-01

    The design of synthetic bone grafts that mimic the structure and composition of bone and possess good surgical handling characteristics remains a major challenge. We report the development of poly(2-hydroxyethyl methacrylate) (pHEMA)-hydroxyapatite (HA) composites termed “FlexBone” that possess osteoconductive mineral content approximating that of human bone yet exhibit elastomeric properties enabling the press-fitting into a defect site. The approach involves crosslinking pHEMA hydrogel in the presence of HA using viscous ethylene glycol as a solvent. The composites exhibit excellent structural integration between the apatite mineral component and the hydroxylated hydrogel matrix. The stiffness of the composite and the ability to withstand compressive stress correlate with the microstructure and content of the mineral component. The incorporation of porous aggregates of HA nanocrystals rather than compact micrometer-sized calcined HA effectively improved the resistance of the composite to crack propagation under compression. Freeze-dried FlexBone containing 50 wt % porous HA nanocrystals could withstand hundreds-of-megapascals compressive stress and >80% compressive strain without exhibiting brittle fractures. Upon equilibration with water, FlexBone retained good structural integration and withstood repetitive moderate (megapascals) compressive stress at body temperature. When subcutaneously implanted in rats, FlexBone supported osteoblastic differentiation of the bone marrow stromal cells pre-seeded on FlexBone. Taken together, the combination of high osteoconductive mineral content, excellent organic-inorganic structural integration, elasticity, and the ability to support osteoblastic differentiation in vivo makes FlexBone a promising candidate for orthopedic applications. PMID:18546185

  9. Relation of perioperative elevation of troponin to long-term mortality after orthopedic surgery.

    PubMed

    Oberweis, Brandon S; Smilowitz, Nathaniel R; Nukala, Swetha; Rosenberg, Andrew; Xu, Jinfeng; Stuchin, Steven; Iorio, Richard; Errico, Thomas; Radford, Martha J; Berger, Jeffrey S

    2015-06-15

    Myocardial necrosis in the perioperative period of noncardiac surgery is associated with short-term mortality, but long-term outcomes have not been characterized. We investigated the association between perioperative troponin elevation and long-term mortality in a retrospective study of consecutive subjects who underwent hip, knee, and spine surgery. Perioperative myocardial necrosis and International Classification of Disease, Ninth Revision-coded myocardial infarction (MI) were recorded. Long-term survival was assessed using the Social Security Death Index database. Logistic regression models were used to identify independent predictors of long-term mortality. A total of 3,050 subjects underwent surgery. Mean age was 60.8 years, and 59% were women. Postoperative troponin was measured in 1,055 subjects (34.6%). Myocardial necrosis occurred in 179 cases (5.9%), and MI was coded in 20 (0.7%). Over 9,015 patient-years of follow-up, 111 deaths (3.6%) occurred. Long-term mortality was 16.8% in subjects with myocardial necrosis and 5.8% with a troponin in the normal range. Perioperative troponin elevation (hazard ratio 2.33, 95% confidence interval 1.33 to 4.10) and coded postoperative MI (adjusted hazard ratio 3.51, 95% confidence interval 1.44 to 8.53) were significantly associated with long-term mortality after multivariable adjustment. After excluding patients with coronary artery disease and renal dysfunction, myocardial necrosis remained associated with long-term mortality. In conclusion, postoperative myocardial necrosis is common after orthopedic surgery. Myocardial necrosis is independently associated with long-term mortality at 3 years and may be used to identify patients at higher risk for events who may benefit from aggressive management of cardiovascular risk factors. PMID:25890628

  10. Biocompatibility Issues with Modern Implants in Bone - A Review for Clinical Orthopedics

    PubMed Central

    Nuss, Katja M.R; von Rechenberg, Brigitte

    2008-01-01

    Skeletal defects may result from traumatic, infectious, congenital or neoplastic processes and are considered to be a challenge for reconstructive surgery. Although the autologous bone graft is still the “gold standard”, there is continuing demand for bone substitutes because of associated disadvantages, such as limited supply and potential donor side morbidity [1]. This is not only true for indications in orthopedic and craniomaxillofacial surgeries, but also in repairing endodontic defects and in dental implantology. Before clinical use all new bone substitute materials have to be validated for their osseoconductive and - depending on the composition of the material also –inductive ability, as well as for their long-term biocompatibility in bone. Serving this purpose various bone healing models to test osteocompatibility and inflammatory potential of a novel material on one hand and, on the other hand, non-healing osseous defects to assess the healing potential of a bone substitute material have been developed. Sometimes the use of more than one implantation site can be helpful to provide a wide range of information about a new material [2]. Important markers for biocompatibility and inflammatory responses are the cell types appearing after the implantation of foreign material. There, especially the role of foreign body giant cells (FBGC) is discussed controversial in the pertinent literature, such that it is not clear whether their presence marks an incompatibility of the biomaterial, or whether it belongs to a normal degradation behavior of modern, resorbable biomaterials. This publication is highlighting the different views currently existing about the function of FBGC that appear in response to biomaterials at the implantation sites. A short overview of the general classes of biomaterials, where FBGC may appear as cellular response, is added for clarity, but may not be complete. PMID:19506701

  11. Bioactive ceramic coating on orthopedic implants for enhanced bone tissue integration

    NASA Astrophysics Data System (ADS)

    Aniket

    Tissue integration between bone and orthopedic implant is essential for implant fixation and longevity. An immunological response leads to fibrous encapsulation of metallic implants leading to implant instability and failure. Bioactive ceramics have the ability to directly bond to bone; however, they have limited mechanical strength for load bearing applications. Coating bioactive ceramics on metallic implant offers the exciting opportunity to enhance bone formation without compromising the mechanical strength of the implant. In the present study, we have developed a novel bioactive silica-calcium phosphate nanocomposite (SCPC) coating on medical grade Ti-6Al-4V orthopedic implant using electrophoretic deposition (EPD) and evaluated bone tissue response to the coated implant at the cellular level. The effect of SCPC composition and suspending medium pH on the zeta potential of three different SCPC formulations; SCPC25, SCPC50 and SCPC75 were analyzed. The average zeta potential of SCPC50 in pure ethanol was more negative than that of SCPC25 or SCPC75; however the difference was not statistically significant. Ti-6Al-4V discs were passivated, coated with SCPC50 (200 nm - 10 mum) and thermally treated at 600 - 800 ºC to produce a coating thickness in the range of 43.1 +/- 5.7 to 30.1 +/- 4.6 μm. After treatment at 600, 700 and 800 ºC, the adhesion strength at the SCPC50/Ti-6Al-4V interface was 42.6 +/- 3.6, 44.7 +/- 8.7 and 47.2 +/- 4.3 MPa, respectively. XRD analyses of SCPC50 before and after EPD coating indicated no change in the crystallinity of the material. Fracture surface analyses showed that failure occurred within the ceramic layer or at the ceramic/polymer interface; however, the ceramic/metal interface was intact in all samples. The adhesion strength of SCPC50-coated substrates after immersion in PBS for 2 days (11.7 +/- 3.9 MPa) was higher than that measured on commercially available hydroxyapatite (HA) coated substrates (5.5 +/- 2.7 MPa), although the

  12. Genetic polymorphism of NOS3 with susceptibility to deep vein thrombosis after orthopedic surgery: a case-control study in Chinese Han population.

    PubMed

    Qin, Jizheng; Dai, Jin; Xu, Zhihong; Chen, Dongyang; Qin, Jianghui; Shi, Dongquan; Teng, Huajian; Jiang, Qing

    2013-01-01

    Deep vein thrombosis is one of the common complications of orthopedic surgery. Studies indicated that genetic factors played a considerable role in the pathogenesis of deep vein thrombosis. Endothelial nitric oxide synthase which encoded by nitric oxide synthase 3 (NOS3), can generate nitric oxide in endothelial cells. As a predominant regulator for vascular homeostasis, nitric oxide might be involved in the pathogenesis of thrombosis. It had been proved that the NOS3 polymorphism (rs1799983) was associated with the development of cardiovascular diseases. Our objective was to evaluate the association between the NOS3 polymorphism (rs1799983) and deep vein thrombosis after orthopedic surgery in Chinese Han population. The polymorphism was genotyped in 224 subjects with deep vein thrombosis after orthopedic surgery and 580 controls. Allele and genotype frequencies were compared between subjects with deep vein thrombosis and control subjects. The allele and genotype frequencies of the NOS3 polymorphism (rs1799983) were significantly different between subjects with deep vein thrombosis and control subjects. There were also significant differences when the subjects were stratified by gender, surgery type and hypertension status. These findings suggested that the NOS3 polymorphism (rs1799983) was associated with susceptibility to the deep vein thrombosis after orthopedic surgery in Chinese Han population, and NOS3 might play a role in the development of deep vein thrombosis after orthopedic surgery.

  13. 99mtc-Ubiquicidin [29–41], a Promising Radiopharmaceutical to Differentiate Orthopedic Implant Infections from Sterile Inflammation

    PubMed Central

    Beiki, Davood; Yousefi, Gholamali; Fallahi, Babak; Tahmasebi, Mohammad Naghi; Gholamrezanezhad, Ali; Fard-Esfahani, Armaghan; Erfani, Mostafa; Eftekhari, Mohammad

    2013-01-01

    Ubiquicidin (UBI) [29-41] is a synthetic cationic antimicrobial peptide that preferentially binds to bacterial cell membrane at the site of infection. We aimed to assess diagnostic value of 99mTc-UBI [29-41] as a radiopharmaceutical in differentiation of bacterial infection from sterile inflammation in suspected orthopedic implants. Nine patients suspected for orthopedic implant infection, all males with the mean age of 41.6 ± 20.9 years, were studied. A dose of 10 MBq/Kg (range : 555-740 MBq) 99mTc-UBI [29-41] was injected intravenously. A dynamic study followed by static whole body imaging at 30, 60 and 120 min post-radiotracer injection was acquired. Periprosthetic tissue culture was considered the closest test to a gold standard for diagnosing infections and scintigraphic scans were categorized as true- or false-positive and true- or false-negative, considering the bacterial culture as the gold standard. No adverse reaction was observed during or after the radiotracer injection days. There were five true positive, four true negative and no false positive and false negative scans. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were all calculated as 100%. We found a high diagnostic accuracy for 99mTc-UBI [29-41] scintigraphy in differentiation of bacterial infection from sterile inflammation in suspected orthopedic implants. Therefore, 99mTc-UBI [29-41] scintigraphy might be potentially recommended as a safe and promising imaging modality in these settings. However, further studies on a larger number of patients and different pathologies are still needed. PMID:24250609

  14. Allergy/hypersensitivity reactions as a predisposing factor to complex regional pain syndrome I in orthopedic patients.

    PubMed

    Li, Xinning; Kenter, Keith; Newman, Ashley; O'Brien, Stephen

    2014-03-01

    Several predisposing conditions have been associated with complex regional pain syndrome I (CRPS I). The purpose of this study was to determine the relationship between a history of allergy/hypersensitivity reactions and CRPS I in orthopedic patients. Orthopedic patients with CRPS I (n=115) who experienced pain relief after a successful sympathetic nerve blockade were identified for study inclusion; a control group (n=115) matched to the CRPS I group by age, sex, and location of injury was also included. All patients in the study had an average age of 42 years. In the CRPS I group, all participants were Caucasian and the majority (80.8%) were women. The skin of patients with CRPS I was described as fair (57.7%), mottled (57.7%), or sensitive (80.8%). Of the patients with CRPS I, 78 (67.8%) reported a statistically significant history of allergies compared with the 39 (33.9%) patients in the control group (P<.0001). Patients with CRPS I who experienced complete pain relief for at least 1 month following a single sympathetic nerve block were asked to answer a questionnaire (n=35), and some then underwent immediate hypersensitivity testing using a skin puncture technique (n=26). Skin hypersensitivity testing yielded an 83.3% positive predictive value with an accuracy of 76.9%. Based on these results, a positive history for allergy/hypersensitivity reactions is a predisposing condition for CRPS I in this subset of orthopedic patients. These hypersensitivity reactions may prove important in gaining a better understanding in the pathophysiology of CRPS I as a regional pain syndrome.

  15. Effect of Oral Pregabalin as Preemptive Analgesic in Patients Undergoing Lower Limb Orthopedic Surgeries under Spinal Anaesthesia

    PubMed Central

    Sebastian, Bon; Nelamangala, Kiran; Krishnamurthy, Dinesh

    2016-01-01

    Introduction Conquering postoperative pain which has significant impact on the surgery outcome can be challenging for the clinicians. Pregabalin is a GABA analogue used for various neuropathic pain syndromes. Very few studies are there with the use of pregabalin as a preemptive analgesic for orthopedic surgeries. Aim To compare pregabalin 150 mg with placebo for postoperative pain control in patients undergoing elective lower limb orthopedic surgeries under spinal anaesthesia and to assess any side effects. Materials and Methods A randomized double blinded prospective study was undertaken. Ninety patients with ASA physical status I, II, aged between 18–50 years were enrolled in the study. One hour prior to spinal anaesthesia Group C - received colour matched empty capsules, Group P – received 150mg of oral pregabalin. Spinal anaesthesia was administered in sitting position in L3-L4 space with Inj. Bupivacaine heavy (0.5%) at a dose of 0.3mg/kg body weight with 20 mg being the maximum dose using 25 gauge spinal needle. Rescue analgesia was provided with using Inj. Diclofenac 1.5 mg/kg intramuscular. Results Time for rescue analgesia (VAS score >3) was significantly increased in Group P than in Group C. The total dose of diclofenac required in the 24 hour postoperative period was significantly lower in Group P than in Group C. The sedation scores and patient satisfaction scores were also more in Group P than in Group C. Conclusion Preemptive pregabalin in an oral dose of 150 mg offers good postoperative analgesia in lower limb orthopedic surgeries under spinal anaesthesia. PMID:27630927

  16. [THE MYCOBIOTA OF TUNICA MUCOSA OF MOUTH AND SURFACE OF REMOVABLE ACRYLIC LAMINAR DENTAL PROSTHESES UNDER ORTHOPEDIC REHABILITATION].

    PubMed

    Chesnokov, V A; Chesnokova, M G; Stafeiev, A A; Mironov, A Yu

    2016-02-01

    The analysis was carried out to detect mycobiota of tunica mucosa of mouth and surface of dental prostheses under orthopedic rehabilitation using removable acrylic laminar dental prostheses. The inoculation of biosamples received from examined patients permitted to isolate Candida albicans. The C. albicans from tunica mucosa of mouth of patients before prosthetics inoculated in low concentration making up 0.33±0.23 CFU/ml in comparison with concentration of 1.92±0.53 CFU/ml after prosthetics. The highest content of C. albicans was marked in biosample from surface of dental prostheses in comparison with biotope of tunica mucosa of mouth of patients. The concentration of microbiota from surface of dental prostheses signicantly surpassed the same on tunica mucosa of mouth of patients prior prosthetics. In patients with removable acrylic laminar dental prostheses under orthopedic rehabilitation various spectrum of representatives of microbiota was detected From biosamples from surface of dentalprostheses of patients the most frequently were inoculated such representatives of gram-positive microbiota as S. aureus, Micrococcus spp., S.haemolyticus, and of gram-negative microbiota Klebsiella pneumonae, Pseudomonas aeruginosa. The cultural analysis of biosamples from patients with removable acrylic laminar dental prostheses detected Candida albicans on tunica mucosa of mouth before and after prosthetics as well as on surfaces of prostheses. The highest concentration of C.albicans is established in case of colonization of removable acrylic laminar dental prostheses. The received data testifies possible involvement of fungi capable of expressed potential ofpathogenicity, in development and maintenance of inflammatory process of tunica mucosa of mouth under orthopedic rehabilitation using removable acrylic laminar dental prostheses.

  17. [THE MYCOBIOTA OF TUNICA MUCOSA OF MOUTH AND SURFACE OF REMOVABLE ACRYLIC LAMINAR DENTAL PROSTHESES UNDER ORTHOPEDIC REHABILITATION].

    PubMed

    Chesnokov, V A; Chesnokova, M G; Stafeiev, A A; Mironov, A Yu

    2016-02-01

    The analysis was carried out to detect mycobiota of tunica mucosa of mouth and surface of dental prostheses under orthopedic rehabilitation using removable acrylic laminar dental prostheses. The inoculation of biosamples received from examined patients permitted to isolate Candida albicans. The C. albicans from tunica mucosa of mouth of patients before prosthetics inoculated in low concentration making up 0.33±0.23 CFU/ml in comparison with concentration of 1.92±0.53 CFU/ml after prosthetics. The highest content of C. albicans was marked in biosample from surface of dental prostheses in comparison with biotope of tunica mucosa of mouth of patients. The concentration of microbiota from surface of dental prostheses signicantly surpassed the same on tunica mucosa of mouth of patients prior prosthetics. In patients with removable acrylic laminar dental prostheses under orthopedic rehabilitation various spectrum of representatives of microbiota was detected From biosamples from surface of dentalprostheses of patients the most frequently were inoculated such representatives of gram-positive microbiota as S. aureus, Micrococcus spp., S.haemolyticus, and of gram-negative microbiota Klebsiella pneumonae, Pseudomonas aeruginosa. The cultural analysis of biosamples from patients with removable acrylic laminar dental prostheses detected Candida albicans on tunica mucosa of mouth before and after prosthetics as well as on surfaces of prostheses. The highest concentration of C.albicans is established in case of colonization of removable acrylic laminar dental prostheses. The received data testifies possible involvement of fungi capable of expressed potential ofpathogenicity, in development and maintenance of inflammatory process of tunica mucosa of mouth under orthopedic rehabilitation using removable acrylic laminar dental prostheses. PMID:27455570

  18. "WhatsApp"ening in orthopedic care: a concise report from a 300-bedded tertiary care teaching center.

    PubMed

    Khanna, Vishesh; Sambandam, Senthil N; Gul, Arif; Mounasamy, Varatharaj

    2015-07-01

    Smartphones have emerged as essential tools providing assistance in patient care, monitoring, rehabilitation, communication, diagnosis, teaching, research and reference. Among innumerable communication apps, WhatsApp has been widely popular and cost effective. The aim of our study was to report the impact of introduction of a smartphone app "WhatsApp" as an intradepartmental communication tool on (1) awareness of patient-related information, (2) efficiency of the handover process and (3) duration of traditional morning handovers among orthopedic residents in a 300-bedded tertiary care teaching center. Written handovers and paging used for communication at our center led to occasional inefficiencies among residents. Widespread use, low cost, availability and double password protection (phone lock and WhatsApp lock) made WhatsApp's group conversation feature an ideal tool for intradepartmental patient-related communication. Twenty-five consecutive admissions before and after WhatsApp (BW, AW) were included in the study. Eight orthopedic residents attempted fifty randomly arranged questions based on the twenty-five patients in each study period. A null hypothesis that introduction of WhatsApp group would neither increase the awareness of patient-related information nor improve the efficiency of the handovers among residents was assumed. A significant improvement observed in scores obtained by residents in the AW group led to rejection of the null hypothesis. The residents also reported swifter and efficient handovers after the introduction of WhatsApp. Our results indicate that the introduction of a smartphone app "WhatsApp" as an intradepartmental communication tool can bring about an improvement in patient-related awareness, communication and handovers among orthopedic residents.

  19. Choice and Participation of Career by STEM Professionals with Sensory and Orthopedic Disabilities and the Roles of Assistive Technologies

    NASA Astrophysics Data System (ADS)

    Pacheco, Heather A.

    This is a qualitative study about sources of self-efficacy and roles of assistive technologies (AT) associated with the science, technology, engineering and mathematics (STEM) choice and participation of STEM professionals and graduate students with sensory and orthopedic disabilities. People with disabilities are underrepresented in STEM, which can be traced back along the STEM pipeline to early undergraduate participation in STEM. Little research exists, however, about pathways and factors associated with successful STEM participation for people with disabilities at any point along their trajectories. Eighteen STEM professionals and graduate students with sensory and orthopedic disabilities were interviewed for this study. Sources of self-efficacy were sought from interview transcripts, as were emergent themes associated with the types, uses and roles of AT. Findings suggest that people with sensory and orthopedic disabilities weigh sources of self-efficacy differently from white males without disabilities in STEM and more like other underrepresented minorities in STEM. Social persuasions were most frequently reported and in far more detail than other sources, suggesting that this source may be most impactful in the development of self-efficacy beliefs for this group. Additionally, findings indicate that AT is critical to the successful participation of people with sensory and orthopedic disabilities in STEM at all points along their STEM pathways. Barriers center around issues of access to full engagement in mainstream STEM classrooms and out of school opportunities as well as the impact of ill-informed perceptions about the capabilities of people with disabilities held by parents, teachers and college faculty who can act as gatekeepers along STEM pathways. Gaps in disability specialists' knowledge about STEM-specific assistive technologies, especially at the college level, are also problematic. The prevalence of mainstream public school attendance reported by

  20. Comparison of ropivacaine with levobupivacaine under epidural anesthesia in the lower limb orthopedic surgeries: A randomized study

    PubMed Central

    Maheshwari, Vijeta; Rasheed, Mohd Asim; Singh, Raj Bahadur; Choubey, Sanjay; Sarkar, Arindam

    2016-01-01

    Context: Epidural anesthesia is nowadays considered as the gold standard anesthetic technique for lower limb orthopedic surgeries, and the present study was conducted to evaluate the efficacy of levobupivacaine and ropivacaine in terms of onset, duration of sensory and motor block with duration of postoperative analgesia in patients undergoing lower limb orthopedic surgeries under epidural anesthesia. Aims: To compare the efficacy of 15 mL of levobupivacaine 0.5% with that of 15 mL of ropivacaine 0.75% in patients undergoing lower limb orthopedic surgeries under epidural anesthesia and to determine the better of the two agents with respect to onset, duration of sensory and motor blockade, postoperative analgesia, and adverse effects; if any. Settings and Design: A double-blind randomized study. Subjects and Methods: A total of seventy patients planned to undergo elective lower limb orthopedic surgeries fulfilling the criteria were enrolled in the study. Group I (n = 35): Received 15 mL 0.5% levobupivacaine epidurally. Group II (n = 35): Received 15 mL 0.75% ropivacaine epidurally. Statistical Analysis: Statistical Analysis was done by Statistical Package for Social Sciences (SPSS Version 15.0) statistical analysis software. The values were represented in number (%) and mean ± standard deviation. Results: Time to achieve sensory onset and motor onset were significantly lower in Group II (17.86 ± 2.51 and 23.14 ± 2.73) as compared to Group I (26.14 ± 2.45 and 31.43 ± 2.59) while the duration of sensory block was significantly higher in Group II (173.29 ± 6.29 min) as compared to Group I (156.71 ± 6.96 min). Although motor block duration of Group I (142.43 ± 8.43 min) was higher than that of Group II (141.43 ± 12.81 min), but this difference was not found to be statistically significant. Conclusions: The inference drawn from this discussion, in general, indicated that both the drugs are comparable for block onset, quality, and duration along with similar

  1. [The young resident between work and family. Status quo and approaches to a solution in orthopedics and traumatology].

    PubMed

    Depeweg, D; Achatz, G; Liebig, K; Lorenz, O

    2013-01-01

    The compatibility between the family and the medical profession requires a new challenge of leadership in hospitals, politics and medical societies. The generation change in the medical profession needs the implementation of modern framework conditions in the departments of orthopedics and traumatology. Topics such as work organisation, family support and programs to assist the return to work need to be discussed and should be used as a competitive advantage. Employees of generation y need a gender-independent role model in the field of modern management methods in employee leadership.

  2. Analyses and comparison of a novel, hybrid, multifunctional orthopedic composite and implant

    NASA Astrophysics Data System (ADS)

    Dicicco, Michael

    In the orthopedic/medical device industry, 2, 2' -bis-(4-(2-hydroxy-3-methacryloxypropoxy)phenyl]propane (Bis-GMA)- and diurethanedimethacrylate (DUDMA)-based polymeric biomaterials have become well-known substitutes for polymethylmethacrylate (PMMA)- and ultra-high molecular weight polyethylene (UHMWPE)-based biomaterials, respectively. The development of these polymeric biomaterials cannot continue without direct comparison studies against currently marketed materials. The initiative for this research stems wholly from developing analytical methodologies that assist in qualifying novel biomaterials under development, by evaluating their chemical properties, performance, and safety. The goals of this research were: (i) Characterize the assay/quality of every resin component and quantify elution of extractable monomers from novel, DUDMA-based RHAKOSS(TM) implant, (ii) Determine degree of conversion (alpha) and rate of polymerization (Rp) for novel, Bis-GMA-based CORTOSS(TM) composite, (iii) Assess risk for radical-induced post-surgical cytotoxicity for CORTOSS, (iv) Determine if surface radical chemistries occur for sterilized RHAKOSS and assess its oxidative stability, and (v) Quantify antibiotic elution from antibiotic-impregnated CORTOSS and identify factors that control elution. The phenomena studied necessitated the utilization of several analytical spectroscopic techniques; fluorometry, differential scanning calorimetry (DSC), electron paramagnetic resonance (EPR), ultraviolet-visible (UV-VIS), attenuated total reflectance---Fourier-transform infrared (ATR-FTIR), and high performance liquid chromatography (HPLC). A battery of lateral chemical techniques were employed as well; including molecular derivatization/tagging, phase partitioning, spin-trapping, and thermal annealing. Results demonstrated that RHAKOSS monomer percent compositions were prepared according to formulations and monomer elution was virtually undetectable, serving as an empirical gauge to

  3. Electrophoretic-deposited novel ternary silk fibroin/graphene oxide/hydroxyapatite nanocomposite coatings on titanium substrate for orthopedic applications

    NASA Astrophysics Data System (ADS)

    Li, Ming; Xiong, Pan; Mo, Maosong; Cheng, Yan; Zheng, Yufeng

    2016-09-01

    The combination of graphene oxide (GO) with robust mechanical property, silk fibroin (SF) with fascinating biological effects and hydroxyapatite (HA) with superior osteogenic activity is a competitive approach to make novel coatings for orthopedic applications. Herein, the feasibility of depositing ternary SF/GO/HA nanocomposite coatings on Ti substrate was firstly verified by exploiting electrophoretic nanotechnology, with SF being used as both a charging additive and a dispersion agent. The surface morphology, microstructure and composition, in vitro hemocompatibility and in vitro cytocompatibility of the resulting coatings were investigated by SEM, Raman, FTIR spectra and biocompatibility tests. Results demonstrated that GO, HA and SF could be co-deposited with a uniform, smooth thin-film morphology. The hemolysis rate analysis and the platelet adhesion test indicated good blood compatibility of the coatings. The human osteosarcoma MG63 cells displayed well adhesion and proliferation behaviors on the prepared coatings, with enhanced ALP activities. The present study suggested that SF/GO/HA nanocomposite coatings could be a promising candidate for the surface functionalization of biomaterials, especially as orthopedic implant coating.

  4. Epoetin alfa plus autologous blood donation in patients with a low hematocrit scheduled to undergo orthopedic surgery.

    PubMed

    Tryba, M

    1996-04-01

    A low predonation hematocrit (Hct) can preclude the collection of sufficient autologous blood (AB) to meet the transfusion requirements of patients scheduled for orthopedic surgery. Subcutaneous (s.c.) administration of epoetin alfa, in conjunction with intravenous (i.v.) iron supplementation, has proved effective for the facilitation of AB donation by such patients. Compared with untreated controls and patients treated with i.v. iron alone, epoetin alfa 50 to 150 IU/kg SC plus i.v. iron twice weekly for 3 weeks prior to surgery significantly increased total red blood cell (RBC) production (P < .01) and the volume of RBCs donated (P < .05). Epoetin alfa was particularly effective in females and patients with a predicted blood volume (PBV) less than 5 L. Treatment with epoetin alfa led to an increase (albeit nonsignificant) in the number of AB units predonated compared with i.v. iron alone. However, in patients with a PBV less than 5 L, a substantially greater percentage of epoetin alfa-treated patients donated > or = 4 AB units (80% v 30%). Allogeneic blood requirements were reduced, albeit not significantly (P = .051), in patients treated with epoetin alfa. However, in comparison with untreated controls, there was a significant reduction in the mean volume of allogeneic blood transfused per transfused patient in the epoetin alfa groups. The optimum s.c. dose of epoetin alfa in patients with a low predonation Hct scheduled for orthopedic surgery appears to be between 100 and 150 IU/kg twice weekly for 3 weeks.

  5. Differential sensitivity of osteoblasts and bacterial pathogens to 405-nm light highlighting potential for decontamination applications in orthopedic surgery

    NASA Astrophysics Data System (ADS)

    Ramakrishnan, Praveen; Maclean, Michelle; MacGregor, Scott J.; Anderson, John G.; Grant, M. Helen

    2014-10-01

    Healthcare associated infections pose a major threat to patients admitted to hospitals and infection rates following orthopedic arthroplasty surgery are as high as 4%. A 405-nm high-intensity narrow spectrum light has been proven to reduce environmental contamination in hospital isolation rooms, and there is potential to develop this technology for application in arthroplasty surgery. Cultured rat osteoblasts were exposed to varying light intensities and it was found that exposures of up to a dose of 36 J/cm2 had no significant effect on cell viability [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay], function (alkaline phosphatase activity), and proliferation rate (BrdU cell proliferation assay). High irradiance exposures (54 J/cm2) significantly affected the cell viability indicating that the effects of 405-nm light on osteoblasts are dose dependent. Additionally, exposure of a variety of clinically related bacteria to a dose of 36 J/cm2 resulted in up to 100% kill. These results demonstrating the differential sensitivity of osteoblasts and bacteria to 405-nm light are an essential step toward developing the technique for decontamination in orthopedic surgery.

  6. Attitudes toward evidence-based clinical practice among doctors of chiropractic with diplomate-level training in orthopedics

    PubMed Central

    2013-01-01

    Background Evidence-based clinical practice (EBCP) is a practice model gaining prominence within healthcare, including the chiropractic profession. The status of EBCP has been evaluated in a variety of healthcare disciplines, but little is known regarding the attitudes doctors of chiropractic (DCs) hold toward this model of healthcare. This project examines the attitudes toward EBCP within a specialty discipline of DCs. Methods We identified a survey questionnaire previously used to evaluate EBCP among non-chiropractic complementary and alternative practitioners. We adapted this questionnaire for use among DCs and pretested it in 5 chiropractic college faculty. The final version was administered to DCs with diplomate-level training in orthopedics. The survey was emailed to 299 potential participants; descriptive results were calculated. Results 144 surveys were returned, resulting in a 48% response rate. The majority of respondents perceived EBCP as an important aspect of chiropractic practice. Respondents also believed themselves to have an above average skill level in EBCP, reported that training originated from their diplomate education, and based the majority of their practice on clinical research. Conclusion Doctors of chiropractic with an orthopedic diplomate appear to have favorable attitudes toward EBCP. Further study will help understand EBCP perceptions among general field DCs. A logical next step includes validation of this questionnaire. PMID:24314309

  7. Dental and orthopedic effects of high-pull headgear in treatment of Class II, division 1 malocclusion.

    PubMed

    Firouz, M; Zernik, J; Nanda, R

    1992-09-01

    In the present study a prospective cephalometric investigation was undertaken to examine the skeletal and dental effects of the high-pull extraoral appliance, when the resultant force was directed through the level of trifurcation of the maxillary molars. Twelve adolescent patients with Class II, Division 1 malocclusions were selected for the study. Each patient wore the headgear for a 6-month period, an average of 12 hours a day. A group of untreated adolescent patients with Class II, Division 1 malocclusions who were in a similar age range, as well as skeletal and dental characteristics were chosen as controls. Lateral cephalometric films were taken before and after the 6-month treatment period, and before and after the observation period in the control group of patients. Our data indicate that by directing the force of the headgear approximately through the center of resistance of the maxillary molars, it is possible to accomplish simultaneously a substantial distal movement of the molars (2.6 +/- 0.6 mm), as well as significant intrusion (0.54 +/- 0.54 mm). In addition, our results demonstrate that the applied force of 500 gm was sufficient to initiate maxillary orthopedic changes in the treated patients. These changes include relative restriction of horizontal and vertical maxillary growth, as well as distal movement (mean: 0.8 mm) of the maxillary anterior border in the treatment group relative to an untreated control group. Such orthopedic changes have been previously described only in association with much higher force levels.

  8. Bilateral Simultaneous Anterior Cruciate Ligament Injury: A Case Report and National Survey of Orthopedic Surgeon Management Preference

    PubMed Central

    Saadat, Ehsan; Curry, Emily J.; Li, Xinning; Matzkin, Elizabeth G.

    2014-01-01

    Unilateral anterior cruciate ligament (ACL) tear is a common injury seen by sports medicine orthopedic surgeons. However, a bilateral simultaneous ACL injury is extremely rare and has been reported only three times in the literature. We present a young female skier with simultaneous bilateral ACL tears that were managed with staged ACL reconstruction. We then conducted a nationwide survey (United States) to determine the prevalence of simultaneous bilateral ACL tear and preferred management strategies by sports medicine orthopedic surgeons. Sports medicine fellowship directors were contacted and asked to send an 8-item survey to colleagues (sports medicine fellowship trained surgeons) asking about overall number of ACL reconstructions performed, number of bilateral simultaneous ACL injuries seen and optimal management strategies of such an injury. Out of 43 responses, only 22 (51.2%) surgeons had seen a bilateral simultaneous ACL injury. Of these, 16 (76.2%) preferred staged reconstruction. Graft choice was mixed between autograft and allograft, but a large majority preferred either patellar tendon autograft (58%) or hamstring autograft (41%) were the most common choice. Staged reconstruction is the treatment of choice by surgeons surveyed in our study. PMID:25568728

  9. Bilateral simultaneous anterior cruciate ligament injury: a case report and national survey of orthopedic surgeon management preference.

    PubMed

    Saadat, Ehsan; Curry, Emily J; Li, Xinning; Matzkin, Elizabeth G

    2014-10-27

    Unilateral anterior cruciate ligament (ACL) tear is a common injury seen by sports medicine orthopedic surgeons. However, a bilateral simultaneous ACL injury is extremely rare and has been reported only three times in the literature. We present a young female skier with simultaneous bilateral ACL tears that were managed with staged ACL reconstruction. We then conducted a nationwide survey (United States) to determine the prevalence of simultaneous bilateral ACL tear and preferred management strategies by sports medicine orthopedic surgeons. Sports medicine fellowship directors were contacted and asked to send an 8-item survey to colleagues (sports medicine fellowship trained surgeons) asking about overall number of ACL reconstructions performed, number of bilateral simultaneous ACL injuries seen and optimal management strategies of such an injury. Out of 43 responses, only 22 (51.2%) surgeons had seen a bilateral simultaneous ACL injury. Of these, 16 (76.2%) preferred staged reconstruction. Graft choice was mixed between autograft and allograft, but a large majority preferred either patellar tendon autograft (58%) or hamstring autograft (41%) were the most common choice. Staged reconstruction is the treatment of choice by surgeons surveyed in our study. PMID:25568728

  10. Automated ribotyping to distinguish the different non Sau/ non Sep staphylococcal emerging pathogens in orthopedic implant infections.

    PubMed

    Campoccia, D; Baldassarri, L; An, Y H; Kang, Q K; Pirini, V; Gamberini, S; Pegreffi, F; Montanaro, L; Arciola, C R

    2006-04-01

    Several species belonging to Staphylococcus genus, other than Staphylococcus aureus and Staphylococcus epidermidis (non Sau/ non Sep species), exhibit increasing abilities as opportunistic pathogens in the colonisation of periprosthetic tissues. Consequently, the availability of means for accurate identification is crucial to assess the pathogenic characteristics and to clarify clinical relevance of the individual species. Here, 146 clinical staphylococcal isolates belonging to non Sau/ non Sep species from prosthesis-associated orthopedic infections were analyzed by conventional enzymatic galleries and by automated ribotyping. Twelve different species were recognised: S. capitis, S. caprae, S. cohnii, S. equorum, S. haemolyticus, S. hominis, S. lugdunensis, S. pasteuri, S. sciuri, S. simulans, S. warneri, S. xylosus. Ribotype identifications were compared with the phenotypes obtained by the Api 20 Staph system and/or ID 32 Staph system. ID 32 Staph profiles were more consistent with ribotyping results than Api Staph profiles. Across the different staphylococcal species investigated, correct identifications with Api Staph were 45%, while with ID 32 Staph they were 59%. It has, however, to be mentioned that ID 32 Staph was mostly applied to discriminate unmatched ribotyping and Api Staph identifications, thus to a subpopulation of strains with "atypical" metabolic profile. Automated ribotyping provided a correct identification for 91% of the isolates. These results confirm automated ribotyping as a convenient rapid technique, still subject to improvements, which will accurately and rapidly recognise the newly emerging staphylococcal pathogens in implant-related orthopedic infections. PMID:16705611

  11. Evaluation of the orthopedic residency training program in Saudi Arabia and comparison with a selected Canadian residency program

    PubMed Central

    Al-Ahaideb, Abdulaziz; Alrabai, Hamza M; Alrehaili, Osama A; Aljurayyan, Abdulaziz N; Alsaif, Ranyah M; Algarni, Nizar; Al-Khawashki, Hazem M; Algarni, Abdulrahman D

    2014-01-01

    Objective The primary aim of the present study was to assess the quality of the Saudi Orthopedic Residency Program. Methodology As a comparator, a cross-sectional survey involving 76 Saudi residents from different training centers in Saudi Arabia namely; Riyadh, Jeddah, Medina, Abha, and Dammam and 15 Canadian. Results The results showed that Canadian residents read more peer-reviewed, scholarly articles compared with Saudi residents (P=0.002). The primary surgical role for residents was to hold retractors during surgery. The survey respondents strongly supported the ability to recommend removal of incompetent trainers. Saudi trainees were more apprehensive of examinations than Canadian trainees (P<0.0001). Most residents preferred studying multiple-choice questions before examinations. Saudi and Canadian participants considered their programs to be overcrowded. Unlike Canadian participants, Saudi trainees reported an inadequate level of training (P<0.0001). Conclusion Educational resources should be readily accessible and a mentorship system monitoring residents’ progress should be developed. The role of the resident must be clearly defined and resident feedback should not be ignored. Given the importance of mastering basic orthopedic operative skills for residents, meaningful remedial action should be taken with incompetent trainers. PMID:25278788

  12. Orthopedic coordination of dentofacial development in skeletal Class II malocclusion in conjunction with edgewise therapy. Part I.

    PubMed

    Bass, N M

    1983-11-01

    The skeletal Class II malocclusion may be considered to develop as a failure of the coordinating process to maintain harmonious relationships within the developing dentofacial apparatus. If the skeletal elements are too far apart for adaptation to occur and/or if there are functional abnormalities of the orofacial musculature which inhibit coordination from taking place, a malocclusion will result. An orthopedic technique and appliance system has been developed with the intention of improving those factors responsible for the development and perpetuation of the skeletal Class II malocclusion in a primary stage of treatment. This is accomplished by means of restraint and redirection of forward maxillary growth and an increase in the velocity of mandibular growth. Concurrently, adverse soft-tissue influences are eliminated or ameliorated. Edgewise appliance therapy is subsequently carried out for the final correction. The subject is considered in two articles. This first article describes the effects of the restraint of maxillary growth on craniofacial development and the dental changes produced by a maxillary removable splint with extraoral traction and shows how they can be used clinically for correction of the skeletal Class II malocclusion. The experimental and clinical evidence supporting this approach is considered, and case histories show the clinical use of the maxillary splint. This form of maxillary therapy for the skeletal Class II malocclusion has limitations, and it is desirable for it to be incorporated into a comprehensive orthopedic system.

  13. Designing Flightdeck Procedures

    NASA Technical Reports Server (NTRS)

    Barshi, Immanuel; Mauro, Robert; Degani, Asaf; Loukopoulou, Loukia

    2016-01-01

    The primary goal of this document is to provide guidance on how to design, implement, and evaluate flight deck procedures. It provides a process for developing procedures that meet clear and specific requirements. This document provides a brief overview of: 1) the requirements for procedures, 2) a process for the design of procedures, and 3) a process for the design of checklists. The brief overview is followed by amplified procedures that follow the above steps and provide details for the proper design, implementation and evaluation of good flight deck procedures and checklists.

  14. Computerized procedures system

    DOEpatents

    Lipner, Melvin H.; Mundy, Roger A.; Franusich, Michael D.

    2010-10-12

    An online data driven computerized procedures system that guides an operator through a complex process facility's operating procedures. The system monitors plant data, processes the data and then, based upon this processing, presents the status of the current procedure step and/or substep to the operator. The system supports multiple users and a single procedure definition supports several interface formats that can be tailored to the individual user. Layered security controls access privileges and revisions are version controlled. The procedures run on a server that is platform independent of the user workstations that the server interfaces with and the user interface supports diverse procedural views.

  15. A modified presurgical orthopedic (nasoalveolar molding) device in the treatment of unilateral cleft lip and palate

    PubMed Central

    Subramanian, Chitravelu Siva; Prasad, N. K. K. Koteswara; Chitharanjan, Arun B.; Liou, Eric Jein Wein

    2016-01-01

    Nasoalveolar molding (NAM) can be done effectively to reshape the nasal cartilage and mold the maxillary dentoalveolar arch before surgical cleft lip repair and primary rhinoplasty. Presurgical NAM helps as an adjunct procedure to enhance the esthetic and functional outcome of the surgical procedures. We have developed a modified NAM device to suit to the needs of the patients coming from distant places for the treatment. This device helps in reducing the number of frequent visits the patient needs to take to the craniofacial center. The purpose of this presentation is to report this treatment technique and discuss its application. PMID:27403068

  16. A modified presurgical orthopedic (nasoalveolar molding) device in the treatment of unilateral cleft lip and palate.

    PubMed

    Subramanian, Chitravelu Siva; Prasad, N K K Koteswara; Chitharanjan, Arun B; Liou, Eric Jein Wein

    2016-01-01

    Nasoalveolar molding (NAM) can be done effectively to reshape the nasal cartilage and mold the maxillary dentoalveolar arch before surgical cleft lip repair and primary rhinoplasty. Presurgical NAM helps as an adjunct procedure to enhance the esthetic and functional outcome of the surgical procedures. We have developed a modified NAM device to suit to the needs of the patients coming from distant places for the treatment. This device helps in reducing the number of frequent visits the patient needs to take to the craniofacial center. The purpose of this presentation is to report this treatment technique and discuss its application. PMID:27403068

  17. Clinical evaluation of a commercial orthopedic metal artifact reduction tool for CT simulations in radiation therapy

    SciTech Connect

    Li Hua; Noel, Camille; Chen, Haijian; Harold Li, H.; Low, Daniel; Moore, Kevin; Klahr, Paul; Michalski, Jeff; Gay, Hiram A.; Thorstad, Wade; Mutic, Sasa

    2012-12-15

    Purpose: Severe artifacts in kilovoltage-CT simulation images caused by large metallic implants can significantly degrade the conspicuity and apparent CT Hounsfield number of targets and anatomic structures, jeopardize the confidence of anatomical segmentation, and introduce inaccuracies into the radiation therapy treatment planning process. This study evaluated the performance of the first commercial orthopedic metal artifact reduction function (O-MAR) for radiation therapy, and investigated its clinical applications in treatment planning. Methods: Both phantom and clinical data were used for the evaluation. The CIRS electron density phantom with known physical (and electron) density plugs and removable titanium implants was scanned on a Philips Brilliance Big Bore 16-slice CT simulator. The CT Hounsfield numbers of density plugs on both uncorrected and O-MAR corrected images were compared. Treatment planning accuracy was evaluated by comparing simulated dose distributions computed using the true density images, uncorrected images, and O-MAR corrected images. Ten CT image sets of patients with large hip implants were processed with the O-MAR function and evaluated by two radiation oncologists using a five-point score for overall image quality, anatomical conspicuity, and CT Hounsfield number accuracy. By utilizing the same structure contours delineated from the O-MAR corrected images, clinical IMRT treatment plans for five patients were computed on the uncorrected and O-MAR corrected images, respectively, and compared. Results: Results of the phantom study indicated that CT Hounsfield number accuracy and noise were improved on the O-MAR corrected images, especially for images with bilateral metal implants. The {gamma} pass rates of the simulated dose distributions computed on the uncorrected and O-MAR corrected images referenced to those of the true densities were higher than 99.9% (even when using 1% and 3 mm distance-to-agreement criterion), suggesting that dose

  18. Characterization of aerosols produced by surgical procedures: A summary

    SciTech Connect

    Yeh, Hsu-Chi; Muggenburg, B.A.; Lundgren, D.L.; Turner, R.S.; Guilmette, R.A.; Snipes, M.B.; Jones, R.K.

    1994-11-01

    In many types of surgery, especially orthopedic procedures, power tools such as saws and drills are used. These tools can impart considerable energy in disrupting tissue and may produce aerosolized blood and material from bone and other tissues. Surgical lasers and electrocautery tools can also produce aerosols due to vaporization of blood and tissues. A number of studies have been reported concerning production of aerosols during surgery, and some of the aerosols produced may contain infectious materials. Health care workers have expressed concern and questions pertaining to the occupational transmission of blood-borne pathogens including the human immunodeficiency virus (HIV) and hepatitis B virus (HBV) via blood aerosols during surgery. Little or no data existed characterizing the aerosols produced performing surgical procedures. Because of this lack of data, the National Institute for Occupational Safety and Health funded a project at ITRI to assess the extent of aerosolization of blood and other tissues during surgical procedures in the laboratory and in a hospital surgical suite.

  19. Public Sector Impasse Procedures.

    ERIC Educational Resources Information Center

    Vadakin, James C.

    The subject of collective bargaining negotiation impasse procedures in the public sector, which includes public school systems, is a broad one. In this speech, the author introduces the various procedures, explains how they are used, and lists their advantages and disadvantages. Procedures discussed are mediation, fact-finding, arbitration,…

  20. Brucella abortus Exposure during an Orthopedic Surgical Procedure—New Mexico, 2010

    PubMed Central

    Nichols, Megin; Thompson, Deborah; Carothers, Joshua T.; Klauber, Judy; Stoddard, Robyn A.; Guerra, Marta A.; Benoit, Tina J.; Traxler, Rita M.

    2015-01-01

    We describe a periprosthetic Brucella abortus infection in a case-patient undergoing hip replacement revision surgery, and the subsequent investigation of laboratory and surgical staff exposures. Although exposures are rare, it is important to have infection prevention recommendations for surgical procedures among patients with suspected or unidentified Brucella spp. infection. PMID:25026630