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Ferguson, Robert P; Thomas, Deborah
Eponyms are a long-standing tradition in medicine. Eponyms usually involve honoring a prominent physician scientist who played a major role in the identification of the disease. Under the right circumstances, a disease becomes well known through the name of this individual. There are no rules on eponym development. It may take an extraordinary period of time, be different in different languages and cultures, and evolve as more is known about the physician or the disease. PMID:25147644
Ferguson, Robert P.; Thomas, Deborah
Eponyms are a long-standing tradition in medicine. Eponyms usually involve honoring a prominent physician scientist who played a major role in the identification of the disease. Under the right circumstances, a disease becomes well known through the name of this individual. There are no rules on eponym development. It may take an extraordinary period of time, be different in different languages and cultures, and evolve as more is known about the physician or the disease. PMID:25147644
Vashisht, Deepak; Baveja, Sukriti
Eponym has originated from the Greek word "eponymos" meaning "giving name". It is a tribute to the pioneers in the field who have significantly contributed towards present understanding of the subject. Syphilis has amazed and plagued mankind since eternity. This disease is a great masquerade and can humble best of physicians with its varied presentations. Keen and immaculate observations of these workers have eased our understanding of many signs and phenomenon associated with this disease. This has led to evolution of number of eponyms, perhaps no other disease has as many eponyms associated with it, as does syphilis. Eponyms such as Kassowitz's law, Clutton's joints, Higoumenaki sign, Argyll-Robertson pupil etc. help in providing easy milieu for remembering. Besides paying tributes to stalwarts in the field, who dedicated their lives for this cause, they also facilitated our current understanding of the great masquerade. PMID:26692628
Vashisht, Deepak; Baveja, Sukriti
Eponym has originated from the Greek word "eponymos" meaning "giving name". It is a tribute to the pioneers in the field who have significantly contributed towards present understanding of the subject. Syphilis has amazed and plagued mankind since eternity. This disease is a great masquerade and can humble best of physicians with its varied presentations. Keen and immaculate observations of these workers have eased our understanding of many signs and phenomenon associated with this disease. This has led to evolution of number of eponyms, perhaps no other disease has as many eponyms associated with it, as does syphilis. Eponyms such as Kassowitz's law, Clutton's joints, Higoumenaki sign, Argyll-Robertson pupil etc. help in providing easy milieu for remembering. Besides paying tributes to stalwarts in the field, who dedicated their lives for this cause, they also facilitated our current understanding of the great masquerade. PMID:26692628
Animals Eponyms in Dermatology
Jindal, Nidhi; Jindal, Pooja; Kumar, Jeevan; Gupta, Sanjeev; Jain, VK
The world of Dermatology is flooded with inflexions among clinical conditions and signs and syndromes; making it interesting, but a tougher subject to remember. Signs and syndromes have always fascinated residents, but simultaneously burdened their minds, as these attractive names are difficult to remember. This work was undertaken to review dermatological conditions and signs based on commonly encountered daily words and objects like animals, etc. Fifty dermatological conditions were found to be based on animal eponyms. For example, the usage of animal terminology in dermatology like leonine facies is present in leprosy, sarcoidosis, mycosis fungoides (MF), and airborne contact dermatitis (ABCD). PMID:25484417
Kutia, S A; Kiselev, V V; Lyashchenko, O I
Eponym--name of the disease, certain structure or method after the person who usually first discovered and described them. Eponyms are widely spread in medicine which appeared to be in the area of a great interest for a lot of scientists. They can serve as a reflection of the evolution of the medical knowledge and making up the majority of anatomical terms. The article describes 12 arterial eponyms of the gastrointestinal tract giving a full anatomical description. It also gives an explanation of why and how those structures were named after certain scientists and what contribution they've made into the development of medicine. PMID:26817114
Eponymous hip joint approaches.
Somford, Matthijs P; Hoornenborg, Daniël; Wiegerinck, Johannes I; Bolder, Stefan B T; Schreurs, Berend W
After the low friction arthroplasty by John Charnley was no longer confined to specialized hospitals but commonplace in the general orthopedic practice, the issue remained how to most optimally reach the hip. The names of the authors of these approaches remain in a lot of cases connected to the approach. By evaluating the original articles in which the approaches are described we ascertain the original description and technique. By various sources we obtained the (short) biography of the people whose name is connected to the approach. Our research covers the biographies of colleagues Smith-Petersen, Watson-Jones, Hardinge, Charnley, Moore and Ludloff. The eponymous approaches are shown and described after the short biography on each individual. This study shows that without the work of our colleagues we cannot proceed in our profession. An understanding and knowledge of the people who dedicated themselves to developing the orthopedic surgery to the high standard it has today is the least honour we should give them. PMID:27139185
Eponyms in dermatology literature linked to Japan
Al Aboud, Ahmad; Al Aboud, Khalid
There are many different eponyms in common use in dermatology today, originating from a variety of countries worldwide. This review discusses a selection of dermatological eponyms that are linked to Japan. PMID:22291476
Names of infamy: tainted eponyms.
Vajda, F J E; Davis, S M; Byrne, E
The use of eponyms is controversial. A distinction must be made between those doctors and scientists after whom disorders and syndromes are named in honour of their discoveries, and those whose discoveries were made as a result of maltreatment of defenceless prisoners, utilizing specimens from victims of Nazi extermination policies, and euthanasia victims of racial policies. The second group of scientists should have their names expunged from the historical record, and their deeds brought to the attention of their colleagues. We are not however advocating the abolition of eponyms in general, only tainted ones. PMID:25564271
Lumbar nerve root: the enigmatic eponyms.
Dyck, P
Man's quest for recognition has not escaped the physician, whose contributions to medicine perpetuate his name in print. It is a final grasp for professional immortality, which for men like Imhotep and Hippocrates, has prevailed for millennia. This fervor was particularly evident in the latter 19th century, which created a flurry of eponyms, often two or more physicians publishing the same clinical observation. This article reviews the eponym epidemic as it relates to lumbar radiculopathy. PMID:6372123
Eponymous Dermatological Signs in Bullous Dermatoses
Ganapati, Sentamilselvi
Clinical signs are evolved by clinicians through their careful clinical examination. Medical professionals are generally familiar with these signs because of the emphasis given to them by the teaching faculty while they were students. Some of these signs are eponymously named after the clinicians giving credit to their observation. Eponymous signs in vesiculobullous diseases such as Nikolsky sign and Asboe Hansen sign (Bulla spread sign) are well known and were described during the 19th and 20th century, respectively. Cerebriform tongue in pemphigus vegetans was described by Premalatha (1981) three decades ago and is well recognized and cited in several text books and articles in leading journals. All these signs are revisited below with an emphasis on cerebriform tongue in pemphigus vegetans which could eponymously be called as Premalatha sign. PMID:24470655
Clothing-related Eponyms and Signs.
Long, Valencia
The world of dermatology is pieced together by clinical conditions unique in their colors, morphology, and configuration. Dermatological signs and terms are influenced by etymology, language, and history. Eponyms also make dermatology a fascinating but linguistically challenging subject. This article reviews dermatological conditions described in relation to fashion, and what we wear in everyday life from top to toe, demonstrating that dermatology can be inspired even in the most common things. PMID:27057040
Clothing-related Eponyms and Signs
Long, Valencia
The world of dermatology is pieced together by clinical conditions unique in their colors, morphology, and configuration. Dermatological signs and terms are influenced by etymology, language, and history. Eponyms also make dermatology a fascinating but linguistically challenging subject. This article reviews dermatological conditions described in relation to fashion, and what we wear in everyday life from top to toe, demonstrating that dermatology can be inspired even in the most common things. PMID:27057040
Park, W.M.; Hughes, S.P.F.
This book is an account of the principles of modern diagnostic imaging techniques and their applications in orthopedics. The aim is to show radiology as a dynamic subject. Orthopaedic Radiology is divided into two sections with the first part focusing on the principles of diagnostic imaging and interpretation and the second applying this information to practical clinical problems.
Clauberg's eponym and crimes against humanity.
Sweet, Frederick; Csapó-Sweet, Rita M
Scientific journals are ethically bound to cite Professor Dr. Carl Clauberg's Nazi medical crimes against humanity whenever the eponym Clauberg is used. Modern articles still publish the eponym citing only the rabbit bioassy used in developing progesterone agonists or antagonists for birth control. Clauberg's Nazi career is traced to his having subjected thousands of Jewish women at the Ravensbruck and Auschwitz-Birkenau death camps to cruel, murderous sterilization experiments that are enthusiastically described by incriminating letters (reproduced here) between him and the notorious Nazi Reichsführer-SS Heinrich Himmler. The experiments were carried out in women's block 10 in Auschwitz-Birkenau where Clauberg's colleague Dr. Josef Mengele worked alongside. After Germany lost World War II in 1945 Mengele fled to South America, where he lived to an old age. Clauberg was caught by Russian soldiers, put on trial in the Soviet Union for his crimes against humanity, and imprisoned in 1948. In 1955 he was repatriated to Germany, once again imprisoned for his crimes, and belatedly expelled from the German Medical Association. To estimate the contemporary usage of the names Mengele and Clauberg, Internet hits were recorded for Clauberg C or Mengele J (with and without adding the term Auschwitz) with the Google and Scirus search engines. The ratios of hits for combinations of these terms reveal that relative to Mengele, Clauberg's name is barely known. We propose that journals and books printing the eponym Clauberg cite its derivation and reference to the convicted Nazi criminal. The present article can serve for such citations. PMID:23393707
Fruit and Food Eponyms in Dermatology
Jindal, Nidhi; Jindal, Pooja; Kumar, Jeevan; Gupta, Sanjeev; Jain, VK
Dermatology world is brimming with myriad of interesting clinical conditions, signs and syndromes. It is infinite, which has systemic clinical connotations too. Complicated pronunciations of diagnosis have always placed residents in an intricate state. Each one is trying his best to make this cumbersome subject comparatively more acceptable and convenient. The present paper is an attempt to further simplify the subject by correlating difficult conditions with commonly used and seen things such as fruit and food. A total of 45 dermatological conditions were found to be based on fruit and food eponyms. For example, strawberries can remind us of strawberry gums of Wegener's granulomatosis and strawberry nevus. PMID:25814737
Fascial eponyms may help elucidate terminological and nomenclatural development.
Adstrum, Sue
It has been reported that at least 700 anatomical eponyms were in existence at the end of the 19th century, yet the number of eponyms expressly relating to fasciae is unknown, and these anatomical expressions have yet to be described as a group. This study accordingly aimed to assemble a comprehensive-as-possible list of these terms, to investigate their customary usage, and to consider whether their existence might usefully shed light on contemporary fascia-relating terminological development. A search for fascia-relating eponyms incorporated within a range of English language anatomical and medical publications during the past 400 years resulted in the discovery of 44 eponyms that explicitly refer to aspects of fascia. This article outlines and discusses the origin, meaning, and use of these terms, and concludes that an understanding of the history of fascial eponyms may be of value when addressing contemporary concerns with the language used to describe fascia. PMID:26118525
Anatomic Eponyms in Neuroradiology: Brain, Cerebral Vasculature, and Calvarium.
Bunch, Paul M; Zamani, Amir A
Medical eponyms are ubiquitous, numerous, and at times controversial. They are often useful for succinctly conveying complex concepts, and familiarity with eponyms is important for proper usage and appropriate communication. In this historical review, we identify 18 anatomic eponyms used to describe structures of the brain, cerebral vasculature, and calvarium. For each structure, we first offer a biographical sketch of the individual for whom the structure is named. This is followed by a description of the anatomic structure and a brief discussion of its clinical relevance. PMID:26916250
Anatomical eponyms, part 1: to look on the bright side.
Olry, Regis
The use of eponyms in medical sciences generally, and in anatomy specifically, remains controversial. In principle, this discussion should have been concluded as far back as 1895 (publication of the first Nomina anatomica): all eponyms should have been removed from the anatomical vocabulary then. In practice, what was believed to be a mere formality proved much more difficult to apply. Most eponyms remain in current use; moreover, their number goes on increasing. Assuming that there's no smoke without fire, we wondered why it seems impossible to get rid of a specific kind of term. The aim of this article and its successor is to weigh up the pros and cons. PMID:24953603
[Eponym 'Reiter' should better no longer be used].
Zegers, Richard H C
From 1977 onwards international appeals have been made to use the descriptive term 'reactive arthritis' instead of the eponym 'Reiter' in medical literature. However, contrary to English publications the Dutch medical literature is not showing any obvious decline in the use of this eponym. As well as the fact that Reiter was not the first to describe the triad of arthritis, urethritis and conjunctivitis, he also was responsible for lethal medical experiments conducted in concentration camps during World War II. Since these two facts do not warrant eponymous regard for Reiter, the author proposes that this eponym no longer should be used in Dutch medical vocabulary and that the descriptive term should be used instead. PMID:25351382
Does Rene Leriche merit eponymous distinction?
Halioua, Bruno
René Leriche accepted the position of President of the Conseil Supérieur de l'Ordre National des médecins, representative institution for the French medical community created by the Vichy government on October 7th 1940. As president of the Conseil Supérieur de l'Ordre National des Médecins until the 28th December 1942, he was responsible for all of the institution's actions of exclusion, repression, spoliation and denunciation of Jewish physicians in France. The question which is now being posed is whether the name Leriche should be dissociated from the two syndromes first described by René Leriche: Leriche's syndrome caused by thrombotic obliteration above or at the bifurcation of the aorta and Sudek-Leriche syndrome due to aseptic necrosis of bone following injury. Actually the René Leriche Prize of the International Society of Surgery is named after him. As Leriche violated principles of confraternity which constitutes a major lack of medical ethical precepts, the question concerning the use of the eponym Leriche's syndrome should be discussed within the scientific community. PMID:17765342
The Clara cell: a "Third Reich eponym"?
Winkelmann, A; Noack, T
German anatomist Max Clara (1899-1966) described the "Clara cell" of the bronchiolar epithelium in 1937. The present article investigates Clara's relationship with National Socialism, as well as his use of tissue from executed prisoners for research purposes, details about both of which are largely unknown to date. Our methodology for the present study focussed on analysis of material from historical archives and the publications of Clara and his co-workers. Clara was appointed as Chair of Anatomy at Leipzig University (Leipzig, Germany) in 1935. He owed his career, at least in part, to Nazi support. He was an active member of the Nazi party (Nationalsozialistische Deutsche Arbeiterpartei (NSDAP)) and engaged in university politics; this included making anti-Semitic statements about other academics in appointment procedures. Nevertheless, he also supported prosecuted colleagues. Much of Clara's histological research in Leipzig, including his original description of the bronchial epithelium, was based on tissue taken from prisoners executed in nearby Dresden (Germany). Max Clara was an active and outspoken Nazi and his histological research exploited the rising number of executions during the Nazi period. Clara's discovery is thus linked to the Nazi system. The facts given in the present paper invite discussion about the eponym's neglected history and its continued and problematic use in medical terminology. PMID:20223917
Orthopaedic Injuries in Equestrian Sports
Young, Jason David; Gelbs, Jared Craig; Zhu, David Shiyu; Gallacher, Stacey Elisa; Sutton, Karen Michelle; Blaine, Theodore Alton
Background: Despite the common nature of orthopaedic injuries in equestrian sports, there is no published review to specifically characterize orthopaedic injuries in equestrian athletes. Purpose: To characterize orthopaedic injury patterns in equine sports–related injuries and their treatment. Study Design: Systematic review; Level of evidence, 4. Methods: This review was performed through a PubMed, EMBASE, and Scopus query (from 1978 to June 2014) in the English literature using search terms "(equine-related OR equestrian-related OR horse-related OR equestrian OR equestrians) AND (injury OR injuries)." Only full-text studies reporting on orthopaedic injury patterns pertinent to equestrian sports in the United States (US) and the United Kingdom (UK) were included. Orthopaedic injuries were defined as those resulting in a fracture or dislocation. In all, 182 studies were excluded, leaving a total of 27 studies for evaluation. The studies included were analyzed for demographic and epidemiological data for orthopaedic injuries, including fractures and dislocations. Cranial and facial injuries were excluded from analysis. Results: The majority of those injured in the US were female (64.5%). The leading cause of injury in the US was falling from a horse. The use of protective equipment seemed to vary widely, with helmet use ranging from less than 6% up to 66.7%. In the UK, fractures were found to account for 17.4% of reported injures, compared with 33.6% of injuries in the US. The majority of fractures in US riders occurred in the upper extremities (50.7%). Conclusion: This review helps characterize the epidemiology of equestrian injuries based on currently available data. PMID:26535400
[Eponyms and epilepsy (history of Eastern civilizations)].
Janković, S M; Sokić, D V; Lević, Z M; Susić, V; Drulović, J; Stojsavljević, N; Veskov, R; Ivanus, J
The history of eponyms for epilepsy in the lands of the Eastern globe present the portrait of the attitudes of both the laymen and skilled people towards the disease and patient, as well as to the Nature itself. As opposed to the West which during the Middle ages changed its concepts of epilepsy as the organic brain disease for the sublime 'alchemic' position, the people of the East were more prone to consider from the beginning of their civilization till the XIX century that epilepsy is the consequence of the evanescent spiritual and extracorporal forces which by themselves were out of their reach. As compared to the western civilization, the historical resources are, often as a consequence of a linguistic barriers, more scarce-as consequently is the number of eponyms, but are nevertheless picturesque. The medical science from Babylonian period presumed that epileptic manifestations are the consequence of the demonic or ill spiritual actions. There existed an attitude that at the beginning of an epileptic attack the patient was possessed by a demon (the Akkadic, i.e., Babylonian verb "sibtu" denoting epilepsy, had the meaning "to seize" or "to be obsessed"); at the end of the clonic phase the demon departed from the body. Different demons were responsible for different forms of epilepsy such as nocturnal and children epilepsy, absence epilepsy and pure convulsions, simple and complex automatisms, and gelastic epilepsy. Thus, the doctors from the period of Babylon aside from making primordial classification of epilepsies, knew about their clinical picture (prodromal symptoms and aura, Jackson's epilepsy. Todd's paralysis), postictal phenomena and intericatl emotional instability; provocative factors were also known (sleep deprivation, emotions, as well as alcohol, albeit in a negative sense-as a cure for epilepsy). There is no doubt than in the period of Babylon the clinical picture of serial fits and its progress to status epilepticus were clearly recognized and
Kallmann Syndrome: Eugenics and the Man behind the Eponym.
Benbassat, Carlos A
Kallmann syndrome is named after Franz Joseph Kallmann, a German-born psychiatrist who described in 1944 twelve subjects from three families who presented with a syndrome of missed puberty, anosmia, and color blindness. Yet, several other eponyms for the same syndrome can be found in the literature. Despite the fact that Kallmann syndrome is the most recognized eponym, very little is known about the man for whom the syndrome is named. A biographical note on Franz Joseph Kallmann and his historical context is presented. PMID:27101217
Kallmann Syndrome: Eugenics and the Man behind the Eponym
Benbassat, Carlos A.
Kallmann syndrome is named after Franz Joseph Kallmann, a German-born psychiatrist who described in 1944 twelve subjects from three families who presented with a syndrome of missed puberty, anosmia, and color blindness. Yet, several other eponyms for the same syndrome can be found in the literature. Despite the fact that Kallmann syndrome is the most recognized eponym, very little is known about the man for whom the syndrome is named. A biographical note on Franz Joseph Kallmann and his historical context is presented. PMID:27101217
Anatomical eponyms, Part 2: The other side of the coin.
Olry, Regis
Over a century after they were removed, at least officially, from anatomical terminology, eponyms remain an obviously controversial topic. In the first part of this paper we acted as their defense counsel, aiming to demonstrate that the 1895 first edition of the Nomina Anatomica and subsequently the Federative Committee on Anatomical Terminology (FCAT) probably put the cart before the horse. However, their authors advanced arguments supporting their decision, and it is now time to develop these arguments. Let us now become the public prosecutor of eponyms. PMID:25067796
Thirty neurological eponyms associated with the nazi era.
Kondziella, Daniel
In the 1920s, the neurosciences in Germany were world-class. Then came Hitler's regime, and with it 2 distinct changes happened to the research milieus in Berlin and elsewhere. First, the persecution of Jews and others deprived Germany of many of its most outstanding scientists. Second, numerous German and Austrian physicians became active in National Socialist (NS)-euthanasia programs. In recent years, the medical community has become more aware of the ethical burden associated with eponyms derived from scientists of the Third Reich. Yet a list of these eponyms with emphasis on clinical neurology is still missing. This paper therefore reviews 30 neurological eponyms derived from 29 physicians who lived in the Nazi era. Among them are victims who were forced out of the country or murdered in concentration camps, protestors who risked their academic careers and often their lives, beneficiaries who published on brains from 'euthanized' children, and collaborators who were directly involved in the planning and execution of NS-euthanasia programs. PMID:19407456
NASA Astrophysics Data System (ADS)
Tan, S. L. E.
Stereoscopy was used in medicine as long ago as 1898, but has not gained widespread acceptance except for a peak in the 1930's. It retains a use in orthopaedics in the form of Radiostereogrammetrical Analysis (RSA), though this is now done by computer software without using stereopsis. Combining computer assisted stereoscopic displays with both conventional plain films and reconstructed volumetric axial data, we are reassessing the use of stereoscopy in orthopaedics. Applications include use in developing nations or rural settings, erect patients where axial imaging cannot be used, and complex deformity and trauma reconstruction. Extension into orthopaedic endoscopic systems and teaching aids (e.g. operative videos) are further possibilities. The benefits of stereoscopic vision in increased perceived resolution and depth perception can help orthopaedic surgeons achieve more accurate diagnosis and better pre-operative planning. Limitations to currently available stereoscopic displays which need to be addressed prior to widespread acceptance are: availability of hardware and software, loss of resolution, use of glasses, and image "ghosting". Journal publication, the traditional mode of information dissemination in orthopaedics, is also viewed as a hindrance to the acceptance of stereoscopy - it does not deliver the full impact of stereoscopy and "hands-on" demonstrations are needed.
What's in a Name? Neurological Eponyms of the Nazi Era.
Kondziella, Daniel; Zeidman, Lawrence A
The 1920s were a booming decade for neuroscience, and perhaps nowhere was this truer than in Germany. Following the rise of Hitler's regime and the persecution of Jews and others, however, Germany and Austria lost numerous world-class neuroscientists. Vacant posts were quickly filled with 'Aryan' and academic staff loyal to the Nazis. Indeed, many physicians and scientists went even further and became engaged in National Socialist (NS)-euthanasia programs. In recent years, the medical community has become more aware of the ethical burden associated with eponyms derived from scientists of the Third Reich. This book chapter reviews 53 neurological eponyms derived from physicians who worked in the Nazi era. Among them are victims who were forced out of the country or murdered in concentration camps, protestors who risked their academic careers and often their lives, beneficiaries who published on brains from 'euthanized' children, and collaborators who were directly involved in the planning and execution of NS-euthanasia programs. PMID:27035717
Retractions in orthopaedic research
Yan, J.; MacDonald, A.; Baisi, L-P.; Evaniew, N.; Bhandari, M.
Objectives Despite the fact that research fraud and misconduct are under scrutiny in the field of orthopaedic research, little systematic work has been done to uncover and characterise the underlying reasons for academic retractions in this field. The purpose of this study was to determine the rate of retractions and identify the reasons for retracted publications in the orthopaedic literature. Methods Two reviewers independently searched MEDLINE, EMBASE, and the Cochrane Library (1995 to current) using MeSH keyword headings and the 'retracted' filter. We also searched an independent website that reports and archives retracted scientific publications (www.retractionwatch.com). Two reviewers independently extracted data including reason for retraction, study type, journal impact factor, and country of origin. Results One hundred and ten retracted studies were included for data extraction. The retracted studies were published in journals with impact factors ranging from 0.000 (discontinued journals) to 13.262. In the 20-year search window, only 25 papers were retracted in the first ten years, with the remaining 85 papers retracted in the most recent decade. The most common reasons for retraction were fraudulent data (29), plagiarism (25) and duplicate publication (20). Retracted articles have been cited up to 165 times (median 6; interquartile range 2 to 19). Conclusion The rate of retractions in the orthopaedic literature is increasing, with the majority of retractions attributed to academic misconduct and fraud. Orthopaedic retractions originate from numerous journals and countries, indicating that misconduct issues are widespread. The results of this study highlight the need to address academic integrity when training the next generation of orthopaedic investigators. Cite this article: J. Yan, A. MacDonald, L-P. Baisi, N. Evaniew, M. Bhandari, M. Ghert. Retractions in orthopaedic research: A systematic review. Bone Joint Res 2016;5:263–268. DOI: 10
[Epilepsy, eponyms and patron saints (history of Western civilization)].
Janković, S M; Sokić, D V; Lević, Z M; Susić, V; Stojsavljević, N; Drulović, J
From a historic point of view, epilepsy and its eponyms were in an ontogenetic symbiosis throughout their history. Epilepsy is a disease with a history of eponyms presenting the frame of mind of both streetwise as well as skilled "authors" about its origin and nature. From ancient times the names for epilepsy, archetypal Hippocratic disease, just as rich in number as varied in their implication, reflected the local folkways of thinking. In this article we briefly presented more than 50 eponyms and patrons of epilepsy. As the source of information we used both the apocryphal, canonical and hagiographic as well as heretic literature, legends and iconography from the Middle Ages of domestic and foreign origin. Pre- and post-Hippocratic era, apart from stemming from the oldest written medical sources, point to the position that the disease had organic origin located in the brain. The period of Rome adopted the attitudes set by Galen which remained en vogue throughout the emerging Middle Ages and Renaissance. These eras generated new eponyms which reflected a downfall in the manor, stating that the disease is the consequence of supernatural forces. In the "Age of darkness" eponyms for epilepsy reflected more the relation of men to the Nature than to the disease or a sick man; this is evidenced through the generation of number of patrons for the disease. The most famous patron of patients with epilepsy was St. Valentine (after conversion from pagandom he died in Rome as a martyr, c. 270). He was allotted a patronage either due to the phonic resemblance of his name with the (past participle of the) verb "fallen"-as Martin Luther claimed, or due to a cure of epilepsy of the son of a Roman rhetor who built for him a chapel in which he continued to cure the sick. The emergence of a flamboyant personality of Paracelsus on the historic scene of the XVI century represents a less successful attempt to revoke the way of thinking set by the old Greek doctors; however, it brought
Health economics and orthopaedics.
Maniadakis, N; Gray, A
It is becoming widely accepted that research which considers only the outcome and not the costs associated with new technologies in health care, is of limited value in making decisions about the use of scarce resources. Economic evaluation is becoming a standard feature of clinical research but many published economic evaluations fall short of best practice in their methodology. We have described the essential features of economic evaluation, using published studies in orthopaedics, in order to try to improve the ability of orthopaedic surgeons to read, understand and appraise such studies critically, and to encourage them to consider including economic evaluation in future investigations. PMID:10697306
NASA Technical Reports Server (NTRS)
Although the need for orthopaedic shoes is increasing, the number of skilled shoemakers has declined. This has led to the development of a CAD/CAM system to design and fabricate, orthopaedic footwear. The NASA-developed RIM database management system is the central repository for CUSTOMLAST's information storage. Several other modules also comprise the system. The project was initiated by Langley Research Center and Research Triangle Institute in cooperation with the Veterans Administration and the National Institute for Disability and Rehabilitation Research. Later development was done by North Carolina State University and the University of Missouri-Columbia. The software is licensed by both universities.
What's in a name? Problems, facts and controversies regarding neurological eponyms.
Teive, Hélio A G; Lima, Plínio M G; Germiniani, Francisco M B; Munhoz, Renato P
The use of eponyms in neurology remains controversial, and important questions have been raised about their appropriateness. Different approaches have been taken, with some eponyms being excluded, others replaced, and new ones being created. An example is Hallervorden-Spatz syndrome, which has been replaced by neurodegeneration with brain iron accuulatium (NBIA). Amiothoplic lateral sclerosys (ALS), for which the eponym is Charcot's disease, has been replaced in the USA by Lou Gehrig's disease. Guillain-Barré syndrome (GBS) is an eponym that is still the subject of controversy, and various different names are associated with it. Finally,restless legs syndrome (RLS), which was for years known as Ekbom's syndrome, has been rechristened as RLS/Willis-Ekbom syndrome. PMID:27191240
Successfully reforming orthopaedic outpatients.
Schoch, Peter A; Adair, Lisa
Since 2005, Barwon Health has successfully reformed its orthopaedic outpatient service to address the following issues: increasing number of referrals, inefficient referral management and triage, long waiting times for non-urgent appointments, high 'Did Not Attend' (DNA) rates and poor utilisation of conservative therapies before referral to surgeon. Numerous strategies have been implemented including: waiting list audits, triage guidelines, physiotherapy-led clinics, a DNA policy, an orthopaedic lead nurse role and a patient-focussed booking system. There has been a 66% reduction in the number of patients waiting for their first appointment; an 87% reduction in the waiting time from referral to first appointment; a 10% reduction in new patient DNAs; and more efficient referral management and communication processes. Patients are now seen in clinically appropriate time frames and offered earlier access to a wider range of conservative treatments. PMID:22624648
Kurup, H V; Clark, C I M; Dega, R K
Footwear is the oldest known fashion accessory in use. Footwear is often implicated in orthopaedic problems affecting lower limbs and back. Hence footwear modifications have a major role in management of these pathologies as well. This review explores footwear and its role in causation and management of orthopaedic problems. Based on our observations we recommend that children with flexible flatfeet should be encouraged to walk barefoot to help in developing their arches. Women with risk factors for secondary arthritis of knee or back pain may be advised to avoid heels. Commercial shoes which decrease hind foot loading may be used in symptomatic management of hindfoot and mid foot problems. Similarly shoes which decrease forefoot loading may be useful in managing forefoot pathology. Flip-flops should be avoided by diabetics as they do not protect from injuries. PMID:22443991
Navarro, M; Michiardi, A; Castaño, O; Planell, J.A
At present, strong requirements in orthopaedics are still to be met, both in bone and joint substitution and in the repair and regeneration of bone defects. In this framework, tremendous advances in the biomaterials field have been made in the last 50 years where materials intended for biomedical purposes have evolved through three different generations, namely first generation (bioinert materials), second generation (bioactive and biodegradable materials) and third generation (materials designed to stimulate specific responses at the molecular level). In this review, the evolution of different metals, ceramics and polymers most commonly used in orthopaedic applications is discussed, as well as the different approaches used to fulfil the challenges faced by this medical field. PMID:18667387
Houlden, Henry; Charlton, Paul; Singh, Dishan
Neurology encompasses all aspects of medicine and surgery, but is closer to orthopaedic surgery than many other specialities. Both neurological deficits and bone disorders lead to locomotor system abnormalities, joint complications and limb problems. The main neurological conditions that require the attention of an orthopaedic surgeon are disorders that affect the lower motor neurones. The most common disorders in this group include neuromuscular disorders and traumatic peripheral nerve lesions. Upper motor neurone disorders such as cerebral palsy and stroke are also frequently seen and discussed, as are chronic conditions such as poliomyelitis. The management of these neurological problems is often coordinated in the neurology clinic, and this group, probably more than any other, requires a multidisciplinary team approach. PMID:17308288
Orthopaedic Management of Spasticity.
Pidgeon, Tyler S; Ramirez, Jose M; Schiller, Jonathan R
Spasticity is a common manifestation of many neurological conditions including multiple sclerosis, stroke, cerebral palsy, traumatic brain injury, and spinal cord injuries. Management of spasticity seeks to reduce its burden on patients and to limit secondary complications. Non-operative interventions including stretching/splinting, postural management, physical therapy/strengthening, anti-spasticity medications, and botulinum toxin injections may help patients with spasticity. Surgical management of these conditions, however, is often necessary to improve quality of life and prevent complications. Orthopaedic surgeons manage numerous sequelae of spasticity, including joint contractures, hip dislocations, scoliosis, and deformed extremities. When combined with the efforts of rehabilitation specialists, neurologists, and physical/occupational therapists, the orthopaedic management of spasticity can help patients maintain and regain function and independence as well as reduce the risk of long-tem complications. PMID:26623452
Delaunay, C
The first nationwide orthopaedic registry was created in Sweden in 1975 to collect data on total knee arthroplasty (TKA). Since then, several countries have established registries, with varying degrees of success. Managing a registry requires time and money. Factors that contribute to successful registry management include the use of a single identifier for each patient to ensure full traceability of all procedures related to a given implant; a long-term funding source; a contemporary, rapid, Internet-based data collection method; and the collection of exhaustive data, at least for innovative implants. The effects of registries on practice patterns should be evaluated. The high cost of registries raises issues of independence and content ownership. Scandinavian countries have been maintaining orthopaedic registries for nearly four decades (since 1975). The first English-language orthopaedic registry was not created until 1998 (in New Zealand), and both the US and many European countries are still struggling to establish orthopaedic registries. To date, there are 11 registered nationwide registries on total knee and total hip replacement. The data they contain are often consistent, although contradictions occur in some cases due to major variations in cultural and market factors. The future of registries will depend on the willingness of health authorities and healthcare professionals to support the creation and maintenance of these tools. Surgeons feel that registries should serve merely to compare implants. Health authorities, in contrast, have a strong interest in practice patterns and healthcare institution performances. Striking a balance between these objectives should allow advances in registry development in the near future. PMID:25553603
Declining use of the eponym "Reiter's syndrome" in the medical literature, 1998-2003.
Lu, Dave W; Katz, Kenneth A
The German physician Hans Reiter (1881-1969) is associated eponymously with the syndrome of arthritis, urethritis, and conjunctivitis occurring during or after episodes of diarrhea or urethritis. During World War II, Reiter, a physician leader of the Nazi party, authorized medical experiments on concentration camp prisoners. Because of this, some physicians have argued against further use of the Reiter eponym. We investigated trends in use of the Reiter eponym from 1998 to 2003. We searched MEDLINE to identify English-language articles published between 1998 and 2003. Articles were classified by whether the eponym was used without qualification (ie, without mentioning its disfavored use) or not. Five hundred thirty-nine articles were identified. Use of the eponym without qualification was less common in articles published later (34.0% in 2003 vs 57.0% in 1998; adjusted relative risk [RR], 0.49, 95% confidence interval [CI], 0.27-0.71; P = .001) and in articles published in higher impact journals (36.8% vs 56.8% in journals without calculated impact factors; adjusted RR, 0.51; 95% CI, 0.29-0.73; P = .002). Use without qualification was more common in articles written by US-based authors (60.6% vs 31.1% for European-based authors; adjusted RR, 2.28; 95% CI, 1.58-2.97; P < .001). We concluded that use of the Reiter eponym without qualification decreased from 1998 to 2003. PMID:16198806
Corruption in the health care sector: A barrier to access of orthopaedic care and medical devices in Uganda
Background Globally, injuries cause approximately as many deaths per year as HIV/AIDS, tuberculosis and malaria combined, and 90% of injury deaths occur in low- and middle- income countries. Given not all injuries kill, the disability burden, particularly from orthopaedic injuries, is much higher but is poorly measured at present. The orthopaedic services and orthopaedic medical devices needed to manage the injury burden are frequently unavailable in these countries. Corruption is known to be a major barrier to access of health care, but its effects on access to orthopaedic services is still unknown. Methods A qualitative case study of 45 open-ended interviews was conducted to investigate the access to orthopaedic health services and orthopaedic medical devices in Uganda. Participants included orthopaedic surgeons, related healthcare professionals, industry and government representatives, and patients. Participants' experiences in accessing orthopaedic medical devices were explored. Thematic analysis was used to analyze and code the transcripts. Results Analysis of the interview data identified poor leadership in government and corruption as major barriers to access of orthopaedic care and orthopaedic medical devices. Corruption was perceived to occur at the worker, hospital and government levels in the forms of misappropriation of funds, theft of equipment, resale of drugs and medical devices, fraud and absenteeism. Other barriers elicited included insufficient health infrastructure and human resources, and high costs of orthopaedic equipment and poverty. Conclusions This study identified perceived corruption as a significant barrier to access of orthopaedic care and orthopaedic medical devices in Uganda. As the burden of injury continues to grow, the need to combat corruption and ensure access to orthopaedic services is imperative. Anti-corruption strategies such as transparency and accountability measures, codes of conduct, whistleblower protection, and higher
Advances in Regenerative Orthopaedics
Evans, Christopher H.
Orthopaedic injuries are very common and a source of much misery and economic stress. Several relevant tissues, such as cartilage, meniscus and intra-articular ligaments, do not heal. And even bone, which normally regenerates spontaneously, can fail to mend. The regeneration of orthopaedic tissues requires four key components: cells, morphogenetic signals, scaffolds and an appropriate mechanical environment. Although differentiated cells from the tissue in question can be used, most cellular research focuses on the use mesenchymal stem cells (MSCs). These can be retrieved from many different tissues, and one unresolved question is the degree to which the origin of the cells matters. Embryonic and induced, pluripotential stem cells are also under investigation. Morphogenetic signals are most frequently supplied by individual, recombinant growth factors or native mixtures provided by, for instance, platelet-rich plasma; MSCs are also a rich source of trophic factors. Obstacles to the sustained delivery of individual growth factors can be addressed by gene transfer or smart scaffolds, but we still lack detailed, necessary information on which delivery profiles are needed. Scaffolds may be based upon natural products, synthetic materials, or devitalized extracellular matrix. Strategies to combine these components to regenerate tissue can follow traditional tissue engineering practices, but these are costly, cumbersome and not well suited to treating large numbers of individuals. More expeditious approaches make full use of intrinsic biological processes in vivo to avoid the need for ex vivo expansion of autologous cells and multiple procedures. Clinical translation remains a bottleneck. PMID:24182709
Eponym of Naso-Jugal Fold and Tear Trough.
Hwang, Kun
The aim of this study is to find out the eponym of the naso-jugal fold and tear trough and to make a suggestion to standardize the terminology.In a PubMed search, the search terms (naso-jugal) and (fold OR groove); (tear trough) and (anatomy) were used, which resulted in 48 and 37 titles, respectively. Eliminating duplicated titles, 80 abstracts were reviewed. Among them, 18 full papers were reviewed. Two papers were excluded and 3 mined papers were added. Finally, 19 papers were reviewed.In a paper published by an ophthalmologist Dr David Miller, "tear trough" was first used for designating the circular trough carved into a scleral contact in 1969. In the remaining 18 papers including 1 conference presentation, 6 terms were used for the same structure; naso-jugal fold (4), naso-jugal groove (4), naso-jugal ditch (1), tear trough (5), tear trough deformity (6), and tear trough depression (1). Whitnall first used "naso-jugal" and 10 other papers stated "naso-jugal." Eight papers cited Whitnall (2), Duke-Elder (2), and Loeb (4) in the origin of the term "naso-jugal." Flowers adapted "tear trough" for the cheek groove and 12 other papers wrote "tear trough." Eleven papers cited Flowers (9), Le Louarn (1), Mendelson (1) when referring to the origin of the term "tear trough."The name of the structure should contain "naso-jugal" rather than "tear trough" because "naso-jugal" was coined earlier and expresses the location of the structure. The recommended term should be "the deepened naso-jugal groove" since it deepens with age. PMID:27315310
Devanathan, D.; Levine, D.
With the increasing demand for superior performance placed on present day orthopaedic devices, there exists a constant demand to look for better materials for construction. Because of their good corrosion resistance, early devices were made from 304 or 316 stainless steels. However, the patient population has broadened to include younger individuals. These patients lead active lives and tend to stress the fracture fixation devices. Another requirement for younger patients is a longer implantable service: up to 20 years. With these requirements in mind, high-performance aerospace metal alloys based on cobalt chromium and titanium are used extensively. This paper discusses the requirements and the deficiencies of new materials; biocompatibility, biofunctionality, and manufacturing costs.
NASA Astrophysics Data System (ADS)
Szumski, Michał
This chapter describes the most important features of capillary electrophoretic equipment. A presentation of the important developments in high voltage power supplies for chip CE is followed by preparation of fused silica capillaries for use in CE. Detection systems that are used in capillary electrophoresis are widely described. Here, UV-Vis absorbance measurements are discussed including different types of detection cells—also those less popular (u-shaped, Z-shaped, mirror-coated). Fluorescence detection and laser-induced fluorescence detection are the most sensitive detection systems. Several LIF setups, such as collinear, orthogonal, confocal, and sheath-flow cuvette, are presented from the point of view of the sensitivity they can provide. Several electrochemical detectors for CE, such as conductivity, amperometric, and potentiometric, are also shown and their constructions discussed. CE-MS and much less known CE (CEC)-NMR systems are also described. The examples of automation and robotized CE systems together with their potential fields of application are also presented.
Providing Orthopaedic Care for the Incarcerated: Obstacles and Challenges.
Sraj, Shafic A
Scant information on healthcare delivery to inmates is available in the medical literature. Healthcare provision to inmates has different rules than that for the general population and presents particular challenges for orthopaedic surgeons because of the nature of this population and restrictions imposed by their confinement. This population is typically of a lower socioeconomic status and is less well educated, has accumulated injuries over a lifetime, and has a considerable prevalence of communicable and blood-borne diseases, along with a high prevalence of smoking and high-risk behavior, such as drug-seeking, abuse, and self-inflicted injury. These variables add levels of complexity of care, including the determination of medical necessity for orthopaedic referral, the logistics of transportation and follow-up, access to durable medical equipment and ancillary services, and the choices the orthopaedic provider must make to optimize care within these limitations. PMID:27479830
Computer applications in orthopaedics.
Pho, R W; Lim, S Y; Pereira, B P
With the rapid developments in microprocessors, the widespread availability of computers has brought about broad applications in the field of orthopaedics. The present technology enables large quantities of data to be logically processed in a very short span of time. This has led to the development of information management database systems where relevant medical information may be retrieved very quickly and effectively. The analytical power of the computer has also been utilised in expert systems to assist in clinical-decision making process. Computer graphics have revolutionised the visualisation of physical features of internal and external body parts, providing new and improved modalities of diagnosis. In some centres, surgical planning and rehearsals are already being carried out at the computer terminal with the use of animation and computer graphics. Computer technology has also played an active role in the field of prosthetics and rehabilitation. Intelligent robotic systems and microprocessor with functional neuromuscular stimulation have been applied to benefit, and in some cases restore some motor functions to the physically disabled. With more collaboration between engineers, scientists and the medical community, several prototypes of computer-controlled prostheses and prosthesis designed and manufactured by Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) technology are available today to assist the amputees in their daily living and ambulatory activities. PMID:2260826
Reno Orthopaedic Trauma Fellowship business curriculum.
Althausen, Peter L; Bray, Timothy J; Hill, Austin D
The Reno Orthopaedic Center (ROC) Trauma Fellowship business curriculum is designed to provide the fellow with a graduate level business practicum and research experience. The time commitments in a typical 12-month trauma fellowship are significant, rendering a traditional didactic master's in business administration difficult to complete during this short time. An organized, structured, practical business education can provide the trauma leaders of tomorrow with the knowledge and experience required to effectively navigate the convoluted and constantly changing healthcare system. The underlying principle throughout the curriculum is to provide the fellow with the practical knowledge to participate in cost-efficient improvements in healthcare delivery. Through the ROC Trauma Fellowship business curriculum, the fellow will learn that delivering healthcare in a manner that provides better outcomes for equal or lower costs is not only possible but a professional and ethical responsibility. However, instilling these values without providing actionable knowledge and programs would be insufficient and ineffective. For this reason, the core of the curriculum is based on individual teaching sessions with a wide array of hospital and private practice administrators. In addition, each section is equipped with a suggested reading list to maximize the learning experience. Upon completion of the curriculum, the fellow should be able to: (1) Participate in strategic planning at both the hospital and practice level based on analysis of financial and clinical data, (2) Understand the function of healthcare systems at both a macro and micro level, (3) Possess the knowledge and skills to be strong leaders and effective communicators in the business lexicon of healthcare, (4) Be a partner and innovator in the improvement of the delivery of orthopaedic services, (5) Combine scientific and strategic viewpoints to provide an evidence-based strategy for improving quality of care in a
Find an Orthopaedic Foot and Ankle MD/DO
... AOFAS / FootCareMD / Find a Surgeon Find an Orthopaedic Foot & Ankle Surgeon Page Content The Orthopaedic Distinction Who are Orthopaedic Foot & Ankle Surgeons? Orthopaedic foot and ankle surgeons are ...
Sources of information influencing decision-making in orthopaedic surgery - an international online survey of 1147 orthopaedic surgeons
Background Manufacturers of implants and materials in the field of orthopaedics use significant amounts of funding to produce informational material to influence the decision-making process of orthopaedic surgeons with regards to choice between novel implants and techniques. It remains unclear how far orthopaedic surgeons are really influenced by the materials supplied by companies or whether other, evidence-based publications have a higher impact on their decision-making. The objective was to evaluate the subjective usefulness and usage of different sources of information upon which orthopaedic surgeons base their decisions when acquiring new implants or techniques. Methods We undertook an online survey of 1174 orthopaedic surgeons worldwide (of whom n = 305 were head of their department). The questionnaire included 34 items. Sequences were randomized to reduce possible bias. Questions were closed or semi-open with single or multiple answers. The usage and relevance of different sources of information when learning about and selecting orthopaedic treatments were evaluated. Orthopaedic surgeons and trainees were targeted, and were only allowed to respond once over a period of two weeks. Baseline information included country of workplace, level of experience and orthopaedic subspecialisation. The results were statistically evaluated. Results Independent scientific proof had the highest influence on decisions for treatment while OEM (Original Equipment Manufacturer) driven activities like newsletters, white papers or workshops had the least impact. Comparison of answers from the three best-represented countries in this study (Germany, UK and USA) showed some significant differences: Scientific literature and congresses are significantly more important in the US than in the UK or Germany, although they are very important in all countries. Conclusions Independent and peer-reviewed sources of information are preferred by surgeons when choosing between methods and
Robotic systems in orthopaedic surgery.
Lang, J E; Mannava, S; Floyd, A J; Goddard, M S; Smith, B P; Mofidi, A; Seyler, T M; Jinnah, R H
Robots have been used in surgery since the late 1980s. Orthopaedic surgery began to incorporate robotic technology in 1992, with the introduction of ROBODOC, for the planning and performance of total hip replacement. The use of robotic systems has subsequently increased, with promising short-term radiological outcomes when compared with traditional orthopaedic procedures. Robotic systems can be classified into two categories: autonomous and haptic (or surgeon-guided). Passive surgery systems, which represent a third type of technology, have also been adopted recently by orthopaedic surgeons. While autonomous systems have fallen out of favour, tactile systems with technological improvements have become widely used. Specifically, the use of tactile and passive robotic systems in unicompartmental knee replacement (UKR) has addressed some of the historical mechanisms of failure of non-robotic UKR. These systems assist with increasing the accuracy of the alignment of the components and produce more consistent ligament balance. Short-term improvements in clinical and radiological outcomes have increased the popularity of robot-assisted UKR. Robot-assisted orthopaedic surgery has the potential for improving surgical outcomes. We discuss the different types of robotic systems available for use in orthopaedics and consider the indication, contraindications and limitations of these technologies. PMID:21969424
Guryel, E; Acton, K; Patel, S
INTRODUCTION Clinical audit plays an important role in the drive to improve the quality of patient care and thus forms a cornerstone of clinical governance. Assurance that the quality of patient care has improved requires completion of the audit cycle. A considerable sum of money and time has been spent establishing audit activity in the UK. Failure to close the loop undermines the effectiveness of the audit process and wastes resources. PATIENTS AND METHODS We analysed the effectiveness of audit in trauma and orthopaedics at a local hospital by comparing audit projects completed over a 6-year period to criteria set out in the NHS National Audit and Governance report. RESULTS Of the 25 audits performed since 1999, half were presented to the relevant parties and only 20% completed the audit cycle. Only two of these were audits against national standards and 28% were not based on any standards at all. Only a third of the audits led by junior doctors resulted in implementation of their action plan compared to 75% implementation for consultant-led and 67% for nurse-led audits. CONCLUSIONS A remarkably large proportion of audits included in this analysis failed to meet accepted criteria for effective audit. Audits completed by junior doctors were found to be the least likely to complete the cycle. This may relate to the lack of continuity in modern medical training and little incentive to complete the cycle. Supervision by permanent medical staff, principally consultants, and involvement of the audit department may play the biggest role in improving implementation of change. PMID:18828963
American Orthopaedic Foot and Ankle Society
... education site of the American Orthopaedic Foot & Ankle Society. Patients Visit the official patient education site of the American Orthopaedic Foot & Ankle Society. Patients Visit the official patient education site of ...
Gas Gangrene in Orthopaedic Patients
Ying, Zhimin; Zhang, Min; Yan, Shigui; Zhu, Zhong
Clostridial myonecrosis is most often seen in settings of trauma, surgery, malignancy, and other underlying immunocompromised conditions. Since 1953 cases of gas gangrene have been reported in orthopaedic patients including open fractures, closed fractures, and orthopaedic surgeries. We present a case of 55-year-old obese woman who developed rapidly progressive gas gangrene in her right leg accompanied by tibial plateau fracture without skin lacerations. She was diagnosed with clostridial myonecrosis and above-the-knee amputation was carried out. This patient made full recovery within three weeks of the initial episode. We identified a total of 50 cases of gas gangrene in orthopaedic patients. Several factors, if available, were analyzed for each case: age, cause of injury, fracture location, pathogen, and outcome. Based on our case report and the literature review, emergency clinicians should be aware of this severe and potentially fatal infectious disease and should not delay treatment or prompt orthopedic surgery consultation. PMID:24288638
Radiation Safety in Pediatric Orthopaedics.
Caird, Michelle S
Patients, surgeons, and staff are exposed to ionizing radiation in pediatric orthopaedic surgery from diagnostic studies and imaging associated with procedures. Estimating radiation dose to pediatric patients is based on complex algorithms and dose to surgeons and staff is based on dosimeter monitoring. Surgeons can decrease radiation exposure to patients with careful and thoughtful ordering of diagnostic studies and by minimizing exposure intraoperatively. Surgeon and staff radiation exposure can be minimized with educational programs, proper shielding and positioning intraoperatively, and prudent use of intraoperative imaging. Overall, better awareness among pediatric orthopaedic surgeons of our role in radiation exposure can lead to improvements in radiation safety. PMID:26049299
Fundamentals of orthopaedics. Fourth edition
Gartland, J.J.
This book discusses topics on orthopaedic medicine. Treatments, radiographic findings, and potential complications are provided for the complete scope of musculoskeletal problems. It reviews the latest diagnostic techniques, including arthroscopy and CT scanning and also gives updates on the newest approaches to the management of skeletal infections, the latest on joint replacements, and offers a review of arthroscopic surgery.
Applications of nanotechnology in orthopaedics.
Tasker, L H; Sparey-Taylor, G J; Nokes, L D M
Nanotechnology is the application of science and engineering at the nanoscale. A diverse range of applications are beginning to emerge in all areas of medicine. We performed a survey from November 2005 to March 2006 using the Internet search engines PubMed, ScienceDirect, ISI Web of Knowledge, and Google Scholar. We report on the role of nanotechnology in orthopaedics, exploring current and potential applications. Nanostructured materials have been proposed as the next generation of orthopaedic implant properties by creating a surface environment more conducive for osteoblast function. Bone substitute materials, whose nanoscale composition emulates the hierarchic organization of natural bone, shows initiation of the desirable formation of an apatite layer. Nanotechnology also has been harnessed to improve the cutting performance and quality of surgical blades. Postoperative infection rates may be reduced by using nanofibrous membrane wound dressings containing antibacterial properties. The most notable application of nanotechnology in orthopaedics may be drug delivery, including nanotherapeutics for treating bone cancer and arthritis. Nanotechnology is being used in orthopaedics, and likely will play a valuable role in future developments. PMID:17224843
Planning for life after orthopaedics.
Barr, Joseph S; McCaslin, Michael J; Hinds, Cynthia K
The word retirement is going out of fashion. Many orthopaedic surgeons want to work in some capacity when they stop performing surgery. Making a smooth transition from a busy orthopaedic practice to alternative work demands advanced planning. The surgeon must consider personal issues that involve how to use human capital (his or her accumulated knowledge and experience). New ventures, hobbies, travel, and spending time with family and friends are some possibilities. Plans for slowing down or leaving the practice should be discussed and agreed on well ahead of time. Agreements for buyouts may be difficult to work out and will require creative thinking. The solo practitioner can close the practice or hire a successor. Financial planning is perhaps the most important consideration and should be started by approximately age 40. It is recommended that the surgeon develop a portfolio of secure investments and annuities to provide adequate income for as long as is needed and then to turn the residual income to one's family, favorite charities, or other desired cause. A team of competent advisors is needed to help develop and achieve one's goals, create financial security, and provide the discipline to carry out the needed planning for life after orthopaedics. PMID:24720335
The American Academy of Orthopaedic Surgeons/Society of Military Orthopaedic Surgeons/Orthopaedic Trauma Associations/Pediatric Orthopaedic Association Disaster Response and Preparedness Course.
Johnson, Anthony E; Gerlinger, Tad L; Born, Christopher T
A disaster is a catastrophic event that disrupts normal infrastructure to such a degree that normal response mechanisms and capabilities cannot manage what is required to respond appropriately to the event. Launched after the largest urban disaster in modern history--the 2010 Haiti Earthquake--the American Academy of Orthopaedic Surgeons/Society of Military Orthopaedic Surgeons/Orthopaedic Trauma Association/Pediatric Orthopaedic Association of North America (AAOS/SOMOS/OTA/POSNA) Disaster Response Course (DRC) is designed to prepare orthopaedic surgeons for service in disaster response and humanitarian assistance efforts in both the acute phases as well as in the recovery and reconstructions phases. To date, 395 orthopaedic surgeons have completed the DRC and 286 (72.4%) have opted to become registered disaster responders. PMID:26356210
American Orthopaedic Society for Sports Medicine
... Support AOSSM Research Publications Toggle American Journal of Sports Medicine Sports Health: A Multidisciplinary Approach Orthopaedic Journal of Sports Medicine Journal Apps Sports Medicine Update Other Professional Resources ...
The case for orthopaedic medicine in Israel
Background Musculoskeletal complaints are probably the most frequent reasons for visiting a doctor. They comprise more than a quarter of the complaints to primary practitioners and are also the most common reason for referral to secondary or tertiary medicine. The clinicians most frequently consulted on musculoskeletal problems, and probably perceived to know most on the topic are orthopaedic surgeons. But in Israel, there is significant ambivalence with various aspects of the consultations provided by orthopaedic surgeons, both among the public and among various groups of clinicians, particularly family practitioners and physiotherapists. Methods In order to understand this problem we integrate new data we have collected with previously published data. New data include the rates of visits to orthopaedic surgeons per annum in one of Israel's large non-profit HMO's, and the domains of the visits to an orthopaedic surgeon. Results Orthopaedic surgeons are the third most frequently contracted secondary specialists in one of the Israeli HMO's. Between 2009 and 2012 there was a 1.7% increase in visits to orthopaedists per annum (P < 0.0001, after correction for population growth). Almost 80% of the domains of the problems presented to an orthopaedic surgeon were in fields orthopaedic surgeons have limited formal training. Discussion While orthopaedic surgeons are clearly the authority on surgical problems of the musculoskeletal system, most musculoskeletal problems are not surgical, and the orthopaedic surgeon often lacks training in these areas which might be termed orthopaedic medicine. Furthermore, in Israel and in many other developed countries there is no accessible medical specialty that studies these problems, trains medical students in the subject and focuses on treating these problems. The neglect of this area which can be called the "Orthopaedic Medicine Lacuna" is responsible for inadequate treatment of non-surgical problems of the
Current use of medical eponyms – a need for global uniformity in scientific publications
Background Although eponyms are widely used in medicine, they arbitrarily alternate between the possessive and nonpossessive forms. As very little is known regarding extent and distribution of this variation, the present study was planned to assess current use of eponymous term taking "Down syndrome" and "Down's syndrome" as an example. Methods This study was carried out in two phases – first phase in 1998 and second phase in 2008. In the first phase, we manually searched the terms "Down syndrome" and "Down's syndrome" in the indexes of 70 medical books, and 46 medical journals. In second phase, we performed PubMed search with both the terms, followed by text-word search for the same. Results In the first phase, there was an overall tilt towards possessive form – 62(53.4%) "Down's syndrome" versus 54(46.6%) "Down syndrome." However, the American publications preferred the nonpossesive form when compared with their European counterpart (40/50 versus 14/66; P < 0.001). In the second phase, PubMed search showed, compared to "Down syndrome," term "Down's syndrome" yielded approximately 5% more articles. The text-word search of both forms between January 1970 and June 2008 showed a gradual shift from "Down's syndrome" to "Down syndrome," and over the last 20 years, the frequency of the former was approximately halved (33.7% versus 16.5%; P < 0.001). The abstracts having possessive form were mostly published from the European countries, while most American publications used nonpossesive form consistently. Conclusion Inconsistency in the use of medical eponyms remains a major problem in literature search. Because of linguistic simplicity and technical advantages, the nonpossessive form should be used uniformly worldwide. PMID:19272131
Heterotopic Ossification in Orthopaedic Trauma
Nauth, Aaron; Giles, Erica; Potter, Benjamin K.; Nesti, Leon J.; O'Brien, Frederick P.; Bosse, Michael J.; Anglen, Jeffrey O.; Mehta, Samir; Ahn, Jaimo; Miclau, Theodore; Schemitsch, Emil H.
Heterotopic ossification (HO) can be defined as the pathological formation of bone in extra-skeletal tissues. There has been a substantial amount of recent research on the pathophysiology, prophylaxis and treatment of HO and traumatic conditions associated with the development of HO. This research has advanced our understanding of this disease and helped to clarify evidence-based approaches to both the prophylaxis and treatment of HO. This article reviews the literature on these topics with a focus on their application in orthopaedic trauma. PMID:23010648
Orthopaedic research and education foundation and industry.
Wurth, Gene R; Sherr, Judy H; Coffman, Thomas M
Members of orthopaedic industry commit a significant amount of funds each year to support research and education programs that are directly related to their product(s). In addition, industry supports organizations such as the Orthopaedic Research and Education Foundation. The relationship between the Orthopaedic Research and Education Foundation and industry began in the early 1980s. The support to the Orthopaedic Research and Education Foundation from industry primarily has come in the form of unrestricted grants. These grants best can be looked at as an investment rather than a contribution. This form of giving, once called corporate philanthropy is more accurately referred to as strategic philanthropy. Members of industry make these investments to enhance their reputations, build brand awareness, market their products and services, improve employee morale, increase customer loyalty, and establish strategic alliances. The specialty of orthopaedics is among the leaders in medicine in the amount of funding raised within the specialty for research and education programs. This is because of the amount of support from members of industry and the surgeons. During the past 15 years, 40% of the annual support to the Orthopaedic Research and Education Foundation has come from industry and the balance has come from surgeons and members of lay public. Future industry support of the Orthopaedic Research and Education Foundation and other organizations within the specialty of orthopaedics will be dependent on the continued demonstration of tangible returns in areas described. PMID:12838052
Surgical skills simulation in trauma and orthopaedic training.
Stirling, Euan R B; Lewis, Thomas L; Ferran, Nicholas A
Changing patterns of health care delivery and the rapid evolution of orthopaedic surgical techniques have made it increasingly difficult for trainees to develop expertise in their craft. Working hour restrictions and a drive towards senior led care demands that proficiency be gained in a shorter period of time whilst requiring a greater skill set than that in the past. The resulting conflict between service provision and training has necessitated the development of alternative methods in order to compensate for the reduction in 'hands-on' experience. Simulation training provides the opportunity to develop surgical skills in a controlled environment whilst minimising risks to patient safety, operating theatre usage and financial expenditure. Many options for simulation exist within orthopaedics from cadaveric or prosthetic models, to arthroscopic simulators, to advanced virtual reality and three-dimensional software tools. There are limitations to this form of training, but it has significant potential for trainees to achieve competence in procedures prior to real-life practice. The evidence for its direct transferability to operating theatre performance is limited but there are clear benefits such as increasing trainee confidence and familiarity with equipment. With progressively improving methods of simulation available, it is likely to become more important in the ongoing and future training and assessment of orthopaedic surgeons. PMID:25523023
Columnar-lined esophagus: time to drop the eponym of "Barrett": Historical review.
Bani-Hani, Kamal E; Bani-Hani, Bayan K
There can be few medical conditions that have been surrounded by as much confusion about their definition or terminology as columnar-lined esophagus (CLE); approximately 30 different terms and eponyms have been used to describe this condition. The history of this condition can be divided into five stages: (i) descriptive stage, 1906-1950; (ii) "argument" stage, 1950-1963; (iii) "significant" stage, 1963-1973; (iv) surveillance stage, 1973-1990; and (v) refined research stage, 1990-present. The use of the eponym "Barrett's" to describe CLE is not justified from a historical point of view. Lining of the lower esophagus by columnar epithelium was termed "Barrett's esophagus" after the presentation by Barrett in 1957. Although this finding has been attributed to Barrett, the work of others, including Tileston, Lortat-Jacob, and Allison and Johnstone, preceded Barrett's description. The historical aspects of CLE were reviewed to show how little Norman Barrett had contributed to the core concept of this condition in comparison to the contributions of other investigators, particularly the contribution of Philip Allison. Based on many discussed historical facts, we are not in favor of retaining the term "Barrett's esophagus" and we propose that CLE be henceforth referred to as "columnar-lined esophagus". PMID:18410605
The Vienna Heritage of Iowa Orthopaedics
Buckwalter, Joseph A
Strong traditions of basic research, clinical innovation, teaching and integrating science and evaluation of outcomes into clinical practice have characterized University of Iowa orthopaedics for ninety years. These traditions were brought to Iowa City from Vienna when Iowa City was a town of fewer than 10,000 people in a sparsely populated rural state. In the last third of the 19th century, surgeons at the University of Vienna, led by Theodore Billroth (1829-1894), helped transform the practice of surgery. They developed new more effective procedures, analyzed the results of their operations, promoted the emergence and growth of surgical specialties and sought understanding of tissue structure, physiology and pathophysiology. Their efforts made Vienna one of the world's most respected centers for operative treatment, basic and clinical research and surgical education. Two individuals who followed Billroth, Eduard Albert (1841-1900) and Adolf Lorenz (1854-1946) focused their research and clinical practice on orthopaedics. Their successes in the study and treatment of musculoskeletal disorders led one of their students, Arthur Steindler (1878-1959), a 1902 graduate of the Vienna Medical School, to pursue a career in orthopaedics. Following medical school, he worked in Lorenz's orthopaedic clinic until 1907 when he joined John Ridlon (1852-1936) at the Chicago Home for Crippled Children. In 1910, Steindler became Professor of Orthopaedics at the Drake Medical School in Des Moines, Iowa, and, in 1913, John G. Bowman, the President of the University of Iowa, recruited him to establish an orthopaedic clinical and academic program in Iowa City. For the next third of a century he guided the development of the University of Iowa Orthopaedics Department, helped establish the fields of orthopaedic biomechanics and kinesiology and tirelessly stressed the importance of physiology, pathology and assessment of the outcomes of operations. From the legacy of Billroth, Albert and
Algodystrophy in major orthopaedic surgery
Tarantino, Umberto; Buharaja, Rodrigo; Piccirilli, Eleonora; Riccardi, Mariastella; Gasbarra, Elena; Feola, Maurizio; Iolascon, Giovanni
Summary Complex Regional Pain Syndrome (CRPS) describes a diversity of painful conditions following trauma, associated with abnormal regulation of blood flow and sweating, trophic changes, and edema of skin. Epidemiology of this disease is not convincing because of the difficulties and inaccuracies in the diagnosis. Several mechanisms are involved in the genesis of CRPS. The higher incidence of CRPS in women over 65 suggests that some changes involving natural and pathologic processes of aging predispose to onset a CRPS. Many features of the orthopaedic management (surgical time, immobilization, surgical incision, fracture osteosynthesis or prosthetic implants) might influence inflammation status in different way. It is mandatory to improve the understanding of both the pathogenesis of CRPS and the conditions that play a decisive role in its genesis. Furthermore it is important to find some biomarkers that allow early diagnosis before the onset of typical clinical signs. PMID:27134627
Older Patients' Unexpressed Concerns About Orthopaedic Surgery
Hudak, Pamela L.; Armstrong, Kristy; Braddock, Clarence; Frankel, Richard M.; Levinson, Wendy
Background: As the U.S. population ages, orthopaedic surgeons will increasingly be required to counsel older patients about major surgical procedures. Understanding patient concerns or worries about surgery could help orthopaedic surgeons to assist their patients in making these decisions. The objectives of this study were to explore the nature of patient concerns regarding orthopaedic surgery and to describe how patients raise concerns during visits with orthopaedic surgeons and how orthopaedic surgeons respond. Methods: As part of a study involving audiotaping of 886 visits between patients and orthopaedic surgeons, fifty-nine patients sixty years of age or older who were considering surgery were recruited to participate in semistructured telephone interviews at five to seven days and one month after the visit. Patients were asked about their perceptions of the visit and how they made their decision about surgery. These interviews were analyzed to identify patients' concerns with the use of qualitative content analysis and then compared with the audiotaped visits to determine whether these concerns were actually raised during the visit and, if so, how well the orthopaedic surgeons responded. Analyses based on patient race (black or white) were also performed. Results: One hundred and sixty-four concerns pertaining to (1) the surgery (anticipated quality of life after the surgery, the care facility, the timing of the operation, and the patient's capacity to meet the demands of the surgery) and (2) the surgeons (their competency, communication, and professional practices) were identified. Patients raised only 53% of their concerns with the orthopaedic surgeons and were selective in what they disclosed; concerns about the timing of the operation and about the care facility were frequently raised, but concerns about their capacity to meet the demands of the surgery and about the orthopaedic surgeons were not. Orthopaedic surgeons responded positively to 66% of the
Orthopaedic Surgeon Burnout: Diagnosis, Treatment, and Prevention.
Daniels, Alan H; DePasse, J Mason; Kamal, Robin N
Burnout is a syndrome marked by emotional exhaustion, depersonalization, and low job satisfaction. Rates of burnout in orthopaedic surgeons are higher than those in the general population and many other medical subspecialties. Half of all orthopaedic surgeons show symptoms of burnout, with the highest rates reported in residents and orthopaedic department chairpersons. This syndrome is associated with poor outcomes for surgeons, institutions, and patients. Validated instruments exist to objectively diagnose burnout, although family members and colleagues should be aware of early warning signs and risk factors, such as irritability, withdrawal, and failing relationships at work and home. Emerging evidence indicates that mindfulness-based interventions or educational programs combined with meditation may be effective treatment options. Orthopaedic residency programs, departments, and practices should focus on identifying the signs of burnout and implementing prevention and treatment programs that have been shown to mitigate symptoms. PMID:26885712
American Academy of Neurological and Orthopaedic Surgeons
... Orthopaedic Surgeons Navigation Menu Home Who We Are Board of Directors Executive Committee Standing Committees Contact Us Membership Our ... gratitude, as well as congratulations from the entire Board of Directors, is extended to Dr. Zamorano for her invaluable ...
The Malaysian Orthopaedic Association humanitarian mission to Indonesia and Sri Lanka.
Sharaf, I; Saw, A; Hyzan, Y; Sivananthan, K S
The tsunami which occurred off the west coast of North Sumatra on December 26, 2004 devastated the coastal areas of North Sumatra, South-West Thailand, South-East India and Sri Lanka killing more than a quarter of a million people. The destruction was enormous with many coastal villages destroyed. The other countries affected were Malaysia, Myanmar, Maldives, Bangladesh, Somalia, Kenya, Tanzania and the Seychelles. In January 2005, volunteers went in weekly rotation to Banda Aceh in collaboration with Global Peace Mission. These were Dr Hyzan Yusof, Dr Suryasmi Duski, Dr Sharaf Ibrahim, Dr Saw Aik, Dr Kamariah Nor and Dr Nor Azlin. In Banda Aceh, the surgical procedures that we could do were limited to external fixation of open fractures and debriding infected wounds at the Indonesian Red Crescent field hospital. In February, a team comprising Dato Dr K S Sivananthan, Dr T Kumar and Dr S Vasan spent a week in Sri Lanka. In Sri Lanka, Dato Sivananthan and his team were able to perform elective orthopaedic operations in Dr Poonambalam Memorial Hospital. We appealed for national and international aid and received support from local hospitals and the orthopaedic industry. International aid bound for Banda Aceh arrived in Kuala Lumpur from the Philippine Orthopaedic Association, the Chiba Children's Hospital in Japan and the Chinese Orthopaedic Association. The COA donated 1.5 tons of orthopaedic equipments. A special handing over ceremony from the COA to the Indonesian Orthopaedic Association was held in Putrajaya in March. Malaysia Airlines flew in the donated equipment to Kuala Lumpur while the onward flight to Aceh was provided by the Royal Malaysian Air Force. In April, Dr Saw Aik and Dr Yong Su Mei joined the Tsu-Chi International Medical Association for volunteer services on Batam Island, Indonesia. The MOA acknowledges the many individuals and organizations, both governmental and non-governmental, for their contributions in the humanitarian efforts. PMID
Bioceramic Coatings for Orthopaedic Implants
Campbell, Allison A.
During the past century, man-made materials and devices have been developed to the point at which they have been used successfully to replace and/or restore function to diseased or damaged tissues. In the field of orthopaedics, the use of metal implants has significantly improved the quality of life for countless individuals. Critical factors for implant success include proper design, material selection, and biocompatibility. While early research focused on the understanding biomechanical properties of the metal device, recent work has turned toward improving the biological properties of these devices. This has lead to the introduction of calcium phosphate (CaP) bioceramics as a bioactive interface between the bulk metal impart and the surrounding tissue. The first calcium phosphate coatings where produced via vapor phase routes but more recently, there has been the emergence of solution based and biomimetic methods. While each approach has its own intrinsic materials and biological properties, in general CaP coatings have the promise to improve implant biocompatibility and ultimately implant longevity.
Digital photography in orthopaedic surgery.
Elbeshbeshy, B; Trepman, E
Digital photography has become a practical alternative to film photography for documentation, communication, and education about orthopaedic problems and treatment. Digital cameras may be used to document preoperative and postoperative condition, intraoperative findings, and imaging studies. Digital photographs are captured on the charged coupler device (CCD) of the camera, and processed as digital data. Images may be immediately viewed on the liquid crystal display (LCD) screen of the camera and reshot if necessary. Photographic image files may be stored in the camera in a floppy diskette, CompactFlash card, or SmartMedia card, and transferred to a computer. The images may be manipulated using photo-editing software programs, stored on media such as Zip disks or CD-R discs, printed, and incorporated into digital presentations. The digital photographs may be transmitted to others using electronic mail (e-mail) and Internet web sites. Transparency film slides may be converted to digital format and used in digital presentations. Despite the initial expense to obtain the required hardware, major cost savings in film and processing charges may be realized over time compared with film photography. PMID:11206828
Randomised Trial Support for Orthopaedic Surgical Procedures
Lim, Hyeung C.; Adie, Sam; Naylor, Justine M.; Harris, Ian A.
We investigated the proportion of orthopaedic procedures supported by evidence from randomised controlled trials comparing operative procedures to a non-operative alternative. Orthopaedic procedures conducted in 2009, 2010 and 2011 across three metropolitan teaching hospitals were identified, grouped and ranked according to frequency. Searches of the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effects (DARE) were performed to identify RCTs evaluating the most commonly performed orthopaedic procedures. Included studies were categorised as "supportive" or "not supportive" of operative treatment. A risk of bias analysis was conducted for included studies using the Cochrane Collaboration's Risk of Bias tool. A total of 9,392 orthopaedic procedures were performed across the index period. 94.6% (8886 procedures) of the total volume, representing the 32 most common operative procedure categories, were used for this analysis. Of the 83 included RCTs, 22.9% (19/83) were classified as supportive of operative intervention. 36.9% (3279/8886) of the total volume of procedures performed were supported by at least one RCT showing surgery to be superior to a non-operative alternative. 19.6% (1743/8886) of the total volume of procedures performed were supported by at least one low risk of bias RCT showing surgery to be superior to a non-operative alternative. The level of RCT support for common orthopaedic procedures compares unfavourably with other fields of medicine. PMID:24927114
Developing Orthopaedic Trauma Capacity in Uganda: Considerations From the Uganda Sustainable Trauma Orthopaedic Program.
O'Hara, Nathan N; O'Brien, Peter J; Blachut, Piotr A
Uganda, like many low-income countries, has a tremendous volume of orthopaedic trauma injuries. The Uganda Sustainable Trauma Orthopaedic Program (USTOP) is a partnership between the University of British Columbia and Makerere University that was initiated in 2007 to reduce the consequences of neglected orthopaedic trauma in Uganda. USTOP works with local collaborators to build orthopaedic trauma capacity through clinical training, skills workshops, system support, technology development, and research. USTOP has maintained a multidisciplinary approach to training, involving colleagues in anaesthesia, nursing, rehabilitation, and sterile reprocessing. Since the program's inception, the number of trained orthopaedic surgeons practicing in Uganda has more than doubled. Many of these newly trained surgeons provide clinical care in the previously underserved regional hospitals. The program has also worked with collaborators to develop several technologies aimed at reducing the cost of providing orthopaedic care without compromising quality. As orthopaedic trauma capacity in Uganda advances, USTOP strives to continually evolve and provide relevant support to colleagues in Uganda. PMID:26356209
Silver nanoparticles and their orthopaedic applications.
Brennan, S A; Ní Fhoghlú, C; Devitt, B M; O'Mahony, F J; Brabazon, D; Walsh, A
Implant-associated infection is a major source of morbidity in orthopaedic surgery. There has been extensive research into the development of materials that prevent biofilm formation, and hence, reduce the risk of infection. Silver nanoparticle technology is receiving much interest in the field of orthopaedics for its antimicrobial properties, and the results of studies to date are encouraging. Antimicrobial effects have been seen when silver nanoparticles are used in trauma implants, tumour prostheses, bone cement, and also when combined with hydroxyapatite coatings. Although there are promising results with in vitro and in vivo studies, the number of clinical studies remains small. Future studies will be required to explore further the possible side effects associated with silver nanoparticles, to ensure their use in an effective and biocompatible manner. Here we present a review of the current literature relating to the production of nanosilver for medical use, and its orthopaedic applications. PMID:25922449
Paralytic ileus in the orthopaedic patient.
Daniels, Alan H; Ritterman, Scott A; Rubin, Lee E
Paralytic ileus is marked by the cessation of bowel motility. This condition is a major clinical concern that may lead to severe patient morbidity in orthopaedic surgery and trauma patients. Ileus most commonly occurs following spinal surgery, traumatic injury, or lower extremity joint reconstruction, but it may also occur following minor orthopaedic procedures. Possible consequences of ileus include abdominal pain, malnutrition, prolonged hospital stay, hospital readmission, bowel perforation, and death. Therapies used in the treatment of ileus include minimization of opioids, early patient mobilization, pharmacologic intervention, and multidisciplinary care. Orthopaedic surgeons should be aware of the clinical signs and symptoms of paralytic ileus and should understand treatment principles of this relatively common adverse event. PMID:25917235
Ionising radiation: are orthopaedic surgeons at risk?
Smith, G. L.; Briggs, T. W.; Lavy, C. B.; Nordeen, H.
Modern orthopaedic trauma practice involves increased exposure of the surgeon to ionising radiation. However, there have been no studies to investigate whether the doses received are within limits for non-classified workers. In this study, whole body, eye and extremity, namely hand, doses were measured in six orthopaedic surgeons during trauma cases requiring the use of X-rays in theatre. None of the subjects approached the recommended maximum dose levels for either the whole body, eyes or hands. This finding is reassuring. In orthopaedics, the limiting dose is that to the hands. This differs from previously studied groups, such as radiologists and cardiologists, in whom the limiting factor is the dose to the lens of the eye. Although current precautions appear to be adequate, safe practice in the future will depend on continuing vigilance and repetition of studies similar to this one as techniques and workloads change. PMID:1416705
Three Dimensional Printing in Orthopaedic Surgery
Mulford, Jonathan; MacKay, N; Babazadeh, S
Objectives: Three dimensional (3D) printing technology has many current and future applications in orthopaedics. The objectives of this article are to review published literature regarding applications of 3D technology in orthopaedic surgery with a focus on knee surgery. Methods: A narrative review of the applications of 3D printing technology in orthopaedic practice was achieved by a search of computerised databases, internet and reviewing references of identified publications. Results: There is current widespread use of 3D printing technology in orthopaedics. 3D technology can be used in education, preoperative planning and custom manufacturing. Custom manufacturing applications include surgical guides, prosthetics and implants. Many future applications exist including biological applications. 3D printed models of anatomy have assisted in the education of patients, students, trainees and surgeons. 3D printed models also assist with surgical planning of complex injuries or unusual anatomy. 3D printed surgical guides may simplify surgery, make surgery precise and reduce operative time. Computer models based on MRI or CT scans are utilised to plan surgery and placement of implants. Complex osteotomies can be performed using 3D printed surgical guides. This can be particularly useful around the knee. A 3D printed guide allows pre osteotomy drill holes for the plate fixation and provides an osteotomy guide to allow precise osteotomy. 3D printed surgical guides for knee replacement are widely available. 3D printing has allowed the emergence of custom implants. Custom implants that are patient specific have been particularly used for complex revision arthroplasty or for very difficult cases with altered anatomy. Future applications are likely to include biological 3D printing of cartilage and bone scaffolds. Conclusion: 3D printing in orthopaedic surgery has and will continue to change orthopaedic practice. Its role is to provide safe, reproducible, reliable models with
The Orthopaedically Handicapped and Computer Usage: The Case of TRNC
ERIC Educational Resources Information Center
Dincyurek, Sibel; Arsan, Nihan; Caglar, Mehmet
Although various studies have been conducted in the field of orthopaedic impairment, research regarding computer education for orthopaedically impaired individuals remains insufficient. This study aimed to evaluate the use of computers by orthopaedically impaired individuals from a wider perspective. The findings of the study emphasise the…
A Psychomotor Skills Course for Orthopaedic Residents
ERIC Educational Resources Information Center
Lippert, Frederick G.; And Others
The course described and evaluated here was developed at the University of Washington School of Medicine to teach 20 orthopaedic residents operative techniques, instrument usage, and safety precautions outside of the operating room without hazard to the patient or regard to time constraints. (JT)
The Orthopaedic Training Study. Final Report.
ERIC Educational Resources Information Center
Miller, George E.; And Others
A four year study was initiated to systematically improve the certification procedures of the American Board of Orthopaedic Surgery. Consequently, the immediate research aim was the development of more valid and reliable techniques in assessing professional competence in orthopedics. A definition of professional competence was reached through…
Recognizing and Preventing Burnout among Orthopaedic Leaders
Quick, James Campbell; Sime, Wesley E.; Novicoff, Wendy M.; Einhorn, Thomas A.
Stress, emotional exhaustion, and burnout are widespread in the medical profession in general and in orthopaedic surgery in particular. We attempted to identify variables associated with burnout as assessed by validated instruments. Surveys were sent to 282 leaders from orthopaedic surgery academic departments in the United States by e-mail and mail. Responses were received from 195 leaders for a response rate of 69%. The average surgeon worked 68.3 hours per week and more than ½ of this time was allocated to patient care. Highest stressors included excessive workload, increasing overhead, departmental budget deficits, tenure and promotion, disputes with the dean, and loss of key faculty. Personal-professional life imbalance was identified as an important risk factor for emotional exhaustion. Withdrawal, irritability, and family disagreements are early warning indicators of burnout and emotional exhaustion. Orthopaedic leaders can learn, and potentially model, ways to mitigate stress from other high-stress professions. Building on the strength of marital and family bonds, improving stress management skills and self-regulation, and improving efficiency and productivity can combine to assist the orthopaedic surgery leader in preventing burnout and emotional exhaustion. Electronic supplementary material The online version of this article (doi:10.1007/s11999-008-0622-8) contains supplementary material, which is available to authorized users. PMID:19030943
Leadership and business education in orthopaedic residency training programs.
Kiesau, Carter D; Heim, Kathryn A; Parekh, Selene G
Leadership and business challenges have become increasingly present in the practice of medicine. Orthopaedic residency programs are at the forefront of educating and preparing orthopaedic surgeons. This study attempts to quantify the number of orthopaedic residency programs in the United States that include leadership or business topics in resident education program and to determine which topics are being taught and rate the importance of various leadership characteristics and business topics. A survey was sent to all orthopaedic department chairpersons and residency program directors in the United States via e-mail. The survey responses were collected using a survey collection website. The respondents rated the importance of leadership training for residents as somewhat important. The quality of character, integrity, and honesty received the highest average rating among 19 different qualities of good leaders in orthopaedics. The inclusion of business training in resident education was also rated as somewhat important. The topic of billing and coding received the highest average rating among 14 different orthopaedically relevant business topics. A variety of topics beyond the scope of clinical practice must be included in orthopaedic residency educational curricula. The decreased participation of newly trained orthopaedic surgeons in leadership positions and national and state orthopaedic organizations is concerning for the future of orthopaedic surgery. Increased inclusion of leadership and business training in resident education is important to better prepare trainees for the future. PMID:21838073
Southern Orthopaedic Association Abstract Publication Rate.
Tait, Mark Adam; Petrus, Cara; Barnes, C Lowry
The purpose of this study was to determine the publication rate of manuscripts presented at the Southern Orthopaedic Association's (SOA) annual meetings. An extensive literature search was performed using Google Scholar and PubMed search engines and all accepted abstracts (posters or podium presentations) presented at an SOA annual meeting from 2005 to 2011 were evaluated. A total of 568 abstracts were presented at SOA meetings between 2005 and 2011. Of these, 234 (41%) were published in the peer-reviewed literature. The publication rate was 66% in 2005 and 28% in 2010. The average time from presentation to peer-reviewed publication was 1.6 ± 0.24 years (range, 2 years in 2006 to 1 year in 2011). The SOA publication rate was comparable with other major orthopaedic conference publication rates, yet more than half of all abstracts remain unpublished. SOA attendees should be aware that approximately 40% of all accepted presentations will go unpublished. PMID:27518291
Setting standards for medical writing in orthopaedics.
Mauffrey, Cyril; Scarlat, Marius M; Pećina, Marko
Once the privilege of few clinical scholars in the field of orthopaedics, medical writing has become a must for career advancement. The number of papers submitted and published yearly has increased steadily, and with the development of the Internet, manuscript and journals have become easily accessible. Medical writing has risen to become a discipline in itself, with rules and standards. However, heterogeneity in the quality of papers submitted still prevails, with large variations in both form and content. With countries such as China and India submitting an exponential number of manuscripts, it is important and helpful that standards of medical writing be emphasised to help writers who do not always have the required support to produce an outstanding manuscript. In this paper, we summarise what may become standards for medical writing in the field of orthopaedics. PMID:24297610
Role of decision aids in orthopaedic surgery
ten Have, Isha A; van den Bekerom, Michel PJ; van Deurzen, Derek FP; Hageman, Michel GJS
Medical treatment of patients inherently entails the risk of undesired complication or side effects. It is essential to inform the patient about the expected outcomes, but also the possible undesired outcomes. The patients preference and values regarding the potential outcomes should be involved in the decision making process. Even though many orthopaedic surgeons are positive towards shared decision-making, it is minimally introduced in the orthopaedic daily practice and decision-making is still mostly physician based. Decision aids are designed to support the physician and patient in the shared- decision-making process. By using decision aids, patients can learn more about their condition and treatment options in advance to the decision-making. This will reduce decisional conflict and improve participation and satisfaction. PMID:26716082
The impact of disruptive innovations in orthopaedics.
Hansen, Erik; Bozic, Kevin J
The US healthcare system is currently facing daunting demographic and economic challenges. Because musculoskeletal disorders and disease represent a substantial and growing portion of this healthcare burden, novel approaches will be needed to continue to provide high-quality, affordable, and accessible orthopaedic care to our population. The concept of "disruptive innovations," which has been studied and popularized by Harvard Business School Professor Clayton Christensen, may offer a potential framework for developing strategies to improve quality and control costs associated with musculoskeletal care. The introduction of mobile fluoroscopic imaging systems, the development of the Surgical Implant Generation Network intramedullary nail for treatment of long bone fractures in the developing world, the expanding role and contributions of physician assistants and nurse practitioners to the orthopaedic team, and the rise of ambulatory surgery centers are all examples of disruptive innovations in the field of orthopaedics. Although numerous cultural and regulatory barriers have limited the widespread adoption of these "disruptive innovations," we believe they represent an opportunity for clinicians to regain leadership in health care while at the same time improving quality and access to care for patients with musculoskeletal disease. PMID:19415405
Evans, C.H.; Ghivizzani, S.C.; Robbins, P.D.
Orthopaedic gene therapy has been the topic of considerable research for two decades. The preclinical data are impressive and many orthopaedic conditions are well suited to genetic therapies. But there have been few clinical trials and no FDA-approved product exists. This paper examines why this is so. The reasons are multifactorial. Clinical translation is expensive and difficult to fund by traditional academic routes. Because gene therapy is viewed as unsafe and risky, it does not attract major funding from the pharmaceutical industry. Start-up companies are burdened by the complex intellectual property environment and difficulties in dealing with the technology transfer offices of major universities. Successful translation requires close interactions between scientists, clinicians and experts in regulatory and compliance issues. It is difficult to create such a favourable translational environment. Other promising fields of biological therapy have contemplated similar frustrations approximately 20 years after their founding, so there seem to be more general constraints on translation that are difficult to define. Gene therapy has noted some major clinical successes in recent years, and a sense of optimism is returning to the field. We hope that orthopaedic applications will benefit collaterally from this upswing and move expeditiously into advanced clinical trials. PMID:21948071
The Affordable Care Act and orthopaedic trauma.
Issar, Neil M; Jahangir, A Alex
The Affordable Care Act has resulted in a dramatic governmental restructuring of the healthcare insurance market and delivery system. Orthopaedic traumatologists must be aware of the law's impact on their clinical practice, finances, and overall business model. This includes the effect of accountable care organizations, the Independent Payment Advisory Board, and the Physician Value-Based Payment Modifier program, as well as the impact of the Affordable Care Act's grace period provision, medical device excise tax, and cuts to funding for the Disproportionate Share Hospital program. PMID:25229683
Nanostructured diamond coatings for orthopaedic applications
With increasing numbers of orthopaedic devices being implanted, greater emphasis is being placed on ceramic coating technology to reduce friction and wear in mating total joint replacement components, in order to improve implant function and increase device lifespan. In this chapter, we consider ultra-hard carbon coatings, with emphasis on nanostructured diamond, as alternative bearing surfaces for metallic components. Such coatings have great potential for use in biomedical implants as a result of their extreme hardness, wear resistance, low friction and biocompatibility. These ultra-hard carbon coatings can be deposited by several techniques resulting in a wide variety of structures and properties. PMID:25285213
Complications of orthopaedic surgery in horses.
Richardson, Dean W
Complications are a price all surgeons eventually pay. Experience and increasing skill will decrease many of them but certainly not all. The most important thing is for the surgeon to react correctly to a complication. Acknowledge the mistake (or bad luck) quickly and take whatever steps you can to correct the problem. Because so many equine orthopaedic cases have the potential for complications, recognizing and responding properly to these complications are imperative for successful outcomes. Discussion of the most common complications, their prevention and corrections, is presented. PMID:19203703
The reconstructive microsurgery ladder in orthopaedics.
Tintle, Scott M; Levin, L Scott
Since the advent of the operating microscope by Julius Jacobson in 1960, reconstructive microsurgery has become an integral part of extremity reconstruction and orthopaedics. During World War I, with the influx of severe extremity trauma Harold Gillies introduced the concept of the reconstructive ladder for wound closure. The concept of the reconstructive ladder goes from simple to complex means of attaining wound closure. Over the last half century microsurgery has continued to evolve and progress. We now have a microsurgical reconstructive ladder. The microsurgical reconstruction ladder is based upon the early work on revascularization and replantation extending through the procedures that are described in this article. PMID:23352571
Release of Chromium from Orthopaedic Arthroplasties
Afolaranmi, G.A.; Tettey, J; Meek, R.M.D; Grant, M.H
Many orthopaedic implants are composed of alloys containing chromium. Of particular relevance is the increasing number of Cobalt Chromium bearing arthroplasies being inserted into young patients with osteoarthritis. Such implants will release chromium ions. These patients will be exposed to the released chromium for over 50 years in some cases. The subsequent chromium ion metabolism and redistribution in fluid and tissue compartments is complex. In addition, the potential biological effects of chromium are also controversial, including DNA and chromosomal damage, reduction in CD8 lymphocyte levels and possible hypersensitivity reactions (ALVAL). The establishment of these issues and the measurement of chromium in biological fluids is the subject of this review. PMID:19461924
One hundred years of orthopaedic education in Singapore.
Wang, W; Lee, E H; Wong, H K
The Department of Orthopaedic Surgery at the University of Malaya (in Singapore) was established in 1952. Prior to this, the teaching of Orthopaedic Surgery at the University was undertaken by the Department of Surgery under the Professor of Surgery and Professor of Clinical Surgery. From a course consisting of 15 weekly classes on fractures for 18 undergraduates in the late 1930s, and the clinical postings in orthopaedic surgery for over 40 students in 1952, the programme now encompasses an exposure to musculoskeletal diseases and trauma in all 5 years of the undergraduate course. Over this time, the spectrum of clinical conditions has also changed, and with it the emphasis on the conditions to be taught; from that dealing primarily with tuberculosis of bones and joints, poliomyelitis, and childhood deformity, to those resulting from degenerative disorders, sports injuries, industrial and motor vehicle accidents, and cancer. The students are now taught orthopaedic surgery in all the major public hospitals. Local postgraduate training programmes for orthopaedic surgery started in the 1980s. From 1993, a more structured training and assessment programme was introduced for basic and advanced training in surgery and orthopaedics. Advanced trainees rotate through the various teaching hospitals to expose them to a wider range of orthopaedic problems as well as teachers. The postgraduate training programme is now well established, and Singapore is accredited by the Royal College of Surgeons of Edinburgh as an orthopaedic training centre for higher surgical training. PMID:16010393
Social Competence and Temperament in Children with Chronic Orthopaedic Disability
ERIC Educational Resources Information Center
Yagmurlu, Bilge; Yavuz, H. Melis
The aim of the study was to investigate social competence in children with orthopaedic disability and its concurrent relations to child's temperament, health condition, and maternal warmth. Participants were 68 Turkish children (mean = 5.94 years) with chronic orthopaedic disability and their mothers coming from disadvantaged backgrounds.…
The management of pain in orthopaedics.
Fetrow, K O
The three general methods of treating pain are pharmacologic, physical and psychological. The goal of medical management of the patient with pain and inflammation is to relieve these symptoms with minimal side effects and inconvenience. Pain associated with inflammation may be relieved with nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin. All NSAIDs relieve pain and stiffness in a similar manner; their primary action appears to be the inhibition of the cyclo-oxygenase system in the arachidonic acid cascade. When prescribing NSAIDs for orthopaedic pain and inflammation, it seems sensible to start with aspirin because of its low cost and safety at analgesic doses. However, if safety and low incidence of side effects are the most important factors in determining appropriate therapy, newer NSAIDs such as ketoprofen will be preferred. The relief of pain is an important aspect of postoperative care. Parenteral and oral opiates serve as the standard against which other therapies for severe pain are compared. When pain cannot be adequately controlled with intramuscular or subcutaneous opiates, intravenous opiates controlled by the patient (patient-controlled analgesia) are often useful. Relatively small doses of epidural or intrathecal opiates can also be used to achieve postoperative pain relief. Thus, treatment for orthopaedic pain begins with NSAIDs, followed by an oral opiate combined with acetaminophen, aspirin, or another NSAID. If these regimens are ineffective, oral opiates followed by parenteral opiates may be tried. PMID:2520438
About the beginnings of orthopaedics in Timisoara.
Poenaru, Dan V
The historical and geographical territory of Banat is part of present-day Romania. Timisoara's history, the capital city of Banat region, dates back to the second century B.C. Medical life in Banat was re-organised after the promulgation of the Aulic Laws in the eighteenth century. Thorough research was undertaken through historic manuscripts, old newspapers, biographies and other papers about the history of Romanian medicine. The eighteenth century witnessed the building of three hospitals in Timisoara. In that period, Banat region benefited from the expertise and professionalism of doctors who graduated and were trained mainly in Central and Western European universities. By the beginning of the twentieth century, many medical clinics or sanatoriums specialising in orthopaedics and traumatology were offering their services to the population. Banat region had many good orthopaedists, and one of them was Prof. Dr. Doc. Berceanu, who graduated from the University of Medicine Bucharest and further specialised in Paris, France. He is the founder of the Orthopaedics and Traumatology Clinic in Timisoara. PMID:26227921
Immobilized antibiotics to prevent orthopaedic implant infections.
Hickok, Noreen J; Shapiro, Irving M
Many surgical procedures require the placement of an inert or tissue-derived implant deep within the body cavity. While the majority of these implants do not become colonized by bacteria, a small percentage develops a biofilm layer that harbors invasive microorganisms. In orthopaedic surgery, unresolved periprosthetic infections can lead to implant loosening, arthrodeses, amputations and sometimes death. The focus of this review is to describe development of an implant in which an antibiotic tethered to the metal surface is used to prevent bacterial colonization and biofilm formation. Building on well-established chemical syntheses, studies show that antibiotics can be linked to titanium through a self-assembled monolayer of siloxy amines. The stable metal-antibiotic construct resists bacterial colonization and biofilm formation while remaining amenable to osteoblastic cell adhesion and maturation. In an animal model, the antibiotic modified implant resists challenges by bacteria that are commonly present in periprosthetic infections. While the long-term efficacy and stability is still to be established, ongoing studies support the view that this novel type of bioactive surface has a real potential to mitigate or prevent the devastating consequences of orthopaedic infection. PMID:22512927
Radiation exposure of eyes, thyroid gland and hands in orthopaedic staff: a systematic review
Background Various procedures, especially minimal invasive techniques using fluoroscopy, pose a risk of radiation exposure to orthopaedic staff. Anatomical sites such as the eyes, thyroid glands and hands are more vulnerable to radiation considering the limited use of personal protective devices in the workplace. The objective of the study is to assess the annual mean cumulative and per procedure radiation dose received at anatomical locations like eyes, thyroid glands and hands in orthopaedic staff using systematic review. Methods The review of literature was conducted using systematic search of the database sources like PUBMED and EMBASE using appropriate keywords. The eligibility criteria and the data extraction of literature were based on study design (cohort or cross-sectional study), study population (orthopaedic surgeons or their assistants), exposure (doses of workplace radiation exposure at hands/fingers, eye/forehead, neck/thyroid), language (German and English). The literature search was conducted using a PRISMA checklist and flow chart. Results Forty-two articles were found eligible and included for the review. The results show that radiation doses for the anatomical locations of eye, thyroid gland and hands were lower than the dose levels recommended. But there is a considerable variation of radiation dose received at all three anatomical locations mainly due to different situations including procedures (open and minimally invasive), work experience (junior and senior surgeons),distance from the primary and secondary radiation, and use of personal protective equipments (PPEs). The surgeons receive higher radiation dose during minimally invasive procedures compared to open procedures. Junior surgeons are at higher risk of radiation exposure compared to seniors. PPEs play a significant role in reduction of radiation dose. Conclusions Although the current radiation precautions appear to be adequate based on the low dose radiation, more in-depth studies
Should a war criminal be rewarded with eponymous distinction?: the double life of hans reiter (1881-1969).
Wallace, D J; Weisman, M
The combination of arthritis, urethritis, conjunctivitis, often associated with a psoriasiform rash has been termed Reiter's syndrome, particularly if the patient is HLA-B27 positive. In this report, the history of "Reiter's syndrome" is investigated by reviewing descriptions of the syndrome and the life and times of Hans Reiter from source materials and recent publications that shed new light on medicine and clinical research in the Nazi regime. The description of the syndrome clearly antedates Reiter's work by several hundred years. Numerous other investigators accurately described a reactive cutaneo-arthropathy before Reiter. Hans Reiter gave his imprimatur to some of the most horrific experiments conducted on concentration camp internees during World War II. We conclude that Reiter does not deserve eponymous distinction. The disorder should be renamed "reactive cutaneo-arthropathy," or a "reactive arthritis" syndrome. PMID:19078450
Contribution of biomechanics to clinical practice in orthopaedics.
Woo, Savio L-Y
Biomechanics is a field that has a very long history. It was described in ancient Chinese and Greek literature as early as 400-500 BC. The foundation of biomechanics, however, was laid during a period between the 1500's to 1700's by renowned personalities, da Vinci, Galileo, Borelli, Hooke, Newton, and so (Fung, Y.C., Biomechanics: Mechanical Properties of Living Tissues, 2nd Ed. Springer Verlag, Chapter 1, 1993). Beginning in the 1950's, Muybridge, Steindler, Inman, Lissner, and Hirsch performed the pioneering work on musculoskeletal biomechanics and the foundation of orthopaedic biomechanics was formed. For the following two decades, the field has blossomed and significant contributions in the biomechanics of bone, articular cartilage, soft tissues, upper and lower extremities, spine and so on has been made. More sophisticated equipment, coupled with mathematical modeling and better engineering design, has enabled us to make great strides. Bioengineers, in collaboration with orthopaedic surgeons, have translated many laboratory discoveries into clinical practice, leading to improved patient treatment and outcome. In the past 30 years, my colleagues and I have focused our research on the biomechanics of musculoskeletal soft tissues, ligaments and tendons, in particular. Therefore, in this lecture, the function of knee ligaments, the associated homeostatic responses secondary to immobilization and exercise, and healing of the ligaments will be reviewed. Examples of scientific findings that help to guide the surgical management of injury to ligaments will be given. New ideas on functional tissue engineering to improve the healing of knee ligaments and tendons will be presented. We have learned that tendons and ligaments are indeed complex biological tissues. To fully understand their behavior, healing and remodelling processes, this author advocates major efforts be made to bring molecular biologists, morphologists, biochemists, bioengineers, physical therapists and
Radiation exposure to the eye lens of orthopaedic surgeons during various orthopaedic procedures.
Romanova, K; Vassileva, J; Alyakov, M
The aim of the present study was to assess the radiation dose to the eye lens of orthopaedic surgeons during various orthopaedic procedures and to make efforts to ensure that radiation protection is optimised. The study was performed for Fractura femoris and Fractura cruris procedures performed in orthopaedic operating theatres, as well as for fractures of wrist, ankle and hand/shoulder performed in the emergency trauma room. The highest mean value of the eye lens dose of 47.2 μSv and higher mean fluoroscopy time of 3 min, as well as the corresponding highest maximum values of 77.1 μSv and 5.0 min were observed for the Fractura femoris procedure performed with the Biplanar 500e fluoroscopy systems. At a normal workload, the estimated mean annual dose values do not exceed the annual occupational dose limit for the lens of eye, but at a heavy workload in the department, this dose limit could be achieved or exceeded. The use of protective lead glasses is recommended as they could reduce the radiation exposure of the lens of the eye. The phantom measurements demonstrated that the use of half-dose mode could additionally reduce dose to the operator's eye lens. PMID:25944961
Perioperative blood transfusions in orthopaedic surgery.
Ponnusamy, Karthikeyan E; Kim, Thomas J; Khanuja, Harpal S
Blood transfusion after orthopaedic surgery accounts for 10% of all packed red blood-cell transfusions, but use varies substantially across hospitals and surgeons. Transfusions can cause systemic complications, including allergic reactions, transfusion-related acute lung injury, transfusion-associated circulatory overload, graft-versus-host disease, and infections. Tranexamic acid is a new cost-effective blood management tool to reduce blood loss and decrease the risk of transfusion after total joint arthroplasty. Current clinical evidence does not justify transfusions for a hemoglobin level of >8 g/dL in the absence of symptoms. Studies have also supported the use of this trigger in patients with a history or risk of cardiovascular disease. PMID:25378512
Evidence-based orthopaedics or 'superstition in the pigeon'.
Evans, R
Pigeon behavioural conditioning methods are similar to the processes that orthopaedic surgeons use to evaluate new surgical procedures. Alternatively, evidence-based orthopaedics is a tool for surgeons to evaluate procedures in a systematic, patient-centred way that is less instinctive than pigeon behaviour. The objective of this article is to describe evidence-based orthopaedics, and then propose changes to surgical culture with the aim of refining the interpretation of the current literature and improving the quality of future research. The proposals are 'institutional' changes rather than calls for increased funding and more randomised controlled trials. PMID:19750292
Patient Internet Use in a Community Outpatient Orthopaedic Practice
Beall, McPherson S; Beall, M Scott; Greenfield, Mary Lou VH; Biermann, J Sybil
This study evaluated Internet use among orthopaedic patients in a private practice general orthopaedic setting. Of 154 respondents, twenty percent had used the Internet to research their orthopaedic diagnosis. Search rates were lowest for patients with arthritis and highest for patients with disorders of the spine or back. Seventy percent of these patients who had searched had found their searches helpful, and over 50% of patients who had searched had questions raised that they planned to address with their physicians. Of those patients who did search the Internet, none reported concern regarding the credibility of Internet retrieved material. PMID:12180601
Fabricating specialised orthopaedic implants using additive manufacturing
NASA Astrophysics Data System (ADS)
Unwin, Paul
It has been hypothesised that AM is ideal for patient specific orthopaedic implants such as those used in bone cancer treatment, that can rapidly build structures such as lattices for bone and tissues to in-grow, that would be impossible using current conventional subtractive manufacturing techniques. The aim of this study was to describe the adoption of AM (direct metal laser sintering and electron beam melting) into the design manufacturing and post-manufacturing processes and the early clinical use. Prior to the clinical use of AM implants, extensive metallurgical and mechanical testing of both laser and electron beam fabrications were undertaken. Concurrently, post-manufacturing processes evaluated included hipping, cleaning and coating treatments. The first clinical application of a titanium alloy mega-implant was undertaken in November 2010. A 3D model of the pelvic wing implant was designed from CT scans. Novel key features included extensive lattice structures at the bone interfaces and integral flanges to fix the implant to the bone. The pelvic device was implanted with the aid of navigation and to date the patient remains active. A further 18 patient specific mega-implants have now been implanted. The early use of this advanced manufacturing route for patient specific implants has been very encouraging enabling the engineer to produce more advanced and anatomical conforming implants. However, there are a new set of design, manufacturing and regulatory challenges that require addressing to permit this technique to be used more widely. This technology is changing the design and manufacturing paradigm for the fabrication of specialised orthopaedic implants.
[Functional and orthopaedic aspects of dystrophinopathies].
Boulay, C; Finidori, G
Although the clinical picture and the natural progression of Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) differ, borderline forms exist. Classical orthopaedic treatment is based on self-rehabilitation (by the parents and the patient), physical therapy, posture alignment with orthotics, ergotherapy to set up technical aides, notably positioning in an electric wheelchair to provide more satisfactory autonomy. The functional aspect predominates over pure orthopaedics. Although surgical indications have evolved for the lower limbs, pelvic-spinal arthrodesis for treatment of scoliosis remains the reference treatment, but the methods have evolved since the advent of corticotherapy for DMD. Corticotherapy slows the progression of motor deficits, the age at which walking ability is lost is delayed (shifting from 10 years to 13-14 years depending on the studies), scoliosis progresses later, respiratory insufficiency is better controlled, and therefore survival is prolonged (between 20 and 40 years). However, although this functional aspect seems to respond better to the progress in overall treatment, it also results from a multidisciplinary approach to the disease. Nevertheless, assessment is required, not at a time t as reflected by the scales currently in use, but during daily activities as proposed by qualitative and quantitative monitoring seeking to model nyctohemeral functional motor skills. The principle is to characterize the type of activity (sitting, standing, lying down, walking), its duration, its intensity (walking speed), its frequency (number of activity changes, number of walking episodes), and their sequence (temporal sequence, organization of activity variation). The goal is to identify the variety of functional motor skills and their occurrence over time to determine whether treatment contributes a functional benefit and whether this benefit is put into practice daily. PMID:26773586
Competencies for a Canadian orthopaedic surgery core curriculum.
Wadey, V M R; Dev, P; Buckley, R; Walker, D; Hedden, D
We have developed a list of 281 competencies deemed to be of importance in the training of orthopaedic surgeons. A stratified, randomised selection of non-university orthopaedic surgeons rated each individual item on a scale 1 to 4 of increasing importance. Summary statistics across all respondents were given. The mean scores and sds were computed. Secondary analyses were computed in general orthopaedics, paediatrics, trauma and adult reconstruction. Of the 156 orthopaedic surgeons approached 131 (84%) responded to the questionnaire. They rated 240 of the 281 items greater than 3.0 suggesting that competence in these was necessary by completion of training. Complex procedures were rated to be less important. The structure, delivery and implementation of the curriculum needs further study. Learning activities are 'driven' by the evaluation of competencies and thus competency-based learning may soon be in the forefront of training programmes. PMID:19949127
The Future of Biologic Coatings for Orthopaedic Implants
Goodman, Stuart B.; Yao, Zhenyu; Keeney, Michael; Yang, Fan
Implants are widely used for othopaedic applications such as fixing fractures, repairing nonunions, obtaining a joint arthrodesis, total joint arthroplasty, spinal reconstruction, and soft tissue anchorage. Previously, orthopaedic implants were designed simply as mechanical devices; the biological aspects of the implant were a byproduct of stable internal/external fixation of the device to the surrounding bone or soft tissue. More recently, biologic coatings have been incorporated into orthopaedic implants in order to modulate the surrounding biological environment. This opinion article reviews current and potential future use of biologic coatings for orthopaedic implants to facilitate osseointegration and mitigate possible adverse tissue responses including the foreign body reaction and implant infection. While many of these coatings are still in the preclinical testing stage, bioengineers, material scientists and surgeons continue to explore surface coatings as a means of improving clinical outcome of patients undergoing orthopaedic surgery. PMID:23391496
Venturing into the overlap between pediatric orthopaedics and hand surgery.
Kozin, Scott H; Zlotolow, Dan A; Ratner, Joshua A
There is an overlap between pediatric orthopaedic surgery and hand surgery. A pediatric orthopaedic surgeon is accustomed to the intricacies of the immature skeleton, whereas a hand surgeon is more familiar with the regional anatomy and finer surgical techniques. Many hand diagnoses and surgical techniques are appropriate for the pediatric orthopaedic surgeon, including straightforward duplicated thumb reconstruction of a trigger thumb. Many pediatric diagnoses are more suitable for treatment by a hand surgeon, including simple syndactyly release and complex duplicated thumb reconstruction. Other procedures, such as pollicization, cleft hand reconstruction, synpolydactyly release, and macrodactyly management, require more advanced expertise for successful treatment. It is helpful for pediatric orthopaedic surgeons and hand surgeons to be familiar with the indications, surgical techniques, outcomes, and complications of pediatric hand surgery. PMID:24720302
Occupational hazards for pregnant or lactating women in the orthopaedic operating room.
Downes, Jessica; Rauk, Philip N; Vanheest, Ann E
Pregnant or lactating staff working in the orthopaedic operating room may be at risk of occupational exposure to several hazards, including blood-borne pathogens, anesthetic gases, methylmethacrylate, physical stress, and radiation. Because the use of proper personal protective equipment is mandatory, the risk of contamination with blood-borne pathogens such as hepatitis B, hepatitis C, and HIV is low. Moreover, effective postexposure prophylactic regimens are available for hepatitis B and HIV. In the 1960s, concerns were raised about occupational exposure to harmful chemicals in the operating room such as anesthetic gases and methylmethacrylate. Guidelines on safe levels of exposure to these chemicals and the use of personal protective equipment have helped to minimize the risks to pregnant or lactating staff. Short periods of moderate physical activity are beneficial for pregnant women, but prolonged strenuous activity can lead to increased pregnancy complications. The risk of prenatal radiation exposure during orthopaedic procedures is of concern, as well. However, proper lead protection and contamination control can minimize the risk of occupational exposure to radiation. PMID:24788448
The American Orthopaedic Association-Japanese Orthopaedic Association 2010 traveling fellowship.
Patel, Alpesh A; Cheng, Ivan; Yao, Jeffrey; Huffman, G Russell
We started this journey excited by the prospects of visiting Japan, a country with a proud and historic past. We ended the fellowship accomplishing those goals, and we left with a great deal of admiration for our orthopaedic colleagues halfway around the world for their excellence in education, clinical care, and research. Their hospitality and attention to the details of our visit were exemplary and a lesson to us as we host visiting fellows in the future. Japan reflects its past, but it also offers a preview into our own nation's future: an aging population, a shrinking workforce, a stagnant economy, nationalized health care, and a mushrooming national debt. Of all of these factors, it is the aging population that we, as orthopaedic surgeons, will be most acutely aware of and involved with. The degenerative disorders that affect elderly patients dominate the landscape of surgical care in Japan. Osteoporosis and osteopenia permeate many aspects of care across orthopaedic subspecialties. The surgeons in Japan are developing innovative and cost-effective means of treating the large volume of older patients within the fiscal constraints of a nationalized health-care system. We learned, and will continue to learn more, from Japan about the management of this growing patient population with its unique pathologies and challenges. With the recent natural disaster and ongoing safety concerns in Japan, the character and will of the people of Japan have been on display. Their courage and resolve combined with order and compassion are a testament to the nation's cultural identity. The seeds of the Traveling Fellowship were planted shortly after Japan's last wide-scale reconstruction, and the ties that have bound the JOA and the AOA together are strengthened through this trying time. We strongly urge our colleagues in the U.S. to help support the people, the physicians, and the health-care system of Japan through its most recent tribulations and offer them the same care and
A metrology solution for the orthopaedic industry
NASA Astrophysics Data System (ADS)
Bills, P.; Brown, L.; Jiang, X.; Blunt, L.
Total joint replacement is one of the most common elective surgical procedures performed worldwide, with an estimate of 1.5 million operations performed annually. Currently joint replacements are expected to function for 10-15 years, however, with an increase in life expectancy, and a greater call for knee replacement due to increased activity levels, there is a requirement to improve their function to offer longer term improved quality of life for patients. The amount of wear that a joint incurs is seen as a good indicator of performance, with higher wear rates typically leading to reduced function and premature failure. New technologies and materials are pushing traditional wear assessment methods to their limits, and novel metrology solutions are required to assess wear of joints following in vivo and in vitro use. This paper presents one such measurement technique; a scanning co-ordinate metrology machine for geometrical assessment. A case study is presented to show the application of this technology to a real orthopaedic measurement problem: the wear of components in total knee replacement. This technique shows good results and provides a basis for further developing techniques for geometrical wear assessment of total joint replacements.
Plaster of Paris: the orthopaedic surgeon heritage.
Hernigou, Philippe
Plastering is one of the most ancient of the building handicrafts. Plaster is the common name for calcium sulphate hemi hydrate made by heating the mineral gypsum, the common name for sulphate of lime. In the tenth century the Arabs used liquid plaster in orthopaedic treatment. At the beginning of the nineteenth century, patients with fractures of the lower extremities-and often of the upper extremities as well-were treated in bed with restriction of all activity for many weeks until the fractures united. It was the practice of surgeons to dress wounds and fractures at frequent intervals. The bandages, pads, and splints were removed, the fractures manipulated, and the dressings reapplied. The search for simpler, less cumbersome methods of treatment led to the development of occlusive dressings, stiffened at first with starch and later with plaster of Paris. The ambulatory treatment of fractures was the direct result of these innovations. Two military surgeons, Antonius Mathijsen of the Netherlands, and Nikolai Ivanovitch Pirogov of Russia, were responsible for the introduction of the new plaster bandage technique. At the beginning of the twentieth century the technique was improved by Jean-François Calot, a French surgeon, who invented the hand manufacture of plaster bandage as a roll. During the twentieth century, walking cast and ambulation for fresh fractures were developed with plaster and pin incorporated in plaster; the open fracture care concept was introduced with plaster of Paris by Trueta before the external fixation. PMID:27055448
Tissue engineering skeletal muscle for orthopaedic applications
NASA Technical Reports Server (NTRS)
Payumo, Francis C.; Kim, Hyun D.; Sherling, Michael A.; Smith, Lee P.; Powell, Courtney; Wang, Xiao; Keeping, Hugh S.; Valentini, Robert F.; Vandenburgh, Herman H.
With current technology, tissue-engineered skeletal muscle analogues (bioartificial muscles) generate too little active force to be clinically useful in orthopaedic applications. They have been engineered genetically with numerous transgenes (growth hormone, insulinlike growth factor-1, erythropoietin, vascular endothelial growth factor), and have been shown to deliver these therapeutic proteins either locally or systemically for months in vivo. Bone morphogenetic proteins belonging to the transforming growth factor-beta superfamily are osteoinductive molecules that drive the differentiation pathway of mesenchymal cells toward the chondroblastic or osteoblastic lineage, and stimulate bone formation in vivo. To determine whether skeletal muscle cells endogenously expressing bone morphogenetic proteins might serve as a vehicle for systemic bone morphogenetic protein delivery in vivo, proliferating skeletal myoblasts (C2C12) were transduced with a replication defective retrovirus containing the gene for recombinant human bone morphogenetic protein-6 (C2BMP-6). The C2BMP-6 cells constitutively expressed recombinant human bone morphogenetic protein-6 and synthesized bioactive recombinant human bone morphogenetic protein-6, based on increased alkaline phosphatase activity in coincubated mesenchymal cells. C2BMP-6 cells did not secrete soluble, bioactive recombinant human bone morphogenetic protein-6, but retained the bioactivity in the cell layer. Therefore, genetically-engineered skeletal muscle cells might serve as a platform for long-term delivery of osteoinductive bone morphogenetic proteins locally.
Justifications and needs for diversity in orthopaedics.
White, A A
America is founded on high humanitarian, democratic ideals. The historic facts of slavery, discrimination, and segregation challenge and taint these democratic principles. Although progress has been made, serious racial problems remain. In 1997, the United States had 474 active hate groups, up 20% from 1996. African American males who have the same education as white males doing the same work earn approximately 75% of what their white counterparts earn. America, as predicted by the Kerner Commission Report, is two societies: black and white, separate, and unequal. Some astonishing disparities in healthcare exist. Peer reviewed medical literature documents that African Americans have higher infant mortality rates, shorter life expectancies, fewer joint replacements, and more amputations than whites. Communications within a diverse group of students and teachers enriches the educational experience. The late Supreme Court Justice Lewis Powell, LLD, asserted that a medical student from a particular background may enrich classmates' understanding of people whose cultures are different from their own, and improve their ability to serve a heterogeneous patient population. Diversity on clinical teams can enhance rapport between patient and physician, and can diminish unthinking insults to patients, born of physician ethnic insensitivity. Healthcare facilities with diverse staffs are more likely than homogeneous facilities to attract and successfully serve the nation's diverse population. A University of California at Davis School of Medicine study showed that diversity can be achieved without compromising quality of patient care. Clinically and ideologically, diversity in orthopaedics is good for patients and for the country. PMID:10335274
HIV and Orthopaedics: Musculoskeletal Manifestations and Outcomes.
Pretell-Mazzini, Juan; Subhawong, Ty; Hernandez, Victor H; Campo, Rafael
➤Advances in combined antiretroviral therapy (cART) in recent years have transformed HIV infection into a chronic disease when treatment is available, increasing a patient's life expectancy and the chances that orthopaedic surgeons will encounter such patients in their clinical practice.➤Musculoskeletal manifestations in patients with HIV infection are common and sometimes are the initial presentation of the disease. Knowledge about neoplasms and associated conditions affecting muscle, bones, and joints is essential for successful management.➤Since the advent of cART, total joint arthroplasty has been shown to be a safe procedure; however, perioperative infection is still a small risk in patients with uncontrolled viral loads or CD4 counts of <400 cells/mm(3).➤With regard to trauma surgery, the rates of early and late infection around implants, as well as union rates, are comparable with those in the HIV-negative population; however, there is an increased risk of pulmonary, renal, and infectious or septic complications in the polytrauma setting.➤Factors such as CD4 count, nutritional status, cART therapy, viral load count, and other comorbidities (hemophilia, infection among intravenous drug users, etc.) should be considered when treating these patients in order to optimize their clinical outcomes. PMID:27147691
Quality measurement in orthopaedics: the purchasers' view.
Lansky, David; Milstein, Arnold
While all of medicine is under pressure to increase transparency and accountability, joint replacement subspecialists will face special scrutiny. Disclosures of questionable consulting fees, a demographic shift to younger patients, and uncertainty about the marginal benefits of product innovation in a time of great cost pressure invite a serious and progressive response from the profession. Current efforts to standardize measures by the National Quality Forum and PQRI will not address the concerns of purchasers, payors, or policy makers. Instead, they will ask the profession to document its commitment to appropriateness, stewardship of resources, coordination of care, and patient-centeredness. One mechanism for addressing these expectations is voluntary development of a uniform national registry for joint replacements that includes capture of preoperative appropriateness indicators, device monitoring information, revision rates, and structured postoperative patient followup. A national registry should support performance feedback and quality improvement activity, but it must also be designed to satisfy payor, purchaser, policymaker, and patient needs for information. Professional societies in orthopaedics should lead a collaborative process to develop metrics, infrastructure, and reporting formats that support continuous improvement and public accountability. PMID:19641973
Interprofessional Relationships between Orthopaedic and Podiatric Surgeons in the UK
Isaac, A; Gwilym, SE; Reilly, IN; Kilmartin, TE; Ribbans, WJ
INTRODUCTION The first comprehensive report on the interprofessional relationships between foot and ankle surgeons in the UK is presented. MATERIALS AND METHODS A questionnaire was sent to orthopaedic surgeons with membership of the British Foot and Ankle Surgery Society (BOFAS), orthopaedic surgeons not affiliated to the specialist BOFAS and podiatrists specialising in foot surgery. The questionnaire was returned by 77 (49%) of the BOFAS orthopaedic consultant surgeons, 66 (26%) of non-foot and ankle orthopaedic consultant surgeons and 99 (73%) of the podiatric surgeons. RESULTS While most respondents have experience of surgeons working in the other specialty in close geographical proximity, the majority do not believe that this has adversely affected their referral base. The experience of podiatrists of the outcomes of orthopaedic surgery has been more positive than orthopaedic surgeons of podiatric interventions. Podiatrists are more welcoming of future orthopaedic involvement in future foot and ankle services than in reverse. However, there are a sizeable number of surgeons in both professions who would like to see closer professional liaisons. The study has identified clear divisions between the professions but has highlighted areas where there is a desire from many clinicians to work more harmoniously together, such as in education, training and research. CONCLUSIONS While major concerns exist over issues such as surgery by non-registered medical practitioners and the suitable spectrum of surgery for each profession, many surgeons, in both professions, are willing to provide training for juniors in both specialties and there is a wish to have closer working relationships and common educational and research opportunities than exists at present. PMID:18796189
Army orthopaedic surgery residency program directors' selection criteria.
Orr, Justin D; Hoffmann, Jeffrey D; Arrington, Edward D; Gerlinger, Tad L; Devine, John G; Belmont, Philip J
Factors associated with successful selection in U.S. Army orthopaedic surgical programs are unreported. The current analysis includes survey data from all Army orthopaedic surgery residency program directors (PDs) to determine these factors. PDs at all Army orthopaedic surgery residency programs were provided 17 factors historically considered critical to successful selection and asked to rank order the factors as well as assign a level of importance to each. Results were collated and overall mean rankings are provided. PDs unanimously expressed that performance during the on-site orthopaedic surgery rotation at the individual program director's institution was most important. Respondents overwhelmingly reported that Steps 1 and 2 licensing exam scores were next most important, respectively. Survey data demonstrated that little importance was placed on letters of recommendation and personal statements. PDs made no discriminations based on allopathic or osteopathic degrees. The most important factors for Army orthopaedic surgery residency selection were clerkship performance at the individual PD's institution and licensing examination score performance. Army PDs consider both USMLE and COMLEX results, because Army programs have a higher percentage of successful osteopathic applicants. PMID:25988694
Graduated introduction of orthopaedic implants: encouraging innovation and minimizing harm.
Zywiel, Michael G; Johnson, Aaron J; Mont, Michael A
There is continued pressure for the development of innovative orthopaedic surgical devices and techniques to meet the demands of increasingly younger and more active patients. However, as demonstrated by several recent orthopaedic implant withdrawals and recalls, clinically important unknown modes of failure for newly introduced devices may not become apparent for several years after widespread adoption, affecting a large number of patients. Different reasons have been implicated for this problem, including weaknesses in the United States medical device approval process, as well as deficiencies in mechanisms for post approval implant performance monitoring. Several remedies have been proposed over the past decades. We aim to stimulate discussion concerning the adoption of orthopaedic technology by describing the concept of a graduated implant approval process for orthopaedic devices that builds on recommendations previously made by other authors; by explaining how this will benefit patients, surgeons, and device manufacturers; and by clarifying why the time has come for the orthopaedic community to reconsider the adoption of such a process. PMID:23138245
Overcoming resistance to implementation of integrated care pathways in orthopaedics.
Manning, Blaine T; Callahan, Charles D; Robinson, Brooke S; Adair, Daniel; Saleh, Khaled J
The future of orthopaedic surgery will be shaped by unprecedented demographic and economic challenges, necessitating movement to so-called "second curve" innovations in the delivery of care. Implementation of integrated care pathways (ICPs) may be one solution to imminent cost and access pressures facing orthopaedic patients in this era of health-care accountability and reform. ICPs can lower costs and the duration of hospital stay while facilitating better outcomes through enhanced interspecialty communication. As with any innovation at the crossroads of paradigm change, implementation of integrated care pathways for orthopaedics may elicit surgeons' concern on a variety of grounds and on levels ranging from casual questioning to vehement opposition. No single method is always effective in promoting cooperation and adoption, so a combination of strategies offers the best chance of success. With a special focus on total joint replacement, we consider general patterns of resistance to change, styles of conflict, and specific issues that may underlie orthopaedic surgeon resistance to implementation of integrated care pathways. Methods to facilitate and sustain orthopaedic surgeon engagement in implementation of such pathways are discussed. PMID:23864183
Development of a method to analyze orthopaedic practice expenses.
Brinker, M R; Pierce, P; Siegel, G
The purpose of the current investigation was to present a standard method by which an orthopaedic practice can analyze its practice expenses. To accomplish this, a five-step process was developed to analyze practice expenses using a modified version of activity-based costing. In this method, general ledger expenses were assigned to 17 activities that encompass all the tasks and processes typically performed in an orthopaedic practice. These 17 activities were identified in a practice expense study conducted for the American Academy of Orthopaedic Surgeons. To calculate the cost of each activity, financial data were used from a group of 19 orthopaedic surgeons in Houston, Texas. The activities that consumed the largest portion of the employee work force (person hours) were service patients in office (25.0% of all person hours), maintain medical records (13.6% of all person hours), and resolve collection disputes and rebill charges (12.3% of all person hours). The activities that comprised the largest portion of the total expenses were maintain facility (21.4%), service patients in office (16.0%), and sustain business by managing and coordinating practice (13.8%). The five-step process of analyzing practice expenses was relatively easy to perform and it may be used reliably by most orthopaedic practices. PMID:10738440
Diabetes and its negative impact on outcomes in orthopaedic surgery
Wukich, Dane K
An estimated 285 million adults (aged 20-79 years) worldwide were diagnosed to have diabetes mellitus (DM) in 2010, and this number is projected to grow to 439 million adults by the year 2030. Orthopaedic surgeons, regardless of their subspecialty interest, will encounter patients with DM during their career since this epidemic involves both developed and emerging countries. Diabetes results in complications affecting multiple organ systems, potentially resulting in adverse outcomes after orthopaedic surgery. The purpose of this review is to discuss the pathophysiology of DM and its potential for impacting orthopaedic surgery patients. Diabetes adversely affects the outcome of all orthopaedic surgery subspecialties including foot and ankle, upper extremity, adult reconstructive, pediatrics, spine surgery and sports medicine. Poorly controlled diabetes negatively impacts bone, soft tissue, ligament and tendon healing. It is the complications of diabetes such as neuropathy, peripheral artery disease, and end stage renal disease which contributes to adverse outcomes. Well controlled diabetic patients without comorbidities have similar outcomes to patients without diabetes. Orthopaedic surgeons should utilize consultants who will assist in inpatient glycemic management as well as optimizing long term glycemic control. PMID:25893176
Antimicrobial biocompatible bioscaffolds for orthopaedic implants.
Qureshi, Ammar T; Terrell, Lekeith; Monroe, W Todd; Dasa, Vinod; Janes, Marlene E; Gimble, Jeffrey M; Hayes, Daniel J
Nationally, nearly 1.5 million patients in the USA suffer from ailments requiring bone grafts and hip and other joint replacements. Infections following internal fixation in orthopaedic trauma can cause osteomyelitis in 22-66% of cases and, if uncontrolled, the mortality rate can be as high as 2%. We characterize a procedure for the synthesis of antimicrobial and biocompatible poly-l-lactic acid (PLLA) and poly-ethyleneglycol (PEG) bioscaffolds designed to degrade and absorb at a controlled rate. The bioscaffold architecture aims to provide a suitable substrate for the controlled release of silver nanoparticles (SNPs) to reduce bacterial growth and to aid the proliferation of human adipose-derived stem cells (hASCs) for tissue-engineering applications. The fabricated bioscaffolds were characterized by scanning transmission microscope (SEM) and it showed that the addition of tncreasing concentrations of SNPs results in the formation of dendritic porous channels perpendicular to the axis of precipitation. The antimicrobial properties of these porous bioscaffolds were tested according to a modified ISO 22196 standard across varying concentrations of biomass-mediated SNPs to determine an efficacious antimicrobial concentration. The bioscaffolds reduced the Staphylococcus aureus and Escherichia coli viable colony-forming units by 98.85% and 99.9%, respectively, at an antimicrobial SNPs concentration of 2000 ppm. Human ASCs were seeded on bioscaffolds and cultured in vitro for 20 days to study the effect of SNPs concentration on the viability of cells. SEM analysis and the metabolic activity-based fluorescent dye, AlamarBlue®, demonstrated the growth of cells on the efficacious antimicrobial bioscaffolds. The biocompatibility of in vitro leached silver, quantified by inductively coupled plasma optical emission spectroscopy (ICP-OES), proved non-cytotoxic when tested against hASCs, as evaluated by MTT assay. PMID:22700366
77 FR 19293 - Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Meeting
Federal Register 2010, 2011, 2012, 2013, 2014
... the Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee. Submit... INFORMATION: Name of Committee: Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory... with or considering hip replacement (...
Understanding Orthopaedic Registry Studies: A Comparison with Clinical Studies.
Inacio, Maria C S; Paxton, Elizabeth W; Dillon, Mark T
Orthopaedic registries are valuable for monitoring patient outcomes in real-world settings. Registries are useful for identifying procedure incidence and device utilization, evaluating outcomes, determining patients at risk for complications and reoperations, identifying devices in recall situations, assessing comparative effectiveness of procedures and devices, and providing data for research studies. In the present report, we describe how orthopaedic registries can be used to conduct research and how they compare with randomized controlled trials (RCTs) in regard to methodology. Using an example, a comparison of the performance of mobile and fixed bearings in total knee arthroplasty, we evaluate the differences between, and the similarities of, RCTs and registry cohort studies with regard to how they are conducted and how their findings are reported. Orthopaedic registry studies differ from RCTs in many ways and offer certain advantages. The strengths and limitations of registry cohort studies and RCTs must be understood to properly evaluate the literature. PMID:26738910
Orthopaedic surgery in patients with von Willebrand disease.
Siboni, S M; Biguzzi, E; Solimeno, L P; Pasta, G; Mistretta, C; Mannucci, P M; Peyvandi, F
Patients with von Willebrand disease (VWD) may need orthopaedic surgery because of disabling chronic arthropathy due to recurrent joint bleeding. They may also require this surgery independently of their haemostasis disorder. Knowledge regarding the management of orthopaedic surgery in VWD is limited. Description of management of orthopaedic surgery in patients with VWD, based upon retrospective data collection and analysis of 32 orthopaedic procedures carried out over a period of 33 years in 23 patients was the aim of this study. Of 32 procedures, six were minor (three hand surgery, one foot surgery, two others) and 26 were major (seven joint replacements, nine arthroscopic procedures, two foot surgery, eight others). Twenty-two procedures were performed using replacement therapy with plasma-derived concentrates containing both factor VIII (FVIII) and von Willebrand factor (VWF). Two procedures in patients with acquired von Willebrand syndrome (AWVS) were performed using FVIII-VWF concentrates associated with intravenous immunoglobulins, or desmopressin plus tranexamic acid. Seven procedures were performed using desmopressin alone and one using intravenous immunoglobulins in AVWS. Bleeding complications occurred in seven procedures (22%). In one patient, an anti-VWF antibody was diagnosed after surgery. Anticoagulant prophylaxis of venous thromboembolism was implemented in four cases only and in two instances there was excessive bleeding. In conclusion, control of surgical haemostasis was achieved in most patients with VWD undergoing orthopaedic surgery. The control of haemostasis combined with an adequate surgical technique and early post-operative rehabilitation are warranted for the successful performance of orthopaedic surgery in VWD, which requires the involvement of specialized haemophilia centres. PMID:23992395
The Orthopaedic Trauma Patient Experience: A Qualitative Case Study of Orthopaedic Trauma Patients in Uganda
O'Hara, Nathan N.; Mugarura, Rodney; Slobogean, Gerard P.; Bouchard, Maryse
The disability adjusted life years (DALYs) associated with injuries have increased by 34% from 1990 to 2010, making it the 10th leading cause of disability worldwide, with most of the burden affecting low-income countries. Although disability from injuries is often preventable, limited access to essential surgical services contributes to these increasing DALY rates. Similar to many other low- and middle-income countries (LMIC), Uganda is plagued by a growing volume of traumatic injuries. The aim of this study is to explore the orthopaedic trauma patient's experience in accessing medical care in Uganda and what affects the injury might have on the socioeconomic status for the patient and their dependents. We also evaluate the factors that impact an individual's ability to access an appropriate treatment facility for their traumatic injury. Semi-structured interviews were conducted with patients 18 year of age or older admitted with a fractured tibia or femur at Mulago National Referral Hospital in Kampala, Uganda. As limited literature exists on the socioeconomic impacts of disability from trauma, we designed a descriptive qualitative case study, using thematic analysis, to extract unique information for which little has been previously been documented. This methodology is subject to less bias than other qualitative methods as it imposes fewer preconceptions. Data analysis of the patient interviews (n = 35) produced over one hundred codes, nine sub-themes and three overarching themes. The three overarching categories revealed by the data were: 1) the importance of social supports; 2) the impact of and on economic resources; and 3) navigating the healthcare system. Limited resources to fund the treatment of orthopaedic trauma patients in Uganda leads to reliance of patients on their friends, family, and hospital connections, and a tremendous economic burden that falls on the patient and their dependents. PMID:25360815
Promoting safety of postoperative orthopaedic patients with obstructive sleep apnea.
Veney, Amy J
Orthopaedic patients with obstructive sleep apnea are at risk for postoperative complications related to administration of pain medications, anxiolytics, and antiemetics. They are more likely to experience respiratory and cardiac complications, be transferred to an intensive care unit, or have an increased length of stay in the hospital. This informational article is for nurses who care for postoperative orthopaedic patients with obstructive sleep apnea. The focus is on promoting patient safety through communication, vigilant postoperative sedation assessment, and nursing interventions that include appropriate patient positioning, patient education, and involving patients and their families in care. PMID:24247310
Imaging in scoliosis from the orthopaedic surgeon's point of view.
Thomsen, Marc; Abel, Rainer
For treating patients with scoliosis orthopaedic surgeons need diagnostic imaging procedures in order to provide answers about a possible underlying disease, choice of treatment, and prognosis. Once treatment is instituted, imaging is also critical for monitoring changes of the deformity so as to optimize therapy. The combined effort of orthopaedic surgeons and radiologists helps detect treatable causes of scoliosis at an early stage, define the need and timing for surgery, and ensure that every precaution is taken to minimize the risks of surgery. Neurosurgical causes, with particular reference to spinal cord tumours and syringomyelia, need to be addressed before scoliosis surgery can be contemplated. PMID:16439089
Computer Aided Orthopaedic Surgery: Incremental shift or paradigm change?
Joskowicz, Leo; Hazan, Eric J
Computer Aided Orthopaedic Surgery (CAOS) is now about 25 years old. Unlike Neurosurgery, Computer Aided Surgery has not become the standard of care in Orthopaedic Surgery. In this paper, we provide the technical and clinical context raised by this observation in an attempt to elucidate the reasons for this state of affairs. We start with a brief outline of the history of CAOS, review the main CAOS technologies, and describe how they are evaluated. We then identify some of the current publications in the field and present the opposing views on their clinical impact and their acceptance by the orthopaedic community worldwide. We focus on total knee replacement surgery as a case study and present current clinical results and contrasting opinions on CAOS technologies. We then discuss the challenges and opportunities for research in medical image analysis in CAOS and in musculoskeletal radiology. We conclude with a suggestion that while CAOS acceptance may be more moderate than that of other fields in surgery, it still has a place in the arsenal of useful tools available to orthopaedic surgeons. PMID:27407004
Reading the Small Print – Labelling Recommendations for Orthopaedic Implants
Haene, Roger A; Sandhu, Ranbir S; Baxandall, Richard
INTRODUCTION There exist, currently, no clear guidelines regarding standards for surgical implant labelling. Dimensions of the laminar flow canopies in orthopaedic use fixes the distance at which implant labels can be read. Mistakes when reading the label on an implant box can pose health risks for patients, and financial consequences for medical institutions. SUBJECTS AND METHODS Using scientifically validated tools such as the Snellen Chart Formula, a theoretical minimum standard for text on implant labels was reached. This theoretical standard was then tested under real operating conditions. After discovering a minimum practical standard for implant labels, the authors then audited current labels in use on a wide range of orthopaedic implant packages. Furthermore, other non-text-related labelling problems were also noted. RESULTS There is a definite minimum standard which should be observed when implant labels are manufactured. Implants in current use bear labels on the packaging that are of an insufficient standard to ensure patient safety in theatre. CONCLUSIONS The authors have established text parameters that will increase the legibility of implant labels. In the interests of improving risk management in theatre, therefore, the authors propose a standard for orthopaedic implant labelling, and believe this will provide a useful foundation for further discussion between the orthopaedic community and implant manufacturers. PMID:19686615
Clubfoot: An Orthopaedic Surgeon Describes Clubfoot and Current Treatment Methods
ERIC Educational Resources Information Center
Vitale, Michael
As an orthopaedic surgeon who has treated numerous cases of clubfoot in his career, the author knows that it takes exceptional parents to deal with the challenges of having a child born with a clubfoot. However, it should be noted that a clubfoot diagnosis does not mean a life of pain, deformity, and disability for a child. Today's treatment…
Military Orthopaedic Trauma Registry: Quality Data Now Available.
Rivera, Jessica C; Greer, Renee M; Wenke, Joseph C; Ficke, James R; Johnson, Anthony E
The Military Orthopaedic Trauma Registry (MOTR) orginally began as part of the Department of Defense Trauma Registry (DoDTR) and became a live registry in 2013. As a quality improvement process, this study examined MOTR data for 20 female amputees compared with DoDTR data. The DoDTR provided diagnosis and procedure codes as a list but no details. The MOTR provided additional data, including specific limb, fracture classifications, and associated injuries per limb. The MOTR allowed for construction of a treatment time line for each limb, including number and timing of debridements, antibiotics, and implant types. Orthopaedic-specific complications were also coded more frequently in the MOTR and clearly identified with a specific injury and treatment. During initial quality control checks, the MOTR provides a greater volume and granularity of detail for orthopaedic-specific injury and treatment information, indicating that the MOTR is on track to provide a valuable repository for data-driven orthopaedic management of combat injury. PMID:27518292
Moire Topography For The Detection Of Orthopaedic Defects
NASA Astrophysics Data System (ADS)
Kamal, Syed A.; Lindseth, Richard E.
Moire topography is applied for the follow-up of scoliosis patients. The results are then compared with the X-rays. A special lamp and scale arrangement is utilized for patient alignment. It is suggested that this technique will be used for the detection of all orthopaedic defects.
Institutional barriers to the orthopaedic clinician-scientist.
Rosier, Randy N
The clinician-scientist faces many career barriers that changes in medicine over the past two decades have accentuated. Political, socioeconomic, and cultural changes in medicine have increased financial pressures on physicians and hospitals, negatively impacting the ability of clinicians to pursue research activities. Examples of institutional barriers include pressure on physicians to increase clinical productivity to help offset rising costs and declining reimbursements, inadequate resources and structures to protect research time, a lack of consideration of the importance of spatial colocalization of interacting researchers and clinicians, insufficient focus on integrating clinician-scientists into research teams, and inadequate accessibility of administrative research infrastructure. Lack of mentorship and role models in orthopaedics also contributes to the barriers confronting the clinician-scientist. A number of steps could be taken by institutions to positively influence orthopaedic clinician-scientist career development. Creation of research teams in which orthopaedic clinician-scientists can collaborate effectively with other researchers is a critical step, as is providing protected time free of clinical responsibilities to be devoted to research. Increased attention to physical co-localization of the research activities of clinicians and scientists, and provision of research infrastructure at the department level are additional approaches that can be taken to ameliorate the institutional barriers to the orthopaedic clinician-scientist. PMID:16888531
Improving translation success of cell-based therapies in orthopaedics.
Bara, Jennifer J; Herrmann, Marietta; Evans, Christopher H; Miclau, Theodore; Ratcliffe, Anthony; Richards, R Geoff
There is a clear discrepancy between the growth of cell therapy and tissue engineering research in orthopaedics over the last two decades and the number of approved clinical therapies and products available to patients. At the 2015 annual meeting of the Orthopaedic Research Society, a workshop was held to highlight important considerations from the perspectives of an academic scientist, clinical researcher, and industry representative with the aim of helping researchers to successfully translate their ideas into clinical and commercial reality. Survey data acquired from workshop participants indicated an overall positive opinion on the future potential of cell-based therapies to make a significant contribution to orthopaedic medicine. The survey also indicated an agreement on areas requiring improvement in the development of new therapies, specifically; increased support for fundamental research and education and improved transparency of regulatory processes. This perspectives article summarises the content and conclusions of the workshop and puts forward suggestions on how translational success of cell-based therapies in orthopaedics may be achieved. PMID:26403666
Your first job in orthopaedic trauma: strategies for your career.
Roberts, Craig S; Cannada, Lisa K
Your first job in orthopaedic surgery is the culmination of years of training and hard work. This article will cover strategies for your first job search and your future career. We discuss job searching strategies prioritizing what is important. And once you start your first job, we discuss tips for how to make a good first impression and begin a successful career. PMID:25147996
Eponymous signs in dermatology
Madke, Bhushan; Nayak, Chitra
Clinical signs reflect the sheer and close observatory quality of an astute physician. Many new dermatological signs both in clinical and diagnostic aspects of various dermatoses are being reported and no single book on dermatology literature gives a comprehensive list of these "signs" and postgraduate students in dermatology finds it difficult to have access to the description, as most of these resident doctor do not have access to the said journal articles. "Signs" commonly found in dermatologic literature with a brief discussion and explanation is reviewed in this paper. PMID:23189246
[Dr. Michiharu Matsuoka, founder of the Department of Orthopaedic Surgery, Kyoto University, and his achievements (Part 6: Studying abroad of Dr. Matsuoka and opening to public, reputation and achievement of the department)].
Hirotani, Hayato
Dr. Michiharu Matsuoka studied orthopaedic surgery in Germany, Austria and other countries during the period from August, 1902 to May, 1906. He visited many university pathological institutes and surgical and orthopaedic clinics to study pathology and to learn the practice of orthopaedic surgery. After that, he started his practice at the newly established Department of Orthopaedic Surgery in the Medical School of Kyoto Imperial University in June, 1906. The department was opened in 1907 and in 1911 it was opened to all citizens and practical doctors in Kyoto City and exhibited many orthopaedic specimens and instruments. In particular, the x-ray apparatus of the Department was so well equipped that a German radiologist who visited the Department admired it in his article that was published in the journal of radiology in 1911. The Department was not surpassed by others for the number of patients with the dislocation of the hip and tuberculous spondylitis as well as the advanced quality and variety of roentgenological and pathological researches on these diseases. PMID:21797054
A NASA discovery has current applications in orthopaedics
Low-level laser therapy (LLLT) has been actively used for nearly 40 yr, during which time it has been known to reduce pain, inflammation, and edema. It also has the ability to promote healing of wounds, including deep tissues and nerves, and prevent tissue damage through cell death. Much of the landmark research was done by the National Aeronautics and Space Administration (NASA), and these studies provided a springboard for many additional basic science studies. Few current clinical studies in orthopaedics have been performed, yet only in the past few years have basic science studies outlined the mechanisms of the effect of LLLT on the cell and subsequently the organism. This article reviews the basic science of LLLT, gives a historical perspective, and explains how it works, exposes the controversies and complications, and shows the new immediately applicable information in orthopaedics. PMID:25541589
Essentials of disaster management: the role of the orthopaedic surgeon.
Born, Christopher T; Monchik, Keith O; Hayda, Roman A; Bosse, Michael J; Pollak, Andrew N
Disaster preparedness and management education is essential for allowing orthopaedic surgeons to play a valuable, constructive role in responding to disasters. The National Incident Management System, as part of the National Response Framework, provides coordination between all levels of government and uses the Incident Command System as its unified command structure. An "all-hazards" approach to disasters, whether natural, man-made, intentional, or unintentional, is fundamental to disaster planning. To respond to any disaster, command and control must be established, and emergency management must be integrated with public health and medical care. In the face of increasing acts of terrorism, an understanding of blast injury pathophysiology allows for improved diagnostic and treatment strategies. A practical understanding of potential biologic, chemical, and nuclear agents and their attendant clinical symptoms is also prerequisite. Credentialing and coordination between designated organizations and the federal government are essential to allow civilian orthopaedic surgeons to access systems capable of disaster response. PMID:21553757
Resident selection: a key to the future of orthopaedics.
Evarts, C McCollister
Recognizing the challenges presented in the process of resident selection, in 1981 the American Orthopaedic Association formed a Steering Committee on Resident Selection. This Committee was charged with studying the processes involved in the selection of orthopaedic residents and developing guidelines and making suggestions to program directors. The activities of the Committee focused on five areas: (1) the mechanics of resident selection; (2) the assessment of cognitive skills; (3) the assessment of motor ability; (4) the assessment of noncognitive factors (the affective domain); (5) the assessment of "dropouts." The Committee made the following recommendations to help program directors in the selection of residents: (1) use of a standardized application form; (2) full disclosure to applicants; (3) careful selection of candidates to be interviewed; (4) careful planning and implementation of the interview and visit; (5) broad faculty representation and discussion at time of selection; (6) due diligence when necessary. We still believe these criteria important in resident selection. PMID:16788399
Considerations in the Radiologic Evaluation of the Pregnant Orthopaedic Patient.
Matzon, Jonas L; Lutsky, Kevin F; Ricci, Emily K; Beredjiklian, Pedro K
Radiographic imaging of the pregnant patient represents a diagnostic and management dilemma for the orthopaedic surgeon. Imaging is often necessary in the setting of trauma; however, in utero radiation exposure can result in deleterious developmental effects in the embryo and fetus. The likelihood of a negative effect is proportional to the radiation dose and the gestational age of the embryo or fetus at the time of exposure. Ionizing radiation doses >100 mGy in the first trimester of pregnancy may lead to spontaneous abortion, malformation, and mental retardation. Whereas plain radiographs of the extremities and cervical spine expose the fetus to minimal doses of radiation of <10 mGy, other commonly performed orthopaedic diagnostic studies, such as CT of the pelvis, emit significantly higher exposure doses of approximately 35 mGy. Non-emitting modalities, such as ultrasonography and MRI, are alternatives for evaluation in the clinical setting. PMID:26116850
Composite Bone Models in Orthopaedic Surgery Research and Education
Elfar, John; Stanbury, Spencer; Menorca, Ron Martin Garcia; Reed, Jeffrey Douglas
Composite bone models are increasingly used in orthopaedic biomechanics research and surgical education—applications that traditionally relied on cadavers. Cadaver bones are suboptimal for myriad reasons, including issues of cost, availability, preservation, and inconsistency between specimens. Further, cadaver samples disproportionately represent the elderly, whose bone quality may not be representative of the greater orthopaedic population. The current fourth-generation composite bone models provide an accurate reproduction of the biomechanical properties of human bone when placed under bending, axial, and torsional loads. The combination of glass fiber and epoxy resin components into a single phase has enabled manufacturing by injection molding. The high anatomic fidelity of the cadaver-based molds and negligible shrinkage properties of the epoxy resin results in a process that allows for excellent definition of anatomic detail in the cortical wall and optimized consistency of features between models. Recent biomechanical studies of composites have validated their use as a suitable substitute for cadaver specimens. PMID:24486757
Minimally invasive surgery in orthopaedics. Small is beautiful?
Yeung, S H
With the blooming of minimally invasive procedures in surgical specialties, many orthopaedic subspecialties have been evolving along such lines. Despite the apparent paradox that many orthopaedic implants are quite bulky to start off with, different methods have been adopted to insert them safely with the least possible trauma. Altering time-honoured incisions and surgical techniques has often been helpful. The industry is also very keen to re-design implants for this purpose and has contributed substantial momentum in this direction. Coupled with the use of operating microscopes, endoscopes, and imaging modalities, operations can be performed with greater precision and lesser trauma. The advent of computer-assisted technology is another step forward. It is through constant attention to minimising tissue trauma and a combination of different methods available, that surgeons can achieve the ultimate goals of minimally invasive surgery. PMID:18685164
Composite bone models in orthopaedic surgery research and education.
Elfar, John; Menorca, Ron Martin Garcia; Reed, Jeffrey Douglas; Stanbury, Spencer
Composite bone models are increasingly used in orthopaedic biomechanics research and surgical education-applications that traditionally relied on cadavers. Cadaver bones are suboptimal for many reasons, including issues of cost, availability, preservation, and inconsistency between specimens. Further, cadaver samples disproportionately represent the elderly, whose bone quality may not be representative of the greater orthopaedic population. The current fourth-generation composite bone models provide an accurate reproduction of the biomechanical properties of human bone when placed under bending, axial, and torsional loads. The combination of glass fiber and epoxy resin components into a single phase has enabled manufacturing by injection molding. The high level of anatomic fidelity of the cadaver-based molds and negligible shrinkage properties of the epoxy resin results in a process that allows for excellent definition of anatomic detail in the cortical wall and optimized consistency of features between models. Recent biomechanical studies of composites have validated their use as a suitable substitute for cadaver specimens. PMID:24486757
Radiation safety for anaesthesia providers in the orthopaedic operating room.
Rhea, E B; Rogers, T H; Riehl, J T
In many orthopaedic operating rooms, anaesthesia providers routinely wear lead aprons for protection from radiation, but some studies have questioned whether this is needed. We conducted a systematic review to identify studies that measured the amount of radiation that anaesthetists were exposed to in the orthopaedic operating room. Multiple studies have shown that at 1.5 m from the source of radiation, anaesthetists received no radiation, or amounts so small that a person would have to be present in an unreasonable number of operations to receive cumulative doses of any significance. Radiation doses at this distance were often at the limits of the sensitivity of the measuring dosimeter. We question the need to wear lead protection for anaesthesia providers who are routinely at 1.5 m or a greater distance from standard fluoroscopy units. PMID:26874074
Step up in orthopaedic care for Stockport Trust.
Baillie, Jonathan
Specialist in the design and construction of modular healthcare buildings MTX Contracts has recently completed, on time and on budget, Stockport NHS Foundation Trust's impressive new four-storey orthopaedic and surgical facility at Stepping Hill Hospital. The company claims the new facility offers a quality of build and finish "as close to that of traditional build as is possible using modular construction techniques". Jonathan Baillie reports. PMID:19452799
Image guidance in orthopaedics and traumatology: A historical perspective.
Székely, Gabor; Nolte, Lutz-P
In this note we summarize the history of computer aided surgery in orthopaedics and traumatology from the end of the nineteenth century to currently observable future trends. We concentrate on the two major components of such systems, pre-operative planning and intra-operative execution. The evolution of the necessary technological components, the numerous platforms and components offered commercially as well as their clinical use are surveyed. PMID:27377330
Neoprene Orthopaedic Supports: An Underrecognised Cause of Allergic Contact Dermatitis.
Hawkey, S; Ghaffar, S
Thioureas, often contained within neoprene to provide water resistance, are an important cause of allergic contact dermatitis (ACD) in those who use neoprene products. We wish to present three cases of thiourea-induced ACD from three different orthopaedic supports containing neoprene. The first case was a 67-year-old woman who developed an itchy rash on her heel three weeks after using a neoprene insole for plantar fasciitis. The second case was a 47-year-old man who developed an itchy rash on his wrist after wearing neoprene wrist splints for psoriatic arthropathy. The third case was a 77-year-old woman who experienced a severe erythematous rash with blistering from a neoprene elbow brace she received following a humeral fracture. All patients were patch tested to the British Society of Cutaneous Allergy Standard and rubber series and a cut piece from all the relevant supports. At 96 hours, all patients had a + reaction to mixed dialkylthiourea, diethylthiourea, and the supports' material. No other positive patch test reactions were identified. As neoprene is fast becoming one of the most popular materials used for orthopaedic supports, awareness of this reaction and close liaison between dermatologists and orthopaedic surgeons are therefore essential to allow for early recognition of this complication. PMID:26236520
Hip arthroscopy: a report on a cohort of orthopaedic surgeons
Byrd, J. W. Thomas; Jones, Kay S.; Chin, Paul C.
Successful hip arthroscopy depends on proper patient selection and reasonable patient expectations. The purpose of this study is to report the results of hip arthroscopy in orthopaedic surgeons who represent the most informed cohort. This report is based on a retrospective review of prospectively collected data among 24 orthopaedic surgeons (1 bilateral). Follow-up averaged 48 months (range 12–120 months). They were all males with an average age of 45 years (range 30–64 years). All improved with an average of 18 points (preoperative 75; post-operative 93); although one underwent repeat arthroscopy and one was converted to total hip arthroplasty at 54 months. There were numerous diagnoses and procedures performed and one complication (acute coronary artery occlusion). They resumed seeing patients at an average of 1.6 weeks (range 2 days–4 weeks) and operating at an average of 3.1 weeks (range 6 days–8 weeks). This report spans three decades, thus representing a heterogeneous population in terms of diagnoses and treatment. Nonetheless, successful results are noted. As a cohort, orthopaedic surgeons possess the greatest insight into hip arthroscopy, but as patients, often they must modulate their expectations in order to match the understanding of the realities of the procedure. PMID:27583146
Orthopaedic Trauma Care Specialist Program for Developing Countries.
Slobogean, Gerard; Sprague, Sheila; Furey, Andrew; Pollak, Andrew
The dire challenges faced in Haiti, both preearthquake and postearthquake, highlight the need for developing surgical infrastructure to care for traumatic musculoskeletal injuries. The proposed Orthopaedic Trauma Care Specialist (OTCS) residency program aims to close the critical human resource gap that limits the appropriate care of musculoskeletal trauma in Haiti. The OTCS program is a proposal for a 2-year residency program that will focus primarily on the management of orthopaedic trauma. The proposed program will be a comprehensive approach for implementing affordable and sustainable strategies to improve orthopaedic trauma care. Its curriculum will be tailored to the injuries seen in Haiti, and the treatments that can be delivered within their health care system. Its long-term sustainability will be based on a "train-the-trainers" approach for developing local faculty to continue the program. This proposal outlines the OTCS framework specifically for Haiti; however, this concept is likely applicable to other low- and middle-income environments in a similar need for improved trauma and fracture care. PMID:26356211
Preparedness of orthopaedic surgeons for modern battlefield surgery.
Kearney, Sean P; Bluman, Eric M; Lonergan, Keith T; Arrington, Edward D; Ficke, James R
Over 220 U.S. Army orthopaedic surgeons have deployed during the Global War on Terrorism (GWOT). This study documents the orthopaedic procedures performed during the GWOT and identifies training that prepared surgeons for deployment. It reveals deficiencies in surgeons' preparedness and intends to improve predeployment training. All surgeons deployed during the GWOT from 2001 to 2007 were surveyed. Questions fit 4 general categories: deployment demographics, medical and surgical experiences, predeployment preparation, and self-perceived preparedness during deployment. Response rate was 70%. Surgeons averaged 138 adult operative cases and 26 pediatric cases per deployment. All surgeons performed irrigation and debridement, 94% external fixation, 93% amputations, 89% arthrotomies, 86% open reduction and internal fixation, and 76% soft-tissue coverage procedures. Residency and fellowship contributed most to surgeon preparedness for deployment. Surgeons generally reported high levels of preparedness, but nearly 1 in 6 reported low levels of medical, surgical and physical preparedness. More reported low levels of mental preparedness. Soft-tissue coverage was the most frequently reported surgical deficiency. This study documents the number and types of orthopaedic procedures performed during the GWOT and identifies the self-perceived preparedness deficiencies of surgeons in a combat environment. Improvements in predeployment training are needed to better prepare surgeons for managing battlefield causalities. PMID:23025135
Expansion of the Coordinator Role in Orthopaedic Residency Program Management
Murphy, Laurie A.; Murphy, James E.
The Accreditation Council of Graduate Medical Education's (ACGME) Data Accreditation System indicates 124 of 152 orthopaedic surgery residency program directors have 5 or fewer years of tenure. The qualifications and responsibilities of the position based on the requirements of orthopaedic surgery residency programs, the institutions that support them, and the ACGME Outcome Project have evolved the role of the program coordinator from clerical to managerial. To fill the void of information on the coordinators' expanding roles and responsibilities, the 2006 Association of Residency Coordinators in Orthopaedic Surgery (ARCOS) Career survey was designed and distributed to 152 program coordinators in the United States. We had a 39.5% response rate for the survey, which indicated a high level of day-to-day managerial oversight of all aspects of the residency program; additional responsibilities for other department or division functions for fellows, rotating medical students, continuing medical education of the faculty; and miscellaneous business functions. Although there has been expansion of the role of the program coordinator, challenges exist in job congruence and position reclassification. We believe use of professional groups such as ARCOS and certification of program coordinators should be supported and encouraged. PMID:18196362
Najibi, S; Banglmeier, R; Matta, JM; Tannast, M
Suture materials in orthopaedic surgery are used for closure of wounds, repair of fascia, muscles, tendons, ligaments, joint capsules, and cerclage or tension band of certain fractures. The purpose of this study was to compare the biomechanical properties of eleven commonly used sutures in orthopaedic surgery. Three types of braided non-absorbable and one type of braided absorbable suture material with different calibers (n=77) underwent biomechanical testing for maximum load to failure, strain, and stiffness. All samples were tied by one surgeon with a single SMC (Seoul Medical Center) knot and three square knots. The maximum load to failure and strain were highest for #5 FiberWire and lowest for #0 Ethibond Excel (p<0.001). The stiffness was highest for #5 FiberWire and lowest for #2-0 Vicryl (p<0.001). In all samples, the failure of the suture material occurred at the knot There was no slippage of the knot in any of the samples tested. This data will assist the orthopaedic surgeon in selection and application of appropriate suture materials and calibers to specific tasks. PMID:21045977
[Orthopaedic implants. Application outside of patient care?].
Manhart, J; Dietze, A; Büttner, A
Internal fracture fixation represents a widespread concept for the treatment of fractures. As the number of implants increases, person tracking may be possible. In spring 2010 near Rostock (Germany), human remains including a stainless steel nail were found. Forensic analysis considered the parts of skeleton to belong to a man of medium height, exposed to outdoor conditions for several years to a few decades. The tibial nail was analysed and according to the product identification number possible hospitals of implant placement and transportation paths were determined and screened. Furthermore a match analysis of the database of missing individuals of the last 15 years was undertaken and a DNA match analysis identified a local individual who had been missing since winter 2003. Equipped with the actual patient's identity, out of academic interest a survey of clinical documents such as discharge letters and operative reports was performed, but was inconclusive. Although technically feasible, tracking the patient in this case based on the implant product number itself was unsuccessful. In this case report, the feasibility, validity and efficiency of this option are presented and discussed. PMID:24458026
The Deployed Military Orthopaedic Surgeon: Experiences of a Recent Iowa Graduate in Afghanistan
Malin, Andrew S.; Brannan, Patrick S
Orthopaedic surgeons deployed to Afghanistan are primarily responsible for the provision of care to injured Us and coalition soldiers. A vast and well-coordinated system of echeloned care has evolved to rapidly treat and evacuate injured soldiers. Orthopaedic care of injured Afghan civilians represents a common secondary mission performed by deployed orthopaedic surgeons. In this article, I describe my experiences while deployed to Afghanistan in 2011 as part of the special Operations surgical team. PMID:23576947
Evaluation of the sterilization efficacy of domestic electric drills used in orthopaedic surgeries
Goveia, Vania Regina; Pinto, Flavia Morais Gomes; Machoshvili, Irene Alexeevna; Penna, Thereza Christina Vessoni; Graziano, Kazuko Uchikawa
It is estimated that electric drills (ED) have been used in orthopaedic surgeries for bone drilling for more than 50 years in Brazilian hospitals. It is an electric, thermosensitive equipment, not indicated for surgical use, which has not been previously evaluated regarding the sterilization efficacy, being suspect of infection risk. This study evaluated the efficacy of sterilization by ethylene oxide (EtO) of new drills that were intentionally contaminated with Bacillus atrophaeus spores. An experimental, laboratory, randomized applied research was developed, where 16 electric drills were analyzed, in addition to positive and negative controls. All the previously cleaned and sterilized equipment were submitted to contamination by spores. The experimental group was submitted to cleaning and sterilization by EtO and test of sterility by filtration through a 0.45 >m membrane. The membranes were cultivated and Gram and Wirtz-Conklin staining were carried out in positive results for spore visualization. An efficacy of 99.99999881% of the process of sterilization by EtO was confirmed, with a probability of survival of 1.19 x 10 -8. Under the development conditions of the experiment, the efficacy of the sterilization of ED by EtO was confirmed. PMID:24031397
One in the eye for an orthopaedic surgeon.
Lourie, J.; Hamid, K.
Despite many reports of injuries to surgeons during operative procedures, there is no record of an eye injury caused by a foreign body. Orthopaedic surgeons are particularly vulnerable to such injury. An instance in which a penetrating eye injury occurred while hammering a rasp into the femur during a hip replacement is described. There is a potential oblique trajectory for a foreign body to reach the eye from the operative field despite the use of a visor for eye protection. Images Figure 1 Figure 2 PMID:8659981
Rapid Prototyping in Orthopaedic Surgery: A User's Guide
Frame, Mark; Huntley, James S.
Rapid prototyping (RP) is applicable to orthopaedic problems involving three dimensions, particularly fractures, deformities, and reconstruction. In the past, RP has been hampered by cost and difficulties accessing the appropriate expertise. Here we outline the history of rapid prototyping and furthermore a process using open-source software to produce a high fidelity physical model from CT data. This greatly mitigates the expense associated with the technique, allowing surgeons to produce precise models for preoperative planning and procedure rehearsal. We describe the method with an illustrative case. PMID:22666160
Improving patient flow: role of the orthopaedic discharge sister.
Tytler, Beverley
Timely and well-planned discharge improves the patient's experience, contributes to patient safety and reduces the length of hospital stays. The role of orthopaedic discharge sister was developed at James Cook University Hospital in 2007 to provide safe, timely and efficient discharge for patients from the trauma and theatre centre, and to improve patient experience and flow. This article gives an overview of the role and describes how the sister works with colleagues to plan patient discharges from pre-assessment and emergency department admission through their hospital stay until their departure. PMID:26948225
The Orthopaedic Training Study, Phase II 1968-1972. Final Report, Volume I.
ERIC Educational Resources Information Center
Olson, Carl J.; And Others
Phase two of the Orthopaedic Training Study was designed to examine time, sequence, and content requirements of existing orthopaedic programs. Specifically, the proposal was designed to achieve the following objectives: (1) to provide a model of individualized graduate education in medicine in which the demonstration of individual competence marks…
Long Sick Leave after Orthopaedic Inpatient Rehabilitation: Treatment Failure or Relapse?
ERIC Educational Resources Information Center
Mangels, Marija; Schwarz, Susanne; Worringen, Ulrike; Holme, Martin; Rief, Winfried
We investigated whether short-term versus long-term sick leave after orthopaedic inpatient rehabilitation can be predicted by initial assessment information, the clinical status at discharge, or whether the follow-up interval is crucial for later sick leave. We examined 214 patients from an orthopaedic rehabilitation hospital at admission,…
75 FR 33995 - Safety Zone; Michigan Orthopaedic Society 50th Anniversary Fireworks, Lake Huron, Mackinac Island...
Federal Register 2010, 2011, 2012, 2013, 2014
... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone; Michigan Orthopaedic Society 50th... Society 50th Anniversary Fireworks display, June 19, 2010. This temporary safety zone is necessary to... vessels during the setup and launching of fireworks in conjunction with the Michigan Orthopaedic...
Battlefield orthopaedic injuries cause the majority of long-term disabilities.
Cross, Jessica D; Ficke, James R; Hsu, Joseph R; Masini, Brendan D; Wenke, Joseph C
Extremity injuries make up 54% of combat wounds sustained in Operation Iraqi Freedom and Operation Enduring Freedom. In a cohort of war-wounded service members, we identified the conditions secondary to battle injury that result in disqualification from continued service. The Army Physical Evaluation Board records of 464 wounded service members who were injured between October 2001 and January 2005 were reviewed to determine the codes indicating unfitting conditions. Sixty-nine percent of these conditions were orthopaedic. Fifty-seven percent of the injured had unfitting conditions that were orthopaedic only. Of those evacuated from theater with a primary diagnosis of injury to the head, thorax, or abdomen and who suffered an orthopaedic injury as well, 76% had an orthopaedic diagnosis as the primary unfitting condition. Orthopaedic-related disability has a significant impact on the affected patient, the health care system, and, in the case of wounded service members, on military strength and readiness. PMID:21304041
Stem cell-based tissue engineering in veterinary orthopaedics.
Brehm, Walter; Burk, Janina; Delling, Uta; Gittel, Claudia; Ribitsch, Iris
Regenerative medicine is one of the most intensively researched medical branches, with enormous progress every year. When it comes to translating research from bench to bedside, many of the pioneering innovations are achieved by cooperating teams of human and veterinary medical scientists. The veterinary profession has an important role to play in this new and evolving technology, holding a great scientific potential, because animals serve widely as models for human medicine and results obtained from animals may serve as preclinical results for human medicine. Regenerative veterinary medicine utilizing mesenchymal stromal cells (MSC) for the treatment of acute injuries as well as chronic disorders is gradually turning into clinical routine. As orthopaedic disorders represent a major part of all cases in veterinary clinical practice, it is not surprising that they are currently taking a leading role in MSC therapies. Therefore, the purpose of this paper is to give an overview on past and current achievements as well as future perspectives in stem cell-based tissue engineering in veterinary orthopaedics. PMID:22287044
What Do Reported Learning Curves Mean for Orthopaedic Surgeons?
Gofton, Wade T; Solomon, Michael; Gofton, Tyson; Pagé, Alex; Kim, Paul R; Netting, Caleb; Bhandari, Mohit; Beaulé, Paul E
Practicing orthopaedic surgeons must assess the effects of the learning curve on patient safety and surgical outcomes if a new implant, technique, or approach is being considered; however, it remains unclear how learning curves reported in the literature should be interpreted and to what extent their results can be generalized. Learning curve reports from other surgical specialties and from orthopaedic surgery can be analyzed to identify the strengths and weaknesses of learning curve reporting. Single-surgeon series and registry data can be analyzed to understand learning challenges and to develop a personalized learning plan. Learning curve reports from single-surgeon series have several limitations that result from the limited dataset reported and inconsistencies in the way data are reported. Conversely, learning curve reports from registry data are likely to have greater generalizability, but are largely beneficial retrospectively, after data from a sufficient number of surgeons are assessed. There is a pressing need for surgeons to develop improved and consistent standards for learning curve reporting. Although registry data may provide better prospective measures in the future, the implementation of such registries faces several challenges. Despite substantial limitations, single-surgeon series remain the most effective way for practicing surgeons to assess their learning challenge and develop an appropriate learning plan. PMID:27049229
Orthopaedic applications for PLA-PGA biodegradable polymers.
Athanasiou, K A; Agrawal, C M; Barber, F A; Burkhart, S S
Biodegradable polymers, especially those belonging to the family of polylactic acid (PLA) and polyglycolic acid (PGA), play an increasingly important role in orthopaedics. These polymers degrade by hydrolysis and enzymatic activity and have a range of mechanical and physical properties that can be engineered appropriately to suit a particular application. Their degradation characteristics depend on several parameters including their molecular structure, crystallinity, and copolymer ratio. These biomaterials are also rapidly gaining recognition in the fledging field of tissue engineering because they can be fashioned into porous scaffolds or carriers of cells, extracellular matrix components, and bioactive agents. Although their future appears to be bright, several questions regarding the biocompatibility of these materials linger and should be addressed before their wide-scale use. In the context of musculoskeletal tissue, this report provides a comprehensive review of properties and applications of biodegradable PLA/PGA polymers and their copolymers. Of special interest are orthopaedic applications, biocompatibility studies, and issues of sterilization and storage of these versatile biomaterials. Also discussed is the fact that terms such as PLA, PGA, or PLA-PGA do not denote one material, but rather a large family of materials that have a wide range of differing bioengineering properties and concomitant biological responses. An analysis of some misconceptions, problems, and potential solutions is also provided. PMID:9788368
Orthopaedic trauma from road crashes: is enough being done?
Donaldson, Lachlan H; Brooke, Kathryn; Faux, Steven G
A file review of patients presenting to the Emergency Department of St Vincent's Hospital with fractures sustained in a road crash was completed to describe patterns of orthopaedic injury, acute intervention and separation as well as the cost of care for adult road crash victims. One-hundred and eighty-seven patients were included. 65.8% were male; 48.1% were pedestrians. Differing patterns of injury corresponded to the role of the patient in the road crash (eg, pedestrian, driver of vehicle, etc). The mean length of stay was 8.8 days. 35.2% of patients were prescribed a different analgesic at discharge to that which they had received in the previous 24 hours. 35.8% had a documented discussion regarding insurance matters, usually with a social worker. 11.9% were discharged to inpatient rehabilitation. 56.2% had orthopaedic follow-up arranged at discharge, while 4.8% were discharged to an outpatient rehabilitation clinic. The mean overall cost was $13 336, with patients aged over 65 costing the most. The quality of acute care for fractures sustained in road crashes could be improved with evidence-based analgesia management, increased screening for psychiatric sequelae, enhanced assistance with insurance matters and vocational issues, and closer follow-up. Further research into the impact of these factors on long-term recovery is warranted. PMID:19203336
Myths and Legends in Orthopaedic Practice: Are We All Guilty?
Immerman, Igor
Over years of practice, many beliefs and practices become entrenched as tried and tested, and we subconsciously believe they are based on scientific evidence. We identified nine such beliefs by interviewing orthopaedic surgeons in which studies (or lack thereof) apparently do not support such practices. These are: changing the scalpel blade after the skin incision to limit contamination; bending the patient's knee when applying a thigh tourniquet; bed rest for treatment of deep vein thrombosis; antibiotics in irrigation solution; routine use of hip precautions; routine use of antibiotics for the duration of wound drains; routine removal of hardware in children; correlation between operative time and infection; and not changing dressings on the floor before scrubbing. A survey of 186 practicing orthopaedic surgeons in academic and community settings was performed to assess their routine practice patterns. We present the results of the survey along with an in-depth literature review of these topics. Most surgeon practices are based on a combination of knowledge gained during training, reading the literature, and personal experience. The results of this survey hopefully will raise the awareness of the selected literature for common practices. PMID:18726654
Comparison of cross-linked polyethylene materials for orthopaedic applications.
Collier, John P; Currier, Barbara H; Kennedy, Francis E; Currier, John H; Timmins, Graham S; Jackson, Simon K; Brewer, Robin L
Cross-linked polyethylenes are being marketed by orthopaedic manufacturers to address the problem of osteolysis caused by polyethylene particulate wear debris. Wear testing of these cross-linked polyethylenes in hip simulators has shown dramatic reduction in wear rate compared with standard ultrahigh molecular weight polyethylene, either gamma irradiated in air or nitrogen - or ethylene oxide-sterilized. However, this reduction in wear rate is not without cost. The cross-linking processes can result in materials with lower mechanical properties than standard ultrahigh molecular weight polyethylene. To evaluate the effect of the various cross-linking processes on physical and mechanical properties of ultrahigh molecular weight polyethylene, commercially available cross-linked polyethylenes from six orthopaedic manufacturers were tested. This study was the culmination of collaboration with these manufacturers, who provided cross-linked polyethylene for this study, wear characteristics of the material they provided, and review of the physical and mechanical properties measure for their polyethylene. Cross-linked materials were evaluated as received and after an accelerated aging protocol. Free radical identity and concentration, oxidation, crystallinity, melt temperature, ultimate tensile strength, elongation at break, tensile stress at yield, and toughness are reported for each material. By comparing these physical and mechanical properties, surgeons can evaluate the trade-off that results from developing materials with substantially lower wear rates. PMID:12966304
Myths and legends in orthopaedic practice: are we all guilty?
Tejwani, Nirmal C; Immerman, Igor
Over years of practice, many beliefs and practices become entrenched as tried and tested, and we subconsciously believe they are based on scientific evidence. We identified nine such beliefs by interviewing orthopaedic surgeons in which studies (or lack thereof) apparently do not support such practices. These are: changing the scalpel blade after the skin incision to limit contamination; bending the patient's knee when applying a thigh tourniquet; bed rest for treatment of deep vein thrombosis; antibiotics in irrigation solution; routine use of hip precautions; routine use of antibiotics for the duration of wound drains; routine removal of hardware in children; correlation between operative time and infection; and not changing dressings on the floor before scrubbing. A survey of 186 practicing orthopaedic surgeons in academic and community settings was performed to assess their routine practice patterns. We present the results of the survey along with an in-depth literature review of these topics. Most surgeon practices are based on a combination of knowledge gained during training, reading the literature, and personal experience. The results of this survey hopefully will raise the awareness of the selected literature for common practices. PMID:18726654
Experimental validation of A-mode ultrasound acquisition system for computer assisted orthopaedic surgery
NASA Astrophysics Data System (ADS)
De Lorenzo, Danilo; De Momi, Elena; Beretta, Elisa; Cerveri, Pietro; Perona, Franco; Ferrigno, Giancarlo
Computer Assisted Orthopaedic Surgery (CAOS) systems improve the results and the standardization of surgical interventions. Anatomical landmarks and bone surface detection is straightforward to either register the surgical space with the pre-operative imaging space and to compute biomechanical parameters for prosthesis alignment. Surface points acquisition increases the intervention invasiveness and can be influenced by the soft tissue layer interposition (7-15mm localization errors). This study is aimed at evaluating the accuracy of a custom-made A-mode ultrasound (US) system for non invasive detection of anatomical landmarks and surfaces. A-mode solutions eliminate the necessity of US images segmentation, offers real-time signal processing and requires less invasive equipment. The system consists in a single transducer US probe optically tracked, a pulser/receiver and an FPGA-based board, which is responsible for logic control command generation and for real-time signal processing and three custom-made board (signal acquisition, blanking and synchronization). We propose a new calibration method of the US system. The experimental validation was then performed measuring the length of known-shape polymethylmethacrylate boxes filled with pure water and acquiring bone surface points on a bovine bone phantom covered with soft-tissue mimicking materials. Measurement errors were computed through MR and CT images acquisitions of the phantom. Points acquisition on bone surface with the US system demonstrated lower errors (1.2mm) than standard pointer acquisition (4.2mm).
The Impact of the Multicenter Orthopaedic Outcomes Network (MOON) Research on Anterior Cruciate Ligament Reconstruction and Orthopaedic Practice
Lynch, T. Sean; Parker, Richard D.; Patel, Ronak M.; Andrish, Jack T.; Spindler, Kurt P.
With an estimated 200,000 anterior cruciate ligament reconstructions performed annually in the United States, there is an emphasis on determining patient-specific information to help educate patients on expected clinically relevant outcomes. The Multicenter Orthopaedic Outcomes Network consortium was created in 2002 to enroll and longitudinally follow a large population cohort of anterior cruciate ligament reconstructions. The study group has enrolled >4,400 anterior cruciate ligament reconstructions from seven institutions to establish the large level I prospective anterior cruciate ligament reconstruction outcomes cohort. The group has become more than a database with information regarding anterior cruciate ligament injuries; it has helped to establish a new benchmark for conducting multicenter, multisurgeon orthopaedic research. The changes in anterior cruciate ligament reconstruction practice resulting from the group include the use of autograft for high school, college, and competitive athletes in their primary anterior cruciate ligament reconstructions. Other modifications include treatment options for meniscus and cartilage injuries, as well as lifestyle choices made after anterior cruciate ligament reconstruction. PMID:25667401
NASA Astrophysics Data System (ADS)
Levinson, Harry J.
Until recently, lithography capability evolved consistently with Moore's law. It appears that semiconductor manufacturers are now deviating from Moore's law, which has implications for lithography equipment. DUV lithography is moving into production in a mix-and-match environment. Step- and-scan technology is the wave of the near-future, as a way to contend with the difficulty of manufacturing wide-field lenses. Resist processing equipment will undergo few fundamental changes, but will often be integrated with steppers, particularly for DUV applications. Metrology is being stretched beyond its limits for technologies below 250 nm. The move is on to 300 m diameter wafers, and 193 nm lithography is under consideration.
International patients on operation vacation – perspectives of patients travelling to Hungary for orthopaedic treatments
Kovacs, Eszter; Szocska, Gabor; Knai, Cécile
Background: The importance of cross-border healthcare, medical and health tourism plays a significant role in the European health policy and health management. After dentistry, orthopaedic treatments are the leading motivation for seeking care in Hungary, as patients with rheumatic and motion diseases are drawn to the thermal spas and well-established orthopaedic centres. This paper aims to gain insight into foreign patients' perspectives on their experience of having sought medical tourism in orthopaedic care in Hungary. Methods: A patient survey was conducted in 2012 on motivations for seeking treatment abroad, orthopaedic care received and overall satisfaction. In addition, health professionals' interviews, and 17 phone interviews were conducted in 2013 with Romanian patients who had orthopaedic treatment in Hungary. Finally, medical records of foreign patients were analysed. Results: The survey was completed by 115 participants – 61.1% females, mean age= 41.9, 87% Romanian origin. Most of the patients came to Hungary for orthopaedic surgeries, e.g. arthroscopy, knee/hip prosthesis or spinal surgery. 72.6% chose Hungary because of related to perceived better quality and longstanding culture of Hungarian orthopaedic care. Over 57% of patients reported being 'very satisfied' with care received and 41.6% 'satisfied'. The follow-up interviews further reflected this level of satisfaction, therefore many respondents stating they have already recommended the Hungarian healthcare to others. Conclusion: Based on the findings, patients from neighbouring regions are increasingly seeking orthopaedic care in Hungary. Patients having orthopaedic care are highly satisfied with the quality of care, the whole treatment process from the availability of information to discharge summaries and would consider returning for further treatments. PMID:25396209
Sir Robert Jones: orthopaedic surgeon and war hero.
Di Matteo, Berardo; Tarabella, Vittorio; Filardo, Giuseppe; Tomba, Patrizia; Viganò, Anna; Kon, Elizaveta; Marcacci, Maurilio
The First World War was a very harsh conflict and statistics recorded a great number of victims, both soldiers and civilians. One hundred years later, the whole world is commemorating the Great War by celebrating people and events that contributed to shaping the XX century. Beyond remembering political figures, war heroes or even famous battles, it is also important to underline the contribution of those who devoted their efforts to improve the living conditions during war campaigns. This is the case of Sir Robert Jones, one of the fathers of XX century orthopaedics, who contributed to re-organize the military medical assistance during war times and whose teachings, coming directly from his "on the field" experience, inspired an entire generation of European surgeons. PMID:25435061
[Treatments of Soft Tissue Sarcomas by Orthopaedic Surgeons in Japan].
Tanaka, Kazuhiro
In Japan, the treatment of soft tissue sarcomas (STS) has been performed mainly by orthopaedic surgeons. The standard therapy for all cases of STS is surgical resection of the tumor. The prognosis of patients with unresectable tumors or distant metastases is poor despite treatment with intensive chemotherapy. Adjuvant chemotherapy is indicated for patients with resectable tumors. Round-cell STS, including extraskeletal Ewing sarcoma and rhabdomyosarcoma, have high sensitivity to chemotherapy. The standard treatment for round-cell STS is multimodal therapy with surgery and chemotherapy, with or without radiotherapy. On the other hand, non-round cell STS, including leiomyosarcoma, synovial sarcoma, and liposarcoma, have low sensitivity to chemotherapy. Thus, the standard treatment for non-round cell STS is essentially, surgery. Large and high-grade non-round cell STS are also treated using adjuvant chemotherapy along with surgery. In this review, the standard therapies for STS and the future perspective in Japan are discussed. PMID:26809525
[Management of war orthopaedic injuries in recent armed conflicts].
Frank, M; Mathieu, L
The extremities continue to be the most frequent sites of wounding during armed conflicts despite the change of combat tactics, soldier armour and battlefield medical support. Due to the advances in prehospital care and timely transport to the hospital, orthopaedic surgeons deal with severe and challenging injuries of the limbs. In contrast to civilian extremity trauma, the most combat-related injuries are open wounds that often have infection-related complications. Data from two recent large armed conflicts (Iraq, Afghanistan) show that extremity injuries are associated with a high complication rate, morbidity and healthcare utilization. A systematic approach that consists of sequential surgical care and good transport capabilities can reduce the complication rate of these injuries. New medical technologies have been implemented in the treatment strategy during the last decade. This article reviews the published scientific data and current opinions on combat-related extremity injuries. Key words: extremity, combat, trauma, medical support system. PMID:23777944
Direct Observation: Assessing Orthopaedic Trainee Competence in the Ambulatory Setting.
Phillips, Donna P; Zuckerman, Joseph D; Kalet, Adina; Egol, Kenneth A
The Accreditation Council of Graduate Medical Education requires that residency programs teach and assess trainees in six core competencies. Assessments are imperative to determine trainee competence and to ensure that excellent care is provided to all patients. A structured, direct observation program is feasible for assessing nontechnical core competencies and providing trainees with immediate constructive feedback. Direct observation of residents in the outpatient setting by trained faculty allows assessment of each core competency. Checklists are used to document residents' basic communication skills, clinical reasoning, physical examination methods, and medical record keeping. Faculty concerns regarding residents' professionalism, medical knowledge, fatigue, or ability to self-assess are tracked. Serial observations allow for the reinforcement and/or monitoring of skills and attitudes identified as needing improvement. Residents who require additional coaching are identified early in training. Progress in educational milestones is recorded, allowing an individualized educational program that ensures that future orthopaedic surgeons excel across all domains of medical and surgical competence. PMID:27479831
Coating analysis of implant materials used in orthopaedic surgery.
Aksakal, B; Yildirim, O S; Okur, A
Biocompatibility of orthopaedic surgical implants with bone tissue allows adequate osseointegration between the bone and implant. To achieve this, implants are coated with biocompatible materials. The costly plasma spray procedure is routinely used to coat implants but uses high temperatures (over 16,000 degrees C), which affect the surface quality and microstructure of the implant. We analysed the effect of sintering temperature, time and rate on coated and uncoated implants using a dipping method. The effectiveness of synthetic hydrated calcium silicate compound as an interlayer was also investigated, using the dipping method and electrophoretic deposition. Sintering temperature, time and rate all affected the quality of the bond with the coating, but the interlayer bonded effectively with both implant and biocompatible coating. Electrophoretic deposition resulted in imperfect bonding and some irregularity on the substrate surface was seen. This technique may be improved by using coating particles of a smaller size. PMID:14587310
[Recent progress in orthopaedic managements of osteoporosis-related fractures].
Yamamoto, Seizo
Recent progress in orthopaedic treatment of osteoporosis-related fractures was reviewed. In the treatment of femoral neck fractures, impacted or nondisplaced type is treated by three cannulated cancellous pins. Displaced type of femoral neck fracture is treated by bipolar prosthesis. Results of femoral neck fractures are influenced by the complications of each patients. Osteoporotic spine fractures are commonly healed within 2 or 3 months. Spinal compression with paraparesis or paraplegia is unusual complication in burst type of spine fractures. Surgical decompression, bone grafting and stabilization with instrumentation can result in some correction of deformity and neurogenic recovery. Distal radius fractures are common fractures in the eldery. Recently advances includes external fixation and plate fixation for the comminuted fractures in the distal radius. Treatments of osteoporosis-related fractures are still difficult problems to be resolved. PMID:21774371
Medical liability and orthopaedic trauma: history and current state of affairs.
Lundy, Douglas W
Orthopaedic trauma has been associated with the history of medical liability all the way back to the dark ages and the bubonic plague. Caps on noneconomic damages and other reforms have been challenged in many states, and an innovative approach to medical liability reform must be developed within the medical profession and the various legislatures. Orthopaedic trauma surgeons have a unique perspective in that they perform a critical service to the community, however they are often deprived of the benefit of preoperative risk reduction best practices because of the critical needs of the patients. Orthopaedic trauma surgeons must advocate for effective medical liability reforms. PMID:25229679
Education and training opportunities in trauma and orthopaedics in SE Thames Region.
Savage, P E; d'A Fearn, C B; Groom, A F; Heatley, F W
In preparation for the introduction of the specialist registrar grade the specialist advisory committee (SAC) in orthopaedics developed a six-year structured training programme leading to the award of the Certificate of Completion of Specialist Training (CCST). A team comprising the regional adviser in orthopaedics, the two regional programme directors and an associate dean of postgraduate medicine visited all the departments of orthopaedics in the South East Thames Region in order to evaluate the training opportunities they provided. This paper describes the methodology used during these visits, the lessons learned and the conclusions drawn. PMID:9496169
Automatic Bone Drilling - More Precise, Reliable and Safe Manipulation in the Orthopaedic Surgery
NASA Astrophysics Data System (ADS)
Boiadjiev, George; Kastelov, Rumen; Boiadjiev, Tony; Delchev, Kamen; Zagurski, Kazimir
Bone drilling manipulation often occurs in the orthopaedic surgery. By statistics, nowadays, about one million people only in Europe need such an operation every year, where bone implants are inserted. Almost always, the drilling is performed handily, which cannot avoid the subjective factor influence. The question of subjective factor reduction has its answer - automatic bone drilling. The specific features and problems of orthopaedic drilling manipulation are considered in this work. The automatic drilling is presented according the possibilities of robotized system Orthopaedic Drilling Robot (ODRO) for assuring the manipulation accuracy, precision, reliability and safety.
Use of supplemental steroids in patients having orthopaedic operations.
Friedman, R J; Schiff, C F; Bromberg, J S
It is commonly thought that patients receiving exogenous glucocorticoids have suppression of the hypothalamic-pituitary-adrenal axis and need high supplemental doses of exogenous glucocorticoids (so-called stress steroids) to meet the demands of operative stress. Several reports have suggested that clinically important suppression of the hypothalamic-pituitary-adrenal axis is extremely uncommon and that the levels of glucocorticoids required for stress are much lower than previously believed. A prospective study of twenty-eight patients who had thirty-five major orthopaedic operations was conducted. No patient received stress steroids; they were given only the baseline immunosuppressive doses of glucocorticoids (mean dose, ten milligrams of prednisone). Clinical information (based on regular physical examinations for signs and symptoms of hypotension, myalgia, arthralgia, ileus, and fever) and laboratory data (serum sodium levels, eosinophil count, and twenty-four-hour urinary free-cortisol levels, determined at perioperative and non-stress postoperative time-periods) were obtained to document any evidence of adrenocortical insufficiency. There was no such evidence in any of the patients, who were monitored during their entire hospitalization. The levels of twenty-four-hour urinary free cortisol showed that all patients had endogenous adrenocortical function and, when this information was considered together with the clinical outcome, it was concluded that this level of function was sufficient to meet the demands of operative stress. Adrenocortical insufficiency in patients who have orthopaedic operations without receiving supplemental stress steroids appears to be much less common than previously thought. While biochemical testing of the function of the hypothalamic-pituitary-adrenal axis may sometimes reveal evidence of adrenal insufficiency, these tests do not predict the clinical outcome and may be too sensitive to guide decisions regarding treatment
Lean Participative Process Improvement: Outcomes and Obstacles in Trauma Orthopaedics
New, Steve; Hadi, Mohammed; Pickering, Sharon; Robertson, Eleanor; Morgan, Lauren; Griffin, Damian; Collins, Gary; Rivero-Arias, Oliver; Catchpole, Ken; McCulloch, Peter
Objectives To examine the effectiveness of a "systems" approach using Lean methodology to improve surgical care, as part of a programme of studies investigating possible synergy between improvement approaches. Setting A controlled before-after study using the orthopaedic trauma theatre of a UK Trust hospital as the active site and an elective orthopaedic theatre in the same Trust as control. Participants All staff involved in surgical procedures in both theatres. Interventions A one-day "lean" training course delivered by an experienced specialist team was followed by support and assistance in developing a 6 month improvement project. Clinical staff selected the subjects for improvement and designed the improvements. Outcome Measures We compared technical and non-technical team performance in theatre using WHO checklist compliance evaluation, "glitch count" and Oxford NOTECHS II in a sample of directly observed operations, and patient outcome (length of stay, complications and readmissions) for all patients. We collected observational data for 3 months and clinical data for 6 months before and after the intervention period. We compared changes in measures using 2-way analysis of variance. Results We studied 576 cases before and 465 after intervention, observing the operation in 38 and 41 cases respectively. We found no significant changes in team performance or patient outcome measures. The intervention theatre staff focused their efforts on improving first patient arrival time, which improved by 20 minutes after intervention. Conclusions This version of "lean" system improvement did not improve measured safety processes or outcomes. The study highlighted an important tension between promoting staff ownership and providing direction, which needs to be managed in "lean" projects. Space and time for staff to conduct improvement activities are important for success. PMID:27124012
Antimicrobial agents in orthopaedic surgery: Prophylaxis and treatment.
Trampuz, Andrej; Zimmerli, Werner
The pathogenesis of implant-associated infection involves interaction between the microorganisms (biofilm formation), the implant and the host. Despite improvement of perioperative prophylaxis, orthopaedic implants still remain highly susceptible to bacterial or fungal contamination, generally resulting in persistent implant-associated infection. Therefore, perioperative and life-long prevention of infection is important. For perioperative prophylaxis, a first- or second-generation cephalosporin is recommended, which should be administered between 60 and 30 minutes before incision. The duration of prophylaxis should not exceed 1 day. In centres with a low incidence of infection, a single dose is sufficient. Treatment of infections associated with orthopaedic devices usually requires appropriate surgical intervention combined with prolonged antimicrobial therapy. The choice of the antimicrobial regimen depends on the duration and pathogenesis of infection, stability of the implant, antimicrobial susceptibility of the pathogen and condition of the surrounding soft tissue. The role of rifampicin (rifampin), which has excellent activity on adherent staphylococci, in combination with beta-lactams, glycopeptides, fluoroquinolones, minocycline, cotrimoxazole or fusidic acid, in the treatment of staphylococcal infections is outlined. Increasing antimicrobial resistance requires the use of alternative agents, such as quinupristin/dalfopristin, linezolid and daptomycin, but results of clinical trials with these agents are limited. Also reviewed are potential new antimicrobial agents currently undergoing investigation, such as the novel oxazolidinone RWJ-416457, the new glycopeptide dalbavancin, the glycylcycline compound tigecycline, the new carbacephem BP-102 and novel rifamycin derivatives. Vaccination against Staphylococcus aureus with StaphVAX induced specific antibodies potentially preventing bacteraemia; however, there are no studies on efficacy in the prophylaxis of
NASA Technical Reports Server (NTRS)
A medical refrigeration and a water pump both powered by solar cells that convert sunlight directly into electricity are among the line of solar powered equipment manufactured by IUS (Independent Utility Systems) for use in areas where conventional power is not available. IUS benefited from NASA technology incorporated in the solar panel design and from assistance provided by Kerr Industrial Applications Center.
Application of the quality and safety education for nurses competencies in orthopaedic nursing: implications for preceptors.
Altmiller, Gerry
For the last decade, quality and safety have been the ardent focus of healthcare improvement. Many agencies provide resources to healthcare providers to assist their endeavors. The Quality and Safety Education for Nurses (QSEN) Collaboration developed competencies that define the concepts of quality and safety in relation to nursing practice and education. These concepts are not new to orthopaedic nursing; they are better defined through the QSEN competencies so that nurses can develop practice behaviors that ensure quality and safety for the patients they care for. The QSEN competencies guide the processes that support the Orthopaedic Core Competencies: Across the Lifespan. Together, they enhance the orthopaedic specialty by deepening the focus on patient safety and high-quality care. Preceptors are in a unique position to influence new nurses and those transitioning into orthopaedic nursing to adopt these practices as they develop skills to meet the requirements of the specialty. PMID:23518753
Significance of Nano- and Microtopography for Cell-Surface Interactions in Orthopaedic Implants
Jäger, M.; Zilkens, C.; Zanger, K.; Krauspe, R.
Cell-surface interactions play a crucial role for biomaterial application in orthopaedics. It is evident that not only the chemical composition of solid substances influence cellular adherence, migration, proliferation and differentiation but also the surface topography of a biomaterial. The progressive application of nanostructured surfaces in medicine has gained increasing interest to improve the cytocompatibility and osteointegration of orthopaedic implants. Therefore, the understanding of cell-surface interactions is of major interest for these substances. In this review, we elucidate the principle mechanisms of nano- and microscale cell-surface interactions in vitro for different cell types onto typical orthopaedic biomaterials such as titanium (Ti), cobalt-chrome-molybdenum (CoCrMo) alloys, stainless steel (SS), as well as synthetic polymers (UHMWPE, XLPE, PEEK, PLLA). In addition, effects of nano- and microscaled particles and their significance in orthopaedics were reviewed. The significance for the cytocompatibility of nanobiomaterials is discussed critically. PMID:18274618
75 FR 32210 - United States v. Idaho Orthopaedic Society, Timothy Doerr, Jeffrey Hessing, Idaho Sports Medicine...
Federal Register 2010, 2011, 2012, 2013, 2014
... any natural person, corporation, firm, company, sole proprietorship, partnership, joint venture... Idaho Orthopaedic Society (``IOS'') is a non-profit corporation organized and doing business under the....A. (``ISMI''), an orthopedic practice group consisting of four physicians, is a...
Bioactive Coatings for Orthopaedic Implants—Recent Trends in Development of Implant Coatings
Zhang, Bill G. X.; Myers, Damian E.; Wallace, Gordon G.; Brandt, Milan; Choong, Peter F. M.
Joint replacement is a major orthopaedic procedure used to treat joint osteoarthritis. Aseptic loosening and infection are the two most significant causes of prosthetic implant failure. The ideal implant should be able to promote osteointegration, deter bacterial adhesion and minimize prosthetic infection. Recent developments in material science and cell biology have seen the development of new orthopaedic implant coatings to address these issues. Coatings consisting of bioceramics, extracellular matrix proteins, biological peptides or growth factors impart bioactivity and biocompatibility to the metallic surface of conventional orthopaedic prosthesis that promote bone ingrowth and differentiation of stem cells into osteoblasts leading to enhanced osteointegration of the implant. Furthermore, coatings such as silver, nitric oxide, antibiotics, antiseptics and antimicrobial peptides with anti-microbial properties have also been developed, which show promise in reducing bacterial adhesion and prosthetic infections. This review summarizes some of the recent developments in coatings for orthopaedic implants. PMID:25000263
Nicholas J. Giannestras (1908-1978): a distinguished orthopaedic surgeon, his work, life and times.
Markatos, Konstantinos; Efstathopoulos, Nikolaos; Kaseta, Kiriaki Maria; Nikolaou, Vasileios; Tsoucalas, Gregory; Sgantzos, Markos
The purpose of our study was to summarize all the knowledge concerning the innovative pioneer in the field of orthopaedic surgery, Nicholas J. Giannestras (1908-1978). A thorough study of texts, medical books and reports, in the field of history of medicine, together with a review of the available literature in PubMed, was undertaken. Giannestras left his mark in the history of orthopaedics with his clinical work and his publications, mainly his treatise "Foot Disorders: Medical and Surgical Management" (1973), while his name lingers in Greece with the introduction of spine fusion with the use of metallic implants. He was an eminent university clinical professor of orthopaedics who had harmonically combined academic writing, teaching and clinical research in every field of orthopaedic surgery. PMID:26255057
Rancho Los Amigos Medical Center. A unique orthopaedic resource and teaching institution.
Hsu, J D
Rancho Los Amigos Medical Center, initially a poor farm in the County of Los Angeles, CA became a world renown medical institution because of the polio epidemics in the 1950s. Responding to the need for day to day inpatient care were an overflow of victims of polio who had spine and extremity weakness and were dependent on respirators. Team care, developed at the institution, was used by Vernon L. Nickel, chief orthopaedic surgeon so that maximum use of the limited staff's efforts would be to take care of patients. This need spawned many innovative developments through clinical observations and trials, basic research, and engineering innovations that resulted in the patient's functional improvement and helped return many victims of polio to independence and to their communities. Subsequently, orthopaedic surgeons, Jacquelin Perry, and Alice Garrett joined the full-time staff as the workload increased. Stabilizing the spine using fascial supports, spinal fusion, spinal instrumentation, orthoses, and seating systems allowed those patients who were not totally dependent on respirators to be upright and mobilized. When polio was eradicated, newer programs were established for physically disabled persons with musculoskeletal disorders affecting the spine and extremities and for those patients with congenital, acquired, neurologic, and neuromuscular disorders. In formal graduate residency affiliations, fellowships, and continuing medical education programs orthopaedic surgeons from around the world have been taught the basic principles of "categorical care" for physically disabled people for 50 years. Orthopaedic care given through these programs formed the basis of a new orthopaedic subspecialty, Orthopaedic Rehabilitation. PMID:10818973
Surgeons' knowledge about the costs of orthopaedic implants.
Rohman, Lebur; Hadi, Saifullah; Whitwell, George
PURPOSE. To investigate consultant surgeons' knowledge about the costs of implants for various joint surgeries. METHODS. Questionnaires were distributed to consultant orthopaedic surgeons at 2 hospitals. Respondents were asked to estimate the implant costs of any brand for low-demand and high-demand total hip replacement (THR), total knee replacement (TKR), uni-compartmental knee replacement, arthroscopy shaver blade, total anterior cruciate ligament (ACL) fixation, and meniscal repair. The actual cost of each implant was obtained from the manufacturer. RESULTS. 16 consultant surgeons completed the questionnaires. The respective mean estimated and actual costs for a low-demand THR implant were £1714 (range, £600-3000) and £1448 (range, £985- 2335), with an overestimation of 18.4%. The respective costs for a high-demand THR implant were £2172 (range, £600-6000) and £1737 (range, £1192-2335), with an overestimation of 25%. The respective costs for a TKR implant were £1550 (range, £600-6000) and £1316 (range, £995-1535), with an overestimation of 17.8%. The respective costs for a uni-compartmental knee replacement implant were £1040 (range, £600-2000) and £1296 (range, £698-1470), with an underestimation of 19.7%. The respective costs for an arthroscopy shaver blade were £110 (range, £75-150) and £94 (range, £80-100), with an overestimation of 16.6%. The respective costs for a total ACL fixation implant were £246 (range, £80-500) and £306 (range, £272-335), with an underestimation of 19.4%. The respective costs for a meniscal repair implant were £153 (range, £50-250) and £242 (range, £170-260), with an underestimation of 37%. CONCLUSION. The knowledge among consultant orthopaedic surgeons about implant costs was poor. To reduce implant costs, cooperation between surgeons and hospital managers and measures to increase surgeons' awareness about cost-reduction programmes are needed. PMID:25163960
NASA Technical Reports Server (NTRS)
The Lifeshear cutter, a rescue tool for freeing accident victims from wreckage, was developed under the Clinton Administration's Technology Reinvestment Program. Prior cutting equipment was cumbersome and expensive; the new cutter is 50 percent lighter and 70 percent cheaper. The cutter is pyrotechnically-actuated, using a miniature version of the power cartridges used for separation devices on the Space Shuttle and other NASA spacecraft. Hi-Shear Technology Corporation developed the cutter with the Jet Propulsion Laboratory and input from the City of Torrance (California) Fire Department.
Two hundred years of orthopaedics in Wuerzburg-one hundred years of the Koenig-Ludwig-Haus.
Jakuscheit, Axel; Rudert, Maximilian
Wuerzburg in the centre of Germany claims to be a cradle of modern orthopaedics. Under the leadership of Johann Georg Heine (1771-1831) the first German orthopaedic hospital, the Carolinum, was established in 1816. Johann Georg Heine's legacy was continued by his son Joseph (1803-1877) and his nephew Bernhard Heine (1800-1846), before Albert Hoffa (1859-1907) put the clinical practice of orthopaedics on a strict scientific basis and further promoted a worldwide exchange of knowledge. In 1916, Albert Hoffa's successor Jakob Riedinger (1861-1917) founded the Koenig-Ludwig-Haus, which hosts the Orthopaedic Hospital and the Centre for Musculoskeletal Research of the University of Wuerzburg. On the occasion of the bicentenary and centenary anniversaries of the founding of the two orthopaedic hospitals, we provide a short view on the development of orthopaedics in Wuerzburg. PMID:27283104
Radiation exposure to the orthopaedic surgeon during periacetabular osteotomy
Daugaard, Henrik; Søballe, Kjeld
The objective of this study was to directly measure the radiation exposure to the orthopaedic surgeon and to measure dose points to the surgeon's fingers, thyroid gland, and forehead during intraoperative fluoroscopy in periacetabular osteotomy (PAO). In a series of 23 consecutive periacetabular osteotomy procedures, exposure monitoring was carried out using thermo luminescent dosimeters. The effective dose received by the operating surgeon was 0.008 mSv per operation which adds up to a yearly dose of 0.64 mSv from PAO. The median point equivalent dose (mSv) exposure under PAO was 0.009 for the forehead and thyroid gland, 0.045 for the right index finger, and 0.039 for the left index finger. The effective estimated yearly dose received by the operating surgeon was very low. Wearing a lead collar reduces radiation exposure to the thyroid gland while the lead gloves did not protect the surgeon's fingers. PMID:18958467
Force and torque modelling of drilling simulation for orthopaedic surgery.
MacAvelia, Troy; Ghasempoor, Ahmad; Janabi-Sharifi, Farrokh
The advent of haptic simulation systems for orthopaedic surgery procedures has provided surgeons with an excellent tool for training and preoperative planning purposes. This is especially true for procedures involving the drilling of bone, which require a great amount of adroitness and experience due to difficulties arising from vibration and drill bit breakage. One of the potential difficulties with the drilling of bone is the lack of consistent material evacuation from the drill's flutes as the material tends to clog. This clogging leads to significant increases in force and torque experienced by the surgeon. Clogging was observed for feed rates greater than 0.5 mm/s and spindle speeds less than 2500 rpm. The drilling simulation systems that have been created to date do not address the issue of drill flute clogging. This paper presents force and torque prediction models that account for this phenomenon. The two coefficients of friction required by these models were determined via a set of calibration experiments. The accuracy of both models was evaluated by an additional set of validation experiments resulting in average R² regression correlation values of 0.9546 and 0.9209 for the force and torque prediction models, respectively. The resulting models can be adopted by haptic simulation systems to provide a more realistic tactile output. PMID:23167723
Nanostructured glass–ceramic coatings for orthopaedic applications
Wang, Guocheng; Lu, Zufu; Liu, Xuanyong; Zhou, Xiaming; Ding, Chuanxian; Zreiqat, Hala
Glass–ceramics have attracted much attention in the biomedical field, as they provide great possibilities to manipulate their properties by post-treatments, including strength, degradation rate and coefficient of thermal expansion. In this work, hardystonite (HT; Ca2ZnSi2O7) and sphene (SP; CaTiSiO5) glass–ceramic coatings with nanostructures were prepared by a plasma spray technique using conventional powders. The bonding strength and Vickers hardness for HT and SP coatings are higher than the reported values for plasma-sprayed hydroxyapatite coatings. Both types of coatings release bioactive calcium (Ca) and silicon (Si) ions into the surrounding environment. Mineralization test in cell-free culture medium showed that many mushroom-like Ca and phosphorus compounds formed on the HT coatings after 5 h, suggesting its high acellular mineralization ability. Primary human osteoblasts attach, spread and proliferate well on both types of coatings. Higher proliferation rate was observed on the HT coatings compared with the SP coatings and uncoated Ti-6Al-4V alloy, probably due to the zinc ions released from the HT coatings. Higher expression levels of Runx2, osteopontin and type I collagen were observed on both types of coatings compared with Ti-6Al-4V alloy, possibly due to the Ca and Si released from the coatings. Results of this study point to the potential use of HT and SP coatings for orthopaedic applications. PMID:21292725
Thermoplastic polymeric adhesive for structural bonding applications for orthopaedic devices
Devanathan, D.; King, R.; Swarts, D.; Lin, S.; Ramani, K.; Tagle, J.
The orthopaedics industry has witnessed tremendous growth in recent years primarily due to the introduction of high performance, porous coated implants. These devices have eliminated the need for the use of bone cement for in vivo implant fixation, replacing it with the ingrowth of bone into the porous surfaces. The metallurgical bonding processes used for attaching the porous to the implant body introduce some undesirable effect i.e., the reduction of the fatigue strength of the implant due to the ``notches`` created and also due to the high temperature exposure during the sintering operations. This paper describes the development of a thermoplastic polymeric adhesive based structural bonding technique. The high performance polymeric adhesive is fully characterized with respect to its intended application. The design of the porous layer is optimized to achieve a reliable bond to the implant. A thermal heating/cooling process was developed to control the final polymer morphology. Static and fatigue tests were conducted to fully characterize the adhesive bond strength. A ring shear test method was developed to determine the shear strength of the bond interface. Besides the characterization of the adhesive bond, the joints will be analyzed using finite element models. The correlation between the analytical models and the
Biodegradable injectable polyurethanes: synthesis and evaluation for orthopaedic applications.
Adhikari, Raju; Gunatillake, Pathiraja A; Griffiths, Ian; Tatai, Lisa; Wickramaratna, Malsha; Houshyar, Shadi; Moore, Tim; Mayadunne, Roshan T M; Field, John; McGee, Margaret; Carbone, Tania
Biodegradable polyurethanes offer advantages in the design of injectable or preformed scaffolds for tissue engineering and other medical implant applications. We have developed two-part injectable prepolymer systems (prepolymer A and B) consisting of lactic acid and glycolic acid based polyester star polyols, pentaerythritol (PE) and ethyl lysine diisocyanate (ELDI). This study reports on the formulation and properties of a series of cross linked polyurethanes specifically developed for orthopaedic applications. Prepolymer A was based on PE and ELDI. Polyester polyols (prepolymer B) were based on PE and dl-lactic acid (PEDLLA) or PE and glycolic acid (PEGA) with molecular weights 456 and 453, respectively. Several cross linked porous and non-porous polyurethanes were prepared by mixing and curing prepolymers A and B and their mechanical and thermal properties, in vitro (PBS/37 degrees C/pH 7.4) and in vivo (sheep bi-lateral) degradation evaluated. The effect of incorporating beta-tricalcium phosphate (beta-TCP, 5 microns, 10 wt.%) was also investigated. The cured polymers exhibited high compressive strength (100-190 MPa) and modulus (1600-2300 MPa). beta-TCP improved mechanical properties in PEDLLA based polyurethanes and retarded the onset of in vitro and in vivo degradation. Sheep study results demonstrated that the polymers in both injectable and precured forms did not cause any surgical difficulties or any adverse tissue response. Evidence of new bone growth and the gradual degradation of the polymers were observed with increased implant time up to 6 months. PMID:18632149
Energy healing: a complementary treatment for orthopaedic and other conditions.
DiNucci, Ellen M
Complementary and alternative therapies continue to grow in popularity among healthcare consumers. Among those modalities is energy healing (EH) (Eisenberg et al., 1998). EH is an adjunctive treatment that is noninvasive and poses little downside risk to patients. Well more than 50 major hospitals and clinics throughout the United States offer EH to patients (DiNucci, research table on healthcare facilities that offer Reiki, unpublished data, 2002). The National Institutes of Health is funding numerous EH studies that are examining its effects on a variety of conditions, including temporomandibular joint disorders, wrist fractures, cardiovascular health, cancer, wound healing, neonatal stress, pain, fibromyalgia, and AIDS (National Institutes of Health, 2004a). Several well-designed studies to date show significant outcomes for such conditions as wound healing (Grad, 1965) and advanced AIDS (Sicher, Targ, Moore, & Smith, 1998), and positive results for pain and anxiety (Aetna IntelliHealth, 2003a; Wardell, Weymouth, 2004), among others (Gallob, 2003). It is also suggested that EH may have positive effects on various orthopaedic conditions, including fracture healing, arthritis, and muscle and connective tissue (Prestwood, 2003). Because negative outcomes risk is at or near zero throughout the literature, EH is a candidate for use on many medical conditions. PMID:16056170
[Richard von Volkmann, one career of orthopaedic surgeon and poet].
Bumbasirević, M; Lesić, A; Sudjić, V; Zagorac, S
Richard von Volkman was one of the most famous and important surgeons in the 19th century. He pioneered antiseptic procedures and was especially known for his achivements in orthopedic surgery. Von Volkmann was born in Leipzig, Germany and attended medical schools in Giessen, Halle, and Berlin. Starting in 1867, he worked as a professor of surgery at the University of Halle, also leading its surgical clinic. He was active as a surgeon during Seven Weeks' War with Austria in 1866 and the Franco-Prussian war 1870/1871, in the latter as consulting Generalarzt. He was important in the introduction of antiseptic wound treatment in Germany, and through it to the United States of America. Two observations in orthopaedic surgery bear his name to these days: Volkmans contracture and Heuter-Volkmans low. Volkmann also wrote poetry under the name Richard Leander and his book entitled "Dreams by French Firesides" which still has a place in literature. He died of paralysis due to a chronic spinal disease, following a prolonged illness, in the Binswanger institution in Jena in 1889, at the top of his careere. PMID:20954309
From Cape Town to Cambridge: Orthopaedic trauma in contrasting environments
Lawrence, John E; Khanduja, Vikas
AIM: To compare the trauma experience gained by a trainee at a United Kingdom major trauma centre and a secondary level hospital in South Africa. METHODS: A profile of inpatient trauma cases during a five-week period in Addenbrooke's Hospital, Cambridge and Somerset Hospital, Cape Town was created. This was achieved by recording various parameters for each patient admitted including age, gender, injury, mechanism of injury and postal/area code. This, together with details of the departments themselves, allows a comparison of the amount and variety of orthopaedic trauma cases experienced by an individual trainee in each setting. RESULTS: The trauma profiles differed significantly. Patients in Cape Town were younger and more likely to be male. In the young, injury in Cape Town was more likely to occur due to assault or being struck by a vehicle, whilst patients in Cambridge were more likely to be injured whilst in a vehicle or in high energy falls. In older patients, trauma at both centres was almost exclusively due to mechanical falls. In a given age group, injuries at the two centres were similar, however the majority of patients admitted to Addenbrooke's were elderly, resulting in less variation in the overall injury profile. CONCLUSION: The trauma profile of a major trauma centre in the United Kingdom is less varied than that of a South African secondary centre, with significantly fewer cases per surgeon. This suggests a more varied training experience in the developing world with a greater caseload. PMID:27190759
New modalities of pain treatment after outpatient orthopaedic surgery.
Beaussier, M; Sciard, D; Sautet, A
Postoperative pain relief is one of the cornerstones of success of orthopaedic surgery. Development of new minimally-invasive surgical procedures, as well as improvements in pharmacological and local and regional techniques should result in optimal postoperative pain control for all patients. The analgesic strategy has to be efficient, with minimal side effects, and be easy to manage at home. Multimodal analgesia allows for a reduction of opiate use and thereby its side effects. Local and regional analgesia is a major component of this multimodal strategy, associated with optimal pain relief, even upon mobilization, and it has beneficial effects on postoperative recovery. Ultrasound guidance improves the success rate of distal nerve blocks and makes distal selective blockade possible, helping to preserve the limb's motility. Besides peripheral nerve blocks, local infiltration (incisional and/or intra-articular) is also important to consider. Duration of the nerve blockade is limited after a single injection. This must be taken into consideration to avoid the recurrence of pain when the patient returns home. Continuous perineural blocks using catheters are an option that can be easily managed at home with monitoring by home-care nurses. Extended-release liposomal bupivacaine and adjuvants such as dexamethasone could significantly enhance the duration of the sensory block, thereby reducing the indications for pain pumps. Non-pharmacological approaches, such as cryotherapy, hypnosis and acupuncture should not be ignored. PMID:26803223
Thermal cycling can extend tool life in orthopaedic operating rooms.
Katchky, Ryan N; McLachlin, Stewart D; Wong, Edwin K Y; Finkelstein, Joel; Kreder, Hans J; Whyne, Cari M
Thermal cycling is a temperature modulation process developed to improve the performance, durability and longevity of materials. This process has been successfully utilized in the automotive, aeronautic and manufacturing industries. Surgical cutting tools undergo cyclical loading and generally fail by dulling, suggesting that thermal cycling may improve their performance and longevity. Ten 2.5 mm orthopaedic drill bits were randomized, with five undergoing thermal cycling within their sterile packaging and five serving as untreated controls. Using a servohydraulic testing machine, 100 drilling cycles were performed with each drill bit into the diaphyseal region of bovine femurs. After every 25 cycles, data was collected by performing identical drilling cycles into simulated human cortical bone material. Maximum force, maximum normalized torque and drilling work were measured, and a scanning electron microscope was used to measure outer corner wear. After 100 drilling cycles, the maximum drilling force, maximum normalized torque, drilling work and microscopic outer corner wear were all significantly lower for the treated drill bits (p < 0.05). Thermal cycling has the potential to decrease operating room costs and thermal necrosis associated with dull cutting tools. Application of this technology may also be relevant to surgical cutting tools such as saw blades, burrs and reamers. PMID:26296244
Clinical applications of vibration therapy in orthopaedic practice
Cerciello, Simone; Rossi, Silvio; Visonà, Enrico; Corona, Katia; Oliva, Francesco
Summary Background Vibration therapy (VT) has been proposed as an option to improve physical performance and reduce the negative effects of ageing on bone, muscles and tendons. Several discrepancies exist on the type of applications, frequency and magnitude. These differences reflex on the contradictory clinical results in literature. Aim of the present study is to carry on an exhaustive review to focus on technical options on the market, clinical applications in orthopaedic practice and expected outcomes. Methods a literature review using the key words "vibration therapy" and "whole-body vibration" and "orthopaedics" was performed. After checking the available abstracts 71 full text articles were evaluated. Results fifty-one articles focused on the effects of VT on muscles and tendons reporting ways of action and clinical outcomes. In a similar way 20 studies focused on the influence of VT on bone tissue with regard on ways of action and clinical trials. Conclusions VT provides anabolic mechanical signals to bone and musculo-tendinous system. The best effects seem to be achieved with devices that deliver low-intensity stimuli at high frequencies providing linear horizontal displacement. PMID:27331044
Nano-Engineered Cubic Zirconia for Orthopaedic Implant Applications
NASA Astrophysics Data System (ADS)
Namavar, F.; Rubinstein, A.; Sabirianov, R.; Thiele, G.; Sharp, J.; Pokharel, U.; Namavar, R.; Garvin, K.
Osseointegration failure of the prosthesis prevents long-term stability, which contributes to pain, implant loosening, and infection that usually necessitates revision surgery. Cell attachment and spreading in vitro is generally mediated by adhesive proteins such as fibronectin and vitronectin. We designed and produced pure cubic zirconia (ZrO2) ceramic coatings by ion beam assisted deposition (IBAD) with nanostructures comparable to the size of proteins. Our ceramic coatings exhibit high hardness and a zero contact angle with serum. In contrast to Hydroxyapatite (HA), nano-engineered zirconia films possess excellent adhesion to all orthopaedic materials. Adhesion and proliferation experiments were performed with a bona fide mesenchymal stromal cells cell line (OMA-AD). Our experimental results indicated that nano-engineered cubic zirconia is superior in supporting growth, adhesion, and proliferation. We performed a comparative analysis of adsorption energies of the FN fragment using quantum mechanical calculations and Monte Carlo simulation on both types of surfaces: smooth and nanostructured. We have found that the initial FN fragment adsorbs significantly stronger on the nanostructured surface than on the smooth surface.
NASA Technical Reports Server (NTRS)
Magnavox Government & Electronics Company originally used the NASTRAN program in the design stage of heavy aluminum fixtures for vibration testing. Program also used to compare the resonant frequencies of the circuitry to predict whether failures may occur because of high vibration levels. The company engineers can then make design alterations to improve the equipment's vibration resistance. Method allows Magnavox to insure reliability and reduce any possibility of vibration-caused failure in critical defense products they manufacture. Magnavox uses another COSMIC software package called GENOPTICS in the development of a Digital Optical Recorder, and also in research and development of other optical systems. This enables use of an optically recorded disc to store and retrieve digital data. It is reported that this program provides accurate results and that its use saved six man-months of time that would have been needed to develop a comparable software package.
Barriers and Facilitators Associated with Non-Surgical Treatment Use for Osteoarthritis Patients in Orthopaedic Practice
Hofstede, Stefanie N.; Marang-van de Mheen, Perla J.; Vliet Vlieland, Thea P. M.; van den Ende, Cornelia H. M.; Nelissen, Rob G. H. H.; van Bodegom-Vos, Leti
Introduction International evidence-based guidelines for the management of patients with hip and knee osteoarthritis (OA) recommend to start with (a combination of) non-surgical treatments, and using surgical intervention only if a patient does not respond sufficiently to non-surgical treatment options. Despite these recommendations, there are strong indications that non-surgical treatments are not optimally used in orthopaedic practice. To improve the adoption of non-surgical treatments, more insight is needed into barriers and facilitators of these treatments. Therefore, this study assessed which barriers and facilitators are associated with the use and prescription of different non-surgical treatments before hip and knee OA in orthopaedic practice among patients and orthopaedic surgeons in the Netherlands. Materials and Methods We performed two internet-based surveys among 172 orthopaedic surgeons and 174 OA patients. Univariate association and multivariable regression techniques are used to identify barriers and facilitators associated with the use of non-surgical treatments. Results Most barriers and facilitators among patients were associated with the use of physical therapy, lifestyle advice and dietary therapy. Among orthopaedic surgeons, most were associated with prescription of acetaminophen, dietary therapy and physical therapy. Examples of barriers and facilitators among patients included "People in my environment had positive experiences with a surgery" (facilitator for education about OA), and "Advice of people in my environment to keep on moving" (facilitator for lifestyle and dietary advice). For orthopaedic surgeons, examples were "Lack of knowledge about guideline" (barrier for lifestyle advice), "Agreements/ deliberations with primary care" and "Easy communication with a dietician" (facilitators for dietary therapy). Also the belief in the efficacy of these treatments was associated with increased prescription. Conclusions
A review of virtual reality based training simulators for orthopaedic surgery.
Vaughan, Neil; Dubey, Venketesh N; Wainwright, Thomas W; Middleton, Robert G
This review presents current virtual reality based training simulators for hip, knee and other orthopaedic surgery, including elective and trauma surgical procedures. There have not been any reviews focussing on hip and knee orthopaedic simulators. A comparison of existing simulator features is provided to identify what is missing and what is required to improve upon current simulators. In total 11 hip replacements pre-operative planning tools were analysed, plus 9 hip trauma fracture training simulators. Additionally 9 knee arthroscopy simulators and 8 other orthopaedic simulators were included for comparison. The findings are that for orthopaedic surgery simulators in general, there is increasing use of patient-specific virtual models which reduce the learning curve. Modelling is also being used for patient-specific implant design and manufacture. Simulators are being increasingly validated for assessment as well as training. There are very few training simulators available for hip replacement, yet more advanced virtual reality is being used for other procedures such as hip trauma and drilling. Training simulators for hip replacement and orthopaedic surgery in general lag behind other surgical procedures for which virtual reality has become more common. Further developments are required to bring hip replacement training simulation up to date with other procedures. This suggests there is a gap in the market for a new high fidelity hip replacement and resurfacing training simulator. PMID:26751581
Administrative Databases in Orthopaedic Research: Pearls and Pitfalls of Big Data.
Patel, Alpesh A; Singh, Kern; Nunley, Ryan M; Minhas, Shobhit V
The drive for evidence-based decision-making has highlighted the shortcomings of traditional orthopaedic literature. Although high-quality, prospective, randomized studies in surgery are the benchmark in orthopaedic literature, they are often limited by size, scope, cost, time, and ethical concerns and may not be generalizable to larger populations. Given these restrictions, there is a growing trend toward the use of large administrative databases to investigate orthopaedic outcomes. These datasets afford the opportunity to identify a large numbers of patients across a broad spectrum of comorbidities, providing information regarding disparities in care and outcomes, preoperative risk stratification parameters for perioperative morbidity and mortality, and national epidemiologic rates and trends. Although there is power in these databases in terms of their impact, potential problems include administrative data that are at risk of clerical inaccuracies, recording bias secondary to financial incentives, temporal changes in billing codes, a lack of numerous clinically relevant variables and orthopaedic-specific outcomes, and the absolute requirement of an experienced epidemiologist and/or statistician when evaluating results and controlling for confounders. Despite these drawbacks, administrative database studies are fundamental and powerful tools in assessing outcomes on a national scale and will likely be of substantial assistance in the future of orthopaedic research. PMID:26836377
Orthopaedic Timing in Polytrauma in a Second Level Emergency Hospital. An Overrated Problem?
Dei Giudici, L; Giampaolini, N; Panfighi, A; Marinelli, M; Procaccini, R; Gigante, A
The main concern for orthopaedic treatment in polytrauma has always been the same for almost forty years, which also regards "where" and "when" to proceed; correct surgical timing and correct interpretation of the DCO concept are still being debated. In the last few years, several attempts have been made to classify patients based on their clinical presentation and by trying to figure out which vital parameters are able to predict the patient's outcome. This study evaluated all patients who presented with code red at the Emergency Department of our Hospital, a level II trauma center. For every patient, the following characteristics were noted: sex, age, day of hospitalization, orthopaedic trauma, time to surgery, presence of an associated surgical condition in the fields of general surgery, thoracic surgery, neurosurgery and vascular surgery, cardiac frequency, blood pressure, oxygen saturation, Glasgow Coma Scale and laboratory data. All patients included were divided into subgroups based on orthopaedic surgical timing. Two other subgroups were also identified and analyzed in detail: deceased and weekend traumas. A total of 208 patients were included. Our primary goal was to identify a correlation between the mortality and surgical timing of the orthopaedic procedures; our secondary goal was to recognize, if present, a statistically relevant association between historical, clinical and laboratory data, and mortality rate, defining any possible risk factor. A correlation between mortality and orthopaedic surgical timing was not found. Analyzing laboratory data revealed an interesting correlation between mortality and: blood pressure, platelet count, cardiac frequency, hematocrit, hemoglobin and age. PMID:26312113
Building the Capacity to Manage Orthopaedic Trauma After a Catastrophe in a Low-Income Country.
Furey, Andrew; Rourke, James; Larsen, Hans
Providing trauma care in an austere environment is very challenging, especially when the country is faced with a natural disaster. Unfortunately the combination of these elements highlights the deficiencies in managing orthopaedic trauma both in a developing country and in the face of a natural disaster, exponentially amplifying the effects of each. When considering the implementation and practice of orthopaedic trauma care in such an environment, one must consider the initial phase of program development and look further to the future in the development of a resilient program, which is sustainable. Through the use of the example of Haiti and a specific Non-Governmental Organization, we discuss the evidence for and thoughts behind developing orthopaedic trauma care program immediately after a natural disaster. This program aims to build capacity and empower a developing nation's health professionals to advance the care of orthopaedic trauma patients. We describe a model of capacity building that serves as a framework to highlight the strengths and weaknesses of low-to middle-income countries in providing orthopaedic trauma care when faced with such a challenge. PMID:26356206
A survey of orthopaedic journal editors determining the criteria of manuscript selection for publication
Background To investigate the characteristics of editors and criteria used by orthopaedic journal editors in assessing submitted manuscripts. Methods Between 2008 to 2009 all 70 editors of Medline listed orthopaedic journals were approached prospectively with a questionnaire to determine the criteria used in assessing manuscripts for publication. Results There was a 42% response rate. There was 1 female editor and the rest were male with 57% greater than 60 years of age. 67% of the editors worked in university teaching hospitals and 90% of publications were in English. The review process differed between journals with 59% using a review proforma, 52% reviewing an anonymised manuscript, 76% using a routine statistical review and 59% of journals used 2 reviewers routinely. In 89% of the editors surveyed, the editor was able to overrule the final decision of the reviewers. Important design factors considered for manuscript acceptance were that the study conclusions were justified (80%), that the statistical analysis was appropriate (76%), that the findings could change practice (72%). The level of evidence (70%) and type of study (62%) were deemed less important. When asked what factors were important in the manuscript influencing acceptance, 73% cited an understandable manuscript, 53% cited a well written manuscript and 50% a thorough literature review as very important factors. Conclusions The editorial and review process in orthopaedic journals uses different approaches. There may be a risk of language bias among editors of orthopaedic journals with under-representation of non-English publications in the orthopaedic literature. PMID:21527007
Adjustable forming of thermoplastic composites for orthopaedic applications.
Hou, M; Friedrich, K
The present study was focused on the development of a special thermoforming technique for manufacturing of continuous fibre reinforced thermoplastic composite parts with complex surface contours. In particular, a stamp forming process was modified to investigate the potential manufacturing advantages of thermoplastic composites in orthopaedic applications. An apparatus was designed which allowed the thermoforming procedure to be fully automatic, i.e. a cold pre-consolidated laminate panel, as the feed material, was heated up in an infrared heating zone and then transferred into a cold mould system, where it was stamp formed. Both halves of the mould were made of many tiny round metal sticks in a metal frame. This needle-bed mould allowed one to copy any contour by pushing it slightly on spring fixed sticks. The desired position of these sticks could then be adjusted by forcing the side plates of the metal frame together. To prevent any press mark of stick-tops on the composite, i.e. to achieve smooth surfaces of the themoformed composite parts, flexible rubber pads were needed to cover the mould surfaces. Experimental results showed that the surface profile of CF/PP and GF/PP composites formed by the needle-bed mould reproduced fairly well the contour of a saddle shaped, complex model sample. Unique properties of this needle-bed mould are that it can be repeatedly used, and that it can copy any complex surface contours, for example a bone surface, by simply adjusting the stick positions according to the special surface requirements. PMID:15348912
Multiscale Inorganic Hierarchically Materials: Towards an Improved Orthopaedic Regenerative Medicine.
Ruso, Juan M; Sartuqui, Javier; Messina, Paula V
Bone is a biologically and structurally sophisticated multifunctional tissue. It dynamically responds to biochemical, mechanical and electrical clues by remodelling itself and accordingly the maximum strength and toughness are along the lines of the greatest applied stress. The challenge is to develop an orthopaedic biomaterial that imitates the micro- and nano-structural elements and compositions of bone to locally match the properties of the host tissue resulting in a biologically fixed implant. Looking for the ideal implant, the convergence of life and materials sciences occurs. Researchers in many different fields apply their expertise to improve implantable devices and regenerative medicine. Materials of all kinds, but especially hierarchical nano-materials, are being exploited. The application of nano-materials with hierarchical design to calcified tissue reconstructive medicine involve intricate systems including scaffolds with multifaceted shapes that provides temporary mechanical function; materials with nano-topography modifications that guarantee their integration to tissues and that possesses functionalized surfaces to transport biologic factors to stimulate tissue growth in a controlled, safe, and rapid manner. Furthermore materials that should degrade on a timeline coordinated to the time that takes the tissues regrow, are prepared. These implantable devices are multifunctional and for its construction they involve the use of precise strategically techniques together with specific material manufacturing processes that can be integrated to achieve in the design, the required multifunctionality. For such reasons, even though the idea of displacement from synthetic implants and tissue grafts to regenerative-medicine-based tissue reconstruction has been guaranteed for well over a decade, the reality has yet to emerge. In this paper, we examine the recent approaches to create enhanced bioactive materials. Their design and manufacturing procedures as well
Surgical advances during the First World War: the birth of modern orthopaedics.
Ramasamy, Arul; Eardley, W G P; Edwards, D S; Clasper, J C; Stewart, M P M
The First World War (1914-1918) was the first truly industrial conflict in human history. Never before had rifle fire and artillery barrage been employed on a global scale. It was a conflict that over 4 years would leave over 750,000 British troops dead with a further 1.6 million injured, the majority with orthopaedic injuries. Against this backdrop, the skills of the orthopaedic surgeon were brought to the fore. Many of those techniques and systems form the foundation of modern orthopaedic trauma management. On the centenary of 'the War to end all Wars', we review the significant advances in wound management, fracture treatment, nerve injury and rehabilitation that were developed during that conflict. PMID:25512441
[The Development and Application of the Orthopaedics Implants Failure Database Software Based on WEB].
Huang, Jiahua; Zhou, Hai; Zhang, Binbin; Ding, Biao
This article develops a new failure database software for orthopaedics implants based on WEB. The software is based on B/S mode, ASP dynamic web technology is used as its main development language to achieve data interactivity, Microsoft Access is used to create a database, these mature technologies make the software extend function or upgrade easily. In this article, the design and development idea of the software, the software working process and functions as well as relative technical features are presented. With this software, we can store many different types of the fault events of orthopaedics implants, the failure data can be statistically analyzed, and in the macroscopic view, it can be used to evaluate the reliability of orthopaedics implants and operations, it also can ultimately guide the doctors to improve the clinical treatment level. PMID:26904871
Publication rates of abstracts presented at the annual meeting of the Society of Military Orthopaedic Surgeons.
Fuller, Brian C; Dowd, Thomas C; Masini, Brendan D; Gerlinger, Tad L
Previous studies have reported publication rates of abstracts presented at orthopaedic meetings from 22 to 68 percent. The objective of this study was to determine the publication rate of papers presented at the Society of Military Orthopaedic Surgeons (SOMOS) meetings from 1999 to 2003. A database was created including all abstracts presented at SOMOS meetings from 1999 to 2003 as listed in official program books. To assess whether each abstract resulted in publication in a peer-reviewed journal, a computerized PubMed search of the presenting author and appropriate keywords from the title was conducted. Overall, 191 of the 435 abstracts presented at SOMOS from 1999 to 2003 were published in a peer-reviewed journal, giving a publication rate of 44%. The publication rate of abstract presentations at annual SOMOS meetings compares favorably with the rates for other orthopaedic meetings. However, less than 50% result in peer-reviewed publication. PMID:22995357
An audit of university education in trauma and orthopaedic surgery in Great Britain.
O'Dowd, J K; Spencer, J D
An audit of undergraduate trauma and orthopaedic surgery teaching was carried out in 24 of the 27 medical schools in Great Britain and major differences were found between the medical schools. The range of time spent in teaching trauma and orthopaedic surgery for undergraduates varied from 3 weeks to 12 weeks and in five out of 27 medical schools trauma and orthopaedic surgery tuition was split between various years of the clinical curriculum. In some schools there were 30 students on a firm and in others only one. The opportunity for undergraduates to give feedback to their teachers, the use of objective assessment at the end of such an appointment by the teachers, varied between medical schools. To avoid some of these very basic differences between our medical schools, the teaching of clinical subjects to undergraduates in medicine should be reviewed nationally and minimum standards set. PMID:1433062
Trace metal determination as it relates to metallosis of orthopaedic implants: Evolution and current status.
Ring, Gavin; O'Mullane, John; O'Riordan, Alan; Furey, Ambrose
In utilising metal surfaces that are in constant contact with each other, metal-on-metal (MoM) surgical implants present a unique challenge, in the sense that their necessity is accompanied by the potential risk of wear particle generation, metal ion release and subsequent patient toxicity. This is especially true of orthopaedic devices that are faulty and subject to failure, where the metal surfaces undergo atypical degradation and release even more unwanted byproducts, as was highlighted by the recent recall of orthopaedic surgical implants. The aim of this review is to examine the area of metallosis arising from the wear of MoM articulations in orthopaedic devices, including how the surgical procedures and detection methods have advanced to meet growing performance and analytical needs, respectively. PMID:26794632
[Prof. Michiharu Matsuoka, founder of the Department of Orthopaedic Surgery at Kyoto University and his achievements in orthopaedic surgery in the Meiji era of Japan (Part 5, Faculty members and training of doctors from Nagoya)].
Hirotani, Hayato
During the years when Dr. M. Matsuoka was professor of the Department of Orthopaedic Surgery, Kyoto Medical School, Kyoto Imperial University (June, 1907-January, 1914), seven doctors worked as his faculty members and founded the base of the current development and reputation of the Department. After resignation from their academic positions, they served in orthopaedic practice in several areas in Japan where orthopaedic surgery was not well recognized. In addition, Prof. Matsuoka trained three doctors from the Aichi Prefectural Medical College (School of Medicine, Nagoya University) in the orthopaedic practice, including x-ray technique and they contributed to the development of orthopaedic surgery in the areas of Nagoya city and Tokai. Backgrounds and achievements of these ten doctors are described. PMID:21560319
Common Intra-Cluster Competencies Needed in Selected Occupational Clusters. Final Report. Supplemental Volume XIV: Orthopaedic Physician's Assistant.
ERIC Educational Resources Information Center
McClurg, Ronald B.
An analysis of survey responses from a sample of orthopaedic physician's assistants on competency characteristics for their occupation is presented in this document. (Orthopaedic physician's assistant is one of seventeen occupation groups included in this research.) The competencies are reported in five categories: (1) those competencies selected…
Retrospective survey of clinical attention taken to osteoporosis in patients admitted in orthopaedic department for fragility fractures
Colì, Giuseppe; Abatelillo, Massimo; Cataldi, Giuseppe; De Caro, Francesco; Esposito, Diego; Mega, Walter; Perrone, Vinicio; Piscitelli, Prisco; Manno, Luigia
Considering that to international level it has put in evidence that often the diagnosis of osteoporosis is underestimated and that diagnostic and therapeutic attention of the same one are often neglected, the authors have assessed the degree of care provided by orthopaedic surgeons about the problem of osteoporosis, considering the medical files of orthopaedics department. Then corrective behaviour were proposed. PMID:22461253
Postinjury Anxiety and Social Support Among Collegiate Athletes: A Comparison Between Orthopaedic Injuries and Concussions
Covassin, Tracey; Crutcher, Bryan; Bleecker, Alisha; Heiden, Erin O.; Dailey, Alexander; Yang, Jingzhen
Context: When an athlete is injured, the primary focus of the sports medicine team is to treat the physical effects of the injury. However, many injured athletes experience negative psychological responses, including anxiety, regarding their injury. Objective: To compare the anxiety and social support of athletes with concussions and a matched group of athletes with orthopaedic injuries. Design: Cross-sectional study. Setting: Athletic training room. Patients or Other Participants: A total of 525 injuries among athletes from 2 Big Ten universities were observed. Of these, 63 concussion injuries were matched with 63 orthopaedic injuries for the athlete's sex, sport, and time loss due to injury. Main Outcome Measure(s): Clinical measures included the State-Trait Anxiety Inventory (which measures both state and trait anxiety) and the modified 6-item Social Support Questionnaire. Results: The group with concussions relied on their family for social support 89% of the time, followed by friends (78%), teammates (65%), athletic trainers (48%), coaches (47%), and physicians (35%). The group with orthopaedic injuries relied on their family for social support 87% of the time, followed by friends (84%), teammates (65%), athletic trainers (57%), coaches (51%), and physicians (36%). We found no differences for the State-Trait Anxiety Inventory (t = −1.38, P = .193) between the concussed and orthopaedic-injury groups. Social Support Questionnaire scores were significant predictors for postinjury state anxiety. Specifically, increased scores were associated with decreased postinjury state anxiety (β = −4.21, P = .0001). Conclusions: Both the concussed athletes and those with orthopaedic injuries experienced similar state and trait anxiety and relied on similar sources of social support postinjury. However, athletes with orthopaedic injuries reported greater satisfaction with support from all sources compared with concussed athletes. In contrast, concussed athletes showed
Custom-Made Antibiotic Cement Nails in Orthopaedic Trauma: Review of Outcomes, New Approaches, and Perspectives
Wasko, Marcin K.; Kaminski, Rafal
Since the first description in 2002 by Paley and Herzenberg, antibiotic bone cement nails (ACNs) have become an effective tool in the orthopaedic trauma surgeons' hands. They simultaneously elute high amounts of antibiotics into medullary canal dead space and provide limited stability to the debrided long bone. In this paper, we perform a systematic review of current evidence on ACNs in orthopaedic trauma and provide an up-to-date review of the indications, operative technique, failure mechanisms, complications, outcomes, and outlooks for the ACNs use in long bone infection. PMID:26509153
AAOS Research Symposium Updates and Consensus: Biologic Treatment of Orthopaedic Injuries.
LaPrade, Robert F; Dragoo, Jason L; Koh, Jason L; Murray, Iain R; Geeslin, Andrew G; Chu, Constance R
Strategies that seek to enhance musculoskeletal tissue regeneration and repair by modulating the biologic microenvironment at the site of injury have considerable therapeutic potential. Current and emerging biologic approaches include the use of growth factors, platelet-rich plasma, stem cell therapy, and scaffolds. The American Academy of Orthopaedic Surgeons hosted a research symposium in November 2015 to review the current state-of-the-art biologic treatments of articular cartilage, muscle, tendon, and bone injuries and identify knowledge gaps related to these emerging treatments. This review outlines the findings of the symposium and summarizes the consensus reached on how best to advance research on biologic treatment of orthopaedic injuries. PMID:27227987
The Basingstoke Orthopaedic Database: a high quality accurate information system for audit.
Barlow, I W; Flynn, N A; Britton, J M
The accuracy of a computerised audit system custom produced for the Orthopaedic Department has been validated by comparison with operating theatre records and patients' case notes. The study revealed only 2.5 per cent missed entries; of the recorded entries information regarding the nature of the operation was found to be 92.5 per cent complete and 98 per cent accurate. The high percentage accuracy reflects the high degree of medical input in operation of the system. The Basingstoke Orthopaedic Database is flexible, cheap and easy to maintain. Data is stored in a form that is readily applicable to standard software packages. PMID:7598401
The Orthopaedic Training Study, Phase II 1968-1972. Final Report Supplement, Part A.
ERIC Educational Resources Information Center
Olson, Carl J.; And Others
This document, as a supplement to the final report of the Orthopaedic Training Study, contains the documents considered to be important in providing the background for the study. The materials are organized into four major areas: initial correspondence, instrumentation, special reports, and psychomotor skills. See also HE 003 275 and HE 003 276.…
The Orthopaedic Training Study, Phase II 1968-1972. Final Report Supplement, Psychomotor Skills, Part B.
ERIC Educational Resources Information Center
Olson, Carl J.; And Others
This document, as a supplement to the final report of the Orthopaedic Training Study, presents a discussion of the rationale behind the implementation of a laboratory course in psychomotor skills development for medical students. Medical educators examined resident training in terms of 3 components of cognitive elements of learning: cognitive,…
Does Change in Functional Performance Affect Quality of Life in Persons with Orthopaedic Impairment?
ERIC Educational Resources Information Center
Ostir, Glenn V.; Berges, Ivonne-Marie; Smith, Pamela M.; Smith, David; Rice, Janida L.; Ottenbacher, Kenneth J.
Background and Purpose: Examine the association between change in functional status and quality of life for individuals with orthopaedic impairments approximately 90 days after discharge from in-patient medical rehabilitation. Methods: A retrospective study from 2001 to 2002 using information from the IT HealthTrack database. The study included…
Boston's contributions to the development of orthopaedics in the United States. A brief history.
Mankin, H J
Since the early part of the nineteenth century, physicians from Boston have had a major impact on orthopaedics in America. Initially, the general surgeons such as John Ball Brown and his son, Buckminster had an impact on orthopaedics, but contributors such as Henry Bigelow and Charles Scudder added greatly to the knowledge and capacity for care. The first orthopaedic ward, Ward I, was located at the Massachusetts General Hospital and began the new era. Surgical treatment by orthopaedists began in the twentieth century with such contributors as Philip Wilson, EA Codman, Robert B. Osgood, Joel Goldthwait, Elliot Brackett, Robert Lovett, and Edward Bradford. These physicians not only treated patients at the Children's, Tufts University, Boston City, the Beth Israel, and the Massachusetts General Hospitals, but assumed the academic responsibilities of a major educational center. More recently the contributors to orthopaedics have included Marius Smith-Petersen, Otto Aufranc, Henry Banks, Edward Cave, Carter Rowe, Joseph Barr, and others who have created a spectacular program for education, research, and clinical care. PMID:10818968
Level of Perception of Individualized Care and Satisfaction With Nursing in Orthopaedic Surgery Patients.
Tekin, Fatma; Findik, Ummu Yildiz
Lately, individualized nursing care and patient satisfaction are important and current issues being discussed. But there is not enough information for patients undergoing orthopaedic surgery. The aim of this study was to determine the individualized care perception and satisfaction in nursing care levels in orthopaedic surgery patients. This descriptive cross-sectional study was conducted with 156 patients who underwent orthopaedic surgery. Data were collected using the personal information form, the Individualized Care Scale, and the Newcastle Satisfaction With Nursing Scale. The Spearman correlation analysis and descriptive statistics were performed. The mean individualized care and satisfaction with nursing care scores were found to be close to the preset maximum value, and it was determined that an increase in the level of awareness about nursing interventions and the level of perceived individualized care caused an increase in satisfaction levels regarding nursing care. Nurses should recognize the importance of performing individualized care in order to increase the level of satisfaction with nursing care in orthopaedic surgery patients. PMID:26575511
Hallmarks in the history of orthopaedic implants for trauma and joint replacement.
Markatos, Konstantinos; Tsoucalas, Gregory; Sgantzos, Markos
This manuscript represents an attempt to review orthopaedic implants and reconstructive orthopaedic surgery for lower limbs lesions or trauma mainly in the 20th century. We emphasized on the type of implants, the biomaterials and their evolution, and we also engaged in a special reference for the pioneers of orthopaedic implant surgery and the innovative designers of those implants, in such a way to understand the ways and the stages through which they evolved to their present forms, as well as the scientific principles that affected their design and progress. A correlation between the evolution of implants and several relevant disciplines (biomaterial chemists and engineers, biomechanics) that developed simultaneously with orthopaedic reconstructive joint surgery is present since the first attempts to reconstruct a damaged joint. In the future, further progress is anticipated in the use of biomaterials, more compatible towards human biology, with minimally invasive applications and a perpetually increased life span. This progress depicts a phenomenon directly related to a multilevel, multifactorial and interdisciplinary scientific and technological field with many expectations. PMID:27598960
Why veteran orthopaedic trauma surgeons are being fired and what we can do about it?
Hill, Austin; Althausen, Peter L; O'Mara, Timothy J; Bray, Timothy J
The financial realities of providing trauma care to injured patients can make it difficult to produce an accurate assessment of the cumulative value orthopaedic trauma surgeons provide to healthcare and university institutions. As with many political battles in the field of medicine, physicians who have been diligently focused on providing patient care were completely unaware of the impending upheaval around them. Whether orthopaedic trauma surgeons are employed or in some type of partnership with hospitals, too often surgeons find the relationship one-sided. In order to effectively negotiate with hospitals, surgeons must demonstrate the comprehensive value they provide to their respective healthcare institutions and universities. Orthopaedic trauma surgeons make direct and indirect financial contributions to the hospital in addition to educational and community services. The sum total of these valued contributions helps fund non-revenue generating programs, provides marketing opportunities, and improves the regional and national reputation of the healthcare institution. This paper provides a comprehensive review of the value contributed to healthcare institutions by orthopaedic trauma surgeons and will serve as a blueprint for all surgeons to accurately account for and demonstrate their value to hospitals while providing efficient and compassionate care to our patients. PMID:23571292
78 FR 20328 - Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee: Notice of...
Federal Register 2010, 2011, 2012, 2013, 2014
... Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee scheduled for April 5, 2013. The meeting was announced in the Federal Register of November 29, 2012 (77 FR 71195). The meeting... Devices Advisory Committee: Notice of Postponement of Meeting AGENCY: Food and Drug Administration,...
Analysis of the basic science section of the orthopaedic in-training examination.
Sheibani-Rad, Shahin; Arnoczky, Steven Paul; Walter, Norman E
Since 1963, the Orthopaedic In-Training Examination (OITE) has been administered to orthopedic residents to assess residents' knowledge and measure the quality of teaching within individual programs. The OITE currently consists of 275 questions divided among 12 domains. This study analyzed all OITE basic science questions between 2006 and 2010. The following data were recorded: number of questions, question taxonomy, category of question, type of imaging modality, and recommended journal and book references. Between 2006 and 2010, the basic science section constituted 12.2% of the OITE. The assessment of taxonomy classification showed that recall-type questions were the most common, at 81.4%. Imaging modalities typically involved questions on radiographs and constituted 6.2% of the OITE basic science section. The majority of questions were basic science questions (eg, genetics, cell replication, and bone metabolism), with an average of 26.4 questions per year. The Journal of Bone & Joint Surgery (American Volume) and the American Academy of Orthopaedic Surgeons' Orthopaedic Basic Science were the most commonly and consistently cited journal and review book, respectively. This study provides the first review of the question content and recommended references of the OITE basic science section. This information will provide orthopedic trainees, orthopedic residency programs, and the American Academy of Orthopaedic Surgeons Evaluation Committee valuable information related to improving residents' knowledge and performance and optimizing basic science educational curricula. PMID:22868614
The 2007 ABJS Marshall Urist Award: The impact of direct-to-consumer advertising in orthopaedics.
Bozic, Kevin J; Smith, Amanda R; Hariri, Sanaz; Adeoye, Sanjo; Gourville, John; Maloney, William J; Parsley, Brian; Rubash, Harry E
Direct-to-consumer advertising (DTCA) has become an influential factor in healthcare delivery in the United States. We evaluated the influence of DTCA on surgeon and patient opinions and behavior in orthopaedics by surveying orthopaedic surgeons who perform hip and knee arthroplasties and patients who were scheduled to have hip or knee arthro-plasty. Respondents were asked for their opinions of and experiences with DTCA, including the influence of DTCA on surgeon and patient decision making. Greater than 98% of surgeon respondents had experience with patients who were exposed to DTCA. The majority of surgeon respondents reported DTCA had an overall negative impact on their practice and their interaction with patients (74%), and their patients often were confused or misinformed about the appropriate treatment for their condition based on an advertisement (77%). Fifty-two percent of patient respondents recalled seeing or hearing advertisements related to hip or knee arthroplasty. These patients were more likely to request a specific type of surgery or brand of implant from their surgeon and to see more than one surgeon before deciding to have surgery. Direct-to-consumer advertising seems to play a substantial role in surgeon and patient decision making in orthopaedics. Future efforts should be aimed at improving the quality and accuracy of information contained in consumer-directed advertisements related to orthopaedic implants and procedures. PMID:17353799
The assessment and management of pain in an orthopaedic out-patient setting: A case study.
Hall, Gillian; Gregory, Julie
The management of pain is an important aspect of an orthopaedic nurse's role. The aim of this paper is to use an individual case study to demonstrate the role of an out-patient orthopaedic nurse in the identification, assessment and management of pain. This paper describes how pain was identified and managed for a patient in the orthopaedic outpatient department, highlighting that pain and its management are not isolated to the in-patient setting. The case study illustrates the importance of recognising pain and taking into account the numerous factors that can influence pain perception. The assessment of an individual patient's pain led to obtaining help from the Acute Pain Team which led to improvement in the patient's pain management and quality of life. The nursing team reflected and discussed the issues identified by this case study which led to changes in practice being introduced. This has resulted in an increased knowledge of and confidence in pain management within the nursing team and development and improvement of pain management practice within the orthopaedic out-patient department. PMID:26711709
Peri-operative blood management in elective orthopaedic surgery. A critical review of the literature.
Moonen, A F C M; Neal, T D; Pilot, P
Blood loss during orthopaedic procedures can be extensive and the need for allogeneic blood is a common requirement. However, blood transfusion conceals a number of well-recognised risks and complications and blood products have become more expensive because of their specific preparation procedure. Surgical technique, awareness of the problem and restriction of transfusion triggers are important factors affecting the management of blood loss. Several studies have additionally shown the efficacy of epoetin injections in increasing the pre-operative haemoglobin level. On the other hand, the true benefit of pre-operative autologous donation, acute normovolemic haemodilution and COX-2 selective NSAIDs remains under dispute. Regarding the role of platelet rich plasmapheresis, fibrin sealing and anti-fibinolytic drugs more data are needed. Hypotensive epidural anaesthesia seems to be an advantageous method in minimising peri-operative blood loss. However, this is not a widely performed technique in orthopaedic surgery. In addition, post-operative blood cell saving systems after total knee or hip arthroplasty have been reported to significantly minimise allogeneic blood transfusions when compared to control groups. It can be concluded that many interventions diminish more or less allogeneic blood transfusion in elective orthopaedic surgery. Nevertheless more prospective studies are needed and appropriate algorithms should be applied in peri-operative blood loss management. This review presents an overview of the available interventions which aim to diminish the use of allogeneic blood in elective orthopaedic surgery. PMID:17338906
Biodegradable magnesium alloys for orthopaedic applications: A review on corrosion, biocompatibility and surface modifications.
Agarwal, Sankalp; Curtin, James; Duffy, Brendan; Jaiswal, Swarna
Magnesium (Mg) and its alloys have been extensively explored as potential biodegradable implant materials for orthopaedic applications (e.g. Fracture fixation). However, the rapid corrosion of Mg based alloys in physiological conditions has delayed their introduction for therapeutic applications to date. The present review focuses on corrosion, biocompatibility and surface modifications of biodegradable Mg alloys for orthopaedic applications. Initially, the corrosion behaviour of Mg alloys and the effect of alloying elements on corrosion and biocompatibility is discussed. Furthermore, the influence of polymeric deposit coatings, namely sol-gel, synthetic aliphatic polyesters and natural polymers on corrosion and biological performance of Mg and its alloy for orthopaedic applications are presented. It was found that inclusion of alloying elements such as Al, Mn, Ca, Zn and rare earth elements provides improved corrosion resistance to Mg alloys. It has been also observed that sol-gel and synthetic aliphatic polyesters based coatings exhibit improved corrosion resistance as compared to natural polymers, which has higher biocompatibility due to their biomimetic nature. It is concluded that, surface modification is a promising approach to improve the performance of Mg-based biomaterials for orthopaedic applications. PMID:27524097
Addressing the Global Disparities in the Delivery of Pediatric Orthopaedic Services: Opportunities for COUR and POSNA.
Shirley, Eric D; Sabharwal, Sanjeev; Schwend, Richard M; Cabral, Cristina; Spiegel, David
The burden of musculoskeletal conditions, especially injuries, is increasing in low-income and middle-income countries. Road traffic injuries have become epidemic. There are multiple barriers to accessing surgical services at both the individual (utilization) and the health system (availability) levels, and deficiencies in education and training of health providers. Specialty societies such as the Pediatric Orthopaedic Society of North America (POSNA) have an opportunity to play an important role through teaching and training. The POSNA Children's Orthopedics in Underserved Regions (COUR) committee has supported the Visiting Scholars Program, which invites surgeons from the developing world to attend a scientific meeting and facilitates the scholar's visit to North American pediatric orthopaedic centers. POSNA members have held global educational courses that support an educational exchange between lecturers and attendees. The COUR web site allows for submission of trip reports that document successes and obstacles experienced by members performing overseas clinical care and teaching. The web site also provides educational resources relevant to providing care in these environments. POSNA collaborates with other societies, such as the American Academy of Orthopaedic Surgeons and the Society of Military Orthopaedic Surgeons, to provide education in disaster management. In addition to increasing member involvement, specialty societies have the opportunity for continued data collection from overseas care, application of US registry data to disease processes in the developing world, and further collaboration with one another. PMID:26296220
Decellularized Tissue and Cell-Derived Extracellular Matrices as Scaffolds for Orthopaedic Tissue Engineering
Cheng, Christina W.; Solorio, Loran D.; Alsberg, Eben
The reconstruction of musculoskeletal defects is a constant challenge for orthopaedic surgeons. Musculoskeletal injuries such as fractures, chondral lesions, infections and tumor debulking can often lead to large tissue voids requiring reconstruction with tissue grafts. Autografts are currently the gold standard in orthopaedic tissue reconstruction; however, there is a limit to the amount of tissue that can be harvested before compromising the donor site. Tissue engineering strategies using allogeneic or xenogeneic decellularized bone, cartilage, skeletal muscle, tendon and ligament have emerged as promising potential alternative treatment. The extracellular matrix provides a natural scaffold for cell attachment, proliferation and differentiation. Decellularization of in vitro cell-derived matrices can also enable the generation of autologous constructs from tissue specific cells or progenitor cells. Although decellularized bone tissue is widely used clinically in orthopaedic applications, the exciting potential of decellularized cartilage, skeletal muscle, tendon and ligament cell-derived matrices has only recently begun to be explored for ultimate translation to the orthopaedic clinic. PMID:24417915
Demonstrating the value of orthopaedic surgery through multicenter trials: AOA critical issues.
Hilibrand, Alan S; Spindler, Kurt; O'Keefe, Regis J
Orthopaedic surgery is expensive and will be carefully scrutinized in the U.S. under health-care reform. Unfortunately, although the orthopaedic literature is replete with clinical outcomes studies, there is still a paucity of meaningful clinical outcomes data that are free from bias. It is possible that orthopaedic procedures may be among the most cost-effective medical treatments for the aging population. However, it is only through the collection of patient-generated outcomes data in prospective randomized and observational studies that orthopaedic surgery can be shown to provide high value (defined as high-quality outcomes at a relatively low cost) to society.The burden of musculoskeletal disease in the U.S. is high; nearly half of all adults describe themselves as having a chronic musculoskeletal condition, and approximately one-quarter of all health-care dollars are spent treating musculoskeletal disease. For this reason, treatment for osteoarthritis, the costliest condition in the elderly population, has drawn great scrutiny from insurers and the government. In the absence of clinical outcomes data that prove the value of orthopaedic interventions, there will be pressure to reduce payments or even deny treatments for these conditions if they are perceived to be too expensive or lack outcomes data supporting their use.Multicenter trials are expensive; this paper analyzes challenges to, and opportunities for, funding. Although National Institutes of Health (NIH) funding has dropped nearly 20% over the past ten years in inflation-adjusted dollars, it has begun a gradual reorientation toward clinical research, which comprised almost 50% of its budget in 2013. The Patient Protection and Affordable Care Act focused more attention on clinical outcomes research, with the establishment of the Patient-Centered Outcomes Research Institute (PCORI), which will ultimately fund $750 million of comparative effectiveness research annually. Another new funding source within
Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis
Sexton, Debbie; Mann, Charles; Donell, Simon
Objective To compare the clinical outcomes of staples versus sutures in wound closure after orthopaedic surgery. Design Meta-analysis. Data sources Medline, CINAHL, AMED, Embase, Scopus, and the Cochrane Library databases were searched, in addition to the grey literature, in all languages from 1950 to September 2009. Additional studies were identified from cited references. Selection criteria Two authors independently assessed papers for eligibility. Included studies were randomised and non-randomised controlled trials that compared the use of staples with suture material for wound closure after orthopaedic surgery procedures. All studies were included, and publications were not excluded because of poor methodological quality. Review methods Two authors independently reviewed studies for methodological quality and extracted data from each paper. Final data for analysis were collated through consensus. The primary outcome measure was the assessment of superficial wound infection after wound closure with staples compared with sutures. Relative risk and mean difference with 95% confidence intervals were calculated and pooled with a random effects model. Heterogeneity was assessed with I2 and χ2 statistical test. Results Six papers, which included 683 wounds, were identified; 332 patients underwent suture closure and 351 staple closure. The risk of developing a superficial wound infection after orthopaedic procedures was over three times greater after staple closure than suture closure (relative risk 3.83, 95% confidence interval 1.38 to 10.68; P=0.01). On subgroup analysis of hip surgery alone, the risk of developing a wound infection was four times greater after staple closure than suture closure (4.79, 1.24 to 18.47; P=0.02). There was no significant difference between sutures and staples in the development of inflammation, discharge, dehiscence, necrosis, and allergic reaction. The included studies had several major methodological limitations, including the
Does Admission to Medicine or Orthopaedics Impact a Geriatric Hip Patient's Hospital Length of Stay?
Greenberg, Sarah E.; VanHouten, Jacob P.; Lakomkin, Nikita; Ehrenfeld, Jesse; Jahangir, Amir Alex; Boyce, Robert H.; Obremksey, William T.; Sethi, Manish K.
Objectives The aim of our study was to determine the association between admitting service, medicine or orthopaedics, and length of stay (LOS) for a geriatric hip fracture patient. Design Retrospective. Setting Urban level 1 trauma center. Patients/Participants Six hundred fourteen geriatric hip fracture patients from 2000 to 2009. Interventions Orthopaedic surgery for geriatric hip fracture. Main Outcome Measurements Patient demographics, medical comorbidities, hospitalization length, and admitting service. Negative binomial regression used to determine association between LOS and admitting service. Results Six hundred fourteen geriatric hip fracture patients were included in the analysis, of whom 49.2% of patients (n = 302) were admitted to the orthopaedic service and 50.8% (3 = 312) to the medicine service. The median LOS for patients admitted to orthopaedics was 4.5 days compared with 7 days for patients admitted to medicine (P < 0.0001). Readmission was also significantly higher for patients admitted to medicine (n = 92, 29.8%) than for those admitted to orthopaedics (n = 70, 23.1%). After controlling for important patient factors, it was determined that medicine patients are expected to stay about 1.5 times (incidence rate ratio: 1.48, P < 0.0001) longer in the hospital than orthopaedic patients. Conclusions This is the largest study to demonstrate that admission to the medicine service compared with the orthopaedic service increases a geriatric hip fractures patient's expected LOS. Since LOS is a major driver of cost as well as a measure of quality care, it is important to understand the factors that lead to a longer hospital stay to better allocate hospital resources. Based on the results from our institution, orthopaedic surgeons should be aware that admission to medicine might increase a patient's expected LOS. PMID:26371621
Development of an orthopaedic surgical skills curriculum for post-graduate year one resident learners - the University of Iowa experience.
Karam, Matthew D; Westerlind, Brian; Anderson, Donald D; Marsh, J Lawrence
Orthopaedic surgery requires a high degree of technical skill. Current orthopaedic surgical education is based largely on an apprenticeship model. In addition to mounting evidence of the value of simulation, recent mandated requirements will undoubtedly lead to increased emphasis on surgical skills and simulation training. The University of Iowa's Department of Orthopaedic Surgery has created and implemented a month long surgical skills training program for PGY-1 residents. The goal of the program was to improve the basic surgical skills of six PGY-1 orthopaedic surgery residents and prepare them for future operative experiences. A modular curriculum was created by members of the orthopaedic faculty which encompassed basic skills felt to be important to the general orthopaedic surgeon. For each module multiple assessment techniques were utilized to provide constructive critique, identify errors and enhance the performance intensity of trainees. Based on feedback and debriefing surveys, the resident trainees were unanimously satisfied with the content of the surgical skills month, and felt it should remain a permanent part of our educational program. This manuscript will describe the development of the curriculum, the execution of the actual skills sessions and analysis of feedback from the residents and share valuable lessons learned and insights for future skills programs. PMID:24027480
Benzoyl peroxide: is it a relevant bone cement allergen in patients with orthopaedic implants?
Treudler, Regina; Simon, Jan C
Contact allergies to orthopaedic implant material are discussed to be relevant for postoperative complaints. We aimed at determining the prevalence of sensitizations to implant metals and to bone cements in patients with implants. We investigated 13 consecutive patients with suspicion of contact allergy to implant material. Epicutaneous patch testing was performed with metals and bone cement components including benzoyl peroxide (BPO). The chief complaints were skin disorders (n = 3), loosening of implant (n = 2), swelling (n = 6), and pain (n = 2). 6 patients had a sensitization to at least 1 allergen. 3 patients reacted to BPO, being of possible relevance in 1 of these patients suffering from dermatitis. Other sensitizations, such as those to nickel, fragrance, and balsam of Peru, were observed, with no clinical relevance (n = 1, respectively). BPO in bone cements may lead to type 4 sensitizations of which the relevance, however, remains questionable. Nevertheless we recommend this allergen to be tested in patients with complicated cemented orthopaedic implants. PMID:17680868
Distribution and drug resistance profile of methicillin-resistant Staphylococcus aureus after orthopaedic surgery.
Song, Wen Chao; Zhang, Si Sen; Gong, Yu Hong
This paper is aimed to comprehend clinical distribution and drug-resistance situation of methicillin-resistant Staphylococcus aureus. This study applied automatic microbe instrument Microscan W/A 96 for strain identification and drug susceptibility screening on the isolated strains. It was found that 312 MRSA strains were isolated in three years, which account for 58.1% of Staphylococcus aureus. MRSA were mainly focused in wound secretion, purulent sputum and prostatic fluid and a few of them were isolated from blood specimens; Endemic area distribution was mainly located in intensive care unit, neurosurgery, respiratory department, dermatology, orthopaedic burns and orthopaedics. MRSA strains showed high drug resistance of 82.37%~100% to most of the antibiotics including vancomycin, cotrimoxazole and rifampicin. Strain was 100% resistance towards ampicillin, amoxicillin/acid, cefalotin, cefazolin, tienam, benzylpenicillin, penicillin and tetracycline and 90% strains resisted clindamycin, cefotaxime, clarithromycin and gentamicin. PMID:26051737
Retention of Skills After Simulation-based Training in Orthopaedic Surgery.
Atesok, Kivanc; Satava, Richard M; Van Heest, Ann; Hogan, MaCalus V; Pedowitz, Robert A; Fu, Freddie H; Sitnikov, Irena; Marsh, J Lawrence; Hurwitz, Shepard R
Simulation-based surgical skills training has become essential in orthopaedic practice because of concerns about patient safety and an increase in technically challenging procedures. Surgical skills training in specifically designed simulation laboratories allows practice of procedures in a risk-free environment before they are performed in the operating room. The transferability of acquired skills to performance with patients is the most effective measure of the predictive validity of simulation-based training. Retention of the skills transferred to clinical situations is also critical. However, evidence of simulation-based skill retention in the orthopaedic literature is limited, and concerns about sustainability exist. Solutions for skill decay include repeated practice of the tasks learned on simulators and reinforcement of areas that are sensitive to decline. Further research is required to determine the retention rates of surgical skills acquired in simulation-based training as well as the success of proposed solutions for skill decay. PMID:27348146
Titanium-Nitride Coating of Orthopaedic Implants: A Review of the Literature
van Hove, Ruud P.; Sierevelt, Inger N.; van Royen, Barend J.; Nolte, Peter A.
Surfaces of medical implants can be enhanced with the favorable properties of titanium-nitride (TiN). In a review of English medical literature, the effects of TiN-coating on orthopaedic implant material in preclinical studies were identified and the influence of these effects on the clinical outcome of TiN-coated orthopaedic implants was explored. The TiN-coating has a positive effect on the biocompatibility and tribological properties of implant surfaces; however, there are several reports of third body wear due to delamination, increased ultrahigh molecular weight polyethylene wear, and cohesive failure of the TiN-coating. This might be due to the coating process. The TiN-coating process should be optimized and standardized for titanium alloy articulating surfaces. The clinical benefit of TiN-coating of CoCrMo knee implant surfaces should be further investigated. PMID:26583113
Improving mechanical properties of polyethylene orthopaedic implants by high frequency cold plasma surface activation
NASA Astrophysics Data System (ADS)
Tudoran, Cristian D.; Vlad, Iulia E.; Dadarlat, Dorin N.; Anghel, Sorin D.
Although a tremendous progress has been made in developing new methods and materials for manufacturing orthopaedic implants, the new technology still faces various problems. Polyethylene implants are relatively easy to manufacture and at lower cost compared to metallic or ceramic implants, but they present a fundamental problem: during usage and in time, due to their manufacturing technology, the material suffers from pitting and delamination which leads to crack propagation and finally to sudden fracture. Our studies and tests performed on polyethylene showed that, using cold plasma surface activation during the manufacturing process of the orthopaedic implants made from polyethylene can significantly increase their mechanical properties. The breaking tests revealed an increase of the tensile strength in the laminated polyethylene samples by a factor of 4 after plasma activation. "Aging" tests have been also performed to investigate how the cold plasma treated samples maintain their properties in time, after the surface activation process.
What is the role of the orthopaedic surgeon in management of fragility fractures?
Sharif, Khalid M; Dimitriou, Rozalia; Giannoudis, Peter V
Fragility fractures are the most prevalent trauma condition that orthopaedic surgeons face today. Osteoporosis and susceptibility to falls are the key predisposing factors. Despite evidence supporting the impact of treating osteoporosis on reducing the incidence of fragility fractures, it is often left untreated. Orthopaedic surgeons are often the first physicians to assess and treat the patient after a fragility fracture. Their role therefore does not end in the skillful fixation of the fractures, but they have a unique opportunity to ensure that preventive measures are implemented. This includes falls prevention, investigation of possible causes underlying osteoporosis, attention to diet, exercise, calcium, and vitamin D supplementation as well as prescription of anti-resorptive and anabolic medication. The need for a dedicated multidisciplinary team needs to be emphasized and therefore effective communication between the different parties is of paramount importance. PMID:21566474
Ambulatory orthopaedic surgery patients' emotions when using different patient education methods.
Heikkinen, Katja; Salanterä, Sanna; Leppänen, Tiina; Vahlberg, Tero; Leino-Kilpi, Helena
A randomised controlled trial was used to evaluate elective ambulatory orthopaedic surgery patients' emotions during internet-based patient education or face-to-face education with a nurse. The internet-based patient education was designed for this study and patients used websites individually based on their needs. Patients in the control group participated individually in face-to-face patient education with a nurse in the ambulatory surgery unit. The theoretical basis for both types of education was the same. Ambulatory orthopaedic surgery patients scored their emotions rather low at intervals throughout the whole surgical process, though their scores also changed during the surgical process. Emotion scores did not decrease after patient education. No differences in patients' emotions were found to result from either of the two different patient education methods. PMID:22919767
Multifunctional coatings to simultaneously promote osseointegration and prevent infection of orthopaedic implants.
Raphel, Jordan; Holodniy, Mark; Goodman, Stuart B; Heilshorn, Sarah C
The two leading causes of failure for joint arthroplasty prostheses are aseptic loosening and periprosthetic joint infection. With the number of primary and revision joint replacement surgeries on the rise, strategies to mitigate these failure modes have become increasingly important. Much of the recent work in this field has focused on the design of coatings either to prevent infection while ignoring bone mineralization or vice versa, to promote osseointegration while ignoring microbial susceptibility. However, both coating functions are required to achieve long-term success of the implant; therefore, these two modalities must be evaluated in parallel during the development of new orthopaedic coating strategies. In this review, we discuss recent progress and future directions for the design of multifunctional orthopaedic coatings that can inhibit microbial cells while still promoting osseointegration. PMID:26851394
Titanium-Nitride Coating of Orthopaedic Implants: A Review of the Literature.
van Hove, Ruud P; Sierevelt, Inger N; van Royen, Barend J; Nolte, Peter A
Surfaces of medical implants can be enhanced with the favorable properties of titanium-nitride (TiN). In a review of English medical literature, the effects of TiN-coating on orthopaedic implant material in preclinical studies were identified and the influence of these effects on the clinical outcome of TiN-coated orthopaedic implants was explored. The TiN-coating has a positive effect on the biocompatibility and tribological properties of implant surfaces; however, there are several reports of third body wear due to delamination, increased ultrahigh molecular weight polyethylene wear, and cohesive failure of the TiN-coating. This might be due to the coating process. The TiN-coating process should be optimized and standardized for titanium alloy articulating surfaces. The clinical benefit of TiN-coating of CoCrMo knee implant surfaces should be further investigated. PMID:26583113
[Short biography of an actor of the institutionalisation of orthopaedics (1830-1850)].
Quin, Grégory
Parts of the socioscientific career of Jules Guérin, an orthopaedic surgeon, are presented in this article. The aim is to deepen the comprehension of intricate processes like specialisation and professionalisation of medicine and development of medical gymnastics. From this point of view Guérin's biography is very informative. The intention is to highlight the institutionalisation process of orthopaedics during two decades: the 1830s and 1840s. For the analysis the author tries to associate historical elements taken from the medical field and the socioeconomic context, however, without digressing too far from Guérin himself. First, Guérin's part in the institutionalisation process will be studied, second, his influence as a surgeon and theorist of spinal deformities and then his role as a controversial figure in the medical field. PMID:20405772
Approach to pain management in chronic opioid users undergoing orthopaedic surgery.
Devin, Clinton J; Lee, Dennis S; Armaghani, Sheyan J; Bible, Jesse; Shau, David N; Martin, Peter R; Ehrenfeld, Jesse M
Opioids are commonly used for the management of pain in patients with musculoskeletal disorders; however, national attention has highlighted the potential adverse effects of the use of opioid analgesia in this and other nonmalignant pain settings. Chronic opioid users undergoing orthopaedic surgery represent a particularly challenging patient population in regard to their perioperative pain control and outcomes. Preoperative evaluation provides an opportunity to estimate a patient's preoperative opioid intake, discuss pain-related fears, and identify potential psychiatric comorbidities. Patients using high levels of opioids may also require referral to an addiction specialist. Various regional blockade and pharmaceutical options are available to help control perioperative pain, and a multimodal pain management approach may be of particular benefit in chronic opioid users undergoing orthopaedic surgery. PMID:25281256
Database and Registry Research in Orthopaedic Surgery: Part I: Claims-Based Data.
Pugely, Andrew J; Martin, Christopher T; Harwood, Jared; Ong, Kevin L; Bozic, Kevin J; Callaghan, John J
The use of large-scale national databases for observational research in orthopaedic surgery has grown substantially in the last decade, and the data sets can be grossly categorized as either administrative claims or clinical registries. Administrative claims data comprise the billing records associated with the delivery of health-care services. Orthopaedic researchers have used both government and private claims to describe temporal trends, geographic variation, disparities, complications, outcomes, and resource utilization associated with both musculoskeletal disease and treatment. Medicare claims comprise one of the most robust data sets used to perform orthopaedic research, with >45 million beneficiaries. The U.S. government, through the Centers for Medicare & Medicaid Services, often uses these data to drive changes in health policy. Private claims data used in orthopaedic research often comprise more heterogeneous patient demographic samples, but allow longitudinal analysis similar to that offered by Medicare claims. Discharge databases, such as the U.S. National Inpatient Sample, provide a wide national sampling of inpatient hospital stays from all payers and allow analysis of associated adverse events and resource utilization. Administrative claims data benefit from the high patient numbers obtained through a majority of hospitals. Using claims, it is possible to follow patients longitudinally throughout encounters irrespective of the location of the institution delivering health care. Some disadvantages include lack of precision of ICD-9 (International Classification of Diseases, Ninth Revision) coding schemes. Much of these data are expensive to purchase, complicated to organize, and labor-intensive to manipulate--often requiring trained specialists for analysis. Given the changing health-care environment, it is likely that databases will provide valuable information that has the potential to influence clinical practice improvement and health policy for
Sample size calculations in orthopaedics randomised controlled trials: revisiting research practices.
Sabharwal, Sanjeeve; Patel, Nirav K; Holloway, Ian; Athanasiou, Thanos
The purpose of this study was to identify how often sample size calculations were reported in recent orthopaedic randomized controlled trials (RCTs) and to determine what proportion of studies that failed to find a significant treatment effect were at risk of type II error. A pre-defined computerized search was performed in MEDLINE to identify RCTs published in 2012 in the 20 highest ranked orthopaedic journals based on impact factor. Data from these studies was used to perform post hoc analysis to determine whether each study was sufficiently powered to detect a small (0.2), medium (0.5) and large (0.8) effect size as defined by Cohen. Sufficient power (1-β) was considered to be 80% and a two-tailed test was performed with an alpha value of 0.05. 120 RCTs were identified using our stated search protocol and just 73 studies (60.80%) described an appropriate sample size calculation. Examination of studies with negative primary outcome revealed that 68 (93.15%) were at risk of type II error for a small treatment effect and only 4 (5.48%) were at risk of type II error for a medium sized treatment effect. Although comparison of the results with existing data from over 10 years ago infers improved practice in sample size calculations within orthopaedic surgery, there remains an ongoing need for improvement of practice. Orthopaedic researchers, as well as journal reviewers and editors have a responsibility to ensure that RCTs conform to standardized methodological guidelines and perform appropriate sample size calculations. PMID:26280864
Characterization of wear in composite material orthopaedic implants. Part II: The implant/bone interface.
Albert, K; Schledjewski, R; Harbaugh, M; Bleser, S; Jamison, R; Friedrich, K
Carbon fiber/PEEK polymer (C/PEEK) composite materials are being developed for use as orthopaedic implant materials. Wear is an issue of increasing importance in orthopaedic implants; particulate debris generated by the wearing of biomaterials may be a causal factor leading to osteolysis and implant loosening. Therefore, numerical and experimental studies were completed to characterize the wear of C/PEEK composite materials in comparison to current orthopaedic implant materials. Finite element analyses (FEA) of a composite material hip stem implanted in a femur and loaded at 890 N determined that peak contact stresses will occur at the proximal-medial and distal regions of the implant. These contact stresses were found to be below 1.0 MPa over most of the implant surface; however the peak stress in the proximal-medial region was 1.8 MPa and higher still at the distal portion of the stem. In vivo forces result in contact stress values up to 9.0 MPa. The composite implant exhibited 10-40% lower contact stresses in the distal region compared to a titanium-alloy implant of identical design. Composite material wear samples were slid against porous hydroxylapatite (HA) to simulate the stem/bone interface. An identical series of experiments was run for comparison to a current orthopaedic implant material--Ti6A14V titanium alloy. Two domains of motion were studied; a composite ring-on-HA disc large amplitude sliding wear test; and a composite pin-on-HA disc small amplitude fretting regimen. Nominal contact pressures during testing were 1.4 MPa and 7.6 MPa for sliding and fretting tests, respectively. Fretting and sliding abrasive wear tests resulted in the composite material exhibiting a lower wear rate than the titanium-alloy. The magnitude of the difference was greatly dependent on the contact pressures, sliding amplitudes, and counterface material properties. PMID:7950869
Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines.
Goodnough, L T; Maniatis, A; Earnshaw, P; Benoni, G; Beris, P; Bisbe, E; Fergusson, D A; Gombotz, H; Habler, O; Monk, T G; Ozier, Y; Slappendel, R; Szpalski, M
Previously undiagnosed anaemia is common in elective orthopaedic surgical patients and is associated with increased likelihood of blood transfusion and increased perioperative morbidity and mortality. A standardized approach for the detection, evaluation, and management of anaemia in this setting has been identified as an unmet medical need. A multidisciplinary panel of physicians was convened by the Network for Advancement of Transfusion Alternatives (NATA) with the aim of developing practice guidelines for the detection, evaluation, and management of preoperative anaemia in elective orthopaedic surgery. A systematic literature review and critical evaluation of the evidence was performed, and recommendations were formulated according to the method proposed by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. We recommend that elective orthopaedic surgical patients have a haemoglobin (Hb) level determination 28 days before the scheduled surgical procedure if possible (Grade 1C). We suggest that the patient's target Hb before elective surgery be within the normal range, according to the World Health Organization criteria (Grade 2C). We recommend further laboratory testing to evaluate anaemia for nutritional deficiencies, chronic renal insufficiency, and/or chronic inflammatory disease (Grade 1C). We recommend that nutritional deficiencies be treated (Grade 1C). We suggest that erythropoiesis-stimulating agents be used for anaemic patients in whom nutritional deficiencies have been ruled out, corrected, or both (Grade 2A). Anaemia should be viewed as a serious and treatable medical condition, rather than simply an abnormal laboratory value. Implementation of anaemia management in the elective orthopaedic surgery setting will improve patient outcomes. PMID:21148637
Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery
Karlakki, S.; Brem, M.; Giannini, S.; Khanduja, V.; Stannard, J.; Martin, R.
Objectives The period of post-operative treatment before surgical wounds are completely closed remains a key window, during which one can apply new technologies that can minimise complications. One such technology is the use of negative pressure wound therapy to manage and accelerate healing of the closed incisional wound (incisional NPWT). Methods We undertook a literature review of this emerging indication to identify evidence within orthopaedic surgery and other surgical disciplines. Literature that supports our current understanding of the mechanisms of action was also reviewed in detail. Results A total of 33 publications were identified, including nine clinical study reports from orthopaedic surgery; four from cardiothoracic surgery and 12 from studies in abdominal, plastic and vascular disciplines. Most papers (26 of 33) had been published within the past three years. Thus far two randomised controlled trials – one in orthopaedic and one in cardiothoracic surgery – show evidence of reduced incidence of wound healing complications after between three and five days of post-operative NPWT of two- and four-fold, respectively. Investigations show that reduction in haematoma and seroma, accelerated wound healing and increased clearance of oedema are significant mechanisms of action. Conclusions There is a rapidly emerging literature on the effect of NPWT on the closed incision. Initiated and confirmed first with a randomised controlled trial in orthopaedic trauma surgery, studies in abdominal, plastic and vascular surgery with high rates of complications have been reported recently. The evidence from single-use NPWT devices is accumulating. There are no large randomised studies yet in reconstructive joint replacement. Cite this article: Bone Joint Res 2013;2:276–84. PMID:24352756
Robotic and Navigation Systems in Orthopaedic Surgery: How Much Do Our Patients Understand?
Benjamin-Laing, Harry; Douglas, Stephen L; Haddad, Fares S
Background Technology in orthopaedic surgery has become more widespread in the past 20 years, with emerging evidence of its benefits in arthroplasty. Although patients are aware of benefits of conventional joint replacement, little is known on patients' knowledge of the prevalence, benefits or drawbacks of surgery involving navigation or robotic systems. Methods In an outpatient arthroplasty clinic, 100 consecutive patients were approached and given questionnaires to assess their knowledge of navigation and robotics in orthopaedic surgery. Participation in the survey was voluntary. Results Ninety-eight patients volunteered to participate in the survey, mean age 56.2 years (range, 19 to 88 years; 52 female, 46 male). Forty percent of patients thought more than 30% of National Health Service (NHS) orthopaedic operations involved navigation or robotics; 80% believed this was the same level or less than the private sector. One-third believed most of an operation could be performed independently by a robotic/navigation system. Amongst perceived benefits of navigation/robotic surgery was more accurate surgery (47%), quicker surgery (50%), and making the surgeon's job easier (52%). Sixty-nine percent believed navigation/robotics was more expensive and 20% believed it held no benefit against conventional surgery, with only 9% believing it led to longer surgery. Almost 50% would not mind at least some of their operation being performed with use of robotics/navigation. Conclusions Although few patients were familiar with this new technology, there appeared to be a strong consensus it was quicker and more accurate than conventional surgery. Many patients appear to believe navigation and robotics in orthopaedic surgery is largely the preserve of the private sector. This study demonstrates public knowledge of such new technologies is limited and a need to inform patients of the relative merits and drawbacks of such surgery prior to their more widespread implementation. PMID
Risk factors for school absence after acute orthopaedic injury in new york city.
Hyman, Joshua E; Jewetz, Shari T; Matsumoto, Hiroko; Choe, Julie C; Vitale, Michael G
The purpose of our study is to identify specific factors that affect a child's ability to attend school after an acute orthopaedic injury. One hundred and sixty-four school-aged patients receiving treatment for an acute orthopaedic injury at the Division of Pediatric Orthopaedics were interviewed along with their parents. Most participants were Hispanic, which reflects the population of the Washington Heights section of Manhattan served by our hospital. Follow-up telephone interviews were conducted with those parents whose children were unable to return to school. The parents were asked of both the total number of school absences and whether the child received home instruction. A survey regarding official school attendance policy was mailed to the principals of all the schools attended by the children in our study. Forty-seven percent of the children were unable to return to school immediately after their injuries. Nearly 70% (n = 51) of the children who did not immediately return to school attributed their nonattendance to their school's attendance policy. Only half of the absentees received home instruction. A multivariate analysis showed that both the type of school (public vs private) and the use of crutches were statistically significant risk factors for school absence. The median household income also trended toward significance in predicting school attendance. The responses to our survey regarding official school attendance policy demonstrated considerable variability among the schools. This study indicates that pediatric orthopaedic injuries and their treatment impact the ability of school-aged patients to attend school. Our study shows that children's socioeconomic background influences their ability to attend school while injured. PMID:17513963
Strengthening of Mg based alloy through grain refinement for orthopaedic application.
Nayak, Soumyaranjan; Bhushan, Bharat; Jayaganthan, R; Gopinath, P; Agarwal, R D; Lahiri, Debrupa
Magnesium is presently attracting a lot of interest as a replacement to clinically used orthopaedic implant materials, due to its ability to solve the stress shielding problems, biodegradability and osteocompatibility. However, the strength of Mg is still lower than the requirement and it becomes worse after it starts degrading fast, while being exposed in living body environment. This research explores the effectiveness of 'grain refinement through deformation', as a tool to modify the strength (while keeping elastic modulus unaffected) of Mg based alloys in orthopaedic application. Hot rolled Mg-3wt% Zn alloy (MZ3) has been investigated for its potential in orthopaedic implant. Microstructure, mechanical properties, bio-corrosion properties and biocompatibility of the rolled samples are probed into. Grain size gets refined significantly with increasing amount of deformation. The alloy experiences a marked improvement in hardness, yield strength, ultimate tensile strength, strain and toughness with finer grain size. An increment in accelerated corrosion rate is noted with decreasing grain size, which is correlated to the increased grain boundary area and mechano-chemical dissolution. However, immersion test in simulated body fluid (SBF) reveals reduction in corrosion rate after third day of immersion. This was possible owing to precipitation of protective hydroxyapatite (HA) layer, formed out of the interaction of SBF and the alloy. More nucleation sites at the grain boundary for fine grained samples help in forming more HA and thus reduce the corrosion rate. Human osteosarcoma cells show less viability and adhesion on grain refined alloy. PMID:26745721
Comparison of published orthopaedic trauma trials following registration in Clinicaltrials.gov
Background After the Food and Drug Administration Modernization Act of 1997, the registration of all clinical trials became mandatory prior to publication. Our primary objective was to determine publication rates for orthopaedic trauma trials registered with ClinicalTrials.gov. We further evaluated methodological consistency between registration and publication. Methods We searched Clinical Trials.gov for all trials related to orthopaedic trauma. We excluded active trials and trials not completed by July 2009, and performed a systematic search for publications resulting from registered closed trials. Information regarding primary and secondary outcomes, intervention, study sponsors, and sample size were extracted from registrations and publications. Results Of 130 closed trials, 37 eligible trials resulted in 16 publications (43.2%). We found no significant differences in publication rates between funding sources for industry sponsored studies and nongovernment/nonindustry sponsored studies (p > 0.05). About half the trials (45%) did not include the NCT ID in the publication. Two (10%) publications had major changes to the primary outcome measure and ten (52.6%) to sample size. Conclusions Registration of orthopaedic trauma trials does not consistently result in publication. When trials are registered, many do not cite NCT ID in the publication. Furthermore, changes that are not reflected in the registry of the trial are frequently made to the final publication. PMID:22151841
Defining reference levels for intra-operative radiation exposure in orthopaedic trauma: A retrospective multicentre study.
Hardman, J; Elvey, M; Shah, N; Simson, N; Patel, S; Anakwe, R
There is currently limited data to define reference levels for the use of ionising radiation in orthopaedic trauma surgery. In this multicentre study, we utilise methodology employed by the Health Protection Agency in establishing reference levels for diagnostic investigations in order to define analogous levels for common and reproducible orthopaedic trauma procedures. Four hundred ninety-five procedures were identified across four Greater London hospitals over a 1-year period. Exposure was defined in terms of both time and dose area product (DAP). Third quartile mean values for either parameter were used to define reference levels. Variations both between centres and grades of lead surgeon were analysed as secondary outcomes. Reference levels; dynamic hip screw (DHS) 1.9225000 Gycm(2)/70.50 s, intramedullary (IM) femoral nail 1.5837500 Gycm(2)/126.00 s, open reduction internal fixation (ORIF) clavicle 0.2042500 Gycm(2)/21.50 s, ORIF lateral malleolus 0.32250500 Gycm(2)/35.00 s, ORIF distal radius 0.1300000 Gycm(2)/56.00 s. Grade of surgeon did not influence exposure in dynamic hip screw, and was inversely related to exposure in intramedullary femoral nails. Less variation was observed with exposure time than with DAP. This study provides the most comprehensive reference to guide fluoroscopy use in orthopaedic trauma to date, and is of value both at the point of delivery and for audit of local practice. PMID:26604035
Nanomaterials and synergistic low intensity direct current (LIDC) stimulation technology for orthopaedic implantable medical devices
Samberg, Meghan E.; Cohen, Paul H.; Wysk, Richard A.; Monteiro-Riviere, Nancy A.
Nanomaterials play a significant role in biomedical research and applications due to their unique biological, mechanical, and electrical properties. In recent years, they have been utilised to improve the functionality and reliability of a wide range of implantable medical devices ranging from well-established orthopaedic residual hardware devices (e.g. hip implants) that can repair defects in skeletal systems to emerging tissue engineering scaffolds that can repair or replace organ functions. This review summarizes the applications and efficacies of these nanomaterials that include synthetic or naturally occurring metals, polymers, ceramics, and composites in orthopaedic implants, the largest market segment of implantable medical devices. The importance of synergistic engineering techniques that can augment or enhance the performance of nanomaterial applications in orthopaedic implants is also discussed,, the focus being on a low intensity direct electric current (LIDC) stimulation technology to promote the long-term antibacterial efficacy of oligodynamic metal-based surfaces by ionization, while potentially accelerating tissue growth and osseointegration. While many nanomaterials have clearly demonstrated their ability to provide more effective implantable medical surfaces, further decisive investigations are necessary before they can translate into medically safe and commercially viable clinical applications. The paper concludes with a discussion about some of the critical impending issues with the application of nanomaterials-based technologies in implantable medical devices, and potential directions to address these. PMID:23335493
Mechanical compatibility of sol-gel annealing with titanium for orthopaedic prostheses.
Greer, Andrew I M; Lim, Teoh S; Brydone, Alistair S; Gadegaard, Nikolaj
Sol-gel processing is an attractive method for large-scale surface coating due to its facile and inexpensive preparation, even with the inclusion of precision nanotopographies. These are desirable traits for metal orthopaedic prostheses where ceramic coatings are known to be osteoinductive and the effects may be amplified through nanotexturing. However there are a few concerns associated with the application of sol-gel technology to orthopaedics. Primarily, the annealing stage required to transform the sol-gel into a ceramic may compromise the physical integrity of the underlying metal. Secondly, loose particles on medical implants can be carcinogenic and cause inflammation so the coating needs to be strongly bonded to the implant. These concerns are addressed in this paper. Titanium, the dominant material for orthopaedics at present, is examined before and after sol-gel processing for changes in hardness and flexural modulus. Wear resistance, bending and pull tests are also performed to evaluate the ceramic coating. The findings suggest that sol-gel coatings will be compatible with titanium implants for an optimum temperature of 500 °C. PMID:26691162
Bioactive glass/ZrO2 composites for orthopaedic applications.
Bellucci, D; Sola, A; Cannillo, V
Binary biocomposites were realized by combining yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) with a bioactive glass matrix. Few works are available regarding composites containing zirconia and a relatively high content of glass because the resulting samples are usually biocompatible but not bioactive after thermal treatment. In the present research, the promising properties of the new BG_Ca-K glass, with its low tendency to crystallize and high apatite-forming ability, allowed us to sinter the composites at a relatively low temperature with excellent effects in terms of bioactivity. In addition, it was possible to benefit from the good mechanical behaviour of Y-TZP, thus obtaining samples with microhardness values that were among the highest reported in the literature. After a detailed analysis regarding the thermal behaviour of the composite powders, the sintered bodies were fully characterized by means of x-ray diffraction, SEM equipped with EDS, density measurements, volumetric shrinkage determination, mechanical testing and in vitro evaluation in a simulated body fluid (SBF) solution. According to the experimental results, the presence of Y-TZP improved the mechanical performance. Meanwhile, the BG_Ca-K glass, which mainly preserved its amorphous structure after sintering, provided the composites with a good apatite-forming ability in SBF. PMID:24343516
Fathers of orthopaedics in Germany (eighteenth and early nineteenth centuries): Lorenz Heister in Helmsted; Johann Friedrich Dieffenbach in Berlin; Heine and family in Würzburg.
Hernigou, Philippe
In orthopaedic medicine in Germany, Lorenz Heister, practicing in the eighteenth century, is considered one of the fathers of German surgery and is renowned for his books on management of hemorrhage, wounds, fractures, bandaging, instrumentation and surgery. After Heister, at the beginning of the nineteenth century, orthopaedic medicine in Germany developed uniformly. In a period when few doctors were interested in a separate discipline of orthopaedics, Germany led in this field. Heine devoted himself to the development of the new profession of orthopaedics, and in 1816, he opened the first orthopaedic institute on German soil in the former monastery of St. Stephen, which later became known as the Karolinen-Institut. Along with Heine and his family, the special development of orthopaedics in Berlin may be attributed to the work of Dieffenbach who, in 1832, became professor at the University of Berlin and in 1840 director of the Clinical Institute for Surgery at Charité Hospital. PMID:26294002
Using simulation to train orthopaedic trainees in non-technical skills: A pilot study
Heaton, Samuel R; Little, Zoe; Akhtar, Kash; Ramachandran, Manoj; Lee, Joshua
AIM To enhance non-technical skills and to analyse participant's experience of a course tailored for orthopaedic surgeons. METHODS A Delphi technique was used to develop a course in human factors specific to orthopaedic residents. Twenty-six residents (six per course) participated in total with seven course facilitators all trained in Crisis Resource Management providing structured feedback. Six scenarios recreated challenging real-life situations using high-fidelity mannequins and simulated patients. Environments included a simulated operating suite, clinic room and ward setting. All were undertaken in a purpose built simulation suite utilising actors, mock operating rooms, mock clinical rooms and a high fidelity adult patient simulator organised through a simulation control room. Participants completed a 5-point Likert scale questionnaire (strongly disagree to strongly agree) before and after the course. This assessed their understanding of non-technical skills, scenario validity, relevance to orthopaedic training and predicted impact of the course on future practice. A course evaluation questionnaire was also completed to assess participants' feedback on the value and quality of the course itself. RESULTS Twenty-six orthopaedic residents participated (24 male, 2 female; post-graduation 5-10 years), mean year of residency program 2.6 out of 6 years required in the United Kingdom. Pre-course questionnaires showed that while the majority of candidates recognised the importance of non-technical (NT) skills in orthopaedic training they demonstrated poor understanding of non-technical skills and their role. This improved significantly after the course (Likert score 3.0-4.2) and the perceived importance of these skills was reported as good or very good in 100%. The course was reported as enjoyable and provided an unthreatening learning environment with the candidates placing particular value on the learning opportunity provided by reflecting on their performance
... protective equipment. Available at: www.cdc.gov/niosh/ppe . Accessed October 27, 2015. Holland MG, Cawthon D. Personal protective equipment and decontamination of adults and children. Emerg Med Clin N ...
... Pool Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily Life At School At Home ... Diagnosed Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily Life Grief & Loss Community & Local ...
Cleaning supplies and equipment
... on any object the person touched or on equipment that was used during their care. Some germs ... why it is important to disinfect supplies and equipment. To disinfect something means to clean it to ...
Mobile Equipment Expands Inventory.
ERIC Educational Resources Information Center
McGough, Robert L.; And Others
Describes the Mobile Equipment Modules (MEM) system in Duluth, Minnesota. MEM is a way to hold down costs and increase learning opportunities by consolidating purchases of expensive shop equipment within the school district, grouping the equipment in modules, and scheduling and moving it from school to school as needed. (MF)
Selecting Microform Reading Equipment.
ERIC Educational Resources Information Center
McIntosh, Melinda
Cites sources of information concerning selection of microform reading equipment and provides step-by-step outline of selection process. Defining specific needs for which equipment is used, determining what equipment is being marketed, and examining and evaluating readers' design features in terms of practicability and aesthetics are discussed.…
Anaesthesia equipment malfunction.
Holley, H S; Carroll, J S
Anaesthetic equipment was studied to determine whether the accuracy was improved and failure rate decreased by routine maintenance and calibration by a biomedical technician. Each piece was evaluated, and then repaired and rechecked at intervals by the same technician. Equipment failures were divided into three types: first, equipment that was completely nonfunctional; second, equipment that was functional but inaccurate; and third, equipment that was functional and accurate but needed minor repairs. The percentage of equipment failures in each group was compared on initial evaluation and after 6 months. Of the 311 pieces of equipment, 40% needed repair at the time of the initial survey; 80% was nonfunctional, and 18% was functional but inaccurate. After six months on a maintenance schedule, only 15% of the equipment needed repair, 3% was nonfunctional, and 6% was functional but inaccurate. The difference between the total percentage of equipment failure initially and after six months was statistically significant. After a regular maintenance, calibration, and checkout schedule by a biomedical technician was instituted, there was a significant improvement in the accuracy of the equipment and a reduction in the percentage of equipment needing repair. PMID:3970340
Renewal of radiological equipment.
In this century, medical imaging is at the heart of medical practice. Besides providing fast and accurate diagnosis, advances in radiology equipment offer new and previously non-existing options for treatment guidance with quite low morbidity, resulting in the improvement of health outcomes and quality of life for the patients. Although rapid technological development created new medical imaging modalities and methods, the same progress speed resulted in accelerated technical and functional obsolescence of the same medical imaging equipment, consequently creating a need for renewal. Older equipment has a high risk of failures and breakdowns, which might cause delays in diagnosis and treatment of the patient, and safety problems both for the patient and the medical staff. The European Society of Radiology is promoting the use of up-to-date equipment, especially in the context of the EuroSafe Imaging Campaign, as the use of up-to-date equipment will improve quality and safety in medical imaging. Every healthcare institution or authority should have a plan for medical imaging equipment upgrade or renewal. This plan should look forward a minimum of 5 years, with annual updates. Teaching points • Radiological equipment has a definite life cycle span, resulting in unavoidable breakdown and decrease or loss of image quality which renders equipment useless after a certain time period.• Equipment older than 10 years is no longer state-of-the art equipment and replacement is essential. Operating costs of older equipment will be high when compared with new equipment, and sometimes maintenance will be impossible if no spare parts are available.• Older equipment has a high risk of failure and breakdown, causing delays in diagnosis and treatment of the patient and safety problems both for the patient and the medical staff.• Every healthcare institution or authority should have a plan for medical imaging equipment upgrade or replacement. This plan should look forward a
The use of damage control orthopaedics to minimize negative sequelae of surgery delay in elderly comorbid patients with hip fracture.
Dong, C-H; Wang, Z-M; Zhao, X-L; Wang, A-M
Hip surgeries count to the most frequent orthopaedic operations in older patients. Nonelective surgeries for hip fractures cause substantial economic burden because of high costs of medical treatment and high associated mortality. Surgery for hip fracture in the elderly comorbid patient still presents a challenge to orthopaedic surgeons. It is recommended that this surgery is performed within 48 hours after sustaining the hip fracture to decrease mortality. Yet the recommended early surgery (i.e. 48 hours after the incident) is not always feasible due to the frequent overall frailty of the patients or conditions of concomitant disease. The care of patients unfit for early surgery has been not adequately addressed in the literature. We have previously introduced an algorithm based on ASA-PS and P-POSSUM scores to stratify elderly comorbid patients for early vs delayed hip surgery, and used principles of Damage Control Orthopaedics to minimized negative sequelae of surgery delay (Dong C et al., PLoS One 2016). In this paper, we elaborate on Damage Control Orthopaedics and the proposed approach in the context of frequent comorbidities in the elderly orthopaedic patients. Further studies on this subject are urgently needed to establish international consensus on hip fracture surgery delayed due to overall patient frailty or extensive comorbidities. PMID:27383299
Machine oil inhibits the osseointegration of orthopaedic implants by impairing osteoblast attachment and spreading.
Bonsignore, Lindsay A; Goldberg, Victor M; Greenfield, Edward M
The most important factor contributing to short-term and long-term success of cementless total joint arthroplasties is osseointegration. Osseointegration leads to a direct structural and functional connection between living bone and the surface of an implant. Surface contaminants may remain on orthopaedic implants after sterilization procedures and impair osseointegration. For example, specific lots of hip replacement Sulzer Inter-OP(TM) acetabular shells that were associated with impaired osseointegration and early failure rates were found to be contaminated with both bacterial debris and machine oil residues. However, the effect of machine oil on implant integration is unknown. Therefore, the goal of this study was to determine if machine oil inhibits the osseointegration of orthopaedic implants. To test this hypothesis in vivo we used our murine model of osseointegration where titanium alloy implants are implanted into a unicortical pilot hole in the mid-diaphysis of the femur. We found that machine oil inhibited bone-to-implant contact and biomechanical pullout measures. Machine oil on titanium alloy discs inhibited early stages of MC3T3-E1 osteogenesis in vitro such as attachment and spreading. Inhibition of osteoblast attachment and spreading occurred in both areas with and without detectable oil. Osteoblast growth was in turn inhibited on discs with machine oil due to both a decrease in proliferation and an increase in cell death. Later stages of osteogenic differentiation and mineralization on titanium alloy discs were also inhibited. Thus, machine oil can inhibit osseointegration through cell autonomous effects on osteoblast cells. These results support routine testing by manufacturers of machine oil residues on orthopaedic implants. PMID:25676177
The TONK score: a tool for assessing quality in trauma and orthopaedic note-keeping
Khan, Zeeshan; Sayers, Adele E.; Khattak, Mohammad Usman; Chambers, Iain Richard
Introduction: Medical case notes are the only lasting interpretation of a patient-physician interaction and are important for good quality patient care. Accurate, legible and contemporaneous note-keeping is important however it can be substandard. This can lead to errors in handover of patients and to medicolegal vulnerability. We present a comprehensive auditing tool for Trauma & Orthopaedics medical case notes and our experience in using it over the last 12 months. Patients and Methods: The TONK score was developed from a pre-existing system with some additions for Trauma & Orthopaedic case notes, with the incorporation of a legibility scoring system. An initial audit was carried out evaluating the case notes for each team against the TONK score. In order to evaluate the reproducibility of this score, we employed the Cohen's Kappa coefficient and noted substantial agreement. The individual team scores were analysed and the audit cycle completed four months later with the provision of feedback. Results: Our first audit revealed a mean of 81 with a range from 70 to 90. Subsequent audits over the next two quarters revealed mean scores in excess of 90. Significant improvement has been noted in all areas of documentation and it has been decided to conduct this audit every six months in our department. Conclusions: The TONK score is an easy, quick and reproducible tool, which aims to eliminate the weaknesses in Trauma & Orthopaedic medical note-keeping. It emphasises the medicolegal importance of accurate medical note-keeping to doctors at all levels of training. PMID:27163084
Improving the outcome of paediatric orthopaedic trauma: an audit of inpatient management in Southampton.
Cox, P J; Clarke, N M
The patterns, management and outcome of non-fatal orthopaedic injury in childhood was audited over a 1 year period in Southampton. A computer-based audit (1 September 1993 to 31 August 1994) was conducted of all children aged under 15 years who were admitted to the orthopaedic unit after accidental injury. Management was audited by studying the primary conservative and operative treatment methods employed. Treatment outcome was evaluated in terms of need for secondary operative treatment, salvage internal fixation, length of hospital stay and unplanned readmission. In all, 398 children, representing 50/10,000 of the local paediatric population, were admitted with a traumatic injury. There was a significant (P < 0.001, Kolmogorov-Smirnov) seasonal variation in admission rate. There were 87.3% admissions required for fractures, 8.5% after soft tissue injury and 2.2% after joint injury. The following areas were identified where management and outcome could be improved: 1 A 12.1% readmission rate (47/346) in children with fractures owing to a 16% incidence of loss of position after closed reduction of distal radial, forearm shaft and distal humeral fractures. 2 In all, 24% of internal fixation procedures were performed as 'salvage' after failure of conservative treatment, entailing either reoperation during the initial admission or a further unplanned readmission. 3 A prolonged inpatient stay for patients with femoral fractures owing to a wide variation in treatment method. The outcome of non-fatal orthopaedic injury can be improved through the selective use of primary internal fixation of distal radial and humeral fractures and the close adherence to a management algorithm in femoral fractures. There may be a role for more specialised supervision of primary treatment of these particular fractures. PMID:9422873
Blood conservation strategies in major orthopaedic surgery: efficacy, safety and European regulations.
Muñoz, M; García-Erce, J A; Villar, I; Thomas, D
Several major orthopaedic surgical procedures may result in significant blood loss and the need for allogeneic blood transfusion (ABT). However, overall concerns about adverse effects of ABT have prompted the review of transfusion practice and the search for transfusion alternatives to decrease or avoid the use of ABT. These strategies include the correction of perioperative anaemia, pharmacological and non-pharmacologic measures to reduce blood loss, preoperative autologous blood donation and perioperative red blood cell salvage. We have reviewed the efficacy and safety of these strategies and where appropriate offer evidence-based recommendations on their use in orthopaedic surgery. We also reviewed the European regulations on ABT alternatives. Pharmacological alternatives need to be used with a total adherence to European regulations in their legal and off-label use. The administration and use of pharmacological agents to stimulate erythropoiesis or reduce blood loss needs to be within the context of attempting to use allogenic blood in a rational manner. As for autologous blood, European Directives cover preoperative autologous blood donation, but not its clinical use, and perioperative red blood cell salvage devices, but not the product yielded by them. Therefore, the development of quality standards and good practice guidelines for perioperative red blood cell salvage, as well as its inclusion in the haemovigilance programme, is urgently needed. Finally, it is noteworthy that some recommendations given for ABT alternatives are not supported by a high level of evidence and that the goal of performing major orthopaedic surgical procedures without the use of ABT may be better accomplished by combining several of these techniques within a defined algorithm. PMID:19121192
Musculoskeletal symptoms and orthopaedic complications in pregnancy: pathophysiology, diagnostic approaches and modern management.
Bhardwaj, Amit; Nagandla, Kavitha
Low back pain is a common musculoskeletal symptom in pregnancy that can present as lumbar pain or pelvic girdle pain, with significant physical and psychosocial implications. Pelvic girdle pain is more prevalent and results in greater disability than lumbar pain. It is possible to distinguish between these two conditions from a detailed history based on the site of the pain, its intensity, disability and pain provocation tests. Management of low back pain in pregnancy is conservative, with physical exercise for lumbar pain and minimising activities that exacerbate pain, analgesics and bed rest for pelvic girdle pain, as well as avoiding abduction beyond the pain-free zone in labour. There is evidence that stabilising exercises in patients with pelvic girdle pain postpartum have a beneficial effect. Other treatment modalities that have been shown to be safe and effective include pelvic belts, transcutaneous electrical nerve stimulation, spinal manipulative therapy, acupuncture and complementary therapy with yoga. Other orthopaedic complications in pregnancy such as carpal tunnel syndrome, pubic symphysis rupture, transient osteoporosis and osteonecrosis are usually self-limiting with a satisfactory outcome. However, a lack of awareness and failure to recognise these complications can result in long-term morbidity. Knowledge of the preoperative diagnostic investigations, surgical approaches and intraoperative positioning of the mother to avoid gravid uterus compression is vital in orthopaedic emergencies such as lumbar disc herniation, cauda equina syndrome, fractures and acute compartment syndrome of the lower limb to ensure a safe maternal and fetal outcome and to prevent serious disability. Pregnancy is not contraindicated in women with pre-existing orthopaedic complications such as kyphoscoliosis and total hip arthroplasty as there is no evidence to suggest increased maternal or fetal risks. PMID:24904047
Aesthetic, urological, orthopaedic and functional outcomes in complex bladder exstrophy-epispadias's management
Kouame, Bertin Dibi; Kouame, Guy Serge Yapo; Sounkere, Moufidath; Koffi, Maxime; Yaokreh, Jean Baptiste; Odehouri-Koudou, Thierry; Tembely, Samba; Dieth, Gaudens Atafi; Ouattara, Ossenou; Dick, Rufin
Background: Postoperative complications are related to the surgical procedures, of failures of initial bladder closure and influence the urological, aesthetical and orthopaedic outcomes. Materials and Methods: We reviewed four patients who underwent complex bladder exstrophy-epispadias repair over a period of 14 years. The outcomes of treatment were assessed using, aesthetic, urological and orthopaedic examination data. Orthopaedic complications were explored by a radiography of the pelvis. Results: Out of four patients who underwent bladder exstrophy surgical management, aesthetic, functional outcomes and complications in the short and long follow-up were achieved in three patients. The first patient is a male and had a good penis aspect. He has a normal erection during micturition with a good jet miction. He has a moderate urinary incontinence, which requires diaper. In the erection, his penis-measures 4 cm long and 3 cm as circumference. The second patient was a female. She had an unsightly appearance of the female external genitalia with bipartite clitoris. Urinary continence could not be assessed; she did not have the age of cleanness yet. The third patient had a significant urinary leakage due to the failure of the epispadias repair. He has a limp, a pelvic obliquity, varus and internal rotation of the femoral head. He has an inequality of limbs length. Pelvis radiograph shows the right osteotomy through the ilium bone, the left osteotomy through the hip joint at the acetabular roof. Conclusion: When, the epispadias repair is performed contemporary to initial bladder closure, its success is decisive for urinary continence. In the female, surgical revision is required after the initial bladder closure for an aesthetic appearance to the external genitalia. Innominate osteotomy must be performed with brilliancy amplifier to avoid osteotomy through to the hip joint to prevent inequality in leg length. PMID:25659552
J. Steinhoff
The objective and the scope of this document are to list and briefly describe the major mobile equipment necessary for waste package (WP) retrieval from the proposed subsurface nuclear waste repository at Yucca Mountain. Primary performance characteristics and some specialized design features of the equipment are explained and summarized in the individual subsections of this document. There are no quality assurance requirements or QA controls in this document. Retrieval under normal conditions is accomplished with the same fleet of equipment as is used for emplacement. Descriptions of equipment used for retrieval under normal conditions is found in Emplacement Equipment Descriptions, DI: BCAF00000-01717-5705-00002 (a document in progress). Equipment used for retrieval under abnormal conditions is addressed in this document and consists of the following: (1) Inclined Plane Hauler; (2) Bottom Lift Transporter; (3) Load Haul Dump (LHD) Loader; (4) Heavy Duty Forklift for Emplacement Drifts; (5) Covered Shuttle Car; (6) Multipurpose Vehicle; and (7) Scaler.
DIY 3D printing of custom orthopaedic implants: a proof of concept study.
Frame, Mark; Leach, William
3D printing is an emerging technology that is primarily used for aiding the design and prototyping of implants. As this technology has evolved it has now become possible to produce functional and definitive implants manufactured using a 3D printing process. This process, however, previously required a large financial investment in complex machinery and professionals skilled in 3D product design. Our pilot study's aim was to design and create a 3D printed custom orthopaedic implant using only freely available consumer hardware and software. PMID:24574013
How to get the most out of your orthopaedic fellowship: thinking about practice-based learning.
Templeman, David
Practice-based learning and improvement is an important skill set to develop during an orthopaedic trauma fellowship and is 1 of the 6 core competencies stated by the ACGME. The review of clinic cases is best done using a few simple models to develop a structured approach for studying cases. Three common sense and easy-to-use strategies to improve clinical practice are as follows: performing each case three times, studying the 4 quadrants of patient outcomes, and the application of the Pareto 80/20 rule. These principles help to develop a structured approach for analyzing and thinking about practice-based experiences. PMID:22732864
The effects on bone cells of metal ions released from orthopaedic implants. A review
Sansone, Valerio; Pagani, Davide; Melato, Marco
Summary The increasing use of orthopedic implants and, in particular, of hip and knee joint replacements for young and active patients, has stimulated interest and concern regarding the chronic, long-term effects of the materials used. This review focuses on the current knowledge of the adverse biologic reactions to metal particles released from orthopaedic implants in vivo and in vitro. More specifically, the purpose of this article is to provide an overview of the current literature about the adverse effects of metal particles on bone cells and peri-implant bone. PMID:23858309
Antibiotic prophylaxis in orthopaedic surgery: difficult decisions in an era of evolving antibiotic resistance.
Bryson, D J; Morris, D L J; Shivji, F S; Rollins, K R; Snape, S; Ollivere, B J
Prophylactic antibiotics can decrease the risk of wound infection and have been routinely employed in orthopaedic surgery for decades. Despite their widespread use, questions still surround the selection of antibiotics for prophylaxis, timing and duration of administration. The health economic costs associated with wound infections are significant, and the judicious but appropriate use of antibiotics can reduce this risk. This review examines the evidence behind commonly debated topics in antibiotic prophylaxis and highlights the uses and advantages of some commonly used antibiotics. Cite this article: Bone Joint J 2016;98-B:1014-19. PMID:27482011
How bone tissue and cells experience elevated temperatures during orthopaedic cutting: an experimental and computational investigation.
Dolan, Eimear B; Vaughan, Ted J; Niebur, Glen L; Casey, Conor; Tallon, David; McNamara, Laoise M
During orthopaedic surgery elevated temperatures due to cutting can result in bone injury, contributing to implant failure or delayed healing. However, how resulting temperatures are experienced throughout bone tissue and cells is unknown. This study uses a combination of experiments (forward-looking infrared (FLIR)) and multiscale computational models to predict thermal elevations in bone tissue and cells. Using multiple regression analysis, analytical expressions are derived allowing a priori prediction of temperature distribution throughout bone with respect to blade geometry, feed-rate, distance from surface, and cooling time. This study offers an insight into bone thermal behavior, informing innovative cutting techniques that reduce cellular thermal damage. PMID:24317222
A novel route for processing cobalt–chromium–molybdenum orthopaedic alloys
Patel, Bhairav; Inam, Fawad; Reece, Mike; Edirisinghe, Mohan; Bonfield, William; Huang, Jie; Angadji, Arash
Spark plasma sintering has been used for the first time to prepare the ASTM F75 cobalt–chromium–molybdenum (Co–Cr–Mo) orthopaedic alloy composition using nanopowders. In the preliminary work presented in this report, the effect of processing variables on the structural features of the alloy (phases present, grain size and microstructure) has been investigated. Specimens of greater than 99.5 per cent theoretical density were obtained. Carbide phases were not detected in the microstructure but oxides were present. However, harder materials with finer grains were produced, compared with the commonly used cast/wrought processing methods, probably because of the presence of oxides in the microstructure. PMID:20200035
Use Of Tv-Frame Memory On Electronic Speckle Pattern Interferometry Applied To Orthopaedics
NASA Astrophysics Data System (ADS)
Soares, O. D.; Lage, A. L.
An automatic image digitizer has been developed to operate on the observation of transient phenomena in real time to the study of orthopaedics systems. The image of the speckle pattern corresponding to the combination of illuminating pulses is recorded in the solid state frame store. The stored electronic image is then automatically subtracted from a sub sequent image corresponding to the second pulse set. The live fringes appear on the monitor and are video recorded for later evaluation. Other operation modes can equally be realized with the Tv-frame memory. Real time hologrammetry can also be performed within the correlation range. Benefits can be acquired in moire techniques utilizing the proposed memory.
Soft Tissue Structure Modelling for Use in Orthopaedic Applications and Musculoskeletal Biomechanics
NASA Astrophysics Data System (ADS)
Audenaert, E. A.; Mahieu, P.; van Hoof, T.; Pattyn, C.
We present our methodology for the three-dimensional anatomical and geometrical description of soft tissues, relevant for orthopaedic surgical applications and musculoskeletal biomechanics. The technique involves the segmentation and geometrical description of muscles and neurovascular structures from high-resolution computer tomography scanning for the reconstruction of generic anatomical models. These models can be used for quantitative interpretation of anatomical and biomechanical aspects of different soft tissue structures. This approach should allow the use of these data in other application fields, such as musculoskeletal modelling, simulations for radiation therapy, and databases for use in minimally invasive, navigated and robotic surgery.
Regional uptake an variations in orthopaedic enhanced recovery pathways in knee and hip total arthroplasty.
Mawdsley, M J; Baker, P N; Desai, A; Green, R N; Jevons, L
The use of enhanced recovery (ER) pathways for hip and knee arthroplasty has increased over the last decade, and the adoption within orthopaedics is becoming more common. We have demonstrated a regional variation and institutional inconsistency of uptake and delivery of ER pathways in our region. Units that have a unified pathway were more likely to have consistency in treatment and early analgesia for patients. We would advocate that units use an agreed enhanced recovery pathway to optimise patient recovery from hip and knee arthroplasties. PMID:27400490
Does Illicit Drug Use Influence Inpatient Adverse Events, Death, Length of Stay, and Discharge After Orthopaedic Trauma?
Babatunde, Victor D; Menendez, Mariano E; Ring, David
Illicit drug use among adults is increasing, but its associated risk following orthopaedic trauma remains largely unexplored. This study assessed the relationship of illicit drug use with inpatient adverse events, in-hospital mortality, prolonged length of stay, and nonroutine discharge. With the use of the Nationwide Inpatient Sample database, 7,118,720 orthopaedic trauma inpatients from 2002 to 2011 were identified and separated into illicit drug users (1.5%) and non-illicit drug users (98.5%). Multivariable regression modeling was used to determine the association between illicit drug use and each outcome variable. Illicit drug use was associated with higher odds of inpatient adverse events, but not greater likelihood of inpatient death. Illicit drug users were also more likely to experience prolonged hospital stay and nonroutine discharge. Prompt recognition and effective treatment interventions for orthopaedic trauma patients with a history of illicit drug use may improve inpatient outcomes. PMID:27082887
Electronic Equipment Thermal Management
NASA Astrophysics Data System (ADS)
Berger, R. L.; Jenkins, L. C.
An assessment is made of the importance of thermal management in electronic equipment design, illustrating the ways in which CAD technology may be used to improve electronic equipment thermal management programs. Attention is given to the Electronic Equipment Thermal Management portion of the aircraft system-level Thermal Management Control (TMC) program. TMC establishes the process by which the airframe's environmental control system and the electronic equipment are integrated to optimize system reliability through life cycle cost minimization, by allocating available cooling capacity to system elements on the basis of derived benefits.
An international survey to identify the intrinsic and extrinsic factors of research studies most likely to change orthopaedic practice
Thornley, P.; de SA, D.; Evaniew, N.; Farrokhyar, F.; Bhandari, M.
Objectives Evidence -based medicine (EBM) is designed to inform clinical decision-making within all medical specialties, including orthopaedic surgery. We recently published a pilot survey of the Canadian Orthopaedic Association (COA) membership and demonstrated that the adoption of EBM principles is variable among Canadian orthopaedic surgeons. The objective of this study was to conduct a broader international survey of orthopaedic surgeons to identify characteristics of research studies perceived as being most influential in informing clinical decision-making. Materials and Methods A 29-question electronic survey was distributed to the readership of an established orthopaedic journal with international readership. The survey aimed to analyse the influence of both extrinsic (journal quality, investigator profiles, etc.) and intrinsic characteristics (study design, sample size, etc.) of research studies in relation to their influence on practice patterns. Results A total of 353 surgeons completed the survey. Surgeons achieved consensus on the 'importance' of three key designs on their practices: randomised controlled trials (94%), meta-analyses (75%) and systematic reviews (66%). The vast majority of respondents support the use of current evidence over historical clinical training; however subjective factors such as journal reputation (72%) and investigator profile (68%) continue to influence clinical decision-making strongly. Conclusion Although intrinsic factors such as study design and sample size have some influence on clinical decision-making, surgeon respondents are equally influenced by extrinsic factors such as investigator reputation and perceived journal quality. Cite this article: Dr M. Ghert. An international survey to identify the intrinsic and extrinsic factors of research studies most likely to change orthopaedic practice. Bone Joint Res 2016;5:130–136. DOI: 10.1302/2046-3758.54.2000578. PMID:27105650
Variation in use of non-surgical treatments among osteoarthritis patients in orthopaedic practice in the Netherlands
Hofstede, Stefanie N; Vliet Vlieland, Thea P M; van den Ende, Cornelia H M; Nelissen, Rob G H H; Marang-van de Mheen, Perla J; van Bodegom-Vos, Leti
Objectives National and international evidence-based guidelines for hip and knee osteoarthritis (OA) recommend to start with non-surgical treatments, followed by surgical intervention if a patient does not respond sufficiently to non-surgical treatments, but there are indications that these are not optimally used. The aim of this study was to assess the extent to which all recommended non-surgical treatments were used by patients with hip or knee OA who receive(d) a total hip or knee replacement, as reported by patients and orthopaedic surgeons. Setting We performed two cross-sectional internet-based surveys among patients and orthopaedic surgeons throughout the Netherlands. Participants 195 OA patients either have undergone total knee arthroplasty or total hip arthroplasty no longer than 12 months ago or being on the waiting list for surgery with a confirmed date within 3 months and 482 orthopaedic surgeons were invited to participate. Primary and secondary outcome measures The use of recommended non-surgical treatments including education about OA/treatment options, lifestyle advice, dietary therapy, physical therapy, acetaminophen, NSAIDs and glucocorticoid injections. Results 174 OA patients (93%) and 172 orthopaedic surgeons (36%) completed the surveys. Most recommended non-surgical treatments were given to the majority of patients (eg, 80% education about OA, 73% physical therapy, 72% acetaminophen, 80% NSAIDs). However, only 6% of patients and 10% of orthopaedic surgeons reported using a combination of all recommended treatments. Dietary therapy was used least frequently. Only 11% of overweight and 30% of obese participants reported having received dietary therapy and 28% of orthopaedic surgeons reported to prescribe dietary therapy to overweight patients. Conclusions While most recommended non-surgical treatments were used frequently as single therapy, the combination is used in only a small percentage of OA patients. Especially, use of dietary therapy
[The singular story of Doctor Worm -Nicholas Andry de Boisregard- and of his daughters Parasitology and Orthopaedics].
Ledermann, Walter
Homini verminoso or Dr. Worm were the nicknames that Nicholas Aindry won in life for his consecration to the study of intestinal worms and for his bad temper, which led him to fiercely attack the surgeons. The article reassumes the studies and contributions that gave Andry the title of Father of Parasitology and the candidacy to Father of Orthopaedics, and mentions some other candidates to this honor. Quite a man, he had -besides his biological one- two famous daughters, growing till our days; wrote at least three valuable books; and planted the immortal "tree of Andry", the symbol of Orthopaedics. PMID:23282505
ERIC Educational Resources Information Center
Day, C. William
Examines telecommunications equipment room design features that allow for growth and can accommodate numerous equipment replacements and upgrades with minimal service disruption and with minimal cost. Considerations involving the central hub, power and lighting needs, air conditioning, and fire protection are discussed. (GR)
ERIC Educational Resources Information Center
Naval Education and Training Program Development Center, Pensacola, FL.
The Rate Training Manual and Nonresident Career Course (RTM/NRCC) form a self-study package to assist Navy Equipment Operators First and Chief in fulfilling the requirements of their rating. (Navy Equipment Operators First and Chief direct and coordinate efforts of individuals and crews in construction, earthmoving, roadbuilding, quarrying, and…
ERIC Educational Resources Information Center
Poitras, Adrian W., Ed.
Presents several new products and equipment for teaching college science courses such as laser optics bench, portable digital thermometer, solar energy furnaces and blackboard optics kit. A description of all equipment or products, cost, and addresses of manufacturers are also included. (HM)
Laboratory Equipment Criteria.
ERIC Educational Resources Information Center
State Univ. Construction Fund, Albany, NY.
Requirements for planning, designing, constructing and installing laboratory furniture are given in conjunction with establishing facility criteria for housing laboratory equipment. Furniture and equipment described include--(1) center tables, (2) reagent racks, (3) laboratory benches and their mechanical fixtures, (4) sink and work counters, (5)…
Troubleshooting rotating equipment
Wong, R.F. )
This paper reports that equipment problems in a Peruvian refinery illustrate the process engineer's role as a troubleshooter. Examples show that rotating equipment problems can stem from mechanical or process factors and involve both inspection/maintenance specialists and process engineers.
Shipboard Electronic Equipments.
ERIC Educational Resources Information Center
Naval Personnel Program Support Activity, Washington, DC.
Fundamentals of major electronic equipments on board ships are presented in this text prepared for naval officers in general. Basic radio principles are discussed in connection with various types of transmitters, receivers, antennas, couplers, transfer panels, remote-control units, frequency standard equipments, teletypewriters, and facsimile…
ERIC Educational Resources Information Center
Marine Corps Inst., Washington, DC.
Developed as part of the Marine Corps Institute (MCI) correspondence training program, this course on engineer equipment mechanics is designed to advance the professional competence of privates through sergeants as equipment mechanics, Military Occupation Specialty 1341, and is adaptable for nonmilitary instruction. Introductory materials include…
Adaptive Recreational Equipment.
ERIC Educational Resources Information Center
Schilling, Mary Lou, Ed.
Designed for teachers interested in therapeutic recreation, the document lists sources of adaptive recreational equipment and their homemade counterparts. Brief descriptions for ordering or constructing recreational equipment for the visually impaired, poorly coordinated, physically impaired, and mentally retarded are given. Specific adaptations…
The influence of surface condition on the localized corrosion of 316L stainless steel orthopaedic implants.
Beddoes, J; Bucci, K
The localized corrosion of austenitic stainless steel 316L intended for use as orthopaedic implants is determined as a function of the surface condition and metallurgical state. From the examination of samples exposed to a ferric chloride solution, at both 22 and 37 degrees C, the independent contribution of crevice and pitting corrosion to localized corrosion is determined. Both forms of localized corrosion occur to a greater extent at the higher temperature. The results indicate that weight loss measurements may not be sufficient to determine the extent of crevice corrosion separately from the influence of pitting corrosion. More importantly, the surface conditions required for the best resistance to crevice or pitting corrosion differ. Electropolished surfaces provide the best resistance to crevice corrosion, while "bead blasted" surfaces provide the best resistance to pitting corrosion. The implication of this result in terms of the serviceability as orthopaedic implants is discussed. The current results indicate the cold-worked state exhibits improved resistance to pitting corrosion. However, the influence of the metallurgical state could not be separated from a possible compositional effect. PMID:15348123
Radiation exposure to operating theatre personnel during fluoroscopic-assisted orthopaedic surgery.
Radhi, A M; Masbah, O; Shukur, M H; Shahril, Y; Taiman, K
Orthopaedic procedures especially dynamic hip screw (DHS) fixation, interlocking nailing (ILN) of the tibia and femur require fluoroscopic assistance. Frequent exposure to radiation is a major concern to members of the orthopaedic surgical team. This study was undertaken to measure shallow (skin) dose to the operating team personnel and deep (whole body) dose to the surgeon during such procedures in view to provide guidelines to the operating team members regarding the number of procedures allowable for them to perform or assist annually. Skin dose for the operating personnel and whole body dose for the operating surgeon during 25 procedures; ten cases of DHS, seven and six cases of ILN of the tibia and femur respectively, was measured using Thermoluminescent Dosimeter (TLD) chips. The shallow radiation dose for theatre personnel ranged from 0.19 mSy to 0.61 per case while the deep dose for the surgeon was 0.28, 0.55 and 0.81 mSy for seven cases of tibial ILN, ten cases of DHS and six cases of femur ILN respectively. The surgeon has the highest radiation exposure than other theatre personnel and the whole body exposure for DHS was higher than that of for ILN. However, the estimated cumulative dose was still far below the permissible annual dose limit. PMID:17042230
The applications of buckminsterfullerene C60 and derivatives in orthopaedic research
Liu, Qihai; Cui, Quanjun; Li, Xudong Joshua; Jin, Li
Buckminsterfullerene C60 and derivatives have been extensively explored in biomedical research due to their unique structure and unparalleled physicochemical properties. C60 is characterized as a "free radical sponge" with an anti-oxidant efficacy several hundred-fold higher than conventional anti-oxidants. Also, the C60 core has a strong electron-attracting ability and numerous functional compounds with widely different properties can be added to this fullerene cage. This review focused on the applications of C60 and derivatives in orthopaedic research, such as the treatment of cartilage degeneration, bone destruction, intervertebral disc degeneration (IVDD), vertebral bone marrow disorder, radiculopathy, etc., as well as their toxicity in vitro and in vivo. We suggest that C60 and derivatives, especially the C60 cores coupled with functional groups presenting new biological and pharmacological activities, are advantageous in orthopaedic research and will be promising in clinical performance for musculoskeletal disorders treatment; however, the pharmacokinetics and toxicology of these agents as local/systemic administration need to be carefully determined. PMID:24409811
Quality and Safety in Orthopaedics: Learning and Teaching at the Same Time: AOA Critical Issues.
Black, Kevin P; Armstrong, April D; Hutzler, Lorraine; Egol, Kenneth A
Increasing attention has been placed on providing higher quality and safer patient care. This requires the development of a new set of competencies to better understand and navigate the system and lead the orthopaedic team. While still trying to learn and develop these competencies, the academic orthopaedist is also expected to model and teach them.The orthopaedic surgeon must understand what is being measured and why, both for purposes of providing better care and to eliminate unnecessary expense in the system. Metrics currently include hospital-acquired conditions, "never events," and thirty-day readmission rates. More will undoubtedly follow.Although commitment and excellence at the individual level are essential, the orthopaedist must think at the systems level to provide the highest value of care. A work culture characterized by respect and trust is essential to improved communication, teamwork, and confidential peer review. An increasing number of resources, both in print and electronic format, are available for us to understand what we can do now to improve quality and safety.Resident education in quality and safety is a fundamental component of the systems-based practice competency, the Next Accreditation System, and the Clinical Learning Environment Review. This needs to be longitudinally integrated into the curriculum and applied parallel to the development of resident knowledge and skill, and will be best learned if resident learning is experiential and taught within a genuine culture of quality and safety. PMID:26537169
Evidence-based surgery – evidence from survey and citation analysis in orthopaedic surgery
Kumar, Malhar; Gopalakrishna, Chethan; Swaminath, Pazhayannur V; Mysore, Sanjay S
INTRODUCTION The results of a survey on evidence-based surgery (EBS) among members of the American Academy of Orthopedic Surgeons (AAOS) and the British Orthopaedic Association (BOA) are presented. The study also analyzes the citations earned by articles with different levels of evidence (LOE) to see if LOE have any bearing on the importance attached to the articles by authors and contributors to the journals. SUBJECTS AND METHODS The questionnaire was e-mailed to 1000 randomly chosen consultant orthopaedic surgeons who were members of either the AAOS or the BOA. Participants were provided with the option of responding through web-based entry. For citation analysis, citation data were gathered from the Journal of Bone and Joint Surgery (American volume) between the years 2003 and 2007 (5-year period). RESULTS The survey showed that awareness and access to EBS have improved greatly over the years. At the present time, these factors are not important barriers to the implementation of EBS in clinical practice in developed countries. There was a statistically significant difference in those with and without additional qualifications with regard to the approach to EBS. However, an equal percentage of surgeons with and without additional qualifications felt that it was difficult to adhere to EBS guidelines in daily clinical practice. Citation analysis showed that readers of professional journals attach importance to LOE category of the article and tend to cite level-I evidence articles more than other articles. PMID:21073824
How to Study Biofilms after Microbial Colonization of Materials Used in Orthopaedic Implants.
Drago, Lorenzo; Agrappi, Serse; Bortolin, Monica; Toscano, Marco; Romanò, Carlo Luca; De Vecchi, Elena
Over the years, various techniques have been proposed for the quantitative evaluation of microbial biofilms. Spectrophotometry after crystal violet staining is a widespread method for biofilm evaluation, but several data indicate that it does not guarantee a good specificity, although it is rather easy to use and cost saving. Confocal laser microscopy is one of the most sensitive and specific tools to study biofilms, and it is largely used for research. However, in some cases, no quantitative measurement of the matrix thickness or of the amount of embedded microorganisms has been performed, due to limitation in availability of dedicated software. For this reason, we have developed a protocol to evaluate the microbial biofilm formed on sandblasted titanium used for orthopaedic implants, that allows measurement of biomass volume and the amount of included cells. Results indicate good reproducibility in terms of measurement of biomass and microbial cells. Moreover, this protocol has proved to be applicable for evaluation of the efficacy of different anti-biofilm treatments used in the orthopaedic setting. Summing up, the protocol here described is a valid and inexpensive method for the study of microbial biofilm on prosthetic implant materials. PMID:26927075
The role of biofilm on orthopaedic implants: the "Holy Grail" of post-traumatic infection management?
Mauffrey, C; Herbert, B; Young, H; Wilson, M L; Hake, M; Stahel, P F
The development of post-traumatic infection is potentially a limb threatening condition. The orthopaedic trauma literature lags behind the research performed by our arthroplasty colleagues on the topic of implant-related infections. Surgical site infections in the setting of a recent ORIF are notoriously hard to eradicate due to biofilm formation around the implant. This bacteria-friendly, dynamic, living pluri-organism structure has the ability to morph and adapt to virtually any environment with the aim to maintain the causative organism alive. The challenges are twofold: establishing an accurate diagnosis with speciation/sensitivity and eradicating the infection. Multiple strategies have been researched to improve diagnostic accuracy, to prevent biofilm formation on orthopaedic implants, to mobilize/detach or weaken the biofilm or to target specifically bacteria embedded in the biofilm. The purpose of our paper is to review the patho-physiology of this mysterious pluri-cellular structure and to summarize some of the most pertinent research performed to improve diagnostic and treatment strategies in biofilm-related infections. PMID:27262848
Contribution of biomechanics, orthopaedics and rehabilitation: the past present and future.
Woo, S L Y; Thomas, M; Chan Saw, S S
Biomechanics is a field that has a very long history. From its beginnings in ancient Chinese and Greek literature, the field of orthopaedic biomechanics has grown in the areas of biomechanics of bone, articular cartilage, soft tissues, upper extremities, spine and so on. Bioengineers in collaboration with orthopaedic surgeons have applied biomechanical principles to study clinically relevant problems, improving patient treatment and outcome. In the past 30 years, my colleagues and I have focused our research on the biomechanics of musculoskeletal soft tissues, ligaments and tendons in particular. Therefore, in this review article, the function of the knee ligaments and the associated homeostatic responses secondary to immobilisation and exercise will be described. Research on healing of the medial collateral ligament (MCL) of the knee and possible future approaches in improving the healing of the knee ligaments will be presented. Finally, improvement of the understanding of ligament reconstruction, specifically of the anterior cruciate ligament (ACL), through the use of robotics technology will be included. Throughout the manuscript, specific scientific findings that have guided or changed the clinical management of injury to these soft tissues will be emphasised. PMID:15570813
Mesenchymal stem cell interaction with ultra smooth nanostructured diamond for wear resistant orthopaedic implants
Clem, William C.; Chowdhury, Shafiul; Catledge, Shane A.; Weimer, Jeffrey J.; Shaikh, Faheem M.; Hennessy, Kristin M.; Konovalov, Valery V.; Hill, Michael R.; Waterfeld, Alfred; Bellis, Susan L.; Vohra, Yogesh K.
Ultra smooth nanostructured diamond (USND) can be applied to greatly increase the wear resistance of orthopaedic implants over conventional designs. Herein we describe surface modification techniques and cytocompatibility studies performed on this new material. We report that hydrogen (H) -terminated USND surfaces supported robust mesenchymal stem cell (MSC) adhesion and survival, while oxygen (O) and fluorine (F) -terminated surfaces resisted cell adhesion, indicating that USND can be modified to either promote or prevent cell/biomaterial interactions. Given the favorable cell response to H-terminated USND, this material was further compared with two commonly-used biocompatible metals, titanium alloy (Ti-6Al-4V) and cobalt chrome (CoCrMo). MSC adhesion and proliferation were significantly improved on USND compared with CoCrMo, although cell adhesion was greatest on Ti-6Al-4V. Comparable amounts of the proadhesive protein, fibronectin, were deposited from serum on the three substrates. Finally, MSCs were induced to undergo osteoblastic differentiation on the three materials, and deposition of a mineralized matrix was quantified. Similar amounts of mineral were deposited onto USND and CoCrMo, whereas mineral deposition was slightly higher on Ti-6Al-4V. When coupled with recently published wear studies, these in vitro results suggest that USND has the potential to reduce debris particle release from orthopaedic implants without compromising osseointegration. PMID:18490051
Capturing orthopaedic surgical site infection data and assessing dental recommendations with respect to total joint arthroplasty.
Florschutz, Anthony V; Parsley, Brian S; Shapiro, Irving M
Greater documentation of patient history and clinical course is crucial for identifying factors that can influence surgical outcomes. The Centers for Medicare and Medicaid Services have already begun public reporting of hospital data on readmission, complication, and infection rates and will soon launch a website to make physician-specific outcomes data public. The orthopaedic community has the opportunity to lead the way in ensuring that adequate and accurate data is collected to facilitate appropriate comparisons that are based on patients' true risk of complications and the complexity of treatment. Several studies have reported a link between oral pathogens and periprosthetic infection, although it remains unclear whether organisms unique to dental tissues are also present in osteoarthritic joints and tissues affected by periprosthetic joint infection. The American Academy of Orthopaedic Surgeons and the American Dental Association are aware of these concerns and have created guidelines for antibiotic prophylaxis in patients who have undergone total hip or knee arthroplasty and require high-risk dental procedures. Because these guidelines have received considerable criticism, recommendations that are based on scientific and case-controlled clinical studies and provide effective guidance on this important subject are needed. PMID:25808970
Diamond-like carbon coatings for orthopaedic applications: an evaluation of tribological performance.
Xu, T; Pruitt, L
A detailed investigation of the tribological behaviour of vacuum arc diamond-like carbon coated Ti-6Al-4V against a medical grade ultra-high molecular weight polyethylene is conducted in this work in order to investigate the potential use of diamond-like carbon coatings for orthopaedic appplications. Lubricated and non-lubricated wear experiments are performed using a standard pin-on-disc wear tester. The coefficient of friction is monitored continuously during testing and wear rate calculations are performed using surface profilometry measurements of worn disc surfaces. Sliding wear tests show the existence of two distinct friction and wear regimes distinguished by physically different mechanisms. In the first stages of wear, adhesion and abrasion are the dominant mechanisms of wear while fatigue processes are activated later in the tests. The effects of diamond-like carbon coating structure, surface roughness and lubrication on tribological behaviour are presented. Optimal process-structure-property design for vacuum arc plasma deposition is utilized in order to obtain strong adhesion to the titanium alloy substrate. Diamond-like carbon coatings significantly improve the friction and wear performance of the orthopaedic bearing pair and show exceptional promise for biomedical applications. PMID:15347929
How to Study Biofilms after Microbial Colonization of Materials Used in Orthopaedic Implants
Drago, Lorenzo; Agrappi, Serse; Bortolin, Monica; Toscano, Marco; Romanò, Carlo Luca; De Vecchi, Elena
Over the years, various techniques have been proposed for the quantitative evaluation of microbial biofilms. Spectrophotometry after crystal violet staining is a widespread method for biofilm evaluation, but several data indicate that it does not guarantee a good specificity, although it is rather easy to use and cost saving. Confocal laser microscopy is one of the most sensitive and specific tools to study biofilms, and it is largely used for research. However, in some cases, no quantitative measurement of the matrix thickness or of the amount of embedded microorganisms has been performed, due to limitation in availability of dedicated software. For this reason, we have developed a protocol to evaluate the microbial biofilm formed on sandblasted titanium used for orthopaedic implants, that allows measurement of biomass volume and the amount of included cells. Results indicate good reproducibility in terms of measurement of biomass and microbial cells. Moreover, this protocol has proved to be applicable for evaluation of the efficacy of different anti-biofilm treatments used in the orthopaedic setting. Summing up, the protocol here described is a valid and inexpensive method for the study of microbial biofilm on prosthetic implant materials. PMID:26927075
Ground-foot reaction forces in hemiplegic gait patterns with and without orthopaedic aids.
Bacik, Bogdan; Saulicz, Edward; Gnat, Rafal
The objective of this study was to attempt the analysis of the ground-foot reaction forces in hemiplegic patients in routine gait re-education conditions, with and without supporting this process with typical orthopaedic aids. Ninety people with hemiparesis participated. The subjects were divided into three groups, according to their locomotion type (no walking aids, stick and elbow crutch). The ground-foot reaction forces during level gait trial were measured for each subject. Analysis was carried out by means of Kistler lane. The ANOVA results showed a considerable effect on almost all ground-foot reaction force parameters, brought about both by the paralysis itself and any walking stick or elbow crutch supporting locomotion. The use of the orthopaedic provisions, especially the elbow crutch, prolongs the time of the single-stance phase duration considerably. In conclusion, the distinct asymmetry of hemiplegic gait manifests itself in the distribution of the ground-foot reaction force. In the sagittal plane, the values of the force impulse indicate that people with a walking stick accelerated using the healthy limb and slowed down using the paralysed limb. In elbow crutch patients the acceleration function seems to be taken over by the crutch. PMID:16900049
Mesenchymal stem cell interaction with ultra-smooth nanostructured diamond for wear-resistant orthopaedic implants.
Clem, William C; Chowdhury, Shafiul; Catledge, Shane A; Weimer, Jeffrey J; Shaikh, Faheem M; Hennessy, Kristin M; Konovalov, Valery V; Hill, Michael R; Waterfeld, Alfred; Bellis, Susan L; Vohra, Yogesh K
Ultra-smooth nanostructured diamond (USND) can be applied to greatly increase the wear resistance of orthopaedic implants over conventional designs. Herein we describe surface modification techniques and cytocompatibility studies performed on this new material. We report that hydrogen (H)-terminated USND surfaces supported robust mesenchymal stem cell (MSC) adhesion and survival, while oxygen- (O) and fluorine (F)-terminated surfaces resisted cell adhesion, indicating that USND can be modified to either promote or prevent cell/biomaterial interactions. Given the favorable cell response to H-terminated USND, this material was further compared with two commonly used biocompatible metals, titanium alloy (Ti-6Al-4V) and cobalt chrome (CoCrMo). MSC adhesion and proliferation were significantly improved on USND compared with CoCrMo, although cell adhesion was greatest on Ti-6Al-4V. Comparable amounts of the pro-adhesive protein, fibronectin, were deposited from serum on the three substrates. Finally, MSCs were induced to undergo osteoblastic differentiation on the three materials, and deposition of a mineralized matrix was quantified. Similar amounts of mineral were deposited onto USND and CoCrMo, whereas mineral deposition was slightly higher on Ti-6Al-4V. When coupled with recently published wear studies, these in vitro results suggest that USND has the potential to reduce debris particle release from orthopaedic implants without compromising osseointegration. PMID:18490051
The effects of blood transfusion on renal functions in orthopaedic surgery
Satoglu, Ismail Safa; Akcay, Serkan; Horoz, Levent; Kaya, Erol; Karakasli, Ahmet; Skiak, Eyad; Basci, Onur
Objective: The effects of perioperative blood transfusion on renal functions have been studied in various studies. In this study, we investigated the effects of blood transfusion on postoperative kidney functions in patients who underwent orthopaedic surgeries. Method: Total 136 patients who were operated for several orthopedic pathologies between June 2013 and December 2014 were evaluated. The patients were divided into two groups according to the amounts of blood transfusion. Ninety five patients (69.8%) who were transfused less than 3 units were included in Group 1 and 41 patients (30.2%) who received 3 and more units of blood were included in Group 2. Results: There were no statistical difference between the two groups in terms of preoperative gender, hypertension, diabetes mellitus, chronical renal failure and smoking habbits (P > 0.05). No statistical differences between the groups were seen in terms of postoperative hospital stay, pulmonary and other complications as well as mortality (P > 0.05). When the two groups were compared for blood parameters showing postoperative renal and other system functions, no statistical differences were detected (P > 0.05). Conclusion: Blood transfusion does not have negative effects on postoperative BUN and creatinine levels in patients operated for orthopaedic pathologies. PMID:26430403
The rate of glove perforations in orthopaedic procedures: single versus double gloving. A prospective study.
Chan, K Y; Singh, V A; Oun, B H; To, B H Se
Glove perforation during surgery has always been a matter of concern as it increases the infection rate and the risk of transmission of blood borne diseases. To determine the common causes, the site and the awareness of glove perforations in orthopaedic surgery, a prospective study was conducted to assess the rate of glove perforation during 130 consecutive orthopaedic operations. All gloves worn by the surgical team were assessed after the surgery using the water-loading test. A total of 1452 gloves were tested, and the rate of perforation was 3.58%. Most of these perforations (61.5%) were unnoticed. The main surgeons had the most perforations (76.9%), followed by first assistants (13.5%) and second assistants (9.6%). Most perforations occurred at the non-dominant hand. The commonest site of perforation was the index finger followed by the thumb. Shearing force with instruments accounted for 45% of the noticed perforations. Majority of these occurred during nailing procedures (33%) and internal fixation without the use of wires (19%). Our rate of glove perforation is similar to other series. Most of them went unnoticed and were mainly due to shearing injuries rather than perforation by sharps. Therefore, there is an increased risk of contamination and break in asepsis during surgery. PMID:17605178
Risk Factors for Deep Venous Thrombosis Following Orthopaedic Trauma Surgery: An Analysis of 56,000 patients
Whiting, Paul S.; White-Dzuro, Gabrielle A.; Greenberg, Sarah E.; VanHouten, Jacob P.; Avilucea, Frank R.; Obremskey, William T.; Sethi, Manish K.
Background: Deep venous thrombosis (DVT) and pulmonary embolism (PE) are recognized as major causes of morbidity and mortality in orthopaedic trauma patients. Despite the high incidence of these complications following orthopaedic trauma, there is a paucity of literature investigating the clinical risk factors for DVT in this specific population. As our healthcare system increasingly emphasizes quality measures, it is critical for orthopaedic surgeons to understand the clinical factors that increase the risk of DVT following orthopaedic trauma. Objectives: Utilizing the ACS-NSQIP database, we sought to determine the incidence and identify independent risk factors for DVT following orthopaedic trauma. Patients and Methods: Using current procedural terminology (CPT) codes for orthopaedic trauma procedures, we identified a prospective cohort of patients from the 2006 to 2013 ACS-NSQIP database. Using Wilcoxon-Mann-Whitney and chi-square tests where appropriate, patient demographics, comorbidities, and operative factors were compared between patients who developed a DVT within 30 days of surgery and those who did not. A multivariate logistic regression analysis was conducted to calculate odds ratios (ORs) and identify independent risk factors for DVT. Significance was set at P < 0.05. Results: 56,299 orthopaedic trauma patients were included in the analysis, of which 473 (0.84%) developed a DVT within 30 days. In univariate analysis, twenty-five variables were significantly associated with the development of a DVT, including age (P < 0.0001), BMI (P = 0.037), diabetes (P = 0.01), ASA score (P < 0.0001) and anatomic region injured (P < 0.0001). Multivariate analysis identified several independent risk factors for development of a DVT including use of a ventilator (OR = 43.67, P = 0.039), ascites (OR = 41.61, P = 0.0038), steroid use (OR = 4.00, P < 0.001), and alcohol use (OR = 2.98, P = 0.0370). Compared to patients with upper extremity trauma, those with lower
Park, W.M.; Hughes, S.P.F.
This book provides an account of the principles of modern diagnostic imaging techniques and their applications in orthopedics. The aim of the book is to show radiology as a dynamic subject which can help clinicians, while at the same time assisting radiologists to understand the needs of the orthopedic surgeon.
Animal Health Equipment Management.
Rethorst, David N
Proper health equipment management requires significant attention to detail. Establishing and following protocols during processing (eg, cleaning and disinfecting equipment at the end of the work day) is required to ensure a safe product that is free of defects and residues. Overall cleanliness of equipment and facilities is important not only from a food safety standpoint but many view these as an overall indicator of attention to detail in the entire production system. Ensuring that needles are changed, implant guns are managed properly, vaccine is handled in an acceptable manner, and that proper chute operation occurs is essential. PMID:26139191
The burden of bone, native joint and soft tissue infections on orthopaedic emergency referrals in a city hospital.
Howell, A; Parker, S; Tsitskaris, K; Oddy, M J
Introduction Bone, native joint and soft tissue infections are frequently referred to orthopaedic units although their volume as a proportion of the total emergency workload has not been reported previously. Geographic and socioeconomic variation may influence their presentation. The aim of this study was to quantify the burden of such infections on the orthopaedic department in an inner city hospital, determine patient demographics and associated risk factors, and review our current utilisation of specialist services. Methods All cases involving bone, native joint and soft tissue infections admitted under or referred to the orthopaedic team throughout 2012 were reviewed retrospectively. Prosthetic joint infections were excluded. Results Almost 15% of emergency admissions and referrals were associated with bone, native joint or soft tissue infection or suspected infection. The cohort consisted of 169 patients with a mean age of 43 years (range: 1-91 years). The most common diagnosis was cellulitis/other soft tissue infection and the mean length of stay was 13 days. Two-thirds of patients (n=112, 66%) underwent an operation. Fifteen per cent of patients were carrying at least one blood borne virus, eleven per cent were alcohol dependent, fifteen per cent were using or had been using intravenous drugs and nine per cent were homeless or vulnerably housed. Conclusions This study has shown that a significant number of patients are admitted for orthopaedic care as a result of infection. These patients are relatively young, with multiple complex medical and social co-morbidities, and a long length of stay. PMID:26688397
Validity of NBME Parts I and II for the Selection of Residents: The Case of Orthopaedic Surgery.
ERIC Educational Resources Information Center
Case, Susan M.
The predictive validity of scores on the National Board of Medical Examiners (NBME) Part I and Part II examinations for the selection of residents in orthopaedic surgery was investigated. Use of NBME scores has been criticized because of the time lag between taking Part I and entering residency and because Part I content is not directly linked to…
The Impact of Early Infant Jaw-Orthopaedics on Early Speech Production in Toddlers with Unilateral Cleft Lip and Palate
ERIC Educational Resources Information Center
Lohmander, Anette; Lillvik, Malin; Friede, Hans
The purpose of study was to investigate the impact of pre-surgical Infant Orthopaedics (IO) on consonant production at 18 months of age in children with Unilateral Cleft Lip and Palate (UCLP) and to compare the consonant production to that of age-matched children without clefts. The first ten children in a consecutive series of 20 with UCLP…
ERIC Educational Resources Information Center
Poitras, Adrian W., Ed.
Reviews new science equipment and products for the laboratory. Includes hand-held calculators, fiberglass fume hoods, motorized microtomy, disposable mouse cages, and electric timers. Describes 11 products total. Provides manufacturer name, address, and price. (MA)
Selecting Library Furniture & Equipment.
ERIC Educational Resources Information Center
Media & Methods, 1997
Offers suggestions for selecting school library furniture and equipment. Describes various models of computer workstations; reading tables and chairs; and shelving. Sidebar lists names and addresses of library furniture manufactures and distributors. (AEF)
Oral anticoagulants in development: focus on thromboprophylaxis in patients undergoing orthopaedic surgery.
Eriksson, Bengt I; Quinlan, Daniel J
Current anticoagulant provision is dominated by parenteral heparin and oral warfarin, which act by inhibiting several steps of the coagulation pathway indirectly. Recent research efforts have focused on the identification of small molecule inhibitors of the coagulation enzymes as novel therapies for thrombotic disorders. There has been particular success in developing nonpeptidic, orally available, small molecules to directly inhibit the key proteases, factor IIa and factor Xa. Of the new oral anticoagulants in development, the two agents in the most advanced stage are dabigatran etexilate (BIBR 1048) and rivaroxaban (BAY 59-7939), which inhibit factor IIa and factor Xa, respectively. Other agents in the early stages of development include several Xa inhibitors (LY-517717, YM150, DU-176b and apixaban [BMS-562247]), a factor IXa inhibitor (TTP889), and an orally active glycosaminoglycan enhancer (odiparcil [SB-424323]), which indirectly enhances thrombin inhibition via heparin cofactor II. Results have been reported from important, phase II dose-finding studies, and a number of registration-track phase III studies have been initiated, reflecting the drive towards potentially more effective, but primarily safer and more convenient therapies for the prevention and treatment of venous and arterial thrombosis. Indeed, two unmet needs for anticoagulation that can be easily identified are safety and ease of use. Safety relates primarily to the incidence of major bleeding and this remains the key concern of orthopaedic surgeons, over and above any efficacy advantage, and convenience of use, which centres on oral administration replacing the need for injections. The clinical development of these new anticoagulants is following the well tested strategy of dose-ranging and registration studies in major orthopaedic surgery, prior to development in arterial indications. There are a number of subtle issues, including the timing of the first perioperative dose, duration of
Physical therapy and health-related outcomes for patients with common orthopaedic diagnoses.
Di Fabio, R P; Boissonnault, W
Assessing both physical and mental health is necessary in clinical settings to quantify the scope of disability and to evaluate the effectiveness of treatment programs. Changes in health-related quality of life following physical therapy treatment for many patients with orthopaedic-related diagnoses is not known. The purposes of this study were to describe changes in health-related quality of life between the initial assessment and the time of discharge from physical therapy for the most common orthopaedic diagnoses and to compare the patterns of deficit among diagnostic categories. Patient outcomes in this study were evaluated from a large database generated by the Focus on Therapeutic Outcomes (FOTO) network. Health-related and employment outcomes were described for adult patients who were classified using ICD-9-CM codes. The most common orthopaedic diagnostic categories were sacroiliac sprain, back sprain, low back pain (radiating and nonradiating), neck sprain, neck pain (radiating and nonradiating), adhesive capsulitis of the shoulder, rotator cuff injury, shoulder sprain, knee dislocation, knee sprain, and knee derangement. The primary outcome measure was a 17-item questionnaire (the MOS-17) derived from the RAND 36-Item Health Survey (SF-36) and the 12-item Short Form Health Survey (SF-12). The comparison of each cohort to population norms was made by calculating a standard score on patient data adjusted for age and gender. An effect size was calculated to measure the change in health or employment status between the initial assessment and discharge from physical therapy. For all diagnostic categories, health-related quality of life with respect to norms and employment status showed a consistent pattern of improvement at the time of discharge compared with the initial assessment. There were only small changes in physical function for neck and shoulder diagnostic categories. Nearly all of the diagnostic categories had large reductions in bodily pain. The
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The first comprehensive computer-based system for managing large inventories of rental equipment in the North Sea has been commissioned by British oilfield services group Expro. Now, after a year of operations in which the system has proved its worth in improving the efficiency of Expro's well testing and other services, it is being offered for sale to other oil industry companies with problems in controlling movement of capital equipment. The computer-based inventory control system to is described.
Medical equipment management strategies.
Wang, Binseng; Furst, Emanuel; Cohen, Ted; Keil, Ode R; Ridgway, Malcolm; Stiefel, Robert
Clinical engineering professionals need to continually review and improve their management strategies in order to keep up with improvements in equipment technology, as well as with increasing expectations of health care organizations. In the last 20 years, management strategies have evolved from the initial obsession with electrical safety to flexible criteria that fit the individual institution's needs. Few hospitals, however, are taking full advantage of the paradigm shift offered by the evolution of joint Commission standards. The focus should be on risks caused by equipment failure, rather than on equipment with highest maintenance demands. Furthermore, it is not enough to consider risks posed by individual pieces of equipment to individual patients. It is critical to anticipate the impact of an equipment failure on larger groups of patients, especially when dealing with one of a kind, sophisticated pieces of equipment that are required to provide timely and accurate diagnoses for immediate therapeutic decisions or surgical interventions. A strategy for incorporating multiple criteria to formulate appropriate management strategies is provided in this article. PMID:16796335
Daptomycin for the treatment of osteomyelitis and orthopaedic device infections: real-world clinical experience from a European registry.
Malizos, K; Sarma, J; Seaton, R A; Militz, M; Menichetti, F; Riccio, G; Gaudias, J; Trostmann, U; Pathan, R; Hamed, K
Osteomyelitis is a serious infection predominantly caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Orthopaedic device-related infections are complex and require a careful combination of surgical intervention and antimicrobial therapy. Daptomycin, a cyclic lipopeptide, effectively penetrates soft tissue and bone and demonstrates rapid concentration-dependent bactericidal activity against Gram-positive pathogens. This retrospective, non-interventional study evaluated clinical outcomes in patients with osteomyelitis or orthopaedic device infections treated with daptomycin from the European Cubicin® Outcomes Registry and Experience (EU-CORE(SM)) study. Patients were treated between January 2006 and April 2012, with follow-up to 2014. Clinical outcomes were assessed as success (cured or improved), failure or non-evaluable. Of 6,075 patients enrolled, 638 (median age, 63.5 years) had primary infections of osteomyelitis or orthopaedic device infections, 224 had non-prosthetic osteomyelitis, 208 had osteomyelitis related to a permanent or temporary prosthetic device, and 206 had orthopaedic device infections. The most commonly isolated pathogen was S. aureus (214 [49.1 %]; 24.8 % were MRSA). Overall, 455 (71.3 %) patients had received previous antibiotic therapy. Patients underwent surgical interventions, including tissue (225 [35.3 %]) and bone (196 [30.7 %]) debridement, as part of their treatment. Clinical success rates were 82.7 % and 81.7 % in S. aureus and coagulase-negative staphylococcal infections. Adverse events (AEs) and serious AEs assessed as possibly related to daptomycin were observed in 6.7 % and 1.9 % of patients, respectively. Daptomycin was discontinued by 5.5 % of patients due to AEs and 10 (1.6 %) deaths were reported. In conclusion, daptomycin was effective and safe in patients with osteomyelitis or orthopaedic device infections. PMID:26563898
Listing of Food Service Equipment.
ERIC Educational Resources Information Center
National Sanitation Foundation, Ann Arbor, MI. Testing Lab.
A comprehensive listing of food service equipment including--(1) companies authorized to use the National Sanitation Foundation seal of approval, and (2) equipment listed as meeting NSF standards including soda fountains, spray-type dishwashers, dishwashing equipment, cooking equipment, commerical cooking and warming equipment, freezers,…
Use of bone marrow derived stem cells in trauma and orthopaedics: A review of current concepts
Pastides, Philip S; Welck, Matthew J; Khan, Wasim S
There is a considerable amount of interest in the future role of bone marrow-derived stem cells (BMDSCs) and tissue engineering techniques to manage conditions within the musculoskeletal system. Repair of soft tissue and bone defects, in the early stages of injury, may lead to a reduction in progression of symptoms. Furthermore, troublesome soft tissue injuries that are notoriously fraught with problems either in healing or function, could be augmented with such techniques. The aim of this review paper is to look at the advances in such strategies to tackle these problems and assess how BMDSCs, with the aid of growth factors and scaffolds, are being used in vitro, animal and even human models to treat problems within the field of trauma and orthopaedics. There is plenty of evidence that the results are encouraging and thus gaining momentum toward their use in human studies. PMID:26191493
Safety and efficacy of use of demineralised bone matrix in orthopaedic and trauma surgery.
Dinopoulos, Haralampos T H; Giannoudis, Peter V
Demineralised bone matrix (DBM) acts as an osteoconductive, and possibly as an osteoinductive, material. It is widely used in orthopaedic, neurosurgical, plastic and dental areas. More than 500,000 bone grafting procedures with DBM are performed annually in the US. It does not offer structural support, but it is well suited for filling bone defects and cavities. The osteoinductive nature of DBM is presumably attributed to the presence of matrix-associated bone morphogenetic proteins (BMPs) and growth factors, which are made available to the host environment by the demineralisation process. Clinical results have not been uniformly favourable; however, a variable clinical response is attributed partly to nonuniform processing methods found among numerous bone banks and commercial suppliers. DBMs remain reasonably safe and effective products. The ultimate safe bone-graft substitute, one that is osteoconductive, osteoinductive, osteogenic and mechanically strong, remains elusive. PMID:17044811
Use of general purpose mechanical computer assisted engineering software in orthopaedic surgical planning: advantages and limitations.
Sutherland, C J; Bresina, S J; Gayou, D E
Two surgical plans were developed for an appropriately complex reconstructive orthopaedic surgery case. One plan was developed with customary methods using two-dimensional (2D) radiographs. The second plan was developed with general purpose mechanical computer assisted engineering (MCAE) software using x-ray computed tomography (CT) data. The limitations of each method are identified. To create a surgical plan using three-dimensional (3D) medical datasets and MCAE software, five necessary steps were identified: (a) data reduction; (b) contour extraction; (c) 3D model creation; (d) extraction of mass properties; (e) model idealization. The principal limitation of general purpose MCAE software is the lack of pre-processing modules with which to address the unique requirements of medical image datasets. PMID:7850738
Antibiotic-Impregnated Bone Grafts in Orthopaedic and Trauma Surgery: A Systematic Review of the Literature
Anagnostakos, Konstantinos; Schröder, Katrin
There exist several options for local antibiotic therapy in orthopaedic and trauma surgery. Over the past years, the use of antibiotic-impregnated bone grafts (AIBGs) has become a popular procedure in the treatment of bone and joint infections. A major advantage of AIBGs involves the possibility of impregnation of various antibiotics depending on the sensitivity profile of the causative organism, whereas an additional surgery with removal of the antibiotic carrier is not necessary, as in the use of antibiotic-loaded bone cement. However, generalized conclusions cannot be clearly drawn from the existing literature due to differences of bone used, impregnation method, antibiotics, their doses, laboratory circumstances, or clinical indications. The present work reviews the literature regarding this topic and sheds some light onto the choice of bone and antibiotics, manufacturing details, and clinical experience. PMID:22899933
Toward the Development of Virtual Surgical Tools to Aid Orthopaedic FE Analyses
NASA Astrophysics Data System (ADS)
Tadepalli, Srinivas C.; Shivanna, Kiran H.; Magnotta, Vincent A.; Kallemeyn, Nicole A.; Grosland, Nicole M.
Computational models of joint anatomy and function provide a means for biomechanists, physicians, and physical therapists to understand the effects of repetitive motion, acute injury, and degenerative diseases. Finite element models, for example, may be used to predict the outcome of a surgical intervention or to improve the design of prosthetic implants. Countless models have been developed over the years to address a myriad of orthopaedic procedures. Unfortunately, few studies have incorporated patient-specific models. Historically, baseline anatomic models have been used due to the demands associated with model development. Moreover, surgical simulations impose additional modeling challenges. Current meshing practices do not readily accommodate the inclusion of implants. Our goal is to develop a suite of tools (virtual instruments and guides) which enable surgical procedures to be readily simulated and to facilitate the development of all-hexahedral finite element mesh definitions.
Diagnostic classification and orthopaedic physical therapy practice: what we can learn from medicine.
Zimny, Nancy J
Concepts of diagnosis and classification have a long history in medicine, while formal schemes of diagnostic classification in physical therapy are relatively new. Basic differences exist between medicine and physical therapy in the phenomena which are diagnosed and classified. However, similarities in the diagnostic and classification process provide an opportunity to learn from medicine as the process now evolves in physical therapy. This paper provides a brief history of the development of the concept of diagnostic classification in medicine and physical therapy. Difficulties associated with the process are described. Knowledge of these difficulties is used to analyze some of the evolving concepts of diagnostic classification in physical therapy, especially those related to orthopaedic physical therapy practice. PMID:15089023
Proactive patient rounding to increase customer service and satisfaction on an orthopaedic unit.
Tea, Christine; Ellison, Michael; Feghali, Fadia
Customer service and patient satisfaction have become increasingly important in the healthcare industry. Given limited resources and a myriad of choices, on which facets of patient satisfaction should healthcare providers focus? An analysis of 40,000 observations across 4 hospitals found 1 important intervention: timely staff responsiveness. Using the Plan-Do-Check-Act (PDCA) quality methodology, the goal was set to improve staff responsiveness to orthopaedic patient needs and requests, thus improving patient satisfaction. A model to improve staff responsiveness was systematically developed and implemented. The I Care Rounding model places the emphasis on proactively meeting patient needs through hourly rounding, rather than caregivers providing care in a reactionary mode. After full implementation, positive improvement was demonstrated. PMID:18677250
Next Generation Orthopaedic Implants by Additive Manufacturing Using Electron Beam Melting
Murr, Lawrence E.; Gaytan, Sara M.; Martinez, Edwin; Medina, Frank; Wicker, Ryan B.
This paper presents some examples of knee and hip implant components containing porous structures and fabricated in monolithic forms utilizing electron beam melting (EBM). In addition, utilizing stiffness or relative stiffness versus relative density design plots for open-cellular structures (mesh and foam components) of Ti-6Al-4V and Co-29Cr-6Mo alloy fabricated by EBM, it is demonstrated that stiffness-compatible implants can be fabricated for optimal stress shielding for bone regimes as well as bone cell ingrowth. Implications for the fabrication of patient-specific, monolithic, multifunctional orthopaedic implants using EBM are described along with microstructures and mechanical properties characteristic of both Ti-6Al-4V and Co-29Cr-6Mo alloy prototypes, including both solid and open-cellular prototypes manufactured by additive manufacturing (AM) using EBM. PMID:22956957
Retrospective study of the risk factors and prevalence of colic in horses after orthopaedic surgery.
Senior, J M; Pinchbeck, G L; Dugdale, A H A; Clegg, P D
The records of 496 orthopaedic operations on 428 horses were reviewed to estimate the prevalence of, and identify the risk factors for, the development of colic in horses after surgery. Colic was defined as any recognised sign of abdominal pain that could not be attributed to a concurrent disease. Fourteen of the horses developed colic; eight of them were undiagnosed, three were classified as impactions, one as tympanic colic of the colon, one as incarceration of the small intestine in the epiploic foramen, and one as left dorsal displacement of the colon in the nephrosplenic space. Morphine was associated with a four-fold increased risk of colic compared with the use of no opioid or butorphanol, and out-of-hours surgery was also associated with an increased risk. PMID:15470967
Toward the development of virtual surgical tools to aid orthopaedic FE analyses
Tadepalli, Srinivas C.; Shivanna, Kiran H.; Magnotta, Vincent A.; Kallemeyn, Nicole A.; Grosland, Nicole M.
Computational models of joint anatomy and function provide a means for biomechanists, physicians, and physical therapists to understand the effects of repetitive motion, acute injury, and degenerative diseases. Finite element models, for example, may be used to predict the outcome of a surgical intervention or to improve the design of prosthetic implants. Countless models have been developed over the years to address a myriad of orthopaedic procedures. Unfortunately, few studies have incorporated patient-specific models. Historically, baseline anatomic models have been used due to the demands associated with model development. Moreover, surgical simulations impose additional modeling challenges. Current meshing practices do not readily accommodate the inclusion of implants. Our goal is to develop a suite of tools (virtual instruments and guides) which enable surgical procedures to be readily simulated and to facilitate the development of all-hexahedral finite element mesh definitions. PMID:20376204
[Sense and content of care pathways in orthopaedic and trauma surgery].
Quint, U; Greiling, M
The aim of the study was to find the best possible methodology to evaluate the perioperative processes in the main diagnosis-related groups in an orthopaedic and trauma centre. A model in five phases was followed to develop the care pathways. Optimization potentials were derived from estimated problems and their origin. Cases of missing objectives led to re-organization and the necessary quality in treatment could be prepared as a new work flow management. The cost-effectiveness of treatment procedures and the costs of processes conditionally led to a change in management. The advantages of the study were increased knowledge of the processes involved in diagnosis and therapy with regard to the evoked costs. So the limited budget became more calculable. PMID:20644909
Comparative Readability of Shoulder and Elbow Patient Education Materials within Orthopaedic Websites.
Beutel, Bryan G; Danna, Natalie R; Melamed, Eitan; Capo, John T
There is growing concern that the readability of online orthopaedic patient education materials are too difficult for the general public to fully understand. It is recommended that this information be at the sixth grade reading level or lower. This study compared the readability of shoulder and elbow education articles from the American Academy of Orthopaedic Surgeons (AAOS) and American Society for Surgery of the Hand (ASSH) websites. Seventy-six patient education articles from the AAOS and ASSH concerning shoulder and elbow disorders were evaluated. Each article was assessed for the number of years since its last update, word count, percentage of passive sentences, Flesch Reading Ease score, Flesch-Kincaid grade level, Simple Measure of Gobbledygook (SMOG) grade, and New Dale-Chall grade level. Only one article was at or below the sixth grade reading level. The AAOS and ASSH articles had the following respective scores: a mean Flesch Reading Ease score of 54.3 and 51.8, Flesch-Kincaid grade level of 9.4 and 10.3, SMOG grade of 8.5 and 9.4, and New Dale-Chall grade of 10.4 and 11.0. Articles from the AAOS were longer (p < 0.001), had a lower percentage of passive sentences (p < 0.001), and were more recently updated (p = 0.02) than their ASSH counterparts. Higher percentages of passive sentences were found to correlate with more difficult readability. Patient education materials regarding the shoulder and elbow on the AAOS and ASSH websites have readability scores above the recommended reading level. These may be too challenging for the majority of patients to read and consequently serve as a barrier to proper patient education. Reducing the percentage of passive sentences may serve as a novel target for improving readability. PMID:26630468
Rapid prototyping for patient-specific surgical orthopaedics guides: A systematic literature review.
Popescu, Diana; Laptoiu, Dan
There has been a lot of hype surrounding the advantages to be gained from rapid prototyping processes in a number of fields, including medicine. Our literature review aims objectively to assess how effective patient-specific surgical guides manufactured using rapid prototyping are in a number of orthopaedic surgical applications. To this end, we carried out a systematic review to identify and analyse clinical and experimental literature studies in which rapid prototyping patient-specific surgical guides are used, focusing especially on those that entail quantifiable outcomes and, at the same time, providing details on the guides' design and type of manufacturing process. Here, it should be mentioned that in this field there are not yet medium- or long-term data, and no information on revisions. In the reviewed studies, the reported positive opinions on the use of rapid prototyping patient-specific surgical guides relate to the following main advantages: reduction in operating times, low costs and improvements in the accuracy of surgical interventions thanks to guides' personalisation. However, disadvantages and sources of errors which can cause patient-specific surgical guide failures are as well discussed by authors. Stereolithography is the main rapid prototyping process employed in these applications although fused deposition modelling or selective laser sintering processes can also satisfy the requirements of these applications in terms of material properties, manufacturing accuracy and construction time. Another of our findings was that individualised drill guides for spinal surgery are currently the favourite candidates for manufacture using rapid prototyping. Other emerging applications relate to complex orthopaedic surgery of the extremities: the forearm and foot. Several procedures such as osteotomies for radius malunions or tarsal coalition could become standard, thanks to the significant assistance provided by rapid prototyping patient-specific surgical
An audit of consent for allograft use in elective orthopaedic surgery.
Mullan, C J; Pagoti, R; Davison, H; McAlinden, M G
Introduction Patients receiving musculoskeletal allografts may be at risk of postoperative infection. The General Medical Council guidelines on consent highlight the importance of providing patients with the information they want or need on any proposed investigation or treatment, including any potential adverse outcomes. With the increased cost of defending medicolegal claims, it is paramount that adequate, clear informed patient consent be documented. Methods We retrospectively examined the patterns of informed consent for allograft bone use during elective orthopaedic procedures in a large unit with an onsite bone bank. The initial audit included patients operated over the course of 1 year. Following a feedback session, a re-audit was performed to identify improvements in practice. Results The case mix of both studies was very similar. Revision hip arthroplasty surgery constituted the major subgroup requiring allograft (48%), followed by foot and ankle surgery (16.3%) and revision knee arthroplasty surgery (11.4%) .On the initial audit, 17/45 cases (38%) had either adequate preoperative documentation of the outpatient discussion or an appropriately completed consent form on the planned use of allograft. On the re-audit, 44/78 cases (56%) had adequate pre-operative documentation. There was little correlation between how frequently a surgeon used allograft and the adequacy of consent (Correlation coefficient -0.12). Conclusions Although the risk of disease transmission with allograft may be variable, informed consent for allograft should be a routine part of preoperative discussions in elective orthopaedic surgery. Regular audit and feedback sessions may further improve consent documentation, alongside the targeting of high volume/low compliance surgeons. PMID:26924483
The link between texting and motor vehicle collision frequency in the orthopaedic trauma population
Issar, Neil M.; Kadakia, Rishin J.; Tsahakis, James M.; Yoneda, Zachary T.; Sethi, Manish K.; Mir, Hassan R.; Archer, Kristin; Obremskey, William T.; Jahangir, Amir A.
Abstract: Background: This study will evaluate whether or not texting frequency while driving and/or texting frequency in general are associated with an increased risk of incurring a motor vehicle collision (MVC) resulting in orthopaedic trauma injuries. Methods: All patients who presented to the Vanderbilt University Medical Center Orthopaedic Trauma Clinic were administered a questionnaire to determine background information, mean phone use, texting frequency, texting frequency while driving, and whether or not the injury was the result of an MVC in which the patient was driving. Results: 237 questionnaires were collected. 60 were excluded due to incomplete date, leaving 57 questionnaires in the MVC group and 120 from patients with non-MVC injuries. Patients who sent more than 30 texts per week ("heavy texters") were 2.22 times more likely to be involved in an MVC than those who texted less frequently. 84% of respondents claimed to never text while driving. Dividing the sample into subsets on the basis of age (25 years of age or below considered "young adult," and above 25 years of age considered "adult"),young, heavy texters were 6.76 times more likely to be involved in an MVC than adult non-heavy texters (p = 0.000). Similarly, young adult, non-heavy texters were 6.65 (p = 0.005) times more likely to be involved in an MVC, and adult, heavy texters were 1.72 (p = 0.186) times more likely to be involved in an MVC. Conclusions: Patients injured in an MVC sent more text messages per week than non-MVC patients. Additionally, controlling for age demonstrated that young age and heavy general texting frequency combined had the highest increase in MVC risk, with the former being the variable of greatest effect. PMID:23416747
Class II functional orthopaedic treatment: a systematic review of systematic reviews.
D'Antò, V; Bucci, R; Franchi, L; Rongo, R; Michelotti, A; Martina, R
This Systematic Review (SR) aims to assess the quality of SRs and Meta-Analyses (MAs) on functional orthopaedic treatment of Class II malocclusion and to summarise and rate the reported effects. Electronic and manual searches were conducted until June 2014. SRs and MAs focusing on the effects of functional orthopaedic treatment of Class II malocclusion in growing patients were included. The methodological quality of the included papers was assessed using the AMSTAR (Assessment of Multiple Systematic Reviews). The design of the primary studies included in each SR was assessed with Level of Research Design scoring. The evidence of the main outcomes was summarised and rated according to a scale of statements. 14 SRs fulfilled the inclusion criteria. The appliances evaluated were as follows: Activator (2 studies), Twin Block (4 studies), headgear (3 studies), Herbst (2 studies), Jasper Jumper (1 study), Bionator (1 study) and Fränkel-2 (1 study). Four studies reviewed several functional appliances, as a group. The mean AMSTAR score was 6 (ranged 2-10). Six SRs included only controlled clinical trials (CCTs), three SRs included only randomised controlled trials (RCTs), four SRs included both CCTs and RCTs and one SR included also expert opinions. There was some evidence of reduction of the overjet, with different appliances except from headgear; there was some evidence of small maxillary growth restrain with Twin Block and headgear; there was some evidence of elongation of mandibular length, but the clinical relevance of this results is still questionable; there was insufficient evidence to determine an effect on soft tissues. PMID:25824331
Computational simulations of stress shielding and bone resorption around existing and computer-designed orthopaedic screws.
Gefen, A
Failure of an orthopaedic fixation due to stress shielding and consequent screw loosening is a major concern among surgeons: the loosened screws could not only interfere with the healing process but also endanger adjacent anatomical structures. In this study, the effect of the screw's engineering design (dimensions, profile shape and material properties) on the load sharing with adjacent bone and consequent bone resorption was tested, using a set of two-dimensional computational (finite element) models. An algorithm simulating local bone adaptation to strain energy density (SED) mechanical stimuli was developed and used to evaluate the biomechanical performances of different commercial screws. Two new designs, a 'graded-stiffness' composite screw, with a reduced-stiffness titanium core and outer polymeric threads, and an active-compression hollow screw that generates compressive stresses on the surrounding bone, were also evaluated. A dimensionless set of stress transfer parameters (STPs) were utilised for ranking the performances of the different screws according to the expected screw-bone load sharing and its evolution with adaptation of the surrounding tissue. The results indicated that commercial wide (6 mm thread diameter) trapezoidal and rectangular screw profiles have superior biomechanical compatibility with bone (i.e. predicted to be stable after 2 years). The graded-stiffness and active-compression screws provided the best biomechanical performances: bone loading around them was predicted to decrease by no more than 15% after 3 years, compared with a decrease of 55-70% in bone loading around commercially available screws. Computer simulations of bone adaptation around orthopaedic screws are demonstrated to be effective means for objective and quantitative evaluation of the biomechanical aspects of implant-tissue compatibility. PMID:12195978
High strength, surface porous polyether-ether-ketone for load-bearing orthopaedic implants
Evans, Nathan T.; Torstrick, F. Brennan; Lee, Christopher S.D.; Dupont, Kenneth M.; Safranski, David L.; Chang, W. Allen; Macedo, Annie E.; Lin, Angela; Boothby, Jennifer M.; Whittingslow, Daniel C.; Carson, Robert A.; Guldberg, Robert E.; Gall, Ken
Despite its widespread clinical use in load-bearing orthopaedic implants, polyether-ether-ketone (PEEK) is often associated with poor osseointegration. In this study, a surface porous PEEK material (PEEK-SP) was created using a melt extrusion technique. The porous layer thickness was 399.6±63.3 µm and possessed a mean pore size of 279.9±31.6 µm, strut spacing of 186.8±55.5 µm, porosity of 67.3±3.1%, and interconnectivity of 99.9±0.1%. Monotonic tensile tests showed that PEEK-SP preserved 73.9% of the strength (71.06±2.17 MPa) and 73.4% of the elastic modulus (2.45±0.31 GPa) of as-received, injection molded PEEK. PEEK-SP further demonstrated a fatigue strength of 60.0 MPa at one million cycles, preserving 73.4% of the fatigue resistance of injection molded PEEK. Interfacial shear testing showed the pore layer shear strength to be 23.96±2.26 MPa. An osseointegration model in the rat revealed substantial bone formation within the pore layer at 6 and 12 weeks via µCT and histological evaluation. Ingrown bone was more closely apposed to the pore wall and fibrous tissue growth was reduced in PEEK-SP when compared to non-porous PEEK controls. These results indicate that PEEK-SP could provide improved osseointegration while maintaining the structural integrity necessary for load-bearing orthopaedic applications. PMID:25463499
Nondestructive evaluation of orthopaedic implant stability in THA using highly nonlinear solitary waves
NASA Astrophysics Data System (ADS)
Yang, Jinkyu; Silvestro, Claudio; Sangiorgio, Sophia N.; Borkowski, Sean L.; Ebramzadeh, Edward; De Nardo, Luigi; Daraio, Chiara
We propose a new biomedical sensing technique based on highly nonlinear solitary waves to assess orthopaedic implant stability in a nondestructive and efficient manner. We assemble a granular crystal actuator consisting of a one-dimensional tightly packed array of spherical particles, to generate acoustic solitary waves. Via direct contact with the specimen, we inject acoustic solitary waves into a biomedical prosthesis, and we nondestructively evaluate the mechanical integrity of the bone-prosthesis interface, studying the properties of the waves reflected from the contact zone between the granular crystal and the implant. The granular crystal contains a piezoelectric sensor to measure the travelling solitary waves, which allows it to function also as a sensor. We perform a feasibility study using total hip arthroplasty (THA) samples made of metallic stems implanted in artificial composite femurs using polymethylmethacrylate for fixation. We first evaluate the sensitivity of the proposed granular crystal sensor to various levels of prosthesis insertion into the composite femur. Then, we impose a sequence of harsh mechanical loading on the THA samples to degrade the mechanical integrity at the stem-cement interfaces, using a femoral load simulator that simulates aggressive, accelerated physiological loading. We investigate the implant stability via the granular crystal sensor-actuator during testing. Preliminary results suggest that the reflected waves respond sensitively to the degree of implant fixation. In particular, the granular crystal sensor-actuator successfully detects implant loosening at the stem-cement interface following violent cyclic loading. This study suggests that the granular crystal sensor and actuator has the potential to detect metal-cement defects in a nondestructive manner for orthopaedic applications.
Ionising Radiation Exposure to Orthopaedic Trainees: The Effect of Sub-Specialty Training
Oddy, MJ; Aldam, CH
INTRODUCTION We monitored image intensifier use by orthopaedic trainees to assess their exposure to ionising radiation and to investigate the influence of sub-specialty training. MATERIALS AND METHODS Five different orthopaedic registrars recorded their monthly image intensifier screening times and exposure doses for all cases (trauma and elective), for a combined total of 12 non-consecutive months. Radiation exposure was monitored using shoulder and waist film badges worn both by surgeons and radiographers screening their cases. RESULTS Registrars in spinal sub-specialties were exposed to significantly higher doses per case and cumulative doses per month than non-spinal trainees (P < 0.05), but significantly lower screening times per case (P < 0.05). There were no significant differences in cumulative screening times per month (P > 0.05). Regression analysis for all surgeons showed a significant relationship between shoulder film badge reading and cumulative dose exposed per month (P < 0.05), but not for cumulative screening time. Shoulder film badge recordings were significantly higher for spinal compared with non-spinal registrars (P < 0.05), although all badges were below the level for radiation reporting. Only one radiographer badge recorded a dose above threshold. CONCLUSIONS Whilst the long-term effects of sub-reporting doses of radiation are not fully understood, we consider that this study demonstrates that trainees should not be complacent in accepting inadequate radiation protection. The higher doses encountered with spinal imaging means that sub-specialty trainees should be alerted to the risk of their increased exposure. The principle of minimising radiation exposure must be maintained by all trainees at all times. PMID:16720002
The Champions League - Improving the quality of in-patient antibiotic prescription in Trauma and Orthopaedics
Evans, Jonathan; Saxby, Clair; Armstrong, Alexander
A Trust level audit demonstrated that the trauma and orthopaedic department did not reach its own standards in adhering to Trust antibiotic prescribing guidelines. Junior doctors are the main prescribers of antibiotics during inpatient stays. Local policy states that for all inpatients on antibiotics, the start date, duration, and indication for antibiotics must be documented on the drug card. Each patient drug card was reviewed by the department pharmacist and it was recorded whether the documentation was in line with Trust policy. A monthly league table, coined 'The Champions League', was created. It was published monthly and displayed in the doctors' office and other clinical areas to highlight which doctors had or had not adhered to the prescribing guidelines. In August 2012 the monthly audit for the trauma and orthopaedic department included 74 patients. The total number of antibiotic courses prescribed was 28; of these courses only 15 (53.5%) had an indication documented and 15 (53.5%) had a review/stop date documented. In December 2012, after two published league tables, 61 patients were reviewed. A total of 19 antibiotic courses were prescribed; 18 (94.7%) had the indication documented and 16 (84.2%) had the review/stop date documented. The standards of prescribing improved within the department and good prescribing practice became ingrained into each doctor's practice. The league table proved to be a novel tool that helped to raise the profile of antibiotic prescribing and change doctor prescribing habits. It created a competitive spirit within the department which improved morale. Doctors responded positively to feedback if they were not achieving the desirable standards, and enjoyed the challenge of improving the standard of prescribing. PMID:26734266
Nichols, R.P.
A wellhead assembly is described for supporting equipment in a well, comprising: a suspension nut having a threaded outer surface; a wellhead member having an inner threaded surface adapted to mesh with the threaded outer surface of the suspension nut; the suspension nut having a projection extending axially from its threaded outer surface and having an inner surface adapted to support equipment in the well; at least a portion of the inner surface for supporting the equipment facing both inwardly and upwardly such that force exerted by the weight of the equipment against the inner surface is transformed at least in part to a radially outwardly directed force; the projecting having an outer surface sized such that the outer surface is spaced from an inner surface of the wellhead member in the absence of force exerted against the inner surface of the projection such that the projection is deflected outwardly by the force exerted by the weight of the equipment against the inner surface.
[Medical Equipment Maintenance Methods].
Liu, Hongbin
Due to the high technology and the complexity of medical equipment, as well as to the safety and effectiveness, it determines the high requirements of the medical equipment maintenance work. This paper introduces some basic methods of medical instrument maintenance, including fault tree analysis, node method and exclusive method which are the three important methods in the medical equipment maintenance, through using these three methods for the instruments that have circuit drawings, hardware breakdown maintenance can be done easily. And this paper introduces the processing methods of some special fault conditions, in order to reduce little detours in meeting the same problems. Learning is very important for stuff just engaged in this area. PMID:26904890
Not Available
The German mining equipment industry developed to supply machines and services to the local mining industry, i.e., coal, lignite, salt, potash, ore mining, industrial minerals, and quarrying. The sophistication and reliability of its technology also won it worldwide export markets -- which is just as well since former major domestic mining sectors such as coal and potash have declined precipitously, and others such as ore mining have all but disappeared. Today, German mining equipment suppliers focus strongly on export sales, and formerly unique German mining technologies such as continuous mining with bucket wheel excavators and conveyors for open pits, or plowing of underground coal longwalls are widely used abroad. The status of the German mining equipment industry is reviewed.
Ellis, T H; Streight, D; Mellion, M B
It is important for the physician to understand bicycle safety equipment in order to prevent and treat bicycle-related injuries effectively. The physician should understand (1) the basic design and function of bicycles, (2) the relationship of improper bicycle fit to injuries, (3) the potential of the various forms of serious riding and racing for injury, and (4) bicycle safety equipment and the standards involved in its fit, manufacture, and care. A decision to use bicycle safety equipment is a decision to control the risk of injury. Physicians should accept a share of the responsibility for decreasing bicycling-related injuries, because they are viewed by the public as credible sources of information regarding the prevention of accidents and injuries. PMID:8111858
Equipment Operational Requirements
Greenwalt, B; Henderer, B; Hibbard, W; Mercer, M
The Iraq Department of Border Enforcement is rich in personnel, but poor in equipment. An effective border control system must include detection, discrimination, decision, tracking and interdiction, capture, identification, and disposition. An equipment solution that addresses only a part of this will not succeed, likewise equipment by itself is not the answer without considering the personnel and how they would employ the equipment. The solution should take advantage of the existing in-place system and address all of the critical functions. The solutions are envisioned as being implemented in a phased manner, where Solution 1 is followed by Solution 2 and eventually by Solution 3. This allows adequate time for training and gaining operational experience for successively more complex equipment. Detailed descriptions of the components follow the solution descriptions. Solution 1 - This solution is based on changes to CONOPs, and does not have a technology component. It consists of observers at the forts and annexes, forward patrols along the swamp edge, in depth patrols approximately 10 kilometers inland from the swamp, and checkpoints on major roads. Solution 2 - This solution adds a ground sensor array to the Solution 1 system. Solution 3 - This solution is based around installing a radar/video camera system on each fort. It employs the CONOPS from Solution 1, but uses minimal ground sensors deployed only in areas with poor radar/video camera coverage (such as canals and streams shielded by vegetation), or by roads covered by radar but outside the range of the radar associated cameras. This document provides broad operational requirements for major equipment components along with sufficient operational details to allow the technical community to identify potential hardware candidates. Continuing analysis will develop quantities required and more detailed tactics, techniques, and procedures.
NASA Astrophysics Data System (ADS)
Crepin, Pierre-Jean; Leblay, Pierrick; Haller, Regine; Tremillon, Isabelle; Sonon, Jean-Pierre
The design of this equipment based on the use of nineteen 500 mW laser diodes is presented. The Beacon is a powerful and collimated optical source based upon semi-conductor lasers. This equipment is implemented in the SILEX GEO2 terminal and its function is to provide a continuous wave light beam towards the LEO or GEO1 satellites during the acquisition phases. The design was experimentally validated with a functional breadboard, and test results demonstrated the feasibility of every performance required by the SILEX system.
NASA Technical Reports Server (NTRS)
The NASA Equipment Management Manual (NHB 4200.1) is issued pursuant to Section 203(c)(1) of the National Aeronautics and Space Act of 1958, as amended (42 USC 2473), and sets forth policy, uniform performance standards, and procedural guidance to NASA personnel for the acquisition, management, and use of NASA-owned equipment. This revision is effective upon receipt. This is a controlled manual, issued in loose-leaf form, and revised through page changes. Additional copies for internal use may be obtained through normal distribution.
Adaptive Equipment from Boxes.
ERIC Educational Resources Information Center
Blanche, Erna, O'Brian, Maryann
The article presents four readily accessible inexpensive equipment designs to promote effective remedial body positioning for children with neuromotor or developmental delays. Assembly instructions are offered for the side lyer, the side sitter, the lab board, and the floor table. (CL)
NASA Technical Reports Server (NTRS)
Jones, C. E.
Final results of the Spaceflight Tracking and Data Network (STDN) Ranging Equipment program are summarized. Basic design concepts and final design approaches are described. Theoretical analyses which define requirements and support the design approaches are presented. Design verification criteria are delineated and verification test results are specified.
Lennox - Student Training Equipment.
ERIC Educational Resources Information Center
Lennox Industries, Inc., Marshalltown, IA.
Presents a series of demonstration units designed by Lennox Industries for the purpose of training students to become familiar with Lennox mechanical equipment. Demonstrators are designed to present technical information in a clear simplified manner thus reducing frustration for the beginning trainee. The following demonstrators are available--(1)…
ERIC Educational Resources Information Center
Marine Corps Inst., Washington, DC.
This student guide, one of a series of correspondence training courses designed to improve the job performance of members of the Marine Corps, deals with the skills needed by engineer equipment operators. Addressed in the seven individual units of the course are the following topics: introduction to Military Occupation Specialty (MOS) 1345…
ERIC Educational Resources Information Center
Marine Corps Inst., Washington, DC.
This student guide, one of a series of correspondence training courses designed to improve the job performance of members of the Marine Corps, deals with the skills needed by engineer equipment chiefs. Addressed in the five individual units of the course are the following topics: construction management (planning, scheduling, and supervision);…
ERIC Educational Resources Information Center
Poitras, Adrian W., Ed.
Presents information about equipment and new products such as the melting point instrument and TV-microscope coupler which are helpful in college science teaching. Descriptions of each product, how it operates, its prices, and address for ordering are presented. (HM)
NASA Technical Reports Server (NTRS)
Lake To Lake Dairy Cooperative, Manitowoc, Wisconsin, operates four plants in Wisconsin for processing milk, butter and cheese products from its 1,300 member farms. The large co-op was able to realize substantial savings by using NASA information for improved efficiency in plant maintenance. Under contract to Marshall Space Flight Center, Midwest Research Institute compiled a handbook consolidating information about commercially available lubricants. The handbook details chemical and physical properties, applications, specifications, test procedures and test data for liquid and solid lubricants. Lake To Lake's plant engineer used the handbook to effect savings in maintenance labor and materials costs by reducing the number of lubricants used on certain equipment. Strict U.S. Department of Agriculture and Food and Drug Administration regulations preclude lubrication changes n production equipment, but the co-op's maintenance chief was able to eliminate seven types of lubricants for ancillary equipment, such as compressors and high pressure pumps. Handbook data enabled him to select comparable but les expensive lubricants in the materials consolidation process, and simplified lubrication schedules and procedures. The handbook is in continuing use as a reference source when a new item of equipment is purchased.
Basic Engineer Equipment Mechanic.
ERIC Educational Resources Information Center
Marine Corps Inst., Washington, DC.
This student guide, one of a series of correspondence training courses designed to improve the job performance of members of the Marine Corps, deals with the skills needed by basic engineer equipment mechanics. Addressed in the four individual units of the course are the following topics: mechanics and their tools (mechanics, hand tools, and power…
ERIC Educational Resources Information Center
Gibbs, John C.; Potter, Granville Bud; DiBiase, Ann-Marie; Devlin, Renee
Youth who present anti-social behavior need powerful interventions that strengthen empathy, counter negative peer influence, and challenge thinking errors. This article recaps some key points about EQUIP, a Positive Peer Culture (PPC)-based cognitive behavioral intervention program for behaviorally at-risk youth, and notes how the program has…
A pilot study of orthopaedic resident self-assessment using a milestones' survey just prior to milestones implementation
Bradley, Kendall E.
Objectives To pilot test if Orthopaedic Surgery residents could self-assess their performance using newly created milestones, as defined by the Accreditation Council on Graduate Medical Education. Methods In June 2012, an email was sent to Program Directors and administrative coordinators of the154 accredited Orthopaedic Surgery Programs, asking them to send their residents a link to an online survey. The survey was adapted from the Orthopaedic Surgery Milestone Project. Completed surveys were aggregated in an anonymous, confidential database. SAS 9.3 was used to perform the analyses. Results Responses from 71 residents were analyzed. First and second year residents indicated through self-assessment that they had substantially achieved Level 1 and Level 2 milestones. Third year residents reported they had substantially achieved 30/41, and fourth year residents, all Level 3 milestones. Fifth year, graduating residents, reported they had substantially achieved 17 Level 4 milestones, and were extremely close on another 15. No milestone was rated at Level 5, the maximum possible. Earlier in training, Patient Care and Medical Knowledge milestones were rated lower than the milestones reflecting the other four competencies of Practice Based Learning and Improvement, Systems Based Practice, Professionalism, and Interpersonal Communication. The gap was closed by the fourth year. Conclusions Residents were able to successfully self-assess using the 41 Orthopaedic Surgery milestones. Respondents' rate improved proficiency over time. Graduating residents report they have substantially, or close to substantially, achieved all Level 4 milestones. Milestone self-assessment may be a useful tool as one component of a program's overall performance assessment strategy. PMID:26752012
Orthopaedic Surgery Under National Health Reform: An Analysis of Power, Process, Adaptation, and Leadership: AOA Critical Issues.
Callahan, Charles D; Adair, Daniel; Bozic, Kevin J; Manning, Blaine T; Saleh, Jamal K; Saleh, Khaled J
Morrison argued that demography, economy, and technology drive the evolution of industries from a formative first-generation state ("First Curve") to a radically different way of doing things ("Second Curve") that is marked by new skills, strategies, and partners. The current health-reform movement in the United States reflects these three key evolutionary trends: surging medical needs of an aging population, dramatic expansion of Medicare spending, and care delivery systems optimized through powerful information technology. Successful transition from a formative first-generation state (First Curve) to a radically different way of doing things (Second Curve) will require new skills, strategies, and partners. In a new world that is value-driven, community-centric (versus hospital-centric), and prevention-focused, orthopaedic surgeons and health-care administrators must form new alliances to reduce the cost of care and improve durable outcomes for musculoskeletal problems. The greatest barrier to success in the Second Curve stems not from lack of empirical support for integrated models of care, but rather from resistance by those who would execute them. Porter's five forces of competitive strategy and the behavioral analysis of change provide insights into the predictable forms of resistance that undermine clinical and economic success in the new environment of care. This paper analyzes the components that will differentiate orthopaedic care provision for the Second Curve. It also provides recommendations for future-focused orthopaedic surgery and health-care administrative leaders to consider as they design newly adaptive, mutually reinforcing, and economically viable musculoskeletal care processes that drive the level of orthopaedic care that our nation deserves-at a cost that it can afford. PMID:24990985
Mortality as an indicator of patient safety in orthopaedics: lessons from qualitative analysis of a database of medical errors
Background Orthopaedic surgery is a high-risk specialty in which errors will undoubtedly occur. Patient safety incidents can yield valuable information to generate solutions and prevent future cases of avoidable harm. The aim of this study was to understand the causative factors leading to all unnecessary deaths in orthopaedics and trauma surgery reported to the National Patient Safety Agency (NPSA) over a four-year period (2005–2009), using a qualitative approach. Methods Reports made to the NPSA are categorised and stored in the database as free-text data. A search was undertaken to identify the cases of all-cause mortality in orthopaedic and trauma surgery, and the free-text elements were used for thematic analysis. Descriptive statistics were calculated based on the incidents reported. This included presenting the number of times categories of incidents had the same or similar response. Superordinate and subordinate categories were created. Results A total of 257 incident reports were analysed. Four main thematic categories emerged. These were: (1) stages of the surgical journey – 118/191 (62%) of deaths occurred in the post-operative phase; (2) causes of patient deaths – 32% were related to severe infections; (3) reported quality of medical interventions – 65% of patients experienced minimal or delayed treatment; (4) skills of healthcare professionals – 44% of deaths had a failure in non-technical skills. Conclusions Most complications in orthopaedic surgery can be dealt with adequately, provided they are anticipated and that risk-reduction strategies are instituted. Surgeons take pride in the precision of operative techniques; perhaps it is time to enshrine the multimodal tools available to ensure safer patient care. PMID:22682470
Comparing sutures versus staples for skin closure after orthopaedic surgery: systematic review and meta-analysis
Krishnan, Rohin; MacNeil, S Danielle; Malvankar-Mehta, Monali S
Objective To determine whether there still remains a significant advantage in the use of sutures to staples for orthopaedic skin closure in adult patients. Design Systematic Review/ Meta-Analysis. Data sources MEDLINE-OVID, EMBASE-OVID, CINAHL and Cochrane Library. Grey and unpublished literature was also explored by searching: International Clinical Trial Registry, Grey Matters BIOSIS Previews, Networked Digital Library of Theses and Dissertations, ClinicalTrials.gov, UK Clinical Trials Gateway, UK Clinical Research Network Study Portfolio, Open Grey, Grey Literature Report, and Web of Science. Selection criteria Articles were from any country, written in English and published after 1950. We included all randomised control trials and observational studies comparing adults (≥18 years) undergoing orthopaedic surgery who either received staples or sutures for skin closure. The primary outcome was the incidence of surgical site infection. Secondary outcomes included closure time, inflammation, length of stay, pain, abscess formation, necrosis, discharge, wound dehiscence, allergic reaction and health-related quality of life. Results 13 studies were included in our cumulative meta-analysis conducted using Review Manager V.5.0. The risk ratio was computed as a measure of the treatment effect taking into account heterogeneity. Random-effect models were applied. There was no significant difference in infection comparing sutures to staples. The cumulative relative risk was 1.06 (0.46 to 2.44). In addition, there was no difference in infection comparing sutures to staples in hip and knee surgery, respectively. Lastly, except for closure time, there was no significant difference in secondary outcomes comparing sutures to staples. Conclusions Except for closure time, there was no significant difference in superficial infection and secondary outcomes comparing sutures to staples was found. Given that there may in fact be no difference in effect between the two skin closure
Managing design excellence tools during the development of new orthopaedic implants.
Défossez, Henri J P; Serhan, Hassan
Design excellence (DEX) tools have been widely used for years in some industries for their potential to facilitate new product development. The medical sector, targeted by cost pressures, has therefore started adopting them. Numerous tools are available; however only appropriate deployment during the new product development stages can optimize the overall process. The primary study objectives were to describe generic tools and illustrate their implementation and management during the development of new orthopaedic implants, and compile a reference package. Secondary objectives were to present the DEX tool investment costs and savings, since the method can require significant resources for which companies must carefully plan. The publicly available DEX method "Define Measure Analyze Design Verify Validate" was adopted and implemented during the development of a new spinal implant. Several tools proved most successful at developing the correct product, addressing clinical needs, and increasing market penetration potential, while reducing design iterations and manufacturing validations. Cost analysis and Pugh Matrix coupled with multi generation planning enabled developing a strong rationale to activate the project, set the vision and goals. improved risk management and product map established a robust technical verification-validation program. Design of experiments and process quantification facilitated design for manufacturing of critical features, as early as the concept phase. Biomechanical testing with analysis of variance provided a validation model with a recognized statistical performance baseline. Within those tools, only certain ones required minimum resources (i.e., business case, multi generational plan, project value proposition, Pugh Matrix, critical To quality process validation techniques), while others required significant investments (i.e., voice of customer, product usage map, improved risk management, design of experiments, biomechanical testing
Peripheral orthopaedic surgery down-regulates hippocampal brain-derived neurotrophic factor and impairs remote memory in mouse.
Fidalgo, A R; Cibelli, M; White, J P M; Nagy, I; Noormohamed, F; Benzonana, L; Maze, M; Ma, D
Peripheral orthopaedic surgery induces a profound inflammatory response. This includes a substantial increase in cytokines and, especially, in the level of interleukin (IL)-1β in the hippocampus, which has been shown to impair hippocampal-dependent memory in mice. We have employed two tests of contextual remote memory to demonstrate that the inflammatory response to surgical insult in mice also results in impairment of remote memory associated with prefrontal cortex (PFC). We have also found that, under the conditions presented in the social interaction test, peripheral orthopaedic surgery does not increase anxiety-like behaviour in our animal model. Although such surgery induces an increase in the level of IL-1β in the hippocampus, it fails to do so in the PFC. Peripheral orthopaedic surgery also results in a reduction in the level of hippocampal brain-derived neurotrophic factor (BDNF) and this may contribute, in part, to the memory impairment found after such surgery. Our data suggest that a reduction in the level of hippocampal BDNF and an increase in the level of hippocampal IL-1β following surgery may affect the transference of fear memory in the mouse brain. PMID:21699962
Arthroscopic verification of objectivity of the orthopaedic examination and magnetic resonance imaging in intra-articular knee injury. Retrospective study
Skowronek, Michał; Skowronek, Paweł; Dutka, Łukasz
Introduction Arthroscopy of the knee joint is regarded as the most objective diagnostic method in intra-articular knee joint lesions. Aim The purpose of this study was to assess the objectivity and diagnostic value of orthopaedic examination (OE) and magnetic resonance imaging (MRI) in reference to the arthroscopic result. Material and methods In a group of 113 patients treated by arthroscopic surgery for post-traumatic knee pathology between 2008 and 2010 in our department, accuracy of clinical and MRI findings that preceded surgery were studied retrospectively using a statistical method. Sensitivity, specificity, accuracy and predictive negative and positive values were the subject of analysis. Results In the presented trial, sensitivity values of the orthopaedic examination for injuries of the anterior cruciate ligament (ACL), meniscus medialis (MM), meniscus lateralis (ML) and chondral injuries (ChI) were 86%, 65%, 38% and 51%, respectively. Specificity values were 90%, 65%, 100% and 100%, respectively. The MR sensitivity and specificity values were 80%, 88%, 44% and 32%, and 86%, 64%, 93% and 97%, respectively. Conclusions Assessment of intra-articular knee joint lesions is a difficult diagnostic problem. In making a decision about arthroscopy of the knee joint, an appropriate sequence of examinations should be carried out: OE, MRI and arthroscopy. The improvement in the effectiveness of the orthopaedic examination and MRI can limit the too high frequency of diagnostic arthroscopies, which generates the risk of operation treatment and costs. PMID:23255995
Maintaining gas cooling equipment
Rector, J.D.
An often overlooked key to satisfactory operation and longevity of any mechanical device is proper operation and maintenance in accordance with the manufacturer`s written instructions. Absorption chillers, although they use a different technology than the more familiar vapor compression cycle to produce chilled water, operate successfully in a variety of applications if operated and maintained properly. Maintenance procedures may be more frequent than those required for vapor compression chillers, but they are also typically less complex. The goal of this article is to describe the basic operation of an absorption chiller to provide an understanding of the relatively simple tasks required to keep the machine operating at maximum efficiency for its design life and beyond. A good starting point is definitions. Gas cooling equipment is generally defined as alternative energy, non-electric cooling products. This includes absorption chillers, engine-drive chillers and packaged desiccant units, among others. Natural gas combustion drives the equipment.
Orbiter based construction equipment
NASA Technical Reports Server (NTRS)
Goodwin, C. J.
Many orbiter based activities need equipment to hold a payload steady while it is being worked on. This work may be construction, updating, repair, services, check out, or refueling operations in preparation for return to Earth. The Handling and Positioning Aid (HPA) is intended for use as general purpose equipment. The HPA provides a wide choice of work station positions, both immediately above the orbiter cargo bay and beyond. It can act in a primary docking role and, if required, can assist actively in the berthing process. From an analysis of ten reference missions, it was determined that two types of HPA mobility are needed; a tilt table, which simply swings out of the cargo bay, pivoting about an athwartships y axis, and an articulated arm. Illustration of the aid are provided.
Cerami, V.J.
The purpose of this article is to define how the selection of HVAC equipment and layout impact the achievable noise criteria (NC) levels in occupied spaces. It will focus on the design of HVAC systems that employ floor-by-floor air handling/air conditioning units and their acoustical ramifications. This is of increasing importance since tenants require incorporation of noise limits in lease agreements.
NASA Astrophysics Data System (ADS)
Tennessee Eastman uses NASTRAN to minimize lost production by pinpointing the causes of equipment failures and preventing recurrences. An example of the program's utility involves a large centrifugal fan which developed cracks during start-ups and shutdowns. This information prompted redesign of the fan. Tennessee Eastman has made extensive use of NASTRAN, both as failure analysis tool and as an aid in redesigning production hardware.
Secure authenticated video equipment
Doren, N.E.
In the verification technology arena, there is a pressing need for surveillance and monitoring equipment that produces authentic, verifiable records of observed activities. Such a record provides the inspecting party with confidence that observed activities occurred as recorded, without undetected tampering or spoofing having taken place. The secure authenticated video equipment (SAVE) system provides an authenticated series of video images of an observed activity. Being self-contained and portable, it can be installed as a stand-alone surveillance system or used in conjunction with existing monitoring equipment in a non-invasive manner. Security is provided by a tamper-proof camera enclosure containing a private, electronic authentication key. Video data is transferred communication link consisting of a coaxial cable, fiber-optic link or other similar media. A video review station, located remotely from the camera, receives, validates, displays and stores the incoming data. Video data is validated within the review station using a public key, a copy of which is held by authorized panics. This scheme allows the holder of the public key to verify the authenticity of the recorded video data but precludes undetectable modification of the data generated by the tamper-protected private authentication key.
George Huntington: the man behind the eponym.
Durbach, N; Hayden, M R
George Huntington first encountered patients with the disease subsequently given his name at the age of 8 while accompanying his father and grandfather on their medical rounds. In 1872, in his twenty-first year, he described this disease so accurately and succinctly that the disease was later named after him. We have explored, through contact with previously unpublished family records and documents, the personal factors which helped George Huntington to make this observation and also investigated why this remains his sole contribution to medical research. We show by documenting his precise examinations of nature that he had profound powers of observation. Furthermore his decision not to pursue medical research was based on a commitment to patient care and a belief that he could make a greater contribution through the practice of primary care medicine rather than the pursuit of research. Images PMID:8320704
George Huntington: the man behind the eponym.
Durbach, N; Hayden, M R
George Huntington first encountered patients with the disease subsequently given his name at the age of 8 while accompanying his father and grandfather on their medical rounds. In 1872, in his twenty-first year, he described this disease so accurately and succinctly that the disease was later named after him. We have explored, through contact with previously unpublished family records and documents, the personal factors which helped George Huntington to make this observation and also investigated why this remains his sole contribution to medical research. We show by documenting his precise examinations of nature that he had profound powers of observation. Furthermore his decision not to pursue medical research was based on a commitment to patient care and a belief that he could make a greater contribution through the practice of primary care medicine rather than the pursuit of research. PMID:8320704
Recognizing conflict of interest in orthopaedic surgery: a survey across medical education levels.
Montero-Lopez, Nicole M; Khan, Mani; Niggam, Shikka; Zuckerman, Joseph D; Egol, Kenneth A
The relationship between pharmaceutical and biomedical technology companies (industry) and medical practitioners has been a topic of discussion and concern for several decades. The large monetary payments and extravagant gifts to physicians from these companies have been regulated and largely stopped; however, there still exists an active rapport between physicians and industry. Little formal instruction is given to medical students and residents on what constitutes a conflict of interest when entering these business partnerships. In this study, we presented a set of scenarios depicting industry-physician interactions to medical students, orthopaedic surgery residents, and attending physicians and asked them to decide whether a conflict of interest is depicted. Our goal was to determine whether a disparity exists in the ability to identify conflicts of interest across the levels of training. Of 200 potential participants, 70 provided responses to the survey (35%). Thirty-five (50%) were attending physicians, 18 (25.7%) residents, 12 (17.1%) medical students, and 8 (11.4%) declined to provide level of training. There was no significant difference in the ability to identify a conflict of interest across seniority level for the 13 questions. Our results suggest that both medical students and resident physicians are able to identify which interactions with industry pose a possible conflict of interest as accurately as attending physicians can. PMID:25986351
The Basics of the Sunshine Act: How It Pertains to the Practicing Orthopaedic Surgeon.
Parisi, Thomas J; Ferre, Isabella M; Rubash, Harry E
The Physician Payments Sunshine Act is a disclosure law requiring all drug, medical device, and biologics companies to report transfers of value to physicians and teaching hospitals. It was passed into law in 2010 as part of the Affordable Care Act. The first set of data was released via an online public database on September 30, 2014, with subsequent annual reports to come. Three categories of payments are recorded: general payments, ownership interests, and research payments. With few exceptions, any transfer of value greater than $10 is reported. The first dataset of 4.4 million payments totaling more than $3.5 billion was released amidst controversy and technical problems. Identified data constituted $1.3 billion in transfer payments; de-identified data constituted $2.2 billion in payments. Data regarding an additional $1.1 billion in payments were not published, in part because of unresolved disputes. The largest amount of funding went to research payments. The highest proportion of general payments went to licensing and royalty payments. Orthopaedic surgeons comprised 3.5% of the physicians represented, and they were responsible for more than 20% of total payments. The full impact of the Sunshine Act will not be clear until several years after its implementation. PMID:26209143
Polypropylene fumarate/phloroglucinol triglycidyl methacrylate blend for use as partially biodegradable orthopaedic cement.
Jayabalan, M; Thomas, V; Rajesh, P N
Polypropylene fumarate/phloroglucinol triglycidyl methacrylate oligomeric blend-based bone cement was studied. Higher the percentage of phloroglucinol triglycidyl methacrylate, lesser the setting time. An optimum setting time could be arrived with 50:50 blend composition of the two oligomers. Composite cement of 50:50 blend prepared with hydroxyapatite granules of particle size 125 microm binds bovine rib bones. The tensile strength of this adhesive bond was found to be 1.11 kPa. The thermal studies suggest the onset of cross-linking reaction in the cured blend if the blend is heated. The absence of softening endotherm in the cured blend shows the thermosetting-like amorphous nature of blend system, which may restrict the changes in creep properties. The in vitro biodegradation studies reveal possible association of calcium ions with negatively charged units of degrading polymer chain resulting in slow down of degradation. Relatively slow degradation was observed in Ringer's solution. The study reveals the potential use of polypropylene fumarate/phloroglucinol triglycidyl methacrylate as partially degradable polymeric cement for orthopaedic applications. PMID:11545309
Virtual interactive musculoskeletal system (VIMS) in orthopaedic research, education and clinical patient care
Chao, Edmund YS; Armiger, Robert S; Yoshida, Hiroaki; Lim, Jonathan; Haraguchi, Naoki
The ability to combine physiology and engineering analyses with computer sciences has opened the door to the possibility of creating the "Virtual Human" reality. This paper presents a broad foundation for a full-featured biomechanical simulator for the human musculoskeletal system physiology. This simulation technology unites the expertise in biomechanical analysis and graphic modeling to investigate joint and connective tissue mechanics at the structural level and to visualize the results in both static and animated forms together with the model. Adaptable anatomical models including prosthetic implants and fracture fixation devices and a robust computational infrastructure for static, kinematic, kinetic, and stress analyses under varying boundary and loading conditions are incorporated on a common platform, the VIMS (Virtual Interactive Musculoskeletal System). Within this software system, a manageable database containing long bone dimensions, connective tissue material properties and a library of skeletal joint system functional activities and loading conditions are also available and they can easily be modified, updated and expanded. Application software is also available to allow end-users to perform biomechanical analyses interactively. Examples using these models and the computational algorithms in a virtual laboratory environment are used to demonstrate the utility of these unique database and simulation technology. This integrated system, model library and database will impact on orthopaedic education, basic research, device development and application, and clinical patient care related to musculoskeletal joint system reconstruction, trauma management, and rehabilitation. PMID:17343764
Technical evaluation of a CAD system for orthopaedic shoe-upper design.
Lord, M; Foulston, J; Smith, P J
Computer aided design is now employed routinely in the volume shoe trade. New styles are developed on a three-dimensional image of the last followed by automated pattern generation and engineering. It is suggested that such systems could be useful in the orthopaedic footwear industry although the different requirements for these bespoke products need careful consideration. A clinical trial has been conducted on the Shoemaster (Clarks Shoes) upper design system both to assess its technical capabilities and to consider its role in improvement of service and cosmetic appearance. This particular system works throughout on a three-dimensional representation of the shoe last, which offers particular advantages for integration with shape capture and reproduction. The report concentrates on the technical evaluation to assess (a) its ability to work with unusual last shapes dictated by medical requirements and (b) its potential for integration into a complete computer system for design of both shoe lasts and shoe uppers. The trial indicates that this particular system is promising in both respects. PMID:1840716
Engineered protein coatings to improve the osseointegration of dental and orthopaedic implants.
Raphel, Jordan; Karlsson, Johan; Galli, Silvia; Wennerberg, Ann; Lindsay, Christopher; Haugh, Matthew G; Pajarinen, Jukka; Goodman, Stuart B; Jimbo, Ryo; Andersson, Martin; Heilshorn, Sarah C
Here we present the design of an engineered, elastin-like protein (ELP) that is chemically modified to enable stable coatings on the surfaces of titanium-based dental and orthopaedic implants by novel photocrosslinking and solution processing steps. The ELP includes an extended RGD sequence to confer bio-signaling and an elastin-like sequence for mechanical stability. ELP thin films were fabricated on cp-Ti and Ti6Al4V surfaces using scalable spin and dip coating processes with photoactive covalent crosslinking through a carbene insertion mechanism. The coatings withstood procedures mimicking dental screw and hip replacement stem implantations, a key metric for clinical translation. They promoted rapid adhesion of MG63 osteoblast-like cells, with over 80% adhesion after 24 h, compared to 38% adhesion on uncoated Ti6Al4V. MG63 cells produced significantly more mineralization on ELP coatings compared to uncoated Ti6Al4V. Human bone marrow mesenchymal stem cells (hMSCs) had an earlier increase in alkaline phosphatase activity, indicating more rapid osteogenic differentiation and mineral deposition on adhesive ELP coatings. Rat tibia and femur in vivo studies demonstrated that cell-adhesive ELP-coated implants increased bone-implant contact area and interfacial strength after one week. These results suggest that ELP coatings withstand surgical implantation and promote rapid osseointegration, enabling earlier implant loading and potentially preventing micromotion that leads to aseptic loosening and premature implant failure. PMID:26790146
The effect of strain hardening on resistance to electrochemical corrosion of wires for orthopaedics
NASA Astrophysics Data System (ADS)
Przondziono, J.; Walke, W.; Hadasik, E.; Szymszal, J.
The purpose of this research is to evaluate electrochemical corrosion resistance of wire with modified surface, made of stainless steel of Cr-Ni-Mo type, widely used in implants for orthopaedics, depending on hardening created in the process of drawing. Tests have been carried out in the environment imitating human osseous tissue. Pitting corrosion was determined on the ground of registered anodic polarisation curves by means of potentiodynamic method with application of electrochemical testing system VoltaLab® PGP 201. Wire corrosion tests were carried out in Tyrode solution on samples that were electrochemically polished as well as electrochemically polished and finally chemically passivated. Initial material for tests was wire rod made of X2CrNiMo17-12-2 steel with diameter of 5.5 mm in supersaturated condition. Wire rod was drawn up to diameter of 1.35 mm. This work shows the course of flow curve of wire made of this grade of steel and mathematical form of yield stress function. The study also presents exemplary curves showing the dependence of polarisation resistance in strain function in the drawing process of electrochemically passivated and electrochemically polished and then chemically passivated wire.
Gastric dysmotility following orthopaedic scoliosis surgery in patients with cerebral palsy: a case series.
Vande Velde, S; Van Biervliet, S; De Bruyne, R; Van Renterghem, K; Plasschaert, F; Van Winckel, M
Scoliosis is a common complication in children with cerebral palsy (CP). In these patients, surgical correction carries a high risk of complications. CP is also associated with gastrointestinal dysmotility such as delayed gastric emptying and gastro-oesophageal reflux. We describe 5 patients with CP in whom symptoms of gastric dysmotility clearly exacerbated after orthopaedic scoliosis surgery. They all showed persisting vomiting, nausea, bloating, weight loss, and anorexia necessitating total parental nutrition and/or jejunal feeding. This intensified nutritional support resulted in weight gain. Symptoms, however, persisted in half of the patients. The aetiology of these gastro-intestinal motility problems following scoliosis surgery remains unclear. Mechanical obstruction needs to be ruled out. Delayed gastric emptying may be due to postprandial antral hypomotility as a consequence of sympathic stimulation. Malnutrition could further aggravate gastrointestinal dysmotility. This complication should be taken into account when surgery for spinal deformities in CP patients is planned, especially in patients with pre-existing gastrointestinal motility problems. PMID:21086223
Stem Cell-Derived Exosomes: A Potential Alternative Therapeutic Agent in Orthopaedics
Burke, John; Kolhe, Ravindra; Hunter, Monte; Isales, Carlos; Hamrick, Mark; Fulzele, Sadanand
Within the field of regenerative medicine, many have sought to use stem cells as a promising way to heal human tissue; however, in the past few years, exosomes (packaged vesicles released from cells) have shown more exciting promise. Specifically, stem cell-derived exosomes have demonstrated great ability to provide therapeutical benefits. Exosomal products can include miRNA, other genetic products, proteins, and various factors. They are released from cells in a paracrine fashion in order to combat local cellular stress. Because of this, there are vast benefits that medicine can obtain from stem cell-derived exosomes. If exosomes could be extracted from stem cells in an efficient manner and packaged with particular regenerative products, then diseases such as rheumatoid arthritis, osteoarthritis, bone fractures, and other maladies could be treated with cell-free regenerative medicine via exosomes. Many advances must be made to get to this point, and the following review highlights the current advances of stem cell-derived exosomes with particular attention to regenerative medicine in orthopaedics. PMID:26904130
Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care
Morton, A.; Anderson, G.; Van Der Meer, R. B.; Rymaszewski, L. A.
Objectives "Virtual fracture clinics" have been reported as a safe and effective alternative to the traditional fracture clinic. Robust protocols are used to identify cases that do not require further review, with the remainder triaged to the most appropriate subspecialist at the optimum time for review. The objective of this study was to perform a "top-down" analysis of the cost effectiveness of this virtual fracture clinic pathway. Methods National Health Service financial returns relating to our institution were examined for the time period 2009 to 2014 which spanned the service redesign. Results The total staffing costs rose by 4% over the time period (from £1 744 933 to £1 811 301) compared with a national increase of 16%. The total outpatient department rate of attendance fell by 15% compared with a national fall of 5%. Had our local costs increased in line with the national average, an excess expenditure of £212 705 would have been required for staffing costs. Conclusions The virtual fracture clinic system was associated with less overall use of staff resources in comparison to national cost data. Adoption of this system nationally may have the potential to achieve significant cost savings. Cite this article: P. J. Jenkins. Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care. Bone Joint Res 2016;5:33–36. DOI: 10.1302/2046-3758.52.2000506 PMID:26851287
Influence of bone morphological properties on a new expandable orthopaedic fastener
NASA Astrophysics Data System (ADS)
Oldakowski, M.; Oldakowska, I.; Kirk, T. B.; Ford, C. T.; Sercombe, T. B.; Hardcastle, P.; Day, R. E.
Previous studies have demonstrated that bone morphological properties are a significant determinant of orthopaedic fastener fixation strength. The authors previously tested a new design of unthreaded expandable fastener (UEF) prototype against screws and demonstrated a significant increase in pull-out strength. However the effect of bone morphology on the pull-out strength of the UEF and expandable fasteners in general is unknown. This study assessed the correlation between failure force and maximum force against five microstructural parameters. The failure force of the UEF was correlated to the trabecular bone volume fraction, as with screws. Unlike screws, however, the maximum force of the UEF has an inverse relationship with cortical volume. No correlation was found between failure force and the Structural Model Index (SMI). Additionally the critical volume of interest (VOI) for the UEF is around the bottom of the fastener where the expansion occurs, whereas for the screw a full height VOI is critical. Furthermore, we observed that screw mechanical performance may be affected more by bone morphological parameters that are associated with poorer quality bone. Therefore the UEF may perform better than screws in low quality osteoporotic bone.
Stem Cell-Derived Exosomes: A Potential Alternative Therapeutic Agent in Orthopaedics.
Burke, John; Kolhe, Ravindra; Hunter, Monte; Isales, Carlos; Hamrick, Mark; Fulzele, Sadanand
Within the field of regenerative medicine, many have sought to use stem cells as a promising way to heal human tissue; however, in the past few years, exosomes (packaged vesicles released from cells) have shown more exciting promise. Specifically, stem cell-derived exosomes have demonstrated great ability to provide therapeutical benefits. Exosomal products can include miRNA, other genetic products, proteins, and various factors. They are released from cells in a paracrine fashion in order to combat local cellular stress. Because of this, there are vast benefits that medicine can obtain from stem cell-derived exosomes. If exosomes could be extracted from stem cells in an efficient manner and packaged with particular regenerative products, then diseases such as rheumatoid arthritis, osteoarthritis, bone fractures, and other maladies could be treated with cell-free regenerative medicine via exosomes. Many advances must be made to get to this point, and the following review highlights the current advances of stem cell-derived exosomes with particular attention to regenerative medicine in orthopaedics. PMID:26904130
Orthochina.org: case-based orthopaedic Wiki project in China.
Ma, Zhen-Sheng; Zhang, Hong-Ju; Yu, Tao; Ren, Gang; Du, Guo-Sheng; Wang, Yong-Hua
Traditional continuing medical education (CME) depended primarily on periodic courses and conferences. The cost-effectiveness of these courses has not been established, and often the content is not tailored to best meet the needs of the students. Internet training has the potential to accomplish these goals. Over the last 10 years, we have developed a Web site entitled "Orthochina.org," based upon the wiki concept, which uses an interactive, case-based format. We describe the development of online case discussions, and various technical and administrative requirements. As of December 31, 2007, there were 33,984 registered users, 9,759 of which passed the confirmation procedures. In 2007, an average of 211 registrants visited daily. The average number of first page clicks was 4,248 per day, and the average number of posts was 70 per day. All cases submitted for discussion include the patient's complaint, physical examination findings, and relevant images based on specific criteria for case discussion. The case discussions develop well professionally. No spam posting or unauthorized personal advertisement is permitted. In conclusion, online academic discussions proceed well when the orthopaedic surgeons who participate have established their identities. PMID:18685911
[Recommendations for documentation of incidents with medical devices in orthopaedic surgery].
Kluess, D; Bader, R; Zenk, K; Mittelmeier, W
The growing number of revisions in orthopaedic surgery as well as the multifactorial reasons for implant failure give cause for taking a closer look at the clinical documentation of adverse events. Based on our long-term experience it is our goal to present recommendations for an adequate documentation and filing. In the framework of the introduction of a quality management system (ISO 9001:2008) in our hospital, a process was developed for reportable incidents with medical devices regulating adequate documentation. Therefore, specific forms were developed. The retrievals are stored for subsequent damage analyses and are available for possible legal claims and tracking. A file should be opened for each reportable incident containing information about the event, a copy of the obligatory BfArM report, surgery report, medical device labels, radiographs and photographs. Declarations of agreement as well as handover certificates should be maintained in order to keep record of the retrievals. In order to assure consistent documentation, we recommend use of specific forms as presented in this paper. Identification of risk factors for implant failure and a long-term reduction of damage cases will only be possible under consequent incident reporting and responsible documentation of adverse events. Processing of cases of damage is accelerated and simplified by the presented recommendations and forms. Together with the newly established joint replacement registry, a higher quality of patient treatment and implant safety should be obtained. PMID:23296561
Properties of open-cell porous metals and alloys for orthopaedic applications.
Lewis, Gladius
One shortcoming of metals and alloys used to fabricate various components of orthopaedic systems, such as the femoral stem of a total hip joint replacement and the tibial plate of a total knee joint replacement, is well-recognized. This is that the material modulus of elasticity (E') is substantially larger than that of the contiguous cancellous bone, a consequence of which is stress shielding which, in turn, has been postulated to be implicated in a cascade of events that culminates in the principal life-limiting phenomenon of these systems, namely, aseptic loosening. Thus, over the years, a host of research programs have focused on the synthesis of metallic biomaterials whose E' can be tailored to match that of cancellous bone. The present work is a review of the extant large volume of literature on these materials, which are called open-cell porous metals/alloys (or, sometimes, metal foams or cellular materials). As such, its range is wide, covering myriad aspects such as production methods, characterization studies, in vitro evaluations, and in vivo performance. The review also includes discussion of seven areas for future research, such as parametric studies of the influence of an assortment of process variables (such as the space holder material and the laser power in the space holder method and the laser-engineered net-shaping process, respectively) on various properties (notably, permeability, fatigue strength, and corrosion resistance) of a given porous metal/alloy, innovative methods of determining fatigue strength, and modeling of corrosion behavior. PMID:23851927
Current status of presurgical infant orthopaedic treatment for cleft lip and palate patients: A critical review
Niranjane, P. Priyanka; Kamble, R. H.; Diagavane, S. Pallavi; Shrivastav, S. Sunita; Batra, Puneet; Vasudevan, S. D.; Patil, Pushkar
Rehabilitation of cleft lip and palate (CLP) patients is a challenge for all the concerned members of the cleft team, and various treatment modalities have been attempted to obtain aesthetic results. Presurgical infant orthopaedics (PSIO) was introduced to reshape alveolar and nasal segments prior to surgical repair of cleft lip. However, literature reports lot of controversy regarding the use of PSIO in patients with CLP. Evaluation of long-term results of PSIO can provide scientific evidence on the efficacy and usefulness of PSIO in CLP patients. The aim was to assess the scientific evidence on the efficiency of PSIO appliances in patients with CLP and to critically analyse the current status of PSIO. A PubMed search was performed using the terms PSIO, presurgical nasoalveolar moulding and its long-term results and related articles were selected for the review. The documented studies report no beneficial effect of PSIO on maxillary arch dimensions, facial aesthetics and in the subsequent development of dentition and occlusion in CLP patients. Nasal moulding seems to be more beneficial and effective in unilateral cleft lip and palate patients with better long-term results. PMID:25593413
Perspectives on the policy 'black box': a comparative case study of orthopaedics services in England.
McLeod, Hugh; Millar, Ross; Goodwin, Nick; Powell, Martin
There has been much recent debate on the impact of competition on the English National Health Service (NHS). However, studies have tended to view competition in isolation and are controversial. This study examines the impact of programme theories associated with the health system reforms, which sought to move from a dominant target-led 'central control' programme theory, to one based on 'market forces', on orthopaedics across six case-study local health economies. It draws on a realistic evaluation approach to open up the policy 'black box' across different contexts using a mixed methods approach: analysis of 152 interviews with key informants and analysis of waiting times and admissions. We find that the urban health economies were more successful in reaching the access targets than the rural health economies, although the gap in performance closed over time. Most interviewees were aware of the policies to increase choice and competition, but their role appeared comparatively weak. Local commissioners' ability to influence demand appeared limited with providers' incentives dominating service delivery. Looking forward, it is clear that the role of competition in the NHS has to be considered alongside, rather than in isolation from, other policy mechanisms. PMID:24556091
Topological design and additive manufacturing of porous metals for bone scaffolds and orthopaedic implants: A review.
Wang, Xiaojian; Xu, Shanqing; Zhou, Shiwei; Xu, Wei; Leary, Martin; Choong, Peter; Qian, M; Brandt, Milan; Xie, Yi Min
One of the critical issues in orthopaedic regenerative medicine is the design of bone scaffolds and implants that replicate the biomechanical properties of the host bones. Porous metals have found themselves to be suitable candidates for repairing or replacing the damaged bones since their stiffness and porosity can be adjusted on demands. Another advantage of porous metals lies in their open space for the in-growth of bone tissue, hence accelerating the osseointegration process. The fabrication of porous metals has been extensively explored over decades, however only limited controls over the internal architecture can be achieved by the conventional processes. Recent advances in additive manufacturing have provided unprecedented opportunities for producing complex structures to meet the increasing demands for implants with customized mechanical performance. At the same time, topology optimization techniques have been developed to enable the internal architecture of porous metals to be designed to achieve specified mechanical properties at will. Thus implants designed via the topology optimization approach and produced by additive manufacturing are of great interest. This paper reviews the state-of-the-art of topological design and manufacturing processes of various types of porous metals, in particular for titanium alloys, biodegradable metals and shape memory alloys. This review also identifies the limitations of current techniques and addresses the directions for future investigations. PMID:26773669
Handover in Trauma and Orthopaedic Surgery – A Human Factors Assessment
Agha, Riaz A.
Handovers permeate healthcare delivery systems. They are critical for patient safety and continuity of care, but also for logistics and clinical efficiency. Poor handovers can cause reduced efficiency, delayed discharge or time to operation, and contributes to patient harm. The Objective was to conduct a human factors assessment (HFA) using a systems approach to study the handover process at an Orthopaedic unit, determine barriers to information transfer, and suggest improvements. A direct observation model was used to help provide insights on the evening handover process. A Systems Engineering Initiative for Patient Safety (SEIPS) model was used to provide a framework. A total of ten handover sessions were observed and the junior doctors were interviewed using a semi-structured approach. Participants had two chief centres of complaint: workspace and environmental issues (such as a small, hot, uncomfortable room), and the lack of the junior house officer at handover leading to 'signal loss' with respect to sick patients who may not be handed over fully. The process also lacked standardisation and structure compounding the potential loss of information. Conclusion Good handover remains a cornerstone of safe and effective clinical practice and continuity of care. This study has shown how an HFA can be useful in determining problems with the handover process locally. It suggests an approach for improvement and recommends better training at all levels in this aspect of patient care. PMID:26257904
The role of 99Tcm-HMPAO white cell imaging in suspected orthopaedic infection.
Copping, C; Dalgliesh, S M; Dudley, N J; Griffiths, P A; Harrington, M; Potter, R; Smith, B D
Accurate diagnosis is essential for the effective management of suspected bone infection. Current imaging techniques have had limited success and further work is required. Although white cell labelling techniques have been available for many years the radiopharmaceuticals employed have disadvantages, particularly in their availability and suitability for imaging. These problems have been overcome by the use of 99Tcm-HMPAO as an in vitro leukocyte labelling agent. The aims of this study were to assess retrospectively its role and accuracy in imaging orthopaedic infection and to compare the results with three-phase bone imaging. 30 patients with suspected bone infection underwent three-phase methylene diphosphonate (MDP) bone imaging and labelled leukocyte imaging on separate occasions. 16 bone scans were positive for infection, of which 14 were subsequently confirmed, and there were no false negatives. There were no false positive white cell studies and only one infection was not identified. 99Tcm-HMPAO white cell imaging has been shown to be an accurate technique for the diagnosis of bone infection but should be performed only following a positive finding on three-phase bone scanning, since the latter is highly sensitive but significantly less expensive, making it a more appropriate screening procedure. PMID:1581787
Hemodynamic performance of NMES in the early post operative period following orthopaedic surgery.
Broderick, Barry J; Breathnach, Oisín; Masterson, Eric; Breen, Paul P; ÓLaighin, Gearóid
Patients post total hip arthroplasty (THA) remain at high risk of developing Deep Vein Thrombosis (DVT) during the recovery period following surgery. The use of calf muscle neuromuscular electrical stimulation (NMES) during the hospitalized recovery period on this patient group may be effective at preventing DVT. However, the haemodynamic effectiveness and comfort characteristics of NMES in post-THA patients immediately following surgery has yet to be demonstrated. The popliteal veins of 5 patients, who had undergone unilateral total hip replacement surgery on the day previous to the study, were measured using Doppler ultrasound during a 4 hour calf-muscle NMES session. The effect of calf muscle NMES on peak venous velocity and volume flow were compared to resting values. Comfort was assessed using a 100 mm non-hatched visual analogue scale taken before application of NMES, once NMES was initiated and before NMES was withdrawn. Results of the study showed that NMES produces a beneficial hemodynamic response in patients in the early postoperative period following orthopaedic surgery. This patient group found extended periods of calf-muscle NMES tolerable. PMID:22256105
Do orthopaedic shoes improve local dynamic stability of gait? An observational study in patients with chronic foot and ankle injuries
Background Complex foot and ankle fractures, such as calcaneum fractures or Lisfranc dislocations, are often associated with a poor outcome, especially in terms of gait capacity. Indeed, degenerative changes often lead to chronic pain and chronic functional limitations. Prescription footwear represents an important therapeutic tool during the rehabilitation process. Local Dynamic Stability (LDS) is the ability of locomotor system to maintain continuous walking by accommodating small perturbations that occur naturally during walking. Because it reflects the degree of control over the gait, LDS has been advocated as a relevant indicator for evaluating different conditions and pathologies. The aim of this study was to analyze changes in LDS induced by orthopaedic shoes in patients with persistent foot and ankle injuries. We hypothesised that footwear adaptation might help patients to improve gait control, which could lead to higher LDS: Methods Twenty-five middle-aged inpatients (5 females, 20 males) participated in the study. They were treated for chronic post-traumatic disabilities following ankle and/or foot fractures in a Swiss rehabilitation clinic. During their stay, included inpatients received orthopaedic shoes with custom-made orthoses (insoles). They performed two 30s walking trials with standard shoes and two 30s trials with orthopaedic shoes. A triaxial motion sensor recorded 3D accelerations at the lower back level. LDS was assessed by computing divergence exponents in the acceleration signals (maximal Lyapunov exponents). Pain was evaluated with Visual Analogue Scale (VAS). LDS and pain differences between the trials with standard shoes and the trials with orthopaedic shoes were assessed. Results Orthopaedic shoes significantly improved LDS in the three axes (medio-lateral: 10% relative change, paired t-test p < 0.001; vertical: 9%, p = 0.03; antero-posterior: 7%, p = 0.04). A significant decrease in pain level (VAS score -29%) was observed
Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey
12. VIEW OF REMOTELY OPERATED EQUIPMENT. OPERATORS VIEWED THE EQUIPMENT THROUGH A WATER-FILLED WINDOW. (10/8/81) - Rocky Flats Plant, Plutonium Recovery Facility, Northwest portion of Rocky Flats Plant, Golden, Jefferson County, CO
Getting Equipped and Staying Equipped, Part 2: Finding the Funds.
ERIC Educational Resources Information Center
Jordahl, Gregory; Orwig, Ann
Suggests how school libraries can fund computer equipment; gain assistance from high-tech businesses; develop business partnerships and foundations; lease equipment; accept equipment donations; fund raise; build money into the budget; and communicate school needs with budget voters. Sidebars include leasing advice; resources for parent-teacher…
Highway Maintenance Equipment Operator. Specialized Equipment. Training Materials.
ERIC Educational Resources Information Center
Perky, Sandra Dutreau; And Others
This curriculum guide provides instructional materials to assist in training equipment operators in the safe and effective use of highway maintenance equipment. It includes 18 units of instruction covering the large equipment used in maintenance operations. Each unit of instruction consists of eight basic components: performance objectives,…
Highway Maintenance Equipment Operator. Miscellaneous Equipment. Training Materials.
ERIC Educational Resources Information Center
Perky, Sandra Dutreau; And Others
This curriculum guide provides instructional materials to assist in training equipment operators in the safe and effective use of highway maintenance equipment. It includes six units of instruction covering the small, specialized equipment used in maintenance operations. Each unit of instruction consists of eight basic components: performance…
Precision Instrument and Equipment Repairers.
ERIC Educational Resources Information Center
Wyatt, Ian
Explains the job of precision instrument and equipment repairers, who work on cameras, medical equipment, musical instruments, watches and clocks, and industrial measuring devices. Discusses duties, working conditions, employment and earnings, job outlook, and skills and training. (JOW)
Adapting Equipment for Special Needs.
ERIC Educational Resources Information Center
Tarr, Sue
All students benefit from physical education, but equipment used in mainstream programs often is not appropriate for students with special needs. Equipment adaptation is necessary to improve students' opportunities for successful participation in class. The article describes how to create and finance adapted equipment and offers a resource list.…
ERIC Educational Resources Information Center
Denham, Willard A.S.
Findings of two recent surveys on safety equipment in laboratory facilities are presented. The first survey was a pilot study of emergency shower and eye wash equipment. This study was followed by a more comprehensive random survey of safety equipment in 2,820 labs. Among other findings, the surveys indicate that many plants are underequipped, or…
Decision Analysis for Equipment Selection
ERIC Educational Resources Information Center
Cilliers, J. J.
Equipment selection during process design is a critical aspect of chemical engineering and requires engineering judgment and subjective analysis. When educating chemical engineering students in the selection of proprietary equipment during design, the focus is often on the types of equipment available and their operating characteristics. The…
Guidelines for Purchasing Playground Equipment.
ERIC Educational Resources Information Center
Neugebauer, Roger
Notes that the purchase of playground equipment is one of the most important decisions center directors make. Offers advice from a number of playground equipment manufacturers that suggests directors consider activities, safety, construction, installation, and warranty when purchasing equipment. Also suggests interviewing other directors about…
Characterization equipment essential drawing plan
The purpose of this document is to list the Characterization equipment drawings that are classified as Essential Drawings. Essential Drawings: Are those drawings identified by the facility staff as necessary to directly support the safe operation of the facility or equipment (HNF 1997a). The Characterization equipment drawings identified in this report are deemed essential drawings as defined in HNF-PRO-242, Engineering Drawing Requirements (HNF 1997a). These drawings will be prepared, revised, and maintained per HNF-PRO-440, Engineering Document Change Control (HNF 1997b). All other Characterization equipment drawings not identified in this document will be considered Support drawings until the Characterization Equipment Drawing Evaluation Report is completed.
Occupational Radiation Exposure from C Arm Fluoroscopy During Common Orthopaedic Surgical Procedures and its Prevention
Samuel, Sumant; Saran, Atul K; Mahajan, M K; Mam, M K
Background: Image intensifiers have become popular due to the concept of minimally invasive surgeries leading to decreasing invasiveness, decreased operative time, and less morbidity. The drawback, however, is an increased risk of radiation exposure to surgeon, patient and theatre staff. These exposures have been of concern due to their potential ability to produce biological effects. The present study was embarked upon to analyse the amount of radiation received by orthopedic surgeons in India using standard precautionary measures and also to bring awareness about the use of image intensifier safety in everyday practice. Materials and Methods: Twelve right-handed male orthopedic surgeons (4 senior consultants, 5 junior consultants and 3 residents) were included in a three month prospective study for radiation exposure measurement with adequate protection measures in all procedures requiring C Arm fluoroscopy. Each surgeon was provided with 5 Thermo Luminescent Dosimeter (TLD) badges which were tagged at the level of neck, chest, gonads and both wrists. Operative time and exposure time of each procedure was recorded. Exposure dose of each badge at the end of the study was obtained and the results were analysed. Results: Mean radiation exposure to all the parts were well within permissible limits. There was a significantly positive correlation between the exposure time and the exposure dose for the left wrist (r=0.735, p<0.01) and right wrist (r=0.58, p<0.05). The dominant hand had the maximum exposure overall. Conclusion: Orthopaedic surgeons are not classified radiation workers. The mean exposure doses to all parts of the body were well within permissible limits. Nothing conclusive, however, can be said about the stochastic effects (chance effects like cancers). Any amount of radiation taken is bound to pose an additional occupational hazard. It is thus desirable that radiation safety precautions should be taken and exposures regularly monitored with at least one
Heat-shock-induced cellular responses to temperature elevations occurring during orthopaedic cutting.
Dolan, E B; Haugh, M G; Tallon, D; Casey, C; McNamara, L M
Severe heat-shock to bone cells caused during orthopaedic procedures can result in thermal damage, leading to cell death and initiating bone resorption. By contrast, mild heat-shock has been proposed to induce bone regeneration. In this study, bone cells are exposed to heat-shock for short durations occurring during surgical cutting. Cellular viability, necrosis and apoptosis are investigated immediately after heat-shock and following recovery of 12, 24 h and 4 days, in osteocyte-like MLO-Y4 and osteoblast-like MC3T3-E1 cells, using flow cytometry. The regeneration capacity of heat-shocked Balb/c mesenchymal stem cells (MSCs) and MC3T3-E1s has been investigated following 7 and 14 day's recovery, by quantifying proliferation, differentiation and mineralization. An immediate necrotic response to heat-shock was shown in cells exposed to elevated temperatures (45°C, 47°C and most severe at 60°C). A longer-term apoptotic response is induced in MLO-Y4s and, to a lesser extent, in MC3T3-E1s. Heat-shock-induced differentiation and mineralization by MSCs. These findings indicate that heat-shock is more likely to induce apoptosis in osteocytes than osteoblasts, which might reflect their role as sensors detecting and communicating damage within bone. Furthermore, it is shown for the first time that mild heat-shock (less than equal to 47°C) for durations occurring during surgical cutting can positively enhance osseointegration by osteoprogenitors. PMID:22915633
Readability of Trauma-Related Patient Education Materials From the American Academy of Orthopaedic Surgeons
Eltorai, Adam E. M.; P. Thomas, Nathan; Yang, Heejae; Daniels, Alan H.; Born, Christopher T.
Context: According to the american medical association (AMA) and the national institutes of health (NIH), the recommended readability of patient education materials should be no greater than a sixth-grade reading level. The online patient education information produced by the american academy of orthopaedic surgeons (AAOS) may be too complicated for some patients to understand. This study evaluated whether the AAOS's online trauma-related patient education materials meet recommended readability guidelines for medical information. Evidence Acquisition: Ninety-nine articles from the "Broken Bones and Injuries" section of the AAOS-produced patient education website, orthoinfo.org, were analyzed for grade level readability using the Flesch-Kincaid formula, a widely-used and validated tool to evaluate the text reading level. Results for each webpage were compared to the AMA/NIH recommended sixth-grade reading level and the average reading level of U.S. adults (eighth-grade). Results: The mean (SD) grade level readability for all patient education articles was 8.8 (1.1). All but three of the articles had a readability score above the sixth-grade level. The readability of the articles exceeded this level by an average of 2.8 grade levels (95% confidence interval, 2.6 - 3.0; P < 0.0001). Furthermore, the average readability of the articles exceeded the average reading skill level of U.S. adults (eighth grade) by nearly an entire grade level (95% confidence interval, 0.6-1.0; P < 0.0001). Conclusions: The majority of the trauma-related articles from the AAOS patient education website have readability levels that may make comprehension difficult for a substantial portion of the patient population. PMID:27218045
Importance of patient-centred signage and navigation guide in an orthopaedic and plastics clinic
Maqbool, Talha; Raju, Sneha; In, Eunji
Gulshan & Nanji Orthopaedic and Plastics Center at the North York General Hospital is the second busiest site after the emergency department serving more than 26,000 patients annually. Increase in patient flow, overworked staff, and recent renovations to the hospital have resulted in patients experiencing long wait times, and thusly patient dissatisfaction and stress. Several factors contribute to patient dissatisfaction and stress: i) poor and unfriendly signage; ii) inconsistent utilization of the numbering system; and iii) difficulty navigating to and from the imaging center. A multidisciplinary QI team was assembled to improve the patient experience. We developed a questionnaire to assess patient stress levels at the baseline. Overall, more than half of the patients (54.8%) strongly agreed or agreed to having a stressful waiting experience. Subsequently, based on patient feedback and staff perspectives, we implemented two PDSA cycles. For PDSA 1, we placed a floor graphic (i.e. black tape) to assist patients in navigating from the clinic to the imaging centre and back. For PDSA 2, we involved creating a single 21"×32" patient-friendly sign at the entrance to welcome patients, with clear instructions outlining registration procedures. Surveys were re-administered to assess patient stress levels. A combination of both interventions caused a statistically significant reduction in patient stress levels based on the Kruskal-Wallis and Mann-Whitney U Tests. The present project highlighted the importance of involving stakeholders as well as frontline staff when undertaking quality improvement projects as a way to identify bottlenecks as well as establish sustainable solutions. Additionally, the team recognized the importance of incorporating empirical based solutions and involving experts in the field to optimize results. The present project successfully implemented strategies to improve patient satisfaction and reduce stress in a high flow community clinic
Does Video Gaming Affect Orthopaedic Skills Acquisition? A Prospective Cohort-Study
Khatri, Chetan; Sugand, Kapil; Anjum, Sharika; Vivekanantham, Sayinthen; Akhtar, Kash; Gupte, Chinmay
Introduction Previous studies have suggested that there is a positive correlation between the extent of video gaming and efficiency of surgical skill acquisition on laparoscopic and endovascular surgical simulators amongst trainees. However, the link between video gaming and orthopaedic trauma simulation remains unexamined, in particular dynamic hip screw (DHS) stimulation. Objective To assess effect of prior video gaming experience on virtual-reality (VR) haptic-enabled DHS simulator performance. Methods 38 medical students, naïve to VR surgical simulation, were recruited and stratified relative to their video gaming exposure. Group 1 (n = 19, video-gamers) were defined as those who play more than one hour per day in the last calendar year. Group 2 (n = 19, non-gamers) were defined as those who play video games less than one hour per calendar year. Both cohorts performed five attempts on completing a VR DHS procedure and repeated the task after a week. Metrics assessed included time taken for task, simulated flouroscopy time and screw position. Median and Bonett-Price 95% confidence intervals were calculated for seven real-time objective performance metrics. Data was confirmed as non-parametric by the Kolmogorov-Smirnov test. Analysis was performed using the Mann-Whitney U test for independent data whilst the Wilcoxon signed ranked test was used for paired data. A result was deemed significant when a two-tailed p-value was less than 0.05. Results All 38 subjects completed the study. The groups were not significantly different at baseline. After ten attempts, there was no difference between Group 1 and Group 2 in any of the metrics tested. These included time taken for task, simulated fluoroscopy time, number of retries, tip-apex distance, percentage cut-out and global score. Conclusion Contrary to previous literature findings, there was no correlation between video gaming experience and gaining competency on a VR DHS simulator. PMID:25333959
Education and Indigenous Knowledge in Africa: Traditional Bonesetting and Orthopaedic Medicine in West Africa
NASA Astrophysics Data System (ADS)
Ezeanya, Chika A.
The underlying philosophy of education in contemporary Africa has been established to be alien, and detached from the indigenous knowledge of the people. Modern day formal education in sub-Saharan Africa came about, for the most part, as a result of missionary activities and colonial efforts of Europe. The education bequeathed to Africa was, therefore, fundamentally European in paradigm and lacking in authenticity. The end of colonialism across sub-Saharan Africa did not herald any tangible transformation in the curriculum of study. Education in Africa is still dependent on foreign input for sustainability, thereby stifling research, creativity and innovation. Sustainable development is founded on indigenous knowledge. When such grassroots knowledge assumes the foundation of learning, home-grown development is easily fostered in all sectors of a national economy. In the field of medicine, indigenous knowledge of healing has been considered unscientific by western biomedical practitioners. Since the days of the missionaries, many Africans have considered indigenous medicine to be fetish; the Christian converts would not be associated with its practice and patronage. However, traditional bonesetting has been proven to be highly efficacious with little supernatural content, it continues to attract huge patronage from Africans, cutting across social and religious boundaries. This study attempts an exploration of the disconnect between indigenous knowledge, practices and learning, on the one hand, and formal education in Africa, on the other. With a focus on traditional bonesetting, the study seeks to determine why that branch of indigenous medicine attracts huge patronage, but is granted very little recognition by modern orthopaedic medical education.
Orbital construction support equipment
NASA Technical Reports Server (NTRS)
Approximately 200 separate construction steps were defined for the three solar power satellite (SPS) concepts. Detailed construction scenarios were developed which describe the specific tasks to be accomplished, and identify general equipment requirements. The scenarios were used to perform a functional analysis, which resulted in the definition of 100 distinct SPS elements. These elements are the components, parts, subsystems, or assemblies upon which construction activities take place. The major SPS elements for each configuration are shown. For those elements, 300 functional requirements were identified in seven generic processes. Cumulatively, these processes encompass all functions required during SPS construction/assembly. Individually each process is defined such that it includes a specific type of activity. Each SPS element may involve activities relating to any or all of the generic processes. The processes are listed, and examples of the requirements defined for a typical element are given.
Seismic qualification of unanchored equipment
Moran, T.J.
This paper describes procedures used to design and qualify unanchored equipment to survive Seismic events to the PC = 4 level in a moderate seismic area. The need for flexibility to move experimental equipment together with the requirements for remote handling in a highly-radioactive non-reactor nuclear facility precluded normal equipment anchorage. Instead equipment was designed to remain stable under anticipated DBE floor motions with sufficient margin to achieve the performance goal. The equipment was also designed to accommodate anticipated sliding motions with sufficient. The simplified design criteria used to achieve these goals were based on extensive time-history simulations of sliding, rocking, and overturning of generic equipment models. The entire process was subject to independent peer review and accepted in a Safety Evaluation Report. The process provides a model suitable for adaptation to similar applications and for assessment of the potential for seismic damage of existing, unanchored equipment In particular, the paper describes: (1) Two dimensional sliding studies of deformable equipment subject to 3-D floor excitation as the basis for simplified sliding radius and sliding velocity design criteria. (2) Two dimensional rocking and overturning simulations of rigid equipment used to establish design criteria for minimum base dimensions and equipment rigidity to prevent overturning. (3) Assumed mode rocking analyses of deformable equipment models used to establish uplift magnitudes and subsequent impacts during stable rocking motions. The model used for these dynamic impact studies is reported elsewhere.
Incidence and root causes of cancellations for elective orthopaedic procedures: a single center experience of 17,625 consecutive cases
Background The purpose of the Swedish public health-care system is to provide care on equal terms for all citizens. In this, as in most other systems where taxes and/or insurances pay for most of the care, normal market forces are set aside at least in part. At times, this has, for example, resulted in long waiting lists, particularly in terms of elective orthopaedic surgery, with several negative consequences, such as cancellations of planned surgery. Methods The main purpose of this retrospective observational single center study was to evaluate and describe the number and reasons for cancellations in elective orthopaedic surgery. Studied were all the elective patients scheduled for joint replacement, arthroscopy and foot & ankle surgery, January 1, 2007 to December 31, 2011, whose procedure was cancelled at least once. Results Of all 17,625 patients scheduled for elective surgery 6,911 (39%) received at least one, some several cancellations. The most common reason for cancelling a planned surgery was different patient-related factors 3,293 (33%). Cancellations due to treatment guarantee legislation reached 2,885 (29%) and 1,181 (12%) of the cancellations were related to incomplete pre-operative preparation of the patients. Organisational reasons were the cause of approximately 869 (9%) of the cancellations. Conclusions In this study of patients waiting for elective orthopaedic surgery 6,911(39%) had their surgical procedure cancelled at least once, some several times. It appears that it should be possible to eliminate many of these cancellations, while others are unavoidable or caused by factors outside the responsibility of the individual clinic or even hospital. One possible way of influencing the high rate of cancellations might be to change the view of the patients and involve them in the overall planning of the care process. PMID:24955115
Bacteriophage Mediated Killing of Staphylococcus aureus In Vitro on Orthopaedic K Wires in Presence of Linezolid Prevents Implant Colonization
Kaur, Sandeep; Harjai, Kusum; Chhibber, Sanjay
Background Infections of bone and joint tissues following arthroplasty surgeries remain a major challenge in orthopaedic settings. Methicillin resistant Staphylococcus aureus (MRSA) is recognised as an established pathogen in such infections. Combination therapy using linezolid and bacteriophage impregnated in biopolymer was investigated in the present study as an alternative strategy to prevent MRSA colonisation on the orthopaedic implant surface. Methodology Coating of stainless steel orthopaedic grade K-wires was achieved using hydroxypropylmethlycellulose (HPMC) mixed with phage alone, linezolid alone and phage and linezolid together. The potential of these agents to inhibit adhesion of S.aureus (MRSA) 43300 on K-wires was assessed. Coated and naked wires were analysed by scanning electron microscopy (SEM) and fluorescent staining. Result Significant reduction in bacterial adhesion was achieved on phage/linezolid wires in comparison to naked as well as HPMC coated wires. However, maximum reduction in bacterial adherence (∼4 log cycles) was observed on the wires coated with phage-linezolid combination. The frequency of emergence of resistant mutants was also negligible in presence of both the agents. Conclusion This study provides evidence to confirm that local delivery system employing linezolid (a potent protein synthesis inhibitor) along with a broad spectrum lytic bacteriophage (capable of self-multiplication) is able to attack the adhered as well as surrounding bacteria present near the implant site. Unlike other antibiotic based therapies, this combination has the potential to significantly restrict the emergence of resistant mutants, thus paving the way for effective treatment of MRSA associated infection of medical implants. PMID:24594764
Towards a National Pediatric Musculoskeletal Trauma Outcomes Registry: the Pediatric Orthopaedic Trauma Outcomes Research Group (POTORG) experience.
Vitale, Michael G; Vitale, Mark A; Lehmann, Charles L; Hyman, Joshua E; Roye, David P; Skaggs, David L; Schmitz, Michael L; Sponseller, Paul D; Flynn, John M
This study is a pilot effort towards the broader implementation of a national pediatric musculoskeletal trauma outcomes registry. The primary goal of this project is to explore the feasibility of a web-based data acquisition and management platform and to identify catalysts and obstacles to multi-center collaboration. A prospective cohort of children presenting to the Pediatric Emergency Departments with ankle, femur, supracondylar humerus, tibial spine, or open fractures at five clinical centers between October 2001 and March 2003 comprised the study population. Patients were enrolled via the treating orthopaedic resident, using a web-based data acquisition and management system. Orthopaedic attendees were sent an automated reminder to complete a follow-up form one week after treatment, and parents of enrolled children were sent child and parent health questionnaires by e-mail and mail in order to capture health-related quality of life and post-traumatic stress symptoms. A total of 299 patients were enrolled in the study with an average age of 7.3 years. Post-treatment follow-up questionnaires were completed by 39% of the attending orthopaedic surgeons, and by 43% of the enrolled patients or patient's parents. Children old enough to complete health questionnaires scored lower in 5 of 12 functional domains including Physical Function, Role/Social Emotional/Behavioral, Parental Impact-Emotional, Family Activities, and Family Cohesion. Within the subset of patients sustaining femur fractures whose parents completed health questionnaires, 9.5% reported significant post-traumatic stress symptoms. This study demonstrates the potential of a multi-center web-based registry to facilitate the collection of a rich array of pediatric trauma, treatment and patient-based outcomes data, although new regulatory issues regarding patient privacy pose challenges to such an approach. PMID:16557126
Orthopaedic metals and their potential toxicity in the arthroplasty patient: A review of current knowledge and future strategies.
Keegan, G M; Learmonth, I D; Case, C P
The long-term effects of metal-on-metal arthroplasty are currently under scrutiny because of the potential biological effects of metal wear debris. This review summarises data describing the release, dissemination, uptake, biological activity, and potential toxicity of metal wear debris released from alloys currently used in modern orthopaedics. The introduction of risk assessment for the evaluation of metal alloys and their use in arthroplasty patients is discussed and this should include potential harmful effects on immunity, reproduction, the kidney, developmental toxicity, the nervous system and carcinogenesis. PMID:17540737
Orthopaedic Surgeons as Clinical Leaders in the National Health Service, United Kingdom (NHS UK): Can the World Learn From Us?
Javed, Mustafa; Moulder, Elizabeth; Mohsen, Amr
This article outlines some of the key concepts in leadership (both styles and theories) to provide a platform for further learning and to help the modern day orthopaedic surgeons to apply these concepts to their current practice. It is focused on two major aspects: management of medical organizations and effective twenty-first century care by surgeons through proper leadership guide and aimed in improving patient care outcomes. Practicing proper leadership skills based on evidence resulted in effective management of organization. Thus achieving patient's satisfaction. PMID:26208560
Equipping surgeons as educators.
Fry, Heather
There is a developing interest in equipping surgeons as educators but a perceived lack of knowledge and evidence about how to do this effectively, or how to reward and recognize educational expertise within the surgical career structure. A brief consideration of the surgical educator role is offered. The findings and conclusions of a meta-analysis of the influence of faculty development in medical education are summarized. Various sources are drawn on to present an overview of master's level provision in medical education and a master's in surgical education is outlined. Issues relating to developing suitable curricula, educational accreditation, recognition, reward and career structure are raised and some UK approaches to these areas summarized. Evidence indicates the importance of context in training medical educators, the value of experiential learning, training that is spread over time and training that mixes theory, practice and reflection. A schema for recognizing educational expertise, created as an outcome of analysis of the evidence and current provision, is presented. The effect of a possible change from educational training being voluntary to the introduction of a compulsory regime is raised as an area requiring further discussion and evidence collection. Mechanisms by which to acknowledge, reward and recognize education expertise in surgeons do not generally exist; it is suggested their development would be timely. PMID:19317787
Unattended optical surveillance equipment
NASA Astrophysics Data System (ADS)
Mangan, D. L.; Johnson, C. S.; Schneider, S. L.
In many security situations, it is necessary to utilize unattended optical surveillance systems. Sandia National Laboratories has developed three optical surveillance systems which operate in the unattended surveillance mode. The first of these systems is known as the Modular Integrated Video System (MIVS). The MIVS is a microprocessor controlled video system which records scenes at selectable intervals. Each scene consists of six to ten frames recorded on a 8 mm videotape. A MIVS video recorder has the capacity to record approximately 26,000 scenes. Scenes can be recorded at intervals ranging from 1 to 99 minutes between recordings. The unit has been designed for permanent installation with facility power. The camera can be located up to 30 m from the recording module with the authentication technology protecting the cable connecting the camera to the recording unit. The Portable Surveillance unit (PSU) is a second system which has been designed for unattended operation. The PSU is designed for situations where quick set up of an optical surveillance device is required. The PSU operates in a manner similar to the MIVS and can be operated off of facility power for long time periods, or from an internal battery pack for short term surveillance applications. The Video Surveillance Unit (VSU) provides similar capabilities for permanent rack mounted installations. This paper describes the MIVS, the PSU, and the VSU, and discusses potential applications for the system. Equipment for reviewing the videotapes produced by the systems is also described.
Orbiter electrical equipment utilization baseline
NASA Technical Reports Server (NTRS)
The baseline for utilization of Orbiter electrical equipment in both electrical and Environmental Control and Life Support System (ECLSS) thermal analyses is established. It is a composite catalog of Space Shuttle equipment, as defined in the Shuttle Operational Data Book. The major functions and expected usage of each component type are described. Functional descriptions are designed to provide a fundamental understanding of the Orbiter electrical equipment, to insure correlation of equipment usage within nominal analyses, and to aid analysts in the formulation of off-nominal, contingency analyses.
Information technology equipment cooling system
Schultz, Mark D.
According to one embodiment, a system for removing heat from a rack of information technology equipment may include a sidecar indoor air to liquid heat exchanger that cools warm air generated by the rack of information technology equipment. The system may also include a liquid to liquid heat exchanger and an outdoor heat exchanger. The system may further include configurable pathways to connect and control fluid flow through the sidecar heat exchanger, the liquid to liquid heat exchanger, the rack of information technology equipment, and the outdoor heat exchanger based upon ambient temperature and/or ambient humidity to remove heat from the rack of information technology equipment.
2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth
Background The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS). Methods All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting. Results The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D. Conclusion These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific
Computer-assisted orthopaedic surgery and robotic surgery in total hip arthroplasty.
Sugano, Nobuhiko
Various systems of computer-assisted orthopaedic surgery (CAOS) in total hip arthroplasty (THA) were reviewed. The first clinically applied system was an active robotic system (ROBODOC), which performed femoral implant cavity preparation as programmed preoperatively. Several reports on cementless THA with ROBODOC showed better stem alignment and less variance in limb-length inequality on radiographic evaluation, less incidence of pulmonary embolic events on transesophageal cardioechogram, and less stress shielding on the dual energy X-ray absorptiometry analysis than conventional manual methods. On the other hand, some studies raise issues with active systems, including a steep learning curve, muscle and nerve damage, and technical complications, such as a procedure stop due to a bone motion during cutting, requiring re-registration and registration failure. Semi-active robotic systems, such as Acrobot and Rio, were developed for ease of surgeon acceptance. The drill bit at the tip of the robotic arm is moved by a surgeon's hand, but it does not move outside of a milling path boundary, which is defined according to three-dimensional (3D) image-based preoperative planning. However, there are still few reports on THA with these semi-active systems. Thanks to the advancements in 3D sensor technology, navigation systems were developed. Navigation is a passive system, which does not perform any actions on patients. It only provides information and guidance to the surgeon who still uses conventional tools to perform the surgery. There are three types of navigation: computed tomography (CT)-based navigation, imageless navigation, and fluoro-navigation. CT-based navigation is the most accurate, but the preoperative planning on CT images takes time that increases cost and radiation exposure. Imageless navigation does not use CT images, but its accuracy depends on the technique of landmark pointing, and it does not take into account the individual uniqueness of the anatomy
Computer-Assisted Orthopaedic Surgery and Robotic Surgery in Total Hip Arthroplasty
Various systems of computer-assisted orthopaedic surgery (CAOS) in total hip arthroplasty (THA) were reviewed. The first clinically applied system was an active robotic system (ROBODOC), which performed femoral implant cavity preparation as programmed preoperatively. Several reports on cementless THA with ROBODOC showed better stem alignment and less variance in limb-length inequality on radiographic evaluation, less incidence of pulmonary embolic events on transesophageal cardioechogram, and less stress shielding on the dual energy X-ray absorptiometry analysis than conventional manual methods. On the other hand, some studies raise issues with active systems, including a steep learning curve, muscle and nerve damage, and technical complications, such as a procedure stop due to a bone motion during cutting, requiring re-registration and registration failure. Semi-active robotic systems, such as Acrobot and Rio, were developed for ease of surgeon acceptance. The drill bit at the tip of the robotic arm is moved by a surgeon's hand, but it does not move outside of a milling path boundary, which is defined according to three-dimensional (3D) image-based preoperative planning. However, there are still few reports on THA with these semi-active systems. Thanks to the advancements in 3D sensor technology, navigation systems were developed. Navigation is a passive system, which does not perform any actions on patients. It only provides information and guidance to the surgeon who still uses conventional tools to perform the surgery. There are three types of navigation: computed tomography (CT)-based navigation, imageless navigation, and fluoro-navigation. CT-based navigation is the most accurate, but the preoperative planning on CT images takes time that increases cost and radiation exposure. Imageless navigation does not use CT images, but its accuracy depends on the technique of landmark pointing, and it does not take into account the individual uniqueness of the anatomy
Welded-woven fabrics for use as synthetic, minimally invasive orthopaedic implants
NASA Astrophysics Data System (ADS)
Rodts, Timothy W.
The treatment of osteoarthritis in healthcare today focuses on minimizing pain and retaining mobility. Osteoarthritis of the knee is a common disease and known to be associated with traumatic injuries, among other factors. An identified trend is that patients are younger and have expectations of life with the preservation of an active lifestyle. As a result, great strain is placed on the available offerings of healthcare professionals and device manufacturers alike. This results in numerous design challenges for managing pain and disease over an extended period of time. The available treatments are being extended into younger populations, which increasingly suffer traumatic knee injuries. However, these patients are not good candidates for total joint replacement. A common problem for young patients is localized cartilage damage. This can heal, but often results in a painful condition that requires intervention. A welded-woven three-dimensional polymer fabric was developed to mimic the properties of articular cartilage. A process for the laser welding reinforcement of the surface layers of three-dimensional fabrics was investigated. Confined compression creep and pin-on-disc wear studies were conducted to characterize the contribution of the surface welding reinforcement. All materials used in the studies have previously been used in orthopaedic devices or meet the requirements for United States Pharmacopeial Convention (USP) Class VI biocompatibility approval. The compressive behavior of three-dimensional fabrics was tailored by the inclusion of surface welds. The compressive properties of the welded-woven fabrics were shown to better approximate articular cartilage compressive properties than conventional woven materials. The wear performance was benchmarked against identical fabrics without welding reinforcement. The wear rates were significantly reduced and the lifespan of the fabrics was markedly improved due to surface welding. Welding reinforcement offers a
Surface texture and micromechanics of ultra high molecular weight polyethylene (UHMWPE) orthopaedic implant bearings
NASA Astrophysics Data System (ADS)
Schmidt, Monica A.
Tibial bearings of ultra-high molecular weight polyethylene (UHMWPE) were characterized to identify differences in morphology, surface texture (roughness and skewness), and micro-scale mechanical behavior. These orthopaedic implant components were fabricated by direct molding or by machining after isostatic compression molding. Sterilization was by gamma irradiation (3.3 Mrad) in air, followed by shelf aging for 2 years. Comparisons were made between unsterile and sterile bearings to identify differences in structure and properties related to wear debris. Characterization methods included confocal optical microscopy, nanoindentation, small angle X-ray scattering (SAXS), wide-angle X-ray diffraction (WAXD), Fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), and polarized light microscopy. Morphology was compared between bulk and surface (top and bottom) specimens of the bearings. Cryo-microtomy was used to prepare thin specimens transverse to the top surface for polarized microscopy. Nanoindentation was performed on the top bearing surfaces, near areas examined by confocal microscopy. Processing methods affected both small- and large-scale morphology of UHMWPE. Direct molding produced thinner lamellae, thicker long periods, and slightly lower crystallinity than isostatic compression molding. Both bearing types contained a thick interface between the crystalline and amorphous phases. Interfacial free energy varied with interface thickness. Resin particles were consolidated better in direct molded bearings than in machined bearings. Segregated amorphous regions were observed in the machined bearings. Sterilization and shelf aging affected nanometer-scale morphology. Chain scission significantly decreased the interface thickness, causing an increase in lamellar thickness and a small increase in crystallinity. Only a small decrease in the amorphous thickness resulted. Heterogeneous oxidation increased these changes in interface
Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey
VIEW OF ULTRA-SONIC TESTING EQUIPMENT IN BUILDING 991. THIS EQUIPMENT NON-DESTRUCTIVELY TESTS WEAPONS COMPONENTS FOR FLAWS AND CRACKS. (9/11/85) - Rocky Flats Plant, Final Assembly & Shipping, Eastern portion of plant site, south of Spruce Avenue, east of Tenth Street & north of Central Avenue, Golden, Jefferson County, CO
Power Product Equipment Technician: Equipment Systems. Teacher Edition. Student Edition.
ERIC Educational Resources Information Center
Hilley, Robert
This packet contains teacher and student editions on the topic of equipment systems, intended for the preparation of power product equipment technicians. This publication contains seven units: (1) principles of power transmission; (2) mechanical drive systems; (3) principles of fluid power; (4) hydraulic and pneumatic drive systems; (5) wheel and…
141. ARAIII Equipment location plan. Includes list of equipment and ...
Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey
141. ARA-III Equipment location plan. Includes list of equipment and location in reactor, control, and other buildings. Aerojet-general 880-area/GCRE-101-U-1. Date: February 1958. Ineel index code no. 063-0101-65-013-192508. - Idaho National Engineering Laboratory, Army Reactors Experimental Area, Scoville, Butte County, ID
Multi-Disciplinary Antimicrobial Strategies for Improving Orthopaedic Implants to Prevent Prosthetic Joint Infections in Hip and Knee
Getzlaf, Matthew A.; Lewallen, Eric A.; Kremers, Hilal M.; Jones, Dakota L.; Bonin, Carolina A.; Dudakovic, Amel; Thaler, Roman; Cohen, Robert C.; Lewallen, David G.; van Wijnen, Andre J.
Like any foreign object, orthopaedic implants are susceptible to infection when introduced into the human body. Without additional preventative measures, the absolute number of annual prosthetic joint infections will continue to rise, and may exceed the capacity of health care systems in the near future. Bacteria are difficult to eradicate from synovial joints due to their exceptionally diverse taxonomy, complex mechanistic attachment capabilities, and tendency to evolve antibiotic resistance. When a primary orthopaedic implant fails from prosthetic joint infection, surgeons are generally challenged by limited options for intervention. In this review, we highlight the etiology and taxonomic groupings of bacteria known to cause prosthetic joint infections, and examine their key mechanisms of attachment. We propose that antimicrobial strategies should focus on the most harmful bacteria taxa within the context of occurrence, taxonomic diversity, adhesion mechanisms, and implant design. Patient-specific identification of organisms that cause prosthetic joint infections will permit assessment of their biological vulnerabilities. The latter can be targeted using a range of antimicrobial techniques that exploit different colonization mechanisms including implant surface attachment, biofilm formation, and/or hematogenous recruitment. We anticipate that customized strategies for each patient, joint, and prosthetic component will be most effective at reducing prosthetic joint infections, including those caused by antibiotic-resistant and polymicrobial bacteria. PMID:26449208
Multi-disciplinary antimicrobial strategies for improving orthopaedic implants to prevent prosthetic joint infections in hip and knee.
Getzlaf, Matthew A; Lewallen, Eric A; Kremers, Hilal M; Jones, Dakota L; Bonin, Carolina A; Dudakovic, Amel; Thaler, Roman; Cohen, Robert C; Lewallen, David G; van Wijnen, Andre J
Like any foreign object, orthopaedic implants are susceptible to infection when introduced into the human body. Without additional preventative measures, the absolute number of annual prosthetic joint infections will continue to rise, and may exceed the capacity of health care systems in the near future. Bacteria are difficult to eradicate from synovial joints due to their exceptionally diverse taxonomy, complex mechanistic attachment capabilities, and tendency to evolve antibiotic resistance. When a primary orthopaedic implant fails from prosthetic joint infection, surgeons are generally challenged by limited options for intervention. In this review, we highlight the etiology and taxonomic groupings of bacteria known to cause prosthetic joint infections, and examine their key mechanisms of attachment. We propose that antimicrobial strategies should focus on the most harmful bacteria taxa within the context of occurrence, taxonomic diversity, adhesion mechanisms, and implant design. Patient-specific identification of organisms that cause prosthetic joint infections will permit assessment of their biological vulnerabilities. The latter can be targeted using a range of antimicrobial techniques that exploit different colonization mechanisms including implant surface attachment, biofilm formation, and/or hematogenous recruitment. We anticipate that customized strategies for each patient, joint, and prosthetic component will be most effective at reducing prosthetic joint infections, including those caused by antibiotic-resistant and polymicrobial bacteria. PMID:26449208
Magnesium-containing layered double hydroxides as orthopaedic implant coating materials--An in vitro and in vivo study.
Weizbauer, Andreas; Kieke, Marc; Rahim, Muhammad Imran; Angrisani, Gian Luigi; Willbold, Elmar; Diekmann, Julia; Flörkemeier, Thilo; Windhagen, Henning; Müller, Peter Paul; Behrens, Peter; Budde, Stefan
The total hip arthroplasty is one of the most common artificial joint replacement procedures. Several different surface coatings have been shown to improve implant fixation by facilitating bone ingrowth and consequently enhancing the longevity of uncemented orthopaedic hip prostheses. In the present study, two different layered double hydroxides (LDHs), Mg-Fe- and Mg-Al-LDH, were investigated as potential magnesium (Mg)-containing coating materials for orthopaedic applications in comparison to Mg hydroxide (Mg(OH)2). In vitro direct cell compatibility tests were carried out using the murine fibroblast cell line NIH 3T3 and the mouse osteosarcoma cell line MG 63. The host response of bone tissue was evaluated in in vivo experiments with nine rabbits. Two cylindrical pellets (3 × 3 mm) were implanted into each femoral condyle of the left hind leg. The samples were analyzed histologically and with μ-computed tomography (μ-CT) 6 weeks after surgery. An in vitro cytotoxicity test determined that more cells grew on the LDH pellets than on the Mg(OH)2-pellets. The pH value and the Mg(2+) content of the cell culture media were increased after incubation of the cells on the degradable samples. The in vivo tests demonstrated the formation of fibrous capsules around Mg(OH)2 and Mg-Fe-LDH. In contrast, the host response of the Mg-Al-LDH samples indicated that this Mg-containing biomaterial is a potential candidate for implant coating. PMID:25939995
Fabrication of poly(propylene fumarate)-based orthopaedic implants by photo-crosslinking through transparent silicone molds.
Timmer, Mark D; Carter, Cory; Ambrose, Catherine G; Mikos, Antonios G
This work presents a new molding process for photo-crosslinked, degradable polymeric networks of poly(propylene fumarate) (PPF) and the crosslinking agent poly(propylene fumarate)-diacrylate (PPF-DA). Transparent room temperature vulcanizing silicone molds were fabricated for parts ranging from simple test coupons to orthopaedic implants. The PPF/PPF-DA resin blend was injected into the cavity and photo-crosslinked as light was transmitted through the mold wall. The volumetric shrinkage, mechanical properties, and the effects of gamma sterilization were reported for molded PPF/PPF-DA networks prepared with varying compositions of the two polymer components. The shrinkage decreased while the mechanical properties displayed a general increasing trend when more of the crosslinking agent was incorporated into the network. Gamma irradiation resulted in an improvement of the mechanical properties. In addition, PPF/PPF-DA replicates of a 70:30 poly(L/DL-lactide) biodegradable fixation plate and a bone allograft interbody fusion spacer were produced to evaluate the performance of PPF/PPF-DA as an orthopaedic implant and allow for a comparison to be made with materials that have been established for clinical use. PMID:12951014
Single-step electrochemical deposition of antimicrobial orthopaedic coatings based on a bioactive glass/chitosan/nano-silver composite system.
Pishbin, F; Mouriño, V; Gilchrist, J B; McComb, D W; Kreppel, S; Salih, V; Ryan, M P; Boccaccini, A R
Composite orthopaedic coatings with antibacterial capability containing chitosan, Bioglass® particles (9.8μm) and silver nanoparticles (Ag-np) were fabricated using a single-step electrophoretic deposition (EPD) technique, and their structural and preliminary in vitro bactericidal and cellular properties were investigated. Stainless steel 316 was used as a standard metallic orthopaedic substrate. The coatings were compared with EPD coatings of chitosan and chitosan/Bioglass®. The ability of chitosan as both a complexing and stabilizing agent was utilized to form uniformly deposited Ag-np. Due to the presence of Bioglass® particles, the coatings were bioactive in terms of forming carbonated hydroxyapatite in simulated body fluid (SBF). Less than 7wt.% of the incorporated silver was released over the course of 28days in SBF and the possibility of manipulating the release rate by varying the deposition order of coating layers was shown. The low released concentration of Ag ions (<2.5ppm) was efficiently antibacterial against Staphyloccocus aureus up to 10days. Although chitosan and chitosan/Bioglass® coating supported proliferation of MG-63 osteoblast-like cells up to 7days of culture, chitosan/Bioglass®/Ag-np coatings containing 342 μg of Ag-np showed cytotoxic effects. This was attributed to the relatively high concentration of Ag-np incorporated in the coatings. PMID:23511807
Finite element modelling approaches for well-ordered porous metallic materials for orthopaedic applications: cost effectiveness and geometrical considerations.
Quevedo González, Fernando José; Nuño, Natalia
The mechanical properties of well-ordered porous materials are related to their geometrical parameters at the mesoscale. Finite element (FE) analysis is a powerful tool to design well-ordered porous materials by analysing the mechanical behaviour. However, FE models are often computationally expensive. This article aims to develop a cost-effective FE model to simulate well-ordered porous metallic materials for orthopaedic applications. Solid and beam FE modelling approaches are compared, using finite size and infinite media models considering cubic unit cell geometry. The model is then applied to compare two unit cell geometries: cubic and diamond. Models having finite size provide similar results than the infinite media model approach for large sample sizes. In addition, these finite size models also capture the influence of the boundary conditions on the mechanical response for small sample sizes. The beam FE modelling approach showed little computational cost and similar results to the solid FE modelling approach. Diamond unit cell geometry appeared to be more suitable for orthopaedic applications than the cubic unit cell geometry. PMID:26260268
Erosions in the foot at baseline are predictive of orthopaedic shoe use after 10 years of treat to target therapy in patients with recent onset rheumatoid arthritis.
Bergstra, Sytske Anne; Markusse, Iris M; Akdemir, Gülşah; Ronday, H Karel; Han, K Huub; Lems, Willem F; Kerstens, Pit J S M; van den Berg, Rosaline; Landewé, Robert B M; Allaart, Cornelia F
The objective of this study is to investigate if foot joint damage due to rheumatoid arthritis (RA) can predict whether patients will start wearing orthopaedic shoes (OS) within 10 years after treatment start. Data from recent onset RA patients with 10 years follow-up from the BeSt (Dutch acronym for treatment strategies) study were used. Treatment was tightly controlled, targeted at disease activity score (DAS) ≤2.4, according to 1 of 4 pre-specified treatment strategies. After 10 years of follow-up, orthopaedic shoe use was recorded in 285/508 patients (responders to questionnaires at 10 years). Between-group differences for orthopaedic shoe users and non-users were calculated at baseline, after 10 years, and change scores over the 10-year period were calculated. Predictors for orthopaedic shoe use were identified by univariable and multivariable logistic regression analyses. Orthopaedic shoe use was reported by 57/285 patients after 10 years. Orthopaedic shoe users had more joint damage, joint swelling and pain in the feet already at baseline and after 10 years. At both time points, DAS of orthopaedic shoe users and non-users was similar. Multivariable logistic regression showed that dichotomized foot erosions score (cut-off ≥1 erosion) (OR 2.42), anti-citrullinated protein antibodies (ACPA) (OR 4.64) and DAS (OR 1.77) were independent predictors of orthopaedic shoe use. Despite intensive targeted treatment, 57/285 recent onset RA patients started using orthopaedic shoes over 10 year of follow-up. Presence of foot erosions at treatment start predicts orthopaedic shoe use after 10 years. The risk of orthopedic shoe use increased for ACPA-positive patients and for those with higher baseline disease activity. PMID:26694056
Food Service Equipment and Appurtenances.
ERIC Educational Resources Information Center
National Sanitation Foundation, Ann Arbor, MI.
Equipment design specifications are presented relating to tables of all kinds, counters, sinks and drainboards, bins, shelves, drawers, hoods and similar kitchen appurtenances, not including baking, roasting, toasting, broiling or frying equipment, food preparation machinery such as slicers, choppers, and cutters, mixers and grinders, steam…
Heavy Equipment Mechanic Program Guide.
ERIC Educational Resources Information Center
Georgia Univ., Athens. Dept. of Vocational Education.
Designed to train an entry-level mechanic, this heavy equipment mechanic program guide presents the standard curriculum for technical institutes in Georgia. The curriculum addresses the minimum competencies for a heavy equipment mechanic program. The general information section contains the following: purpose and objectives; program description,…
Available Equipment in School Foodservice.
ERIC Educational Resources Information Center
Meyer, Mary Kay
This report provides data on the National Food Service Management Institute's multi-year research project that identified type, style, age, and condition of available food service equipment in K-12 schools nationwide. The study found that smaller schools, serving less than 400 lunches per day, had kitchens equipped with ranges, small…
Heavy Equipment Mechanic. Instructor Edition.
ERIC Educational Resources Information Center
Hendrix, Laborn J.; And Others
This manual is intended to assist heavy equipment instructors in teaching the latest concepts and functions of heavy equipment. It includes 7 sections and 27 instructional units. Sections (and units) are: orientation (shop safety and first aid, hand tools and miscellaneous tools, measuring, basic rigging and hoisting), engines (basic engine…
Aeration equipment for small depths
NASA Astrophysics Data System (ADS)
Sluše, Jan; Pochylý, František
Deficit of air in water causes complications with cyanobacteria mainly in the summer months. Cyanobacteria is a bacteria that produces poison called cyanotoxin. When the concentration of cyanobacteria increases, the phenomena "algal bloom" appears, which is very toxic and may kill all the organisms. This article describes new equipment for aeration of water in dams, ponds and reservoirs with small depth. This equipment is mobile and it is able to work without any human factor because its control is provided by a GPS module. The main part of this equipment consists of a floating pump which pumps water from the surface. Another important part of this equipment is an aerator where water and air are blended. Final aeration process runs in the nozzles which provide movement of all this equipment and aeration of the water. Simulations of the flow are solved by multiphase flow with diffusion in open source program called OpenFOAM. Results will be verified by an experiment.
Information technology equipment cooling method
Schultz, Mark D.
According to one embodiment, a system for removing heat from a rack of information technology equipment may include a sidecar indoor air to liquid heat exchanger that cools air utilized by the rack of information technology equipment to cool the rack of information technology equipment. The system may also include a liquid to liquid heat exchanger and an outdoor heat exchanger. The system may further include configurable pathways to connect and control fluid flow through the sidecar heat exchanger, the liquid to liquid heat exchanger, the rack of information technology equipment, and the outdoor heat exchanger based upon ambient temperature and/or ambient humidity to remove heat generated by the rack of information technology equipment.
iPadagogy 101: Using Clinical ORthopedic Exam (C.O.R.E.) to Facilitate Evidence-Based Practice in the Orthopaedic Evaluation Classroom
ERIC Educational Resources Information Center
Hamson-Utley, J. Jordan; Stiller-Ostrowski, Jennifer L.
Evidence-based practice (EBP) and educational technology have become fundamental skills within athletic training programs. The objective of this article is to share experiences implementing clinical orthopaedic evaluation applications ("apps") that can be integrated into classroom and clinical education to enhance students' proficiency…
Reflections in a time of transition: orthopaedic faculty and resident understanding of accreditation schemes and opinions on surgical skills feedback
Gundle, Kenneth R.; Mickelson, Dayne T.; Hanel, Doug P.
Introduction Orthopaedic surgery is one of the first seven specialties that began collecting Milestone data as part of the Accreditation Council for Graduate Medical Education's Next Accreditation System (NAS) rollout. This transition from process-based advancement to outcome-based education is an opportunity to assess resident and faculty understanding of changing paradigms, and opinions about technical skill evaluation. Methods In a large academic orthopaedic surgery residency program, residents and faculty were anonymously surveyed. A total of 31/32 (97%) residents and 29/53 (55%) faculty responded to Likert scale assessments and provided open-ended responses. An internal end-of-rotation audit was conducted to assess timeliness of evaluations. A mixed-method analysis was utilized, with nonparametric statistical testing and a constant-comparative qualitative method. Results There was greater familiarity with the six core competencies than with Milestones or the NAS (p<0.05). A majority of faculty and residents felt that end-of-rotation evaluations were not adequate for surgical skills feedback. Fifty-eight per cent of residents reported that end-of-rotation evaluations were rarely or never filled out in a timely fashion. An internal audit demonstrated that more than 30% of evaluations were completed over a month after rotation end. Qualitative analysis included themes of resident desire for more face-to-face feedback on technical skills after operative cases, and several barriers to more frequent feedback. Discussion The NAS and outcome-based education have arrived. Residents and faculty need to be educated on this changing paradigm. This transition period is also a window of opportunity to address methods of evaluation and feedback. In our orthopaedic residency, trainees were significantly less satisfied than faculty with the amount of technical and surgical skills feedback being provided to trainees. The quantitative and qualitative analyses converge on one
Symptomatic venous thromboembolism and mortality in orthopaedic surgery – an observational study of 45 968 consecutive procedures
Background Little information exists on the presentation of symptomatic venous thromboembolism (VTE) in orthopaedic surgery when a defined protocol for thromboprophylaxis is used. The objective with this study was to establish the VTE rate and mortality rate in orthopaedic surgery. Methods We performed a prospective, single centre observational cohort study of 45 968 consecutive procedures in 36 388 patients over a 10 year period. Follow-up was successful in 99.3%. The primary study outcome was the incidence of symptomatic deep vein thrombosis (DVT), symptomatic pulmonary embolism (PE) and mortality at 6 weeks, specified for different surgical procedures. The secondary outcome was to describe the DVT distribution in proximal and distal veins and the proportion of VTEs diagnosed after hospital discharge. For validation purposes, a retrospective review of VTEs diagnosed 7–12 weeks postoperatively was also performed. Results In total, 514 VTEs were diagnosed (1.1%; 95% CI: 1.10-1.14), the majority (84%) after hospital discharge (432 out of 514).With thromboprophylaxis, high incidence of VTE was found after internal fixation (IF) of pelvic fracture (12%; 95% CI: 5–26), knee replacement surgery (3.7%; 95% CI: 2.8-5.0), after internal fixation (IF) of proximal tibia fracture (3.8%; 95% CI: 2.3-6.3) and after IF of ankle fracture (3.6%; 95% CI: 2.9-4.4). Without thromboprophylaxis, high incidence of VTE was found after Achilles tendon repair (7.2%; 95% CI: 5.5-9.4). In total 1094 patients deceased (2.4%; 95% confidence interval (CI): 2.33- 2.44) within 6 weeks of surgery. Highest mortality was seen after lower limb amputation (16.3%, CI: 13.8-19.1) and after hip hemiarthroplasty due to hip fracture (9.6%, CI; 7.6-12.1). Conclusion The overall incidence of VTE is low after orthopaedic surgery but our study highlights surgical procedures after which the risk for VTE remains high and improved thromboprophylaxis is needed. PMID:23734770
Medication at discharge in an orthopaedic surgical ward: quality of information transmission and implementation of a medication reconciliation form.
Monfort, Anne-Solène; Curatolo, Niccolo; Begue, Thierry; Rieutord, André; Roy, Sandrine
Background Medication reconciliation (MedRec) at discharge is a cumbersome but necessary process to reduce the risk of medication errors at transitions of care. The main barriers to implementing such a process are the large number of professionals involved and a lack of collaboration among caregivers. Objective This study was designed to assess the need for a medication reconciliation form at discharge in an orthopaedic surgical ward. Setting The study was conducted in the orthopaedic surgery ward among inpatients at a 407-bed French teaching hospital. Method We first performed a retrospective audit to evaluate the quality of discharge medication information in the medical record, after which a 5-week prospective study was conducted in 2013. All patients admitted to the orthopaedic surgery unit who had at least two chronic diseases and three medications underwent MedRec at discharge. We designed a Best Possible Medication at Discharge List (BPMDL) to be completed by hospital staff and transmitted to community caregivers. Mean outcome measures We assessed the completeness of medication information in the medical records, discrepancies between medications noted on the BPMDL and those prescribed on the discharge order, and the value of the BPMDL for stakeholders. Results Thirty patients were included in the study. Only 4 % of medical records contained a discharge summary with complete medication information. In 67 % of cases, treatment discontinuations at admission were justified, and medications were reintroduced before discharge, while 107 treatments (45 %) were added but not prescribed on discharge orders. Discontinuations prior to discharge were justified in 60 % of cases (treatments were ended or supportive treatment was required during hospitalization). An average of 2.1 treatments were prescribed on discharge orders (vs. 9.4 prescribed on the BPMDL). Patients, general practitioners (GP), and physicians in long-term care settings (PLTCS) rated the format
Orthopaedic Enhanced Recovery Programme for Elective Hip and Knee Arthroplasty – Could a Regional Programme be Beneficial?
McCusker, Darren; Gupta, Nidhi; Bunn, Jonathon; Murnaghan, Mark
Introduction Arthroplasty is commonplace in orthopaedic practice, and post operative pain has been shown to substantially hinder recovery and discharge from hospital. Objectives The current study assessed a multidisciplinary, multimodal Orthopaedic ERP in terms of its effect on patient perceived post operative pain in hip and knee arthroplasty. Secondary outcome was in the form of a cost analysis. Methods A prospective study was performed on consecutive arthroplasty patients across a 6 week period in a district orthopaedic unit. A multidisciplinary approach to devising an ERP was undertaken between anaesthetists, surgeons and physiotherapists. Domains included optimising pre-operative nutrition, anaesthetic pre-meds, standardised anaesthetic technique, standardised intra-operative technique and use of locally infiltrated anaesthetic (LIA), as well as a post operative pain regimen. The multidisciplinary team (MDT) involved physiotherapy for the patient on day 0. Demographic data, day 1 and day 2 post operative subjective pain scores using an analogue scale were recorded. Data was collated and analysed using appropriate statistical methods. A p-value of <0.05 was considered significant. Results A total of 40 patients (25 total hip replacements and 15 total knee replacements) were included. All conformed to the ERP. Reductions in patient reported pain scores were observed. Specifically, in total hip arthroplasty (THA), day 1 scores were not significantly improved (p=0.25), however day 2 scores improved significantly (p=0.02). For total knee arthroplasty (TKA), both day 1 and day 2 scores improved significantly (p=0.02 & p<0.001, respectively) Analgesic requirements were not significantly different between hip and knee replacements. Early mobilization occurred in 95% of patients. Length of stay was reduced significantly in hip (1.8 days, p=0.003) and knee (1.9 days(p<0.001) replacements following ERP. Cost analysis demonstrated a potential annual saving of
The objective and the scope of this document are to list and briefly describe the major mobile equipment necessary for waste package (WP) Transport and Emplacement in the proposed subsurface nuclear waste repository at Yucca Mountain. Primary performance characteristics and some specialized design features of the equipment are explained and summarized in the individual subsections of this document. The Transport and Emplacement equipment described in this document consists of the following: (1) WP Transporter; (2) Reusable Rail Car; (3) Emplacement Gantry; (4) Gantry Carrier; and (5) Transport Locomotive.
Heavy Equipment Mechanic Program Standards.
ERIC Educational Resources Information Center
Georgia Univ., Athens. Dept. of Vocational Education.
This publication contains statewide standards for the heavy equipment mechanic program in Georgia. The standards are divided into 12 categories: foundations (philosophy, purpose, goals, program objectives, availability, evaluation); admissions (admission requirements, provisional admission requirements, recruitment, evaluation and planning);…
The efficacy of using search engines in procuring information about orthopaedic foot and ankle problems from the World Wide Web.
Nogler, M; Wimmer, C; Mayr, E; Ofner, D
This study has attempted to demonstrate the feasibility of obtaining information specific to foot and ankle orthopaedics from the World Wide Web (WWW). Six search engines (Lycos, AltaVista, Infoseek, Excite, Webcrawler, and HotBot) were used in scanning the Web for the following key words: "cavus foot," "diabetic foot," "hallux valgus,"and "pes equinovarus." Matches were classified by language, provider, type, and relevance to medical professionals or to patients. Sixty percent (407 sites) of the visited websites contained information intended for use by physicians and other medical professionals; 30% (206 sites) were related to patient information; 10% of the sites were not easily classifiable. Forty-one percent (169 sites) of the websites were commercially oriented homepages that included advertisements. PMID:10353772
Quality orthopaedic care in sudden-onset disasters: suggestions from Médecins Sans Frontières-France.
Herard, Patrick; Boillot, François
A huge change is needed in the conception and implementation of surgical care during sudden-onset disasters (SOD). The inadequate surgical response mounted by the majority of foreign medical teams (FMT) after Haiti's earthquake is a striking example of the need for a structured professional approach. Logistical capacity already exists to provide safe, timely, effective, efficient, equitable and ethical patient-centred care with minimum standards. However, knowledge, skills and training in the fields of general, orthopaedic and plastic surgery need further clarification. Surgical activity data and clinical examples from several Médecins Sans Frontières-France (MSF) projects are used here to describe the skill set and experience essential for surgeons working in SOD contexts. PMID:26614107
Water-Using Equipment: Domestic
Solana, Amy E.; Mcmordie, Katherine
Water management is an important aspect of energy engineering. This article addresses water-using equipment primarily used for household purposes, including faucets, showers, toilets, urinals, dishwashers, and clothes washers, and focuses on how the equipment can be optimized to save both water and energy. Technology retrofits and operation and maintenance changes are the primary methods discussed for water and energy conservation. Auditing to determine current consumption rates is also described for each technology.
Authorities and foundation of the orthopaedic school in Germany in the 19th century: part II: Richard von Volkmann, Julius Wolff, Albert Hoffa, Friedrich Trendelenburg and other German authors.
Hernigou, Philippe
The national achievements of the orthopaedic school of Germany became international in the second part of the 19th century, and from 1860 through 1914 its educational system attracted many physicians and surgeons from all over the world. During this period of 50 years, German surgeons asserted their dominance in orthopaedic surgery, particularly with four famous surgeons: Richard von Volkmann, Julius Wolff, Albert Hoffa, and Friedrich Trendelenburg. They held annual meetings, during which papers were read and discussed. We also present contributions to orthopaedic sciences of the other German authors during 19th century according to different cities. PMID:26585866
Revolutionizing orthopaedic biomaterials: The potential of biodegradable and bioresorbable magnesium-based materials for functional tissue engineering
Farraro, Kathryn F.; Kim, Kwang E.; Woo, Savio L-Y.; Flowers, Jonquil R.; McCullough, Matthew B.
In recent years, there has been a surge of interest in magnesium (Mg) and its alloys as biomaterials for orthopaedic applications, as they possess desirable mechanical properties, good biocompatibility, and biodegradability. Also shown to be osteoinductive, Mg-based materials could be particularly advantageous in functional tissue engineering to improve healing and serve as scaffolds for delivery of drugs, cells, and cytokines. In this paper, we will present two examples of Mg-based orthopaedic devices: an interference screw to accelerate ACL graft healing and a ring to aid in the healing of an injured ACL. In vitro tests using a robotic/UFS testing system showed that both devices could restore function of the goat stifle joint. Under a 67-N anterior tibial load, both the ACL graft fixed with the Mg-based interference screw and the Mg-based ring-repaired ACL could restore anterior tibial translation (ATT) to within 2 mm and 5 mm, respectively, of the intact joint at 301, 601, and 901 of flexion. In-situ forces in the replacement graft and Mg-based ring-repaired ACL were also similar to those of the intact ACL. Further, early in vivo data using the Mg-based interference screw showed that after 12 weeks, it was non-toxic and the joint stability and graft function reached similar levels as published data. Following these positive results, we will move forward in incorporating bioactive molecules and ECM bioscaffolds to these Mg-based biomaterials to test their potential for functional tissue engineering of musculoskeletal and other tissues. PMID:24373510
In vivo degradation in modern orthopaedic UHMWPE bearings and structural characterization of a novel alternative UHMWPE material
NASA Astrophysics Data System (ADS)
Reinitz, Steven D.
Ultra-high molecular weight polyethylene (UHMWPE) remains the most common bearing material for total joint arthroplasty. Advances in radiation cross-linking and other post-consolidation treatments have led to a rapid differentiation of polyethylene products on the market, with more than twenty unique materials currently being sold by the five largest orthopaedic manufacturers alone. Through oxidation, cross-link density, and free radical measurements, this work demonstrates for the first time that in vivo material degradation is occurring in cross-linked UHMWPE materials. Based on the rate of the reaction in certain materials, it is concluded that oxidative degradation may compromise the mechanical properties of the bearings in as few as ten years, potentially leading to early clinical failure of the devices. Using the knowledge gained from this work as well as previously published observations about UHMWPE oxidation, a two-mechanism model of oxidation is proposed that offers an explanation for the observed in vivo changes. From this model it is concluded that oxidative degradation is in part the result of in vivo chemical species. The two-mechanism model of oxidation suggests that different processing techniques for UHMWPE may reduce the risk of oxidative degradation. It is concluded that by avoiding any radiation cross-linking step, Equal Channel Angular Processing (ECAP) can produce UHMWPE materials with a reduced risk for in vivo oxidation while at the same time offering superior mechanical properties compared to commercially available UHMWPE materials, as well as similar wear behavior. Using dynamic mechanical analysis, the entanglement density in ECAP materials is quantified, and is related back to the ECAP processing parameters. The relationship between entanglement density and resultant material properties is established. The results will allow informed processing parameter selection for producing optimized materials for orthopaedics and other applications.
An examination of inpatient medical record keeping in the Orthopaedic Department of Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
Hollis, Alexander Conor; Ebbs, Samuel Robert
Introduction There is a lack of published evidence examining the quality of patient notes in African healthcare settings. We aim to examine the completeness of the orthopaedic inpatient notes and begin development of a formal audit framework in a large Tanzanian Hospital. Methods A retrospective review of 155 orthopaedic inpatient notes at Kilimanjaro Christian Medical Centre (KCMC) was conducted spanning 3 months. Notes were reviewed using an agreed data collection pro forma considering 3 main outcomes; i) quantity of complete entries, ii) percentage completeness of individual sections, iii) documentation of follow-up. Results: Primary outcome 8% (n = 13) of the inpatient documents were complete (10/10 sections). 11% (n = 17) of the inpatient documents had 9 of 10 sections completed. 30% (n = 46) of the inpatient documents had 8 of 10 sections completed. Therefore, 51% (n = 79) of inpatient entries had 7 or fewer sections filled in. Secondary outcome Admission information and Demographics were both completed 88% (n = 137) of the time. History and the Examination sections were complete in 96% (n = 149) of cases. Investigations were complete in 77% (n = 119) and Diagnosis in 88% (n = 137). The Treatment section was complete 85% (n = 132) of the time and the Attending doctor 50% (n = 78). Procedures were 27% (n = 42) filled in while Summary of a day and Follow-up were 32% (n = 49) and 0% (n = 0) respectively. Tertiary outcome Follow-up was not completed in any entries. Conclusion There are a number of sections of the inpatient pro forma that remain inadequately completed. Regular auditing is essential for the continued progress in patient care. PMID:27347296
Evaluation of the duration of thromboembolic prophylaxis after high-risk orthopaedic surgery: the ETHOS observational study.
Bergqvist, David; Arcelus, Juan I; Felicissimo, Paulo
Real-life data on post-discharge venous thromboembolism (VTE) prophylaxis practices and treatments are lacking. We assessed post-operative VTE prophylaxis prescribed and received in a prospective registry, compared with the 2004 American College of Chest Physicians (ACCP) guidelines in high-risk orthopaedic surgery patients. Consecutive patients undergoing total hip arthroplasty (THA), hip fracture surgery (HFS), or knee arthroplasty (KA) were enrolled at discharge from 161 centres in 17 European countries if they had received in-hospital VTE prophylaxis that was considered in accordance with the ACCP guidelines by the treating physician. Data on prescribed and actual prophylaxis were obtained from hospital charts and patient post-discharge diaries. Post-operative prophylaxis prescribed and actual prophylaxis received were considered adherent or adequate, respectively, if recommended therapies were used for ≥28 days (HFS and THA) or ≥10 days (KA). Among 4,388 patients, 69.9% were prescribed ACCP-adherent VTE prophylaxis (THA: 1,411/2,217 [63.6%]; HFS: 701/1,112 [63.0%]; KA: 955/1,059 [90.2%]). Actual prophylaxis received was described in 3,939 patients with an available diary after discharge (non-evaluability rate of 10%). Mean actual durations of pharmacological prophylaxis from surgery were: 28.4 ± 13.7 (THA), 29.3 ± 13.9 (HFS), and 28.7 ± 14.1 days (KA). ACCP-adequate VTE prophylaxis was received by 66.5% of patients (60.9% THA, 55.4% HFS, and 88.7% KA). Prophylaxis inadequacies were mainly due to inadequate prescription, non-recommended prophylaxis prescription at discharge, or too short prophylaxis prescribed. In high-risk orthopaedic surgery patients with hospital-initiated prophylaxis, there is a gap between ACCP recommendations, prescribed and actual prophylaxis received, mainly due to inadequate prescription at discharge. PMID:22186708
Post-discharge compliance to venous thromboembolism prophylaxis in high-risk orthopaedic surgery: results from the ETHOS registry.
Bergqvist, David; Arcelus, Juan I; Felicissimo, Paulo
Venous thromboembolism (VTE) risk persists for several weeks following high-risk orthopaedic surgery (HROS). The ETHOS registry evaluated post-operative VTE prophylaxis prescribed, and actual VTE prophylaxis received, compared with the 2004 American College of Chest Physicians (ACCP) guidelines in HROS patients. We performed a subanalysis of ETHOS to assess patient compliance with ACCP-adherent prophylaxis after discharge and the factors predicting poor compliance. Consecutive patients undergoing hip fracture surgery, total hip arthroplasty, or knee arthroplasty were enrolled at discharge from 161 centres in 17 European countries if they had received adequate in-hospital VTE prophylaxis. Data on prescribed and actual prophylaxis received were obtained from hospital charts and patient post-discharge diaries. Good compliance was defined as percentage treatment intake ≥80% with no more than two consecutive days without treatment. A total of 3,484 patients (79.4%) received ACCP-adherent anticoagulant prescription at discharge and 2,999 (86.0%) had an evaluable patient diary. In total, 87.7% of evaluable patients were compliant with prescribed treatment after discharge. The most common reason for non-compliance (33.4%) was "drug was not bought". Injection of treatment was not a barrier to good compliance. Main factors affecting compliance related to purchase of and access to treatment, patient education, the person responsible for administering injections, country, and type of hospital ward at discharge. Within our study population, patient compliance with ACCP-adherent thromboprophylaxis prescribed at discharge was good. Improvements in patient education and prescribing practices at discharge may be important in further raising compliance levels in high-risk orthopaedic surgery patients. PMID:22186771
Strontium- and calcium-containing, titanium-stabilised phosphate-based glasses with prolonged degradation for orthopaedic tissue engineering.
Al Qaysi, Mustafa; Walters, Nick J; Foroutan, Farzad; Owens, Gareth J; Kim, Hae-Won; Shah, Rishma; Knowles, Jonathan C
Strontium- and calcium-releasing, titanium-stabilised phosphate-based glasses with a controlled degradation rate are currently under development for orthopaedic tissue engineering applications. Ca and/or Sr were incorporated at varying concentrations in quaternary phosphate-based glasses, in order to promote osteoinduction. Ti was incorporated at a fixed concentration in order to prolong degradation. Glasses of the general formula (P2O5)-(Na2O)-(TiO2)-(CaO)-(SrO) were prepared via the melt-quench technique. The materials were characterised by energy-dispersive X-ray spectroscopy, X-ray diffraction, (31)P magic angle spinning nuclear magnetic resonance, Fourier transform infrared spectroscopy, differential thermal analysis and density determination. The dissolution rate in distilled water was determined by measuring mass loss, ion release and pH change over a two-week period. In addition, the cytocompatibility and alkaline phosphatase activity of an osteoblast-like cell line cultured on the surface of glass discs was assessed. The glasses were shown to be amorphous and contained Q(1), Q(2) and Q(3) species. Fourier transform infrared spectroscopy revealed small changes in the glass structure as Ca was substituted with Sr and differential thermal analysis confirmed a decrease in crystallisation temperature with increasing Sr content. Degradation and ion release studies also showed that mass loss was positively correlated with Sr content. These results were attributed to the lower electronegativity of Sr in comparison to Ca favouring the formation of phosphate-based mineral phases. All compositions supported cell proliferation and survival and induced at least 2.3-fold alkaline phosphatase activity relative to the control. Glass containing 17.5 mol% Sr had 3.6-fold greater alkaline phosphatase activity than the control. The gradual release of Ca and Sr supported osteoinduction, indicating their potential suitability in orthopaedic tissue engineering applications
Strontium- and calcium-containing, titanium-stabilised phosphate-based glasses with prolonged degradation for orthopaedic tissue engineering
Al Qaysi, Mustafa; Walters, Nick J; Foroutan, Farzad; Owens, Gareth J; Kim, Hae-Won; Shah, Rishma
Strontium- and calcium-releasing, titanium-stabilised phosphate-based glasses with a controlled degradation rate are currently under development for orthopaedic tissue engineering applications. Ca and/or Sr were incorporated at varying concentrations in quaternary phosphate-based glasses, in order to promote osteoinduction. Ti was incorporated at a fixed concentration in order to prolong degradation. Glasses of the general formula (P2O5)–(Na2O)–(TiO2)–(CaO)–(SrO) were prepared via the melt-quench technique. The materials were characterised by energy-dispersive X-ray spectroscopy, X-ray diffraction, 31P magic angle spinning nuclear magnetic resonance, Fourier transform infrared spectroscopy, differential thermal analysis and density determination. The dissolution rate in distilled water was determined by measuring mass loss, ion release and pH change over a two-week period. In addition, the cytocompatibility and alkaline phosphatase activity of an osteoblast-like cell line cultured on the surface of glass discs was assessed. The glasses were shown to be amorphous and contained Q1, Q2 and Q3 species. Fourier transform infrared spectroscopy revealed small changes in the glass structure as Ca was substituted with Sr and differential thermal analysis confirmed a decrease in crystallisation temperature with increasing Sr content. Degradation and ion release studies also showed that mass loss was positively correlated with Sr content. These results were attributed to the lower electronegativity of Sr in comparison to Ca favouring the formation of phosphate-based mineral phases. All compositions supported cell proliferation and survival and induced at least 2.3-fold alkaline phosphatase activity relative to the control. Glass containing 17.5 mol% Sr had 3.6-fold greater alkaline phosphatase activity than the control. The gradual release of Ca and Sr supported osteoinduction, indicating their potential suitability in orthopaedic tissue engineering applications
Titanium coated with functionalized carbon nanotubes--a promising novel material for biomedical application as an implantable orthopaedic electronic device.
Przekora, Agata; Benko, Aleksandra; Nocun, Marek; Wyrwa, Jan; Blazewicz, Marta; Ginalska, Grazyna
The aim of the study was to fabricate titanium (Ti) material coated with functionalized carbon nanotubes (f-CNTs) that would have potential medical application in orthopaedics as an implantable electronic device. The novel biomedical material (Ti-CNTs-H2O) would possess specific set of properties, such as: electrical conductivity, non-toxicity, and ability to inhibit connective tissue cell growth and proliferation protecting the Ti-CNTs-H2O surface against covering by cells. The novel material was obtained via an electrophoretic deposition of CNTs-H2O on the Ti surface. Then, physicochemical, electrical, and biological properties were evaluated. Electrical property evaluation revealed that a Ti-CNTs-H2O material is highly conductive and X-ray photoelectron spectroscopy analysis demonstrated that there are mainly COOH groups on the Ti-CNTs-H2O surface that are found to inhibit cell growth. Biological properties were assessed using normal human foetal osteoblast cell line (hFOB 1.19). Conducted cytotoxicity tests and live/dead fluorescent staining demonstrated that Ti-CNTs-H2O does not exert toxic effect on hFOB cells. Moreover, fluorescence laser scanning microscope observation demonstrated that Ti-CNTs-H2O surface retards to a great extent cell proliferation. The study resulted in successful fabrication of highly conductive, non-toxic Ti-CNTs-H2O material that possesses ability to inhibit osteoblast proliferation and thus has a great potential as an orthopaedic implantable electronic device. PMID:25491831
A retrospective analysis of massive blood transfusion and post-operative complications in patients undergoing supra-major orthopaedic oncosurgeries
Gupta, Ankit; Kulkarni, Atul
Background and Aims: Anaesthetic management of patients undergoing supra-major orthopaedic oncosurgeries is challenging. We wanted to evaluate the effects of pre-operative co-morbid conditions, intraoperative blood loss and transfusion, haemodynamic instability on post-operative complications and hospital outcomes in patients after such surgeries. Methods: We collected data from the patient files, anaesthesia records and the electronic medical records about pre-operative morbidities, intraoperative management, complications, blood loss, fluid therapy and blood products transfused. We also collected data on post-operative complications, intensive care unit (ICU) and hospital length of stay (LOS) and status at discharge. Data were summarised using percentages for categorical data and mean and median for continuous data. Results: The mean blood loss was 4567.44 ml (range 1200–16,000 ml); 95% of all patients received blood transfusion. Twenty patients needed massive blood transfusion. Fresh frozen plasma was needed in 17 patients while 1 patient needed single donor platelets. Haemodynamic instability was present in 38 patients, of which 8 needed continuous vasopressor infusion. Nineteen patients were ventilated post-operatively. Coagulopathy occurred in 22 patients while thrombocytopaenia was seen in 6 patients. The median ICU LOS was 3 (1–6) days, and median hospital stay was 17 (6–53) days. All patients were discharged alive. Conclusion: Supra-major orthopaedic oncosurgeries are associated with massive intraoperative blood loss and transfusion. Common complications include anaemia, coagulopathy and hyperbilirubinaemia and prolonged ICU stay. Meticulous care, anticipating the complications with timely treatment can lead to excellent outcomes. PMID:27141111
Postoutbreak disinfection of mobile equipment.
Alphin, R L; Ciaverelli, C D; Hougentogler, D P; Johnson, K J; Rankin, M K; Benson, E R
Current control strategies for avian influenza virus, exotic Newcastle disease, and other highly contagious poultry diseases include surveillance, quarantine, depopulation, disposal, and decontamination. Skid steer loaders and other mobile equipment are extensively used during depopulation and disposal. Movement of contaminated equipment has been implicated in the spread of disease in previous outbreaks. One approach to equipment decontamination is to power wash the equipment, treat with a liquid disinfectant, change any removable filters, and let it sit idle for several days. In this project, multiple disinfectant strategies were individually evaluated for their effectiveness at inactivating Newcastle disease virus (NDV) on mechanical equipment seeded with the virus. A small gasoline engine was used to simulate typical mechanical equipment. A high titer of LaSota strain, NDV was applied and dried onto a series of metal coupons. The coupons were then placed on both interior and exterior surfaces of the engine. Liquid disinfectants that had been effective in the laboratory were not as effective at disinfecting the engine under field conditions. Indirect thermal fog showed a decrease in overall virus titer or strength. Direct thermal fog was more effective than liquid spray application or indirect thermal fog application. PMID:20521731
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Code of Federal Regulations, 2010 CFR
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14 CFR 27.1415 - Ditching equipment.
Code of Federal Regulations, 2010 CFR
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14 CFR 23.1415 - Ditching equipment.
Code of Federal Regulations, 2010 CFR
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Code of Federal Regulations, 2010 CFR
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14 CFR 29.1415 - Ditching equipment.
Code of Federal Regulations, 2010 CFR
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Code of Federal Regulations, 2010 CFR
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40 CFR 63.1022 - Equipment identification.
Code of Federal Regulations, 2013 CFR
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40 CFR 63.1003 - Equipment identification.
Code of Federal Regulations, 2014 CFR
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Code of Federal Regulations, 2012 CFR
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