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Orthopedic Surgeons (orthopedic + surgeon)
Selected AbstractsI PREVENT Bacterial Resistance.DERMATOLOGIC SURGERY, Issue 10 2009An Update on the Use of Antibiotics in Dermatologic Surgery BACKGROUND AND OBJECTIVES Prophylaxis may be given to prevent a surgical wound infection, infective endocarditis (IE), or infection of a prosthetic joint, but its use before cutaneous surgery is controversial. Our aim was to review the current literature and provide a mnemonic to assist providers in appropriately prescribing prophylactic antibiotics. METHODS AND MATERIALS We reviewed the current literature, including the new guidelines provided by the American Heart Association (AHA). RESULTS The new AHA guidelines recommend prophylaxis for patients with high risk of an adverse outcome from IE instead of high risk of developing IE. The American Academy of Orthopedic Surgeons and the American Dental Association also provide guidelines. Given the paucity of conclusive studies, prophylaxis against a surgical wound infection is based more on clinical judgment. CONCLUSION The mnemonic we propose, "I PREVENT," represents: Immunosuppressed patients; patients with a Prosthetic valve; some patients with a joint Replacement; a history of infective Endocarditis; a Valvulopathy in cardiac transplant recipients; Endocrine disorders such as uncontrolled diabetes mellitus; Neonatal disorders including unrepaired cyanotic heart disorders (CHDs), repaired CHD with prosthetic material, or repaired CHD with residual defects; and the Tetrad of antibiotics: amoxicillin, cephalexin, clindamycin, and ciprofloxacin. [source] Iatrogenic Forearm Compartment Syndrome in a Cardiac Intensive Care Unit Induced by Brachial Artery Puncture and Acute AnticoagulationJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2002M.H.A, SHAY SHABAT M.D. A previously healthy patient developed late compartment syndrome in the cardiac intensive care unit after a brachial artery puncture due to acute heparinization after successful percutaneous transluminal coronary angioplasty (PTCA) and stent implantation. The cardiologists recognized the problem and immediately consulted an orthopedic surgeon, who promptly performed surgery. The latter consisted of decompression and fasciotomy. The patient recovered excellent hand function without any neurologic or muscular deficits. Knowledge and understanding of the clinical aspects of this complication are crucial in this devastating syndrome. [source] Pain related to rotator cuff abnormalities: MRI findings without clinical significanceJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2010Jenny T. Bencardino MD Abstract MRI has become an important diagnostic tool in the evaluation of rotator cuff pathology and the technology continues to evolve. Direct MR arthrography, diagnosis-specific sequencing such as fat suppression, special positioning such as abducted externally rotated (ABER) views and ultra high field magnets allow for an unprecedented level of detail in imaging. In this article, we review MRI findings in patients with rotator cuff abnormalities that are anatomic variants or incidental findings. Although MRI findings may be diagnostic in some cases, we find that clinical correlation with history and physical examination is critical to differentiate between anatomic variants, incidental findings, and true pathology. We conclude that good communication between the orthopedic surgeon and the radiologist is necessary to optimize diagnostic yield. J. Magn. Reson. Imaging 2010;31:1286,1299. © 2010 Wiley-Liss, Inc. [source] Phylogenetic analysis indicates transmission of hepatitis C virus from an infected orthopedic surgeon to a patientJOURNAL OF MEDICAL VIROLOGY, Issue 4 2002R. Stefan Ross Abstract During recent years, a controversial discussion has emerged in the medical community on the real number and possible public health implications of hepatitis C virus (HCV) transmissions from infected medical staff to susceptible patients. We report here on molecular virological and epidemiological analyses involving 229 patients who underwent exposure-prone operations by an HCV-infected orthopedic surgeon. Of the 229 individuals affected, 207 could be tested. Three were positive for HCV antibodies. Molecular and epidemiological investigation revealed that two of them were not infected by the surgeon. The third patient, a 50-year-old man, underwent complicated total hip arthroplasty with trochanteric osteotomy. He harbored an HCV 2b isolate that in phylogenetic analysis of the hypervariable region 1 (HVR 1) was closely related to the HCV strain recovered from the infected surgeon, indicating that HCV-provider-to-patient transmission occurred intraoperatively. To our knowledge, this is the first documented case of HCV transmission by an orthopedic surgeon. The recorded transmission rate of 0.48% (95% confidence interval: 0.09,2.68%) was within the same range reported previously for the spread of hepatitis B virus during orthopedic procedures. Since the result of our investigation sustains the notion that patients may contract HCV from infected health-care workers during exposure-prone procedures, a series of further retrospective exercises is needed to assess more precisely the risk of HCV provider-to-patient transmission and to delineate from these studies recommendations for the guidance and management of HCV-infected medical personnel. J. Med. Virol. 66:461,467, 2002. © 2002 Wiley-Liss, Inc. [source] Quantification of upper extremity function and range of motion in children with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 12 2008L Andrew Koman MD This study evaluated the hypothesis that upper extremity function and range of motion can be quantified reliably in children with cerebral palsy (CP) in a busy clinical setting. The specific aim was to determine the inter- and intrarater reliability of a modified House Functional Classification (MHC) system to evaluate upper extremity function and a standardized instrument to document upper extremity range of motion (Upper Extremity Rating Scale [UERS]). Sixty-five children with CP (43 males, 22 females, mean age 9y 2mo, SD 4y 1mo) with spasticity involving the upper extremity (quadriplegia n=22; hemiplegia n=36; diplegia n=7; Gross Motor Functional Classification System Levels I n=41, II n=6, III n=3, IV n=5, V n=10) were evaluated independently by occupational therapists and orthopedic surgeons using both instruments at several visits. Inter- and intrarater reliability were determined for both instruments by calculating measures of agreement (weighted kappa values and intraclass correlation coefficients [ICCs]). Interrater agreement (ICC=0.94) and intrarater agreement (ICC=0.96) on the MHC were good to excellent. Similarly, inter-rater agreement (kappa 0.66,0.81) and intrarater agreement (kappa 0.64,0.88) on the UERS was either good or excellent. The MHC and the UERS provide standardized, reliable, reproducible, and efficient instruments that can be used by occupational therapists and orthopedic surgeons to evaluate the upper extremities of children with CP. [source] Geriatric Co-Management of Proximal Femur Fractures: Total Quality Management and Protocol-Driven Care Result in Better Outcomes for a Frail Patient PopulationJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2008Susan M. Friedman MD Hip fractures in older adults are a common event, leading to substantial morbidity and mortality. Hip fractures have been previously described as a "geriatric, rather than orthopedic disease." Patients with this condition have a high prevalence of comorbidity and a high risk of complications from surgery, and for this reason, geriatricians may be well suited to improve outcomes of care. Co-management of hip fracture patients by orthopedic surgeons and geriatricians has led to better outcomes in other countries but has rarely been described in the United States. This article describes a co-managed Geriatric Fracture Center program that has resulted in lower-than-predicted length of stay and readmission rates, with short time to surgery, low complication rates, and low mortality. This program is based on the principles of early evaluation of patients, ongoing co-management, protocol-driven geriatric-focused care, and early discharge planning. This is a potentially replicable model of care that uses the expertise of geriatricians to optimize the management of a common and serious condition. [source] Targeted mechanical properties for optimal fluid motion inside artificial bone substitutesJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 8 2009L.D. Blecha Abstract Our goal was to develop a method to identify the optimal elastic modulus, Poisson's ratio, porosity, and permeability values for a mechanically stressed bone substitute. We hypothesized that a porous bone substitute that favors the transport of nutriments, wastes, biochemical signals, and cells, while keeping the fluid-induced shear stress within a range that stimulates osteoblasts, would likely promote osteointegration. Two optimization criteria were used: (i) the fluid volume exchange between the artificial bone substitute and its environment must be maximal and (ii) the fluid-induced shear stress must be between 0.03 and 3 Pa. Biot's poroelastic theory was used to compute the fluid motion due to mechanical stresses. The impact of the elastic modulus, Poisson's ratio, porosity, and permeability on the fluid motion were determined in general and for three different bone substitute sizes used in high tibial osteotomy. We found that fluid motion was optimized in two independent steps. First, fluid transport was maximized by minimizing the elastic modulus, Poisson's ratio, and porosity. Second, the fluid-induced shear stress could be adjusted by tuning the bone substitute permeability so that it stayed within the favorable range of 0.03 to 3 Pa. Such method provides clear guidelines to bone substitute developers and to orthopedic surgeons for using bone substitute materials according to their mechanical environment. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 1082,1087, 2009 [source] Langerhans cell histiocytosis and human herpes virus 6 (HHV-6), an analysis by real-time polymerase chain reactionJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 3 2006Michael P. Glotzbecker Abstract Patients with Langerhans cell histiocytosis (LCH) usually present to orthopedic surgeons because this disease most commonly affects bone. The pathogenesis of LCH is unknown, although roles for environmental, infectious, immunologic, and genetic causes have been postulated. More specifically, there is limited data suggesting that human herpes virus 6 (HHV-6) may be a potential etiologic agent. Frozen biopsy material was obtained from 13 patients with LCH and 20 patients without the disease. After ensuring histologic adequacy of the material, the tissue was tested for HHV-6 by qualitative and quantitative real-time TaqMan PCR. Four of 13 patients with LCH had evidence of HHV-6 DNA in their tissue while 7 of 20 control patients tested positive for HHV-6 genome. Viral loads are reported for the positive patients; no statistical difference was observed in the presence or quantity of HHV-6 DNA found in either population, suggesting that the prevalence of HHV-6 in the tissue of LCH patients is the same as that found in tissue from individuals without disease. © 2005 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 24:313,320, 2006 [source] Intraoperative magnification: Who uses it?,MICROSURGERY, Issue 6 2004Ch.B. FRCS Ed (Tr. & Orth.), Paul Max Jarrett M.B. Surgeons over recent decades have made increasing use of intraoperative magnification to enhance the outcome of surgical procedures, yet no published information exists regarding the extent of magnification use within surgical specialties. A sample of surgeons consisting of 148 specialists and senior surgical trainees in the west of Scotland was surveyed by postal questionnaire regarding their frequency and types of magnification use. Patterns of use were similar within each specialty, but varied markedly between specialties. Otolaryngologists and plastic, maxillofacial, and ophthalmic surgeons use both loupes and microscopes frequently. Cardiothoracic and pediatric surgeons tend only to utilize loupes, whereas neurosurgeons tend only to use microscopes. General surgeons, urologists, orthopedic surgeons, and gynecologists are infrequent users or nonusers of magnification, and when required will utilize loupes rather than microscopes. As a clear pattern of magnification use exists, it should be possible to anticipate the equipment needs of surgeons when providing theater services. © 2004 Wiley-Liss, Inc. Microsurgery 24:420,422, 2004. [source] Ceramic-On-Metal for Total Hip Replacement: Mixing and Matching Can Lead to High WearARTIFICIAL ORGANS, Issue 4 2010Saverio Affatato Abstract Ceramic-on-ceramic and metal-on-metal bearing surfaces are often employed for total hip replacement because of their resistance to wear. However, they have some limits: brittleness is a major concern for ceramic, and ion release is a drawback for metal. To reduce the effect of these limitations, a hybrid coupling of ceramic-on-metal has been proposed. The theoretical advantage of this new coupling might lead orthopedic surgeons to use it indiscriminately. We asked whether the wear rate of this innovative solution was comparable with that of ceramic-on-ceramic, which is considered to be the gold standard for wear resistance. In a hip simulator study, we tested the wear pattern of a hybrid ceramic-on-metal coupling supplied by the same distributor; in particular, three different configurations were tested for 5 million cycles: 36-mm ceramic-on-ceramic, 32-mm and 36-mm ceramic-on-metal. These combinations were gravimetrically and geometrically evaluated. After 5 million cycles, the volumetric loss for the metal acetabular cups (, 36-mm) was 20-fold greater than that of the ceramic cups of the same size (, 36-mm); a volumetric loss of 4.35 mm3 and 0.26 mm3 was observed, respectively, for ceramic-on-metal and ceramic-on-ceramic combinations. Significant statistical differences were observed between all 36-mm different combinations (P < 0.0001). The increased diameter of the 36-mm ceramic-on-metal configuration resulted in a lower volumetric loss compared with that of the 32-mm ceramic-on-metal configuration. Our findings showed an increase in wear for the proposed hybrid specimens with respect to that of the ceramic-on-ceramic ones. This confirms that even in the case of ceramic-on-metal bearings, mixing and matching could not prove effective wear behavior, not even comparable with that of the ceramic-on-ceramic gold standard. [source] | |||||||||||||