bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison Between Intermittent (Spring-Loaded) and Continuous Closed Suction Drainage of Orthopedic Wounds: A Controlled Clinical Trial
Authors: Berman Arnold T , Fabiano Daniel , Bosacco Stephen J , Weiss Albert A
Published: April 2021

ABSTRACT: A randomized prospective trial of a continuous vacuum system (VariDyne) and an intermittent spring type system (Hemovac) was conducted in 126 consecutive orthopedic surgical wounds between February 1988 and October 1988 in which postoperative suction drainage was required. Comparison between the two groups showed a statistically significant difference among total drainage removed by the vacuum units and wound drainage into the dressing following drain removal. Hip and knee arthroplasty patients receiving continuous vacuum suction experienced a greater average drainage volume and better wound healing than those receiving the spring-loaded device. Overall, all wounds which utilized continuous vacuum drained less serosanguinous or serous fluid than those wounds utilizing the intermittent system following drain removal. A clear advantage to using a continuous vacuum suction device over an intermittent spring-loaded device is seen with respect to hematoma evacuation, wound drainage, wound healing, and possible complications.
INTRAMEDULLARY REAMING AND SOFT TISSUE PROCEDURES IN TREATMENT OF CHRONIC OSTEOMYELITIS OF LONG BONES
Authors: Ochsner P E , Brunazzi M G
Published: April 2021

ABSTRACT

Forty patients suffering from chronic osteomyelitis were treated by intramedullary reaming at the authors' clinic from 1985 to 1991. The patients were divided into two groups according to follow-up time. The observation period averaged 4.4 years in the intermediate-term group and 1.7 years in the short-term group. Four patients suffered a recurrence. Special attention was given to plastic surgical procedures involving intramedullary reaming. Techniques and results of 7 fasciocutaneous flaps, 1 pedicled gastrocnemius muscle flap, and 1 free microvascular rectus abdominis muscle flap are reported. Intramedullary reaming is recommended as a valuable method in the treatment of long-term chronic osteomyelitis. Primary soft tissue grafting with the objective of providing total wound coverage with all available means seems to be the most advantageous method of achieving primary wound healing and avoiding reinfection.
PREDOMINANCE OF LEFT-SIDED FRACTURES OF THE PROXIMAL FEMUR IN A GERIATRIC POPULATION
Authors: Rudolph Valerie
Published: April 2021

ABSTRACT

Two hundred consecutive admissions to a community medical center with a diagnosis of proximal femoral fracture were analyzed to determine the left:right ratio. It was found that there were 134 left-sided and 66 rightsided fractures. Although no apparent reason was noted, this appears to be a significant finding that warrants further investigation.
THE MANAGEMENT OF DOG BITES AND DOG BITE INFECTIONS TO THE HAND
Authors: Wiggins Michael E , Akelman Edward , Weiss Arnold-Peter C
Published: April 2021

ABSTRACT

Dog bites account for approximately one of 200 emergency room visits. The majority of bites are from dogs known to the victim. Due to the numerous small compartments and the thin covering of soft tissue over the bones and joints, bite wounds to the hand are more likely to become infected than are bites to the arm, leg, or face. Improper management can result in significant morbidity and prolonged treatment. This article discusses the microbiology of dog bite wounds, antibiotic selection, and proper wound management.
A GREATER TROCHANTERIC INSERTION SITE FOR FEMORAL INTRAMEDULLARY NAILING IN LIPOMATOUS PATIENTS
Authors: Ostrum Robert F
Published: April 2021

ABSTRACT

This is a review of the treatment of 12 femoral shaft fractures and three nonunions in lipomatous patients who had a greater trochanteric insertion point for intra medullary nailing. Indications included overweight patients and trochanteric lipodystrophy. Combined with a small proximal extension of the incision, maximal limb adduction, and a slotted intramedullary nail, the greater trochanteric insertion point was effective, and no complications directly related to this procedure were encountered.
TREATMENT OF POSTERIOR TIBIAL TENDON DYSFUNCTION WITH FLEXOR DIGITORUM LONGUS TENDON TRANSFER AND CALCANEAL OSTEOTOMY
Authors: Myerson Mark S , Corrigan John
Published: April 2021

ABSTRACT

We treated 32 patients with stage-II posterior tibial tendon dysfunction with calcaneal osteotomy and flexor digitorum longus tendon transfer. These 32 patients (29 women, 3 men) had an average age of 58 years (range, 46 to 73 years) and had been symptomatic for an average of 2.5 years (range, 1 to 8 years) before surgical correction. The indication for surgery was the presence of medial foot pain refractory to nonoperative treatments, including shoewear modifications, orthoses, and bracing. All patients were examined at a mean of 20 months (range, 14 to 48 months) after surgery. Functional and radiographic examinations were performed for each patient and the American Orthopaedic Foot and Ankle Society (AOFAS) foot rating scale was used. Of the 32 patients, 30 were satisfied with the outcome of surgery, had improved function, and exhibited radiographic correction of the foot deformity. The AOFAS score improved from a preoperative mean of 48 points (range, 23 to 76) to a postoperative mean of 84 points (range, 68 to 92). In one patient, treatment failed, necessitating a triple arthrodesis for worsening deformity. The short-term results of this procedure are encouraging. Most patients (94%) experienced pain relief, had improvement in the arch of the foot, and were able to wear regular shoes without orthotic support. In order to correct deformity and provide substantial relief of foot pain and dysfunction, a medial translational calcaneal osteotomy was performed in addition to a flexor digitorum longus tendon transfer for management of stage-II posterior tibial tendon dysfunction.
VALGUS TILTING OF THE ANKLE JOINT AFTER SUBTALAR (HINDFOOT) FUSION: COMPLICATION OR NATURAL PROGRESSION OF VALGUS HINDFOOT DEFORMITY?
Authors: Fitzgibbons Timothy C
Published: April 2021

ABSTRACT

Six patients treated over a 2-year period were noted to have valgus tilting of the talus at the ankle joint on standing anteroposterior ankle films taken after subtalar (hindfoot) fusions. All patients had significant preoperative hindfoot valgus, but no changes on ankle films. All patients underwent "moldable insitu fusions." Severity and duration of preoperative deformity, as well as obesity, appear to be predisposing factors. Most patients were satisfied with their pain relief despite their persistent valgus deformity. Treatment alternatives may include medial displacement calcaneal osteotomy, lateral column lengthening, combination bone and soft tissue procedures, or even tibial talar calcaneal fusion.
LONG-TERM FOLLOW UP OF TALUS FRACTURES
Authors: Inokuchi Suguru , Ogawa Kiyohisa , Usami Norio , Hashimoto Takeshi
Published: April 2021

ABSTRACT

Eighty-six patients who had experienced a fracture of the talus more than 10 years previously were assessed. The fracture had occurred in the neck of the talus in 52 feet and in the body of the talus in 27 feet. The fracture was complicated by dislocation in 47 feet, and aseptic necrosis had developed in 33 feet. The outcome was rated as excellent in 20 feet, good in 43, fair in 18, and poor in 7. The cause of poor outcome in the late stage was posttraumatic osteoarthritis secondary to avascular necrosis and incongruity of the joint surface. Early active exercise without weight bearing is recommended to prevent contracture and bone atrophy due to disuse, which may promote osteoarthrosis. Arthrodesis is recommended in patients with pain because the outcome is greatly improved by arthrodesis, even when performed more than 10 years after the injury.
FRACTURES IN CHILDREN TREATED WITH RADIOTHERAPY FOR SOFT TISSUE SARCOMA
Authors: Wall Judith E , Kaste Sue C , Greenwald Carol A , Jenkins Jesse J , Douglass Edwin C , Pratt Charles B
Published: April 2021

ABSTRACT

There is a clear association between multimodal therapy for bone tumors and the development of skeletal complications; however, this has not been addressed in children with soft tissue sarcomas. We reviewed records of the 70 children treated for soft tissue sarcoma of the lower extremity at St Jude Children's Research Hospital between 1962 and 1991. Of the 12 patients who received radiation after surgical excision of their tumors, three subsequently developed fractures. Two of the three had also received chemotherapy. Our findings indicate that, although the risk of fracture after therapy for soft tissue sarcoma may be multifactorial, radiation may play a significant role. Minimizing the size of surgical incisions, improving radiotherapy techniques, maximizing chemotherapy, and emphasizing physical therapy and appropriate follow up can all serve to decrease long-term toxicities. Such optimal use of therapy could subsequently reduce side effects, such as osteoporosis and muscle and bone atrophy, that predispose patients to fractures.
Use of Autologous Grafts for Reconstruction of Osteochondral Defects of the Knee
Authors: Marcacci M , Kon E , Zaffagnini S , Visani A
Published: April 2021

ABSTRACT

This study reports on 13 patients (mean age: 31 years) with a femoral condyle defect >1 .5 cm
p 2
who underwent treatment with an osteochondral graft of the same size obtained from the superior aspect of the lateral condyle, preserving the patellar groove. Mean follow-up was 61.5 months (range: 13-141 months). Twelve results were rated clinically as satisfactory with patients able to resume their normal pre-injury level of activity, and 1 case was rated as poor. No patient reported any patellar problems. Radiographic and computed tomographic evaluation demonstrated good integration of the graft in the host bone.

The results of this technique at relatively long-term follow-up are encouraging, with a high percentage of subjective satisfaction. This technique appears to be reliable and provides a valid solution for treatment of wide cartilage defects when other techniques are too complex or inadequate.
Revision Total Hip Arthroplasty in Patients With Avascular Necrosis
Authors: Wei Steven Y , Klimkiewicz John J , Lai Max , Garino Jonathan P , Steinberg Marvin E
Published: April 2021

ABSTRACT

This retrospective study compared the results of revision total hip arthroplasty (THA) In patients with avascular necrosis to patients with osteoarthritis. Twenty-two revision THAs (34 components) in 19 patients with avascular necrosis were compared with 35 revision THAs (55 components) in 31 patients with osteoarthritis. All of the procedures were performed by a single surgeon between 1981 and 1994, and all patients had a minimum of 2 years of follow-up. At the time of revision surgery, the average age was 54 years for the avascular necrosis patients and 67 years for the osteoarthritis patients (P=.002). Clinical and radiographic follow-up was performed for an average of 7 years (range: 2-12 years).

Six (18%) components in the avascular necrosis group and nine (16%) components in the osteoarthritis group required re-revision for aseptic loosening an average of 7 years after the original revision (range: 2-11 years). Statistical analysis demonstrated no significant difference between the two groups in regard to the incidence of failure, time to failure, Harris Hip Score, and radiographic appearance. Contrary to expectations derived from the literature on primary THA, no difference was found between the outcome and survivorship of revision THA in patients with avascular necrosis and patients with osteoarthritis, despite a significant difference in age.
Medium- and Long-Term Results of Open Reduction and Internal Fixation for Unstable Pelvic Ring Fractures
Authors: Korovessis Panagiotis , Baikousis Andreas , Stamatakis Marios , Katonis Pavios
Published: April 2021

ABSTRACT

Over a 1 0-year period, 74 patients with unstable pelvic injuries were treated with open reduction and internal fixation. Radiographic and clinical follow-up averaged 71 months (range: 38-141 months). Satisfactory (ie, good and very good) radiographic results were obtained in 90% of patients. Clinical results were superior in patients without associated injuries (f^=.Q5-.001). Most of the complications in this series were due to associated injuries. Sepsis was mostly due to open pelvic injuries and malunion to either lack of patient cooperation or inadequate open reduction and internal fixation. Careful preoperative analysis of the nature of the pelvic injury and selection of the appropriate operative technique for open reduction and internal fixation result in a satisfactory outcome for the majority of operative patients.
Human Immunodeficiency Virus Testing for Elective Orthopedic Procedures: Results in a Community-Based Hospital
Authors: LaPorte Dawn M , Mont Michael A , Jones Lynne C , Padden David A , Hungerford David S
Published: April 2021

ABSTRACT

Between January 1, 1989 and July 31 , 1995, voluntary preoperative screening tests for human immunodeficiency virus (HIV) infection, using an enzyme-linked immunosorbant assay, were completed on 2727 patients who underwent elective orthopedic surgical procedures. There were 2719 (99.7%) negative, 4 (0.15%) positive, and 3 (0.11%) false-positive results; 1 test was indeterminate (0.04%). All 4 positive patients were men with a mean age of 32 years (range: 26-43 years). Although the prevalence of positive tests is low in this setting, voluntary testing alerts the surgeon to higher risk patients, does not sacrifice patient care, and enables the incorporation of more extensive precautionary measures in the operating room to minimize occupational risks to the surgical team.
Use of a Calcium Sulfate-Based Bone Graft Substitute for Benign Bone Lesions
Authors: Gitelis Steven , Piasecki Patricia , Turner Thomas , Haggard Warren , Charters John , Urban Robert
Published: April 2021

ABSTRACT

Twenty-three patients with a benign bone lesion grafted with calcium sulfate, with and without demineralized bone matrix, were reviewed. At a minimum of 1 year postoperatively, 21 patients had achieved between 76% and 100% bone repair based on anteroposterior and lateral radiographs. Overall, the mean Enneklng Functional Evaluation System score was 98%. Calcium sulfate is a well-tolerated, biodegradable, osteoconductive bone graft substitute. It is a reasonable alternative to autogenous bone graft for benign bone lesions.
The Role of Hip Arthroscopy in the Evaluation of Avascular Necrosis
Authors: Ruch David S , Sekiya Jon , Schaefer W Dickson , Koman L Andrew , Pope Thomas L , Poehling Gary G
Published: April 2021

ABSTRACT

This prospective study evaluated the correlation between plain radiographs, magnetic resonance imaging (MRI), and diagnostic arthroscopy in the staging of avascular necrosis of the femoral head. Fifty-two hips in 46 patients were prospectively staged using radiographic and MRI staging systems. Patients subsequently underwent hip arthroscopy to visualize the articular surface prior to considering salvage of the femoral head and debride delaminated osteochondral fragments. Weighted Kappa analysis revealed only moderate correlation between MRI and plain radiographs (κ=.11), MRI and arthroscopy (κ=.21), and plain radiographs and arthroscopy (κ=.19). Six (46%) of 13 patients with a radiographically apparent subchondral fracture demonstrated collapse of the articular surface at arthroscopy. Four (24%) of 17 hips with >2 mm of collapse of the femoral head on plain radiographs demonstrated fragmentation of the osteochondral surface of the femoral head at arthroscopy. In 5 patients with flattening of the femoral head, 3 patients had delamination of both the femoral and acetabular surfaces. In regard to labral pathology, 5 of 22 post-collapse hips also had large bucket handle tears of the labrum. Arthroscopy of the hip revealed osteochondral degeneration that was not detected by plain radiographs or MRI in 36% of post-collapse femoral heads.
The Harris-Galante Porous Acetabular Component at Intermediate Follow-Up
Authors: D'Lima Darryl D , Yashar Arnold A , Venn-Watson Eric J , Colwell Clifford W , Walker Richard H
Published: April 2021

ABSTRACT

Outcome of the acetabular component in 90 consecutive primary noncemented total hip arthroplasties (THAs) was prospectively studied. The acetabular cup consisted of a hemispherical titanium alloy shell with a titanium fiber-mesh porous coating and a modular polyethylene liner (Harris-Galante Porous-1, Zimmer, Warsaw, Ind). The cup was implanted using line-to-line reaming with adjunctive dome screw fixation. The femoral component consisted of a titanium alloy stem with titanium fibermesh porous coating and a 28-mm cobalt-chrome modular head. Mean patient age was 53 years (range: 27-75 years); male:female ratio was 48:42; and mean follow-up was 6 years (range: 4.5-8 years).

One acetabular component was revised for aseptic loosening. Of 81 unrevised hips available for follow-up, mean Harris hip score was 57 preoperatively and 96 at final follow-up (72% excellent, 15% good, 13% fair, and none poor). Of 61 unrevised hips with adequate radiographic follow-up, radiographic failure (complete periprosthetic radiolucency) was evident in 3 (4.9%) and periacetabular osteolysis in none. Radiographic failure did not correlate with poor clinical outcome. Linear polyethylene wear rate (mean: 0.13 mm/year) did not correlate with age, gender, weight, outcome, or cup abduction angle, but did correlate with the presence of femoral periprosthetic osteolysis (0.18 mm/year with femoral osteolysis versus 0.11 mm/year without; P=.01).

This series of porous-coated hemispherical cups demonstrated excellent intermediate-term clinical and radiographic outcome, comparable with similarly favorable results reported by the prosthesis designers. A potentially adverse effect of polyethylene wear on the longevity of a THA was supported by a positive correlation between polyethylene wear rate and femoral osteolysis.
The Possible Role of Locally Produced Cytokines in the Pathogenesis of Peritrochanteric Fractures in the Elderly
Authors: Spiliopoulou Iris , Korovessis Panagiotis , Stamatakis Marios , Paliogianni Fotini , Dimitracopoulos George
Published: April 2021

ABSTRACT

Sixteen patients with intertrochanteric femoral fractures were studied for possible involvement of the cytokines interleukin-6 (IL-6), interleukin-1 beta (IL-1β), tumor necrosis factor-alpha, and the disease activity factors C-reactive protein and alpha
1
-antitrypsin as local bone-resorbing agents. Cytokine and disease activity factor levels were measured in gluteus medius muscle and serum samples and were compared to sera obtained from age- and sex-matched healthy controls.

Interleukin-6 and IL-1β levels were significantly higher (P=.0024 and P=.036, respectively) in the muscle samples from the fractured side than in the samples from the contralateral unaffected side. Levels of IL-6 and IL-1β also were significantly higher in patients' sera than in the sera of healthy controls. These results support a new hypothesis that may contribute to the pathogenesis of fractures in the elderly: unilaterally locally overproduced IL-6 and IL-1β may lead to local bone resorption in the intertrochanteric region, which subsequently weakens the femoral bone and increases the risk of unilateral peritrochanteric fractures.
Evaluation of Suspected Stress Fractures
Authors: Roebuck Jonathan D , Finger David R , Irvin Thomas L
Published: April 2021

ABSTRACT

Stress fractures can occur if normal bone is exposed to repeated abnormal stress (fatigue fractures) or if normal stress is placed on bones with compromised elastic resistance (insufficiency fractures). This article describes two patients without a history of excessive stressful activity or apparent metabolic bone disease who developed bilateral distal tibial stress fractures. Different etiologies, clinical presentation, differential diagnosis, and diagnostic imaging modalities of stress fractures are discussed.
Role of FGF9 and FGF Receptor 3 in Osteochondroma Formation
Authors: Robinson D , Hasharoni A , Oganesian A , Sandell L J , Yayon A , Nevo Zvi
Published: April 2021

ABSTRACT

Osteochondromas are chondro-osseous protuberances that occur in metaphyses of long bones. The cartilaginous cap is assumed to be responsible for the growth of the lesions during childhood and adolescence, but mitotic figures are rarely seen in the cap. Therefore, another cell population, probably mesenchymal cells, is responsible for proliferation and growth. Residual mesenchymal cells capable of rapid proliferation are difficult to detect due to lack of specific histologic features.

Two specific markers for mesenchymal cells, FGF receptor 3 (FCFR3) and collagen type Ha, have been described. Osteochondroma mesenchymal cells are found in the soft tissues overlying the cartilage cap. The surrounding areas of typical cartilage are negative for both mesenchymal cell associated antigens. The soft tissues overlying the cartilage do not have cartilaginous features. The undifferentiated cells overlying the exostosis yield in culture a rapidly proliferating homogenous population of fibroblast-like cells. Expression at the mRNA level of FGF9, FGFR3, and collagen type 11a is found in these cells, but not in skin fibroblasts from afflicted or healthy individuals. Exogenous administration of TGF^sub β1^ to cultures of hereditary multiple exostosis eliminates FGF9 expression. These results indicate fibrous regions contain the mesenchymal cells responsible for osteochondroma growth.
A Prospective Trial of Night Splinting in the Treatment of Recalcitrant Plantar Fasciitis: The Ankle Dorsiflexion Dynasplint
Authors: Berlet Gregory C , Anderson Robert B , Davis W Hodges , Kiebzak Gary M
Published: April 2021

Abstract

Twelve patients were treated with the Ankle Dorsiflexion Dynasplint (Dynasplint Systems Inc, Severna, Md) for recalcitrant plantar fasciitis. Using a modified plantar fasciitis functional assessment scale and a visual analog pain assessment scale for evaluation, 75% of patients reported improvement of symptoms at 1-month follow-up. The average percentage of weekly sleeping hours spent in the splint was 95%. There was no tendency to deterioration of results by 6 months postsplinting. The Ankle Dorsiflexion Dynasplint is effective in the treatment of recalcitrant heel pain in a majority of patients. This study supports its use for the treatment of recalcitrant plantar fasciitis.
Coccygodynia: Treatment
Authors: Ramsey Michael L , Toohey John S , Neidre Arvo , Stromberg Lynn J , Roberts David A
Published: April 2021

Abstract

This article presents a retrospective review of the treatment of coccygodynia. The past 5 years of conservative treatment for coccygodynia were reviewed, including local injection. The results were evaluated. Retrospectively, the past 20 years of surgical treatment for coccygodynia were reviewed and the clinical results were evaluated.

Twenty-four patients were treated with local injection and 15 patients were treated with coccygectomy. Local injection was successful in 78% of patients. Coccygectomy was successful in 87% of patients.

The results of conservative treatment with local injection for coccygodynia appear to be successful. However, no other historical literature exists to compare these results. The results of coccygectomy for coccygodynia were also highly successful, and the success rate compares favorably to previous historical data in the literature.
Anatomic and Radiographic Analysis of Arthroscopic Tack Placement into the Anteroinferior Glenoid
Authors: Ilahi Omer A , Younas Shiraz A , Trusler Marshall L , Espiritu Michael T
Published: April 2021

Abstract

Tack location within the anteroinferior aspect of the glenoid when performing simulated repairs of anteroinferior capsulolabral avulsions (Bankart lesions) was evaluated anatomically and radiographically. Arthroscopy was performed on six fresh-frozen cadaveric shoulders, and bioabsorbable tacks were placed through an accessory anteroinferior portal coming into the joint just above the subscapularis tendon using an outside-in technique.

Tack location was studied after removal of all soft tissues. In addition to their position on the glenoid, the tacks were also evaluated for being partially or completely within bone. The tacks were recannulated with guide pins and anteroposterior, axillary, and en face glenoid radiographs of each specimen were obtained.

This study provides quantitative data about the inferior placement limitations of the insertion angle and location of fixation devices within the anteroinferior glenoid through the anteroinferior accessory portal.
Percutaneous Treatment of Long Bone Nonunions: The Use of Autologous Bone Marrow and Allograft Bone Matrix
Authors: Wilkins Ross M , Chimenti Brian T , Rifkin Robert M
Published: April 2021

Abstract

Sixty-six patients with 69 "stiff" nonunions (no gross motion) of long bones were entered into a prospective study. The only therapeutic intervention was the percutaneous administration of a mixture of autologous bone marrow and allograft demineralized bone matrix on an outpatient basis. Sixty-one of the percutaneous treatments (88%) resulted in union at an average of 8.1 months (range: 2 months to 3 years). This method of treating nonunions is as successful as standard iliac crest autologous bone grafting and offers the distinct advantages of decreased morbidity, reduced costs, and shorter hospital stay.
The Use of Acellular Dermal Matrix as a Scaffold for Periosteum Replacement
Authors: Beniker Dan , McQuillan David , Livesey Stephen , Urban Robert M , Turner Thomas M , Blum Barbara , Hughes Kim , Haggard Warren O
Published: April 2021

Abstract

Three preclinical models were used to evaluate GraftJacket Acellular Periosteum Replacement Scaffold (Wright Medical Technology, Inc, Arlington, Tenn). The studies assessed the ability of the acellular dermal matrix to repopulate with cells, revascularize, provide a protected environment for bone defect restoration, and minimize fibrous tissue infiltration. An athymic nude rat muscle implantation study demonstrated a steady increase in cellular repopulation through days 2-21. The formation of blood vessels occurred between days 7-14 in this study. Results from a porcine femoral drill hole study indicated that the scaffold material was intact and adherent to surrounding bone and allowed cellular repopulation and vascular infiltration at a 5-week time period. A preliminary porcine segmental bone defect model at a 6-week time period demonstrated the ability of the scaffold material to protect the bone defect site as revealed by new bone formation within the margins of the defect and adjacent to the scaffold. The segmental model also indicated minimal to no soft tissue invasion into the defect site. The combined studies provided preliminary evidence that the dermal membrane material may be used as a scaffold for periosteum regeneration by allowing for cellular repopulation, revascularization, and bone defect restoration.
Retrograde Interlocked Intramedullary Nailing of Supracondylar Distal Femur Fractures in an Average 76-Year-Old Patient Population
Authors: Armstrong Robert , Milliren Angela , Schrantz William , Zeliger Keith
Published: April 2021

Abstract

Twenty-seven fractures of the distal femur in 27 adult patients were treated with retrograde, interlocked, intramedullary nails after intercondylar fracture extension had been reduced and treated with lag screws. Postoperatively, early mobilization exercises began immediately, but weight bearing was not allowed until clinical union was achieved, after which full weight bearing was permitted. Retrograde, interlocked, intramedullary nailing provides an excellent technique to establish union of supracondylar and distal femoral shaft fractures with a low complication rate and opportunity to regain knee motion in the mentally competent, motivated patient.
Takeoff Forces Transmitted to the Upper Extremity During Water-Skiing
Authors: Keverline Jeffrey P , Englund Richard , Cooney Timothy E
Published: April 2021

Abstract

As data were unavailable, this study quantified the forces acting on the upper extremities during water-skiing takeoff in 10 male volunteers (mean age: 28 years). Body weight ranged between 141 and 195 lbs. Low, medium, and full-power takeoffs were used to propel each skier out of the water. Although low-power takeoffs produced significantly less peak force (P≤.Q004), they yielded a trend toward greater time under load (P=.097). As the data suggest that forces assume roughly one and one-half times body weight, individuals with pre-existing shoulder morbidity may risk exacerbation of their condition.
Single Anterior Incision Suture Anchor Technique for Distal Biceps Tendon Ruptures
Authors: Kobayashi Ky , Bruno Roderick J , Cassidy Charles
Published: April 2021

This article presents a single anterior incision suture anchor technique using a locking "whip" stitch to repair distal biceps tendon injuries.
Effects of Selected Growth Factors on Porcine Meniscus in Chemically Defined Medium
Authors: Lietman Steven A , Hobbs William , Inoue Nozomu , Reddi A Hari
Published: April 2021

Abstract

Some evidence shows that selected growth factors can increase proteoglycan synthesis and that fibrin clot aids in the repair of meniscal tears. A significant (P<.05) dosedependent stimulation of proteoglycan synthesis was found with platelet-derived growth factor AB (PDGF[AB]), transforming growth factor-β1 and bone morphogenetic protein-7 (osteogenic protein-l). In separate experiments, a significant increase in celiularity was found in the deep and superficial aspects of the expiants treated with PDGF-(AB) compared with those treated with basal medium alone. The current study provides data as to which growth factors might prove most useful in the maintenance and repair of menisci.
Shoulder Arthroplasty Without a Rotator Cuff
Authors: Rockwood Charles A
Published: April 2021

Patients with glenohumeral arthritis and absent or irreparable lesions of the rotator cuff represent a therapeutic challenge for orthopedic surgeons. In the June issue of Orthopedics, Dr Gilles Walch discussed the Delta reverse design shoulder prosthesis as a method of managing this problem.

Although the Delta prosthesis is currently successful in Europe, it is not yet available in the United States. One technique for managing this problem in North America as well as Europe is a new system that uses the standard Global Advantage humeral component with the special Cuff Tear Arthropathy head.

In this issue of Orthopedics, codeveloper and inventor of the Global™ Total Shoulder Prosthesis System, Dr Charles A. Rockwood, Jr discusses treatment options, which are currently available in the United States, for patients with glenohumeral arthritis and irreparable rotator cuff defects.
Modular Junctions
Authors: Cameron Hugh U
Published: April 2021

abstract

A concern about modular stems is that the taper will not provide an adequate seal, causing the stem distal to the taper to become part of the effective joint space. In this study, 380 primary patients and 309 revision patients were treated with a proximally modular stem. Follow-up was between 5 and 17 years (mean 9.4 years). Three patients only had distal osteolysis. All three patients had failure of proximal bone ingrowth. It was concluded that a Morse taper provides an adequate seal or gasket.
The S-ROM Modular Stem for Femoral Deformities
Authors: Mattingly David A
Published: April 2021

abstract

Many conditions produce femoral deformities that complicate primary total hip arthroplasty (THA). In each patient, treatment must be individualized to address the level of the deformity, the type of deformity, and bone quality, as well as surgeon preference. The S-ROM femoral component (DePuy Orthopaedics, Warsaw, lnd) is useful for many deformities from the level of the greater trochanter to the diaphysis. The S-ROM stem optimizes proximal and distal implant stability, allows maximal torsional stability during osteotomies, and permits easy adjustments to anteversion, offset, and leg length to provide optimal biomechanieal reconstruction of the deformed femur in THA. Clinical results with few complications are achievable when using the S-ROM stem in complex deformities.
The Management of Malalignment in Hip Revision Surgery
Authors: Marega Luca
Published: April 2021

abstract

When facing revision surgery, the deformation of the femur must be considered for the important implications in the strategy of the operation and the choice of the implant. Deformation can occur in varus and retroversion, or both, in different degrees. For severe varus deformations a straightening osteotomy is generally indispensable and different types of distal fixations of the implant are necessary; in milder deformations other solutions are possible. Retroversion can be generally managed with proximally modular stems, stems without metaphyseal component, or, rarely, with a derotation osteotomy.
The Rationale and Performance of Modularity in Total Hip Arthroplasty
Authors: Heim Christine S , Greenwald A Seth
Published: April 2021

abstract

Modularity in total hip arthroplasty design is an evolving concept that continues to receive citation in the clinical literature. The advantages of these systems include off-the-shelf flexibility for customizing proximal and distal canal filling, as well as accommodation of difficult situations of femoral deformity and bone loss. Clinical concerns in the application of modular femoral stem hip designs include the maintenance of anatomical stability within the femoral canal component dissociation, structural compromise at metal-metal interconnections due to cyclic microdisplacements (fretting), and the increased potential for metallic-wear debris generation. This article reviews the rationale and performance of typical modular systems.
How Does Pulsed Low-Intensity Ultrasound Enhance Fracture Healing?
Authors: Stein Haim , Lerner Alexander
Published: April 2021

Pulsed low-energy ultrasound, a non-invasive therapeutic treatment modality, may improve callus formation and enhance fracture healing by initiating enhanced angioneogenesis.
OrthoPilot Total Hip Arthroplasty Workflow and Surgery
Authors: Kiefer Hartmuth , Othman Aneis
Published: April 2021

abstract

To analyze the workflow and navigation principles of the OrthoPilot total hip arthroplasty (THA) Version 2.0 (B. Braun-Aesculap, Tuttlingen, Germany), a consecutive series of 60 patients was used to compare the navigated intraoperative data and postoperative measurements of stem and cup position. Within the safe zone, 96.3% of 54 acetabular cups were positioned. The rotational accuracy of femoral instruments was 65° in 41 THAs. The femoral offset was medialized by 6.05 mm in 76% and lateralized by 2.1 mm in 14%. The data for leg length and range of motion from 60 THAs and the navigated data were similar. Thus, the first clinical validation of the workflow of the OrthoPilot THA Version 2.0 is encouraging.
Minimally Invasive Navigated Knee Surgery: A European Perspective
Authors: Gregori Alberto
Published: April 2021

abstract

European surgeons and North American surgeons have different approaches to minimally invasive total knee arthroplasty (TKA). Computer-assisted navigation emphasizes these differences. In this article, the author rethinks what surgeons are trying to achieve and notes that quality control is demanded by patients and surgeons. Although minimally invasive TKA is an accepted procedure, reflection on the facts suggests that the use of minimally invasive surgery and TKA navigation are intertwined and cannot be separated.
Reducing the Risk of Deep Wound Infection in Primary Joint Arthroplasty With Antibiotic Bone Cement
Authors: Block Jon E , Stubbs Harrison A
Published: April 2021

abstract

Despite significant advances in intraoperative antimicrobial procedures, deep wound infection remains the most serious complication associated with primary, cemented total joint arthroplasty. A systematic review was conducted to evaluate studies oí antibiotic bone cement prophylaxis for reducing the risk of deep wound infection. The literature included 22 articles providing estimates of the prophylactic effectiveness of antibiotic cement. In reducing deep wound infection, antibiotic cement was consistently superior to plain cement, similar to systematic antiobiotics, and independent and additive in effect when combined with other prophylactic measures. Randomized controlled trials in particular had important methodological limitations. However, the collective results nearly unanimously favored prophylactic use of antibiotic cement in primary arthoplasty procedures.
Extramedullary Versus Intramedullary Tibial Alignment Guides for Total Knee Arthroplasty
Authors: Rottman Steven J , Dvorkin Michael , Gold David
Published: April 2021

abstract

This retrospective study evaluated whether intramedullary or extramedullary tibial alignment guides are more accurate in assuring correct tibial component positioning in total knee arthroplasties (TKAs). Fifty-five TKAs were performed with the only difference being whether an intramedullary (31) or extramedullary (24) cutting guide was used. Pre- and postoperative tibiofemoral angle, tibial component alignment angle, and femoral component alignment angles were measured and the results were statistically analyzed. We also performed a subgroup analysis on the preoperative varus knees to determine if the presence of a varus deformity would have better results with either the intramedullary or extramedullary cutting guide. The 2-sample t test was used to compare the results of the two groups. The results showed no statistical difference in alignment of the tibial component when using the intramedullary or extramedullary guides.
The Reverse Sural Neurocutaneous Flap for Hindfoot and Ankle Coverage: Experience and Review of the Literature
Authors: Rohmiller Michael T , Callahan Barry S
Published: April 2021

abstract

Soft-tissue defects about the ankle are common in orthopedic surgery. The wounds usually involve exposed bone or hardware, making skin grafting a poor option. Free tissue transfer remains a mainstay of treatment. Recently, the reverse sural neurocutaneous flap has gained popularity. At our institution, 1 1 fasciocutaneous flaps have been performed for defects averaging 53cm-. All flaps achieved stable coverage. One patient required repeat skin grafting. Given its reliability, easy dissection, and outpatient capability, this flap should be considered for coverage in this region.
Microcomputers Enhance Student Health Fairs
Authors: Ahijevych Karen , Boyle Kathleen Kluznik , Burger Karen
Published: April 2021

ABSTRACT

To stimulate student interest in learning about health, faculty assigned students the task of planning and implementing a university health fair. Two questions were posed: (1) Could sophomore students effectively plan and implement a health fair as a learning opportunity? (2) Could microcomputers be used appropriately to influence client participation and to enhance the nurse-client interactions?

Literature regarding the efficacy of the health fair as a mode of health care delivery and as a student learning opportunity and literature addressing the advantages of microcomputer use were reviewed. Two health fairs were piloted. Microcomputers were employed in three areas: nutrition, stress, and substance abuse. Students, with faculty guidance, developed educational materials using principles of teaching, learning, and health promotion. Clients rated the health fair as congruent with their health needs. Students identified learning gained from the experience. Students and clients were receptive to computer use. Future directions are discussed.
Professional Nursing Education: What is its Purpose?
Authors: Butterfield Shona E
Published: April 2021

ABSTRACT

Rogers (1970, p. 88) has written "The purpose of professional education is to provide the knowledge and tools whereby an individual may become an artist in his field. It is not to prepare the skilled practitioner." This statement is used to provide a basis for discussion of some issues involved in relation to nursing and nursing education.

The problem area is first clarified before discussion moves on to show the relevance of conceptual models and theory to professional nursing education and to look at the kinds of knowledge and tools which could be provided to promote artistry in nursing.
A Demystification of the Clinical Nurse Specialist Role: Perceptions of Clinical Nurse Specialists and Nurse Administrators
Authors: Tarsitano Betty J , Brophy Elizabeth B , Snyder Dona J
Published: April 2021

ABSTRACT

Differences of nurse administrators and clinical nurse specialists regarding components of the clinical specialist role were investigated. To be effective in facilitating the maximum use of the abilities of the clinical specialist, it is essential that nurse educators establish a data base about the clinical nurse specialist role from the perspective of employers and the clinical nurse specialists themselves. Subjects were 54 nurse administrators and 35 clinical specialists from a large metropolitan area. The results indicated that, generally, both groups were in agreement except for the research component. Administrators placed a higher value on research than did the clinical specialists. Both groups valued the clinical practice component with the clinical specialists tending to see themselves more heavily committed to direct specialized patient care than did the administrators. The educational component was also valued with the consultant function receiving the highest rating of all the functions surveyed. The administration component was valued least highly of all the components. It is recommended that nurse educators evaluate their educational endeavors in preparation of clinical specialists especially for research functions, and, also, consultation and those functions supportive of nursing staff.
Meeting the Challenge of Multiple Academic Roles Through a Nursing Center Practice Model
Authors: Duffy Diane M , Halloran M Catherine S
Published: April 2021

ABSTRACT

Filling the multiple requirements of academic life - to teach, to conduct research, and to give service to the community - can be difficult for any academician. When the educator is also a nurse, meshing academic life with that of a practicing professional adds to the difficulties. Maintaining control and managing resources for practice can be time consuming and wearisome. The authors use quotes from the sociologist Paul Starr to describe and examine this professional dilemma. The process they followed in implementing a practice model in a community nursing center is described. Using this approach teaching, research, and service requirements were biended with practice for greater professional control and more productive scholarly endeavors.
The Effects of a Well Older Adult Clinical Experience on Students' Knowledge and Attitudes
Authors: Greenhill E Dianne , Baker Marion F
Published: April 2021

ABSTRACT

Is a planned learning experience with well older adults a positive influence on a nursing student's attitude, level of gerontological knowledge, and willingness to work with older adults after graduation? Students in a baccalaureate program were divided into treatment or control groups based on their attitudes on the Kogan's Attitude Toward Old People Scale. Knowledge was measured by the PaImore's Facts on Aging Quiz (Palmore, 1977).

Half of the students were given experiences with well elderly while the other group had no experience with this population. Differences in pre- and post-test scores were compared by analysis of variance. All students, regardless of planned experience with older adults, increased their knowledge. Students who initially had negative attitudes significantly improved their attitudes regardless of the type of clinical experience. The investigation failed to support the idea that experiences with well elderly would make a difference on attitude and knowledge base. This project suggests knowledge and attitude changes are not dependent upon a particular type of clinical learning activity.
Predicting the Success of Minority Students in a Baccalaureate Nursing Program
Authors: Boyle Kathleen Kluznik
Published: April 2021

ABSTRACT

Entering grade point average (ENTGPA), American College Test Assessment (ACT), high school rank (HSRANK), high school GPA (HSGPA), number of college credit hours prior to program admission (HRSPTA), age at admission, and an index of applicant motivation and related experience (MEP) were investigated to determine the best predictive combination of variables for success among minorities in a baccalaureate nursing program. Final GPA, program completion, and State Board Examination (SBTPE) performance were used as indicators of success. Minority students (N = 145) admitted between 1971-1981 were identified by record review. Two minority subgroups, blacks (n = 111) and nonblack minorities (n = 34) were compared using multiple regression and discriminant analysis procedures. ACT was the strongest, most consistent predictor of SBTPE performance and final GPA for all minorities. ENTGPA and ACT provided substantial predictive power for both subgroups, but explained markedly less variance for blacks. HSGPA, HRSPTA, and HSRANK explained some variance differently by subgroup. ENTGPA provided the only discrimination between graduates and dropouts. Cognitive attributes are critical to academic success among minorities, although predictors may vary in explanatory power by minority group. Variables interfering with program completion need to be explored.
Facilitating Student Involvement in Large Classroom Settings
Authors: Boman Jeanette
Published: April 2021

ABSTRACT

Diminishing resources and increasing student enrollment in the basic and post-basic programs at the Faculty of Nursing, University of Alberta, have led to large teacher-student ratios in the area of classroom lectures. This article is a discussion about the issue of student involvement in the learning process where there may be 100 or more students in one class. The meaning of student involvement, factors which inhibit student involvement, and strategies to increase student involvement in a large classroom situation are addressed.
Top Ranked Schools of Nursing: The Role of the Dean
Authors: Pollock Susan E
Published: April 2021

ABSTRACT

The Top Ranked School of Nursing Study (TRSN) was a nationwide investigation for the purpose of delineating a composite of elements that constitute a top ranked school. The role of the dean was identified as the most frequent, if not the most significant, element of administration. The influence and scope of the administration in a TRSN were described as were the ways in which these endeavors are pursued and supported. The findings will be of benefit to anyone interested in promoting and improving nursing scholarship.
Belief Systems Which Influence Research in Nursing: Implications for Preparing Future Investigators
Authors: Arnold Jean M , Sherwen Laurie N
Published: April 2021

ABSTRACT

In the view of the authors, students enrolled in their first research course should become aware of the different belief systems held by investigators about research. All nurse researchers, including faculty who teach undergraduate research courses, have either consciously or unconsciously adopted a belief system. That philosophy determines what the educator sees as appropriate nursing theory, research questions, research designs and methods for nursing inquiry. Students may be confused by the apparent discrepancies in the content and methods of teaching a research course between two and among faculty who possess divergent philosophical views. They should be aware of some of the important belief systems which can influence theory development and research in nursing in order to use nursing research in clinical practice.

Two dichotomous belief systems influencing approaches to the study of the phenomenon of pain are discussed: Empiricism and Phenomenology. Teaching strategies which help students know and appreciate different philosophical orientations are proposed. Finally, a rationale for including this content within an undergraduate research course will be given.