bluuebunny/crossref_metadata_2025 huggingface dataset:
Research Application: Teaching Staff Nurses to Use Library Search Strategies
Authors: Stephens Lana C , Selig Cindy L , Jones L Colette , Gaston-Johansson Fannie
Published: April 2021

ABSTRACT

Journal reading is a major mechanism for disseminating research but much goes unread by practicing nurses. A survey revealed the 10 most frequently read journals are primarily of a clinical/technical nature. To encourage reading of research, we organized a series of library sessions to familiarize nurses with the library and modern search strategies. Over half of the 77 nurse participants indicated they had not visited the library in six months and were less than confident in their library skills. Hands-on experiences, including computerized literature search, gave nurses an opportunity to learn techniques for locating research articles.
Effective Screening and Orientation of Independent Contract Nurses
Authors: Leidy Karen
Published: April 2021

ABSTRACT

The numbers of nurses working in independent contract positions are increasing. This article describes the development of a preemployment screening tool and an efficient, cost-effective orientation for independent contract nurses who may work infrequently or for short duration. The success of the orientation is attributed to a high degree of learner involvement, decreased orientation time, and focusing on essential "need to know" information.
Assessment of Continuing Nursing Education Needs: A Literature Review
Authors: Kristjanson Linda J , Scanlan Judith M
Published: April 2021

ABSTRACT

Continuing education (CE) literature is replete with disagreement and confusion regarding the value and methods of conducting needs assessments for nurses. Literature that describes the usefulness of needs assessment ranges from fuzzy rhetoric to sound empirical studies of learners' needs. Sorting through the numerous articles is a difficult and tedious task for the CE planner. In addition, the lack of consistency in the writings makes comparison of needs assessment findings onerous. This article presents a synthesis and critical analysis of the needs assessment literature in nursing. One hundred and thirty-two articles and books were reviewed, and four major themes emerged from the analysis.
Consulting for Quality CE
Authors: Kopper Judith A
Published: April 2021

ABSTRACT

The consultant's role in continuing education (CE) is presented and discussed from a variety of perspectives. This article proposes that using a consultant will enhance the quality of continuing education and be cost effective at the same time.

The steps to be taken to select a consultant include: determining the consultant's role, acquiring a content or process expert, and finalizing the contractual agreement. The American Nurses Association (ANA) criteria for CE offerings are provided as a reference table. Emphasis throughout the article is on how to obtain quality service at a minimal cost.
Program Characteristics Influencing Nurse Selection of CE Offerings
Authors: Craft Martha J , Heick Merle , Richards Beverly , Murray Judith , Lathrop Nancy , Reed Sandra
Published: April 2021

ABSTRACT

The purpose of this study was to identify program characteristics that influence decisionmaking in the selection of continuing education (CE) offerings by registered nurses licensed in a state with mandatory CE. A sample of 238 nurses were asked to identify the level of importance for 35 CE program characteristics on a Likert-like scale. The data indicated that all characteristics were of some importance to participants, with high levels of importance given to items demonstrating professional values. The findings suggest that even though CE may be mandatory, nurses still select educational offerings on the basis of quality and contribution to their professional practice.
A Comparison of Educational Methods to Enhance Nursing Performance in Pain Assessment
Authors: McNaull Faye W , McLees Joanne R , Belyea Michael J , Clipp Elizabeth C
Published: April 2021

ABSTRACT

The purpose of this study was to identify an effective method of teaching nurses to assess and document pain severity using a numerical rating scale prior to narcotic administration. Nurses received a combination of educational methods. Although overall nurse performance using the pain scale was low, nurses receiving video were significantly more likely to use the scale, a finding that remained significant after controlling for nurses' education and years of experience, and for patient age and acuity.
Interactive Television Presentation Style and Teaching Materials
Authors: Hegge Marge
Published: April 2021

ABSTRACT

Special teaching techniques and presentation style are required for an effective telecourse. This article describes modification of a traditional graduate nursing course for televised delivery to remote students. Teacher appearance and behaviors as well as student activities for telecourses are proposed.
Sexual Harassment: Perspectives from the Past, Present Practice, Policy, and Prevention
Authors: Goodner Ellen D , Kolenich Diane B
Published: April 2021

ABSTRACT

During the times of Florence Nightingale, elements of sexual harassment were evident and were addressed in her writings. The more recent Anita Hill-Clarence Thomas judicial hearings brought more attention to the issue. It is imperative that hospitals and their staff development departments have a clear understanding of what constitutes sexual harassment so that effective policies can be implemented. Preventive training can be implemented to avoid absenteeism, staff turnover, lost productivity, decreased quality of patient care, and exorbitant legal costs.
Structured Controversy Versus Lecture on Nursing Students' Beliefs About and Attitude Toward Providing Care for Persons with AIDS
Authors: Pederson Carol
Published: April 2021

ABSTRACT

Like many nurses in clinical practice, a small sample of RN-to-BSN nursing students reported their negative attitude toward providing care for persons with AIDS (PWAX Structured controversy is an interactive educational approach that may promote positive attitudes. This experimental study compared the effectiveness of structured controversy with lecture on BSN students' beliefs about and attitude toward providing care for PWA. A questionnaire, based on Ajzen and Fishbein's (1980) theory of reasoned action, was completed by 51 BSN students following an AIDS class session, and by nursing faculty. When compared with students who had listened to the lecture, students who had participated in structured controversy were more positive in general, and were significantly more positive on individual attitude and belief items. Faculty perceptions of these nursing students' beliefs and attitudes were less positive than the students' actual beliefs and attitudes.
Clinical Ladder Development: Implementing Contract Learning
Authors: Kreider Mary C , Barry Margaret
Published: April 2021

ABSTRACT

Expanding the clinical ladder concept in nursing at the Presbyterian Hospital in New York prompted the Department of Education, Research, and Development to further implement contract learning as an innovative adult education technique. The process was applied in orienting new Clinical Nurse IIs (experienced nurse preceptors) and Clinical Nurse IIIs (assistants to the Nursing Care Clinicians) to their advanced clinical roles. The process of implementation, the development of learning contracts, and the week-long workshop designed for each of the new clinical leaders is discussed.
Don't Go 'Way, It's Time to Play . . . The Safety Game!
Authors: Roberts Carol , Rondestvedt Janice
Published: April 2021

ABSTRACT

In an attempt to decrease the amount of time and dollars spent while increasing positive staff response, Emanual Hospital in Portland, Oregon, developed a game format to review required safety information. The game was piloted, then presented to the hospital's safety committee where it was approved as part of the hospital's education program. The game has significantly increased the percentage of staff participation in required classes. At the same time, cost of presenting the classes has decreased significantly.
Critical Thinking: A Foundation for Consumer-Focused Care
Authors: Snyder Marsha
Published: April 2021

ABSTRACT

Both providers and recipients of health care services are now focusing attention on not only what is provided but also how services are provided. The goal is consumer satisfaction, with pressure on the provider of services to meet customer demands. This shift in focus challenges the knowledge and skills of nurses, and their ability to solve problems in collaboration with their customers. To provide consumer-focused care, nurses will need to develop critical thinking skills that utilize logical/analytical and intuitive/creative approaches to solving problems. Critical thinking skills that integrate these two approaches will provide practitioners expertise in flexible, individualized, and situation-specific problem solving. Nursing staff who are able to focus on the consumer will be better prepared to meet the demands of today's competitive health care market. The challenge facing educators is to prepare nurses with a foundation from which to provide this care.
Personal Reflections
Authors: Braceland Francis J
Published: April 2021

On Comprehensive Cardiac Rehabilitation
EDITORIAL
Authors: Anonymous
Published: April 2021

"Crabbit Old Woman" - Popular Old Woman
CHONDROSARCOMA OF THE FOOT: A REPORT OF THREE NEW CASES PLUS A REVIEW OF THE MEDICAL LITERATURE
Authors: Wu Kent K , Guise Edwin R
Published: April 2021

ABSTRACT: Our paper presents three new cases of chondrosarcoma of the foot and a clinical analysis of all the known cases of similar tumors. We feel that surgery is still the treatment of choice and recurrence and metastases are uncommon following adequate surgical treatments.
OPERATIVE ARTHROSCOPY FOR THE TREATMENT OF PROBLEMS OF THE MEDIAL COMPARTMENT OF THE KNEE
Authors: Del Pizzo Wilson , Fox James M , Blazina Martin E , Friedman Marc J , Loos William C
Published: April 2021

ABSTRACT: This study reports early results in patients who underwent operative arthroscopy involving the medial compartment of the knee. The patients were selected because they had meniscus and articular lesions associated with middle age. Visualization of defects was via video camera and television screen. Triangulation was the main technique used for operative arthroscopy. Results were classified as Good (67%) Fair (20%), or Poor (13%). Marked arthritis involving the medial compartment was felt to account for the final result in nearly all of the patients in the Fair and Poor groups. The report concludes that operative arthroscopy is generally well tolerated. In this group of patients the results depended on the amount of arthritis. The greater the amount of arthritis in the knee, the worse the result. The results in these middle-aged patients are comparable with those achieved by formal arthrotomy in similar groups.
TUBERCULOUS TENOSYNOVITIS OF THE HAND ("COMPOUND PALMAR GANGLION"): LITERATURE REVIEW AND CASE REPORT
Authors: Borgsmiller William K , Whiteside Leo A
Published: April 2021

ABSTRACT: Tuberculous tenosynovitis of the wrist or "compound palmar ganglion" is an uncommon lesion that requires early recognition and treatment for the best possible prognosis. It is an infrequent cause of chronic inflammation of the tendon sheaths about the hand and wrist, but it can destroy the enclosed tendons. A definite diagnosis can be made only through biopsy and culture. Proper treatment includes early complete excision of the diseased tissue with appropriate chemotherapy postoperatively. With proper early treatment a favorable prognosis can be expected for what otherwise might be a devastating disease.
EXPANDED SPECTRUM OF ORGANISMS CAUSING OSTEOMYELITIS AFTER PUNCTURE WOUNDS OF THE FOOT
Authors: Congeni Blaise L , Weiner Dennis S , Izsak Eugene
Published: April 2021

ABSTRACT: Although there is a general awareness developing about the role of Pseudomonas aeruginosa in producing osteomyelitis following puncture wounds of the foot, it is not generally appreciated that other organisms may gain access to the bones of the foot following penetrating injuries. This paper addresses two additional cases of osteomyelitis produced by organisms other than Pseudomonas, and characterized by the same indolent course. It is emphasized that puncture wound osteomyelitis generally requires surgical intervention, not only for proper diagnosis, but for evacuation of the infective process.
COMPLICATIONS OF OSTEOTOMIES ABOUT THE KNEE IN CHILDREN
Authors: Mycoskie Philip John
Published: April 2021

ABSTRACT: Eighteen years experience performing osteotomies about the knee in children is reviewed. The underlying pathology producing the angular deformity included rickets, Blount's disease, epiphyseal and metaphyseal injuries, physiologic angulation, benign tumors, cartilage disorders, and muscle imbalance due to polio, meningomyelocele, cerebral palsy, and soft tissue tumors. Sixty-five procedures were performed by a variety of techniques with the majority being on the proximal tibia.

Postoperative complications were numerous with 63% of the patients having one or more. These complications included loss of alignment, vascular complications, pathologic fractures, wound infection, anterior and posterior angulation at the osteotomy site, tibial tubercle prominence and patellofemoral malalignment.

A thorough understanding of the underlying disease process and its usual clinical course, an appreciation of the pertinent surgical anatomy, and an awareness of the potential complications are all needed to obtain the best results when dealing with angular deformities about the knee in children.
CALCULATION OF DISABILITY USING THE CYBEX II SYSTEM
Authors: Simmons James W , Rath Diane , Merta Richard
Published: April 2021

ABSTRACT: The determination of how much disability should be assigned a patient has been a point of contention in many clinics and numerous court trials involving workmen's compensation and personal injury cases. The Cybex II* isokinetic system can produce objective data which, when used in a disability formula, can take the guesswork out of disability evaluation. It will also reduce legal and medical confusion regarding the determination.
RADIOLOGIC CASE STUDY
Authors: Silberstein M J , Brodeur A E , Graviss E R , Sundaram M
Published: April 2021

DIAGNOSIS: Congenital Generalized Fibromatosis
High-Performance Activity With Below-Knee Cast Treatment, Part II: Clinical Application and The Weak Link Hypothesis
Authors: Nuzzo Roy M
Published: April 2021

ABSTRACT: High-performance casting methods offer a different approach to treating a variety of ailments. Because this approach has excellent patient acceptance, it can be used when more aggressive treatments are undesirable or refused. Observations made during six years of experience with high-performance casting and orthotic management are divided into clinically related groups. These clinical groupings cross conventional diagnostic boundaries. Success depends upon careful patient selection, which, in turn, requires both a detailed history and the seeking of subtle physical signs. The practical details of high-performance cast application are described for each group. Although specific cases so treated have had spectacular results, many of the clinical groupings remain hypothetical, in recognition of the need for a wider experience over a longer span of time. If a casting technique that leaves the patient fully functional is available, treatment methods for a variety of ailments can be reconsidered. In so treating patients with orthotics and casts over the last six years, the author has made a series of observations that have evolved into a rather simple and unifying theory that may prove useful to the clinician.
Operative Treatment of Subtrochanteric Fractures
Authors: Munson Mark
Published: April 2021

ABSTRACT: Sixty-four patients with subtrochanteric fractures of the femur treated with internal fixation are reviewed. Twenty-six patients treated with Jewett nails are compared to 23 patients treated with Zickel nails. Total length of hospital stay, time to union, and time to full weightbearing were similar between the two groups. Six patients treated with Jewett nails had loss of fixation or failure of union, compared to only one patient in the Zickel nail group. The comminuted subtrochantericfracture adjacent to the lesser trochanter was frequently associated with complications in the elderly patient.
Hepatocellular Carcinoma Presenting as a Solitary Metastasis to the Scapula: Case Report and Review of the Literature
Authors: Zeller John L , Ireland Mary L
Published: April 2021

ABSTRACT: Although primary hepatocellular carcinoma is uncommon, metastasis to the upper extremity as a presenting symptom is even more rare. Recent case reports and autopsy surveys document that extrahepatic spread of this carcinoma occurs in 30% to 78% of patients, who usually are without regional symptoms involving bone. Although metastatic spread to the lungs and lymph nodes occurs more commonly, the incidence of bone metastases has increased according to previous reports and is now estimated from 2% to 13%. This case report concerns widely disseminated hepatocellular carcinoma presenting initially without any other systemic signs except for shoulder pain and induration. Due to the aggressive nature of this tumor, early detection is crucial. Early diagnosis may offer the only real hope for establishing effective treatment and improving the chances for long-term survival.
Early Post-Surgical Prosthetic Fitting With a Pre-Fabricated Plastic Limb
Authors: Kraker David , Pinzur Michael S , Daley Robert , Osterman Helen
Published: April 2021

ABSTRACT: Early prosthetic fitting and independent ambulation are major goals in the rehabilitation of amputees with early walking being extremely valuable in the physical and psychosocial rehabilitation of the amputee. With early resumption of weight bearing and ambulation, deterioration of postural reflexes can be prevented and the residual limb (stump) can be shaped for definitive prosthetic fitting. A new temporary prosthesis was evaluated in its use on new below-knee amputees. The prosthesis is a plastic, hollow form which fits over the conventional rigid, plaster postoperative dressing. It comes in one size and is cut to fit the patient. The prosthesis is readily available, needs little training for its application, can be re-used, and is inexpensive. Twenty-two consecutive patients treated at Hines Veteran's Administration Hospital and Loyola University Medical Center underwent below-knee amputations. All were determined to be potential walkers. The average age at surgery was 61 years with a range of 17 to 74 years. Amputation was performed for trauma in two patients and gangrene in the other 20. All wounds were dressed with conventional rigid, plaster dressings with cast changes five days postoperatively. The pre-fabricated temporary prosthesis was applied at the second cast application at an average of 8.1 days postoperatively with permanent prosthetic fitting at 7.7 weeks. There were no complications related to the use of the plastic temporary prosthesis. The use of a new plastic temporary prosthesis has been found to be advantageous in the early rehabilitation of below-knee amputees.
Treatment of Upper Extremity Reflex Sympathetic Dystrophy With Joint Stiffness Using Sympatholytic Bier Blocks and Manipulation
Authors: Duncan Kenneth H , Lewis Royce C , Racz Gabor , Nordyke Mark D
Published: April 2021

ABSTRACT: Twenty patients with reflex sympathetic dystrophy involving the upper extremity with associated joint stiffness were treated by manipulation under Bier blocks composed of lidocaine, methylprednisolone, and reserpine or guanethidine. Depending on the patients' response, repeat blocks were performed at 48to 72-hour intervals. Range of motion in the affected joints (primarily the hand and wrist) improved from a pre-block mean of 46% to 61% of normal following the blocks. Patients also reported an 80% mean improvement in their pain. The treatment of advanced reflex sympathetic dystrophy using joint manipulation under sympatholytic Bier blocks appears to be a safe and effective method of treatment.
Infraclavicular Median Nerve Compression Caused by a Lipoma
Authors: Weinzweig Norman , Browne Earl Z
Published: April 2021

ABSTRACT: The most common site of median nerve compression is in the carpal tunnel, the most common of all entrapment neuropathies. Less frequent entrapment neuropathies of the median nerve include the anterior interosseous and pronator syndromes in the proximal forearm. Even less commonly seen is entrapment at the infraclavicular segment of the brachial plexus. Median nerve compression at the level of the axilla has been reported as being caused by anomalous axillary arch muscles, anomalous vascular perforations of the nerve or its roots, the pectoralis minor muscle, and a thickening of the deltopectoral fascia. To the authors' knowledge, this is the first report of compression at that level by a benign tumor.
ANSWER PLEASE
Authors: Pascale Mark S , Grana William A
Published: April 2021

Salter-Harris II Fracture of the Metacarpal Neck
Evaluation of Reimplant Total Hip Prostheses and Resection Arthroplasty
Authors: Pazzaglia Ugo E , Ghisellini Franco , Ceffa Remo , Riccardi Carlo , Ceciliani Luciano
Published: April 2021

ABSTRACT: Results of reimplanted total hip prostheses and resection arthroplasty were compared. Using the Iowa hip rating scale, the reimplanted prostheses population was rated higher for function, gait, and absence of deformity, however, the resection arthroplasty population rated better in freedom from pain. Radiographic findings in the reimplanted prostheses population included radiolucent lines around the cement, loosening, and cortex bone stock loss. These findings cause concern for the future of these implants. Repair and remodeling of the bone lesions were observed in resection arthroplasties. It was concluded that if healing of infection is achieved or if resection is performed for mechanical failure, the results may be considered permanent.
Prophylaxis of Deep Venous Thromboembolism: Literature Review
Authors: Gold Edward W
Published: April 2021

ABSTRACT: The prophylaxis of deep venous thrombosis is critically related to potentially lifethreatening pulmonary embolism. Each of the available agents has benefits and drawbacks which are reviewed in this article. While the search for the ideal method of prophylaxis continues, the appropriate agent appears to be one that balances the risk of complication with the potential risk of development of thromboembolism. Recommendations for acceptable prophylaxis are made for various procedures.
Complex Shoulder Trauma: Three-Dimensional CT Imaging
Authors: Kuhlman Janet E , Fishman Elliot K , Ney Derek R , Magid Donna
Published: April 2021

ABSTRACT: Volumetric three-dimensional imaging is a new technique for CT image processing which generates realistic, three-dimensional models of complex musculoskeletal anatomy from routine transaxial CT data. Volumetric three-dimensional imaging is particularly helpful in evaluating complex shoulder trauma, demonstrating significant advantages over plain film radiography. Multipartite fractures involving the shoulder girdle are displayed in a comprehensive fashion with 3D imaging. With volumetric imaging as implemented on a Pixar Imaging Computer, a 3D model of the injured shoulder can be generated with overlapping structures removed from view, and then rotated about the vertical and horizontal axis for better understanding of abnormal anatomy prior to surgical correction.
Arthroscopy in Diagnosis and Treatment of Hip Disorders
Authors: Frich Lars Henrik , Lauritzen Jørgen , Juhl Magne
Published: April 2021

ABSTRACT: Fourteen hip arthroscopies between January 1985 and May 1988 were reviewed. Included were ten women and four men with an age ranging from 12 to 76 years. Indications were avascular necrosis; loose bodies; osteoarthrosis, arthritis, or pain; and snapping hip. The diagnosis was verified in five cases, including arthroscopic removal of a loose body in one and resection of a plica bridging the space between the femoral head and acetabular roof in two patients. The diagnosis was rejected in three cases. In five cases, no pathologic changes were found. One arthroscopy was inconclusive because of a narrow field of vision in a dysplastic hip. No serious complications occurred. Hip arthroscopy is useful in diagnostics and surgical treatment of selected hip disorders. The rehabilitation time is short. Hip arthroscopy is, however, a technically demanding procedure.
The Structure and Development of Osteogenetic Repair Tissue According to Ilizarov Technique in Man: Characterization of Extracellular Matrix
Authors: Tajana G F , Morandi Massimo , Zembo Michele M
Published: April 2021

ABSTRACT: Distraction osteogenesis by the method of Ilizarov has permitted the study of bone formation. This is an analysis of 64 human biopsies in patients who were undergoing tibial lengthening by the method of Ilizarov. After analysis by conventional and polarized light microscopy, four stages of bone formation were identified. Bone formation is of the direct type with no cartilaginous phase.
Synthetic Biomaterials for Spinal Fusion
Authors: Nasca Richard J , Lemons Jack E , Deinlein Donald A
Published: April 2021

ABSTRACT: Calcium hydroxylapatite (HAP), tricalcium phosphate (TCP), and Bioglass (BG) were implanted in the spines of dogs to determine their potential in augmenting and enhancing spinal fusion. HAP and TCP showed continuous bone to biomaterial interfaces of varying degrees. Trabecular bone surrounded and incorporated the particulate hydroxylapatite. Tricalcium phosphate ceramic showed little evidence of resorption. The glass particulate, BG, showed a thin, fibrous encapsulation with some adjacent bony trabeculae. Decortication and autogenous bone enhanced incorporation. This multivariant initial study showed that trends found for the biomaterials implanted independently were similar to those used in combination. No adverse tissue reactions were noted for the combination of materials.
Low Dose Dextran 40 in Reconstructive Hip Surgery Patients
Authors: Roberts Thomas S , Nelson Carl L , Barnes C Lowry , Boone David W , Ferris Ernest J , Holder John L
Published: April 2021

ABSTRACT: Preoperative and postoperative bilateral lower extremity venography was used to evaluate the efficacy of low dose dextran 40 in prophylaxis of deep venous thrombosis in reconstructive hip surgery patients. Patients were given dextran 40 at 50 cc/hr, with 250 cc given perioperatively and 500 cc given on postoperative days two and four. Five of 227 patients had positive venograms preoperatively. Of these 227 patients, 179 met protocol requirements and had venography postoperatively. Venous thrombosis occurred in 33 (18%) of those studied postoperatively. Of these, 11 were calf clots without extension to the popliteal region. Therefore, there were 22 patients (12%) with femoral or popliteal involvement overall. There were two deaths, neither of which was secondary to pulmonary embolus or a complication of dextran. There were two wound complications. These results suggest that low dose dextran 40 administered as indicated is a safe and efficacious means of deep venous thrombosis prophylaxis in reconstructive hip surgery patients.
Single-Vessel Forearm Arterial Repairs: Patency Rates Using Nuclear Angiography
Authors: Stricker Stephen J , Burkhalter William E , Ouellette Anne E
Published: April 2021

ABSTRACT: Nuclear angiograms were used to determine early and delayed patency rates following primary microvascular repair of 12 radial and 24 ulnar arteries in 36 patients. All patients had nuclear angiograms within 1 week after repair, demonstrating an early patency rate of 86.1%. Nineteen patients had additional nuclear angiograms at various intervals from 30 days to 2 years, showing a delayed patency rate of 68.4% at an average of 5.4 months follow up. Survival analysis showed that patency fell steadily during the first 90 days postoperatively, after which no further arterial occlusions occurred. Patency rates were not significantly affected by age or sex of the patient, level of forearm injury, total tourniquet time, treatment delay, or the diameter of nylon suture used for arterial repair. At follow up, there were statistically insignificant trends for higher patency rates in patients with partial vessel lacerations and in nonsmokers.
Value of Continuous Passive Motion in Total Knee Arthroplasty
Authors: Wasilewski Stephen A , Woods Lee C , Torgerson William R , Healy William L
Published: April 2021

ABSTRACT: Two methods of rehabilitation after 91 total knee arthroplasties in 74 patients were reviewed. Patients in each group were well matched for age, sex, and diagnosis. Forty-four knees in 39 patients were treated with conventional physiotherapy, consisting of 3 days of immobilization followed by a program of active assisted range-of-motion exercises. Forty-seven knees in 41 patients were placed in a continuous passive motion machine immediately after operation. Other aspects of preoperative, intraoperative, and postoperative care were identical in both groups.

Patients in the continuous passive motion group were found to have a lower incidence of complications, especially of wound healing problems and thromboembolic disease. Analgesic use in patients in the continuous passive motion group was reduced. Straight leg raising was achieved slightly earlier in patients in the continuous passive motion group (4.9 days) compared with patients not treated with continuous passive motion (5.2 days). Although the range of motion of the knee at discharge from the hospital in patients in the continuous passive motion group was greater (91°) compared with patients not treated with continuous passive motion (81°), the range of motion in both groups at ultimate follow up was equivalent. However, when knee-rating scores were considered, patients treated with continuous passive motion averaged 9 points higher on a 100-point scale than patients not treated with continuous passive motion. In addition, the length of hospital stay for patients in the continuous passive motion group was 2.1 days shorter.

We concluded that continuous passive motion was an effective adjunct to physiotherapy in the postoperative care of patients undergoing total knee arthroplasty. The benefits included improved wound healing, a decreased number of thromboembolic events, decreased analgesic use, and a higher ultimate knee score. We also concluded that the use of continuous passive motion had little effect on the ultimate range of motion of the knee after arthroplasty.
TIMING OF WOUND CLOSURE IN SEVERE COMPOUND FRACTURES
Authors: Ostermann Peter A W , Henry Stephen L , Seligson David
Published: April 2021

ABSTRACT

In a consecutive series of 1085 open fractures treated from May 1983 to July 1992, 381 severe compound fractures in 335 patients were managed with the antibiotic bead pouch technique. There were 27 grade I (marked swelling, compartment syndrome), 115 grade II, and 239 grade III open fractures (94 type IIIA, 114 type IIIB, and 31 type IIIC). These fractures were managed with early administration of broad spectrum antibiotics, copious wound irrigation, serial debridements, and external skeletal stabilization. TobramycinPMMA beads were placed in the wound, and porous plastic film (Opsite, Smith and Nephew Medical, Limited, Hall, England) covered the soft tissue defect. This dressing was changed every 48 to 72 hours until wound coverage/ closure could be obtained. Infection rate, either on an acute or chronic basis, was 2.6% in grade II open fractures and 8.4% in grade III compound fractures. There was no infected wound or bone in the grade I category. Those fractures that did not develop an infection were closed at a mean time of 7.6 days; those that developed an infection were closed at a mean time of 17.9 days. The difference was statistically significant (P<0.001). When severe open fractures are managed with the antibiotic bead pouch technique, wound closure should be obtained within 1 week to prevent infectious complications.
SHOULDER PYARTHROSIS: A CONCOMITANT PROCESS
Authors: Ward William G , Goldner Richard D
Published: April 2021

ABSTRACT

Thirty cases of glenohumeral pyarthrosis are reported. Systemic immune compromise and local tissue abnormalities were each present in 74% of the adult patients. Both were present in 52%. Most adult patients were debilitated by chronic diseases. Diagnosis was frequently delayed due to mild symptoms and minimal, nonspecific laboratory findings. Poor results correlated with treatment delay. Shoulder pyarthrosis occurred ipsilateral to forearm arteriovenous dialysis fistulas in four patients. Postoperative shoulder pyarthroses were eradicated only in patients with clinically intact immune systems. Three patients (10%) with intact rotator cuffs had unsuspected associated subacromial bursa abscesses. Evaluation of suspected glenohumeral pyarthrosis should include evaluation of the subacromial bursa.
ANSWER PLEASE
Authors: Stansbury Neal A , Bosacco Stephen J
Published: April 2021

CAPITELLUM FRACTURES
ORTHOPEDIC SURGERY RESIDENTS AND THE CDC AND AAOS HIV PRECAUTIONARY MEASURES
Authors: Hutchinson Susan Gusich , Delene Linda M , Hutchinson Mark R , Halpern Alan A
Published: April 2021

ABSTRACT

A randomized national survey of orthopedic surgery residents concerning their knowledge, attitudes, and behaviors of the Centers for Disease Control's and the American Academy of Orthopaedic Surgeons' (AAOS) universal human immunodeficiency virus (HIV) precautionary measures was conducted. The residents' basic knowledge about the HIV precautionary measures was, in general, poor. Thirty-seven percent indicated that they were "uncertain" or "would not" care for HIV positive patients. Further, the residents' practice behaviors in many instances did not fulfill prescribed universal precautions. Sound educational and professional programs, such as those initiated by the AAOS, are needed to increase the knowledge and improve the practice behaviors of orthopedic residents.
THE VALUE OF SKELETAL SCINTIGRAPHY IN PREDICTING THE NEED FOR REVISION SURGERY IN TOTAL KNEE REPLACEMENT
Authors: Henderson J J , Bamford D J , Noble J , Brown J D K
Published: April 2021

ABSTRACT

We have reviewed the results of ^sup 99m^technetium-methylene diphosphonate (Tc-MDP) bone scintigrams performed on patients following total knee arthroplasty. In addition,
p 67
gallium (Ga) citrate scintigrams were carried out sequentially on 29 patients. Three groups of patients were identified: those with asymptomatic knees (undergoing scans for other reasons); those with aseptic or septic loosening; and those with pain without radiologic evidence of loosening. There was good correlation between the results of the scans and the final outcome. We conclude that sequential ^sup 99m^Tc-MDP and
p 67
Ga citrate scintigrams are useful for demonstrating the presence of aseptic and septic loosening in knee prostheses, and pain with a normal scan appearance is probably not due to loosening or infection.
Total Knee Arthroplasty in Paget's Disease: Technical Problems and Results
Authors: Schai Pascal A , Scott Richard D , Younger Alastair S E
Published: April 2021

ABSTRACT

Eleven total knee arthroplasties performed in 10 patients with Paget's disease were reviewed at 2 to 1 6 years postoperatively. Cemented total knee arthroplasties were performed in all cases. Range of motion improved by 21° postoperatively and the follow-up Knee Society score averaged 83 points. One knee was rated poor with a score <70 points; this knee was the only knee with a loose component. All components resting on pagetic bone had a solid interface on radiographic review at an average of SJ years postoperatively. Although technical difficulties are encountered in achieving correct alignment and exposing the knee with local Pagefs disease, good long-term outcome can be achieved.
Pediatric Vertebral and Spinal Cord Tumors: A Retrospective Study of Musculoskeletal Aspects of Presentation, Treatment, and Complications
Authors: Mehlman Charles T , Crawford Alvin H , McMath Jeffery A
Published: April 2021

ABSTRACT

Fifty-two pediatric patients with documented vertebral and spinal cord tumors were reviewed to evaluate the musculoskeletal manifestations of presentation, treatment, and management of complications. Diagnoses included 16 malignant and 36 nonmalignant vertebral and spinal cord tumors. Mean age at diagnosis was 8 years 1 month, and the male-to-female ratio was 1.7:1. Overall, there was an average delay in diagnosis of 12 months for this group of patients. Mean clinical followup was 5 years.

The two most common reasons for presentation were pain (67%) and spinal deformity (46%). Initial plain radiographs were positive in 82% of patients. Postlaminectomy spinal deformity occurred at a rate of 45% in patients undergoing laminectomies, and 60% of those with deformity required spinal fusion. Overall, 67% of the 52 patients underwent spinal fusion, with a 9% asymptomatic pseudarthrosis rate. Complications were common, with 1.9 complications per patient; 59% of complications required surgical management. There were no perioperative deaths. At follow-up, 1 9% of patients had neurologic deficits ranging from neurogenic bladder to lower extremity weakness and difficulty walking to quadriplegic. Eighty-six percent of patients were ambulating without difficulty at followup. The survival rate was 94% and the local recurrence rate was 27% at most recent follow-up.
Developments in Blood Management: The Potential Therapeutic Role for Epoetin alfa in Orthopedic Trauma
Authors: Mears Dana C , Durbhakula Sridhar M , Miller Bernadette
Published: April 2021

ABSTRACT

Orthopedic trauma is a major source of morbidity and mortality in the United States and other countries. Major orthopédie trauma often results in significant blood loss, which is the most common cause of shock in the trauma setting. Transfusion of allogeneic blood and blood products may be used to maintain blood pressure but may not be the most effective therapy for the acute anemia that results from trauma-induced hemorrhage. Because acute anemia can interfere with successful and timely rehabilitation of these patients, it is important to be aggressive in treating anemia. One approach is to administer Epoetin alfa to stimulate erythropoiesis. A pilot study is currently in progress to test the efficacy of this approach in major trauma patients.
Head and Neck Replacement Prostheses in Revision Hip Arthroplasty: Experience With a Single Modern Design
Authors: Clarke Henry D , Damron Timothy A , Trousdale Robert T , Sim Franklin H , Larson Dirk R
Published: April 2021

ABSTRACT

This study reviewed 52 revision hip arthroplasties in which calcar cortical deficiencies were addressed by implantation of a cemented, modern-design head and neck replacement femoral prosthesis. Mean clinical follow-up was 38 months. Radiographic follow-up beyond 22 months was available for 34 patients (mean: 35.8 months). Mean Mayo clinical hip score (maximum; 80) improved from 28.2 preoperatively to 55.2 at last follow-up. No femoral component was revised for aseptic loosening. However, radiographic analysis demonstrated one prosthesis was probably loose and two were possibly loose. A 92.7% Kaplan-Meier 5-year implant survival rate free from radiographic loosening was projected. This type of prosthesis has yielded good clinical results and excellent early survival.
Sterilization of Contaminated Bone-Tendon Autografts Using 10% Povidone-Iodine Solution
Authors: Stanford Ralph , Solomon Michael , Levick Mark , Kohan Lawrence , Bell Sydney
Published: April 2021

ABSTRACT

This study evaluates methods of sterilizing contaminated bone-tendon autografts using 10% povidone-iodine solution. Sterile grafts were prepared from human cadavers. Grafts were immersed in a suspension of either Staphylococcus aureus or Pseudomonas aeruginosa, and three sets of sterilization experiments were performed in 10% povidone-iodine for 30 minutes: one each with S aureus and P aeruginosa by static soaking and a third with S aureus by serial washing with agitation.

Of grafts inoculated with S aureus, six of six grew the test organism after soaking at room temperature, as did five of six after soaking at 36°C and also eight of nine after washing with agitation. Of grafts inoculated with P aeruginosa, five of six grew the test strain after soaking at room temperature, as did six of six after soaking at 36°C. Thirty minutes of exposure to aqueous 10% povidone-iodine does not adequately sterilize an inoculated graft.
Periarticular Neural Elements in the Shoulder Joint
Authors: Guanche Carlos A , Noble John , Solomonow Moshe , Wink Carole S
Published: April 2021

ABSTRACT

Due to its unconstrained nature, the glenohumeral joint must necessarily have several mechanisms to regulate its position in space. The neural mechanisms associated with this positioning have not been fully evaluated anatomically. In this study, three fresh-frozen human cadaveric adult shoulders were dissected. Specimens were excised from the proximal biceps insertion, the superior, middle, and inferior glenohumeral ligaments, and the capsule superior to the glenohumeral ligaments. In two specimens, a portion of glenoid labrum was analyzed using a modified gold chloride staining method and light microscopy. A portion of mid-biceps tendon was used as a control.

In the superior glenohumeral ligament, 45% of sections contained neural elements consisting of Golgi's, Ruffini's, and Pacini's corpuscles as well as free nerve endings. The predominant types were Ruffini's and Golgi's. The middle glenohumeral ligament sections revealed all four receptor types in 42%, with the most common elements being Pacini's and Ruffini's receptors. The inferior glenohumeral ligament specimens contained the four receptor types in 48% of sections, with Ruffini's, Pacini's, and Golgi's types equally distributed. The shoulder capsule specimens revealed Ruffini's and Pacini's receptors in 47.5% of sections. Only free nerve endings were identified in the biceps tendon and glenoid labral tissue. These findings suggest that the pattern of neural elements does not appear to be random in nature and may have some correlation with the specific functions of some of the glenohumeral ligaments.
A Practical Approach to Dealing With Bone Loss in Revision Total Knee Arthroplasty
Authors: Lucey Stephen D , Scuderi Giles R , Kelly Michael A , Insall John N
Published: April 2021

With current techniques and improved instrumentation to deal with bone loss, surgeons can obtain reproducibly good results.
Control of Bone Bleeding at the Sternum and Iliac Crest Donor Sites Using a Collagen-Based Composite Combined With Autologous Plasma: Results of a Randomized Controlled Trial
Authors: Sherman Randy , Chapman William C , Hannon Gwen , Block Jon E
Published: April 2021

ABSTRACT

In a randomized controlled trial, hemostatic effectiveness of a collagen-based composite (experimental group) was compared with standard hemostatic methods (ie, electrocautery and collagen sponge) (control group) at two bone sites. Hemostatic success, time to "controlled bleeding," and time to "complete hemostasis" were determined at the sternal edge following median sternotomy (n=64) and at the iliac crest following bone graft harvest (n=19). Almost twice the percentage of sternal edge patients (83% versus 44%, P=.QQ2) and nearly three times the percentage of iliac crest patients (83% versus 29%, P<.05) achieved complete hemostasis in the experimental group compared to controls. Time to controlled bleeding and complete hemostasis for all bone sites also favored the experimental group over the control group at highly significant levels (P<.0001 for most comparisons). There were no adverse events related to experimental treatment use. The results support the use of this investigational hemostatic agent to control cancellous bone bleeding.
Treatment of Lumbosacral Radicular Pain With Epidural Steroid Injections
Authors: Papagelopoulos Panayiotis J , Petrou Haralambos G , Triantafyllidis Pantelis G , Vlamis John A , Psomas-Pasalis Maria , Korres Demetrios S , Stamos Konstantinos G
Published: April 2021

ABSTRACT

Fifty patients with an average age of 47 years received epidural steroid injections for lumbosacral radicular pain due to disk herniation or spinal stenosis. All patients had failed previous conservative treatment. Mean follow-up was 24 months (range: 12-36 months). Immediately after injection, all 50 patients reported various degrees of relief from leg and back pain. At the last follow-up examination, 68% of patients were asymptomatic, 20% had no change in preinjection radicular symptoms, and 12% had various degrees of relief. No significant correlation was found between pain relief, age, or number of injections. Early pain relief may be anticipated after epidural steroid injections in 80% of patients with radicular symptoms due to disk herniation or spinal stenosis.
Impending or Completed Pathologic Femur Fractures Treated With Intramedullary Hip Screws
Authors: Favorito Paul J , McGrath Brian E
Published: April 2021

ABSTRACT

This study examined the use of the long intramedullary hip screw in 13 consecutive patients with metastatic disease of the femur with impending or completed fractures. There were 6 impending and 7 completed fractures. Eleven of 13 patients had unreamed rods placed with an average operative time of 100 minutes and blood loss of 280 cc. Eleven of 12 patients who were able to ambulate preoperativery regained that status postoperatively. Postoperative complications included death (1), myocardial infarction (1), and urinary tract infection (2). These results indicate the long intramedullary hip screw is a safe and effective surgical device for treating metastatic disease of the femur.
Operative Treatment With Radial Shortening in Kienböck's Disease
Authors: Wintman Bruce I , Imbriglia Joseph E , Buterbaugh Glenn A , Hagberg William C
Published: April 2021

ABSTRACT

Eighty-eight patients underwent radial shortening for Kienböck's disease. Prerequisites for surgery were radiographic studies positive for Kienböck's disease without evidence of radiocarpal arthritis and wrist pain unrelieved by conservative management. Thirty-nine patients were evaluated by subjective questionnaire at a mean postoperative follow-up of 86 months (range: 24-188 months). Following surgery, a significant decrease was noted in pain severity, frequency, and duration. Functional status improved postoperatively, with the most significant gains noted in the following activities: opening jars, opening car doors, carrying bags, and shoveling. Only 3 of 34 patients employed outside the home were unable to return to their original occupations due to their wrist problems. Seventy-six patients were evaluated by physical examination at a mean postoperative follow-up of 31 months (range: 3-87 months). Objective evaluation by physical examination revealed a significant improvement in wrist motion and grip strength. Seventy-seven patients underwent radiographic evaluation at a mean postoperative follow-up of 31 months (range: 3-180 months). A significant progression in Lichtman stage of Kienböck's disease was noted despite the favorable subjective findings and high satisfaction ratings. Thirty-six of 39 patients stated they would undergo the surgery again. The long-term data demonstrate radial shortening in patients with stage II-IIIA Kienböck's disease provides substantial improvement over preoperative status.