bluuebunny/crossref_metadata_2025 huggingface dataset:
PROPHYLACTIC CERCLAGE: A METHOD OF PREVENTING FEMUR FRACTURE IN UNCEMENTED TOTAL HIP ARTHROPLASTY
Authors: Herzwurm Paul J , Walsh John , Pettine Kenneth A , Ebert Frank R
Published: April 2021

Abstract

The incidence of femur fracture in noncemented hip arthroplasty has been reported to be between 4.1 % and 27.8%. To quantitate the hoop stress generated during insertion of a femoral broach in total hip arthroplasty and determine the effect of cerclage with both braided cable and wire, we harvested 14 pairs of embalmed cadaver femurs. These were reamed and broached to duplicate the surgical technique of inserting a straight non-cemented femoral component. Group one consisted of eight matched cadaver femurs which were tested using a single 2.0 mm chrome-cobalt cable placed around the calcar of one femur, with the other serving as a control. Group two consisted of five matched cadaver femurs which were tested using a single 18 gauge cerclage wire in the same manner. In group one, the femurs serving as controls were found to have a mean microstrain of (1425.00 ± 1 180.19). The eight femurs tested with a 2 mm cable were determined to have a mean microstrain of (4179 + 2853.89).

In group two, the femurs serving as controls were found to have a mean microstrain of (962.60 ±956.78). The five femurs in group two tested with a cerclage wire were determined to have a mean microstrain of (1112.00 ±975.66). Using a paired t-test, statistical significance was achieved with a confidence level of P=s.01 in group one. Prophylactic wiring of the proximal femur with 2 mm cable increases the hoop stress resistance and, therefore, should decrease the incidence of intraoperative femur fractures in uncemented total hip arthroplasty.
A COMPARISON OF EPIDURAL AND NON-EPIDURAL ANESTHESIA AND ANALGESIA IN TOTAL HIP OR KNEE ARTHROPLASTY PATIENTS
Authors: McQueen David A , Kelley Helen K , Wright Timothy F
Published: April 2021

ABSTRACT

This retrospective study explores a number of variables encountered with the use of either epidural or non-epidural anesthesia and analgesia. Postoperative mobility, amount of narcotic used, incidence of blood transfusion, length of stay, and presence of urinary retention, prurjtis, nausea and vomiting, or respiratory depression were compared in a group of 101 consecutive patients scheduled for total hip or knee arthroplasty. Fifty-two patients received epidural anesthesia and analgesia; the remaining 49 received nonepidural anesthesia, followed by standard IM/IV postoperative analgesia. Epidural patients required significantly less narcotic than the non-epidural group. There were significantly fewer blood transfusions in the epidural group; however, epidural patients had significantly increased incidence of urinary retention and pruritis. The use of epidural anesthesia and analgesia for total hip and knee arthroplasty patients has definite merit, but is most safely administered in a monitored, skilled nursing unit
ARTHROSCOPIC CAPSULAR SUTURE FOR ANTERIOR INSTABILITY OF THE SHOULDER
Authors: Rhee Kwang-Jin , Ahn Sang-Rho , Lee Jeong-Koo
Published: April 2021

ABSTRACT

We assessed the results of arthroscopic transglenoid capsular suture in eight recurrent traumatic unidirectional anterior dislocations. At an average follow up of 11 months, ranging from eight to 18 months, assessment by Rowe's scoring system were excellent or good in all shoulders. There were no redislocations and all patients achieved near full, painless range of motion. There were no complications. We propose a new classification of anterior capsular lesions (Bankart lesion) and we describe the details of the arthroscopic suture technique. We conclude that arthroscopic suture is an effective method with low surgical morbidity and low cost in the treatment of recurrent anterior dislocation of the shoulder.
Unstable Thoracolumbar Injuries
Authors: Willén Jan
Published: April 2021

Abstract

The treatment of thoracolumbar fractures was traditionally conservative. With increasing demands for early mobilization, operative reduction and stabilization has become more popular, even in less severe injuries. The Harrington instrumentation is still useful and efficient However, in fractures with posterior element ruptures, the internal fixator is superior in stabilizing the fracture. Early mobilization in a body cast is an equivalent treatment to surgery in less severe burst fractures if the neurology is intact. A treatment program for different fractures is presented.
GIANT CELL TUMOR OF BONE TREATED BY CURETTAGE, CEMENTATION, AND BONE GRAFTING
Authors: Pals Steven D , Wilkins Ross M
Published: April 2021

ABSTRACT

Giant cell tumor, a relatively rare, occasionally malignant tumor of bone, remains a difficult therapeutic problem for the orthopedic surgeon. Various treatment options, including curettage alone, curettage with bone grafting, radiation, and curettage with acrylic cementation have been utilized and reported. Therapeutic complications such as infection, recurrence, and loss of support of the articular surface have continued to plague the treatment of giant cell tumors. This article reports the results of 10 consecutive cases of giant cell tumor of bone treated by curettage and methyl methacrylate cementation, followed by bone grafting of the surface of the lesion with demineralized bone matrix to reconstitute the cortex at the site of the tumor. At an average follow up of 36 months, eight patients had an excellent functional result and two had a fair result as scored on the Musculoskeletal Tumor Society rating system. To date, there have been no tumor recurrences or metastases, and all patients have radiographic evidence of healing of the weight bearing cortical surface.
FRACTURES OF THE DISTAL HUMERUS
Authors: Jupiter Jesse B , Mehne David K
Published: April 2021

ABSTRACT

We present a rational approach to the classification and surgical management of intraarticular fractures of the distal humerus. The fractures are classified on the basis of the surgical anatomy of the distal humerus, which is divided into two skeletal columns held together by the trochlea. The basic surgical aim is to restore all three elements with sufficient stability to permit functional movement The surgical tactics are presented in detail.
INITIAL MECHANICAL STABILITY OF ACETABULAR PROSTHESES
Authors: Litsky Alan S , Pophal Stephen G
Published: April 2021

Abstract

Secure initial stability is crucial for prostheses designed for biological ingrowth; without it, subsequent tissue ingrowth is impossible. Mechanical testing was performed in vitro to measure the interface shear stability of acetabular cup prostheses. Cemented, threaded, finned, and press-fit cups, both with and without supplemental screw fixation, were tested. A mechanically consistent polyethylene foam was used as a substrate to obviate the variations inherent in cadaver bones. Ramped, eccentric rim loads were applied using a servohydraulic materials testing system. Reaming, insertion, and loading variables were carefully controlled. Cups with external threads were significantly more stable than those fixed by fins or screws. Pressfit cups were significantly looser than all other tested designs. None of the uncemented prostheses approached the initial stability of cups secured with acrylic bone cement.
THE DIABETIC NEUROPATHIC FOOT: A TRIPLE CRUSH SYNDROME-MEASUREMENT OF COMPARTMENTAL PRESSURES OF NORMAL AND DIABETIC FEET
Authors: Lower Raymond F , Kenzora John E
Published: April 2021

ABSTRACT

The role of chronic swelling in the feet of diabetic patients with severe neuropathy is unclear. It was hypothesized that swelling might raise the compartment pressures of the foot high enough above normal to produce nerve and soft tissue injury, ie, the triple crush syndrome. Four compartment measurements were recorded in 30 feet of 15 normal patients and in 34 feet of 20 patients with severe diabetic neuropathy and normal large vessel arterial blood flow. The lateral compartments produced unreliable results and were discarded from statistical evaluation. The mean medial compartment pressure was 7.8 mm Hg (SD 2.55) in the normal feet and 9.4 mm Hg (SD 4.08) in the diabetic feet. This was not a statistically significant difference. Highly significant differences were recorded in the interosseous and central compartments where the mean pressures were 6.4 mm Hg (SD 2.72) and 5.7 mm Hg (SD 2.89), respectively, in the normal feet and 9.3 mm Hg (SD 4.75) and 8.9 mm Hg (SD 5.0) in the diabetic feet (P<.05 for each group). Furthermore, within the diabetic group, 9 of 9 patients (100%) with clinically swollen feet had at least one compartment pressure measure two standard deviations (12 mm Hg) or greater compared with 5 of 11 (45%) in those without clinical swelling. This difference is significant (P<.01). We could not correlate elevated compartment pressures directly with soft tissue pathology. Nevertheless, we infer that the presence of increased volumes of serous fluid and significantly higher than normal compartment pressures over long periods cannot produce a healthy environment for the soft tissues of the foot.
A NEW NECK PRESERVING TOTAL HIP ARTHROPLASTY FOR THE YOUNG PATIENT
Authors: Krackow Kenneth A , Mont Michael A , Maar Dean C
Published: April 2021

ABSTRACT

A retrospective review of a femoral neck preserving custom total hip replacement was performed on seven young patients with disabling hip arthrosis. This design was created to provide greater rotational control to off-axis load and to provide greater proximal medial support to counteract varus bending forces. Eight hip arthroplasties, with a minimum follow up of 24 months, were reviewed and all had good and excellent clinical Harris scores. Presented is a treatment alternative to the standard total hip replacement.
ELECTROMYOGRAPHY AND BIOMECHANICS OF A DYNAMIC KNEE BRACE FOR ANTERIOR CRUCIATE LIGAMENT DEFICIENCY
Authors: Acierno S P , D'Ambrosia Christopher , Solomonow M , Baratta R V , D'Ambrosia Robert D
Published: April 2021

ABSTRACT

Twelve anterior cruciate ligament (ACL)-deficient subjects performed concentric isokinetic knee extensions at maximum effort both with and without the Bledsoe Pro Shifter knee brace. EIectromyogram signals from the quadriceps, hamstrings, knee angle, and the extension force were recorded and evaluated to determine the effects of such dynamic bracing on muscle activity and joint stability. High activity, or asymptomatic, subjects (n=5) experienced no change in muscle activity, but displayed a decrease in extension force throughout the active range of the brace. Low activity, or symptomatic, subjects (n=7) exhibited increased quadriceps activity and decreased hamstrings activity, and displayed a minor increase in force in the mid-range (80° to 40° flexion). These results indicate that dynamic bracing prevents quadriceps inhibition in symptomatic subjects by exerting a posteriorly directed force to the superior tibia; thus, the brace compensates externally for the absence of the ACL.
ESTABLISHING A UNIVERSAL PROTOCOL FOR DEEP VEIN THROMBOSIS FOLLOWING ORTHOPEDIC SURGERY: TOTAL KNEE ARTHROPLASTY
Authors: Sculco Thomas P
Published: April 2021

ABSTRACT

The incidence of deep vein thrombosis (DVT) after total knee replacement surgery is reported to occur in 84% of all unprotected patients and may be as high as 68% in patients who receive DVT prophylaxis. Moreover, controversy exists as to which pharmacologic or mechanical agent is most effective. Although the scientific literature provides some answers, many issues of DVT prophylaxis are not completely addressed, especially with regard to the duration of prophylaxis. The most recent report from the American College of Chest Physicians Consensus Conference on Antithrombotic Therapy reconfirms the recommendations offered from previous consensus groups on the importance of establishing and applying a universal protocol for the prevention of DVT in orthopedic surgery.
Primary Bone Tumors of the Pelvis Presenting as Spinal Disease
Authors: Thompson Roby C , Berg Troy L
Published: April 2021

ABSTRACT

Low back pain and sciatica are usually attributed to localized structural pathology; however, tumors of the pelvis may also cause these symptoms. Pelvic bone neoplasms are seldom immediately diagnosed and, therefore, may result in significant morbidity and mortality. Fourteen cases of malignant primary bone tumors of the pelvis that caused spinal symptoms were referred to our Musculoskeletal Tumor Service. Several recurring characteristics of these cases that may alert the clinician to the possibility of underlying pelvic bone malignancy in a patient with low back pain were identified: 1 ) age &45 years; 2) insidious onset of symptoms without antecedent trauma; 3) prolonged symptoms for more than 1 month; 4) progressive pain that fails conservative therapy; and 5) presence of anorexia, malaise, or night pain. We suggest that in diagnosis of a patient presenting with these characteristics, the clinician Instruct that the pelvis be Included in initial radiographs. If plain radiograph Is non-diagnostic and symptoms remain unresponsive, we recommend obtaining a bone scan, and then, if necessary, computerized tomography or magnetic resonance imaging.
Pilon Fractures Treated With an Articulated External Fixator: A Preliminary Report
Authors: DiChristina Daniel , Riemer Barry L , Butterfield Spencer L , Burke Charles J
Published: April 2021

ABSTRACT

Nine high-energy pilon fractures with severe soft tissue injuries were treated by a medial external fixator with an articulated ankle-hinge and limited internal fixation (1 .7 screws per case). A 100% union rate was achieved; however, there was a 100% complication rate associated with the fixator. Both B3 fractures required a vertical transarticular pin to maintain reduction. Seven C2 fractures suffered calcaneal screw loosening and drainage, necessitating removal of the fixator prior to union. Due to these complications, the articulated ankle hinge could not be utilized. At a minimum of 6 months follow up, eight of nine fractures had acceptable radiographic and early clinical results.
Injuries to the Subaxial Cervical Spine: Posterior Approach Options
Authors: Davis John
Published: April 2021

Spinal Trauma
Thoracolumbar Spine Injuries
Authors: Criscitiello Arnold A , Fredrickson Bruce E
Published: April 2021

Spinal Trauma
The Role of Anterior Surgery in the Treatment of Thoracolumbar Fractures
Authors: McGuire Robert A
Published: April 2021

Spinal Trauma
Clinical Results of the Modular Porous-Coated Anatomic (PCA) Total Knee Arthroplasty With Cement: A 5-Year Prospective Study
Authors: Knight Jonathan L , Atwater Richard D , Grothaus Louis
Published: April 2021

ABSTRACT

Our study examines the clinical, radiographic, and patient satisfaction outcome of the cemented Modular Porous-Coated Anatomic (PCA) total knee arthroplasty with a minimum 5-year follow up. All data were gathered prospectively and consecutively. Patient satisfaction was assessed with a self-administered survey. Statistical analysis examined the effect of 1 7 patient factors, 19 surgical factors, and postoperative continuous passive motion use on range of motion (ROM) and HSS scores at 2 years.

Seventy-eight Modular PCA arthroplasties performed by 9 orthopedic surgeons on 71 patients between January 1 988 and November 1 989 are reported in this study. Preoperative HSS scores averaged 51.2 and improved to an average of 89 at 1 and 2 years, and 86 at 5 years after surgery (90% good or excellent). ROM changed after surgery through improvement in preoperative knee flexion contracture, but not in increased knee flexion. One patient underwent reoperation for patellar instability, and one patient's arthroplasty was revised at 53 months for late instability. The total reoperation rate for any reason was 7.7%. Zonal analysis for progressive radiolucency at the bone-cement interface showed Increasing frequency of narrow (<1 mm) radiolucencies concentrated on the anterior and medial aspect of the tibial tray. Ninety-eight percent of patients responded to an outcome questionnaire, and 96% rated themselves improved. The Kaplan-Meier probability of an implant surviving without loosening at 5 years was 100%. The Modular PCA TKA has a low incidence of patellofemoral problems, is clinically successful, and results are stable at a minimum 5-year follow-up examination.
Freeze-Dried Cortical Allograft in Posterior Spinal Arthrodesis: Use With Segmental Instrumentation for Idiopathic Adolescent Scoliosis
Authors: Stricker Stephen J , Sher Jerry S
Published: April 2021

ABSTRACT

Many surgeons use cancellous or corticocancellous allogeneic bone grafts to augment spinal arthrodeses. The efficacy of onlay freeze-dried cortical allografts for posterior spinal fusions has been questioned in the past. In this report, freeze-dried, crushed cortical bone allograft was used as the sole fusion material in 32 consecutive posterior spinal fusions for idiopathic adolescent scoliosis. Absence of clinical or radiographic pseudarthrosis in all patients at an average follow up of 34 months suggests that freeze-dried, crushed cortical bone allograft is a suitable material for augmentation of the fusion mass during posterior spinal fusion with segmental instrumentation.
Magnetic Resonance Imaging and Knee Stability Following ACL Reconstruction
Authors: Kühne J-H , Dürr H R , Steinborn M , Jansson V , Refiort H J
Published: April 2021

ABSTRACT

This study was undertaken to determine whether there is a correlation between magnetic resonance imaging (MRI) and clinical success after reconstruction of the anterior cruciate ligament (ACL). In a prospective study, 28 patients underwent clinical and MRI examination 3 to 5 years after ACL reconstruction with either the semitendinosus tendon (n=15) or patellar ligament (n=13). Knee stability was assessed both clinically and by KT-1000 arthrometer testing. Magnetic resonance imaging was performed with a 0.2-T dedicated system (Artoscan, Esaote, Italy) including sagittal and oblique coronal T1 and T2-weighted images. Magnetic resonance images were evaluated by two readers with regard to signal intensity and continuity of the ACL reconstruction and presence or absence of posterior cruciate ligament buckling. Knee stability and MRI evaluation were each summarized in a 6-point score. Statistical correlation was checked with the Spearman ranked correlation for testing non-normal distributed samples. Statistical testing of all patients' results together showed a significant correlation with a prediction value of 12%, indicating no significant correlation between clinical results and MRI evaluation. Separate statistical testing of the patellar ligament and semitendinosus patients' results showed no significant correlation in either group at all. Thus, no correlation between clinical stability and MRI could be established. Magnetic resonance images after ACL reconstruction using the techniques mentioned above should be interpreted with caution, as they may not relate to the clinical function of the ligament.
Early Results of Lower Limb Surgery for Osteogenic Sarcoma of Bone
Authors: Zunino Jorge H , Johnston James O
Published: April 2021

ABSTRACT

Little information is available in the literature about early follow up of patients undergoing surgical procedures for osteogenic sarcoma of lower limbs as a part of their treatment protocol. In the present study the authors evaluate the functional and subjective condition of patients during a 2-year postoperative period, and analyze the nature and frequency of complications arising during that period. A scoring system was designed to represent the functional condition of the patients; compiled scores could therefore account for a given trend, which was further submitted to statistical analysis. Nature and frequency of complications following surgery were related to tumor location and to performed surgical procedures. Results of the study show that during the first 6 postoperative months, most patients have poor functional and subjective condition, which progressively improves throughout the first and second year. There is a high rate of complications during this period (46%), most frequently related to proximal femur and proximal tibia sites. Complications and functional disabilities are mainly related to mechanical disfunction of the reconstructive systems currently used.
Patellar Stabilization: A Quantitative Evaluation of the Vastus Medialis Obliquus Muscle
Authors: Raimondo Rick A , Ahmad Christopher S , Blankevoort Leendert , April Ernest W , Grelsamer Ronald P , Henry Jack H
Published: April 2021

ABSTRACT

Twenty-one cadaveric knees were dissected to analyze the functional anatomy of the vastus medialis complex (VMC), which is composed of the vastus medialis obliquus (VMO) and the vastus medialis longus (VML) muscles. The physiologic cross-sectional area of the VMO for 20 of the knees was 29% of the total physiologic cross-sectional area for the VMC. These values differed in one knee with a dysplastic VMO. The quantitative description of the VMO provided by this study will facilitate future efforts to accurately model the physiologic function of the VMO in cadaveric investigations on patellofemoral mechanics. The effect of simulated pathologies and surgical reconstructions then may be determined with more certainty to improve patient management.
Overuse Tendinitis of the Intrinsic Muscles
Authors: Silver Julie K , Rozmaryn Leo M
Published: April 2021

ABSTRACT

Repetitive strain injuries are currently the leading cause of occupational illnesses. This report describes seven patients who presented with the sole symptom of hand pain and subsequently were diagnosed with intrinsic tendinitis. Six of the 7 patients were given injections of a local anesthetic and steroid solution into the region of the lumbrical tunnels for both diagnostic and therapeutic purposes. All 6 patients had immediate short-term resolution of their symptoms in the office, thereby confirming the diagnosis. Complete resolution of symptoms after both the injection and other treatment interventions occurred in 4 patients, and partial resolution of symptoms occurred in the remaining two patients. Follow-up ranged from 3 to 20 months for 6 patients, and the seventh patient was lost to follow-up. The clinical presentation, diagnostic work-up, and treatment of intrinsic tendinitis are described.
Piriformis Syndrome: Assessment of Current Practice and Literature Review
Authors: Silver Julie K , Leadbetter Wayne B
Published: April 2021

ABSTRACT

Although piriformis syndrome was initially described in 1928, it has remained a nebulous and controversial diagnosis. A literature review reveals that there is no consensus on the diagnosis or treatment of piriformis syndrome. In addition, a survey of 75 physiatrists revealed that whether the diagnosis of piriformis syndrome even exists is controversial. This survey and literature review examines the diagnosis and treatment of piriformis syndrome. The fact that It remains controversial is likely due to a lack of objective clinical trials.
Influence of Anteroposterior and Mediolateral Instability on Range of Motion After Total Knee Arthroplasty: An Ultrasonographic Study
Authors: Itokazu Mansho , Masuda Kazuaki , Wada Eiji , Ohno Takatoshi , Yoshida Minoru , Takatu Toshiro
Published: April 2021

ABSTRACT

Ultrasonographicaliy, the femoral component and the tibial plate of total knee prostheses are strongly echogenic, while the high-density polyethylene insert is hypoechoic. This study evaluated the influence of mediolateral and anteroposterior stability after total knee arthroplasty (TKA) on range of motion using realtime monitoring with ultrasound. Mediolateral stress translation, which is increased by horizontal resection of more bone at the ends of the femur or tibia for easy prosthesis implantation, was examined on coronal scans at the level of the collateral ligaments. Anteroposterior drawer was examined on sagittal scans at the level of the patellar tendon. Mediolateral translation (0-10 mm; mean 2.24 mm) did not correlate with range of motion, white anteroposterior drawer (2-10 mm, mean 5.05 mm) correlated well with range of motion.

These ultrasonographic findings suggest that horizontal over-resection of the ends of the femur and tibia contributed to joint laxity, which would not result in better ROM. Rollback and sliding of the femoral component on the tibia, which is believed to be correlated with anteroposterior drawer, may be important in achieving better range of motion and obtaining excellent results in TKA.
Comparison of Ender Nails, Dynamic Hip Screws, and Gamma Nails in the Treatment of Peritrochanteric Femoral Fractures
Authors: Habernek Hans , Wallner Thomas , Aschauer Erwin , Schmid Lothar
Published: April 2021

ABSTRACT

Three hundred seventy-six patients with peritrochanteric fractures treated over a 1 0-year period were reviewed. In 85 patients treated with Ender nailing, the most frequent complications were leg shortening (34), external rotation failure (21), and postoperative distal gliding of the nails (7). In 1 83 patients treated with dynamic hip screws or a 95° condylar or a 1 30° blade plate, 3 presented with infection, 5 with instability, and 4 with femoral head necrosis. In 105 patients treated with Gamma nailing, the most serious complications were infections (3), inward rotation failure (2), postoperative bleeding at the insertion site (2), and shaft fracture (1).

Because of its inherent instability, Ender nailing is no longer used. The implantation technique for the dynamic hip screw is safer and simpler than the various models of the ASIF blade plate. However, the dynamic hip screw has been superseded by the Gamma nail because of its absolute stability. In the beginning, Gamma nailing was technically more demanding with a higher number of intraoperative complications. In this study, the number of malalignments did not differ siginificantly between the dynamic hip screw (14) and the Gamma nail (11), but was high with Ender nailing (56).
Musculoskeletal Trauma in Tobacco Farming
Authors: Pugh K J , Pienkowski D , Gorczyca J T
Published: April 2021

ABSTRACT

The incidence of musculoskeletal injury sustained during tobacco farming has been poorly documented. Using the trauma registry for all farm-related injuries occurring during a 1 6-month period, hospital charts, radiographs, and clinic charts were reviewed to identify those patients sustaining tobacco farming-related injury.

Twenty-three of 24 persons who sustained a farm-related injury during the study period were injured while farming tobacco. Seventeen (74%) were injured in falls from vented tobacco-drying barns, and 18 (75%) sustained skeletal injury. Extreme heat, humidity, and poor barn design and maintenance contribute to the incidence of falling. These injuries, largely underreported, may be substantially reduced by improvements in barn design and construction.
A Biomechanical Evaluation of Internal Fixation for Ankle Arthrodesis Comparing Two Methods of Joint Surface Preparation
Authors: Miller Richard A , Firoozbakhsh Keikhosrow , Veitch Andrew J
Published: April 2021

ABSTRACT

This study compared the biomechanics of two methods of joint preparation for ankle fusion with internal fixation. In the first method, the articular cartilage of the ankle joint was removed leaving the joint contour intact. In the second method, parallel flat saw cuts were used to prepare the joint surface for fusion. The specimens were loaded submaximally in a cyclic repetitive fashion before they were loaded to failure. Increasing joint motion occurred as the number of cycles increased. The difference between the two specimen types was not statistically significant during the repetitive tests or when loaded to failure. These results demonstrate both techniques of joint preparation studied are useful and biomechanically sound.
The Effect of Isometric Graft Posterior Cruciate Ligament Reconstruction on Anterior Tibial Translation
Authors: Pearsall Albert W , Mayeux Ray H , Mukerjee Debi P , Albright James A
Published: April 2021

ABSTRACT

Eight fresh-frozen cadaver knees were studied to evaluate whether an isometrically placed posterior cruciate ligament (PCL) graft restores normal posterior tibial translation without overconstraining anterior tibial translation. Each knee was tested with a three-axis load cell in the intact state, after PCL sectioning, and after PCL reconstruction. After PCL reconstruction, posterior tibial displacement was restored to values observed in the intact state for all flexion angles except 60° and 90°. Anterior tibial translation was not significantly changed for any of the three states. These results indicate isometric reconstruction of the PCL significantly reduces posterior tibial translation without overconstraining anterior tibial translation.
COX-2 Specific Inhibitors Offer Improved Advantages Over Traditional NSAIDs
Authors: Urban Michael K
Published: April 2021

ABSTRACT

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely prescribed medications worldwide and are often the first choice of treatment for acute myalgias, orthopedic injuries, postoperative pain, chronic rheumatoid arthritis, and osteoarthritis. The mechanism through which NSAIDs provide analgesia and suppress inflammation is the inhibition of the enzyme cyclooxygenase, resulting in decreased prostaglandin synthesis. The suppression of prostaglandin synthesis can also produce gastric and renal toxicity, as well as impair normal platelet function. Thus, NSAIDs are associated with potentially harmful side effects.

Cyclooxygenase exists in two isoenzymatic forms, cyclooxygenase-1 (COX-1 ) and cyclooxygenase-2 (COX2). Cyclooxygenase-1 appears to be constitutively expressed in many tissues and produces prostaglandins, which regulate normal cellular functions. However, COX-2 activity is induced by proinflammatory cytokines and produces prostaglandins that mediate the inflammatory response and pain signaling transmission. Traditional nonspecific NSAIDs inhibit both COX-1 and COX-2, and in doing so, not only decrease inflammation and pain, but also promote gastrointestinal tract damage and bleeding. The potential clinical benefit of COX-2 inhibitors is significant due to the number of patients chronically treated with NSAIDs and the three- to ten-fold higher risk of gastrointestinal injury and death associated with traditional NSAIDs.

Recently, a class of anti-inflammatory medications has been developed that primarily inhibits COX-2 while sparing the enzymatic activity of COX-1 at therapeutic dosages. Two medications that predominantly inhibit only COX-2, rofecoxib and celecoxib, are currently available by prescription in the United States.
Use of COX-2 Specific Inhibitors in Operative and Nonoperative Management of Patients With Arthritis
Authors: Goodman Stuart B
Published: April 2021

ABSTRACT

Arthritis is a major burden on society and the individual. Arthritis affects all age groups and races, and is more prevalent in women than men by approximately 1.65:1. Nearly one half of people aged 5=65 years report the presence of arthritic symptoms; however, by no means is arthritis a disease of only the elderly. The burden of arthritis will continue to increase due to expected future increases in the size and age of the general population. Currently, the total costs of medical care and lost wages due to arthritis are in excess of $64 billion per year in the United States.

For the individual, arthritis may cause substantial pain, impair mobility, curtail physical activity, and have a negative impact on mental health. The two most common forms of arthritis, osteoarthritis and rheumatoid arthritis, have major health complications. From the perspective of the orthopedic surgeon, the aim of treatment of arthritic conditions includes early, accurate diagnosis and appropriate treatment to minimize pain and maximize function.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used as part of the medical management of patients with arthritis. These medications are effective in mitigating pain and inflammation associated with arthritis. However, side effects (most notably of the gastrointestinal tract) have limited the more widespread use of NSAIDs. The newer cyclooxygenase-2 (COX-2) inhibitors have proven to be efficacious and have demonstrated fewer gastrointestinal adverse effects. Furthermore, COX-2 inhibitors do not appear to adversely affect platelet function. For these reasons, consideration may be given to using COX-2 perioperatively, however, drug interactions must be closely monitored.
Interlocking Intramedullary Nailing in Distal Tibial Fractures
Authors: Tyllianakis Minos , Megas Panagiotis , Giannikas Dimitrios , Lambiris Elias
Published: April 2021

ABSTRACT

This retrospective study examined the results of nonpilon fractures of the distal part of the tibia treated with interlocking intramedullary nailing. Seventy-three patients with equal numbers of fractures treated surgically between 1990 and 1998 were reviewed. Mean patient age was 39.8 years, and follow-up averaged 34.2 months. The AO fracture classification system was used. Concomitant fractures of the lateral malleolus were fixed. All but three fractures achieved union within 4.2 months on average. Satisfactory or excellent results were obtained in 86.3% of patients. These results indicate interlocking intramedullary nailing is a reliable method of treatment for these fractures and is characterized by high rates of union and a low incidence of complications.
Osteosynthesis and Allogeneic Bone Grafting in Complex Osteoporotic Fractures
Authors: Kuokkanen H , Räty S , Korkala O , Niskanen R , Syrjänen K J
Published: April 2021

ABSTRACT

Thirty patients with osteoporotic fractures were treated operatively. An allogeneic bone transplant was used in combination with a conventional osteosynthesis in each patient. The bone graft was pulverized in a bone mill and used as a substitute graft to fill the bone defect, add stability, and enhance bone union. Fractures healed without complications in 20 patients. The osteosynthesis failed in 4 patients. The fracture failed to unite in an additional 3 patients. One deep infection occurred. A biopsy taken from the allogeneic bone at plate removal after fracture union demonstrated mature bone and new bone formation. The use of pulverized allograft bone for large bone defects in patients with osteoporotic fractures yields acceptable results with no adverse effects.
Tosic External Fixator in the Management of Proximal Tibial Fractures in Adults
Authors: Tosic Aleksandar , Ebraheim Nabil A , Chakra Iman Abou , Emara Khaled
Published: April 2021

ABSTRACT

This retrospective clinical study assessed proximal tibial fractures managed with the Tosic external fixator. Nineteen patients with 21 proximal tibial fractures treated with the Tosic external fixator between July 1997 and October 1998 comprised the study population. Eleven fractures were graded as 41A2, 3 fractures as 41A3, 4 fractures as 41C1, and 3 fractures as 41C2. Fourteen fractures were closed, and 7 fractures were open. Average time to healing was 17 weeks. No revision of fixation was needed. There were five cases of pin tract infection. Average range of knee motion was 2°-135°. These results indicate the Tosic external fixator is an efficient and simple way to treat proximal tibial metaphyseal fractures.
Long-Term Local Intensive Preoperative Chemotherapy and Joint-Preserving Conservative Surgery for Osteosarcoma Around the Knee
Authors: Abe Satoshi , Tateishi Akio , Ogawa Kazuhiko , Ganev Gerson Gandhi , Nakano Hirotaka
Published: April 2021

ABSTRACT

This study evaluated conservative joint-sparing surgery for patients with osteosarcoma around the knee. Of 23 patients with stage IIB osteosarcoma around the knee, 5 were treated with long-term (30-56 weeks) local intensive preoperative chemotherapy consisting of high-dose methotrexate, intra-arterial and intravenous cisplatinum, doxorubicin, and hyperthermic isolated regional perfusion. More conservative resection, sparing the knee joint, was performed with smaller sufficient surgical margin in these 5 patients, preserving good limb function. Excellent local effects were achieved in the resected specimens. These results suggest long-term local intensive preoperative chemotherapy, including intra-arterial cisplatin and hyperthermic isolated regional perfusion, help control local tumor and allow for more conservative surgery.
Tension-Band Arthrodesis of the Small Joints of the Hand
Authors: Stahl Shalom , Rozen Nimrod
Published: April 2021

ABSTRACT

A review of 72 cases of tension-band arthrodesis in the small joints of the digits was conducted. Fusion was achieved in all joints with no complications apart from 2 cases of superficial infection. No failure of the hardware was noted, although hardware was removed in 5 patients after fusion was attained due to technical failure or pain. This technique provides immediate skeletal stability, thereby facilitating early digital motion and recovery.
Decline in Transfixing K-Wire Tension of the Circular External Fixator: Experimental Continuous In Vivo Measurements
Authors: Stein Haim , Perren Stephan M , Mosheiff R , Baumgart F , Cordey J
Published: April 2021

The mechanical stiffness of the circular (ring) external fixation frame, based on the ilizarov design, is determined by the tension of the transfixing K-wires. This tension has to be adequate to create optimal biomechanical conditions for efficient bone healing.
Predicting the Rotationally Neutral State of the Femur by Comparing the Shape of the Contralateral Lesser Trochanter
Authors: Kim Jung-Jae , Kim Eugene , Kim Key-Yong
Published: April 2021

ABSTRACT

The rotationally neutral state of the femur was measured by comparing the shape of the contralateral lesser trochanter in 1 00 adults. Three observers predicted a position presumed to be neutral by comparing the shape of the neutrally positioned contralateral lesser trochanter previously recorded by C-arm image intensification. The mean (SD) angular discrepancy between the neutral point and the predicted angle was 3.4° (±2.4) without interobserver variation (P=.87). Seventyseven percent indicated the value within 4°, and none of the observations exceeded 15°. These findings suggest the outline of the contralateral lesser trochanter may be a useful reference during surgical treatment of femoral fractures to minimize rotational deformity.
Patterns of Job Search and Mobility Among Nurse Educators
Authors: Lenz Elizabeth R , Waltz Carolyn F
Published: April 2021

Abstract

This paper reports the results of a survey of job search and mobility among 790 faculty in baccalaureate and higher degree nursing programs in the South. The study examined activities which nursing educators carried out in seeking their present positions, the sources from which they gained information, and the characteristics which they considered most important in the decision to accept or leave a position.

Slightly fewer than half of the educators actively sought their present position; the remainder were recruited by the institution or learned of the availability of the position by chance. The modal job search pattern was to contact the institution directly without knowing whether any opportunities were available, then to seek additional information via discussions with friends and colleagues, visits to the institution and review of documents. Salary, geographical location, administrative leadership style, and the school's reputation were the most important factors in choosing the present position.

The decision to leave the previous job was related primarily to a desire for geographical mobility or career advancement and tended not to be motivated by dissatisfaction. Those planning to leave their present position rated salary, location of the school and leadership style of the administrator as the most important determinants of their decision to leave. Implications of the findings for faculty recruitment and retention are discussed.
The Impact of Nursing Education on Ethical/Moral Decision Making
Authors: Felton Gwen M , Parsons Mary Ann
Published: April 2021

ABSTRACT

A study of 227 baccalaureate and 111 master's nursing students was conducted to determine the influence of the level of formal education on three selected factors: ethical/ moral reasoning, attribution of responsibility, and ethical/ moral dilemma resolution. Moral development theory and Heider's attribution of responsibility construct provided the theoretical framework. A comparison of the overall index of ethical/moral reasoning showed that graduate students reasoned at a higher level than undergraduate students. The amount of attribution of responsibility assigned and the dilemma resolution score did not differ for the two groups.

The results of this study suggest that undergraduate and graduate nursing programs must place more emphasis on identifying dilemmas, increasing ethical/moral reasoning levels and attributing responsibility in a justifiable manner. Nurse researchers must continue to study how nurses respond in dilemma situations and how personal characteristics, factors in the environment, education, and the assignment of responsibility affect nurses' ability to resolve ethical/moral dilemmas.
Response Changing and Student Achievement on Objective Tests
Authors: Cassidy Virginia R
Published: April 2021

ABSTRACT

The purposes of this study were to evaluate the types of response changes made by undergraduate nursing majors on an objective test and to provide additional data which support the limited research on this topic. Responses were evaluated for the percent of total responses, direction of the changes made, and the effects of the changes on student achievement. Approximately 70% (n=39) of the students changed one or more responses; the mean gain was 2.47 items. Major findings include significant differences in overall achievement on the test between response changers and nonresponse changers (t=2.14; p<.03); significance (X
p 2
- 41.67; p<.001) in the direction of the changes made by students; and significant X
p 2
=19.463; p<.0000) gain in the achievement of students who changed responses. The results of this study support the previous, but limited, research in the investigation of response changing among students. The limitation of this study and implications for future research are also presented.
Effects of a Training Model on Active Listening Skills of Post-RN Students
Authors: Olson Joanne K , Iwasiw Carroll L
Published: April 2021

ABSTRACT

This study investigated the effects of a training module on the active listening skills of non-degree registered nurses. Active listening skills were defined as understanding what another person is saying and feeling and then communicating this understanding of his thoughts and feelings back to him. The sample consisted of 26 postdiploma RNs registered in the first year of a baccalaureate degree nursing program. Pretraining and posttraining data were collected when subjects verbally responded to two portions of the Behavioral Test of Interpersonal Skills for Health Professionals (BTIS). Subjects were audiotaped while responding and tapes were scored using BTIS guidelines. Paired t-tests were used to determine differences between pretraining and posttraining scores. Active listening scores increased significantly (p_< .0005) while attempts to suppress or discount speakers' feelings decreased significantly (2<-005). A six-hour training session significantly increased active listening skills.
Ten Criteria for Evaluating Qualitative Research Proposals
Authors: Cobb Ann Kuckelman , Hagemaster Julia Nelson
Published: April 2021

ABSTRACT

With the proliferation of interest in qualitative research in nursing comes the attendant problem of how to evaluate it appropriately. Qualitative research has its own unique history, philosophical foundations, and methodologies that separate it from the quantitative approach. Although the literature is crowded with guidelines for evaluating the latter, little is offered for the qualitative reviewer. The Research Proposal Evaluation Form: Qualitative Methodology is a partial solution to this dilemma. It provides a framework for critiquing the proposal phase of a qualitative study and can be an important guide both for the educator and for the novice researcher.
The Relationship of Hardiness and Social Support to Student Appraisal of Stress in an Initial Clinical Nursing Situation
Authors: Pagana Kathleen Deska
Published: April 2021

ABSTRACT

The stressful nature of the clinical experience of nursing students was examined within the context of Lazarus' theory of cognitive appraisal of stress. The students' evaluation of their initial medical-surgical clinical experience as a threat or a challenge was determined along with the hypothesized mediating variables of hardiness and social support. The sample of 246 students from seven different colleges and universities in Pennsylvania completed a hardiness measure, the Norbeck Social Support Questionnaire (NSSQ), and a Clinical Stress Questionnaire (CSQ).

Although the correlations were low, hardiness was found to be positively related to the evaluation of challenge and negatively related to the evaluation of threat. Social support was positively related to the evaluation of challenge only when using a work-related measure of support. The hypothesis that social support would be negatively related to the evaluation of threat was not supported. This research raises important questions related to the theories of hardiness, social support, and cognitive appraisal of stress. Implications for further research in this area are offered.
Self-Care Deficit Theory and Nursing Diagnosis: A Test of Conceptual Fit
Authors: Jenny Jean
Published: April 2021

ABSTRACT

Conceptual frameworks and nursing diagnoses represent recent additions to nursing's theoretical base, but their relationship and potential to interface has not been explored. This study describes the results of 130 registered nurse baccalaureate students' integration of current North American Nursing Diagnosis Association (NANDA) nursing diagnoses into major concepts of Orem's Self-Care Deficit Theory (SCDT). It identifies areas of agreement and difficulty inherent in this challenge, and suggests directions for needed theoretical work.
Use of Clinical Logs by Beginning Nursing Students and Faculty to Identify Learning Needs
Authors: Sedlak Carol A
Published: April 2021

ABSTRACT

Students entering a nursing program bring with them an increasing variety of life experiences. This study compares the learning needs of nontraditional and traditional nursing students during the first clinical experience. Twenty sophomore students wrote weekly reactions to their clinical experiences in the form of a log. The logs analyzed each week's clinical experience, assessed attainment of the week's goals, and identified goals for the following week. Descriptive analysis identified the following major themes and patterns of learning needs: learning from negative experiences, awareness of contextual influences, recognition of improved communication skills, identification of locus of motivation, and ability to conduct client teaching. Building on students' prior experiences can provide opportunities for self-reflection and promote the development of self-directed learning.
Honors Program Participation and Performance Postgraduation
Authors: Williams Phoebe Dauz , Snider Martha Josephine
Published: April 2021

ABSTRACT

Four groups of students were surveyed four to six years postgraduation regarding enrollment in graduate studies, research involvement, and occupancy of leadership positions in professional organizations. Group 1 (n = 20) consisted of honors graduates, Group 2 (n = 52) were high GPA non-honors graduates, Group 3 (n = 39) were low GPA graduates, and Group 4 (n = 16) were RN-to-BSN graduates with high GPAs but not in the honors program. Enrollment in graduate studies was the strongest outcome indicator of participation in the honors program. Honors graduates also held leadership roles in professional organizations significantly more than Groups 2 and 3, but were quite comparable to Group 4. Follow-up at 10 years postgraduation and replication of the study in other settings are recommended.