Contemporary orthopaedics最新文献

A case is reported that demonstrates the impact of psychological variables on a patient's reaction to stressful medical procedures. The evaluation and management of psychological variables that might have an effect on treatment outcome is discussed.

Guidelines are provided for prescribing nonsteroidal antiinflammatory drugs (NSAIDs) pre- and postoperatively for arthritis patients. Most NSAIDs impair platelet aggregation and prolong bleeding time, increasing the risk of complications during and immediately following surgery; thus, the effects of individual NSAIDs must be considered prior to surgery. Postoperative treatment issues that must be considered include gastrointestinal safety, renal and hepatic safety, safety in the elderly, and efficacy of various NSAIDs. Various strategies to improve gastrointestinal safety, including use of NSAIDs with low ulcerogenic potential such as nabumetone, low-dose ibuprofen, and etodolac, are discussed. As all NSAIDs can reduce pain and inflammation, selection of a particular NSAID should be based on careful consideration of pharmacologic and clinical differences.

Removal of a stable, well-fixed cementless femoral arthroplasty component occasionally is necessary because of infection, component malposition, persistent pain, or incompatibility with a femoral revision component. Restricted access to ingrowth surfaces may make implant removal exceedingly difficult and increases the risk of iatrogenic damage to the proximal femur. A new extended proximal femoral osteotomy technique is described for use in removing well-fixed cementless femoral components. Previous techniques have been modified to allow access to the bone-implant interface and to provide straight-shot access to the femoral canal for proper sizing and positioning of the revision implant. The osteotomy can be extended to accommodate the entire length of the porous coating on the revision component. If a shorter osteotomy is desired, access to the prosthesis for transection with a metal-cutting burr is possible. The osteotomy is easily repositioned with cerclage wires or cables and reliable healing has been demonstrated.

The use of artificial neural networks (ANN) for the identification of a positive correlation between the QuiOs quotient, a single-valued indicator of bone mineral density, and multisite dual energy x-ray absorptiometry (DEXA) measurements is described. The measurements were obtained using the Hologic QDRR-2000 x-ray bone densitometer in a multicenter clinical trial including 374 female patients. The QuiOs quotient estimates bone mineral density and determines the severity of bone density loss. This quotient is calculated by using a proprietary software program to perform a multivariate analysis of the results of testing of serum levels of calcium, phosphate, total alkaline phosphate, two alkaline phosphatase isoenzymes (liver and intestine), estradiol, and progesterone. The results show that given the four DEXA measurements obtained from the bone densitometer, the trained neural network can predict whether the corresponding QuiOs score of the same patient will be below the cutoff score of 0.690. The findings in this study indicate a positive correlation between DEXA measurements and the QuiOs quotient obtained from two different sources.

When introduced, the Wisconsin segmental spine instrumentation (WSSI) and the Cotrel Dubousset instrumentation (CDI) were promoted as technical advances for the correction of spinal deformities. Both systems provide acceptable correction and greatly reduce the need for postoperative immobilization. A retrospective study of a homogeneous group of 53 adolescent patients with idiopathic scoliosis with King Type II curves who had reached skeletal maturity at follow-up was conducted to compare and analyze the results of these two systems. Thirty-six of these patients had been operated on using WSSI and 17 had been operated on using CDI. CDI and WSSI were found to be equally effective in treating King Type II curves. No difference was found between the two groups in the fusion rates, spinal balance, time required for surgery, or amount of curve correction. The answer to the question of which system is "better" depends on the surgeon's experience and familiarity with the equipment.

Fractures below proximal humeral prostheses are rare and their successful management presents technical difficulties. Closed treatment usually results in nonunion. A case illustrating this disabling complication is reported and a literature review is presented that summarizes the classification, treatment options, and complications of these uncommon fractures.

During the past five years, systemic IgE-mediated anaphylactic reactions to latex have been reported more frequently, and a significant proportion of these anaphylactic reactions have occurred intraoperatively. Anaphylactic reactions under general anesthesia occur without warning, and early signs often are obscured by surgical drapes. Therefore, early recognition of symptoms and prevention are essential to avoid catastrophic results. Orthopaedic surgeons must be aware of the risk, diagnosis, prevention, and treatment of latex anaphylaxis. Patients at risk, testing, and prevention are discussed in this review. Additionally, a classification system and the corresponding regimen for prophylaxis that is currently being used at Children's Hospital of Philadelphia is described.