Immediate orthopedic surgery in multiple trauma

The increase in mortality and morbidity from multiple trauma due to road accidents, industrial trauma and combat injuries obligates treatment based on emergency systems and trauma centers. Follow-up of the frequency of different types of injury calls attention to increasing involvement of the orthopedic surgeon in primary treatment. This situation calls for appropriate deployment of immediate surgical treatment which will rapidly enable mobility. We present several methods for immediate orthopedic treatment of multiple-trauma patients.     

Prevention of infection in the orthopedic surgery patient

A surgical site infection in an orthopedic surgery is a dreaded and often catastrophic complication. This article provides an overview of the incidence, pathogenesis, financial impact, as well as a discussion of patient and operation-related risk factors for orthopedic surgical site infections. The reader is provided insight into infection control interventions intended to minimize surgical site infections in orthopedic patients. Some of these practices are evidence-based and others exist only because of theoretical benefit.     

Cell culture and orthopedic surgery. II. Medical applications. Diagnosis, biomaterials evaluation, therapy

Currently, cell cultures are used for 3 kinds of applications in orthopaedics: diagnosis: they can help to diagnose hereditary diseases like Marfan syndrome, osteogenesis imperfecta, or some osteochondrodysplasia. biomaterial evaluation: cell cultures bring information to ensure safety and efficacy of medical devices following the European Community's directive concerning medical devices. Results of in vitro biomaterial evaluation must be related to cell types (osteoblasts or fibroblasts), cell species (human or rat) and methods used (primary cell line or immortalised cell line). therapy: first clinical applications of cell cultures have been published recently. They concern cultured autologous chondrocytes reimplantation. Bone cells cultured on biomaterials have been tested in animal reimplantation experiments. Animal cells mediated gene therapy experiments are now developed on muscle cells. Cell cultures allow also to determine the best therapeutic way to cure bone tumors. For the moment, these applications are still limited but in the next years, they could develop considerably. Therefore, orthopaedic surgeons must keep interest in this new field.     

Self-efficacy, optimism, health competence, and recovery from orthopedic surgery.

The authors tested whether self-efficacy for orthopedic rehabilitation tasks accounted for significant variance in rehabilitation outcome, over the variance accounted for by dispositional optimism, health competence, and health value. Whether health value moderated expectancy-outcome relationships also was examined. One hundred five older clients at 2 orthopedic rehabilitation facilities completed a battery of instruments; physical functioning also was assessed. After controlling for physical functioning at admission and for other variables, self-efficacy predicted significant variance in rehabilitation outcome. Health value did not moderate expectancy-outcome relationships. Results suggest that psychologists can improve patients' recovery from serious orthopedic problems by augmenting their self-efficacy beliefs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Infection prevention and management in orthopedic surgery

Six nonneoplastic ovarian lesions (or alterations) are associated with pregnancy or the puerperium, each of which can simulate a neoplasm on clinical, gross, or microscopic examination. These lesions include pregnancy luteoma, hyperreactio luteinalis, large solitary luteinized follicle cyst of pregnancy and puerperium, intrafollicular granulosa cell proliferations, hilus cell hyperplasia, and ectopic decidua. Because these lesions involute spontaneously after termination of pregnancy or are adequately treated by a conservative surgical approach, unnecessarily radical operations can be avoided if the correct diagnosis is made by the pathologist.     

Pediatric craniocerebral trauma. Special characteristics, therapy and prognosis

The mortality rate after traumatic brain injury in children ranges between 2.5% and 21%. Standardized diagnostic procedures and therapeutic strategies for the management of traumatic brain damage are presented in this article. Children with traumatic cerebral lesions have a better clinical outcome than head-injured adults. Optimized medical management and intensive rehabilitation may help to reduce the frequency of mental retardation and physical disability following such injuries in children.     

Intraoperative and postoperative autologous transfusion in orthopedic surgery

Information was collected retrospectively on three comparable groups, 25 patients in each, who had been operated on for thoracic scoliosis. Group 1 received homologous transfusions only. Group 2 and group 3 were transfused postoperatively with drained whole blood (Solcotrans orthopaedics). Group 3 received in addition peroperatively washed packed red blood cells (Haemolite 2 Cell Saver) recirculated. The need for homologous transfusions was reduced from 119 units to 23 patients in group 1, to 36 units to 14 patients in group 2 and 34 units to 13 patients in group 3. Three of the first 15 patients in group 2 experienced chills and fever reactions in connection with the autologous transfusion. No reactions were seen after infusion when we scrapped the last 50 to 100 ml of drained blood.     

Acute ulcer disease: diagnosis, therapy, complications, indications for surgery

The development of fiberoptic endoscopy, the creation of drugs with well understood mechanisms of action, and the definition of the role of Helicobacter pylori have resulted in a considerably better understanding of ulcer pathogenesis. This has led to rational concepts of ulcer therapy, which are discussed in detail in this review. Moreover, the role of non-steroidal antiinflammatory drugs in peptic ulcer disease, and the use of drugs and endoscopic measures in treatment of ulcer complications, especially g.i. hemorrhage, are discussed in detail. The implications of these advances with regard to the indications for surgical treatment of peptic ulcer disease are outlined.     

Hypoglycemia. Symptoms, differential diagnosis, therapy

The article deals with epidemiologic evaluation of long-term chemical effects. The authors stress difficulties in setting the "cause-effect" relationships and define some typical mistakes in such research.     

Antibiotic prophylaxis in Danish orthopedic alloplastic surgery

In order to assess the routine use of prophylactic antibiotics (AB) in arthroplastic surgery in Denmark, questionnaires were sent to all Danish orthopaedic departments and all general surgical departments that perform orthopaedic surgery. Fifty-six departments (93%) returned the questionnaires. All departments use prophylactic AB in primary knee and hip arthroplasty and in revision arthroplasty. In addition, all departments but one use prophylactic AB in arthroplasty secondary to osteosynthesis. The largest group of departments uses penicillinase-resistant penicillin (PRP) in their standard prophylaxis regimens. The second largest group uses second generation cephalosporins. With one exception, all use cefuroxime. A small group uses other types of AB. Fifteen percent of the departments combine systemic AB with gentamicin bone cement (GC) in primary hip arthroplasty, whereas 22% use this combination in primary knee arthroplasty. Significantly more departments use GC in revision arthroplasty (89%) and in arthroplasty secondary to osteosynthesis (63%). Prolonged antibiotic prophylaxis (beyond 24 hours) is practised to a significantly higher degree in revision arthroplastic surgery than in the primary arthroplasties. In conclusion, one of two homogeneous groups of prophylactic AB is used in arthroplastic surgery in Denmark as prescribed in the literature.     

Acute pancreatitis. Classification, diagnosis, therapy

Acute pancreatitis is a multietiologic entity with rather diverse clinical courses. Whereas edematous pancreatitis has a mortality of less than 1%, nowadays; still approximately 20% of all patients with the necrotizing form succumb to the disease. To further improve therapeutic results a standardized approach should be used. For effective treatment the differentiation between edematous and necrotizing pancreatitis is crucial. All patients with signs of pancreatic necroses during abdominal ultrasound and patients with organ insufficiencies should undergo a CT-scan to define exactly the nature and the extent of the disease. Primarily all patients are treated conservatively. Main indications for operative intervention are signs for infection of pancreatic necroses and an acute abdomen due to local complications of acute pancreatitis. In cases of biliary origin an elective cholecystectomy has to be performed during a free interval to prevent a recurrence.