Prophylaxis for thromboembolism in elective orthopaedic surgery

Thromboembolism is a major complication for patients undergoing elective hip and knee surgery. It can delay full recovery and increase the cost of treatment. This review article focuses on the pathophysiology, risk factors, and methods of prophylaxis in this select patient group. Emphasis is placed on the role of the nurse in the ongoing assessment of the patient's risk for thromboembolism.     

Global blood management in orthopaedic surgery

Blood loss tends to be significant in many orthopaedic procedures because of the nature of the tissues and the inability to cauterize or coagulate bleeding bony surfaces. Regional hypotensive anesthesia has been useful in reducing blood loss particularly for joint replacement. A spectrum of measures is available to retrieve autologous blood and reinfuse it. The loop consists of predeposit autologous blood, preoperative hemodilution, intraoperative and postoperative red cell retrieval, and reinfusion. The safety of autologous blood has been accepted universally, but the measures to preserve it must be used judiciously to avoid excessive cost and, most importantly, ensure patient safety.     

Teaching medical ethics to orthopaedic surgery residents

Orthopaedic surgery residents will be faced with a variety of ethical issues when they enter clinical practice. A previous survey suggested that they lack knowledge about how to approach several types of medical ethics dilemmas. We developed a medical ethics curriculum for orthopaedic surgery residents and presented it over a one-year period to the residents in one training program. The effect of the educational intervention on the residents' knowledge of medical ethics and their ability to handle hypothetical situations was measured by comparing their responses to a questionnaire, administered before and after the intervention, with those of residents in a training program in which the intervention was not provided. The twenty-five residents at the site of the educational intervention had a mean improvement of 0.10 in the overall score, from a mean score of 0.71 on the baseline survey to a mean score of 0.81 on the follow-up survey. This improvement was significantly greater than the mean improvement of 0.02 for the thirty residents at the control site, who had a mean score of 0.72 on the baseline survey and a mean score of 0.74 on the follow-up survey (p = 0.002). Six residents who participated in the medical ethics curriculum rated it as very useful; seventeen, as somewhat useful; one, as slightly useful; and one, as not at all useful. A medical ethics curriculum can increase orthopaedic residents' knowledge of medical ethics. Whether this curriculum also will lead to behavioral changes requires additional evaluation.     

Further uses of polymethylmethacrylate in orthopaedic surgery

The Esophageal-Tracheal Combitube is a new alternative airway device. Few complications of its use have been reported. This article reports a case of a 71-year-old female with angioedema of the tongue and airway obstruction who suffered piriform sinus rupture during Combitube placement by prehospital personnel, resulting in massive subcutaneous emphysema. Caution is required when using this device in all but the most controlled situations.     

The incidence of post-operative wound infection in orthopaedic surgery

The alkylation of 7,8-dihydroimidazo[1,2-a]-1,3,5-triazine-2,4-(3H,6H)-dithione [I] with 2-chloro-N-arylacetamides gave 2-alkyltio derivatives [III]. Further reactions of 2-(alkyltio)-7,8-dihydroimidazo[1,2-a]-1,3,5-triazine-4(6H)- thiones [III] or [IV] with aryl isothiocyanates, sulfochlorides or 2-bromo-1-phenylethanone afforded corresponding B-substituted products [V,VI,VII].     

Screening times with image intensifier in orthopaedic trauma surgery

Primary lymphoma of the bladder is rare. Of the very few cases reported, most appear to be of low grade with a generally good prognosis. Since the concept of low grade lymphoma of mucosa associated lymphoid tissue (also known as marginal zone lymphoma in the REAL classification) was introduced, only six examples of this entity have been recorded at this site. We present a further case and describe its phenotypic characterization.     

Computer assisted orthopaedic surgery with image based individual templates

Recent developments in computer assisted surgery offer promising solutions for the translation of the high accuracy of the preoperative imaging and planning into precise intraoperative surgery. Broad clinical application is hindered by high costs, additional time during intervention, problems of intraoperative man and machine interaction, and the spatially constrained arrangement of additional equipment within the operating theater. An alternative technique for computerized tomographic image based preoperative three-dimensional planning and precise surgery on bone structures using individual templates has been developed. For the preoperative customization of these mechanical tool guides, a desktop computer controlled milling device is used as a three-dimensional printer to mold the shape of small reference areas of the bone surface automatically into the body of the template. Thus, the planned position and orientation of the tool guide in spatial relation to bone is stored in a structural way and can be reproduced intraoperatively by adjusting the position of the customized contact faces of the template until the location of exact fit to the bone is found. No additional computerized equipment or time is needed during surgery. The feasibility of this approach has been shown in spine, hip, and knee surgery, and it has been applied clinically for pelvic repositioning osteotomies in acetabular dysplasia therapy.     

Antimicrobial prophylaxis in orthopaedic surgery: the role of teicoplanin

Associational responses from 128 schizophrenic people and 120 healthy ones were collected. Four words with aggressive emotional shade were given as the stimuli. Semantic analysis of stimulus words was made, which made it possible to obtain a range of content categories. The collected material was analysed then according to them. Significant differences in five content categories were discovered. Basing on these differences we can infer that associational meaning at schizophrenic people is in some way varied. It was also possible to draw some conclusions concerning emotional life of the examined people.     

Computer assisted orthopaedic surgery. Image guided and robotic assistive technologies

Technologies are emerging that will influence the way in which orthopaedic surgery is planned, simulated, and performed. Recent advances in the fields of medical imaging, computer vision, and robotics have provided the enabling technologies to permit computer aided surgery to become an established area which can address clinical needs. Although these technologies have been applied in industry for more than 20 years, the field of computer assisted orthopaedic surgery is still in its infancy. Image guided and surgical navigation systems, robotic assistive devices, and surgical simulators have begun to emerge from the laboratory and hold the potential to improve current surgical practice and patients' outcomes. The goals of these new clinically focused technologies are to develop interactive, patient specific preoperative planners to optimize the performance of surgery and the postoperative biologic response, and develop more precise and less invasive interactive smart tools and sensors to assist in the accurate and precise performance of surgery. The medical community is beginning to see the benefit of these enabling technologies which can be realized only through the collaboration and combined expertise of engineers, roboticists, computer scientists, and surgeons.     

Internet resources for orthopaedic surgeons

PURPOSE: Using polarized bovine brain microvessel endothelial cells (BBMEC) monolayers as in vitro model of the blood brain barrier and Caco-2 monolayers as a model of the intestinal epithelium, the present work investigates the effects of Pluronic P85 block copolymer (P85) on the transport of the P-gycoprotein (P-gp)- dependent probe, rhodamine 123 (R123). METHODS: The permeability and cell efflux studies are performed with the confluent cell monolayers using Side-Bi-Side diffusion cells. RESULTS: At concentrations below the critical micelle concentration, P85 inhibits P-gp efflux systems of the BBMEC and Caco-2 cell monolayers resulting in an increase in the apical to basolateral permeability of R123. In contrast, at high concentrations of P85 the drug incorporates into the micelles, enters the cells and is then recycled back out to the apical side resulting in decrease in R123 transport across the cell monolayers. Apical to basolateral permeability of micelle-incorporated R123 in BBMEC monolayers was increased by prior conjugation of P85 with insulin, suggesting that modified micelles undergo receptor-mediated transcytosis. CONCLUSIONS: Pluronic block copolymers can increase membrane transport and transcellular permeability in brain microvessel endothelial cells and intestinal epithelium cells. This suggests that these block copolymers may be useful in designing formulations to increase brain and oral absorption of select drugs.     

Vascular complications in orthopaedic patients treated by orthopaedic microsurgeons

Over a 20 year period, five patients experienced serious vascular complications involving major arterial insult during various routine orthopaedic procedures. The nature of the vascular damage necessitated immediate surgical repair which was performed successfully by an orthopaedic microsurgeon who was either a member of the initial surgical team or the hospital's Orthopaedic Unit. The purpose of this study is to illustrate not only the severity of these limb and/or life-threatening complications, but also to focus attention on the importance of the orthopaedic surgeon's ability to manage these serious injuries promptly. This suggests the need for Orthopaedic Units to have surgeons with adequate training in microvascular techniques, so as to be able to successfully manage these unexpected and serious complications. We conclude that the presence of a vascular surgeon or an orthopaedic surgeon trained in microvascular surgery represents an invaluable attribute to the orthopaedic team, and minimizes, if not eliminates the potentially disastrous outcome from these serious intraoperative vascular complications.