No abstract available.
Diffusion of Innovation ; Humans ; Learning Curve ; *Orthopedic Procedures/adverse effects

PURPOSE: Scar assessment tools can be utilized during the post-operative period to monitor scar progress. The primary aim of this systematic review was to evaluate current subjective scar assessment scales utilized in orthopaedic surgery. The secondary aim was to identify determinants of patients' satisfaction with their scars and evaluate current measurement scales. METHODS: The preferred reporting items for systematic reviews and meta-analyses checklist was followed. Electronic databases, currently registered studies, conference proceedings and the reference lists of included studies were searched. There were no constraints based on language or publication status. A narrative synthesis provided a description and evaluation of scales utilized in orthopaedic surgery. Determinants of patient satisfaction were identified along with the scales used to measure satisfaction. RESULTS: A total of 6059 records were screened in the initial search. Twenty-six articles satisfied the inclusion criteria, assessing 7130 patients. In the literature, six validated subjective scar scales were identified, including the Vancouver scar scale, patient and observer scar assessment scale, Manchester scar scale, Stony Brook scar evaluation scale, visual analogue scale, and Hollander wound evaluation scale. Studies utilizing these scales to evaluate scars following orthopaedic procedures did so successfully. These were total hip arthroplasty, total knee arthroplasty, and limb reconstruction. The scales demonstrated satisfactory validity. Functional outcomes such as restoration of movement ranked among patients' highest concerns. Scar cosmesis was found to be amongst patients' lowest priorities. CONCLUSIONS Subjective scar assessment scales identified in the literature were not designed specifically for orthopaedic surgery. However, these were able to appropriately assess scars in the studies identified in this review. Current evidence suggests the effect of scar cosmesis on patient satisfaction with orthopaedic procedures is limited.
Humans ; Cicatrix ; Orthopedic Procedures/adverse effects* ; Patient Satisfaction ; Pain Measurement

BACKGROUNDDiversity of orthopedic infections with various local environments affects the pattern and prevalence of pathogens. It is not well-characterized whether different pathogens have different propensity to cause different types of orthopedic infections. We aimed to investigate the frequency of different pathogens derived from orthopedic infections, and determine the relationship between the prevalence of clinical isolates and the type of orthopedic implants, especially focusing on staphylococci.

METHODSFrom January 2006 to December 2011, orthopedic infections were identified retrospectively from clinical microbiology laboratory and orthopedic medical records. The sources of orthopedic infections were divided into two main groups: those associated with implants and those not associated with implants. Implants-associated infections were further subdivided into five subgroups: arthroplasty, internal fixation, external fixation, internal and external fixation, and others. We analyzed microbiological spectrum in different groups and subgroups. Antibiotic susceptibility of staphylococci was analyzed.

RESULTSOnly coagulase-negative staphylococci (CoNS) was significantly more likely to be associated with implants-associated infections (P = 0.029). The overall pathogens prevalence of arthroplasty was significantly different from other subgroups (P < 0.05). 65% isolates from external fixation was Gram-negative bacteria. Some percentage (55%) of S. aureus and (83%) CoNS were resistant to methicillin. No resistance to glycopeptide was seen in all of staphylococci.

CONCLUSIONSStaphylococcus aureus was the most frequent isolates in orthopedic infections but was not associated with the presence or absence of implants. Only CoNS was implants-associated, especially for arthroplasty infection. Cefazolin alone is not enough for orthopedic surgery prophylaxis in settings with a high prevalence of methicillin-resistant staphylococci.

Humans ; Orthopedic Procedures ; adverse effects ; Prostheses and Implants ; microbiology ; Retrospective Studies ; Staphylococcus aureus ; pathogenicity ; physiology

OBJECTIVETo systematically review the efficacy and safety of fondaparinux and enoxaparin in the prevention of venous thromboembolism (VTE) after major orthopedic surgery.

METHODSThe MEDLINE, EMbase, the Cochrane Library, CNKI, CBM, VIP and Wanfang databases (from their establishment to October, 2012) were searched for randomized controlled trials (RCTs) comparing the effects of fondaparinux and enoxaparin in preventing VTE after major orthopedic surgery. The related journals and conference papers were manually searched. The outcome measurements were the incidence of total VTE, deep venous thrombosis (DVT), symptomatic VTE, pulmonary embolism (PE), major bleeding and any other adverse event. The quality of literatures was evaluated and the data were extracted for meta-analysis.

RESULTSFive RCTs involving 7611 patients were included pertaining to major knee surgery (1 RCT), hip fracture surgery (2 RCTs) and total hip arthroplasty (3 RCTs). The incidences of total VTE and DVT were significantly lower in fondaparinux group than in enoxaparin group [RR=0.52, 95%CI (0.40,0.67), P<0.00001; RR=0.49, 95%CI (0.42, 0.58), P<0.00001]. The incidence of symptomatic VTE was similar between the two groups [RR=1.52, 95%CI (0.80,2.88), P=0.20]. Fondaparinux was associated with a significantly increased incidence of major bleeding compared to enoxaparin group [RR=1.55, 95%CI (1.14,2.12), P=0.006], but the mortality rates were comparable between the two groups [RR=0.93, 95%CI (0.63,1.37), P=0.72].

CONCLUSIONCompared with enoxaparin, fondaparinux can reduce the risk of postoperative VTE and do not increase the mortality rate following major orthopedic surgery though with an increased risk of major bleeding.

Enoxaparin ; adverse effects ; therapeutic use ; Humans ; Orthopedic Procedures ; adverse effects ; Polysaccharides ; adverse effects ; therapeutic use ; Randomized Controlled Trials as Topic ; Treatment Outcome ; Venous Thromboembolism ; etiology ; prevention & control

Lower extremity deep venous thrombosis (LDVT) is one of the most common complications in orthopedic surgery, and it often occurs in the first 24 h after operation. We report a case of delayed LDVT, which occurred on d 16 after operation for osteofibrous dysplasia on the left femur. Upon the diagnosis confirmed, thrombolysis and anticoagulation therapy was conducted. The symptoms disappeared 3 weeks later and lower limb vascular ultrasound examination showed no remnant thrombosis.
Adult ; Bone Diseases, Developmental ; surgery ; Female ; Femur ; surgery ; Humans ; Leg ; pathology ; Orthopedic Procedures ; adverse effects ; Venous Thrombosis ; etiology

BACKGROUNDPulmonary problems often occur in patients with early-onset scoliosis (EOS). However, lung function in patients with EOS after growing rod surgery has not been documented. The aim of this study was to investigate lung function after the treatment for EOS with growing rod and its possible correlative factors.

METHODSEight patients with EOS were treated with growing rod surgery at Peking Union Medical College Hospital from September 2002 to September 2009. Four patients had finished the final fusion surgery (group 1), and the other 4 (group 2) were in the process of periodic lengthening. Preoperative forced vital capacity (FVC), ratio of FVC to predicted FVC, forced expiratory volume in 1 second (FEV1), ratio of FEV1 to predicted FEV1, and radiographic measurements of Cobb's angle and C7-S1 distance were recorded. Lung function changes and correlations between lung function changes and radiographic changes (Cobb's angle and C7-S1 distance) were analyzed.

RESULTSIn group 1, FVC and FEV1 both increased. FVC showed a significant difference (P = 0.01), but FEV1 did not (P = 0.05). In group 2, FVC and FEV1 also increased, and both showed a significant difference (P = 0.04 and P = 0.02, respectively). Ratio of FVC to predicted FVC and ratio of FEV1 to predicted FEV1 changed similarly and did not show statistical differences in the 2 groups. There were no significant correlations between lung function changes and radiographic changes (Cobb's angle and C7-S1 distance) (P = 0.10 and P = 0.41, respectively).

CONCLUSIONSLung function increases after growing rod surgery in patients with EOS. Lung function changes do not correlate with Cobb's angle changes or C7-S1 distance changes.

Child ; Female ; Forced Expiratory Volume ; physiology ; Humans ; Male ; Orthopedic Procedures ; adverse effects ; Scoliosis ; physiopathology ; surgery ; Vital Capacity ; physiology

Blood Loss, Surgical ; prevention & control ; Epilepsy ; chemically induced ; Humans ; Orthopedic Procedures ; Spine ; surgery ; Tranexamic Acid ; adverse effects

Antegrade transmalleolar drilling method is one of the options for the treatment of osteochondral lesion of talus (OLT). We present five patients who underwent tibial drilling for treatment of OLT and later developed distal tibial cystic formation induced by cartilage opening or heat necrosis during drilling. Antegrade transmalleolar drilling can be a possible option for the treatment of OLT if the lesion is not easily reachable; however, other viable treatment should be considered due to its possibility of distal tibial pathologic change.
Adult ; Ankle Joint/surgery ; Cartilage, Articular/*surgery ; Female ; Humans ; *Iatrogenic Disease ; Male ; *Musculoskeletal Diseases/etiology/surgery ; *Orthopedic Procedures/adverse effects/methods ; Talus/*surgery ; *Tibia/injuries/surgery ; Young Adult

Because complications are more common in patients with cerebral palsy (CP), surgeons and anesthesiologists must be aware of perioperative morbidity and be prepared to recognize and treat perioperative complications. This study aimed to determine the incidence of and risk factors for perioperative complications of orthopedic surgery on the lower extremities in patients with CP. We reviewed the medical records of consecutive CP patients undergoing orthopedic surgery. Medical history, anesthesia emergence time, intraoperative body temperature, heart rate, blood pressure, immediate postoperative complications, Gross Motor Function Classification System (GMFCS) level, Cormack-Lehane classification, and American Society of Anesthesiologists physical status classification were analyzed. A total of 868 patients was included. Mean age at first surgery was 11.8 (7.6) yr. The incidences of intraoperative hypothermia, absolute hypotension, and absolute bradycardia were 26.2%, 4.4%, and 20.0%, respectively. Twenty (2.3%) patients had major complications, and 35 (4.0%) patients had minor complications postoperatively. The incidences of intraoperative hypothermia, absolute hypotension, and major postoperative complications were significantly higher in patients at GMFCS levels IV and V compared with patients at GMFCS levels I to III (P<0.001). History of pneumonia was associated with intraoperative absolute hypotension and major postoperative complications (P<0.001). These results revealed that GMFCS level, patient age, hip reconstructive surgery, and history of pneumonia are associated with adverse effects on intraoperative body temperature, the cardiovascular system, and immediate postoperative complications.
Adolescent ; Adult ; Cerebral Palsy/*complications ; Child ; Child, Preschool ; Female ; Humans ; Intraoperative Complications/*etiology ; Lower Extremity/*surgery ; Male ; Middle Aged ; Orthopedic Procedures/*adverse effects ; Postoperative Complications/*etiology

OBJECTIVETo study the effect of Shenfu Injection (SI) on the post-operative cognitive dysfunction in senile patients receiving the orthopedic surgeries after general anesthesia.

METHODS100 patients, 60-89 years old, waiting for selective surgery at the orthopedics department, were randomly assigned to two groups, the SI group (50 cases) and the control group (50 cases), who met the standard of the American Society of Anesthesiologists (ASA) II-III. After surgical incision, patients in the SI group were transfused with SI 200 mL (50 mL SI was added in 200 mL normal saline), while those in the control group were transfused with 200 mL normal saline at the same time. The mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO2) were compared between the two groups before anesthesia, after intubation, 30 min and 60 min after anesthesia, 5 min and 30 min after extubation. The time for surgery, the time of intra-operative hypotension, the volume of hemorrhage, the time for post-operative consciousness recovery, the liver function, the kidney function, and the fasting blood glucose of patients before surgery, 3 days and 7 days after operation were compared. The cognitive functions of patients were tested before surgery, 3 days and 7 days after operation. The incidence of post-operative cognitive dysfunction of patients was compared between the two groups.

RESULTSThere was insignificant difference in MAP, HR, and SpO2 between the two groups at each time point (P > 0.05). There was insignificant difference in the pre-operative cognitive function score, the time for surgery, the time of intra-operative hypotension, the volume of hemorrhage, the liver function, the kidney function, and the fasting blood glucose between the two groups ( P > 0.05). The time for post-operative consciousness recovery was obviously shorter in the SI group than in the control group, showing significant difference (P < 0.05). The post-operative 3-day and 7-day cognitive function scores were obviously better in the SI group than in the control group, showing significant difference (P < 0.05). The incidence of post-operative cognitive dysfunction of the SI group [3 days: 12% (6 cases); 7 days: 8% (4 cases) ] was significantly lower than that of the control group [3 days: 20% (10 cases); 7 days: 14% (7 cases) ] ( P < 0.05).

CONCLUSIONSI could improve the post-operative cognitive function of senile patients receiving the orthopedic surgeries after general anesthesia, lower the incidence of post-operative cognitive dysfunction rate, and shorten the time for post-operative consciousness recovery.

Aged ; Aged, 80 and over ; Anesthesia, General ; adverse effects ; Cognition ; Cognition Disorders ; etiology ; Drugs, Chinese Herbal ; pharmacology ; Humans ; Injections ; Middle Aged ; Orthopedic Procedures ; Postoperative Period