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

OBJECTIVETo design transoralpharyngeal atlantoaxial reduction plate (TARP), evaluate its biomechanical performance and observe its preliminary clinical effect.

METHODSA brand-new TARP system was designed, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operation instruments. Twelve fresh occipital bone-C(3) specimen were designed for biomechanical test including range of motion (ROM) (n = 6) and screw pull-out strength (n = 12). Preliminary clinical application of TARP was reported.

RESULTSThe reduction mechanism of the TARP system was designed cleverly. TARP had equal effect with Magerl + Brooks and it was more stable than the other three clinically widely used atlantoaxial fixators: Magerl, Brooks and anterior transarticular screw fixation through C(2) vertebral body. TARP's C(1) and C(2) screws were strong enough for atlantoaxial arthrodesis and their antipull-out performance was excellent. Clinical application on irreducible atlantoaxial dislocation proved that TARP had the function of instant reduction, the operation was feasible and the operation effect was significant.

CONCLUSIONTARP's design is novel and it has excellent biomechanical performance. The operation procedure is simple and reasonable. Furthermore, instant reduction could be completed during the operation and the fixation is strong. Above all, TARP is creative and will have excellent prospect.

Adolescent ; Adult ; Atlanto-Axial Joint ; surgery ; Equipment Design ; standards ; Equipment and Supplies ; adverse effects ; standards ; Female ; Humans ; Joint Dislocations ; etiology ; surgery ; Male ; Orthopedic Procedures ; methods ; Pharynx ; surgery ; Treatment Outcome

OBJECTIVETo assess Chinese surgeon practice of thromboprophylaxis following major orthopedic surgery.

METHODSA questionnaire survey was conducted amongst Chinese orthopedic surgeons. A total of 293 surgeons were surveyed concerning five key aspects of thromboembolic prophylaxis after major orthopedic surgery at the proseminar of Chinese guidelines for prevention of venous thromboembolism (VTE) after major orthopedic surgery in January of 2009.

RESULTSTotally, 208 surgeons (71.0%) responded, successfully completing the questionnaire. Of them, 57.6% respondents selected combined basic, mechanical, and pharmacologic methods for thromboprophylaxis; 51.0% respondents prefer starting prophylaxis 12-24 hours after surgery; 60.3% surgeons would use chemoprophylaxis for 7-10 days; 47.6% respondents prefer VTE prevention based on patients' special conditions and needs upon discharge."Safety" was the most repeated and emphasized factor during VTE prophylaxis.

CONCLUSIONSMultimodal thromboprophylaxis is frequently used after major orthopedic surgery. Half surgeons prefer to start chemoprophylaxis 12-24 hours after surgery. Thromboprophylaxis regimen varies for discharged patients.

Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Orthopedic Procedures ; adverse effects ; Orthopedics ; Postoperative Complications ; prevention & control ; Surveys and Questionnaires ; Thromboembolism ; prevention & control

OBJECTIVETo analyzes the major cause of acute gastric dilatation in orthopaedic patients.

METHODSThere are nine confirmed cases of acute gastric dilatation from Aug. 2006 to Mar. 2008. All the patients were given the systematic treatment such as water deprivation, negative-pressure apparatus and parenteral nutrition. The causes of this complication were concluded by the observation through the course of disease.

RESULTSSix patients were dead and 3 patients got recovery.

CONCLUSIONAcute gastric dilatation is an orthopaedic complication with high mortality. And the wound, surgery stimulation, long-term bedridden and general weakness are higher dangerous factors for this kind of complication.

Acute Disease ; Adult ; Aged ; Female ; Gastric Dilatation ; etiology ; Humans ; Male ; Middle Aged ; Orthopedic Procedures ; adverse effects ; Postoperative Complications ; etiology ; Retrospective Studies