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Schiltenwolf M, Dresing K, Eckert J, Eyfferth T, Gaidzik PW, Grotz M, Lundin S, Thomann KD, Widder B, Zeichen J. [From the Assessment Section of the German Society for Orthopedics and Trauma Surgery in collaboration with the German Society for Neuroscientific Assessment (DGNB) : Assessment recommendations for musculoskeletal injury consequences in private accident insurance]. Orthopadie (Heidelb) 2024; 53:348-360. [PMID: 38592440 PMCID: PMC11052837 DOI: 10.1007/s00132-024-04499-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 04/10/2024]
Affiliation(s)
- Marcus Schiltenwolf
- Sektion Begutachtung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
- Konservative Orthopädie, Schmerzambulanz, Gutachtenambulanz, Klinik für Orthopädie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118 Heidelberg, Deutschland
| | - Klaus Dresing
- Sektion Begutachtung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Johannes Eckert
- Sektion Begutachtung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
- Konservative Orthopädie, Schmerzambulanz, Gutachtenambulanz, Klinik für Orthopädie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118 Heidelberg, Deutschland
| | - Torsten Eyfferth
- Sektion Begutachtung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
- Service- und Rehabilitationszentrum, BGU Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
| | - Peter Wolfgang Gaidzik
- Sektion Begutachtung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
- Institut für Medizinrecht, Private Universität Witten/Herdecke gGmbH, Witten, Deutschland
| | - Martin Grotz
- Sektion Begutachtung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
- Geschäftsbereich Behandlungsfehler, Medizinischer Dienst Niedersachsen, Hannover, Deutschland
| | - Sven Lundin
- Sektion Begutachtung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
- BG-Klinikum Duisburg, Duisburg, Deutschland
| | - Klaus-Dieter Thomann
- Sektion Begutachtung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
- IVM – Institut für Versicherungsmedizin, Frankfurt, Deutschland
| | - Bernhard Widder
- Deutsche Gesellschaft für Neurowissenschaftliche Begutachtung (DGNB), Stuttgart, Deutschland
| | - Johannes Zeichen
- Sektion Begutachtung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
- Deutsche Gesellschaft für Neurowissenschaftliche Begutachtung (DGNB), Stuttgart, Deutschland
- Klinik für Unfallchirurgie und Orthopädie, Johannes Wesling Klinikum Minden, Minden, Deutschland
| | - DGOU Sektion Begutachtung
- Sektion Begutachtung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
- Konservative Orthopädie, Schmerzambulanz, Gutachtenambulanz, Klinik für Orthopädie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118 Heidelberg, Deutschland
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
- Service- und Rehabilitationszentrum, BGU Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
- Institut für Medizinrecht, Private Universität Witten/Herdecke gGmbH, Witten, Deutschland
- Geschäftsbereich Behandlungsfehler, Medizinischer Dienst Niedersachsen, Hannover, Deutschland
- BG-Klinikum Duisburg, Duisburg, Deutschland
- IVM – Institut für Versicherungsmedizin, Frankfurt, Deutschland
- Deutsche Gesellschaft für Neurowissenschaftliche Begutachtung (DGNB), Stuttgart, Deutschland
- Klinik für Unfallchirurgie und Orthopädie, Johannes Wesling Klinikum Minden, Minden, Deutschland
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Muzzammil M, Minhas MS, Yaqoob U, Shah SGM, Jahanzeb S, Qadir A, Fazlani SA, Jabbar S. Introducing the Muzzammil classification for spoke wheel injuries in children to enhance injury assessment and treatment in developing countries. Sci Rep 2023; 13:19252. [PMID: 37935763 PMCID: PMC10630287 DOI: 10.1038/s41598-023-46255-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/30/2023] [Indexed: 11/09/2023] Open
Abstract
Motorbike spoke wheel injuries (SWIs) among children are a notable public health concern, especially in low and middle-income regions. The primary objective of this study is to comprehensively examine the patterns of motorbike spoke wheel injuries (SWIs) in children. Additionally, the study introduces a novel classification system for these injuries. The implementation of this classification system aims to streamline the management of SWIs, making it more efficient and facilitating the development of standardized treatment protocols. This prospective observational study was conducted in the Accident and Emergency Department from January 2019 to 2021. Children < 14 years of age of either gender with foot and ankle injury due to motorbike spoke wheels as passengers and presenting within 3 days were included. The motorbike SWI was assessed for its location and classified by a new classification as Class I, Soft tissue injury without skin loss; Class II, Skin loss of more than 1 cm without underlying tissue involvement; Class III, Skin loss with underlying tissue involvement, this class is further divided on basis of underlying soft-tissue involvement; Class IV: mangled foot/toe. Management plan and outcome were noted. In our study158 children suffering from SWI were registered with a mean age of 6.2 ± 5.4 years, 127 (80.37%) males and 31 (19.62%) females. Class I injury was seen in 18 (11.39%) patients, class II in 69 (43.67%), and class III in 68 (43.03%) patients. Class III injuries were further subcategorized as follows: IIIT (Tendon) injuries, which accounted for 32 cases (20.25%); IIIB (Bone) injuries, with 29 cases (18.35%); and IIINV (Neurovascular) injuries, identified in 7 cases (4.43%). Class IV injuries were observed in 3 (1.8%) children. The flap was needed in 33 (20.88%) patients. There were no complications like flap necrosis or graft rejection. In this current study, a new classification system specific for a motorbike SWI has been introduced along with its application on children presenting at tertiary care hospital's emergency department. The application of the proposed classification will enable universal management guidelines for SWIs, especially in the Ino-Pak region where SWIs are common.
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Affiliation(s)
- Muhammad Muzzammil
- Department of Orthopedics, Sindh Gov. Services Hospital, Karachi, Pakistan.
| | | | - Uzair Yaqoob
- Surgical Department, Dr Ruth K M Pfau Civil Hospital, Karachi, Pakistan
| | | | - Syed Jahanzeb
- Department of Orthopedics, Dr Ruth K M Pfau Civil Hospital, Karachi, Pakistan
| | - Abdul Qadir
- Department of Orthopedics, Dr Ruth K M Pfau Civil Hospital, Karachi, Pakistan
| | | | - Saadia Jabbar
- Jinnah Postgraduate Medical Center, Karachi, Pakistan
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Gazendam AM, Schneider P, Bhandari M, Busse JW, Ghert M. Defining Minimally Important Differences in Functional Outcomes in Musculoskeletal Oncology. J Bone Joint Surg Am 2022; 104:1659-1666. [PMID: 35809001 DOI: 10.2106/jbjs.21.01539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Functional outcomes are commonly reported in studies of patients undergoing limb-salvage surgery for the treatment of musculoskeletal tumors; however, interpretation requires knowledge of the smallest amount of improvement that is important to patients: the minimally important difference (MID). We established the MIDs for the Musculoskeletal Tumor Society Rating Scale-93 (MSTS-93) and Toronto Extremity Salvage Score (TESS) for patients with bone tumors undergoing lower-extremity endoprosthetic reconstruction. METHODS This study was a secondary analysis of the recently completed PARITY (Prophylactic Antibiotic Regimens in Tumor Surgery) study. We used MSTS-93 and TESS data from this trial to calculate (1) the anchor-based MIDs with use of an overall function scale and a receiver operating characteristic curve analysis and (2) the distribution-based MIDs based on one-half of the standard deviation of the change scores from baseline to the 12-month follow-up and one-half the standard deviation of baseline scores. RESULTS Five hundred and ninety-one patients were available for analysis. The Pearson correlation coefficients for the association between changes in MSTS-93 and TESS scores and changes in the external anchor scores were 0.71 and 0.57, indicating high and moderate correlations. The anchor-based MID was 12 points for the MSTS-93 and 11 points for the TESS. Distribution-based MIDs were larger: 16 to 17 points for the MSTS-93 and 14 points for the TESS. CONCLUSIONS Two methods for determining MIDs for the MSTS-93 and TESS for patients undergoing lower-extremity endoprosthetic reconstruction for musculoskeletal tumors yielded quantitatively different results. We suggest the use of anchor-based MIDs, which are grounded in changes in functional status that are meaningful to patients. These thresholds can facilitate responder analyses and indicate whether significant differences following interventions are clinically important to patients. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Aaron M Gazendam
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Patricia Schneider
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Ghert
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Affiliation(s)
- R Plastow
- University College London Hospitals NHS Foundation Trust, UK
| | | | - F S Haddad
- University College London Hospitals NHS Foundation Trust, UK
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Paliwal M, Weber KA, Smith AC, Elliott JM, Muhammad F, Dahdaleh NS, Bodurka J, Dhaher Y, Parrish TB, Mackey S, Smith ZA. Fatty infiltration in cervical flexors and extensors in patients with degenerative cervical myelopathy using a multi-muscle segmentation model. PLoS One 2021; 16:e0253863. [PMID: 34170961 PMCID: PMC8232539 DOI: 10.1371/journal.pone.0253863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/14/2021] [Indexed: 12/27/2022] Open
Abstract
Background In patients with degenerative cervical myelopathy (DCM) that have spinal cord compression and sensorimotor deficits, surgical decompression is often performed. However, there is heterogeneity in clinical presentation and post-surgical functional recovery. Objectives Primary: a) to assess differences in muscle fat infiltration (MFI) in patients with DCM versus controls, b) to assess association between MFI and clinical disability. Secondary: to assess association between MFI pre-surgery and post-surgical functional recovery. Study design Cross-sectional case control study. Methods Eighteen patients with DCM (58.6 ± 14.2 years, 10 M/8F) and 25 controls (52.6 ± 11.8 years, 13M/12 F) underwent 3D Dixon fat-water imaging. A convolutional neural network (CNN) was used to segment cervical muscles (MFSS- multifidus and semispinalis cervicis, LC- longus capitis/colli) and quantify MFI. Modified Japanese Orthopedic Association (mJOA) and Nurick were collected. Results Patients with DCM had significantly higher MFI in MFSS (20.63 ± 5.43 vs 17.04 ± 5.24, p = 0.043) and LC (18.74 ± 6.7 vs 13.66 ± 4.91, p = 0.021) than controls. Patients with increased MFI in LC and MFSS had higher disability (LC: Nurick (Spearman’s ρ = 0.436, p = 0.003) and mJOA (ρ = -0.399, p = 0.008)). Increased MFI in LC pre-surgery was associated with post-surgical improvement in Nurick (ρ = -0.664, p = 0.026) and mJOA (ρ = -0.603, p = 0.049). Conclusion In DCM, increased muscle adiposity is significantly associated with sensorimotor deficits, clinical disability, and functional recovery after surgery. Accurate and time efficient evaluation of fat infiltration in cervical muscles may be conducted through implementation of CNN models.
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Affiliation(s)
- Monica Paliwal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- * E-mail:
| | - Kenneth A. Weber
- Department of Anesthesiology, Systems Neuroscience and Pain Laboratory, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, United States of America
| | - Andrew C. Smith
- Department of Physical Medicine and Rehabilitation, School of Medicine, Physical Therapy Program, Aurora, Colorado, United States of America
| | - James M. Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Faculty of Medicine and Health, University of Sydney, Kolling Institute of Medical Research, St. Leonards, New South Wales, Australia
| | - Fauziyya Muhammad
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Nader S. Dahdaleh
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, Oklahoma, United States of America
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, United States of America
| | - Yasin Dhaher
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Todd B. Parrish
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Sean Mackey
- Department of Anesthesiology, Systems Neuroscience and Pain Laboratory, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, United States of America
| | - Zachary A. Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
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Jumtins A, Jakusonoka R, Vikmanis A, Grigorjevs D, Ciems M, Krupenko I, Lerner A. COVID-19 Crisis Effect: Experience at Two Orthopedic Trauma Units. Isr Med Assoc J 2021; 23:71-75. [PMID: 33595209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND The coronavirus disease-2019 (COVID-19) crisis has affected how hospitals work and has had an effect on orthopedic surgery. OBJECTIVES To compare patient management and low-energy and high-energy trauma treatment at two orthopedic trauma units during the COVID-19 crisis and to clarify resource demands and preparedness in orthopedic clinics during the state of emergency caused by the COVID-19 pandemic. METHODS This retrospective study was conducted at two orthopedic trauma units from 14 March 2019 to 14 April 2019 and from 14 March 2020 to 14 April 2020. RESULTS The proportion of patients admitted in the multi-trauma orthopedic unit decreased by one-third, the mean time interval from admission to surgery significantly decreased, and the number of surgeries and mean length of stay in hospital decreased in 2020 compared to the same test period in 2019. In the orthopedic trauma unit, the number of patients and surgeries also decreased. CONCLUSIONS Our study highlights changes in orthopedic injury characteristics in two orthopedic units during the COVID-19 crisis in Latvia and compares these changes to data from the same time period one year earlier.
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Affiliation(s)
- Andris Jumtins
- Department of Orthopaedics, Riga Stradins University, Riga, Latvia
- Hospital of Traumatology and Orthopaedics, Riga, Latvia
| | - Ruta Jakusonoka
- Department of Orthopaedics, Riga Stradins University, Riga, Latvia
| | - Andris Vikmanis
- Department of Orthopaedics, Riga Stradins University, Riga, Latvia
- Hospital of Traumatology and Orthopaedics, Riga, Latvia
| | - Dmitrijs Grigorjevs
- Department of Residency, Riga Stradins University, Riga, Latvia
- Hospital of Traumatology and Orthopaedics, Riga, Latvia
| | - Modris Ciems
- Hospital of Traumatology and Orthopaedics, Riga, Latvia
| | - Ivans Krupenko
- Department of Traumatology and Orthopaedics, Clinical Centre "Gailezers", Riga Eastern Clinical University Hospital, Riga, Latvia
| | - Alexander Lerner
- Department of Orthopedics, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Department of Orthopedic Surgery, Ziv Medical Center, Safed, Israel
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Krishnamoorthy V, Ellis AR, McLean DJ, Stefan MS, Nathanson BH, Cobert J, Lindenauer PK, Brookhart MA, Ohnuma T, Raghunathan K. Bleeding After Musculoskeletal Surgery in Hospitals That Switched From Hydroxyethyl Starch to Albumin Following a Food and Drug Administration Warning. Anesth Analg 2020; 131:1193-1200. [PMID: 32925340 DOI: 10.1213/ane.0000000000004942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND While US Food and Drug Administration (FDA) black box warnings are common, their impact on perioperative outcomes is unclear. Hydroxyethyl starch (HES) is associated with increased bleeding and kidney injury in patients with sepsis, leading to an FDA black box warning in 2013. Among patients undergoing musculoskeletal surgery in a subset of hospitals where colloid use changed from HES to albumin following the FDA warning, we examined the rate of major perioperative bleeding post- versus pre-FDA warning. METHODS The authors of this article used a retrospective, quasi-experimental, repeated cross-sectional, interrupted time series study of patients undergoing musculoskeletal surgery in hospitals within the Premier Healthcare Database, in the year before and year after the 2013 FDA black box warning. We examined patients in 23 "switcher" hospitals (where the percentage of colloid recipients receiving HES exceeded 50% before the FDA warning and decreased by at least 25% in absolute terms after the FDA warning) and patients in 279 "nonswitcher" hospitals. Among patients having surgery in "switcher" and "nonswitcher" hospitals, we determined monthly rates of major perioperative bleeding during the 12 months after the FDA warning, compared to 12 months before the FDA warning. Among patients who received surgery in "switcher" hospitals, we conducted a propensity-weighted segmented regression analysis assessing differences-in-differences (DID), using patients in "nonswitcher" hospitals as a control group. RESULTS Among 3078 patients treated at "switcher" hospitals (1892 patients treated pre-FDA warning versus 1186 patients treated post-FDA warning), demographic and clinical characteristics were well-balanced. Two hundred fifty-one (13.3%) received albumin pre-FDA warning, and 900 (75.9%) received albumin post-FDA warning. Among patients undergoing surgery in "switcher" hospitals during the pre-FDA warning period, 282 of 1892 (14.9%) experienced major bleeding during the hospitalization, compared to 149 of 1186 (12.6%) following the warning. In segmented regression, the adjusted ratio of slopes for major perioperative bleeding post- versus pre-FDA warning was 0.98 (95% confidence interval [CI], 0.93-1.04). In the DID estimate using "nonswitcher" hospitals as a control group, the ratio of ratios was 0.93 (95% CI, 0.46-1.86), indicating no significant difference. CONCLUSIONS We identified a subset of hospitals where colloid use for musculoskeletal surgery changed following a 2013 FDA black box warning regarding HES use in sepsis. Among patients undergoing musculoskeletal surgery at these "switcher" hospitals, there was no significant decrease in the rate of major perioperative bleeding following the warning, possibly due to incomplete practice change. Evaluation of the impact of systemic changes in health care may contribute to the understanding of patient outcomes in perioperative medicine.
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Affiliation(s)
- Vijay Krishnamoorthy
- From the Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Alan R Ellis
- Department of Social Work, North Carolina State University, Raleigh, North Carolina
| | - Duncan J McLean
- Department of Anesthesiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mihaela S Stefan
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | | | - Julien Cobert
- Department of Anesthesiology, University of California, San Francisco, California
- Anesthesiology Service Durham VA Medical Center, Durham, North Carolina
| | - Peter K Lindenauer
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - M Alan Brookhart
- Department of Epidemiology, University of North Carolina (UNC) Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- NoviSci LLC, Durham, North Carolina
| | - Tetsu Ohnuma
- From the Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Karthik Raghunathan
- From the Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
- Anesthesiology Service Durham VA Medical Center, Durham, North Carolina
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Yun JS, Chung HW, Song JS, Lee SH, Lee MH, Shin MJ. Dedifferentiated liposarcoma of the musculoskeletal system: expanded MR imaging spectrum from predominant fatty mass to non-fatty mass. Acta Radiol 2019; 60:1474-1481. [PMID: 30907094 DOI: 10.1177/0284185119833060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Jae Sung Yun
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Joon Seon Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sang Hoon Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Min Hee Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Myung Jin Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Butler BA, Lawton CD, Johnson DJ, Nicolay RW, Yamaguchi JT, Stover MD. The Experiential Benefit of an Orthopedic Trauma Fellowship: An Analysis of ACGME Case Log Data From 2006 to 2017. J Surg Educ 2019; 76:1556-1561. [PMID: 31196768 DOI: 10.1016/j.jsurg.2019.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/16/2019] [Accepted: 05/20/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The Accreditation Council for Graduate Medical Education (ACGME) has published orthopedic case log data since the 2006/2007 academic year. Here, we use this data to analyze the variability in orthopedic trauma case experience reported by orthopedic trainees and to better understand the impact of an orthopedic trauma fellowship on orthopedic surgical training. DESIGN, SETTING, AND PARTICIPANTS Data were gathered from ACGME case log reports for orthopedic residents (reporting the cumulative case experience of graduating residents) and orthopedic trauma fellows (reporting the case experience of their fellowship year only) for all available years. RESULTS The average orthopedic trauma fellow reported significantly more trauma cases in multiple body regions ("Pelvis/Hip", "Femur/Knee", and "Foot/Toes") and "Open Complex" reductions (as defined by the ACGME) in their 1 year of fellowship than the average resident reported in their 5 years of residency. CONCLUSION On average, orthopedic trauma fellowships substantially increase the trauma case volumes of orthopedic trainees, especially with respect to lower extremity trauma.
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Affiliation(s)
- Bennet A Butler
- Northwestern Memorial Hospital Department of Orthopaedic Surgery, Chicago, Illinois.
| | - Cort D Lawton
- Northwestern Memorial Hospital Department of Orthopaedic Surgery, Chicago, Illinois
| | - Daniel J Johnson
- Northwestern Memorial Hospital Department of Orthopaedic Surgery, Chicago, Illinois
| | - Richard W Nicolay
- Northwestern Memorial Hospital Department of Orthopaedic Surgery, Chicago, Illinois
| | | | - Michael D Stover
- Northwestern Memorial Hospital Department of Orthopaedic Surgery, Chicago, Illinois
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Abstract
BACKGROUND Postoperative pain is caused by surgical trauma and poses a significant challenge for health care providers. Opioid analgesics are commonly used to control postoperative pain. However, these drugs are associated with a number of negative side effects. This review will assess the clinical evidence for and against the use of herbal medicine formulas as a treatment for postoperative pain, especially after musculoskeletal surgery. METHODS Twelve databases will be searched from inception to March 2019. We will include randomized controlled trials (RCTs) assessing herbal medicine decoctions used to treat any type of postoperative pain. All RCTs of decoctions or modified decoctions will be included. The methodologic qualities of the RCTs will be assessed using the Cochrane Collaboration tool for assessing risk of bias, while confidence in the cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation method. CONCLUSION This systematic review will be published in a peer-reviewed journal and disseminated electronically and in print. The review will be updated to inform and guide health care practices.Registration number: CRD42018094897.
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Affiliation(s)
| | - Ji Hwan Kim
- Department of Sasang Constitutional Medicine, College of Korean Medicine, Gachon University, Seongnam, Korea
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Moore W, Doshi A, Bhattacharji P, Gyftopoulos S, Ciavarra G, Kim D, Recht M. Automated Radiology-Operative Note Communication Tool; Closing the Loop in Musculoskeletal Imaging. Acad Radiol 2018; 25:244-249. [PMID: 29122473 DOI: 10.1016/j.acra.2017.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 08/23/2017] [Accepted: 08/26/2017] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES Correlation of imaging studies and reference standard outcomes is a significant challenge in radiology. This study evaluates the effectiveness of a new communication tool by assessing the ability of this system to correctly match the imaging studies to arthroscopy reports and qualitatively assessing radiologist behavior before and after the implementation of this system. MATERIALS AND METHODS Using a commercially available communication or educational tool and applying a novel matching rule algorithm, radiology and arthroscopy reports were matched from January 17, 2017 to March 1, 2017 based on anatomy. The interpreting radiologist was presented with email notifications containing the impression of the imaging report and the entire arthroscopy report. Total correlation rate of appropriate report pairings, modality-specific correlation rate, and the anatomy-specific correlation rate were calculated. Radiologists using the system were given a survey. RESULTS Overall correlation rate for all musculoskeletal imaging was 83.1% (433 or 508). Low correlation was found in fluoroscopic procedures at 74.4%, and the highest correlation was found with ultrasound at 88.4%. Anatomic location varied from 51.6% for spine to 98.8% for hips and pelvis studies. Survey results revealed 87.5% of the respondents reporting being either satisfied or very satisfied with the new communication tool. The survey also revealed that some radiologists reviewed more cases than before. CONCLUSIONS Matching of radiology and arthroscopy reports by anatomy allows for excellent report correlation (83.1%). Automated correlation improves the quality and efficiency of feedback to radiologists, providing important opportunities for learning and improved accuracy.
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Affiliation(s)
- William Moore
- New York University Medical Center Department of Radiology, 660 First Avenue, New York, NY 10016.
| | - Ankur Doshi
- New York University Medical Center Department of Radiology, 660 First Avenue, New York, NY 10016
| | - Priya Bhattacharji
- New York University Medical Center Department of Radiology, 660 First Avenue, New York, NY 10016
| | | | - Gina Ciavarra
- New York University Medical Center Department of Radiology, New York, New York
| | - Danny Kim
- New York University Medical Center Department of Radiology, 660 First Avenue, New York, NY 10016
| | - Michael Recht
- New York University Medical Center Department of Radiology, 660 First Avenue, New York, NY 10016
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Nowicki M, Castro NJ, Rao R, Plesniak M, Zhang LG. Integrating three-dimensional printing and nanotechnology for musculoskeletal regeneration. Nanotechnology 2017; 28:382001. [PMID: 28762957 PMCID: PMC5612478 DOI: 10.1088/1361-6528/aa8351] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The field of tissue engineering is advancing steadily, partly due to advancements in rapid prototyping technology. Even with increasing focus, successful complex tissue regeneration of vascularized bone, cartilage and the osteochondral interface remains largely illusive. This review examines current three-dimensional printing techniques and their application towards bone, cartilage and osteochondral regeneration. The importance of, and benefit to, nanomaterial integration is also highlighted with recent published examples. Early-stage successes and challenges of recent studies are discussed, with an outlook to future research in the related areas.
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Affiliation(s)
- Margaret Nowicki
- Department of Mechanical and Aerospace Engineering, The George Washington University, 800 22nd Street, NW, Washington DC 20052, United States of America
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13
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Bernhardt M. Providing Musculoskeletal Care and Education in Kansas City. Mo Med 2017; 114:267. [PMID: 30228608 PMCID: PMC6140072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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14
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Scheer JK, Osorio JA, Smith JS, Schwab F, Lafage V, Hart RA, Bess S, Line B, Diebo BG, Protopsaltis TS, Jain A, Ailon T, Burton DC, Shaffrey CI, Klineberg E, Ames CP. Development of Validated Computer-based Preoperative Predictive Model for Proximal Junction Failure (PJF) or Clinically Significant PJK With 86% Accuracy Based on 510 ASD Patients With 2-year Follow-up. Spine (Phila Pa 1976) 2016; 41:E1328-E1335. [PMID: 27831987 DOI: 10.1097/brs.0000000000001598] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review of large, multicenter adult spinal deformity (ASD) database. OBJECTIVE The aim of this study was to build a model based on baseline demographic, radiographic, and surgical factors that can predict clinically significant proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). SUMMARY OF BACKGROUND DATA PJF and PJK are significant complications and it remains unclear what are the specific drivers behind the development of either. There exists no predictive model that could potentially aid in the clinical decision making for adult patients undergoing deformity correction. METHODS Inclusion criteria: age ≥18 years, ASD, at least four levels fused. Variables included in the model were demographics, primary/revision, use of three-column osteotomy, upper-most instrumented vertebra (UIV)/lower-most instrumented vertebra (LIV) levels and UIV implant type (screw, hooks), number of levels fused, and baseline sagittal radiographs [pelvic tilt (PT), pelvic incidence and lumbar lordosis (PI-LL), thoracic kyphosis (TK), and sagittal vertical axis (SVA)]. PJK was defined as an increase from baseline of proximal junctional angle ≥20° with concomitant deterioration of at least one SRS-Schwab sagittal modifier grade from 6 weeks postop. PJF was defined as requiring revision for PJK. An ensemble of decision trees were constructed using the C5.0 algorithm with five different bootstrapped models, and internally validated via a 70 : 30 data split for training and testing. Accuracy and the area under a receiver operator characteristic curve (AUC) were calculated. RESULTS Five hundred ten patients were included, with 357 for model training and 153 as testing targets (PJF: 37, PJK: 102). The overall model accuracy was 86.3% with an AUC of 0.89 indicating a good model fit. The seven strongest (importance ≥0.95) predictors were age, LIV, pre-operative SVA, UIV implant type, UIV, pre-operative PT, and pre-operative PI-LL. CONCLUSION A successful model (86% accuracy, 0.89 AUC) was built predicting either PJF or clinically significant PJK. This model can set the groundwork for preop point of care decision making, risk stratification, and need for prophylactic strategies for patients undergoing ASD surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Justin K Scheer
- University of California, San Diego, School of Medicine, La Jolla, CA
| | - Joseph A Osorio
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA
| | - Frank Schwab
- Spine Service, Hospital for Special Surgery, New York, NY
| | | | - Robert A Hart
- Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR
| | - Shay Bess
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Breton Line
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Bassel G Diebo
- Spine Service, Hospital for Special Surgery, New York, NY
| | | | - Amit Jain
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Tamir Ailon
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | | | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, CA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
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Grandizio LC, Huston JC, Shim SS, Parenti JM, Graham J, Klena JC. Levels of evidence have increased for musculoskeletal trauma questions on the orthopaedic in-training examination. J Surg Educ 2015; 72:258-263. [PMID: 25487680 DOI: 10.1016/j.jsurg.2014.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/26/2014] [Accepted: 10/10/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The purpose of this study was to determine if the levels of evidence for primary journal articles used as references for musculoskeletal trauma questions on the Orthopaedic In-Training Examination (OITE) have increased over a 15-year period. DESIGN Basic science article. SETTING Geisinger Medical Center (Danville, PA), tertiary referral center. PARTICIPANTS All 329 questions in the musculoskeletal trauma content domain on the OITE from 1995 to 1997 and 2010 to 2012 were reviewed. Baseline characteristics for each question and each reference were recorded. References were categorized as a textbook, a journal review article, an instructional course lecture, or a primary journal article. For each primary journal article, the level of evidence for the article was determined in accordance with the American Academy of Orthopaedic Surgeons Levels of Evidence Guidelines. RESULTS The level of evidence used for primary journal articles demonstrated a statistically significant increase from 1995 to 1997 to 2010 to 2012. Overall, 27% of primary journal articles cited on the 1995 to 1997 OITEs were level I, II, or III studies, increasing to 43% during the 2010 to 2012 period (p = 0.04). The Buckwalter classification for the OITE questions changed significantly between the 2 periods, with questions from 2010 to 2012 including more T1 questions (25% vs 39%) and fewer T3 questions (46% vs 39%, p = 0.016). The Journal of Bone and Joint Surgery and the Journal of Orthopaedic Trauma were the most frequently cited journals overall. CONCLUSIONS The levels of evidence for primary journal articles cited on the OITE for questions within the musculoskeletal trauma content domain have increased between 1995 and 2012. Our analysis can be used as a guide to help examinees prepare for musculoskeletal trauma questions on the OITE and as an aid in core curriculum development.
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Affiliation(s)
- Louis C Grandizio
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania.
| | - James C Huston
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Stephanie S Shim
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - John M Parenti
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Jove Graham
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Joel C Klena
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
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Plehutsa IM, Sydorchuk RI, Plehutsa OM. [THE SYSTEMIC IMMUNITY CELLULAR LINK REACTION IN PATIENTS WITH TRAUMATIC ILLNESS]. Lik Sprava 2015:26-32. [PMID: 26118023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The effect of trauma on parameters of cellular immunity changes is studied. The study includes 52 patients with various forms of traumatic illness, aged 18-69 years (37.91-4.28). The control group consisted of 16 patients who underwent routine surgery not related to the pathology of musculoskeletal system. All patients of the main group were divided into 3 groups according to severity of the condition. Analysis of parameters of cellular link of immune system was performed by defining subpopulations of T-lymphocytes in indirect immunofluorescence method using a panel of monoclonal antibodies for CD3, CD4, CD8, CD22 lymphocytes' receptors and calculation of integrated indicators. The highest expression (immune disorders of II-III grades) of changes of cellular immunity observed in patients with severe traumatic: illness (expand clinical picture). Surgical intervention, even without traumatic injury significantly impact cellular immunity, but in patients with traumatic illness immunity violation were significantly higher than in comparison groups patients except immunoregulatory index.
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Varela E, Oral A, Ilieva E, Küçükdeveci AA, Valero R, Berteanu M, Christodoulou N. Musculoskeletal perioperative problems. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM Section Professional Practice Committee. Eur J Phys Rehabil Med 2013; 49:753-759. [PMID: 24145233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
One of the objectives of the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the Union of European Medical Specialists (UEMS) is the development of the field of competence of PRM physicians in Europe. To achieve this objective, UEMS PRM Section PPC has adopted a systematic action plan of preparing a series of papers describing the role of PRM physicians in a number of disabling health conditions, based on the evidence of effectiveness of the physical and rehabilitation medicine interventions. According to the UEMS-PRM section, the role of PRM physician in musculoskeletal perioperative settings has to be situated inside general pain management. Musculoskeletal surgery (MSS) represents a frequent medical situation among patients suffering from musculoskeletal disorders (MSDs), in which PRM physicians need to be involved. A wide number of MSDs have to be operated in order to diminish disability and relieve symptoms, thus improving the patient´s functioning and social participation: Joint replacements, spine decompressions, vertebroplasties, internal fixation of unstable fractures, arthroscopies for tendon and joint repairs, and others. This paper describes the role of the PRM physician during the perioperative period. A well-coordinated rehabilitation programme followed by a good home rehabilitation programme results in pain reduction, faster recovery with better patient participation and increased cost effectiveness. PRM physicians have to identify patients at risk of continuing activity limitation and participation restriction who will benefit from an early rehabilitation process and formulate a PRM programme of care taking into account each patient's environmental factors.
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Affiliation(s)
- E Varela
- Member, Professional Practice Committee, UEMS Section of PRM, Departamento de Medicina Física y Rehabilitación, Facultad de Medicina UCM, Ciudad Universitaria, Madrid, Spain -
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Castagna A. The fifth monographic issue of Musculoskeletal Surgery edited by the Italian Society of Shoulder and Elbow Surgery exhibits a further progress in contents and in quality. Musculoskelet Surg 2012; 96 Suppl 1:S1-2. [PMID: 22528852 DOI: 10.1007/s12306-012-0197-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Knobe M, Carow JB, Ruesseler M, Leu BM, Simon M, Beckers SK, Ghassemi A, Sönmez TT, Pape HC. Arthroscopy or ultrasound in undergraduate anatomy education: a randomized cross-over controlled trial. BMC Med Educ 2012; 12:85. [PMID: 22958784 PMCID: PMC3473305 DOI: 10.1186/1472-6920-12-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 09/06/2012] [Indexed: 05/10/2023]
Abstract
BACKGROUND The exponential growth of image-based diagnostic and minimally invasive interventions requires a detailed three-dimensional anatomical knowledge and increases the demand towards the undergraduate anatomical curriculum. This randomized controlled trial investigates whether musculoskeletal ultrasound (MSUS) or arthroscopic methods can increase the anatomical knowledge uptake. METHODS Second-year medical students were randomly allocated to three groups. In addition to the compulsory dissection course, the ultrasound group (MSUS) was taught by eight, didactically and professionally trained, experienced student-teachers and the arthroscopy group (ASK) was taught by eight experienced physicians. The control group (CON) acquired the anatomical knowledge only via the dissection course. Exposure (MSUS and ASK) took place in two separate lessons (75 minutes each, shoulder and knee joint) and introduced standard scan planes using a 10-MHz ultrasound system as well as arthroscopy tutorials at a simulator combined with video tutorials. The theoretical anatomic learning outcomes were tested using a multiple-choice questionnaire (MCQ), and after cross-over an objective structured clinical examination (OSCE). Differences in student's perceptions were evaluated using Likert scale-based items. RESULTS The ASK-group (n = 70, age 23.4 (20-36) yrs.) performed moderately better in the anatomical MC exam in comparison to the MSUS-group (n = 84, age 24.2 (20-53) yrs.) and the CON-group (n = 88, 22.8 (20-33) yrs.; p = 0.019). After an additional arthroscopy teaching 1% of students failed the MC exam, in contrast to 10% in the MSUS- or CON-group, respectively. The benefit of the ASK module was limited to the shoulder area (p < 0.001). The final examination (OSCE) showed no significant differences between any of the groups with good overall performances. In the evaluation, the students certified the arthroscopic tutorial a greater advantage concerning anatomical skills with higher spatial imagination in comparison to the ultrasound tutorial (p = 0.002; p < 0.001). CONCLUSIONS The additional implementation of arthroscopy tutorials to the dissection course during the undergraduate anatomy training is profitable and attractive to students with respect to complex joint anatomy. Simultaneous teaching of basic-skills in musculoskeletal ultrasound should be performed by medical experts, but seems to be inferior to the arthroscopic 2D-3D-transformation, and is regarded by students as more difficult to learn. Although arthroscopy and ultrasound teaching do not have a major effect on learning joint anatomy, they have the potency to raise the interest in surgery.
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Affiliation(s)
- Matthias Knobe
- Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
| | - John Bennet Carow
- Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
| | - Miriam Ruesseler
- Department of Trauma Surgery, Medical Faculty, Johann Wolfgang Goethe Hospital, Frankfurt University, 7 Theodor Stern Kai, Frankfurt am Main 60590, Germany
| | - Benjamin Moritz Leu
- Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
| | - Melanie Simon
- Dean' office for study affairs, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
| | - Stefan K Beckers
- AIXTRA – Aix-la-Chapelle Centre for Interdisciplinary Training in Medical Education, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
| | - Alireza Ghassemi
- Department of Oral and Maxillofacial and Plastic Facial Surgery, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
| | - Tolga T Sönmez
- Department of Oral and Maxillofacial and Plastic Facial Surgery, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
| | - Hans-Christoph Pape
- Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
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Karam MD, Kho JY, Yehyawi TM, Ohrt GT, Thomas GW, Jonard B, Anderson DD, Marsh JL. Application of surgical skill simulation training and assessment in orthopaedic trauma. Iowa Orthop J 2012; 32:76-82. [PMID: 23576925 PMCID: PMC3565418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Matthew D Karam
- Department of Orthopaedics & Rehabilitation, The University of Iowa, Iowa City, IA 52242, USA.
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Abstract
As a result of the demographic development of industrial nations the number of musculoskeletal diseases and injuries rises continuously. This challenges health care as well as clinical research and demands additional endeavours. The United Nations have recognised this issue at an early stage. With their in 2000 declared Bone and Joint Decade they have significantly contributed to a sustainable support of research activities. The German government has also perceived the need and, with their roadmap programme, encourages research of musculoskeletal disease.Today, surgical and orthopaedic clinics increasingly support the exchange between research and clinic and run their own research departments. The Berlin Center for Musculoskeletal Surgery (CMSC) and its research institute Julius Wolff Institut show the potential for surgical research. It shows that based on a clinical understanding of the problem, basic research needs to be complemented in a network with partners from other disciplines. However, interdisciplinary cooperation demands new and individual ways of communication and education. The example in Berlin also illustrates that the research on prevention not only completes the network but more over opens unexpected possibilities in understanding basic research and translation.
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Affiliation(s)
- G N Duda
- Julius Wolff Institut and Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany.
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Affiliation(s)
- Feza Korkusuz
- Department of Biomedical Engineering and Medical Center, Middle East Technical University, Inonu Cd., Balgat, Ankara, 06531 Turkey
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24
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[Abstracts of the 83rd Annual Meeting of the French Society of Surgical Orthopedics and Trauma]. Rev Chir Orthop Reparatrice Appar Mot 2008; 94 Suppl 7:S224-333. [PMID: 19388199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Dewo P, Magetsari R, Busscher HJ, van Horn JR, Verkerke GJ. Treating natural disaster victims is dealing with shortages: an orthopaedics perspective. Technol Health Care 2008; 16:255-259. [PMID: 18776602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
During natural disasters such as earthquakes or tsunamis, most of the casualties are known to suffer from musculoskeletal injuries. This leads to an enormous need of orthopaedic (surgical) implants such as osteosynthesis plates, which are difficult to provide in developing countries that rely on imported ones. One of the alternatives is utilization of local resources, but only after they have been proven safe to use, and meet the international standards set. Through this paper we would like to urge the international community to include locally produced biomedical products, like osteosynthesis plates in their scientific evaluations and communications. When the quality of local products is proven, the reluctance to use local products also by surgeons from developing countries will disappear and larger scale production can be initiated. This in its turn solves many problems that come after natural disasters and stimulates the national economy in an efficient and effective way.
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Affiliation(s)
- Punto Dewo
- Department of Orthopaedics and Traumatology, School of Medicine University of Gadjah Mada, Jogjakarta, Indonesia.
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Heller MO, Matziolis G, König C, Taylor WR, Hinterwimmer S, Graichen H, Hege HC, Bergmann G, Perka C, Duda GN. [Musculoskeletal biomechanics of the knee joint. Principles of preoperative planning for osteotomy and joint replacement]. Orthopade 2007; 36:628-34. [PMID: 17605127 DOI: 10.1007/s00132-007-1115-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The long-term clinical outcome of surgical interventions at the knee is dependent upon the quality of the restoration of normal function, together with moderate musculoskeletal loading conditions. In order to achieve this, it is essential to consider biomechanical knowledge during the planning and execution of the procedures. Until now, such knowledge has only been available in books and journal manuscripts and is merely considered during preoperative planning. Its transfer into the specific intraoperative situation is, however, primarily dependent upon the surgeon's skills and understanding. Mathematical models hold the potential to provide the surgeon with detailed, patient-specific information on the in vivo forces, as well as their spatial and temporal distribution. Their application in clinical routine, however, requires a comprehensive validation. Based on a model validated against patient data, it has been shown that - mainly as a result of the action of the muscles - both the tibiofemoral as well as the patellofemoral joints experience substantial mechanical loads even during normal activities of daily living. The calculations further indicate that malalignment at the knee in the frontal plane of more than approximately 4 degrees results in considerably increased forces across the tibiofemoral joint. The actual change in force to a given degree of malalignment might, however, vary greatly between subjects. In order to additionally determine the distribution of the forces in more detail, a sufficiently accurate model of knee joint kinematics is required. In combination with MR-based in vivo imaging techniques, new mathematical models offer the possibility to capture the individual characteristics of knee kinematics and might additionally allow the effect of muscle activity on joint kinematics to be considered. By implementing these technologies in preoperative planning and navigation systems, up-to-date biomechanical knowledge can be made available at the surgeons' fingertips. We propose that optimizing the biomechanical conditions through using these approaches will allow the long-term function of the replaced joint to be significantly enhanced.
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Affiliation(s)
- M O Heller
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin
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[Abstracts of the 82nd Annual Meeting of the French Society of Surgical Orthopedics and Trauma]. Rev Chir Orthop Reparatrice Appar Mot 2007; 93:4S22-161. [PMID: 18181293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Abstracts of the 15th European SICOT Trainees Meeting, Prague, Czech Republic, September 14-16, 2006. Acta Chir Orthop Traumatol Cech 2007; 74 Suppl 1:7-40. [PMID: 17953044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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[Abstracts of the 81st Annual Meeting of the French Society of Surgical Orthopedics and Trauma]. Rev Chir Orthop Reparatrice Appar Mot 2006; 92:3S25-162. [PMID: 17378086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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30
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Affiliation(s)
- Brian C Toolan
- University of Chicago Medical Center, 5841 South Maryland Avenue, MC 3079, IL 60637, USA.
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Abstract
Stem cells offer a glimpse into a future that might unravel the promising ability of wide-ranging biological reconstructions.
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Affiliation(s)
- Haim Stein
- Department of Orthopedic Surgery A, Rambam Medical Center, Haifa, Israel
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Faisham WI, Zulmi W, Nor Azman MZ, Rhendra Hardy MZ. Forequarter amputation of the upper extremity for musculoskeletal tumors: posterior approach revisited. Med J Malaysia 2006; 61 Suppl A:57-61. [PMID: 17042232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Forequarter amputation entails surgical removal of entire upper extremity, scapula and clavicle. Several techniques of forequarter amputation have been described. The anterior approach has been the preferred technique of exploration of axillary vessels and brachial plexus. The posterior approach has been condemned to be unreliable and dangerous for most large tumor of the scapula and suprascapular area. We describe a surgical technique using posterior approach of exploration of major vessels for forequarter amputation of upper extremity in eight patients who presented with humeral-scapular tumor. There were six patients with osteosarcoma: three with tumor recurrent and three chemotherapy recalcitrant tumors with vessels involvement. One patient had massive fungating squamous cell carcinoma and another had recurrent rhabdomyosarcoma. Four patients had fungating ulcer and six patients had multiple pulmonary metastases at the time of surgery. The mean estimated blood transfusion was 900 ml (range 0-1600 ml) and two patients did not require transfusion. The duration of surgery ranged 2.5-6.0 hours (mean 3.8 hours). Two patients with known pulmonary metastases required post-operative intensive care monitoring. The mean duration of survival was 5.8 months. The posterior approach of exploring major vessels for forequarter amputation of upper extremity with musculoskeletal tumor is safe and reliable.
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Affiliation(s)
- W I Faisham
- Musculoskeletal Oncology Unit, School of Medical Science Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Abstracts of the 7th Congress of the European Federation of National Associations of Orthopaedics and Traumatology, Lisbon, Portugal, 4-7 June 2005. J Bone Joint Surg Br 2006; 88 Suppl 1:1-192. [PMID: 16625754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Brongel L, Lorkowski J, Hładki W, Trybus M. [Bone and joint decade--"mile step" in diagnostics and treatment of movement system diseases?]. Przegl Lek 2006; 63 Suppl 5:9-13. [PMID: 17469516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Musculoskeletal disorders affect hundreds of millions of people across the world and are the most common causes of severe long-term pain and physical disability. The impact from such disorders on the individual and on society let to propose by WHO for the Decade of the Bone and Joint from 2000 to 2010. The goal of the Decade is to improve the health-related quality of life for people with musculoskeletal disorders throughout the world and this could be achieved by raising awareness of the growing burden of bone and joint diseases on society, promoting prevention and treatment and advancing understanding of musculoskeletal disorders through research. The main fields of interest during the Decade are joint diseases, spinal disorders and low back pain, osteoporosis and severe trauma of the extremities. In our Department we study problems concerning on traumatology of old patients, multitrauma injury, biomechanics in spinal disorders, in degenerative joint disease and foot diseases. Apart from contemporary imaging methods like US or CT we use pedobarographic diagnostics and fotogrammetric examination. In this study we present strategic goals and the summary of our ongoing projects in our Department related to the goals of the Bone and Joint Decade.
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Affiliation(s)
- Leszek Brongel
- Klinika Medycyny Ratunkowej i Obrazeń Wielonarzadowych, II Katedry Chirurgii Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie
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Keller C, Brimacombe J, Hoermann C, Loeckinger A, Kleinsasser A. Pressure support ventilation with the ProSeal laryngeal mask airway. A comparison of sevoflurane, isoflurane and propofol. Eur J Anaesthesiol 2005; 22:630-3. [PMID: 16119601 DOI: 10.1017/s0265021505001055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE There are no data about the influence of anaesthetics on cardiovascular variables during pressure support ventilation of the lungs through the laryngeal mask airway. We compared propofol, sevoflurane and isoflurane for maintenance of anaesthesia with the ProSeal laryngeal mask airway during pressure support ventilation. METHODS Sixty healthy adults undergoing peripheral musculo-skeletal surgery were randomized for maintenance with sevoflurane end-tidal 2%, isoflurane end-tidal 1.1% or propofol 6 mg kg(-1) h(-1) in oxygen 33% and air. Pressure support ventilation comprised positive end-expiratory pressure set at 5 cmH2O, and pressure support set 5 cmH2O above positive end-expiratory pressure. Pressure support was initiated when inspiration produced a 2 cmH2O reduction in airway pressure. A blinded observer recorded cardiorespiratory variables (heart rate, mean blood pressure, oxygen saturation, airway occlusion pressure, respiratory rate, expired tidal volume, expired minute volume and end-tidal CO2), adverse events and emergence times. RESULTS Respiratory rate and minute volume were 10-21% lower, and end-tidal CO2 6-11% higher with the propofol group compared with the sevoflurane or isoflurane groups, but otherwise cardiorespiratory variables were similar among groups. No adverse events occurred in any group. Emergence times were longer with the propofol group compared with the sevoflurane or isoflurane groups (10 vs. 7 vs. 7 min). CONCLUSION Lung ventilation is less effective and emergence times are longer with propofol than sevoflurane or isoflurane for maintenance of anaesthesia during pressure support ventilation with the ProSeal laryngeal mask airway. However, these differences are small and of doubtful clinical importance.
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Affiliation(s)
- C Keller
- Leopold-Franzens University, Department of Anesthesia and Intensive Care Medicine, Innsbruck, Austria
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[Abstracts of the 80th Annual Meeting of the French Society of Surgical Orthopedics and Trauma]. Rev Chir Orthop Reparatrice Appar Mot 2005; 91:3S27-178. [PMID: 16315402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Nepola J. Musculoskeletal trauma care means orthopaedic trauma care. J Orthop Trauma 2005; 19:589-90. [PMID: 16247301 DOI: 10.1097/01.bot.0000187937.50562.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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[Abstracts of the 79th Annual Meeting of the French Society of Surgical Orthopedics and Trauma]. Rev Chir Orthop Reparatrice Appar Mot 2004; 90:2S23-159. [PMID: 15559989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Abstract
The global burden of musculoskeletal disease in low and middle-income countries is large, growing, and neglected. While there is considerable funding for the control of communicable disease, there has been little attention paid to either the prevention or the treatment of orthopaedic problems in developing countries. "Safe Roads" was the theme for World Health Day 2004, and this paper examines the magnitude of injury in low and middle-income countries, as well as the motors powering its growth, and addresses the balance between the prevention and the treatment of injuries. Finally, it calls upon orthopaedic surgeons in developed countries to build partnerships with their colleagues in less developed countries to improve clinical care, teaching, and research aimed at reducing the global burden of injury.
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Affiliation(s)
- Massey Beveridge
- Sunnybrook and Womens' College Health Sciences Centre, University of Toronto, ON M4N 3M5, Canada.
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Abstract
The contribution of musculo skeletal trauma to morbidity and disability in developing countries is often underestimated. As Head of Department of Surgery and Orthopaedics for 3 years at a non-paying hospital in Malawi/East Africa (one of the least developed countries according to UNDP), I analysed my operation log book of 658 cases. Although there are many specific and local factors influencing the picture, the main problems of trauma care in rural Africa become evident. Based on personal experience views on non-operative versus operative fracture treatment, indications, quality control and training are presented. First world standards, equipment and implants of yesterday are often the only ones available but they scarcely meet the demands of clinical practice in developing countries. Contemporary state-of-the-art knowledge lacks most of its material basis to be successfully introduced. However, transforming it into "appropriate technologies" is most rewarding not only for the individual trauma surgeon, but for the wider community within orthopaedics.
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Affiliation(s)
- O Bach
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Friedrich-Schiller-Universität Jena, Bachstrasse 18, 07740 Jena, Germany.
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von Goedecke A, Voelckel WG, Wenzel V, Hörmann C, Wagner-Berger HG, Dörges V, Lindner KH, Keller C. Mechanical versus manual ventilation via a face mask during the induction of anesthesia: a prospective, randomized, crossover study. Anesth Analg 2004; 98:260-263. [PMID: 14693633 DOI: 10.1213/01.ane.0000096190.36875.67] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED One approach to make ventilation safer in an unprotected airway has been to limit tidal volumes; another one might be to limit peak airway pressure, although it is unknown whether adequate tidal volumes can be delivered. Accordingly, the purpose of this study was to evaluate the quality of automatic pressure-controlled ventilation versus manual circle system face-mask ventilation regarding ventilatory variables in an unprotected airway. We studied 41 adults (ASA status I-II) in a prospective, randomized, crossover design with both devices during the induction of anesthesia. Respiratory variables were measured with a pulmonary monitor (CP-100). Pressure-controlled mask ventilation versus circle system ventilation resulted in lower (mean +/- SD) peak airway pressures (10.6 +/- 1.5 cm H(2)O versus 14.4 +/- 2.4 cm H(2)O; P < 0.001), delta airway pressures (8.5 +/- 1.5 cm H(2)O versus 11.9 +/- 2.3 cm H(2)O; P < 0.001), expiratory tidal volume (650 +/- 100 mL versus 680 +/- 100 mL; P = 0.001), minute ventilation (10.4 +/- 1.8 L/min versus 11.6 +/- 1.8 L/min; P < 0.001), and peak inspiratory flow rates (0.81 +/- 0.06 L/s versus 1.06 +/- 0.26 L/s; P < 0.001) but higher inspiratory time fraction (48% +/- 0.8% versus 33% +/- 7.7%; P < 0.001) and end-tidal carbon dioxide (34 +/- 3 mm Hg versus 33 +/- 4 mm Hg; not significant). We conclude that in this model of apneic patients with an unprotected airway, pressure-controlled ventilation resulted in reduced inspiratory peak flow rates and peak airway pressures when compared with circle system ventilation, thus providing an additional patient safety effect during mask ventilation. IMPLICATIONS In this model of apneic patients with an unprotected airway, pressure-controlled ventilation resulted in reduced inspiratory peak flow rates and lower peak airway pressures when compared with circle system ventilation, thus providing an additional patient safety effect during face-mask ventilation.
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Affiliation(s)
- Achim von Goedecke
- *Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria; and †Department of Anesthesiology and Intensive Care Medicine, University Hospital of Kiel, Kiel, Germany
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[Abstracts of the 78th Annual Meeting of the French Society of Orthopedic and Trauma Surgery]. Rev Chir Orthop Reparatrice Appar Mot 2003; 89:3S21-191. [PMID: 14640128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Abstract
Historically, surgeons have sought and used different procedures in order to augment the repair of various skeletal tissues. Now, with the completion of the Human Genome Project, many researchers have turned to gene therapy as a means to aid various ailments. In the orthopedic field, many strides have been made toward using gene therapy and tissue engineering in a clinical setting. In this review, several studies are outlined in different areas that gene therapy has or will influence orthopedic surgery. Gene therapy and tissue engineering can aid in fracture healing and spinal fusions by inducing bone formation, ligamentous repairs by increasing the production of connective tissue fibers, intervertebral disc disease by creating potential replacements, and articular cartilage repairs by providing means to improve cartilage. As we continue to see great contributions, such as the few mentioned here, this field will continue to mature and develop.
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Affiliation(s)
- Daniel Wu
- Department of Orthopedic Surgery, North Shore University, Long Island Jewish Health System, Manhasset, New York, USA
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[Abstracts of the 77th Annual Meeting of the French Society of Surgical Orthopedics and Traumatology]. Rev Chir Orthop Reparatrice Appar Mot 2002; 88:2S18-176. [PMID: 12484396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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Abstract
BACKGROUND Scoliosis surgery has undergone a dramatic evolution over the past 20 years with the advent of new surgical techniques and sophisticated instrumentation. Surgeons have realized scoliosis is a complex multiplanar deformity that requires thorough knowledge of spinal anatomy and pathophysiology in order to manage patients afflicted by it. Nonoperative modalities such as bracing and casting still play roles in the treatment of scoliosis; however, it is the operative treatment that has revolutionized the treatment of this deformity that affects millions worldwide. As part of the evolution of scoliosis surgery, newer implants have resulted in improved outcomes with respect to deformity correction, reliability of fixation, and paucity of complications. Each technique and implant has its own set of unique complications, and the surgeon must appreciate these when planning surgery. MATERIALS AND METHODS Various surgical techniques and types of instrumentation typically used in scoliosis surgery are briefly discussed. Though scoliosis surgery is associated with a wide variety of complications, only those that directly involve the hardware are discussed. The current literature is reviewed and several illustrative cases of patients treated for scoliosis at the Connecticut Children's Medical Center and the Newington Children's Hospital in Connecticut are briefly presented. CONCLUSION Spine surgeons and radiologists should be familiar with the different types of instrumentation in the treatment of scoliosis. Furthermore, they should recognize the clinical and roentgenographic signs of hardware failure as part of prompt and effective treatment of such complications.
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Affiliation(s)
- Kaushik Bagchi
- Present address: 5302 Bishop's View Circle, Cherry Hill, NJ 08002, USA.
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Watanabe N, Takai S, Hirasawa Y, Kawata M. Introduction for "donor transplant vs. recipient cells in musculoskeletal system". Microsc Res Tech 2002; 58:1-2. [PMID: 12112415 DOI: 10.1002/jemt.10109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nobuyoshi Watanabe
- Department of Orthopaedic Surgery, Kyoto Prefectual University of Medicine, Kyoto, 602-8566, Japan.
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[76th Annual meeting of the French Society of Surgical Orthopedics and Traumatology. Abstracts]. Rev Chir Orthop Reparatrice Appar Mot 2001; 87:2S17-166. [PMID: 11727719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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