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(orthopedic) from:2005 to:2010)

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121. Pragmatic approach to the clinical work-up of patients with putative allergic disease to metallic orthopaedic implants before and after surgery. (Abstract)

Pragmatic approach to the clinical work-up of patients with putative allergic disease to metallic orthopaedic implants before and after surgery. Allergic complications following insertion of metallic orthopaedic implants include allergic dermatitis reactions but also extracutaneous complications. As metal-allergic patients and/or surgeons may ask dermatologists and allergologists for advice prior to planned orthopaedic implant surgery, and as surgeons may refer patients with complications (...) following total joint arthroplasty for diagnostic work-up, there is a continuous need for updated guidelines. This review presents published evidence for patch testing prior to surgery and proposes tentative diagnostic criteria which clinicians can rely on in the work-up of patients with putative allergic complications following surgery. Few studies have investigated whether subjects with metal contact allergy have increased risk of developing complications following orthopaedic implant insertion. Metal

2010 British Journal of Dermatology

122. The Effect of Patient Race on Total Joint Replacement Recommendations and Utilization in the Orthopedic Setting. Full Text available with Trip Pro

The Effect of Patient Race on Total Joint Replacement Recommendations and Utilization in the Orthopedic Setting. The extent to which treatment recommendations in the orthopedic setting contribute to well-established racial disparities in the utilization of total joint replacement (TJR) in the treatment of advanced knee/hip osteoarthritis has not been explored.To examine whether orthopedic surgeons are less likely to recommend TJR to African-American patients compared to white patients (...) with similar clinical indications, and whether there are racial differences in the receipt of TJR within six months of study enrollment.Prospective, observational study.African-American (AA; n = 120) and white (n = 337) patients seeking treatment for knee or hip osteoarthritis in Veterans Affairs orthopedic clinics.Patients completed surveys that assessed socio-demographic and clinical variables that could influence osteoarthritis treatment. Orthopedic surgeons' notes were reviewed to determine whether

2010 Journal of General Internal Medicine

123. Appropriateness of patient transfer with associated orthopaedic injuries to a Level I trauma center. (Abstract)

Appropriateness of patient transfer with associated orthopaedic injuries to a Level I trauma center. To prospectively evaluate the appropriateness, indications, risk factors, and epidemiology of patients with orthopaedic injuries transferred to a Level I trauma center.Prospective data were supplemented through chart review on all patients transferred to a Level I trauma center with orthopaedic injuries (n = 546) from January 1, 2007, to December 31, 2007. The accepting orthopaedic trauma (...) surgeon evaluated the appropriateness of transfer by visual analog scale.A Level I trauma center.Patients transferred to the trauma center requiring orthopaedic trauma service involvement.Demographics and visual analog scale appropriateness scores were collected on each patient.The authors considered 16.5% of the cohort inappropriate transfers, 49.3% appropriate, and the remaining 34.2% were designated as intermediate. The transfers came from an emergency department physician in 81% of cases

2010 Journal of Orthopaedic Trauma

124. Financial impact of a dedicated orthopaedic traumatologist on a private group practice. (Abstract)

Financial impact of a dedicated orthopaedic traumatologist on a private group practice. The purpose of the study was to demonstrate the financial impact of the addition of a dedicated orthopaedic traumatologist to a private group practice at a Level II community-based trauma system.Retrospective review of financial records.Level II trauma center and large group practice.Office billing and financial data were evaluated for the 12 months before the addition of a dedicated, hospital-based (...) , orthopaedic traumatologist and for a 2-year period after the hiring. Outcomes such as payor mix, collection rates, time to breakeven, days off, call days, evenings worked, durable medical equipment, and x-ray and casting reimbursement were analyzed.The addition of a dedicated traumatologist was financially beneficial for the partnership. Existing practices increased 23% in charges and 32% in collections despite partners taking more vacation days and 14% less call. This was partially the result

2010 Journal of Orthopaedic Trauma

125. Inappropriate transfer of patients with orthopaedic injuries to a Level I trauma center: a prospective study. (Abstract)

Inappropriate transfer of patients with orthopaedic injuries to a Level I trauma center: a prospective study. The objective of this study was to analyze the appropriateness of transfer of patients with orthopaedic injuries to a Level I trauma center from surrounding Level II to IV centers.A prospective study was conducted over a 5-month period by collecting data on all orthopaedic patients being transferred to our facility. All transfer diagnoses were designated as appropriate or inappropriate (...) . Patient demographics were calculated.The transfer of patients occurred from 23 Level II to IV hospitals to a Level I trauma center. These hospitals service 1 to 1.5 million people a year. PATIENTS/PARTICIPANTS MAIN OUTCOME MEASUREMENTS: All patients transferred with orthopaedic injuries were recorded. Patient variables such as transfer diagnosis, age, gender, insurance status, time of arrival, day of transfer, transferring and accepting physicians, previous imaging studies, and patient disposition

2010 Journal of Orthopaedic Trauma

126. Invasive group A streptococcal infection: AN UPDATE ON THE EPIDEMIOLOGY AND ORTHOPAEDIC MANAGEMENT. Full Text available with Trip Pro

Invasive group A streptococcal infection: AN UPDATE ON THE EPIDEMIOLOGY AND ORTHOPAEDIC MANAGEMENT. Invasive group A streptococcus (iGAS) is the most common cause of monomicrobial necrotising fasciitis. Necrotising infections of the extremities may present directly to orthopaedic surgeons or by reference from another admitting specialty. Recent epidemiological data from the Health Protection Agency suggest an increasing incidence of iGAS infection in England. Almost 40% of those affected had

2010 The Journal of Bone and Joint Surgery British Volume

127. The orthopaedic manifestations and management of children with Stuve-Wiedemann syndrome. Full Text available with Trip Pro

The orthopaedic manifestations and management of children with Stuve-Wiedemann syndrome. Stüve-Wiedemann syndrome is an autosomal-recessive disorder characterised by bowing of the long bones, progressive scoliosis, episodic hyperthermia and respiratory distress, usually resulting in death in infancy. We reviewed five children with the condition who had been followed since birth and who survived into childhood with a mean age at operation of 7.8 years (5 to 14). There was marked functional

2010 The Journal of Bone and Joint Surgery British Volume

128. The impact of new hospital orthopaedic surgery programs on total joint arthroplasty utilization. Full Text available with Trip Pro

The impact of new hospital orthopaedic surgery programs on total joint arthroplasty utilization. Utilization of arthroplasty is increasing, but there are little data exploring the causes of this increase. The objective of this study was to examine the relationship between new programs for arthroplasty of the lower extremity joints and the utilization of arthroplasty.We identified twenty-four markets (hospital referral regions) that experienced the entry of new physician-owned specialty (...) hospitals, using 1991 to 2005 Medicare data. We matched each market with a new specialty hospital to two different control markets (one market with a new arthroplasty program in a general hospital and one market without a new arthroplasty program), using a propensity score that accounted for market supply and demand for orthopaedic surgery and the regulatory environment. We compared the utilization of arthroplasty of the lower extremity joints (total hip arthroplasty and total knee arthroplasty) in each

2010 The Journal of Bone and Joint Surgery. American Volume

129. Computational Ontologies in Orthopaedic Surgery. Full Text available with Trip Pro

Computational Ontologies in Orthopaedic Surgery. Information Technology (IT) plays an important role in storing and collating the vast amounts of healthcare data. However, analyzing and integrating this data to extract useful information is difficult due to the heterogeneous, siloed, disparate, and unstructured nature of the data. WHERE ARE WE NOW?: Attempts to standardize data reporting by establishing reporting standards, checklists and guidelines have not been optimal. Moreover, efforts (...) to integrate data through the use of registries, data sharing networks, vocabularies and data standards have also yielded limited results. These efforts, when applied to orthopaedics, where theoretical knowledge is scattered over subspecialties, make it a cognitively challenging and tedious process. WHERE DO WE NEED TO GO?: Implementing data standardization is an important step towards homogenizing the data so that it can be integrated. Once integrated, the next step would be data analysis for information

2010 Clinical Orthopaedics and Related Research

130. Assessing Readability of Patient Education Materials: Current Role in Orthopaedics. Full Text available with Trip Pro

Assessing Readability of Patient Education Materials: Current Role in Orthopaedics. Health literacy is the single best predictor of an individual's health status. It is important to customize health-related education material to the individual patient's level of reading skills. Readability of a given text is the objective measurement of the reading skills one should possess to understand the written material.In this article, some of the commonly used readability assessment tools are discussed (...) and guidelines to improve the comprehension of patient education handouts are provided. Where are we now? Several healthcare organizations have recommended the readability of patient education materials be no higher than sixth- to eighth-grade level. However, most of the patient education materials currently available on major orthopaedic Web sites are written at a reading level that may be too advanced for comprehension by a substantial proportion of the population. WHERE DO WE NEED TO GO

2010 Clinical Orthopaedics and Related Research

131. The Current Practice of Orthopaedic Oncology in North America. Full Text available with Trip Pro

The Current Practice of Orthopaedic Oncology in North America. The field of orthopaedic oncology in North America has been formalized over the past 30 years with the development of the Musculoskeletal Tumor Society (MSTS) and fellowship education opportunities.To characterize current practices we assessed the fellowship education, practice setting, constitution of clinical practice, bone and soft tissue sarcoma treatment volume, perceived challenges and rewards of the career (...) , and the nonclinical activities of orthopaedic oncologists.Members of the MSTS and attendees of the 2009 AAOS-MSTS Specialty Day meeting were invited to participate in a twenty-three question online survey. One hundred and four surgeons including 99 of the 192 (52%) MSTS members completed the online survey.Sixty-nine of the 104 (66%) responding surgeons completed a 1-year musculoskeletal oncology fellowship. Thirty-eight (37%) completed an additional orthopaedic subspecialty fellowship. Seventy-four (79%) work

2010 Clinical Orthopaedics and Related Research

132. Predictors of Late Clinical Outcome Following Orthopedic Injuries After Multiple Trauma. Full Text available with Trip Pro

Predictors of Late Clinical Outcome Following Orthopedic Injuries After Multiple Trauma. The long-term clinical status of surviving patients with multiple injuries has not been well described. The aim of this study was to evaluate whether certain injury patterns predispose a patient to a poor clinical outcome 10 or more years after multiple injuries.Patients who were treated at a level I trauma center at least 10 years before participation in this study were reinvited for a follow-up physical

2010 Journal of Trauma

133. The need for better analysis of observational studies in orthopedics. Full Text available with Trip Pro

The need for better analysis of observational studies in orthopedics. The conventional statistical methods employed in observational studies in orthopedics require the fundamental assumption that the outcomes are independent. However, fractures treated by the same surgeon cannot be regarded as being independent of each other and should be nested in the statistical analysis. If the effect on outcome of early rather than delayed surgery depends on the severity of the fracture, we have a case (...) of interaction. This is rarely considered in orthopedic research, but could affect the conclusions drawn. The aim of this paper is to describe the concepts of multilevel modeling and interaction in orthopedics.In a cohort of 112 patients with single supracondylar humerus fractures, 78 patients were examined clinically on average 4 years after surgery. The range of motion was measured and the global satisfaction was assessed. The results were used to compare traditional least-squares regression analysis

2010 Acta Orthopaedica

134. Virtual Reality in Orthopaedics: Is It a Reality? Full Text available with Trip Pro

Virtual Reality in Orthopaedics: Is It a Reality? Virtual reality (VR) simulation has been a requirement for airline and military pilots for decades and is only now being integrated into surgical training programs. Thus far, orthopaedic training programs have been slow to adopt VR training.We therefore asked (1) how VR has worked for other surgical specialties; (2) what VR solutions are available for orthopaedics; and (3) should VR simulation become part of the orthopaedic curriculum (...) ?An informal literature review was performed, searching for orthopaedically-oriented VR surgical simulators and comparing this to the number of programs available for general surgery teaching programs. An in-depth review of a VR simulator for knee arthroscopy is also presented. WHERE ARE WE NOW?: The number of papers specific to orthopaedics and VR is limited. VR is used effectively in other specialties, especially general surgery. VR simulators are readily available for shoulder and knee arthroscopy

2010 Clinical Orthopaedics and Related Research

135. A Comparison of Quantitative Ultrasound of the Calcaneus With Dual-Energy X-ray Absorptiometry in Hospitalized Orthopaedic Trauma Patients. (Abstract)

A Comparison of Quantitative Ultrasound of the Calcaneus With Dual-Energy X-ray Absorptiometry in Hospitalized Orthopaedic Trauma Patients. Osteoporosis remains underdiagnosed in orthopaedic trauma patients. Recently, protocols have emerged to identify and treat osteoporosis in this population. Our purpose was to compare the usefulness of quantitative ultrasound of calcaneus (QUS) with dual-energy x-ray absorptiometry (DXA) for identifying orthopaedic trauma patients at risk for osteoporotic (...) fractures.A retrospective review of an osteoporosis screening protocol comparing QUS and DXA.Regional trauma center.Three hundred sixty consecutive hospitalized orthopaedic trauma patients treated by a single surgeon.QUS T-score and DXA bone mineral density T-scores (hip or radius) were obtained relative to U.S. normative data.QUS and DXA data were statistically compared to analyze their relationship. Potential thresholds for osteoporosis risk were subsequently defined.Testing was successfully performed

2010 Journal of Orthopaedic Trauma

136. Use of Serotonergic Antidepressants and Bleeding Risk in Orthopedic Patients. Full Text available with Trip Pro

Use of Serotonergic Antidepressants and Bleeding Risk in Orthopedic Patients. Selective serotonin reuptake inhibitors have been associated with an increased bleeding tendency. Information on the impact of a possible impaired hemostasis associated with the perioperative use of selective serotonin reuptake inhibitors is limited. This study aimed to determine the association between the perioperative use of selective serotonin reuptake inhibitors and the amount of blood loss during surgery

2010 Anesthesiology

137. Visual Loss After Orthopedic Procedures. (Abstract)

Visual Loss After Orthopedic Procedures. Perioperative visual loss (PVL) is a very rare and unpredictable complication of surgery performed at distance from the visual pathways, mostly after spine or cardiac procedures. We report 6 consecutive patients with PVL after routine orthopedic procedures (osteosynthesis for complex fracture of the femur [2], total hip arthroplasty [2], hip prosthesis arthroplasty [1], bilateral simultaneous total knee arthroplasty [1]) and reviewed the literature

2010 Journal of Arthroplasty

138. Medicine versus Orthopaedic Service for Hospital Management of Hip Fractures. Full Text available with Trip Pro

Medicine versus Orthopaedic Service for Hospital Management of Hip Fractures. Hospital care of patients with hip fractures often is managed primarily by either a medicine or orthopaedic service, depending on the institution. Whether complication rates, length of stay, or time to surgery differs on different services is unknown.We therefore determined whether (1) perioperative complication rates, and (2) length of stay and time to surgery for patients undergoing surgical management of hip (...) fractures differed by the specialty of the primary service.We performed a retrospective cohort study at a university-based academic hospital of patients undergoing surgery for hip fracture admitted to medicine and orthopaedic services during 2006. Of the 98 patients included in the analysis, 34% were managed by a medicine service and 66% by orthopaedics. Using multivariable regression models to adjust for patient characteristics and comorbidities, we determined whether service designation predicted

2010 Clinical Orthopaedics and Related Research

139. Do Men Outperform Women During Orthopaedic Residency Training? Full Text available with Trip Pro

Do Men Outperform Women During Orthopaedic Residency Training? Orthopaedic surgery residency has one of the lowest percentages of women (13.1%) of all primary surgical specialties. There are many possible reasons for this, including bias during the selection process.We therefore asked whether performance during residency might adversely bias the selection of future female orthopaedic residents by researching whether males and females perform equally in orthopaedic surgery residency.Ninety-seven (...) . Although females pursue orthopaedic residency less frequently than males, performance during residency should not bias their future selection.

2010 Clinical Orthopaedics and Related Research

140. Nonadherence in Outpatient Thrombosis Prophylaxis with Low Molecular Weight Heparins after Major Orthopaedic Surgery. Full Text available with Trip Pro

Nonadherence in Outpatient Thrombosis Prophylaxis with Low Molecular Weight Heparins after Major Orthopaedic Surgery. According to some current guidelines, extended thromboprophylaxis after hip and knee arthroplasties is recommended. Outpatient prophylaxis with low molecular weight heparins (LMWH) is an important part of this prophylaxis, although the rates of adherence to these regimens is not known.We determined (1) the degree of nonadherence (NA) of patients with LMWH outpatient prophylaxis

2010 Clinical Orthopaedics and Related Research

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