A Survey of Orthopaedic Traumatologists Concerning the Use of Bone Growth Stimulators -- Robert D. Zura, MD; Beau Sasser, MD; Vani Sabesan, MD; Ricardo P.
The purpose of the study was to determine the attitudes of members of the Orthopaedic Trauma Association (OTA) concerning the use and efficacy of bone growth stimulators. A questionnaire regarding bone growth stimulators was sent to the active members of the OTA. Descriptive statistics was performed using frequencies and percentages. All analyses were performed using Stata for Linux, version 8.0 (Intercooled Stata, Stata Corporation; College Station, TX). A response rate of 43% was obtained. Respondents indicated that they only occasionally used bone stimulators for the treatment of acute fractures and stress fractures. A majority of respondents have utilized stimulators for the treatment of delayed unions and nonunions. It was concluded that many members of the OTA utilize bone stimulators for delayed unions and nonunions, but not routinely for the treatment of acute fractures or stress fractures. (Journal of Surgical Orthopaedic Advances 16(1):1–4, 2007)
Microdiscectomy: Spinal Anesthesia Offers Optimal Results in General Patient Population -- Robert F. McLain, MD; John E. Tetzlaff, MD; Gordon R. Bell, MD; Kai U.
Spinal anesthesia provides a safe and highly satisfactory alternative to general anesthesia in patients undergoing limited lumbar surgery. Nevertheless, it is not commonly used for spinal surgery, and in some centers it is not even considered as an option for spinal procedures. This study presents the current anesthetic technique for patients undergoing microdiscectomy and compares the peri- and postoperative outcomes in 76 patients drawn from a case-controlled study group. Patients underwent microdiscectomy for herniated nucleus pulposus under spinal (43 patients) or general anesthesia (33 patients). Patients ranged from 18 to 40 years, and all were anesthesia class 1. Surgical and anesthesia times were longer for the general anesthetic group, as was total anesthetic time. Urinary retention was more common in the general anesthesia group (p D .035). Postanesthetic care unit admission times were significantly shorter among general anesthetic patients compared with spinal anesthetic patients (p < .001). Spinal anesthesia patients required less pain medication and experienced less nausea and emesis. Even among young, medically fit patients, spinal anesthesia provided specific advantages over general anesthesia, including decreased anesthesia time, decreased nausea and antiemetic requirements, reduced analgesic requirements, and a trend toward lower complication rates and shorter hospital stay. Both surgeon and patient satisfaction with this anesthetic approach is high. (Journal of Surgical Orthopaedic Advances 16(1):5–11, 2007)
Serum Cobalt and Chromium Elevations Following Hip Resurfacing With the Cormet 2000 Device -- D. Gordon Allan, MD, FRCS(C); Rita Trammell, PhD; Bradley Dyrstad
This study was designed to monitor serum cobalt (Co) and chromium (Cr) levels at multiple time points following hip resurfacing with the Cormet 2000 device. Serum samples were obtained preoperatively, at 6 months, 1, 2, and 3 years after surgery. Co/Cr levels (µg/L) were determined by high-resolution inductively coupled plasma mass spectrometry. Thirty-five subjects were followed. Median preoperative Co/Cr levels were 0.21 and 0.22, respectively. Serum levels following device implantation were increased at all follow-up time points when compared to preoperative controls. Peak levels were observed at 1 year (Co, 3.34; Cr, 4.67) and levels at 3 years were trending down (Co, 2.08; Cr, 3.55), but this decrease was not statistically significant. This study is the first to report significant elevations in serum Co/Cr levels at multiple time points up to 3 years following hip resurfacing with the Cormet 2000 device. Future studies are needed to determine what serum Co/Cr levels are of clinical concern, particularly in outlier cases. (Journal of Surgical Orthopaedic Advances 16(1):12–18, 2007)
The Effect of Resident Work Hour Regulations on Orthopaedic Surgical Education Brian A. Weatherby, MD; Joseph N. Rudd, PhD; Timothy B. Ervin, BSE; Paul R. Staff
Accreditation Council for Graduate Medical Education (ACGME) resident work hour regulations have been effective since July 2003. Several areas affected by these changes have been identified, including surgical education. In the current study, the authors evaluated the impact of these changes on surgical education at a two-person-per-year orthopaedic training program. Operative case experiences of PGY 2 and 3 residents during the academic years 2002–2003 and 2003–2004 were compared utilizing ACGME case logs. A data entry log was also distributed to examine subjectively the effects on operative case load. ACGME data showed that PGY 2 and 3 residents performed 21.5% fewer cases between years. The average number of cases per rotation decreased by 20.44% (p D .009, paired t-test). Subjective results also showed a decrease, with an average of 10.8% of cases missed per resident. This study shows that residents who have begun training post-80-hour work week will do fewer procedures. This may result in a decreased level of skill, or it may shift operative experience to the senior resident years, prolonging the learning curve. Regardless, future analysis must be done to determine the full impact on training of the orthopaedic resident. (Journal of Surgical Orthopaedic Advances 16(1):19–22, 2007)
Massive Prepatellar Bursitis in Cerebral Palsy -- Herrick J. Siegel, MD; Robert Lopez-Ben, MD; Michael J. Pitt, MD; William K. Dunham, MD
This case report describes a 36-year-old African American male with cerebral palsy and bilateral slowly enlarging knee masses. He has 90° fixed flexion knee contractures bilaterally. Although he has poor communication skills, he does not have discomfort while ambulating. He has developed massive bilateral prepatellar bursitis from chronic and repetitive injury to the region bearing his body weight while ambulating. As the result of a protective response, the bursa provides a cushion for the underlying bone prominences of the tibial tubercle and patella. This compensatory mechanism has allowed the patient to have functional, painless household ambulation. (Journal of Surgical Orthopaedic Advances 16(1):23–26, 2007)
Hemorrhagic Upper Extremity Complications From Tissue Plasminogen Activator -- Kathleen A. Crick; John C. Crick, MD; Michael T. Pulley, MD, PhD
Five patients, ages 63 to 79, had hemorrhagic complications involving the upper extremity from fibrinolytic therapy using intravenous tissue plasminogen activator (tPA) for acute myocardial infarction. The hemorrhages varied in severity. Three patients were treated for superficial hematomas, one with a deep subcutaneous hematoma producing skin necrosis, and one compartment syndrome with posterior interosseous nerve palsy and marked intramuscular bleeding. tPA is currently being used in the treatment of acute myocardial infarction and acute nonhemorrhagic stroke. Caution should be used particularly for IV sites, central lines, arterial catheterization, and pneumatic tourniquets, to avoid upper extremity hemorrhage. (Journal of Surgical Orthopaedic Advances 16(1):27–30, 2007)
Venous Thromboembolism Following Total Knee Replacement -- Bryan Y. Choi, BA; Michael H. Huo, MD
Venous thromboembolic disease (VTE) remains the most common and potentially fatal complication following total knee replacement (TKR). Its incidence has been reported in excess of 50% if no prophylaxis is used. Even with current prophylaxis regimens, VTE incidence remains high in the range of 25% to 30%. Three prophylaxis regimens are recommended according to the guidelines put forth by the American College of Chest Physicians: 1) low-molecular-weight heparin, 2) indirect factor Xa inhibitor, and 3) adjusted-dose warfarin. Phase II and III clinical trials are currently underway to evaluate the efficacy and safety of newer antithrombotic agents as prophylaxis against VTE following TKR. (Journal of Surgical Orthopaedic Advances 16(1):31–35, 2007)