Analysis of published evidence on minimally invasive total hip arthroplasty.

Minimally invasive surgery has become a popular method of total hip arthroplasty. This study reviewed the literature to determine the number and quality of scientific publications analyzing different types of minimally invasive surgery approaches. The miniposterior approach has been studied the most and to our knowledge is the only approach with good quality randomized control study evidence.

Detection and management of pre-existing cognitive impairment and associated behavioral symptoms in the Intensive Care Unit.

Recent increase in both the elderly population and associated incidence of dementia are of critical importance to patient care in ICUs in the United States. Identification of pre-existing cognitive impairment, such as mild cognitive impairment and dementia, could prevent delirium and associated morbidity and mortality in the ICU. Additionally, noncognitive behavioral symptoms, such as depression, psychosis, agitation, and catastrophic reactions, are common in patients with pre-existing cognitive impairment.

A biomechanical comparison of lateral and posterior approaches to sacroplasty.

Study Design: Biomechanical cadaveric bench study.

Objective: To measure the augmentation effect and extravasation risk of posterior and lateral approaches to sacroplasty.

Summary Of Background Data: The biomechanical stabilizing effect of sacroplasty is unknown.

Visibility of surgical site marking after preoperative skin preparation.

Objective: It is important that during preoperative skin preparation surgical site markings are not erased. The effects of 2 common types of skin preparation solutions on surgical site markings were compared.

Methods: Fasciocutaneous skin flaps were harvested and 20 random combinations of 3 letters were written on the skin flaps with a black permanent marker.

Biomechanical comparison of expandable and locked intramedullary femoral nails.

Objectives: The expandable intramedullary (IM) nail does not require locking and fluoroscopy use is minimized. However, the lack of cross-locking screws may adversely affect the fixation's rotational stability. The purpose of our study was to compare the rotational stability afforded by an expandable nail with that of a standard locked nail.

Case report: treatment of open femoral shaft fracture in a severely burned patient.

Objective: To present a case report of a patient with an open fracture and severe burns and review the literature.

Methods: The patient was treated with intubation, intravenous antibiotics, and debridement and intramedullary nailing for the femur fracture. He later underwent multiple burn excision procedures with allograft and autograft skin coverage.

The strength of the osteoporotic sacrum.

Study Design: Biomechanical cadaveric bench study.

Objective: To determine the strength of the osteoporotic sacrum subjected to vertical force.

Summary Of Background Data: Sacral insufficiency fractures are thought to be caused by vertical shear forces acting in the sacral ala.

Evaluation of a computerized measurement technique for joint alignment before and during periacetabular osteotomy.

Periacetabular osteotomy (PAO) is intended to treat a painful dysplastic hip. Manual radiological angle measurements are used to diagnose dysplasia and to define regions of insufficient femoral head coverage for planning PAO. No method has yet been described that recalculates radiological angles as the acetabular bone fragment is reoriented.

The importance of exercise training in patients with chronic heart failure.

This article discusses the cardiac care and rehabilitation needs of patients with chronic heart failure (CHF). Research suggests that patients with CHF who are in a stable condition can undertake supervised exercise programmes. Patients are rarely prescribed exercise; however exercise in patients with CHF reduces mortality and hospital admission rates.

Orthopaedic care of the aging athlete.

Increasing numbers of middle-aged and older adults participate in sports, and athletes wish to remain active as they age. Understanding the anatomic, physiologic, and psychosocial differences between older and younger athletes can help aging athletes maintain function. Athletic capacity may be sustained well into advanced age, and many of the physiologic consequences of aging may be mitigated or reversed by regular exercise.

Effectiveness of a multidisciplinary team approach to hip fracture management.

The purpose of the current study was to evaluate the effectiveness of a multidisciplinary Hip Fracture Service in the treatment of hip fractures in elderly patients. Baseline information and hospital outcomes were compared for 510 patients over the age of 65 with hip fracture treated before and after the institution of the Hip Fracture Service. Data included basic demographic data, admission laboratory results, surgical information, number of comorbidities, mortality, medical complications, discharge information, time to surgery, and length of stay in hospital.

Patient-oxygen dissociation curves: surveying the spectrum of oxygen-delivery methods.

Objective: To describe the spectrum of oxygen-delivery methods.

Design: Clinical audit.

Setting: Medical wards of a tertiary referral teaching hospital in August 2004.

Salvage of functional elbow range of motion in complex open injuries using a sensate transposition lateral arm flap.

Complex open posterior elbow injuries pose three principal challenges to the reconstructive surgeon. First, the surgeon must provide stable soft-tissue closure over the joint/skeletal reconstruction. Second, the coverage must be thin and supple and promote the free gliding of the underlying structures.

Interns are from Venus, consultants are from Mars: differential perception among clinicians.

Objective: To test for the presence of sex-based differences in perception (the notion that men and women "think" differently, and that differences in perception are biologically based) among healthcare professionals.

Design: Prospective survey.

Setting And Participants: 90 medical personnel at a tertiary care hospital in Newcastle, NSW.

Treatment of osteoarthritic cartilage lesions with osteochondral autograft transplantation.

Twenty-two osteochondral autograft transplantations were performed on two types of knees: those with isolated (group 1) and multiple (group 2) degenerative cartilage lesions. At minimum 24-month follow-up, group 1 had significantly better pain relief and function than group 2 based on the Western Ontario and McMaster Universities Osteoarthritis Index and pain scores (10-point visual analog scale). Osteochondral autograft transplantation may be effective in treating knees with isolated degenerative cartilage lesions but appears contraindicated in those with multiple lesions.

Antibodies to myelin-associated glycoprotein accelerate preferential motor reinnervation.

Predegeneration of nerve enhances its ability to support axon regeneration. Trophic factors are upregulated by reactive Schwann cells while potentially inhibitory molecules are removed. These experiments isolate the effects of one such inhibitory molecule, the myelin-associated glycoprotein (MAG), to determine its role in modifying regeneration after nerve repair.

Evidence-based physicians' dressing: a crossover trial.

Objective: To describe the effect of physicians' dress on patient confidence and trust.

Design: A prospective crossover trial involving physicians dressed in "respectable" versus "retro" attire.

Setting: A general medicine ward at a tertiary hospital.

Metformin-associated lactic acidosis after elective cervical spine fusion: a case report.

Study Design: A case of metformin-associated lactic acidosis after elective spinal surgery is reported.

Objective: To inform spinal surgeons of this potentially fatal side effect and make them aware that metformin should be stopped 48 hours before surgery.

Summary Of Background Data: Metformin is a commonly used oral hypoglycemic agent used in the treatment of non-insulin-dependent diabetes mellitus.

Host location, survival and fecundity of the Oriental rat flea Xenopsylla cheopis (Siphonaptera: Pulicidae) in relation to black rat Rattus rattus (Rodentia: Muridae) host age and sex.

Host choice and fecundity are two factors that may contribute to the variation in flea counts observed when assessing the potential risk of flea-borne transmission of pathogens from rodents to humans. Using the black rat, Rattus rattus Linnaeus, as host the effects of age and sex on host choice and fecundity of the Oriental rat flea, Xenopsylla cheopis Rothschild, were examined experimentally at 25 degrees C and 80% rh. During the first two days of emergence from cocoons, female fleas dominated the sex ratio by 4:1 but from the third day onwards this switched to a male-dominated sex ratio of 4:1.

Coding of diagnoses, comorbidities, and complications of total hip arthroplasty.

International Classification of Diseases coding of patient charts is used by hospitals to allow for billing of patients. Coding information also is used for assessing physician effectiveness. The purpose of the current study was to examine hospital coding for patients having total hip arthroplasty.

Is coding of diagnoses, comorbidities, and complications in total knee arthroplasty accurate?

Coding of diagnoses, comorbidities, and complications is important for health care delivery, not only for appropriate hospital and physician reimbursement, but also for a correct assessment of complication rates. The purpose of this study was to determine the agreement of coding of diagnoses, comorbidities, and complications for total knee arthroplasty between 2 groups of coders. Between January 1, 1997, and November 18, 1997, 100 consecutive primary total knee arthroplasties were done by 2 orthopaedic surgeons.

Surgical treatment options for cartilage defects within the knee.

Injury to articular cartilage is increasingly diagnosed as a cause of knee pain. New surgical treatment options are now available to treat this clinical entity. Diagnosis is made easier by improved magnetic resonance imaging protocols that better visualize articular cartilage.

Formation of specific monosynaptic connections between muscle spindle afferents and motoneurons in the mouse.

In adult vertebrates, sensory neurons innervating stretch-sensitive muscle spindles make monosynaptic excitatory connections with specific subsets of motoneurons in the spinal cord. Spindle afferents (Ia fibers) make the strongest connections with motoneurons supplying the same (homonymous) muscle but make few or no connections with motoneurons supplying antagonistic or functionally unrelated muscles. In lower vertebrates these connections are specific from the time they first are formed, but there is comparatively little information about how these reflex connections form in mammals.

A critical period for the influence of peripheral targets on the central projections of developing sensory neurons.

During development, the projections that sensory neurons make within the spinal cord are influenced by the specific targets they contact in the periphery. If sensory ganglia normally supplying principally cutaneous targets are forced to grow into limb muscles, in early stage tadpoles, many sensory neurons within these ganglia innervate limb muscles and subsequently develop spinal projections appropriate for muscle spindle afferents. If the same procedure is performed with adult frogs, however, these novel projections do not form.