Geriatric orthopaedics

Summary The aggressive attack on the orthopaedic ailments of the elderly is well rewarded by the results. That old people are going to die sooner rather than later is recognised not only by the patient but sometimes, with too much emphasis, by the surgeon who is then fearful of operating. Many old people prefer to take a reasonable chance to achieve a happy and satisfactory quality of life by having a major operation than to linger on in pain, unhappiness, and without independence. To deny these old people an operation may well deny them hope and condemn them to an existence not worth living.

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Résumé L'audace chirurgicale des maladies orthopédiques du vieillard est amplement récompensée par les résultats obtenus.Le fait que pour le vieillard, la mort soit proche, constitue pour le patient, mais également pour le chirurgien, un frein à l'intervention.La plupart des gens âgés préfèrent prendre le risque raisonnable d'une intervention majeure, de façon à poursuivre une vie heureuse, plutôt que de souffrir et de se sentir dépendant sur le plan social.Refuser aux vieillards une intervention, c'est leur refuser aussi l'espoir et les astreindre à une vie sans horizon.

     

Diversity in orthopaedics.

There is little doubt that women, African Americans, and Hispanics, have fewer opportunities to enter, or once in, to become contributing members of orthopaedic programs in the United States. The expressed reasons for this by faculty members sometimes sound reasonable, but on analysis all are spurious. It is the responsibility of the chief of service and the faculty members to change this pattern and offer all individuals equal opportunity and treat them identically to anyone in the program or on the faculty. Some guidelines are provided.     

数字骨科学:一门骨科学新分支的萌生

美国可视人计划（1989）的出现推动了数字人和医学图像研究的进程。数字人研究是现代计算机信息技术与医学等学科相互结合的前沿性交叉项目，对科技发展有着深远意义。数字化技术可以利用动态三维图像对传统二维医学图像进行补充，用连续断层图像进行三维重建，可以精确地显示生物组织复杂的三维结构，并可进行任意旋转、剖切等观察和操作，可以对重建的三维结构进行测量获得长度、面积、     

Perioperative antibiotic prophylaxis. Use in orthopaedics

Perioperative antibiotic prophylaxis in orthopaedics is only indicated if a foreign body such as a prosthetic joint remains in the operation site. For this indication first or second generation cephalosporins should be preferred. It is essential to administer the antibiotic within 30 min before incision. In the case of an extended intervention (more than 3 h) a repeated dose should be considered. It is evidence-based that prolonged perioperative antibiotic prophylaxis (more then 24 h) is not beneficial. To avoid the emergence of resistances or hygienic insufficiencies surveillance of surgical site infections should be enforced. Optimal conditions are necessary to achieve a rate of surgical site infection in orthopaedics below 1% in patients with normal infection risk profile.     

Trends in infection prophylaxis in orthopaedics.

The current measures employed by consultant orthopaedic surgeons in Scotland to prevent infection were established by postal questionnaire. Our findings were compared with those of a similar study carried out 5 years previously. An increasing number of surgeons use routine systemic antibiotic prophylaxis for total hip arthroplasty (99% versus 91% 5 years ago), in treating compound fractures (89% versus 75% 5 years ago) and for internal fixation of closed fractures with metal implants (49% versus 12% 5 years ago). Cephalosporins are increasingly used as the antibiotic of choice. By starting antibiotics earlier than the day of surgery or continuing for more than 24 h after surgery, just over half the surgeons questioned administer antibiotics for longer than would seem to be necessary for elective surgery.     

Justifications and needs for diversity in orthopaedics.

America is founded on high humanitarian, democratic ideals. The historic facts of slavery, discrimination, and segregation challenge and taint these democratic principles. Although progress has been made, serious racial problems remain. In 1997, the United States had 474 active hate groups, up 20% from 1996. African American males who have the same education as white males doing the same work earn approximately 75% of what their white counterparts earn. America, as predicted by the Kerner Commission Report, is two societies: black and white, separate, and unequal. Some astonishing disparities in healthcare exist. Peer reviewed medical literature documents that African Americans have higher infant mortality rates, shorter life expectancies, fewer joint replacements, and more amputations than whites. Communications within a diverse group of students and teachers enriches the educational experience. The late Supreme Court Justice Lewis Powell, LLD, asserted that a medical student from a particular background may enrich classmates' understanding of people whose cultures are different from their own, and improve their ability to serve a heterogeneous patient population. Diversity on clinical teams can enhance rapport between patient and physician, and can diminish unthinking insults to patients, born of physician ethnic insensitivity. Healthcare facilities with diverse staffs are more likely than homogeneous facilities to attract and successfully serve the nation's diverse population. A University of California at Davis School of Medicine study showed that diversity can be achieved without compromising quality of patient care. Clinically and ideologically, diversity in orthopaedics is good for patients and for the country.     

Prophylaxis of thromboembolism in orthopaedics and traumatology.

In a retrospective study we collected patient data relating to clinically detected postoperative thromboembolic complications before (n = 1710) and after (n = 2212) adopting a protocol for prophylaxis of deep vein thrombosis (DVT). A relatively low incidence of clinically diagnosed DVT, four per thousand, before systematic instructions for prophylaxis in 1981 could be explained by the frequent use of dextran as a volume expander in critically ill patients. However, following systematic prophylaxis the frequency of DVT decreased further (one per thousand).     

Molecular biology in orthopaedics: the advent of molecular orthopaedics

Molecular biology is the study, at the molecular level, of how genetic information is stored, inherited, and expressed and how it influences the structure and function of cells. Although molecular biology approaches have been used for decades in orthopaedic research, they are only now beginning to influence clinical practice. A variety of sophisticated techniques permit rapid and affordable DNA sequencing, gene expression profiling, gene cloning, gene manipulation, gene transfer, recombinant protein production, and other technologies of enormous biomedical importance. Success in genomics has spawned additional ambitious endeavors, including proteomics, pharmacogenetics, and bioinformatics. These techniques are providing new diagnostic, staging, prognostic, and therapeutic opportunities in all areas of medicine, including orthopaedics. With the use of molecular criteria, treatment of the orthopaedic patient may become more individualized, and greater emphasis will be placed on preventative strategies based on the patient's genetic makeup. Both surgical and nonsurgical decisions will increasingly accommodate molecular criteria.     

Quality management. Concepts and applications in orthopaedics

A growing number of Health Care Systems have introduced Quality Management Systems to manage both quality in medicine and financial resources of the society. These Systems have been developed successfully for manufacturing and service business. Service Quality Management Systems can be modified for the purpose of non-profit-systems, such as Health Care. The view of quality differs among institutions and persons acting within this system. The focus of the customer is most important for any service offer to the patient. The variety of external, internal and total Quality Management Systems is discussed with regard to the adoption in elective orthopaedic surgery. Strong process orientation may favour the DIN ISO System, as the definition of processes in medicine should be enforced. Once the processes are clearly defined, elaborated (total) systems may be introduced easily. The process of the implantation of a total hip prothesis has been designed to DIN ISO conformity by a project team of experienced surgeons and is given here as an example for process orientation in elective surgery.