CT-generated Radiographs in Obese Patients With Acetabular Fractures: Can They Be Used in Lieu of Plain Radiographs?

Photograph of a scene in the Chickasaw National Recreation Area

External fixation of femoral defects in athymic rats: Applications for human stem cell implantation and bone regeneration

An appropriate animal model is critical for the research of stem/progenitor cell therapy and tissue engineering for bone regeneration in vivo. This study reports the design of an external fixator and its application to critical-sized femoral defects in athymic rats. The external fixator consists of clamps and screws that are readily available from hardware stores as well as Kirschner wires. A total of 35 rats underwent application of the external fixator with creation of a 6-mm bone defect in one femur of each animal. This model had been used in several separate studies, including implantation of collagen gel, umbilical cord blood mesenchymal stem cells, endothelial progenitor cells, or bone morphogenetic protein-2. One rat developed fracture at the proximal pin site and two rats developed deep tissue infection. Pin loosening was found in nine rats, but it only led to the failure of external fixation in two animals. In 8 to 10 weeks, various degrees of bone growth in the femoral defects were observed in different study groups, from full repair of the bone defect with bone morphogenetic protein-2 implantation to fibrous nonunion with collagen gel implantation. The external fixator used in these studies provided sufficient mechanical stability to the bone defects and had a comparable complication rate in athymic rats as in immunocompetent rats. The external fixator does not interfere with the natural environment of a bone defect. This model is particularly valuable for investigation of osteogenesis of human stem/progenitor cells in vivo

Orthopedic Trauma Surgeons\u27 Attitudes and Practices Towards Bloodborne Pathogens

A survey was conducted to determine orthopedic trauma surgeons\u27 attitudes and practices towards occupational exposures to bloodborne pathogens. The survey was distributed to orthopedic trauma surgeons either by mail or through participation at the annual 1993 OTA meeting or the 1994 update meetings. Of the 1,058 surveys distributed, 504 were successfully completed (48%). The majority of respondents were attendings (72%) who performed at least 100 orthopedic procedures annually. Of the respondents, 74% reported they were moderately to very concerned about acquiring HIV at work. Despite their concern, 42% reported not routinely wearing gloves when changing wound dressings. Of the 340 respondents who have access to maximum barrier protection, 83% reported not wearing it to nail a femur fracture and 33% reported not wearing it when operating on an HIV+ patient. At an institutional level, almost one-third of those surveyed did not believe their facility promoted safe work practices. Facilities judged by respondents to promote safe practices were significantly more likely to have resources available and infection control policies in place compared to facilities judged not to promote safe practices. Orthopedic trauma surgeons need to improve their compliance with infection control recommendations. Further efforts by individuals and their institutions are warranted

Reprodutibilidade da classificação de Tile para fraturas do acetábulo Reproducibility of Tile's classification of acetabular fractures

Classificar corretamente as fraturas acetabulares é crucial para bom planejamento pré-operatório e para redução cirúrgica eficiente. Entretanto, para cumprir seus objetivos, qualquer sistema de classificação deve ser simples e reprodutível. O objetivo deste artigo é avaliar a reprodutibilidade interobservador da classificação de Tile para fraturas do acetábulo. Foram utilizadas 30 imagens radiográficas de 10 fraturas acetabulares nas incidências de Judet, analisadas por 10 observadores, sendo cinco especialistas em cirurgia de quadril e cinco residentes do terceiro ano de ortopedia. A concordância global obtida foi de 72,44% com Kappa (K) = 0,52 (0,48 entre residentes e 0,57 entre especialistas). Conclui-se que a classificação de Tile para fraturas acetabulares apresenta moderada concordância interobservador, não havendo diferença estatisticamente significante entre residentes e especialistas.<br>Properly classifying acetabular fractures is crucial for a good preoperative planning and for an efficient surgical reduction. However, in order to accomplish its objectives, any classification system must be simple and reproducible. The objective of this article is to assess inter-observer reproducibility of Tile’s classification concerning acetabular fractures. Thirty X-ray images of 10 acetabular fractures at Judet planes were used and assessed by 10 observers, being five hip surgery experts and five 3rd-grade orthopaedic residents. The global consistency achieved was 72.44% to Kappa (K) = 0.52 (0.48 among resident doctors and 0.57 among experts). It was concluded that the Tile’s classification of acetabular fractures reveals a moderate inter-observer consistency, with no statistically significant difference between resident doctors and experts