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Biomedical subjects

G D Paiement

Publications and source records attributed to G D Paiement.

At least 19 recordsLinked to original sources
PubMed2001

Infection after total joint arthroplasty in patients with human immunodeficiency virus or intravenous drug use.

Patients with intravenous drug use (IVDU) and patients with human immunodeficiency virus (HIV) with painful joint arthrosis present a difficult treatment decision. The purpose of this study was to determine the rate of deep periprosthetic infection in patients with HIV or IVDU after total joint arthroplasty (TJA). Twenty-nine patients with HIV or a history of IVDU or both underwent TJA. Of 28 HIV-positive patients undergoing TJA, 4 (14%) developed infections. Two of 8 joints (25%) in the IVDU group developed an infection. Two of 5 joints (40%) with both IVDU and HIV developed a deep infection. Patients with HIV or a history of IVDU are more likely to develop a deep infection compared with other patients undergoing TJA. The decision to proceed with TJA in HIV-positive and IVDU patients should be made only after weighing the ratio of risks and benefits.

Adult↗
PubMed2000

Evaluation of a new method of small fragment fixation in a medial malleolus fracture model.

OBJECTIVE: To evaluate a new method of small fragment fixation in a medial malleolus fracture model. DESIGN/METHODS: The authors measured the pullout strength, resistance to shear stress, and speed of insertion of 4.0-millimeter partially threaded cancellous screws, 2.4-millimeter smooth K-wires, and a small fragment fixation system with 2.2-millimeter threaded K-wires. Pullout strength was tested in eighty-one synthetic foam blocks and resistance to shear stress in thirty synthetic tibias by use of a servohydraulic testing machine. Six randomized time trials with the threaded K-wires and cancellous screws were also conducted. RESULTS: Pullout strength increased with increasing foam density, increasing insertion depth, and varied with fixation method (p < 0.05). Maximum pullout strengths were as follows: partially threaded cancellous screws, 730+/-4 Newtons; threaded K-wires, 316+/-12 Newtons; and smooth K-wires, 172 +/-5 Newtons. Percent difference in pullout strength between the partially threaded cancellous screw and threaded K-wire diminished with increased depth of insertion and increased foam density. Offset axial load to initiate fracture displacement in a synthetic tibia model averaged 1540+/-138 Newtons for the partially threaded cancellous screws, 1,318+/-117 Newtons for the threaded K-wires, and 1,287+/-121 Newtons for the smooth K-wires (p > 0.05). Average time of fixation of a medial malleolar fragment by orthopedic surgeons with a variety of experience levels in a synthetic tibia with two threaded K-wires (114+/-8 seconds) was significantly faster (p < 0.05) than with two partially threaded cancellous screws (207+/-20 seconds). CONCLUSIONS: Threaded K-wires show substantial pullout strength and similar resistance to offset axial load when compared with partially threaded cancellous screws. These threaded K-wires offer an alternative for the internal fixation of medial malleolus fractures.

Bone Screws↗
PubMed2000

Prevention of falls and fall-related fractures through biomechanics.

Falls and fall-related injuries are a major health problem for elderly people. Biomechanical studies provide important insight into the cause of such events and reveal new techniques for preventing them. The topics reviewed in this article include balance recovery, safe landing responses, impact forces during falls, and fracture prevention through exercise programs, hip pads, and energy-absorbing floors.

Accidental Falls↗
PubMed1998

Prevention and treatment of venous thromboembolic disease complications in primary hip arthroplasty patients.

This chapter is a brief and incomplete overview of a rapidly changing field. The following points are helpful for the management of hip arthroplasty patients. There is no clinically significant difference between warfarin and enoxaparin prophylaxis in terms of efficacy (venographic or clinical events) and safety. Hip arthroplasty patients should receive warfarin or enoxaparin for at least 7 to 10 days postoperatively. There is a high rate of postdischarge venographic DVT even if prophylaxis is used for 7 to 10 days after surgery. There is a 2% rate of postdischarge symptomatic DVT if prophylaxis is used for 7 to 10 days after surgery. There is a 0.1% rate of postdischarge fatal PE at 90 days postoperatively if prophylaxis is used for 7 to 10 days after surgery. The value of routine predischarge surveillance for DVT is not clear at this moment.

Arthroplasty, Replacement, Hip↗
PubMed1997

The risk of venous thromboembolism in the orthopedic patient: epidemiological and physiological data.

Venous thromboembolism is responsible for 500,000 deaths annually in industrialized countries. It is probably the most common preventable cause of death in elective orthopedic surgery patients. Rates of deep vein thrombosis (DVT) and fatal pulmonary embolism (PE) in unprotected orthopedic patient populations are high. The overall DVT rate is > 40% in patients undergoing hip or knee arthroplasty or suffering from multiple injuries. The proximal DVT rate for these patients is > or = 15%, and the fatal PE rate is > or = 1%. Risk factors associated with venous thromboembolism are related to the vascular injury, activation of blood coagulation, and venous stasis. Lower extremity orthopedic procedures carry a risk greater than that of surgery itself. Thus, orthopedic patients are at high risk for venous thromboembolic conditions. A systematic assessment of this risk should be performed in every patient, and an appropriate management plan should be implemented.

Humans↗
PubMed1996

Physical examination of the knee.

Knee injuries are common, and many primary providers are uncomfortable with the clinical diagnosis of these conditions. The following article emphasizes the importance of obtaining a good history from the patient and accurately determining the mechanism of injury to narrow the diagnostic possibilities. It briefly reviews some pertinent points of anatomy to facilitate the physical examination and to understand the rationale of some clinical tests. A brief description of the most useful clinical tests in an acute situation also is given.

Humans↗
PubMed1996

Prevention of venous thromboembolism in orthopaedics in the United States.

The use of different types of antithrombotic prophylactics in various clinical settings was examined. A standardized questionnaire was mailed to 5000 randomly selected practicing orthopaedic surgeons that detailed practice profile, surgical case type and frequency, method of thromboembolism prophylaxis used, incidence of morbidity, and type of screening used. Twenty-one percent (n = 1046) of surgeons surveyed returned the questionnaire. Four of 5 surgeons performing elective hip arthroplasty used some form of thromboembolic prophylaxis for all of their patients, 13% used prophylaxis only for patients considered to be at high risk, and 3% of respondents never used prophylaxis. The rates of prophylactic use for patients undergoing elective knee arthroplasty were similar. A considerably lower rate of routine prophylactic use was seen among surgeons performing surgery for pelvic and lower extremity trauma. Except for cases involving neurologic compromise, most patients undergoing either elective or traumatic spinal surgery were not given prophylaxis. Low dose warfarin alone was the most commonly used prophylaxis modality. A comparison of the results of the current survey with those of past surveys showed that the use of aspirin has fallen. The use of routine pharmacologic prophylaxis against thromboembolism in hip and knee arthroplasty has become the standard of care in the United States. Among patients undergoing surgery for hip fracture and other lower extremity trauma, however, prophylaxis remains underused.

Adult↗
PubMed1996

Treatment of supracondylar femoral fractures with a retrograde intramedullary nail.

From August 1992 to January 1995, 24 patients with 26 supracondylar femoral fractures were treated with a retrograde intramedullary nail. There were 22 patients with 24 nails available for review. Eight fractures were open and 13 were intraarticular fractures. There were a significant number of associated injuries. The average followup interval was 18 months (range, 4-36 months). All fractures healed by 4 months, (average, 3 months). Only 1 patient required bone grafting. There were no implant failures or superficial or deep infections. One malunion occurred. Average knee range of motion was 104 degrees. A previously described rating scale was used to evaluate function. There were 4 excellent, 16 good, 2 fair, and 2 poor results. The supracondylar nail provides rigid internal fixation for rapid healing and comparable functional outcomes to lateral fixation devices with significantly less soft tissue dissection.

Adult↗
PubMed1996

Use of low molecular weight heparin in preventing thromboembolism in trauma patients.

OBJECTIVE: To investigate the safety and effectiveness of low molecular weight heparin (LMWH) in preventing deep venous thrombosis (DVT) in high-risk trauma patients, compared with mechanical methods of prophylaxis. DESIGN: A prospective randomized trial conducted over a 19-month period in an urban, academic trauma center. METHODS: All trauma patients with the following risk factors for the development of DVT were considered for enrollment in this study: any injury with an Abbreviated Injury Scale score > or = 3; major head injury (Glasgow Coma Scale score < or = 8); spine, pelvic, or lower extremity fractures; acute venous injury; or age > 50 years. After a screening venous duplex examination, the patients were assigned to a Heparin versus No-Heparin group, depending upon the presence of injuries precluding the use of heparin. In the Heparin group, the patients were then randomized to receive either LMWH or optimal mechanical compression (defined as bilateral sequential gradient pneumatic compression (SCD) or, in the presence of lower extremity injuries precluding the use of the SCD, the arteriovenous impulse (AVI) compression system). All the patients in the No-Heparin group received optimal compression. Enrolled patients underwent sequential duplex examinations every 5 to 7 days until discharge. RESULTS: Of the 487 consecutive patients initially enrolled in this study, 372 were available for at least the first two duplex examinations and comprise the study population. Only nine (2.4%) patients developed DVT, compared with the predicted 9.1% rate in high-risk trauma patients receiving no prophylaxis (p = 0.037). Of the 120 patients who were randomized to receive LMWH, only one (0.8%) developed DVT. In the SCD group, there were 5 of 199 patients (2.5%) with DVT, and 3 of 53 (5.7%) in the AVI group. One patient with DVT also had clinical symptoms of pulmonary embolism, but there were no deaths secondary to pulmonary embolism. There was one major bleeding complication potentially associated with the use of LMWH. CONCLUSIONS: The administration of LMWH is a safe and extremely effective method of preventing DVT in high-risk trauma patients. When heparin is contraindicated, aggressive attempts at mechanical compression are warranted.

Adult↗
PubMed1995

Thromboembolic complications following trauma surgery: incidence and outcomes.

Thromboembolic disease is an unusual condition in the general community. The incidence of symptomatic acute deep vein thrombosis (DVT) is very low in the general population before the age of 50 years. After the age of 50 years, the annual incidence increases. Thromboembolic disease is, however, a major cause of death and morbidity among hospitalized patients. In this setting, it has been estimated that pulmonary embolism (PE) kills about 100,000 Americans each year, and contributes to the death of another 100,000. It is probably the most common preventable cause of death in hospitalized patients. Thromboembolic disease is a cluster of related conditions, many of them clinically silent. DVT and PE manifest themselves with very general symptoms, making the clinical diagnosis (symptoms and physical signs) insensitive and nonspecific.

Anticoagulants↗
PubMed1994

Double-blind randomized prospective study of the efficacy of antibiotic prophylaxis for open reduction and internal fixation of closed ankle fractures.

Antibioprophylaxis has been proven to be efficient for some orthopaedic procedures. However, its efficacy for clean limited procedures with metallic implants is not clear. One hundred twenty-two closed ankle fracture patients undergoing open reduction and internal fixation were randomized, double-blindly, to receive either cephalothin (1 g i.v. every 6 h x four doses) or a placebo starting before tourniquet application. Mean trauma-surgery delay was 30.2 h, and average tourniquet duration was 65.4 min. Four patients (three of 62 on placebo and one of 60 on cephalothin) developed a superficial wound infection. One of the patients in the placebo group was hospitalized and treated with i.v. antibiotics. However, there was no osteomyelitis or premature hardware removal. The difference between the two groups was not statistically significant (chi 2 test of appreciation p = 0.33, two-tailed probabilities). Therefore, cephalothin prophylaxis does not seem justified in this patient population. A larger series is needed to avoid a type II error.

Adult↗
PubMed1994

Postoperative infections in asymptomatic HIV-seropositive orthopedic trauma patients.

In a retrospective study of 476 surgical orthopedic trauma patients, we compared postoperative infection rates between individuals seropositive for the human immunodeficiency virus (HIV) and with no associated clinical symptoms with HIV-seronegative patients. Overall, the surgical postoperative infection rate was 16.7% in seropositive patients and 5.4% in the seronegative group (Chi-square, p = 0.035). When open fractures were considered separately, the seropositive group had a 55.6% infection rate compared with 11.3% in the seronegative group (Fisher's exact test, p = 0.004). Similarly, seropositive patients also had significantly increased rates of postoperative non-wound infections and complications (Chi-square p < 0.001). Asymptomatic HIV-seropositive orthopedic trauma patients are at significantly higher risk for postoperative infections than their seronegative counterparts. For HIV-seropositive patients with open fractures, this risk is especially pronounced.

Adult↗
PubMed1994

Practice patterns in prophylaxis of deep vein thrombosis among US orthopedic surgeons.

Thromboembolic disease meets all the criteria of a major public health problem. Some studies have estimated that up to 200,000 Americans die each year as a result of pulmonary embolism. Furthermore, at least 50% of these people had an otherwise very good prognosis and should not have died. Thus, about 100,000 deaths from pulmonary embolism are preventable. This study indicates that, while primary prophylaxis is almost universal among orthopedic surgeons, very few practice secondary prevention, which could be the reason for the large number of deaths attributed to thromboembolic disease.

Anticoagulants↗
PubMed1994

[Efficacy and safety of prophylactic preoperative administration of low-dose warfarin in cemented total knee prostheses].

One hundred and fifty six consecutive cemented total knee arthroplasties (TKA) in 147 patients (39 males, 108 females, mean age: 67) received preoperatively low-dose-warfarin for thromboembolic prophylaxis. Warfarin 10 mg was given the night before surgery and warfarin 5 mg the night of surgery. Thereafter, the dosage was adjusted to maintain a prothrombin time between 1.2-1.5 times control (INR = 2.0-3.0). The screening for any deep vein thrombosis (DVT) in the operated limb was by ascending venography. The reported incidence of DVT after TKA without prophylaxis is superior to 50%, more than 10% of those are proximal DVT. In this study, the overall incidence of DVT is down to 22.4%. Only five patients (3.4%) had a proximal DVT. There were no deaths and no clinical pulmonary embolisms. Patients with venous insufficiency had a significantly higher incidence of DVT (36.7%, p = 0.05). The average blood loss was 406 ml. Three major local bleedings occurred (2.0%). At one year follow-up, there were no infections. Low dose warfarin is efficacious in reducing DVT formation with TKA. It is safe and does not create excessive bleeding in cemented TKA.

Adult↗