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Surgical Technology International I contains 66 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.

 

1991 - ISBN 1 85745 020 5

 

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Introduction by Ben Eiseman MD, FACS

Sections

Orthopaedic Surgery

 

Technological Advances in Spine Care
Arthur H. White MD, Spine Institute, Seton Medical Center, Daly City, California

01-371

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Abstract

Spinal medicine is one of the most rapidly evolving specialities of surgery and of medicine. The more critical and life saving specialties seem to have evolved first. General surgery, of course, existed for decades before the vascular and cardiac surgeon evolved in the 1950s and 1960s. Hand surgery and total joint surgery was in its heyday by the early 1970s. Spine surgery did not become a recognised specialty by the Academy of Orthopedic Surgery until almost 1990.

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Technology in the Management of Spinal Cord Injuries
David F. Apple MD, Medical Director, Shepherd Spinal Center, Atlanta, Georgia

01-379

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Abstract

Injury to the spinal cord is catastrophic and usually permanent. Whereas other injured tissues, such as bone, skin, blood vessels and peripheral nerves, are capable of being repaired and resuming near normal function, such is not the case with the spinal cord. Thus far, all attempts to repair the cord using every conceivable technique has ended in failure. The physician and other members of the treatment team involved with a patient with spinal cord injury, must deal with permanent, long-term consequences of the injury.

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Antibiotic Impregnated Beads, Indications in musculoskeletal infection
Stephen L. Henry MD, Veterans Administration Hospital, Louisville, Kentucky

01-383

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Abstract

The management of musculoskeletal infection as a result of acute extremity injury remains a challenge to the experienced surgeon. The current treatment of acute debridement and wound irrigation remain the most important factors in the prevention of acute or chronic infection. Skeletal stabilisation and appropriate soft tissue coverage are also imperative in the standard care of these complicated traumatic wounds. Once stabilised, severe open fractures remain at risk as a result of the compromised vascularity of the bone and soft tissue. Parenteral broad-spectrum antibiotics are recommended as a prophylaxis to the open wound contamination. In such injuries the therapeutic levels of the antibiotics are frequently diminished by the impaired tissue perfusion, vasospasm, edema and vascular damage.

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Orthopaedic Trends in the 1990s An introduction
David S. Bradford MD, Department of Orthopaedic Surgery, UCSF, San Francisco, California

01-393

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Abstract

Recent advances in orthopaedic technology have been among the most exciting medical developments of the past decade. More than 90 percent of the procedures and implants in use today did not exist a decade ago. The development of new prostheses and implants, the modifications of existing ones, and the development of new surgical techniques have allowed orthopaedic surgeons to treat and rehabilitate patients with diseases and deformities that were previously unmanageable. Furthermore, the newer and less invasive procedures have decreased the cost of treatment and recovery time for many patients. Prosthetic joint replacement is now capable of relieving arthritic pain in a predictable fashion, and spinal deformities of any magnitude can be treated in patients of any age with a high probability of success. The reattachment of amputated parts has become commonplace, and techniques of tissue transfer have enabled the salvage and reconstruction of cancerous or traumatised limbs that previously would have been lost to amputation.

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Advances in Sports Medicine
W. Dilworth Cannon Jr. MD, UCSF Orthopaedic Institute, San Francisco, California

01-395

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Abstract

The tremendous surge of interest in sports participation and body conditioning in this country has necessitated technical advances in the field of sports medicine to diagnose and treat a variety of related injuries that are increasingly confronting orthopaedic surgeons. Perhaps the two areas of the body that deserve discussion are the advances in surgery of the knee and the shoulder. In both joints, the development of arthroscopic techniques and treatment has been perhaps the greatest advancement in the past 25 years.

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Advances in Spine Surgery
Serena S. Hu MD, Department of Orthopaedic Surgery, UCSF, San Francisco, California, David S. Bradford MD, Department of Orthopaedic Surgery, UCSF, San Francisco, California

01-401

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Abstract

Technological advances in the field of spine surgery have most often involved instrumentation. In recent years, a great deal of attention has been focused on variable hookscrew-rod systems, the prototype of which is the Cotrel-Dubousset instrumentation (CDI). This French-designed system and similar ones such as the Texas-Scottish Rite (TSRH), or the Isola, provide significantly better fixation and rigidity than has ever been possible, and they allow many patients to be spared the discomfort and inconvenience of post-operative brace or cast support. These features are particularly important for older and chronically ill patients, whose often difficult problems can also be addressed more safely and effectively with this new technology.

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Advances in Orthopaedic Oncology
James O. Johnston MD, Professor of Clinical Orthopaedics, Department of Orthopaedic Surgery, UCSF, San Francisco, California

01-407

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Abstract

Advances in MR imaging, allograft tissue use, and the design of prosthetic implants have dramatically improved survival rates and clinical results in patients with tumours. In younger patients with high-grade sarcomas, adjuvant chemotherapy has increased the chance of survival from 25 per cent to 75 per cent, and tumorous limbs now have a 90 per cent chance of being salvaged.

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Advances in Adult Reconstructive Orthopaedics Total joint arthroplasty
Harry B. Skinner MD PhD, Department of Surgery, UCSF, San Francisco, California

01-414

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Abstract

The greying of America has produced a strong demand for improving total joint arthroplasty. The primary application of joint replacement technology is at the hip and knee, but arthroplasty of the shoulder and elbow has also made significant advances. Increasing numbers of people are reaching retirement age and require a level of function that will enable their enjoyment of leisure activities such as golf and bicycling. The increased popularity of sports in general also has produced a population of younger adults who need arthroplasty to restore function after a disabling trauma. In addition to patients with traumatic arthritis, patients with crippling arthritis - for example, those affected by rheumatoid arthritis - need more normal function. Thus, there is a great need for total joint replacements that will perform better and last longer.

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Advances in Paediatric Orthopaedics
John T. Smith MD, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah

01-419

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Abstract

As a direct result of the technological advances of the past decade, complex skeletal deformities in children are being treated with increasingly greater efficiency, and the pathologic mechanisms of heritable disorders are understood in greater depth. This chapter will briefly describe the recent innovations that have stimulated new areas of research and enhanced our ability to manage orthopaedic problems in children.

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Advances in Microsurgery
Leonard Gordon MD, Department of Orthopaedic Surgery, UCSF, San Francisco, California

01-425

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Abstract

The beginnings of microsurgery date back to the early part of the century. In 1906, the first description of small vessel anastomosis was presented to the Johns Hopkins Medical Society by Alexis Carrel, who eventually won the Nobel Prize for his work in 1912. The next major advance, reported by Jacobson and Suarez in 1960, was the anastomosis of 1mm vessels. This feat was a pivotal accomplishment and soon became clinically feasible with the manufacture of fine needles (50µ to 100µ) and sutures measuring between 15µ and 20µ, or approximately three times the size of a human red blood cell. Two years later, Malt performed a landmark operation the first replantation of an upper extremity above the elbow and soon after, Susumi Tamai of Japan successfully reattached a completely amputated thumb. The first toe-to-thumb transplant was performed in the early 1970s, and, within a few years, free microvascular muscle and bone transplantation had been described. By the early 1980s, microsurgical procedures had undergone a dramatic evolution, seeing the development of an expansive array of microvascular alternatives to address a wide variety of clinical problems.

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