Medical Malpractice Insurance for orthopaedic surgeons

V-Y Local Advancement Flaps

– See:       – Nail Bed Injuries       – Finger Tip Injuries: – Discussion:     – may be used for finger tip amputations which have more dorsal soft tissue loss than palmar loss);     – advancement flaps from same finger provide advantage of rapid healing, limited morbidity, and critical sensibility … Read more

Vaccum Mixing of Methylmethacrylate

– Discussion:           – see cement mixing:            – in the study by Geiger MH, et al (2001), the authors performed a controlled study compared the strength and porosity of 48                    polymethylmethacrylate cement-implant constructs prepared with open bowl versus vacuum mix technique;                   – 48 blast finished stainless … Read more

Urine Analysis

pH Specific Gravity Blood Glucose Ketones Nitrite/Leukocyte Esterase Protein Pyuria Spot/Random Urine Chem Urine culture  Perioperative factors associated with septic arthritis after arthroplasty. Prospective multicenter study of 362 knee and 2,651 hip operations.      – prospectively evaluated perioperative factors associated with septic arthritis after 362 knee and 2,651 hip arthroplasties;      – preoperative urinary tract … Read more

Urine analysis: Glucose

Positive: Diabetes mellitus. Pancreatitis, Pancreatitic ca Pheochromocytoma, Cushing’s dz Shock Burns Pain Steroids, Hyperthyroidism Renal Tubular dz Iatrogenic causes; Common after heavy meals Ascorbic acid overdose  – Misc:  – large amount of ketones will give False Negatives;  – precise timing is essential or dipstick color change is meaningless, & over timing by only 1-3 seconds … Read more

Urine analysis : Ketones

– Detects primarily Acetone & AcetoAcetic Acid, not Beta-Hydroxybutyric acid;  – Positive: Starvation, High Fat Diet, DKA (See Hyperglycemia) Vomiting Diarrhea Hyperthyroidism, Pregnancy, Fever  – Misc:  – precise timing is essential or dipstick color change is meaningless & over timing by only 1-3 seconds will cause false elevation;  – carbohydrate free diets as well as … Read more

Urine Analysis: Protein

– Discussion:  – Persistent proteinuria by dipsick should be quantified by 24hr;  – Positive: pyelonephritis, glomerulonephritis, Kimmelstiel-Wilson dz Nephrotic syndrome, Myeloma, Postural causes, Pre-eclampsia, Inflammation and Malignancies of Lower Urinary Tract, Functional causes (Fever, Stress, Heavy Exercise, Malignant Hypertension)

Urine analysis: Specific Gravity: > 1.023 indicates nl [ abilities

 – Increased:  – Volume depletion, CHF, Adrenal Insufficiency, DM, SIADH, Increased proteins (nephrosis) (upto 1.050);  – If markedly increased (1.040-1.050), Suspect artifact or excretion of radiographic contrast media;  – Decreased:  – DI, Pyelonephritis, Glomerulonephritis, Waterload w/ Nl Renal Function;  – Misc:  – Specific gravity varies inversely with urine excretion – In some conditions this relationship … Read more

Urine Analysis: UTI

– See: Urine Culture – Conversion of nitrates to nitrite;  – Positive: infection (negative test does not rule out infection since some organisms such as Strep faecalis & other gram positive cocci will not produce nitrite, & note that urine must also be retained in bladder for several hours to allow the reaction to take … Read more

Urine Chemistries and Osmolarity

    Diagnostic Indexes in Acute Renal Failure                    PreRenal     PostRenal      Renal     Acute GN ————— U/P osm              >  1.5      1.0 – 1.5    1.0 – 1.5   1.0 – 1.5 Urine Na, mEq/l … Read more

Upper Extremity Touniquet

– Forearm:     – in the report by Edwards et al, the authors performed a prospective study was undertaken to compare            the use of forearm and upper arm tourniquets for local anaesthetic procedures on the hand;            – 100 consecutive patients with an upper arm … Read more