Dissertations / Theses on the topic 'Orthopaedics and trauma'

Introduction: Trauma is the main cause of death in working-age adults in the UK. Multiple organ failure (MOF) is associated with a high proportion of late trauma deaths, and MOF survivors have poor long-term outcomes. Early prediction of patients at risk of MOF would assist treatment decisions and allow targeted interventions. Methods: A cohort of major trauma patients requiring intensive care unit (ICU) treatment at the John Radcliffe Hospital was identified. Data were obtained from the two national databases of the Trauma Audit Research Network and the Intensive Care National Audit and Research Centre, and from a local ICU database with hourly data recording. Literature review and questionnaire analysis of trauma clinicians identified candidate predictors of MOF, grouped into patient, injury, physiological, laboratory and management variables. MOF scoring systems were reviewed to determine the most appropriate for use in trauma patients. Prediction models of post-trauma MOF were developed using logistic regression at a range of times from 0 to 48 hours after injury. Models were internally validated using bootstrapping. Results: 517 adult trauma patients were identified from 2003-2011. Overall mortality was 14.9%, with 491 patients surviving more than 48 hours, and therefore being at risk of MOF development. For these 491 patients, MOF incidence depended on the definition, and ranged from 23% (Denver score) to 58% (SOFA score). MOF was associated with mortality, time to ICU admission, and length of ICU and hospital stay. MOF could be predicted with an accuracy of up to 81.3% at 2 hours post-injury, and 84.2% at 12 hours post-injury using small numbers of clinical variables. Age, head injury, abdominal injury, maximum heart rate and the need for vasopressors were strong predictors of all definitions of MOF. Conclusions: Post-trauma MOF can be predicted early after injury using combinations of clinical variables. Further validation of the identified variables on external populations would allow development of a clinical score to assist clinicians in trauma management.

Adequately assessing injury severity is critical in treating articular fractures. Severity assessment is used to inform clinical and surgical decision making through anticipation of patient outcomes. The assessments generally involve interpreting radiographs or CT image data. In recognition of the poor reliability of existing clinical severity assessments, objective severity metrics have been developed that are firmly rooted in mechanics and provide capable alternatives for use in research, where reliable data is paramount. Their broader clinical utility remains to be established. An existing CT-based method for determining the energy expended in a bone fracture was extended to facilitate its use in more fracture types. Its utility in different articular joints was evaluated. Specifically, the severities of articular fractures of the proximal tibia (plateau), of the distal tibia (plafond), and of the calcaneus were compared with present clinical severity metrics, patient outcomes, and/or surgeon rankings of severity. Differences in the fracture energies in the different joints were also compared. The objective fracture energy metric compared favorably with present clinical severity metrics. The fracture energies for fractures of the tibial plateau had between 71% and 78% concordance with surgeon rankings of severity. The calcaneal fracture energies had a 75% concordance with the present clinical standard. Fracture energy was also predictive of later radiographic indicators of post-traumatic osteoarthritis. The fracture energy metric is a capable tool for analyzing fracture severity in various joints. Fracture energy correlated well with outcomes and present clinical gold standards for severity assessment. The methods for assessing fracture energy described are highly useful for orthopaedic research and have potential as an important clinical tool.

This thesis details my contribution to the literature on military surgery, based on both front-line surgical experiences as well as research carried out on causes of death and disability, particularly in relation to limb injuries, the most common site of wounding in conflict. Injury analysis (6 papers). Injury prevention/mitigation (5 papers). Management (8 papers). Outcome (13 papers). Education (9 papers).

Thesis (MScPhysio (Interdisciplinary Health Sciences))--Stellenbosch University, 2008.
Introduction In clinical physiotherapy, there is a growing importance for the accuracy and reliability of assessment and outcome measures. The purpose of this study is to develop a valid outcome measure for orthopaedic trauma inpatients. Item generation was done by conducting a systematic review of published functional outcome measures and patients' interview. Item reduction was conducted by using a panel of physiotherapists and patients. Objectives The overall study objectives were: 1) To determine if a functional outcome measurement scale for trauma inpatients exists and has been published; 2) To generate functional items for the construction of a new outcome measurement tool for trauma inpatients; 3) To construct a new outcome measurement tool for trauma inpatients and assess elements of validity and reliability (face and content validity, response to change, internal consistency and floor and ceiling effects) of the new developed outcome measure. Methodology Convenience sampling was applied to collect data from 35 trauma inpatients in trauma wards at Rashid Hospital in Dubai, UAE. 88% of the trauma inpatients were male (total sample n= 100), mean age =34.75, and the standard deviation = 14.46. 21 functional activity items were generated from the collated results of the patient interviews. Internal consistency reliability, responsiveness and floor and ceiling effect were assessed. Data analysis was conducted using Statistica Version 7. Results The final number of functional activity items included in the newly developed Functional Scale outcome measure was 29 activity items relevant for trauma inpatients. A Cronbach's alpha ranged between 0.76 and 0.97. The lowest alpha result was for the 'ADL' activities at follow-up (0.76). The highest alpha result was for 'out of bed' activity at admission and discharge (0.97). The response to change of the Functional Scale for trauma inpatients over time results illustrates that there was a significant difference in the mean scores over three administrations of 'Bed', 'Out of bed' and 'ADL' activity items of Functional Scale for trauma inpatients (p=O.OOOO). In general, there was no significant floor and ceiling effects at admission or discharge for 'bed', 'out of bed' and 'ADL' activities, except there was a floor effect noted at discharge for 'bed' activities and 'ADL' activities, and a ceiling effect noted at admission for 'out of bed activities' only. Discussion and Conclusion The newly developed Functional Scale outcome measurement for trauma inpatients has been shown to be internally consistent and appears to be valid with respect to response to change in this sample of trauma inpatients. The results of this study thus suggest that the Functional Scale for trauma inpatients may be an appropriate tool when the goal is the assessment of change in disability functions in trauma inpatients, although further psychometric testing may be required.

Patient reported outcome (PRO) measurement of disability is integral to a patient-centered approach to health care and gauging the biopsychosocial impact of health conditions from the patient's perspective. This thesis investigates disability after proximal humerus, elbow and distal radius fractures; conditions that constitute a major burden in musculoskeletal health care and a substantial impact on health-related quality of life (HrQoL). Disability is defined by the World Health Organisation (WHO) International Classification of Disability, Functioning and Health (ICF) as ‘a multi-dimensional construct involving a dynamic interaction between impairment, activity limitations and participation restrictions, that are influenced by contextual factors'. This international, consensus-based framework acts as a guide for the application of outcome measures in performing scientific research. The WHO ICF also considers other patient perspectives on health and health care systems, including patient experience and patient activation within the contextual factors component. Patient experience encompasses aspects such as satisfaction, expectation management and confidence with care, and is measured using a variety of scales and questionnaires. Patient activation relates to 'the knowledge, skills and confidence a person has in managing their own health and health care'. This concept is quantified using patient activation measures (PAMs). The overarching goal of this thesis is to identify the most influential factors predicting disability after proximal humerus, elbow and distal radius fractures. This work also aimed to define the relationship between disability, experience and activation to inform the development of a patient-centred approach to managing these challenging injuries. The first systematic review highlights the dominance of psychosocial factors in influencing disability associated with a range of upper extremity conditions. Few studies have assessed this relationship in specific trauma populations. The second review underlines the paucity of upper extremity PRO measures incorporating fracture populations in their original development. It also reports the highly variable quality of initial studies introducing these measures. The final review demonstrates the superior measurement properties of computer adaptive tests (CATs), a contemporary form of PRO measurement, over fixed-scale instruments. Few studies apply CATs in trauma and few have been performed outside the U.S. These reviews collectively informed the selection of PRO measures for the experimental studies in this thesis. Firstly, a pilot study establishes a methodology for addressing the key objectives and the feasibility of using a web-based platform for measuring patient outcomes. Strong correlation between PROMIS Physical function CAT, a computer adaptive measure of physical function, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), a region-specific, fixed scale is observed. The core experiment (n=734) expands upon this work and demonstrates correlations between a range of generic and region-specific measures in an upper extremity trauma population. Disability is shown to correlate with satisfaction, and the strength of this correlation increases over time. Applying PRO measures of disability in populations with shoulder, elbow and wrist fractures show that self-efficacy (i.e. coping ability) within 6 weeks of injury was the strongest predictor of medium-term disability at 6-9 months. In proximal humerus and elbow fractures, kinesiophobia (i.e. fear of movement) within a week of injury was also a strong predictor of disability. The final study concludes that greater patient activation is associated with greater health-related and experiential outcomes. However, psychosocial factors including self-efficacy, superseded activation in predicting disability and satisfaction. This thesis contributes evidence for musculoskeletal health care professionals (HCPs) to consider specific psychosocial factors, such as coping abilities, and patient activation early in the recovery process to improve disability following these injuries.

碩士
國立臺北科技大學
工業工程與管理系碩士班
100
In recent years, people have paid attention on the service quality of healthcare providers under the competitive medical service industry. Patient waiting time is a critical factor that affects patients’ satisfaction. Based on Taoyuan Armed Forces General Hospital (TYAFGH) survey questionnaire, it showed that the long waiting time is the major problem of patient dissatisfaction. The average walk-in patient waiting time is approximately 2 hours in trauma team of orthopaedic surgery department. The hospital has a mixed registration type which accepts for both walk-in and scheduled patients. The reason of long waiting time is probably caused by the uncertain number of walk-in patients, or patient arrival time. In order to improve patient satisfaction, this research used a computer simulation approach to simulate all consultation sections of two physicians’ outpatient in trauma team of orthopaedics surgery department in TYAFGH. In the beginning, we analyzed the real data of two physicians during two months to build a valid simulation model. Then, this research applied three main patient scheduling scenarios. The first scenario made adjustments for proportion of walk-in and scheduled patients. The second scenario applied different policies for late patients and then adjusted late patient proportion. Third, this research applied various sequences for walk-in and scheduled patients. Finally, we did sensitivity analysis to find out the influential factor for reducing patient waiting time. The simulation results showed that the improvement of walk-in patient waiting time was average 53% in the first scenario and 33% in the third scenario. The second scenario has not shown effective improvement. Thus, in conclusion, through testing three scenarios, we could find out the adjustment of walk-ins proportion is the best way to improve patient waiting time.

Tibial plateau fractures are associated with reduced lower limb function and poor patient reported outcomes. Allowing earlier postoperative weight bearing in could improve these outcomes. The central aim of this thesis was to improve upon methods for modelling the local mechanical environment in surgically repaired tibial plateau fractures to further understand the mechanics associated with fracture recovery, and to investigate long-term patient responses to immediate postoperative weight bearing. To achieve this, a combination of in silico, ex vivo, and in vivo studies were undertaken. Neuromusculoskeletal methods for estimating knee joint loads were improved and validated using data from instrumented knee replacements. These methods could be applied to tibial plateau fracture patients to better estimate the load applied to their fractures when walking immediately postoperative. Micro-CT imaging during concurrent mechanical loading methods were developed for determining the internal mechanical environment of the proximal tibia. Using these methods, the internal strains calculated using digital volume correlation were compared to subject specific finite element models of the same tibias. The strains within the proximal tibia were within the expected physiological region (200-3000 μϵ) and showed similar median strains to the FE models (error less than 35%). The experimental methods developed were applied to split tibial plateau fractures, showing that, under three bodyweights of load, there is little fracture fragment displacement (<0.3 mm) measured using image correlation. These results suggest that, with adequate mechanical fixation, it is unlikely that simple split fracture fragments would significantly displace from loads applied during basic activities of daily living. Two-year longitudinal patient responses to immediate postoperative weight bearing identified that patients showed similar joint kinematics to immediate postoperative weight bearing when compared to TPF patients who were not prescribed weight bearing. The work presented in this thesis enables further computational and cohort studies of TPF mechanics to assess the safety of postoperative weight bearing.
Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2022

Bibliography: leaves 193-200.
ix, 200 leaves ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Argues that pain or discomfort so widely experienced in "normal" populations cannot, in all cases, have a pathological basis and that, therefore, there must be a non pathological cause. As well, a possible aetiology is suggested for other activity-related conditions which have not yet received generally accepted explanations such as Fibromyalgia.
Thesis (Ph.D.)--University of Adelaide, Dept. of Surgery, RAH, 1996

Bibliography: leaves 193-200.
ix, 200 leaves ; 30 cm.
Argues that pain or discomfort so widely experienced in "normal" populations cannot, in all cases, have a pathological basis and that, therefore, there must be a non pathological cause. As well, a possible aetiology is suggested for other activity-related conditions which have not yet received generally accepted explanations such as Fibromyalgia.
Thesis (Ph.D.)--University of Adelaide, Dept. of Surgery, RAH, 1996

The principal aim of the study was to establish the HIV Seroprevalence in an acute Orthopaedic trauma setting in an urban teaching hospital. Secondary aims were (i), to establish if the seroprevalence compares with the national averages and findings from other similar studies, and (ii), to establish the effect of informed consent on the response rate to recruitment in HIV related studies. Methodology All illegible patients (able and qualified to give an informed consent for HIV testing) admitted to the Orthopaedic trauma unit at the Johannesburg hospital, were pre-counselled and tested for HIV after admission. Those that tested positive were then counselled again and referred accordingly to the HIV clinics for follow up. Results A total of 797 patients were admitted during the period. 159 (20%) did not meet the inclusion criteria, declined counselling or could not be counselled for various reasons. The main reason for non response was cited as a need to wait until after the acute event before they considered the test. A total of 648 patients were therefore eligible for recruitment. All patients were pre-counselled for the test and 246 (39%) consented and signed the informed consent form. Of those that were tested, 57 (23%) tested positive and were followed up accordingly. This result was then compared with previous non Orthopaedic studies on the HIV Seroprevalence. The rate of HIV infection in our acute orthopaedic trauma setting was found to be 23%. This is higher than the national averages but compares with other studies. Most acutely traumatized patients are not willing to be tested for HIV in the acute setting. This has a huge bearing on recruitment of suitable candidates for future studies in HIV in an acute trauma setting. Higher response rates to recruitment in HIV studies are directly proportional to the use of qualified counsellors in organized centres like the Voluntary Counselling and Testing centres.

碩士
國立中正大學
雲端計算與物聯網數位學習碩士在職專班
106
In recent years, common clinical cases of bone fractures, bone defect, and other trauma cases have been made custom implants. Implantation simulation through pre-operative digitalization, can more closely construct a customized medical implant model that meets the needs of patients. With the multi-layer manufacturing technology, it is also a 3D printing technology that can quickly and in accordance with various special models to establish the medical implants required by patients. In order to pursue a better osseointegration effect between the implant and the human bone tissue, the implant is designed with a hole in the popular application. Produces a bone sponge state similar to the internal bone mass, providing a good bone cell growth environment between the implant and the bone mass, and efficiently traversing and adhering the bone cell tissue to the implant. The implant and the bone are tightly joined to form a high-strength structural osseointegration, which also reduces the risk of secondary injury caused by separation and breakage between the implant and the bone. In this paper, we will study traumatic cases such as bone fragments and bone defects that are common in clinical practice. 3D reconstruction of CT(Computed Tomography) images will be carried out through professional 3D medical image reconstruction software system. Symmetrical relationship through the left and right bones of the human body. In 3D visualization of virtual 3D space for 3D model movement, mirroring, and fallback fitting calculation. 3D bone block reduction simulation before surgery from the reference healthy bone block. And after the reduction, such as the formation of a bone defect case, the spatial structure model logic gate is used to calculate the bone implant model that needs to fill the defect. And through the calculus combination of the basic cubic crystal model and several different cubic structures, an array of porous mesh structure models is generated. Compare the different bone mineral density of human bone tissue, and combine the model and the implant with the model logic gate. Generating a medical implant with a porous structural mesh inside. Establish a customized implant model with 3D printing process. From the pre-operative bone trauma reduction simulation to the planning and establishment of the implant model, and the rapid creation of the pore structure grid inside the implant model. Provide medical engineering end to quickly establish a customized porous medical implant method. Keywords: 3D printer, structural grids, cubic crystals

Research Doctorate - Doctor of Philosophy (PhD)
Continued tobacco smoking after orthopaedic trauma surgery can have a negative impact on health outcomes. Despite this, limited research has been conducted with the orthopaedic trauma population to determine current rates of care, and interest in receiving help to quit during hospital admission. Further, rates of current tobacco smoking among the orthopaedic trauma population has previously been found to be high, indicating a need to address rates of smoking in this population. The implementation of hospital smoke-free policy in Australia mandates the provision of smoking cessation care for all patients, and that the hospital admission may provide an ideal time when individuals are receptive to health messages. Despite this, implementation of hospital smoke-free policy has been found to be low, with care previously found to be sub-optimal. The aim of this thesis was to explore the current provision of care, the barriers faced by staff, and possible factors which may help address hospital smoke-free policy. The development and pilot testing of an online smoking cessation program designed specifically for orthopaedic trauma patients is described. Competing priorities and comorbid conditions in the lives of orthopaedic trauma patients were identified as complicating smoking cessation treatment and are discussed.

Parathyroid hormone is a vital mediator of bone metabolism and studies have shown that exogenous treatment can enhance the fracture repair process in murine models. Bone remodeling is a complex process that necessitates multiple molecular and cellular interactions that are affected by genetic variations. These differences contribute to both histological and whole organ level differences of fracture healing. This study was performed to determine the effect of genetic variability of fracture healing in mice treated with parathyroid hormone during two time windows. The first window was the first 14-day period post fracture associated with chondrogensis and the second was the day 15 to day 28 post fracture, which is associated with osteogenesis. Three inbred strains of mice A/J (AJ), C57BL/6J (B6), and C3H/HeJ (C3) that have material and structural differences in bone quality were given Femoral shaft fractures and healing was evaluated at different time points post fracture using quantitative real-time polymerase chain reaction (qRT-PCR) and qualitative radiographic analysis. Chondrogenic genes Sox9, ColIIa, aggrecan, and ColXa and osteogenic genes ostrix, osteocalcin, BSP, and DMP1 were examined. The temporal analysis of mRNA expression revealed that PTH treatment given in the first 14 days post fracture enhanced osteogenic and chondrogenic expression in B6 mice, but hindered expression in AJ mice. Treatment with PTH from post fracture day 14 to day 28 greatly affected the osteogenic expression of B6 mice, but had little affect on other animals. Radiographic analysis showed that each strain presents callus formation at approximately day 7 and reaches maximum size at day 21 post fracture. Additionally B6 mice appear with the largest callus and AJ the smallest. Taken together, these results are consistent with past studies in showing that different strains of mice express a unique temporal and mRNA expression pattern of chondrogenic and osteogenic differentiation. Furthermore, these variations affect the biomechanical properties of the fracture callus during bone remodeling.

Tese de Doutoramento (Programa Doutoral em Engenharia Biomédica)
The introduction of imaging techniques in 1970 is one of the most relevant historical milestones in modern medicine. Medical imaging techniques have dramatically changed our understanding of the Human anatomy and physiology. The ability to non-invasively extract visual information allowed, not only the three-dimensional representation of the internal organs and musculo-skeletal system, but also the simulation of surgical procedures, the execution of computer aided surgeries, the development of more accurate biomechanical models, the development of custom-made implants, among others. The combination of the most advanced medical imaging systems with the most advanced CAD and CAM techniques, may allow the development of custom-made implants that meet patient-speci c traits. The geometrical and functional optimization of these devices may increase implant life-expectancy, especially in patients with marked deviations from the anatomical standards. In the implant customization protocol from medical image data, there are several steps that need to be followed in a sequential way, namely: Medical Image Processing and Recovering; Accurate Image Segmentation and 3D Surface Model Generation; Geometrical Customization based on CAD and CAE techniques; FEA Optimization of the Implant Geometry; and Manufacturing using CAD-CAM Technologies. This work aims to develop the necessary procedures for custom implant development from medical image data. This includes the extraction of highly accurate three-dimensional representation of the musculo-skeletal system from the Computed Tomography imaging, and the development of customized implants, given the speci c requirements of the target anatomy, and the applicable best practices found in the literature. A two-step segmentation protocol is proposed. In the rst step the region of interest is pre-segmented in order to obtain a good approximation to the desired geometry. Next, a fully automatic segmentation re nement is applied to obtain a more accurate representation of the target domain. The re nement step is composed by several sub-steps, more precisely, the recovery of the original image, considering the limiting resolution of the imaging system; image cropping; image interpolation; and segmentation re nement over the up-sampled domain. Highly accurate segmentations of the target domain were obtained with the proposed pipeline. The limiting factor to the accurate description of the domain accuracy is the image acquisition process, rather the following image processing, segmentation and surface meshing steps. The new segmentation pipeline was used in the development of three tailor-made implants, namely, a tibial nailing system, a mandibular implant, and a Total Hip Replacement system. Implants optimization is carried with Finite Element Analysis, considering the critical loading conditions that may be applied to each implant in working conditions. The new tibial nailing system is able of sustaining critical loads without implant failure; the new mandibular endoprosthesis that allows the recovery of the natural stress and strain elds observed in intact mandibles; and the Total Hip Replacement system that showed comparable strain shielding levels as commercially available stems. In summary, in the present thesis the necessary procedures for custom implant design are investigated, and new algorithms proposed. The guidelines for the characterization of the image acquisition, image processing, image segmentation and 3D reconstruction are presented and discussed. This new image processing pipeline is applied and validated in the development of the three abovementioned customized implants, for di erent medical applications and that satisfy speci c anatomical needs.
Um dos principais marcos da história moderna da medicina e a introdução da imagem médica, em meados da década de 1970. As tecnologias de imagem permitiram aumentar e potenciar o nosso conhecimento acerca da anatomia e fisiologia do corpo Humano. A capacidade de obter informação imagiológica de forma não invasiva permitiu, não são a representação tridimensional de órgãos e do sistema músculo-esquelético, mas também a simulação de procedimentos cirúrgicos, a realização de cirurgias assistidas por computador, a criação de modelos biomecânicos mais realistas, a criação de implantes personalizados, entre outros. A conjugação dos sistemas mais avançados de imagem medica com as técnicas mais avançadas de modelação e maquinagem, pode permitir o desenvolvimento de implantes personalizados mais otimizados, que vão de encontro as especificidades de cada paciente. Por sua vez, a otimização geométrica e biomecânica destes dispositivos pode permitir, quer o aumento da sua longevidade, quer o tratamento de pessoas com estruturas anatómicas que se afastam dos padrões normais. O processo de modelação de implantes a partir da imagem medica passa por um conjunto de procedimentos a adotar, sequencialmente, ate ao produto final, a saber: Processamento e Recuperação de Imagem; Segmentação de Imagem e Reconstrução tridimensional da Região de Interesse; Modelação Geométrica do Implante; Simulação Numérica para a Otimização da Geometria; a Maquinagem do Implante. Este trabalho visa o desenvolvimento dos procedimentos necessários para a criação de implantes personalizados a partir da imagem medica, englobando a extração de modelos ósseos geométricos rigorosos a partir de imagens de Tomografia Computorizada e, a partir desses modelos, desenvolver implantes personalizados baseados nas melhores praticas existentes na literatura e que satisfaçam as especificidades da anatomia do paciente. Assim, apresenta-se e discute-se um novo procedimento de segmentação em dois passos. No primeiro e feita uma pre-segmentação que visa obter uma aproximação iniciala região de interesse. De seguida, um procedimento de refinamento da segmentação totalmente automático e aplicada a segmentação inicial para obter uma descrição mais precisa do domínio de interesse. O processo de refinamento da segmentação e constituído por vários procedimentos, designadamente: recuperação da imagem original, tendo em consideração a resolução limitante do sistema de imagem; o recorte da imagem na vizinhança da região pre-segmentada; a interpolação da região de interesse; e o refinamento da segmentação aplicando a técnica de segmentação Level-Sets sobre o domínio interpolado. O procedimento de segmentação permitiu extrair modelos extremamente precisos a partir da informação imagiológica. Os resultados revelam que o fator limitante a descrição do domínio e o processo de aquisição de imagem, em detrimento dos diversos passos de processamento subsequentes. O novo protocolo de segmentação foi utilizado no desenvolvimento de três implantes personalizados, a saber: um sistema de fixação interna para a tíbia; um implante mandibular; e um sistema para a Reconstrução Total da articulação da Anca. A otimização do comportamento mecânico dos implantes foi feita utilizado o Método dos Elementos Finitos, tendo em conta os carregamentos críticos a que estes podem estar sujeitos durante a sua vida útil. O sistema de fixação interna para a tíbia e capaz de suportar os carregamentos críticos, sem que a sua integridade mecânica seja comprometida; o implante mandibular permite recuperar os campos de tensão e deformação observados em mandíbulas intactas; e a Prótese Total da Anca apresenta níveis de strain shielding ao longo do fémur proximal comparáveis com os níveis observados em dispositivos comercialmente disponíveis. Em suma, nesta tese de Doutoramento são investigados e propostos novos procedimentos para o projeto de implantes feitos por medida. São apresentadas e discutidas as linhas orientadoras para a caracterização precisa do sistema de aquisição de imagem, para o processamento de imagem, para a segmentação, e para a reconstrução 3D das estruturas anatómicas a partir da imagem medica. Este conjunto de linhas orientadoras é aplicado e validado no desenvolvimento de três implantes personalizados, citados anteriormente, para aplicações médicas distintas e que satisfazem as necessidades anatómicas específicas de cada paciente.
Fundação para a Ciência e Tecnologia (FCT)

yes
Corsets have been used both to create a fashionable silhouette and as an orthopaedic treatment for spinal conditions, but skeletal changes associated with the use of corsetry are rarely reported on in the palaeopathological literature. Here, we report on a 19th-century adult male with Pott’s disease of the vertebral column and related vertebral compression deformities, which probably result from the use of a corset. Wolverhampton HB40 presented destruction of the vertebral bodies of T6 to L4, ankylosis of the apophyseal joints of L1 and L2 and an angular kyphosis of the lumbar region, the result of tuberculosis. The presence of flattened spinous processes and bilateral acute angulation of multiple ribs in the lower thoracic region is indicative of plastic deformation caused by the use of the corset. The presence of both of these changes in an adult male, at a time when the use of cosmetic corsets by men was in decline, suggests that the compression trauma was the result of an orthopaedic corset used to correct the defective posture resulting from tubercular kyphosis, although corset use to obtain a fashionable silhouette cannot be ruled out.

Les patients atteints de mono-traumatisme à un membre doivent consulter un médecin de première ligne qui assurera la prise en charge initiale et référera au besoin le patient vers un orthopédiste. L‟objectif principal de cette étude est de décrire ce mécanisme de référence envers un Service d‟orthopédie affilié à un Centre de traumatologie Niveau 1. La collecte de données concernant l‟accès aux soins spécialisés et la qualité des soins primaires a été faite lors de la visite en orthopédie. Nous avons étudié 166 patients consécutifs référés en orthopédie sur une période de 4 mois. Avant leur référence en orthopédie, 23 % des patients ont dû consulter 2 médecins de première ligne ou plus pour leur blessure. Le temps entre la consultation en première ligne et la visite en orthopédie (68 heures) dépasse le temps compris entre le traumatisme et l‟accès au généraliste (21 heures). Parmi les cas jugés urgents, 36 % n‟ont pas été vus dans les temps recommandés. La qualité des soins de première ligne fut sous-optimale chez 49 % des patients concernant l‟analgésie, l‟immobilisation et/ou l‟aide à la marche. Les facteurs associés à une diminution d‟accès en orthopédie et/ou une qualité de soins inférieure sont : tabagisme, jeune âge, habiter loin de l‟hôpital, consulter initialement une clinique privée, avoir une blessure au membre inférieur ou des tissus mous et une faible sévérité de la blessure selon le patient. Ces résultats démontrent qu‟il faut mieux cibler l‟enseignement relié aux mono-traumatismes envers les médecins de première ligne afin d‟améliorer le système de référence.
Patients with isolated traumatic limb injuries usually consult primary care for first line treatment. The primary care physician will often refer the patient to an orthopaedic surgeon when needed. The research objective was to study the referral mechanism to an Orthopaedic Service in a Level 1 Trauma Center for patients with an isolated limb injury. Access to specialized care and quality of primary care are used to describe the referral mechanism. We studied 166 consecutives patients referred to orthopaedic surgery over a 4 months period. Before the orthopaedic visit, 23 % had seen 2 or more doctors for their injury. The time between the first primary care visit and the orthopaedic evaluation was greater (68 hours) then the interval between the injury and the visit with primary care (21 hours). Among the cases that were considered urgent, 36 % had not been seen within the recommended delay. Quality of initial care was judged sub optimal for 49 % of patients in terms of immobilization, analgesia and/or walking aids. Factors associated with decreased access or quality of care are: smoking, younger age, living far from the hospital, consulting first in a private clinic, lower limb or soft tissue injury and a patient‟s low self-perception of severity. These results underline the necessity of targeting primary care education and improving the referral mechanism for patients with isolated limb injuries.