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To understand the relationship between standardisation and originality in surgery, the contributions of three surgeons in the 20th century are analysed. The individual Arbuthnot Lane, the collectivist Robert Jones and the scientist Alexis Carrel changed the practice of orthopaedic surgery. It is argued that the factors influencing innovation are not binary but multifactorial and that advances in surgery occur when individual freedom is permitted within a system. It is concluded that innovation and standardisation in orthopaedic surgery need not conflict with each other. [ABSTRACT FROM AUTHOR]

This study sought to examine the ability of motion analysis to detect long and short-term changes in performance following lumbar decompression surgery. These changes were compared with changes in more traditional questionnaire based assessments of outcome. Fifty-two patients from an original pool of 84 patients who underwent spinal surgery were assessed pre-operatively using spinal motion analysis and standard questionnaires of pain and function. These assessments were repeated at 6 weeks, and 6 months post-operatively. Significant Improvements in back and leg pain were noted at 6 weeks (p < 0.001) with no further improvements occurring at 6 months. Changes in the Oswestry Disability Score were noted only at the 6-month review, and only certain constructs of the SF-36 reported improvement. Of the motion analysis measures only measures of sagittal posture and anterior-posterior flexion appeared sensitive to change in the patient's condition. However, change in motion was not correlated with change in functional disability scales or pain. Measures of posture and range of motion of flexion may provide useful indices of objective performance in future outcome studies, however, they do not correlate with changes in subjective function or pain, thus their full relevance remains uncertain. [ABSTRACT FROM AUTHOR]

External fixation of fractures is now used frequently in orthopaedics. This paper reviews the results of 30 fractures treated by a single bar system, the Sukhtian-Hughes, over a period of 4 years. The results are encouraging, particularly in compound tibial fractures and in patients with non-union of fractures. [ABSTRACT FROM AUTHOR]

Lumbar arteries are important because they are the main source of blood supply to the lumbar spine structures. However, these vessels and their flow characteristics have received little attention and their role in conditions such as low back pain remains unclear. The present study 1. describes the application of duplex ultrasonography in the assessment of lumbar artery blood flow and 2. evaluates the interobserver and intraobserver reproducibility of lumbar artery Doppler velocimetry. A total of 13 healthy volunteers were evaluated by two different examiners successively on the same day and measurements repeated by the same examiners 1 week later. Peak systolic velocities of lumbar arteries were recorded at an optimal angle below 60 degrees . Overall mean peak systolic velocity (+/-SD) for lumbar arteries was 0.158 +/- 0.051 m/s, and mean Doppler angle (+/-SD) was 24.6 +/- 14.5 degrees . For interobserver variability, the coefficient of variation was 23.4% and SD of differences 0.037 m/s. Reliable results of lumbar artery Doppler velocimetry demonstrate its applicability in future clinical investigations in patients with low back disorders. (E-mail: ).

Objective: Preliminary studies have suggested that prolonged retraction of the paraspinal muscle during spinal surgery may produce ischemic damage. We report the continuous measurement of intramuscular pressure (IMP) during decompressive lumbar laminectomy and its relationship to subsequent back pain and disability., Methods: Twenty patients undergoing two-level decompressive lumbar laminectomy for lumbar canal stenosis were recruited. Back pain and disability were assessed by use of the Visual Analog Score (VAS), Oswestry Disability Index (ODI), and Short-Form 36 (SF-36) Health Survey. During surgery, IMP was recorded continuously from the multifidus muscle by use of a pressure transducer. The intramuscular perfusion pressure (IPP) was estimated as the difference between the patient's mean arterial pressure and IMP., Results: Two muscle retractors were used: the Norfolk and Norwich (n = 10) and the McCulloch (n = 10). The mean duration of deep muscle retraction was 62.7 +/- 8 minutes (range, 19-133 min). On application of deep muscle retraction, there was a rapid and sustained increase in IMP (P < 0.001), and overall, the calculated mean IPP approached 0 mm Hg or less during this period (P < 0.001). On release of deep muscle retraction, there was a rapid decrease in IMP to preoperative levels. The IPP was greater with the Norfolk and Norwich than the McCulloch retractor (P < 0.001). Compared with preoperative values, there was a decrease in ODI (P < 0.001) and VAS for back pain (P < 0.001) at discharge and 4 to 6 weeks and 6 months after surgery. In addition, there was a decrease in SF-36 scores at 6 months compared with preoperative values (P < 0.001). Total duration of muscle retraction greater than 60 minutes was associated with worse VAS scores for back pain and ODI and SF-36 scores for disability at 6 months after surgery (P < 0.05). There was no relationship between the VAS, ODI, and SF-36 scores and other parameters measured, including the mean IPP, retractor type, operating surgeon, and wound length., Conclusion: The McCulloch retractor generates a higher IMP than the Norfolk and Norwich retractor. However, postoperative improvement in VAS, ODI, and SF-36 scores in these patients was associated with a shorter duration of muscle retraction and not the degree of IMP or IPP generated. In this respect, periodic relaxation of the paraspinal muscle retractors during surgery to allow muscle perfusion may help to reduce postoperative back pain and disability.

The goal of the current study was to investigate whether preoperative rehabilitation advice reinforced by a patient information booklet can aid recovery after total hip arthroplasty in terms of pain, function, satisfaction, and quality of life. Thirty-five patients awaiting primary total hip arthroplasty were recruited into this study and randomly allocated before admission to receive either the standard pathway of care or the rehabilitation program and booklet. All patients showed increases in function and psychological variables with time. The preoperative class and booklet, however, seemed to have the greatest impact on length of hospital stay, reducing the hospital stay by 3 days, and therapy input required, significantly influencing the cost of the procedure (the rehabilitation class led to a cost saving of 587 British pounds; approximately 810 dollars, per patient). In addition, patients attending the class reported higher levels of satisfaction (99% satisfied in the preoperative rehabilitation class compared with 80% in the control group 3 months postoperatively) and had more realistic expectations of surgery.