The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 2011
Safety syringes and anti-needlestick devices in orthopaedic surgery.
The American Academy of Orthopaedic Surgery (AAOS), The Joint Commission, the Occupational Safety and Health Administration (OSHA), and the Needlestick Safety and Prevention Act encourage the integration of safety-engineered devices to prevent needlestick injuries to health-care workers and patients. We hypothesized that safety syringes and needles could be used in outpatient orthopaedic injection and aspiration procedures. ⋯ The most effective and reliable safety devices for orthopaedic syringe procedures are shielded safety needles, mechanical syringes, manual retractable syringes, and shielded syringes, but not automatic retractable syringes. Even when adopting safety-engineered devices for an orthopaedic clinic, conventional syringes larger than 20 mL and conventional needles longer than 1.5 in (3.8 cm) are necessary.
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J Bone Joint Surg Am · Aug 2011
CommentCadaveric study suggests femoral nerve at risk during transpsoas approach to L4-L5 disc: commentary on an article by Timothy T. Davis, MD, et al.: "Lumbar plexus anatomy within the psoas muscle: implications for the transpsoas lateral approach to the L4-L5 disc".
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J Bone Joint Surg Am · Aug 2011
Lumbar plexus anatomy within the psoas muscle: implications for the transpsoas lateral approach to the L4-L5 disc.
The transpsoas lateral surgical approach has been advocated as an alternative to direct anterior approaches for less invasive or minimally invasive access to the spine. Postoperative thigh pain, paresthesia, and/or weakness have been described after the use of this surgical approach. The purpose of this cadaveric anatomic study is to provide a description of the lumbar plexus as it relates to the transpsoas lateral surgical approach. ⋯ Because of the proximity of the neural elements, in particular the femoral nerve, to the center of the disc space, the transpsoas lateral surgical approach to the L4-L5 disc space will likely cause intraoperative displacement of neural structures from their anatomic course during retractor dilation. Careful attention should be paid to retractor placement and dilation time during transpsoas lateral access surgery, particularly at the L4-L5 disc.
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J Bone Joint Surg Am · Aug 2011
Bone contusion and associated meniscal and medial collateral ligament injury in patients with anterior cruciate ligament rupture.
The present study examined the prevalence of bone contusions in patients with anterior cruciate ligament (ACL) injury as well as its association with tears of the lateral meniscus, medial meniscus, and medial collateral ligament (MCL). ⋯ Bone contusions were prevalent in patients with ACL ruptures, and injuries of the menisci and the MCL tended to increase with the progression of bone contusion. The contrecoup mechanism of bone contusion on the medial compartment resulting from an ACL injury was supported. These results suggest that a higher-energy injury led to a more extensive bone contusion and a greater prevalence of associated injury of other anatomic structures in the knee.