Orthopedics
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Newer studies on surgical management of ankle fractures have given us a greater appreciation of the spectrum of stability for multiple patterns of injury, and newer fixation approaches and techniques may allow us to optimize fixation.
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The annual incidence of elbow dislocation is 6 to 8 cases per 100,000 in the United States; these dislocations represent 11% to 28% of all elbow injuries. The frequency of elbow dislocation is second to that of shoulder dislocation. Adult elbow dislocations are classified by the direction of displacement and associated fractures. ⋯ Early mobilization of the elbow resulted in a stable joint with full range of motion. The rehabilitation of elbow dislocation ranges from aggressive immediate active motion to traditional plaster of Paris immobilization for several days. Forceful passive mobilization in the rehabilitation period must be avoided, since the elbow joint has a natural tendency to develop myositis ossificans following passive manipulation.
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Numerous reports in the literature describe cerebrospinal fluid (CSF) leaks resulting from dural tears; however, most of these reports document symptoms of incidental durotomy occurring ,48 hours postoperatively. This case report describes patients with symptoms of CSF leak occurring a few days to a few weeks after lumbar spine surgery who required additional surgery to repair the dura and alleviate their symptoms. Records for patients who had lumbar spine surgery performed by 2 spine surgeons at a single institution between 1990 and 2005 were reviewed. ⋯ The incidence of durotomy has been noted to be increased in patients undergoing revision spine surgery secondary to adhesions and scarring of the dura. As this was the first spine operation for both cases reported, we believe that residual bone spikes are responsible for puncturing the dural sac postoperatively. Spine surgeons should be exceedingly cautious in inspecting for bone spikes following an extensive dural exposure and recognize the significance of the new onset of an orthostatic headache, even days or weeks following spine surgery.
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Morel-Lavallée lesions are closed soft-tissue degloving injuries that occur when the skin and subcutaneous tissues are separated from underlying fascia as a result of a sudden shearing force. The space that is created has the potential to be filled with a mixture of blood, lymph fluid, or necrotic fat, which may easily become infected. The optimal treatment of Morel-Lavallée lesions is controversial. ⋯ In many cases these lesions can persist for months before they are recognized. For long-standing Morel-Lavallée lesions, it is important to determine the nature of the fluid in the cavity before planning treatment. In the current case, it was unclear based on the official radiographic interpretation whether the lesion was filled with frank blood versus serous or serosanguineous fluid.