Orthopedics
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In 1938, Dr Henry Milch described a maneuver for the reduction of acute anterior shoulder dislocations consisting of shoulder abduction and external rotation with "pulsion" of the humeral head. Although many methods may be used to reduce the dislocated glenohumeral joint, the Milch technique is unique because of its gentle, effective, and relatively painless nature. This article studied the effectiveness of this technique on 76 consecutive acute anterior shoulder dislocations in 75 patients seen in our institution's two campuses over an 18-month period. ⋯ All 76 shoulders were reduced on the first attempt. No anesthesia was used, and no complications were reported from the reduction maneuver. The Milch method is an ideal first line treatment for all acute anterior shoulder dislocations including those associated with fracture of the greater tuberosity.
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We induced hemorrhagic shock in seven dogs and then resuscitated them with intravenous (IV) lactated ringers. We then monitored anterior leg compartment pressures via a slit catheter during both bleeding and reperfusion. These values were compared with controls that received IV fluids without being bled. ⋯ These values were statistically significant when compared to controls via the paired student t test (P < .01). This model demonstrates that sufficient swelling occurs to significantly elevate compartment pressures, even in the absence of local trauma. While this elevation may not be sufficient enough to cause a compartment syndrome, it reinforces the notion that extremities that have experienced ischemia and reperfusion are at an increased risk for developing compartment syndrome.
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This article reports the results using a previously described technique of obtaining iliac crest bone graft using an acetabular reamer in a consecutive series of patients with complex acute traumatic injuries and nonunions. A retrospective chart review was conducted on a cohort of 34 consecutive patients who underwent complex orthopedic procedures for the definitive management of acute or reconstructive problem fractures and nonunions using autogenous iliac crest bone graft. All of the patients had autogenous bone graft prepared using a low speed, high torque power source and small acetabular reamers. ⋯ No patients experienced morbidity from the graft harvest site. Specifically, no patients developed a superficial or deep wound hematoma or infection, nor did they experience persistent donor-site pain or paresthesias. Autogenous iliac crest bone graft harvest using the reaming technique provides a large volume of corticocancellous graft that has proven effective in treating complex acute nd reconstructive trauma cases.
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This article illustrates the posteromedial elbow approach to address both coronoid and olecranon ulnar fractures. Olecranon and coronoid fractures were simulated in 6 cadaveric elbows. The osteotomies were made with a percutaneously placed osteotome through the olecranon fossa and the elbow joint. ⋯ This technique allowed supine positioning of the cadaver and the use of an arm table for radiographic imaging in the lateral and anteroposterior planes. The direct visualization of both the coronoid and olecranon fracture facilitated anatomic reduction using standard surgical techniques. This technique also preserved the pronator attachment to the humerus, transposed the ulna nerve, and reapproximated the flexor carpi ulnaris fascia.
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While patient-controlled analgesia and intermittent intravenous opioids are primarily used for pain control, transdermal drug delivery is a possible adjuvant treatment.