Orthopedics
-
Review
'Clearing' cervical spine injuries in polytrauma patients: is it really safe to remove the collar?
Polytrauma patients are at increased risk for occult cervical spine injuries. Those unable to provide clinical clues to injury either remain in hard collars until they are able to cooperate with the physical examination or are deemed "clear of cervical injury" if the emergency room screening radiographs are without obvious bony abnormality. ⋯ Missed ligamentous injuries can lead to cervical instability, which in turn can result in permanent neurologic sequelae. This article reviews the current methodologies to "clear the cervical spine" and highlights the inadequacies.
-
This article reviews some of the anatomic and mechanical aspects of thoracolumbar injuries as they relate to classification systems and stability. In addition, an overview of the initial management including surgical and conservative treatment options is provided.
-
In addition to consultation with an experienced hematologist, the following are recommendations regarding compartment syndrome in a patient with an inherited bleeding disorder. Von Willebrand's Disease. Humate-P (rich in von Willebrand factor) is the replacement therapy of choice for surgical procedures in patients with von Willebrand's disease. ⋯ Then while waiting for closure, the loops can be gradually tightened at the bedside. Definitive closure should be attempted around the fifth postoperative day. All closure techniques should be pre
-
Six cadavers were used to define the projection of the external iliac artery on the inner table of the acetabulum, and to quantitatively determine bony dimensions of the danger zone with regard to screw placement. The results showed that the majority of projections of the external iliac arteries were located on the superior portion of the posterosuperior quadrant and extended to the mid-superior portion of the anterosuperior quadrant (danger zone). The inferior portion of the danger zone was relatively far from the external iliac artery. ⋯ This anatomic study showed that the real danger zone was found in the middle and superior portions of the anterosuperior quadrant of the acetabulum. The inferior portion of the anterosuperior quadrant was relatively safer. This area may be considered if transacetabular screw replacement in the anterosuperior quadrant is required.
-
Acute anterior shoulder dislocations are extremely painful conditions that force patients to present to emergency rooms or physicians' offices immediately. The diagnosis usually is established through a careful history and examination, and may be confirmed by appropriate radiography. The immediate treatment objective is to achieve reduction as early as possible, preferably through a closed reduction method with the least discomfort. ⋯ In addition, the technique eliminates failing factors of current reduction methods such as the surgeons' weakening or slippery grip when using traction methods. It is expected, by virtue of the method, that it would reduce the chances for complications such as humeral shaft fractures as can occur in leverage maneuvers. This method addresses all potential anatomical and pathological features of acute anterior dislocations of the shoulder to facilitate an earlier and more comfortable reduction.