Orthopedics
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Review Clinical Trial Controlled Clinical Trial
The use of ketorolac in the management of postoperative pain.
Ketorolac tromethamine (Toradol) is a nonsteroidal antiinflammatory drug (NSAID) available in intramuscular (IM) and oral formulations for the management of acute pain. Intramuscular ketorolac is the only parenteral NSAID available for analgesic use in the US. The clinical profile is reviewed, and clinical studies most applicable to a postoperative patient are discussed in detail. ⋯ In this single-dose study, 176 patients received either 10 mg of oral ketorolac, 5 mg or 10 mg of IM morphine, or placebo after orthopedic surgery. The analgesic efficacy of ketorolac was comparable to both doses of morphine and significantly superior to placebo. Ketorolac, when administered intramuscularly or orally, is a safe and effective analgesic agent for the short-term management of acute postoperative pain and can be used as an alternative to opioid therapy.
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Ankle arthroscopy has rapidly become an important diagnostic and therapeutic procedure. Currently, indications for operative arthroscopy include transchondral talar dome fractures, acute articular fractures with hemarthrosis, posttraumatic synovitis, loose bodies, inflammatory synovitis, degenerative joint disease, and soft tissue impingement. Diagnostic arthroscopy is indicated for the patient with a chronically painful, symptomatic ankle when nonoperative treatment has failed and other measures have failed to produce a diagnosis. ⋯ The use of lasers in arthroscopy has yet to be clearly defined. The small size of the laser is an advantage in the ankle, but cost remains a disadvantage. Advances in technique and equipment will continue to expand the indications for this procedure.
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Femur fractures in the pediatric population are common injuries which may be either isolated or associated with polytrauma. The orthopedist is faced with treatment options ranging from skin traction to more aggressive methods, including internal or external fixation. We review the pros and cons of current treatment options. A simple treatment algorithm based on age of the patient, other associated injuries, and open vs closed injury is presented.
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Several areas of controversy still exist when discussing the treatment of burst fractures in the thoracolumbar and lumbar regions of the spine. This article addresses the role of anterior stabilization with instrumentation in these regions. Pertinent clinical and biomechanical data will be reviewed so that readers will be able to identify the relative indications and contraindications for this procedure.