Orthopedics
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Despite advances in pain management, little formal teaching is given to practitioners and nurses in its use for postoperative orthopedic patients. The goal of our study was to determine the educational needs for orthopedic pain management of our residents, nurses, and physical therapists using a quantitative and qualitative assessment. The needs analysis was conducted in a 10-bed orthopedic unit at a teaching hospital and included a survey given to 20 orthopedic residents, 9 nurses, and 6 physical therapists, followed by focus groups addressing barriers to pain control and knowledge of pain management. ⋯ This needs assessment showed that orthopedic residents and nurses receive little formal education on pain management, despite having to address pain on a daily basis. This information will be used to develop an educational program to improve pain management for postoperative orthopedic patients. An integrated educational program with orthopedic residents, nurses, and physical therapists would promote understanding of issues for each discipline.
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Sacral tumors are rare. Appropriate surgical resection is crucial to treat the disease while minimizing disease recurrence. We present the results of 93 patients with sacral tumors to analyze the long-term functional and oncological results of patients undergoing en bloc resection. ⋯ After follow-up, we did not find that sacrificed nerve roots and surgical margins have an impact on the recurrence of the tumor. Patients undergoing intralesional curettage lost more blood than those patients with wide excision. Postoperative bladder/bowel dysfunction was more severe for patients with removal of S1 and S2.
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Eight men with Andersson lesions associated with ankylosing spondylitis who underwent surgical treatment were reviewed for this study. Eight Andersson lesions were found in the 8 patients, and all presented as pseudoarthrosis. Including a patient with obvious vertebral body destruction, no obvious local kyphosis was observed. ⋯ Based on these results, surgical treatment with only posterior instrumentation supplemented by posterolateral autograft was effective for patients with Andersson lesions without obvious vertebral body destruction requiring reconstruction. Anterior lesion curettage and bone graft were not necessary. Solid immobilization, achieved by posterior instrumentation, should be the focus of the treatment of Andersson lesions with ankylosing spondylitis.