Orthopedics
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The stress response, which is triggered by a number of factors, including surgery, results in activation of the hypothalamic pituitary adrenal axis and subsequent release of cortisol from the adrenal glands. Critical illness-related corticosteroid insufficiency is an inadequate corticosteroid response relative to a patient's illness; patients with critical illness-related corticosteroid insufficiency have both insufficient circulating cortisol and impaired cellular use of glucocorticoids. Corticosteroids, such as hydrocortisone, have been cited to improve survival, oxygenation, duration of mechanical ventilation, and intensive care unit-free days in critically ill patients. Perioperative glucocorticoid supplementation is also recommended in patients with secondary adrenal insufficiency due to chronic corticosteroid use.
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Damage from spinal cord injury (SCI) may be complicated by concomitant hemodynamic alterations within hours to months of the initial insult. Neurogenic shock, symptomatic bradycardia, autonomic dysreflexia, and orthostatic hypotension are specific conditions occurring commonly with SCI. Early recognition and appropriate management of each disorder may minimize secondary injury to the cord, avert systemic complications, and help alleviate patient discomfort.
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The Emperion femoral component (Smith & Nephew, Memphis, Tenn) is a modern incarnation of the S-ROM femoral component (Depuy, Warsaw, Ind). This fit-and-fill modular design has had great clinical success for more than 20 years. ⋯ The modularity can uniquely weather difficult proximal femoral deformities encountered during THR, including developmental dysplasia of the hip and slipped capital femoral epiphysis. In addition, the nomenclature attached to this implant has made using the device and its instruments user friendly.
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Skeletal osteochondromas or osteocartilaginous exostoses represent the most common of all benign bone tumors and 10% to 15% of all bone tumors. Osteochondromas are solitary or multiple, pedunculated or sessile exophytic outgrowths from the bone surface that are composed of cortical and medullary bone with an overlying hyaline cartilage cap. ⋯ After adolescence and skeletal maturity, osteochondromas usually exhibit no further growth. In adults, growth or imaging alterations of an osteochondroma suggest the rare diagnosis of malignant transformation; however, extensive growth of osteochondromas without histological evidence of malignancy has been reported