The American journal of orthopedics
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Dissection and measurements of the first 2 sacral nerve roots with regard to the commonly used entrance points for S1 and S2 pedicle screw placement were performed to determine the location of the first 2 sacral nerve roots in relation to the pedicle screw entrance points in the upper 2 sacral vertebrae. The sacral nerve roots, dural sac, and pedicles were exposed after laminectomy. The mean distance from the reference point to the adjacent nerve roots superiorly and inferiorly at the S2 pedicle level was smaller than those at the S1 pedicle level. ⋯ Pedicle screw placement in the first 2 sacral vertebral pedicles has been recommended for lumbosacral fusion and internal fixation of sacral fractures. No anatomic study is available regarding the location of the sacral nerve roots relative to the entrance points of sacral pedicle screw placement. Violation of the sacral canal and foramina by a sacral pedicle screw may injure the sacral nerve roots, especially at the level of the S2 pedicle.
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Selective spinal injections are being performed with increasing frequency in the management of acute and chronic pain syndromes. Because these procedures require a needle to be placed in or around the spine, there is always a risk of complications. ⋯ Physician training and patient preparation and monitoring are required to maximize the safety and efficacy of the specific spinal procedures. This focused review article discusses the primary general and specific complications of spinal injection procedures as well as treatments.
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We evaluated the use of Kocher's original method (without humeral traction) for reduction of acute anterior glenohumeral dislocation in 28 alpine skiers and snowboarders at a single ski area during the 1995-1996 ski season. In all cases, reduction was begun within 1 hour of the acute injury. ⋯ Only 1 patient experienced discomfort significant enough to require analgesia, and no patients required sedation. The complication rate was minimal, with 1 patient developing hyperesthesia in the axillary nerve distribution; no fractures of the humerus or glenoid resulted from the reduction technique.
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Review Comparative Study
Pediatric analgesia and sedation for the management of orthopedic conditions.
Orthopedic injuries are common in the emergency department; this is especially true in children. The orthopedist must often supervise sedation and analgesia for the injured child. ⋯ The purpose of this review is to outline a reasonable approach to sedation and analgesia in the pediatric patient. In addition, current monitoring guidelines are reviewed, as well as the basic pharmacology of the most commonly used drugs.
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Comparative Study
Contributing factors influencing the functional outcome of floating knee injuries.
The purpose of the present study was to retrospectively review the floating knee injuries treated at our institute and to determine various factors, such as severity of soft-tissue or skeletal injuries, site of fractures, and treatment methods that may significantly influence the final functional result in these injuries. Between 1986 and 1996, 65 patients with 66 floating knee injuries were treated in our institution. Among 66 fractures of the femur, 19 (29%) were open. ⋯ The satisfactory rate in closed, grade I+II, and grade III injuries of the femoral fractures was 53.2%, 81.8%, and 25%, respectively (grade I+II vs. grade III: P < .03). There were no significant correlations between the functional result and the following factors: soft-tissue injuries of the tibia; the fracture pattern of both fractures; the combination of open/closed injuries in each fracture; injury severity score; the existence of neurovascular injuries and double femoral fractures; treatment methods; and operation timing. Severity of damage to the knee joint and open injuries in the thigh were found to be significant factors contributing to the functional outcome in floating knee injuries.