J Am Acad Orthop Sur
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J Am Acad Orthop Sur · Jan 2012
ReviewVariations in sacral morphology and implications for iliosacral screw fixation.
Posterior pelvic percutaneous fixation following either closed or open reduction is a popular procedure. Knowledge of the posterior pelvic anatomy, its variations, and related imaging is critical to performing reproducibly safe surgery. ⋯ Other characteristics include the presence of mammillary bodies (ie, underdeveloped transverse processes) at the sacral mid-alar area, anterior upper sacral foramina that are not circular, residual upper sacral disks, an acute alar slope oriented from cranial-posterior-central to caudal-anterior-lateral on the outlet and lateral views of the sacrum, a tongue-in-groove sacroiliac joint surface visualized on CT, and cortical indentation of the anterior ala on the inlet radiographic view. The surgeon must be knowledgeable about individual patient anatomy to ensure safe iliosacral screw placement.
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Immediately after the January 2010 earthquake in Haiti, many private citizens, governmental and nongovernmental organizations, and medical associations struggled to mount an effective humanitarian aid response. The experiences of these groups have led to changes at their institutions regarding disaster preparedness and response to future events. ⋯ In Haiti, minimal capacity to deliver such care existed before the earthquake, making subsequent transition difficult. If successful, several initiatives proposed to improve disaster response and increase surgical capacity in Haiti could be deployed to other low- and middle-income countries.
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J Am Acad Orthop Sur · Jan 2012
The role of pain management in recovery following trauma and orthopaedic surgery.
War often serves as a catalyst for medical innovation and progressive change. The current conflicts are no exception, particularly in the area of pain management of wounded warriors. Morphine administration has served as the primary method of battlefield pain management since the American Civil War. ⋯ These side effects (eg, sedation, nausea and vomiting, ileus, respiratory depression) can be fatal to persons wounded in combat. This fact, along with recent research findings indicating that pain itself may constitute a disease process, points to the need for significant improvements in pain management in order to adequately address current battlefield realities. The US Army Pain Management Task Force evaluated pain medicine practices at 28 military and civilian institutions and provided several recommendations to enhance pain management in wounded warriors.
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J Am Acad Orthop Sur · Jan 2012
ReviewBrachial plexus blocks for upper extremity orthopaedic surgery.
Regional anesthesia of the upper extremity has several clinical applications and is reported to have several advantages over general anesthesia for orthopaedic surgery. These advantages, such as improved postoperative pain, decreased postoperative opioid administration, and reduced recovery time, have led to widespread acceptance of a variety of regional nerve blocks. ⋯ Other brachial plexus nerve blocks used for orthopaedic surgery of the upper extremity are supraclavicular, infraclavicular, and axillary. Several practical and theoretical aspects of regional nerve blocks must be considered to optimize the beneficial effects and minimize the risk of complications.
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J Am Acad Orthop Sur · Jan 2012
Factors associated with mortality in combat-related pelvic fractures.
Pelvic fractures were sustained by ≥26% of service members who died during Operation Enduring Freedom and Operation Iraqi Freedom in 2008. To determine factors associated with patient mortality following combat-related pelvic fracture (CRPF), the Joint Theater Trauma Registry database was searched to identify service members who survived CRPF sustained in the year 2008 (group 1), and the Armed Forces Medical Examiner System was searched to identify nonsurvivors of such trauma in the same year (group 2). ⋯ Compared with a similar cohort of nonsurvivors, persons who survive CRPF have less severe pelvic fractures and associated injuries. In addition, pelvic fractures secondary to direct combat (ie, blast-related blunt injury, penetrating injury) were significantly more lethal than were those caused by mechanisms analogous to civilian trauma.