Instructional course lectures
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The symptoms associated with lumbar spinal stenosis can decrease quality of life and may cause patients to seek treatment. Except in rare cases of rapid neurologic progression or cauda equina syndrome, nonsurgical modalities should be the initial treatment choice. Activity modification, a variety of medications, epidural steroid injections, and other methods are recommended for pain reduction. ⋯ Arthrodesis, either with or without instrumentation, is also indicated in some patients. Several studies report that surgical treatment produces better outcomes than nonsurgical treatment in the short term; however, the results tend to deteriorate with time. Lumbar decompressive surgery can be complicated by epidural hematoma, deep venous thrombosis, dural tear, infection, nerve root injury, and recurrence of symptoms.
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Unstable pelvic ring injuries in hemodynamically unstable patients are life-threatening emergencies that many orthopaedic surgeons encounter in practice. Therefore, it is important to be up to date regarding current methods of evaluating, assessing, and treating patients with these complex and severe injuries. Surgeons should first determine whether patients have hemodynamic instability and identify the source of the hemorrhage. Patients should then be assessed for stabilization of unstable pelvic ring injuries.
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One of the primary goals in the perioperative care of orthopaedic patients undergoing surgery is the avoidance of allogeneic transfusion. There are a number of ways to lessen blood loss during surgical intervention including regional hypotensive anesthesia, careful and atraumatic surgical technique, and coagulation of bleeding surfaces. ⋯ The use of perioperative recombinant erythropoietin is also a useful adjunct to promote stimulation of the bone marrow and increased red cell production. Although many infectious diseases that are transmitted through allogeneic blood transfusions have been lessened by better screening techniques, there is still potential life threatening reactions and viral transmissions that may be avoided by comprehensive blood management in joint arthroplasty.
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Posterior pelvic ring injuries disrupt the weight-bearing function of the pelvis and cause deformity that results in pain and loss of function. The indications for reduction and fixation are the presence of instability and/or deformity. ⋯ Although techniques exist for both open and closed reductions, the main dfficulty remains achieving anatomic restoration of the pelvis. Whether posterior pelvic ring injuries are best treated using closed reduction and fixation or open reduction and fixation remains a controversial topic.
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Abnormal posttraumatic pain may delay recovery and severely impact health-related quality of life. The term complex regional pain syndrome describes abnormally intense and prolonged pain that is not related to tissue damage and is sometimes a sequela of injury. Various treatment strategies, including therapy, parental interventions, and peripheral surgery, are used to manage the condition.