The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 1991
Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus.
Twelve patients, ranging in age from thirty-four to seventy-two years (average, fifty-three years), were evaluated an average of five years (range, two to eight years) after open reduction and internal fixation of a two-part displaced fracture of the greater tuberosity of the proximal part of the humerus. The indication for operative reduction was one centimeter or more of displacement of the fracture as seen on the diagnostic radiographs. The anterosuperior deltoid-splitting approach, combined with rotation of the humerus, allowed adequate exposure of the retracted tuberosity. ⋯ All fractures healed without postoperative displacement. Six patients had an excellent result and six had a good result; active elevation averaged 170 degrees. There was one partial, transient palsy of the axillary nerve.
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J Bone Joint Surg Am · Apr 1991
Case ReportsUpper-airway obstruction after multilevel cervical corpectomy for myelopathy.
We reviewed the cases of seven patients who had had obstruction of the upper airway immediately after an anterior procedure on the cervical spine and had required reintubation. All patients had had moderate or severe myelopathy preoperatively (average, 3.6 on the Nurick scale), and all had had a multilevel anterior cervical corpectomy for decompression followed by arthrodesis. The early compromise of the upper airway was believed to be due to edema rather than to the formation of a hematoma. ⋯ Risk factors common to these patients included moderate or severe myelopathy and multilevel corpectomy. Six patients had a history of heavy smoking and one, of asthma. We believe that extra caution should be used in the postoperative management of the airways when multilevel corpectomy is performed in patients who have these pre-existing conditions.
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J Bone Joint Surg Am · Apr 1991
Randomized Controlled Trial Comparative Study Clinical TrialPrevention of deep-vein thrombosis and pulmonary embolism after total hip replacement. Comparison of low-molecular-weight heparin and unfractionated heparin.
In a prospective, randomized, double-blind study, the efficacy and safety of a low-molecular-weight heparin were compared with those of unfractionated sodium heparin (standard heparin) in 136 patients who had elective total hip replacement. The patients received subcutaneous injection of either 5000 international units of low-molecular-weight heparin once daily or 5000 international units of standard heparin three times a day. Treatment with low-molecular-weight heparin began twelve hours before the operation, and treatment with standard heparin began two hours preoperatively; both regimens were continued for ten days. ⋯ Total loss of blood and the total amount of blood that was transfused were significantly reduced in the patients who received low-molecular-weight heparin compared with those who received standard heparin. Prophylaxis was not discontinued because of hemorrhage in any patient. The efficacy of low-molecular-weight heparin was superior to that of standard heparin in the prevention of femoral thrombosis and pulmonary embolism, although the over-all incidence of deep-vein thrombosis was not statistically different.(ABSTRACT TRUNCATED AT 400 WORDS)