Musculoskeletal surgery
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Musculoskeletal surgery · Dec 2013
ReviewPractical management of new oral anticoagulants after total hip or total knee arthroplasty.
Within the past 5 years, the oral anticoagulants rivaroxaban, apixaban, and dabigatran etexilate have been approved for the prevention of venous thromboembolism in adult patients after elective hip or knee arthroplasty in the European Union and many other countries worldwide. These agents differ from the previously available anticoagulants because they selectively and directly inhibit a single factor in the coagulation cascade-rivaroxaban and apixaban inhibit Factor Xa, and dabigatran inhibits Factor IIa (thrombin)-potentially enhancing the predictability of their anticoagulant effect. Currently, although some guidelines provide recommendations for the use of rivaroxaban, dabigatran etexilate, and apixaban in clinical practice, there are still questions regarding the optimal practical management of patients receiving these agents. This article briefly reviews the practical limitations associated with conventional anticoagulants, discusses potential issues with the practical management of the newer oral anticoagulants, and provides clinical experience from a single institution where rivaroxaban and dabigatran etexilate have been used within their approved indications.
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Musculoskeletal surgery · Dec 2013
Surgical treatment for pelvic ring fractures in pediatric and adolescence age.
Fractures of the pelvis in pediatric population are extremely rare. Children with complex pelvic fractures are most often pedestrians who have been struck by a motor vehicle. Head injuries are the main cause of death, unlike the adult, where severe hemorrhages are common and contribute to mortality. Long-term follow-up studies have reported significant residual morbidity in children's pelvic fractures treated non-operatively. The aim of this study is to analyze our cases in order to evaluate the final outcome and to suggest the surgical indications for the management of this kind of injuries. ⋯ Fractures of the pelvic ring should be carefully assessed by radiographs and CT scan. The centralization of these young patients is important to get the experience and ensure the proper treatment. A correct indication for surgery may prevent or limit the consequences of these complex fractures.