The Orthopedic clinics of North America
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Scapulothoracic dissociation is rare, resulting from high-energy trauma to the shoulder girdle and disruption of the scapulothoracic articulation. The associated musculoskeletal, vascular, and neurologic injuries carry potentially devastating outcomes. ⋯ However, given the wide spectrum of injury in scapulothoracic dissociation and limited data concerning outcomes, general recommendations regarding the management of this injury have been difficult to discern. This article reviews the current data regarding the evaluation, diagnosis, treatment, and outcomes after scapulothoracic dissociation.
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Orthop. Clin. North Am. · Nov 2012
Hip resurfacing is less painful at 24 hours than hip replacement.
This article quantifies pain differences in the immediate postoperative period between patients undergoing total hip arthroplasty (THA) and metal-on-metal hip resurfacing (MoMHR). Patients less than 65 years old indicated for either a primary MoMHR or THA were screened for consent. ⋯ The MoMHR cohort experienced a significantly shorter length of stay than the THA cohort. MoMHR shows a significantly lower pain level at 24 hours than THA and a significantly earlier discharge.
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During pregnancy, hormonal fluctuations, fluid shifts, and musculoskeletal changes predispose women to carpal tunnel syndrome. While the clinical presentation is similar to other patients, the history obtained must include information regarding the pregnancy itself. ⋯ Given that symptoms often improve with conservative treatment and abate after delivery, EMG/NCV testing can often be avoided. However, if symptoms are severe or persist, carpal tunnel release is indicated and is considered a safe procedure for both mother and fetus.
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Orthop. Clin. North Am. · Jan 2012
Review Comparative StudyPosterior surgery for cervical myelopathy: indications, techniques, and outcomes.
This article details the controversies associated with the different treatment strategies in patients with cervical spondylotic myelopathy. The natural history, incidence, pathophysiology, physical examination, and imaging findings are discussed followed by the indications, techniques, and outcomes of patients treated with posterior cervical decompression via decompressive laminectomy, laminectomy and instrumented fusion, and laminoplasty.
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Principles of revision cervical spine surgery are based on adequate decompression of neural elements and mechanical stability via appropriate selection of surgical approach and constructs producing long-term stability with arthrodesis. When planning revision surgery, the surgeon must consider the cause of the underlying problem (eg, biological, mechanical), the potential for complications, and clinical outcomes that can reasonably be expected. This information should be clearly explained to the patient during the informed consent process. This article provides the spine care provider with an understanding of how to appropriately evaluate and manage the most common cervical conditions that require revision cervical spine surgery.