The Orthopedic clinics of North America
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Orthop. Clin. North Am. · Oct 1998
ReviewThe use of diagnostic imaging to assess spinal arthrodesis.
Despite advances in surgical techniques and internal fixation devices, pseudarthrosis remains a significant factor in the clinical failure of attempted fusions in the cervical, thoracic, and lumbar spine. This article reviews the use of diagnostic imaging in the assessment of spinal fusion, with a focus on the accuracy of different imaging modalities based on surgical exploration. A cost-effective strategy for the radiographic follow-up of patients after spinal fusion surgery also is presented.
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The application of external fixation for acute treatment of unstable pelvic fractures can be a lifesaving procedure; however, it must be coordinated with other efforts of the trauma team. The patient with a pelvic fracture must be adequately resuscitated and carefully evaluated. ⋯ A proper evaluation enables classification of the pelvic injury and appropriate selection of patients that require acute pelvic external fixation. In this article, both open and percutaneous techniques for pin placement and fixator frame configurations are discussed.
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Orthop. Clin. North Am. · Jul 1997
ReviewAssessment and management of pelvic fracture in the hemodynamically unstable patient.
Hypotensive patients with pelvic ring injuries present a diagnostic and therapeutic challenge. This article reviews pelvic anatomy, the classification of pelvic injuries, and how to rapidly identify patients' unstable pelvic injuries. Current recommendations for the evaluation and treatment of these patients are reviewed.
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Orthop. Clin. North Am. · Jul 1997
Multicenter StudyOpen pelvic fractures. A multicenter retrospective analysis.
A marked discrepancy exists in the reported mortality rates in patients with open pelvic fractures, ranging from 4.8% to 50%. A retrospective review of patients with open pelvic fractures was performed at three centers. Thirty-nine patients with open pelvic fractures were identified; the average age was 32. ⋯ Delay in performing diverting colostomy correlated with a poor outcome. Previously described methods of treatment are still valid; however, there is a need for re-emphasis of early diverting colostomy in the patient with a rectal or perineal injury. A classification system for open pelvic fractures is proposed in this article.
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The radial nerve is frequently more involved in entrapment syndromes than the ulnar and median nerves. Common sites of compression are the juncture of the middle and distal third of the arm (especially with fractures of the humerus), just distal to the elbow (radial tunnel), and proximal to the wrist between the brachioradialis and extensor carpi radialis longus. ⋯ Radial tunnel syndrome is rare, but decompression when indicated, can provide relief. Radial sensory nerve entrapment in the forearm (distal third) does occur, but patients often respond to temporary thumb spica splinting.