The Orthopedic clinics of North America
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Orthop. Clin. North Am. · Apr 1996
ReviewClinical diagnosis of peripheral nerve compression in the upper extremity.
Compression neuropathies are common in clinical practice. This article is a review of the clinical features of the common entrapment neuropathies affecting the upper extremity. The frequently found entrapment syndromes are discussed in detail. Uncommon syndromes are also briefly discussed.
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A detailed review of the TJUH experience and the published literature on gunshot and stab wounds to the spine has been presented. The following statements are supported. (1) Military (high-velocity) gunshot wounds are distinct entities, and the management of these injuries cannot be carried over to civilian (low-velocity) handgun wounds. (2) Gunshot wounds with a resultant neurologic deficit are much more common than stab wounds and carry a worse prognosis. (3) Spinal infections are rare following a penetrating wound of the spine and a high index of suspicion is needed to detect them. (4) Extraspinal infections (septic complications) are much more common than spinal infections following a gunshot or stab wound to the spine. (5) Steroids are of no use in gunshot wounds to the spine. In fact, there was an increased incidence of spinal and extraspinal infections without a difference in neurologic outcome compared with those who did not receive steroids. (6) Spinal surgery is rarely indicated in the management of penetrating wounds of the spine. ⋯ These cases must be evaluated in an individual case-by-case manner. The neurologic outcomes of patients with incomplete neurologic deficits at TJUH who underwent acute spine surgery (usually for neural compression secondary to a bullet) were worse than the outcomes for the patients who did not have spine surgery. A selection bias against the patients undergoing spine surgery was likely present as these patients had evidence of ongoing neural compression. (3) A high index of suspicion is necessary to detect spinal and extraspinal infections. (4) Do not use glucorticoid steroids for gunshot wound victims. (5) Conservative (nonoperative) treatment with intravenous broad spectrum antibiotics and tetanus prophylaxis is the sole therapy indicated in the majority of patients who sustain a penetrating wound to the thoracic or lumbar spines.
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An overview of the individual with spinal cord injury caused by gunshot wounds is presented. In addition to the demographics of the group of patients, the cost estimates of care are discussed. The authors' experience in monitoring neurologic recovery and rehabilitation expectations and outcomes are also reported.
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Orthop. Clin. North Am. · Jan 1995
ReviewSurgical stabilization of humeral shaft fractures due to gunshot wounds.
Humeral shaft fractures resulting from gunshot wounds are challenging injuries to treat. The results of surgical stabilization depend upon the appropriate indication and operative techniques. Compression plating, intramedullary fixation, and external fixation are discussed.
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Compartment syndrome is a devastating consequence of extremity trauma that is preventable with early recognition and treatment. A high index of suspicion and careful clinical evaluation will detect most impending or established compartment syndromes. ⋯ The functional and cosmetic results of fasciotomy are always acceptable if done early. The results of inadequate treatment of compartment syndrome are never satisfactory.