The Orthopedic clinics of North America
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A compartment syndrome is a symptom complex caused by elevated tissue pressure in a closed osseofascial compartment of a limb. Left unrecognized, it results in permanent damage to muscle and nerve in that compartment. ⋯ The pain is increased with passive stretching of the muscles in the involved compartment or on palpation of the involved muscles. Once the diagnosis is suspected, prompt treatment by appropriate fasciotomy should result in maintenance of normal limb function.
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Orthop. Clin. North Am. · Apr 1990
ReviewOperative treatment of fractures and dislocations of the hand and wrist region in children.
The indications for open treatment of skeletal injury of the pediatric hand and wrist region are limited, but failure to surgically treat these fractures and dislocations will cause later morbidity. Irreducible dislocations of the small joints of a child's hand require open reduction. ⋯ Irreducible Salter-Harris II fractures of the distal radius and unstable Galeazzi type fracture-dislocations of the distal radius in the older child should also be treated using open methods if a satisfactory closed reduction cannot be obtained. All treatment recommendations are based on limited case reports, and the surgeon treating such rare injuries should review the limited pertinent literature before beginning treatment of these rare injuries.
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Fractures of the ankle (distal tibia) that involve the physis or the articular surface are one of the more common injuries for which operative treatment is indicated in children. It should be considered if accurate reduction of the articular surface, the physis, or both cannot be achieved by closed means. Operative treatment often will be required in Salter-Harris type III and IV fractures, juvenile Tillaux, and triplane fractures.
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When a Monteggia fracture is recognized and treated immediately, the results are excellent. Poor results are mostly caused by initially missing the diagnosis. Operative intervention is usually required for those fractures that are unstable after manipulation or recognized too late after injury.
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Arthroscopic debridement is a valuable alternative procedure in the management of osteoarthritis of the knee joint. Although palliative in nature, in many instances it yields permanent relief in the low-demand knee of the elderly. ⋯ Sclerotic lesions, synovitis, loose bodies, osteophytes, chondromalacia, and degenerative tears of menisci are encountered often in various combinations and must be addressed judiciously and completely. The procedure simplifies rehabilitation, and the risk/benefit ratio is very favorable.