The Orthopedic clinics of North America
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A midshaft femoral fracture in a high-energy trauma victim should prompt the orthopedist to search carefully for an ipsilateral fracture of the femoral neck. This fracture will be present in 5 per cent of patients, and the incidence may be increasing. ⋯ Successful methods of management of the femoral shaft fracture have included compression plating, retrograde Kuntscher nailing, and interlocking nails. Approaches to the treatment of concomitant intertrochanteric and femoral shaft fractures should be selected according to the skill and experience of the surgeon and the availability of equipment.
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The complications of knee dislocations may be disastrous and must be anticipated. In most series, a 25 to 30 per cent incidence of arterial damage is reported. If the artery is not repaired, the incidence of amputation can be up to 72.5 per cent. ⋯ After all problems affecting limb survival are solved, open repair of all ligamentous injuries is recommended to provide ligamentous stability and congruity of the joint. Prior to performing the procedure, a surgeon must have a thorough knowledge of the anatomy of the knee. Rehabilitation techniques and early postoperative motion are important for guiding the injured patient through the immediate and late postoperative period.
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What are the essential elements of office automation that can be directly applied to the practice of orthopedics? New technology, when implemented into a planned, logical system, can increase practice efficiency and productivity.
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In summary, the clinical goal in regional anesthesia for hand surgery is to constantly approach the ideal of a well-conducted, smooth, "balanced regional technique." This begins with the preoperative interview, assurance, and preoperative sedation (po). In the operating room, monitoring (EKG, BP) and safety measures (IV port, nasal oxygen) precede the regional technique. The block is performed with asepsis, minimal "needling," and correct dosages. ⋯ Monitoring is continued in the recovery room, where special attention is given to positioning, cushioning of pressure areas, dressing, analgesia, and specific physical rehabilitation exercises. With a "balanced regional technique," the patient becomes an early participant in his or her own postoperative care and result. This balanced technique reduces the patient's overall operative risk and maximizes the surgical result.
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For almost two decades, great strides have been made in improving the early care of trauma patients both at the trauma scene and in the hospital. Highly skilled providers in the field rapidly extricate, stabilize, and transport patients to trauma centers. In those centers, teams of clinicians can quickly resuscitate, evaluate, and treat life-threatening conditions. These improvements should lead to an increase in survival and functional capacity of all trauma victims, including those with cervical spine injury.