The Orthopedic clinics of North America
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This article reviews the general principles that apply to the radiographic evaluation of acute injury of the cervical and thoracolumbar spine and discusses the possible use of various imaging techniques.
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Computed tomography defines the anatomy and pathology of the talus, the calcaneus, and intervening joints better than conventional modalities. It enhances the understanding and diagnosis of the various musculoskeletal disorders affecting those structures. As a result, the clinical and surgical management is improved.
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Fractures of the hand should be managed so as to achieve accurate and stable reduction and the resumption of active motion in the early phase of fracture healing. Methods are discussed for reducing and retarding edema, which expedites healing. The incidence of complications can be reduced by a carefully supervised therapy program consisting of range of motion exercises, splinting, and functional activities.
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Orthop. Clin. North Am. · Jul 1983
Comparative StudyChemonucleolysis in the treatment of lumbar disc disease.
In a follow-up study of a large group of patients who had been treated by chemonucleolysis, of those patients who had definite neurologic change in the form of reflex, sensory, or motor disturbance, 74 per cent had reverted to normalcy by the time of evaluation one year after injection. The most significant complication (anaphylaxis) was found in 1 per cent of our first 500 patients, but after we started using preoperative steroids along with other safeguards, we were able to control this complication. It is still something to be constantly on guard against. ⋯ Studies in our laboratory again confirm beyond a doubt that, in the dog, injection of very large amount of chymopapain in the epidural space of the lumbar spine has no effect on the subarachnoid contents, the dura, or the spinal nerves as they lie outside the dura and exit through the intervertebral foramina. The rare patient in whom there is a direct communication between the disc space and the subarachnoid space can be detected as the contrast medium is injected. If, by chance, chymopapain were inadvertently injected intrathecally, the maximum dose of that would be injected at any one level, 8 mg, would be well within the tolerable range in the human being.