The Orthopedic clinics of North America
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Traumatic dislocations and subluxations of the upper extremity in children have been surveyed. The elbow joint is most commonly dislocated and is dislocated more frequently in children than in adults. ⋯ Most of these injuries are the result of predictable indirect forces. Principles of reduction and immobilization are based on the unique anatomic structure of the joint involved and the known anatomic disruption resulting from the trauma.
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Pyogenic vertebral osteomyelitis is a disease of adults that should be distinguished from true disk space infection. It is due to a hematogenous seeding (either venous or arterial) of the subchondral bony elements of the vertebral body. The disk space is involved secondarly, later in the course of the disease. ⋯ Soft tissue abscesses may require open débridement and drainage. Treatment of both types consists of rest, immobilization, and specific antibiotic treatment. The prognosis for resolution of the infectious process within six to nine months, with adequate treatment, is excellent.
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A study of the bacteriologic environment of the conventional operating rooms in the hospitals used by the Mayo Clinic orthopedic surgical section revealed several areas of potential contamination of the surgical wound. Such areas included the back table and the unsterile suction receptacle. Use of an impermeable hood with a large mask diminished contamination of the instruments and the wound originating in direct fallout from members of the surgical team. ⋯ The level of airborne bacterial contamination in the operating room can be reduced by limiting the traffic and controlling the activity and the number of operating room personnel. Although none of these factors could be directly related to operative wound sepsis in any of our studies, their potential was obvious. They can be controlled by the methods we have described.