The Orthopedic clinics of North America
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Morel-Lavallée lesions are closed degloving injuries sustained during violent soft tissue shear that separate the subdermal fat from its strong underlying fascia. Lesions most often occur in the peritrochanteric region, and patients may have concomitant polytrauma. As a result, a hematoma develops that has a high rate of acute bacterial colonization and chronic recurrence. ⋯ However, diagnosis is often delayed or missed. Furthermore, there is no universally accepted treatment algorithm. Diagnosis and treatment depend on a surgeon's thorough understanding of the cause, pathophysiology, imaging characteristics, and treatment options of Morel-Lavallée lesions.
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In the surgical management of solid tumors, adequacy of tumor resection has implications for local recurrence and survival. The standard method of intraoperative identification of tumor margin is frozen section pathologic analysis, which is time-consuming with potential for sampling error. Intraoperative tumor visualization has the potential to significantly improve surgical cancer care across disciplines, by guiding accuracy of biopsies, increasing adequacy of resections, directing adjuvant therapy, and even providing diagnostic information. We provide an outline of various methods of intraoperative tumor visualization developed to aid in the real-time assessment of tumor extent and adequacy of resection.
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Marked blood loss during lower extremity total joint arthroplasties may lead to higher rates of transfusion, which may negatively affect surgical outcomes and yield greater complication rates. It is therefore ideal to identify factors that may increase the likelihood of blood loss, so they can be modified. From this review, it can be concluded that preoperative anemia, older age, multiple comorbidities, increased operative time, and use of postoperative anticoagulation may lead to higher blood loss and transfusion rates, although the influence of other factors remains controversial.
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Orthop. Clin. North Am. · Oct 2015
ReviewPercutaneous Sacroiliac Screw Fixation of the Posterior Pelvic Ring.
Percutaneous sacroiliac (SI) screw fixation is indicated for unstable posterior pelvic ring injuries, sacral fractures, and SI joint dislocations. This article provides a review of indications and contraindications, preoperative planning, imaging techniques and relevant anatomy, surgical technique, complications and their management, and outcomes after SI screw insertion.
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Orthop. Clin. North Am. · Oct 2015
ReviewTraumatic Knee Dislocations: Evaluation, Management, and Surgical Treatment.
Knee dislocations are catastrophic injuries that demand emergent evaluation and often require a multidisciplinary approach. Long-term outcome studies are relatively scarce secondary to the variability in any given study population and the wide variety of injury patterns between knee dislocations. Multiple controversies exist with regard to outcomes using various treatment methods (early vs late intervention, graft selection, repair vs reconstruction of medial and lateral structures, rehabilitation regimens). Careful clinical evaluation is essential when knee dislocation is suspected.