Orthopedics
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Spinal hematoma is a rare and potentially catastrophic complication of spinal or epidural anesthesia. Risk factors include traumatic needle/catheter placement, sustained anticoagulation in an indwelling neuraxial catheter, and catheter removal during therapeutic levels of anticoagulation. ⋯ Signs of cord compression, such as severe back pain, progression of numbness or weakness, and bowel and bladder dysfunction, warrant immediate radiographic evaluation. A delay in diagnosis and intervention of spinal hematoma may lead to irreversible cord ischemia.
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Deep vein thrombosis and pulmonary embolism are major causes of morbidity and mortality after knee and hip arthroplasty in the United States. Although patients frequently receive prophylaxis for thromboembolism postarthroplasty, surgeons vary in their choice of modality and often use suboptimal strategies due to the possibility of provoking postoperative bleeding. ⋯ Supporting medical evidence for these recommendations is described. A summary of current prophylactic regimens and discussion of duration of therapy are also presented.
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In a study of 41 supracondylar-intercondylar femur fractures treated with open reduction and plate fixation, 15 patients requested plate removal due to lateral knee pain over the hardware. A refracture of the distal femur occurred within 10 weeks of hardware removal in 4 (27%) of 15 patients. All refractures occurred during normal functional activities. Patients who request hardware removal following union of a distal femur fracture treated with open reduction and plating should be informed of the possibility of refracture.