Orthopedics
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Orthopedists who use prophylaxis for deep vein thrombosis (DVT) in total joint arthroplasty are often called on to care for trauma patients. Much less is known or published about the effects of such prophylaxis in the trauma patient than in the arthroplasty patient. The questions to ask are: what is the incidence of DVT in trauma patients; what are the benefits of DVT prophylaxis; and what are the risks of DVT prophylaxis, and do the risks outweigh the benefits?
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This article reviews the available literature on the surgical options for the correction of kyphosis in ankylosing spondylitis and presents the radiologic appearance of the post-operative spine. In the postsurgical evaluation of the spine, the focus is on appreciation of the patterns of correction, early and late determination of angular correction, recognition of various complications (infection, nonunion, improper location, or breakage of hardware), and alertness to the possibility of complications at all levels of the spine.
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Review Clinical Trial Controlled Clinical Trial
The use of ketorolac in the management of postoperative pain.
Ketorolac tromethamine (Toradol) is a nonsteroidal antiinflammatory drug (NSAID) available in intramuscular (IM) and oral formulations for the management of acute pain. Intramuscular ketorolac is the only parenteral NSAID available for analgesic use in the US. The clinical profile is reviewed, and clinical studies most applicable to a postoperative patient are discussed in detail. ⋯ In this single-dose study, 176 patients received either 10 mg of oral ketorolac, 5 mg or 10 mg of IM morphine, or placebo after orthopedic surgery. The analgesic efficacy of ketorolac was comparable to both doses of morphine and significantly superior to placebo. Ketorolac, when administered intramuscularly or orally, is a safe and effective analgesic agent for the short-term management of acute postoperative pain and can be used as an alternative to opioid therapy.