The Iowa orthopaedic journal
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Many types of projectiles, including modern hollow point bullets, fragment into smaller pieces upon impact, particularly when striking bone. This study was performed to examine the effect on time to union with retained bullet material near a fracture site in cases of gunshot injury. ⋯ Level III.
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Lower extremity injuries secondary to low-energy gunshot wounds are frequently seen in the civilian populations of urban areas. Although these wounds have fewer complications than high-energy gunshot injuries, the functional and psychological damage is still significant making appropriate timely orthopaedic treatment and follow-up imperative. ⋯ Gunshot injuries to the extremities may involve bone, soft tissue, and neurovascular structures. Execution of appropriate therapeutic methods in such situations is critical for treating surgeons given the potential for complications. At our level one trauma center, gunshot victims were predominantly young, uninsured adult men. Complications included infection, compartment syndrome, and arterial injuries. Functional data collected demonstrated that patients continued to have difficulties with ADL's at long-term follow-up.
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Comparative Study
Impact of Age, Gender and Anesthesia Modality on Post-Operative Pain in Total Knee Arthroplasty Patients.
Optimizing pain control following total knee arthroplasty is of utmost importance to the immediate post-operative course. Various anesthesia modalities are available, but studies comparing multiple anesthesia modalities, patient age, and sex are limited. ⋯ Level III, Therapeutic Study, (Retrospective Comparative study).
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Comparative Study
Expedited Operative Care of Hip Fractures Results in Significantly Lower Cost of Treatment.
There are an estimated 150,000 hip fractures per year in the United States, with estimated costs of care between $10.3 billion and $15.2 billion. With such high costs and an increasing burden of care, there has been interest in newer methods to increase efficiency of care. One such method is expedited fracture care, with earlier operative intervention. The purpose of this study was to determine if intervention within six hours of admission decreased costs with no change in the rate of major complications. ⋯ Level IV, therapeutic case series.
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Chronic Regional Pain Syndrome type I (CRPSI) in children is a disorder of unknown etiology. No standard diagnostic criteria or treatment exists. Published treatment protocols are often time and resource intensive. Nonetheless, CRPSI is not rare and can be disabling. This reports the results of a simple and inexpensive treatment protocol involving no medicines, nerve blockades, physical therapy resources or referrals to pain specialists. The patient is instructed in a self-administered massage and mobilization program. The diagnosis required allodynia (pain on light touch of the skin) and signs or the history of signs of autonomic dysfunction. ⋯ Therapeutic Level IV.