The Iowa orthopaedic journal
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The purpose of this study was to compare the results of adjusted-dose heparin (ADH) in the prevention of thromboembolism in knee replacement with those obtained for its use hip fracture surgery and elective hip replacement. Ultrasound was used to diagnose deep vein thrombosis (DVT) and ventilation/perfusion (V/Q) scan to diagnose pulmonary embolus (PE). Analysis of 438 operations was available. ⋯ Complications of heparin occurred in 4.6% of patients. Our ADH protocol was equally effective in prophylaxis against thromboembolism in knee replacement, hip fracture surgery and elective hip replacement. Direct comparison with other methods should not be done because ultrasound was used to screen for DVT.
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Giant cell tumor is an aggressive benign neoplasm of bone. A number of adjuvant agents have been used to supplement intralesional curettage to reduce the otherwise high local recurrence rate. High concentration ethanol is more readily available and less toxic to use than some common alternatives. ⋯ Multiple washes with high concentration ethanol, when used in conjunction with aggressive curettage including high-speed burring, is an effective and safe adjuvant. The necessity of any chemical adjuvant after appropriately aggressive curettage and burring can only be definitively demonstrated with a prospective, randomized, multi-center trial. Until such evidence becomes available, the use of adjuvant ethanol offers a compromise between higher toxicity adjuvants and no chemical adjuvant at all.
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Outpatient pain rehabilitation programs that include an interdisciplinary approach have been shown to be effective treatments for patients with chronic pain. The objectives of this article are to describe the common interdisciplinary pain rehabilitation programs available, the appropriate indications for use, the components of typical pain rehabilitation programs, the short-term and long-term success rates, the costs of attending these programs, and the significant societal costs of those patients who do not complete these programs and do not return to work.
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In Caucasians, the range of normal intracompartmental pressure of the leg is from 0 mmHg to 15 mmHg. In the literature, such measurements have not been done in Africa to identify normal leg intracompartmental pressures. We have sought to identify the normal range of pressures in such a population of Nigerians, and to demonstrate the reproducibility of the Whitesides injection technique with materials that are easily available in most hospitals so that compartment syndromes could be identified promptly and inexpensively in developing countries. ⋯ The pressure in the deep posterior compartment ranged from 3 mmHg to 14 mmHg with mean of 7.4 +/- 2.7 mmHg. The values are similar to those reported in the literature. There was no statistically significant difference between the pressures in the two compartments (p = 0.668).
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The orthopedic surgery literature is replete with techniques for managing primary humeral shaft nonunions, with success rates upwards of 90 percent with plate fixation and autogenous bone grafting. Despite this success, persistent nonunion following one or more initial failed nonunion interventions can occur, imposing a significant clinical and surgical challenge. ⋯ Six of seven patients were clinically satisfied with the outcome of surgery; one remained dissatisfied secondary to a chronic neuropathic pain syndrome. Although more complex surgical options such as Ilizarov external fixation and allograft cortical strut augmentation have been reported, and are available in the salvage situation of refractory humeral nonunions, we conclude strict application of basic nonunion principles can result in successful salvage of humerus nonunions in patients who have failed two or more prior surgical interventions.