The Iowa orthopaedic journal
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Review
Blood management and patient specific transfusion options in total joint replacement surgery.
Strategies for blood management in the perioperative period of total joint replacement are changing with the better understanding of blood loss and blood replacement options in this population. The preoperative, intraoperative and postoperative options for blood management are outlined. Rationale for patient specific options are described.
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Fifteen patients with thoracolumbar and lumbar spine injuries were treated between November, 1993, and April, 1996, using a posterior approach that involved short segment distal fixation at or one level below the level of injury. Medical records and radiographs were reviewed for complications, maintenance of correction, repeat surgeries and functional status. Indications for this technique included fractures and ligamentous injuries that did not require direct canal decompression and were without severe comminution. ⋯ There were no mechanical complications at the distal end of the fixation. Three patients returned to relatively normal preinjury status, five suffered partial disability, six suffered full disability and one was lost to follow-up. From our review of this relatively small group of patients, short segment fixation distally for selected thoracolumbar and lumbar injuries appears to be a reasonable option.
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A retrospective study of all patients (N = 343) with pelvic fractures admitted to our trauma service was conducted to evaluate the impact of pelvic fractures on mortality. All patients sustained additional injuries with an average Injury Severity Score (ISS) of twenty. Thirty-six patients died. ⋯ This greater than four-fold increase in deaths in the elderly appears to be an age related effect because the elderly patients generally had a lower ISS and less severe pelvic trauma than younger patients. We conclude that sustaining a pelvic fracture places the patient at an increased risk of death. Pelvic fractures contributed directly to death in one-third of the mortalities, one-third died from complications associated with pelvic fractures, and one-third died from other causes.
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We have treated four cases of previously quiescent osteomyelitis which presented as septic arthritis in an adjacent joint. The osteomyelitic focus was in the bone proximal to the involved joints (zero to ten centimeters above the joint line). ⋯ Aggressive surgical debridement of both bone and joint, followed by a prolonged course of antibiotics led to resolution in all patients. A high index of suspicion combined with adequate radiographs of the surrounding bones should lead to the appropriate diagnosis and treatment.