The American journal of orthopedics
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Intraosseous (IO) catheters have been used for vascular access in trauma and critically ill patients with increasing frequency in emergency departments and critical care units across the United States. Their use has long been accepted as a reliable method of obtaining vascular access in pediatric patients with difficult intravascular access. Articles about the complications of using IO catheters are scarce. ⋯ In a literature search, we identified 5,759 patients treated with IO catheters. The overall complication rate was 2.1%. In this article, we discuss the literature on IO catheter complications and report 2 cases of orthopedic management of IO catheter complications.
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Review Case Reports
Complicated acromioclavicular joint cyst with massive rotator cuff tear.
An acromioclavicular (AC) joint cyst is an unusual presentation of full-thickness rotator cuff tears in patients with degenerative changes of the AC joint. It is important to understand the relationship between AC joint cysts and rotator cuff tears because there is a high recurrence rate if the cyst is treated without addressing the rotator cuff tear. ⋯ We present 2 cases involving an infected AC joint cyst with a massive rotator cuff tear caused by simple cyst excision. When patients have an AC joint cyst, physicians should consider the following points: (1) There is the possibility of an underlying rotator cuff tear, (2) Surgical treatment is indicated for a symptomatic cyst, (3) Aspiration and simple cyst excision are not recommended, because of the potential for postoperative complications such as recurrence, a draining sinus, and infection, and (4) Lateral clavicle resection should be performed if there is an irreparable rotator cuff tear.
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Review Case Reports
Treatment of postoperative infection after posterior spinal fusion and instrumentation in a patient with neuromuscular scoliosis.
According to the literature, patients with neuromuscular scoliosis have a higher rate of infection after spinal fusion. No randomized controlled trials have been completed to assess the optimal treatment and related outcomes for patients with infections after posterior spinal fusion. In this article, we examine the data and report a case in which a vacuum-assisted closure (VAC) device was used as definitive treatment for a deep wound infection after posterior spinal fusion and instrumentation in a patient with neuromuscular scoliosis. ⋯ The wound VAC was used for more than 2 months, until skin closure was complete. The deep polymicrobial wound infection was treated successfully and definitively with a wound VAC. This case report suggests that good long-term outcomes can be achieved with use of a wound VAC for definitive closure, with possible avoidance of other secondary surgeries requiring skin grafts or flaps for wound closure.
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Controversy exists among the orthopedic community regarding the treatment of gunshot injuries. No consistent treatment algorithm exists for treatment of low energy gunshot wound (GSW) trauma. The purpose of this study was to critically examine the wound contamination following low velocity GSW based upon bullet caliber and clothing fiber type found within the injury track. ⋯ Low velocity GSWs result in significant contamination regardless of bullet caliber and jacket type. Based upon our results further investigation of low velocity GSW tracks is warranted. Further clinical investigation should focus on the degree to which debridement should be undertaken.
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Review Case Reports
Symptomatic hip impingement due to exostosis associated with supra-acetabular pelvic external fixator pin.
Expedient stabilization of unstable pelvic fractures has been shown to significantly reduce morbidity and mortality in the polytrauma patient. Application of a pelvic external fixator is one of the methods used to provide effective pelvic stability. However, pelvic external fixators are not without drawbacks. ⋯ To our knowledge this is the first description of hip impingement due to reactive bone formation secondary to a supra-acetabular pelvic external fixation pin. The impinging bone was completely excised utilizing the anterior approach to the hip. A 40° improvement in the patient's hip flexion range of motion was noted after exostosis excision.