The American journal of orthopedics
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We conducted this study to evaluate the hypothesis that the need for a higher level of care is the most important reason for the transfer of patients with hand trauma to a level I trauma center. We prospectively assessed 53 patients transferred to our level I trauma center for evaluation of an acute hand injury. ⋯ On the basis of injury severity, we judged that 40 of the 53 patients required the immediate care of a hand surgeon but that only 13 required the resources of a level I trauma center. Most of the patients were transferred without prior evaluation by a hand surgeon, despite there being an on-staff surgeon at many of the hospitals.
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Pulmonary embolism (PE) is a potentially fatal complication of total joint arthroplasty. Therefore, it is essential to have reliable means for diagnosis and evaluation of severity. In the study reported here, we evaluated the reliability of common clinical signs and symptoms in the diagnosis of PE. ⋯ Overall, clinical signs and symptoms as well as severity of hypoxia did not correlate with size and location of PE. Patients with PE demonstrated a significant decrease in arterial oxygen content; an abnormal alveolar-arterial gradient was the most consistent finding in these patients. Common clinical signs and symptoms, as well as changes in vital signs, have a low sensitivity for diagnosis.
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Continuous peripheral nerve catheters (CPNCs) have become increasingly popular for postoperative analgesia in orthopedic surgery involving the lower limbs. The CPNC technique has been found to reduce postoperative pain and facilitate earlier discharge and recovery. Until recently, potential infectious complications associated with CPNCs have remained largely unreported. In this report, we present the case of a posterior thigh abscess that developed after placement of a continuous popliteal nerve catheter and required surgical débridement.
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Compartment syndrome is a potentially devastating entity, and timely recognition is critical for appropriate management. Diagnosis is classically a clinical one and based largely on serial examinations. When clinical examinations are compromised, compartment pressure monitoring may be useful. ⋯ These reports illustrate a previously unreported at-risk population and demonstrate that compartment syndrome can recur in a previously released compartment. Therefore, prior fasciotomy should not be considered protective against acute compartment syndrome. These patients should be evaluated and managed no differently from patients with primary compartment syndrome.
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A Morel-Lavallée lesion is a relatively rare condition involving a closed, degloving injury to the pelvis, resulting in a blood-filled cystic cavity created by separation of the subcutaneous tissue from the underlying fascia. This injury typically occurs following high-speed trauma. We describe a case that occurred in a professional American football player who was treated with percutaneous decompression and evacuation of the hematoma. The player returned to playing football at the professional level 22 days after the injury without residual deformity or disability.