The American journal of orthopedics
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Pharmacologic thromboprophylaxis with low-molecular-weight heparins, vitamin K antagonists, or fondaparinux is well tolerated and effective in preventing venous thromboembolism (VTE) in major orthopedic surgery but is often limited to in-hospital use. However, 45% to 80% of all symptomatic VTE events occur after hospital discharge. Extended-duration VTE prophylaxis for 28 to 35 days reduces risk for late VTE by up to 70%. In this article, I review the evidence supporting guideline recommendations regarding extended-duration prophylaxis after major orthopedic surgery and provide an overview of current and emerging literature regarding prevention of postoperative VTE in patients undergoing this surgery.
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Odontoid fractures are the most common cervical spine fractures for patients older than 70 years and are the most common of all spinal fractures for patients older than 80. Type II fracture, the most common type of odontoid fracture, is considered relatively unstable. It occurs at the base of the odontoid between the level of the transverse ligament and the C2 vertebral body. ⋯ Halo vest immobilization in the elderly is associated with a significant nonunion rate and several complications. Generally accepted surgical indications are polytrauma, neurologic deficit, associated unstable subaxial spine injury that requires surgical fixation, and symptomatic nonunion. Surgical management includes either anterior odontoid screw fixation or posterior C1-C2 instrumentation with fusion.
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Use of peripheral nerve blocks (PNBs) during lower extremity surgery has evolved. In this article, we review the pertinent anatomy and the literature concerning the advantages and disadvantages of both PNBs and traditional methods of postoperative analgesia (neuraxial and patient-controlled) for total hip arthroplasty and total knee arthroplasty. We conclude that use of PNBs for total hip and total knee arthroplasty compares favorably with traditional methods of postoperative analgesia. As use of PNBs becomes more widespread, understanding their risks and benefits will be of great value to orthopedic surgeons.
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Multicenter Study Clinical Trial
Clinical outcomes of lumbar degenerative disc disease treated with posterior lumbar interbody fusion allograft spacer: a prospective, multicenter trial with 2-year follow-up.
The clinical benefits and complications of posterior lumbar interbody fusion (PLIF) have been studied over the past 60 years. In recent years, spine surgeons have had the option of treating low back pain caused by degenerative disc disease using PLIF with machined allograft spacers and posterior pedicle fixation. The purpose of this clinical series was to assess the clinical benefits of using a machined PLIF allograft spacer and posterior pedicle fixation to treat degenerative disc disease, both in terms of fusion rates and patient outcomes, and to compare these results with those in previous studies using autograft and metal interbody fusion devices. ⋯ The graft-related complication rate among all patients who underwent PLIF was 1.61%. When performed with machined allograft spacers and posterior pedicle fixation, PLIF is a safe and effective surgical treatment for low back pain caused by degenerative disc disease. The patients in this clinical series had outcomes equal or superior to the outcomes in previous series.
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Randomized Controlled Trial
Acute operative stabilization versus nonoperative management of clavicle fractures.
We conducted a prospective, randomized study to determine if patients with midshaft clavicle fractures would benefit from immediate operative stabilization with a modified Hagie pin in comparison with a matched group treated with nonoperative therapy. At a level II trauma center, patients with closed midshaft clavicle fractures were prospectively randomized to receive either operative or nonoperative treatment. Fifty-seven (29 operative, 28 nonoperative) patients were enrolled in the study. ⋯ Complications were higher in the operative group, and most were related to pin prominence at the posterior shoulder. Results of this study suggest that, though patients with midshaft clavicle fractures had higher functional scores at short-term follow-up after internal fixation, functional scores were similar at 6 months and 1 year. In addition, internal fixation with a modified Hagie pin was associated with a higher complication rate.