The American journal of orthopedics
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Compartment syndromes of the upper arm are rare clinical entities but can be a serious problem, especially in unconscious patients or those presenting with altered mental status. A high index of suspicion is needed to make an accurate diagnosis. ⋯ Fasciotomy and débridement of necrotic and nonviable tissue are the treatments of choice for a patient with a compartment syndrome, but initiating medical management and providing medical stability for systemic complications resulting from a crush syndrome may be necessary prior to surgical intervention to prevent organ failure and death. Overall, prognosis is improved by early diagnosis and treatment.
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Hemophilia is an X-linked inherited bleeding disorder characterized by a deficiency of clotting factor VIII or IX in the intrinsic pathway of the coagulation cascade. This disease can have a profound, debilitating effect on the musculoskeletal system through recurrent hemarthroses and intermuscular hematomas. ⋯ Radioactive synovectomy performed at select hemophilia centers and arthroscopic or open synovectomy are helpful for chronic, active synovitis. Arthroplasty helps improve function and pain relief for most patients, but complication rates, particularly for infection, are higher than those for arthroplasty performed on patients without hemophilia.
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Vertebral fractures, particularly if they are nonsymptomatic, are old, and have not produced kyphotic deformity, should be treated with conservative care, including appropriate medical management. Those fractures that are symptomatic, produce pain that persists over several weeks (4 out of 10 on the visual analog score), and have resulted in some kyphotic deformity should be treated with a vertebroplasty or kyphoplasty. ⋯ Currently we treat all Colles' fractures, all hip fractures, and all tibia plateau fractures. The time has come to treat all symptomatic vertebral fractures.
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This article reviews the rationale, suggested benefits, and techniques of minimally invasive surgery (MIS) of the spine. While the efficacy and outcomes of open spinal decompression and fusion procedures have been validated in numerous longitudinal studies, these surgeries typically involve significant soft-tissue dissection and muscle retraction. MIS techniques aim to minimize iatrogenic damage to the soft tissues around the spine while allowing surgeons to perform effective decompression and fusion procedures. Here we summarize the rationale for the trend toward spinal MIS and highlight the more common procedures.
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Simultaneous bilateral total hip arthroplasty (THA) is an increasingly common procedure. Although use of a cementless stem can eliminate cement complications, some surgeons limit application of cementless THA because of concerns about early implant loosening. ⋯ Polyethylene wear rates (left, 0.154 mm/y; right, 0.114 mm/y) did not differ significantly. The excellent clinical results obtained with simultaneous bilateral cementless THA are comparable with those obtained with unilateral THA.