The American journal of orthopedics
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The mainstays for pain relief after total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been the opioids, but these medications, though excellent analgesics, have problems limiting their effectiveness. Alternative analgesics have been considered too mild for the pain caused by THA and TKA. These medications have been used in combination, but only in pairs and not in a "stacked modality." Here we report a trial of around-the-clock acetaminophen, rofecoxib, tramadol, and dexamethasone combined with bupivicaine pain pumps and on-demand opioid use (patient-controlled analgesia with morphine). ⋯ In addition, there was a trend in improved pain scores for the PP group with THA. Minor adverse events were similar for the groups, but major medical complications were fewer in the PP group. Preemptive analgesia with multiple non-narcotic medications used in a stacked modality can significantly reduce postoperative pain.
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This study reviews spinal cord abnormalities found in children initially referred for an orthopedic problem. Over a 5-year period in an academic pediatric orthopedic referral clinic, 167 children aged 3 months to 18 years (average, 9.4 years) underwent spine magnetic resonance imaging (MRI) scans and had records available for review. The patients were divided into 7 major groups based on the primary indication for the MRI. ⋯ Spine MRI was not very helpful in evaluating children who had some degree of back pain without neurological signs or symptoms. However, the spine MRI was helpful in evaluating children with atypical idiopathic scoliosis or congenital scoliosis, gait abnormality, limb pain or weakness, or rigid or recurrent foot deformities. Given the high frequency of occult spinal cord abnormality in children with severe foot deformity, the use of screening spine MRI may be especially useful in this group.
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Review Case Reports
Luxatio erecta (inferior dislocation of the shoulder): a report of 5 cases and a review of the literature.
Luxatio erecta (inferior dislocation of the glenohumeral joint) is an unusual type of shoulder dislocation. The authors present 5 new cases of luxatio erecta. All cases were hyperabduction injuries. ⋯ One suffered axillary nerve injuries. No vascular injuries were noted in our series. The mechanism of the injury is discussed.
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A lack of information exists regarding predisposing factors to peroneus brevis tendon (PBT) tears. In 30 human cadaveric specimens, the location of the musculotendinous junction (MTJ) with respect to the fibula tip and peroneal tubercle was measured, as well as the tendon width. ⋯ The data suggest that longitudinal location of the peroneus brevis MTJ may have an influence on the development of degenerative tears. This feature might be an important clinical risk factor for the development of PBT tears and warrants further clinical investigation.
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Case Reports
Compartment syndrome after acute rupture of the peroneus longus in a high school football player: a case report.
We report the case of a young athlete who sustained an inversion injury to his ankle and presented several hours later with leg pain out of proportion to the injury. Pressure measurements suggested a lateral compartment syndrome and he underwent an emergency fasciotomy. ⋯ Expedient release by emergent fasciotomy can minimize the likelihood of serious consequences such as myonecrosis and ischemic contracture. Most commonly, compartment syndrome is the result of acute high-energy trauma and typically is managed by the orthopedic traumatologist.