The American journal of orthopedics
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Intraspinal narcotic analgesia (INA) has been used for chronic pain from nonmalignant causes with moderate success. To ascertain the efficacy of the morphine pump, we reviewed the 2-year results of continuous INA in 18 patients with failed back syndrome or arachnoiditis and intractable, debilitating pain that was unrelieved by conventional means. All patients underwent a trial screening of single-dose intrathecal narcotics with good pain relief. ⋯ Our patients averaged 1.4 additional procedures or hospitalizations after initial pump insertion. Overall, only 4 patients had objective evidence of benefit from INA, for a success rate of 25%. Results of this review suggest INA should not be used for the long-term management of chronic pain from nonmalignant causes.
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Review Case Reports
Traumatic hip dislocation during childhood. A case report and review of the literature.
Traumatic hip dislocations rarely occur during childhood. Males sustain pediatric hip dislocations four times more often than do females. ⋯ Potential associated injuries include fractures and neurovascular injury, whereas avascular necrosis (AVN) and degenerative joint disease are potential sequelae. Optimal treatment should be prompt reduction of the hip in order to minimize the risk of AVN of the femoral head.
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The use of a very proximal insertion site for rigid intramedullary nailing was evaluated in a biomechanical study. The purpose of this study was to compare the bursting strains generated in a proximal tibia fracture fragment during rigid nailing, using the recommended insertion sites versus a more proximal site just anterior to the tibial plateau in the midline. Proximal one-third tibia fractures were created in 12 pairs of fresh cadaver specimens. ⋯ In the Lottes group, much larger bursting strains were generated in the lateral cortex when using a distal starting point (P < 0.05). In the unreamed Russell-Taylor group, the anteromedial surface strains were significantly increased using a distal starting point (P < 0.05). The Grosse-Kempf group showed no significant difference in strains associated with any insertion point during tibial intramedullary nailing.
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Isolated acute compartment syndrome of the hand is relatively rare phenomenon, Acute compartment syndrome occurs when the tissue pressure within an enclosed space is elevated to the extent that there is decreased blood flow within the space, decreasing tissue oxygenation and impairing metabolic function. In this review, compartment syndrome of the forearm and wrist involving the hand will not be included because the clinical presentation of these patients can be quite different compared with compartment syndrome within the hand.
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Case Reports
Perioperative complications in patients with sickle cell disease. An orthopedic perspective.
Osteonecrosis of the femoral head has been reported to occur in 19% to 31% of patients with sickle cell disease, with the condition often being bilateral. Current surgical options for these patients include various forms of arthrodesis, resection arthroplasty, osteotomy, and uncemented hip arthroplasty. Poor surgical outcome, coupled with frequent perioperative medical complications, makes the treatment of these patients very challenging. A case report of a 33-year-old black woman with a 21-year history of sickle cell disease who underwent hip arthroplasty and developed sickle chest syndrome is presented.