Acta Orthop Belg
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The results of the treatment of 36 patients with posttraumatic reflex sympathetic dystrophy of the upper extremity with regional intravenous blocks of methylprednisolone and lidocaine are presented. The extremity is exsanguinated and a tourniquet is applied. A solution of methylprednisolone, lidocaine and heparin is injected. ⋯ Physiotherapy was applied in all patients (program of finger exercises, whirlpool therapy). Complications in 2 cases were transient superficial thrombophlebitis of the forearm; in 2 other patients the block was interrupted because of severe pain in the limb. We found this method simple, easy to perform, safe and inexpensive; the results are comparable to other established methods of the treatment i.e. sympathetic blocks or calcitonin.
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The treatment of supracondylar fractures of the femur with an intramedullary nail presents some theoretical advantages. Compared to plate osteosynthesis, intramedullary fixation requires less extensive dissection and is biomechanically more favorable. In the elderly patient, these characteristics seem important since bone quality, extensive procedures and bone grafting remain problematic. ⋯ When previous hip or knee surgery precludes the use of antegrade nailing techniques or when the fracture extends into the intercondylar region, retrograde supracondylar nailing offers some advantages compared to conservative treatment or plate osteosynthesis. On the other hand in young patients, anatomic reduction and alignment should be the goal, and open reduction with plate osteosynthesis, supplemented by bone grafting if needed, should remain the gold standard. When this seems technically impossible, the antegrade or retrograde insertion of an intramedullary nail with intraoperative assessment of length and fracture alignment is an interesting alternative.
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The indications for conservative and surgical management of fractures of the thoracolumbar spine are reviewed, based upon the morphology of the lesions, which is assessed by meticulous analysis of radiographs, CT scan and in some cases MRI. The author advocates using the AO classification, which considers several subtypes of fractures: compression fractures, distraction fractures and fractures with multidirectional displacement. The indication for treatment is based upon morphological analysis of the lesions, while other factors such as the general condition of the patient or the locally available surgical environment must also be taken into consideration. Up to 50% of thoracolumbar fractures can benefit from surgical management, with posterior or anterior stabilisation, the latter performed through thorascoscopy in selected cases.