J Am Acad Orthop Sur
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The complex history of treating traumatic injury in Western warfare consistently included issues such as proximity to surgical care, the organization of medical systems, and the progressive development of technologies and procedures used to treat military service members who are injured in battle. Significant advances have been made in each of these areas, as evidenced in the changes in medical care in conflicts involving US forces. These advances include, among others, organized attempts to improve sanitation; panels of surgeons to assess optimal surgical approaches; the introduction of triage, wound débridement, and delayed wound closure; the development of chemotherapeutics and antibiotics; and increasingly more timely treatment. Perhaps the least recognized historical contribution to military medical care, however, is the compiled medical statistic, which informs bold research and response.
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J Am Acad Orthop Sur · Dec 2005
ReviewThe use of ultrasound in evaluating orthopaedic trauma patients.
Musculoskeletal ultrasound is a low-cost, noninvasive method of evaluating orthopaedic trauma patients. It is particularly useful for patients with metallic hardware, which may degrade computed tomography or magnetic resonance images. Ultrasound has been used to evaluate fracture union and nonunion, infection, ligamentous injury, nerve compression, and mechanical impingement caused by hardware. Real-time dynamic examination allows identification of pathology and provides direct correlation between symptoms and the observed pathology.
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J Am Acad Orthop Sur · Nov 2005
ReviewAcute compartment syndrome in lower extremity musculoskeletal trauma.
Acute compartment syndrome is a potentially devastating condition in which the pressure within an osseofascial compartment rises to a level that decreases the perfusion gradient across tissue capillary beds, leading to cellular anoxia, muscle ischemia, and death. A variety of injuries and medical conditions may initiate acute compartment syndrome, including fractures, contusions, bleeding disorders, burns, trauma, postischemic swelling, and gunshot wounds. Diagnosis is primarily clinical, supplemented by compartment pressure measurements. ⋯ On diagnosis of impending or true compartment syndrome, immediate measures must be taken. Complete fasciotomy of all compartments involved is required to reliably normalize compartment pressures and restore perfusion to the affected tissues. Recognizing compartment syndromes requires having and maintaining a high index of suspicion, performing serial examinations in patients at risk, and carefully documenting changes over time.
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Distal radius fractures are common injuries that can be treated by a variety of methods. Restoration of the distal radius anatomy within established guidelines yields the best short- and long-term results. Guidelines for acceptable reduction are (1) radial shortening < 5 mm, (2) radial inclination > 15 degrees , (3) sagittal tilt on lateral projection between 15 degrees dorsal tilt and 20 degrees volar tilt, (4) intra-articular step-off < 2 mm of the radiocarpal joint, and (5) articular incongruity < 2 mm of the sigmoid notch of the distal radius. ⋯ Buttress plates reduce and stabilize vertical shear intra-articular fractures through an antiglide effect, where-as conventional and locking plates address metaphyseal comminution and/or preserve articular congruity/reduction. With conventional and locking plates, intra-articular fractures are directly reduced; with buttress plates, the plate itself helps reduce the intra-articular fracture. Complications associated with plating include tendon irritation or rupture and the need for plate removal.
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Typically, patients with failed internal fixation of a hip fracture have marked pain and disability. These patients may present treatment challenges. Salvage is tailored to the anatomic site of the nonunion, the quality of the remaining bone and articular surface, and patient factors such as age and activity level. ⋯ For conversion to arthroplasty, the major challenges are assessing the need for acetabular resurfacing, selecting the femoral implant, and managing the greater trochanter. Technical challenges include broken hardware, deformity, and femoral bone defects. Attention to technical details can minimize potential complications.