Journal of surgical orthopaedic advances
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The USNS Mercy, one of the two hospital ships in the United States Navy, has provided disaster relief and humanitarian assistance for multiple natural disasters around the world. As a self-sustaining 1000-bed hospital, the USNS Mercy provides a full complement of surgical and medical capabilities to care for the sick and injured in a mobile platform environment. This article describes the recent missions of the USNS Mercy, highlighting the capabilities and humanitarian mission goals.
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Care of the combat casualty with spinal column or spinal cord injury has not been previously described, particularly in regards to spinal immobilization. The ultimate goal of spinal immobilization in the combat casualty is to first ``do no further harm'' and then provide a stable, painless spine and an optimal neurologic recovery. ⋯ Selective prehospital spine immobilization, which involves spinal immobilization with backboard, semi-rigid cervical collar, lateral supports, and straps or tape, is recommended if there is suspicion of spinal column or spinal cord injury in the combat casualty and when conditions and resources permit. The authors do not recommend spinal immobilization for the combat casualty with isolated penetrating trauma.
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Litigation involving Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndrome (CRPS), because of its complexities, is often difficult to prove or defend. In our review of 56 verdicts and settlements in the state of Florida, in cases involving a diagnosis or misdiagnosis of RSD or CRPS, over half resulted in a substantial verdict or settlement for the plaintiff.
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Clinical Trial
Functional outcome and complications using the intramedullary hip screw for intertrochanteric fractures.
We prospectively studied 110 consecutive patients with intertrochanteric hip fractures treated with the 130 degree angle, 10-mm short IMHS intramedullary hip screw (IMHS, Smith & Nephew, Richards, Memphis, TN). Surgery was performed within 36 hours from admission; all patients were mobilized immediately postoperatively. Fracture union, pre- and post-operative mobility status and complications were evaluated. ⋯ Periprosthetic femoral shaft fractures were not observed. At the latest examination, the mean mobility score decreased from 8.4 +/- 1.6 to 7.1 +/- 2.1 (p = 0.0001); 26 patients (32%) fully achieved the preoperative mobility score and 54 patients (68%) achieved more than 90% of the preoperative mobility score. The IMHS intramedullary hip screw represents a reliable method for the treatment of patients with intertrochanteric hip fractures, and provides for early mobilization and rehabilitation of the patients with acceptable complications.
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There is a significant need for orthopaedic care in developing countries. For the past 10 years, the United States Army has supported annual orthopaedic hand surgery humanitarian missions to Honduras. The goal of this article is to compare the premission planning to the realities of mission execution to provide a template for future missions. ⋯ A total of 58 surgeries were performed using innovative methods to stretch available supplies. A multidisciplinary and multination concerted effort is required for a successful humanitarian medical mission. A premission plan is critical prior to arrival and a contingency plan must be in place for missing mission-critical items.