Journal of surgical orthopaedic advances
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Case Reports
Use of a Fascial Flap to Stabilize an Unstable Ulnar Nerve in Its Bed During In Situ Decompression.
This case report involves a man with ulnar neuropathy at the elbow, who was to undergo an in situ decompression of the ulnar nerve. When the nerve was noted intraoperatively to sublux partially over the posterior portion of the medial epicondyle, the surgeon stabilized the nerve in situ by using a fascial flap that was secured to the anterior rim of the cubital tunnel and loosely sutured posteriorly to the medial side of the olecranon, rather than performing an anterior transposition or medial epicondylectomy. This method could be considered a middle-ground surgical technique because it allowed the nerve to remain in its bed, did not disturb its blood supply, dealt with the problem of a slightly unstable ulnar nerve with a fascial flap, and avoided methods that could be considered as having greater surgical magnitude.
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Factors associated with successful selection in U. S. Army orthopaedic surgical programs are unreported. ⋯ PDs made no discriminations based on allopathic or osteopathic degrees. The most important factors for Army orthopaedic surgery residency selection were clerkship performance at the individual PD's institution and licensing examination score performance. Army PDs consider both USMLE and COMLEX results, because Army programs have a higher percentage of successful osteopathic applicants.
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Insufficient control of pain after total hip arthroplasty (THA) can delay rehabilitation and adversely affect long-term surgical outcomes. The current study directly compares 36 THA patients who were given a routine wound infiltration (RWI group) with 36 patients who were administered an injection of liposomal bupivacaine infiltration (LBUP group). ⋯ The average number of opioid doses was 13.14 for the RWI group compared with 4.97 for the LBUP group (p < .0001), and the total opioid dosage consumed was greater in the RWI group (105.4 vs. 72.3, p = .0075; significant only in regression model). The results of this study support the conclusion that liposomal bupivacaine infiltration, as part of a multimodal program after THA, can improve postoperative analgesia and reduce opioid consumption when compared with routine wound infiltration.
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There is a known bleeding risk with administration of the antiplatelet drug clopidogrel, but in certain patients the likelihood of thrombosis is too high to cease its administration perioperatively. The risks of performing total joint arthroplasty in this population are unknown. An inpatient pharmacy database query identified seven patients who underwent eight hip or knee arthroplasties from 2007 to 2009 without perioperative interruption in clopidogrel administration. ⋯ The majority of bleeding-related events occurred following knee arthroplasty. Uninterrupted perioperative clopidogrel administration was associated with a high risk of bleeding-related events following total joint arthroplasty, particularly of the knee. Consideration should be given to delaying total joint arthroplasty until clopidogrel can safely be held in the perioperative period.
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This case study reviews the pathophysiology of scapholunate advanced collapse (SLAC), which is the most common etiology of degenerative arthritis in the wrist. The scapholunate ligament serves a critical role in stability of the carpus. Disruption of the scapholunate ligament, its sequela, and the magnetic resonance imaging evaluation are discussed, with review of the defining features of this disease and its progression.