Journal of surgical orthopaedic advances
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Although its use has fallen out of favor, the Halifax interlaminar clamp was used for many years to treat cervical instability through a posterior approach. Numerous complications, the majority of which are related to hardware failure, have been reported with the use of the interlaminar clamps and have led to the development of alternative techniques for posterior fusion, such as transarticular screw fixation. ⋯ To the authors' knowledge, this is the first case report of symmetric fractures through the posterior C1 ring lateral to the site of the Halifax clamps, resulting in recurrent atlantoaxial instability. This report focuses on the surgical management of this complication and provides a review of the literature that pertains to complications following the use of the Halifax clamp to treat atlantoaxial instability.
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Achilles tendon ruptures commonly affect middle-aged athletes and can result in considerable functional impairment. While the cause is multifactorial, the greatest risk is present for athletes involved in sports that involve sudden acceleration and deceleration. A thorough history and physical examination can accurately yield a diagnosis, but when question remains, magnetic resonance imaging is superior to ultrasound-guided evaluation. ⋯ Percutaneous methods of fixation have lower complication rates without an increase in the rate of rerupture when compared with open methods. Augmentation of an Achilles tendon repair has demonstrated no clinical benefit. Rehabilitation with early mobilization leads to improved patient-reported outcomes.
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Coccygodynia (pain in the region of the coccyx) has many causes, but it may be posttraumatic beginning after a fracture or contusion. Pain is typically triggered by or occurs while sitting. Nonsurgical management, including cushions, nonsteroidal anti-inflammatory drugs, and corticosteroid injections, can be successful in up to 85% of patients. ⋯ The average visual analog score was 3.4 cm. Four patients sustained a wound breakdown. The study concluded that for patients with conservative therapy-resistant coccygodynia, operative treatment with coccygectomy is a feasible management option.
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Comparative Study
Late postoperative infection following spinal instrumentation: stainless steel versus titanium implants.
Late postoperative infection following instrumented spinal surgery is a clinical entity that has emerged in recent years. The extended surface of the spinal instrumentation in combination with hematogenous seeding or intraoperative inoculation is the main predisposing factor. In order to investigate the contribution of the instrumentation material (stainless steel versus titanium implants) and mechanical loosening, two groups of patients are presented. ⋯ Common intraoperative findings were excessive inflammatory tissue and some degree of instrumentation loosening and corrosion (stainless steel). Removal of instrumentation in combination with appropriate antibiotics was an effective treatment. Further study with long-term follow-up is necessary in order to understand the exact incidence and pathology of such infections.
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Multicenter Study Comparative Study
The influence of arterial flow on capillary refill in pediatric lower extremity.
This study assesses the relationship between capillary refill time (CRT) and arterial blood flow (ABF) in the lower extremities of pediatric patients to determine if a correlation exists that would demonstrate CRT as an accurate means of monitoring tissue perfusion. The ABF and CRT were evaluated in 20 pediatric patients at four different pressures (0, (1/2) systolic blood pressure [SBP], SBP, and 1(1/2) SBP) using Doppler ultrasound and a stop-frame digital camera. ⋯ Thus, at significantly decreased rates of blood flow, a possible inverse relationship exist between ABF and CRT in the lower extremities of this pediatric population. However, the change in CRT correlating to the decrease in ABF is too small to be considered practically useful for clinically monitoring tissue perfusion.