Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · Aug 1994
Prevention of deep vein thrombosis and pulmonary embolism in acetabular and pelvic fracture surgery.
In a prospective nonrandomized study, a protocol was examined for prophylaxis of deep venous thrombosis and pulmonary embolism in patients with operative treatment of acetabular and pelvic fractures. There were 197 patients in the study with 203 fractures, including 148 acetabular and 55 pelvic fractures. There were 2 cases of bilateral acetabular fractures and 4 cases with both acetabular and pelvic fractures. ⋯ There were 6 cases of postoperative deep venous thrombosis and 2 cases of pulmonary embolism. The incidence of postoperative venous thrombosis and pulmonary embolism was 3% and 1%, respectively. The protocol was found to be effective for preoperative detection of venous thrombosis and prevention of deep venous thrombosis and pulmonary embolism in trauma patients with minimal bleeding complications and no morbidity from embolic disease.
-
Between 1972 and 1993, 1899 patients with fractures of the pelvis were treated at the authors institution. The pelvic ring was fractured in 1479 patients, and 1029 sustained polytrauma. A retrospective study included four parts: (1) Demographic analysis of 1409 patients showed an increase in the severity of pelvic and general trauma during this period. ⋯ Standardized protocols for primary care and operative procedures of pelvic injuries optimize therapy. Complex pelvic trauma requires early, aggressive surgical management with surgical hemostasis. Further developments in open reduction and internal fixation of the pelvis focus on minimizing additional soft tissue trauma and implants.
-
Clin. Orthop. Relat. Res. · Aug 1994
Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results.
Between March 1991 and December 1992 the authors surgically treated 55 acetabular fractures using a modified Stoppa anterior intrapelvic extensile approach. Indications for utilization of this approach included displaced anterior column or wall fractures, transverse fractures, T shaped fractures, both column fractures and anterior column or wall fractures associated with a posterior hemitransverse component. The approach involves a transverse skin incision 2 cm above the pubic symphysis followed by a midline split of the rectus abdominis. ⋯ Clinical results were excellent (47%), good (42%), fair (9%) and poor (2%). The modified Stoppa incision offers the experienced trauma surgeon a new approach for fixation of displaced acetabular fractures. The approach offers improved reduction and fixation possibilities and may decrease the rate of complications associated with extrapelvic or extensile approaches.
-
Clin. Orthop. Relat. Res. · Aug 1994
Biography Historical ArticleAcetabular fractures. A tribute to Emile Letournel.
-
State of the art techniques for perioperative pain management in orthopaedic surgery have evolved from cumulative advances in basic sciences, technology, psychology, and changes in physician and nursing practices. Each advance in the understanding of pain physiology and pharmacology and the pain experience has suggested more effective strategies for intervention. ⋯ Coincident with an increase in demand for these services has been the evolution of interdisciplinary pain management teams commonly known as the Acute Pain Treatment Service. In the context of the national debate on health care reform, research priorities in the field include documentation of impacts on patient outcomes, and influences on the cost of health care.