Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Aug 2004
Multicenter StudyClinical spectrum of acute compartment syndrome of the thigh and its relation to associated injuries.
The reason for the described clinical variability of acute compartment syndrome of the thigh, with high morbidity and mortality in some patients and an uncomplicated clinical course in others, is not known. To better define the clinical spectrum and factors determining the clinical course of this rare clinical entity, we did a retrospective multicenter study of 28 patients with 29 thigh compartment syndromes. The leading cause of acute thigh compartment syndrome was blunt trauma from motor vehicle accidents (46%) or contusion (39%). ⋯ The incidence of complications correlated with the time to fasciotomy. Mortality was limited to patients with high injury severity scores. The clinical spectrum of thigh compartment syndrome is comparable with that of other compartment syndromes and its clinical course is determined by its associated injuries.
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Clin. Orthop. Relat. Res. · Aug 2004
ReviewSystemic pharmacologic postoperative pain management in the geriatric orthopaedic patient.
Although older adults have surgical procedures more frequently than any other group, they also experience the worst postoperative pain management. Among patients with orthopaedic disorders, this undertreatment of pain impacts postsurgical functional recovery and clinical outcomes. Recently adopted evidence-based pain management guidelines have improved care, but there still is significant room for improvement. We review standards for pain assessment in cognitively intact and impaired older adults, provide detailed guidelines for the pharmacologic treatment of postoperative pain in the orthopaedic geriatric patient, and review the stepwise approach to effective side-effect management in this population.
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Clin. Orthop. Relat. Res. · Aug 2004
ReviewBiomechanical considerations of fracture treatment and bone quality maintenance in elderly patients and patients with osteoporosis.
Osteoporosis is a major public health problem that is characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures of the hip, spine, and wrist. Poor bone quality in patients with osteoporosis presents the surgeon with difficult treatment decisions. Bone fracture repair has more pathways with combinations of bone formation mechanisms, which depend on the type of fracture fixation to be applied to achieve the desirable immobilization. ⋯ We describe the biomechanical considerations of osteoporosis and fracture treatment from various aspects. First, bone structure and strength characterization are discussed using a hierarchical approach, followed by an innovative knowledge-based approach for fracture reduction planning and execution, which particularly is beneficial to osteoporotic fracture. Finally, a brief review of the results of several experimental animal models under different fracture types, gap morphologic features, rigidity of fixation devices, subsequent loading conditions, and biophysical stimulation is given to elucidate adverse mechanical conditions associated with different bone immobilization techniques that can compromise normal bone fracture healing significantly.