Clinical orthopaedics and related research
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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.
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Clin. Orthop. Relat. Res. · Aug 1994
Results of 75 consecutive patients with an acetabular fracture.
From 1988 to 1991, 75 consecutive patients with an acetabular fracture were treated. Follow up was for a minimum of 2 years (average, 3 years; range, 2-5 years). Sixty five patients had a solitary acetabular fracture, and in 10 the acetabular fracture was associated with a pelvic fracture (52 men and 23 women; average age, 46 years; range, 17 to 99 years). ⋯ One patient died perioperatively of pulmonary embolus. In 2 patients a collapse of the posterior wall resulted in a total hip replacement. The results were good to excellent according to the d'Aubigne scale in 76% of all patients.
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Clin. Orthop. Relat. Res. · Aug 1994
Extended iliofemoral versus triradiate approaches in management of associated acetabular fractures.
From July 1988 to June 1991, 110 complex acetabular fractures were operatively treated. A triradiate approach was used in 38 patients and an extended iliofemoral approach in 21. The mean patient age was 32 years (range, 15-80 years). ⋯ Deep infection was seen in one patient in the extended iliofemoral group and two in the triradiate group. Eight patients developed heterotopic ossification of Brooker Grade III or IV despite prophylactic treatment with indomethacin. Both approaches provided good visualization of complex acetabular fractures.
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Clin. Orthop. Relat. Res. · Aug 1994
Case ReportsThe extended ilioinguinal approach for specific both column fractures.
The surgical approach for exposure of an acetabular fracture is determined by Letournel's fracture classification. Both column fractures typically can be treated through the ilioinguinal approach. If a fracture extends posteriorly to involve the sacroiliac joint or the sciatic buttress, exposure through the ilioinguinal approach can be quite difficult and the extended iliofemoral approach is often recommended. ⋯ The approach allows improved visualization and should prevent some morbidity usually associated with the extended iliofemoral approach. Perfect or near perfect reductions were achieved in all cases. The extended ilioinguinal approach can be useful when treating both column fractures extending posteriorly to involve the sacroiliac joint or the sciatic buttress.
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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.