Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 1989
Care of the multiply injured patient with cervical spine injury.
Cervical spine injuries can be disastrous. The treatment begins at the accident scene by obtaining an appropriate history, physical examination, and evaluation of the mechanics of the accident. Emergency medical stabilization takes precedence, but the cervical spine should be stabilized until an injury in this area is ruled out. ⋯ Of 58 patients with cervical spine injuries evaluated by this aggressive approach, 14 patients had associated spine fractures, and 9 patients had positive peritoneal lavage requiring surgical exploration. Injuries involving other organ systems were also diagnosed and treated. Formal, rigid evaluation plans and aggressive multidisciplinary treatment are useful in saving the lives and salvaging neurologic function of these patients.
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Cervical spondylosis is a generalized disease process affecting all levels of the cervical spine. Cervical spondylosis encompasses a sequence of degenerative changes in the intervertebral discs, osteophytosis of the vertebral bodies, hypertrophy of the facets and laminal arches, and ligamentous and segmental instability. ⋯ Clinical manifestations of cervical spondylosis may arise when morphologic sequelae are superimposed on a developmentally narrow spinal canal. The two clinical syndromes of spondylotic radiculopathy and myelopathy are distinct, yet they may overlap.
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Clin. Orthop. Relat. Res. · Jan 1989
Review Case ReportsShoulder girdle dysplasia associated with nail patella syndrome. A case report and literature review.
Hereditary oncycho-osteodysplasia is a well-defined clinical entity consisting of four characteristics: (1) complete or partial absence of finger and thumb nails typically more severe on the radial side of the hand; (2) bony dysplasia about the knee consisting of patellar and lateral femoral condylar hypoplasia; (3) bony dysplasia about the elbow consisting of hypoplasia of the capitellum and radial head; and (4) iliac horns. The hereditary pattern is autosomal dominant with complete penetrance and variable expressivity. ⋯ The acromion was deformed and slanted upwards at the lateral border. A slightly attenuated glenoid pointed laterally or slightly inferiorly, giving a humeral acromial interval of 2.5 cm.
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There were 157 patients following major lower extremity amputation who were evaluated to determine functional prosthetic ambulation. Twenty-eight patients were evaluated in the amputee clinic and found not to be candidates for prosthetic fitting. Forty-one patients were fit with a prosthesis but did not become functional prosthetic ambulators. ⋯ Of all below-the-knee amputees, 66% became functional ambulators. The presence of coronary artery disease decreased the ambulatory potential in above-the-knee or bilateral amputees but not in below-the-knee amputees. A screening method for elderly, dysvascular amputees should be instituted prior to prosthetic fitting.
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The occurrence of pain was investigated in 118 patients with posttraumatic brachial plexus injuries (BPI). Ninety-five patients were operated upon by the same surgeon. Three to 14 years after BPI and reconstructive surgery, 91% of the patients experienced permanent pain that was severe in 40% and mild in 51% of cases. ⋯ For 57% of patients with pain, a plurimodal medical treatment with tricyclic antidepressants, antiepileptic drugs, and behavioral therapy efficiently reduced pain. For the patients with unbearable paroxystic pain, when medical treatment failed, the destruction of deafferented dorsal horns at the level of avulsion (Nashold procedure) could produce pain relief. In all cases psychosocial management produced early rehabilitation.