Orthopaedic review
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Paper focuses on the following topics: choice of local anesthetic drug, systemic toxicity of local anesthetics, equipment for major regional blocks, stellate ganglion block, brachial plexus blocks (axillary, supraclavicular and interscalene), and intravenous regional anesthesia. The discussion of individual nerve blocks is divided into the following areas: anatomy, indications, choice of local anesthetic, technique and complications.
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Regional anesthesia has some advantages over general anesthesia for shoulder surgery. Cervical epidural anesthesia, a regional technique not previously described for shoulder operations, was successfully used for surgical procedures on or near the shoulder joint. The technique provided good surgical anesthesia and postoperative analgesia, with few complications and a high degree of patient acceptance. Cervical epidural anesthesia offers some advantages over previously described techniques of regional anesthesia for shoulder operations, including a single needle insertion with no need to elicit paresthesias, lesser volumes of local anesthetic agents, and the ability to easily reinject the catheter intraoperatively if necessary and postoperatively for pain relief.
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This review paper presents a summary of concepts, ideas, theories, symptoms, stages, diagnostic procedures, and treatment modalities of a syndrome causing significant disability in a large segment of the American population. Diagnosis and early treatment will prevent significant and devastating disability in those individuals afflicted with this syndrome.
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Trauma cases admitted to hospitals are often associated with chest-cage injuries. Sternal injuries may be overlooked and may cause persistent pain. Sternal injuries were reviewed at the Health Sciences Center General Hospital from 1963 to 1983 to ascertain the severity of chest-cage trauma and complications from this type of injury, including long-term sequelae. ⋯ Stabilization of the sternum and chest cage is often necessary early treatment. Motor vehicle accidents were by far the most common cause of trauma producing these injuries. Thirty-six cases of injury to the sternum form the basis for this review.
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We prospectively evaluated an external rotation method for closed reduction of acute anterior shoulder dislocations that had been described recently. Seventy-eight of 100 consecutive emergency patients who presented with anterior shoulder dislocations experienced successful reduction using this external rotation method. The method proved to be easy to perform and relatively safe. Based on our findings, we recommend that it be included in the physician's armamentarium for initial closed reduction of anterior shoulder dislocation.