Current reviews in musculoskeletal medicine
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The purpose of this review is to discuss key anatomic and pathoanatomic factors, treatment principles, and patient outcomes of Lisfranc injuries. ⋯ Although open reduction and internal fixation (ORIF) remains the current gold standard of treatment, ORIF with primary arthrodesis has become increasingly popular in recent years, both for pure ligamentous and for bony-ligamentous injuries. Return to activity and competitive sports as well as overall patient outcomes have been further defined, suggesting that most patients are able to return to near pre-injury level if properly diagnosed and appropriately treated. Considerable controversy remains as to the optimal method of treatment of Lisfranc injuries and may ultimately be defined by activity-specific or sport-specific criteria.
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Subaxial cervical spine trauma is common and an often missed diagnosis. Accurate and efficient diagnosis and management is necessary to avoid devastating complications such as spinal cord injury. Several classification schemes have been devised to help categorize fractures of the subaxial spine and define treatment algorithms. ⋯ More modern classification systems have been developed, which aim to improve the interobserver reliability; however, further large-scale studies are needed for more definitive evaluation. Overall, treatment of subaxial cervical spine injuries should include a protocol with initial trauma evaluation, leading to expedient operative intervention if indicated. Surgical techniques include both anterior and posterior approaches to the cervical spine depending on fracture classification.
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Curr Rev Musculoskelet Med · Dec 2016
ReviewThe natural history and management of brachial plexus birth palsy.
Brachial plexus birth palsy (BPBP) is an upper extremity paralysis that occurs due to traction injury of the brachial plexus during childbirth. Approximately 20 % of children with brachial plexus birth palsy will have residual neurologic deficits. These permanent and significant impacts on upper limb function continue to spur interest in optimizing the management of a problem with a highly variable natural history. ⋯ The key finding on physical examination that determines need for microsurgery is recovery of antigravity elbow flexion by 3-6 months of age. When indicated, both microsurgery and secondary shoulder and elbow procedures are effective and can substantially improve functional outcomes. These procedures include nerve transfers and nerve grafting in infants and secondary procedures in children, such as botulinum toxin injection, shoulder tendon transfers, and humeral derotational osteotomy.
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Curr Rev Musculoskelet Med · Sep 2015
Blurred front lines: triage and initial management of blast injuries.
Recent armed conflicts and the expanded reach of international terror groups has resulted in an increased incidence of blast-related injuries in both military and civilian populations. Mass-casualty incidents may require both on-scene and in-hospital triage to maximize survival rates and conserve limited resources. ⋯ Special considerations such as patient transport, infection control and prevention, and amputation management are also discussed. All orthopedic surgeons, regardless of practice setting, should be familiar with the basic principles of evaluation, resuscitation, and initial management of explosive blast injuries.
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Rotator cuff repair (RCR) is a common procedure performed by orthopedic surgeons via arthroscopic, open, or mini-open techniques. While this surgery is considered to be of low morbidity, several potential complications can arise either intraoperatively or during the postoperative time period. ⋯ There are several different ways to classify complications after RCR repair: timing, severity, preventability, whether or not the pathology is intra- or extra-articular, and the type of treatment necessary. It is essential that the surgeon is cognizant of the etiology contributing to the failed RCR surgery in order to provide timely and proper management.