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Cervical spine injury
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Another classification describes typical patterns of injury based on the mechanism and impact on the C-spine.18 Flexion forces may exert injury alone or may be compounded by axial loading or distraction. Flexion by itself or flexion with superimposed distraction can lead to unilateral and bilateral facet dislocations, and various degrees of neurologic deficit are commonly seen. Medical professionals may attempt to use traction or manipulation under anesthesia; however, open surgical reduction and stabilization is often required. Flexion with axial loading may result in anterior vertebral body fracture and disruption of posterior ligaments and locked facets. In severe cases (eg, “teardrop fracture”), surgery may be necessary. Similarly, extension forces on the C-spine may act alone or be compounded by axial compression or distraction and, in most cases, result in less severe injuries involving the spinous processes and laminae, as well as fractures through the lateral mass and facets. When the C-spine and head are in a neutral position, pure compression may result in burst fractures. Distraction forces, on the other hand, may cause complete ligamentous disruption with instability.15
Patellar fractures
Published in Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth, Musculoskeletal Trauma in the Elderly, 2016
Stable fixation of patellar fractures should allow for early range of motion. If immobilization is required or chosen for the initial 4–6 weeks, Shabat et al.4,51 have shown that functional range of motion can be regained with physical therapy. If stiffness does not improve after a course of therapy, manipulation under anaesthesia can be considered. This must be performed carefully to prevent soft tissue rupture or failure of fixation. Should manipulation not achieve adequate range of motion, arthroscopic lysis of adhesions can be considered in severe cases. Epidural anesthesia, continuous passive motion and frequent physical therapy can be used in conjunction with surgery. Quadricepsplasty can be considered if stiffness persists at the 9- to 12-month postoperative period, although in the elderly this will likely be used sparingly.
Paediatric upper limb trauma
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
Chethan Jayadev, Tanvir Khan, Manoj Ramachandran
These fractures have excellent remodelling potential because they are close to the distal radial physis. Twenty to 25° of sagittal angulation can be accepted in children <12 years old; in patients > 12 years old, 10–15° is acceptable, depending on skeletal maturity. Where angulation is unacceptable, manipulation under anaesthesia is performed. Check radiographs must be obtained at 1 week to exclude re-displacement. Indications for operative intervention include unstable fractures and fracture re-displacement following manipulation. Percutaneous pinning with crossed K-wires is usually sufficient; open injuries and irreducible fractures may require open reduction.
The efficacy and safety of patient-specific instrumentation in primary total knee replacement: a systematic review and meta-analysis
Published in Expert Review of Medical Devices, 2023
J.H. Hinloopen, R. Puijk, P.A. Nolte, J.W. Schoones, R. de Ridder, B.G. Pijls
A summary of the data-synthesis for safety is presented in Table 1. In the PSI group there was 66 ml [CI 31 ml to 101 ml] less blood loss compared to the non-PSI group. This difference was, however, not clinically relevant as it did not result in fewer blood transfusions; risk difference −0.5% [CI −2.2% to 1.3%]. There was no clinically relevant difference in the risk of hematoma, revision for any reason, revision for aseptic loosening, revision for infection, revision for instability, manipulation under anesthesia, fractures, total reoperations, total reinterventions, DVT/PE, PE or total complications. It is of note that there were 6 cases of DVT/PE in the PSI group (6 out of 558 patients) compared to 2 cases of DVT/PE in the non-PSI group (2 out of 551 patients), although the number of cases was too small to make any definite conclusions.
Effectiveness of surgical and non-surgical interventions for managing diabetic shoulder pain: a systematic review
Published in Disability and Rehabilitation, 2022
Sanaa A. Alsubheen, Joy C. MacDermid, Kenneth J. Faber
Studies were included in this systematic review if the below criteria were met:Design: RCTs and cohort studies (prospective and retrospective) published in English and in a peer-reviewed journal.Participants: patients with diabetes aged 18 years or older with shoulder pain with known underlying joint pathology such as AC, rotator cuff disease, or osteoarthritis.Interventions: studies that investigated one or a combination of the surgical (arthroscopy, open surgery, and arthroplasty) and non-surgical interventions (physiotherapeutic treatments, steroids injection, manipulation under anesthesia (MUA), shoulder distension technique, and suprascapular nerve block).Outcome: shoulder pain assessed using reliable and validated patient-reported outcome measures.
Influence of psychiatric disorders and chronic pain on the surgical outcome in the patient with chronic coccydynia: a single institution’s experience
Published in Neurological Research, 2020
Kristopher A. Lyon, Jason H. Huang, David Garrett
The proper patient for coccygectomy must be considered in a selective manner since up to 90% of patients suffering from chronic coccydynia, regardless of the cause, may have pain relief, if not pain freedom, from conservative therapy alone [17]. In the literature, conservative therapy consists of at least three months of non-steroidal anti-inflammatory drugs, rest, soft cushions, hot water baths, local anesthetic or steroid injections, and digital manipulation with or without anesthesia [14]. This patient cohort followed the same measures of conservative therapy as published in the literature with the exception of digital manipulation under anesthesia. For those in which conservative therapy fails, coccygectomy can be considered. Although the literature cites a 60–90% success rate after coccygectomy, it also warns of poor results after coccygectomy in the patient with comorbid psychiatric disorders or chronic pain [11,14–16].