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Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Patients should be placed in a sling for approximately 3 weeks following reduction to aid support and recovery. In young patients below the age of 25, an orthopaedic referral is mandated due to the high risk of recurrence, and there is now a move to initiate primary stabilization through a Bankart's repair.
Orthopaedic Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Give the patient a sling and analgesics, and review in the next fracture clinic. As the fracture is often unstable, it is prone to slipping and the patient usually requires weekly X-ray follow-up to ensure continued fracture reduction.
How to perform revision lumbar decompression
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Jacob Hoffman, Ryan Murphy, Mark L. Prasarn, Shah-Nawaz M. Dodwad
In the majority of cases, general anesthesia is preferred. Alternatively, spinal anesthesia may be used in one- or two-level revision laminectomy. Appropriate intravenous (IV) access is placed by the anesthesiology and nursing team in the operating room (OR). An arterial line and a Foley catheter are placed depending on the overall medical status of the patient. The patient is then carefully logrolled prone on a radiolucent open-frame Jackson table (Mizuho OSI, Union City, California). The open frame allows the abdomen to hang free, thereby decreasing the epidural venous pressure and potentially reducing intraoperative bleeding. Pads are placed just distal to the anterior superior iliac spine and on the thighs. If the desired level of decompression is the caudal lumbar spine, a sling may be used to allow flexion of the lumbar spine, which increases the interlaminar space. In the sling, the patient's thigh and knee should be flexed to facilitate lumbar flexion. Only the pads for the pelvis are placed when a sling is used. The arms are placed forward with the shoulders and elbows bent at less than 90 degrees each. A chest pad should be placed just distal to the sternal notch.
Brachial artery trauma as a complication of bicep muscle injury
Published in Baylor University Medical Center Proceedings, 2023
Charles Graham, Sarah Bergkvist, Peter Kimball, Katelyn Taylor, Mudassir Syed, Michael M. Mohseni
A 48-year-old man presented to the emergency department with complaints of swelling, pain, and limited range of motion of the right upper extremity (RUE). His symptoms began after feeling a pop in his right arm while losing an arm-wrestling contest 48 hours earlier. He was evaluated 12 hours after the initial injury and diagnosed with a possible bicep tendon rupture. At that time, the patient was discharged with a sling, pain medications, and orthopedic follow-up. He experienced worsening RUE swelling, numbness, paresthesias, and uncontrolled pain, prompting a return visit to the emergency department. The patient endorsed a history of untreated hypertension and testosterone use but denied any surgeries. His exam was significant for swelling and tenderness extending from the right anterior chest near the pectoralis major muscle distally to the antecubital fossa and forearm. Diffuse ecchymoses was present in the medial upper arm. He reported significant pain with active or passive range of motion testing of the RUE, thus limiting strength examination. The right radial pulse was difficult to palpate given the degree of swelling, but bedside Doppler ultrasound confirmed the presence of good pulse waveform. Laboratory evaluation was notable for a creatinine of 1.36 mg/dL and a creatine kinase of 520 U/L. Orthopedic surgery was consulted given concerns for development of compartment syndrome.
Reoperation rates for stress urinary incontinence and pelvic organ prolapse in women after undergoing Mid-Urethral sling with or without concomitant colporrhaphy in academic centers within the United States
Published in Journal of Obstetrics and Gynaecology, 2022
Phillip Kim, Alexander B. Cantrell, Stacey J. Wallach, Jennifer Rothschild, Blythe Durbin-Johnson, Eric A. Kurzrock
Patients with commercial insurance have lower rates of re-operation. After considering other variables, Medicaid and Medicare were found to be associated with increased HR of any secondary surgery HR1.32, p =.005 and HR1.14 p =.057, respectively. Specifically, Medicaid was associated with increased HR of secondary MUS, SUI sling revision, and repeat prolapse procedure. Medicare patients had lower HR for repeat SUI procedures but higher SUI sling revision rates. Medicaid and Medicare status has been associated with adverse post-operative outcomes in other fields such as orthopaedics, trauma and surgical oncology (Churilla et al. 2016; Gabriel et al. 2016; Armenia et al. 2017; Li et al. 2017). This trend towards higher secondary treatment may be due to poor access to care, leading either to delayed presentation and/or worse primary disease (Li et al. 2017).
Predicting independence of gait by assessing sitting balance through sitting posturography in patients with subacute hemiplegic stroke
Published in Topics in Stroke Rehabilitation, 2021
Hyun Haeng Lee, Jong Won Lee, Bo-Ram Kim, Ho Joong Jung, Dong-Hee Choi, Jongmin Lee
We provided each patient with a chair with appropriate height to ensure that the patient’s feet had full contact with the ground when the patient was seated. We applied arm slings to the affected arm of all the patients. The examiner asked the patients to spread their legs shoulder-width apart with the unaffected arm placed comfortably on the thigh and to move the trunk in each direction as far as possible without using the arms nor moving their feet. Patients were instructed to follow an arrow on a screen, assume a stable position as far as possible from the original position, and maintain this position for as long as the arrow remained on the screen. The patients were asked to reach using the unaffected side first, followed by the affected side. The BioRescue system measured the surface area that could be moved as far as possible in any direction without loss of balance. A large LOS value represented a stable balance. We used deviation of the WBD and the surface area of the LOS, quantified as follows: