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  • Moon Stampe posted an update 1 week ago

    Musculoskeletal injuries comprise a large percentage of hospital admissions for adults and often contribute to persistent daily pain as an illness; opioid dependence; disability; and complaints of increased depression, anxiety, and symptoms of post-traumatic stress disorder. The prevalence of depression and post-traumatic stress disorder after orthopaedic trauma has been found to be considerably greater than the general adult cohort. Soon after sustaining a fracture, psychological factors can predict pain and disability many months after injury, even after controlling for injury severity. Thus, early in the care of orthopaedic trauma, there exists an opportunity to improve overall health by attending to psychological and social concerns, along with physical health. Recent literature has identified clinically actionable subgroups within the orthopaedic trauma cohort that are at psychological risk after an injury. Improving positive factors such as resilience, social support, and self-efficacy via validated interventions such as Cognitive-Behavioral Therapy, mindfulness training, and other types of mindset training has helped people return to their daily routine. Raising awareness of the psychological effects of trauma among the orthopaedic community could improve post-treatment planning, increase referrals to appropriate nonmedical professionals, and implement earlier effective interventions.Cast saw burns are an avoidable complication of cast removal and cast splitting. These iatrogenic injuries often lead to unacceptable clinical sequalae with significant financial and legal consequences. Therefore, a considerable body of research has been directed toward cast saw burn prevention. This review of currently published data provides clinicians with a summary of the literature to guide practice based on the best available evidence, with the goal of preventing iatrogenic cast saw burns. The PubMed database was queried for articles published from 1980 until present with the following key words cast saw burns, cast saw blades, cast saws, orthopaedic education or surgical simulation. Relevant articles were reviewed and summarized. The prevention of cast saw burns involves awareness of clinical risk factors, maintenance of equipment, use of the proper technique, and the education of novice providers. By implementing evidence-based methods, orthopaedic surgeons and associated healthcare providers can aim to eliminate these preventable complications from their practice.Accessory ossicles are a common radiographic finding about the foot and ankle in children and adolescents. They are often noted incidentally during evaluation of foot and ankle injuries, and most can be managed nonsurgically. Although over 20 accessory ossicles have been described around the foot and ankle, five specific structures generate the most concern in pediatric patients. An accessory navicular presents commonly with medial midfoot pain and may require surgical intervention after failure of nonsurgical treatment. Although an accessory navicular can be treated surgically with simple excision, there is some recent evidence that supports concomitant reconstruction of associated flatfoot deformities. Os trigonum, an ossicle posterior to the talus, is also commonly asymptomatic. However, os trigonum may be associated with persistent posterior ankle pain, and open and endoscopic resection techniques are successful. Os subfibulare is an uncommon ossicle that may be associated with recurrent ankle sprains. Recent literature reports successful return to activities after ossicle excision and ligament reconstruction. Os subtibiale may be confused with a medial malleolar fracture in skeletally immature patients. Os peroneum may contribute to lateral midfoot pain.The national recommendations for school screening programs for scoliosis in the United States have undergone a shift in perspective over the past two decades. Edralbrutinib In 2004, the United States Preventive Services Task Force recommended against screening programs but changed its recommendation to be inconclusive in 2018. Early diagnosis of scoliosis can allow for close monitoring of the deformity and early initiation of bracing treatment when appropriate, with the goal of preventing costly and invasive surgical intervention. Several different diagnostic tools are available, including Adam’s forward bending test alone, Adam’s forward bending test with scoliometry, the humpometer, and Moiré topography, each with varying degrees of sensitivity and specificity. Controversy prevails over the cost efficacy of screening programs and possible unnecessary exposure of adolescents to radiation for confirmatory radiographs after a positive screening test. However, the recent definitive evidence of bracing treatment efficacy in slowing the progression of scoliotic curves and preventing the need for surgery indicates that school screening programs may still have a role in allowing early diagnosis.Intraoperative periprosthetic fractures are challenging complications that may affect implant stability and survivorship. Periprosthetic acetabular fractures are uncommon and infrequently are the focus of studies. Acetabular fractures are occasionally recognized after patients report unremitting groin pain weeks postoperatively. The widespread use of cementless acetabular cups might lead to higher number of fractures than is clinically detectable. Conversely, the incidence of intraoperative periprosthetic femoral fractures are more common and encompass a broad spectrum, ranging from a small cortical perforation to displaced fractures with an unstable prosthesis. Appropriate recognition, including mindfulness of preoperative patient and surgical risk factors, is critical to the successful management of acetabular and femoral complications. This comprehensive review article focuses on the incidence, patient and surgical risk factors, diagnosis, management, and clinical outcomes associated with intraoperative acetabular and femur fractures in primary total hip arthroplasty.Closed pantalar dislocation mainly occurs among male adults aged 20 to 45 years and is usually associated with high-energy trauma, mostly falls (50.0%). The talus dislocates anterolaterally in about 85% of cases. Pure pantalar dislocation is more common (54.7%) than cases with concomitant fractures (45.3%). Ankle fractures are the most common associated fractures, followed by fractures of the talar posterior process. Among 40 reported cases, 24 had successful closed reduction (60%), 11 had unsuccessful closed reduction (27.5%), and 5 underwent open reduction without attempting closed reduction (12.5%). The success rate for closed reduction of closed pantalar dislocation is 68.5% (24/35 cases). Post-traumatic arthrosis occurs in 32.3%. Osteonecrosis occurs less often than previously reported. Infection after closed reduction of pantalar dislocation is very rare except after open reduction and fixation for concomitant talar fractures. Conclusively, closed pantalar dislocations are very rare injuries and may portend a poor prognosis.

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