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Orthopedic Clinics of North America

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https://www.readbyqxmd.com/read/28336048/infection
#1
EDITORIAL
Frederick M Azar
No abstract text is available yet for this article.
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336047/posttraumatic-reconstruction-of-the-foot-and-ankle-in-the-face-of-active-infection
#2
REVIEW
Brandon Jonard, Erin Dean
Posttraumatic infection of the foot and ankle is a challenging issue for orthopedic surgeons. Making the diagnosis often requires combining laboratory and radiologic testing, patient examination, and history. Patient comorbidities should be identified and optimized whenever possible. Treatment must combine effective antibiotic therapy with thorough debridement of the infected zone. Reconstruction often requires a 2-staged approach using antibiotic spacers and temporary external fixation, with the goal of obtaining a functional, pain-free limb that is free of infection...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336046/charcot-arthropathy-versus-osteomyelitis-evaluation-and-management
#3
REVIEW
John Womack
Charcot arthropathy of the foot and ankle is a severe complication of peripheral neuropathy and is most commonly seen in the developed world in association with diabetes mellitus. Correct diagnosis and differentiation from osteomyelitis of the foot and ankle are critical to guide treatment. It can exist concomitantly with osteomyelitis, typically in the setting of an advanced midfoot ulcer. Simple plain radiographs and contrasted MRI studies often yield inconclusive or confusing data. Correct use of imaging studies and a clinical algorithm can be effective tools to help make accurate and early diagnoses and guide clinical interventions for these conditions...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336045/atypical-hand-infections
#4
REVIEW
Edward Chan, Mark Bagg
Atypical infections of the hand are caused by organisms such as Mycobacterium, fungi, and viruses, and often do not respond to conventional management. They exist within a wide spectrum of presentations, ranging from cutaneous lesions to deep infections such as tenosynovitis and osteomyelitis. Having a high clinical suspicion for atypical hand infections is vital because diagnosis often requires special tests and/or cultures. Obtaining a detailed medical, work, and travel history is extremely important. An indolent clinical course, late diagnosis, and delayed treatment are common...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336044/flexor-tenosynovitis
#5
REVIEW
Brad T Hyatt, Mark R Bagg
For patients with suspected flexor tenosynovitis, the mainstay of diagnosis is a thorough history and physical examination. The examination is guided by evaluating the patient for Kanavel's four cardinal signs. Empiric antibiotics should be started immediately on diagnosis covering skin flora and gram-negative bacteria. Typically, surgery is required. Appropriate exposure is required for adequate treatment and incisions should be tailored to preserve areas of skin compromised from draining sinuses and abscess pressure...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336043/pediatric-septic-arthritis
#6
REVIEW
Nicole I Montgomery, Howard R Epps
Acute septic arthritis is a condition with the potential for joint destruction, physeal damage, and osteonecrosis, which warrants urgent identification and treatment. The organism most frequently responsible is Staphylococcus aureus; however, our understanding of pathogens continues to evolve as detection methods continue to improve. MRI has improved our ability to detect concurrent infections and is a useful clinical tool where available. The treatment course involves intravenous antibiotics followed by transition to oral antibiotics when clinically appropriate...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336042/acute-hematogenous-osteomyelitis-in-children-pathogenesis-diagnosis-and-treatment
#7
REVIEW
Shawn S Funk, Lawson A B Copley
Acute hematogenous osteomyelitis (AHO) in children is an ideal condition to study due to its representation of a wide spectrum of disorders that comprise pediatric musculoskeletal infection. Proper care for children with AHO is multidisciplinary and collaborative. AHO continues to present a significant clinical challenge due to evolving epidemiology and complex pathogenesis. A guideline-driven, multidisciplinary approach has been introduced and shown to effectively reduce hospital stay, improve the timing and selection of empirical antibiotic administration, reduce delay to initial MRI, reduce the rate of readmission, and shorten antibiotic duration...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336041/double-edged-sword-musculoskeletal-infection-provoked-acute-phase-response-in-children
#8
REVIEW
Michael Benvenuti, Thomas An, Emilie Amaro, Steven Lovejoy, Gregory Mencio, Jeffrey Martus, Megan Mignemi, Jonathan G Schoenecker
The acute phase response has a crucial role in mounting the body's response to tissue injury. Excessive activation of the acute phase response is responsible for many complications that occur in orthopedic patients. Given that infection may be considered continuous tissue injury that persistently activates the acute phase response, children with musculoskeletal infections are at markedly increased risk for serious complications. Future strategies that modulate the acute phase response have the potential to improve treatment and prevent complications associated with musculoskeletal infection...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336040/the-impact-of-negative-pressure-wound-therapy-on-orthopaedic-infection
#9
REVIEW
Lawrence X Webb
By hastening the resolution of edema and improving local microcirculation, topical negative pressure wound therapy (TNP) aids the establishment of early wound coverage. Its use in the setting of type III open fractures is reviewed. The author's initial use of TNP for closed surgical incisions and how it morphed its way into being applied to closed surgical wounds with heightened likelihood for infection is presented. Several case studies are presented to illustrate the role and the technique for management of acute or subacute infections involving bone and implant...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336039/the-antibiotic-nail-in-the-treatment-of-long-bone-infection-technique-and-results
#10
REVIEW
Kenneth L Koury, John S Hwang, Michael Sirkin
Antibiotic cement nails provide a useful and relatively simple technique to treat intramedullary osteomyelitis of the long bones. These devices provide stability as well as local, targeted antibiotics, which are both critical aspects of osteomyelitis management. Additionally, the use of a threaded core is a critical component of successful cement nail assembly. With adherence to the simple principles outlined in this review, surgeons can expect reliably good results using these drug-delivery implants.
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336038/role-of-systemic-and-local-antibiotics-in-the-treatment-of-open-fractures
#11
REVIEW
David C Carver, Sean B Kuehn, John C Weinlein
The orthopedic community has learned much about the treatment of open fractures from the tremendous work of Ramon Gustilo, Michael Patzakis, and others; however, open fractures continue to be very difficult challenges. Type III open fractures continue to be associated with high infection rates. Some combination of systemic and local antibiotics may be most appropriate in these high-grade open fractures. Further research is still necessary in determining optimal systemic antibiotic regimens as well as the role of local antibiotics...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336037/deep-vein-thrombosis-and-pulmonary-embolism-considerations-in-orthopedic-surgery
#12
REVIEW
Jasmine Saleh, Mouhanad M El-Othmani, Khaled J Saleh
Patients undergoing orthopedic surgery have an increased risk for deep venous thrombosis (DVT) and pulmonary embolism (PE). These complications are considered detrimental, as they cause major postoperative morbidity and mortality and lead to a substantial health care burden. Because of the high incidence and serious nature of these complications, it is essential for orthopedic surgeons to have a comprehensive knowledge of the risk factors, diagnosis, and treatment of acute DVT and PE. Perioperative management of orthopedic patients to prevent postoperative DVT and PE and optimize postoperative outcomes is also discussed in this review...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336036/physical-function-and-physical-activity-in-obese-adults-after-total-knee-arthroplasty
#13
REVIEW
Webb A Smith, Audrey Zucker-Levin, William M Mihalko, Michael Williams, Mark Loftin, James G Gurney
Obese patients are more likely to have osteoarthritis and total knee arthroplasty (TKA). This investigation sought to evaluate physical function, activity level, and quality of life (QOL). Obese participants near 1-year postsurgical follow-up appointment were recruited. Evaluation included QOL and activity questionnaire, medical histories, anthropometrics, strength, and aerobic capacity. Sixty participants completed assessments. Obese TKA patients have physical performance limitations and low physical activity levels 1 year after surgery and completion of postoperative rehabilitation...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336035/effect-of-tranexamic-acid-on-transfusion-rates-following-total-joint-arthroplasty-a-cost-and-comparative-effectiveness-analysis
#14
Perry J Evangelista, Michael W Aversano, Emmanuel Koli, Lorraine Hutzler, Ifeoma Inneh, Joseph Bosco, Richard Iorio
Tranexamic acid (TXA) is used to reduce blood loss in orthopedic total joint arthroplasty (TJA). This study evaluates the effectiveness of TXA in reducing transfusions and hospital cost in TJA. Participants undergoing elective TJA were stratified into 2 cohorts: those not receiving and those receiving intravenous TXA. TXA decreased total hip arthroplasty (THA) transfusions from 22.7% to 11.9%, and total knee arthroplasty (TKA) from 19.4% to 7.0%. The average direct hospital cost reduction for THA and TKA was $3083 and $2582, respectively...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27886688/controversies-in-fracture-care
#15
EDITORIAL
Frederick M Azar
No abstract text is available yet for this article.
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27886687/current-controversies-in-management-of-calcaneus-fractures
#16
REVIEW
Heather E Gotha, Jacob R Zide
Displaced intraarticular fractures of the calcaneus represent a technically challenging injury. Although there is conflicting evidence regarding advantages and disadvantages of operative versus nonoperative treatment, a growing body of literature suggests operative management with near-anatomic reduction of the posterior facet and restoration of overall calcaneal morphology offers greater potential for superior short- and long-term outcomes. A thorough understanding of calcaneal anatomy, fracture pattern, and associated injuries, along with careful selection of surgical approach and timing to surgery are critical to minimize the risk of complication and maximize potential for optimal outcomes...
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27886686/preoperative-versus-postoperative-initiation-of-warfarin-therapy-in-patients-undergoing-total-hip-and-knee-arthroplasty
#17
REVIEW
Cara Cipriano, Nicholas Erdle, Kai Li, Brian Curtin
The optimal strategy for postoperative deep venous thrombosis prophylaxis remains controversial in hip and knee arthroplasty. Warfarin causes transient hypercoagulability; however, the optimal timing of treatment remains unclear. We evaluated the effects of preoperative versus postoperative warfarin therapy with a primary endpoint of perioperative change in hemoglobin. Warfarin was dosed according to a standard nomogram. No difference in perioperative hemoglobin change was observed. The preoperative group demonstrated higher INRs...
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27886685/posterior-malleolus-fractures
#18
REVIEW
Shay Tenenbaum, Nachshon Shazar, Nathan Bruck, Jason Bariteau
Posterior malleolus fractures vary in morphology. A computed tomography scan is imperative to evaluate fragment size, comminution, articular impaction, and syndesmotic disruption. Despite an increasing body of literature regarding posterior malleolus fractures, many questions remain unanswered. Although, historically, fragment size guided surgical fixation, it is becoming evident that fragment size should not solely dictate treatment. Surgical treatment should focus on restoring ankle joint structural integrity, which includes restoring articular congruity, correcting posterior talar translation, addressing articular impaction, removing osteochondral debris, and establishing syndesmotic stability...
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27886684/controversies-in-fractures-of-the-proximal-ulna
#19
REVIEW
Christopher M Hopkins, James H Calandruccio, Benjamin M Mauck
The olecranon process, coronoid process, and greater sigmoid notch are important components of the complex proximal ulna. Along with providing bony stability to the ulnohumeral joint, the proximal ulna serves as the attachment site of many important muscles and ligaments that impart soft tissue stability to the elbow joint. Management of proximal ulnar fractures continues to evolve as advances in imaging and anatomic and biomechanical studies have led to improvements in available implants; however, controversies remain, as shown in the current relevant literature...
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27886683/complications-of-pediatric-foot-and-ankle-fractures
#20
REVIEW
Jaime R Denning
Ankle fractures account for 5% and foot fractures account for approximately 8% of fractures in children. Some complications are evident early in the treatment or natural history of foot and ankle fractures. Other complications do not become apparent until weeks, months, or years after the original fracture. The incidence of long-term sequelae like posttraumatic arthritis from childhood foot and ankle fractures is poorly studied because decades or lifelong follow-up has frequently not been accomplished. This article discusses a variety of complications associated with foot and ankle fractures in children or the treatment of these injuries...
January 2017: Orthopedic Clinics of North America
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