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Nonsurgical + management + fracture

Perry O Hooper, Patrick J Bevan, Christopher Silko, Lutul D Farrow
Background: The true prevalence of displaced tibial-sided avulsion injuries of the posterior cruciate ligament (PCL; Video 1) is unknown, and the majority of data regarding management has been published in areas other than the Western world, such as China and India (perhaps due to the higher prevalence of two-wheeler motorcycle accidents in these areas). Despite the rarity of data, a better understanding of the approach, fixation techniques, and outcomes is necessary to provide quality patient care...
March 28, 2018: JBJS Essential Surgical Techniques
Thomas R Blattert, Klaus J Schnake, Oliver Gonschorek, Erol Gercek, Frank Hartmann, Sebastian Katscher, Sven Mörk, Robert Morrison, Michael Müller, Axel Partenheimer, Stefan Piltz, Michael A Scherer, Bernhard W Ullrich, Akhil Verheyden, Volker Zimmermann
Study Design: Prospective clinical cohort study (data collection); expert opinion (recommendation development). Objectives: Treatment options for nonsurgical and surgical management of osteoporotic vertebral body fractures are widely differing. Based on current literature, the knowledge of the experts, and their classification for osteoporotic fractures (OF classification) the Spine Section of the German Society for Orthopaedics and Trauma has now introduced general treatment recommendations...
September 2018: Global Spine Journal
Brent Wiesel, Sameer Nagda, Samir Mehta, Ryan Churchill
Fractures of the clavicle are common injuries that occur across all age groups but are most frequently seen in the young, active patient population. Among the different types of clavicle fractures, those occurring in the middle third of the clavicular shaft are the most common. Historically, most of these fractures were treated by closed means even when notable displacement was present. Recently, there has been a renewed interest in assessing the best treatment option for these patients. Although nonsurgical treatment is a reliable method for treating many of these fractures, more recent data suggest that fractures with notable displacement (>2 cm of shortening or >100% displacement) and/or comminution have better short-term outcomes and lower rates of nonunion with surgical management...
August 31, 2018: Journal of the American Academy of Orthopaedic Surgeons
Ram Kiran Alluri, Andrew Sabour, Nathanael Heckmann, George F Hatch, Curtis VandenBerg
BACKGROUND: The purpose of this study was to identify temporal trends in the management of pediatric femoral shaft fractures in 4- and 5-year-old children. METHODS: The Kids' Inpatient Database was used to extract data on patients aged 4 and 5 years with closed femoral shaft fractures. The frequency of nonsurgical and surgical management was calculated, and temporal trends were evaluated. RESULTS: Between 1997 and 2012, the absolute increase in surgical fixation was 35% and 58% in 4- and 5-year-old patients, respectively...
August 31, 2018: Journal of the American Academy of Orthopaedic Surgeons
Bharti Khurana, S Mohammed Karim, Jay M Zampini, Hamdi Jimale, Charles H Cho, Mitchel B Harris, Aaron D Sodickson, Christopher M Bono
PURPOSE: To assess whether a focused MRI limited to the region of known acute traumatic thoracic or lumbar fracture(s) would miss any clinically significant injuries that would change patient management. STUDY DESIGN/SETTING: Multi-center retrospective clinical study. PATIENT SAMPLE: Adult patients with acute traumatic thoracic and/or lumbar spine fracture(s). OUTCOME MEASURES: Pathology identified on MRI (ligamentous disruption, epidural hematoma, cord contusion) outside of the focused zone, an alteration in patient management, including surgical and nonsurgical, as a result of the identified pathology outside the focused zone...
August 23, 2018: Spine Journal: Official Journal of the North American Spine Society
Kevin Tetsworth, Erik Hohmann, Vaida Glatt
Most closed humeral shaft fractures can be successfully managed nonsurgically. However, fractures for which closed treatment is unsuccessful are stabilized using either plates or intramedullary nails. There are shortcomings associated with each technique, including the potential complications of nonunion, infection, shoulder pain, and radial nerve injury. Minimally invasive plate osteosynthesis (MIPO), an innovative alternative treatment, is gaining in popularity. This technique is based on the anterior humeral shaft providing a relatively safe surface for plate application, and limited open exposures proximally and distally allow percutaneous insertion of the necessary implant...
September 15, 2018: Journal of the American Academy of Orthopaedic Surgeons
Geoffrey S Marecek, John A Scolaro
The evaluation and management of pelvic ring injuries continues to evolve. Historic treatment was primarily nonsurgical, which yielded to open surgical treatment as the benefits of restoring pelvic anatomy and stability became clear. The development of percutaneous techniques for pelvic ring fixation enabled surgeons to reduce and stabilize certain injuries without the need for large open surgical dissections. Although percutaneous iliosacral screw fixation of sacral fractures and sacroiliac disruptions is the standard for most posterior pelvic ring injuries, the evaluation and treatment of anterior pelvic ring disruptions remains a controversial topic among surgeons who treat these injuries...
September 2018: Journal of Orthopaedic Trauma
Bryan M Saltzman, Timothy S Leroux, Nikhil N Verma, Anthony A Romeo
Glenohumeral osteoarthritis in the young patient (aged <60 years) is a difficult condition, given both age and functional demands. Primary osteoarthritis is the most common etiology in this patient demographic, but secondary causes include osteonecrosis, previous trauma (eg, fracture-dislocation), previous infection (eg, septic arthritis), previous capsulorrhaphy, previous arthroscopic surgery (eg, chondrolysis), and glenoid dysplasia. Nonsurgical modalities, including activity modification, pharmacotherapy, physical therapy, and intra-articular injections, are the mainstay of management; however, in young patients who have exhausted nonsurgical management, surgical options include arthroscopic débridement, humeral head replacement with or without glenoid treatment (ie, biologic glenoid resurfacing, glenoid reaming), and total or reverse total shoulder arthroplasty...
September 1, 2018: Journal of the American Academy of Orthopaedic Surgeons
Venkatesh Anehosur, Abhijit Joshi, Saravanan Rajendiran
Management of condylar fractures is a highly controversial and debatable area. Open reduction and internal fixation (ORIF) using an extraoral approach has certain benefits over the nonsurgical treatment. Risk of damage to the facial nerve and an extraoral scar remains constant deterrents. An endoscopic-assisted ORIF offers an intraoral approach, thus eliminating consequences such as scarring. Though this technique offers unparalleled advantages, it is associated with a steep learning curve. Surgical results improve only with patience and experience...
September 2018: Craniomaxillofacial Trauma & Reconstruction
Joseph M Pappachan, Mohamed Nabil Elnaggar, Ravinder Sodi, Kahtan Jbeili, Paul R Smith, Ian M Lahart
BACKGROUND: Although there are international guidelines on diagnosis and management of primary hyperparathyroidism (PHPT), clinical practice varies in different centres. Periodic review of diagnostic work-up, surgical treatment by parathyroidectomy (PTX) and clinical surveillance in nonsurgical treatment group among patients with PHPT is expected to improve the quality of care. We report a retrospective study of cases with PHPT managed at a regional centre in the United Kingdom. METHODS: Clinical data of cases with calcium ≥2...
October 2018: Endocrine
Andrew Nataraj, Andrew S Jack, Ihsan Ihsanullah, Shawn Nomani, Frank Kortbeek, Richard Fox
STUDY DESIGN: This is a single-center, retrospective, observational cohort study. OBJECTIVE: To determine whether surgery or nonoperative treatment has better clinical outcomes in neurologically intact patients with an intermediate severity thoracolumbar burst fracture. SUMMARY OF BACKGROUND DATA: Optimal management, whether initial operative or nonoperative treatment, for thoracolumbar injury classification score (TLICS) 4 burst fractures remains controversial...
July 2018: Clinical Spine Surgery
Jack G Graham, Michael Rivlin, Jack Abboudi, Kevin Lutsky, Pedro K Beredjiklian
Trapeziectomy with suture-button suspensionplasty is a surgical treatment option for thumb carpometacarpal osteoarthritis refractory to nonsurgical management. We describe the cases of 3 patients who presented with index metacarpal fracture, in the absence of traumatic injury, over 4 months after trapeziectomy with suture-button suspensionplasty. All 3 fractures demonstrated the same pattern: short oblique/spiral, oriented proximal radial to distal ulnar with the distal end in the vicinity of the index metacarpal button, presumably after the orientation of the metacarpal drill hole...
May 24, 2018: Journal of Hand Surgery
Sarah D Berry, Randi R Rothbaum, Douglas P Kiel, Yoojin Lee, Susan L Mitchell
Importance: The decision whether to surgically repair a hip fracture in nursing home (NH) residents with advanced dementia can be challenging. Objective: To compare outcomes, including survival, among NH residents with advanced dementia and hip fracture according to whether they underwent surgical hip fracture repair. Design, Setting, and Participants: We conducted a retrospective cohort study of 3083 NH residents with advanced dementia and hip fracture, but not enrolled in hospice care, using nationwide Medicare claims data linked with Minimum Data Set (MDS) assessments from January 1, 2008, through December 31, 2013...
June 1, 2018: JAMA Internal Medicine
C Bree Johnston, Amanda Holleran, Thuan Ong, Ursula McVeigh, Elizabeth Ames
IMPORTANCE: Many older patients with a limited life expectancy experience fragility fracture of the hip, and this event is associated with increased risk of premature mortality, functional decline, and institutionalization. The treating team, in collaboration with patients and their families, must determine whether a surgical or conservative approach is in the patient's best interest when a patient has limited life expectancy. OBSERVATION: Goals of care discussions appear to be rare in the setting of fragility fracture...
August 2018: Journal of Palliative Medicine
Brian C F Chan, B Catharine Craven, Julio C Furlan
OBJECTIVE Acute spine trauma (AST) has a relatively low incidence, but it often results in substantial individual impairments and societal economic burden resulting from the associated disability. Given the key role of neurosurgeons in the decision-making regarding operative management of individuals with AST, the authors performed a systematic search with scoping synthesis of relevant literature to review current knowledge regarding the economic burden of AST. METHODS This systematic review with scoping synthesis included original articles reporting cost-effectiveness, cost-utility, cost-benefit, cost-minimization, cost-comparison, and economic analyses related to surgical management of AST, whereby AST is defined as trauma to the spine that may result in spinal cord injury with motor, sensory, and/or autonomic impairment...
May 2018: Neurosurgical Focus
Marc D Lipman, Trenton M Gause, Victor A Teran, A Bobby Chhabra, D Nicole Deal
Radial head and neck fractures are one of the most common elbow fractures, comprising 2% to 5% of all fractures, and 30% of elbow fractures. Although uncomplicated Mason type I fractures can be managed nonsurgically, Mason type II-IV fractures require additional intervention. Mason type II-III fractures with 3 or fewer fragments are typically treated with open reduction and internal fixation using 2 to 3 lag screws. Transverse radial neck involvement or axial instability with screw-only fixation has historically required the additional use of a mini fragment T-plate or locking proximal radius plate...
June 2018: Journal of Hand Surgery
Eric J Strauss, Daniel James Kaplan, Maxwell E Weinberg, Jonathan Egol, Laith M Jazrawi
Tibial spine fractures are uncommon injuries affecting the insertion of the anterior cruciate ligament on the tibia. They typically occur in skeletally immature patients aged 8 to 14 years and result from hyperextension of the knee with a valgus or rotational force. Diagnosis is based on history, physical examination, and standard radiographs. The use of MRI can identify entrapped soft tissue that may prevent reduction. Open or arthroscopic repair is indicated in patients with partially displaced fractures (>5 mm) with one third to one half of the avulsed fragment elevated, in patients who have undergone unsuccessful nonsurgical reduction and long leg casting or bracing, and in patients with completely displaced fractures...
May 15, 2018: Journal of the American Academy of Orthopaedic Surgeons
Jacob R Brodsky, Talia N Shoshany, Sophie Lipson, Guangwei Zhou
Objective To review peripheral vestibular disorders in pediatric patients with dizziness following concussion. Study Design Case series with chart review. Setting Pediatric vestibular clinic and pediatric multidisciplinary concussion clinic at a tertiary level pediatric hospital. Subjects and Methods We retrospectively reviewed 109 patients seen for dizziness following a concussion between September 2012 and July 2015. Patients were ≤20 years of age at the time of concussion. Incidences of specific peripheral vestibular disorders were assessed along with timing of diagnosis relative to the date of injury, diagnostic test findings, and treatment interventions associated with those diagnoses...
August 2018: Otolaryngology—Head and Neck Surgery
Christopher D Shank, Beverly C Walters, Mark N Hadley
Acute traumatic spinal cord injury (SCI) affects more than 250,000 people in the USA, with approximately 17,000 new cases each year. It continues to be one of the most significant causes of trauma-related morbidity and mortality. Despite the introduction of primary injury prevention education and vehicle safety devices, such as airbags and passive restraint systems, traumatic SCI continues to have a substantial impact on the healthcare system. Over the last three decades, there have been considerable advancements in the management of patients with traumatic SCI...
April 12, 2018: Neurocritical Care
Salah Aldekhayel, Erfan Ghanad, Chaitanya S Mudgal
PURPOSE: To report on 4 cases of avascular necrosis of the metacarpal head. METHODS: We retrospectively reviewed 4 patients who received a diagnosis of avascular necrosis of the metacarpal head and were treated from 2000 to 2016. RESULTS: All patients were males with involvement of the dominant hand. Three patients had a history of trauma and/or fractures in another finger and one had a history of fracture in the same finger. The diagnosis was confirmed on regular x-rays and magnetic resonance imaging...
April 3, 2018: Journal of Hand Surgery
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