Enhanced recovery after surgery (ERAS) protocols for total joint replacement surgery.

The enhanced recovery after surgery (ERAS) protocols are a comprehensive therapeutic approach that prioritizes the well-being of patients. It encompasses several aspects such as providing sufficient nutritional support, effectively managing pain, ensuring appropriate fluid management and hydration, and promoting early mobilization after surgery. The advent of ERAS theory has led to a shift in focus within modern ERAS protocols. At present, ERAS protocols emphasize perioperative therapeutic strategies employed by surgeons and anesthesiologists, as well as place increased importance on preoperative patient education, interdisciplinary collaboration, and the enhancement of patient satisfaction and clinical outcomes. This editorial highlights the application of ERAS protocols in the current context of total joint replacement surgery.

Orthopaedic cardiac considerations in emergency.

Orthopaedic patients undergoing emergency orthopaedic surgery should be referred for cardiac evaluation only when they are symptomatic or when a specific cardiac intervention is expected to reduce the surgical risk. A preoperative delay of 24-48 h of emergency orthopaedic operations has been associated with increased mortality and poor functional status of the patients. Research in the preoperative setting is almost exclusively retrospective because randomized studies are difficult to be performed and pose serious ethical concerns. Moreover, inevitably, guidelines have a low level of evidence and do not always provide a straightforward framework for the preoperative care of the patients. This editorial revisits the most common clinical cardiology dilemmas for emergency orthopaedic surgery to explore controversies of current recommendations and elaborate on the role of echocardiography in the perioperative period in emergency orthopaedic surgery.

The Hippocratic Oath: Analysis and Contemporary Meaning.

The Hippocratic oath is traditionally taken by medical school graduates at the time of their graduation, either in its original form or in a modern variation. It is considered the earliest expression of medical ethics, establishing principles of ethics that remain of paramount significance today. However, it was written in antiquity, whereas medicine has been constantly evolving. This article reviews, analyzes, and interprets each section of the oath to determine to what extent it remains relevant to contemporary medicine. [Orthopedics. 2021;44(5):264-272.].

Echinococcosis of the spine.

Echinococcosis or hydatid disease affecting the spine is an uncommon manifestation of Echinococcus granulosus infection of the spine.More commonly found in endemic areas, it causes significant morbidity and mortality as it grows slowly and produces symptoms mainly by compressing the spinal cord.As diagnostic methods are non-specific, diagnosis and management are usually delayed until the disease is advanced, thereby therapy is usually unlikely.Treatment is usually surgical, aiming at cyst excision, spinal cord decompression and spinal stabilization.This article summarizes the clinical findings of echinococcosis of the spine, discusses the specific laboratory and diagnostic findings, lists the current treatment options, and reviews the patients' outcomes.The aim is to prompt clinicians to be aware of the possibility of echinococcosis as a possible diagnosis in endemic areas. Cite this article: EFORT Open Rev 2021;6:288-296. DOI: 10.1302/2058-5241.6.200130.

The Asclepian art of medicine and surgery.

PURPOSE: To summarize the available information from mythology, archeology, and classical literature aiming to compose the image of Asclepieia, Asclepius, and the Asclepiads, and to depict the atmosphere of medicine in its infancy. METHOD: A thorough literature search was undertaken in PubMed and Google Scholar as well as in physical books in libraries to summarize the pharmacies and pain practices used for trauma in ancient Greece. RESULTS: The antiquity of medicine is confirmed by the worship of God Apollo and Asclepius, who were the persons who possessed the knowledge of medicine and surgery, and delivered it to mortals. The available archaeological data, stone offerings, and inscriptions from Asclepieia were the first testimonies of divine and human knowledge and provide insights on individual cases of patients cured by the Asclepiads. Sparse descriptions offer a first glimpse of the methods and means used by the first priests-physicians for wound healing and diseases treatment. CONCLUSION: Asclepieia established the roots of medicine and the first step of human knowledge, and contributed to the field of surgery and pharmacology that gave birth to the rational medicine. With Hippocrates and his research, the circle of Asclepieia ended, and the era of the organized medical schools with theories and experiments on every aspect of medicine begun.

The history of microsurgery.

Microsurgery is a term used to describe the surgical techniques that require an operating microscope and the necessary specialized instrumentation, the three "Ms" of Microsurgery (microscope, microinstruments and microsutures). Over the years, the crucial factor that transformed the notion of microsurgery itself was the anastomosis of successively smaller blood vessels and nerves that have allowed transfer of tissue from one part of the body to another and re-attachment of severed parts. Currently, with obtained experience, microsurgical techniques are used by several surgical specialties such as general surgery, ophthalmology, orthopaedics, gynecology, otolaryngology, neurosurgery, oral and maxillofacial surgery, plastic surgery and more. This article highlights the most important innovations and milestones in the history of microsurgery through the ages that allowed the inauguration and establishment of microsurgical techniques in the field of surgery.

Pharmacies for pain and trauma in ancient Greece.

PURPOSE: To summarize pharmacies for pain and trauma in ancient Greece, to present several pharmaceutical/therapeutical methods reported in myths and ancient texts, and to theorize on the medical explanation upon which these pharmacies were used. METHOD: A thorough literature search was undertaken in PubMed and Google Scholar as well as in physical books in libraries to summarize the pharmacies and pain practices used for trauma in ancient Greece. RESULTS: Archeological findings and historical texts have revealed that humans have always suffered from diseases and trauma that were initially managed and healed by priests and magicians. In early Greek antiquity, the term pharmacy was related to herbal inquiries, with the occupants called charmers and pharmacists. Additionally, apart from therapeutic methods, ancient Greeks acknowledged the importance of pain therapy and had invented certain remedies for both acute and chronic pain management. With observations and obtaining experience, they used plants, herbs, metals and soil as a therapeutic method, regardless of the cultural level of the population. They achieved sedation and central and peripheral analgesia with opium and cold, as well as relaxation of smooth muscle fibers and limiting secretions with atropina. CONCLUSION: History showed a lot of experience obtained from empirical testing of pain treatment in ancient people. Experience and reasoning constructed an explanatory account of diseases, therapies and health and have provided for the epistemology of medicine.

Reduction techniques for difficult subtrochanteric fractures.

Subtrochanteric fractures can result from high-energy trauma in young patients or from a fall or minor trauma in the elderly. Intramedullary nails are currently the most commonly used implants for the stabilization of these fractures. However, the anesthetic procedure for the patients, the surgical reduction and osteosynthesis for the fractures are challenging. The anesthetic management of orthopedic trauma patients should be based upon various parameters that must be evaluated before the implementation of any anesthetic technique. Surgery- and patient-related characteristics and possible comorbidities must be considered during the pre-anesthetic evaluation. Adequate fracture reduction and proper nail entry point are critical. Understanding of the deforming forces acting on various fracture patterns and knowledge of surgical reduction techniques are essential in obtaining successful outcomes. This article discusses the intraoperative reduction techniques for subtrochanteric fractures in adults and summarizes tips and tricks that the readers may find useful and educative.

The ABC and pain in trauma.

Musculoskeletal trauma in the emergency setting is a challenge for orthopaedic surgeons. Life- and limb-threatening injuries of the extremities should be treated as soon as possible, since major musculoskeletal trauma can be the cause of significant bleeding. However, musculoskeletal trauma is often related to thoracic trauma. Management of the former should be performed only after patient's airway is maintained and breathing is secured with appropriate pain monitoring and management by expert anesthesiologists. This article discusses the association of musculoskeletal with thoracic trauma care and emphasizes on pain as a vital sign in trauma.