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2.
Medicine (Baltimore) ; 99(2): e18577, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914036

RESUMO

BACKGROUND: Autologous blood transfusion helps to avoid or reduce the need for allogenic blood transfusion in patients undergoing major surgery. We examined the value of erythropoietin therapy to support preoperative autologous blood donation (PABD) in patients undergoing orthopedic surgery. METHODS: For this systematic review and meta-analysis, Medline, Cochrane, EMBASE, and Google Scholar databases were searched from October 26th, 1989 until September 30th, 2017. Primary outcomes were percentages of patients able to donate ≥4 units of blood for autologous transfusion, amount of allogeneic blood transfused, changes in hematocrit and hemoglobin levels from before PABD to immediately before surgery, and adverse events. RESULTS: Of 256 studies identified, 18 studies met the inclusion criteria with a total of 1914 patients (mean age 51-69 years), of whom 1153 were treated with erythropoietin. Erythropoietin was associated with a greater percentage of patients able to donate ≥4 units of blood for autologous use compared to controls (OR = 6.00, 95% CI = 3.97 to 9.09, P < .001). Patients receiving preoperative erythropoietin had significantly less of a reduction in hematocrit and hemoglobin levels from before PABD to immediately before surgery compared with controls (hematocrit: mean differences = -1.438, 95% CI = -2.14 to -0.73, P < .001; hemoglobin: mean differences = -1.426, 95% CI = -1.78 to -1.07, P < .001). No significant differences were observed in the amount of allogenic blood transfused between patients receiving erythropoietin and controls (difference in means = -0.220, 95% CI = -0.536 to 0.097, P = .174). Patients who received erythropoietin were less likely to experience dizziness than controls, but the incidence of nausea or fatigue were similar between groups. CONCLUSION: Erythropoietin therapy during the PABD period results in less of a reduction in hematocrit and hemoglobin levels and an increase in the percentage of patients able to donate blood preoperatively.


Assuntos
Transfusão de Sangue Autóloga/métodos , Eritropoetina/uso terapêutico , Procedimentos Ortopédicos/métodos , Período Pré-Operatório , Idoso , Eritropoetina/administração & dosagem , Eritropoetina/efeitos adversos , Feminino , Hematócrito , Hemoglobinas , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Orthop Clin North Am ; 51(1): 37-53, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739878

RESUMO

In situ pinning of slipped capital femoral epiphysis (SCFE) is a safe and effective treatment modality, but often results in residual deformity leading to femoroacetabular impingement, which may limit patient activities and predispose to early onset arthritis. Enhanced understanding of the implications of femoroacetabular impingement and new surgical techniques have prompted interest in treating post-slipped capital femoral epiphysis deformity to both improve current symptoms and delay or prevent hip arthrosis.


Assuntos
Coxa Magna/cirurgia , Quadril/diagnóstico por imagem , Osteoartrite do Quadril/prevenção & controle , Escorregamento das Epífises Proximais do Fêmur/cirurgia , Artroscopia/métodos , Pinos Ortopédicos/efeitos adversos , Pinos Ortopédicos/normas , Impacto Femoroacetabular/etiologia , Impacto Femoroacetabular/cirurgia , Fêmur/cirurgia , Quadril/cirurgia , Luxação do Quadril/cirurgia , Humanos , Procedimentos Ortopédicos/métodos , Osteoartrite do Quadril/cirurgia , Osteotomia/métodos , Cuidados Pós-Operatórios , Estudos Retrospectivos , Resultado do Tratamento
4.
Emerg Med Clin North Am ; 38(1): 1-13, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757244

RESUMO

Acute musculoskeletal injuries are commonly seen in our emergency departments, and are commonly missed. There are many reasons for more missed injures and a significant one is over-reliance on radiographs. An emergency department orthopedic assessment goes far beyond the radiographs. A focused, yet comprehensive history is vital to understand the forces and mechanism of injury. That injury must be understood in the context of the patient, because older and much younger patients have weaker bone. Finally, the physical examination is instrumental in localizing the pathology and is essential to put radiograph results in the proper clinical context.


Assuntos
Gerenciamento Clínico , Medicina de Emergência/métodos , Procedimentos Ortopédicos/métodos , Exame Físico/métodos , Radiografia/métodos , Ferimentos e Lesões/terapia , Humanos , Ferimentos e Lesões/diagnóstico
5.
Emerg Med Clin North Am ; 38(1): 103-124, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757245

RESUMO

Shoulder pain is a common presentation in the emergency department. The list of differential diagnoses is broad. This article summarizes common diagnoses of shoulder pain, including bony, infectious, and connective tissue pathologies and their proper treatment. It also reviews which shoulder pain conditions are emergency diagnoses and need immediate treatment and which diagnoses need conservative management and outpatient follow-up.


Assuntos
Articulação Acromioclavicular/lesões , Clavícula/lesões , Emergências , Úmero/lesões , Procedimentos Ortopédicos/métodos , Radiografia/métodos , Ferimentos e Lesões/diagnóstico , Articulação Acromioclavicular/diagnóstico por imagem , Clavícula/diagnóstico por imagem , Gerenciamento Clínico , Humanos , Úmero/diagnóstico por imagem , Ferimentos e Lesões/terapia
6.
Emerg Med Clin North Am ; 38(1): 125-142, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757246

RESUMO

Traumatic injuries of the hip and pelvis are commonly encountered in the emergency department. This article equips all emergency medicine practitioners with the knowledge to expertly diagnose, treat, and disposition these patients. Pelvic fractures occurring in young patients tend to be associated with high-energy mechanisms and polytrauma. Pelvic and hip fractures in the elderly are often a result of benign trauma but are associated with significant morbidity and mortality.


Assuntos
Gerenciamento Clínico , Emergências , Fraturas Ósseas/diagnóstico , Traumatismo Múltiplo , Procedimentos Ortopédicos/métodos , Ossos Pélvicos/lesões , Radiografia/métodos , Fraturas Ósseas/terapia , Humanos , Ossos Pélvicos/diagnóstico por imagem
7.
Emerg Med Clin North Am ; 38(1): 143-165, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757247

RESUMO

Knee and leg injuries are extremely common presentations to the emergency department. Understanding the anatomy of the knee, particularly the vasculature and ligamentous structures, can help emergency physicians (EPs) diagnose and manage these injuries. Use of musculoskeletal ultrasonography can further aid EPs through the diagnostic process. Proper use of knee immobilizers can also improve long-term patient outcomes.


Assuntos
Gerenciamento Clínico , Emergências , Traumatismos do Joelho/diagnóstico , Articulação do Joelho/diagnóstico por imagem , Procedimentos Ortopédicos/métodos , Humanos , Traumatismos do Joelho/terapia , Traumatismos da Perna/diagnóstico , Traumatismos da Perna/terapia
8.
Emerg Med Clin North Am ; 38(1): 15-29, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757248

RESUMO

Appropriate recognition of the physiologic, psychological, and clinical differences among geriatric patients, with respect to orthopedic injury and disease, is paramount for all emergency medicine providers to ensure they are providing high-value care for this vulnerable population.


Assuntos
Gerenciamento Clínico , Avaliação Geriátrica , Geriatria/métodos , Procedimentos Ortopédicos/métodos , Ortopedia/métodos , Ferimentos e Lesões/terapia , Idoso , Humanos , Ferimentos e Lesões/diagnóstico
9.
Emerg Med Clin North Am ; 38(1): 167-191, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757249

RESUMO

Neck and back pain are among the most common symptom-related complaints for visits to the emergency department (ED). They contribute to high levels of lost work days, disability, and health care use. The goal of ED assessment of patients with neck and back pain is to evaluate for potentially dangerous causes that could result in significant morbidity and mortality. This article discusses the efficient and effective evaluation, management, and treatment of patients with neck and back pain in the ED. Emphasis is placed on vertebral osteomyelitis, epidural abscess, acute transverse myelitis, epidural compression syndrome, spinal malignancy, and spinal stenosis.


Assuntos
Dor nas Costas/diagnóstico , Gerenciamento Clínico , Emergências , Cervicalgia/diagnóstico , Procedimentos Ortopédicos/métodos , Medição da Dor/métodos , Dor nas Costas/terapia , Humanos , Cervicalgia/terapia
10.
Emerg Med Clin North Am ; 38(1): 193-206, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757250

RESUMO

Many orthopedic injuries can have hidden risks that result in increased liability for the emergency medicine practitioner. It is imperative that emergency medicine practitioners consider the diagnoses of compartment syndrome, high-pressure injury, spinal epidural abscess, and tendon lacerations in the right patient. Consideration of the diagnosis and prompt referrals can help to minimize the complications these patients often develop.


Assuntos
Emergências , Tratamento de Emergência/métodos , Responsabilidade Legal , Imperícia/legislação & jurisprudência , Procedimentos Ortopédicos/legislação & jurisprudência , Gestão de Riscos/legislação & jurisprudência , Ferimentos e Lesões/terapia , Humanos , Procedimentos Ortopédicos/métodos
11.
Emerg Med Clin North Am ; 38(1): 31-59, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757254

RESUMO

Approximately one-third of children sustain a fracture before the age of 16 years; however, their unique anatomy and healing properties often result in a good outcome. This article focuses on the diagnosis and management of pediatric extremity injuries. The article describes the anatomic features and healing principles unique to children and discusses pediatric upper and lower extremity fractures and presents evidence-based and standard practice for their management. Finally, the article describes the conditions under which emergency physicians are likely to miss pediatric fractures by highlighting specific examples and discussing the general factors that lead to these errors.


Assuntos
Traumatismos do Braço/diagnóstico , Emergências , Serviço Hospitalar de Emergência , Fraturas Ósseas/diagnóstico , Traumatismos da Perna/diagnóstico , Procedimentos Ortopédicos/métodos , Radiografia/métodos , Traumatismos do Braço/terapia , Criança , Gerenciamento Clínico , Fraturas Ósseas/terapia , Humanos , Traumatismos da Perna/terapia
12.
Emerg Med Clin North Am ; 38(1): 61-79, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757255

RESUMO

Injury patterns of the hand and wrist can be complex and challenging for the emergency physician to diagnose and treat. The ability of the hand to perform delicate maneuvers requires a very intricate interplay of bones, ligaments, and tendons. Unfortunately, due to the omnipresence of the hand, the hand and wrist are commonly injured. These injuries can be debilitating if not treated correctly and can be both time-consuming and fraught with medicolegal risk. This article provides the necessary knowledge to diagnose and treat common hand and wrist injuries encountered in the emergency department.


Assuntos
Gerenciamento Clínico , Emergências , Fraturas Ósseas , Traumatismos da Mão , Procedimentos Ortopédicos/métodos , Radiografia , Traumatismos do Punho , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/terapia , Saúde Global , Traumatismos da Mão/diagnóstico , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/terapia , Humanos , Incidência , Traumatismos do Punho/diagnóstico , Traumatismos do Punho/epidemiologia , Traumatismos do Punho/terapia
13.
Emerg Med Clin North Am ; 38(1): 81-102, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757256

RESUMO

This article provides an updated review of the emergent evalution and treatment of elbow and forearm injuries in the emergency department. Clinically necessary imaging is discussed. Common and uncommon injuries of the elbow and forearm are reviewed with an emphasis on early recognition, efficient management, and avoidance of complications. The astute emergency physician will rely on a focused history and precise examination, applied anatomic knowledge, and strong radiographic interpretative skills to avoid missed injuries and complications.


Assuntos
Gerenciamento Clínico , Articulação do Cotovelo/lesões , Emergências , Traumatismos do Antebraço/diagnóstico , Procedimentos Ortopédicos/métodos , Radiografia/métodos , Articulação do Cotovelo/diagnóstico por imagem , Traumatismos do Antebraço/terapia , Humanos
14.
J Craniomaxillofac Surg ; 47(12): 1881-1886, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31812313

RESUMO

In synchronous primary premaxillary setback and cleft lip repair for bilateral cases with severely protruding premaxilla, stabilization of the premaxilla is mostly achieved by gingivoperiosteoplasty. This kind of repair carries risk of impairment of blood supply to the premaxilla and/or prolabium, and at the same time it cannot ensure adequate stabilization of the premaxilla postoperatively. To overcome these problems, we have developed a unique technique of fixation of the premaxilla. In this paper, we discussing this technique, its advantages, and potential complications associated with it. From 2016, 10 patients aged 4-10 months, with bilateral cleft lip and palate with premaxillary protrusion (≥10 mm) underwent premaxillary setback and cheilorhinoplasty in the same stage. Instead of gingivoperiosteoplasty, a 'lag screw' fixation technique was used to stabilize the premaxilla. The follow-up period ranged between 5 and 32 months. In all the cases, we achieved adequate stabilization of the premaxilla. None of the patients had any issue related to the vascularity of the premaxilla or prolabium. There was no impairment in the eruption process of deciduous teeth in the premaxillary segment. Overall aesthetic outcomes of the lip and nose were acceptable. This technique of premaxillary fixation with lag screw gives us the liberty to perform primary cheilorhinoplasty along with premaxillary setback in the same stage, without risking the vascularity of premaxilla and prolabium. It ensures adequate stabilization of the premaxilla, but evaluation of regular growth of the midface and, if needed, corrective orthodontic and surgical treatment in the follow-up periods are advisable.


Assuntos
Parafusos Ósseos , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Maxila/anormalidades , Maxila/cirurgia , Osteotomia Maxilar/métodos , Vômer/cirurgia , Estética Dentária , Feminino , Humanos , Lactente , Masculino , Procedimentos Ortopédicos/métodos , Resultado do Tratamento
16.
Bone Joint J ; 101-B(12): 1479-1488, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31786992

RESUMO

AIMS: Computer-based applications are increasingly being used by orthopaedic surgeons in their clinical practice. With the integration of technology in surgery, augmented reality (AR) may become an important tool for surgeons in the future. By superimposing a digital image on a user's view of the physical world, this technology shows great promise in orthopaedics. The aim of this review is to investigate the current and potential uses of AR in orthopaedics. MATERIALS AND METHODS: A systematic review of the PubMed, MEDLINE, and Embase databases up to January 2019 using the keywords 'orthopaedic' OR 'orthopedic AND augmented reality' was performed by two independent reviewers. RESULTS: A total of 41 publications were included after screening. Applications were divided by subspecialty: spine (n = 15), trauma (n = 16), arthroplasty (n = 3), oncology (n = 3), and sports (n = 4). Out of these, 12 were clinical in nature. AR-based technologies have a wide variety of applications, including direct visualization of radiological images by overlaying them on the patient and intraoperative guidance using preoperative plans projected onto real anatomy, enabling hands-free real-time access to operating room resources, and promoting telemedicine and education. CONCLUSION: There is an increasing interest in AR among orthopaedic surgeons. Although studies show similar or better outcomes with AR compared with traditional techniques, many challenges need to be addressed before this technology is ready for widespread use. Cite this article: Bone Joint J 2019;101-B:1479-1488.


Assuntos
Realidade Aumentada , Procedimentos Ortopédicos/métodos , Cirurgia Assistida por Computador/métodos , Atitude do Pessoal de Saúde , Humanos , Procedimentos Ortopédicos/tendências , Ortopedia/métodos , Ortopedia/tendências , Cirurgiões , Cirurgia Assistida por Computador/tendências
17.
Bone Joint J ; 101-B(12): 1542-1549, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31786996

RESUMO

AIMS: Spinal tuberculosis (TB) remains an important concern. Although spinal TB often has sequelae such as myelopathy after treatment, the predictive factors affecting such unfavourable outcomes are not yet established. We investigated the clinical manifestations and predictors of unfavourable treatment outcomes in patients with spinal TB. PATIENTS AND METHODS: We performed a multicentre retrospective cohort study of patients with spinal TB. Unfavourable outcome was defined according to previous studies. The prognostic factors for unfavourable outcomes as the primary outcome were determined using multivariable logistic regression analysis and a linear mixed model was used to compare time course of inflammatory markers during treatment. A total of 185 patients were included, of whom 59 patients had unfavourable outcomes. RESULTS: In multivariate regression analysis, the factors associated with unfavourable outcome were old age (odds ratio (OR) 2.51; 95% confidence interval (CI) 1.07 to 5.86; p = 0.034), acid-fast bacilli (AFB) smear positivity in specimens obtained through biopsy (OR 3.05; 95% CI 1.06 to 8.80; p = 0.039), and elevated erythrocyte sedimentation rate (ESR) at the end of treatment (OR 3.85; 95% CI 1.62 to 9.13; p = 0.002). Patients with unfavourable outcomes had a significant trend toward higher ESR during treatment compared with patients with favourable outcome (p = 0.009). Duration of anti-TB and surgical treatment did not affect prognosis. CONCLUSION: Elevated ESR at the end of treatment could be used as a marker to identify spinal TB patients with a poor prognosis. Patients whose ESR is not normalized during treatment, as well as those with old age and AFB smear positivity, should be aware of unfavourable outcomes. Cite this article: Bone Joint J 2019;101-B:1542-1549.


Assuntos
Antituberculosos/uso terapêutico , Procedimentos Ortopédicos , Tuberculose da Coluna Vertebral/diagnóstico , Tuberculose da Coluna Vertebral/terapia , Adulto , Idoso , Biomarcadores/sangue , Sedimentação Sanguínea , Terapia Combinada , Efeitos Psicossociais da Doença , Feminino , Seguimentos , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Prognóstico , República da Coreia , Estudos Retrospectivos , Resultado do Tratamento , Tuberculose da Coluna Vertebral/sangue
18.
Bone Joint J ; 101-B(12): 1563-1569, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31787003

RESUMO

AIMS: The aim of this study was to compare the surgical and quality-of-life outcomes of children with skeletal dysplasia to those in children with idiopathic early-onset scoliosis (EOS) undergoing growth-friendly management. PATIENTS AND METHODS: A retrospective review of two prospective multicentre EOS databases identified 33 children with skeletal dysplasia and EOS (major curve ≥ 30°) who were treated with growth-friendly instrumentation at younger than ten years of age, had a minimum two years of postoperative follow-up, and had undergone three or more lengthening procedures. From the same registries, 33 matched controls with idiopathic EOS were identified. A total of 20 children in both groups were treated with growing rods and 13 children were treated with vertical expandable prosthetic titanium rib (VEPTR) instrumentation. RESULTS: Mean preoperative major curves were 76° (34° to 115°) in the skeletal dysplasia group and 75° (51° to 113°) in the idiopathic group (p = 0.55), which were corrected at final follow-up to 49° (13° to 113°) and 46° (12° to 112°; p = 0.68), respectively. T1-S1 height increased by a mean of 36 mm (0 to 105) in the skeletal dysplasia group and 38 mm (7 to 104) in the idiopathic group at the index surgery (p = 0.40), and by 21 mm (1 to 68) and 46 mm (7 to 157), respectively, during the distraction period (p = 0.0085). The skeletal dysplasia group had significantly worse scores in the physical function, daily living, financial impact, and parent satisfaction preoperatively, as well as on financial impact and child satisfaction at final follow-up, than the idiopathic group (all p < 0.05). The domains of the 24-Item Early-Onset Scoliosis Questionnaire (EOSQ24) remained at the same level from preoperative to final follow-up in the skeletal dysplasia group (all p > 0.10). CONCLUSION: Children with skeletal dysplasia gained significantly less spinal growth during growth-friendly management of their EOS and their health-related quality of life was significantly lower both preoperatively and at final follow-up than in children with idiopathic EOS. Cite this article: Bone Joint J 2019;101-B:1563-1569.


Assuntos
Doenças do Desenvolvimento Ósseo/complicações , Procedimentos Ortopédicos/métodos , Escoliose/cirurgia , Estudos de Casos e Controles , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Masculino , Procedimentos Ortopédicos/instrumentação , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Estudos Retrospectivos , Escoliose/etiologia , Coluna Vertebral/crescimento & desenvolvimento , Coluna Vertebral/cirurgia , Resultado do Tratamento
20.
Medicine (Baltimore) ; 98(51): e18061, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860955

RESUMO

Close suction drainage systems are widely used in orthopedics and spine surgeries. There are less studies investigating the outcomes of using subfascial closed suction drains in adolescent patients who had undergone idiopathic scoliosis surgery. We evaluated the outcomes of patients with and without closed suction drainage and to investigate whether close suction drainage is needed after adolescent idiopathic scoliosis (AIS) surgery.We retrospectively investigated 63 patients, who underwent posterior spinal surgery for AIS from January 2015 to January 2018. The patients were divided into the following groups: Groups A (drainage group) and B (nondrainage group). We evaluated the wound drainage (wound oozing), need for transfusion, preoperative and postoperative hemoglobin levels, length of hospital stay, and postoperative blood loss from closed suction drains. Patients' scoliosis was categorized according to the Lenke Classification System for Scoliosis. The level of instrumentations was also evaluated.The median postoperative hemoglobin level was lower in group A than in group B. Postoperatively, group A underwent more blood transfusions than group B. Postoperative hospital stay was also significantly longer in group A than in group B. There was no statistical difference in the infection rate between the two groups.Using drains after AIS surgery increases hospital stay duration, blood transfusion rate and patients' anxiety of drain tube removal. Thus, closed suction drainage may not be suitable after AIS surgery.


Assuntos
Procedimentos Ortopédicos/métodos , Escoliose/cirurgia , Sucção/efeitos adversos , Sucção/métodos , Infecção da Ferida Cirúrgica/diagnóstico , Adolescente , Estudos de Coortes , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Papel (figurativo) , Escoliose/diagnóstico por imagem , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Infecção da Ferida Cirúrgica/epidemiologia
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