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Surgery_Schwartz_12402 | Surgery_Schwartz | on MRI scans in asymptomatic patients. Symptomatic patients usually present with headache, neck pain, or symptoms of myelopathy, including numbness or weakness in the extremities. A syrinx may be associated, but the brain stem and lower cranial nerves are normal in Chiari I malfor-mations. Chiari II malformations are more severe and involve caudal displacement of the lower brain stem and stretching of the lower cranial nerves. Symptomatic patients may be treated with suboccipital craniectomy to remove the posterior arch of the foramen magnum, along with removal of the posterior ring Brunicardi_Ch42_p1827-p1878.indd 187301/03/19 7:17 PM 1874SPECIFIC CONSIDERATIONSPART IIFigure 42-35. T1-weighted sagittal magnetic resonance imaging of a patient with a Chiari I malformation. The large arrowhead points to the cerebellar tonsils. The small arrowhead points to the posterior arch of the foramen magnum.of C1. Removal of these bony structures relieves the compres-sion of the cerebellar | Surgery_Schwartz. on MRI scans in asymptomatic patients. Symptomatic patients usually present with headache, neck pain, or symptoms of myelopathy, including numbness or weakness in the extremities. A syrinx may be associated, but the brain stem and lower cranial nerves are normal in Chiari I malfor-mations. Chiari II malformations are more severe and involve caudal displacement of the lower brain stem and stretching of the lower cranial nerves. Symptomatic patients may be treated with suboccipital craniectomy to remove the posterior arch of the foramen magnum, along with removal of the posterior ring Brunicardi_Ch42_p1827-p1878.indd 187301/03/19 7:17 PM 1874SPECIFIC CONSIDERATIONSPART IIFigure 42-35. T1-weighted sagittal magnetic resonance imaging of a patient with a Chiari I malformation. The large arrowhead points to the cerebellar tonsils. The small arrowhead points to the posterior arch of the foramen magnum.of C1. Removal of these bony structures relieves the compres-sion of the cerebellar |
Surgery_Schwartz_12403 | Surgery_Schwartz | arrowhead points to the cerebellar tonsils. The small arrowhead points to the posterior arch of the foramen magnum.of C1. Removal of these bony structures relieves the compres-sion of the cerebellar tonsils and cervicomedullary junction, and may allow reestablishment of normal CSF flow patterns. Figure 42-35 demonstrates typical MRI appearance of a Chiari I malformation.REFERENCESEntries highlighted in bright blue are key references. 1. Kandel E, Schwartz J, Jessell T. Principles of Neural Science, 4th ed. New York: McGraw-Hill Professional; 2000. 2. Schellinger PD, Bryan RN, Caplan LR, et al. Evidence-based guideline: The role of diffusion and perfusion MRI for the diagnosis of acute ischemic stroke. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2010;75(2):177-185. 3. Wintermark M, Flanders AE, Velthuis B, et al. Perfusion-CT assessment of infarct core and penumbra. Stroke. 2006;37(4):979-985. 4. Takasawa M, Jones | Surgery_Schwartz. arrowhead points to the cerebellar tonsils. The small arrowhead points to the posterior arch of the foramen magnum.of C1. Removal of these bony structures relieves the compres-sion of the cerebellar tonsils and cervicomedullary junction, and may allow reestablishment of normal CSF flow patterns. Figure 42-35 demonstrates typical MRI appearance of a Chiari I malformation.REFERENCESEntries highlighted in bright blue are key references. 1. Kandel E, Schwartz J, Jessell T. Principles of Neural Science, 4th ed. New York: McGraw-Hill Professional; 2000. 2. Schellinger PD, Bryan RN, Caplan LR, et al. Evidence-based guideline: The role of diffusion and perfusion MRI for the diagnosis of acute ischemic stroke. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2010;75(2):177-185. 3. Wintermark M, Flanders AE, Velthuis B, et al. Perfusion-CT assessment of infarct core and penumbra. Stroke. 2006;37(4):979-985. 4. Takasawa M, Jones |
Surgery_Schwartz_12404 | Surgery_Schwartz | of Neurology. Neurology. 2010;75(2):177-185. 3. Wintermark M, Flanders AE, Velthuis B, et al. Perfusion-CT assessment of infarct core and penumbra. Stroke. 2006;37(4):979-985. 4. Takasawa M, Jones PS, Guadagno JV, et al. How reliable is perfusion MR in acute stroke? Stroke. 2008;39(3):870-877. 5. Masters SJ, McClean PM, Arcarese JS, et al. Skull x-ray examinations after head trauma. Recommendations by a multidisciplinary panel and validation study. N Engl J Med. 1987;316:84-91. 6. Bullock MR, Chesnut R, Ghajar J, et al. Surgical man-agement of depressed cranial fractures. Neurosurgery. 2006;58:S56-S60. 7. Dula DJ, Fales W. The ‘ring sign’: is it a reliable indicator for cerebral spinal fluid? Annals of emergency medicine. 1993 Apr 1; 22(4):718-20. 8. Sonig A, Thakur JD, Chittiboina P, Khan IS, Nanda, A. Is posttraumatic cerebrospinal fluid fistula a predictor of post-traumatic meningitis? A US Nationwide Inpatient Sample database study. Neurosurgical Focus. 2012;32(6):E4. 9. Ratilal | Surgery_Schwartz. of Neurology. Neurology. 2010;75(2):177-185. 3. Wintermark M, Flanders AE, Velthuis B, et al. Perfusion-CT assessment of infarct core and penumbra. Stroke. 2006;37(4):979-985. 4. Takasawa M, Jones PS, Guadagno JV, et al. How reliable is perfusion MR in acute stroke? Stroke. 2008;39(3):870-877. 5. Masters SJ, McClean PM, Arcarese JS, et al. Skull x-ray examinations after head trauma. Recommendations by a multidisciplinary panel and validation study. N Engl J Med. 1987;316:84-91. 6. Bullock MR, Chesnut R, Ghajar J, et al. Surgical man-agement of depressed cranial fractures. Neurosurgery. 2006;58:S56-S60. 7. Dula DJ, Fales W. The ‘ring sign’: is it a reliable indicator for cerebral spinal fluid? Annals of emergency medicine. 1993 Apr 1; 22(4):718-20. 8. Sonig A, Thakur JD, Chittiboina P, Khan IS, Nanda, A. Is posttraumatic cerebrospinal fluid fistula a predictor of post-traumatic meningitis? A US Nationwide Inpatient Sample database study. Neurosurgical Focus. 2012;32(6):E4. 9. Ratilal |
Surgery_Schwartz_12405 | Surgery_Schwartz | IS, Nanda, A. Is posttraumatic cerebrospinal fluid fistula a predictor of post-traumatic meningitis? A US Nationwide Inpatient Sample database study. Neurosurgical Focus. 2012;32(6):E4. 9. Ratilal BO, Costa J, Sampaio C, Pappamikail L. Antibiotic pro-phylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev. 2015;(4):CD004884. 10. Carney N, Totten AM, OMReilly C, et al. Guidelines for the management of severe traumatic brain injury. Neuro-surgery. 2017;80(1):6-15. 11. Brain Trauma Foundation, American Association of Neuro-logical Surgeons, Congress of Neurological Surgeons. Guide-lines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24:S91-S95. 12. Ingebrigtsen T, Romner B. Routine early CT-scan is cost sav-ing after minor head injury. Acta Neurologica Scandinavica. 1996;93:207-210. 13. Stein SC, Ross SE. The value of computed tomographic scans in patients with low-risk head injuries. Neurosurgery. | Surgery_Schwartz. IS, Nanda, A. Is posttraumatic cerebrospinal fluid fistula a predictor of post-traumatic meningitis? A US Nationwide Inpatient Sample database study. Neurosurgical Focus. 2012;32(6):E4. 9. Ratilal BO, Costa J, Sampaio C, Pappamikail L. Antibiotic pro-phylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev. 2015;(4):CD004884. 10. Carney N, Totten AM, OMReilly C, et al. Guidelines for the management of severe traumatic brain injury. Neuro-surgery. 2017;80(1):6-15. 11. Brain Trauma Foundation, American Association of Neuro-logical Surgeons, Congress of Neurological Surgeons. Guide-lines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24:S91-S95. 12. Ingebrigtsen T, Romner B. Routine early CT-scan is cost sav-ing after minor head injury. Acta Neurologica Scandinavica. 1996;93:207-210. 13. Stein SC, Ross SE. The value of computed tomographic scans in patients with low-risk head injuries. Neurosurgery. |
Surgery_Schwartz_12406 | Surgery_Schwartz | sav-ing after minor head injury. Acta Neurologica Scandinavica. 1996;93:207-210. 13. Stein SC, Ross SE. The value of computed tomographic scans in patients with low-risk head injuries. Neurosurgery. 1990;26:638-640. 14. Kelly JP, Nichols JS, Filley CM, et al. Concussion in sports. Guidelines for the prevention of catastrophic outcome. JAMA. 1991;266:2867-2869. 15. McCrory P, Meeuwisse WH, Aubry M, et al. Consensus state-ment on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013;47(5):250-258. 16. Forgione MA, Moores, LE, Wortmann GW; Prevention of Combat-Related Infections Guidelines Panel. Prevention of infections associated with combat-related central nervous system injuries. J Trauma Acute Care Surg. 2011;71(2): S258-S263. 17. Bullock MR, Chesnut R, Ghajar J, et al. Surgical man-agement of acute subdural hematomas. Neurosurgery. 2006;58:S16-S24. 18. Howard MA III, Gross AS, Dacey RG Jr, et al. Acute | Surgery_Schwartz. sav-ing after minor head injury. Acta Neurologica Scandinavica. 1996;93:207-210. 13. Stein SC, Ross SE. The value of computed tomographic scans in patients with low-risk head injuries. Neurosurgery. 1990;26:638-640. 14. Kelly JP, Nichols JS, Filley CM, et al. Concussion in sports. Guidelines for the prevention of catastrophic outcome. JAMA. 1991;266:2867-2869. 15. McCrory P, Meeuwisse WH, Aubry M, et al. Consensus state-ment on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013;47(5):250-258. 16. Forgione MA, Moores, LE, Wortmann GW; Prevention of Combat-Related Infections Guidelines Panel. Prevention of infections associated with combat-related central nervous system injuries. J Trauma Acute Care Surg. 2011;71(2): S258-S263. 17. Bullock MR, Chesnut R, Ghajar J, et al. Surgical man-agement of acute subdural hematomas. Neurosurgery. 2006;58:S16-S24. 18. Howard MA III, Gross AS, Dacey RG Jr, et al. Acute |
Surgery_Schwartz_12407 | Surgery_Schwartz | S258-S263. 17. Bullock MR, Chesnut R, Ghajar J, et al. Surgical man-agement of acute subdural hematomas. Neurosurgery. 2006;58:S16-S24. 18. Howard MA III, Gross AS, Dacey RG Jr, et al. Acute subdural hematomas: an age-dependent clinical entity (see comment). J Neurosurg. 1989;71:858-863. 19. Hamilton MG, Frizzell JB, Tranmer BI. Chronic subdural hematoma: the role for craniotomy reevaluated. Neurosurgery. 1993;33:67-72. 20. Almenawer SA, Farrokhyar F, Hong C, et al. Chronic subdural hematoma management: a systematic review and meta-analysis of 34829 patients. Ann Surg. 2014;259(3):449-457. 21. Lega BC, Danish SF, Malhotra NR, Sonnad SS, Stein SC. Choosing the best operation for chronic subdural hema-toma: a decision analysis: clinical article. J Neurosurg. 2010;113(3):615-621. 22. Bullock MR, Chesnut R, Ghajar J, et al. Surgical manage-ment of traumatic parenchymal lesions. Neurosurgery. 2006;58:S25-S46. 23. Dandy WE. Pneumocephalus (intracranial penumatocele or aerocele). Arch Surg. | Surgery_Schwartz. S258-S263. 17. Bullock MR, Chesnut R, Ghajar J, et al. Surgical man-agement of acute subdural hematomas. Neurosurgery. 2006;58:S16-S24. 18. Howard MA III, Gross AS, Dacey RG Jr, et al. Acute subdural hematomas: an age-dependent clinical entity (see comment). J Neurosurg. 1989;71:858-863. 19. Hamilton MG, Frizzell JB, Tranmer BI. Chronic subdural hematoma: the role for craniotomy reevaluated. Neurosurgery. 1993;33:67-72. 20. Almenawer SA, Farrokhyar F, Hong C, et al. Chronic subdural hematoma management: a systematic review and meta-analysis of 34829 patients. Ann Surg. 2014;259(3):449-457. 21. Lega BC, Danish SF, Malhotra NR, Sonnad SS, Stein SC. Choosing the best operation for chronic subdural hema-toma: a decision analysis: clinical article. J Neurosurg. 2010;113(3):615-621. 22. Bullock MR, Chesnut R, Ghajar J, et al. Surgical manage-ment of traumatic parenchymal lesions. Neurosurgery. 2006;58:S25-S46. 23. Dandy WE. Pneumocephalus (intracranial penumatocele or aerocele). Arch Surg. |
Surgery_Schwartz_12408 | Surgery_Schwartz | MR, Chesnut R, Ghajar J, et al. Surgical manage-ment of traumatic parenchymal lesions. Neurosurgery. 2006;58:S25-S46. 23. Dandy WE. Pneumocephalus (intracranial penumatocele or aerocele). Arch Surg. 1926;12(5):949-982. 24. Schirmer CM, Heilman CB, Bhardwaj A. Pneumocepha-lus: case illustrations and review. Neurocrit Care. 2010; 13(1):152-158. 25. Ishiwata Y, Fujitsu K, Sekino T, et al. Subdural tension pneu-mocephalus following surgery for chronic subdural hema-toma. J Neurosurg. 1988;68(1):58-61. 26. Gore PA, Maan H, Chang S, Pitt AM, Spetzler RF, Nakaji P. Normobaric oxygen therapy strategies in the treatment of post-craniotomy pneumocephalus. 2008;108(5):926-929. 27. Temkin NR, Dikmen SS, Wilensky AJ, et al. A random-ized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med. 1990;323:497-502. 28. Edwards P, Arango M, Balica L, et al. Final results of MRC CRASH, a randomised placebo-controlled trial of intrave-nous corticosteroid in adults | Surgery_Schwartz. MR, Chesnut R, Ghajar J, et al. Surgical manage-ment of traumatic parenchymal lesions. Neurosurgery. 2006;58:S25-S46. 23. Dandy WE. Pneumocephalus (intracranial penumatocele or aerocele). Arch Surg. 1926;12(5):949-982. 24. Schirmer CM, Heilman CB, Bhardwaj A. Pneumocepha-lus: case illustrations and review. Neurocrit Care. 2010; 13(1):152-158. 25. Ishiwata Y, Fujitsu K, Sekino T, et al. Subdural tension pneu-mocephalus following surgery for chronic subdural hema-toma. J Neurosurg. 1988;68(1):58-61. 26. Gore PA, Maan H, Chang S, Pitt AM, Spetzler RF, Nakaji P. Normobaric oxygen therapy strategies in the treatment of post-craniotomy pneumocephalus. 2008;108(5):926-929. 27. Temkin NR, Dikmen SS, Wilensky AJ, et al. A random-ized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med. 1990;323:497-502. 28. Edwards P, Arango M, Balica L, et al. Final results of MRC CRASH, a randomised placebo-controlled trial of intrave-nous corticosteroid in adults |
Surgery_Schwartz_12409 | Surgery_Schwartz | seizures. N Engl J Med. 1990;323:497-502. 28. Edwards P, Arango M, Balica L, et al. Final results of MRC CRASH, a randomised placebo-controlled trial of intrave-nous corticosteroid in adults with head injury-outcomes at 6 months. Lancet. 2005;365(9475):1957-1959. 29. Chesnut RM, Marshall LF, Klauber MR, et al. The role of sec-ondary brain injury in determining outcome from severe head injury. J Trauma. 1993;34(2):216-222. 30. Berry C, Ley EJ, Bukur M, et al. Redefining hypotension in traumatic brain injury. Injury. 2012;43(11):1833-1837.Brunicardi_Ch42_p1827-p1878.indd 187401/03/19 7:17 PM 1875NEUROSURGERYCHAPTER 42 31. Spaite DW, Hu C. Bobrow BJ, et al. Mortality and prehos-pital blood pressure in patients with major traumatic brain injury: implications for the hypotension threshold. JAMA Surg. 2017;152(4):360-368. 32. Basali A, Mascha EJ, Kalfas I, Schubert A. Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. J Am Soc Anesthesiol. | Surgery_Schwartz. seizures. N Engl J Med. 1990;323:497-502. 28. Edwards P, Arango M, Balica L, et al. Final results of MRC CRASH, a randomised placebo-controlled trial of intrave-nous corticosteroid in adults with head injury-outcomes at 6 months. Lancet. 2005;365(9475):1957-1959. 29. Chesnut RM, Marshall LF, Klauber MR, et al. The role of sec-ondary brain injury in determining outcome from severe head injury. J Trauma. 1993;34(2):216-222. 30. Berry C, Ley EJ, Bukur M, et al. Redefining hypotension in traumatic brain injury. Injury. 2012;43(11):1833-1837.Brunicardi_Ch42_p1827-p1878.indd 187401/03/19 7:17 PM 1875NEUROSURGERYCHAPTER 42 31. Spaite DW, Hu C. Bobrow BJ, et al. Mortality and prehos-pital blood pressure in patients with major traumatic brain injury: implications for the hypotension threshold. JAMA Surg. 2017;152(4):360-368. 32. Basali A, Mascha EJ, Kalfas I, Schubert A. Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. J Am Soc Anesthesiol. |
Surgery_Schwartz_12410 | Surgery_Schwartz | JAMA Surg. 2017;152(4):360-368. 32. Basali A, Mascha EJ, Kalfas I, Schubert A. Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. J Am Soc Anesthesiol. 2000;93(1):48-54. 33. Kuramatsu JB, Gerner ST, Schellinger PD, Glahn J, Endres M, Sobesky J, Flechsenhar J, Neugebauer H, Jüttler E, Grau A, Palm F. Anticoagulant reversal, blood pressure levels, and anti-coagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. Jama. 2015 Feb 24;313(8):824-36. 34. Sorrentino E, Diedler J, Kasprowicz M, et al. Critical thresh-olds for cerebrovascular reactivity after traumatic brain injury. Neurocrit Care. 2012;16(2):258-266. 35. Cooper DJ, Rosenfeld JV, Murray L, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364(16):1493-1502. 36. Hutchinson PJ, Kolias AG, Timofeev IS, et al. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. | Surgery_Schwartz. JAMA Surg. 2017;152(4):360-368. 32. Basali A, Mascha EJ, Kalfas I, Schubert A. Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. J Am Soc Anesthesiol. 2000;93(1):48-54. 33. Kuramatsu JB, Gerner ST, Schellinger PD, Glahn J, Endres M, Sobesky J, Flechsenhar J, Neugebauer H, Jüttler E, Grau A, Palm F. Anticoagulant reversal, blood pressure levels, and anti-coagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. Jama. 2015 Feb 24;313(8):824-36. 34. Sorrentino E, Diedler J, Kasprowicz M, et al. Critical thresh-olds for cerebrovascular reactivity after traumatic brain injury. Neurocrit Care. 2012;16(2):258-266. 35. Cooper DJ, Rosenfeld JV, Murray L, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364(16):1493-1502. 36. Hutchinson PJ, Kolias AG, Timofeev IS, et al. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. |
Surgery_Schwartz_12411 | Surgery_Schwartz | brain injury. N Engl J Med. 2011;364(16):1493-1502. 36. Hutchinson PJ, Kolias AG, Timofeev IS, et al. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. 2016;375(12):1119-1130. 37. Lyrer P, Engelter S. Antithrombotic drugs for carotid artery dissection. Stroke. 2004;35:613-614. 38. Maynard FM Jr, Bracken MB, Creasey G, et al. International standards for neurological and functional classification of spi-nal cord injury. American Spinal Injury Association. Spinal Cord. 1997;35:266. 39. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983;8:817-831. 40. Biffl WL, Cothren CC, Moore EE, et al. Western Trauma Association critical decisions in trauma: screening for and treatment of blunt cerebrovascular injuries. J Trauma Acute Care Surg. 2009;67(6):1150-1153. 41. Lockwood MM, Smith GA, Tanenbaum J, Lubelski D, Seicean A, Pace J, Benzel EC, Mroz TE, Steinmetz MP. Screening via CT | Surgery_Schwartz. brain injury. N Engl J Med. 2011;364(16):1493-1502. 36. Hutchinson PJ, Kolias AG, Timofeev IS, et al. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. 2016;375(12):1119-1130. 37. Lyrer P, Engelter S. Antithrombotic drugs for carotid artery dissection. Stroke. 2004;35:613-614. 38. Maynard FM Jr, Bracken MB, Creasey G, et al. International standards for neurological and functional classification of spi-nal cord injury. American Spinal Injury Association. Spinal Cord. 1997;35:266. 39. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983;8:817-831. 40. Biffl WL, Cothren CC, Moore EE, et al. Western Trauma Association critical decisions in trauma: screening for and treatment of blunt cerebrovascular injuries. J Trauma Acute Care Surg. 2009;67(6):1150-1153. 41. Lockwood MM, Smith GA, Tanenbaum J, Lubelski D, Seicean A, Pace J, Benzel EC, Mroz TE, Steinmetz MP. Screening via CT |
Surgery_Schwartz_12412 | Surgery_Schwartz | cerebrovascular injuries. J Trauma Acute Care Surg. 2009;67(6):1150-1153. 41. Lockwood MM, Smith GA, Tanenbaum J, Lubelski D, Seicean A, Pace J, Benzel EC, Mroz TE, Steinmetz MP. Screening via CT angiogram after traumatic cervical spine fractures: nar-rowing imaging to improve cost effectiveness. Experience of a Level I trauma center. Journal of Neurosurgery: Spine. 2016 Mar;24(3):490-5. 42. Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the second national acute spinal cord injury study (see comment). N Engl J Med. 1990;322:1405-1411. 43. Bracken MB, Shepard MJ, Collins WF Jr, et al. Methyl-prednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second national acute spinal cord injury study (see comment). J Neurosurg. 1992;76:23-31. 44. Bracken MB, Shepard MJ, Holford TR, et al. Admin-istration of methylprednisolone | Surgery_Schwartz. cerebrovascular injuries. J Trauma Acute Care Surg. 2009;67(6):1150-1153. 41. Lockwood MM, Smith GA, Tanenbaum J, Lubelski D, Seicean A, Pace J, Benzel EC, Mroz TE, Steinmetz MP. Screening via CT angiogram after traumatic cervical spine fractures: nar-rowing imaging to improve cost effectiveness. Experience of a Level I trauma center. Journal of Neurosurgery: Spine. 2016 Mar;24(3):490-5. 42. Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the second national acute spinal cord injury study (see comment). N Engl J Med. 1990;322:1405-1411. 43. Bracken MB, Shepard MJ, Collins WF Jr, et al. Methyl-prednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second national acute spinal cord injury study (see comment). J Neurosurg. 1992;76:23-31. 44. Bracken MB, Shepard MJ, Holford TR, et al. Admin-istration of methylprednisolone |
Surgery_Schwartz_12413 | Surgery_Schwartz | data. Results of the second national acute spinal cord injury study (see comment). J Neurosurg. 1992;76:23-31. 44. Bracken MB, Shepard MJ, Holford TR, et al. Admin-istration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury: results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. JAMA. 1997;277(20):1597-1604. 45. Bracken MB. Steroids for acute spinal cord injury. Cochrane Database Syst Rev. 2012;(1):CD001046. 46. Walters BC, Hadley MN, Hurlbert RJ, et al. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery. 2013;60:82-91. 47. Fehlings M. Recommendations regarding the use of methyl-prednisolone in acute spinal cord injury: making sense out of the controversy [editorial]. Spine J. 2001;26(suppl):S56-S57. 48. Hugenholtz H, Cass DE, Dvorak MF, et al. High-dose meth-ylprednisolone for acute closed spinal cord injuryord injuryyy Injury | Surgery_Schwartz. data. Results of the second national acute spinal cord injury study (see comment). J Neurosurg. 1992;76:23-31. 44. Bracken MB, Shepard MJ, Holford TR, et al. Admin-istration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury: results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. JAMA. 1997;277(20):1597-1604. 45. Bracken MB. Steroids for acute spinal cord injury. Cochrane Database Syst Rev. 2012;(1):CD001046. 46. Walters BC, Hadley MN, Hurlbert RJ, et al. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery. 2013;60:82-91. 47. Fehlings M. Recommendations regarding the use of methyl-prednisolone in acute spinal cord injury: making sense out of the controversy [editorial]. Spine J. 2001;26(suppl):S56-S57. 48. Hugenholtz H, Cass DE, Dvorak MF, et al. High-dose meth-ylprednisolone for acute closed spinal cord injuryord injuryyy Injury |
Surgery_Schwartz_12414 | Surgery_Schwartz | out of the controversy [editorial]. Spine J. 2001;26(suppl):S56-S57. 48. Hugenholtz H, Cass DE, Dvorak MF, et al. High-dose meth-ylprednisolone for acute closed spinal cord injuryord injuryyy Injury Random Can J Neurol Sci. 2002;29:227-235. 49. Resnick DK, Kaiser MG, Fehlings M, et al. Hypothermia and Human Spinal Cord Injury: Position Statement and Evidence Based Recommendations From the AANS/CNS Joint Section on Disorders of the Spine and the AANS/CNS Joint Section on Trauma. Washington: AANS/CNS Joint Section of Disorders of the Spine and Peripheral Nerves; 2007. 50. Vaccaro AR, Falatyn SP, Flanders AE, Balderston RA, Northrup BE, Cotler JM. Magnetic resonance evaluation of the intervertebral disc, spinal ligaments, and spinal cord before and after closed traction reduction of cervical spine disloca-tions. Spine. 1999;24(12):1210-1217. 51. Fehlings MG, Vaccaro A, Wilson JR, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical | Surgery_Schwartz. out of the controversy [editorial]. Spine J. 2001;26(suppl):S56-S57. 48. Hugenholtz H, Cass DE, Dvorak MF, et al. High-dose meth-ylprednisolone for acute closed spinal cord injuryord injuryyy Injury Random Can J Neurol Sci. 2002;29:227-235. 49. Resnick DK, Kaiser MG, Fehlings M, et al. Hypothermia and Human Spinal Cord Injury: Position Statement and Evidence Based Recommendations From the AANS/CNS Joint Section on Disorders of the Spine and the AANS/CNS Joint Section on Trauma. Washington: AANS/CNS Joint Section of Disorders of the Spine and Peripheral Nerves; 2007. 50. Vaccaro AR, Falatyn SP, Flanders AE, Balderston RA, Northrup BE, Cotler JM. Magnetic resonance evaluation of the intervertebral disc, spinal ligaments, and spinal cord before and after closed traction reduction of cervical spine disloca-tions. Spine. 1999;24(12):1210-1217. 51. Fehlings MG, Vaccaro A, Wilson JR, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical |
Surgery_Schwartz_12415 | Surgery_Schwartz | spine disloca-tions. Spine. 1999;24(12):1210-1217. 51. Fehlings MG, Vaccaro A, Wilson JR, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PloS One. 2012;7(2):e32037. 52. Seddon HJ. Three types of nerve injury. Brain. 1943;66:237. 53. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. (see comment). N Engl J Med. 1991;325:443-445. 54. Ferguson GG, Eliasziw M, Barr HW, et al. The North Amer-ican Symptomatic Carotid Endarterectomy Trial : surgical results in 1415 patients. Stroke. 1999;30(9):1751-1758. 55. Brott TG, Howard G, Roubin GS, et al; CREST Investigators. Long-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med. 2016;374(11):1021-1031. 56. The National Institute of Neurological Disorders and Stroke rt-PA Stroke | Surgery_Schwartz. spine disloca-tions. Spine. 1999;24(12):1210-1217. 51. Fehlings MG, Vaccaro A, Wilson JR, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PloS One. 2012;7(2):e32037. 52. Seddon HJ. Three types of nerve injury. Brain. 1943;66:237. 53. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. (see comment). N Engl J Med. 1991;325:443-445. 54. Ferguson GG, Eliasziw M, Barr HW, et al. The North Amer-ican Symptomatic Carotid Endarterectomy Trial : surgical results in 1415 patients. Stroke. 1999;30(9):1751-1758. 55. Brott TG, Howard G, Roubin GS, et al; CREST Investigators. Long-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med. 2016;374(11):1021-1031. 56. The National Institute of Neurological Disorders and Stroke rt-PA Stroke |
Surgery_Schwartz_12416 | Surgery_Schwartz | Long-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med. 2016;374(11):1021-1031. 56. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. (see comment). N Engl J Med. 1995;333:1581-1588. 57. Bhatia R, Hill MD, Shobha N, et al. Low rates of acute recana-lization with intravenous recombinant tissue plasminogen acti-vator in ischemic stroke: real-world experience and a call for action. Stroke. 2010;41(10):2254-2258. 58. Jovin TG, Chamorro A, Cobo E, et al; REVASCAT Trial Inves-tigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296-2306. 59. J0. J24 E, Unterberg A, Woitzik J, et al. Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl J Med. 2014;370(12):1091-1100. 60. Pledl HW, Hoyer C, Rausch J, et al. Decompressive hemi-craniectomy in malignant middle cerebral artery | Surgery_Schwartz. Long-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med. 2016;374(11):1021-1031. 56. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. (see comment). N Engl J Med. 1995;333:1581-1588. 57. Bhatia R, Hill MD, Shobha N, et al. Low rates of acute recana-lization with intravenous recombinant tissue plasminogen acti-vator in ischemic stroke: real-world experience and a call for action. Stroke. 2010;41(10):2254-2258. 58. Jovin TG, Chamorro A, Cobo E, et al; REVASCAT Trial Inves-tigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296-2306. 59. J0. J24 E, Unterberg A, Woitzik J, et al. Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl J Med. 2014;370(12):1091-1100. 60. Pledl HW, Hoyer C, Rausch J, et al. Decompressive hemi-craniectomy in malignant middle cerebral artery |
Surgery_Schwartz_12417 | Surgery_Schwartz | with extensive middle-cerebral-artery stroke. N Engl J Med. 2014;370(12):1091-1100. 60. Pledl HW, Hoyer C, Rausch J, et al. Decompressive hemi-craniectomy in malignant middle cerebral artery infarction: the ‘real world’ beyond studies. Eur Neurol. 2016;76(1-2): 48-56. 61. Mendelow AD, Gregson BA, Fernandes HM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005;365:387-397. 62. Fam MD, Hanley D, Stadnik A, et al. Surgical performance in minimally invasive surgery plus recombinant tissue plasmino-gen activator for intracerebral hemorrhage evacuation phase III clinical trial. Neurosurgery. 2017;81(5):860-866. 63. Molyneux A, Kerr R, Stratton I, et al. International sub-arachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial | Surgery_Schwartz. with extensive middle-cerebral-artery stroke. N Engl J Med. 2014;370(12):1091-1100. 60. Pledl HW, Hoyer C, Rausch J, et al. Decompressive hemi-craniectomy in malignant middle cerebral artery infarction: the ‘real world’ beyond studies. Eur Neurol. 2016;76(1-2): 48-56. 61. Mendelow AD, Gregson BA, Fernandes HM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005;365:387-397. 62. Fam MD, Hanley D, Stadnik A, et al. Surgical performance in minimally invasive surgery plus recombinant tissue plasmino-gen activator for intracerebral hemorrhage evacuation phase III clinical trial. Neurosurgery. 2017;81(5):860-866. 63. Molyneux A, Kerr R, Stratton I, et al. International sub-arachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial |
Surgery_Schwartz_12418 | Surgery_Schwartz | A, Kerr R, Stratton I, et al. International sub-arachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial (see comment) (reprint in J Stroke Cerebrovasc Dis 11:304, 2002). Lancet. 2002;360:1267-1274. 64. Mitchell P, Kerr R, Mendelow AD, et al. Could late rebleeding overturn the superiority of cranial aneurysm coil embolization over clip ligation seen in the international subarachnoid aneu-rysm trial? J Neurosurg. 2008;108:437-442. 65. Raftopoulos C, Goffette P, Vaz G, et al. Surgical clipping may lead to better results than coil embolization: results from a series of 101 consecutive unruptured intracranial aneurysms. Neurosurgery. 2003;52:1280-1287, discussion 1287-1290.Brunicardi_Ch42_p1827-p1878.indd 187501/03/19 7:17 PM 1876SPECIFIC CONSIDERATIONSPART II 66. Mohr JP, Parides MK, Stapf C; International ARUBA Inves-tigators. Medical management with or without interventional | Surgery_Schwartz. A, Kerr R, Stratton I, et al. International sub-arachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial (see comment) (reprint in J Stroke Cerebrovasc Dis 11:304, 2002). Lancet. 2002;360:1267-1274. 64. Mitchell P, Kerr R, Mendelow AD, et al. Could late rebleeding overturn the superiority of cranial aneurysm coil embolization over clip ligation seen in the international subarachnoid aneu-rysm trial? J Neurosurg. 2008;108:437-442. 65. Raftopoulos C, Goffette P, Vaz G, et al. Surgical clipping may lead to better results than coil embolization: results from a series of 101 consecutive unruptured intracranial aneurysms. Neurosurgery. 2003;52:1280-1287, discussion 1287-1290.Brunicardi_Ch42_p1827-p1878.indd 187501/03/19 7:17 PM 1876SPECIFIC CONSIDERATIONSPART II 66. Mohr JP, Parides MK, Stapf C; International ARUBA Inves-tigators. Medical management with or without interventional |
Surgery_Schwartz_12419 | Surgery_Schwartz | 187501/03/19 7:17 PM 1876SPECIFIC CONSIDERATIONSPART II 66. Mohr JP, Parides MK, Stapf C; International ARUBA Inves-tigators. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet. 2014;383(9917):614-621. 67. Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322:494-500. 68. Aoyama H, Shirato H, Tago M, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized con-trolled trial. JAMA. 2006;295:2483-2491. 69. Stupp R, Mason WP, van den Bent MJ; European Organisa-tion for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. | Surgery_Schwartz. 187501/03/19 7:17 PM 1876SPECIFIC CONSIDERATIONSPART II 66. Mohr JP, Parides MK, Stapf C; International ARUBA Inves-tigators. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet. 2014;383(9917):614-621. 67. Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322:494-500. 68. Aoyama H, Shirato H, Tago M, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized con-trolled trial. JAMA. 2006;295:2483-2491. 69. Stupp R, Mason WP, van den Bent MJ; European Organisa-tion for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. |
Surgery_Schwartz_12420 | Surgery_Schwartz | of Cancer Brain Tumor and Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987-996. 70. Patchell RA, Tibbs PA, Regine WF, et al. Direct decompres-sive surgical resection in the treatment of spinal cord compres-sion caused by metastatic cancer: a randomised trial. Lancet. 2005;366:643-648. 71. Fisher CG, DiPaola CP, Ryken TC, et al. A novel classifi-cation system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976). 2010;35(22): E1221-E1229. 72. Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016;131(6):803-820. 73. Le Roux PD, Haglund MM, Harris AB. Thoracic disc disease: experience with the transpedicular approach in twenty con-secutive | Surgery_Schwartz. of Cancer Brain Tumor and Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987-996. 70. Patchell RA, Tibbs PA, Regine WF, et al. Direct decompres-sive surgical resection in the treatment of spinal cord compres-sion caused by metastatic cancer: a randomised trial. Lancet. 2005;366:643-648. 71. Fisher CG, DiPaola CP, Ryken TC, et al. A novel classifi-cation system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976). 2010;35(22): E1221-E1229. 72. Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016;131(6):803-820. 73. Le Roux PD, Haglund MM, Harris AB. Thoracic disc disease: experience with the transpedicular approach in twenty con-secutive |
Surgery_Schwartz_12421 | Surgery_Schwartz | Nervous System: a summary. Acta Neuropathol. 2016;131(6):803-820. 73. Le Roux PD, Haglund MM, Harris AB. Thoracic disc disease: experience with the transpedicular approach in twenty con-secutive patients. Neurosurgery. 1993;33:58-66. 74. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical vs nonop-erative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA. 2006;296(20):2451-2459. 75. Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, Fye M, Welch WC. Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Annals of internal medicine. 2015 Apr 7;162(7):465-73. 76. Mulholland RC, Sengupta DK. Rationale, principles, and experimental evaluation of the concept of soft stabilization. Eur Spine J. 2002;11:S198-S205. 77. Dawson D, Hallett M, Wilbourn A. Entrapment Neuropathie. 3rd ed. Baltimore: Lippincott Raven; 1999. 78. Darouiche RO. Spinal epidural abscess. N Engl J Med. | Surgery_Schwartz. Nervous System: a summary. Acta Neuropathol. 2016;131(6):803-820. 73. Le Roux PD, Haglund MM, Harris AB. Thoracic disc disease: experience with the transpedicular approach in twenty con-secutive patients. Neurosurgery. 1993;33:58-66. 74. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical vs nonop-erative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA. 2006;296(20):2451-2459. 75. Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, Fye M, Welch WC. Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Annals of internal medicine. 2015 Apr 7;162(7):465-73. 76. Mulholland RC, Sengupta DK. Rationale, principles, and experimental evaluation of the concept of soft stabilization. Eur Spine J. 2002;11:S198-S205. 77. Dawson D, Hallett M, Wilbourn A. Entrapment Neuropathie. 3rd ed. Baltimore: Lippincott Raven; 1999. 78. Darouiche RO. Spinal epidural abscess. N Engl J Med. |
Surgery_Schwartz_12422 | Surgery_Schwartz | Eur Spine J. 2002;11:S198-S205. 77. Dawson D, Hallett M, Wilbourn A. Entrapment Neuropathie. 3rd ed. Baltimore: Lippincott Raven; 1999. 78. Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006;355:2012-2020. 79. Benbadis SR, Heriaud L, Tatum WO, et al. Epilepsy surgery, delays and referral patterns patients controlled? Seizure. 2003;12:167-170. 80. Rausch R, Kraemer S, Pietras CJ, et al. Early and late cogni-tive changes following temporal lobe surgery for epilepsy (see comment). Neurology. 2003;60:951-959. 81. Ben-Menachem E, Manon-Espaillat R, Ristanovic R, et al. Vagus nerve stimulation for treatment of partial seizures. A controlled study of effect on seizures. First International Vagus Nerve Stimulation Study Group. Epilepsia. 1994;35:616-626. 82. Handforth A, DeGiorgio CM, Schachter SC, et al. Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology. 1998;51:48-55. 83. Amar AP, Heck CN, Levy ML, et al. An institutional | Surgery_Schwartz. Eur Spine J. 2002;11:S198-S205. 77. Dawson D, Hallett M, Wilbourn A. Entrapment Neuropathie. 3rd ed. Baltimore: Lippincott Raven; 1999. 78. Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006;355:2012-2020. 79. Benbadis SR, Heriaud L, Tatum WO, et al. Epilepsy surgery, delays and referral patterns patients controlled? Seizure. 2003;12:167-170. 80. Rausch R, Kraemer S, Pietras CJ, et al. Early and late cogni-tive changes following temporal lobe surgery for epilepsy (see comment). Neurology. 2003;60:951-959. 81. Ben-Menachem E, Manon-Espaillat R, Ristanovic R, et al. Vagus nerve stimulation for treatment of partial seizures. A controlled study of effect on seizures. First International Vagus Nerve Stimulation Study Group. Epilepsia. 1994;35:616-626. 82. Handforth A, DeGiorgio CM, Schachter SC, et al. Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology. 1998;51:48-55. 83. Amar AP, Heck CN, Levy ML, et al. An institutional |
Surgery_Schwartz_12423 | Surgery_Schwartz | Schachter SC, et al. Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology. 1998;51:48-55. 83. Amar AP, Heck CN, Levy ML, et al. An institutional experi-ence with cervical vagus nerve trunk stimulation for medically refractory epilepsy: rationale, technique, and outcome. Neuro-surgery. 1998;1265-1276. 84. Fields JA, Troster AI, Woods SP, et al: Neuropsychologi-cal and quality of life outcomes 12 months after unilateral thalamic stimulation for essential tremor. J Neurol Neurosurg Psychiatry. 2003;74:305-311. 85. Rehncrona S, Johnels B, Widner H, et al. Long-term efficacy of thalamic deep brain stimulation for tremor: double-blind assessments. Mov Disord. 2003;18:163-170. 86. Kleiner-Fisman G, Herzog J, Fisman DN, et al. Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord. 2006;21:S290-S304. 87. Perozzo P, Rizzone M, Bergamasco B, et al. Deep brain stimulation of the subthalamic nucleus in | Surgery_Schwartz. Schachter SC, et al. Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology. 1998;51:48-55. 83. Amar AP, Heck CN, Levy ML, et al. An institutional experi-ence with cervical vagus nerve trunk stimulation for medically refractory epilepsy: rationale, technique, and outcome. Neuro-surgery. 1998;1265-1276. 84. Fields JA, Troster AI, Woods SP, et al: Neuropsychologi-cal and quality of life outcomes 12 months after unilateral thalamic stimulation for essential tremor. J Neurol Neurosurg Psychiatry. 2003;74:305-311. 85. Rehncrona S, Johnels B, Widner H, et al. Long-term efficacy of thalamic deep brain stimulation for tremor: double-blind assessments. Mov Disord. 2003;18:163-170. 86. Kleiner-Fisman G, Herzog J, Fisman DN, et al. Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord. 2006;21:S290-S304. 87. Perozzo P, Rizzone M, Bergamasco B, et al. Deep brain stimulation of the subthalamic nucleus in |
Surgery_Schwartz_12424 | Surgery_Schwartz | deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord. 2006;21:S290-S304. 87. Perozzo P, Rizzone M, Bergamasco B, et al. Deep brain stimulation of the subthalamic nucleus in Parkinsonor: es 12 mocomparison of preand postoperative neuropsychological evaluation. J Neurol Sci. 2001;192:9-15. 88. Weaver FM, Follett K, Stern M, et al. Bilateral deep brain stimulation vs. best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA. 2009;301:63-73. 89. Follett KA, Weaver FM, Stern M, et al. Pallidal versus sub-thalamic deep-brain stimulation for ParkinsonWeaver FM, S N Engl J Med. 2010;362(22):2077-2091. 90. Vidailhet M, Vercueil L, Houeto JL, et al. Bilateral deep-brain stimulation of the globus pallidus in primary generalized dys-tonia. N Engl J Med. 2005;352(5):459-467. 91. Goodman WK, Foote KD, Greenberg BD, et al. Deep brain stimulation for intractable obsessive compulsive disorder: pilot study using a blinded, | Surgery_Schwartz. deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord. 2006;21:S290-S304. 87. Perozzo P, Rizzone M, Bergamasco B, et al. Deep brain stimulation of the subthalamic nucleus in Parkinsonor: es 12 mocomparison of preand postoperative neuropsychological evaluation. J Neurol Sci. 2001;192:9-15. 88. Weaver FM, Follett K, Stern M, et al. Bilateral deep brain stimulation vs. best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA. 2009;301:63-73. 89. Follett KA, Weaver FM, Stern M, et al. Pallidal versus sub-thalamic deep-brain stimulation for ParkinsonWeaver FM, S N Engl J Med. 2010;362(22):2077-2091. 90. Vidailhet M, Vercueil L, Houeto JL, et al. Bilateral deep-brain stimulation of the globus pallidus in primary generalized dys-tonia. N Engl J Med. 2005;352(5):459-467. 91. Goodman WK, Foote KD, Greenberg BD, et al. Deep brain stimulation for intractable obsessive compulsive disorder: pilot study using a blinded, |
Surgery_Schwartz_12425 | Surgery_Schwartz | dys-tonia. N Engl J Med. 2005;352(5):459-467. 91. Goodman WK, Foote KD, Greenberg BD, et al. Deep brain stimulation for intractable obsessive compulsive disorder: pilot study using a blinded, staggered-onset design. Biol Psychiatry. 2010;67:535-542. 92. Lozano AM, Giacobbe P, Hamani C, et al. A multicenter pilot study of subcallosal cingulate area deep brain stimu-lation for treatment-resistant depression. J Neurosurg 2012;116:315-322. 93. Bewernick BH, Kayser S, Sturm V, et al. Long-term effects of nucleus accumbens deep brain stimulation in treatment-resistant depression: evidence for sustained efficacy. Neuro-psychopharmacology 2012;37:1975-1985. 94. Fisher R, Salanova V, Witt T, et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia. 2010;51:899-908. 95. Vassoler FM, Schmidt HD, Gerard ME, et al. Deep brain stimulation of the nucleus accumbens shell attenuates cocaine priming-induced reinstatement of drug seeking in rats. | Surgery_Schwartz. dys-tonia. N Engl J Med. 2005;352(5):459-467. 91. Goodman WK, Foote KD, Greenberg BD, et al. Deep brain stimulation for intractable obsessive compulsive disorder: pilot study using a blinded, staggered-onset design. Biol Psychiatry. 2010;67:535-542. 92. Lozano AM, Giacobbe P, Hamani C, et al. A multicenter pilot study of subcallosal cingulate area deep brain stimu-lation for treatment-resistant depression. J Neurosurg 2012;116:315-322. 93. Bewernick BH, Kayser S, Sturm V, et al. Long-term effects of nucleus accumbens deep brain stimulation in treatment-resistant depression: evidence for sustained efficacy. Neuro-psychopharmacology 2012;37:1975-1985. 94. Fisher R, Salanova V, Witt T, et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia. 2010;51:899-908. 95. Vassoler FM, Schmidt HD, Gerard ME, et al. Deep brain stimulation of the nucleus accumbens shell attenuates cocaine priming-induced reinstatement of drug seeking in rats. |
Surgery_Schwartz_12426 | Surgery_Schwartz | 2010;51:899-908. 95. Vassoler FM, Schmidt HD, Gerard ME, et al. Deep brain stimulation of the nucleus accumbens shell attenuates cocaine priming-induced reinstatement of drug seeking in rats. J Neurosci. 2008;28:8735-8739. 96. Halpern CH, Tekriwal A, Santollo J, et al. Amelioration of binge eating by nucleus accumbens shell deep brain stimu-lation in mice involves D2 receptor modulation. J Neurosci. 2013;33(17):7122-7129. 97. Barker FG II, Jannetta PJ, Bissonette DJ, et al. The long-term outcome of microvascular decompression for trigeminal neu-ralgia. N Engl J Med. 1996;334:1077-1083. 98. Kondo A. Microvascular decompression surgery for trigeminal neuralgia. Stereotact Funct Neurosurg. 2001;77:187-189. 99. Bova FJ, Goetsch SJ. Modern linac stereotactic radiosurgery systems have rendered the gamma knife obsolete. Medical Physics. 2001;28:1839-1841. 100. Konigsmaier H, de Pauli-Ferch B, et al. The costs of radio-surgical treatment: comparison between gamma knife and linear accelerator. | Surgery_Schwartz. 2010;51:899-908. 95. Vassoler FM, Schmidt HD, Gerard ME, et al. Deep brain stimulation of the nucleus accumbens shell attenuates cocaine priming-induced reinstatement of drug seeking in rats. J Neurosci. 2008;28:8735-8739. 96. Halpern CH, Tekriwal A, Santollo J, et al. Amelioration of binge eating by nucleus accumbens shell deep brain stimu-lation in mice involves D2 receptor modulation. J Neurosci. 2013;33(17):7122-7129. 97. Barker FG II, Jannetta PJ, Bissonette DJ, et al. The long-term outcome of microvascular decompression for trigeminal neu-ralgia. N Engl J Med. 1996;334:1077-1083. 98. Kondo A. Microvascular decompression surgery for trigeminal neuralgia. Stereotact Funct Neurosurg. 2001;77:187-189. 99. Bova FJ, Goetsch SJ. Modern linac stereotactic radiosurgery systems have rendered the gamma knife obsolete. Medical Physics. 2001;28:1839-1841. 100. Konigsmaier H, de Pauli-Ferch B, et al. The costs of radio-surgical treatment: comparison between gamma knife and linear accelerator. |
Surgery_Schwartz_12427 | Surgery_Schwartz | gamma knife obsolete. Medical Physics. 2001;28:1839-1841. 100. Konigsmaier H, de Pauli-Ferch B, et al. The costs of radio-surgical treatment: comparison between gamma knife and linear accelerator. Acta Neurochirurgica. 1998;140: 1110-1111. 101. Suh JH, Barnett GH, Miller DW, et al. Successful conver-sion from a linear accelerator-based program to a gamma knife radiosurgery program: The Cleveland Clinic experience. Stereot Funct Neurosurg. 1999;72:159-167. 102. Chen CC, Chapman P, Petit J, et al. Proton radiosurgery in neurosurgery. Neurosurg Focus. 2007;23:E5. 103. Gerszten PC, Ozhasoglu C, Burton SA, et al. CyberKnife frameless stereotactic radiosurgery for spinal lesions: clinical experience in 125 cases. Neurosurgery. 2004;55:89-98, discus-sion 98-99.Brunicardi_Ch42_p1827-p1878.indd 187601/03/19 7:17 PM 1877NEUROSURGERYCHAPTER 42 104. Karlsson B, Lax I, Soderman M. Risk for hemorrhage during the 2-year latency period following gamma knife radiosurgery for arteriovenous | Surgery_Schwartz. gamma knife obsolete. Medical Physics. 2001;28:1839-1841. 100. Konigsmaier H, de Pauli-Ferch B, et al. The costs of radio-surgical treatment: comparison between gamma knife and linear accelerator. Acta Neurochirurgica. 1998;140: 1110-1111. 101. Suh JH, Barnett GH, Miller DW, et al. Successful conver-sion from a linear accelerator-based program to a gamma knife radiosurgery program: The Cleveland Clinic experience. Stereot Funct Neurosurg. 1999;72:159-167. 102. Chen CC, Chapman P, Petit J, et al. Proton radiosurgery in neurosurgery. Neurosurg Focus. 2007;23:E5. 103. Gerszten PC, Ozhasoglu C, Burton SA, et al. CyberKnife frameless stereotactic radiosurgery for spinal lesions: clinical experience in 125 cases. Neurosurgery. 2004;55:89-98, discus-sion 98-99.Brunicardi_Ch42_p1827-p1878.indd 187601/03/19 7:17 PM 1877NEUROSURGERYCHAPTER 42 104. Karlsson B, Lax I, Soderman M. Risk for hemorrhage during the 2-year latency period following gamma knife radiosurgery for arteriovenous |
Surgery_Schwartz_12428 | Surgery_Schwartz | 187601/03/19 7:17 PM 1877NEUROSURGERYCHAPTER 42 104. Karlsson B, Lax I, Soderman M. Risk for hemorrhage during the 2-year latency period following gamma knife radiosurgery for arteriovenous malformations. Int J Radiat Oncol Biol Phys. 2001;49:1045-1051. 105. Maruyama K, Kawahara N, Shin M, et al. The risk of hemor-rhage after radiosurgery for cerebral arteriovenous malforma-tions. N Engl J Med. 2005;352:146-153. 106. Pan DH, Guo WY, Chung WY, et al. Gamma knife radiosur-gery as a single treatment modality for large cerebral arterio-venous malformations. J Neurosurg. 2000;93:113-119. 107. Regis J, Pellet W, Delsanti C, et al. Functional outcome after gamma knife surgery or microsurgery for vestibular schwan-nomas. J Neurosurg. 2002;97:1091-1100. 108. Shin M, Ueki K, Kurita H, et al. Malignant transformation of a vestibular schwannoma after gamma knife radiosurgery. Lancet. 2002;360:309-310. 109. Elsmore AJ, Mendoza ND. The operative learning curve for vestibular schwannoma excision | Surgery_Schwartz. 187601/03/19 7:17 PM 1877NEUROSURGERYCHAPTER 42 104. Karlsson B, Lax I, Soderman M. Risk for hemorrhage during the 2-year latency period following gamma knife radiosurgery for arteriovenous malformations. Int J Radiat Oncol Biol Phys. 2001;49:1045-1051. 105. Maruyama K, Kawahara N, Shin M, et al. The risk of hemor-rhage after radiosurgery for cerebral arteriovenous malforma-tions. N Engl J Med. 2005;352:146-153. 106. Pan DH, Guo WY, Chung WY, et al. Gamma knife radiosur-gery as a single treatment modality for large cerebral arterio-venous malformations. J Neurosurg. 2000;93:113-119. 107. Regis J, Pellet W, Delsanti C, et al. Functional outcome after gamma knife surgery or microsurgery for vestibular schwan-nomas. J Neurosurg. 2002;97:1091-1100. 108. Shin M, Ueki K, Kurita H, et al. Malignant transformation of a vestibular schwannoma after gamma knife radiosurgery. Lancet. 2002;360:309-310. 109. Elsmore AJ, Mendoza ND. The operative learning curve for vestibular schwannoma excision |
Surgery_Schwartz_12429 | Surgery_Schwartz | transformation of a vestibular schwannoma after gamma knife radiosurgery. Lancet. 2002;360:309-310. 109. Elsmore AJ, Mendoza ND. The operative learning curve for vestibular schwannoma excision via the retrosigmoid approach. Br J Neurosurg. 2002;16:448-455. 110. Gerosa M, Nicolato A, Foroni R, et al. Gamma knife radio-surgery for brain metastases: a primary therapeutic option. J Neurosurg. 2002;97:515-524. 111. Pollock BE, Brown PD, Foote RL, et al. Properly selected patients with multiple brain metastases may benefit from aggressive treatment of their intracranial disease. J Neurooncol. 2003;61:73-80.Brunicardi_Ch42_p1827-p1878.indd 187701/03/19 7:17 PM | Surgery_Schwartz. transformation of a vestibular schwannoma after gamma knife radiosurgery. Lancet. 2002;360:309-310. 109. Elsmore AJ, Mendoza ND. The operative learning curve for vestibular schwannoma excision via the retrosigmoid approach. Br J Neurosurg. 2002;16:448-455. 110. Gerosa M, Nicolato A, Foroni R, et al. Gamma knife radio-surgery for brain metastases: a primary therapeutic option. J Neurosurg. 2002;97:515-524. 111. Pollock BE, Brown PD, Foote RL, et al. Properly selected patients with multiple brain metastases may benefit from aggressive treatment of their intracranial disease. J Neurooncol. 2003;61:73-80.Brunicardi_Ch42_p1827-p1878.indd 187701/03/19 7:17 PM |
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Surgery_Schwartz_12431 | Surgery_Schwartz | Orthopedic SurgeryNabil A. Ebraheim, Bert J. Thomas, Freddie H. Fu, Bart Muller, Dharmesh Vyas, Matt Niesen, Jonathan Pribaz, and Klaus Draenert 43chapterIntroduction 1880Orthopedic Trauma 1881Introduction / 1881Open Fractures / 1881Compartment Syndrome / 1883Treatment of Fractures and Dislocations 1883Clavicle Fractures / 1883Scapula Fractures / 1883Shoulder Dislocations / 1884Proximal Humerus Fractures / 1884Humeral Shaft Fractures / 1884Distal Humerus Fractures / 1885Elbow Dislocations / 1885Radial Head Fractures / 1886Olecranon Fractures / 1886Forearm Fractures / 1886Distal Radius Fractures / 1886Scaphoid Fractures / 1887Pelvic Fractures / 1887Acetabular Fractures / 1888Hip Dislocations / 1888Hip Fractures / 1888Femoral Shaft Fractures / 1890Distal Femur Fractures / 1890Knee Dislocations / 1890Patella/Extensor Mechanism Injuries / 1891Tibial Plateau Fractures / 1891Tibial Shaft Fractures / 1891Tibial Plafond (Pilon) Fractures / 1892Ankle and Subtalar Dislocations / 1892Ankle | Surgery_Schwartz. Orthopedic SurgeryNabil A. Ebraheim, Bert J. Thomas, Freddie H. Fu, Bart Muller, Dharmesh Vyas, Matt Niesen, Jonathan Pribaz, and Klaus Draenert 43chapterIntroduction 1880Orthopedic Trauma 1881Introduction / 1881Open Fractures / 1881Compartment Syndrome / 1883Treatment of Fractures and Dislocations 1883Clavicle Fractures / 1883Scapula Fractures / 1883Shoulder Dislocations / 1884Proximal Humerus Fractures / 1884Humeral Shaft Fractures / 1884Distal Humerus Fractures / 1885Elbow Dislocations / 1885Radial Head Fractures / 1886Olecranon Fractures / 1886Forearm Fractures / 1886Distal Radius Fractures / 1886Scaphoid Fractures / 1887Pelvic Fractures / 1887Acetabular Fractures / 1888Hip Dislocations / 1888Hip Fractures / 1888Femoral Shaft Fractures / 1890Distal Femur Fractures / 1890Knee Dislocations / 1890Patella/Extensor Mechanism Injuries / 1891Tibial Plateau Fractures / 1891Tibial Shaft Fractures / 1891Tibial Plafond (Pilon) Fractures / 1892Ankle and Subtalar Dislocations / 1892Ankle |
Surgery_Schwartz_12432 | Surgery_Schwartz | / 1890Patella/Extensor Mechanism Injuries / 1891Tibial Plateau Fractures / 1891Tibial Shaft Fractures / 1891Tibial Plafond (Pilon) Fractures / 1892Ankle and Subtalar Dislocations / 1892Ankle Fractures / 1893Maisonneuve Fractures / 1893Calcaneal Fractures / 1893Talus Fractures / 1894Foot Fractures / 1894Sports Medicine 1895Introduction / 1895Shoulder 1895Rotator Cuff / 1895Shoulder Instability / 1896Posterior Dislocation of the Shoulder / 1896Superior Labrum and Biceps Tendon / 1896Impingement Syndromes / 1896The Acromioclavicular Joint / 1897Knee 1897Menisci / 1897Collateral Ligaments / 1898Cruciate Ligaments / 1898Posterolateral Corner / 1899Hip 1899Femoroacetabular Impingement / 1899Spine 1900Spinal Trauma / 1900Occipital Cervical Dislocation / 1900Fractures of C1 (Jefferson Fracture) / 1900Fractures of C2 (Odontoid Fracture) / 1900Hangman’s Fractures of C2 / 1901Compression Fracture of the Cervical Spine / 1901Burst Fractures of the Cervical Spine / 1901Unilateral and | Surgery_Schwartz. / 1890Patella/Extensor Mechanism Injuries / 1891Tibial Plateau Fractures / 1891Tibial Shaft Fractures / 1891Tibial Plafond (Pilon) Fractures / 1892Ankle and Subtalar Dislocations / 1892Ankle Fractures / 1893Maisonneuve Fractures / 1893Calcaneal Fractures / 1893Talus Fractures / 1894Foot Fractures / 1894Sports Medicine 1895Introduction / 1895Shoulder 1895Rotator Cuff / 1895Shoulder Instability / 1896Posterior Dislocation of the Shoulder / 1896Superior Labrum and Biceps Tendon / 1896Impingement Syndromes / 1896The Acromioclavicular Joint / 1897Knee 1897Menisci / 1897Collateral Ligaments / 1898Cruciate Ligaments / 1898Posterolateral Corner / 1899Hip 1899Femoroacetabular Impingement / 1899Spine 1900Spinal Trauma / 1900Occipital Cervical Dislocation / 1900Fractures of C1 (Jefferson Fracture) / 1900Fractures of C2 (Odontoid Fracture) / 1900Hangman’s Fractures of C2 / 1901Compression Fracture of the Cervical Spine / 1901Burst Fractures of the Cervical Spine / 1901Unilateral and |
Surgery_Schwartz_12433 | Surgery_Schwartz | / 1900Fractures of C2 (Odontoid Fracture) / 1900Hangman’s Fractures of C2 / 1901Compression Fracture of the Cervical Spine / 1901Burst Fractures of the Cervical Spine / 1901Unilateral and Bilateral Facet Dislocation / 1901Clay-Shoveler’s Injury / 1902Fractures of the Thoracic and Lumbar Spine 1902Thoracic Lumbar Spine Injury / 1902Compression Fracture / 1902Burst Fracture / 1902Seatbelt Injuries (Flexion Distraction Injuries) / 1902Fracture Dislocations of the Spine / 1903Disc Herniation / 1903Cauda Equina Syndrome / 1903Spinal Stenosis / 1903Back Pain and Degenerative Disc Disease / 1904Scoliosis / 1904Idiopathic Scoliosis / 1904Neuromuscular Scoliosis / 1904Joint Reconstruction 1904Introduction to Arthritis / 1904Examination of the Patient / 1904Nonoperative Management and Prevention of Arthritis / 1905Injections / 1905Surgical Management of Arthritis / 1906Computer Navigation, Robotics, and Joint Arthroplasty / 1908Fixation Options in Joint Arthroplasty / 1910Complications | Surgery_Schwartz. / 1900Fractures of C2 (Odontoid Fracture) / 1900Hangman’s Fractures of C2 / 1901Compression Fracture of the Cervical Spine / 1901Burst Fractures of the Cervical Spine / 1901Unilateral and Bilateral Facet Dislocation / 1901Clay-Shoveler’s Injury / 1902Fractures of the Thoracic and Lumbar Spine 1902Thoracic Lumbar Spine Injury / 1902Compression Fracture / 1902Burst Fracture / 1902Seatbelt Injuries (Flexion Distraction Injuries) / 1902Fracture Dislocations of the Spine / 1903Disc Herniation / 1903Cauda Equina Syndrome / 1903Spinal Stenosis / 1903Back Pain and Degenerative Disc Disease / 1904Scoliosis / 1904Idiopathic Scoliosis / 1904Neuromuscular Scoliosis / 1904Joint Reconstruction 1904Introduction to Arthritis / 1904Examination of the Patient / 1904Nonoperative Management and Prevention of Arthritis / 1905Injections / 1905Surgical Management of Arthritis / 1906Computer Navigation, Robotics, and Joint Arthroplasty / 1908Fixation Options in Joint Arthroplasty / 1910Complications |
Surgery_Schwartz_12434 | Surgery_Schwartz | of Arthritis / 1905Injections / 1905Surgical Management of Arthritis / 1906Computer Navigation, Robotics, and Joint Arthroplasty / 1908Fixation Options in Joint Arthroplasty / 1910Complications in Joint Arthroplasty / 1910Orthopedic Pathology and Oncology 1910Diagnosis of Malignant Bone Tumors / 1910Osteosarcoma 1911Intramedullary Osteosarcoma / 1911Parosteal Osteosarcoma / 1912Periosteal Osteosarcoma / 1912Paget’s Sarcoma / 1912Radiation-Induced Sarcoma / 1912Ewing’s Sarcoma 1912Cartilage-Forming Tumors 1912Chondrosarcomas / 1912Fibrous Lesions of Bone 1912Desmoplastic Fibroma / 1912Malignant Fibrous Histiocytoma of Bone / 1913Malignant Vascular Tumors / 1913Miscellaneous Tumors 1913Giant Cell Tumor of Bone / 1913Adamantinoma and Osteofibrous Dysplasia / 1913Primary Lymphoma of Bone / 1914Chordoma / 1914Multiple Myeloma / 1914Metastatic Bone Tumors 1914Pediatric Orthopedics 1915Birth Injuries / 1915Skeletal Growth / 1915Pediatric Fractures / 1916Classification of Growth Plate | Surgery_Schwartz. of Arthritis / 1905Injections / 1905Surgical Management of Arthritis / 1906Computer Navigation, Robotics, and Joint Arthroplasty / 1908Fixation Options in Joint Arthroplasty / 1910Complications in Joint Arthroplasty / 1910Orthopedic Pathology and Oncology 1910Diagnosis of Malignant Bone Tumors / 1910Osteosarcoma 1911Intramedullary Osteosarcoma / 1911Parosteal Osteosarcoma / 1912Periosteal Osteosarcoma / 1912Paget’s Sarcoma / 1912Radiation-Induced Sarcoma / 1912Ewing’s Sarcoma 1912Cartilage-Forming Tumors 1912Chondrosarcomas / 1912Fibrous Lesions of Bone 1912Desmoplastic Fibroma / 1912Malignant Fibrous Histiocytoma of Bone / 1913Malignant Vascular Tumors / 1913Miscellaneous Tumors 1913Giant Cell Tumor of Bone / 1913Adamantinoma and Osteofibrous Dysplasia / 1913Primary Lymphoma of Bone / 1914Chordoma / 1914Multiple Myeloma / 1914Metastatic Bone Tumors 1914Pediatric Orthopedics 1915Birth Injuries / 1915Skeletal Growth / 1915Pediatric Fractures / 1916Classification of Growth Plate |
Surgery_Schwartz_12435 | Surgery_Schwartz | / 1914Chordoma / 1914Multiple Myeloma / 1914Metastatic Bone Tumors 1914Pediatric Orthopedics 1915Birth Injuries / 1915Skeletal Growth / 1915Pediatric Fractures / 1916Classification of Growth Plate Injuries / 1916Diaphyseal Injuries in a Pediatric Patient / 1916Fractures of the Pediatric Hip / 1916Fractures of the Femoral Shaft / 1916Pediatric Ankle Fractures / 1917Pediatric Elbow Fractures / 1917Brunicardi_Ch43_p1879-p1924.indd 187922/02/19 10:40 AM 1880Key Points1 The main principle of internal fixation for fracture care (most commonly intramedullary nails or plate and screw fixation) is to create a stable construct that will allow the fracture to heal in proper length, alignment, and rotation.2 In open fractures, early administration of intravenous antibiotics is important to avoid infection. An external fixator is used when the wound is grossly contaminated, and definitive treatment of the wound is delayed until the wound is sufficiently clean. Early wound coverage is | Surgery_Schwartz. / 1914Chordoma / 1914Multiple Myeloma / 1914Metastatic Bone Tumors 1914Pediatric Orthopedics 1915Birth Injuries / 1915Skeletal Growth / 1915Pediatric Fractures / 1916Classification of Growth Plate Injuries / 1916Diaphyseal Injuries in a Pediatric Patient / 1916Fractures of the Pediatric Hip / 1916Fractures of the Femoral Shaft / 1916Pediatric Ankle Fractures / 1917Pediatric Elbow Fractures / 1917Brunicardi_Ch43_p1879-p1924.indd 187922/02/19 10:40 AM 1880Key Points1 The main principle of internal fixation for fracture care (most commonly intramedullary nails or plate and screw fixation) is to create a stable construct that will allow the fracture to heal in proper length, alignment, and rotation.2 In open fractures, early administration of intravenous antibiotics is important to avoid infection. An external fixator is used when the wound is grossly contaminated, and definitive treatment of the wound is delayed until the wound is sufficiently clean. Early wound coverage is |
Surgery_Schwartz_12436 | Surgery_Schwartz | to avoid infection. An external fixator is used when the wound is grossly contaminated, and definitive treatment of the wound is delayed until the wound is sufficiently clean. Early wound coverage is important.3 Early diagnosis and treatment of compartment syndrome is important in order to prevent irreversible damage to the muscles and the nerves, which is time sensitive. Emergency fasciotomy by releasing the tight fascia is a limb-saving procedure.4 Fractures of the scapula are typically the result of a high-energy trauma with a high incidence of associated injuries that typically involve the ribs and the lungs.5 The shoulder is one of the most commonly dislocated joints, and most dislocations are anterior. Posterior dislo-cations may be missed and are typically associated with seizures or electric shock. Anterior-posterior and axillary views of the shoulder are necessary for the diagnosis.6 Isolated humeral shaft fractures are usually treated conser-vatively. The radial nerve | Surgery_Schwartz. to avoid infection. An external fixator is used when the wound is grossly contaminated, and definitive treatment of the wound is delayed until the wound is sufficiently clean. Early wound coverage is important.3 Early diagnosis and treatment of compartment syndrome is important in order to prevent irreversible damage to the muscles and the nerves, which is time sensitive. Emergency fasciotomy by releasing the tight fascia is a limb-saving procedure.4 Fractures of the scapula are typically the result of a high-energy trauma with a high incidence of associated injuries that typically involve the ribs and the lungs.5 The shoulder is one of the most commonly dislocated joints, and most dislocations are anterior. Posterior dislo-cations may be missed and are typically associated with seizures or electric shock. Anterior-posterior and axillary views of the shoulder are necessary for the diagnosis.6 Isolated humeral shaft fractures are usually treated conser-vatively. The radial nerve |
Surgery_Schwartz_12437 | Surgery_Schwartz | or electric shock. Anterior-posterior and axillary views of the shoulder are necessary for the diagnosis.6 Isolated humeral shaft fractures are usually treated conser-vatively. The radial nerve spirals around the humeral shaft and is at risk for injury; therefore, a careful neurovascular exam is important. The patient should be checked for wrist drop.7 Hemorrhage from pelvic trauma can be life-threatening. An important first line of treatment in the emergency department is resuscitation of the patient with fluids, including blood, and the application of a pelvic binder or sheet that is wrapped tightly around the pelvis to control bleeding.8 In spinal injury, spinal stability must be assessed, and the patient should be immobilized until there is further under-standing of the injury. A computed tomography scan is more reliable in assessing spine injury than plain radiographs.9 Spinal cord injuries can be complete or incomplete, and every attempt should be made to avoid further injury. | Surgery_Schwartz. or electric shock. Anterior-posterior and axillary views of the shoulder are necessary for the diagnosis.6 Isolated humeral shaft fractures are usually treated conser-vatively. The radial nerve spirals around the humeral shaft and is at risk for injury; therefore, a careful neurovascular exam is important. The patient should be checked for wrist drop.7 Hemorrhage from pelvic trauma can be life-threatening. An important first line of treatment in the emergency department is resuscitation of the patient with fluids, including blood, and the application of a pelvic binder or sheet that is wrapped tightly around the pelvis to control bleeding.8 In spinal injury, spinal stability must be assessed, and the patient should be immobilized until there is further under-standing of the injury. A computed tomography scan is more reliable in assessing spine injury than plain radiographs.9 Spinal cord injuries can be complete or incomplete, and every attempt should be made to avoid further injury. |
Surgery_Schwartz_12438 | Surgery_Schwartz | tomography scan is more reliable in assessing spine injury than plain radiographs.9 Spinal cord injuries can be complete or incomplete, and every attempt should be made to avoid further injury. Patients should be triaged to trauma centers since trauma center care is associated with reduced paralysis and improved outcome.10 According to the Centers for Disease Control and Prevention and the National Health Interview Survey, approximately 55 million adults have been diagnosed with some form of arthritis. This number is projected to grow substantially in the future.11 A combination of nonsteroidal anti-inflammatory medica-tions, physiotherapy, and weight loss with the help of a dietary consultation, and physical therapy are typically the first line of treatment for knee osteoarthritis. Weight loss of as little as 11 lbs (5 kg) has been shown to decrease the risk of developing knee osteoarthritis in women by 50%.12 Minimally invasive surgical techniques improve cosmesis and allow for | Surgery_Schwartz. tomography scan is more reliable in assessing spine injury than plain radiographs.9 Spinal cord injuries can be complete or incomplete, and every attempt should be made to avoid further injury. Patients should be triaged to trauma centers since trauma center care is associated with reduced paralysis and improved outcome.10 According to the Centers for Disease Control and Prevention and the National Health Interview Survey, approximately 55 million adults have been diagnosed with some form of arthritis. This number is projected to grow substantially in the future.11 A combination of nonsteroidal anti-inflammatory medica-tions, physiotherapy, and weight loss with the help of a dietary consultation, and physical therapy are typically the first line of treatment for knee osteoarthritis. Weight loss of as little as 11 lbs (5 kg) has been shown to decrease the risk of developing knee osteoarthritis in women by 50%.12 Minimally invasive surgical techniques improve cosmesis and allow for |
Surgery_Schwartz_12439 | Surgery_Schwartz | loss of as little as 11 lbs (5 kg) has been shown to decrease the risk of developing knee osteoarthritis in women by 50%.12 Minimally invasive surgical techniques improve cosmesis and allow for early rehabilitation. However, they may be associated with decreased visualization intraoperatively, associated risks of component malposition, intraoperative fracture, and nerve or vascular injury.Developmental Disease 1917Developmental Dysplasia of the Hip / 1917Treatment of DDH / 1918Legg-Calvé-Perthes Disease / 1918Slipped Capital Femoral Epiphysis / 1918Lower Extremity Rotational Abnormalities / 1918Congenital Talipes Equinovarus (Clubfoot) / 1918Osgood-Schlatter Disease / 1918INTRODUCTIONEvery physician should be familiar with orthopedics and ortho-pedic surgery. Anyone who cares for patients in an outpatient or emergency room setting will find that the majority of presenting complaints involve the musculoskeletal system. A basic under-standing of the principles of care for | Surgery_Schwartz. loss of as little as 11 lbs (5 kg) has been shown to decrease the risk of developing knee osteoarthritis in women by 50%.12 Minimally invasive surgical techniques improve cosmesis and allow for early rehabilitation. However, they may be associated with decreased visualization intraoperatively, associated risks of component malposition, intraoperative fracture, and nerve or vascular injury.Developmental Disease 1917Developmental Dysplasia of the Hip / 1917Treatment of DDH / 1918Legg-Calvé-Perthes Disease / 1918Slipped Capital Femoral Epiphysis / 1918Lower Extremity Rotational Abnormalities / 1918Congenital Talipes Equinovarus (Clubfoot) / 1918Osgood-Schlatter Disease / 1918INTRODUCTIONEvery physician should be familiar with orthopedics and ortho-pedic surgery. Anyone who cares for patients in an outpatient or emergency room setting will find that the majority of presenting complaints involve the musculoskeletal system. A basic under-standing of the principles of care for |
Surgery_Schwartz_12440 | Surgery_Schwartz | for patients in an outpatient or emergency room setting will find that the majority of presenting complaints involve the musculoskeletal system. A basic under-standing of the principles of care for musculoskeletal conditions is essential for the health care profession.For physicians, the field of orthopedics offers an array of subspecialties with such diversity that it seems that “there is something for everyone.” Trauma specialists have the satis-faction of physically putting complex fractures back together. Sports medicine offers remarkably rapid recovery in athletes who have suffered fibrocartilage and ligament tears with ever-improving arthroscopic techniques and instrumentation. Spine surgeons see remarkable results from their minimally inva-sive microscopic techniques, while also managing massive deformities with new instrumentation and open surgery. Joint reconstruction is one of our most exciting subspecialties, work-ing with orthopedic bioengineers to develop improved | Surgery_Schwartz. for patients in an outpatient or emergency room setting will find that the majority of presenting complaints involve the musculoskeletal system. A basic under-standing of the principles of care for musculoskeletal conditions is essential for the health care profession.For physicians, the field of orthopedics offers an array of subspecialties with such diversity that it seems that “there is something for everyone.” Trauma specialists have the satis-faction of physically putting complex fractures back together. Sports medicine offers remarkably rapid recovery in athletes who have suffered fibrocartilage and ligament tears with ever-improving arthroscopic techniques and instrumentation. Spine surgeons see remarkable results from their minimally inva-sive microscopic techniques, while also managing massive deformities with new instrumentation and open surgery. Joint reconstruction is one of our most exciting subspecialties, work-ing with orthopedic bioengineers to develop improved |
Surgery_Schwartz_12441 | Surgery_Schwartz | also managing massive deformities with new instrumentation and open surgery. Joint reconstruction is one of our most exciting subspecialties, work-ing with orthopedic bioengineers to develop improved designs, biomaterials, and minimally invasive surgical approaches for faster return to function for patients debilitated by arthritis and injury. Musculoskeletal oncology offers the intellectual chal-lenge of arriving at appropriate differential diagnoses as well as the technical challenge of limb salvage and major reconstruc-tive surgery. Pediatric orthopedics is an especially challenging and rewarding subspecialty because of the remarkable ability of children to heal their fractures quickly and remodel their bones. The incredible array of congenital and developmental disorders makes pediatrics a uniquely intellectually challenging field as well. The authors hope that our readers will share our enthusi-asm for orthopedic surgery and all of its subspecialties: trauma, sports, spine, joint | Surgery_Schwartz. also managing massive deformities with new instrumentation and open surgery. Joint reconstruction is one of our most exciting subspecialties, work-ing with orthopedic bioengineers to develop improved designs, biomaterials, and minimally invasive surgical approaches for faster return to function for patients debilitated by arthritis and injury. Musculoskeletal oncology offers the intellectual chal-lenge of arriving at appropriate differential diagnoses as well as the technical challenge of limb salvage and major reconstruc-tive surgery. Pediatric orthopedics is an especially challenging and rewarding subspecialty because of the remarkable ability of children to heal their fractures quickly and remodel their bones. The incredible array of congenital and developmental disorders makes pediatrics a uniquely intellectually challenging field as well. The authors hope that our readers will share our enthusi-asm for orthopedic surgery and all of its subspecialties: trauma, sports, spine, joint |
Surgery_Schwartz_12442 | Surgery_Schwartz | a uniquely intellectually challenging field as well. The authors hope that our readers will share our enthusi-asm for orthopedic surgery and all of its subspecialties: trauma, sports, spine, joint replacement, musculoskeletal oncology, foot and ankle, hand, and pediatric orthopedics.Brunicardi_Ch43_p1879-p1924.indd 188022/02/19 10:40 AM 1881ORTHOPEDIC SURGERYCHAPTER 43ORTHOPEDIC TRAUMAIntroductionMusculoskeletal injuries resulting from trauma include frac-tures of bones, damage to joints, and injuries to soft tissues. Long bone fractures can be described as transverse, oblique, spiral, segmental, or comminuted (Fig. 43-1). The goals of treat-ing musculoskeletal injuries are to restore the normal anatomy, stabilize fractures to allow early mobility and minimize com-plications related to multiple system trauma, and to repair or reconstruct these injuries to restore function.Fractures frequently result from high-energy trauma as well as from falls onto an extremity (Fig. 43-2). The | Surgery_Schwartz. a uniquely intellectually challenging field as well. The authors hope that our readers will share our enthusi-asm for orthopedic surgery and all of its subspecialties: trauma, sports, spine, joint replacement, musculoskeletal oncology, foot and ankle, hand, and pediatric orthopedics.Brunicardi_Ch43_p1879-p1924.indd 188022/02/19 10:40 AM 1881ORTHOPEDIC SURGERYCHAPTER 43ORTHOPEDIC TRAUMAIntroductionMusculoskeletal injuries resulting from trauma include frac-tures of bones, damage to joints, and injuries to soft tissues. Long bone fractures can be described as transverse, oblique, spiral, segmental, or comminuted (Fig. 43-1). The goals of treat-ing musculoskeletal injuries are to restore the normal anatomy, stabilize fractures to allow early mobility and minimize com-plications related to multiple system trauma, and to repair or reconstruct these injuries to restore function.Fractures frequently result from high-energy trauma as well as from falls onto an extremity (Fig. 43-2). The |
Surgery_Schwartz_12443 | Surgery_Schwartz | to multiple system trauma, and to repair or reconstruct these injuries to restore function.Fractures frequently result from high-energy trauma as well as from falls onto an extremity (Fig. 43-2). The majority of fractures can heal well with immobilization, which stabilizes the fracture while new bone forms at the fracture site. Methods of immobilization can vary and depend on the fracture being treated. The most common tool used in orthopedics to treat fractures is immobilization with a splint, cast, or braces, and their proper application is important to successfully treat the injury without causing additional problems. A successful splint contains adequate padding on the underlying skin, particularly over bony prominences, to prevent pressure or burns that can be caused by plaster. Splints, which are not circumferential, are preferred for acute injuries because they allow room for swell-ing that inevitably occurs after a fracture. The splint may later be changed to a cast as the | Surgery_Schwartz. to multiple system trauma, and to repair or reconstruct these injuries to restore function.Fractures frequently result from high-energy trauma as well as from falls onto an extremity (Fig. 43-2). The majority of fractures can heal well with immobilization, which stabilizes the fracture while new bone forms at the fracture site. Methods of immobilization can vary and depend on the fracture being treated. The most common tool used in orthopedics to treat fractures is immobilization with a splint, cast, or braces, and their proper application is important to successfully treat the injury without causing additional problems. A successful splint contains adequate padding on the underlying skin, particularly over bony prominences, to prevent pressure or burns that can be caused by plaster. Splints, which are not circumferential, are preferred for acute injuries because they allow room for swell-ing that inevitably occurs after a fracture. The splint may later be changed to a cast as the |
Surgery_Schwartz_12444 | Surgery_Schwartz | which are not circumferential, are preferred for acute injuries because they allow room for swell-ing that inevitably occurs after a fracture. The splint may later be changed to a cast as the swelling subsides.Fractures that are displaced or angulated require closed reduction to properly realign the bone. This is done using anal-gesia, local or general anesthesia, and often muscle relaxation. Reduction is performed with axial traction and reversal of the mechanism of injury in order to restore length, rotation, and angu-lation. A splint is then applied and can be gently molded to help hold the reduction in place. It is important to obtain X-rays after a closed reduction to verify acceptable alignment of the fracture, and to perform a neurovascular exam to ensure the splint is not too tight or that manipulation did not change the neurovascular status. Careful monitoring with timely clinical and radiological examination is necessary in the outpatient setting.For certain fractures, | Surgery_Schwartz. which are not circumferential, are preferred for acute injuries because they allow room for swell-ing that inevitably occurs after a fracture. The splint may later be changed to a cast as the swelling subsides.Fractures that are displaced or angulated require closed reduction to properly realign the bone. This is done using anal-gesia, local or general anesthesia, and often muscle relaxation. Reduction is performed with axial traction and reversal of the mechanism of injury in order to restore length, rotation, and angu-lation. A splint is then applied and can be gently molded to help hold the reduction in place. It is important to obtain X-rays after a closed reduction to verify acceptable alignment of the fracture, and to perform a neurovascular exam to ensure the splint is not too tight or that manipulation did not change the neurovascular status. Careful monitoring with timely clinical and radiological examination is necessary in the outpatient setting.For certain fractures, |
Surgery_Schwartz_12445 | Surgery_Schwartz | tight or that manipulation did not change the neurovascular status. Careful monitoring with timely clinical and radiological examination is necessary in the outpatient setting.For certain fractures, splint or cast immobilization is inad-equate, and in these instances internal fixation or external fixa-tion is used. A variety of implants can be used to stabilize the fracture such as screws, plates, rods, and external fixators. The main principle of orthopedic implants for fracture care is to cre-ate a stable construct that will allow the fracture to heal in proper length, alignment, and rotation. Screws can be placed across a fracture to create compression at the fracture site, which promotes healing. Plates can be placed on the cortex of bones and held with screws, which creates a long area of fixa-tion to stabilize the fracture. Intramedullary rods are commonly used for long bone fractures, such as the femur and tibia (Fig. 43-3A,B). Usually, the fracture is reamed prior to the | Surgery_Schwartz. tight or that manipulation did not change the neurovascular status. Careful monitoring with timely clinical and radiological examination is necessary in the outpatient setting.For certain fractures, splint or cast immobilization is inad-equate, and in these instances internal fixation or external fixa-tion is used. A variety of implants can be used to stabilize the fracture such as screws, plates, rods, and external fixators. The main principle of orthopedic implants for fracture care is to cre-ate a stable construct that will allow the fracture to heal in proper length, alignment, and rotation. Screws can be placed across a fracture to create compression at the fracture site, which promotes healing. Plates can be placed on the cortex of bones and held with screws, which creates a long area of fixa-tion to stabilize the fracture. Intramedullary rods are commonly used for long bone fractures, such as the femur and tibia (Fig. 43-3A,B). Usually, the fracture is reamed prior to the |
Surgery_Schwartz_12446 | Surgery_Schwartz | area of fixa-tion to stabilize the fracture. Intramedullary rods are commonly used for long bone fractures, such as the femur and tibia (Fig. 43-3A,B). Usually, the fracture is reamed prior to the insertion of the rod into the intramedullary canal. Screws can then be placed across the cortices of the bone through holes in the rod proximal and distal to the fracture to create a locked construct that further stabilizes the rod. When the fracture is locked proximally and distally, this is called static locking. In situations where patients are severely injured and cannot safely undergo more invasive open surgery, damage control orthope-dics is done by utilizing an external fixator. External fixators are also used when the soft tissues are too swollen or injured to allow for surgical incisions to be safely made. The wrinkle test is helpful in guiding the most suitable time for definitive sur-gery. An external fixation device can be used to temporarily immobilize the fracture, especially | Surgery_Schwartz. area of fixa-tion to stabilize the fracture. Intramedullary rods are commonly used for long bone fractures, such as the femur and tibia (Fig. 43-3A,B). Usually, the fracture is reamed prior to the insertion of the rod into the intramedullary canal. Screws can then be placed across the cortices of the bone through holes in the rod proximal and distal to the fracture to create a locked construct that further stabilizes the rod. When the fracture is locked proximally and distally, this is called static locking. In situations where patients are severely injured and cannot safely undergo more invasive open surgery, damage control orthope-dics is done by utilizing an external fixator. External fixators are also used when the soft tissues are too swollen or injured to allow for surgical incisions to be safely made. The wrinkle test is helpful in guiding the most suitable time for definitive sur-gery. An external fixation device can be used to temporarily immobilize the fracture, especially |
Surgery_Schwartz_12447 | Surgery_Schwartz | to be safely made. The wrinkle test is helpful in guiding the most suitable time for definitive sur-gery. An external fixation device can be used to temporarily immobilize the fracture, especially if the fracture is open and contaminated. External fixators involve pins placed into bone proximal and distal to the fracture (through healthy tissues), which are then connected by strong rods on the outside of the extremity, creating a stable construct.Open FracturesAn open fracture occurs when the bone breaks through the skin. These typically result from high-energy injuries and are often associated with significant damage to the surrounding soft tissues and contamination of the wound. These injuries are classified into three types according to the Gustillo-Anderson Classification.• Type I injuries are low energy and wounds are usually less than 1 cm.• Type II injuries have a wound length of 2 to 10 cm with mod-erate soft tissue damage and wound contamination.1ABCDEFFigure 43-1. Types of | Surgery_Schwartz. to be safely made. The wrinkle test is helpful in guiding the most suitable time for definitive sur-gery. An external fixation device can be used to temporarily immobilize the fracture, especially if the fracture is open and contaminated. External fixators involve pins placed into bone proximal and distal to the fracture (through healthy tissues), which are then connected by strong rods on the outside of the extremity, creating a stable construct.Open FracturesAn open fracture occurs when the bone breaks through the skin. These typically result from high-energy injuries and are often associated with significant damage to the surrounding soft tissues and contamination of the wound. These injuries are classified into three types according to the Gustillo-Anderson Classification.• Type I injuries are low energy and wounds are usually less than 1 cm.• Type II injuries have a wound length of 2 to 10 cm with mod-erate soft tissue damage and wound contamination.1ABCDEFFigure 43-1. Types of |
Surgery_Schwartz_12448 | Surgery_Schwartz | are low energy and wounds are usually less than 1 cm.• Type II injuries have a wound length of 2 to 10 cm with mod-erate soft tissue damage and wound contamination.1ABCDEFFigure 43-1. Types of fractures. A. Normal bone. B. Transverse. C. Oblique. D. Spiral. E. Segmental. F. Comminuted.Figure 43-2. Transverse tibia fracture and segmental fibula fracture.Brunicardi_Ch43_p1879-p1924.indd 188122/02/19 10:40 AM 1882SPECIFIC CONSIDERATIONSPART II• Type III injuries are high-energy wounds usually greater than 10 cm in length with extensive muscle devitalization. The wound is highly contaminated with extensive soft tissue damage.These injuries require immediate administration of antibi-otics and irrigation and debridement of the wound. The goal of the treatment is to achieve fracture healing and to prevent wound infections and osteomyelitis. They are frequently associated with injuries to surrounding vessels and nerves, which must be addressed as well. When the wound is contami-nated, an | Surgery_Schwartz. are low energy and wounds are usually less than 1 cm.• Type II injuries have a wound length of 2 to 10 cm with mod-erate soft tissue damage and wound contamination.1ABCDEFFigure 43-1. Types of fractures. A. Normal bone. B. Transverse. C. Oblique. D. Spiral. E. Segmental. F. Comminuted.Figure 43-2. Transverse tibia fracture and segmental fibula fracture.Brunicardi_Ch43_p1879-p1924.indd 188122/02/19 10:40 AM 1882SPECIFIC CONSIDERATIONSPART II• Type III injuries are high-energy wounds usually greater than 10 cm in length with extensive muscle devitalization. The wound is highly contaminated with extensive soft tissue damage.These injuries require immediate administration of antibi-otics and irrigation and debridement of the wound. The goal of the treatment is to achieve fracture healing and to prevent wound infections and osteomyelitis. They are frequently associated with injuries to surrounding vessels and nerves, which must be addressed as well. When the wound is contami-nated, an |
Surgery_Schwartz_12449 | Surgery_Schwartz | and to prevent wound infections and osteomyelitis. They are frequently associated with injuries to surrounding vessels and nerves, which must be addressed as well. When the wound is contami-nated, an external fixator is initially used (Fig. 43-4A,B). Often, definitive treatment of the fracture is delayed until the wound is 2ABFigure 43-3. A. Transverse femur fracture. B. Intramedullary rod stabilizes femur fracture.ABFigure 43-4. A. Gustillo-Anderson fracture type III open fracture. B. Image of external fixator of the tibia.Brunicardi_Ch43_p1879-p1924.indd 188222/02/19 10:40 AM 1883ORTHOPEDIC SURGERYCHAPTER 43sufficiently cleaned and healthy soft tissue is available to cover the fracture. Early coverage of the wound is important to avoid infection. Usually a large wound in the proximal or middle third of the tibia can be covered using local muscle flaps, while the distal third of the tibia will require a free flap. In general, an increase in Gustillo grade is associated with an | Surgery_Schwartz. and to prevent wound infections and osteomyelitis. They are frequently associated with injuries to surrounding vessels and nerves, which must be addressed as well. When the wound is contami-nated, an external fixator is initially used (Fig. 43-4A,B). Often, definitive treatment of the fracture is delayed until the wound is 2ABFigure 43-3. A. Transverse femur fracture. B. Intramedullary rod stabilizes femur fracture.ABFigure 43-4. A. Gustillo-Anderson fracture type III open fracture. B. Image of external fixator of the tibia.Brunicardi_Ch43_p1879-p1924.indd 188222/02/19 10:40 AM 1883ORTHOPEDIC SURGERYCHAPTER 43sufficiently cleaned and healthy soft tissue is available to cover the fracture. Early coverage of the wound is important to avoid infection. Usually a large wound in the proximal or middle third of the tibia can be covered using local muscle flaps, while the distal third of the tibia will require a free flap. In general, an increase in Gustillo grade is associated with an |
Surgery_Schwartz_12450 | Surgery_Schwartz | or middle third of the tibia can be covered using local muscle flaps, while the distal third of the tibia will require a free flap. In general, an increase in Gustillo grade is associated with an increase in infec-tion risk.Compartment SyndromeCompartment syndrome is an orthopedic emergency caused by significant swelling within a compartment of an injured extrem-ity that jeopardizes blood flow and microcirculation to the limb. Increased pressure within the compartment compromises perfu-sion to muscles and nerves and can cause ischemia or necrosis. Patients complain of pain that is greater than expected for the injury or surgery. There may be an increase in analgesic require-ments. Early high index of suspicion is necessary for timely diagnosis and treatment of compartment syndrome. The usual clinical findings are pain, swelling, and pain with passive stretch of the compartment muscles. Numbness, paralysis, and the absence of a pulse are late findings. While the diagnosis is usu-ally | Surgery_Schwartz. or middle third of the tibia can be covered using local muscle flaps, while the distal third of the tibia will require a free flap. In general, an increase in Gustillo grade is associated with an increase in infec-tion risk.Compartment SyndromeCompartment syndrome is an orthopedic emergency caused by significant swelling within a compartment of an injured extrem-ity that jeopardizes blood flow and microcirculation to the limb. Increased pressure within the compartment compromises perfu-sion to muscles and nerves and can cause ischemia or necrosis. Patients complain of pain that is greater than expected for the injury or surgery. There may be an increase in analgesic require-ments. Early high index of suspicion is necessary for timely diagnosis and treatment of compartment syndrome. The usual clinical findings are pain, swelling, and pain with passive stretch of the compartment muscles. Numbness, paralysis, and the absence of a pulse are late findings. While the diagnosis is usu-ally |
Surgery_Schwartz_12451 | Surgery_Schwartz | clinical findings are pain, swelling, and pain with passive stretch of the compartment muscles. Numbness, paralysis, and the absence of a pulse are late findings. While the diagnosis is usu-ally based on clinical exam, compartment pressures can be mea-sured with needles placed into the compartment, which is necessary in unconscious patients and those who will not coop-erate with the exam. Compartment pressure within 30 mmHg of the diastolic pressure is diagnostic of compartment syndrome. When compartment syndrome is suspected, emergent fasciot-omy (Fig. 43-5A,B) must be performed in which the overlying tight fascia is released through long incisions. Fasciotomy must be done as soon as possible to prevent damage to muscles and nerves that will result in irreversible necrosis and Volkmann’s ischemic contractures with severe loss of function.TREATMENT OF FRACTURES AND DISLOCATIONSClavicle FracturesFractures of the clavicle are one of the most common fractures in orthopedics. They | Surgery_Schwartz. clinical findings are pain, swelling, and pain with passive stretch of the compartment muscles. Numbness, paralysis, and the absence of a pulse are late findings. While the diagnosis is usu-ally based on clinical exam, compartment pressures can be mea-sured with needles placed into the compartment, which is necessary in unconscious patients and those who will not coop-erate with the exam. Compartment pressure within 30 mmHg of the diastolic pressure is diagnostic of compartment syndrome. When compartment syndrome is suspected, emergent fasciot-omy (Fig. 43-5A,B) must be performed in which the overlying tight fascia is released through long incisions. Fasciotomy must be done as soon as possible to prevent damage to muscles and nerves that will result in irreversible necrosis and Volkmann’s ischemic contractures with severe loss of function.TREATMENT OF FRACTURES AND DISLOCATIONSClavicle FracturesFractures of the clavicle are one of the most common fractures in orthopedics. They |
Surgery_Schwartz_12452 | Surgery_Schwartz | ischemic contractures with severe loss of function.TREATMENT OF FRACTURES AND DISLOCATIONSClavicle FracturesFractures of the clavicle are one of the most common fractures in orthopedics. They typically occur following a fall onto the shoulder. The majority of clavicle fractures occur in the middle third of the clavicle. Since the clavicle is subcutaneous, the frac-ture is often evident on inspection. Most clavicle fractures can be treated nonoperatively with a sling, early range of motion exercises, and gradual return to normal activities. Fractures that are significantly displaced and shortened or that penetrate or tent the skin are treated with open reduction and internal fixa-tion, typically with plate and screw fixation.Distal clavicle fractures are less common and may occur with coracoclavicular ligament ruptures. These injuries can be more troublesome and are at risk for nonunion if the bone ends are not in contact. If there is displacement of the fracture and the fracture is | Surgery_Schwartz. ischemic contractures with severe loss of function.TREATMENT OF FRACTURES AND DISLOCATIONSClavicle FracturesFractures of the clavicle are one of the most common fractures in orthopedics. They typically occur following a fall onto the shoulder. The majority of clavicle fractures occur in the middle third of the clavicle. Since the clavicle is subcutaneous, the frac-ture is often evident on inspection. Most clavicle fractures can be treated nonoperatively with a sling, early range of motion exercises, and gradual return to normal activities. Fractures that are significantly displaced and shortened or that penetrate or tent the skin are treated with open reduction and internal fixa-tion, typically with plate and screw fixation.Distal clavicle fractures are less common and may occur with coracoclavicular ligament ruptures. These injuries can be more troublesome and are at risk for nonunion if the bone ends are not in contact. If there is displacement of the fracture and the fracture is |
Surgery_Schwartz_12453 | Surgery_Schwartz | ligament ruptures. These injuries can be more troublesome and are at risk for nonunion if the bone ends are not in contact. If there is displacement of the fracture and the fracture is proximal to the coracoclavicular ligament, surgical management is often recommended.Acromioclavicular (AC) joint injuries occur from either a fall directly onto the shoulder or onto an outstretched hand and can result in tears of the acromioclavicular and cora-coclavicular ligaments. A step-off, or separation, of the AC joint may be apparent on radiographs. The majority of these injuries can be treated with a sling and gentle range of motion. Although controversial, injuries resulting in severe displacement of the clavicle at the AC joint usually require open reduction and surgical repair, especially in athletes and manual workers.The sternoclavicular (SC) joint is the only articulation between the upper extremity and the axial skeleton. Injuries to this joint are rare. Anterior dislocations occur more | Surgery_Schwartz. ligament ruptures. These injuries can be more troublesome and are at risk for nonunion if the bone ends are not in contact. If there is displacement of the fracture and the fracture is proximal to the coracoclavicular ligament, surgical management is often recommended.Acromioclavicular (AC) joint injuries occur from either a fall directly onto the shoulder or onto an outstretched hand and can result in tears of the acromioclavicular and cora-coclavicular ligaments. A step-off, or separation, of the AC joint may be apparent on radiographs. The majority of these injuries can be treated with a sling and gentle range of motion. Although controversial, injuries resulting in severe displacement of the clavicle at the AC joint usually require open reduction and surgical repair, especially in athletes and manual workers.The sternoclavicular (SC) joint is the only articulation between the upper extremity and the axial skeleton. Injuries to this joint are rare. Anterior dislocations occur more |
Surgery_Schwartz_12454 | Surgery_Schwartz | and manual workers.The sternoclavicular (SC) joint is the only articulation between the upper extremity and the axial skeleton. Injuries to this joint are rare. Anterior dislocations occur more frequently, and although closed reduction can be attempted, recurrence of the dislocation is typical. Patients are given a sling and the out-come is usually good, despite the visible bump and swelling. Posterior SC joint dislocations are rare and not grossly visible and can be easily missed. They can be dangerous injuries, result-ing in pulmonary or neurovascular compromise. Therefore, closed or open reduction under general anesthesia is recom-mended with a cardiac surgeon back-up.Scapula FracturesFractures of the scapula often result from significant high-energy trauma (Fig. 43-6) with about 80% associated injuries, 3Compartmentsyndrome ofthe forearmABFigure 43-5. A. Image showing compartment syndrome of the forearm. B. Fasciotomy of the leg. Notice gaping of the wound and bulging of the | Surgery_Schwartz. and manual workers.The sternoclavicular (SC) joint is the only articulation between the upper extremity and the axial skeleton. Injuries to this joint are rare. Anterior dislocations occur more frequently, and although closed reduction can be attempted, recurrence of the dislocation is typical. Patients are given a sling and the out-come is usually good, despite the visible bump and swelling. Posterior SC joint dislocations are rare and not grossly visible and can be easily missed. They can be dangerous injuries, result-ing in pulmonary or neurovascular compromise. Therefore, closed or open reduction under general anesthesia is recom-mended with a cardiac surgeon back-up.Scapula FracturesFractures of the scapula often result from significant high-energy trauma (Fig. 43-6) with about 80% associated injuries, 3Compartmentsyndrome ofthe forearmABFigure 43-5. A. Image showing compartment syndrome of the forearm. B. Fasciotomy of the leg. Notice gaping of the wound and bulging of the |
Surgery_Schwartz_12455 | Surgery_Schwartz | 80% associated injuries, 3Compartmentsyndrome ofthe forearmABFigure 43-5. A. Image showing compartment syndrome of the forearm. B. Fasciotomy of the leg. Notice gaping of the wound and bulging of the muscles.Brunicardi_Ch43_p1879-p1924.indd 188322/02/19 10:40 AM 1884SPECIFIC CONSIDERATIONSPART IImost commonly involving the head, ribs, and lungs. Pulmonary injuries occur in over one-third of patients. Most scapula fractures are treated nonoperatively with a sling and early range of motion. Surgery is performed when there is involve-ment of the glenoid with a major articular step-off or if there is a glenoid rim fracture with subluxation of the joint.Shoulder DislocationsThe shoulder is the most commonly dislocated large joint. Most dislocations are anterior. They are often associated with injuries to the anterior inferior glenoid labrum (Bankart lesion), impac-tion fractures of the humeral head (Hill-Sachs lesion) (Fig. 43-7), and rotator cuff tears in the elderly. The axillary | Surgery_Schwartz. 80% associated injuries, 3Compartmentsyndrome ofthe forearmABFigure 43-5. A. Image showing compartment syndrome of the forearm. B. Fasciotomy of the leg. Notice gaping of the wound and bulging of the muscles.Brunicardi_Ch43_p1879-p1924.indd 188322/02/19 10:40 AM 1884SPECIFIC CONSIDERATIONSPART IImost commonly involving the head, ribs, and lungs. Pulmonary injuries occur in over one-third of patients. Most scapula fractures are treated nonoperatively with a sling and early range of motion. Surgery is performed when there is involve-ment of the glenoid with a major articular step-off or if there is a glenoid rim fracture with subluxation of the joint.Shoulder DislocationsThe shoulder is the most commonly dislocated large joint. Most dislocations are anterior. They are often associated with injuries to the anterior inferior glenoid labrum (Bankart lesion), impac-tion fractures of the humeral head (Hill-Sachs lesion) (Fig. 43-7), and rotator cuff tears in the elderly. The axillary |
Surgery_Schwartz_12456 | Surgery_Schwartz | with injuries to the anterior inferior glenoid labrum (Bankart lesion), impac-tion fractures of the humeral head (Hill-Sachs lesion) (Fig. 43-7), and rotator cuff tears in the elderly. The axillary nerve is at risk of being injured in shoulder dislocation. If the patient is unable to raise the arm after reduction of shoulder dislocation, then it is most likely due to a rotator cuff tear in the elderly and axillary nerve injury in the young.There is a high recurrence rate that correlates with the age of the patient at the time of dislocation. There is a 90% redislocation rate if the patient is younger than 20 years of age. Posterior dislocations are associated with seizures or electric shock. Adequate radiographs are required to diagnose a shoul-der dislocation, with the axillary view being the most important. The patient’s shoulder is usually locked in internal rotation with limitation of external rotation and axillary view will show the posterior dislocation (Fig. 43-8A,B). If proper | Surgery_Schwartz. with injuries to the anterior inferior glenoid labrum (Bankart lesion), impac-tion fractures of the humeral head (Hill-Sachs lesion) (Fig. 43-7), and rotator cuff tears in the elderly. The axillary nerve is at risk of being injured in shoulder dislocation. If the patient is unable to raise the arm after reduction of shoulder dislocation, then it is most likely due to a rotator cuff tear in the elderly and axillary nerve injury in the young.There is a high recurrence rate that correlates with the age of the patient at the time of dislocation. There is a 90% redislocation rate if the patient is younger than 20 years of age. Posterior dislocations are associated with seizures or electric shock. Adequate radiographs are required to diagnose a shoul-der dislocation, with the axillary view being the most important. The patient’s shoulder is usually locked in internal rotation with limitation of external rotation and axillary view will show the posterior dislocation (Fig. 43-8A,B). If proper |
Surgery_Schwartz_12457 | Surgery_Schwartz | the most important. The patient’s shoulder is usually locked in internal rotation with limitation of external rotation and axillary view will show the posterior dislocation (Fig. 43-8A,B). If proper X-rays are not performed, then dislocations can be missed and can result in significant disability to the patient. A computed tomography (CT) scan should be performed if an axillary view is unable to be obtained. In general, dislocation of the shoulders can be managed with closed reduction followed by a short period of sling immobilization.Proximal Humerus FracturesProximal humerus fractures occur most frequently in elderly female patients following a fall onto the shoulder, though they can also occur following high-energy trauma in young patients. They have historically been classified by the number of fracture fragments using Neer’s classification (Fig. 43-9), which divides the proximal humerus into four parts: the humeral head, greater tuberosities, lesser tuberosities, and the humeral | Surgery_Schwartz. the most important. The patient’s shoulder is usually locked in internal rotation with limitation of external rotation and axillary view will show the posterior dislocation (Fig. 43-8A,B). If proper X-rays are not performed, then dislocations can be missed and can result in significant disability to the patient. A computed tomography (CT) scan should be performed if an axillary view is unable to be obtained. In general, dislocation of the shoulders can be managed with closed reduction followed by a short period of sling immobilization.Proximal Humerus FracturesProximal humerus fractures occur most frequently in elderly female patients following a fall onto the shoulder, though they can also occur following high-energy trauma in young patients. They have historically been classified by the number of fracture fragments using Neer’s classification (Fig. 43-9), which divides the proximal humerus into four parts: the humeral head, greater tuberosities, lesser tuberosities, and the humeral |
Surgery_Schwartz_12458 | Surgery_Schwartz | number of fracture fragments using Neer’s classification (Fig. 43-9), which divides the proximal humerus into four parts: the humeral head, greater tuberosities, lesser tuberosities, and the humeral shaft. Treat-ment is determined by the displacement of the fracture frag-ments, the amount of angulation of the fracture, and the amount of comminution (which means multiple fracture fragments). If there is suspicion of an intra-articular fracture, CT scan is often indicated. The majority of proximal humerus fractures are mini-mally displaced and can be treated with sling immobilization, followed by early shoulder motion and pendulum exercises. Physiotherapy should be started within 2 weeks of the injury to prevent stiffness, especially in the elderly. Displaced fractures and fractures involving the humeral head are at increased risk for osteonecrosis, and therefore surgery is often recommended. If there is adequate bone stock and the fracture can be success-fully reduced, open reduction | Surgery_Schwartz. number of fracture fragments using Neer’s classification (Fig. 43-9), which divides the proximal humerus into four parts: the humeral head, greater tuberosities, lesser tuberosities, and the humeral shaft. Treat-ment is determined by the displacement of the fracture frag-ments, the amount of angulation of the fracture, and the amount of comminution (which means multiple fracture fragments). If there is suspicion of an intra-articular fracture, CT scan is often indicated. The majority of proximal humerus fractures are mini-mally displaced and can be treated with sling immobilization, followed by early shoulder motion and pendulum exercises. Physiotherapy should be started within 2 weeks of the injury to prevent stiffness, especially in the elderly. Displaced fractures and fractures involving the humeral head are at increased risk for osteonecrosis, and therefore surgery is often recommended. If there is adequate bone stock and the fracture can be success-fully reduced, open reduction |
Surgery_Schwartz_12459 | Surgery_Schwartz | the humeral head are at increased risk for osteonecrosis, and therefore surgery is often recommended. If there is adequate bone stock and the fracture can be success-fully reduced, open reduction internal fixation with plate and screw fixation is the treatment of choice. Older patients with osteoporosis, comminuted fractures, head-splitting fractures, and four-part fractures or fracture dislocations are typically treated with a prosthetic replacement of the humeral head or a hemiarthroplasty. Reverse shoulder arthroplasty is gaining popularity in the elderly as well.Humeral Shaft FracturesThe majority of humeral shaft fractures can heal with nonsurgi-cal management if they are within an acceptable degree of angulation. The radial nerve spirals around the humeral shaft and is at risk for injury; therefore, a careful neurovascular exam is important. If you have a patient with a humeral shaft fracture, check the patient for wrist drop (Fig. 43-10). Most radial nerve injuries are | Surgery_Schwartz. the humeral head are at increased risk for osteonecrosis, and therefore surgery is often recommended. If there is adequate bone stock and the fracture can be success-fully reduced, open reduction internal fixation with plate and screw fixation is the treatment of choice. Older patients with osteoporosis, comminuted fractures, head-splitting fractures, and four-part fractures or fracture dislocations are typically treated with a prosthetic replacement of the humeral head or a hemiarthroplasty. Reverse shoulder arthroplasty is gaining popularity in the elderly as well.Humeral Shaft FracturesThe majority of humeral shaft fractures can heal with nonsurgi-cal management if they are within an acceptable degree of angulation. The radial nerve spirals around the humeral shaft and is at risk for injury; therefore, a careful neurovascular exam is important. If you have a patient with a humeral shaft fracture, check the patient for wrist drop (Fig. 43-10). Most radial nerve injuries are |
Surgery_Schwartz_12460 | Surgery_Schwartz | for injury; therefore, a careful neurovascular exam is important. If you have a patient with a humeral shaft fracture, check the patient for wrist drop (Fig. 43-10). Most radial nerve injuries are neurapraxias, or stretching of the nerve, and function typically returns within 3 to 4 months. A spiral fracture of the distal one-third of the humeral shaft is commonly associated with neurapraxia of the radial nerve, and this fracture is called a Holstein-Lewis fracture. Humeral shaft fractures are typically treated with a coaptation splint or functional bracing, which consists of a plastic clamshell brace with Velcro straps. Criteria for acceptable alignment are less than 20° anterior angulation, less than 30° varus/valgus angulation, and less than 3 cm shortening. Radial nerve palsy is not a contraindication to conservative treatment. Close follow-up with serial radiographs 456Figure 43-6. Scapula fracture. Notice the body and the glenoid are involved.Figure 43-7. Hill-Sachs humeral head | Surgery_Schwartz. for injury; therefore, a careful neurovascular exam is important. If you have a patient with a humeral shaft fracture, check the patient for wrist drop (Fig. 43-10). Most radial nerve injuries are neurapraxias, or stretching of the nerve, and function typically returns within 3 to 4 months. A spiral fracture of the distal one-third of the humeral shaft is commonly associated with neurapraxia of the radial nerve, and this fracture is called a Holstein-Lewis fracture. Humeral shaft fractures are typically treated with a coaptation splint or functional bracing, which consists of a plastic clamshell brace with Velcro straps. Criteria for acceptable alignment are less than 20° anterior angulation, less than 30° varus/valgus angulation, and less than 3 cm shortening. Radial nerve palsy is not a contraindication to conservative treatment. Close follow-up with serial radiographs 456Figure 43-6. Scapula fracture. Notice the body and the glenoid are involved.Figure 43-7. Hill-Sachs humeral head |
Surgery_Schwartz_12461 | Surgery_Schwartz | contraindication to conservative treatment. Close follow-up with serial radiographs 456Figure 43-6. Scapula fracture. Notice the body and the glenoid are involved.Figure 43-7. Hill-Sachs humeral head impaction fracture and Bankart lesion, which is an avulsion of the anterior inferior labrum.Brunicardi_Ch43_p1879-p1924.indd 188422/02/19 10:40 AM 1885ORTHOPEDIC SURGERYCHAPTER 43is important to verify healing of the fracture, and gentle motion exercises are begun within 1 to 2 weeks. Fractures with signifi-cant angulation are most commonly treated with open reduc-tion and plate fixation, with care to protect the radial nerve as it often lies close to the fracture site. Intramedullary nailing can also be performed, though it carries the risk of shoulder pain from the nail insertion. A plate is usually more stable than a nail and allows early weight-bearing through the humerus. Sponta-neous recovery of radial nerve palsy can occur up to 6 months after injury. The patient should have an | Surgery_Schwartz. contraindication to conservative treatment. Close follow-up with serial radiographs 456Figure 43-6. Scapula fracture. Notice the body and the glenoid are involved.Figure 43-7. Hill-Sachs humeral head impaction fracture and Bankart lesion, which is an avulsion of the anterior inferior labrum.Brunicardi_Ch43_p1879-p1924.indd 188422/02/19 10:40 AM 1885ORTHOPEDIC SURGERYCHAPTER 43is important to verify healing of the fracture, and gentle motion exercises are begun within 1 to 2 weeks. Fractures with signifi-cant angulation are most commonly treated with open reduc-tion and plate fixation, with care to protect the radial nerve as it often lies close to the fracture site. Intramedullary nailing can also be performed, though it carries the risk of shoulder pain from the nail insertion. A plate is usually more stable than a nail and allows early weight-bearing through the humerus. Sponta-neous recovery of radial nerve palsy can occur up to 6 months after injury. The patient should have an |
Surgery_Schwartz_12462 | Surgery_Schwartz | is usually more stable than a nail and allows early weight-bearing through the humerus. Sponta-neous recovery of radial nerve palsy can occur up to 6 months after injury. The patient should have an EMG to monitor recov-ery of the nerve. In an open fracture of the humeral shaft with radial nerve palsy, the nerve should be explored for the possibil-ity of a significant nerve injury or laceration.Distal Humerus FracturesFractures of the distal humerus result from falls onto the elbow or onto an outstretched arm. Supracondylar fractures occurring above the elbow joint are most common and do not involve the articular surface. Minimally displaced fractures can occasion-ally be treated with a posterior long arm splint, with the elbow typically flexed to 90°. However, fixation is often recommended to allow early range of motion and prevent stiffness. Fractures involving the articular surface are treated with plate fixation, and depending on the fracture pattern they may require more than one | Surgery_Schwartz. is usually more stable than a nail and allows early weight-bearing through the humerus. Sponta-neous recovery of radial nerve palsy can occur up to 6 months after injury. The patient should have an EMG to monitor recov-ery of the nerve. In an open fracture of the humeral shaft with radial nerve palsy, the nerve should be explored for the possibil-ity of a significant nerve injury or laceration.Distal Humerus FracturesFractures of the distal humerus result from falls onto the elbow or onto an outstretched arm. Supracondylar fractures occurring above the elbow joint are most common and do not involve the articular surface. Minimally displaced fractures can occasion-ally be treated with a posterior long arm splint, with the elbow typically flexed to 90°. However, fixation is often recommended to allow early range of motion and prevent stiffness. Fractures involving the articular surface are treated with plate fixation, and depending on the fracture pattern they may require more than one |
Surgery_Schwartz_12463 | Surgery_Schwartz | to allow early range of motion and prevent stiffness. Fractures involving the articular surface are treated with plate fixation, and depending on the fracture pattern they may require more than one (usually anatomically contoured) plate. As with other intra-articular fractures, the goals of treatment are anatomic reduction of the joint surface with stable fixation, restoration of the anatomic alignment of the joint, and early range of motion. Severely comminuted fractures, especially in the elderly, may be treated with a total elbow replacement. Fractures about the elbow are notorious for developing stiffness and therefore early motion of the elbow is paramount to a successful outcome. Range of motion should be started as soon as the patient can tolerate therapy.Elbow DislocationsDislocations of the elbow are common and typically occur posteriorly after a fall on an outstretched hand. A dislocation results in injury to the joint capsule and rupture of the lateral collateral ligament, | Surgery_Schwartz. to allow early range of motion and prevent stiffness. Fractures involving the articular surface are treated with plate fixation, and depending on the fracture pattern they may require more than one (usually anatomically contoured) plate. As with other intra-articular fractures, the goals of treatment are anatomic reduction of the joint surface with stable fixation, restoration of the anatomic alignment of the joint, and early range of motion. Severely comminuted fractures, especially in the elderly, may be treated with a total elbow replacement. Fractures about the elbow are notorious for developing stiffness and therefore early motion of the elbow is paramount to a successful outcome. Range of motion should be started as soon as the patient can tolerate therapy.Elbow DislocationsDislocations of the elbow are common and typically occur posteriorly after a fall on an outstretched hand. A dislocation results in injury to the joint capsule and rupture of the lateral collateral ligament, |
Surgery_Schwartz_12464 | Surgery_Schwartz | of the elbow are common and typically occur posteriorly after a fall on an outstretched hand. A dislocation results in injury to the joint capsule and rupture of the lateral collateral ligament, with possible involvement of the medial collateral ligament, as well as possible fractures of the radial head and coronoid. This combination of injuries is called the “terrible triad,” which is a challenging injury and carries the Figure 43-8. A. Posterior shoulder dislocation showing limitation of external rotation. B. Axillary view sowing posterior dislocation of the shoulder.Figure 43-9. Four-part proximal humeral head fracture.Figure 43-10. Radial nerve palsy due to humeral shaft fracture causing wrist drop.Brunicardi_Ch43_p1879-p1924.indd 188522/02/19 10:40 AM 1886SPECIFIC CONSIDERATIONSPART IIworst prognosis. Simple elbow dislocations should be urgently reduced with the patient under sedation and treated with a short period of immobilization, utilizing a posterior splint. Stiffness | Surgery_Schwartz. of the elbow are common and typically occur posteriorly after a fall on an outstretched hand. A dislocation results in injury to the joint capsule and rupture of the lateral collateral ligament, with possible involvement of the medial collateral ligament, as well as possible fractures of the radial head and coronoid. This combination of injuries is called the “terrible triad,” which is a challenging injury and carries the Figure 43-8. A. Posterior shoulder dislocation showing limitation of external rotation. B. Axillary view sowing posterior dislocation of the shoulder.Figure 43-9. Four-part proximal humeral head fracture.Figure 43-10. Radial nerve palsy due to humeral shaft fracture causing wrist drop.Brunicardi_Ch43_p1879-p1924.indd 188522/02/19 10:40 AM 1886SPECIFIC CONSIDERATIONSPART IIworst prognosis. Simple elbow dislocations should be urgently reduced with the patient under sedation and treated with a short period of immobilization, utilizing a posterior splint. Stiffness |
Surgery_Schwartz_12465 | Surgery_Schwartz | prognosis. Simple elbow dislocations should be urgently reduced with the patient under sedation and treated with a short period of immobilization, utilizing a posterior splint. Stiffness of the elbow is a common complication following elbow dislocations and therefore only short-term immobiliza-tion (about 7–10 days) followed by early range of motion is recommended.Dislocations associated with fractures may be treated sur-gically if there is any instability of the elbow joint. The “terrible triad” is an unstable injury comprising of an elbow disloca-tion as well as fractures to the radial head and coronoid, which requires surgery. Surgery includes repair of the torn lateral col-lateral ligament, fixation or replacement of the radial head, and possible fixation of the coronoid, depending on the size of this fracture fragment.Radial Head FracturesMost fractures of the radial head can be treated nonoperatively, simply with a sling for 1 to 2 days followed by motion exercises. Surgery is | Surgery_Schwartz. prognosis. Simple elbow dislocations should be urgently reduced with the patient under sedation and treated with a short period of immobilization, utilizing a posterior splint. Stiffness of the elbow is a common complication following elbow dislocations and therefore only short-term immobiliza-tion (about 7–10 days) followed by early range of motion is recommended.Dislocations associated with fractures may be treated sur-gically if there is any instability of the elbow joint. The “terrible triad” is an unstable injury comprising of an elbow disloca-tion as well as fractures to the radial head and coronoid, which requires surgery. Surgery includes repair of the torn lateral col-lateral ligament, fixation or replacement of the radial head, and possible fixation of the coronoid, depending on the size of this fracture fragment.Radial Head FracturesMost fractures of the radial head can be treated nonoperatively, simply with a sling for 1 to 2 days followed by motion exercises. Surgery is |
Surgery_Schwartz_12466 | Surgery_Schwartz | the size of this fracture fragment.Radial Head FracturesMost fractures of the radial head can be treated nonoperatively, simply with a sling for 1 to 2 days followed by motion exercises. Surgery is recommended if there is a displaced fracture, if the fracture blocks pronation or supination of the forearm, if there is an associated dislocation of the elbow, or if the patient has associated wrist pain (Essex-Lopresti fracture). Surgery can be fixation or replacement. If the fracture can be well reduced, it is fixed with 1 or 2 screws. If the radial head is fractured into multiple pieces, the treatment of choice is a radial head replace-ment with a metallic implant. Simple excision of the radial head can also be performed in low demand patients with an isolated radial head fracture; otherwise, it may lead to instability of the elbow and the wrist over time.Olecranon FracturesOlecranon fractures usually occur following a fall directly onto a flexed elbow (Fig. 43-11). Nondisplaced | Surgery_Schwartz. the size of this fracture fragment.Radial Head FracturesMost fractures of the radial head can be treated nonoperatively, simply with a sling for 1 to 2 days followed by motion exercises. Surgery is recommended if there is a displaced fracture, if the fracture blocks pronation or supination of the forearm, if there is an associated dislocation of the elbow, or if the patient has associated wrist pain (Essex-Lopresti fracture). Surgery can be fixation or replacement. If the fracture can be well reduced, it is fixed with 1 or 2 screws. If the radial head is fractured into multiple pieces, the treatment of choice is a radial head replace-ment with a metallic implant. Simple excision of the radial head can also be performed in low demand patients with an isolated radial head fracture; otherwise, it may lead to instability of the elbow and the wrist over time.Olecranon FracturesOlecranon fractures usually occur following a fall directly onto a flexed elbow (Fig. 43-11). Nondisplaced |
Surgery_Schwartz_12467 | Surgery_Schwartz | it may lead to instability of the elbow and the wrist over time.Olecranon FracturesOlecranon fractures usually occur following a fall directly onto a flexed elbow (Fig. 43-11). Nondisplaced fractures are treated with a splint in 45° to 90° of flexion for a short time followed by range of motion exercises to prevent stiffness. Because the triceps inserts on the olecranon, the pull of the muscle often causes active extension of the elbow and displacement of the fracture, and therefore the olecranon fracture should be fixed surgically. Simple transverse fractures can be fixed with a tension band construct, which consists of wire passing through the ulna, distal to the fracture, and wrapped in a figure-of-8 fashion around two or more pins placed proximally into the olecranon, crossing and stabilizing the fracture. This tension band construct creates a compressive force across the articular aspect of the fracture that will promote healing. Fractures that are comminuted or have large | Surgery_Schwartz. it may lead to instability of the elbow and the wrist over time.Olecranon FracturesOlecranon fractures usually occur following a fall directly onto a flexed elbow (Fig. 43-11). Nondisplaced fractures are treated with a splint in 45° to 90° of flexion for a short time followed by range of motion exercises to prevent stiffness. Because the triceps inserts on the olecranon, the pull of the muscle often causes active extension of the elbow and displacement of the fracture, and therefore the olecranon fracture should be fixed surgically. Simple transverse fractures can be fixed with a tension band construct, which consists of wire passing through the ulna, distal to the fracture, and wrapped in a figure-of-8 fashion around two or more pins placed proximally into the olecranon, crossing and stabilizing the fracture. This tension band construct creates a compressive force across the articular aspect of the fracture that will promote healing. Fractures that are comminuted or have large |
Surgery_Schwartz_12468 | Surgery_Schwartz | stabilizing the fracture. This tension band construct creates a compressive force across the articular aspect of the fracture that will promote healing. Fractures that are comminuted or have large fragments are usually treated with plate and screw fixation. Excision of the olecranon with advancement of the triceps can be done in elderly patients when the fracture involves less than 50% of the joint surface. Because of the subcutaneous location of the olecranon, symp-tomatic hardware is a frequent complication, causing irritation to the patient; it may need to be removed after the fracture has healed. Stiffness of the elbow is another complication seen in a large number of patients.Forearm FracturesForearm fractures are common injuries that result from high-energy trauma or from falls onto an outstretched arm. Both bone forearm fractures generally require surgery with plate and screw fixation. The radius has a bow and rotates around the straight ulna for proper pronation and supination | Surgery_Schwartz. stabilizing the fracture. This tension band construct creates a compressive force across the articular aspect of the fracture that will promote healing. Fractures that are comminuted or have large fragments are usually treated with plate and screw fixation. Excision of the olecranon with advancement of the triceps can be done in elderly patients when the fracture involves less than 50% of the joint surface. Because of the subcutaneous location of the olecranon, symp-tomatic hardware is a frequent complication, causing irritation to the patient; it may need to be removed after the fracture has healed. Stiffness of the elbow is another complication seen in a large number of patients.Forearm FracturesForearm fractures are common injuries that result from high-energy trauma or from falls onto an outstretched arm. Both bone forearm fractures generally require surgery with plate and screw fixation. The radius has a bow and rotates around the straight ulna for proper pronation and supination |
Surgery_Schwartz_12469 | Surgery_Schwartz | an outstretched arm. Both bone forearm fractures generally require surgery with plate and screw fixation. The radius has a bow and rotates around the straight ulna for proper pronation and supination of the forearm, and therefore this anatomic relationship needs to be restored to maintain function. An isolated fracture of the ulna shaft, or a “nightstick fracture,” occurs from a direct blow to the side of the forearm. These can usually be treated in a cast, splint, or brace. Fractures that are angulated or displaced can be treated with open reduction and plate fixation. A Monteggia fracture is a fracture of the proximal third of the ulna associated with a radial head dislocation. The radial head dislocation may be missed. Careful evaluation of the radiograph, especially the relation-ship with the radial head to the capitellum is necessary for the diagnosis of this injury. These fractures are common in children and rare in adults. These injuries require surgery to fix the ulna fracture | Surgery_Schwartz. an outstretched arm. Both bone forearm fractures generally require surgery with plate and screw fixation. The radius has a bow and rotates around the straight ulna for proper pronation and supination of the forearm, and therefore this anatomic relationship needs to be restored to maintain function. An isolated fracture of the ulna shaft, or a “nightstick fracture,” occurs from a direct blow to the side of the forearm. These can usually be treated in a cast, splint, or brace. Fractures that are angulated or displaced can be treated with open reduction and plate fixation. A Monteggia fracture is a fracture of the proximal third of the ulna associated with a radial head dislocation. The radial head dislocation may be missed. Careful evaluation of the radiograph, especially the relation-ship with the radial head to the capitellum is necessary for the diagnosis of this injury. These fractures are common in children and rare in adults. These injuries require surgery to fix the ulna fracture |
Surgery_Schwartz_12470 | Surgery_Schwartz | the radial head to the capitellum is necessary for the diagnosis of this injury. These fractures are common in children and rare in adults. These injuries require surgery to fix the ulna fracture with plate and screw fixation and to reduce the radial head dislocation. A Galeazzi fracture is a fracture of the distal third radial shaft associated with distal radioulnar joint (DRUJ) injury at the wrist. If the fracture of the radius is less than 7.5 cm from the joint, the distal radioulnar joint is injured in a large number of cases. After the radius is fixed with plate and screw fixation, the DRUJ is assessed for stability and may need wires placed across the joint temporarily.Distal Radius FracturesDistal radius fractures commonly occur in older patients due to a fall or osteoporosis. In younger patients, these fractures usu-ally occur due to high-energy trauma. A Colles fracture is a low energy fracture that is extra-articular and usually dorsally displaced. It has a characteristic | Surgery_Schwartz. the radial head to the capitellum is necessary for the diagnosis of this injury. These fractures are common in children and rare in adults. These injuries require surgery to fix the ulna fracture with plate and screw fixation and to reduce the radial head dislocation. A Galeazzi fracture is a fracture of the distal third radial shaft associated with distal radioulnar joint (DRUJ) injury at the wrist. If the fracture of the radius is less than 7.5 cm from the joint, the distal radioulnar joint is injured in a large number of cases. After the radius is fixed with plate and screw fixation, the DRUJ is assessed for stability and may need wires placed across the joint temporarily.Distal Radius FracturesDistal radius fractures commonly occur in older patients due to a fall or osteoporosis. In younger patients, these fractures usu-ally occur due to high-energy trauma. A Colles fracture is a low energy fracture that is extra-articular and usually dorsally displaced. It has a characteristic |
Surgery_Schwartz_12471 | Surgery_Schwartz | younger patients, these fractures usu-ally occur due to high-energy trauma. A Colles fracture is a low energy fracture that is extra-articular and usually dorsally displaced. It has a characteristic appearance of a fork, naming the fracture the “dinner-fork” deformity. A Smith’s fracture is a reverse Colles fracture, usually extra-articular and volarly displaced. A Chauffer’s fracture involves the radial styloid process and may cause occult carpal disruption. A Barton’s fracture can be either volar or dorsal. It is a fracture dislocation of the radiocarpal joint, with an intra-articular volar or dorsal fracture.Every attempt should be made to rule out fractures that extend intra-articularly into the wrist joint or involve the DRUJ. Patients should be evaluated for a median nerve injury and osteoporosis if suspected. Loss of thumb extension from extensor pollicus longus tendon rupture can occur especially in nondisplaced distal radius fractures. Treatment is often a closed Figure | Surgery_Schwartz. younger patients, these fractures usu-ally occur due to high-energy trauma. A Colles fracture is a low energy fracture that is extra-articular and usually dorsally displaced. It has a characteristic appearance of a fork, naming the fracture the “dinner-fork” deformity. A Smith’s fracture is a reverse Colles fracture, usually extra-articular and volarly displaced. A Chauffer’s fracture involves the radial styloid process and may cause occult carpal disruption. A Barton’s fracture can be either volar or dorsal. It is a fracture dislocation of the radiocarpal joint, with an intra-articular volar or dorsal fracture.Every attempt should be made to rule out fractures that extend intra-articularly into the wrist joint or involve the DRUJ. Patients should be evaluated for a median nerve injury and osteoporosis if suspected. Loss of thumb extension from extensor pollicus longus tendon rupture can occur especially in nondisplaced distal radius fractures. Treatment is often a closed Figure |
Surgery_Schwartz_12472 | Surgery_Schwartz | and osteoporosis if suspected. Loss of thumb extension from extensor pollicus longus tendon rupture can occur especially in nondisplaced distal radius fractures. Treatment is often a closed Figure 43-11. Displaced olecranon fracture.Brunicardi_Ch43_p1879-p1924.indd 188622/02/19 10:40 AM 1887ORTHOPEDIC SURGERYCHAPTER 43reduction and immobilization. Surgery utilizing a variety of sur-gical techniques is done for unstable fractures as well as those with significant intra-articular involvement.Scaphoid FracturesScaphoid fracture is the most common fracture of the carpal bone. Its diagnosis can be easily missed, and the fracture can lead to nonunion and avascular necrosis. It usually occurs in the waist of the scaphoid but can occur in the proximal or distal pole. Proximal scaphoid fracture will have a higher inci-dence of avascular necrosis due to interruption of the retro-grade blood supply. Tenderness in the anatomic snuffbox after trauma should be considered a scaphoid fracture | Surgery_Schwartz. and osteoporosis if suspected. Loss of thumb extension from extensor pollicus longus tendon rupture can occur especially in nondisplaced distal radius fractures. Treatment is often a closed Figure 43-11. Displaced olecranon fracture.Brunicardi_Ch43_p1879-p1924.indd 188622/02/19 10:40 AM 1887ORTHOPEDIC SURGERYCHAPTER 43reduction and immobilization. Surgery utilizing a variety of sur-gical techniques is done for unstable fractures as well as those with significant intra-articular involvement.Scaphoid FracturesScaphoid fracture is the most common fracture of the carpal bone. Its diagnosis can be easily missed, and the fracture can lead to nonunion and avascular necrosis. It usually occurs in the waist of the scaphoid but can occur in the proximal or distal pole. Proximal scaphoid fracture will have a higher inci-dence of avascular necrosis due to interruption of the retro-grade blood supply. Tenderness in the anatomic snuffbox after trauma should be considered a scaphoid fracture |
Surgery_Schwartz_12473 | Surgery_Schwartz | will have a higher inci-dence of avascular necrosis due to interruption of the retro-grade blood supply. Tenderness in the anatomic snuffbox after trauma should be considered a scaphoid fracture until proven otherwise. Magnetic resonance imaging (MRI) will be help-ful in early diagnosis if no fracture is visible on an X-ray. A thumb spica cast is used for stable nondisplaced fracture, while reduction and screw fixation of the fracture is usually done for displaced fractures. The dorsal approach is used for proximal fractures, and the volar approach is used for the majority of other fractures.Pelvic FracturesPelvic fractures are indicative of high-energy trauma and are associated with head, chest, abdominal, and urogenital injuries. Hemorrhage from pelvic trauma can be life-threatening and patients can present with hemodynamic instability, requiring significant fluid resuscitation and blood transfusions. The bleed-ing that occurs is often due to injury to the venous plexus in the | Surgery_Schwartz. will have a higher inci-dence of avascular necrosis due to interruption of the retro-grade blood supply. Tenderness in the anatomic snuffbox after trauma should be considered a scaphoid fracture until proven otherwise. Magnetic resonance imaging (MRI) will be help-ful in early diagnosis if no fracture is visible on an X-ray. A thumb spica cast is used for stable nondisplaced fracture, while reduction and screw fixation of the fracture is usually done for displaced fractures. The dorsal approach is used for proximal fractures, and the volar approach is used for the majority of other fractures.Pelvic FracturesPelvic fractures are indicative of high-energy trauma and are associated with head, chest, abdominal, and urogenital injuries. Hemorrhage from pelvic trauma can be life-threatening and patients can present with hemodynamic instability, requiring significant fluid resuscitation and blood transfusions. The bleed-ing that occurs is often due to injury to the venous plexus in the |
Surgery_Schwartz_12474 | Surgery_Schwartz | and patients can present with hemodynamic instability, requiring significant fluid resuscitation and blood transfusions. The bleed-ing that occurs is often due to injury to the venous plexus in the posterior pelvis or from the fracture itself. It can also be due to a large vessel injury such as the superior gluteal artery at the greater sciatic notch. Immediate resuscitation with fluids and blood is critical. In hemodynamically unstable patients, blood, fresh frozen plasma, and platelets are given in a 1:1:1 ratio. These patients may require surgical exploration or interven-tional radiology embolization to stop the bleeding. An important first-line treatment in the emergency department is the application of a pelvic binder or sheet that is wrapped tightly around the pelvis to help control bleeding. This is important when there is an increase in the volume of the pelvis by the anteroposterior compression mechanism (an open book mechanism). The pelvic binder is clearly the initial | Surgery_Schwartz. and patients can present with hemodynamic instability, requiring significant fluid resuscitation and blood transfusions. The bleed-ing that occurs is often due to injury to the venous plexus in the posterior pelvis or from the fracture itself. It can also be due to a large vessel injury such as the superior gluteal artery at the greater sciatic notch. Immediate resuscitation with fluids and blood is critical. In hemodynamically unstable patients, blood, fresh frozen plasma, and platelets are given in a 1:1:1 ratio. These patients may require surgical exploration or interven-tional radiology embolization to stop the bleeding. An important first-line treatment in the emergency department is the application of a pelvic binder or sheet that is wrapped tightly around the pelvis to help control bleeding. This is important when there is an increase in the volume of the pelvis by the anteroposterior compression mechanism (an open book mechanism). The pelvic binder is clearly the initial |
Surgery_Schwartz_12475 | Surgery_Schwartz | bleeding. This is important when there is an increase in the volume of the pelvis by the anteroposterior compression mechanism (an open book mechanism). The pelvic binder is clearly the initial management of an unstable open book fracture of the pelvis with bleeding. Traction pins may be applied in the emergency department if there is vertical migration of the hemipelvis. An external fixator may also be placed in the operating room, but it is less fre-quently used. Other associated injuries are bladder and urethral injuries that manifest with bleeding from the urethral meatus or blood in the urinary catheter, and these need to be assessed with a retrograde urethrogram.The pelvis is a ring structure made up of the sacrum and the two innominate bones that are held together by strong liga-ments. Because it is a ring, displacement can only occur if the ring is disrupted in two places. This may occur either from frac-tures of the bones or tears of the ligaments that can cause dis-location. | Surgery_Schwartz. bleeding. This is important when there is an increase in the volume of the pelvis by the anteroposterior compression mechanism (an open book mechanism). The pelvic binder is clearly the initial management of an unstable open book fracture of the pelvis with bleeding. Traction pins may be applied in the emergency department if there is vertical migration of the hemipelvis. An external fixator may also be placed in the operating room, but it is less fre-quently used. Other associated injuries are bladder and urethral injuries that manifest with bleeding from the urethral meatus or blood in the urinary catheter, and these need to be assessed with a retrograde urethrogram.The pelvis is a ring structure made up of the sacrum and the two innominate bones that are held together by strong liga-ments. Because it is a ring, displacement can only occur if the ring is disrupted in two places. This may occur either from frac-tures of the bones or tears of the ligaments that can cause dis-location. |
Surgery_Schwartz_12476 | Surgery_Schwartz | Because it is a ring, displacement can only occur if the ring is disrupted in two places. This may occur either from frac-tures of the bones or tears of the ligaments that can cause dis-location. When you see an anterior fracture of the ring, check for a posterior injury (Fig. 43-12). There are three main fracture patterns that occur from trauma to the pelvis. An anteroposterior force to the pelvis causes an “open book” injury pattern in which the pelvis springs open, hinged on the intact posterior ligaments with widening of the pubic symphysis. A lateral compression pattern results from a crush injury that causes fractures to the ilium, sacrum, and pubic rami. Vertical shear injuries are very unstable since they result from disruption of the strong posterior pelvic ligaments and are associated with significant blood loss and visceral injuries. Fractures of the sacrum may be difficult to see on X-ray, and therefore CT scans are often needed to completely visualize the fracture | Surgery_Schwartz. Because it is a ring, displacement can only occur if the ring is disrupted in two places. This may occur either from frac-tures of the bones or tears of the ligaments that can cause dis-location. When you see an anterior fracture of the ring, check for a posterior injury (Fig. 43-12). There are three main fracture patterns that occur from trauma to the pelvis. An anteroposterior force to the pelvis causes an “open book” injury pattern in which the pelvis springs open, hinged on the intact posterior ligaments with widening of the pubic symphysis. A lateral compression pattern results from a crush injury that causes fractures to the ilium, sacrum, and pubic rami. Vertical shear injuries are very unstable since they result from disruption of the strong posterior pelvic ligaments and are associated with significant blood loss and visceral injuries. Fractures of the sacrum may be difficult to see on X-ray, and therefore CT scans are often needed to completely visualize the fracture |
Surgery_Schwartz_12477 | Surgery_Schwartz | associated with significant blood loss and visceral injuries. Fractures of the sacrum may be difficult to see on X-ray, and therefore CT scans are often needed to completely visualize the fracture pattern. The sacral nerves pass through foramen in the sacrum, and therefore fractures that are close to the foramen can result in nerve injuries. Fractures that involve the sacral canal have a high incidence of nerve injuries and cauda equina syndrome. Fractures that involve the ala of the sacrum may involve the L5 nerve root. Vertical fractures of the 7ABFigure 43-12. A. Pelvic fracture showing anterior and posterior disruption of the pelvis. B. Image depicting a vertical shear fracture with cephalad migration of the hemi-pelvis.Brunicardi_Ch43_p1879-p1924.indd 188722/02/19 10:40 AM 1888SPECIFIC CONSIDERATIONSPART IIsacrum can be highly unstable even after fixation and may be associated with sacral nerve root injuries.Treatment of pelvic fractures depends on the fracture pat-tern. | Surgery_Schwartz. associated with significant blood loss and visceral injuries. Fractures of the sacrum may be difficult to see on X-ray, and therefore CT scans are often needed to completely visualize the fracture pattern. The sacral nerves pass through foramen in the sacrum, and therefore fractures that are close to the foramen can result in nerve injuries. Fractures that involve the sacral canal have a high incidence of nerve injuries and cauda equina syndrome. Fractures that involve the ala of the sacrum may involve the L5 nerve root. Vertical fractures of the 7ABFigure 43-12. A. Pelvic fracture showing anterior and posterior disruption of the pelvis. B. Image depicting a vertical shear fracture with cephalad migration of the hemi-pelvis.Brunicardi_Ch43_p1879-p1924.indd 188722/02/19 10:40 AM 1888SPECIFIC CONSIDERATIONSPART IIsacrum can be highly unstable even after fixation and may be associated with sacral nerve root injuries.Treatment of pelvic fractures depends on the fracture pat-tern. |
Surgery_Schwartz_12478 | Surgery_Schwartz | CONSIDERATIONSPART IIsacrum can be highly unstable even after fixation and may be associated with sacral nerve root injuries.Treatment of pelvic fractures depends on the fracture pat-tern. Stable, minimally displaced fractures such as many lower energy lateral compression fractures can be treated nonopera-tively with protected weight-bearing. Open book injuries in which the pubic symphysis is widened more than 2.5 cm may require an anterior plate, and if the posterior pelvic ligaments are also injured, the patient will need posterior fixation. Pos-terior stabilization is typically performed with screws placed percutaneously through the ilium into the sacrum to stabilize the pelvis posteriorly, and a plate is applied over the pubic symphy-sis for anterior stabilization. Displaced sacral fractures and iliac wing fractures are treated with screws or plates, while pubic rami fractures can usually be managed nonoperatively. While most pelvic fractures are caused by high-energy trauma, | Surgery_Schwartz. CONSIDERATIONSPART IIsacrum can be highly unstable even after fixation and may be associated with sacral nerve root injuries.Treatment of pelvic fractures depends on the fracture pat-tern. Stable, minimally displaced fractures such as many lower energy lateral compression fractures can be treated nonopera-tively with protected weight-bearing. Open book injuries in which the pubic symphysis is widened more than 2.5 cm may require an anterior plate, and if the posterior pelvic ligaments are also injured, the patient will need posterior fixation. Pos-terior stabilization is typically performed with screws placed percutaneously through the ilium into the sacrum to stabilize the pelvis posteriorly, and a plate is applied over the pubic symphy-sis for anterior stabilization. Displaced sacral fractures and iliac wing fractures are treated with screws or plates, while pubic rami fractures can usually be managed nonoperatively. While most pelvic fractures are caused by high-energy trauma, |
Surgery_Schwartz_12479 | Surgery_Schwartz | fractures and iliac wing fractures are treated with screws or plates, while pubic rami fractures can usually be managed nonoperatively. While most pelvic fractures are caused by high-energy trauma, elderly patients with osteoporotic bone can also suffer pelvic fractures after a fall, usually fracturing the pubic rami. Since these are stable injuries, they can be managed nonoperatively with pro-tected weight-bearing.Acetabular FracturesThe acetabulum forms the socket of the hip joint, and fractures occur when the femoral head is driven into the acetabulum in the setting of high-energy trauma. Sciatic nerve function should be examined carefully after an acetabulum fracture. It is impor-tant to rule out dislocation of the hip, which should be reduced immediately to prevent avascular necrosis of the femoral head. Usually 45° oblique views, called Judet views, are utilized. CT scans are very important to visualize the fracture pattern. According to Judet and Letournel, there are ten | Surgery_Schwartz. fractures and iliac wing fractures are treated with screws or plates, while pubic rami fractures can usually be managed nonoperatively. While most pelvic fractures are caused by high-energy trauma, elderly patients with osteoporotic bone can also suffer pelvic fractures after a fall, usually fracturing the pubic rami. Since these are stable injuries, they can be managed nonoperatively with pro-tected weight-bearing.Acetabular FracturesThe acetabulum forms the socket of the hip joint, and fractures occur when the femoral head is driven into the acetabulum in the setting of high-energy trauma. Sciatic nerve function should be examined carefully after an acetabulum fracture. It is impor-tant to rule out dislocation of the hip, which should be reduced immediately to prevent avascular necrosis of the femoral head. Usually 45° oblique views, called Judet views, are utilized. CT scans are very important to visualize the fracture pattern. According to Judet and Letournel, there are ten |
Surgery_Schwartz_12480 | Surgery_Schwartz | of the femoral head. Usually 45° oblique views, called Judet views, are utilized. CT scans are very important to visualize the fracture pattern. According to Judet and Letournel, there are ten acetabular fracture patterns: five simple and five complex fracture types (Fig. 43-13). These fractures often require surgery in order to obtain anatomic reduction and to minimize the development of degenerative arthritis.Hip DislocationsHip dislocations almost always result from high-energy trauma; they most commonly occur posteriorly and less commonly ante-riorly (Fig. 43-14). They can cause injury to the sciatic nerve, which runs directly posterior to the hip joint. Examine the patient for foot drop and numbness at the top of the foot. Hip dislocation can be simple, or it may be associated with a fracture of the acetabulum or femoral head. Hip dislocations need to be emergently reduced because of the risk of osteonecrosis of the femoral head if the reduction is delayed. Closed reduction is | Surgery_Schwartz. of the femoral head. Usually 45° oblique views, called Judet views, are utilized. CT scans are very important to visualize the fracture pattern. According to Judet and Letournel, there are ten acetabular fracture patterns: five simple and five complex fracture types (Fig. 43-13). These fractures often require surgery in order to obtain anatomic reduction and to minimize the development of degenerative arthritis.Hip DislocationsHip dislocations almost always result from high-energy trauma; they most commonly occur posteriorly and less commonly ante-riorly (Fig. 43-14). They can cause injury to the sciatic nerve, which runs directly posterior to the hip joint. Examine the patient for foot drop and numbness at the top of the foot. Hip dislocation can be simple, or it may be associated with a fracture of the acetabulum or femoral head. Hip dislocations need to be emergently reduced because of the risk of osteonecrosis of the femoral head if the reduction is delayed. Closed reduction is |
Surgery_Schwartz_12481 | Surgery_Schwartz | a fracture of the acetabulum or femoral head. Hip dislocations need to be emergently reduced because of the risk of osteonecrosis of the femoral head if the reduction is delayed. Closed reduction is usually successful with adequate sedation or under general anes-thesia. Once reduction is done, a CT scan is ordered to define the extent of the injury. A CT scan will show associated frac-tures, trapped intraarticular fracture fragments, and the congru-ity of the reduction. If the reduction is unsuccessful, or if there is a fracture fragment inside the joint, then an open reduction is indicated. Hip dislocations that are associated with a femoral head fracture are at increased risk for osteonecrosis of the femo-ral head and posttraumatic osteoarthritis. The femoral head frac-ture associated with hip dislocation is called a Pipkin fracture. If the dislocation is associated with posterior wall fractures, the stability of the hip joint should be assessed carefully, even if the fragment is | Surgery_Schwartz. a fracture of the acetabulum or femoral head. Hip dislocations need to be emergently reduced because of the risk of osteonecrosis of the femoral head if the reduction is delayed. Closed reduction is usually successful with adequate sedation or under general anes-thesia. Once reduction is done, a CT scan is ordered to define the extent of the injury. A CT scan will show associated frac-tures, trapped intraarticular fracture fragments, and the congru-ity of the reduction. If the reduction is unsuccessful, or if there is a fracture fragment inside the joint, then an open reduction is indicated. Hip dislocations that are associated with a femoral head fracture are at increased risk for osteonecrosis of the femo-ral head and posttraumatic osteoarthritis. The femoral head frac-ture associated with hip dislocation is called a Pipkin fracture. If the dislocation is associated with posterior wall fractures, the stability of the hip joint should be assessed carefully, even if the fragment is |
Surgery_Schwartz_12482 | Surgery_Schwartz | with hip dislocation is called a Pipkin fracture. If the dislocation is associated with posterior wall fractures, the stability of the hip joint should be assessed carefully, even if the fragment is small. This is usually done by an examination of the patient under anesthesia.Hip FracturesHip fractures are an extremely common injury seen in orthope-dics and are associated with significant morbidity and mortal-ity. They most often occur in elderly patients after ground level falls, are much more common in women than men, and occur more commonly in patients with osteoporosis. The three most common fractures in the elderly are those of the wrist, spine, and hip. Patients who suffer hip fractures are at increased risk for many complications, including deep vein thrombosis, pul-monary embolism, pneumonia, deconditioning, pressure sores, and even death. The mortality rate in the first year following a hip fracture is around 25%. One of the most important rea-sons for performing surgery is | Surgery_Schwartz. with hip dislocation is called a Pipkin fracture. If the dislocation is associated with posterior wall fractures, the stability of the hip joint should be assessed carefully, even if the fragment is small. This is usually done by an examination of the patient under anesthesia.Hip FracturesHip fractures are an extremely common injury seen in orthope-dics and are associated with significant morbidity and mortal-ity. They most often occur in elderly patients after ground level falls, are much more common in women than men, and occur more commonly in patients with osteoporosis. The three most common fractures in the elderly are those of the wrist, spine, and hip. Patients who suffer hip fractures are at increased risk for many complications, including deep vein thrombosis, pul-monary embolism, pneumonia, deconditioning, pressure sores, and even death. The mortality rate in the first year following a hip fracture is around 25%. One of the most important rea-sons for performing surgery is |
Surgery_Schwartz_12483 | Surgery_Schwartz | pneumonia, deconditioning, pressure sores, and even death. The mortality rate in the first year following a hip fracture is around 25%. One of the most important rea-sons for performing surgery is to prevent these complications because getting patients out of bed and walking as soon as pos-sible diminishes their risk for many of these adverse events. Performing early surgery also decreases the complications in these patients. Therefore, surgery is almost always the treat-ment of choice for hip fractures. The type of surgery performed is determined by the anatomic location of the fracture and the fracture pattern. Surgery should be performed as soon as pos-sible, typically within 24 to 48 hours; however, since many of these patients suffer other comorbidities, they must be properly medically optimized before surgery. The goals of surgery are to minimize pain, restore hip function, and allow early mobi-lization, the importance of which cannot be overemphasized. The functional outcome | Surgery_Schwartz. pneumonia, deconditioning, pressure sores, and even death. The mortality rate in the first year following a hip fracture is around 25%. One of the most important rea-sons for performing surgery is to prevent these complications because getting patients out of bed and walking as soon as pos-sible diminishes their risk for many of these adverse events. Performing early surgery also decreases the complications in these patients. Therefore, surgery is almost always the treat-ment of choice for hip fractures. The type of surgery performed is determined by the anatomic location of the fracture and the fracture pattern. Surgery should be performed as soon as pos-sible, typically within 24 to 48 hours; however, since many of these patients suffer other comorbidities, they must be properly medically optimized before surgery. The goals of surgery are to minimize pain, restore hip function, and allow early mobi-lization, the importance of which cannot be overemphasized. The functional outcome |
Surgery_Schwartz_12484 | Surgery_Schwartz | optimized before surgery. The goals of surgery are to minimize pain, restore hip function, and allow early mobi-lization, the importance of which cannot be overemphasized. The functional outcome for patients following a hip fracture is largely based on their level of mobility and independence Figure 43-13. Types of acetabular fractures.Figure 43-14. Posterior and anterior dislocation.Brunicardi_Ch43_p1879-p1924.indd 188822/02/19 10:40 AM 1889ORTHOPEDIC SURGERYCHAPTER 43before their injury. Many patients become less independent, may require assistive devices to help them walk, and some may require a long-term nursing or rehabilitation facility. Hip frac-tures can be femoral neck fractures, intertrochanteric fractures, or subtrochanteric fractures (Fig. 43-15).Femoral Neck Fractures. Femoral neck fractures occur within the capsule of the hip joint. The main blood supply to the femo-ral neck and head comes from the deep branches of the medial femoral circumflex arteries, which run | Surgery_Schwartz. optimized before surgery. The goals of surgery are to minimize pain, restore hip function, and allow early mobi-lization, the importance of which cannot be overemphasized. The functional outcome for patients following a hip fracture is largely based on their level of mobility and independence Figure 43-13. Types of acetabular fractures.Figure 43-14. Posterior and anterior dislocation.Brunicardi_Ch43_p1879-p1924.indd 188822/02/19 10:40 AM 1889ORTHOPEDIC SURGERYCHAPTER 43before their injury. Many patients become less independent, may require assistive devices to help them walk, and some may require a long-term nursing or rehabilitation facility. Hip frac-tures can be femoral neck fractures, intertrochanteric fractures, or subtrochanteric fractures (Fig. 43-15).Femoral Neck Fractures. Femoral neck fractures occur within the capsule of the hip joint. The main blood supply to the femo-ral neck and head comes from the deep branches of the medial femoral circumflex arteries, which run |
Surgery_Schwartz_12485 | Surgery_Schwartz | neck fractures occur within the capsule of the hip joint. The main blood supply to the femo-ral neck and head comes from the deep branches of the medial femoral circumflex arteries, which run along the femoral neck, and when the fracture is displaced, there is an interruption in the blood supply of the femoral head, which can lead to osteonecro-sis. Femoral neck fractures that are nondisplaced have a low risk of disruption of blood flow and therefore can be treated with in situ internal fixation. Three partially threaded cancellous screws are placed through a small incision over the lateral proximal femur, directed through the femoral neck and into the femoral head. Patients can usually begin protected weight-bearing imme-diately after surgery. Displaced femoral neck fractures will likely disrupt the blood supply and therefore need to be treated with a prosthetic replacement in older adults. Most commonly a hemi-arthroplasty is performed in which the femoral head and neck are replaced | Surgery_Schwartz. neck fractures occur within the capsule of the hip joint. The main blood supply to the femo-ral neck and head comes from the deep branches of the medial femoral circumflex arteries, which run along the femoral neck, and when the fracture is displaced, there is an interruption in the blood supply of the femoral head, which can lead to osteonecro-sis. Femoral neck fractures that are nondisplaced have a low risk of disruption of blood flow and therefore can be treated with in situ internal fixation. Three partially threaded cancellous screws are placed through a small incision over the lateral proximal femur, directed through the femoral neck and into the femoral head. Patients can usually begin protected weight-bearing imme-diately after surgery. Displaced femoral neck fractures will likely disrupt the blood supply and therefore need to be treated with a prosthetic replacement in older adults. Most commonly a hemi-arthroplasty is performed in which the femoral head and neck are replaced |
Surgery_Schwartz_12486 | Surgery_Schwartz | disrupt the blood supply and therefore need to be treated with a prosthetic replacement in older adults. Most commonly a hemi-arthroplasty is performed in which the femoral head and neck are replaced with a metal head and neck into the femoral canal. Higher demand patients and those who have osteoarthritis of the hip joint and hip pain before their fracture may receive a total hip replacement, in which the acetabulum is also replaced with a prosthesis, typically a plastic cup inside a metal shell. Patients can begin weight-bearing immediately after surgery. Displaced femoral neck fractures in young patients are the result of a high-energy trauma and are usually treated by reduction with screw fixation. The reduction may be closed or open.Intertrochanteric Hip Fractures. Intertrochanteric hip frac-tures occur between the greater and lesser trochanters of the proximal femur. Because the blood supply to this area is abun-dant, osteonecrosis is uncommon, and therefore these fractures can | Surgery_Schwartz. disrupt the blood supply and therefore need to be treated with a prosthetic replacement in older adults. Most commonly a hemi-arthroplasty is performed in which the femoral head and neck are replaced with a metal head and neck into the femoral canal. Higher demand patients and those who have osteoarthritis of the hip joint and hip pain before their fracture may receive a total hip replacement, in which the acetabulum is also replaced with a prosthesis, typically a plastic cup inside a metal shell. Patients can begin weight-bearing immediately after surgery. Displaced femoral neck fractures in young patients are the result of a high-energy trauma and are usually treated by reduction with screw fixation. The reduction may be closed or open.Intertrochanteric Hip Fractures. Intertrochanteric hip frac-tures occur between the greater and lesser trochanters of the proximal femur. Because the blood supply to this area is abun-dant, osteonecrosis is uncommon, and therefore these fractures can |
Surgery_Schwartz_12487 | Surgery_Schwartz | hip frac-tures occur between the greater and lesser trochanters of the proximal femur. Because the blood supply to this area is abun-dant, osteonecrosis is uncommon, and therefore these fractures can be treated with reduction and internal fixation. Displaced fractures need to be realigned, and this often involves placing the patient on a fracture table where traction and rotation can be applied to the affected leg to reduce the fracture. There are two devices that can be used. In stable fractures, a sliding hip screw includes a large screw placed from the lateral cortex of the proximal femur across the fracture and into the femoral neck and head, followed by a side plate along the lateral cortex of the femur, which is then fixed to the shaft with screws. A cephalom-edullary nail includes a nail placed down the medullary canal of the femur and a large screw that engages the nail as it is passed from the lateral cortex up into the neck and head. Nails are usually used in unstable | Surgery_Schwartz. hip frac-tures occur between the greater and lesser trochanters of the proximal femur. Because the blood supply to this area is abun-dant, osteonecrosis is uncommon, and therefore these fractures can be treated with reduction and internal fixation. Displaced fractures need to be realigned, and this often involves placing the patient on a fracture table where traction and rotation can be applied to the affected leg to reduce the fracture. There are two devices that can be used. In stable fractures, a sliding hip screw includes a large screw placed from the lateral cortex of the proximal femur across the fracture and into the femoral neck and head, followed by a side plate along the lateral cortex of the femur, which is then fixed to the shaft with screws. A cephalom-edullary nail includes a nail placed down the medullary canal of the femur and a large screw that engages the nail as it is passed from the lateral cortex up into the neck and head. Nails are usually used in unstable |
Surgery_Schwartz_12488 | Surgery_Schwartz | a nail placed down the medullary canal of the femur and a large screw that engages the nail as it is passed from the lateral cortex up into the neck and head. Nails are usually used in unstable fractures and allow protected weight-bearing postoperatively. The reverse oblique intertrochanteric fracture is a specific type of fracture that exits on the lateral cortex (Fig. 43-16). This is best treated with a cephalomedullary Figure 43-15. Types of hip fractures.Figure 43-16. Classic intertrochanteric fracture and reverse oblique fracture. Notice that the fracture line of the reverse oblique fracture exits on the lateral cortex.Brunicardi_Ch43_p1879-p1924.indd 188922/02/19 10:40 AM 1890SPECIFIC CONSIDERATIONSPART IInail; a dynamic hip screw is the wrong device to be used in reverse oblique fractures because it will lead to sliding, shorten-ing, and medial displacement of the fracture.Subtrochanteric Hip Fractures. Subtrochanteric hip frac-tures occur in the proximal femoral shaft just | Surgery_Schwartz. a nail placed down the medullary canal of the femur and a large screw that engages the nail as it is passed from the lateral cortex up into the neck and head. Nails are usually used in unstable fractures and allow protected weight-bearing postoperatively. The reverse oblique intertrochanteric fracture is a specific type of fracture that exits on the lateral cortex (Fig. 43-16). This is best treated with a cephalomedullary Figure 43-15. Types of hip fractures.Figure 43-16. Classic intertrochanteric fracture and reverse oblique fracture. Notice that the fracture line of the reverse oblique fracture exits on the lateral cortex.Brunicardi_Ch43_p1879-p1924.indd 188922/02/19 10:40 AM 1890SPECIFIC CONSIDERATIONSPART IInail; a dynamic hip screw is the wrong device to be used in reverse oblique fractures because it will lead to sliding, shorten-ing, and medial displacement of the fracture.Subtrochanteric Hip Fractures. Subtrochanteric hip frac-tures occur in the proximal femoral shaft just |
Surgery_Schwartz_12489 | Surgery_Schwartz | fractures because it will lead to sliding, shorten-ing, and medial displacement of the fracture.Subtrochanteric Hip Fractures. Subtrochanteric hip frac-tures occur in the proximal femoral shaft just distal to the lesser trochanter in an area of high biomechanical stresses. While they can occur in older adult patients after a fall, they are also seen in high-energy trauma. Because of the forces of muscles attached to the fractured segments, they tend to be significantly displaced (Fig. 43-17) and may be difficult to reduce. They are most often treated with a long cephalomedullary nail that includes a screw distally to lock the nail in place and prevent rotation of the femur. Fixed angle plates or blade plates are sometimes used in the treatment of subtrochanteric fractures. In most cases, pro-tected weight-bearing can begin soon after surgery. Complica-tions usually include malunion and nonunion of the fracture.Bisphosphonate-related subtrochanteric fractures are an example of | Surgery_Schwartz. fractures because it will lead to sliding, shorten-ing, and medial displacement of the fracture.Subtrochanteric Hip Fractures. Subtrochanteric hip frac-tures occur in the proximal femoral shaft just distal to the lesser trochanter in an area of high biomechanical stresses. While they can occur in older adult patients after a fall, they are also seen in high-energy trauma. Because of the forces of muscles attached to the fractured segments, they tend to be significantly displaced (Fig. 43-17) and may be difficult to reduce. They are most often treated with a long cephalomedullary nail that includes a screw distally to lock the nail in place and prevent rotation of the femur. Fixed angle plates or blade plates are sometimes used in the treatment of subtrochanteric fractures. In most cases, pro-tected weight-bearing can begin soon after surgery. Complica-tions usually include malunion and nonunion of the fracture.Bisphosphonate-related subtrochanteric fractures are an example of |
Surgery_Schwartz_12490 | Surgery_Schwartz | cases, pro-tected weight-bearing can begin soon after surgery. Complica-tions usually include malunion and nonunion of the fracture.Bisphosphonate-related subtrochanteric fractures are an example of insufficiency fractures that may be related to the long-term use of bisphosphonates. These fractures have been recently identified. An intramedullary nail is the treatment of choice for this fracture.Femoral Shaft FracturesFractures of the femoral shaft are caused by high-energy trauma and may be associated with other severe injuries. Long bone fractures, such as femoral shaft fractures, put these patients at risk for complications such as thromboembolic events and acute respiratory distress syndrome (ARDS), and therefore it is important to fix these quickly, typically within 24 hours. They are most commonly fixed with an intramedullary nail that can be placed antegrade (from the piriformis fossa or greater tro-chanter down the canal) or retrograde (through an incision into the knee joint | Surgery_Schwartz. cases, pro-tected weight-bearing can begin soon after surgery. Complica-tions usually include malunion and nonunion of the fracture.Bisphosphonate-related subtrochanteric fractures are an example of insufficiency fractures that may be related to the long-term use of bisphosphonates. These fractures have been recently identified. An intramedullary nail is the treatment of choice for this fracture.Femoral Shaft FracturesFractures of the femoral shaft are caused by high-energy trauma and may be associated with other severe injuries. Long bone fractures, such as femoral shaft fractures, put these patients at risk for complications such as thromboembolic events and acute respiratory distress syndrome (ARDS), and therefore it is important to fix these quickly, typically within 24 hours. They are most commonly fixed with an intramedullary nail that can be placed antegrade (from the piriformis fossa or greater tro-chanter down the canal) or retrograde (through an incision into the knee joint |
Surgery_Schwartz_12491 | Surgery_Schwartz | most commonly fixed with an intramedullary nail that can be placed antegrade (from the piriformis fossa or greater tro-chanter down the canal) or retrograde (through an incision into the knee joint and up the canal), with screws placed through proximal and distal holes to lock the nail in place, creating a stable construct to allow weight-bearing. Trauma patients who are hemodynamically unstable or who have other life-threatening injuries are treated temporarily with an external fixator until they can safely undergo surgery. This is called “damage control orthopedics.” The base deficit and lactic acid levels are moni-tored and used as guides to indicate if the patient is adequately resuscitated. When their levels are normal, it means the tissue is adequately oxygenated and the patient can undergo definitive fixation of the femur.Distal Femur FracturesDistal femur fractures are the result of a fall from a height or from high-energy trauma. They can also occur in elderly patients with | Surgery_Schwartz. most commonly fixed with an intramedullary nail that can be placed antegrade (from the piriformis fossa or greater tro-chanter down the canal) or retrograde (through an incision into the knee joint and up the canal), with screws placed through proximal and distal holes to lock the nail in place, creating a stable construct to allow weight-bearing. Trauma patients who are hemodynamically unstable or who have other life-threatening injuries are treated temporarily with an external fixator until they can safely undergo surgery. This is called “damage control orthopedics.” The base deficit and lactic acid levels are moni-tored and used as guides to indicate if the patient is adequately resuscitated. When their levels are normal, it means the tissue is adequately oxygenated and the patient can undergo definitive fixation of the femur.Distal Femur FracturesDistal femur fractures are the result of a fall from a height or from high-energy trauma. They can also occur in elderly patients with |
Surgery_Schwartz_12492 | Surgery_Schwartz | undergo definitive fixation of the femur.Distal Femur FracturesDistal femur fractures are the result of a fall from a height or from high-energy trauma. They can also occur in elderly patients with osteoporotic bone after a fall onto the knee. While nondisplaced fractures in the elderly may be treated nonoper-atively with a hinged knee brace and early motion exercises, most require surgery. These fractures can involve the articu-lar surface of the knee joint, so anatomic reduction of the joint surface is crucial. They are fixed with plates and screws, often utilizing a locking construct. The plate is placed over the lateral, or rarely the medial cortex depending on the fracture pattern. A retrograde intramedullary rod inserted through the knee can also be used, especially in extraarticular fracture patterns. The goal of surgery is to achieve anatomic reduction, stable fixation, and allow early knee range of motion. Intra-articular fractures require the patient to be non–weight-bearing | Surgery_Schwartz. undergo definitive fixation of the femur.Distal Femur FracturesDistal femur fractures are the result of a fall from a height or from high-energy trauma. They can also occur in elderly patients with osteoporotic bone after a fall onto the knee. While nondisplaced fractures in the elderly may be treated nonoper-atively with a hinged knee brace and early motion exercises, most require surgery. These fractures can involve the articu-lar surface of the knee joint, so anatomic reduction of the joint surface is crucial. They are fixed with plates and screws, often utilizing a locking construct. The plate is placed over the lateral, or rarely the medial cortex depending on the fracture pattern. A retrograde intramedullary rod inserted through the knee can also be used, especially in extraarticular fracture patterns. The goal of surgery is to achieve anatomic reduction, stable fixation, and allow early knee range of motion. Intra-articular fractures require the patient to be non–weight-bearing |
Surgery_Schwartz_12493 | Surgery_Schwartz | fracture patterns. The goal of surgery is to achieve anatomic reduction, stable fixation, and allow early knee range of motion. Intra-articular fractures require the patient to be non–weight-bearing until the frac-ture shows signs of healing. Complications of these fractures include nonunion, malunion, and stiffness of the knee. Be aware of Hoffa fractures, a coronal fractures that usually involve the lateral femoral condyle. They can be missed on X-rays, but they are easily diagnosed by CT scan. It may need a different fixa-tion than that required for the associated supracondylar fracture component.Knee DislocationsDislocation of the knee is a rare but devastating injury that can be limb-threatening. Some dislocations spontaneously reduce and can be underdiagnosed. When the knee dislocates, the anterior cruciate ligament (ACL) and posterior cruciate liga-ment (PCL) are torn, and various degrees of injury occur to the lateral collateral ligament (LCL), medial collateral ligament | Surgery_Schwartz. fracture patterns. The goal of surgery is to achieve anatomic reduction, stable fixation, and allow early knee range of motion. Intra-articular fractures require the patient to be non–weight-bearing until the frac-ture shows signs of healing. Complications of these fractures include nonunion, malunion, and stiffness of the knee. Be aware of Hoffa fractures, a coronal fractures that usually involve the lateral femoral condyle. They can be missed on X-rays, but they are easily diagnosed by CT scan. It may need a different fixa-tion than that required for the associated supracondylar fracture component.Knee DislocationsDislocation of the knee is a rare but devastating injury that can be limb-threatening. Some dislocations spontaneously reduce and can be underdiagnosed. When the knee dislocates, the anterior cruciate ligament (ACL) and posterior cruciate liga-ment (PCL) are torn, and various degrees of injury occur to the lateral collateral ligament (LCL), medial collateral ligament |
Surgery_Schwartz_12494 | Surgery_Schwartz | the anterior cruciate ligament (ACL) and posterior cruciate liga-ment (PCL) are torn, and various degrees of injury occur to the lateral collateral ligament (LCL), medial collateral ligament (MCL), posterolateral corner, joint capsule, and menisci. How-ever, the danger is due to the close proximity of the popliteal artery, which runs directly behind the knee and may kink or sustain a tear of the intimal wall when the knee dislocates. A neurovascular exam is extremely important, focusing on the common peroneal nerve and the vascular status of the extrem-ity, followed by immediate reduction of the knee and repeat neurovascular exam. If the pulses are normal, the ankle brachial index (ABI) should be measured. If the ABI is more than 0.9, then the patient should be monitored with serial examination. If the ABI is less than 0.9, then a CTA or an arterial duplex ultra-sound should be performed. If there is evidence of diminished pulses after reduction, an angiogram must be performed. If the | Surgery_Schwartz. the anterior cruciate ligament (ACL) and posterior cruciate liga-ment (PCL) are torn, and various degrees of injury occur to the lateral collateral ligament (LCL), medial collateral ligament (MCL), posterolateral corner, joint capsule, and menisci. How-ever, the danger is due to the close proximity of the popliteal artery, which runs directly behind the knee and may kink or sustain a tear of the intimal wall when the knee dislocates. A neurovascular exam is extremely important, focusing on the common peroneal nerve and the vascular status of the extrem-ity, followed by immediate reduction of the knee and repeat neurovascular exam. If the pulses are normal, the ankle brachial index (ABI) should be measured. If the ABI is more than 0.9, then the patient should be monitored with serial examination. If the ABI is less than 0.9, then a CTA or an arterial duplex ultra-sound should be performed. If there is evidence of diminished pulses after reduction, an angiogram must be performed. If the |
Surgery_Schwartz_12495 | Surgery_Schwartz | If the ABI is less than 0.9, then a CTA or an arterial duplex ultra-sound should be performed. If there is evidence of diminished pulses after reduction, an angiogram must be performed. If the pulses are absent after reduction, immediate surgical explora-tion and/or repair should be done by a vascular surgeon. Pro-phylactic fasciotomy of the leg is usually done. Time is critical to reestablish the circulation of the limb. If ischemia time is more than 8 hours, then there is a very high rate of amputation. With regard to the ligamentous injuries, an external fixator may be initially used to stabilize the unstable knee and protect the reduction. Subsequently, an MRI will identify what structures have been torn. Because a dislocation causes so much damage to the knee, a delayed multiligamentous reconstruction is recom-mended on an elective basis in order to stabilize the knee joint. Figure 43-17. Illustration showing subtrochanteric fracture with the deforming forces of the | Surgery_Schwartz. If the ABI is less than 0.9, then a CTA or an arterial duplex ultra-sound should be performed. If there is evidence of diminished pulses after reduction, an angiogram must be performed. If the pulses are absent after reduction, immediate surgical explora-tion and/or repair should be done by a vascular surgeon. Pro-phylactic fasciotomy of the leg is usually done. Time is critical to reestablish the circulation of the limb. If ischemia time is more than 8 hours, then there is a very high rate of amputation. With regard to the ligamentous injuries, an external fixator may be initially used to stabilize the unstable knee and protect the reduction. Subsequently, an MRI will identify what structures have been torn. Because a dislocation causes so much damage to the knee, a delayed multiligamentous reconstruction is recom-mended on an elective basis in order to stabilize the knee joint. Figure 43-17. Illustration showing subtrochanteric fracture with the deforming forces of the |
Surgery_Schwartz_12496 | Surgery_Schwartz | reconstruction is recom-mended on an elective basis in order to stabilize the knee joint. Figure 43-17. Illustration showing subtrochanteric fracture with the deforming forces of the muscle.Brunicardi_Ch43_p1879-p1924.indd 189022/02/19 10:40 AM 1891ORTHOPEDIC SURGERYCHAPTER 43Stiffness and instability of the knee are common complications after this injury.Patella/Extensor Mechanism InjuriesThe extensor mechanism is comprised of the quadriceps ten-don, the patella, and the patella ligament. This mechanism func-tions to extend the knee. Injuries can result after a fall directly onto the knee or from forcible contraction of the quadriceps. It is important to examine the knee for the ability to actively extend the knee. Quadriceps tendon ruptures, patella fractures, or patella ligament ruptures can result in a loss of active knee extension requiring surgery. Nondisplaced patella fractures with intact active knee extension can be treated nonoperatively with a cast or knee immobilizer, | Surgery_Schwartz. reconstruction is recom-mended on an elective basis in order to stabilize the knee joint. Figure 43-17. Illustration showing subtrochanteric fracture with the deforming forces of the muscle.Brunicardi_Ch43_p1879-p1924.indd 189022/02/19 10:40 AM 1891ORTHOPEDIC SURGERYCHAPTER 43Stiffness and instability of the knee are common complications after this injury.Patella/Extensor Mechanism InjuriesThe extensor mechanism is comprised of the quadriceps ten-don, the patella, and the patella ligament. This mechanism func-tions to extend the knee. Injuries can result after a fall directly onto the knee or from forcible contraction of the quadriceps. It is important to examine the knee for the ability to actively extend the knee. Quadriceps tendon ruptures, patella fractures, or patella ligament ruptures can result in a loss of active knee extension requiring surgery. Nondisplaced patella fractures with intact active knee extension can be treated nonoperatively with a cast or knee immobilizer, |
Surgery_Schwartz_12497 | Surgery_Schwartz | can result in a loss of active knee extension requiring surgery. Nondisplaced patella fractures with intact active knee extension can be treated nonoperatively with a cast or knee immobilizer, holding the knee in full extension, and weight-bearing is permitted. Displaced or comminuted frac-tures require surgery with tension band wiring and/or screws. Symptomatic hardware is a common complication. Acute osteo-chondral fractures can be managed with internal fixation. Quad-riceps tendon and patella tendon ruptures with loss of active knee extension are treated with suture repair. After surgery, the knee is held in extension, and knee flexion is slowly increased over several weeks using a hinged knee brace.Patella dislocations are common injuries that occur when the femur is forcibly internally rotated on an externally rotated tibia while the foot is planted on the ground. They typically dislocate laterally and often relocate spontaneously. The medial patellofemoral ligament is the | Surgery_Schwartz. can result in a loss of active knee extension requiring surgery. Nondisplaced patella fractures with intact active knee extension can be treated nonoperatively with a cast or knee immobilizer, holding the knee in full extension, and weight-bearing is permitted. Displaced or comminuted frac-tures require surgery with tension band wiring and/or screws. Symptomatic hardware is a common complication. Acute osteo-chondral fractures can be managed with internal fixation. Quad-riceps tendon and patella tendon ruptures with loss of active knee extension are treated with suture repair. After surgery, the knee is held in extension, and knee flexion is slowly increased over several weeks using a hinged knee brace.Patella dislocations are common injuries that occur when the femur is forcibly internally rotated on an externally rotated tibia while the foot is planted on the ground. They typically dislocate laterally and often relocate spontaneously. The medial patellofemoral ligament is the |
Surgery_Schwartz_12498 | Surgery_Schwartz | rotated on an externally rotated tibia while the foot is planted on the ground. They typically dislocate laterally and often relocate spontaneously. The medial patellofemoral ligament is the primary stabilizer of the patella. Patients present with a significant knee effusion and medial-sided tenderness. During the physical exam, these patients may elicit a positive apprehension test, in which a lateral force to the patella elicits pain and the sensation of an impending dis-location. Dislocated patellas can be reduced by extending the knee and manual reduction and are treated with temporary knee immobilization. Make sure that there is no fracture or loose bod-ies, which would be an indication for surgery. MRIs will show the classic bone bruise and edema involving the medial facet of the patella and the lateral condyle of the femur. There is a high rate of recurrent dislocation with nonoperative treatment, which may require surgical intervention.Tibial Plateau FracturesThe tibial | Surgery_Schwartz. rotated on an externally rotated tibia while the foot is planted on the ground. They typically dislocate laterally and often relocate spontaneously. The medial patellofemoral ligament is the primary stabilizer of the patella. Patients present with a significant knee effusion and medial-sided tenderness. During the physical exam, these patients may elicit a positive apprehension test, in which a lateral force to the patella elicits pain and the sensation of an impending dis-location. Dislocated patellas can be reduced by extending the knee and manual reduction and are treated with temporary knee immobilization. Make sure that there is no fracture or loose bod-ies, which would be an indication for surgery. MRIs will show the classic bone bruise and edema involving the medial facet of the patella and the lateral condyle of the femur. There is a high rate of recurrent dislocation with nonoperative treatment, which may require surgical intervention.Tibial Plateau FracturesThe tibial |
Surgery_Schwartz_12499 | Surgery_Schwartz | the patella and the lateral condyle of the femur. There is a high rate of recurrent dislocation with nonoperative treatment, which may require surgical intervention.Tibial Plateau FracturesThe tibial plateau is comprised of the articular surfaces and underlying cancellous bone of the medial and lateral plateaus of the proximal tibia. Fractures of the plateau result from axial loads sustained in falls from a height or high-energy trauma, and they are often associated with injuries to the menisci and cartilage of the knee. Fractures can involve the medial, lat-eral, or both plateaus with significant comminution, angula-tion, and depression, creating a challenging injury to fix. The Schatzker classification is commonly used in tibial plateau fractures (Fig. 43-18).• Type I: Lateral split fracture• Type II: Lateral split-depressed fracture• Type III: Lateral pure depression fracture• Type IV: Medial plateau fracture• Type V: Bicondylar fracture• Type VI: Metaphyseal-diaphyseal | Surgery_Schwartz. the patella and the lateral condyle of the femur. There is a high rate of recurrent dislocation with nonoperative treatment, which may require surgical intervention.Tibial Plateau FracturesThe tibial plateau is comprised of the articular surfaces and underlying cancellous bone of the medial and lateral plateaus of the proximal tibia. Fractures of the plateau result from axial loads sustained in falls from a height or high-energy trauma, and they are often associated with injuries to the menisci and cartilage of the knee. Fractures can involve the medial, lat-eral, or both plateaus with significant comminution, angula-tion, and depression, creating a challenging injury to fix. The Schatzker classification is commonly used in tibial plateau fractures (Fig. 43-18).• Type I: Lateral split fracture• Type II: Lateral split-depressed fracture• Type III: Lateral pure depression fracture• Type IV: Medial plateau fracture• Type V: Bicondylar fracture• Type VI: Metaphyseal-diaphyseal |
Surgery_Schwartz_12500 | Surgery_Schwartz | split fracture• Type II: Lateral split-depressed fracture• Type III: Lateral pure depression fracture• Type IV: Medial plateau fracture• Type V: Bicondylar fracture• Type VI: Metaphyseal-diaphyseal disassociationMeniscal tears occur more on the lateral side and tend to be peripheral tears, especially if there is more than 6 mm depres-sion or separation of the joint. Type IV, which is the medial tibial plateau fracture, could be a variant of a knee dislocation. The ankle brachial index (ABI) should be used in this situation and in more complex types of tibial plateau fractures. Clinically, laxity of more than 10° may indicate instability of the fracture; however, the test may be painful and hard to perform. A CT scan is important to visualize the intra-articular involvement of the fracture. Minimally displaced fractures may be treated nonoperatively with strict non–weight-bearing until the fracture heals. Fractures associated with displaced articular fragments require surgery in order | Surgery_Schwartz. split fracture• Type II: Lateral split-depressed fracture• Type III: Lateral pure depression fracture• Type IV: Medial plateau fracture• Type V: Bicondylar fracture• Type VI: Metaphyseal-diaphyseal disassociationMeniscal tears occur more on the lateral side and tend to be peripheral tears, especially if there is more than 6 mm depres-sion or separation of the joint. Type IV, which is the medial tibial plateau fracture, could be a variant of a knee dislocation. The ankle brachial index (ABI) should be used in this situation and in more complex types of tibial plateau fractures. Clinically, laxity of more than 10° may indicate instability of the fracture; however, the test may be painful and hard to perform. A CT scan is important to visualize the intra-articular involvement of the fracture. Minimally displaced fractures may be treated nonoperatively with strict non–weight-bearing until the fracture heals. Fractures associated with displaced articular fragments require surgery in order |
Surgery_Schwartz_12501 | Surgery_Schwartz | Minimally displaced fractures may be treated nonoperatively with strict non–weight-bearing until the fracture heals. Fractures associated with displaced articular fragments require surgery in order to restore the smooth contour of the articular surface. They are treated with plates and screws placed medially, laterally, or both. Stabilization of a posteromedial fragment may require a separate posteromedial approach. Since there is often a depression of the cancellous bone, bone graft or bone substitutes, particularly calcium phosphate which resists compression, may be needed to buttress the articular surface and restore the anatomic alignment of the tibia. Patients are kept strictly non–weight-bearing for several months until the fracture begins to heal, though early range of motion is encouraged to prevent stiffness. Repair of ligament or meniscus injuries may also be indicated at the time of surgery. Knee stiffness and osteoarthritis are common complications of these injuries. The | Surgery_Schwartz. Minimally displaced fractures may be treated nonoperatively with strict non–weight-bearing until the fracture heals. Fractures associated with displaced articular fragments require surgery in order to restore the smooth contour of the articular surface. They are treated with plates and screws placed medially, laterally, or both. Stabilization of a posteromedial fragment may require a separate posteromedial approach. Since there is often a depression of the cancellous bone, bone graft or bone substitutes, particularly calcium phosphate which resists compression, may be needed to buttress the articular surface and restore the anatomic alignment of the tibia. Patients are kept strictly non–weight-bearing for several months until the fracture begins to heal, though early range of motion is encouraged to prevent stiffness. Repair of ligament or meniscus injuries may also be indicated at the time of surgery. Knee stiffness and osteoarthritis are common complications of these injuries. The |
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