Asunto(s)
Traumatismos del Tobillo , Síndromes Compartimentales/etiología , Enfermedades del Pie/etiología , Esguinces y Distensiones/complicaciones , Adulto , Angiografía , Articulación del Tobillo/irrigación sanguínea , Síndromes Compartimentales/diagnóstico por imagen , Síndromes Compartimentales/cirugía , Enfermedades del Pie/diagnóstico por imagen , Enfermedades del Pie/cirugía , Humanos , MasculinoRESUMEN
A retrospective review of 19 cases of pure tibiotalar dislocation without associated fractures showed that most patients with closed injuries will have a good long-term result. Closed injuries generally have functionally insignificant instability, loss of motion, and no roentgenographic evidence of degenerative changes. The long-term results were worse in open dislocations that had a high incidence of concurrent neurovascular injury. These neurovascular injuries were of minimal functional significance. The role of primary ligament repair is difficult to delineate.
Asunto(s)
Articulación del Tobillo/diagnóstico por imagen , Luxaciones Articulares/diagnóstico por imagen , Adolescente , Adulto , Articulación del Tobillo/cirugía , Femenino , Estudios de Seguimiento , Humanos , Luxaciones Articulares/cirugía , Masculino , Persona de Mediana Edad , Radiografía , Estudios RetrospectivosRESUMEN
Prehospital management of musculoskeletal injuries in the traumatized patient is based on the application of a few basic principles in an orderly but expeditious manner. The patient must be assessed for immediate life-threatening conditions involving airway, respiratory, and circulatory functions while the cervical spine is protected. Resuscitative efforts to reestablish and preserve an adequate circulating volume of oxygenated blood must follow, using airways, oxygen therapy, and fluid replacement through MAST trousers and intravenous fluids. Cardiac function must be maintained as well. Respiratory function must be monitored and assisted as required. Finally, neurologic status must be assessed and monitored. Secondary assessment of all pertinent history and physical findings is made to delineate all other injuries that do not pose an immediate threat to the life or limb of the patient. Definitive care follows but is limited to basic resuscitation, stabilization, and immobilization techniques under medical control through telemetry and radio communication. Immediate definitive care of the traumatized patient requires the expeditious intervention of the trauma team in a hospital setting with surgical, blood banking, radiographic, laboratory, and other hospital-based capabilities available. Field management of the traumatized patient is directed at the expeditious delivery of the viable patient to the trauma team. In the multiply traumatized patient with severe injuries to several organ systems, prehospital care may need to be expedited to provide this patient the in-hospital care required to save his or her life. Appropriate treatment in such life-threatening trauma situations will consist of a rapid primary assessment, airway and cervical spine control, appropriate respiratory and cardiovascular assistance, gross whole body fracture immobilization using a backboard, and immediate transport. For less severely injured patients, primary assessment, resuscitation, stabilization, full secondary assessment, initial definitive care, and immobilization should be completed before transport begins.
Asunto(s)
Servicios Médicos de Urgencia , Sistema Musculoesquelético/lesiones , Traumatismos del Brazo/terapia , Primeros Auxilios , Fijación de Fractura , Humanos , Inmovilización , Traumatismos de la Pierna/terapia , Resucitación , Traumatismos Vertebrales/terapia , TriajeRESUMEN
A reactive synovitis secondary to intra-articular particles of silicone elastomer developed in three patients who had undergone Silastic hemiarthroplasty. In an attempt to duplicate this phenomenon, we used an animal model in which finely ground particulate silicone elastomer was introduced into the knee joints of adult New Zealand White rabbits. In three of thirteen rabbits (p = 0.066) histological evidence of inflammatory changes developed in the synovial tissue, similar to those seen in our patients. Intraarticular particulate silicone elastomer created by abrasion of a Silastic hemiarthroplasty may be responsible for the development of an iatrogenic reactive synovitis.
Asunto(s)
Elastómeros de Silicona/efectos adversos , Membrana Sinovial/patología , Sinovitis/etiología , Adulto , Animales , Femenino , Reacción a Cuerpo Extraño/patología , Humanos , Prótesis Articulares/efectos adversos , Masculino , Microscopía de Contraste de Fase , Conejos , Sinovitis/patologíaRESUMEN
To assess the value of routine preoperative chest x-ray films in pediatric patients, a prospective study of 1,500 patients, ages newborn to 19 years, was undertaken. Of all the patients, 7.5% demonstrated at least one roentgenographic abnormality, with 4.7% of the patients demonstrating a totally unsuspected significant roentgenographic anomaly. In 3.8% of the patients, surgery was eihter postponed or cancelled or the anesthetic technique was altered as a result of the roentgenographic finding. It is believed that the routine preoperative chest film is justified if the film is evaluated before surgery and the results clinically followed up.