Common complications in orthopedics:
Gespeichert in:
| Weitere Verfasser: | |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Philadelphia, Pennsylvania
Elsevier
[2016]
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| Schriftenreihe: | Orthopedic clinics of North America
April 2016, volume 47, number 2 |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | xix Seiten, Seite 302-483 Illustrationen |
| ISBN: | 9780323417617 |
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| 245 | 1 | 0 | |a Common complications in orthopedics |c editors James H. Calandruccio, Benjamin J. Grear, Benjamin M. Mauck, Jeffrey R. Sawyer, Patrick C. Toy, John C. Weinlein |
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| adam_text | Titel: Common complications in orthopedics
Autor: Calandruccio, James H
Jahr: 2016
Common Complications in Orthopedics
Contents
Note from the Publisher
xvii
Jennifer Flynn-Briggs
Preface: Common Complications in Orthopedics
Jennifer Flynn-Briggs
xix
Adult Reconstruction
Patrick C. Toy
Proprioception and Knee Arthroplasty: A Literature Review
301
Andrew J. Wodowski, Colin W. Swigler, Hongchao Liu, Keith M. Nord, Patrick C. Toy, and
William M. Mihalko
Proprioceptive mechanoreceptors provide neural feedback for position in space and
are critical for three-dimensional interaction. Proprioception is decreased with oste-
oarthritis of the knees, which leads to increased risk of falling. As the prevalence of
osteoarthritis increases, so does the need for total knee arthroplasty (TKA), and
knowing the effect of TKA on proprioception is essential. This article reviews the
literature regarding proprioception and its relationship to balance, aging, osteoar-
thritis, and the effect of TKA on proprioception. Knee arthroplasty involving retention
of the cruciate ligaments is also reviewed, as well as the evidence of proprioception
in the posterior cruciate ligament after TKA.
Instability After Total Knee Arthroplasty 311
Umberto Cottino, Peter K. Sculco, Rafael J. Sierra, and Matthew P. Abdel
Instability is one of the most common causes of failure after total knee arthroplasty.
Although there are several contributing causes, surgical error and poor implant
design selection contribute. For this reason, an accurate diagnosis is fundamental
and is largely based on a thorough history and physical examination. In general,
tibiofemoral instability can be classified into 3 different patterns: flexion instability,
genu recurvatum, and extension instability. In this article, these 3 patterns are
reviewed in greater depth.
The Painful Total Knee Arthroplasty 317
Mitchell McDowell, Andrew Park, and Tad L. Gerlinger
There are many causes of residual pain after total knee arthroplasty (TKA). Evalua-
tion and management begins with a comprehensive history and physical examina-
tion, followed by radiographic evaluation of the replaced and adjacent joints, as
well as previous films of the replaced joint. Further workup includes laboratory anal-
ysis, along with a synovial fluid aspirate to evaluate the white blood cell count with
differential as well as culture. Advanced imaging modalities may be beneficial when
the diagnosis remains unclear. Revision surgery is not advisable without a clear
diagnosis, as it may be associated with poor results.
xii Contents
Avoiding Hip Instability and Limb Length Discrepancy After Total Hip Arthroplasty 327
Peter K. Sculco, Umberto Cottino, Matthew P. Abdel, and Rafael J. Sierra
Instability and limb length discrepancy are two common complications after total hip
arthroplasty (THA) and the most common cause for revision surgery. Maximizing
impingement-free range of motion, recreating appropriate offset, and equalizing limb
lengths and producing a pain-free and dynamically stable THA is the ultimate goal of
a successful THA. In this article, patient risk factors for hip instability and limb length
discrepancy are reviewed along with, key elements of the preoperative template, the
anatomic landmarks for accurate component placement, device options, the leg posi-
tions for soft tissue stability testing, and the management of postoperative instability.
Trauma
John C. Weinlein
Thromboembolic Disease After Orthopedic Trauma 335
Paul S. Whiting and A. Alex Jahangir
Orthopedic trauma results in systemic physiologic changes that predispose patients
to venous thromboembolism (VTE). In the absence of prophylaxis, VTE incidence
may be as high as 60%. Mechanical and pharmacologic thromboprophylaxis are
effective in decreasing rates of VTE. Combined mechanical and pharmacologic
thromboprophylaxis is more efficacious for decreasing VTE incidence than either
regimen independently. If pharmacologic thromboprophylaxis is contraindicated,
mechanical prophylaxis should be used. Patients with isolated lower extremity frac-
tures who are ambulatory, or those with isolated upper extremity trauma, do not
require pharmacologic prophylaxis in the absence of other VTE risk factors.
Arthrofibrosis After Periarticular Fracture Fixation 345
Ian McAlister and Stephen Andrew Sems
Arthrofibrosis after periarticular fractures can create clinically significant impair-
ments in both the upper and lower extremities. The shoulder, elbow, and knee are
particularly susceptible to the condition. Many risk factors for the development of
arthrofibrosis cannot be controlled by the patient or surgeon. Early postoperative
motion should be promoted whenever possible. Manipulations under anesthesia
are effective for a period of time in certain fracture patterns, and open or arthro-
scopic surgical debridements should be reserved for the patient for whom nonoper-
ative modalities fail and who has a clinically significant deficit.
Impact of Infection on Fracture Fixation 357
Michael Willey and Matthew Karam
Surgical site infection can be a devastating complication that results in significant
morbidity in patients who undergo operative fixation of fractures. Reducing the
rate of infection and wound complications in high-risk trauma patients by giving
early effective antibiotics, improving soft tissue management, and using anti-
septic techniques is a common topic of discussion. Despite heightened aware-
ness, there has not been a significant reduction in surgical site infection over
the past 40 years. Patients should be treated aggressively to eliminate or
Contents
suppress the infection, heal the fracture if there is a nonunion, and maintain the
function of the patient.
Nonunion of the Femur and Tibia: An Update
Anthony Bell, David Templeman, and John C. Weinlein
Delayed union and nonunion of tibial and femoral shaft fractures are common
orthopedic problems. Numerous publications address lower extremity long bone
nonunions. This review presents current trends and recent literature on the evalua-
tion and treatment of nonunions of the tibia and femur. New studies focused on tibial
nonunion and femoral nonunion are reviewed. A section summarizing recent treat-
ment of atypical femoral fractures associated with bisphosphonate therapy is also
included.
Pediatrics
Jeffrey R. Sawyer
Complications of Pediatric Elbow Fractures
Brad T. Hyatt, Matthew R. Schmitz, and Jeremy K. Rush
Fractures about the elbow in children are common and varied. Both diagnosis
and treatment can be challenging, and optimal treatment protocols continue to
evolve with new research data. This article reviews common complications
related to pediatric elbow fractures and presents recent literature to help guide
treatment.
Surgical Site Infections After Pediatric Spine Surgery
Lorena V. Floccari and Todd A. Milbrandt
Surgical site infection (SSI) after spinal deformity surgery is a complication in the
pediatric population resulting in high morbidity and cost. Despite modern surgical
techniques and preventative strategies, the incidence remains substantial, espe-
cially in the neuromuscular population. This review focuses on recent advance-
ments in identification of risk factors, prevention, diagnosis, and treatment
strategies for acute and delayed pediatric spine infections. It reviews recent liter-
ature, including the best practice guidelines for infection prevention in high-risk
patients. Targets of additional research are highlighted to assess efficacy of cur-
rent practices to further reduce risk of SSI in pediatric patients with spinal
deformity.
Complications After Surgical Treatment of Adolescent Idiopathic Scoliosis
Rodrigo Goes Medea de Mendonga, Jeffrey R. Sawyer, and Derek M. Kelly
Even with current techniques and instrumentation, complications can occur after
operative treatment of adolescent idiopathic scoliosis. The most dreaded com-
plications—neurologic deficits—are relatively infrequent, occurring in 1% or less
of patients. Nonneurologic deficits, such as infection, pseudarthrosis, curve pro-
gression, and proximal junctional kyphosis, are more frequent, but are much less
likely to require reoperation or to cause poor functional outcomes. Understanding
xiv Contents
the potential complications of surgical treatment of pediatric spinal deformity is
essential for surgical decision-making.
Complications Related to the Treatment of Slipped Capital Femoral Epiphysis 405
John Roaten and David D. Spence
Slipped capital femoral epiphysis (SCFE) is a condition of the immature hip in which
mechanical overload of the proximal femoral physis results in anterior and superior
displacement of the femoral metaphysis relative to the epiphysis. The treatment of
SCFE is surgical, as the natural history of nonsurgical treatment is slip progression
and early arthritis. Despite advances in treatment, much controversy exists
regarding the best treatment, and complication rates remain high. Complications
include osteonecrosis, chondrolysis, SCFE-induced impingement, and related artic-
ular degeneration, fixation failure and deformity progression, growth disturbance of
the proximal femur, and development of bilateral disease.
Upper Extremity
Benjamin M. Mauck and James H. Calandruccio
Complications of Distal Radius Fixation 415
Dennis S. Lee and Douglas R. Weikert
Complications following any form of distal radius fixation remain prevalent. With an
armamentarium of fixation options available to practicing surgeons, familiarity with
the risks of newer plate technology as it compares with other conventional methods
is crucial to optimizing surgical outcome and managing patient expectations. This
article presents an updated review on complications following various forms of distal
radius fixation.
Complications of Carpal Tunnel Release 425
John W. Karl, Stephanie M. Gancarczyk, and Robert J. Strauch
Carpal tunnel release for compression of the median nerve at the wrist is one of the
most common and successful procedures in hand surgery. Complications, though
rare, are potentially devastating and may include intraoperative technical errors,
postoperative infection and pain, and persistent or recurrent symptoms. Patients
with continued complaints after carpal tunnel release should be carefully evaluated
with detailed history and physical examination in addition to electrodiagnostic
testing. For those with persistent or recurrent symptoms, a course of nonoperative
management including splinting, injections, occupational therapy, and desensitiza-
tion should be considered prior to revision surgery.
Complications of Distal Biceps Repair 435
Mark Tyson Garon and Jeffrey A. Greenberg
Modern techniques to repair the distal biceps tendon include one-incision and 2-
incision techniques that use transosseous sutures, suture anchors, interference
screws, and/or cortical buttons to achieve a strong repair of the distal biceps brachii.
Repair using these techniques has led to improved functional outcomes when
Contents xv
compared with nonoperative treatment. Most complications consist of neurapraxic
injuries to the lateral antebrachial cutaneous nerve, posterior interosseous nerve,
stiffness and weakness with forearm rotation, heterotopic ossification, and wound
infections. Although complications certainly affect outcomes, patients with distal bi-
ceps repairs report a high satisfaction rate after repair.
Complications of Lateral Epicondylar Release 445
Michael Lucius Pomerantz
Reported complication rates are low for lateral epicondylitis management, but the
anatomic complexity of the elbow allows for possible catastrophic complication.
This review documents complications associated with lateral epicondylar release:
68 studies reporting outcomes of lateral epicondylar release with open, percuta-
neous, or arthroscopic methods are reviewed and 6 case reports on specific com-
plications associated with the procedure are included. Overall complication rate was
3.3%. For open procedures it was 4.3%, percutaneous procedures 1.9%, and
arthroscopic procedures 1.1%. In higher-level studies directly comparing modal-
ities, the complication rates were 1.3%, 0%, and 1.2%, respectively.
Foot and Ankle
Benjamin J. Grear
Deep Vein Thrombosis in Foot and Ankle Surgery 471
John Chao
The routine use of venous thromboembolism prophylaxis in patients undergoing foot
and ankle procedures is not well supported in the literature. Multiple studies draw
conclusions from heterogeneous populations, and specific studies have small
numbers of specific pathologic conditions. Depending on the study, recommenda-
tions for and against venous thromboembolism prophylaxis in foot and ankle surgery
can be made. The identification of risk factors for venous thromboembolism is para-
mount in the decision making of postoperative venous thromboembolism
prophylaxis.
Index
477
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