By Harry Skinner, Michael Fitzpatrick
present necessities: Orthopedics -- the final word at-a-glance bedside guide!
- “Nutshell” details at the prognosis and therapy of the 2 hundred commonest orthopedic ailments and problems
- One ailment in keeping with web page, with bulleted lists for simple entry
- Covers all suitable systems, from grownup reconstructive surgical procedure to foot and ankle surgical procedure
- ICD9-CM codes for every subject, permitting you to code and classify morbidity info after making the analysis
- Included in each one subject --Essentials of analysis --Differential prognosis --Treatment --Pearl --Reference
- Handy tabs
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Additional info for CURRENT Essentials Orthopedics
J Am Acad Orthop Surg 2006;14:278. 5 Open ■ Essentials of Diagnosis • Incidence is increasing in the over-60 age group • Occurs after trauma (relatively minor in the older age groups) • Classiﬁed according to whether the fracture is extra-articular, intra-articular, unicondylar, or bicondylar (Y, T, H, or lambda patterns), or comminuted • Presence of pain, deformity, and swelling • Radiographs are diagnostic ■ Differential Diagnosis • Radial head fracture • Olecranon fracture • Elbow dislocation ■ Treatment • Some loss of motion is likely from stiffness associated with the fracture • Open treatment with internal ﬁxation is almost uniformly indicated for intercondylar fractures; in older, low-demand patients, total elbow arthroplasty is an option to provide good pain relief and early motion • Some physicians advocate the “bag-of-bone” treatment (ie, no ﬁxation and early motion as tolerated) for older, more sedentary and medically ill patients ■ Pearl Casting is the worst treatment for these fractures due to resultant stiffness.
The acutely dislocated knee: evaluation and management. J Am Acad Orthop Surg 2004;12:334. 1 Open ■ Essentials of Diagnosis • • • • • Direct blow to the anterior knee usually causes comminution Indirect loading causes a transverse fracture Resisted hyperﬂexion of the knee can cause fracture Other conditions are bone bruises or osteochondral fracture Need to test active straight leg raise to determine status of extensor mechanism • Signiﬁcant hemarthrosis is usually present • Displacement of the fragments may be palpated • Radiographs are diagnostic ■ Differential Diagnosis • • • • • • ■ Bone bruise Osteochondral fracture Patellar dislocation Quadriceps or patellar tendon rupture Hyperparathyroidism Renal osteodystrophy Treatment • Treat minimally displaced comminuted fractures with a cylinder cast for 8 wk • Displaced fractures (transverse or comminuted) require open treatment with the tension hand technique • Displacement >3 mm or articular step-off >2 mm requires surgical treatment • Transverse fractures with one small fragment can be treated by excising the small fragment and reattaching the extensor mechanism to the large fragment • Patellectomy should be considered as the last possible treatment choice ■ Pearl Always test the extensor mechanism for continuity of the extensor retinaculum.
Minimally invasive treatment of pilon fractures with a low proﬁle plate: preliminary results in 17 cases. Arch Orthop Trauma Surg 2006;Sept 2 [Epub ahead of print]. 32 Open ■ Essentials of Diagnosis • Direct or indirect trauma, open or closed (see Classiﬁcation of Open Fractures, p. XXX) • Higher rate of nonunions due to poor periosteal blood supply, lack of soft tissue (muscle) coverage, and single posterior nutrient artery • Displaced fractures are usually clinically obvious • Radiographs are diagnostic in most undisplaced fractures ■ Differential Diagnosis • Contusion, hematoma, or laceration • Fibula shaft fracture ■ Treatment • Acceptable reduction: diameter of both ends should appose >50%; varus, valgus, recurvatum, antecurvatum angulation <5 degrees; rotation <10 degrees; shortening <1 cm • Low-energy closed fracture: closed reduction with 6 wk in a longleg cast; serial biweekly radiographs to rule out displacement • Cast (long or short) until healed (usually ≥12 wk in adults) • External ﬁxation: for open fractures (wound care easily accessible), or hemodynamically unstable patient or high-energy closed fractures • Reamed intramedullary nail for closed fractures, including highenergy fractures irrespective of soft tissue condition • Elevated compartment pressures or impending compartment syndrome may be indications for an alternative mode of treatment (eg, unreamed nail, external ﬁxation), at least initially • Open treatment with internal ﬁxation for pediatric patients is rarely indicated except for polytrauma ■ Pearl The most common malunion is in rotation.