Arthroscopy and Sports Medicine
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Arthroscopy and Sports Medicine
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In preparation for surgery, the patient received of intravenous midazolam in the holding area. In the operating room she was induced with propofol without muscle relaxant and the trachea was intubated. The epidural space was easily accessed via the loss-of-resistance technique and bupivacaine was given through the epidural needle. An epidural catheter was threaded smoothly, Given the patient’s uncontrolled pain and nausea with opioids, the decision was made to offer him a continuous femoral nerve block as a primary analgesic in order to prolong analgesia beyond the potential of a single injection approach.
The femoral nerve block and catheter placement were performed in the post-anesthesia recovery room, utilizing an ultrasound guided approach in order to avoid vascular trauma in the setting of planned anticoagulation. The local anesthetic infusion for the continuous femoral nerve block was combined with a patient controlled function with the goal to tailor dosing to the patient’s needs and minimize excessive motor block. The patient required minimal systemic opioids and did not develop any adverse respiratory depression
Fracture healing may involve several interlinked
processes contributing in varying degrees to the
healing of any individual fracture. It has been suggested that in the first few days and weeks there is a primary callus response occurring as a fundamental reaction to bone injury. This response is thought to be short-lived and peters out if it fails to provide satisfactory bridging between the fragments. In that case, a second mechanism may come into play called ‘ bridging external callus.
If the fracture is rigidly fi xed, virtually no callus
is seen and direct union across the fracture gap
may eventually occur without a callus stage. In
these circumstances, the rigid fi xation takes the
place of the callus. Rigid internal fi xation may suppress or even replace the fi rst two processes of fracture healing and may cause the fi nal stage of cortex – to – cortex union to be long delayed, because the fi xation device takes most of the stresses.
Because of the potential for rigid fi xation to delay union, many fi xation devices allow some movement to occur at the fracture. These devices allow the limb to be normally aligned, to take weight without displacement at the fracture site (so-called ‘ load sharing ’devices), but also allow preservation of the normal healing process. External fi xators and to a lesser extent intramedullary nails follow these principles.
The treatment of these fractures is an orthopedic emergency. The most important consideration when dealing with an open fracture is to reduce the risks of infection. The development of chronic osteomyelitis at the fracture site is a catastrophe, which may lead to the delayed or non – union, requiring months or even years of treatment and sometimes leading to loss of the limb. There is a general agreement that sepsis is best prevented by early and aggressive cleaning of the wound with excision of dead tissue and all foreign material. In order
Some fractures and dislocations may be reduced slowly by traction. This is usually used
when manipulation is inappropriate, perhaps
because an anesthetic would be dangerous, e.g. subluxation or dislocation of one or more facets of the cervical spine.
This has the advantage of allowing very accurate reduction but carries the risk of infection. Usually, open reduction is reserved for those cases where closed methods will
not give the desired reduction, or where internal
fi cation is going to be needed for some other
reason (see below). The open reduction does not necessarily imply internal fixation, although usually, it does.
If the fracture is left to unite in the displaced position, often there will be functional impairment, such as a short limb. In general, fractures involving joints require anatomical reduction if possible, because of the need for the surfaces to glide accurately. With fractures of the shafts of the radius and ulna, any malalignment is likely to cause restriction of pronation and supination; this may be considered to function like an intra – articular fracture. Limbs need to be well aligned,
because if they are not there are risks of later
joint degeneration due to abnormal loading at
Because of the heaviness and ease of water
damage, newer casting materials have been developed. Most of these are made from a fabric base impregnated with a resin which undergoes a setting process when activated by heat or water. They all have slightly different characteristics, but, in general, they have advantages over plaster of Paris in that they are light in weight, but very strong.
During the last couple of years the city of Baroda has witnessed variety of educational, social, religious & many other activities from the stage of VAISHVI ORTHOPEDIC HOSPITAL.
G-2|3|4 Status Avenue, 9, Sampatroa Colony, Jetalpur Road, Vadodara, Gujarat
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