The document summarizes the MUSC Ortho Haiti Experience following the 2010 earthquake in Haiti. Over several missions, teams of orthopedic surgeons, nurses, and other medical professionals provided relief efforts at Hospital Lumiere including performing numerous surgeries such as amputations, external and internal fixations, and wound care. The document outlines the damage to infrastructure, acute and long term orthopedic needs, lessons learned from each mission, and suggestions for improving future disaster relief responses.
Surgery and Therapy for the Elbow and Hand: A Primer for the Rheumatologistwashingtonortho
This document provides an overview of surgical options for the elbow and hand from an orthopaedic surgeon. It discusses appropriate patients for referral, current surgical techniques, expected outcomes, and rehabilitation considerations. For the elbow, it describes treatments for conditions like osteoarthritis, inflammatory arthritis, and tennis elbow. Surgical options discussed include total elbow arthroplasty and fascial arthroplasty. For the wrist, it compares procedures like total wrist arthroplasty, fusion, and proximal row carpectomy. For the hand, it outlines treatments for common issues like carpometacarpal arthritis, trigger finger, and finger joint arthritis or deformities.
The document discusses guidelines for deep vein thrombosis (DVT) prophylaxis for orthopedic trauma patients. It notes that many existing guidelines do not adequately address trauma patients, who have higher DVT risks due to immobility from injury. A review found that 77% of patients transferred to the authors' hospitals did not receive pre-transfer DVT prophylaxis, including 67% of hip fracture patients despite being at high risk. The authors developed new DVT prophylaxis guidelines for orthopedic trauma patients to help standardize care and lower DVT risks.
Orthopaedic Perspective of the Boston Marathon BombingArun Shanbhag
The document summarizes the medical response to the 2013 Boston Marathon bombing. It describes how the 6 level 1 trauma centers in Boston were prepared through disaster planning and quickly mobilized over 150 injured patients. Key lessons learned include: having prepared trauma teams, organizing patient care amidst chaos, focusing on conservative care like debridement over amputation when possible, and ensuring adequate equipment like external fixators were available across operating rooms. The extraordinary coordination between emergency responders and hospitals resulted in effective triage and treatment that minimized loss of life from the bombing.
1) Doctors from Partners in Health arrived in Haiti on January 16th, 2010 to provide medical relief after the devastating earthquake. They were sent to St. Nicholas Hospital, 80 miles from Port-au-Prince, which was overwhelmed with over 200 untreated earthquake victims lying on the floor without necessary medical supplies or equipment.
2) Over the next two weeks, the doctors performed 216 earthquake-related surgeries and procedures with only basic resources, and established a triage system to prioritize the many severe injuries. They also trained local staff. Unfortunately 12 patients died from their injuries.
3) The doctors continued their relief efforts in Haiti and hope to maintain a long-term presence to help the thousands of
Management of Primary Traumatic Shoulder Instabilitywashingtonortho
This document discusses the management of primary traumatic shoulder instability through a presentation by Dr. J.R. Rudzki. Some key points discussed include:
- Age is a primary risk factor for recurrence, with rates of 100% in patients <10 years old and 79% in patients aged 20-30 years old.
- Surgical stabilization may have better outcomes than conservative treatment for young, active patients based on data from randomized controlled trials.
- For first-time dislocators, arthroscopic Bankart repair reduces the risk of recurrent instability by 76-82% compared to non-operative management.
- Factors like glenoid bone loss, large Hill-Sachs lesions, and capsular
Trauma Rounds, 1:3; Evaluating The Cervical SpineArun Shanbhag
This document discusses evaluating cervical spine injuries. It begins by contrasting evaluating a knee injury versus a neck injury after a fall. For neck injuries, a focused physical exam and imaging are important to rule out fractures or ligament injuries. The preferred imaging is a multi-detector CT scan, which is highly sensitive and specific for fractures. If the CT is normal but the physical exam is painful, a collar should remain on until follow-up. If both the CT and physical exam are normal, the collar can be removed safely. An MRI may also be useful if the physical exam is difficult. The "2/3 rule" states that if two of three tests - CT, MRI, and physical exam - are normal, a
Surgery and Therapy for the Elbow and Hand: A Primer for the Rheumatologistwashingtonortho
This document provides an overview of surgical options for the elbow and hand from an orthopaedic surgeon. It discusses appropriate patients for referral, current surgical techniques, expected outcomes, and rehabilitation considerations. For the elbow, it describes treatments for conditions like osteoarthritis, inflammatory arthritis, and tennis elbow. Surgical options discussed include total elbow arthroplasty and fascial arthroplasty. For the wrist, it compares procedures like total wrist arthroplasty, fusion, and proximal row carpectomy. For the hand, it outlines treatments for common issues like carpometacarpal arthritis, trigger finger, and finger joint arthritis or deformities.
The document discusses guidelines for deep vein thrombosis (DVT) prophylaxis for orthopedic trauma patients. It notes that many existing guidelines do not adequately address trauma patients, who have higher DVT risks due to immobility from injury. A review found that 77% of patients transferred to the authors' hospitals did not receive pre-transfer DVT prophylaxis, including 67% of hip fracture patients despite being at high risk. The authors developed new DVT prophylaxis guidelines for orthopedic trauma patients to help standardize care and lower DVT risks.
Orthopaedic Perspective of the Boston Marathon BombingArun Shanbhag
The document summarizes the medical response to the 2013 Boston Marathon bombing. It describes how the 6 level 1 trauma centers in Boston were prepared through disaster planning and quickly mobilized over 150 injured patients. Key lessons learned include: having prepared trauma teams, organizing patient care amidst chaos, focusing on conservative care like debridement over amputation when possible, and ensuring adequate equipment like external fixators were available across operating rooms. The extraordinary coordination between emergency responders and hospitals resulted in effective triage and treatment that minimized loss of life from the bombing.
1) Doctors from Partners in Health arrived in Haiti on January 16th, 2010 to provide medical relief after the devastating earthquake. They were sent to St. Nicholas Hospital, 80 miles from Port-au-Prince, which was overwhelmed with over 200 untreated earthquake victims lying on the floor without necessary medical supplies or equipment.
2) Over the next two weeks, the doctors performed 216 earthquake-related surgeries and procedures with only basic resources, and established a triage system to prioritize the many severe injuries. They also trained local staff. Unfortunately 12 patients died from their injuries.
3) The doctors continued their relief efforts in Haiti and hope to maintain a long-term presence to help the thousands of
Management of Primary Traumatic Shoulder Instabilitywashingtonortho
This document discusses the management of primary traumatic shoulder instability through a presentation by Dr. J.R. Rudzki. Some key points discussed include:
- Age is a primary risk factor for recurrence, with rates of 100% in patients <10 years old and 79% in patients aged 20-30 years old.
- Surgical stabilization may have better outcomes than conservative treatment for young, active patients based on data from randomized controlled trials.
- For first-time dislocators, arthroscopic Bankart repair reduces the risk of recurrent instability by 76-82% compared to non-operative management.
- Factors like glenoid bone loss, large Hill-Sachs lesions, and capsular
Trauma Rounds, 1:3; Evaluating The Cervical SpineArun Shanbhag
This document discusses evaluating cervical spine injuries. It begins by contrasting evaluating a knee injury versus a neck injury after a fall. For neck injuries, a focused physical exam and imaging are important to rule out fractures or ligament injuries. The preferred imaging is a multi-detector CT scan, which is highly sensitive and specific for fractures. If the CT is normal but the physical exam is painful, a collar should remain on until follow-up. If both the CT and physical exam are normal, the collar can be removed safely. An MRI may also be useful if the physical exam is difficult. The "2/3 rule" states that if two of three tests - CT, MRI, and physical exam - are normal, a
This document provides information on pediatric supracondylar fractures of the elbow. It discusses that these fractures are common in children and often present with neurovascular injuries. Nondisplaced or minimally displaced fractures can be treated with immobilization, while displaced fractures typically require closed reduction and pin fixation. Fractures with preoperative neurovascular deficits or those that cannot be adequately reduced closed may require open reduction to address entrapment issues. Open reduction through an anterior incision allows exposure and release of trapped nerves and vessels. Postoperative monitoring is important to identify any developing complications.
Acromioclavicular joint injury Andrew Gardner NWULGLennard Funk
This document discusses the conservative rehabilitation and post-operative rehabilitation of AC joint injuries. It provides information on the causes, diagnosis, classification, aims of physiotherapy management, rehabilitation protocols, return to sport considerations, prognosis, and complications for both conservative and post-operative treatment of AC joint injuries. Research on the outcomes of conservative versus surgical management is also reviewed, finding similar results between the two approaches.
This document summarizes key issues in treating fractures of the distal humerus. It discusses the increasing incidence of these fractures, especially in elderly women. Classification systems and preoperative planning are outlined. Surgical approaches like the olecranon osteotomy are described, along with techniques for fracture stabilization and indications for total elbow arthroplasty in complex fractures of elderly patients.
This document discusses the presentation, diagnosis, and management of a pathological fracture in a 14-year-old male patient. It summarizes the patient's history, physical exam findings, imaging results, and diagnosis of osteosarcoma based on biopsy results. It then discusses pathological fractures in general, the diagnosis and treatment of osteosarcoma, and considerations for operative versus non-operative management of pathological fractures.
1) THA can provide better outcomes than fixation for displaced femoral neck fractures, but presents unique challenges including risk of intraoperative fracture and leg length discrepancy.
2) Care must be taken to choose a press-fit femoral stem and supplement acetabular fixation to reduce risk of intraoperative fracture. The C-arm is important for guiding component placement and assessing leg length.
3) Recovery from THA after fracture may be more difficult than for osteoarthritis due to associated soft tissue injury, so managing expectations is important.
The document summarizes the treatment of a Libyan rebel soldier with infected nonunions of the left distal femur and right tibia using the Masquelet technique at Spaulding Hospital. Key points:
- The patient underwent debridement and placement of antibiotic cement spacers at the nonunion sites to induce membrane formation per the Masquelet technique.
- After membrane maturation, the spacers were removed and the defects were filled with iliac crest bone graft within the membranes.
- At 8 months post-op the patient was weight bearing with assistance and showing healing of the nonunions without recurrent infection.
- The Masquelet technique allowed reconstruction of these severe wartime injuries in a
This document provides information on acromioclavicular (AC) joint injuries. It discusses the anatomy and biomechanics of the AC joint. It also outlines the epidemiology, mechanisms of injury, clinical evaluation, classification systems and treatment options for different grades of AC joint separation. For acute injuries under 4 weeks, treatment options discussed include conservative management or surgical stabilization techniques like hook plates, tightropes or ligament reconstruction. For chronic injuries, options include AC joint excision or reconstruction of the coracoclavicular ligaments.
The document discusses the decision between limb salvage and amputation for severely injured extremities. It outlines factors to consider like injury classification, soft tissue damage, vascular and nerve injury. Scoring systems like MESS, LSI and PSI are mentioned but have limitations. With advances in wound care, fixation and reconstruction, more limbs can now be salvaged that would have previously required amputation. The optimal decision involves a multidisciplinary team at an experienced trauma center tailored to each patient's injuries and prognosis.
This study examined the effect of mechanical environment on healing of critical-sized femoral defects in rats, finding that applying an initial period of loose fixation ("reverse dynamization") followed by rigid fixation led to better healing than rigid fixation alone, as assessed by radiology, histology, and mechanical testing. The reverse dynamization approach counters current clinical practice of immediate rigid fixation for large segmental defects and warrants further optimization and study to determine if it could improve treatment of such injuries in patients.
Limb Complex Multi system Injury (Mangled Extremity) is one of the most challenging problems in Orthopaedic surgery. Mangled Extremity is a limb with an injury to at least three out of four systems (soft tissue, bone, nerves, and vessels). Decision have to be made either amputation + Prosthesis or limb salvage procedure. The decision of Primary Amputation in the acute setting is difficult for the patient, family, & the treating surgical team. The majority of mangled extremities are potentially salvageable for which, in the acute setting, a treatment plan needs to be made.
This document summarizes a presentation on AC joint and distal clavicle injuries. It discusses the classification of AC joint injuries, controversies around treatment of type III injuries, surgical techniques for repair and reconstruction, and recent biomechanical studies. While the literature is limited, current evidence suggests conservative treatment may be adequate for many type III injuries, with surgical intervention favored for more active patients or overhead athletes. Surgical techniques like the tightrope and anatomic reconstruction show promise but further research is still needed.
Spinal immobilization, Treatment or Torture?Luke Winkelman
This document discusses the history and evidence surrounding spinal immobilization practices in EMS. It begins with a brief history of spinal motion restriction from the 1960s to present. It then discusses the anatomy of the spine, costs of spinal cord injuries, and mechanisms of injury that could cause spinal injuries. The majority of the document questions the evidence and potential harms of traditional spinal immobilization using backboards and cervical collars. It presents research showing low rates of spinal injuries from blunt trauma and questions whether immobilization benefits outweigh risks like respiratory compromise, pressure ulcers, and delayed treatment. Alternative approaches adopted by some agencies are presented, as well as calls from organizations to use immobilization more judiciously.
Patients with orthopedic injuries constitute a large portion of ED patients. The document outlines guidelines for initially managing orthopedic injuries, including following ABCDE protocol, performing thorough secondary surveys, and reducing fractures or dislocations with neurovascular compromise. It also provides descriptions and treatments for injuries like compartment syndrome, amputations, and fractures/dislocations. Precise terminology is important to clearly communicate orthopedic injury details.
This document discusses potential interventions for preventing hip fractures in geriatric patients. It summarizes a new technique called Anisotropy Restoring Femoroplasty (ARF) that aims to restore mechanical properties to the proximal femur through a minimally invasive procedure. ARF involves inserting metallic elements embedded in an isotropic filler like calcium phosphate into the femur via small drill holes. Testing in a porcine model found ARF restored load and strength to levels comparable to healthy bone. The researchers believe ARF may help reduce hip fracture risk in high-risk patients, and could be performed alongside traditional hip fracture repair.
This document discusses the evidence for and against cervical spine (c-spine) immobilization in trauma patients. While c-spine immobilization has long been standard practice, recent studies show little evidence that it prevents secondary c-spine injury and evidence that it can cause complications. Immobilization may increase intracranial pressure, interfere with airway management, and cause pressure ulcers. The document concludes that c-spine fractures are rare, immobilization has not been shown to improve outcomes, and it can harm some patients, making clinical decision-making difficult.
Ligamentotaxis principle in the treatment of intra articular fractures of dis...Sitanshu Barik
This study assessed the correlation between radiological outcomes and functional outcomes in 45 patients treated with external fixation for intra-articular fractures of the distal radius. Good or acceptable restoration of radial length and palmar slope on radiographs post-operatively was found to produce good to excellent functional results regardless of fracture type. While poor radiological outcomes did not always lead to poor function, maintenance of radial length and correction of palmar tilt were important for functional outcomes. The study concluded that achieving good function is more important than surgical precision on radiographs alone.
This document discusses the anatomy, classification, diagnosis, and treatment of acromioclavicular joint injuries. It begins with an overview of the anatomy of the AC joint and its ligaments. It then describes the Rockwood classification system for AC joint injuries, which ranges from Type I to Type VI injuries with increasing severity. For mild Type I and II injuries, nonsurgical treatment with immobilization is recommended. For more severe Type III injuries, the literature is reviewed and there is a trend toward initial nonsurgical treatment. For severe Types IV-VI injuries that are displaced, surgical treatment is generally recommended.
CT-Guided Percutaneous Radiofrequency Thermal Ablation of Osteoid Osteoma-Cri...CrimsonPublishersOPROJ
CT-Guided Percutaneous Radiofrequency Thermal Ablation of Osteoid Osteoma by Pedro Manuel Serrano* in Crimson Publishers: Orthopedic Research and Reviews Journal
Roald Dahl was a British author born in 1916 and died in 1990 who wrote over 21 books with his best known being The BFG. In addition to being an author, Dahl also worked as a shell executive in Africa and was a Royal Air Force pilot during World War II.
The document summarizes new guidelines for pap smears, HPV vaccines, and mammograms.
For pap smears, the guidelines recommend starting at age 21 and screening every 2-3 years depending on age and prior results. Two HPV vaccines are available to prevent cervical cancer and genital warts in girls and boys ages 9-26. HPV vaccines do not replace pap smears.
Guidelines for mammograms are controversial. The USPSTF recommends less frequent screening than the ACOG for some age groups. Women should see their doctor urgently for issues like abnormal bleeding or breast lumps.
This document provides information on pediatric supracondylar fractures of the elbow. It discusses that these fractures are common in children and often present with neurovascular injuries. Nondisplaced or minimally displaced fractures can be treated with immobilization, while displaced fractures typically require closed reduction and pin fixation. Fractures with preoperative neurovascular deficits or those that cannot be adequately reduced closed may require open reduction to address entrapment issues. Open reduction through an anterior incision allows exposure and release of trapped nerves and vessels. Postoperative monitoring is important to identify any developing complications.
Acromioclavicular joint injury Andrew Gardner NWULGLennard Funk
This document discusses the conservative rehabilitation and post-operative rehabilitation of AC joint injuries. It provides information on the causes, diagnosis, classification, aims of physiotherapy management, rehabilitation protocols, return to sport considerations, prognosis, and complications for both conservative and post-operative treatment of AC joint injuries. Research on the outcomes of conservative versus surgical management is also reviewed, finding similar results between the two approaches.
This document summarizes key issues in treating fractures of the distal humerus. It discusses the increasing incidence of these fractures, especially in elderly women. Classification systems and preoperative planning are outlined. Surgical approaches like the olecranon osteotomy are described, along with techniques for fracture stabilization and indications for total elbow arthroplasty in complex fractures of elderly patients.
This document discusses the presentation, diagnosis, and management of a pathological fracture in a 14-year-old male patient. It summarizes the patient's history, physical exam findings, imaging results, and diagnosis of osteosarcoma based on biopsy results. It then discusses pathological fractures in general, the diagnosis and treatment of osteosarcoma, and considerations for operative versus non-operative management of pathological fractures.
1) THA can provide better outcomes than fixation for displaced femoral neck fractures, but presents unique challenges including risk of intraoperative fracture and leg length discrepancy.
2) Care must be taken to choose a press-fit femoral stem and supplement acetabular fixation to reduce risk of intraoperative fracture. The C-arm is important for guiding component placement and assessing leg length.
3) Recovery from THA after fracture may be more difficult than for osteoarthritis due to associated soft tissue injury, so managing expectations is important.
The document summarizes the treatment of a Libyan rebel soldier with infected nonunions of the left distal femur and right tibia using the Masquelet technique at Spaulding Hospital. Key points:
- The patient underwent debridement and placement of antibiotic cement spacers at the nonunion sites to induce membrane formation per the Masquelet technique.
- After membrane maturation, the spacers were removed and the defects were filled with iliac crest bone graft within the membranes.
- At 8 months post-op the patient was weight bearing with assistance and showing healing of the nonunions without recurrent infection.
- The Masquelet technique allowed reconstruction of these severe wartime injuries in a
This document provides information on acromioclavicular (AC) joint injuries. It discusses the anatomy and biomechanics of the AC joint. It also outlines the epidemiology, mechanisms of injury, clinical evaluation, classification systems and treatment options for different grades of AC joint separation. For acute injuries under 4 weeks, treatment options discussed include conservative management or surgical stabilization techniques like hook plates, tightropes or ligament reconstruction. For chronic injuries, options include AC joint excision or reconstruction of the coracoclavicular ligaments.
The document discusses the decision between limb salvage and amputation for severely injured extremities. It outlines factors to consider like injury classification, soft tissue damage, vascular and nerve injury. Scoring systems like MESS, LSI and PSI are mentioned but have limitations. With advances in wound care, fixation and reconstruction, more limbs can now be salvaged that would have previously required amputation. The optimal decision involves a multidisciplinary team at an experienced trauma center tailored to each patient's injuries and prognosis.
This study examined the effect of mechanical environment on healing of critical-sized femoral defects in rats, finding that applying an initial period of loose fixation ("reverse dynamization") followed by rigid fixation led to better healing than rigid fixation alone, as assessed by radiology, histology, and mechanical testing. The reverse dynamization approach counters current clinical practice of immediate rigid fixation for large segmental defects and warrants further optimization and study to determine if it could improve treatment of such injuries in patients.
Limb Complex Multi system Injury (Mangled Extremity) is one of the most challenging problems in Orthopaedic surgery. Mangled Extremity is a limb with an injury to at least three out of four systems (soft tissue, bone, nerves, and vessels). Decision have to be made either amputation + Prosthesis or limb salvage procedure. The decision of Primary Amputation in the acute setting is difficult for the patient, family, & the treating surgical team. The majority of mangled extremities are potentially salvageable for which, in the acute setting, a treatment plan needs to be made.
This document summarizes a presentation on AC joint and distal clavicle injuries. It discusses the classification of AC joint injuries, controversies around treatment of type III injuries, surgical techniques for repair and reconstruction, and recent biomechanical studies. While the literature is limited, current evidence suggests conservative treatment may be adequate for many type III injuries, with surgical intervention favored for more active patients or overhead athletes. Surgical techniques like the tightrope and anatomic reconstruction show promise but further research is still needed.
Spinal immobilization, Treatment or Torture?Luke Winkelman
This document discusses the history and evidence surrounding spinal immobilization practices in EMS. It begins with a brief history of spinal motion restriction from the 1960s to present. It then discusses the anatomy of the spine, costs of spinal cord injuries, and mechanisms of injury that could cause spinal injuries. The majority of the document questions the evidence and potential harms of traditional spinal immobilization using backboards and cervical collars. It presents research showing low rates of spinal injuries from blunt trauma and questions whether immobilization benefits outweigh risks like respiratory compromise, pressure ulcers, and delayed treatment. Alternative approaches adopted by some agencies are presented, as well as calls from organizations to use immobilization more judiciously.
Patients with orthopedic injuries constitute a large portion of ED patients. The document outlines guidelines for initially managing orthopedic injuries, including following ABCDE protocol, performing thorough secondary surveys, and reducing fractures or dislocations with neurovascular compromise. It also provides descriptions and treatments for injuries like compartment syndrome, amputations, and fractures/dislocations. Precise terminology is important to clearly communicate orthopedic injury details.
This document discusses potential interventions for preventing hip fractures in geriatric patients. It summarizes a new technique called Anisotropy Restoring Femoroplasty (ARF) that aims to restore mechanical properties to the proximal femur through a minimally invasive procedure. ARF involves inserting metallic elements embedded in an isotropic filler like calcium phosphate into the femur via small drill holes. Testing in a porcine model found ARF restored load and strength to levels comparable to healthy bone. The researchers believe ARF may help reduce hip fracture risk in high-risk patients, and could be performed alongside traditional hip fracture repair.
This document discusses the evidence for and against cervical spine (c-spine) immobilization in trauma patients. While c-spine immobilization has long been standard practice, recent studies show little evidence that it prevents secondary c-spine injury and evidence that it can cause complications. Immobilization may increase intracranial pressure, interfere with airway management, and cause pressure ulcers. The document concludes that c-spine fractures are rare, immobilization has not been shown to improve outcomes, and it can harm some patients, making clinical decision-making difficult.
Ligamentotaxis principle in the treatment of intra articular fractures of dis...Sitanshu Barik
This study assessed the correlation between radiological outcomes and functional outcomes in 45 patients treated with external fixation for intra-articular fractures of the distal radius. Good or acceptable restoration of radial length and palmar slope on radiographs post-operatively was found to produce good to excellent functional results regardless of fracture type. While poor radiological outcomes did not always lead to poor function, maintenance of radial length and correction of palmar tilt were important for functional outcomes. The study concluded that achieving good function is more important than surgical precision on radiographs alone.
This document discusses the anatomy, classification, diagnosis, and treatment of acromioclavicular joint injuries. It begins with an overview of the anatomy of the AC joint and its ligaments. It then describes the Rockwood classification system for AC joint injuries, which ranges from Type I to Type VI injuries with increasing severity. For mild Type I and II injuries, nonsurgical treatment with immobilization is recommended. For more severe Type III injuries, the literature is reviewed and there is a trend toward initial nonsurgical treatment. For severe Types IV-VI injuries that are displaced, surgical treatment is generally recommended.
CT-Guided Percutaneous Radiofrequency Thermal Ablation of Osteoid Osteoma-Cri...CrimsonPublishersOPROJ
CT-Guided Percutaneous Radiofrequency Thermal Ablation of Osteoid Osteoma by Pedro Manuel Serrano* in Crimson Publishers: Orthopedic Research and Reviews Journal
Roald Dahl was a British author born in 1916 and died in 1990 who wrote over 21 books with his best known being The BFG. In addition to being an author, Dahl also worked as a shell executive in Africa and was a Royal Air Force pilot during World War II.
The document summarizes new guidelines for pap smears, HPV vaccines, and mammograms.
For pap smears, the guidelines recommend starting at age 21 and screening every 2-3 years depending on age and prior results. Two HPV vaccines are available to prevent cervical cancer and genital warts in girls and boys ages 9-26. HPV vaccines do not replace pap smears.
Guidelines for mammograms are controversial. The USPSTF recommends less frequent screening than the ACOG for some age groups. Women should see their doctor urgently for issues like abnormal bleeding or breast lumps.
This document lists various geographic locations around the world, including national parks, cities, states, islands, rivers, forests, and other landmarks across 6 continents and over 15 countries. Locations span from the Adirondack Mountains in New York to Victoria Land in Antarctica, with many listings for parks, reserves, and areas in Africa, India, Texas, Colorado, Greece and other regions globally.
1) A study was conducted in rural Tanzania to evaluate options for cervical cancer screening in low-resource settings. Over 300 women were enrolled and tested using the careHPV rapid HPV test and Pap smears.
2) The results found an HPV infection rate of 12.8% among participants. Comparison of careHPV to the Hybrid Capture 2 HPV test showed high agreement.
3) The most common HPV genotypes found were HPV 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 56, and 58. However, the prevalence of HPV 16 and 18 was much lower than expected, implying lower potential effectiveness of the current HPV vaccines in this population.
Since Coming to University... discusses the social and academic experiences of first-year university students. Socially, students attend introductory parties like Fresher's Ball, join new societies, see bands, meet new people, and play on sports teams. Academically, students have lectures, IT and lab practicals, complete lab reports, use the virtual learning environment, and take MCQ tests. The document also provides brief descriptions of GIF, JPEG, and WMF file formats.
Enid Blyton was a popular and prolific children's author from the UK who wrote over 131 books. She was born in 1897 in London and died in 1968 at the age of 71, having become one of the most popular children's authors of her time according to a 2008 UK survey. Some of her most famous works were the 21 books in the Famous Five series which became very popular in the United Kingdom.
This document discusses Dr. Jimmy McElligott's experience in Tanzania working with children. It covers several topics including culture and travel, children's basic rights to health, education and protection. It also discusses using medicine to treat common illnesses like pneumonia, malaria and malnutrition. The document describes academics in Africa, teaching and learning. It further details going "into the bush" and ends with a reflection on the many ways to care for children.
Oral the need for guidelines for common disabling conditions in natural disas...gosneyjr
The document discusses guidelines for rehabilitation of common disabling conditions in natural disasters. It outlines the International Society of Physical and Rehabilitation Medicine's (ISPRM) Rehabilitation Disaster Relief Subcommittee's (RDRC) approach to developing such guidelines. The RDRC aims to provide guidelines for conditions like spinal cord injury, traumatic brain injury, amputations, fractures, burns and more. It details a multi-phase plan to search for existing guidelines, identify gaps, and task experts to develop new guidelines as needed.
Damage control orthopaedics By Dr Navin Kr singh;AIIMS New DelhiDcoNavin Singh
This document summarizes a presentation on damage control orthopedics (DCO) for polytrauma patients. It defines polytrauma and trauma scoring systems like AIS and ISS. It describes the historical evolution from early total care to DCO, including the recognition that early definitive fixation increased complications. DCO focuses on temporary stabilization through external fixation to minimize surgical insult until the patient is stabilized. The goals are to stop ongoing injury, facilitate care, and later restore function. Studies found DCO with early external fixation and later internal fixation had low mortality and infection rates comparable to primary internal fixation.
16001107 01 X Stop Surgeon To Patient FinalWilliamYoungMD
This document summarizes lumbar spinal stenosis, including its symptoms, treatment options, and a new minimally invasive treatment called the X-STOP spacer. Lumbar spinal stenosis causes back and leg pain due to narrowing of the spinal canal. Treatment options discussed include non-operative care, laminectomy, and the X-STOP procedure, which separates the spinous processes with an implanted spacer to relieve pressure on nerves. The X-STOP procedure provides relief of symptoms with less risks and recovery time compared to laminectomy.
This document discusses the management of traumatic amputations in the emergency department. It provides details on initial assessment, handling of amputated parts, criteria for replantation versus amputation, and various scoring systems used to predict outcomes. Key points include controlling bleeding, administering antibiotics and tetanus prophylaxis, placing amputated parts in saline-moistened bags on ice, and consulting plastic/vascular surgeons for possible replantation depending on the level of injury and time since amputation. Scoring systems aim to guide the decision for limb salvage versus amputation based on factors like soft tissue, bone, nerve and vascular injuries.
This document discusses basic trauma care principles including the ABCs of trauma care, airway obstruction, bleeding and shock, soft tissue injuries, and musculoskeletal injuries. It provides guidance on assessing and treating life-threatening injuries, controlling bleeding, splinting fractures, and infection prevention for wounds. Tetanus prophylaxis and signs of local anesthetic overdose are also summarized. The goal is to stabilize the patient and minimize mortality, disability, and disfigurement from traumatic injuries.
This document discusses the management of hand injuries and associated infections. Some key points:
- Hand injuries are common, usually affecting young males, and are often caused by domestic or work-related accidents. Proper treatment is important to prevent stiffness.
- Evaluation of hand injuries involves assessing wound characteristics, neurovascular status, and underlying bone or tendon injuries. Management principles aim to preserve the hand and restore function.
- Treatment depends on wound type but typically involves debridement, irrigation, splinting, antibiotics, and reconstruction of tendons, nerves or bone as needed. Complications can include infection, stiffness if not managed properly.
- Specific injuries like bites, foreign bodies, fingertip injuries
The document discusses the challenges and approach to managing patients with polytrauma or injuries to multiple body systems. It describes the components of an organized trauma system including leadership, designated trauma facilities, and protocols like ATLS. ATLS focuses on assessing and treating life threats during the primary survey. Shock is a major cause of preventable death, so controlling bleeding and resuscitation are priorities. Surgical fixation may be delayed until resuscitation is complete. Effective communication, a multidisciplinary team, and adherence to guidelines can help optimize outcomes for polytrauma patients.
This document discusses various topics related to traumatic amputations, including:
1) Etiologies of amputations based on prevalence data, which found trauma as a leading cause of upper limb amputations but dysvascular issues as more common for lower limbs.
2) Factors to consider in the decision between salvaging a mangled limb versus amputation, such as weight bearing needs, sensation, and ability to tolerate pressure.
3) Tips for emergency care of patients with traumatic amputations or mangled limbs to control bleeding and protect tissues.
4) Differences in approaches to upper versus lower limb injuries and considerations for various amputation levels.
Patients with orthopedic injuries constitute a large portion of ED patients. The document outlines guidelines for initially managing orthopedic injuries, including following ABCDEs in the primary survey and thoroughly examining each body region in the secondary survey. It describes techniques for reducing fractures or dislocations if they cause vascular compromise. Traumatic amputations require carefully preserving the amputated part and consulting specialists. Compartment syndrome is a risk, especially with leg injuries, and may require fasciotomy. The document also provides terminology for precisely describing fractures, dislocations, and other orthopedic injuries.
Damage control orthopedics (DCO) is an approach for treating severely injured polytrauma patients to avoid worsening their unstable condition from additional surgical stress. It involves early stabilization of fractures through temporary external or minimal internal fixation to be followed later by definitive treatment after the patient's physiology is stabilized. While early total care was previously favored, DCO is now widely accepted for polytrauma patients as it decreases systemic complications by limiting the "second hit" effect compared to prolonged definitive surgeries. The approach and timing of DCO versus early total care must be individualized based on the patient's clinical status and injury pattern.
This document discusses orthopaedic emergencies and the evaluation and management of trauma patients. It notes that open fractures and dislocations can threaten limbs and must be addressed immediately. The primary survey focuses on the ABCDEs - Airway, Breathing, Circulation, Disability, and Exposure. Circulation issues like hemorrhage must be controlled through direct pressure, tourniquets, IV fluids and possible blood transfusion. Immobilization is important to stabilize fractures and dislocations while avoiding complications. Antibiotics are often needed for open injuries. Special considerations are discussed for pediatric patients and complications of casting or traction.
This document provides information on trauma care including mechanisms of injury, assessments of trauma patients, nursing interventions, and considerations in trauma patients. It discusses the primary and secondary survey process for trauma patients and identifying life-threatening injuries. Nursing priorities include establishing and maintaining a patent airway, ensuring adequate breathing and circulation, providing pain management and comfort measures. Special considerations are discussed for aging trauma patients, those with alcohol or drug use, and supporting family coping after a traumatic event.
This document provides an overview of a foot and ankle session. It discusses topics like imaging the foot and ankle, common injuries like lateral ankle sprains and their treatment, and case studies involving various foot and ankle conditions like plantar fasciitis, pes planus, and Achilles tendinopathy. Clinical tests and management strategies are described for different injuries and conditions.
Calcar replacement arthroplasty in treatment of failed trochanteric fractures AhmedYoussef671419
This document discusses the treatment of nonunion and fixation failure of pertrochanteric fractures through calcar replacement arthroplasty. It begins by outlining the objectives and providing background on pertrochanteric fractures. It then discusses causes of fixation failure, classification systems, and various treatment options including revision fixation and hip arthroplasty. The study aims to evaluate the clinical and radiological outcomes of using calcar replacement arthroplasty to treat nonunion or previously failed fixation of these fractures. It provides details on patients, surgical technique, post-operative outcomes including Harris Hip Scores, complications, and conclusions. In general, it finds the procedure provides acceptable clinical outcomes with improved pain and function though it is technically challenging.
A fracture is a break or disruption in the continuity of bone. Fractures occur when stress placed on a bone exceeds its strength, and can be caused by direct impact, twisting, compression or muscle contraction. There are many types of fractures classified by the bone location and nature of the break. Treatment depends on the type and severity of fracture, and may involve casting, traction, closed or open reduction, internal or external fixation to realign and immobilize the bone while it heals. Nursing care focuses on pain management, preventing complications like infection, and helping the patient regain mobility and function.
Trauma refers to physical injury caused by transfer of kinetic energy. A standardized protocol called Advanced Trauma Life Support (ATLS) exists for evaluating and treating trauma patients. It involves primary, secondary, and tertiary surveys to address life threats and identify injuries in a systematic manner. Common musculoskeletal injuries include fractures, dislocations, amputations, and soft tissue injuries. Proper splinting and hemorrhage control are important initial steps in management.
A 13-year-old boy presented with 4 months of right knee pain. Radiographs, bone scan, CT scan, and biopsy were performed. The most likely diagnosis based on the imaging and biopsy is Ewing's sarcoma. Ewing's sarcoma commonly presents in long bones of adolescents with pain and is an aggressive round cell tumor that typically affects the metaphysis of long bones. The imaging and biopsy are consistent with this diagnosis.
2. Objectives Briefly summarize the events and efforts by the department and local individuals to provide immediate relief in the weeks following the earthquake Describe Damage Control Orthopaedics and how to implement in austere environments Provide and discuss case presentations involving amputations, external fixation, internal fixation, skin grafting, and revision techniques Outline the future orthopaedic and therapy directed needs for Haiti, both acute and long term Suggest improvements for future disaster related relief and surgical responses
3. Why Haiti? Why Haiti Chile - 8.8 Haiti – 7.0 Japan Islands - 7.0 China/Russia/Korea 6.9 Illinois – 3.8 Offshore N CA – 5.9 Papa NG – 6.2 Haiti – 5.9 Oklahoma – 4.0
4. January 12, 2010 Haiti sustained a 7.0 magnitude earthquake of epic proportions Poorest nation in the Western Hemisphere Just recovering from 4 large hurricanes over the last year Poor building infrastructure with little to no earthquake codes
6. SC 1st Team Number Operations: 45 Types performed: Amputations, External Fixators Compartment releases, Irrigation and Debridements, Traction pins Complications 2 deaths ( 1 gas gangrene) 2nd from Left: Bob Belding MD, Columbia Rick Reed MD, Charleston Mike Petrillo EMT, Hilton Head Aaron Kurtz, EMT Aaron Stephens, Water Missions International
21. Acute Conditions days old open fractures and wounds crushed limbs (spines) blood loss severe dehydration, traumatic amputation, infection, delayed compartment, unstable fractures
22. Walking Wounded Casting for stable fractures Splinting limbs and pain relief Stabilize for future surgery
30. Damage control orthopaedics External fixators to achieve rapid stabilization and mobilization (Fixators placed emergently with no radiographs may need to be revised later) Most closed fractures should be managed with plaster splints, traction or external fixation. Open reduction and implant fixation risks converting a closed injury into an infected open injury Traumatic or initial amputations may need to be done at a higher level than first anticipated – revisions expected
31. Damage Control Orthopaedics Orthopaedic treatment should occur when appropriate, however patients with long bone fractures should undergo some sort of fixation to decrease the likely hood of any further respiratory compromise. Treatment trends have occurred in three main eras: Early total care (ETC) – 1980s Early definitive fixation was the goal Intermediate (INT) – 1990-1992 Early fixation was still performed in most cases Adverse outcomes such as the systemic inflammatory response in the multiply injured patient were coming to light Damage control orthopaedics (DCO) – 1993 – present Benefits of temporary stabilization with ex fix followed by conversion to IMN (when appropriate) were reported Bone LB, Johnson KD, Weiglet J, Schneiberg R. Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am. 1989;71:336-40. Scalea TM, Boswell SA, Scott JD, Mitchell KA, Kramer ME, Pollak AN. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: Damage control orthopedics. J Trauma. 2000;48:613-23.
33. Who Should Go? Stay home if you are not fit Go as a team with a plan and work closely with an established and respected NGO who had programs in place before the earthquake Make sure someone on the team knows the language and culture Make sure that all personnel traveling on team have specific roles that they know. Minimize non-essential personnel to avoid taxing an already overburdened infra structure Expect to be a generalist and not just a specialist and be willing to work outside your training to do what is needed for the patient
35. What to take Surgical instruments – sterile Cydex or sterilizers IV fluids – extra for irrigation Pain medication – local, regional, oral Antibiotics – IV and oral Bandages, betadine, gloves Casting supplies and splints Must travel with you or it will be “diverted” Must Haves balanced with “Oughta” Haves Leave Behinds
36. Medshare Supplies Drapes Impervious General Small Drapes Paper Towels Non-sterile Cloth Towels Ioban Fenestrated Dressings Band-aids Transparent (Tegaderm) 4 X 4 Drain Sponges 2 X 2 Drain Sponges Abdominal pad (WetPruf pad/ABD combine) Stockinette, standard Stockinette, impervious Gauze non-sterile Gauze rolls, sterile Steri-stri Anesthesia/Respiratory Circuit Bags Ambu bags Tracheal kits CPR/ Anesthesia masks Oxygen Masks/Tubing Airways Tracheal tubes Breathing circuits Drainage/Suction Closed Wound Suction Evacuator (Hard) Closed Wound Suction Evacuator (Soft) Salem Sump (Naso Gastric tube) Yankauer tips Drains (flat/round) Penrose drain Drainage/Collection Bag www.medshare.org
41. The Department of Health and Human Services has requested that NO medical personnel go to Haiti unless they are members of the State Medical Reserve Corps or are certified members of the ESAR-VHP program. The situation is such that unless individuals are with one of these organized groups, they will be at risk, and in need of supervision and supplies that cannot be provided. At present, other than those in the above groups, we have been requested not to go….. GME’s Interpretation= NO RESIDENTS TO GO
42. TEAM A January 26th -Feb 2nd Shane Woolf, MD Megan Fulton, PA Susan Wimberly, RN Jennifer Haughney, RN Jean Hilliard, Pharm Student
66. MEBSH: Missionary Evangelical Baptists of Southern HaitiACWR: Apostolic Christian World ReliefMTI: Missions Training International LMM: Lumiere Medical MinistriesOMS: One Mission Society (Jackson, Miss Team)
67. TEAM B February 2nd – February 11th Lee Cross, MD (Atlanta) David Jaskwich, MD (Charleston) Chris Keto, CRNA (MUSC) HannekeTenhultzer, RN (MUSC) Susan Wimberely, RN (MUSC) (Extended Tour)
88. ORIF in Austere Settings Due to the nature of wounds and the environment, internal fixation is generally discouraged in battlefield settings.Concerns have been raised regarding anecdotally high infection rates in fractures treated with intramedullary nailing. Operation Iraq Freedom (OIE) and Operation Enduring Freedom (OEF) experiences showed that 50% of open upper extremity fractures were culture positive on admission to Bethesda
89. Outcomes of Internal Fixation in a Combat Environment 50 Cases Reviewed in which primary ORIF was utilized in selected patients. The majority were hip (28%), forearm (28%), and ankle fractures (20%) Sixteen (32%) were open NO femoral fractures were listed 1 case (2%) eventually had infection Ten (20%) required additional revisionConclusion: Judicious use of internal fixation could be used in a combat setting without an increased risk of infection Stinner et al, JSOA, 2010
90. External fixation conversion to IM nail Scalea et al.’s retrospective chart review: Initial ex fix placement vs. primary IMN of the femur Conclusions Allowed for rapid correction, negligible blood loss, conversion to IMN when patient is stabilized, with minimal complications The benefits of DCO is greatest in patients with severe head trauma or pulmonary injury Scalea TM, Boswell SA, Scott JD, Mitchell KA, Kramer ME, Pollak AN. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: Damage control orthopedics. J Trauma. 2000;48:613-23. Pape H-C, Auf'm'Kolk M, Paffrath T, Regel G, Sturm J, Tscherne H. Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion--a cause of posttraumatic ards? J Trauma. 1993;34:540-8.
126. TEAM D Langdon Harstock, MD Harry Demos, MD Richard Hawkins, MD (Spatanburg) Zeke Walton, MD Phil Botham, RN (Wound Care) Phil Tolman, PA (On Loan from Dr. Merrill)
148. Comments from Dr Bernard Nau 89% of the injuries were orthopedic trauma with lower limb fracture being the most common injury. Infected open fractures, lower limb wound infection with a different distribution of pathogens isolated than before the earthquake and a high rate of isolated drug resistant bacteria will be a challenge. These changes in the spectrum of pathogens and in the drug resistance pathogens isolated following this earthquake will provide a basis for the long term treatment. Those children will undergo many surgeries for osteomyelitis care, flaps, skin grafts... so a good pain management program will be very helpful. It should be a NATION WIDE PLAN and we should propose to have a medical team specialized in shock trauma treatment for adult & children
149. Disability Legacy of the Haitian Earthquake Large number of children suffered debilitating injuries, particularly affecting arms and legs – many required amputations Nearly 50 per cent of Haiti's population is under the age of 18 Shriner’s is considering prosthetics in Haiti and transfer of many patients 6,000-8,000 persons with amputations Annals of Internal Medecine. March 2010
150. Second Phase Relief Postoperative care and follow-up of patients who have undergone surgery Rehabilitative services for people with disabilities Prosthetic limbs for amputees Provide primary healthcare services to the displaced and control epidemic disease Tetanus Cholera Malaria Typhoid Dysentery Food borne
151. Long Range Grass root efforts begun now are need to rebuild a fragmented health care delivery system plagued by limited education and corruption Disaster relief can be administered successfully in small, rural areas like Bonne Finn and HopitalLumiere. These locations could network as receiving hospitals for Haitians requiring acute medical care in categories defined by Haitian physician levels of expertise.
154. What Can Team E Expect? Rain Opened Commercial Traffic Stabilized Wounds Many Revisions Delayed Presentations Maybe even larger humanitarian needs John McFadden, MD Noah Weiss, MD Eric Angermeier, MD PT (2) Anaesthesia Nurses (2)
155. Latest Update from Rudolph Over 600 trauma people since the quake treated at Hospital Lumiere *300 admissions and 300 more seen in ER and out patient clinic department 300+ Surgical Procedures Performed 5 Deaths : septicemia with multiple open wound;3 patients post-op from late stage of sepsis and hemodynamic and hydro-electrolytic imbalanced, 1 case non traumatic. -30% of the patients had to undergo amputations secondary to crush injury complications with delayed compartment syndrome and limb necrosis. More risks of amputations for Naika Etienne and Paul Bethlie are of high concerns if advanced care are not available (transfer in USA is in good process for both of them) -95% of the skin grafts have taken. -95% success of the internal fixation of the femur fx (5 patients still inward). -95% success of the fasciotomies (with 2 patients still inward Shirley Peltrop and KervensDorvilier). -85% success of the Ex-Fix (12 patients still inward) would need further evaluation for long term bone fx healing r/o pseudarthosis or non union from chronic infections. Currently 40 Ortho patients : 15 new patients with tib/fib fx, pelvic fractures, t-spine and L-spine fx with lower ext paralysis with decubitusulcers,open hand fx,forearmosteomyelitis head trauma,...