We report 33 cases of venous thrombosis of the limb, in children aged 15 years or less (average age is 10 years old): 22 acute thrombophlebitis have been treated, 11 children shown post-phlebitic disease. The thrombus was found, most of the time, in the iliac and/or femoral vein. Acute complications were seen in 30% of our cases, and 25% treated children reviewed, had post-phlebitic sequelae. Congenital disease of hemostasis (deficiency of antithrombin III, protein C or S) must be detect before anticoagulant start, because such deficiency influence the treatment and the prognosis. There is non indication for preventive treatment, because of the rarity of spontaneous thrombophlebitis by children. Nevertheless, we can draw an "high risk" population: antecedent of phlebitis, antecedent of congenital disease of hemostasis, antecedent of thrombophlebitis by parents below 40 years old, thrombogenic disease (homocystinuria), vertebral arthrodesis.
The Journal of Bone and Joint Surgery. 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Management of the Unstable Anterior Pelvic of Orthopaedic Trauma, Vol. 32, No. and of Tile C pelvic ring injuries using a external fixation December | European Journal of Orthopaedic Surgery & Traumatology, Vol. 28, No. of After Operative Treatment of Pelvic Ring InjuriesJournal of Orthopaedic Trauma, Vol. 32, No. 7Biomechanical of fixation techniques in sacrum type II fracture with December | Journal of Orthopaedic Vol. 36, No. for Injury after Pelvic Ring Vol. No. of Fractures Using a Clinical and Operative June 2018 | Journal of Orthopaedics, Trauma and Rehabilitation, Vol. No. 1The trauma from a A case study the of vertical Science International, Vol. Posterior Pelvic for Unstable Sacral Fractures: A Fixation of Orthopaedic Trauma, Vol. 32, No. compression type pelvic ring fractures in young patients do May | European Journal of Trauma and Emergency Surgery, Vol. 44, No. analysis of anterior ring fixation of the ramus in type C pelvis April | European Journal of Trauma and 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The Journal of Bone and Joint Surgery. British volumeVol. 86-B, No. 3 Aspects of Current ManagementFree AccessPosterior dislocation of the shoulderN. CicakN. CicakOrthopaedic SurgeonSearch for more papers by this authorPublished Online:1 Apr 2004https://doi.org/10.1302/0301-620X.86B3.14985AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited bySurgical management of bilateral concomitant posterior fracture-dislocation of the shoulderTrauma Case Reports, Vol. 41Posterior shoulder dislocation with associated reverse Hill–Sachs lesion: clinical outcome 10 years after joint-preserving surgery3 June 2022 | Archives of Orthopaedic and Trauma Surgery, Vol. 39Posterior Shoulder InstabilityTreatment of chronic locked posterior dislocation of the shoulder with the modified McLaughlin procedureJournal of Shoulder and Elbow Surgery, Vol. 31, No. 1Principles of Radiological Examination28 September 2022Posterior Instability4 October 2022Mid-Term outcomes following fresh-frozen humeral head osteochondral allograft reconstruction for reverse Hill Sachs lesion: a case series8 September 2021 | BMC Musculoskeletal Disorders, Vol. 22, No. 1Management of Locked Posterior Shoulder Dislocation with Reverse Hill–Sachs Lesions via Anatomical Reconstructions11 October 2021 | Orthopaedic Surgery, Vol. 232Traumi della spalla e del braccioEMC - Urgenze, Vol. 25, No. 3Arthroscopic Knotless Subscapularis Bridge Technique for Reverse Hill-Sachs Lesion With Posterior Shoulder InstabilityArthroscopy Techniques, Vol. 10, No. 1A Modified Reverse Remplissage Procedure for Management of a Locked Posterior Shoulder DislocationCase Reports in Orthopedics, Vol. 2020Shoulder Dislocations in the Emergency Department: A Comprehensive Review of Reduction TechniquesThe Journal of Emergency Medicine, Vol. 58, No. 4Missed posterior shoulder fracture dislocations: a new protocol from a London major trauma centre18 March 2020 | BMJ Open Quality, Vol. 9, No. 1New Reduction Technique for Traumatic Posterior Glenohumeral Joint Dislocations24 January 2020 | Clinical Practice and Cases in Emergency Medicine, Vol. 4, No. 1Glenohumeral Joint16 April 2020Conservative Treatment in Posterior Dislocation16 June 2020Surgical Treatment of Humeral Head Defect in Shoulder Posterior Instability16 June 2020Shoulder and proximal humerusIndications for Reverse Shoulder ArthroplastyAll-Arthroscopic McLaughlin's Procedure in Patients with Reverse Hill–Sachs Lesion Caused by Locked Posterior Shoulder Dislocation31 December 2019 | Joints, Vol. 07, No. 03The dual subscapularis procedure: a modified Hawkins’ technique for neglected posterior fracture/dislocation of the shoulder19 March 2019 | European Journal of Orthopaedic Surgery & Traumatology, Vol. 29, No. 5Remplissage With Bankart Repair in Anterior Shoulder Instability: A Systematic Review of the Clinical and Cadaveric LiteratureArthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 35, No. 4McLaughlin artroscópico modificado no tratamento de luxação glenoumeral posterior – nota técnica10 May 2019 | Revista Brasileira de Ortopedia, Vol. 54, No. 02Posterior Shoulder Dislocation During Morning PT: A Case Report13 June 2018 | Military Medicine, Vol. 184, No. 3-4The aetiology of posterior glenohumeral dislocations and occurrence of associated injuriesa systematic reviewM. 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Molony2 January 2019 | The Bone & Joint Journal, Vol. 101-B, No. 1Luxación posterior inveterada de hombro asociada a lesión de Hill-Sachs reversa tratada con modificación de la técnica de McLaughlinActa Ortopédica Mexicana, Vol. 33, No. 5Inestabilidad posterior del hombroActa Ortopédica Mexicana, Vol. 33, No. 5National Athletic Trainers' Association Position Statement: Immediate Management of Appendicular Joint DislocationsJournal of Athletic Training, Vol. 53, No. 12痙攣により生じた肩関節後方脱臼骨折の1例Orthopedics & Traumatology, Vol. 67, No. 3Posterior shoulder dislocation in a 10-year-old child: Case reportAnnals of Medicine and Surgery, Vol. 33Arthroscopic Management of Locked Posterior Shoulder DislocationsArthroscopy Techniques, Vol. 7, No. 9Posterior Shoulder Dislocation Associated With the Head (Splitting) and Humeral Neck Fracture: Impact of Understanding Radiologic Signs and Experience With an Extended Deltopectoral ApproachTechniques in Hand & Upper Extremity Surgery, Vol. 22, No. 2A treatment algorithm for locked posterior dislocation of shoulderJournal of Arthroscopy and Joint Surgery, Vol. 5, No. 2Reverse-Hill-Sachs-Läsion bei dorsal verhakter Schulterluxation16 October 2017 | Arthroskopie, Vol. 31, No. 1Posterieure instabiliteit30 November 2017Posterior Shoulder InstabilityPosterior shoulder dislocation with associated reverse Hill-Sachs lesion: treatment options and functional outcome after a 5-year follow up13 November 2017 | BMC Musculoskeletal Disorders, Vol. 18, No. 1Dimple on the shoulder after a ski injury23 October 2017 | Emergency Medicine Journal, Vol. 34, No. 11Posterior shoulder dislocation with a reverse Hill–Sachs lesion treated with frozen femoral head bone allograft combined with osteochondral autograft transfer23 June 2016 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 25, No. 10Transfer of the lesser tuberosity for reverse Hill-Sachs lesions after neglected posterior dislocations of the shoulder: A retrospective clinical study of 13 casesActa Orthopaedica et Traumatologica Turcica, Vol. 51, No. 5Risk of Engagement of Bipolar Bone Defects in Posterior Shoulder Instability28 June 2017 | The American Journal of Sports Medicine, Vol. 45, No. 12EXPERIENCE IN USE OF MODIFIED MCLAUGHLIN PROCEDURE FOR NEGLECTED LOCKED POSTERIOR SUBLUXATION OF THE HUMERAL HEAD30 September 2017 | Vestnik travmatologii i ortopedii imeni N.N. Priorova, No. 3Experience in Use of Modified McLaughlin Procedure for Neglected Locked Posterior Subluxation of the Humeral Head15 September 2017 | N.N. Priorov Journal of Traumatology and Orthopedics, Vol. 24, No. 3Treatment of The Posterior Unstable ShoulderThe Open Orthopaedics Journal, Vol. 11, No. 1Luxación glenohumeral posteriorFMC - Formación Médica Continuada en Atención Primaria, Vol. 24, No. 7Complete avulsion of the rotator cuff footprint in an irreducible traumatic posterior glenohumeral fracture-dislocation due to infraspinatus interpositionJournal of Shoulder and Elbow Surgery, Vol. 26, No. 8Orthopedic Pearls and PitfallsPhysician Assistant Clinics, Vol. 2, No. 3Rekonstruktion anteromedialer Humeruskopfimpressionsfrakturen mit knöchernen Auto- oder Allografts26 April 2017 | Obere Extremität, Vol. 12, No. 2Step-by-Step Technique for Segmental Reconstruction of Reverse Hill-Sachs Lesions Using Homologous Osteochondral AllograftTechniques in Hand & Upper Extremity Surgery, Vol. 21, No. 2Treatment of Locked Posterior Shoulder Dislocation With Bone DefectOrthopedics, Vol. 40, No. 3Posterior shoulder fracture–dislocation: an update with treatment algorithm25 August 2016 | European Journal of Orthopaedic Surgery & Traumatology, Vol. 27, No. 3Pitch-side management of acute shoulder dislocations: a conceptual review12 March 2017 | BMJ Open Sport & Exercise Medicine, Vol. 2, No. 1Glenohumeral Instability9 February 2018Dislocations and Fracture Dislocations of the Shoulder Girdle11 October 2017Shoulder: Glenohumeral Instability20 April 2017Locked Posterior Shoulder Dislocation (LPSD)9 May 2017Posterior Shoulder Instability in the Young Patient9 May 2017Orthopedics & Traumatology, Vol. 66, No. 2Modified technique for reconstructing reverse Hill–Sachs lesion in locked chronic posterior shoulder dislocation19 August 2016 | European Journal of Orthopaedic Surgery & Traumatology, Vol. 26, No. 8A systematic and technical guide on how to reduce a shoulder dislocationTurkish Journal of Emergency Medicine, Vol. 16, No. 4Balloon-guided inflation osteoplasty in the treatment of Hill-Sachs lesions of the humeral head: case report of a new technique1 February 2016 | Patient Safety in Surgery, Vol. 10, No. 1Locked Posterior Dislocation of Shoulder With Fracture of the Lesser Tuberosity of the Humerus: A Case Report and Review of the Literature5 November 2016 | Archives of Trauma Research, Vol. 6, No. 2Traumatic posterior shoulder dislocation with a large engaging Hill-Sachs lesion: splinting techniqueThe American Journal of Emergency Medicine, Vol. 34, No. 3Defect Characteristics of Reverse Hill-Sachs Lesions8 January 2016 | The American Journal of Sports Medicine, Vol. 44, No. 3Bone block procedures in posterior shoulder instability24 April 2015 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 24, No. 2Evaluation of Bone Loss and the Glenoid Track30 December 2015Sideline Management of Joint DislocationsCurrent Sports Medicine Reports, Vol. 15, No. 3Posterior Glenohumeral DislocationBilateral posterior shoulder dislocation after electrical shock: A case reportAnnals of Medicine and Surgery, Vol. 4, No. 4Proximal humerus derotational osteotomy for internal rotation instability after locked posterior shoulder dislocation: early experience in four patients8 May 2015 | Patient Safety in Surgery, Vol. 9, No. 1New technique in reconstructing humeral head defect in locked posterior dislocation of the shoulder: a case series of nine patients1 July 2015 | European Orthopaedics and Traumatology, Vol. 6, No. 3Luxación de hombro posterior y bilateral en contexto de crisis convulsivaSEMERGEN - Medicina de Familia, Vol. 41, No. 3Posterior capsular release and coracoid transfer for cases of neglected locked anterior shoulder dislocation in tramadol addicts14 September 2014 | European Orthopaedics and Traumatology, Vol. 6, No. 1Acute Shoulder Trauma: What the Surgeon Wants to KnowRadioGraphics, Vol. 35, No. 2Influence of Defect Size and Localization on the Engagement of Reverse Hill-Sachs Lesions2 February 2015 | The American Journal of Sports Medicine, Vol. 43, No. 3Reverse shoulder arthroplasty in acute fractures provides better results than in revision procedures for fracture sequelae31 December 2014 | International Orthopaedics, Vol. 39, No. 2Acute Posterior Dislocations and Posterior Fracture–Dislocations of the Shoulder10 June 2015Neglected Posterior Dislocations and Treatment Modalities10 June 2015Posterior Shoulder Instability in the Contact AthleteReconstruction of Humeral Head Defect in Locked Posterior Dislocation Shoulder. A Case Series of Nine PatientsOpen Journal of Orthopedics, Vol. 05, No. 02Konservative Therapie der akuten verhakten posterioren Schultergelenkluxation20 September 2013 | Der Unfallchirurg, Vol. 117, No. 12Operative Versorgung der posterioren Schulterluxation9 March 2014 | Der Unfallchirurg, Vol. 117, No. 12Bilateral Posterior Fracture Dislocation of the Shoulder Following an Epileptic Seizure17 October 2014 | MOJ Orthopedics & Rheumatology, Vol. 1, No. 2Posterior Shoulder Instability with a Reverse Hill-Sachs Defect: Repair with Use of Combined Arthroscopic Labral Repair and Fracture DisimpactionJBJS Case Connector, Vol. 4, No. 3Tratamiento artroscópico de lesión tipo Hill-Sachs inversa sin uso de material de osteosíntesis para su fijación: Reporte de casoRevista Colombiana de Ortopedia y Traumatología, Vol. 28, No. 2Acute Traumatic Posterior Shoulder DislocationJournal of the American Academy of Orthopaedic Surgeons, Vol. 22, No. 3Acute Posterior Dislocations and Posterior Fracture–Dislocations of the Shoulder26 December 2014Neglected Posterior Dislocations and Treatment Modalities14 October 2014Addendum: schouderluxatie1 April 2014Fused 99mTc-HDP SPECT/MR Imaging of Reverse Hill-Sachs DeformityClinical Nuclear Medicine, Vol. 39, No. 1Excellent results of lesser tuberosity transfer in acute locked posterior shoulder dislocation26 September 2012 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 21, No. 12Lussazioni posteriori della scapolo-omerale: diagnosi e terapia1 January 2014 | Aggiornamenti CIO, Vol. 19, No. 2Locked posterior dislocation of the shoulder joint: Report of two casesFormosan Journal of Musculoskeletal Disorders, Vol. 4, No. 4Posterieure schouderluxatie bij een claviculafractuur1 November 2013 | Nederlands Tijdschrift voor Traumatologie, Vol. 21, No. 5Posterior Shoulder Instability in the Contact AthleteClinics in Sports Medicine, Vol. 32, No. 4Traumatic Shoulder Injuries: A Force Mechanism Analysis—Glenohumeral Dislocation and InstabilityAmerican Journal of Roentgenology, Vol. 201, No. 2Modified arthroscopic McLaughlin procedure for treatment of posterior instability of the shoulder with an associated reverse Hill-Sachs lesion7 October 2012 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 21, No. 7Modified McLaughlin Technique for Neglected Locked Posterior Dislocation of the ShoulderOrthopedics, Vol. 36, No. 7Posterior shoulder dislocationReliability of a New Standardized Measurement Technique for Reverse Hill-Sachs Lesions in Posterior Shoulder DislocationsArthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 29, No. 3Bilateral locked posterior shoulder dislocation after an undiagnosed brain tumorCurrent Orthopaedic Practice, Vol. 24, No. 2WITHDRAWN: Posterior dislocation of the shoulder: a case reportJournal of Clinical Orthopaedics and TraumaTraumatic bilateral posterior dislocation of the shoulder: a case reportOpen Medicine, Vol. 8, No. 6Uncommon Indications for Reverse Total Shoulder ArthroplastyClinics in Orthopedic Surgery, Vol. 5, No. 4Orthopedic Pitfalls of the Upper Extremity15 November 2012Recurrent Posterior Shoulder Instability After Rifle ShootingOrthopedics, Vol. 35, No. 11Shoulder and Proximal Humerus22 October 2012Shoulder Resurfacing for Acute Locked Posterior Dislocation Allows Early Rehabilitation6 February 2017 | Shoulder & Elbow, Vol. 4, No. 4Bilateral Neglected Posterior Fracture–Dislocation of the ShouldersOrthopedics, Vol. 35, No. 10Eine neue Repositionstechnik für die verhakte hintere Schulterluxation9 December 2011 | Der Unfallchirurg, Vol. 115, No. 8Delayed Diagnosis of Bilateral Scapula Fractures in a Patient with Cardiac Syncope1 July 2012 | Shoulder & Elbow, Vol. 4, No. 3Bilateral Talar Avulsion Fractures Secondary to Seizure: A Case ReportThe Journal of Foot and Ankle Surgery, Vol. 51, No. 3Anatomical Reconstruction of Reverse Hill-Sachs Lesions Using the Underpinning TechniqueOrthopedics, Vol. 35, No. 5Acute bilateral posterior dislocation of the shoulder: One-stage reconstruction of both humeral heads with cancellous autograft and cartilage preservationChirurgie de la Main, Vol. 31, No. 1Recurrent, Locked Posterior Glenohumeral Dislocation Requiring Hemiarthroplasty and Posterior Bone Block With Humeral Head AutograftOrthopedics, Vol. 35, No. 2Acute Posterior Dislocations22 June 2011Failed Arthroscopic Repair of a Large Reverse Hill-Sachs Lesion Using Bone Allograft and Cannulated Screws: A Case ReportArthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 28, No. 1Posterior Shoulder Dislocation: Systematic Review and Treatment AlgorithmArthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 27, No. 11Lateral Clavicular Autograft for Repair of Reverse Hill-Sachs DefectThe Open Orthopaedics Journal, Vol. 5, No. 1Bilateral posterior shoulder dislocation with defect secondary to hypoglycemic comaJournal of Orthopaedic Science, Vol. 16, No. 1Shoulder and humerusGlenohumeral instabilityClosed Reduction of Bilateral Posterior Shoulder Dislocation with Medium Impression Defect of the Humeral Head: A Case Report and Review of Its TreatmentCase Reports in Medicine, Vol. 2011Die dorsal verhakte Schulterluxation6 November 2010 | Obere Extremität, Vol. 5, No. 4Articular cartilage and labral lesions of the glenohumeral joint: diagnostic performance of 3D water-excitation true FISP MR arthrography17 December 2009 | Skeletal Radiology, Vol. 39, No. 5Chronic locked posterior shoulder dislocation with severe head involvement20 March 2009 | International Orthopaedics, Vol. 34, No. 1ShoulderSHOULDERLes luxations invétérées de l’épauleRéférencesBilateral Traumatic Locked Posterior Dislocation of the Shoulder - A Case Report -The Journal of the Korean Shoulder and Elbow Society, Vol. 12, No. 2Reconstruction of Humeral Head Defect for Locked Posterior Shoulder DislocationOrthopedics, Vol. 32, No. 9Rehabilitation and Functional Outcomes in Collegiate Wrestlers Following a Posterior Shoulder Stabilization ProcedureJournal of Orthopaedic & Sports Physical Therapy, Vol. 39, No. 7Modified MacLaughlin procedure in the treatment of neglected posterior dislocation of the shoulder16 March 2009 | MUSCULOSKELETAL SURGERY, Vol. 93, No. S1Tratamiento quirúrgico de la inestabilidad posterior del hombroEMC - Técnicas Quirúrgicas - Ortopedia y Traumatología, Vol. 1, No. 1Reconstruction of a missed posterior locked shoulder fracture-dislocation with bone graft and lesser tuberosity transfer: a case report5 August 2008 | Journal of Medical Case Reports, Vol. 2, No. 1Acute Traumatic Posterior Shoulder Dislocation: MR FindingsRadiology, Vol. 248, No. 1Arthroscopy-assisted reduction of impression fracture of the humeral head: A case reportJournal of Shoulder and Elbow Surgery, Vol. 17, No. 3Diagnostik und Behandlungsregime der traumatischen dorsalen Schulterluxation2 June 2007 | Der Unfallchirurg, Vol. 110, No. 12Posterior shoulder subluxation most likely caused by retching in the lateral head-down position for prevention of aspirationJournal of Clinical Anesthesia, Vol. 19, No. 8Allografts in the Treatment of Athletic Injuries of the ShoulderSports Medicine and Arthroscopy Review, Vol. 15, No. 3Anatomical reconstruction for Reverse Hill-Sachs lesions after posterior locked shoulder dislocation fracture: a case series of six patients24 May 2007 | Archives of Orthopaedic and Trauma Surgery, Vol. 127, No. 7Emergency Department Management of Selected Orthopedic InjuriesEmergency Medicine Clinics of North America, Vol. 25, No. 3One-stage operation for locked bilateral posterior dislocation of the shoulderA. Ivkovic, I. Boric, N. Cicak1 June 2007 | The Journal of Bone and Joint Surgery. British volume, Vol. 89-B, No. 6Closed Reduction for Traumatic Posterior Dislocation of the Shoulder Using the ‘Lever Principle’: Two Case Reports and a Review of the Literature4 December 2016 | Journal of Orthopaedic Surgery, Vol. 14, No. 3The success of closed reduction in acute locked posterior fracture-dislocations of the shoulderJournal of Shoulder and Elbow Surgery, Vol. 15, No. 6Humeral head impression fracture in acute posterior shoulder dislocation: new surgical technique5 January 2006 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 14, No. 7Traitement chirurgical de la luxation post-traumatique gléno-humérale postérieureJournal de Traumatologie du Sport, Vol. 23, No. 2Traitement chirurgical de l'instabilité postérieure de l'épauleEMC - Techniques chirurgicales - Orthopédie - Traumatologie, Vol. 1, No. 1POSTERIOR SHOULDER DISLOCATIONS AND FRACTURE-DISLOCATIONSThe Journal of Bone and Joint Surgery-American Volume, Vol. 87, No. 3 Vol. 86-B, No. 3 Metrics History Published online 1 April 2004 Published in print 1 April 2004 InformationCopyright © 2004, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download
The purpose of this study was to quantify the representation of women among the authors and editorial board members of prominent general orthopedics journals and to determine how these proportions have changed over time. Gender was determined for the authors of all original research studies, case reports, and review articles published in 2 prominent general orthopedics journals in 1970, 1980, 1990, 2000, and 2007. Gender was also determined for each individual serving on the editorial boards of these journals during these years. Between 1970 and 2007, the representation of women increased from 0.8% to 6.5% among first authors (P<.001), from 0.0% to 4.3% among last authors (P = .015), and from 1.6% to 5.4% among editorial board members (P = .16). However, the rates of increase observed in orthopedics were lower than those observed in other fields (P<.05). Between 1970 and 2007, female representation increased significantly among physicians publishing in 2 prominent general orthopedics journals, but these rates of increase were lower than those observed in other fields of medicine.
Patients undergoing cancer chemotherapy are living longer and with better quality of life, and they require dental care both during and after their treatments. Bisphosphonates have been associated with drug-related osteonecrosis of the jaw (ONJ) since the discoveries of Marx in 2003 and Ruggiero and Woo in 2008. Recent literature has indicated a similar association with nonbisphosphonate drugs used in cancer therapy. Denosumab, an osteoclast inhibitor with applications in orthopedics and oncology, causes ONJ at a rate comparable to that for intravenously administered bisphosphonates. Case reports and drug agency records have indicated a correlation between ONJ and the neoangiogenesis inhibitors bevacizumab and sunitinib, which are used to treat many common cancers. The pharmacologic mechanisms of these 3 drugs appear distinct, yet a common effect on bone metabolism may occur in susceptible hosts. This review explores the mechanisms of these drugs that could lead to ONJ, according to current scientific understanding. The American Academy of Oral and Maxillofacial Surgeons has provided detailed recommendations for the management of bisphosphonate-related ONJ, which we suggest should also be applied in the management of patients with exposure to denosumab, bevacizumab and sunitinib.
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A five-year-old and four-month-old male patient presented with Class I malocclusion, anterior crossbite (pseudo-class III) with an overbite, midline deviation to the left (5 mm), left unilateral chewing preference, and incisors in bi-retrusion with diastemas. Initial Bimler cephalometry showed negative anterior face angle (< A), negative bone overjet (A’B’), mesoprosope biotype, negative suborbital facial index, microrhinic dysplasia, and reduced T-TM distance. Pre-treatment gnathostatic models revealed vertical asymmetry and increased left occlusal plane. After the initial assessment, we initiated the treatment with resin-composite planas direct tracks in the deciduous upper molar surface to lift the bite. The patient was oriented to perform right-side mastication movements using hyperboloid exercises. After one month, a new resin-composite lift was carried out in the lower deciduous molar occlusion surface. Planas direct tracks were built directly on the occlusal of the maxillary molars 64 and 65 to start centering the patient’s midline, which was deviated to the left, raising the bite, and increasing the vertical dimension. In the same dental appointment, we completed the right side on the occlusal of the teeth 54 and 55, to adjust the occlusion using 200 microns articulated paper. After a month, the patient returned to the dental office and resins were placed in the occlusal surface of teeth 74, 75, 84, and 85, completing the direct planas tracks and leaving the occlusal plane the most parallel to the Camper’s Plan. Direct planas tracks’ adjustments were made throughout the patient's treatment returns, with 200 microns articulated paper and selective wear. Hyperboloid (silicone-made accessory to stimulate the stomatognathic system) was used to perform chewing exercises on the right side and instructed to be performed before the main meals, for five minutes, encouraging chewing on the right side. The subsequent masticatory evaluation showed protrusive movements. To reduce this movement, planas direct tracks from canine-to-canine were prepared, correcting the anterior bite, and reducing the midline deviation to the left. Posteriorly, functional orthopedic treatment began with the Simões Network 3 (SN3) device, with Bimler’s upper dental arch not touching the incisors and an upper expander. Concomitantly, in the lower dental arch, we initiated the treatment with a Hawley dental appliance against the cervical third of lower incisors and a W-shaped lingual retainer. The SN3 device was built in a laboratory specialized in maxillary functional orthopedics, after molding the patient with alginate and wax bite registration. After 12 months of treatment, the patient presented a centralized midline, had permanent lower incisors, erupting upper central incisors, and adequate bilateral chewing. After 24 months of treatment, the patient presented physiological limits with the contact of the upper central incisors in a determined area with 2 mm overjet, centralized midline, efficient bilateral chewing, and balanced maxillomandibular growth. Post-treatment Bimler cephalometry showed a negative anterior face angle (< A), positive bone overjet (A’B’), mesoprosope biotype, increased T-TM distance. In addition, Planas’ gnathostatic models evidenced a symmetric occlusal plane. In conclusion, functional jaw orthopedics approaches can significantly contribute to the inhibitory and excitatory stimulation of the mandible to the maxilla. Furthermore, functional orthopedics might establish an appropriate development of the stomatognathic system in patients with mixed dentition.
BACKGROUND: In many industries, collaboration with end users is a standard practice when developing or improving a product or service. This process aims for a much better understanding of who the end user is and how the product or service could be of added value to them. Although patient (end user) involvement in the development of eHealth apps is increasing, this involvement has mainly focused on the design, functionalities, usability, and readability of its content thus far. Although this is very important, it does not ensure that the content provided aligns with patients' priorities. OBJECTIVE: In this study, we aimed to explore the added value of patient involvement in developing the content for an eHealth app. By comparing the findings from this study with the existing app, we aimed to identify the additional informational needs of patients. In addition, we aimed to help improve the content of apps that are already available for patients with knee replacements, including the app our group studied in 2019. METHODS: Patients from a large Dutch orthopedic clinic participated in semistructured one-on-one interviews and a focus group session. All the patients had undergone knee replacement surgery in the months before the interviews, had used the app, and were therefore capable of discussing what information they missed or wished for before and after the surgery. The output was inductively organized into larger themes and an overview of suggestions for improvement. RESULTS: The interviews and focus group session with 11 patients identified 6 major themes and 30 suggestions for improvement, ranging from information for better management of expectations to various practical needs during each stage of the treatment. The outcomes were discussed with the medical staff for learning purposes and properly translated into an improved version of the app's content. CONCLUSIONS: In this study, patients identified many suggestions for improvement, demonstrating the added value of involving patients when creating the content of eHealth interventions. In addition, our study demonstrates that a relatively small group of patients can contribute to improving an app's content from the patient's perspective. Given the growing emphasis on patients' self-management, it is crucial that the information they receive is not only relevant from a health care provider's perspective but also aligns with what really matters to patients. TRIAL REGISTRATION: Netherlands Trial Register NL8295; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8295.
BACKGROUND: Placement of external fixation frames is an expedient and minimally invasive method of achieving bone and joint stability in the setting of severe trauma. Although anatomic safe zones are established for placement of external fixation pins, neurovascular structures may be at risk in the setting of severe trauma. CASE REPORT: We present a case of a 21-year-old female involved in a high speed motorcycle accident who sustained a Type IIIB open segmental femur fracture with significant thigh soft tissue injury. Damage control orthopedic principals were applied and a spanning external fixator placed for provisional femoral stabilization. Intraoperative vascular examination noted absent distal pulses, however an intraoperative angiogram showed arterial flow distal to the trifurcation. Immediately postoperatively the dorsalis pedis pulse was detected using Doppler ultrasound but was then non-detectable over the preceding 12-hours. Femoral artery CT angiogram revealed iatrogenic superficial femoral artery occlusion due to kinking of the artery around an external fixator pin. Although the pin causing occlusion was placed under direct visualization, the degree of soft tissue injury altered the appearance of the local anatomy. The pin was subsequently revised allowing the artery to travel in its anatomic position, restoring perfusion. CONCLUSION: This case highlights the dangers associated with damage control orthopedics, especially when severe trauma alters normal local anatomy. Careful assessment of external fixator pin placement is crucial to avoiding iatrogenic injury. We recommend a thorough vascular examination pre-operatively and prior to leaving the operating room, which allows any abnormalities to be further evaluated while the patient remains in a controlled environment. When an unrecognized iatrogenic injury occurs, serial postoperative neurovascular examinations allow early recognition and corrective actions.
The welter of clinical reports in the orthodontic literature and the profusion of short courses being given on so-called functional appliances (often featuring specialists from other countries) have engendered great interest in this approach to orthodontic and orthopedic treatment of malocclusion. The popularity and large of sales of the first edition of this book and of Removable Orthodontic Appliances by T.M. Graber are testimony to the enhanced desire to learn more about these appliances on the American side of the Atlantic. Functional jaw orthopedics has been used (and misused) for many years in Europe, ever since it was promulgated by Andresen of Norway. As in America, cultism, dogma, and the arbitrary follow-the-leader approaches have too often dominated the scene. The results have been spotty. There is an old aphorism It is not the tool but how you use it that counts. This can be rephrased to cover aspect of the topic at hand: although functional appliances may provide dramatic anecdotal examples of stable and balanced corrections of severe malocclusions, they also may show problems in which only partial correction was achieved or excessive lower incisor proclination was the result. Multiple factors may be responsible.It is unfortunate that the glowing functional appliance 'successes have been emphasized and oversold by some American proponents. Weekend motel and tailgate courses also have been given too often by inadequately trained orthodontists, pediatric dentists, or would-be orthodontists who were interested more in the financial returns from these courses or the ego inflation that goes with standing behind a podium with a captive audience. Glitzy, glossy brochures promise as much as a $100,000 benefit to course attendees. Thus what has become a hot number for orthodontists and dentofacial orthopedists has effectively burned more than a few clinicians and patients who have been promised too much.Despite the admonitions in the previous edition of this book and other books and articles on the subject by superbly qualified leaders such as Rakosi, Frankel, Eirew, McNamara, Moss, Binder, Vardimon, Clark, Hamdton, and others, hundreds of clinicians have succumbed to the blandishments of the domestic gurus and used these appliances indiscriminately and in shotgun style on their patients. The inexorable unfavorable patient response from excessive use by inadequately trained orthodontists and unqualified pediatric dentists and general practitioners has produced a wave of frustration and backlash to functional appliances in many quarters.Yet if the clinician realizes that diagnosis is as demanding for functional orthopedics as it is for conventional fixed appliances, that case selection is critical, that construction bite details can make or break a treatment regimen (no matter how perfectly an appliance is constructed), that it takes time to learn how to manipulate these appliances, that mistakes will be made, that growth direction and growth amount as well as growth timing are major factors in the ultimate success or failure of a treatment regimen, and that patient compliance and motivation demand constant reinforcement after careful patient selection -- if all of these are absorbed into the clinician's modus cogitandi, they cannot help engendering a warm glow of success and pride in the beautiful results attained on many patients, results not possible from fixed appliances alone. This is not a recommendation for a one shot approach, nor does it diminish the importance of fixed appliances as needed.It is the purpose of this book to present those essential details on the Achilles' heel of functional appliances, or diagnosis, give detailed instructions on how to obtain a correct construction bite, describe fabrication and use of various types of functional appliances alone or in combination, and particularize specific treatment regimens for different malocclusion categories. We hope to be able to offset the antagonism engendered against functional appliances by the mixed experiences of the past 8 to 9 years.It might appear unseemly that the qualifications of the authors should be extolled. However, this aspect is vitally important if the objectives elaborated in the previous paragraph are to be achieved.
Orthopedic surgeons have become increasingly subspecialized, and recent studies have shown that American Board of Orthopaedic Surgery (ABOS) Step II applicants are performing a higher percentage of their cases within their chosen subspecialties. However, these studies focused exclusively on surgeons who have completed a single fellowship; little data exist on those who pursue a second fellowship. All applicants to the ABOS Part II examination from 2004 to 2016 were classified by their self-reported fellowship training history using the ABOS Part II examination database. Trends in the number of applicants completing multiple fellowships and the types of fellowships combined were analyzed. In addition, cases performed by applicants who had performed multiple fellowships were analyzed to determine what percentage were within their chosen subspecialties. A total of 9776 applicants to ABOS Part II were included in the database from 2004 to 2016, including 444 (4.5%) applicants who completed more than one fellowship. There were 43 different combinations of fellowships; the most common additional fellowships were trauma (40.1%), sports medicine (38.7%), and joints (30.4%). The most common combinations were joints and sports medicine (10.6%) and foot and ankle and sports medicine (10.1%). A significant increase occurred in physicians training in both pediatric orthopedics and sports medicine (P=.02). The percentage of cases within the applicants' chosen specialties ranged from 91.4% in sports to 73.6% in tumor. Multiple fellowship applicants represent a small percentage of all applicants, and although subspecialization in orthopedics is increasing, no increasing trend toward multiple fellowships within this dataset was observed. However, the significant increase in applicants who combined pediatric orthopedic and sports medicine fellowships suggests an increasing interest in treating this increasing patient population in addition to social and economic factors. [Orthopedics. 2018; 41(1):e33-e37.].
The use of digital radiography is becoming more prevalent in orthopedics. This transition impacts the ability to preoperatively plan for implants in total hip arthroplasty (THA) and total knee arthroplasty (TKA). This article reports on the clinical success of digital templating using the Advanced Case Plan (Stryker Imaging, Flower Mound, Texas) system in primary THA and TKA. Digital radiographs of 269 consecutive patients undergoing primary THA (93 cases) or TKA (176 cases) were templated using the Advanced Case Plan digital software package. A 25.4-mm metallic sphere was used as a calibrating marker. Anteroposterior hip and lateral knee radiographs were digitally templated preoperatively and compared to the actual size of the implants at the time of surgery. The accuracy of calibrating images using the metallic sphere was validated by measuring the diameter of femoral heads on 25 postoperative hip radiographs. Digital templating was accurate in predicting the correct implant size in 58.5% of THAs and 66% of TKAs. In 93% of THAs and 98.5% of TKAs, preoperative templating was within 1 size of the final implant. There were no cases in which the predicted implant size varied from the final components by >2 sizes. Calibrating the image using the metallic sphere marker was found to be highly accurate, predicting the correct femoral head size within 1.5 mm in all 25 cases (7 hemiarthroplasties and 18 THAs). Digital templating is an effective means for predicting the size of THA and TKA components, thus remaining a viable option as we transition into the modern era of digital radiography. Future studies will evaluate interobserver reliability and the impact of level of training on templating accuracy.
BACKGROUND: Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. METHODS: Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. RESULTS: 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. CONCLUSION: 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D-printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost-effectiveness analysis.
OBJECTIVE: The aim of the study was to delineate and update the bacteriological spectrum, characterize patterns and sites of injury, evaluate laboratory tests and possible causes of complications in patients with bacterial hand infections. METHODS: All hand infections operated on in the department of orthopedics at Odense University Hospital during the period 1992-2001 were reviewed retrospectively. A standard protocol was used to collect data for each patient. We also examined all laboratory reports and recorded the identity of the etiologic organism, if known, for all cases of bacterial hand infections. RESULTS: Four hundred and eighteen patients (296 men and 122 women) with hand infections were operated on between 1992 and 2001 in our department. The median age of the patients was 40 years (range 1-93). The average interval from primary injury to operation was 10 days (range 1-50). The etiology was laceration/puncture in 35%. The site of infection was subcutaneous in 45% followed by tendon, joint and bone in 27, 18 and 5%, respectively. The bacteria isolated from the patients showed that 184 cultures (44%) were pure Staphylococcus aureus followed by 49 cultures (11.7%) of mixed organisms. Body temperature and C-reactive protein (CRP) were normal in three quarters of all patients with hand infections in our series. However the erythrocyte sedimentation rate (ESR) was elevated in 50% of the patients and was a significantly better test for infection in this study than CRP (p = 0.002). Neither the severity of infection nor the etiology of infection was related in any way to the initial temperature, CRP or ESR in this study. Complications were noted in 14.8% of all patients, and were especially related to diabetes, and mixed infection. CONCLUSION: Despite modern antibiotics, hand infections with a variety of organisms continue to be a source of morbidity and possible long-term disability. Most hand infections are the result of minor wounds that have been neglected. A complete history and physical examination is necessary to exclude other associated medical conditions (diabetes, arthritis, immunosuppression) that may compromise therapy. Furthermore, our study confirms that Staphylococcus aureus is responsible for most instances of hand infection, followed by mixed organisms. Gram-negative organisms are frequently cultured in patients with diabetes and intravenous drug abuse.
OBJECTIVE: To describe incorrect surgical procedures reported from Veterans Health Administration (VHA) Medical Centers from 2001 to mid-2006 and provide proposed solutions for preventing such events. DESIGN: Descriptive study. SETTING: Veterans Health Administration Medical Centers. PARTICIPANTS: Veterans of the US Armed Forces. INTERVENTIONS: The VHA instituted an initial directive, "Ensuring Correct Surgery and Invasive Procedures," in January 2003. The directive was updated in 2004 to include non-operating room (OR) invasive procedures and incorporated requirements of The Joint Commission Universal Protocol for preventing wrong-site operations. MAIN OUTCOME MEASURES: The categories included 5 incorrect event types (wrong patient, side, site, procedure, or implant), major or minor surgical procedures, location in or out of the OR, therapeutic or diagnostic events, adverse event or close call, inpatient or ambulatory events, specialty department, body segment, and severity and probability of harm. RESULTS: We reviewed 342 reported events (212 adverse events and 130 close calls). Of these, 108 adverse events (50.9%) occurred in an OR, and 104 (49.1%) occurred elsewhere. When examining adverse events only, ophthalmology and invasive radiology were the specialties associated with the most reports (45 [21.2%] each), whereas orthopedics was second to ophthalmology for number of reported adverse events occurring in the OR. Pulmonary medicine cases (such as wrong-side thoracentesis) and wrong-site cases (such as wrong spinal level) were associated with the most harm. The most common root cause of events was communication (21.0%). CONCLUSIONS: Incorrect ophthalmic and orthopedic surgical procedures appear to be overrepresented among adverse events occurring in ORs. Outside the OR, adverse events by invasive radiology were most frequently reported. Incorrect surgical procedures are not only an OR challenge but also a challenge for events occurring outside of the OR. We support earlier communication based on crew resource management to prevent surgical adverse events.
To identify high risk areas for back injury in a large teaching hospital, we calculated standard injury rates and newly developed composite statistics for nursing and non-nursing work groups. Data were extracted from the hospital's workers' compensation database. The hospital-wide total injury rate was 4.6 reports per 100 full-time equivalents (FTE); Compensation Case Rate, 1.4 cases per 100 FTE; Compensation Severity Rate, 76 days lost per 100 FTE; and the Cost Rate, $3742 per 100 FTE. The Total Injury Reports Rate for nursing varied from 14.2 per 100 FTE for Intensive Care Unit (ICU) Nursing to 3.8 per 100 FTE for Pediatric Nursing. Non-nursing areas also demonstrated increased rates for back injury. Individual statistical rates ranked areas differently in risk, whereas composite statistical measures consistently ranked ICU Nursing, Buildings and Grounds, and Orthopedics/Neurological Nursing as the top three. Patient handling was the precipitating event in the majority of nursing back injuries, indicating the need for ergonomic intervention. The use of combined statistical measures provided a more integrative measure for describing and following back injury risk over time.
Incentive for this study was the discovery within a short period of time of two shoulders, each of which presented a large defect or groove in the posterolateral aspect of the head of the humerus (Figs. 3 and 4). The defect was variously interpreted by different consultants as due to infection, metastasis, and post-traumatic osteoporosis. A survey of the standard textbooks on roent-gen diagnosis and on orthopedics was of no assistance in differential diagnosis. Accordingly, a detailed study of the literature was made and 119 cases of dislocated shoulder, examined roentgenographically at the San Francisco Hospital between the years 1930 and 1940, were reviewed. This led to a clarification of our original conceptions regarding the nature of this lesion, and identified it not as a late result of dislocation of the shoulder, but as a true fracture. Review of the Literature Inasmuch as shoulder dislocations are the most frequent of all dislocations of the body, this subject has been of medical interest since ancient times. Hippocrates described the symptoms of dislocation of the shoulder and a method of reducing the luxation. Following Hippocrates, little was added to this subject until late in the nineteenth century when progress began to be made in the pathologico-anatomic changes occurring in shoulder dislocations. In 1861, Flower (8) reported upon 41 shoulder specimens which he had studied after collecting them from all of the pathologic museums of London. He described cases which showed rupture of the tendons inserted upon the greater tuberosity, fracture of the tuberosity, or the presence of a groove excavated on the articular head posterior to the greater tuberosity. Between 1880 and 1903, there were many case reports (Kuster, 1882; Cramer, 1882; Popke, 1882; Loebker, 1887; Schuller, 1890; Staffell, 1895; Francke, 1898; Wendel, 1903), which described the pathologico-anatomic findings in humeral heads resected for the relief of chronic or habitual dislocation (9). In all these cases there was such a similarity in the change found by the various operators that the groove or excavation became known as the “typical defect.” A composite description of these resected specimens may be summed up as follows: The defect is located posterior and medial to the greater tuberosity on the posterolateral aspect of the articulating surface of the humeral head. The groove is navicular or wedge-shaped and its average measurements are 2.5 cm. in length (cephalocau-dad), 1.5 em. in width, and 0.75 cm. in depth. The defect is demarcated from the surrounding normal bone by sharp or vertically projecting walls, which in the larger defects stand at a right-angle to each other. The spongiosa bordering the defect is thicker than elsewhere and is covered with a glossy, smooth connective tissue layer. No fragment avulsed from the humerus is to be seen (Fig. 1).
In Europe and the United States, there is an increasing prevalence of the use of autologous blood products to facilitate healing in a variety of applications. Recently, we have learned more about specific growth factors, which play a crucial role in the healing process. With that knowledge there is abundant enthusiasm in the application of concentrated platelets, which release a supra-maximal quantity of these growth factors to stimulate recovery in non-healing injuries. For 20 years, the application of autologous PRP has been safely used and documented in many fields including; orthopedics, sports medicine, dentistry, ENT, neurosurgery, ophthalmology, urology, wound healing, cosmetic, cardiothoracic, and maxillofacial surgery. This article introduces the reader to PRP therapy and reviews the current literature on this emerging treatment modality. In summary, PRP provides a promising alternative to surgery by promoting safe and natural healing. However, there are few controlled trials, and mostly anecdotal or case reports. Additionally the sample sizes are frequently small, limiting the generalization of the findings. Recently, there is emerging literature on the beneficial effects of PRP for chronic non-healing tendon injuries including lateral epicondylitis and plantar fasciitis and cartilage degeneration (Mishra and Pavelko, The American Journal of Sports Medicine 10(10):1-5, 2006; Barrett and Erredge, Podiatry Today 17:37-42, 2004). However, as clinical use increases, more controlled studies are needed to further understand this treatment.
BACKGROUND: ) is a dynamic system of psychometrically sound patient-reported outcome (PRO) measures. There has been a recent increase in the use of PROMIS measures, yet little has been written about the reporting of these measures in the field of orthopedics. The purpose of this study was to conduct a systematic review to determine the uptake of PROMIS measures across orthopedics and to identify the type of PROMIS measures and domains that are most commonly used in orthopedic research and practice. METHODS: We searched PubMed, Embase, and Scopus using keywords and database-specific subject headings to capture orthopedic studies reporting PROMIS measures through November 2018. Our inclusion criteria were use of PROMIS measures as an outcome or used to describe a population of patients in an orthopedic setting in patients ≥ 18 years of age. We excluded non-quantitative studies, reviews, and case reports. RESULTS: Our final search yielded 88 studies published from 2013 through 2018, with 57% (50 studies) published in 2018 alone. By body region, 28% (25 studies) reported PROMIS measures in the upper extremity (shoulder, elbow, hand), 36% (32 studies) reported PROMIS measures in the lower extremity (hip, knee, ankle, foot), 19% (17 studies) reported PROMIS measures in the spine, 10% (9 studies) reported PROMIS measures in trauma patients, and 6% (5 studies) reported PROMIS measures in general orthopedic patients. The majority of studies reported between one and three PROMIS domains (82%, 73 studies). The PROMIS Computerized Adaptive Test (CAT) approach was most commonly used (81%, 72 studies). The most frequently reported PROMIS domains were physical function (81%, 71 studies) and pain interference (61%, 54 studies). CONCLUSION: Our review found an increase in the reporting of PROMIS measures over the recent years. Utilization of PROMIS measures in orthopedic populations is clinically appropriate and can facilitate communication of outcomes across different provider types and with reduced respondent burden. REGISTRATION: The protocol for this systematic review was designed in accordance with the PRISMA guidelines and is registered with the PROSPERO database (CRD42018088260).