Post Op Orders
– See Orders for the Spine Injured Patient – Neuro / C-spine – Morphine PCA (Fetanyl in the unstable pt); – Tylenol 650 PO q4hr prn – HOB – Cardiac Orders / Meds: – Hct: T & C and Sulcotrans … Read more
Spine
Post Operative Diskitis
– See: Osteomyelitis of the Spine: – Discussion: – acute infections usually occur between 1-2 wks after surgery; – pt who has recently undergone excision of a herniated disc and who presents with localized back pain and spasm following a relatively pain-free interval should be suspected; – when infection has … Read more
Post Traumatic / Post Surgical Kyphosis
– Discussion: – commonly results from: – frx of throracolumbar spine treated non-operatively, esp when posterior ligamentous complex has been disrupted; – fractures treated by laminectomy w/o fusion (or w/ failed fusion); – children who have had extensive laminectomies, … Read more
Posterior Acetabular Wall Frx: Danger Zone
– Discussion: – refers to the portion of the posterior wall and column at the mid acetabulum lying above the ischial spine; – screws placed in this one are at risk for joint penentration; – anatomic safe zone: – entry point … Read more
Positioning for Femoral Shaft Fractures
– Assess ISS: – w/ multiple injuries (Pelvic Frx) consider supine position and use of universal femoral distractor; – Rotational Alignment – 45 deg Lateral on Flouro Table: – indications: – include ipsilateral femoral and acetabular frx or vertical unstable pelvic fracture; … Read more
Polyethylene and Polyethylene Wear
– See: Osteolysis and Insertion of Polyethylene – Discussion: – originally Charnley used high density polyethylene and later this was changed to ultrahigh molecular weight polyethylene – impact strength of UHMWPE is higher than that for HDPE and the density of UHMWPE is much lower than … Read more
Polyarticular JRA
(see also: juvenile RA menu) Discussion definition: > 5 involved joints; large and small joint may be affected; accounts for about 50% of patients w/ JRA; may occur at 1-3 yrs or during early adolescence (after age 10); children w/ seronegative arthritis usually present before age 5 years and have iridocyclitis if fewer than five … Read more
Pneumothorax
– Pneumothorax: – even a small pneumothorax will generally require a chest tube if any type of surgery is required since the size of the pneumothorax may increase due to the positive pressure ventilation; – Tension Pneumothorax: – condition in which air is under pressure … Read more
Plate Fixation of Olecranon Fracture
– Discussion: (see olecranon frx menu) – indicated for comminuted olecranon frx and frx which occur at or distal to the coronoid process; – if frx extends distally past midpoint of trochlear notch, it no longer represents only a disruption of the triceps mechanism but also comprimises the stability of elbow in withstanding varus & … Read more
Pilon Frx: ORIF of the Fibula
– Discussion: (see pilon frx discussion) – fibula is usually fractured above the joint line; – some authors will avoid ORIF of the fibula in these injuries if there is excessive fibular comminution (ie poor chance of good fixation) and if there is excessive varus of the articular surface (ORIF would accentuate the varus); … Read more