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Columbus, OH, United States

Gluteal compartment syndrome as a result of hematoma from a ruptured superior gluteal artery is exceedingly rare; to date, one similar case in a pelvic fracture model has been reported. We report a case of acute gluteal compartment syndrome from a ruptured superior gluteal artery resulting from a simple posterior hip dislocation in an otherwise healthy young male. Timely surgical exploration, evacuation of the hematoma, and achievement of hemostasis allowed for an excellent outcome at follow-up. We review the gluteal compartments as well as treatment protocols for this injury. Source

Ewald A.,Grant Medical Center
American Family Physician | Year: 2011

Adhesive capsulitis is a common, yet poorly understood, condition causing pain and loss of range of motion in the shoulder. It can occur in isolation or concomitantly with other shoulder conditions (e.g., rotator cuff tendinopathy, bursitis) or diabetes mellitus. It is often self-limited, but can persist for years and may never fully resolve. The diagnosis is usually clinical, although imaging can help rule out other conditions. The differential diagnosis includes acromioclavicular arthropathy, autoimmune disease (e.g., systemic lupus erythematosus, rheumatoid arthritis), biceps tendinopathy, glenohumeral osteoarthritis, neoplasm, rotator cuff tendinopathy or tear (with or without impingement), and subacromial and subdeltoid bursitis. Several treatment options are commonly used, but few have high-level evidence to support them. Because the condition is often self-limited, observation and reassurance may be considered; however, this may not be acceptable to many patients because of the painful and debilitating nature of the condition. Nonsurgical treatments include analgesics (e.g., acetaminophen, nonsteroidal anti-infammatory drugs), oral prednisone, and intra-articular corticosteroid injections. Home exercise regimens and physical therapy are often prescribed. Surgical treatments include manipulation of the joint under anesthesia and capsular release. © American Academy of Family Physicians. Source

Chambers L.A.,Grant Medical Center | Chow S.J.,Trauma and Acute Care Surgical Services | Shaffer L.E.T.,OhioHealth Research and Innovation Institute
American Journal of Clinical Pathology | Year: 2011

A massive transfusion protocol (MTP) in which most non-RBC transfusions were laboratory result-driven was updated to a 1:1:1 RBC/plasma/platelet formula-driven protocol. Platelet count, fibrinogen level, and prothrombin time (PT) were monitored. In the patients who survived the first 12 hours, the results of coagulation tests were analyzed. Irrespective of the MTP or transfused RBC/plasma ratio, a majority of patients became coagulopathic, usually within the first 2 hours, and a fibrinogen deficiency (fibrinogen level, <100 mg/dL [2.9 μmol/L]) was almost always the initial abnormality. The laboratory value trends under each MTP were indistinguishable: PTs were prolonged and platelet counts and fibrinogen levels fell during the first 100 minutes and then corrected back toward baseline. More than 80% of patients in each group were noncoagulopathic at 12 hours. A 1:1:1 formula-driven MTP did not affect the frequency, nature, or duration of coagulopathy according to laboratory test results. © American Society for Clinical Pathology. Source

Wermert A.M.,Grant Medical Center
Journal of trauma nursing : the official journal of the Society of Trauma Nurses | Year: 2012

Compared with other age groups, teenagers have the lowest rate of safety belt use. We sought to determine whether an ongoing, student-led initiative would be effective in increasing safety belt use among high school students compared with another school in which the intervention did not take place. At the intervention school, there was a statistically significant increase of 15% in observed safety belt use and evidence of increased knowledge regarding proper safety belt use. High schools can be effective in changing the traffic safety behaviors of its students. Source

Kusuma S.K.,Grant Medical Center | Ward J.,Loyola University New Orleans | Jacofsky M.,Core Institute | Sporer S.M.,Rush University Medical Center | Della Valle C.J.,Rush University Medical Center
Clinical Orthopaedics and Related Research | Year: 2011

Background: Two-stage exchange arthroplasty is the gold standard for treatment of infected TKA. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and synovial fluid white blood cell (WBC) count with differential are often used to determine treatment response; however, it is unclear whether these tests can answer the critical question of whether joint sepsis has been controlled between stages and if reimplantation is indicated. Questions/purposes: We therefore asked if (1) these serologies respond between stage one explantation and stage two reimplantation during two-stage knee reconstruction for infection; and (2) changes in the values of these serologies are predictive of resolution of joint infection. Methods: We retrospectively reviewed the serologies of 76 infected patients treated with a two-stage exchange protocol. The ESR, CRP, and aspiration were repeated a minimum of 2 weeks following antibiotic cessation and prior to second stage reoperation. Comparisons were made to identify trends in these serologies between the first and second stage procedures. Results: Eight knees (12%) were persistently infected at the time of second stage reoperation. The ESR remained persistently elevated in 37 knees (54%), and the CRP remained elevated in 14 knees (21%) where infection had been controlled. We were unable to identify an optimum cutoff value for the ESR, CRP, or the two combined. The best test for confirmation of infection control was the synovial fluid WBC count. Conclusions: Although the ESR, CRP, and synovial fluid WBC counts decreased in cases of infection control, these values frequently remained elevated. We were unable to identify any patterns in these tests indicative of persistent infection. Level of Evidence: Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence. © The Association of Bone and Joint Surgeons® 2010. Source

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