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Tarascon Pocket Orthopaedica Tarascon Pocket Orthopaedica Fourth Edition From the publishers of the Tarascon Pocket Pharmacopoeia® Damian M. Rispoli World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 [email protected] www.jblearning.com Jones & Bartlett Learning books and products are available through most bookstores and online book- sellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com. Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to [email protected]. Copyright © 2020 by Jones & Bartlett Learning, LLC, an Ascend Learning Company All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. The content, statements, views, and opinions herein are the sole expression of the respective authors and not that of Jones & Bartlett Learning, LLC. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not constitute or imply its endorsement or recommendation by Jones & Bartlett Learning, LLC and such reference shall not be used for advertising or product endorsement purposes. All trademarks displayed are the trademarks of the parties noted herein. [Title, Edition] is an independent publication and has not been authorized, sponsored, or otherwise approved by the owners of the trademarks or service marks referenced in this product. There may be images in this book that feature models; these models do not necessarily endorse, represent, or participate in the activities represented in the images. Any screenshots in this product are for educational and instructive purposes only. Any individuals and scenarios featured in the case studies throughout this product may be real or fictitious, but are used for instructional purposes only. Nursing/Medicine/Communication & Speech Disorders The authors, editor, and publisher have made every effort to provide accurate information. However, they are not responsible for errors, omissions, or for any outcomes related to the use of the contents of this book and take no responsibility for the use of the products and procedures described. Treatments and side effects described in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice, and government regulations often change the accepted standard in this field. When consider- ation is being given to use of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations on dose, precautions, and contraindications, and determining the ap- propriate usage for the product. This is especially important in the case of drugs that are new or seldom used. Production Credits Director of Product Management: Amanda Martin Cover Design: Kristin E. Parker Product Manager: Teresa Reilly Rights & Media Specialist: John Rusk Product Assistant: Anna-Maria Forger Media Development Editor: Troy Liston Production Editor: Daniel Stone Cover Image (Title Page, Part Opener, Marketing Manager: Lindsay White Chapter Opener): © Library of Congress Manufacturing and Inventory Control Supervisor: Printing and Binding: Cenveo Amy Bacus Cover Printing: Cenveo Composition: S4Carlisle Publishing Services ISBN: 978-1-284-05034-9 6048 Printed in the United States of America 22 21 20 19 18 10 9 8 7 6 5 4 3 2 1 Tarascon Pocket Orthopaedica Fourth Edition Trauma Protocols 1 Suggested Antibiotic Prophylaxis Initial Approach to Trauma If Urologic Criteria Are Met 76 Assessment and Management 1 Suggested Antibiotic Prophylaxis Trauma Radiographs 2 for GI Procedures 76 Tension Pneumothorax 2 Anticoagulation Therapy 76 Chest Tube 2 Blood Transfusion 77 IV Maintenance Therapy 3 Viral 77 Cardiac Tamponade 3 Systemic Reactions 77 Foley Catheter 3 Ca++/Phosphate 78 Major Differences in Pediatric Regulation of Calcium and Versus Adult Polytrauma 5 Phosphate Metabolism 78 Anatomy 7 Laboratory 78 Muscle Tables 7 Joint Fluid Analysis 78 Approaches 17 Gross Examination 79 Cross Sections 21 Differential (% Neutrophils) 79 Arteries 26 Culture 79 Ligaments 30 Polarized Microscopy 79 Nerve Plexi 36 Tests For Infection 80 Peripheral Nerves (Motor) 39 Gram Stain 80 Peripheral Nerves (Sensory) 46 Tissue Frozen Section 80 Nerves 47 Metabolic Bone Disease 80 Dermatomes 49 Clinical and Radiologic Overview Antimicrobials 51 of Metabolic Bone Disease 80 Arthritis—Septic 51 Nerves, EMG/NCV 81 Total Joint Arthroplasty—Criteria EMG Findings/Meaning 81 for Infection 53 Electrodiagnostic Findings in Antibiotics for Surgical Prophylaxis 63 Various Peripheral Nerve Disorders 82 Emergency Procedures 65 Nerve Injury Classification 83 Compartment Syndrome 65 Obesity 83 Acute Stabilization of the Pelvis Obesity Standards [World Health Methods 72 Organization] 83 GENERAL ORTHOPAEDICS 75 Osteonecrosis 84 Antibiotic Prophylaxis 75 Etiologies 84 Potentially Increased Risk 75 MRI 84 Suggested Antibiotic Prophylaxis If Surgeon Chooses Dental Prophylaxis 75 iv Tarascon Pocket Orthopaedica Natural History 84 Reflexes 96 Treatment Options 84 Characteristics of Myelodysplasia Staging System for Osteonecrosis Levels 97 of the Hip 84 Growth Centers 97 Osteoporosis 85 Growth Plates 97 Osteoporosis 85 Foot 99 DEXA Osteoporosis Criteria 85 Angles and Characteristics 100 Osteoporosis Risk Factors 85 Normal Talo-Calcaneal Angle Is Calcium Recommendations 86 20–40 Degrees 100 Vitamin D 86 Clubfoot Treatment—Ponseti Prophylactic Reccomendations 86 Technique 100 Pain Management, Degenerative Brachial Plexus 100 Arthritis 86 Brachial Plexus Birth Injuries 100 1st Line of Treatment 86 Osteochondroses (Osteonecrosis at 2nd Line of Treatment 87 Apophysis/Physis) 101 Perioperative Management 87 General 101 Perioperative Management in the Arthroscopic Classification of Patient With Rheumatologic Osteochondritis Dissecans (Guhl) 101 Disorders 87 Night Pains 101 Nonsteroidal Anti-Inflammatory Back Pain in Children 102 Drug Half-Life 88 Mucopolysaccharidosis 102 Supplemental Hydrocortisone for Dysplastic Conditions 103 Surgical Stress 89 Disproportionate Dwarfism 103 Tetanus 89 Proportionate Dwarfism 104 Wound Classification for Tetanus Salter-Harris Classification 105 Prophylaxis 89 Salter-Harris Classification Tetanus Immunization Schedule 89 of Physeal Injuries 105 Tobacco Abuse 90 Slipped Capital Femoral Epiphysis 106 Tobacco’s Effects 90 Slipped Capital Femoral Epiphysis 106 Tourniquet 90 Classification 106 Tourniquet Use 90 Radiographic Evaluation 106 Venous Thromboembolic Disease 91 Physical Exam 106 Commonly Used Prophylaxis Grading 106 Options 92 Treatment 106 Guidelines for Duration of Therapy 92 Limp 107 Wound Healing 93 Evaluation 107 PEDIATRIC ORTHOPAEDICS 95 Radiographs 107 Medications 95 Ultrasound 107 Analgesics 95 MRI 107 Antihistamines 95 Transient Synovitis vs. Septic Milestones and Angles 95 Arthritis 108 Gait 95 Five Predictors of Septic Hip Rotational Profile 96 Arthritis 108 Development of Cervical Spine 96 Osteomyelitis in Children 109 Limp—Differential Diagnosis 110 Tarascon Pocket Orthopaedica v Vertebral Infection 110 Concussion 164 Discitis 110 Concussion: Major Features 164 Genu Varum 110 Neuropsychological Testing 164 Scoliosis 111 Concussions in Athletes 164 Neuromuscular Scoliosis 111 Stages of Concussive Injury 165 Infantile Idiopathic Scoliosis 111 Spinal Evaluation 165 Early Onset Idiopathic Scoliosis 111 Steroids in Emergent Cord Injury 165 Adolescent Idiopathic Scoliosis 111 Autonomic Dysreflexia 166 Treatment Guidelines 112 Spondylolysis and Progression Risk Factors 112 Spondylolisthesis 166 Lenke Classification of Adolescent Listhesis Grades 166 Idiopathic Scoliosis 114 Muscle Strength Testing 166 Congenital Spinal Deformities 114 Reflexes 166 Child Abuse 117 Lumbar Spinal Stenosis 167 Skeletal Survey in Child Abuse 117 Spondylolysis 167 Differential Diagnosis in Child Frankel Grade 167 Abuse 117 Low Back Pain Treatment 168 Specificity of Musculoskeletal Acute Low Back Pain (≤ 6 wk) 168 Findings in Child Abuse 117 Chronic LBP (> 6 wk), Worsening Legg-Calves-Perthes 118 Radiculopathy 168 Legg-Calvé-Perthes Stages 118 Spinal Cord Injury Syndromes 169 Herring Classification 118 Spinal Cord Injury Treatment Risks 118 by Functional Level 169 Physical signs 118 Traction 171 Key to prognosis 118 Traction Setups 171 DDH 119 Traction Pin Placement 171 Developmental Dysplasia Distal Femoral Pin 172 of the Hip 119 Proximal Tibial Traction Pin 172 Risk With History 119 Traction Types 173 Distribution 119 Trauma—Adult 177 Algorithm for Evaluation and Hand 177 Treatment of DDH 120 Small Joint Fusion 179 Physical Exam and Injections 121 Fingers 179 Physical Exam: Hand 121 Thumb 179 Wrist Injection
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