Ortho Preferred Malpractice Insurance

Shoulder: Internal Impingement Syndrome

Discussion:      – the hyperextension phase of throwing may be the most important component of internal impingement; – in the late cocking position (abduction, external rotation, extension) may cause the postero-superior edge of the glenoid labrum to become caught between the humeral head and rotator cuff (surface of the infraspinatus and posterior fibers of supraspinatus tendon); –  posterior glenoid … Read more

9. Fogarty Catheter Use

CPT David Crawford MAJ Joanna Branstetter Insert catheter into thrombosed vessel proximal to area of thrombus. The vessel should be clamped proximal to catheter insertion. Inflate the balloon once distal to the thrombus and remove catheter and thrombus. The view(s) expressed herein are those of the author(s) and do not reflect the official policy or … Read more

8. Vascular Shunt

CPT David Crawford MAJ Joanna Branstetter I. Patient Preparation             A. Always prep to allow access for proximal vascular control                         1. upper extremity: subclavian artery                         2. lower extremity: common femoral artery             B. Preparation should include access to uninvolved limb in case vein graft is needed to be harvested             C. Systemic heparinization (50-75 … Read more

7. Cut-down for Vascular Access

CPT David Crawford MAJ Joanna Branstetter Cutdown for vascular access: Locate the saphenous vein along the anteromedial distal tibia. Incise skin overlying the vein and insert 18-G catheter. The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical … Read more

6. Soft Tissue Coverage (Austere Environment) — Flaps and Vacuum-Assisted Closure (VAC)

COL Richard Pope MAJ Michelle Fontaine CPT Charles Grooters I. Soft Tissue Coverage in Austere Environment             A. Normally best performed in controlled environment with availability of microscope or loupe magnification             B. In rare circumstances, surgeons may need to perform soft tissue coverage procedures in austere environment when evacuation to higher echelon of care not feasible             … Read more

5. Escharotomy

CPT Daniel J. Stinner, M.D.   Introduction (see figure 3) Typically performed at bedside under sterile condition with IV sedation using electrocautery Can also be performed in operating room if immediate access available Electrocautery has added benefit of haemostatic control, but if unavailable, scalpel can be used General principle to make surgical incisions through burned eschar to … Read more

4. Fasciotomy

CPT Brendan Masini, MD I. Onset of Tissue Injury             A. Muscle and nerves may survive up to 4 hours of ischemia without development of irreversible damage             B. Nerves may have neuropraxic damage at 4 hours, however greater ischemic time will produce irreversible injury including axonotmesis at 8 hours II. Indications for Fasciotomy in Austere Combat … Read more

THR: Posterolateral Approach – Discussion

– Discussion: – Anterior Capsule: – a curved retractor is passed anterior to the anteior capsule and superior to psoas major tendon; – retract femur anteriorly w/ a bone hook to keep capsule under tension; – if sig flexion contracture is present before hip is dislocated, note tight structures capsule & insertions of rectus femoris & sartorius) & incise them … Read more

Posterior Shoulder Dislocation / Instability

– See: Fracture Dislocation / Anterior Instability – Discussion: – posterior dislocation is rare & should raise possibility of seizure as cause, other causes include an electric shock or ECT without muscle relaxants; – mechanism: – axial loading of the adducted, internally rotated arm; – because the internal rotator muscles are approx twice as powerful as the exernal rotator muscles, a sudden … Read more

Tibial Non Unions

– Discussion:     – non union general discussion – frx healing discussion – definition: no evidence of healing over 3 months; – FDA definition: frx that is over 9 months old w/ no radiographic signs of progression toward healing for 3 months; – pain on weight bearing is a classical symptom of nonunion – final stage of … Read more