PubMed · 5450732
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I Alvik. 1970-05-10. [Pseudarthrosis].. https://pubmed.ncbi.nlm.nih.gov/5450732/
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Elbow fractures encompass a spectrum of severity from low energy nondisplaced fractures to high energy fractures with associated severe soft-tissue injury. Treatment is based on fracture pattern, patient age, bone quality, associated soft-tissue injuries, and associated fractures. The basis for treatment relies on the knowledge of the complex osseous and soft-tissue anatomy of the elbow. The goals of operative and nonoperative treatment are to achieve a stable, anatomic reduction that allows early motion to maximize function.
In treating thoracolumbar injuries, an accurate diagnosis of the structural injury to the spine is critical. I recommend the Allen classification, but all classifications assist in obtaining an accurate understanding of the spine dynamics resulting from the injury. It is essential to remember that the majority of thoracolumbar injuries result from high-energy trauma. It is incumbent upon the spinal surgeon to ensure that multisystem trauma and life-threatening injuries, with the exception of a deteriorating neurologic injury, are cared for before embarking on spinal surgery. Even treatment of these injuries may have to be delayed if cardiovascular or abdominal hemorrhagic injuries take precedence. A critically important piece of information is the neurologic diagnosis. I recommend the ASIA Motor Index as the gold standard for diagnosing injuries and prognosticating outcome. Accurate neurologic diagnosis must be obtained prior to surgery. Finally, I recommend a firm understanding and a good working relationship with the device system used for fixation. Other instructional course authors agree that whether the anterior or the posterior approach is used, familiarity with the device nuances, by not only the surgeon but also the operating team, is very helpful in achieving a successful uncomplicated implantation. If all of the above recommendations are followed, successful outcome and optimal patient recovery can be anticipated in most cases.
Complex injuries of the shoulder require differentiated management. Interestingly there is a relative lag of warranted information on this subject. Generally the different lesions are discussed separately. However it is not acceptable to simply add the standard diagnostic and therapeutic measures, because major tactic, strategic and rehabilitation incompatibilities could occur. Diagnostic and therapeutic difficulties are frequent for the following injuries: complex proximal humerus dislocation fractures, dislocation fractures with associated lesions of the rotator cuff, posterior dislocation fractures, peri- and intraarticular segmental fractures and fractures or dislocations associated with major neurovascular lesions. Increased awareness of the most relevant diagnostic and therapeutic aspects should contribute to optimize treatment protocols.