scholarly journals Posterolateral corner knee injuries: a narrative review

2021 ◽  
Vol 6 (8) ◽  
pp. 676-685
Author(s):  
Francisco Figueroa ◽  
David Figueroa ◽  
Sven Putnis ◽  
Rodrigo Guiloff ◽  
Patricio Caro ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Knee Injuries ◽  
Operative Management ◽  
Posterolateral Corner ◽  
Dark Side ◽  
Reconstruction Technique ◽  
Orthopaedic Literature ◽  
And Function ◽  
Non Operative Management ◽  
Case Basis

Limited knowledge of the anatomy and biomechanics of the posterolateral corner (PLC) of the knee, coupled with poor patient outcomes with non-operative management, resulted in the PLC often being labelled as the ‘dark side’ of the knee. In the last two decades, extensive research has resulted in a better understanding of the anatomy and function of the PLC, and has led to the development of anatomic reconstructions that have resulted in improved patient outcomes. Despite considerable attention in the clinical orthopaedic literature (nearly 400 articles published in the last decade), a standardized algorithm for the diagnosis and treatment of the PLC is still lacking, and much controversy remains. Considering the literature review, there is not a reconstruction technique that clearly prevails over the others. As anatomic, biomechanical, and clinical knowledge of PLC injuries continues to progress, finding the balance between re-creating native anatomy and safely performing PLC reconstruction provides a big challenge. Treatment decisions should be made on a case-by-case basis. Cite this article: EFORT Open Rev 2021;6:676-685. DOI: 10.1302/2058-5241.6.200096

scholarly journals State of the Art Regarding the Management of Multiligamentous Injuries of the Knee

2014 ◽  
Vol 8 (1) ◽  
pp. 215-218 ◽  
Author(s):  
Nigel T Mabvuure ◽  
Marco Malahias ◽  
Behrooz Haddad ◽  
Sandip Hindocha ◽  
Wasim S Khan
Keyword(s):  
Best Practice ◽  
Knee Injuries ◽  
Operative Management ◽  
Convincing Evidence ◽  
Optimal Timing ◽  
Active Debate ◽  
Recommendations For Practice ◽  
High Level ◽  
Non Operative Management ◽  
Serious Injuries

Multiligamentous knee injuries are rare but serious injuries that can threaten limb viability. As such, they require careful management to give patients the best chance of immediate and ultimate functional recovery. However, as these injuries are rare, there is paucity in prospective comparative studies large enough to provide high level evidence for best practice. This lack of comprehensive and convincing evidence has made the management of multiligamentous knee injuries an area of active debate and controversy. The debate on whether surgical management leads to better outcomes than non-operative management, the optimal timing of surgery after injury and whether repair is better than reconstruction is still ongoing. Using the Oxford Levels of Evidence, this review summarises the latest high level evidence to provide answers to these issues. Recommendations for practice have also been offered and assigned a grade using a published scale.

Non-union of Non-operatively Treated Displaced Olecranon Fractures

2012 ◽  
Vol 4 (4) ◽  
pp. 273-276 ◽  
Author(s):  
Wendy Bruinsma ◽  
Anneluuk Lindenhovius ◽  
Michael Mckee ◽  
George S. Athwal ◽  
David Ring
Keyword(s):  
Operative Treatment ◽  
Case Series ◽  
Operative Management ◽  
Olecranon Fracture ◽  
Loss Of Function ◽  
Non Union ◽  
Flexion Extension ◽  
Displaced Fracture ◽  
And Function ◽  
Non Operative Management

Background With this case series, we report the management of patients who present with non-union after no treatment or intentional non-operative management of a displaced olecranon fracture. We hypothesized that the majority of these patients would be satisfied with their symptoms and function. Methods Ten patients (six women and four men) with a mean age of 59 years (range 21 years to 94 years) presented to one of seven surgeons with non-union of a displaced fracture of the olecranon a mean of 17 months (range 3 months to 7 years) after injury. Results The mean flexion-extension arc at presentation was 117° (range 100° to 135°) with a mean flexion of 137° (range 120° to 150°) and a mean extension of 21° (range 10° to 40°). Forearm rotational arc was a mean of 172° (range 150° to 180°) with a mean pronation of 86° (range 75° to 90°) and a mean supination of 86° (range 75° to 90°). Two patients who had difficulty participating in daily activities because of pain or loss of function requested operative treatment. Eight patients declined operative treatment. Conclusions Patients who present with a non-union after a displaced olecranon fracture managed non-operatively have reasonable elbow function and uncommonly request operative treatment.

scholarly journals The Use of Antibiotics in Diverticulitis: An Update in Non-operative Management

2021 ◽  
Author(s):  
Mariana Morales-Cruz ◽  
Paulina Moctezuma Velázquez
Keyword(s):  
Acute Diverticulitis ◽  
The Elderly ◽  
Operative Management ◽  
Acute Onset ◽  
Common Disease ◽  
Severity Of The Disease ◽  
Non Operative Management ◽  
Developed Nations ◽  
Case Basis ◽  
Common Manifestation

Diverticulosis is a common disease among Western and developed nations. Approximately 20% of patients with diverticulosis will become symptomatic. Acute diverticulitis is a common manifestation of diverticular disease. Different classifications exist to try to categorize it but, it is generally considered as complicated or uncomplicated. Eighty-five percent of patients with an acute onset of diverticulitis will have an uncomplicated presentation. The best way to assess the degree and severity of the disease is a CT scan along with some biochemical parameters like CRP. Recent guidelines from associations all over the world accept non-antibiotic therapy as a valid strategy of treatment for the non-complicated diverticulitis. Antibiotics are still compulsory in immune-compromised patients, the elderly, those with comorbidities, and those with signs of sepsis. Recommendations should be made on a case-by-case basis.

scholarly journals SP4.2.2 The hidden harm of conservative management in emergency general surgery during the COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Andrew Jackson ◽  
Oliver Ng ◽  
Balamurali Bharathan ◽  
Alastair Simpson ◽  
David Humes ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
General Surgery ◽  
Operative Management ◽  
Biliary Disease ◽  
Emergency General Surgery ◽  
Readmission Rates ◽  
Tertiary Centre ◽  
Lengths Of Stay ◽  
June July ◽  
Non Operative Management

Abstract Aims Appendicitis, biliary disease and abscesses make up almost half of the emergency general surgery (EGS) workload. Our aim was to establish whether the shift towards non-operative management during the COVID-19 pandemic for these conditions has led to adverse patient outcomes. Methods Patient data were analysed from a prospective EGS database at a large UK tertiary centre. Patients were grouped by admission date into quarters (January-March, April-June, July-September, October-December) and compared with the corresponding time period from the preceding year. Results EGS saw 8226 and 7589 patients in 2019 and 2020 respectively. Following the first lockdown EGS admissions fell by 31%. Operative management of appendicitis fell from nearly 100% in 2019 to 32.9% and 54.7% in two of the four study periods. Complicated appendicitis was more common in 2020 leading to a 50% rise in length of stay (LOS), 4.5 days average. 30 day readmissions increased by 228% (n = 7, 2019 v n = 16, 2020). Biliary disease was managed conservatively with 11 patients undergoing percutaneous drainage from Apr-Dec 2020.Very few patients received emergency cholecystectomy in 2019 or 2020 due to institution preference. Readmission rates and LOS remained similar between years. Fewer abscesses were seen and operated on in 2020 with similar readmission rates and LOS between years. Conclusions Non-operative management and delays in presentation of appendicitis during the pandemic has had an adverse effect on patient outcomes. The rise in more complex cases has led to higher readmission rates and longer lengths of stay. The outcomes for biliary disease and abscesses remained unchanged.

Lesse Greeke? Homer in Jonson and Shakespeare

2016 ◽  
Vol 23 (1) ◽  
pp. 101-126 ◽  
Author(s):  
Robert S. Miola
Keyword(s):  
William Shakespeare ◽  
Free Will ◽  
Ben Jonson ◽  
Dark Side ◽  
Julius Caesar ◽  
Troilus And Cressida ◽  
English Translations ◽  
Love's Labor's Lost ◽  
And Function

Throughout their careers both Jonson and Shakespeare often encountered Homer, who left a deep impress on their works. Jonson read Homer directly in Greek but Shakespeare did not, or if he did, he left no evidence of that reading in extant works. Both Jonson and Shakespeare encountered Homer indirectly in Latin recollections by Vergil, Horace, Ovid and others, in English translations, in handbooks and mythographies, in derivative poems and plays, in descendant traditions, and in plentiful allusions. Though their appropriations differ significantly, Jonson and Shakespeare both present comedic impersonations of Homeric scenes and figures – the parodic replay of the council of the gods (Iliad 1) in Poetaster (1601) 4.5 and the appearance of “sweet warman” Hector (5.2.659) in the Masque of the Nine Worthies (Love's Labor's Lost, 1588–97). Homer's Vulcan and Venus furnish positive depictions of love and marriage in The Haddington Masque (1608) as do his Hector and Andromache in Julius Caesar (1599), which features other significant recollections. Both Jonson and Shakespeare recall Homer to explore the dark side of honor and fame: Circe and Ate supply the anti-masque in the Masque of Queens (1609), and scenes from Chapman's Iliad supply the comical or tragical satire, Troilus and Cressida (c. 1601). Both poets put Homer to abstract and philosophical uses: Zeus's chain and Venus's ceston (girdle), allegorized, appears throughout Jonson's work and function as central symbols in Hymenaei (1606); Homer's depiction of the tension between fate and free will, between the omnipotent gods and willing humans, though mediated, inflects the language and action of Coriolanus (c. 1608). Ben Jonson and William Shakespeare practice a kind of inventive imitatio which, according to classical and neo-classical precept, re-reads classical texts in order to make them into something new.

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