OKOJ, Volume 11, No. 12

Avoiding Adverse Effects of Regional Anesthesia in Orthopaedic Surgery

Regional anesthesia has specific advantages for providing anesthesia and analgesia for orthopaedic surgery. The types of anesthesia used include neuraxial blocks and peripheral nerve blocks. Unfortunately, these procedures may be associated with certain adverse events, which have deterred some practitioners from using them in the care of patients undergoing orthopaedic surgery. Identifying the patients susceptible to these adverse events, and following pathways of evidence-based care, may allow the prevention and better management of such events in order to benefit from these techniques of regional anesthesia. This article discusses techniques for avoiding adverse events in regional anesthesia in orthopaedic surgery.

    • Keywords:
    • pain management

    • regional anesthesia

    • peripheral nerve block

    • neural block

    • adverse events

    • Subspecialty:
    • Pain Management

Surgical Exposures of the Wrist

The neurovascular, muscular, and ligamentous anatomy of the carpus and hand is complex. Therefore, precise exposures are required to avoid iatrogenic injury. The purpose of this review is to highlight important and frequently used approaches to the distal radius, radiocarpal joint, and carpal rows. Indications for each approach, extensile measures, and tips and techniques to avoid common complications are reviewed in detail. Dorsal and volar approaches to the wrist are the focus.

    • Keywords:
    • dorsal midline approach

    • dorsolulnar approach

    • volar distal radial approach

    • volar scaphoid approach

    • carpal tunnel approach

    • Guyons canal approach

    • Subspecialty:
    • Hand and Wrist

The Genetic, Mechanical, and Inflammatory Components of Posttraumatic Osteoarthritis

Joint trauma affects all joint tissues to some extent, and in the case of the knee, there is a critical need for rigorous clinical and laboratory studies to define the factors responsible for joint deterioration associated with injury of the meniscus or anterior cruciate ligament. Posttraumatic osteoarthritis constitutes a subtype of osteoarthritis in which the end stage of the disease may be very similar but the initial causes, stages of development and progression, patient populations, and potential approaches to treatment may be viewed as quite different. General risk factors for the pathogenesis of osteoarthritis, but particularly for posttraumatic osteoarthritis, include biomechanical instability of the affected joint, and inflammation. Understanding how to prevent synovial inflammation and cartilage damage during the days and weeks after injury, before irreversible progression of joint pathology begins, may provide a window of opportunity for diagnosis at an early stage of posttraumatic osteoarthritis and for evaluation of the risk of its progression. Studies of tissues and fluids taken at the time of arthroscopic surgery, and subsequent evaluation of longitudinal postoperative outcome data, may permit the identification of surrogate markers with predictive value in defining postoperative outcomes, and permit testing and implementation of novel treatments to halt or slow the development of posttraumatic osteoarthritis.

    • Keywords:
    • posttraumatic osteoarthritis

    • mouse models

    • biomechanics

    • inflammatory mediators

    • genetics

    • ACL injury

    • meniscus injury

    • Subspecialty:
    • Basic Science

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