6/26/2018 at 4:10 PM
Managing Sports-related Concussions From Time of Injury Through Return to Play
Shirley, Eric, MD; Hudspeth, L. Jared, MD; Maynard, Jennifer R., MD
JAAOS - Journal of the American Academy of Orthopaedic Surgeons: July 1, 2018 - Volume 26 - Issue 13 - p e279–e286
"Sports-related concussions continue to generate widespread interest. A concussion is a complex pathophysiologic process, with or without loss of consciousness, that results in a disturbance of brain function. Risk factors include age <18 years, female sex, and history of a previous concussion. A sideline physical examination with standardized assessment tools can assist diagnosis. Management for suspected concussion begins with immediate removal from play and requires clinical follow-up. Symptoms are usually self-limited and resolve within 2 to 3 weeks. Initial treatment consists of a reduction in cognitive activity and physical rest. A stepwise return-to-play protocol, taking into consideration state laws, with a gradual increase in activity until the athlete is able to perform full activity without symptoms should be followed. Neuropsychologic testing may be used as a tool in management. For prolonged concussion, physical rehabilitation or medications for headaches, mood, or sleep disturbance may be required. Education, rule changes, and equipment improvements may assist in prevention. The long-term consequences of concussions are not fully understood and merit additional research."
6/12/2018 at 5:00 PM
Pelvic Fractures: Evaluation and Acute Management.
Wade R. Smith, MD, Takashi Suzuki, MD; Paul Tornetta, MD.
September 2017, Vol 15, Issue 9.
Orthopaedic Knowledge Online Archive
"Pelvic fractures encompass a broad spectrum of injury from low-energy ramus fractures to high-energy dissociations of the pelvic ring. Although minimally displaced injuries can often be treated nonsurgically with expectant management, higher energy and more displaced injuries can result in severe disability unless optimally treated.
Unstable patients with pelvic fractures continue to present significant challenges in acute management. Successful treatment of pelvic fracture bleeding is best accomplished by a multidisciplinary team approach involving orthopaedic surgeons. Angiography and subsequent embolization can provide effective control of ongoing hemorrhage caused by arterial bleeding, if immediately available. Although its use is currently not widespread, pelvic packing is useful for hemodynamically unstable patients as part of a combined approach in conjunction with pelvic angiography. Standardized protocols should be adopted at any institution treating these severely injured patients to facilitate effective assessment and treatment. Ongoing quality assessments and further efforts to understand and minimize bleeding in the acute phase will improve the outcome for pelvic fracture patients."
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Board Certified Orthopaedic Surgeon Focusing on Independent Medical Exams, Disability Ratings, and Expert Case Review