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Femoral Neck Stress Fracture

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161. Clinical care of severe acute respiratory infections – Tool kit

systolic blood pressure (not reliable in children and the elderly): Carotid (neck) pulse ? SBP = 60 mmHg Femoral (groin) pulse ? SBP = 70 mmHg Radial (wrist) pulse ? SBP =80 mmHg SAMPLE History Signs & Symptoms Allergies Medications PMH Last oral intake Events APPROACH TO THE PATIENT WITH TRAUMA Key fi ndings from the Trauma Primary Survey [see also ABCDE card] ASSESSMENT FINDINGS IMMEDIATE MANAGEMENT Airway A Not speaking, with limited or no air movement Use jaw thrust with c-spine protection. Suction (...) external bleeding Apply pressure, deep wound packing or tourniquet as indicated. Signs of tamponade (poor perfusion, distended neck veins, mu ed heart sounds) Give IV uids, oxygen. Disability D Signs of brain injury (AMS with wound, deformity or bruising of head/face) Immobilize cervical spine, check glucose, give nothing by mouth. ? Will need neurosurgical care Signs of open skull fracture (as above, with blood or uid from the ears/nose) As above, and give IV antibiotics per local protocol. REMEMBER

2020 WHO Coronavirus disease (COVID-19) Pandemic

162. Metastatic Carcinoma and Myeloma of the Femur

. 11. Long Stem Hemiarthroplasty In the absence of reliable evidence, it is the opinion of the workgroup that when treating a femoral neck fracture with hemiarthroplasty, use of a long stem can be associated with increased intra-operative and post-operative complications and should only be used in patients with additional lesions in the femur. Strength of Recommendation: Consensus Description: In the absence of reliable evidence, the clinical practice guideline development group is making (...) be beneficial with appropriately randomized samples, power, and follow up times, examining the intramedullary nail revision rate due to the occurrence of new femoral neck lesions in the setting of metastatic disease and pathological fractures due to diaphyseal lesions • Future studies would be enhanced by the establishment of a multisite registry for the accumulation of prospectively collected data. 15 METHODS The methods used to perform this systematic review were employed to minimize bias and enhance

2020 American Society of Clinical Oncology Guidelines

164. Thoracic Endovascular Aneurysm Repair TEVAR Full Text available with Trip Pro

considered at high risk for symptomatic TAA or acute aortic syndrome, we recommend urgent imaging, usually Computed Tomography Angiography (CTA) due to its speed and ease of use for pre-operative planning. Level of recommendation: Grade 1 (Strong), Quality of Evidence: B (Moderate), 2) if TEVAR is being considered, we recommend fine cut (less than or equal to 0.25 mm) CTA of the entire aorta, as well as the iliac and femoral arteries. CTA of the head/neck is also needed to determine the anatomy (...) ) Recommendation 4 : If TEVAR is being considered, we recommend fine cut (less than or equal to 0.25 mm) CTA of the entire aorta, as well as the iliac and femoral arteries. CTA of the head/neck is also needed to determine the anatomy of the vertebral arteries. Level of recommendation: Grade 1 (Strong), Quality of Evidence: A (High) Recommendation 5: We recommend routine use of three-dimensional centerline reconstruction software for accurate case planning and execution in TEVAR. Level of recommendation: Grade

2020 Society for Vascular Surgery

165. Endovascular Aortic Repair of Aneurysms Involving the Renal-Mesenteric Arteries (FEVAR) Full Text available with Trip Pro

of juxtarenal aneurysms with fenestrated endovascular grafting. J Vasc Surg. 2004; 39 : 279-287 , Verhoeven E.L. Prins T.R. Tielliu I.F. van den Dungen J.J. Zeebregts C.J. Hulsebos R.G. et al. Treatment of short-necked infrarenal aortic aneurysms with fenestrated stent-grafts: short-term results. Eur J Vasc Endovasc Surg. 2004; 27 : 477-483 , Anderson J.L. Adam D.J. Berce M. Hartley D.E. Repair of thoracoabdominal aortic aneurysms with fenestrated and branched endovascular stent grafts. J Vasc Surg. 2005 (...) for endovascular repair of thoracic aortic aneurysms. J Vasc Surg. 2006; 43 ( 111A-5A ) , Greenberg R.K. Sternbergh 3rd, W.C. Makaroun M. Ohki T. Chuter T. Bharadwaj P. et al. Intermediate results of a United States multicenter trial of fenestrated endograft repair for juxtarenal abdominal aortic aneurysms. J Vasc Surg. 2009; 50 : 730-737 e1 , Verhoeven E.L. Vourliotakis G. Bos W.T. Tielliu I.F. Zeebregts C.J. Prins T.R. et al. Fenestrated stent grafting for short-necked and juxtarenal abdominal aortic

2020 Society for Vascular Surgery

166. AACE Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis

with permission from Mechanick JI, et al. Endocr Pract. 2017;23:1006-1021 (1).6 Postmenopausal Osteoporosis Guidelines, Endocr Pract. 2020;26(Suppl 1) Copyright © 2020 AACE (Grade B; BEL 2). Osteoporosis is also diagnosed based on a T-score of -2.5 or lower in the lumbar spine (antero- posterior), femoral neck, total hip, or 1/3 radius (33% radius), even in the absence of a prevalent fracture (Grade B; BEL 4, upgraded by consensus). When the initial diagnosis of osteoporosis is made according to a T-score (...) ) or osteoporosis (9). The average femoral neck T-score by dual-energy X-ray absorptiometry (DXA) for 75-year-old women is -2.5, meaning that more than half of women age 75 and older meet the criterion for osteoporosis (10). More than 20% of postmenopausal women have prevalent vertebral fractures (11). Although these guidelines focus only on the evaluation and treat- ment of osteoporosis in postmenopausal women, osteo- porosis may affect men as well as women before and after menopause. Q1. How Is Fracture Risk

2020 American Association of Clinical Endocrinologists

167. Noninvasive Nonpharmacological Treatment for Chronic Pain

for common chronic pain conditions. Key Messages • Interventions that improved function and/or pain for =1 month: o Low back pain: Exercise, psychological therapy, spinal manipulation, low-level laser therapy, massage, mindfulness-based stress reduction, yoga, acupuncture, multidisciplinary rehabilitation (MDR) o Neck pain: Exercise, low-level laser, mind-body practices, massage, acupuncture o Knee osteoarthritis: Exercise, cognitive behavioral therapy (CBT) o Hip osteoarthritis: Exercise, manual (...) report) and from September 2017 through September 2019 (for this update report), reference lists, ClinicalTrials.gov, and our previous report. Review methods. Using predefined criteria, we selected randomized controlled trials (RCTs) of noninvasive nonpharmacological treatments for five common chronic pain conditions (chronic low back pain; chronic neck pain; osteoarthritis of the knee, hip, or hand; fibromyalgia; and tension headache) that reported results for a at least 1 month postintervention. We

2020 Effective Health Care Program (AHRQ)

168. Opioid Treatments for Chronic Pain

of addiction, 22 overdose, 22 fractures, 23-25 falls 24,26 and cardiovascular events; 27 a new study also found an association between opioid use and risk of all-cause mortality. 27 New observational studies were also consistent with the 2014 AHRQ report in finding associations between higher doses of opioids and risks of overdose, addiction, and endocrinological adverse events; 22,23,26-29 new studies also found an association between higher dose and increased risk of incident or refractory depression (...) Res. 2018;11:1087-93. doi: https://dx.doi.org/10.2147/JPR.S149830. PMID: 29922084. 13. Furlan AD, Malmivaara A, Chou R, et al. 2015 Updated Method Guideline for Systematic Reviews in the Cochrane Back and Neck Group. Spine (Phila Pa 1976). 2015 Nov;40(21):1660-73. doi: 10.1097/brs.0000000000001061. PMID: 26208232. 14. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011 Oct 18;155(8):529-36. doi: 10.7326

2020 Effective Health Care Program (AHRQ)

169. Osseointegrated Prosthetic Implants for People With Lower-Limb Amputation

infection, occurring in about half of patients in some studies. Deep or bone infection was a serious adverse event, with variable rates among the studies depending on the length of follow-up. The treatment of deep or bone infection required long- term antibiotic use, surgical debridement, revision surgery, and implant extraction in some cases. Other adverse events included femoral bone fracture, implant breakage, issues with extramedullary parts that required replacement, and implant removal. Our (...) . It also looked at the budget impact of publicly funding them and at the experiences, preferences, and values of people with a lower-limb amputation. What Did This Health Technology Assessment Find? Osseointegrated prosthetic implants improve people’s ability to walk and function in daily life, but their use can lead to serious adverse events such as bone infection or fractures, which may require additional surgeries. Compared with conventional socket prostheses for people with chronic socket-related

2019 Health Quality Ontario

170. Clinical practice guideline for evaluation of psychosocial factors influencing recovery from adult orthopaedic trauma

similar numbers of extremity wounds and fractures, accounting for approximately 54% of all wounds (Cross, 2011, Owens, 2007). Combat-related extremity injuries are extremely costly, accounting 10 View background material via the PRF CPG eAppendix for approximately two-thirds of initial hospitalization costs and estimated disability payments (Cross, 2011, Masini, 2009). Risk Factors and Emotional/Physical Impact Anxiety, post-traumatic stress disorder (PTSD), depression, premorbid psychiatric (...) adult orthopedic trauma. 3. Ethical issues associated with no screening given that cognitive, emotional, and social aspects of recovery are to be expected based on human illness behavior. 4. Ethical issues associated with no treatment given the evidence that cognitive behavioral therapy and its derivatives (as well as psychotherapy and medication) are effective at alleviating stress and psychological distress and fostering optimal cognitive coping strategies. 12 View background material via the PRF

2020 American Academy of Orthopaedic Surgeons

171. Overview of sport-related injuries

that requires swift diagnosis and treatment to prevent irreversible spinal cord injury and long-term disability. Acute spinal cord injury should be suspected in any patient following trauma, particularly when the trauma is to the head or neck and when the patient is unresponsive due to hypotension and has respiratory compromise. Can occur as a result of spine trauma, vertebral compression fracture, intervertebral disc herniation, primary or metastatic spinal tumour, or infection. The resulting spinal cord (...) subluxation or dislocation, labral tears, chondral injuries, and fractures. Chronic/overuse causes include bursitis, tendonitis, athletic pubalgia (sports hernia), osteitis pubis, snapping hip syndrome, and stress fractures. Holderbaum D, Haqqi TM, Moskowitz RW. Genetics and osteoarthritis: exposing the iceberg. Arthritis Rheum. 1999;42:397-405. http://onlinelibrary.wiley.com/doi/10.1002/1529-0131%28199904%2942:3%3C397::AID-ANR1%3E3.0.CO;2-X/pdf http://www.ncbi.nlm.nih.gov/pubmed/10088759?tool

2018 BMJ Best Practice

172. Overview of musculoskeletal pain

/jama/fullarticle/197628 http://www.ncbi.nlm.nih.gov/pubmed/14612481?tool=bestpractice.com Related conditions Condition Description Chronic fibrosing condition characterised by insidious, progressive, and severe restriction of both active and passive shoulder range of motion. Many patients experience shoulder pain, but shoulder pain is not an essential component of adhesive capsulitis. Although other fractures around and including the ankle can occur (such as distal tibial plafond fractures (...) ), the term 'ankle fracture' generally refers to the medial, lateral, or posterior malleolus. An inflammatory arthritis predominantly affecting the sacroiliac joints and axial spine. Inflammatory back pain is the hallmark clinical feature. This is defined as back pain/stiffness, which is worse in the morning and improves with exercise. Injury typified by sudden, painful, audible 'pop' noise. Patient typically presents with inability to return to activity, joint instability, and rapid development

2018 BMJ Best Practice

173. Adalimumab (Hefiya) - Juvenile Rheumatoid Arthritis, Hidradenitis Suppurativa, Psoriasis, Ankylosing Spondylitis, Uveitis

substance is stable under the recommended conditions. Supporting information on accelerated and stress stability data and data from thermal freeze/thaw cycles as well as photo-stability data have been provided. Comparability exercise for Active Substance The development activities include the initial development of the AS manufacturing process, the following scale up and transfer from the pilot scale to the manufacturing scale at different plants and lines. Comparability was demonstrated in data between (...) , and additional sampling demonstrate that the manufacturing process is reliable and delivers product of consistent quality. Hold and process times have been defined and are supported by adequate microbiological and physicochemical hold time studies. Adequacy of the established shipment conditions was verified by a transport validation study which included four shipments of Hefiya FP PFS from Mylan to Cook using qualified shipment containers and shippers. A potential impact of mechanical stress on quality

2018 European Medicines Agency - EPARs

174. Adalimumab (Halimatoz) - Juvenile Rheumatoid Arthritis, Psoriatic Arthritis, Rheumatoid Arthritis, Hidradenitis Suppurativa, Psoriasis, Ankylosing Spondylitis, Uveitis

-term stability data. The results demonstrate that Halimatoz active substance is stable under the recommended conditions. Supporting information on accelerated and stress stability data and data from thermal freeze/thaw cycles as well as photo-stability data have been provided. Comparability exercise for Active Substance The development activities include the initial development of the AS manufacturing process, the following scale up and transfer from the pilot scale to the manufacturing scale (...) FP PFS from Mylan to Cook using qualified shipment containers and shippers. A potential impact of mechanical stress on quality and integrity of Halimatoz bulk PFS was sufficiently addressed by a second transport validation study. A continued process verification program is in place to ensure process consistency throughout the life-cycle. To validate the assembly and packaging process three process runs were performed at Cook for each the NSD and AI. The presented AQL, IPC, functional testing

2018 European Medicines Agency - EPARs

175. Menopause

. Osteoporosis Osteoporosis is a condition of the skeleton in which bone strength is compromised, predisposing the woman to an increased risk of fracture (NOS, 2017). In the UK, 1-in-3 women and 1-in-12 men over the age of 50 will suffer a fragility fracture due to osteoporosis (Torgeson et al., 2001). The most common fracture sites are the femoral neck, forearm and spine (NICE, 2017c). As oestrogen levels decline, the risk of osteoporosis increases. The disease leads to weakness in the skeleton which can (...) continue for many years afterwards. Psychological problems It is unclear why psychological symptoms occur at the menopause, and these may well have little to do with hormonal fluctuations. Life stresses at this age, as well as past problems, are an obvious causative factor. Many women do not realise that the following symptoms are very normal at this stage of life and fear they may be on the verge of a breakdown: • loss of confidence • depressed mood • irritability • forgetfulness • difficulty

2018 Royal College of Nursing

177. Pharmacological Management of Osteoporosis in Postmenopausal Women Full Text available with Trip Pro

-risk thresholds for other age groups ( ). In the United States, pharmacological therapy is recommended for postmenopausal women with hip or vertebral fractures; those with T-scores of −2.5 or less in the femoral neck, total hip, or lumbar spine; and those with T-scores of −1 to −2.5 and a 10-year probability of ≥20% for major osteoporotic fractures or ≥3% for hip fractures based on the US-adapted FRAX tool ( ). BMD T-score is defined as the number of SDs from the mean BMD of white females age 20 (...) to 29 years in the Third National Health and Nutrition Examination Survey database. For the treatment of osteoporosis, only lumbar spine, total hip, and femoral neck BMD T-scores are usually considered. Data suggest that a recent fracture (within the past 2 years) is a better predictor of imminent fracture risk ( i.e. , risk of fracture within the next 2 years) than is a distant fracture history (>5 years ago) ( , ). This is true for recent vertebral fractures ( , ) as well as nonvertebral fractures

2019 The Endocrine Society

179. AIM Clinical Appropriateness Guidelines for Joint Surgery

and placement of a prosthesis anchored to the bone. Numerous implants composed of various biomaterials have been approved by the U.S. Food and Drug Administration (FDA) for use in hip arthroplasty. The goal of the procedure is long-term pain relief and restoration of function. Degenerative joint disease, or osteoarthritis, is the most common condition leading to the need for THA. Other conditions that may also cause significant hip joint damage include neoplasm, femoral fracture, avascular necrosis (...) Surgery 21 3. Department of Veterans Affairs DoDN-SMoHaKOWG, VA/DoD clinical practice guideline for the non-surgical management of hip and knee osteoarthritis., (2014) Washington DC, 126. 4. Goyal N, Chen AF, Padgett SE, et al. Otto Aufranc Award: A Multicenter, Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty. Clinical orthopaedics and related research. 2017;475(2):364-72. 5. Hagel A, Siekmann H, Delank KS. Periprosthetic femoral fracture - an interdisciplinary challenge. Dtsch

2019 AIM Specialty Health

180. Extremity imaging

scenario: ? Evaluation of acute shoulder pain following initial radiographs when imaging is required to establish the diagnosis and the patient is a candidate for corticosteroid or anesthetic injection IMAGING STUDY - MRI upper extremity joint Imaging of the Extremities Copyright © 2019. AIM Specialty Health. All Rights Reserved. 16 - CT may be utilized when MRI contraindicated Trauma Fracture Note: Sites at high risk for fracture include femoral neck/proximal femur, tibia (anterior/lateral), great toe (...) to persons of all ages. See the Coding section for a list of modalities included in these guidelines. Technology Considerations In general, conventional radiographs should be obtained prior to advanced imaging. Computed tomography (CT) is often the preferred modality for evaluation of displaced fractures and subluxations, whereas stress fractures and some incomplete and non-displaced fractures may be better imaged with magnetic resonance imaging (MRI) or radionuclide bone scintigraphy. Tendons

2019 AIM Specialty Health

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