[Expert Opinion on Surgical Care Pathway Management of Neurologic Patients From Neuro-Urology Committee of the French National Association of Urology (AFU)].
[Expert opinion on surgical care pathway management of neurologic patients from neuro-urology committee of the French national association of urology (AFU)].
Prog Urol. 2013 Apr; 23(5): 309-16
Caremel R, Phé V, Bart S, Castel-Lacanal E, De Sèze M, Duchene F, Bertrandy-Loubat M, Mazerolles M, Scheiber-Nogueira MC, Karsenty G, Gamé X
The surgical care pathway of neurologic patients has two aims: preventing urinary morbidity and mortality and improving their quality of life. It requires taking into account the specificities of disabilities in domains of body functions: circulatory, ventilation and digestive physiology, motor functions, sensory functions, mental functions, and skin fragility which are responsible of dependencies in this heterogeneous group of patients. This management is necessarily multidisciplinary to be optimal and through specific clinical care pathway, providing guidance to the surgical procedure: preparation of the surgery, its realization, and post-operative rehabilitation. The indication for surgery must be coordinated and validated in neuro-urology multidisciplinary staff. Preoperative stay in a physical and rehabilitation medicine center may be useful to ensure a complete assessment and anticipate problems related to surgery. The patient will be hospitalized in the urology department in a single room suited to their disabilities and handicaps. The chronic treatments should be not modified if possible. The lack of sensitivity does not dispense anesthesia to prevent autonomic hyperreflexia, the most severe complication after high complete spinal cord injury. The laparoscopy and sub-peritoneal surgery, the early removal nasogastric tube and early refeeding make it possible to early resumption of intestinal transit. In many cases, the patients should be transferred to a physical and rehabilitation medicine during post-operative period where the nursing care will be most suitable. A quickly adapted rehabilitation must be able to reduce loss of function and physical dependence. HubMed – rehab
Osteoporotic ankle fractures.
Orthop Clin North Am. 2013 Apr; 44(2): 225-41
Olsen JR, Hunter J, Baumhauer JF
Ankle fractures are one of the most common injuries in the elderly and their incidence is anticipated to increase over the next 20 years. Appropriate management of ankle fractures in this population requires an understanding of the issues unique to the elderly. Osteoporosis must be considered when counseling patients about their ankle fracture. Good outcomes can be achieved with surgical fixation of ankle fractures in the elderly. Postoperative complications are higher in patients with diabetes and peripheral vascular disease, and in patients who smoke. This article reviews how to evaluate and treat ankle fractures in elderly patients with osteoporosis, evaluates the outcomes, and discusses surgical techniques. HubMed – rehab
Osteoporotic pelvic ring injuries.
Orthop Clin North Am. 2013 Apr; 44(2): 217-24
Leslie MP, Baumgaertner MR
As with most fractures associated with osteoporosis, the incidence of pelvic ring injuries in this population of patients is rising rapidly. Osteoporotic pelvic ring injuries are exceedingly different in their etiology, natural history, and treatment from the more recognizable patterns in young patients with high-energy pelvic ring injuries. Recognition of a potentially unstable fracture pattern, careful evaluation of the ambulatory and functional status of each patient before injury, and the potential pitfalls and benefits of operative versus nonoperative care are critical to the effective treatment. HubMed – rehab