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Compartment syndrome due to massive leg hematoma after primary total hip arthroplasty: a previously unreported complication of fondaparinux

Hannon, Michael G; Lamont, Justin G
Fondaparinux is an accepted form of deep venous thrombosis prophylaxis after hip arthroplasty. Cited advantages of its use include once-daily administration, standard dosage, and superiority as compared with enoxaparin. However, there have been several case reports of serious associated bleeding complications. We describe the case of a 77-year-old woman who developed a massive leg hematoma in the operative extremity nearly 3 weeks after a primary total hip arthroplasty while on fondaparinux. The patient developed a compartment syndrome requiring decompression of the hematoma, fasciotomy, and subsequent additional plastic surgery for split thickness skin grafting.
PMID: 22177799
ISSN: 0883-5403
CID: 178215

Surface replacement arthroplasty of the hip

Schachter, Aaron K; Lamont, Justin G
Treatment of the young patient with degenerative disease of the hip has historically been a difficult problem for the orthopaedist. Total hip arthroplasty in the young patient has generally produced inferior results as compared to older patients. Surface replacement arthroplasty (SRA) was initially developed over 50 years ago to treat degenerative disease of the hip. It has regained enthusiasm over the last 10 to 15 years as an alternative to total hip arthroplasty for the treatment of degenerative disease of the hip in younger patients. The modern metal-on-metal bearing provides improved wear characteristics over its metal-on-polyethylene predecessor. Multiple studies have demonstrated mid-term results of metal-on-metal SRA, which are comparable to total hip arthroplasty. The long-term survival data of SRA remains to be seen, as does the long-term effect of elevated serum ion levels
PMID: 19302061
ISSN: 1936-9719
CID: 99289

Retrieval of a trial femoral head that displaces into the periacetabular soft tissue during mini-incision total hip arthroplasty. A case report [Case Report]

Alfonso, Daniel; Idjadi, Jeremy; Lamont, Justin G
PMID: 16595480
ISSN: 0021-9355
CID: 64475

Sjogren's syndrome: a critical review of clinical management

Bell, M; Askari, A; Bookman, A; Frydrych, S; Lamont, J; McComb, J; Muscoplat, C; Slomovic, A
Sjogren's syndrome (SS) is greatly under recognized in clinical practice, primarily for 2 reasons: its presentations are variable and often nonspecific and there are still no clear, uniform diagnostic criteria for this clinical entity. The prevalence, natural history, pathogenesis, and clinical taxonomy of SS are still not well understood. Potential criteria include both subjective symptoms and objective criteria such as measurements of salivary and tear flow, minor salivary gland biopsy, and an increasing variety of serological markers. Physicians often fail to appreciate the profound impact of SS on quality of life. Therefore, screening for SS should include questions exploring symptoms in terms of their effect on the patient's daily life. At present, there is no curative treatment for SS. For symptom relief, local treatments (such as artificial tears or oral topical sprays) are limited in their effects, whereas systemic treatment offers the advantage of addressing a wider range of symptoms. Controlled studies show that oral pilocarpine significantly improves sicca symptoms in the eyes, mouth, and other sites. Clinical experience to date suggests it is safe and well tolerated, with no serious adverse effects, tachyphylaxis, or drug to drug interactions of concern. The most frequent adverse effects are sweating, urinary frequency, diarrhea, and other parasympathomimetic effects, but these do not lead to substantial drug withdrawal rates. Patients should be forewarned that subjective improvement may lag behind improvement in objective measures. Because management often spans several specialties, coordination among them is essential. Dental, gynecological, and ophthalmological perspectives on diagnosis and management are discussed; the primary practitioner has the opportunity to play both a coordinating role and a direct role in early diagnosis and treatment.
PMID: 10493692
ISSN: 0315-162x
CID: 717532

Sacroiliac joint injuries

Chapter by: Lamont, JG
in: Spinal trauma by Errico, Thomas J; Bauer, R. David; Waugh, Theodore R [Eds]
Philadelphia : Lippincott, c1991
pp. 351-374
ISBN: 9780397509836
CID: 718572

Immediate spica casting for pelvic fractures

Cotler HB; LaMont JG; Hansen ST Jr
Records of 52 polytraumatized patients with closed pelvic fractures were reviewed retrospectively to determine if spica cast application decreased mortality due to exsanguination. Twelve patients had supplemental stabilization with external fixators or internal fixation of the pelvis. Their results indicated that the spica cast is effective in decreasing or controlling bleeding since no patient died of exsanguination. Several patients did die, however, but the cause of death in these patients was usually adult respiratory distress syndrome with or without other sepsis. Injury severity score, age, hypotension, and platelet count were found to be prognostic indicators for both transfusion requirements and mortality. A spica cast may be a useful adjunctive method for decreasing blood loss in the immediate postinjury period, but prolonged or improper use may lead to additional complications and death
PMID: 3225708
ISSN: 0890-5339
CID: 22531

Radiographic evaluation of modern orthopedic fixation devices

Richardson ML; Kilcoyne RF; Mayo KA; Lamont JG; Hastrup W
Orthopedic surgeons employ a wide variety of modern fixation devices in the treatment of fractures. In order to assess these instruments correctly, the radiologist should be aware of both their purpose and their normal appearance. A review of the common internal and external fixation devices used at a major trauma center and the complications of their use has been presented
PMID: 3329363
ISSN: 0271-5333
CID: 22532

Tibial plateau fractures: CT evaluation and classification

Rafii M; Lamont JG; Firooznia H
Fractures of the tibial plateau consist of two important components. One is depression of the plateau surface and the other a detached and peripherally displaced component referred to as the split fragment. The classification of these fractures is based on the morphologic appearance as well as the location of the above components. The surgical treatment of these fractures is dependent upon several factors, including the type of fracture, the degree of the fracture depression, and fracture fragment separation as well as the patient's age and physical condition. The degree of the plateau depression is a particularly important criteria for surgical-treatment planning. However, the anatomic configuration of the proximal tibia is such that the fractures of these regions are not adequately visualized on conventional radiographs. In the past, conventional tomography was routinely employed for evaluation of tibial plateau fractures. Recently, computed tomography (CT) has shown to be a more accurate and easier method for evaluation of these fractures. CT can be performed without removal of the knee brace or cast and usually requires less than 12 axial images. Furthermore, the degree of fracture separation and depression can be measured by computerized technique. CT scanning is a reliable method for evaluation and an accurate classification of tibial plateau fractures
PMID: 3608544
ISSN: 1040-8371
CID: 22533

Functional anatomy of the lower limb

LaMont JG
To understand the functional anatomy of the lower limb, one must apply one's knowledge of the gross anatomy to the gait cycle. Gait analysis then leads to a better understanding of the function and dysfunction seen in the lower limb. Data from biochemical studies help one appreciate the forces the major joints are subjected to. These loads are three to five times body weight. The reason normal gait is so smooth is that there is minimal motion of the center of gravity located in the pelvis. Supple joints and good muscle strength are needed or gait disturbances result
PMID: 3769390
ISSN: 0094-1298
CID: 22534

Alternative method for removing an impacted AO intramedullary nail [Case Report]

Yoslow W; LaMont JG
An intramedullary femoral nail became impacted after approximately one third of it had been removed by standard AO technique in a 28-year-old man. Vise-grip pliers were used to twist the nail into a cigar-wrapper shape. While the standard nail removal should always be tried first, this method, although arduous and time-consuming, should be considered when faced with the possibility of having to split the femur or saw through the impacted nail
PMID: 3955955
ISSN: 0009-921x
CID: 47467