The Orthopedic clinics of North America
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Orthop. Clin. North Am. · Oct 2019
ReviewPosttraumatic Arthritis After Intra-Articular Distal Femur and Proximal Tibia Fractures.
Posttraumatic arthritis (PTA) is a form of joint degeneration that occurs after physical trauma to a synovial joint. Development of PTA is multifactorial and results from mechanical damage at the time of trauma, a cell-mediated inflammatory response, and abnormal articulation due to persistent malalignment or joint instability. Although some risk factors may be unavoidable, preventing the development of PTA of the knee after intra-articular fracture (IAF) requires restoring anatomic articulation and alignment. Reconstruction with total knee arthroplasty is the treatment of choice for PTA and may be a useful primary treatment for IAF in some.
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Orthop. Clin. North Am. · Jul 2019
Review Case ReportsArthroscopic-Assisted Reduction of Tibial Plateau Fractures.
Arthroscopic reduction of tibial plateau fractures have been gaining in popularity. Advantages include accurate diagnosis and treatment of joint pathology, minimally invasive soft tissue dissection, quicker recovery of joint motion, and anatomic reduction of joint surface. ⋯ With arthroscopic-assisted reduction of tibial plateau fractures, patient set-up is similar to standard knee arthroscopy, but the C-arm is used to aid with fracture reduction and fixation. Outcomes are comparable or even improved when compared with standard procedures, and morbidity with arthroscopic reduction can often be lower with decreased rates of infection, wound complications, and thromboembolism.
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Orthop. Clin. North Am. · Jul 2019
ReviewThe Canary in the Coal Mine: Wellness Among Pediatric Orthopedic Surgeons.
Physician burnout is a pervasive problem affecting our workforce. More than one-third of surveyed pediatric orthopedists are experiencing symptoms of burnout. ⋯ Both personal strategies to foster resilience and systemic responses to make space for supporting physician wellness are required to truly effect change. Mindfulness is a studied tool that can be easily and strategically implemented to help combat physician burnout.
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Orthop. Clin. North Am. · Oct 2018
ReviewPerioperative Safety: Keeping Our Children Safe in the Operating Room.
The entire operating room team is responsible for the safety of children in the operating room. As a leader in the operating room, the surgeon is impactful in ensuring that all team members are committed to providing this safe environment. This is achieved by the use of perioperative huddles or briefings, the use of appropriate surgical checklists, operating room standardization, surgeons proficient in the care they provide, and team members that embrace Just Culture.
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Orthop. Clin. North Am. · Apr 2018
ReviewArticular Incongruity in the Lower Extremity: How Much Is Too Much?
Intraarticular fractures carry a significant risk for posttraumatic osteoarthritis, and this risk varies across different joint surfaces of the lower extremity. These differences are likely due to the anatomic and biomechanical specifics of each joint surface. High-quality human studies are lacking to delineate the threshold articular incongruity that significantly increases risk for posttraumatic osteoarthritis and diminished clinical outcomes for many joint surfaces. Even with anatomic reduction of the articular surface, close attention must be paid to mechanical axis and joint stability to optimize outcomes.