Instructional course lectures
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Scaphoid fractures are among the most common fractures of the bones of the wrist and usually result from a forceful extension of the wrist. If the diagnosis cannot be established by clinical and radiographic examination, bone scans are recommended and are preferred over tomography or MRI, which are more expensive diagnostic procedures. Scaploid fractures should be classified as either undisplaced, stable or displaced, unstable. ⋯ The recommended treatment for unstable scaphoid fractures is open reduction and screw fixation. Closed reduction and percutaneous screw or pin fixation can be considered in minimally displaced or reducible fractures, whereas open reduction is recommended for all other displaced fractures. The following treatment protocols are recommended: (1) bone scan or, if necessary, tomography for early diagnosis; (2) percutaneous screw fixation of nondisplaced or minimally displaced scaphoid fractures as an alternative to treatment with a thumb spica cast; (3) open reduction of displaced scaphoid fractures; (4) early mobilization of stable fractures after internal fixation; and (5) the possible use of a playing splint after athletic injuries when secure internal fixation is achieved.
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Compression of the spinal cord and nerve roots caused by spondylotic changes or disk herniations is the most common etiology for cervical myelopathy, radiculopathy, or myeloradiculopathy. Surgical intervention in treating these conditions has been very successful. Anterior approaches to the cervical spine are being used for the treatment of cervical radiculopathy and myelopathy. The technical aspects of anterior diskectomy and corpectomy, methods of fusion, and the use of instrumentation are important treatment considerations.
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Degenerative cervical disk disease is a ubiquitous condition that is, for the most part, asymptomatic. When symptoms do arise as a result of these degenerative changes, they can be easily grouped into axial pain, radiculopathy and myelopathy. While the pathophysiology of radiculopathy and myelopathy is better understood, the source of neck pain remains somewhat controversial. ⋯ The natural history of these conditions suggests that for the most part patients with axial symptoms are best treated without surgery, while some patients with radiculopathy will continue to be disabled by their pain, and may be candidates for surgery. Myelopathic patients are unlikely to show significant improvement, and in most cases will show stepwise deterioration. Surgical decompression and stabilization should be considered in these patients.
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Review
Fractures of the distal aspect of the radius: changes in treatment over the past two decades.
Fractures of the distal end of the radius are among the most common orthopaedic injuries, and treatment of these fractures has changed over the course of time. Many fractures of the distal radius are in fact relatively uncomplicated and are effectively treated by closed reduction and casting. However, fractures that are either unstable and/or involve the articular surfaces can jeopardize the integrity of the articular congruence and/or the kinematics of these articulations. ⋯ The fracture pattern, degree of displacement, the stability of the fracture, and the age and physical demands of the patient determine the best treatment option. Over the past 20 years, there has been a development of more sophisticated internal and external fixation techniques and devices for the treatment of displaced fractures of the distal radius. The use of percutaneous pin fixation, external fixation devices that permit distraction and palmar translation, low profile internal fixation plates and implants, arthroscopically-assisted reduction, and bone grafting techniques including bone graft substitutes all have contributed to improving fracture stability and outcome.
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Knee injuries commonly occur in children and adolescents who participate in athletic activities. Open growth plates, apophyses, and chondroepiphyses are unique to the skeletally immature knee and account for the differences in injury patterns observed in children and adults. An understanding of anatomy and classification as related to treatment and outcome of fractures in the skeletally immature knee is important.