Instructional course lectures
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The two-incision minimally invasive technique for total hip arthroplasty is described in detail, with attention to pearls of technique, for a prospective group of 200 patients, as well as a matched-pair group of 43 patients who underwent either the two-incision procedure or the mini-incision (single-incision posterior) procedure. The importance of a total hip critical pathway is emphasized, and the economic benefits are presented. Results reveal that the two-incision and mini-incision techniques have acceptable complication rates, are cost effective, and are beneficial to the patient, with reduced hospital stays, high patient satisfaction, and earlier return to function.
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Performing hip arthroscopy with the patient in the lateral decubitus position is advantageous in aiding in visualization of the hip joint, in maneuvering instruments in obese patients, and in facilitating entry to the hip joint in patients with spurs on the anterolateral aspect of the acetabulum. The patient is placed in the lateral decubitus position with the hip on which the surgery is being performed on the top. The leg is placed in traction and a well-padded perineal post is applied for countertraction. ⋯ A regular traction table requires adjustments of the perineal and traction posts to apply traction to the leg of a patient in the lateral decubitus position. Special traction devices make setup easier. The lateral approach to hip arthroscopy provides a safe and consistent method of entering, visualizing, and performing surgical procedures on the hip.
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Injuries of the cervical spine in the pediatric and adolescent athlete are less common than other musculoskeletal injuries. Although many of these injuries are relatively minor, serious and potentially unstable or progressive spinal injury must be excluded. Important anatomic differences between the child younger than 10 years and older children and adolescents influence the types of injuries sustained and make assessment of the child's cervical spine sometimes difficult for practitioners accustomed to treating adolescent and adult athletes. ⋯ Young athletes sustain CCN secondary to hypermobility of the immature cervical spine. Return to play after these injuries is controversial. The athlete with Down syndrome and potential cervical hypermobility requires a careful cervical and neurologic evaluation prior to clearance for participation in sports.
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A concussion is defined as a complex pathophysiologic process affecting the brain that is induced by traumatic biomechanical forces. Concussions are caused by a direct or indirect blow that leads to a graded set of syndromes characterized by functional rather than structural disturbances to the brain. Concussions are characterized by a wide variety of presenting symptoms, including loss of consciousness, amnesia, confusion, headache, and nausea. ⋯ Computerized neuropsychologic testing is a new tool in the treatment of concussions. These tests measure memory, new learning, attention, and reaction time and should be used as an adjunct to other tools for clinical decision making. Published guidelines will assist in treatment decisions; however, it should be kept in mind that all concussions are unique injuries.
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The evaluation of injury of the cervical spine in children is complicated by biomechanics of the pediatric cervical spine that differ from those in the adult, by incomplete maturation and ossification of the vertebral segments, and by difficulties the physician may have in communicating with the child. Because the upper cervical region, from occiput to C2, is most susceptible to injury in children, it is important to have an understanding of mechanisms of injury, diagnostic imaging modalities, and therapeutic interventions. A clear understanding of adult and pediatric cervical spine differences will facilitate early diagnosis and appropriate treatment of cervical spine injuries in young children.