Instructional course lectures
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The indications for thoracic pedicle screw fixation have expanded over the past decade. Thoracic pedicle screws are now being used in the treatment of degenerative, traumatic, neoplastic, congenital, and developmental disorders. ⋯ With strict adherence to the surgical techniques of insertion, thoracic pedicle screw fixation is a safe and effective method of stabilization. It offers several advantages over other forms of fixation, especially in the upper thoracic spine where the options are limited.
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Plate fixation of fractures began before the start of the 20th century. Initially, plates and screws were used to decrease deformity. There was minimal interest in the biology of fracture union. As knowledge increased in regard to the science of bone healing, fixation techniques and implants also evolved, from the development of rudimentary rigid constructs to stable locked plating.
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Review
Radiculopathy and the herniated lumbar disk: controversies regarding pathophysiology and management.
Lumbar disk herniation is one of the most common problems encountered in orthopaedic practice. Despite the frequency of its occurrence, however, much about lumbar disk herniation is poorly understood. It is important to review the basic and clinical science underlying the pathophysiology and treatment, surgical and nonsurgical, of this disorder.
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A significant proportion of patients will experience moderate to severe pain after hip or knee replacement surgery. Multimodal pain control regimens have been developed to address this issue. ⋯ Cyclooxygenase-2 inhibitors, a class of NSAIDs, are not believed to increase the risk of bleeding and may be useful in this population of patients. However, recent research shows increased cardiovascular and renal risks with cyclooxygenase-2 inhibitors and has limited their use for postoperative pain control in joint arthroplasty patients.
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Theoretically, an appropriately designed and implemented multimodal pain protocol should reduce postoperative pain levels, need for narcotic medication, and adverse events while improving functional recovery including ambulation, discharge from hospital, range of motion, and return to work. A complete, perioperative multimodal pain protocol for total hip replacement and total knee replacement, including use of a novel periarticular injection, has been described and early clinical results are reported.