Instructional course lectures
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The volume of total hip and knee arthroplasties continues to increase as the US population ages. The number of prosthetic complications, specifically those involving periprosthetic fractures, is also increasing. Periprosthetic fractures can be difficult to manage. ⋯ It is crucial to consider the fracture location, implant stability, and bone quality when determining a treatment plan. Expertise in both fracture management and joint reconstruction is often necessary to provide the best care and outcomes for patients. Although periprosthetic fractures are challenging, advancements in surgical techniques and available implants offer the surgeon tools to provide good outcomes and patient satisfaction.
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Intra-articular fractures of the tibial plateau, pilon, and calcaneus often present a challenge for the treating orthopaedic surgeon. These injuries can have substantial comminution in the joint and the metaphyseal areas and are often accompanied by considerable soft-tissue trauma. ⋯ These myths include the beliefs that most patients with intra-articular fractures will have poor outcomes even with good surgical treatment, severe intra-articular fractures require a later reconstructive procedure regardless of the treatment, and the surgical treatment of comminuted intra-articular fractures has a high complication rate and may result in infection and limit the available options for limb salvage. A review of the literature regarding the treatment of common intra-articular fractures is helpful in determining if these myths concerning treatment options can be confirmed or disproved.
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The midfoot is a complex association of five bones and many articulations between the forefoot metatarsals and the talus and calcaneus, which make up the hindfoot. These anatomic relationships are connected and restrained by an even more complex network of ligaments, capsules, and fascia, which must function as a unit to provide normal and painless locomotion. ⋯ Midfoot injuries range from single ligament strains to complicated fracture-dislocations involving multiple bones and joints. To provide best outcomes for patients, it is important to understand the anatomy and the mechanical function of the midfoot; to review the epidemiology, mechanism, and classification of injuries encountered in an orthopaedic clinical practice; and to review the principles, indications, and surgical techniques for managing midfoot fractures and dislocations.
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The management of some orthopaedic extremity injuries has changed over the past decade because of changing resource availability and the risks of complications. It is helpful to review the current literature regarding orthopaedic extremity emergencies and urgencies. The effects of the techniques of damage control orthopaedic techniques and the concept of the orthopaedic trauma room have also affected the management of these injuries. ⋯ Patient survival rates have improved with current resuscitative protocols. Definitive fixation of extremity injuries should be delayed until the patient's physiologic and extremity soft-tissue status allows for appropriate definitive management while minimizing the risks of complications. In patients with semiurgent orthopaedic injuries, the use of an orthopaedic trauma room has led to more efficient care of patients, fewer complications, and better time management for surgeons who perform on-call service for patients with traumatic orthopaedic injuries.
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Orthopaedic education is replete with unsubstantiated recommendations (myths) from predecessors in the field of orthopaedics. Even in the presence of sound evidence, some of these myths can be perpetuated through generations. ⋯ Today's physicians must decide whether the physical, emotional, and financial costs of limb salvage can be justified by the expected functional outcome. Accumulated evidence suggests that functional outcomes are similar for amputation and limb salvage, whereas those treated with limb salvage have more hospitalizations and longer treatment times.