Instructional course lectures
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The metaphyseal deformity, in even a mild slipped capital femoral epiphysis (SCFE), results in acetabular labral and cartilage injury. SCFE is the most extreme form of femoroacetabular impingement, and the mechanism of cartilage and labral injuries is similar. ⋯ In situ pinning is the most effective treatment to halt short-term slip progression; outcomes are favorable in many hips. In medical centers with substantial experience with hip preservation techniques, open or arthroscopic osteochondroplasty can be used to treat mild SCFE, and a modified Dunn epiphyseal reorientation can be used for more severe deformities to decrease the potential for secondary osteoarthritis.
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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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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.