Instructional course lectures
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Although periprosthetic fractures of the acetabulum are relatively uncommon after total hip arthroplasty, a variety of patient-, surgeon-, and implant-related risk factors can contribute to the occurrence of this serious complication. These risk factors, combined with the increased use of cementless acetabular cups, will likely result in an increased prevalence of these fractures in the future. By better understanding the risk factors, classification schemes, and treatment options for periprosthetic fractures of the acetabulum, orthopaedic surgeons can achieve better outcomes for their patients.
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Safety information in spine surgery is important for informed patient choice and performance-based payment incentives, but measurement methods for surgical safety assessment are not standardized. Published reports of complication rates for common spinal procedures show wide variation. Factors influencing variation may include differences in safety ascertainment methods and procedure types. ⋯ The observed frequency of adverse events is influenced by the ascertainment modality. Voluntary reports by surgeons and other team members missed more than 50% of the events identified through a medical records review. Increased surgery invasiveness, measured from medical records or billing codes, is quantitatively associated with an increased risk of adverse events.
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Iatrogenic nerve injuries frequently occur during procedures around the hand and wrist, although they are not always recognized at the time of injury or in the immediate postoperative period. Because preventing injuries is of paramount importance, extensive knowledge of the anatomy of the at-risk nerves is critical. Best results occur after immediate repair because a substantial delay before secondary surgery diminishes the chances for recovery from motor or sensory nerve dysfunction and relief from pain. It is helpful to review iatrogenic nerve injuries associated with common hand surgical procedures.
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Disorders of the patellofemoral joint are commonly seen in musculoskeletal clinics. In recent years, the expansion of imaging techniques, improvements in correlative injury anatomy, and more focused physical examinations have resulted in new knowledge about patellofemoral disorders. To achieve optimal patient outcomes, it is helpful for orthopaedic surgeons who treat knee problems to review the management of patellar dislocations and isolated patellofemoral arthritis, including treatment algorithms.
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The management of complex spinal deformities in the growing child continues to evolve. The implementation of new techniques and biomaterial constructs has improved outcomes of deformity correction procedures but has also led to unforeseen complications. ⋯ These complications can lead to poor cosmesis, function, and quality of life, and a higher risk for revision surgery. Although postoperative spinal imbalance develops in few children, diligent monitoring of patients with predisposing risk factors for decompensation will allow surgeons to better predict, manage, and potentially prevent these complications.