Instructional course lectures
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The demand for total hip arthroplasty is increasing, as are patients' expectations to return to high activity levels. Metal-on-metal bearings are being used in an effort to maximize the longevity of primary hip replacements. Acetabular component inclination has been a recognized aspect of surgical technique for more than 20 years; it now is considered critical, especially in hip resurfacing or implantation of a stem-type device with a larger diameter femoral head and a monoblock acetabular component. It is important to understand the indications for using metal-on-metal bearings as well as the key clinical factors for avoiding early implant failure.
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Comparative Study
Mobile- versus fixed-bearing unicompartmental knee arthroplasty.
Unicompartmental knee arthroplasty using either a mobile- or fixed-bearing technique is an attractive alternative to osteotomy or total knee arthroplasty in selected patients with osteoarthritis. Both techniques appear to yield equivalent early results. ⋯ They also offer the potential for decreased long-term wear complications because of the high conformity of the articulation. The longevity of fixed-bearing components will likely be improved in the future with better prosthetic designs and improved polyethylene to minimize the incidence of late wear complications.
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The thumb trapeziometacarpal joint is a saddle joint that is subject to high compressive forces during prehensile hand function. Fractures to the base of the thumb metacarpal occur commonly following axial load to a partially flexed thumb. Although reduction is easily performed, severe deforming forces act to displace the fractures into a varus and shortened position. ⋯ Most Bennett fractures can be treated with closed reduction with percutaneous Kirschner wire fixation. Fractures with large Bennett fragments and Rolando fractures should be treated with open reduction and internal fixation to allow anatomic reduction with rigid fixation and early range of motion. Comminuted intra-articular fractures are challenging injuries that are best treated with application of an external fixator with limited open reduction and internal fixation, followed by bone grafting of metaphyseal bone defects if necessary.
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Periprosthetic fracture with preexisting severe loss of bone stock is a challenging condition to treat. Available surgical options can be divided into three categories: complex reconstruction of the deficient proximal femur with secure distal fixation; segmental substitution of the proximal femur with a megaprosthesis or allograft/stem composite; and distally fixed replacement with a modular stem, which acts as a scaffold around which the remaining deficient proximal bone can be assembled, to unite and possibly reconstitute.
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Fractures of the foot and ankle are common injuries that often are successfully treated nonsurgically; however, some injuries require surgical intervention. To restore anatomy and avoid the need for additional surgery, surgeons must pay attention to detail and understand common, avoidable complications. The surgeon should have an understanding of the pathologic characteristics of three common injuries of the foot and ankle as well as the potential complications and their prevention.