Instructional course lectures
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The need for surgical treatment of femoral shaft and distal femoral fractures is undisputed. The treatment options are varied, and often the choice is based on the surgeon's preference rather than orthopaedic science. ⋯ The primary goal of treatment for a supracondylar femoral fracture is to restore limb alignment while preventing angular deformity. Proper technique, not the choice of a nail or plate, is key to recovery.
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Surgical management of a thoracolumbar fracture varies according to many factors. Fracture morphology, neurologic status, and surgeon preference play major roles in deciding on an anterior, a posterior, or a combined approach. ⋯ Unstable burst fractures can be treated with anterior-only fixation using a strut graft and a modern thoracolumbar plating system or with a posterior-only construct using pedicle screws and possibly hooks. A circumferential construct is considered for extremely unstable injuries.
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Two factors are primarily responsible for complications after treatment of proximal femoral fractures. First, the strong deforming forces across the hip joint and proximal femur can make fracture reduction difficult. ⋯ In intertrochanteric fractures, lag screw cutout can be prevented by correct implant positioning. In femoral neck fractures, nonunion can be avoided by careful attention to reduction and hardware positioning.
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Adequate control of postoperative pain following hip and knee arthroplasty can be a challenging task fraught with potential complications. Postoperative pain is perceived by the patient via a complex network and a multitude of molecular messengers in both the peripheral and central nervous systems. ⋯ Using both contemporary and traditional pain modulators, the delivery and timing of these medications can affect postoperative pain and, ultimately, rehabilitation of the arthroplasty patient. Current techniques for controlling pain use both multimodal and preemptive analgesia to improve the outcome of the surgery while minimizing the potential adverse effects of the medications given.
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Femoral neck fractures in physiologically young adults, which often result from high-energy trauma, are less common than intracapsular femoral neck fractures in elderly patients. They are associated with higher incidences of femoral head osteonecrosis and nonunion. Understanding the multiple factors that play a significant role in preventing these complications will contribute to a good outcome. ⋯ The timing of the open reduction and internal fixation is controversial. Until conclusive data are available through prospective, controlled studies, performing a capsulotomy followed by open reduction and internal fixation on an urgent basis is recommended. The goals of treating femoral neck fractures should include early diagnosis, early surgery, anatomic reduction, capsular decompression, and stable internal fixation.