Instructional course lectures
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Rapid advances in the field of orthopaedic trauma have improved treatment options while keeping pace with the changing characteristics of the trauma population. The availability of locking implants has changed the approach to treating fractures in older patients with osteoporotic bones as well as in those with comminuted and complex injuries. Minimally invasive approaches have allowed the preservation and protection of soft tissues while allowing adequate reduction and fixation of fractures. This biologically friendly approach coupled with newer implants and instruments will improve early and long-term outcomes in trauma care.
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Hallux valgus correction by distal soft-tissue release and proximal metatarsal osteotomy is the procedure of choice for most patients with moderate and severe hallux valgus deformity. Complications can be avoided by selecting a procedure that provides adequate correction of the intermetatarsal angle and ensuring proper balancing of the metatarsophalangeal joint though lateral soft-tissue releases and medial joint plication. Arthrodesis should be considered when revision of failed surgery is planned, degenerative joint disease is present, and where the likelihood of failure of a bunion procedure is high (such as in elderly individuals with osteoporosis, severe deformity with significant involvement of the lesser metatarsophalangeal joint, and when spasticity is present). A review of biomechanical data, clinical studies, and surgical techniques is important for successful treatment of moderate and severe hallux valgus deformity.
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It is important for physicians who treat upper extremity disorders to understand motor palsy or pain syndromes caused by compression of the median and radial nerves about the elbow and forearm. Patients with anterior interosseous nerve syndrome may report hand weakness, whereas those with pronator syndrome may present with pain and paresthesia that can be confused with carpal tunnel syndrome. Patients with posterior interosseous nerve syndrome report hand weakness, whereas those with radial tunnel syndrome report pain in the lateral elbow and forearm, which may be confused with lateral epicondylitis. Because each syndrome has overlapping symptoms, serial examinations are needed to determine the correct diagnosis.
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The indications for thoracic pedicle screw fixation have expanded over the past decade. Thoracic pedicle screws are now being used in the treatment of degenerative, traumatic, neoplastic, congenital, and developmental disorders. ⋯ With strict adherence to the surgical techniques of insertion, thoracic pedicle screw fixation is a safe and effective method of stabilization. It offers several advantages over other forms of fixation, especially in the upper thoracic spine where the options are limited.
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Plate fixation of fractures began before the start of the 20th century. Initially, plates and screws were used to decrease deformity. There was minimal interest in the biology of fracture union. As knowledge increased in regard to the science of bone healing, fixation techniques and implants also evolved, from the development of rudimentary rigid constructs to stable locked plating.