Instructional course lectures
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A concussion is defined as a complex pathophysiologic process affecting the brain that is induced by traumatic biomechanical forces. Concussions are caused by a direct or indirect blow that leads to a graded set of syndromes characterized by functional rather than structural disturbances to the brain. Concussions are characterized by a wide variety of presenting symptoms, including loss of consciousness, amnesia, confusion, headache, and nausea. ⋯ Computerized neuropsychologic testing is a new tool in the treatment of concussions. These tests measure memory, new learning, attention, and reaction time and should be used as an adjunct to other tools for clinical decision making. Published guidelines will assist in treatment decisions; however, it should be kept in mind that all concussions are unique injuries.
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Although total hip arthroplasty has been shown to be an effective surgical procedure, long-term outcomes are compromised by wear of the bearing surfaces. Recent technologic advances have been made in the design of bearing surfaces that offer extended performance to these artificial joints.
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The evaluation of injury of the cervical spine in children is complicated by biomechanics of the pediatric cervical spine that differ from those in the adult, by incomplete maturation and ossification of the vertebral segments, and by difficulties the physician may have in communicating with the child. Because the upper cervical region, from occiput to C2, is most susceptible to injury in children, it is important to have an understanding of mechanisms of injury, diagnostic imaging modalities, and therapeutic interventions. A clear understanding of adult and pediatric cervical spine differences will facilitate early diagnosis and appropriate treatment of cervical spine injuries in young children.
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Total hip arthroplasty was originally indicated for older, sedentary patients because of concerns that catastrophic wear and failure would occur in younger and more active patients. With advances in implant design, tribology, and surgical technique, total hip arthroplasty has now become a viable option for younger patients seeking excellent pain relief and improvement in function. Long-term studies are needed to evaluate the outcome of hip arthroplasty in younger patients using the modern generation of implants and bearing surfaces.
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Fixed sagittal imbalance of the spine leads to a disabling posture with compensatory hip and knee flexion. The most common causes of fixed sagittal imbalance include degenerative lumbar disease, complications from the use of distraction instrumentation in the lower lumbar spine, ankylosing spondylitis, and posttraumatic kyphosis. Surgical procedures to correct sagittal deformities include the posterior Smith-Petersen osteotomy, pedicle subtraction osteotomy, and posterior vertebral column resection. ⋯ Current reports of these procedures stress the importance of patient selection, radiographic evaluation, and meticulous surgical technique. Complications include excessive blood loss, incomplete correction, wound infection, and pseudarthrosis. Most patients who are treated with these procedures report a high level of satisfaction with the outcome.