Instructional course lectures
-
The principles and techniques used to reduce or eliminate blood transfusions can be applied to the standard practice of orthopaedic surgery. The overall goal is to enable orthopaedic surgeons who are interested in reducing allogeneic transfusions to find a method that fits their practice.
-
The symptoms associated with lumbar spinal stenosis can decrease quality of life and may cause patients to seek treatment. Except in rare cases of rapid neurologic progression or cauda equina syndrome, nonsurgical modalities should be the initial treatment choice. Activity modification, a variety of medications, epidural steroid injections, and other methods are recommended for pain reduction. ⋯ Arthrodesis, either with or without instrumentation, is also indicated in some patients. Several studies report that surgical treatment produces better outcomes than nonsurgical treatment in the short term; however, the results tend to deteriorate with time. Lumbar decompressive surgery can be complicated by epidural hematoma, deep venous thrombosis, dural tear, infection, nerve root injury, and recurrence of symptoms.
-
Unstable pelvic ring injuries in hemodynamically unstable patients are life-threatening emergencies that many orthopaedic surgeons encounter in practice. Therefore, it is important to be up to date regarding current methods of evaluating, assessing, and treating patients with these complex and severe injuries. Surgeons should first determine whether patients have hemodynamic instability and identify the source of the hemorrhage. Patients should then be assessed for stabilization of unstable pelvic ring injuries.
-
Adolescent idiopathic scoliosis is a three-dimensional deformity of the spine. Despite active efforts by different research teams, the etiology of scoliosis remains unclear. Treatment of scoliosis requires a solid understanding of the natural history of the disorder as well as sound clinical judgment. ⋯ Bracing is the only nonsurgical measure proven to have any effect on halting the progression of scoliosis. Other forms of conservative treatment have not been shown to significantly modify the natural history of idiopathic scoliosis. Bracing results are directly related to compliance with brace treatment; therefore, optimal results cannot be achieved without the patient's cooperation and family support.
-
The Lenke and associates classification system of adolescent idiopathic scoliosis (AIS) was developed to provide a comprehensive and reliable means to categorize all surgical AIS curves. This classification system requires analysis of the upright coronal and sagittal radiographs along with the supine side bending radiographic views. The triad classification system consists of a curve type (1-6), a lumbar spine modifier (A, B, C), and a sagittal thoracic modifier (-, N, +). ⋯ The recommendations are that the major and structural minor curves are included in the instrumentation and fusion and the nonstructural minor curves are excluded. Overall, the classification system is treatment directed; however, there are other aspects of the radiographic and clinical deformity that may suggest deviation from the recommendations of the classification system. The ultimate goal of this classification system is to allow organization of similar curve patterns to provide comparisons of various treatment methods to provide optimal treatment for each AIS surgical patient.