Instructional course lectures
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Although almost any spinal deformity can occur in any skeletal dysplasia, there are specific spinal problems in each disorder that require periodic assessment and a particular awareness. Atlantoaxial instability frequently accompanies spondyloepiphyseal dysplasia congenita and Morquio's syndrome. Severe progressive kyphoscoliosis is found in diastrophic dysplasia. ⋯ The most common deformity found in skeletal dysplasias as a whole seems to be kyphosis: cervical kyphosis in diastrophic dysplasia and thoracolumbar kyphosis in achondroplasia, pseudoachondroplasia, and many of the short-stature syndromes of metabolic etiology. Spinal stenosis is extremely common in achondroplasia, both at the lumbar and cervical areas. It is important to establish the correct diagnosis early so that the orthopaedist is able to focus on the areas at highest risk of developing spinal problems, and proceed with efficacious and timely treatment.
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Certain factors regarding amputation level, such as the level of traumatic amputation, the position of a malignant tumor in a limb, or the level to which gangrene has progressed, cannot be changed. More important, in this regard, is the attitude of the surgeon toward amputation. This attitude determines the care with which the final level is selected, the manner in which the amputation is performed, and the way in which postoperative management, including prosthetic care, is handled. To achieve the desired long-term result for the amputee, the surgeon should view amputation as a reconstructive procedure rather than a destructive one, should be willing to do staged procedures to preserve potentially functional tissue, should be ready to consider and plan innovative surgical approaches, and should keep abreast of prosthetic advances as they affect surgical technique and postoperative management.