Instructional course lectures
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Biologic and synthetic scaffolds, mechanical loads, vitamin D, and diabetes can affect tendon and tendon-to-bone healing, muscle recovery, and growth in the perioperative period. Despite important advances in technical approaches to achieve surgical repair of soft tissues in a minimally invasive fashion, structural healing after tendon-to-bone repair remains a formidable challenge that is complicated by our incomplete knowledge of complex natural biologic processes and a diverse patient population with various comorbidities and deficiencies. ⋯ Augmentation with scaffolds may reinforce the initial repair biomechanically and can be coupled with growth factors to promote a favorable biologic environment for healing. Careful consideration of the implications of postoperative rehabilitation and endocrine and nutritional deficiencies on structural healing and muscle recovery are also critical to optimize patient outcomes.
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Volar locking plates have provided surgeons with enhanced capability to reliably repair both simple and complex fractures and avoid the hardware-related complications associated with dorsal plating. However, there have been an increasing number of published reports on the frequency and types of complications and failures associated with volar locked plating of distal radius fractures. An informed, critical assessment of distal radius fracture characteristics will allow surgeons to select an individualized treatment strategy that maximizes the likelihood of a successful outcome. Knowledge of the anatomy, patterns, and characteristics of the diverse types of distal radius fractures and the complications and failures associated with volar locked plating will be helpful to orthopaedic surgeons who treat patients with these injuries.
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Most patients are evaluated by an internist for medical clearance before undergoing an elective orthopaedic procedure. Internists and anesthesiologists evaluate a patient's risk for morbidity or mortality from a procedure, whereas orthopaedic surgeons are often primarily concerned with a patient's risk for a poor outcome. Nutritional and systemic comorbidities can increase the risks for surgical site infections and poor outcomes. Knowing how to handle and identify these issues before surgery can have a substantial effect on improving the likelihood of good outcomes from elective orthopaedic procedures.
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Much has been written about cervical spine trauma. Although occipitocervical dislocations result in high mortality rates at the scene of the injury, more patients are surviving this injury as a result of safety improvements. ⋯ Substantial controversy and debate remain surrounding cervical spinal clearance, spinal cord injury, odontoid fractures, traumatic spondylolisthesis of C2 on C3, and subaxial cervical spine facet subluxations and dislocations. Although debate regarding appropriate treatment algorithms for these injuries still exists, management recommendations based on the available evidence will be helpful to the treating surgeon.
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The volume of total hip and knee arthroplasties continues to increase as the US population ages. The number of prosthetic complications, specifically those involving periprosthetic fractures, is also increasing. Periprosthetic fractures can be difficult to manage. ⋯ It is crucial to consider the fracture location, implant stability, and bone quality when determining a treatment plan. Expertise in both fracture management and joint reconstruction is often necessary to provide the best care and outcomes for patients. Although periprosthetic fractures are challenging, advancements in surgical techniques and available implants offer the surgeon tools to provide good outcomes and patient satisfaction.