Instructional course lectures
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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.
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Being served with a medical negligence lawsuit usually is a traumatic event for an orthopaedic surgeon. The course of litigation is long and tedious, and the defendant physician must be well prepared for the experience. It is imperative that the physician contact his or her insurance carrier immediately after being served with the complaint because many legal actions are time dependent. ⋯ Because the testimony of expert witnesses often decides the outcome of the case, it is important for the physician to help the attorney identify the best potential witnesses. A thorough knowledge of the tactics that the plaintiff's attorney may use during cross-examination can help ensure that the truth is clearly portrayed. The American Academy of Orthopaedic Surgeons Professional Compliance Program is designed to ensure that all testimony in medical liability cases is fair and factual.
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Pediatric musculoskeletal infections can cause devastating complications (including death) in this era of methicillin-resistant Staphylococcus aureus and other virulent bacterial strains. The complexity and severity of these infections require timely diagnosis and treatment. A thorough emergency department evaluation, diagnostic workup, and early surgical intervention can influence outcomes. ⋯ Because of genetic changes and inducible resistance, methicillin-resistant Staphylococcus aureus causes more complex infections than in the past. Deep, soft-tissue abscesses; pyomyositis; osteomyelitis; and septic arthritis often occur concurrently, causing destruction of musculoskeletal tissue. Severe and life-threatening complications, such as septic emboli, deep venous thrombosis, and multiorgan system failure may result from these infections.
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Orthopaedic education is replete with unsubstantiated recommendations (myths) from predecessors in the field of orthopaedics. Even in the presence of sound evidence, some of these myths can be perpetuated through generations. ⋯ Today's physicians must decide whether the physical, emotional, and financial costs of limb salvage can be justified by the expected functional outcome. Accumulated evidence suggests that functional outcomes are similar for amputation and limb salvage, whereas those treated with limb salvage have more hospitalizations and longer treatment times.
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The management of some orthopaedic extremity injuries has changed over the past decade because of changing resource availability and the risks of complications. It is helpful to review the current literature regarding orthopaedic extremity emergencies and urgencies. The effects of the techniques of damage control orthopaedic techniques and the concept of the orthopaedic trauma room have also affected the management of these injuries. ⋯ Patient survival rates have improved with current resuscitative protocols. Definitive fixation of extremity injuries should be delayed until the patient's physiologic and extremity soft-tissue status allows for appropriate definitive management while minimizing the risks of complications. In patients with semiurgent orthopaedic injuries, the use of an orthopaedic trauma room has led to more efficient care of patients, fewer complications, and better time management for surgeons who perform on-call service for patients with traumatic orthopaedic injuries.