Instructional course lectures最新文献

There are several issues associated with nerve compression syndromes of the upper limb; ultrasonography is a useful diagnostic tool. The orthopaedic surgeon should know how to evaluate and treat patients who do not obtain expected relief following carpal or cubital tunnel release, and also be knowledgeable about the workup and evaluation of patients with conditions of debatable pathology and treatment, such as radial tunnel syndrome or pronator syndrome. Recent studies on suprascapular neuropathy include discussions about the pathophysiology and etiology of the condition, its natural history, and who might benefit from surgery.

Ultrasonography has the potential to become a fundamental component of the diagnosis and management of musculoskeletal conditions and injuries. Moreover, in the context of modern healthcare systems that are focused on optimizing value, ultrasonography has the advantage of minimizing costs when compared with other advanced imaging modalities. Because of its low cost, lack of radiation exposure, speed, and capability to diagnose dynamic conditions, more orthopaedic surgeons are routinely integrating musculoskeletal ultrasonography into their daily practice. It is important to provide a comprehensive review of and approach to common musculoskeletal conditions of the lower extremity for the busy orthopaedic surgeon.

Intertrochanteric hip fractures are among the most common osteoporotic fractures seen by orthopaedic surgeons. These fractures have a significant effect on a patient's mobility, independence, and mortality. In addition, they represent a substantial component of health care spending. Treatment is almost universally surgical, and surgeons must pay attention to patient optimization, fracture characteristics, and surgical planning. The goal of surgical intervention is to maximize the patient's ability to return to preinjury level of function by early postoperative mobilization. This can be achieved by obtaining and maintaining reduction to fracture healing.

With the recent increase in primary total knee arthroplasties and the associated rise in failures of the index operation, there has been growing demand for orthopaedic surgeons to perform revision procedures. The orthopaedic surgeon performing revision total knee arthroplasty should be knowledgeable about the various etiologies of primary total knee arthroplasty failure, the steps for proper patient evaluation, and important factors in the preoperative planning process. A systematic methodology for obtaining surgical exposure, strategies for reconstruction, fundamentals of soft-tissue closure, and postoperative care also should be reviewed.

A first-time shoulder dislocation is a challenging topic that requires consideration of anatomic and patient-specific factors. Initial management is predicated on determining functional demands, activity level, and expectations of the patient, in addition to assessing the risk of recurrent instability. When considering surgical indications, it is imperative to understand the biomechanical implications of injury to the glenohumeral joint complex and how specific surgical procedures can restore stability. It is important to provide an overview of the current treatment algorithm for management of first-time shoulder dislocation, with a special focus on diagnosis and intervention in the young athlete.

Reverse shoulder arthroplasty has become the predominant shoulder arthroplasty procedure. Despite newer design modifications, complications still occur after reverse shoulder arthroplasty. Early complications include instability, acromial and scapular spine stress fractures, periprosthetic fractures, periprosthetic joint infections, and neurologic injury. It is important to discuss the diagnosis and management of these early complications.

Management of subtrochanteric femur fractures is challenging because of the multiple planes of fracture deformity. Specific techniques starting with patient positioning and appropriate operating room table selection can improve the efficiency of the surgery. Sequential reduction techniques starting with closed methods, percutaneous techniques, and finally open clamping can be performed to obtain anatomic reduction of the fracture. The gold standard implant for definitive fixation is a locked intramedullary nail and overall outcomes are excellent if anatomic alignment and stable fixation is achieved.

The diagnosis and management of compartment syndrome remains challenging and controversial. There continues to be a significant burden of disease and substantial resource implications associated with fractures complicated by compartment syndrome. Achieving consensus opinions regarding the diagnosis and treatment of this problem has important implications given the profound effect on patient outcomes.

Nerve compression syndromes of the upper extremity are among the most common pathologies encountered in orthopaedic surgery. Symptoms can be debilitating for patients-affecting their work, activity level, sleep patterns, and overall quality of life. The community orthopaedic specialist should be familiar with the anatomy, etiology, and presentation of upper extremity nerve entrapment. Furthermore, knowledge of current evidence surrounding the management of these common syndromes can prove valuable for treating clinicians. Treatment ranges from nonsurgical (including medication and splinting) to surgical (when symptoms are severe). Although the gold standard treatment for nerve compression syndromes of the upper extremity is typically surgical release, nonsurgical methods should also be reviewed and understood because these can play an important role for patients as well. Community orthopaedic specialists should be well aware of the risks and complications associated with surgical releases.

Orthopaedic surgeons have long been aware of the importance of metabolic bone health for fracture healing; however, recent attention has focused on optimization of bone health before elective surgery and also regarding pathways to ensure patients have appropriate evaluation and treatment for bone health issues. It is important to describe issues of importance to fragility fracture care and prevention and optimization of outcomes before elective or fracture surgery. To address the challenge of who has the time, expertise, and appropriate patient contact to identify and treat patients at risk of bone metabolic issues, one model for a suggested pathway to ensure these patients are identified and treated is outlined.