Instructional course lectures最新文献

Ankle arthritis is a severely disabling condition. Treatment poses many unique challenges to orthopaedic surgeons because ankle kinematics differs from that seen in the hip or knee joint and the loads transmitted through the ankle are greater during activity. Historically, motion-sacrificing procedures dominated management of ankle arthritis. It is important to review the updates on joint-preserving and joint-sacrificing strategies for the management of ankle arthritis.

External fixation is a powerful tool in orthopaedic trauma surgery. Beyond serving as provisional or temporizing fixation, external fixation has utility as an intraoperative reduction tool, adjunct to internal fixation, and definitive fixation. It is important to summarize the indications, techniques, and considerations of various roles of external fixation in orthopaedic trauma.

The present-day treatment for advanced osteoarthritis is joint replacement. However, modern nonsurgical treatments have been used as a first-line option to delay or avoid arthroplasty, especially if treatments are started when osteoarthritis is moderate. Among many nonsurgical options, there has been an increased interest recently in the use of orthobiologics. Orthobiologics are natural substances harvested from one's own body and used to treat several conditions, such as arthritis, tendinopathies, bone healing, and others. Given these are relatively new therapies, there is limited evidence supporting their use. The most common emerging biologic strategies are discussed.

Complications occur with total shoulder arthroplasty (TSA), and they can be daunting to diagnose and treat. It is important to review common TSA-related complications and to summarize risk factors along with causes of these complications and how to avoid them. The orthopaedic surgeon should be knowledgeable about how to successfully manage complications to achieve good patient outcomes and the etiologies and management of the painful and stiff shoulder arthroplasty, subscapularis failure after anatomic TSA, instability after reverse shoulder arthroplasty, and acromion stress fractures in the setting of reverse TSA.

Flexor tendon injuries are a commonly encountered hand problem caused by trauma. They can be associated with fractures or neurovascular injury or occur in isolation. Thorough physical examination is an integral aspect of management of these injuries to identify concomitant pathology and to facilitate preoperative planning and timing of surgery to improve outcome. Management of flexor tendon injuries varies based on the zone of injury, associated fractures, neurovascular inquiries, and injury acuity. The goal of management of flexor tendon injuries is a strong repair and smooth-gliding tendon that heals in a timely manner, resulting in a functional digit. Appropriate rehabilitation is essential in managing these injuries to regain satisfactory motion and prevent adhesion formation and stiffness.

Ulnar collateral ligament injury of the elbow is a problem most associated with baseball pitchers but can be a challenging pathology for any overhead throwing athlete. The prevalence of these injuries has been steadily increasing over the past several decades, as has the need for surgical management. Surgical reconstruction has long been considered the gold standard for complete ulnar collateral ligament injuries in throwers, but repair has surfaced as a viable option for younger patients or those with isolated proximal or distal injuries with good tissue quality. Ulnar collateral ligament repair continues to evolve with modified techniques, including graft augmentation.

The traditional dual-option debate of cruciate-retaining versus posterior-
stabilized knee arthroplasty designs has evolved into a more complex discussion in recent years. The growing interest and rapid adoption of medial conforming and medial pivot designs has made the original debate surrounding cruciate-retaining versus posterior-stabilized designs more interesting. Each liner option has its own advantages and disadvantages. Although conforming tibial liner options are increasing rapidly, traditional cruciate retaining and posterior stabilized are the most common designs, as recorded in most registries. However, it is important to understand the updated pros and cons of each liner design as surgeons focus on personalization of their total knee arthroplasty procedures to the individual patient. Different liner options may be more advantageous in certain situations or vary with surgical technique. Several different types of tibial liner options are currently available, and it is important to review and summarize the latest literature available for each.

Pain management remains a challenge in the optimization of outcomes after total knee arthroplasty. Multimodal analgesia is commonplace for modern elective joint replacement, combining various medications and anesthetics along the pain pathway. Local analgesics have the advantage of avoiding systemic effects and offering concentrated local delivery of medications. Long-acting local anesthetics provide the added advantage of providing sustained pain relief when other treatment options may no longer be effective. It is important to provide an update on current local analgesic strategies available with a review of the current literature, outlining the potential benefits and unique considerations of each treatment. Novel medications in development targeting pain management following total knee arthroplasty are possible options in the future.

Elbow stiffness is a common consequence of trauma and can significantly limit the functionality of the affected arm. Intervention may be necessary for those with a motion arc less than 100°, but the decision to intervene should be based on individual patient needs. Restoration of joint motion in a stiff elbow can be challenging, time consuming, and costly. Nonsurgical treatment is the primary management option, and surgical intervention is considered for refractory stiffness. However, recurrent stiffness is a common issue following surgical elbow contracture release. An overview of relevant elbow anatomy, principles and technical pearls of arthroscopic and open contracture release, and postoperative rehabilitation methods to reduce the risk of recurrent stiffness is provided. It is important to tailor the treatment plan to each patient's unique needs and functional expectations.

Flexor tendon injury surgical repairs can be challenging for surgeons, where the timing of surgery and precision of repair matter the most. The latest evidence and basic science discoveries in flexor tendon management are provided. It is important to review how wide-awake local anesthesia no tourniquet surgery has been a paradigm shift in surgical management and pearls learned from incorporating this into practice.