Instructional course lectures最新文献

Orthobiologic techniques can be used in the treatment of a variety of sports medicine pathologies, using an evidence-based approach focused on the value of all available approaches. The orthopaedic surgeon should be aware of the indications for and any technical pearls and pitfalls related to the use of orthobiologic agents as treatment for, or as an adjunct to management of, common sports medicine injuries and pathologies. Expected outcomes, including return to sport/activity, as well as potential complications and how to avoid them, should be considered. Although promising results have been reported, significant lack of high-level studies, inconsistent findings, and variability among current research make it challenging to reach a definitive conclusion about application, target populations, and overall effectiveness.

Surgeon wellness, and the means by which it may be realized, has recently come to the forefront as awareness of burnout among orthopaedic surgeons has increased. Individual surgeons face unique challenges toward finding their own path to thrive. It is important to incorporate varying perspectives regarding potential solutions to surgeons' stresses in both work and extracurricular life. Specifically, the goal is to initiate a discussion regarding wellness by providing insight into the challenges facing surgical residents, supplemented with the perspectives of women and minorities within the field. Peer coaching plays an essential role in optimizing mental health.

Ankle arthroscopy has seen increased utilization and application in recent years. Through the advent of improved instrumentation and techniques, indications have been expanded to include the management of traumatic, degenerative, inflammatory, and neoplastic conditions. It is important to review anterior and posterior ankle arthroscopies along with the history, pertinent anatomy, techniques, indications, and complications as well as gain insight into the future of ankle arthroscopy.

It is important to identify and describe practical applications of arthroscopy in the management of foot and ankle pathology. Utilization of the arthroscope provides a minimally invasive means of evaluating and addressing pathology. It obviates the need for a large open approach, which has additional value in the setting of a multiprocedure surgery. In addition to reducing surgical time, arthroscopy provides a potentially enhanced field of view and an adequate working space to address injury. As interest in minimally invasive options grows, the need for safe, effective tendoscopic and arthroscopic options in the foot and ankle increases. A clear and high-yield reference is needed with which to approach these procedures.

Achieving fusion in spine surgery can be challenging because of patient factors such as smoking and diabetes. The consequences of pseudarthrosis can be severe, including pain, instability, and additional surgery. Autologous iliac crest bone graft is the historical standard for augmenting spine fusion, providing high rates of fusion throughout the cervical, thoracic, and lumbar spine. Harvest of autologous iliac crest bone can be associated with comorbidities and this has led to development of alternative biologic materials to enhance spine fusion. Substitutes include various forms of allograft products including decellularized allograft; demineralized bone matrix; synthetic materials including bioactive glass; and autologous and allograft mesenchymal stem cells. Bone morphogenetic proteins can be efficacious for fusion but have significant risks and are not suitable for all spine procedures. There is a wide variety of utilization of biologics for spine fusion that are influenced by spinal region, surgeon preference, surgical training, health system formulary, and cost.

Dupuytren disease is associated with benign fibroproliferative changes to the palmar fascia of the hand sometimes resulting in progressive contractures of the fingers. The earliest descriptions of these contractures date back to the 18th century. Much has been learned about the condition since the clawing condition was first described; however, optimal treatment still poses significant challenges to modern-day surgeons. It is important to examine the treatment options for Dupuytren disease and highlight the current evidence, techniques, and cost considerations of open fasciectomy, needle aponeurotomy, and recently described minimally invasive treatment.

Endoscopic spine surgery is a rapidly developing technique. Initially used for diskectomies, endoscopic spine surgery is now considered for bony decompressions and fusions. Endoscopic spine surgery uses one or two small incisions so a camera can be inserted for visualization under high magnification while a working window is provided through the camera apparatus or through a separate incision. The suggested benefits of endoscopic spine surgery include less muscle trauma, decreased need for anesthesia, reduced blood loss, and faster recovery. The typical complications associated with spinal surgery such as bleeding, infection, nerve injury, and durotomy still exist. Although the disadvantages may have historical claims, recent literature suggests endoscopic spine surgery may outperform traditional techniques for certain pathologies. However, the learning curve of endoscopic spine surgery may present challenges with adoption by practicing spinal surgeons. The outcomes of appropriately applied endoscopic techniques provide support that endoscopic spine surgery has the potential to revolutionize spine surgery.

Unicompartmental knee arthroplasty (UKA) has become an increasingly used procedure for patients with unicompartmental knee osteoarthritis. The success of UKA relies on appropriate patient selection and patient optimization before surgery is performed. Improved prosthesis design and surgical techniques for medial and lateral and fixed and mobile bearing UKA have also contributed to improved knee biomechanics, faster recovery, and improved outcomes. Indications, factors affecting patient selection, the role of limb alignment, and the surgical pearls for fixed and mobile bearing and medial and lateral UKA are important topics for discussion.

It is important to focus on common pediatric fractures seen in community emergency rooms, including supracondylar humerus, elbow, forearm, distal radius, and femoral shaft fractures, along with periarticular fractures around the knee and ankle in children. The principles of surgical and nonsurgical management of these fractures are based on the fracture type and age of the patient. The orthopaedic surgeon should be aware of important tips and tricks to help manage these injuries and be familiar with common complications that may occur when these injuries are encountered during trauma call.

Artificial intelligence can improve various orthopaedic subspecialties in the next 5 to 10 years. There are several image recognition applications particularly in orthopedic trauma and orthopedic spine. Specifically, convolutional neural networks have been shown to work well for making diagnoses and recreating more advanced imaging form radiographs. There are many applications of artificial intelligence with predictive in total joint arthroplasty, particularly with shared decision making. And there are many day-to-day applications that can be improved with natural language processing, particularly administrative tasks. This includes several applications in billing and charting. When investigating the landscape of artificial intelligence in healthcare, there are many barriers to their adoption. This includes overcoming bias, incorporating new applications into clinical workflow, regulatory approval, and billing.