Instructional course lectures
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The need for surgical treatment of femoral shaft and distal femoral fractures is undisputed. The treatment options are varied, and often the choice is based on the surgeon's preference rather than orthopaedic science. ⋯ The primary goal of treatment for a supracondylar femoral fracture is to restore limb alignment while preventing angular deformity. Proper technique, not the choice of a nail or plate, is key to recovery.
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The field of hip arthroscopy continues to grow as surgeons become more familiar with disorders of the intra-articular and extra-articular compartments of the hip. Recent studies have described the endoscopic treatment of injuries to the lateral peritrochanteric compartment of the hip, including recalcitrant trochanteric bursitis, external coxa saltans, and tears of the gluteus medius and minimus tendons.
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Fractures of the foot and ankle are common injuries that often are successfully treated nonsurgically; however, some injuries require surgical intervention. To restore anatomy and avoid the need for additional surgery, surgeons must pay attention to detail and understand common, avoidable complications. The surgeon should have an understanding of the pathologic characteristics of three common injuries of the foot and ankle as well as the potential complications and their prevention.
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Femoral neck fractures in physiologically young adults, which often result from high-energy trauma, are less common than intracapsular femoral neck fractures in elderly patients. They are associated with higher incidences of femoral head osteonecrosis and nonunion. Understanding the multiple factors that play a significant role in preventing these complications will contribute to a good outcome. ⋯ The timing of the open reduction and internal fixation is controversial. Until conclusive data are available through prospective, controlled studies, performing a capsulotomy followed by open reduction and internal fixation on an urgent basis is recommended. The goals of treating femoral neck fractures should include early diagnosis, early surgery, anatomic reduction, capsular decompression, and stable internal fixation.
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Blood management during total hip arthroplasty is a critical component of successful patient care, and an overall strategy is necessary. Multiple options for blood management are available, including the use of predeposited autologous blood, perioperative blood salvage, hemodilution techniques, erythropoietic agents, hemostatic agents, and allogeneic blood. Rather than relying on automatic so-called transfusion triggers, the surgeon should identify patient-specific risk factors such as the anticipated difficulty of the procedure, preoperative hemoglobin level, comorbidities, and a plan for blood management.