Instructional course lectures
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The absolute number of periprosthetic fractures seen by the orthopaedic surgeon is increasing. The basic principles of fracture management include preoperative patient optimization and determining the stability of the associated components. Loose components require revision, whereas fractures associated with well-fixed implants are generally treated with internal fixation. Although these fractures are challenging to manage, advances in surgical techniques, including the use of locking plates for internal fixation and improved revision systems and biomaterials (such as highly porous metals), offer the surgeon enhanced tools for treating these complex clinical disorders.
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The thumb trapeziometacarpal joint is a saddle joint that is subject to high compressive forces during prehensile hand function. Fractures to the base of the thumb metacarpal occur commonly following axial load to a partially flexed thumb. Although reduction is easily performed, severe deforming forces act to displace the fractures into a varus and shortened position. ⋯ Most Bennett fractures can be treated with closed reduction with percutaneous Kirschner wire fixation. Fractures with large Bennett fragments and Rolando fractures should be treated with open reduction and internal fixation to allow anatomic reduction with rigid fixation and early range of motion. Comminuted intra-articular fractures are challenging injuries that are best treated with application of an external fixator with limited open reduction and internal fixation, followed by bone grafting of metaphyseal bone defects if necessary.