Instructional course lectures
-
Unstable posterior pelvic ring injuries are commonly treated with percutaneous iliosacral screw fixation. Despite the efficiency of the minimally invasive technique, complications and failures occur. To maximize reduction quality and fixation stability, open techniques for pelvic ring fixation exist. Timing, approaches, clamp positioning, and implant options determine the effectiveness of the open techniques.
-
Although definitive fixation of anterior pelvic ring injuries is usually referred to an orthopaedic trauma surgeon or a surgeon proficient in pelvic surgery, all orthopaedic surgeons should be familiar with the initial management and resuscitation of patients with high-energy pelvic ring injuries. The initial treatment may be limited to sheet or binder application in the emergency department to allow transfer of the patient to a trauma center or the application of an external fixator by an on-call surgeon, even though that surgeon may not be responsible for definitive fixation. It is important to understand the general principles and approaches used at the time of definitive surgery because decisions made by the initial treating physician may affect (or limit) the ability of the orthopaedic traumatologist to provide definitive care.
-
Pain management is a major concern for patients contemplating total knee replacement surgery and is one of the leading causes of dissatisfaction after knee replacement. Substantial progress has been made over the past several years in improving pain control after total knee replacement using multimodal pain control, preemptive analgesia, and periarticular injections.
-
Pelvic fractures represent a significant transfer of kinetic energy to the body, and more than 80% of patients with unstable pelvic fractures have additional musculoskeletal injuries. A systematic approach with prompt intervention is critical in the initial management of patients with pelvic fractures. If intra-abdominal bleeding is suspected, diagnostic peritoneal lavage, focused assessment with sonography for trauma, or a CT examination is usually performed. ⋯ The orthopaedic surgeon provides prompt stabilization using external immobilizers, external fixation, or traction. The bladder, urethra, and nerve roots have an intimate location within the pelvis and are predisposed to injury in patients with pelvic fractures. Appropriately identifying associated abdominal, urologic, or neurologic injuries will provide important opportunities to reduce patient morbidity and improve long-term outcomes.
-
An increasing percentage of emergency departments are reporting an inadequate number of on-call specialists. This situation is causing a growing crisis in emergency department on-call coverage for patients requiring orthopaedic care. Many orthopaedic surgeons are electing to opt out of emergency department on-call service. ⋯ Initially, it may be necessary to incentivize on-call service so more surgeons are willing to participate. Incentives may include improving the group governance and bylaws to avoid confusion on the rules for providing on-call coverage. The on-call experience may require financial improvements, outsourcing with locum tenens, or a complete restructuring of the on-call arrangement with the formation of a hospitalist program.