Instructional course lectures
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The scaphoid is the most commonly fractured carpal bone of the wrist. It is an unusual carpal bone in that it bridges both the proximal and the distal rows; this subjects it to continuous shearing and bending forces. Approximately 80% of the scaphoid is covered by cartilage, which limits its ligamentous attachment and vascular supply. ⋯ There also has been a significant improvement in the management of difficult scaphoid nonunions, with or without deformity. Improved techniques include open and dorsal approaches and vascularized bone grafting of resistant scaphoid nonunions. Declining in popularity is the prolonged immobilization of unstable fractures when surgical stabilization may have been a better treatment option.
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Multimodal pain management techniques using femoral and sciatic nerve blocks can dramatically improve a patient's experience after total knee arthroplasty. Nerve blocks reduce postoperative pain and the need for parenteral opioids and result in fewer medical complications associated with opioid use. ⋯ Although it is difficult to isolate the added benefit of sciatic nerve blocks, there is a growing body of evidence for using femoral and/or sciatic nerve blocks as part of a multimodal approach to pain management. With many years of experience and published results on thousands of patients, it is clear that the risks of peripheral nerve blocks are minimal, whereas the benefits are substantial.
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There is considerable overlap in the clinical and imaging presentation of general orthopaedic conditions and musculoskeletal neoplasms. At centers that treat orthopaedic oncologic conditions, it is not uncommon to see patients with spine and extremity tumors previously treated for presumed general orthopaedic ailments. It is important for orthopaedic surgeons to understand how to interpret commonly ordered radiographic studies (radiographs, MRIs, and CT scans) as they relate to bone and soft-tissue tumors, to be familiar with the imaging appearance of common musculoskeletal lesions in the extremities and spine, and to understand what imaging findings should trigger a referral to an orthopaedic oncologist.