Instructional course lectures
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The management of some orthopaedic extremity injuries has changed over the past decade because of changing resource availability and the risks of complications. It is helpful to review the current literature regarding orthopaedic extremity emergencies and urgencies. The effects of the techniques of damage control orthopaedic techniques and the concept of the orthopaedic trauma room have also affected the management of these injuries. ⋯ Patient survival rates have improved with current resuscitative protocols. Definitive fixation of extremity injuries should be delayed until the patient's physiologic and extremity soft-tissue status allows for appropriate definitive management while minimizing the risks of complications. In patients with semiurgent orthopaedic injuries, the use of an orthopaedic trauma room has led to more efficient care of patients, fewer complications, and better time management for surgeons who perform on-call service for patients with traumatic orthopaedic injuries.
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Intra-articular fractures of the tibial plateau, pilon, and calcaneus often present a challenge for the treating orthopaedic surgeon. These injuries can have substantial comminution in the joint and the metaphyseal areas and are often accompanied by considerable soft-tissue trauma. ⋯ These myths include the beliefs that most patients with intra-articular fractures will have poor outcomes even with good surgical treatment, severe intra-articular fractures require a later reconstructive procedure regardless of the treatment, and the surgical treatment of comminuted intra-articular fractures has a high complication rate and may result in infection and limit the available options for limb salvage. A review of the literature regarding the treatment of common intra-articular fractures is helpful in determining if these myths concerning treatment options can be confirmed or disproved.
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The metaphyseal deformity, in even a mild slipped capital femoral epiphysis (SCFE), results in acetabular labral and cartilage injury. SCFE is the most extreme form of femoroacetabular impingement, and the mechanism of cartilage and labral injuries is similar. ⋯ In situ pinning is the most effective treatment to halt short-term slip progression; outcomes are favorable in many hips. In medical centers with substantial experience with hip preservation techniques, open or arthroscopic osteochondroplasty can be used to treat mild SCFE, and a modified Dunn epiphyseal reorientation can be used for more severe deformities to decrease the potential for secondary osteoarthritis.