Instructional course lectures
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Although periprosthetic fractures of the acetabulum are relatively uncommon after total hip arthroplasty, a variety of patient-, surgeon-, and implant-related risk factors can contribute to the occurrence of this serious complication. These risk factors, combined with the increased use of cementless acetabular cups, will likely result in an increased prevalence of these fractures in the future. By better understanding the risk factors, classification schemes, and treatment options for periprosthetic fractures of the acetabulum, orthopaedic surgeons can achieve better outcomes for their patients.
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Disorders of the patellofemoral joint are commonly seen in musculoskeletal clinics. In recent years, the expansion of imaging techniques, improvements in correlative injury anatomy, and more focused physical examinations have resulted in new knowledge about patellofemoral disorders. To achieve optimal patient outcomes, it is helpful for orthopaedic surgeons who treat knee problems to review the management of patellar dislocations and isolated patellofemoral arthritis, including treatment algorithms.
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The management of complex spinal deformities in the growing child continues to evolve. The implementation of new techniques and biomaterial constructs has improved outcomes of deformity correction procedures but has also led to unforeseen complications. ⋯ These complications can lead to poor cosmesis, function, and quality of life, and a higher risk for revision surgery. Although postoperative spinal imbalance develops in few children, diligent monitoring of patients with predisposing risk factors for decompensation will allow surgeons to better predict, manage, and potentially prevent these complications.
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Most patients are evaluated by an internist for medical clearance before undergoing an elective orthopaedic procedure. Internists and anesthesiologists evaluate a patient's risk for morbidity or mortality from a procedure, whereas orthopaedic surgeons are often primarily concerned with a patient's risk for a poor outcome. Nutritional and systemic comorbidities can increase the risks for surgical site infections and poor outcomes. Knowing how to handle and identify these issues before surgery can have a substantial effect on improving the likelihood of good outcomes from elective orthopaedic procedures.
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Much has been written about cervical spine trauma. Although occipitocervical dislocations result in high mortality rates at the scene of the injury, more patients are surviving this injury as a result of safety improvements. ⋯ Substantial controversy and debate remain surrounding cervical spinal clearance, spinal cord injury, odontoid fractures, traumatic spondylolisthesis of C2 on C3, and subaxial cervical spine facet subluxations and dislocations. Although debate regarding appropriate treatment algorithms for these injuries still exists, management recommendations based on the available evidence will be helpful to the treating surgeon.