Instructional course lectures
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Volar locking plates have provided surgeons with enhanced capability to reliably repair both simple and complex fractures and avoid the hardware-related complications associated with dorsal plating. However, there have been an increasing number of published reports on the frequency and types of complications and failures associated with volar locked plating of distal radius fractures. An informed, critical assessment of distal radius fracture characteristics will allow surgeons to select an individualized treatment strategy that maximizes the likelihood of a successful outcome. Knowledge of the anatomy, patterns, and characteristics of the diverse types of distal radius fractures and the complications and failures associated with volar locked plating will be helpful to orthopaedic surgeons who treat patients with these injuries.
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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.
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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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Safety information in spine surgery is important for informed patient choice and performance-based payment incentives, but measurement methods for surgical safety assessment are not standardized. Published reports of complication rates for common spinal procedures show wide variation. Factors influencing variation may include differences in safety ascertainment methods and procedure types. ⋯ The observed frequency of adverse events is influenced by the ascertainment modality. Voluntary reports by surgeons and other team members missed more than 50% of the events identified through a medical records review. Increased surgery invasiveness, measured from medical records or billing codes, is quantitatively associated with an increased risk of adverse events.