Instructional course lectures
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Iatrogenic nerve injuries frequently occur during procedures around the hand and wrist, although they are not always recognized at the time of injury or in the immediate postoperative period. Because preventing injuries is of paramount importance, extensive knowledge of the anatomy of the at-risk nerves is critical. Best results occur after immediate repair because a substantial delay before secondary surgery diminishes the chances for recovery from motor or sensory nerve dysfunction and relief from pain. It is helpful to review iatrogenic nerve injuries associated with common hand surgical procedures.
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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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Biologic and synthetic scaffolds, mechanical loads, vitamin D, and diabetes can affect tendon and tendon-to-bone healing, muscle recovery, and growth in the perioperative period. Despite important advances in technical approaches to achieve surgical repair of soft tissues in a minimally invasive fashion, structural healing after tendon-to-bone repair remains a formidable challenge that is complicated by our incomplete knowledge of complex natural biologic processes and a diverse patient population with various comorbidities and deficiencies. ⋯ Augmentation with scaffolds may reinforce the initial repair biomechanically and can be coupled with growth factors to promote a favorable biologic environment for healing. Careful consideration of the implications of postoperative rehabilitation and endocrine and nutritional deficiencies on structural healing and muscle recovery are also critical to optimize patient outcomes.