Instructional course lectures
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The thumb trapeziometacarpal joint is a saddle joint that is subject to high compressive forces during prehensile hand function. Fractures to the base of the thumb metacarpal occur commonly following axial load to a partially flexed thumb. Although reduction is easily performed, severe deforming forces act to displace the fractures into a varus and shortened position. ⋯ Most Bennett fractures can be treated with closed reduction with percutaneous Kirschner wire fixation. Fractures with large Bennett fragments and Rolando fractures should be treated with open reduction and internal fixation to allow anatomic reduction with rigid fixation and early range of motion. Comminuted intra-articular fractures are challenging injuries that are best treated with application of an external fixator with limited open reduction and internal fixation, followed by bone grafting of metaphyseal bone defects if necessary.
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The demand for total hip arthroplasty is increasing, as are patients' expectations to return to high activity levels. Metal-on-metal bearings are being used in an effort to maximize the longevity of primary hip replacements. Acetabular component inclination has been a recognized aspect of surgical technique for more than 20 years; it now is considered critical, especially in hip resurfacing or implantation of a stem-type device with a larger diameter femoral head and a monoblock acetabular component. It is important to understand the indications for using metal-on-metal bearings as well as the key clinical factors for avoiding early implant failure.
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The absolute number of periprosthetic fractures seen by the orthopaedic surgeon is increasing. The basic principles of fracture management include preoperative patient optimization and determining the stability of the associated components. Loose components require revision, whereas fractures associated with well-fixed implants are generally treated with internal fixation. Although these fractures are challenging to manage, advances in surgical techniques, including the use of locking plates for internal fixation and improved revision systems and biomaterials (such as highly porous metals), offer the surgeon enhanced tools for treating these complex clinical disorders.
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The need for surgical treatment of femoral shaft and distal femoral fractures is undisputed. The treatment options are varied, and often the choice is based on the surgeon's preference rather than orthopaedic science. ⋯ The primary goal of treatment for a supracondylar femoral fracture is to restore limb alignment while preventing angular deformity. Proper technique, not the choice of a nail or plate, is key to recovery.
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The field of hip arthroscopy continues to grow as surgeons become more familiar with disorders of the intra-articular and extra-articular compartments of the hip. Recent studies have described the endoscopic treatment of injuries to the lateral peritrochanteric compartment of the hip, including recalcitrant trochanteric bursitis, external coxa saltans, and tears of the gluteus medius and minimus tendons.