Instructional course lectures
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In some groups of polytrauma patients, particularly those with chest injuries, head injuries, and those with mangled extremities, early total care of major bone fractures may be potentially harmful. Delaying all orthopaedic surgery, however, is also not always the best approach. In these situations, damage control orthopaedics, which emphasizes the stabilization and control of the injury rather than repair will add little additional physiologic insult to the patient and is a treatment option that should be considered.
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The increasing number of hip fractures in the elderly constitutes a health care burden. The subset of unstable intertrochanteric hip fractures is important because the treatment of these fractures continues to be hampered by a moderate complication rate. Osteoporosis, fracture geometry, and the success of surgical treatment are strong predictors of outcome. The surgeon is in control of fracture reduction, implant selection, and implant placement, all of which must be optimized to ensure the success of surgical intervention.
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The principles and techniques used to reduce or eliminate blood transfusions can be applied to the standard practice of orthopaedic surgery. The overall goal is to enable orthopaedic surgeons who are interested in reducing allogeneic transfusions to find a method that fits their practice.
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Adolescent idiopathic scoliosis is a three-dimensional deformity of the spine. Despite active efforts by different research teams, the etiology of scoliosis remains unclear. Treatment of scoliosis requires a solid understanding of the natural history of the disorder as well as sound clinical judgment. ⋯ Bracing is the only nonsurgical measure proven to have any effect on halting the progression of scoliosis. Other forms of conservative treatment have not been shown to significantly modify the natural history of idiopathic scoliosis. Bracing results are directly related to compliance with brace treatment; therefore, optimal results cannot be achieved without the patient's cooperation and family support.
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The Lenke and associates classification system of adolescent idiopathic scoliosis (AIS) was developed to provide a comprehensive and reliable means to categorize all surgical AIS curves. This classification system requires analysis of the upright coronal and sagittal radiographs along with the supine side bending radiographic views. The triad classification system consists of a curve type (1-6), a lumbar spine modifier (A, B, C), and a sagittal thoracic modifier (-, N, +). ⋯ The recommendations are that the major and structural minor curves are included in the instrumentation and fusion and the nonstructural minor curves are excluded. Overall, the classification system is treatment directed; however, there are other aspects of the radiographic and clinical deformity that may suggest deviation from the recommendations of the classification system. The ultimate goal of this classification system is to allow organization of similar curve patterns to provide comparisons of various treatment methods to provide optimal treatment for each AIS surgical patient.