Instructional course lectures
-
A significant proportion of patients will experience moderate to severe pain after hip or knee replacement surgery. Multimodal pain control regimens have been developed to address this issue. ⋯ Cyclooxygenase-2 inhibitors, a class of NSAIDs, are not believed to increase the risk of bleeding and may be useful in this population of patients. However, recent research shows increased cardiovascular and renal risks with cyclooxygenase-2 inhibitors and has limited their use for postoperative pain control in joint arthroplasty patients.
-
The indications for thoracic pedicle screw fixation have expanded over the past decade. Thoracic pedicle screws are now being used in the treatment of degenerative, traumatic, neoplastic, congenital, and developmental disorders. ⋯ With strict adherence to the surgical techniques of insertion, thoracic pedicle screw fixation is a safe and effective method of stabilization. It offers several advantages over other forms of fixation, especially in the upper thoracic spine where the options are limited.
-
Review
Radiculopathy and the herniated lumbar disk: controversies regarding pathophysiology and management.
Lumbar disk herniation is one of the most common problems encountered in orthopaedic practice. Despite the frequency of its occurrence, however, much about lumbar disk herniation is poorly understood. It is important to review the basic and clinical science underlying the pathophysiology and treatment, surgical and nonsurgical, of this disorder.
-
A concussion is defined as a complex pathophysiologic process affecting the brain that is induced by traumatic biomechanical forces. Concussions are caused by a direct or indirect blow that leads to a graded set of syndromes characterized by functional rather than structural disturbances to the brain. Concussions are characterized by a wide variety of presenting symptoms, including loss of consciousness, amnesia, confusion, headache, and nausea. ⋯ Computerized neuropsychologic testing is a new tool in the treatment of concussions. These tests measure memory, new learning, attention, and reaction time and should be used as an adjunct to other tools for clinical decision making. Published guidelines will assist in treatment decisions; however, it should be kept in mind that all concussions are unique injuries.
-
The evaluation of injury of the cervical spine in children is complicated by biomechanics of the pediatric cervical spine that differ from those in the adult, by incomplete maturation and ossification of the vertebral segments, and by difficulties the physician may have in communicating with the child. Because the upper cervical region, from occiput to C2, is most susceptible to injury in children, it is important to have an understanding of mechanisms of injury, diagnostic imaging modalities, and therapeutic interventions. A clear understanding of adult and pediatric cervical spine differences will facilitate early diagnosis and appropriate treatment of cervical spine injuries in young children.