Instructional course lectures
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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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Unstable pelvic ring injuries in hemodynamically unstable patients are life-threatening emergencies that many orthopaedic surgeons encounter in practice. Therefore, it is important to be up to date regarding current methods of evaluating, assessing, and treating patients with these complex and severe injuries. Surgeons should first determine whether patients have hemodynamic instability and identify the source of the hemorrhage. Patients should then be assessed for stabilization of unstable pelvic ring injuries.
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One of the primary goals in the perioperative care of orthopaedic patients undergoing surgery is the avoidance of allogeneic transfusion. There are a number of ways to lessen blood loss during surgical intervention including regional hypotensive anesthesia, careful and atraumatic surgical technique, and coagulation of bleeding surfaces. ⋯ The use of perioperative recombinant erythropoietin is also a useful adjunct to promote stimulation of the bone marrow and increased red cell production. Although many infectious diseases that are transmitted through allogeneic blood transfusions have been lessened by better screening techniques, there is still potential life threatening reactions and viral transmissions that may be avoided by comprehensive blood management in joint arthroplasty.
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Posterior pelvic ring injuries disrupt the weight-bearing function of the pelvis and cause deformity that results in pain and loss of function. The indications for reduction and fixation are the presence of instability and/or deformity. ⋯ Although techniques exist for both open and closed reductions, the main dfficulty remains achieving anatomic restoration of the pelvis. Whether posterior pelvic ring injuries are best treated using closed reduction and fixation or open reduction and fixation remains a controversial topic.
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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.