Instructional course lectures
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Pain management is a major concern for patients contemplating total knee replacement surgery and is one of the leading causes of dissatisfaction after knee replacement. Substantial progress has been made over the past several years in improving pain control after total knee replacement using multimodal pain control, preemptive analgesia, and periarticular injections.
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Pelvic fractures represent a significant transfer of kinetic energy to the body, and more than 80% of patients with unstable pelvic fractures have additional musculoskeletal injuries. A systematic approach with prompt intervention is critical in the initial management of patients with pelvic fractures. If intra-abdominal bleeding is suspected, diagnostic peritoneal lavage, focused assessment with sonography for trauma, or a CT examination is usually performed. ⋯ The orthopaedic surgeon provides prompt stabilization using external immobilizers, external fixation, or traction. The bladder, urethra, and nerve roots have an intimate location within the pelvis and are predisposed to injury in patients with pelvic fractures. Appropriately identifying associated abdominal, urologic, or neurologic injuries will provide important opportunities to reduce patient morbidity and improve long-term outcomes.
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The scaphoid is the most commonly fractured carpal bone of the wrist. It is an unusual carpal bone in that it bridges both the proximal and the distal rows; this subjects it to continuous shearing and bending forces. Approximately 80% of the scaphoid is covered by cartilage, which limits its ligamentous attachment and vascular supply. ⋯ There also has been a significant improvement in the management of difficult scaphoid nonunions, with or without deformity. Improved techniques include open and dorsal approaches and vascularized bone grafting of resistant scaphoid nonunions. Declining in popularity is the prolonged immobilization of unstable fractures when surgical stabilization may have been a better treatment option.
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Although definitive fixation of anterior pelvic ring injuries is usually referred to an orthopaedic trauma surgeon or a surgeon proficient in pelvic surgery, all orthopaedic surgeons should be familiar with the initial management and resuscitation of patients with high-energy pelvic ring injuries. The initial treatment may be limited to sheet or binder application in the emergency department to allow transfer of the patient to a trauma center or the application of an external fixator by an on-call surgeon, even though that surgeon may not be responsible for definitive fixation. It is important to understand the general principles and approaches used at the time of definitive surgery because decisions made by the initial treating physician may affect (or limit) the ability of the orthopaedic traumatologist to provide definitive care.
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There is considerable overlap in the clinical and imaging presentation of general orthopaedic conditions and musculoskeletal neoplasms. At centers that treat orthopaedic oncologic conditions, it is not uncommon to see patients with spine and extremity tumors previously treated for presumed general orthopaedic ailments. It is important for orthopaedic surgeons to understand how to interpret commonly ordered radiographic studies (radiographs, MRIs, and CT scans) as they relate to bone and soft-tissue tumors, to be familiar with the imaging appearance of common musculoskeletal lesions in the extremities and spine, and to understand what imaging findings should trigger a referral to an orthopaedic oncologist.