Instructional course lectures
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Neck pain is a common complaint that typically represents a spectrum of disorders affecting the cervical spine. The clinical history and examination of patients with neck pain dictate the proper timing and selection of diagnostic studies such as plain radiography, MRI, and myelography with CT. ⋯ Nonsurgical treatment is the most appropriate first step in almost all cases of cervical radiculopathy. In contrast, the conservative care of cervical spondylotic myelopathy with measures such as physical therapy, spinal manipulation, medications, collars, and traction is limited.
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Neural injuries that occur after total hip arthroplasty (THA) can be classified as involving either the central nervous system or peripheral nerves. Central nervous system changes after THA may be attributed to increased appreciation of fat embolism syndrome associated with THA. Certain maneuvers such as impacting the acetabulum, femoral reaming, and cement pressurization can force marrow fat into the venous system. ⋯ The mechanisms of vascular injury include occlusion associated with preexisting peripheral vascular disease and vascular injury during removal of cement during screw fixation of acetabular components, cages, or structural grafts. Perioperative assessment should include vascular evaluation of patients with absent pulses, previous vascular bypass surgery, or dysvascular limbs. A CT scan should be considered when cement or components extend medially into the pelvis.
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Degenerative cervical disk disease is a ubiquitous condition that is, for the most part, asymptomatic. When symptoms do arise as a result of these degenerative changes, they can be easily grouped into axial pain, radiculopathy and myelopathy. While the pathophysiology of radiculopathy and myelopathy is better understood, the source of neck pain remains somewhat controversial. ⋯ The natural history of these conditions suggests that for the most part patients with axial symptoms are best treated without surgery, while some patients with radiculopathy will continue to be disabled by their pain, and may be candidates for surgery. Myelopathic patients are unlikely to show significant improvement, and in most cases will show stepwise deterioration. Surgical decompression and stabilization should be considered in these patients.
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Review
Fractures of the distal aspect of the radius: changes in treatment over the past two decades.
Fractures of the distal end of the radius are among the most common orthopaedic injuries, and treatment of these fractures has changed over the course of time. Many fractures of the distal radius are in fact relatively uncomplicated and are effectively treated by closed reduction and casting. However, fractures that are either unstable and/or involve the articular surfaces can jeopardize the integrity of the articular congruence and/or the kinematics of these articulations. ⋯ The fracture pattern, degree of displacement, the stability of the fracture, and the age and physical demands of the patient determine the best treatment option. Over the past 20 years, there has been a development of more sophisticated internal and external fixation techniques and devices for the treatment of displaced fractures of the distal radius. The use of percutaneous pin fixation, external fixation devices that permit distraction and palmar translation, low profile internal fixation plates and implants, arthroscopically-assisted reduction, and bone grafting techniques including bone graft substitutes all have contributed to improving fracture stability and outcome.
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Knee injuries commonly occur in children and adolescents who participate in athletic activities. Open growth plates, apophyses, and chondroepiphyses are unique to the skeletally immature knee and account for the differences in injury patterns observed in children and adults. An understanding of anatomy and classification as related to treatment and outcome of fractures in the skeletally immature knee is important.