Principles of Open Fracture Management.
Authors: Patzakis MJ, Levin LS, Zalavras CG, Marcus RE Abstract Open fractures are contaminated wounds that contain gram-positive and gram-negative organisms; therefore, wide-spectrum antibiotic therapy should be incorporated into the treatment plan. Antibiotics should be initiated as soon after injury as possible, preferably within 3 hours of injury, after which time the rate of infection has been reported to increase. Time to surgical débridement within 12 hours of injury has not been reported to affect the rate of infection, given that a patient is being treated with antibiotics. An antibiotic bead pouch ...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Open Reduction and Internal Fixation Versus Acute Arthroplasty for the Management of Common Extremity Injuries: Evidence-Based Decision Making.
Authors: Schemitsch E, Nauth A, McKee MD, Kreder HJ, Schmidt AH Abstract A considerable burden of disease is associated with the management of periarticular fractures. Increasingly, evidence-based medicine is used to define the standard of clinical care. The role of internal fixation in the management of periarticular fractures, particularly in elderly patients, has been questioned. Currently available evidence-based medicine studies may help surgeons decide whether open reduction and internal fixation or arthroplasty is appropriate for the management of common periarticular injuries. The management of periarticula...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Femoral Neck Fractures in Young Patients.
Authors: Crist BD, Eastman J, Lee MA, Ferguson TA, Finkemeier CG Abstract Femoral neck fractures in patients 55 years or younger, although relatively uncommon, may cause considerable surgeon stress because they may be thought to be surgical emergencies and are difficult to manage, resulting in serious complications. Orthopaedic surgeons should understand the optimal timing for, the reduction options and techniques for, the fixation options for, and the results of surgical management of femoral neck fractures in patients 55 years or younger. The optimal timing of the surgical management of femoral neck fractures in ...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Supracondylar Femur Fractures.
Authors: Siegel J, Tornetta Iii P Abstract Supracondylar femur fractures are common fractures that represent a management challenge. Despite consistent fracture patterns and predictable challenges associated with reduction and stabilization, complications, including malunion, nonunion, and implant failure, can occur in patients who undergo treatment for the management of a supracondylar femur fracture. Although improvements in intramedullary nailing techniques, the emergence of biologically friendly surgical techniques, and the introduction of locked plating constructs have revolutionized orthopaedic fracture care,...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Intramedullary Nailing of Subtrochanteric Femur Fractures.
Authors: Haddix KP, Ostrum RF Abstract Intramedullary nailing of subtrochanteric femur fractures may be a challenge because of the deforming muscle forces on the proximal fragment; the inability to attain an ideal starting point or fracture reduction; and the high risk for nonunion, malunion, and hardware failure as a result of the great amount of stress present in the subtrochanteric region of the femur. Surgeons should understand the surgical technique for and the outcomes of intramedullary nailing of subtrochanteric femur fractures. A proper starting point, maintenance of reduction during reaming, and careful co...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Reduction Techniques for Diaphyseal Femur Fractures.
Authors: Wolinsky PR, Lucas JF Abstract Achieving and maintaining reduction in patients with a diaphyseal femur fracture may be difficult; therefore, thorough preoperative planning is required. To fully prepare for successful surgical management of diaphyseal femur fractures, surgeons must consider appropriate patient positioning and necessary tools, including surgical tables, traction devices, and instruments. Principles of acceptable reduction rely on the restoration of length, alignment, and rotation. Reduction of diaphyseal femur fractures should be attained in the least invasive manner, via percutaneous reduct...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Ankle Fractures in Elderly Patients with Osteopenia and Neuropathy.
Authors: Kubiak EN, Horwitz DS Abstract Ankle fractures are increasingly common in elderly patients given the number of aging individuals who remain active. The already difficult aspects of ankle fixation are amplified by the compromised soft-tissue envelope and bone quality present in elderly patients with an ankle fracture. In addition, elderly patients with an ankle fracture often have compromised neuroprotective mechanisms and are physically unable to follow postoperative protected weight-bearing protocols during ambulation. Surgeons should be aware of strategies to improve fixation and maintain the tibiotalar ...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Stemless Prosthesis for Total Shoulder Arthroplasty.
Authors: Lazarus MD, Cox RM, Murthi AM, Levy O, Abboud JA Abstract The fourth generation of humeral components currently are being used in anatomic shoulder arthroplasty. Anatomic shoulder arthroplasty implants have evolved to better re-create anatomy, improve fixation, preserve bone, and facilitate revision surgery. Most of the design changes for shoulder arthroplasty implants have centered on the humeral stem, with a transition to shorter, metaphyseal humeral stems. Many of these humeral component design changes may be beneficial; however, long-term studies are necessary to determine if the results of anatomic sh...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Glenohumeral Arthritis in Young Patients: Scope, Arthroplasty, Interposition, Arthrodesis, and Resurfacing.
Authors: Murthi AM, Cox RM, Strelzow JA, Athwal GS, Tashjian RZ, Abboud JA Abstract The management of glenohumeral arthritis in young patients is a challenge given the higher demand for use of the arms, need for longer implant survivorship, and higher postoperative expectations in this patient population. Shoulder arthroplasty is an excellent treatment option for elderly patients with glenohumeral arthritis because this patient population does not have demands as high as those of younger patients with glenohumeral arthritis. Common causes of glenohumeral arthritis in young patients include chondrolysis, inflammator...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Management of Failed Shoulder Surgery.
Authors: Levine WN, Jobin CM, Sperling JW, Walch G, Cole BJ, Shiu B Abstract The popularity of shoulder surgery has increased in the past several decades, which has resulted in a concomitant increase in the number of complications that occur in patients who undergo shoulder surgery. Surgeons should understand the complications that may occur in patients who undergo common shoulder procedures. A plan for the management of shoulder surgery complications is necessary regardless whether a surgeon is an expert shoulder surgeon or a novice shoulder surgeon. PMID: 31411406 [PubMed] (Source: Instructional Course Lectures)
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Alternatives to Reverse Total Shoulder Arthroplasty for Management of Massive Rotator Cuff Tears.
Authors: Paschos NK, Bannister ER, Kelly Iv JD, Zgonis MH Abstract Multiple alternatives to reverse total shoulder arthroplasty exist for the management of massive rotator cuff tears. Surgeons should understand the current indications for and outcomes of alternatives to reverse total shoulder arthroplasty for the management of massive rotator cuff tears. Successful rotator cuff repair involves two major challenges: the creation of forceful mechanical integrity of the repair and the creation of a biologic environment that enhances tissue healing. Given the latest advancements in grafts and biologic enhancement, arth...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Management of Failed Rotator Cuff Repair in Young Patients.
Authors: Elhassan BT, Cox RM, Shukla DR, Lee J, Murthi AM, Tashjian RZ, Abboud JA Abstract Management of failed rotator cuff repair may be very difficult, especially in young patients. Various nonmodifiable and modifiable patient factors, including age, tendon quality, rotator cuff tear characteristics, acute or chronic rotator cuff tear, bone quality, tobacco use, and medications, affect rotator cuff repair healing. Surgical variables, such as the technique, timing, tension on the repair, the biomechanical construct, and fixation, as well as the postoperative rehabilitation strategy also affect rotator cuff repair...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Current Perspectives on Complex Wrist Fracture-Dislocations.
Authors: Jupiter JB, Nunez FA, Nunez F, Fernandez DL, Shin AY Abstract Although perilunate injuries represent only 5% of all carpal injuries, they compose a spectrum of devastating complex wrist injuries. Perilunate injuries result from high-energy trauma to the wrist and may be associated with multiple fractures, dislocations, and ligament injuries. Although the diagnosis of a perilunate injury is made via radiographic assessment, missed diagnosis occurs in 25% of patients with a perilunate injury. Immediate diagnosis of perilunate injuries is critical to optimize patient outcomes. Closed reduction of perilunate i...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Preoperative Patient Preparation for Total Knee Arthroplasty.
Authors: Levine B, Caccavallo P, Springer BD, Meneghini RM Abstract The perioperative treatment of patients who undergo total knee arthroplasty is commonly discussed and the focus of many researchers. Typically, protocols and pathways are developed by surgeons and hospitals to standardize the care of, improve the outcomes of, and minimize complications in these patients. Intraoperative and postoperative total knee arthroplasty protocols have been well documented in the literature and are the subject of a substantial number of peer-reviewed studies. The preoperative treatment and optimization of these patients is a ...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Practical Surgical Techniques for Revision Total Hip Arthroplasty.
Authors: Petrie J, Haidukewych GJ, Liporace FA, Kyle RF, Bernasek TL, Werger MM Abstract Although total hip arthroplasty is an extremely successful procedure, the continual increase in the number of total hip arthroplasties that are performed is associated with the substantial burden of revision total hip arthroplasty. Modes of total hip arthroplasty failure include instability, aseptic loosening, infection, periprosthetic fracture, hardware failure, and component wear, all of which are indications for revision total hip arthroplasty. Surgeons must have a sound preoperative revision total hip arthroplasty plan and ...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Management of Acetabular Bone Loss in Revision Total Hip Arthroplasty.
Authors: Melnic CM, Paprosky WG, Sheth NP Abstract Revision total hip arthroplasty in patients with acetabular bone loss is a challenge and should only be performed by experienced surgeons. Correct classification of the acetabular bone loss pattern allows for the formulation and execution of a detailed treatment plan. However, reclassification of the bone loss pattern is essential if additional bone loss is discovered intraoperatively so that the patient is appropriately treated. Modular, uncemented, porous metal augments and a jumbo acetabular cup should be used to treat patients with severe acetabular bone loss (...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Management of Chronic Pelvic Discontinuity in Revision Total Hip Arthroplasty.
Authors: Sheth NP, Paprosky WG, Melnic CM Abstract Acetabular bone loss is commonly encountered in patients who undergo revision total hip arthroplasty. Severe bony defects may be associated with chronic pelvic discontinuity, which makes acetabular reconstruction considerably more difficult. Surgeons must understand the current treatment options for patients with severe acetabular bone loss and chronic pelvic discontinuity. Surgeons also should understand how to perform acetabular distraction with the use of a porous acetabular shell and porous, modular metal augments. PMID: 31411413 [PubMed] (Source: Instructi...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Periprosthetic Fractures About the Hip and Knee: Contemporary Techniques for Internal Fixation and Revision.
Authors: Liporace FA, Kubiak EN, Levine B, Yoon RS Abstract The number of periprosthetic fractures is expected to increase given the growing number of elderly individuals who are living longer and advances in technology that allow for total hip and knee arthroplasty in younger patients. Evolving technologies in combination with a better understanding of required total hip and knee reconstruction has allowed for continued improvements in applied fixation strategies and patient outcomes. Current fixation and revision options have led to reliable, reproducible management of periprosthetic fractures about the hip and k...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Postoperative Patient Treatment for Total Knee Arthroplasty.
Authors: Levine B, Caccavallo P, Springer B, Meneghini RM Abstract In the current healthcare environment, the postoperative treatment of patients who undergo total knee arthroplasty (TKA) is critical to successful outcomes, patient satisfaction, and controlling costs. Preemptive analgesia and the avoidance of excessive narcotics may help improve the outcomes and satisfaction of patients who undergo TKA because it allows for a more rapid rehabilitation program and reduces overall pain. Various techniques can be used to minimize the postoperative pain routinely observed in these patients. In addition, appropriate pos...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Surgical Management of Charcot Arthropathy.
Authors: Jones C, McCormick JJ, Pinzur MS Abstract The historic management of Charcot foot arthropathy has consisted of immobilization until the active phase of the disease resolves, followed by longitudinal accomodative bracing of the acquired deformity. This historic management of Charcot foot arthropathy has not resulted in improved quality of life and has fostered interest in the surgical correction of the acquired deformity. Orthopaedic surgeons should understand the current indications for the surgical management of and the specific surgical techniques to correct acquired deformities in patients with Charcot ...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Avoiding Failure and Complications in Cavovarus Foot Deformity Reconstruction.
Authors: Raikin SM, Parekh SG Abstract Symptomatic cavovarus foot deformity is frequently associated with neuromuscular conditions, such as Charcot-Marie-Tooth disease, which cause an imbalance between antagonistic muscle groups, thereby leading to the deformity. Avoiding complications in the treatment of patients with cavovarus foot deformity requires a detailed understanding of this imbalance between antagonistic muscle groups and the resulting three-dimensional deformity. Because of the poor outcomes reported in patients with cavovarus foot deformity who undergo nonsurgical treatment or fusion procedures, joint-...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Management of Achilles Tendon Rupture Complications.
Authors: Wang C, Parekh SG, Mithani SK Abstract The management of Achilles tendon rupture complications has always been a challenge. Rerupture, infection, wound problems, suture reaction, weakness as a result of Achilles tendon lengthening, sural nerve injury, and thrombosis are the most common complications in patients who undergo treatment for Achilles tendon rupture. Given the increasing incidence of Achilles tendon rupture, orthopaedic surgeons must understand the basic principles for the management of Achilles tendon rupture and the appropriate techniques to help reduce the rate of complications. PMID: 314...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Osteochondral Defects of the Talus: Current Management Dilemmas.
Authors: Younger A, Shimozono Y, Kennedy JG, Ferkel RD, Stone JW, Giza E, Glazebrook M, Bentley R Abstract Osteochondral defects or lesions of the talus represent a management challenge. Arthroscopic débridement is the treatment of choice for patients with an osteochondral lesion of the talus in whom nonsurgical treatment fails. Although surgeons have a better understanding of the risk factors for failed débridement in patients with an osteochondral lesion of the talus, the treatment of patients in whom a high risk for failed débridement exists and patients in whom débridement fails is c...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Spinal Trauma in the Pediatric Polytrauma Patient.
Authors: Bunch JT, Dimar Ii JR Abstract Pediatric spine trauma, although relatively uncommon, encompasses several spinal injuries that may be associated with substantial neurologic injury and multiple traumatic injuries. Spinal injuries may have considerable lifelong effects on pediatric patients; therefore, early diagnosis and management of spinal injuries in pediatric patients is imperative to ensure optimal outcomes. Anatomic features unique to the pediatric spine predispose pediatric patients to injury patterns that are not frequently observed in adults. Careful assessment of the injury pattern and the associat...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Neurologic Recovery in Polytrauma Patients With Acute Spinal Cord Injury.
Authors: Bourassa-Moreau É, Kwon BK Abstract Traumatic spinal cord injury results in devastating and lifelong neurologic impairment in thousands of individuals each year. An understanding of the factors that influence neurologic outcome in polytrauma patients with a spinal cord injury allows for early treatment, which may improve neurologic recovery. Neurologic impairment in polytrauma patients with spinal cord injury is clinically classified based on the American Spinal Injury Association International Standards for Neurological Classification of Spinal Cord Injury. In general, neurologic recovery is worse ...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Occiput to C1-2 Fractures: Assessment, Bracing, and Reconstructive Techniques.
Authors: Yao R, Fisher CG Abstract The craniocervical junction is a transitional segment from the cranium to the cervical spine with a unique architecture that accommodates a high degree of motion and requires considerable contributions from surrounding ligamentous structures for stability. The assessment, immobilization, and management of upper cervical spine injuries requires consideration of the complex architecture that exists and the movement that occurs in the craniocervical junction. Early diagnosis and stabilization of upper cervical spine injuries is crucial because devastating complications may occur in p...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Subaxial Cervical Spine Injuries in the Polytrauma Patient.
Authors: Anderson PA, Dimar Ii JR Abstract Management of cervical spine injuries in polytrauma patients involves a comprehensive assessment that consists of a physical examination and imaging studies to identify substantial injury. The management of diagnosed cervical spine injuries in polytrauma patients should be coordinated with the management of other injuries. Timely management is required in polytrauma patients with a spinal cord injury. A high oxygen saturation level must be maintained and a mean arterial blood pressure of 85 mm Hg is recommended. Reduction via traction or urgent surgical decompression, as i...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Surgical Decision Making for Thoracolumbar Spine Injuries in Polytrauma Patients.
Authors: Morrissey PB, Murphy H, Astolfi MM, Sandhu H, Vaccaro AR Abstract The management of thoracolumbar spine injuries in patients with multiple traumatic injuries is a challenge complicated by multiple competing medical and surgical demands. Safe and effective treatment of polytrauma patients with a thoracolumbar spine injury requires a multidisciplinary approach that involves surgical and critical care teams. The Thoracolumbar Injury Classification and Severity Score, which was developed to facilitate consistent surgical decision making in patients with a thoracolumbar spine injury, provides objective criteria...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Management of Unstable Fracture-Dislocations of the Spine in Polytrauma Patients.
Authors: Jazini E, Carreon LY, Dimar Ii JR, Glassman SD Abstract A multidisciplinary and systematic approach is required for the treatment of polytrauma patients with a thoracolumbar fracture-dislocation to provide timely care and prevent iatrogenic injury. Thoracolumbar fracture-dislocations frequently occur in patients who sustain a high-energy mechanism of injury; therefore, they are associated with other orthopaedic and visceral injuries that need to be identified via a systematic protocol. Orthopaedic surgeons must obtain a thorough patient history, perform an appropriate physical examination, and obtain adequ...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

A Practical Guide to Avoiding and Managing Complications in Pediatric Spinal Deformity Surgery.
Authors: Miller DJ, Shah SA, Lonner BS, Yaszay B, Cahill PJ Abstract Despite recent research and improvements in spinal implants, complications remain frequent in patients who undergo pediatric spinal deformity surgery. Although the rate of neurologic injury after pediatric spinal deformity surgery is low, the rate of surgical site infection after pediatric spinal deformity surgery is high, particularly in patients who have neuromuscular scoliosis. Although symptomatic implant complications that require revision surgery are rare with the use of modern spinal fusion constructs, they are common in patients who have e...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Challenges in the Management of Anterior Cruciate Ligament Ruptures in Skeletally Immature Patients.
Authors: DeFrancesco CJ, Storey EP, Shea KG, Kocher MS, Ganley TJ Abstract Although initially considered rare, anterior cruciate ligament (ACL) ruptures in pediatric patients recently have increased substantially as a result of greater awareness of the injury and increased participation in youth sports. Although pediatric patients with an ACL injury and a clinically stable joint may handle the injury well and return to sports activity without requiring surgical reconstruction, young, active patients with an ACL rupture and an unstable joint may be good candidates for ACL reconstruction to prevent ongoing instabilit...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Osteochondritis Dissecans in the Skeletally Immature Knee.
Authors: Shea KG, Richmond CG, Ganley TJ Abstract Osteochondritis dissecans of the knee, which results in knee symptoms and activity-related pain, is a condition that commonly affects young individuals. The etiology of osteochondritis dissecans remains unclear; however, genetic and endocrine factors, ischemia, inflammation, repetitive microtrauma, and spontaneous osteonecrosis have been suggested as causes of osteochondritis dissecans. Skeletally immature patients with a stable osteochondritis dissecans lesion typically have minimal clinical symptoms and, if treated nonsurgically, experience a high rate of healing....
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Shoulder Instability: An American Perspective.
Authors: Frank RM, Arciero RA, Erickson BJ, Trenhaile ST, Provencher MT, Verma NN Abstract The recognition and management of glenohumeral instability has become an increasingly important aspect of orthopaedic care. Substantial controversy exists with regard to the indications for soft-tissue stabilization versus bony augmentation in patients with glenohumeral instability, particularly among surgeons in the United States and Europe. Although bone loss procedures are frequently performed in the United States and abroad, surgical techniques and indications for bone loss procedures are different. Surgeons should unders...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Superior Capsule Reconstruction.
Authors: Burkhart SS Abstract In patients who have a massive rotator cuff tear without glenohumeral arthritis in whom surgery is indicated, surgeons should always attempt a complete repair. Interval slides and linked high-strength repair constructs can be used; however, despite advanced mobilization and repair techniques, some rotator cuff tears are not fully repairable. Promising early outcomes have been reported in select patients with a massive rotator cuff tear who undergo superior capsule reconstruction with the use of acellular dermal allograft. PMID: 31411430 [PubMed] (Source: Instructional Course Lectures)
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Management of Biceps Tendon Pathology: From the Glenoid to the Radial Tuberosity.
Authors: Frank RM, Cotter EJ, Strauss EJ, Jazrawi LM, Romeo AA Abstract Management of proximal and distal biceps tendon pathology is evolving. The long head of the biceps tendon, if inflamed, may be a pain-producing structure. In appropriately indicated patients, a symptomatic long head of the biceps tendon can be surgically managed via tenotomy, tenodesis, and/or superior labrum anterior to posterior repair. In some patients, primary superior labrum anterior to posterior pathology can be managed via biceps tenodesis. Determining which procedure is most appropriate for and which technique and implant are preferred ...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Incorporating Hip Arthroscopy Into A Practice.
Authors: Safran MR, Bedi A, Byrd JWT, Guanche CA, Ilizaliturri V, Lynch TS, Martin HD, Matsuda DK, McCarthy JC, Philippon MJ, Sampson TG, Suarez-Ahedo C Abstract Hip arthroscopy is one of the most rapidly growing areas in orthopaedic surgery because of increased awareness of nonarthritic hip pathologies, advanced imaging modalities, and advanced techniques to reproducibly manage nonarthritic hip pathologies within a deep soft-tissue envelope and a constrained joint. In addition, more academic medical centers are providing residents with education on hip arthroscopy, and many hip preservation fellowships and courses...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

The Utility of Biologics, Osteotomy, and Cartilage Restoration in the Knee.
Authors: Frank RM, Cotter EJ, Strauss EJ, Gomoll AH, Cole BJ Abstract The management of complex cartilage and meniscal pathology in young, athletic patients is extremely challenging. Patients with concomitant knee pathologies, including cartilage defects, meniscal deficiency, malalignment, and/or ligamentous insufficiency, are the patients in whom joint preservation surgery is most difficult. Clinical decision making for these patients is further complicated by articular cartilage lesions, which often are incidental findings; therefore, treatment decisions must be based on the confirmed contribution of articular ca...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Management of Meniscal Pathology: From Partial Meniscectomy to Transplantation.
Authors: Pickell M, Jejurikar N, Anil U, Salata M, Davidson PA, Jazrawi LM, Strauss EJ Abstract Meniscal tears are common injuries that may result in functionally limiting pain, swelling, and mechanical symptoms. The management of meniscal pathology has evolved as surgeons' understanding of the important role the menisci play in normal knee kinematics increases. Recent emphasis on partial meniscectomy, expanding indications for meniscal repair, and the increased use of meniscal allograft transplantation have helped improve the outcomes of patients with a meniscal tear who undergo treatment. Orthopaedic surgeons sho...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Basic Science for the Practicing Orthopaedic Surgeon: A Focus on Fracture Healing.
Authors: Bravo D, Leucht P Abstract The key stages of fracture healing are proliferation, differentiation, and remodeling. Each stage of fracture healing is regulated by specific growth factors. Orthopaedic surgeons should understand the basic biologic principles of fracture repair and the therapeutic targets that can augment the natural regenerative capacity of the human body. In addition, orthopaedic surgeons should be aware of the key regulators in fracture healing and their potential uses in the field of orthopaedics. PMID: 31411435 [PubMed] (Source: Instructional Course Lectures)
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

How Can I Get This Bone to Heal?
Authors: Zalavras CG, Marcus RE, Sontich JK Abstract A nonunion is a reconstructive challenge that may have a devastating effect on a patient's quality of life. To develop an individualized treatment plan, surgeons must carefully assess several factors related to the nonunion, including the involved bone, the existing implants, the presence of infection, the soft-tissue envelope, and the function of the involved extremity, as well as the status of the patient. Essential components of an individualized treatment plan for a patient with a nonunion include management of infection (if present); optimization of the syst...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

The Answer is Vitamin D! From Pediatrics to Geriatrics in Orthopaedics.
Authors: Minkowitz B, Sawyer A, Fung EB, Dvorzhinskiy A, Lane JM Abstract Vitamin D is necessary for the regulation of calcium and phosphate in the human body. Decreased vitamin D levels can alter the bone mineralization process. The prevalence of vitamin D deficiency in the general population is high, and low vitamin D levels are associated with disorders such as rickets and osteoporosis. As knowledge about vitamin D metabolism increases, physicians of all specialties are becoming more attentive to the vitamin D status of their patients. Similarly, orthopaedic surgeons, through various initiatives such as "Ow...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Proper Use of Antibiotic Agents in the Management of Musculoskeletal Infection.
Authors: Lowenberg DW, Goel R, Parvizi J Abstract Musculoskeletal infections have plagued all creatures for millions of years. The ability to manage infection via antibiotic agents has emerged only in the past 100 years. The use of antibiotic agents has not always been appropriate and judicious, which has led to widespread microbial resistance to certain antibiotic agents. Although antibiotic resistance is a considerable consequence of inappropriate antibiotic use, the systemic adverse effects of chronic antibiotic use on patients have largely been ignored. These systemic adverse effects may have been prevented if ...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Bone and Soft-Tissue Tumors for the General Orthopaedic Surgeon: Diagnosis, Management, and Avoiding Errors.
Authors: Morris CD, Forsberg JA, Lewis VO Abstract Orthopaedic surgeons will encounter a variety of bone and soft-tissue lesions throughout their careers. Although most of these lesions will be benign and nonaggressive, many others will require management that is time consuming, challenging, and stressful for surgeons and patients. Errors in management, if they occur, may delay diagnosis and hinder efforts to perform limb-sparing surgery. A systematic approach to the evaluation of adult and pediatric patients with bone or soft-tissue tumors will help general orthopaedic surgeons correctly diagnose and manage tumors...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Modern Techniques for the Management of Metastatic Spine Disease.
Authors: Ashana A, Kay A, Marco RAW Abstract The management of metastatic spine disease has evolved substantially in the past 5 years. Early treatment approaches with more aggressive surgical indications were based on studies that misinterpreted or overemphasized the advantages of the surgical management of metastatic spine disease. However, substantial advantages in radiation therapy, chemotherapy, and biologic agents have led to considerable improvements in patient outcomes and have, in many patients, shifted the paradigm back to nonsurgical or less invasive treatment modalities. Surgeons should be aware of criti...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Introduction to Additive Manufacturing and Three-Dimensional Printing in Orthopaedics.
Authors: Jakus AE, Mihalko WM, Golish SR, Anderson PA, Hsu W Abstract Additive manufacturing involves the construction of devices via the layer-by-layer deposition of materials. Additive manufacturing, which also is referred to as three-dimensional printing, is different from traditional machining, which involves the subtraction of material from a workpiece. Although traditional machining methods have been used in the field of manufacturing for decades, a recent rise in the commercial use of additive manufacturing has occurred in the field of orthopaedic surgery. Orthopaedic surgeons should understand the pertinent...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Applications of Three-Dimensional Printing in Orthopaedic Surgery.
Authors: Anderson PA, Hsu W, Golish SR, Jakus AE, Mihalko WM Abstract Orthopaedic surgeons should be aware of the variety of applications of three-dimensional printing, which range from rough-and-ready applications, such as rapid prototyping of implant designs with the use of polymers to the fabrication of patient-specific implants and custom implants with the use of the principles of metallurgy. The local manufacture of low-cost prosthetic devices in third-world nations is the best example of the potential application of three-dimensional printing. Orthopaedic surgeons should understand the multiple applications o...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Three-Dimensional Printing and Tissue Engineering in Orthopaedics.
Authors: Jakus AE, Hsu W, Anderson PA, Golish SR, Mihalko WM Abstract Additive manufacturing and three-dimensional printing technology may revolutionize tissue-engineering strategies. Many clinical needs, including multitissue regeneration, remain unmet among patients with orthopaedic conditions. Ongoing research efforts in three-dimensional printing, including cell-containing bioinks for bioprinting, have resulted in acellular and cellular biomaterials that may help regenerate or replace damaged or missing biologic tissues. Recent advances in additive manufacturing aid in the preservation of biologic activity, suc...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Office Pediatric Orthopaedics for the General Orthopaedic Surgeon: Staying Current and Avoiding Mistakes.
Authors: Horn BD, Milbrandt TA, Young E, Herman MJ, Parikh D, Dasgupta R, Mody KS Abstract Pediatric and adolescent patients frequently are seen in the outpatient practices of general orthopaedic surgeons. Orthopaedic conditions may be a challenge to diagnose and manage in pediatric and adolescent patients. To avoid complications, general orthopaedic surgeons should understand current diagnostic techniques, evaluation methods, and treatment options for orthopaedic spine, hip, and lower extremity conditions that are common in pediatric and adolescent patients. General orthopaedic surgeons should understand the indic...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Lessons Learned From Bundled Payment Programs.
Authors: Jiranek WA, Fehring TK, Pagnano MW, Meneghini RM, Garvin KL, Gannon EJ, Golladay G, Della Valle CJ, Bozic KJ, Yates AJ, Froimson MI, Iorio R, Shaia A Abstract To encourage the shift to value-based health care, the Center for Medicare & Medicaid Innovation created bundled payment programs in which episodes of care are paid for in a bundled fashion. Hip arthroplasty and knee arthroplasty were believed to be good procedures to pilot in bundled payment programs because these procedures had an easily defined episode of care and accounted for a considerable amount of the Medicare budget. Cost savings for hip...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Employment Contracts: The Good, the Bad, and the Ugly.
Authors: Bert JM, Larson JR, Sgaglione NA, McIntyre LF, Glaser D Abstract Recent trends indicate that a greater number of orthopaedic surgeons who complete their residency and/or fellowship training are accepting employment positions at hospitals. Moreover, established orthopaedic surgeons with successful private practices have begun to consider whether aligning with hospitals and larger health systems can be effectively accomplished. A comprehensive evaluation of institution-based employment opportunities is essential for orthopaedic surgeons considering hospital-based employment. Surgeons should be aware of the h...
Source: Instructional Course Lectures - August 16, 2019 Category: Orthopaedics Tags: Instr Course Lect Source Type: research