Ankle Malunion: When and How to Perform Supramalleolar Osteotomy
Instr Course Lect. 2024;73:209-219.ABSTRACTAnkle osteoarthritis is usually posttraumatic, creating asymmetric damage on the ankle joint in approximately 80% of cases. The talus is susceptible to tilt to the damaged cartilage area, producing a supramalleolar deformity with localized ankle arthritis. Supramalleolar osteotomy is joint-preserving surgical treatment for patients with localized ankle arthritis. This procedure's objectives include improving intra-articular load distribution by overcorrecting the axis, slowing down or stopping the degeneration of the tibiotalar joint, and improving function. Preoperative planning ...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Cristian Ortiz Mateluna Ximena Ahumada Pavez Source Type: research
Management of the Hindfoot and Ankle in
Charcot Arthropathy
Instr Course Lect. 2024;73:221-230.ABSTRACTNeuropathic destabilization of the hindfoot and/or ankle is a significant complication for the patient with diabetes/neuropathy. The loss of ligamentous integrity and bony destruction results in a limb that is not stable for weight bearing. This loss of independence adds significant health risks to the patient. Management of this disease process is both time consuming and technically demanding for both the practitioner and the patient. Attention to detail and aggressive decision making is often necessary to salvage the limb. The goal for treatment is to produce a stable, weight-be...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: John S Early Source Type: research
Midfoot Fusion Using Superconstructs for the Charcot Foot: Current Techniques and Complications
Instr Course Lect. 2024;73:231-245.ABSTRACTNeuroarthropathy of the foot and ankle presents a series of challenges. The treating physician faces a perfect storm of pathomechanics, deformity, and medical comorbidities. Successful treatment requires a systematic approach in diagnosis, nonsurgical management, surgical management, and long-term maintenance of the affected extremity. Nonsurgical care of the Charcot foot remains the mainstay of treatment and is successful in most cases. Surgery has become more accepted for patients with severe deformity. The concept of a superconstruct has been introduced to describe modern surgi...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Vincent James Sammarco Josika A Sammarco Mark E Baratz G James Sammarco Source Type: research
Managing the Severe Cavus Foot Deformity in Global Humanitarian Programs
Instr Course Lect. 2024;73:247-261.ABSTRACTThe cavus foot represents a complex spectrum of deformity ranging from the subtle idiopathic to the severe sensorimotor neuropathy and other neuromuscular deformities. The successful surgical treatment of the cavus foot depends on a fundamental understanding of the underlying multiplanar deformity, inherent muscle balance, and the rigidity of the hindfoot. The location of the deformity is described and understood according to its multiple apices. These deformities are addressed with osteotomies or arthrodesis directed at the apices of deformity. Simultaneously, correction of muscu...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Brady T Williams Shuyuan Li Mark S Myerson Source Type: research
Management of Infections and Osteomyelitis in
Patients With Charcot Foot Arthropathy
Instr Course Lect. 2024;73:263-267.ABSTRACTThere is growing interest in performing reconstruction of deformities associated with Charcot foot arthropathy. At least half of the patients undergoing this reconstruction will have chronic wounds and osteomyelitis overlying the deformity. It is important to provide orthopaedic surgeons with tools for making the diagnosis of osteomyelitis in this patient population and creating a strategy for treatment.PMID:38090903 (Source: Instructional Course Lectures)
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Michael S Pinzur Source Type: research
Total Wrist Arthroplasty: An International Perspective
Instr Course Lect. 2024;73:271-284.ABSTRACTConcerns about implant durability and technical difficulty continue to make total wrist arthroplasties a specialized procedure with a narrow scope of indications. As a result, more routinely performed total or partial wrist arthrodesis continues to maintain popularity over arthroplasty. However, wrist motion preservation is undoubtedly preferable for patients and current literature is trending to more favorable outcomes for total wrist arthroplasties. In the setting of the evolving role of wrist arthroplasties in clinical practice, it is important to focus on providing hand surgeo...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Marco Rizzo Amitava Gupta Guillaume Herzberg Marion Burnier Michel E H Boeckstyns S øren Merser Robert Gvozdenovic Christine Schaeffer Timothy J Irwin A Lee Osterman Nina Suh Source Type: research
Hand Fractures-Management and the Complications That Inevitably Occur: Metacarpal Fractures
Instr Course Lect. 2024;73:285-304.ABSTRACTMetacarpal fractures are among the most common hand fractures. To properly manage these injuries, surgeons must understand the anatomy, biomechanics, clinical assessment, surgical and nonsurgical treatment options, and potential complications. Metacarpal head fractures often require surgical treatment to restore the joint surface by using a variety of techniques. Metacarpal neck fractures are usually stable injuries that do not require surgical intervention, but surgeons must know when surgical intervention is indicated. Fractures of the metacarpal shaft can be treated surgically ...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Tristan B Weir Joshua M Abzug R Glenn Gaston Meredith N Osterman A Lee Osterman Source Type: research
Phalangeal Fractures and Fingertip Injuries
Instr Course Lect. 2024;73:305-324.ABSTRACTA comprehensive analysis of the assessment, diagnosis, and management of phalangeal fractures and fingertip injuries should emphasize the importance of achieving the right balance between undertreatment and overtreatment. Phalangeal injuries are complex, requiring an in-depth understanding of hand anatomy, fracture patterns, and treatment options to optimize patient outcomes. A thorough examination of proximal and middle phalangeal fractures and fingertip injuries, including those to the nail bed and distal phalanx, is important. A systematic approach to addressing the most preval...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: James Tyler Frix Ryan Phillip Serbin R Glenn Gaston Source Type: research
Proximal Interphalangeal Joint Fractures
Instr Course Lect. 2024;73:325-346.ABSTRACTMultiple fracture patterns can occur around the proximal interphalangeal joint and require surgeons to have a thorough understanding of the anatomy, clinical and radiographic examination, common fracture patterns, surgical and nonsurgical treatment options, and potential complications. Proximal phalangeal condylar fractures are typically managed surgically, because even nondisplaced fractures have a propensity for displacement. Middle phalangeal base fractures most commonly present as a volar lip fracture with or without dorsal subluxation or dislocation. Treatment options include...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Tristan B Weir Joshua M Abzug R Glenn Gaston A Lee Osterman Meredith N Osterman Source Type: research
Top No-Nonsense Tips: The Dos and Don'ts of Managing Flexor Tendon Injuries
Instr Course Lect. 2024;73:347-355.ABSTRACTFlexor tendon injury surgical repairs can be challenging for surgeons, where the timing of surgery and precision of repair matter the most. The latest evidence and basic science discoveries in flexor tendon management are provided. It is important to review how wide-awake local anesthesia no tourniquet surgery has been a paradigm shift in surgical management and pearls learned from incorporating this into practice.PMID:38090908 (Source: Instructional Course Lectures)
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Maureen A O'Shaughnessy Marco Rizzo Nicholas Pulos Donald G Pitts Source Type: research
Advances in Oncologic Shoulder Girdle Resection and Reconstruction
Instr Course Lect. 2024;73:359-368.ABSTRACTThe bony shoulder girdle consists of the clavicle, humerus, and scapula, which work synergistically to form a complex articulation that is essential for use of the upper extremity. The shoulder girdle is the most common location for primary and secondary bone tumors in the upper extremity, and following resection of these tumors, reconstruction of the upper extremity is challenging. Compared with those in the lower extremity, reconstructive techniques in the upper extremity have historically been unreliable and fraught with complications and poor functional outcomes. Newer reconst...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Matthew T Houdek Bassem T Elhassan Steven L Moran Eric R Wagner Source Type: research
Reconstruction of Bony Defects With Motorized Intramedullary Nails After Tumor Resection
Instr Course Lect. 2024;73:369-385.ABSTRACTMotorized intramedullary lengthening nails allow for transport of a bone segment for limb lengthening, deformity correction, healing of nonunion, and intercalary distraction osteogenesis. Resection of tumors involving the bone can result in substantial defects that require reconstruction. Use of these nails allows for a biologic reconstruction with the incorporation of allograft or by distraction osteogenesis. Limb lengthening after an internal hemipelvectomy where the hip joint is resected can be performed to improve gait, decrease pain, and prevent the need for a custom shoe or ...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Lee M Zuckerman Valerae O Lewis Daniel E Prince Michael D Neel Source Type: research
Controversies in Oncologic Pediatric
Limb Salvage
Instr Course Lect. 2024;73:387-398.ABSTRACTWith advances in chemotherapy and radiation therapy, surgical treatment of patients with bone sarcomas has advanced from most patients undergoing an amputation to now most patients undergoing a limb salvage procedure. With the advances of limb salvage surgical techniques, reconstructive procedures have expanded to include autografts, allografts, endoprosthetic replacements, and rotationplasty. In a growing child, the decision to perform each of these reconstructive options is individualized and each needs to be considered to provide the patient with the optimal oncologic and funct...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Matthew T Houdek Akihiko Takeuchi Lee Jeys R Lor Randall Source Type: research
Controversies in the Management of Pediatric Musculoskeletal Infections: An International Viewpoint
Instr Course Lect. 2024;73:401-420.ABSTRACTPediatric musculoskeletal infections (MSIs) are a major contributor to the global burden of musculoskeletal disease in children and young adults. If untreated, or treated inappropriately or inadequately, pediatric bone and joint infections can be fatal or result in morbidity that causes significant functional disabilities to the patient and economic burden to the family and the community at large. The past decade has witnessed many advances in this field with respect to early diagnosis, management, and prevention of complications. It is important to discuss the current controversi...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Mohan V Belthur Ashish S Ranade Fergal Monsell Martin J Herman Source Type: research
Supracondylar Humerus Fractures: When Lateral Entry Pins Are Not Enough
Instr Course Lect. 2024;73:421-425.ABSTRACTPercutaneous pin configuration for the management of pediatric supracondylar humerus fractures has been studied extensively both in the biomechanics laboratory and in the clinical setting. Medial entry pins (ie, crossed pinning) increase supracondylar humerus fracture construct stability under certain loading conditions. However, there are noted drawbacks of medial entry pinning, specifically the risk of iatrogenic ulnar nerve injury. In most circumstances, the additional biomechanical stability of crossed pinning is unlikely to be clinically necessary for maintenance of fracture ...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Peter D Fabricant Source Type: research
