Glenoid Bone Loss: Etiology, Evaluation, and Classification.
Authors: Sanchez-Sotelo J Abstract Understanding the location and magnitude of glenoid bone loss is extremely important at the time of both primary and revision shoulder arthroplasty. Specific patterns of glenoid bone loss have been described for primary glenohumeral osteoarthritis, cuff tear arthropathy, inflammatory arthritis, and failed shoulder arthroplasty. Although radiographs are useful in planning arthroplasty procedures, CT has become the imaging modality of choice to evaluate and classify bone loss before shoulder arthroplasty. Two-dimensional images may be used to measure various angles and calculate are...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Navigating the Research in Rotator Cuff Disease: An Evidence-Based Approach to Improved Patient Outcomes.
Authors: Monroe E, Feeley B, Keener J, Kuhn J, Bishop J, Ma CB Abstract Rotator cuff tears are prevalent injuries, yet their management and identifying patients who will benefit from surgical intervention are controversial topics. Population studies demonstrate high rates of asymptomatic tears that, with time, show a general progression of the pathologic state. However, not all tears are or will become symptomatic or require surgical intervention. Surgeons should be aware of the natural history of rotator cuff tears and be able to identify injuries at risk of progression or causing symptoms, be able to determine th...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Running Out of Room: Managing Humeral and Glenoid Bone Loss in Shoulder Arthroplasty.
Authors: Duquin TR, Matthews JR, Dubiel MJ, Sperling JW Abstract Glenoid bone loss is frequently encountered in arthritic conditions. The Walch classification is commonly used to categorize glenoid bone loss into several different types. Preoperative CT can assist in identifying the type and extent of bone loss for development of the appropriate treatment plan. Restoration of glenoid alignment and soft-tissue balancing is essential in shoulder arthroplasty, which can be achieved through a variety of techniques including high side reaming, augmented components, and bone grafting. Reverse total shoulder arthroplasty,...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

It's All About the Timing: When Do I Take This Injury to the Operating Room?
Authors: Tejwani NC, Nork S, Kubiak EN, Podolnick J, Wolinsky PR Abstract Over time, what was considered urgent or emergent in orthopaedic trauma has been revisited, and as awareness of factors associated with outcomes has increased, priorities have changed. There are multiple procedures performed urgently in the belief that early intervention allowed for better outcomes for the injury and the patient. Classic examples of conditions for which urgent intervention has been implemented include open fractures, femoral neck fractures in the young adult, talus fractures, and compartment syndrome. All of these conditions ...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Sports Injuries of the Hand, Wrist, and Elbow.
Authors: Goldfarb C, Dy C, Brogan D, Osei D Abstract Sports injuries of the upper extremity are a common problem seen by those who care for athletes and those who manage upper extremity injuries. The term "high-level athlete" may include adolescents and high school students, collegiate athletes, and of course, the professional athlete. However, the "weekend warrior" can sustain similar injuries and can have a similar desire to return to play as quickly as possible. The challenge in management of these injuries to the elbow, wrist, and hand is identifying those injuries that will benefit from ear...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Infections of the Upper Extremity: New Developments and Challenges.
Authors: Buterbaugh KL, Jebson PJL, Wysocki RW, Shah AS Abstract Hand infections are common in all patient populations. However, because of variability in presentation and severity, they can be challenging to correctly diagnose and complex to manage. It is important to be aware of special populations such as children, individuals who are immunocompromised, those with diabetes, and intravenous drug users who may have uncommon pathogens or unusual types of infection. Atypical or rare bacterial and fungal infections, even in an immunocompetent host, can be equally challenging to manage. In each of these scenarios, it ...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Avoiding and Managing Complications After Hip Fracture Fixation.
Authors: McMillan TE, Stevenson I, Lawendy AR, Donohoe E, Olson SA, Schemitsch EH Abstract There is an enormous burden of disease associated with the management of a failed hip fracture fixation. The goal of surgical management is to facilitate an early return to mobilization with the retention of as much independence as possible. Despite numerous studies that are focused on the care of patients with proximal femur fractures, complication rates remain high. Surgeons should review current strategies to avoid and manage complications after hip fracture fixation. This will have important implications given the detrime...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Clavicle Trauma: From Acromioclavicular Joint Injuries to Distal Clavicle Fractures and Midshaft Fractures in Contact Athletes.
Authors: McKee MD, Rudzki JR, Gamradt S, Matava MJ Abstract Injuries to the clavicle and its articulations (the acromioclavicular and sternoclavicular joints) are becoming increasingly common. Conventional treatment has been dominated by nonsurgical techniques; however, the active patient was often left with substantial residual disability that was underreported. It is now recognized that surgical intervention may be advantageous in specific patients, especially athletes. Surgeons should consider pathophysiology, indications, and surgical techniques to best manage these injuries. PMID: 32032037 [PubMed - in pro...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

The Current Treatment of Hip Fractures: Can a Consensus Be Reached?
Authors: Blankstein M, O'Toole RV, Slobogean G, Sanders D, Schemitsch EH Abstract There is a significant global burden of disease associated with the management of hip fractures. Despite numerous studies that are focused on the treatment of patients with proximal femur fractures, the management of these injuries remains controversial. Clinicians should become familiar with the current evidence regarding the management of these common injuries and understand the key issues and controversies because they will have important implications given the large-scale effect of hip fractures internationally. PMID: 32032038...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Ensuring Accurate Component Placement in Glenoid Bone Loss.
Authors: Throckmorton TQ Abstract Glenoid component malposition has important implications for implant wear and longevity after shoulder arthroplasty. Although not confirmed by long-term clinical studies, multiple biomechanical studies have identified altered wear forces, increased contact pressures, decreased contact area, eccentric loading, and potential for loosening associated with inaccurate component placement. Accurate placement is especially challenging with glenoid bone loss. Developments in the improvement of component placement include advanced imaging modalities (MRI and two- and three-dimensional CT), ...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Pediatric Polytrauma: What Is the Role of Damage Control Orthopaedics in the Pediatric Population?
Authors: Anari JB, Hosseinzadeh P, Herman MJ, Eberson CP, Baldwin KD Abstract Severe pediatric trauma can be complicated for clinicians to manage because it is unusual and behaves somewhat differently from severe trauma in adults. Damage control orthopaedics is a philosophy that has gained traction in the past 30 years and has become standard in unstable adult trauma patients. Studies have failed to demonstrate clear utility for this approach in pediatric patients. Clinicians should understand the concepts of early total care and damage control orthopaedics for the patient with polytrauma, the physiologic factors a...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Elbow Trauma Sequelae: Instability, Stiffness, Non-arthroplasty, and Arthroplasty Options.
Authors: Cheung E, Nathani A, Tashjian R, Armstrong A, Morrey M Abstract Sequelae of elbow trauma are complicated to manage. Undiagnosed instability patterns are important to recognize to get the elbow into concentric alignment for further reconstructive efforts. Stiffness is also common after elbow trauma. Surgeons should be familiar with the different approaches to the elbow to safely address stiffness. Non-arthroplasty and arthroplasty salvage options are also important to understand because the indications are expanding and outcomes for these procedures are being better understood. PMID: 32032041 [PubMed - ...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Management of Three- and Four-Part Proximal Humerus Fractures.
Authors: Allert JW, Berglund D, Campbell J, Hernandez-Ortiz E, Lorenzetti AJ, Momaya AM, Frankle MA, Hawkins RJ, Levy JC, Mighell MA Abstract The management of three- and four-part proximal humerus fractures remains controversial because the literature has supported all forms of management, including nonsurgical management, open reduction and internal fixation (ORIF), and shoulder arthroplasty. Specific patient factors ultimately influence the decision of which treatment best fits the patient and the fracture. Surgeons should understand the rationale for nonsurgical and surgical management of these fractures, inclu...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Challenges in Pediatric Trauma: What We All Need to Know About Diaphyseal Forearm Fractures.
Authors: Herman MJ, Ashok AP, Williams CS Abstract Diaphyseal fractures of the radius and ulna are common injuries in children and often result from a fall on an outstretched hand. Fractures are classified by completeness, angular and rotational deformity, and displacement. The goal of management is to correct the deformity to the anatomic position or within acceptable alignment parameters as defined in the literature. This is primarily achieved by closed reduction and immobilization. Greenstick fractures are reduced by rotation of the palm toward the apex of the deformity. Complete fractures are reduced with susta...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Lateral Condyle Fractures in Children.
Authors: Huser AJ, Baldwin KD, Milbrandt TA, Abzug JM, Hosseinzadeh P Abstract Lateral condyle fractures are the second most common fracture sustained in the pediatric elbow. Several classification systems are used to describe these fractures. The more recently described classifications help guide management, which is based on the degree of displacement and stability of the fracture. The goal of management is to obtain reduction of the articular surface and fracture union using closed or open reduction and fixation with Kirschner wires or screws. Motion should improve after the surgery. Complications, such as osteo...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Revision of the Failed Bunion Surgery.
Authors: Sherman TI, Schon L Abstract Complications and failures of corrective surgery for hallux valgus are not infrequent, and their reported rates vary widely. This is at least partly because of the variety of surgical techniques performed as well as a lack of consensus regarding what constitutes a successful outcome. Some of the most commonly encountered reasons for failure include recurrence, hallux varus, nonunion, and malunion. These problems present a challenging scenario for both the patient and surgeon. A comprehensive understanding of these complications and a nuanced, critical analysis of each case is p...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Displaced Radial Neck Fractures: What Are My Options?
Authors: Shlykov MA, Milbrandt TA, Abzug JM, Baldwin KD, Hosseinzadeh P Abstract Pediatric radial head and neck fractures are uncommon injuries. Fractures are classified using the Judet system based on fracture angulation and displacement. Judet type I and II fractures can be managed nonsurgically with a short course of immobilization in a cast or splint without closed reduction. Most of these patients have an excellent prognosis and functional outcomes. Judet type III and IV injuries, as well as injuries that demonstrate a mechanical block to motion, should be closed reduced with the patient under conscious sedati...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Monteggia Fracture-Dislocations in Children: History and Current Concepts and Management Schemes.
Authors: Baldwin KD, Hosseinzadeh P, Milbrandt TA, Abzug JM Abstract Since pediatric Monteggia fracture-dislocations were first described in 1814, they have been a complicated injury for orthopaedic surgeons to manage. These injuries typically consist of a fracture of the ulna with dislocation of the radial head. Unlike most pediatric injuries, Monteggia fracture-dislocations remodel very poorly, and the relationship between the radial head and the capitellum does not improve with time. As such, a more attentive approach is necessary. It is important for orthopaedic surgeons to be knowledgeable about the history of...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Hand Fractures in Children: When Do I Need to Start Thinking About Surgery?
Authors: Case AL, Hosseinzadeh P, Baldwin KD, Abzug JM Abstract Each year, a hand fracture is diagnosed in 24.2 of 100,000 children in Canada. Hand injuries are the most common fractures in children, making up approximately one fifth of all pediatric fractures. The incidence of hand fractures peaks between the ages of 10 and 14 years, with the highest frequencies observed among adolescent males. These increased frequencies coincide with the age at which most children begin playing contact sports, with sport-related injuries found to be the largest cause of adolescent fractures. The fifth digit is the most commonly ...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Developmental Dysplasia of the Hip From Birth to Arthroplasty: Clear Indications and New Controversies.
Authors: Rosenfeld SB, Weinstein SL, Schoenecker JG, Matheney T Abstract Developmental dysplasia of the hip is the all-encompassing term used to describe the wide spectrum of disorders of the development of the hip that manifest in various forms and at different ages. Developmental dysplasia of the hip often evolves over time because the structures of the hip are normal during embryogenesis but gradually become abnormal. Such variability in pathology is associated with a similarly wide range in management options and recommendations aimed at preventing hip joint arthrosis. These options may be instituted at any tim...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Management of Pediatric Forearm Fractures After Failed Closed Reduction.
Authors: Dua K, Hosseinzadeh P, Baldwin KD, Abzug JM Abstract Pediatric and adolescent forearm fractures account for nearly 40% of all fractures in childhood. The incidence of these fractures has increased over the past decade with a 10-fold increase in surgical intervention. A thorough physical examination of the upper extremity, with plain radiographs of the forearm, should be obtained to make the diagnosis. The primary modality of management for closed both-bone forearm fractures is a closed reduction if needed and long arm immobilization. Patients should be followed up weekly, for at least 3 weeks, to ensure ma...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Prevention and Management of the Failed Flatfoot.
Authors: Johnson JE, Stautberg EF Abstract The acquired adult flatfoot deformity is a challenging condition to manage and even more so in a revision setting. To "get it right" the first time, it is important to completely understand the deformity by performing a complete history, careful physical examination, and deliberate evaluation of radiographs. There are several techniques to achieve the complete correction of complex flatfoot deformities. There are also strategies for revising failed flatfoot reconstruction in the setting of overcorrection and undercorrection and malunion. PMID: 32032051 [PubMe...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

New Paradigms in the Throwing Shoulder: Pathophysiology and Examination.
Authors: Kibler WB, Sennett B, Sciascia A Abstract There continues to be a high incidence of shoulder injuries in throwing athletes, with sometimes disappointing return-to-play outcomes, creating an increased need to understand the pathophysiology of the injury and to better characterize the injury during the clinical examination. Current concepts suggest that the disabled throwing shoulder is a useful construct to develop a more comprehensive view of the complex local and distant musculoskeletal alterations that can be seen associated with the clinical symptoms. The pathophysiology can be seen as a cascade to inju...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Pediatric Ankle Fractures: When to Operate and When to Leave Alone?
Authors: Devries C, Meyer Z, Abzug JM, Baldwin KD, Milbrandt TA, Hosseinzadeh P Abstract Ankle fractures are a common pediatric orthopaedic injury and are the second most common site of physeal injury after the distal radius. Concerns regarding these injuries include the risk of premature physeal closure and intra-articular incongruence with subsequent degenerative changes. Salter-Harris type I and II injuries have high rates of premature physeal closure especially in those with a physeal gap greater than 3 mm and pronation-abduction injuries. The authors of this chapter recommend surgical management if acceptable ...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

New Paradigms in the Throwing Shoulder: Labral Injury, Surgery, and Rehabilitation.
Authors: Kibler WB, Sciascia A Abstract Knowledge regarding the importance of the superior labrum in shoulder function is evolving as biomechanical and clinical studies define the roles of the labrum in shoulder function and dysfunction. The diagnosis of the clinically significant labral injury, the alteration in labral anatomy that is associated with the production of clinical symptoms and dysfunction and requires management, is based on specific history and clinical examination findings that point to the loss of labral roles. Surgical management should address all aspects of the altered labral anatomy and repair ...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Recurrent Dislocation After Total Hip Arthroplasty: Controversies and Solutions.
Authors: Sutter EG, Jones SA, Kleeman-Forsthuber LT, Lachiewicz PF, Wellman SS Abstract Instability remains one of the most common complications after total hip arthroplasty and a notable cause of patient morbidity as well as patient and surgeon dissatisfaction. Isolated dislocations can often be managed successfully with closed reduction; however, recurrent instability poses a substantial diagnostic and therapeutic challenge. The causes are varied and may be related to patient, surgical, and implant factors. A thorough evaluation is important in determining the cause of instability and effectively managing this di...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Proximal Femur Fractures in Children: Enigmatic Injuries.
Authors: Anari JB, Sankar W, Hosseinzadeh P, Baldwin KD Abstract Proximal femoral fractures in the skeletally immature patient can be challenging for the orthopaedic surgeon to manage. This type of injury includes the femoral head/neck, intertrochanteric, and subtrochanteric fractures. The Delbet classification system historically describes all injuries in the pediatric proximal femur, except subtrochanteric fractures. Understanding the possible complications (coxa vara, osteonecrosis, premature physeal closure, nonunion) when managing these injuries can help with preoperative and intraoperative decision making. Al...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Epidemiology, Therapeutic Strategies, Outcomes, and Complications of Pathologic Fractures.
Authors: Miller BJ, Yang R, Geller DS, Hoang BH Abstract Much can be learned about the epidemiology of metastatic disease of bone through large databases. Secondary data analyses add substantial knowledge of the incidence, prevalence, cost, complications, risk factors, and treatment variability by using modern statistical methods in a large patient cohort. Investigators must be aware of the intentions of these data sources as well as the limitations in any conclusions drawn. Large databases are primarily beneficial in generating hypotheses and will likely continue to be an important source of information. For the g...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Four Challenges in Revision Total Knee Arthroplasty: Exposure, Safe and Effective Component Removal, Bone Deficit Management, and Fixation.
Authors: Lombardi AV, MacDonald SJ, Lewallen DG, Fehring TK Abstract With utilization of both primary and revision total knee arthroplasty projected to increase in coming decades particularly in younger, more active patients, a determination of best surgical practices is vital to meet the burden of demand. Four challenges in surgical techniques for revision total knee arthroplasty include surgical exposure, careful removal of components, bone deficit management, and fixation options. Surgical exposure may be more complicated in patients presenting for revision who have a history of multiple prior surgeries, infecti...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Reconstruction of the Shoulder and Humerus in Metastatic Bone Disease.
Authors: Cheng EY, Ogilvie CM Abstract Metastatic disease involving the skeleton most often affects the spine, pelvis, and proximal long bones of the extremities. In the upper extremity, the proximal humerus is frequently affected. Although many of the principles of managing metastatic bone disease are similar, regardless of the metastatic site, the upper extremity has some unique anatomic and functional traits that warrant consideration when making management decisions. The main anatomic differences from the lower extremity pertain to the smaller bone size, rotator cuff function, and proximity to major neurologic ...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

New Paradigms in the Continuum of Spine Care: From Newborns to Elderly Patients.
Authors: Guzman JZ, Larson AN, Sanders JO, Newton PO, Berven S, Mundis G, Dimar JR, Albert TJ, Sethi RK, Shah SA Abstract The evaluation and management of spinal disorders is complex and constantly evolving. Back pain and spinal deformity are substantial contributors to hospital and outpatient physician visits even for young patients. With new insights into the etiology, clinical presentation, and evaluation, children can be more accurately diagnosed and treated. Patients with adolescent idiopathic scoliosis may undergo selective fusion to preserve motion segments, and in some cases, vertebral body tethering or oth...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Tibial Shaft Fractures in Children: What to Do When Casting Fails?
Authors: Meyer Z, Devries C, Baldwin KD, Milbrandt TA, Abzug JM, Hosseinzadeh P Abstract Tibial shaft fractures in children can often be successfully managed with a well-molded cast that controls length, alignment, and rotation of the fracture. Acceptable alignment of tibial shaft fractures in children is less than 10° of coronal and sagittal angulation, 50% translation, and 10 mm of shortening. Fractures of the tibial shaft without an associated fibular shaft fracture may fall into varus malalignment despite initial adequate reduction and should be followed closely during the first 3 weeks after injury. Surgic...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Femoral Shaft Fractures in Pediatric Patients: An Algorithm for Success.
Authors: Baldwin KD, Hosseinzadeh P, Abzug JM, Milbrandt TA, Flynn JM Abstract Femoral shaft fractures in children are common injuries requiring orthopaedic intervention. Options for management have expanded in the past several decades to include an array of surgical and nonsurgical intervention. The American Academy of Orthopaedic Surgeons has produced practice guidelines for this injury to guide appropriate management. The age of the patient, the stability of the fracture, and the energy of the injury are factors when deciding the appropriate treatment for a patient. Orthopaedic surgeons should be familiar with t...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Fractures Around the Knee in Children.
Authors: Young EY, Shlykov MA, Hosseinzadeh P, Abzug JM, Baldwin KD, Milbrandt TA Abstract Knee injuries are common in children, but epiphyseal and physeal injuries involving the distal femur and proximal tibia are relatively rare. This can make diagnosis and evaluation of pediatric knee injuries challenging. Pediatric knee physeal injuries can also be complicated by vascular injuries with potentially devastating consequences, and thus, a heightened suspicion for these injuries is indicated. Distal femoral and proximal tibial physeal injuries can be diagnosed with plain radiographs or with advanced imaging if the i...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Revision Open Reduction and Internal Fixation of Ankle and Syndesmosis Malunions.
Authors: Clare MP, Berkowitz MJ Abstract Malreduction of the fibula and syndesmosis remains a common complication associated with the surgical management of ankle fractures. This malreduction leads to profound alterations in the biomechanics of the ankle, leading to chronic pain and premature degenerative changes of the ankle. It is possible to correct many fibular and syndesmotic malunions with reconstructive surgical techniques, of which there are several for revising and salvaging the malreduced ankle mortise and tibiofibular syndesmosis. PMID: 32032064 [PubMed - in process] (Source: Instructional Course Lectures)
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

The Benefits of National and Regional Arthroplasty Registries.
Authors: Galea VP, Rojanasopondist P, Matuszak SJ, Connelly JW, Bragdon CR, Paxton L, Malchau H Abstract Since the first arthroplasty registries were established in the 1970s, they have become powerful tools in improving the efficiency of health care delivery and patient outcomes. As demonstrated over the past decades, registries can offer benefits not only to patients and surgeons but also to a variety of other stakeholders, such as hospitals, payers, and implant manufacturers. Registry data may be leveraged to address a variety of pressing concerns in the field of arthroplasty. These examples include the role of ...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Comprehensive Case-Based Review of Knee Ligament Injuries.
Authors: Levy BA, Stuart MJ, MacDonald PB, Marx RG, Stannard JP, LaPrade RF, Engebretsen L, Miller MD, Whelan D, Boyd JL, Fanelli GC Abstract The management of knee ligament injuries continues to evolve, and much debate persists over the timing of surgery, repair versus reconstruction, surgical technique, postoperative rehabilitation, graft selection, and fixation. Surgeons should be aware of updates on the best management strategies of knee ligament injuries in 2018 and understand the important history and physical examination findings of the knee with ligamentous injury; the anterior cruciate ligament; the role o...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Pharmacologic and Radiation Therapies for Cancer-Induced Bone Loss.
Authors: Henderson SE, Dussik C, Brand J, Ibe IK, Lee FY Abstract Advancements in medical and radiation oncology have improved the prognosis for many cancers during the past few decades. As a result, physicians are challenged with managing a greater burden of disease for a longer time. In orthopaedics, bone loss secondary to metastatic tumor places patients at risk of impending and pathologic fractures. These events limit functional independence, lessen the quality of life, and place a financial burden on patients and their families. Thus, it is important for clinicians to be aware of measures capable of mitigating...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Metastatic Cancers to Bone: An Overview and Cancer-Induced Bone Loss.
Authors: Ibe IK, Sahlstrom A, White A, Henderson SE, Lee FY Abstract Metastatic bone disease is a substantial driver of morbidity and mortality in many cancers. The presence of bone metastases often indicates a worse prognosis for patients. The mechanisms underlying bone metastases and bone loss are complex and involve interaction between the local factors controlling bone remodeling, systemic regulators, cancer cells, the immune system, and pharmaceutical agents. Cancer cells hone to and initiate interactions with bone cells, thereby resulting in an increase or decrease of local bone mass. Osteolytic metastases ar...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Avoiding and Managing Complications in Routine Lumbar Spine Surgery.
Authors: Daffner SD, Kim DH, Radcliff KE, Smith HE Abstract Elective lumbar surgery for common degenerative lumbar spine pathology has been consistently demonstrated to have excellent outcomes by multiple validated measures and improves patient quality of life. The rate of complication is low but not unavoidable; there is an increasing recognition of risk factors that can be mitigated to decrease complication rates. When complications occur, prompt recognition and management may minimize deleterious effects on patient outcome. There are considerations for identifying risk factors and, when possible, minimizing them...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Lower Extremity Fractures in Children: How to Avoid Pitfalls and Manage Complications.
Authors: Giertych BF, Hosseinzadeh P, Milbrandt TA, Muchow R, Noonan K Abstract One in three children in the United States will sustain a fracture before the age of 16 years, and nearly one of every four pediatric visits is for a lower extremity musculoskeletal complaint. Clinicians should be familiar with the epidemiology, management, and complications of pediatric pelvis, hip, femur, tibia, and ankle fractures. PMID: 32032070 [PubMed - in process] (Source: Instructional Course Lectures)
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

The Opioid Epidemic: America's Epidemic.
Authors: Conti Mica M, Ring D, Hsu JR, Mir H Abstract The opioid epidemic in the United States has changed how medicine is practiced. There are tools and resources available to help the surgeon understand pain and provide appropriate pain management. Understanding pain, setting expectations, and diagnosing underlying medical dispositions that can lead to opioid addiction should become standard practice. Understanding available tools for communication, setting appropriate expectations, and preoperative planning for postoperative pain will provide better pain control. Through physical, mental, and medicinal modalitie...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Patient-Reported Outcome Measures: How and Why They Are Collected.
Authors: Makhni EC, Baumhauer JF, Ayers D, Bozic KJ Abstract Patient-reported outcomes measures (PROM) have become increasingly emphasized in the transition from volume-based to value-based orthopaedic care. Incorporation of PROM collection into daily clinical practice can be challenging, however, because of financial and logistic constraints. In modern orthopaedics, PROM are important and can be successfully and practically incorporated into clinical practice. PMID: 32032076 [PubMed - in process] (Source: Instructional Course Lectures)
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Staying Out of Trouble: Complications of Supracondylar Humerus Fractures.
Authors: Joshi T, Koder A, Herman MJ Abstract Supracondylar fractures are among the most common fractures in children that require surgery. These fractures are also associated with some of the most serious complications of all fractures seen in children. Timely recognition and careful management can mitigate the potentially poor outcomes of these complications. Pin-site irritation and superficial infections are the most common complications seen. Cubitus varus remains another common complication, even with the use of closed reduction and pinning for management of most displaced fractures. Neurapraxias are seen in a...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Revision of the Failed Ankle Fusion.
Authors: Mills A, Fortin PT Abstract A failed ankle fusion is a complicated and not-uncommon occurrence. Successful management requires a thorough preoperative evaluation to determine the cause of initial clinical failure and identify surgical strategies to maximize the likelihood of clinical success. Because revision ankle fusion is a risk factor for failed ankle fusion, a measured approach is required. Patients typically fall into one of three categories. In patients without infection or substantial malalignment, clinical success can be achieved with a broad scope of surgical interventions tailored to the specifi...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Bone Tumors and Reconstructive Options in Pediatric and Young Adult Patients.
Authors: Sorger JI, Scharschmidt T, Rajani R, Randall RL Abstract Sarcomas represent less than 1% of adult cancers but account for approximately 21% of pediatric malignancies and pose great risks for mortality and morbidity in children and young adults. Both benign bone and soft-tissue tumors may not be life-threatening but can be limb-threatening. Missed diagnosis, misdiagnosis, and mismanagement of either benign or malignant tumors may lead to increased mortality and morbidity. A good understanding of the clinical presentation, radiographic findings, and treatment options is needed to make the proper diagnosis an...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Pathologic Vertebral Fractures: Diagnosis, Treatment, Complications, and Controversies Through Case-Based Learning.
Authors: Tobert DG, Schwab JH Abstract Vertebral compression fractures commonly occur as sequelae to osteoporosis, malignancy, infection, or trauma. Although all compression fractures have an underlying pathology, the term pathologic vertebral compression fracture (pVCF) is traditionally reserved for fractures that result from primary or metastatic spine tumors. Discriminating a pVCF from osteoporotic vertebral compression fractures is important because the subsequent diagnostic workup and therapeutic plan differ substantially between the two etiologies. A carefully obtained history inquiring about high-risk sympto...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Femoral and Tibial Reconstruction for Skeletal Metastases and Pathologic Fractures.
Authors: Henderson SE, Yu K, Alder KD, Ibe IK, Lee FY, Lindskog DM Abstract Skeletal metastases of the femur and tibia leading to pathologic fractures or large skeletal defects can be managed with surgical reconstruction, resulting in improved patient outcomes and functionality. The indications for femoral and tibial reconstruction are dependent on several factors, including goals of management, age, comorbidities, site and extent of the lesion, soft-tissue involvement, and history of radiation or other systemic therapy. The goal of reconstruction of large bone defects is to restore anatomy and function while minim...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Designing and Implementing Value-Based Care Delivery and Payment Models for Musculoskeletal Care.
Authors: Keswani A, Koenig KM, Torchia MT, Jevsevar DS, Bozic KJ Abstract Payors, purchasers, health care providers, and patients are increasingly focused on improving the value-defined as health outcomes that matter to patients per dollar expended-of health care delivered to patients. Orthopaedic providers are in a unique position to pioneer this transition given the introduction of alternative payment models as well as the longitudinal, multidisciplinary, and relatively homogenous nature of high-cost, high-burden orthopaedic conditions (eg, osteoarthritis). First, doing so requires identifying and objectively mea...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

Pain Relief and the Opioid Crisis in the United States and Canada.
Authors: Sohn D, Ring D, Toy KA, Julian JA, Arnstein P Abstract Opioid analgesics hijack the body's innate wellness machinery (eg, naloxone blocks the placebo effect) and alleviate both physical and emotional pain. Starting in the 1980s, marketing and advocacy created an opioid-centric pain relief strategy based on the idea that physicians undermanage pain and worry too much about addiction. The increase of prescription opioids in the ecosystem (along with a resurgence in heroin use) contributed to dependence, misuse, overdoses, and overdose deaths. Laws punishing undermanagement of pain from the opioid crisis comb...
Source: Instructional Course Lectures - February 9, 2020 Category: Orthopaedics Tags: Instr Course Lect Source Type: research