An Approach to Recurrent Clubfoot Deformity
in Adolescents
Instr Course Lect. 2024;73:487-496.ABSTRACTEven under ideal circumstances, recurrence of infantile clubfoot deformity following the Ponseti method of treatment is to be expected to occur in as many as 20% of patients. When encountered early in childhood, these recurrences are usually amenable to further casting and limited surgery. Creation of a plantigrade foot, however, becomes much more challenging when recurrences present during adolescence and early adulthood. Because of the stiffer nature of these deformities in older patients, the fact that they are often more severe because of varying lengths of neglect, and the of...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Anthony I Riccio Source Type: research
Pediatric Phalanx Fractures
Instr Course Lect. 2024;73:497-510.ABSTRACTPhalangeal fractures are extremely common in the pediatric and adolescent populations. The incidence of phalangeal fractures peaks in children ages 10 to 14 years, corresponding to the age in which children begin contact sports. Younger children are more likely to experience crush injuries, whereas older children often sustain phalangeal fractures during sports. The physis is particularly susceptible to fracture because of the biomechanically weak nature of the physis compared with the surrounding ligaments and bone. Phalangeal fractures are identified through a thorough physical ...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Catherine C May Julia L Conroy R Glenn Gaston Tristan B Weir Meredith N Osterman A Lee Osterman Joshua M Abzug Source Type: research
Infection in Shoulder Arthroplasty: Prevention, Diagnosis, and Treatment
Instr Course Lect. 2024;73:513-526.ABSTRACTProsthetic joint infection is a devastating complication following shoulder arthroplasty that can lead to pain, poor function, and poor quality of life. With the increasing number of shoulder arthroplasties performed annually, recognition of prosthetic infection and treatment is necessary. The skin surrounding the shoulder has a unique microbiome, and Cutibacterium acnes is the most commonly encountered bacteria causing prosthetic joint infection. C acnes is a low-virulence organism that resides in the subcutaneous layer of the skin. As a result, the clinical presentation is typic...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Grant E Garrigues Albert Lin Alexander J Hodakowski Amin Karimi Noah J Quinlan Paul S Pottinger Jason E Hsu Source Type: research
Common Complication From Routine Shoulder Surgery: Postoperative Stiffness After Rotator Cuff Repair
Instr Course Lect. 2024;73:527-534.ABSTRACTRotator cuff repair is commonly performed, and stiffness represents one of the most common complications. Unique characteristics of postoperative stiffness, including its natural history and pathoanatomy, differentiate it from other etiologies of shoulder stiffness. Patient risk factors that have been associated with postoperative stiffness should be reviewed to better help clinicians tailor their presurgical risk assessment. Although stiffness in this setting has clinical consequences for patients' postoperative shoulder function, it is important to discuss the important implicat...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Liam T Kane Jay D Wilkening Majd Keener Robert Z Tashjian Reza Omid Surena Namdari Source Type: research
Proximal Humerus Fractures: How to Achieve Best Outcomes
Instr Course Lect. 2024;73:535-545.ABSTRACTThe treatment of proximal humerus fractures remains controversial. Although treatment modalities may vary, the goal of obtaining the best outcomes for patients remains the same. Most proximal humerus fractures can be treated nonsurgically but should still be managed actively. Deciding on surgical management requires a good understanding of indications and options. Indications for open reduction and internal fixation include younger or active patients with displaced two-, three-, and four-part fractures as well as fracture-dislocations with head-split patterns. Obtaining ideal outc...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Erika Roddy Michael J Gardner Surena Namdari George S Athwal Jonah Hebert-Davies Source Type: research
Preparing for and Executing the Ideal Posterior
Labral Repair
Instr Course Lect. 2024;73:547-557.ABSTRACTPosterior labral tears are a source of pain and instability of the shoulder. Despite being relatively uncommon (reported in approximately 10% of instability cases), the incidence of posterior labral tear is increasingly recognized as underestimated in highly active populations. Posterior labral tears can result from a traumatic posterior dislocation or repetitive microtrauma, leading to posterior chondral/labral attrition. Patients often present with vague, deep-seated shoulder discomfort rather than the sensation of instability. Unfavorable results with nonsurgical management wil...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Daniel J Stokes Jeffrey D Hassebrock Lisa A Malyak Rachel M Frank Source Type: research
Humeral Head Reconstruction of Reverse
Hill-Sachs Lesions
Instr Course Lect. 2024;73:559-571.ABSTRACTCompared with anterior instability, posterior shoulder dislocations are a rare entity and are often missed at presentation. A concomitant anteromedial impression fracture of the humeral head, or a reverse Hill-Sachs lesion, is commonly present with these dislocations and is more pronounced with a longer timeline to reduction. Treatment of these defects ranges from nonsurgical treatment to soft-tissue procedures, bony reconstruction, and arthroplasty. Management may be dictated by various factors, such as patient demands, defect size and location, concomitant injuries, and underlyi...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Jelle P van der List Brian R Waterman Source Type: research
Posterior Glenoid Bone Block Reconstruction: Indications, Techniques, and Outcomes
Instr Course Lect. 2024;73:573-586.ABSTRACTPosterior shoulder instability is of particular therapeutic interest, as it typically affects patients with high functional demands such as young athletes and active adults. Although posterior capsulolabral repair has high return-to-sport rates, it is associated with recurrent instability of up to 11%. Posterior glenoid bone loss and significant glenoid retroversion have been identified as risk factors for recurrent instability and failure after primary arthroscopic soft-tissue repair. Therefore, posterior glenoid bone block reconstruction may be indicated for glenoid bone loss 20...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Rajiv P Reddy Matthew Como Anya Singh-Varma Amin Karimi Julie Y Bishop Albert Lin Source Type: research
The Scapula: The Greater Masquerader of
Shoulder Pathologies
Instr Course Lect. 2024;73:587-607.ABSTRACTA comprehensive review of scapular pathologies and their effect on shoulder function is necessary to determine the best treatment options. The coordinated motion between the scapulothoracic and glenohumeral joints is essential for shoulder motion and depends on the balanced activity of the periscapular muscles. Disruption in these muscles can cause abnormal scapular motion and compensatory glenohumeral movements, leading to misdiagnosis or delayed diagnosis. Scapular pathologies can arise from muscle overactivity or underactivity/paralysis, resulting in a range of scapulothoracic ...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Eric R Wagner Zaamin B Hussain Anthony L Karzon Jon J P Warner Bassem T Elhassan Joaquin Sanchez-Sotelo Source Type: research
Scapular Dyskinesia: How to Differentiate
Between Etiologies
Instr Course Lect. 2024;73:609-624.ABSTRACTIt is important to discuss the importance of synchronous balance between periscapular muscles for scapulothoracic motion and resultant scapulohumeral rhythm. Abnormalities in this balance can lead to scapular dyskinesia and winging, affecting shoulder motion and leading to impingement. Strategies exist to diagnose and differentiate between pathologies such as muscle paralysis (eg, trapezius or serratus anterior) or overactivity (eg, pectoralis minor). The physician should be aware of the role of diagnostic imaging, as well as the unique considerations for patients with Ehlers-Danl...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Eric R Wagner Anthony L Karzon Zaamin B Hussain Jon J P Warner Bassem T Elhassan Joaquin Sanchez-Sotelo Source Type: research
Open and Arthroscopic Elbow Contracture Release:
Tips and Pearls
Instr Course Lect. 2024;73:625-637.ABSTRACTElbow stiffness is a common consequence of trauma and can significantly limit the functionality of the affected arm. Intervention may be necessary for those with a motion arc less than 100°, but the decision to intervene should be based on individual patient needs. Restoration of joint motion in a stiff elbow can be challenging, time consuming, and costly. Nonsurgical treatment is the primary management option, and surgical intervention is considered for refractory stiffness. However, recurrent stiffness is a common issue following surgical elbow contracture release. An overview ...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: H Mike Kim Mark E Morrey Scott Steinmann Raul Barco Source Type: research
Avoiding Pitfalls in Adult Spinal Deformity
Instr Course Lect. 2024;73:641-649.ABSTRACTTo avoid the high rate of complications associated with the surgical management of adult spinal deformity, it is important to recognize and avoid three major pitfalls. The first is patient selection and determining which cases are appropriately indicated. The second is optimizing modifiable medical issues that can lead to a poor outcome, such as smoking, vitamin D deficiency, nutritional status, and poor bone quality. The third is optimizing surgical factors such as defining clinically appropriate, patient-specific target alignment goals as well as using techniques to avoid proxim...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Hao-Hua Wu Michael Kelly Brian Neuman Themistocles Protopsaltis Stuart Hershman Source Type: research
C1-C2 Posterior Screw-Rod Fixation
Instr Course Lect. 2024;73:651-664.ABSTRACTMultiple approaches for instrumentation of the upper cervical spine have evolved to treat atlantoaxial instability which, until the 20th century, was largely considered to be inoperable and managed nonsurgically with immobilization. Surgeons set out to provide safe and effective approaches in a clearly dangerous and technically complex anatomic region. It is important to provide a historical analysis of the evolution of techniques that have shaped C1-C2 instrumentation, and how the diligent efforts of surgeons to improve the biomechanical stability and fusion rates of their constr...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Ali Saif R Khan Bradford L Currier Melissa M Erickson Ahmad Nassr Najib E El Tecle Charbel D Moussallem Source Type: research
Updates in the Management of Metastatic Spine Disease
Instr Course Lect. 2024;73:665-673.ABSTRACTThe number of cancer diagnoses continues to increase each year in the United States, and given the propensity for bone metastases from solid organ malignancies, orthopaedic spine surgeons will inevitably encounter patients with metastatic spine disease and need to have a framework for approaching the evaluation and treatment of these complex patients. Many patients seeking care for spinal metastases already have a history of disseminated malignancy, but metastatic spine disease itself will be the presenting symptom of cancer in approximately 20% of patients. Because the first pres...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: S Mohammed Karim Andrew J Schoenfeld Maksim Vaynrub Source Type: research
Treatment of Spinal Infections
Instr Course Lect. 2024;73:675-687.ABSTRACTThe treatment of spinal infections is not well defined, and a cursory review of the literature can lead to conflicting treatment strategies. To add to the complexity, infections can include primary infection of the spine, infection secondary to another primary source, and postoperative infections including epidural abscesses, discitis, osteomyelitis, paraspinal soft-tissue infections, or any combination. Furthermore, differing opinions often exist within the medical and surgical communities regarding the outcomes and effectiveness of varying treatment strategies. Given the paucity...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Christopher C J Kleck Laura Damioli David Ou-Yang Source Type: research
