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
Transphyseal Fracture of the Distal Humerus
Instr Course Lect. 2024;73:427-434.ABSTRACTTransphyseal fractures of the distal humerus often occur in children younger than 4 years as a result of birth trauma, nonaccidental trauma, or falls from a low height. It is important to identify and treat these injuries in a timely manner to ensure successful management. Most transphyseal fractures of the distal humerus are treated with closed reduction and percutaneous pinning with the aid of an elbow arthrogram. The most common complication following a fracture is cubitus varus caused by growth arrest, malunion, or osteonecrosis of the medial condyle. Normal carrying angles ma...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Catherine C May Joshua M Abzug Source Type: research
Update on Pediatric Medial Epicondyle
Fractures
Instr Course Lect. 2024;73:435-446.ABSTRACTThe ideal evaluation and treatment of pediatric patients with medial epicondyle fractures remain controversial. It is important to examine the most recent literature and provide an update on the current clinical practices, imaging modalities, treatment techniques, outcomes, and complications associated with displaced pediatric medial epicondyle fractures. There remains substantial variability across recommended treatment options and the outcomes between surgical versus nonsurgical management of these injuries. Despite the lack of consensus regarding management of pediatric medial ...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Giancarlo Medina P érez Neal Gerard Canastra Aristides I Cruz Source Type: research
Management Principles and Current Debates Surrounding Common Pediatric Elbow Fractures
Instr Course Lect. 2024;73:447-457.ABSTRACTElbow fractures are among the most common fractures sustained in pediatric patients. A specific set of pediatric elbow fractures (olecranon, radial neck, and lateral condyle fractures) comprises the ones that occur most often. It is important to review commonly accepted principles in the evaluation and treatment of these injuries as well as highlight some debates that exist within the literature regarding the optimal management of these injuries. Although management of pediatric olecranon, radial neck, and lateral condyle fractures has been well described, controversy persists amo...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: John R Hanna Neal Gerard Canastra Aristides I Cruz Craig P Eberson Source Type: research
Tweener Fractures in Children and Adolescents
Instr Course Lect. 2024;73:459-469.ABSTRACTTweener fractures are defined as long bone or metadiaphyseal fractures in a pediatric population for which multiple treatment options may be used. It is important to focus specifically on patients nearing skeletal maturity who present with length-unstable femoral shaft fractures, both-bone forearm fractures, distal radius metadiaphyseal fractures, and adolescent tibial shaft fractures. Although there is no gold standard of treatment for any of these fracture patterns, it is important to discuss the risks and benefits, proper application, and important technical aspects of each tre...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Dustin A Greenhill Arianna Trionfo Source Type: research
Hip Pain in Adolescent Patients
Instr Course Lect. 2024;73:471-486.ABSTRACTHip pain is a common complaint in adolescents. There are several causes for hip pain in this population, with dysplasia and impingement being the most common; however, other conditions such as extra-articular impingement, torsional disorders, labral tears, and osteochondral lesions also require consideration. Many of these conditions are related to underlying anatomic abnormalities and increased activity in this age group. An understanding of the common pathologies of the adolescent hip is integral to the evaluation, diagnosis, and treatment of these patients.PMID:38090918 (Source...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Ishaan Swarup Christopher Makarewich Todd J Blumberg Nirav K Pandya Source Type: research
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
