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
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
