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Instructional Course Lectures

Kenneth Chin, Scott H Kozin, Martin Herman, Bernard D Horn, Craig P Eberson, Donald S Bae, Joshua M Abzug
Monteggia fracture-dislocations typically involve a dislocation of the radial head with an associated fracture of the ulnar shaft. The prompt diagnosis and treatment of these acute injuries result in excellent outcomes. Unfortunately, a Monteggia fracture-dislocation is often missed during diagnostic testing and results in a chronic Monteggia fracture-dislocation. The subsequent timing and treatment of chronic Monteggia fracture-dislocations are debatable because outcomes are suboptimal. Therefore, it is critical that the initial injury be correctly diagnosed and treated as close to the time of injury as possible to ensure excellent outcomes...
February 15, 2016: Instructional Course Lectures
Gurpal S Pannu, Craig P Eberson, Joshua M Abzug, Bernard D Horn, Donald S Bae, Martin Herman
Supracondylar humerus fractures and lateral condyle fractures are the two most common pediatric elbow fractures that require surgical intervention. Although most surgeons are familiar with supracondylar humerus fractures and lateral condyle fractures, these injuries present challenges that may lead to common errors in evaluation and management and, thus, compromise outcomes. It is well agreed upon that nondisplaced supracondylar fractures (Gartland type I) are best managed nonsurgically with cast immobilization...
February 15, 2016: Instructional Course Lectures
Joshua M Abzug, Christine Ann Ho, Todd F Ritzman, Brian Brighton
Transphyseal distal humerus fractures typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Prompt and accurate diagnosis of a transphyseal distal humerus fracture is crucial for a successful outcome. Recognizing that the forearm is not aligned with the humerus on plain radiographs may aid in the diagnosis of a transphyseal distal humerus fracture. Surgical management is most commonly performed with the aid of an arthrogram. Closed reduction and percutaneous pinning techniques similar to those used for supracondylar humerus fractures are employed...
February 15, 2016: Instructional Course Lectures
Daniel Bouton, Christine Ann Ho, Joshua M Abzug, Brian Brighton, Todd F Ritzman
Although flexion-type supracondylar humerus fractures account for a minority of all supracondylar humerus fractures, they warrant special attention because of their relatively high rate of requirement for open reduction and their potential for ulnar nerve injury or entrapment. The severity of flexion-type supracondylar humerus fractures may be difficult to appreciate on initial radiographs; therefore, surgeons must have a high index of suspicion in the evaluation of a patient who has a suspected flexion-type supracondylar humerus fracture...
February 15, 2016: Instructional Course Lectures
Jessica Jane Wingfield, Christine Ann Ho, Joshua M Abzug, Todd F Ritzman, Brian Brighton
Supracondylar humerus fractures are the most common elbow fractures in children. Displaced supracondylar humerus fractures that are associated with neurologic and/or vascular injuries should be treated with timely reduction via closed techniques. If closed reduction fails, reduction via open techniques is indicated. There is controversy about which surgical approach yields the best cosmetic and functional outcomes while minimizing postoperative complications. Open reduction, if indicated, has been reported to yield good outcomes in patients in whom closed reduction fails...
February 15, 2016: Instructional Course Lectures
Brian Brighton, Joshua M Abzug, Christine Ann Ho, Todd F Ritzman
Pediatric supracondylar humerus fractures are the most commonly encountered type of elbow fractures in children that require surgical fixation. Many pediatric supracondylar humerus fractures can be treated with closed reduction and percutaneous skeletal fixation. In difficult fractures, adjunct pin techniques, such as joystick wires and leverage pins, can be used to help attain a satisfactory and stable reduction before an open approach is used. After the fracture is reduced, optimal pinning, with the use of either crossed or lateral-entry techniques, and fixation that achieves maximal spread at the fracture site as well as bicortical engagement in both fragments are essential to maintain reduction and avoid complications that are associated with malunion...
February 15, 2016: Instructional Course Lectures
Kenneth Chin, Joshua M Abzug, Donald S Bae, Bernard D Horn, Martin Herman, Craig P Eberson
Management of pediatric polytrauma patients is one of the most difficult challenges for orthopaedic surgeons. Multisystem injuries frequently include complex orthopaedic surgical problems that require intervention. The physiology and anatomy of children and adolescent trauma patients differ from the physiology and anatomy of an adult trauma patient, which alters the types of injuries sustained and the ideal methods for management. Errors of pediatric polytrauma care are included in two broad categories: missed injuries and inadequate fracture treatment...
February 15, 2016: Instructional Course Lectures
Thomas Throckmorton
No abstract text is available yet for this article.
2016: Instructional Course Lectures
Tanishq Suryavanshi, C David Geier, J Martin Leland, Lance Silverman, Naven Duggal
Social media presents unique opportunities and challenges for practicing orthopaedic surgeons. Social media, such as blogging, Facebook, and Twitter, provides orthopaedic surgeons with a new and innovative way to communicate with patients and colleagues. Social media may be a way for orthopaedic surgeons to enhance communication with patients and healthcare populations; however, orthopaedic surgeons must recognize the limitations of social media and the pitfalls of increased connectedness in patient care.
2016: Instructional Course Lectures
Wade T Gofton, Michael Solomon, Tyson Gofton, Alex Pagé, Paul R Kim, Caleb Netting, Mohit Bhandari, Paul E Beaulé
Practicing orthopaedic surgeons must assess the effects of the learning curve on patient safety and surgical outcomes if a new implant, technique, or approach is being considered; however, it remains unclear how learning curves reported in the literature should be interpreted and to what extent their results can be generalized. Learning curve reports from other surgical specialties and from orthopaedic surgery can be analyzed to identify the strengths and weaknesses of learning curve reporting. Single-surgeon series and registry data can be analyzed to understand learning challenges and to develop a personalized learning plan...
2016: Instructional Course Lectures
Wade T Gofton, Steven R Papp, Tyson Gofton, Paul E Beaulé
As surgical techniques continue to evolve, surgeons will have to integrate new skills into their practice. A learning curve is associated with the integration of any new procedure; therefore, it is important for surgeons who are incorporating a new technique into their practice to understand what the reported learning curve might mean for them and their patients. A learning curve should not be perceived as negative because it can indicate progress; however, surgeons need to understand how to optimize the learning curve to ensure progress with minimal patient risk...
2016: Instructional Course Lectures
Jack M Bert, William R Beach, Louis F McIntyre, Ranjan Sachdev
For the past 24 years, most developed countries have used the International Classification of Diseases, Tenth Revision (ICD-10) to report physician services. In the United States, physicians have continued to use the American Medical Association Current Procedural Terminology, Fourth Edition and the Healthcare Common Procedure Coding System. The ICD-10-Clinical Modification (CM) has approximately 4.9 times more codes than the International Classification of Diseases, Ninth Revision. ICD-10-CM allows for more specific descriptors of a procedure and is broken down by category, etiology, anatomic site, severity, and extension...
2016: Instructional Course Lectures
David S Jevsevar, Kevin G Shea, Alexandra Styhl, Karl Koenig
The passage of the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015 (HR 2) helps ensure patient access to care and stable physician reimbursement for the near future. HR 2's underlying theme is the improvement of value to address the unsustainable rise in national healthcare spending. Quality improvement and performance improvement, which affect outcomes and costs as well as address variation, are the keys to improve the value of orthopaedic healthcare delivery. Orthopaedic surgeons should examine quality and performance strategies as well as several examples before they begin to implement these processes to improve quality and performance in their practices...
2016: Instructional Course Lectures
John M Tokish, Thomas C Alexander
Advances in information technology have allowed for improvements in the collection and analysis of large-scale outcomes data. These data can be used in the practice of orthopaedics for benchmarking, value analysis, and comparative effectiveness research. The implementation of registries within a busy surgical practice can be challenging, costly, and inefficient. Content, platform, and characteristics are the key elements required to successfully implement a patient-based orthopaedic outcomes data registry. Specific barriers to implementing registries are discussed, and solutions are proposed, to provide an example for optimal integration within clinical practices that may have varying goals...
2016: Instructional Course Lectures
Richard J Hawkins
The changing healthcare environment has essentially mandated that outcome scores play an increasing role in orthopaedic research and clinical care. Value is defined as the best outcome at the lowest cost. The reasoning behind the collection of outcome scores can be examined from several perspectives. The process of selecting an appropriate outcome measure involves analyzing its psychometrics in addition to other aspects, such as responsiveness, reliability, validity, and the ability to detect change in a reasonable manner...
2016: Instructional Course Lectures
John E Kuhn
The concept of measuring the outcomes of treatment in health care was promoted by Ernest Amory Codman in the early 1900s, but, until recently, his ideas were generally ignored. The forces that have advanced outcome measurement to the forefront of health care include the shift in payers for health care from the patient to large insurance companies or government agencies, the movement toward assessing the care of populations not individuals, and the effort to find value (or cost-effective treatments) amid rising healthcare costs...
2016: Instructional Course Lectures
Nicholas G Mohtadi
Measuring patient-reported outcomes is the current method for conducting clinical research. Creating a new outcome measure is an exhaustive process that should be carefully monitored and concentrated on only important and common conditions. The evaluation of an existing outcome measure should involve assessing its internal consistency, reliability, floor and ceiling effects, validity, and ability to measure clinically meaningful change. The most important characteristic of a patient-reported outcome is that it is developed with direct input from its target patient population...
2016: Instructional Course Lectures
David S Jevsevar, John W Karl, Mohit Bhandari, Kevin J Bozic, Mark A Piasio, Stuart L Weinstein
Healthcare costs in the United States continue to rise, and substantial variations in the type, quality, and location of that care persist. It is critically important for all healthcare stakeholders to address and define value in orthopaedic care delivery. Evidence-based orthopaedic care delivery, reliable quality and performance measurement, and the delivery of the best care at the lowest cost are the key strategies to improve the value of musculoskeletal care. A failure to implement these strategies could negatively affect the reimbursement of all healthcare providers--at both the private and government payer levels...
2016: Instructional Course Lectures
James P Doran, Alan H Beyer, Joseph Bosco, Peggy L Naas, Brian S Parsley, James Slover, Stephen J Zabinski, Joseph D Zuckerman, Richard Iorio
Although the Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January 2013, it may be years before the data can determine if the BPCI Initiative enhances value without decreasing quality. Private insurers have implemented other bundled payment arrangements for the delivery of total joint arthroplasty in a variety of practice settings. It is important for surgeons to review the early results of the BPCI Initiative and other bundled payment arrangements to understand the challenges and benefits of healthcare delivery systems with respect to total joint arthroplasty...
2016: Instructional Course Lectures
Richard A Berger, Michael B Cross, Sheila Sanders
Rapid recovery and early discharge after total joint arthroplasty are becoming more common. To develop a successful, safe, outpatient arthroplasty practice, surgeons must have the support of a multidisciplinary team, which includes an orthopaedic surgeon, an anesthesiologist, nurses, physical therapists, and a discharge planner. The authors of this chapter recommend surgeons start with healthier, motivated patients and focus on total hip replacements and unicompartmental knee replacements in the learning curve phase of the transition to outpatient total joint arthroplasty...
2016: Instructional Course Lectures
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