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  • 1,41200lei 1300.00 lei

     

    DESCRIPTION:

    Salivary Gland Pathology: Diagnosis and Management, Third Edition is an authoritative reference to this important discipline in medicine, dentistry, and surgery. Covering the etiology, diagnosis, and treatment of a broad range of pathologies, this comprehensive textbook provides insight into every facet of diagnosis and treatment for all salivary gland pathologies, and offers a wealth of high-quality clinical images, detailed surgical illustrations, and video clips of actual surgeries via a companion website.  

    The fully revised third edition contains new chapters on complications in salivary gland surgery and minimally invasive salivary gland pathology, and includes approximately 100 new clinical images and numerous surgical line drawings. Salivary Gland Pathology now features case presentations to place the information in context, as well as additional treatment algorithms in each chapter to assist in clinical decision making. Written by highly respected clinicians, educators, and researchers with extensive expertise in oral and maxillofacial surgery, this authoritative resource:   

    ·         Reviews the etiology, diagnosis, and treatment of all salivary gland pathologies, with detailed explanations and hundreds of full-color clinical images 

    ·         Incorporates new information on the taxonomy of salivary gland tumors, neoplastic and non-neoplastic entities, image guided biopsies of salivary gland lesions, and complications in traditional and non-traditional forms of salivary gland surgery 

    ·         Offers expanded coverage of histopathology, including classification, grading, and staging of salivary gland tumors 

    ·         Features up-to-date chapters on anatomy and physiology, imaging, cysts, systemic diseases, tumors, trauma, and innovative salivary gland surgical techniques 

    ·         Includes a discussion of meta-analyses and systematic reviews to support evidence-based practice  

    Salivary Gland Pathology: Diagnosis and Management, Third Edition remains the definitive resource for oral and maxillofacial surgeons, otolaryngologists, head and neck surgeons, and general surgeons as well as their residents providing care for patients with salivary gland pathology. 

     

    TABLE OF CONTENTS:

    Contributors vii

    Foreword to the First Edition ix

    Foreword to the Second Edition xi

    Foreword to the Third Edition xiii

    Preface to the First Edition xv

    Preface to the Second Edition xvii

    Preface to the Third Edition xix

    Acknowledgments xxi

    About the Companion Website xxiii

    Chapter 1 Surgical Anatomy, Embryology, and Physiology of the Salivary Glands 1
    John D. Langdon

    Chapter 2 Diagnostic Imaging of Salivary Gland Pathology 19
    J. Michael McCoy and Pradeep K. Jacob

    Chapter 3 Infections of the Salivary Glands 79

    Chapter 4 Cysts and CystLike Lesions of the Salivary Glands 117

    Chapter 5 Sialolithiasis 145

    Chapter 6 Systemic Diseases Affecting the Salivary Glands 175

    Chapter 7 Salivary Gland Pathology in Children and Adolescents 201

    Chapter 8 Classification, Grading, and Staging of Salivary Gland Tumors 225
    J. Michael McCoy and John Sauk

    Chapter 9 The Molecular Biology of Benign and Malignant Salivary Gland Tumors 269
    Randy Todd

    Chapter 10 Tumors of the Parotid Gland 301

    Chapter 11 Tumors of the Submandibular and Sublingual Glands 345

    Chapter 12 Tumors of the Minor Salivary Glands 373

    Chapter 13 Radiation Therapy for Salivary Gland Malignancies 435
    Joseph R. Kelley and Max Ofori

    Chapter 14 Systemic Therapy for Salivary Gland Cancer 455
    Janakiraman Subramanian and Lara Kujtan

    Chapter 15 Nonsalivary Tumors of the Salivary Glands 471

    Chapter 16 Trauma and Injuries to the Salivary Glands 509

    Chapter 17 Miscellaneous Pathologic Processes of the Salivary Glands 543

    Chapter 18 Complications of Salivary Gland Surgery 569
    Michael D. Turner

    Chapter 19 Innovations in Salivary Gland Surgery 601
    Mark McGurk and Katherine George

    Index 625

     

  • 335.00 lei

     

    Purchase the new print edition of this Lippincott® Connect title includes lifetime access to the digital version of the book, plus related materials such as videos and multiple-choice Q&A and self-assessments.

    This updated fourth edition of Hazel Clarkson’s 
    Musculoskeletal Assessment: Joint Motion and Muscle Testing offers a student-friendly approach to both Joint Motion and Muscle Testing (MMT) and Range of Motion (ROM).  Now in striking full color, the fourth edition provides just the right amount of detail students need to prepare for effective practice.
     
    Each chapter is devoted to a separate anatomical region to help physical therapists-in-training hone their understanding of pertinent surface and deep anatomy. The clear narrative outlines the steps of taking the assessments and interpreting the results and is enhanced by a strong art program with meticulously created illustrations and photographs that demonstrate patient and therapist positions and instrument placement.

    • NEW! Full-color photos and colorized line illustrations help students master key techniques and anatomical structures.
    • NEW! Online Practical Testing Forms list the criteria and correct sequence for performing each assessment—an ideal tool for students.
    • NEW! Online Instructor Resources include a Test Bank and pre-loaded PowerPoint slides for use in building course materials and lectures.
    • UNIQUE! Coverage of both muscle testing and goniometry, allows you to cover both topics in just one book. 
    • VISUAL: A Physical Therapy video library of over 100 videos covering MMT and ROM is accessible online via thePoint. 
    • Clear step-by-step instructions for muscle testing make it easy for students to master key concepts and techniques.
    • Clinical tie-ins give students opportunities to apply the material they are learning to clinical situations.

    Lippincott® Connect features:

    • Lifetime access to the digital version of the book with the ability to highlight and take notes on key passages for a more personal, efficient study experience.
    • Carefully curated resources, including interactive diagrams, video tutorials, flashcards, organ sounds, and self-assessment, all designed to facilitate further comprehension.

    Lippincott® Connect also allows users to create Study Collections to further personalize the study experience. With Study Collections you can:

    • Pool content from books across your entire library into self-created Study Collections based on discipline, procedure, organ, concept or other topics.
    • Display related text passages, video clips and self-assessment questions from each book (if available) for efficient absorption of material.
    • Annotate and highlight key content for easy access later.
    • Navigate seamlessly between book chapters, sections, self-assessments, notes and highlights in a single view/page.

     

  • Evidence-Based Physical Diagnosis
    La comanda in aproximativ 4 saptamani
    325.00 lei

     

    Description:

     


    Evidence-based insights into physical signs have evolved and progressed greatly over the past few years, further defining how physical findings identify disease, solve clinical problems, and forecast patient outcomes. Evidence-Based Physical Diagnosis, 5th Edition, is an up-to-date, authoritative resource for guidance on interpreting physical signs, enabling you to determine the most appropriate physical finding to confirm a diagnosis. Incorporating more than 200 new studies, this definitive text helps you glean the most from what you hear, see, and feel at the bedside-information that, combined with modern technologic testing, will grant clinicians the keys to outstanding patient care. 

     

     

    Table Of Contents:

     

    Part One: Principles of Family Medicine
    1. The Family Physician
    2. The Patient-Centered Medical Home
    3. Psychosocial Influences on Health
    4. Care of the Elderly Patient
    5. Care of the Dying Patient
    6. Care of the Self
    7. Preventive Health Care
    8. Behavioral Change and Patient Empowerment
    9. Interpreting the Medical Literature:  Applying Evidence-Based Medicine in Practice
    10. Information Technology
    11. Clinical Problem Solving
    12. Integrative Medicine
    13. Establishing Rapport
    14. Interpreting Laboratory Tests

    Part Two:  Practice of Family Medicine
    15. Infectious Diseases
    16. Pulmonary Medicine
    17. Ophthalmology
    18. Otorhinolaryngology
    19. Allergy
    20. Obstetrics
    21. Care of the Newborn
    22. Growth and Development
    23. Behavioral Problems in Children and Adolescents
    24. Child Abuse
    25. Gynecology
    26. Contraception
    27. Cardiovascular Disease
    28. Common Office Procedures
    29. Sports Medicine
    30. Common Issues in Orthopedics
    31. Neck and Back Pain
    32. Rheumatology and Musculoskeletal Problems
    33. Dermatology
    34. Diabetes Mellitus
    35. Endocrinology
    36. Obesity
    37. Nutrition
    38. Gastroenterology
    39. Hematology
    40. Urinary Tract Disorders
    41. Neurology
    42. Human Sexuality
    43. Clinical Genomics
    44. Crisis Intervention, Trauma, and Disasters
    45. Patients with Personality Disorders; Difficult Encounters
    46. Anxiety and Depression
    47. Delirium and Dementia
    48. Alcohol Use Disorders
    49. Nicotine Addiction
    50. Substance Use Disorders

     

       

     

  • 930.00 lei

     

    Description:

    Nutritional Oncology: Nutrition in Cancer Prevention, Treatment, and Survivorship presents evidence-based approaches to the study and application of nutrition in all phases of cancer including prevention, treatment, and survivorship. There is a long history of interest in the role of nutrition in cancer but only in the last 50 years has this interdisciplinary field developed scientific evidence from a combination of population studies, basic research, and clinical studies. Precision oncology, targeted  therapies and immunonutrition have led to advances in cancer treatment and prevention. Highlighting insights from Precision Oncology and Precision Nutrition to improve cancer prevention, treatment and survival is the core mission of this book. The editors have over 40 years of clinical and research experience integrating science with practical advice based on available evidence for healthcare professionals while highlighting research vistas for the scientific community. Features: Comprehensive treatment of all aspects of nutrition and cancer, including prevention, response to treatment, avoidance of relapse and promotion of quality of life for cancer survivors. Examines alternative medicines and botanical dietary supplements and identifies hypotheses for future research based on science. This book is written for doctors, dietitians, and other health care professional advising cancer patients, cancer survivors and the general public.

     

    Table of Contents:

     

    Chapter 1 Historical Evolution of the Role of Nutrition in Cancer

    Chapter 2 Cancer Metabolism and Nutrition

    Chapter 3 Precision Oncology and Nutrition

    Chapter 4 Phytonutrients and Cancer

    Chapter 5 Nutrition and Immune Function

    Chapter 6 Personalized Nutrition and Cancer

    Chapter 7 Epidemiology of Nutrition, Diet, and Cancer Risk

    Chapter 8 Oxidant Stress and Carcinogenesis

    Chapter 9 Nutrition, Angiogenesis, and Cancer

    Chapter 10 Cholesterol and Prostate Cancer

    Chapter 11 The Microbiome and Cancer

    Chapter 12 Exercise, Energy Balance, Body Composition, and Cancer Risk

    Chapter 13 Nutrition, Hormones, Cancer Risk, and Progression

    Chapter 14 Nutrition Support for Cancer Patients throughout the Continuum of Care

    Chapter 15 Malnutrition and Cancer Cachexia

    Chapter 16 Nutrition and Chemotherapy in the Epidemic of Obesity

    Chapter 17 Integrative Oncology and Nutrition

    Chapter 18 Susceptibility to Common Age-Related Chronic Diseases

    Chapter 19 Nutritional Advice and Dietary Supplements for the Cancer Survivor

    Chapter 20 Lifestyle Changes and Behavioral Approaches for the Cancer Survivor

    Chapter 21 Environmental Factors in Cancer Risk

    Chapter 22 Minority Health Disparities in Nutrition and Cancer

    Chapter 23 The Critical Questions on Nutrition and Cancer That Remain

    Index

     

  • 265.00 lei

     

    Description:

    Essential Endocrinology and Diabetes provides the accurate and up-to-date knowledge required for treating all areas of endocrinology and diabetes, covering the latest research, clinical guidelines, investigational methods, and therapies. This classic text explains the vital aspects of endocrine physiology in a succinct and easy-to-use format, with full-colour illustrations, clinical images, and case studies to assist readers in applying theory to practice. 

    The text covers the principles of endocrinology, clinical endocrinology, and clinical diabetes and obesity, and has been revised throughout to present the most recent developments in the field. The seventh edition includes new and updated material on the latest molecular techniques, approaches to clinical investigation and diagnostics, next generation sequencing technology, and positron emission tomography (PET). The treatment of type 1 diabetes and type 2 diabetes has been updated with clinical algorithms and reflects significant advances such as incretin-based therapies, SGLT2 inhibitors, the development of better insulins, and technologies that support self-management. 

    Provides students and practitioners with comprehensive and authoritative information on all major aspects of endocrine physiology 

    Covers diagnosis, management, and complications of clinical disorders such as endocrine neoplasia, and type 1 diabetes and type 2 diabetes 

    Explains the core principle of feedback regulation, which is vital for the correct interpretation of many clinical tests 

    Features case histories, learning objectives, ‘recap’ links to chapter content, cross-referencing guides, key information boxes, and chapter summaries 

    Essential Endocrinology and DiabetesSeventh Edition is the ideal textbook for medical and biomedical students, junior doctors, and clinicians looking to refresh their knowledge of endocrine science. 

     

    Table of Contents:

     

    Part 1: Foundations of Endocrinology

    CHAPTER 1: Overview of endocrinology

    A brief history of endocrinology and diabetes

    The role of hormones

    Classification of hormones

    Control systems regulating hormone production

    Endocrine disorders

    CHAPTER 2: Basic cell biology and hormone synthesis

    Chromosomes, mitosis and meiosis

    Synthesizing a peptide or protein hormone

    Synthesizing a hormone derived from amino acids or cholesterol

    Hormone transport

    CHAPTER 3: Molecular basis of hormone action

    Cellsurface receptors

    Nuclear receptors

    CHAPTER 4: Investigations in endocrinology and diabetes

    Preanalytical requirements for accurate endocrine testing

    Laboratory assay platforms

    Reference ranges

    Static and dynamic testing

    Cell and molecular biology as diagnostic tools

    Imaging in endocrinology

    Part 2: Endocrinology – Biology to Clinical Practice

    CHAPTER 5: The hypothalamus and pituitary gland

    Embryology and anatomy

    Pituitary tumours

    The hypothalamus

    The hypothalamic–anterior pituitary hormone axes

    The anterior pituitary hormones

    Hypopituitarism

    Hormones of the posterior pituitary

    CHAPTER 6: The adrenal gland

    The adrenal cortex

    The adrenal medulla

    CHAPTER 7: Reproductive endocrinology

    Embryology of the reproductive organs

    The male reproductive system

    The female reproductive system

    Pubertal disorders

    Subfertility

    CHAPTER 8: The thyroid gland

    Embryology

    Anatomy and vasculature

    Thyroid hormone biosynthesis

    Circulating thyroid hormones

    Function of thyroid hormones

    Thyroid function tests

    Clinical disorders

    CHAPTER 9: Calcium and metabolic bone disorders

    Calcium

    Hormones that regulate calcium

    Clinical disorders of calcium homeostasis

    Bone health and metabolic bone disease

    Clinical conditions of bone metabolism

    Vitamin D deficiency, osteomalacia and rickets

    CHAPTER 10: Pancreatic and gastrointestinal endocrinology and endocrine neoplasia

    Pancreatic endocrinology

    Gastrointestinal endocrinology and associated clinical conditions

    Endocrine tumour predisposition syndromes

    Tumours with ectopic hormone production

    Hormonesensitive tumours

    Other tumours relevant to endocrinology

    Part 3: Diabetes and Obesity

    CHAPTER 11: Overview of diabetes

    A brief history of diabetes and its classification

    Classification of diabetes

    Diagnosis of diabetes

    Insulin

    Glucagon

    CHAPTER 12: Type 1 diabetes

    What is type 1 diabetes?

    Epidemiology

    Pathogenesis

    Aetiology

    Clinical features

    Diagnosis

    Management of type 1 diabetes

    Acute metabolic emergencies

    CHAPTER 13: Type 2 diabetes

    Epidemiology

    Pathophysiology

    Prognosis

    Clinical features

    Prevention of diabetes

    Screening for diabetes

    Management of type 2 diabetes

    CHAPTER 14: Complications of diabetes

    Introduction

    Microvascular complications

    Pathology of microvascular complications

    Pathogenesis of microvascular complications

    Clinical features of microvascular complications

    Diabetesrelated kidney disease

    Neuropathy

    The diabetic foot

    Genitourinary and sexual problems of diabetes

    Atherosclerotic cardiovascular disease

    Heart failure

    Cancer

    Nonalcoholic fatty liver disease

    Gastrointestinal tract

    Bone and Joint

    Skin disorders

    Psychological and psychiatric sequelae of diabetes

    Diabetes and pregnancy

    Social sequelae of diabetes

    Organization of diabetes care

    CHAPTER 15: Obesity

    Introduction

    What is obesity?

    The health and social consequences of overweight and obesity

    Regulation of body weight

    The causes of obesity

    Genetic factors

    Environmental changes

    Prevention of obesity

    Management of the individual with obesity

    Conclusions

    Index

    End User License Agreement

     

     

     

  • 55800lei 520.00 lei

    DESCRIPTION:

    Haematology

    Diagnostic haematology requires the assessment of clinical and laboratory data together with a careful morphological assessment of cells in blood, bone marrow and tissue ­fluids. Subsequent investigations including flow cytometry, immunohistochemistry, cytogenetics and molecular studies are guided by the original morphological findings. These targeted investigations help generate a prompt unifying diagnosis. Haematology: From the Image to the Diagnosis presents a series of cases illustrating how skills in morphology can guide the investigative process. In this book, the authors capture a series of images to illustrate key features to recognize when undertaking a morphological review and show how they can be integrated with supplementary information to reach a final diagnosis.

    Using a novel format of visual case studies, this text mimics ‘real life’ for the practising diagnostic haematologist – using brief clinical details and initial microscopic morphological triage to formulate a differential diagnosis and a plan for efficient and economical confirmatory investigation to deduce the correct final diagnosis. The carefully selected, high-quality photomicrographs and the clear, succinct descriptions of key features, investigations and results will help haematologists, clinical scientists, haematology trainees and haematopathologists to make accurate diagnoses in their day-to-day work.

    Covering a wide range of topics, and including paediatric as well as adult cases, Haematology: From the Image to the Diagnosis is a succinct visual guide which will be welcomed by consultants, trainees and scientists alike.

     

     

    TABLE OF CONTENTS:

    Preface

    Abbreviations

    1. Haemophagocytic syndrome secondary to anaplastic large cell lymphoma

    2. Bone marrow AL amyloidosis

    3. Cup-like blast morphology in acute myeloid leukaemia

    4. Neutrophil morphology

    5. Primary myelofibrosis

    6. Sarcoidosis

    7. Leishmaniasis

    8. Gelatinous transformation of the bone marrow

    9. Acanthocytic red cell disorders

    10. Large granular lymphocytic leukaemia

    11. Pure erythroid leukaemia

    12. Reactive mesothelial cells

    13. Plasmablastic myeloma

    14. Septicaemia

    15. Unstable haemoglobin (haemoglobin Köln) and a myeloproliferative neoplasm

    16. Sickle cell anaemia in crisis

    17. Acute myeloid leukaemia with t(8;21)(q22;q22.1)

    18. Chronic neutrophilic leukaemia

    19. Essential thrombocythaemia

    20. Hairy cell leukaemia

    21. Mantle cell lymphoma in leukaemic phase

    22. Infantile osteopetrosis

    23. Reactive eosinophilia

    24. Stomatocytic red cell disorders

    25. Reactive lymphocytosis due to viral infection

    26. Therapy-related acute myeloid leukaemia with eosinophilia

    27. Red cell fragmentation syndromes

    28. NK/T-cell lymphoma in leukaemic phase

    29. Myelodysplastic syndrome with del(5q)

    30. Classical Hodgkin lymphoma

    31. Cryoglobulinaemia

    32. Congenital dyserythropoietic anaemia

    33. Acute monoblastic leukaemia with t(9;11)(p21.3;q23.3)

    34. Chronic myeloid leukaemia presenting with myeloid sarcoma and extreme thrombocytosis

    35. Glucose-6-phosphate dehydrogenase deficiency

    36. Leukaemic presentation of hepatosplenic gamma-delta T-cell lymphoma

    37. Myelodysplastic syndromes

    38. Pelger–Huët anomaly

    39. Russell bodies in lymphoplasmacytic lymphoma

    40. T-cell prolymphocytic leukaemia

    41. Myeloid maturation arrest

    42. MDS/MPN with ring sideroblasts and thrombocytosis

    43. Acute myeloid leukaemia with inv(16)(p13.1q22)

    44. Babesiosis

    45. Haemoglobin E disorders

    46. Juvenile myelomonocytic leukaemia

    47. Non-haemopoietic tumours

    48. Richter transformation of chronic lymphocytic leukaemia

    49. Sickle cell-haemoglobin C disease

    50. T cell/histiocyte-rich B-cell lymphoma

    51. Miliary tuberculosis

    52. Pure red cell aplasia

    53. Lymphoblastic transformation of follicular lymphoma

    54. Primary hyperparathyroidism

    55. Gamma heavy chain disease

    56. Acute promyelocytic leukaemia with t(15;17)(q24.1;q21.2)

    57. AA amyloidosis

    58. Acquired sideroblastic anaemia

    59. Diffuse large B-cell lymphoma

    60. Hickman line infection

    61. Monocytes and their precursors

    62. Paroxysmal cold haemoglobinuria

    63. Transient abnormal myelopoiesis

    64. Systemic lupus erythematosus

    65. Granular blast cells in acute lymphoblastic leukaemia

    66. Chronic myelomonocytic leukaemia

    67. Burkitt lymphoma/leukaemia

    68. Gaucher’s disease

    69. Myelodysplastic syndrome with haemophagocytosis

    70. Primary oxalosis

    71. Acute myeloid leukaemia with inv(3)(q21.3q26.2)

    72. Autoimmune haemolytic anaemia

    73. Chronic eosinophilic leukaemia due to FIP1L1-PDGFRA fusion gene

    74. Leukaemic phase of follicular lymphoma

    75. Megaloblastic anaemia

    76. Reactive bone marrow and an abnormal PET scan

    77. Acute megakaryoblastic leukaemia

    78. Erythrophagocytosis and haemophagocytosis

    79. Hyposplenism

    80. Acquired haemoglobin H disease

    81. Cystinosis

    82. Familial platelet disorder with a predisposition to AML

    83. Nodular lymphocyte predominant Hodgkin lymphoma

    84. Acute monocytic leukaemia with NPM1 mutation

    85. Adult T-cell leukaemia/lymphoma

    86. Hereditary elliptocytosis and pyropoikilocytosis

    87. Sézary syndrome

    88. Spherocytic red cell disorders

    89. Acute myeloid leukaemia and metastatic carcinoma

    90. Chédiak-Higashi syndrome

    91. Cortical T-lymphoblastic leukaemia/lymphoma

    92. Trypanosomiasis

    93. Acute myeloid leukaemia with myelodysplasia-related changes

    94. Blastic plasmacytoid dendritic cell neoplasm

    95. Inherited macrothrombocytopenias

    96. Persistent polyclonal B-cell lymphocytosis

    97. Acute myeloid leukaemia with t(6;9)(p23;q34.1)

    98. B-cell prolymphocytic leukaemia

    99. Various red cell enzyme disorders

    100. Sea blue histiocytosis in multiple myeloma

    101. Enteropathy-associated T-cell lymphoma

    Answers to multiple choice questions and further reflections on the theme

     


  • Evidence–Based Orthopedics
    La comanda in aproximativ 4 saptamani
    1,23300lei 1050.00 lei

     

    Description:

    Evidence-Based Orthopedics is an up-to-date review of the best evidence for the diagnosis, management, and treatment of orthopedic conditions. Covering orthopedic surgery as well as pre- and post-operative complications, this comprehensive guide provides recommendations for implementing evidence-based practice in the clinical setting. Chapters written by leading clinicians and researchers in the field are supported by tables of evidence that summarize systematic reviews and randomized controlled trials. In areas where evidence is insufficient to recommend a practice, summaries of the available research are provided to assist in decision-making.

    This fully revised new edition reflects the most recent evidence using the approved evidence-based medicine (EBM) guidelines and methodology. The text now places greater emphasis on GRADE--a transparent framework for developing and presenting summaries of evidence--to allow readers to easily evaluate the quality of evidence and the strength of recommendations. The second edition offers a streamlined presentation and an improved standardized format emphasizing how evidence in each chapter directly affects clinical decisions. Incorporating a vast amount of new evidence, Evidence-Based Orthopedics:

    Features thoroughly revised and updated content, including a new chapter on pediatric orthopedics and new X-ray images

    Provides the evidence base for orthopedic surgery as well as pediatric orthopedics and orthopedic conditions requiring medical treatment

    Covers the different methods for most orthopedic surgical procedures, such as hip replacements, arthroscopy, and knee replacements

    Helps surgeons and orthopedic specialists achieve a uniform optimum standard through a condition-based approach

    Aligns with internationally accepted guidelines and best health economic principles Evidence-Based Orthopedics is an invaluable resource for orthopedic specialists, surgeons, trauma surgeons, trainees, and medical students.

     

     

     

    Table of Contents:

     

    I: Methodology of EvidenceBased Orthopedics

    1 Principles of EvidenceBased Orthopedics

    Introduction

    Importance of evidencebased orthopedics

    Top four questions

    Question 1: What are the most important principles of evidencebased orthopedics?

    Question 2: How do you apply evidencebased orthopedics?

    Question 3: What is an example of applying evidencebased orthopedics?

    Question 4: What are the misconceptions of evidencebased orthopedics?

    Summary of answers

    References

    2 Hierarchy of Evidence and Common Study Designs

    Introduction

    Top five questions

    Question 1: What is the hierarchy of evidence for therapy studies?

    Question 2: What are randomized controlled trials (RCTs)?

    Question 3: What are observational studies?

    Question 4: What are case series and case reports?

    Question 5: What are systematic reviews and where do they fit in the hierarchy of evidence?

    Summary

    References

    3 Systematic Reviews and MetaAnalyses

    Introduction

    Top four questions

    Question 1: What are the types of literature reviews?

    Question 2: How is a systematic review performed?

    Question 3: How is a metaanalysis performed?

    Question 4: How does one critically appraise a systematic review and metaanalysis?

    Summary of answers

    References

    4 Healthcare Recommendations: Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Approach

    Case scenario

    Top three questions

    Question 1: What is GRADE?

    Question 2: What are the components of a GRADE quality of evidence assessment, and how do you evaluate them for a body of evidence?

    Question 3: How do you use your GRADE quality of evidence assessment to develop a clinical recommendation?

    Summary of answers

    Additional resources

    References

    5 Outcomes and Their Interpretations

    Introduction

    Top three questions

    Question 1: What is an outcome measure?

    Question 2: What properties of outcome measures do I have to know?

    Question 3: How should I choose an outcome measure?

    Biophysical/clinical outcome measures

    Patientreported outcome measures (PROMs)

    Objective physical function outcome measures

    Summary of answers

    References

    6 ValueBased Orthopedics

    Introduction

    Top four questions

    Question 1: What is valuebased healthcare?

    Question 2: How can value be improved?

    Question 3: How can valuebased healthcare be applied to orthopedics?

    Question 4: What are the practical challenges with valuebased orthopedics?

    Summary of answers

    References

    Further reading

    II: Orthopedic Medicine

    7 Critical Issues in Osteoporosis Management

    Clinical scenario

    Importance of the problem

    Top three questions

    Question 1: In postmenopausal women aged >50 who have sustained fragility fractures, how does the diagnosis of osteoporosis determine the risk for future fracture?

    Question 2: In postmenopausal women with low BMD or prior fragility fractures, which pharmacological therapies, compared to no medications, best reduce the risk for future fractures?

    Question 3: In patients with low BMD or who have sustained a fragility fracture, what is the appropriate duration of pharmacotherapy to avoid adverse side effects?

    Summary of answers

    References

    8 Venous Thromboembolic Events

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing major orthopedic surgery, does one modality, compared to others, most effectively reduce thromboembolic event rates?

    Question 2: In patients undergoing major orthopedic surgery, does preoperative initiation of thromboprophylaxis, compared to peri or postoperative initiation, reduce thromboembolic event rates?

    Available literature and quality of the evidence

    Question 3: In patients with isolated lowerlimb injuries who require immobilization, does thromboprophylaxis, compared to no prophylaxis, reduce thromboembolic event rates?

    Summary of answers

    References

    9 Blood Transfusion

    Clinical scenario

    Top three questions

    Question 1: Amongst patients undergoing orthopedic surgery, how common are perioperative blood transfusions compared to patients undergoing other types of surgery?

    Question 2: In patients undergoing orthopedic surgery, are perioperative blood management strategies effective at reducing transfusion rates compared to usual care?

    Question 3: In postoperative orthopedic surgery patients, what transfusion threshold results in optimal outcomes compared to usual care?

    Summary of answers

    References

    10 Wound Infections

    Clinical scenario

    Question 1: In patients undergoing orthopedic surgery, does routine antibiotic prophylaxis, compared to antibiotic administration, prevent surgical site infections?

    Question 2: In patients with a suspected surgical site infection, what is the optimal workup leading to accurate diagnosis and treatment?

    Question 3: In patients with a surgical site infection and infected hardware, does hardware retention, compared to removal of hardware, result in improved outcomes?

    Summary of answers

    References

    11 Smoking Cessation

    Clinical scenario

    Introduction

    Top three questions

    Question 1: In patients undergoing orthopedic procedures, do smokers, compared to nonsmokers, have worse outcomes?

    Question 2: In patients undergoing orthopedic procedures, does smoking cessation, compared to persistent smoking, decrease the likelihood of a poor outcome?

    Question 3: In orthopedic patients, are certain modalities, compared to others, more effective at initiating smoking cessation in orthopedic patients?

    Summary of answers

    References

    12 Perioperative Medical Management

    Top three questions

    Question 1: In patients presenting with a fragility hip fracture, does routine preoperative echocardiography, compared to no echocardiography, improve survival?

    Question 2: In fragility fracture patients, does orthopedic and medical comanagement, compared to usual care, improve outcomes such as length of stay, mortality, and readmission?

    Question 3: In fragility fracture patients undergoing surgery, does early surgery, when compared to delayed surgery, have an effect on mortality risk?

    Summary of answers

    References

    13 Orthobiologics

    Clinical scenario 1

    Clinical scenario 2

    Top three questions

    Question 1: In patients with open tibial shaft fractures, does the addition of bonemorphogenetic protein (BMP) at the fracture site during intramedullary nailing reduce the risk of nonunion compared to intramedullary nailing alone?

    Question 2: In patients with longbone nonunions, does the use of BMP during revision surgery improve the rate of union compared to revision surgery alone?

    Question 3: In patients undergoing primary spinal fusion, does the use of BMP improve the rate of union compared to the use of iliac crest bone graft?

    Summary of answers

    References

    14 Intimate Partner Violence

    Clinical scenario

    Top three questions

    Question 1: In adult women with orthopedic injuries who present to fracture clinics, what is the prevalence of intimate partner violence (IPV), and how does this compare to the general population?

    Question 2: Do specific educational programs, compared to traditional education, for healthcare professionals improve universal IPV identification and referral to assistance programs?

    Question 3: In adult women who present to fracture clinics, are universal IPV identification and assistance interventions, compared to standard practice, effective at improving health outcomes for women?

    References

    15 Pain Management in Orthopedic Surgery

    Clinical scenario 1

    Clinical scenario 2

    Top three questions

    Question 1: In adult patients undergoing surgery, which acute perioperative pain management strategies, compared to others, are most effective at managing perioperative pain?

    Systemic analgesia

    Regional analgesia

    Nonpharmacological options

    Question 2: In adult patients undergoing surgery, which opioidsparing strategies, compared to standard care, are most effective?

    Question 3: In adult patients undergoing surgery, what is the burden of persistent postoperative pain, and are there any interventions which, compared to usual care, can prevent persistent postsurgical pain?

    Summary of answers

    References

    16 PostTraumatic Stress Disorder and Depression

    Clinical scenario

    Top three questions

    Question 1: What are posttraumatic stress disorder and depression, and does their presence, in orthopedic patients, have an impact on postoperative outcomes?

    Question 2: How prevalent is PTSD and depression after acute trauma in the orthopedic trauma population?

    Question 3: In orthopedic trauma patients with PTSD and/or depression, are there resources that, compared to usual care, improve outcomes?

    Summary of answers

    References

    17 Nutrition and Supplements in Orthopedic Care

    Clinical scenario

    Top three questions

    Question 1: In orthopedic surgery patients, do vitamin D and calcium supplementation, compared to no supplementation, confer a benefit in terms of fracture risk, fracture healing, or bone mineral density?

    Question 2: Among patients undergoing orthopedic surgery, do those with a high BMI have a higher risk of complications compared to those with a normal BMI?

    Question 3: Among patients undergoing orthopedic surgery, do those with undernutrition or malnutrition have poorer outcomes compared to those with adequate nutrition?

    Summary of answers

    References

    III: Joint Reconstruction

    18 Outpatient Total Joint Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In eligible patients undergoing TJA, does performing the procedure and discharging the patient on the same day of the operation result in an additional risk of serious adverse events or readmissions compared to the same procedures performed on an inpatient basis?

    Question 2: In eligible patients undergoing TJA, does performing the procedure on an outpatient basis result in cost savings compared to the same procedures performed on an inpatient basis?

    Question 3: In patients undergoing an outpatient TJA, what factors are necessary to ensure a successful procedure compared to the general population undergoing TJA?

    Summary of answers

    References

    19 Hip Preservation

    Introduction

    Clinical scenario

    Top three questions

    Question 1: In patients with femoroacetabular impingement, does hip preservation surgery, compared to nonoperative treatment, result in better functional outcomes?

    Question 2: In young adults with acetabular dysplasia, does periacetabular osteotomy, compared to conservative care, result in better functional outcomes?

    Question 3: Among patients with mild or borderline acetabular dysplasia, does hip arthroscopy, compared to conservative care, produce better functional outcomes?

    Summary of answers

    References

    20 The Direct Anterior Approach

    Clinical scenario

    Top three questions

    Question 1: In patients requiring THA for arthritis, does a DAA provide early and late functional benefit compared to posterior and lateral approaches?

    Question 2: In patients requiring THA for arthritis, does a DAA provide acceptable radiographic alignment compared to other approaches?

    Question 3: In patients who undergo THA, does a DAA have a higher complication rate compared to lateral or posterior approaches?

    Summary of answers

    References

    21 Computer Navigation in Total Hip Arthroplasty

    Clinical scenario

    Top three questions

    Question 2: In patients undergoing total hip arthroplasty, which surgical techniques, compared to other techniques, result in optimal implant positioning and biomechanical hip reconstruction to reduce impingement and dislocation?

    Question 3: In patients undergoing total hip arthroplasty, does computer navigated surgery, compared to manual techniques, demonstrate superior implant positioning?

    Summary of answers

    References

    22 Highly Crosslinked Polyethylene in Total Hip Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In patients receiving a THA, does highly crosslinked polyethylene (HCLPE) result in a reduction in the wear rate compared to standard UHMWPE?

    Question 2: In patients receiving a THA, does HCLPE result in a reduction in osteolysis compared to UHMWPE?

    Question 3: In patients with a THA, does the use of HCLPE result in the potential for mechanical failure compared to standard UHMWPE?

    Summary of answers

    References

    23 Hip Resurfacing

    Clinical scenario

    Top three questions

    Question 1: In young, active patients with advanced degenerative hip disease, does hip resurfacing result in superior patientreported outcome measures compared to total hip arthroplasty (THA)?

    Question 2: In patients with advanced hip osteoarthritis, does hip resurfacing result in higher revision rates compared to THA?

    Question 3: Does more surgeon experience or technique, compared to less surgeon experience or other techniques, impact the clinical outcome of patients undergoing hip resurfacing?

    Summary of answers

    References

    24 MetalonMetal Hip Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In young, active patients undergoing MoMHR, is the revision rate higher than those undergoing metalonmetal total hip arthroplasty (MoMTHA)?

    Question 2: In patients who have undergone MoMHR, does monitoring metal ion levels, compared to no active monitoring, affect outcomes or revision rates?

    Question 3: In patients with suspected pseudotumor and systemic toxicity, which diagnostic tests, compared to other tests, are most accurate?

    Summary of answers

    References

    25 Ceramic in Total Hip Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing total hip arthroplasty (THA), do ceramic bearing surfaces, compared to metal or polyethylene, result in better outcomes?

    Question 2: In patients undergoing THA, are ceramic bearing surfaces, compared to metal or polyethylene, associated with a unique set of complications?

    Question 3: In patients who have undergone THA with ceramic bearing surfaces, compared to metal or polyethylene, are revisions more likely and/or more difficult to perform?

    Summary of answers

    References

    26 Cement in Total Hip Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing primary total hip arthroplasty (THA), does a cemented femoral stem, compared to an uncemented femoral stem, provide better function and patient outcomes?

    Question 2: In patients undergoing primary THA, does a cemented femoral stem, compared to an uncemented femoral stem, provide longerterm survival?

    Question 3: In patients undergoing cemented primary THA, does antibiotic cement, compared to plain cement, effectively prevent infection?

    Summary of answers

    References

    27 Head Size in Total Hip Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing THA, does larger femoral head size, compared to smaller head size, result in improved stability?

    Question 2: In patients undergoing THA, do certain bearing couples, compared to others, result in better outcomes depending on femoral head size?

    Question 3: In patients undergoing THA, do larger femoral head sizes, compared to smaller sizes, result in greater levels of trunnion corrosion?

    Summary of answers

    References

    28 Dual Mobility in Total Hip Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing primary total hip arthroplasty (THA), do some patient characteristics, compared to others, predict dislocation?

    Question 2: In patients undergoing THA, do dual mobility (DM) implants, compared to standard implants, result in a different type of dislocation?

    Question 3: In patients undergoing THA, do DM implants, compared to standard implants, have better longterm survival?

    Summary of answers

    References

    29 Trunnionosis

    Clinical scenario

    Top three questions

    Question 1: In patients with metalonpolyethylene (MoP) THA who develop an adverse local tissue reaction (ALTR), does the mechanism by which this occurs differ from that observed in metalonmetal (MoM) THA?

    Question 2: In patients undergoing THA, are there factors which increase the risk of trunnionosis and potential subsequent development of an ALTR in MoP THA when compared to ceramiconpolyethylene (CoP)?

    Question 3: In patients with MoP THA and radiological evidence of an ALTR secondary to trunnionosis, does management differ compared to that of patients with ALTRs from MoM THA?

    Summary of answers

    References

    30 Periprosthetic Hip Fractures

    Clinical scenario

    Top three questions

    Question 1: In patients who sustain a periprosthetic femur facture, are there factors that may be predictive of this complication after primary THA?

    Question 2: In patients with periprosthetic fractures of the femur, is there a validated classification system that has satisfactory intraobserver and interobserver reliability and validity that aids in therapeutic planning?

    Question 3: In patients with Vancouver type B periprosthetic femur fractures, does operative management, compared to nonoperative management, result in a better clinical outcome?

    Summary of answers

    References

    31 The Infected Total Hip Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In patients with suspected PJI, are novel biomarkers such as alphadefensin and leukocyteesterase better screening tests for than ESR, CRP, and synovial fluid PMNs?

    Available literature and quality of the evidence

    Question 2: In patients with late PJI, do twostage revisions have better rates of infection eradication than onestage revisions?

    Question 3: In patients who have undergone twostage revision, does an additional course of prophylactic oral antibiotics reduce the rates of reinfection compared to no additional antibiotics?

    Summary of answers

    References

    32 The Painful Total Hip Arthroplasty

    Clinical scenario

    Introduction

    Top three questions

    Question 1: In patients presenting with a painful THA, what are the key features on history, clinical examination, and investigation, compared to others, that are pertinent to formulating the diagnosis?

    Question 2: In patients presenting with a painful THA, which diagnostic tools, compared to others, are most evidencebased to diagnose periprosthetic joint infection (PJI)?

    Question 3: In patients presenting with a painful metalonpolyethylene (MoP) THA, what is the role of metal ion levels, compared to other diagnostic tools, in diagnosing trunnionosis?

    Summary of answers

    References

    33 Revision of the Femoral Component

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing revision arthroplasty with impaction grafting and segmental replacement, what are the technical aspects of impaction, compared to routine technique, that improve clinical outcome?

    Question 2: In patients who are undergoing revision THA, how does impaction allografting for femoral revision, compared to no impaction allografting, perform in terms of outcomes?

    Question 3: In patients who are undergoing revision THA, how does proximal femoral segmental allografting, compared to other treatments, perform in terms of clinical outcomes?

    Summary of answers

    References

    34 Revision of the Acetabular Component

    Clinical scenario

    Top three questions

    Question 1: In patients with acetabular bone loss, which classification system, compared to others, is most useful?

    Question 2: In patients undergoing revision THA, which acetabular bone loss management techniques, compared to others, perform best in terms of outcomes?

    Question 3: In patients undergoing revision THA, does the use of porous tantalum, compared to other alternatives, result in better outcomes?

    Summary of answers

    Acknowledgments

    References

    35 Antibiotic Cement in Total Knee Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: For patients undergoing primary TKA, does the routine use of antibiotic-loaded bone cement (ALBC) reduce the rate of periprosthetic joint infection (PJI) compared to cement without antibiotics?

    Question 2: In patients undergoing TKA, does the routine use of ALBC lead to higher aseptic mechanical failure rates compared to cement without antibiotics?

    Question 3: In patients undergoing TKA, is the routine use of antibioticimpregnated cement costeffective compared to antibiotics without cement?

    Summary of answers

    References

    36 Unicompartmental Knee Arthroplasty and Patellofemoral Resurfacing Arthroplasty

    Clinical scenario 1

    Clinical scenario 2

    Top three questions

    Question 1: Does unicompartmental knee arthroplasty (UKA) provide better patientreported outcomes despite worse survivorship than total knee arthroplasty (TKA) in patients under age 60 with isolated medial compartment OA?

    Question 2: Is lateral UKA a better alternative to TKA for this patient under age 60 with respect to functional outcome?

    Question 3: What are the patientreported outcomes for PF arthroplasty (PFA) versus TKA for patients under age 55 with isolated PF OA?

    Summary of answers

    References

    37 Cemented versus Uncemented Fixation in Total Knee Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In total knee arthroplasty (TKA) in younger patients, is the survival of the implant improved with uncemented components as compared to cemented fixation?

    Question 2: In patients undergoing TKA, are the clinical outcomes improved with cementless fixation versus those fixed with cement?

    Question 3: In patients undergoing TKA, is the bone quality adjacent to the TKA improved following uncemented TKA as opposed to cemented TKA with intended benefit for future TKA revision?

    Summary of answers

    References

    38 Cruciate Retaining versus Posterior Stabilized Total Knee Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In older active patients with osteoarthritis of the knee, is the use of CR TKA implants associated with differences in patientreported clinical outcomes as compared to PS designs?

    Question 2: In older active patients with osteoarthritis of the knee, is the use of CR TKA implants associated with differences in implant survival as compared to PS designs?

    Question 3: In older active patients with osteoarthritis of the knee, is the use of CR TKA implants associated with differences in ROM as compared to PS designs?

    Summary of answers

    References

    39 Patellar Resurfacing in Total Knee Arthroplasty

    Clinical scenario

    Top four questions

    Question 1: In older active patients with osteoarthritis of the knee, is patellar resurfacing associated with differences in patientreported clinical outcomes as compared to nonresurfacing?

    Question 2: In older active patients with osteoarthritis of the knee, is patellar resurfacing associated with differences in objective functional outcomes as compared to nonresurfacing?

    Question 3: In older active patients with osteoarthritis of the knee, is patellar resurfacing associated with differences in complications (anterior knee pain, and complications other than anterior knee pain) as compared to nonresurfacing?

    Question 4: In older active patients with osteoarthritis of the knee, is patellar resurfacing associated with differences in reoperation rates as compared to nonresurfacing?

    Summary of answers

    References

    40 Mechanical versus Kinematic Alignment in Total Knee Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing TKA, does kinematic alignment provide better functional outcomes than mechanical alignment?

    Question 2: In patients undergoing TKA, does kinematic alignment (KA) result in different complications compared to mechanical alignment (MA)

    Question 3: In patients with knee degeneration, is KA TKA suitable for all patients' anatomies treated with MA TKA?

    Summary of answers

    References

    41 Ligament Balancing in Total Knee Arthroplasty

    Top three questions

    Question 1: In subjects without knee pathology, what are the normal collateral ligaments' tensions/laxities during range of motion?

    Question 2: In patients with knee degeneration treated with a total knee arthroplasty (TKA), do those with greater ligament stability, compared to those with laxer ligaments, have better clinical results?

    Question 3: In patients with knee degeneration treated with a TKA, do some surgical techniques, compared to others, achieve better ligament balance and knee stability?

    Summary of answers

    References

    42 Robotics in Total Knee Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing knee arthroplasty, does roboticassisted surgery result in more accurate component positioning compared to conventional knee arthroplasty?

    Question 2: In patients undergoing knee arthroplasty, does roboticassisted surgery result in improved patientcentered outcomes compared to conventional knee arthroplasty?

    Question 3: In patients undergoing knee arthroplasty, is roboticassisted surgery costeffective compared to conventional knee arthroplasty?

    Summary of answers

    References

    43 PatientSpecific Instrumentation in Total Knee Arthroplasty

    Clinical scenario

    Top three questions

    Question 3: In patients undergoing TKA with PSI, are CTbased PSI systems more accurate than MRIbased PSI systems?

    Summary of answers

    References

    44 Metal Allergy in Total Knee Arthroplasty

    Clinical scenario

    Introduction

    Top three questions

    Question 1: Among patients awaiting TKA, does routine allergy screening, compared to no screening, affect management and/or outcomes?

    Question 2: Among patients with suspected hypersensitivity reaction, does any diagnostic method perform better than others?

    Question 3: Among patients with a confirmed hypersensitivity reaction, which treatment options, compared to others, result in the best outcomes?

    Summary of answers

    References

    45 Perioperative Management in Total Knee Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In patients scheduled for primary TKA, does preoperative bathing/showering or wiping with antiseptics result in fewer SSIs compared to nonantiseptic preparations?

    Question 2: In patients after primary TKA, does a fasttrack (FT) earlymobilization schedule lead to an improved outcome in functional scores and hospitalization time compared to a regular joint care protocol?

    Question 3: In patients after primary TKA, does local cryotherapy have a positive effect on early postoperative parameters compared to protocols without cryotherapy application?

    Summary of answers

    References

    46 Arthrofibrosis following Total Knee Arthroplasty

    Top three questions

    Question 1: In patients undergoing total knee arthroplasty (TKA), does continuous passive motion (CPM), compared to standard postoperative care, help prevent arthrofibrosis?

    Available literature and quality of the evidence

    Question 2: In patients undergoing manipulation under anesthesia (MUA) for stiffness after TKA, is early manipulation better than late manipulation at restoring range of motion (ROM)?

    Question 3: In patients with arthrofibrosis following TKA, does open arthrolysis provide superior outcomes compared to arthroscopic arthrolysis?

    Summary of answers

    References

    47 HighFlexion Implants in Total Knee Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In a patient who is considering a total knee arthroplasty (TKA), what design rationale can be provided for HR implants and are patients more satisfied with such designs compared to a conventional knee prosthesis?

    Question 2: Are functional outcomes superior in a patient who has undergone a TKA with a HF prosthesis compared to a conventional total knee prosthesis?

    Question 3: In a patient who has undergone TKA with a HF TKA, what unique complications are encountered as compared to a conventional TKA?

    Summary of answers

    References

    48 Venous Thromboembolism in Total Knee Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing TKA, are newer generation anticoagulants superior to older agents for venous thromboembolism prophylaxis?

    Question 2: In patients undergoing TKA, is routine postoperative screening, compared to no screening, for venous thromboembolic disease effective in preventing morbidity and mortality?

    Question 3: In patients undergoing TKA, is extended duration venous thromboembolism prophylaxis more effective than short duration prophylaxis?

    Summary of answers

    References

    49 Highly CrossLinked Polyethylene in Total Knee Arthroplasty

    Top three questions

    Question 1: For patients with total knee arthroplasty (TKA), is highly crosslinked polyethylene (XLPE) more resistant to wear than conventional polyethylene (nonXLPE)?

    Question 2: For patients with TKA, does XLPE provide better clinical outcomes and a lower revision rate than conventional polyethylene (nonXLPE)?

    Question 3: For patients with TKA, does the addition of antioxidants to XLPE, compared to no antioxidants, make it more resistant to wear?

    Summary of answers

    References

    50 Exposure and Implant Options in Revision Total Knee Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing revision TKA, does one surgical approach, compared to others, result in optimal outcomes?

    Question 2: In patients undergoing revision TKA, does a tibial tubercle osteotomy (TTO), compared to quadriceps snip (QS), result in improved functional outcomes and fewer complications?

    Question 3: In patients undergoing revision TKA and requiring augmentation due to bone defects, do metaphyseal cones, compared to sleeves, result in better outcomes?

    Summary of answers

    References

    51 The Painful Total Knee Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: For patients with painful TKA, what are the best evidencebased clinical investigations to assess for intra and extraarticular etiologies in the initial workup?

    Question 2: Are SPECT scans superior to nuclear medicine imaging or plain computed tomography (CT) scans in the evaluation of the painful TKA?

    Question 3: Are synovial biomarkers (i.e. alphadefensin) superior to aspiration for microbiology and serum laboratory investigations in the evaluation of the painful TKA?

    Summary of answers

    References

    52 Diagnosing the Infected Total Knee Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In patients with signs and symptoms of infection, what is the sensitivity and specificity of synovial fluid cytology, compared to preoperative serologic investigations, for diagnosis of TKA infection?

    Question 2: In patients with signs and symptoms of TKA infection, what intraoperative measures can be used for identification of joint infection?

    Question 3: For patients with failed twostage prosthetic exchange secondary to infection, how do patient outcomes compare for repeat attempts at implant exchange, compared to arthrodesis or amputation?

    Summary of answers

    References

    53 Management of the Infected Total Knee Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: What is the role of debridement, antibiotics, and implant retention in patients with early/acute hematogenous versus chronic prosthetic joint infection?

    Question 2: Which type of revision surgery strategy provides the better outcome in chronically infected TKA: onestage or twostage revision?

    Question 3: Which type of spacer leads to superior outcome after twostage revision TKA: a static or a dynamic knee spacer?

    Summary of answers

    Reference

    54 Management of the Unstable Total Knee Arthroplasty

    Top three questions

    Question 1: In patients who have undergone total knee arthroplasty (TKA), which risk factors, compared to others, predict instability?

    Question 2: Among patients with instability who undergo revision TKA, how do functional outcomes compare to primary TKA?

    Question 3: In patients undergoing revision TKA for instability, which surgical techniques, compared to others, produce optimal outcomes?

    Summary of answers

    References

    55 Stem Choices in Revision Total Knee Arthroplasty

    Introduction

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing revision TKA, how do uncemented components, compared to cemented components, perform in terms of outcomes?

    Question 2: In patients undergoing revision TKA, how do hybrid components, compared to fully cemented or uncemented components, perform in terms of outcomes?

    Question 3: In patients undergoing revision TKA, how do cemented components, compared to uncemented components, perform in terms of outcomes?

    Clinical scenario continued

    Summary of answers

    References

    56 Periprosthetic Fractures: Knee

    Clinical scenario

    Top three questions

    Question 1: In elderly patients with displaced periprosthetic distal femur fractures, are outcomes improved with open reduction and internal fixation (ORIF) compared to revision TKA?

    Question 2: In elderly patients with displaced periprosthetic distal femur fractures, are outcomes improved with retrograde intramedullary nailing (RIMN) compared to periarticular locked plating?

    Question 3: In elderly patients with displaced periprosthetic distal femur fractures, what is the minimal remaining bone stock required to successfully perform ORIF?

    References

    57 Femoral Bone Defects in Revision Total Knee Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In patients with periprosthetic distal femoral bone defects, does computed tomography (CT) scan more accurately estimate defect size when compared to xray?

    Question 2: In large contained distal femoral defects with metaphyseal compromise, does metallic reconstruction (cones/sleeves) yield improved survivorship compared to structural allograft reconstruction?

    Question 3: In patients with large, uncontained structural distal femoral defects (type 3), does distal femoral replacement revision knee arthroplasty yield superior clinical results compared to reconstruction with segmental allograft or allograftprosthetic composite?

    Summary of answers

    References

    58 Management of Structural Defects in Revision Knee Arthroplasty: Tibial Side

    Clinical scenario

    Top three questions

    Question 1: In patients with moderate tibial bone loss at revision TKA, are porous metal block augments a better option for implant survival compared to cement filling?

    Question 2: In patients with moderate to severe tibial bone loss at revision TKA, is impaction bone grafting (IBG), compared to other options, a viable technique in terms of survival – specifically aseptic loosening?

    Question 3: In patients with severe tibial bone loss at revision TKA, do metaphyseal trabecular metal (TM) sleeves and cone augments improve implant survival compared to structural allografts?

    Summary of answers

    References

    59 Patellar Options in Revision Total Knee Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In patients with deficient patellar bone stock, does the use of bone grafting or trabecular metalbacked components improve outcomes compared to patellectomy?

    Question 2: In patients with anterior knee pain following TKA with an unresurfaced patella, does secondary resurfacing reduce anterior knee pain compared to conservative management?

    Question 3: When revising a femoral component for aseptic loosening, does retaining a wellfixed patellar component improve outcome compared to revision to compatible patellar and femoral components?

    References

    60 Implant Design Options in the Treatment of Shoulder Osteoarthritis

    Clinical scenario

    Top three questions

    Question 1: In this patient with endstage shoulder osteoarthritis, what is the ideal surgical treatment?

    Question 2: If an anatomic total shoulder arthroplasty (TSA) is elected, what is the ideal glenoid component design?

    Question 3: If an anatomic TSA is chosen, what is the ideal humeral component design?

    Summary of answers

    References

    61 Cement in Shoulder Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In patients with advanced shoulder osteoarthritis, does cemented fixation of the humeral component result in improved functional outcomes compared to uncemented fixation?

    Question 2: In patients undergoing anatomic total shoulder arthroplasty (TSA), is there a difference in implant survival with a cemented versus uncemented technique?

    Question 3: In patients undergoing anatomic TSA with a cemented glenoid and/or humeral component, is there a difference in infection rates with the use of antibioticimpregnated cement compared to plain cement?

    Summary of answers

    References

    62 Management of Glenoid Bone Loss

    Clinical scenario

    Top three questions

    Question 1: In patients with glenoid bone loss, does computed tomography (CT), compared to other imaging modalities, perform better diagnostically?

    Question 2: In patients with glenohumeral bone loss, does reverse total shoulder arthroplasty (rTSA), compared to other treatment options, result in better outcomes?

    Question 3: In patients undergoing rTSA, do any bone graft options, compared to others, result in the best outcomes?

    Summary of answers

    References

    63 Reverse Total Shoulder Arthroplasty

    Clinical scenario

    Relevant anatomy

    Importance of the problem

    Top three questions

    Question 1: Among patients with shoulder pain and dysfunction, which indications, compared to others, are most relevant for reverse total shoulder arthroplasty (rTSA)?

    Question 2: In patients undergoing rTSA, do some surgical techniques, compared to others, result in better outcomes?

    Question 3: In patients undergoing rTSA, what are the clinical outcomes?

    Summary of answers

    References

    64 Glenoid Components in Total Shoulder Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: In patients with primary osteoarthritis, do keeled or pegged glenoid components correlate with lower revision rates?

    Question 2: In patients with primary osteoarthritis, do patientspecific components or intraoperative navigation, compared to traditional techniques, improve accuracy compared to traditional instrumentation?

    Question 3: In patients with primary osteoarthritis, do allpolyethylene cemented or metalbacked uncemented glenoid components result in lower failure rates?

    Summary of answers

    References

    65 Periprosthetic Joint Infection in Shoulder Arthroplasty

    Clinical scenario

    Top three questions

    Question 1: Are infection prevention strategies, including modifiable patient factors and perioperative interventions, effective in reducing periprosthetic joint infection (PJI) in patients who undergo shoulder arthroplasty procedures?

    Question 2: In patients with possible PJI, do preoperative serum indices, aspiration, or imaging aid in establishing the diagnosis of infection compared with preoperative tissue culture?

    Question 3: In patients with shoulder PJI, does a twostage revision result in lower reinfection rates compared with onestage revision?

    Summary of answers

    References

    66 Ankle Osteoarthritis

    Clinical scenario

    Top three questions

    Question 1: In patients with ankle osteoarthritis, does age predict different outcomes for ankle fusion (AF) versus total ankle replacement (TAR)?

    Question 2: For patients with ankle osteoarthritis, what is the best evidence to assess for AF or TAR according to the underlying cause of arthritis?

    Question 3: For patients with ankle osteoarthritis who are treated surgically, how do medium and longterm outcomes compare between AF and TAR?

    Summary of answers

    References

    67 Osteoarthritis of the 1st Metatarsophalangeal Joint

    Clinical scenario

    Top three questions

    Question 1: In patients with 1st MTP joint osteoarthritis (OA), do any nonoperative treatment modalities result in better functional outcomes compared to other nonoperative treatment modalities?

    Question 2: In patients undergoing surgery for 1st MTP OA, does arthroplasty result in better functional outcomes compared to arthrodesis?

    Question 3: In patients undergoing surgery for 1st MTP OA, do some procedures offer faster or higher rates of return to activity compared to other procedures?

    Summary of answers

    References

    68 Hallux Valgus

    Clinical scenario

    Top three questions

    Question 1: In adult patients with HV, does percutaneous correction result in quicker recovery versus open surgery?

    Question 2: In adult patients with HV, does long chevron (LC) osteotomy result in fewer complications versus scarf (SC) osteotomy ?

    Question 3: In adult patients with severe HV, does modified Lapidus result in better functional outcomes than 1st metatarsophalangeal joint arthrodesis (MTP)?

    Summary of answers

    References

    69 Cavovarus Foot

    Clinical scenario

    Top three questions

    Question 1: In patients with cavovarus foot and CharcotMarieTooth (CMT), does physiotherapy result in better functional scores compared to no physiotherapy?

    Question 2: In patients undergoing peroneus longus (PL) to peroneus brevis (PB) tendon transfer, does running locked suture result in improved construct strength compared to vertical mattress sutures?

    Question 3: In patients undergoing lateralizing calcaneal osteotomy, does prophylactic tarsal tunnel release result in less neurologic deficit compared to no tarsal tunnel release?

    Summary of answers

    References

    IV: Trauma

    70 Damage Control Orthopedics

    Clinical scenario

    Top three questions

    Question 1: In patients with multiple injuries in a borderline or unstable condition, what parameters best describe a patient in danger for complications?

    Question 2: In patients with multiple injuries in a borderline or unstable condition, which fracture is associated with the most complications?

    Question 3: In patients with multiple injuries after placement of an external fixation on longbone fractures, does early or late conversion to intramedullary nailing lead to increased infections?

    Summary of answers

    References

    71 Open Fractures

    Clinical scenario

    Top three questions

    Question 1: In trauma patients with open fractures, does early antibiotic administration result in lower infection rates as compared to delayed antibiotic administration?

    Question 2: In polytrauma patients with open fractures, does timely irrigation and debridement result in decreased complications and infection rates as compared to delayed irrigation and debridement?

    Question 3: In patients with open fractures, does irrigation with normal saline versus an additive solution, and high pressure versus low pressure, result in lower infection/complication rates?

    Clinical comment

    Summary of answers

    References

    72 The Mangled Extremity

    Clinical scenario

    Top three questions

    Question 1: In patients with a mangled extremity injury, does limb salvage necessitate greater resource investment than amputation?

    Question 2: In patients with a mangled extremity injury, what patient factors influence the success of therapy and the rate of RTW?

    Question 3: In patients with a mangled extremity injury, is limb salvage associated with better longterm outcomes when compared to amputation?

    Summary of answers

    References

    73 Acute Compartment Syndrome

    Clinical scenario

    Top three questions

    Question 1: In patients with CS, do open fractures pose greater risk of missed diagnosis and delayed fasciotomy compared to closed fractures?

    Question 2: In patients with CS, are patients who undergo compartment pressure monitoring diagnosed faster than patients undergoing clinical assessment?

    Question 3: In patients with anterior CS of the leg, does a oneincision fasciotomy of the anterior compartment achieve better decompression and fewer complications compared to the full twoincision/fourcompartment release?

    Summary of answers

    References

    74 Noninvasive Technologies for Fracture Repair

    Clinical scenario

    Top three questions

    Question 1: In patients with acute tibial fractures, does lowintensity pulsed ultrasound (LIPUS) accelerate fracture healing and improve healthrelated quality of life (QOL) of the patient compared to no treatment to accelerate fracture healing?

    Question 2: In patients with chronic tibial nonunion, does LIPUS promote fracture healing of nonunion and improve healthrelated QOL of the patient compared to no treatment to accelerate fracture healing?

    Question 3: In patients with acute tibial fractures, does pulsed electromagnetic field treatment (PEMF) and extracorporeal shockwave therapy (ESWT) accelerate fracture healing and improve healthrelated QOL of the patient compared to no treatment to accelerate fracture healing?

    Summary of answers

    Reference

    75 CalciumBased Bone Substitutes

    Clinical scenario

    Top three questions

    Question 2: In patients with a fracture requiring bone graft augmentation, does the use of calcium phosphate cement instead of autogenous iliac crest bone graft result in fewer complications?

    Question 3: In osteoporotic fractures, does calcium phosphate augmentation improve fixation of implants when compared with no augmentation of fixation?

    Summary of answers

    References

    76 Scapula Fractures

    Clinical scenario

    Top three questions

    Question 1: For patients with a scapula fracture, does CT, compared to plain Xrays, provide an advantage in terms of diagnosis and management?

    Question 2: In patients with scapula fractures, does operative management, compared to nonoperative management, result in better outcomes?

    Question 3: In patients with scapula fracture, do rehabilitation protocols differ for those who have undergone surgery compared to those managed nonoperatively?

    Summary of answers

    References

    77 Sternoclavicular Joint

    Clinical scenario

    Top three questions

    Question 1: In patients with posterior SC joint dislocations does CT provide a better understanding of the injury severity when compared to plain radiographs?

    Question 2: In patients with an SC joint dislocation undergoing closed reduction, is the shoulder abduction and traction technique more successful and have fewer complications than other closed reduction techniques?

    Question 3: In patients with an SC joint dislocation, does open fixation with allograft or autograft result in improved patient outcomes when compared to open fixation with metal implants?

    Findings

    References

    78 Clavicle Fractures

    Clinical scenario

    Top three questions

    Question 1: In patients with clavicle fractures managed nonoperatively, do displaced fractures have worse outcomes than nondisplaced fractures?

    Question 2: In patients with displaced clavicle fractures, does open reduction and internal fixation offer improved outcomes compared to nonoperative management?

    Question 3: In patients with clavicle fractures managed operatively, does intramedullary nailing result in improved outcomes compared to plating?

    Summary of answers

    References

    79 Acromioclavicular Joint

    Clinical scenario

    Top three questions

    Question 1: In patients with AC joint injuries undergoing operative repair, do those with lowgrade injuries have worse functional outcomes compared to those with highgrade injuries?

    Question 2: In patients with highgrade AC joint injuries treated operatively, do reconstruction methods offer improved results over temporary hook plate fixation?

    Resolution of clinical scenario

    Question 3: In patients with AC joint injuries treated operatively, does early intervention offer improved outcomes compared to delayed surgery?

    Summary of answers

    References

    80 Proximal Humeral Fractures

    Clinical scenario

    Top three questions

    Question 1: In patients with a proximal humerus fracture, does adding CT imaging improve classification of fractures or improve patient outcomes compared with radiographs alone?

    Question 2: In patients choosing nonoperative treatment of a fracture of the proximal humerus, does early initiation of exercises (before one week) improve pain or patientreported function compared with delayed exercise programs (after three weeks)?

    Question 3: In patients with displaced three or fourpart humerus fractures, does nonoperative treatment lead to better outcomes than surgical treatment (open reduction and internal fixation, hemiarthroplasty, or reverse total shoulder arthroplasty)?

    Summary of answers

    References

    81 Humeral Shaft Fractures

    Clinical scenario

    Top three questions

    Question 1: In adult patients with displaced humeral shaft fractures, does operative treatment result in improved function compared to nonoperative treatment?

    Question 2: In adult patients with displaced humeral shaft fractures undergoing operative treatment, how does plate osteosynthesis compare to intramedullary nailing in terms of fracture union and complication rates?

    Question 3: In adult patients sustaining humeral shaft fractures with radial nerve palsy, is there a difference in the recovery rate with primary radial nerve palsy, as compared to secondary radial nerve palsy (i.e. with fracture manipulation) radial nerve palsy?

    Summary of answers

    References

    82 Distal Humerus Fractures

    Clinical scenario

    Top three questions

    Question 1: In patients with intraarticular distal humerus fractures, does a triceps splitting approach result in better patient outcomes when compared to an olecranon osteotomy?

    Question 2: In patients with distal humerus fractures, does parallel plating result in better outcomes when compared to orthogonal plating?

    Question 3: In elderly patients with comminuted, intraarticular, distal humerus fractures does total elbow arthroplasty (TEA) result in better outcomes than openreduction and internal fixation?

    Summary of answers

    References

    83 Elbow Dislocations

    Clinical scenario

    Top three questions

    Question 1: In patients with AMF fractures, does operative management result in improved outcomes compared to nonoperative management?

    Question 2: In patients with terrible triad injuries, does surgical management of the coronoid improve clinical outcomes compared to nonoperative management?

    Question 3: In patients with terrible triad injuries, does radial head arthroplasty lead to improved clinical outcomes compared to internal fixation?

    Summary of answers

    References

    84 Radial Head Fractures

    Clinical scenario

    Top three questions

    Question 1: In patients with radial head fractures, does aspiration/injection aid in the initial management compared to radiographs alone?

    Question 2: In patients with displaced isolated partial radial head fractures, does operative treatment result in better outcomes compared to nonoperative treatment?

    Question 3: In patients with unstable or displaced fractures of the radial head that are part of a complex injury, does open reduction internal fixation (ORIF) have better outcomes compared with excision with or without prosthetic replacement?

    References

    85 Olecranon Fractures

    Clinical scenarios

    Top three questions

    Question 1: In patients with displaced olecranon fractures treated surgically, how do the outcomes compare between those treated with internal fixation vs fragment excision and triceps advancement?

    Question 2: In lowdemand elderly patients with displaced olecranon fractures, does surgery result in improved outcomes compared with nonsurgical treatment?

    Question 3: In patients with simple or minimally comminuted, stable, displaced olecranon fractures treated with surgery, how does tensionband wiring (TBW) compare with dorsal plating in terms of outcomes, complications, and costs?

    References

    86 Forearm Fractures

    Clinical scenarios

    Top four questions

    Question 1: In patients with radial shaft fractures/Galeazzitype fracturedislocations, does radiological radial shortening more accurately predict distal radioulnar joint (DRUJ) injury compared with radial shaft fracture location?

    Question 2: In patients with isolated ulnar fractures, does surgical treatment lead to better functional outcomes compared with nonsurgical treatment?

    Question 3: In patients with Galeazzitype fractures, does surgical reconstruction or temporary transfixion of the DRUJ prevent decrease in range of motion (ROM) of the forearm compared to nonsurgical treatment?

    Question 4: In patients with forearm fractures treated with plate fixation, does plate removal after bony union lead to higher refracture/complication rates compared with patients who retain their hardware?

    Summary of answers

    References

    87 Distal Radius Fractures

    Clinical scenario

    Top three questions

    Question 1: In patients with displaced intraarticular distal radius fractures, does open reduction and internal fixation (ORIF) with a plate result in improved outcomes as compared to temporary spanning external fixation with or without supplementary pin fixation?

    Question 2: In patients with displaced intraarticular distal radius fractures, does dorsal plating result in higher complication rates as compared to volar plating?

    Question 3: In patients with displaced intraarticular distal radius fractures, does arthroscopic reduction improve the outcomes over fluoroscopic reduction?

    Resolution of clinical scenario

    Summary of answers

    References

    88 Carpal Dislocations

    Clinical scenario

    Top three questions

    Question 1: In patients with perilunate dislocations, does advanced imaging (such as CT scan, US, MRI, or arthroscopy) lead to changes in diagnosis or operative planning compared to radiographs alone?

    Question 2: In patients with reducible perilunate dislocations, does delay in operative fixation lead to worse functional outcomes compared with early fixation?

    Question 3: In patients with perilunate dislocations, does temporary fixation of the carpus with screws achieve better functional and radiographic outcomes than Kirschner wire (Kwire) fixation?

    Summary of answers

    References

    89 Carpal Fractures

    Clinical scenario

    Top three questions

    Question 1: In patients with a suspected scaphoid fracture but negative findings on initial xrays, is magnetic resonance imaging (MRI) more sensitive and costeffective than temporary immobilization and repeated xrays after two weeks?

    Resolution of clinical scenario

    Question 2: In patients with a nondisplaced scaphoid fracture undergoing conservative treatment, does a short arm thumb spica cast achieve higher union rates compared to a belowelbow casting without thumb?

    Question 3: In patients with a nondisplaced fracture of the scaphoid, does conservative treatment achieve similar union rates to surgical treatment of the scaphoid?

    Summary of answers

    References

    90 Metacarpal Fractures

    Clinical scenario

    Top three questions

    Question 1: In adult patients with angulated fifth metacarpal neck fractures, does surgical treatment offer better final range of motion (ROM) or grip strength than nonsurgical treatment?

    Question 2: In adult patients with angulated fifth metacarpal neck fractures, does closed reduction and casting improve ROM, grip strength, or patientreported outcomes compared to less rigid immobilization?

    Question 3: In adult patients with a metacarpal neck fracture, does correction of angulation result in improved ROM or grip strength compared to consolidation without angulation correction?

    Summary of answers

    References

    91 Pelvic Fractures

    Clinical scenario

    Top three questions

    Question 1: During the initial management of patients with suspected pelvic bleeding, does the application of an invasive external fixator provide superior pelvic hemorrhage control when compared to a noninvasive external pelvic binder (PB)?

    Question 2: For patients with ongoing pelvic bleeding after resuscitation, does giving priority to preperitoneal pelvic packing (PPP), before angioembolization (AE), reduce mortality?

    Question 3: In pelvic fracture patients at high risk of bleeding and pulmonary embolism (PE), is mechanical thromboprophylaxis or even prophylactic inferior vena cava (IVC) filter insertion safer than a chemical strategy?

    Summary of answers

    References

    92 Acetabular Fractures

    Clinical scenario

    Top three questions

    Question 1: In elderly patients (over 65 years old) with acetabular fractures, does surgical treatment achieve better functional outcomes compared to conservative treatment?

    Question 2: In elderly patients (over 65 years old) with acetabular fractures, does surgical fixation delay the need for total hip arthroplasty (THA) compared to conservative treatment?

    Question 3: In elderly patients (above 65 years) with acetabular fractures, does acute THA achieve better patientreported outcomes and fewer surgical complications compared to a delayed THA?

    Summary of answers

    References

    93 Hip Dislocations

    Clinical scenario

    Top three questions

    Question 1: In patients with a traumatic dislocation of the hip, does a delay in hip reduction increase the risk of femoral head osteonecrosis (avascular necrosis [AVN]) as compared with an earlier reduction?

    Question 2: In patients with an isolated traumatic hip dislocation, do advanced imaging examinations (computed tomography [CT] and/or MRI) change treatment approach, as compared with Xrays alone?

    Question 3: In patients with hip dislocations who are diagnosed with an acetabular labral tear after closed reduction, does surgical treatment (with debridement and/or repair) achieve better functional outcomes than nonsurgical management?

    Summary of answers

    References

    94 Femoral Head Fractures

    Clinical scenario

    Top three questions

    Question 1: In patients with femoral head fractures, which types benefit from operative intervention more than others?

    Question 2: In patients with operatively treated femoral head fractures, does a surgical dislocation utilizing an anterior surgical approach result in improved outcomes compared to the digastric trochanteric flip osteotomy?

    Question 3: In patients with femoral head fractures, are there situations in which hip arthroplasty may have improved outcomes compared to open reduction and internal fixation?

    Summary of answers

    References

    95 Femoral Neck Fractures in Younger Patients

    Clinical scenario

    Top three questions

    Question 1: In young adult patients with displaced femoral neck fractures, does time to surgery of <6 hours result in lower rates of avascular necrosis (AVN) compared to surgery performed 6–24 hours from injury?

    Question 2: In young adult patients with displaced femoral neck fractures, does treatment with open reduction provide superior outcomes compared to treatment with closed reduction?

    Question 3: In young adult patients with displaced femoral neck fractures, does implant choice of cannulated screws (CS) result in higher complication rates when compared to an SHS?

    Summary of answers

    References

    96 Femoral Neck Fractures in the Elderly

    Clinical scenario

    Top three questions

    Question 1: In patients over the age of 65 undergoing treatment of a displaced femoral neck fracture, does arthroplasty result in decreased mortality and reoperation rates compared to internal fixation?

    Question 2: In patients over the age of 65 undergoing internal fixation for a displaced femoral neck fracture, does use of cancellous screws result in reduced risk of complications and reoperation compared to sliding hip screws (SHSs)?

    Question 3: In patients over the age of 65 undergoing arthroplasty for a displaced femoral neck fracture, does use of total hip arthroplasty (THA) result in decreased complications and improved outcomes compared to hemiarthroplasty?

    Summary of answers

    References

    97 Extracapsular Hip Fractures

    Clinical scenario

    Top three questions

    Question 1: In patients with extracapsular hip fractures undergoing fixation, does a cephalomedullary nail (CMN) result in a lower rate of reoperation when compared with sliding hip screw (SHS) and stratified by fracture pattern?

    Question 2: In patients with extracapsular hip fractures, do comprehensive orthogeriatric comanagement programs, compared to usual care, improve outcomes after hip fracture surgical fixation?

    Available literature and quality of the evidence

    Question 3: In patients with failed fixation of an extracapsular hip fractures, does revision fixation compared to arthroplasty lead to better longterm function?

    Summary of answers

    References

    98 Subtrochanteric Femur Fractures

    Clinical scenario

    Top three questions

    Question 1: In patients with subtrochanteric femur fractures treated with an intramedullary nail (IMN), does a trochanteric start point provide superior outcomes to a piriformis fossa start point?

    Question 2: In patients with subtrochanteric femur fractures treated with an IMN, does a nonanatomic reduction result in higher failure rates and higher mal/nonunion rates than anatomic reduction?

    Question 3: In patients with subtrochanteric femur fractures treated with an IMN, does open reduction lead to increased complication rates (i.e. infection, nonunion) when compared to closed reduction and intramedullary nailing?

    Summary of answers

    References

    99 Femoral Shaft Fractures

    Clinical scenario

    Top three questions

    Question 1: In polytrauma patients with femoral shaft fractures, does early definitive fixation of the femoral fracture result in lesser systematic complications and decreased mortality compared to the damage control orthopedics (DCO) approach?

    Question 2: Does early, simultaneous intramedullary nailing (IMN) of bilateral femur fractures predispose the patient to increased complication rates compared to the DCO approach?

    Question 3: In open femur fractures, does early IMN result in increased complication rates compared to delayed IMN?

    Summary of answers

    References

    100 Distal Femur Fractures

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing distal femoral fixation, do locking plates result in less construct failures and nonunions than nonlocking constructs?

    Question 2: In geriatric patients with distal femur fractures, does early surgery result in improved morbidity and mortality in comparison with delayed surgery?

    Question 3: In patients undergoing lateral locking plate fixation, are some patient and surgical factors, such as patient BMI, plate length, etc., more likely to result in nonunion and mechanical failure compared to other factors?

    Summary of answers

    References

    101 Proximal Tibia Fractures

    Clinical scenario

    Top three questions

    Question 1: Amongst adult patients presenting with bicondylar tibial plateau fracture, does open reduction and internal fixation, when compared to external fixation with use of limited open techniques, lead to fewer operative complications?

    Question 2: Amongst adult patients who have proximal tibial fractures with metaphyseal bone defects, does iliac crest bone grafting (ICBG), when compared to bone substitute (calcium phosphate or other), improve patientreported and radiographic outcomes?

    Question 3: Amongst adult patients who have undergone operative treatment for a tibial plateau fracture, what patient and injuryspecific factors, when compared to the general population, yield improvement in knee ROM at oneyear followup?

    Summary of answers

    References

    102 Tibial Shaft Fractures

    Clinical scenario

    Top three questions

    Question 1: In tibial shaft fractures, does intramedullary (IM) nailing offer better outcomes compared with open reduction and internal fixation (ORIF)?

    Question 2: In open tibial shaft fractures, does IM nailing offer improved outcomes compared to external fixation?

    Question 3: In tibial shaft fractures (open and closed), what is the effect of reamed versus unreamed intramedullary (IM) nailing in the rates of major reoperations and secondary complications?

    Summary of answers

    References

    103 IntraArticular Distal Tibia (Pilon/Plafond) Fractures

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing operative management for distal tibia intraarticular fractures, does staged open reduction and internal fixation (ORIF) result in better clinical and postsurgical outcomes compared to acute fracture management?

    Question 2: In patients undergoing operative management for distal tibia intraarticular fractures, does definitive management with limited internal fixation with external fixation result in better clinical and postsurgical outcomes compared to ORIF (early or delayed)?

    Question 3: In patients undergoing operative management for distal tibia intraarticular fractures, does any specific surgical exposure result in better clinical and postsurgical outcomes compared to other exposures?

    Summary of answers

    References

    104 Malleolar Fractures

    Clinical scenario

    Top three questions

    Question 1: Amongst adult patients presenting with lowenergy inversion ankle injuries, are the Ottawa Ankle Rules (OAR), when compared to other ankle injury screening tools, more accurate in diagnosing patients with ankle fractures?

    Question 2: Amongst adult patients, who have syndesmotic injuries proven with intraoperative stress testing, do novel suture button devices, when compared to standard screw fixation, improve the reduction of syndesmosis and patientreported outcomes?

    Question 3: Amongst adult patients who have posterior malleolar ankle fracture, at what percentage of articular surface involvement does operative intervention when compared to nonoperative management, yield improvement in patientreported outcomes at oneyear followup?

    Summary of answers

    References

    105 Talus Fractures

    Clinical scenario

    Top three questions

    Question 1: In patients with displaced talar neck fractures, does urgent definitive fixation result in better outcomes and fewer complications, compared with delayed definitive fixation?

    Question 2: In patients with displaced talar neck fractures, does surgery with dual approaches (anteromedial and anterolateral) result in better outcomes and fewer complications, compared with surgery with percutaneous fixation or arthroscopicassisted reduction and fixation?

    Question 3: In patients with displaced talar neck fractures, does plate fixation result in better biomechanical stability compared with fixation using only screws?

    Summary of answers

    References

    106 Calcaneal Fractures

    Clinical scenario

    Top three questions

    Question 1: In adults with displaced intraarticular calcaneal fractures, does nonoperative treatment provide longterm functional outcomes as good as operative care (open reduction and internal fixation [ORIF])?

    Question 2: In adults with displaced intraarticular calcaneal fractures, does minimally invasive reduction and percutaneous fixation provide longterm functional outcomes as good as ORIF?

    Question 3: In adults with displaced intraarticular calcaneal fractures, does primary fusion provide longterm functional outcomes as good as ORIF?

    Summary of answers

    References

    107 Lisfranc Injuries

    Clinical scenario

    Top three questions

    Question 1: In a patient with a Lisfranc injury, does an anatomical reduction and fixation result in better outcomes than primary arthrodesis?

    Question 2: In a patient with a Lisfranc injury, does delayed or misdiagnosis adversely affect the outcomes compared to successful diagnosis and treatment?

    Question 3: In the active patient with a Lisfranc injury does, operative treatment allow for return to preinjury level of sport compared to nonoperative treatment?

    Summary of answers

    References

    108 Fifth Metatarsal Fractures

    Clinical scenario

    Top three questions

    Question 1: In patients with a proximal fifth metatarsal fracture, does the pattern of injury affect the clinical and radiological outcome?

    Question 2: In patients with a proximal fifth metatarsal fracture, does operative fixation result in better outcomes than nonoperative management?

    Question 3: In patients with a proximal fifth metatarsal fracture, does intramedullary screw fixation lead to better biomechanical and clinical outcomes than other operative treatment options?

    Summary of answers

    References

    V: Spine

    109 Mechanical Neck Pain

    Clinical scenario

    Top three questions

    Question 1: In adults with nonwhiplashassociated mechanical neck pain, do patient education strategies improve pain, function, and/or quality of life compared to no treatment?

    Question 2: Have nonsteroidal antiinflammatory drugs (NSAIDs), muscle relaxants, or analgesics demonstrated efficacy compared to placebo or other treatments in treating patients with nonspecific neck pain?

    Question 3: In adults with nonwhiplashassociated mechanical neck pain, does the addition of exercise to mobilization/manipulation improve pain and function compared to mobilization/manipulation alone?

    Summary of answers

    References

    110 Whiplash

    Clinical scenario

    Top three questions

    Question 1: In athletes with whiplash and/or cervical spine injuries, what are the returntoplay criteria, and what injuries/conditions are contraindications to return to play?

    Question 2: In athletes who sustain a cervical disc herniation, do those who undergo surgery have higher returntoplay rates than individuals treated nonoperatively?

    Question 3: In athletes who sustain a burner/stinger injury, do preexisting factors contribute to an increased risk of this condition, and how do these factors impact resolution of symptoms and return to play?

    Summary of answers

    References

    111 Cervical Radiculopathy and Myelopathy

    Clinical scenario

    Top three questions

    Question 1: In patients with mild, moderate, or severe degenerative cervical myelopathy (DCM), does surgical decompression provide superior functional outcomes, as graded by the modified Japanese Orthopaedic Association (mJOA) scale, compared to nonoperative management strategies?

    Question 2: In patients with asymptomatic cervical spinal cord compression (imaging evidence of cervical spinal cord compression without signs or symptoms of myelopathy or radiculopathy), what is the role of prophylactic surgery, and what are the frequency and timing of symptom development and clinical, radiological, and electrophysiological predictors of myelopathy development?

    Question 3: In patients with imaging evidence of cervical spinal cord compression and clinical and/or electrophysiological evidence of radiculopathy, but without myelopathy, what is the role of surgery, and what are the frequency and timing of symptom development and clinical, radiological, and electrophysiological predictors of myelopathy development?

    Summary of answers

    References

    112 Mechanical Low Back Pain: Operative Management

    Clinical scenario

    Top three questions

    Question 1: In patients with isolated mechanical back pain, does fusion provide improved pain relief compared to nonoperative treatment?

    Question 2: In patients with chronic low back pain (LBP), do some diagnostic tests more accurately select the right patient for spine fusion than other tests?

    Question 3: In patients undergoing spine fusion, what risk factors are associated with poorer outcomes?

    Summary of answers

    References

    113 Mechanical Low Back Pain: Nonoperative Management

    Clinical scenario

    Top three questions

    Question 1: In patients presenting with acute or subacute LBP, does early advanced imaging, e.g. computed tomography (CT) and magnetic resonance imaging (MRI), lead to improved outcomes when compared to delayed imaging?

    Question 2: For patients undergoing initial treatment of mechanical LBP, does skeletal manipulation prevent the progression of symptoms more effectively than medical care?

    Question 3: Is there a role for spinal injections in the treatment of patients with mechanical LBP instead of oral medications?

    Summary of answers

    References

    114 Neurogenic Claudication

    Clinical scenario

    Top three questions

    Question 1: In elderly patients with lumbar spinal stenosis, does decompressive surgery result in better patientreported outcomes compared to nonoperative treatment?

    Question 2: In elderly patients with lumbar spinal stenosis, does minimally invasive (midlinesparing) decompression result in better patientreported outcomes compared to laminectomy?

    Question 3: In elderly patients with lumbar spinal stenosis and concomitant spondylolisthesis, does surgical treatment with decompression and fusion result in better patientreported outcomes compared to decompression alone?

    Summary of answers

    References

    115 Lumbar Radiculopathy

    Clinical scenario

    Top three questions

    Question 1: In adult patients with lumbar radiculopathy, what workup is needed to establish a diagnosis?

    Question 2: In adult patients with lumbar radiculopathy, do injections alter the natural history of the symptoms compared to noninvasive or surgical treatments?

    Question 3: In adult patients with lumbar radiculopathy, does surgical treatment result in superior sustained symptom relief compared to nonsurgical treatment?

    Summary of answers

    References

    116 Adolescent and Adult Spinal Deformity: Nonoperative Management

    Clinical scenario

    Top three questions

    Question 1: In patients with adolescent idiopathic scoliosis (AIS), how does bracing influence healthrelated quality of life (HRQoL)?

    Question 2: In patients with AIS, does nonoperative management result in pulmonary compromise in adulthood?

    Question 3: Which risk factors predict patients with adult scoliosis curves will progress and cause low back pain (LBP)?

    Summary of answers

    References

    117 Adolescent and Adult Spinal Deformity: Operative Management

    Clinical scenarios

    Top three questions

    Question 1: Have current classification systems improved preoperative planning and fusion level determination for AIS and ASD patients?

    Question 2: For AIS and ASD patients, do minimally invasive surgical techniques have better operative and radiographic outcomes compared to traditional open techniques?

    Question 3: For AIS and ASD patients, does operative management achieve better correction and quality of life outcomes compared to patients treated otherwise?

    Summary of answers

    References

    118 Metastatic/Myeloma Disease

    Clinical scenario

    Top three questions

    Question 1: In patients with metastatic carcinoma or myeloma disease resulting in metastatic epidural spinal cord compression, does radiation combined with direct decompressive surgery result in improved functional status for patients compared to radiation alone?

    Question 2: In patients with metastatic carcinoma or myeloma disease affecting the spine, does assessment of spinal stability by a scoring algorithm provide reliable and useful prognostic information compared to opinion alone?

    Question 3: In patients with metastatic carcinoma or myeloma disease affecting the spine, do simple prognostication algorithms that take patientspecific and tumorspecific factors into account better predict outcomes than those that do not?

    Summary of answers

    References

    119 Spinal Infections

    Clinical scenario

    Top three questions

    Question 1: What are the typical presentation, examination findings, and imaging characteristics of patients with VO/epidural abscess?

    Question 2: What is the evidence for operative compared to nonoperative management for patients with VO/epidural abscess?

    Question 3: What is the prognosis for patients with VO and epidural abscess, including posttreatment morbidity?

    Summary of answers

    References

    VI: Sports Medicine

    120 Ergogenic Aids

    Clinical scenario

    Top three questions

    Question 1: Do young adults using creatine supplementation experience an enhancement in performance compared to nonsupplemented young adults?

    Question 2: In young adults supplementing with creatine, is there resultant physiological change associated with supplementation as compared to nonsupplemented young adults?

    Question 3: Do young adults using creatine supplementation experience adverse side effects compared to nonsupplemented young adults?

    Summary of answers

    References

    121 First Time Shoulder Dislocation

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing reduction of primary glenohumeral dislocations, does intravenous (IV) sedation for closed reduction present a greater chance for successful reduction and fewer complications than other methods of premedication for reduction?

    Question 2: In a patient undergoing a primary glenohumeral dislocation reduction, is there an ideal reduction and immobilization method that results in fewer complications and reduced recurrence rates?

    Question 3: What is the longterm prognosis for a patient who sustains a primary anterior glenohumeral dislocation?

    Summary of answers

    References

    122 Recurrent Shoulder Instability

    Clinical scenario

    Top three questions

    Question 1: In patients with recurrent posttraumatic anterior shoulder instability with a bony defect, does a bony procedure lead to less recurrent instability in comparison to a labrum repair alone?

    Question 2: In patients undergoing a bony procedure in shoulder instability, does the original Latarjet procedure (onlay) show superiority to other bony procedures in the prevention of recurrent instability?

    Question 3: In recurrent posttraumatic anterior shoulder instability with a large Hill–Sachs lesion without considerable glenoid bone loss, is a remplissage combined with a labrum repair superior to a labrum repair alone?

    Summary of answers

    References

    123 Rotator Cuff Tears

    Clinical scenario

    Top three questions

    Question 1: Among patients with rotator cuff tears, does older age, compared to younger age, have an impact on the success of rotator cuff repair

    Resolution of clinical scenario

    Question 2: In patients with an acute rotator cuff tear, does early surgery, compared to delayed surgery, result in better functional outcomes?

    Question 3: Among patients undergoing rotator cuff repair, does double row repair, compared to single row repair, have an advantage in terms of outcomes?

    Summary of answers

    References

    124 Massive and Irreparable Rotator Cuff Tears

    Clinical scenario

    Top three questions

    Question 1: In active patients with a full thickness, massive, retracted rotator cuff tear, does single row rotator cuff repair (RCR) result in better clinical outcomes than double row RCR?

    Question 2: In middleaged active men with full thickness, massive, retracted rotator cuff tears, does RCR with patch augmentation result in better clinical outcomes than RCR in isolation?

    Question 3: In middleaged men with irreparable rotator cuff tears, does superior capsular reconstruction (SCR) result in better functional outcomes than tendon transfers?

    Summary of answers

    References

    125 Subacromial Pain Syndrome

    Clinical scenario

    Top three questions

    Question 1: Does the Hawkins–Kennedy test predict subacromial pain syndrome (SAPS) better in patients with shoulder pain compared to other physical tests?

    Question 2: How sensitive is an MRI scan in comparison to US for diagnosing SAPS in patients with shoulder pain?

    Question 3: Does surgery lead to a better functional outcome compared to conservative treatment (physiotherapy, infiltrations) in patients with SAPS?

    Summary of answers

    References

    126 Pathology of the Long Head of the Biceps

    Clinical scenario

    Top three questions

    Question 1: What is the role of clinical examination and imaging in isolating biceps tendinopathy in patients with shoulder symptoms?

    Question 2: What is involved in the decisionmaking to perform a biceps tendon debridement versus tenodesis or tenotomy in patients with biceps tendinopathy?

    Question 3: In patients undergoing biceps tenodesis, are there any differences in the clinical outcome and complication rates among various techniques used for biceps tenodesis? Between arthroscopic biceps tenodesis versus open biceps tenodesis?

    Summary of answers

    References

    127 Superior Labral Tears and Throwing Shoulder Injuries

    Clinical scenario

    Top three questions

    Question 1: In overhead throwing athletes, how reliable is the physical exam compared to imaging studies in the diagnosis of symptomatic superior labral tear anterior to posterior (SLAP) tears?

    Question 2: In overhead throwing athletes with symptomatic SLAP tears, does primary operative intervention result in improved return to play (RTP) compared to nonoperative treatment?

    Question 3: Are overhead nonthrowing athletes better able to return to competition following surgical treatment of SLAP tears compared to overhead throwing athletes?

    Summary of answers

    References

    128 Ulnar Collateral Ligament Injuries of the Elbow

    Clinical scenario

    Top three questions

    Question 1: Is magnetic resonance arthrography (MRA) a more accurate test to diagnose ulnar collateral ligament (UCL) injury in adult athletes than conventional magnetic resonance imaging (MRI)?

    Question 2: Do UCL reconstructions performed with a docking technique result in a higher returntosport rate compared to the “classical” Jobe technique in athletes with UCL injury?

    Question 3: Is there any difference in pitching performance in athletes after UCL reconstruction compared to matched uninjured pitchers?

    Summary of answers

    References

    129 Lateral Epicondylitis (Tennis Elbow)

    Clinical scenario

    Top three questions

    Question 1: In adult patients with lateral epicondylitis, does advanced imaging result in improved diagnosis compared with clinical exam with or without radiography?

    Question 2: In adult patients with lateral epicondylitis, does conservative management result in improved pain and function compared to therapy with injections?

    Question 3: In adult patients with lateral epicondylitis, does surgery result in improved pain and function compared to nonoperative treatments?

    Summary of answers

    References

    130 Osteochondritis Dissecans Lesions of the Elbow

    Clinical scenario

    Top three questions

    Question 1: In patients with osteochondritis dissecans (OCD) of the capitellum, are outcomes with nonoperative treatment better in patients with an open capitellar physis compared to patients with a closed capitellar physis?

    Question 2: In patients with a clinically and radiographically unstable capitellar OCD, are clinical outcomes better after surgical debridement in patients with small defects compared to patients with large defects?

    Question 3: In patients with a clinically and radiographically unstable capitellar OCD, does osteochondral autograft transfer result in superior outcomes compared to debridement for pain and return to sport?

    Summary of answers

    References

    131 Labral Tears

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing surgical treatment for a labral tear of the hip, do patients treated with labral repair have superior functional outcome scores to those treated with labral debridement?

    Question 2: In patients undergoing surgical treatment for an irreparable labral tear of the hip, do patients treated with labral reconstruction have superior functional outcome scores to those treated with labral debridement or a matchcontrolled labral repair group?

    Question 3: In patients undergoing surgical treatment for a labral tear of the hip, do younger patients have superior functional outcome scores and lower rates of conversion to hip arthroplasty compared to older patients?

    Summary of answers

    References

    132 Femoroacetabular Impingement

    Clinical scenario

    Introduction

    Top three questions

    Question 1: In young adults with hip pain, which physical examination maneuvers are most accurate in the diagnosis of FAI, compared to others?

    Question 2: In patients with cartilage defects of the hip, do some treatment options, compared to others, result in better outcomes?

    Question 3: In young patients who have undergone treatment for FAI, what are the timelines for return to sport?

    Summary of answers

    Conclusion

    References

    133 Initial Management of the Sports Injured Knee

    Clinical scenario

    Top three questions

    Question 1: In patients with an acutely injured knee, does magnetic resonance imaging (MRI) performed acutely provide greater diagnostic ability compared to delayed MRI?

    Question 2: In patients with an acutely injured knee, does MRI, compared to diagnostic arthroscopy, provide sufficient diagnostic capability?

    Question 3: In acute posttraumatic hemarthrosis, does aspiration, compared to no aspiration, play a diagnostic or therapeutic role?

    Summary of answers

    References

    134 Meniscal Tears

    Clinical scenario

    Top three questions

    Question 1: In patients with suspected meniscal lesions, is US preferable for tear detection compared to arthroscopy and MRI?

    Question 2: In patients with meniscal lesions, does a specific repair technique result in better surgical outcomes compared to others?

    Question 3: In patients with meniscal lesions, does a specific rehabilitation protocol result in better clinical outcomes compared to others?

    Summary of answers

    References

    135 Anterior Cruciate Ligament Injuries

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing ACL reconstruction, does autograft result in improved outcomes compared to allograft?

    Question 2: In patients undergoing ACL reconstruction, does hamstring or quadriceps tendon autograft result in differences in outcomes compared to conventional bone patellar tendon bone (BPTB) autograft?

    Question 3: In patients undergoing ACL reconstruction, does early surgical intervention improve outcomes compared to delayed reconstruction in both skeletally mature and immature patients?

    Summary of answers

    References

    136 Posterior Cruciate Ligament Injuries

    Clinical scenario

    Top three questions

    Question 1: In patients with a posterior cruciate ligament (PCL) injury, how accurate is the clinical examination in the diagnosis of PCL injury compared to magnetic resonance imaging (MRI)?

    Question 2: In patients with isolated PCL injury, does reconstruction surgery result in improved patientcentered outcomes compared to nonoperative management?

    Question 3: In patients with isolated PCL injury, does a doublebundle (DB) reconstruction technique result in improved patientcentered outcomes compared to a singlebundle (SB) reconstruction technique?

    Summary of answers

    References

    137 Combined Anterior Cruciate Ligament and Medial Collateral Ligament Injuries

    Clinical scenario

    Top three questions

    Question 1: In patients with ACL+MCL tears, are some clinical examination maneuvers more accurate in terms of diagnostic ability compared to others?

    Question 2: Are there any specific risk factors that predispose individuals to combined ACL+MCL injuries?

    Question 3: In patients with ACL+MCL tears, does a specific treatment result in better clinical outcomes compared to others?

    Summary of answers

    References

    138 Multiligamentous Knee Injuries

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing surgical treatment for knee dislocation, does collateral ligament reconstruction result in better clinical outcome compared to repair?

    Question 2: In patients diagnosed with knee dislocation, does acute reconstruction within three weeks after the injury result in improved results compared to delayed reconstruction?

    Question 3: In patients undergoing knee surgery, does restricted blood flow therapy yield better clinical outcomes, muscle strength, and size compared to conventional rehabilitation?

    Summary of answers

    References

    139 Posterolateral Corner Injuries

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing surgical treatment for an isolated posterolateral corner (PLC) injury, does PLC reconstruction result in superior functional outcome scores and reduced rerupture rates compared to PLC repair?

    Question 2: How do the functional outcomes and rupture rates in patients with isolated PLC injuries compare between surgical management and nonoperative management?

    Question 3: In patients undergoing surgical treatment for a PLC injury, do anatomic PLC reconstructions improve functional outcomes and rupture rates compared to other reconstruction techniques?

    Summary of answers

    References

    140 Lateral ExtraArticular Tenodesis Procedures and the Anterolateral Ligament

    Clinical scenario

    Top three questions

    Question 1: In patients undergoing anterior cruciate ligament reconstruction (ACLR), does the addition of lateral extraarticular tenodesis (LET), compared to ACLR alone, improve function, and return to sport results while diminishing failure rate?

    Question 2: In patients undergoing ACLR, does the addition of LET, compared to ACLR alone, reduce rotational laxity, thus preventing osteoarthritis (OA) and meniscal lesions?

    Question 3: In patients undergoing ACLR, is there a surgical technique of LET, as an augmentation to ACLR, that has proven to have superior biomechanical and clinical results compared to other techniques?

    Summary of answers

    References

    141 Cartilage Lesions of the Knee

    Clinical scenario

    Top three questions

    Question 1: In patients with suspected chondral knee injury, how accurate is magnetic resonance imaging (MRI) compared to subsequent arthroscopic findings in the diagnosis of focal cartilage lesions of the knee?

    Question 2: In patients with fullthickness cartilage lesions undergoing knee preservation surgery, what is the difference in clinical outcomes between common surgical options for treating focal cartilage pathology?

    Question 3: For patients undergoing articular cartilage surgery, do certain patientspecific, prognostic factors predict improved or inferior clinical outcomes following surgical intervention compared to others?

    Summary of answers

    References

    142 Patellofemoral Pain Syndrome (Runner's Knee)

    Clinical scenario

    Top four questions

    Question 1: In patients with a diagnosis of runner's knee, are there specific imaging findings that are different compared with patients without runner's knee?

    Question 2: In patients with a diagnosis of runner's knee, does neuromuscular electrical stimulation (NMES) associated with conservative treatment result in better patientreported outcome measures (PROMs), compared with conservative treatment without NMES?

    Question 3: In patients with a diagnosis of runner's knee, are combined hip and knee exercises associated with better clinical outcomes, compared with knee exercises alone?

    Question 4: In patients with a diagnosis of runner's knee, does being overweight predict worse PROMs, compared with being normal weight?

    Summary of answers

    References

    143 Osteotomy and Lower Extremity Realignment Procedures

    Clinical scenario

    Top three questions

    Question 1: In middleaged patients with varus malalignment and medial osteoarthritis (OA), does high tibial osteotomy (HTO) result in superior outcomes (i.e. survivorship, function, complications) compared to unicompartmental knee arthroplasty (UKA)?

    Question 2: In middleaged patients with lower limb varus malalignment, concomitant meniscal deficiency, and OA, does medial openwedge high tibial osteotomy (OWHTO) result in improved outcomes (i.e. limb length alignment, function, timedependent improvement) compared to lateral closedwedge high tibial osteotomy (CWHTO)?

    Question 3: In middleaged patients undergoing HTO, does bone graft supplementation improve bone healing and patient outcomes compared to no bone graft supplementation?

    Summary of answers

    References

    144 Ankle Ligament Injuries

    Clinical scenario

    Relevant anatomy

    Top three questions

    Question 1: In patients with acute lateral ankle injuries, does advanced imaging result in better diagnosis compared to radiographs only?

    Question 2: In patients with lateral ankle ligament injuries, does functional support result in better outcomes compared to cast immobilization?

    Question 3: In patients with acute injury of the lateral ligament complex, does surgical treatment lead to better outcomes compared to conservative treatment?

    Summary of answers

    References

    145 Achilles Tendinopathy

    Clinical scenario

    Top three questions

    Question 1: In patients with AT, does a program of eccentric exercises result in better clinical outcomes compared to control?

    Question 2: In patients with AT, does a program of eccentric exercises result in better clinical outcomes compared to shockwave therapy?

    Question 3: In patients with AT, does a program of eccentric exercises result in better clinical outcomes compared to PRP injections plus eccentric exercises?

    Summary of answers

    References

    VII: Wrist

    146 Distal Radius Malunions

    Clinical scenario

    Top three questions

    Question 1: In patients with distal radius fracture, does malunion increase the risk of greater patientreported disability and poor functional outcomes compared to those that heal in a near anatomical position?

    Question 2: In patients with displaced distal radius fracture, does treatment with open reduction and volar lockingplate fixation reduce the incidence of malunion compared to closed reduction and cast or percutaneous pin fixation?

    Question 3: In patients with a malunited distal radius fracture, is corrective osteotomy effective in improving patientreported disability and function?

    Summary of answers

    References

    147 Distal Radial–Ulnar Joint

    Clinical scenario

    Top three questions

    Question 1: Should patients with concomitant ulnar styloid base fracture be treated with open reduction and internal fixation (ORIF) or conservatively at the time of distal radius locked plating to preserve distal radial–ulnar joint (DRUJ) stability and wrist function?

    Question 2: In patients with DRUJ instability, how successful are anatomical reconstructions of the volar and dorsal radioulnar ligaments in restoring DRUJ stability and improving clinical symptoms?

    Question 3: In patients with DRUJ instability that lead to DRUJ arthritis, does semiconstrained total DRUJ arthroplasty provide greater function, pain relief, and implant longevity compared to total ulnar head replacement?

    Summary of answers

    References

    148 Wrist Osteoarthritis

    Clinical scenario

    Top three questions

    Question 1: In patients with wrist osteoarthritis with involvement of the radiocarpal and midcarpal joint, is arthroplasty more appropriate than total wrist fusion?

    Question 2: In patients with radioscaphoid arthritis, and preservation of the radiolunate joint, does proximal row carpectomy (PRC) result in better wrist motion than fourcorner arthrodesis (4CA)?

    Question 3: In patients with STT joint arthritis is excisional arthroplasty (either distal scaphoid excision or trapeziectomy with ligament reconstruction) more effective than STT joint arthrodesis?

    Summary of answers

    References

    149 Rheumatoid Wrist Reconstruction

    Clinical scenario

    Top three questions

    Question 1: In RA patients with DRUJ arthritis, does prosthetic arthroplasty provide better outcomes and stability compared to distal ulnar resection arthroplasty (Darrach)?

    Question 2: In RA patients with radiocarpal deformities (arthritis or carpal subluxation), does limited arthrodesis provide acceptable longterm results compared to total wrist arthrodesis?

    Question 3: In RA patients with advanced radiocarpal and midcarpal arthritis, do total wrist arthroplasty outcomes justify the expense when compared to wrist arthrodesis?

    Summary of answers

    References

    150 Acute Scaphoid Fractures

    Clinical scenario

    Background

    Top three questions

    Question 1: In adult patients with a scaphoid fracture, do some imaging modalities provide better ability to determine union compared to other modalities?

    Question 2: In adult patients with a clear bicortical fracture of the scaphoid, does cast immobilization or screw fixation result in higher union rates and faster time to union?

    Question 3: In adults with clear bicortical fractures, are there certain fracture characteristics that influence union rates or the decision to treat operatively versus nonoperatively?

    Summary of answers

    References

    151 Scaphoid Nonunions

    Clinical scenario

    Top three questions

    Question 1: In patients with a scaphoid fracture, which risk factors are associated with scaphoid nonunion?

    Question 2: In patients with a scaphoid nonunion, which management options, compared to others, yield the best outcomes?

    Question 3: In patients with scaphoid nonunion advanced collapse (SNAC), which treatment options, compared to others, yield the best outcomes?

    Summary of answers

    References

    152 Carpal Instability

    Clinical scenario

    Top three questions

    Question 1: In patients with wrist pain, what is the role of arthroscopy in diagnosing and treating ligamentous injuries of the wrist?

    Question 2: In a young, healthy patient with subacute scapholunate ligament tear and no radiographic arthritic changes, what is the best treatment option to ensure optimal outcomes?

    Question 3: What are the best treatment options to ensure optimal outcomes for a patient with an isolated lunotriquetral injury and no radiographic arthritis?

    Summary of answers

    References

    153 Kienböck's Disease

    Introductory statement/disclaimer

    Clinical scenario

    Top three questions

    Question 1: Do patients under 20 years of age have good outcomes with nonoperative treatment in Kienböck's disease?

    Question 2: What is the role of radial shortening osteotomy in improving outcomes in patients with Kienböck's disease?

    Question 3: Is arthroscopy warranted as an assessment and treatment tool in patients with Kienböck's disease?

    Summary of answers

    References

    154 Trapeziometacarpal Osteoarthritis

    Clinical scenario

    Top three questions

    Question 1: In a patient who presents with symptomatic TM arthritis, what nonoperative intervention is most effective in relieving symptoms compared to placebo?

    Question 2: In a patient with TM osteoarthritis, which arthroplasty procedures have been shown to result in improved patient outcomes with the fewest complications?

    In a patient who presents with symptomatic TM osteoarthritis, does implant arthroplasty or arthrodesis offer any advantages over trapeziectomy with or without ligament reconstruction and tendon interposition (LRTI)?

    Summary of answers

    References

    VIII: Hand

    155 Carpal Tunnel Syndrome: Nonoperative Management

    Clinical scenario

    Top three questions

    Question 1: In patients with symptoms suggestive of carpal tunnel syndrome (CTS), how helpful is the clinical exam in the diagnosis of CTS?

    Question 2: In patients with symptoms suggestive of CTS, are electrodiagnostic studies (EMG/NCS) required in assessing and treating CTS?

    Question 3: In patients with mild to moderate CTS, what are, and how effective are, the nonoperative treatment options in mild to moderate CTS?

    Summary of answers

    References

    156 Carpal Tunnel Syndrome: Operative Management

    Clinical scenario

    Top three questions

    Question 1: In patients with carpal tunnel syndrome (CTS), is electrodiagnostic testing necessary prior to carpal tunnel release (CTR)?

    Question 2: In patients undergoing CTR, is endoscopic carpal tunnel release (ECTR) advantageous relative to open carpal tunnel release (OCTR)?

    Question 3: In patients undergoing CTR, what type of anesthesia is best for CTR?

    Summary of answers

    References

    157 Carpal Tunnel Release: Minor Procedure Room or Operating Room?

    Clinical scenario

    Background

    Top three questions

    Question 1: For patients with carpal tunnel syndrome (CTS), does performing CTR in the minor procedure room, compared to the OR, result in lower costs and improved efficiency?

    Question 2: For patients with CTS, are there differences in patient outcomes and complication rates for CTR performed in the minor procedure setting compared to the main OR?

    Question 3: For patients with CTS, are there (relative or absolute) contraindications to performing CTR under local anesthetic in the minor procedure setting?

    Summary of answers

    References

    158 Thumb Carpometacarpal Osteoarthritis

    Clinical scenario

    Top three questions

    Question 1: In patients with primary thumb carpometacarpal osteoarthritis (CMC OA), does intraarticular corticosteroid injection result in greater pain relief than placebo or hyaluronic acid?

    Question 2: In patients with primary thumb CMC OA, does an orthosis improve pain and function?

    Question 3: In patients with primary thumb CMC OA, does trapeziectomy plus ligament reconstruction and tendon interposition (LRTI) result in greater pain relief than trapeziectomy alone?

    Summary of answers

    References

    159 Flexor Tendon Injuries: Surgical Management

    Clinical scenario

    Top three questions

    Question 1: In patients with acute zone II flexor tendon lacerations, does multistrand coresuture repair result in fewer reruptures and better range of motion (ROM) compared to twostrand repairs?

    Question 2: In patients undergoing zone II flexor tendon repair, does release of the A2 or A4 pulley result in poorer outcome or bowstringing compared to preservation of these annular pulleys?

    Question 3: In cooperative patients with zone II flexor tendon lacerations, does wide awake, local anesthesia, no tourniquet (WALANT) flexor tendon repair improve ROM and function compared to repairs done under regional or general anesthesia?

    Summary of answers

    References

    160 Flexor Tendon Injuries: Rehabilitation

    Clinical scenario

    Top three questions

    Question 1: In adults with zone II flexor tendon injuries, would an early active ROM rehabilitation protocol result in better finger ROM than early controlled passive ROM?

    Question 2: In adults with zone II flexor tendon injury, does immediate initiation of motion result in better total finger ROM than those initiated in a delayed fashion?

    Question 3: In adults with zone II flexor tendon injury, after surgical repair does splinting in a neutral wrist position result in better total finger ROM than with the wrist held in flexion?

    Summary of answers

    References

    161 Extensor Tendon Injuries

    Clinical scenario

    Top three questions

    Question 1: In patients with fully lacerated extensor tendons, does a multistrand core suture technique result in better functional outcomes when compared to other techniques?

    Question 2: In patients with fully lacerated extensor tendons, does an early active range of motion (ROM) rehabilitation protocol result in better outcomes when compared to immobilization?

    Question 3: In patients with fully lacerated extensor tendons, what preoperative factors contribute to better functional outcomes?

    Summary of answers

    References

    162 Dupuytren's Disease

    Clinical scenario

    Top three questions

    Question 1: In patients with Dupuytren's disease (DD), is collagenase injection superior to open partial palmar fasciectomy in correcting extension deficits?

    Question 2: In patients with DD, which treatment – limited palmar fasciectomy or collagenase injection – offers the patient better prognosis in terms of (i) fewer and less severe postprocedural complications and (ii) lower rates of disease recurrence?

    Question 3: In patients with DD, which of the following common treatment options results in the lowest disease recurrence rate: collagenase, open fasciectomy, or percutaneous needle fasciotomy (PNF)?

    Summary of answers

    References

    163 Rheumatoid Hand Reconstruction

    Clinical scenario

    Top three questions

    Question 1: In rheumatoid arthritis (RA) patients, does small joint synovectomy improve pain and joint swelling compared to nonsurgical management?

    Question 2: In RA patients, does flexor tenosynovectomy improve extensor lag and pain compared to nonsurgical management?

    Question 3: In RA patients, does metacarpophalangeal (MCP) joint arthroplasty improve hand function compared to nonsurgical management?

    Summary of answers

    References

    164 Replantation

    Clinical scenario

    Top three questions

    Question 1: In patients requiring replantation, how many veins should be anastomosed when performing digital replantation to achieve optimal outcomes?

    Question 2: In patients undergoing replantation, does prophylactic anticoagulation and/or do antithrombotic agents ordered postoperatively prevent thrombosis compared to placebo or control?

    Question 3: In patients who have undergone replantation, does early range of motion (ROM), compared to delayed ROM, restore total ROM more effectively?

    Summary of answers

    References

    165 Ulnar Neuropathy

    Clinical scenario

    Top three questions

    Question 1: In patients with ulnar neuropathy, what are the indications for surgical management versus nonoperative management?

    Question 2: In patients with ulnar nerve distribution symptoms, what is the most effective surgical technique for managing compressive ulnar neuropathy at the elbow?

    Question 3: In patients with severe ulnar neuropathy, are there adjunct procedures to augment intrinsic muscle dysfunction?

    Summary of answers

    References

    166 Finger Fractures

    Clinical scenario

    Top three questions

    Question 1: How long should patients with extraarticular small finger metacarpal (aka boxer's) fractures be immobilized to achieve optimal outcomes?

    Question 2: Should open reduction and internal fixation (ORIF) or a dynamic external device be used for the management of patients with unstable proximal interphalangeal (PIP) joint fracture/dislocations to optimize outcomes?

    Question 3: Which is a better treatment for achieving optimal outcomes in patients with extraarticular metacarpal and phalanx fractures: pinning or ORIF?

    Summary of answers

    References

    IX: Oncology

    167 Radiation Therapy in Soft Tissue Sarcoma

    Clinical scenario

    Importance of the problem

    Top three questions

    Question 1: Is there evidence to use XRT in the management of STS?

    Question 2: What are the relative advantages and disadvantages of pre versus postoperative XRT?

    Question 3: What are the short and longterm complications of XRT?

    Summary of answers

    References

    168 Chemotherapy in Soft Tissue Sarcoma

    Introduction

    Clinical scenario

    Top two questions

    Question 1: In patients with STS, is there a role for neoadjuvant chemotherapy in the treatment of the disease?

    Question 2: In patients with STS, is there a role for adjuvant chemotherapy in the treatment of the disease?

    Summary of answers

    References

    169 Surgical Margins in Soft Tissue Sarcoma

    Clinical scenario

    Top three questions

    Question 1: Is surgical tumor excision with narrow margins associated with a higher rate of local recurrence than wide margins in patients with localized soft tissue sarcomas (STS)?

    Question 2: Does the use of pre or postoperative radiation therapy (XRT) alter the impact of surgical margin on local recurrence in patients with localized STS?

    Question 3: How does the histological subtype affect the relationship between surgical margins and local recurrence among patients with localized STS?

    Summary of answers

    References

    170 Allograft versus Megaprosthesis

    Clinical scenario (proximal humerus)

    Clinical scenario (proximal tibia)

    Top three questions

    Question 1: In patients receiving allograft megaprosthesis, what is the comparative risk of postoperative complications between osteoarticular allografts, APCs, and endoprostheses?

    Question 2: In patients receiving allograft megaprosthesis, what are the comparative functional outcomes between osteoarticular allografts, APCs, and endoprostheses via Musculoskeletal Tumor Society (MSTS) score or range of motion, if applicable?

    Question 3: In patients receiving allograft megaprosthesis, what is the comparative success of limb salvage and implant survival at 5, 10, and 20 years between osteoarticular allografts, APCs, and endoprostheses?

    Summary of answers

    References

    171 Biopsy of Soft Tissue Masses

    Clinical scenario

    Top three questions

    Question 1: In patients requiring diagnostic biopsies, does percutaneous biopsy result in different diagnostic accuracy and complication rates compared to surgical biopsy?

    Question 2: In patients undergoing biopsy of a soft tissue mass, what are the evidencebased biopsy principles that reduce potential complications and improve outcomes?

    Question 3: In patients with soft tissue masses, does biopsy by a specialist at a sarcoma center, compared to a community surgeon in a nonspecialized center, reduce biopsyrelated complications and improve survival?

    Summary of answers

    References

    172 Denosumab in Giant Cell Tumors of Bone

    Introduction

    Top three questions

    Question 1: In patients with truly inoperable GCTB, is denosumab a safe treatment in the long term?

    Question 2: For patients with extensive GCTB, does denosumab allow salvage of the joint where previously the joint would have been sacrificed?

    Question 3: How would patients on denosumab benefit from further research?

    Summary of answers

    References

    X: Pediatrics

    173 Outcomes in Pediatric Orthopedics

    Measuring outcomes that matter in pediatric orthopedics

    Clinical scenario

    What are outcomes?

    Frameworks of health and disease and the evaluation of outcomes

    The Priority Framework for Outcomes Evaluation (Figure 173.1)

    Outcome measures in pediatric orthopedics: general considerations

    Generic versus conditionspecific measures

    Mortality, health, and quality of life

    Psychometric properties of an outcome measure (See also in Chapter 5)

    Outcome measures for ambulatory cerebral palsy

    Gait Outcomes Assessment List (GOAL) questionnaire

    Generic patientreported outcomes measures of pediatric musculoskeletal function

    Generic patientreported outcome measures of healthrelated quality of life

    Conditionspecific patientreported outcome measures

    Challenges of measuring meaningful outcomes in pediatric orthopedics

    Summary

    Table of instrument measures

    References

    174 Cerebral Palsy

    Clinical scenario

    Top three questions

    Question 1: Does multilevel orthopedic surgery (MLS) improve gait outcomes for children with ambulatory CP?

    Question 2: Is threedimensional gait analysis (3DGA) essential for surgical decisionmaking for children with ambulatory CP?

    Question 3: Does surveillance for hip displacement result in improved outcomes for nonambulatory children with CP?

    Summary of answers

    References

    175 Pediatric Osteoarticular Infections

    Clinical scenario

    Top three questions

    Questions 1: In children aged less than four years with suspected osteoarticular infection, is oropharyngeal Kingella kingae carriage status a viable indirect diagnostic alternative to synovial fluid/bone sample cultures?

    Questions 2: In children with acute osteomyelitis, is outpatient oral antibiotic therapy equivalent to inpatient treatment with intravenous (IV) antibiotics?

    Questions 3: In children with a chronic benign bone lesion, what is the best method to differentiate chronic nonbacterial osteomyelitis (CNO)/chronic recurrent multifocal osteomyelitis (CRMO) from bacterial osteomyelitis (BOM)?

    Conclusion

    References

    176 Simple Bone Cysts

    Clinical scenario

    Top three questions

    Question 1: In children with an isolated lucent lesion in a long bone, are radiographs and clinical presentation sufficient to make the diagnosis of SBC?

    Question 2: In children with an SBC, which features should prompt treatment of the lesion?

    Question 3: In children with an SBC, which treatment yields the most successful results at maturity, considering cyst healing and (re)fracture rate?

    Summary of answers

    References

    177 Pediatric Clavicle Fractures

    Clinical scenario

    Top three questions

    Question 1: Does primary surgical fixation of displaced clavicle fractures in the pediatric and adolescent population improve patient function or patient outcomes, compared with nonoperative treatment?

    Question 2: What risks are associated with surgical fixation of clavicle fractures in the pediatric and adolescent population, including risk of secondary surgery, such as removal of implants?

    Question 3: Does the amount of shortening influence outcomes in displaced clavicle fractures in pediatric and adolescent patients?

    Summary of answers

    References

    178 Supracondylar Humerus Fractures

    Clinical scenario

    Top three questions

    Question 1: In children with a supracondylar humerus fracture, when should an open reduction be performed instead of a closed reduction to ensure optimal outcomes?

    Question 2: In a child whose supracondylar humerus fracture needs an open reduction, which surgical approach is best to optimize outcomes?

    Question 3: In a child who presents with a supracondylar humerus fracture without a palpable pulse, when should a vascular, open exploration be performed to optimize outcomes?

    Summary of answers

    References

    179 Adolescent Spondylolisthesis

    Clinical scenario

    Top three questions

    Question 1: In adolescent patients with acute low back pain, what is the ideal diagnostic imaging to assess for spondylolysis?

    Question 2: In adolescent patients with a radiographic diagnosis of acute lumbar spondylolysis, what is the natural history of this condition?

    Question 3: In adolescent patients, what is the ideal treatment for lowgrade versus highgrade spondylolisthesis?

    Summary of answers

    References

    180 Early Onset Scoliosis

    Clinical scenario

    Top three questions

    Question 1: In patients with nonidiopathic early onset scoliosis (EOS), does serial casting control curve progression as compared to idiopathic EOS?

    Question 2: In patients with EOS, do magnetically controlled growing rods (MCGRs) result in fewer complications as compared to traditional growing rods (TGRs)?

    Question 3: In patients with EOS, does treatment with traditional spinal growing rods result in greater spine growth compared to ribbased distraction?

    Summary of answers

    References

    181 Developmental Dysplasia of the Hip

    Clinical scenario

    Top three questions

    Question 1: In newborn infants, what is the evidence to support universal compared to selective ultrasound (US) imaging in conjunction with clinical examination for screening for DDH?

    Question 2: For infants with risk factors for DDH, to what extent is clinical and radiologic followup required after a normal screening US to ensure optimal outcomes?

    Question 3: For infants treated successfully by harness/brace treatment for DDH, what extent of clinical and radiologic followup is required to ensure optimal outcomes?

    Summary of answers

    References

    182 Legg–Calvé–Perthes Disease

    Clinical scenario

    Top three questions

    Question 1: In children with Legg–Calvé–Perthes disease, are the chances of preserving the spherical shape of the femoral head (i.e. preventing the femoral head from getting deformed) greater following surgical or nonsurgical containment than following symptomatic treatment?

    Question 2: In children with Legg–Calvé–Perthes disease, are the chances of preventing femoral head deformation greater if containment is achieved early in the course of the disease (by Modified Waldenström Stage IIa) than if containment is achieved later in the evolution of the disease?

    Questions 3: In children with Legg–Calvé–Perthes disease, which of these methods of containment offers the best chance of preventing femoral deformation: bracing, proximal femoral osteotomy, innominate osteotomy, shelf acetabuloplasty, or combined femoral and innominate osteotomy?

    Summary of answers

    References

    183 Slipped Capital Femoral Epiphysis

    Clinical scenario

    Top three questions

    Question 1: In adolescent patients with completely displaced unstable SCFE, does an open procedure result in a lower proportion of osteonecrosis compared to in situ fixation?

    Question 2: In patients with unilateral SCFE, does prophylactic fixation of the contralateral hip safely reduce the risk of subsequent slip in the initially unaffected hip?

    Question 3: In patients with chronic stable moderate and severe SCFE, does subcapital realignment yield improved results as compared to in situ fixation and intertrochanteric realignment?

    Summary of answers

    References

    184 Pediatric Femoral Shaft Fractures

    Clinical scenario

    Top three questions

    Question 1: In children younger than four years of age with a femoral shaft fracture who are treated with a hip spica cast, does a singleleg cast portend improved clinical and radiographic outcomes when compared with doubleleg casting?

    Question 2: In children between 4 and 11 years of age with a femoral shaft fracture, what is the ideal management of fracture fixation to optimize outcomes?

    Question 3: In children older than 11 years of age with a femoral shaft fracture, what is the ideal management of fracture fixation to optimize outcomes?

    Summary of answers

    References

    185 Infantile Blount Disease

    Clinical scenario

    Top three questions

    Question 1: Will all children who present with radiographic evidence of infantile Blount disease develop a progressive varus deformity?

    Question 2: Is bracing an effective treatment to prevent progression of deformity in patients with infantile Blount disease?

    Question 3: Is guided growth an effective treatment for correcting deformity in patients with infantile Blount disease?

    Summary of answers

    References

    186 Pediatric Anterior Cruciate Ligament Injuries

    Clinical scenario

    Top three questions

    Question 1: In a child or teenager with acute ACL tear, what are the effects on cartilage and meniscus with delayed reconstruction compared to acute reconstruction?

    Question 2: In children/adolescents with acute ACL tear, is one surgical technique superior to others with respect to ACL rerupture rates, pain, or return to sport (RTS)?

    Question 3: In children/adolescents with an acute ACL tear, what is the risk of reinjury to the same and contralateral side, and what can be done to prevent reinjury?

    Summary of answers

    References

    187 Clubfoot

    Clinical scenario

    Top three questions

    Question 1: What are the success rates and recurrence rates following primary Ponseti treatment of infants with idiopathic clubfeet compared to other casting methods or surgical release?

    Question 2: What is the optimal application, duration, and length of use of foot abduction orthoses following Ponseti treatment to optimize outcomes in patients with idiopathic clubfoot?

    Question 3: How effective is the Ponseti method in correcting (untreated) idiopathic clubfeet in older children?

    Summary of answers

    References

    188 Tarsal Coalitions

    Clinical scenario

    Top three questions

    Question 1: In children with subtalar tarsal coalition and flatfoot deformity, what are the indications for coalition resection alone, flatfoot reconstruction alone, versus combined resection and concomitant flatfoot reconstruction?

    Question 2: In children with calcaneonavicular (CN) tarsal coalition and flatfoot deformity, what are the indications for coalition resection alone, flatfoot reconstruction alone, versus combined resection and concomitant flatfoot reconstruction?

    Question 3: In children with tarsal coalition and flatfoot deformity, when is arthrodesis of the subtalar joint indicated?

    Summary of answers

    References

    Index

    End User License Agreement

     

  • 62000lei 515.00 lei

    DESCRIPTION:

    How to diagnose allergic contact dermatitis, perform and interpret patch tests, and select the best treatment options

    Written for a broad range of dermatologic professionals, Common Contact Allergens is a straightforward and useful guide that bridges the gap between detailed reference texts and basic handbooks on contact allergy, making it an ideal addition to general dermatology practices for practical use in the office.

    The first section of the book leads practitioners through the steps necessary to effectively and accurately perform patch testing. This covers basic immunological knowledge, various ways in which contact allergy can present, patch test techniques, and how to diagnose allergic contact dermatitis. Giving attention to all standard allergens, the second section offers an overview of the current literature on each, with detailed analysis on determining the clinical relevance of a positive patch test reaction. This convenient companion:

    ·         Offers universally applicable guidance on when and how to perform patch testing, as well as how to interpret test reactions and arrive at accurate diagnoses

    ·         Characterizes allergens from the Standard 'Baseline' Series, the International Series, and the T.R.U.E. Test Series

    ·         Profiles allergens such as metals, fragrances, medicaments, rubber chemicals, plant chemicals, hair and clothing dyes, excipients, and resins

    ·         Contains case reports, clinical images, patch test tips, and more

    ·         Features color-coded exposure templates for easy consultation

    ·         Provides key pointers on how to take patient histories and handle challenging cases

    ·         Introduces new concepts such as 'microhistory' and 'microexamination'

    ·         Allows access to online supplementary material featuring CAS numbers, toxicology, immunology, prevalence rates, chemical structures, additional case reports, and more

    Common Contact Allergens is a valuable reference tool for trainee and practicing general dermatologists, dermatology nurses, occupational health physicians, allergists, and other medical professionals with an interest in dermatology.

     

    TABLE OF CONTENTS:

    List of Contributors ix

    Preface xi

    About the Companion Website xiii

    Section 1: Methodology 1

    1 Immunology of Allergic Contact Dermatitis 3

    2 Patch Test Technique 5

    3 The Detective’s Guide to Contact Dermatitis 15

    4 History, Microhistory, and Sources of Contact Allergen Exposure 23

    5 Microexamination 55

    6 Setting up a Patch Test Practice 89

    7 The Role of Providers of Patch Test Products 93

    Section 2: NonAllergic Dermatoses 99

    8 Elimination or Inclusion of NonAllergic Skin Diseases 101

    9 Irritant Contact Dermatitis 123

    Section 3: Common Contact Allergens 127

    Metals 129

    10 Nickel 129

    11 Cobalt 145

    12 Chromate 151

    13 Gold 161

    Fragrances 167

    14 Fragrances Incorporating Fragrance Mix 1, Fragrance Mix 2, Hydroxyisoheyl 3cyclohexene Carboxaldehyde, Limonene, and Linalool 167

    Preservatives 181

    15 Formaldehyde 181

    16 Quaternium15 187

    17 Diazolidinyl Urea and Imidazolidinyl Urea 191

    18 2Bromo2nitropropane1,3diol 197

    19 Methylchloroisothiazolinone/Methylisothiazolinone 201

    20 Methylisothiazolinone 205

    21 Parabens 211

    Dyes 217

    22 paraPhenylenediamine 217

    23 Disperse Blue 106 227

    Rubber 233

    24 Rubber: Mercaptobenzothiazole, Mercapto Mix, Thiurams, Carbamates, Thioureas, N IsopropylNPhenylpphenylenediamine 233

    Resins 245

    25 Colophonium 245

    26 Epoxy Resin 255

    27 Tosylamide Formaldehyde Resin 263

    28 paraTertiaryButylphenol Formaldehyde Resin 267

    Plants 273

    29 Sesquiterpene Lactone Mix and Compositae Mix 273

    30 Primin 281

    Medicaments 287

    31 Neomycin 287

    32 Clioquinol 293

    33 Benzocaine 297

    34 Tixocortol21pivalate Budesonide, and Hydrocortisone 17butyrate 303

    Others 311

    35 Lanolin 311

    36 Cetearyl Alcohol 317

    Index 321

    E-Supplements

    10 Nickel

    11 Cobalt

    12 Chromate

    14 Fragrances

    15 Formaldehyde

    16 Quaternium 15

    17 Diazolidinyl Urea and Imidazolidinyl Urea

    19 Methylchloroisothiazolinone/Methylsiothiazolinone

    20 Methylisothiazolinone

    21 Parabens

    22 para-Phenylenediamine

    24 Rubber

    25 Colophonium

    26 Epoxy Resin

    28 4-tert-Butylphenol Formaldehyde Resin

    29 Sesquiterpene Lactone Mix and Compositae Mix

    30 Primin

    31 Neomycin

    32 Clioquinol

    33 Benzocaine

    34 Corticosteroids: Tixocortol-21-pivalate, Budesonide, and Hydrocortisone 17-butyrate

    35 Lanolin

     


  • 1,75300lei 1460.00 lei

     

    Description:


    Offering the comprehensive, authoritative information needed for effective diagnosis, treatment, and management of sick and premature infants, Fetal and Neonatal Physiology, 6th Edition, is an invaluable resource for board review, clinical rounds, scientific research, and day-to-day practice. This trusted two-volume text synthesizes recent advances in the field into definitive guidance for today’s busy practitioner, focusing on the basic science needed for exam preparation and key information required for full-time practice. It stands alone as the most complete text available in this complex and fast-changing field, yet is easy to use for everyday application. 

     

    Key Features:

     

    • Offers definitive guidance on how to effectively manage the many health problems seen in newborn and premature infants. 
    • Contains new chapters on Pathophysiology of Genetic Neonatal Disease, Genetic Variants and Neonatal Disease, and Developmental Biology of Lung Stem Cells,  as well as significantly revised chapters on Cellular Mechanisms of Neonatal Brain Injury, Neuroprotective Therapeutic Hypothermia, Enteric Nervous System Development and Gastrointestinal Motility, and Physiology of Twin-Twin Transfusion. 
    • Features 1,000 full-color diagrams, graphs and anatomic illustrations, 170+ chapters, and more than 350 global contributors. 
    • Includes chapters devoted to clinical correlation that help explain the implications of fetal and neonatal physiology, as well as clinical applications boxes throughout. 
    • Provides summary boxes at the end of each chapter and extensive cross-referencing between chapters for quick reference and review. 
    • Allows you to apply the latest insights on genetic therapy, intrauterine infections, brain protection and neuroimaging, and much more. 
    • Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices. 




    Table Of Contents:

     

    Volume 1

    Section I Genetics and

    Basic Genetic Principles, 1

    Epigenetics, 11

    Basic Embryology, 23

    Regulation of Embryogenesis, 38

    The Extracellular Matrix in Development, 47

    Angiogenesis, 54

    Prenatal Diagnosis, 58

    Section II Placenta and

    Intrauterine Environment

    Placental Development, 67

    Regulation of the Placental Circulation, 80

    10 Mechanisms of Transfer Across the Human

    Placenta, 89

    11 Endocrine and Paracrine Function of the Human

    Placenta, 101

    Anna A. Penn

    12 Intra-Amniotic Infection/Inflammation and the

    Fetal Inflammatory Response Syndrome, 111

    13 Fetal Origins of Adult Disease: A Classic

    14 Placental Function in Intrauterine Growth

    Restriction, 137

    Section III Developmental

    Pharmacology

    15 Basic Pharmacologic Principles, 150

    16 Principles of Pharmacokinetics, 166

    17 The Physiology of Placental Drug

    Disposition, 173

    18 Pharmacogenomics, 187

    19 Drug Distribution in Fetal Life, 194

    20 Drug Transfer During Breastfeeding, 203

    Thomas W. Hale | Kaytlin Krutsch

    Section IV Intrauterine and

    Postnatal Growth

    21 Placental and Fetal Circulatory and Metabolic

    Changes Accompanying Fetal Growth

    Restriction, 214

    22 Endocrine Factors Affecting Neonatal

    Growth, 224

    23 Human Milk Composition and Function in the

    Infant, 241

    24 Physiology of Lactation, 249

    Section V Perinatal Iron, Mineral, and Vitamin Metabolism

    25 Fetal and Neonatal Iron Metabolism, 257

    26 Fetal and Neonatal Calcium, Phosphorus, and

    Magnesium Homeostasis, 265

    27 Zinc in the Fetus and Neonate, 282

    28 Vitamin A Metabolism in the Fetus and Neonate, 287

    29 Vitamin E Nutrition in Pregnancy and the

    Newborn Infant, 295

    30 Vitamin K Metabolism in the Fetus and

    Neonate, 303

    Section VI Lipid Metabolism

    31 Maternal-Fetal Transfer of Lipid

    Metabolites, 311

    32 Brown Adipose Tissue: Development and

    Function, 323

    33 Lipids as an Energy Source for the Premature

    and Term Neonate, 332

    34 Ketone Body Metabolism in the Neonate, 339

    35 Long-Chain Polyunsaturated Fatty Acids in

    Neurodevelopment, 348

    Section VII Carbohydrate

    Metabolism

    36 Glucose Metabolism in the Fetus and Newborn,

    and Methods for Its Investigation, 358

    37 Oxygen Consumption and General

    Carbohydrate Metabolism of the Fetus, 368

    38 Role of Glucoregulatory Hormones in Hepatic

    Glucose Metabolism During the Perinatal

    Period, 382

    39 Cell Glucose Transport and Glucose Handling

    During Fetal and Neonatal Development, 392

    Section VIII Protein

    Metabolism

    40 General Concepts of Protein Metabolism, 400

    41 Placental Transfer and Fetal Requirements of

    Amino Acids, 408

    Section IX

    Thermoregulation

    42 Temperature Control in Newborn Infants, 423

    Section X Skin

    43 Structure and Development of the Skin and

    Cutaneous Appendages, 446

    44 Physiologic Development of the Skin, 454

    Section XI Fetal and Neonatal Cardiovascular Physiology

    45 Cardiovascular Development, 473

    46 Developmental Electrophysiology in the Fetus

    and Neonate, 482

    47 Developmental Biology of the Pulmonary

    Vasculature, 501

    48 Development of the Gastrointestinal Circulation

    in the Fetus and Newborn, 517

    49 Physiology of Congenital Heart Disease in the

    Neonate, 521

    50 Regulation of Cardiovascular Function During

    Fetal and Newborn Life, 534

    51 Nutritional and Environmental Effects on the

    Fetal Circulation, 545

    52 Mechanisms Regulating Closure of the Ductus

    Arteriosus, 553

    53 Umbilical Circulation, 564

    54 Fetal and Placental Circulation During Labor, 576

    Section XII The Lung

    55 Normal and Abnormal Structural Development

    of the Lung, 585

    56 Regulation of Alveolarization, 600

    57 Physiologic Mechanisms of Normal and Altered

    Lung Growth Before and After Birth, 605

    58 Molecular Mechanisms of Lung Development

    and Lung Branching Morphogenesis, 617

    59 Regulation of Liquid Secretion and Absorption

    by the Fetal and Neonatal Lung, 626

    60 Upper Airway Structure: Function, Regulation,

    and Development, 635

    61 Regulation of Lower Airway Function, 645

    62 Functional Development of Respiratory Muscles, 652

    63 Mechanics of Breathing, 665

    64 Pulmonary Gas Exchange in the Developing Lung, 673

    65 Oxygen Transport and Delivery, 684

    66 Control of Breathing in Fetal Life and Onset and

    Control of Breathing in the Neonate, 697

    67 Basic Mechanisms of Oxygen Sensing and

    Adaptation to Hypoxia, 707

    68 Evaluation of Pulmonary Function in the

    Neonate, 714

    69 Mechanisms of Neonatal Lung Injury, 728

    70 Impaired Lung Growth After Injury in Preterm

    Lung, 734

    71 Antenatal Factors That Influence Postnatal Lung

    Development and Injury, 748

    72 Regulation of Pulmonary Circulation, 757

    SECTION XIII Surfactant

    73 Historical Perspective, 765

    74 Developmental Biology of Lung Stem Cells, 768

    75 Surfactant Homeostasis: Composition and

    Function of Pulmonary Surfactant Lipids and

    Proteins, 776

    76 Structure and Development of Alveolar

    Epithelial Cells, 787

    77 Regulation of Surfactant-Associated

    Phospholipid Synthesis and Secretion, 792

    78 Antenatal Hormonal Therapy for Prevention of

    Respiratory Distress Syndrome, 804

    79 Surfactant Treatment, 813

    80 Genetics and Physiology of Surfactant Protein

    Deficiencies, 825

    SECTION XIV Physiology of Gastrointestinal Tract in the

    Fetus and Neonate

    81 Trophic Factors and Regulation of Gastrointestinal Tract and Liver

    Development, 838

    82. Organogenesis of the Gastrointestinal Tract, 845

    83 Development of Gastric Secretory Function, 854

    84 Development of the Enteric Nervous System and

    Gastrointestinal Motility, 859

    85 Development of the Endocrine and Exocrine Pancreas, 868

    86 Digestive-Absorptive Functions in Fetuses,

    Infants, and Children, 881

    87 The Developing Microbiome of the Fetus and

    Neonate: A Multiomic Approach, 888

    SECTION XV Liver and Bilirubin Metabolism

    88 Organogenesis and Histologic Development of

    the Liver, 896

    89 Bile Acid Metabolism During Development, 901

    90 Fetal and Neonatal Bilirubin Metabolism, 915

    91 Hereditary Contributions to Neonatal

    Hyperbilirubinemia, 919

    92 Mechanistic Aspects of Phototherapy for

    Neonatal Hyperbilirubinemia, 930

    Volume 2

    Section XVI The Kidney

    93 Development of the Kidney: Morphology and

    Mechanisms, 941

    94 Functional Development of the Kidney in

    Utero, 954

    95 Development and Regulation of Renal Blood

    Flow in the Neonate, 965

    96 Postnatal Development of Glomerular Filtration

    Rate in Neonates, 975

    97 Renal Transport of Sodium During Development, 984

    98 Potassium Homeostasis in the Fetus and

    Neonate, 992

    99 Role of the Kidney in Calcium and Phosphorus

    Homeostasis, 1006

    100 Transport of Amino Acids in the Fetus and

    Neonate, 1018

    101 Organic Anion Transport in the Developing

    Kidney, 1024

    102 Concentration and Dilution of Urine, 1030

    103 Urinary Acidification, 1047

    104 Response to Nephron Loss in Early

    Development, 1056

    SECTION XVII Fluid and

    Electrolyte Metabolism

    105 Fluid Distribution in the Fetus and Neonate, 1064

    106 Regulation of Acid-Base Balance in the Fetus

    and Neonate, 1076

    Section XVIII Developmental Hematopoiesis

    107 Developmental Biology of Hematopoietic Stem

    Cells, 1082

    108 Neutrophil Granulopoiesis and Homeostasis, 1093

    109 Developmental Erythropoiesis, 1104

    110 Developmental Megakaryopoiesis, 1125

    Section XIX Hemostasis

    111 Developmental Hemostasis, 1145

    112 Platelet–Vessel Wall Interactions, 1153

    Section XX Developmental Immunobiology

    113 Host Defense Mechanisms Against Bacteria, 1158

    114 Host Defense Mechanisms Against Fungi, 1167

    115 Host Defense Mechanisms Against Viruses, 1172

    116 T-Cell Development, 1195

    117 B-Cell Development, 1200

    118 Mononuclear Phagocyte System, 1206

    119 Normal and Abnormal Neutrophil Physiology in

    the Newborn, 1215

    120 The Complement System of the Fetus and

    Newborn, 1232

    121 Cytokines and Inflammatory Response in the

    Fetus and Neonate, 1243

    122 Immunology of Human Milk, 1257

    123 Neonatal Pulmonary Host Defense, 1265

    Section XXI Neurology

    124 Development of the Nervous System, 1297

    125 Mechanisms of Cell Death in the Developing

    Brain, 1318

    126 Development of the Blood-Brain Barrier, 1327

    127 Trophic Factor, Nutritional, and Hormonal

    Regulation of Brain Development, 1341

    David Pleasure

    128 Developmental Aspects of Pain, 1347

    129 Cerebellar Development—The Impact of Preterm

    Birth and Comorbidities, 1353

    130 Electroencephalography in the Preterm and

    Term Infant, 1367

    131 Intraventricular Hemorrhage in the

    Neonate, 1394

    132 Pathophysiology of Neonatal White Matter

    Injury, 1414

    133 Cellular and Molecular Mechanisms of Neonatal Brain Injury and

    Neuroprotection, 1422

    134 Neuroprotective Therapeutic Hypothermia, 1432

    Section XXII Special Sensory Systems in the Fetus and

    Neonate

    135 Early Development of the Human Auditory System, 1440

    136 Development of Olfaction and Taste in the

    Human Fetus and Neonate, 1455

    Section XXIII Musculoskeletal

    137 The Growth Plate: Embryologic Origin,

    Structure, and Function, 1465

    138 Ontogenesis of Striated Muscle, 1475

    Section XXIV Endocrine Function

    139 Hypothalamus: Neuroendometabolic Center, 1495

    140 Growth Factor Regulation of Fetal Growth, 1505

    141 Growth Hormone, Prolactin, and Placental

    Lactogen in the Fetus and Newborn, 1514

    142 Luteinizing Hormone and Follicle-Stimulating

    Hormone Secretion in the Fetus and Newborn Infant, 1520

    143 Development of the Hypothalamus-Pituitary-

    Adrenal Axis in the Fetus, 1532

    144 Fetal and Neonatal Adrenocortical

    Physiology, 1538

    145 Fetal and Neonatal Thyroid Physiology, 1546

    Section XXV Ovary and Testis

    146 Genetics of Sex Determination and

    Differentiation, 1555

    147 Differentiation of the Ovary, 1566

    148 Testicular Development and Descent, 1574

    Section XXVi

    PAT HOPHYSIOLOGY OF NEONATAL

    DISEASES

    149 The Pathophysiology of Twin-Twin Transfusion

    Syndrome, Twin-Anemia Polycythemia Sequence,

    and Twin-Reversed Arterial Perfusion, 1582

    150 Physiology of Neonatal Resuscitation, 1589

    151 Pathophysiology of Neonatal Sepsis, 1606

    152 Pathophysiology of Neonatal

    Hypoglycemia, 1624

    153 Pathophysiology of Cardiomyopathies, 1633

    154 Pathophysiology of Persistent Pulmonary

    Hypertension of the Newborn, 1648

    155 Pathophysiology of Shock in the Fetus and

    Neonate, 1662

    156 Pathophysiology of Apnea of

    Prematurity, 1671

    157 Pathophysiology of Respiratory Distress

    Syndrome, 1680

    158 Pathophysiology of Meconium Aspiration

    Syndrome, 1696

    159 Pathophysiology of Bronchopulmonary

    Dysplasia, 1703

    160 Pathophysiology of Ventilator-Dependent

    Infants, 1710

    161 Pathophysiology of Gastroesophageal

    Reflux, 1722

    162 Pathophysiology and Prevention of Neonatal

    Necrotizing Enterocolitis, 1732

    163 Pathophysiology of Kernicterus, 1738

    164 Pathophysiology of Neonatal Acute Kidney

    Injury, 1750

    165 Pathophysiology of Edema, 1760

    166 Pathophysiology of Retinopathy of

    Prematurity, 1765

    167 Pathophysiology of Neonatal Hypoxic-Ischemic

    Brain Injury, 1773

    168 Pathophysiology of Neonatal Acute Bacterial

    Meningitis, 1784

    169 Pathophysiology of Neural Tube

    Defects, 1797

    170 Pathophysiology of Preeclampsia, 1811

    171 Pathophysiology of Preterm Birth, 1820

    172 Pathophysiology of Chorioamnionitis: Host

    Immunity and Microbial Virulence, 1828

    173 Pathophysiology of Genetic Neonatal

    Disease, 1837

    174 Genetic Variants and Neonatal Disease, 1846

     

     

     

  • 1102.00 lei

     



    Description:


    Acquire a better understanding of disease evolution and treatment response with Neuroradiology Spectrum and Evolution of Disease. The unique format includes carefully chosen clinical images that depict the pathologic evolution of disease from initial presentation across the continuum of progression. Colorful graphics plot characteristic changes, helping you visualize how normal and abnormal variations alter over time. Extensive illustrations and concise descriptions distill complex concepts, making this first-of-its-kind resource an excellent tool for imaging interpretation and clinical problem solving.




    Table Of Contents:

     

    Section I BRAIN

    Parenchymal Hemorrhage and Trauma

    1. Brain Parenchymal Hematoma

    2. Subdural Hemorrhage and Post-traumatic Hygroma

    Disorders of Cerebral Vascular Autoregulation

    3. Posterior Reversible Encephalopathy Syndrome

    Arteriopathy

    4. Cerebral Amyloid Angiopathy

    Metabolic Disorders

    5. Wernicke Encephalopathy

    6. Central Pontine Myelinolysis

    Infection

    7. Herpes Simplex Encephalitis

    8. Toxoplasmosis

    9. Neurocysticercosis

    Autoimmune/Inflammatory Disorders

    10. Acute Disseminated Encephalomyelitis

    11. Autoimmune Encephalitis

    12. Progressive Multifocal Leukoencephalopathy

    13. Immune Reconstitution Inflammatory Syndrome

    14. Neurosarcoidosis

    Tumors

    15. Glial Tumors

    16. Hemangioblastoma

    Ventricular System Alterations

    17. Intracranial Hypotension

    18. Intracranial Hypertension

    Pituitary Abnormalities

    19. Partially Empty Sella

    20. Rathke’s Cleft Cyst

    21. Pituitary Apoplexy

    Neurodegenerative Disease

    22. Hypertrophic Olivary Degeneration

    Section II SPINE

    Degenerative Disease

    23. Ossification of the Posterior Longitudinal Ligament

    24. Lumbar Interbody Fusion

    Post-traumatic Effects

    25. Kummel’s Disease

    Infection

    26. Discitis-Osteomyelitis

    27. Tuberculous Spinal Infection

    Bone Lesions

    28. Chordoma

    29. Vertebral Hemangioma

    Cord Lesions

    30. Syringohydromyelia

    31. Cord Infarct

    32. Subacute Progressive Ascending Myelopathy

    Cord Tumors

    33. Spinal Cord Ependymoma

    34. Astrocytoma

    Spine Deformity

    35. Hiryama

    36. Thoracic Web

    Section III HEAD AND NECK

    Infection

    37. Orbital Infection

    38. Suppurative Thyroiditis

    Inflammatory Disorders

    39. Thyroid-Associated Orbitopathy

    40. IgG4-Related Disease in the head and neck

    41. Sjogren’s

    42. Cholesteatoma

    43. Labyrinthitis

    Tumors

    44. Paraganglioma

    45. Esthesioneuroblastoma

    Post-traumatic Effects

    46. Vocal Cord Augmentation

    Bone Lesions

    47. Otospongiosis

    48. Paget’s

    Vascular Lesions

    49. Carotid Blowout Syndrome

       

     

  • 945.00 lei

     

    Description:

    Neurosurgery Tricks of the Trade: Spine and Peripheral Nerves presents core surgical procedures in a concise, highly didactic format, enabling surgeons to quickly grasp their essence from the bulleted text and superb illustrations that accompany them. Expert neurosurgeons specializing in the spine and peripheral nerves describe how they perform common procedures and offer surgical tips and pearls.

    Key Features:

    Distills a wealth of information in a concise, step-by-step format, making it easy for neurosurgeons and other spine specialists to review how procedures are performed

    Includes more than 100 procedures focusing on the spine and peripheral nerves, each accompanied by high-quality, original illustrations

    Presents all procedures using a consistent outline and covers topics in either a pathology-based or an approach-based manner

    Surgeons at all levels, from residents learning procedures to experienced practitioners needing a quick refresher, will find this book and its companion volume, Neurosurgery Tricks of the Trade: Cranial, to be invaluable resources throughout their surgical careers.

     

    Table of Contents:

     

    Acronyms

    Approaches to the Spine

    Craniocervical and Atlantoaxial Junctions

    1 Transoral Approach to the Craniovertebral Junction

    2 Odontoid Screw Placement

    3 Occipital Cervical Instrumentation

    4 C1-C2 Posterior Instrumentation

    5 C1-C2 Transarticular Screw Fixation

    6 C1-C2 and Subaxial Posterior Wiring: Sublaminar Technique

    Anterior Cervical Approaches

    7 Anterior Cervical Diskectomy and Fusion

    8 Cervical Corpectomy

    9 Cervical Artificial Disk

    Posterior Cervical Approaches

    10 Cervical Laminectomy

    11 Cervical Laminoforaminotomy

    12 Posterior Cervical Wiring (Interspinous and Facet Wiring)

    13 Cervical Lateral Mass Screw Placement

    14 Cervical Laminoplasty

    15 Cervicothoracic Junction Approach

    Thoracic Approaches

    16 Transthoracic Diskectomy: Anterior Approach

    17 Thoracic Transpedicular/Lateral Costotransversectomy Corpectomy

    18 Lateral Extracavitary Approach to the Thoracic Spine

    19 Thoracic Pedicle Screw Placement

    Anterior Lumbar Approaches

    20 Approach to Anterior Lumbar Interbody Fusion

    21 Retroperitoneal Approach for Lumbar Corpectomy

    22 Lumbar Artificial Disk

    Posterior Lumbar Approaches

    23 Lumbar Laminectomy and Laminotomy

    24 Posterior Lumbar Diskectomy

    25 Posterior Lumbar Interbody Fusion

    26 Transforaminal Lumbar Interbody Fusion

    27 Lumbar Pedicle Screw Placement

    28 Surgical Reduction of Spondylolisthesis

    29 Sacral Iliac Screw Placement

    30 Sacroiliac Joint Arthrodesis and Fixation

    31 Dynamic Posterior Lumbar Stabilization

    32 Interspinous Distraction Device

    Minimally Invasive Spine Surgery

    33 Endoscopic Transcervical Odontoidectomy

    34 Minimally Invasive Cervical Decompression: Anterior Cervical Microforaminotomy

    35 Thoracoscopic Approach to the Thoracic Spine

    36 Vertebroplasty and Kyphoplasty

    37 Minimally Invasive Lumbar Microdiskectomy

    38 Minimally Invasive Transforaminal Lumbar Interbody Fusion

    39 Direct Lateral Interbody Fusion

    40 Transsacral Axial Lumbar Interbody Fusion

    41 Percutaneous Facet Screws

    42 Percutaneous Pedicle Screws

    43 Percutaneous Endoscopic Thoracic Diskectomy

    44 Percutaneous Endoscopic Lumbar Diskectomy

    45 3D Navigation for Pedicle Screw Placement: Image Guidance

    Spine by Pathology

    Spine Trauma

    46 Cervical Jumped Facets

    47 Cervical Fracture/Dislocation

    48 Thoracolumbar Burst Fractures: Posterior Approach

    49 Anterior Transthoracic Approach for the Treatment of Vertebral Fractures

    Spine Infections

    50 Spinal Epidural Abscess

    51 Thoracoscopic Diskectomy and Instrumented Fusion for Thoracic Diskitis and Osteomyelitis

    52 Primary Reconstruction in Spinal Infection

    53 C1-C2 Puncture

    54 Lumbar Puncture/Drain

    55 Lumboperitoneal Shunt for Coccidiomycosis Meningitis

    Spinal Tumors

    56 Anterolateral Approach to Thoracic Spinal Tumors: Retropleural Corpectomy

    57 Thoracoscopic Corpectomy and Stabilization for Metastatic Spine Tumors

    58 Total En Bloc Spondylectomy in Tumor Resection

    59 Intradural Extramedullary Tumors: Spinal Schwannomas

    60 Extramedullary Tumors: Metastatic Tumor

    61 Intramedullary Spinal Cord Tumors: Ependymomas and Astrocytomas

    62 Radiosurgery for Metastatic Spinal Disease

    Spinal Vascular Malformations

    63 Spinal Arteriovenous Fistulas and Malformations

    64 Cavernous Malformation of the Spinal Cord

    65 Endovascular Treatment of Spinal Vascular Lesions

    66 Stereotactic Radiosurgery of Spinal Arteriovenous Malformations

    Spine Pain / Spasticity Management

    67 Spinal Cord Stimulation

    68 Spinal Cord Stimulation for Ischemic Heart Disease

    69 Placement of Intrathecal Baclofen or Morphine Pump

    70 Microsurgical DREZotomy for Pain

    71 Percutaneous Cordotomy

    72 Sacral Nerve Stimulation for Bladder Emptying after Spinal Cord Injury

    73 Cervical Facet Joint Injection

    74 Lumbar Epidural Steroid Injections

    75 Lumbar Diskography

    76 Lumbar Facet Blocks

    Pediatric Spine Surgery

    77 Selective Dorsal Rhizotomies for Children with Cerebral Palsy

    78 Spinal Dysraphism and Lipomas

    79 Spinal Dysraphism: Meningocele and Myelomeningocele

    80 Management of Chiari Malformations and Syringohydromyelia

    81 Tethered Cord Release in Children

    Special Topics

    82 Management of Progressive Posttraumatic Cystic/Myelomalacic Myelopathy (Tethered Cord Syndrome) i

    83 Duraplasty

    84 Surgical Management of Cervical Ossification of Posterior Longitudinal Ligament

    85 Surgical Management of Ankylosing Spondylitis

    86 Cauda Equina Syndrome

    87 Arthrodesis: Source and Technique

    88 Neuromonitoring: Electromyography, Somatosensory Evoked Potentials, and Motor Evoked Potentials ?

    Peripheral Nerves: Upper Extremity

    89 Carpal Tunnel Release Surgery

    90 In Situ Decompression of the Ulnar Nerve at the Elbow

    91 Radial Nerve Decompression

    92 Brachial Plexus Repair

    93 Obstetric Brachial Plexus Injury Repair

    94 Thoracic Outlet Syndrome

    95 Thoracoscopic Sympathectomy

    96 Thoracoscopic Resection of Paraspinal Tumors

    Peripheral Nerves: Lower Extremity

    97 Exposure of the Sciatic Nerve

    98 Tibial and Peroneal Nerve Exposure

    99 Tarsal Tunnel Release

    100 Femoral and Lateral Femoral Cutaneous Nerve Exposure

    101 Sural Nerve Biopsy

    Peripheral Nerves: Special Topics

    102 Muscle Biopsy

    103 Peripheral Nerve Grafting

    Index

     

     

     

     

     

  • Neuroradiology: The Essentials with MR and CT
    La comanda in aproximativ 4 saptamani
    525.00 lei

     

    Description:

    An image-rich neuroradiology reference and board prep from renowned experts

    Neuroradiology: The Essentials with MR and CT, Second Edition, written by world-renowned neuroradiologist and MRI pioneer Val Runge, builds on the acclaimed prior edition. The splendidly illustrated compendium features in-depth discussion of important imaging findings, focused primarily on common disease processes. An impressive cadre of international experts contribute to the text, which is written from a clinical radiology perspective and draws from firsthand experiences. MRI physics pearls and tips throughout the book will help radiologists avoid common pitfalls.

    Designed as a practical educational resource for clinical neuroradiology, the text is divided into three sections: the brain, head and neck, and spine. The brain and spine chapters are divided into subsections covering normal anatomy and major disease categories such as congenital, traumatic, degenerative, vascular, infectious, and neoplastic. Head and neck chapters are organized by major anatomic region. Clinical cases encompass the use of advanced imaging techniques such as perfusion, high-resolution imaging, and spectroscopy.

    Key Features

    About 1,300 high-quality MR and CT images illustrate relevant findings and cases, including those often not well-described in more traditional academic textbooks

    New figures, updates on ultra-high-field 7T MRI, and additional in-depth text on cerebrovascular disease – especially brain aneurysms and AVMs

    Covers a wide array of diseases – from stroke and multiple sclerosis to cases one might see once a year, such as glutaric acidemia type 1 and CADASIL

    This excellent clinical resource provides a robust study prep for the boards and is a must-read for radiology residents prior to neuroradiology rotation. A quick reference for diagnosing challenging cases encountered in daily practice, it will also benefit neuroradiology fellows and general radiologists.

     

    Table of Contents:

     

    1. Brain

    1.1 Normal Anatomy and Common Variants.

    1.1.1 Normal Intracranial Anatomy

    1.1.2 Normal Arterial Anatomy

    1.1.3 Normal Venous Anatomy

    1.1.4 Normal Myelination

    1.1.5 Variants Involving the Septum Pellucidum

    1.1.6 Physiological Calcification

    1.1.7 Incidental Cystic Lesions

    1.1.8 Dilated Perivascular Spaces

    1.1.9 Other Incidental Lesions

    1.2 Congenital Malformations

    1.2.1 Posterior Fossa Malformations

    1.2.2 Cortical Malformations

    1.2.3 Callosal Malformations

    1.2.4 Holoprosencephaly and Related Disorders

    1.2.5 Phakomatoses

    1.2.6 Lipomas

    1.2.7 Anomalies of

    1.3 Inherited Metabolic Disorders

    1.3.1 Diseases Affecting White Matter

    1.3.2 Disease Affecting Gray Matter: Huntington Disease

    1.3.3 Diseases Affecting Both White and Gray Matter

    1.4 Acquired Metabolic, Systemic, and Toxic Disorders Toxic Disorders

    1.4.1 Acute Hypertensive Encephalopathy

    1.4.2 Wernicke Encephalopathy

    1.4.3 Hepatic Encephalopathy

    1.4.4 Carbon Monoxide Poisoning

    1.4.5 Osmotic Demyelination

    1.4.6 Mesial Temporal Sclerosis

    1.5 Hemorrhage

    1.5.1 Parenchymal Hemorrhage

    1.5.2 Subarachnoid Hemorrhage

    1.5.3 Superficial Siderosis

    1.6 Trauma

    1.6.1 Parenchymal Injury

    1.6.2 Epidural Hematoma

    1.6.3 Subdural Hematoma

    1.6.4 Nonaccidental Trauma (Child Abuse)

    1.6.5 Penetrating Injuries

    1.7 Herniation

    1.8 Infarction

    1.8.1 Arterial Territory Infarcts

    1.8.2 Lacunar Infarcts

    1.8.3 Medullary Infarcts

    1.8.4 Temporal Evolution

    1.8.5 Abnormal Contrast Enhancement

    1.8.6 CT in Infarction

    1.8.7 Chronic Infarcts

    1.8.8 Hemorrhagic Transformation

    1.8.9 Periventricular Leukomalacia

    1.9 Dementia and Degenerative Disease

    1.9.1 Alzheimer Disease

    1.9.2 Frontotemporal Dementia

    1.9.3 Multisystem Atrophy

    1.9.4 Small Vessel White Matter Ischemic Disease

    1.10 Vasculitis and Vasculitides

    1.10.1 Sickle Cell Disease

    1.10.2 Moyamoya Disease

    1.10.3 CADASIL and Behçet Disease .

    1.10.4 Systemic Lupus Erythematosus

    1.11 Vascular Lesions

    1.11.1 Aneurysms

    1.11.2 Vascular Malformations

    1.11.3 Sinus Thrombosis

    1.12 Infection and Inflammation

    1.12.1 Parenchymal Abscess

    1.12.2 Epidural and Subdural Abscesses

    1.12.3 Meningitis

    1.12.4 Ventriculitis

    1.12.5 Encephalitis

    1.12.6 Toxoplasmosis

    1.12.7 Neurocysticercosis

    1.12.8 Tuberculosis

    1.12.9 Creutzfeldt-Jakob Disease

    1.12.10 Neurosarcoidosis

    1.12.11 HIV/AIDS

    1.13 Demyelinating Disease

    1.13.1 Multiple Sclerosis

    1.13.2 Neuromyelitis Optica

    1.13.3 Acute Disseminated Encephalomyelitis

    1.14 Neoplasms

    1.14.1 Pilocytic Astrocytoma

    1.14.2 Low-grade Astrocytoma

    1.14.3 Anaplastic Astrocytoma

    1.14.4 Glioblastoma Multiforme

    1.14.5 Gliomatosis Cerebri

    1.14.6 Oligodendroglioma

    1.14.7 Ganglioglioma

    1.14.8 Hemangioblastoma

    1.14.9 Primary CNS Lymphoma

    1.14.10 Medulloblastoma

    1.14.11 Supratentorial PNET

    1.14.12 Dysembryoplastic Neuroepithelial Tumor

    1.14.13 Choroid Plexus Papilloma

    1.14.14 Ependymoma

    1.14.15 Pituitary Microadenoma

    1.14.16 Pituitary Macroadenoma

    1.14.17 Craniopharyngioma

    1.14.18 Pineal Region Neoplasms

    1.14.19 Brain (Parenchymal) Metastases

    1.14.20 Leptomeningeal Metastases

    1.14.21 Calvarial Metastases

    1.14.22 Langerhans Cell Histiocytosis

    1.14.23 Calvarial Hemangioma

    1.14.24 Fibrous Dysplasia

    1.14.25 Meningioma

    1.14.26 Hemangiopericytoma

    1.14.27 Radiation Injury

    1.14.28 Radiation Necrosis

    1.15 Nonneoplastic Cysts

    1.15.1 Arachnoid Cyst

    1.15.2 Epidermoid Cyst

    1.15.3 Dermoid Cyst

    1.15.4 Colloid Cyst

    1.16 Cerebrospinal Fluid Disorders

    1.16.1 Obstructive Hydrocephalus, Intraventricular

    1.16.2 Obstructive Hydrocephalus, Extraventricular

    1.16.3 Normal Pressure Hydrocephalus

    1.16.4 CSF Shunts and Complications

    1.16.5 Idiopathic Intracranial Hypertension

    1.16.6 Intracranial Hypotension

    2. Head and Neck

    2.1 Skull Base

    2.2 Temporal Bone

    2.2.1 Neoplasms

    2.3 Orbit

    2.3.1 Inflammation/Infection

    2.3.2 Neoplasms

    2.4 Globe

    2.5 Visual Pathway

    2.6 Paranasal Sinuses, Nasal Cavity, and Face

    2.6.1 Inflammation/Infection

    2.6.2 Fractures

    2.6.3 Sinus Surgery

    2.6.4 Neoplasms

    2.7 Mandible

    2.8 Temporomandibular Joint

    2.9 Nasopharynx

    2.10 Oral Cavity, Oropharynx

    2.11 Salivary Glands

    2.12 Parapharyngeal Space

    2.13 Larynx

    2.14 Soft Tissues of the Neck

    2.14.1 Lymph Nodes

    2.14.2 Congenital Anomalies

    2.14.3 Inflammation/Infection

    2.14.4 Neoplasms

    2.14.5 Vascular Lesions

    3. Spine

    3.1 Normal Anatomy, Imaging Technique, and Common Variants

    3.1.1 Anatomy of the Normal Spine

    3.1.2 Imaging Technique

    3.1.3 Common Normal Variants and Incidental Findings

    3.1.4 Incidental Cystic Lesions

    3.2 Congenital Disease

    3.2.1 Congenital Spinal Stenosis

    3.2.2 Scoliosis

    3.2.3 Tethered Cord

    3.2.4 Syringohydromyelia

    3.2.5 Meningomyeloceles and Lipomyelomeningoceles

    3.2.6 Diastematomyelia

    3.2.7 Caudal Regression

    3.2.8 Anterior Sacral Meningocele

    3.2.9 Dorsal Dermal Sinus

    3.2.10 Intraspinal Enteric Cyst (Neurenteric Cyst)

    3.2.11 Spinal Cord Herniation

    3.2.12 Dermoid and Epidermoid Cysts

    3.2.13 Neurofibromatosis

    3.2.14 Klippel-Feil

    3.2.15 Achondroplasia

    3.3 Trauma

    3.3.1 Cervical Spine Trauma

    3.3.2 Burst Fracture

    3.3.3 Flexion Injury

    3.3.4 Benign Osteoporotic Fractures

    3.3.5 Spinal Cord Injury

    3.3.6 Epidural Hemorrhage

    3.3.7 Brachial Plexus Injury

    3.4 Degenerative Disease

    3.4.1 Degenerative Spinal Stenosis

    3.4.2 Disk, Endplate, Foraminal, and Spinal Canal Disease

    3.4.3 Abnormalities of Vertebral Alignment

    3.4.4 Surgery

    3.4.5 Spondyloarthropathies

    3.5 Arteriovascular Disease and Ischemia

    3.5.1 Spinal Dural Arteriovenous Fistulas

    3.5.2 Spinal Cord Arteriovenous Malformations

    3.5.3 Spinal Cord Arterial Ischemia

    3.5.4 Cavernous Malformation

    3.6 Infection and Inflammation

    3.6.1 Disk Space Infection

    3.6.2 Tuberculous Spondylitis

    3.6.3 Epidural Abscess

    3.6.4 Meningitis and Myelitis

    3.6.5 Arachnoiditis

    3.6.6 Guillain-Barré

    3.6.7 Chronic Inflammatory Demyelinating Polyneuropathy

    3.6.8 Sarcoidosis

    3.6.9 Multiple Sclerosis

    3.6.10 Neuromyelitis Optica

    3.6.11 Acute Transverse Myelitis

    3.6.12 Vitamin B12Deficiency

    3.6.13 Paget Disease

    3.7 Neoplasms

    3.7.1 Nerve Sheath Tumors (Neurofibroma, Schwannoma)

    3.7.2 Meningioma

    3.7.3 Ependymoma

    3.7.4 Astrocytoma

    3.7.5 Hemangioblastoma

    3.7.6 Leptomeningeal and Spinal Cord Metastases

    3.7.7 Vertebral Body Hemangioma

    3.7.8 Aneurysmal Bone Cyst

    3.7.9 Osteoid Osteoma

    3.7.10 Osteochondroma

    3.7.11 Giant Cell Tumor

    3.7.12 Chordoma

    3.7.13 Sacrococcygeal Teratoma

    3.7.14 Focal Vertebral Body Metastatic Disease

    3.7.15 Pathologic Compression Fracture

    3.7.16 Langerhans Cell Histiocytosis

    3.7.17 Diffuse Marrow Disease

    3.7.18 Lymphoma

    3.7.19 Leukemia

    3.7.20 Multiple Myeloma

    Index

     

  • 577.00 lei

     

    Description:

    A case-based guide to the interventional management of stroke from leading international experts!

    Stroke is the most prevalent cerebrovascular emergency, impacting an estimated 15 million people worldwide every year. Endovascular treatment (EVT) of ischemic stroke has expanded at an unforeseen pace, with EVT the most common neurointerventional procedure performed at most large centers. Endovascular Management of Ischemic Stroke: A Case-Based Approach by renowned stroke pioneer Vitor Mendes Pereira and distinguished co-editors features contributions from a "who's who" of global experts. This practical resource provides straightforward guidance for clinicians who need to learn and master state-of-the-art endovascular interventions reflecting the new, evidenced-based treatment paradigm for acute stroke.

    This carefully crafted reference takes readers on a journey from the early building blocks that led to modern stroke interventions to meticulous step-by-step descriptions of the latest approaches. Fifty high-yield cases mirror real-life scenarios trainees and professionals are likely to encounter in clinical practice. Seven sections encompass a full spectrum of diverse patient presentations, anatomical variations, advanced techniques, complex pathologies, complications, and stroke mimics.

    Key Highlights

    Discussion of emerging techniques likely to stand the test of time such as SAVE, ARTS, transradial access, and transcarotid access

    Stroke mimics important for differential diagnoses, including hemiplegic migraine, MELAS, RCVS, seizure, and more

    An appendix that covers fundamental terms, trials, and tools

    This cutting-edge resource is essential reading for trainee and early-career interventionalists, as well as seasoned practitioners in interventional radiology, neuroradiology, endovascular neurosurgery, and interventional neurology.

     

     

     

    Table of Contents:

     

    Section I Evolution of Endovascular Management

    1 Intra-arterial Tissue Plasminogen Activator: The First Step

    1.1 Case Description

    1.1.1 Clinical Presentation

    1.1.2 Imaging Workup and Investigations

    1.1.3 Diagnosis

    1.1.4 Management

    1.1.5 Technique

    1.1.6 Outcome

    1.1.7 Discussion

    1.2 References

    2 Transcatheter MERCI Clot Retrieval: The Early Generation

    2.1 Case Description

    2.1.1 Clinical Presentation

    2.1.2 Imaging Workup and Investigations

    2.1.3 Diagnosis

    2.1.4 Management

    2.1.5 Technique

    2.1.6 Outcome

    2.1.7 Discussion

    2.2 References

    3 Penumbra Clot Aspiration Technique: The Dark Days

    3.1 Case Description

    3.1.1 Clinical Presentation

    3.1.2 Imaging Workup and Investigations

    3.1.3 Diagnosis

    3.1.4 Management

    3.1.5 Technique

    3.1.6 Outcome

    3.1.7 Discussion

    3.1.8 Further Attempts and Critiques

    3.2 References

    4 Trevo Stent-Retriever Thrombectomy: Light on the Horizon

    4.1 Case Description

    4.1.1 Clinical Presentation

    4.1.2 Imaging and Workup

    4.1.3 Diagnosis

    4.1.4 Technique

    4.1.5 Outcome

    4.1.6 Discussion

    4.2 References

    5 Solitaire Stent-Retriever Thrombectomy: Building the Evidence

    5.1 Case Description

    5.1.1 Clinical Presentation

    5.1.2 Imaging and Workup

    5.1.3 Diagnosis

    5.1.4 Technique

    5.1.5 Outcome

    5.1.6 Discussion

    5.2 References

    Section II Case Selection

    6 Timing in Stroke and the Tissue Clock

    6.1 Case Description

    6.1.1 Clinical Presentation

    6.1.2 Imaging Workup and Investigations

    6.1.3 Diagnosis

    6.1.4 Treatment

    6.1.5 Outcome

    6.2 Companion Case

    6.2.1 Clinical Presentation

    6.2.2 Imaging Workup and Investigations

    6.2.3 Diagnosis

    6.2.4 Treatment

    6.2.5 Endovascular

    6.2.6 Outcome

    6.2.7 Discussion

    6.2.8 Pearls and Pitfalls

    6.3 References

    7 Role of Leptomeningeal Collaterals

    7.1 Case Description

    7.1.1 Clinical Presentation

    7.1.2 Imaging Workup and Investigations

    7.1.3 Diagnosis

    7.1.4 Treatment

    7.2 Postprocedure Care/Outcome

    7.3 Companion Case

    7.3.1 Clinical Presentation

    7.3.2 Imaging Workup and Investigations

    7.3.3 Diagnosis

    7.3.4 Treatment

    7.4 Postprocedure Care/Outcome

    7.4.1 Discussion

    7.4.2 Workup and Diagnosis

    7.4.3 Imaging Findings

    7.4.4 Decision-Making Process

    7.4.5 Management

    7.4.6 Postprocedural Care

    7.4.7 Literature Synopsis

    7.4.8 Pearls and Pitfalls

    7.5 Further Reading

    8 Importance of Clot Burden and Clot Location

    8.1 Case Description

    8.1.1 Clinical Presentation

    8.1.2 Imaging Workup and Investigations

    8.1.3 Diagnosis

    8.1.4 Treatment

    8.1.5 Discussion

    8.1.6 Workup and Diagnosis

    8.1.7 Imaging Findings

    8.1.8 Decision-Making Process

    8.1.9 Postprocedural Care

    8.1.10 Pearls and Pitfalls

    8.2 References

    9 ASPECTS: When Not to Treat

    9.1 Case Description

    9.1.1 Clinical Presentation

    9.1.2 Imaging Workup and Investigations

    9.1.3 Diagnosis

    9.1.4 Management

    9.1.5 Endovascular Treatment

    9.1.6 Postprocedural Care

    9.1.7 Outcome

    9.1.8 Background

    9.1.9 Discussion

    9.1.10 Pearls and Pitfalls

    9.2 References

    10 Microbleeds Are Not a Contraindication to Thrombolysis in Acute Stroke

    10.1 Case Description

    10.1.1 Clinical Presentation

    10.1.2 Imaging Workup and Investigations

    10.2 Diagnosis

    10.3 Treatment

    10.3.1 Initial Management

    10.3.2 Endovascular Management

    10.3.3 Outcome

    10.4 Discussion

    10.4.1 Background

    10.4.2 Workup and Diagnosis

    10.4.3 Decision-Making Process

    10.5 Literature Synopsis

    10.6 Pearls and Pitfalls

    10.7 References

    10.8 Further Reading

    11 Stroke Etiologies: Hemodynamic, Embolic, and Perforator Stroke

    11.1 Case Description

    11.1.1 Clinical Presentation

    11.1.2 Imaging Workup and Investigations

    11.1.3 Diagnosis

    11.1.4 Treatment

    11.2 Companion Case

    11.2.1 Clinical Presentation

    11.2.2 Imaging Workup and Investigations

    11.2.3 Diagnosis

    11.2.4 Treatment

    11.3 Additional Companion Case

    11.3.1 Clinical Presentation

    11.3.2 Imaging Findings

    11.3.3 Diagnosis

    11.3.4 Treatment

    11.4 Discussion

    11.4.1 Background

    11.4.2 Workup and Diagnosis

    11.4.3 Imaging Findings

    11.4.4 Decision-Making Process

    11.4.5 Literature Synopsis

    11.4.6 Pearls and Pitfalls

    11.5 Further Reading

    12 Endovascular Therapy in a Patient with a Proximal MCA Occlusion and No Neurological Deficits

    12.1 Case Description

    12.1.1 Clinical Presentation

    12.1.2 Imaging Workup and Investigations

    12.1.3&#