Notes

miR-21a-5p Encourages Inflammation following Disturbing Spinal Cord Injuries by means of Upregulation regarding Neurotoxic Sensitive Astrocyte (A2) Polarization by Curbing the particular CNTF/STAT3/Nkrf Walkway.
Osteochondritis dissecans and cartilage injuries of the knee are among the most challenging clinical entities that pediatric sports medicine specialists encounter. As a weight-bearing joint with significant long-term implications on mobility and overall physical health, the knee also happens to be the most injured or adversely affected joint in preadolescent and adolescent athletes. However, cartilage injuries are unique among other musculoskeletal pathologies in children, in that the healing potential of articular cartilage tissue is limited, and minor injuries or small focal defects can have devastating implications on the lifelong health of the joint. Although the most common form of degenerative joint disease affecting the general population is, of course, osteoarthritis, other conditions such as osteochondritis dissecans or acute, traumatic osteochondral shear injuries can activate their own arthritic pathway, whereby focal injuries precipitate an eventual cascade of diffuse degeneration. Thus, it is important for sports medicine and pediatric orthopaedic specialists alike to understand, diagnose, and initiate early, evidence-based management for cartilage conditions of the knee in pediatric patients. This chapter reviews principles of diagnosis and management of both knee osteochondritis dissecans (a chronic condition of subchondral bone that often secondarily affects the articular cartilage) and acute traumatic cartilage shear injuries. Although the two entities are quite different from an etiologic standpoint, there is significant overlap in technical considerations and treatment principles between these two conditions.As the number of pediatric and adolescent patients participating in sports continues to increase, so too does the incidence of anterior cruciate ligament (ACL) tears in this population. There is increasing research on pediatric and adolescent ACL tears; hundreds of articles on the topic have been published in the past few years alone. It is important to highlight the most pertinent information in the past decade. In discussing pediatric ACL tears, it is also important to review tibial spine fractures. These injuries are rightfully grouped together because tibial spine fractures often occur with a mechanism of injury similar to that of ACL tears, but typically in a younger age group. Because management is different, understanding the similarities and differences between the two pathologies is important. Recent updates on the epidemiology, diagnosis, management, and outcomes of both pediatric ACL tears and tibial spine fractures need to be reviewed.Taking call as an orthopaedic surgeon is commonplace and expected at many institutions. UNC3866 mw Taking general orthopaedic call without specialized backup physicians can be challenging and daunting. Pediatric patients commonly present to emergency departments around the country with a host of pathologies, many of which are different from those of adults. It is imperative to recognize injuries and scenarios that require emergent or urgent intervention, those that can potentially become difficult, and how to triage nonurgent ones. Just as important is identifying one's ability to treat these patients (as a surgeon or an institution) and the capacity and mechanism to transfer these patients to specialized care centers. The general orthopaedic surgeon will be required to assess on-call challenges with pediatric patients.The advantages of anterior, muscle-sparing interbody fusion for the management of degenerative scoliosis have been well defined in the literature. These include both direct and indirect decompression, restoration of disk/foraminal height and spinal biomechanics, correction of sagittal balance, and improved fusion rates. The continued evolution of minimally invasive techniques and surgical instrumentation has led to reduced morbidity for patients and increased popularity for anterior interbody techniques among surgeons. It is important to remember that when deciding on what interbody approach to use, the surgeon must consider goals of care, anatomic characteristics as seen on preoperative imaging, and surgical levels. Although each approach has distinct advantages and disadvantages, ultimately the most important deciding factor should lie with the surgeons' experience and comfort levels with each approach.Osteoporosis is common, affecting more than 40 million people, and is associated with increased fracture risk, loss of independence, chronic pain, and disability. Osteoporosis is underdiagnosed and undertreated even after fracture where secondary fracture prevention has been shown to be cost effective in reducing further fracture risk and mortality. Osteoporosis is also undiagnosed in patients undergoing orthopaedic and spine surgery in up to one-third of cases and negatively affects outcomes, need for revision surgery, and risk of complications. The diagnosis of osteoporosis was previously based on bone mineral density; however, recent clinical definitions include T-scores less than -2.5, the presence of hip and spine fractures, and high fracture risk. Surgeons should adopt bone health optimization for elective surgery. This program screens patients to determine whether a bone mineral density test is indicated and provides counseling for nutritional supplements, elimination of toxins, fall risk assessment, and education regarding bone health. Following assessment, patients meeting the criteria for osteoporosis are referred to a bone health specialist or a fracture liaison program. Both antiresorptive and anabolic antiosteoporotic medications appear effective at improving outcomes and reducing complications of orthopaedic and spine surgery, although a delay in surgery may be required.Spinal injuries are common and are a significant burden in the professional athlete population. From single-level disk herniation to career-ending fractures, the consequences of these conditions vary widely. Both contact and noncontact injuries can substantially affect the health and performance of elite athletes competing in a variety of sports. The nature and severity of these injuries have great influence on the prospects for full recovery and successful return to play. Common spinal injuries, management decisions, and return to play prospects are important considerations in the professional athlete population.
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