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Orthopaedic surgeons perform a variety of procedures where life-threatening or limb-threatening clinical scenarios or complications are relatively rare. Because these devastating complications and disaster presentations are infrequent, the occurrence can lead to concerns regarding training and preparedness. This chapter will provide a general knowledge base of common intraoperative disasters as well as life-threatening and/or limb-threatening conditions related to the upper extremity, pelvis, and lower extremity. Fundamental clinical and surgical management strategies are explored with respect to these conditions to provide a level of preparedness to help any orthopaedic surgeon control a potentially devastating complication or emergency.The goal of this chapter is to familiarize orthopaedic surgeons with the latest information pertaining to typical problems of the forefoot. Painful and deforming problems of the forefoot are surprisingly common. The understanding of forefoot deformity and pathology has evolved considerably over the past decade. A more precise understanding of the mechanics of deformity and resulting pathology has resulted in significant improvements in nonsurgical and surgical managements. This chapter provides an up-to-date examination of the literature regarding the management of forefoot pathology. First, a review of recent advances in the understanding of the pathology and mechanics of these problems and then a thorough review of specific diseases are presented. These include management of the bunion deformity, hallux rigidus, metatarsalgia and plantar plate disruption, hammer toe deformities, and interdigital neuritis. Nonsurgical and surgical options are described. This chapter provides information that will lead to thoughtful treatment options for surgeons.As orthopaedic surgeons become more specialized, it is important that they remain up to date in the diagnosis and management of common orthopaedic problems. These can include conditions encountered in the clinic and/or on call. It is important that practicing surgeons stay abreast of recognition and management of problems, not only for the patients, but also to avoid commonly missed conditions or less-than-optimal treatment. The orthopaedic surgeon should be aware of the top tips in multiple disciplines, including orthopaedic oncology, hand, and trauma.The practicing orthopaedic surgeon must understand the relationship between fracture biomechanics and fracture biology to optimize patient outcomes. Patient characteristics, fracture pattern, and desired type of bone healing all drive decision making. The benefits of performing an open approach to a fracture, obtaining an anatomic reduction, and achieving absolute stability must be weighed against the biologic cost to the tissues and the potential to compromise healing. this website Similarly, the decision to perform a closed fracture reduction; apply a splint, bridge plate, or intramedullary nail; and achieve relative stability requires that the surgeon understand the implications of increased strain at a given fracture site. The purpose of this chapter is to review the basic science of primary and secondary bone healing with special attention given to the clinical implications for practicing surgeons.Tendinopathy describes a spectrum of degenerative and inflammatory changes occurring in tendons, usually caused by mechanical loading. It is associated with pain and reduced function and can often lead to tendon rupture. Although advances have been made in recent years, it remains challenging to manage tendinopathy because its definition and the understanding of its risk factors and pathophysiology are still evolving. The objective of this chapter is to present current ideas on the basic science of tendinopathy and in particular new findings in regard to pathophysiology. Current therapies and insights into potential novel therapies for tendinopathy are also discussed.Osteoarthritis was traditionally thought of as a noninflammatory disease, but improved molecular techniques have recognized a significant inflammatory component. An initial joint injury or biomechanical imbalance leads to local tissue damage and inflammation, which is propagated by the innate immune system. The production of damage-associated molecular patterns (DAMPs) results in the activation of immune-modulated mechanisms, leading to the production of catabolic factors that can damage native joint structures such as cartilage. DAMPs may originate from extracellular matrix degradation products, intracellular components of lysed cells, complement, or joint crystals-even plasma proteins can enter through an inflamed synovium and further perpetuate the inflammatory process. Therapeutic interventions have traditionally focused on symptom management; however, there is potential for pharmacologic modification of the disease process in osteoarthritis through novel anti-inflammatory agents.Osteoporosis is a skeletal condition characterized by decreased bone mineral density and poor bone quality with resultant greater fracture risk. There has been a focus on bone mineral density deficiency, which is easily measured with dual-energy x-ray absorptiometry and managed with pharmaceutic medications. More recently, impaired bone quality independent of bone mineral density has been recognized as a potential cause of fragility fracture and poor bone healing. Many conditions lead to poor bone quality; the most common is vitamin D deficiency and others are genetic causes and other nutritional deficits. In addition, the cellular and molecular changes associated with osteoporosis are being investigated and are potential targets for treatment. Treatment of patients with poor bone health include nutritional supplementation with vitamin D and calcium, weight-bearing exercises, and antiosteoporotic medications when warranted. Antiosteoporotic medications include antiresorptive drugs such as diphosphonate and denosumab that inhibit osteoclastic bone resorption. Anabolic agents such as teriparatide, abaloparatide, and romosozumab stimulate osteoblastic differentiation and bone formation. All these agents are effective in reducing fracture risk.