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The specialty of orthopaedics includes management of musculoskeletal pathology of the upper limbs, spine and lower limbs across the lifespan, from the very young to the very old.
Viewpoint
Some recent advances affect the practice of general orthopaedics, while others may be more specific to subspecialty practice, such as refinements of surgical techniques.
Clinical
Management of basal thumb arthritis is dependent on both the clinical stage of the disease and patient expectations and demands.
Appropriate education of patients regarding the nature of the illness, lifestyle modifications to avoid aggravating activities and appropriate use of analgesics are critical in effective management.
Pre-operative education and exercise, termed prehabilitation, has an important role in optimising patient outcomes following hip and knee arthroplasty.
Management of acute Achilles tendon rupture has evolved, with increasing evidence that non-operative management is appropriate providing patients participate in a functional rehabilitation protocol.
The natural history of bunions is of progression, and patients are unlikely to obtain long-term pain relief or resolution of symptoms with non-operative management.
Treatment of central low back pain is difficult given the numerous treatment options available.
Editorial
Letters
Readers express their opinions on published articles and topics of interest.
The sinonasal cavity is an important route of entry and infection for SARS-CoV-2 and carries the highest viral load in the respiratory tract.
Clinical trials evaluating the impact of sentinel node biopsy, completion lymph node dissection and adjuvant medical therapies on patient outcomes have changed practice significantly.
Management of individual fractures depends on the fracture pattern and age of the child.
Research
Characterising the general practice response to the COVID-19 pandemic is important for ongoing policy planning.
Prognostic uncertainty delays discussions and leads to unnecessary treatments for older patients who are dying.
Predominantly hospital-based prevocational paediatric training offers limited exposure to – and, thus, confidence in – managing behavioural, mental health and developmental issues.
Clinical challenge
This clinical challenge is based on this month’s Focus articles. To complete this activity, go to the RACGP website.