Mucopolysaccharide Disorders in Orthopaedic Surgery
Klane K. White, Abstract The mucopolysaccharidoses (MPSs) are a family of disorders characterized by the accumulation of glycosaminoglycans, which is caused by enzyme deficiencies in the lysosomal metabolism of these normal cellular byproducts. Skeletal abnormalities are early and prominent features of MPS, and the orthopaedic surgeon is often the first healthcare provider to raise suspicion […]
Anterior Cruciate Ligament Rupture: Differences Between Males and Females
Karen M. Sutton Abstract The rate of anterior cruciate ligament (ACL) rupture is three times higher in female athletes than in male athletes. Intrinsic factors such as increased quadriceps angle and increased posterior tibial slope may predispose girls and women to ACL injury. Compared with males, females have smaller notch widths and smaller ACL cross-sectional […]
Posterior Malleolus Fracture
Todd A. Irwin, Abstract Posterior malleolus fractures are a common component of ankle fractures. The morphology is variable; these fractures range from small posterolateral avulsion injuries to large displaced fracture fragments. The integrity of the posterior malleolus and its ligamentous attachment is important for tibiotalar load transfer, posterior talar stability, and rotatory ankle stability. Fixation […]
Adjacent Segment Disease Following Cervical Spine Surgery
Samuel K. Cho, Abstract Cervical spine surgery is broadly divided into fusion and nonfusion procedures. Anterior cervical diskectomy and fusion (ACDF) is a common procedure, although adjacent segment disease following the surgery is an ongoing clinical concern. Adjacent segment cervical disease occurs in approximately 3% of patients per year, with an expected incidence of 25% […]
Bone Graft and Bone Graft Substitutes in Spine Surgery: Current Concepts and Controversies
Gregory Grabowski, Abstract Iliac crest bone graft has long been the standard adjunct used in spine fusion surgery. This graft provides osteogenic, osteoinductive, and osteoconductive elements that aid in creation of a fusion mass. However, morbidity associated with bone graft harvest has led surgeons to seek other potential adjuncts, including bone morphogenetic proteins, demineralized bone […]
Soft-tissue Management in Revision Total Shoulder Arthroplasty
Joseph A. Abboud, Abstract Revision total shoulder arthroplasty can be technically challenging. Results are inferior to those of primary arthroplasty, particularly when the indications for revision are related to soft-tissue problems. Patient selection is important. In the stiff arthroplasty, the surgeon must address rotator cuff and capsular contractures as well as exuberant soft-tissue adhesions. Unstable […]
MRI Techniques: A Review and Update for the Orthopaedic Surgeon
Katherine G. Hartley J Am Acad Orthop Surg December 2012 ; 20 Abstract MRI plays a critical role in all orthopaedic practices. A basic working knowledge of the most commonly used pulse sequences in musculoskeletal imaging and the appearance of normal tissues on those sequences is critical to confident MRI interpretation. The orthopaedic surgeon should […]
Perioperative Pain Control in Pediatric Patients Undergoing Orthopaedic Surgery
Philip D. Nowicki, J Am Acad Orthop Surg December 2012 ; 20 Abstract Management of perioperative pain is critical in the pediatric patient undergoing orthopaedic surgery. A variety of modalities can be used to manage pain and optimize recovery and patient satisfaction, including nonopioid and opioid analgesia; local anesthetic injection; and regional analgesia such as […]
Heat- and Cold-induced Injuries in Athletes: Evaluation and Management
Benjamin Noonan J Am Acad Orthop Surg December 2012 ; 20 Abstract Both extreme heat and cold can be challenging for athletes during training and competition. One role of the team physician is to educate coaches and athletes on the risks of exposure to these conditions and how to best prevent and manage their adverse […]
Radiographic Methods of Wear Analysis in Total Hip Arthroplasty
Luthfur Rahman Abstract Polyethylene wear is an important factor in failure of total hip arthroplasty (THA). With increasing numbers of THAs being performed worldwide, particularly in younger patients, the burden of failure and revision arthroplasty is increasing, as well, along with associated costs and workload. Various radiographic methods of measuring polyethylene wear have been developed […]