JAAOS

JAAOS, Volume 14, No. 7


Complications after treatment of flexor tendon injuries.

The goals of flexor tendon repair are to promote intrinsic tendon healing and minimize extrinsic scarring in order to optimize tendon gliding and range of motion. Despite advances in the materials and methods used in surgical repair and postoperative rehabilitation, complications following flexor tendon injuries continue to occur, even in patients treated by experienced surgeons and therapists. The most common complication is adhesion formation, which limits active range of motion. Other complications include joint contracture, tendon rupture, triggering, and pulley failure with tendon bowstringing. Less common problems include quadriga, swan-neck deformity, and lumbrical plus deformity. Meticulous surgical technique and early postoperative tendon mobilization in a well-supervised therapy program can minimize the frequency and severity of these complications. Prompt recognition of problems and treatment with hand therapy, splinting, and/or surgery may help minimize recovery time and improve function. In the future, the use of novel biologic modulators of healing may nearly eliminate complications associated with flexor tendon injuries.

    • Keywords:
    • Connective Tissue Diseases|Humans|Joint Diseases|Reconstructive Surgical Procedures|Tendon Injuries

    • Subspecialty:
    • Trauma

    • Hand and Wrist

Hip arthroscopy.

    • Keywords:
    • Arthroscopes|Arthroscopy|Hip Joint|Humans|Joint Diseases|Physicians Practice Patterns|Practice Guidelines as Topic

    • Subspecialty:
    • Adult Reconstruction

On the horizon from the ORS.

    • Keywords:
    • Biomedical Research|Bone Morphogenetic Protein 2|Bone Morphogenetic Protein Receptors|Bone Morphogenetic Proteins|Calcinosis|Fracture Healing|Fractures

    • Bone|Humans|Orthopedics|Transforming Growth Factor beta|United States

    • Subspecialty:
    • Clinical Practice Improvement

Perioperative management of the obese orthopaedic patient.

With nearly a third of American adults considered be obese, it is increasingly important that orthopaedic surgeons be familiar with management issues pertinent to these patients. Preoperative examination must assess cardiopulmonary status and other comorbid conditions, most notably diabetes. Intraoperative considerations include requirements for special equipment, patient positioning, intravenous line placement, central monitoring lines, and anesthesia specific to the physiologic changes in obese patients. Postoperatively, obese patients have higher rates of deep vein thrombosis and wound sepsis than do nonobese patients, and they may differ from other patients in supplemental oxygen requirements, medication dosing, and outcomes in intensive care units. Obese patients can successfully undergo virtually all orthopaedic procedures; however, the procedures are frequently more technically challenging, and obese patients appear to have higher rates of prosthetic failure, infection, hardware failure, and fracture malunion, although many of these complications can be minimized by appropriate countermeasures.

    • Keywords:
    • Humans|Obesity|Orthopedic Procedures|Perioperative Care|Postoperative Complications|Risk Assessment|Risk Factors

    • Subspecialty:
    • General Orthopaedics

Psychosocial factors and surgical outcomes: an evidence-based literature review.

The influence of psychosocial factors on clinical outcomes after surgery has been investigated in several studies. This review is limited to surgical outcomes studies published between 1990 and 2004 that include (1) psychosocial variables (eg, depression, social support) as predictors of outcome and that focus on (2) clinical outcomes (eg, postoperative pain, functional recovery) using (3) specific multivariate analytic techniques with (4) relevant clinical variables (eg, presurgical health status) included as covariates. Twenty-nine studies met these criteria. Results indicate that psychosocial factors play a significant role in recovery and are predictive of surgical outcome, even after accounting for known clinical factors. Attitudinal and mood factors were strongly predictive; personality factors were least predictive. The results suggest that preoperative consideration of attitudinal and mood factors will assist the surgeon in estimating both the speed and extent of postoperative recovery.

    • Keywords:
    • Affect|Anxiety|Attitude to Health|Evidence-Based Medicine|Humans|Outcome Assessment (Health Care)|Psychology|Risk Assessment|Risk Factors|Stress

    • Psychological|Surgical Procedures

    • Operative|Treatment Outcome

    • Subspecialty:
    • Clinical Practice Improvement

Spondylolysis and spondylolisthesis in children and adolescents: I. Diagnosis, natural history, and nonsurgical management.

Spondylolysis and spondylolisthesis are often diagnosed in children presenting with low back pain. Spondylolysis refers to a defect of the vertebral pars interarticularis. Spondylolisthesis is the forward translation of one vertebral segment over the one beneath it. Isthmic spondylolysis, isthmic spondylolisthesis, and stress reactions involving the pars interarticularis are the most common forms seen in children. Typical presentation is characterized by a history of activity-related low back pain and the presence of painful spinal mobility and hamstring tightness without radiculopathy. Plain radiography, computed tomography, and single-photon emission computed tomography are useful for establishing the diagnosis. Symptomatic stress reactions of the pars interarticularis or adjacent vertebral structures are best treated with immobilization of the spine and activity restriction. Spondylolysis often responds to brief periods of activity restriction, immobilization, and physiotherapy. Low-grade spondylolisthesis (< or =50% translation) is treated similarly. The less common dysplastic spondylolisthesis with intact posterior elements requires greater caution. Symptomatic high-grade spondylolisthesis (>50% translation) responds much less reliably to nonsurgical treatment. The growing child may need to be followed clinically and radiographically through skeletal maturity. When pain persists despite nonsurgical interventions, when progressive vertebral displacement increases, or in the presence of progressive neurologic deficits, surgical intervention is appropriate.

    • Keywords:
    • Adolescent|Child|Humans|Immobilization|Physical Therapy Modalities|Physicians Practice Patterns|Spondylolisthesis|Spondylolysis

    • Subspecialty:
    • Pediatric Orthopaedics

    • Spine

Surgical treatment of nonarticular distal tibia fractures.

Distal tibia metaphyseal fractures can be difficult to manage. Treatment selection is influenced by the proximity of the fracture to the plafond, fracture displacement, comminution, and injury to the soft-tissue envelope. Nonsurgical management is possible for stable fractures with minimal shortening. Indications for intramedullary nailing have expanded to include distal metaphyseal tibia fractures. Intramedullary nailing allows atraumatic, closed stabilization while preserving the vascularity of the fracture site and integrity of the soft-tissue envelope. Intramedullary canal anatomy at this level prevents intimate contact between the nail and endosteum, however, and concerns have been raised regarding the biomechanical stability of fixation and risk of malunion. Plate fixation is effective in stabilizing distal tibia fractures. Conventional techniques involve extensive dissection and periosteal stripping, which increase the risk of soft-tissue complications. Percutaneous plating techniques use indirect reduction methods and allow stabilization of distal tibia fractures while preserving vascularity of the soft-tissue envelope. External fixation is effective in the setting of contaminated wounds or extensive soft-tissue injury. Careful preoperative planning with consideration for fracture pattern and soft-tissue condition helps guide implant selection and minimize postoperative complications.

    • Keywords:
    • Bone Nails|Bone Plates|Fracture Fixation|Humans|Physicians Practice Patterns|Practice Guidelines as Topic|Tibial Fractures

    • Subspecialty:
    • Trauma

    • Foot and Ankle

Advertisements

Advertisement