JAAOS

JAAOS, Volume 15, No. 12


Cycling injuries of the lower extremity.

Cycling is an increasingly popular recreational and competitive activity, and cycling-related injuries are becoming more common. Many common cycling injuries of the lower extremity are preventable. These include knee pain, patellar quadriceps tendinitis, iliotibial band syndrome, hip pain, medial tibial stress syndrome, stress fracture, compartment syndrome, numbness of the foot, and metatarsalgia. Injury is caused by a combination of inadequate preparation, inappropriate equipment, poor technique, and overuse. Nonsurgical management may include rest, nonsteroidal anti-inflammatory drugs, corticosteroid injection, ice, a reduction in training intensity, orthotics, night splints, and physical therapy. Injury prevention should be the focus, with particular attention to bicycle fit and alignment, appropriate equipment, proper rider position and pedaling mechanics, and appropriate training.

    • Keywords:
    • Ankle Injuries|Bicycling|Fracture Fixation|Hip Injuries|Humans|Knee Injuries|Leg Injuries|Multiple Trauma|Trauma Severity Indices

    • Subspecialty:
    • Trauma

    • Foot and Ankle

    • Sports Medicine

De quervain tenosynovitis of the wrist.

De quervain disease, or stenosing tenosynovitis of the first dorsal compartment of the wrist, is a common wrist pathology. Pain results from resisted gliding of the abductor pollicis longus and the extensor pollicis brevis tendons in the fibro-osseus canal. de Quervain tenosynovitis of the wrist is more common in women than men. Diagnosis may be made on physical examination. Radiographs are helpful in ruling out offending bony pathology. Nonsurgical management, consisting of corticosteroid injections and supportive thumb spica splinting, is usually successful. In resistant cases, surgical release of the first dorsal compartment is done, taking care to protect the radial sensory nerve and identify all accessory compartments. Repair of the extensor retinaculum by step-cut lengthening or other techniques is rarely required.

    • Keywords:
    • De Quervain Disease|Diagnosis

    • Differential|Diagnostic Imaging|Humans|Orthopedic Procedures

    • Subspecialty:
    • Hand and Wrist

Fracture of the femoral head.

Fracture of the femoral head is a severe, relatively uncommon injury; typically, it occurs following traumatic posterior dislocation of the hip joint. The Pipkin classification is the most commonly used classification system. Diagnosis is aided by a complete history, physical examination, and imaging, including computed tomography. Treatment consists of urgent closed reduction of the dislocated hip followed by nonsurgical or surgical management of any associated fractures. Controversies include the preferred surgical approach (anterior versus posterior) and whether to perform femoral head fragment excision or internal fixation. Complications associated with fracture of the femoral head and subsequent treatment include osteonecrosis, posttraumatic osteoarthritis, and heterotopic ossification. Fracture of the femoral head has been associated with a relatively poor functional outcome.

    • Keywords:
    • Femoral Neck Fractures|Fracture Fixation

    • Internal|Humans|Prognosis|Tomography

    • X-Ray Computed|Trauma Severity Indices

    • Subspecialty:
    • Trauma

    • Adult Reconstruction

Minimal incision total hip arthroplasty.

Although debate regarding minimally invasive hip surgery is inconclusive, information published to date on the risks and benefits of small-incision approaches focuses the discussion on quality and outcomes. Small-incision surgical approaches include the posterior, anterolateral, direct anterior, and two-incision approach. Computer navigation assists in mapping hip replacement surgery. Obesity is a risk factor and has been found to increase complications. Patient education, pain management, and rehabilitation are important to recovery after minimal incision hip arthroplasty. Total hip replacement may be successfully achieved via smaller incisions, but functional improvement, discharge to home, patient satisfaction, and analgesic requirement may be similar regardless of the length of the incision.

    • Keywords:
    • Arthroplasty

    • Replacement

    • Hip|Hip Joint|Humans|Joint Diseases|Surgical Procedures

    • Minimally Invasive|Treatment Outcome

    • Subspecialty:
    • Adult Reconstruction

    • Pain Management

The halo fixator.

The halo fixator may be used for the definitive treatment of cervical spine trauma, preoperative reduction in the patient with spinal deformity, and adjunctive postoperative stabilization following cervical spine surgery. Halo fixation decreases cervical motion by 30% to 96%. Absolute contraindications include cranial fracture, infection, and severe soft-tissue injury at the proposed pin sites. Relative contraindications include severe chest trauma, obesity, advanced age, and a barrel-shaped chest. In children, a computed tomography scan of the head should be obtained before pin placement to determine cranial bone thickness. Complications of halo fixation include pin loosening, pin site infection, and skin breakdown. A concerning rate of life-threatening complications, such as respiratory distress, has been reported in elderly patients. Despite a paucity of contemporary data, recent retrospective studies have demonstrated acceptable results for halo fixation in managing some upper and lower cervical spine injuries.

    • Keywords:
    • Braces|Cervical Vertebrae|Equipment Design|Fracture Fixation|Humans|Posture|Spinal Fractures

    • Subspecialty:
    • Trauma

    • Pediatric Orthopaedics

    • Spine

The pediatric triplane ankle fracture.

The pediatric triplane ankle fracture represents a unique spectrum of injury that does not fit neatly into the Salter-Harris classification of physeal injury. This fracture is particular to the pediatric population and often is termed a transitional injury. It is the result of the characteristic asymmetric closure of the distal tibial physis over a period of approximately 18 months. The triplane ankle fracture is a multiplanar injury with three classically described fracture fragments. It has several variations and represents 5% to 10% of pediatric intra-articular ankle injuries. The fracture typically presents in children aged 12 to 15 years; incidence is slightly higher in boys than in girls. Nondisplaced triplane fractures and extra-articular fractures can be managed with immobilization in a long leg cast. Displaced fractures are treated with open reduction and internal fixation performed through an anterolateral approach or an anteromedial approach. Intra-articular reduction to within 2 mm is required for optimal treatment of these unique pediatric ankle fractures.

    • Keywords:
    • Ankle Injuries|Child|Fracture Fixation

    • Internal|Humans|Tibial Fractures|Trauma Severity Indices

    • Subspecialty:
    • Trauma

    • Foot and Ankle

    • Pediatric Orthopaedics

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