JAAOS

JAAOS, Volume 15, No. 7


Amniotic band syndrome of the upper extremity: diagnosis and management.

Amniotic band syndrome, a condition involving fetal entrapment in strands of amniotic tissue, causes an array of deletions and deformations. Band formation most frequently affects the distal segments, including the hand. Because of the heterogeneous nature of expression of this disease, treatment is individualized. Timing of repair and surgical planning are important in improving functional outcome. In the patient with distal edema and acrosyndactyly, early repair portends better prognosis. Improvements in prenatal diagnosis and fetoscopic surgical technique may eventually allow treatment of amniotic band syndrome in utero.

    • Keywords:
    • Amniotic Band Syndrome|Diagnosis

    • Differential|Fetal Diseases|Fetoscopy|Humans|Infant

    • Newborn|Prenatal Diagnosis|Prognosis|Upper Extremity

    • Subspecialty:
    • Shoulder and Elbow

    • Hand and Wrist

Correspondence

    • Keywords:
    • Aged|Data Collection|Economics|Education

    • Medical

    • Graduate|Forecasting|Health Services Needs and Demand|Humans|Internship and Residency|Models

    • Theoretical|Needs Assessment|Orthopedics|Patient-Centered Care|Physicians|Population Dynamics|Professional Practice|United States

    • Subspecialty:
    • Clinical Practice Improvement

Disasters and mass casualties: I. General principles of response and management.

Disaster planning and response to a mass casualty incident pose unique demands on the medical community. Because they would be required to confront many casualties with bodily injury and surgical problems, surgeons in particular must become better educated in disaster management. Compared with routine practice, triage principles in disasters require an entirely different approach to evaluation and care and often run counter to training and ethical values. An effective response to disaster and mass casualty events should focus on an "all hazards" approach, defined as the ability to adapt and apply fundamental disaster management principles universally to any mass casualty incident, whether caused by people or nature. Organizational tools such as the Incident Command System and the Hospital Incident Command System help to effect a rapid and coordinated response to specific situations. The United States federal government, through the National Response Plan, has the responsibility to respond quickly and efficiently to catastrophic incidents and to ensure critical life-saving assistance. International medical surgical response teams are capable of providing medical, surgical, and intensive care services in austere environments anywhere in the world.

    • Keywords:
    • Disaster Planning|Disasters|Emergency Medical Service Communication Systems|Emergency Medical Services|Humans|Orthopedics|Patient Care Team|Physicians Role|Transportation of Patients|Triage|United States

    • Subspecialty:
    • Trauma

    • Clinical Practice Improvement

Fractures of the radial head and neck: current concepts in management.

Despite advances in surgical techniques, fractures of the radial head are challenging to manage. Most radial head fractures can be managed nonsurgically, with emphasis on early motion to achieve good results. Treatment of more complex radial head fractures, however, especially those associated with elbow instability, remains controversial. The choice for such injury is between open reduction and internal fixation and arthroplasty. Modern implants and techniques have led to improvements in both of these technically demanding procedures. With proper care and understanding of the mechanism of elbow function, better long-term results can be achieved. The current literature suggests that the Mason classification guides choice of the best treatment modality to achieve optimal long-term function. Fracture complexity also should be used as a guide when selecting treatment, and proper surgical technique is critical for success.

    • Keywords:
    • Arthroplasty|Biomechanics|Fracture Fixation

    • Internal|Humans|Internal Fixators|Postoperative Complications|Prostheses and Implants|Radius Fractures

    • Subspecialty:
    • Trauma

    • Shoulder and Elbow

    • Hand and Wrist

Surgical management of pelvic sarcoma in children.

Survival rates of children with pelvic sarcoma have demonstrated unprecedented improvement during the past few decades, with a corresponding increase in the number of limb-sparing surgical procedures being performed. This increase may be attributed to earlier detection with advanced imaging techniques, the availability of a wider armamentarium of surgical techniques of reconstruction and limb salvage, and advances achieved in neoadjuvant chemotherapy and radiation therapy. Undertaking reconstruction after resection of pelvic sarcoma while preserving function of the hip and limb can be extremely challenging; this is especially true in children, who invite concern regarding growth potential and limb-length discrepancy. Decisions for surgery and reconstruction are individualized based on tumor type, size, and location as well as the probability of achieving a wide resection with negative margins and acceptable morbidity.

    • Keywords:
    • Arthroplasty|Biopsy|Child|Decision Making|Diagnostic Imaging|Humans|Limb Salvage|Pelvic Neoplasms|Reconstructive Surgical Procedures|Sarcoma

    • Subspecialty:
    • Pediatric Orthopaedics

    • Spine

    • Musculoskeletal Oncology

The athlete with muscular cramps: clinical approach.

Muscle cramps are involuntary, painful, spasmodic contractions of the skeletal muscle. Although cramps are a common clinical complaint, their etiology and management have not been well established. Exercise-associated muscle cramps occur during or immediately following exercise, and they are associated with muscular fatigue and shortened muscle contraction. The main challenges for treating physicians are to identify whether the complaint represents a true muscle cramp as well as to rule out the presence of an underlying serious clinical condition. Muscle cramps may be a symptom of any of several conditions, including radiculopathies, Parkinson's disease, hypothyroidism, diabetes mellitus, vascular problems, electrolyte disorders, and metabolic myopathies. Cramps also may occur as a side effect of certain drugs (eg, lipid-lowering agents, antihypertensives, beta-agonists, insulin, oral contraceptives, alcohol). Most athletes who experience exercise-associated muscle cramps are healthy individuals without systemic illness. Therapy should focus on preventing premature fatigue by means of appropriate nutrition and adequate training.

    • Keywords:
    • Acute Disease|Diagnosis

    • Differential|Humans|Muscle Cramp|Muscle Fatigue|Recurrence|Sports

    • Subspecialty:
    • Sports Medicine

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