JAAOS

JAAOS, Volume 16, No. 1


Cast and splint immobilization: complications.

During the past three decades, internal fixation has become increasingly popular for fracture management and limb reconstruction. As a result, during their training, orthopaedic surgeons receive less formal instruction in the art of extremity immobilization and cast application and removal. Casting is not without risks and complications (eg, stiffness, pressure sores, compartment syndrome); the risk of morbidity is higher when casts are applied by less experienced practitioners. Certain materials and methods of ideal cast and splint application are recommended to prevent morbidity in the patient who is at high risk for complications with casting and splinting. Those at high risk include the obtunded or comatose multitrauma patient, the patient under anesthesia, the very young patient, the developmentally delayed patient, and the patient with spasticity.

    • Keywords:
    • Casts

    • Surgical|Compartment Syndromes|Contracture|Fracture Fixation|Humans|Paralysis|Skin Diseases|Splints

    • Subspecialty:
    • Trauma

Management of lateral epicondylitis: current concepts.

Lateral epicondylitis, or tennis elbow, is a common cause of elbow pain in the general population. Traditionally, lateral epicondylitis has been attributed to degeneration of the extensor carpi radialis brevis origin, although the underlying collateral ligamentous complex and joint capsule also have been implicated. Nonsurgical treatment, the mainstay of management, involves a myriad of options, including rest, nonsteroidal anti-inflammatory drugs, physical therapy, cortisone, blood and botulinum toxin injections, supportive forearm bracing, and local modalities. For patients with recalcitrant disease, the traditional open débridement technique has been modified by multiple surgeons, with others relying on arthroscopic or even percutaneous procedures. Without a standard protocol (nonsurgical or surgical), surgeons need to keep abreast of established and evolving treatment options to effectively treat patients with lateral epicondylitis.

    • Keywords:
    • Anti-Inflammatory Agents

    • Non-Steroidal|Arthroscopy|Debridement|Humans|Patient Care|Physical Therapy Modalities|Rest|Tennis Elbow

    • Subspecialty:
    • Sports Medicine

    • Shoulder and Elbow

Psychiatric aspects of orthopaedics.

Although psychiatric problems are seen less frequently than previously, the orthopaedic surgeon must remain aware of their possible effect. A high index of suspicion for the presence of psychiatric disorders is important in treating the orthopaedic patient with multiple trauma, chronic disease, factitious disorder, or suspected malingering or who fails to improve with recognized treatment. Recognition of a psychiatric problem should be part of preoperative planning in orthopaedic practice, and a formal psychiatric referral for diagnosis and treatment should be made for the patient with significant psychiatric involvement. When associated psychiatric disease is diagnosed and controlled before orthopaedic treatment commences, the patient is more likely to comply with the treatment regimen, which may lead to better results.

    • Keywords:
    • Bone Diseases|Bone and Bones|Humans|Mental Disorders|Orthopedics|Wounds and Injuries

    • Subspecialty:
    • Trauma

    • General Orthopaedics

    • Clinical Practice Improvement

Unicompartmental knee arthroplasty.

Recent increased interest in less invasive surgical techniques has led to a concurrent resurgence in unicompartmental knee arthroplasty. The procedure has evolved significantly over the past three decades. Proponents of unicompartmental knee arthroplasty cite as advantages lower perioperative morbidity and earlier recovery. Both clinical outcome and kinematic studies have indicated that successful unicompartmental knee arthroplasty functions closer to a normal knee. Recent reports have demonstrated success in expanding the classic indications of unicompartmental knee arthroplasty to younger and heavier patients. Both fixed- and mobile-bearing implants can yield excellent clinical outcomes at >10 years, but with different modes of long-term failure. Proper execution of surgical technique remains critical to optimizing outcome. Long-term studies are needed to appropriately define the role of less invasive unicompartmental surgical approaches as well as the role of computer navigation.

    • Keywords:
    • Arthroplasty

    • Replacement

    • Knee|Humans|Osteoarthritis

    • Knee|Prosthesis Design|Prosthesis Failure|Surgery

    • Computer-Assisted|Surgical Procedures

    • Minimally Invasive

    • Subspecialty:
    • Adult Reconstruction

Xenotransplantation in orthopaedic surgery.

We define xenotransplantation as including any procedure that involves the transplantation, implantation, or infusion into a human recipient of cells, tissues, or organs from a nonhuman animal source or of human body fluids, cells, tissues, or organs that have had ex vivo contact with nonhuman animal cells, tissues, or organs. The current FDA definition of xenotransplantation relates to procedures involving live, nonhuman materials. The proposed use of xenotransplanted tissues for treatment of a wide variety of human diseases is increasing. In orthopaedic surgery, a number of xeno-based products for treatment of musculoskeletal conditions have been cleared by the FDA. Commercially available products include those used as alternatives for bone, cartilage, and soft-tissue repair. Most xenografts are from bovine- or porcine-derived sources. Studies internationally have demonstrated a low relative risk of disease transmission, although there is concern regarding the potential for transmission into humans of agents not considered pathogenic or not detected in animals.

    • Keywords:
    • Animals|Cattle|Guidelines as Topic|Humans|Orthopedics|Risk Factors|Swine|Transplantation

    • Heterologous|United States|United States Food and Drug Administration

    • Subspecialty:
    • Sports Medicine

    • General Orthopaedics

    • Clinical Practice Improvement

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