JAAOS

JAAOS, Volume 16, No. 9


Coronoid process fracture.

The coronoid process is one of the main constraints providing ulnohumeral joint stability. The coronoid process and the radial head provide a buttress against posterior displacement of the elbow joint. Fracture of the coronoid process can be either an isolated finding following elbow dislocation or part of a more complex fracture-dislocation. Much attention has been focused on treatment of radial head fractures and lateral ligament reconstruction, although recently, attention has been directed at detection and treatment of coronoid fractures. Surgical approaches to coronoid fractures depend on the condition of the radial head. When an associated radial head fracture is present, a lateral approach to the coronoid fracture is often performed. An isolated coronal fracture is typically approached from the medial side. Intraoperative stress testing may be helpful in assessing the need for surgery and choosing the surgical approach.

    • Keywords:
    • Biomechanics|Diagnostic Imaging|Elbow Joint|Fracture Fixation|Humans|Radius Fractures|Ulna Fractures

    • Subspecialty:
    • Trauma

    • Shoulder and Elbow

    • Basic Science

Design features of current total ankle replacements: implants and instrumentation.

Development of total ankle replacements began nearly 40 years ago. The initial devices were cemented and highly constrained, and they eventually failed. These were followed by second-generation cementless ankle implants with a fixed (two-component design) or mobile (three-component design) polyethylene bearing. Currently, four ankle replacements are approved by the US Food and Drug Administration. These four-Agility, INBONE, Salto-Talaris, and Eclipse-are two-component designs; the Scandinavian Total Ankle Replacement, a three-part mobile-bearing design, has been recommended for approval by the FDA. It is anticipated to arrive in the US market in late 2008. Although interest in total ankle replacements is increasing, midterm clinical results to date are few and often have not been validated by independent practitioners. In addition, no level I or II studies have been published. Therefore, the design rationale for these implants and instruments should be carefully evaluated.

    • Keywords:
    • Ankle Joint|Arthroplasty

    • Replacement|Biomechanics|Humans|Joint Prosthesis|Prosthesis Design

    • Subspecialty:
    • Foot and Ankle

    • Clinical Practice Improvement

Management of radiation-associated fractures.

High-dose radiation is injurious to bone and is a known risk factor for the development of late fracture. Management of radiation-induced fractures is generally thought to be difficult, with prolonged healing times and a high nonunion rate. There is a relative paucity of literature to guide treatment. Fractures of the long bones typically should be managed with intramedullary nailing. A low threshold should exist for supplemental bone grafting, and a vascularized fibula graft should be considered for persistent nonunion. To prevent refracture, fixation should be left in situ indefinitely. Resection of the fracture site and reconstruction with an oncologic endoprosthesis is an effective salvage procedure. Periarticular fractures should be treated with joint arthroplasty, which allows early mobilization and avoids prolonged healing times. Fractures of expendable bones, primarily the clavicle, typically should be managed with débridement or resection.

    • Keywords:
    • Fractures

    • Bone|Humans|Osteoradionecrosis|Radiotherapy|Wound Healing

    • Subspecialty:
    • Trauma

    • Musculoskeletal Oncology

Neuromuscular control of trunk stability: clinical implications for sports injury prevention.

Recent prospective evidence supports the hypothesis that impaired trunk control is a contributing factor to sports injuries of the spine as well as to segments of the kinetic chain. The current concepts regarding neuromuscular control of trunk stability are best described from a systems engineering perspective. In the analysis of current neuromuscular training protocols for sports injury prevention, these principles are applied to identify components that optimize neuromuscular control of trunk stability. Current perspectives of neuromuscular learning can be applied clinically to aid in the formulation of injury prevention strategies.

    • Keywords:
    • Athletic Injuries|Humans|Muscle Strength|Physical Education and Training|Sports|Thorax

    • Subspecialty:
    • Sports Medicine

    • Spine

Posterolateral corner injury of the knee: evaluation and management.

Posterolateral corner injury, an increasingly recognized entity, is commonly associated with concomitant ligament disruptions. Prompt recognition is critical for several reasons. Missed posterolateral corner injuries increase the failure rates for both anterior and posterior cruciate ligament reconstructions. Also, untreated posterolateral corner injuries lead to chronic disability. Acute (ie, immediate) surgical intervention results in superior outcomes compared with chronic (ie, late) reconstruction. Although no universal classification system has been adopted, attention to both varus and rotational stability is critical. Multiple options exist for posterolateral corner reconstruction, although recent trends have shifted toward anatomic reconstruction techniques.

    • Keywords:
    • Biomechanics|Diagnostic Imaging|Humans|Knee Injuries|Knee Joint

    • Subspecialty:
    • Sports Medicine

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