JAAOS

JAAOS, Volume 20, No. 12


Dropped Head Syndrome: Etiology and Management

Dropped head syndrome (DHS) is characterized by severe weakness of the cervical paraspinal muscles that results in the passively correctable chin-on-chest deformity. DHS is most commonly associated with neuromuscular disorders. However, it is not always accompanied by electromyographic findings or noticeable changes on muscle biopsy. In such cases, the term isolated neck extensory myopathy (INEM) is used instead. The literature on the management of INEM is limited. Most reports suggest that nonsurgical interventions help to stabilize the deformity. The literature on surgical management of INEM is limited and mixed, with outcomes ranging from poor to excellent. The prevalence of DHS likely will increase as life expectancy increases. Recent advances in our understanding of sagittal malalignment and surgical techniques have improved our ability to provide better quality of life for patients with cervical deformity.

      • Subspecialty:
      • Spine

    Elder Abuse: An Update on Prevalence, Identification, and Reporting for the Orthopaedic Surgeon

    Elder abuse is an underestimated mechanism of musculoskeletal injury and is of significant concern in geriatric and rapidly aging populations of the United States. Abuse can occur in a home or institutional setting and may include physical, sexual, emotional, or financial abuse as well as neglect or abandonment. Elderly persons with shared living arrangements, those with a history of domestic violence, and those with cognitive impairment are at high risk of abuse. Prevalence studies in the United States estimate that more than 1 million elderly persons are victims of abuse annually, and up to 25% have been physically abused. Multiple fractures, inconsistent histories, bruising, dehydration, and malnutrition are indications of abuse that can be identified by the orthopaedic surgeon. Elder abuse is often overlooked and is severely underreported. Because physicians are required to report abuse to agencies such as Adult Protective Services, awareness of its prevalence is essential, and the orthopaedic surgeon must know how best to identify, treat, and report elder abuse.

        • Subspecialty:
        • Trauma

      Heat- and Cold-induced Injuries in Athletes: Evaluation and Management

      Both extreme heat and cold can be challenging for athletes during training and competition. One role of the team physician is to educate coaches and athletes on the risks of exposure to these conditions and how to best prevent and manage their adverse effects. Heat illness varies in degree from mild to severe, with the most severe forms being potentially fatal. Cold exposure can result in systemic effects and peripheral injury to the extremities.

          • Subspecialty:
          • Sports Medicine

        MRI Techniques: A Review and Update for the Orthopaedic Surgeon

        MRI plays a critical role in all orthopaedic practices. A basic working knowledge of the most commonly used pulse sequences in musculoskeletal imaging and the appearance of normal tissues on those sequences is critical to confident MRI interpretation. The orthopaedic surgeon should be familiar with appropriate use of intravenous and intra-articular contrast and its limitations. Concepts key to MRI interpretation include image contrast and resolution, signal, noise, and pulse sequence. Recent advances in anatomic and functional imaging highlight the robust potential of MRI for musculoskeletal evaluation. As MRI technology evolves, the orthopaedic surgeon must stay current on these technologic advances to use this tool to its fullest potential.

            • Subspecialty:
            • Basic Science

          Perioperative Pain Control in Pediatric Patients Undergoing Orthopaedic Surgery

          Management of perioperative pain is critical in the pediatric patient undergoing orthopaedic surgery. A variety of modalities can be used to manage pain and optimize recovery and patient satisfaction, including nonopioid and opioid analgesia; local anesthetic injection; and regional analgesia such as intrathecal morphine, epidural therapy, and peripheral nerve blocks. Acute pain management can be tailored based on the needs of the patient, the surgical site, and the anticipated level of postoperative pain. A preoperative discussion of the plan for perioperative pain control with the patient, his or her parents, and the anesthesiologist can help manage expectations and maximize patient satisfaction.

              • Subspecialty:
              • Pediatric Orthopaedics

            Radiographic Methods of Wear Analysis in Total Hip Arthroplasty

            Polyethylene wear is an important factor in failure of total hip arthroplasty (THA). With increasing numbers of THAs being performed worldwide, particularly in younger patients, the burden of failure and revision arthroplasty is increasing, as well, along with associated costs and workload. Various radiographic methods of measuring polyethylene wear have been developed to assist in deciding when to monitor patients more closely and when to consider revision surgery. Radiographic methods that have been developed to measure polyethylene wear include manual and computer-assisted plain radiography, two- and three-dimensional techniques, and radiostereometric analysis. Some of these methods are important in both clinical and research settings. CT has the potential to provide additional information on component orientation and enables assessment of periprosthetic osteolysis, which is an important consequence of polyethylene wear.

                • Subspecialty:
                • Adult Reconstruction

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