JAAOS

JAAOS, Volume 3, No. 6


Genu Varum in Children: Diagnosis and Treatment.

Genu varum is a relatively common finding in children. Physiologic bowing, which is seen most often, has a well-documented favorable natural history. Idiopathic tibia vara is the most common of the pathologic conditions that are associated with bowed legs; treatment strategies vary with the patient's age and the stage of disease and deformity. Genu varum may also accompany systemic conditions, such as achondroplasia, vitamin D-resistant rickets, renal osteodystrophy, and osteogenesis imperfecta-all of which can result in short stature. Indications for intervention are not always well defined. A rare disorder, focal fibrocartilaginous dysplasia, usually requires no treatment. Standing radiographs of the entire lower limbs are necessary for surgical planning, as the deformity can sometimes affect the distal femur rather than the proximal tibia. Restoration of the mechanical axis of the limb is the principal goal of treatment; the particular type of internal fixation is of secondary importance.

      • Subspecialty:
      • Trauma

      • Pediatric Orthopaedics

    Paget's Disease of Bone: Pathophysiology, Diagnosis, and Management.

    Paget's disease of bone is a common geriatric disorder of skeletal remodeling, which may have a viral etiology. Safe and effective treatments are now available for associated complications of symptomatic involvement. The orthopaedic surgeon should have a fundamental understanding of the complications of Paget's disease and should be familiar with the indications for treatment, as well as available medical and surgical therapies.

        • Subspecialty:
        • Musculoskeletal Oncology

        • Basic Science

      Running Injuries to the Knee.

      Approximately one third of serious runners will incur an injury in a given year, and approximately one third of the injuries will involve the knee. Biomechanical studies on running reveal the tremendous cyclic forces to which the knee is subjected. There are several etiologic factors involved, including training errors, anatomic and biomechanical variations, and differences in shoes and running surfaces. Training errors, particularly rapid transitions in training, are responsible for two thirds of injuries. Knee injuries in runners must be approached with a thorough review of the training program and a complete examination of the lower extremity. Several conditions can cause anterior knee pain commonly involving the extensor mechanism, and these must be differentiated. Most knee injuries can be resolved with conservative treatment, but occasionally surgery is indicated. After a layoff due to injury or surgery, appropriate rehabilitation, including a graduated return to running, is essential to avoid reinjury.

          • Subspecialty:
          • Sports Medicine

        Scapular Winging.

        Scapular winging, one of the more common scapulothoracic disorders, is caused by a number of pathologic conditions. It can be classified as primary, secondary, or voluntary. Primary scapular winging may be due to neurologic injury, pathologic changes in the bone, or periscapular soft-tissue abnormalities. Secondary scapular winging occurs as a result of glenohumeral and subacromial conditions and resolves after the primary pathologic condition has been addressed. Voluntary scapular winging is not caused by an anatomic disorder and may be associated with underlying psychological issues. The evaluation and treatment of these three types are discussed.

            • Subspecialty:
            • Shoulder and Elbow

          Thoracolumbar Spine Trauma: I. Evaluation and Classification.

          A timely and thorough evaluation of thoracolumbar injuries and rational treatment based on a complete understanding of the mechanism of bone, soft-tissue, and nerve injury is essential for maximizing the patient's neurologic and functional recovery and minimizing associated complications, the time to recovery, and the problems of long-term pain and deformity. The initial evaluation includes both clinical and radiologic assessment. Clinical evaluation includes the general trauma examination as well as a detailed spinal and neurologic examination to determine the level (or levels) of spinal injury. Radiologic evaluation includes both plain radiography and the appropriate use of advanced imaging modalities. A review of the evolution of thoracolumbar injury classifications is presented.

              • Subspecialty:
              • Trauma

              • Spine

            Thoracolumbar Spine Trauma: II. Principles of Management.

            The care of patients with thoracolumbar spine trauma with or without neurologic deficits has evolved dramatically over the past 20 years with the emergence of tertiary-care spinal injury centers and the development of more effective spinal instrumentation and anesthesia techniques. Despite these advances, the majority of patients with thoracolumbar injuries are still treated nonoperatively with cast or brace immobilization and early ambulation. More aggressive treatment is guided by the use of classification systems that detail the mechanism of injury, the degree of compromise of spinal structures, and the potential for late mechanical instability or neural injury. The goal of treatment remains attainment of spinal stability with protection or improvement of the patient's neurologic status, allowing rapid and maximal functional recovery.

                • Subspecialty:
                • Trauma

                • Spine

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