JAAOS

JAAOS, Volume 9, No. 6


Acute hand and wrist injuries in athletes: evaluation and management.

Acute hand and wrist injuries in the athlete constitute a unique orthopaedic challenge. Because of the particular demands on the athlete (e.g., financial implications, coaching and administration pressures, self-esteem issues), a specialized management approach is often necessary. Common sites of injury include the ulnar collateral ligament of the thumb metacarpophalangeal joint, proximal interphalangeal joint, metacarpals and phalanges, scaphoid, hamate, and distal radius. Treatment of these injuries varies depending on the patient's age, sport, position played, and level of competition, but departures from standard practice as regards surgery, rehabilitation, and return to competition should never compromise care.

    • Keywords:
    • Acute Disease|Adolescent|Adult|Athletic Injuries|Child|Female|Follow-Up Studies|Hand Injuries|Humans|Injury Severity Score|Male|Recovery of Function|Risk Assessment|Treatment Outcome|Wrist Injuries

    • Subspecialty:
    • Sports Medicine

    • Hand and Wrist

Cervical spondylotic myelopathy: diagnosis and treatment.

The delineation of cervical spondylotic myelopathy as a clinical entity has improved with the development of high-quality cross-sectional neuroradiologic imaging. The natural history of this disorder is usually slow deterioration in a stepwise fashion, with worsening symptoms of gait abnormalities, weakness, sensory changes, and often pain. The diagnosis can usually be made on the basis of findings from the history, physical examination, and plain radiographs, but confirmation by magnetic resonance imaging or computed tomography and myelography is necessary. Minimal symptoms without hard evidence of gait disturbance or pathologic reflexes warrant nonoperative treatment, but patients with demonstrable myelopathy and spinal cord compression are candidates for operative intervention. Both anterior and posterior approaches have been utilized for surgical treatment of cervical myelopathy. Anterior decompression frequently requires corpectomy at one or more levels and strut grafting with bone from the ilium or fibula. Multilevel laminectomies were initially used for posterior decompression but now are either combined with fusion or replaced by laminoplasty. Any operative technique requires proper patient selection and demands adequate decompression of the canal to effect neurologic improvement. Perioperative complications can be devastating in this group of high-risk patients with cervical spondylotic myelopathy, but careful attention to detail, meticulous technique, and experience can result in excellent outcomes.

    • Keywords:
    • Adult|Cervical Vertebrae|Female|Humans|Laminectomy|Magnetic Resonance Imaging|Male|Middle Aged|Physical Therapy Modalities|Prognosis|Risk Assessment|Spinal Cord Compression|Spinal Cord Diseases|Spinal Osteophytosis

    • Subspecialty:
    • Spine

Closed-chain rehabilitation for upper and lower extremities.

Closed-chain exercise protocols are used extensively in rehabilitation of knee injuries and are increasingly used in rehabilitation of shoulder injuries. They are felt to be preferable to other exercise programs in that they simulate normal physiologic and biomechanical functions, create little shear stress across injured or healing joints, and reproduce proprioceptive stimuli. Because of these advantages, they may be used early in rehabilitation and have been integral parts of "accelerated" rehabilitation programs. The authors review the important components of a closed-chain rehabilitation program and provide examples of specific exercises that are used for rehabilitation of knee and shoulder injuries.

    • Keywords:
    • Arm|Exercise Therapy|Female|Humans|Joint Diseases|Leg|Male|Musculoskeletal Diseases|Prognosis|Rehabilitation|Sensitivity and Specificity|Treatment Outcome

    • Subspecialty:
    • Sports Medicine

    • Shoulder and Elbow

    • Basic Science

Developmental dysplasia of the hip from six months to four years of age.

Developmental dysplasia of the hip (DDH) denotes a wide spectrum of pathologic conditions, ranging from subtle acetabular dysplasia to irreducible hip dislocation. When DDH is recognized in the first 6 months of life, treatment with a Pavlik harness frequently results in an excellent outcome. In children older than 6 months, achieving a concentrically reduced hip while minimizing complications is more challenging. Bracing, traction, closed reduction, open reduction, and femoral or pelvic osteotomies are frequently used treatment modalities for children aged 6 months to 4 years. In the past, treatment recommendations have often been based on the patient's age. However, recent practice has placed more emphasis on addressing the specific disorder and avoiding iatrogenic osteonecrosis. The incidence of osteonecrosis of the femoral head has been reduced by avoiding immobilization of the hip in extreme abduction and by using femur-shortening osteotomies when appropriate. Pelvic osteotomy continues to gain favor for the treatment of selected patients over 18 months of age.

    • Keywords:
    • Acetabulum|Child Development|Child

    • Preschool|Female|Hip|Hip Dislocation

    • Congenital|Humans|Infant|Male|Orthopedic Procedures|Prognosis|Range of Motion

    • Articular|Rehabilitation|Risk Assessment|Treatment Outcome

    • Subspecialty:
    • Pediatric Orthopaedics

Mobile bearings in primary knee arthroplasty.

Mobile-bearing knee arthroplasty (MBKA) has potential advantages compared with conventional fixed-bearing total knee arthroplasty (TKA). By allowing unconstrained axial rotation, MBKA can offer greater articular conformity without an increased probability of loosening due to increased axial torque. Increased articular conformity minimizes polyethylene contact stresses, thereby reducing linear wear and subsurface fatigue failure. Axial rotation of the platform also enables self-correction of tibial component malrotation. Despite these advantages, the long-term clinical results obtained with current MBKA devices are similar to those obtained with well-designed fixed-bearing TKA prostheses, with no data suggesting their superiority. The disadvantages of MBKA include bearing dislocation and breakage, soft-tissue impingement, a steep technique learning curve, and concerns about volumetric wear. Hypothetically, longer-term follow-up of MBKA results may reveal a significant difference from fixed-bearing TKA results as the fatigue failure threshold of incongruent polyethylene is exceeded.

    • Keywords:
    • Biomechanics|Female|Humans|Knee Prosthesis|Male|Prosthesis Design|Prosthesis Failure|Prosthesis Fitting|Range of Motion

    • Articular|Sensitivity and Specificity|Stress

    • Mechanical|Weight-Bearing

    • Subspecialty:
    • Adult Reconstruction

Recreational injuries in children: incidence and prevention.

Participation in eight common types of recreational activities leads annually to more than 2 million medically treated musculoskeletal injuries in children aged 5 to 14 years. Many of these injuries could have been prevented if current safety guidelines and protective equipment had been used. Studies have demonstrated the value of safety education programs in preventing injuries. Parents consider their child's physician an important source of safety education, and orthopaedic surgeons have a unique opportunity to provide injury prevention counseling. The American Academy of Orthopaedic Surgeons recognizes the importance of injury prevention and has developed advocacy programs that are readily available to physicians and the public. Individual orthopaedists should be involved in injury prevention through patient education, research, community programs, and regulatory efforts that promote safe play for children.

    • Keywords:
    • Adolescent|Age Distribution|Athletic Injuries|Child|Child

    • Preschool|Female|Humans|Incidence|Male|Recreation|Risk Assessment|Risk Factors|Sex Distribution|Sports|United States

    • Subspecialty:
    • Sports Medicine

    • Pediatric Orthopaedics

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