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Decellular Nerve Allografts

Multiple treatment options are available for patients who have peripheral nerve injuries with a gap. Decellular nerve allografts are one option and provide an extracellular scaffold for neuronal cells to migrate for axonal regrowth. Immunosuppression is not needed because improved nerve processing technologies have rendered decellular nerve allografts nonimmunogenic. These allografts have also shown promising results in both animal and human studies as an alternative repair option.

Collateral Ligament Injuries of the Thumb Metacarpophalangeal Joint

The ulnar and radial collateral ligaments are primary stabilizers of the thumb metacarpophalangeal (MP) joint. Injury to these ligaments can lead to instability and disability. Stress testing is essential to establish the diagnosis. Complete tear is diagnosed on physical examination when the proximal phalanx of the thumb can be angulated ulnarly or radially on the metacarpal head by 30 to 35 with the MP joint in either zero degrees of extension or 30 of flexion. Lack of a firm end point or angulation measuring >15 on stress testing compared with the contralateral thumb MP joint are also indicative of complete tear. Partial ligament injuries may be managed nonsurgically, but complete tears are usually managed surgically. Various techniques are used to reattach the ligament to bone, including suture anchors and, less commonly, repair of midsubstance tears. Options for managing chronic injuries include ligament repair, ligament reconstruction with a free tendon graft, and arthrodesis of the MP joint.

Evaluation of Idiopathic Scoliosis

Scoliosis is a multiplanar spinal deformity characterized by a lateral curvature in the coronal plane, lordosis in the sagittal plane, and rotational abnormality in the axial plane. The deformity may present in pediatric patients of any age and is typically classified according to age of onset as infantile (<3 years of age), juvenile (3 to 10 years of age), or adolescent (>10 years of age). A two-part classification has been proposed that divides the population into two sets: early onset (<5 years of age) and late onset (>5 years of age) scoliosis. Although this two-part classification is simpler and likely more clinically relevant, the three-part classification is used in this review given its prevalence in the available scoliosis literature. The critical components of the evaluation of the patient with idiopathic scoliosis are discussed, and the current understanding of the etiology and pathophysiology of the disease are reviewed. The central components of the history, physical examination, and radiographic evaluation of the patient with idiopathic scoliosis are also detailed.