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Flatfoot in the Adult.

Flatfoot in the adult has long been a poorly understood "wastebasket" diagnosis, often used to unfairly deny asymptomatic individuals equal employment opportunities in our society. Now that flatfoot has been classified into a variety of congenital and acquired conditions, the parameters for assessment have been well defined, and rational treatment protocols have been established. Clearly, if the foot painlessly supinates/inverts to become a rigid lever for push-off and pronates/everts to absorb stress during stance, then it "functions normally" no matter what the height of the arch. However, the biomechanically offset position of pes planus with excessive heel valgus coupled with rigidity or instability can alter the connected interplay of the bones of the foot and weaken the entire kinetic chain of the lower extremity. Careful clinical and radiographic evaluation, coupled with a thorough understanding of the anatomy and biomechanics of the foot, will allow accurate evaluation and appropriate treatment.

Periprosthetic Fractures About the Knee

More than 400,000 total knee arthroplasty (TKA) procedures are performed annually in the United States, most on elderly patients. With the increasing life expectancy and heightened activity levels of the elderly population, the number of patients who undergo TKA procedures will likely double over the course of the next decade and result in an increased incidence of periprosthetic knee fractures. The prevalence of these fractures varies considerably among fracture location, patient predisposition to risk factors, and intraoperative and postoperative fracture incidence. Treatment options vary based on the fracture type and whether the fracture is identified intraoperatively or postoperatively. Use of appropriate bone cuts, proper positioning and gentle impaction of the components, meticulous care in removal of components and cement, and avoidance of stress risers help prevent periprosthetic fractures about the knee. Surgical treatment can include the use of Rush rods, Zickel supracondylar rods, plate and screw fixation, or supracondylar intramedullary rods.

Recognition and Treatment of Leg Pain in Athletes

Leg pain is a common complaint among athletes in running and jumping sports, and can be a significant, even career-ending, disability. Clinical conditions considered in the differential diagnosis of leg pain in an athlete include medial tibial stress syndrome, stress fracture, chronic exertional compartment syndrome, and popliteal artery entrapment syndrome. Although the sources of leg pain in the athlete are varied, a thorough history and physical examination can help define contributing factors, of which duration, location, and intensity of the pain and its pattern with respect to activity level are most important. Additional testing depends on the differential diagnosis, but includes radiography in most patients and selected use of other imaging modalities. Treatment for most conditions is conservative and involves rest or a change in training regimen.

Proximal Humerus Fractures

Proximal humerus fractures make up approximately 5% of all fractures in adults and occur primarily in the elderly population, typically as a result of low-energy falls. Younger patients may sustain these injuries due to higher-energy mechanisms. Women are more commonly affected than men, by a ratio varying from 2:1 to 5:1. Approximately three fourths of proximal humerus fractures have only minor displacement and should be managed nonsurgically. This article reviews the identification and surgical treatment of displaced fractures of the proximal humerus.