JAAOS, Volume 14, No. 11

Metastatic disease of the spine.

Metastatic spine disease accounts for 10% to 30% of new cancer diagnoses annually. The most frequent presentation is axial pain. A thorough spinal examination includes assessment of local tenderness, deformity, limitation of motion, and signs of nerve root or cord compression. Plain radiographs are obtained routinely; for a suspected or known malignancy, radionuclide studies are essential. Magnetic resonance imaging is more specific than bone scans. Computed tomography-guided biopsy is considered to be safe and accurate for evaluating spinal lesions. Treatment is multidisciplinary, and virtually all treatment is palliative. Management is guided by three key issues: neurologic compromise, spinal instability, and individual patient factors. Site-directed radiation, with or without chemotherapy, is the mainstay of treating painful lesions that are not impinging on neural elements. New data documenting the benefit of surgical decompression using improved techniques such as anterior approaches have amplified the role of the spine surgeon in the care of these patients.

    • Keywords:
    • Decompression

    • Surgical|Humans|Magnetic Resonance Imaging|Orthopedics|Spinal Cord Compression|Spinal Neoplasms|Spine|Tomography

    • X-Ray Computed

    • Subspecialty:
    • Musculoskeletal Oncology

    • Spine

Rehabilitation of the rotator cuff: an evaluation-based approach.

Rotator cuff disease of the shoulder, a common condition, is often incapacitating. Whether nonsurgical or surgical, successful management of rotator cuff disease is dependent on appropriate rehabilitation. Numerous rehabilitation protocols for the management of rotator cuff disease are based primarily on anecdotal clinical observation. The available literature on shoulder rehabilitation, in conjunction with clinical observation that takes into consideration the underlying tissue quality and structural integrity of the rotator cuff, can be compiled into a set of rehabilitation guidelines. The four phases of rehabilitation begin with maintaining and protecting the repair in the immediate postoperative period, followed by progression from early passive range of motion through return to preoperative levels of function.

    • Keywords:
    • Biomechanics|Humans|Postoperative Care|Practice Guidelines as Topic|Range of Motion

    • Articular|Rehabilitation|Rotator Cuff|Shoulder Impingement Syndrome

    • Subspecialty:
    • Shoulder and Elbow

    • Basic Science

Down syndrome in children: the role of the orthopaedic surgeon.

Down syndrome, the result of trisomy of chromosome 21, is one of the most common chromosomal abnormalities. Patients have a characteristic facial appearance, variable levels of intelligence and self-care skills, and a variety of associated medical conditions. Orthopaedic manifestations occur frequently; most are related to hypotonia, joint hypermobility, and ligamentous laxity. Atlanto-occipital and atlantoaxial hypermobility, as well as bony anomalies of the cervical spine, can produce atlanto-occipital and cervical instability. Methods of screening for this instability, particularly with regard to participation in sports, are a subject of controversy. Scoliosis, hip instability, slipped capital femoral epiphysis, patellar instability, and foot deformities are other musculoskeletal conditions found in patients with Down syndrome that can be challenging for the orthopaedic surgeon to treat.

    • Keywords:
    • Adolescent|Child|Child

    • Preschool|Down Syndrome|Humans|Joint Instability|Muscle Hypotonia|Musculoskeletal Abnormalities|Orthopedics|Scoliosis

    • Subspecialty:
    • Pediatric Orthopaedics

Impaction bone grafting for revision hip arthroplasty: biology and clinical applications.

Impaction bone grafting techniques are useful when the orthopaedic surgeon is faced with large cavitary acetabular defects or a large ectatic femoral metaphysis or diaphysis. Impaction bone grafting of the acetabulum involves packing of cavitary defects with compressed particulate graft, followed by insertion of either a cemented or cementless acetabular component. Impaction grafting of the femur involves retrograde filling of the femoral canal with impacted particulate graft, creating a neomedullary canal into which a cemented femoral stem can be placed. Use of the impaction allografting technique is appealing, especially in young patients, because of its potential to restore bone stock. The technically demanding nature of the procedure, the risk of complications, and the unknown long-term fate of the impacted allograft highlight the need for ongoing assessment of this technique for revision total hip arthroplasties.

    • Keywords:
    • Acetabulum|Age Factors|Arthroplasty

    • Replacement

    • Hip|Bone Transplantation|Humans|Reoperation|Transplantation

    • Homologous

    • Subspecialty:
    • Basic Science

    • Adult Reconstruction