JAAOS, Volume 17, No. 1

Traumatic hip dislocations in children and adolescents: pitfalls and complications.

Traumatic hip dislocation is an uncommon injury in children. Lack of familiarity with management of the treating physician may lead to complications. Hip dislocation in young children can occur with minor trauma; in adolescents, greater force is required to produce a traumatic complete hip dislocation. Transient hip dislocation with spontaneous but incomplete reduction is a diagnostic pitfall that can occur in adolescents. Any asymmetric widening of the hip joint warrants additional investigation. Most dislocations in children can be reduced with gentle manipulation. Urgent reduction of the hip within 6 hours of injury reduces the risk of osteonecrosis. However, closed reduction in adolescents should be performed with caution because of the risk of displacement of the femoral head during manipulation. Open reduction is indicated when closed reduction fails or when there is interposition of bone or soft tissue following attempted closed reduction. Late complications include osteonecrosis, coxa magna, and osteoarthritis.

    • Keywords:
    • Adolescent|Buttocks|Child|Diagnostic Imaging|Early Diagnosis|Hip Dislocation|Humans|Osteoarthritis

    • Hip|Osteonecrosis|Recurrence|Sciatic Nerve|Time Factors

    • Subspecialty:
    • Trauma

    • Pediatric Orthopaedics

Magnetic resonance imaging of the spine.

Historically, magnetic resonance imaging has offered poor specificity in the diagnosis of back pain. Researchers currently are engaged in developing new techniques, and clinicians are successfully utilizing existing technologies (ie, diffusion-weighted imaging) that previously were not used to evaluate the spine. Magnetic resonance imaging may be used in several spinal applications: intervertebral disk and facet joint degeneration, spinal canal stenosis, suspected diskitis or osteomyelitis, suspected spinal column neoplasia, vascular disorders, trauma, and demyelinating disease.

    • Keywords:
    • Contrast Media|Humans|Magnetic Resonance Imaging|Spinal Diseases

    • Subspecialty:
    • Spine

Surgical treatment for chronic disease and disorders of the achilles tendon.

Chronic Achilles tendon disorders range from overuse syndromes to frank ruptures. Numerous forms of treatment have been used, depending on the nature of the disorder or injury. Ultrasonography and magnetic resonance imaging are commonly used for evaluation. The spectrum of disease comprises paratenonitis, tendinosis, paratenonitis with tendinosis, retrocalcaneal bursitis, insertional tendinosis, and chronic rupture. However, there is no clear consensus on what defines a chronic Achilles disorder. Nonsurgical therapy is the mainstay of treatment for most patients with overuse syndromes. Surgical techniques for overuse syndromes or chronic rupture include débridement, local tissue transfer, augmentation, and synthetic grafts. Local tissue transfer most commonly employs either the flexor hallucis longus or flexor digitorum longus tendon to treat a chronic rupture. Reports on long-term outcomes are needed before useful generalizations can be made regarding treatment.

    • Keywords:
    • Achilles Tendon|Bursitis|Chronic Disease|Cumulative Trauma Disorders|Diagnostic Imaging|Humans|Rupture|Tendon Injuries|Tendon Transfer

    • Subspecialty:
    • Foot and Ankle

Knee injury outcomes measures.

Outcomes measures have long been used in the assessment of knee injuries and management protocols. In the past decade, there has been a shift from clinician-based outcomes tools to the development and validation of patient-reported outcomes measures. General health as well as disease- and medical condition-specific outcomes measures have been so modified. The Medical Outcomes Study 36-Item Short Form is the most commonly used general health measure in orthopaedics. Joint-specific measures include the Western Ontario and McMaster Universities Osteoarthritis Index, the Knee Injury and Osteoarthritis Outcome Score, and the International Knee Documentation Committee Subjective Form. The Lysholm Knee Scale and the Cincinnati Knee Rating Scale continue to be popular, especially for the assessment of ligamentous injuries. The ACL Quality of Life score is a disease-specific, patient-reported outcomes measure of anterior cruciate ligament deficiency. The historically used Tegner activity level scale and the recently developed Marx activity level scale are used in conjunction with these outcomes measures to make possible a global assessment of recovery from knee injuries and clinician interventions.

    • Keywords:
    • Disability Evaluation|Humans|Knee Injuries|Outcome Assessment (Health Care)|Quality of Life

    • Subspecialty:
    • Sports Medicine

    • Clinical Practice Improvement

Soft-tissue sarcoma.

Soft-tissue sarcomas are rare malignancies of mesodermal origin. Common sites of involvement include the extremities, trunk, retroperitoneum, and the head and neck. Soft-tissue sarcomas of the extremities and pelvis are the most relevant to the orthopaedic surgeon. The patient with extremity soft-tissue sarcoma typically presents with a painless, enlarging mass. Advanced imaging techniques and biopsy, which are best done at tertiary referral centers, usually confirm the diagnosis. Factors such as sarcoma size, location, grade, histologic subtype, and stage, as well as patient age and comorbidities, determine the specific approach to management and patient outcome. Limb-sparing surgical resection is the mainstay of treatment. Radiation is used for unresectable tumors and as a neoadjuvant or an adjuvant to resection. The use of chemotherapy is controversial, and no standardized protocol has been established.

    • Keywords:
    • Biopsy|Combined Modality Therapy|Diagnosis

    • Differential|Diagnostic Imaging|Humans|Neoplasm Staging|Prognosis|Radiotherapy

    • Adjuvant|Sarcoma|Soft Tissue Neoplasms

    • Subspecialty:
    • Musculoskeletal Oncology

Parkinson's disease and the orthopaedic patient.

Parkinson's disease is a progressive neurologic disorder that affects the musculoskeletal system in multiple ways. As medication and surgical management of this disorder have improved, the life spans and quality of life of patients affected by it also have improved. With age, the risk of fracture, osteoarthritis, and osteopenia increase in patients with Parkinson's disease compared with the general population. The symptoms of Parkinson's disease predispose patients to gait abnormalities and loss of bone mass, which commonly result in falls and fracture. Although preventive measures such as medication, lifestyle changes, and vitamin replacement may help, surgical intervention is often indicated. Surgical treatment and postoperative management of both elective and emergent surgery are complicated and controversial.

    • Keywords:
    • Humans|Musculoskeletal Diseases|Orthopedics|Parkinson Disease|Risk Factors

    • Subspecialty:
    • General Orthopaedics

    • Trauma