JAAOS, Volume 21, No. 6

Automobile Safety in Children: A Review of North American Evidence and Recommendations

In the United States, the rate of vehicle occupant deaths in children aged 1 to 3 years has decreased by over 50% in the past three decades. However, the Centers for Disease Control and Prevention report that motor vehicle crashes remain the leading cause of death in children aged 1 to 17 years. Parental compliance with child safety seats is poor, with up to 99% of children in certain age groups improperly restrained. Epidemiologic data support the proper use of automobile restraint systems to save lives. When appropriate restraint systems (based on age and weight) are used, a significant decrease occurs in the rates of mortality and serious injury. Legislation and public service campaigns can increase awareness regarding appropriate use of automobile restraint systems to decrease pediatric injury and fatality rates. Fluency and awareness, rather than cost, have been found to be the main reasons for improper use of automobile restraint systems; appropriately targeted education programs should continue to be developed. Physicians are optimally poised to educate patients and parents about automobile safety.

      • Subspecialty:
      • Pediatric Orthopaedics

    Shoulder Arthroscopy: Basic Principles of Positioning, Anesthesia, and Portal Anatomy

    Advances in modern arthroscopy have contributed significantly to greater flexibility and efficacy in addressing shoulder pathology. Advantages of arthroscopy include less invasive approaches, improved visualization, decreased risk of many postoperative complications, and faster recovery. As a result, arthroscopy is often preferred by both orthopaedic surgeons and patients. Common shoulder conditions that can be managed arthroscopically include rotator cuff tears, shoulder instability, and labral pathology. A thorough understanding of anatomic principles in conjunction with proper patient positioning and portal selection and placement are essential for successful arthroscopic shoulder surgery.

        • Subspecialty:
        • Shoulder and Elbow

      Lower Extremity Arthroplasty in Patients With Inflammatory Arthritis: Preoperative and Perioperative Management

      Spondylarthritis, which includes conditions such as ankylosing spondylitis and psoriatic arthritis, and rheumatoid arthritis are the most common forms of inflammatory arthritis. Joint inflammation and damage may result in the need for arthroplasty, and the surgeon must be aware of the perioperative challenges associated with these systemic diseases. In patients with inflammatory arthritis who have polyarticular disease and spinal involvement at the time of presentation for lower extremity arthroplasty, preoperative evaluation must include careful evaluation of all joints, including the cervical spine. Preoperative assessment and perioperative management must be appropriate to minimize cardiac and pulmonary complications. Finally, the perioperative management of medications used to manage inflammatory arthritis is critical because these medications may increase the risk of infection and compromise wound healing.

          • Subspecialty:
          • Adult Reconstruction

        Basic Principles for Conducting Human Research in Orthopaedic Medicine

        Researchers and clinicians operate in an increasingly complex clinical and regulatory environment in which understanding the principles governing human research is essential. However, most orthopaedic surgeons have not received in-depth training in regulatory requirements and scientific research methods. Ensuring that research is conducted in accordance with state and federal laws and ethical principles is essential to guard compromising patient information and avoid severe penalties for noncompliance. The researcher must understand the regulations for compliance and proper data management, including the requirements of the Health Insurance Portability and Accountability Act, proper application of informed consent, use of the Institutional Review Board, and data protection guidelines. Tools such as a regulatory binder can assist investigators in complying with requirements, maintaining regulatory standards, and ensuring a robust study design and conduct.

            • Subspecialty:
            • Basic Science

          Madelung Deformity

          Madelung deformity is a rare congenital anomaly of the wrist caused by asymmetric growth at the distal radial physis secondary to a partial ulnar-sided arrest. The deformity is characterized by ulnar and palmar curvature of the distal radius, positive ulnar variance, and proximal subsidence of the lunate. It more commonly occurs in females than males and typically affects both wrists. The deformity can occur in isolation or as part of a genetic syndrome. The pattern of inheritance varies, with some cases following a pseudoautosomal pattern and many others lacking a clear family history. Nonsurgical management is typically advocated in asymptomatic patients. Few studies exist on the natural history of the condition; however, extensor tendon ruptures have been reported in severe and chronic cases. Stiffness, pain, and patient concerns regarding wrist cosmesis have been cited as indications for surgery. Various techniques for surgical management of Madelung deformity have been described, but clear evidence to support the use of any single approach is lacking.

              • Subspecialty:
              • Hand and Wrist