OKOJ, Volume 10, No. 1

HOT TOPIC: Arthroereisis for Correction of Flexible Flatfoot in Children and Adolescents

Flexible flatfoot is a common condition characterized by heel valgus and flattening of the medial longitudinal arch. Most patients are asymptomatic, but the condition may cause foot pain, limitation of activity, or early fatigue of the foot. In subtalar arthroereisis, a cone-shaped implant is inserted into the sinus tarsi to restrict excessive motion at the subtalar joint and elevate the talus. Short-term studies of arthroereisis for flexible flatfoot in children and adolescents have demonstrated promising outcomes, but long-term studies and comparisons with traditional surgical procedures are currently lacking.

    • Keywords:
    • arthroereisis

    • subtalar arthroereisis

    • flatfoot

    • pes planus

    • flexible flatfoot

    • acquired flatfoot

    • adult flatfoot

    • congenital flatfoot

    • pediatric flatfoot

    • subtalar joint

    • flexible pes planovalgus

    • Subspecialty:
    • Foot and Ankle

Clinical and Surgical Approach to Benign Bone Tumors in Children

Bone tumors are uncommon in children, and, fortunately, most are benign. The most common benign bone tumors in the growing child are unicameral bone cyst, aneurysmal bone cyst, fibrous cortical defect, nonossifying fibroma, osteoid osteoma, osteoblastoma, osteochondroma, multiple hereditary exostosis, and chondroblastoma. Although some benign bone tumors are incidentally found, others cause pain or other symptoms, such as a visible or palpable mass or a pathologic fracture. This article reviews the clinical and radiographic features, management, and prognosis of the most common benign bone lesions in children and adolescents.

    • Keywords:
    • unicameral bone cyst

    • aneurysmal bone cyst

    • nonossifying fibroma

    • fibrous cortical defect

    • fibrous dysplasia

    • osteofibrous dysplasia

    • osteoid osteoma

    • osteoblastoma

    • osteochondroma

    • multiple hereditary exostosis

    • chondroblastoma

    • chondromyxoid fibroma

    • Langerhans cell histiocytosis

    • Subspecialty:
    • Pediatric Orthopaedics

Laminectomy and Fusion and Laminoplasty: Indications and Techniques

Posterior cervical decompression has been available as a treatment option for cervical spondylotic myelopathy since the 1940s. Patients may present with axial neck pain, radiculopathy, myelopathy, or a combination of these symptoms. The natural history of cervical spondylotic myelopathy is generally defined by slow, progressive deterioration. Posterior surgical options include multilevel laminectomy and fusion or laminoplasty. Laminectomy without fusion has also been extensively used in the past, but is less commonly used now because of a high rate of postoperative complications. The choice of posterior procedure is based on multiple factors, including the severity of disease and levels of compression, the presence of degenerative changes, preoperative sagittal alignment, instability, and other patient factors.

    • Keywords:
    • posterior cervical decompression

    • laminectomy

    • fusion

    • laminoplasty

    • cervical spondylotic myelopathy

    • cervical stenosis

    • Subspecialty:
    • Spine

Spinal Cord Injury: Pathophysiology, Classification, Treatment, and Complications

Injury to the spinal cord is a devastating event that usually results in significant functional impairments for patients. The incidence of spinal cord injury in the United States alone is roughly 10,000 to 14,000 new cases per year, with a prevalence of 229,000 to 306,000 patients. Motor vehicle accidents and falls are the most common causes. Injuries to the cervical spine make up 55% of all spinal cord injuries, with an equal distribution of injuries to the thoracic, lumbar, and lumbosacral areas. Incomplete tetraplegia is seen in approximately 30% of patients with spinal cord injury, and approximately 25% of patients will have complete motor and sensory loss caudal to the neurologic level of injury. In this article, we review the pathophysiology, diagnosis, radiographic assessment, clinical syndromes, acute management, treatment options, and associated complications of spinal cord injury.

    • Keywords:
    • spinal cord injury

    • SCI

    • ASIA classification

    • ASIA impairment scale

    • central cord syndrome

    • Brown-Sequard syndrome

    • anterior cord syndrome

    • posterior cord syndrome

    • conus medullaris syndrome

    • cauda equina syndrome

    • Subspecialty:
    • Spine

Combined Cartilage Restoration and Distal Realignment for Patellar and Trochlear Chondral Lesions

Chondral lesions of the patellofemoral joint are relatively common and pose a treatment challenge to the orthopaedic surgeon because of the complex three-dimensional topography and high contact stresses. Anterior knee pain, either at or surrounding the patella, is the most common symptom in patients with patellofemoral cartilage defects; however, posterior knee pain may also suggest a trochlear defect. Given the wide differential diagnosis for anterior knee pain, the patient history and physical examination should focus on osseous, cartilaginous, and tendinous structures from the hip to the ankle. MRI and CT should be considered to better visualize the state of the underlying cartilage and to quantify the patellar alignment and tilt. Treatment options for patellofemoral cartilage defects include realignment procedures such as anteromedialization of the tibial tubercle, or cartilage restoration procedures such as autologous chondrocyte implantation, microfracture, and osteochondral allograft transplantation. Although reasonable results have been reported with distal realignment and cartilage restoration used in isolation, better outcomes are seen when these types of procedures are combined.

    • Keywords:
    • patellofemoral joint

    • chondral lesion

    • cartilage lesion

    • osteochondral lesion

    • chondral defect

    • cartilage defect

    • osteochondral defect

    • cartilage restoration

    • autologous chondrocyte implantation

    • autogenous chondrocyte implantation

    • ACI

    • microfracture

    • osteochondral allograft transplantation

    • anteromedialization of the tibial tubercle

    • tibial tubercle osteotomy

    • distal realignment

    • Q angle

    • Subspecialty:
    • Sports Medicine