OKOJ, Volume 10, No. 10

Rupture of the Achilles Tendon: Diagnosis and Management

Rupture of the Achilles tendon occurs in an estimated 18 per 100,000 persons, making it one of the most common tendon injuries. This injury is most frequently seen in middle-aged individuals, predominantly men, with a male-to-female ratio of approximately 12:1. Diagnosis of Achilles tendon rupture is initially missed in an estimated 20% to 25% of cases, because patients often continue to have active ankle plantar flexion due to the action of other ankle flexor muscles. The optimal treatment of Achilles tendon rupture remains controversial. Surgical treatment is usually recommended for healthy, active individuals with good healing potential. However, recent studies have shown comparable outcomes with nonsurgical treatment and an accelerated functional rehabilitation program.

    • Keywords:
    • Achilles tendon rupture

    • Achilles rupture

    • Achilles tendon tear

    • Achilles tendon repair

    • open repair

    • gift box technique

    • Subspecialty:
    • Foot and Ankle

Ulnar Nerve Compression at the Wrist

Ulnar tunnel syndrome is a disorder that occurs when abnormal pressure is placed on the ulnar nerve as it passes through the ulnar tunnel (Guyon's canal) in the wrist. Compression of the ulnar nerve at the wrist is rare and has many causes. The most common cause is a ganglion, and the second most common is repetitive trauma to the hypothenar area. In ulnar tunnel syndrome, it is the site of compression that determines the clinical picture and the presence of motor and/or sensory abnormality. In our experience, the most common compression is type II, which occurs at the distal end of the ulnar tunnel and includes only motor deficit, affecting the intrinsic muscles of the hand, but with sparing of the hypothenar muscles. These patients typically present late because of the absence of sensory changes. Ulnar tunnel syndrome should be suspected if spontaneous clumsiness and weakness in using the hand occurs in a middle-aged patient. In this article, we review the pathophysiology and etiology of ulnar tunnel syndrome and provide current strategies on diagnosis and management.

    • Keywords:
    • ulnar tunnel syndrome

    • ulnar neuropathy

    • Guyons canal

    • ulnar nerve entrapment

    • ulnar nerve compression

    • Subspecialty:
    • Hand and Wrist

HOT TOPIC: Musculoskeletal Effects of Down Syndrome

Down syndrome is one of the most common genetic disorders in humans, with an incidence of 1 per every 660 live births. The syndrome is seen with increased frequency in those with advanced maternal age (35 years and older). The diagnosis of Down syndrome is definitively made via chromosomal analysis, although multiple physical features can also support and confirm the diagnosis. Advances in the care of patients with Down syndrome have led to increased life expectancy. In addition to the myriad of associated medical conditions seen in patients with Down syndrome, there is also a multitude of orthopaedic conditions that warrant consistent examinations and potential surgical treatment. In this article, we review the medical conditions associated with Down syndrome as they relate to the orthopaedic needs of the patient, and provide an update on the most common orthopaedic manifestations of this syndrome, including diagnosis and current treatment strategies.

    • Keywords:
    • Down syndrome

    • ligamentous laxity

    • metatarsus primus varus

    • hallux valgus

    • pes planus

    • patellofemoral instability

    • patellofemoral dislocation

    • hip

    • knee

    • pediatric

    • patellar instability

    • slipped capitalfemoral epiphysis

    • acetabular deficiency

    • hip instability

    • scoliosis

    • cervical spine instability

    • Subspecialty:
    • Pediatric Orthopaedics

Antibiotic Prophylaxis in Orthopaedic Trauma

Antimicrobial prophylaxis has become common practice across most surgical disciplines, including fracture care. The perioperative administration of antibiotics is beneficial in reducing infections following the fixation of closed fractures. It should be begun within 1 hour before incision and not continued for more than 24 hours postoperatively. For open fractures, antibiotics provide benefit in the setting of wound contamination, and should be begun as soon as possible after injury, with the most effective agent for this being a broad-spectrum, first-generation cephalosporin. Coverage should be broadened in cases of severe contamination. Similarly, in facilities in which methicillin-resistant Staphylococcus aureus infections are a known problem, the use of vancomycin may be justified for prophylaxis. However, because the use of antibiotics is not benign and can have associated toxicities and allergies, and may also be met with antimicrobial resistance, the surgeon should be cognizant of the indications for and duration of administration of any antibiotic used in the care of fractures.

    • Keywords:
    • antibiotic prophylaxis

    • antimicrobial prophylaxis

    • MRSA

    • methicillin-resistant Staphylococcus aureus

    • vancomycin-resistant Staphylococcus aureus

    • open fractures

    • closed fractures

    • gunshot wounds

    • combat injuries

    • osteomyelitis

    • infection

    • Subspecialty:
    • Trauma