OKOJ, Volume 10, No. 11

Tendon Transfers in Foot and Ankle Surgery

Tendon transfers are a powerful tool in foot and ankle surgery. By detaching a functioning muscle-tendon unit from its insertion and reattaching it to another tendon or bone, tendon transfers can help restore function and correct deformity in a wide variety of conditions, including nerve injury, congenital conditions, and tendon injury or degeneration. A thorough preoperative evaluation and careful surgical technique are critical to the clinical success of any tendon transfer. It is also necessary to identify and treat any bony deformities or soft-tissue contractures to achieve the best results. This article reviews the general principles and application of tendon transfers in foot and ankle surgery. Although it is not possible to discuss every tendon transfer used around the foot and ankle, two of the most commonly applied will be reviewed: tibialis posterior tendon transfer through the interosseous membrane for footdrop and flexor hallucis longus tendon transfer to the calcaneus for Achilles tendon pathology.

    • Keywords:
    • flexor hallucis longus tendon transfer

    • tibialis posterior tendon transfer

    • equinovarus deformity

    • footdrop

    • peroneal nerve palsy

    • Achilles tendon pathology

    • Subspecialty:
    • Foot and Ankle

Diagnosis and Management of Scapholunate Advanced Collapse Wrist

Scapholunate advanced collapse (SLAC) is a common pattern of arthritis of the wrist characterized by radiographic findings of scapholunate dissociation accompanied by varying degrees of arthritic change involving the radius, lunate, scaphoid, and capitate bones. The condition is thought to be most commonly caused by a traumatic disruption of the scapholunate ligament, although nontraumatic conditions may also compromise the integrity of the scapholunate articulation. Nonsurgical treatment may suffice for many patients with SLAC of the wrist; however, no studies have been done of the long-term success of nonsurgical treatment of SLAC of the wrist, nor have any long-term studies been done of its natural history. Surgical procedures used in treating SLAC of the wrist include arthroscopic débridement, denervation, radial styloidectomy, scaphoid excision and four-corner arthrodesis, scaphoid excision and capitolunate arthrodesis, proximal row carpectomy, arthroplasty of the wrist, and total wrist arthrodesis, or a combination of these procedures. Controversy persists about the relative merits of proximal row carpectomy versus four-corner arthrodesis, and about whether carpectomy of the proximal row may be performed in the setting of capitolunate arthritis.

    • Keywords:
    • SLAC wrist

    • scapholunate interosseous ligament dissociation

    • SNAC wrist

    • scaphoid nonunion advanced collapse

    • proximal row carpectomy

    • four-corner arthrodesis

    • scaphoid excision

    • radial styloidexctomy

    • Subspecialty:
    • Hand and Wrist

Shoulder Arthroscopy: Basic Concepts and Fundamental Procedures

Shoulder arthroscopy is an essential skill in the armamentarium of every new shoulder and elbow surgeon. In this article, we describe a basic step-by-step guide for arthroscopy of the shoulder, including steps for making the initial diagnosis, provocative shoulder tests, standard patient positioning and arthroscopic instrumentation, portal placement, surgical techniques, and common pearls and pitfalls. It is our hope that this review will help residents learn the essential techniques they need to improve their skills and become as comfortable with arthroscopic surgery as they are with open procedures.

    • Keywords:
    • shoulder arthroscopy

    • instability

    • impingement

    • rotator cuff tear

    • biceps tendon pathology

    • SLAP tear

    • acromioclavicular abnormalities

    • Subspecialty:
    • Shoulder and Elbow

HOT TOPIC: Decision Making in the Treatment of Femoral Neck Fractures in the Elderly

With an aging population comes an increased emphasis on the management of femoral neck fractures, and keeping their clinical and social consequences in mind is essential for achieving good outcomes. Given the importance of this topic, we had developed Femoral Neck Fractures for Orthopaedic Knowledge Online Journal in 2003. While many of the technical considerations remain relevant, recent clinical work has led to a substantial evolution in the practice patterns of many orthopaedic surgeons. Notable among these changes are lessened reliance on reduction and fixation in unstable fractures and a shift toward total hip arthroplasty. This article focuses on recent clinical literature and its influence on contemporary decision making for treatment. Given the increasing use of hip replacement as a treatment alternative, video is provided to highlight the nuances and demonstrate the technical considerations inherent to total hip arthroplasty in the setting of femoral neck fracture.

    • Keywords:
    • femoral neck fracture

    • total hip arthroplasty

    • internal fixation

    • closed reduction

    • hemiarthroplasty

    • multiple cannulated screw fixation

    • fixed-angle hip compression screw

    • sliding hip screw

    • angular stability

    • femoral stem fixation

    • press-fit stem

    • bipolar prosthesis

    • unipolar prosthesis

    • Subspecialty:
    • Trauma