OKOJ, Volume 10, No. 3

Tumors of the Foot and Ankle

Tumors involving the foot and ankle are relatively rare. Less than 2% of all sarcomas and less than 10% of soft-tissue sarcomas arise in this location. Pain, swelling, and the presence of a mass are typically diagnosed as the much more common benign tumors, and are treated as such. As a consequence, delays in diagnosis, misdiagnosis, and unplanned surgical excisions lead to poor local control and presumably an increase in systemic disease. Appropriate prebiopsy imaging and a suspicion of malignancy are therefore extremely important. The location and type of biopsy performed are also crucial to optimize treatment. For many soft-tissue sarcomas, chemotherapy is reserved for metastatic disease, or for preoperative reduction of the tumor mass in order to obtain a limb-sparing surgical resection. The impact of long-term survival of patients with soft-tissue sarcomas, with few exceptions, has yet to be proven. Neoadjuvant chemotherapy for primary bone malignancies, Ewing sarcoma, and osteosarcoma, followed by resection with negative margins with limb preservation or amputation, remains the mainstay of treatment.

    • Keywords:
    • foot and ankle tumors

    • malignancy

    • limb salvage

    • soft-tissue sarcoma

    • bonesarcoma

    • chemotherapy

    • radiation therapy

    • benign soft-tissue tumor

    • benign bonetumor

    • medical management

    • Subspecialty:
    • Foot and Ankle

Hand Fractures: Current Concepts

Hand fractures are common injuries, and most do not require surgical treatment. Even with modern techniques of surgical fixation, the best results are often obtained with closed treatment. Regardless of the method of treatment, most fractures heal adequately enough to allow gentle range of motion by 3 to 4 weeks. Temporary fixation should usually be removed and protected rehabilitation initiated at that time, unless there are specific contraindications. If the patient is not progressing on a timeline to achieve full digital range of motion by 6 to 8 weeks postinjury, formal hand therapy should be initiated. Current concepts for the management of fractures of the metacarpals and phalanges are discussed.

    • Keywords:
    • Bennetts fracture

    • metacarpal fractures

    • phalangeal fractures

    • phalangeal shaft fractures

    • phalangeal base fractures

    • finger metacarpal base fractures

    • thumb metacarpal base fractures

    • metacarpal neck fractures

    • metacarpal head fractures

    • periarticular phalangeal fractures

    • Subspecialty:
    • Hand and Wrist

Lateral Approach to the Lumbar Spine

Minimally invasive surgery of the spine has increased in popularity worldwide. Such minimally invasive techniques, when achievable, have been associated with decreased postoperative pain, a shorter hospital stay, and a quicker return to activities compared with traditional techniques. One such minimally invasive technique is the lateral approach to the spine. This approach to the spine is a relatively new technique for performing interbody fusion through a lateral retroperitoneal approach. Similar to traditional open anterior interbody fusions, insertion of an intervertebral cage with this technique can restore the height of the disk space and assist in correction of the deformity at each level. In this article, we describe the technique of lateral interbody fusion of the lumbar spine.

    • Keywords:
    • minimally invasive spine surgery

    • MIS

    • lumbar interbody fusion

    • anterior lumbar interbody fusion

    • posterior lumbar interbody fusion

    • extreme lateral interbody fusion

    • transforaminal interbody fusion

    • ALIF

    • PLIF

    • XLIF

    • TLIF

    • mini-open lumbar surgery

    • minimally invasive lumbar diskectomy

    • minimally invasive multilevel percutaneous correction and fusion

    • degenerative disk disease

    • spondylolisthesies

    • stenosis

    • scoliosis

    • pseudarthrosis

    • Subspecialty:
    • Spine

HOT TOPIC: ACL Graft Size Matters in Younger Patients

We hypothesized that decreased graft size and younger patient age are predictors of early revision following primary ACL reconstruction with hamstring autograft. In a recent study at our institution, 256 of 338 consecutive patients (75.7%) were evaluated at an average of 14 months following surgery. The overall revision rate was 7%. Age younger than 20 years at the time of reconstruction (OR = 18.97; 95% CI = 2.43–147.06; = 0.005) and decreased graft size (OR = 2.20; 95% CI = 1.00–4.85; = 0.05) were associated with significantly increased risk of revision. Most revisions (16 of 18) were performed in patients younger than 20 years of age, with grafts 8 mm in diameter or less. The revision rate in this population was 16.4% (16 of 97 patients). Graft size may be an important variable in predicting the outcome of primary ACL reconstructions performed with hamstring autograft.

    • Keywords:
    • ACL reconstruction

    • autograft

    • hamstring graft

    • semitendinosus graft

    • graft size

    • revision rate

    • Subspecialty:
    • Sports Medicine