OKOJ, Volume 10, No. 9

Increased recognition of structural hip deformities as predisposing causes of hip osteoarthritis has led to earlier and more aggressive nonarthroplasty surgical treatments in young adult patients with hip pain. The understanding of such predisposing hip pathomorphologic conditions as hip dysplasia and femoroacetabular impingement is rapidly evolving. Although dysplasia and femoroacetabular impingement constitute most of the structural hip problems seen in young adults, there exists a myriad of less frequent causes of hip pain. Physical examination of the young adult with hip pain is directed at reproducing pain and assessing range of motion. Tests specific to certain disorders are useful, and examination findings can direct imaging studies. Advanced imaging such as magnetic resonance arthrography or CT can further demonstrate underlying pathomorphology and associated chondrolabral damage. When nonsurgical management fails to provide adequate relief, arthroplasty or nonarthroplasty procedures may be deemed appropriate. This decision is based on patient age, activity level, degree of articular cartilage damage, and other factors. Older patients with more extensive damage are more appropriate candidates for arthroplasty, whereas younger patients (<45 years of age) may be better suited for hip preservation surgery. Postoperative rehabilitation is specific to the intervention, and protocols are not currently standardized.

The use of external fixation in the treatment of fractures dates from the early 1900s. Since then there has been a number of revolutionary advances in both frame design and application of external fixation. In addition to its utilization in the management of difficult foot and ankle fractures, external fixation is used for neuropathic joint (Charcot) management, ulcer/wound management, contracture correction, arthrodesis, limb salvage, bone transport, osteomyelitis, malunion, and nonunion. External fixation provides a rigid construct, permitting early weight bearing, minimal soft-tissue dissection, soft-tissue access, and gradual deformity correction, and may be the safest form of fixation in the presence of active infection. This article will review some of the different usages for external fixation in the foot and ankle.

Chondroblastoma is a benign primary tumor of bone that is potentially locally aggressive, and represents approximately 1% of all biopsied and histologically analyzed benign bone tumors. Chondroblastoma is commonly diagnosed in patients between the ages of 5 and 25 years, and has a twofold greater predominance in males than in females. The radiographic appearance is usually that of a lytic lesion with a sclerotic rim of bone located in the epiphysis of a long bone. Histologically, chondroblastoma is characterized by a mixture of mononuclear cells and giant cells with a cartilaginous matrix. The mainstay of treatment of chondroblastoma is intralesional curettage. Complete removal of the lesion is a key factor in minimizing recurrence, but must be balanced against the risk of damage to articular cartilage or open physes. Local recurrence after curettage is observed in as many as one third of cases of chondroblastoma. Metastasis is rare but can occur, particularly to the lungs.

Treatment of a bone fracture is the most common orthopaedic operation, and frequently these surgeries involve open fractures. An open fracture is a fracture that communicates with an overlying break in the skin. This communication between bone and the external environment adds an additional level of complexity to the treatment algorithm. The principles of treatment of open fractures include early administration of systemic antibiotics, surgical débridement, and fracture stabilization. Recent evidence has questioned some of these traditional treatment principles, and suggests that not all compound fractures require surgery or antibiotics, and that treatment can be immediate or staged. This article provides an overview on the management of open fractures, with special emphasis on new techniques of treatment.