OKOJ, Volume 11, No. 5

Periprosthetic Fractures of the Femur After Total Hip Arthroplasty

The incidence of periprosthetic fracture of the femur associated with total hip arthroplasty is increasing. These fractures can occur following surgery or intraoperatively, and are associated with substantial morbidity and mortality. Among the risk factors for periprosthetic fracture of the femur after total hip arthroplasty are diminished bone strength, older age, osteoporosis, rheumatoid arthritis, inflammatory arthropathies, female gender, and revision surgery. Although several systems exist for classifying such fractures, the most widely accepted is the Vancouver system, which recognizes three major types of postoperative and intraoperative fractures. Early recognition and careful examination for fracture propagation are critical to the management of intraoperative periprosthetic femur fractures. This article reviews the current status of diagnosis and management of periprosthetic fractures of the femur associated with total hip arthroplasty.

    • Keywords:
    • periprosthetic fracture

    • total hip arthroplasty

    • femoral fracture

    • postoperative fracture

    • Vancouver classification

    • type A fracture

    • type B fracture

    • type C fracture

    • periprosthetic joint infection

    • osteolysis

    • Subspecialty:
    • Adult Reconstruction

Patellar Dislocations in the Pediatric Population

Patellar dislocation is a common problem in the skeletally immature patient, and has a high rate of recurrence. The workup and management of this disorder are quite complex and vary significantly with the acuity, functional demands, and comorbidities of the patient. The principles of management of patellar dislocation in the pediatric population also differ from those in the adult population, and the pediatric patient with an acute initial patellar dislocation is managed differently from a patient with multiple recurrent dislocations. Attention should be paid to the presence of trochlear dysplasia, patella alta, a lateralized tibial tuberosity, and compromise of proximal medial soft-tissue restraints on the patella, with management varying greatly according to the location of the patient's pathology. Controversy continues to exist about appropriate management of the patient with an initial acute patellar dislocation. Pediatric patients with syndromic conditions related to patellar dislocation represent a distinct group in terms of management, and have their own special set of considerations.

    • Keywords:
    • pediatric

    • patella

    • dislocation

    • acute

    • chronic

    • syndromic

    • traumatic

    • Subspecialty:
    • Pediatric Orthopaedics

Diagnosis and Management of Cervical Radiculopathy: Current Concepts

Cervical radiculopathy is a neurologic condition caused by compression of a nerve root in the cervical spine, most commonly as a result of degenerative cervical spondylosis or intervertebral disk herniation. The disease typically manifests as unilateral neck pain radiating to the arm in a dermatomal pattern. Numbness, tingling, and muscle weakness may also be seen. The most common level of involvement is C5-6, followed by C6-7. Most patients with cervical radiculopathy can be successfully managed with nonsurgical treatment. Surgery can be helpful in patients who do not respond to nonsurgical management or in those with significant weakness in one or more muscle groups. Options for surgical treatment include anterior cervical diskectomy and fusion and posterior laminoforaminotomy. The decision to perform one procedure over the other depends on the location of the compressive pathology, the number of levels involved, and whether the patient has neck pain. Relief of arm pain and improvements in motor and sensory function have been reported in 80% to 90% of patients following cervical nerve root decompression.

    • Keywords:
    • intervertebral disk herniation

    • chronic disk degeneration

    • stenosis

    • nerve root compression

    • Spurling test

    • surgical treatment

    • anterior cervical diskectomy and fusion

    • posterior laminoforaminotomy

    • Subspecialty:
    • Spine