OKOJ, Volume 12, No. 3

Arthroscopic Ankle Fusion: The Posterior Approach

Arthrodesis of the ankle is a well-established procedure for managing end-stage arthritis of the ankle. Because the most common cause of ankle arthritis is previous trauma, it often presents with compromised soft tissues. The evolution of arthroscopy has led to several arthroscopic techniques for ankle arthrodesis. The universal primary goal of these techniques is reliable fusion of the bones of the ankle with a reduced risk of complication. The posterior arthroscopic approach to ankle fusion presented in this article has several well-defined advantages. It offers a wide view and working area while allowing for maximal compression of the talar surface onto the tibial dome with two parallel screws. The position of the foot is well controlled through the direct visualization of hindfoot alignment. From the time of its introduction into our practice, the posterior arthroscopic approach to ankle fusion has proven to be a safe and reliable treatment option.

    • Keywords:
    • arthroscopic ankle fusion

    • posterior approach

    • ankle arthrodesis

    • hindfoot alignment

    • posttraumatic arthritis

    • open surgical technique

    • mini-open technique

    • posterolateral portal

    • posteromedial portal

    • American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale

    • Visual Analog Scale

    • Subspecialty:
    • Foot and Ankle

Surgical Exposures of the Hand

The hand and wrist are neurovascularly complex structures capable of motion in multiple planes. As such, a thorough understanding of the anatomy of the hand and wrist is critical to prevent iatrogenic injury during surgical exposures. Surgical incisions must be carefully planned to prevent scar hypersensitivity and unwanted contractures. Incisions may be created within flexion creases or at oblique angles to minimize tension on the skin and allow better scar formation, which may in turn improve cosmesis. Because a patient's pattern of skin creases is as individual as a fingerprint, creativity and flexibility in designing hand incisions are necessary. However, adherence to the basic principles of surgical incision-making will yield better cosmetic and functional results than a rigid one-scar-fits-all approach. This article reviews surgical approaches to the metacarpals, metacarpophalangeal joints, and phalanges commonly used for fixation of fractures, arthroplasty, and reconstructive surgery.

    • Keywords:
    • hand anatomy

    • volar approaches

    • dorsal approaches

    • carpometacarpal joints

    • trapeziometacarpal joint

    • basal joint of the thumb

    • metacarpals

    • metacarpophalangeal joints

    • thumb

    • phalanges

    • fingers

    • interphalangeal joints

    • Subspecialty:
    • Hand and Wrist

Midcarpal Instability

Palmar midcarpal instability is characterized by kinematic dysfunction of the proximal carpal row, and is often associated with a painful ulnar catch-up "clunk" as the wrist moves from radial to ulnar deviation. Clinical and laboratory findings suggest that palmar midcarpal instability is caused by a functional loss of midcarpal constraints, primarily the dorsal radiotriquetral (dorsal radiocarpal) ligament and the ulnar arm of the palmar arcuate ligament, which permits hypermobility of the proximal carpal row. The midcarpal shift test is diagnostic when the test recreates the painful clunk. When nonsurgical management fails, surgical options include extensor carpi ulnaris reconstruction, dorsal capsular reefing, arthroscopic thermal capsulorrhaphy, and limited midcarpal arthrodesis. Although much has been learned about the kinematics of wrist instability, there remains much opportunity for future clinical and biomechanical research, with the goal of developing better surgical and nonsurgical techniques that produce more successful patient outcomes.

    • Keywords:
    • midcarpal instability

    • wrist pathomechanics

    • dorsal intercalated segment instability

    • volar intercalated segment instability

    • palmar midcarpal instability

    • dorsal carpal subluxation

    • extensor carpi ulnaris ligament reconstruction

    • dorsal reefing

    • limited midcarpal arthrodesis

    • arthoscopic thermal capsulorrhaphy

    • Subspecialty:
    • Hand and Wrist

Current Concepts in the Management of Metastatic Disease of the Cervical Spine

Metastatic disease of the spine is a relatively common cause of spinal pathology. Approximately 1.6 million new diagnoses of cancer were made in 2012, and 70% of the patients with these diagnoses will develop spinal metastases, with up to 20% of these occurring in the cervical spine. The past 10 years have seen substantial progress in the classification and management of metastatic lesions of the cervical spine. This article reviews the current treatment options for metastatic disease of the cervical spine and demonstrates how the use of classification systems and an algorithmic approach to such disease can optimize its treatment.

    • Keywords:
    • metastatis

    • cervical spine

    • metastatic lesion

    • Spine Instability Neoplastic Score (SINS)

    • single-photon emission computed tomography (SPECT)

    • positron emission tomography (PET)

    • NOMS framework

    • Tokuhashi score

    • neurologic deficit

    • neurologic compression

    • mechanical instability

    • Subspecialty:
    • Musculoskeletal Oncology

    • Spine