OKOJ, Volume 12, No. 4

Proximal Oblique Sliding Closing-wedge Osteotomy for Wide-angle Hallux Valgus

Proximal metatarsal osteotomies are generally recommended for treating severe hallux valgus deformities. The most common complications after surgery for such deformities are recurrence, hallux varus, or dorsal malunion. To decrease these complications, modifications have been made in the design, technique, and fixation procedure for this corrective surgery. In this article, we describe the proximal metatarsal osteotomy procedure known as the proximal oblique sliding closing-wedge (POSCOW) osteotomy, which was developed to include a proximal lateral displacement and a lateral closing-wedge osteotomy, thereby combining the effects of rotation and displacement of the hallux following preoperative planning. Plate fixation has been used in this procedure to improve fixation and decrease malunion. We report in detail the preoperative considerations, surgical technique, results, and complications of the POSCOW procedure.

    • Keywords:
    • proximal oblique sliding closing-wedge osteotomy

    • POSCOW

    • hallux valgus

    • hallux varus

    • dorsal malunion

    • Plate fixation

    • intermetatarsal angle

    • diaphyseal osteotomy

    • distal osteotomy

    • metatarsophalangeal angle

    • distal metatarsal articular angle

    • distal biplanar chevron osteotomy

    • inverted L capsulotomy

    • transarticular lateral capsulotomy

    • Akin osteotomy

    • proximal crescentic osteotomy

    • Subspecialty:
    • Foot and Ankle

Use of Systemic Pharmaceutical Adjuncts to Enhance Bone Healing After Surgery

Anabolic agents such as parathyroid hormone and anti-catabolic agents such as diphosphonates were originally approved to treat bone disorders, including osteoporosis, Paget disease, and osteogenesis imperfecta. Today, these agents are increasingly being used to enhance bone healing after surgery. Yet despite the reported benefits of these medications in the postoperative period, most orthopaedic surgeons in the United States remain reluctant to use them after total joint arthroplasty, trauma surgery, or spine surgery. This article reviews the most commonly prescribed systemic pharmacologic agents for enhancing bone healing after surgery, with a particular focus on the mechanisms by which these medications work and their potential therapeutic applications, the complications and risks attending their prescription, and contraindications to their use. Prospects and trends in the use of both established and new therapeutic agents for enhancing bone healing are also presented.

    • Keywords:
    • systemic pharmacologic agents

    • anabolic

    • anti-catabolic

    • bone healing

    • osseointegration

    • Subspecialty:
    • Basic Science

Tendon Transfers for Scapular Winging

Scapular winging is an uncommon shoulder disorder often caused by a disruption of the neuromuscular unit of the scapulothoracic articulation, leading to abnormalities in scapular posture and altered scapulothoracic motion and stabilization. Lesions of the long thoracic or spinal accessory nerves, causing serratus anterior palsy or trapezius palsy, respectively, are common etiologies. Patients classically report burning periscapular pain with muscle weakness and fatigue, which can be highly debilitating, particularly with overhead activities. Most patients do well with nonsurgical treatment consisting of rest, use of anti-inflammatory medications, and sometimes brief sling immobilization. Surgical treatment for scapular winging involves the use of tendon transfers, directed at restoring scapular stability, strength, and function.

    • Keywords:
    • scapular winging

    • serratus anterior palsy

    • trapezius palsy

    • rhomboid palsy

    • facioscapulohumeral dystrophy

    • modified Eden-Lange tendon transfer

    • pectoralis major transfer

    • Subspecialty:
    • Shoulder and Elbow