OKOJ, Volume 12, No. 6

Common Acute Hand Infections

Up to 35% of admissions to a clinical hand service is for infections. The patient typically has localized pain, swelling, and erythema over the affected part of the hand. There may be overlying cellulitis or a history of recent trauma. Systemic symptoms are rare and usually seen only in patients with overwhelming infections. The peculiar anatomy of the hand, with its many closed spaces and vital structures in proximity to each other, is a suitable environment for the rapid multiplication and spread of bacteria. The multiplying bacteria release toxins and proteolytic enzymes that destroy cartilage in septic joints and, in pyogenic flexor tenosynovitis, can cause the necrosis of tendons. The damage done by delayed or inappropriate treatment of hand infections can lead to significant morbidity. Thus, for example, inadequately treated felon may lead to suppurative flexor tenosynovitis, septic arthritis, and osteomyelitis, and ultimately to amputation of the distal phalanx. Flexor tenosynovitis often results in loss of full range of motion of the affected digits. Osteomyelitis can lead to chronic pain, stiffness, deformity, and weakness despite eradication of the infection. For such reasons, the prompt diagnosis and treatment of hand infections are necessary to minimize morbidity and provide the best functional outcomes. This article provides an overview of the diagnosis and management of the most common acute infections of the hand.

    • Keywords:
    • paronychia

    • felon

    • pyogenic flexor tenosynovitis

    • deep-space infection

    • bite injuries

    • septic arthritis

    • osteomyelitis

    • Subspecialty:
    • Hand and Wrist

Angular Deformities of the Lower Extremity in Children

Angular deformities of the lower limb in children are a frequent cause of referral to a pediatric orthopaedic surgeon. Two of the most common such conditions are bowleggedness, or genu varum, and knock-knees, or genu valgum, with a further group of angular deformities marked by malalignment at the hip or ankle. A detailed knowledge of physiologic and pathologic alignment and growth of the lower extremity is imperative in determining the individually appropriate treatment of patients. This article discusses the etiology and diagnosis of four angular deformities of the lower limb commonly seen in children, consisting of genu varum, genu valgum, ankle varus, and ankle valgus, as well as strategies for their management, including bracing, guided growth, and osteotomy. Conditions affecting the hip (coxa vara) and rotational alignment of the lower extremity (anteversion/retroversion/tibial torsion), and deformities of the lower extremity in the sagittal plane (genu procurvatum/recurvatum) are beyond the scope of this article, but should be included in the complete evaluation of every patient.

    • Keywords:
    • genu varum

    • genu valgum

    • Blount disease

    • tibia vara

    • tibia valgum

    • ankle varus

    • anklevalgus

    • alignment

    • mechanical axis deviation

    • Subspecialty:
    • Pediatric Orthopaedics

Distal Tibia Allograft for the Management of Anterior Glenoid Bone Loss

Recurrent anterior instability of the shoulder remains a growing problem in the young, athletic patient population. Despite recent advances in both surgical technique and implant design, recurrent instability remains a concern, reaching rates as high as 30% following both open and arthroscopic approaches to its correction. Many factors have been identified as potential sources of the unsuccessful repair of anterior instability of the shoulder, among which have been bone loss in both the glenoid and head of the humerus. The treatment of bone loss in the glenoid in the setting of recurrent instability is difficult, mainly because of the nonanatomic and therefore incongruous joint resulting from most bone augmentation procedures at this anatomic site. Recently, the use of fresh osteochondral allografts from the distal tibia has been described as an option for treating large bone defects in the glenoid in the setting of anterior instability of the glenohumeral joint. However, despite cadaveric studies demonstrating the feasibility of using distal tibia allografts for such reconstruction, the lack of published clinical data supporting their use for this purpose mandates caution. This article describes a safe, reliable method for the repair of major glenoid bone deficiency and the rehabilitation of patients with acute and/or recurrent anterior instability of the shoulder.

    • Keywords:
    • recurrent anterior glenohumeral instability

    • glenoid bone loss

    • distal tibia allograft

    • Subspecialty:
    • Shoulder and Elbow