OKOJ, Volume 14, No. 3

Malignant Bone Tumors of the Hand

Malignant bone tumors of the upper extremity, and particularly those that develop in the distal forearm, are matters of serious concern. A malignant tumor of the distal upper extremity threatens the function of the affected limb. The main issue with such tumors is that they do not occur in easily defined compartments, making them difficult to excise with a desired wide margin. This requires the surgeon to either excise them with a narrow margin of normal tissue or amputate the affected region. Despite meaningful advances in prosthetic technology, the absence of sensory feedback in a prosthesis makes tumor resection combined with reconstruction a desired choice in many patients. This chapter reviews malignant bone tumors of the hand and the choices available for their treatment.

    • Keywords:
    • malignant bone tumor

    • hand tumor

    • metastatic bone tumor

    • chondrosarcoma

    • giant cell tumor of bone

    • Subspecialty:
    • Hand and Wrist

Cubital Tunnel Syndrome

Compression neuropathy of the ulnar nerve at the elbow, more familiarly known as cubital tunnel syndrome, is a common condition in part caused by complex underlying anatomy. Cubital tunnel syndrome is described under a variety of classification systems, and several diagnostic tests and treatment options are available for it. Both extrinsic and intrinsic factors contribute to cubital tunnel syndrome, and its symptoms present initially as paresthesia in the distribution of the ulnar nerve. Severe cases are marked by loss of sensory function and intrinsic muscle weakness and atrophy. The diagnosis of cubital tunnel syndrome is based on a history and physical examination, but may be helped by electrodiagnostic tests. Provocative findings consist of a positive Tinel sign in the retrocondylar groove and positive findings on an elbow flexion test, and occasionally the presence of nerve hypermobility. The management of cubital tunnel syndrome includes nonsurgical treatment or any of various surgical procedures directed at relieving nerve traction and compression. Nonsurgical treatment is aimed at reducing direct pressure on the ulnar nerve and avoiding prolonged elbow flexion through activity modification and the use of night splinting. Historically, the options for surgical treatment have included medial epicondylectomy, in situ decompression without transposition (open vs endoscopic) of the ulnar nerve, and anterior transposition of the ulnar nerve via subcutaneous, intramuscular, or submuscular positioning. Early diagnosis and appropriate treatment will contribute to improved outcomes of the management of cubital tunnel syndrome.

    • Keywords:
    • cubital tunnel

    • ulnar nerve

    • compression neuropathy

    • Subspecialty:
    • Hand and Wrist

Diagnosis and Treatment of Pediatric Knee Fractures

Knee fractures are relatively rare injuries in children, occurring with an incidence of approximately 13 per 100,000. Due to the presence of physes and apophyses, traumatic forces to the knee of a skeletally immature individual result in patterns of injury that are different from those seen in an adult knee. Areas of the skeleton where there is growing cartilage tend to be weaker than the ligaments that attach to them, and are thus more susceptible to injury. The frequency and severity of pediatric knee fractures are increasing due to increasing participation in sports. Many pediatric knee fractures require surgical intervention, and some are associated with acute and late complications. This article reviews the pathophysiology, etiology, diagnosis, and treatment options for the most common knee fractures in children and adolescents.

    • Keywords:
    • tibial spine fracture

    • tibial eminence fracture

    • tibial tubercle avulsion fracture

    • patella fracture

    • patellar sleeve fracture

    • distal femoral physeal fracture

    • proximal tibial physeal fracture

    • proximal tibial metaphyseal fracture

    • Salter-Harris fracture

    • Subspecialty:
    • Pediatric Orthopaedics