OKOJ, Volume 14, No. 5

Arthroplasty Management of Hip Fractures: Hemiarthroplasty Versus Total Hip Arthroplasty—Results and Complications

The choice between total hip arthroplasty (THA) and hemiarthroplasty for the treatment of femoral neck fracture remains a controversial issue in orthopaedic surgery. The recent scientific literature and registry data indicate that THA is associated with improved clinical outcomes, but at the cost of a higher dislocation rate. The same data provide conflicting results regarding implant survivorship; therefore, both treatments can be appropriate and treatment algorithms have been developed to simplify the choice and optimize the results of THA and hemiarthroplasty in the treatment of femoral neck fractures.

    • Keywords:
    • hip fracture

    • hemiarthroplasty

    • total hip arthroplasty

    • Subspecialty:
    • Adult Reconstruction

Adolescent Idiopathic Scoliosis

Adolescent idiopathic scoliosis is a three-dimensional deformity of the spine affecting approximately 2% to 3% of children. Treatment goals are aimed at minimizing patient deformity and maximizing functional outcome throughout life. The risk of progression of scoliosis is affected by the magnitude of the deformity and growth potential, with younger children and larger deformities at higher risk of progression. Traditional treatment options include observation, brace treatment, and surgical intervention consisting of spinal fusion. More recent alternative treatments, such as scoliosis-specific physical therapy protocols and motion-preserving growth modulation surgery, are generating increasing interest from the public and the medical community. Although surgical techniques have evolved over time with more powerful correction ability, limited data exist regarding the changes in functional and patient-reported health-related outcomes associated with these changes in surgical technique. Future investigation into the outcomes of patients with adolescent idiopathic scoliosis will be important to determine the optimal cost-benefit decisions for nonsurgical and surgical treatment of this disease.

    • Keywords:
    • adolescent idiopathic scoliosis

    • nonsurgical treatment

    • spinal fusion

    • Subspecialty:
    • Pediatric Orthopaedics

Pediatric Scaphoid Fractures

Scaphoid fractures are the most common type of carpal injuries that occur in children and adolescents. The injury pattern seen in children and adolescents who have scaphoid fractures has recently shifted to resemble that of adults who have scaphoid fractures, with scaphoid waist fractures being the most common injury pattern. This shift has been attributed to increased body mass index in children and adolescents as well as more intense participation in extreme sports by both children and adolescents. The diagnosis of scaphoid fractures is based on both a clinical examination and radiographic findings. If a scaphoid fracture is clinically suspected but the initial radiographs are negative, cast immobilization followed by repeat imaging can lead to accurate diagnosis of the injury. MRI can aid in the diagnosis of a scaphoid injury in pediatric patients with incomplete ossification of the scaphoid. Acute nondisplaced scaphoid fractures have a high rate of healing with cast immobilization; however, surgery should be considered for patients who have displaced scaphoid fractures with delayed presentation. In general, patients with scaphoid fractures who undergo appropriate treatment and achieve successful union have excellent long-term functional outcomes.

    • Keywords:
    • pediatric fractures

    • pediatric wrist injuries

    • scaphoid fracture

    • Subspecialty:
    • Hand and Wrist

    • Pediatric Orthopaedics