OKOJ, Volume 5, No. 1

Posterior Tibial Tendon Problems

Posterior tibial tendon dysfunction (PTTD) is an inflammation and/or overstretching of the posterior tibial tendon in the foot. An important function of the posterior tibial tendon is to help support the arch of the foot. In PTTD, the tendon's ability to perform that job is impaired, often resulting in a flattening of the foot. The exact cause of PTTD is unknown; however, several causes have been suggested, including mechanical overload and hypovascularity in the portion of the tendon distal to the medial malleolus. Nonsurgical treatment of disease stages 1 and 2 involves treatment with nonsteroidal anti-inflammatory drugs and supportive shoes. Stage 2 disease is addressed surgically with a flexor digitorum longus to posterior tibial tendon transfer with medializing calcaneal osteotomy and/or lateral column lengthening, with possible selective gastrocnemius lengthening; however, appropriate surgical treatment for stage 2 disease remains controversial.

    • Keywords:
    • acquired adult flatfoot

    • posterior tibial tendon dysfunction

    • PTT dysfunction

    • posterior tibial tendon insufficiency

    • PTT insufficiency

    • PTTD

    • too-many-toes sign

    • flexor digitorum longus transfer

    • medializing calcaneal osteotomy

    • lateral column lengthening

    • Subspecialty:
    • Foot and Ankle

Kienböck's Disease

Kienböck's disease, or osteonecrosis of the lunate bone, can lead to intermittent pain, weakness, and limited range of motion in the wrist. Patients often experience pain for a long period of time (months to years) before seeking medical treatment. The etiology of Kienböck's disease is multifactorial. Certain factors put the lunate bone at risk of osteonecrosis, including its blood supply and geometry, trauma, and various underlying disorders, such as sickle cell anemia, athetosis, and ulnar negative variance. Nonsurgical treatment that includes splinting or cast immobilization can be considered for patients with stage I Kienböck's disease. Surgical options descrbed in this article include procedures for lunate unloading (radial shortening osteotomy, capitate-shortening osteotomy), revascularization (vascularized bone grafting), preserving motion (scaphocapitate fusion), and salvage (proximal row carpectomy, total wrist arthrodesis).

    • Keywords:
    • lunate

    • lunatomalacia

    • avascular necrosis

    • osteonecrosis

    • bone scan

    • radial-shortening osteotomy

    • vascularized bone graft

    • capitate-shortening osteotomy

    • scaphocapitatate fusion

    • intercarpal arthrodesis

    • proximal row carpectomy

    • total wrist arthrodesis

    • total wrist fusion

    • Subspecialty:
    • Hand and Wrist

Supracondylar Fractures of the Humerus in Children

Fractures of the distal end of the humerus above the growth plate are the most common elbow fractures in children. This fracture typically occurs in children between the ages of 2 and 12 years and account for two thirds of all hospitalizations for elbow injuries in children. The history usually involves the child falling on an outstretched hand, hyperextending the elbow and forcing the olecranon into its posterior humeral fossa.

The pathophysiology and clinical presentation of supracondylar fractures in children is reviewed extensively and nonsurgical and surgical management options are presented in detail. In addition to a review of nonoperative reduction and casting, closed reduction and percutaneous pinning and open reduction and internal fixation are explored in detail. Video is available.

    • Keywords:
    • elbow fracture

    • elbow joint fracture

    • broken elbow

    • distal humerus fracture

    • extension-type injury

    • flexion-type injury

    • casting

    • cast immobilization

    • percutaneous pin fixation

    • internal fixation

    • Subspecialty:
    • Trauma

    • Pediatric Orthopaedics