OKOJ, Volume 5, No. 10

Total Shoulder Arthroplasty

Dr. Evan Flatow performs a left shoulder replacement in a 58-year-old woman with glenohumeral osteoarthritis. The patient has loss of the joint surfaces with bone-on-bone touching and osteophytes, but the rotator cuff is intact. Therefore, an unconstrained shoulder arthroplasty is performed. Cemented glenoid and humeral components are used.

    • Keywords:
    • Biceps release

    • subscapularis insertion osteotomy

    • cephalic vein

    • pectoralis tendon

    • tendon of the deltoid insertion

    • axillary nerve

    • circumflex vessels

    • coricohumeral ligament

    • Subspecialty:
    • Shoulder and Elbow

Freiberg's Infraction

Freiberg's infraction is an osteochondrosis of a lesser metatarsal head. In most patients, the lesion is found on the second metatarsal. The disease most commonly occurs unilaterally in teenage or young adult females between 11 and 17 years of age; however, it can occur at any age. The exact cause of Freiberg's infraction is unknown—multiple etiologic factors have been reported in the literature, including trauma and osteonecrosis. Conservative treatment for Freiberg's infraction involves unloading of the affected metatarsal head to alleviate the mechanical irritation of the joint. Surgical intervention for Freiberg's infraction is generally indicated for patients who have not responded to conservative measures. Retrograde drilling, elevation of depressed articular fragments, joint debridement, osteochondral plug transplantation, metatarsal osteotomy,and shortening osteotomy are discussed. The surgical steps of the author's preferred treatment, dorsal closing wedge osteotomy, are presented.

    • Keywords:
    • infraction of the metatarsal head

    • osteochondrosis of the metatarsal head

    • avascular necrosis of the metatarsal head

    • Subspecialty:
    • Foot and Ankle

Spinal Tuberculosis

Tuberculous spondylitis is a spine infection associated with tuberculosis that is characterized by bone destruction, fracture, and collapse of the vertebrae, resulting in kyphotic deformity. The spinal canal can be narrowed by abscesses, granulation tissue, or direct dural invasion, leading to spinal cord compression and neurologic deficits. Spinal tuberculosis may be caused by hematogenous spread from well-established, extra-spinal foci, or from visceral lesions by direct extension. The goals of treatment are to eradicate the infection and prevent or treat neurologic deficits and spinal deformity. Mortality from tuberculous spondylitis has decreased dramatically with the introduction of effective chemotherapeutic agents, which play an integral role in the management of spinal tuberculosis. Currently used first-line drugs include isoniazid, rifampin, pyrazinamide, streptomycin, and ethambutol. Second-line agents that are used in special circumstances include ethionamide, cycloserine, kanamycin, capreomycin, prothionamide, and aminosalicylic acid. Surgery may be performed to drain abscesses, to débride sequestered bone and disk, to decompress the spinal cord, or to stabilize the spine for the prevention or correction of deformity.

    • Keywords:
    • Pott disease

    • Potts disease

    • Potts paraplegia

    • tuberculous spondylitis

    • tuberculous spondyloarthropathy

    • spinal TB

    • musculoskeletal tuberculosis

    • Subspecialty:
    • Spine