OKOJ, Volume 5, No. 12

Bunionette Deformity

A bunionette is a painful prominence on the lateral aspect of the head of the fifth metatarsal bone. The deformity is common in adolescents and adults, mostly females and athletes. Like bunions, most bunionettes are caused by frequent wearing of ill-fitting shoes that constrict the forefoot. Additionally, several anatomic variations of the fifth metatarsal have been documented and may lead to bunionette deformity. Nonsurgical treatment for bunionette includes local padding of the prominence, wearing shoes with a wider toe box area, and anti-inflammatory medications. Surgery is indicated for bunionette if conservative care fails to relieve symptoms. Surgical treatment should be determined by the type and location of each bunionette deformity. Surgical options include lateral resection or shaving, distal chevron osteotomy, and diaphyseal oblique osteotomy.

    • Keywords:
    • tailors bunion

    • fifth metatarsalgia

    • opposite side bunion

    • type I bunionette

    • type II bunionette

    • type III bunionette

    • type IV bunionette

    • distal oblique osteotomy

    • Subspecialty:
    • Foot and Ankle

Spinal Epidural Abscess

A spinal epidural abscess is a collection of pus or inflammatory granulation tissue that is localized to the epidural space of the spinal cord. The abscess causes swelling in the area and threatens the spinal cord by compression and vascular disruption. The presence of a spinal epidural abscess is typically associated with a disk space infection or vertebral osteomyelitis. Common presenting symptoms include back pain, neurologic deficit, fever/chill, local tenderness, and paresthesias. Weakness or paralysis may not develop for many months or may occur suddenly and unpredictably in a matter of hours. Treatment goals for patients with spinal epidural abscess are eradication of infection, pain relief, preservation or improvement of neurologic status, and preservation of spinal stability. Laminectomy generally is the treatment of choice because the abscess is posterior in most patients. With surgery, most patients will recover fully or with minimal weakness.

    • Keywords:
    • epidural space infection

    • spinal infection

    • spinal epidural sepsis

    • spinal extradural abscess

    • SEA

    • spinal cord compression

    • vertebral osteomyelitis

    • disk space infection

    • spinal subdural empyema

    • laminectomy

    • Subspecialty:
    • Spine

Posterior Cruciate Ligament Reconstruction

The posterior cruciate ligament (PCL) is a primary stabilizer of the knee joint and the major restraint to posterior translation of the tibia. PCL injuries commonly occur as a result of motor vehicle accidents and athletic activities. Numerous specific tests for PCL injury exist, and these tests offer a reliable way to diagnose pathology. Conservative nonsurgical treatment is recommended for acute isolated grade I or grade II PCL tears and consists of splinting and protective weight bearing followed by range-of-motion and quadriceps-strengthening exercises. Indications for surgical intervention include avulsion fractures of the PCL, combined ligamentous injuries involving the PCL, chronic injuries with persistent instability or pain despite nonsurgical treatment, and chronic injuries that demonstrate progressive degenerative changes on bone scans or radiographs. Surgical treatment options include arthroscopic transtibial single-bundle reconstruction, tibial inlay techniques, and double-bundle reconstruction.

    • Keywords:
    • PCL injury

    • PCL tear

    • PCL rupture

    • cruciate ligament injury

    • knee ligament injury

    • posterior cruciate ligament tear

    • single-bundle reconstruction

    • double-bundle reconstruction

    • transtibial tunnel

    • tibial inlay

    • double femoral tunnel

    • Subspecialty:
    • Sports Medicine

Distal Radius Malunion

Malunion with associated dysfunction is a common complication of distal radius fracture. The deformity may be extra-articular, characterized by loss of radial length and abnormal metaphyseal angulation, or intra-articular, involving either the radiocarpal joint or the distal radioulnar joint, or both. Dysfunction can be loss of mobility, loss of strength, loss of functional use of the hand, or pain. Deformity does not always result in dysfunction, however, particularly in older patients with lower functional demands; therefore, impairment of function rather than radiographic deformity is the reason to treat a distal radius malunion. Careful radiographic evaluation is an essential step in the preoperative workup of patients with distal radius malunion and permits the measurement of key radiographic parameters that form the basis of surgical planning. There are no absolute surgical indications for distal radius malunion; therefore, in deciding treatment, the severity and duration of symptoms and the risk of progression should be weighed against the risks of surgery. Nonsurgical treatment involving physical therapy, splinting, and other modalities may improve function to a level at which the patient may not need surgery. Surgical intervention usually consists of corrective osteotomy, bone grafting, and fixation. This article describes standard opening wedge osteotomies commonly used in correction of radial malalignment.

    • Keywords:
    • wrist fracture

    • distal radius fracture

    • Colles fracture

    • Smith fracture

    • Barton fracture

    • malalignment

    • osteotomy

    • opening wedge osteotomy

    • Subspecialty:
    • Hand and Wrist

    • Trauma