OKOJ, Volume 6, No. 1


Myeloma, a malignancy of the plasma cells in the bone marrow, is the most common primary neoplasm in the skeletal system. It is called multiple myeloma when myeloma cells occur in more than one bone marrow site in the body. The etiology of myeloma is a clonal proliferation of a B cell, with a resultant increase in a single immunoglobulin and its fragments in the blood or urine. Patients with undiagnosed myeloma often present with bone pain, most commonly in a weight-bearing location. Patients may also have systemic symptoms, such as fatigue, renal insufficiency, and recurrent infections. Radiographically, multiple myeloma is characterized by well-circumscribed, "punched out" lytic lesions within the skull, spine, pelvis, and long bones. The International Myeloma Working Group has simplified the diagnostic criteria for myeloma to include (1) M protein in serum or urine, (2) clonal plasma cells in bone marrow or solitary plasmacytoma, and (3) related organ or tissue impairment (end organ damage, including bone lesions). Multiple myeloma is an incurable disease. Evolving treatments in the past 25 years, including intralesional curettage, radiation therapy, chemotherapy, and bone marrow transplantation, have increased the median survival rates. The most recent Surveillance Epidemiology and End Results (SEER) data state that the median survival rate is just more than 3 years. There are some studies that report survival rates of 5 years, but these are small series.

    • Keywords:
    • multiple myeloma

    • MM

    • plasma cell myeloma

    • Kahlers disease

    • bone marrow cancer

    • bone marrow malignancy

    • monoclonal gammopathy of unknown significance

    • MGUS

    • plasmacytoma

    • asymptomatic "

    • smoldering"

    • myeloma

    • nonsecretory myeloma

    • Subspecialty:
    • Musculoskeletal Oncology

Orthopaedic Aspects of Child Abuse

Child abuse is a pervasive social and medical problem that remains a major cause of disability and death among children. Increased awareness has lead to a better understanding of the social, medical, and epidemiologic aspects of this complex issue. During 2005, 899,000 children in the 50 states, the District of Columbia, and Puerto Rico were determined to be the victims of abuse or neglect, and nearly 1,500 children died as a result of this maltreatment. The diagnosis of child abuse is seldom easy to make and involves a careful consideration of sociobehavioral factors and clinical findings. Fractures are the second most common presentation of physical abuse after skin lesions, and approximately one third of abused children are eventually seen by an orthopaedic surgeon. Thus, an understanding of the differences in the general and musculoskeletal manifestations of accidental and nonaccidental injury is essential for recognition and appropriate management of the abused child. There is no pathognomonic fracture pattern in child abuse. Rather, the age of the child, the overall injury pattern, the stated mechanism of injury, and pertinent psychosocial factors must all be considered in each case. Musculoskeletal injury patterns suggestive of abuse include multiple fractures in various stages of healing, posterior rib fractures, and long bone fractures in children younger than 2 years.

    • Keywords:
    • batterd child syndrome

    • domestic violence

    • family violence

    • physical abuse

    • nonaccidental injuries

    • skeletal trauma

    • soft-tissue injuries

    • Subspecialty:
    • Trauma

    • Pediatric Orthopaedics

Arthroscopic Extensor Carpi Radialis Brevis Excision

Lateral epicondylitis, or tennis elbow, is a common affliction of the elbow and is primarily the result of microscopic tearing with formation of reparative tissue in the origin of the extensor carpi radialis brevis (ECRB) muscle. In this presentation, Dr. Baker performs an arthroscopic ECRB excision in a 35-year-old man with a 3-year history of pain on extension of his right elbow. The arthroscopy is performed through two small incisions with visualization of the site of pathology from a medial portal and arthroscopic débridement and resection through a lateral portal. The advantages of an arthroscopic versus an open technique include the ability to débride the anatomic origin of the ECRB without dividing the common extensor aponeurosis or affecting the extensor carpi radialis longus, the ability to inspect the joint and treat intra-articular pathology, a shortened period of immobilization and rehabilitation, and outcomes that are comparable or better to those of open surgery. Patients who are recalcitrant to conservative therapy (including corticosteroid injections) are candidates for this surgery.

    • Keywords:
    • lateral epicondylitis

    • tennis elbow

    • lateral elbow tendinosis

    • lateral elbow pain

    • Subspecialty:
    • Shoulder and Elbow