OKOJ, Volume 6, No. 3

More than 400,000 total knee arthroplasty (TKA) procedures are performed annually in the United States, most on elderly patients. With the increasing life expectancy and heightened activity levels of the elderly population, the number of patients who undergo TKA procedures will likely double over the course of the next decade and result in an increased incidence of periprosthetic knee fractures. The prevalence of these fractures varies considerably among fracture location, patient predisposition to risk factors, and intraoperative and postoperative fracture incidence. Treatment options vary based on the fracture type and whether the fracture is identified intraoperatively or postoperatively. Use of appropriate bone cuts, proper positioning and gentle impaction of the components, meticulous care in removal of components and cement, and avoidance of stress risers help prevent periprosthetic fractures about the knee. Surgical treatment can include the use of Rush rods, Zickel supracondylar rods, plate and screw fixation, or supracondylar intramedullary rods.

Boutonniere finger deformity is characterized by proximal interphalangeal (PIP) joint flexion, distal interphalangeal (DIP) joint extension, and hyperextension of the metacarpophalangeal (MCP) joint, with volar subluxation of the lateral bands. The deformity is common in patients with rheumatoid arthritis; however, it is not specific to this disorder and may occur following trauma or other inflammatory arthritides. Treatment of boutonniere finger is individualized and is based on the patient's current level of function, deformity, medical status, limitations of the surgeon, and expectations. Not all patients with rheumatoid hand deformities are candidates for surgery because many will adapt over time and achieve an acceptable functional level. Nonsurgical management is indicated for patients with early stage disease and consists of nighttime splinting of the PIP joint in extension. Additionally, a corticosteroid injection is useful if active PIP joint synovitis is present. A variety of surgical procedures are available for boutonniere finger deformity, including tenotomy of the terminal extensor tendon and reconstruction of the central slip. The choice of surgical treatment is based on the flexibility of the PIP joint and the status of the articular cartilage.

Spine tumors can be broadly categorized as either primary spine tumors, which originate in the spinal elements, or metastatic tumors, which originate elsewhere in the body. As with all tumors, spine tumors can also be classified as malignant or benign. Spine tumors are relatively rare, and the related signs and symptoms are similar to those of degenerative spinal disorders. A comprehensive history and physical examination is essential to prevent a delay in diagnosis, which can have a significant effect on prognosis. Additionally, judicious use of imaging modalities and awareness of available nonsurgical treatments are necessary to achieve the best outcomes.

Patients with a femoral shaft fracture typically have sustained high-energy trauma, such as that which occurs in a motor vehicle accident. As such, femoral shaft fractures are severe and are associated with potentially life-threatening pulmonary and vascular complications. Fractures of the femoral diaphysis are commonly described by location and geometry of the fracture, degree of comminution, and severity of the soft-tissue injury. Associated injuries to other parts of the femur, other bones, and soft tissue are common.

This article reviews the pathophysiology and clinical presentation of femoral shaft fractures, and reviews the considerations for surgical and nonsurgical treatment. Specific surgical techniques reviewed in this article include a detailed, step-by-step video of the reamed, interlocking, rigid, retrograde intramedullary nailing procedure. An audio panel discussion on antegrade versus retrograde nailing is also featured.