OKOJ, Volume 7, No. 10

Instability After Total Knee Replacement: Treatment

The authors provide an overview of total knee replacement (TKR) instability causes and discuss how to diagnose these problems in an attempt to help orthopaedic surgeons treat and resolve TKR instability. A thorough workup is essential to provide detailed knowledge of the TKR instability; this enables orthopaedic surgeons to define the nature of the instability and thus develop an appropriate treatment plan. Ligament balancing for primary TKR is discussed in detail because an understanding of the principles is essential for understanding TKR instability. Diagnosis, features, and treatment options for the three main types of TKR instability (flexion-extension instability, flexion instability, and extension instability) are also discussed.

    • Keywords:
    • primary TKR ligament balancing

    • flexion-extension instability

    • flexion instability

    • extension instability

    • genu recurvatum

    • knee hyperextension

    • Subspecialty:
    • Adult Reconstruction

Radial Nerve Palsy

Radial nerve palsy is caused by damage to the radial nerve, often because of a fracture of the humeral shaft or compression at the elbow. When evaluating a radial nerve palsy, it is important to determine whether the injury is to the radial nerve proper (high radial nerve palsy) or to the posterior interosseous nerve (low radial nerve palsy). Functional deficits associated with high radial nerve palsy include a loss of wrist extension, digital extension, and thumb extension/abduction, whereas in low radial nerve palsy wrist extension is spared. Many radial nerve palsies recover spontaneously and nerve surgery is not required. Surgery for radial nerve palsy is performed to release compression of the nerve, or to repair it with sutures or grafting. Tendon transfer is the most common surgical treatment for patients with radial nerve palsy. This article focuses specifically on the diagnosis and treatment of radial nerve paralysis, with special attention given to the use of tendon transfers to correct the secondary functional deficits associated with this condition. In addition, the controversy over the timing of surgical exploration for radial nerve palsies is addressed.

    • Keywords:
    • radial nerve paralysis

    • radial nerve injury

    • radial nerve compression

    • radial nerve entrapment

    • high radial nerve palsy

    • low radial nerve palsy

    • neuropraxia

    • neurotmesis

    • axonotmesis

    • posterior interosseous nerve syndrome

    • radial tunnel syndrome

    • tendon transfer

    • Subspecialty:
    • Hand and Wrist

Outcomes of ACL Reconstruction

Due to variations in graft type, fixation methods, and rehabilitation protocols in the ACL reconstruction literature, it is a challenge for the orthopaedic surgeon to compare the large number of available studies and draw conclusions about graft choice. The biggest debate in the literature is between the use of bone-patellar tendon-bone (BPTB) versus hamstring autografts. Some studies have shown more motion loss, more anterior knee pain, and more pain or difficulty with kneeling with BPTB graft, whereas hamstring graft has been associated with decreased knee flexion strength. The most consistent finding in the evidence-based research, however, has been the similarity in the outcomes between the two types of graft. This article is designed to aid the orthopaedic surgeon in making an informed decision when planning ACL surgery by reviewing the best and most current literature available on outcomes of ACL reconstruction.

    • Keywords:
    • ACL injury

    • knee injury

    • knee ligament injury

    • anterior cruciate ligament reconstruction

    • allograft reconstruction

    • Subspecialty:
    • Sports Medicine

2007 OTA Fracture and Dislocation Classification: Part II. Application

The revised Orthopaedic Trauma Association (OTA) Fracture and Dislocation Classification compendium republished in 2007 provides a complete system of fracture classification for all bones in the body that uses consistent methodology throughout the skeletal system. The 2007 OTA Fracture and Dislocation Classification has been established as the standard for the classification of fractures by OTA, AO, Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT), the Journal of Orthopaedic Trauma, and many other organizations and publications, and can now be recommended as the standard fracture classification for general use. In part II of this two-part series, the application of the revised classification is discussed in detail and several case examples are provided.

    • Keywords:
    • patella

    • scapula

    • clavicle

    • skull and facial bone

    • long bone fractures

    • humerus

    • tibia

    • forearm segment

    • radius and ulna

    • femur

    • pelvis

    • tarsal and metatarsal

    • spine

    • fracture-dislocation

    • Subspecialty:
    • Trauma