OKOJ, Volume 8, No. 1

Paget's Disease of Bone

Paget's disease of bone is a benign metabolic bone disease of the elderly. Diagnosis is typically based on characteristic features observed on radiographs. Measurement of serum alkaline phosphatase levels and bone scintigraphy have been shown to be sensitive for diagnosing Paget's disease of bone, especially in patients with a positive family history of the disease. Bisphosphonates are the mainstay of treatment and have been shown to heal radiographic lesions and restore normal histology. Paget's disease of bone can degenerate into a sarcoma, in which case it carries a poor prognosis. Although the exact etiology of Paget's disease of bone still remains unclear, future studies are directed to understanding the cell biology of the disease.

    • Keywords:
    • pagetic bone

    • Pagets sarcoma

    • bisphosphonate therapy

    • zoledronic acid

    • risedronate

    • alendronate

    • pamidronate

    • tiludronate

    • etidronate

    • calcitonin

    • Subspecialty:
    • Musculoskeletal Oncology

Clavicle Shaft Fractures

Clavicle fractures are common injuries, representing approximately 3% to 5% of all fractures and 35% to 44% of all shoulder girdle fractures. Most are midshaft fractures resulting from a blow to the lateral aspect of the shoulder or a fall onto the lateral shoulder. Clavicle fractures typically produce a painful deformity. The scapula appears slightly internally rotated and the shoulder appears shortened relative to the opposite side. Radiographs in two projections (standard AP view and 45° cephalic tilt view) are necessary to evaluate the fracture pattern, presence of comminution, displacement, and shortening or distraction of the clavicle fracture. There is a general consensus that nondisplaced and minimally displaced clavicle fractures, and virtually all clavicle fractures in children, are treated nonsurgically with use of a sling or brace. Surgery is indicated for open fractures, fractures associated with neurologic or vascular injury, significantly displaced fractures, closed fractures with greater than 15 to 20 mm of shortening, and comminuted fractures. Good results have been reported with both plate-and-screw fixation and with intramedullary fixation of clavicle shaft fractures.

    • Keywords:
    • clavicle fracture

    • clavicular fractures

    • collarbone fracture

    • broken collarbone

    • shoulder trauma

    • intramedullary fixation

    • plate fixation

    • Subspecialty:
    • Trauma

Apophyseal Avulsion Fractures of the Pelvis and Lower Extremity

Apophyseal avulsion fractures of the hip and pelvis typically occur in patients between the ages of 14 and 25 years. The three most common locations of occurrence are the ischial tuberosity, anterior inferior iliac spine, and anterior superior iliac spine. Avulsion fractures of the greater trochanter, lesser trochanter, iliac crest, and pubic symphysis also occur, although much less frequently. These injuries can usually be diagnosed based on a thorough history and physical examination. Most avulsion fractures of the hip and pelvis can be detected on a standard AP pelvis radiograph. Pelvic apophyseal avulsion fractures are treated conservatively or surgically depending on the amount of displacement. Typical indications for surgical repair include displacement greater than 2 cm, non-unions, and painful exostosis.

    • Keywords:
    • pediatric pelvic fractures

    • ischial tuberosity avulsion fractures

    • tibial tubercle avulsion fractures

    • greater trochanter avulsion fracture

    • anterior superior iliac spine avulsion fracture

    • Subspecialty:
    • Trauma

    • Pediatric Orthopaedics