OKOJ, Volume 8, No. 3

Treatment of cervical intervertebral disk degeneration has traditionally been limited to procedures that remove pathologic disk material and address the bony and neurologic pathology in the region surrounding the excised disk. However, although anterior diskectomy and fusion has been shown to have a high rate of success in some patients, this procedure is associated with a number of complications, most notably adjacent-level disease, pseudarthrosis, and recurrence of neurologic symptoms. As a result, there has been increasing interest in the United States in cervical disk arthroplasty, which preserves motion, avoids the limitations of fusion and the morbidity of bone graft harvest, and allows patients to quickly return to normal activities. Although cervical disk arthroplasty has its own set of complications, early outcomes in US IDE trials suggest that cervical disk arthroplasty may ultimately provide a viable alternative to the current standard of care.

Tibial shaft fractures are common injuries that most often result from high-energy mechanisms. These fractures are particularly likely to be open fractures; many of them are severe. Intramedullary nailing is an effective technique for treatment of most tibial shaft fractures, with restoration of alignment, immediate motion, early weight bearing, and good/excellent clinical outcomes. Most surgeons consider displaced or unstable tibial shaft fractures as surgical indications, while some recommend intramedullary nailing for all complete tibial shaft fractures, unless a specific contraindication is present. In this article, the author provides a step-by-step description and video presentation of his surgical technique, including indications and contraindications, pearls and pitfalls, postoperative care, rehabilitation protocols, and reported outcomes.

The devastating earthquake that struck Haiti in January 2010, and other tragedies of the recent past—including the watershed terrorist attack on New York City?s Twin Towers on September 11, 2001—have heightened awareness in the medical community about the critical importance of disaster and mass casualty preparedness. In fact, the risk of mass casualty disaster events is increasing due to a rise in global population density, an upsurge in volatile weather patterns, newly emergent infectious diseases such as the H1N1 influenza virus, improper and careless disposal of hazardous materials, and terrorist activity. This article addresses the principles of planning and preparation for disasters and mass casualty events; the roles and responsibilities of responders; chemical, biological, radiological, and nuclear agents and prodromal signs of exposure; and the importance of overcoming complacency to achieve a unified, well-orchestrated and rehearsed, regularly evaluated and updated plan for managing the effects of natural and man-made catastrophes.