OKOJ, Volume 9, No. 1

Advances in biomaterials have been central to improvements in orthopaedic implants in all fields of orthopaedics. For the clinician, patient care decisions are most enhanced by key principles and facts, as opposed to technical details. In part II of this series, we review the basic principles of metallurgy, including common materials, commercial implant applications, and modern manufacturing processes. Emphasis is given to clinical relevance for patient care decisions.

Low back pain is among the most common painful disorders among adults of all ages. Familiarity with the most common causes of low back pain and an approach to the diagnosis and management of these conditions are essential for physicians in nearly every specialty of medicine. This article provides a broad, evidence-based, and up-to-date overview of the most common causes of acute, subacute, and chronic low back pain, along with a logical approach to establishing the most precise anatomic diagnosis and making rational use of the most effective available therapies.

Pseudarthrosis of the lumbar spine is a known complication after spinal fusion and can lead to persistent or recurrent symptoms. However, not all patients with pseudarthrosis are necessarily symptomatic. Careful assessment should include a thorough patient history, physical examination, and corresponding imaging studies. The diagnosis of a symptomatic pseudarthrosis can be difficult, and a high index of suspicion is necessary. If feasible, nonsurgical options should be instituted first; if they fail, surgical intervention is warranted. Surgical options vary depending on the pathology present and should be individualized to the patient.

Proximal humerus fractures make up approximately 5% of all fractures in adults and occur primarily in the elderly population, typically as a result of low-energy falls. Younger patients may sustain these injuries due to higher-energy mechanisms. Women are more commonly affected than men, by a ratio varying from 2:1 to 5:1. Approximately three fourths of proximal humerus fractures have only minor displacement and should be managed nonsurgically. This article reviews the identification and surgical treatment of displaced fractures of the proximal humerus.

Fractures of the distal fibula are often associated with other ankle injuries, including medial injuries to the deltoid ligament or the medial malleolus. Isolated distal fibula fractures are generally considered stable and do well with nonsurgical treatment. When the deltoid ligament is torn with a distal fibula fracture, the ankle mortise may be widened or reduced. If it is widened, the deltoid ligament injury can be deduced from the radiograph. However, some of these injuries do not demonstrate mortise widening and can result in poor ankle function and poor position of the ankle mortise if treated nonsurgically; therefore, surgical treatment is generally recommended for distal fibula fractures with associated deltoid ligament injury. This article reviews current understanding of the treatment of distal fibula fractures with questionable medial injury, and identifies the role of stress radiographs in determining indication for surgery. The associated medial injury is not "all or none" but represents a spectrum of injury, with optimal treatment based on the amount of displacement and possibly the results of alternative noninvasive testing.