Orthopaedics
Adult orthopaedics resources from the Orthopaedics Hyperguide.
Plain radiographs may reveal posterior spurs and calcification in the distal extent of the tendon and bony overgrowth or cystic changes in the calcaneus consistent with chronic inflammation. Although we do not use MRI…
Injury to the acromioclavicular (AC) joint is one of the more common injuries to the shoulder girdle. The subcutaneous position of the joint and relative paucity of surrounding muscle make it prone to injury. Most of…
Avulsion fractures of the dorsal lip of the navicular account for about 50% of navicular fractures. The mechanism of injury is acute foot plantar flexion in which the talonavicular ligament and joint capsule pull off…
Tutorial All of the above, with the exception of diabetes, are causes of secondary frozen shoulder. A healing surgical neck or tuberosity fracture can scar the capsuloligamentous structures leading to frozen shoulder.…
Introduction The term spondylolisthesis is used to describe the displacement of one vertebral segment on another. Most commonly, it relates to pathology associated with the lumbosacral spine. The lumbar spine has a…
Despite the lack of Food and Drug Administration (FDA) approval, the use of antibiotic-impregnated polymethylmethacrylate spacers has become an important step in treating chronic, deep infections of total hip…
Ideal management of partial thickness and massive rotator cuff tears continues to challenge the orthopedic surgeon. With recent advances in technique, surgical options have evolved from simple open debridement to…
The association between secondary osteoarthritis of the hip and residual acetabular dysplasia in early adulthood has been reported previously.1 The main cause of osteoarthritis is believed to be increased joint contact…
Biceps Tendinitis and Rupture This entity is most commonly a component of rotator cuff disease caused by impingement. Attrition due to chronic inflammation may lead to frank rupture. Glenohumeral arthritis with…
Blood management in orthopedic surgery today consists of allogenic transfusions, autologous blood, intra- and postoperative blood salvage, and erythropoietin alpha.1 In my experience, intraoperative salvage is never…
Tutorial Boutonniere deformity is not synonymous with a proximal interphalangel joint (PIP) flexion contracture (i.e., post fracture, osteoarthritis or flexor tendon etiology). The position of a finger where the PIP…
Etiology The etiology of calcific tendinitis is unknown. It may be caused by ischemic changes in association with inflammation and calcium salt deposition. Microtrauma may also play a role. It commonly occurs in the…
Cemented femoral component and cement removal in revision total hip arthroplasty occupies a substantial portion of surgical time, even for a well-prepared surgeon. A variety of tools and techniques are available to…
Approximately three-quarters of patients who undergo THA are revised due to aseptic loosening caused by the release of submicron particulate debris from the bearing surfaces and subsequent host reactions within the…
Debris-associated osteolysis is the most common cause for revision total hip arthroplasty (THA) when polyethylene is used. Cross-linked polyethylenes show some promise but raise more questions. New polyethylenes are…
Eversmann. Entrapment and Compression Neuropathies: Operative Hand Surgery. 3rd ed.; Green DP, (ed.); New York, NY:Churchill Livingstone 1993.
The posterior cruciate ligament (PCL) is saved approximately 60% of the time and substituted 40% of the time. When substituting, a more conforming, deep-dish polyethylene can be used.
Intermediate to long-term reports of posterior stabilized total knee replacement (TKR) have demonstrated durable results with excellent function at 10- to 15-year follow-up.1,2 In addition, fluoroscopic kinematic…
Introduction Dupuytren contracture is a progressive fibromatosis of subcutaneous palmar connective tissue leading to the development of flexion contractures of the hand. The structures involved in this disease are the…
Incidence and Epidemiology Arthrodesis of the elbow is a rare procedure. Hallock in 1932 was one of the first surgeons to report on a technique for elbow fusion. Historically, most of the reported cases have been done…
Incidence and Epidemiology Dislocations of the elbow usually result from a fall onto the outstretched extended elbow. Simple elbow dislocations have no associated fracture and are classified according to the direction…
The scapula is a bone with complex geometry which overlies the second through seventh ribs and is tilted forward 30° with respect to the coronal plane. Seventeen muscles completely encase the scapula and provide dynamic…
Tutorial The elbow joint is a trochoginglymoid joint providing both flexion and extension through an ulnohumeral hinge and axial rotation through a radiohumeral and proximal radioulnar pivoting motion (trochoid). Normal…
The thoracic spine consists of 12 vertebrae, and represents the largest segment of the spine. As surgical approaches and internal fixation techniques in the spine continue to evolve, a thorough knowledge of the…
Stiffness after total knee replacement (TKR) can be one of the more frustrating complications of this usually successful procedure. This article reviews potential causes of this complication and discusses the evaluation…
In the 1980s, excellent 10-year results were reported from numerous centers that used the so-called "second-generation cement technique." This consisted of using a canal plug, a doughy high-strength cement, a cement gun…
Distal femurs come in a spectrum of sizes and shapes. Inventory management demands a finite number of proportional sizes to be available. Most systems have at least six full sizes and a variable number of half sizes.…
Introduction The carpometcarpal (CMC) joint of the thumb is formed by the articular surfaces of the distal trapezium and the proximal thumb metacarpal. Osteoarthritis (OA) of the CMC joint is a common and disabling…
For mild deformity, (i.e., HV with an intermetatarsal angle of equal to or less than 13 degrees and HV angle less than 30°), a distal metatarsal osteotomy with or without a distal lateral soft tissue release may be…
Hip fusion remains an important but often overlooked option for selected patients with unilateral hip disease. This article considers the indications for hip fusion and current reconstructive practice and describes the…
Since its description by Robert Kienböck over 85 years ago, the disease bearing his name has remained a mystery to orthopedic surgeons. Neither the causes nor a universally accepted treatment for this condition has been…
Tutorial Overloading conditions can adversely effect a tendon structure via chronic microtrauma. These conditions often manifest histologically as the degeneration of collagen fibers (tendinosis) and often exist without…
The lateral talar process is a wedged-shaped prominence that compromises the most lateral aspect of the talar body. Superiorly, it articulates with the talofibular joint, and inferiorly, with the posterior talocalcaneal…
Plain radiographs, myelography, computed tomography (CT) and magnetic resonance imaging (MRI) are the core imaging modalities used in the evaluation of the lumbosacral spine. Despite the increased sophistication and…
The spinal column consists of 33 vertebrae that form a firm, but flexible, shaft that supports the trunk and appendages and provides protection for the spinal cord. The lumbar spine is characterized by five robust…
The consequences of normal aging of the spine include progressive disk dehydration, chemical alterations and subsequent mechanical "incompetence," which may be manifested in low back pain, although an exact correlation…
The prevalence of symptomatic lumbosacral disk herniation is relatively small. It is important to differentiate between the reasonably well-defined entity of sciatica resulting from a herniated intervertebral disk and…
The spine is the most common site of skeletal metastasis, with the lumbar vertebrae being the most frequently affected. Metastatic disease to the spine may occur with almost any of the solid tumors of the body as well…
Spinal stenosis represents a narrowing of the spinal canal or neural foramina producing root ischemia and neurogenic claudication. Degenerative lumbar spinal stenosis is the result of chronic disc degeneration,…
Spinal infections may involve the vertebral body (vertebral osteomyelitis), the intervertebral disc (infectious discitis), or the spinal canal and its contents (spinal epidural abscess). Vertebral osteomyelitis is…
Restoration of function in revision total knee replacement (TKR) often depends on careful documentation of bone loss prior to and at revision TKR. To obtain durable results in revision TKR, it is necessary to have a…
Extensor mechanism disruption is among the most feared and devastating complications of total knee arthroplasty (TKA). In the past, generally poor treatment results of this complication have led to the conclusion that…
Tutorial Patients complaining of medial epicondylitis describe aching pain in the flexor musculature arising from the medial epicondyle. Often wrist flexion or pronation against resistance can elicit symptoms. The…
Since the work of Zuppinger1 and the treatise published by Strasser,2 orthopedists and engineers who designed total knee prostheses believed human knee motion was guided by the cruciate ligaments acting in a crossed…
Metasul (Sulzer Orthopedics Ltd, Baar, Switzerland) has been used for 13 years in Europe. Presently, more than 150,000 Metasul articulation surfaces are implanted worldwide. With changes that have occurred in…
Pain is followed by weakness of the lower extremities, sensory loss and bladder and bowel changes. Complete paraplegia may be the final sequence of thoracic metastatic disease. In patients whose paraplegia develops…
Knee joint replacement is one of the most successful operations in orthopedic surgery. Over 95% of patients have excellent relief of pain, good mobility, and the ability to return to most of their normal activities of…
Stress fractures of the tarsal navicular are seen in young athletes who run and jump frequently. Patients experience dorsomedial foot pain that worsens with activity. Cavus feet and calcaneal-navicular coalitions are…
Non-traumatic disorders of the sternoclavicular (SC) are numerous and include non-traumatic subluxation, arthritis, and infection. Spontaneous, congenital, or developmental dislocation have all been reported and are…
Nonoperative therapies are appropriate for management of patients with osteoarthritis of the knee. This article focuses on several such measures including exercise as a therapeutic modality, effect of weight loss,…
Osteochondral defects of the talus occur on both medial and lateral sides of the talar dome. Lateral lesions are more closely associated with trauma, and are caused by dorsiflexion-inversion injuries. They are usually…
Osteoporosis is the most common metabolic bone disease and is characterized by low bone mass and microarchitectural deterioration of the bone tissue. A normal mineral:collagen ratio is present in osteoporosis, whereas…
Total knee arthroplasty (TKA) has been a major advance for the treatment of the arthritic knee, predictably achieving excellent results at 10- to 15-year follow-up in more than 95% of patients.1 The infection rate is…
The evolution and selection of femoral fixation in primary total hip arthroplasty (THA) has moved toward biological fixation with immediate stability and ingrowth of the implant. Concerns with the use of cementless…
Early in the development of modern, surface total knee replacement (TKR) the prostheses were intended to function with either retention of the posterior cruciate ligament (PCL) or after removing the PCL. With the…
With the patient sitting, palpation of the posteromedial aspect of the ankle may identify edema and tenderness along the PTT. Manual testing of tendon strength is performed by asking the patient to simultaneously…
Preoperative planning is important in revision total knee replacement (TKR). Revision TKR can be a challenging experience for all involved. Multiple implant options include cemented and cementless primary and revision…
Introduction The median nerve is formed by the anterior divisions of the lateral and medial cords. It travels down the arm adjacent to the brachial artery just anterior to the medial intermuscular septum and posterior…
Spinal cord compromise can result from direct compression of epidural abscess, granulation tissue, or destroyed disk fragments, and caused by collapsed vertebral body. Ischemia may aggravate spinal cord damage as a…
Compression neuropathy of the radial nerve is much less common than in the ulna or median nerves. Five distinct clinical syndromes have been described.
Rotator cuff disease comprises a spectrum of pathology from inflammation of the sub-acromial bursa and supraspinatus tendon to full thickness tears of the supraspinatus tendon to involvement of the other rotator cuff…
Hip fractures that fail to heal typically cause marked pain and profound disability. Effective strategies to salvage these difficult problems are important. Treatment of failed hip fractures is divided by fracture…
In 1982, Charles Neer II, MD introduced the concept of “limited goals” when treating patients with glenohumeral arthritis and a deficient rotator cuff.1 This concept illustrates the therapeutic challenge represented by…
Stenosing tenosynovitis, commonly referred to as trigger finger, most commonly occurs in otherwise healthy middle-aged women. It is also seen in younger patients whose vocations involve repetitive and prolonged gripping…
Tutorial The elbow is prone to develop stiffness as a result of its high degree of joint congruity. The surrounding tissues also play a role in elbow stiffness. Both the close continuity of the capsule to the overlying…
Originating from spinal roots C5 and C6, the suprascapular nerve courses laterally across the posterior triangle of the neck deep to the trapezius muscle to reach the suprascapular notch. It then courses beneath the…
Swan-neck deformity describes a posture of the finger in which the proximal interphalangeal joint (PIP) is in hyperextension and the distal interphalangeal (DIP) joint is in flexion. Initially, this is a flexible…
Talar neck fractures constitute 50% of talus fractures. The mechanism of injury is acute dorsiflexion of the forefoot, and usually occurs in motor vehicle accidents, falls, or as originally described, in airplane…
Achilles tendon rupture can be a debilitating injury that results in significant loss of function if left untreated. Ruptures are generally associated with a gradual degeneration of the tendon precipitated by a…
Diabetes mellitus is the most common metabolic disorder in the Western hemisphere. Diabetes mellitus affects approximately 5% to 8% of Caucasians. It is estimated that for every known patient there is another patient…
A successful total knee arthroplasty (TKA) is a function of proper implant selection, proper alignment, and especially achieving proper soft-tissue balance. Establishing posterior stability (flexion balance) is a…
Historically, there has been limited treatment options available for diseases that affect the cartilage, bone, or synovium in the hip joint. Nonoperative treatment may result in persistent symptoms whereas open…
Thoracic disk herniation is extremely uncommon as compared to incidence in the cervical and lumbar region. The variable and nonspecific presentations make correct diagnosis more difficult, especially at the upper and…
Tutorial Implant arthroplasties of the elbow are designated as constrained, semi-constrained, and unconstrained. The differentiation is based on the rigidity of the fixation of the humeral component to the ulnar…
Periprosthetic fractures about total knee arthoplasty (TKA) are relatively rare (0.5% to 3%). The most common periprosthetic fracture about TKA is the supracondylar fracture. It is an infrequent injury; however, the…
Sensory loss extends distally to the underneath of the little finger and to the ulnar-volar aspect of the ring finger. There is also sensory loss proximally in the ulnar-dorsal aspect of the palm and the back of the…
Avascular necrosis (AVN) of the femoral head is a progressive, crippling syndrome for which no widely accepted treatment is available. Avascular necrosis is associated with a variety of both traumatic and nontraumatic…
Wound healing is critical for the success of any total knee arthroplasty (TKA). Delays in wound healing risk infection and failure. Wound problems are minimized by selecting the proper skin incision, understanding…
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