Volume 18-1, Spring 2009

Meniscus tears in athletes display a variety of clinical resentations. Three different case scenarios are presented along with diagnoses and treatment options, and the best available evidence, at present, is reviewed. (Journal of Surgical Orthopaedic Advances 18(1):2–8, 2009). Key words: athlete, diagnosis, meniscal tear, treatment

The objective of this study was to determine the inter- and intraobserver reliability of plain films as compared with CT scans in quantitatively measuring articular displacement in acetabular fractures utilizing a standardized measurement technique. Three independent reviewers compared the standardized measurement technique to direct measurement of the articular displacement. Weighted kappa statistics were performed to assess the inter- and intraobserver agreement. The standardized method of measurement showed slightly better inter- (0.24) and intraobserver (0.36) reliability for measuring articular displacement, as compared to direct measurement (0.12 and 0.22). Measurements using CT scans showed higher inter- (0.3) and intraobserver (0.43) reliability, when compared to plain radiographs (0.27 and 0.36). Measurements performed on fracture patterns which did not include a posterior wall component had higher inter- (0.41) and intraobserver (0.44) reliability, when compared to patterns with posterior wall fractures (0.12 and 0.22). Based on these results, it was concluded that the use of the standardized method of measurement, as described by Borrelli et al., was not superior to direct measurement of articular displacement. (Journal of Surgical Orthopaedic Advances 18(1):9–12, 2009) Key words: acetabulum fracture, congruity, interobserver reliability, radiographic assessment.

Cervical nerve root compression, in contrast to nerve root irritation, results in an objective neurologic deficit of the affected nerve root. The purpose of this article is to highlight current diagnostic and treatment options that have proven efficient and safe in managing cervical root compression. The natural history of cervical disc disease and the clinical patterns and causes of cervical radiculopathy are reviewed. Electromyography and reformatted mutiplanar CT scans in addition to MRI are valuable diagnostic modalities. Although anterior cervical discectomy and interbody fusion remains the gold standard of treatment, microendoscopic foraminotomies and discectomies done from posterior and anterior approaches are effective and safe. The role of disc arthroplasty in the treatment of radiculopathy is evolving. (Journal of Surgical Orthopaedic Advances 18(1):13–18, 2009). Key words: cervical decompression and fusion, cervical radiculopathy, microendoscopic foraminotomies and discectomies.

This study examined the seasonal birth patterns of patients with cerebral palsy (CP) in North Carolina. Data regarding live births in North Carolina were obtained for years 1980 to 2002 from the National Center for Health Statistics. Data from a pediatric orthopaedic multidisciplinary cerebral palsy clinical database at a regional medical center were weighted against the live births data. The results showed that despite slight fluctuations throughout the year, there was no significant difference between the actual monthly distribution of CP births and the expected monthly distribution (p = .68). There was no significant difference between the actual and expected seasonal distributions for overall CP births (p = .40). In conclusion, the monthly and seasonal distributions of cerebral palsy births are similar to those of live births in North Carolina. This study failed to identify any seasonal birth patterns specific for cerebral palsy. (Journal of Surgical Orthopaedic Advances 18(1):19–22, 2009). Key words: cerebral palsy, live births, North Carolina, seasonal birth patterns.

The purpose of this study was to evaluate the difference between 4.5-mm and 5.5-mm diameter pedicle screws inserted into the pedicles of upper thoracic vertebrae (T2 to T5). Seven fresh human spines were obtained. The bone mineral density was measured by dual-energy radiograph absorptiometry. The 4.5-mm and 5.5-mm diameter screws were inserted alternately in the right or left pedicle of each vertebra. The insertion torque and force (applied in the cephalic direction) to produce loosening of the screw were measured. The average bone mineral density for the seven thoracic spines was 0.710 g/cm2. All of the vertebrae were classified as osteoporotic. The torque of insertion for the 5.5-mm diameter screws was significantly greater (59% greater on average) than that for the 4.5-mm diameter screws (p = .001). Although the average force to loosening for the 5.5-mm diameter screws was higher than the average force to loosening for the 4.5-mm diameter screws (14%), the difference was not significant(p = .33). (Journal of Surgical Orthopaedic Advances 18(1):23–27, 2009). Key words: biomechanics, force to loosening, pedicle screws, torque of insertion.

Fourteen patients with acute displaced proximal humerus fractures were treated with a proximal locked antegrade humeral intramedullary nail (Polarus nail). These patients were treated by one surgeon and records were reviewed retrospectively. Clinical outcome measurements included active elevation and external rotation; a functional outcome measure, the Shoulder Pain and Disability Index (SPADI); and complications. Radiographic outcome measures were union, alignment, and presence of avascular necrosis. All 14 fractures went on to clinical and radiographic union. Mean time to union was 4 months (range, 2–9 months). Four patients had postoperative complications. Mean SPADI score was 30 (good) (range, 4–67). There were no cases of postoperative avascular necrosis, and the average radiologic neck/shaft angle was 121° (range 90° –144°). The proximal locked antegrade humeral intramedullary nail used in the treatment of displaced proximal humerus fractures results in predictable union and good alignment and function. (Journal of Surgical Orthopaedic Advances 18(1):28–34, 2009). Key words: displaced humerus fractures, intramedullary nail, two-part fractures.

Osteoarthritis in patients who have had poliomyelitis creates a significant challenge. The loss, or reduction of power in the quadriceps, combined with recurvatum and often patella baja can cause problems when considering total knee arthroplasty. The authors present the first case report of a unicondylar knee arthroplasty in such a patient. Functional knee scores improved, although some persistent degree of disability remained due to the preexisting poor muscle power. (Journal of Surgical Orthopaedic Advances 18(1):35–38, 2009). Key words: poliomyelitis, unicondylar knee arthroplasty.

Nonunion of humerus fractures is an extensively reviewed topic in orthopedic literature. The current case describes the successful outcome of a hypertrophic nonunion in a patient who chose not to undergo any intervention when the nonunion was identified and the treatment options were discussed with him. Hence this case report is a good example of the transition of the medical world to the concept of patient-centered decision making having a successful outcome. (Journal of Surgical Orthopaedic Advances 18(1):39–41, 2009). Key words: humerus, nonunion, patient-centered decision making, pseudoarthrosis.

This report describes an 80-year-old woman who underwent intraarticular steroid treatment for her arthritic knee and ended up with avascular necrosis of her medial femoral condyle. This rare complication should alert all clinicians that even minor procedures such as arthrocentesis may result in complications. (Journal of Surgical Orthopaedic Advances 18(1):42–44, 2009). Key words: avascular necrosis, cortisone, glucocorticoids, osteonecrosis, steroid injection.

Although its use has fallen out of favor, the Halifax interlaminar clamp was used for many years to treat cervical instability through a posterior approach. Numerous complications, the majority of which are related to hardware failure, have been reported with the use of the interlaminar clamps and have led to the development of alternative techniques for posterior fusion, such as transarticular screw fixation. This report presents a case of recurrent atlantoaxial instability due to fracture of the posterior C1 ring that occurred 12 years after a posterior C1-C2 fusion with Halifax clamps. To the authors’ knowledge, this is the first case report of symmetric fractures through the posterior C1 ring lateral to the site of the Halifax clamps, resulting in recurrent atlantoaxial instability. This report focuses on the surgical management of this complication and provides a review of the literature that pertains to complications following the use of the Halifax clamp to treat atlantoaxial instability. (Journal of Surgical Orthopaedic Advances 18(1):45–50, 2009). Key words: atlantoaxial instability, cervical, fusion, Halifax clamp.

Well-fixed metal-metal hip resurfacing components are removed for infection, instability, or hypersensitivity reactions. This article presents a technique for removal of a porous resurfacing acetabular component with minimal bone loss. (Journal of Surgical Orthopaedic Advances 18(1):51–53, 2009). Key words: acetabular component removal, hip resurfacing, hip revision.