Volume 18-3, Fall 2009

Achilles tendon ruptures commonly affect middle-aged athletes and can result in considerable functional impairment. While the cause is multifactorial, the greatest risk is present for athletes involved in sports that involve sudden acceleration and deceleration. A thorough history and physical examination can accurately yield a diagnosis, but when question remains, magnetic resonance imaging is superior to ultrasound-guided evaluation. The best evidence available suggests that operative treatment has a lower rate of rerupture, a higher rate of return to the same level of sport participation, and a higher complication rate, if an open technique is used. Percutaneous methods of fixation have lower complication rates without an increase in the rate of rerupture when compared with open methods. Augmentation of an Achilles tendon repair has demonstrated no clinical benefit. Rehabilitation with early mobilization leads to improved patient-reported outcomes. (Journal of Surgical Orthopaedic Advances 18(3):115–121, 2009) Key words: Achilles tendon, nonoperative, operative, rehabilitation, rupture, treatment

A review of the current literature demonstrates considerable debate regarding the pathogenesis, natural history and treatment of Scheuermann’s kyphosis. Most of the views and recommendations provided in various reports are weakly supported by levels of evidence. In addition, prospective studies using validated questionnaire instruments and long-term follow-ups to assess clinical outcomes in patients treated conservatively or surgically versus those untreated that would document the natural history of the condition are still unavailable. This systematic review summarizes the current knowledge on Scheuermann’s kyphosis and attempts to present a rational approach in the evaluation and management of this group of patients. (Journal of Surgical Orthopaedic Advances 18(3):122–128, 2009) Key words: kyphosis, Scheuermann, treatment

The purpose of this study was to determine whether the presence or absence of bleeding after drilling of the femoral head can be used to predict the development of avascular necrosis (AVN) after operative treatment of acetabular fractures. A computerized medical record search from 1996 to 2005 of all patients with an operatively treated acetabular fracture yielded 146 patients who had an intraoperative assessment of the vascularity of their femoral head and 72 of whom were available for a minimum of 12 months of follow-up. The average time to the development of AVN was 99.6 weeks with a range of 21–290 weeks. Eleven of the patients in the analysis eventually developed AVN. The p value is not significant at. 092. Although the difference between groups is not significant, it does appear that there is a relationship between femoral head bleeding and the development of avascular necrosis. (Journal of Surgical Orthopaedic Advances 18(3):129–133, 2009) Key words: acetabular fracture, avascular necrosis

The purpose of the study was to determine the risk of digital or distal segmental amputation and permanent unemployment in patients with these injury patterns. A retrospective chart review of 23 patients with multiple, ipsilateral injuries of the foot and ankle was performed. Amputations occurred in five patients (21.7%) and were most common in those with three-level injuries. Odds ratios showed that patients with an amputation were 9.75 times more likely to have a three-level injury than a two-level injury. At a mean follow-up of 12.9 months, 12 patients had not returned to work (60%), seven returned with restrictions, and only one patient returned to preinjury activities. It was concluded that patients with segmental foot and ankle injuries are at risk for amputation of the distal portion of the involved extremity and inability to return to their preinjury employment level (disability). (Journal of Surgical Orthopaedic Advances 18(3):134–138, 2009) Key words: amputation, disability, foot, segmental

The purpose of the current study was to examine the functional outcomes of C3.1 and C3.2 distal radius fractures. A trauma registry was used to identify patients with C3.1 and C3.2 distal radius fractures (n D 33). Clinical follow-up consisted of completion of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and assignment of a Gartland and Werley Demerit Point System score. Average follow-up duration was 62 months. Mean DASH score was 14 points; mean Gartland and Werley score was 6 points. Results were 14 excellent, 12 good, 10 fair, and one poor. Patients regained an average of 78% of the flexion–extension arc, 94% of the pronation–supination arc, and 83% of grip strength compared with the uninjured side. Standardized and uniformly applied attempts at reconstruction of the distal radial articular surface led to successful outcomes in the majority of patients. (Journal of Surgical Orthopaedic Advances 18(3):139–146, 2009) Key words: AO types C3.1 and C3.2 distal radius fractures, functional outcomes

Coccygodynia (pain in the region of the coccyx) has many causes, but it may be posttraumatic beginning after a fracture or contusion. Pain is typically triggered by or occurs while sitting. Nonsurgical management, including cushions, nonsteroidal anti-inflammatory drugs, and corticosteroid injections, can be successful in up to 85% of patients. The objective of the study was to show that coccygectomy can be a successful surgical treatment for patients who fail nonoperative treatment. This study is a retrospective analysis of all patients who underwent a coccygectomy performed by one surgeon between the years 2002 and 2008. All patients were asked to complete an Oswestry low back pain disability questionnaire and a visual analog pain scale. The average Oswestry disability score was 25.75%. The average visual analog score was 3.4 cm. Four patients sustained a wound breakdown. The study concluded that for patients with conservative therapy-resistant coccygodynia, operative treatment with coccygectomy is a feasible management option. (Journal of Surgical Orthopaedic Advances 18(3):147–149, 2009) Key words: coccygectomy, coccygodynia

The porous-coated anatomic (PCA) total hip was a first-generation cementless implant system introduced in 1983 for both primary and revision total hip arthroplasty. Between February 1983 and June 1989, 219 uncemented PCA total hips were implanted in 194 patients as part of a multisurgeon, single-institution, prospective study. Short-term follow-up data were available on 212 hips at an average of 21.7 months. At the time of final follow-up, data were available on 121 hips at an average of 20.2 years (range, 18–24 years). Of the surviving patients, 55% had undergone revision. Of those patients with known failure mechanisms, 66% underwent revision for isolated acetabular osteolysis or loosening, 23% for femoral component failure, and 11% for failure of both components. As has been reported in other series, the acetabular component appeared to be the most common cause for revision, while the femoral component proved more durable. (Journal of Surgical Orthopaedic Advances 18(3):150–154, 2009) Key words: porous-coated anatomic prosthesis, total hip arthroplasty, uncemented fixation

Patients with spastic quadriplegia secondary to cerebral palsy manifest with severe spasticity and often with neuromuscular scoliosis. In order to optimize treatment and minimize morbidity in selected cases, the authors present a surgical option concurrently addressing these problems. This study reviews one case and describes the surgical technique in detail where intrathecal baclofen pump implantation and posterior spinal fusion are concomitantly performed to manage spasticity and scoliosis, respectively. (Journal of Surgical Orthopaedic Advances 18(3):155–158, 2009) Key words: cerebral palsy, intrathecal baclofen, neuromuscular scoliosis, posterior spinal fusion