Volume 14-1, Spring 2005

Golf has demonstrated increasing popularity and with this heightened enthusiasm has come an increased awareness of the significant number of injuries associated with playing golf. While back injuries represent the most commonly injured specific body part, upper extremity injuries are most frequent overall and the most likely to result in loss of play. Patterns of injury differ based on level of play and time spent playing or practicing golf. Among golf professionals, the hand/wrist is the most commonly injured upper extremity structure. Among amateurs, the elbow is most commonly injured. The vast majority of upper extremity injuries are due to overuse. Age, ability, equipment, and swing mechanics also play contributing roles. Most upper extremity golf injuries can be successfully treated with appropriate cessation or modification of play, anti-inflammatory modalities, and rehabilitation. Surgical treatment is rarely required, but if needed can prove successful in a high percentage of patients. (Journal of Surgical Orthopaedic Advances 14(1):1–7, 2005) Key words: golf injuries, upper extremity

Adjuvant use of autologous platelet concentrate (APC) to assist bone healing in foot and ankle surgery has not been reported. This study examined the clinical results and complications after the adjuvant use of APC in high-risk patients undergoing elective foot and ankle surgery. Patients at risk for bone-healing complications were prospectively enrolled over a 6-month period for the intraoperative application of APC. Patients were followed every 2 weeks for radiographic union and complications. Sixty-two high-risk patients were enrolled, totaling 123 procedures. Mean patient age was 51 years (range, 16–76), there were 36 females and 26 males, and 24 patients were smokers. Overall, a 94% union rate was achieved at a mean of 41 days. For APC alone, the mean time to union was 40 days; when APC was used with autograft, the mean time to union was 45 days (p D .173, two-tailed t test). These data suggest that adjuvant APC results in an acceptable time to union and may be a useful adjunct to promote osseous healing in high-risk patients undergoing elective foot and ankle surgery. (Journal of Surgical Orthopaedic Advances 14(1):17–22, 2005) Key words: autologous platelet concentrate, bone healing, complications, fusion, high-risk patients, nonunion, platelet-rich plasma

The aim of the study was to evaluate the significance of odontoid lateral mass interval (OLMI) asymmetry on open-mouth view, in neck injury patients who have otherwise normal cervical spine x-rays. Thirteen neck injury patients were reviewed. Average age was 23.5 years (range, 16–30 years) and average follow-up was 15 weeks (range, 6–39 weeks). All the patients, referred from the casualty department, had computed tomography (CT) scans because of the OLMI asymmetry to rule out rotary subluxation. Clinically none of the patients had torticollis. CT scans were reported normal except for OLMI asymmetry, in 11 patients. Two patients were reported as having rotary subluxation and one was found, after normal initial plain films, to have an undisplaced lateral mass fracture of the atlas with bony avulsion of the transverse ligament. The average OLMI asymmetry was 3.1 mm (range, 2–4 mm). The authors concluded that although OLMI asymmetry has low sensitivity and specificity for true subluxation or instability, it may be a sign of significant cervical injury and should be evaluated with CT. (Journal of Surgical Orthopaedic Advances 14(1):23–26, 2005) Key words: cervical spine, CT scan, OLMI asymmetry, open-mouth view, rotary subluxation

Traumatic injuries to the cervical spine are often difficult to detect and are associated with substantial morbidity and mortality. Along with standard trauma radiographs, a thorough physical examination and meticulous documentation are of the utmost importance because many neurologic injuries evolve over time. Although many injuries to the cervical spine can be treated nonoperatively, any injuries with neurologic deficits, instability, or ligamentous injury require instrumentation and fusion. It is crucial to recognize injuries to the cervical spine and the different treatment options. Computed tomography can be very helpful in defining the bony injury and evaluating the spinal canal, whereas magnetic resonance imaging can better evaluate the spinal cord and assess ligamentous injury. (Journal of Surgical Orthopaedic Advances 14(1):8–16, 2005) Key words: cervical spine, management, trauma

The presence of a fracture of the femoral neck and ipsilateral diaphyseal femur fracture has been reported previously. In all femoral shaft fractures, scrutiny of the femoral neck is mandatory in order to direct proper management toward this potentially devastating complication. This report discusses a case of an intraoperative radiographic artifact secondary to retrograde nailing of a femoral shaft fracture which may be interpreted as an occult or iatrogenic ipsilateral fracture of the femoral neck. The etiology of this artifact and its proper interpretation are described. (Journal of Surgical Orthopaedic Advances 14(1):32–36, 2005) Key words: femoral neck fracture, femur, retrograde femoral nail

This case report discusses two cases in which patients present with the uncommon triad of extremity pain, focal periosteal reaction on imaging studies, and intramuscular hemangioma on pathologic examination. Both patients presented in this article were older than those previously reported in the literature. Neither patient reported complete resolution of pain following excision, although there was marked improvement. (Journal of Surgical Orthopaedic Advances 14(1):37–41, 2005) Key words: epithelioid hemangioendothelioma, intramuscular angiomatous tumors, intramuscular hemangioma, periosteal reaction

The purpose of the current study was to evaluate the effectiveness of a multidisciplinary Hip Fracture Service in the treatment of hip fractures in elderly patients. Baseline information and hospital outcomes were compared for 510 patients over the age of 65 with hip fracture treated before and after the institution of the Hip Fracture Service. Data included basic demographic data, admission laboratory results, surgical information, number of comorbidities, mortality, medical complications, discharge information, time to surgery, and length of stay in hospital. The demographics of the two groups of patients were similar. Patients treated as part of the Hip Fracture Service had fewer medical complications (36% vs. 51%), more often had surgery within 24 hours (63% vs. 35%), and had shorter hospital stays (mean, 5.7 days vs. 8.1 days) than patients treated before the Hip Fracture Service. These findings provide the rationale for a prospective, randomized trial of the service. (Journal of Surgical Orthopaedic Advances 14(1):27–31, 2005) Key words: cost, hip fracture, medical complication, multidisciplinary team

Dysplasia epiphysealis hemimelica (Trevor’s disease) is a rare developmental disorder characterized by unilateral, asymmetrical proliferation of epiphyseal cartilage. Cases involving the upper extremity are unusual. Three cases, the largest series to date, involving dysplasia epiphysealis hemimelica of the carpus, are discussed here. Two of the patients had been treated previously at other institutions where their disorders were not recognized. The purpose of this article is to present a clear description of this disorder and its natural course. A treatment algorithm is also recommended. Needless workup, treatment, and anxiety of the patient and family can be avoided by an early, accurate diagnosis. (Journal of Surgical Orthopaedic Advances 14(1):42–47, 2005) Key words: carpus, dysplasia epihpysealis hemimelica, Trevor’s disease