Wrist Arthroscopy -- George D. Chloros, MD, Jian Shen, MD, Mahir Mahirogullari, MD, and Ethan R. Wiesler, MD
Wrist arthroscopy allows complete visualization under magnification, and its purpose is to establish an anatomic diagnosis and, if feasible, provide treatment for the anatomic lesion. Current indications, though numerous and potentially expanding, are also controversial. Wrist arthroscopy will continue to expand as new techniques and instrumentation evolve, and it has now become the gold standard for the diagnosis of intra-articular pathology and triangular fibrocartilage lesions. The present review focuses on the current applications of arthroscopy in the management of intra-articular fractures of the distal radius, triangular fibrocartilage complex injuries, intercarpal ligament injuries, and ganglion cysts.. (Journal of Surgical Orthopaedic Advances 16(2):49–61, 2007)
Intertrochanteric Hip Fractures Treated With the Trochanteric Fixation Nail and Sliding Hip Screw -- J. Brian Gill, MD, MBA, Layne Jensen, MD, MBA, Paul C. C.
The primary treatment options for intertrochanteric hip fractures are a sliding hip screw (SHS) and an intramedullary device, with each having its own advantages and disadvantages. The authors retrospectively compared all intertrochanteric hip fractures between 2003 and 2005 using a cephalomedullary nail — the trochanteric fixation nail (TFN) — to those using a SHS. Outcome measures included the following parameters: age, gender, fracture classification, operation time, blood loss, transfusions, complications, follow-up, length of stay, and hospital cost. A total of 95 patients were included in the study (51 SHS and 44 TFN). The two groups were similar in age (p D .52), blood loss (p D .20), follow-up (p D .13), length of stay (p D .63), and hospital costs (p D .70). The TFN procedure required shorter operative times (56.5 min, p < .004) and was used in more complex fracture patterns (p < .03). The SHS group had fewer blood transfusions (1.2 units, p < .0008). The SHS group had a higher complication rate of 19.6%, versus the TFN group’s 11.4% rate (p D .13). The TFN is an appropriate and acceptable treatment method for intertrochanteric hip fractures. (Journal of Surgical Orthopaedic Advances 16(2):62–66, 2007)
Cryotherapy Temperature Differences After Total Knee Arthroplasty: A Prospective Randomized Trial -- Christopher A. Radkowski, MD, Ricardo Pietrobon, MD, PhD
In spite of its widespread use after orthopaedic procedures, the literature evaluating the clinical efficacy of cryotherapy is controversial. The purpose of this prospective randomized trial was to compare two different temperatures for administering cryotherapy after total knee arthroplasty with regards to short-term postoperative outcomes. Sixty-four subjects were assigned either the 45°F group or the 75°F group. Subjects in the 45° group were as likely to report a lower pain score at the time of follow-up compared to the 75° group. Our results demonstrate no additional analgesic effect associated with the lower temperature of cryotherapy. Postoperative narcotic consumption, postoperative drainage, selfreported knee function, and range ofmotion were not affected by the different cryotherapy temperatures. No adverse effects were reported with the cryotherapy treatment. (Journal of Surgical Orthopaedic Advances 16(2):67–72, 2007)
Osteomyelitis and Intraosteoblastic Staphylococcus aureus -- Lawrence X. Webb, MD; William Wagner, PhD; David Carroll, PhD; Holly Tyler, BS; Faith Coldren, BS
Chronic osteomyelitis is a disease process that is characterized not infrequently by periods of clinical quiescence interspersed by symptomatic episodes of varying duration and severity. These periods of clinical quiescence have been attributed to several possible factors, including effective host defenses that keep the process at bay as well as glycocalyceal sequestration of the implicated pathogen. Recent work has demonstrated a potential third explanation for this phenomenon, that is, intracellular incorporation of the pathogen within the host osteoblast. This is a report of a successful osteoblast cell culture demonstrating the facultative intraosteoblastic location of a human osteomyelitis Staphylococcus aureus isolate as well as its microscopic features. (Journal of Surgical Orthopaedic Advances 16(2):73–78, 2007)
Repair of Pars Interarticularis Defect With a Modified Cable-Screw Construct -- Gordon R. Bozarth, MD; Guy R. Fogel, MD; John S. Toohey, MD; Arvo Neidre, MD
Operative treatment of symptomatic spondylolysis is not common. Multiple surgical techniques have been described for direct repairs of the pars defects. Reported success rates are high, although few reports describe successful return to sports in athletes. The purpose of the study was to assess the outcome after bone grafting and fixation of pars interarticularis defects utilizing a modification of the previously described techniques of Scott and of Songer. A retrospective single-arm cohort study was performed at a single center. This article reports on three athletes with symptomatic spondylolysis or grade I spondylolisthesis unresponsive to conservativemanagement who were treated with bone grafting and a screw-cable repair. The outcome measure was the return to sports activities. A retrospective chart and radiographic analysis was conducted on three athletes. Patients were assessed for return to sports, clinical evidence of return to functional activities, and radiographic evidence of healing of the pars defects. All three patients proceeded to radiographic and clinical success. All patients reported resolution of their preoperative pain and return to sports. One patient did require occasional anti-inflammatory drugs for episodic low back pain. The use of this modified cable-screw technique for symptomatic spondylolysis provided excellent clinical, radiographic, and functional results in this small cohort.
Ewing’s Sarcoma of the Hip Presenting as a Benign Cystic Lesion -- Panayiotis J. Papagelopoulos, MD, DSc; Andreas F. Mavrogenis, MD; Ioannis S. Benetos, MD
A 14-year-old girl with a Ewing’s sarcoma of the left femoral head and neck is presented. The imaging features mimicked a benign cystic lesion. Biopsy and molecular analysis confirmed the diagnosis. The patient was treated with chemotherapy, wide tumor resection, and proximal femoral reconstruction using an allograft–prosthesis composite. Differential diagnosis, imaging, and pathologic features of Ewing’s sarcoma are discussed.
Primary Malignant Giant Cell Tumor of Bone: A Series of Three Rare Cases -- Sudhir K. Kapoor, MS; Vineet Jain, MS; Mayank Agrawal, MBBS; Sompal Singh, MD
The purpose of this research was to study incidence; clinical, histological, and radiological features; and outcome of primary malignant giant cell tumor (PMGCT). The authors retrospectively reviewed all cases of giant cell tumor (GCT) in which a diagnosis of GCT was related to sarcoma treated in their department between 1997 and 2004. Three cases of PMGCT were found according to the criterion of Hutter and Dahlin. Histological and radiological records of all the three cases were reviewed. In these three cases of PMGCT, the initial clinical and radiological findings were the same as those for benign giant cell tumor. Wide excision of the tumor was performed in all three cases. In two cases, knee arthrodesis was performed, and in one case a custom-made total knee replacement was performed. PMGCT was diagnosed on initial biopsy in one patient, in the second patient it was diagnosed in the excised specimen, and in third case it was only diagnosed after local recurrence 6 months after initial treatment. All the patients died within 5 months of detection of recurrence and metastasis. PMGCT has a very poor prognosis. Histological examination is highly significant in such cases. Awareness about this entity, adequate biopsy, and sampling of specimen can aid in early diagnosis, which may improve the overall prognosis.
Atraumatic Acetabular Fracture in Secondary Protrusio Acetabuli: A Case Report -- Mark A. Vann, MD; Aham Onyike, MD; Stephen W. Gentry; Willie J. Banks, MD
This case report presents the case of a patient with a history of rheumatoid arthritis and protrusio acetabuli progressing to a medical wall acetabular fracture. A detailed history and physical examination revealed previous radiation treatment of prostate cancer requiring extensive preoperative workup and consultation. Prompt recognition and elective surgical intervention of protrusio acetabuli, prior to fracture, may obviate the need for prolonged hospitalization and delayed surgical intervention. The preoperative evaluation and surgical technique used to optimize the outcome are described.