Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 471 | Issue 4 | Apr, 2013

Orthopaedic Surgeons’ Knowledge and Misconceptions in the Identification of Intimate Partner Violence Against Women

Gregory J. Della Rocca MD, PhD, FACS, Sheila Sprague MSc, Sonia Dosanjh MSW, Emil H. Schemitsch MD, FRCS(C), Mohit Bhandari MD, PhD, FRCS(C)

Intimate partner violence (IPV)—physical, sexual, psychologic, or financial abuse between intimate partners—is the most common cause of nonfatal injury to women in North America. As many IPV-related injuries are musculoskeletal, orthopaedic surgeons are well positioned to identify and assist these patients. However, data are lacking regarding surgeons’ knowledge of the prevalence of IPV in orthopaedic practices, surgeons’ screening and management methods, and surgeons’ perceptions about IPV.

Growth Plate Alteration Precedes Cam-type Deformity in Elite Basketball Players

Klaus A. Siebenrock MD, Anna Behning MD, T. Charles Mamisch MD, Joseph M. Schwab MD

Vigorous sporting activity during the growth years is associated with an increased risk of having a cam-type deformity develop. The underlying cause of this osseous deformity is unclear. One may speculate whether this is caused by reactive bone apposition in the region of the anterosuperior head-neck junction or whether sports activity alters the shape of and growth in the growth plate. If the latter is true, then one would expect athletes to show an abnormal shape of the capital growth plate (specifically, the epiphyseal extension) before and/or after physeal closure.

Biographical Sketch: Franz König, MD 1832–1910

Richard A. Brand MD [object Object],(Translated by Drs. Richard A. Brand and Christian-Dominik Peterlein).

A Review of Knowledge in Osteochondritis Dissecans: 123 Years of Minimal Evolution from König to the ROCK Study Group

Eric W. Edmonds MD, John Polousky MD

Osteochondritis dissecans (OCD) was first described to provide an explanation for the nontraumatic development of loose bodies within a joint. Despite many reports on the subject, there remains no clear understanding of the etiology, natural history, or treatment.

Osteochondritis Dissecans Knee Histology Studies Have Variable Findings and Theories of Etiology

Kevin G. Shea MD, John C. Jacobs BS, James L. Carey MD, MPH, Allen F. Anderson MD, Julia T. Oxford PhD

Although many etiological theories have been proposed for osteochondritis dissecans (OCD), its etiology remains unclear. Histological analysis of the articular cartilage and subchondral bone tissues of OCD lesions can provide useful information about the cellular changes and progression of OCD. Previous research is predominantly comprised of retrospective clinical studies from which limited conclusions can be drawn.

Preoperative Imaging Criteria for Unstable Osteochondritis Dissecans of the Capitellum

Hiroshi Satake MD, PhD, Masatoshi Takahara MD, PhD, Mikio Harada MD, PhD, Masahiro Maruyama MD

The stability of an osteochondritis dissecans (OCD) lesion of the humeral capitellum may be determined by intraoperative probing with unstable lesions being displaceable. Although preoperative imaging is used to diagnose and determine treatment of these lesions, it is unclear whether unstable lesions on imaging correspond to those found intraoperatively.

Drilling Juvenile Osteochondritis Dissecans: Retro- or Transarticular?

Matthew J. Gunton MD, James L. Carey MD, MPH, Colin R. Shaw BSc (Hons), MSc, M. Lucas Murnaghan MD, MEd, FRCSC

Early diagnosis and successful treatment of juvenile osteochondritis dissecans (JOCD) is essential in preventing articular degeneration at a young age. Surgical treatment of stable JOCD lesions failing nonoperative treatment involves retroarticular or transarticular drilling to induce revascularization and healing. Multiple case series report high healing rates and infrequent complications for both retroarticular and transarticular drilling modalities; however, it is unclear from these individual reports whether one mode of drilling provides higher healing rates.

Cell-based Therapy Improves Function in Adolescents and Young Adults With Patellar Osteochondritis Dissecans

Bryon J. X. Teo, Kizher Buhary BEng, Bee-Choo Tai PhD, James H. Hui FRCS

Recent advances have been made in using chondrocytes and other cell-based therapy to treat cartilage defects in adults. However, it is unclear whether these advances should be extended to the adolescent and young adult-aged patients.

Does Extracorporeal Shock Wave Therapy Enhance Healing of Osteochondritis Dissecans of the Rabbit Knee?: A Pilot Study

Roger Lyon MD, Xue Cheng Liu MD, PhD, Martin Kubin MD, Joseph Schwab MD

Severe osteochondritis dissecans (OCD) in children and adolescents often necessitates surgical interventions (ie, drilling, excision, or débridement). Since extracorporeal shock wave therapy (ESWT) enhances healing of long-bone nonunion fractures, we speculated ESWT would reactivate the healing process in OCD lesions.

Can Fresh Osteochondral Allografts Restore Function in Juveniles With Osteochondritis Dissecans of the Knee?

Roger Lyon MD, Carl Nissen MD, Xue Cheng Liu MD, PhD, Brian Curtin MD

Failure of initial treatment for juvenile osteochondritis dissecans (OCD) may require further surgical intervention, including microfracture, autograft chondrocyte implantation, osteochondral autografting, and fresh osteochondral allografting. Although allografts and autografts will restore function in most adults, it is unclear whether fresh osteochondral allograft transplantations similarly restore function in skeletally immature patients who failed conventional treatment.

Oligo[poly(ethylene glycol)fumarate] Hydrogel Enhances Osteochondral Repair in Porcine Femoral Condyle Defects

James H. Hui FRCS, MD, Xiafei Ren PhD, Mohd Hassan Afizah MSc, Kerm Sin Chian PhD, Antonios G. Mikos PhD

Management of osteochondritis dissecans remains a challenge. Use of oligo[poly(ethylene glycol)fumarate] (OPF) hydrogel scaffold alone has been reported in osteochondral defect repair in small animal models. However, preclinical evaluation of usage of this scaffold alone as a treatment strategy is limited.

Three Osteochondritis Dissecans Lesions in One Knee: A Case Report

Nathan L. Grimm BS, Breann Tisano BS, James L. Carey MD, MPH

Osteochondritis dissecans (OCD) has been defined as a localized process in which a focus of subchondral bone and adjacent articular cartilage separates from the surrounding bone. With the knee being the most common location for OCD development and the propensity for this lesion to be found in those who participate in sports, a repetitive microtrauma hypothesis for its cause has gained favor. However, the cause of OCD remains controversial, as does the most appropriate treatment for the varying degrees of OCD lesions.

Childhood Obesity as a Risk Factor for Lateral Condyle Fractures Over Supracondylar Humerus Fractures

Eric D. Fornari MD, Mike Suszter DO, Joanna Roocroft MA, Tracey Bastrom MA, Eric W. Edmonds MD, John Schlechter DO

Obese children reportedly have an increased risk of sustaining musculoskeletal injuries compared with their normal-weight peers. Obese children are at greater risk for sustaining fractures of the forearm, particularly from low-energy mechanisms. Furthermore, obesity is a risk factor for sustaining an extremity fracture requiring surgery. However, it is unclear what role obesity plays in fractures about the distal humerus.

Childhood Obesity Is Associated With Increased Risk of Most Lower Extremity Fractures

Jeff Kessler MD, Corinna Koebnick PhD, MPH, Ning Smith PhD, Annette Adams PhD, MPH

A number of studies have found an increased risk of lower extremity injuries in obese patients. Most studies, however, are unable to provide stable population-based estimates based on the degree of obesity and few assess the risk pertaining to more detailed fracture location in the lower extremities.

Does Obesity Affect Fracture Healing in Children?

Rushyuan J. Lee MD, Nigel N. Hsu MD, Colleen M. Lenz CRNP, Arabella I. Leet MD

Obesity is a risk factor for various orthopaedic diseases, including fractures. Obesity’s influence on circulating hormones and cytokines and bone mineralization ultimately influences the body’s osteogenic response and bone mineralization, potentially increasing the risk of fracture and impacting fracture healing.

How Does Bone Quality Differ Between Healthy-weight and Overweight Adolescents and Young Adults?

Christa L. Hoy MSc, Heather M. Macdonald PhD, Heather A. McKay PhD

Overweight youth have greater bone mass than their healthy-weight peers but sustain more fractures. However, it is unclear whether and how excess body fat influences bone quality in youth.

Get Up, Get Out, Get Moving: An Interactive Tool for Education at Your Local School

Jennifer Weiss MD, Elizabeth Matzkin MD, Michael Flippin MD, Mark Pallis DO, Mark Rankin MD

Childhood obesity is a growing problem in America. Orthopaedic surgeons have an opportunity to interact with communities to educate children about healthy eating and physical activity. The American Academy of Orthopedic Surgeons (AAOS) Leadership Fellows Program [1] Class of 2012 created a presentation for AAOS members to bring to local schools. The goal was to teach the children about the potential complications of childhood obesity and the benefits of healthy living.

Obesity Negatively Affects Spinal Surgery in Idiopathic Scoliosis

Christina K. Hardesty MD, Connie Poe-Kochert RN, CNP, Jochen P. Son-Hing MD, FRCSC, George H. Thompson MD

Are obese patients with idiopathic scoliosis undergoing spinal surgery at higher risk for perioperative complications? This is not clearly understood. One previous study showed a greater preoperative thoracic kyphosis but no increase in perioperative complications.

Lower Extremity Pain Is Associated With Reduced Function and Psychosocial Health in Obese Children

Sharon Bout-Tabaku MD, MSc, Matthew S. Briggs DPT, Laura C. Schmitt PT, MPT, PhD

Childhood obesity is associated with reduced quality of life, physical fitness, and a higher prevalence of lower extremity (LE) pain; however, it is unclear whether and how these factors are related.

Motion and Pain Relief Remain 23 Years After Manipulation Under Anesthesia for Frozen Shoulder

Heidi Vastamäki MD, Martti Vastamäki MD, PhD

Manipulation under anesthesia (MUA) as treatment for idiopathic frozen shoulder increases motion, provides pain relief, and restores function, but it is unclear whether the improvements persist long term.

3-D CT is the Most Reliable Imaging Modality When Quantifying Glenoid Bone Loss

Julie Y. Bishop MD, Grant L. Jones MD, Michael A. Rerko MD, Chris Donaldson MD

Posttraumatic anterior shoulder instability is associated with anterior glenoid bone loss, contributing to recurrence. Accurate preoperative quantification of bone loss is paramount to avoid failure of a soft tissue stabilization procedure as bone reconstruction is recommended for glenoid defects greater than 20% to 27%.

Immediate Postoperative Radiographs After Shoulder Arthroplasty Are Often Poor Quality and Do Not Alter Care

Surena Namdari MD, MSc, Jason E. Hsu MD, Matthew Barron BS, G. Russell Huffman MD, MPH, David Glaser MD

It is technically difficult to obtain high-quality, postoperative shoulder radiographs immediately after surgery. Further, poor-quality radiographs may be unlikely to change clinical practice or improve patient outcomes. We therefore questioned the value of routine postoperative radiographs after shoulder arthroplasty.

Less Invasive Rotational Acetabular Osteotomy for Hip Dysplasia

Masaaki Maruyama MD, PhD, Shinji Wakabayashi MD, PhD, Keiji Tensho MD

Broad dissection with a long skin incision and detachment of the gluteus medius muscle performed for rotational acetabular osteotomy (RAO) can result in weakness in abduction strength of the hip. We use a surgical procedure for RAO that minimizes operative invasion of soft tissue and reduces incision length compared with conventional procedures.

Pelvic Flexion Measurement From Lateral Projection Radiographs is Clinically Reliable

Norio Imai MD, Tomoyuki Ito PhD, Ken Suda MD, Dai Miyasaka PhD, Naoto Endo PhD

Pelvic flexion affects orientation of the acetabular cup; however, pelvic position is not static in daily activities. During THA it is difficult to know the degree of pelvic flexion with the patient in the lateral position and that position is static. However, surgeons need to appropriately determine pelvic tilt to properly insert the acetabular component.

Surgical Technique: Arthroscopic Treatment of Heterotopic Ossification of the Hip After Prior Hip Arthroscopy

Crispin Ong MD, Michael Hall MD, Thomas Youm MD

The incidence of heterotopic ossification (HO) after hip arthroscopy reportedly ranges from less than 1.0% to 6.3%. Although open debridement has been described and a few series mention arthroscopic debridement, the techniques for arthroscopic excision of HO have not been described in detail. We describe the arthroscopic treatment of this complication.

Is Limited Incision Better Than Standard Total Hip Arthroplasty? A Meta-analysis

Joseph T. Moskal MD, Susan G. Capps PhD

The literature comparing limited incision and standard incision THAs is confusing regarding whether limited incision THA improves short-term recovery without compromising long-term durability and survival. Further, previously published meta-analyses cannot conclude that limited incision THA is better. With new data, we seek to discover if the answers now exist.

The Intact Posterior Cruciate Ligament Not Only Controls Posterior Displacement but Also Maintains the Flexion Gap

Yoshio Matsui PhD, MD, Yoshinori Kadoya PhD, MD, Shuji Horibe PhD, MD

The PCL is a strong stabilizer of the knee and provides posterior stability to the tibia. However, sagittal alignment of the PCL with the knee at 90° flexion suggests the PCL might play a role not only in posterior stabilization but also in maintaining the flexion gap.

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

Danilo Bruni MD, Francesco Iacono MD, Bharat Sharma DNB (Ortho), Stefano Zaffagnini MD, Maurilio Marcacci MD

Although 7% to 38% of revision total knee arthroplasties (RTKAs) are attributable to prosthetic knee infections, controversy exists regarding the best surgical approach while reducing the risk of extensor mechanism complications and the reinfection rate.

Does Single Use of an Autologous Transfusion System in TKA Reduce the Need for Allogenic Blood?: A Prospective Randomized Trial

Johannes Cip MD, Mark Widemschek MD, Thomas Benesch PhD, Roman Waibel MD, Arno Martin MD, MSc

Mechanical autotransfusion systems for washed shed blood (WSB) were introduced to reduce the need for postoperative allogenic blood transfusions (ABTs). Although some authors have postulated decreased requirements for ABT by using autologous retransfusion devices, other trials, mostly evaluating retransfusion devices for unwashed shed blood (USB), verified a small or no benefit in reducing the need for postoperative ABT. Because of these contradictory findings it is still unclear whether autologous retransfusion systems for WSB can reduce transfusion requirements.

Intraoperative Joint Gaps Affect Postoperative Range of Motion in TKAs With Posterior-stabilized Prostheses

Toshifumi Watanabe MD, PhD, Takeshi Muneta MD, PhD, Ichiro Sekiya MD, PhD, Scott A. Banks PhD

Joint gaps and mediolateral (ML) soft tissue balance have long been known to affect clinical scores and patient function after TKA, but the relationship between gaps and soft tissue balance remain poorly defined. If specific relationships exist between soft tissue tension and patient function, then objective targets could be established to assist surgeons in achieving more consistent postoperative knee function.

Lateral Soft Tissue Laxity Increases but Medial Laxity Does Not Contract With Varus Deformity in Total Knee Arthroplasty

Shigetoshi Okamoto MD, Ken Okazaki MD, PhD, Hiroaki Mitsuyasu MD, Shuichi Matsuda MD, PhD, Yukihide Iwamoto MD, PhD

In TKA, soft tissue balance (the joint gap) depends on the amount of resected bone and soft tissue release. Some studies report preoperative bony deformity correlates with soft tissue balance evaluated intraoperatively and that the medial tissues are contracted with varus deformity. However, these studies did not take into account the amount of resected bone and did not describe whether the soft tissue was tight or loose. Therefore, it remains unclear whether in varus deformity the soft tissues on the medial side are contracted.

Three-dimensional Morphologic Study of the Child’s Hip: Which Parameters Are Reproducible?

Virginie Rampal MD, Jérome Hausselle PhD, Patricia Thoreux PhD, Philippe Wicart MD PhD, Waffa Skalli PhD

Biplanar x-ray images obtained with patients in a standing weightbearing position allow reconstruction of three-dimensional (3-D) bone geometries, with lower radiation exposure than CT scans and better bone definition than MRI.

Convergence of Outcomes for Hip Fracture Fixation by Nails and Plates

Foster Chen BS, Zhong Wang PhD, MPH, Timothy Bhattacharyya MD

Recent popularity of intramedullary nails over sliding hip screws for treatment of intertrochanteric fractures is concerning given the absence of evidence for clinical superiority for nailing yet the presence of reimbursement differences.

Surgical Technique: Talar Neck Osteotomy to Lengthen the Medial Column After a Malunited Talar Neck Fracture

Thomas Suter MD, Alexej Barg MD, Markus Knupp MD, Heath Henninger PhD, Beat Hintermann MD

Treatment of malunited talar neck fractures is challenging, and few studies address anatomic reconstruction as an alternative to arthrodesis. We describe a new surgical approach attempting to improve function and avoid development of degenerative changes in the adjacent joints.

Bone Turnover Markers Do Not Predict Stress Fracture in Elite Combat Recruits

Ran Yanovich PhD, Rachel K. Evans PhD, Eitan Friedman MD, PhD, Daniel S. Moran PhD

With bone resorption rates greater than formation, stress fracture pathogenesis plausibly involves bone remodeling imbalance. If this is the case, one would anticipate serum levels of bone turnover markers would be higher in patients with stress fractures than in those without.

Diagnosis of Elbow Fracture Patterns on Radiographs: Interobserver Reliability and Diagnostic Accuracy

Job N. Doornberg MD, PhD, Thierry G. Guitton PhD, David Ring MD, PhD

Studies of traumatic elbow instability suggest that recognition of a pattern in the combination and character of the fractures and joint displacements helps predict soft tissue injury and guide the treatment of traumatic elbow instability, but there is no evidence that patterns can be identified reliably.

Intramedullary Nails Result in More Reoperations Than Sliding Hip Screws in Two-part Intertrochanteric Fractures

Kjell Matre MD, Leif Ivar Havelin MD, PhD, Jan-Erik Gjertsen MD, PhD, Birgitte Espehaug MSc, PhD, Jonas Meling Fevang MD, PhD

Sliding hip screws (SHSs) and intramedullary (IM) nails are well-documented implants for simple two-part intertrochanteric fractures; however, there is no consensus regarding which type of implant is better.

Case Report: Failure of Rotating-hinge Total Knee Prosthesis by Disengagement of the Hinge-post Extension

Debdut Biswas MD, Bryan Haughom MD, Robert E. Mayle MD, Craig J. Della Valle MD

Although modern-generation rotating-hinge knee implants have been modified to mitigate earlier complications related to aseptic loosening with these devices in revision TKAs, there are few, if any, reports of failure related to the hinge mechanism in these prostheses.

Reply to Letter to the Editor: Does PFNA II Avoid Lateral Cortex Impingement for Unstable Peritrochanteric Fractures?

George A. Macheras MD, PhD, Stefanos D. Koutsostathis MD, PhD, Spyridon P. Galanakos MD, PhD, Konstantinos Kateros MD, PhD, Stamatios A. Papadakis MD, PhD
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