OKOJ

OKOJ, Volume 1, No. 5


Dupuytren's Disease

Since its earliest description more than 200 years ago, Dupuytren's disease has fascinated clinicians and basic scientists. Population studies have shown that the prevalence of Dupuytren's disease is influenced by four factors: age, gender, geography, and ethnicity. The nodule and cord are the quintessential pathologic findings in Dupuytren's disease. In the classic scenario of typical disease, the condition is ushered by skin changes, nodule formation, cord formation, disease progression, maturation and contracture, and progressive digital flexion deformity.

Historical perspectives on the disease, pathophysiology, clinical diagnosis, and nonsurgical and surgical treatment of Dupuytren's Disease are reviewed in detail in this OKO article.

    • Keywords:
    • hand

    • palm

    • palmar fascia

    • Dupuytrens contracture

    • non-Dupuytrens contracture

    • atypical Dupuytrens contracture

    • typical Dupuytrens disease

    • epidemiology

    • percutaneous fasciotomy

    • segmental aponeurectomy

    • dermofasciectomy

    • partial fasciectomy

    • total fasciectomy

    • extensive fasciectomy

    • capsulotomy

    • salvage procedures

    • wound management

    • Subspecialty:
    • Hand and Wrist

Femoral Neck Fractures

Femoral neck fractures are fractures that occur within the capsular space of the hip joint. They are the subclassification of proximal femur fractures that involve the portion of the femur between the proximal intertrochanteric region and the articular surface of the femoral head. Femoral neck fractures are very common in the elderly and are a leading cause of mortality and morbidity in society. It is no surprise that the incidence of hip fractures increases with age congruent with the increased incidence and severity of osteopenia and osteoporosis in the elderly. The diagnosis of femoral neck fracture is made by careful gathering of history and investigating for physical findings consistent with fracture of the proximal femur. Treatment options for femoral neck fractures include nNonoperative management, closed reduction with percutaneous pin fixation, Open reduction with internal fixation, hemiarthroplasty, and total hip arthroplasty.

This article reviews the pathophysiology and clinical presentation of femoral neck fractures, and reviews the considerations for surgical and nonsurgical treatment. Specific surgical techniques reviewed in this article includ closed reduction and percutaneous pinning, open reduction and internal fixation, and prosthetic replacement. Video is available.

    • Keywords:
    • hip fracture

    • broken hip

    • Powell classification

    • Linton classification

    • Garden classification

    • Delbet classification

    • OTA classification

    • scintigraphy

    • percutaneous pin fixation

    • internal fixation

    • Subspecialty:
    • Trauma

Fractures of the Calcaneus

The calcaneus is the irregularly shaped quadrangular bone located at the back of the foot. Calcaneal fractures are the most common tarsal fractures and represent 2% of all fractures. The proximate cause of a calcaneal fracture is a damaging blow to the foot. This article discusses displaced intra- and extra-articular fractures of the tuberosity and body, and fractures of the anterior process of the calcaneus. Treatment of calcaneal fractures is difficult and complex, and a number of options exist.

This article reviews the clinical presentation of calcaneal fractures and outlines contraindications and indications for various surgical techniques. The technique of open reduction and internal fixation if reviewed in detail.

    • Keywords:
    • os calcis fracture

    • calcaneal fracture

    • broken heel

    • heel fracture

    • joint-depression calcaneus fracture

    • tongue-type calcaneus fracture

    • Essex-Lopresti classification

    • Hannover classification

    • Sanders classification

    • OTA classification

    • splinting

    • soft-tissue care

    • open fractures

    • internal fixation

    • Subspecialty:
    • Trauma

    • Foot and Ankle

Posterolateral Corner Injuries

Posterolateral corner injuries are defined to be an injury of the structures on the lateral and posterolateral aspect of the knee which contribute to an increased amount of varus, external rotation, and/or coupled posterior drawer and external rotation of the knee. Most posterolateral corner knee injuries are due to blows to the anteromedial aspect of the knee, contact and noncontact hyperextension injuries, and varus contact injuries to a flexed knee. The overall incidence of isolated posterolateral corner injuries is between 20% and 30%, with a majority of these occurring in combination with either an anterior cruciate ligament and/or posterior cruciate ligament injury. The main treatment options for posterolateral knee injuries depend upon the grade of instability (grade I through grade III), acute versus chronic injuries, functional deficits, and whether there are any other associated ligament injuries concurrent with the posterolateral corner injury.

This article reviews the pathophysiology and clinical presentation for paterolateral corner injuries and reviews indications and contraindications for nonsurgical and for surgical treatment. The article also reviews the surgical technique of posterolateral corner reconstruction in detail. Video is available.

    • Keywords:
    • knee injury

    • external rotation recurvatum test

    • varus stress test

    • dial test

    • posterolateral drawer test

    • Lachman test

    • reverse pivot shift test

    • gait analysis

    • posterolateral corner reconstruction

    • Subspecialty:
    • Sports Medicine

Trigger Finger

Trigger finger, or tendon entrapment of the digits, is one of the most common causes of hand pain and disability. The complaints can range from mild pain and stiffness in the involved finger to a locked and contracted joint. Trigger finger is characterized by stenosing tendovaginitis of the flexor tendon sheath at the level of the metacarpal head. Tendovaginitis refers to the inflamed and thickened A1 pulley that characterizes the disorder. Trigger fingers affects people in all age groups, but it is most common in the fifth and sixth decades. The condition occurs two to six more times more frequently in women than in men. Involvement of multiple fingers is not unusual, and the thumb is the most commonly affected digit, followed by the ring, long, little, and index fingers.

The pathophysiology, clinical presentation, and management options are extensively reviewed. Surgical techniques decribed include Open release and percuatneous release (Eastwood procedure).

    • Keywords:
    • TF

    • trigger digit

    • snapping digit

    • locking digit

    • stenosing tendovaginitis

    • peritendinitis stenosans

    • digitus saltans

    • flexor tendon entrapment

    • open release

    • percutaneous release

    • Eastwood procedure

    • pulley release

    • Subspecialty:
    • Hand and Wrist

Unicompartmental Knee Arthroplasty

Unicompartmental arthroplasty of the knee is a surgical technique for the treatment of arthritis of the medial or lateral tibiofemoral compartment. It involves the replacement of the arthritic compartment with a metal-on-polyethylene articulation. In an appropriately selected patient population, it offers reliable relief of pain and improves function providing an attractive alternative to both total knee arthroplasty and realignment osteotomies.

    • Keywords:
    • knee joint

    • osteoarthritis

    • scintigraphy

    • bone scan

    • unicompartmental knee arthroplasty

    • Subspecialty:
    • Adult Reconstruction

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