OKOJ

OKOJ, Volume 11, No. 1


HOT TOPIC: New Innovations in the Diagnosis and Management of Posttraumatic Osteoarthritis

Posttraumatic osteoarthritis after acute joint injury is a common and significant health issue that can cause severe disability in affected individuals. The disease may occur following a variety of joint injuries, but is most predictable secondary to fractures of the articular surface, particularly severe high-energy fractures. To minimize the long-term mechanical effects of joint incongruity, surgeons reduce and stabilize fractures using concepts and techniques that have been developed and refined over decades. Despite these efforts, however, posttraumatic osteoarthritis remains common, and further advances to improve surgical reduction or fixation techniques are unlikely to appreciably change the prognosis. Although posttraumatic osteoarthritis is initiated by physical damage, biologic responses contribute decisively to the progression of the disease process, suggesting that it may be treatable with drugs that target biologic responses. Controlled clinical trials are needed to realize the potential of these drugs. In addition, advances in imaging now allow assessment of the mechanical and biologic aspects of injury and treatment in ways not previously possible, opening the door for new clinical investigations to enhance the understanding and treatment of this complex disease.

    • Keywords:
    • articular fracture

    • degenerative arthritis

    • posttraumatic arthritis

    • osteoarthritis

    • articular cartilage destruction

    • cartilage degeneration

    • chondrocyte death

    • cartilage injury

    • fracture severity

    • Subspecialty:
    • Trauma

Management of Talus Fractures

Fractures of the talus are uncommon injuries. Perhaps more so for these fractures than for other fractures, successful treatment requires thorough knowledge of the bony and vascular anatomy of the region. Furthermore, many talar fractures are missed because of the inadequacy of conventional imaging techniques. Because of the rarity of talus fractures in a general orthopaedic practice, many surgeons are unfamiliar with current techniques of management. This article reviews the anatomy, imaging, classification, and treatment of fractures of the talus, including talar neck fractures, talar body fractures, talar process fractures, and talar extrusion. Recent information regarding the timing of treatment of displaced talus fractures is also discussed.

    • Keywords:
    • talar neck fracture

    • talar body fracture

    • talus fracture

    • lateral process fracture

    • talarextrusion

    • osteonecrosis of the talus

    • Hawkins classification

    • Subspecialty:
    • Foot and Ankle

Muscle: Structure, Physiology, and Response to Injury

Skeletal muscle injuries are among the most common injuries in sports, with strain, contusion, laceration, and delayed-onset muscle soreness accounting for the majority. Although nonsurgical management is the foundation of treatment for muscle strain and contusion, complete tears or laceration injuries will benefit from surgical repair, which allows the muscle to regain a significant amount of strength. Researchers are currently trying to use recombinant human growth factors to improve muscle healing, and gene therapy is being explored as a method for delivering stable high concentrations of growth factors to injured muscle. Nevertheless, the need remains for Level I clinical evidence that advises of the best treatment strategies for these injuries. In this review, we discuss muscle structure, physiology, common mechanisms of muscle injury, and response to injury. We also provide an overview of diagnostic pearls and potential treatment strategies.

    • Keywords:
    • muscle injury

    • muscle strain

    • muscle contusion

    • muscle laceration

    • delayed-onset muscle soreness

    • DOMS

    • muscle repair

    • sarcomere

    • sliding filament theory of muscle contraction

    • motor unit

    • all or none phenomenon

    • satellite muscle cell

    • myositis ossificans

    • Subspecialty:
    • Sports Medicine

    • Basic Science

Rotational Variations of the Lower Extremity in Children

Variations of the rotational profile of the lower extremities are so common in healthy children that most torsional deviations involving the legs and feet should be viewed as variations of normal rotation rather than as true pathologies. Parents are primarily concerned about the possibility of their child having a permanent disability in adulthood as a result of such variations, and secondarily concerned that these variations may hinder the child's athletic activities that involve running. In this article, we review the etiology and pathophysiology of some commonly seen variations in the rotational profile of the lower extremities of children, discuss their natural histories, outline several potentially serious causes of rotational abnormality identified by physical examination, provide guidelines for radiologic imaging of the lower extremities in such situations, and discuss considerations for the management of these situations with the goal of helping the clinician to better formulate an appropriate plan of care for the children they affect and to better educate these children's families and referring care providers.

    • Keywords:
    • femoral anteversion

    • femoral retroversion

    • femoral antetorsion

    • tibial torsion

    • metatarsus adductus

    • rotational abnormalities

    • in-toeing

    • out-toeing

    • rotational profile

    • gait abnormality

    • genu valgum

    • genu varum

    • cerebral palsy

    • gait analysis

    • Subspecialty:
    • Pediatric Orthopaedics

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