OKOJ

OKOJ, Volume 11, No. 2


Damage Control Orthopaedics

Damage control orthopaedics refers to limited early surgical intervention for stabilization of musculoskeletal injuries in the unstable polytrauma patient. The goals of damage control orthopaedics are to limit ongoing hemorrhage and soft-tissue injury through efficient fracture stabilization while minimizing additional physiologic insult. Specifically, care is taken to avoid development of the lethal triad (hypothermia, coagulopathy, and acidosis) and to limit secondary injury to vital organ systems, such as the brain and lungs. External fixation is typically employed for significant long bone and pelvic injuries, in addition to débridement of open fracture wounds, removal of devitalized tissue, surgical management of hemorrhage, and fasciotomies, as needed. As our understanding of the role fracture care plays in the body's systemic inflammatory response to trauma continues to evolve, the criteria best used to determine which patients are best treated with a damage control approach remain a source of much debate and investigation.

    • Keywords:
    • polytrauma patient

    • multiply injured patient

    • damage control orthopaedics

    • DCO

    • Early Total Care

    • ETC

    • Systemic Immune Response Syndrome

    • SIRS

    • Adult Respiratory Distress Syndrome

    • ARDS

    • second-hit hypothesis

    • borderline patient

    • femoral shaft fracture

    • pelvic ring injury

    • external fixation

    • Subspecialty:
    • Trauma

Evaluation and Management of Meniscal Root Tears

The medial and lateral menisci play a key role in load transmission and secondary stabilization of the tibiofemoral joint; thus, meniscal injuries or meniscectomy can significantly affect the intra-articular environment of the knee. Tears of the meniscal root have become increasingly recognized as a cause of meniscal extrusion, joint-space narrowing, and progressive knee osteoarthritis. Studies show that meniscal root repair can successfully restore joint biomechanics, and thereby prevent the degenerative changes associated with meniscal deficiency. The purpose of this article is to review the steps for clinical evaluation of meniscal root tears and describe our technique for arthroscopic pull-out suture repair of these injuries.

    • Keywords:
    • meniscus

    • meniscal root repair

    • meniscectomy

    • knee

    • articular cartilage

    • knee arthroscopy

    • meniscus repair

    • Subspecialty:
    • Sports Medicine

Spinal Orthoses

Spinal orthoses are currently used in the treatment of a variety of conditions of the spine. Clinical indications for their use include spinal trauma, correction of deformity, chronic neck and back pain, and postoperative bracing following spinal surgery. Many types of spinal orthoses are available, grouped by the region of the spine they are designed to support or immobilize and by their degree of rigidity. However, despite the widespread use of these devices, evidence supporting their effectiveness is lacking. A good understanding of spinal mechanics is a prerequisite to the use of spinal orthoses. The clinician should also be familiar with the variety of orthoses on the market, the indications and contraindications for their use, and the various complications associated with these devices. An explanation or demonstration of the appropriate fit of an orthotic device remains essential to patient compliance and successful outcomes.

    • Keywords:
    • orthosis

    • orthotic device

    • cervical orthosis

    • cervical collar

    • cervicothoracic orthosis

    • CTO

    • halo vest

    • thoracolumbar orthosis

    • thoracolumbosacral orthosis

    • TLSO

    • cruciform anterior spinal hyperextension brace

    • CASH brace

    • Minerva

    • brace

    • Lerman brace

    • Jewett brace

    • lumbosacral orthosis

    • LSO

    • lumbosacral corset

    • Subspecialty:
    • Spine

Total Ankle Replacement With the Mobility Ankle

The Mobility Total Ankle System (DePuy) is a three-component, mobile-bearing ankle replacement device composed of an articulating, ultra-high-molecular-weight polyethylene bearing inserted between separate cobalt chrome tibial and talar components. At the time of this publication, the Mobility ankle device is not approved for use in the United States. In this article, we describe our surgical technique for implantation of the Mobility ankle, including the incision made for insertion of the prosthesis and exposure of the ankle joint, planning of bone cuts for implantation of the device, techniques for enhancing foot-ankle alignment and balance, and approaches to correcting deformities of the ankle, hindfoot, or midfoot. Clinical considerations, indications, and contraindications for total ankle replacement are also discussed.

    • Keywords:
    • total ankle replacement

    • TAR

    • total ankle arthroplasty

    • ankle replacement

    • ankle arthritis

    • degenerative joint disease

    • Subspecialty:
    • Foot and Ankle

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