OKOJ, Volume 12, No. 7

Diagnostic Knee Arthroscopy: Surgical Technique

The ability to perform a diagnostic arthroscopic examination of the knee is an essential skill for the orthopaedic surgeon. The skills required for arthroscopy are typically taught and developed in the early years of residency training. During these initial training sessions, it is imperative for the beginning arthroscopist to develop excellent habits to build a foundation on which to increase his/her skills for not only diagnosing but also treating different knee pathologies. Importantly, the arthroscopist must develop a reproducible routine to perform a complete examination without missing additional diagnoses. Often, the hand-eye coordination, triangulation, and physical skills required for arthroscopy are learned "on the go" as residents gain more experience with simulation equipment and performing in the operating room. The purpose of this article is to provide basic information on the surgical technique for performing a thorough, accurate, and efficient diagnostic knee arthroscopy.

    • Keywords:
    • arthroscopic surgery

    • knee joint

    • patellofemoral joint

    • patient positioning

    • portals

    • portal placement

    • knee compartments

    • Subspecialty:
    • Sports Medicine

Neuromas of the Foot and Ankle

A neuroma of the foot or ankle can occur within a traumatized nerve, in which case it is defined as a neuroma in continuity, or on the end of a nerve, when it is defined as a terminal neuroma. Iatrogenic trauma is a common etiology of neuromas of the foot and ankle. This article describes the anatomy and physiology of neuromas of the foot and ankle and the clinical symptoms and signs required for their diagnosis. Their treatment may be nonsurgical, through medical, physical, or electrical means, or surgical, which is done for neuromas that fail to respond to conservative measures. This article also discusses reconstruction for a neuroma in continuity, and excision, excision with redirection, and the use of conduits and other measures for neuromas recalcitrant to standard treatment. The individual nerves of the foot and ankle, the usual sites and causes of injury leading to a neuroma, and the optimal management for each nerve affected by a neuroma are described, with examples based on the literature and direct experience.

    • Keywords:
    • Morton neuroma

    • terminal neuroma

    • neuroma in continuity

    • interdigital neuroma

    • collagen conduits

    • Subspecialty:
    • Foot and Ankle

Pathologic Fractures of the Femur and Humerus

Pathologic fractures are those that occur in bones with abnormal structure, and are commonly associated with metastatic invasion of primary carcinomas such as breast, lung, and renal cell. Preoperative evaluation of patients should include a thorough patient history and physical examination, as well as focused laboratory tests and imaging studies. A multidisciplinary approach is recommended for determining an optimal surgical plan. The goals of treatment of pathologic fractures are focused on pain control, maintaining mobility, and improving the patient’s quality of life. Options for reconstruction should allow for early weight bearing and should be based on the location of the fracture, the quality of surrounding bone, and the histologic diagnosis. Patients with displaced pathologic fractures of the femur who have a life expectancy estimated to be beyond 12 months should be evaluated for endoprosthetic reconstruction to avoid late complications associated with internal fixation.

    • Keywords:
    • bone metastases

    • metastatic disease

    • endoprosthesis

    • pathologic fracture

    • Subspecialty:
    • Trauma

    • Musculoskeletal Oncology

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