OKOJ

OKOJ, Volume 9, No. 11


Application of Thoracic, Lumbar, and Sacral Pedicle Screws and Iliac Screws

Pedicle screws have revolutionized the use of posterior instrumentation in spinal surgery by providing three-column fixation, which allows for more rigid constructs and more powerful reduction of spinal deformities. The application of pedicle screws requires knowledge of spinal anatomy and relationships. This article provides written and video-assisted descriptions of the applied anatomy and surgical technique for the application of thoracic, lumbar, and sacral pedicle screws and iliac screws in spinal surgery.

    • Keywords:
    • spine fusion

    • arthrodesis

    • spine stabilization

    • three-column fixation

    • pedicle screws

    • thoracic pedicle screws

    • lumbar pedicle screws

    • sacral pedicle screws

    • iliac screws

    • posterior spinal instrumentation

    • screw insertion

    • anatomic trajectory

    • anatomic method

    • straight-forward trajectory

    • straight-forward method

    • Subspecialty:
    • Spine

HOT TOPIC: Early Versus Delayed Physical Therapy After Arthroscopic Rotator Cuff Repair

Physical therapy is an important component in the postoperative management of patients undergoing arthroscopic rotator cuff repair. Debate exists, however, with regard to the appropriate timing of this therapy. The classical approach stresses early passive range-of-motion exercise after surgery in an effort to minimize postoperative stiffness. However, there is concern that early therapy may result in unwanted strain at the repair site, which may not be optimal for rotator cuff healing. Recent studies have demonstrated no significant differences in shoulder range of motion at 1 year postoperatively using either an early or delayed range of motion protocol. The timing of therapy after arthroscopic rotator cuff surgery continues to be an area of investigation, and currently both early and delayed rehabilitation protocols are successfully used.

    • Keywords:
    • arthroscopy

    • arthroscopic surgery

    • rotator cuff repair

    • rotator cuff surgery

    • arthroscopic rotator cuff repair

    • rotator cuff tear

    • physical therapy

    • range-of-motion exercises

    • passive motion

    • Subspecialty:
    • Shoulder and Elbow

INBONE Total Ankle Replacement: Current Status

The INBONE Total Ankle (Wright Medical Technology, Arlington, TN) replacement is a modular ankle replacement system consisting of an intramedullary stem whose pieces are inserted through the ankle and pushed up into the tibia to support the tibial tray of the device. The original talar component of the INBONE ankle is a saddle-shaped prosthesis that resurfaces only the top of the talus. A new talar design feature of the INBONE II ankle is a sulcus and two anterior prongs. Between the tibial and talar components of the INBONE, each consisting of a cobalt-chrome alloy, lies an ultra-high–molecular-weight polyethylene spacer locked into the tibial baseplate. In the INBONE II ankle, this polyethylene component is V shaped, to fit into the talar component of the prosthesis. This article describes the use of the INBONE ankle in total ankle arthroplasty and provides a detailed review of the surgical technique used for its achievement.

    • Keywords:
    • ankle replacement

    • total ankle replacement

    • total ankle arthroplasty

    • Subspecialty:
    • Foot and Ankle

INBONE Total Ankle Replacement: Supplementary Procedures

Important variables determine the performance of a total ankle arthroplasty in the patient with moderate or severe ankle deformity. Not only are special surgical techniques necessary, but the prosthetic device used must have design characteristics that lend themselves to correcting the deformity. Although many design features and implantation techniques can be carried from one prosthesis to another, this article addresses the effective prosthetic management of moderate or severe ankle deformity, bone loss, and implant revision with the INBONE Total Ankle (Wright Medical Technology, Arlington, TN). Because of its modularity and adaptability, the INBONE total ankle is particularly suited for use as a primary total replacement for ankles with moderate or severe deformity or bone loss, and for the revision of prior ankle replacements. This article provides a detailed review of the techniques and the multiple ways in which the INBONE ankle may be used as a total ankle replacement in difficult situations.

    • Keywords:
    • ankle replacement

    • total ankle replacement

    • total ankle arthroplasty

    • Subspecialty:
    • Foot and Ankle

Management of Trauma to the Upper Cervical Spine: Occiput to C2

Trauma to the upper cervical spine occurs in various patterns of injury, including atlanto-occipital dislocations, atlantoaxial rotatory subluxations, fractures of the atlas or odontoid, and hangman's fractures. All of these patterns of injury can be associated with substantial morbidity and mortality. The management of patients who have sustained trauma to the upper cervical spine is guided by a set of basic principles. However, the ultimate strategies for managing these patients vary with the pattern and subtype of injury. Considering the potentially devastating outcomes associated with trauma to the upper cervical spine, it is essential that all patients sustaining such trauma be given appropriate, evidence-based care. Further research and information obtained from prospective clinical trials are needed to reach more definitive conclusions about optimal treatment protocols, based on various patient-specific factors, for different patterns of injury to the upper cervical spine.

    • Keywords:
    • occipitovertebral dissociation

    • atlanto-occipital dislocation

    • atlantooccipital dissociation

    • AOD

    • Jeffersons fracture

    • dens fracture

    • odontoid fracture

    • atlantoaxial instability

    • atlantoaxial rotatory subluxation

    • hangmans fracture

    • atlas fracture

    • Subspecialty:
    • Spine

STAR Total Ankle Replacement: Current Status and Technique

The US Food and Drug Administration approved use of the Scandinavian Total Ankle Replacement (STAR) in May 2009. Since that time the surgical technique for installing this new instrumentation has been taught to greater than 400 surgeons. The design of the STAR ankle is identical to the one used in the FDA study from 2000 to 2006, although the technique continues to be refined and the instruments improved. This article provides a brief introduction to total ankle arthroplasty and a detailed technique for the STAR ankle prosthesis to guide the prospective surgeon in the latest technique for implantation.

    • Keywords:
    • ankle replacement

    • total ankle replacement

    • total ankle arthroplasty

    • Subspecialty:
    • Foot and Ankle

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