Managing risk: Compartment syndromes of the foot

Steven L. Haddad, MD

Heightened awareness will assist the observant orthopaedic surgeon in avoiding litigation for the sequela of a missed compartment syndrome. Acute compartment syndrome of the foot was first described in the literature in 1981. It is similar in pathophysiology to compartment syndrome of the lower leg and results in ischemic changes to both nerves and muscles due to elevated interstitial pressures within tight osseofascial compartments.

AAOS makes connections at Thai orthopaedic meeting

Peter Pollack

Orthopaedic surgeons in Thailand work 40 hours or more each week in government-run hospitals, then provide care in the evenings and on weekends in their private practices In October 2006, a group of physicians representing AAOS travelled to Pattaya, Thailand, as part of a combined meeting of AAOS, the Association of Southeast Asian Nations Orthopaedic Association (ASEAN-OA), the Royal College of Orthopaedic Surgeons of Thailand (RCOST) and the Thai Orthopaedic Association (TOA).

Global opportunities for orthopaedists on new AAOS Web site

Are you looking for a temporary orthopaedic-related opportunity around the world? Or perhaps you have a short-term or long-term temporary position you need to fill? The AAOS now offers a free, online resource for posting and seeking precisely those types of opportunities.

Practicing defensive medicine—Not good for patients or physicians

Paul A. Manner, MD

Recently, several studies have focused on the effects of “defensive medicine” on physicians and patients. In addition, calls for tort reform hold that the practice of defensive medicine is a major factor increasing the cost of medical care. Although the concept of defensive medicine seems obvious, a true estimate of its costs and impact is surprisingly hard to find. What is defensive medicine?

Why bother with double-bundle?

Mary Ann Porucznik

Richard Hawkins, MD, has another viewpoint on the topic Not all surgeons are as enthusiastic as Freddie Fu, MD, about the double-bundle technique for ACL reconstruction. Richard Hawkins, MD, believes Dr. Fu should be applauded for his initiative in trying to improve patient outcomes, but recommends that both surgeons and patients wait until more evidence on the efficacy of the technique has been amassed.

ACL anatomy

The ACL consists of individual fiber bundles, named for their insertion points on the tibial footprint. The larger anteromedial (AM) bundle inserts anteromedially on the tibial side and originates more proximally on the femoral side than the posterolateral (PL) bundle, which is posterolateral relative to AM bundle. Studies indicate that the AM bundle tightens in flexion while the PL bundle relaxes; in extension, the PL bundle tightens while the AM bundle relaxes.

Award-winning study debunks advantages of two-incision THA

Mary Ann Porucznik

Although a faster recovery is reported as one of the advantages of two-incision total hip arthroplasty (THA), two studies conducted as part of a prospective randomized clinical trial dispel that notion. The results were presented at the 2006 fall meeting of the American Association of Hip and Knee Surgeons (AAHKS). No faster healing The first study showed that patients who underwent a two-incision THA did not recover more quickly than those who had a mini-posterior approach.

What’s making the noise in squeaky hips?

Mary Ann Porucznik

You might expect a squeak or two from a new pair of shoes, but from a new total hip? At the recent fall meeting of the American Association of Hip and Knee Surgeons (AAHKS), attendees watched—and heard—videos of patients who had received ceramic-on-ceramic (COC) total hip arthroplasties (THA). As the patients walked, climbed stairs or sat, a distinct squeaking sound emanated from their hips.

Computer navigation: Does it make you a better TKA surgeon?

Mary Ann Porucznik

It’s expensive and it takes longer. But these surgeons say the results are worth it. For many orthopaedic surgeons, making the transition from standard techniques to computer-assisted surgery (CAS) is “a leap of faith.”

Surgeon-industry collaboration: Absolutely critical or a threat to public trust?

Mary Ann Porucznik

Five perspectives on the surgeon-industry relationship In March 2005, the U.S. Department of Justice (DOJ) issued subpoenas to several orthopaedic device makers, seeking information about their relationships with surgeons. Although the issue of industry-surgeon collaborations has often been discussed, the DOJ’s action brought “conflict of interest” into sharp focus.

The down side of CAS

The technology to implement computer-assisted surgery is not cheap. Systems can range from $150,000 to $220,000, depending on the type and vendor. List prices for disposables, per case, range from $206 to $850. Another down side is time. All the panelists agreed that CAS TKAs take an average of 15 minutes longer than conventional TKAs. “Set-up takes about 5 minutes,” noted Dr. Wixson, “with an additional 9 minutes during the surgery to verify cuts and check trial reduction.” Dr.

Is double-bundle ACL repair better?

An interview with Freddie H. Fu, MD By Mary Ann Porucznik Freddie H. Fu, MD, DSc(Hon), DPs(Hon) is a strong proponent of the double-bundle technique, which has been called a “gimmick” by some. More than 100,000 anterior cruciate ligament (ACL) reconstructions are performed every year in the United States, making this one of the most commonly performed orthopaedic procedures.