Orthopedic Surgery Clerkship

 

Description:

This quick-reference guide is the first book written specifically for the many third- and fourth-year medical students rotating on an orthopedic surgery service. Organized anatomically, it focuses on the diagnosis and management of the most common pathologic entities. Each chapter covers history, physical examination, imaging, and common diagnoses. For each diagnosis, the book sets out the typical presentation, options for non-operative and operative management, and expected outcomes. Chapters include key illustrations, quick-reference charts, tables, diagrams, and bulleted lists. Each chapter is co-authored by a senior resident or fellow and an established academic physician and is concise enough to be read in two or three hours. Students can read the text from cover to cover to gain a general foundation of knowledge that can be built upon when they begin their rotation, then use specific chapters to review a sub-specialty before starting a new rotation or seeing a patient with a sub-specialty attending.  Practical and user-friendly, Orthopedic Surgery Clerkship is the ideal, on-the-spot resource for medical students and practitioners seeking fast facts on diagnosis and management. Its bullet-pointed outline format makes it a perfect quick-reference, and its content breadth covers the most commonly encountered orthopedic problems in practice.

 

Table of Contents:

 

Part I: The Basics

1: General Orthopedic Terminology

Introduction

Subspecialties

Adult Reconstruction (Joint Replacement/Arthroplasty)

Trauma

Shoulder and Elbow

Hand

Spine

Foot and Ankle

Sports Medicine

Oncology

Pediatrics

General Anatomy and Motion

Anatomy

Postural/Positional or Deformity Descriptions

Motion Descriptors

Bone Growth and Anatomy

Bone Types

Bone Cells

Bone Growth and Healing

Cartilage

Hyaline Cartilage

Fibrocartilage

Pharmacology

Anticoagulation

Antibiotics

Orthopedic Implants

Screws

Intramedullary Nails

External Fixator

Percutaneous Pins

Arthroplasty

Miscellaneous

References

2: Radiology: The Basics

Types (Modalities) of Musculoskeletal Imaging

Types/Patterns of Fractures

Steps to Reading Musculoskeletal Imaging from an Orthopedic Perspective

Example

How to Describe a Fracture

Suggested Readings

3: Fractures

Bone Composition [4]

Anatomy [3]

Vascularity [1]

Bone Healing [2]

Inflammatory Phase [4]

Reparative Phase [4]

References

4: Dislocations

Definition

Etiology

Management

Complications [1]

Neurovascular Injuries [2]

Avascular Necrosis (Hip) [4]

Heterotopic Ossification (Elbow and Hip Most Common) [1]

Articular Cartilage [1]

References

5: Orthopedic Emergencies

Compartment Syndrome

Unstable Pelvic Fracture

Necrotizing Fasciitis

Septic Arthritis

Cauda Equina Syndrome

Open Fracture

Hip Dislocation

Knee Dislocation

References

6: Principles of Trauma

Overview: Trauma

Management of the Trauma Patient

Damage Control Orthopedics

Indicators for Early Total Care

Open Fractures

Gunshot Wounds (GSW)

Suggested Readings

Part II: The Upper Extremity

7: Physical Exam of the Shoulder

Four Aspects

8: Rotator Cuff Pathology

Anatomy

Function

Epidemiology

Etiology

Pathology

Presentation

Exam

Workup

Classification

Treatment

Postoperative Course

Complications

References

9: Adhesive Capsulitis

Epidemiology

Etiology (See Table 9.1 for Risk Factors)

Pathology

Diagnosis

Natural History/Clinical Stages (Table 9.2): 3 to 4 Months Each

Arthroscopic/Descriptive Stages

Treatment

Outcomes

Suggested Readings

10: Calcific Tendonitis

Definition

Epidemiology

Etiology

Pathology

Diagnosis

Stages: Reactive Calcification

Treatment

Outcomes

References

11: Proximal Humerus Fractures

Epidemiology

Anatomy

Presentation and Evaluation

Classification and Treatment

Posttreatment Rehabilitation

Complications

References

12: Clavicle Fractures

Epidemiology

Associated Injuries

Anatomy

Classification

Presentation and Exam

Imaging

Treatment

References

13: Acromioclavicular Joint Separation

Anatomy

Mechanism

Presentation/Exam

Imaging

Classification

Treatment

Postoperative Protocol

Complications

References

14: Glenohumeral Pathology

Osteoarthritis (OA)

Epidemiology

Pathoanatomy

History

Physical Exam

Imaging

Classification: Walch Primary OA Glenoid Morphology

Inflammatory Arthritis

Epidemiology

Pathoanatomy

Physical Exam

Labs

Imaging

Classification: Neer

Osteonecrosis

Epidemiology

Pathoanatomy

History

Physical Exam

Imaging

Classification: Cruess

Treatment

References

15: Arthroplasty of the Shoulder

Work-Up

Types

Hemiarthroplasty

Total Shoulder Arthroplasty (TSA) (Fig. 15.1)

Reverse Total Shoulder Arthroplasty (RTSA) (Fig. 15.2)

Reference

16: Glenoid Superior Labrum Anterior to Posterior (SLAP) Lesions

Anatomy and Function

Pathology

Snyder’s Original Classification [3]

Clinical Presentation

Imaging

Management

References

17: Biceps Brachii Tendon Injuries: Biceps Tendon Rupture

Proximal Biceps Tendon Injuries

Anatomy

Proximal Biceps Rupture

Proximal Biceps Instability

Presentation

Imaging

Management

Distal Biceps Injuries

Anatomy

Presentation

Imaging

Management

References

18: Humeral Shaft Fractures

Anatomy

Fracture Classification

Characteristics

Exam

Treatment

Special Fractures

Radial Nerve Palsy

Suggested Readings

19: Tennis and Golfer’s Elbow: Epicondylitis

Overview

Anatomy and Pathophysiology

Pathology

Presentation and Physical Exam Findings

Presentation [1, 7, 12]

Evaluation

Physical Exam

Work-Up

Treatment

Nonoperative (First Line) [7, 9, 12]

Operative Treatment

Lateral Epicondylitis

Medial Epicondylitis

Post-op

References

20: Olecranon Bursitis

Olecranon Bursitis: “Student’s Elbow,” “Baker’s Elbow,” and “Swellbow”

Epidemiology/Demographics [1, 2]

Etiology

Signs/Symptoms

Treatment

Complications

References

21: Distal Humeral Fractures

Anatomy

Epidemiology/Demographics

Signs/Symptoms/Exam

Intercondylar Fractures

Classification

Treatment [1, 2]

Capitellum Fractures

Classification

Treatment

Complications

References

22: Olecranon Fracture

Overview

Anatomy

Classification

Colton Classification [2]

The Mayo Classification [3]

Evaluation

History

Physical Examination

Imaging

Treatment

Nonoperative

Operative

Complications

References

23: Radial Head Fracture

Overview

Anatomy

Classification

Evaluation

History

Physical Examination

Imaging

Treatment

Nonoperative

Operative

Complications

References

24: Coronoid Fractures

Introduction

Overview

Epidemiology

Anatomy

Mechanism

Pathoanatomy

Presentation

History [7]

Physical Exam [6]

Imaging

X-Ray

CT

Classification

Reagan and Morrey Classification: Based on Fragment Size [9]

Alternate Classification System: O’Driscoll Classification

Current Concepts in Treatment

Nonoperative Treatment

Operative Treatment

Potential Complications

References

25: Elbow Dislocation

Overview

Anatomy and Pathophysiology

Stabilizers of the Elbow

Osseous Stabilizers

Soft Tissue Stabilizers

Mechanism of Injury

Evaluation

Presentation

Physical Exam

Imaging

CT Indications

Classification

Anatomic Description

Simple vs Complex

Treatment

Nonoperative Indications

Operative Indications

Ligamentous Repair or Construction

Hinged External Fixator

Potential Complications [12, 13]

References

26: Degenerative Joint Disease of the Elbow

Osteoarthritis (Refer to Chaps. 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20

Post-traumatic Arthritis (Refer to Chaps. 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17,

Inflammatory Arthritis (Rheumatoid Arthritis)

Etiology

Pathology

Evaluation

Treatment

Neuropathic Arthritis

Etiology

Pathology

Evaluation

Treatment

Septic Arthritis

Etiology

Pathology

Evaluation

Treatment

References

27: Osteoarthritis of the Elbow

Incidence and Etiology

Clinical Presentation

Work-Up

Non-operative Treatment

Operative Treatment

Arthroscopic Ulnohumeral Arthroplasty

Open Ulnohumeral Arthroplasty (Outerbridge-Kashiwagi Procedure)

Total Elbow Arthroplasty (TEA)

Interposition Arthroplasty

Arthrodesis

References

28: Post-traumatic Arthritis of the Elbow

Incidence and Etiology

Clinical Presentation

Work-Up

Non-operative Treatment

Operative Treatment

Arthroscopy

Open Techniques

Interposition Arthroplasty

Total Elbow Arthroplasty

Arthrodesis

Isolated Radiocapitellar or Distal Humeral Joint Disease

References

29: Cubital Tunnel Syndrome

Incidence and Etiology

Anatomy (Fig. 29.1)

Clinical Presentation

Evaluation

Non-operative Treatment

Operative Treatment [3]

In Situ Decompression (Fig. 29.2)

Transposition

Subcutaneous Transposition

Submuscular Transposition

Medial Epicondylectomy

References

30: Radius and Ulna Fractures

Introduction

Anatomy

Osteology

Ligaments

Clinical Evaluation

History

Physical Exam

Radiographic Evaluation

Classification

Treatment

Nonoperative Management

Operative Management

Complications

Suggested Readings

31: Monteggia and Galeazzi Fractures

Introduction

Anatomy

Osteology

Ligaments

Clinical Evaluation

History

Physical Exam

Radiographic Evaluation (Figs. 31.1 and 31.2)

Classification

Treatment

Nonoperative Management

Operative Management

Approaches

Volar Henry (Radius): Used for Galeazzi Fractures

Posterior Approach to Elbow: Used for Monteggia Fractures

Complications

Suggested Readings

32: Distal Radius and Ulna Fractures

Distal Radius Fractures [1]

Anatomy

Presentation

Classification Systems

Operative Indications

Non-operative Treatment

Operative Techniques

Associated Injuries of the DRUJ

Distal Ulna Fractures [1, 8]

Anatomy

Epidemiology

Presentation

Classification

Treatment

References

33: Carpal Tunnel Syndrome

Introduction

Anatomy

Pathophysiology

Etiology

Trauma-Related Structural Changes

Systemic Diseases

Anomalous Anatomic Structures

Hormonal Changes

Tumors/Neoplasms

Mechanical Overuse

Diagnosis

Physical Examination

Phalen’s Test (Fig. 33.2)

Tinel’s Sign

Durkan’s Test (Fig. 33.3)

Other Provocative Tests

Innervation-Density Tests

Imaging

Electrodiagnostic Studies

Overview

Nerve Conduction Velocity Test (NCV)

Electromyography (EMG)

Differential Diagnosis

Nonoperative Treatment

First Line

Adjunctive Conservative Treatment

Operative Treatment

Open Carpal Tunnel Release (Fig. 33.4)

Complications

Suggested Reading

34: Kienbock’s Disease (Lunatomalacia)

Epidemiology

Anatomy

Pathophysiology

Clinical Presentation

Natural History

Imaging/Classification

Treatment Based on Classification

Technical Details

Radial Shortening Osteotomy

Biomechanics

Outcome [21, 22]

Complications

Capitate Shortening Osteotomy

Biomechanics

Outcome

Complications

Scaphocapitate Arthrodesis

Biomechanics

Outcome

Complications

Nickel-Titanium Memory Alloy Arthrodesis

Outcome

Proximal Row Carpectomy

Outcome

Complications

References

35: De Quervain’s Syndrome

Introduction

Anatomy

Pathophysiology

Clinical Evaluation

History

Physical Exam

Differential Diagnosis

Radiographic Evaluation

Treatment

Nonoperative Management: First-�Line Therapy

Operative Management

References

36: Dupuytren Disease (Contracture)

Dupuytren Disease (Contracture)

References

37: Trigger Digit

Overview

Anatomy

Adult Trigger Finger

Classification

Treatment

Complications: Rare

Suggested Readings

38: Scaphoid Fractures

Anatomy

Demographics

Presentation

Imaging

Classification

Treatment

Non-operative

Operative

Complications

Suggested Readings

39: Thumb Ulnar Collateral Ligament Injuries (Gamekeeper’s and Skier’s Thumb)

Eponyms

Anatomy

Presentation

Imaging

Treatment

Nonoperative

Operative

Suggested Reading

40: Peri-lunate and Lunate Dislocations

Anatomy

Classification

Presentation and Diagnosis

Treatment

Closed Reduction

Surgical Stabilization

Postoperative Rehab

Complications

Outcomes

Suggested Readings

41: First Metacarpal Base Fractures

Classification

Extra-articular Fractures

Anatomy

Presentation and Diagnosis

Treatment

Postoperative Rehabilitation

Outcomes

Bennett Fractures

Anatomy

Presentation and Diagnosis

Treatment

Postoperative Rehabilitation

Outcomes

Rolando Fractures

Anatomy

Presentation and Diagnosis

Treatment

Postoperative Rehabilitation

Outcomes

Suggested Reading

42: Non-scaphoid Carpal Bone Fractures

General Anatomy

Incidence of Fractures

Triquetrum

Fracture Pattern

Diagnosis

Radiographs

Treatment

Complications

Trapezium

Fracture Pattern

Diagnosis

Radiographs: Standard Wrist Radiographs Often Not Adequate

Treatment

Complications

Capitate

Diagnosis

Radiographs

Treatment

Complications

Hamate

Fracture Pattern

Diagnosis

Radiographs

Treatment

Complications

Pisiform

Diagnosis

Radiographs

Treatment

Complication

Trapezoid

Diagnosis

Radiographs

Treatment

Complications

Lunate

Diagnosis

Radiographs

Treatment

Complications

Suggested Readings

43: Boxer’s Fractures

Overview

Evaluation

Radiographs (Figs. 43.1 and 43.2)

Treatment: Most Treated Nonsurgically

Complications: Rare

Suggested Readings

44: Phalangeal Fractures

Distal Phalanx

Shaft Fractures

Intra-articular Fractures

Tuft Fractures

Middle Phalanx

Articular Fractures

Shaft Fractures

Proximal Phalanx

Articular Fractures

Shaft Fractures

Suggested Readings

45: Phalangeal Dislocations

Anatomical Considerations

Proximal Interphalangeal (PIP) Joint

Distal Interphalangeal (DIP) Joint

Metacarpophalangeal (MCP or MP) Joint

PIP Joint Injuries: Dorsal Dislocations

Type I: Hyperextension Injury

Type II: Pure Dorsal Dislocation

Simple Versus Complex

Type III: Fracture-Dislocation

Kiefhaber Modification of Hastings Classification

PIP Joint Injuries: Volar Dislocations

PIP Joint Injuries: Rotatory Dislocations

DIP Joint Dislocations

MP Joint Dislocations

Suggested Readings

46: Metacarpal Fractures

Overview

Evaluation

Radiographic Evaluation and Treatment Options (Figs. 46.1, 46.2, and 46.3)

Treatment

Complications

Suggested Readings

47: Traumatic Upper Extremity Amputations

Presentation

Mechanism of Injury

Factors Affecting Treatment:

Patient Factors:

Treatment by Injury Location

Goals of Amputation Surgery

General Considerations:

Fingertip Amputations

Amputations Through the DIP Joint

Amputation Through the Middle Phalanx

Proximal Limb Amputations

Postoperative Management

Complications

References

48: Tears of the Triangular Fibrocartilage Complex

Anatomy

Injury Mechanism

Physical Exam

Imaging

Classification

Treatment

Suggested Reading

49: Carpal Instability

The Carpal Rows

Ligamentous Anatomy of the Wrist

Biomechanics

Carpal Instability

Carpal Instability Dissociative (CID)

Scapholunate Ligament Injuries: Dorsal Intercalated Segment Instability (DISI)

Lunotriquetral Ligament Injuries: Volar Intercalated Segment Instability (VISI)

Carpal Instability Nondissociative (CIND)

Radiocarpal Instability (Fig. 49.1)

Midcarpal Instability

Classification [27, 28]

Treatment

Carpal Instability Complex (CIC)

Perilunate Dislocations

Radiographs

Treatment

Axial Carpal Dislocations

Treatment

Isolated Carpal Bone Dislocation

Carpal Instability Adaptive (CIA)

References

50: Flexor Tendon Injuries of the Upper Extremity

Anatomy

Tendon Structure

Tendon Nutritional Supply

Relationship of Flexor Digitorum Superficialis (FDS) and Flexor Digitorum Profundus (FDP)

Phases of Tendon Wound Healing

Presentation

Mechanism

Treatment

Nonoperative Management with Wound Care and Early Range of Motion

Operative Management

Pearls

Postoperative Rehabilitation

Controlled Mobilization Postoperatively Is Key

Complications

References

51: Extensor Tendon Injuries of the Upper Extremity

Anatomy

Muscles and Tendons

Anatomy of the Extensor Mechanism

Extensor Compartments

Extensor Tendon Zone of Injury (Fig. 51.1)

Other Structures

Presentation

Mechanism

Loss of Active Extension

Neurovascular Exam

Imaging

Specific Injuries by Zone

Treatment

Nonoperative Management

Operative Management

Postoperative Protocol

Complications

Adhesions

References

Suggested Readings

52: Nerve Injury

Anatomy

Classification of Nerve Injuries (Modified Seddon Classification)

Nondegenerative Lesions

Degenerative Lesions (Undergo Wallerian Degeneration)

Mechanism of Injury

Presentation

History

Physical Exam

Imaging

Prognosis

Treatment

Nonoperative

Operative

Peripheral Neuromas

Suggested Readings

53: Upper Extremity Replantation

Introduction

Evaluation and Early Management

Indications/Contraindications to Replantation

Other Severe Diseases or Injuries, Such as Polytrauma

Classification

Treatment

Operative

Postoperative Care

Environment

Monitoring Replantation

Arterial Insufficiency

Complications

References

54: Ulnar Compressive Neuropathies

Cubital Tunnel Syndrome

Introduction [1]

Anatomy [1]

Presentation [1]

Studies

Surgical Treatment Types [2]

Comparison of Surgical Treatment [3]

Treatment [1]

Nonoperative

Operative

Complications

Surgical Failure [4]

Persistent or Recurrent Symptoms Can Lead to Revision Surgery

Possible Symptomatic Complications

Causes of Failed Surgery

Guyon’s Canal Syndrome

Introduction

Anatomy

Presentation

Treatment

Nonsurgical

Surgical

Complications

References

55: Degenerative Arthritis of the Hand

What Is Degenerative Arthritis?

Hand OA Epidemiology [1]

Prevalence

Factors Associated with Hand OA

Pathology of OA [2, 3]

Pathogenesis

Types

Presentation in the Hand [1, 4]

Commonly Involved Hand Joints [1, 3, 4]

Radiographic Evaluation [2, 3, 5]

Conservative Treatment [4, 6, 7]

Surgical Treatment [2, 3, 4]

Arthrodesis (Joint Fusion)

Arthroplasty (Joint Replacement)

Arthroscopy

Mucous Cyst Excision

References

56: Inflammatory Arthritis of the Hand

Types of Inflammatory Arthritis

Rheumatoid Arthritis (RA)

Effects of RA

Medical Management of RA

Surgical Management of the RA Hand

Characteristic Pathology of the RA Hand

References

57: Chronic Regional Pain Syndrome

Definition

Pathophysiology

Epidemiology

Signs and Symptoms

Acute or Warm Stage

Intermediate or Dystrophic Stage

Third or Chronic Stage (Cold, Atrophic)

Diagnosis

Imaging [1, 2]

Treatment Options

Physical Therapy/Occupational Therapy

Psychological Therapy

Pharmacologic Therapy [2]

Procedural Interventions

Prevention

Distal Radius Fractures

Surgery on Limb Previously Affected by CRPS

References

58: Upper Extremity Infections

General

Incidence

Treatment Principles

Organisms

Common Soft Tissue Infections

Cellulitis

Felon

Paronychia/Eponychia

Onychomycosis

Flexor Tendon Infections

Deep Space Infections of the Palm

Horseshoe Abscess

Bite Wounds

Human Bites

Animal Bites

Osteomyelitis

Atypical Infections

Necrotizing Fasciitis

Immunocompromised Patients

Suggested Reading

Part III: Lower Extremity

59: Hip Fractures

Femoral Neck Fractures

Background [2, 4]

Risk Factors [2, 4]

Anatomic Considerations [4]

Classification

Garden Classification: Based on Displacement (Figs. 59.1 and 59.2) [2]

Pauwel Classification: Based on Angle of Fracture Line Relative to Horizontal

Stress Fractures [2]

Presentation/Evaluation

Impacted and Stress Fractures [4]

Displaced Fractures [4]

Treatment Considerations

Basic Principles [3]

Nonoperative Treatment [3]

Open Reduction Internal Fixation [3]

Cannulated Screws (Fig. 59.3) [3, 4]

Sliding Hip Screw [1, 3]

Arthroplasty (Fig. 59.4) [3]

Complications

Avascular Necrosis [4]

Nonunion [4]

Intertrochanteric Femur Fractures

Background [2, 4]

Anatomic Considerations [4]

Classification

Presentation/Evaluation [4]

Imaging

Treatment Considerations

Basic Principles [3]

Nonoperative Treatment [3]

Sliding Hip Screw (Fig. 59.7) [1, 3]

Cephalomedullary Nail (Fig. 59.8) [3]

Arthroplasty [3]

Complications [4]

Hardware Failure/Cutout (Fig. 59.9)

Nonunion

Malunion

References

60: Hip Dislocations

Overview

Classification

Simple

Complex

Anatomic Classification

Presentation

Symptoms

Physical Exam

Imaging

Radiographs

Computed tomography (CT) scan

MRI

Treatment

Nonoperative

Operative

Complications

References

61: Osteoarthritis of the Hip and Knee

Introduction

Definition [2–4]

Epidemiology [2, 4]

Risk Factors [2, 4]

Pathology [2]

Physical Exam and Clinical Evaluation [2–4]

Other Factors to Consider and Evaluate [2, 3]

Imaging [3]

Nonsurgical Treatment of Symptomatic Osteoarthritis [1, 3, 4]

Activity

Medications

Bracing

Surgical Treatment of Symptomatic Osteoarthritis [1, 3]

References

62: Avascular Necrosis

Avascular Necrosis

Definition

Pathophysiology [1]

Histologic Changes

Radiographic Changes (Fig. 62.2)

Presentation

Classification and Staging

Femoral Head [2]

Knee [3]

Humeral Head [5]

Talus [6]

Lunate

Scaphoid [7]

Navicular

Freiberg’s Disease

References

63: Total Hip Arthroplasty

Overview

Femoral Component: Cementless and Cemented

Acetabular Component

Bearing Surfaces (Femoral Head on Cup Liner)

Approaches: Direct Anterior, Anterolateral, Direct Lateral, and Posterior/Posterolateral Approach

Direct Anterior (Smith-Petersen)

Anterolateral (Watson-Jones)

Direct Lateral (Hardinge)

Posterolateral

Ideal Positioning of Components

Postoperative

Hip Precautions

Anticoagulation

Complications

Dislocation

Periprosthetic Fracture

Revision

General Tips for Medical Students

64: External Snapping Hip

Overview

Anatomy

Classification of Snapping Hip

Evaluation

Imaging

Treatment

Nonoperative Treatment

Operative Treatment After Failure of Conservative Treatment

Complications

Reference

65: Femoral Shaft Fractures

Introduction

Bimodal Age Distribution [1]

Younger Population

Older Population

Anatomy [1–3]

Vascular Supply [1]

Classification: Based on Fracture Pattern and Comminution [1–3]

Winquist and Hansen (Fig. 65.1)

Clinical Evaluation [5]

Imaging [5]

Treatment

Nonoperative [1, 2]

Operative Fixation of Femoral Shaft Fractures Is Mainstay of Treatment [1, 3]

Antegrade Reamed Intramedullary Nail (IMN) (Figs. 65.4 and 65.5) [6]

Retrograde IM Nailing [6]

Plate Fixation (Fig. 65.6) [5]

External Fixation [11]

Complications [1, 5, 6]

Malunion [10]

Nonunion [9]

Leg Length Discrepancy

Infection

Special Situations

Multitrauma Patients [1, 7, 6]

Ipsilateral Femoral Shaft and Hip Fractures (Femoral Neck or Intertrochanteric) [8, 6]

Open Fractures [6]

Treatment

Gunshot Injuries

Periprosthetic Femoral Shaft Fractures [5]

References

66: Knee Ligament Injuries

Anterior Cruciate Ligament (ACL) [1, 2]

Anatomy/Biomechanics

Diagnosis

History

Physical Exam

Imaging

Treatment

Nonoperative

Operative

Surgical Options

Rehab/Injury Prevention [6]

Complications

Posterior Cruciate Ligament (PCL) [7, 8]

Anatomy/Biomechanics

Diagnosis

History

Physical Exam

Imaging

Treatment [9]

Nonoperative

Operative

Surgical Options

Medial Collateral Ligament (MCL) [10]

Anatomy/Biomechanics

Diagnosis

History

Physical Exam

Imaging

Treatment

Nonoperative

Operative treatment

Posterolateral Corner (PLC) [11, 12]

Anatomy/Biomechanics [13]

Diagnosis

History

Physical Exam

Imaging

Treatment

Nonoperative

Operative

Complications

References

67: Meniscal Tear

Anatomy and Basic Science

Function

Histology

Layers

Vascular Supply

Innervation

Medial Meniscus

Lateral Meniscus

Injury

Epidemiology

Patterns of Injury

Presentation and Physical Exam

Symptoms

Physical Exam Maneuvers (Sensitivity, Specificity)

Diagnostic Studies

Treatment

Nonoperative

Operative

Partial Meniscectomy

Meniscal Repair

Meniscal Transplant

Complications

References

68: Extensor Mechanism Injuries: Quadriceps and Patellar Tendon Ruptures

Anatomy

Epidemiology

Presentation

Exam

Imaging

Treatment

Postoperative Rehabilitation

Complications

References

Suggested Reading

69: Tibial Plateau Fractures

Introduction/Overview [1]

Anatomy [2]

Mechanism of Injury [1]

Associated Injuries [2]

Classification [1]

History and Physical Exam [1]

Imaging [2]

Overview Fracture Management [1]

Nonoperative Treatment [2]

Surgical Treatment [1]

References

70: Distal Femoral Fractures

Introduction/Overview [1]

Anatomy [1]

Mechanism of Injury [1]

Associated Injuries [2]

History and Physical Examination [1]

Imaging [2]

Classification [1]

Management [2]

Operative Treatment [2]

References

71: Patella Fractures

Overview

Anatomy

Extensor Mechanism Biomechanics

Mechanism of Injury

History and Physical Examination

Imaging

Classification

Nonoperative Treatment

Operative Treatment

Suggested Reading

72: Patella Dislocation

Anatomy

Risk Factors

Mechanism

Presentation

Physical Exam

Imaging

Weight-Bearing Plain Radiographs of the Knee

CT Scan

MRI

Treatment

Nonoperative: Generally for First-­Time Dislocators Without Osteochondral Defects

Operative: Generally for Repeat Dislocators or Acute Dislocations with Osteochondral Injuries

Complications

Suggested Reading

73: Total Knee Arthroplasty

Overview

TKA Components

TKA Design Concepts

Cruciate Retaining (CR) Knee

Posterior-Stabilized (PS) Knee

Constrained Non-hinged Knee

Constrained Hinged Knee

Approaches for TKA

Minimally Invasive Approaches

Extensile Approaches/Exposure

TKA Alignment

TKA Balancing (Need to Balance Coronal and Sagittal Planes)

Coronal Balancing

Sagittal Balancing: Balance Components in Flexion and Extension

Complications of TKA

Patellar Maltracking

Stiffness/Arthrofibrosis

Periprosthetic Infection

Poorly Balanced/Unstable TKA

Nerve Injury

Revision

General Tips for Medical Students

74: Patellofemoral Pain Syndrome

Anatomy

Patella

Trochlea

Presentation

Pathophysiology

Treatment

Nonoperative

Multimodal Approach

Tape/Bracing

Physical Therapy

Operative

Outcomes

References

75: Iliotibial Band Syndrome

Anatomy

Risk Factors

Differential Diagnosis

Evaluation

Imaging

Treatment

Nonoperative Treatment

Operative Treatment After Failure of Conservative Treatment

Complications

Suggested Reading

76: Tibial and Fibular Fracture

Overview

Anatomy

Compartments

Anterior

Lateral

Deep Posterior

Superficial Posterior

Classification

Open Fractures: Gustilo-Anderson System [2]

Soft Tissue Injury: Tscherne Classification [3]

Orthopedic Trauma Association Classification [4]

Evaluation

History

Physical Exam

Imaging

Treatment

Nonoperative

Operative

External Fixation

Plate Fixation

Intramedullary Nailing

Complications

Open Fracture

Compartment Syndrome

Malunion

Nonunion

Isolated Fibular Shaft Fractures

References

77: Stress Fractures

Epidemiology

Pathogenesis

Overuse Injuries

Risk Factors

Extrinsic Factors

Intrinsic Factors

History

Physical Exam

Differential Diagnosis

Imaging

Radiographs

Technetium-99M-labeled Diphosphonate Bone Scan

MRI

Ultrasound

CT

Single-Photon Emission Computed Tomography (SPECT)

High-Risk Stress Fractures

Characteristics

Femoral Neck

Tibia

Medial Malleolus

Navicular

Fifth Metatarsal

Great Toe Sesamoids

Pars Interarticularis

Low-Risk Stress Fractures

Characteristics

Upper extremity

Lower extremity

Pelvis

Femur

Tibia

Fibula

Calcaneus

Metatarsals

Suggested Readings

78: Metatarsalgia

Definition

Pathophysiology

Causes [1, 3]

Primary: Related to the Anatomic Configuration of the MT

Secondary: Indirectly Leads to Greater Loads on Forefoot

Iatrogenic

Presentation

Symptoms

Signs [2, 3]

Evaluation

History

Clinical Examination

Radiology

Treatment [1, 4]

Nonoperative

Operative

Postoperative Rehabilitation

Complications [1, 3]

References

79: Hallux Valgus

Definitions

Anatomy

Pathoanatomy

Demographics

Etiology

Angular Measurements

History and Physical

Conservative Treatment

Surgical Treatment

80: Heel Pain

Plantar Heel Pain

Etiology/Epidemiology

Anatomy

History and Physical

Imaging/Other Diagnostics

Treatment

Reference

81: Ankle Sprains and Fractures

Anatomy [2, 3, 4]

Osseous Structure

Lateral Ligamentous Complex

Deltoid Ligament

Distal Tibiofibular Syndesmosis

Radiographic Imaging

Indications (Ottawa Ankle Rules) [8]

Views [2, 4, 7]

Ankle Sprains

Classification of Acute Lateral Ankle Instability [7]

Treatment [7, 9]

Nonoperative

Operative Indications

Ankle Fractures

Classification Systems

Danis-Weber Classification: Basis of AO-OTA Classification

Anatomic Classification

Lauge-Hansen Classification System (Fig. 81.1) [5]

Supination-Adduction

Supination-External Rotation

Pronation-Abduction

Pronation External-Rotation

Treatment

Nonoperative [3, 4, 6, 7]

Operative [2, 3, 4, 6, 7]

Postoperative Rehabilitation

Complications [1, 3, 6, 7]

References

82: Talar Fracture

Anatomy

Articulations

Blood Supply [3]

Fracture Types and Classifications

Lateral Process Fracture

Posterior Process Fracture

Talar Body Fracture

Talar Neck Fracture (Fig. 82.1)

Treatment

Nonoperative

Operative

Surgical Approaches

Fixation

Postoperative Course

Complications

References

83: Calcaneus Fractures

Anatomy

Presentation

Mechanism

Physical Exam

Demographics

Fracture Types

Intra-articular

Extra-articular

Imaging

Radiographs

CT Scan

MRI Scan

Treatment

Nonoperative

Operative

Postoperative Rehabilitation

Complications

Outcomes

Suggested Reading

84: Lisfranc Injuries

Anatomy and Function [1, 2]

Osseous

Ligamentous

Vascular

Injury Classification [1]

Pathophysiology

Definition

Cause of Injury [2]

Presentation

Symptoms

Signs

Radiology

Radiographic Signs of Injury [4]

Other Signs

Treatment [5]

Nonoperative

Operative [6]

Postoperative Rehabilitation [5]

Complications [1]

References

85: Metatarsal Fractures

Metatarsal Fracture

Background [1]

History

Etiology

Physical Exam

Radiology

Treatment

Nonoperative [10]

Operative [1]

Metatarsal Shaft Fractures

Metatarsal Base Fractures [10]

Metatarsal Neck Fractures

Open Fractures

Fifth Metatarsal Fractures (Fig. 85.1 and Table 85.1)

Background

Anatomy

Blood Supply

History

Mechanism of Injury [10]

Zone I (Fig. 85.2)

Zone II (Fig. 85.3)

Zone III

Physical Exam

Radiology [1]

Zones

Zone I (Pseudo-Jones Fracture)

Zone II (Jones Fracture)

Zone III (Diaphyseal Stress Fracture)

Treatment

Zone I

Nonoperative

Operative

Zone II

Nonoperative

Operative

Zone III

Nonoperative

Operative

Outcomes

Zone II (Jones Fracture)

Zone III

Metatarsal Stress Fracture

Background

History [9]

Physical Exam

Radiographs [1]

Treatment

Nonoperative

References

86: Pilon Fractures

Introduction

Anatomy

Tibiotalar (Ankle) Joint

Ankle Syndesmosis

Vascular

Neurological

Imaging

Radiographs

CT Scan

Classification

AO/OTA Fracture Classification (4-tibia,3-distal)

Gustilo and Anderson Classification for Soft Tissue Injury in Open Fractures

Tscherne Classification for Soft Tissue Injury in Closed Fractures

Presentation

Epidemiology

History and Physical Exam

Treatment

Initial Treatment

Open Fracture Management

Subluxated or Dislocated Joint Management

Nonsurgical Treatment

Surgical Treatment

Ankle-Spanning External Fixation

Delayed ORIF

Circular Ring Fixation

Prognosis

Complications

References

87: Achilles Tendon Pathology

Anatomy

Spectrum of Disorders

Presentation

Retrocalcaneal Bursitis/Insertional Achilles Tendinopathy

Achilles Tendinosis/Tendonitis (Non-insertional)

Achilles Tendon Rupture

Treatment

Retrocalcaneal Bursitis/Insertional Achilles Tendinopathy

Nonoperative: First-Line Management Strategy

Operative: Indicated After Failed Nonoperative Management

Achilles Tendinosis/Tendonitis (Non-insertional)

Nonoperative: First-Line Management Strategy

Operative: Refractory Tendinosis or Tendinitis

Achilles Tendon Rupture

Nonoperative

Operative

Outcomes Retrocalcaneal Bursitis/Insertional Achilles Tendinopathy

Nonoperative

Operative

Achilles Tendinosis/Tendonitis (Non-insertional)

Nonoperative

Operative

Achilles Tendon Rupture

Nonoperative

Operative

References

88: Other Foot Fractures

Cuboid (Fig. 88.1)

Anatomy

Fractures

Mechanism

Treatment

Avulsion and Non-displaced Fractures

ORIF for Depressed Fractures

Complications

Navicular

Anatomy

Fractures

Mechanism

Treatment

Complications

Cuneiforms

Anatomy

Fractures

Treatment

Complications

References

89: The Diabetic Foot

Diabetes

Types

Epidemiology

Pathophysiology

Nervous System

Vascular System

Immune System

The Diabetic Foot

Evaluation

Vascular Evaluation

Radiographs

Ulceration

Classifications

Brodsky Depth-Ischemia Classification [5]

Wagner Classification [5]

Treatment

Conservative Treatment

Surgical Management

Associated Conditions

Infection

Microbiology

Treatment

References

90: Charcot Neuroarthropathy

Background

Pathophysiology

Neurotraumatic Destruction

Neurovascular Destruction

Presentation and Evaluation

Staging/Classification

Brodsky Anatomic Classification [1]

Treatment

References

91: Tarsal Tunnel Syndrome

Overview

Intrinsic Causes of TTS

Extrinsic Causes of TTS

Anatomy of the Tarsal Tunnel

Borders of the Tunnel

Contents of the Tunnel Include Anterior to Posterior- (Pneumonic: Tom Dick & A Very Nervous Har

Tibial Nerve

Clinical Signs

History

Physical Exam

Diagnostic Tests

Treatment

Nonoperative

Operative

Outcomes

Complications

Suggested Reading

92: Peroneal Tendon Pathology

Anatomy

Peroneus Longus (PL)

Peroneus Brevis (PB)

Force Couples: Opposing Pulling Forces

Tendon Stability

Anomalies

Tendon Subluxation

Imaging

Treatment

Peroneus Brevis Tears

Peroneus Longus Tears

Painful Os Peroneum Syndrome

References

93: Adult-Acquired Flat Foot Deformity

Definition

Anatomy and Function

Pathophysiology

Etiology

Physical Exam

Clinical Staging

Imaging

MRI

Conservative Treatment

Surgical Treatment

94: Plantar Fasciitis

Introduction

Epidemiology and Etiology [1–3]

Pathophysiology [1–3]

Anatomy

Plantar Fascia

Heel Fat Pad

Clinical Evaluation

History

Physical Exam

Imaging

Differential Diagnoses

Treatment [1–3]

Nonsurgical

Overview

Stretching

Splinting

Casting

Foot Orthoses

NSAIDs

Injections

Extracorporeal Shock Wave Therapy (ESWT)

Surgical

Plantar Fascia Release

Gastrocnemius Recession

References

95: Morton’s Neuroma

Introduction

Anatomy

Pathogenesis

Histopathology

Clinical Presentation

History and Physical Findings [1, 2, 5]

Provocative Tests

Imaging

Differential Diagnosis

Nonoperative Treatment

Operative Treatment

Dorsal Approach is Most Common [4, 5]

Longitudinal Plantar Incision: Typically Used for Recurrent/Failed First Excision [4, 5]

References

96: Foot and Ankle Arthritis

Ankle

Background [2–4]

History

Physical Exam [1]

Radiology (Fig. 96.1)

Treatment

Nonoperative

Operative

Hindfoot [1, 6]

Background

History

Physical Exam

Radiographs

Treatment

Nonoperative

Operative

Midfoot [1, 7]

Background

History

Physical Exam

Radiology (Fig. 96.2)

Treatment

Nonoperative

Operative

Hallux Rigidus

Background

History

Physical Exam

Radiographs (Fig. 96.3)

Treatment

Nonoperative

Operative

References

Part IV: The Axial Skeleton

97: Vertebral Disc Disease

Intervertebral Disc

Composition of the Disc

Annulus Fibrosus

Nucleus Pulposus

Intervertebral Disc Degeneration

Disc Herniation and Neural Compression

Radiculopathy (Nerve Root Compromise)

Myelopathy (Spinal Cord Compression)

References

98: Spondylolysis and Spondylolisthesis

Applied Anatomy

The Vertebral Arch (Fig. 98.1a)

Pars Interarticularis (Fig. 98.1b)

Spinal Cord and Nerve Roots

Definition [1]

Spondylolysis (also Known as a Pars Fracture)

Spondylolisthesis (Forward Slip of One Vertebra Relative to Another)

Clinical Presentation

Type I Dysplastic Spondylolisthesis

Type II Isthmic Spondylolisthesis

Type III Degenerative Spondylolisthesis

Risks Factors Associated with Slip Progression

Diagnosis [2–5]

Plain Radiographs

CT and MRI Scans

Management [6–9]

Non-operative Management

Operative Management

References

99: Spinal Stenosis

Cervical Spinal Stenosis

Definition

Causes

Evaluation

History

Physical Exam

Imaging

Treatment

Lumbar Spinal Stenosis

Types

Causes

Evaluation

History

Physical Examination

Imaging

Treatment

100: Spinal Cord Injury

Epidemiology

Age Distribution: Bimodal

Location

Pathophysiology [1]

Primary Injury

Secondary Injury

Glial Scarring

Acute Management

Classification [2]

Common Syndromes (Incomplete Injuries)

Central Cord Syndrome

Brown-Sequard Syndrome

Anterior Cord Syndrome

Posterior Cord Syndrome

Conus Medullaris Syndrome

Cauda Equina Syndrome

Imaging [3]

CT Scan

MRI

Treatment/Therapies [4, 5]

Complications

Presentation

Treatment

Rehabilitation

�References

101: Cervical Fracture and Dislocation

Cervical Spine Trauma

Occipito-Cervical Junction Injuries

Atlas or C1 Ring Injuries

Axis or C2 Fractures

Subaxial Spine Injuries

Facet Dislocations

Fractures

Central Cord Syndrome

102: Thoracolumbar Fractures

Anatomy

“Three-Column” Model

Posterior Ligamentous Complex (PLC)

Imaging Studies

Plain Radiographs

Computed Tomography (CT)

Magnetic Resonance Imaging (MRI)

Classification Systems

Denis Three-Column Classification (1983)

Thoracolumbar Injury Classification and Severity Score (TLICS; 2005)

AOSpine Thoracolumbar Spine Injury Classification System (2013)

Treatment

Goals of Treatment

Nonoperative Treatment

Surgical Treatment

Approaches

References

103: Lumbar Strain and Lumbar Disk Herniation

Lumbar Strain

Definition

Epidemiology and Natural History [5]

Clinical Presentation

Investigations

Treatment

Overlying Principles

Pharmacotherapy

Activity Modification

Physical Therapy and Exercise

Other

Pearls and Perils

Lumbar Disk Herniation

Definitions

Containment

Geographic Location [4]

Epidemiology and Natural History

Anatomy

Intervertebral Disk Anatomy

Lumbar Spine Anatomy

Pathophysiology

Degenerative Changes

Mechanical Stress

Chemical Cascade

Clinical Presentation

Both Back and/or Leg Pain Are Common

Radiculopathy

Cauda Equina

Treatment

Multimodal Approach

Physical Therapy

Pharmacotherapy

Epidural Steroid Injections

Operative

Outcomes

Nonoperative

Operative

Comparative

Complications of Surgery

Pearls and Pitfalls

References

104: Adult Spine Deformity

Introduction

Normal Spine Anatomy

Adult Deformity

Adult Deformity Etiology

Scoliosis

Sagittal Imbalance: Commonly Loss of Lumbar Lordosis or Exaggerated Thoracic Kyphosis

Describing and Measuring Deformity

Scoliosis

Sagittal Imbalance

Presentation

History

Physical Exam

Neurological Exam

Scoliosis

Sagittal Imbalance

Treatment: Adult Kyphoscoliosis

Nonoperative

Indications

Symptomatic Relief

Physical Therapy

Bracing

Injections

Operative (Fig. 104.5)

Indications

Goals

Preop Work-Up

Surgical Options

Postoperative Rehabilitation

Long Term

References

105: Tumors of the Spine

Clinical Presentation

Patient Age [1, 4]

Location [1, 4]

Symptoms/Signs [4]

Classification of Tumors of the Spinal Column [1, 4, 5]

Secondary Tumors

Metastatic Tumors [1, 4]

Lymphoma [4]

Primary Tumors: Malignant

Multiple Myeloma/Plasmacytoma [1, 3, 4]

Ewing Sarcoma [1, 4]

Chondrosarcoma [1, 4]

Osteosarcoma [1, 4]

Chordoma [1, 4]

Primary Tumors: Benign

Hemangioma [1, 4]

Osteoid Osteoma (<2 cm)/Osteoblastoma (>2 cm) [1, 4]

Aneurysmal Bone Cyst (ABC) [1, 4]

Giant Cell Tumor [1, 4]

Eosinophilic Granuloma/Langerhans Cell Histiocytosis [1]

References

106: Infections of the Spine

Pyogenic Discitis and Osteomyelitis

Epidemiology

Anatomy

Microbiology

Clinical Presentation

Diagnostic Studies

Laboratory Studies

Imaging Studies (Table 106.1)

Medical Management

Surgical Management

Surgical Indications

Goals of Surgery

Surgical Approach Options

Reconstruction Options

Pyogenic Spinal Abscess

Epidural Abscess

Clinical Presentation

Radiographic Findings

Treatment

Granulomatous Spinal Infection

Postoperative Wound Infection

Risk Factors

Treatment

Prevention

Surgical Debridement

References

107: Pelvic Ring Fractures

Introduction

Epidemiology

Mechanism

Anatomy

Osteology

Sacrum

Innominate Bones

Ligaments

Evaluation

Clinical Evaluation

Associated Injuries

Vascular Injury

Bowel Injury

Urologic Injury

Neurologic Injury

Other Associated Injuries

Imaging

Radiographs

Computed Tomography (CT) (Fig. 107.2c)

Classification

Young and Burgess Classification: Based on Mechanism and Injury Pattern

Tile Classification

Denis Classification of Sacral Fractures (Figs. 107.2c and 107.6)

Treatment

Initial Emergency Room Management

Nonoperative Treatment

Operative Indications

Operative Options

Postoperative Management

Complications

References

108: Acetabular Fractures

Anatomy

Etiology

Evaluation

Physical Exam

Associated Injuries Common

Radiographs

Classification

Treatment

Non-operative

Indications

Management

Operative

Emergent Situations

Indications

Complications

Approaches

Postoperative Care

References

Part V: Pediatric Orthopedics

109: Lower Extremity Angular Deformities

Genu Valgum (Knock Knee)

Pathologic Etiology

Bilateral Genu Valgum

Unilateral Genu Valgum

Normal Physiologic Process of Genu Valgum

Treatment

Genu Varum (Bow Legged)

Etiology

Infantile Blount’s Disease

Physiologic Varus

Pathologic Process

Radiographs

Langenskiold Classification (Fig. 109.9)

Treatment

Operative

Adolescent Blount’s Disease

Pathologic Varus (Children >10 years)

Physical Exam

Radiographs

Treatment

Suggested Readings

110: Principles of Pediatric Fracture Treatment

Structure and Biomechanics [2]

Physis [2]

Anatomy [2]

Biomechanics [1]

Blood Supply (Fig. 110.1) [3]

Embryology [2]

Limb Growth [1]

Fracture Classification [1]

Extra-physeal

Physeal Fractures [3]

Open Fractures [1]

Evaluation [1, 2]

Treatment [2]

Nonoperative

Operative

Remodeling [2]

Complications [1, 2]

References

111: Radial Head Dislocation

Radial Head Dislocation

Congenital Dislocation

Monteggia Fracture

References

112: Slipped Capital Femoral Epiphysis

Epidemiology [1]

Endocrine 5–8%

Renal Osteodystrophy

Radiation Therapy

Pathological Anatomy

Macro

Micro

Diagnosis

Clinical Presentation

Imaging Studies

Classification

Radiological: Southwick Angle

Clinical

Stable/Unstable

Natural History

Short Term

Long Term: Early OA, Poor Hip Function

Treatment

Rationale

The Treatment Is Surgical

Complications

Avascular Necrosis [2]

Chondrolysis

Osteoarthritis

SCFE Essentials

References

113: Developmental Hip Dysplasia

Definition

Embryology

Etiology

Epidemiology/Risk Factors

Pathology

Clinical Presentation (See Above)

Imaging Studies

Treatment – Age Dependent

Complications: Proximal Femoral Growth Disturbance

114: Congenital Coxa Vara

Background

Anatomy

Pathogenesis

Physical Exam

Imaging

Treatment

Suggested Reading

115: Osteochondropathies of the Knee: Osteochondritis Dissecans and Osgood-Schlatter Disease

Osteochondritis Dissecans

Overview

Etiology

Incidence <1% [6]

Anatomic Considerations

Classifications

Guhl’s Arthroscopy [7]

Dipaola: MRI [8]

Clinical Presentation

Imaging

Prognosis

Treatment

Nonsurgical

Surgical

Osgood-Schlatter Disease

Overview

Anatomy

Clinical Presentation

Imaging

Natural History

Treatment

Nonoperative

Operative

Complications

References

116: Osteogenesis Imperfecta

Background

Classification

Pathophysiology

Physical Exam

Imaging

Treatment

Conservative Treatment

Surgical Treatment

References

117: Child Abuse

Introduction

Background

Statistics

Types of Abuse

Soft Tissue Injuries: Types

Soft Tissue Injuries: Characteristics

Burns

Abusive Head Trauma

Internal Injuries

Fractures

High-Specificity Fracture Findings

Low-Specificity Fracture Findings

Elements of the History

Physical Exam

Radiologic Exam

Skeletal Survey

Ultrasound

Bone Scan

MRI/PET Scan

Estimating Fracture Age

Differential Diagnosis

Treatment

Reporting

References

118: Legg-Calve-Perthes

Background

Anatomy

Pathogenesis

Coagulation-Controversial

Arterial

Venous

Classification Systems

Waldenstrom Classification

Lateral Pillar (Herring) Classification (Only Done in Fragmentation Stage)

Catterall Classification

Stulberg Classification

Usefulness

Physical Exam

Imaging

Treatment

Suggested Readings

119: Cerebral Palsy

Overview of Cerebral Palsy (CP)

Diagnosis

Classification

Anatomic

Neurological

Clinical Features

Nonoperative Treatment

Operative Treatment

Spasticity Management: Typically Done by Neurosurgery to Decrease Spasticity

Hip: Progressive Neuromuscular Hip Dysplasia Is Common in CP

Spine: Deformity Very Common in GMFCS Levels IV and V (Almost 90%)

Lower Extremity: Rotational Abnormalities Very Common

Foot

Upper Extremity

Suggested Reading

120: Spina Bifida

Overview

Classification

Diagnosis

Initial Treatment

Spine Deformities [3]

Pathologic Fractures

Hip Disorders

Knee Deformities

Foot Deformities [2]

Prognosis

References

121: Charcot-Marie-Tooth Disease

Introduction

Background

Epidemiology

Genetics and Inheritance

Pathophysiology

General CMT Hallmarks

CMT-I

CMT-II

Orthopedic Manifestations

Cavovarus Foot

Hip Dysplasia

Scoliosis

Diagnostic Workup

Treatment

Cavovarus Foot

Claw Hallux

Hip Dysplasia

Scoliosis

Suggested Readings

122: Duchenne Muscular Dystrophy

Background

Presentation and Evaluation

Differential Diagnosis

Treatment

References

123: Arthrogryposis

Background

Pathophysiology

Prognosis

Presentation and Evaluation

General

Upper Extremity

Spine

Lower Extremity

Treatment

General

Upper Extremity Disorders

Spine

Hip Disorders

Knee Disorders

Foot Disorders

References

124: Achondroplasia

Background

Presentation and Evaluation

Symptoms

Physical Exam

Radiographic Work-Up

Further Testing

Treatment

References

125: Skeletal Dysplasias

Spondyloepiphyseal Dysplasia (SED)

Multiple Epiphyseal Dysplasia (MED)

Diastrophic Dysplasia

Cleidocranial Dysplasia

Suggested Reading

126: Chromosomal and Inherited Syndromes

Marfan’s Syndrome:

Ehlers-Danlos Syndrome:

Neurofibromatosis (NF):

Mucopolysacharide (MPS) Disorders:

Down’s Syndrome:

Prader-Willi Syndrome:

Turner Syndrome:

References

127: Juvenile Idiopathic Arthritis

Juvenile Idiopathic Arthritis (JIA)

Common Symptoms

Subtypes

Systemic-Onset Arthritis

Oligoarticular Arthritis

Polyarticular RF-Positive Arthritis

Polyarticular RF-Negative Arthritis

Psoriatic Arthritis

Enthesitis-Related Arthritis

Undifferentiated Arthritis

Complications

Treatment

Pharmacological Therapies

Surgical Therapies

References

128: Shoulder and Elbow Deformities

Post-traumatic Cubitus Varus/Valgus

Reference

129: Hand and Wrist Deformities

Pediatric Trigger Thumb (Fig. 129.1)

Overview

Anatomy

Classification

Evaluation

Treatment

Nonsurgical

Surgical

Clinodactyly

Overview

Anatomy

Classification

Proposed by Cooney

Evaluation

History

Physical Examination

Associated Syndromes

Imaging

Treatment

Nonsurgical

Surgical

Camptodactyly

Overview

Anatomy

Classification

Evaluation

History

Physical

Associated Syndromes

Imaging

Treatment

Nonsurgical

Surgical

Syndactyly (Fig. 129.2)

Overview

Anatomy

Classification

Evaluation

History

Physical

Associated Syndromes

Imaging

Treatment

Nonsurgical

Surgical

Symphalangism (Stiff Interphalangeal Joints)

Overview

Anatomy

Classification

Flatt and Wood

Based on Type of Ankylosis

Evaluation

Treatment

Symbrachydactyly (Fused Short Fingers)

Overview

Anatomy

Classification

Blauth and Gekeler

Yamauchi: Focuses on the Number of Phalanges Missing

Evaluation

Treatment

Macrodactyly

Overview

Anatomy

Classification: Flatt

Evaluation

Treatment

Polydactyly

Overview

Classification

Preaxial: Thumb Duplication

Postaxial: Small Finger Duplication

Evaluation

History

Physical

Treatment

Nonsurgical

Surgical

Thumb Hypoplasia (Fig. 129.4)

Overview

Classification: Modified Blauth (Describes Severity of the Hypoplasia and Guides Treatment)

Radial Club Hand (a.k.a. Radial Longitudinal Deficiency)

Classification: Bayne and Klug

Associated Anomalies

Treatment

Madelung Deformity

Clinical Presentation

Etiology

Treatment

Further Reading

130: Genu Varum

Definition

Etiology

Physiologic: Most Common Form Seen in Young Childhood

Blount’s Disease: Unique Growth Disturbance Medial Aspect Proximal Tibia

Significance of Genu Varum

Evaluation

Clinical Examination

Radiologic Imaging

Treatment

Suggested Reading

131: Genu Valgum

Normal Growth and Development

Indications for Further Evaluation in Young Children

X-Ray Evaluation

Metabolic Bone Disease

Trauma

Genu Valgum Secondary to Bone Lesions

Obesity

Adolescent Genu Valgum

Treatment Options

Suggested Reading

132: Lower Extremity Rotational Deformities

Internal Tibial Torsion (ITT)

External Tibial Torsion (ETT)

Femoral Anteversion (Internal Femoral Torsion)

Femoral Retroversion (External Femoral Torsion)

Suggested Readings

133: Limb Deficiency

Epidemiology [1–3]

Embryology [4, 5]

Classification

Lower Extremity Conditions

Tibial Deficiency [6]

Fibular Deficiency [7]

Proximal Femoral Focal Deficiency [8, 9]

Upper Extremity Conditions

Radial Deficiencies [5]

Ulnar Deficiencies

Central Deficiencies [5]

Syndactyly [5]

References

134: Limb Length Discrepancy (LLD)

Presentation

Causes

Congenital Disorders

Physeal Disruption

Normal Physiology

Classification

Static LLD

Progressive LLD

Imaging

Scanogram

CT Scan

Left Hand for Bone Age

Estimation of LLD at Skeletal Maturity

Estimation

Multiplier Method

Treatment

Nonoperative

Operative

References

135: Pseudarthrosis of the Tibia

Pseudarthrosis of the Tibia

Etiology

Several Theories Proposed [1]

Anatomy

Pathology [2]

Classification

Boyd [3]

Andersen [4]

Crawford [5]

Clinical Features/Presentation

Treatment [1, 6]

Goals

Brace Once Deformity Identified

Principles of Surgical Intervention

Intramedullary Stabilization

Free Vascularized Fibula Graft

Circular Frame (Ilizarov) Technique [7]

Bone Morphogenetic Protein -7

Amputation

Complications

References

136: Foot Deformities

Clubfoot (Congenital Talipes Equinovarus)

Epidemiology [1, 3]

The Deformity (CAVE) [1, 2]

Clinical Evaluation

Radiographic Evaluation [4]

Treatment

Complications

Pes Cavus Foot

Introduction

Clinical evaluation

Radiographic Evaluation (Fig. 136.2) [2]

Treatment [1, 2]

Congenital Vertical Talus

Introduction [2, 3]

Clinical Evaluation (Fig. 136.3a) [1, 2]

Radiographic Evaluation [1]

Treatment [1, 4]

Juvenile Hallux Valgus (Bunion)

Introduction [2, 3]

Clinical Evaluation

Radiographic Evaluation (Fig. 136.4) [2]

Treatment [1, 2, 4]

Metatarsus Adductus

Introduction [1, 3]

Clinical Evaluation [2]

Treatment [1, 2]

Flatfoot (Pes Planus)

Flexible Flatfoot (FFF) [5]

Introduction [2, 3]

Clinical evaluation [5]

Radiographic Evaluation [1]

Treatment [1, 5]

Tarsal Coalition/Peroneal Spastic Flatfoot (PSFF) [5]

Introduction [1, 2]

Clinical Evaluation [1, 2, 5]

Radiographic Evaluation [1]

Treatment [1, 2, 5]

References

137: Idiopathic Scoliosis

Definition

Classifications

Epidemiology

Tendencies

Etiology

Diagnosis

History

Physical Exam

Imaging

Classification Systems

Treatment

Infantile

Juvenile

Adolescent

Complications

Untreated Progressive Scoliosis

Posterior spinal fusion

References

138: Neuromuscular Spine Deformity

Definition

Etiology and Natural History

Clinical Presentation

Imaging

Treatment

Nonoperative

Operative

Prerequisites for Surgery

Complications

References

(Students are encouraged to peruse these textbook chapters which have extensive bibliographies)

139: Congenital Spinal Anomalies

Overview

Causes [3]

Associated Conditions (Up to 61%)

Prognosis

Classification (Figs. 139.2 and 139.3)

Failure of Formation [1, 3]

Failure of Segmentation [1, 3]

Mixed [3]

Natural History [2]

Treatment

Nonoperative [2, 3]

Operative [2, 3]

Complications from Surgery [3]

References

140: Scheuermann’s Kyphosis

Introduction/Definitions

Etiology and Pathologic Anatomy

Presentation

Natural History

Imaging

Differential Diagnoses

Treatment

Nonoperative

Operative

Summary

Reference

(Students are encouraged to peruse the collection of classic papers included in the bibliographies o

141: Pediatric Cervical Spine Conditions

Pseudosubluxation in Cervical Spine

Introduction

Incidence

Etiology

Investigation

Treatment

Atlantoaxial Instability

Introduction

Pathoanatomy

Etiology

Clinical Features

Investigation

Treatment

Atlantoaxial Instability in Down Syndrome

Atlantoaxial Rotatory Subluxation

Etiology

Classification

Clinical Features

Investigation

Treatment

Anomalies of Odontoid (Dens)

Introduction

Types

Embryology

Etiology

Pathogenesis

Clinical Features

Investigation

Prognosis

Treatment

Klippel-Feil Syndrome (Congenital Synostosis of Cervical Vertebrae)

Introduction

Etiology

Clinical Features

Associated Anomalies

Classification

Pattern of Cervical Fusion with Poor Prognosis (Fielding and Hensinger et al.)

Investigation

Treatment

Congenital Muscular Torticollis (Wry Neck)

Introduction

Etiology

Differential Diagnosis

Clinical Features

Investigation

Treatment

Basilar Impression

Introduction

Types and Etiology of Basilar Impression

Clinical Features

Investigation

Treatment

References

Pseudosubluxation in Cervical Spine

Atlantoaxial Instability

Atlantoaxial Rotatory Subluxation

Anomalies of Odontoid (Dens)

Klippel-Feil Syndrome (Congenital Synostosis of Cervical Vertebrae, Brevicollis)

Torticollis (Wry Neck)

Basilar Impression

142: Pediatric Spondylolysis and Spondylolisthesis

Introduction

Etiology and Risk of Slippage

Developmental Type: Dysplasia of the Formation of the L-S Junction

Acquired Type: Most Common (Lytic Type), Essential Component – Pars Defect

Risk Factors for Further Slip

Presentation

Diagnosis

Treatment

Spondylolysis

Spondylolisthesis

Summary

Reference

(Students are encouraged to peruse the extensive collection of classic papers included in the biblio

143: Pediatric Spine Trauma

Spine Trauma Evaluation

Imaging

Upper Cervical Spine Trauma

Occipitocervical Dissociation or Atlanto-occipital Dissociation

Occipital Condyle Fractures

Atlas or C1 Ring Injuries

Atlantoaxial Rotatory Subluxation (AARS)

Odontoid or Dens Fractures

Os Odontoideum

Traumatic Spondylolisthesis, also Called “Hangman’s Fracture”

Lower Cervical Spine Trauma

Ligamentous Injuries

Compression Fractures Are Failure of the Anterior Column or Anterior Vertebral Body

Facet Dislocations

Thoracolumbar Spine Trauma

Commonly Caused by Inappropriate Seat Belt Use

Denis Three-Column Classification

Compression Fractures

Burst Fractures

Flexion-Distraction Injuries (Chance Injuries)

Apophyseal Fractures

Spinous and Transverse Process Fractures

Cauda Equina Syndrome

Spinal Cord Injury

Part VI: Systemic Conditions

144: Septic Arthritis

Definition

Location in Order of Occurrence

Mechanism of Infection

Hematogenous

Adjacent Osteomyelitis

Pathogens

Pathophysiology

Cellular Mechanism of Injury

Presentation (Red Hot Swollen Joint)

Symptoms

Physical Examination

Differential Diagnosis

Imaging

Radiographs

MRI

Laboratory Studies

CBC

ESR and CRP

Criteria for Predicting Septic Arthritis and Distinguishing Transient Synovitis in Children

Joint Aspiration

Treatment (Surgical Emergency)

References

145: Osteomyelitis

Definition

Pathophysiology

Mechanism of Infection: Three Common Etiologies

Inflammatory Response [2]

Host Risk Factors [1]

Microbiology

Pediatric Skeleton [6]

Clinical Presentation

Symptoms

Signs

Diagnosis

Imaging

Laboratory

Culture and Histologic Evaluation

Differential Diagnosis

Classification [4]

Surgical Treatment

Medical Therapy [5]

Complications

Local

Marjolin’s Ulcer/Squamous Cell Carcinoma

Systemic

References

146: Necrotizing Fasciitis

Description

Pathophysiology

Microbiology

Presentation

Diagnosis

Treatment

Pearls

References

147: Rheumatoid Arthritis

Overview [1]

Pathogenesis [1]

Classification Criteria

Evaluation [4]

Treatment [6]

References

148: Crystalline-Induced Arthropathies

Overview [1–4]

Pathogenesis [1, 2, 4, 6–8]

Evaluation

History [1–3]

Physical Examination [1, 3]

Laboratory Tests [1, 3, 6, 7]

Imaging [1–4]

Treatment [1–7]

Management of Acute Gouty Arthritis

Uric Acid-Lowering Agents

References

149: Fibromyalgia

Diagnosis

1990 American College of Rheumatology (ACR) Classification Criteria [1]

2010 ACR Diagnostic Criteria [3]

Modification to the ACR 2010 Fibromyalgia Diagnostic Criteria (Fig. 149.1) [4]

Pathophysiology [5]

Presentation

Treatment [6]

Pharmacologic Therapies

Anticonvulsants

Antidepressants

Muscle Relaxers

Tramadol

Medications to Avoid

References

150: Seronegative Spondyloarthritis

Introduction

Classification

Clinical Features

Inflammatory Back Pain

Peripheral Arthritis and Enthesitis

Eye Involvement

Diagnosis

Subtypes

Ankylosing Spondylitis

Psoriatic Arthritis

Spondyloarthritis with Inflammatory Bowel Disease (IBD)

Reactive Arthritis

Undifferentiated Spondyloarthritis (USpA)

References

151: Polymyalgia Rheumatica

Polymyalgia Rheumatica

Definition

Epidemiology

Pathogenesis

Clinical Features

Diagnosis

Treatment

Complications

References

152: Osteoporosis

Introduction

Describing and Measuring Osteoporosis

Treatment

References

153: Osteomalacia and Rickets

Osteomalacia

Definition

Etiologies

Clinical Presentations [6]

General Presentations

Specific Considerations

Diagnostics

Lab Studies (See Table 153.1 for Overview of Expected Lab Results)

Imaging Studies

Treatments

Nutritional OM

TIO

Outcome

Rickets

Etiologies

Nutritional Rickets

Vitamin D-Dependent Rickets Type 1 (VDDR-1)

Hereditary Vitamin D-Resistant Rickets (HVDRR)

X-Linked Hypophosphatemic Rickets (XLH)

Autosomal Dominant Hypophosphatemic Rickets (ADHR)

Hereditary Hypophosphatemic Rickets with Hypercalciuria (HHRH)

Clinical Presentations

General Presentations

Specific Considerations

Diagnostics

Lab Studies

Imaging Studies

Treatments

Outcomes

References

154: Renal Osteodystrophy

Pathophysiology

High-Turnover Renal Osteodystrophy

Low-Turnover Renal Osteodystrophy

Clinical Findings

Adults

Children [4]

Radiologic Findings [5]

Adults

Children

Evaluation

Physical Exam

Associated Conditions

Treatment [6]

Medical Management

Surgical Considerations

References

155: Paget’s Disease

Epidemiology

Etiology

Pathophysiology

Clinical Presentation

Location

Symptoms

Physical Exam

Imaging

Laboratory Data

Histology

Treatment

Paget’s Sarcoma

References

156: Osteopetrosis

Classification

Autosomal Recessive Osteopetrosis (ARO)

Intermediate Recessive Osteopetrosis (IRO)

The Autosomal Dominant Osteopetrosis (ADO)

X-Linked Form of Osteopetrosis (XLO)

Therapy

ARO

ADO

References

157: Benign Bone Tumors

Introduction

Clinical Workup

Clinical Pearls

Imaging

Imaging Pearls

Radiographic Pearls

Staging Systems

Types [3, 4]

Chondrogenic

Osteogenic

Fibrohistiocytic

Giant Cell

Undefined

Treatment Principles

References

158: Malignant Bone Tumors

Introduction

Clinical Workup

Clinical Pearls

Imaging

Imaging Pearls

Radiographic Pearls

Staging Systems

Types [1–3]

Chondrogenic

Osteogenic

Hematopoietic

Notochordal

Vascular

Myogenic, Lipogenic, and Epithelial

Treatment Principles

References

Index

 

An aparitie	10-08-17
Autor	Adam E. M. Eltorai; Craig P. Eberson; Alan H. Daniels
Dimensiuni	17.78 x 4.45 x 24.77 cm
Editura	Springer
Format	Paperback
ISBN	9783319525655
Limba	Engleza
Nr pag	811