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Surgery_Schwartz_12602 | Surgery_Schwartz | “squeaking.” In metal or ceramic on polyethylene articulations, wear debris is produced, and polyethylene particles are phagocytized by local macro-phages. Activated macrophages lead to an osteolytic process and bone resorption. Particulate methylmethacrylate cement debris can also play a role in osteolysis by damaging the polyethylene bearing surface. Osteolysis has been shown to be significantly decreased with the advent and use of highly cross-linked poly-ethylene. Improperly positioned components or patient-related factors such as high impact activities can lead to increased wear. A substantial osteolytic response may occur and lead to compo-nent micromotion and aseptic loosening. Patients who present to clinic with pain following joint arthroplasty and an increas-ing zone of osteolysis in the periprosthetic region frequently need revision surgery (Fig. 43-43). Alternative bearing surfaces continue to be explored in hopes of decreasing component wear, associated osteolysis, and | Surgery_Schwartz. “squeaking.” In metal or ceramic on polyethylene articulations, wear debris is produced, and polyethylene particles are phagocytized by local macro-phages. Activated macrophages lead to an osteolytic process and bone resorption. Particulate methylmethacrylate cement debris can also play a role in osteolysis by damaging the polyethylene bearing surface. Osteolysis has been shown to be significantly decreased with the advent and use of highly cross-linked poly-ethylene. Improperly positioned components or patient-related factors such as high impact activities can lead to increased wear. A substantial osteolytic response may occur and lead to compo-nent micromotion and aseptic loosening. Patients who present to clinic with pain following joint arthroplasty and an increas-ing zone of osteolysis in the periprosthetic region frequently need revision surgery (Fig. 43-43). Alternative bearing surfaces continue to be explored in hopes of decreasing component wear, associated osteolysis, and |
Surgery_Schwartz_12603 | Surgery_Schwartz | in the periprosthetic region frequently need revision surgery (Fig. 43-43). Alternative bearing surfaces continue to be explored in hopes of decreasing component wear, associated osteolysis, and aseptic loosening.Complications in Joint ArthroplastyThe risk of any complication following joint arthroplasty proce-dures falls in the range of 5% to 10%. Risks shared by hip and knee arthroplasties include infection, intraoperative or postop-erative fracture, vascular injury, need for intraoperative or post-operative blood transfusion, nerve injury or nerve palsy (most commonly involving the deep peroneal nerve and loss of ankle dorsiflexion), stress shielding, component fracture or wear, and medical complications, including venous thromboembolic dis-ease (DVT and PE), myocardial infarction, or cerebrovascular accident. Complications unique to total hip arthroplasty include dislocation, leg length discrepancy, and iliopsoas impingement or tendonitis.Dislocation Following Hip | Surgery_Schwartz. in the periprosthetic region frequently need revision surgery (Fig. 43-43). Alternative bearing surfaces continue to be explored in hopes of decreasing component wear, associated osteolysis, and aseptic loosening.Complications in Joint ArthroplastyThe risk of any complication following joint arthroplasty proce-dures falls in the range of 5% to 10%. Risks shared by hip and knee arthroplasties include infection, intraoperative or postop-erative fracture, vascular injury, need for intraoperative or post-operative blood transfusion, nerve injury or nerve palsy (most commonly involving the deep peroneal nerve and loss of ankle dorsiflexion), stress shielding, component fracture or wear, and medical complications, including venous thromboembolic dis-ease (DVT and PE), myocardial infarction, or cerebrovascular accident. Complications unique to total hip arthroplasty include dislocation, leg length discrepancy, and iliopsoas impingement or tendonitis.Dislocation Following Hip |
Surgery_Schwartz_12604 | Surgery_Schwartz | infarction, or cerebrovascular accident. Complications unique to total hip arthroplasty include dislocation, leg length discrepancy, and iliopsoas impingement or tendonitis.Dislocation Following Hip Arthroplasty. Dislocation can result from malpositioned components (inadequate com-bined version of the femoral stem and acetabular component; extremes of inclination of the acetabular component), noncom-pliance, cognitive or neuromuscular disorders, compromised soft tissue envelope from revision surgery, fracture, or insuf-ficient restoration of length and/or offset. Comparable disloca-tion rates have been found with anterolateral, lateral, anterior, and posterior with soft tissue repair (approximately 0.5%) approaches. History, physical examination, and radiographs are vital to proper treatment of dislocation. Closed reduction can usually be performed with conscious sedation and gentle traction or manipulation. Rarely, open reduction may be neces-sary. Component position should be | Surgery_Schwartz. infarction, or cerebrovascular accident. Complications unique to total hip arthroplasty include dislocation, leg length discrepancy, and iliopsoas impingement or tendonitis.Dislocation Following Hip Arthroplasty. Dislocation can result from malpositioned components (inadequate com-bined version of the femoral stem and acetabular component; extremes of inclination of the acetabular component), noncom-pliance, cognitive or neuromuscular disorders, compromised soft tissue envelope from revision surgery, fracture, or insuf-ficient restoration of length and/or offset. Comparable disloca-tion rates have been found with anterolateral, lateral, anterior, and posterior with soft tissue repair (approximately 0.5%) approaches. History, physical examination, and radiographs are vital to proper treatment of dislocation. Closed reduction can usually be performed with conscious sedation and gentle traction or manipulation. Rarely, open reduction may be neces-sary. Component position should be |
Surgery_Schwartz_12605 | Surgery_Schwartz | treatment of dislocation. Closed reduction can usually be performed with conscious sedation and gentle traction or manipulation. Rarely, open reduction may be neces-sary. Component position should be assessed in patients with multiple dislocations. Patients with recurrent dislocations and suboptimally positioned components may require component revision. Patients with recurrent dislocations and properly posi-tioned components should be considered for conversion to a device with a larger prosthetic head (dual mobility construct) or a constrained total hip arthroplasty implant that provides improved stability.ORTHOPEDIC PATHOLOGY AND ONCOLOGYDiagnosis of Malignant Bone TumorsHistory. Diagnosis of musculoskeletal tumors begins with a thorough patient history. A history of unremitting pain unre-lated to activity or pain that interferes with sleep suggests malig-nancy. Patient age can help in establishing a differential. Round Figure 43-43. Failed total knee replacement. Note subsided, | Surgery_Schwartz. treatment of dislocation. Closed reduction can usually be performed with conscious sedation and gentle traction or manipulation. Rarely, open reduction may be neces-sary. Component position should be assessed in patients with multiple dislocations. Patients with recurrent dislocations and suboptimally positioned components may require component revision. Patients with recurrent dislocations and properly posi-tioned components should be considered for conversion to a device with a larger prosthetic head (dual mobility construct) or a constrained total hip arthroplasty implant that provides improved stability.ORTHOPEDIC PATHOLOGY AND ONCOLOGYDiagnosis of Malignant Bone TumorsHistory. Diagnosis of musculoskeletal tumors begins with a thorough patient history. A history of unremitting pain unre-lated to activity or pain that interferes with sleep suggests malig-nancy. Patient age can help in establishing a differential. Round Figure 43-43. Failed total knee replacement. Note subsided, |
Surgery_Schwartz_12606 | Surgery_Schwartz | unre-lated to activity or pain that interferes with sleep suggests malig-nancy. Patient age can help in establishing a differential. Round Figure 43-43. Failed total knee replacement. Note subsided, loose, tibial component.Brunicardi_Ch43_p1879-p1924.indd 191022/02/19 10:41 AM 1911ORTHOPEDIC SURGERYCHAPTER 43blue cell lesions are most likely neuroblastoma in a 5-year-old, Ewing’s sarcoma in a 10-year-old, lymphoma in a 20-year-old, and myeloma in a 60-year-old. Gender also aids in the differen-tial. For instance, giant cell tumor is more common in females, while osteosarcoma is more common in males. Multiple bone involvement may suggest enchondromas (Ollier disease, Maffucci’s syndrome) or osteochondromas (multiple hereditary exostoses).Laboratory Tests. Laboratory tests determine the level of cellular turnover (lactate dehydrogenase [LDH]) or of bone destruction (calcium, alkaline phosphatase). Elevated prostate-specific antigen (PSA) suggests prostate | Surgery_Schwartz. unre-lated to activity or pain that interferes with sleep suggests malig-nancy. Patient age can help in establishing a differential. Round Figure 43-43. Failed total knee replacement. Note subsided, loose, tibial component.Brunicardi_Ch43_p1879-p1924.indd 191022/02/19 10:41 AM 1911ORTHOPEDIC SURGERYCHAPTER 43blue cell lesions are most likely neuroblastoma in a 5-year-old, Ewing’s sarcoma in a 10-year-old, lymphoma in a 20-year-old, and myeloma in a 60-year-old. Gender also aids in the differen-tial. For instance, giant cell tumor is more common in females, while osteosarcoma is more common in males. Multiple bone involvement may suggest enchondromas (Ollier disease, Maffucci’s syndrome) or osteochondromas (multiple hereditary exostoses).Laboratory Tests. Laboratory tests determine the level of cellular turnover (lactate dehydrogenase [LDH]) or of bone destruction (calcium, alkaline phosphatase). Elevated prostate-specific antigen (PSA) suggests prostate |
Surgery_Schwartz_12607 | Surgery_Schwartz | tests determine the level of cellular turnover (lactate dehydrogenase [LDH]) or of bone destruction (calcium, alkaline phosphatase). Elevated prostate-specific antigen (PSA) suggests prostate cancer.Imaging. Radiographic studies are critical in the diagnosis of bony tumors. Radiographs can help assess the aggressive-ness of the tumor. Four questions should be addressed when assessing radiographs: (a) Where is the tumor—in which bone (Table 43-1) and in which part of the bone is the lesion? (Table 43-2) (b) What is the tumor doing to the bone (clinical behavior)? (c) What is the bone doing to the tumor (biologic response)? and (d) What is the matrix pattern? Matrix is the acellular interstitial substance produced by tumor cells. Particu-lar attention should be paid to the junction between the tumor and the host bone since this margin can also indicate the aggres-siveness of the tumor. Ewing’s sarcoma has a characteristic “onion skin” periosteal reaction pattern. This reaction pattern | Surgery_Schwartz. tests determine the level of cellular turnover (lactate dehydrogenase [LDH]) or of bone destruction (calcium, alkaline phosphatase). Elevated prostate-specific antigen (PSA) suggests prostate cancer.Imaging. Radiographic studies are critical in the diagnosis of bony tumors. Radiographs can help assess the aggressive-ness of the tumor. Four questions should be addressed when assessing radiographs: (a) Where is the tumor—in which bone (Table 43-1) and in which part of the bone is the lesion? (Table 43-2) (b) What is the tumor doing to the bone (clinical behavior)? (c) What is the bone doing to the tumor (biologic response)? and (d) What is the matrix pattern? Matrix is the acellular interstitial substance produced by tumor cells. Particu-lar attention should be paid to the junction between the tumor and the host bone since this margin can also indicate the aggres-siveness of the tumor. Ewing’s sarcoma has a characteristic “onion skin” periosteal reaction pattern. This reaction pattern |
Surgery_Schwartz_12608 | Surgery_Schwartz | the tumor and the host bone since this margin can also indicate the aggres-siveness of the tumor. Ewing’s sarcoma has a characteristic “onion skin” periosteal reaction pattern. This reaction pattern also occurs in other tumors and infections.OSTEOSARCOMAThe most common primary malignant bone tumor is osteosar-coma (Fig. 43-44). Osteosarcomas are classified as osteoblas-tic, chondroblastic, fibroblastic, telangiectatic, round cell, or MFH-like, according to the predominant cell type. Most osteo-sarcomas present in patients between 10 and 20 years of age. Secondary osteosarcomas occur in older patients in abnormal bone affected by Paget’s disease, radiation, or bone infarct.Intramedullary OsteosarcomaThis is the most common primary sarcoma of the bone. It usu-ally occurs in the distal femur or the proximal tibia in young people. This condition may also occur at the proximal humerus, proximal femur, or pelvis. It usually presents itself as a high-grade extracompartmental disease. It can | Surgery_Schwartz. the tumor and the host bone since this margin can also indicate the aggres-siveness of the tumor. Ewing’s sarcoma has a characteristic “onion skin” periosteal reaction pattern. This reaction pattern also occurs in other tumors and infections.OSTEOSARCOMAThe most common primary malignant bone tumor is osteosar-coma (Fig. 43-44). Osteosarcomas are classified as osteoblas-tic, chondroblastic, fibroblastic, telangiectatic, round cell, or MFH-like, according to the predominant cell type. Most osteo-sarcomas present in patients between 10 and 20 years of age. Secondary osteosarcomas occur in older patients in abnormal bone affected by Paget’s disease, radiation, or bone infarct.Intramedullary OsteosarcomaThis is the most common primary sarcoma of the bone. It usu-ally occurs in the distal femur or the proximal tibia in young people. This condition may also occur at the proximal humerus, proximal femur, or pelvis. It usually presents itself as a high-grade extracompartmental disease. It can |
Surgery_Schwartz_12609 | Surgery_Schwartz | or the proximal tibia in young people. This condition may also occur at the proximal humerus, proximal femur, or pelvis. It usually presents itself as a high-grade extracompartmental disease. It can metastasize to the bone, which is called a “skip lesion,” but the lung is the primary site of metastases. Long term survival is 75% with adequate treatment. The response to chemotherapy (98% necrosis of the Table 43-1Common locations of bone tumorsFEMURDistal posteriorParosteal osteosarcomaDistal anteriorPeriosteal osteosarcoma, periosteal chondroma or chondrosarcoma, myositis ossificansTIBIAAdamantinoma, chondromyxoid, fibromaHANDS AND FEETEnchondroma, exostosisCalcaneusUnicameral bone cyst, lipoma, chondroblastoma, osteosarcomaSPINEAnteriorMetastatic, myeloma, Paget’s disease, vascular malformation, giant cell tumorPosteriorOsteoid osteoma, osteoblastoma; aneurysmal bone cystPELVISMetastatic, myeloma, chondrosarcoma, giant cell tumor, aneurysmal bone cyst, Paget’s disease, Ewing’s | Surgery_Schwartz. or the proximal tibia in young people. This condition may also occur at the proximal humerus, proximal femur, or pelvis. It usually presents itself as a high-grade extracompartmental disease. It can metastasize to the bone, which is called a “skip lesion,” but the lung is the primary site of metastases. Long term survival is 75% with adequate treatment. The response to chemotherapy (98% necrosis of the Table 43-1Common locations of bone tumorsFEMURDistal posteriorParosteal osteosarcomaDistal anteriorPeriosteal osteosarcoma, periosteal chondroma or chondrosarcoma, myositis ossificansTIBIAAdamantinoma, chondromyxoid, fibromaHANDS AND FEETEnchondroma, exostosisCalcaneusUnicameral bone cyst, lipoma, chondroblastoma, osteosarcomaSPINEAnteriorMetastatic, myeloma, Paget’s disease, vascular malformation, giant cell tumorPosteriorOsteoid osteoma, osteoblastoma; aneurysmal bone cystPELVISMetastatic, myeloma, chondrosarcoma, giant cell tumor, aneurysmal bone cyst, Paget’s disease, Ewing’s |
Surgery_Schwartz_12610 | Surgery_Schwartz | malformation, giant cell tumorPosteriorOsteoid osteoma, osteoblastoma; aneurysmal bone cystPELVISMetastatic, myeloma, chondrosarcoma, giant cell tumor, aneurysmal bone cyst, Paget’s disease, Ewing’s SarcomaSACRUMChordoma (midline), chondrosarcoma, giant cell tumor, aneurysmal bone cyst, lymphomaRIBSMetastatic, myeloma, fibrous dysplasia, chondrosarcomaTable 43-2Tumor location in boneEpiphysisChondroblastoma, clear cell chondrosarcoma, giant cell tumor (GCT), infection, dysplasia epiphysealis hemimelica (DEH)MetaphysisMost common site of involvementDiaphysisF-Fibrous dysplasia, EG-Eosinophilic Granuloma, N-Nonossifying Fibroma, O-Osteoid osteoma, M-Myeloma, A-Adamantinoma, S-Simple Bone Cyst, H-Histiocytosis, I-InfectionFigure 43-44. Osteosarcoma.Brunicardi_Ch43_p1879-p1924.indd 191122/02/19 10:41 AM 1912SPECIFIC CONSIDERATIONSPART IItumor after chemotherapy is a good sign) and the stage of the disease determines the prognosis. Young patients may present with pain and swelling, | Surgery_Schwartz. malformation, giant cell tumorPosteriorOsteoid osteoma, osteoblastoma; aneurysmal bone cystPELVISMetastatic, myeloma, chondrosarcoma, giant cell tumor, aneurysmal bone cyst, Paget’s disease, Ewing’s SarcomaSACRUMChordoma (midline), chondrosarcoma, giant cell tumor, aneurysmal bone cyst, lymphomaRIBSMetastatic, myeloma, fibrous dysplasia, chondrosarcomaTable 43-2Tumor location in boneEpiphysisChondroblastoma, clear cell chondrosarcoma, giant cell tumor (GCT), infection, dysplasia epiphysealis hemimelica (DEH)MetaphysisMost common site of involvementDiaphysisF-Fibrous dysplasia, EG-Eosinophilic Granuloma, N-Nonossifying Fibroma, O-Osteoid osteoma, M-Myeloma, A-Adamantinoma, S-Simple Bone Cyst, H-Histiocytosis, I-InfectionFigure 43-44. Osteosarcoma.Brunicardi_Ch43_p1879-p1924.indd 191122/02/19 10:41 AM 1912SPECIFIC CONSIDERATIONSPART IItumor after chemotherapy is a good sign) and the stage of the disease determines the prognosis. Young patients may present with pain and swelling, |
Surgery_Schwartz_12611 | Surgery_Schwartz | 10:41 AM 1912SPECIFIC CONSIDERATIONSPART IItumor after chemotherapy is a good sign) and the stage of the disease determines the prognosis. Young patients may present with pain and swelling, with X-rays showing plastic lesions in some areas of destruction with periosteal reaction called “Codman’s Triangle.” X-rays may show bone formation with a sunburst appearance. MRI should involve the entire bone to diagnose the skip metastasis. CT scans of the chest are usually done to find primary metastases. Alkaline phosphatase is usu-ally high. Diagnosis is typically confirmed with a biopsy, which is done after staging the tumor. Proper biopsy technique should be employed, which includes longitudinal incisions. As a gen-eral rule, the biopsy should be done by the same surgeon who will provide the definitive treatment for the patient. Treatment of osteosarcoma will be preoperative chemotherapy and wide resection, followed by postoperative chemotherapy.Parosteal OsteosarcomaParosteal | Surgery_Schwartz. 10:41 AM 1912SPECIFIC CONSIDERATIONSPART IItumor after chemotherapy is a good sign) and the stage of the disease determines the prognosis. Young patients may present with pain and swelling, with X-rays showing plastic lesions in some areas of destruction with periosteal reaction called “Codman’s Triangle.” X-rays may show bone formation with a sunburst appearance. MRI should involve the entire bone to diagnose the skip metastasis. CT scans of the chest are usually done to find primary metastases. Alkaline phosphatase is usu-ally high. Diagnosis is typically confirmed with a biopsy, which is done after staging the tumor. Proper biopsy technique should be employed, which includes longitudinal incisions. As a gen-eral rule, the biopsy should be done by the same surgeon who will provide the definitive treatment for the patient. Treatment of osteosarcoma will be preoperative chemotherapy and wide resection, followed by postoperative chemotherapy.Parosteal OsteosarcomaParosteal |
Surgery_Schwartz_12612 | Surgery_Schwartz | the definitive treatment for the patient. Treatment of osteosarcoma will be preoperative chemotherapy and wide resection, followed by postoperative chemotherapy.Parosteal OsteosarcomaParosteal osteosarcoma is a low-grade surface osteosarcoma that appears as if it were stuck on the bone, especially in the pos-terior distal femoral metaphysis (80%). The differential diagno-sis includes osteochondroma and myositis ossificans. Treatment consists of wide excision. The prognosis is 95% 5-year survival as it is a low-grade tumor.Periosteal OsteosarcomaPeriosteal osteosarcoma is a high-grade tumor. It occurs on the anterior surface of the distal femur or proximal tibia. The lesion appears chondroblastic on histology. Radiographs show scalloping of the underlying cortex with a “sunburst” periosteal reaction. Treatment is chemotherapy and wide surgical excision. The 5-year survival rate is 80%.Paget’s SarcomaPaget’s sarcoma is a rare complication of Paget’s disease. In Paget’s disease with | Surgery_Schwartz. the definitive treatment for the patient. Treatment of osteosarcoma will be preoperative chemotherapy and wide resection, followed by postoperative chemotherapy.Parosteal OsteosarcomaParosteal osteosarcoma is a low-grade surface osteosarcoma that appears as if it were stuck on the bone, especially in the pos-terior distal femoral metaphysis (80%). The differential diagno-sis includes osteochondroma and myositis ossificans. Treatment consists of wide excision. The prognosis is 95% 5-year survival as it is a low-grade tumor.Periosteal OsteosarcomaPeriosteal osteosarcoma is a high-grade tumor. It occurs on the anterior surface of the distal femur or proximal tibia. The lesion appears chondroblastic on histology. Radiographs show scalloping of the underlying cortex with a “sunburst” periosteal reaction. Treatment is chemotherapy and wide surgical excision. The 5-year survival rate is 80%.Paget’s SarcomaPaget’s sarcoma is a rare complication of Paget’s disease. In Paget’s disease with |
Surgery_Schwartz_12613 | Surgery_Schwartz | reaction. Treatment is chemotherapy and wide surgical excision. The 5-year survival rate is 80%.Paget’s SarcomaPaget’s sarcoma is a rare complication of Paget’s disease. In Paget’s disease with multiple bone involvement, osteogenic sar-coma, fibrosarcoma, chondrosarcoma, and MFH have occurred, most often in the pelvis, but also in the femur, humerus, spine, and skull. This malignant transformation occurs in less than 1% of patients. The patient will complain of new onset pain and swelling. The physician must have a high index of suspicion in patients with Paget’s who previously had no pain. Imaging may demonstrate osteolytic areas and loss of normal fatty marrow and multifocal lesions. Treatment of Paget’s sarcoma is chemo-therapy and wide surgical excision. The prognosis is poor, and the 5-year survival rate is less than 10%.Radiation-Induced SarcomaThe three criteria for diagnosis of radiation-induced sarcoma are (a) histology different from the original lesion, (b) sarcoma develops | Surgery_Schwartz. reaction. Treatment is chemotherapy and wide surgical excision. The 5-year survival rate is 80%.Paget’s SarcomaPaget’s sarcoma is a rare complication of Paget’s disease. In Paget’s disease with multiple bone involvement, osteogenic sar-coma, fibrosarcoma, chondrosarcoma, and MFH have occurred, most often in the pelvis, but also in the femur, humerus, spine, and skull. This malignant transformation occurs in less than 1% of patients. The patient will complain of new onset pain and swelling. The physician must have a high index of suspicion in patients with Paget’s who previously had no pain. Imaging may demonstrate osteolytic areas and loss of normal fatty marrow and multifocal lesions. Treatment of Paget’s sarcoma is chemo-therapy and wide surgical excision. The prognosis is poor, and the 5-year survival rate is less than 10%.Radiation-Induced SarcomaThe three criteria for diagnosis of radiation-induced sarcoma are (a) histology different from the original lesion, (b) sarcoma develops |
Surgery_Schwartz_12614 | Surgery_Schwartz | 5-year survival rate is less than 10%.Radiation-Induced SarcomaThe three criteria for diagnosis of radiation-induced sarcoma are (a) histology different from the original lesion, (b) sarcoma develops in the irradiated field, and (c) a 3to 5-year latent period between radiation and sarcoma development. Radiation for carcinoma of the breast and cervix can result in osteosar-coma, chondrosarcoma, fibrosarcoma, or MFH. Treatment is a combination of chemotherapy and surgery.EWING’S SARCOMAEwing’s sarcoma is the second most common primary bone tumor in patients under 25 years of age. The typical presenta-tion is a tumor in the diaphysis of long bones, especially the femur. It can also be seen in the pelvis, the proximal tibia, and proximal humerus, and it is usually seen in young white males. It has a t(11:22) translocation and positive CD99. The patient may have pain and fever with an elevated sedimentation rate and WBC count; the condition may be confused with an infection. An “onion | Surgery_Schwartz. 5-year survival rate is less than 10%.Radiation-Induced SarcomaThe three criteria for diagnosis of radiation-induced sarcoma are (a) histology different from the original lesion, (b) sarcoma develops in the irradiated field, and (c) a 3to 5-year latent period between radiation and sarcoma development. Radiation for carcinoma of the breast and cervix can result in osteosar-coma, chondrosarcoma, fibrosarcoma, or MFH. Treatment is a combination of chemotherapy and surgery.EWING’S SARCOMAEwing’s sarcoma is the second most common primary bone tumor in patients under 25 years of age. The typical presenta-tion is a tumor in the diaphysis of long bones, especially the femur. It can also be seen in the pelvis, the proximal tibia, and proximal humerus, and it is usually seen in young white males. It has a t(11:22) translocation and positive CD99. The patient may have pain and fever with an elevated sedimentation rate and WBC count; the condition may be confused with an infection. An “onion |
Surgery_Schwartz_12615 | Surgery_Schwartz | It has a t(11:22) translocation and positive CD99. The patient may have pain and fever with an elevated sedimentation rate and WBC count; the condition may be confused with an infection. An “onion skin” periosteal reaction may be seen on radiographs. A large soft-tissue extension from the primary bone tumor may be seen, and histology reveals a small, round, blue cell tumor (Fig. 43-45). Diagnosis is confirmed with bone marrow biopsy specimen. Bone scan can identify multiple lesions. Treatment is chemotherapy and surgery or radiation therapy for spine or pelvic lesions.CARTILAGE-FORMING TUMORSChondrosarcomasChondrosarcomas typically occur in male patients over 40 years of age, and they are the third most common primary bone malignancies. Primary chondrosarcomas can form clear cell, mesenchymal, or dedifferentiated neoplastic cartilage. Secondary chondrosarcomas may also develop in preexisting lesions such as exostoses or enchondromas. Pelvis, shoulder, and ribs are common locations. | Surgery_Schwartz. It has a t(11:22) translocation and positive CD99. The patient may have pain and fever with an elevated sedimentation rate and WBC count; the condition may be confused with an infection. An “onion skin” periosteal reaction may be seen on radiographs. A large soft-tissue extension from the primary bone tumor may be seen, and histology reveals a small, round, blue cell tumor (Fig. 43-45). Diagnosis is confirmed with bone marrow biopsy specimen. Bone scan can identify multiple lesions. Treatment is chemotherapy and surgery or radiation therapy for spine or pelvic lesions.CARTILAGE-FORMING TUMORSChondrosarcomasChondrosarcomas typically occur in male patients over 40 years of age, and they are the third most common primary bone malignancies. Primary chondrosarcomas can form clear cell, mesenchymal, or dedifferentiated neoplastic cartilage. Secondary chondrosarcomas may also develop in preexisting lesions such as exostoses or enchondromas. Pelvis, shoulder, and ribs are common locations. |
Surgery_Schwartz_12616 | Surgery_Schwartz | or dedifferentiated neoplastic cartilage. Secondary chondrosarcomas may also develop in preexisting lesions such as exostoses or enchondromas. Pelvis, shoulder, and ribs are common locations. Chondroid or “popcorn” cal-cifications are typical on radiographs. Clear cell chondrosar-coma and mesenchymal chondrosarcoma occur in younger patients (second to fifth decades of life). Clear cell chondro-sarcomas are low-grade lesions that often affect the epiphyses. The dedifferentiated chondrosarcoma is a high-grade chondro-sarcoma with a less than 10% survival rate. It has a biomor-phic histology, with a chondroid component and a high-grade spindle cell component.The treatment of chondrosarcoma is surgical excision, since cells are not chemosensitive or radiosensitive. For high-grade lesions, wide or radical resection is recommended. Pelvic and scapular chondrosarcomas have a high recurrence rate, and adjuvant chemotherapy does not improve survival rates.FIBROUS LESIONS OF BONEDesmoplastic | Surgery_Schwartz. or dedifferentiated neoplastic cartilage. Secondary chondrosarcomas may also develop in preexisting lesions such as exostoses or enchondromas. Pelvis, shoulder, and ribs are common locations. Chondroid or “popcorn” cal-cifications are typical on radiographs. Clear cell chondrosar-coma and mesenchymal chondrosarcoma occur in younger patients (second to fifth decades of life). Clear cell chondro-sarcomas are low-grade lesions that often affect the epiphyses. The dedifferentiated chondrosarcoma is a high-grade chondro-sarcoma with a less than 10% survival rate. It has a biomor-phic histology, with a chondroid component and a high-grade spindle cell component.The treatment of chondrosarcoma is surgical excision, since cells are not chemosensitive or radiosensitive. For high-grade lesions, wide or radical resection is recommended. Pelvic and scapular chondrosarcomas have a high recurrence rate, and adjuvant chemotherapy does not improve survival rates.FIBROUS LESIONS OF BONEDesmoplastic |
Surgery_Schwartz_12617 | Surgery_Schwartz | or radical resection is recommended. Pelvic and scapular chondrosarcomas have a high recurrence rate, and adjuvant chemotherapy does not improve survival rates.FIBROUS LESIONS OF BONEDesmoplastic FibromaDesmoplastic fibroma is a rare tumor occurring in the mandible, femur, pelvis, radius, or tibia in young adults. It presents as a painful lesion. Radiographs show a metadiaphyseal “soap bubble” appearance and endosteal scalloping. Histology resembles Figure 43-45. Ewing’s sarcoma.Brunicardi_Ch43_p1879-p1924.indd 191222/02/19 10:41 AM 1913ORTHOPEDIC SURGERYCHAPTER 43desmoid tumors or fibromatosis. Recommended treatment is wide excision to avoid recurrence.Malignant Fibrous Histiocytoma of BoneMFH occurs in the metadiaphysis of long bones after condi-tions like nonossifying fibromas and bone infarcts. It may pres-ent with pain or by a pathologic fracture. Radiographs typically show destructive lesions with soft-tissue extension. Histology resembles osteosarcoma with pleomorphic | Surgery_Schwartz. or radical resection is recommended. Pelvic and scapular chondrosarcomas have a high recurrence rate, and adjuvant chemotherapy does not improve survival rates.FIBROUS LESIONS OF BONEDesmoplastic FibromaDesmoplastic fibroma is a rare tumor occurring in the mandible, femur, pelvis, radius, or tibia in young adults. It presents as a painful lesion. Radiographs show a metadiaphyseal “soap bubble” appearance and endosteal scalloping. Histology resembles Figure 43-45. Ewing’s sarcoma.Brunicardi_Ch43_p1879-p1924.indd 191222/02/19 10:41 AM 1913ORTHOPEDIC SURGERYCHAPTER 43desmoid tumors or fibromatosis. Recommended treatment is wide excision to avoid recurrence.Malignant Fibrous Histiocytoma of BoneMFH occurs in the metadiaphysis of long bones after condi-tions like nonossifying fibromas and bone infarcts. It may pres-ent with pain or by a pathologic fracture. Radiographs typically show destructive lesions with soft-tissue extension. Histology resembles osteosarcoma with pleomorphic |
Surgery_Schwartz_12618 | Surgery_Schwartz | and bone infarcts. It may pres-ent with pain or by a pathologic fracture. Radiographs typically show destructive lesions with soft-tissue extension. Histology resembles osteosarcoma with pleomorphic spindle cells, his-tiocytes, and giant cells, but no neoplastic osteoid formation. Treatment is chemotherapy and wide surgical excision.Malignant Vascular TumorsHemangioendothelioma. Hemangioendothelioma is a malig-nant neoplasm arising from vascular endothelium in long bones and most often occurs in the lower extremity. Radiographs show a metadiaphyseal lytic lesion with a “soap bubble” appearance. Histology reveals eosinophilic cells in a basophilic stroma. Lesions may be multifocal. Treatment consists of curettage for low-grade lesions and wide excision +/radiation therapy for high-grade lesions.Hemangiopericytoma. Hemangiopericytoma is usually a solitary lesion occurring in the soft tissues or the axial skeleton and proximal long bones in middle-aged or older adult males. Histology | Surgery_Schwartz. and bone infarcts. It may pres-ent with pain or by a pathologic fracture. Radiographs typically show destructive lesions with soft-tissue extension. Histology resembles osteosarcoma with pleomorphic spindle cells, his-tiocytes, and giant cells, but no neoplastic osteoid formation. Treatment is chemotherapy and wide surgical excision.Malignant Vascular TumorsHemangioendothelioma. Hemangioendothelioma is a malig-nant neoplasm arising from vascular endothelium in long bones and most often occurs in the lower extremity. Radiographs show a metadiaphyseal lytic lesion with a “soap bubble” appearance. Histology reveals eosinophilic cells in a basophilic stroma. Lesions may be multifocal. Treatment consists of curettage for low-grade lesions and wide excision +/radiation therapy for high-grade lesions.Hemangiopericytoma. Hemangiopericytoma is usually a solitary lesion occurring in the soft tissues or the axial skeleton and proximal long bones in middle-aged or older adult males. Histology |
Surgery_Schwartz_12619 | Surgery_Schwartz | lesions.Hemangiopericytoma. Hemangiopericytoma is usually a solitary lesion occurring in the soft tissues or the axial skeleton and proximal long bones in middle-aged or older adult males. Histology reveals branching “staghorn” vascular spaces. The tumor cells resemble cells normally seen adjacent to capillaries. Treatment is wide excision.Angiosarcoma of Bone. Angiosarcoma is a soft tissue malig-nancy usually seen in older adult males; chronic vascular stasis is a risk factor. Histology reveals vascular channels with ana-plasia. Treatment is wide excision, or if the tumor is surgically inaccessible, radiation.MISCELLANEOUS TUMORSGiant Cell Tumor of BoneGiant cell tumor is a benign aggressive tumor. Fifty per-cent of these tumors occur around the knee, especially at the distal femur and the proximal tibial. Giant cell tumors may also occur in the distal radius, proximal humerus, and pelvis (especially the sacrum ala) in women 20 to 40 years of age. Presenting complaints include pain | Surgery_Schwartz. lesions.Hemangiopericytoma. Hemangiopericytoma is usually a solitary lesion occurring in the soft tissues or the axial skeleton and proximal long bones in middle-aged or older adult males. Histology reveals branching “staghorn” vascular spaces. The tumor cells resemble cells normally seen adjacent to capillaries. Treatment is wide excision.Angiosarcoma of Bone. Angiosarcoma is a soft tissue malig-nancy usually seen in older adult males; chronic vascular stasis is a risk factor. Histology reveals vascular channels with ana-plasia. Treatment is wide excision, or if the tumor is surgically inaccessible, radiation.MISCELLANEOUS TUMORSGiant Cell Tumor of BoneGiant cell tumor is a benign aggressive tumor. Fifty per-cent of these tumors occur around the knee, especially at the distal femur and the proximal tibial. Giant cell tumors may also occur in the distal radius, proximal humerus, and pelvis (especially the sacrum ala) in women 20 to 40 years of age. Presenting complaints include pain |
Surgery_Schwartz_12620 | Surgery_Schwartz | the proximal tibial. Giant cell tumors may also occur in the distal radius, proximal humerus, and pelvis (especially the sacrum ala) in women 20 to 40 years of age. Presenting complaints include pain and pathologic fracture. Imaging reveals eccentric, epimetaphyseal lytic lesions erod-ing the subchondral bone. Histology reveals multinucleate giant cells and mononuclear stromal cells. An abundance of giant cells in the field can help establish the diagnosis, and the nuclei of giant cells appear the same as the stroma cells (all nuclei look similar) (Fig. 43-46). Giant cell tumors must be differentiated from the Brown tumor of hyperparathy-roidism. While both have giant cells, hyperparathyroidism affects multiple areas, and the serum calcium is not normal. Epiphyseal lesions such as chondroblastoma should also be part of the differential diagnosis. These tumors can occasion-ally metastasize to the chest. Primary malignant giant cell tumor has a poor prognosis. Treatment of giant cell | Surgery_Schwartz. the proximal tibial. Giant cell tumors may also occur in the distal radius, proximal humerus, and pelvis (especially the sacrum ala) in women 20 to 40 years of age. Presenting complaints include pain and pathologic fracture. Imaging reveals eccentric, epimetaphyseal lytic lesions erod-ing the subchondral bone. Histology reveals multinucleate giant cells and mononuclear stromal cells. An abundance of giant cells in the field can help establish the diagnosis, and the nuclei of giant cells appear the same as the stroma cells (all nuclei look similar) (Fig. 43-46). Giant cell tumors must be differentiated from the Brown tumor of hyperparathy-roidism. While both have giant cells, hyperparathyroidism affects multiple areas, and the serum calcium is not normal. Epiphyseal lesions such as chondroblastoma should also be part of the differential diagnosis. These tumors can occasion-ally metastasize to the chest. Primary malignant giant cell tumor has a poor prognosis. Treatment of giant cell |
Surgery_Schwartz_12621 | Surgery_Schwartz | should also be part of the differential diagnosis. These tumors can occasion-ally metastasize to the chest. Primary malignant giant cell tumor has a poor prognosis. Treatment of giant cell tumors is with curettage and high-speed burr. Recurrence rates are high with simple curettage, and the use of adjuvants such as cryosurgery, phenol, or polymethylmethacrylate bone cement may help decrease recurrence rates. After pathologic fractures, wide excision with reconstruction or amputation may be required.Adamantinoma and Osteofibrous DysplasiaAdamantinomas are low-grade malignant tumors usually seen in the tibia (Fig. 43-47). Adamantinomas are capable of metas-tasizing to the lung. The patient may present with pain and/or bowing of the tibia. X-ray reveals multiple lucent lesions on the cortex of the tibia. Histology reveals a biphasic tumor with nests of epithelial cells and fibrous stroma (see Fig. 43-46). Osteofibrous dysplasia is considered the precursor to ada-mantinoma and should be | Surgery_Schwartz. should also be part of the differential diagnosis. These tumors can occasion-ally metastasize to the chest. Primary malignant giant cell tumor has a poor prognosis. Treatment of giant cell tumors is with curettage and high-speed burr. Recurrence rates are high with simple curettage, and the use of adjuvants such as cryosurgery, phenol, or polymethylmethacrylate bone cement may help decrease recurrence rates. After pathologic fractures, wide excision with reconstruction or amputation may be required.Adamantinoma and Osteofibrous DysplasiaAdamantinomas are low-grade malignant tumors usually seen in the tibia (Fig. 43-47). Adamantinomas are capable of metas-tasizing to the lung. The patient may present with pain and/or bowing of the tibia. X-ray reveals multiple lucent lesions on the cortex of the tibia. Histology reveals a biphasic tumor with nests of epithelial cells and fibrous stroma (see Fig. 43-46). Osteofibrous dysplasia is considered the precursor to ada-mantinoma and should be |
Surgery_Schwartz_12622 | Surgery_Schwartz | of the tibia. Histology reveals a biphasic tumor with nests of epithelial cells and fibrous stroma (see Fig. 43-46). Osteofibrous dysplasia is considered the precursor to ada-mantinoma and should be part of the differential diagnosis. Osteofibrous dysplasia is a benign lesion, usually occurring in children, at the anterior tibia, which is treated with obser-vation. The treatment of adamantinoma is with wide surgical excision.Figure 43-46. Giant cell tumor.Figure 43-47. Typical location of adamantinoma.Brunicardi_Ch43_p1879-p1924.indd 191322/02/19 10:41 AM 1914SPECIFIC CONSIDERATIONSPART IIPrimary Lymphoma of BonePrimary lymphoma accounts for about 5% of all neoplasms of bone. Long bone involvement is more frequent than spine. Lym-phoma of bone typically occurs in males in their forties. Histol-ogy reveals large B cell lymphomas. Treatment is a combination of chemotherapy and radiation. Surgery may be required for stabilization of pathologic fractures.ChordomaChordoma arises from | Surgery_Schwartz. of the tibia. Histology reveals a biphasic tumor with nests of epithelial cells and fibrous stroma (see Fig. 43-46). Osteofibrous dysplasia is considered the precursor to ada-mantinoma and should be part of the differential diagnosis. Osteofibrous dysplasia is a benign lesion, usually occurring in children, at the anterior tibia, which is treated with obser-vation. The treatment of adamantinoma is with wide surgical excision.Figure 43-46. Giant cell tumor.Figure 43-47. Typical location of adamantinoma.Brunicardi_Ch43_p1879-p1924.indd 191322/02/19 10:41 AM 1914SPECIFIC CONSIDERATIONSPART IIPrimary Lymphoma of BonePrimary lymphoma accounts for about 5% of all neoplasms of bone. Long bone involvement is more frequent than spine. Lym-phoma of bone typically occurs in males in their forties. Histol-ogy reveals large B cell lymphomas. Treatment is a combination of chemotherapy and radiation. Surgery may be required for stabilization of pathologic fractures.ChordomaChordoma arises from |
Surgery_Schwartz_12623 | Surgery_Schwartz | Histol-ogy reveals large B cell lymphomas. Treatment is a combination of chemotherapy and radiation. Surgery may be required for stabilization of pathologic fractures.ChordomaChordoma arises from notochordal remnants in the sacrum. It is usually midline in location. These tumors are found in middle-aged to older men and presents with bladder and bowel symptoms due to involvement of the cauda equina. Visual-ization of the lesion may be difficult because of the bowel gas shadow. Diagnosis may be delayed. An MRI shows a destructive extensile midline lesion with a large soft tissue mass. Histology shows epithelioid cells arranged in cords with vacuolated foamy physaliferous cells. These cells are keratin positive. Treatment is surgical excision and muscle flaps and a mesh for reconstruction. Urinary diversion and colostomy may be needed for loss of bladder and bowel control. Local recurrence is common.Multiple MyelomaMyeloma, the most common primary bone malignancy, is a pro-liferative | Surgery_Schwartz. Histol-ogy reveals large B cell lymphomas. Treatment is a combination of chemotherapy and radiation. Surgery may be required for stabilization of pathologic fractures.ChordomaChordoma arises from notochordal remnants in the sacrum. It is usually midline in location. These tumors are found in middle-aged to older men and presents with bladder and bowel symptoms due to involvement of the cauda equina. Visual-ization of the lesion may be difficult because of the bowel gas shadow. Diagnosis may be delayed. An MRI shows a destructive extensile midline lesion with a large soft tissue mass. Histology shows epithelioid cells arranged in cords with vacuolated foamy physaliferous cells. These cells are keratin positive. Treatment is surgical excision and muscle flaps and a mesh for reconstruction. Urinary diversion and colostomy may be needed for loss of bladder and bowel control. Local recurrence is common.Multiple MyelomaMyeloma, the most common primary bone malignancy, is a pro-liferative |
Surgery_Schwartz_12624 | Surgery_Schwartz | Urinary diversion and colostomy may be needed for loss of bladder and bowel control. Local recurrence is common.Multiple MyelomaMyeloma, the most common primary bone malignancy, is a pro-liferative disorder of B cells with plasma cells producing immu-noglobins. These plasma cells have a classic eccentric nucleus giving a “signet ring” appearance (Fig. 43-48). Evidence of monoclonal protein in the serum and/or urine (Bence Jones proteinuria), and hypercalcemia, renal insufficiency, anemia, or bone disease are usually present.Presenting symptoms in myeloma range from bone pain and osteopenia to focal lytic lesions with pathologic fractures and hypercalcemia. Myeloma protein 1-α stimulates osteo-clast formation. Osteoclast activating factors increase recep-tor activator of nuclear factor κB ligand (RANKL) in the bone marrow. RANKL induces osteoclast differentiation and acti-vation. Myeloma cells inhibit osteoblast differentiation and activity. Serum and urine electrophoresis detect the M | Surgery_Schwartz. Urinary diversion and colostomy may be needed for loss of bladder and bowel control. Local recurrence is common.Multiple MyelomaMyeloma, the most common primary bone malignancy, is a pro-liferative disorder of B cells with plasma cells producing immu-noglobins. These plasma cells have a classic eccentric nucleus giving a “signet ring” appearance (Fig. 43-48). Evidence of monoclonal protein in the serum and/or urine (Bence Jones proteinuria), and hypercalcemia, renal insufficiency, anemia, or bone disease are usually present.Presenting symptoms in myeloma range from bone pain and osteopenia to focal lytic lesions with pathologic fractures and hypercalcemia. Myeloma protein 1-α stimulates osteo-clast formation. Osteoclast activating factors increase recep-tor activator of nuclear factor κB ligand (RANKL) in the bone marrow. RANKL induces osteoclast differentiation and acti-vation. Myeloma cells inhibit osteoblast differentiation and activity. Serum and urine electrophoresis detect the M |
Surgery_Schwartz_12625 | Surgery_Schwartz | (RANKL) in the bone marrow. RANKL induces osteoclast differentiation and acti-vation. Myeloma cells inhibit osteoblast differentiation and activity. Serum and urine electrophoresis detect the M protein. Workup also includes complete blood cell count, erythrocyte sedimentation rate, calcium levels, renal function assessment, β2-microglobulin levels, and a skeletal survey. X-ray will show multiple punched out lytic lesions. Bone scans may be cold in about 30% of cases. The SPEP, UPEP, and bone marrow biopsy are helpful in diagnosis. Histology will show atypical plasma cells with eccentric nuclei, its appearance resembles a “signet ring (Fig. 43-49).” Plasmacytoma is a solitary tumor with a negative bone marrow biopsy, usually treated with radiation to the lesion. Myeloma is treated with bisphosphonates, chemo-therapy, stem cell transplantation, and radiation therapy. Surgi-cal stabilization and irradiation is done for pathologic fractures or impending fractures. Many patients with | Surgery_Schwartz. (RANKL) in the bone marrow. RANKL induces osteoclast differentiation and acti-vation. Myeloma cells inhibit osteoblast differentiation and activity. Serum and urine electrophoresis detect the M protein. Workup also includes complete blood cell count, erythrocyte sedimentation rate, calcium levels, renal function assessment, β2-microglobulin levels, and a skeletal survey. X-ray will show multiple punched out lytic lesions. Bone scans may be cold in about 30% of cases. The SPEP, UPEP, and bone marrow biopsy are helpful in diagnosis. Histology will show atypical plasma cells with eccentric nuclei, its appearance resembles a “signet ring (Fig. 43-49).” Plasmacytoma is a solitary tumor with a negative bone marrow biopsy, usually treated with radiation to the lesion. Myeloma is treated with bisphosphonates, chemo-therapy, stem cell transplantation, and radiation therapy. Surgi-cal stabilization and irradiation is done for pathologic fractures or impending fractures. Many patients with |
Surgery_Schwartz_12626 | Surgery_Schwartz | bisphosphonates, chemo-therapy, stem cell transplantation, and radiation therapy. Surgi-cal stabilization and irradiation is done for pathologic fractures or impending fractures. Many patients with myeloma develop a vertebral compression fracture. Kyphoplasty can be useful in providing pain relief. The risks of cement extravasation and related complications are lower with kyphoplasty than with ver-tebroplasty. If there is instability or if there is neural compres-sion, surgical stabilization may be required.METASTATIC BONE TUMORSMetastatic bone tumors are more common than primary bone tumors. Metastatic tumors affect the lung, liver, and bone. Cancers that commonly metastasize to bone are breast, lung, thyroid, kidney, and prostate. In patients older than 40 years of age, metastases and myeloma are the most common causes of destructive lesions in bone. The most common site of involve-ment is the axial skeleton, especially the thoracic spine, and proximal ends of long bones, especially | Surgery_Schwartz. bisphosphonates, chemo-therapy, stem cell transplantation, and radiation therapy. Surgi-cal stabilization and irradiation is done for pathologic fractures or impending fractures. Many patients with myeloma develop a vertebral compression fracture. Kyphoplasty can be useful in providing pain relief. The risks of cement extravasation and related complications are lower with kyphoplasty than with ver-tebroplasty. If there is instability or if there is neural compres-sion, surgical stabilization may be required.METASTATIC BONE TUMORSMetastatic bone tumors are more common than primary bone tumors. Metastatic tumors affect the lung, liver, and bone. Cancers that commonly metastasize to bone are breast, lung, thyroid, kidney, and prostate. In patients older than 40 years of age, metastases and myeloma are the most common causes of destructive lesions in bone. The most common site of involve-ment is the axial skeleton, especially the thoracic spine, and proximal ends of long bones, especially |
Surgery_Schwartz_12627 | Surgery_Schwartz | are the most common causes of destructive lesions in bone. The most common site of involve-ment is the axial skeleton, especially the thoracic spine, and proximal ends of long bones, especially the proximal femur. Lung and renal cell carcinomas can metastasize distal to the knee and elbow. Malignant cells are able to detach from one location and set up a focus at a distant site. The tumor activates osteoclasts and causes destruction of the bone, a mechanism that involves the RANK/RANKL pathway. The patient may present with pain, pathologic fractures, or the manifestation of hypercalcemia. Workup of a patient with a suspected metastatic disease to bone and an unknown primary tumor should include CT of the chest, abdomen, and pelvis. The extent of the disease is evaluated by bone scans (myeloma and thyroid are usually cold in bone scans), mammography, tumor markers, serum, and urine electrophoresis (SPEP and UPEP). A biopsy may be nec-essary to rule out primary bone lesions if the | Surgery_Schwartz. are the most common causes of destructive lesions in bone. The most common site of involve-ment is the axial skeleton, especially the thoracic spine, and proximal ends of long bones, especially the proximal femur. Lung and renal cell carcinomas can metastasize distal to the knee and elbow. Malignant cells are able to detach from one location and set up a focus at a distant site. The tumor activates osteoclasts and causes destruction of the bone, a mechanism that involves the RANK/RANKL pathway. The patient may present with pain, pathologic fractures, or the manifestation of hypercalcemia. Workup of a patient with a suspected metastatic disease to bone and an unknown primary tumor should include CT of the chest, abdomen, and pelvis. The extent of the disease is evaluated by bone scans (myeloma and thyroid are usually cold in bone scans), mammography, tumor markers, serum, and urine electrophoresis (SPEP and UPEP). A biopsy may be nec-essary to rule out primary bone lesions if the |
Surgery_Schwartz_12628 | Surgery_Schwartz | (myeloma and thyroid are usually cold in bone scans), mammography, tumor markers, serum, and urine electrophoresis (SPEP and UPEP). A biopsy may be nec-essary to rule out primary bone lesions if the primary site is not identified. Treatment of bone tumors depends on the diagnosis, as metastatic tumors are treated differently than primary bone tumors. Metastatic tumors are usually treated by bisphospho-nates and by surgical stabilization with postoperative radiation if warranted. Primary bone tumors are usually treated by wide excision with chemotherapy in high-grade tumors (chondrosar-coma are treated only with wide excision). Radiation therapy can be used in Ewing’s.Multiple myelomaEccentricnucleusSignet ring appearanceFigure 43-48. Signet ring.Figure 43-49. Multiple Myeloma showing the eccentric nuclei and the signet appearance of cells.Brunicardi_Ch43_p1879-p1924.indd 191422/02/19 10:41 AM 1915ORTHOPEDIC SURGERYCHAPTER 43PEDIATRIC ORTHOPEDICSBirth InjuriesNeonatal Brachial | Surgery_Schwartz. (myeloma and thyroid are usually cold in bone scans), mammography, tumor markers, serum, and urine electrophoresis (SPEP and UPEP). A biopsy may be nec-essary to rule out primary bone lesions if the primary site is not identified. Treatment of bone tumors depends on the diagnosis, as metastatic tumors are treated differently than primary bone tumors. Metastatic tumors are usually treated by bisphospho-nates and by surgical stabilization with postoperative radiation if warranted. Primary bone tumors are usually treated by wide excision with chemotherapy in high-grade tumors (chondrosar-coma are treated only with wide excision). Radiation therapy can be used in Ewing’s.Multiple myelomaEccentricnucleusSignet ring appearanceFigure 43-48. Signet ring.Figure 43-49. Multiple Myeloma showing the eccentric nuclei and the signet appearance of cells.Brunicardi_Ch43_p1879-p1924.indd 191422/02/19 10:41 AM 1915ORTHOPEDIC SURGERYCHAPTER 43PEDIATRIC ORTHOPEDICSBirth InjuriesNeonatal Brachial |
Surgery_Schwartz_12629 | Surgery_Schwartz | the eccentric nuclei and the signet appearance of cells.Brunicardi_Ch43_p1879-p1924.indd 191422/02/19 10:41 AM 1915ORTHOPEDIC SURGERYCHAPTER 43PEDIATRIC ORTHOPEDICSBirth InjuriesNeonatal Brachial Plexus Palsy. Injury of the brachial plexus during delivery occurs in 2 births in every 1000. Large birth weight, forceps delivery, breech presentation, and pro-longed second stage of labor with shoulder dystocia are risk factors. Brachial plexus injury usually represents a stretch injury on the nerve roots of the upper or lower plexus.Upper plexus injuries (Erb-Duchenne) are lesions mani-fested by weakness of shoulder abductors and external rota-tors as well as the elbow flexors (Fig. 43-50). The hand is not involved. It has a good prognosis, if the biceps function is pres-ent early.In lower plexus injury, the hand is involved, with defor-mity of the fingers. An ipsilateral Horner’s Syndrome consist-ing of ptosis, myosis, anhidrosis, and enophthalmos may occur indicating a preganglionic | Surgery_Schwartz. the eccentric nuclei and the signet appearance of cells.Brunicardi_Ch43_p1879-p1924.indd 191422/02/19 10:41 AM 1915ORTHOPEDIC SURGERYCHAPTER 43PEDIATRIC ORTHOPEDICSBirth InjuriesNeonatal Brachial Plexus Palsy. Injury of the brachial plexus during delivery occurs in 2 births in every 1000. Large birth weight, forceps delivery, breech presentation, and pro-longed second stage of labor with shoulder dystocia are risk factors. Brachial plexus injury usually represents a stretch injury on the nerve roots of the upper or lower plexus.Upper plexus injuries (Erb-Duchenne) are lesions mani-fested by weakness of shoulder abductors and external rota-tors as well as the elbow flexors (Fig. 43-50). The hand is not involved. It has a good prognosis, if the biceps function is pres-ent early.In lower plexus injury, the hand is involved, with defor-mity of the fingers. An ipsilateral Horner’s Syndrome consist-ing of ptosis, myosis, anhidrosis, and enophthalmos may occur indicating a preganglionic |
Surgery_Schwartz_12630 | Surgery_Schwartz | plexus injury, the hand is involved, with defor-mity of the fingers. An ipsilateral Horner’s Syndrome consist-ing of ptosis, myosis, anhidrosis, and enophthalmos may occur indicating a preganglionic injury of the T1 cervical sympathetic nerve. This condition has a poor prognosis.Management is therapy and gentle, passive range-of-motion exercises to preserve motion in the shoulder and prevent muscle contractures and joint incongruency in the early neonatal period while awaiting return of neurologic function and motor reinnervation. Early surgical intervention for the brachial plexus is indicated in infants who did not recover elbow flexion by 3 months of age, as they are anticipated to have a poor chance of full recovery.Surgical intervention includes microsurgical repair proce-dures in the form of neurolysis, nerve transfer, or nerve grafts. Later orthopedic reconstruction such as muscle rebalancing procedures may be considered to improve function around the shoulder.Cerebral | Surgery_Schwartz. plexus injury, the hand is involved, with defor-mity of the fingers. An ipsilateral Horner’s Syndrome consist-ing of ptosis, myosis, anhidrosis, and enophthalmos may occur indicating a preganglionic injury of the T1 cervical sympathetic nerve. This condition has a poor prognosis.Management is therapy and gentle, passive range-of-motion exercises to preserve motion in the shoulder and prevent muscle contractures and joint incongruency in the early neonatal period while awaiting return of neurologic function and motor reinnervation. Early surgical intervention for the brachial plexus is indicated in infants who did not recover elbow flexion by 3 months of age, as they are anticipated to have a poor chance of full recovery.Surgical intervention includes microsurgical repair proce-dures in the form of neurolysis, nerve transfer, or nerve grafts. Later orthopedic reconstruction such as muscle rebalancing procedures may be considered to improve function around the shoulder.Cerebral |
Surgery_Schwartz_12631 | Surgery_Schwartz | in the form of neurolysis, nerve transfer, or nerve grafts. Later orthopedic reconstruction such as muscle rebalancing procedures may be considered to improve function around the shoulder.Cerebral Palsy. Cerebral palsy results from an injury to the brain, which may be associated with mental impairment. Cere-bral palsy is classified as spastic, athetotic, or ataxic and may present with spasticity, hemiplegia, diplegia, or scoliosis. The typical cerebral palsy patient is hyperreflexic with increased muscle tone and spasm. Treatment includes tendon lengthen-ing procedures, release of contractures, and tendon transfers to maintain motion and function.Figure 43-50. Erb’s point.Reserve zone(resting zone)Proliferative zoneHypertrophic zoneZone ofmaturationZone ofdegenerationWWeaWeWeaWeaWeaWeaWeaWWWWWWWWWWWWWWWkkzkzkzkzkkzkzkzkzkzkkkkkkkk zkkkkkzkkoWeak zoneZone ofprovisionalcalcificationFigure 43-51. Different zones of the growth plate.Hip dislocation or subluxation results from unbalanced | Surgery_Schwartz. in the form of neurolysis, nerve transfer, or nerve grafts. Later orthopedic reconstruction such as muscle rebalancing procedures may be considered to improve function around the shoulder.Cerebral Palsy. Cerebral palsy results from an injury to the brain, which may be associated with mental impairment. Cere-bral palsy is classified as spastic, athetotic, or ataxic and may present with spasticity, hemiplegia, diplegia, or scoliosis. The typical cerebral palsy patient is hyperreflexic with increased muscle tone and spasm. Treatment includes tendon lengthen-ing procedures, release of contractures, and tendon transfers to maintain motion and function.Figure 43-50. Erb’s point.Reserve zone(resting zone)Proliferative zoneHypertrophic zoneZone ofmaturationZone ofdegenerationWWeaWeWeaWeaWeaWeaWeaWWWWWWWWWWWWWWWkkzkzkzkzkkzkzkzkzkzkkkkkkkk zkkkkkzkkoWeak zoneZone ofprovisionalcalcificationFigure 43-51. Different zones of the growth plate.Hip dislocation or subluxation results from unbalanced |
Surgery_Schwartz_12632 | Surgery_Schwartz | zkkkkkzkkoWeak zoneZone ofprovisionalcalcificationFigure 43-51. Different zones of the growth plate.Hip dislocation or subluxation results from unbalanced muscle forces in many cerebral palsy patients. Early treatment consists of soft tissue releases in the form of adductor tendon releases, iliopsoas releases, and immobilization in an abduction brace.In older children with severe deformity, bony procedures in the form of open reduction and femoral or acetabular osteoto-mies are usually required. Femoral head resection is considered to be a salvage procedure in nonambulatory patients with pain-ful dislocated hips.Knee flexion contractures are treated with hamstring muscle lengthenings and immobilization in knee extension braces.Foot and ankle deformities are treated even in nonambu-latory patients to facilitate shoe wear. The most common foot deformity in cerebral palsy is an equinovalgus foot caused by heel cord contracture and peroneal spasm. Tendon balancing is usually necessary, | Surgery_Schwartz. zkkkkkzkkoWeak zoneZone ofprovisionalcalcificationFigure 43-51. Different zones of the growth plate.Hip dislocation or subluxation results from unbalanced muscle forces in many cerebral palsy patients. Early treatment consists of soft tissue releases in the form of adductor tendon releases, iliopsoas releases, and immobilization in an abduction brace.In older children with severe deformity, bony procedures in the form of open reduction and femoral or acetabular osteoto-mies are usually required. Femoral head resection is considered to be a salvage procedure in nonambulatory patients with pain-ful dislocated hips.Knee flexion contractures are treated with hamstring muscle lengthenings and immobilization in knee extension braces.Foot and ankle deformities are treated even in nonambu-latory patients to facilitate shoe wear. The most common foot deformity in cerebral palsy is an equinovalgus foot caused by heel cord contracture and peroneal spasm. Tendon balancing is usually necessary, |
Surgery_Schwartz_12633 | Surgery_Schwartz | patients to facilitate shoe wear. The most common foot deformity in cerebral palsy is an equinovalgus foot caused by heel cord contracture and peroneal spasm. Tendon balancing is usually necessary, and bony reconstruction may also be needed in severe cases.Skeletal GrowthInjury, inflammatory disease, and developmental disorders in actively growing bones requires special attention to preserve the growth plates. The pediatric skeleton is incompletely ossi-fied making the diagnosis of an injury difficult, since signifi-cant portions of the skeleton are invisible on radiographs. The epiphysis, generally containing an articular surface, is found at the ends of the long bone. The physis, or growth plate, is found beneath the epiphysis. The physis is divided into spe-cific zones: the reserve zone, the zone of proliferation, and the hypertrophic zone. The hypertrophic zone has three phases: the maturation zone, the degenerative zone, and the zone of calcification (Fig. 43-51).Injury or insult | Surgery_Schwartz. patients to facilitate shoe wear. The most common foot deformity in cerebral palsy is an equinovalgus foot caused by heel cord contracture and peroneal spasm. Tendon balancing is usually necessary, and bony reconstruction may also be needed in severe cases.Skeletal GrowthInjury, inflammatory disease, and developmental disorders in actively growing bones requires special attention to preserve the growth plates. The pediatric skeleton is incompletely ossi-fied making the diagnosis of an injury difficult, since signifi-cant portions of the skeleton are invisible on radiographs. The epiphysis, generally containing an articular surface, is found at the ends of the long bone. The physis, or growth plate, is found beneath the epiphysis. The physis is divided into spe-cific zones: the reserve zone, the zone of proliferation, and the hypertrophic zone. The hypertrophic zone has three phases: the maturation zone, the degenerative zone, and the zone of calcification (Fig. 43-51).Injury or insult |
Surgery_Schwartz_12634 | Surgery_Schwartz | the zone of proliferation, and the hypertrophic zone. The hypertrophic zone has three phases: the maturation zone, the degenerative zone, and the zone of calcification (Fig. 43-51).Injury or insult to the growth plate can lead to premature growth arrest or angular deformity of the limb. Surrounding the metaphyseal and diaphyseal bone is the periosteum. This meta-bolically active layer of tissue synthesizes new bone onto the diaphyseal and metaphyseal bone and provides circumferential growth of the bones.Ossification centers in the epiphysis appear in a predict-able order and can help determine “bone age.”Brunicardi_Ch43_p1879-p1924.indd 191522/02/19 10:41 AM 1916SPECIFIC CONSIDERATIONSPART IIPediatric FracturesIn a pediatric patient, the epiphyseal growth plate is unossified and weak and is at risk of fracture. Reduction and stabiliza-tion of epiphyseal fractures is critical to minimize permanent growth disturbances and deformity. Fractures near the growth plate have significant | Surgery_Schwartz. the zone of proliferation, and the hypertrophic zone. The hypertrophic zone has three phases: the maturation zone, the degenerative zone, and the zone of calcification (Fig. 43-51).Injury or insult to the growth plate can lead to premature growth arrest or angular deformity of the limb. Surrounding the metaphyseal and diaphyseal bone is the periosteum. This meta-bolically active layer of tissue synthesizes new bone onto the diaphyseal and metaphyseal bone and provides circumferential growth of the bones.Ossification centers in the epiphysis appear in a predict-able order and can help determine “bone age.”Brunicardi_Ch43_p1879-p1924.indd 191522/02/19 10:41 AM 1916SPECIFIC CONSIDERATIONSPART IIPediatric FracturesIn a pediatric patient, the epiphyseal growth plate is unossified and weak and is at risk of fracture. Reduction and stabiliza-tion of epiphyseal fractures is critical to minimize permanent growth disturbances and deformity. Fractures near the growth plate have significant |
Surgery_Schwartz_12635 | Surgery_Schwartz | and is at risk of fracture. Reduction and stabiliza-tion of epiphyseal fractures is critical to minimize permanent growth disturbances and deformity. Fractures near the growth plate have significant potential to remodel. For example, 80% of the growth of the humerus occurs from the proximal humeral growth plate; therefore, severely displaced proximal humeral fracture can remodel in the younger age group.Classification of Growth Plate InjuriesSalter and Harris described a useful classification for epiphyseal fractures (Fig. 43-52). A Salter-Harris type I injury is a simple transverse fracture through the physis. A Salter-Harris type II fracture contains a component of fracture through the growth plate in continuity with a fracture of the metaphysis. A Salter-Harris type III fracture occurs through the epiphysis and exits through the growth plate, while a Salter-Harris type IV fracture extends through the physis from the metaphysis into the epiphy-sis. A Salter-Harris type V fracture is | Surgery_Schwartz. and is at risk of fracture. Reduction and stabiliza-tion of epiphyseal fractures is critical to minimize permanent growth disturbances and deformity. Fractures near the growth plate have significant potential to remodel. For example, 80% of the growth of the humerus occurs from the proximal humeral growth plate; therefore, severely displaced proximal humeral fracture can remodel in the younger age group.Classification of Growth Plate InjuriesSalter and Harris described a useful classification for epiphyseal fractures (Fig. 43-52). A Salter-Harris type I injury is a simple transverse fracture through the physis. A Salter-Harris type II fracture contains a component of fracture through the growth plate in continuity with a fracture of the metaphysis. A Salter-Harris type III fracture occurs through the epiphysis and exits through the growth plate, while a Salter-Harris type IV fracture extends through the physis from the metaphysis into the epiphy-sis. A Salter-Harris type V fracture is |
Surgery_Schwartz_12636 | Surgery_Schwartz | through the epiphysis and exits through the growth plate, while a Salter-Harris type IV fracture extends through the physis from the metaphysis into the epiphy-sis. A Salter-Harris type V fracture is a crushing injury to the physis. Type III and type IV involve the joint.Treatment of growth plate fracture requires anatomic reduction of the fragments, closed or open. If internal fixation is used, avoid placing the hardware across the growth plate to minimize the chance of injury and premature growth plate clo-sure. When hardware needs to be placed across the physis, it should be limited to smooth K-wires. The most common com-plication is a physeal arrest resulting in leg length discrepancy (LLD) and/or angular deformity. Complete arrest will lead to LLD. Partial arrest will result in angulation in the area of the bar, bridge, and fusion. If less than 50% of the physis is involved and the patient has two years of growth remaining, the bar is usually resected with interposition of fat | Surgery_Schwartz. through the epiphysis and exits through the growth plate, while a Salter-Harris type IV fracture extends through the physis from the metaphysis into the epiphy-sis. A Salter-Harris type V fracture is a crushing injury to the physis. Type III and type IV involve the joint.Treatment of growth plate fracture requires anatomic reduction of the fragments, closed or open. If internal fixation is used, avoid placing the hardware across the growth plate to minimize the chance of injury and premature growth plate clo-sure. When hardware needs to be placed across the physis, it should be limited to smooth K-wires. The most common com-plication is a physeal arrest resulting in leg length discrepancy (LLD) and/or angular deformity. Complete arrest will lead to LLD. Partial arrest will result in angulation in the area of the bar, bridge, and fusion. If less than 50% of the physis is involved and the patient has two years of growth remaining, the bar is usually resected with interposition of fat |
Surgery_Schwartz_12637 | Surgery_Schwartz | in the area of the bar, bridge, and fusion. If less than 50% of the physis is involved and the patient has two years of growth remaining, the bar is usually resected with interposition of fat graft. If the bar (fusion area) is more than 50%, the surgeon will complete the arrest on the same side and will do a contralateral epiphysiodesis on the other extremity.Distal femur physeal fractures are known to have a high rate of leg length discrepancy and angular deformity. The injury will need an anatomical reduction and close follow-up. Parents need to be counseled about the poor prognosis associated with these fractures.Diaphyseal Injuries in a Pediatric PatientLong bone diaphyseal fractures are generally treated closed. Pediatric patients are capable of extensive remodeling so that an angular deformity within the plane of an adjacent joint is often completely remodeled by the growth of the child. Older children do not remodel as well. A 10° angulation in both bones of the forearm in a | Surgery_Schwartz. in the area of the bar, bridge, and fusion. If less than 50% of the physis is involved and the patient has two years of growth remaining, the bar is usually resected with interposition of fat graft. If the bar (fusion area) is more than 50%, the surgeon will complete the arrest on the same side and will do a contralateral epiphysiodesis on the other extremity.Distal femur physeal fractures are known to have a high rate of leg length discrepancy and angular deformity. The injury will need an anatomical reduction and close follow-up. Parents need to be counseled about the poor prognosis associated with these fractures.Diaphyseal Injuries in a Pediatric PatientLong bone diaphyseal fractures are generally treated closed. Pediatric patients are capable of extensive remodeling so that an angular deformity within the plane of an adjacent joint is often completely remodeled by the growth of the child. Older children do not remodel as well. A 10° angulation in both bones of the forearm in a |
Surgery_Schwartz_12638 | Surgery_Schwartz | deformity within the plane of an adjacent joint is often completely remodeled by the growth of the child. Older children do not remodel as well. A 10° angulation in both bones of the forearm in a child over an age of 10 years may cause significant limitation of rotation of the forearm. When internal fixation of a diaphyseal fracture is required, fixation through the physis is avoided.Fractures of the Pediatric HipFractures of the pediatric hip can occur with high-energy trauma, and there is a high rate of avascular necrosis. Pedi-atric patients with hip fractures may be treated with a spica cast. The spica cast includes the abdomen, lower back, pelvis, and lower limb, and derives its name from the resemblance of the plaster wrap over the hip to wheat “spica.” Closed or open reduction and internal fixation is done in fractures with severe displacement. Avascular necrosis is the most common complication after hip fractures. The incidence depends on the age of the patient and the type of | Surgery_Schwartz. deformity within the plane of an adjacent joint is often completely remodeled by the growth of the child. Older children do not remodel as well. A 10° angulation in both bones of the forearm in a child over an age of 10 years may cause significant limitation of rotation of the forearm. When internal fixation of a diaphyseal fracture is required, fixation through the physis is avoided.Fractures of the Pediatric HipFractures of the pediatric hip can occur with high-energy trauma, and there is a high rate of avascular necrosis. Pedi-atric patients with hip fractures may be treated with a spica cast. The spica cast includes the abdomen, lower back, pelvis, and lower limb, and derives its name from the resemblance of the plaster wrap over the hip to wheat “spica.” Closed or open reduction and internal fixation is done in fractures with severe displacement. Avascular necrosis is the most common complication after hip fractures. The incidence depends on the age of the patient and the type of |
Surgery_Schwartz_12639 | Surgery_Schwartz | fixation is done in fractures with severe displacement. Avascular necrosis is the most common complication after hip fractures. The incidence depends on the age of the patient and the type of the fracture. Children between 3 and 8 years old with very proximal fractures such as transphyseal fractures have the highest incidence of avas-cular necrosis.Fractures of the Femoral ShaftConsider child abuse if a femoral shaft fracture occurs before the walking age. Femoral shaft fractures in a child younger than 6 months are usually treated by a Pavlik harness or spica cast. A child between 6 months and 5 years with an acceptable shortening of the femur is usually treated by an immediate spica cast. The child between 5 years and 11 years is usu-ally treated by surgery. If the fracture is transverse, flexible IM nails may be used, especially if the child weighs less than 100 lbs (45 kg). If the fracture is too proximal or too distal, or if the fracture is comminuted and unstable, a submuscu-lar | Surgery_Schwartz. fixation is done in fractures with severe displacement. Avascular necrosis is the most common complication after hip fractures. The incidence depends on the age of the patient and the type of the fracture. Children between 3 and 8 years old with very proximal fractures such as transphyseal fractures have the highest incidence of avas-cular necrosis.Fractures of the Femoral ShaftConsider child abuse if a femoral shaft fracture occurs before the walking age. Femoral shaft fractures in a child younger than 6 months are usually treated by a Pavlik harness or spica cast. A child between 6 months and 5 years with an acceptable shortening of the femur is usually treated by an immediate spica cast. The child between 5 years and 11 years is usu-ally treated by surgery. If the fracture is transverse, flexible IM nails may be used, especially if the child weighs less than 100 lbs (45 kg). If the fracture is too proximal or too distal, or if the fracture is comminuted and unstable, a submuscu-lar |
Surgery_Schwartz_12640 | Surgery_Schwartz | flexible IM nails may be used, especially if the child weighs less than 100 lbs (45 kg). If the fracture is too proximal or too distal, or if the fracture is comminuted and unstable, a submuscu-lar bridge plate is usually used; alternatively, an external fix-ator may also be used, especially in multiple trauma patients. If the patient is older than 11 years, an interlocking IM rod with a lateral trochanteric entry is used. Insertion of IM rod in younger children can cause avascular necrosis of the femoral head due to interruption of the blood supply. Refracture of the femur is a risk after using an external fixator. Overgrowth of the injured femur with leg length discrepancy can occur in children between 2 and 10 years of age.Figure 43-52. Classification of growth plate injuries.Brunicardi_Ch43_p1879-p1924.indd 191622/02/19 10:41 AM 1917ORTHOPEDIC SURGERYCHAPTER 43Pediatric Ankle FracturesPediatric ankle fractures include several types. Salter-Harris type I and type II usually | Surgery_Schwartz. flexible IM nails may be used, especially if the child weighs less than 100 lbs (45 kg). If the fracture is too proximal or too distal, or if the fracture is comminuted and unstable, a submuscu-lar bridge plate is usually used; alternatively, an external fix-ator may also be used, especially in multiple trauma patients. If the patient is older than 11 years, an interlocking IM rod with a lateral trochanteric entry is used. Insertion of IM rod in younger children can cause avascular necrosis of the femoral head due to interruption of the blood supply. Refracture of the femur is a risk after using an external fixator. Overgrowth of the injured femur with leg length discrepancy can occur in children between 2 and 10 years of age.Figure 43-52. Classification of growth plate injuries.Brunicardi_Ch43_p1879-p1924.indd 191622/02/19 10:41 AM 1917ORTHOPEDIC SURGERYCHAPTER 43Pediatric Ankle FracturesPediatric ankle fractures include several types. Salter-Harris type I and type II usually |
Surgery_Schwartz_12641 | Surgery_Schwartz | 191622/02/19 10:41 AM 1917ORTHOPEDIC SURGERYCHAPTER 43Pediatric Ankle FracturesPediatric ankle fractures include several types. Salter-Harris type I and type II usually involve the fibula, and the fracture may not be apparent. The patient may present with pain and swelling. Salter-Harris type III usually involves fracture of the medial malleolus or avulsion of the anterior inferior tibiofibular ligament from the tibia. It is called a Tillaux fracture. Tillaux fractures occur because the lateral part of the ankle is not fused and it is weak. Triplane fractures are complex ankle fractures in older children as a result of partial closure of the growth plate, and they appear as a Salter II in the lateral view and as a Salter III in an AP view (Fig. 43-53). Salter-Harris I and II fractures are usually managed with casting. Salter-Harris III or IV fractures are usually managed by closed or open reduction and internal fixation. Smooth percutaneous pins or screws are utilized, avoiding | Surgery_Schwartz. 191622/02/19 10:41 AM 1917ORTHOPEDIC SURGERYCHAPTER 43Pediatric Ankle FracturesPediatric ankle fractures include several types. Salter-Harris type I and type II usually involve the fibula, and the fracture may not be apparent. The patient may present with pain and swelling. Salter-Harris type III usually involves fracture of the medial malleolus or avulsion of the anterior inferior tibiofibular ligament from the tibia. It is called a Tillaux fracture. Tillaux fractures occur because the lateral part of the ankle is not fused and it is weak. Triplane fractures are complex ankle fractures in older children as a result of partial closure of the growth plate, and they appear as a Salter II in the lateral view and as a Salter III in an AP view (Fig. 43-53). Salter-Harris I and II fractures are usually managed with casting. Salter-Harris III or IV fractures are usually managed by closed or open reduction and internal fixation. Smooth percutaneous pins or screws are utilized, avoiding |
Surgery_Schwartz_12642 | Surgery_Schwartz | are usually managed with casting. Salter-Harris III or IV fractures are usually managed by closed or open reduction and internal fixation. Smooth percutaneous pins or screws are utilized, avoiding the physis.Pediatric Elbow FracturesManagement of pediatric elbow fractures is complex. Famil-iarity with the timing of the ossification centers’ appearance aids in diagnosis. Distal humeral physeal separation can occur from child abuse and can be mistaken for an elbow dislocation. A lateral condylar fracture of the elbow is a significant injury, and when it is displaced it will need anatomical surgical reduc-tion. Medial epicondyle fractures of the elbow are usually treated conservatively unless they are severely displaced. It is associated with elbow dislocation in 50% of cases. When the elbow is reduced, the fragment may lodge in the joint itself and must be removed and fixed. In supracondylar fractures of the humerus (Fig. 43-54), the neurovascular status of the extrem-ity must be | Surgery_Schwartz. are usually managed with casting. Salter-Harris III or IV fractures are usually managed by closed or open reduction and internal fixation. Smooth percutaneous pins or screws are utilized, avoiding the physis.Pediatric Elbow FracturesManagement of pediatric elbow fractures is complex. Famil-iarity with the timing of the ossification centers’ appearance aids in diagnosis. Distal humeral physeal separation can occur from child abuse and can be mistaken for an elbow dislocation. A lateral condylar fracture of the elbow is a significant injury, and when it is displaced it will need anatomical surgical reduc-tion. Medial epicondyle fractures of the elbow are usually treated conservatively unless they are severely displaced. It is associated with elbow dislocation in 50% of cases. When the elbow is reduced, the fragment may lodge in the joint itself and must be removed and fixed. In supracondylar fractures of the humerus (Fig. 43-54), the neurovascular status of the extrem-ity must be |
Surgery_Schwartz_12643 | Surgery_Schwartz | elbow is reduced, the fragment may lodge in the joint itself and must be removed and fixed. In supracondylar fractures of the humerus (Fig. 43-54), the neurovascular status of the extrem-ity must be assessed carefully before, during, and after treat-ment. The anterior interosseous nerve could be injured, and the patient may not be able to make an “OK sign” (Fig. 43-55). The brachial artery may also be injured. Closed reduction, pos-sible open reduction, and percutaneous pinning is usually done for these fractures. The procedure should be done emergently if there is concern about the vascular status of the extremity. Close follow-up for maintenance of reduction and neurovas-cular status is needed.DEVELOPMENTAL DISEASEDevelopmental Dysplasia of the HipDevelopmental dysplasia of the hip (DDH) involves a spectrum of disease that includes dysplasia, subluxation, or dislocation of the hip. Teratologic hip dislocation is a different entity in which the hip is dislocated in utero and | Surgery_Schwartz. elbow is reduced, the fragment may lodge in the joint itself and must be removed and fixed. In supracondylar fractures of the humerus (Fig. 43-54), the neurovascular status of the extrem-ity must be assessed carefully before, during, and after treat-ment. The anterior interosseous nerve could be injured, and the patient may not be able to make an “OK sign” (Fig. 43-55). The brachial artery may also be injured. Closed reduction, pos-sible open reduction, and percutaneous pinning is usually done for these fractures. The procedure should be done emergently if there is concern about the vascular status of the extremity. Close follow-up for maintenance of reduction and neurovas-cular status is needed.DEVELOPMENTAL DISEASEDevelopmental Dysplasia of the HipDevelopmental dysplasia of the hip (DDH) involves a spectrum of disease that includes dysplasia, subluxation, or dislocation of the hip. Teratologic hip dislocation is a different entity in which the hip is dislocated in utero and |
Surgery_Schwartz_12644 | Surgery_Schwartz | hip (DDH) involves a spectrum of disease that includes dysplasia, subluxation, or dislocation of the hip. Teratologic hip dislocation is a different entity in which the hip is dislocated in utero and irreducible on neonatal examination, usually associated with neuromuscular conditions and genetic syndromes. Developmental dysplasia of the hip is most often seen in firstborn females with a positive family history or with breech birth.Untreated hip dislocations can lead to a dysplastic acetab-ulum, and they should be recognized and treated early. New-borns are examined for hip instability within the first 72 hours HumerusFigure 43-54. Supracondylar fracture of the humerus.Figure 43-55. Unable to make the “OK” sign due to interosseous nerve injury.Figure 43-53. Triplane fracture of the ankle in children.Brunicardi_Ch43_p1879-p1924.indd 191722/02/19 10:42 AM 1918SPECIFIC CONSIDERATIONSPART IIof life. Ortolani’s test consists of gentle elevation and abduction of the femur causing a | Surgery_Schwartz. hip (DDH) involves a spectrum of disease that includes dysplasia, subluxation, or dislocation of the hip. Teratologic hip dislocation is a different entity in which the hip is dislocated in utero and irreducible on neonatal examination, usually associated with neuromuscular conditions and genetic syndromes. Developmental dysplasia of the hip is most often seen in firstborn females with a positive family history or with breech birth.Untreated hip dislocations can lead to a dysplastic acetab-ulum, and they should be recognized and treated early. New-borns are examined for hip instability within the first 72 hours HumerusFigure 43-54. Supracondylar fracture of the humerus.Figure 43-55. Unable to make the “OK” sign due to interosseous nerve injury.Figure 43-53. Triplane fracture of the ankle in children.Brunicardi_Ch43_p1879-p1924.indd 191722/02/19 10:42 AM 1918SPECIFIC CONSIDERATIONSPART IIof life. Ortolani’s test consists of gentle elevation and abduction of the femur causing a |
Surgery_Schwartz_12645 | Surgery_Schwartz | in children.Brunicardi_Ch43_p1879-p1924.indd 191722/02/19 10:42 AM 1918SPECIFIC CONSIDERATIONSPART IIof life. Ortolani’s test consists of gentle elevation and abduction of the femur causing a palpable click in the relocation of a dis-located hip. Barlow’s test is gentle adduction and depression of the femur, which causes a palpable click as the hip slips into a dislocated position. In older infants (older than 3 months), limited abduction of the involved hip is an important finding. Infants with a dislocated or dislocatable hip will have apparent length discrepancies of the femur when the hip is positioned at 90° (Galeazzi test).Since the bones are not ossified at birth, X-ray images of the acetabulum and femoral head are not reliable for diag-nosis. Ultrasound is the imaging modality of choice in the neonatal period and can often demonstrate a dislocated or dislocatable hip.Treatment of DDHThe main goal in the treatment of DDH is to achieve stable concentric reduction of the | Surgery_Schwartz. in children.Brunicardi_Ch43_p1879-p1924.indd 191722/02/19 10:42 AM 1918SPECIFIC CONSIDERATIONSPART IIof life. Ortolani’s test consists of gentle elevation and abduction of the femur causing a palpable click in the relocation of a dis-located hip. Barlow’s test is gentle adduction and depression of the femur, which causes a palpable click as the hip slips into a dislocated position. In older infants (older than 3 months), limited abduction of the involved hip is an important finding. Infants with a dislocated or dislocatable hip will have apparent length discrepancies of the femur when the hip is positioned at 90° (Galeazzi test).Since the bones are not ossified at birth, X-ray images of the acetabulum and femoral head are not reliable for diag-nosis. Ultrasound is the imaging modality of choice in the neonatal period and can often demonstrate a dislocated or dislocatable hip.Treatment of DDHThe main goal in the treatment of DDH is to achieve stable concentric reduction of the |
Surgery_Schwartz_12646 | Surgery_Schwartz | of choice in the neonatal period and can often demonstrate a dislocated or dislocatable hip.Treatment of DDHThe main goal in the treatment of DDH is to achieve stable concentric reduction of the hip.• Neonate to 6 months: Early treatment with abduction and flexion in a Pavlik harness for 6 to 12 weeks is usually suf-ficient. Avoid severe abduction and flexion in the Pavlik har-ness to avoid the risk of avascular necrosis of the femoral head and femoral nerve palsy.• Children 6 to 18 months: Closed reduction and application of hip spica cast is indicated in this age group and in those children who failed Pavlik harness treatment.• Children older than 18 months: Open reduction and cap-sulorrhaphy is indicated in this age group. A variety of procedures, including femoral shortening and pelvic osteoto-mies, are done in older age groups and in more severe cases. Osteonecrosis of the femoral head is a possible complication of treatment and can result in pain and decreased range of | Surgery_Schwartz. of choice in the neonatal period and can often demonstrate a dislocated or dislocatable hip.Treatment of DDHThe main goal in the treatment of DDH is to achieve stable concentric reduction of the hip.• Neonate to 6 months: Early treatment with abduction and flexion in a Pavlik harness for 6 to 12 weeks is usually suf-ficient. Avoid severe abduction and flexion in the Pavlik har-ness to avoid the risk of avascular necrosis of the femoral head and femoral nerve palsy.• Children 6 to 18 months: Closed reduction and application of hip spica cast is indicated in this age group and in those children who failed Pavlik harness treatment.• Children older than 18 months: Open reduction and cap-sulorrhaphy is indicated in this age group. A variety of procedures, including femoral shortening and pelvic osteoto-mies, are done in older age groups and in more severe cases. Osteonecrosis of the femoral head is a possible complication of treatment and can result in pain and decreased range of |
Surgery_Schwartz_12647 | Surgery_Schwartz | and pelvic osteoto-mies, are done in older age groups and in more severe cases. Osteonecrosis of the femoral head is a possible complication of treatment and can result in pain and decreased range of motion.Legg-Calvé-Perthes DiseaseOsteonecrosis of the proximal femoral epiphysis can cause flattening of the femoral head called Legg-Calvé Perthes disease. The age at presentation is between 4 and 8 years of age and occurs more in males, usually affecting one side. Younger age at presentation (less than 6 years old) will have a better prognosis. The patient presents with groin or knee pain, decreased hip motion, and a limp. Treatment includes traction, physical therapy, abduction exercises, and crutches. Restoration of range of motion is important. Femoral and pelvic osteotomies may be needed in extreme cases and in older children.Slipped Capital Femoral EpiphysisChildren ages 10 to 16 years can develop displacement of the epiphysis on the femoral neck with no history of injury. The | Surgery_Schwartz. and pelvic osteoto-mies, are done in older age groups and in more severe cases. Osteonecrosis of the femoral head is a possible complication of treatment and can result in pain and decreased range of motion.Legg-Calvé-Perthes DiseaseOsteonecrosis of the proximal femoral epiphysis can cause flattening of the femoral head called Legg-Calvé Perthes disease. The age at presentation is between 4 and 8 years of age and occurs more in males, usually affecting one side. Younger age at presentation (less than 6 years old) will have a better prognosis. The patient presents with groin or knee pain, decreased hip motion, and a limp. Treatment includes traction, physical therapy, abduction exercises, and crutches. Restoration of range of motion is important. Femoral and pelvic osteotomies may be needed in extreme cases and in older children.Slipped Capital Femoral EpiphysisChildren ages 10 to 16 years can develop displacement of the epiphysis on the femoral neck with no history of injury. The |
Surgery_Schwartz_12648 | Surgery_Schwartz | in extreme cases and in older children.Slipped Capital Femoral EpiphysisChildren ages 10 to 16 years can develop displacement of the epiphysis on the femoral neck with no history of injury. The slippage occurs through the weak zone (hypertrophic zone) of the growth plate. When slippage occurs in young patients, check for endocrine disorders such as hypothyroid-ism, renal osteodystrophy, and growth hormone deficiency. Slipped capital femoral epiphysis (SCFE) is associated with African-American heritage and obesity, and it is more com-mon in boys than in girls. One-quarter of cases are bilateral. In patients with endocrine etiology, the condition is usually bilateral. Patients generally present with groin and anterior thigh pain, and the patient may have antalgic gait and a limp. Patient may present with knee pain that can lead to missing the diagnosis. In pediatric patients with knee pain, the ipsi-lateral hip should be assessed as well.Examination of the patient will show obligatory | Surgery_Schwartz. in extreme cases and in older children.Slipped Capital Femoral EpiphysisChildren ages 10 to 16 years can develop displacement of the epiphysis on the femoral neck with no history of injury. The slippage occurs through the weak zone (hypertrophic zone) of the growth plate. When slippage occurs in young patients, check for endocrine disorders such as hypothyroid-ism, renal osteodystrophy, and growth hormone deficiency. Slipped capital femoral epiphysis (SCFE) is associated with African-American heritage and obesity, and it is more com-mon in boys than in girls. One-quarter of cases are bilateral. In patients with endocrine etiology, the condition is usually bilateral. Patients generally present with groin and anterior thigh pain, and the patient may have antalgic gait and a limp. Patient may present with knee pain that can lead to missing the diagnosis. In pediatric patients with knee pain, the ipsi-lateral hip should be assessed as well.Examination of the patient will show obligatory |
Surgery_Schwartz_12649 | Surgery_Schwartz | present with knee pain that can lead to missing the diagnosis. In pediatric patients with knee pain, the ipsi-lateral hip should be assessed as well.Examination of the patient will show obligatory external rotation with flexion and loss of internal rotation of the hip. Obtain AP and frog leg lateral views of both the hips.Slipped epiphysis is classified as either stable or unstable on the basis of the patient’s ability to bear weight. It is classi-fied as stable if the patient is able to bear weight and the risk of osteonecrosis is less than 10%. It is classified as unstable if the patient is unable to bear weight even with crutches, and the incidence of avascular necrosis is high.Treatment for slipped capital femoral epiphysis patients is percutaneous screw fixation through the femoral neck to engage the epiphysis, causing the growth plate to close. Reduc-tion of the slipped epiphysis is not recommended because of an increased risk of avascular necrosis. One screw is usually adequate | Surgery_Schwartz. present with knee pain that can lead to missing the diagnosis. In pediatric patients with knee pain, the ipsi-lateral hip should be assessed as well.Examination of the patient will show obligatory external rotation with flexion and loss of internal rotation of the hip. Obtain AP and frog leg lateral views of both the hips.Slipped epiphysis is classified as either stable or unstable on the basis of the patient’s ability to bear weight. It is classi-fied as stable if the patient is able to bear weight and the risk of osteonecrosis is less than 10%. It is classified as unstable if the patient is unable to bear weight even with crutches, and the incidence of avascular necrosis is high.Treatment for slipped capital femoral epiphysis patients is percutaneous screw fixation through the femoral neck to engage the epiphysis, causing the growth plate to close. Reduc-tion of the slipped epiphysis is not recommended because of an increased risk of avascular necrosis. One screw is usually adequate |
Surgery_Schwartz_12650 | Surgery_Schwartz | to engage the epiphysis, causing the growth plate to close. Reduc-tion of the slipped epiphysis is not recommended because of an increased risk of avascular necrosis. One screw is usually adequate to prevent further slip.Lower Extremity Rotational AbnormalitiesIntoeing can result from femoral anteversion, tibial torsion, and metatarsus adductus. Mild degree of intoeing is normal in young children 3 to 5 years of age.Excessive internal rotation of the femur will usually cor-rect by age 8. Severe rotation with functional impairment that does not correct by age 10 or 11 may require rotational femoral osteotomy.Tibial torsion is the most common cause of intoeing in toddlers and could be bilateral. The condition usually resolves without treatment.Metatarsus adductus in infants will also resolve spontane-ously in most cases.Congenital Talipes Equinovarus (Clubfoot)Clubfoot is a congenital disorder, and its etiology is not known. Clubfoot is a common problem associated with con-tractures of | Surgery_Schwartz. to engage the epiphysis, causing the growth plate to close. Reduc-tion of the slipped epiphysis is not recommended because of an increased risk of avascular necrosis. One screw is usually adequate to prevent further slip.Lower Extremity Rotational AbnormalitiesIntoeing can result from femoral anteversion, tibial torsion, and metatarsus adductus. Mild degree of intoeing is normal in young children 3 to 5 years of age.Excessive internal rotation of the femur will usually cor-rect by age 8. Severe rotation with functional impairment that does not correct by age 10 or 11 may require rotational femoral osteotomy.Tibial torsion is the most common cause of intoeing in toddlers and could be bilateral. The condition usually resolves without treatment.Metatarsus adductus in infants will also resolve spontane-ously in most cases.Congenital Talipes Equinovarus (Clubfoot)Clubfoot is a congenital disorder, and its etiology is not known. Clubfoot is a common problem associated with con-tractures of |
Surgery_Schwartz_12651 | Surgery_Schwartz | spontane-ously in most cases.Congenital Talipes Equinovarus (Clubfoot)Clubfoot is a congenital disorder, and its etiology is not known. Clubfoot is a common problem associated with con-tractures of the medial tendons of the foot, a tight Achilles tendon, and contractures of the ankle, hindfoot, and midfoot. The foot is usually small, and it is in the equinus, varus, cavus, and adduction position. Talipes equinovarus can be corrected by sequential corrective casting of the foot. The serial manip-ulation and the casting technique is called the Ponseti tech-nique, and it has a high success rate. A successful program of casting may be complete in 1 to 5 months. In patients with severe disease or who initiate treatment after 9 months of age, surgical release of contracted soft tissues may be necessary. The procedure is called posteromedial soft tissue release and tendon lengthening.Osgood-Schlatter DiseaseOsgood-Schlatter disease is a common problem most often seen in athletically active | Surgery_Schwartz. spontane-ously in most cases.Congenital Talipes Equinovarus (Clubfoot)Clubfoot is a congenital disorder, and its etiology is not known. Clubfoot is a common problem associated with con-tractures of the medial tendons of the foot, a tight Achilles tendon, and contractures of the ankle, hindfoot, and midfoot. The foot is usually small, and it is in the equinus, varus, cavus, and adduction position. Talipes equinovarus can be corrected by sequential corrective casting of the foot. The serial manip-ulation and the casting technique is called the Ponseti tech-nique, and it has a high success rate. A successful program of casting may be complete in 1 to 5 months. In patients with severe disease or who initiate treatment after 9 months of age, surgical release of contracted soft tissues may be necessary. The procedure is called posteromedial soft tissue release and tendon lengthening.Osgood-Schlatter DiseaseOsgood-Schlatter disease is a common problem most often seen in athletically active |
Surgery_Schwartz_12652 | Surgery_Schwartz | necessary. The procedure is called posteromedial soft tissue release and tendon lengthening.Osgood-Schlatter DiseaseOsgood-Schlatter disease is a common problem most often seen in athletically active adolescents, especially in sprint-ers and jumpers. It is a traction apophysitis of tibial tubercule (Figs. 43-56 and 43-57). One must know the difference between the epiphysis, apophysis, and physis. This disorder is charac-terized by ossification in the distal patellar tendon at the point of its tibial insertion, and it is thought to result from mechani-cal stress on the tendinous insertion. The disease presents with severe local pain and tenderness in the area of the tibial tubercle. Radiographs may show calcified ossicles within the tendon at its insertion.Brunicardi_Ch43_p1879-p1924.indd 191822/02/19 10:42 AM 1919ORTHOPEDIC SURGERYCHAPTER 43Treatment for the disease is activity restriction and anti-inflammatory drugs. The majority of patients improve with con-servative treatment, | Surgery_Schwartz. necessary. The procedure is called posteromedial soft tissue release and tendon lengthening.Osgood-Schlatter DiseaseOsgood-Schlatter disease is a common problem most often seen in athletically active adolescents, especially in sprint-ers and jumpers. It is a traction apophysitis of tibial tubercule (Figs. 43-56 and 43-57). One must know the difference between the epiphysis, apophysis, and physis. This disorder is charac-terized by ossification in the distal patellar tendon at the point of its tibial insertion, and it is thought to result from mechani-cal stress on the tendinous insertion. The disease presents with severe local pain and tenderness in the area of the tibial tubercle. Radiographs may show calcified ossicles within the tendon at its insertion.Brunicardi_Ch43_p1879-p1924.indd 191822/02/19 10:42 AM 1919ORTHOPEDIC SURGERYCHAPTER 43Treatment for the disease is activity restriction and anti-inflammatory drugs. The majority of patients improve with con-servative treatment, |
Surgery_Schwartz_12653 | Surgery_Schwartz | 191822/02/19 10:42 AM 1919ORTHOPEDIC SURGERYCHAPTER 43Treatment for the disease is activity restriction and anti-inflammatory drugs. The majority of patients improve with con-servative treatment, and athletic participation can be resumed. Usually, symptoms regress after skeletal maturity or after activ-ity modification. In refractory cases, surgery in the form of ossicle excision is rarely done.BIBLIOGRAPHYEntries highlighted in bright blue are key references.TraumaBhandari M, Devereaux PJ, Tornetta III P, et al. Operative man-agement of displaced femoral neck fractures in elderly patients: an international survey. J Bone Joint Surg Am. 2005;87(9):2122-2130.Bond CD, Shin AY, McBride MT, Dao KD. Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid frac-tures. J Bone Joint Surg Am. 2001;83(4):483-488.Bone LB, Johnson KD, Weigelt J, et al. Early vs. delayed stabiliza-tion of femoral fractures. A prospective randomized study. J Bone Joint Surg Am. | Surgery_Schwartz. 191822/02/19 10:42 AM 1919ORTHOPEDIC SURGERYCHAPTER 43Treatment for the disease is activity restriction and anti-inflammatory drugs. The majority of patients improve with con-servative treatment, and athletic participation can be resumed. Usually, symptoms regress after skeletal maturity or after activ-ity modification. In refractory cases, surgery in the form of ossicle excision is rarely done.BIBLIOGRAPHYEntries highlighted in bright blue are key references.TraumaBhandari M, Devereaux PJ, Tornetta III P, et al. Operative man-agement of displaced femoral neck fractures in elderly patients: an international survey. J Bone Joint Surg Am. 2005;87(9):2122-2130.Bond CD, Shin AY, McBride MT, Dao KD. Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid frac-tures. J Bone Joint Surg Am. 2001;83(4):483-488.Bone LB, Johnson KD, Weigelt J, et al. Early vs. delayed stabiliza-tion of femoral fractures. A prospective randomized study. J Bone Joint Surg Am. |
Surgery_Schwartz_12654 | Surgery_Schwartz | J Bone Joint Surg Am. 2001;83(4):483-488.Bone LB, Johnson KD, Weigelt J, et al. Early vs. delayed stabiliza-tion of femoral fractures. A prospective randomized study. J Bone Joint Surg Am. 1989;71:336-340.Bottlang M, Krieg JC, Mohr M, Simpson TS, Madey SM. Emergent management of pelvic ring fractures with use of circumferential compression. J Bone Joint Surg Am. 2002;84-A(suppl 2):43-47.Burgess AR, Eastridge BJ, Young JWR, et al. Pelvic ring disrup-tions: Effective classification system and treatment protocols. J Trauma. 1990;30(7):848-856.De Ugarte DA, Morizono K, Elbarbary A, et al. Comparison of multi-lineage cells from human adipose and bone marrow. Cells, Tissue, and Organs. 2003;174:101-109.Dragoo JL, Samimi B, Zhu M, et al. Tissue-engineered cartilage and bone using stem cells from human infrapatellar fat pads. JBJS. 2003;85-B:740-747.Ebraheim N, Cooper J, Siddiqui S. Compartment syndrome book-let. University of Toledo Medical Center. March 1, 2018. Avail-able at: | Surgery_Schwartz. J Bone Joint Surg Am. 2001;83(4):483-488.Bone LB, Johnson KD, Weigelt J, et al. Early vs. delayed stabiliza-tion of femoral fractures. A prospective randomized study. J Bone Joint Surg Am. 1989;71:336-340.Bottlang M, Krieg JC, Mohr M, Simpson TS, Madey SM. Emergent management of pelvic ring fractures with use of circumferential compression. J Bone Joint Surg Am. 2002;84-A(suppl 2):43-47.Burgess AR, Eastridge BJ, Young JWR, et al. Pelvic ring disrup-tions: Effective classification system and treatment protocols. J Trauma. 1990;30(7):848-856.De Ugarte DA, Morizono K, Elbarbary A, et al. Comparison of multi-lineage cells from human adipose and bone marrow. Cells, Tissue, and Organs. 2003;174:101-109.Dragoo JL, Samimi B, Zhu M, et al. Tissue-engineered cartilage and bone using stem cells from human infrapatellar fat pads. JBJS. 2003;85-B:740-747.Ebraheim N, Cooper J, Siddiqui S. Compartment syndrome book-let. University of Toledo Medical Center. March 1, 2018. Avail-able at: |
Surgery_Schwartz_12655 | Surgery_Schwartz | cells from human infrapatellar fat pads. JBJS. 2003;85-B:740-747.Ebraheim N, Cooper J, Siddiqui S. Compartment syndrome book-let. University of Toledo Medical Center. March 1, 2018. Avail-able at: www.utoledo.edu/med/cme/pdf/Compartment%20Syndrome%20Booklet%20and%20Post%20Test%20water marked.pdf. Accessed August 14, 2018.Ebraheim N, Cooper J, Corba L. Synopsis of fractures and dislo-cations. University of Toledo Medical Center. March 1, 2018. Available at: www.utoledo.edu/med/cme/pdf/Synopsis%20of%20Fractures%20and%20Dislocations%20Booklet%20and%20Post%20Test%20Watermarked.pdf. Accessed August 13, 2018.Ebraheim N, Lea J, Cooper J, Corba L. Orthopaedic emergencies booklet. University of Toledo Medical Center. March 1, 2018. Available at: www.utoledo.edu/med/cme/pdf/Orthopedic%20Emergencies%20Booklet%20and%20Post%20Test%20Water marked.pdf. Accessed August 14, 2018.Frankle MA, Herscovici D, DiPasquale TG, Vasey MB, Sanders RW. A comparison of open reduction and internal fixation and | Surgery_Schwartz. cells from human infrapatellar fat pads. JBJS. 2003;85-B:740-747.Ebraheim N, Cooper J, Siddiqui S. Compartment syndrome book-let. University of Toledo Medical Center. March 1, 2018. Avail-able at: www.utoledo.edu/med/cme/pdf/Compartment%20Syndrome%20Booklet%20and%20Post%20Test%20water marked.pdf. Accessed August 14, 2018.Ebraheim N, Cooper J, Corba L. Synopsis of fractures and dislo-cations. University of Toledo Medical Center. March 1, 2018. Available at: www.utoledo.edu/med/cme/pdf/Synopsis%20of%20Fractures%20and%20Dislocations%20Booklet%20and%20Post%20Test%20Watermarked.pdf. Accessed August 13, 2018.Ebraheim N, Lea J, Cooper J, Corba L. Orthopaedic emergencies booklet. University of Toledo Medical Center. March 1, 2018. Available at: www.utoledo.edu/med/cme/pdf/Orthopedic%20Emergencies%20Booklet%20and%20Post%20Test%20Water marked.pdf. Accessed August 14, 2018.Frankle MA, Herscovici D, DiPasquale TG, Vasey MB, Sanders RW. A comparison of open reduction and internal fixation and |
Surgery_Schwartz_12656 | Surgery_Schwartz | marked.pdf. Accessed August 14, 2018.Frankle MA, Herscovici D, DiPasquale TG, Vasey MB, Sanders RW. A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraar-ticular distal humerus fractures in women older than age 65. J Ortho Trauma. 2003;17(7):473-480. Holstein A, Lewis GB. Fractures of the humerus with radial-nerve paralysis. J Bone Joint Surg Am. 1963;45:1382-1388.Lauge-Hansen N. Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg. 1950;60:957-985.Leslie IJ, Dickson RA. The fractured carpal scaphoid. Natu-ral history and factors influencing outcome. Bone Joint J. 1981;63(2):225-230.Letournel E. Acetabulum fractures: classification and management. Clin Orthop Relat Res. 1980;151:81-106.Lin J. Treatment of humeral shaft fractures with humeral locked nail and comparison with plate fixation. J Trauma. 1998;44(5):859-864.Liporace FA, Adams MR, Capo JT, et al. | Surgery_Schwartz. marked.pdf. Accessed August 14, 2018.Frankle MA, Herscovici D, DiPasquale TG, Vasey MB, Sanders RW. A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraar-ticular distal humerus fractures in women older than age 65. J Ortho Trauma. 2003;17(7):473-480. Holstein A, Lewis GB. Fractures of the humerus with radial-nerve paralysis. J Bone Joint Surg Am. 1963;45:1382-1388.Lauge-Hansen N. Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg. 1950;60:957-985.Leslie IJ, Dickson RA. The fractured carpal scaphoid. Natu-ral history and factors influencing outcome. Bone Joint J. 1981;63(2):225-230.Letournel E. Acetabulum fractures: classification and management. Clin Orthop Relat Res. 1980;151:81-106.Lin J. Treatment of humeral shaft fractures with humeral locked nail and comparison with plate fixation. J Trauma. 1998;44(5):859-864.Liporace FA, Adams MR, Capo JT, et al. |
Surgery_Schwartz_12657 | Surgery_Schwartz | Relat Res. 1980;151:81-106.Lin J. Treatment of humeral shaft fractures with humeral locked nail and comparison with plate fixation. J Trauma. 1998;44(5):859-864.Liporace FA, Adams MR, Capo JT, et al. Distal radius fractures. J Orthop Trauma. 2009;23(10):739-748.McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome: who is at risk? J Bone Joint Surg Br. 2000;82(2): 200-203.Figure 43-57. Differences between physis, epiphysis, and apophysis.Figure 43-56. Osgood Schlatter lesion.Brunicardi_Ch43_p1879-p1924.indd 191922/02/19 10:42 AM 1920SPECIFIC CONSIDERATIONSPART IIMoran CG, Wenn RT, Sikand M, Taylor AM. Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am. 2005;87:483-489.Moro JK, Werier J, MacDermid JC, Patterson SD, King GJ. Arthro-plasty with a metal radial head for unreconstructible fractures of the radial head. J Bone Joint Surg Am. 2001;83-A(8):1201-1211.Neer CS. Displaced proximal humeral fractures. J Bone Joint Surg Am. | Surgery_Schwartz. Relat Res. 1980;151:81-106.Lin J. Treatment of humeral shaft fractures with humeral locked nail and comparison with plate fixation. J Trauma. 1998;44(5):859-864.Liporace FA, Adams MR, Capo JT, et al. Distal radius fractures. J Orthop Trauma. 2009;23(10):739-748.McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome: who is at risk? J Bone Joint Surg Br. 2000;82(2): 200-203.Figure 43-57. Differences between physis, epiphysis, and apophysis.Figure 43-56. Osgood Schlatter lesion.Brunicardi_Ch43_p1879-p1924.indd 191922/02/19 10:42 AM 1920SPECIFIC CONSIDERATIONSPART IIMoran CG, Wenn RT, Sikand M, Taylor AM. Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am. 2005;87:483-489.Moro JK, Werier J, MacDermid JC, Patterson SD, King GJ. Arthro-plasty with a metal radial head for unreconstructible fractures of the radial head. J Bone Joint Surg Am. 2001;83-A(8):1201-1211.Neer CS. Displaced proximal humeral fractures. J Bone Joint Surg Am. |
Surgery_Schwartz_12658 | Surgery_Schwartz | with a metal radial head for unreconstructible fractures of the radial head. J Bone Joint Surg Am. 2001;83-A(8):1201-1211.Neer CS. Displaced proximal humeral fractures. J Bone Joint Surg Am. 1970;52(6):1077-1089.Nicoll EA. Fractures of the tibial shaft: a survey of 705 cases. J Bone Joint Surg Br. 1964;46:373-387.Nork SE, Cannada LK. Hip dislocations and femoral head and neck fractures. In: Baumgaertner MR, Tornetta P III, eds. Orthopaedic Knowledge Update: Trauma 3. Rosemont: American Academy of Orthopaedic Surgeons; 2005:365-376.Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg Am. 2002;84:547-551.Ring D, Quintero J, Jupiter JB. Open reduction and internal fixa-tion of fractures of the radial head. J Bone Joint Surg Am. 2002;84-A(10):1811-1815.Roberts CS, Pape HC, Jones AL. Damage control orthopaedics: evolving concepts in the treatment of patients who have sus-tained orthopaedic trauma. Instr | Surgery_Schwartz. with a metal radial head for unreconstructible fractures of the radial head. J Bone Joint Surg Am. 2001;83-A(8):1201-1211.Neer CS. Displaced proximal humeral fractures. J Bone Joint Surg Am. 1970;52(6):1077-1089.Nicoll EA. Fractures of the tibial shaft: a survey of 705 cases. J Bone Joint Surg Br. 1964;46:373-387.Nork SE, Cannada LK. Hip dislocations and femoral head and neck fractures. In: Baumgaertner MR, Tornetta P III, eds. Orthopaedic Knowledge Update: Trauma 3. Rosemont: American Academy of Orthopaedic Surgeons; 2005:365-376.Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg Am. 2002;84:547-551.Ring D, Quintero J, Jupiter JB. Open reduction and internal fixa-tion of fractures of the radial head. J Bone Joint Surg Am. 2002;84-A(10):1811-1815.Roberts CS, Pape HC, Jones AL. Damage control orthopaedics: evolving concepts in the treatment of patients who have sus-tained orthopaedic trauma. Instr |
Surgery_Schwartz_12659 | Surgery_Schwartz | J Bone Joint Surg Am. 2002;84-A(10):1811-1815.Roberts CS, Pape HC, Jones AL. Damage control orthopaedics: evolving concepts in the treatment of patients who have sus-tained orthopaedic trauma. Instr Course Lect. 2005;54: 447-462.Ross G, McDevitt ER, Chronister R, Ove PN. Treatment of sim-ple elbow dislocation using immediate motion protocol. Am J Sports Med. 1999;27:308-311.Sanders S, Tejwani N, Egol KA. Traumatic hip dislocation. Bull NYU Hosp Jt Dis. 2010;68(2):91-96.Sarmiento A, Kinman PB, Galvin EG, et al. Functional bracing of fractures of the shaft of the humerus. J Bone Joint Surg Am. 1977;59:596-601.Schatzker J, McBroom R, Bruce DD. The tibial plateau fracture: the Toronto experience 1968-1975. ClinOrthop. 1979;138:94-104.Schemitsch EH, Richards RR. The effect of malunion on functional outcome after plate fixation of fractures of both bones of the forearm in adults. J Bone Joint Surg Am. 1992;74(7):1068-1078.Schmidt AH, Asnis SE, Haidukewych GI, et al. Femoral neck frac-tures. | Surgery_Schwartz. J Bone Joint Surg Am. 2002;84-A(10):1811-1815.Roberts CS, Pape HC, Jones AL. Damage control orthopaedics: evolving concepts in the treatment of patients who have sus-tained orthopaedic trauma. Instr Course Lect. 2005;54: 447-462.Ross G, McDevitt ER, Chronister R, Ove PN. Treatment of sim-ple elbow dislocation using immediate motion protocol. Am J Sports Med. 1999;27:308-311.Sanders S, Tejwani N, Egol KA. Traumatic hip dislocation. Bull NYU Hosp Jt Dis. 2010;68(2):91-96.Sarmiento A, Kinman PB, Galvin EG, et al. Functional bracing of fractures of the shaft of the humerus. J Bone Joint Surg Am. 1977;59:596-601.Schatzker J, McBroom R, Bruce DD. The tibial plateau fracture: the Toronto experience 1968-1975. ClinOrthop. 1979;138:94-104.Schemitsch EH, Richards RR. The effect of malunion on functional outcome after plate fixation of fractures of both bones of the forearm in adults. J Bone Joint Surg Am. 1992;74(7):1068-1078.Schmidt AH, Asnis SE, Haidukewych GI, et al. Femoral neck frac-tures. |
Surgery_Schwartz_12660 | Surgery_Schwartz | outcome after plate fixation of fractures of both bones of the forearm in adults. J Bone Joint Surg Am. 1992;74(7):1068-1078.Schmidt AH, Asnis SE, Haidukewych GI, et al. Femoral neck frac-tures. Instr Course Lect. 2005;54:417-445.Schutz M, Ruedi TP. Principles of internal fixation. In: Buchholz C. Rockwood and Green’s Fractures in Adults. Philadelphia: Wolters Kluwer Health; 2014.Shin SSS. Circulatory and vascular changes in the hip following traumatic hip dislocation. ClinOrthop. 1979;140:255-261.Sidor ML, Zuckerman JD, Lyon T, Koval K, Cuomo F, Schoen-berg N. The Neer classification system for proximal humeral fractures. An assessment of interobserver reliabil-ity and intraobserver reproducibility. J Bone Joint Surg Am. 1993;75(12):1745-1750.Tidermark J, Ponzer S, Svensson O, Söderqvist A, et al. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly: a randomised, controlled trial. J Bone Joint Surg Br. 2003;85(3):380-388.Tile MM. | Surgery_Schwartz. outcome after plate fixation of fractures of both bones of the forearm in adults. J Bone Joint Surg Am. 1992;74(7):1068-1078.Schmidt AH, Asnis SE, Haidukewych GI, et al. Femoral neck frac-tures. Instr Course Lect. 2005;54:417-445.Schutz M, Ruedi TP. Principles of internal fixation. In: Buchholz C. Rockwood and Green’s Fractures in Adults. Philadelphia: Wolters Kluwer Health; 2014.Shin SSS. Circulatory and vascular changes in the hip following traumatic hip dislocation. ClinOrthop. 1979;140:255-261.Sidor ML, Zuckerman JD, Lyon T, Koval K, Cuomo F, Schoen-berg N. The Neer classification system for proximal humeral fractures. An assessment of interobserver reliabil-ity and intraobserver reproducibility. J Bone Joint Surg Am. 1993;75(12):1745-1750.Tidermark J, Ponzer S, Svensson O, Söderqvist A, et al. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly: a randomised, controlled trial. J Bone Joint Surg Br. 2003;85(3):380-388.Tile MM. |
Surgery_Schwartz_12661 | Surgery_Schwartz | A, et al. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly: a randomised, controlled trial. J Bone Joint Surg Br. 2003;85(3):380-388.Tile MM. Acute pelvic fracture II. Principles of management. J Am Acad Orthop. 1996;4:152-161.Tile MM. Acute pelvic fracture: I. Causation and classification. J Am Acad Orthop. 1996;4:143-151.Wolfe SW. Distal radius fractures. Green’s Operative Hand Surgery. 6th ed. Philadelphia, PA: Churchill Livingstone; 2011:561-638.Yagishita K, Thomas BJ. Use of allograft for large Hill-Sachs lesion associated with anterior glenohumeral dislocation. A case report. Injury. 2002;33:791-794.SportsAllaire R, Muriuki M, Gilbertson L, Harner CD. Biomechani-cal consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am. 2008;90(9):1922-1931.Araujo P, Van Eck CF, Torabi M, Fu FH. How to optimize the use of MRI in anatomic ACL reconstruction. Knee Surg | Surgery_Schwartz. A, et al. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly: a randomised, controlled trial. J Bone Joint Surg Br. 2003;85(3):380-388.Tile MM. Acute pelvic fracture II. Principles of management. J Am Acad Orthop. 1996;4:152-161.Tile MM. Acute pelvic fracture: I. Causation and classification. J Am Acad Orthop. 1996;4:143-151.Wolfe SW. Distal radius fractures. Green’s Operative Hand Surgery. 6th ed. Philadelphia, PA: Churchill Livingstone; 2011:561-638.Yagishita K, Thomas BJ. Use of allograft for large Hill-Sachs lesion associated with anterior glenohumeral dislocation. A case report. Injury. 2002;33:791-794.SportsAllaire R, Muriuki M, Gilbertson L, Harner CD. Biomechani-cal consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am. 2008;90(9):1922-1931.Araujo P, Van Eck CF, Torabi M, Fu FH. How to optimize the use of MRI in anatomic ACL reconstruction. Knee Surg |
Surgery_Schwartz_12662 | Surgery_Schwartz | meniscus. Similar to total meniscectomy. J Bone Joint Surg Am. 2008;90(9):1922-1931.Araujo P, Van Eck CF, Torabi M, Fu FH. How to optimize the use of MRI in anatomic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2013;21(7):1495-1501.Arnoczky SP, Warren RF, Spivak JM. Meniscal repair using an exogenous fibrin clot. An experimental study in dogs. J Bone Joint Surg Am. 1988;70(8):1209-1217.Baer GS, Harner CD. Clinical outcomes of allograft versus auto-graft in anterior cruciate ligament reconstruction. Clin Sports Med. 2007;26(4):661-681.Brophy RH, Marx RG. The treatment of traumatic anterior insta-bility of the shoulder: nonoperative and surgical treatment. Arthroscopy. 2009;25:298-304.Byers PD, Contepomi CA, Farkas TA. A post mortem study of the hip joint. Including the prevalence of the features of the right side. Ann Rheum Dis. 1970;29(1):15-31.Byrd JWT, Jones KS. Arthroscopic femoroplasty in the manage-ment of cam-type femoroacetabular impingement. Clin Orthop Relat Res. | Surgery_Schwartz. meniscus. Similar to total meniscectomy. J Bone Joint Surg Am. 2008;90(9):1922-1931.Araujo P, Van Eck CF, Torabi M, Fu FH. How to optimize the use of MRI in anatomic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2013;21(7):1495-1501.Arnoczky SP, Warren RF, Spivak JM. Meniscal repair using an exogenous fibrin clot. An experimental study in dogs. J Bone Joint Surg Am. 1988;70(8):1209-1217.Baer GS, Harner CD. Clinical outcomes of allograft versus auto-graft in anterior cruciate ligament reconstruction. Clin Sports Med. 2007;26(4):661-681.Brophy RH, Marx RG. The treatment of traumatic anterior insta-bility of the shoulder: nonoperative and surgical treatment. Arthroscopy. 2009;25:298-304.Byers PD, Contepomi CA, Farkas TA. A post mortem study of the hip joint. Including the prevalence of the features of the right side. Ann Rheum Dis. 1970;29(1):15-31.Byrd JWT, Jones KS. Arthroscopic femoroplasty in the manage-ment of cam-type femoroacetabular impingement. Clin Orthop Relat Res. |
Surgery_Schwartz_12663 | Surgery_Schwartz | of the features of the right side. Ann Rheum Dis. 1970;29(1):15-31.Byrd JWT, Jones KS. Arthroscopic femoroplasty in the manage-ment of cam-type femoroacetabular impingement. Clin Orthop Relat Res. 2009;467:739-746.Byrd JWT, Jones KS. Prospective analysis of hip arthroscopy with 10-year follow-up. Clin Orthop Relat Res. 2010;468: 741-746.Carey JL, Dunn WR, Dahm DL, Zeger SL, Spindler KP. A sys-tematic review of anterior cruciate ligament reconstruction with autograft compared with allograft. J Bone Joint Surg Am. 2009;91(9):2242-2250.Clarke MT, Arora A, Villar RN. Hip arthroscopy: complications in 1054 cases. Clin Orthop Relat Res. 2003;(406):84-88.Fetto JF, Marshall JL. Medial collateral ligament injuries of the knee: a rationale for treatment. Clin Orthop Relat Res. 1978;(132):206-218.Frost A, Zafar MS, Maffulli N. Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps brachii. Am J Sports Med. 2009;37(4):828-833.Ganz R, Parvizi | Surgery_Schwartz. of the features of the right side. Ann Rheum Dis. 1970;29(1):15-31.Byrd JWT, Jones KS. Arthroscopic femoroplasty in the manage-ment of cam-type femoroacetabular impingement. Clin Orthop Relat Res. 2009;467:739-746.Byrd JWT, Jones KS. Prospective analysis of hip arthroscopy with 10-year follow-up. Clin Orthop Relat Res. 2010;468: 741-746.Carey JL, Dunn WR, Dahm DL, Zeger SL, Spindler KP. A sys-tematic review of anterior cruciate ligament reconstruction with autograft compared with allograft. J Bone Joint Surg Am. 2009;91(9):2242-2250.Clarke MT, Arora A, Villar RN. Hip arthroscopy: complications in 1054 cases. Clin Orthop Relat Res. 2003;(406):84-88.Fetto JF, Marshall JL. Medial collateral ligament injuries of the knee: a rationale for treatment. Clin Orthop Relat Res. 1978;(132):206-218.Frost A, Zafar MS, Maffulli N. Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps brachii. Am J Sports Med. 2009;37(4):828-833.Ganz R, Parvizi |
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Surgery_Schwartz_12667 | Surgery_Schwartz | posterior cruciate ligament reconstruction: minimum 2-year follow-up. Arthroscopy. 2006;22:320-328.Mohtadi NG, Hollinshead RM, Sasyniuk TM, et al. A randomized clinical trial comparing open to arthroscopic acromioplasty with mini-open rotator cuff repair for full-thickness rotator cuff tears: disease-specific quality of life outcome at an aver-age 2-year follow-up. Am J Sports Med. 2008;36(6):1043-1051.Morse K, Davis AD, Afra R, et al. Arthroscopic versus mini-open rotator cuff repair: a comprehensive review and meta-analysis. Am J Sports Med. 2008;36:1824-1828.Nho SJ, Shindle MK, Sherman SL, et al. Systematic review of arthroscopic rotator cuff repair and mini-open rotator cuff repair. J Bone Joint Surg Am. 2007;89:127-136.Pallis M, Svoboda SJ, Cameron KL, et al. Survival comparison of allograft and autograft anterior cruciate ligament reconstruc-tion at the United States Military Academy. Am J Sports Med. 2012;40(6):1242-1246.Philippon MJ, Briggs KK, Yen YM, et al. Outcomes | Surgery_Schwartz. posterior cruciate ligament reconstruction: minimum 2-year follow-up. Arthroscopy. 2006;22:320-328.Mohtadi NG, Hollinshead RM, Sasyniuk TM, et al. A randomized clinical trial comparing open to arthroscopic acromioplasty with mini-open rotator cuff repair for full-thickness rotator cuff tears: disease-specific quality of life outcome at an aver-age 2-year follow-up. Am J Sports Med. 2008;36(6):1043-1051.Morse K, Davis AD, Afra R, et al. Arthroscopic versus mini-open rotator cuff repair: a comprehensive review and meta-analysis. Am J Sports Med. 2008;36:1824-1828.Nho SJ, Shindle MK, Sherman SL, et al. Systematic review of arthroscopic rotator cuff repair and mini-open rotator cuff repair. J Bone Joint Surg Am. 2007;89:127-136.Pallis M, Svoboda SJ, Cameron KL, et al. Survival comparison of allograft and autograft anterior cruciate ligament reconstruc-tion at the United States Military Academy. Am J Sports Med. 2012;40(6):1242-1246.Philippon MJ, Briggs KK, Yen YM, et al. Outcomes |
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Surgery_Schwartz_12671 | Surgery_Schwartz | cruciate ligament reconstruction flow-chart. Arthroscopy. 2010;26:258-268.Verma NN, Dunn W, Adler RS, et al. All-arthroscopic versus mini-open rotator cuff repair: a retrospective review with minimum 2-year follow-up. Arthroscopy. 2006;22:587-594.Weaver JK, Dunn HK. Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg. 1972;54(6):1187-1194.Wolf RS, Zheng N, Weichel D. Long head biceps tenotomy versus tenodesis: a cadaveric biomechanical analysis. Arthroscopy. 2005;21:182-185.SpineAnderson LD, D’alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg. 1974;56(8):1663-1674.Apuzzo ML, Heiden JS, Weiss MH, Ackerson TT, Harvey JP, Kurze T. Acute fractures of the odontoid process: an analysis of 45 cases. J Neurosurg. 1978 Jan;48(1):85-91.Asher MA, Burton DC. Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis. 2006;1(1):2.Bailitz J, Starr F, Beecroft M, et al. CT should | Surgery_Schwartz. cruciate ligament reconstruction flow-chart. Arthroscopy. 2010;26:258-268.Verma NN, Dunn W, Adler RS, et al. All-arthroscopic versus mini-open rotator cuff repair: a retrospective review with minimum 2-year follow-up. Arthroscopy. 2006;22:587-594.Weaver JK, Dunn HK. Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg. 1972;54(6):1187-1194.Wolf RS, Zheng N, Weichel D. Long head biceps tenotomy versus tenodesis: a cadaveric biomechanical analysis. Arthroscopy. 2005;21:182-185.SpineAnderson LD, D’alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg. 1974;56(8):1663-1674.Apuzzo ML, Heiden JS, Weiss MH, Ackerson TT, Harvey JP, Kurze T. Acute fractures of the odontoid process: an analysis of 45 cases. J Neurosurg. 1978 Jan;48(1):85-91.Asher MA, Burton DC. Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis. 2006;1(1):2.Bailitz J, Starr F, Beecroft M, et al. CT should |
Surgery_Schwartz_12672 | Surgery_Schwartz | 1978 Jan;48(1):85-91.Asher MA, Burton DC. Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis. 2006;1(1):2.Bailitz J, Starr F, Beecroft M, et al. CT should replace three-view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma. 2009;66(6):1605-1609.Bellabarba C, Mirza SK, West GA, et al. Diagnosis and treatment of craniocervical dislocation in a series of 17 consecutive survivors during an 8-year period. J Neurosurg Spine. 2006;4(6): 429-440.Ben Galim PJ, Sibai T, Hipp JA, et al. Internal decapitation: survival after head to neck dissociation injuries. Spine. 2008;33(16):1744-1749.Bransford RJ, Alton TB, Patel AR, Bellabarba C. Upper cervical spine trauma. J Am Acad Orthop Surg. 2014;22(11):718-729.Ceroni D, Mousny M, Lironi A, Kaelin A. Pediatric seatbelt inju-ries: unusual Chance’s fracture associated with intra-abdominal lesions in a child. | Surgery_Schwartz. 1978 Jan;48(1):85-91.Asher MA, Burton DC. Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis. 2006;1(1):2.Bailitz J, Starr F, Beecroft M, et al. CT should replace three-view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma. 2009;66(6):1605-1609.Bellabarba C, Mirza SK, West GA, et al. Diagnosis and treatment of craniocervical dislocation in a series of 17 consecutive survivors during an 8-year period. J Neurosurg Spine. 2006;4(6): 429-440.Ben Galim PJ, Sibai T, Hipp JA, et al. Internal decapitation: survival after head to neck dissociation injuries. Spine. 2008;33(16):1744-1749.Bransford RJ, Alton TB, Patel AR, Bellabarba C. Upper cervical spine trauma. J Am Acad Orthop Surg. 2014;22(11):718-729.Ceroni D, Mousny M, Lironi A, Kaelin A. Pediatric seatbelt inju-ries: unusual Chance’s fracture associated with intra-abdominal lesions in a child. |
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Surgery_Schwartz_12674 | Surgery_Schwartz | review of the literature. J Spinal Disord Tech. 2011;24(7):469-473.El-Khoury GY, Kathol MH, Daniel WW. Imaging of acute injuries of the cervical spine: value of plain radiography, CT, and MR imaging. AJR Am J Roentgenol. 1995;164(1):43-50.Fehlings MG, Sekhon LH, Tator C. The role and timing of decompression in acute spinal cord injury. Spine. 2001;26: s101-s110.Fehlings MG, Tator CH. An evidence-based review of decompres-sive surgery in acute spinal cord injury: rationale, indications, and timing based on experimental and clinical studies. J Neuro-surg Spine. 1999;91:1-11.Genevay S, Courvoisier DS, Konstantinou K, et al. Clinical classification criteria for neurogenic claudication caused by lumbar spinal stenosis. The N-CLASS criteria. Spine J. 2018;18(6):941-947.Joaquim AF, Patel AA, Schroeder GD, Vaccaro AR. A simplified treatment algorithm for treating thoracic and lumbar spine trauma. J Spinal Cord Med. 2018;7:1-11.Kesterson L, Benzel E, Orrison W, Coleman J. Evaluation and | Surgery_Schwartz. review of the literature. J Spinal Disord Tech. 2011;24(7):469-473.El-Khoury GY, Kathol MH, Daniel WW. Imaging of acute injuries of the cervical spine: value of plain radiography, CT, and MR imaging. AJR Am J Roentgenol. 1995;164(1):43-50.Fehlings MG, Sekhon LH, Tator C. The role and timing of decompression in acute spinal cord injury. Spine. 2001;26: s101-s110.Fehlings MG, Tator CH. An evidence-based review of decompres-sive surgery in acute spinal cord injury: rationale, indications, and timing based on experimental and clinical studies. J Neuro-surg Spine. 1999;91:1-11.Genevay S, Courvoisier DS, Konstantinou K, et al. Clinical classification criteria for neurogenic claudication caused by lumbar spinal stenosis. The N-CLASS criteria. Spine J. 2018;18(6):941-947.Joaquim AF, Patel AA, Schroeder GD, Vaccaro AR. A simplified treatment algorithm for treating thoracic and lumbar spine trauma. J Spinal Cord Med. 2018;7:1-11.Kesterson L, Benzel E, Orrison W, Coleman J. Evaluation and |
Surgery_Schwartz_12675 | Surgery_Schwartz | Schroeder GD, Vaccaro AR. A simplified treatment algorithm for treating thoracic and lumbar spine trauma. J Spinal Cord Med. 2018;7:1-11.Kesterson L, Benzel E, Orrison W, Coleman J. Evaluation and treat-ment of atlas burst fractures (Jefferson fractures). J Neurosurg. 1991;75(2):213-220.Kwon BK, Vaccaro AR, Grauer JN, Fisher CG, Dvorak MF. Subaxial cervical spine trauma. J Am Acad Orthop Surg. 2006;14(2):78-89.Li XF, Dai LY, Lu H, Chen XD. A systematic review of the manage-ment of hangman’s fractures. Eur Spine J. 2006;15(3):257-269.Brunicardi_Ch43_p1879-p1924.indd 192122/02/19 10:42 AM 1922SPECIFIC CONSIDERATIONSPART IIMacias CA, Rosengart MR, Puyana JC, et al. The effects of trauma center care, admission volume, and surgical volume on paralysis after traumatic spinal cord injury. Ann Surg. 2009;249(1):10-17.McAFEE PC, Yuan HA, Lasda NA. The unstable burst fracture. Spine. 1982;7(4):365-373.Negrini S, Aulisa AG, Aulisa L, et al. 2011 SOSORT guidelines: orthopaedic and | Surgery_Schwartz. Schroeder GD, Vaccaro AR. A simplified treatment algorithm for treating thoracic and lumbar spine trauma. J Spinal Cord Med. 2018;7:1-11.Kesterson L, Benzel E, Orrison W, Coleman J. Evaluation and treat-ment of atlas burst fractures (Jefferson fractures). J Neurosurg. 1991;75(2):213-220.Kwon BK, Vaccaro AR, Grauer JN, Fisher CG, Dvorak MF. Subaxial cervical spine trauma. J Am Acad Orthop Surg. 2006;14(2):78-89.Li XF, Dai LY, Lu H, Chen XD. A systematic review of the manage-ment of hangman’s fractures. Eur Spine J. 2006;15(3):257-269.Brunicardi_Ch43_p1879-p1924.indd 192122/02/19 10:42 AM 1922SPECIFIC CONSIDERATIONSPART IIMacias CA, Rosengart MR, Puyana JC, et al. The effects of trauma center care, admission volume, and surgical volume on paralysis after traumatic spinal cord injury. Ann Surg. 2009;249(1):10-17.McAFEE PC, Yuan HA, Lasda NA. The unstable burst fracture. Spine. 1982;7(4):365-373.Negrini S, Aulisa AG, Aulisa L, et al. 2011 SOSORT guidelines: orthopaedic and |
Surgery_Schwartz_12676 | Surgery_Schwartz | injury. Ann Surg. 2009;249(1):10-17.McAFEE PC, Yuan HA, Lasda NA. The unstable burst fracture. Spine. 1982;7(4):365-373.Negrini S, Aulisa AG, Aulisa L, et al. 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis. 2012;7(1):3.Reid AB, Letts RM, Black GB. Pediatric Chance fractures: associa-tion with intra-abdominal injuries and seatbelt use. J Trauma. 1990;30(4):384-391.Rorabeck CH, Rock MG, Hawkins RJ, Bourne RB. Unilateral facet dislocation of the cervical spine. An analysis of the results of treatment in 26 patients. Spine. 1987;12(1):23-27.Shapiro S. Medical realities of cauda equina syndrome secondary to lumbar disc herniation. Spine. 2000;25(3):348-352.Shields CB, Zhang YP, Shields LB, Han Y, Burke DA, Mayer NW. The therapeutic window for spinal cord decompression in a rat spinal cord injury model. J Neurosurg Spine. 2005;3: 302-307.Spector LR, Madigan L, Rhyne A, Darden B 2nd, Kim D. Cauda equina syndrome. J Am Acad | Surgery_Schwartz. injury. Ann Surg. 2009;249(1):10-17.McAFEE PC, Yuan HA, Lasda NA. The unstable burst fracture. Spine. 1982;7(4):365-373.Negrini S, Aulisa AG, Aulisa L, et al. 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis. 2012;7(1):3.Reid AB, Letts RM, Black GB. Pediatric Chance fractures: associa-tion with intra-abdominal injuries and seatbelt use. J Trauma. 1990;30(4):384-391.Rorabeck CH, Rock MG, Hawkins RJ, Bourne RB. Unilateral facet dislocation of the cervical spine. An analysis of the results of treatment in 26 patients. Spine. 1987;12(1):23-27.Shapiro S. Medical realities of cauda equina syndrome secondary to lumbar disc herniation. Spine. 2000;25(3):348-352.Shields CB, Zhang YP, Shields LB, Han Y, Burke DA, Mayer NW. The therapeutic window for spinal cord decompression in a rat spinal cord injury model. J Neurosurg Spine. 2005;3: 302-307.Spector LR, Madigan L, Rhyne A, Darden B 2nd, Kim D. Cauda equina syndrome. J Am Acad |
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Surgery_Schwartz_12681 | Surgery_Schwartz | versus computer-navigated acetabular component insertion. J Arthroplasty. 2007;22(2):151-159.Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br. 1982;64(1):17-19.Hootman JM, Helmick CG. Projections of U.S. prevalence of arthritis and associated activity limitations. Arthritis Rheum. 2006;54(1):266-229.Hürlimann M, Schiapparelli FF, Rotigliano N, Testa E, Amsler F, Hirschmann MT. Influence of surgical approach on hetero-topic ossification after total hip arthroplasty—is minimal inva-sive better? A case control study. BMC Musculoskelet Disord. 2017;18(1):27.Jewett BA, Collis DK. High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Rel Res. 2010;469(2):503-507.Johnston RC, Brand RA, Crowninshield RD. Reconstruction of the hip. A mathematical approach to determine optimum geometric relationships. J Bone Joint Surg Am. 1979;61:639-652.Jones CW, Jerabek SA. Current role of computer navigation in total knee arthroplasty. J | Surgery_Schwartz. versus computer-navigated acetabular component insertion. J Arthroplasty. 2007;22(2):151-159.Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br. 1982;64(1):17-19.Hootman JM, Helmick CG. Projections of U.S. prevalence of arthritis and associated activity limitations. Arthritis Rheum. 2006;54(1):266-229.Hürlimann M, Schiapparelli FF, Rotigliano N, Testa E, Amsler F, Hirschmann MT. Influence of surgical approach on hetero-topic ossification after total hip arthroplasty—is minimal inva-sive better? A case control study. BMC Musculoskelet Disord. 2017;18(1):27.Jewett BA, Collis DK. High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Rel Res. 2010;469(2):503-507.Johnston RC, Brand RA, Crowninshield RD. Reconstruction of the hip. A mathematical approach to determine optimum geometric relationships. J Bone Joint Surg Am. 1979;61:639-652.Jones CW, Jerabek SA. Current role of computer navigation in total knee arthroplasty. J |
Surgery_Schwartz_12682 | Surgery_Schwartz | A mathematical approach to determine optimum geometric relationships. J Bone Joint Surg Am. 1979;61:639-652.Jones CW, Jerabek SA. Current role of computer navigation in total knee arthroplasty. J Arthroplasty. 2018;33(7):1989-1993.Kim YH, Park JW, Kim JS. Computer-navigated versus conven-tional total knee arthroplasty: a prospective randomized trial. J Bone Joint Surg Am. 2012;94(22):2017-2024.Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780-785.Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ. Does surgical approach affect total hip arthroplasty dislocation rates? Clin Orthop Relat Res. 2006;447:34-38.Maratt JD, Gagnier JJ, Butler PD, Hallstrom BR, Urquhart AG, Roberts KC. No difference in dislocation seen in anterior vs posterior approach total hip arthroplasty. J Arthroplasty. 2016;31(9):127-130.Meneghini, R. Michael, et al. Direct | Surgery_Schwartz. A mathematical approach to determine optimum geometric relationships. J Bone Joint Surg Am. 1979;61:639-652.Jones CW, Jerabek SA. Current role of computer navigation in total knee arthroplasty. J Arthroplasty. 2018;33(7):1989-1993.Kim YH, Park JW, Kim JS. Computer-navigated versus conven-tional total knee arthroplasty: a prospective randomized trial. J Bone Joint Surg Am. 2012;94(22):2017-2024.Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780-785.Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ. Does surgical approach affect total hip arthroplasty dislocation rates? Clin Orthop Relat Res. 2006;447:34-38.Maratt JD, Gagnier JJ, Butler PD, Hallstrom BR, Urquhart AG, Roberts KC. No difference in dislocation seen in anterior vs posterior approach total hip arthroplasty. J Arthroplasty. 2016;31(9):127-130.Meneghini, R. Michael, et al. Direct |
Surgery_Schwartz_12683 | Surgery_Schwartz | BR, Urquhart AG, Roberts KC. No difference in dislocation seen in anterior vs posterior approach total hip arthroplasty. J Arthroplasty. 2016;31(9):127-130.Meneghini, R. Michael, et al. Direct anterior approach: risk factor for early femoral failure of cementless total hip arthroplasty: a multicenter study. J Bone Joint Surg Am. 2017;99(2):99-105.Miller, Larry E., et al. Does surgical approach affect outcomes in total hip arthroplasty through 90 days of follow-up? A systematic review with meta-analysis. J Arthroplasty. 2018;33(4):1296-1302.Murphy L, Schwartz TA, Helmick CG, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008;59(9):1207-1213.Pai VS. A modified direct lateral approach in total hip arthroplasty. J Orthop Surg. 2002;10(1):35-39.Penninx BW, Messier SP, Rejeski WJ, et al. Physical exercise and the prevention of disability in activities of daily liv-ing in older persons with osteoarthritis. Arch Intern Med. 2001;161(19):2309-2316.Pivec R, Johnson | Surgery_Schwartz. BR, Urquhart AG, Roberts KC. No difference in dislocation seen in anterior vs posterior approach total hip arthroplasty. J Arthroplasty. 2016;31(9):127-130.Meneghini, R. Michael, et al. Direct anterior approach: risk factor for early femoral failure of cementless total hip arthroplasty: a multicenter study. J Bone Joint Surg Am. 2017;99(2):99-105.Miller, Larry E., et al. Does surgical approach affect outcomes in total hip arthroplasty through 90 days of follow-up? A systematic review with meta-analysis. J Arthroplasty. 2018;33(4):1296-1302.Murphy L, Schwartz TA, Helmick CG, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008;59(9):1207-1213.Pai VS. A modified direct lateral approach in total hip arthroplasty. J Orthop Surg. 2002;10(1):35-39.Penninx BW, Messier SP, Rejeski WJ, et al. Physical exercise and the prevention of disability in activities of daily liv-ing in older persons with osteoarthritis. Arch Intern Med. 2001;161(19):2309-2316.Pivec R, Johnson |
Surgery_Schwartz_12684 | Surgery_Schwartz | SP, Rejeski WJ, et al. Physical exercise and the prevention of disability in activities of daily liv-ing in older persons with osteoarthritis. Arch Intern Med. 2001;161(19):2309-2316.Pivec R, Johnson AJ, Mears SC, et al. Hip arthroplasty. Lancet. 2012;380(9855):1768-1777.Pospischill M, Kranzl A, Attwenger B, Knahr K. Minimally inva-sive compared with traditional transgluteal approach for total hip arthroplasty: a comparative gait analysis. J Bone Joint Surg Am. 2010;92(2):328-337.Brunicardi_Ch43_p1879-p1924.indd 192222/02/19 10:42 AM 1923ORTHOPEDIC SURGERYCHAPTER 43Sassoon A, Nam D, Nunley R, et al. Systematic review of patient-specific instrumentation in total knee arthroplasty: new but not improved. Clin Orthop Relat Res. 2015;473(1):151-158.Shih M, Hootman JM, Kruger J, Helmick CG. Physical activity in men and women with arthritis National Health Interview Survey, 2002. Am J Prev Med. 2006;30(5):385-393.Soong M, Rubash HE, Macaulay W. Dislocation after total hip arthroplasty. | Surgery_Schwartz. SP, Rejeski WJ, et al. Physical exercise and the prevention of disability in activities of daily liv-ing in older persons with osteoarthritis. Arch Intern Med. 2001;161(19):2309-2316.Pivec R, Johnson AJ, Mears SC, et al. Hip arthroplasty. Lancet. 2012;380(9855):1768-1777.Pospischill M, Kranzl A, Attwenger B, Knahr K. Minimally inva-sive compared with traditional transgluteal approach for total hip arthroplasty: a comparative gait analysis. J Bone Joint Surg Am. 2010;92(2):328-337.Brunicardi_Ch43_p1879-p1924.indd 192222/02/19 10:42 AM 1923ORTHOPEDIC SURGERYCHAPTER 43Sassoon A, Nam D, Nunley R, et al. Systematic review of patient-specific instrumentation in total knee arthroplasty: new but not improved. Clin Orthop Relat Res. 2015;473(1):151-158.Shih M, Hootman JM, Kruger J, Helmick CG. Physical activity in men and women with arthritis National Health Interview Survey, 2002. Am J Prev Med. 2006;30(5):385-393.Soong M, Rubash HE, Macaulay W. Dislocation after total hip arthroplasty. |
Surgery_Schwartz_12685 | Surgery_Schwartz | Physical activity in men and women with arthritis National Health Interview Survey, 2002. Am J Prev Med. 2006;30(5):385-393.Soong M, Rubash HE, Macaulay W. Dislocation after total hip arthroplasty. Am Acad Orthop Surg. 2004;12:314-321.Taunton MJ, Trousdale RT, Sierra RJ, Kaufman K, Pagnano MW. John Charnley award: Randomized Clinical Trial of Direct Anterior and Miniposterior Approach THA: Which Provides Better Functional Recovery? Clin Orthop Rel Res. 2018;476(2):216-229.Tronzo RG. Surgical approaches to the hip. Surgery of the Hip Joint. New York: Springer; 1984:75-113.Vail T, Callaghan J. Minimal incision total hip arthroplasty. J Am Acad Orthop Surg. 2007;15:707-715.Whatling GM, Dabke HV, Holt CA, Jones L, Madete J, Alderman PM, Roberts P. Objective functional assessment of total hip arthroplasty following two common surgical approaches: the posterior and direct lateral approaches. Proc Inst Mech Eng H. 2008;222(6):897-905.Whiteside LA. Soft tissue balancing: the knee. J | Surgery_Schwartz. Physical activity in men and women with arthritis National Health Interview Survey, 2002. Am J Prev Med. 2006;30(5):385-393.Soong M, Rubash HE, Macaulay W. Dislocation after total hip arthroplasty. Am Acad Orthop Surg. 2004;12:314-321.Taunton MJ, Trousdale RT, Sierra RJ, Kaufman K, Pagnano MW. John Charnley award: Randomized Clinical Trial of Direct Anterior and Miniposterior Approach THA: Which Provides Better Functional Recovery? Clin Orthop Rel Res. 2018;476(2):216-229.Tronzo RG. Surgical approaches to the hip. Surgery of the Hip Joint. New York: Springer; 1984:75-113.Vail T, Callaghan J. Minimal incision total hip arthroplasty. J Am Acad Orthop Surg. 2007;15:707-715.Whatling GM, Dabke HV, Holt CA, Jones L, Madete J, Alderman PM, Roberts P. Objective functional assessment of total hip arthroplasty following two common surgical approaches: the posterior and direct lateral approaches. Proc Inst Mech Eng H. 2008;222(6):897-905.Whiteside LA. Soft tissue balancing: the knee. J |
Surgery_Schwartz_12686 | Surgery_Schwartz | hip arthroplasty following two common surgical approaches: the posterior and direct lateral approaches. Proc Inst Mech Eng H. 2008;222(6):897-905.Whiteside LA. Soft tissue balancing: the knee. J Arthroplasty. 2002;17(4):23-27.Orthopedic OncologyAndresen KJ, Sundaram M, Unni KK, Sim FH. Imaging features of low-grade central osteosarcoma of the long bones and pelvis. Skeletal Radiol. 2004;33(7):373-379.Becker N. Epidemiology of multiple myeloma. In: Moehler T, Goldschmidt H, eds. Multiple Myeloma. Berlin: Springer; 2011:25-35.Chakarun CJ, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk Jr GR. Giant cell tumor of bone: review, mim-ics, and new developments in treatment. Radiographics. 2013;33(1):197-211.Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res. 2006;12(20): 6243s-6249s.Dai X, Ma W, He X, Jha RK. Review of therapeutic strategies for osteosarcoma, chondrosarcoma, and Ewing’s sarcoma. Med Sci Monit. | Surgery_Schwartz. hip arthroplasty following two common surgical approaches: the posterior and direct lateral approaches. Proc Inst Mech Eng H. 2008;222(6):897-905.Whiteside LA. Soft tissue balancing: the knee. J Arthroplasty. 2002;17(4):23-27.Orthopedic OncologyAndresen KJ, Sundaram M, Unni KK, Sim FH. Imaging features of low-grade central osteosarcoma of the long bones and pelvis. Skeletal Radiol. 2004;33(7):373-379.Becker N. Epidemiology of multiple myeloma. In: Moehler T, Goldschmidt H, eds. Multiple Myeloma. Berlin: Springer; 2011:25-35.Chakarun CJ, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk Jr GR. Giant cell tumor of bone: review, mim-ics, and new developments in treatment. Radiographics. 2013;33(1):197-211.Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res. 2006;12(20): 6243s-6249s.Dai X, Ma W, He X, Jha RK. Review of therapeutic strategies for osteosarcoma, chondrosarcoma, and Ewing’s sarcoma. Med Sci Monit. |
Surgery_Schwartz_12687 | Surgery_Schwartz | risk of skeletal morbidity. Clin Cancer Res. 2006;12(20): 6243s-6249s.Dai X, Ma W, He X, Jha RK. Review of therapeutic strategies for osteosarcoma, chondrosarcoma, and Ewing’s sarcoma. Med Sci Monit. 2011;17(8):RA177-190.Gaspar N, Hawkins DS, Dirksen U, et al. Ewing sarcoma: current management and future approaches through collaboration. J Clin Oncol. 2015;33(27):3036-3046.Giuffrida AY, Burgueno JE, Koniaris LG, Gutierrez JC, Duncan R, Scully SP. Chondrosarcoma in the United States (1973 to 2003): an analysis of 2890 cases from the SEER database. J Bone Joint Surg Am. 2009;91(5):1063-1072.Inwards CY, Wenger D. Parosteal osteosarcoma. In: Tumors and Tumor-Like Lesions of Bone. London: Springer; 2015: 217-226.Jawad MU, Cheung MC, Min ES, Schneiderbauer MM, Koniaris LG, Scully SP. Ewing’s sarcoma demonstrates racial disparities in incidence-related and sex-related differences in outcome: an analysis of 1631 cases from the SEER database, 1973-2005. Cancer. 2009;115(15):3526-3536.Klenke | Surgery_Schwartz. risk of skeletal morbidity. Clin Cancer Res. 2006;12(20): 6243s-6249s.Dai X, Ma W, He X, Jha RK. Review of therapeutic strategies for osteosarcoma, chondrosarcoma, and Ewing’s sarcoma. Med Sci Monit. 2011;17(8):RA177-190.Gaspar N, Hawkins DS, Dirksen U, et al. Ewing sarcoma: current management and future approaches through collaboration. J Clin Oncol. 2015;33(27):3036-3046.Giuffrida AY, Burgueno JE, Koniaris LG, Gutierrez JC, Duncan R, Scully SP. Chondrosarcoma in the United States (1973 to 2003): an analysis of 2890 cases from the SEER database. J Bone Joint Surg Am. 2009;91(5):1063-1072.Inwards CY, Wenger D. Parosteal osteosarcoma. In: Tumors and Tumor-Like Lesions of Bone. London: Springer; 2015: 217-226.Jawad MU, Cheung MC, Min ES, Schneiderbauer MM, Koniaris LG, Scully SP. Ewing’s sarcoma demonstrates racial disparities in incidence-related and sex-related differences in outcome: an analysis of 1631 cases from the SEER database, 1973-2005. Cancer. 2009;115(15):3526-3536.Klenke |
Surgery_Schwartz_12688 | Surgery_Schwartz | sarcoma demonstrates racial disparities in incidence-related and sex-related differences in outcome: an analysis of 1631 cases from the SEER database, 1973-2005. Cancer. 2009;115(15):3526-3536.Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH. Giant cell tumor of bone: risk factors for recurrence. Clin Orthopaed Relat Res. 2011;469(2):591-599.Kyle RA, Rajkumar SV. Criteria for diagnosis, staging, risk strati-fication and response assessment of multiple myeloma. Leukemia. 2009;23(1):3-9.Luetke A, Meyers PA, Lewis I, Juergens H. Osteosarcoma treat-ment–where do we stand? A state of the art review. Cancer Treat Rev. 2014;40(4):523-532.Mankin HJ, Hornicek FJ. Paget’s sarcoma: a historical and outcome review. Clin Orthopaed Relat Res. 2005;438:97-102.Mirabello L, Troisi RJ, Savage SA. Osteosarcoma incidence and survival rates from 1973 to 2004: data from the sur-veillance, epidemiology, and end results program. Cancer. 2009;115(7):1531-1543.Most MJ, Sim FH, Inwards CY. Osteofibrous | Surgery_Schwartz. sarcoma demonstrates racial disparities in incidence-related and sex-related differences in outcome: an analysis of 1631 cases from the SEER database, 1973-2005. Cancer. 2009;115(15):3526-3536.Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH. Giant cell tumor of bone: risk factors for recurrence. Clin Orthopaed Relat Res. 2011;469(2):591-599.Kyle RA, Rajkumar SV. Criteria for diagnosis, staging, risk strati-fication and response assessment of multiple myeloma. Leukemia. 2009;23(1):3-9.Luetke A, Meyers PA, Lewis I, Juergens H. Osteosarcoma treat-ment–where do we stand? A state of the art review. Cancer Treat Rev. 2014;40(4):523-532.Mankin HJ, Hornicek FJ. Paget’s sarcoma: a historical and outcome review. Clin Orthopaed Relat Res. 2005;438:97-102.Mirabello L, Troisi RJ, Savage SA. Osteosarcoma incidence and survival rates from 1973 to 2004: data from the sur-veillance, epidemiology, and end results program. Cancer. 2009;115(7):1531-1543.Most MJ, Sim FH, Inwards CY. Osteofibrous |
Surgery_Schwartz_12689 | Surgery_Schwartz | incidence and survival rates from 1973 to 2004: data from the sur-veillance, epidemiology, and end results program. Cancer. 2009;115(7):1531-1543.Most MJ, Sim FH, Inwards CY. Osteofibrous dysplasia and ada-mantinoma. J Am Acad Orthop Surg. 2010;18(6):358-366.Rougraff BT. Evaluation of the patient with carcinoma of unknown origin metastatic to bone. Clin Orthop Relat Res. 2003;415(suppl):S105-S109.Spychalski JN, Thomas BJ. Treatment and rehabilitation of patho-logic fractures. State of the Art Reviews: Physical Medicine and Rehabilitation. 1995;9(1):77-92.Visuri T, Pukkala E, Paavolainen P, Pulkkinen P, Riska EB. Cancer risk after metal on metal and polyethylene on metal total hip arthroplasty. Clin Orthop Relat Res. 1996; (329 suppl):S280-S289.Walcott BP, Nahed BV, Mohyeldin A, Coumans JV, Kahle KT, Ferreira MJ. Chordoma: current concepts, management, and future directions. Lancet Oncol. 2012;13(2):e69-e76.Pediatric OrthopedicsBoardman MJ, Herman MJ, Buck B, Pizzutillo PD. Hip | Surgery_Schwartz. incidence and survival rates from 1973 to 2004: data from the sur-veillance, epidemiology, and end results program. Cancer. 2009;115(7):1531-1543.Most MJ, Sim FH, Inwards CY. Osteofibrous dysplasia and ada-mantinoma. J Am Acad Orthop Surg. 2010;18(6):358-366.Rougraff BT. Evaluation of the patient with carcinoma of unknown origin metastatic to bone. Clin Orthop Relat Res. 2003;415(suppl):S105-S109.Spychalski JN, Thomas BJ. Treatment and rehabilitation of patho-logic fractures. State of the Art Reviews: Physical Medicine and Rehabilitation. 1995;9(1):77-92.Visuri T, Pukkala E, Paavolainen P, Pulkkinen P, Riska EB. Cancer risk after metal on metal and polyethylene on metal total hip arthroplasty. Clin Orthop Relat Res. 1996; (329 suppl):S280-S289.Walcott BP, Nahed BV, Mohyeldin A, Coumans JV, Kahle KT, Ferreira MJ. Chordoma: current concepts, management, and future directions. Lancet Oncol. 2012;13(2):e69-e76.Pediatric OrthopedicsBoardman MJ, Herman MJ, Buck B, Pizzutillo PD. Hip |
Surgery_Schwartz_12690 | Surgery_Schwartz | JV, Kahle KT, Ferreira MJ. Chordoma: current concepts, management, and future directions. Lancet Oncol. 2012;13(2):e69-e76.Pediatric OrthopedicsBoardman MJ, Herman MJ, Buck B, Pizzutillo PD. Hip fractures in children. J Am Acad Orthop Surg. 2009;17(3):162-173.Brown JH, DeLuca SA. Growth plate injuries: Salter-Harris clas-sification. Am Fam Phys. 1992;46(4):1180-1184.Crawford AH, Mehlman CT, Slovek RW. The fate of untreated developmental dislocation of the hip: Longterm follow-up of eleven patients. J Pediatr Orthop. 1999;19(5):641-644; 369(9572):1541-1552.Foad SL, Mehlman CT, Ying J. The epidemiology of neonatal bra-chial plexus palsy in the United States. J Bone Joint Surg Am. 2008;90:1258-1264.Flynn JM, Schwend RM. Management of pediatric femoral shaft fractures. J Am Acad Orthop Surg. 2004;12(5):347-359.Gilbert A, Khouri N, and Carloiz H. Birth palsy of the brachial plexus—surgical exploration and attempted repair in twenty one cases (in French). Rev Chir Orthop Reparatrice Appar | Surgery_Schwartz. JV, Kahle KT, Ferreira MJ. Chordoma: current concepts, management, and future directions. Lancet Oncol. 2012;13(2):e69-e76.Pediatric OrthopedicsBoardman MJ, Herman MJ, Buck B, Pizzutillo PD. Hip fractures in children. J Am Acad Orthop Surg. 2009;17(3):162-173.Brown JH, DeLuca SA. Growth plate injuries: Salter-Harris clas-sification. Am Fam Phys. 1992;46(4):1180-1184.Crawford AH, Mehlman CT, Slovek RW. The fate of untreated developmental dislocation of the hip: Longterm follow-up of eleven patients. J Pediatr Orthop. 1999;19(5):641-644; 369(9572):1541-1552.Foad SL, Mehlman CT, Ying J. The epidemiology of neonatal bra-chial plexus palsy in the United States. J Bone Joint Surg Am. 2008;90:1258-1264.Flynn JM, Schwend RM. Management of pediatric femoral shaft fractures. J Am Acad Orthop Surg. 2004;12(5):347-359.Gilbert A, Khouri N, and Carloiz H. Birth palsy of the brachial plexus—surgical exploration and attempted repair in twenty one cases (in French). Rev Chir Orthop Reparatrice Appar |
Surgery_Schwartz_12691 | Surgery_Schwartz | 2004;12(5):347-359.Gilbert A, Khouri N, and Carloiz H. Birth palsy of the brachial plexus—surgical exploration and attempted repair in twenty one cases (in French). Rev Chir Orthop Reparatrice Appar Mot. 1980;66:33-42.Herring JA, Tachdjian MO. Tachdjian’s Pediatric Orthopedics. 5th ed. Philadelphia: Saunders/Elsevier; 2014.Jessel RH, Zurakowski D, Zilkens C, Burstein D, Gray ML, Kim YJ. Radiographic and patient factors associated with pre-radiographic osteoarthritis in hip dysplasia. J Bone Joint Surg Am. 2009;91(5):1120-1129.Jowett CR, Morcuende JA, Ramachandran M. Management of con-genital talipes equinovarus using the Ponseti method: a system-atic review. J Bone Joint Surg Br. 2011;93(9):1160-1164.Kim HK. Legg-Calve-Perthes disease. J Am Acad Orthop Surg. 2010;18(11):676-686.Lee SS, Mahar AT, Miesen D, Newton PO. Displaced pediat-ric supracondylar humerus fractures: biomechanical analy-sis of percutaneous pinning techniques. J Pediatr Orthop. 2002;22(4):440-443.Lincoln TL, Suen | Surgery_Schwartz. 2004;12(5):347-359.Gilbert A, Khouri N, and Carloiz H. Birth palsy of the brachial plexus—surgical exploration and attempted repair in twenty one cases (in French). Rev Chir Orthop Reparatrice Appar Mot. 1980;66:33-42.Herring JA, Tachdjian MO. Tachdjian’s Pediatric Orthopedics. 5th ed. Philadelphia: Saunders/Elsevier; 2014.Jessel RH, Zurakowski D, Zilkens C, Burstein D, Gray ML, Kim YJ. Radiographic and patient factors associated with pre-radiographic osteoarthritis in hip dysplasia. J Bone Joint Surg Am. 2009;91(5):1120-1129.Jowett CR, Morcuende JA, Ramachandran M. Management of con-genital talipes equinovarus using the Ponseti method: a system-atic review. J Bone Joint Surg Br. 2011;93(9):1160-1164.Kim HK. Legg-Calve-Perthes disease. J Am Acad Orthop Surg. 2010;18(11):676-686.Lee SS, Mahar AT, Miesen D, Newton PO. Displaced pediat-ric supracondylar humerus fractures: biomechanical analy-sis of percutaneous pinning techniques. J Pediatr Orthop. 2002;22(4):440-443.Lincoln TL, Suen |
Surgery_Schwartz_12692 | Surgery_Schwartz | Mahar AT, Miesen D, Newton PO. Displaced pediat-ric supracondylar humerus fractures: biomechanical analy-sis of percutaneous pinning techniques. J Pediatr Orthop. 2002;22(4):440-443.Lincoln TL, Suen PW. Common rotational variations in children. J Am Acad Orthop Surg. 2003;11(5):312-320.Loder RT, Aronsson DD, Weinstein SL, Breur GJ, Ganz R, Leunig M. Slipped capital femoral epiphysis. Instr Course Lect. 2008;57:473-498.Mahan ST, Katz JN, Kim YJ. To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip. J Bone Joint Surg Am. 2009;91(7):1705-1719.Murray AW, Wilson NI. Changing incidence of slipped capital fem-oral epiphysis: a relationship with obesity? J Bone Joint Surg Br. 2008;90(1):92-94.O’Donnell S. Pediatric ankle fractures. In: The Orthopedic Consult Survival Guide. New York: Springer; 2017:265-269.Palocaren T, Holmes L, Rogers K, Kumar SJ. Outcome of in situ pinning in patients with unstable slipped capital femoral | Surgery_Schwartz. Mahar AT, Miesen D, Newton PO. Displaced pediat-ric supracondylar humerus fractures: biomechanical analy-sis of percutaneous pinning techniques. J Pediatr Orthop. 2002;22(4):440-443.Lincoln TL, Suen PW. Common rotational variations in children. J Am Acad Orthop Surg. 2003;11(5):312-320.Loder RT, Aronsson DD, Weinstein SL, Breur GJ, Ganz R, Leunig M. Slipped capital femoral epiphysis. Instr Course Lect. 2008;57:473-498.Mahan ST, Katz JN, Kim YJ. To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip. J Bone Joint Surg Am. 2009;91(7):1705-1719.Murray AW, Wilson NI. Changing incidence of slipped capital fem-oral epiphysis: a relationship with obesity? J Bone Joint Surg Br. 2008;90(1):92-94.O’Donnell S. Pediatric ankle fractures. In: The Orthopedic Consult Survival Guide. New York: Springer; 2017:265-269.Palocaren T, Holmes L, Rogers K, Kumar SJ. Outcome of in situ pinning in patients with unstable slipped capital femoral |
Surgery_Schwartz_12693 | Surgery_Schwartz | In: The Orthopedic Consult Survival Guide. New York: Springer; 2017:265-269.Palocaren T, Holmes L, Rogers K, Kumar SJ. Outcome of in situ pinning in patients with unstable slipped capital femoral Brunicardi_Ch43_p1879-p1924.indd 192322/02/19 10:42 AM 1924SPECIFIC CONSIDERATIONSPART IITokmakova KP, Stanton RP, Mason DE. Factors influenc-ing the development of osteonecrosis in patients treated for slipped capital femoral epiphysis. J Bone Joint Surg Am. 2003;85(5):798-801.Trousdale RT. Acetabular osteotomy: indications and results. Clin Orthop Relat Res. 2004;429:182-187.Wainwright AM, Auld T, Benson MK, Theologis TN. The clas-sification of congenital talipes equinovarus. Bone Joint J. 2002;84(7):1020-1024.Weiler R, Ingram M, Wolman R. Osgood-Schlatter disease. Br Med J (Online). 2011;1:343.epiphysis: assessment of risk factors associated with avascular necrosis. J Pediatr Orthop. 2010;30(1):31-36.Parsch K, Weller S, Parsch D. Open reduction and smooth Kirschner wire fixation for | Surgery_Schwartz. In: The Orthopedic Consult Survival Guide. New York: Springer; 2017:265-269.Palocaren T, Holmes L, Rogers K, Kumar SJ. Outcome of in situ pinning in patients with unstable slipped capital femoral Brunicardi_Ch43_p1879-p1924.indd 192322/02/19 10:42 AM 1924SPECIFIC CONSIDERATIONSPART IITokmakova KP, Stanton RP, Mason DE. Factors influenc-ing the development of osteonecrosis in patients treated for slipped capital femoral epiphysis. J Bone Joint Surg Am. 2003;85(5):798-801.Trousdale RT. Acetabular osteotomy: indications and results. Clin Orthop Relat Res. 2004;429:182-187.Wainwright AM, Auld T, Benson MK, Theologis TN. The clas-sification of congenital talipes equinovarus. Bone Joint J. 2002;84(7):1020-1024.Weiler R, Ingram M, Wolman R. Osgood-Schlatter disease. Br Med J (Online). 2011;1:343.epiphysis: assessment of risk factors associated with avascular necrosis. J Pediatr Orthop. 2010;30(1):31-36.Parsch K, Weller S, Parsch D. Open reduction and smooth Kirschner wire fixation for |
Surgery_Schwartz_12694 | Surgery_Schwartz | assessment of risk factors associated with avascular necrosis. J Pediatr Orthop. 2010;30(1):31-36.Parsch K, Weller S, Parsch D. Open reduction and smooth Kirschner wire fixation for unstable slipped capital femoral epiphysis. J Pediatr Orthop. 2009;29(1):1-8.Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109(suppl 109):8-14.Sjöberg I, Erichs K, Bjerre I. Cause and effect of obstetric (neonatal) brachial plexus palsy. Acta Paediatrica. 1988;77(3): 357-364.Stevenson DA, Mineau G, Kerber RA, Viskochil DH, Schaefer C, Roach JW. Familial predisposition to developmental dysplasia of the hip. J Pediatr Orthop. 2009;29(5):463-466.Brunicardi_Ch43_p1879-p1924.indd 192422/02/19 10:42 AM | Surgery_Schwartz. assessment of risk factors associated with avascular necrosis. J Pediatr Orthop. 2010;30(1):31-36.Parsch K, Weller S, Parsch D. Open reduction and smooth Kirschner wire fixation for unstable slipped capital femoral epiphysis. J Pediatr Orthop. 2009;29(1):1-8.Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109(suppl 109):8-14.Sjöberg I, Erichs K, Bjerre I. Cause and effect of obstetric (neonatal) brachial plexus palsy. Acta Paediatrica. 1988;77(3): 357-364.Stevenson DA, Mineau G, Kerber RA, Viskochil DH, Schaefer C, Roach JW. Familial predisposition to developmental dysplasia of the hip. J Pediatr Orthop. 2009;29(5):463-466.Brunicardi_Ch43_p1879-p1924.indd 192422/02/19 10:42 AM |
Surgery_Schwartz_12695 | Surgery_Schwartz | Surgery of the Hand and WristScott D. Lifchez and Brian H. Cho 44chapterINTRODUCTIONThe highly mobile, functional, and strong hand is a major dis-tinguishing point between humans and the nonhuman primates. The hand is an essential participant for activities of daily living, vocation, and recreational activities. The hand is even adaptable enough to read for the blind and speak for the mute. The under-lying goal of all aspects of hand surgery is to maximize mobil-ity, sensibility, stability, and strength while minimizing pain. These goals are then maximized to the extent possible given the patient’s particular pathology. Hand surgery is a regional specialty.Hand surgeons integrate components of neurologic, ortho-pedic, plastic, and vascular surgery in the care of patients with disorders of the upper extremities.1ANATOMY OF THE HAND AND WRISTIn order to understand any disorder of the hand, one must under-stand the anatomy of the underlying structures. Examina-tion of the hand is based | Surgery_Schwartz. Surgery of the Hand and WristScott D. Lifchez and Brian H. Cho 44chapterINTRODUCTIONThe highly mobile, functional, and strong hand is a major dis-tinguishing point between humans and the nonhuman primates. The hand is an essential participant for activities of daily living, vocation, and recreational activities. The hand is even adaptable enough to read for the blind and speak for the mute. The under-lying goal of all aspects of hand surgery is to maximize mobil-ity, sensibility, stability, and strength while minimizing pain. These goals are then maximized to the extent possible given the patient’s particular pathology. Hand surgery is a regional specialty.Hand surgeons integrate components of neurologic, ortho-pedic, plastic, and vascular surgery in the care of patients with disorders of the upper extremities.1ANATOMY OF THE HAND AND WRISTIn order to understand any disorder of the hand, one must under-stand the anatomy of the underlying structures. Examina-tion of the hand is based |
Surgery_Schwartz_12696 | Surgery_Schwartz | the upper extremities.1ANATOMY OF THE HAND AND WRISTIn order to understand any disorder of the hand, one must under-stand the anatomy of the underlying structures. Examina-tion of the hand is based on demonstrating the function or lack thereof of each of these structures.BonesThe hand is highly mobile in space to allow maximum flex-ibility in function. As such, a number of directions particular to the hand are necessary in order to properly describe posi-tion, motion, and so on.1 Palmar (or volar) refers to the anterior surface of the hand in the anatomic position; dorsal refers to the posterior surface in the anatomic position. The hand can rotate at the wrist level; rotation to bring the palm down is called 2Introduction 1925Anatomy of the Hand and Wrist 1925Bones / 1925Muscles Affecting the Hand and Wrist / 1926Tendons and Pulleys / 1929Vascular / 1929Nerve / 1930Hand Examination 1931Emergency Department/Inpatient Consultation / 1931Hand Imaging 1932Plain X-Rays / 1932Computed | Surgery_Schwartz. the upper extremities.1ANATOMY OF THE HAND AND WRISTIn order to understand any disorder of the hand, one must under-stand the anatomy of the underlying structures. Examina-tion of the hand is based on demonstrating the function or lack thereof of each of these structures.BonesThe hand is highly mobile in space to allow maximum flex-ibility in function. As such, a number of directions particular to the hand are necessary in order to properly describe posi-tion, motion, and so on.1 Palmar (or volar) refers to the anterior surface of the hand in the anatomic position; dorsal refers to the posterior surface in the anatomic position. The hand can rotate at the wrist level; rotation to bring the palm down is called 2Introduction 1925Anatomy of the Hand and Wrist 1925Bones / 1925Muscles Affecting the Hand and Wrist / 1926Tendons and Pulleys / 1929Vascular / 1929Nerve / 1930Hand Examination 1931Emergency Department/Inpatient Consultation / 1931Hand Imaging 1932Plain X-Rays / 1932Computed |
Surgery_Schwartz_12697 | Surgery_Schwartz | the Hand and Wrist / 1926Tendons and Pulleys / 1929Vascular / 1929Nerve / 1930Hand Examination 1931Emergency Department/Inpatient Consultation / 1931Hand Imaging 1932Plain X-Rays / 1932Computed Tomography / 1932Ultrasonography / 1932Magnetic Resonance Imaging / 1933Angiography / 1933Trauma 1933Fractures and Dislocations / 1934Tendons / 1935Nerve Injuries / 1936Vascular Injuries / 1936Anesthesia 1936Local Anesthesia / 1936Hand Surgery Under Local Anesthesia / 1938Postoperative Pain Management / 1938Special Considerations 1938Amputations and Replantation / 1938Fingertip Injuries / 1938High-Pressure Injection Injuries / 1939Compartment Syndrome / 1939Complications 1943Nonunion / 1943Stiffness / 1943Neuroma / 1943Regional Pain Syndromes / 1943Nerve Compression 1943Carpal Tunnel Syndrome / 1944Cubital Tunnel Syndrome / 1944Other Sites of Nerve Compression / 1945Degenerative Joint Disease 1945Small Joints (Metacarpophalangeal and Interphalangeal) 1945Wrist / 1945Rheumatoid Arthritis / | Surgery_Schwartz. the Hand and Wrist / 1926Tendons and Pulleys / 1929Vascular / 1929Nerve / 1930Hand Examination 1931Emergency Department/Inpatient Consultation / 1931Hand Imaging 1932Plain X-Rays / 1932Computed Tomography / 1932Ultrasonography / 1932Magnetic Resonance Imaging / 1933Angiography / 1933Trauma 1933Fractures and Dislocations / 1934Tendons / 1935Nerve Injuries / 1936Vascular Injuries / 1936Anesthesia 1936Local Anesthesia / 1936Hand Surgery Under Local Anesthesia / 1938Postoperative Pain Management / 1938Special Considerations 1938Amputations and Replantation / 1938Fingertip Injuries / 1938High-Pressure Injection Injuries / 1939Compartment Syndrome / 1939Complications 1943Nonunion / 1943Stiffness / 1943Neuroma / 1943Regional Pain Syndromes / 1943Nerve Compression 1943Carpal Tunnel Syndrome / 1944Cubital Tunnel Syndrome / 1944Other Sites of Nerve Compression / 1945Degenerative Joint Disease 1945Small Joints (Metacarpophalangeal and Interphalangeal) 1945Wrist / 1945Rheumatoid Arthritis / |
Surgery_Schwartz_12698 | Surgery_Schwartz | / 1944Cubital Tunnel Syndrome / 1944Other Sites of Nerve Compression / 1945Degenerative Joint Disease 1945Small Joints (Metacarpophalangeal and Interphalangeal) 1945Wrist / 1945Rheumatoid Arthritis / 1946Dupuytren’s Contracture 1947Infections 1947Cellulitis / 1947Abscess / 1948Collar-Button Abscess / 1948Osteomyelitis / 1949Pyogenic Arthritis / 1949Necrotizing Infections / 1949Infectious Flexor Tenosynovitis / 1950Felon / 1951Paronychia / 1951Tumors 1952Benign Soft Tissue Tumors / 1953Malignant Soft Tissue Tumors— Cutaneous / 1955Malignant Soft Tissue Tumors—Noncutaneous / 1956Benign Bone Tumors / 1956Malignant Bone Tumors / 1957Secondary Metastatic Tumors / 1958Burns 1958Acute Management / 1958Surgical Management / 1959Reconstruction / 1959Special Considerations / 1960Vascular Disease 1960Progressive Thrombotic Disease / 1960Systemic Vasculopathy / 1960Vasospastic Disorders / 1961Congenital Differences 1961Failure of Formation / 1961Failure of Differentiation / 1961Duplication / | Surgery_Schwartz. / 1944Cubital Tunnel Syndrome / 1944Other Sites of Nerve Compression / 1945Degenerative Joint Disease 1945Small Joints (Metacarpophalangeal and Interphalangeal) 1945Wrist / 1945Rheumatoid Arthritis / 1946Dupuytren’s Contracture 1947Infections 1947Cellulitis / 1947Abscess / 1948Collar-Button Abscess / 1948Osteomyelitis / 1949Pyogenic Arthritis / 1949Necrotizing Infections / 1949Infectious Flexor Tenosynovitis / 1950Felon / 1951Paronychia / 1951Tumors 1952Benign Soft Tissue Tumors / 1953Malignant Soft Tissue Tumors— Cutaneous / 1955Malignant Soft Tissue Tumors—Noncutaneous / 1956Benign Bone Tumors / 1956Malignant Bone Tumors / 1957Secondary Metastatic Tumors / 1958Burns 1958Acute Management / 1958Surgical Management / 1959Reconstruction / 1959Special Considerations / 1960Vascular Disease 1960Progressive Thrombotic Disease / 1960Systemic Vasculopathy / 1960Vasospastic Disorders / 1961Congenital Differences 1961Failure of Formation / 1961Failure of Differentiation / 1961Duplication / |
Surgery_Schwartz_12699 | Surgery_Schwartz | Thrombotic Disease / 1960Systemic Vasculopathy / 1960Vasospastic Disorders / 1961Congenital Differences 1961Failure of Formation / 1961Failure of Differentiation / 1961Duplication / 1961Overgrowth / 1961Constriction Band Syndrome / 1961Generalized Skeletal Anomalies and Syndromes / 1961Reconstructive Transplantation of the Upper Extremity 1962Brunicardi_Ch44_p1925-p1966.indd 192520/02/19 2:48 PM 1926pronation, and rotation to bring the palm up is called supina-tion. Because the hand can rotate in space, the terms medial and lateral are avoided. Radial and ulnar are used instead as these terms do not vary with respect to the rotational position of the hand. Abduction and adduction, when used on the hand, refer to movement of the digits away from and toward the middle finger, respectively (Fig. 44-1).The hand is comprised of 19 bones arranged in five rays.2 A ray is defined as a digit (finger or thumb) from the metacarpal base to the tip of the digit (Fig. 44-2A). The rays are | Surgery_Schwartz. Thrombotic Disease / 1960Systemic Vasculopathy / 1960Vasospastic Disorders / 1961Congenital Differences 1961Failure of Formation / 1961Failure of Differentiation / 1961Duplication / 1961Overgrowth / 1961Constriction Band Syndrome / 1961Generalized Skeletal Anomalies and Syndromes / 1961Reconstructive Transplantation of the Upper Extremity 1962Brunicardi_Ch44_p1925-p1966.indd 192520/02/19 2:48 PM 1926pronation, and rotation to bring the palm up is called supina-tion. Because the hand can rotate in space, the terms medial and lateral are avoided. Radial and ulnar are used instead as these terms do not vary with respect to the rotational position of the hand. Abduction and adduction, when used on the hand, refer to movement of the digits away from and toward the middle finger, respectively (Fig. 44-1).The hand is comprised of 19 bones arranged in five rays.2 A ray is defined as a digit (finger or thumb) from the metacarpal base to the tip of the digit (Fig. 44-2A). The rays are |
Surgery_Schwartz_12700 | Surgery_Schwartz | (Fig. 44-1).The hand is comprised of 19 bones arranged in five rays.2 A ray is defined as a digit (finger or thumb) from the metacarpal base to the tip of the digit (Fig. 44-2A). The rays are numbered 1 to 5, beginning with the thumb. By convention, however, they are referred to by name: thumb, index, middle, ring, and small. There are five metacarpals, comprising the visible palm of the hand. Each digit has a proximal and a distal phalanx, but only the fingers have a middle phalanx as well. The metacarpopha-langeal (MP) joint typically allows 90° of flexion with a small amount of hyperextension. In addition, the fingers can actively abduct (move away from the middle finger) and adduct (move toward the middle finger). The thumb, in contrast, moves prin-cipally in the flexion-extension arc at the MP joint. Although there can be laxity in the radial and ulnar direction, the thumb cannot actively move in these directions at the MP level. The proximal interphalangeal joint (PIP) is the | Surgery_Schwartz. (Fig. 44-1).The hand is comprised of 19 bones arranged in five rays.2 A ray is defined as a digit (finger or thumb) from the metacarpal base to the tip of the digit (Fig. 44-2A). The rays are numbered 1 to 5, beginning with the thumb. By convention, however, they are referred to by name: thumb, index, middle, ring, and small. There are five metacarpals, comprising the visible palm of the hand. Each digit has a proximal and a distal phalanx, but only the fingers have a middle phalanx as well. The metacarpopha-langeal (MP) joint typically allows 90° of flexion with a small amount of hyperextension. In addition, the fingers can actively abduct (move away from the middle finger) and adduct (move toward the middle finger). The thumb, in contrast, moves prin-cipally in the flexion-extension arc at the MP joint. Although there can be laxity in the radial and ulnar direction, the thumb cannot actively move in these directions at the MP level. The proximal interphalangeal joint (PIP) is the |
Surgery_Schwartz_12701 | Surgery_Schwartz | at the MP joint. Although there can be laxity in the radial and ulnar direction, the thumb cannot actively move in these directions at the MP level. The proximal interphalangeal joint (PIP) is the critical joint for finger mobility. Normal motion is 0° to 95° (full extension to flexion). The distal interphalangeal joint (DIP) also moves only in a flexion-extension plane from 0° to 90° on average. The thumb interphalangeal joint (IP) also moves only in a flexion-extension plane. Its normal motion is highly variable between individuals, but averages 0° to 80°.Each of the MP and IP joints has a radial and ulnar col-lateral ligament to support it. The IP joint collateral ligaments are on tension with the joint fully extended. For the fingers, the MP joint collateral ligaments are on tension with the joint bent 90°. Collateral ligaments have a tendency to contract when not placed on tension; this becomes relevant when splinting the hand (see later “Trauma” section on splinting).The wrist | Surgery_Schwartz. at the MP joint. Although there can be laxity in the radial and ulnar direction, the thumb cannot actively move in these directions at the MP level. The proximal interphalangeal joint (PIP) is the critical joint for finger mobility. Normal motion is 0° to 95° (full extension to flexion). The distal interphalangeal joint (DIP) also moves only in a flexion-extension plane from 0° to 90° on average. The thumb interphalangeal joint (IP) also moves only in a flexion-extension plane. Its normal motion is highly variable between individuals, but averages 0° to 80°.Each of the MP and IP joints has a radial and ulnar col-lateral ligament to support it. The IP joint collateral ligaments are on tension with the joint fully extended. For the fingers, the MP joint collateral ligaments are on tension with the joint bent 90°. Collateral ligaments have a tendency to contract when not placed on tension; this becomes relevant when splinting the hand (see later “Trauma” section on splinting).The wrist |
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