Essentials of Orthopedic Surgery, third edition / 14-Answers to Questions

Orthopedic infections

with joint arthroplasty, 102–3 osteomyelitis

acute vs. chronic, 84 inflammatory/immunological

pathways in, 85 pathogenesis of, 84

surgical treatment of, 97–98 pediatric

acute hematogenous osteomyelitis, 87–93

septic arthritis, 93–96 Orthoscopic debridement, in acute

infections, 96, 100 Ortolani test, for pediatric hip

dislocation, 208 OS. See Osteosarcoma

Osgood-Schlatter’s disease, of pediatric knee, 220

Ossification embryology, 1–5

endochondral model of, 2–3 in fetal bone growth, 1–5, 172 heterotopic

around THR, 448 Brooker grading of, 449 of elbow, 376

mesenchymal model of, 2–3 primary vs. secondary, 3–4

Osteoarthritis, 26

in glenohumeral joint differential diagnosis, 354 examination, 353

history, 353 radiographs, 354 treatment, 355

of hip, 433–36 diagnosis, 553 discussion, 554 history, 551

NSAIDs for, 219, 554 physical examination,

551–52

radiographs of, 553–55 treatment, 553–54

hip replacement for, 69 joint replacement for, 580 of knees, 461

pain from, 580

Index 607

primary interventions, nonoperative, 434

primary vs. secondary, 26 of shoulder

arthroplasty, 580 differential diagnosis, 578 history, 577

imaging, 578–80

laboratory results/studies, 578 treatment, 578

spinal canal and, 312 THR for, 554–55 X-ray of, 355

Osteoarthritis, early (OA), 353 Osteoblastoma bone tumors, 146 Osteochondritis Dissecans (Panner’s

Disease) elbow, 382–83 of elbow, 382–83

of pediatric knee, 221 Osteochondromas bone tumors,

143–45 Osteodystrophy, renal, 20–21 Osteogenesis imperfecta,

196–97 deformity in, 22 radiograph of, 23 scoliosis and, 196

sick cell syndrome of, Silence classification in, 22–23

Osteogenic bone tumors, 110 Osteoid osteoma

clinical characteristics/physical examination of, 146–47 common anatomic sites of, 146 physical characteristics of, 146

radiographic appearance/evaluation of, 147

treatment of, 148 Osteomalacia

diseases associated with, 18 mineralization defects and, 19 miscellaneous, 19

phosphate depletion and, 19 Vitamin D and, 19

Looser’s lines in, 17, 19 mineral to matrix ration in, 11 radiograph of, 19

rickets and, 19

608 Index

Osteomyelitis

acute vs. chronic, 84

adult, septic arthritis in, 96–99 blood count and, 91

bone cortices, devascularization of, 92

bone scanning for, 91–92 case study

discussion, 549–50 history, 545

MRI, 548–49

physical examination, 545 radiographic/laboratory

evaluation, 546–47 treatment, 546, 549

in children’s orthopedics clinical feature, 181 diagnosis, 182–83 trauma and, 87–88 treatment, 184–85

Cierny classification of, 97 diagnosis and treatment of, 84–86,

91–93, 181–85 hematogenous spread of, 84 inflammatory/immunological

pathways in, 85 localization of, 182 metaphyseal, 186 pathogenesis of, parameter

classification in, 84 pathophysiology of, 84–87 pediatric, 87–93, 181–85

with prosthesis/fracture implant, 87 radiography of, 91

Salmonella in, 194 treatment, 87

surgical, 97–98 Osteopenia

DEXA scanning and, 15

in osteogenesis imperfecta, 196–97 Osteopetrosis

radiological appearance of, 24 sick cell syndromes in, 23–24

Osteoporosis

Calcitonin treatment of, 16 etiologies of, 11–13 eucalcemic states of, 11–16 involutional, 14

mineral to matrix ration in, 11

postmenopausal, 11

in rheumatoid arthritis, 28 spine radiograph of, 14 treatment regimens for

bisphosphonates, 16 Calcitonin, 16 prophylactic, 15 therapeutic, 15–16

Osteosarcoma. See also Sarcomas chemotherapy for, 119–21 classical, 119–26

clinical characteristics/physical examination, 119–20

history/prognosis, 119–20 limb-sparing resection for, 121 microscopic characteristic of,

119–20 parosteal, 127

radiography of, 119–20

skeletal reconstruction and, 121 variants, parosteal, 127

Outerbridge classification, of articular cartilage, 264

Oxycodone (Percodan, Tylox), for low back pain, 321, 326

P

Pain

in anterior thigh, 323–24

in degenerative spondylolisthesis, 528

foot and ankle, 493–94 with hallux valgus, 531–33 herniated disk, 310–11

carisoprodol for, 311 diazepam (Valium) for, 312 methocarbamol for, 311 Valium for, 312

location of, 276, 301 low back

carisoprodol for, 311 cyclobenzaprine (Flexeril) for, 327 diazepam (Valium) for, 321 lidocaine for, 320

meperidine (Demerol) for, 326 methocarbamol (Robaxin) for,

327

treatment for, 319–21, 326–30 neck, 283, 296–97

Index 609

differential diagnosis of, 294 psychosocial evaluation of, 297

from osteoarthritis, 580 in posterior thigh, 324–25 posterior thigh, lidocaine

(Xylocaine), 324 sources of, 278

tenderness with, types of, 277–88 thigh, 323–25

Xylocaine for, 324 Parosteal osteosarcoma, 127

Pars defect. See Spondylolisthesis Patella fracture, 75–76

Pathologic fracture, pediatric, 189 Pavlic harness, 212

PCL. See Posterior cruciate ligament Pediatric orthopedics. See Children’s

orthopedics Pelvic bones

chondrosarcoma of, 128 CT of, 429

fractures stable, 69 traumatic, 69

treatment of, 69 sarcomas, 128 trauma to, 69, 429

Periosteum, pediatric, 170–71 Peripheral nerve tumors

aggressive fibromatosis, 165 benign fibrous, 164 neurilemmoma, 163–64 neurofibroma, 164

Peripheral plate structures, pediatric, 171

Perthes’ disease, 206, 213

femoral head deformity in, 214–15 pediatric, 213–16

prognosis for, 216 Pes valgus, 202

Phalangeal fracture, of hand, 65 Physical therapy, for lumbar spine

disorders, 330 Physis. See Growth plate

Pigmented villonodular synovitis, 151–53

Pilon fractures, of ankle, 77 Pleomorphic lipomas, 162 Polio, pediatric, 203

Ponseti method, for congenital clubfoot, 225

Popliteal cysts, in pediatric knee, 222–23

POS. See Parosteal osteosarcoma Posterior cruciate ligament (PCL), of

knee, 454–57 Psychosocial evaluation

for herniated disk, 321 for neck pain, 297

PVNS. See Pigmented villonodular synovitis

Q

Quadriplegia, 202

R

Radial dysplasia, long bone, 230 Radial nerve, 368

elbow, 368 Radiation therapy

for Ewing’s sarcoma, 137 for soft tissue sarcomas, 159

Radiculopathy, 287 Radiographic evaluation

ACL, 571–72 angiography, 115, 157 calcific tendonitis, 358

of cervical spine disorders, 279–81 of chondrosarcoma, 128–29

of cubital tunnel syndrome, 561 of Ewing’s sarcoma, 136

of fibrosarcoma, 134

of flexor tendon avulsion, 565 of foot and ankle, 482–83

of hallux valgus, 534–36 of involucrum, 90

of lumbar spine disorders, 304 of osteomyelitis, 91, 546–47 of osteosarcoma, 119–20

for parosteal osteosarcoma, 127 of renal osteodystrophy, 20–21 of rheumatoid arthritis, 28

of rickets, 19

of rotator cuff, 351 of SCFE, 556–58 of shoulder, 346

of spondylolisthesis, 315 Rang, Dr. Mercer, 175

610 Index

RC. See Rotator cuff

Renal osteodystrophy, 20–21 metabolic bone disease of, 20 radiograph of, 20–21 unmineralized osteoid presence in,

20 Rheumatoid arthritis

in cervical spine, 289–90, 331 of elbow, 384

foot and ankle, 495–96 hand, 395–97

hands, 395–97 osteoporosis in, 28 radiograph of, 28

synovial membrane impact by, 26–27

Rheumatoid disease, juvenile, 189–91

Rickets

Dilantin therapy and, 192 etiology of, 192

Glomerular disease and, 192 histologic appearance of, 192 neurofibromatosis and, 192 osteomalacia and, 16–17 radiograph of, 19

renal, 192

Vitamin D deficiency, 192–93 Robaxin. See Methocarbamol Rotator cuff, 337

calcific tendonitis of, 358–59 disease of, 349

algorithmic diagnosis of, 350 differential diagnosis, 351 examination, 351

history, 351

initial treatment for, 352 MRI scan for, 351–52 radiographic evaluation, 351 surgical treatment for, 353

impingement of, 344–45 Rotator interval, 336

S

Salk vaccine, 203

Salmonella, in osteomyelitis, 194 Salter classification, of epiphyseal

plate fractures, 44

Sarcomas, 106. See also Chondrosarcoma; Ewing’s sarcoma; Osteosarcoma; Soft tissue sarcomas

behavior patterns, 109–10 biological behavior of, 107 biopsy of, 115–16 chemotherapy for, 158 distal femur and, 117 Ewing’s, 106

in femur, 117, 129 ganglion, 153

local anatomy impact on, 107 of pelvic bones, 128

skip metastases and, 110 spindle cell, 107

surgical staging system of, 110–11 tumor staging of, 110–11

Scaphoid fracture, of wrists/hands, 66 Scapula, Sprengel’s deformity and,

228–29

SCFE. See Slipped capital femoral epiphysis

Scheuermann’s kyphosis, 247–48 Cobb technique for, 249

Schwannoma. See Neurilemmoma Sciatica

lumbar spine and, 321–23 refractory patients with, 321

Scoliosis adult, 242

congenital, 245–46 neuromuscular causes of, 246 osteogenesis imperfecta and, 196 pediatric, 240

etiology of, 241 kyphosis and, 245 management of, 242–45

of spine, 240–45 Scottish-Rite orthosis, 216

Selective estrogen receptor modulators (SERMs), therapeutic regimen of, 15–16

Sepsis, after THR, 448

Septic arthritis, 93–99, 186–87 in adult osteomyelitis, 96–99 adult, synovial fluid, 99 aspiration in, 95

common pathogens in, 90, 98

pathogens and treatment for, 94 pediatric, 93–96, 185–89

diagnosis and treatment, 94–96, 185–87

from osteomyelitis, 93 susceptible joints, 94–96

Septic joint destruction, pediatric, 187 Sequestrum

abscess formation and, 90 involucrum and, 90

SERMs. See Selective estrogen receptor modulators

Shoulder. See also Glenohumeral joint AC joint of, 334

deformity at, 269 anterior view of, 334

apprehension test and, 268, 345 arthroplasty, 355

arthroscopic adhesiolysis of, 358 arthroscopy, 358, 361

bursitis in, 359

clinical examination of, 339–40 functional assessment, 341 history, 340–41

imaging studies and, 346–48 inspection, 341–42 neurological examination, 343 palpitation, 342

range of motion, 342–43 special tests, signs, 344 strength assessment, 342–43

CT of, 348 EMG of, 348

evaluation and treatment adhesive capsulitis, 357–58 calcific tendonitis, 358–59 miscellaneous arthropathy,

356–57

multidirectional instability, 357–61

osteoarthritis, 353–55 rotator cuff disease, 349–53

fractures-dislocations of, 53–60 functional anatomy of

AC, 337–38

biceps tendon, long head, 336–37 brachial plexus, 339 glenohumeral joint, 333–34 glenohumeral ligaments, 334–35

Index 611

labrum, 336 rotator cuff, 337

rotator interval, 336 scapulothoracic articulation, 339 sternoclavicular joint, 338 subacromial space, 337

Hawkins’s impingement of, 344–45 hemophilic arthropathy of, 191 instability tests for

apprehension, 345 load-and-shift, 346

lesions in, 360 MRI of, 348 NCV of, 348

Neer impingement of, 344 osteoarthritis of

arthroplasty, 580 differential diagnosis, 578 history, 577

imaging, 578–80

laboratory results/studies, 578 treatment, 578

radiographs of, 346 separated, 269

Sickle-cell disease, 33 pediatric, 194

Simple lipoma, 162

Skeletal disease, diagnostic groups of, 10

Skeletal dysplasias achondroplasia, 199–201 pediatric, 198–99

Skeletal growth, pediatric factors in

coexistent disease, 174 endocrine, 174 environmental, 174 genetic impact, 174 nutrition, 174

variations in angular, 177–79

differential diagnosis of, 179–80 torsional, 175–76

Skin cancer, hand, 408

Skip metastases, sarcomas and, 110 Slipped capital femoral epiphysis

(SCFE), 206, 216–19, 268 among Afro-Americans vs.

Caucasians, 559

612 Index

Slipped capital femoral epiphysis (SCFE) (cont.)

AVN wt., 560 case study of

discussion, 559–60 Kline’s line, 559 MRI, 559

pain, 559

physical examination, 556 treatment, 557, 559

complications of, 560

SLRT. See Straight leg-raising test Sofield-Millar intramedullary rod

fixation, Williams modification of, 197

Soft disk protrusion, 284

Soft tissue, healing of, protein/caloric malnutrition and, 102

Soft tissue sarcomas (STS), 153 biological behavior, 154 chemotherapy for

with cisplatin, 158 with Dacarazine, 158

with doxorubicin hydrochloride (Adriamycin), 158

with ifosfamide, 158 with methotrexate, 158

clinical findings/physical examination, 153–54

decision-making process in, 155–56 epithelioid sarcoma, 161 fibrosarcoma, 161

liposarcoma, 160–61

malignant fibrous histiocytoma, 160 natural history, 154–55 pathology/staging of, 155 radiographic evaluation of

angiography, 157 bone scans, 157 MRI vs. CT, 155 synovial sarcoma, 161

treatment of

with chemotherapy, 157–58 with radiation therapy, 159 with surgery, 159–60

Soma. See Carisoprodol

Specific organisms, in pediatric bone infection, 90

Spinal bifida (myelodysplasia), pediatric, 203–5

Spinal canal, osteoarthritis and, 312 Spinal column, anatomy of, 67 Spinal stenosis, 287, 312, 528 Spindle cell lipoma, 162

Spine. See also Cervical spine disorders/injuries; Lumbar spine disorders/injuries

cervical

drug therapy, 298–99 EMG for, 282 exercise for, 300

herniated disk of, clinical features of, 304–7, 309–12

lumbar

braces and corsets for, 313 drug therapy, 321, 326–27 exercise for, 329–30

pediatric, 240–54 kyphosis of, 245, 247–50 scoliosis of, 240–45

skeletal affectations in, 240–54 Spondylolisthesis, 322

degenerative

decompressive laminectomy for, 527, 530

discussion, 528–30 history, 527

lateral radiograph of, 528 MRI of, 529

pain in, 528 treatment, 527–28

grading system for, 314 heredity and, 313 pediatric, 250–53

radiographic evaluation of, 315 Sports medicine

arthroscopy in, 273 injury evaluation

history, 266–67

physical examination, 267–68 special tests, 268–71

injury patterns, 257 microtraumatic injuries, treatment

of, 272–73 musculoskeletal tissues

articular cartilage, 262–64 ligaments, 259–61 meniscus, 264–65

muscle, 261–62 tendons, 258

prevention and, 273 treatment, of macrotraumatic

injuries, 271–72 Sprengel’s deformity, in upper

extremity and neck, 228–29 Sternoclavicular joint, 338 Steroids. See Epidural steroid

injection; Trigger-point injection

Still’s disease. See Juvenile rheumatoid disease

Straight leg-raising test (SLRT), for lumbar spine disorders, 301–2, 322

Strains, muscular, 261 Subacromial space, 337 Supracondylar fracture

of elbow and forearm, 60 of femur, 60

pediatric, 60 Surgical procedures

amputation, 118

reconstruction, 118–19, 123, 125 resection, 117

segmental prostheses, 125 Surgical staging system (SSS), of

sarcoma tumors, 110–11 Synovial inflammation, corticosteroid

injection for, 358 Synovial sarcoma, 161 Synovitis

aggressive, 151–53

pigmented villonodular synovitis, 151–53

in rheumatoid arthritis, 26–27

T

Technetium-99, 372 Tendonosis, 258 Tendons, 258

elbow, 379 foot and ankle

Achilles, 491–93 anterior tibial, 491 peroneal, 491 posterior, 492

hand, compression syndromes, 399–400

soft tissue damage to, 44–48 sports injuries sights in, 259

Index 613

Thigh, pain in anterior, 323–24 lidocaine for, 324 posterior, 324–25

Thoracic outlet syndrome, 278 THR. See Total hip replacement

Thromboembolic disease, after THR, 446

Tibia

bone scan of, 270 open fracture of

assessment, 538 discussion, 538–41 history, 537 laboratory values, 538 pain with, 537–38

physical examination, 537–38 radiographs of, 539–41 treatment, 538

X-rays, 538

Tibial torsion, pediatric, 175–76 Tibia plateau fracture, 76

Tibia shaft fracture, 76–77

TKR. See Total knee replacement Torsional variations, measuring of, 176 Total hip replacement (THR), 439,

442–46

Coumadin with, 446–47 MIS approach, 440–41 for osteoarthritis, 554–55 sepsis after, 448

Total knee replacement (TKR), for knee arthritis, 465–69

Traction

for cervical spine disorders, 299 for lumbar spine disorders, 328

Transient synovitis, pediatric, hip, 219 Trauma, 388

arthritis and, 395 avascular necrosis and, 31 AVN, 31

elbow

dislocations, 377–78 fractures, 377

ligamentous injuries, 378–79 tendon ruptures, 379

foot and ankle, 79–81 calcaneus fractures, 486 pilon fractures, 484 syndesmosis injuries, 484

614 Index

Trauma (cont.)

talus fractures, 484–86 fractures (See also Galeazzi

fracture-dislocation; Monteggia fracture-dislocation)

around the ankle, 77–78 both forearm bones, 62 complications of, 49–53 deformity in, 41–42 descriptors of, 2, 40

of femur, 69–73

healing phases of, 41–42 knee, 74–77

loading mode in, 41–42 patterns of, 41–45 pediatric, 231–36

of pelvis, 69

soft tissue damage in, 44–48 special types, 47–48

of spine, 67–68

treatment principles for, 49 of wrists and hands, 65–66 fractures, soft tissue injuries, of

foot, 79–81 hand, 65–66

fractures/dislocations, 403–5 lacerations, 402

mallet finger, 406 other, 406 severe/complex, 405–6

to ligaments, 260

muscular contusions from, 261–62 neural injury in

axonotmesis, 46 neuropraxia, 46 neurotmesis, 46 open tibia fracture assessment, 538

discussion, 538–41 history, 537 laboratory values, 538 pain from, 537–38

physical examination, 537–38 radiograph, 539–41 treatment, 538

X-rays, 538

orthopedic emergencies of, 49 patient evaluation and, 49 pediatric, 87–88, 231–35

Battered child syndrome, 235 to pelvis, 69, 429

to shoulder, 349 Treatment

for cervical spine injuries, 298–300 of chondrosarcoma, 130

for lumbar spine injuries, 325–30 of macrotraumatic injuries, 271

of microtraumatic injuries, 272–73 Trendelenburg gait, 423 Trendelenburg limp, 237 Trigger-point injection

for cervical spine disorders, 300 for lumbar spine disorders, 327

Tumors. See also Sarcomas anatomic compartment

determination of, 108 aneurysmal bone cysts, 148–49 behavioral classification of, 109 benign, 107, 118, 142, 162, 165

curettage/marginal excision for, 118

fibrous, 164

growth mechanisms of, 107 microscopic characteristics of, 162 pleomorphic, 162

simple lipoma, 162 soft tissue, 162 spindle cell, 162 vascular, 165

biology/growth of, 107–8

biopsy considerations/importance, 115–16

bone/soft tissue, 107–11 chemotherapy for, 119–21 chondroblastoma, 146 chondrogenic, 110 chondrosarcomas, 127–31 decision-making process in,

111–12 dissemination of, 108–11 early detection of, 106 enchondromas, 145–46

eosinophilic granuloma, 151 Ewing’s sarcoma, 119, 135–38 fibrogenic, 110

fibrosarcoma of bone, 134 of foot and ankle, 499–500 general classification of, 110

giant cell, 131, 132 hematopoietic, 110 of joint, 151–53 lipogenic, 110 lipomas, 163

mesenchymal neoplasms, 107 metastatic bone disease, 138–42 multiple myeloma/plasmocytoma,

138 neurogenic, 110 notochordal, 110 osteoblastoma, 146

osteochondromas, 143–45 osteogenic, 110

osteoid osteoma, 146 pathologic fracture, 138–42 in peripheral nerves, 163–65

radiographic imaging/evaluation of, 106, 113–15, 122–24

sarcoma behavior patterns, 108–9 soft tissue

behavioral classification of, 109 biology/growth of, 107–8 dissemination of, 108–11 general classification of, 110

sarcoma behavior patterns, 108–9 soft tissue sarcomas, 153–61 surgical procedures for, 117–19, 123,

125–26

tissue types and, 106 treatment strategy for, 126 typical locations for, 108

unicameral bone cysts, 148, 150–51 unknown origin, 110

vascular, 110 Tumors, malignant

chondrosarcoma, 127–31 fibrous histiocytoma, 134, 160 osteosarcoma

chemotherapy for, 119–21 classical, 119–26

clinical characteristics/physical examination, 119–20

history/prognosis, 119–20 microscopic characteristic of,

119–20

radiography of, 119–20

Index 615

variants, 126–27 osteosarcoma, variants, 126–27

U

UBC. See Unicameral bone cysts Ulnar nerve, 368

in cubital tunnel syndrome, 562 decompression/anterior

transposition of, 381 elbow, 368, 381

Unicameral bone cysts, 148, 150–51 United States, cancer in, 106 Upper extremity and neck

cervical spine disorders and, 279 pediatric, 228–31

skeletal affectations in, 228–31 Sprengel’s deformity, 228–29

V

Valium. See Diazepam Vascular bone tumors, 110 Vascular disease

hand and, 406–8 pediatric, 193–95

leukemia, 194–95 sickle cell disease, 194

skeletal affectations in, 193–95 Vater syndrome, 230

Vitamin D deficiency, rickets and, 193 Volkmann’s contracture, 60

W

Whiplash. See Cervical hypertension injuries

Wolff’s law, 8 Wrist

aneurysms of, 408 Colles fracture of, 65 scaphoid fracture, 66

X

X-rays, 268. See also Radiographic evaluation

cartilage, 171

of glenohumeral joint, 347, 354, 356 radiographic evaluation, 113–14

Xylocaine. see Lidocaine