bluuebunny/crossref_metadata_2025 huggingface dataset:
Complex regional pain syndrome
Authors: Atkins Roger M.
Published: April 2012

♦ Complex regional pain syndrome (CRPS) is a disabling chronic pain condition of unknown aetiology

♦ Traditionally it was thought to be rare; however, prospective studies demonstrate it to be common following both trauma and operative procedures involving the upper and lower limbs

♦ The condition is usually self-limiting over a maximum period of 2 years, although minor abnormalities may remain

♦ In a minority of cases it does not resolve and is responsible for severe chronic disability

♦ Treatment is aimed at functional restoration of limb function supported by pharmacological intervention.
Neuromuscular disorders
Authors: Theologis Tim
Published: April 2012

♦ Neurological disorders can be sensory, motor, or a combination of the two

♦ Motor disorders may be flaccid or spastic, static or progressive

♦ Splints may improve function but are not proven to prevent contractures

♦ Botulinum toxin and tenotomy can be used to manage spasticity

♦ Osteotomies may be needed to manage rotatory abnormalities

♦ Sensory nerve abnormalities may cause Charcot joints.
Neuromuscular and skeletal manifestations of neurofibromatosis
Authors: Fairbank Jeremy
Published: April 2012

♦ Neurofibromatosis type 1

♦ Single gene disorder

♦ Serious scoliosis

♦ Pseudoarthrosis of a long bone

♦ Hypertrophy of a part

♦ An unusual radiographic lesion of bone.
Choice of surgery for tumour: Staging and surgical margins
Authors: Gikas Panagiotis D. , Briggs Timothy W.R.
Published: April 2012

♦ Bone and soft tissue tumours are rare and should therefore be assessed and treated in specialized centres

♦ Clinical staging and pathological grading is used to classify the extent of a tumour

♦ Clinical staging uses various imaging techniques, pathological grading requires tumour biopsy following clinical staging

♦ The Enneking system is commonly used for surgical staging of bone and soft tissue tumours

♦ Surgery is the mainstay of treatment for musculoskeletal tumours

♦ The surgical margin describes the extent of the procedure

♦ Intralesional margins describe a procedure that removes the tumour alone, radical margins may require removal of entire bone

♦ Open incisional biopsy is the gold standard method for obtaining a representative specimen of tumour

♦ Careful planning and good collaboration between surgeons, radiologists, and pathologists is crucial to avoid unnecessary or dangerous biopsy procedures.
Amputations, endoprosthetic joint replacement, massive bone replacement, other alternatives
Authors: Aston William J.S. , Blunn Gordon , Briggs Timothy W.R.
Published: April 2012

♦ The aims of the bone tumour surgeon are to improve survival and maintain optimal function of the patient; this can be achieved by amputation or limb salvage

♦ Limb salvage provides no greater risk to the survival of the patient than with amputation

♦ Reconstruction after removal of the tumour is commonly achieved by using endoprosthetic replacements, autografts, or massive allografts

♦ Complications of limb salvage include infection and difficulties associated with soft tissue reattachment and coverage of the bone replacement.
Benign tumours of soft tissues
Authors: Sri-Ram Kesavan , Mcgrath Anthony , Yeung Eric , Spiegelberg Ben , Kalson Nick , Rose Barry , Pollock Rob , Skinner John
Published: April 2012

♦ Ganglion cyst

♦ Intramuscular myxoma

♦ Myositis ossificans

♦ Nodular fasciitis

♦ Haemangioma

♦ Lipoma

♦ Cavernous lymphangioma

♦ Glomus tumour

♦ Neurofibroma

♦ Desmoid tumour

♦ Elastofibroma

♦ Schwannoma

♦ Synovial chondromatosis.
Malignant tumours of soft tissues
Authors: Bhumbra Rej S. , Gikas Panagiotis D. , Hanna Sammy , Jagiello Jakub , Cannon Stephen R.
Published: April 2012

♦ Malignant vascular tumours of soft tissue

♦ Synovial sarcoma

♦ Malignant peripheral nerve sheath tumours

♦ Rhabdomyosarcoma

♦ Leiomyosarcoma

♦ Epithelioid sarcoma

♦ Clear cell sarcoma

♦ Malignant fibrous histiocytoma

♦ Chordoma.
Benign bone tumours
Authors: Mcgrath Anthony , Sri-Ram Kesavan , Yeung Eric , Spiegelberg Ben , Kalson Nick , Rose Barry , Pollock Rob , Skinner John
Published: April 2012

♦ Unicameral bone cyst

♦ Aneurysmal bone cyst

♦ Non-ossifying fibroma/fibrous cortical defect

♦ Bone island

♦ Fibrous dysplasia

♦ Osteochondroma

♦ Enchondroma

♦ Langerhans cell histiocytosis

♦ Chondroblastoma

♦ Giant cell tumour

♦ Osteoblastoma/osteoid osteoma

♦ 12.Periosteal chondroma.
Malignant bone tumours
Authors: Bhumbra Rej S. , Gikas Panagiotis D. , Hanna Sammy , Jagiello Jakub , Cannon Stephen R.
Published: April 2012

♦ Chondrosarcoma

♦ Osteosarcoma

♦ Ewing’s sarcoma

♦ Myeloma of bone

♦ Fibrosarcoma of bone or soft tissue

♦ Lymphoma of bone

♦ Malignant vascular tumours of bone.
Metastatic bone disease
Authors: Gikas Panagiotis D. , Briggs Timothy W.R.
Published: April 2012

♦ Metastatic pathological fractures rarely unite, even if stabilized

♦ Never rush to fix a pathological fracture; traction or splintage will suffice while investigations are performed and surgical intervention discussed

♦ When surgery is indicated for spinal metastases, both decompression and stabilization are generally required

♦ Implants should allow immediate weight-bearing and last the lifetime of the patient

♦ Always use a multidisciplinary team.
Cervical spine disorders
Authors: An Howard
Published: April 2012

♦ Degenerative cervical spine disorders may manifest clinically with axial neck pain, radiculopathy, myelopathy, or a combination of these clinical symptoms

♦ The findings on radiographs and MRI are pertinent if they correlate with the clinical symptoms

♦ The initial treatment for patients with degenerative cervical spine disorders is conservative, including non-narcotic analgesics, anti-inflammatory medications, exercise program, physiotherapy, and occasional injections

♦ Surgical indications include significant radicular pain despite conservative treatment, profound neurologic deficits, and presence of significant myelopathy

♦ Surgical treatment for cervical radiculopathy includes lamino-foraminotomy, anterior cervical discectomy and fusion (ACDF), and artificial disk replacement, and surgical treatment for myelopathy includes anterior discectomy and/or corpectomy with fusion, posterior laminoplasty, and posterior laminectomy and fusion. The surgeon should be familiar with the specific indications as well as advantages and disadvantages of each procedure.
Degenerative disease of the thoracic spine
Authors: Hiratzka Jayme R. , Hart Robert A. , Bohlman Henry H.
Published: April 2012

♦ Thoracic degenerative disease is an uncommon problem and is often misdiagnosed

♦ Posterolateral approaches such as transpedicular or lateral extracavitary reduce morbidity associated with thoracotomy while avoiding the risk of neurologic injury associated with posterior laminectomy

♦ Correct preoperative identification of level is crucial and requires specific imaging, such as full-length MRI or CT.
Clinical presentations of the lumbar spine
Authors: Fairbank Jeremy , Buchanan Elaine
Published: April 2012

♦ Classification of back pain has proved challenging

♦ This is important both for clinical practice and research

♦ MRI scanning is important for radicular pain but can be difficult in back pain patients as there is such a high incidence of asymptomatic abnormality.
Non-operative management of non-specific low back pain (types 1 and 2)
Authors: Fairbank Jeremy , Buchanan Elaine
Published: April 2012

♦ Back pain is common

♦ Most attacks are self limiting

♦ Exercise and fitness programmes seem to be the most effective intervention

♦ CPP programmes are effective for chronic back pain and should be introduced early.
Cauda equina syndrome
Authors: Fairbank Jeremy
Published: April 2012

♦ Cauda equina syndrome is a devastating consequence of cauda equina compression

♦ The most common cause is a large disc herniation in the presence of a narrow vertebral canal

♦ Expeditious decompression can prevent the syndrome when some urinary function is preserved.
Surgical management of chronic low back pain
Authors: Fairbank Jeremy
Published: April 2012

♦ A very small proportion of back pain patients respond to surgical treatment

♦ Patient selection is poorly defined

♦ The rationale of treatment ranges from immobilization (fusion) to claimed restoration of normal movement (disc replacement and flexible fixation).
Management of nerve root pain (syn: sciatica, radicularpain)
Authors: Fairbank Jeremy
Published: April 2012

♦ Radicular pain can be diagnosed clinically and confirmed by imaging

♦ Pain caused by disc herniation can be very severe, but often resolves without intervention

♦ Surgery is often successful if non-operative treatment fails.
Management of neurogenic claudication and spinal stenosis
Authors: Fairbank Jeremy
Published: April 2012

♦ Neurogenic claudication is a common symptom

♦ Back pain and leg pain occur with standing and walking

♦ Spinal stenosis may be developmental or acquired or a combination of both

♦ An important spinal differential diagnosis is loss of sagittal balance

♦ There are many causes, both medical and orthopaedic, that may contribute to difficulty with walking and poor outcomes from surgical treatment.
Clinical presentation of spinal deformities
Authors: Fairbank Jeremy
Published: April 2012

♦ Incidence 2–4/1000

♦ Idiopathic most common pattern

♦ Sagittal and coronal balance are critical for management of spinal deformity.
Congenital scoliosis and kyphosis
Authors: Fairbank Jeremy
Published: April 2012

♦ Congenital scoliosis and kyphosis accounts for about 20% patients with spinal deformity

♦ Associated with other developmental anomalies of neuraxis, cardiovascular and urogenital systems.
Neuromuscular scoliosis
Authors: Fairbank Jeremy
Published: April 2012

♦ All children with neurogenic or myogenic conditions are at risk of developing scoliosis

♦ The more severe the involvement, particularly in those who cannot stand, the more likely is the curve to progress

♦ Surgery is the only effective way of treating these curves, and in general the earlier the better.
Syndromal scoliosis
Authors: Davies Evan M.
Published: April 2012

♦ Syndromes which affect bone and muscle may affect the ability of the spinal column to stay balanced and lead to scoliosis

♦ Scoliosis associated with syndromes behaves differently from idiopathic scoliosis

♦ Intervention in syndromic scoliosis may require more complex intervention and multiagency support.
Brace treatment in idiopathic scoliosis: the case for treatment
Authors: Harding Ian
Published: April 2012

♦ Brace treatment has best chance of success in younger children and those with smaller curves

♦ In most cases it can be expected to stop the curve becoming worse.
Iatrogenic spinal deformity
Authors: Davies Paul Rhys , Webb John K.
Published: April 2012

♦ Laminectomy, especially in the growing child can lead to late kyphosis

♦ Various strategies are available to prevent this.
Kyphosis
Authors: Grevitt Michael , Webb John K.
Published: April 2012

♦ Kyphosis may be a focal deformity limited to a few spinal segments or a more global problem involving the thoraco-lumbar spine

♦ The causes are myriad and reflect all the disease processes that affect bone

♦ As well as producing pain from disturbed sagittal balance, neurological complications can occur infrequently

♦ Conservative treatment in established kyphotic deformity has a limited role

♦ The aims of surgery are to correct the deformity, restore sagittal alignment and decompress the neural elements as required.
Spondylolisthesis and spondylolysis
Authors: Schlenzka Dietrich
Published: April 2012

♦ Spondylolysis is a stress fracture of the vertebral arch. It may lead to vertebral slipping, spondylolisthesis.

♦ Spondylolysthesis is commonly lytic, isthmic, or degenerative.

♦ Spondylolysis and Spondylolysthesis can affect both children and adults.

♦ Most common symptoms are low-back pain and/or radiating pain. True neurologic deficit is rare

♦ Treating clinicians should be aware of the processes involved and the common consequences.

♦ The majority of symptomatic patients are treated nonoperatively

♦ Operation is indicated in rare cases with neurologic deficit and in children or adolescents with a slip of 50 per cent or more

♦ Most common complications of surgery are nerve root compromise (especially in connection with slip reduction) and non-union.
The infected spine
Authors: Fairbank Jeremy
Published: April 2012

♦ TB is the most common spine infection worldwide

♦ In the developed world, staphylococcal infections are more frequent

♦ Untreated these infections can cause paralysis or even death.
The clinical evaluation of the shoulder
Authors: Bunker Tim D.
Published: April 2012

♦ History: onset event, radiation, exacerbation, night pain, functional deficit

♦ Examination: active and passive movement, impingement signs, instability tests

♦ Investigation: x-rays, ultrasound, CT and MR.
Pathology of cuff tears
Authors: Reilly Peter
Published: April 2012

♦ Rotator cuff tears are common

♦ Aetiology complex and multifactorial

♦ Tendons deteriorate with age

♦ Posterosuperior tears are more common

♦ They evolve in a typical fashion

♦ Anterosuperior tears are less common.
Biceps
Authors: Ahrens Philip M.
Published: April 2012

♦ LHB pathology is a commonn cause of anterior shoulder pain

♦ Clinical evaluation and diagnostic imaging are both imprecise

♦ Isolated biceps pathology may be present in the younger athlete

♦ Degenerative biceps pathology is often associated with rotator cuff pathology

♦ Failure to treat concomitant LHB pathology is a cause for surgical failures in many other shoulder conditions
Frozen shoulder
Authors: Bunker Tim D.
Published: April 2012

♦ Frozen shoulder is caused by a contracture of the capsule

♦ Counterintuitively not all patients recover completely

♦ At arthroscopy spectacular angiogenesis is seen

♦ Pathology shows bands and nodules of type III collagen populated by fibroblasts and myofibroblasts

♦ Arthroscopic capsular release has improved the management of this condition.
Calcifying tendinitis
Authors: Wallace Don , Carr Andrew
Published: April 2012

♦ Calcifying tendonitis remains an enigmatic condition

♦ The pathology shows hydroxyapatite crystals lying in extra-cellular matrix vesicles

♦ There are two presentations, acute and chronic

♦ Acute episodes can be treated by analgesia and barbottage

♦ Chronic lesions can be treated conservatively, or by excision of the calcific deposit, arthroscopically or by barbottage.
Instability
Authors: Lambert Simon M.
Published: April 2012

♦ The fundamental principle or essence of the shoulder is concavity compression. Stability of the shoulder is the condition in which a balanced centralizing joint reaction force (CJRF) exists to maintain concavity compression of the glenohumeral joint whatever the position of the limb and hand.

♦ Instability is a symptom. It can be defined as the condition of symptomatic abnormal motion of the joint. It refers to a perturbation of concavity compression. It is not a diagnosis.

♦ Instability is the result of perturbations of structural factors and non-structural factors.

♦ The clinical syndrome of instability is a disturbance of one or more of these factors in isolation or together. The relative importance of each factor to the syndrome can change over time. The relationship between these factors is described by the Stanmore triangle.

♦ Both structural and non-structural factors can be perturbed by arrested or incomplete development (dysplasia) or by injury (disruption).

♦ The aim of treatment is the restoration of (asymptomatic) stable motion by restoration of the CJRF and so restoration of the condition of concavity compression.

♦ Management follows simple principles: surgery should be undertaken within the context of a well-considered rehabilitation program largely centred around optimizing rotator cuff function.

♦ Failures of management are often due to failure of or incomplete diagnosis, failure of healing, inadequate attention to patient- and pathology- specific rehabilitation programs, or insufficient attention to lifestyle considerations.

♦ Disrupted anatomy is restored, preferably by anatomic operations with predictably good outcomes. Dysplastic anatomy is augmented, often by non-anatomic operations with less predictable outcomes. Revision stabilizations are generally nonanatomic, and have higher failure rates.
Surface replacement of the shoulder
Authors: Copeland Stephen , Relwani Jai
Published: April 2012

♦ The design of the surface replacement arthroplasty has evolved over the past 20 years. From cemented prostheses such as the SCAN, to cementless prostheses such as the Copeland, the basic concept and design of the surface replacement favouring maximal bone preservation has remained constant.

♦ Indications and surgical technique have been refined over this period, the latest modification being the use of computer-assisted navigation to optimise the size and position the implant in situ.

♦ Surface replacement prosthesis has demonstrated clinical results at least equal to those of conventional stemmed prostheses.
Stemmed total shoulder replacement
Authors: Trail Ian A.
Published: April 2012

♦ Stemmed shoulder replacement remains the gold standard for shoulder with an intact rotator cuff.

♦ The scarred capsule must be released before the implant is introduced.

♦ This chapter discusses the merits of total shoulder replacement versus hemiarthroplasty and the management of complications.
Acromioclavicular joint
Authors: Potter David
Published: April 2012

♦ The acromioclavicular joint is the sole skeletal connection between the upper limb and the axial skeleton, providing strength and stability to the shoulder

♦ The acromioclavicular joint is one of the most commonly injured joints of the body

♦ Arthropathy of the joint is often associated with contact sport or heavy manual work

♦ Treatment of arthropathy can either be by activity modification, steroid injection or surgery

♦ Surgery involves removing the distal end of the clavicle

♦ Dislocations of the acromioclavicular joint are common injuries, most often due to a fall landing directly on the tip of the shoulder

♦ Dislocations are classified into six grades (I to VI), grades I and II are treated non-surgically, grades IV-VI are treated surgically

♦ Numerous surgical options are available for treatment of acute and chronic dislocations
The clavicle and sternoclavicular joint
Authors: Roberts Simon N.J.
Published: April 2012

♦ Fractures and dislocations of the sternoclavicular joint are uncommon and often successfully treated non-operatively

♦ There are a number of poorly defined sclerotic, sometimes inflammatory, conditions with a predilection for the medial clavicle.
Disorders of the scapula
Authors: Emery Roger
Published: April 2012

♦ Sprengel’s deformity causes a high riding, fixed, hypoplastic scapula

♦ Sprengel’s deformity may be associated with Klippel Fiel syndrome

♦ Winging of the scapula can be caused by trapezius palsy or serratus anterior palsy

♦ Trapezius palsy is usually due to damage to the spinal accessory nerve

♦ Serratus palsy is usually caused by damage to the long thoracic nerve

♦ Fascio-scapulo-humeral dystrophy presents with loss of scapula control from the late teens to the late twenties

♦ FSHD is autosomal dominant and linked to alteration of the 4q35 gene.
Reverse geometry replacement
Authors: Watkinson Duncan J. , Boileau Pascal
Published: April 2012

♦ RSR provides a unique tool for patients with cuff tear arthropathy

♦ RSR is a useful tool for fractures, tumours, and revision of shoulder replacements

♦ However RSR comes with specific complications such as scapular notching and acromial fractures

♦ The 10 year results of RSR show that prosthetic loosening is no more frequent than with anatomical prostheses.
Osteoarthritis of the elbow joint
Authors: Shahane Shantanu
Published: April 2012

♦ Symptomatic, primary osteoarthritis of the elbow usually occurs in young men involved in heavy manual labour.

♦ Common causes of secondary osteoarthritis of the elbow are trauma, infection, bleeding disorders and neuropathic conditions.

♦ Clinically, the commonest presenting symptom is loss of motion. Patients can also complain of pain, locking and ulnar nerve symptoms.

♦ Plain X-rays are usually sufficient for diagnosis. They show reduction in joint space and osteophytes at the tip of olecranon and coronoid processes. Loose bodies are also frequently seen.

♦ Symptoms in early stages of arthritis are controlled by nonoperative means. Steroids are rarely used in clinical practice.

♦ In advanced cases, numerous operative treatments including arthroscopic and open procedures are available.

♦ Total Elbow replacement (TER) for primary degenerative arthritis of the elbow is only to be considered as the last option and when stringent pre and post-operative requirements are followed.
Elbow arthroscopy
Authors: Qureshi Amir A. , Hay Stuart M.
Published: April 2012

♦ Indications relate to experience

♦ Neurovascular considerations are paramount

♦ Elbow Arthroscopy is an evolving technique.
Bursitis of the elbow
Authors: Hinsche Andreas F.
Published: April 2012

♦ Inflammation of the bursa

♦ Non-Septic or Septic

♦ Repetitive Micro-traumata

♦ Bloods, XR, USS, MRI, Aspirate

♦ Splintage, NSAID, Antibiotics, I+D

♦ 85% Staph. aureus
Assessment and investigation of chronic wrist pain
Authors: Trail I.A. , Temperley D. , Stanley J.K.
Published: April 2012

♦ A careful history and a thorough physical examination is of paramount importance in the diagnosis of chronic wrist pain

♦ The mechanism of injury and the position of the wrist when injured is crucial information

♦ The localization of swelling and local tenderness can be invaluable in diagnosis

♦ Imaging of the wrist is often helpful is diagnosis, with plain radiography standard

♦ Fluoroscopy, nuclear medicine, CT and MRI scans, arthrography and arthroscopy can also help with diagnosis

♦ The choice of imaging technique and its interpretation depend upon clinical information derived from the history and physical examination
Degenerative arthritis of the wrist
Authors: Burge Peter
Published: April 2012

♦ The multiple joint compartments of the wrist show very different susceptibility to degenerative arthritis

♦ Secondary, not primary, degenerative arthritis of the radiocarpal joint is more common, and non-operative treatment is often sufficient

♦ Scaphoid-trapezoid-trapezium osteoarthritis is common and often asymptomatic or only mildly symptomatic, non-operative treatment is usually sufficient

♦ Pisotriquetral osteoarthritis is uncommon and often asymptomatic

♦ Range of movement, features of pain and radiography are important in diagnosis
Kienböck’s disease
Authors: Langdon Ilana , Giddins Grey
Published: April 2012

♦ Uncommon but well recognised

♦ Cause – avascular necrosis

♦ Probably related to ulna positive variance

♦ History and examination may be suggestive but rarely diagnostic

♦ Radiographs or MRI are diagnostic

♦ Treatment is non-operative or operative

♦ Various operations are performed especially ulna shortening

♦ Most patients do well even with poor radiographs.
Rheumatoid arthritis of the hand and wrist
Authors: Stothard J.
Published: April 2012

♦ RA is common

♦ Medical treatment is the mainstay and newer anti-TNF drugs are reducing morbidity and thus referral for surgery

♦ Assessment is primarily clinical

♦ Investigations – Primarily radiographs

♦ Treatment

• Non-operative

• Steroid injections are often very useful

• Operative

• Site and condition specific

♦ In general

• DRUJ – excision ulna head

• Wrist – partial fusion, arthrodesis, arthroplasty

• MP joints – synvestomy, arthroplasty

• PIP joints – soft tissue rebalancing, arthrodesis

• DIP joints – arthrodesis

• Thumb MP and IP joints – arthrodesis
Osteoarthritis of the hand
Authors: Davis T.R.C. , Downing N.D.
Published: April 2012

♦ Prevalence of hand osteoarthritis increases with age

♦ Most hand osteoarthritis causes few symptoms

♦ Non-operative management is sufficient for the majority of cases

♦ Surgical treatment is sometimes required

♦ Total joint replacements have significant failure rates.
Dupuytren’s disease
Authors: Burge Peter
Published: April 2012

♦ Dupuytren’s disease is characterised by contracture of a finger resulting from thickening and shortening of the palmar fascia

♦ A genetic component to the aetiology is apparent, smoking, alcohol and diabetes can increase the risk

♦ The pathogenesis of Dupuytren’s disease remains elusive

♦ Non-surgical treatment options include splintage, steroid injection and collagenase injection

♦ Surgery cannot cure the disease but can straighten bent digits and minimize recurrence

♦ Operative methods can be considered with regards to incision, management of the diseased fascia and closure techniques

♦ Operative complications include injury of digital nerves and arteries
Tendon disorders
Authors: Mason Will , Warwick David
Published: April 2012

♦ The term tenosynovitis should be restricted to inflammatory disorders; De Quervain’s syndrome and trigger finger do not show inflammatory changes histologically and are more appropriately termed tenovaginosis

♦ The cause of most tenovaginoses is unclear; they are occasionally secondary to trauma and rarely linked to overuse

♦ Rupture of individual tendons may not require surgical reconstruction but it is important to establish the underlying cause of rupture to prevent sequential rupture of adjacent tendons.
Reconstruction after nerve injury
Authors: Hems T.E.J.
Published: April 2012

♦ Late reconstructive procedures may improve function if there is persisting paralysis after nerve injury

♦ Transfer of a functioning musculotendinous unit to the tendon of the paralysed muscle is the most common type of procedure

♦ Passive mobility must be maintained in affected joints before tendon transfer can be performed

♦ The transferred muscle should be expendable, have normal power, and have properties appropriate to the function it is required to restore

♦ Tendon transfers can provide reliable improvement in function after isolated radial nerve palsy

♦ A number of procedures have been described for reconstruction of thumb opposition but impaired sensation after median nerve injury may limit gain in function

♦ Tendon transfers are possible to improve clawing of fingers and lateral pinch of the thumb after ulnar nerve palsy or other cases of intrinsic paralysis.
Peripheral nerve entrapment
Authors: Weiss Krista E. , Weiss Arnold-Peter C.
Published: April 2012

♦ Peripheral nerve compression syndromes are common when involving the median nerve at the wrist and the ulnar nerve at the elbow

♦ All patients are primarily diagnosed using a careful history and clinical examination

♦ Neurophysiological studies are very helpful especially in confusing presentations but do have a low false positive and false negative rate

♦ Conservative management should be tried in nearly all patients for 6-12 weeks

♦ Surgical treatment is generally very successful in relieving the symptoms of peripheral nerve compression

♦ Delayed treatment can result in permanent nerve damage which cannot be corrected by surgery.
Neurophysiological examination of the hand and wrist
Authors: Mills Kerry R.
Published: April 2012

♦ Neurophysiological assessment includes:

• Clinical assessment

• Sensory testing

• Motor testing

• EMG

♦ Sensory testing (SAP) is generally the most useful

♦ Motor studies – there are 4 main measurements

♦ EMG – looks for (abnormal) spontaneous activity. It is operator dependent.
Tumours and hand reconstruction
Authors: Glynn Bolitho D.
Published: April 2012

♦ Hand tumours are common

♦ The vast majority are benign

♦ Soft tissue – commonest Giant cell tumour of tendon sheath. Treatment marginal excision

♦ Bone – commonest – Enchondroma. Treatment – leave if incidental or currette +/− bone grafting

♦ Malignant – need full work up with detailed clinical examination, investigation, and planning in a multidisciplinary meeting

♦ Treatment is wide/radical excision often with partial amputation +/− plastic surgical reconstruction.
Ganglia of the wrist and hand
Authors: Campbell Douglas A. , Burge Peter
Published: April 2012

♦ Ganglia are common; typically age 20–40, in women more so than men

♦ Cause: unclear but associated with underlying ligament or tendon ‘irritation’ or joint osteoarthritis

♦ Diagnosis: usually obvious. Investigations are generally not needed

♦ Most recover spontaneously especially in children

♦ Good operative techniques are generally successful.
Hand infection
Authors: Leonard Lisa
Published: April 2012

♦ Common

♦ Typically with common bacteria: Staphylococcus or Streptococcus

♦ Typically in common sites:

• Fingertip

• Tendon sheath

• Deep palmar spaces

♦ Atypical infections such as MRSA becoming more frequent.
Indications for hip replacement
Authors: Miles J. , Briggs Timothy W.R.
Published: April 2012

♦ Hip replacement is commonly performed as treatment of a multitude of degenerative hip disorders

♦ Pain, stiffness, and loss of function remain the primary indicators of the need for hip surgery

♦ As implant designs and surgical techniques have improved, the range of indications has expanded

♦ Contraindications and risks must always be counterbalanced with the potential benefits.
Approaches to the hip
Authors: Miles J. , Briggs Timothy W.R.
Published: April 2012

♦ The development of safe and reliable approaches has allowed hip replacement surgery to be undertaken successfully

♦ There are four main approaches, each with their inherent advantages and disadvantages

♦ Awareness of the structures at risk with each approach reduces the risk of iatrogenic injury

♦ All of the approaches have been modified and improved upon to address specific weaknesses.
Preoperative planning for total hip replacement, consent, and complications
Authors: Carrington R.W.J.
Published: April 2012

♦ Preoperative planning is essential to achieve successful results after total hip replacement

♦ Obtaining informed consent is important for both surgeon and patient

♦ The surgeon must have a comprehensive knowledge of the aetiology and treatment of the common associated complications.
Total hip replacement: implant fixation
Authors: Sochart David H.
Published: April 2012

♦ Cemented fixation in total hip replacement set the standard and has stood the test of time

♦ Improved generations of cementing technique have led to improved results

♦ The long term results of uncemented implants have improved with better designs and materials

♦ The most important determinant of the outcome and longevity of the implant is the quality and accuracy of the initial implantation
Bearing surfaces
Authors: Blunn Gordon
Published: April 2012

♦ Traditionally bearings were made from polyethylene and cobalt chrome. These bearings are still most commonly used for knee replacements. In hip replacements due to osteolysis caused by polyethylene wear alternative material combinations at the bearing surface are used

♦ Highly cross linked plastics have been developed and have been shown to reduce wear. There are a number of different types available which differ in their performance

♦ Metal on metal bearings first used in the 1960s have also been developed and show very low wear rates. These bearings are more susceptible to edge loading and the resulting metal ion release can result in adverse biological reactions leading to failure

♦ Whilst ceramic on plastic surfaces have been used for a considerable amount of time the reduction in wear is not as great as with well functioning metal on metal bearings

♦ Ceramic on ceramic bearings have been used for a considerable time and show even lower wear rates than metal on metal bearings. In the past there has been an incidence of catastrophic fracture of these bearings but developments in materials technology have considerably reduced these events.
The young arthritic hip
Authors: Malik Ahmad K. , Hashemi-Nejad Aresh
Published: April 2012

♦ Impingement:

• Primary femoroacetabular impingement:

▪ Cam type

▪ Pincer type

▪ Combined cam and pincer

• Secondary femoroacetabular impingement:

▪ Slipped upper femoral epiphysis (cam type)

▪ Protusio (pincer type)

▪ Retroverted acetabulum (pincer type)

▪ Malunited femoral head/neck fracture (cam type)

▪ Acetabular fracture (pincer type)

▪ Perthes disease (cam type)

♦ Instability:

• Developmental dysplasia of the hip (treated/residual and untreated)

• Dislocation

• Subluxation

• Dysplasia

♦ Inflammatory:

• Juvenile idiopathic arthritis

• Rheumatoid arthritis.
The complex primary total hip replacement
Authors: Donaldson James , Carrington Richard
Published: April 2012

♦ Hip Dysplasia

• Despite screening programs, a large number of patients are affected by dysplastic hips and their sequelae

• An understanding of anatomical abnormalities is crucial

• Appropriate techniques and implants make arthroplasty feasible

• Complications are significantly higher than standard primary hip replacements

♦ Protrusio Acetabuli

• Technical difficulties include inadequate medial wall and restoring offset, hip centre and leg lengths

• Neck may need to be cut in-situ; bone graft is usually necessary and ideally should be taken from the femoral head

• Antiprotrusio cages or custom implants may be needed in cases with excessive bone loss

♦ Arthrodesed hip to total hip replacement

• Careful evaluation of the gluteal muscles is mandatory and predicts final walking ability and patient satisfaction

• Long-term effectiveness of total hip replacement in ankylosed hips is satisfactory but there is a higher complication rate
Surgical options excluding total hip replacement for hip pain
Authors: Malik Ahmad K. , Hashemi-Nejad Aresh
Published: April 2012

♦ Intra-articular steroid and local anaesthetic

♦ Soft tissue releases

♦ Synovectomy

• Open

• Arthroscopically

♦ Acetabular osteotomy

• Bernese periacetabular osteotomy

• Triple

• Dial

• Chiari

• Shelf

♦ Femoral osteotomy

• Varus

• Valgus

♦ Hip arthroscopy

♦ Open surgical dislocation of the hip

♦ Hip arthrodesis
Total hip replacement: modes of failure
Authors: Pollock Rob
Published: April 2012

♦ Total hip replacements (THRs) may fail in various ways. They may become infected, they may be subject to aseptic loosening, they may dislocate, or a periprosthetic fracture may occur. The patient with a failed THR must be thoroughly assessed before treatment is contemplated

♦ Infection may be acute or chronic. Assessment involves clinical assessment, plain radiographs, blood tests (C-reactive protein and erythrocyte sedimentation rate), hip aspiration, and, sometimes, nuclear medicine. The acutely infected hip may be treated with one-stage revision. This involves thorough lavage, debridement, and exchange of all modular components as well as long-term antibiotic therapy. The gold standard of treatment for a chronically infected THR is a two-stage revision. Success rates of 80–90% can be expected

♦ Aseptic loosening typically occurs at the cement bone interface in hips where a metal-on-polyethylene bearing couple has been used. Bone resorption takes place as a result of an inflammatory response to small wear particles. After infection has been excluded the treatment of choice is a single-stage revision

♦ Dislocation may be the result of patient factors, implant factors, or poor surgical technique. It is imperative for the clinician to minimize the risk by selecting patients carefully, using the correct combination of implants and performing surgery accurately

♦ The management of periprosthetic fractures depends on how well the implants are fixed and quality of bone stock. Treatment ranges from simple fixation of the fracture through to revision augmented with strut allograft.
Revision total hip replacement and complications in total hip replacement
Authors: Miles J. , Carrington R.W.J.
Published: April 2012

♦ Revision hip replacement requires careful preoperative planning

♦ Accurate diagnosis is vital: particular attention must be paid to whether infection is present or not

♦ Extensile approaches are preferred

♦ Appropriate equipment is greatly helpful in explantation of the failed components

♦ Imaging, classification, and templating are useful in determining the best reconstruction techniques.
Management of total hip replacement periprosthetic fractures
Authors: Haddad F.S. , Rayan F.
Published: April 2012

♦ Periprosthetic fractures: intraoperative or postoperative femoral or acetabular fractures

♦ Third commonest reason for reoperation after THA

♦ Vancouver classification Type A, B, and C

♦ Three most important factors that determine treatment are:

• Site of the fracture

• Stability of the implant

• Quality of the surrounding bone stock.
Management of the infected total hip replacement
Authors: Stockley I.
Published: April 2012

♦ Diagnosis of infected hip arthroplasty requires a multidisciplinary team approach

♦ Aims of treatment are to eradicate infection, alleviate pain, and restore function

♦ Treatment should be conducted in specialist centers.
Hip resurfacing
Authors: Kumar Deepak , Carrington Richard
Published: April 2012

♦ Hip resurfacing has emerged as an alternative method of hip arthroplasty for younger patients

♦ It is technically more demanding than total hip replacement

♦ The reported early and mid-term results are good with revision rates below 5% at 7 years

♦ Long term effect of raised levels of metal ions remains a major concern

♦ Long term clinical follow up and further research must continue.
Sports injuries in the pelvic region
Authors: Wolman Roger
Published: April 2012

♦ The pelvis acts as a fulcrum for the forces transmitted between the lower limb and trunk especially on twisting and turning movements while running, and in the reverse direction when kicking. Sports injuries around the pelvis are therefore common in weight-bearing sports, such as running, football, rugby, and basketball

♦ Injury can occur to the various structures around the pelvis. Bone stress injuries affect the symphysis pubis, pubic rami, femoral neck, and sacrum. Stress fractures are more common in women and may occur as part of the female athlete triad (Box 7.15.1) where there is hypo-oestrogenaemia and low bone density

♦ Tendon injuries, including enthesopathies, most commonly affect the adductors, lower abdominals, glutei and hamstrings. Hip injuries can occur as a result of labral tears and femoroacetabular impingement. Sacroiliac joint instability may also cause symptoms especially in the buttock region. Synovitis of either joint may suggest an inflammatory arthritis

♦ Pain is the most common symptom. However it may be referred from elsewhere, especially the lumbar spine. Pain may also originate from other systems including the reproductive organs and the gastrointestinal and urinary tracts.
Inflammatory and metabolic bone disorders of the pelvis
Authors: Keen Richard W.
Published: April 2012

♦ Avascular Necrosis

♦ Paget’s disease

♦ Transient Osteoporosis of the Hip.
Hip pain in the radiologically normal hip
Authors: Hashemi-Nejad Aresh
Published: April 2012

♦ Patients who present with hip pain can have multiple origins of pathology—this may be intra- or extra-articular in origin

♦ In the majority, a definable diagnosis can be obtained through a detailed history, examination, and subsequent radiological evaluation

♦ However, there remains a group of patients who have intractable hip pain without a definitive diagnosis despite extensive non-invasive radiological investigation.
Hip arthroscopy: assessment, investigations, and interventions
Authors: Singh Parminder J. , O’Donnell John M. , Field Richard E
Published: April 2012

♦ Learning objectives:

• Understand hip arthroscopic anatomy

• Awareness of indications and contraindications for hip arthroscopy

• Understand what femoroacetabular impingement (FAI) is, and how to investigate and treat this condition

♦ Assessment: FADIR and FABER tests

♦ Investigations: plain x-ray, magnetic resonance imaging/arthroscopy, computed tomography scan in Pritchard O’Donnell (POD) position

♦ Interventions: central and peripheral compartments, periarticular space, lateral compartment, FAI correction—cam, pincer, or combined.
Implant choice for primary total hip arthroplasty
Authors: Singh Parminder J. , Field Richard E.
Published: April 2012

♦ Types of acetabular components available

♦ Types of femoral components available

♦ Types of bearings
History and examination of the knee
Authors: Spalding Tim
Published: April 2012

♦ History and examination of the knee are linked and specific examination is determined by the likely diagnosis indicated by the history

♦ The 5 diagnostics groups are: Anterior knee pain; Traumatic injury to knee ligaments, meniscus, or other structures; Degenerative osteoarthritis; Inflammatory joint problem; and other problems

♦ General examination of the knee is still required with the patient, walking, standing, sitting, and lying supine

♦ Specific examination is targeted to 4 areas: The patello-femoral joint and extensor mechanism; Meniscal pathology; Ligament stability; and Arthritis. The pattern of signs elicited should lead to definitive diagnosis.
Cartilage repair in the young knee
Authors: Spalding Tim , Peterson Lars
Published: April 2012

♦ Articular cartilage has a poor capacity to heal by itself

♦ Left alone, large areas are likely to progress into osteoarthritis

♦ The goal of cartilage repair is both short term improvement in function and long term durability

♦ There are several available strategies including non-surgical options, and these are formulated into an algorithm

♦ Cartilage repair is an advancing field and the future lies in bioengineering and high quality comparative clinical analysis.
Magnetic resonance imaging of the knee
Authors: Shulman Ryan , Wilson Adrian , Peppercorn Delia
Published: April 2012

♦ ACL tear: abnormal fibres, tibial translation, PCL/patella tendon buckling, bone bruising

♦ Meniscal tear: signal change to free edge

♦ Bone bruising:

• Reticular—not continuous subarticular bone

• Geographic—extends to subarticular bone

♦ Posterolateral corner:

• Oblique slices through fibular head

• Consists of lateral collateral ligament, popliteus, popliteofibular ligament, and arcuate complex.

Magnetic resonance imaging (MRI) has revolutionized the investigation and treatment of the painful knee. It is non-invasive and avoids patient exposure to ionizing radiation. MRI has the advantage of establishing diagnoses in a painful knee without the morbidity of surgical intervention. It is now widely available and has moved from a simple diagnostic adjunct into a key planning tool. It offers improved management of theatre resources and it allows for more accurate planning of postoperative rehabilitation.

The role of MRI in management of the injured knee is determined by its cost-effectiveness and its ability to augment the diagnostic accuracy of clinical examination. Accuracy of clinical examination by specialist orthopaedic surgeons is comparable to MRI when interpreted by specialist radiologists (Table 8.3.1). Increasingly, MRI has been shown to be cost neutral. Whilst costs are high, diagnostic information reduces the need for unnecessary surgery.
Osteotomies around the knee
Authors: Lim Mui-Hong , Bartlett John
Published: April 2012

♦ Osteotomy about the knee can correct deformity and alter the alignment of the knee in different planes.

♦ Osteotomy of the knee is indicated for correction of alignment and offloading of affected compartment in osteoarthritis, instability, post cartilage repair and meniscectomy.

♦ Pre-operative planning for osteotomy of the knee involves patient selection, clinical and radiological assessment to achieve the desired knee alignment.

♦ Depending of the type of knee deformity, distal femoral or proximal osteotomy is indicated of the correction of the deformity.

♦ Osteotomy of the knee has been shown to provide pain relief and improve function in majority of patient.
Arthrodesis of the knee
Authors: Floyd Andrew
Published: April 2012

♦ Rare operation in developed countries

♦ Most often used for post infection damage in developing countries

♦ Still used as a last resort for failed knee replacements.
Total knee replacement
Authors: Long William J. , Scuderi Giles R.
Published: April 2012

♦ Modern total knee replacement is a safe, effective, durable, and reproduceable solution to address symptomatic degenerative joint disease of the knee.
Complications of total knee replacement
Authors: Jones Bryn
Published: April 2012

♦ 81–89% overall patient satisfaction following total knee replacement

♦ 1 in 8 patients experience unexplained postoperative pain

♦ Obesity, increasing age, and medical comorbidities increase the risk of postoperative complications

♦ Prosthetic infection rate at 1 year is 1–2%

♦ Preoperative range of movement often determines postoperative range

♦ Low risk of acute vascular event and neurological and ligamentous injury

♦ Duration and method of venous thromboprophylaxis remains controversial

♦ Periprosthetic femoral and tibial fractures require stabilisation. Fixation of periprosthetic patella fractures is not recommended

♦ New surgical techniques and innovations require long term evaluation.
Revision total knee replacement
Authors: Vince Kelly , Munro Jacob
Published: April 2012

♦ Understanding the reason for failure of the original knee replacement is crucial prior to revision

♦ The surgery should be a revision and not a repeat of the failed arthroplasty

♦ There are eight reasons for failure of original knee replacements which should each be approached individually

♦ Unexplained pain relating to a knee replacement requires further investigation before revision surgery can occur

♦ Successful revision surgery is performed in three steps – preparation of a tibial surface, the knee in flexion and the knee in extension
Miscellaneous conditions around the knee
Authors: Monk Paul , Gibbons Max , Temple Tom
Published: April 2012

♦ Intra and extra-articular

♦ X-ray for bone or soft tissue origin

♦ Solid tumours consider malignancy

♦ MRI for diagnosis.
The patellofemoral joint
Authors: Donell Simon
Published: April 2012

♦ The symptomatic patellofemoral joint is difficult to manage.

♦ It is difficult to be certain that the pain felt by the patient is actually arising from the joint.

♦ The majority of symptomatic patients should be managed conservatively with exercises aimed at improving muscle control.

♦ Surgical treatment gives best results in patellofemoral instability when there are defined anatomical abnormalities that are then corrected.

♦ Surgical treatment of patellofemoral arthritis has uncertain outcomes.
Surgical techniques of anterior cruciate ligament reconstruction
Authors: Feller Julian
Published: April 2012

♦ The principal indication for ACL reconstruction is instability, either existent or predicted

♦ In general, it is crucial that the knee has settled and motion has been restored prior to surgery

♦ Accurate tunnel position is the most important aspect of surgery
Combined ligament injuries around the knee
Authors: Williams Andy , Narvani Ali
Published: April 2012

♦ Any knee with major disruption of two ligaments is likely to have been dislocated at the time of injury

♦ Knee dislocations are associated with high risk of neurovascular injury. Angiography or vascular ultrasound is mandatory

♦ In knee dislocations, following immediate reduction and stabilization usually with a brace, acute repair of the ruptured soft tissue structure within 2–3 weeks of injury is likely to provide superior results compared to later reconstruction

♦ Management of most multiligament injuries is complex and requires surgical intervention therefore specialist centres are best to be involved early

♦ In cases with associated malalignment, osteotomy can improve the results of ligament reconstruction.
Unicompartmental knee replacement
Authors: Pandit Hemant , Dodd Christopher , Murray David
Published: April 2012

♦ Ideal treatment option for end-stage osteoarthritis affecting a single compartment of the knee

♦ Unicompartmental knee replacement has many advantages over total knee replacement

• Restores near normal kinematics

• Usually gives a better range of movement

• Patients require a shorter hospital stay

• Fewer serious complications