bluuebunny/crossref_metadata_2025 huggingface dataset:
Meniscal injury and management
Authors: Bollen Steve
Published: April 2012

♦ Menisci have a complex load bearing function

♦ Loss leads to accelerated articular cartilage wear

♦ Injury is common but symptomatic relief straightforward with skilled arthroscopic surgery

♦ Peripheral tears have a blood supply and are potentially repairable.
Ankle and hindfoot arthritis
Authors: Cooke Paul H. , Goldberg Andy
Published: April 2012

♦ Hind foot arthritis is usually treated orthotically but may need surgical fusion

♦ Severe ankle arthritis requiring surgical intervention is uncommon

♦ Arthroscopic debridement of early ankle arthritis is effective

♦ End stage ankle arthritis can be treated by fusion or arthroplasty

♦ Ankle replacement has a higher failure rate than hip or knee arthroplasty

♦ Correct alignment of the hind foot and forefoot are essential for good results.
Disorders of the forefoot
Authors: Robinson Andrew H.N. , Bhatia Maneesh
Published: April 2012

♦ The aim of modern forefoot surgery is to refunction the first ray, and balance the lesser rays around it

♦ The indications for surgery in hallux valgus are of pain over the bunion, or of pain with subluxation or dislocation of the lesser rays as a result of first ray insufficiency

♦ Hallux valgus surgery aims to reposition the metatarsal head over the sesamoids whilst maintaining length. The osteotomy should be stable to allow early mobilization

♦ The mainstays of the surgical treatment of hallux rigidus are dorsal cheilectomy and fusion of the first MTPJ

♦ 96% excellent and good results in reconstruction of the rheumatoid forefoot have been reported with fusion of the first MTPJ and resection of the lesser metatarsal heads.
Diabetic foot
Authors: Goldberg Andy , Cooke Paul H.
Published: April 2012

♦ Diabetic foot problems are of major socioeconomic importance

♦ Aetiology is multifactorial, with a neuropathic, vascular, and immune component

♦ A multidisciplinary approach must be adopted, with education and prevention being key aims

♦ If ulceration develops, restoration/preservation of an intact soft tissue envelope and the creation of a plantigrade foot that can bear weight are the key treatment goals.
Orthoses of the foot and leg
Authors: Mitchell Jo , Cooke Paul H.
Published: April 2012

♦ Orthoses may be corrective or accommodative

♦ Orthoses are described according to their anatomical application

♦ A knowledge of material properties, anatomy, and function is essential to prescribe

♦ Patients will only tolerate effective orthoses.
Tendon and ligament disorders of the foot and ankle
Authors: Solan Matthew C. , Davies Mark S.
Published: April 2012

♦ Treatment of tendon and ligament disorders of the foot depends on accurate clinical diagnosis, supported by investigation

♦ The treatment of posterior tibial tendon dysfunction is guided by classification

♦ Ankle ligament injuries only need surgical treatment if very severe or chronic

♦ Achilles tendonitis is usually treated conservatively

♦ Rupture of the Achilles tendon may be treated operatively or conservatively.
Metabolic disease of skeleton and inherited disorders
Authors: Wordsworth Paul
Published: April 2012

♦ Classic metabolic bone diseases include osteoporosis, osteomalacia, Paget’s disease, and parathyroid bone disease

♦ Heritable disorders of the skeleton include numerous osteochrondrodysplasias, Marfan syndrome, and Ehlers-Danlos syndrome

♦ Investigation of short stature is indicated for those below 0.4 percentile, with skeletal disproportion and/or progressive shortness

♦ Genetic mutations for most of these conditions have been identified but clinical/radiographic features are usually diagnostic.
Rheumatoid arthritis
Authors: Bawa Sandeep , Wordsworth Paul
Published: April 2012

♦ Rheumatoid arthritis (RA) is one of the most common disabling chronic diseases of the Western world.

♦ New biologic treatments have provided great benefit in the management of this condition, reducing morbidity and mortality.

♦ RA diagnosis requires careful clinical, biochemical, and radiological assessment

♦ Rheumatoid factor is not a reliable diagnostic test for rheumatoid arthritis (RA)

♦ The core of its management requires careful input from all members of the multidisciplinary team.
Crystal arthropathies
Authors: Bawa Sandeep , Wordsworth Paul
Published: April 2012

♦ Always exclude infection in acute hot joint

♦ Raised serum uric acid does not necessarily confirm a diagnosis of gout

♦ Aspiration and microscopy is essential for accurate diagnosis of crystal arthropathies

♦ Non-steroidal anti-inflammatory drugs and intra-articular steroids are the treatments of choice

♦ Wait 2 weeks for acute gout to settle before starting hypouricaemic therapy

♦ Aim for target urate of <300µmol/L.
Spondyloarthropathies
Authors: Bawa Sandeep , Wordsworth Paul , Atukorala Inoshi
Published: April 2012

♦ Spondyloarthropathies are related conditions typically associated with axial skeletal involvement, absence of rheumatoid factor, familial clustering, and a variable positive association with HLA-B27

♦ Ankylosing spondylitis is the prototype with sacroiliac joint involvement being a prerequisite for diagnosis

♦ Diagnosis is frequently delayed for several years but the use of magnetic resonance imaging to detect sacroiliitis greatly facilitates the establishment of an early diagnosis

♦ Psoriatic arthritis, reactive arthritis, and enteropathic arthritis have prominent peripheral joint involvement with variable degrees of spinal involvement

♦ Non-steroidal anti-inflammatory drugs and physical therapy are the cornerstones of management but slow-acting disease-modifying antirheumatic drugs only have a role in peripheral arthritis

♦ Anti-tumour necrosis factor biologic agents have revolutionized the treatment of the spondyloarthropathies.
Inflammatory connective tissue disease
Authors: Swales Catherine
Published: April 2012

♦ Systemic lupus erythematosus (SLE) is the commonest multisystem connective tissue disease

♦ All patients with SLE are antinuclear antibody (ANA) positive, but not all ANA-positive patients have SLE

♦ Renal lupus carries a high mortality and requires aggressive immunosuppression

♦ Dermatomyositis may be associated with malignancy in the elderly

♦ The vasculitides are classified according to vessel size and ANCA (antineutrophil cytoplasmic antibody) profile

♦ Therapy for vasculitis includes corticosteroids, steroid-sparing agents, and cytotoxics.
Osteoporosis
Authors: Magliano Malgorzata
Published: April 2012

♦ Osteoporotic fractures affect one in two women and one in five men over the age of 50

♦ Previous fragility fracture increases future fracture risk and should prompt further assessment and treatment

♦ Clinical risk factors in combination with bone mineral density measurement allow identifying patients at risk

♦ Screening for secondary causes of osteoporosis is important, particularly in men and younger women

♦ Patients at high risk for future fracture should be offered appropriate treatment. Bisphosphonates together with adequate calcium and vitamin D supplementation constitute first-line therapy

♦ Compliance with treatment and clinical response need to be monitored.
Osteoarthritis
Authors: Javaid Kassim , Wordsworth Paul
Published: April 2012

♦ Osteoarthritis is the outcome of many different disease processes

♦ Correlation between radiographic appearance and symptoms is poor

♦ Prevalence increases rapidly with age

♦ A multidimensional approach in treatment should include patient education, physical therapy, analgesia, and ergonomic assessment

♦ Surgical approaches to treatment should adopt a holistic approach.
Chronic long bone osteomyelitis
Authors: Calder Peter
Published: April 2012

Pathological features of chronic osteomyelitis

♦ Necrotic bone

♦ Compromised soft tissues with reduction in vascularity

♦ Ineffective host response

♦ Sequestrum formation

♦ New bone formation from viable periosteum and endosteum

♦ Formation of involucrum:

Treatment principles in chronic osteomyelitis

♦ Surgical debridement – remove all devitalized necrotic tissue

♦ Dead space management:

• Soft tissue defect – avoid healing by secondary intention. Consider local and free flaps

• Bone defects – small structural with autologous bone graft, consider Papineau ‘open bone grafting’ where free tissue transfer is not an option, distraction osteogenesis with bifocal and bone transport for large defects including fibula transfer

♦ Bone stability – movement needs to be eliminated

♦ Antibiotic therapy – based on culture and sensitivity, local administration with PMMA beads or collagen sponge, Lautenbach procedure in resistant cases.
Miscellaneous orthopaedic infections
Authors: Tennant Sally , Calder Peter
Published: April 2012

♦ Clinical features and treatment of: leprosy; brucellosis; syphilis of bone and joints; hydatid disease of the bone; mycetoma; salmonella infection; staphylococcus aureus infections associated with Panton-Valentine leucocidin; Poliomyelitis; Tuberculosis.
Amputations and prostheses
Authors: Hanspal Rajiv S. , Calder Peter
Published: April 2012

♦ Amputation surgery should produce a new end-organ for locomotion with a prosthesis or interaction with the environment

♦ The choice of amputation level should be based on healing, functional expectations, and prosthetic use

♦ Success of rehabilitation depends on multi-disciplinary input and management of complications

♦ The prostheses prescribed should depend on functional need and expectation.
Acute osteomyelitis
Authors: Calder Peter
Published: April 2012

♦ Bacteraemia resulting in bone deposition of bacteria

♦ Local bony tenderness, fever, and malaise may not be present initially

♦ WCC may be normal, ESR and CRP normally raised

♦ Plain radiographs normally take 10–12 days to occur

♦ Staphylococcus aureus remains the commonest organism

♦ Immediate antibiotics with surgical drainage of abscess formation.
Septic arthritis
Authors: Calder Peter
Published: April 2012

♦ Painful swollen joint with significant limitation in movement

♦ Systemic symptoms, fever, and malaise

♦ Antibiotics following blood cultures, joint aspiration

♦ Wash out and joint splintage in position of function

♦ Low threshold to repeat washout if symptoms do not resolve.
Fracture classification
Authors: DeCoster Thomas A.
Published: April 2012

♦ The 2007 OTA Comprehensive Classification of Fractures and Dislocations is recommended as the standard for fracture classification

♦ Practitioners should be aware of the limited reliability and reproducibility of fracture classifications.
Complications of fractures
Authors: Wilson-MacDonald James , James Andrew
Published: April 2012

♦ Fat embolism syndrome is defined as the presence of globules of fat in the lungs and in other tissues and occurs occasionally in long bone fractures

♦ Reflex sympathetic dystrophy is characterized by intense prolonged pain, vasomotor disturbance, delayed functional recovery, and trophic changes

♦ Avascular necrosis typically affects intra-articular bone after fracture and can occur in up to 70% of displaced talar neck fractures

♦ Immobility associated with recovery from fracture is associated with deep vein thrombosis, which carries a risk of pulmonary embolism, and should be treated with anti-coagulants

♦ Gas gangrene is a rapidly-spreading infection of devitalized tissue, removal of the affected area and treatment with penicillin is required

♦ Compartment syndrome within a closed compartment can result in tissue ischaemia and necrosis followed by fibrosis and muscle contracture
Orthopaedic approach to the multiply injured patient
Authors: Gray Andrew C.
Published: April 2012

♦ Major trauma results in a systemic stress response proportional to both the degree of initial injury (1st hit) and the subsequent surgical treatment (2nd hit).

♦ The key physiological processes of hypoxia, hypovolaemia, metabolic acidosis, fat embolism, coagulation and inflammation operate in synergy during the days after injury/surgery and their effective management determines prognosis.

♦ The optimal timing and method of long bone fracture fixation after major trauma remains controversial. Two divergent views exist between definitive early intramedullary fixation and initial external fixation with delayed conversion to an intramedullary nail once the patient’s condition has been better stabilised.

♦ There is agreement that the initial skeletal stabilisation should not be delayed and that the degree of initial injury has a more direct correlation with outcome and the development of subsequent systemic complications rather than the method of long bone fracture stabilisation.

♦ Trauma patients can be screened to identify those more ‘at risk’ of developing systemic complications such as respiratory insufficiency. Specific risk factors include: A high injury severity score; the presence of a femoral fracture; the combination of blunt abdominal or thoracic injury combined with an extremity fracture; physiological compromise on admission and uncorrected metabolic acidosis prior to surgery.

♦ The serum concentration of pro-inflammatory cytokine interleukin (IL) 6 may offer an accurate method of quantifying the degree of initial injury and the response to surgery.

♦ The effective management of the polytraumatised patient involves a team approach and effective communication with allied specialties and theatre staff. A proper hierarchy of the injuries sustained can then be compiled and an effective surgical strategy made.
Head, thoracic, and abdominal injury in the orthopaedic patient
Authors: Boffard K.
Published: April 2012

♦ The orthopaedic trauma surgeon will be involved in the majority of poly trauma patients.

♦ It is essential that the associated non-orthopaedic injuries are identified and appropriately managed.

It is my contention that failure to care for the surgical patient… is the most powerful disincentive to know the science of surgery. A surgical registrar who has not been exposed to the trauma patient and to intensive care is incompletely trained, unqualified, and unprepared for surgical practice or specialty training.

Donald Trunkey, Address to the Association of Surgeons of Great Britain and Ireland, 1988
Massive transfusion
Authors: Boffard K.
Published: April 2012

♦ Treatment of anaemia has changed substantially since the early 1990s

♦ Although massive transfusion may be necessary, trauma surgeons have modified their practice to provide aggressive control of haemorrhage, prevent hypothermia and acidosis, optimize haemodynamic management in intensive care units, and rationalize transfusion support in severely injured patients. The result has been an improvement in the outcomes of these patients

♦ Given the importance of early intervention in the care of the injured, understanding the physiology and true indications for early massive transfusion in trauma care has the potential to save many lives.
Blast and ballistic injury
Authors: Clasper J.
Published: April 2012

♦ Unlike civilian trauma most ballistic injuries are due to penetrating wounds

♦ Although weapons may change, the principles of treatment remain the same, prevent death by stopping bleeding, and prevent infection by removing dead and foreign material

♦ The severity of the injury is related to the energy transfer to the tissues as well as the specific structures injured

♦ Mass casualty situations may require Triage of the casualties.
Management of open fractures
Authors: McMaster John
Published: April 2012

♦ Restore soft tissue cover

♦ Prevent infection

♦ Achieve union

♦ Maintain function.
Soft tissue coverage
Authors: Caddy Christopher M. , Morritt Andrew N.
Published: April 2012

♦ Soft tissue cover is a complex process

♦ Soft tissue cover requires specialist skills

♦ Soft tissue cover should ideally be performed in collaboration with a Plastic & Reconstructive Surgeon.
Combined vascular and orthopaedic injuries
Authors: Chaloner E.
Published: April 2012

♦ Early diagnosis of an arterial injury is critical in reducing the risk of limb loss

♦ Don’t assume that missing pulses are due to arterial ‘spasm’

♦ Don’t assume that presence of distal pulses rules out a proximal vascular injury – arterial intimal tears can occlude the vessel many hours after the initial injury

♦ After an arterial repair has been completed there is still a risk of subsequent compartment syndrome from reperfusion

♦ Arterial shunts can procure some time for skeletal fixation prior to definitive arterial repair or grafting.
Limb salvage versus amputation
Authors: Georgiadis Gregory M.
Published: April 2012

♦ The decision to attempt limb salvage or amputate is difficult and depends on many factors

♦ Scoring systems provide guidelines only and not absolute treatment mandates

♦ Severe limb trauma results in a high degree of self reported disability regardless of treatment

♦ These injuries are best managed by a multidisciplinary approach.
Functional bracing
Authors: Sarmiento Augusto , Latta Loren L.
Published: April 2012

♦ Inexpensive

♦ Avoids complications of internal fixation

♦ Allows mobilization of joints

♦ Weight bearing and movement as tolerated, guided by pain.
Principles of plate and screw osteosynthesis
Authors: Clewer Glenn , McMaster John
Published: April 2012

♦ Fixation using plates and screws requires an understanding of basic principles rather than simple pattern recognition

♦ Although plates and screws are simple mechanical devices their correct application requires good technique.
Principles of intramedullary nailing
Authors: Noyes David , McMaster John
Published: April 2012

♦ Intramedullary nailing provides the trauma surgeon with a biologic solution to the stabilization of both simple and complex long bone fractures

♦ An appreciation of the biomechanics and the technical difficulties is essential.
Principles of monolateral external fixation
Authors: Lavini F. , Dall’Oca C. , Renzi Brivio L.
Published: April 2012

Monolateral external fixation is a system for the stabilization, reduction, and manipulation of bone segments by means of bone anchorage consisting of pins fastened to an external frame. Monolateral external fixators in their various forms have the advantage that they allow the use of half-pins (bicortical pins that do not penetrate both sides of the soft tissue envelope), thereby avoiding major damage to the neurovascular structures contralateral to the insertion point. The simple structure of monolateral systems permits rapid application and simplified preoperative planning, both of which are features particularly appreciated in traumatology.
Principles of circular external fixation in trauma
Authors: McNally Martin A. , Catagni Maurizio A.
Published: April 2012

♦ The ideal frame should be versatile, stable during load bearing and allow joint movement, correction of deformity and closed application

♦ Circular fixators consist of rings, connecting rods, fine wires and special parts

♦ Meticulous preoperative planning with the patient and radiographs is essential

♦ Recovery of limb function is the primary goal of fracture care; the patient must be fully involved in the rehabilitation

♦ Fixator removal once union is complete should be performed under general anaesthetic for children or with sedation and analgesia in adults
Absorbable implants for fracture fixation
Authors: Böstman O. M.
Published: April 2012

♦ Use of absorbable fracture fixation devices eliminates hardware removal procedures

♦ Of the macromolecular biodegradable compounds, suited for the manufacturing of these implants, polylactide is the most widely used

♦ Small-fragment intra-articular fractures, especially at the elbow and at the ankle, are the most rewarding clinical applications

♦ Absorbable implants can be inserted through articular surfaces and, in children, also transphyseally

♦ Mechanical failures of the implants and redisplacements of fractures are rare, but local, transient inflammatory foreign-body reactions occurr

♦ In certain intra-articular applications the absorbable fixation devices are superior to metallic ones.
Stress fractures
Authors: Henry M.
Published: April 2012

♦ Stress fractures are fractures occurring as the result of repetitive, submaximal loads, in the absence of a specific precipitating traumatic event.

♦ These fractures can be subdivided into two groups on the basis of aetiology. Whereas ‘fatigue fractures’ result from the excessive repetitive (i.e. abnormal) loading of normal bone, ‘insufficiency fractures’ are fractures resulting from normal forces acting on abnormal bone.

♦ Early diagnosis allows the initiation of effective treatment that can prevent prolonged pain and disability, as well as avoiding the progression to displacement or a non-union.

♦ While management decisions are generally focused on activity modification, protection of weight bearing, and immobilization, there is a subset of fractures at high risk for progression to complete fracture, non-union, or delayed union. These high-risk stress fractures, including tension-side femoral neck fractures and anterior tibial cortex fractures, require aggressive treatment to prevent the sequelae of poor healing.
Pathological fractures
Authors: Porter D.E.
Published: April 2012

♦ Pathological fractures should be recognized before treatment, but often are not.

♦ If solitary and potentially malignant, pathological fractures should be investigated prior to treatment.

♦ Inappropriate management may compromise outcome.

♦ Maximize patient fitness for surgery.

♦ Preoperative assessment to look for other tumours e.g. CT scan of chest and abdomen.

♦ Biopsy if possible before definitive management.

♦ Aim to relive pain and restore function.
Management of segmental bone defects
Authors: Matthews Stuart J.E.
Published: April 2012

♦ Segmental defects are a significant, but surmountable, problem for the Trauma surgeon

♦ The best results will only be achieved if all potential solutions are considered and used correctly in either: isolation; sequentially; or concurrently.

♦ Failure to create a bone defect, during debridement of some open fractures, may be catastrophic. An appreciation of the techniques available to treat segmental defects is necessary to allow the surgeon to debride with confidence.
Injuries to muscle–tendon units
Authors: Deo S.D.
Published: April 2012

♦ Most injuries at junction of muscle and tendon

♦ Early gentle movement best for recovery

♦ Tendon heals more slowly than muscle

♦ Surgery may include direct repair or more complex procedures e.g. lengthening/augmentation

♦ Minimally invasive procedures often best e.g. Achilles tendon.
Dislocations and joint injuries in the hand
Authors: Burge Peter
Published: April 2012

♦ Dislocation – X-ray first if possible, then early reduction

♦ Many injuries can be treated with splintage

♦ Many unstable injuries can be treated with percutaneous wire fixation

♦ Chronic instability most commonly affects the thumb

♦ CMC joint injuries often need wiring if unstable.
Flexor tendon injuries
Authors: Savage Robert
Published: April 2012

♦ Restoring continuity to the supple yet high tensile flexor tendon system presents a challenge unique in surgery. Although there is continuing debate about many details of technique, the central tenet of modern flexor tendon surgery is to repair and move the flexor tendons within a few days of injury

♦ Knowledge and experience count for everything at all points of patient care beginning with accurate and timely diagnosis. Emergency services should be arranged to relocate these injuries to appropriately trained surgeons and team-work with specialist hand therapists is an essential part of today’s treatment

♦ While all flexor tendon surgery is complicated, it is simplest in the newly injured and unscarred digit, and the results of the correctly rehabilitated primary repair appear to be the best attainable

♦ However, occasions will arise when secondary surgery will be necessary and the appropriate skills must be learned.
Extensor tendon injuries in the hand and wrist
Authors: Evans David M.
Published: April 2012

♦ Injuries common as tendons vulnerable

♦ 5 zones described

♦ Mallet finger usually treated in splint, but some fractures may require fixation

♦ Capener splint for boutonniere deformity, but sometimes surgery necessary

♦ Most open tendon injuries need direct repair

♦ Rehabilitation needs attention to detail.
Soft tissue hand injuries
Authors: Furniss Dominic , Heywood Anthony J.
Published: April 2012

♦ Limit initial soft tissue damage

♦ Reconstruct key soft tissue elements

♦ Functional rehabilitation.
Nerve injuries
Authors: Giddins Grey
Published: April 2012

♦ Nerve injuries are common

♦ The history is usually clear but the examination may be less so

♦ Neurophysiology is only useful after 3 weeks

♦ Imaging is of limited value as yet

♦ Treatment is removal of the cause/repair as appropriate

♦ Recovery is dependent upon many factors especially patient age, severity of the injury, how proximal the injury is and the type of nerve

♦ Post operative therapy is crucial

♦ Late reconstruction is primarily for motor function.
Brachial plexus injuries
Authors: Giddins Grey
Published: April 2012

♦ Serious injury, usually closed

♦ C5/C6 injuries commonest

♦ More proximal injuries have best results

♦ Early treatment leads to better results

♦ Direct repair if possible

♦ Arthrodesis or muscle transfer may be useful.
Replantation
Authors: Grinsell D. , Theile D.R. , Morrison W.A.
Published: April 2012

♦ Digital replantation is the best reconstruction available for the correct indications

♦ Amputated thumbs, multiple fingers, and paediatric replants are the strongest indications

♦ A functional result requires a mobile, stable, sensate digit of adequate length

♦ Replant survival and functional results are dependent on multiple factors including microsurgical expertise

♦ Spare part surgery is a unique opportunity to salvage tissue in an unreplantable limb.
Metacarpal and phalangeal fractures
Authors: Davis T.R.C. , Oni J.A.
Published: April 2012

♦ Proximal phalanx unicondylar and spiral fractures most unstable

♦ If axially stable can be considered for non-operative treatment

♦ Kirschner wires offer stability without excessive soft tissue dissection

♦ Ring and little finger metacarpal flexion deformity is well tolerated, but this is not the case for the radial metacarpals

♦ Displaced proximal and middle phalanx fractures are a common cause of stiffness

♦ Displaced condylar fractures are usually best reduced and fixed.
Scaphoid fractures
Authors: Tan Simon , Craigen Mike
Published: April 2012

♦ Commonest fracture in the wrist

♦ Immobilization and serial X-ray is no longer the preferred method of management – use MRI scan

♦ Trend towards more frequent fixation especially displaced proximal fractures

♦ Untreated non-union leads to arthritis and pain

♦ Non-unions treated with bone grafting +/- fixation.
Instabilities of the carpus
Authors: Lawrie David , Little Chris , McNab Ian
Published: April 2012

♦ Most injuries occur in hyperextension

♦ The force vector and size dictates the injury

♦ History and x-rays still prevail in diagnosis

♦ Classification has helped choose management

♦ Instability often associated with poor bone healing.
Injuries to the distal radioulnar joint
Authors: Lawrie David , Little Chris , McNab Ian
Published: April 2012

♦ Commonly missed injury

♦ Triangular fibro-cartilagenous complex integrity essential for DRUG stability

♦ Arthroscopy useful in assessing instability and the injury

♦ MRI increasingly accurate in diagnosis

♦ Ulnar shortening can be very useful in impingement.
Distal radius fracture
Authors: Alastair Graham
Published: April 2012

♦ Active treatment increasingly used

♦ It is important to recognize type B fractures

♦ CT useful to define complex fractures

♦ K wiring quick and simple but complex fractures often require plating

♦ Palmar locking plates useful for complex fractures

♦ Dorsal plates only used occasionally because of complications.
Forearm fractures
Authors: Ollivere Ben , Porteous Matthew
Published: April 2012

♦ Failure to restore anatomical alignment of the radius and ulna will result in significant functional limitations

♦ Plating techniques should be considered the gold standard in displaced fractures of the adult forearm.
Elbow fractures and dislocations
Authors: Williams John R. , Holdsworth Brian J.
Published: April 2012

♦ These are very complex fractures to treat; the elbow is intolerant of immobilization in the adult

♦ Posterior approach best for complex fractures

♦ AO classification widely used

♦ Most intra-articular fractures best internally fixed

♦ Most distal humeral fractures require two plates.
Humeral shaft fractures
Authors: Little Chris
Published: April 2012

♦ Deformity is well tolerated

♦ Anterior approach for proximal shaft, but avoid damaging the axillary nerve

♦ Nerve lesions which do not recover within three weeks should be investigated with nerve conduction studies

♦ Most isolated fractures treated non-operatively

♦ Floating elbow, multiple injuries, open or pathological fractures consider fixation

♦ Open plating and nailing both give good results.
Fractures and dislocations of the shoulder girdle
Authors: Kambouroglou Gregoris
Published: April 2012

♦ The function of the girdle is to position the hand in space

♦ The spectrum of injuries range from common and uneventful to rare and life threatening

♦ The functional outcome depends on individual demand, severity of the injury and the presence of complications.
Imaging in spinal trauma
Authors: McNee P. , Gaba S. , McNally E.
Published: April 2012

♦ Clinical criteria and the nature of the injury determine who needs imaging

♦ Plain films are still commonly employed though CT finds more fractures

♦ Alignment, bony contour, cartilage (Disc and facets) and soft tissue are assessed in turn (ABC’S)

♦ CT is superior to MRI in assessing the bony configuration of fracture

♦ MRI is superior to CT in assessing the ligament tears and associated disc herniations

♦ Plain films have little role in the assessment of more chronic back pain and radiculopathy

♦ Sacral insufficiency fractures may be misdiagnosed as metastases on MRI.
Emergency management of the traumatized cervical spine
Authors: Chapman Jens R. , Bransford Richard J.
Published: April 2012

♦ Unconscious patients should have CT scan of neck

♦ Emergency MRI if possible in spinal cord injury

♦ Avoid flexion/extension views if possible

♦ In spinal shock avoid over transfusion and consider epinephrine; high dose steroids probably not indicated

♦ Reduce dislocation acutely (MRI before in intact patients if possible)

♦ Do not put distraction injury into traction

♦ Urgent surgery for traumatic disc hernaition, expanding epidural haematoma, depressed lamina fracture or complex facet fractures with dislocation.
Upper cervical injuries
Authors: Anderson Paul A.
Published: April 2012

♦ Upper cervical spine injuries should be considered in all blunt trauma patients.

♦ Critical review of plain radiographs or CT should carefully examine the alignment of the articulations between the occiput-C1 and C1-2 to determine if ligamentous injury is present.

♦ The initial stabilization of unstable upper cervical injuries usually should avoid the use of traction in favour of the halovest.

♦ Definitive stabilization is based on fracture type and the status of the cranio-cervical ligaments.
Subaxial cervical spine injuries
Authors: Mendoza-Lattes Sergio , Clark Charles R.
Published: April 2012

♦ The spine study group classification describes three families of fractures

♦ Clinical examination can exclude a cervical spine injury in a non-distracted conscious patient without pain and neurological deficit

♦ CT scan is the investigation of choice where fracture is suspected

♦ Pure ligamentous injuries are rare

♦ Priorities are immobilization and assessment, reduction of dislocations and then surgical decompression and stabilization.
Whiplash-associated disorders
Authors: Amirfeyz Rouin , Kelley Simon , Gargan Martin , Bannister Gordon
Published: April 2012

♦ Whiplash costs UK economy approximately £3.64 billion per year

♦ Most occur after rear end vehicle collision

♦ Patients present with neck pain and stiffness, occipital headache, thoracolumbar back pain and upper limb pain and parasthesia

♦ Over 66% make a full recovery but 2% will be permanently disabled

♦ The outcome can be predicted in 70% after three months.
Thoracic fractures
Authors: Dare Christopher J. , Davies Evan M.
Published: April 2012

♦ Thoracic fractures are associated with severe trauma in young patients

♦ Multiple injuries are common

♦ Early fixation of unstable injuries is recommended to prevent neurological deterioration

♦ Almost all surgery best carried out posteriorly

♦ Long implants can be used

♦ Anterior reconstruction may be required where the anterior column is deficient.
Thoracolumbar, lumbar, and sacral fractures
Authors: Sell Philip
Published: April 2012

♦ High-energy trauma often results in serious spinal fractures. The junctional zone between the relatively stiff thoracic spine and the more mobile lumbar spine is particularly susceptible to injury

♦ The role of decompression in spinal cord injury remains uncertain at level three or four evidence

♦ Unstable fractures may be stabilized using modern fracture fixation methods enabling easier nursing care in polytrauma and earlier mobilization than non-surgical treatment

♦ There is level two evidence that stable thoracolumbar fractures have similar outcomes with surgical and non-surgical treatment

♦ There are many fracture classification systems that are not validated or have poor inter- and intraobserver error. Recent modern validated systems may in the future assist in the rational planning of interventions for spinal injury.
Post-traumatic spinal reconstruction
Authors: Freeman Brian J.C.
Published: April 2012

♦ The commonest site for post-traumatic kyphosis (PTK) is the thoraco-lumbar junction

♦ Symptoms of PTK may include pain, progressive deformity, neurological deficit and unacceptable cosmesis

♦ Localized kyphotic deformity greater than 30 degrees increases the risk of chronic pain

♦ Surgical options for the correction of PTK depend on the magnitude and location of the deformity and whether the deformity is fixed or mobile.
Rehabilitation of spinal cord injuries
Authors: Gardner B.
Published: April 2012

♦ Fragmentation of care is the greatest threat to the treatment of patients with spinal cord injury

♦ Level of injury defines disability

♦ Early care critical to prevent late complications

♦ Tertiary spinal cord injury may occur (e.g. syrinx of the spinal cord)

♦ Complications affect almost all body systems directly or indirectly.
Pelvic ring fractures: assessment, associated injuries, and acute management
Authors: McMaster John
Published: April 2012

♦ The contribution of the soft tissue and bone in each fracture pattern must be understood

♦ A large proportion of pelvic fractures will have significant associated injuries

♦ Successful management of haemodynamically unstable pelvic fractures requires advance planning.
Pelvic fracture: definitive management
Authors: McMaster John
Published: April 2012

♦ Pelvic fractures must be actively managed to avoid peri-operative complications

♦ Understanding stability is the key to pelvic fracture management. Fixation is used to compensate for instability until healing occurs

♦ Long term disability can occur despite optimum fixation.
Fractures of the acetabulum: radiographic assessment and classification
Authors: Boudreau John A , Moed Berton R
Published: April 2012

♦ This injury is relatively uncommon at 3 per 100,000 patients annually

♦ Understanding the complex anatomy of the innominate bone is key

♦ Assessment is based on interpretation of three basic plain radiographs supplemented by computed tomography

♦ Fractures are classified into five elementary and five associated types

♦ A systematic approach to the radiographic interpretation facilitates diagnosis and treatment.
Management of acetabular fractures
Authors: Moed Berton R.
Published: April 2012

♦ Acetabular fracture patients often have associated injuries

♦ Restoration of hip joint congruity and stability are the treatment goals

♦ Stable concentrically reduced fractures can be considered for non-operative management

♦ Operative treatment is indicated for fractures with hip joint instability or incongruity

♦ Choosing the proper surgical approach is one of the most important treatment aspects

♦ Although the surgery is demanding, an experienced surgeon can obtain excellent results.
Dislocations of the hip and femoral head fractures
Authors: Pohl A.
Published: April 2012

♦ Most injuries are high violence, so look for associated injuries

♦ Immediate closed reduction usually best under general anaesthetic

♦ Do not proceed to open reduction without appropriate imaging studies

♦ Surgical approach depends on injury pattern

♦ Some long term complications can be minimized/avoided by appropriate early treatment (e.g. avascular necrosis).
Femoral neck fractures
Authors: Parker Martyn J.
Published: April 2012

♦ Intracapsular fractures are classified by division into those fractures that are essentially undisplaced and those that are displaced

♦ Undisplaced fractures are generally treated by reduction and internal fixation

♦ Displaced fractures may be treated by reduction and internal fixation but this incurs the potential complications of re-displacement of the fracture, non-union, and avascular necrosis

♦ Displaced fractures in the elderly are generally treated with a replacement arthroplasty.
Trochanteric and subtrochanteric fractures
Authors: Parker Martyn J.
Published: April 2012

♦ Traction is not useful for trochanteric fractures

♦ Surgery should not be delayed unless the medical condition of the patient can be improved

♦ Dynamic implants are best (sliding hip screw best)

♦ Early full weight bearing should be achieved

♦ Most patients return to their own home.
Femur shaft fractures
Authors: DeCoster Thomas A. , Xing Zhiqing
Published: April 2012

♦ Intramedullary reamed nailing provides very good results

♦ Antegrade and retrograde nailing give similar results

♦ Associated injuries increase the risk of complications.
Supracondylar fractures of the femur
Authors: Jarvis Wingrove T. , Nanu Ananda M.
Published: April 2012

♦ Supracondylar fractures of the femur are seen in the young (high energy) and the old (low energy). Both groups have their own specific problems

♦ The advantages and disadvantages of each surgical option must be considered in relation to the individual patient and their fracture pattern.
Patella fractures and dislocations
Authors: Marsh J.L.
Published: April 2012

♦ Differentiate multipartite patella from fracture

♦ Non-operative treatment results satisfactory if extensor mechanism intact

♦ Avoid total patellectomy if possible

♦ Modified AO technique allows tension wires to be placed through cannulated screws

♦ Results of dislocation independent of duration of immobilization

♦ Osteochondral fractures should be either removed or internally fixed.
Tibial plateau fractures
Authors: Walmsley Phil , Keating John
Published: April 2012

♦ Split depression pattern lateral plateau most common type

♦ Bicondylar and medial plateau fractures high energy injuries

♦ Compartment syndrome, vascular injury, and common peroneal palsy may occur with high energy patterns

♦ Internal fixation preferred treatment with good soft tissue envelope

♦ Limited internal fixation suitable for many simple patterns

♦ Plate fixation preferred for medial and bicondylar fractures

♦ External fixation used with poor soft tissues

♦ Fine wire external fixation should be considered for most complex patterns.
Tibial shaft fractures
Authors: Naidu Maripuri S. , Mohanty K.
Published: April 2012

♦ The tibia is the most commonly fractured long bone

♦ The orthopaedic surgeon needs to be familiar with all of the management options available in order to effectively manage the simple and complex cases

♦ Problems associated with the soft tissue envelope are frequently encountered.
Tibial plafond fractures
Authors: Marsh J.L.
Published: April 2012

♦ Tibial plafond fractures demand respect, largely due to the fragile soft tissue envelope that surrounds the distal tibia

♦ Careful preoperative planning followed by meticulous operative handling of the soft tissues is required to avoid devastating complications.
Ankle fractures
Authors: Handley R. , Gandhe A.
Published: April 2012

♦ Ankle fracture management is dependent on the patient, stability and congruence

♦ Comparative studies of treatment options should be interpreted with caution.
Fractures of the talus and peritalar dislocations
Authors: Matthews Stuart J.E.
Published: April 2012

♦ Talar fractures are uncommon injuries and the outcome is very dependent on the tenuous blood supply

♦ Fixation with absolute stability must be achieved

♦ Osteochondral and process fractures are sometimes difficult to appreciate on plain x-rays. Clinical examination and a high degree of suspicion will help to identify these problems early.
Fractures of the calcaneum
Authors: Atkins Roger M.
Published: April 2012

♦ Surgical management of displaced fractures is becoming the norm

♦ Fixation and soft tissue procedures should allow early mobilization

♦ Subtalar fusion should not be used at the time of primary surgery

♦ In children minimal intervention indicated

♦ Abnormal hindfoot biomechanics frequent cause of long term disability.
Midfoot and forefoot fractures and dislocations
Authors: Taylor Andrew
Published: April 2012

♦ Mid- and forefoot injuries are common

♦ Minimally displaced and stable injuries allow early weight-bearing rehabilitation and lead to a good functional outcome

♦ Displaced and unstable injuries require restoration of the length, alignment, and joint congruency followed by stable fixation

♦ Respect the soft tissue element of the foot injury.
Osteomyelitis and septic arthritis in children
Authors: Huntley J.S. , Crawford H.
Published: April 2012

♦Staphylococcus aureus is the commonest organism causing both septic arthritis and osteomyelitis

♦ There has been a decline in the number of infantile infections due to Haemophilus influenzae but both Kingella kingae and methicillin-resistant Staphylococcus aureus (MRSA) infections are increasing

♦ Early diagnosis and prompt treatment are key elements to the treatment of both conditions (Boxes 13.1.1 and 13.1.2).
Juvenile idiopathic arthritis: medical aspects
Authors: Pilkington Clarissa
Published: April 2012

♦ Juvenile idiopathic arthritis is defined as an arthritis persisting for at least 6 weeks

♦ The cause may relate to the immune system response to a stimulus with a synovial or systemic manifestation

♦ Classification depends on the clinical picture and the immunological markers

♦ Joint sepsis is often a differential diagnosis

♦ Most cases respond to simple measures, a few need a structured medical management plan. Surgery is indicated in 10% of cases. All require physiotherapy

♦ Complications may occur secondary to the disease or its treatment.
An overview of cerebral palsy
Authors: Carr Lucinda J.
Published: April 2012

♦ Cerebral palsy is a permanent disorder of movement or posture due to non-progressive lesions of the immature brain

♦ Magnetic resonance imaging is generally recommended and can provide important prognostic information

♦ Only a minority of cases are due to birth trauma

♦ Modern classification systems incorporate function as well as anatomical involvement

♦ Management aims to maximize a child’s potential both as an individual and within society. Other associated conditions may impact on quality of life and participation

♦ Multidisciplinary involvement is essential with use of physiotherapy, orthotics, and tone management (focal and systemic) as necessary.
Lower limb management in cerebral palsy
Authors: Theologis Tim , Paterson J.M.H.
Published: April 2012

♦ All patients with cerebral palsy have lower limb involvement

♦ Determination of the pattern of neurological involvement and the degree of selective muscle control is important when considering orthopaedic intervention

♦ The neurological insult is non-progressive but the musculoskeletal effects do progress.

♦ Specific treatment aims must be identified and realistic targets defined

♦ The appropriate treatment must be selected for the child’s age and stage of development

♦ It is important to differentiate between dynamic and fixed contractures

♦ Surgery is only one of the management options and is rarely successful if considered in isolation.
Upper limb management in cerebral palsy
Authors: Buckingham Rachel
Published: April 2012

♦ Evaluation of the upper limb must assess all aspects of sensation, motor control, and function. Will the hand be used for bimanual activities?

♦ Individual treatment goals must be established

♦ Non-operative treatment may encourage use and awareness of the more affected limb

♦ Many muscles cross two joints and therefore the limb must be considered as a whole and not as a series of isolated joints.
Management of the child with total body involvement
Authors: Theologis Tim
Published: April 2012

♦ The most common musculoskeletal problems in TBI are scoliosis and hip dislocation

♦ Hip screening is necessary in young non-ambulant children

♦ The role of soft tissue surgery to prevent hip displacement is unclear

♦ Bony surgery offers more predictable results but complications are frequent

♦ Spinal stabilization should be considered for curves exceeding 50 degrees.
The orthopaedic management of myelomeningocoele
Authors: Henman Philip
Published: April 2012

♦ Myelomeningocoele is a congenital failure of neural tube development

♦ Hydrocephalus is a common association

♦ Multidisciplinary management is important

♦ An alteration in neurological status requires further investigation

♦ Beware the insensate skin

♦ A supple plantigrade foot aids independence.
Neurological aspects of spinal disorders in children
Authors: Farooq Najma , Tucker S.K. , Thompson D.
Published: April 2012

♦ Spinal neurological problems may be a focal anomaly or part of a systemic disorder

♦ The neuro-orthopaedic syndrome should be considered in any dysraphic patient with a changing clinical picture—urological symptoms respond well to prompt untethering

♦ Ten per cent of central nervous system tumours originate in the spinal cord—they may be intramedullary, intradural extramedullary, or extradural.
Arthrogryposis
Authors: Duncan Roderick
Published: April 2012

♦ A rare condition with the potential to cause serious physical disability

♦ Early recognition and treatment reduces the impact of the condition on the individual

♦ Physiotherapists, occupational therapists, and orthotists play a pivotal role in patient management and a coordinated multidisciplinary team is required

♦ Many children need orthopaedic surgery but the treatment principles differ from those applied to unaffected children with similar individual deformities

♦ Prolonged postoperative splinting reduces the risk of recurrent deformities

♦ Individuals with amyoplasia or distal arthrogryposis often have normal intelligence and great potential to cope with their physical disability.
Common disorders of the lower limb
Authors: Theologis Tim
Published: April 2012

♦ Most torsional or angular deviations are physiological and resolve with time

♦ Ensure the child has normal growth parameters

♦ Take care to exclude the rare underlying condition that will require treatment

♦ Coronal knee deformities may be due to a systemic or local bone dysplasia.
Congenital upper limb anomalies
Authors: Hudson Benjamin J. , Eastwood Deborah M.
Published: April 2012

♦ Anomalies are common but often minor and of little functional concern

♦ Often associated with other manifestations that are of greater clinical significance

♦ A knowledge of embryological development allows a better understanding of the clinical picture and informs management plans.
Congenital brachial plexus palsy
Authors: Sinisi Marco
Published: April 2012

♦ The congenital brachial plexus palsy is significantly different from the adult injury

♦ The mechanism of injury is invariably traction

♦ Classifying the lesion at 1–2 weeks of age aids with prognosis and management

♦ Surgical exploration and repair is indicated early in selected cases

♦ Good shoulder function is essential for a useful upper limb

♦ Recovery of hand function is slow and may continue until age 5 years.