OrthopaedicsOne is the collaborative orthopaedic knowledge network for orthopaedic surgeons and musculoskeletal health care professionals – a repository of educational materials and a professional network for the exchange of information. All members can add or edit information throughout the workspace and all content is protected by a Creative Commons License to improve knowledge translation. OrthopaedicsOne has Managing Editors, Editors, Content Partners, an Advisory Board, Participating Groups, and Sponsoring Organizations but it belongs to the Community of Practice for orthopaedics and musculoskeletal health.
Articles
Recent articles from OrthopaedicsOne Articles space.
Recently Updated
June 27, 2024Most patients with musculoskeletal tumors present with one or more of five signs or symptoms. In some cases (for example the patient complaining of a soft tissue or bony mass), the symptoms are easily referable to the tumor. In other instances, the tumor may be incidental to the real cause of symptoms, or the patient may have pain or a pathologic fracture resulting from the lesion. For all of these circumstances, the clinician should rely on an orderly clinical sequence of eliciting the history, performing a physical examination, and obtaining appropriate investigations to gain a differential diagnosis of the clinical problem.
Tumor Definitions
In discussing the clinical presentation of bone tumors, several terms will be used that require definition.
Benign musculoskeletal tumors are bone or soft tissue lesions that have no risk of metastasis. Benign bone lesions may be further characterized as to their effect on the local skeleton.
Benign latent lesions are inactive lesions that show little or no evidence of recent bone destruction or remodeling. Examples include enchondroma, non-ossifying fibroma, or a healed unicameral bone cyst.
Benign active lesions cause local bone destruction or remodeling and may result in symptoms through weakening of the bone or development of a bony mass. Examples include active unicameral bone cysts, fibrous dysplasia, and osteochondromas during active skeletal growth.
Benign aggressive lesions cause more significant bone destruction. These lesions are at risk for local relapse after treatment but do not metastasize (or metastasize only rarely). Examples are aneurysmal bone cysts, osteoblastoma, or giant cell tumor (this last aggressive tumor has a small risk of metastases). Malignant tumors are lesions that may metastasize and are potentially lethal. They may be primary in bone and derived from mesenchymal cells (osteosarcoma, chondrosarcoma), derived from marrow elements (myeloma, lymphoma), or metastatic to the bone (breast or prostate cancer).
These terms will be used in describing the clinical presentation of bone and soft tissue tumors.
The Presenting Complaints
Soft tissue mass
Painless bony mass
Bone tumor as an incidental finding
Painful bone lesion
Pathologic fracture [...] Read more...
June 27, 2024Name of test Posterior drawer test of the knee
What it tests Posterior cruciate ligament (PCL) in the knee
How to do it The patient should be supine, with the hips flexed to 45 degrees, the knees flexed to 90 degrees, and the feet flat on the table. The examiner sits on the patient’s feet and grasps the patient’s tibia and pulls it backward. If the tibia pulls backward more than normal, the test is considered positive.
The normal response The tibia should be displaced backward no more than would normally be expected
What it means if not normal Excessive displacement of the tibia posteriorly indicates that the PCL is likely torn
Comments Enter tips and tricks
Citations Unknown macro: {cite} Figures [...] Read more...
June 27, 2024Origin Anterior surface of the inferior ramus and body of the pubis Insertion The lesser trochanter and linea aspera of the femur Action(s) Adduction of hip Nerve Supply Obturator nerve Arterial Supply Obturator artery Physical Exam Enter physical examination maneuvers for muscle Clinical Importance Enter clinical importance of muscle Disease States Enter links to pages where muscle involved Discussion The adductor brevis is a muscle in the thigh situated immediately behind the pectineus and adductor longus.
It is somewhat triangular in form, and arises by a narrow origin from the outer surfaces of the superior and inferior rami of the pubis, between the gracilis and obturator externus.
Its fibers, passing backward, lateralward, and downward, are inserted, by an aponeurosis, into the line leading from the lesser trochanter to the linea aspera and into the upper part of the linea aspera, immediately behind the pectineus and upper part of the adductor longus. Figures
Click thumbnail for larger image Credits:
From Wikipedia:
Adductor brevis Attachments: Adductor brevis.png (image/png) [...] Read more...
June 27, 2024Origin Subscapular fossa Insertion Lesser tubercle of humerus Action(s) The Subscapularis rotates the head of the humerus medially (internal rotation); when the arm is raised, it draws the humerus forward and downward. It is a powerful defense to the front of the shoulder-joint, preventing displacement of the head of the humerus. Nerve Supply Upper subscapular nerve, lower subscapular nerve (C5, C6) Arterial Supply Transverse cervical artery, subscapular artery Physical Exam Injury Diagnosis:
The Bear Hug test (internal rotation while palm is held on opposite shoulder and elbow is held in a position of maximal anterior translation) for Subscapularis muscle tears has high sensitivity. Positive Bear-Hug and Belly Press tests indicate significant tearing of subscapularis. Clinical Importance Enter clinical importance of muscle Disease States Enter links to pages where muscle involved Discussion Relations:
The tendon of the muscle is separated from the neck of the scapula by a large bursa, which communicates with the cavity of the shoulder-joint through an aperture in the capsule. Figures
Click thumbnail for larger image Credits:
From Wikipedia:
Subscapularis Attachments: Subscapularis.png (image/png) [...] Read more...
Reviews
Recent resources from OrthopaedicsOne Review for Residents and Review for Medical Students spaces.
Recently Updated
June 27, 2024Classic triple arthrodesis described by Ryerson (1923) -also by Dunn (1921). Lambrinudi described his operation in 1927.
Angus & Cowel (1986) reported 310 triples
~ 60% had residual deformity.
~ 23% Pseudarthrosis.
~25% Significant pain.
~38% Degenerative changes in the ankle
Wedge resection of the talus to correct fixed equinus deformity. May need elongation of tendo Achilles and soft tissue release, before being able to obtain correction. This may decrease the resection required and the incidence of AVN of the talus.
Operative Technique
Make a straight incision over the sinus tarsi, from peroneus brevis tendon to the lateral border of the extensor tendons (shoe-top)
Elevate the periosteum of the calcaneus and reflect EDB distally, as a flap of tissue
Incise the capsule of the calcaneo-cuboid, talo-navicular and subtalar joints
Establish correct position of bones prior to resection, if wedges are required to correct deformity
First remove articular surfaces of calcaneo-cuboid and talo-navicular joints (may need second dorso-medial incision to get adequate exposure of talo-navicular joint)
Finally excise the articular surface of the subtalar joint
Reduce the bone surfaces and stabilise with percutaneous ‘K’ wires
Place chips of cortio-cancellous graft in the junction of the bone cuts and in any remaining spaces
Replace EDB and close the wound
Apply a BK walking POP and mobilise when swelling settled, commencing with PWB for 2/52, then WB as tolerated
Remove pins at 6 weeks and re-apply walking cast for another 2 – 4 weeks [...] Read more...
June 27, 2024Most ankle sprains occur in the 15 – 35 year old athletes and dancers
97% of all ankle ligament ruptures occur on the antero-lateral side
Injury to the Anterior Talo-Fibular Ligament (ATFL) is the most common
Injury to the Calcaneo-Fibular Ligament (CFL) occurs in more severe injuries
Disruption of the Posterior Talo-Fibular Ligament (PTFL) is rare
It is almost impossible to injure the CFL alone. ATFL is torn first, then CFL, rarely then PTFL. Finally the ankle dislocates
Usually, an inversion injury
Important to accurately delineate mechanism; gives clues to structures injured
May be associated with
Syndesmosis injury
Known as ‘High ankle sprain’
10% of all ankle sprains
Usual mechanism is eversion-dorsiflexion which also puts stress on Deltoid ligament
Except the most severe injuries, usually PTFL, transverse tibio-fibular ligament and interosseous membrane remain intact 5th metatarsus base fracture
Talus lateral process fracture
Osteo-chondral fractures of talus dome
Calcaneal anterior process fracture
Peroneal tendon injury Beware of distal fibular Salter-Harris type I fractures in adolescents presenting with ankle sprain
Clinically
Inspect for swelling, palpate for tenderness over each ligament
Anterior drawer test : knee flexed, ankle plantar flexed 10 degrees, slight internal rotation to relax deltoid ligament, compare with other side. Positive test indicates torn anterior talo-fibular ligament (major restraint to anterior shift)
Talartilt test : similar positon; ankle 10 degrees plantar flexed, slight internal rotation, palpate joint line, compare with other side. Positive test indicates torn anterior talo-fibular and calcaneo-fibular ligaments
Investigations
Plain X-Ray
AP, Lateral and Mortise views
Primarily used to rule out fracture/dislocation
Indications for obtaining X-Ray according to Ottawa rules are:
Patient is unable to walk on the affected foot
Tendernes at the base of 5th metatarsus
Lateral/medial malleolus tenderness Stress views
Anterior talar shift stress test : position as above
ATFL is the primary restraint to anterior shift
A side to side difference of >3 mm = torn ATFL Talartilt stress test : position as above
CFL is the major restraint to "tilt"
A side to side difference of 10 degrees or more = torn ATFL and CFL External rotation stress view
Shows syndesmotic injury
Widening of >6 mm is abnormal Ankle arthrography / peroneal tenography
ATFL is a capsular ligament; tear will show dye leakage
CFL is extracapsular and closely related to the peroneal sheath; tear will show dye leaking into peroneal sheath on ankle arthrography,or leakage of dye into joint on peroneal tenography
Ultrasound
MRI
Demonstrates tears, but other tests are less expensive
Limited Indications
Classification
May be graded as unstable/stable,high/low or traditionally as:
Grade 1
Stretch of the ligament, without macroscopic tearing
Little swelling or tenderness
Little or no functional loss Grade 2
Partial macroscopic tear of the tendon
Moderate pain, swelling and tenderness
Some loss of motion
Mild instability of joint (positive drawer test) Grade 3
Complete rupture of the both ATFL and CFL
Severe swelling, tenderness, ecchymosis
Severe loss of function
Major instability (positive drawer and tilt tests) Treatment
Functional treatment for acute injuries
NSAIDs
RICE
Short periods (3 weeks) of immobilisation may be necessary in grades 2 and 3
Physiotherapy after pain and swelling subsides and patient is able to bear weight The only indication for operative reconstruction acutely is in the high demand sports person
If residual instability remains despite exercise, strapping or use of a splint, reconstruction is indicated
The type of procedure used is not critical
85% good / excellent results
Options are :
Late direct repair of the torn ligaments (Brostrom)
Augmented reconstruction; e.g. peroneus brevis (Evans, Watson-Jones) Prognosis
Primary repair of the lateral ligament is rarely indicated
Greater than 85% require no further treatment
Most cases are able to return to full activity after 6 weeks
Results of early repair no better than delayed
Risidual pain after 6 weeks, despite adequate therapy, necessitates work-up
ref: Kannus and Renstrom "Current concepts review: Treatment for acute tears of the lateral ligaments of the ankle" JBJS 73A:305-312, 1991 Marder "Current Methods for evaluation of ankle ligament injuries"JBJS 76A:1103,1994 Colville " Reconstruction of the lateral ankle ligaments" JBJS 76A: 1092, 1994 [...] Read more...
June 27, 2024Radiofrequency electric current used to sever tissue or achieve hemostasis
Desiccation: (coagulation)
Current is passed through the electrical resistance of the tissue and heat is generated in the tissue (similar to the phenomenon in a toaster where the wire becomes hot when current is passed through it). When the tissue becomes hot the water is slowly driven out and the tissue becomes desiccated.
Cutting Diathermy
Electrical sparking to the tissue with a cutting effect. The object is to heat the tissue so rapidly that the cells explode into steam leaving a cavity in the cell matrix. Heat is dissipated in the steam and therefore, it does not conduct through the tissue to dry out adjacent cells.
Bipolar Diathermy
Simple forceps which has an active and return electrode built into the tips and no patient return electrode is required. Current flow is from the active electrode through the tissue to the return electrode.
Use of Diathermy in joints
Use of Glycine is preferable as it has an appropriate osmolarity and is a relatively poor conductor of electricity. Sodium has high electrical conduction and causes short circuit. Water will also enable diathermy use and may be suitable for short procedures. [...] Read more...
June 27, 2024Walks awkwardly and trips over feet
Observe patient walking, with the patient prone (hips extended and knees flexed)
If internal rotation is greater than 70 then medial femoral torsion or persistent femoral neck anteversion is present (normal children have more external rotation than internal rotation)
Natural history is correction of the deformity with time (up to 8 years old)
Surgery may be indicated if more than 8 years with significant deformity and functional impairment
Tibial torsion is assessed with the patient again prone with knees flexed and the axis of the thigh is compared with that of the foot and is a normal finding in children up to 2 years of age
Often associated with lateral bowing
Metatarsus Adductus is associated with tibial torsion in 75% and should have a normal hindfood and no calf wasting
Measure femoral anteversion fluoroscopically with knees flexed and the patient prone, externally rotate the leg until the neck and shaft are in alignment, then measure the angle of the leg
Natural History
86% correct spontaneously
10% have mild deformity of no significance to the patient
4% have stiff and persistent deformity
Commonest causes
Excessive anteversion of the femoral neck which usually improves with growth, correction by osteotomy seldom indicated and certainly not before the age of 8 years
Femoral / Tibial torsion and forefoot adduction : inspect initially with the leg extended (femoral torsion) then flexed to 90° (tibial torsion) and finally examine the foot
Less than 18 months commonest cause fore-foot adduction
Less than 3 years tibial torsion commonest cause
More than 3 years femoral torsion or anteversion commonest [...] Read more...
June 27, 2024Thomas Splint Traction
Hugh Owen Thomas introduced his splint which he called "The Knee Appliance" in 1875
The method of Hugh Owen Thomas uses fixed traction with the counter traction being applied against the perineum by the ring of the splint
This is in contrast to other methods using weight traction which is countered by the weight of the body
Backward angulation of the distal fragment can never be corrected by traction in the axis of the femur which only results in elongation with persistence of the deformity
A Thomas splint and fixed traction is only capable of maintaining a reduction previously achieved by manipulation
The use of supports enables correction of angulation caused by muscle tension
Placement of a large pad behind the lower fragment acts as a fulcrum over which backward angulation is then corrected by the traction force
The pad should be 6" in width, 9" long and 2" thick, applied transversely across the splint under the distal fragment and popliteal fossa
It is the splint which controls alignment and not the traction
The tension in the apparatus should only be that sufficient to balance resting muscle tone
Suspension of the splint using an overhead beam enables the splint to move easily with the patient when they move in bed
Its use in combination with a Pearson Knee-flexion piece enables mobilisation of the knee, while maintaining traction, alignment and splinting of the fracture
Hamilton Russell Traction
Robert Hamilton Russell wrote "Fracture of the femur: A clinical study" in which he described his traction in 1924
Sling under the distal 1/3 of the thigh provides upward lift, as well as longitudinal traction in the line of the tibia
The sling under the distal fragment controls posterior angulation and the lifting force is related to the main traction force through the medium of pullies
No rigid splinting is used in this method
Combines a means of suspending the lower extremity and a means of applying traction in the axis of the femur
Many other varieties of both skeletal and skin traction result in a similar effect
Buck Traction
Buck introduced simple horizontal traction in 1861
Traction is analogous to Pugh’s traction only the inclination of the bed is replaced by the application of weights over a pulley
Bryant’s traction
Vertical extension traction was described by Bryant in 1873 and applied to the management of femoral fractures
The development of ischemia of the lower leg through reduced perfusion resulted in limitation of its application to the short term management of a fractured femur
A modification of his traction has been shown to reduce the risk of limb ischemia and may be applicable where prolonged traction is required in an infant
Braun Frame
This is merely a cradle for the limb
Disadvantage is that the position of the pulleys cannot be altered and the size of the splint often does not fit the limb as might be wished
Lateral bowing is common as the splint and the distal fragment are fixed to the frame, while the patient and the proximal fragment can move sideways leaving the frame behind
Perkins Traction
Here no splinting is used at all
The posterior angulation of the thigh is controlled by a pillow
The alignment and fixation depend entirely on the action of continuous traction
Fisk Traction
Hinged version of a Thomas splint is arranged to allow 90 of knee movement
It is particularly attractive as it allows active extension of the knee joint
Fixation and alignment is dependent entirely on the weight traction and the splint merely applies the motive power for assisted knee movement
90 – 90 Traction
The thigh is suspended in the vertical plane by weight traction pulling vertically upwards
The ill effect of gravity as the cause of backward angulation of the fragments is thus eliminated
Charnley
Strongly recommends the use of a BK POP incorporating the Steinmann or Denham pin in the upper end, in order to reduce pressure on the soft structures around the knee
Benefits of POP/Traction unit (Charnley) :
Foot supported at right angles to the tibia
Common peroneal nerve and calf muscles protected from pressure against the slings of the splint and the splint itself
The tibia is suspended from the skeletal pin inside the POP, so that an air space develops under the tibia as the calf muscles loose their bulk
External rotation of the foot and distal fragments is controlled
The tendo achilles is protected from pressure sores
Comfort; The patient is unaware of the traction when applied through the medium of a nail Upper Limb
A number of skin traction methods have been described and a number more utilised without documentation in the literature
Ingerbrightsen’s overhead skin traction (A); Dunlop’s side arm skin traction (B); and Graham’s extension skin traction (C) are but a few
Skeletal pin traction can also be utilised :
Overhead (A)
Overhead with secondary distal forearm traction directed cephalad (B)
Side arm pin traction (C) [...] Read more...
eBooks
Recent resources from OrthopaedicsOne PORT Notes, MSK Medicine for Medical Students, and Atlas of Musculoskeletal Oncology spaces.
Recently Updated
June 28, 2024DEFINITION AND PATHOGENESIS
A tumor of unknown origin
IMPORTANCE
No bony counterpart has been reported
Intermediate malignant potential counterpart must be ruled out
CLINICAL FEATURES
Usually present as a slow growing, small painless, well circumscribed subcutaneous or muscular mass
Has been reported presenting as a scalp cyst M:F = 2:1
Median age 50 yrs (21-81)
Reported in the subcutaneous tissue of the head of a 2-yr-old
Retroperitoneal location reported ina 6-yr-old girl with paraspinal extension and disease free 9 yrs after resection Median duration of sxs = 4 yrs
?? alk?
RADIOLOGIC FEATURES
Radiographs may be normal
Peripheral ossification can occur ? uptake on BS
MRI with a well defined mass, with heterogeneous signal
Unusual location
Ethmoid sinus
Parotid/zygomatic arch region
Mediastinum GROSS PATHOLOGY
Tumor size 0.7-17 cm (median 3- cm)
Fibrous capsule with incomplete peripheral shell of mature bone reported
HISTOLOGIC AND MOLECULAR FEATURES
Round to oval cells in cords or nests within a myxoid matrix ± transition to hyaline fibrosis and focal osteoid
Few or no mitotic activity
Higher mitotic activity reported (suggests the malignant counterpart
Mitotic activity reported from 0-50hpf ± necrosis (17%) (suggests the malignant counterpart
± vascular invasion (11%) (suggests the malignant counterpart
± stromal cyst formation Incomplete capsular shell of mature bone
Moderate amounts of myxocollagenous matrix
± focal peripheral metaplastic bone formation
Central zone bone formation has been reported
40% with bone present Background cells can include histiocytes, lymphocytes, and mast cells
Immunohistochemisty
+ S-100 in 6094% reported
Pancytokeratin (10%)
SMA (%)
Desmin (13%)
Collagen II (%)
Glial fibrillary acidic protein positivity reported
Vimentin positivity reported
Neurofilament and neuron specific enolase positivity reported suggesting neural origin
+ synaptophysin reported EM
Abundant intermediate filaments, primitive cell junctions, focally present external lamina reported (suggesting neural origin)
Cytoplasmic dense-core granules measuring 100-200nm Ctyogenetics
42 approximately 46,XY,-Y,add(1)(q42),add(6)(p21),t(10;18)(q26;q11),der(11)t(11;15)(q23;q15),add(12)(q13),ins(14;?)(q13;?),-15,+mar reported
45,XY, der(6;14)(p10;q10),add(12)(q24.3) reported DIFFERENTIAL CLINICOPATHOLOGIC DIAGNOSIS
Calcifying hematoma
Aponeurotic fibroma
Nodular fasciitis
Neurilemoma
Epithelioid" type Myoepithelioma
Mesenchymal hamartoma
Ossifying epithelioid hemangioendothelioma
Chondromyxoid fibroma
Osteosarcoma of soft tissue
Malignant schwannoma
Low-grade fibromyxoid sarcomas
Malignant ossifying fibromyxoid tumor (the malignant counterpart
DISEASE COURSE AND TREATMENT
22-30% LR (may result in amputation)(esp in large tumors, ? cellularity, ? mitoses)
LR usu ? 10 yrs
Subcutaneous LR reported
Chest wall LR reported after only 1 yr > 2 mitotic figures/50 HPFs risk for LR Wide resection with clear margins indicated because of the indistinct differentiation between the benign and malignant counterparts
One report associated with pulmonary metastases extending into the L atrium has been reported representing the malignant counterpart
FIGURES There are no images attached to this page. REFERENCES
Adamek D, Stachura J, Katuza J: Recurrent ossifying fibromyxoid tumour of soft parts. Immunohistochemical profile and ultrastructure. Pol J Pathol 1998;49(3):179-82.
Akai M, Azuma H, Ohno T, Kimura H, Sugano I, Nagao K: Case report 685: ossifying fibromyxoid tumor of the soft parts of the upper arm. Skeletal Radiol 20:608-12,1991.
Al-Brahim N, Dashti MA: Ossifying fibromyxoid tumor of soft parts. Report of a rare tumor in Kuwait. Med Princ Pract 2008;17(4):340-2.
Barrett TL, Skelton HG, Smith KJ, O’Grady TC, Proctor-Shipman L: Ossifying fibromyxoid tumor of soft parts: a case report and review. J Cutan Pathol 1996 Aug 23(4):378-80.
Donner LR: Ossifying fibromyxoid tumor of soft parts: evidence supporting Schwann cell origin. Hum Pathol 1992 Feb;23(2):200-2.
Ekfors TO, Kulju T, Aaitonen M, Kallajoki M: Ossifying fibromyxoid tumour of soft parts: report of four cases including one mediastinal and one infantile. APMIS 1998 Dec;106(12):1124-30. Enzinger FM, Weiss SW, Liang CY: Ossifying fibromyxoid tumor of soft part: a clinicopathological analysis of 59 cases. Am J Surg Pathol 13:817-27,1989. Pubmed
Fisher C, Hedges M, Weiss SW: Ossifying fibromyxoid tumor of soft parts with stromal cyst formation and ribosome-lamella complexes. Ultrastruct Pathol 1994 Nov-Dec;18(6):593-600.
Folpe AL, Weiss SW: Ossifying fibromyxoid tumor of soft parts: a clinicopathologic study of 70 cases with emphasis on atypical and malignant variants. Am J Surg Pathol 2003 Apr;27(4):421-31. Pubmed
Fukunaga M, Ushigome S, Ishikawa E: Ossifying subcutaneous tumor with myofibroblastic differentiation: a variant of ossifying fibromyxoid tumor of soft parts? Pathol Int 1994 Sep;44(9):727-34.
Hanski W, Lewicki Z: New observations on three cases of ossifying fibromyxoid tumor of soft parts. Pol J Pathol 1994;45(3):231-8.
Holck S, Pedersen JG, Ackermann T, Daugaard S: Ossifying fibromyxoid tumour of soft parts, with focus on unusual clinicopathological features. Histopathology 2003 Jun;42(6):599-604.
Ijiri R, Tanaka Y, Misugi K, Sekido K, Nishi T: Ossifying fibromyxoid tumor of soft parts in a child: a case report. J Pediatr Surg 1999 Aug;34(8):1294-6.
Kawashima H, Ogose A, Umezu H, Hotta T, Tohyama T, Tsuchiya M, Endo N: Ossifying fibromyxoid tumor of soft parts with clonal chromosomal aberrations. Cancer Genet Cytogenet 2007 Jul 15;176(2):155-60.
Kilpatrick SE, Ward WG, Mozes M, Miettine M, Fukunaga M, Fletcher CDM: Atypical and malignant variants of fibromyxoid tumor: Clinicopathologic analysis of six cases. Am J Surg Pathol 19:1039-46,1995. Pubmed
Kiryu H, Hashimoto H, Hori Y: Ossifying epithelioid hemangioendothelioma. J Cutan Pathol 1996 Dec;23(6):558-61.
Lax SF, Ratschek M, Steindorfer P, Langsteger W, Harms D, Beham A: Ossifying fibromyxoid tumour of the neck clinically mimicking a primary neoplasm of the thyroid gland. Pathol Res Pract 1995 Feb;191(1):57-60.
Martinez-Rodriguez M, Subramaniam MM, Calatayud AM, Ramos D, Navarro S, Llombart-Bosch A: Ossifying fibromyxoid tumor of soft parts mimicking a schwannoma with uncommon histology: a potential diagnositic pitfall. J Cutan Pathol 2009 Jan;36(1):71-3.
Matsumoto K, Yamamoto T, Min W, Yamada N, Asano G, Moriyama M, Matsumoto T: Ossifying fibromyxoid tumor of soft parts: clinicopathologic, immunohistochemical and ultrastructural study of four cases. Pathol Int 1999 Aug;49:742-6.
McCormack D, Lane H, Bennett D, Fenelon G: Ossifying fibromyxoid tumour of soft parts. Ir J Med Sci 1997 Jul-Sep;166(3):130-1.
Miettinen M: Ossifying fibromyxoid tumor of soft parts. Additional observations of a distinctive soft tissue tumor. Am J Clin Pathol 1991 Feb;95(2):142-9.
Michal M, Miettinen M: Myoepitheliomas of the skin and soft tissues. Report of 12 cases. Virchows Arch 1999 May;434(5):393-400.
Michal M, Sokol L: Benign polymorphous mesenchymal tumor (mesenchymal hamartoma) of soft parts. Report of two cases. Am J Dermatopathol 1997 Jun;19(3):271-5.
Miettinen M, Finnell V, Fetsch JF: Ossifying fibromyxoid tumor of soft parts–a clinicopathologic and immunohistochemical study of 104 cases with long-term follow-up and a critical review of the literature. Am J Surg Pathol 2008 Jul;32(7):996-1005. Pubmed
Nakayama F, Kuwahara T: Ossifying fibromyxoid tumor of soft parts of the back. J Cutan Pathol 1996 Aug;23(4):385-8.
Nishio J, Iwasaki H, Ohjimi Y, Ishiguro M, Isayama T, Naito M, Okabayashi H, Kaneko Y, Kikuchi M: Ossifying fibromyxoid tumor of soft parts. Cytogenetic findings. Cancer Genet Cytogenet 2002 Mar;133(2):124-8. Pubmed
Oda N, Yasui W, Ito H, Tahara E: Ossifying fibromyxoid tumor of soft parts: a case report. Jpn J Clin Oncol 1993 Feb 23(1):64-8.
Orosz Z, Sapi Z, Szentirmay Z: Unusual benign neurogenic soft tissue tumour. Epithelioid schwannoma or an ossifying fibromyxoid tumour? Pathol Res Pract 1993 Jun;189(5):601-5; discussion 605-7.
Raith J, Ranner G, Schaffier G, Groll R, Lindbirchier F, Fritz K, Weybora W: Bone scan in ossifying fibromyxoid tumor of soft parts. Clin Nucl Med 1998 Apr;23(4):262-4.
Sarraj A, Duarte J, Dominguez L, Pun YW: Resection of metastatic pulmonary lesion of ossifying fibromyxoid tumor extending into the left atrium and ventricle via pulmonary vein. Eur J Echocardiogr 2007 Oct;8(5):384-6.
Schofield JB, Krausz T, Stamp GW, Fletcher CD, Fisher C, Azzopardi JG: Ossifying fibromyxoid tumour of soft parts: immunohistochemical and ultrastructural analysis. Histopathology 1993 Feb;22(2):101-12.
Seykora JT, Kutcher C, van de Rijn M, Dzubow L, Junkins-Hopkins J, Ioffreda M: Ossifying fibromyxoid tumor of soft parts presenting as a scalp cyst. J Cutan Pathol 2006 Aug 33(8):569-72.
Sovani V, Velagaleti GV, Filipowicz E, Gatalica Z, Knisely AS: Ossifying fibromyxoid tumor of soft parts: report of a case with novel cytogenetic findings. Cancer Genet Cytogenet 2001 May;127(1):1-6.
Velasco-Pastor AM, Martinez-Escribano J, del Pino Gil-Mateo M, Quecedo-Estebanez E, Fortea-Baixauli JM, Allaga-Boniche A: J Cutan Pathol 1996 Aug;23(4):381-4.
White WL: Self assessment–1993. Non-ossifying variant of ossifying fibromyxoid tumor of soft parts. J Cutan Pathol 1994 Dec;21(6):571-3.
Williams RW, Case CP, Irvine GH: Ossifying fibromyxoid tumour of soft parts–a new tumour of the parotid/zygomatic arch region. Br J Oral Maxillofac Surg 1994 Jun;32(3):174-7.
Williams SB, Ellis GL, Meis JM, Heffner DK: Ossifying fibromyxoid tumour (of soft parts) of the head and neck: a clinicopathological and immunohistochemical study of nine cases. J Laryngol Otol 1993 Jan;107(1):75-80. Pubmed
Willamson ME, Dallimore N: A new bony lump for general surgeons: ossifying fibromyxoid tumour of soft parts. Case report. Eur J Surg 1994 Jan;160(1):53-4.
Yang P, Hirose T, Hasegawa T, Gao Z, Hizawa K: Ossifying fibromyxoid tumor of soft parts: a morphological and immunohistochemical study. Pathol Int 1994 Jun;44(6):448-53.
Yoshida H, Minamizaki T, Yumoto T, Furuse K, Nakadera T: Ossifying fibromyxoid tumor of soft parts. Acta Pathol Jpn 1991 Jun;41(6):480-6.
Zamecnik M, Michal M, Simpson RH, Lamovec J, Hlavcak P, Kinkor Z, Mukensnabl P, Matejovsky Z, Betlach J: Ossifying fibromyxoid tumor of soft parts: a report of 17 cases with emphasis on unusual histological features. Ann Diagn Pathol 1997 Dec;1(2):73-81. Pubmed [...] Read more...
June 28, 2024Crawford Jennings Campbell, MD (1914-1983), as a visiting professor at Tufts in Boston in 1974. Doctor Campbell grew up in Panama, graduated from college at Yale, and medical school at Yale with honors in 1940. He began his training under Dr Dallas Phemister in Chicago and completed his residency at the University of Chicago Clincis under Dr Howard Hatcher in 1948 after a brief interlude in the military. He was an influential chairman of the Section of Orthopaedic Surgery in Albany, New York from 1948 until 1975, transferring to Massachusetts General Hospital. His teaching in the field of pathology and basic science was recognized throughout the world. His publications were focused mainly on topics of orthopaedic
pathology and his research included histologic studies. He served on the Committee on Pathology of The American Academy of Orthopaedic Surgeons and was the orthopaedic representative of the Surgical Study Section of the National Institutes of Health to name two of his organizational participations (photo courtesy of Mohinder Mital, MD). No question is unimportant, as is evident as Crawford Campbell intently listens to a question. He could make the most junior resident at ease.
Bone and soft-tissue sarcomas represent < 1% of all malignancies.
Nevertheless, they and their benign counterpart, represent a significant problem for the orthopaedic surgeon, the radiologist, and the pathologist. This whole mount proximal tibial section was cut in by Crawford Campbell, MD from an AKA specimen in a young boy in 1974. The extent of the osteosarcoma from the diaphysis to the physeal plate can be seen in this low power view (1X)(courtesy of Mohinder Mital, MD). “It is amazing now and then what a surgeon can do if fortified with an aggressive attitude in operating for cancer.” Owen Harding Wangensteen
Attachments: jennings1.jpg (image/jpeg) jennings2.jpg (image/jpeg) proximal_tibia.jpg (image/jpeg) [...] Read more...
June 28, 2024Next to knowing when to seize an opportunity, the most important thing in life is to know when to forego an advantage." Benjamin Disraeli [...] Read more...
June 28, 2024Definition and pathogenesis
Upregulation of insulin in NIDDM results in IGF-I receptor binding and bone formation
Importance
2-4% prevalence in Asian countries
Clinical features
Endocrinological disorders
Glucose (NIDDM)
Calcium
Radiological features
? systemic bone mineral density
Gross pathology
Histologic features
Undifferentiated mesenchymal cells differentiating into chondrocytes
Endochondral ossification
Differential clinicopathologic diagnosis
Ankylosing spondylitis
Disease course and treatment
Severe paralysis with progression of the ossification and spinal cord compression [...] Read more...
Community
Recent talks, cases, images and questions from OrthopaedicsOne Cases, Talks, Images and Question Bank spaces.
Recently Updated
June 29, 2024Subtrochanteric nonunion in patient on chronic steroids.
Title:
Forty-nine Year-Old Female with Subtrochanteric Nonunion
Presenter:
Chris Estes
Location:
Adult Reconstruction Conference
Mayo Clinic
Phoenix, Arizona
Date: 11-Aug-2008
Attachments: Forty Nine Year Old Female With Subtrochanteric Nonunion_Orthopaedia.ppt (application/vnd.ms-powerpoint) [...] Read more...
June 29, 2024Introduction Glomus tumor is a relatively rare tumor usually found in the subungal region. An extra-digital glomus tumor often poses a diagnostic dilemma. We present a patient with severe thigh pain with hyperesthesia. The diagnosis was finally made through histopathology. This case suggests that glomus tumor should be considered in the differential diagnosis in such a scenario.
Presentation A 30-year-old woman presented to our outpatient clinic with the complaint of pain on her right mid-thigh. The pain had started insidiously 6 years earlier, was constant with hyperesthesia of the overlying skin, was aggravated by movement or touch and reduced by rest, and had increased in severity over the past 2 months. The patient had difficulty walking due to the pain.
Physical examination revealed marked wasting of the quadriceps muscles of the right thigh, especially the vastus medialis obliquus. Although no obvious mass was visible or palpable, the patient exhibited exquisite tenderness at a point on the medial aspect of the mid-thigh. The overlying skin was normal without any redness or evidence of inflammation. Range of motion of the right hip and knee were within normal limits. Neurological examination of the right lower extremity was normal.
Routine laboratory analysis, including complete blood count, erythrocyte sedimentation rate, C-reactive protein and serum chemistry, was within normal limits.
Plain radiographs, ultrasound, and MRI scan were obtained and interpreted. The plain radiographs and ultrasound of the right thigh in both anteroposterior and lateral views were normal. The MRI scan of the right thigh (Figures 1a-b) showed marked atrophy of the vastus medialis, intermedius and lateralis muscles. T2- weighted and STIR images showed increased signal intensity in these muscles. A small focal hyperintense lesion adjacent to the distal medial femoral diaphysis deep to the vastus medialis muscle was seen.
Management An open excision biopsy (Figure 2) was performed through the medial approach, with the goal of establishing the diagnosis and relieving pain. Surgical exploration of the right thigh revealed a well-defined reddish nodular mass (Figure 3) in the substance of the vastus medialis obliquus adjacent and adherent to the periosteum. The mass was resected and sent for histopathologic examination.
Macroscopically, the resected tumor was dark red, measured 3.5 x 1.6 cm, and was friable in consistency. (Figure 4). Histopathologic examination showed a solid proliferation of round to cuboidal cell arranged in sheets, arising from the wall of intervening blood vessels. Focally, the cells were concentrically arranged around the blood vessel and had uniform to mildly pleomorphic round nuclei with acidophilic cytoplasm. Some mitotic activity and apoptotic bodies were also seen (Figures 5a-b).
The diagnosis of glomus tumor was made based on the clinical, MRI, and histologic findings. Pain relief was immediate and complete after surgical excision of the mass, and the patient was ambulating without symptoms at 6 months follow-up.
Figures Discussion References Attachments: Figure 1A.JPG (image/jpeg) Figure 1B.JPG (image/jpeg) Figure 2.JPG (image/jpeg) Figure 3.JPG (image/jpeg) Figure 4.JPG (image/jpeg) Figure 5A.JPG (image/jpeg) Figure 5B.JPG (image/jpeg) [...] Read more...
June 29, 2024Search Cases
> Browse CasesBy Category
Joint Reconstruction ( Evidence-Based Practice ( Foot and Ankle ( Hand and Wrist ( Hip and Knee ( Informatics ( Pain Management ( Pediatrics ( Shoulder and Elbow ( Spine ( Sports Medicine ( Trauma ( Tumor ( Miscellaneous ( Unknown ( ORCID ( By Type
Case NotesCase PresentationsCase ConferencesCase ReportsCase UnknownsUS Army Orthopaedic Trauma [...] Read more...
June 29, 2024Introduction Radical amputation of a limb following resection of huge bone and soft tissue sarcomas usually produces a defect necessitating a coverage procedure. There could be many choices for coverage. We are reporting two cases in which the post-amputation defects were covered using “Spare Parts”: as free myocutaneous flaps harvested from the amputated limb, distal to the primary tumor.
We report two cases in which bone and soft tissue sarcomas progressed to an extent where amputation was required. This can occur due to inappropriate primary surgery but more importantly, due to delayed presentation of tumor when the primary lesion is big and extra-compartmental. The huge defect left by the amputation necessitates a coverage procedure; this can be adequately provided by using spare parts, as free flaps from the amputated limb.
The harvest of free flaps from amputated extremities for use in reconstruction is a well described reconstructive and plastic surgical procedure. This technique has been reported for closure of large traumatic wounds and for coverage and closure following large amputations for oncologic purposes. Both myocutaneous and fascio-cutaneous varieties have been used.
Our experience of utilizing spare parts is being presented in the following two cases. The first is a maltreated case of osteogenic sarcoma affecting the head and neck of femur. The second case is that of a huge neglected primary Spindle cell sarcoma of the shoulder girdle.
Presentation Case 1
This 40 year old male; presented to the clinic with pain in the left hip for one year.
All initial evaluation and surgeries were done outside our institution. Bone scan and X-ray were reported as Avascular Necrosis of the femoral head. CT scan revealed both radio-lucent and radio-opaque changes in the head and neck of femur ( Fig. 1a).
He underwent core decompression/curettage with fibular grafting ( Fig. 1b). Bone was sent for biopsy during core decompression reported Osteogenic sarcoma on histopathalogical basis. Based on this information the primary surgeon performed inter-lesional resection of the femoral head and replaced it with an Austin Moore prosthesis ( Fig. 1c).
With time the tumor progressed to involve the acetabulum and the femoral shaft. As a consequence, the patient developed a pathological peri-prosthetic fracture in the proximal shat of left femur ( Fig. 1d). In addition the incisions utilized for the above mentioned procedures ( Fig. 2a) violated the anterior and posterior flaps of skin. On presentation to our clinic he was planned for MRI scan; to assess the local extent of the disease. The Austin Moore implant was thus, removed as the first phase of treatment ( Fig. 1e). The staging work up revealed a locally advanced non-metastatic disease which had not yet invaded the medial wall of the acetabulum.( Fig. 1f).
Case 2
49 year old gentleman, presented to our clinic with right shoulder swelling and pain for the last one year.
History of the patient revealed; the mass arising as a small swelling on the right shoulder one year prior to the first presentation. Fine needle aspiration cytology was done and revealed atypical cells. No further intervention was done. On presentation at our clinic the swelling had greatly increased in size ( Fig. 4a, Fig. 4b). He was offered a forequarter amputation, but left without any decision.
He then presented to the clinic 4 months later with a proximal arm mass, much increased in size since prior presentation, it was now ulcerating at various points and was accompanied by purulent discharge ( Fig. 4c). The distal neuro-vasculature was, however, intact.
Following the second presentation, staging workup was ordered. MRI revealed lesion of the right shoulder involving proximal humerus, Scapula, third rib, rotator cuff muscles, Serratus anterior, intercostals muscles in the second and third space ( Fig. 3a, Fig. 3b). CT scan of the chest did not reveal any mets. Core biopsy revealed a malignant spindle cell sarcoma.
Management Case 1
Considering the progression and extent of the disease an external hemipelvectomy was planned. No typical flap, anterior or posterior could be raised for closure as the previous incisions and the pathological fracture had contaminated both of them, so an incision as shown in ( Fig. 2b) was made. Pelvic osteotomy was done just close to the sacro-illiac joint and the symphysis. A huge section of exposed bone and peritoneal fat ( Fig. 2c) required coverage.
Before proceeding with the surgery a tourniquet was applied below the fracture on the thigh and the limb was disarticulated at the knee joint, use of spare parts from the amputated limb was employed in the form of a free myocutaneous flap of posterior calf skin supplied by the sural nerve, comprising of the Gastrocnemius and Soleus, based on the popliteal artery and vein was harvested. The free flap harvested from amputated leg was sutured into place and popliteal artery anastamosed with the internal iliac artery and the popliteal vein with the internal iliac vein. ( Fig. 2d).
Post- surgery biopsy confirmed Osteogenic Sarcoma and Approximately 15-20% of the tumor showed necrosis and all the marrow resection and all marrow resection margins of the pubic and, iliac and ischial bones were tumor free. All nine inguinal lymph nodes from the inguinal region were negative for tumor. He subsequently showed uneventful healing. The patient has had a two year follow-up with no evidence of reoccurence ( Fig. 2e).
Case 2
Based on aforementioned the findings a right forequarter amputation with the excision of the third rib, rotator cuff muscles, Pectoralis major, Seratous anterior and intercostals muscles in the second and third intercostals space was done ( Fig. 4d). Before amputating, the upper limb was disarticulated at the elbow under tourniquet control and a free myocutaneous flap from the forearm was harvested including skin from both the dorsal and volar aspects of the forearm as well as all the flexors of the forearm. This was done to increase the thickness and hence the viability of the flap. The flap taken was based on the brachial artery which was eventually anastamosed with the Subclavian artery and vein using end to side anastomosis to cover the defect created by fore-quarter amputation ( Fig. 4e).
The skin and muscle margins were negative for tumor. Post operative course was marked by local infection which responded to IV antibiotics and progressed to complete healing. The patient has had close to two years of follow-up and there is no evidence of local disease ( Fig. 4f). He did, however develop multiple small nodules in both lungs after a year and half of the index surgery for which he is currently receiving palliative chemotherapy.
Figures Discussion References Attachments: figure_1b.jpg (X-ray showed the presence of a fibular graft along with two screws.) figure_1f.jpg (MRI reveals the extent of the disease, and the pathological fracture.) figure_1e.jpg (X-ray shows the Austin Moore implant removed; for staging purposes.) figure_1a.jpg (CT scan showed lytic lesion with sclerotic changes in head and neck of femur.) figure_1c.jpg. (This X-ray revealed an Austin Moore implant in place, put through the tumor into the femoral shaft) figure_1d.jpg (X-ray in AP projection reveals the development of a pathological fracture in the femoral shaft.) figure_2e.jpg (Photograph of the flap at 4 month follow up.) figure_2d.jpg (Photograph illustrating the myocutaneous flap, based on the popliteal artery, sutured in place.) figure_2a.jpg (Photograph showing the two previous surgical scars.) figure_2b.jpg (Photograph outlinning the bounderies of the surgical incision used.) figure_2c.jpg (Photograph demonstrating the huge post amputation surgical defect.) figure_4c.jpg (Photograph shows the later presentation of the tumor with fungating masses and ulceration at different points.) figure_4b.jpg (Photograph revealing the spread of the tumor in both anterior and lateral planes.) figure_3a.jpg (MRI demonstrating the huge expanse of the tumor.) figure_3b.jpg (MRI (axial view) showing the tumor abbuting on the intercostal spaces.) figure_4a.jpg (Photograph showing the posterior aspect of the shoulder and the extent to which the tumor had spread.) figure_4d.jpg (Per-operative photgraph showing the post forequarter amputation surgical defect.) figure_4e.jpg (Per-operative photograph demonstrating the myocutaneous flap, based on the brachial artery, sutured in place.) figure_4f.jpg (Photograph showing the flap at 3 month follow up.) [...] Read more...
June 29, 2024Presentation The Compress device offers simple, predictable biologic fixation with minimal compromise of the remaining host bone. It has a low complication rate, does not burn any bridges, is simple to use, is durable and subsequent revision if required is easy to accomplish and removes almost no further bone. Used for extreme biologic situations our experience in revision arthroplasty of failed megaprosthesis, some infected, is very satisfactory with dependable biologic fixation in over 90% of patients. I have chosen to display all of the failures first.
Figures Diagnosis (Click to see answer) Notes References Attachments: Slide2.JPG (image/jpeg) Slide18.JPG (image/jpeg) Slide19.JPG (image/jpeg) Slide20.JPG (image/jpeg) Slide21.JPG (image/jpeg) Slide22.JPG (image/jpeg) Slide23.JPG (image/jpeg) Slide24.JPG (image/jpeg) Slide25.JPG (image/jpeg) Slide26.JPG (image/jpeg) Slide27.JPG (image/jpeg) Slide28.JPG (image/jpeg) Slide29.JPG (image/jpeg) Slide30.JPG (image/jpeg) Slide31.JPG (image/jpeg) Slide32.JPG (image/jpeg) 1.jpg (image/jpeg) 2.jpg (image/jpeg) 3.jpg (image/jpeg) 4.jpg (image/jpeg) 5.jpg (image/jpeg) 6.jpg (image/jpeg) 7.jpg (image/jpeg) 8.jpg (image/jpeg) 9.jpg (image/jpeg) 10.jpg (image/jpeg) 11.jpg (image/jpeg) 12.jpg (image/jpeg) 13.jpg (image/jpeg) 14.jpg (image/jpeg) 15.jpg (image/jpeg) 16.jpg (image/jpeg) 17.jpg (image/jpeg) [...] Read more...
Pages
Recent pages from OrthopaedicsOne Residency, Fellowships, Companies, Associations spaces.
Recently Updated
June 29, 2024Program Information Residency Program: St Mary’s Hospital and Medical Center Orthopaedic Surgery Residency Program Program Director: William A McGann, MD Number of Residents: 16 Number of Staff: 2 Accredited: Accredited Length of Program: 5 Start Dates: July Program Contact Information Name: Monica H Bastidas Address: St Mary’s Medical Center
Orthopaedic Education Department
450 Stanyan St City: San Francisco State/Province: California Zip/Postal code 94117 Phone: (415) 750-5782 Fax: (415) 750-5938 Email: [email protected] Website: http://www.sforp.org Program Highlights
Covers all aspects of orthopaedic surgery and musculoskeletal medicine, including:
Joints
Trauma
Spine/foot and ankle
Sports/plastic surgery
General orthopaedics Program Gallery Program Curriculum
PGY-1: Internship year includes comprehensive introduction to medicine and surgery
PGY-2 through PGY-5: Rotations in general orthopaedics, joints, spine, foot and ankle, sports medicine, trauma, hand surgery, tumors, pediatrics, and research
Program Hospitals
St Mary’s Hospital and Medical Center – San Francisco, CA
Shriners Hospitals for Children (Sacramento) – Sacramento, CA
Kaiser Permanente Medical Center (Oakland) – Oakland, CA
St Francis Memorial Hospital – San Francisco, CA
Alameda County Medical Center – Oakland, CA
Children’s Hospital-Oakland – Oakland, CA [...] Read more...
June 29, 2024Program Information Residency Program: University of Manitoba Orthopaedic Surgery Residency Program Program Director: John McPherson, MD Number of Residents: 18 Number of Staff: 18 Accredited: Accredited Length of Program: 5 Start Dates: Program Contact Information Name: Debbie Hepples Address: AD420, Orthopedic Surgery
Health Sciences Centre
820 Sherbrook Street City: Winnipeg State/Province: Ontario Zip/Postal code R3A 1R9 Phone: 204.787-1219 Fax: 204.787-2460 Email: [email protected] Website: http://umanitoba.ca/faculties/medicine/surgery/orthopaedics_residency/ Program Highlights
Academic sessions
Weekly seminars (didactic lecture, resident presentations, simulation labs, surgical skills labs, debate)
Weekly grand rounds
Weekly subspecialty rounds (hand, trauma, templating, pediatric, sports medicine, spine)
Visiting Professor program
Monthly journal club
Academic Day
Conferences Research
Pan Am Foundation Research and Skills Lab Program Gallery Program Curriculum
PGY-1: General surgery, adult orthopaedics, pediatric orthopaedics, internal medicine, elective
PGY-2: Adult orthopaedics, sports orthopaedics, surgical intensive care, medical intensive care, electives
PGY-3: Adult orthopaedics, adult reconstruction, pediatric orthopaedics, spine, internal elective
PGY-4: Adult orthopaedics, spine, adult reconstruction, elective
PGY-5: Adult orthopaedics, adult reconstruction, sports, spine, pediatric, exam prep
Program Hospitals
Winnipeg Health Sciences Centre
Pan Am Center (Sports medicine centre)
Concordia Hospital [...] Read more...
June 29, 2024Program Information Residency Program: Kalamazoo Center for Medical Studies – Michigan State University Orthopaedic Surgery Residency Program Program Director: Dale E Rowe, MD Number of Residents: 15 Number of Staff: 7 Accredited: Accredited Length of Program: 5 Start Dates: June, July Program Contact Information Name: Jennifer Austad Address: MSU-Kalamazoo Center for Medical Studies
Orthopaedic Surgery Program
1000 Oakland Dr City: Kalamazoo State/Province: Michigan Zip/Postal code 49008-1284 Phone: (269) 337-6554 Fax: (269) 337-6441 Email: [email protected] Website: http://kcms.msu.edu/orthopaedicsurgery Program Highlights
Clinics for children, hand, spine, adults, fracture, multiple handicaps, myelodsyplasia, diabetic foot, scoliosis
Didactic program
Weekly anatomy and clinical conference
Weekly bioskills/pathology
Monthly journal club
Monthly M&M Research project
Completed and presented end of PGY-4
Manuscript submitted for publication during PGY-5 Program Gallery Program Curriculum
PGY-1: Emergency medicine, general surgery, vascular surgery, internal medicine, CCU, rheumatology, neurosurgery, orthopaedic surgery, pediatric surgery, plastic surgery, trauma/ICU
PGY-2: General orthopaedics, hand, trauma
PGY-3: General orthopaedics, pediatrics, foot and ankle, research, hand
PGY-4: Elective, ortho/spine, sports, joints
PGY-5: General orthopaedics, trauma, hand
Program Hospitals
Michigan State Univ/Kalamazoo Center for Medical Studies – Kalamazoo, MI
Great Lakes Plastic Surgery – Portage, MI
Bronson Methodist Hospital Affiliated Physician Practices – Kalamazoo, MI
Borgess Medical Center Affiliated Physician Practices – Kalamazoo, MI
Western Michigan University Dept Biological Sciences – Kalamazoo, MI
Borgess Medical Center – Kalamazoo, MI
Bronson Methodist Hospital – Kalamazoo, MI
HealthCare Midwest Affiliated Physican Practices – Kalamazoo, MI
Advanced Vascular Surgery – Kalamazoo, MI
Midwest Orthopaedic Surgery – Kalamazoo, MI
K Valley Orthopaedics – Kalamazoo, MI [...] Read more...
June 29, 2024Program Information Residency Program: Medical College of Georgia Orthopaedic Surgery Residency Program Program Director: Simeon M Fulcher, MD Number of Residents: 15 Number of Staff: 12 Accredited: Accredited Length of Program: 5 Start Dates: July Program Contact Information Name: Dorothy J Harmon Address: Medical College of Georgia
Department of Orthopaedic Surgery BP-2109
1120 15th St City: Augusta State/Province: Georgia Zip/Postal code 30912-3040 Phone: (706) 721-1633 Fax: (706) 721-6001 Email: [email protected] Website: http://www.mcg.edu/resident/ortho/index.html Program Highlights
All rotations on main GHSU campus
Two clinic days per week
Subspecialty orthopaedic clinics
4-month-long rotations
Didactic training:
Daily teaching conference, covering basic science and clinical topics
Weekly subspecialty conferences
Bi-weekly grand rounds
Monthly journal club
Monthly M&M
Quarterly research updates
Variety of yearly conferences Program Gallery Program Curriculum
PGY-1: Trauma ICU, plastic surgery, vascular surgery, orthopaedics, pediatric ER, neuroradiology, anesthesiology, trauma service (not ICU), pediatric surgery, VAMC, neurosurgery
PGY-2: Pediatric orthopaedics and scoliosis, total joint and foot, trauma
PGY-3: Spine, general orthopaedics, sports medicine
PGY-4: Hand/upper extremity, pediatric orthopedics and scoliosis, orthopaedic trauma
PGY-5: Total joint/reconstructive, general orthopaedics, sports medicine, total joint and foot
Program Hospitals
Georgia Health Sciences University – Augusta, GA
Veterans Affairs Medical Center (Augusta) – Augusta, GA [...] Read more...
June 29, 2024Program Information Residency Program: Ohio State University Hospital Orthopaedic Surgery Residency Program Program Director: Joel Mayerson, MD Number of Residents: 5 per year Number of Staff: 31 Accredited: Accredited Length of Program: 5 Start Dates: July Program Contact Information Name: Julia A Panzo Address: Ohio State University Medical Center
4118 Cramblett Hall
456 W 10th Ave City: Columbus State/Province: Ohio Zip/Postal code 43210 Phone: (614) 293-6194 Fax: (614) 293-3596 Email: [email protected] Website: http://www.ortho.ohio-state.edu/ Program Highlights
One 6-year research position available per year
Rotations in the following subspecialties:
Foot and ankle
General orthopaedics
Hand
Infection
Joints
Oncology
Pediatrics
Shoulder
Spine
Sports
Trauma Conferences:
Educational conferences specific to each affiliated hospital
Weekly fracture conference
Weekly Grand Rounds
Monthly journal club
Monthly teaching conferences Program Gallery Program Curriculum
Program Hospitals
Ohio State University Hospital – Columbus, OH
Riverside Methodist Hospitals (OhioHealth) – Columbus, OH
Grant Medical Center (OhioHealth) – Columbus, OH
Nationwide Children’s Hospital – Columbus, OH [...] Read more...
At A Glance
OrthopaedicsOne is more than a “Wikipedia for Orthopaedics” or a “Living Orthopaedic Textbook”. OrthopaedicsOne is a knowledge sharing portal for orthopaedics and musculoskeletal health. OrthopaedicsOne consists of Spaces that provide different features as outlined below. Spaces with networking functionality require a FREE membership.
Articles – Open textbook of musculoskeletal medicine & orthopaedic surgery
Reviews
For Residents – Review notes and case modules for Board or Fellowship exams
For Medical Students – Study guide for medical students on a clerkship rotation in orthopaedics
eBooks
PORT Notes – The Pathology, Orthopaedics, and Radiology of musculoskeletal Tumors.
MSK Medicine – Collaborative workspace for the creation and dissemination of the Musculoskeletal Medicine for Medical Students eTextbook
Tumor Library – An Atlas of Musculoskeletal Oncology
Community
Talks – Share PowerPoint presentations from rounds, lectures and meetings (Login required)
Images – Repository of clinical, surgical and diagnostic imaging on orthopaedic topics
Viewpoints – Point-counterpoint debates on current orthopaedic topics
Question Bank – Collaborative question and answer review for resident intraining exam (Login required)
Devices – Open database of descriptions, images and attributes for orthopaedic implants
Pages
Residency – Orthopaedic residency program pages and open forum on issues in residency training
Fellowships – Orthopaedic fellowship program pages
Companies – Profile pages for orthopaedic and related companies
Associations – Profile pages for orthopaedic and related associations, societies and organisations
Getting Started
FUSE (Find, Use, Share, Expand) Orthopaedic Knowledge
OrthopaedicsOne enables orthopaedic surgeons, residents, medical students and allied health professionals to Find, Use, Share, and Expand (FUSE) orthopaedic knowledge.
- Managing Editors
- Editorial Board
- Medical Illustrators
- Content Partners
- Participating Groups
- Advisory Board
- Sponsoring Organizations
Frequently Asked Questions
White Papers and Case Studies
Disclaimer
Privacy Policy
Creative Commons License
Copyright Infringement
Instructions for Authors
- Author Credit
- How to Write an Article
- How to Edit an Article
- Citation Methods
- How to Insert Figures
- How to Watermark an Image
Mobile Interface
Peer Review Workflow
Personal Space Templates
Video Tutorials
User Guide
Contact Us
Browse Articles by Topic
OrthopaedicsOne Contents forms an outline of the knowledge of orthopaedics and musculoskeletal health. Each section shows the structure of its subject and serves as a table of contents for its coverage on OrthopaedicsOne. For more information on writing for OrthopaedicsOne, please review our Instructions for Authors and Available Topics on OrthopaedicsOne.
Getting Started
Welcome to OrthopaedicsOne
Take the Feature Tour to learn about all the features/services OrthopaedicsOne provides.
Editor’s Choice
Introduction
Define/describe the condition
Anatomy
Describe the pertinent anatomy
Pathogenesis
Describe the biomechanics/biologic basis of the disorder or the mechanism of injury
Natural History
Describe the natural history, epidemiology and prognosis
Clinical Presentation
Describe the means to elicit the most useful information from the patient history and physical examination as well as the relevant findings
Imaging and Diagnostic Studies
Describe appropriate radiologic and other diagnostic studies
Classification
Include a list with links to relevant conditions
Treatment
Include:
Medical therapy
Nonoperative treatment
Operative treatment – include links to pages with detailed surgical techniques
Indications and contraindications
Outcome
Include functional and prosthetic survivorship data as applicable
Complications
Include overview of complications
Pearls and Pitfalls
Tips and problems to avoid
Controversy
Include current controversies in diagnosis or treatment
References
Insert selected references and landmark articles [...] Read more...
Indications
Discuss indications and more general concerns.
Preoperative Planning
Material to be reviewed and conditions to be addressed before surgery. Include any exams preformed under anesthesia
Positioning
Describe and provide OR photos to illustrate positioning
Approach
Consider the various approaches. Provide links to relevant anatomy and surgical approaches.
Techniques
Step by step description to illustrate surgical technique
Pearls and Pitfalls
Tips and problems to avoid
Postoperative Care
Include immediate postoperative care and rehabilitation
Outcome
Include functional and prosthetic survivorship data as applicable
Complications
Include overview of complications
References
Include limited reference list [...] Read more...
Introduction
Summary about significance of fracture including epidemiology.
Anatomy
Review the relevant anatomy of the bone, the joint, surrounding soft tissues etc. Discuss important neurovascular considerations (blood supply etc).
Classification
Describe current classifications, including strength and weaknesses.
Presentation
Include:
Classic history
Physical Examination
Radiographic studies – which to order and pertinent findings
Lab studies (if relevant)
Diagnosis
Discuss important factors in making the diagnosis. What else should you be thinking of? Associated injuries? Underlying conditions?
Treatment
Include:
Immobilization – describe technique
Percutaneous fixation
Open fixation
Other surgical
Create link to article on operative technique
Complications
Include:
Complications of injury
Complications of treatment
Red Flags and Controversies
Outcomes
Include functional and implant issues as applicable
References
Insert recent references and landmark articles [...] Read more...
Indications
Discuss indications and more general concerns.
Preoperative Planning
Material to be reviewed and conditions to be addressed before surgery. Include any exams preformed under anesthesia
Positioning
Describe and provide OR photos to illustrate positioning
Approach
Consider the various approaches. Provide links to relevant anatomy and surgical approaches.
Techniques
Step by step description to illustrate surgical technique
Pearls and Pitfalls
Tips and problems to avoid
Postoperative Care
Include immediate postoperative care and rehabilitation
Outcome
Include functional and prosthetic survivorship data as applicable
Complications
Include overview of complications
References
Include limited reference list [...] Read more...
Announcements
Exciting News for OrthopaedicsOne Members!
/0 Comments/in Announcements/by [email protected]We’re thrilled to announce the migration of 16 spaces from Confluence to a new content management platform. This move will enhance maintenance and unlock exciting new features for our collaborative knowledge network. Rest assured, we’ve diligently transferred as much vital content as possible. While the look and feel may evolve over the coming months, our […]