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Recent articles from OrthopaedicsOne Articles space.
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June 27, 2024
Contents Introduction
Anatomy
Biomechanics
Clinical Presentation
Pathogenesis
Classification (Staging)
Physical Examination
Imaging
Conservative Treatment
Operative Treatment
Controversy
References
Introduction
Anatomy
Biomechanics
Clinical Presentation
Pathogenesis
Classification (Staging)
Physical Examination
Imaging
Conservative Treatment
Operative Treatment
Controversy
References [...] Read more...
June 27, 2024Term Definition Alpha threshold The scientific method tests hypotheses. We don’t actually prove our hypothesis, we set out to disprove the opposite (called the null hypothesis). And we don’t even get to actually disprove the the null hypothesis either; the best we can manage is to say that the probability of the null hypothesis being right is very low. How low is very low? That is in the eye of the beholder, and the beholder sets this level by defining the alpha threshold. In medicine, for historical and arbitrary reasons, we set alpha to be 0.05. That is, we are willing to accept the a 5% chance of a false positive study result, aka Type I error. If the p-value of a study is below alpha (p < 0.05, typically), the study results are said to be statistically significant. In some cases, it may make sense to set alpha even lower than 0.05; but that of course increases the risk of failing to reject a false null hypothesis, Type II error. As in many situations in clinical medicine, setting alpha is a compromise. One cannot "err on the side of caution" with a uniformly high or low threshold. The conservative approach depends on the clinical details. Incidence Incidence is a measure of the number of new cases of a disease that crop up in a population over a specified time interval. It is often confused with prevalence. Prevalence Prevalence is the fraction of the population with the disease, or the ratio of the number of people with the disease to the number of individuals in the population. Prevalence should not to be confused with incidence – the latter is a measure of new occurrences of a disease within a given time interval, whereas prevalence counts total cases, regardless of when they were contracted. Prevalence is typically greater than incidence, unless the disease is highly fatal. Mean The mean is the average value for all of the data points. Note that only continuous, not categorical, data can have a mean. The "mean result" of a series of 6 patients, 2 of whom were rated "bad", 2 "ok", and 2 "good" is not "ok"; rather, in that case, the term "mean" is meaningless (no pun intended). Median The median is the value of the "middle number" of the sorted data set; by definition, half of the values are above the median, and half are below. If there are 101 data points, the median is the value of sorted item number 51 (50 are below it and 50 are above). The median is also the 50th percentile. The median of the set (1,2,3,4,5,6,7,8,9) is obviously 5. The key to finding the median is sorting the set; the median of the set is not so obvious when not sorted: (8,5,6,1,2,7,4,9,3). Mode The mode is defined as the most frequently occurring value or item within a distribution. P-value This is a test statistic representing the probability that the null hypothesis (typically, the assumption the two groups are not different) is true. Hence, the lower the value, the more likely that the two groups are indeed different. Statistical significance When we say two sample means are different and that the difference is statistically significant, we are saying that the probability that the two means come from the same group is so low that we can ignore that possibility and consider that the samples represent groups that are indeed distinct. Ordinarily, one sets a standard for significance, called the alpha threshold, and then calculates a p- value of the results. The p-value is compared with the alpha threshold, and if the p-value is below alpha, the results are said to be statistically significant. Type I error A false positive. Example: A small (n=2) study of ankle fractures showed that ORIF leads to faster union than casting. In fact, if a larger study were undertaken, time to union would be the same. This is a Type I error. Type II error A false negative. Example: A small (n=2) study of ankle fractures showed that ORIF and casting have the same wound infection complication rate; zero in both groups. In fact, if a larger study were undertaken, wound infections would be found only in the surgical group. This is a Type II error. The Power of the Study is the ability to detect differences if they truly are present. Power increases with sample size. The small study size caused the error here. [...] Read more...
June 27, 2024Inborn Errors of Metabolism
Hurler’s Syndrome
Sanfilippos
Sickle cell anemia
OI II and III
Hypophosphatasia
Hereditary Vit. D dependent rickets
Diastrophic dysplasia
Metaphyseal chondrodysplasia [...] Read more...
June 27, 2024Physical therapy for selected orthopaedic conditions
Disorders of the rotator cuff
Instability
Labral injuries
Adhesive capsulitis [...] Read more...
Reviews
Recent resources from OrthopaedicsOne Review for Residents and Review for Medical Students spaces.
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June 27, 2024Includes transcondylar, supracondylar, intercondylar, and capitallar fractures
Classification AO
Type
Extra-articular
Partial intra-articular
Complete intra-articular
Treatment
Use closed treatment for undisplaced / minimally displaced fracture
Use ORIF for displaced fractures in all but the very low demand patients
Closed
Indicated for nondisplaced, stable fractures or patients who are not surgical candidates
Options include:
Cast immobilisation
Traction
Early motion (bag of bones) Operative
ORIF
Surgical Approach
olecranon osteotomy
provides superior exposure of articular surface triceps-sparing approach
triceps-splitting approach
triceps-reflecting approach Fixation
dual plating preferred, either with parallel plates or 90-90 plating
1/3 tubular plates are not sufficient Rehab
Average residual flexion contracture is approximately 25 degrees. Arthroplasty
preferred for lower demand pts, osteoporotic, comminuted fractures ref: Jupiter " complex fractures of the distal part of the humerus and associated complications" JBJS 76A: 1252- 1264, 1994
Capitellum fractures
Type
(Hahn – Steinthal) involves a large part of the osseous portion of the capitulum and may contain part of the adjacent lip of the trochlea
(Kocher – Lorenz) involves articular cartilage with little bone attached
Medial and Lateral Condylar fractures
If there is associated capsular/ ligamentous disruption (medially for fractured lateral condyle and laterally for fractured medial condyle), this allows radius and ulna to translate medial to lateral or lateral to medial, respectively
Type (Milch)
Lateral condylar ridge remains intact providing stability medial to lateral
Lateral condylar ridge is part of the fractured condyle [...] Read more...
June 27, 2024Calcium Pyrophosphate Dihydrate Deposition disease
Hyper-parathyroidism
Haemochromatosis
Acromegaly
Gout
Wilson’s’ Disease [...] Read more...
June 27, 2024If fragment is small : Non operative management
If fragment is large with minimal displacement : Non operative management
If fragment is large and displaced more than 10 mm : ORIF/excision and muscle reattachment [...] Read more...
June 27, 2024Definition
Death of bone from ischaemia. Reduction in O2 supply, below the level required to sustain life of the cellular component of bone.
Osteocytes will survive 12 – 48 hours of ischaemia and marrow cells 5 or 6 hours
Incidence
Peak incidence 40 – 50 years
Most commonly involves the proximal femur, then in descending order, distal femoral condyle (medial), proximal humerus, talus and less commonly the lunate, capitulum and metatarsal heads
5% of THR performed as a result of OA secondary to AVN Clinically
Majority present with pain, usually near the joint association with stiffness
Acute pain often worse at night
Pain may be severe for 6-8 weeks and then subsides
Mild symptoms + effusion usually persist Investigations
Xray
Increased bone density secondary to compression , collapse or deposition of new bone on existing dead trabeculae
Subarticular fractures : occasionally the necrotic segment separates ? crescent sign
Kerboul etal JBJS 56B:291-296, 1974 – described the combined necrotic angle – the arc of the surface involved by the necrosis is measured on both AP and lat XR and added – when the combined angle is more than 200 degrees, outcome is poor
Bone scan
Cold area may be only evident in early stages of disease (14 – 21 days), prior to revascularization
Usually, uptake increases at time of study
Increased uptake on both sides of joint suggests OA rather than AVN
75-80% sensitivity in pre collapse stage
MRI
Marrow changes of ischaemia before bone changes are earliest evident finding
T1 image : decreased signal from ischemic marrow
T2 image : a second, high signal intensity line can be found within the line seen on T1 images – believed to represent hypervascular granulation tissue ( = the double line sign) Rarely AVN may be found on histology with a normal MRI
100% sensitivity, 98% specificity
ref : Shimizu etal "Prediction of collapse with MRI of AVN of the femoral head" JBJS 76A:215-223, 1994
When at least 1/4 of diameter of the femoral head and at least 2/3 of the major weight bearing area is involved, 74% collapsed within 32 months
Functional exploration of bone
Measure intra-osseous pressure / intra-osseous venography
Technique:
3 mm trocar introduced, wait 5 minutes, read pressure then inject 1 ml saline over 5-30 seconds, wait 5 minutes, read
Normal baseline 20 mm Hg (average 18 mm Hg) with upper limit of normal 30 mm Hg
Should not increase more than 10 mm Hg, following injection of 5 ml saline and should be normal after appropriate delay
Then perform Intramedullary venography
10 ml of contrast normally cleared within 10 minute
If AVN reflux into diaphysis and stasis
50% of patients with increased pressure and no signs, develop AVN over the next 3 years Core biopsy (Forage) [...] Read more...
June 27, 2024Stages
Soft tissue swelling
Osteoporosis, epiphyseal overgrowth but joint integrity maintained
Disorganisation of the joint with subchondral cysts, squaring of patella and intercondylar notch with trochlear widening
Narrowing of joint space and cartilage destruction
Marked narrowing and fibrou capsular contracture [...] Read more...
eBooks
Recent resources from OrthopaedicsOne PORT Notes, MSK Medicine for Medical Students, and Atlas of Musculoskeletal Oncology spaces.
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June 28, 2024Topics:
(Chordoma)
Clear Cell Chondrosarcoma
Conventional Chondrosarcoma, Central or Medullary
Conventional Chondrosarcoma, Juxtacortical, Periosteal or Peripheral
Dedifferentiated Chondrosarcoma
Mesenchymal Chondrosarcoma
SECONDARY CHONDROSARCOMA, CENTRAL OR MEDULLARY
Secondary Chondrosarcoma, Exostotic [...] Read more...
June 28, 2024DEFINITION AND PATHOGENESIS
Histologically similar to the renal lesion and may occur nearly anywhere
IMPORTANCE
May rarely be associated with multicentric disease
CLINICAL FEATURES
Usually occurs in children and adolescents, involving the trunk and proximal extremities, usually in a deep location
RADIOLOGIC FEATURES
GROSS PATHOLOGY
Infiltrative
Areas of necrosis
HISTOLOGIC FEATURES
Sheets of trapezoidal cells with eccentric nucleaus (mitoses frequent) and eosinophilic cytoplasmic filaments
Special stains:
+ vimentin and keratin (intracytoplasmic filaments) DIFFERENTIAL CLINICOPATHOLOGIC DIAGNOSIS
Rhabdomyosarcoma
Epithelioid sarcoma
Melanoma
DISEASE COURSE AND TREATMENT
Metastases to lungs, liver, LN, soft tissues
Mean survival 6 months
REFERENCES [...] Read more...
June 28, 2024DiseaseEnzyme deficiencyManifestations
Alkaptonuriahomognetisic acid oxidase ochronosis; ankylosis of hips, knees, spine; fxs through
(needed for tyrosine and ankylosed joints have been reported; black cartilage
phenylalanine metabolism)pigmentation; ochronotic degeneration of cardiac valves,
disc degeneration and chronic LBP [...] Read more...
June 28, 2024There is no shortage of good days. It is good lives that are hard to come by…" Annie Dillard [...] Read more...
Community
Recent talks, cases, images and questions from OrthopaedicsOne Cases, Talks, Images and Question Bank spaces.
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June 29, 2024History Initial Imaging Diagnosis (Click to see answer) Treatment Discussion References Attachments: se5.jpg (image/jpeg) se6.jpg (image/jpeg) se8.jpg (image/jpeg) se3.jpg (image/jpeg) se4.jpg (image/jpeg) se5.jpg (image/jpeg) se mri.jpg (image/jpeg) [...] Read more...
June 29, 2024Select Case Type Select the type of case template to use and enter the title of the case on the next page. [...] Read more...
June 29, 2024
Introduction
The purpose of revision hip arthroplasty is to reconstruct the hip to reproduce, as closely as possible, the form and function of the native joint. The indications for revision include significant polyethylene wear, fractures of the components, component malposition, hip instability, severe thigh pain, excessive damage to the femoral Morse taper, and severe infection [].
In revision hip surgery, the removal of well-fixed cementless components can be extremely demanding, time consuming, and requiring patience and caution to limit the amount of host bone destruction. Many surgeons opt to retain a well-fixed acetabular cup unless it is malpositioned or shows signs of impingement or severe wear. Fortunately, indications for implant removal are scarce, and most of the contemporary cementless components perform very well through improved bony in-growth [].
Because of the diversity of the components and the methods used to secure them, an equal diversity of approaches and tools are necessary for component extraction. Component removal in total hip arthroplasty revision is a crucial and essential step in the operation because it dictates the possibilities for component reimplantation and reconstruction, and, therefore, of the patient outcome. It is imperative that the surgeon be comfortable and familiar with the basic techniques of implant removal. On the other hand, the implant industry has responded accurately to the needs of the revision surgeon and has developed instruments to overcome such issues with less effort [].
We describe a technique to remove a well-fixed polyethylene titanium-coated RM cup using acetabular reamers in a revision total hip arthroplasty. The reamers’ action reduces the thickness of the polyethylene to a thin lamina, and this way the cementless cup can be removed easily, minimizing acetabular bone loss. The cup was removed by a significant polyethylene wear at 20 years of follow-up.
Presentation
A 75-year-old man presented a bilateral hip arthroplasty. Clinical examination and radiographic findings showed aseptic loosening of a cementless prosthesis on the left side 20 years following the procedure.. The polyethylene titanium-coated RM acetabular cup was well positioned and well fixed; no radiolucent lines were present in the bone/implant interface. The isoelastic femoral stem showed a mechanical instability, the two screws of stem being broken (Figure ).
Management
Revision hip arthroplasty was performed with the patient in the lateral decubitus position under general anesthesia; the hip was exposed through a standard posterior approach. The femoral implant was loose in the femoral cavity and was removed without difficulty. Metallic debris was found in the soft tissues of the femoral implant/bone interface.
The acetabular component was a monobloc hemispherical cup manufactured from ultra high molecular weight polyethylene (UHMWPE), with a pure titanium particle-coated surface. With heat and pressure, the particles are blasted into the polyethylene surface. The coating promotes osseointegration. Stability of the cup is provided by two anchoring pegs on the weight-bearing part on its outer surface. The inclination of pegs and holes diverges by 5 degrees, providing a press-fit effect that increases the rigidity of the primary fixation. This is supplemented by screws inserted through the periphery of the cup [].
The RM cup was removed because significant wear of the polyethylene surface was presented on direct observation and by placing an appropriately sized head into the cup.
First, we removed the three screws of the cup. The polyethylene layer of the cup was sequentially reamed using powered acetabular reamers.
The first reamer was a small standard-powered cheese grater acetabular reamer (40 or 44 mm). It was placed in the middle of the inner part of the cup (Figure ). Reamers of increasing sizes were used successively to wear the polyethylene layer (Figure ). A minimal amount of polyethylene debris ("polyethylene chips") was removed from the articular soft tissues to avoid any biological reaction.
In this case, we used chisels to weaken the superior part of the implant and to create a roughened surface for the reamer action. When the polyethylene was thin enough, it was removed easily by hand tools without the risks of bone fractures and bone stock loss. This technique is not time-consuming; it took 12 minutes.
The cup surface was osseointegrated without interposition of soft tissues in the bone/implant interface by a process of contact osteogenesis.
A metallic support ring and a cemented polyethylene cup were implanted. The femur was reconstructed with a revision conical stem and morselized cancellous bone allograft, cryopreserved [11]. The bone allograft was impacted to fill the space between the proximal part of the implant and the cortical native bone (Figure ). No complications were reported in the perioperative course and during the hospitalization period.
Figures Discussion
A major concern during revision hip arthroplasty is the acetabular bone loss during the extraction of well-fixed acetabular components. In fact, removing a well-fixed cementless cup is not always an easy task as it may lead to significant bone loss, particularly in the medial wall of the acetabulum, and subsequently result in a higher incidence of component loosening [12].
For safe component removal during revision hip procedures, it is essential to use the appropriate equipment and surgical techniques. During the last two decades, continuous efforts have resulted in the development of better tools to remove the cemented and cementless components. Hand tools such as osteotomes and chisels, ultrasonic devices, and ballistically driven chiseling systems controlled by an endoscope have been used with good results. There are no controlled studies comparing the outcomes of the different tools and techniques because often more than one device or approach is used simultaneously in the same revision procedure [].
Removal of an ingrown, fully porous-coated acetabular cup is a difficult procedure because there is no interface between host bone and the cup. The procedure begins with complete acetabular rim exposure and extraction of the polyethylene. Because of the problems encountered in trying to replace an acetabular component associated with bone loss, surgeons have begun retaining the well-fixed component in situ by exchanging the polyethylene liner while attempting to encourage bone formation through grafting the defects with bone or bone substitutes []. This is typically done in older patients as a last resort.
If screws are present, it is imperative to have the appropriate screwdrivers available during the cup removal. A high-speed metal burr can be used to cut off the screw head if the screw is stripped or if difficulty is incurred during attempted extraction. In these situations, we can use pliers, small trephines, or screw removal instruments to remove the remaining part of the screw.
After adequate exposure, the implant-bone interface is disrupted with the use of narrow curved osteotomes. Short curved osteotomes are used in a circumferential manner, with gradual progression to longer osteotomes. Specific instruments have been developed and used to achieve the goal of safe component removal with minimal bone loss. The Explant system by Zimmer has been gaining popularity. This instrument allows safe penetration at the metallic cup-bone interface [12]. However, to remove a well-fixed titanium-coated RM acetabular cup, the technique that we described is more efficient in preserving host bone.
In special situations, the metallic cup can be sectioned with a high-speed metal cutting burr. The sectioned component pieces are removed sequentially with minimal destruction of the underlying bone [].
Despite the technology available and the numerous techniques described, the key element in component removal depends on a careful preoperative planning, technical expertise, and patience. Stepwise, logical progression can result in successful and complete removal of all components, whereas impatience can result in catastrophic bone loss and fracture [].
In cases of well-fixed polyethylene titanium-coated RM acetabular component, we can also use the general procedures recommended for removal of the cementless cups. However, there is always the risk of bone loss and bone fracture because the cup is osseointegrated.
For that, we would recommend wearing the polyethylene layer with powered acetabular reamers. When the polyethylene is thin enough, the remaining cup is removed easily by hand tools, despite the osseointegration of the cup surface. The acetabular bone stock is preserved and the risks of fractures and bleeding are minimized.
We have used this technique in 10 cases with excellent results; no complications were noted. To our knowledge and on reviewing the literature, these principles were applied only in cemented cups [13].
Conclusion
Removal of a well-fixed cementless titanium-coated RM acetabular cup can be associated with bone loss, bone fracture, and bleeding when curved gouges, osteotomes, and chisels are used to disrupt the implant-bone interface. We have found a technique using acetabular reamers that allow cup thinning to be simple, reproducible, non-costly, non-timing consuming, and safe. The acetabular bone stock is preserved and the risks of complications are minimized. This technique can also be performed in the revision of a well-fixed all-polyethylene cemented cup.
Ethical Approval
The investigation process was developed in accordance with ethical research principles. The patient was informed that data concerning the case would be submitted for publication, and he consented.
Author Information
Fernando M.J. Judas, Rui F. Dias, and Francisco M. Lucas are from the University Clinic of Orthopaedics, FMUC – Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Source
Judas FMJ, Dias RF, Lucas, FM. A Technique to Remove a Well-Fixed Titanium-Coated RM Acetabular Cup on Revision Hip Arthroplasty. Journal of Orthopaedic Surgery and Research 2011, 6:31 doi:10.1186/1749-799X-6-31. http://www.josr-online.com/content/6/1/31; accessed 12/3/12.
© 2011 Judas et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References Attachments: img_2012_article_1_revisiontha_fig1_200x408.JPG (image/jpeg) img_2012_article_1_revisiontha_fig2_300x202.JPG (image/jpeg) img_2012_article_1_revisiontha_fig3_300x224.JPG (image/jpeg) img_2012_article_1_revisiontha_fig4_200x465.JPG (image/jpeg) img_2012_article_1_revisiontha_fig1_200x408.JPG (image/jpeg) img_2012_article_1_revisiontha_fig1_200x408.JPG (image/jpeg) Figure 1.jpg (image/jpeg) [...] Read more...
June 29, 202446 year old male with varus ankle deformity and arthritis
Title:
Varus ankle arthritis in young patient
Presenter:
Jonathan Deland
Location:
Hospital for Special Surgery
New York
Date: 04-Jan-2011 Attachments: case3.ppt (application/vnd.ms-powerpoint) case3.ppt (application/vnd.ms-powerpoint) [...] Read more...
June 29, 2024Contents Case: Hydatid cysts
Comments
Bibliography
Case: Hydatid cysts
Reported by Bharat Kelkar, Hospital for Orthopaedic and Reconstructive Surgery, India
35 yr old male complains of pain in right leg with soft swelling in the upper third region, nil distal neurovascular. X-ray shows extra osseous lesion scalloping on upper tibia laterally. Sonography shows multiple cystic lesions suggesting hydatid cysts.
MEDLINE shows that this is rare occurrence, but does not mention whether the excision also requires formalin wash.
Below are x-ray and images of the hydatid cysts removed at surgery. Comments
From: Mehmet Arazi, MD
Hydatid disease of the bone and soft tissue of the musculoskeletal system is uncommon. Turkey is an endemic area of the disease, too. Therefore we treated some patients affected the disease. We reported two articles about this (1,7). Recently, a spinal case has been published in Orthopedics (1).
It leads to many diagnostic and therapeutic problems. Because early diagnosis of the disease is difficult, the patients often are admitted to the hospital when the disease is advanced and widespread. Therefore, treatment failure not unusual. Recurrence is common.
I suggested radical extensive resection of the lesion and albendazole medication, after surgery. Recently successful clinical results have been reported with albendazole (3,7,15).
For bacterial superinfection, broad-spectrum antibiotics (such as cephalosporins) should be administered following radical excision. I also suggest some references may be useful.
Mehmet Arazi, MD
Assistant Professor
Department of Orthopaedics and Traumatology
Selcuk University, Medical School
Konya, 42080, Turkey
Email: [email protected]
References
ArazI M, MemIk R, Kapicioglu MI. Answer please. Hydatid disease of the spine. Orthopedics 1998 21(8):912,909-910.
Agarwal S, Shah A, Kadhi SKM, Rooney RJ: Hydatid disease of the pelvis. Clin Orthop 1991; 280:251-255.
Szypryt EP, Morris DL, Mulholland RC: Combined chemotherapy and surgery for hydatid bone disease. J Bone Joint Surg 1987; 69B(1):141-144.
Alldred AJ, Nisbet NW: Hydatid disease of bone in Australasia. J Bone Joint Surg 1964; 46B(2):260-267.
Booz MK: The management of hydatid disease of bone and joint. J Bone Joint Surg 1972; 54B(4):698-709.
Duran H, Fernandez L, Gomez-Castresana F, et al: Osseous hydatidosis. J Bone Joint Surg 1978; 60A:685-690.
Saglýk Y, Memik R, Özbarlas S, Kapicioglu S, Demirtas M: Idatidosi Dell’osso (Hydatid disease of bone). Giorn Italian Orthop Trauma 1994; XX(2):281-287. Italian.
Markasis P, Markaki S, Prevedorou D, Bouropoulou V: Echinococcosis of bone: clinicolaboratory findings and differential diagnostic problems. Arch Anat Cytol Path 1990; 38:92-94.
Rao S, Parikh S, Kerr R: Echinococcal infestation of the spine in North America. Clin Orthop 1991; 271:164-169.
Torricelli P, Martinelli C, Biagini R, Ruggieri P, De Cristofaro R: Radiographic and computed tomographic findings in hydatid disease of bone. Skeletal Radiol 1990; 19:435-439.
Rong SH, Nie ZQ: Hydatid disease of bone. Clin. Rad 1985; 36:301-305.
Bellini MA: Osteohydatidosis: its radiological features. Radiology 1946; 47:569-574.
Beggs I: The radiology of hydatid disease. AJR 1985; 145:639-648.
Ocete G, Guerrero A, Diaz-Peletier R, Burgos J, Bouza E, DeMiguel C: Experience in the treatment of osseous hydatidosis. International Orthop (SICOT) 1986; 10:141-145.
Saimot AG, Cremieux AC, Hay JM, et al: Albendazole as a potential treatment for human hydatidosis. Lancet 1983; ii:652-656.
Bibliography
Savas R, et al. Spinal cord compression due to costal Echinococcus multilocularis. Comput Med Imaging Graph. 1999 Mar-Apr;23(2):85-8.
Kabbaj-El Kouhen N, et al. Isolated lumbar intradural hydatid cyst. J Radiol. 1999 Feb;80(2):147-9. French.
Briant JF, et al. Osteoarticular involvement in parasitic diseases: bone echinococcosis. J Radiol. 1998 Nov;79(11):1351-7. Review. French.
Pau A, et al. Computed tomography and magnetic resonance imaging in spinal hydatidosis. Surg Neurol. 1987 Apr;27(4):365-9.
Fahl M, et al. Magnetic resonance imaging in intradural and extradural spinal echinococcosis. Clin Imaging. 1994 Jul-Sep;18(3):179-83.
Campesi G, et al. Unusual reactional mechanisms of the bone in echinococcosis. Riv Anat Patol Oncol. 1967 Mar;31(3):Suppl:31-5. Italian.
Bairak VG, et al. Diagnosis and treatment of echinococcosis of the bones. Sov Med. 1987;(3):102-4. Russian.
Bondiau PY, et al. Bone hydatidosis. Pseudosarcomatous aspect. Presse Med. 1993 Oct 2;22(29):1367. French.
Rusakov AB. On the diagnosis and treatment of echinococcosis of the bone. Ortop Travmatol Protez. 1967 Jan;28(1):68-70. Russian.
Morano JU, et al. Radiologic seminar CCXII: bone involvement in echinococcosis. J Miss State Med Assoc. 1981 Mar;22(3):55-7.
Oueslati A, et al. Bone echinococcosis. Apropos of 4 cases. Tunis Med. 1987 Apr;65(4):291-7. French.
Attachments: hydat1.jpg (image/jpeg) hydat2.jpg (image/jpeg) hydat3.jpg (image/jpeg) [...] Read more...
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June 29, 2024Program Information Residency Program: University of Arkansas for Medical Sciences Orthopaedic Surgery Residency Program Program Director: Robert D Blasier, MD Number of Residents: 20 Number of Staff: 11 Accredited: Accredited Length of Program: 5 Start Dates: July Program Contact Information Name: Darlene M Clinton Address: University of Arkansas for Medical Sciences
Mail Slot 531
4301 W Markham St City: Little Rock State/Province: Arkansas Zip/Postal code 72205 Phone: (501) 686-5259 Fax: (501) 603-1984 Email: [email protected] Website: http://uams.edu/ortho Program Highlights
Program Gallery Program Curriculum
Program Hospitals
University of Arkansas College of Medicine – Little Rock, AR
Central Arkansas Veterans Healthcare System – Little Rock, AR
St Vincent Infirmary Medical Center – Little Rock, AR
Arkansas Children’s Hospital – Little Rock, AR
Baptist Medical Center – Little Rock, AR
UAMS Medical Center – Little Rock, AR [...] Read more...
June 29, 2024Program Information Residency Program: University of Virginia Orthopaedic Surgery Residency Program Program Director: Bobby Chhabra, MD Number of Residents: 25 Number of Staff: 26 Accredited: Accredited Length of Program: 5 Start Dates: June, July Program Contact Information Name: Mindy C Franke, BS Address: University of Virginia Health System
Orthopaedic Surgery Program
PO Box 800159 City: Charlottesville State/Province: Virginia Zip/Postal code 22908 Phone: (434) 243-0265 Fax: (434) 243-5387 Email: [email protected] Website: http://healthsystem.virginia.edu/internet/orthopaedics Program Highlights
5-year and 6-year (research) positions available
Conferences
Daily sessions in a weekly rotation of:
Fracture
Indications, core curriculum
Grand rounds, M&M
Service specific
Anatomy, basic science Monthly journal club Research project required
Optional international rotation for selected students
Program Gallery Program Curriculum
PGY-1: Orthopaedics, adult reconstruction, spine, musculoskeletal radiology, anesthesiology, plastics/burn, multi-system trauma, cardiac/thoracic, cardiovascular, emergency medicine, vascular surgery, general surgery
PGY-2: Adult reconstruction, oncology, pediatric orthopaedics, sports medicine, night float, spine surgery
PGY-3: Spine, float, emergency department, sports medicine, research, hand/upper extremity
PGY-4: Chief (Roanoke), trauma, night float, trauma, foot and ankle
PGY-5: Chief in pediatric orthopaedics, sports medicine, hand/upper extremity, adult reconstruction, oncology, trauma, emergency department
Program Hospitals
University of Virginia Medical Center – Charlottesville, VA
Carilion Roanoke Memorial Hospital – Roanoke, VA [...] Read more...
June 29, 2024Program Information Residency Program: University of British Columbia Orthopaedic Surgery Residency Program Program Director: Henry M. Broekhuyse, MD Number of Residents: 28 Number of Staff: Accredited: Accredited Length of Program: 5 Start Dates: Program Contact Information Name: Elizabeth Denton Address: UBC Department of Orthopaedics
3114 – 910 West 10th Avenue City: Vancouver State/Province: British Columbia Zip/Postal code V5Z 4E3 Phone: Fax: Email: [email protected] Website: http://www.orthosurgery.ubc.ca/ Program Highlights
Preceptor-based training model
Divisions
Arthroscopic, reconstructive surgery and joint preservation
Comprehensive orthopaedics
Distal extremities
Lower limb reconstruction and oncology
Paediatric orthopaedics
Spine
Trauma Academic
Weekly half-day lecture and seminar sessions
Daily teaching rounds
Weekly subspecialty rounds
Weekly training sessions
Journal club
Summer anatomy/dissection sessions Two research project required, with presentation at end of PGY-3 and PGY-5
Program Gallery Program Curriculum
PGY-1 and PGY-2: General surgery, trauma surgery, CTU, CCU, emergency, plastics, vascular, ICU, spine, paediatric orthopaedics
PGY-3 through PGY-5: General orthopaedics, orthopaedic trauma, reconstructive orthopedics, paediatric orthopaedics, orthopaedic oncology, hand surgery, foot and ankle surgery, athletic injuries, upper extremity orthopaedics, elective
Program Hospitals
Vancouver Hospital
Royal Columbian Hospital
University Hospital
St Paul’s Hospital
Eagle Ridge Hospital
Burnaby General Hospital
Children’s & Womens Health Centre of British Columbia
Prince George Regional Hospital
Victoria General Hospital
Royal Jubilee Hospital [...] Read more...
June 29, 2024Program Information Residency Program: University at Buffalo Orthopaedic Surgery Residency Program Program Director: Lawrence B Bone, MD Number of Residents: 5 per year Number of Staff: 33 Accredited: Accredited Length of Program: 5 Start Dates: June Program Contact Information Name: Tammy L Smith Address: Erie County Medical Center
Department of Orthopaedic Surgery Ground Floor
462 Grider St City: Buffalo State/Province: New York Zip/Postal code 14215 Phone: (716) 898-5053 Fax: (716) 898-3323 Email: [email protected] Website: http://www.ubortho.buffalo.edu Program Highlights
Weekly clinic involvement in arthroplasty, spine, foot and ankle, sports medicine, hand and shoulder
Research
Rotation in PGY-2 to begin project design
Extensive core facilities, along with numerous affiliated specialty locations Didactic sessions
Weekly conferences cover: case discussions, Grand Rounds, basic science
Fracture board 3-4x per week
Monthly anatomy lab
Monthly journal club
Periodic sessions for fractures, casting, splinting techniques, IM rodding and screw fixation Program Gallery Program Curriculum
PGY-1: Multi-system trauma, burns, vascular surgery, emergency, anesthesiology, orthopaedics
PGY-2: Trauma, adult reconstruction, foot and ankle, osteotomies, spine, shoulder, hand, upper extremity, general orthopaedics, research
PGY-3: Sports, pediatrics, oncology
PGY-4: Pediatric, adult reconstruction, spine, hand
PGY-5: Chief resident, trauma, adult elective surgery, arthroplasty, spine, general orthopaedics
Program Hospitals
University at Buffalo School of Medicine – Buffalo, NY
University at Buffalo Affiliated Physician Practices (UBAPP) – Buffalo, NY
University at Buffalo Physician Practices (UBPP) – Buffalo, NY
Kaleida Health System (Buffalo General Hospital) – Buffalo, NY
Kaleida Health System (Women and Children’s Hospital of Buffalo) – Buffalo, NY
Kaleida Health System (Millard Fillmore Gates Circle Hospital) – Buffalo, NY
Erie County Medical Center – Buffalo, NY [...] Read more...
June 29, 2024Program Information Residency Program: Hamot Medical Center Orthopaedic Surgery Residency Program Program Director: John D Lubahn, MD Number of Residents: 3 per year Number of Staff: 15 Accredited: Accredited Length of Program: 5 Start Dates: July Program Contact Information Name: Patricia J Rogers Address: Hamot Medical Center
Department of Orthopaedic Surgery
201 State St City: Erie State/Province: Pennsylvania Zip/Postal code 16550 Phone: (814) 877-6257 Fax: (814) 877-4010 Email: [email protected] Website: http://www.hamot.org Program Highlights
Two half-days of clinical training per week
Basic science rotation in PGY-3 provides basic science research and clinical studies
Subspecialty training in:
Foot and ankle
Hand
Hip and knee
Spine
Shoulder and elbow
Tumor
Pediatrics
Sports medicine
Trauma Program Gallery Program Curriculum
PGY-1: Trauma, general surgery, plastic surgery, neurosurgery, orthopaedic surgery, vascular surgery, internal medicine, anesthesia, rheumatology, radiology, ICU
PGY-2 through PGY-4: Hand, adult reconstruction, sports medicine, shoulder, trauma, spine, pediatric, basic science/research
PGY-5: Chief Resident, all services
Program Hospitals
Hamot Medical Center – Erie, PA
Shriners Hospitals for Children (Erie) – Erie, PA [...] 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
Sensory innervation
Description of sensory innervation
Motor innervation
Description of motor innervation
Contributing spinal nerve roots
List contributing spinal nerve roots, boldface major ones
Course of nerve
Description of course of nerve
Clinical correlates
Link to clinical conditions
References
Key references [...] Read more...
OrthopaedicsOne is led by co-founders Joseph Bernstein, MD, MS, FACS, and Christian Veillette MD, MSc, FRCSC.
Joseph Bernstein, MD, MS, FACS
Dr. Bernstein is a Clinical Associate Professor of Orthopaedic Surgery at the University of Pennsylvania School of Medicine, Philadelphia, Pa. A graduate of Columbia University Medical College, Dr. Bernstein did his internship, residency, and a fellowship in sports medicine and shoulder surgery at the Hospital of the University of Pennsylvania. Dr. Bernstein serves as the Director of Education for OrthopaedicsOne, as well as a Managing Editor.
Christian Veillette MD, MSc, FRCSC
Dr. Veillette, also a Managing Editor of OrthopaedicsOne and the site’s Director of Technology, is an Assistant Professor at the University of Toronto, Toronto, Ontario, Canada. He has an active shoulder and elbow reconstructive surgery practice at Toronto Western Hospital, part of the University Health Network in Toronto. Dr. Veillette is a graduate of the University of Calgary, and he completed his orthopaedic residency training at the University of Toronto, which included a Masters of Science degree as part of the Surgeon Scientist Program. He did two fellowships, one in upper extremity trauma and reconstruction (St. Michael’s Hospital, Toronto) and the other in shoulder and elbow arthroscopy and reconstruction (Mayo Clinic, Rochester, Minn.).
Drs. Bernstein and Veillette are supported by an outstanding group of Editors and Associate Editors
Section Editors
Clinical Topics
Johnny Lau
W. Norman Scott
Charles Day
Matthew Dobbs
Rick Papandrea
Saad Chaudhary
Paul Dougherty
John Healey
Professional Topics
Mohit Bhandari
Myles Clough
Orrin Franko
David Levine
Associate Editors
Eric Bluman
Jonathan Deland
Daniel Farber
Vinod Panchbhavi
Brian Straus
Mary O’Connor
Arlen Hanssen
Vincent Pellegrini
Stephanie Böhm
Haemish A. Crawford
Christopher Iobst
Noppachart Limpaphayom
Edward McFarland
Steve Petersen
Guido Marra
Michael Vives
Sheeraz Qureshi
Thomas Mroz
Jaimo Ahn
Jay Wunder
Peter Ferguson
Contributors
OrthopaedicsOne is privileged to host content from individual orthopaedic surgeons — from the very elite of the profession to trainees just getting started — and from orthopaedic organizations, including The Association of Bone and Joint Surgeons, the American Orthopaedic Foot and Ankle Surgeons, the Canadian Orthopaedic Association, and the International Congress for Joint Reconstruction.
By posting their content on OrthopaedicsOne, these contributors have acknowledged that a new paradigm has emerged in orthopaedic publishing, one that is not bound by paper-and-ink traditions. Positioned at the forefront of this new paradigm, OrthopaedicsOne is charting the future of information and knowledge management in orthopaedic surgery. [...] Read more...
Arthrokinematics
Ankle joint
Elbow joint
Foot
Hand
Hip joint
Knee joint
Sacroiliac joint
Shoulder joint
Spinal
Wrist joint [...] Read more...
Origin Spine of ischium Insertion Obturator internus tendon Action(s) Rotates laterally thigh Nerve Supply Nerve to obturator internus (S1, S2, S3) Arterial Supply Inferior gluteal 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 superior gemellus muscle is a muscle of the human body.
The Gemelli are two small muscular fasciculi, accessories to the tendon of the Obturator internus which is received into a groove between them.
The Gemellus superior, the smaller of the two, arises from the outer surface of the spine of the ischium, blends with the upper part of the tendon of the Obturator internus, and is inserted with it into the medial surface of the greater trochanter. It is sometimes wanting. Figures
Click thumbnail for larger image Credits:
From Wikipedia:
Superior gemellus Attachments: Superior gemellus.png (image/png) Superior gemellus.png (image/png) [...] Read more...
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...
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 […]