{"title":"Spinal cord injury: pathophysiology and principles of management","authors":"Simon B Roberts, Athanasios I Tsirikos","doi":"10.1016/j.mporth.2024.07.002","DOIUrl":"10.1016/j.mporth.2024.07.002","url":null,"abstract":"<div><div>Spinal cord injury (SCI) is a catastrophic neurological condition resulting in increased physical dependency, medical comorbidity, psychological distress and economic burden. New SCI affects 250,000–500,000 individuals globally each year. The pathophysiological mechanisms following SCI are incompletely understood, and the management of patients following SCI is challenging. Understanding the evolution of pathophysiological changes following SCI is fundamental to delivering and developing appropriate management strategies. Timely interventions following acute SCI can prevent secondary neurological deterioration and improve potential for neurological recovery. A bespoke, multidisciplinary and holistic approach to the management and rehabilitation of SCI patients can optimize physical and mental wellbeing and maximize patient's neurological recovery and functional capabilities. Current therapeutic options following SCI are limited and do not overcome the debilitating effects of SCI. Current knowledge of the pathophysiological mechanism following SCI, management strategies and novel therapies for adult and paediatric SCI patients are reviewed.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 5","pages":"Pages 264-272"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Biomechanics of the spine and the implications for spinal injuries","authors":"Simon B Roberts, Athanasios I Tsirikos","doi":"10.1016/j.mporth.2024.07.001","DOIUrl":"10.1016/j.mporth.2024.07.001","url":null,"abstract":"<div><div>Biomechanics is the application of principles of engineering and computers to biological problems. Clinical biomechanics of the spine is the understanding of normal and pathological functions of the human vertebral column in response to mechanical insult, which may include traumatic, degenerative, pathological, or slowly applied loads to the spine. Spinal biomechanics involves the regional features of the vertebrae, intervertebral discs, ligaments, facet joints and muscles. The role of these structures individually and in concert in relation to spinal injuries is discussed. Regional spinal biomechanics, maintenance of spinal stability and assessment of spinal instability following injury are described. Finally, the biomechanical principles, individual structural components, mechanisms of injury and principles specific to the adult and paediatric spine are reviewed.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 5","pages":"Pages 258-263"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Answers to the CME questions on The Elbow","authors":"","doi":"10.1016/j.mporth.2024.07.012","DOIUrl":"10.1016/j.mporth.2024.07.012","url":null,"abstract":"","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 5","pages":"Page 333"},"PeriodicalIF":0.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"CME questions on Spinal Trauma","authors":"","doi":"10.1016/j.mporth.2024.07.011","DOIUrl":"10.1016/j.mporth.2024.07.011","url":null,"abstract":"","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 5","pages":"Pages 331-332"},"PeriodicalIF":0.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alistair Ian Eyre-Brook, Lawrence Majkowski, Margo Dirckx, Amjid Ali, Simon Booker
{"title":"Revision total elbow arthroplasty: a primer for exam candidates","authors":"Alistair Ian Eyre-Brook, Lawrence Majkowski, Margo Dirckx, Amjid Ali, Simon Booker","doi":"10.1016/j.mporth.2024.05.007","DOIUrl":"10.1016/j.mporth.2024.05.007","url":null,"abstract":"<div><p>Total elbow arthroplasty (TEA) has a relatively high revision rate compared to conventional joint arthroplasties (4–7% at 5 years). The cause for revision is most commonly implant loosening. A thorough work-up with history, examination, bloods, radiographs and joint tissue or fluid samples are all required to rule out peri-prosthetic infection. Patient factors and soft tissue management must be considered before revising a TEA to ensure the best outcome and longevity of the revised implant. Surgical strategies for TEA revision include single or two-stage revision, bearing exchange, bone windows and strut grafts.</p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 4","pages":"Pages 245-252"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Answers to the CME questions on Principles of Orthopaedics","authors":"","doi":"10.1016/j.mporth.2024.05.008","DOIUrl":"10.1016/j.mporth.2024.05.008","url":null,"abstract":"","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 4","pages":"Page 255"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Distal biceps pathology: an evidence-based approach","authors":"Leanne Dupley, Adam Watts","doi":"10.1016/j.mporth.2024.05.002","DOIUrl":"10.1016/j.mporth.2024.05.002","url":null,"abstract":"<div><p>Distal biceps tendons are a potential source of anterior elbow pain, with pathology ranging from tendinopathy to degenerative ruptures and acute traumatic ruptures. In some instances, non-surgical management is appropriate, but the majority of acute ruptures should be managed surgically for superior outcomes. This article will discuss distal biceps pathology, the relevant surgical anatomy, fixation and approach options and the potential complications following repair and reconstruction.</p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 4","pages":"Pages 190-196"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lateral elbow pain in adults: a review of the less common causes","authors":"Blair Tweedie, Sam Vollans","doi":"10.1016/j.mporth.2024.05.004","DOIUrl":"10.1016/j.mporth.2024.05.004","url":null,"abstract":"<div><p>Lateral elbow pain and tennis elbow have been considered almost synonymous, in that historically all patients with lateral elbow pain were assumed to have tennis elbow. With the evolution of diagnostic imaging, elbow arthroscopy and further understanding of the pathological processes, alongside analysis of failed tennis elbow treatment, a whole host of possible differential diagnoses that might cause lateral elbow pain became recognized. In addition to tendinopathies (tennis and golfers elbow), these include intraarticular mechanical issues (radiocapitellar plica and snapping annular ligament), elbow instability, nerve compression syndromes, osteochondral defects and degenerative joint disease (radiocapitellar joint arthritis). Accurate clinical assessment and diagnosis is key, alongside selective use of investigations that can confirm or refute diagnoses and guide ongoing management. This article serves to provide an overview of the history, examination findings, investigations and management options for lateral elbow pain. Whilst we will cover the whole scope of possible diagnoses responsible for lateral elbow pain, we will not be considering <em>in detail</em> those covered in other articles in this issue (tennis elbow, osteochondritis dissecans, elbow instability). The focus of this article will be to elaborate on the tips and tricks within the clinical assessment, and how to properly assess the lateral side of the elbow. We will mention the rarer conditions encountered (posterior interosseous nerve entrapment, synovial plica syndrome and snapping annular ligament) and discuss the reconstructive ladder for lateral sided degenerative joint disease.</p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 4","pages":"Pages 206-212"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Elbow instability","authors":"Siddharth Virani, Joideep Phadnis","doi":"10.1016/j.mporth.2024.05.005","DOIUrl":"10.1016/j.mporth.2024.05.005","url":null,"abstract":"<div><p>The elbow joint consists of the ulnohumeral joint, radiocapitellar joint and the proximal radio-ulnar joint. The osseous anatomy, static ligamentous restraints and dynamic stabilizers all contribute to maintain elbow stability. Elbow instability is a commonly encountered condition in clinical practice. There are several ways to classify elbow instability. Instability can be classified as simple or complex based on presence of an associated fracture, it could be classified based on mechanism of injury or it could be classified in a temporal fashion as acute or chronic. It is critical to understand injury patterns that can be treated non-operatively with physiotherapy and mobilization and the ones that need surgery. Surgical management of elbow instability could involve a combination of interventions addressing various ligaments like the lateral ulnar collateral ligament and medial collateral ligament; osseous structures including the radial head, coronoid and proximal ulna based on the mechanism and extent of injury. Adjunctive and salvage procedures may be necessary in delayed presentations or severe injuries. These include application of an internal joint stabilizer, external fixator, internal bracing of the ligament and bone grafting of the coronoid. The goal of treatment of instability is to provide an elbow that is stable and amenable to early active mobilization.</p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 4","pages":"Pages 213-227"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Compressive neuropathies of the elbow","authors":"Angus T McMillan, Gráinne Bourke","doi":"10.1016/j.mporth.2024.05.003","DOIUrl":"10.1016/j.mporth.2024.05.003","url":null,"abstract":"<div><p>The major peripheral nerves supplying motor and sensory function to the forearm and hand traverse the elbow joint. The complex anatomical relationships of these nerves to the joint and its surrounding musculotendinous structures creates a series of sites where these nerves are vulnerable to compression. Compression syndromes result in distressing constellations of pain, paraesthesia, weakness and loss of coordinated motor function. This article discusses the anatomy and pathophysiology of compressive neuropathies around the elbow joint, their presentation, how they are investigated and diagnosed, and the available management options.</p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 4","pages":"Pages 197-205"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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