Journal of orthopedics for physician assistants最新文献

{"title":"Parsonage-Turner Syndrome in a 9-Year-Old Boy","authors":"Susana Donadeu Sánchez, C. Arvinius, Antonio Fernandez Fernandez-Arroyo, D. Llanos Perez, Mercedes Alambrada Valverde","doi":"10.2106/JBJS.JOPA.23.00012","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.23.00012","url":null,"abstract":"We present the case of a 9-year-old boy who presented to the emergency department with acute shoulder pain that progressed to right arm radialis paralysis. After a magnetic resonance imaging, he was diagnosed with Parsonage-Turner syndrome and treated accordingly. Parsonage-Turner syndrome (PTS) is an uncommon disorder in children. Only case reports or small series have being published around this topic in the pediatric population. Sudden pain with loss of strength on the upper extremities after a viral infection should make physicians include PTS in the diagnosis. Current treatment includes pain relief and physiotherapy, to regain as much function as possible.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"11 1","pages":"e23.00012"},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47844132","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":"Systematic Literature Review and Meta-Analysis on Miserable Malalignment Syndrome","authors":"S. Atallah, Maged R Hanna","doi":"10.2106/JBJS.JOPA.23.00009","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.23.00009","url":null,"abstract":"Background: Miserable malalignment syndrome (MMS) is a rare condition that entails increased femoral anteversion and increased external tibial torsion, as well as the presentation of one, some, or all the following: squinting patella, patella alta, patellar instability, an increased Q angle, genus valgus (knock knees) or genus varum (bow leggedness), genus recurvatum, feet pronation, or pes planus. Methods: The Sample, Phenomenon of Interest, Design, Evaluation, Research type search strategy was used to retrieve eligible studies from databases fitting the established inclusion criteria. Results: All studies agreed that nonoperative treatment is ineffective in improving MMS. Surgical treatment is effective, although it involves osteotomies at 2 levels per limb. Conclusions: Double-level osteotomies were effective in all studies, vastly improving range of motion, chronic knee pain, chronic hip pain, and other factors. Surgical treatment of this condition should only be reserved for severe cases because complications are possible. Level of Evidence: Most articles used were part of a case series, indicating this review article is based on level 4 evidence.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"11 1","pages":"e23.00009"},"PeriodicalIF":0.0,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49568560","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":"Cervicothoracic Morel-Lavallée Lesion After a High-Speed Motor Vehicle Crash","authors":"Giuliana S. Scuderi, Alex R. Vaccaro, G. Scuderi","doi":"10.2106/JBJS.JOPA.23.00005","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.23.00005","url":null,"abstract":"The Morel-Lavallée (ML) lesion occurs as a result of a shearing force that separates the subcutaneous tissue from fascia, with no discontinuity with the dermis to the environment. Although most commonly occurring in the proximal lower extremity and pelvis, awareness of the injury has led to recognition of ML lesion in other regions of the body such as the thoracolumbar and lumbar spine. Late or misdiagnoses can lead to complications and increased morbidity. Awareness and early recognition of these lesions, which can occur anywhere in the spine posteriorly, often lead to successful conservative management. A complete physical examination during patient follow-up will likely lead to increased diagnoses of these lesions in a subacute setting. We present a unique case of a patient with 2 ML lesions a first report of this, with one ML lesion involving the cervicothoracic junction, previously unreported, and the other involving the thigh, the most common site for ML lesions, in the patient after a high-speed rollover motor vehicle collision. The etiology and pathophysiology of these lesions are discussed.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"11 1","pages":"e23.00005"},"PeriodicalIF":0.0,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47541118","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":"Foundation of Diagnosing and Treating a Hoffa Fracture","authors":"Saoirse Connolly, Mia Adler-Lustig, Sean M. Hazzard","doi":"10.2106/JBJS.JOPA.23.00008","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.23.00008","url":null,"abstract":"Introduction: Hoffa fractures are a rare type of intra-articular fracture characterized by disruption in the coronal plane. They are challenging to diagnose because of the orientation of the fracture and the common radiography views used to evaluate knee pain. Methods: A literature review search was obtained with PubMed. Primary and secondary sources were included. Results: Hoffa fractures are typically found after highly traumatic events such as motor vehicle accidents or falls from great heights. Hoffa fractures are classified by the Letenneur system, which categorizes fractures into 1 of 3 types. Hoffa fractures typically go undiagnosed on typical radiographs, so CT scans are necessary for proper diagnosis. Physical symptoms can include trouble walking, swelling, and periarticular pain. Conservative treatment is not favorable compared with surgical reduction and fixation. Postop care and rehabilitation can affect the outcome of the surgery and should be closely monitored. Discussion: Hoffa fractures often go unnoticed because traumas result in other injuries and might overlook a fracture that is not detected on radiographs especially traditional anteroposterior (AP) or posteroanterior (PA) views. Once they are diagnosed, they are difficult to manage conservatively because these fractures have a slow healing process and may lead to nonunion of the femur. Surgical treatment is the most reliable option regarding healing and returning to normal weight-bearing and activities. Conclusion: Hoffa fractures are fractures involving the femoral condyle in the coronal plane, which are more rare than fractures in the sagittal plane and therefore commonly missed. This type of fracture is complicated to assess and treat because of its positioning and is easily missed on standard AP/PA radiographs. Surgical intervention is the best option to ensure the best outcomes.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"11 1","pages":"e23.00008"},"PeriodicalIF":0.0,"publicationDate":"2023-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48847504","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":"A Comparison Review of Various Corticosteroids in the Orthopaedic Setting for Various Injections","authors":"Saoirse Connolly, Sean M. Hazzard","doi":"10.2106/JBJS.JOPA.23.00003","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.23.00003","url":null,"abstract":"Corticosteroids injections are a common nonsurgical treatment for musculoskeletal conditions. There are a variety of corticosteroids for providers to choose from, but there is little empirical evidence to suggest the use of one over the other for a particular condition. Dexamethasone and triamcinolone acetonide (Kenalog) are 2 such corticosteroids in which the decision to use one is often due to provider opinion or anecdotal evidence. This brief review notes the outcomes of studies comparing these 2 corticosteroids to create a guide for providers.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"11 1","pages":"e23.00003"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43120726","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":"Prompt Recognition","authors":"S. Bolander, Gretchen Post","doi":"10.2106/JBJS.JOPA.23.00001","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.23.00001","url":null,"abstract":"There is a wide range of traumatic elbow injuries that require prompt recognition and management. Fractures of the elbow are common in children; however, because of the complexity of radiographic evaluation in skeletally immature patients, diagnosis of pathology may be missed or misinterpreted, leading to delay in treatment and complications. Careful history and thorough physical examination and utilization of a systematic approach to radiographic evaluation will reduce the chance of a delayed or missed diagnosis. This article will provide an overview of 5 pediatric elbow injuries not to miss, including potential complications and unique considerations for each fracture type to avoid common pitfalls.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"11 1","pages":"e23.00001"},"PeriodicalIF":0.0,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49055990","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":"Fabella Syndrome of the Knee","authors":"Mia Lustig, Sean M. Hazzard","doi":"10.2106/JBJS.JOPA.23.00004","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.23.00004","url":null,"abstract":"Purpose: The purpose of this analysis is to review the strategies to diagnose fabella syndrome of the knee and examine the most effective management options. Methods: A literature review and primary source search was completed through PubMed and EBSCO ultimate academic database. Several articles were reviewed, and articles with the most relevant data were selected and analyzed. Results: Less than 50% of the population have a fabella, and most patients who present with fabella syndrome are between ages 15 to 17 years. Fabella syndrome is diagnosed by posterolateral pain in the gastrocnemius especially with extension or added pressure on the bone. The possible treatment plans for the condition are steroid injections, physical therapy, shockwave therapy, or a fabellectomy. Conclusion: Fabella syndrome is difficult to diagnose because it has a low incidence rate and the symptoms to diagnose it are broad. One of the best ways to identify the condition is to rule out other diagnoses in addition to meeting the symptom criteria. The best long-term treatment for fabella syndrome is to perform surgery to remove the fabella bone, which presents low risk and a high rate of positive outcomes.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"11 1","pages":"e23.00004"},"PeriodicalIF":0.0,"publicationDate":"2023-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47613719","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":"Preoperative Computed Tomography Angiography to Prevent Vascular Injuries in 4-Part Proximal Humerus Fracture-Dislocations","authors":"Fernando Ferrera, Dylan J. Lawrence, D. Williams","doi":"10.2106/JBJS.JOPA.23.00006","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.23.00006","url":null,"abstract":"Cases: This study compares 2 cases of 4-part proximal humerus fracture-dislocations managed by reverse total shoulder arthroplasty: one with significant medialization and acute surgical management and another with mild medialization and delayed surgical management. Both presented with normal vascular examination; however, computed tomography angiography (CTA) revealed vascular involvement necessitating thoracic or vascular surgery consultation. Conclusion: Although vascular injuries are rare, they should be considered in patients with complex injuries, particularly those with delayed treatment or medialization of a bony structure. Our cases highlight important fracture characteristics where a preoperative CTA should be considered even with a normal vascular examination.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"11 1","pages":"e23.00006"},"PeriodicalIF":0.0,"publicationDate":"2023-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43947158","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":"Sciatic Nerve Palsy After Total Hip Arthroplasty","authors":"J. M. van der Merwe","doi":"10.2106/JBJS.JOPA.23.00002","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.23.00002","url":null,"abstract":"COPYRIGHT © 2023 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED. Sciatic nerve (SN) injuries are well-known and potentially devastating postoperative injuries. Nerve injuries can involve compression, traction, transection, and/or ischemia. The prevalence of SNpalsies in the literature ranges between 0.08% and 3.7%. Some studies state that the posterior approach is the most commonly involved, whereas other studies do not favor one approach over the other as being a higher risk. In revision cases, it could increase between 0% to 8%. This number can be even higher because electromyographic (EMG) studies performed after a routine total hip replacementhavedemonstrated thata subclinical injury could occur in up to 70% of the cases. Although there are multiple causes described in the literature that can cause a SN palsy, in 50% of cases the reason remains unknown. Studies have shown revision surgery, surgeon inexperience, female gender, underlying spinal stenosis, and hip dysplasia as some risk factors for SN palsies. Potential intraoperative causes include patient positioning, draping, forceful dislocation of the femoral head dislocation, leg lengthening, placement of retractors with subsequent compression of the nerve, involvement of the nerve due to the use of cerclage wires, and the combination movements (hip flexion, adduction, and internal or external rotation) during femoral preparation. Multiple reduction maneuvers of a dislocated total hip arthroplasty should be limited. Multiple attempts can injure the adjacent soft tissue and/or cause a hematoma, which can either displace the nerve anteriorly into a more vulnerable position or cause compression on the nerve leading to a palsy. There are also case reports of the nerve being entrapped around the femoral neck after a reduction maneuver. The absolute lengthening threshold is controversial. Hasija et al. noted an increased risk for nerve injuries with less lengthening of “fixed” nerves (peroneal branch) compared with more “free-moving” nerves (tibial branch). Dehart and Riley demonstrated that SN injuries occurred in animal models with lengthening more than 25%. Others have demonstrated an increased risk of SN neuropraxia, after a hip replacement, with lengthening more than 2 to 3 cm. There is, however, no known maximum leg lengthening that may be performed to prevent nerve palsy. Although positioning was a contributing factor for SN injury, Takada et al. did not see a difference in the distance between the SN and the posterior acetabular edge, when patients transitioned between supine and lateral decubitus positions. Dellon included preoperative neuropathy as a risk factor that can cause nerve injuries. They concluded that surgeons should keep this inmindduring the surgery to avoid using excessive force during arthroplasty. In a retrospective study by O’Brien et al. looking at 10,624 patients who underwent a primary total hip arthroplasty, a mere 0.09% had a permanent SN palsybutdemonstra","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"11 1","pages":"e23.00002"},"PeriodicalIF":0.0,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44151193","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":"Joint Space Narrowing in the Osteoarthritic Knee","authors":"Joseph S. Vespe, D. Hope, David E. Vizurraga, Meghan Joyce","doi":"10.2106/JBJS.JOPA.22.00029","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.22.00029","url":null,"abstract":"Background: When patients with knee osteoarthritis (OA) are referred to an orthopaedic specialist for care, standard evaluation includes anterior-to-posterior (AP) weight-bearing (WB) radiographs to best evaluate the degree of arthritis and residual joint space, which can tailor treatment recommendations. Primary care guidelines do not require radiographs for their diagnosis; if performed, they are often non–weight-bearing (NWB). This study assessed the significance of joint space narrowing (JSN) between NWB and WB knee radiographs in patients evaluated for OA. We also compared demographic data with the measure of JSN. Methods: This was a prospective quantitative study that followed an experimental design comparing the JSN of the same AP NWB knee with WB knee radiographs. Two blinded fellowship-trained orthopaedic adult reconstruction surgeons and 1 musculoskeletal radiology fellow performed the joint space measurements. Data were analyzed using the Student t test and χ2 test as appropriate. Results: The mean JSN between WB and NWB was 1.20 mm (95% confidence interval 0.93-1.49 mm, p < 0.0001). Interrater reliability between NWB and WB measurements was 0.87 and 0.93, respectively. As body mass index (BMI) increased in our population, the amount of JSN decreased. There were significantly higher rates of JSN in those who were not obese compared with those who were. Conclusions: Weight-bearing radiographs are better able to evaluate JSN than NWB. BMI had a negative correlation with JSN in our population. Level of Evidence: II.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"11 1","pages":"e22.00029"},"PeriodicalIF":0.0,"publicationDate":"2023-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49114995","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}